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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: Reexpansion Pulmonary Edema
Medical Image of the Month: Bilateral Atrial Enlargement
Medical Image of the Month: Thymolipoma
Medical Image of the Month: Double Aortic Arch
May 2019 Imaging Case of the Month: Asymptomatic Pulmonary
   Nodules and Cysts in a 47-Year-Old Woman
Medical Image of the Month: Ludwig’s Angina
Medical Image of the Month: Incarcerated Morgagni Hernia
Medical Image of the Month: Pectus Excavatum
February 2019 Imaging Case of the Month: Recurrent Bronchitis and 
   Pneumonia in a 66-Year-Old Woman
Medical Image of the Month: Massive Right Atrial Dilation After Mitral Valve
Replacement
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

 

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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Saturday
Mar022019

Medical Image of the Month: Incarcerated Morgagni Hernia

Figure 1. Lateral view of abdominal-thoracic CT in soft tissue windows.

 

Figure 2. Coronal view of thoracic CT scan in lung windows.

 

A Morgagni hernia is a congenital diaphragmatic hernia in which abdominal viscera herniate into the thorax via a defect within an anterior attachment of the diaphragm. As with any bowel-containing hernia, the most feared complication is strangulation with subsequent bowel necrosis. In the present case, a 67-year-old woman presented with a five-day history of acute onset and progressively worsening upper abdominal pain and inability to tolerate oral intake, associated with nausea, vomiting, and mild shortness of breath. A CT revealed a large defect in the right hemidiaphragm consistent with a Morgagni hernia with herniation of the omentum, vessels, and a segment of transverse colon (Figure 1). Findings of bowel ischemia were observed, including (a) pneumatosis intestinalis, seen as cystic foci of air lining the bowel wall, and (b) fluid and fat-stranding adjacent to the affected bowel (Figure 2). Evidence of bowel wall perforation include large volume free air adjacent to the bowel in the right hemithorax and within the abdomen (Figures 1 and 2). Bowel ischemia and necrosis can occur with any hernia and requires prompt diagnosis and management.

Samandip Hothi MD1 and Viral Patel MD2

1Department of Medicine, Division of Internal Medicine and 2Department of Medical Imaging

University of Arizona College of Medicine-Tucson

Tucson, AZ USA

References

  1. Arora S, Haji A, Ng P. Adult Morgagni Hernia: The Need for Clinical Awareness, Early Diagnosis and Prompt Surgical Intervention. Ann R Coll Surg Engl. 2008 Nov;90(8):694-5. [CrossRef] [PubMed]
  2. Ly JQ. The Rigler Sign. Radiology. 2003;228(3):706-7. [CrossRef] [PubMed]
  3. Morgan TB, Nguyen DN, Tran CD, Maheshwary RK, Mickus TJ. Morgagni Hernia Causing Incarcerated Bowel and Contributing to Cardiac Arrest. Curr Probl Diagn Radiol. 2018 Jul 31. pii: S0363-0188(18)30181-6. [CrossRef]

Cite as: Hothi S, Patel V. Medical image of the month: Incarcerated Morgagni hernia. Southwest J Pulm Crit Care. 2019;18:59-60. doi: https://doi.org/10.13175/swjpcc001-19 PDF 

Saturday
Feb022019

Medical Image of the Month: Pectus Excavatum

Figure 1. A) PA chest radiograph at 38 years old demonstrates rib cage growth arrest at the time of pectus repair. B) and C) demonstrate the coronal and sagittal CT chest views.

 

Figure 2: Pulmonary function tests demonstrate severe restrictive ventilatory defect.

 

Clinical History

A 38-year-old man with obesity and history of pectus excavatum post-operative surgical repair at age 4 presented to the general pulmonary clinic with symptoms of severe dyspnea on exertion after walking one block. Chest x-ray and thoracic CT scan demonstrate anterior chest wall depression. (Figure 1). Pulmonary function testing demonstrated a severe restrictive lung disease (Figure 2).  High resolution CT demonstrated anterior chest wall depression. The Haller index was 2.5—mild excavatum—with associated scarring in the anterior right lung. Expiratory air-trapping was seen consistent with small airways disease.

Haller Index

The Haller index is calculated by dividing the transverse diameter of the chest by the anterior-posterior distance on the CT of the chest on the axial slice that demonstrates the smallest distance between the anterior surface of the vertebral body and the posterior surface of the sternum (1). Normal chest < 2.0; mild excavatum 2.0 – 3.2; moderate excavatum 3.2 – 3.5; severe excavatum > 3.5. Corrective surgery is considered for a Haller index of greater than or equal to 3.25.  Secondary thoracic dystrophy is a known consequence of too early repair of pectus excavatum (1).  Cases like our patient have changed when surgical repair is attempted until after puberty.

Michael Insel, MD and Janet Campion, MD

Division of Pulmonary, Allergy, Critical Care and Sleep Medicine

Banner University Medical Center-Tucson

Tucson, AZ USA

Reference

  1. Haller JA Jr, Colombani PM, Humphries CT, Azizkhan RG, Loughlin GM. Chest wall constriction after too extensive and too early operations for pectus excavatum. Ann Thorac Surg. 1996 Jun;61(6):1618-24. [CrossRef] [PubMed]

Cite as: Insel M, Campion J. Medical image of the month: pectus excavatum. Southwest J Pulm Crit Care. 2019;18(2):50-1. doi: https://doi.org/10.13175/swjpcc124-18 PDF