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EEE 01-01 Feel the rhythm of the beat! Imaging the left atrium: what the electophysiologist wants to know
A. Shmukler1, A. Bader2, N. Kumarasamy2, E. Bader3, L. Haramati2
1Montefiore Medical Center, Brooklyn, NY, 2Montefiore Medical Center, Bronx, NY, 3Yale New Heaven Health, northeast medical group, Greenwich, CT. Learning Objectives: Atrial fibrillation is the most common sustained arrhythmia, with significant morbidly and mortality including stroke, heart failure and death. Limited efficacy of rhythm control medications and risks of anticoagulation have led to development of procedures such as catheter ablation and left atrial appendage occlusion and exclusion. Pre-procedure image-based planning can increase the likelihood of safety and success, providing imaging of the left atrium (LA), left atrial appendage (LAA), and the pulmonary veins. Proper protocolling, choice of effective imaging modality, and comparison with prior exams is crucial. Outcomes: Summary of Content: We will discuss pathophysiology of AF and need for non-invasive procedures. Pre-ablation imaging should be targeted at optimal opacification of the LA to highlight LA anatomy. We will discuss procedural approaches to the LA, with sources of difficulty for the ablationist including anatomical variants, such as azygos continuation of the IVC, lipomatous hypertrophy of the interatrial septum, ASD, Persistent left SVC and possible need for CS ablation, pulmonary vein anatomy and variants The risk of embolic event correlates with the morphology of the LAA which can be assessed with multimodality 2D and 3D images, examples of which will be presented. LAA morphologies include: chicken wing, cactus, cauliflower, windsock. Proper protocoling to evalute for thrombus is essential. LAA occlusion devices include Watchman device and LARIAT procedure Post-procedure imaging examples will be included. null
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EEE 01-02 Thoracic Aortic Aneurysms with a Genetic Basis
A. Hamid, E. Lee, M. Ghadimi Mahani, S. Brian, A.L Dorfam, J. Lu, P. Agarwal
University of Michigan Health System, Ann Arbor, MI. Learning Objectives/Outcomes: 1. To familiarize imagers with the spectrum of syndromic and nonsyndromic genetic conditions associated with thoracic aortic aneurysms.2. To describe and illustrate CT and MR aortic findings in these genetic conditions.3. To outline the recommendations for detection, monitoring and management. Summary of Content: There are several syndromic and nonsyndromic genetic conditions associated with the development of thoracic aortic aneurysms that present with dissections and adverse outcomes at smaller diameters than usual. Prompt recognition as well as knowledge of surveillance and management guidelines are essential in facilitating a timely diagnosis and directing appropriate management.In this exhibit we will review the CT and MR imaging appearances of specific entities as well as outline features that have been described to have a role in prognostication such as vertebral tortuosity index.The key entities that are included in this exhibit and should be considered in young patients presenting with aortic aneurysms are:- Marfan syndrome.- Ehlers-Danlos syndrome.- Loeys-Dietz syndrome (LDS).- Familial thoracic aortic aneurysms and dissections (TAAD).- Turner syndrome.- Autosomal dominant polycystic kidney disease (ADPKD).- Less common causes such as neurofibromatosis, tuberous sclerosis, Noonan syndrome, osteogenesis imperfecta and homocystinuria. null
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EEE 01-03 Overview of complications of acute & chronic myocardial infarction- Revisiting
pathogenesis and cross sectional imaging

A. J. Baxi1, R. Katre1, S. Saboo2, C. Restrepo1
1UTHSCSA, San Antonio, TX, 2University of Texas Southwestern Medical Center, Dallas, TX. Learning Objectives: 1. To discuss pathophysiology of acute and chronic myocardial infarction 2. To study the role of imaging in evaluating complications of myocardial infarction 3. To discuss imaging and differential diagnosis Outcomes: • Introduction • Anatomy • Pathology, imaging findings & role of imaging § Acute infarct § Chronic infarction § True aneurysm § Pseudoaneurysm § Acute and chronic thrombus § Systemic thromboembolism § Pericardial tamponade § Pericarditis § Myocardial and septal perforation § Papillary muscle rupture § Mitral regurgitation § Cardiac failure • Differential diagnosis • Conclusion Summary of Content: Chest pain is always cause of concern especially if cardiac in origin. The diagnosis of acute myocardial infarction and it`s complication is initially established on clinical, laboratory and echocardiography evaluation. Many a times, these may not be sufficient in evaluating complications of acute and chronic myocardial infarction and evaluation using cardiac MRI and MDCT imaging is mandatory for reaching accurate diagnosis as many of the pathologies may have similar clinical presentation. Accurate diagnosis is very important to optimizing proper treatment. Categorizing these pathologies serves as a road map in patient care. Recognizing typical imaging manifestations with adequate clinical correlation is essential for timely and accurate diagnosis as well as for guiding treatment. In this exhibit, we discuss the characteristic multimodality imaging findings and differential diagnosis of common and uncommon complications of myocardial infarction. Increased awareness of such entities will contribute to optimized care of patients. null
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EEE 01-04 Cardiac Applications of Hybrid PET/MRI
P. J. Bergquist1, J. Jeudy1, C. White1, M. Chung2
1University of Maryland School of Medicine, Baltimore, MD, 2The Icahn School of Medicine at Mount Sinai, New York, NY. Learning Objectives/Outcomes: Both positron emission tomography (PET) and cardiac magnetic resonance imaging (CMR) provide important anatomic and physiologic information with regard to the heart. Being able to combine the data from these two examinations in a hybrid technique allows for a more complete evaluation of cardiac pathology. While hybrid PET/CT has already established the utility of a combined imaging approach, the use of CMR in lieu of CT allows for elimination of ionizing radiation and for improved tissue contrast. This exhibit will provide an overview of the clinical applications of hybrid PET/CMR with emphasis on specific scenarios where both techniques together provide added information. Summary of Content: 1. Background 2. Atherosclerosis imaging 3. Myocardial Perfusion Imaging a. Perfusion and Function b. Viability 4. Nonischemic Cardiomyopathies a. Myocarditis b. Sarcoidosis c. Hypertrophic Cardiomyopathy 5. Cardiac Tumors null
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EEE 01-05 Assessment of Right-Sided Cardiac Masses by Cardiac MRI: Case-Based Review and Imaging Tips
M. Arzanauskaite, R. H. Mohiaddin
Royal Brompton Hospital, London, UNITED KINGDOM. Learning Objectives/Outcomes: 1. To review the spectrum of right-sided cardiac masses 2. To explain the utility of cardiac MRI in this setting and discuss imaging protocol 3. To provide a histologically confirmed case-based review of cardiac MRI findings Summary of Content: Cardiac masses are being increasingly encountered as cardiovascular imaging accessibility grows every year. Mimickers and non-neoplastic lesions are more commonly seen in the heart compared to tumours. Cardiac neoplasms often present late and in a non-specific manner, therefore timely diagnosis is of key importance for these patients. The majority of malignancies in the heart particularly on the right side are metastatic. Primary tumours are rare but show a wide spectrum of MRI appearance. Cardiac MRI offers high advantage due to its soft tissue contrast allowing tissue characterization, high spatial and temporal resolution and the wide field of view to assess paracardiac structures including caval veins and therefore may predict malignancy. This educational exhibit reviews a spectrum of masses of the right heart and suggests a general cardiac MRI protocol with tips for each depicted scenario. null
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EEE 01-06 Preoperative CT in Re-operative Sternotomy for Cardiac Surgery: What the Surgeon Wants to Know
D. Grant, Jr., R. Edwards, J. Hermsen, G. Kicska
University of Washington, Seattle, WA. Learning Objectives: Identify pertinent measurements and descriptive criteria to reduce re-operative morbidity and mortality Summary of Content: 1. Quantitative measurements, 2. Qualitative assessment for surgical approach planning null
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EEE 01-07 Coronary artery fistula from A to Z: pathophysiology, spectrum of imaging findings and management with coronary CT angiography
E. Chun, G. Yun, T. Nam
Seoul National University Bundang Hospital, Seongnam-si, KOREA, REPUBLIC OF. Learning Objectives: 1. To understand pathophysiology and clinical manifestations according to the various connection in coronary artery fistula (CAF). 2. ECG-gated Coronary CT angiography (CCTA) is very effective for non-invasive evaluation of various connection from origin to drainage of CAF. 3. CCTA is a promising tool to guide the treatment plan and to assess the post-procedural complication. Outcomes: CCTA is useful for the evaluation from origin to drainage of CAF and post- management complication. Summary of Content: 1. Pathophysiology and Clinical manifestations of CAF. 2. Protocol of CCTA for the assessment of CAF. 3. Spectrum of findings of various CAF. 1) Coronary-pulmonary fistula, 2) Coronary cameral fistula, 3) Coronary-bronchial fistula, 4) Coronary artery-sinus (cardiac vein) fistula, 5) Multiple extracardiac connections; internal mammary artery, inferior phrenic artery. 4. Role of CCTA for the pre- and post-management of CAF. 1) Pre-surgical/procedural assessment; location, number, size and complexity of origin and draining vessels of CAF. 2) Post-surgical/procedural complications; postprocedural recanalization, thrombus, aneurysmal change of remained CAF null
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EEE 01-08 CT Imaging of Bioresorbable Stents - A Primer for Radiologists
E. Zdanovich, S. Mansour, A. S. Chin, Y. Provost, C. Chartrand-Lefebvre
Hotel-Dieu CHUM, Montreal, QC, CANADA. Learning Objectives: Most stents have a metallic scaffold which causes CT blooming artifacts, potentially leading to severe impairment to the diagnosis of intrastent restenosis. The bioresorbable (BRS) platform is made of resorbable polymers, with metal-free struts that do not cause blooming artifacts. BRS struts are invisible with coronary CT angiography, even after immediate implantation. BRS can however be identified by the small platinum markers at their extremities. BRS usually allow adequate assessment of in-stent lumen and, for the first time, in-stent plaque imaging with CT, without the need of metal artifact reduction strategies. Outcomes: BRS are a promising alternative to bare-metal and drug-eluting metallic stents, with good clinical outcomes and increased CT assessability of in-stent lumen. Summary of Content: BRS polymer scaffolds are mostly made of poly-L-lactic acid (PLLA) or poly-D,L-lactic acid (PDLLA). They are associated with a cytotaxic agent, such as everolimus or novolimus. BRS completely resorb from the vessel wall at 2 years after implantation in contrast to bare-metal or drug-eluting stents, which will remain throughout the patient's life. Most clinical trials with BRS were performed using invasive techniques: conventional coronary angiography, intravascular ultrasound or optical coherence tomography. The ABSORB II and III trials showed similar mid-term clinical outcomes for everolimus-eluting BRS compared to everolimus-eluting metallic stent. In vitro or clinical studies involving CT imaging of BRS are still scarce. They confirmed the excellent in-stent lumen visibility allowed by BRS, and also demonstrated good patency outcomes. null
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EEE 01-09 Coronary Artery Anomalies from Birth to Adulthood; the Role of CT Coronary Angiography in Sudden Cardiac Death Screening
E. O'Dwyer1, C. O'Brien1, A. Snow2, B. Hogan1, B. Loo1, O. Franklin2, O. Buckley1
1AMNCH, Dublin24, IRELAND, 2OLCHC, Dublin12, IRELAND. Learning Objectives: The learning objectives of this educational exhibit are: • To discuss the technique of CT coronary angiography. • To describe the classic cardiac anatomy, common cardiac anomalies and the proposed mechanism of injury that leads to sudden cardiac death. • To provide an easily accessible tool which aids radiologists when reporting coronary anatomy anomalies. Summary of content: Sudden cardiac death (SCD), especially in the young, has a devastating impact on families, care providers and the community. SCD is defined as an unexpected death due to cardiac causes that occurs in a short time period in a person with known or unknown cardiac disease. Up to 19% of SCD in the young are caused by coronary artery anomalies, occurring in approximately 0.3 to 1% of the population. CT coronary angiography has been demonstrated to be more sensitive than conventional coronary angiography in the detection of anomalies and also offers significant reduction in the radiation dose, especially important in screening populations. We reviewed patients aged 0 to 40 years who presented to two tertiary referral adult and paediatric hospitals for a screening CT coronary angiography with personal risk factors or family history of SCD over the period 2013 and 2016 who had a proven coronary artery anomaly. This resulted in a concise review of typical imaging patterns for common cardiac anomalies affecting adult and paediatric population. Through this we created a guide which is hoped to be an useful aid to both Residents and Attending Physicians. null
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EEE 01-10 Cardiac CT in Electrophysiology Intervention
S. Liddy1, U. Buckley2, T. Kok1, B. Loo1, B. Glover3, O. Buckley1
1Tallaght Hospital, Dublin, IRELAND, 2University of California, Los Angeles, CA, 3Queen's Universty, Belfast, UNITED KINGDOM. Learning Objectives: 1. Describe how cardiac CT is performed.2. Identify the anatomical structures of interest to the electrophysiologist.3. Describe the value of cardiac CT pre- and post- radiofrequency catheter ablation, left atrial appendage occlusion and cardiac device implantation. Summary of Content: Cross-sectional cardiac imaging is being increasingly requested in advance of complex and potentially hazardous procedures. Cardiac CT offers a valuable imaging modality for guiding electrophysiology intervention and evaluating for post procedural complications. Prior to pulmonary vein ablation for atrial ablation, CT is valuable in: 1) assessing the pulmonary vein number, branching pattern and ostial dimensions; 2) assessing left atrial size and morphology; 3) excluding left atrial appendage thrombus; and 4) evaluating for post procedural complications such as pulmonary vein stenosis. In patients undergoing left atrial appendage occlusion, CT can be used to assess the size, location and morphology of the left atrial appendage as well as confirm correct position of the device and evaluate for leakage around the device. Prior to cardiac device implantation, CT can assist lead placement by demonstrating the size and location of the coronary sinus and anatomical configuration of the coronary veins. null
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EEE 01-11 Imaging of Constrictive Pericarditis
I. Drexler, A. Legasto, J. Gruden
Weill Cornell Medicine, New York, NY. Learning Objectives: (1) To compare the advantages of using chest/cardiac CT versus MRI for detection of constrictive pericarditis (2) To familiarize imagers with direct and indirect findings of constrictive pericarditis on both CT and MRI (3) To demonstrate the common MRI sequences (e.g. double inversion recovery imaging and delayed enhancement images) that best detect the classic findings of constrictive pericarditis (4) To discuss newer MRI sequences (e.g. free breathing techniques and myocardial tagging) to evaluate ventricular interdependence and pericardial movement (5) To correlate findings of CT and MR with echocardiography Outcomes: N/A Summary of Content: The PowerPoint Educational Exhibit will consists primarily of CT and MRI images of the heart that demonstrate findings of constrictive pericarditis. While cardiac disease is routinely evaluated with echocardiogram, ultrasound is poor at detecting myocardial thickening, and is also subject to operator dependence and limited acoustic windows. It is important for the cardiothoracic imager to be familiar with findings of constrictive pericarditis, as some findings may be only visible on CT and/or MRI. We will provide information about what advantages and disadvantages of MR and CT cardiac imaging for the evaluation of constrictive pericarditis. We will show images that demonstrate basic findings of constructive pericarditis, such as pericardial calcification and thickening, as well as more subtle findings such as interventricular dependence and delayed enhancement on MRI. We will then correlate CT and MR findings with echocardiography. null
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EEE 01-12 The Aortic Annulus: The Role of CT Angiography in Transcatheter Aortic Valve Implantation (TAVI).
