IMAGING

A rare case of disseminated pulmonary ossification associated with fibrotic lung disease.

Manish Kumar — 2022-09-14

Disseminated pulmonary ossification (DPO) is a rare disease characterized by diffuse calcification/ossification of lung parenchyma. Most of the cases are idiopathic, while the rest of the causes may have an underlying cause like lung congestion, lung injury, lung amyloidosis, and interstitial lung disease (ILD). We present a rare case of a 58-year-old woman with progressive dyspnoea and dry cough. On CT, there was extensive confluent nodular and linear calcification of bilateral lung parenchyma associated with lung fibrosis. Imaging findings lead to the diagnosis of DPO associated with idiopathic lung fibrosis. The development of such calcification in ILD is very unusual, therefore knowledge of imaging features of DPO is very crucial for its diagnosis.

Intracoronary Thrombus Visualized by Optical Coherence Tomography in a Patient with Antiphospholipid Syndrome

Ravi Choxi — 2022-09-14

A patient with a history of deep venous thrombosis on warfarin underwent coronary angiography and was found to have a red intracoronary thrombus in the mid left anterior descending artery by optical coherence tomography. Percutaneous coronary intervention was successfully performed. On discharge, the patient continued triple therapy with aspirin, clopidogrel, and apixaban for 30 days then discontinued aspirin. A hypercoagulable work up was notable for antiphospholipid syndrome and lifelong anticoagulation was recommended. The patient continued apixaban twice daily given recurrent thrombosis while on warfarin and was event free at 6-month follow up.

Hematocolpos on late-onset hymenal imperforation: a case report

Daouda DIARRA — 2022-09-14

We report the case of a patient with hematocolpos on hymenal imperforation, revealed following cyclic pelvic pain with primary amenorrhea associated with pelvic heaviness for one year. MRI showed significant distension of the vagina forming a pseudo mass, well limited, in T1 hypersignal, in moderate T2 hypersignal, with the presence of declining deposits in hyposignal related to hemosiderin. A hymenotomy was performed under general anaesthesia, the postoperative course was favourable. This case illustrates the particularity of suspecting a hematocolpos in the presence of a pelvic mass in a young girl with amenorrhea.

Massive necrotizing myocarditis in a young patient with idiopathic hypereosinophilic syndrome

Laura Ceriello — 2022-09-14

A 27-years-old female with multiple autoimmune disorders presented to our cardiology unit for acute chest pain and worsening dyspnoea. Admission blood tests revealed increased serum levels of high-sensitive cardiac troponin, eosinophilic count and C-reactive protein. Laboratory findings, low QRS voltages by ECG, mildly reduced left ventricular systolic function in the context of pseudohypertrophy, mild and diffuse late gadolinium enhancement associated with markedly increased native T1 and T2 mapping levels assessed by echocardiography and cardiovascular magnetic resonance imaging, raised the suspicion of massive eosinophilic myocarditis, subsequently confirmed by histological examination of endomyocardial biopsy. Prompt initiation of immunosuppressive treatment allowed swift regression of myocardial inflammation and full recovery of left ventricular systolic function within one month. After ruling-out clonal myeloid disorder, lymphocyte-variant and reactive hypereosinophilia, the young lady was eventually diagnosed with idiopathic hypereosinophilic syndrome. This case report turns the spotlight on the role and importance of advanced multi-modality cardiovascular imaging for raising clinical suspicion of acute eosinophilic myocarditis, guiding diagnostic work-up and monitoring response to treatment.

HRCT Chest in Patients Suffering from COVID-19: Experience from a Tertiary Care Centre in India During Second Wave of the Pandemic

Ruzina Firdose Syed — 2022-09-14

Aim: The objective of the present study is to describe high-resolution CT (HRCT) chest manifestations of coronavirus disease 2019 (COVID-19) patients during second wave of the pandemic in a tertiary care hospital in New Delhi, India and to analyse the distribution of the radiological findings in lungs. Additionally, we assess the role of chest CT severity scoring to determine the severity of pneumonia.

Methods: We analysed HRCT chest findings in 237 patients infected with COVID-19 admitted at our institute from 1st April 2021 to 31st May 2021. Covid-19 infection was confirmed by reverse transcription polymerase chain reaction (rt-PCR) or rapid antigen test (RAT) in all these patients.

