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Imaging

Last 50 Imaging Postings

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

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
January 2022 Medical Image of the Month: Bronchial Obstruction
   Due to Pledget in Airway Following Foregut Cyst Resection
December 2021 Medical Image of the Month: Aspirated Dental Implant
Medical Image of the Month: Cavitating Pseudomonas
   aeruginosa Pneumonia
November 2021 Imaging Case of the Month: Let’s Not Dance
   the Twist
Medical Image of the Month: COVID-19-Associated Pulmonary
   Aspergillosis in a Post-Liver Transplant Patient

 

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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Sunday
Dec022018

Medical Image of the Month: Chronic Ogilvie’s Syndrome

Figure 1. Coronal view of abdominal CT scan showing a massively dilated colon.

 

Figure 2. Sagittal view of abdominal CT scan.

 

Figure 3. Axial view of abdominal CT scan.

 

A 42-year-old man with chronic encephalopathy secondary to traumatic brain injury (TBI), craniotomy, seizure disorder, chronic alcohol abuse, and chronic Ogilvie syndrome presented to the Banner University Medical Center-South Campus emergency department (ED) after being found in his driveway with altered mental status. He complained of multiple episodes of non-bloody diarrhea for the last day but otherwise altered & unhelpful. He was noted to have to be hypotensive with a blood pressure of 70-90/35-56 mm Hg, afebrile with a temperature of 36  C, an elevated white cell count of 13.3 X 109 cells/L, a hemoglobin of 4.4 g/dL, a creatinine of 2.6 mg/dL, a BUN of 30 mg/dL, and an elevated lactic acid to 5.4 mmol/L. Physical exam showed a massively dilated tympanic abdomen. Resuscitation and broad-spectrum antibiotics were initiated, a CT scan ordered (Figures 1-3) and he was admitted to the medical intensive care unit (MICU) for further work up and management.

On chart review, it was shown that he had presented to the same ED twice in the past with episodes of chronic constipation. Gastroenterology and general surgery consults concluded that he had developed a chronic pseudo-obstruction pattern due to likely decreased gastrointestinal motility presumed secondary to TBI and immobility. He was evaluated and deemed to not qualify for neostigmine treatment due to finding of stool acting as a mechanical obstruction. During this MICU visit, he was treated for septic shock but unfortunately did not survive the hospital stay.

Learning Points/Take Home Message:

  1. Ogilvie syndrome is an acquired dilation of the colon in the absence of any mechanical obstruction in severely ill patients characterized by abnormalities affecting the involuntary, rhythmic muscular contractions within the colon. The symptoms of Ogilvie syndrome mimic those of mechanical obstruction of the colon, but no physical obstruction is present.
  2. Studies have shown that intravenous administration of neostigmine has led to rapid decompression of the colon in individuals with Ogilvie syndrome who did not respond to conservative management. 
  3. Colonoscopic decompression, in which a thin, flexible tube is inserted into the anal passage and threaded up to the colon, may be used in refractory cases. Although colonoscopic decompression has not undergone clinical study, numerous reports in the medical literature cite it as an effective method for removing air from the colon and, potentially, reducing the risk of perforation. 
  4. Surgery is used when affected individuals have signs of perforation or ischemia or have failed to respond to other treatment options. Surgery can be associated with significant morbidity and mortality.

Michael Bernaba MD, Emilio Power MD, Sidra Raoof MD, Babitha Bijin MD, Yuet-Ming Chan MD

Department of Internal Medicine

University of Arizona College of Medicine at South Campus

Tucson, AZ USA

References

  1. McNamara R, Mihalakis MJ. Acute colonic pseudo-obstruction: rapid correction with neostigmine in the emergency department. J Emerg Med. 2008;35:167-70. [CrossRef] [PubMed]
  2. Saunders MD, Kimmey MB. Systemic review: acute colonic pseudo-obstruction. Aliment Pharmacol Ther. 2005;22:917-25. [CrossRef] [PubMed]
  3. Maloney N, Vargas HD. Acute intestinal pseudo-obstruction (Ogilvie's syndrome). Clin Colon Rectal Surg. 2005;18:96-101. [CrossRef] [PubMed]
  4. De Giorgio R, Knowles CH. Acute colonic pseudo-obstruction. Br J Surg. 2009;96:229-39. [CrossRef] [PubMed]

Cite as: Bernaba M, Power E, Raoof S, Bijin B, Chan Y-M. Medical image of the month: chronic Ogilivie's syndrome. Southwest J Pulm Crit Care. 2018;17(6):146-8. doi: https://doi.org/10.13175/swjpcc117-18 PDF

Friday
Nov022018

Medical Image of the Month: Malignant Pleural and Pericardial Effusions

Figure 1. CTA chest axial view showing moderate pericardial effusion, bilateral pleural effusions and an anterior mediastinal mass.

 

Figure 2. Echocardiography subcostal four-chambered view showing a large pericardial effusion with right ventricular collapse during diastole.

 

A 67-year-old woman with a history of presumed thymoma presented to the emergency department with four weeks of progressive shortness of breath and wheezing. CT imaging of the chest on arrival demonstrated a 13.1 x 8.6 x 8.2 cm anterior mediastinal mass with compression of the SVC, pulmonary veins, and right pulmonary artery (Figure 1). A moderate pericardial effusion was also seen. A transthoracic echocardiogram was performed to further evaluate the pericardial effusion, which revealed diastolic collapse of the right ventricle consistent with cardiac tamponade (Figure 2). The patient was taken for urgent pericardiocentesis, which drained 450cc of sanguineous fluid. Percutaneous biopsy of the mass revealed poorly differentiated carcinoma suspicious for a primary breast malignancy. Cytology of the pericardial fluid did not demonstrate malignancy, however. Cytology of subsequent pleural effusion also was not positive for malignancy, although, both effusions are believed to be related to the malignancy even if no malignant cells were present on analysis.

Malignant pericardial effusions account for 18-23% of cases, and are one of the most common causes of hemorrhagic effusions. Multiple types of cancers can involve the pericardium; lung cancer is the most common but lymphoma, leukemia, melanoma, and breast cancer are other potentially causative malignancies. Presence of a symptomatic malignant effusion is a poor prognostic indicator with median survival on the order of 2-4 months after diagnosis, although certain malignancies (e.g. hematologic rather than solid) may have better results (1).

Nathan Coffman MD and Jessica Vondrak MD

Department of Internal Medicine

Banner University Medical Center

University of Arizona

Tucson, AZ USA

Reference

  1. Dequanter D, Lothaire P, Berghmans T, Sculier JP. Severe pericardial effusion in patients with concurrent malignancy: a retrospective analysis of prognostic factors influencing survival. Ann Surg Oncol. 2008 Nov;15(11):3268-71. [CrossRef] [PubMed] 

Cite as: Coffman N, Vondrak J. Medical image of the month: Malignant pleural and pericardial effusions. Southwest J Pulm Crit Care. 2018;17(5): . doi: https://doi.org/10.13175/swjpcc107-18 PDF