B. Chandrasekaran, A. Rende
Saint Vincent Hospital, Worcester, MA. Learning Objectives/Outcomes: Transcatheter Aortic Valve Implantation (TAVI) has become the standard of care in patients with severe Aortic Stenosis (AS), considered poor surgical candidates. The aortic annulus is an important anatomic landmark, whose proper pre procedural evaluation is of utmost importance as improper implantation of the valve leads to suboptimal results. CT angiography provides a non invasive assessment of the aortic annulus and prevents the chance of post procedure complications such as aortic regurgitation, valve embolization, annular rupture and patient prosthetic mismatch. Oblique coronal and sagittal reconstructions help in creating a true double oblique transverse image of the root, from which the aortic annular size is measured. Summary of content: Going forward, TAVI will be able to offer moderate risk patients a safer, less invasive option to traditional surgery. It has seen substantial advancements over the recent years, not only in the technical aspects of the procedure, but also in preprocedural evaluation for more successful outcomes. Although echocardiography is key to imaging, CTA plays a role, in providing comprehensive information about annulus anatomy and geometry, thus supporting patient selection and prosthesis sizing. It is likely that TAVI will soon become a preferred option for a broad group of patients, and will be performed in a number of smaller hospital settings. This places an impetus on the non cardiac trained radiologist to interpret more of pre procedural scans, for which a sound understanding of the aortic annulus anatomy and pertinent reconstruction techniques is fundamental. null
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EEE 01-13 Overview of Aortic Root Pathologies - Complete Radiological Spectrum
A. J. Baxi1, M. Zahid1, S. Saboo2, C. Restrepo1
1UTHSCSA, San Antonio, TX, 2University of Texas Southwestern Medical Center, Dallas, TX. Learning Objectives: 1. To study anatomy of aortic root in multiple imaging modalities 2. To study the role of imaging in the diagnosis and evaluation of various aortic root pathologies 3. To discuss pathology based pertinent imaging findings helpful in preoperative planning 4. To discuss imaging based differential diagnosis Outcomes: • Introduction • Anatomy • Pathology, imaging findings & role of imaging § Normal anatomic variants including bicuspid aortic valve § Congenital anomalies • Marfan Syndrome • Ehlers-Danlos Syndrome • Turner Syndrome § Aortic stenosis & regurgitation § Aortic dissection § Dilated aortic root/aneurysm § Sinus of Valsalva aneurysm § Sinus of Valsalva rupture § Aortic valve infection § Sub-aortic membrane § Supravalvular obstruction § Aortic root tumours § Normal & abnormal post-operative appearances Infection & peudoaneurysms Summary of Content: Aortic root is the anatomic segment between left ventricle & ascending aorta & consists of aortic annulus, cusps, sinus of Valsalva, & sino-tubular junction functioning as a unit. Though echocardiography is usually the initial imaging modality, it has many limitations & may not be sufficient in evaluating many pathologies. Cross sectional imaging (MDCT/MRI) offers excellent non-invasive assessment in accurately diagnosing and evaluating many pathologies. Recognizing typical imaging manifestations with adequate clinical correlation is essential for timely and accurate diagnosis as well as for guiding treatment. In this exhibit, we discuss the characteristic multimodality imaging findings and differential diagnosis of common congenital and acquired aortic root pathologies. Increased awareness of such entities will contribute to optimized care of patients. null
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EEE 01-14 Look and Locker: Novel Applications of the Inversion Time Mapping Sequence in Cardiac MRI
L. Azour, J. Sanz, M. D. Cham, A. H. Jacobi
Icahn School of Medicine at Mount Sinai, New york, NY. 1. Explore the concept of inversion time (TI) mapping, and how it is most commonly applied in cardiac MRI. 2. Describe acquisition of the TI mapping sequence, including: a. Physics of the inversion recovery pulse sequence; b. Contrast kinetics of the normal heart. 3. Identify and discuss novel applications of TI Mapping: a. Mobile Masses; b. Fat-containing lesions; c. Amyloidosis; d. Cardiac mass versus thrombus; e. Myocardial infarction. 4. Review the diagnostic strengths and limitations of TI mapping.The concept of inversion time mapping originated from the work of Look and Locker in nuclear magnetic resonance spectroscopy over 40 years ago, with subsequent application to cardiac magnetic resonance (CMR) imaging. Determination of the proper inversion time is necessary to sufficiently null the myocardium during acquisition of late gadolinium enhancement (LGE) images, and thus best see abnormal myocardial enhancement. Inversion time mapping is performed as the TI Scout (Siemens) or Cine IR (GE) sequence. Beyond TI scout acquisition for determination of optimal TI, the TI scout alone is useful in multiple additional scenarios. Inversion time mapping is often used to pin the optimal inversion time for myocardial nulling. This sequence yields additional diagnostic information in clinical contexts ranging from depositional disease, ischemia, and evaluation of cardiac masses. null
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EEE 01-15 What does the cardiac surgeon want to know from you? An interpretation guide for imaging prior to congenital cardiac surgery
A. Brixey, C. Fuss
Oregon Health & Science University, Portland, OR. Learning Objectives: The objective of this educational exhibit is to describe the most common congenital heart diseases, define adequate imaging parameters for these diseases, understand the imaging pitfalls that these diseases may present, and to provide an accurate and concise interpretation that adequately addresses the key imaging questions raised by cardiac surgeons prior to repair of congenital cardiac anomalies. Summary of Content: Four commonly encountered congenital heart diseases requiring imaging prior to surgical repair include D-transposition of the great vessels (TGA), aortic arch anomalies, anomalous pulmonary venous return (APVR), and univentricle/hypoplastic left heart syndrome. Examples of important concepts that the cardiac imager should be familiar with include assessing for concurrent abnormalities (such as VSD or major aortopulmonary collateral arteries in the setting of D-TGA), differentiating between hypoplasia and interruption in aortic arch anomalies, assessing the integrity of potential recipient vessels in APVR, and understanding the need for individualized intravenous contrast injection techniques for imaging in post-Fontan procedure hypoplastic left heart patients. Understanding and addressing specific critical imaging questions within the imaging report may prevent unexpected intra-operative findings and complications. null
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EEE 01-16 Cardiac MR Viability Imaging Parameters that Lead to Common Associated Image Artifacts and How to Troubleshoot Them
B. M. Smiley, J. Stojanovska, A. Hamid, E. Lee, M. Ghadimi Mahani, D. Vummidi
Univeristy of Michigan, Ann Arbor, MI. Learning Objectives/Outcomes: 1. Review the principals of cardiac MR viability imaging utilizing late gadolinium enhancement (LGE).2. Review and illustrate common MR artifacts associated with LGE imaging.3. Illustrate different strategies to optimize imaging parameters in order to minimize and eliminate MR artifacts associated with LGE imaging which would result in more accurate evaluation of true myocardial scar. Summary of Content:Cardiac magnetic resonance imaging is an established method to evaluate for late gadolinium enhancement and plays an important role in the management of patients with cardiovascular disease, particularly in terms of evaluation for myocardial infarction and scar. Resultant images use inversion recovery imaging coupled with intravenous contrast agent administration to take advantage of the high spatial and contrast resolution capabilities of MR imaging in order to evaluate for optimal contrast between myocardium and scar. Optimal settings of inversion recovery and LGE imaging parameters are necessary for artifact-free assessment of true late gadolinium enhancement as well as accurate assessment of scar size and extent of involvement. In this exhibit, we will use a case-based approach to review and illustrate how inappropriate imaging parameters lead to specific artifacts and subsequently offer strategies to minimize them. Examples of such parameters include inversion time (TI) selection, TI scouting adjustment, preparation flip angle, phase-encoding direction, spatial resolution, slice thickness, shot duration, acceleration factor, fat suppression, and imaging time after injection. null
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EEE 01-17 Imminent Cardiac Collapse - The Catastrophe You Cannot Afford To Miss
A. J. Baxi, C. Restrepo
UTHSCSA, San Antonio, TX. Learning Objectives: 1. To discuss taxonomy and etiopathogenesis of cardiac collapse 2. To review characteristic imaging findings Outcomes: · Introduction· Taxonomy · Pathology, imaging findings & role of imaging in cardiac circulatory collapse · Dfferential diagnosis. Conclusion · Teaching points Summary of Content: Cardiac arrest is not rare in clinical practice and is often reversible in most cases if treated at the earliest. However, imaging a patient having a cardiac arrest on the CT examination table is not common and limited radiology literature is available. Altered hemodynamics resulting from cardiac failure causes stasis of blood in the dependent organs of the body and injected intravenous contrast material, being heavier than blood, tends to accumulate in the dependent portions of the venous system seen as dependent contrast pooling and layering, which in appropriate clinical scenario is a marker of the worsening clinical condition. It is therefore very important to identify the pertinent findings and act quickly. Recognizing the typical imaging manifestations of imminent cardiac failure with adequate clinical correlation is thus extremely critical not only for timely and accurate diagnosis but also for guiding treatment. Imaging thus plays a critical role in the patient management. In this exhibit, we discuss the pertinent CT imaging findings of on table cardiac arrest. Increased awareness of such entities will contribute to optimized care of patients. null
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EEE 01-18 Non-traumatic acute cardiac emergencies: Complete radiological spectrum
A. J. Baxi1, R. Katre1, S. Saboo2, C. Restrepo1
1UTHSCSA, San Antonio, TX, 2University of Texas Southwestern Medical Center, Dallas, TX. Learning Objectives: 1. To discuss non-traumatic cardiac emergencies 2. To study the role of imaging in the diagnosis and evaluation of these conditions 3. To discuss imaging based differential diagnosis Outcomes: • Introduction • Anatomy • Pathology, imaging findings & role of imaging § Acute infarct § Myocarditis § Arrhythmogenic right ventricular dysplasia § Hypertrophic cardiomyopathy § Collapsing heart § Malignant coronary artery origin § Acute thrombus § Pericardial tamponade § Pericarditis § Malignant pericardial effusion § Aneurysms and their complications including rupture § Foreign body • Differential diagnosis Summary of Content: Chest pain is always cause of concern especially if cardiac in origin. The diagnosis of cardiac origin is initially established on clinical, laboratory and echocardiography evaluation. Many a times, these may not be sufficient and evaluation using cardiac MRI and MDCT imaging is mandatory for reaching accurate diagnosis as many of the pathologies presenting with non-traumatic cardiac pain/emergency have distinct imaging appearance. Accurate diagnosis is very important to optimizing proper treatment. Categorizing these pathologies serves as a road map in patient care. Recognizing typical imaging manifestations with adequate clinical correlation is essential for timely and accurate diagnosis as well as for guiding treatment. In this exhibit, we discuss the characteristic multimodality imaging findings and differential diagnosis of common non-traumatic cardiac emergencies. Increased awareness of such entities will contribute to optimized care of patients. null
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EEE 01-19 Epicardial fat in HIV population: A potential risk biomarker for coronary artery disease
M. Sadouni1,3, M. Durand1,2,3, A. Chin1,2, S. M. Le1,2,3, J. Chalaoui1,2,3, C. Tremblay1,2,3, C. Chartrand-Lefebvre1,2,1
1Universite de Montreal, Montreal, QC, CANADA, 2CHUM, Montreal, QC, CANADA 3CRCHUM, Montreal, QC, Canada Learning Objectives: Objectives of this educational exhibit are to describe: - Anatomy and physiology of epicardial fat; - Methods of measurement of epicardial fat with computed tomography (CT); - Relationships of epicardial fat CT quantitative parameters with cardiovascular disease in the general population and, especially, HIV-infected patients. Outcome: Epicardial fat may become a novel CT-measurable biomarker in the stratification of cardiovascular disease risk in the general population, and especially HIV patients. Summary of Content: Epicardial fat is the visceral fat of the heart; it is found between the visceral layer of the pericardium and the myocardium. Evidences suggest that epicardial fat have many physiologic functions including providing energy to the heart in times of high demand. It is also an extremely active organ that produces both anti-inflammatory and pro-inflammatory adipokines and cytokines. These mediators are among factors involved in the development of atherosclerotic plaques. Cardiac CT is an imaging option of choice to quantify epicardial fat, with commercial postprocessing softwares, and also allows screening for coronary atherosclerosis. Although previous studies have established a link between epicardial fat and atherosclerosis, only few studies have assessed epicardial fat in the HIV population and especially its relationship to coronary artery disease. Preliminary results suggest increased epicardial fat in HIV patients, as well as an independent association with coronary artery plaque burden, after adjusting for traditional risk factors. Observed associations and potential mechanisms may link epicardial fat to the pathogenesis of atherosclerosis in HIV-infected patients. null
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EEE 01-20 Spikes and Dips: Cardiac Magnetic Resonance Imaging Manifestations of the EKG
L. Azour, J. Sanz, M. D. Cham, A. H. Jacobi
Icahn School of Medicine at Mount Sinai, New York, NY. Learning Objectives: 1. Review basic EKG interpretation, and the findings of ischemic disease. 2. Discuss the imaging correlates of conduction abnormalities including atrial fibrillation, bigeminy, and left bundle branch block. 3. Identify the imaging correlates of various cardiomyopathies (hypertrophic, dilated, Takotsubo, ARVD, amyloid, sarcoid). 4. Optimizing image acquisition in the setting of abnormal EKG Summary: Cardiologists have often described the echocardiographic correlates of abnormal EKG findings. Radiologists have limited, if any, exposure to echocardiography during training. However, the ability to assess dynamic heart motion on cardiac magnetic resonance (CMR) imaging is an integral component of exam interpretation, and like echocardiography, should be interpreted in the context of the known cardiac rhythm. Understanding how the EKG may foreshadow wall motion abnormalities allows the radiologist to not only better plan exam acquisition but also arrive at more accurate diagnosis. null
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EEE 01-21 Cardiac MR Imaging of Patients with Cardiac Implantable Electronic Devices: A Changing Landscape
J. Fishman, R. Mitrani, I. Novoa
University of Miami, Miami, FL. Learning Objectives: 1. Understand the documented and possible risks of performing MR in patients with non-MR conditional cardiac implantable electronic devices (CIEDs). 2. Outline the protocol for screening and scanning patients with CIEDs that either are or are not MR conditional, including the roles of radiology and cardiology personnel. 3. Recognize artifacts on cardiac MR scans of patients with CIEDs and potential methods to reduce them. Outcomes: The ability to confidently triage, scan, and interpret cardiac MR scans in patients with CIEDs. Summary of Content: It is estimated that 50-75% of patients with CIEDs, including pacemakers, defibrillators, and cardiac resynchronization devices, will require an MR scan during the lifetime of the device. An increasing number of institutions have developed protocols for performing cardiac and other MR scans in such patients. Furthermore, since 2011 an increasing number of new CIEDs are FDA-approved as “MR conditional,” meaning that MR scanning is approved under certain conditions. Nevertheless, a majority of both previously and newly implanted devices are not MR conditional. There are also differences in “approved” devices among nations. Centers that perform MR scans in CIED patients must be familiar with the devices, prerequisites, protocols, and pitfalls in doing so. In this exhibit we will present the current state of knowledge in safely performing cardiac and other MR imaging in patients with both non-MR conditional and MR conditional CIEDs. We will also address issues of safety, image quality, and techniques specific to cardiac MR scans in these patients. null
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EEE 01-22 Incidental Findings Not to Be Missed on Cardiac MRI
F. Kay, A. Kandathil, S. Saboo, K. Batra, P. Rajiah, S. Abbara
UT Southwestern Medical Center, Dallas, TX. Learning Objectives/Outcomes: - To compile and illustrate the spectrum of clinically relevant extracardiac findings that may be incidentally found in patients undergoing cardiac MRI - Raise awareness and educate cardiologists and radiologists on the importance of screening different image series on cardiac MRI studies for incidental findings Summary of Content: Cardiac MRI generally utilizes advanced pulse sequences with small fields of view. However, patients undergoing cardiac studies can harbor unsuspected clinically significant conditions, that may be encountered on MRI images. It is crucial to raise awareness and educate both cardiologists and radiologists about the importance of screening different pulse sequences, including scout images, acquired on cardiac MRI exams, in order to avoid missing significant diagnostic information that may impact patient prognosis. null
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EEE 01-23 Pulmonary hypertension -How imaging can help?
K. BATRA, P. RAJIAH, C. Maroules, S. SABOO, A. KANDATHIL, A. madhuranthakam, S. ABBARA
UTSOUTHWESTERN MEDICAL CENTRE, Dallas, TX. Learning Objectives/outcomes: 1. To define pulmonary hypertension. 2. To review and exemplify the revised DANA classification (based on the 5th world symposium Nice 2013) on pulmonary hypertension by illustrated examples. 3.To highlight role of imaging, inclusive of non -invasive and invasive modalities, in the diagnosis, and management with emphasis on the emerging role of cardiac MRI as a marker for longitudinal follow up of patients with pulmonary arterial hypertension. 4.To elucidate an imaging algorithm with a step wise approach in the diagnosis and management of pulmonary hypertension Summary of Content: Pulmonary hypertension is a chronic and progressive disease leading to right heart failure and untimely death if untreated. Imaging has a pivotal role in the diagnosis, management and prognosis for this debilitating disease. The role of invasive and non-invasive imaging modalities including Cardiac mri , Contrast enhanced CT , MR pulmonary angiography, High resolution CT scan , ventilation- perfusion scan , echocardiogram and right heart catheterization amongst others are of utmost importance in the diagnosis, management and follow up in these patients. An imaging algorithm in the work up and follow up emphasizing the role of non-invasive imaging in screening, diagnosis and classification of Pulmonary hypertension will be described. Future directions on MRI strategies for quantifiying hemodynamic status including Arterial spin labelling, an emerging non-contrast MR perfusion imaging method that can provide regional distribution of quantitative pulmonary vasculature, with potential use in characterization and monitoring of PHT will be alluded to null
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EEE 01-24 Overview of cardiac and paracardiac aneurysms/pseudoaneurysms: Radiologist`s perspective
A. J. Baxi1, C. Restrepo1, S. Jimenez2
1UTHSCSA, San Antonio, TX, 2Saint Luke's Imaging Associates, Kansas City, MO. Learning Objectives: 1. Study pathophysiology of cardiac & paracardiac aneurysms/pseudoaneurysms 2. Study role of imaging in diagnosis & evaluation of aneurysms/pseudoaneurysms 3. To discuss pathology based pertinent imaging findings helpful in preoperative planning Outcomes: • Introduction • Pathology, imaging findings & role of imaging § True & false aneurysms involving cardiac chambers/pericardium § Ruptured aneurysm § Septal aneurysms § Coronary artery aneurysms • Congenital • Atherosclerotic • Infective • Inflammatory • Traumatic § Saphenous venous graft aneurysm § Radial/Internal mammary artery graft aneurysm § Aortic root & Sinus of Valsalva aneurysm § Post-operative peudoaneurysms Summary of Content: Cardiac aneurysm is a defect usually in ventricle (mostly left) produced by transmural infarction. Aneurysm can be true (large, localized to apical LV wall, & made up of damaged myocardial wall) or false (small, usually along posterolateral LV & represents localized myocardial rupture covered by pericardium. Though echocardiography is usually performed initially, it has many limitations & may not be sufficient in evaluating many pathologies. Cross sectional imaging (MDCT/MRI) offers excellent non-invasive assessment in accurately diagnosing & guiding treatment. Coronary artery aneurysms are as such rare; however, with advent of MDCT, they are frequently. Recognizing typical imaging manifestations using MDCT/MRI with clinical correlation is essential for timely and accurate diagnosis, classification, etiology, pathogenesis, as well as for guiding treatment. definition, classification, epidemiology, etiology & pathogenesis. In this exhibit, we discuss characteristic imaging findings & differential diagnosis of cardiac & paracardiac aneurysms/ pseudoaneurysms. Increased awareness of such entities will contribute to optimized patient care. null
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EEE 02-01 Is it really honeycombing? Limitations and pitfalls in radiological diagnosis of honeycombing.
