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: Bronchus Sui
Figure 1. Panel A: Coronal view of the thoracic CT scan showing the right upper lobe superior subsegment bronchus taking off from the trachea (arrow). Panel B: Bronchoscopy confirming the tracheal origin of the superior subsegment bronchus.
A 65 year-old man presented to the outpatient clinic for evaluation of a chronic cough. The patient underwent CT Chest (Figure 1A) that shows a right upper lobe (RUL) infiltrate with an incidental right-sided tracheal bronchus. The incidence of right-sided tracheal bronchus is 0.1-2% and has different subtypes. This patient has the most common subtype called a displaced tracheal bronchus as the aberrant, superior segment has normal RUL branching, which coexists with normal right-sided anatomy except that the one branch of the upper lobe bronchus is missing. A true “bronchus sui” (pig bronchus) is when the RUL takes off from the trachea and the right main bronchus acts as the bronchus intermedius feeding the right middle and lower lobes. A tracheal bronchus is usually asymptomatic but can be associated with recurrent pneumonia, chronic bronchitis and bronchiectasis. Bronchoscopy (Figure 1B) was performed for the purpose of RUL bronchoalveolar lavage and endobronchial ultrasound of the mediastinal lymphadenopathy.
Nathaniel Reyes MD, Bhupinder Natt MD, Janet Campion MD
Division of Pulmonary and Critical Care Medicine
Arizona Respiratory Center
University of Arizona
Tucson, AZ
Reference
Findik S. Tracheal bronchus in the adult population. J Bronchology Interv Pulmonol. 2011;18(2):149-52. [CrossRef] [PubMed]
Reference as: Reyes N, Natt B, Campion J. Medical image of the week: bronchus sui. Southwest J Pulm Crit Care. 2014;8(5):281. doi: http://dx.doi.org/10.13175/swjpcc043-14 PDF
Medical Image of the Week: Azygous Lobe
Figure 1. Chest X-Ray (A) and thoracic CT scan (B) shows the azygos fissure and the ‘tadpole’ appearance (arrow). Chest CT (C) shows the lateral course of the azygos vein (arrow) and the accessory lobe.
A 59 year old man underwent chest radiography for evaluation of fever and cough. Imaging showed an accessory azygous lobe. An azygos lobe is found in 1% of anatomic specimens and forms when the right posterior cardinal vein, one of the precursors of the azygos vein, fails to migrate over the apex of the lung (1). Instead, the vein penetrates the lung carrying along pleural layers that entrap a portion of the right upper lobe. The vein appears to run within the lung, but is actually surrounded by both parietal and visceral pleura. The azygos fissure therefore consists of four layers of pleura, two parietal layers and two visceral layers, which wrap around the vein giving the appearance of a tadpole. Apart from an interesting incidental radiological finding, it is of limited clinical importance except that its presence should be recognized during thoracoscopic procedures. This patient was found to have a cavitary lung lesion which was the cause of his symptoms.
Bhupinder Natt MD, Abdulmagid Eddib MD, Dena H’Leureux MD
Department of Pulmonary, Allergy, Critical Care and Sleep Medicine
University of Arizona and the Southern Arizona VA Health Care System
Tucson, AZ
Reference
Mata J, Cáceres J, Alegret X, Coscojuela P, De Marcos JA. Imaging of the azygos lobe: normal anatomy and variations. AJR Am J Roentgenol. 1991;156(5):931-7. [CrossRef] [PubMed]
Reference as: Natt B, Eddib A, H'Leureux D. Medical image of the week: azygous lobe. Southwest J Pulm Crit Care. 2013;7(6):353-4. doi: http://dx.doi.org/10.13175/swjpcc158-13 PDF