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.
March 2015 Imaging Case of the Month
Michael B. Gotway, MD
Department of Radiology
Mayo Clinic Arizona
Scottsdale, AZ
Clinical History: A 35-year-old man presented with a history of Von Hippel-Lindau syndrome, including prior right-sided renal cell carcinomas, cerebellar hemangioblastomas, and retinal hemangiomas. The patient’s renal malignancies were treated with laparoscopic radiofrequency ablations 6 and 8 years prior to presentation, and subsequently with percutaneous microwave ablations in the interim between 2008 and presentation. The latest percutaneous microwave ablation procedure (Figure 1) was performed to address two nodular enhancing foci in the posterior superior pole of the right kidney and one interpolar enhancing, septated lesion that were noted to have enlarged slightly on a recent MRI examination (Figure 2) of the abdomen compared with one year earlier.
Figure 1. Percutaneous microwave of three right-sided renal lesions, 2 posterior-superior pole, the other lateral interpolar in location, shows two NeuWave microwave antennas inserted into suspicious lesions in the right kidney.
Figure 2. MRI of abdomen (A and B, axial steady-state free precession fat saturation images and, C and D, coronal subtraction contrast-enhanced images) shows three potentially solid, enhancing foci, two in the posterior and superior pole of the right kidney (arrowheads), and one in the lateral interpolar kidney, the latter with thick septations (arrow) that have shown slight enlargement from MR. performed one year previously.
A CT of the abdomen (Figure 3), performed 2 years earlier, is shown as a baseline comparison.
Figure 3. Upper panel: selected image from the CT of the abdomen performed 2 years prior to presentation shows enlargement of the bilateral kidneys with numerous, bilateral renal cystic lesions. No pleural or lung base abnormality is evident. Lower panel: movie of CT scan performed 2 years prior to presentation.
Several days following the percutaneous microwave ablation procedure, the patient complained of right-sided chest pain, and frontal chest radiography was performed (Figure 4).
Figure 4. Frontal and lateral chest radiography performed several days following the right-sided percutaneous microwave ablation procedure.
Which of the following statements regarding the chest radiograph is most accurate? (Click on the correct answer to proceed to the second of seven panels)
Reference as: Gotway MB. March 2015 imaging case of the month. Southwest J Pulm Crit Care. 2015;10(3):112-24. doi: http://dx.doi.org/10.13175/swjpcc031-15 PDF