J. Arenas-Jimenez, E. Garcia-Garrigos, M. Sirera-Matilla, M. C. Planells-Alduvin, F. I. Aranda
Hospital General Universitario de Alicante, ALICANTE, SPAIN. Learning Objectives: To show the limitations in diagnosing honeycombing in lung CT with pathologic correlation and to review potential pitfalls that could cause a wrong diagnosis of honeycombing. Summary of Content: Diagnosis of radiological honeycombing is crucial for establishing an usual interstitial pneumonia pattern, so a confident diagnosis is desirable. Although there is a relatively low interobserver agreement in the diagnosis of honeycombing, typical appearance of clustered peripheral thick wall air cysts cause few problems. However, potential pitfalls that we have to keep in mind will be reviewed, some of them follow: Small cysts: radiologists must be aware that a microscopic honeycombing under CT scans resolution frequently exists and occasionally very small cysts in regions with other signs of fibrosis can correspond to this microscopic honeycombing. Sometimes there is a gap between what pathologist and radiologists call honeycombing. Big cysts: honeycombing in areas with emphysema and fibrosis can be difficult to differentiate from each other. Bronchiectasis: sometimes, appearance and distribution of ectatic bronchi can mimic honeycombing, review of contiguous slices and multiplanar reformatting can be useful to differentiate. Infection or edema superimposed to centrilobular emphysema can closely resemble the appearance of honeycombing. Distribution of the abnormality and visualization of centrilobular arteries are the clue to avoid a false diagnosis. null
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EEE 02-02 Off the Beaten Track: A Pictorial Review of Atypical Features of Pulmonary Metastases
M. J. Hora, C. W. Koo, C. W. Cox
Mayo Clinic, Rochester, MN. Learning Objectives/Outcomes: 1. Identify typical and atypical imaging features of pulmonary metastases. 2. Describe the mechanisms of tumor spread to the lungs and the underlying pathophysiology of the atypical imaging features. 3. Recognize the most common primary malignancies that result in various patterns of pulmonary metastases. 4. Briefly discuss the common nonmalignant diseases that atypical metastases mimic. Summary of Content: Extrathoracic malignancies have a marked predilection for spreading to the lung parenchyma with 20-54% of patients having pulmonary metastases at autopsy. Many extrathoracic malignancies will present with typical radiologic findings of hematogenous metastases (multiple peripherally located round nodules) or lymphangitic carcinomatosis (thickening and nodularity of the interstitium). However, a subset of pulmonary metastases have atypical imaging features. Even though these atypical features serve as clues to the origin of the primary tumor, the considerable overlap of imaging findings characteristic of common nonmalignant conditions (infectious/inflammatory processes, benign tumors) poses a diagnostic challenge for the radiologist. Familiarity with these atypical imaging findings can both help prevent the radiologist from dismissing a metastatic lesion as benign and further assist the clinician in the search for an unknown primary malignancy. The following patterns will be displayed in case format with discussion of the underlying pathophysiology and most common primary tumor types: Typical hematogenous metastases (miliary, cannonball patterns), typical lymphangitic carcinomatosis, cystic metastases, calcified metastases (eccentric and mucoid), cavitary metastases, endobronchial metastases, tumor emboli (including tree in bud pattern), metastases presenting with spontaneous pneumothorax, metastases with perilesional hemorrhage, solitary metastasis, and metastases with lepidic growth. null
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EEE 02-03 Thoracic complications of precision cancertherapies: A practical guide for radiologists in the new era of cancer treatment
M. Nishino1, H. Hatabu2, N. Ramaiya1
1Dana-Farber Cancer Institute, Boston, MA, 2Brigham and Women's Hospital, Boston, MA. Learning Objectives: Recent advances in understanding of molecular mechanisms of cancers have opened a new era of precision medicine approaches for advanced cancer patients. Acting by targeting specific molecules, precision cancer therapies are associated with a variety of thoracic complications, which is often unique to agents or classes of agents. Knowledge of the imaging manifestations of these thoracic complications in specific cancer therapies is essential for chest radiologists. The purpose of this exhibit is to provide a comprehensive review of thoracic complications of precision cancer therapies and familiarize the audience with the spectrum of imaging manifestations. Emerging knowledge of pneumonitis and other thoracic complications during novel immune-checkpoint inhibitor therapy will be emphasized. Outcomes: The exhibit is designed to serve as a practical guide for day-to-day practice in the chest reading room. Summary of Content: Important thoracic complications of precision cancer therapy listed below will be reviewed with the representative cases from a tertiary cancer center, along with discussions of the underlying mechanisms, clinical features and radiologic manifestations, treatment options and outcome. Pneumonitis: mTOR inhibitors (everolimus, tesilorimus), EGFR inhibitors (erlotinib, gefitinib, afatinib, osimertinib), PD-1 inhibitors (nivolumab, pembrolizumab), Her-2 inhibitors (Trastuzumab), CD20 antibody (Rituximab) Sarcoid-like lymphadenopathy: CTLA-4 inhibitor (ipilimumab), PD-1 inhibitors (nivolumab, pembrolizumab) Pleural edema and effusion: Tyrosine kinase inhibitors (dasatinib, imatinib) Pulmonary hemorrhage: VEGF inhibitors (bevacizumab) Pulmonary embolism: VEGF inhibitors (bevacizumab, sorafinit, sunitinib); Cardiomyopathy: Her-2 inhibitors (Trastuzumab), PD-1 inhibitors null
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EEE 02-04 Chronic Lung Allograft Dysfunction - More than just Bronchiolitis Obliterans Syndrome
P. V. Hota, C. Dass, S. Simpson
Temple University Hospital, Philadelphia, PA. Learning Objectives/Outcomes: This pictorial review is designed for residents, fellows, general radiologists, thoracic radiologists, and non-radiology participants. The primary goals are to describe the unique radiologic characteristics of chronic lung allograft dysfunction (CLAD) subtypes with pathologic and clinical correlation from our patient database obtained at our Lung Transplant Center. This will be achieved by: Illustrating the proposed pathophysiology of CLAD subtypes including: Bronchiolitis Obliterans Syndrome (BOS), Restrictive Allograft Syndrome (RAS), and Neutrophilic Reversible Allograft Dysfunction (NRAD) Describing unique characteristics of CLAD phenotypes on CT imaging with practical tips for aiding in diagnosis as well as describing current diagnostic challenges Clinical correlation with pulmonary function tests and pathologic correlation with specimens from our Lung Transplant Center Summary of Content: Long-term survival and allograft function following lung transplantation is significantly shorter than other organ transplants with an estimated survival rate of 50% 5 years post-transplantation. This discordance is felt to be secondary to the development of CLAD. CLAD is multi-factorial with etiologies including antibody-mediated rejection, inflammatory factors, and fibroproliferative processes. Increasing evidence has shown that CLAD is a heterogeneous condition with distinct subtypes including: BOS, NRAD, and RAS. In addition to unique imaging characteristics, these phenotypes have specific clinical and pathologic manifestations as well as treatment strategies. With continual yearly growth in the number of lung transplantations, numbering 3,614 in 2014, and differing treatment strategies based on CLAD subtypes, understanding the unique imaging manifestations, clinical presentations, and pathophysiology of each is increasingly important for both the radiologist and clinician. null
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EEE 02-05 Lung Transplantation 2.0: Updates on Indications, Donor and Recipient Selection, Surgical Techniques, and Post-transplant Complications
C. Chang
University of California - Los Angeles, Los Angeles, CA. Learning Objectives: To review the current indications and contraindications for lung transplant based on the 2014 consensus guidelines from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation To discuss donor and recipient selection criteria To describe the surgical techniques for lung transplantation To discuss the current clinical and imaging findings of post-transplant complications Summary of Content: With the increase in number of lung transplants and the continually evolving knowledge of lung transplant pathology and immunosuppression, it is important for thoracic imagers to not only be cognizant of the pre- and post-transplants imaging findings, but also to understand the factors which guide clinical decisions in managing these patients. This exhibit will review the indications and contraindications for lung transplant, discuss patient selection criteria, and describe the surgical techniques in order to better comprehend the when, why, and how of lung transplantation. The clinical, radiologic and pathologic findings of postoperative complications will be discussed along a time continuum, including surgical, infectious, inflammatory, rejection, and neoplastic processes, with particular focus on chronic lung allograft dysfunction null
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EEE 02-06 Pictorial Review of Chemotherapy-induced Pneumonitisin Oncologic Patients
J. Han1, K. Lee2, J. Baek1
1Dongnam Institute of Radiological and Medical Sciences Cancer Center, Busan, KOREA, REPUBLIC OF, 2Dong-A University, Medical Center, Busan, KOREA, REPUBLIC OF, 3Inje University Busan Paik Hospital, Busan, KOREA, REPUBLIC OF. Learning Objectives: 1. To understand comprehensive diagnostic approach of chemotherapy-induced pneumonitis (CIP) considering clinical, laboratory, pathologic and radiologic findings 2. Pictorial review of CIP classified by clinical onset 3. To describe challenging differential diagnosis of CIP with case review Outcomes: Early diagnosis helps prompt withdrawal of the offending agent and prevents fatal outcomes or significant pulmonary sequelae. Summary of Content: Introduction Pathogenesis Diagnostic approach and risk factors Thin-section CT finding -Early-onset CIP -- Diffuse alveolar damage -- Pulmonary edema -- Diffuse alveolar hemorrhage -- Hypersensitivity pneumonitis -Late-onset CIP -- Eosinophilic pneumonia -- Organizing pneumonia -- Nonspecific interstitial pneumonia -- Radiation recall pneumonitis -- Miscellaneous Differential diagnosis Conclusion null
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EEE 02-07 The Thoracic Radiologist's Guide to the Breast
Jillian Krauss MD, Gurpryia Gupta MD, Sayf Al-Katib MD, and Michael Farah MD
Oakland University William Beaumont School of Medicine, Beaumont Health, Royal Oak, MI. Title: The Thoracic Radiologist’s Guide to the Breast Exhibit Category: Other (Neoplastic and Non-Neoplastic Chest Wall Diseases) Learning Objectives: 1. To become familiar with cross sectional breast anatomy and proper descriptors of anatomic location 2. To recognize normal CT and MRI appearance of breast tissue 3. To identify cross sectional imaging appearance of benign breast processes in females and males 4. To recognize cross sectional imaging appearance of malignant breast disorders 5. To learn the appropriate mammographic imaging study recommendations for further workup of a suspected breast abnormality detected on a thoracic imaging exam 6. To become familiar with expected cross sectional imaging appearance of the post-operative breast and recognize post-operative complications Summary of Content: 1. Breast anatomy 2. Normal CT and MRI appearance of the breast 3. Benign breast disorders a. Benign masses b. Infections c. Gynecomastia 4. Malignant breast disorders a. Primary breast malignancies b. Metastatic disease 5. Post-operative breast a. Normal post-operative appearance b. Post-operative complications c. Breast prosthesis null
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EEE 02-08 Upcoming Changes in Lung Cancer Staging in the Forthcoming Eighth Edition of the TNM Classification: What Radiologists Need to Know
S. H. Novak, A. David, N. K. Gupta
University of Pennsylvania, Philadelphia, PA. Learning Objectives: Explain the key changes in the forthcoming TNM staging system updateApply the system to radiologic studies of patients with lung cancer Summary of Content: The Lung Cancer Staging Project of the International Association for the Study of Lung Cancer (IASLC) has published proposed updates of the TNM Classification of Lung Cancer, and the full TNM update publication is forthcoming soon. We provide a practical guide for radiologists to the updated TNM staging system for lung cancer. The primary tumor (T) component will subclassify T1 into subgroups <1 cm, 1-2 cm, and 2-3 cm, T2 into 3-4 cm, 4-5 cm, and T3 to 5-7 cm, and T4 as > 7 cm. Involvement of a main bronchus indicates T2 at any distance from carina. Atelectasis and pneumonitis also quality as T2. Diaphragm invasion indicates T4. Mediastinal pleura invasion has been deleted as a descriptor. The node (N) classification is to be separated into N1 with anterior and N2 with deep lymph nodes. In regards to the metastatic (M) descriptor, M1a indicates those with pleural or pericardial effusions and/or lung or pleural nodules. M1b indicates those patients with metastatic lesions in a single distant organ. M1c indicates multiple lesions in multiple organs. By using this updated TNM classification to assign the correct stage, the radiologist serves a critical role in planning treatment for patients with lung cancer. null
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EEE 02-10 Tropical and Subtropical Parasitic Infections of the Chest: a Guide for Radiologists
G. S. P. Meirelles1, J. Capobianco1, D. Jasinowodolinski2, D. Escuissato3, C. A. Neto4, B. Hochhegger5, A. S. Souza Jr6, E. Marchiori7
1Fleury Group, Sao Paulo, BRAZIL, 2Hospital do Coracao, Sao Paulo, BRAZIL, 3DAPI, Curitiba, BRAZIL, 4DASA, Salvador, BRAZIL, 5Santa Casa de Porto Alegre e PUC/RS, Porto Alegre, BRAZIL, 6Ultra-X, Sao Jose do Rio Preto, BRAZIL, 7UFRJ, Rio de Janeiro, BRAZIL. Learning Objectives/Outcomes: Tropical and subtropical parasitic diseases are very common worldwide and will probably become more frequent due to increasing globalization and changes in natural ecosystem and climate. As chest is frequently involved, knowledge about chest parasitic diseases is crucial for their prompt recognition and appropriate treatment. The authors will describe the main tropical and subtropical parasitic diseases in terms of their geographic distribution, with emphasis on South American infections, and will demonstrate their most common imaging, clinical and pathological findings. Summary of Content: The authors will focus on the following points: 1. Geographic distribution of tropical and subtropical parasitic diseases. 2. Review of clinical, imaging and pathological findings of the following diseases, with sample cases: Amebiasis, Schistosomiasis, Toxoplasmosis, Hydatid lung disease, Malaria, Trypanosomiasis, Ascariasis, Strongyloidiasis, Dirofilariasis, Cysticercosis, Syngamosis, Schistosomosis and Paragonimiasis. 3. Summary of findings and conclusions. The major teaching points of this exhibit are: 1. Parasitic infections are common in tropical and subtropical regions, but their chest imaging findings are unknown to the majority of radiologists. 2. Familiarity with their geographic distribution, besides their clinical and imaging features, may help in the differential diagnosis. null
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V. S. A. Lajarin1, I. G. Padilha2, A. Marchini1, J. T. A. Grill2, C. V. Castro2, C. G. R. Junior2, F. B. Assunçao2
1Santa Casa De Misericordia de Sao Paulo/Fleury Medicina Diagnostica, Sao Paulo, BRAZIL, 2Santa Casa De Misericordia de Sao Paulo, Sao Paulo, BRAZIL. Learning Objectives: Cobb syndrome, or cutaneomeningospinal angiomatosis, is a neurocutaneous disorder characterized by spinal vascular abnormalities in association with vascular lesions of the skin at the same metamere. Patients are diagnosed at any age but most commonly in late childhood and typically after the onse of neurologic symptoms such as paraplegia, quadriplegia, back pain, and fatigue due to heart failure. This report aims to review the main image findings on computed tomography and magnetic resonance imaging to support the diagnosis of Cobb syndrome, in the context of thoracic/intramedullary arteriovenous malformations (AVM) investigation. Outcomes: We have described in this study a serie of 2 patients with thoracic cutaneous vascular nevi associated to spinal vascular pathology. A 23-year-old man presented with paraparesis and paresthesia of the lower extremities for 9 years. Vascular skin lesions, some of them port-wine stain over his left upper midback correlated precisely with MR imaging that demonstrated an enhacing dilated and tortuous intra-and extramedullary AVM between T3-T10 causing compression of the cord and edema. Associated to cardiomegaly, intrapulmonary arterial dilation and parenchymatous perfusion abnormalities. A 16-year-old man also presented with progressive myelopathy and port-wine stains within the C7-T2 left dermatomal region, associated to a spinal arteriovenous malformation. Summary of Content: Cobb syndrome is an unusual entity and should be considered when there is an association of cutaneous manifestation and underlying neurological deficit. The presence of vascular skin nevus associated to Cobb syndrome should incite the investigation of corresponding intramedullary AVM to approach the diagnosis of this metameric pathology. null
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EEE 02-12 Lung Cancer Associated with Cystic Airspaces: Don't let This Lesion Fool You!
