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: 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
October 2016 Imaging Case of the Month
Medical Image of the Week: Bronchopleural Fistula
Medical Image of the Week: Renal Cell Carcinoma Metastasis
Medical Image of the Week: Tracheobronchopathia Osteochondroplastica
Medical Image of the Week: Pneumothorax with Air Bronchograms
September 2016 Imaging Case of the Month
Medical Image of the Week: Superior Vena Cava Syndrome
Medical Image of the Week: MAC Infection
Medical Image of the Week: Subarachnoid Hemorrhage
Medical Image of the Week: Catheter-Induced Right Atrial Thrombus

 

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
May242017

Medical Image of the Week: Lymphangitic Carcinomatosis

Figure 1. Mass like consolidation and interlobular septal thickening (arrows). 

A 64-year-old woman, never-smoker, was evaluated for shortness of breath and left leg swelling. An abnormal initial chest X-Ray lead to computed tomography (CT) scan of the chest. She was also diagnosed with deep vein thrombosis (DVT) of her left leg.

CT of the chest with intravenous contrast showed a mass-like consolidation in the right upper lobe and thickening of the peripheral interlobular septa and of the bronchovascular bundles consistent with lymphangitic carcinomatosis (Figure 1). Endobronchial ultrasound (EBUS) guided transbronchial needle aspirations of the station 10 R Lymph node were positive for adenocarcinoma of lung origin.

Lymphangitic carcinomatosis occurs when cancer cells spread along the pulmonary lymphatic system and result in thickening of the bronchovascular bundle, the interlobular septa, or both (1). Histopathologically, specimens show interlobular and subpleural interstitial desmoplastic thickening and obstruction of lymphatic vessels by tumor cells. It carries a poor prognosis.

Mohammad R. Dalabih, MBBS1 and Joshua Malo, MD2

1Pulmonary Consultants LLC, Tacoma, WA USA

2Division of Pulmonary, Allergy, Critical Care. And Sleep, University of Arizona College of Medicine, Tucson, AZ USA

Reference

  1. Munk PL, Müller NL, Miller RR, Ostrow DN. Pulmonary lymphangitic carcinomatosis: CT and pathologic findings. Radiology. 1988 Mar;166(3):705-9. [CrossRef] [PubMed]

Cite as: Dalabih MR, Malo J. Medical image of the week: lymphangitic cacinomatosis. Southwest J Pulm Crit Care. 2017;14(5):240. doi: https://doi.org/10.13175/swjpcc053-17 PDF

Wednesday
May172017

Medical Image of the Week: Type A Aortic Dissection Extending Into Main Coronary Artery

Figure 1. Electrocardiogram at presentation showing ST segment elevation in anterior leads (arrows).

 

Figure 2. Coronary angiogram showing RAO caudal view of left main coronary artery after contrast injection with the smooth proximal linear irregularity suspicious for dissection flap into the left anterior descending artery (arrow).

 

Figure 3. Panel A: Computed tomography angiogram transverse view showing true lumen and false lumen of both ascending and descending aorta (arrow). Panel B: Computed tomography angiogram sagittal view showing dissection from root into abdominal aorta. 

 

A 58-year-old woman with no significant past medical history, presented to the emergency department with complains of sudden onset, severe , non-radiating epigastric pain associated with nausea and vomiting. An electrocardiogram (EKG) done in emergency department showed ST segment elevation in the anterior leads (Figure 1). Blood pressure at presentation was 141/79, and she had symmetrical bilateral pulses of the upper extremities, no diastolic murmur, and no neurologic deficit. The patient was taken to catherization laboratory, for ST segment elevated myocardial infarction (STEMI). She was found have aortic dissection extending to the left main coronary artery (Figure 2). Cardiothoracic surgery was called immediately. Computed tomography angiogram (CTA) of the thoracic and abdominal aorta revealed Debakey type 1 aortic dissection. (Figure 3). The patient was taken to the operating room. Unfortunately, the patient suffered pulseless electrical activity (PEA) arrest during anesthesia induction from which she could not be revived.

Aortic dissection is a critical compromise in the lining of the main arterial outflow from the heart (1).  Two theories have been proposed to explain the pathogenesis. A tear in the tunica intima, of the aorta, leads to blood from the aortic lumen surging into the tunica media (2). In contrast, the second theory holds that the vasa vasorum in the more outer portions of the tunica media hemorrhage first and then cause the rupture of the tunica intima (2). The pressure of the pulsatile blood flow extends the dissection, typically in an anterograde fashion (2). Anatomically aortic dissection is classified as Debakey 1,2, and 3 and Stanford A and B (1). Rarely aortic dissections can also extend in a retrograde fashion to reach the coronary ostia (3). Signs of myocardial ischemia including ST segment changes, adversely affect survival outcomes in patients with type A aortic dissection extending to the coronary arteries (4).

Ali Osama Malik MD1, Oliver Abela MD2, Chowdhury Ahsan MD2, and Jimmy Diep MD2

1Department of Internal Medicine

2Department of Cardiovascular Medicine

University of Nevada School of Medicine

Las Vegas, NV USA

References

  1. Golledge J, Eagle KA. Acute aortic dissection. Lancet. 2008 Jul 5;372(9632):55-66. [CrossRef] [PubMed]
  2. Patel AY, Eagle KA, Vaishnava P. Acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection. Ann Cardiothorac Surg. 2014 Jul;3(4):368-74. [CrossRef] [PubMed]
  3. Neri E, Toscano T, Papalia U, Frati G, Massetti M, Capannini G, et al. Proximal aortic dissection with coronary malperfusion: presentation, management, and outcome. J Thorac Cardiovasc Surg. 2001 Mar;121(3):552-60. [CrossRef] [PubMed]
  4. Imoto K, Uchida K, Karube N, Yasutsune T, Cho T, Kimura K, et al. Risk analysis and improvement of strategies in patients who have acute type A aortic dissection with coronary artery dissection. Eur J Cardiothorac Surg. Sep;44(3):419-24; discussion 24-5. [CrossRef] [PubMed]

Cite as: Malik AO, Abela O, Ahsan C, Diep J. Medical image of the week: type A aortic dissection extending into main coronary artery. Southwest J Pulm Crit Care. 2017;14(5):238-9. doi: https://doi.org/10.13175/swjpcc044-17 PDF