Complications of thoracic endovascular aneurysm repair (TEVAR): A pictorial review.

Thoracic endovascular aneurysm repair (TEVAR) has replaced open surgical repair as the treatment of choice for several aortic conditions. Despite its lower morbidity and mortality, several TEVAR-related complications can occur and some of which may necessitate surgical or endovascular re-intervention. The current article reviews common and rare complications of TEVAR procedure with emphasis on complications identifiable on cross-sectional imaging and potential pitfalls of pre-procedural planning.

Pulmonary manifestations of amyloidosis.

Amyloidosis is caused by abnormal protein deposition in various tissues, including the lungs. Pulmonary manifestations of amyloidosis may be categorized by areas of involvement, such as parenchymal, large airway and pleural involvement. We describe four distinct manifestations of amyloidosis involving the lung and review their clinical, radiological and pathological features and summarize the evidence for treatment in each of these presentations. We describe alveolar-septal amyloidosis, cystic amyloid lung disease, endobronchial amyloidosis and pleural amyloidosis.

Inter-observer variability of expert-derived morphologic risk predictors in aortic dissection.

OBJECTIVES: Establishing the reproducibility of expert-derived measurements on CTA exams of aortic dissection is clinically important and paramount for ground-truth determination for machine learning. METHODS: Four independent observers retrospectively evaluated CTA exams of 72 patients with uncomplicated Stanford type B aortic dissection and assessed the reproducibility of a recently proposed combination of four morphologic risk predictors (maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and intercostal arteries). For the first inter-observer variability assessment, 47 CTA scans from one aortic center were evaluated by expert-observer 1 in an unconstrained clinical assessment without a standardized workflow and compared to a composite of three expert-observers (observers 2-4) using a standardized workflow. A second inter-observer variability assessment on 30 out of the 47 CTA scans compared observers 3 and 4 with a constrained, standardized workflow. A third inter-observer variability assessment was done after specialized training and tested between observers 3 and 4 in an external population of 25 CTA scans. Inter-observer agreement was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots. RESULTS: Pre-training ICCs of the four morphologic features ranged from 0.04 (-0.05 to 0.13) to 0.68 (0.49-0.81) between observer 1 and observers 2-4 and from 0.50 (0.32-0.69) to 0.89 (0.78-0.95) between observers 3 and 4. ICCs improved after training ranging from 0.69 (0.52-0.87) to 0.97 (0.94-0.99), and Bland-Altman analysis showed decreased bias and limits of agreement. CONCLUSIONS: Manual morphologic feature measurements on CTA images can be optimized resulting in improved inter-observer reliability. This is essential for robust ground-truth determination for machine learning models. KEY POINTS: • Clinical fashion manual measurements of aortic CTA imaging features showed poor inter-observer reproducibility. • A standardized workflow with standardized training resulted in substantial improvements with excellent inter-observer reproducibility. • Robust ground truth labels obtained manually with excellent inter-observer reproducibility are key to develop reliable machine learning models.

Pneumothorax and pneumomediastinum in COVID-19: A case series.

COVID- 19 has become a major pandemic affecting more than 11 million people worldwide. Common radiological manifestations of COVID-19 include peripheral based ground-glass or consolidative opacities; however, pneumothorax and pneumo-mediastinum are very rare manifestations; even more so within patients not on mechanical ventilation. We present a case series of 5 patients with COVID-19 who either presented with or developed spontaneous pneumothorax or pneumo-mediastinum within the course of hospitalization. With the exception of one patient, all other patients developed pneumothorax as a late manifestation in their illness; more than 10 days after initial symptom onset in COVID-19. From within this case series, all patients who developed spontaneous pneumothorax or pneumo-mediastinum during hospitalization subsequently succumbed to the illness. Spontaneous pneumothorax or pneumo-mediastinum may be an important late manifestation in COVID-19; even in spontaneously breathing patients. This may be related to development of cystic changes within the lung parenchyma. Although the clinical relevance of this finding is unknown; in our series, it portended a worse prognosis in the majority of patients.

It's Not All in Your Head: Thoracic Manifestations of Neurologic Diseases and Disorders.

Myriad conditions may affect both the neurologic system and the thorax, while other diseases primarily affecting the thorax may manifest with neurologic abnormalities. Correlation of signs, symptoms, and imaging findings in the neurological system with those in the thorax can help diagnose certain conditions and/or guide further diagnostic work-up and treatment. We will review and illustrate the imaging appearance of several systemic/neurological diseases with thoracic manifestations as well as discuss conditions in the thorax that can lead to neurologic symptoms.

Thoracic Cardiovascular Complications of Tuberculosis.

ABSTRACT: Mycobacterium infection remains a leading cause of morbidity and mortality worldwide. Although rare, thoracic cardiovascular complications are associated with devastating consequences if not promptly diagnosed using computed tomography. Intrapulmonary complications include tuberculous aortitis, Rasmussen aneurysms, involvement of bronchial and nonbronchial systemic arteries, and thromboembolic events. Extrapulmonary complications include pericarditis, myocarditis, endocarditis, involvement of coronary arteries, annular-subvalvular left ventricle aneurysms and mediastinal fibrosis. This article will review these complications and their computed tomography features.

