Thoracic Diseases With Musculoskeletal Manifestations and Vice Versa: A Review.

OBJECTIVE: The purpose of this article is to review several thoracic conditions that are associated with certain musculoskeletal radiological abnormalities using imaging of patients with concomitant chest and musculoskeletal manifestations as illustrative examples. CONCLUSION: Radiologic findings of many thoracic diseases are often nonspecific. When standing alone, their interpretation commonly results in long differential diagnosis. However, in certain instances, a reasonably accurate diagnosis can be made based on imaging findings alone.

Coronary-pulmonary arterial fistula in a neonate with pulmonary atresia-ventricular septal defect and single coronary artery.

In cases of pulmonary atresia with ventricular septal defect (PA-VSD), coronary-pulmonary arterial fistula (CPAF) as the main source of pulmonary blood supply is extremely rare. These fistulae may arise from the left coronary artery, right coronary artery, or a single coronary artery. Fistulae from a single coronary artery are unusual. We are reporting a case of PA-VSD with single coronary artery and CPAF as the main source of pulmonary supply in addition to two major aortopulmonary collateral arteries (MAPCAS). Successful surgical correction with VSD closure and right ventricle (RV) to the pulmonary artery (PA) conduit was made.

Impact of Implementing Cardiac CT in Evaluating Patients Suspected of Cardioembolic Stroke.

BACKGROUND AND OBJECTIVES: In practice, clinical and logistic hurdles may hamper performing transesophageal echocardiography in stroke patients. Cardiac computed tomography (CT) is a recently introduced noninvasive modality able to detect various embolic causes. Thus, we retrospectively assessed possible added values of applying cardiac CT in the real-world work-up of suspected cardioembolic stroke cases. METHODS: Forty-seven patients were neurology service referrals for suspected cardioembolic stroke. The CT images and clinical reports of our cardiac CT radiologists were retrospectively evaluated. Cardiac CT was assessed in terms of detecting major embolic potential findings, potentially significant stroke-unrelated findings, and coronary arterial disease (CAD). Computed tomography results were correlated with echocardiographic reports. RESULTS: Cardiac CT showed findings of major embolic potential in 10 patients (21%, 5 thrombi cases, 2 vasculitis cases, 1 case of metastasis invading the left superior pulmonary artery, 1 myocardial infarction case, and 1 pulmonary arteriovenous malformations case), none of which were documented in echocardiography reports. Two cases (4%) with findings of major embolic potential where identified on echocardiography but not on CT (1 left atrial appendage thrombus and 1 mitral valve vegetation). Computed tomography of 13 patients (28%) showed 16 potentially significant stroke-unrelated findings. Twenty-one patients (47%) had unexpected CAD on CT, 11 (52%) of which were obstructive. CONCLUSIONS: Implementing cardiac CT in assessing patients suspected of cardioembolic stroke added value to echocardiographic evaluation, by detecting major embolic potential findings. In addition, cardiac CT revealed additional potentially significant stroke-unrelated findings and CAD.

Middle East respiratory syndrome coronavirus (MERS-CoV) infection: chest CT findings.

OBJECTIVE: The purpose of this study was to describe the chest CT findings in seven patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. CONCLUSION: The most common CT finding in hospitalized patients with MERS-CoV infection is that of bilateral predominantly subpleural and basilar airspace changes, with more extensive ground-glass opacities than consolidation. The subpleural and peribronchovascular predilection of the abnormalities is suggestive of an organizing pneumonia pattern.

Comparing Two Methods of Aortic Annulus Computed Tomography Measurements: A Retrospective Teleradiology Saudi Study.

