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Emad Y, Ragab Y, Farber HW, Erkan D, Ibrahim O, Kindermann M, Tekavec-Trkanjec J, Jayakrishnan B, El-Shaarawy N, Kechida M, Young P, Pankl S, Fabi M, Bawaskar P, Kably I, Ghirardo S, Frikha F, Abou-Zeid A, Hassan M, Robinson C, Abdelbary MH, Tornes L, Margolesky J, Barman B, Bennji S, Agarwala MK, Alhusseiny K, Amezyane T, Silva RS, Cruz V, Niemeyer B, Al-Zeedy K, Al-Jahdali H, Jaramillo N, Demirkan S, Guffroy A, Kim JT, Ruffer N, Tharwat S, Cozzi D, Abdelali M, Joy TC, Sayed M, Sherwina J, Gheita T, Rasker JJ. Pulmonary embolism versus pulmonary vasculitis in Hughes-Stovin syndrome: Characteristic computed tomography pulmonary angiographic findings and diagnostic and therapeutic implications. HSS International Study Group. Thromb Res 2024; 239:109040. [PMID: 38795561 DOI: 10.1016/j.thromres.2024.109040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/11/2024] [Accepted: 05/21/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND AND AIM Hughes-Stovin syndrome (HSS) is a rare systemic vasculitis with widespread venous/arterial thrombosis and pulmonary vasculitis. Distinguishing between pulmonary embolism (PE) and in-situ thrombosis in the early stages of HSS is challenging. The aim of the study is to compare clinical, laboratory, and computed tomography pulmonary angiography (CTPA) characteristics in patients diagnosed with PE versus those with HSS. METHODS This retrospective study included 40 HSS patients with complete CTPA studies available, previously published by the HSS study group, and 50 patients diagnosed with PE from a single center. Demographics, clinical and laboratory findings, vascular thrombotic events, were compared between both groups. The CTPA findings were reviewed, with emphasis on the distribution, adherence to the mural wall, pulmonary infarction, ground glass opacification, and intra-alveolar hemorrhage. Pulmonary artery aneurysms (PAAs) in HSS were assessed and classified. RESULTS The mean age of HSS patients was 35 ± 12.3 years, in PE 58.4 ± 17 (p < 0.0001). Among PE 39(78 %) had co-morbidities, among HSS none. In contrast to PE, in HSS both major venous and arterial thrombotic events are seen.. Various patterns of PAAs were observed in the HSS group, which were entirely absent in PE. Parenchymal hemorrhage was also more frequent in HSS compared to PE (P < 0.001). CONCLUSION Major vascular thrombosis with arterial aneurysms formation are characteristic of HSS. PE typically appear loosely-adherent and mobile whereas "in-situ thrombosis" seen in HSS is tightly-adherent to the mural wall. Mural wall enhancement and PAAs are distinctive pulmonary findings in HSS. The latter findings have significant therapeutic ramifications.
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Affiliation(s)
- Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt.
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Harrison W Farber
- Tufts University School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Boston, MA, USA
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Ossama Ibrahim
- Morecambe Bay University Hospitals Lancaster, Lancashire, Ashton Rd, Lancaster LA1 4RP, United Kingdom
| | - Michael Kindermann
- Innere Medizin III (Kardiologie/Angiologie), Universitätskliniken des Saarlandes, Kirrberger Straße, D 66421 Homburg/Saar, Germany
| | - Jasna Tekavec-Trkanjec
- Department of Pulmonary medicine, Dubrava University Hospital, AvenijaGojkaŠuška 6, 10000 Zagreb, Croatia
| | | | - Nashwa El-Shaarawy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia 4.5 Km the Ring Road, 41522 Ismailia, Egypt
| | - Melek Kechida
- Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, University of Monastir, Rue du 1er juin 1955, Monastir 5019, Tunisia
| | - Pablo Young
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Sonia Pankl
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Marianna Fabi
- Pediatric Cardiology and Adult Congenital Unit, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
| | - Parag Bawaskar
- Department of Cardiology, Topiwala National Medical College & B.Y.L Nair Charitable Hospital, Dr. A.L. Nair road, Mumbai 400008, Maharashtra, India
| | - Issam Kably
- Department of Radiology, Section of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sergio Ghirardo
- Clinical Department of Medical, Surgical and Health Science, University of Trieste, Piazzale Europa, 1, 34127 Trieste, TS, Italy
| | - Faten Frikha
- Department of Internal Medicine, HediChaker Hospital, 3029 Sfax, Tunisia
| | - Alaa Abou-Zeid
- Public health Department, Faculty of medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University - Al kartoom square, al Azareta, Alexandria 21526, Egypt
| | - Cal Robinson
- Department of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mohamed H Abdelbary
- Department of Radiology, Badr Hospital, Faculty of medicine, Helwan University, Egypt
| | - Leticia Tornes
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
| | - Jason Margolesky
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
| | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati, India
| | - Sami Bennji
- Division of Pulmonology, Department of Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Manoj Kumar Agarwala
- Department of Cardiology, Apollo Hospitals, Jubilee Hills, Hyderabad 500096, India
| | - Khalid Alhusseiny
- Radiology department, Dr Erfan General hospital, Jeddah, Saudi Arabia
| | - Taoufik Amezyane
- Department of Internal Medicine, Mohammed V Military Teaching Hospital, Mohammed V-Souissi University, School of Medicine, Rabat, Morocco
| | - Rafael S Silva
- Unidad de Enfermedades Respiratorias, Hospital Regional de Talca, Calle 1 Norte 1990, Talca, Chile
| | - Vitor Cruz
- Serviço de Reumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Bruno Niemeyer
- Departamento de Radiologia, Instituto Estadual do Cérebro Paulo Niemeyer, R. do Rezende, 156 - Centro, 20231-092 Rio de Janeiro, RJ, Brazil
| | - Khalfan Al-Zeedy
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB Buenos Aires, Argentina
| | - Hamdan Al-Jahdali
- Pulmonary Division, Department of Medicine, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
| | - Natalia Jaramillo
- Cardiology Department, Hospital Puerta de HierroMajadahonda, C/Joaquin Rodrigo 3, Madrid 28222, Spain
| | - Serkan Demirkan
- Department of Dermatology and Venerology, Izmir KatipÇelebi University Faculty of Medicine, Karabağlar, Izmir, Turkey
| | - Aurelien Guffroy
- Service d'immunologieclinique et médecine interne, centre de référence des maladies auto-immunes systémiquesrares (RESO), hôpitauxuniversitaires de Strasbourg, nouvelhôpital civil, 67091 Strasbourg, France; UFR médecine Strasbourg, université de Strasbourg, 67000 Strasbourg, France
| | - Jung Tae Kim
- Department of Cardiovascular and Thoracic Surgery, Cheonan Chungmu Hospital, 8 Dagamal 3-gil Seobuk-gu, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Nikolas Ruffer
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Samar Tharwat
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Mabrouk Abdelali
- Department of Radiology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Tubig C Joy
- Division of Pulmonary and Critical Care Medicine, Philippine Heart Center, Quezon City, Philippines
| | - Mona Sayed
- Nursing Medical Surgical Critical Care Department, Minia University, Minia, Egypt
| | - Juljani Sherwina
- Division of Pulmonary and Critical Care Medicine, Philippine Heart Center, Quezon City, Philippines
| | - Tamer Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt
| | - Johannes J Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Drienerlolaan 5, 7522NB Enschede, the Netherlands
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Gui XY, Ahmad W, Ali I. A Fatal Case of Cerebral Fat Embolism: A Case Report. Cureus 2024; 16:e59107. [PMID: 38803752 PMCID: PMC11128378 DOI: 10.7759/cureus.59107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Fat embolism syndrome (FES) is a rare but serious multisystem syndrome that occurs after 0.9% to 2.2% of fractures, with long bone and pelvic fractures being the most common. The classic triad of FES consists of neurological impairment, respiratory insufficiency, and petechial rash, which develops 12-72 hours after the initial incident. We hereby present a case of a patient who developed persistent altered consciousness, seizures, and hypoxia secondary to a comminuted sacral fracture. Although the patient could not survive owing to multiple factors, imaging played a pivotal role in expediting the diagnostic process and aiding early management.
