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: Coral Reef Aorta
Figure 1. Coronal (A) and lateral (B) thoracic CT in soft tissue windows showing the coral reef calcification (arrows).
A 52-year-old woman with no past medical history presented to the emergency department with signs and symptoms concerning for pneumonia. Chest x-ray showed incidental findings of a calcified aortic mass. Subsequently, a follow up computed tomography scan (CT) was obtained which showed coral reef aorta (Figure 1). On physical examination, vital signs were only significant for mildly elevated blood pressure to 146/62 mmHg. She also had normal and equal pulses and pressures throughout all 4 extremities. In retrospect, patient had complaints of bilateral lower extremity claudication on strenuous exercise.
Coral reef aorta, a rare condition that was first described in 1984 by Qvarfordt et al. (1) is characterized by an eccentric, heavily calcified polypoid lesion and stenosis of the juxtarenal and suprarenal aorta. The rock-hard, irregular, gritty, whitish surface of the calcification strongly resembled a coral reef. The most common presentation is severe hypertension and intermittent claudication. Magnetic resonance angiogram (MRA) and CT have the ability to diagnose and appreciate the extent of this phenomenon (2).
Lance Eberson MS1 and Sehem Ghazala MD2
1College of Medicine and 2Department of Internal Medicine
University of Arizona
Tucson, Arizona, USA
References
- Qvarfordt PG, Reilly LM, Sedwitz MM, Ehrenfeld WK, Stoney RJ. "Coral reef" atherosclerosis of the suprarenal aorta: a unique clinical entity. J Vasc Surg. 1984 Nov;1(6):903-9. [CrossRef] [PubMed]
- Kopani K, Liao S, Shaffer K. The Coral Reef Aorta: Diagnosis and Treatment Following CT. Radiol Case Rep. 2016 Oct 4;4(1):209. eCollection 2009. [CrossRef] [PubMed]
Cite as: Eberson L, Ghazala S. Medical image of the week: coral reef aorta. Southwest J Pulm Crit Care. 2017:15(1):49. doi: https://doi.org/10.13175/swjpcc080-17 PDF
Medical Image of the Week: Leriche Syndrome
Figure 1. Axial CT of the abdomen demonstrating complete occlusion of the abdominal aorta at the level of the renal arteries (black arrow). An extensive network of collateral arteries is noted throughout the abdomen (white arrow showing representative collateral in anterior abdominal wall). An atrophic left kidney is also noted.
Figure 2. CT runoff demonstrating extensive abdominal network of collateral arteries, with relatively maintained distal perfusion in the setting of complete abdominal aorta occlusion.
A 68-year-old man with GOLD stage 4 COPD was admitted to the Intensive Care Unit for worsening hypoxic and hypercarbic respiratory failure. The patient was treated with steroids for COPD exacerbation, and required continuous BIPAP. On hospital day 2 concern arose for possible pulmonary embolism given worsening oxygenation despite BIPAP, and a thoracic CT angiogram was performed. On imaging, an incidental finding was discovered that the patient had complete occlusion of his aortic artery at the level of the renal arteries with extensive collaterals throughout the abdomen (Figure 1). The patient had palpable pulses in both feet and extremities were warm to touch bilaterally with recovered circulation, as verified on CT runoff (Figure 2). Vascular surgery was consulted, and a decision was made for no surgical intervention given the extensive collateral system and likely chronic time course. On further questioning the patient had limited ability to ambulate due to claudication. The patient also had diminished femoral pulses bilaterally, as well as erectile dysfunction, constituting the triad associated with Leriche syndrome (1).
Adam Berlinberg MD1, Tanner Elaini MD2, and Cameron Hypes MD3
1Department of Internal Medicine
2Department of Pulmonary and Critical Care Medicine
3Department of Emergency Medicine, Critical Care Medicine
Banner-University Medical Center Tucson
Tucson, AZ
Reference
- Leriche R, Morel A. The syndrome of thrombotic obliteration of the aortic bifurcation. Ann Surg. 1948;127(2):193-206. [PubMed]
Cite as: Berlinberg A, Elaini T, Hypes C. Medical image of the week: Leriche syndrome. Southwest J Pulm Crit Care. 2016;12(2):72-3. doi: http://dx.doi.org/10.13175/swjpcc004-16 PDF