A. Snoeckx, P. Reyntiens, M. J. Spinhoven, L. Carp, P. E. Y. Van Schil, P. Pauwels, J. P. van Meerbeeck, P. M. Parizel
Antwerp University Hospital and University of Antwerp, Edegem, BELGIUM. Learning Objectives: - To illustrate the spectrum of imaging findings of "lung cancer associated with cystic airspaces"- To define key imaging findings- To discuss and illustrate differential diagnoses Summary of Content: "Lung cancer associated with cystic airspaces" is a rare radiological entity that is increasingly reported on imaging studies since the widespread use of CT for lung cancer screening. The pathogenesis is not yet understood. Four different morphologic types have been described on imaging: Type I is a nodule or mass extruding from the wall. Type II is a nodule or mass confined to the cystic airspace. Type III is a soft tissue density extending along the wall and Type IV a soft tissue density intermixed within clusters of cystic airspaces. Early diagnosis can be difficult since findings may be subtle. Lesions are often misdiagnosed as "probably infectious abnormalities" and this type of tumor is often not recognized in the initial stage. Differential diagnoses include lung nodules or masses with bubble like lucencies, cylindrical bronchiectasis in an area of consolidation, cavitary lung lesions, ... Since data from lung cancer screening trials have shown that these cancers are aggressive, familiarity with this "uncommon face of a common disease" is mandatory for early recognition and subsequent diagnosis. Radiologists should carefully examine the wall of cystic airspaces, especially in patients at risk for lung cancer. Progressive wall thickening and wall irregularities should alert the radiologist to the possibility of lung cancer. null
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EEE 02-13 Thoracostomy: An Update on Imaging Features and Current Surgical Practice
R. Ambrosini, C. Gange, K. Kaproth-Joslin, S. K. Hobbs
URMC-Strong Memorial Hospital, Rochester, NY. Learning Objectives: 1) What are the clinical indications for a thoracostomy 2) What radiologic features can imaging physicians provide to aid in clinical decision making prior to thoracostomy 3) What are the imaging features of the thorax post thoracostomy 4) What are the long-term changes in patients who have had a thoracostomy Summary of Content: The aim of this educational exhibit is to provide a review of the clinical decision making prior to a thoracostomy procedure, preoperative imaging features that may help guide the surgeon to consider a thoracostomy, and to illustrate the imaging features on plain film and cross sectional images after a thoracostomy is performed. This exhibit will also provide information on the procedures currently performed. null
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EEE 02-14 Uncommon lung tumors: Radiologic-pathologic correlation
Samsung medical center, Seoul, KOREA, REPUBLIC OF. Learning Objectives/Outcomes1. To review the rare lung tumors based on the 2015 World Health Organization (WHO) classification of tumors of the lungs. 2. To illustrate the radiologic features of the rare lung tumors on CT and PET/CT 3. To correlate radiologic features of the rare lung tumors with histologic and genetic features Summary of Content The 2015 World Health Organization (WHO) Classification of Tumors of the Lung has been published with numerous important changes from the 2004 WHO classification. The main change in this edition is the completely different approach to lung adenocarcinoma as proposed by the 2011 IASLC/ATS/ERS classification. In addition, there are minor changes and updates on other rare histologic subtypes of lung tumors such as changing the term sclerosing hemangioma to sclerosing pneumocytoma, adding NUT carcinoma, creating a group of PEComatous tumors, and adding the entities myoepithelioma and myeoepithelial carcinomas, and so on. The classification also includes uncommon tumors such as colloid adenocarcinoma, enteric adenocarcinoma, sarcomatoid carcionoma, glandular papilloma and intravascular lymphomatosis, and the imaging features of these rare tumors have not been addressed in detail. In this educational exhibit, we review the rare lung tumors based on the 2015 WHO classification and illustrate typical imaging features correlated with histologic and genetic features. null
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EEE 02-15 Cardiothoracic Interplay: When the clue is in the Heart and Vessels
University of Virginia Learning Objectives: After reviewing this exhibit, the learner will be able to: Understand the intimate interaction between cardiac and pulmonary physiology and how many cardiovascular disorders manifest with abnormalities in the pulmonary parenchyma Identify the specific main pulmonary and cardiovascular imaging findings of these entities that cue the diagnosis Relate the imaging manifestations and the physiopathology of these entities Summary of Content: The organs of the cardiopulmonary system function closely related to each other and not infrequently the pathology of one results in dysfunction of the other. Several functional and anatomical abnormalities of the heart and intrathoracic vessels commonly manifest as pulmonary pathology. The differential diagnosis of diffuse parenchymal opacities is wide when the etiology is not clear. Recognizing diagnostic clues in the cardiovascular system helps orienting the diagnosis; optimizes and guides further imaging work-up and treatment, and thus impacts patient outcome.We will present a group of cardiovascular entities that frequently manifest with pulmonary pathology and illustrate the key imaging findings in the cardiovascular system that help in the diagnosis; leading the learner to a better understanding of the physiopathology of these entities and the reason behind the pulmonary manifestations. null
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EEE 02-16 Pseudoaneurysms in the Chest: You See Only WhatYou Look For; You Recognize Only What You Know
C. Silva, J. Alegria, J. Diaz, C. Ramos
Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, CHILE. Purpose: Pseudoaneurysms in the chest are rarely seen in chest CT, mostly related to high-energy trauma, associated to unstable hemodynamic status, which precludes performance of non-invasive imaging. In addition, we may see them after the event of a myocardial infarct or as an iatrogenic result. When detected, the radiologist must be proactive in providing accurate and precise information to the cardiothoracic surgeon. In this exhibit, we will present various appearances of pseudoaneurysms in the chest, their CT characteristic imaging findings, and the information the surgeon will expect. Outline: 1) Definition 2) Imaging findings of: a. Post-traumatic aortic pseudoaneurysm b. Post-traumatic pulmonary vein pseudoaneurysm c. Post-myocardial infarction cardiac pseudoaneurysm d. Post-catheter pulmonary artery pseudoaneurysm 3) Differential diagnosis 4) Important information to provide the surgeon null
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EEE 02-17 A quick radiologic review of the ATS/ERS/JRS/ALAT diagnostic criteria for IPF
H. Shoushtari Zadeh
University of Ottawa, Ottawa, ON, CANADA. Learning Objectives: With innovation of CT scan machine and improvement of their resolution different radiologic Features have been discovered. On the other hand, expectation from radiologist to diagnose and differentiate various patterns in Interstitial Lung Disease is rising. Furthermore, early differentiation between Usual Interstitial Pneumonia, which is the most common form of idiopathic interstitial pneumonitis and has the worse outcome, from other IIPs is a dilemma for radiologists. Fortunately, ATS/ERS/JRS/ALAT committee has provided an exclusive criteria for differentiation of UIP Pattern from other less common forms of IIPs. Outcomes: In this educational presentation, I have attributed any findings of the ATS/ERS/JRS/ALAT table with an imaging example to make it easier for audience to recognize and imply the criteria in their everyday practice. Summary of Content: Educational power point matches each part of the criteria with images and provides an overview of consistent and inconsistent findings. null
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EEE 02-18 Non-neoplastic Conditions in the Mediastinum
H. Koo, M. Kim, J. Song
Asan Medical Center, Seoul, Seoul, KOREA, REPUBLIC OF. Learning Objectives: To know clinical and imaging characteristics of mediastinal non-neoplastic conditions To learn the imaging findings of rare mediastinal non-neoplastic conditions with various cases To facilitates the accurate and prompt diagnosis of mediastinal non-neoplastic diseases Summary of Content: 1. Mediastinitis Retropharyngeal abscess Fibrosing Mediastinitis 2. Vascular lesions Iatrogenic aortic arch injury Iatrogenic left innominate vein injury Bronchial artery aneurysm Aortoesophageal fistula 3. Esophageal lesions Esophageal perforation/dissection Esophagonodal fistula Esophageal submucosal hematoma Esophageal diverticulum 4. LN disease Sarcoidosis Tuberculosis Castleman’s disease 5. Others Bronchial wall rupture Pancreatic pseudocyst Thoracic duct dilatation Extramedullary hematopoiesis null
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EEE 02-19 Nuked, Fried, Frozen: A Pictoral Journey Through Pulmonary Changes in Response to Different Treatment Modalities
J. Huang, B. Zigmund
Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA. Learning Objectives: To explore the appearance of pulmonary parenchymal changes following treatment using different energy sources including: Microwave (MWA), Radiofrequency (RFA), Cryoablation (CRYO), Stereotactic Body Radiation Therapy (SBRT), and Conformal Radiotherapy (CRT) Outcomes: The different treatment modalities evoke different patterns of parenchymal damage (coagulative, thermal, cellular disruption, apoptotic). Summary of Content: Introduction to pulmonary tumor ablation: - History of ablation - Overview of treatment options for pulmonary masses v Radiofrequency Ablation Ø Mechanism of action Ø Indications Ø Technical Considerations Ø Case overview followed by images § Pre-ablation § Immediate Post ablation § 1-3 month followup § 3-6 month followup § 6-12 month followup v Microwave Ablation Ø Mechanism of action Ø Indications Ø Technical Considerations Ø Case overview followed by images § Pre-ablation § Immediate Post ablation § 1-3 month followup § 3-6 month followup § 6-12 month followup v Cryoablation Ø Mechanism of action Ø Indications Ø Technical Considerations Ø Case overview followed by images § Pre-ablation § Immediate Post ablation § 1-3 month followup § 3-6 month followup § 6-12 month followup v Stereotactic Body Radiation Therapy Ø Mechanism of action Ø Indications Ø Technical Considerations Ø Case overview followed by images § Pre-ablation § Immediate Post ablation § 1-3 month followup § 3-6 month followup § 6-12 month followup v Conformal Radiotherapy Ø Mechanism of action Ø Indications Ø Technical Considerations Ø Case overview followed by images § Pre-ablation § Immediate Post ablation § 1-3 month followup § 3-6 month followup § 6-12 month followup null
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EEE 02-20 Bones That Take Your Breath Away! Pulmonary Manifestation of Skeletal Disorders
U. A. Saeed, J. Nair, R. Khosla, K. Sayegh, J. Kosiuk, J. Taylor
McGill University Health Centre, Montreal, QC, CANADA. Learning Objectives: 1) Identification of pulmonary manifestations of various skeletal disorders. The skeletal disorders would include but not limited to Rheumatoid Arthritis, Hypertrophic Osteoarthropathy (HOA), Ankylosing Spondylitis, Langerhans Cells Histiocytosis (LCH), Erdheim-Chester Disease, Mixed connective tissue diseases like Systemic Lupus Erythomatosus (SLE), Scleroderma and Osteophyte induced fibrosis. 2) Correlation of clinical and characteristic CT chest findings in various skeletal disorders to improve better understanding of these pathologies. 3) Discussion of the relevant differential diagnosis of each of these disorders. Outcome: Knowledge of imaging manifestations of these groups of disorders are important for radiologists as they help in narrowing the differential diagnosis and hence aiding in accurate and timely management of the disease process. Summary of Content: Lungs may be involved as part of extra-osseous features of many skeletal disorders. null
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EEE 02-21 Imaging of the Large Airways
A. Donuru
Thomas Jefferson University Hospital, Philadelphia, PA. Learning Objectives: Describe the CT techniques for imaging the large airways. Demonstrate CT findings of focal and diffuse tracheobronchial disease. Reveal the utility of advanced airway imaging techniques for diagnosis and intervention planning. Outcomes: A range of neoplastic, inflammatory and congenital diseases may affect the trachea and main stem bronchi. We review the anatomy of the central airways and describe different pathologic conditions. The appearance and differential diagnosis of the most common disorders affecting the large airways will be discussed. Summary of Content: Although bronchoscopy remains the gold standard in the diagnosis of tracheal pathology, the proper utilization of radiologic imaging with Multidetector computed tomography permits improved patient care. Recent technical advances, including routine use of multiplanar reformations, 3-D volume rendered images, and virtual bronchoscopy can provide additional information. null
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EEE 02-22 LungAtelectasis: Types, Mechanisms and Imaging Findings
M. F. F. Hanna1, V. F. A. Salama2
1UT health science center, houston, HOUSTON, TX, 2Graduate School of Bio-medical Science, HOUSTON, TX. Learning Objectives: Demonstrate the segmental normal lung anatomy. Discuss various types of lung atelectasis. Discuss with illustrations various mechanisms of atelectasis.Case based discussion of clinical features and imaging presentations of atelectasis. Outcomes: Lung atelectasis is common finding in our daily work. Awareness of various etiologies, clinical and imaging features associated with volume loss will help in accurate and timely diagnosis as well appropriate guidance for the clinician to start the proper management. Summary of Content: Background information.Segmental anatomy.Various types of atelectasisIllustration of various mechanisms of atelectasisCase presentation for various types of atelectasis null
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EEE 03-01 Clinical and Radiologic Manifestations of Combined Pulmonary Fibrosis and Emphysema (CPFE)
W. Choi, K. Lee, E. Kang
Dong-A University Hospital, Busan, KOREA, REPUBLIC OF. Learning Objectives: 1. To review various important clinical and radiologic manifestations of combined pulmonary fibrosis and emphysema (CPFE) 2. To improve the awareness of this syndrome and help effective therapeutic strategies in clinical practice Outcomes: Combined pulmonary fibrosis and emphysema (CPFE) is a clinical syndrome characterized by the coexistence of upper lobe emphysema and lower lobe fibrosis. Patients with this syndrome may have severe dyspnea and impaired gas exchange with preserved lung volumes. CPFE shows different natural history and prognosis than IPF or emphysema alone. Correct and early recognition of this syndrome and early diagnosis of its complications are important for providing the patients with the best treatment. Summary of Content: 1. Definition: diagnostic criteria and exclusion criteria 2. Etiology and prevalence A. Risk factors - cigarette smoking, male sex, occupational exposures, others 3. Pathogenesis 4. Clinical characteristics A. Symptoms B. Pulmonary function test findings - preserved lung volume, marked reduction in diffusing capacity for carbon monoxide (DLco) 5. Radiologic manifestations on CT A. Emphysema - centrolobular emphysema, paraseptal emphysema, bullae B. Fibrosis - honeycombing, reticulation, traction bronchiectasis - UIP pattern, NSIP pattern, other patterns of fibrosis C. Thick-walled cystic lesions (TWCLs): unique feature of CPFE D. Ground glass opacity (GGO) 6. Complications A. Pulmonary hypertension B. Lung cancer C. Acute lung injury 7. Prognosis and mortality null
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EEE 03-02 Dual-Energy Perfusion CT: Basic and Clinical Applications
Y. Kunihiro, M. Okada, N. Matsunaga
Yamaguchi University Graduate School of Medicine, Ube, JAPAN. Learning Objectives: The purpose of this exhibit is: 1. To explain the basic principles of dual-energy perfusion CT (DEpCT). 2. To review the lung perfusion blood volume (PBV) images on DEpCT in patients with pulmonary emphysema and assess the relation to pulmonary function. 3. To review the volumetric lung PBV images in patients with pulmonary thromboembolism (PTE) and assess the relation to the severity of PTE. Outcomes: DEpCT enables to us to evaluate enhancement of the lung parenchyma. DEpCT provides images in good agreement with lung perfusion scintigraphy. Pulmonary comorbidity such as pulmonary emphysema affected the lung perfusion, and in these areas, iodine perfusion map shows focal iodine defect on DEpCT. The iodine defect on DEpCT shows a correlation with pulmonary function. The volumetric evaluation of DEpCT images shows a good correlation with factors reflecting the severity of PTE. Summary of Content: Principles of DEpCT Review of lung PBV images in sample cases - Normal - Pulmonary emphysema - PTE Clinical applications - The relationship between DEpCT and pulmonary function tests in pulmonary emphysema - The relationship between DEpCT and the severity of PTE null
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EEE 03-03 New radiological approaches in lung cancer to evaluate tumor response to new treatments (targeted therapies and immunotherapy): morphological and functionalimaging
M. Benegas Urteaga, I. Vollmer, N. Reguart, R. Perea, T. de Caralt, M. Sanchez
Hospital Clinic de Barcelona, Barcelona, SPAIN. Learning Objectives: -To show morphologic and functional changes in lung cancer treated with targeted and conventional chemotherapy -To describe the role of multidetector CT and functional imaging (CT perfusion, Dual-Energy CT, positron emission tomography and MRI) in the evaluation of the treatment response -To illustrate case-based lung cancer response evaluation approaches comparing anatomic and functional imaging with RECIST criteria -To show Immune-Related Response Criteria in patients treated with immunotherapy Summary of Content: The development of targeted cancer therapies represents a major advance in lung cancer treatment. The effects of anti-angiogenic therapies and immunotherapy are more complex than simple size changes. RECIST criteria based on tumor size have several limitations in the evaluation of treatment response in these therapies. We will show imaging findings on anatomic and functional techniques with a practical case-based presentation using different evaluation criteria. Cavitation, necrosis and tumor perfusion changes have been included to assess lung cancer response to anti-angiogenic drug treatment. Perfusion imaging techniques evaluate the tumor vascularization and angiogenesis. We will present the technique and data processing to perform a perfusion CT of lung tumors. RECIST criteria underestimates the response in patients treated with immunotherapy. We will describe and show the Immune-Related Response Criteria (irRC). null
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EEE 03-04 Dealing with Diaphragmatic Hernias - Keypoints to a Proper Diagnosis
G. Schiappacasse, C. Silva, J. Alegria
Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile. Learning objectives: To illustrate MDCT findings of diaphragmatic hernia in adult patients. To discuss relevant pointers for proper diagnosis of the different variants. Summary of content Diaphragmatic hernia is the protrusion of abdominal content into the chest cavity through a structural defect. Congenital hernias may be posterior (Bochdalek) or anterior (Morgagni), and the acquired ones can be traumatic or non-traumatic. Multidetector Computed Tomography is fundamental in characterization and detection of possible complications. Relevant embryological fundamentals and anatomic landmarks will be reviewed. Key points for characterization will be presented for Bochdalek, Morgagni, hiatal (and its variants) and traumatic diaphragmatic hernias. This exhibit offers an opportunity to review findings on MDCT to characterize these hernias and emphasizes on imaging key points to identify complications and thus avoid misinterpretation of these entities. null
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EEE 03-05 Cystic Lung Disease: What Can Cause Holes in the Lung?