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Affiliation(s)
- Xi Yao Gui
- Department of Radiology, University of British Columbia, Faculty of Medicine, Vancouver, CAN
| | - Waqas Ahmad
- Department of Radiology, Vancouver General Hospital, Vancouver, CAN
| | - Ismail Ali
- Department of Radiology, Vancouver General Hospital, Vancouver, CAN
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Gil-García CA, Cueto-Robledo G, Gonzalez-Hermosillo LM, Alfaro-Cruz A, Roldan-Valadez E. Nonthrombotic Pulmonary Embolism Associated With Non-Hodgkin Lymphoma. Curr Probl Cardiol 2023; 48:102001. [PMID: 37506958 DOI: 10.1016/j.cpcardiol.2023.102001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
Nonthrombotic pulmonary embolism (NTPE) challenges the medical community with its diverse etiologies and potential life-threatening implications. The classification section delves into the multifaceted nature of NTPE, which includes various embolic agents that traverse the vascular system. From air and fat emboli to tumor and amniotic fluid emboli, this exploration of diverse etiologies sheds light on the complexity of NTPE. Diagnostic methods play a crucial role in the effective management of NTPE. This article describes a range of traditional and cutting-edge diagnostic techniques, from computed tomography angiography to novel biomarkers, enabling the accurate and timely identification of NTPE. NTPE treatment options are diverse and patient-specific, requiring customized approaches to address varying embolic sources. Anticoagulation, embolus removal, and emerging interventions under study are discussed, providing clinicians with a comprehensive understanding of management strategies. This article uncovers the rare but captivating association between NTPE and non-Hodgkin lymphoma. Although rare, documented cases have sparked curiosity among researchers and medical practitioners. We explore potential pathophysiological connections, discussing challenges and considerations when encountering this unique scenario. In conclusion, this captivating review encapsulates the multifaceted realm of NTPE, covering its classification, diagnostics, and treatment modalities. Moreover, it presents a fascinating connection with non-Hodgkin lymphoma. This article offers a comprehensive and concise review of NTPE, guiding readers through its intricate classification, diagnostic approaches, and therapeutic interventions.
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Affiliation(s)
- Cesar-Alejandro Gil-García
- Faculty of Medicine, Autonomous University of Sinaloa, Los Mochis, Sinaloa, México; Directorate of Research, General Hospital of Mexico "Dr. Eduardo Liceaga," Mexico City, Mexico
| | - Guillermo Cueto-Robledo
- Cardiorespiratory Emergencies, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; Pulmonary Circulation Clinic, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
| | | | - Ana Alfaro-Cruz
- Department of Surgical Pathology, General Hospital of Mexico, "Dr. Eduardo Liceaga," Mexico City, Mexico
| | - Ernesto Roldan-Valadez
- Directorate of Research, General Hospital of Mexico "Dr. Eduardo Liceaga," Mexico City, Mexico; Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
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4
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Merchant SA, Nadkarni P, Shaikh MJS. Augmentation of literature review of COVID-19 radiology. World J Radiol 2022; 14:342-351. [PMID: 36186515 PMCID: PMC9521431 DOI: 10.4329/wjr.v14.i9.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/26/2022] [Accepted: 08/21/2022] [Indexed: 02/08/2023] Open
Abstract
We suggest an augmentation of the excellent comprehensive review article titled “Comprehensive literature review on the radiographic findings, imaging modalities, and the role of radiology in the coronavirus disease 2019 (COVID-19) pandemic” under the following categories: (1) “Inclusion of additional radiological features, related to pulmonary infarcts and to COVID-19 pneumonia”; (2) “Amplified discussion of cardiovascular COVID-19 manifestations and the role of cardiac magnetic resonance imaging in monitoring and prognosis”; (3) “Imaging findings related to fluorodeoxyglucose positron emission tomography, optical, thermal and other imaging modalities/devices, including ‘intelligent edge’ and other remote monitoring devices”; (4) “Artificial intelligence in COVID-19 imaging”; (5) “Additional annotations to the radiological images in the manuscript to illustrate the additional signs discussed”; and (6) “A minor correction to a passage on pulmonary destruction”.
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Affiliation(s)
| | - Prakash Nadkarni
- College of Nursing, University of Iowa, Iowa City, IA 52242, United States
| | - Mohd Javed Saifullah Shaikh
- Department of Radiology, North Bengal Neuro Centre - Jupiter MRI & Diagnostic Centre, Siliguri 734003, West Bengal, India
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5
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Dong A, Zhang Z, Yang Q, Cheng C, Zuo C. 68 Ga-FAPI-04 Versus 18 F-FDG PET/CT in a Case With Intimal Sarcoma of the Pulmonary Artery. Clin Nucl Med 2022; 47:748-750. [PMID: 35353737 DOI: 10.1097/rlu.0000000000004141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Intimal sarcoma of the pulmonary artery is a rare entity, mimicking acute or chronic pulmonary thromboembolism. We describe 68 Ga-FAPI-04 and 18 F-FDG PET/CT findings in a case with intimal sarcoma of the pulmonary artery. The intrapulmonary artery tumor showed inhomogeneously increased FDG and FAPI uptake. Compared with FDG PET/CT, FAPI PET/CT more clearly delineated the tumor partially because of a very low background FAPI activity in the walls of the main pulmonary artery and right ventricle, which showed diffuse FDG uptake.
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Affiliation(s)
- Aisheng Dong
- From the Department of Nuclear Medicine, Changhai Hospital, Navy Medical University, Shanghai, China
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6
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Owji S, Choi WJ, Al-Jabbari E, Manral K, Palacio D, Bhargava P. Computed tomography findings in septic pulmonary embolism: A case report and literature review. Radiol Case Rep 2022; 17:2639-2642. [PMID: 35663809 PMCID: PMC9160282 DOI: 10.1016/j.radcr.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
This case report describes the findings of septic pulmonary embolism (SPE) in a young adult male with a history of intravenous drug use who initially presented with signs and symptoms of acute sepsis. The patient underwent evaluation by computed tomography (CT) imaging as well as blood cultures and echocardiography, which confirmed the diagnosis of SPE secondary to Staphylococcus aureus positive bacterial endocarditis. In this case report, we discuss the presentation and characteristic CT imaging findings of SPE as well as highlight the value of this imaging modality in the timely diagnosis and management of this urgent condition.
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7
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Hajiahmadi S, Tabesh F, Shayganfar A, Shirani F, Ebrahimian S. Pulmonary artery obstruction index, pulmonary artery diameter and right ventricle strain as prognostic CT findings in patient with acute pulmonary embolism. RADIOLOGIA 2022. [DOI: 10.1016/j.rxeng.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Ahuja J, Palacio D, Jo N, Strange CD, Shroff GS, Truong MT, Wu CC. Pitfalls in the imaging of pulmonary embolism. Semin Ultrasound CT MR 2022; 43:221-229. [PMID: 35688533 DOI: 10.1053/j.sult.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pulmonary embolism (PE) can present with a wide spectrum of clinical symptoms that can overlap considerably with other cardiovascular diseases. To avoid PE related morbidity and mortality, it is vital to identify this disease accurately and in a timely fashion. Several clinical criteria have been developed to standardize the diagnostic approach for patients with suspected PE. Computed tomographic pulmonary angiogram has significantly improved the detection of pulmonary embolism and is considered the imaging modality of choice to diagnose this disease. However, there are several potential pitfalls associated with this modality which can make diagnosis of PE challenging. In this review, we will discuss various pitfalls routinely encountered in the diagnostic work up of patients with suspected PE, approaches to mitigate these pitfalls and incidental pulmonary embolism.
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Affiliation(s)
- Jitesh Ahuja
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Diana Palacio
- Department of Radiology, The University of Texas Medical Branch, UTMB. Galveston TX
| | - Nahyun Jo
- Department of Radiology, The University of Texas Medical Branch, UTMB. Galveston TX
| | - Chad D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Girish S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carol C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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9
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Niemiec A, Kosowski M, Hachuła M, Basiak M, Okopień B. Fungal infection mimicking COVID-19 infection - A case report. Open Med (Wars) 2022; 17:841-846. [PMID: 35582198 PMCID: PMC9055255 DOI: 10.1515/med-2022-0443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 12/31/2022] Open
Abstract
For the last 2 years, one of the most frequent causes of respiratory failure is coronavirus disease 2019 (COVID-19). The symptoms are not specific. Imaging diagnostics, especially high-resolution computed tomography, is a diagnostic method widely used in the diagnosis of this disease. It is important to emphasize that not only SARS-CoV-2 infection may manifest as interstitial pneumonia. Other diseases such as other viral, fungal, atypical bacterial pneumonia, autoimmune process, and even cancer can also manifest as ground-glass opacities or consolidations in the imaging of the lungs. In this case report, we described a patient who manifested many symptoms that seemed to be COVID-19. However, all performed antigen and polymerase chain reaction tests were negative. The diagnostics must have been extended. Microbiological and mycological blood cultures and sputum cultures were performed. Blood cultures were negative but in sputum, Candida albicans and Candida glabrata were identified. Targeted therapy with fluconazole was implemented with a satisfactory result. The patient was discharged from the hospital in a good general condition with no complaints.