Objectives The objective of this study was to determine the overall mean size of the aortic valve annulus and to compare two distinct methods of quantifying aortic valve annulus dimensions using computed tomography (CT) in pre-transcatheter aortic valve implantation (TAVI) Saudi teleradiology cohort. Materials and methods This retrospective cohort study, conducted from December 2019 to September 2023, included 31 patients identified using "TAVI" in our teleradiology picture archiving and communication system. CT examinations followed standardized protocols. Three experienced radiologists assessed the aortic valve annulus, measuring maximum, minimum, and mean transverse diameters, area, and area-derived diameter. The statistical analysis involved calculating mean values and standard deviations and conducting t-tests to compare measurement methods. Results The study cohort had an average age of 73.35 ± 8.55 years, with 67.74% males. No significant age difference was observed between genders (p = 0.8421). Aortic valve annulus measurements showed the mean transverse diameter to be 22.51 ± 2.04 mm and the area-derived diameter at 22.83 ± 1.99 mm, with no significant difference between these methods (p = 0.53). Additional parameters included the maximum transverse measurement (25.78 ± 2.92 mm), minimum transverse measurement (19.23 ± 2.31 mm), and area (4.12 ± 0.72 cm²). Conclusion This study employed mean and area-derived diameter methods to evaluate the average size of the aortic valve annulus within a Saudi teleradiology cohort. The average sizes determined were 22.51 mm and 22.83 mm for the mean and area-derived diameter methods, respectively. The lack of a statistically significant difference between these two methods suggests their comparable efficacy in assessing aortic valve annulus size in this cohort.

Technical Quality and Diagnostic Impact of Chest X-rays in Tuberculosis Screening: Insights From a Saudi Teleradiology Cohort.

Objectives To assess the standard of chest X-ray techniques in tuberculosis (TB) screening within Saudi Arabian healthcare facilities and evaluate the impact of technical quality on radiological interpretation. Materials and methods Analysis of 250 posteroanterior chest radiographs sourced from a network of five clinics was conducted. These images were scrutinized for technical quality by a radiologist. Results Of the radiographs analyzed, 57% exhibited technical issues, with overexposure and clothing artifacts being the most commonly encountered. Notably, only 14% of these radiographs were deemed to have compromised diagnostic ability. Conclusion The presence of technical issues in most chest X-rays for TB screening highlights a significant area for improvement. However, the relatively low percentage of radiographs impacting diagnostic quality indicates that most issues do not critically hinder the radiologist's interpretative capability. This underscores the importance of balanced quality control measures in radiographic practices for effective TB detection in the region.

Reference for Normal Diameters of the Abdominal Aorta and Common Iliac Arteries in the Saudi Population.

The abdominal aorta is the largest artery in the abdomen. It then bifurcates giving the two common iliac arteries. Knowing the normal abdominal aorta diameter is a basis for diagnosing abdominal aortic aneurysms (AAAs) and subsequently developing an optimal management plan. In order to diagnose AAA, one must have a reference for the normal abdominal aortic diameter that represents the anatomical variation in the population being studied. The aim of this research is to establish normal abdominal aortic diameters in the Saudi population.

Sinusitis and its association with deviated nasal septum at a tertiary hospital: A retrospective study.

Objectives: Sinusitis is common and deviated nasal septum (DNS) is a frequent anatomical variant in the paranasal sinuses (PNS). Whether DNS can cause sinusitis has been a subject of debate. This study determined the rate of sinusitis and its possible association with DNS and other factors in patients attending King Abdulaziz University Hospital (KAUH). Methods: We conducted a hospital-based cross-sectional study and reviewed the electronic health records of KAUH retrospectively. We recruited all patients aged ≥18 years who were referred to the Diagnostic Radiology Department for a PNS computed tomography scan from January 2018 to December 2020. Descriptive and inferential statistics were calculated. Results: A total of 676 participants met the eligibility criteria, with a mean (SD) age of 38.9 (13) years. Sinusitis was present in 47.5% of patients, 54.8% ofwhich were males. Patients aged 31-40 years suffered sinusitis more than the other age groups.Approximately three-fourths (75.1%) of the total sample had DNS, and 51.3% of them had sinusitis. Those who did not have DNS but had sinusitis were 27.8%.There were significant associations between sinusitis and both sex (P <0.001) and age (P <0.05). Patients with DNS were approximately three times more likely to have sinusitis than those without DNS (OR =2.74, 95% CI:1.86-4.04; P <0.001). Conclusion: Almost half of the patients had sinusitis, and three-fourths had DNS. Sex, age, and DNS are possible factors associated with sinusitis. Assessing the presence of DNS and correcting it, if possible, is recommended to prevent the occurrence of sinusitis.