Results: The mean age in our study group was 51.3 ± 12.1 years (range 19-79 years) comprising of 136 males (57.4%) and 101 females (42.6%). The majority of the patients showed bilateral (95.3%) and peripheral (42.6%) distribution of the disease. Ground glass opacities were the most common finding, seen in 214 (90.3%) study patients, followed by interlobular septal thickening in 202 (85.8%) and crazy paving in 194 (81.3%) patients. Majority (36.7%) of these patients had a CT severity score above 20 indicating severe disease.

Conclusion: HRCT chest plays a pivotal role in the management of COVID-19 affected patients and works as an indicator of disease severity and possible outcome. The abnormalities on HRCT chest in patients with infection from the delta variant of SARS-Cov-2 are more or less similar to abnormalities described earlier from the other variants of this virus.

Identification of Radiomic Features as an Imaging Marker to Differentiate Benign and Malignant Breast Masses Based on Magnetic Resonance Imaging

Sachini Wickramasinghe — 2022-09-14

Background - Breast cancer is one of the most common cancers among women globally. Therefore, the main aim of this study is to identify the essential radiomic features as an image marker and compare the diagnostic feasibility of feature parameters derived from radiomics analysis and conventional Magnetic Resonance Imaging (MRI) to differentiate benign and malignant breast masses.

Methodology - T1weighted Dynamic Contrast-Enhanced (DCE) breast MR axial images of 151 (benign (79) and malignant (72)) patients were chosen. Regions of interest were selected using both manual delineation and semi-automatic segmentation methods from each lesion. 382 radiomic features computed on the selected regions. A random forest model was employed to detect the most important features that differentiate benign and malignant breast masses. The ten most important radiomics features were obtained from manual delineation and semi-automatic segmentation based on the Gini index to train a support vector machine.

Results - The accuracy of the model built from the ten most significant features obtained from manual delineation was 0.815, and sensitivity 0.84. The accuracy of the model built from the 10 most significant features obtained from semi-automatic segmentation was 0.821, and sensitivity 0.87. The top 10 features obtained from manual delineation and semi-automatic segmentation showed a significant difference (p<0.05) between benign and malignant breast lesions.

Conclusion - This radiomics analysis based on DCE-BMRI revealed distinct radiomic features to differentiate benign and malignant breast masses. Therefore, the radiomics analysis can be used as a supporting tool in detecting breast MRI lesions.

Extracardiac findings on cardiac computed tomography in patients undergoing atrial fibrillation catheter ablation

Judit Simon — 2022-09-14

Background and Aim

To assess the prevalence of incidental extracardiac findings in patients who underwent cardiac CT for the evaluation of left atrial (LA) anatomy before atrial fibrillation (AF) catheter ablation. We also aimed to determine the independent predictors of relevant extracardiac alterations.

Patients and Methods

We studied consecutive patients who underwent cardiac CT with a 256-slice scanner for the visualization of LA anatomy before AF ablation. Prevalence of clinically significant and not significant extracardiac findings were recorded. Moreover, we determined the variables associated with relevant extracardiac alterations with uni- and multivariate logistic regression analyses.

Results

In total, 1,952 consecutive patients between 2010 and 2020 were included in our study (mean age 61.2±10.6 years; 66.2% male). Incidental extracardiac findings were detected in 820 (42.0%; 95%CI=0.40-0.44%) patients, while clinically significant alterations were reported in 416 (21.3%; 95%CI=20.0-23.2%) patients. When analyzing the predictors of clinically relevant alterations, age (OR=1.04; 95%CI=1.03-1.05), male sex (OR=1.39; 95%CI=1.12-1.73), chest pain (OR=1.46; 95%CI=1.09-1.93), hypertension (OR=1.42; 95%CI=1.12-1.81), heart failure (OR=1.68; 95%CI=1.09-2.53), obstructive CAD (OR=1.56; 95%CI=1.16-2.09) and prior stroke/TIA (OR=1.56; 95%CI=1.04-2.30) showed association with clinically significant incidental findings in the univariate analysis (all p<0.05). In the multivariate analysis, age (OR=1.04; 95%CI=1.02-1.06; p<0.001) proved to be the only significant predictor of clinically relevant extracardiac finding.