Cross-Sectional Abdominal Imaging Findings in Patients With COVID-19.

Objective We aimed to review and analyze cross-sectional abdominal imaging findings in a cohort of 10 patients who had tested positive for coronavirus disease 2019 (COVID-19). Methods This retrospective study conducted from April 1, 2020, to May 13, 2020, involved two institutions that comprised a central tertiary academic institution and multiple smaller community hospitals. We reviewed and examined cross-sectional imaging studies of patients who tested positive for COVID-19 either during the emergency room (ER) visit or hospital admission. Salient imaging findings and medical records were reviewed. Results A total of 10 COVID-19-positive patients (seven males and three females) of ages ranging from 21-75 years underwent cross-sectional abdominopelvic imaging. Nine of the 10 patients demonstrated typical lung base findings associated with COVID-19 on both CT and MRI. Twelve CT abdominopelvic examinations, one MRI abdomen, and one right upper quadrant ultrasound (RUQ US) were performed, with three patients undergoing two CT scans during the course of hospitalization. Gastric and bowel wall abnormalities were found on 25% (n=3/12) of abdominal CT scans. Acute interstitial pancreatitis and acute cholecystitis were both found on one CT exam. The remaining (n=7/12, 58%) CT studies demonstrated no acute intraabdominal pathology with incidental findings including fatty liver disease, cirrhosis, and splenomegaly. Conclusion A spectrum of abdominal imaging findings ranging from colitis to pancreatitis may be correlated with COVID-19 infection, even though the majority of our patients with gastrointestinal (GI) symptoms did not have identifiable GI pathology on imaging.

Coronavirus Disease 2019 (COVID-19)-Associated Thromboembolic Disease: A Report of Three Patients With Pulmonary Embolism.

Coagulopathy and thromboembolic disease, including pulmonary embolism (PE), are reported complications of coronavirus disease 2019 (COVID-19). The mechanism is not fully understood. We present three patients with COVID-19 and concurrent PE.

Developmental lung anomalies in adults: A pictorial review.

Developmental lung anomalies represent a heterogeneous group of diverse, yet related abnormalities that involve the lung parenchyma, pulmonary vasculature or a combination of both-which usually present prenatally and in early childhood. However, a substantial number of cases go unnoticed during childhood and present either incidentally or with recurrent respiratory infections progressing into adulthood. Defective development of the tracheobronchial tree and the pulmonary vasculature are proposed to cause these developmental anomalies. Encountering these lung anomalies in adults is a diagnostic challenge given their rarity and they are often mistaken as other serious pathological conditions, resulting in unnecessary diagnostic tests and procedures. The developmental lung anomalies in adults can be broadly divided into three categories: bronchopulmonary anomalies encompassing congenital bronchial atresia, bronchogenic cysts, congenital lobar emphysema and congenital pulmonary airway malformations. Vascular anomalies include pulmonary agenesis-aplasia- hypoplasia complex, unilateral absence of the pulmonary artery, pulmonary artery sling, partial anomalous pulmonary venous return, pulmonary venous varix and pulmonary arteriovenous malformations. Finally combined lung parenchymal-vascular anomalies of the lung involve hypogenetic lung (scimitar) syndrome and bronchopulmonary sequestration. This article discusses the spectrum of these developmental anomalies of the lung, their etiopathogenesis, clinical and radiographic presentations in adults and management in brief.

Clinical Characteristics and Etiologies of Miliary Nodules in the US: A Single-Center Study.

BACKGROUND: Miliary nodules have been typically described as a radiological manifestation of disseminated tuberculosis. However, miliary nodules are known to occur in a wide variety of conditions. The primary objective of the study was to identify clinical characteristics and etiologies of miliary nodules within our institution. METHODS: Using International Classification of Diseases, Ninth and Tenth Revision codes, electronic medical records were used to retrospectively identify 53 patients who fulfilled criteria of miliary nodules over the last 10 years. Demographic and clinical data were extracted for all the patients in this cross-sectional study. RESULTS: The diagnosis of tuberculosis was made in 15 (28.3%) patients, sarcoidosis in 12 (22.6%), silicosis in 7 (13.2%), extrathoracic malignancy in 5 (9.4%), and histoplasmosis in 4 (7.6%) patients. Four of 9 HIV patients had histoplasmosis. There was 1 case each of hypersensitivity pneumonitis, Pneumocystis jiroveci pneumonia, Mycobacterium-avium complex, Epstein-Barr virus pneumonia, cryptococcosis, aspergillosis, and primary lung cancer. Sputum was positive for acid fast bacilli in 4 cases (28%), and bronchoscopy had a 57% successful yield in miliary tuberculosis. CONCLUSION: Our study is the largest single-center data review evaluating the etiology of miliary nodules within the United States; most of the data exist in case reports.

