Diagnostic Performance of Chest CT for SARS-CoV-2 Infection in Individuals with or without COVID-19 Symptoms.

Background The use of chest CT for coronavirus disease 2019 (COVID-19) diagnosis or triage in health care settings with limited severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) capacity is controversial. COVID-19 Reporting and Data System (CO-RADS) categorization of the level of COVID-19 suspicion might improve diagnostic performance. Purpose To investigate the value of chest CT with CO-RADS classification to screen for asymptomatic SARS-CoV-2 infections and to determine its diagnostic performance in individuals with COVID-19 symptoms during the exponential phase of viral spread. Materials and Methods In this secondary analysis of a prospective trial, from March 2020 to April 2020, parallel SARS-CoV-2 PCR and CT with categorization of COVID-19 suspicion was performed with CO-RADS for individuals with COVID-19 symptoms and control participants without COVID-19 symptoms admitted to the hospital for medical emergencies unrelated to COVID-19. CT with CO-RADS was categorized on a five-point scale from 1 (very low suspicion) to 5 (very high suspicion). Area under the receiver operating curve (AUC) was calculated in symptomatic versus asymptomatic individuals to predict positive SARS-CoV-2 PCR, and likelihood ratios for each CO-RADS score were used for rational selection of diagnostic thresholds. Results A total of 859 individuals (median age, 70 years; interquartile range, 52-81 years; 443 men) with COVID-19 symptoms and 1138 control participants (median age, 68 years; interquartile range, 52-81 years; 588 men) were evaluated. CT with CO-RADS had good diagnostic performance (P < .001) in both symptomatic (AUC, 0.89) and asymptomatic (AUC, 0.70) individuals. In symptomatic individuals (42% PCR positive), CO-RADS 3 or greater detected positive PCR with high sensitivity (89%, 319 of 358) and specificity of 73%. In asymptomatic individuals (5% PCR positive), a CO-RADS score of 3 or greater detected SARS-CoV-2 infection with low sensitivity (45%, 27 of 60) but high specificity (89%). Conclusion CT with Coronavirus Disease 2019 Reporting and Data System (CO-RADS) had good diagnostic performance in symptomatic individuals, supporting its application for triage. Sensitivity in asymptomatic individuals was insufficient to justify its use as a first-line screening approach. Incidental detection of CO-RADS 3 or greater in asymptomatic individuals should trigger testing for respiratory pathogens. © RSNA, 2020 Online supplemental material is available for this article.

Hemoptysis after Lung Transplantation Caused by Bronchial Arterial Neovascularization: Angiographic Analysis and Successful Embolization.

This report discusses 3 bilateral lung transplant recipients (2 female, 1 male) who presented with late hemoptysis (10 y, 18 y, and 19 y after transplantation). All patients had a history of pulmonary infections, bronchiectasis, and/or Aspergillus infection. Arteriography, through catherization of the common femoral artery, demonstrated spontaneous bronchial and systemic neovascularization arising from the thyrocervical trunk, internal thoracic artery, intercostal arteries, and dorsal scapular artery. Embolization was performed with microspheres, polyvinyl alcohol microparticles, and/or glue and effectively terminated hemoptysis. One patient died 10 d later as a result of fungal infection, and the 2 others remained in stable condition (18- and 26-mo postembolization follow-up available).

Endovascular management of an isolated dissection of the celiac artery following a blunt deceleration-type trauma.

A 29-year-old, otherwise healthy male was brought to the emergency department after suffering an injury from falling from the roof of his house. Whole-body computed tomography (CT) showed a small ostial dissection of the celiac artery (CA) associated with a pseudoaneurysm, thrombosis, and retroperitoneal periaortic hematoma. The celiac trunk was otherwise normal with good distal patency and no signs of intestinal ischemia. The patient was successfully managed via an endovascular approach with the placement of a covered stent in the CA.

Embolization therapy for type 2 endoleaks after endovascular aortic aneurysm repair: imaging-based predictive factors and clinical outcomes on long-term follow-up

PURPOSE: To evaluate the technical, radiological, and clinical outcomes after type 2 endoleak (T2EL) embolization in patients with a growing aneurysm sac after endovascular aortic aneurysm repair (EVAR). Additionally, to determine clinical and imaging-based factors for outcome prediction after embolization of a T2EL. METHODS: A single-institution, retrospective analysis was performed of 60 patients who underwent a T2EL embolization procedure between September 2005 and August 2016 to treat a growing aneurysm sac diameter following EVAR. The patients' electronic medical records and all available pre- and post-embolization imaging were reviewed. Statistical analysis methods included logistic regression models for binary outcomes, proportional odds models for ordinal outcomes, and linear regression models for continuous outcomes. The Kaplan-Meier method was used to estimate the overall survival probability. RESULTS: Technical, radiological, and clinical success rates after T2EL embolization were 95% (n = 57), 26.7% (n = 16), and 76.7% (n = 46), respectively. Persistent aneurysm sac expansion was found in 31 patients (51.7%). Unsharp or blurred T2EL delineation on pre-interventional computed tomography (CT) was a predictive factor for a post-embolization persistent visible endoleak and persistent growth of the aneurysm sac (P = 0.025). Median survival after T2EL embolization was 5.35 years, with no difference observed between patients with persistent sac expansion compared with patients with stable or decreased sac diameter. CONCLUSION: Progression of the aneurysm sac diameter was observed in half the study patients, despite technically successful T2EL embolization. Unsharp or blurred T2EL delineation on pre-interventional CT seemed to be an imaging-based predictor for a persistent T2EL and progressive aneurysm sac growth after embolization.