H. Koo, M. Kim, J. Song
Asan Medical Center, Seoul, Seoul, KOREA, REPUBLIC OF. Learning Objectives: To know the pathogenesis of the creation of cystic lung lesions To learn the imaging findings of various cystic lung disease To facilitates the accurate and prompt diagnosis of cystic lung disease Summary of Content: 1. Introduction: terminology 2. Various cases 1) Diffuse cystic lung disease Pulmonary Langerhans cell histiocytosis (PLCH) Lymphangioleiomyomatosis (LAM) and tuberous sclerosis (TSC) Lymphocytic interstitial pneumonia (LIP) Desquamative interstitial pneumonia (DIP) and respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) Birt-Hogg-Dube syndrome (BHD) Cavitary metastasis 2) Multifocal cystic lung disease Septic embolism Bullous lung disease with paraseptal emphysema Lung pneumatocele Fungal infection including invasive aspergillosis, mucormycosis Tuberculosis Pneumocystis jiroveci pneumonia (PJP) Paragonimiasis Vasculitis null
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EEE 03-06 Imaging of Tracheobronchomalacia: Case-based comprehensive review
L. Sivakumaran1, K. Sayegh2, B. Kovacina2, S. Digumarthy1
1Universite de Montreal, Montreal, QC, CANADA, 2McGill University, Montreal, QC, CANADA, 3Harvard University, Boston, MA. Learning Objectives/Outcomes: 1) Normal airways anatomy 2) Definition of tracheobronchomalacia (TM) 3) Clinical features of TM 4) Diagnosis and assessment: a) Bronchoscopy b) Imaging evaluation c) Scan techniques d) Imaging findings: i) Types of TM: Diffuse vs segmental e) Treatment of TM Summary of Content: Tracheobronchomalacia (TM) refers to weakening and excessive collapse of the tracheal and bronchial lumens. It can be diffuse or segmental and primary or acquired. TM is most often encountered clinically post-intubation, but may also occur in a variety of other settings such as lung transplantation and relapsing polychondritis. TM may present with respiratory complaints, be unmasked by a stressor, or may be asymptomatic and discovered incidentally on imaging. Currently, bronchoscopy is the gold standard for diagnosis, however, dedicated CT techniques have led to comparable diagnostic accuracy. As the pathophysiology of TM typically presents during expiration, a variety of CT protocols can be used to detect changes in tracheal calibre. This often includes a dual-phase scan with an end-inspiratory acquisition combined to an end-expiratory CT, a dynamic expiratory CT, or a cine during coughing. In patients who suffer from recurrent sequelae of TM, surgical management may be necessary. CT imaging plays an important in surgical planning and follow-up of such patients. In conclusion, TM represents the tracheal and bronchial manifestations of various airway insults. This review presents various causes of TM with emphasis on their imaging appearance and management. null
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EEE 03-07 Non-Malignant Histiocytic Disorders of the Thorax: Revised Classification Scheme with Illustration of Typical and Variant Imaging Presentations and Histopathologic and Immunohistochemical Correlation
C. E. Jokerst, M. L. Smith, P. M. Panse, K. W. Cummings, E. A. Jensen, M. B. Gotway
Mayo Clinic Arizona, Phoenix, AZ. Learning Objectives/Outcomes: -Review the genesis and recent revised classification of non - malignant histiocytic disorders affecting the thorax -Illustrate histopathological, immunohistochemical, and typical/atypical imaging findings of these disorders -Enumerate imaging features that allow diagnosis of these disorders Summary of Content: The histiocytoses are rare disorders characterized by tissue accumulation of macrophages, dendritic cells, or cells derived from monocytes. Traditionally, the histiocytoses have been classified into three categories- Langerhans cell histiocytosis, non-Langerhans cell histiocytosis, and malignant histiocytosis- or as primary vs. secondary etiologies, depending on whether causative insult known. Recently, owing to newer insights regarding histology, phenotype, molecular alterations, clinical manifestations, & imaging presentations of these disorders, the histiocytoses have undergone reclassification into 5 categories: the L (Langerhans) group (including Langerhans cell histiocytosis, indeterminate cell histiocytosis, and Erdheim-Chester disease), the C group (often skin lesions affecting young patients, such as juvenile xanthogranuloma, and others), the R group, (including Rosai-Dorfman disease), the M group (malignant disorders), and the H group (inherited disorders leading to hemophagocytic lymphohistiocytosis). Multi-modality imaging findings, including atypical imaging presentations, as well as histopathologic and immunohistochemical features of the non-malignant histiocytoses with thoracic manifestations are reviewed with a focus on Langerhans cell histiocytosis, Erdheim-Chester disease, indeterminate cell histiocytosis, cutaneous non-Langerhans cell histiocytosis, and Rosai-Dorfman disease. Serial imaging findings of patients with these disorders undergoing therapy is also presented. null
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EEE 03-08 Non-Thrombotic Pulmonary Embolism: Spectrum of CT and MR Imaging Findings
M. Arzanauskaite1, V. Buroviene2, J. Zaveckiene2
1Royal Brompton Hospital, London, UNITED KINGDOM, 2Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, LITHUANIA. Learning Objectives/Outcomes: 1. To review the spectrum of non-thrombotic pulmonary embolism. 2. To provide a case-based review of thoracic CT and cardiothoracic MRI findings Summary of Content: Non-thrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas, excluding thrombus embolization or formation in situ. Pathogenesis of outcomes caused by NTPE is more complex than just mechanical obstruction of the vessel, contrary to the setting of thrombi. It may also lead to a severe inflammatory reaction not only in pulmonary and systemic circulation, but also in the lung parenchyma. The diagnosis is challenging as clinical findings may be non-specific. Knowledge of the imaging features particularly of advanced techniques such as CT and MRI play a vital role for the differential diagnosis as well as for an adequate and timely treatment. null
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EEE 03-09 The Chest Wall: A CT Guided Anatomic Atlas and Review of Common Incidental Findings for the Cardiothoracic Radiologist
M. Chung
Mount Sinai, New York, NY. Learning Objectives/Outcomes: (1) To provide a detailed overview of chest wall anatomy on CT, something that is often overlooked by the cardiothoracic radiologist. (2) To review the common normal and benign variations in anatomy that are important for all radiologists to know. (3) To summarize the various common surgeries performed in the chest and their effects on the appearance of the chest wall Summary of Content: Because the chest wall can be involved in either malignancies, trauma, or severe infections, being familiar with its anatomy is crucial for our reports. Common normal anatomic variants in the chest wall are important to know so benign findings are properly reported to clinicians and so patients do not undergo unnecessary followup imaging or procedures. There are many commonly performed surgeries which can distort the normal anatomy of the chest wall. Understanding these changes and being able to discern underlying abnormalities is important. null
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EEE 03-10 The Imaging Journey of Patients with Malignant Pleural Mesothelioma: Experience of a Tertiary Mesothelioma MDT
V. Lam, J. Brozik, A. J. Sharkey, A. Bajaj, D. T. Barnes
Glenfield Hospital, Leicester, UNITED KINGDOM. Learning Objectives: The aim is to: 1) Review the common and uncommon imaging features of malignant pleural mesothelioma (MPM) on chest x-ray and computed tomography (CT); 2) Describe the optimum CT imaging technique for pleural disease (a "pleural protocol"); 3) Describe the methods of obtaining histological diagnosis including VATS biopsy, thoracoscopy and CT guided biopsy: to describe "normal" post diagnostic intervention imaging appearances including pleurodesis; 4) Describe the CT findings which are a contraindication to radical surgery (T4 disease); 5) Describe the different operations performed on patients with MPM (radical versus non-radical) including post-operative complications; 6) Highlight the normal post-operative appearances of radical versus non-radical surgery, including diaphragmatic and pericardial patch reconstructions; 7) Review the imaging features of recurrent or progressive disease versus normal post-operative appearances; and 8) Discuss the multi-disciplinary based approaches to managing end-stage MPM, including outpatient based approaches such as indwelling pleural drains. Outcomes: As above. Summary of Content: In this exhibit, we will select cases from the dedicated regional University Hospitals of Leicester Malignant Pleural Mesothelioma Multi-Disciplinary Team meeting to meet these learning objectives. This will be predominantly case based, with a focus on the common and uncommon imaging features of MPM before and after interventions and diagnosis. null
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EEE 03-11 Congenital Bronchopulmonary Anomalies: Not just for kids
S. Faruqui, A. Laroia
University of Iowa Hospitals and Clinics, Iowa City, IA. Learning Objectives: This pictorial essay will highlight imaging features of pulmonary developmental anomalies that may be encountered in the adult. These features may aid in the differentiation from other pulmonary diseases and direct correct management. Summary of Content: -Brief description of embryology of the lung, pulmonary arteries and veins -Anomalies will be categorized as: Bronchopulmonary anomalies:-Lung agenesis, aplasia, and hypoplasia -Congenital bronchial atresia -Congenital pulmonary airway malformation -Bronchogenic cyst -Tracheal bronchus Pulmonary vascular anomalies: -Pulmonary artery agenesis -Pulmonary sling -Pulmonary arteriovenous malformation -Partial anomalous pulmonary venous return Combined pulmonary and vascular anomalies: -Bronchopulmonary sequestration -Scimitar syndrome null
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EEE 03-12 Complete Understanding of the Metastatic Lung Tumors: Basic and Applied Knowledge for Radiologists
M. Yanagawa, O. Honda, A. Hata, N. Kikuchi, N. Tomiyama
Osaka University Graduate School of Medicine, Suita, JAPAN. Learning Objectives: Metastatic lung tumor is typically detected on CT as multiple peripherally located nodules with various sizes. However, it is sometimes difficult to differentiate from non-malignant tumors because of atypical CT findings including calcification, endobronchial spread, ground-glass opacity around nodules (halo sign), pneumothorax, lepidic growth pattern, and reversed halo sign. The purpose of this exhibit is to review the typical and atypical radiological findings of metastatic lung tumors with making differential diagnoses. Outcomes: 1. Radiological findings according to metastatic patterns or primary sites: a) Hematogenous metastasis, from various malignant tumors and benign tumors such as leiomyoma of uterus; b) Lymphatic metastasis, from breast cancer, gastric cancer, etc.; and c) Endobronchial metastasis, from renal cell cancer, breast cancer, colon cancer, etc. 2. Metastases with atypical radiological findings: Calcification, Halo sign, Cavitation and Pneumothorax, Lepidic growth pattern, and Reversed halo sign. Summary of Content: Although it is difficult to diagnose metastases with atypical CT findings, a solid understanding of various CT findings in metastatic lung tumors based on metastatic patterns or primary sites is of great importance and may contribute to the differentiation from other non-malignant pulmonary diseases. null
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EEE 03-13 "A Breath of Fresh Air - Update of Imaging in AsthmaAsthma
F. Masood, A. Barker, R. Gore, S. Ramasundara, J. Babar, S. Karia
Cambridge University Hospitals, Cambridge, UNITED KINGDOM. Learning Objectives/Outcomes: • Identify common Multidetector CT findings in patients with asthma.• Understand that different phenotypes exist in asthma and how imaging may aid in this.• Demonstrate additional CT findings that may suggest a disease association or recognized complication of asthma.• Be aware of differential diagnosis that may mimic the clinical features of asthma.• Applications of CT technologies to offer improved patient selection for treatments and ability to gain quantitative measures to assess treatment response. Summary of Content: We will demonstrate the evolving use of multidetector Computed Tomography in patients referred with a potential diagnosis of asthma. There are classic imaging findings that are commonly seen such as bronchial wall thickening and narrowing, air trapping with a higher incidence of bronchiectasis. There are often unsuspected associated conditions which may be suggested by the radiologist such as Allergic bronchopulmonary aspergillosis and Eosinophilic lung disease (including Eosinophilic Granulomatosis with Polyangiitis). There are also several conditions that may mimic the clinical and physiological features of asthma. We also highlight quantitative techniques at CT (lung density, airway morphology/remodelling), which may correlate with certain disease phenotypes and severities and offer a potential further parameter of assessment of treatment response alongside traditional clinical and biochemical markers. We will review the use of novel treatments such as Bronchial Thermoplasty, in particular the CT features which may suggest a patient that may benefit from this procedure. null
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EEE 03-14 Large Airway stenosis: narrowing the differential diagnosis
R. V. A. Torres, M. Wanderley, M. V. Y. Sawamura, H. J. Lee, V. C. S. Rubin, R. M. Guerrini
Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, BRAZIL. Learning Objectives:-To show imaging findings in large airway stenosis-Brief review of the diseases that may cause airway stenosis-To show how key imaging findings may narrow the differential diagnosisSummary of Content: Diseases of the central airways may be neoplastic, infectious, iatrogenic, inflammatory or idiopathic. Chest computed tomography can detect and characterize pathologic changes, guide interventions and detect additional findings in the mediastinum or lung parenchyma. The objective of this pictorial essay is to show typical imaging findings in diseases like amyloidosis, tracheobronchopathia osteochondroplastica, tracheobronchial papillomatosis, relapsing polychondritis, granulomatosis with polyangiitis, tuberculosis, south american blastomycosis, foreign body granuloma and neoplasms. We will categorize the diseases by focal or diffuse airway involvement and by circumferential or non-circumferential airway involvement in an instructive presentation. null
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EEE 03-15 Potential Pitfalls in Chest Diffusion Weighted Imaging
Y. Kurihara, M. Matsusako, R. Miyazawa, T. Wada, J. Starkey
St. Luke's International Hospital, Tokyo, JAPAN. Leaning Objectives/Outcomes Diffusion weighted image (DWI) of chest may be obtained incidentally on abdominal MRI or on routine chest MRI. Reduced diffusion can be present for a variety of reasons that are not malignant. This exhibit aims to: 1. Demonstrate mimics of malignancy on chest DWI 2. Teach how to avoid misinterpretations on chest DWI Summary of Content We present the basics of chest DWI of non-tumor etiology, while presenting cases in a pictorial essay format as follows: 1. Introduction 2. Review of MRI DWI Techniques 3. Normal structures that are bright on DWI, mimicking pathology - Bone marrow (ribs, thoracic spine, and sternum) - Lymph nodes (axillary and chest wall) - Nervous system (brachial plexus) - Veins (slow flow in jugular veins, the superior vena cava, and the azygos vein) - Esophagus (mucosa) - Adrenal glands 4. Non-malignant pathological conditions causing DWI hyperintensity - T2 shine through (mediastinal cysts) - Hemorrhage - Hemangiomas - Subcutaneous epidermal inclusion cysts - Tuberculomas mimicking lung cancer 5. Conclusion - Chest DWI is a promising diagnostic technique and awareness and understanding of the associated pitfalls will minimize errors in diagnosis. null
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EEE 03-16 Pre-procedural CT Angiography for Transaortic Valve Implantation: What a Radiologist Needs toKnow
E. O'Dwyer, C. O'Brien, C. Shortt, I. Murphy, O. Buckley
AMNCH, Dublin24, IRELAND. Learning Objectives/Outcomes: • Describe the role of CT angiography in pre-procedural work up for Transaortic Valve Implantation (TAVI). • Describe the importance of a standardized protocol. • Describe pearls and pitfalls when reporting CT angiography in pre-procedure TAVI patients. Summary of Content: Aortic stenosis (AS) is the most prevalent cardiac valvular disease in the Western world. Once patients become symptomatic with severe AS, aortic valve replacement is indicated to increase quality of life and life expectancy. Although surgical valve replacement is possible in patients of any age, up to 30% of patients with severe AS are deemed unfit for surgery due to high operative risk. Transcatheter aortic valve implantation (TAVI) procedures now offer an alternative therapy for surgery in high operative risk patients. Accurate pre-procedural evaluation of candidates for TAVI is crucial to optimize the success rate and reduce the related vascular complications. CT angiography is a central in the evaluation of patients by providing information on AS severity, aortic valve anatomy and annular dimensions and peripheral vascular anatomy. Thus this allows interventionists to accurately select the prosthesis size and the procedural approach. We reviewed the pre-procedure CT angiograms performed in our institution in the last year in patients being considered for TAVI and compared our current CT protocol to current gold standard recommendation. This allowed us to review our protocol and key findings which our interventionists wish to know from our CT reports. This educational exhibit provides a practical guide for radiologist on how to report theses studies. null
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EEE 03-17 Incidental Esophageal Findings on Chest CT
A. Hussien, K. Song, E. Fishman
Johns Hopkins, Baltimore, MD. Learning Objectives: Although CT has not been used as the primary modality for evaluating the benign esophageal diseases, incidental esophageal abnormalities can be found in routine CT of the chest performed for a wide variety of reasons. A wide range of diseases can affect the esophagus including congenital anomalies, infection, inflammation, benign tumors and others. In diseases such as fibrovascular polyps, duplication cysts, scleroderma, hiatal hernia, esophageal diverticulum, achalasia, and paraesophageal varices, the CT findings are specific, obviating the need for further invasive diagnostic work-up. This article uses a series of illustrative cases to describe the CT appearance of benign esophageal diseases. By being familiar of the appearance of various benign diseases that affect the esophagus, the radiologists can play an important role in detecting and further diagnostic planning of such diseases. Summary: Incidental esophageal abnormalities are encountered in routine cross sectional imaging of the chest. Awareness of the CT findings of various esophageal diseases is important in diagnosis of such diseases. null
