Radiology Of The Month: Spontaneous Bilateral Pneumothoraces in an HIV-Infected Patient.

A 36-year-old woman with past medical history of HIV/AIDS not on HAART therapy (CD4 count of 34) and recurrent Pneumocystis jiroveci pneumonia presented to the emergency room for cough, chest pain, and worsening shortness of breath over the past 72 hours.

Radiology Case of the Month: An Unusual Etiology of Increased Abdominal Girth in a 42-Year-Old Man.

A 42-year-old man with diabetes and hypertension presented to the emergency room after experiencing a several month history of gradually increasing abdominal girth with the sudden onset of abdominal pain.

Colonic stricture: A rare complication of ultraselective transcatheter arterial embolization with microcoils for transverse colonic diverticular hemorrhage.

Ultraselective transcatheter arterial embolization with microcoils is a highly effective and safe treatment for lower gastrointestinal bleeding. Here we present a patient with a history of pandiverticulosis, who was hospitalized with acute hemorrhage in the mid-transverse colon. The patient underwent a successful embolization with a microcatheter and microcoils. Postembolization angiography demonstrated no residual flow to the areas of concern. One-month postembolization, however, the patient presented to the emergency department with nonspecific abdominal symptoms. After imaging and endoscopy studies, a colonic stricture-a rare complication of ultraselective embolization with microcoils- was found. The patient underwent partial colectomy of the mid-transverse colon; postcolectomy course was uneventful. The case suggests a rare but clinically significant complication of ultraselective embolization using microcoils for patients with diverticular hemorrhage. We therefore hope to assist clinicians in making the appropriate diagnosis and intervention when presented with similar clinical presentations and history of embolization.

Relationship between serum markers and volume of liver metastases in castration-resistant prostate cancer.

BACKGROUND: Prostate cancer patients with liver metastases have a poor prognosis. To date, no study exists investigating the relationship between liver tumor burden and clinical laboratory markers. MATERIALS AND METHODS: Metastatic castrate-resistant prostate cancer (mCRPC) patients with radiographic evidence of liver metastases were selected for this study. Volumetric measurements of liver metastases were ascertained for all available patients. Prostate specific antigen (PSA), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), total bilirubin and hemoglobin (HGB) levels were then assessed to coincide with the scan dates. Univariate and multivariate mixed-model regression analysis were performed to evaluate the relationship between laboratory markers and liver lesion volume. Data sets with non-normal distribution were logarithmically transformed. Akaike information criteria (AIC) was used to identify the most reliable multivariate model. RESULTS: In our heavily pretreated liver-metastatic patient population, univariate analysis demonstrated a statistically significant positive correlation between PSA (p = 0.0002), ALP (p = 0.0305), AST (p < 0.0001), ALT (p = 0.0049), and LDH (p = 0.0019) and liver lesion volume. Additionally, ALB (p = 0.0006) and HGB (p = 0.0103) had statistically significant negative correlation. Multivariate analysis identified AST and hemoglobin assessments as the best predictors of increasing liver lesion burden. Preliminary data on circulating tumor DNA (ctDNA) mutational and amplification findings are also reported. CONCLUSIONS: Analysis identified AST and hemoglobin as optimal predictors of liver lesion volume. These patients have a heavy burden of ctDNA abnormalities. Further studies with a larger patient population are needed to verify these results. Micro Abstract: This study investigates the association between liver lesion burden and clinical laboratory markers in castrate-resistant prostate cancer patients with hepatic metastases. Our univariate analysis identified multiple laboratory markers as significant indicators of worsening hepatic disease. Multivariate analysis demonstrated that AST and hemoglobin were the most effective predictors of change in liver lesion volume.