Incidental finding of large pneumothorax on Cardiac MR scan

Abstract Background We believe this is the first case report of a pneumothorax being identified using cardiac magnetic resonance imaging. This case also illustrates the haemodynamic effect a large pneumothorax can have on right ventricular filling in diastole. Case presentation A 26-year-old attended for an interval follow up Cardiac Magnetic Resonance (CMR) of his thoracic aorta after a thoracic co-arctation repair aged 3. He was found to have an incidental large pneumothorax by the reporting cardiology fellow which was confirmed by the on-call radiologist. The pneumothorax was most notable for its compression of the right ventricle in diastole. Although the patient had worrying features on CMR imaging, he remained clinically stable and a conservative approach to management saw the pneumothorax resolve after a 3 week period. Conclusions Pneumothoraces are important, potentially life threatening conditions. Although very rarely identified on MR imaging, radiographers and reporting doctors should be aware of their key features. This case serves to identify not only the abnormal lung parenchymal features but also the striking compressional effect of the pneumothorax on the right ventricle in diastole. Indeed we believe this is the first case report of a pneumothorax identified on CMR imaging

Incidental Findings of Malignancy of the Chest by Single Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT-CT MPI): One Year Follow-up Report

INTRODUCTION. We recently reported 6 cases of pulmonary/hilar malignancies as the result of incidental findings (IF) on CT attenuation correction (CTAC) during SPECT-CT MPI. In this study, we examined clinical features, diagnostic procedures and clinical outcome on all patients who were had malignancies or significant IF that required further follow-up.  METHODS. Of 1098 consecutive patients who underwent cardiac SPECT-CT MPI from 9/1/2017 to 8/31/2018, their MPI and CTAC were reviewed contemporaneously.  Patients with known history of prior pulmonary or chest malignancy were excluded.  RESULTS. A total of 79 (7.2%) patients were identified to have significant IF on CTAC; after diagnostic CT, 47 patients were found to have significant findings that warranted further follow-up and included in this study. Eight patients (0.73%) were found to have malignancy of the chest because of IF on the CTAC.   There was no statistical difference in baseline characteristics and cancer risk factors among patients who were found to have cancer vs those without.  At the time of diagnosis, 4 patients were found to have cancer at advanced stage who all died within 12 months while 3 others had lung cancer of early stage and 1 mantle cell lymphoma were alive at a mean follow-up of 17.5+/-2.1 months. Biopsy for tissue diagnosis were performed safely: with needle biopsy, major complication occurred in 1 patient (1/9 or 11.1%); none with surgical biopsy. CONCLUSIONS. This study underscores the importance of reviewing CTAC images obtained during cardiac SPECT-CT MPI to potentially detect clinically important incidental findings

Diseases of the Chest, Breast, Heart and Vessels 2019-2022

This open access book focuses on diagnostic and interventional imaging of the chest, breast, heart, and vessels. It consists of a remarkable collection of contributions authored by internationally respected experts, featuring the most recent diagnostic developments and technological advances with a highly didactical approach. The chapters are disease-oriented and cover all the relevant imaging modalities, including standard radiography, CT, nuclear medicine with PET, ultrasound and magnetic resonance imaging, as well as imaging-guided interventions. As such, it presents a comprehensive review of current knowledge on imaging of the heart and chest, as well as thoracic interventions and a selection of "hot topics". The book is intended for radiologists, however, it is also of interest to clinicians in oncology, cardiology, and pulmonology

How to distinguish between surgical and non-surgical pneumoperitoneum?

Not all cases of pneumoperitoneum found on abdominal X-ray or computed tomography (CT) scan are caused by hollow viscus perforation. Non-surgical or spontaneous pneumoperitoneum is a repeatedly described entity. However, not all physicians in emergency departments are aware of it, and in such cases unnecessary laparotomy is often performed which reveals no intra-abdominal pathology. Non-surgical pneumoperitoneum can have thoracic, abdominal, gynecological, or other causes. When we acknowledge the possibility of non-surgical pneumoperitoneum, the primary goal is to discern surgical from non-surgical pneumoperitoneum. Identifying cases in which laparotomy can be avoided is important to prevent unnecessary surgery and its associated morbidity and financial costs. In this paper we propose a practical algorithm which may help the attending physicians to distinguish between surgical and non-surgical pneumoperitoneum

How to distinguish between surgical and non-surgical pneumoperitoneum?

