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.

Rick Robbins, M.D. Rick Robbins, M.D.

Medical Image of the Week: Remote Calvarial Renal Cell Metastases

Figure 1. Contrast enhanced axial MRI image shows the metastatic lesion in the right skull with mass effect and midline shift.

 

Figure 2. Coronal Image shows the extensive calvarial metastatic lesion and its mass effect.

A 57-year-old woman with past medical history significant for clear cell renal carcinoma and radical nephrectomy 9 years prior was admitted to our hospital for headache and left hemiparesis with associated numbness. Symptoms were progressive and had begun about 5 days prior to her presenting to our emergency department. Neurologic exam was significant for reduced strength in her left upper and lower extremities as well as well as sensory deficit to fine touch and vibratory sensation in her left arm. Her gait was unsteady and she was unable to ambulate without assistance. Her right calvarium was grossly enlarged and asymmetrical with softening of the underlying boney structures. 

MRI of the brain showed a 10 cm x 5 cm mass that was obliterating the calvarium and invading the dura mater (Figure 1).  There was mass effect with shift of the midline structures from right to left by approximately 6.5 mm (Figures 1 and 2). This was biopsy proven to be metastatic renal cell carcinoma. Additional smaller calvarium lesions were also seen. At least 3 and possibly 4 parenchymal metastatic deposits are seen in the left occipital lobe. Renal cell carcinoma has been well described to recur after long periods of remission, up to 33 years (1).

She was initially treated with intravenous dexamethasone with resolution of symptoms after 48 hours. Palliative radiation is being provided at this time.

Anthony Witten MD, Hem Desai MD, Ryan Wong MD and Joao Ferreira MD

Department of Internal Medicine

University of Arizona College of Medicine

Tucson, AZ USA

Reference

  1. Parada SA, Franklin JM, Uribe PS, Manoso MW. Renal cell carcinoma metastases to bone after a 33-year remission. Orthopedics. 2009 Jun;32(6):446. [CrossRef] [PubMed]

Cite as: Witten A, Desai H, Wong R, Ferreira J. Medical image of the week: calvairial renal cell metastases. Southwest J Pulm Crit Care. 2016;12(1):32-3. doi: http://dx.doi.org/10.13175/swjpcc154-15 PDF

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Rick Robbins, M.D. Rick Robbins, M.D.

November 2013 Imaging Case of the Month

Michael B. Gotway, MD

 

Department of Radiology

Mayo Clinic Arizona

Scottsdale, AZ

 

Clinical History

A 67-year-old man complained of intermittent shortness of breath. A few crackles were audible in the patient’s lung bases bilaterally. Chest radiography (Figure 1) was performed.

 

Figure 1: Frontal (A) and lateral (B) chest radiography.

Which of the following statements regarding the chest radiograph is most accurate?

  1. The chest radiograph shows basal predominant linear opacities suggesting fibrosis
  2. The chest radiograph shows large lung volumes with cystic change
  3. The chest radiograph shows multifocal ground-glass opacity and cavitary consolidation
  4. The chest radiograph shows multifocal ground-glass opacity and consolidation associated with linear and reticular abnormalities
  5. The chest radiograph shows multiple nodules

Reference as: Gotway MB. November 2013 imaging case of the month. Southwest J Pulm Crit Care. 2013;7(5):291-9. doi: http://dx.doi.org/10.13175/swjpcc149-13 PDF

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