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Imaging

Last 50 Imaging Postings

(Click on title to be directed to posting, most recent listed first, CME offerings in bold)

Medical Image of the Month: Chronic Ogilvie’s Syndrome
Medical Image of the Month: Malignant Pleural and Pericardial Effusions
November 2018 Imaging Case of the Month: Respiratory Failure in a 
   36-Year-Old Woman
Medical Image of the Month: Superior Vena Cava Syndrome
Medical Image of the Month: Hot Tub Lung
Medical Image of the Week: Chylothorax
August 2018 Imaging Case of the Month: Dyspnea in a 55-Year-Old 
   Smoker
Medical Image of the Week: Tracheobronchopathia Osteochondroplastica
Medical Image of the Week: Plastic Bronchitis in an Adult Lung Transplant
   Patient
Medical Image of the Week: Medical Administrative Growth
Medical Image of the Week: Malposition of Central Venous Catheter
Medical Image of the Week: Fournier’s Gangrene with a Twist
July 2018 Imaging Case of the Month
Medical Image of the Week: Intracavitary View of Mycetoma
Medical Image of the Week: Neuromyelitis Optica and Sarcoidosis
Medical Image of the Week: Pulmonary Amyloidosis in Primary Sjogren’s
   Syndrome
Medical Image of the Week: Post Pneumonectomy Syndrome
June 2018 Imaging Case of the Month
Medical Image of the Week: Elemental Mercury Poisoning
Medical Image of the Week: Thoracic Splenosis
Medical Image of the Week: Valley Fever Cavity with Fungus Ball
Medical Image of the Week: Recurrent Sarcoidosis Resembling Malignancy
May 2018 Imaging Case of the Month
Medical Image of the Week: Cardiac Magnetic Resonance Imaging Findings
   of Severe RV Failure
Medical Image of the Week: Mediastinal Lipomatosis
Medical Image of the Week: Dobhoff Tube Placement with Roux-En-Y
   Gastric Bypass
Medical Image of the Week: Atypical Deep Sulcus Sign
April 2018 Imaging Case of the Month
Medical Image of the Week: Headcheese Sign
Medical Image of the Week: Chronic Bilateral Fibrocavitary Pulmonary
   Coccidioidomycosis
Medical Image of the Week: Paget-Schroetter Syndrome
A Finger-Like Projection in the Carotid Artery: A Rare Source of Embolic 
   Stroke Requiring Carotid Endarterectomy
Medical Image of the Week: Post-Traumatic Diaphragmatic Rupture
Medical Image of the Week: Bronchogenic Cysts
March 2018 Imaging Case of the Month
Medical Image of the Week: Acute Pneumonitis Secondary to Boric Acid 
   Exposure
Medical Image of the Week: Traumatic Aortic Dissection
Medical Image of the Week: Blue-Green Urine and the Serotonin 
   Syndrome
Medical Image of the Week: Acute Encephalopathy in a Multiple
   Myeloma Patient
February 2018 Imaging Case of the Month
Medical Image of the Week: Stomach Rupture
Medical Image of the Week: Methemoglobinemia
Medical Image of the Week: Pulmonary Artery Dilation
Medical Image of the Week: Plastic Bronchitis
January 2018 Imaging Case of the Month
Medical Image of the Week: Pulmonary Alveolar Proteinosis
Medical Image of the Week: Fat Embolism
Medical Image of the Week: Central Venous Access with Dextrocardia
Medical Image of the Week: Mucous Plugs Forming Airway Casts
Medical Image of the Week: Barium Aspiration
December 2017 Imaging Case of the Month
Medical Image of the Week: Yellow Nail Syndrome
Medical Image of the Week: Moyamoya Disease
Medical Image of the Week: Lemierre Syndrome
Medical Image of the Week: Chemotherapy-Induced Diffuse Alveolar 
   Hemorrhage

 

For complete imaging listings click here.

Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary and Critical Care publishes case-based articles with characteristic chest imaging and related pathology. The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend. Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary and Critical Care publishes case-based articles with characteristic chest imaging and related pathology. The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend.

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Sunday
Dec022018

Medical Image of the Month: Chronic Ogilvie’s Syndrome

Figure 1. Coronal view of abdominal CT scan showing a massively dilated colon.

 

Figure 2. Sagittal view of abdominal CT scan.

 

Figure 3. Axial view of abdominal CT scan.

 

A 42-year-old man with chronic encephalopathy secondary to traumatic brain injury (TBI), craniotomy, seizure disorder, chronic alcohol abuse, and chronic Ogilvie syndrome presented to the Banner University Medical Center-South Campus emergency department (ED) after being found in his driveway with altered mental status. He complained of multiple episodes of non-bloody diarrhea for the last day but otherwise altered & unhelpful. He was noted to have to be hypotensive with a blood pressure of 70-90/35-56 mm Hg, afebrile with a temperature of 36  C, an elevated white cell count of 13.3 X 109 cells/L, a hemoglobin of 4.4 g/dL, a creatinine of 2.6 mg/dL, a BUN of 30 mg/dL, and an elevated lactic acid to 5.4 mmol/L. Physical exam showed a massively dilated tympanic abdomen. Resuscitation and broad-spectrum antibiotics were initiated, a CT scan ordered (Figures 1-3) and he was admitted to the medical intensive care unit (MICU) for further work up and management.

