Imaging in Lung Transplantation: Surgical Considerations of Donor and Recipient.

Modifications in recipient and donor criteria and innovations in donor management hold promise for increasing rates of lung transplantation, yet availability of donors remains a limiting resource. Imaging is critical in the work-up of donor and recipient including identification of conditions that may portend to poor posttransplant outcomes or necessitate modifications in surgical technique. This article describes the radiologic principles that guide selection of patients and surgical procedures in lung transplantation.

CT of Atypical and Uncommon Presentations of Hepatocellular Carcinoma.

OBJECTIVE: The purpose of this article is to familiarize radiologists with uncommon presentations of hepatocellular carcinoma (HCC) with an emphasis on the CT spectrum of atypical appearances. CONCLUSION: HCC is the fifth most common neoplasm worldwide and the second most common cause of cancer-related death. In many cases, HCC can be confidently diagnosed with noninvasive imaging. However, there are numerous unusual appearances of HCC with which the radiologist must be familiar.

Selective non-operative management of a left ventricular pseudoaneurysm after penetrating cardiac wound.

Post-traumatic cardiac pseudoaneurysm (PSA) is a rare, potentially life-threatening complication after penetrating cardiac injury. Early surgical intervention has been the treatment of choice for this sequela due to the risk of rupture. Nevertheless, selective non-operative management (SNOM) has been practiced in patients with postinfarct PSA that are small and stable. We report a case of a post-traumatic cardiac PSA subjected to SNOM.

Incidental myocardial infarct on conventional nongated CT: a review of the spectrum of findings with gated CT and cardiac MRI correlation.

OBJECTIVE: Myocardial infarctions (MIs) are frequently evident on routine chest or abdominal CT, even when studies are not performed for cardiac-specific indications. However, the telltale signs of an MI may be easily overlooked. Herein, we present the spectrum of appearances of MIs, including areas of fat attenuation, myocardial calcifications, focal areas of wall thinning or aneurysm formation, and perfusion abnormalities. Thrombi, especially when present at the apex of the left ventricle, may also suggest an MI. CONCLUSION: The increased use of CT in the evaluation of patients for a variety of indications gives the radiologist the unique opportunity to recognize findings consistent with MI in patients who may not have a prior diagnosis of ischemic heart disease.

Chemical shift artifact on steady-state free precession cardiac magnetic resonance sequences as a result of lipomatous metaplasia: a novel finding in chronic myocardial infarctions.

BACKGROUND: Because balanced steady-state free precession (SSFP) sequences are opposed-phase gradient echo techniques, linear low signal due to chemical shift artefact is observed at fat-water interfaces. We observed that some patients with chronic myocardial infarctions had linear low signal along the inner myocardial wall in areas of infarction, which we postulated was due to chemical shift artefact, as a result of lipomatous metaplasia. The purpose of this retrospective review was to evaluate whether subendocardial low signal on SSFP, likely related to chemical shift artifact, could be used to identify chronic myocardial infarctions. METHODS: Of 128 patients who underwent cardiac magnetic resonance, 79 with myocardial infarctions were included in this retrospective study. RESULTS: Of the 79 patients, 35 (44%) demonstrated areas of linear subendocardial decreased signal. In 16 of those 35 (46%), the infarcts were confirmed as fatty by correlation with CT. In 29 of 35 (83%) of these patients, the infarcts were likely chronic based on fixed wall thinning to less than 4 mm. In 3 patients, chemical shift artifact due to lipomatous metaplasia was also confirmed with conventional in-phase and opposed-phase T1-weighted sequences. Subendocardial chemical shift artefacts were not seen in any of the 19 patients with known, acute infarcts included in this series. Aneurysms were more common when subendocardial chemical shift artefact was present (22 of 35), in comparison to patients who did not have this finding (10 of 44, P = 0.02). CONCLUSIONS: Identification of linear subendocardial chemical shift artefacts on SSFP sequences is a sign of lipomatous metaplasia in chronic myocardial infarcts and is associated with an increased incidence of ventricular aneurysms.

Classic images: coronary computed tomographic angiography.

