Multimodality imaging of left ventricular apical pseudoaneurysm after apical approach transcatheter aortic valve replacement.

Left ventricular pseudoaneurysm formation is a rare complication of transapical approach transcatheter aortic valve replacement. It can cause chest pain and shortness of breath or remain asymptomatic. Mortality rate is high, and therefore, timely diagnosis and management are essential. Different imaging modalities can provide anatomic or functional information and are essential for the primary diagnosis or during follow-up.

Multimodality imaging of IgG4 related coronary artery aneurysm.

Involvement of the coronary arteries by immunoglobulin G4-related disease is rare. It can cause coronary artery aneurysm and arterial wall thickening. Imaging plays a key role in the assessment of the coronary arteries and multimodality approach imaging is helpful to make the diagnosis and provide functional and prognostic information.

Multimodality imaging of tumefactive lipomatous hypertrophy of the right ventricle extending to the right ventricular outflow tract.

Lipomatous hypertrophy of the right ventricle is a rare entity that is usually asymptomatic and diagnosed incidentally in an otherwise healthy individual. Accurate diagnosis and assessment of possible hemodynamic consequences of this pathology is, however, necessary to secure an appropriate treatment. Multimodality imaging with echocardiography, CT, and cardiac MR can provide useful functional and anatomic information that can help to reach this goal.

Multimodality approach to the diagnosis and management of constrictive pericarditis.

Despite advances in cardiovascular imaging, the diagnosis of constrictive pericarditis remains challenging. A multimodality approach to the diagnosis of CP is essential to (a) fully assess the extent of pericardial thickening and calcification, (b) detect the functional and hemodynamic consequences of the constricting pericardium, and (c) implement the optimal management strategy in these often complex cases. This case-based review highlights the role and diagnostic ambiguities of multimodality imaging.

Myocarditis associated with immune checkpoint inhibitor therapy: a case report of three patients.

Immune checkpoint inhibitor (ICI)-associated myocarditis is a rare but potentially fatal complication associated with development of other immune-related adverse events (irAEs). Troponin levels, ECG, echocardiography, and cardiac MR can assist with the diagnosis of this rare albeit serious adverse effect related to immunotherapy. In this case report, we present the clinical and radiological features of myocarditis in three patients presenting with acute symptoms while receiving therapy with ICIs. Blood troponin and ECG were abnormal in all three myocarditis cases. Initial echocardiography was abnormal in two patients with reduced left ventricular ejection fraction (LVEF). The third patient demonstrated an initially normal LVEF with subsequent transient decrease in LVEF on follow-up echocardiogram. Cardiac MR was abnormal in three cases with areas of mid-myocardial/epicardial delayed enhancement. All patients experienced additional irAEs. One patient died shortly after myocarditis diagnosis, one was made comfort care due to poor clinical status, and one improved with steroid treatment.

Multimodality imaging of quadricuspid pulmonary valve associated with pulmonary artery aneurysm.

Quadricuspid pulmonary valve is a rare entity that can be associated with pulmonary artery aneurysm. It is usually asymptomatic and diagnosed incidentally. Association with other congenital or acquired heart diseases has been reported. Echocardiography and gated CT angiography can provide useful functional and anatomic information that can help in the diagnosis and management.

Impact of pretransplant rifaximin therapy on early post-liver transplant infections.

Bacterial and fungal infections are major causes of morbidity and mortality after liver transplantation (LT). The role of intestinal decontamination in the prevention of post-LT infections is controversial. Rifaximin is widely used for the treatment of hepatic encephalopathy. The effect of rifaximin on post-LT infections is unknown. The aim of our study was to determine the effect of rifaximin therapy in the pretransplant period on early bacterial infections (EBIs) and fungal infections within the first 30 days after LT. All adult patients who underwent LT at our institution (January 2009 to July 2011) were included in this retrospective cohort study. Patients receiving antibiotics other than pretransplant protocol antibiotics were excluded. Patients were stratified into 2 groups based on the presence or absence of rifaximin therapy for at least 2 days before LT. Infections were defined by the isolation of any bacterial or fungal organisms within 30 days of LT. Multivariate regression analysis, Student t tests, and Pearson's chi-square tests were used to compare the 2 groups. Two hundred sixty-eight patients were included, and 71 of these patients (26.5%) were on rifaximin at the time of LT. The 2 groups were comparable with respect to age, sex, race, and Model for End-Stage Liver Disease score. There were no significant differences in the rates of EBIs (30% for the non-rifaximin group and 25% for the rifaximin group, P = 0.48) or fungal infections between the 2 groups. There was no increase in antimicrobial resistance among the infecting organisms. There was no difference in survival between the rifaximin and non-rifaximin groups (98% versus 97%, P = 0.36). In conclusion, the use of rifaximin in the pre-LT period was not associated with an increased risk of bacterial or fungal infections in the early post-LT period.

Once-weekly semaglutide in people with HIV-associated lipohypertrophy: a randomised, double-blind, placebo-controlled phase 2b single-centre clinical trial.