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Affiliation(s)
- Aleksandra Niemiec
- Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, 40-752 Katowice, Poland
| | - Michał Kosowski
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Marcin Hachuła
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Marcin Basiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
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10
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Sierra E, Ramírez T, Bernaldo de Quirós Y, Arregui M, Mompeó B, Rivero MA, Fernández A. Pulmonary and Systemic Skeletal Muscle Embolism in a Beaked Whale with a Massive Trauma of Unknown Aetiology. Animals (Basel) 2022; 12:ani12040508. [PMID: 35203216 PMCID: PMC8868372 DOI: 10.3390/ani12040508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary A severe trauma of unknown aetiology was suspected as the cause of death in an adult female Sowerby’s beaked whale found floating dead in the Canary Islands in December 2016. Many bruises in the skin and muscles (contusions) were observed in the chest wall and bone fractures, mainly located in the mandible and ribs. The broken rib bones also affected thoracic muscles, which escaped into the blood circulation once ruptured, reaching several organic locations, including the lungs, where they became trapped within the small lumen of pulmonary blood vessels, leading to a systemic and pulmonary skeletal muscle embolism. An embolism occurs when a piece of intravascular internal or foreign material obstructs the lumen of a blood vessel, starving tissues of blood and oxygen. An embolism necessarily needs cardiac function, indicating a survival time after trauma. This case report aimed to include the diagnosis of skeletal muscle embolism as a routine tool to determine if the traumatic event occurred before or after death. This is especially valuable when working with dead animals because no other evidence of traumatic injury may be recorded if carcasses are in advanced decay. Abstract An adult female Sowerby’s beaked whale was found floating dead in Hermigua (La Gomera, Canary Islands, Spain) on 7 December 2016. Severe traumas of unknown aetiology were attributed, and the gross and microscopic findings are consistent with catastrophic trauma as a cause of death. Rib fractures affected the intercostals, transverse thoracis skeletal muscles, and thoracic rete mirabile. Degenerated muscle fibres were extruded to flow into vascular and lymphatic vessels travelling to several anatomic locations into the thoracic cavity, including the lungs, where they occluded the small lumen of pulmonary microvasculature. A pulmonary and systemic skeletal muscle embolism was diagnosed, constituting the first description of this kind of embolism in an animal. The only previous description has been reported in a woman after peritoneal dialysis. Skeletal pulmonary embolism should be considered a valuable diagnostic for different types of trauma in vivo in wild animals. This is especially valuable when working with decomposed carcasses, as in those cases, it is not always feasible to assess other traumatic evidence.
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Affiliation(s)
- Eva Sierra
- Division of Histology and Animal Pathology, University Institute of Animal Health and Food Security (IUSA), Universidad de Las Palmas de Gran Canaria (ULPGC), 35413 Las Palmas, Canary Islands, Spain; (E.S.); (T.R.); (Y.B.d.Q.); (M.A.); (M.A.R.)
| | - Tania Ramírez
- Division of Histology and Animal Pathology, University Institute of Animal Health and Food Security (IUSA), Universidad de Las Palmas de Gran Canaria (ULPGC), 35413 Las Palmas, Canary Islands, Spain; (E.S.); (T.R.); (Y.B.d.Q.); (M.A.); (M.A.R.)
| | - Yara Bernaldo de Quirós
- Division of Histology and Animal Pathology, University Institute of Animal Health and Food Security (IUSA), Universidad de Las Palmas de Gran Canaria (ULPGC), 35413 Las Palmas, Canary Islands, Spain; (E.S.); (T.R.); (Y.B.d.Q.); (M.A.); (M.A.R.)
| | - Marina Arregui
- Division of Histology and Animal Pathology, University Institute of Animal Health and Food Security (IUSA), Universidad de Las Palmas de Gran Canaria (ULPGC), 35413 Las Palmas, Canary Islands, Spain; (E.S.); (T.R.); (Y.B.d.Q.); (M.A.); (M.A.R.)
| | - Blanca Mompeó
- Department of Morphology, Universidad de Las Palmas de Gran Canaria (ULPGC), 35016 Las Palmas, Canary Islands, Spain;
| | - Miguel A. Rivero
- Division of Histology and Animal Pathology, University Institute of Animal Health and Food Security (IUSA), Universidad de Las Palmas de Gran Canaria (ULPGC), 35413 Las Palmas, Canary Islands, Spain; (E.S.); (T.R.); (Y.B.d.Q.); (M.A.); (M.A.R.)
| | - Antonio Fernández
- Division of Histology and Animal Pathology, University Institute of Animal Health and Food Security (IUSA), Universidad de Las Palmas de Gran Canaria (ULPGC), 35413 Las Palmas, Canary Islands, Spain; (E.S.); (T.R.); (Y.B.d.Q.); (M.A.); (M.A.R.)
- Correspondence:
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11
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Affiliation(s)
- Satish Swain
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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12
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Dwivedi S, Kimmel LA, Kirk A, Varma D. Radiological features of pulmonary fat embolism in trauma patients: a case series. Emerg Radiol 2021; 29:41-47. [PMID: 34410546 DOI: 10.1007/s10140-021-01969-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Fat embolism syndrome (FES) is a rare complication in trauma patients (usually with long bone fractures) in which migrating medullary fat precipitates multiorgan dysfunction, classically presenting with dyspnoea, petechiae and neurocognitive dysfunction. Although this triad of symptoms is rare, it nonetheless aids diagnosis of pulmonary fat embolism (PuFE). Typical imaging features of PuFE are not established, although increasing use of CT pulmonary angiography (CTPA) in this cohort may provide important diagnostic information. We therefore conducted a case series of FES patients with CTPA imaging at a Level 1 Trauma Centre in Melbourne, Australia. METHODS Medical records and various radiological investigations including CTPA of consecutive patients diagnosed clinically with FES between 2006 and 2018, including demographics, injury and their progress during their admission, were reviewed. RESULTS Fifteen FES patients with retrievable CTPAs were included (mean age 31.2 years, range 17-69; 12 males [80%]). 93.3% had long bone fractures. CTPA was performed 2.00 ± 1.41 days post-admission. Review of these images showed pulmonary opacity in 14 (93.3%; ground-glass opacities in 9 [64.3%], alveolar opacities in 6 [42.9%]), interlobular septal thickening in 10 (66.7%), and pleural effusions in 7 (46.7%). Filling defects were identified in three (20%) CTPAs, with density measuring - 20HU to + 63HU. Ten patients (66.7%) had neuroimaging performed, with two patients demonstrating imaging findings consistent with cerebral fat emboli. CONCLUSION CTPA features of PuFE are variable, with ground-glass parenchymal changes and septal thickening most commonly seen. Filling defects were uncommon.
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Affiliation(s)
- Shourye Dwivedi
- Department of Radiology, Alfred Health, Melbourne, Australia.
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Australia.
| | - Lara A Kimmel
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Asher Kirk
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Dinesh Varma
- Department of Radiology, Alfred Health, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
- National Trauma Research Institute, Melbourne, Australia
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13
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Abstract
The diagnosis of pulmonary embolism (PE) is often made more challenging by the presence of diseases that can mimic thromboembolic disease. There is no specific or sensitive constellation of clinical signs or symptoms that can be used to diagnose PE. Ventilation/perfusion scans can have false-positive findings related to mediastinal conditions that can compress the pulmonary arteries, and pulmonary hemorrhage can resemble PE on V/Q scanning with potentially devastating consequences if anticoagulation is started. CT-scan related issues l eading to potential false-positive diagnoses range from inadequate imaging technique, to systemic-pulmonary shunting, to non-thrombotic occlusion of pulmonary arteries by tumor, septic emboli, and emboli of fat, air, and foreign material, as well as vasculitic processes. Careful assessment of the patient and consideration of these potential mimickers is imperative to correct diagnosis of this potentially life-threatening condition.