Not all cases of pneumoperitoneum found on abdominal X-ray or computed tomography (CT) scan are caused by hollow viscus perforation. Non-surgical or spontaneous pneumoperitoneum is a repeatedly described entity. However, not all physicians in emergency departments are aware of it, and in such cases unnecessary laparotomy is often performed which reveals no intra-abdominal pathology. Non-surgical pneumoperitoneum can have thoracic, abdominal, gynecological, or other causes. When we acknowledge the possibility of non-surgical pneumoperitoneum, the primary goal is to discern surgical from non-surgical pneumoperitoneum. Identifying cases in which laparotomy can be avoided is important to prevent unnecessary surgery and its associated morbidity and financial costs. In this paper we propose a practical algorithm which may help the attending physicians to distinguish between surgical and non-surgical pneumoperitoneum

Vascular anomaly diagnosis by central venous catheter misplacement:a case report

BACKGROUND: Congenital heart diseases rarely have a primary manifestation in adulthood. They are a rare cause of pulmonary hypertension in adults. CASE PRESENTATION: A 70-year-old woman of Eurasian descent underwent emergency surgery for bowel ischemia. Her history of mild pulmonary hypertension likely correlates with a peculiar diagnosis of an anatomic anomaly on the postoperative x-ray and computed tomography scan. The central venous catheter was misplaced. Initial management consisted of removal of the catheter. The diagnosis, partial anomalous pulmonary venous return, may pose a clinical therapeutic dilemma. CONCLUSIONS: Partial anomalous pulmonary venous return is a potentially treatable cause of pulmonary hypertension. With the current trend toward more medical imaging, we expect this diagnosis to be made more often in the future

Novel approaches to the assessment of patients with chest systoms in the acute medical and outpatient settings: the use of multislice computed tomography

This thesis evaluated the clinical utility of cardiopulmonary computed tomography (CT) in patients presenting with chest pain and dyspnoea. Studies within this thesis confirmed the following. Firstly, there is a requirement for improved diagnostic pathways to minimise patients being discharged without a diagnosis, which currently occurs in 30-40% of patients admitted with chest pain and dyspnoea. Historically, CT has been utilised in 32% of admissions with chest pain and 10% of admissions with dyspnoea. Secondly, challenges exist to the wider adoption of cardiopulmonary CT. These include patient-related factors, institutional capabilities and guideline restrictions. In acute admissions, 11% of patients with dyspnoea and 7% of patients with chest pain and a low to moderate likelihood of CAD are suitable for CT. In the RACPC setting, including patients across the entire spectrum of CAD likelihood, 18% of patients are suitable for CT. NICE CG95 would recommend only 1% of acute chest pain admissions and 2% of RACPC attenders for CT. Thirdly, NICE CG95 would recommend 51% of acute chest pain admissions and 66% of RACPC attenders for discharge without cardiac investigation. In the RACPC population, significant CAD is identified in 10% of these patients and a major adverse cardiac event in 2%. Fourthly, in selected patients with suspected cardiac chest pain, cardiac CT has a diagnostic yield of 21% in acute admissions and 13% in RACPC attenders for significant CAD. In acute admissions with dyspnoea, cardiopulmonary CT has a diagnostic yield of 20% for CAD, 20% for pulmonary embolism, nil for aortic dissection and 89% for non-vascular chest pathology. Fifthly, inclusion of CT in diagnostic pathways for chest pain result in fewer patients discharged without a diagnosis, fewer invasive angiography procedures and reduced diagnostic costs. In patients with dyspnoea, CT provides value to clinicians making diagnoses and supports early discharge without detrimental outcomes.Open Acces