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: Granulation Tissue
Figure 1. Subglottic space showing the presence of granulation tissue (arrows).
Figure 2. Argon Plasma Coagulation of the granulation tissue
A 57 year old woman presented with a tickling sensation in the back of throat and intermittent bleeding from the healing stoma one month after decannulation of her tracheostomy tube. On bronchoscopy a granuloma with surrounding granulation tissue was present in the subglottic space (Figure 1). Argon plasma coagulation (APC) was performed to cauterize the granulation tissue (Figure 2).
Formation of granulation tissue after tracheostomy is a common complication which can result in tracheal stenosis. APC and electrocautery using flexible bronchoscopy has been shown to safely and effectively remove the granulation tissue.
Aarthi Ganesh, MBBS and James Knepler, MD
Pulmonary, Allergy, Critical Care, & Sleep Medicine
University of Arizona
Tucson, AZ
Reference
- Epstein SK. Late complications of tracheostomy. Respir Care. 2005;50(4):542-9. [PubMed]
Reference as: Ganesh A, Knepler J. Medical image of the week: granulation tissue. Southwest J Pulm Crit Care. 2014;8(3):192-3. doi: http://dx.doi.org/10.13175/swjpcc029-14 PDF
Medical Image of the Week: Squamous Cell Carcinoma Presenting as an Endobronchial Mass
Figure 1. CT axial cut showing large endobronchial mass (arrow) at the junction of the right upper lobe bronchus and bronchus intermedius.
Figure 2. Endobronchial lesion with view from trachea before (Panel A) and after (Panel B) removal by APC.
A 65 year old woman with previously diagnosed emphysema presented with two weeks of worsening dyspnea on exertion. CT scan of the chest showed a 14mm x 12mm irregular endobronchial lesion (arrow) occluding the bronchus intermedius. Right-sided compensatory “ball-valve” emphysematous changes are noted. Right posterior atelectasis is also seen. Endobronchial biopsy revealed squamous cell carcinoma. The patient later underwent palliative argon plasma coagulation (APC) therapy with removal of the tumor (Figure 2) with re-expansion of the right middle lobe.
Sage P. Whitmore, MD; James L. Knepler, Jr. MD and Linda Snyder, MD
Division of Pulmonary and Critical Care Medicine
Arizona Respiratory Center
University of Arizona
Tucson, Arizona
Reference as: Whitmore SP, Knepler JL Jr, Snyder L. Medical image of the week: squamous cell carcinoma presenting as an endobronchial mass. Southwest J Pulm Crit Care 2013;6(2):85-6. PDF