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Affiliation(s)
- Yuri Matusov
- Cedars-Sinai Medical Center - Pulmonary & Critical Care Medicine, Los Angeles, California, United States
| | - Victor F Tapson
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Cedars-Sinai Medical Center - Venous Thromboembolism and Pulmonary Vascular Disease Research Program, Los Angeles, California, United States
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14
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Tale S, Ghosh S, Pahel Meitei S, Kolli M, Garbhapu AK. Feeding vessel sign: a radiological sign of septic pulmonary embolism. QJM 2021; 114:213-214. [PMID: 32521011 DOI: 10.1093/qjmed/hcaa193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Tale
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - S Ghosh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - S Pahel Meitei
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - M Kolli
- Department of Pulmonary Medicine, All India Institute of Medical SCIENCES, Rishikesh, Uttarakhand 249203, India
| | - A K Garbhapu
- Department of Pediatric Surgery, RML Hospital, New Delhi 110001, India
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15
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Hettie KS. Targeting Contrast Agents With Peak Near-Infrared-II (NIR-II) Fluorescence Emission for Non-invasive Real-Time Direct Visualization of Thrombosis. Front Mol Biosci 2021; 8:670251. [PMID: 34026844 PMCID: PMC8138325 DOI: 10.3389/fmolb.2021.670251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
Thrombosis within the vasculature arises when pathological factors compromise normal hemostasis. On doing so, arterial thrombosis (AT) and venous thrombosis (VT) can lead to life-threatening cardio-cerebrovascular complications. Unfortunately, the therapeutic window following the onset of AT and VT is insufficient for effective treatment. As such, acute AT is the leading cause of heart attacks and constitutes ∼80% of stroke incidences, while acute VT can lead to fatal therapy complications. Early lesion detection, their accurate identification, and the subsequent appropriate treatment of thrombi can reduce the risk of thrombosis as well as its sequelae. As the success rate of therapy of fresh thrombi is higher than that of old thrombi, detection of the former and accurate identification of lesions as thrombi are of paramount importance. Magnetic resonance imaging, x-ray computed tomography (CT), and ultrasound (US) are the conventional non-invasive imaging modalities used for the detection and identification of AT and VT, but these modalities have the drawback of providing only image-delayed indirect visualization of only late stages of thrombi development. To overcome such limitations, near-infrared (NIR, ca. 700-1,700 nm) fluorescence (NIRF) imaging has been implemented due to its capability of providing non-invasive real-time direct visualization of biological structures and processes. Contrast agents designed for providing real-time direct or indirect visualization of thrombi using NIRF imaging primarily provide peak NIR-I fluorescence emission (ca. 700-1,000 nm), which affords limited tissue penetration depth and suboptimal spatiotemporal resolution. To facilitate the enhancement of the visualization of thrombosis via providing detection of smaller, fresh, and/or deep-seated thrombi in real time, the development of contrast agents with peak NIR-II fluorescence emission (ca. 1000-1,700 nm) has been recently underway. Currently, however, most contrast agents that provide peak NIR-II fluorescence emissions that are purportedly capable of providing direct visualization of thrombi or their resultant occlusions actually afford only the indirect visualization of such because they only provide for the (i) measuring of the surrounding vascular blood flow and/or (ii) simple tracing of the vasculature. These contrast agents do not target thrombi or occlusions. As such, this mini review summarizes the extremely limited number of targeting contrast agents with peak NIR-II fluorescence emission developed for non-invasive real-time direct visualization of thrombosis that have been recently reported.
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Affiliation(s)
- Kenneth S. Hettie
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, CA, United States
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16
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Hajiahmadi S, Tabesh F, Shayganfar A, Shirani F, Ebrahimian S. Pulmonary artery obstruction index, pulmonary artery diameter and right ventricle strain as prognostic CT findings in patient with acute pulmonary embolism. RADIOLOGIA 2021; 65:S0033-8338(21)00076-X. [PMID: 33865608 DOI: 10.1016/j.rx.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/07/2021] [Accepted: 02/01/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study was designed to determine predictors of pulmonary hypertension and signs of right heart dysfunction caused by pulmonary embolism (PE) that may lead to early detection of high-risk patients. So the predictive value of pulmonary artery obstruction index (PAOI), measured by pulmonary CT angiography (PCTA) in the acute setting, in predicting the patients susceptible to PE cardiac complications was evaluated. Also two other PCTA indices, pulmonary artery diameter (PAD), and right ventricle (RV) strain, in these patients were investigated and their predictive value for cardiac complications on follow up echocardiography were demonstrated. MATERIALS AND METHODS In the study 120 patients with a definite diagnosis of PE were included. The PAOI, PAD and RV strain were measured using PCTA at the time of the initial diagnosis. Transthoracic echocardiography was done 6 months after the diagnosis of PE and RV echocardiographic indices were measured. Pearson correlation was used to investigate correlation between PAOI, PAD, RV strain and signs of right heart dysfunction. RESULTS PAOI was strongly correlated with systolic pulmonary artery pressure (SPAP) (r=0.83), RV systolic pressure (r=0.78) and RV wall thickness (r=0.61) in long-term follow up echocardiography. A higher rate of RV dysfunction and RV dilation was detected among the patients with higher PAOI (P<0.001). PAOI≥18 was strongly predictive for development of RV dysfunction. Also developments of pulmonary hypertension, RV systolic hypertension, RV dilation, RV dysfunction, and RV hypertrophy were significantly more common among patients with higher PAD and RV strain (P<0.001). CONCLUSIONS PAOI, PAD and RV strain are sensitive and specific PCTA indices that can predict the development of long-term complications such as pulmonary hypertension and right heart dysfunction, at the time of initial PE diagnosis.
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Affiliation(s)
- S Hajiahmadi
- Assistant Professor, Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - F Tabesh
- Assistant Professor, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Shayganfar
- Assistant Professor, Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fattane Shirani
- Resident, Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - S Ebrahimian
- Postdoctoral researcher, Massachusetts General Hospital, United States of America
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17
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Matos MJRD, Rosa MEE, Brito VM, Amaral LTW, Beraldo GL, Fonseca EKUN, Chate RC, Passos RBD, Silva MMA, Yokoo P, Sasdelli Neto R, Teles GBDS, Silva MCBD, Szarf G. Differential diagnoses of acute ground-glass opacity in chest computed tomography: pictorial essay. EINSTEIN-SAO PAULO 2021; 19:eRW5772. [PMID: 33729289 PMCID: PMC7935089 DOI: 10.31744/einstein_journal/2021rw5772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/23/2020] [Indexed: 12/24/2022] Open
Abstract
Ground-glass opacity is a very frequent and unspecified finding in chest computed tomography. Therefore, it admits a wide range of differential diagnoses in the acute context, from viral pneumonias such as influenza virus, coronavirus disease 2019 and cytomegalovirus and even non-infectious lesions, such as vaping, pulmonary infarction, alveolar hemorrhage and pulmonary edema. For this diagnostic differentiation, ground glass must be correlated with other findings in imaging tests, with laboratory tests and with the patients' clinical condition. In the context of a pandemic, it is extremely important to remember the other pathologies with similar findings to coronavirus disease 2019 in the imaging exams.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Patrícia Yokoo
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | | | - Gilberto Szarf
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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18
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Guarnera A, Podda P, Santini E, Paolantonio P, Laghi A. Differential diagnoses of COVID-19 pneumonia: the current challenge for the radiologist-a pictorial essay. Insights Imaging 2021; 12:34. [PMID: 33704615 PMCID: PMC7948690 DOI: 10.1186/s13244-021-00967-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND COVID-19 pneumonia represents the most severe pandemic of the twenty-first century and has crucial clinical, social and economical implications. The scientific community has focused attention and resources on clinical and radiological features of COVID-19 pneumonia. Few papers analysing the vast spectrum of differential diagnoses have been published. MAIN BODY Complexity of differential diagnosis lays in the evidence of similar radiological findings as ground-glass opacities, crazy paving pattern and consolidations in COVID-19 pneumonia and a multitude of other lung diseases. Differential diagnosis is and will be extremely important during and after the pandemic peak, when there are fewer COVID-19 pneumonia cases. The aim of our pictorial essay is to schematically present COVID-19 pneumonia most frequent differential diagnoses to help the radiologist face the current COVID-19 pneumonia challenge. CONCLUSIONS Clinical data, laboratory tests and imaging are pillars of a trident, which allows to reach a correct diagnosis in order to grant an excellent allocation of human and economical resources. The radiologist has a pivotal role in the early diagnosis of COVID-19 pneumonia because he may raise suspicion of the pathology and help to avoid COVID-19 virus spread.
