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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 Week: Pembrolizumab-induced Pneumonitis
Medical Image of the Week: Asbestos Related Pleural Disease
Medical Image of the Week: Fast-growing Primary Malignant Mediastinal 
   Mixed Germ Cell Tumor
September 2017 Imaging Case of the Month
Medical Image of the Week: The Atoll Sign in Cryptogenic Organizing 
   Pneumonia
Medical Image of the Week: Cannon V Waves
Medical Image of the Week: Bilateral Vocal Cord Paralysis
Medical Image of the Week: Tortuosity of Thoracic Aorta Mimicking a Lung
   Mass
August 2017 Imaging Case of the Month
Medical Image of the Week: Portal Vein Thrombosis in a Patient with
   Polycythemia Vera
Medical Image of the Week: Coral Reef Aorta
Medical Image of the Week: Hematopneumatoceles from Pulmonary 
   Lacerations
Medical Image of the Week: Idiopathic Subglottic Stenosis
July 2017 Imaging Case of the Month
Medical Image of the Week: Zenker’s Diverticulum
Medical Image of the Week: Superior Sulcus Tumor with Neural Invasion
Medical Image of The Week: Urothelial Carcinoma with Pulmonary
   Metastases Presenting with Shoulder Pain
Medical Image of the Week: Spontaneous Pneumothorax in End Stage
   Fibrotic Lung Disease
Medical Image of the Week: Saber Sheath Trachea
June 2017 Imaging Case of the Month
Medical Image of the Week: Coronary Artery Ectasia
Medical Image of the Week: Lymphangitic Carcinomatosis
Medical Image of the Week: Type A Aortic Dissection Extending Into Main 
   Coronary Artery 
The “Hidden Attraction” of Cardiac Magnetic Resonance Imaging for 
   Diagnosing Pulmonary Embolism
Medical Image of the Week: Pulmonary Vein Thrombosis
May 2017 Imaging Case of the Month
Medical Image of the Week: A Positive Sniff Test
Medical Image of the Week: Staphylococcal Pneumonia in a Patient with
   Influenza
Medical Image of the Week: Bronchopulmonary Sequestration
Medical Image of the Week: Wolff-Parkinson-White Syndrome
Medical Image of the Week: DISH with OPLL and C3 Fracture
April 2017 Imaging Case of the Month
Medical Image of the Week: Artery of Percheron Infarction
Medical Image of the Week: Papillomatosis
Medical Image of the Week: VA Shunt Remnant Fibrosing into Right Atrium
March 2017 Imaging Case of the Month
Medical Image of the Week: Evolution of Low Grade Adenocarcinoma
Medical Image of the week: Chronic Pulmonary Histoplasmosis
Medical Image of the Week: Endovascular Intervention for Life-
   threatening Hemoptysis 
Medical Image of the Week: Fibrosing Mediastinitis
February 2017 Imaging Case of the Month
Medical Image of the Week: Disseminated Coccidioidomycosis
Medical Image of the Week: Pulmonary Metastases of Rectal Cancer
Medical Image of the Week: ICU Chest X-Ray
Medical Image of the Week: Infected Emphysematous Bulla
Medical Image of the Week: The Luftsichel Sign
January 2017 Imaging Case of the Month
Medical Image of the Week: NG Tube Misplacement with a Pneumothorax 
Medical Image of the Week: Subcutaneous Calcification in Dermatomyositis
Medical Image of the Week: Spirochetemia
Medial Image of the Week: Purpura Fulminans
Medical Image of the Week: Osmotic Demyelination
December 2016 Imaging Case of the Month

 

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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Wednesday
Sep202017

Medical Image of the Week: Pembrolizumab-induced Pneumonitis

Figure 1. Thoracic CT showing multifocal, bilateral extensive lung opacities consistent with consolidation with a striking peribronchovascular distribution. Note the opacities are primarily distributed along the airways. Peripheral lung opacity, both ground-glass opacity and consolidation, is also present.

 

Figure 2. Axial thoracic CT performed several months after Figure 1 following discontinuation of the pembrolizumab and initiation, and subsequent tapering, of corticosteroid therapy, shows significant regression in the previously noted extensive peribronchovascular consolidation. Residual areas of consolidation and ground-glass opacity associated with architectural distortion are consistent with scarring.

