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.
April 2015 Imaging Case of the Month
Michael B. Gotway, MD
Department of Radiology
Mayo Clinic Arizona
Scottsdale, AZ
Clinical History: A 73-year-old woman with a history of ovarian malignancy in remission for several years and treated with hysterectomy and oopherectomy, hypothyroidism, and hypertension, presented with rather abrupt onset cough, chest pain, dyspnea and low-grade fever (99.6°F). Her past medical history was otherwise unremarkable. Her medications included thyroid replacement, amlodipine, benazepril, and, recently, calcium and magnesium supplementation. Chest radiography was performed (Figure 1).
Figure 1. Frontal (panel A) and lateral (panel B) chest radiographs.
Which of the following statements regarding the chest radiograph is most accurate? (Click on the correct answer to proceed to the second of nine panels)
Reference as: Gotway MB. April 2015 imaging case of the month. Southwest J Pulm Crit Care. 2015;10(4):171-81. doi: http://dx.doi.org/10.13175/swjpcc048-15 PDF
Medical Image of the Week: Right Neck Mass with Thoracic Extension
Figure 1. Coronal MRI image showing cavitary lesion (1.9 cm, yellow arrow) in the right lower lobe and multiple enlarged mediastinal and hilar lymph nodes with the largest lymph node measuri 2 x 2.5 cm.
Figure 2. Coronal MRI image of neck showing ill-defined infiltrative mass (2.8 x 4.1 x 6.4 cm, yellow star) in the right lateral neck posterior to the sternocleidomastoid muscle and jugular vein.
Figure 3. Right upper lobe endobronchial lesion (yellow arrow). Biopsy showed Coccidioides spherules.
Figure 4. Hematoxylin and eosin (upper panel) and Gomori's methenamine silver stain stains of 4R lymph node showing Coccidioides spherule.
A 28-year-old female with a history of chronic pancreatitis s/p total pancreatectomy and auto-islet cell transplantation developed a progressively enlarging right neck mass of 4 weeks duration. Coccidioides IgM antibodies were negative and IgG antibodies were positive by immunoassay (EIA), with titers 1:4 by complement fixation (CF). Fine needle aspiration with subsequent excisional biopsy of the right neck mass was performed and showed reactive lymphoid hyperplasia without fungal elements. Bronchoscopy with right upper lobe endobronchial biopsy and 4R lymph node endobronchial ultrasound-fine needle aspiration revealed granulomatous inflammation and Coccidioides spherules on Gomori's methenamine silver stain. Fungal cultures from the right neck mass fine needle aspiration, endobronchial biopsy, and 4R lymph node grew Coccidioides after three weeks of culture.
Tauseef Afaq Siddiqi, MD1
Candy Wong, MD1
Robert Ricciotti, MD2
Afshin Sam, MD1
1 Department of Medicine, Section of Pulmonary, Allergy, Critical Care and Sleep Medicine
2 Department of Pathology
University of Arizona
Tucson, AZ 85724
Reference as: Siddiqi TA, Wong C, Ricciotti R, Sam A. Medical image of the week: right neck mass with thoracic extension. Southwest J Pulm Crit Care. 2013;6(5):196-8. 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