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Affiliation(s)
- Alessia Guarnera
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
| | - Pierfrancesco Podda
- Department of Radiology, San Giovanni Addolorata Hospital, Via Dell'Amba Aradam 9, 00184, Rome, Italy
| | - Elena Santini
- Department of Radiology, San Giovanni Addolorata Hospital, Via Dell'Amba Aradam 9, 00184, Rome, Italy
| | - Pasquale Paolantonio
- Department of Radiology, San Giovanni Addolorata Hospital, Via Dell'Amba Aradam 9, 00184, Rome, Italy
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
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19
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Gonzalo-Carballes M, Ríos-Vives MÁ, Fierro EC, Azogue XG, Herrero SG, Rodríguez AE, Rus MN, Planes-Conangla M, Escudero-Fernandez JM, Coscojuela P. A Pictorial Review of Postpartum Complications. Radiographics 2020; 40:2117-2141. [PMID: 33095681 DOI: 10.1148/rg.2020200031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The postpartum period, also known as the puerperium, begins immediately after delivery of the neonate and placenta and ends 6-8 weeks after delivery. The appearance of physiologic uterine changes during puerperium can overlap with that of postpartum complications, which makes imaging interpretation and diagnosis difficult. Obstetric and nonobstetric postpartum complications are a considerable source of morbidity and mortality in women of reproductive age, and the radiologist plays an important role in the assessment of these entities, which often require a multimodality imaging approach. US and contrast material-enhanced CT are the techniques of choice in the emergency department, and they can show characteristic radiologic findings that enable differentiation between normal and abnormal features to help radiologists and emergency department practitioners to reach a correct diagnosis and provide timely treatment. The spectrum of postpartum complications ranges from relatively self-limiting to life-threatening conditions that can be divided into six categories: infectious conditions (endometritis), thrombotic complications (eg, deep vein thrombosis, ovarian vein thrombophlebitis, HELLP [hemolysis, elevated liver enzymes, and low platelet count] syndrome, or cerebral sinus thrombosis), hemorrhagic conditions (eg, uterine atony, trauma of the lower portion of the genital tract, retained products of conception, uterine artery arteriovenous malformations, or uterine artery pseudoaneurysm), cesarean delivery-related complications (eg, bladder flap hematoma, subfascial hematoma, rectus sheath hematoma, abscess formation, uterine dehiscence, uterine rupture, vesicovaginal fistula, or abdominal wall endometriosis), iatrogenic conditions (eg, uterine perforation), and nonobstetric complications (eg, acute cholecystitis, acute appendicitis, uterine fibroid degeneration, renal cortical necrosis, pyelonephritis, posterior reversible encephalopathy syndrome, or pituitary gland apoplexy). The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Marta Gonzalo-Carballes
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Miguel Ángel Ríos-Vives
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Eva Castellà Fierro
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Xavier Gurí Azogue
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Susana Gispert Herrero
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Alberto Escudero Rodríguez
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - María Neus Rus
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Marina Planes-Conangla
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jose Miguel Escudero-Fernandez
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Pilar Coscojuela
- From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
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20
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Haramati A, Haramati LB. Imaging of Chronic Thromboembolic Disease. Lung 2020; 198:245-255. [PMID: 32166427 DOI: 10.1007/s00408-020-00344-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/28/2020] [Indexed: 12/19/2022]
Abstract
Acute pulmonary embolism (PE) is a leading cause of cardiovascular morbidity. The most common long-term complication of acute PE is chronic thromboembolic disease, a heterogenous entity which ranges from asymptomatic imaging sequelae to persistent symptoms. Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease that can develop in this population and represents the only treatable type of pulmonary hypertension. Recognition of the characteristic findings of chronic pulmonary embolism and CTEPH provides not only diagnostic information, but is also crucial for guiding therapy. The present state-of-the-art review focuses on the multimodality imaging features of chronic pulmonary embolism. Detailed description and illustrations of relevant imaging findings will be demonstrated for ventilation/perfusion (V/Q) scan, CT scan and Dual-Energy CT and MRI and features that distinguish chronic PE from common imaging mimics.
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Affiliation(s)
- Adina Haramati
- Department of Radiology, Northwell Health, Manhasset, NY, USA.
| | - Linda B Haramati
- Departments of Radiology and Internal Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
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21
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Rotzinger DC, Dunet V, Ilic V, Hugli OW, Meuli RA, Schmidt S. Pulmonary embolism during pregnancy: a 17-year single-center retrospective MDCT pulmonary angiography study. Eur Radiol 2020; 30:1780-1789. [PMID: 31728689 PMCID: PMC7033070 DOI: 10.1007/s00330-019-06501-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/23/2019] [Accepted: 10/08/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To determine the prevalence of pulmonary embolism (PE) and alternative diagnoses detected by computed tomography pulmonary angiography (CTPA) in pregnant women; and to assess changes over time regarding radiation dose, technical quality, and examination frequency. MATERIALS AND METHODS This retrospective study included all pregnant women referred for CTPA due to clinically suspected PE over 17 years. Two blinded radiologists reviewed the CTPAs in consensus with regard to PE, alternative diagnoses, and technical quality. We retrieved patient data regarding radiation dose metrics and associated clinical and laboratory parameters. Subgroup comparisons were performed (Wilcoxon and Kruskal-Wallis tests). RESULTS Of the 237 identified patients, 8 (3.3%) were excluded due to inadequate technical CTPA quality, and 229 patients were analyzed (mean age, 31.7 years; mean gestational age, 28 ± 7 weeks). The four different CT systems used over the study period had similar technical quality (p = 0.28). Of 229 patients 16 (7%) patients had PE, 144 (62.9%) had no abnormal findings, and 69 (30.1%) had an alternative diagnosis (consolidation, other pulmonary opacities, pleural effusion, and basal atelectasis). Gestational age, symptoms, and D-dimer levels were not significantly different between patients with or without PE (p > 0.05). Over time, radiation dose exposure decreased by 30% (p < 0.001), while the number of annual examinations increased by > 4-folds. CONCLUSIONS In pregnant women, CTPA rarely indicates PE and more often shows alternative diagnoses. Over 17 years, the use of CTPA in pregnancy has notably increased, while the radiation dose exposure has decreased by one third. KEY POINTS • The use of CTPA in pregnancy has steadily risen over the last 17 years • In pregnant women, CTPA rarely reveals PE and more often shows alternative diagnoses • Recent technical improvements have substantially decreased the radiation dose exposure inherent in CTPA without reducing diagnostic image quality.
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Affiliation(s)
- David C Rotzinger
- Department of Diagnostic and Interventional Radiology, Emergency Radiology Division, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Emergency Radiology Division, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Vesna Ilic
- Centre d'Imagerie du Nord Vaudois (CINOV), Yverdon-les-Bains, Switzerland
| | - Olivier W Hugli
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- Emergency Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Reto A Meuli
- Department of Diagnostic and Interventional Radiology, Emergency Radiology Division, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Sabine Schmidt
- Department of Diagnostic and Interventional Radiology, Emergency Radiology Division, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
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22
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Ufuk F, Kaya F, Sagtas E, Kupeli A. Non-thrombotic pulmonary embolism in emergency CT. Emerg Radiol 2020; 27:343-350. [PMID: 32002737 DOI: 10.1007/s10140-020-01755-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/24/2020] [Indexed: 02/06/2023]
Abstract
Non-thrombotic pulmonary embolism (NTPE) results from the embolization of non-thrombotic materials. It can often be a challenging diagnosis due to non-specific (similar to thrombotic pulmonary embolism) or uncommon clinical and imaging findings. Patients with NTPE often present to the emergency department with acute respiratory distress, and contrast-enhanced computed tomography (CT) of the chest and CT pulmonary angiography are the imaging modalities of choice for respiratory distress. Since the treatment of NTPE is entirely different from thromboembolism, its distinction is essential. Moreover, early diagnosis of NTPE is necessary. Radiologists must be familiar with the diagnostic findings of NTPE, and this article aims to review the imaging features of various causes of NTPE.
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Affiliation(s)
- Furkan Ufuk
- Department of Radiology, University of Pamukkale, Denizli, Turkey.
| | - Furkan Kaya
- Department of Radiology, University of Kocatepe, Afyonkarahisar, Turkey
| | - Ergin Sagtas
- Department of Radiology, University of Pamukkale, Denizli, Turkey
| | - Ali Kupeli
- Department of Radiology, Erzincan Binali Yildirim University, Erzincan, Turkey
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23
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Patino Gonzalez A, Modahl L, Kowal D. High-Yield Imaging Review of Pulmonary Infections. Semin Ultrasound CT MR 2020; 41:63-73. [DOI: 10.1053/j.sult.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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24
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Cheng J, Li C, Corsini EM, Antonoff MB, Hekmat K, Liu L. Left destroyed lung caused by a pen cap in the left lower lobe bronchus "swallowed" 25 years ago. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:711. [PMID: 31930110 DOI: 10.21037/atm.2019.11.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A delayed diagnosis of tracheobronchial foreign body aspiration (FBA) may result in severe respiratory complications such as pneumonia, bronchiectasis, and atelectasis. Here, we present a rare case of a left lung destruction caused by a pen cap that remained in the left lower lobe bronchus for 25 years and was previously misdiagnosed as cavitary tuberculosis. The foreign body was not detected in bronchoscopic examination prior to surgery due to severe stenosis of the left main bronchus. The foreign body was found incidentally while the patient was undergoing left pneumonectomy. To the best of our knowledge, this the second longest delay to diagnosis of FBA reported. This case also exemplifies the grave consequences of misdiagnosis of FBA.
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Affiliation(s)
- Jiahan Cheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China.,Department of Pathology, School of Medicine, Stanford University, Palo Alto, CA,94304, USA
| | - Chuan Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Erin M Corsini
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Khosro Hekmat
- Department of Cardiothoracic Surgery, University of Cologne, 50937 Cologne, Germany
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
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25
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Leitman EM, McDermott S. Pulmonary arteries: imaging of pulmonary embolism and beyond. Cardiovasc Diagn Ther 2019; 9:S37-S58. [PMID: 31559153 DOI: 10.21037/cdt.2018.08.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The pulmonary arteries are not just affected by thrombus. Various acquired and congenital conditions can also affect the pulmonary arteries. In this review we discuss cross sectional imaging modalities utilized for the imaging of the pulmonary arteries. Acquired pulmonary artery entities, including pulmonary artery sarcoma (PAS), vasculitis, aneurysm, and arteriovenous malformations, and congenital anomalies in adults, including proximal interruption of the pulmonary artery, pulmonary sling, pulmonary artery stenosis, and idiopathic dilatation of the pulmonary trunk, are also discussed. An awareness of these entities and their imaging findings is important for radiologists interpreting chest imaging.