Therapeutic lymphangiography with ethiodized oil for the management of lymphoceles and chylous ascites.

PURPOSE: The purpose of this study was to analyze the safety, technical success and clinical outcome of percutaneous intranodal ethiodized oil (Lipiodol®) based lymphangiography (L-LAG) for the management of refractory pelvic lymphoceles or chylous ascites using high doses of ethiodized oil. MATERIALS AND METHODS: Thirty-four patients presenting with symptomatic, refractory postoperative pelvic lymphocele or chylous ascites referred for theranostic, inguinal, intranodal L-LAG treatment between May 2018 and November 2021 were retrospectively included. There were 21 men and 13 women, with a mean age of 62.7 ± 16.2 (standard deviation) years (age range: 9-86 years), who underwent a total of 49 L-LAG for the management of lymphoceles (n = 14), chylous ascites (n = 18) or a combination of lymphocele and chylous ascites (n = 2). Clinical and radiological pre-interventional, procedural and follow-up data up to January 2022 were collected from patients' electronic medical records and imaging files. RESULTS: Technical success was obtained in 48 out of 49 L-LAG (98%). No complications related to L-LAG were noted. After one or more L-LAG, clinical success was obtained in 30 patients (88%) with a mean of 1.4 interventions per patient and mean intranodal injected volume of 29 mL of ethiodized oil per session. The remaining four patients (12%), with one or more failed L-LAG, underwent additional surgical intervention to definitively treat the postoperative lymphatic leakage. CONCLUSION: L-LAG using high doses of ethiodized oil is a minimally invasive, safe and effective treatment of postoperative pelvic lymphocele or chylous ascites. Multiple sessions may be needed to obtain a meaningful clinical result.

Bilateral pulmonary sequestration complicated with a bibasal pneumonia in an adult patient.

Pulmonary sequestrations (PS) are rare congenital pulmonary malformations, characterized by non-functioning and dysplastic pulmonary tissue, without a normal connection to the tracheobronchial tree and supplied by the systemic arterial circulation. PS typically occur in the lower lobes and the radiologist should consider the possibility of a PS in a patient with persistent or recurrent pneumonia in the lower lobes, especially in children. We hereby present a rare case of bilateral intralobar PS complicated with bilateral pneumonia, in a previously healthy 37-year-old male patient, who was referred to the emergency department by his general practitioner because of persisting dyspnea and fever. The hospital stay was complicated with central nervous aspergillosis due to septic emboli.

Factors influencing the long-term outcome of tunneled hemodialysis catheters.

PURPOSE: To review the incidence and type of tunneled hemodialysis catheter (THC) complications in a large cohort of patients with end-stage renal disease. Additionally, the longevity of the THC and factors predicting high risk for catheter complications were assessed. MATERIAL AND METHODS: Between August 2009 and December 2016, a cohort of 538 patients underwent primary THC insertion; in 119 patients, THC was inserted after failed arteriovenous fistula or graft. Patients without available clinical follow-up data (n = 67) were excluded for further analysis. The Charlson comorbidity index (CCI) was calculated for each patient. The cumulative incidence function (CIF) was used for THC overall longevity, while Cox proportional hazards models were used for risk factor analysis. RESULTS: In 352 patients, THC was inserted in a virgin neck. THC-related complications were observed in n = 104 (29.55%) of the patients. Infection occurred in n = 38 (10.80%) and malfunction, related to thrombosis or mechanical damage, in n = 45 (12.78%). Removal of the THC for the purpose of switching to alternative dialysis methods was planned in n = 135 (38.4%). The remaining patients were still alive with a functioning THC (n = 18; 5.11%) or died (n = 95; 27%) with a functioning THC. The THC survival rate was 82.67%, 78.13%, 74.15%, 72.96%, 71.02%, and 70.63% on follow-up after 6 months, and after 1-5 years, respectively. Gender, CCI, age, and site of placement of the catheter were found not to affect the life of the catheter. CONCLUSION: The overall complication rate in primary inserted THC was nearly 30% and mainly related to infection and malfunction. THC survival was more than 70% after 5 years, which supports its use for permanent dialysis access, irrespective of gender, CCI, age, and jugular side of THC placement.