BACKGROUND: HIV-associated lipohypertrophy, which is characterised by an abnormal accumulation of abdominal visceral adipose tissue, remains problematic in people with HIV. Effective interventions are lacking, despite HIV-associated lipohypertrophy carrying a substantial risk of cardiometabolic comorbidity. The primary aim of this trial was to investigate effects of the GLP-1 receptor agonist, semaglutide, on adipose tissue in HIV-associated lipohypertrophy. METHODS: This randomised, double-blind, placebo-controlled phase 2b clinical trial was conducted at a single US site. Key inclusion criteria included people with HIV aged 18 years or older with controlled HIV-1, a BMI of 25 kg/m2 or more, and lipohypertrophy but without type 1 or type 2 diabetes. Participants were randomly assigned 1:1 to receive 32 weeks of once-weekly subcutaneous semaglutide (8-week dose titration and 24 weeks at 1·0 mg) or placebo; all research personnel and participants remained masked to treatment assignment. Primary outcomes were changes at 32 weeks in adipose tissue quantity by body compartment. Analyses, including safety, were performed using intention-to-treat principles. This trial was registered ClinicalTrials.gov (NCT04019197) and is complete. FINDINGS: Between June 10, 2019, and July 28, 2022, 108 participants were randomly assigned to receive semaglutide (n=54) or placebo (n=54). Eight (15%) in each group withdrew prematurely. Significant effects of semaglutide were seen over the 32-week study period in sex-adjusted multiplicative regression analyses for the primary outcome, abdominal visceral adipose tissue (ß -30·82 cm2, 95% CI -50·13 to -11·51; % change -30·6%). Decreases were also seen in other key measures, including abdominal subcutaneous adipose tissue (ß -42·01 cm2, 95% CI -75·49 to -8·52; % change -11·2%) and total body fat (natural logarithmic -0·21 kg, 95% CI -0·33 to -0·08; % change -18·9%). There were no statistically significant differences in possibly related or related adverse events (absolute risk difference 0·1111, 95% CI -0·0727 to 0·2869); however, one semaglutide-related grade 4 elevated lipase and two possibly related cases of cholelithiasis (grades 1 and 2) were observed. INTERPRETATION: Semaglutide holds promise as an effective treatment for HIV-associated lipohypertrophy. The potential risk of serious adverse events deserves further scrutiny in large trials in people with HIV. FUNDING: National Institutes of Health.

Application of dual energy CT in the diagnosis of amiodarone lung toxicity as a cause of lung mass.

BACKGROUND: Diagnosis of amiodarone lung toxicity on computerized tomography (CT) can be challenging especially in the presence of mass-like consolidation. Additional causes of mass-like consolidation including malignancy and pneumonia should be excluded, sometimes requiring tissue sampling. CASE: Here we present a case of amiodarone lung toxicity, with diagnosis suspected based on patient's history of chronic cardiac disease, amiodarone treatment, and imaging characteristics. Evaluation with dual energy CT demonstrated high iodine content in the mass-like consolidation further supporting the diagnosis. Biopsy of the mass-like consolidation confirmed amiodarone toxicity. CONCLUSION: Dual energy CT has potential utility in differentiating mass-like consolidation from other etiologies such as malignancy or pneumonia.

High-dose interleukin-2 therapy related adverse events and implications on imaging.

High-dose interleukin-2 (HDIL-2) therapy was initially approved by the U.S. Food and Drug Administration for metastatic renal cell carcinoma (mRCC) and metastatic melanoma. IL-2 is able to promote CD8+ T cell and natural killer (NK) cell cytotoxicity to increase tumoricidal activity of the innate immune system. HDIL-2 therapy is associated with a wide spectrum of immune-related adverse events (irAEs) that can be radiologically identified. HDIL-2 toxicity can manifest in multiple organ systems, most significantly leading to cardiovascular, abdominal, endocrine, and neurological adverse events. The collective impact of the irAEs and the rise of immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors led to the demise of HDIL-2 as a primary therapy for mRCC and metastatic melanoma. However, with innovation in ICIs and the creation of mutant IL-2 conjugates, there has been a drive for combination therapy. Knowledge of the HDIL-2 therapy and HDIL-2 related adverse events with radiology relevance is critical in diagnostic image interpretation.

Sensitivity of ultrasound in detecting hepatocellular carcinoma in obese patients compared to explant pathology as the gold standard.

BACKGROUND/AIMS: The American Association for the Study of Liver Diseases recommends ultrasound (US) screening for hepatocellular carcinoma (HCC) among cirrhotic patients, regardless of body mass index (BMI), every 6 months. We examined US sensitivity for diagnosis of HCC in obese patients. METHODS: Liver transplant patients data with HCC in explant was used (January 2012-December 2017). All patients underwent liver US within 3 months of diagnosis of HCC. Number/size of HCC lesions were extracted from radiologic and pathologic reports. Obesity was defined as BMI ≥30 kg/m2. RESULTS: One hundred sixteen patients were included. 80% were male, with mean BMI of 31 kg/m2. The most common underlying liver disease was hepatitis C virus (62%). At the time of diagnosis, median number of HCC lesions was 2 (interquartile range [IQR], 1-3), and median size of the largest lesion was 2.5 cm (IQR, 1.75-3.9). Overall sensitivity of US study for detection of HCC was 33% (95% confidence interval [CI], 29-48%). Sensitivity was 77% (95% CI, 62-93%) in patients with BMI<30 and 21% (95% CI, 11-30%) in patients with BMI≥30 (P<0.001). Size of the largest HCC lesion (P=0.290) and number of lesions (P=0.505) were not different between groups. Computed tomography (CT) scan detected HCC in 98% of the obese patients with negative US. CONCLUSION: Sensitivity of US for detection of HCC is significantly lower among obese patients compared to overweight and normal weight patients. These patients may benefit from alternating between US and a different imaging modality.

