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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: 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
Medical Image of the Week: Pulsus Alternans
Medical Image of the Week: Bronchial Clot Removal via Cryotherapy
Medical Image of the Week: Extrapleural Pneumolysis for Tuberculosis
Medical Image of the Week: Intraventricular Hemorrhage Casting
November 2016 Imaging Case of the Month
Medical Image of the Week: Lynch Syndrome
Medical Image of the Week: Tracheobronchial Foreign Body Aspiration
Medical Image of the Week: Arachnoid Cyst
Medical Image of the Week: Chilaiditi Syndrome
Medical Image of the Week: Abdominal Hematoma

 

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
Jul262017

Medical Image of the Week: Coral Reef Aorta

Figure 1. Coronal (A) and lateral (B) thoracic CT in soft tissue windows showing the coral reef calcification (arrows).

 

A 52-year-old woman with no past medical history presented to the emergency department with signs and symptoms concerning for pneumonia. Chest x-ray showed incidental findings of a calcified aortic mass. Subsequently, a follow up computed tomography scan (CT) was obtained which showed coral reef aorta (Figure 1). On physical examination, vital signs were only significant for mildly elevated blood pressure to 146/62 mmHg. She also had normal and equal pulses and pressures throughout all 4 extremities. In retrospect, patient had complaints of bilateral lower extremity claudication on strenuous exercise.

Coral reef aorta, a rare condition that was first described in 1984 by Qvarfordt et al. (1) is characterized by an eccentric, heavily calcified polypoid lesion and stenosis of the juxtarenal and suprarenal aorta. The rock-hard, irregular, gritty, whitish surface of the calcification strongly resembled a coral reef. The most common presentation is severe hypertension and intermittent claudication. Magnetic resonance angiogram (MRA) and CT have the ability to diagnose and appreciate the extent of this phenomenon (2).

Lance Eberson MS1 and Sehem Ghazala MD2

1College of Medicine and 2Department of Internal Medicine

University of Arizona

Tucson, Arizona, USA

References

  1. Qvarfordt PG, Reilly LM, Sedwitz MM, Ehrenfeld WK, Stoney RJ. "Coral reef" atherosclerosis of the suprarenal aorta: a unique clinical entity. J Vasc Surg. 1984 Nov;1(6):903-9. [CrossRef] [PubMed]
  2. Kopani K, Liao S, Shaffer K. The Coral Reef Aorta: Diagnosis and Treatment Following CT. Radiol Case Rep. 2016 Oct 4;4(1):209. eCollection 2009. [CrossRef] [PubMed] 

Cite as: Eberson L, Ghazala S. Medical image of the week: coral reef aorta. Southwest J Pulm Crit Care. 2017:15(1):49. doi: https://doi.org/10.13175/swjpcc080-17 PDF

Wednesday
Jul192017

Medical Image of the Week: Hematopneumatoceles from Pulmonary Lacerations

Figure 1. Chest x-ray showing irregular patchy regions of ill-defined consolidation in the left upper lobe and lingula, as well as suggestion of cystic changes (arrow).

 

Figure 2. Chest CT axial views, soft tissue and lung windows at the level of the aortic arch (A), right pulmonary artery (B) and the heart (C) showing mixed consolidative and nodular left lung opacities suggestive of pulmonary contusions, as well as contrecoup injury in the right lung, in addition to multiple cystic spaces containing air-fluid levels consistent with pulmonary lacerations.

 

Figure 3. Chest CT coronal views, soft tissue and lung windows showing consolidative and nodular lung opacities as well as fluid layering in cystic spaces (red arrows). A shattered spleen (yellow arrow) is also seen.

 

A 17-year-old man was brought to the emergency room after a fall from a 50-foot bridge. He was hypoxemic on presentation, requiring endotracheal intubation. Chest computed tomography (CT) revealed bilateral airspace opacities consistent with pulmonary contusions, and multiple air-fluid levels diagnostic of pulmonary lacerations (Figures 1-3).

Pulmonary lacerations are rare complications of blunt chest trauma (1). They can be contained within the lung parenchyma or may extend through the visceral pleura causing a pneumothorax. Due to its elastic recoil, the surrounding lung tissue pulls back from the laceration resulting in a round or oval cavity that may fill with air (pneumatocele), blood (hematocele) or both (hematopneumatocele). Lacerations are often obscured on chest x-ray as they are usually surrounded by contusion, requiring a CT for detection (2). They are classified into four types according to the mechanism of injury: Type 1 (compression rupture injury, most common type, usually centrally located), Type 2 (shearing against the thoracic spine, involving the paraspinal region of the lower lobes), Type 3 (rib penetration into the lung periphery, usually associated with a pneumothorax) and Type 4 (adhesion tear, in regions of pleuropulmonary adhesions) (3). Pulmonary lacerations heal more slowly than contusions and may last up to several months, over time becoming increasingly filled with blood, before regressing (2).

Our patient underwent an exploratory laparotomy with a splenectomy. The pulmonary lacerations were managed conservatively. He was successfully extubated on day#10 and discharged home on day#14 with a plan to follow his lacerations with monthly chest radiography.

Udit Chaddha MD1, Darren Maehara MD1, Ioan Puscas DO1, Ashley Prosper MD2, and Ramyar Mahdavi MD1

1Division of Pulmonary, Critical Care and Sleep Medicine and 2Department of Radiology

Keck School of Medicine of the University of Southern California

Los Angeles, CA USA

References

  1. Nishiumi N, Maitani F, Tsurumi T, Kaga K, Iwasaki M, Inoue H. Blunt chest trauma with deep pulmonary laceration. Ann Thorac Surg. 2001;71(1):314-8. [CrossRef] [PubMed]
  2. Kaewlai R, Avery LL, Asrani AV, Novelline RA. Multidetector CT of blunt thoracic trauma. Radiographics. 2008;28(6):1555-70. [CrossRef] [PubMed]
  3. Wagner RB, Crawford WO, Schimpf PP. Classification of parenchymal injuries of the lung. Radiology. 1988;167(1):77-82. [CrossRef] [PubMed]

Cite as: Chaddha U, Maehara D, Puscas I, Prosper A, Mahdavi R. Medical image of the week: hematopneumatoceles from pulmonary lacerations. Southwest J Pulm Crit Care. 2017;15(1):46-8. doi: https://doi.org/10.13175/swjpcc078-17 PDF