Imaging

Last 50 Imaging Postings

(Most recent listed first. Click on title to be directed to the manuscript.)

August 2025 Medical Image of the Month: Crazy Paving in a Case of 
   Eosinophilic Granulomatosis with Polyangiitis
July 2025 Medical Image of the Month: A Case of Severe Hiatal Hernia
   Presenting as Atypical Chest Pain
July 2025 Imaging Case of the Month: A Growing Lung Nodule in a
   Patient with Heart Disease
June 2025 Medical Image of the Month: Neurofibromatosis-Associated Diffuse
   Cystic Lung Disease
May 2025 Medical Image of the Month: Aspirated Dental Screw
April 2025 Medical Image of the Month: An Unfortunate Case of Mimicry
March 2025 Medical Image of the Month: An Unusual Case of Pulmonary
   Infarction
February 2025 Medical Image of the Month: Unexpected Complications of
   Transjugular Intrahepatic Portosystemic Shunt (TIPS) 
February 2025 Imaging Case of the Month: A Wolf in Sheep’s Clothing
January 2025 Medical Image of the Month: Psoriasis with Pulmonary
   Involvement
December 2024 Medical Image of the Month: An Endobronchial Tumor
November 2024 Medical Image of the Month: A Case of Short Telomeres
November 2024 Imaging Case of the Month: A Recurring Issue
October 2024 Medical Image of the Month: Lofgren syndrome with Erythema
   Nodosum
September 2024 Medical Image of the Month: A Curious Case of Nasal
   Congestion
August 2024 Image of the Month: Lymphomatoid Granulomatosis
August 2024 Imaging Case of the Month: An Unexplained Pleural Effusion
July 2024 Medical Image of the Month: Vocal Cord Paralysis on PET-CT 
June 2024 Medical Image of the Month: A 76-year-old Man Presenting with
   Acute Hoarseness
May 2024 Medical Image of the Month: Hereditary Hemorrhagic
   Telangiectasia in a Patient on Veno-Arterial Extra-Corporeal Membrane
   Oxygenation
May 2024 Imaging Case of the Month: Nothing Is Guaranteed
April 2024 Medical Image of the Month: Wind Instruments Player Exhibiting
   Exceptional Pulmonary Function
March 2024 Medical Image of the Month: Sputum Cytology in Patients with
   Suspected Lung Malignancy Presenting with Acute Hypoxic Respiratory
   Failure
February 2024 Medical Image of the Month: Pulmonary Alveolar Proteinosis
   in Myelodysplastic Syndrome
February 2024 Imaging Case of the Month: Connecting Some Unusual Dots
January 2024 Medical Image of the Month: Polyangiitis Overlap Syndrome
   (POS) Mimicking Fungal Pneumonia 
December 2023 Medical Image of the Month: Metastatic Pulmonary
   Calcifications in End-Stage Renal Disease 
November 2023 Medical Image of the Month: Obstructive Uropathy
   Extremis
November 2023 Imaging Case of the Month: A Crazy Association
October 2023 Medical Image of the Month: Swyer-James-MacLeod
   Syndrome
September 2023 Medical Image of the Month: Aspergillus Presenting as a
   Pulmonary Nodule in an Immunocompetent Patient
August 2023 Medical Image of the Month: Cannonball Metastases from
   Metastatic Melanoma
August 2023 Imaging Case of the Month: Chew Your Food Carefully
July 2023 Medical Image of the Month: Primary Tracheal Lymphoma
June 2023 Medical Image of the Month: Solitary Fibrous Tumor of the Pleura
May 2023 Medical Image of the Month: Methamphetamine Inhalation
   Leading to Cavitary Pneumonia and Pleural Complications
April 2023 Medical Image of the Month: Atrial Myxoma in the Setting of
   Raynaud’s Phenomenon: Early Echocardiography and Management of
   Thrombotic Disease
April 2023 Imaging Case of the Month: Large Impact from a Small Lesion
March 2023 Medical Image of the Month: Spontaneous Pneumomediastinum
   as a Complication of Marijuana Smoking Due to Müller's Maneuvers
February 2023 Medical Image of the Month: Reversed Halo Sign in the
   Setting of a Neutropenic Patient with Angioinvasive Pulmonary
   Zygomycosis
January 2023 Medical Image of the Month: Abnormal Sleep Study and PFT
   with Supine Challenge Related to Idiopathic Hemidiaphragmatic Paralysis
December 2022 Medical Image of the Month: Bronchoesophageal Fistula in
   the Setting of Pulmonary Actinomycosis
November 2022 Medical Image of the Month: COVID-19 Infection
   Presenting as Spontaneous Subcapsular Hematoma of the Kidney
November 2022 Imaging Case of the Month: Out of Place in the Thorax
October 2022 Medical Image of the Month: Infected Dasatinib Induced
   Chylothorax-The First Reported Case 
September 2022 Medical Image of the Month: Epiglottic Calcification
Medical Image of the Month: An Unexpected Cause of Chronic Cough
August 2022 Imaging Case of the Month: It’s All About Location
July 2022 Medical Image of the Month: Pulmonary Nodule in the
   Setting of Pyoderma Gangrenosum (PG) 
June 2022 Medical Image of the Month: A Hard Image to Swallow
May 2022 Medical Image of the Month: Pectus Excavatum
May 2022 Imaging Case of the Month: Asymmetric Apical Opacity–
   Diagnostic Considerations
April 2022 Medical Image of the Month: COVID Pericarditis
March 2022 Medical Image of the Month: Pulmonary Nodules in the
   Setting of Diffuse Idiopathic Pulmonary NeuroEndocrine Cell Hyperplasia
   (DIPNECH) 
February 2022 Medical Image of the Month: Multifocal Micronodular
   Pneumocyte Hyperplasia in the Setting of Tuberous Sclerosis
February 2022 Imaging Case of the Month: Between A Rock and a
   Hard Place