Chronic airspace disease: Review of the causes and key computed tomography findings.

Chronic airspace diseases are commonly encountered by chest, body or general radiologists in everyday practice. Even though there is significant overlap in the imaging findings of different causes of chronic airspace disease, some key clinical, laboratory and imaging findings can be used to guide the radiologist to the correct diagnosis. The goal of this article is to review and compare these features.

Dual-energy Subtraction Chest Radiography: Application in Cardiovascular Imaging.

The chest radiograph is the most frequently performed imaging in radiology and by including the heart and central vessels can suggest the presence of cardiovascular disease. Dual-energy subtraction radiography of the chest provides improved detection of a wide variety of cardiovascular pathologies including coronary artery disease, valvular pathologies, and pericardial disease given the presence of calcification in many subtypes of these diseases. We review the principles of dual-energy subtraction radiography and demonstrate its added value in the assessment of cardiovascular disease.

Tracheobronchial Tumors: Radiologic-Pathologic Correlation of Tumors and Mimics.

Tracheobronchial masses encompass a broad spectrum of entities, ranging from benign and malignant neoplasms to infectious and inflammatory processes. This article reviews the cross-sectional findings of tracheal tumors and tumor-like entities, correlates imaging findings with histologic pathology, and discusses pearls and pitfalls in accurately diagnosing and classifying tracheal tumors and mimics.

E-cigarette use related lung disease, review of clinical and imaging findings in 3 cases.

Electronic-cigarette use (vaping), has gained popularity among the young adult population, causing an alarming rise in electronic-cigarette, or vaping, product use-associated lung injury (EVALI). The specific chemical agent(s) responsible for lung injuries remains to be further investigated, but tetrahydrocannabinol, the active ingredient in marijuana, and vitamin E acetate are involved in most cases. A variety of pulmonary diseases causing different imaging findings have been described with EVALI. The clinical and imaging findings of three cases recently seen in our emergency department are reviewed.

Cardiovascular findings on cross-sectional imaging: spectrum of incidental and critical findings and clinical relevance for the abdominal radiologist.

Although not the primary focus of the exams, cardiovascular structures are included to some extent on all abdominal or whole-body cross-sectional studies. Cardiovascular findings often present incidentally and may range from chronic to acute and emergent pathologies. Among the most common cardiovascular findings are the presence of cardiac calcifications, most commonly coronary, which correlate with the presence of coronary artery and valvular disease. Signs of myocardial ischemia, both acute and chronic, and its complications may also be visualized. Cardiac filling defects most commonly represent thrombus and are associated with systemic arterial embolic complications. Pericardial findings often manifest as effusion or thickening, which may lead to hemodynamic consequences visible at imaging. Incidental pulmonary emboli and systemic venous thrombi may be incidentally detected, particularly in hospitalized and oncologic patients, and warrant immediate attention. This review will highlight the appearance of common and important incidental cardiovascular findings and related pitfalls and discuss reporting and follow-up recommendations relevant to the abdominal radiologist.

Unusual MRI appearance of a well differentiated hepatocellular carcinoma, mimicking a cavernous hemangioma: A case report.

The typical imaging findings in hepatocellular carcinoma (HCC) are arterial hyperenhancement with washout on portal venous and/or equilibrium phases. Larger HCCs can have atypical imaging findings including fibrous capsule or mosaic appearance. We describe an unusual biopsy proven HCC in a cirrhotic liver with imaging features mimicking cavernous hemangioma which also demonstrated some atypical features such as thick capsule. In addition to knowing the typical imaging findings of HCC, it is important to be familiar with its atypical imaging findings especially in larger lesions.

Alveolar Sarcoidosis With Intense FDG Uptake, Mimicking Multi-focal Pneumonia and Infiltrative Lung Malignancy.

Alveolar sarcoidosis is an uncommon radiologic manifestation of pulmonary sarcoidosis which appears as infiltrative or mass-like opacities mimicking multifocal pneumonia or infiltrative lung malignancies such as multi-focal adenocarcinoma or pulmonary lymphoma. It has correlation with a more acute and symptomatic phase of thoracic sarcoidosis and therefore expected to show a more severely increased metabolic activity on FDG PET. Alveolar sarcoidosis shows a relatively rapid radiological improvement after initiation of corticosteroid therapy. Tissue diagnosis might be needed in some cases to exclude malignancy.