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EEE 03-18 Central Venous Catheters - Abnormal Positioning
M. Wanderley
Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Pau, Sao Paulo, BRAZIL. Learning Objectives: Knowledge of the normal and abnormal central venous catheters positioning in thoracic imagingOutcomes: Central venous catheterization (CVC) can be lifesaving, being mainly indicated when peripheral veins are inaccessible, for hemodynamic monitoring, fluid replacement, hemodialysis, total parenteral nutrition, delivery of blood products and drugs such as vasopressors, chemotherapy and antibiotics. More than 5 million CVCs are performed each year in the United States, with superior vena cava catheterization thru right internal jugular vein or thru right subclavian vein being the most frequent and preferred. Ultrasound-guided puncture and fluoroscopic wire/catheter guidance should be the gold standard for medium to long-term CVCs. Summary of Content: Although there are no absolute contraindications, CVCs are associated with complication rates of approximately 15%. Imaging also plays a key role confirming adequate position and determining procedure complications, such as bleeding, pneumothorax or erroneous trajectory of the catheter. null
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EEE 03-19 CT images after lung transplantation:early,late and time-independent complications
N. Kikuchi, O. Honda, M. Yanagawa, A. Hata, N. Tomiyama
Osaka University Graduate School of Medicine, suita, JAPAN. Learning Objectives: Lung transplantation is the ultimate therapy for patients with end-stage lung disease such as cystic fibrosis, pulmonary hypertension, chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, and so on. However, there are a lot of side effects following the surgery, resulting in a necessity of longer follow-up. Side effects after lung transplantation can be classified into early complication (within two months after transplantation), late complication (more than two months after transplantation), and time-independent complication (at any time after transplantation). The purpose of our educational exhibition is to review complications at each phase and their CT imagings. Outcomes: We show you various cases : primary graft dysfunction,pleural effusions, some kinds of infection(cytomegalovirus etc.)and so on are shown at early phase , chronic lung allograft rejection(bronchiolitis obliterans etc.),lymphoproliferative disorder and so on are shown at late phase and infections (bacterial,mycobacterial,viral,fungal), acute cellular rejection, , large-airway complications, ,thromboembolism , and so on are shown at each phase. Summary of Content: It is important to understand various complications and their CT findings after lung transplantation at each phase for the more accurate detection of them and for the optimal therapeutic planning. null
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EEE 03-20 Dilemma of Thoracic Tuberculosis (TB) vs. Sarcoidosis in TB Endemic Areas: An Imaging Approach
ALL INDIA INSTITUTE OF MEDICAL SCIENCES (AIIMS), New Delhi, INDIA. Body: Learning Objectives: • To review the typical, atypical and indeterminate imaging features of thoracic sarcoidosis. • To illustrate the differentiating and overlapping imaging features of thoracic sarcoidosis and tuberculosis. • To propose a diagnostic algorithm for evaluation of patients with non-specific clinical features Summary Sarcoidosis is a multi-systemic chronic granulomatous disease of unknown etiology that bears close resemblance to tuberculosis (TB) in clinico-radiological and histopathological manifestations. This exhibit aims to elucidate the diagnostic dilemma between the two entities especially in TB-endemic regions through a spectrum of cases, reviewing the imaging features which are definitive for each entity and which show overlap between them. To address the ambiguity of diagnosing sarcoidosis in TB endemic areas, the authors propose a modified algorithm for work-up of patients presenting with non-specific clinical features. The authors suggest that a contrast-enhanced CT must always be done in such cases. Sampling is often required in the presence of lymphadenopathy and whenever imaging is more suggestive of sarcoidosis. This is because unusual manifestations of TB are common in endemic areas and may mimic sarcoidosis. null
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EEE 03-21 Should the Word "Infiltrate" Be Used in Chest Radiology Reports? An Analysis of Arguments
A. K. Retzer1, K. J. Coakley2
1Southern Illinois University, Springfield, IL, 2Clinical Radiologist, S.C., Springfield, IL." Learning Objectives/Outcomes: Analyze arguments for and against the use of the word "infiltrate" in chest radiology. Demonstrate through analogy how the use of the term "infiltrate" leads to miscommunication. Discuss proposed ways to avoid this miscommunication. Summary of Content: The use of the word "infiltrate" in chest radiology reports is controversial. The published arguments for and against the use of "infiltrate" were reviewed. There is evidence that "infiltrate" means different things to different physicians (some have a very broad differential, while others have a very narrow differential, specifically pneumonia). It is this ambiguity of "infiltrate" which is problematic. To illustrate how this ambiguity leads to miscommunication and potential problems with patient management, a unique analogy is presented. Proposed ways to decrease the miscommunication caused by the use of "infiltrate" are evaluated. null
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EEE 03-22 Beyond pulmonary emboli: Acquired abnormalities of the pulmonary arteries on CTA
S. Cleary, K. A. Kaproth-Joslin
University of Rochester Medical Center, Rochester, NY. Learning Objectives: Review common imaging features of bland pulmonary artery embolus How to identify tumor thrombus (primary or metastatic) on computed tomography angiogram (CTA) Discuss less common pulmonary artery abnormalities, including pulmonary artery aneurysm and pulmonary artery vasculitis (i.e. Behçet disease) Brief discussion of chronic pulmonary emboli Identify common mimics of pulmonary embolism on CTA, including motion artifact, contrast opacification artifacts, bronchial obstruction, and pulmonary vein thrombus Summary of Content: CTA of the pulmonary arteries is one of the most frequently performed examinations in the emergency setting. Due to this large volume of studies, it is important to recognize the other conditions that can occur in the pulmonary arteries in addition to pulmonary embolus. Our exhibit will be presented as an image rich, case based review of the acquired abnormalities of the pulmonary arteries. We will begin with a review of the common imaging features of bland pulmonary artery embolus. We will then discuss how to identify tumor thrombus (primary or metastatic), focusing on a case of pulmonary artery sarcoma which was originally misdiagnosed as a pulmonary thromboembolism. Pathology correlation of this case will be provided. We then discuss other rare acquired abnormalities affecting the pulmonary arteries that can be seen on CTA. Examples of pulmonary aneurysms/pseudoaneurysm related to metastatic malignancy and vasculitis (Behçet disease) will be provided. Finally, we will identify the common mimics of pulmonary embolism on CTA, including motion and contrast artifacts that are commonly encountered. Additional mimics will include bronchial obstruction and pulmonary vein thrombus. null
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EEE 03-23 Do You Want To Be An Excellent Radiologist Focus On Thoracic Aorta on Lateral Chest Image
S. Shin1, D. Han1, D. Sung1, E. Lee2
1Kyung Hee University Hospital, Seoul, KOREA, REPUBLIC OF, 2Dept. of Diagnostic Radiology, Medical College, Hallym University, Seoul, KOREA, REPUBLIC OF. Learning Objectives: 1. To be familiar with normal chest lateral plain radiograph and to improve reading skill. 2. To be aware of areas revolve around the aorta which easy to overlook via impressive cases and to increase lesion detection rate without unnecessary CT exam. Outcomes: Familiarity with the normal radiographic findings of aorta as well as its easily overlooked surrounding structures can be helpful in detecting potential lesions in lateral radiographs. The major teaching points of this exhibit includes A. Smooth margin and continuity density of aorta has to be seen in the lateral chest imaging. B. The lateral chest imaging can help to detect location of lesion which cannot be detected in chest PA. Summary of Content: 1. Normal chest anatomy on chest lateral image and it’s radiographic technique2. Divide to three compartment along the aorta.A. Ascending thoracic aortic area, B. Aortic arch area, C. Descending thoracic aortic area3. Impressive cases4. Limitation of lateral image to interpret null
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EEE 03-24 Imaging findings of thoracic cavitating and cystic lesions
Y. Ozawa1, M. Hara2, M. Nakagawa1, T. Sekiguchi1, Y. Shibamoto1
1Nagoya City University Graduate School of Medical Sciences, Nagoya, JAPAN, 2Nagoya City West Medical Center, Nagoya, JAPAN. Learning Objectives/Outcomes The purpose of this article was to assess the image finding of cavitary lung lesions. We reviewed cases with cavitating lung lesions, and we summarized those imaging findings and characteristics. There were various diseases that showed cavitation on CT, in which mycobacterial, fungal and bacterial infection, septic emboli, lung cancer, metastasis, granulomatosis with polyangitis (GPA), and infected bulla were included. It was important to evaluate characteristics of their walls and distributions of the nodules to differentiate these diseases. Summary of Content: The lung lesions with cavity had some characteristic findings. To know this information could be useful for diagnosis of these lesions. null
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EEE 04-01 Cavitation in Primary Lung Cancer: Characteristic Features and Mechanisms
Y. Kunihiro1, T. Kobayashi1, N. Tanaka2, T. Matsumoto3, N. Matsunaga1
1Yamaguchi University Graduate School of Medicine, Ube, JAPAN, 2Saiseikai Yamaguchi General Hospital, Yamaguchi, JAPAN, 3National Hospital Organization, Yamaguchi Ube Medical Center, Ube, JAPAN. Learning Objectives: The purpose of this exhibit is: 1. To explain the common mechanisms of cavity formation and their association with prognosis. 2. To review the HRCT and pathological findings of primary lung cancer with cavitation. 3. To discuss the pitfalls in making a differential diagnosis. Outcomes: Cavitation in lung cancer has been increasingly detected with the widespread use of HRCT. Necrosis is frequently observed in squamous cell carcinoma, and that leads to a high incidence of cavitation and is a risk factor for poor prognosis. Intratumoural bronchiectasis including bubble-like appearance is frequently observed in adenocarcinoma, and that could be a relatively good prognosis. A check-valve could be another mechanism of cavity development. Two or more mechanisms sometimes coexist. Summary of Content: Mechanisms of cavity formation Review of imaging findings in sample cases - Necrosis - Intratumoral ectatic bronchus including bubble-like appearance - Check-valve Review of imaging findings in sample cases - High-resolution CT - Correlation with pathological findings Differential diagnosis Pitfalls - Pre-existing emphysema or honeycombing - Air bronchogram null
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D. Vummidi, C. Galban, B. Ross, G. Yanik, V. Lama, M. Han, E. Kazerooni
University of Michigan, Ann Arbor, MI. Body: Learning Objectives: Parametric response mapping is a novel imaging biomarker that allows for the accurate characterization and quantification of the COPD spectrum and more recently bronchiolitis obliterans following hematopoietic stem cell and lung transplantation Summary of Content: Parametric response mapping (PRM) is a quantitative imaging biomarker used for the assessment of obstructive lung disease. It is a post processing technique consisting of linking inspiratory and expiratory CT lung scans to provide a classification of individual voxels of lung parenchyma as normal, functional small airways disease (fSAD), and emphysema. Current clinical and imaging biomarkers cannot accurately phenotype chronic obstructive pulmonary disease (COPD) into airway predominant, parenchymal predominant or mixed. PRM allows for characterization and quantification of obstructive pulmonary disease from any volumetric inspiratory/expiratory HRCT acquisition without any additional radiation exposure by generating color maps of the lungs. On the provided color maps, green - normal lung, yellow - functional small airways disease, red - emphysema. Emerging applications of PRM are in recognizing bronchiolitis obliterans syndrome (BOS) in the context of hematopoietic stem cell transplant (HSCT) and lung transplantation earlier than afforded by the current clinical criteria and thereby influencing management null
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JW Song
Asan Medical Center, Seoul, KOREA, REPUBLIC OF. Learning Objectives: Atypical radiological manifestations of pulmonary tuberculosis are common in increasing number of patients with various immune-compromised clinical conditions. Radiologists have to know and familiar with those atypical imaging features of tuberculosis. Outcomes: Radiologists can understand the immune mechanisms of pulmonary tuberculosis, categorize and know the atypical imaging features of tuberculosis in various immune impaired status. Summary of Content: This presentation will include basic immune-mechanism of tuberculosis, changed traditional imaging concept of primary and reactivation tuberculosis, immune reconstitution inflammatory syndrome, various atypical imaging features of tuberculosis in immune impaired conditions as follows: HIV-infection, DM, combined malignant diseases including lung cancer, long-term steroid and tumor necrosis factor-? inhibitor therapy, transplantation, IPF, and so on. null
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EEE 04-04 Systemic air embolism in transthoracic lung biopsy: Risk factors, detection and management.
A. K. Verma, H. Bayanati, A. Gupta, C. Souza, J. Inacio, E. Pena, R. Peterson, J. Seely, C. Dennie
The Ottawa Hospital, University of Ottawa, Ottawa, ON, CANADA. Learning Objectives: - To discuss risk factors for air embolism in a transthoracic lung biopsy. - To practice detection with a review of cases during the procedure. - To review step by step management plan to improve outcome. Outcomes: We present seven cases of systemic air embolism during image-guided transthoracic biopsies. The onset of symptoms was during the procedure to few minutes after the biopsy. CT scans of chest and brain done immediately after the onset of symptoms showed air bubbles in the cerebral or cardiovascular system or in both concordant with symptoms. A multidisciplinary approach to proper positioning, immediate resuscitation, and definitive hyperbaric oxygen therapy were key of management with no long-term complications. Summary of Content: Systemic air embolism is a rare but serious complication of transthoracic lung biopsy. The complication is usually managed sub-optimally due to unfamiliarity to warning signs and management strategy, which can lead to long-term morbidity or mortality. Early detection is key to proper management. In this educational exhibit, we present case-based review of risk factors and step-by-step management including role of hyperbaric oxygen therapy to improved outcome. null
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EEE 04-05 Radiation Induced Lung Injury: Distinguishing New Patterns of Toxicity From Recurrent Malignancy
M. D. Martin, A. M. Baschnagel, C. A. Meyer
University of Wisconsin School of Medicine and Public Health, Madison, WI. Learning Objectives: 1. Describe the principles of modern radiotherapy techniques. 2. Illustrate and discuss newer patterns of radiation induced lung injury. 3. Discuss radiosensitizing and radioprotective agents. 4. Discuss methods of detecting disease recurrence. Summary of Content: Pulmonary toxicity associated with therapeutic thoracic radiation is well described. With the advent of stereotactic body radiation therapy (SBRT) and intensity modulated radiotherapy (IMRT) the appearance and temporal evolution of these patterns no longer conforms to previously reported patterns. Newer radiation induced lung injury (RILI) patterns will be illustrated and correlated with isodose delivery in simulation plans. This exhibit will describe the principles of modern radiotherapy techniques. It will review the pathogenesis of radiation induced lung injury and contrast the "classic" manifestations of RILI with currently observed patterns of the more modern techniques. Radiosensitizing and radioprotective agents will be discussed and "recall" pneumonitis is described. Finally, methods of detecting disease recurrence will be discussed including morphologic observations, texture analysis and the utility of PET/CT in distinguishing evolving RILI and recurrent malignancy. null
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EEE 04-06 Radiologic Assessment of the Elderly Chest: Normal Aging vs. Clinical Significances
E. Kang1, J. Lee1, Choo J2, H. Yong1, K. Lee2, Y. Oh1
1Korea University Guro Hospital, Seoul, KOREA, REPUBLIC OF, 2Korea University Ansan Hospital, Seoul, KOREA, REPUBLIC OF, 3Korea University Anam Hospital, Seoul, KOREA, REPUBLIC OF. Learning Objectives: Radiologic examinations of the elderly are rising continuously due to progressive increase in life expectancy. Structural and functional changes occur in the chest with advancing age. For accurate interpretation of the chest radiographs and CT, distinguishing physiological and pathological changes is important. This exhibit reviews age-related morphologic changes of the thorax. Summary of Content: Radiologic images show many age-related morphologic changes in elderly chest. We categorize the aging chest according to changes in the lung parenchyma, the airways, the mediastinum, the chest wall, and the diaphragm. Changes in the lung parenchyma include age-related alveolar hyperinflation, ground-glass opacity in basal dependent lungs, mosaic attenuation pattern, minimal reticular densities in subpleural and basal lungs, incidental lung nodules, and air cysts. Changes in the airway include tracheobronchial wall cartilage calcifications, increased AP diameter of trachea, increased bronchoarterial ratio and increased bronchial wall thickness in CT. Changes in the mediastinum include cardiac enlargement, coronary and cardiac valve/annulus calcification, vessel lengthening, dilation, and calcification, and excessive fat deposition. Changes in the chest wall include osteoporosis, decreased muscle mass, rib cartilage calcifications, and increased thoracic AP diameter. Changes in the diaphragm include bulging contour and esophageal hiatal hernia.Radiologists should have knowledge regarding the age-related changes in elderly chest. Differentiation between normal age-related changes and clinically significant disease is essential in the interpretation of chest radiologic images. null
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EEE 04-07 Tracheal and Bronchial content: Is it always mucus?