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Affiliation(s)
| | - Shaunagh McDermott
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
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26
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Makino Y, Kojima M, Yoshida M, Motomura A, Inokuchi G, Chiba F, Torimitsu S, Hoshioka Y, Yamaguchi R, Saito N, Urabe S, Tsuneya S, Horikoshi T, Yajima D, Iwase H. Postmortem CT and MRI findings of massive fat embolism. Int J Legal Med 2019; 134:669-678. [PMID: 31375910 DOI: 10.1007/s00414-019-02128-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 07/26/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To elucidate postmortem computed tomography (PMCT) and postmortem magnetic resonance (PMMR) imaging findings suggesting massive fat embolism. MATERIALS AND METHODS Consecutive forensic cases with PMCT and PMMR scans of subjects prior to autopsy were assessed. For PMCT, 16- or 64-row multidetector CT scans were used; for PMMR, a 1.5 T system was used. MRI sequences of the chest area included T2- and T1-weighted fast spin-echo imaging, T2*-weighted imaging, T1-weighted 3-dimensional gradient-echo imaging with or without a fat-suppression pulse, short tau inversion recovery, and in-phase/opposed-phase imaging. At autopsy, forensic pathologists checked for pulmonary fat embolism with fat staining; Falzi's grading system was used for classification. RESULTS Of 31 subjects, four were excluded because fat staining for histopathological examination of the lung tissue could not be performed. In three of the remaining 27 subjects, histology revealed massive fat embolism (Falzi grade III) and the cause of death was considered to be associated with fat embolism. CT detected a "fat-fluid level" in the right heart or intraluminal fat in the pulmonary arterial branches in two subjects. MRI detected these findings more clearly in both subjects. In one subject, CT and MRI were both negative. There were no positive findings in the 24 subjects that were fat embolism-negative by histology. DISCUSSION AND CONCLUSION In some subjects, a massive fat embolism can be suggested by postmortem imaging with a "fat-fluid level" in the right heart or intraluminal fat in the pulmonary arterial branches. PMMR potentially suggests fat embolism more clearly than PMCT.
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Affiliation(s)
- Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Masatoshi Kojima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Maiko Yoshida
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Ayumi Motomura
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, 286-8686, Japan
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Rutsuko Yamaguchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Naoki Saito
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shumari Urabe
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shigeki Tsuneya
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Takuro Horikoshi
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Daisuke Yajima
- Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, 286-8686, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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Sonaglioni A, Binda G, Rigamonti E, Vincenti A, Trevisan R, Nicolosi GL, Zompatori M, Lombardo M, Anzà C. A rare case of native pulmonary valve infective endocarditis complicated by septic pulmonary embolism. J Cardiovasc Med (Hagerstown) 2019; 20:152-155. [DOI: 10.2459/jcm.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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29
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Bryce YC, Perez-Johnston R, Bryce EB, Homayoon B, Santos-Martin EG. Pathophysiology of right ventricular failure in acute pulmonary embolism and chronic thromboembolic pulmonary hypertension: a pictorial essay for the interventional radiologist. Insights Imaging 2019; 10:18. [PMID: 30758687 PMCID: PMC6375098 DOI: 10.1186/s13244-019-0695-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/15/2019] [Indexed: 12/18/2022] Open
Abstract
Pulmonary embolus (PE) is the third most common cause of cardiovascular death with more than 600,000 cases occurring in the USA per year. About 45% of patients with acute PE will have acute right ventricular failure, and up to 3.8% of patients will develop chronic thromboembolic pulmonary hypertension (CTEPH) with progressive, severe, chronic heart failure. The right ventricle (RV) is constructed to accommodate a low-resistance afterload. Increases in afterload from acute massive and submassive PE and CTEPH may markedly compromise the RV function leading to hemodynamic collapse and death. The purpose of this educational manuscript is to instruct on the pathophysiology of RV failure in massive and submassive PE and CTEPH. It is important to understand the pathophysiology of these diseases as it provides the rationale for therapeutic intervention by the Interventional Radiologist. We review here the pathophysiology of right ventricular (RV) failure in acute massive and submassive PE and CTEPH.
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Affiliation(s)
- Yolanda C Bryce
- Radiology Department, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
| | - Rocio Perez-Johnston
- Radiology Department, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Errol B Bryce
- Internal Medicine, Health Science Center, University of North Texas, 1622 8th Ave, Suite 110, Fort Worth, TX, 76104, USA
| | - Behrang Homayoon
- Radiology Department, University of British Columbia, 13750 96th Ave, Surrey, BC, V3V 1Z2, Canada
| | - Ernesto G Santos-Martin
- Radiology Department, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
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30
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Marini TJ, He K, Hobbs SK, Kaproth-Joslin K. Pictorial review of the pulmonary vasculature: from arteries to veins. Insights Imaging 2018; 9:971-987. [PMID: 30382495 PMCID: PMC6269336 DOI: 10.1007/s13244-018-0659-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/14/2018] [Accepted: 09/12/2018] [Indexed: 01/27/2023] Open
Abstract
Pathology of the pulmonary vasculature involves an impressive array of both congenital and acquired conditions. While some of these disorders are benign, disruption of the pulmonary vasculature is often incompatible with life, making these conditions critical to identify on imaging. Many reviews of pulmonary vascular pathology approach the pulmonary arteries, pulmonary veins and bronchial arteries as individual topics. The goal of this review is to provide an integrated overview of the high-yield features of all major disorders of the pulmonary vasculature. This approach provides a more cohesive and comprehensive conceptualisation of respiratory pathology. In this review, we present both the salient clinical and imaging features of congenital and acquired disorders of the pulmonary vasculature, to assist the radiologist in identifying pathology and forming a robust differential diagnosis tailored to the presenting patient. TEACHING POINTS: • Abnormalities of the pulmonary vasculature are both congenital and acquired. • Pathology of a single pulmonary vascular territory often affects the entire pulmonary vasculature. • Anomalous pulmonary venous flow is named as a function of its location and severity. • Bronchial arteries often undergo dilatation secondary to cardio-respiratory pathology.
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Affiliation(s)
- Thomas J Marini
- Department of Imaging Sciences, University of Rochester, Rochester, NY, USA.
| | - Kevin He
- Department of Imaging Sciences, University of Rochester, Rochester, NY, USA
| | - Susan K Hobbs
- Department of Imaging Sciences, University of Rochester, Rochester, NY, USA
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31
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McCabe BE, Veselis CA, Goykhman I, Hochhold J, Eisenberg D, Son H. Beyond Pulmonary Embolism; Nonthrombotic Pulmonary Embolism as Diagnostic Challenges. Curr Probl Diagn Radiol 2018; 48:387-392. [PMID: 30232041 DOI: 10.1067/j.cpradiol.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 12/23/2022]
Abstract
Nonthrombotic pulmonary embolism (NTPE) is less well understood and is encountered less frequently than pulmonary embolism from venous thrombosis. NTPE results from embolization of nonthrombotic material to the pulmonary vasculature originating from many different cell types as well as nonbiologic or foreign materials. For many radiologists NTPE is a challenging diagnosis, presenting nonspecific or unusual imaging findings in the setting of few or unusual clinical signs. The aim of this paper is to review the pathophysiology of diverse causes of NTPE, which should aid radiologists to better understand and, more importantly, diagnose these infrequent events.