Enhancement of Anemia Detection by Correlating Computed Tomography Findings of Abdominal Aorta and Inferior Vena Cava With Laboratory Investigations.

Anemia affects approximately a quarter of the global population, and improved detection may reduce the associated morbidity and mortality. This study investigated correlations between the results of laboratory hematological determinations of hemoglobin levels and attenuation values measured in the lumina of the abdominal aorta and inferior vena cava (IVC) via unenhanced computed tomography (CT) with the aim of expanding diagnostic options for anemia. The data of 423 patients who underwent abdominal unenhanced CT examinations and laboratory examinations at a tertiary hospital were retrospectively evaluated. CT data were collected using a standard abdominal protocol without contrast. The 151 patients who met the inclusion criteria were categorized by hemoglobin values as follows: <8 (severe anemia), 8-10.9 (moderate anemia), 10.9-12 (mild anemia in females), 10.9-13 (mild anemia in males), and >13 g/dL (non-anemic). The mean CT attenuation values in the aorta and IVC were 37.7 and 36.1 Hounsfield units (HU), respectively. A regression analysis performed to evaluate the correlation and predictability of hemoglobin-based aortic and IVC density yielded a coefficient of determination, R2: 0.42 (F ratio: 149.23, p < 0.0001). The highest contribution in the dependent variable (hemoglobin) was reported to IVC density, showing a significant positive correlation between hemoglobin and IVC density. Our study results demonstrate significant correlations between the densities of the aorta, IVC, and hemoglobin value. Accordingly, radiologists and clinicians can use these readily available values to facilitate diagnosis and patient care.

Revisiting Middle East Respiratory Coronavirus (MERS-CoV) Outbreak Chest Radiographic Initial Findings, Temporal Progression, and Correlation to Outcomes: A Multicenter Study.

Objectives Accounts of initial and follow-up chest X-rays (CXRs) of the Middle East respiratory coronavirus (MERS-CoV) patients, and correlation with outcomes, are sparse. We retrospectively evaluated MERS-CoV CXRs initial findings, temporal progression, and outcomes correlation. Materials and methods Fifty-three real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR)-confirmed MERS-CoV patients with CXRs were retrospectively identified from November 2013 to October 2014. Initial and follow-up CXR imaging findings and distribution were evaluated over 75 days. Findings were correlated with outcomes. Results Twenty-two of 53 (42%) initial CXRs were normal. In 31 (68%) abnormal initial CXRs, 15 (48%) showed bilateral non-diffuse involvement, 16 (52%) had ground-glass opacities (GGO), and 13 (42%) had peripheral distribution. On follow-up CXRs, mixed airspace opacities prevailed, seen in 16 (73%) of 22 patients 21-30 days after the initial CXRs. Bilateral non-diffuse involvement was the commonest finding throughout follow-up, affecting 16 (59%) of 27 patients 11-20 days after the initial CXRs. Bilateral diffuse involvement was seen in five (63%) of eight patients 31-40 days after the initial CXRs. A bilateral diffuse CXR pattern had an odds ratio for mortality of 13 (95% CI=2-78) on worst and 18 (95% CI=3-119) on final CXRs (P-value <0.05). Conclusion Initially, normal CXRs are common in MERS-CoV patients. Peripherally located ground-glass and mixed opacities are common on initial and follow-up imaging. The risk of mortality is higher when bilateral diffuse radiographic abnormalities are detected.

A prospective randomized controlled trial to assess the diagnostic performance of reduced tube voltage for coronary CT angiography.