C. Y. Verrastro1, V. B. Antunes1, P. T. S. Torres2, G. Szarf1, J. Capobianco1, I. Missrie1, M. M. L. Marchenta1, G. S. P. Meirelles1
1Grupo Fleury, Sao Paulo, BRAZIL, 2Multimagem Diagnosticos, Goiania, BRAZIL. Learning Objectives: to show imaging findings and differential diagnosis of central airways contents. Outcomes: To recognize and differentiate lesions inside central airways. Summary of Content: Central airways abnormalities are often missed in diagnostic imaging tests. Trachea and main bronchus are centrally located in most chest imaging studies but frequently represent blind spots to radiologists. Multiplanar and 3D imaging techniques are essential tools for evaluating central airways. Mucus is the most frequent cause of endotracheal or endobronchial content but other neoplastic and non neoplastic conditions may show similar findings. Non neoplastic diseases may be further classified as infectious or non infectious. As exemples of non neoplastic, non infectious endobronchial content we have foreign bodies and broncholiths. Infectious disease, such as tracheal papillomatosis, is characterized by multiple papillomas attached to tracheal walls. Neoplastic diseases may be benign or malignant and primary or secondary. Benign tumors of trachea and main bronchus are rare and more often related to mesenchymal tissue. The most common primary malignant tumors arises from surface epithelium (squamous cell carcinoma) or salivary glands (adenoid cystic and mucoepidermoid carcinomas). Secondary malignant tumors of central airways are far more common than primary and may be a direct invasion of adjacent cancer (lung, esophagus, thyroid, larynx) or hematogenous spread (kidney, breast, melanoma, colon). Imaging findings such as location, tiny gas bubbles, fat attenuation and pattern of enhancement may aid radiologists reaching the correct diagnosis. More advanced techniques such as virtual bronchoscopy and PET/CT may provide additional information. null
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EEE 04-08 Tuberculosis: Not Just a Hole in the Lung
C. Y. Verrastro1, G. Szarf1, I. Missrie1, J. Capobianco1, V. S. A. Lajarin1, G. D'Ippolito1, R. F. C. A. Neves2, G. S. P. Meirelles1
1Grupo Fleury, Sao Paulo, BRAZIL, 2Hospital do Rim e Hipertensao, Sao Paulo, BRAZIL. Learning Objectives: To show typical and atypical thoracic manifestations of tuberculosis, including pulmonary, airways, pleuropericardial, nodal, chest wall, and osseous disease. To demonstrate extrathoracic imaging findings that may help thoracic radiologists reach a diagnosis in challenging cases. Outcomes: To better understand tuberculous disease in the chest and some selected extra thoracic sites. Summary of Content: We shall present a pictorial essay illustrating multimodality findings of tuberculosis involving thoracic and extrathoracic sites. Common and uncommon parenchymal findings in the immunocompetent and immunosuppressed hosts will be presented. Signs of active versus residual disease will be explained. Tuberculous disease affecting the chest wall, bone, as well as the pleuropericardial and mediastinal compartments will be illustrated. In cases of multisystemic tuberculosis, we shall elucidate extrathoracic findings that may help thoracic radiologists in their diagnostic process. The commonest findings of active post primary tuberculosis are cavitary opacities with signs of bronchogenic spread. Primary tuberculosis usually manifest as consolidations and lymphadenopathy. In addition to the typical cases, pulmonary tuberculosis may also manifest as nodules, masses, atelectasis, and extensive airspace disease among others. Atypical locations may pose an extra challenge for imaging diagnosis. A patient's immune status is another source of confusion as immunosuppressed hosts may present with complications (miliary pattern, empyema) or atypical findings. Tuberculosis may also present as a multisystemic disease and any organ can be affected. In conclusion tuberculosis is not just a hole in the lung but a myriad of findings that may mimic other diseases. null
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EEE 04-09 From the Radiologic Pathology Archives Thoracic Intimal Sarcoma
M. A. Morris, B. Saboury, G. Rose, A. Ropp, N. Bandla, A. Burke, A. A. Frazier
University of Maryland Medical Center, Baltimore, MD. Learning Objectives-The authors review the locations and common clinical presentations of thoracic intimal sarcoma. Key imaging findings and features across multiple modalities will be reviewed in conjunction with corresponding gross pathologic findings. The histopathologic basis for the gross pathology and imaging findings will be dissected. The relevant impact of imaging and pathologic findings on modern patient management options will be identified. Outcomes-The reader will have a better understanding of thoracic intimal sarcomas and their imaging manifestations. Summary of Content-The authors review the literature in conjunction with five cases of intimal sarcoma encountered at a large academic medical center and cases from the American Institute of Radiologic Pathology. Cases involving the aorta, left, and right pulmonary arteries are included along with relevant pathologic correlation. The cases will be presented in series and clinical presentations and diagnostic challenges will be reviewed. The imaging findings will be presented via CT angiography, MRI, PET/CT, and Digital Subtraction Angiography studies. Pathologic findings will be presented as correlates to imaging findings and in order to better understand the imaging manifestations of disease through gross pathology, macrosection, and histopathological specimens. Endovascular, surgical, and medical/chemotherapeutic management implications of findings will be discussed in order to convey an understanding of the key aspects of disease that are important in conveying actionable findings to referring clinicians. null
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EEE 04-10 Illustrated Guide for the 8th Edition of the Lung Cancer TNM Staging Criteria
F. Kay, A. Kandathil, K. Batra, S. Saboo, S. Abbara, P. Rajiah
UT Southwestern Medical Center, Dallas, TX. Learning Objectives/Outcomes: - To review the proposed 8th edition of TNM criteria for lung cancer staging - To discuss the important differences from the 7th edition of the TNM staging system - To identify the correct TNM stage of lung cancer using clinical cases from our institution - To describe the common pitfalls in lung cancer imaging - To understand the clinical implications of the new staging Summary of Content: Lung cancer is a significant worldwide health problem, accounting for 224,390 estimated new cases in 2016, only in the US. Patient prognosis and treatment management is highly dependent on disease staging. A new update in the TNM staging criteria has been proposed earlier this year1, and will be effective in late 2016. Radiologists must be educated in order to incorporate these proposed changes into clinical practice. Our aim is to review this new system, highlight the modifications from the existing criteria and describe the lung cancer stages with clinical cases from our institution. Common pitfalls that are encountered in imaging will also be discussed. The rationale and clinical implications of the new staging system will also be discussed. 1. J Thorac Oncol. 2015 Dec;10(12):1675-84. null
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EEE 04-11 Imaging of Cystic Paravertebral Masses - Key Discriminators and Pathologic Correlation
J. Lichtenberger1, K. Soderlund2
1Uniformed Services University of the Health Sciences, Bethesda, MD, 2Naval Medical Center, San Diego, San Diego, CA. LEARNING OBJECTIVES/OUTCOMES: After viewing this educational exhibit, the radiologist should be able to: - Discuss key anatomic structures of the thoracic paravertebral compartment - Describe characteristic imaging appearances of various cystic paravertebral masses - Give a focused, organized differential diagnosis for a cystic paravertebral mass based on clinical history and key distinguishing imaging features - Recommend appropriate imaging and procedural tests to assist in diagnosis and treatment of cystic paravertebral masses SUMMARY OF CONTENT: OBJECTIVE: The paravertebral compartment of the thorax contains numerous different anatomic structures, and pathology in this space can present in multiple ways. Cystic paravertebral masses of the thorax share common imaging characteristics but have a broad differential diagnosis. While the term cyst implies a fluid filled structure lined by epithelial cells, not all cystic paravertebral masses are true cysts. Infectious, post-traumatic, vascular, developmental, and benign and malignant neoplasms can present as a cystic paravertebral mass in the chest. Often, a multimodality approach to definitive diagnosis is necessary. CONCLUSION: This exhibit will discuss the imaging characteristics of cystic paravertebral masses, with a focus on key discriminating features using a multimodality approach. Knowledge of the clinical history, relevant anatomy, and distinguishing features of various cystic paravertebral masses will allow the radiologist to provide a narrow a differential diagnosis and assist clinicians in providing a definitive treatment. null
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EEE 04-12 Imaging Spectrum of Allergic Lung Disease:Hypersensitivity Reactions on the LungParenchyma
M. Kim, K. Lee, W. Choi, B. Kim, E. Kang
Dong-A University Hospital, Busan, KOREA, REPUBLIC OF. Learning Objectives: 1. To describe the imaging findings of allergic lung disease and correlate them with clinical information 2. To discuss features that are helpful in differential diagnosis of allergic lung diseases 3. To discuss lung involvement of other uncommon systemic allergic diseases Outcomes: Allergic lung diseases include various disease entities with overlapping radiologic manifestations and a wide range of clinical presentations. Integration of laboratory, imaging, and clinical findings is essential in making the correct diagnosis of this complex group of disorders. Summary of Content: 1. Types and pathogenesis of hypersensitivity reactions 2. Hypersensitivity pneumonitis 3. Eosinophilic lung diseases 1) Idiopathic eosinophilic lung diseases 2) Eosinophilic lung diseases with known causes 4. Asthma 5. Pulmonary manifestations of other allergic diseases null
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EEE 04-13 Thoracic mycotic aneurysm: All you need to know.
C. S. Restrepo1, D. Gonzalez2, A. Baxi1, D. Lamus3, D. Vargas4
1UTHSCSA, San antonio, TX, 2Universidad CES, Medellin, COLOMBIA, 3UT Southwestern, Dallas, TX, 4University of Colorado, Denver, CO. Learning Objectives: 1.To illustrate the pathophysiology and imaging manifestation of infected aneurysms affecting the different intrathoracic vessels, including pulmonary arteries, the aorta and its branches.2.To discuss the morphologic features that help differentiate from non-infectious aneurysms and pseudo-aneurysms in the same vascular territories. Outcomes:Thoracic Mycotic aneurysm are usually saccular lesions in the thoracic vasculature, most commonly the aorta, accompanied with inflammatory response. Summary of Content: Although uncommon, thoracic mycotic (infectious) aneurysm are life threatening. Diagnosis can be challenging and their clinical manifestation is usually obscure. Diagnostic imaging, especially CT angiography, play a major role in early diagnosis and follow-up, improving mortality and morbidity, in affected patients. Early diagnosis of infected aneurysms and pseudo-aneurysms is critical for appropriate patient management. Infected or mycotic aneurysm are variable in presentation and a low threshold of suspicion is recommended. null
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EEE 04-14 Tracheal tumors: Radiologic-Pathologic correlation of tumors and tumor mimics.
A. Bedayat, 943051, E. Yang1, P. Galera2, H. Guo1
1Stanford, Stanford, CA, 2University of Massachusetts, Worcester, MA. Teaching points: Review cross sectional findings of tracheobronchial tumors and tumor-like entities. Comparisons of imaging findings with histologic pathology findings. Discuss pearls and pitfalls in accurately diagnosing and classifying tumors and mimics. Table of contents/outline: Classification of tracheobronchial tumors. Describe the cross sectional features of tumors and their mimics with their pathologic correlates. Identify the imaging and non-imaging features of each of these tumors that may allow differentiation from others. Discuss the mimics, diagnostic pitfalls and management of the discussed entities. null
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EEE 04-15 Bronchocentric Granulomatosis: An overview
C. S. Restrepo1, D. Gonzalez2, A. Baxi1, J. Carrillo3, D. Vargas4, D. Ocazionez1
1UTHSCSA, San antonio, TX, 2Universidad CES, Medellin, COLOMBIA, 3Universidad Nacional de Colombia, Bogota., COLOMBIA, 4University of Colorado, Denver, CO. Learning Objectives: 1. To review the pathophysiology and clinical manifestations of bronchocentric granulomatosis. 2. To discuss the imaging and morphologic features of this entity with pathologic correlation. Outcomes: Bronchocentric Granulomatosis a reactive inflammatory response that must be included in the aproach of a pulmonary nodule, that usually appears as a spiculated mass lesion or a lobar consolidation near the bronchi. Summary of Content: Bronchocentric granulomatosis represent a reactive inflammatory process with intimate involvement of the airways, typically related to infection and inflammation such as fungal infection. The diagnosis of this condition is challenging and is often confused with other bronchopulmonary pathologies including tumors. This exhibits aims to provide awareness and better understanding on this condition. null
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EEE 04-16 Community-Acquired Acinetobacter baumannii Pneumonia : Initial Chest Radiographic Findings and Follow-up CT Findings in Helping Predict Patient Outcome
J. Woo, D. Lee, J. An
Eulji University, Eulji Hospital, Seoul, KOREA, REPUBLIC OF. Learning Objectives: To assess the radiographic, thin-section CT and clinical characteristics of community-acquired Acinetobacter baumannii (AB) pneumonia and to evaluate whether findings on initial chest radiographs and follow-up CT of community-acquired AB pneumonia patients can help predict clinical outcome Outcomes: : Findings on radiographs were bilateral patchy alveolar opacities in nine patients, focal alveolar opacity in five patients, patchy peribronchial nodular opacities in four patients and pleural effusion in three patients. On thin-section CT, bilateral patchy consolidation in 12 patients, patchy ground glass opacities in 9 patients, consolidation containing cavity in two patients and patchy peribronchial branching nodular opacities in six patients were observed. Pleural effusion was seen in five patients. There was no statistically significant findings on initial chest radiographs between recovery group and grave outcome group. However, follow-up CT findings of multilobar consolidation with extensive ground-glass opacities were significantly more often seen with grave outcome ( P=.01). The patients with grave outcome were significantly older compared with the other patients (mean age,78 years vs 67 years, retrospectively, P=.04). Almost all of the patients (17 of 20 patients) had underlying chronic illness, including diabetes mellitus, chronic obstructive pulmonary disease, and heart disease.Summary of Content: The initial radiograph findings were nonspecific, with bilateral or focal consolidation being most common finding and there was no significant different finding between recovery group and grave outcome group. Rapid progress to bilateral consolidation with patchy GGA on follow-up CT within a week is associated with grave outcome. null
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P. P. Santana1, A. K. Medeiros2, M. C. Gravinatti2, B. M. Lima2, M. P. A. Brotto2, S. W. Tanaka2, A. P. Gomes2
1H. Beneficencia Portuguesa de Sao Paulo and Fleury Group, Sao Paulo, BRAZIL, 2H. Beneficencia Portuguesa de Sao Paulo, Sao Paulo, BRAZIL. Learning Objectives: To illustrate the current possible applications of Dual-Energy CT (DECT) in thoracic abnormalities. Outcomes: To familiarize radiologists with DECT applications in chest disorders. Summary of Content: The introduction of DECT has permitted better material differentiation and tissue characterization compared to the traditional CT attenuation scale, modifying the noninvasive approach to chest disorders. DECT can provide both anatomic and functional information about the lungs. The most actively investigated principle of dual energy is material decomposition based on attenuation differences at different energy levels. The use of perfusion imaging has been shown to improve the diagnosis of acute and chronic PEs, which is probably the most important current application of DECT in chest disorders. The other major possibility offered by DECT is virtual monochromatic imaging that represents a new option for standard chest CT in daily routine. This technique is able to reduce the beam-hardening artifacts due to iodine contrast agent injection or metallic instrumentation. Other applications are characterization of pulmonary nodules and evaluation of intra- and extracapsular silicone implant rupture. Radiologists should be familiarized with the ongoing technological developments of DECT techniques, enhancing the utility of this application in clinical practice. null
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L. Leonela, S. Rossi, M. Ramos, V. Rubio, V. Soroa, M. Volpacchio
CENTRO DIAGNOSTICO DR ENRIQUE ROSSI, Buenos Aires, ARGENTINA. Learning Objectives: In PET-CT imaging of the chest: Identify sites of physiological uptake; review hypermetabolic processes that mimic malignant lesions; and therapeutic procedures that can produce false-positive. Summary of Content: Integrated positron emission tomography (PET)/computed tomography (CT) is an imaging modality that allows complementary anatomic and metabolic evaluation. PET-CT has an important role in oncology. It is useful in the metabolic evaluation of pulmonary nodules, staging, treatment response and re-staging of malignancy. Increased accumulation of 18F-FDG in neoplastic cells occurs because an uptake expression and activity of glucose transporter proteins and hexokinase activity. Thus, the greatest accumulation of FDG in the cell reflects increased of metabolic activity, in particular increased glucose consumption, which occurs in most neoplastic cells. However, this is not exclusively for oncological cells. Under physiological conditions 18F-FDG accumulates in normal tissues. Moreover, inflammatory, infectious, trauma, among other etiologies, may also demonstrate increased uptake of FDG. Radiologists play an important role in interpretation of PET-CT findings and their correlation with chest tomographic images in the context of patient 's current condition and history. Over-diagnosis (false positive) could be avoided. null
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EEE 04-19 Healthcare-associated Pneumonia in the Elderly: Difficulties in Radiologic Assessment
E. Kang1, J. Lee1, Choo J2 H. Yong1, K. Lee2, Y. Oh1
1Korea University Guro Hospital, Seoul, KOREA, REPUBLIC OF, 2Korea University Ansan Hospital, Seoul, KOREA, REPUBLIC OF, 3Korea University Anam Hospital, Seoul, KOREA, REPUBLIC OF. Learning Objectives: Along with the rapid rise in the elderly population, the need for healthcare in the elderly population will rise quickly. The elderly are vulnerable to pneumonia because of functional disabilities and comorbidities. Healthcare-associated pneumonia (HCAP) is proposed by the American Thoracic Society/Infectious Diseases Society of America in 2005. Elderly patients include aged ? 65 years. HCAP includes hospitalization for two days or more within the preceding 90 days, residence in a nursing home or extended care facility, the use of home infusion therapy, receipt of chronic dialysis within 30 days, home wound care and a history of infection with a multidrug-resistant pathogen in a family member. This exhibit reviews the radiologic assessment of HCAP in the elderly. Summary of Content: Elderly patients with HCAP show more severe pneumonia, higher rates of potentially drug-resistant pathogens, and worse clinical outcomes. Difficulties in radiologic assessment of elderly HCAP are mostly due to clinical overlapping pathology with multiple comorbidities and false negative findings on chest radiographs. Normal findings on chest radiographs do not exclude pneumonia in patients with suspected HCAP. Bronchopneumonia pattern is commonly observed with gravity dependent distribution in elderly HCAP. Early chest CT can provide more valuable information for the elderly patients with HCAP. null
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EEE 04-20 Identification manual for foreign bodies by using the chest phantom and the dual energy subtraction radiography
K. Endo, S. Sakai
Tokyo Women's Medical University, Tokyo, JAPAN. Learning Objectives: 1. To learn the usefulness of dual energy subtraction (DES) radiography for the diagnosis of chest foreign body. 2. To know what foreign bodies can be visualized in bone images obtained from DES radiography. Outcomes: 1. Foreign bodies can be detected easily in the DES radiograph than in the conventional chest radiograph. 2. A foreign body made of resin is faintly visualized in the bone image, whereas it is almost undetectable in the conventional radiograph. Summary of Content: DES radiography can be useful in detecting foreign bodies. null
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EEE 04-21 Pictorial Review of Pulmonary Venous Anomalies - What is their Clinical Relevance?