Conclusion

Cardiac CT performed before AF ablation is not only helpful in understanding LA anatomy, but might also identify clinically significant pathologies. These incidental findings might have further diagnostic or therapeutic consequences.

Echocardiography in the intensive care unit: an essential tool for diagnosis, monitoring and guiding clinical decision-making

Hatem Soliman Aboumarie — 2022-09-14

In the last years, new trends on patient diagnosis for admission in cardiac intensive care unit (CICU) have been observed, shifting from acute myocardial infarction or acute heart failure to non-cardiac disease such as sepsis, acute respiratory failure or acute kidney injury. Moreover, thanks to the advances in scientific knowledge and higher availability, there has been an increasing use of mechanical circulating support devices and positive-pressure mechanical ventilation. Therefore, there is a growing need of support for CICU clinicians to quickly, noninvasively and repeatedly evaluate diagnosis, hemodynamic conditions and response to therapy.

Transthoracic critical care echocardiography (CCE) currently represents a never-missing tool in CICU, as it is essential to evaluate biventricular function and complications following acute coronary syndromes, identify the mechanisms of circulatory failure, acute valvular heart or aortic disease, tailoring and titrating intravenous treatment or mechanical circulatory support. This could be completed with transoesophageal echocardiography, advanced echocardiography and lung ultrasound to provide a thorough evaluation and monitoring of CICU patients. However, CCE could sometimes be challenging as the acquisition of good-quality images is limited by mechanical ventilation, suboptimal patient position or recent surgery with drains on the chest. Moreover, there are some technical caveats that one should bear in mind while performing CCE in order to optimize its use and avoid misleading findings. The aim of this review is to highlight the key role of CCE, providing an updated overview of its main applications and possible pitfalls in order to facilitate its use in CICU for clinical decision-making.

The role of imaging in the diagnosis and management of idiopathic pulmonary fibrosis

Chiara Nardocci — 2022-09-14

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive disease lacking a definite etiology, characterized by the nonspecific symptoms of dyspnea and dry cough. Due to its poor prognosis, imaging techniques play an essential role in diagnosing and managing IPF. High resolution computed tomography (HRCT) has been shown to be the most sensitive modality for the diagnosis of pulmonary fibrosis. It is the primary imaging modality used for the assessment and follow-up of patients with IPF. Other not commonly used imaging methods are under research, such as ultrasound, magnetic resonance imaging and positron emission tomography-computed tomography are alternative imaging techniques. This literature review aims to provide a brief overview of the imaging of IPF-related alterations.

Pulmonary Embolism and Computed Tomography Angiography: characteristic findings and technical advices

Emanuele Muscogiuri — 2022-09-14

Pulmonary embolism (PE) is a condition due to blood clots obstructing pulmonary arteries, often related to deep venous thrombosis (DVT). PE can be responsible for acute and even life-threatening clinical situations and it may also lead to chronic sequelae such as chronic thromboembolic pulmonary hypertension (CTEPH). Signs and symptoms associated to PE may overlap those of many other diseases (e.g. chest pain, dyspnea, etc.), therefore an accurate clinical evaluation is mandatory before referring the patient to the most appropriate imaging technique. Pulmonary angiography (PA) has been traditionally considered the gold standard regarding the diagnosis of PE and it is also useful regarding the treatment of said condition. However, PA is an invasive technique, implying all the known risks concerning endovascular procedures. Nowadays, computed tomography angiography (CTA) is considered the imaging technique of choice regarding the diagnosis of PE. This technique is readily-available in most centers and it is able to provide high resolution images, although it implies the administration of ionizing radiations and iodinated contrast medium. Conventional CTA has further been improved with the use of ECG-gated protocols, aimed to reduce motion artifacts due to heartbeat and to evaluate other causes of sudden onset chest. Moreover, another interesting technique is dual-energy computed tomography (DECT), which allows to elaborate iodine maps, allowing to detect area of hypoperfusion due to the presence of emboli in pulmonary arteries. This review is aimed to describe the main findings related to PE with an emphasis on CTA, also discussing technical aspects concerning image acquisition protocol.