OBJECTIVE: Tube voltage reduction has been shown to be an effective method to reduce radiation dose in nonobese patients undergoing coronary CT angiography. To date, the impact of reduced tube voltage on objective measures of diagnostic accuracy, as defined by quantitative coronary angiography (QCA), has not been established. The purpose of this article was to investigate the impact of tube voltage reduction on the diagnostic performance of coronary CTA compared with QCA. SUBJECTS AND METHODS: We performed a prospective randomized trial evaluating 50 consecutive patients referred for catheter angiography with a body mass index (BMI) ≤ 35 kg/m². Patients were randomly assigned to reduced (n = 24) or standard tube voltage (n = 26). Reduced tube voltage was defined as 80 or 100 kVp for individuals with BMI < 25 kg/m² or 25-35 kg/m², respectively; whereas standard tube voltage was defined as 100 or 120 kVp for individuals with BMI < 25 kg/m² or 25-35 kg/m², respectively. Tube current was fixed by study protocol as 600 mA (BMI < 30 kg/m²) or 650 mA (BMI ≥ 30 kg/m²). Coronary CTA examinations were interpreted by two blinded experienced readers with a third reader providing consensus. QCA was performed by an independent experienced core laboratory blinded to coronary CTA findings. Coronary artery segments were graded for stenosis as < 50%, 50-69%, and ≥ 70% by coronary CTA and as percentage stenosis by QCA. In an intention-to-diagnose fashion, all segments were included for final analysis, with nonevaluable segments by coronary CTA graded as obstructive. Signal and noise; contrast (mean signal-signal in left ventricular myocardium); and signal-to-noise ratio (SNR) and contrast-to-noise (CNR) ratio were compared. RESULTS: Mean age of the study cohort was 60.2 years; 78% were men. Prospective ECG gating was used in all patients, and no differences existed in scan length between groups (p = 0.19). Standard versus reduced tube voltage was associated with a reduction in effective radiation dose (2.6 ± 0.4 vs 1.3 ± 0.5 mSv, p < 0.001). The patient prevalence of luminal stenosis ≥ 50% was 56% (28/50). For detection of ≥ 50% stenosis in the standard versus reduced kVp groups, there were no differences in per-segment sensitivity (87% vs 84%, p = 0.73), specificity (92% vs 93%, p = 0.81), or accuracy (92% vs 91%, p = 0.70). No differences were noted for reduced versus standard tube current for SNR (13 ± 4 vs 13 ± 3, p = 0.59), CNR (10 ± 3 vs 10 ± 2, p = 0.99), or graded (0-4) image quality score (3.4 ± 0.8 vs 3.5 ± 0.6, p = 0.19). CONCLUSION: Compared with standard tube voltage, coronary CTA using reduced tube voltage results in lower effective radiation dose with comparable diagnostic performance.

Role of imaging in penetrating and blunt traumatic injury to the heart.

Cardiac injury due to blunt or penetrating chest trauma is common and is associated with significant morbidity and mortality. Understanding the mechanisms, types, and complications of cardiac injuries and the roles of various imaging modalities in characterizing them is important for appropriate diagnosis and treatment. These injuries have not been well documented at imaging, but there are now fast and accurate methods for evaluating the heart and associated mediastinal structures. The authors review the broad spectrum of injuries that can result from blunt or penetrating trauma to the chest, as well as the imaging modalities commonly used in the acute trauma setting for evaluation of the heart and mediastinal structures. A pictorial review of both common and, to date, rarely documented cardiac injuries imaged with a variety of modalities is also presented. While many imaging modalities are available, the authors demonstrate the value of multidetector computed tomography (CT) for the initial evaluation of patients with blunt or penetrating chest trauma. With the advent of multidetector CT, imaging of cardiac injury has increased and accurate identification of these rare but potentially lethal injuries has become paramount for improving survival. Selection of the most appropriate modality for evaluation and recognition of the imaging findings in cardiac injuries in the acute trauma setting is important to expedite treatment and improve survival.

Confirmed swine-origin influenza A(H1N1) viral pneumonia: computed tomographic findings in the immunocompetent and the immunocompromised.

