Imaging
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.
Medical Image of the Week: Pulmonary Arteriovenous Malformations
Figure 1. Cardiac ultrasound showing right to left shunting.
Figure 2. Thoracic CT scan showing arteriovenous malformations (AVM's, arrows).
A 34 year old woman presented to the clinic with exertional dyspnea since childhood. Oxygen saturations in clinic were 92% on room air. On review of systems she admitted to recurrent epistaxis and her daughter also suffered from frequent epistaxis. Bubble contrast echocardiography showed severe right to left shunting without evidence of intracardiac shunt (Figure 1). Computed tomography angiogram of the chest revealed multiple bilateral arteriovenous malformations (AVM’s), the largest measuring 9mm on coronal images (Figure 2). MRI of the brain was negative for AVM’s. She was referred to interventional radiology for microcoil embolization. She met two of four Curaçao criteria for the diagnosis of hereditary hemorrhagic telangiectasia (HHT), giving her “possible HHT”. She was referred for genetic testing to confirm the diagnosis.
Chris Strawter MD and Laura Meinke MD
University of Arizona
Tucson, Arizona
References
- Lacombe P, Lacout A, Marcy PY, et al. Diagnosis and treatment of pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: an overview. Diagn Interv Imaging. 2013;94:835-48. [CrossRef] [PubMed]
- Gossage JR, Kanj G. Pulmonary arteriovenous malformations. A state of the art review. Am J Respir Crit Care Med. 1998;158:643-61. [CrossRef] [PubMed]
- Faughnan ME, Palda VA, Garcia-Tsao G, et al. International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet. 2011;48:73-87. [CrossRef] [PubMed]
Reference as: Strawter C, Meinke L. Medical image of the week: pulmonary arteriovenous malformations. Southwest J Pulm Crit Care. 2014;9(4):238-9. doi: http://dx.doi.org/10.13175/swjpcc131-14 PDF
Medical Image of the Week: Osler-Weber-Rendu Syndrome
A 44 year-old woman with Osler-Weber-Rendu syndrome (commonly known as Hereditary Hemorrhagic Telangiectasia [HHT]) presented with hemoptysis. Her past history was notable for hemoptysis treated with hemostatic coil placement in multiple areas of arteriovenous (AV) malformations. Her last episode of hemoptysis was 15 years prior to this admission and she had not been seen by a physician for almost 2 years. Her CT Chest revealed multiple previous hemostatic coils and new AV malformations.
Figure 1. Chest X-Ray: Multiple hemostatic metallic coils throughout both lungs.
Figure 2. Axial images of CT Chest: Metallic foreign bodies are seen within the lungs. Several areas are enhancing and somewhat serpentine, possibly representing small residual or new areas of arteriovenous abnormality with dilated veins (arrows).
Tauseef Afaq Siddiqi MD, Toral Parikh MD and Phillip Factor DO
Department of Medicine, Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona, Tucson, AZ 85724, United States
Reference as: Siddiqi TA, Parikh T, Factor P. Medical image of the week: Osler-Weber-Rendu syndrome. Southwest J Pulm Crit Care. 2013;6(5):241-2. PDF