Congenital anomalies of the pulmonary arteries: an imaging overview.

Congenital pulmonary artery anomalies represent a diverse group of abnormalities, ranging from asymptomatic incidental findings to causes of sudden cardiac death. While some may be recognized in childhood, others may be found incidentally in adulthood. We review the clinical and imaging findings in patients with congenital anomalies of the pulmonary arteries, including valvular and perivavular anomalies as well as abnormal narrowing, course and communications of the pulmonary arteries. We also discuss the role of various imaging modalities in the evaluation of these patients. It is vital to be aware of the key radiologic manifestations and associated haemodynamic consequences in these conditions in order to facilitate accurate diagnosis and prognostic stratification.

Aortic arch tortuosity, a novel biomarker for thoracic aortic disease, is increased in adults with bicuspid aortic valve.

INTRODUCTION: Arterial tortuosity has emerged as a predictor of adverse outcomes in congenital aortopathies using 3D reconstructed images. We validated a new method to estimate aortic arch tortuosity on 2D CT. We hypothesize that arch tortuosity may identify bicuspid aortic valve (BAV) patients at high risk to develop thoracic aortic aneurysms or aortic dissections (TAD). METHODS: BAV subjects with chest CT scans were retrospectively identified in our clinical records and matched to tricuspid aortic valve (TAV) controls by age, gender, and presentation with TAD. Subjects with prior ascending aortic intervention were excluded. Measurements included aortic arch tortuosity, length, angle, width and height. Total aortic tortuosity was estimated in subjects with available abdominal images. RESULTS: 120 BAV and 234 TAV subjects were included. Our 2D measurements were highly correlated with 3D midline arch measurements and had high inter- and intra-observer reliability. Compared to TAV, BAV subjects had increased arch tortuosity (median 1.76 [Q1-Q3: 1.62-1.95] vs. 1.63 [1.53-1.78], P < 0.01), length (149 [136-160] vs. 135 [122-152] mm, P < 0.01), height (46 [41-53] vs. 39 [34-47] mm, P < 0.01), and vertex acuity (70 [61-77] vs. 75 [68-81] degree, P < 0.01). In a multivariable analysis, arch tortuosity remained independently associated with BAV after adjusting for aortic diameter and other clinical characteristics. CONCLUSIONS: We found that aortic arch tortuosity is significantly increased in BAV and may identify BAV patients who are at increased risk for TAD. Further studies to evaluate the association between tortuosity and clinical outcomes are in progress.

Post-operative imaging of pulmonary vessels.

Complications following cardiothoracic surgery are responsible for prolonged hospital stay, increase cost in patient care and increased morbidity and mortality. Vascular complications in particular are significant contributors to poor patient outcome due to either hemorrhage or thrombosis and ischemia. Evaluation of vascular complications in the postoperative patient requires a rapid and reliable imaging approach. Vascular complications after cardiothoracic surgery include pulmonary artery thrombosis, pseudoaneurysm, pulmonary vein thrombosis, vascular fistulas, stenosis and infarction. Multidetector CT (MDCT), often the imaging modality of choice, offers a one-stop-shop capability to visualize the entire cardiothoracic vasculature, airways, lung parenchyma, mediastinum and chest wall with excellent temporal and spatial resolution.

Radiographic Review of Current Therapeutic and Monitoring Devices in the Chest.

Chest radiographs are obtained as a standard part of clinical care. Rapid advancements in medical technology have resulted in a myriad of new medical devices, and familiarity with their imaging appearance is a critical yet increasingly difficult endeavor. Many modern thoracic medical devices are new renditions of old designs and are often smaller than older versions. In addition, multiple device designs serving the same purpose may have varying morphologies and positions within the chest. The radiologist must be able to recognize and correctly identify the proper positioning of state-of-the-art medical devices and identify any potential complications that could impact patient care and management. To familiarize radiologists with the arsenal of newer thoracic medical devices, this review describes the indications, radiologic appearance, complications, and magnetic resonance imaging safety of each device. ©RSNA, 2018.

CT for evaluation of acute pericardial emergencies in the ED.

Acute pericardial emergencies may present with acute chest pain. Although complete diagnosis and physiological effects of acute pericardial disease may require a combination of different imaging, CT plays a critical role in identifying the cause of chest pain in the ED. Many of these pericardial diseases can be fatal unless emergent treatment is obtained. The presentation can often be non-specific and symptoms can be overlapping with other diseases originating in the thorax or abdomen. Optimizing the CT scan is imperative when acute pericardial disease is suspected from clinical examination or preliminary imaging. The interpreting radiologist needs to be aware of the different entities which represent acute pericardial emergencies requiring urgent therapeutic intervention. Time is the essence, the clock is ticking, and every minute counts!

Spontaneous Lung Hernia Secondary to Persistent Cough: A Rare Entity / Hernia pulmonar espontánea secundaria a tos persistente: una entidad rara

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