AIM: This study aimed to retrospectively evaluate the computed tomographic (CT) appearance of cases of swine-origin influenza A(H1N1) viral infection (S-OIV) in immunocompetent and immunocompromised patients confirmed with reverse transcription-polymerase chain reaction and to determine whether the timing of CT relative to the onset of symptoms affected the overall imaging appearance [corrected]. METHODS: A total of 23 patients (15 men and 8 women) from 2 tertiary care centers formed the final study population. Patients were divided into 2 groups based on their immune status: group 1 (n = 14) were patients who were immunocompromised, whereas group 2 (n = 9) were patients who were immunocompetent. The radiologic appearances of pulmonary abnormalities, distribution, and extent of involvement on the initial chest CT scan were documented, and correlation with the onset of symptoms was performed. RESULTS: The most common CT pattern in both groups of S-OIV patients was ground-glass opacities and consolidation (group 1, 86%; group 2, 71%) in a bilateral, subpleural, and peribronchovascular pattern. Small airways disease [corrected] was seen only in a minority of patients (group 1, 7%; group 2, 11%. Onset of symptoms to time of CT showed a mean duration of 9.7 days in group 1 and 6.7 days in group 2 and did not affect the overall imaging appearance. CONCLUSIONS: The most common abnormalities on CT scans of both immunocompetent and immunocompromised S-OIV patients were ground-glass opacities and consolidation in a bilateral, subpleural, and peribronchovascular distribution, resembling organizing pneumonia. This appearance was seen regardless of the timing of CT relative to the onset of symptoms.

Magnetic resonance imaging in the management of Crohn's disease: a systematic review and meta-analysis.

OBJECTIVES: Crohn's disease (CD) is a condition that can occur in any part of the gastrointestinal tract, although usually forms in the colon and terminal ileum. Magnetic resonance imaging (MRI) has become a beneficial modality in the evaluation of small bowel activity. This study reports on a systematic review and meta-analysis of magnetic resonance enterography for the prediction of CD activity and evaluation of outcomes and possible complications. METHODS: Following the PRISMA guidelines, a total of 25 low-risk studies on established CD were selected, based on a QUADAS-II score of ≥ 9. RESULTS: A sensitivity of 90% was revealed in a pooled analysis of the 19 studies, with heterogeneity of χ2 = 81.83 and I2 of 80.3%. Also, a specificity of 89% was calculated, with heterogeneity of χ2 = 65.12 and I2 of 70.0%. CONCLUSION: It was concluded that MRI provides an effective alternative to CT enterography in the detection of small bowel activity in CD patients under supervision of radiologist for assessment of disease activity and its complications. Its advantages include the avoidance of radiation exposure and good diagnostic accuracy.

Minute pulmonary meningothelial-like nodules: a case of incidentally detected diffuse cystic micronodules on thin-section computed tomography.

Minute pulmonary meningothelial-like nodules are common incidental pathologic findings but are sparsely described in the radiology literature. They are of uncertain origin and significance, but they can occasionally manifest as mild restrictive lung disease or as incidental micronodules on computed tomography. We present a case of multiple incidentally detected, randomly distributed, cavitating micronodules with pathologic correlation. Awareness of the rare presentation of this entity is important because it may simulate neoplastic or other nonneoplastic diseases.

Angiomatoid fibrous histiocytoma: magnetic resonance imaging appearance in 2 cases.

OBJECTIVE: Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor usually affecting the extremities of children and young adults and has a favorable prognosis. The purpose of this study was to report the magnetic resonance imaging appearance in 2 cases of AFH. CONCLUSIONS: Although the overall features of AFH can be confused with other subtypes of malignant fibrous histiocytoma, the young age at presentation, the location of the mass, the presence of intralesional blood-filled cystic spaces with fluid-fluid levels, associated features of hemosiderin deposition, and an enhancing fibrous pseudocapsule are all potential hints favoring this entity.

Swine-origin influenza A (H1N1) viral infection: radiographic and CT findings.

OBJECTIVE: The objective of our study was to review the chest radiographic and CT findings in patients with swine-origin influenza A (H1N1) virus (S-OIV) infection. CONCLUSION: The most common radiographic and CT findings in seven patients with S-OIV infection are unilateral or bilateral ground-glass opacities with or without associated focal or multifocal areas of consolidation. On MDCT, the ground-glass opacities and areas of consolidation had a predominant peribronchovascular and subpleural distribution, resembling organizing pneumonia.

Intracholecystic fat herniation in traumatic gallbladder perforation: a case report.

Gallbladder injuries from blunt trauma are uncommon and are also challenging to diagnose both clinically and radiologically. We present a case of intracholecystic fat herniation as a computed tomographic sign of gallbladder perforation.