Congenital Lung Malformations: A Pictorial Review of Imaging Findings and a Practical Guide for Diagnosis.

The term congenital lung malformation (CLM) is used to describe a wide range of pathological conditions with different imaging and clinical manifestations. These anomalies stem from abnormal embryological lung development, potentially occurring across various stages of prenatal life. Their natural history can be variable, presenting in a wide range of severity levels and encompassing asymptomatic individuals who remain so until adulthood, as well as those who experience respiratory distress in the neonatal period. Through the PubMed database, we performed an extensive review of the literature in the fields of congenital lung abnormalities, including their diagnostic approach and findings. From our RIS-PACS database, we have selected cases with a final diagnosis of congenital lung malformation. Different diagnostic approaches have been selected, including clinical cases studied using plain radiograph, CT scan, prenatal ultrasound, and MR images. The most encountered anomalies can be classified into three categories: bronchopulmonary anomalies (congenital pulmonary airway malformations (CPAMs), congenital lobar hyperinflation, bronchial atresia, and bronchogenic cysts), vascular anomalies (arteriovenous malformation), and combined lung and vascular anomalies (scimitar syndrome and bronchopulmonary sequestration). CLM causes significant morbidity and mortality; therefore, the recognition of these abnormalities is necessary for optimal prenatal counseling and early peri- and postnatal management. This pictorial review aims to report relevant imaging findings in order to offer some clues for differential diagnosis both for radiologists and pediatric consultants.

Multidisciplinary Approach to Suspected Sudden Death Caused by Arteriovenous Malformation Rupture: A Case Report.

Arteriovenous malformations (AVMs) are rare congenital conditions with a prevalence of less than 1% and are mostly asymptomatic. However, these malformations can suddenly cause intense pain or bleeding, leading to life-threatening medical problems. This report presents a case of an unexpected death in a 37-year-old previously healthy woman due to an intra-cerebellum arteriovenous malformation rupture identified during autopsy. While infective processes where preliminarily excluded, a Post Mortem Computed Tomography (PMCT) identified a tetra ventricular hemorrhage and intra-cerebellum hemorrhage. Toxicological examination was negative for most substances of abuse. During autopsy an intense hemorrhagic infiltrate in the subarachnoid space was observed. After formalin fixation of the brain the cerebellum showed hemorrhagic infarction on fourth ventricle sides, as well as several small reddish infarctions across the entire cerebellum parenchyma. Histological examination of the brain and cerebellum showed a suffusion of erythrocytes in the sub-arachnoid region. Evidence of an arterio-venous malformation, with several intertwine vessels of variable diameter, surrounded by hemorrhagic evidence. The autopsy played a crucial role in identifying the location and the possibly affected vessel, as well as defining the cause of death. It is necessary to have a greater number of autopsies to make an epidemiological contribution. Furthermore, it is crucial to create a multicenter data network with other authors from other departments to improve information about epidemiological, clinical, diagnostic and therapeutic data. Most brain AVMs as cause of death are often undiscovered.

Two Cases of Spontaneous Isolated Dissection of Superior Mesenteric Artery in One Night: Report of a (Noninvasive) Double Challenge.

BACKGROUND Spontaneous isolated dissection of the superior mesenteric artery (SID-SMA) is a rare but potentially fatal condition. Although many cases of SID-SMA have been reported in the literature in recent years because of the increased use of contrast-enhanced computed tomography (CT) scanning, optimal management has not yet been firmly established. CASE REPORT We report 2 cases of SID-SMA that were managed with stenting and angioplasty via transfemoral access. In case 1 a 54-year-old man presented with diffuse abdominal pain without Blumberg sign. Laboratory data were unremarkable. Abdominal CT scanning revealed SID-SMA and initial bowel ischemia. The angiogram revealed a dissected true lumen of SMA with a narrowing of the ileo-colic artery managed, respectively, with self-expandable stent placement and angioplasty. In case 2, a 45-year-old man presented with severe abdominal cramping and pain of 3 days' duration. Physical examination revealed abdominal tenderness with positive Blumberg sign. Laboratory tests showed leukocytosis and increased lactate dehydrogenase. Abdominal CT scan revealed SID-SMA and initial bowel ischemia. After an SMA angiogram, 2 self-expandable stents were placed and an angioplasty was performed. Although a postprocedural angiogram showed good patency of the SMA in both patients, the first patient had a recurrence of abdominal pain after 5 days with a new narrowing tract of the SMA and more inferiorly a dissection with aneurysm of a false lumen, detected on CT scan, treated respectively with stenting and coils. CT follow-up showed successful morphological results in both patients. CONCLUSIONS In our experience, endovascular treatment of SID-SMA is safe and effective, including in cases of recurrence and postprocedural evolution.

Proximal and distal radial artery approaches for endovascular percutaneous procedures: anatomical suitability by ultrasound evaluation.

PURPOSE: To describe the variability of the radial artery (RA) diameters at 2 levels, proximal (pRA), within 2 cm to the styloid process, and distal (dRA) at the snuff box, both eligible accesses for percutaneous approach, and to correlate these diameters with population features. METHODS: A total of 700 patients (377 females, 323 males) have been enrolled from July 2018 to March 2019. The diameters of left and right RA were measured using ultrasound (US) examination. Diameters of pRA and dRA were compared between different sex and CRF (tabagism, hypertension, hyperlipidemia, BMI > 30, diabetes) using multivariate analysis and unpaired t test; the feasibility of radial access was evaluated considering a diameter ≥ of 2 mm as a cut-off or a vessel/sheath ratio >1. The time needed to perform each assessment of the four vessels was recorded. RESULTS: The average proximal diameter of pRA was 2.58 mm (sd = 0.58 mm). The caliber of the dRA resulted 19.5% lower than the proximal one, with an average diameter of 1.99 mm (sd = 0.47 mm). On unpaired t test, a significant difference was reported for two of the parameters taken into account: sex and a BMI > 30. CONCLUSION: Our results show that 88% of patients have an estimated radial artery caliber suitable for pTRA at US examination. Males and patients with BMI > 30 show a higher mean pRA and dRA; thus, they could be the ideal candidates for radial access.

Eagle's syndrome: a case report and CT pictorial review.

Eagle's syndrome (ES) refers to symptomatic elongation of the ossified styloid process. A styloid process greater than 2.5 cm in length should be considered abnormal; however, an elongated styloid process is not sufficient for a diagnosis of ES; only an abnormal styloid process in association with symptoms can confirm the syndrome. In this case report, we discuss a 54-year-old man who has come to our attention with various symptoms: dysphagia to both solids and liquids, difficulty swallowing, neck pain, and a foreign body sensation during bilateral neck rotation and mouth opening. The diagnosis is performed radiologically because conventional radiographs have many potential disadvantages, whereas, computed tomography (CT) scans and reconstructions allow the length and angulation of the styloid process to be measured and the relationship between the elongated styloid processes and adjacent anatomical structures to be evaluated. Moreover, CT allows for differential diagnosis and provides detailed information needed for surgical planning.