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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: 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
Medical Image of the Week: Splenic Infarction
August 2016 Imaging Case of the Month
Medical Image of the Week: Lung Entrapment
Medical Image of the week: Endobronchial Valves
Medical Image of the Week: Bronchial Artery Embolization
Medical Image of the Week: Massive Abdominal Aortic Aneurysm
July 2016 Imaging Case of the Month
Medical Image of the Week: Bronchiectasis
Medical Image Of The Week: Tricuspid Valve Vegetation with Septic
   Pulmonary Emboli
Medical Image of the Week: Boerhaave Syndrome
Medical Image of the Week: Left Ventricular Non-compaction
June 2016 Imaging Case of the Month
Medical Image of the Week: Bochdalek Hernia
Medical Image of the Week: Right Middle Lobe Syndrome
Medical Image of the Week: Complex Arteriovenous Malformation
Medical Image of the Week: Achalasia with Lung Abscess
Medical Image of the Week: Saddle Pulmonary Embolism

 

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
Feb222017

Medical Image of the Week: Endovascular Intervention for Life-threatening Hemoptysis

Video 1. Pre-embolization video showing collateral vessels.

 

Video 2. Post embolization video showing the endovascular implants and cessation of collateral flow.

 

Idiopathic pulmonary arterial hypertension (PAH) is an uncommon life threatening disease characterized by a progressive increase in pulmonary vascular resistance with subsequent right ventricular failure and death. Hemoptysis is known to be one of the complications in PAH patients although the exact incidence and mechanism of hemoptysis remains unclear (1,2).

Ours is a case of a 40-year-old woman with known severe idiopathic pulmonary hypertension who was admitted for recurrent episodes of hemoptysis for the past one month. On her first presentation with non-massive hemoptysis, she underwent elective embolization with Amplatzer® vascular plug (St. Jude Medical, St. Paul, MN USA) of the aorto-pulmonary collaterals. These included a large collateral off the right subclavian artery, right internal mammary artery and a large collateral off the descending aorta to the right lung (Video 1). Her hemoptysis resolved. She was admitted seven days’ post first embolization with massive hemoptysis, and immediately underwent repeat embolization with Onyx® (Medtronic, Minneapolis, MN USA), a non-adhesive liquid embolic agent. Embolization was performed on the right intercostal arteries, left bronchial artery, with some abnormal vessels noticed (Video 2).  No active bleeding was visualized during the procedure. Hemoptysis resolved once again.

The management of hemoptysis in patients with PAH remains indeterminate. However, embolization of bronchial arteries has been recommended as an effective method of managing PAH patients with recurrent hemoptysis to control the acute hemorrhage (2,3).

See-Wei Low MBBS1 Huthayfa Ateeli, MBBS2

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

Banner University Medical Center

Tucson, AZ, USA

References

  1. Broberg C, Ujita M, Babu-Narayan S, Rubens M, Prasad SK, Gibbs JS, Gatzoulis MA. Massive pulmonary artery thrombosis with hemoptysis in adults with Eisenmenger's syndrome: a clinical dilemma. Heart. 2004;90:e63. [CrossRef] [PubMed]
  2. Swanson KL, Johnson CM, Prakash UB, McKusick MA, Andrews JC, Stanson AW. Bronchial artery embolization: experience with 54 patients. Chest. 2002;121:789-95. [CrossRef] [PubMed]
  3. Reesink HJ, van Delden OM, Kloek JJ, Jansen HM, Reekers JA, Bresser P. Embolization for hemoptysis in chronic thromboembolic pulmonary hypertension: report of two cases and a review of the literature. Cardiovasc Intervent Radiol. 2007;30:136-9. [CrossRef] [PubMed] 

Cite as: Low S-W, Ateeli H. Medical image of the week: endovascular intervention for life-threatening hemoptysis. Southwest J Pulm Crit Care. 2017;14(2):86-7. doi: https://doi.org/10.13175/swjpcc017-17 PDF

Wednesday
Feb152017

Medical Image of the Week: Fibrosing Mediastinitis

Figure 1. Panel A: Thoracic CT showing airway occlusion (arrowhead) from fibrosing mediastinitis. Panel B: pulmonary artery obstruction (arrow) from fibrosing mediastinitis.

Histoplasmosis is endemic to the Midwest US and commonly causes an acute infection that presents as a subacute pneumonia. Chronic sequelae of histoplasmosis range from asymptomatic nodules to debilitating fibrosing mediastinitis (1). Mediastinal fibrosis represents exuberant scarring in response to histoplasmosis infection. Fibrosis may occlude airways (Figure 1A, arrow head) obstruct pulmonary arteries (figure 1B, arrow) or veins and impinge upon the esophagus and other vital structures residing in the mediastinum. Chest imaging shows subcarinal or mediastinal widening. CT scans may reveal fibrotic encasing of mediastinal structures and calcification of regional lymph nodes. Recurrent and often serious hemoptysis results from lung or airway damage and vascular compromise. Respiratory failure can occur. Treatment rarely includes stenting of airways or surgery (2). Vascular stenting may be indicated in some cases. Regardless, these difficult cases must be referred to centers with experience in histoplasmosis related complications.

1Kenneth S. Knox, MD and 2Veronica A. Arteaga, MD

1University of Arizona College of Medicine- Phoenix

2University of Arizona College of Medicine- Tucson

References

  1. Peikert T, Colby TV, Midthun DE, Pairolero PC, Edell ES, Schroeder DR, Specks U.Fibrosing mediastinitis: clinical presentation, therapeutic outcomes, and adaptive immune response. Medicine (Baltimore). 2011 Nov;90(6):412-23. [CrossRef] [PubMed]
  2. Hammoud ZT, Rose AS, Hage CA, Knox KS, Rieger K, Kesler KA. Surgical management of pulmonary and mediastinal sequelae of histoplasmosis: a challenging spectrum. Ann Thorac Surg. 2009 Aug;88(2):399-403. [CrossRef] [PubMed] 

Cite as: Knox KS, Arteaga VA. Medical image of the week: fibrosing mediastinitis. Southwest J Pulm Crit Care. 2017;14(2):85. doi: https://doi.org/10.13175/swjpcc015-17 PDF