 

A 76-year-old man with metastatic melanoma, undergoing treatment with pembrolizumab, an antibody against programmed cell death 1 (PD-1), beginning 8 months ago developed low-grade fever, non-productive cough, and shortness of breath. A thoracic CT scan showed multifocal, bilateral extensive lung opacities (Figure 1). The patient underwent bronchoscopy with bronchoalveolar lavage which showed non-specific inflammatory changes associated with foci of organizing pneumonia. Microbiologic studies, including Coccioides antibody enzyme immunoassay and Aspergillus antigen, were negative.

The patient was begun on corticosteroid therapy for presumed medication-induced pulmonary injury, manifestation as an organizing pneumonia pattern, due to pembrolizumab. Over the ensuing months, his symptoms abated and his CT scan abnormalities regressed (Figure 2).

Organizing pneumonia may occur as an idiopathic, primary pulmonary process, often referred to as “cryptogenic organizing pneumonia,” or may occur in the context of a number of systemic conditions, a situation often referred to as secondary organizing pneumonia. Among the various etiologies of secondary organizing pneumonia, medication-induced pulmonary injury is fairly common and when imaging features of organizing pneumonia are seen, careful correlation regarding the possibility of a medication-induced etiology should be undertaken. Recently, three cases of pembrolizumab-induced pneumonitis were described, two being consistent with organizing pneumonia (1).

The thoracic CT findings of organizing pneumonia include peripheral and peribronchovascular consolidation and ground-glass opacity, areas of consolidation surrounding ground-glass opacity (often referred to as the “atoll” or reverse ground-glass halo” sign- see Medical Image of the Week: The Atoll Sign in Cryptogenic Organizing Pneumonia), single and multiple nodules, and perilobular consolidation. The case illustrates a dramatically peribronchovascular distribution of pulmonary consolidation as a manifestation of medication-induced organizing pneumonia.

Michael B. Gotway, MD

Department of Radiology

Mayo Clinic Arizona

Scottsdale, AZ USA

Reference

  1. Leroy V, Templier C, Faivre JB, Scherpereel A, Fournier C, Mortier L, Wemeau-Stervinou L. Pembrolizumab-induced pneumonitis. ERJ Open Res. 2017 May 2;3(2). pii: 00081-2016. [CrossRef] [PubMed]

Cite as: Gotway MB. Medical image of the week: pembrolizumab-induced pneumonitis. Southwest J Pulm Crit Care. 2017;15(3):118-9. doi: https://doi.org/10.13175/swjpcc110-17 PDF 

Wednesday
Sep132017

Medical Image of the Week: Asbestos Related Pleural Disease

Figure 1. Chest radiograph demonstrates bilateral coarse calcification, most elongated and vertically oriented in nature (white arrows). Also note coarse calcification outlining the hemidiaphragms (dark arrows). Editor's note: the patient's only chest x-ray was two different AP views which are merged above.

 

Figure 2.  Holly leaf. Its shape is similar to the irregular thickened nodular edges of pleural plaques on chest radiograph, referred to as “the holly leaf sign”.

 

Figure 3. Thoracic CT shown in soft tissue (A: top) and lung (B: bottom) windows clearly localizes the calcifications to the parietal pleura.

 

Pleural plaques are strongly associated with inhalational exposure to asbestos (1). The lesions may take up to thirty years to develop. Plaques are typically bilateral, involve the parietal pleura, commonly along the sixth through ninth ribs and are usually absent at the lung apices and costophrenic sulci (Figures 1 and 3). On chest radiograph, the “holly leaf sign” refers to the shape of the calcifications with thickened rolled and nodular edges (Figure 2). The plaques per se are benign in nature. However, they can potentially impair lung function, resulting in restriction.  They are also markers of the individual’s greater risk of developing a lung cancer or mesothelioma.

Wesley Hunter MS IV1, Veronica Arteaga MD2, and Diana Palacio MD2

1College of Medicine and 2Department of Medical Imaging

University of Arizona

Tucson, AZ USA

Reference

  1. Norbet C, Joseph A, Rossi SS, Bhalla S, Gutierrez FR. Asbestos-related lung disease: a pictorial review. Curr Probl Diagn Radiol. 2015 Jul-Aug;44(4):371-82. [CrossRef] [PubMed] 

Cite as: Hunter W, Arteaga V, Palacio D. Medical image of the week: asbestos related pleural disease. Southwest J Pulm Crit Care. 2017;15(3):116-7. doi: https://doi.org/10.13175/swjpcc104-17 PDF