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Affiliation(s)
| | - Clinton A Veselis
- Temple University Hospital, Department of Radiology, Philadelphia, PA.
| | - Igor Goykhman
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
| | - John Hochhold
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
| | - Daniel Eisenberg
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
| | - Hongju Son
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
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Sirajuddin A, Donnelly EF, Crabtree TP, Henry TS, Iannettoni MD, Johnson GB, Kazerooni EA, Maldonado F, Olsen KM, Wu CC, Mohammed TL, Kanne JP. ACR Appropriateness Criteria ® Suspected Pulmonary Hypertension. J Am Coll Radiol 2018; 14:S350-S361. [PMID: 28473092 DOI: 10.1016/j.jacr.2017.01.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 11/15/2022]
Abstract
Pulmonary hypertension may be idiopathic or related to a large variety of diseases. Various imaging examinations that may be helpful in diagnosing and determining the etiology of pulmonary hypertension are discussed. Imaging examinations that may aid in the diagnosis of pulmonary hypertension include chest radiography, ultrasound echocardiography, ventilation/perfusion scans, CT, MRI, right heart catheterization, pulmonary angiography, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Edwin F Donnelly
- Panel Vice-Chair, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Traves P Crabtree
- Southern Illinois University School of Medicine, Springfield, Illinois; Society of Thoracic Surgeons
| | - Travis S Henry
- University of California, San Francisco, San Francisco, California
| | | | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Carol C Wu
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tan-Lucien Mohammed
- Specialty Chair, University of Florida College of Medicine, Gainesville, Florida
| | - Jeffrey P Kanne
- Panel Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Reicher J, Brooke S, Arnold D, Counter P, Abdelgalil A. An unusual case of cavitating pulmonary nodules: Lemierre’s syndrome with isolated involvement of the external jugular vein. BJR Case Rep 2018; 4:20170093. [PMID: 31489210 PMCID: PMC6711281 DOI: 10.1259/bjrcr.20170093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/27/2017] [Accepted: 02/04/2018] [Indexed: 11/23/2022] Open
Abstract
A 65-year-old female presented with symptoms of tonsillitis and sepsis. Despite
initial treatment with i.v. fluid and antibiotics, her condition deteriorated
and she became hypoxaemic. CT pulmonary angiography showed no filling defects in
the pulmonary arteries, but there were multiple cavitating lung nodules,
initially thought to represent metastases. A subsequent contrast-enhanced CT of
the neck and thorax demonstrated thrombosis of the left external jugular vein
(EJV), leading to a revised diagnosis of Lemierre’s syndrome
(i.e. septic embolization from jugular thrombophlebitis).
Noteworthy aspects of the case include the initial misdiagnosis of the
cavitating lung nodules by the reporting radiologist and the isolated
involvement of the EJV—Lemierre’s syndrome usually involves the
internal jugular vein. The case highlights the importance of septic emboli in
the differential diagnosis of cavitating lung nodules, and of assessment of the
EJV as well as internal jugular vein in the context of oropharyngeal
infection.
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Affiliation(s)
- John Reicher
- North Cumbria University Hospitals NHS Trust, Carlisle, UK
| | - Sam Brooke
- North Cumbria University Hospitals NHS Trust, Carlisle, UK
| | - Dominic Arnold
- North Cumbria University Hospitals NHS Trust, Carlisle, UK
| | - Paul Counter
- North Cumbria University Hospitals NHS Trust, Carlisle, UK
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34
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Carter BW, Muse VV, Mansouri M. Imaging of Nontraumatic Mediastinal and Pulmonary Processes. Emerg Radiol 2018. [DOI: 10.1007/978-3-319-65397-6_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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35
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Kwok KY, Lo SSM, Chu KM, Tsang TK. X-Ray Quiz: An Elderly Woman with Shortness of Breath. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ong SCL, Balasingam V. Characteristic imaging findings in pulmonary fat embolism syndrome (FES). BMJ Case Rep 2017; 2017:bcr-2017-223007. [PMID: 29170189 DOI: 10.1136/bcr-2017-223007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sidney Ching Liang Ong
- Radiology Department, Clinical Campus, International Medical University, Seremban, Negeri Sembilan, Malaysia
| | - Viknesh Balasingam
- Department of Diagnostic Imaging, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
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Merad M, Alibay A, Ammari S, Antoun S, Bouguerba A, Ayed S, Vincent F. [Pulmonary tumor thrombotic microangiopathy]. Rev Mal Respir 2017; 34:1045-1057. [PMID: 29153757 DOI: 10.1016/j.rmr.2017.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 02/08/2017] [Indexed: 12/25/2022]
Abstract
Pulmonary tumor thrombotic microangiopathy syndrome is a rare clinicopathological entity in which tumor cell micro-emboli in the pulmonary microcirculation induced thrombotic microangiopathy. This can cause respiratory failure, and acute or sub-acute right heart failure. Histological features include micro tumor emboli in the small arteries and arterioles of the lung associated with thrombus formation and fibro-cellular and fibro-muscular intimal proliferation. The diagnosis is however extremely difficult to make before death. Thus, most of the observations reported are based on autopsy data. Very rare diagnostic observations made before death suggest the potential effectiveness of chemotherapy. Many details remain to be elucidated, interdisciplinary research is a priority with close collaboration between pathologists and clinicians to better understand this, often fatal, syndrome. It may be that the use of targeted therapies will improve the very poor prognosis allowing survival of several weeks or months after diagnosis.
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Affiliation(s)
- M Merad
- Service d'urgence en oncologie médicale, Gustave-Roussy Cancer Campus Grand Paris, Villejuif, 94805 Villejuif cedex, France
| | - A Alibay
- Service d'urgence en oncologie médicale, Gustave-Roussy Cancer Campus Grand Paris, Villejuif, 94805 Villejuif cedex, France
| | - S Ammari
- Service de radiologie, Gustave-Roussy Cancer Campus Grand Paris, Villejuif, 94805 Villejuif cedex, France
| | - S Antoun
- Service d'urgence en oncologie médicale, Gustave-Roussy Cancer Campus Grand Paris, Villejuif, 94805 Villejuif cedex, France
| | - A Bouguerba
- Réanimation polyvalente, GHIC Le-Raincy Montfermeil, 93370 Montfermeil, France
| | - S Ayed
- Réanimation polyvalente, GHIC Le-Raincy Montfermeil, 93370 Montfermeil, France
| | - F Vincent
- Réanimation polyvalente, GHIC Le-Raincy Montfermeil, 93370 Montfermeil, France.
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Plowman RS, Javidan-Nejad C, Raptis CA, Katz DS, Mellnick VM, Bhalla S, Cornejo P, Menias CO. Imaging of Pregnancy-related Vascular Complications. Radiographics 2017; 37:1270-1289. [DOI: 10.1148/rg.2017160128] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- R. Scooter Plowman
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Cylen Javidan-Nejad
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Constantine A. Raptis
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Douglas S. Katz
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Vincent M. Mellnick
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Patricia Cornejo
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Christine O. Menias
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
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Şahpaz A, İrez A, Gülbeyaz H, Şener MT, Kök AN. Non-thrombotic Pulmonary Embolism Due to Liver Hydatic Cyst: A Case Report. Balkan Med J 2017; 34:275-277. [PMID: 28443563 PMCID: PMC5450869 DOI: 10.4274/balkanmedj.2016.0391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: A non-thrombotic pulmonary embolism is defined as embolization to the pulmonary circulation. It may be caused by microorganisms, foreign bodies, different cell types or gas in the pulmonary circulation. Pulmonary hydatid cyst-induced embolization is a rare complication of heart or liver hydatid cysts. Case Report: We describe the fatal case of a 15-year-old boy without any known prior illness who was admitted to the hospital after feeling unwell and dropping to the ground while playing ball. During the autopsy, a lesional mass, with dimensions of 13x6 cm, was observed in the left lobe of the liver. The histomorphological examination of pulmonary sections showed scolices observed in pulmonary vessel lumina, thus a non-thrombosis hydatid embolism was diagnosed. Based on the findings, the cause of death was recorded as a non-thrombotic hydatid embolism. Conclusion: The present case is interesting because a non-thrombotic pulmonary embolism rarely results in sudden death, and a definitive diagnosis was possible only by a histopathological examination.