 

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, Critical Care & Sleep 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, Critical Care & Sleep 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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Monday
May112015

May 2015 Imaging Case of the Month

Michael B. Gotway, MD 

Department of Radiology

Mayo Clinic Arizona

Scottsdale, AZ

  

Clinical History: A 66 year-old woman presented with a history of hypothyroidism on replacement therapy, and a past medical history of pancreatitis, presented to her gastroenterologist with complaints of abdominal pain and loose stools. The episodes of pancreatitis began over a decade earlier with epigastric pain that was ultimately attributed to cholecystitis, for which endoscopic retrograde cholangiopancreatography (ERCP) was performed; this procedure precipitated her first episode of pancreatitis. During the ERCP procedure, her common bile duct was noted to be narrowed and several stones were removed, with placement of a stent, after which her epigastric pain resolved. A second stent placement procedure was required for recurrent epigastric pain approximately three weeks later, with good result.

Nearly a decade later, the patient presented with loose stools and fecal urgency associated with abdominal pain. Upper endoscopy showed mild gastric erosions (the patient was taking non-steroidal anti-inflammatory agents for intermittent back pain) and colonoscopy showed mild, non-specific colitis. The paint was diagnosed with pancreatic insufficiency and enzyme replacement therapy was begun, with symptomatic improvement.

During the course of her gastrointestinal consult, a frontal chest radiograph (Figure 1) was performed.

 

Figure 1. Frontal chest radiograph.

Which of the following statements regarding the chest radiograph is most accurate? (Click on the correct answer to proceed to the second of nine panels)

Reference as: Gotway MB. May 2015 imaging case of the month. Southwest J Pulm Crit Care. 2015;10(5):223-34. doi: http://dx.doi.org/10.13175/swjpcc070-15 PDF

Wednesday
May062015

Medical Image of the Week: Nocardiosis

Figure 1. Panel A: Thoracic CT scan showing enlarged left upper lobe mass. Panel B: CT scan from one month earlier showing a smaller lesion.

