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.

May 2020 Imaging Case of the Month: Still Another Emerging Cause for Infiltrative Lung Abnormalities

Prasad M. Panse MD

Clinton E. Jokerst MD

Michael B. Gotway MD

 

Department of Radiology

Mayo Clinic, Arizona

Scottsdale, Arizona 85054

 

Clinical History: A 46-year-old man with a history of well-controlled asthma presented to the Emergency Room with complaints of worsening non-productive cough for 4-5 days followed by fever to 104°F over the previous 3 days. The patient also complained of some chills and loose stools. The patient denied rhinorrhea, sore throat, congestion, and nausea or vomiting. The patient also denied illicit drug use, and drinks alcohol only occasionally and denied smoking.

The patient’s physical examination showed a pulse rate of 79 / minute and a respiratory rate of 18 / minute, although his blood pressure was mildly elevated at 149/84 mmHg; he was afebrile with a temperature of 97.7 °F (36.5 °C). The patient’s room air oxygen saturation was 98%. The physical examination showed some mild expiratory wheezes bilaterally, but was otherwise entirely within normal limits.

Which of the following represents the most appropriate step for the patient’s management? (Click on the correct answer to be directed to the second of twelve pages)

  1. Obtain a complete blood count
  2. Obtain a travel history
  3. Obtain serum chemistries
  4. Perform chest radiography
  5. All of the above

Cite as: Panse PM, Jokerst CE, Gotway MB. May 2020 imaging case of the month: still another emerging cause for infiltrative lung abnormalities. Southwest J Pulm Crit Care. 2020;20(5):147-62. doi: https://doi.org/10.13175/swjpcc027-20 PDF 

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

Medical Image of the Week: Acute Aortic Dissection

Figure 1: Panel A: Axial view of the thoracic CT angiography showing aortic dissection in descending aorta where the true lumen (yellow arrow) with outer-wall calcification (red arrow) as well as false lumen with contrast (orange arrow) is seen.  Panel B: Coronal view showing the true (T) and false (F) lumen.

An 85-year-old gentleman with the past medical history significant for hypertension, smoking, and coronary artery disease presented to the emergency department (ED) with complains of sudden onset of chest pain.  His pain was described as squeezing and radiating to the back, associated with nausea and vomiting. His chest pain improved with nitroglycerin in ED.  Chest x-ray showed a tortuous aortic knob and widened mediastinum.

He underwent a CT angiogram, which showed, Stanford Type B aortic dissection, from distal aortic arch to renal arteries (Figure 1).  He was managed in the hospital conservatively with tight blood pressure control given the type of dissection and no surgical intervention was done. He was uneventfully discharged with follow up arranged with vascular surgery.

Aortic dissection is classified by Stanford Criteria as Type A which involves the ascending aorta and arch and Type B when it involves the descending aorta. Type A dissection is a surgical emergency and guidelines suggest medical / non-surgical management for Type B dissection except in cases where the pain is not controlled despite BP control, acute expansion of the false lumen, peri-aortic hematoma or distal mal-perfusion.

Hem Desai MD1, Aung Bajaj MD1, Kamalani Hanamaikai MD1 & Bhupinder Natt MD2

1Department of Internal Medicine and the 2Division of Pulmonary, Allergy, Critical Care and Sleep Medicine  

University of Arizona

Tucson, AZ USA

References

  1. LePage MA, Quint LE, Sonnad SS, Deeb GM, Williams DM. Aortic dissection: CT features that distinguish true lumen from false lumen. AJR Am J Roentgenol. 2001;177(1):207-11. [CrossRef] [PubMed]
  2. von Kodolitsch Y, Nienaber CA, Dieckmann C, Schwartz AG, Hofmann T, Brekenfeld C, Nicolas V, Berger J, Meinertz T. Chest radiography for the diagnosis of acute aortic syndrome. Am J Med. 2004;116(2):73-7. [CrossRef] [PubMed]

Reference as: Desai H, Bajaj A, Hanamaikai K, Natt B. Medical image of the week: acute aortic dissection. Southwest J Pulm Crit Care. 2015;10(6):348-9. doi: http://dx.doi.org/10.13175/swjpcc063-15 PDF

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