ABSTRACT
Radiation therapy is part of a multimodality treatment approach to lung cancer. The radiologist must be aware of both the expected and the unexpected imaging findings of the post-radiation therapy patient, including the time course for development of post- radiation therapy pneumonitis and fibrosis. In this review, a brief discussion of radiation therapy techniques and indications is presented, followed by an image-heavy differential diagnostic approach. The review focuses on computed tomography imaging examples to help distinguish normal postradiation pneumonitis and fibrosis from alternative complications, such as infection, local recurrence, or radiation-induced malignancy.
Subject(s)
Lung Neoplasms , Tomography, X-Ray Computed , Humans , Lung Neoplasms/radiotherapy , Lung Neoplasms/diagnostic imaging , Radiation Pneumonitis/etiology , Radiation Pneumonitis/diagnostic imaging , Diagnosis, DifferentialABSTRACT
Subsolid nodules are heterogeneously appearing and behaving entities, commonly encountered incidentally and in high-risk populations. Accurate characterization of subsolid nodules, and application of evolving surveillance guidelines, facilitates evidence-based and multidisciplinary patient-centered management.
Subject(s)
Lung Neoplasms , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology , Lung Neoplasms/therapy , Solitary Pulmonary Nodule/diagnosis , Solitary Pulmonary Nodule/diagnostic imaging , Solitary Pulmonary Nodule/pathology , Multiple Pulmonary Nodules/diagnostic imaging , Multiple Pulmonary Nodules/diagnosis , Multiple Pulmonary Nodules/pathology , Diagnosis, DifferentialABSTRACT
Imaging plays a major role in the care of the intensive care unit (ICU) patients. An understanding of the monitoring devices is essential for the interpretation of imaging studies. An awareness of their expected locations aids in identifying complications in a timely manner. This review describes the imaging of ICU monitoring and support catheters, tubes, and pulmonary and cardiac devices, some more commonly encountered and others that have been introduced into clinical patient care more recently. Special focus will be placed on chest radiography and potential pitfalls encountered.
Subject(s)
Intensive Care Units , Radiography, Thoracic , Humans , Critical Care/methods , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To determine lung cancer screening eligibility, knowledge, and interest and to quantify the effect of the expanded 2021 lung cancer screening eligibility criteria among women presenting for screening mammography, a group with demonstrable interest in cancer screening. METHODS: A single-page survey was distributed to patients presenting for screening mammography, from January-March 2020 and June 2020-January 2021, at 2 academic medical centers on the East and West Coasts. The population served by the East Coast institution has greater poverty, greater ethnic/racial diversity, and lower education levels. Survey questions included age, smoking history, lung cancer screening knowledge, participation, and interest. Lung cancer screening eligibility was determined for both 2013 and 2021 USPSTF guidelines. Descriptive statistics were calculated, and data were compared between groups using the Chi-square test, Mann-Whitney nonparametric test, and the 2-sample t test. RESULTS: 5512 surveys were completed; 33% (1824) of women reported a history of smoking-30% (1656) former smokers and 3% (156) current smokers. Among women with a smoking history, 7% (127/1824) were eligible for lung cancer screening using 2013% and 11% (207/1824) using the 2021 USPSTF criteria. Interest in lung cancer screening was high (73%; 151/207) among eligible women using 2021 USPSTF criteria, but only 42% (87/207) had heard of lung cancer screening and only 28% (57/207) had received prior LDCT screening. CONCLUSION: Eligible screening mammography patients reported high levels of interest in lung cancer screening but low levels of knowledge and participation. Linking mammography and LDCT appointments may improve lung cancer screening participation.
Subject(s)
Breast Neoplasms , Lung Neoplasms , Humans , Female , Lung Neoplasms/diagnostic imaging , Early Detection of Cancer , Breast Neoplasms/diagnostic imaging , Mammography , Smoking/epidemiology , Mass ScreeningABSTRACT
BACKGROUND: COVID-19 is associated with pulmonary embolism (PE) in adults. However, the rate of PE in pediatric patients with acute COVID-19 evaluated by CT pulmonary angiography (CTPA) has not been evaluated. OBJECTIVE: Determine PE rate in pediatric patients with acute COVID-19 and compare to adults. MATERIALS AND METHODS: A retrospective review of CTPA studies, performed between March 2020 and January 2021 on pediatric patients with acute COVID-19, but not MIS-C, was performed. CTPAs performed on an adult cohort of acute COVID-19 patients during April 2020 were reviewed for comparison. Pediatric and chest radiologists independently reviewed CTPAs of pediatric and adult patients, respectively. RESULTS: Of the 355 acute COVID-19 pediatric patients treated during the study period, 14 (16.6 ± 4.8y, median-18.5y, 64% female) underwent CTPA. Of the 1868 acute COVID-19 adults treated during two weeks in April 2020, 50 (57.2 ± 17.0y, median-57.0y, 42% female) underwent CTPA. The PE rate was 14% in the pediatric group (2 patients) and 18% in the adult group (9 patients) (p = 1.0). Both pediatric patients with PE were obese, over 18y, and had asthma, diabetes mellitus, or hypertension. No child<18y with acute COVID-19 had PE. In the adult cohort, higher alanine-aminotransferase and D-dimer levels were associated with PE (p = 0.04 and p = 0.004, respectively). CONCLUSION: Despite similar PE rates in pediatric and adult patients, PE occurred in acute COVID-19 pediatric patients who were >18y, obese, and had at least 1 comorbidity. Children <18y with COVID-19 did not have PE.
Subject(s)
COVID-19 , Pulmonary Embolism , Adult , Angiography , COVID-19/complications , Child , Computed Tomography Angiography , Female , Humans , Male , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/epidemiology , Retrospective StudiesABSTRACT
Contrast-enhanced chest computed tomography (CT) is not considered part of the evaluation of myocardial infarction. However, acute myocardial infarction has been detected on contrast-enhanced chest CT as areas of decreased myocardial enhancement in patients evaluated for other indications, such as pulmonary embolism and aortic dissection. We present a case of acute myocardial infarction on a nongated chest CT in a 67-year-old male who presented with atypical chest pain and initial nondiagnostic electrocardiogram. This case highlights that acute myocardial infarction may be detectable on contrast-enhanced CT. When evaluating contrast-enhanced chest CT's for other etiologies of chest pain, radiologists should look for potential myocardial perfusion abnormalities that can provide clues to the presence of myocardial infarction.