 

Figure 2. Panel A: GMS Silver stain showing Nocardia (200X magnification). Panel B: GMS silver stain showing Nocardia (400X magnification).

 

Figure 3. MRI Brain with arrows pointing to the lesion.

 

A 67 year-old man with advanced adenocarcinoma of the lung on chemotherapy and severe steroid dependent chronic obstructive pulmonary disease (COPD) was admitted for treatment of acute on chronic respiratory failure. He was admitted to the intensive care unit and required non-invasive positive pressure ventilation. He had a chest computed tomography scan (Figure 1A), with a left upper lobe mass, which was significantly larger than noted on a previous PET/CT scan (Figure 1B) from one month ago. He was placed on empiric broad-spectrum antibiotics and clinically improved. He underwent a transthoracic lung biopsy (Figure 2), which revealed the presence of organisms consistent with Nocardia on silver stain.  A brain MRI (Figure 3) showed the presence of a 4 mm enhancing lesion likely consistent with Nocardia.

Nocardiosis is a gram-positive bacterial infection caused by aerobic actinomycetes and is an important opportunistic pulmonary infection. It should be considered in the differential diagnosis of pulmonary infiltrates in immunosuppressed patients, including those with neoplasms, after organ transplantation, advanced HIV disease and those receiving chronic corticosteroid therapy or chemotherapy (1). Of importance to pulmonologists, in two reviews, COPD was a common underlying condition, representing over 20% of patients with Nocardiosis in these reports (2,3). Nocardia species are found in soil and infection is generally acquired through inhalation. The most common symptoms are fever, cough, pleuritic chest pain and headache. Common chest radiographic findings include consolidation, nodules, cavities and pleural effusions. Nocardia infections can disseminate to any organ but it has a predilection for spread to the central nervous system and patients with pulmonary Nocardia infections should have brain imaging to evaluate for cerebral dissemination. Antibiotics that are typically effective in Nocardia infections include trimethoprim-sulfamethoxazole (TMP-SMX), imipenim, amikacin, ceftriaxone and cefotaxime. However, antibiotic susceptibilities should be obtained and treatment tailored accordingly. It is recommended to treat severe systemic infections with two or three intravenous agents while awaiting susceptibility results. Treatment is usually prolonged because of the tendency of Nocardia infections to relapse or progress.  For patients with serious pulmonary infections and immunocompromised patients, duration of therapy is often at least 6 to 12 months or longer. Our patient was treated with TMP-SMX and meropenem and clinically improved. His steroids were rapidly tapered. Sputum cultures grew Nocardia farcinica.

Aarthi Ganesh MD, Muna Omar MD, James Knepler MD, and Linda Snyder MD

Department of Pulmonary and Critical Care

Banner University Medical Center

Tucson, AZ

References

  1. Grigor LM, Hoover SE. Nocardiosis at a university medical center in the American southwest. Infect Dis Clin Pract 2014:22:279-82. [CrossRef]
  2. Minero MV, Marín M, Cercenado E, Rabadán PM, Bouza E, Mu-oz P. Nocardiosis at the turn of the century. Medicine (Baltimore). 2009;88(4):250-61. [CrossRef] [PubMed]
  3. Martínez Tomás R, Menéndez Villanueva R, Reyes Calzada S, Santos Durantez M, Vallés Tarazona JM, Modesto Alapont M, Gobernado Serrano M. Pulmonary nocardio-sis: risk factors and outcomes. Respirology. 2007;12(3):394-400. [CrossRef] [PubMed]

Reference as: Ganesh A, Omar M, Knepler J, Snyder L. Medical image of the week: nocardiosis. Southwest J Pulm Crit Care. 2015;10(5):220-2. doi: http://dx.doi.org/10.13175/swjpcc046-15 PDF