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Affiliation(s)
- Ahmet Şahpaz
- Department of Histopathology, Erzurum Branch of Council of Forensic Medicine, Erzurum, Turkey
| | - Azem İrez
- Department of Autopsy, Erzurum Branch of Council of Forensic Medicine, Erzurum, Turkey
| | - Hatice Gülbeyaz
- Department of Autopsy, Erzurum Branch of Council of Forensic Medicine, Erzurum, Turkey
| | - Mustafa Talip Şener
- Department of Forensic Medicine, Atatürk University School of Medicine, Erzurum, Turkey
| | - Ahmet Nezih Kök
- Department of Forensic Medicine, Atatürk University School of Medicine, Erzurum, Turkey
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Winningham PJ, Martínez-Jiménez S, Rosado-de-Christenson ML, Betancourt SL, Restrepo CS, Eraso A. Bronchiolitis: A Practical Approach for the General Radiologist. Radiographics 2017; 37:777-794. [DOI: 10.1148/rg.2017160131] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Peter J. Winningham
- From the Division of Thoracic Imaging, Department of Radiology, University of Missouri-Kansas City, St Luke’s Hospital, 4401 Wornall Rd, Kansas City, MO 64111 (P.J.W., S.M.J., M.L.R.d.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (S.L.B.); Department of Cardiothoracic Radiology, University of Texas Health Science Center at
| | - Santiago Martínez-Jiménez
- From the Division of Thoracic Imaging, Department of Radiology, University of Missouri-Kansas City, St Luke’s Hospital, 4401 Wornall Rd, Kansas City, MO 64111 (P.J.W., S.M.J., M.L.R.d.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (S.L.B.); Department of Cardiothoracic Radiology, University of Texas Health Science Center at
| | - Melissa L. Rosado-de-Christenson
- From the Division of Thoracic Imaging, Department of Radiology, University of Missouri-Kansas City, St Luke’s Hospital, 4401 Wornall Rd, Kansas City, MO 64111 (P.J.W., S.M.J., M.L.R.d.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (S.L.B.); Department of Cardiothoracic Radiology, University of Texas Health Science Center at
| | - Sonia L. Betancourt
- From the Division of Thoracic Imaging, Department of Radiology, University of Missouri-Kansas City, St Luke’s Hospital, 4401 Wornall Rd, Kansas City, MO 64111 (P.J.W., S.M.J., M.L.R.d.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (S.L.B.); Department of Cardiothoracic Radiology, University of Texas Health Science Center at
| | - Carlos S. Restrepo
- From the Division of Thoracic Imaging, Department of Radiology, University of Missouri-Kansas City, St Luke’s Hospital, 4401 Wornall Rd, Kansas City, MO 64111 (P.J.W., S.M.J., M.L.R.d.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (S.L.B.); Department of Cardiothoracic Radiology, University of Texas Health Science Center at
| | - Andrés Eraso
- From the Division of Thoracic Imaging, Department of Radiology, University of Missouri-Kansas City, St Luke’s Hospital, 4401 Wornall Rd, Kansas City, MO 64111 (P.J.W., S.M.J., M.L.R.d.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (S.L.B.); Department of Cardiothoracic Radiology, University of Texas Health Science Center at
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Nonthrombotic Pulmonary Artery Embolism: Imaging Findings and Review of the Literature. AJR Am J Roentgenol 2017; 208:505-516. [DOI: 10.2214/ajr.16.17326] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
Many different diseases present as cavitary pulmonary nodules. The spectrum of diseases ranges from acute to chronic infections, chronic systemic diseases, and malignancies. To decide on the most likely or correct diagnosis may be challenging. Knowledge of common and uncommon radiological findings in correlation with relevant clinical history and findings is necessary to make the right diagnosis and recommend the correct follow-up or step forward. The aim of this pictorial review is to present a brief overview of CT findings of common cavitary lung diseases seen in adult patients.
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Lin CT, Raman SP, Fishman EK. An algorithmic approach to CT of pulmonary arterial disorders. Clin Imaging 2016; 40:1226-1236. [DOI: 10.1016/j.clinimag.2016.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/05/2016] [Accepted: 08/22/2016] [Indexed: 01/10/2023]
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Taslakian B, Latson LA, Truong MT, Aaltonen E, Shiau MC, Girvin F, Alpert JB, Wickstrom M, Ko JP. CT pulmonary angiography of adult pulmonary vascular diseases: Technical considerations and interpretive pitfalls. Eur J Radiol 2016; 85:2049-2063. [PMID: 27776659 DOI: 10.1016/j.ejrad.2016.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/30/2016] [Accepted: 09/15/2016] [Indexed: 12/28/2022]
Abstract
Computed tomography pulmonary angiography (CTPA) has become the primary imaging modality for evaluating the pulmonary arteries. Although pulmonary embolism is the primary indication for CTPA, various pulmonary vascular abnormalities can be detected in adults. Knowledge of these disease entities and understanding technical pitfalls that can occur when performing CTPA are essential to enable accurate diagnosis and allow timely management. This review will cover a spectrum of acquired abnormalities including pulmonary embolism due to thrombus and foreign bodies, primary and metastatic tumor involving the pulmonary arteries, pulmonary hypertension, as well as pulmonary artery aneurysms and stenoses. Additionally, methods to overcome technical pitfalls and interventional treatment options will be addressed.
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Affiliation(s)
| | - Larry A Latson
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | - Mylene T Truong
- Department of Radiology, University of Texas, MD Anderson Cancer Center, TX, USA.
| | - Eric Aaltonen
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | - Maria C Shiau
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | - Francis Girvin
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | | | - Maj Wickstrom
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | - Jane P Ko
- Department of Radiology, NYU Langone Medical Center, NY, USA.
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Ansari-Gilani K, Gilkeson RC, Hsiao EM, Rajiah P. Unusual Pulmonary Arterial Filling Defect caused by Systemic to Pulmonary Shunt in the Setting of Chronic Lung Disease Demonstrated by Dynamic 4D CTA. J Radiol Case Rep 2016; 9:17-23. [PMID: 27252791 DOI: 10.3941/jrcr.v9i11.2480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Even though pulmonary embolism is by far the most common cause of filling defect in the pulmonary arterial system, other less common etiologies should be considered especially in the setting of atypical clinical scenario or unusual imaging findings. Unusual pattern of filling defect in the pulmonary artery in the setting of chronic inflammatory/fibrotic parenchymal lung disease should raise the concern for systemic to pulmonary artery shunt. This diagnosis is typically made by conventional angiography. Dynamic 4D CT angiography however can be a safe, noninvasive and effective alternative tool for making such a diagnosis. It has the added value of multiplanar reconstruction capabilities and providing detailed anatomy which can be vital for interventional radiologists when planning their approach for possible intervention. We present 2 cases of such shunts, and illustrate the demonstration of these shunts by using dynamic 4D CT angiography.
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Affiliation(s)
- Kianoush Ansari-Gilani
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
| | - Robert C Gilkeson
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
| | - Edward M Hsiao
- Department of Radiology, Macquarie University Hospital, Macquarie University, Australia
| | - Prabhakar Rajiah
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
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Malviya A, Kalita JP, Jha PK, Mishra A. Fatal complication of ductal arteritis in a malnourished child. Indian Heart J 2016; 68 Suppl 2:S241-S242. [PMID: 27751302 PMCID: PMC5067727 DOI: 10.1016/j.ihj.2016.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Amit Malviya
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health & Medical Science, Shillong, India.
| | - Jyoti Prasad Kalita
- Department of CTVS, North Eastern Indira Gandhi Regional Institute of Health & Medical Science, Shillong, India
| | - Pravin Kumar Jha
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health & Medical Science, Shillong, India
| | - Animesh Mishra
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health & Medical Science, Shillong, India
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Karia S, Screaton N. Pulmonary embolism. IMAGING 2016. [DOI: 10.1183/2312508x.10002615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Dalpiaz G, Piolanti M. Non-infectious Parenchymal Lung Disease. EMERGENCY RADIOLOGY OF THE CHEST AND CARDIOVASCULAR SYSTEM 2016. [PMCID: PMC7121959 DOI: 10.1007/174_2016_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute dyspnea is a common presenting complaint in the emergency room, emergency medicine and intensive care. It may have a cardiovascular or a non-cardiovascular origin, the latter including pulmonary parenchymal diseases. Depending on the cause, it may be associated with fever, cough, hemoptysis, and/or chest pain, with a duration of symptoms that can range from hours to days. Prompt identification of the underlying cause of acute dyspnea is essential in guiding appropriate therapy and management, as patients may rapidly progress to acute respiratory failure. Evaluation with chest radiography is vital for initial assessment and may reveal diffuse parenchymal abnormalities, which may require further assessment with computed tomography (HRCT). Acute non-infectious parenchymal lung diseases are often overlooked and may be under-diagnosed. Their diagnosis requires the evaluation, along with the HRCT pattern, of the clinical and laboratory features and of the bronchoalveolar lavage. Biopsy may be necessary in more complex cases. Although the most frequent cause of diffuse non-infectious parenchymal lung involvement is acute hydrostatic pulmonary edema, there is a wide variety of diseases that may be encountered, including acute drug toxicity, hypersensitivity pneumonitis (HP), acute respiratory distress syndrome (ARDS) and diffuse alveolar hemorrhage (DAH). In trauma patients, fat embolism syndrome (FES) must be taken into account. Acute respiratory failure is an eventuality that can occur during the course of chronic lung diseases (UIP for example), which may have been unknown until then.
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You JS, Chung YE, Baek SE, Chung SP, Kim MJ. Imaging Findings of Liposuction with an Emphasis on Postsurgical Complications. Korean J Radiol 2015; 16:1197-206. [PMID: 26576108 PMCID: PMC4644740 DOI: 10.3348/kjr.2015.16.6.1197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 08/02/2015] [Indexed: 12/17/2022] Open
Abstract
Liposuction is one of the most frequently performed cosmetic surgeries worldwide for reshaping the body contour. Although liposuction is minimally invasive and relatively safe, it is a surgical procedure, and it carries the risk of major and minor complications. These complications vary from postoperative nausea to life-threatening events. Common complications include infection, abdominal wall injury, bowel herniation, bleeding, haematoma, seroma, and lymphoedema. Life-threatening complications such as necrotizing fasciitis, deep vein thrombosis, and pulmonary embolism have also been reported. In this paper, we provide a brief introduction to liposuction with the related anatomy and present computed tomography and ultrasonography findings of a wide spectrum of postoperative complications associated with liposuction.
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Affiliation(s)
- Je Sung You
- Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Yong Eun Chung
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Song-Ee Baek
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Myeong-Jin Kim
- Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
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