On chart review, it was shown that he had presented to the same ED twice in the past with episodes of chronic constipation. Gastroenterology and general surgery consults concluded that he had developed a chronic pseudo-obstruction pattern due to likely decreased gastrointestinal motility presumed secondary to TBI and immobility. He was evaluated and deemed to not qualify for neostigmine treatment due to finding of stool acting as a mechanical obstruction. During this MICU visit, he was treated for septic shock but unfortunately did not survive the hospital stay.

Learning Points/Take Home Message:

  1. Ogilvie syndrome is an acquired dilation of the colon in the absence of any mechanical obstruction in severely ill patients characterized by abnormalities affecting the involuntary, rhythmic muscular contractions within the colon. The symptoms of Ogilvie syndrome mimic those of mechanical obstruction of the colon, but no physical obstruction is present.
  2. Studies have shown that intravenous administration of neostigmine has led to rapid decompression of the colon in individuals with Ogilvie syndrome who did not respond to conservative management. 
  3. Colonoscopic decompression, in which a thin, flexible tube is inserted into the anal passage and threaded up to the colon, may be used in refractory cases. Although colonoscopic decompression has not undergone clinical study, numerous reports in the medical literature cite it as an effective method for removing air from the colon and, potentially, reducing the risk of perforation. 
  4. Surgery is used when affected individuals have signs of perforation or ischemia or have failed to respond to other treatment options. Surgery can be associated with significant morbidity and mortality.

Michael Bernaba MD, Emilio Power MD, Sidra Raoof MD, Babitha Bijin MD, Yuet-Ming Chan MD

Department of Internal Medicine

University of Arizona College of Medicine at South Campus

Tucson, AZ USA

References

  1. McNamara R, Mihalakis MJ. Acute colonic pseudo-obstruction: rapid correction with neostigmine in the emergency department. J Emerg Med. 2008;35:167-70. [CrossRef] [PubMed]
  2. Saunders MD, Kimmey MB. Systemic review: acute colonic pseudo-obstruction. Aliment Pharmacol Ther. 2005;22:917-25. [CrossRef] [PubMed]
  3. Maloney N, Vargas HD. Acute intestinal pseudo-obstruction (Ogilvie's syndrome). Clin Colon Rectal Surg. 2005;18:96-101. [CrossRef] [PubMed]
  4. De Giorgio R, Knowles CH. Acute colonic pseudo-obstruction. Br J Surg. 2009;96:229-39. [CrossRef] [PubMed]

Cite as: Bernaba M, Power E, Raoof S, Bijin B, Chan Y-M. Medical image of the month: chronic Ogilivie's syndrome. Southwest J Pulm Crit Care. 2018;17(6):146-8. doi: https://doi.org/10.13175/swjpcc117-18 PDF

Friday
Nov022018

Medical Image of the Month: Malignant Pleural and Pericardial Effusions

Figure 1. CTA chest axial view showing moderate pericardial effusion, bilateral pleural effusions and an anterior mediastinal mass.

 

Figure 2. Echocardiography subcostal four-chambered view showing a large pericardial effusion with right ventricular collapse during diastole.

 

A 67-year-old woman with a history of presumed thymoma presented to the emergency department with four weeks of progressive shortness of breath and wheezing. CT imaging of the chest on arrival demonstrated a 13.1 x 8.6 x 8.2 cm anterior mediastinal mass with compression of the SVC, pulmonary veins, and right pulmonary artery (Figure 1). A moderate pericardial effusion was also seen. A transthoracic echocardiogram was performed to further evaluate the pericardial effusion, which revealed diastolic collapse of the right ventricle consistent with cardiac tamponade (Figure 2). The patient was taken for urgent pericardiocentesis, which drained 450cc of sanguineous fluid. Percutaneous biopsy of the mass revealed poorly differentiated carcinoma suspicious for a primary breast malignancy. Cytology of the pericardial fluid did not demonstrate malignancy, however. Cytology of subsequent pleural effusion also was not positive for malignancy, although, both effusions are believed to be related to the malignancy even if no malignant cells were present on analysis.

Malignant pericardial effusions account for 18-23% of cases, and are one of the most common causes of hemorrhagic effusions. Multiple types of cancers can involve the pericardium; lung cancer is the most common but lymphoma, leukemia, melanoma, and breast cancer are other potentially causative malignancies. Presence of a symptomatic malignant effusion is a poor prognostic indicator with median survival on the order of 2-4 months after diagnosis, although certain malignancies (e.g. hematologic rather than solid) may have better results (1).

Nathan Coffman MD and Jessica Vondrak MD

Department of Internal Medicine

Banner University Medical Center

University of Arizona

Tucson, AZ USA

Reference

  1. Dequanter D, Lothaire P, Berghmans T, Sculier JP. Severe pericardial effusion in patients with concurrent malignancy: a retrospective analysis of prognostic factors influencing survival. Ann Surg Oncol. 2008 Nov;15(11):3268-71. [CrossRef] [PubMed] 

Cite as: Coffman N, Vondrak J. Medical image of the month: Malignant pleural and pericardial effusions. Southwest J Pulm Crit Care. 2018;17(5): . doi: https://doi.org/10.13175/swjpcc107-18 PDF