A number of congenital and acquired conditions may affect the coronary arteries, ranging from very common entities, such as atherosclerotic disease, to very rare coronary anomalies. Some of the conditions that affect the coronary arteries are unique in the body. As a result, readers of cardiac computed tomography are faced with several unique challenges in classifying and stratifying a wide array of diseases. Herein, we discuss some of the technical aspects of coronary computed tomographic angiography and review the spectrum of coronary abnormalities that may be detected with this modality. The typical imaging findings of common and uncommon coronary disease states will be demonstrated.

Does coronary calcium score predict future cardiac function? Association of subclinical atherosclerosis with left ventricular systolic and diastolic dysfunction at MR imaging in an elderly cohort.

PURPOSE: To evaluate subclinical atherosclerosis measured by using coronary artery calcium (CAC) as a predictor of future left ventricular (LV) systolic and diastolic function in asymptomatic elderly participants. MATERIALS AND METHODS: The institutional review boards of the University of Southern California and the Harbor University of California Los Angeles Research and Education Institute (where the South Bay Heart Watch study was initially conducted) approved this HIPAA-compliant study of 386 participants (mean age, 75.2 years) from among the original 1461 participants in the longitudinal South Bay Heart Watch prospective investigation of subclinical atherosclerosis. CAC at computed tomography was correlated with LV ejection fraction (LVEF), regional wall motion abnormalities (RWMAs), and peak filling rate (PFR) assessed a mean of 11.4 years ± 0.6 (standard deviation) later with cardiac magnetic resonance imaging. Analysis of variance and covariance testing was performed with the Wald test, testing for trends across the CAC groups. Covariates included age, level of total cholesterol, level of high-density lipoprotein cholesterol, systolic blood pressure, use of lipid-lowering medication, and smoking status. RESULTS: Mean LVEF was 60.3% ± 9.9, with 11 (2.8%) of 386 participants having an LVEF of less than 40%. Forty-six (11.9%) of 386 participants had RWMAs. Higher CAC scores were associated with slightly lower LVEF (P for trend = .04) and a greater percentage of participants with decreased PFR (P for trend = .47) and RWMAs (P for trend = .01). After age- and risk factor-adjustment, only RWMA (P = .05) was associated with higher CAC. RWMAs were associated with significantly (P < .001) lower mean LVEF and PFR. Nineteen (41%) of 46 participants with RWMAs had documented Q-wave myocardial infarction, and three (7%) underwent coronary revascularization. CAC scores of 100 or greater were associated with a 2.2-fold (95% confidence interval: 1.30, 3.75) increase in RWMA (P < .001). CONCLUSION: Subclinical atherosclerosis assessed by using CAC is associated with an increased future likelihood of RWMA, as a marker of previous and possible subclinical coronary artery disease.

Calcific constrictive pericarditis demonstrated on 99mTc-MDP bone scintigraphy.

The authors present a case of calcific constrictive pericarditis, imaged with bone scintigraphy. The patient presented with three months of shortness of breath, chest pain, and chest tightness during exercise, among other nonspecific symptoms. Although the diagnosis was made based on chest radiography and cardiac MRI, bone scintigraphy was used to corroborate the diagnosis of calcific constrictive pericarditis. Bone scintigraphy showed a pattern of tracer accumulation consistent with pericardial uptake. Calcific constrictive pericarditis was also confirmed at the time of surgery.

Rare chronic gastric volvulus associated with left atrial and mediastinal compression.

We report a case of chronic gastric volvulus associated with left atrial compression in a 75-year-old woman who presented with chest pain, shortness of breath, and hypotension after elective hemiarthroplasty of the left hip. The patient's medical history included a paraesophageal hernia and gastric volvulus diagnosed in 1997 but left untreated. The present diagnosis of gastric volvulus was made on the basis of a chest radiograph and subsequent computed tomography. Echocardiography showed the volvulus compressing the left atrium. Surgery to repair the defect was successful, and there were no operative or postoperative complications. A review of the world medical literature revealed that gastric volvulus is rarely reported to cause hemodynamic compromise or compression of the heart and mediastinal structures.