A. David, S. H. Novak, E. J. M. Barbosa, Jr.
Hospital of University of Pennsylvania, Philadelphia, PA. Learning Objectives/Outcomes: To illustrate typical imaging features of pulmonary venous anomalies, as well as their clinical relevance Summary of Content: Pulmonary venous anomalies are relatively uncommon, however may potentially cause substantial morbidity. This exhibit emphasizes partial anomalous pulmonary venous return (PAPVR), pulmonary arteriovenous malformation (pAVM), pulmonary vein varix (PVV), variants in the number of veins and pulmonary vein stenosis (PVS). Imaging is the cornerstone for diagnosis. 1) PAPVR requires at least one pulmonary vein draining into a systemic vein, most frequently affecting the right superior vein. Scimitar syndrome is a rare form. PAPVR may be clinically silent during childhood, however pulmonary hypertension can occur later. 2) pAVM is an abnormal direct communication between a pulmonary artery and a pulmonary vein. CTA shows simultaneous enhancement of feeding pulmonary artery, nidus and early draining pulmonary vein. They require treatment if symptomatic (paradoxic embolization), or when greater than 2-3 cm. Percutaneous transcatheter embolization is the treatment of choice. 3) PVV is a focal aneurysmal dilation of a pulmonary vein. It can be congenital or acquired. Complications include rupture, thromboembolism and hemoptysis, although most small varices are asymptomatic. 4) Variant Anatomy: Left sided variants include a common trunk of the left pulmonary veins. Right sided variants include accessory middle lobe vein. These are generally inconsequential, however should be noted prior to cardiovascular intervention, to decrease risk of unexpected complications. 5) PVS can be congenital or acquired. Clinical presentation may include venous congestion, pulmonary edema and alveolar hemorrhage, with surgical or endovascular correction generally performed. null
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EEE 04-22 Thoracic Manifestations of Hemolytic Anemias
D. Grant, Jr., R. Edwards, D. Godwin, G. Reddy, G. Kicska
University of Washington, Seattle, WA. Learning Objectives: 1. Describe the acute and chronic thoracic imaging appearance of the hemolytic and anemias, 2. Review cardiac complications in hemolytic anemia. Summary of Content: 1. Imaging appearance of acute chest syndrome, extramedullary hematopoiesis, and chronic lung disease, 2. Cardiac complications including cardiomyopathy and pulmonary hypertension. null
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EEE 04-23 Various etiologies of pulmonary infarction: Beyond theUsual Suspects.
B. Nam, T. Kim, K. Lee, T. Kim, J. Han, M. Chung
Samsung Medical Center, Seoul, KOREA, REPUBLIC OF. Body: Learning Objectives/Outcomes: After reviewing this educational exhibit, the reader will be able to: Understand the anatomy and physiology of the dual pulmonary blood circulation and the pathophysiology of pulmonary infarction Describe the various conditions resulting in pulmonary infarction, not only arterial thromboembolism but also tumorous or infectious conditions with characteristic imaging findings at chest CT. Discuss the key imaging features of pulmonary infarction than can be differentiated from other causes of pulmonary consolidation on CT. Summary of Content: The majority of pulmonary infarction is caused by pulmonary arterial thromboembolism. However, although unusual, there are many causes of pulmonary infarctions other than thromboembolism, including venous infarction due to stenosis of pulmonary vein related with radiofrequency ablation or lung surgery, direct invasion of pulmonary vessels by tumor, lung torsion after pulmonary resection, and pulmonary infections, most typically invasive fungal pneumonia. In spite of various etiologies of pulmonary infarction, the image findings on chest CT demonstrate similar patterns, which consist of peripheral consolidation, poor contrast-enhancement, ground-glass opacity, septal thickening and central lucency. Central lucency in the peripheral consolidation is especially useful for detection and characterization of pulmonary infarction in clinical practice. In this education exhibit, various etiologies of pulmonary infarction and their characteristic and informative imaging features will be illustrated. null
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EEE 04-24 What is Your Thoracic Radiology IQ?
Y. Rivaud, P. Maldjian
Rutgers New Jersey Medical School, Newark, NJ. Learning Objectives/Outcomes: When presented with puzzling thoracic imaging abnormalities, findings outside of the thorax can provide clues to the correct diagnosis. The challenge for the radiologist is to recognize and correlate both the intrathoracic and extrathoracic disease processes to formulate a reasonable interpretation. Summary of Content: This exhibit consists of a series of cases, presented as unknowns, which will allow participants to test their ability to identify and integrate intrathoracic and extrathoracic findings on imaging studies. Participants should examine the images presented for each case, identify the intrathoracic and extrathoracic abnormalities and attempt to arrive at a single diagnosis that best incorporates all the findings. The correct answer with a brief discussion is provided following each case. At the end of the presentation a score chart will allow participants to gauge their “Thoracic Radiology IQ.” Our aim is that participants find this exercise both informative and entertaining. null
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EEE 05-01 How Diffusion Weighted Imaging Helps in Lung Cancer Radiotherapy Planning
D. Baruah, E. Gore, E. Paulson, Z. Laste, S. Baginski, K. Thounlasenh, K. Shahir
Medical college of Wisconsin, Brookfield, WI. Learning Objectives: 1. Understanding diffusion weighted imaging (DWI) sequence and how we do it for lung cancer.2. Advantages of DWI sequence for radiotherapy planning as compared to CT, PET/CT and other MRI sequences.3. Limitation of DWI in lung cancer imaging and radiotherapy planning. Outcomes: Our experience with DWI for radiotherapy planning helps understanding usefulness of this sequence and also its limitations. Summary of Content:Role of DWI is well recognized in brain and head and neck tumors and continually improving for lung cancer imaging. We are using MRI with diffusion weighted imaging in select cases for radiotherapy planning of lung cancer. We are sharing our initial experience how DWI helps in planning and correctly identifying tumor margin. null
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EEE 05-02 3D Printing in Thoracic and Cardiac Imaging
J. Lichtenberger
Uniformed Services University of the Health Sciences, Bethesda, MD. LEARNING OBJECTIVES/OUTCOMES: After viewing this educational exhibit, the radiologist should be able to: - Discuss emerging technologies in 3D printing (additive manufacturing) relevant to thoracic and cardiac radiology - Describe the benefits to clinical care, medical education and training brought about by additive manufacturing - Give concrete examples of 3D printing improving clinical care, medical education and training - Recommend key elements of a successful 3D printing program in the clinical setting Summary of Content: OBJECTIVE: Recent advancements in high spatial resolution imaging in radiology has enabled the accurate acquisition of data in three dimensions. An emerging application of this data is the physical modeling of patient-specific anatomic structures by one of several 3D printing techniques. Production of clinically useful physical models requires integration of precise imaging and production techniques, a detailed understanding of the patient’s anatomy and pathology, and working knowledge of the planned therapy. This overview of the thoracic and cardiac imaging applications of 3D printing highlights developing roles of this technology and the key role of the radiologist not only in the diagnosis of disease but in its depiction. CONCLUSION: Many clinical questions are answered not by a single diagnosis but by a visual depiction of physical relationships. At the leading edge of the complex interplay between emerging imaging technologies and clinical demand, radiologists will play a central role in the medical application of 3D printing. null
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EEE 05-03 A Guide to Endobronchial Ultrasound and Endoscopic Ultrasound (EBUS and EUS) for Thoracic Radiologists
A. Barker1, S. Karia1, N. Carroll1, R. Rintoul2, J. Herre1, E. Godfrey1, S. Ramasundara1, J. L. Babar1
1Addenbrooke's hospital, Cambridge, UNITED KINGDOM, 2Papworth hospital, Cambridge, UNITED KINGDOM. Learning Objectives / Outcomes: • To identify situations that EBUS and EUS can be appropriately recommended to obtain tissue diagnosis when reporting a CT chest with mediastinal and pulmonary abnormalities. • To enhance knowledge of the basic technical aspects and limitations of these procedures. • To revise mediastinal lymph node stations. Summary of Content: Endobronchial (EBUS) and Endoscopic Ultrasound (EUS) are minimally invasive procedures that are performed with bronchoscopy and gastrointestinal endoscopy, to obtain samples of tissue from hilar and mediastinal lesions and lymph nodes for pathological and microbiological examination. • We will review the indications, limitations and technical considerations of EBUS and EUS. • We will focus on their use in sampling mediastinal lymph nodes; revising the International Association for the Study of Lung Cancer (IASLC) lymph node map and highlighting which nodal stations are particularly accessible. • With the use of thoracic CT images we will show case examples where these techniques in sampling mediastinal and central pulmonary lesions have diagnosed a wide spectrum of typical and uncommon neoplastic and non-neoplastic conditions. • Illustrate the role of EBUS and EUS in the staging of non-small cell lung cancer. • Review the evidence based trials and guidelines for the use of EBUS and EUS. null
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EEE 05-04 Unraveling Gastroesophageal Junction: Radiologist`s Perspective
A. J. Baxi, M. Zahid, R. Katre, A. Sunnapwar, C. Restrepo
UTHSCSA, San Antonio, TX. Learning objectives: 1. To study various disorders Gastroeosophageal junction 2. To review the pathophysiology, imaging findings and differential diagnosis with clinical correlation Outcome: GEJ is a histologically variable area between distal oesophagus and proximal stomach supported by diaphragmatic crurae. It is affected by various pathological entities. Proper knowledge of anatomy and pathologies is crucial for accurate diagnosis. A delay in diagnosis and management may lead to serious complications, thus increasing morbidity and mortality. Radiological imaging is not only crucial to identify them but also serves as a guide to management. In this educational exhibit, we discuss the Multimodality Approach for Understanding various gastrooesophageal junction disorders. Summary of content: The gastroesophageal junction is a complex anatomic and functional entity where the distal esophagus joins the proximal stomach. The main function of GEJ is to prevent reflux of stomach acid contents into the oesophagus. This antireflux mechanism is due to composite function of the lower esophageal sphincter (LES), and the crural diaphragm that functions as an external sphincter. In this exhibit, we will discuss: Anatomy Function Role of imaging modalities Pathologies: The various pathologies affecting GEJ are infection, strictures, achalasia, diverticulum, hernia, malignancies, and miscellaneous conditions. Clinical and laboratory findings cannot always diagnose these conditions. Imaging modalities like chest radiographs, barium studies, endoscopy, CT and MRI plays a crucial role in diagnosis and management. null
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EEE 05-05 Diffuse Mediastinal Widening on the Chest Radiograph: How to Narrow the Differential Diagnosis
I. Russell, P. Maldjian
Rutgers - New Jersey Medical School, Newark, NJ. Learning Objectives: Even the most experienced radiologist may find it challenging to formulate a pertinent differential diagnosis when confronted with a case of diffuse mediastinal widening on a chest radiograph. The purpose of this presentation is to: (1) illustrate various causes of diffuse mediastinal widening on chest radiography; (2) correlate the radiographic appearance with findings on CT; (3) describe the key radiographic features and clinical information (when relevant) that suggest the correct diagnosis. Summary of Content: Entities covered in this exhibit include artifactual causes of mediastinal widening, mediastinal hematoma (traumatic aortic injury, hematoma from non-aortic imjury) vascular abnormalities (aneurysms, right-sided aortic arch, venous anomalies), esophageal diseases (neoplasms, achalasia), lymphadenopathy (neoplastic and inflammatory causes) and mediastinal lipomatosis. An understanding of the distinguishing radiographic features of each of these disorders will help the radiologist to ascertain the correct diagnosis and properly direct the patient workup. null
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EEE 05-06 Imaging of Nonneoplastic Abnormalities of the Large Airways
M. Murota1, Y. Yamamoto1, K. Satoh2, Y. Nishiyama1
1Faculty of Medicine, Kagawa University, Kagawa, JAPAN, 2Kagawa Prefectural University of Health Sciences, Kagawa, JAPAN. Learning Objectives: To review the normal anatomy of the tracheobronchial tree on X-ray and CT. To review the imaging features of various nonneoplastic abnormalities affecting the large airways. Outcomes: To be familiar with the imaging features and differential diagnoses of nonneoplastic abnormalities affecting the large airways. Summary of Content: 1. Normal radiologic anatomy of the large airways 2. Imaging features and clinical findings of nonneoplastic abnormalities of the large airway lesions - Morphologic abnormalities: congenital bronchial variant, diverticulum, saber-sheath trachea - Diffuse diseases: relapsing polychondritis, granulomatosis with polyangitis, amyloidosis, others - Infection: endobronchial tuberculosis - Bronchiectasis: allergic bronchopulmonary aspergillosis, others - Others: broncholithiasis, postintubation stenosis, pulmonary artery sling, foreign body 3. How to approach to the differential diagnosis null
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EEE 05-07 Post Lung Transplant Complications: Emphasis on CT Imaging Findings
R. Katre, C. Restrepo, A. Baxi
UTHSCSA, San Antonio, TX. Learning Objectives: 1. To identify the pulmonary complications and pathological processes which may occur after lung transplantation 2. To describe the role of imaging in post transplant patients with emphasis on the CT imaging findings of the select relevant entities Summary of Content: Lung transplantation has been widely accepted as a treatment of choice among patients with end stage lung disease. Past experiences have shown its efficacy in improving the longevity as well as quality of life in many patients. Nevertheless, it is not devoid of complications which may vary from trivial and treatable entities to life threatening conditions. The complications can be divided into plural, pulmonary and airway diseases such as; hyperacute, acute, and chronic rejection including bronchiolitis obliterans organizing pneumonia; pulmonary infections; bronchial anastomotic complications; pleural effusions; pneumothoraces, lung herniation, pulmonary thromboembolism; upper-lobe fibrosis; primary disease recurrence; posttransplantation lymphoproliferative disorder. Post operative imaging, especially CT is crucial in early detection, evaluation and diagnosis of these complications, in order to decrease the morbidity and mortality associated with certain conditions. This educational exhibit addresses the pathological processes after lung transplantation and discusses the role of imaging, with emphasis on CT imaging findings. null
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EEE 05-08 Immunotherapy: Clinical, Imaging and Pathological Evaluation of a New Treatment Modality for Cancer
G. S. P. Meirelles1, F. G. Barbosa1, A. B. Pavani2, P. R. P. Santana1, J. Capobianco1, C. Verrastro1, M. T. A. Saieg1, M. T. Laloni1
1Fleury Group, Sao Paulo, BRAZIL, 2Fleury Group and ICESP, Sao Paulo, BRAZIL, 3Centro Paulista de Oncologia (CPO), Sao Paulo, BRAZIL. Learning Objectives/Outcomes: To demonstrate clinical, imaging and pathological aspects related to cancer immunotherapy, a novel treatment with emerging response patterns and immune-related adverse events. Summary of Content: Active cancer immunotherapy activates and modulates the immune system to fight cancer. WHO and RECIST criteria are inadequate for evaluating response to immunotherapy, as novel patterns of treatment response can be seen, such as: 1. Decrease in size of known tumors with no evidence of new foci of disease; 2. Clinically stable disease after completion of treament; 3. Delayed tumor response to treatment after a transient enlargement of tumors; 4. Appearance of new foci of disease after the completion of treatment followed by shrinkage of tumors or long-term stability of the disease. Activation of the immune system may also result in undesired immune-mediated complications. Toxic events related to immunotherapy include colitis, hepatitis, dermatitis, hypophysitis, thyroiditis, pancreatitis, myositis arthritis, sarcoid-like reactions, and pneumonitis. Clinicians, radiologists and pathologists should be aware of these novel response patterns and immune-related adverse events in order to successfully manage patients being treated with this new treatment modalit null
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EEE 05-09 Lung disorders in patients with Swine-origin influenza A (H1N1) viral infection: thoracic findings
V. S. A. Lajarin1, G. Meirelles1, C. Verrastro1, E. Marchiori2
1Fleury Medicina Diagnostica, Sao Paulo, BRAZIL, 2UFRJ, Sao Paulo, BRAZIL. Learning Objectives: The goal of this exhibit is to present the main computed tomography findings identified in patients with pneumonia caused by infection with influenza A (H1N1). The spectrum of the pandemic H1N1 virus infection ranges between non-febrile mild upper respiratory tract disease to severe and even fatal pneumonia. Pneumonia is one of the most common complications of H1N1 influenza and results in the majority of fatal outcomes in the world. High-resolution CT is an important tool when the clinical suspicion of pneumonia is high, and the radiographic findings are normal or questionable. Outcomes: The main finding was the presence of ground-glass opacities, with or without consolidation and peripheral predominance. Other findings may be present as crazy-paving pattern, centrilobular nodules, lymphadenophathy and pleural effusion. Fibrotic changes can occur, especially after the third week. Summary of Content: The novel swine-origin influenza virus generally known as "swine flu" was first identified in Mexico in April 2009. Similar to the seasonal influenza, the virus spreads through hand contact, respiratory tract and aerosol-generating procedures. Patients with H1N1 pulmonary infection can present with a wide variety of pulmonary changes, none of with specific for diagnosis. However, when associated with clinical and laboratory data, CT findings can be of great value to stratify disease severity, assess for complications, and follow-up, especially in cases with a more severe course. null
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EEE 05-10 Pulmonary Microvascular Disease - Changing concepts in pathogenesis and cross sectional imaging findings
C. Restrepo1, D. Vargas2, S. Saboo3, A. J. Baxi1
1UTHSCSA, San Antonio, TX, 2University of Colorado Hospital, Aurora, CO, 3University of Texas Southwestern Medical Center, Dallas, TX. Learning Objectives: 1. To discuss taxonomy and etiopathogenesis of pulmonary microvascular disease (PMD) 2. To review characteristic multimodality imaging findings Outcomes: · Introduction · Taxonomy · Pathology, imaging findings & role of imaging o Pulmonary Veno-Occlusive Disease o Pulmonary Capillary Hemangiomatosis o Plexogenic Arteriopathy o Small Vessel Vasculitis o Septic Emboli o Intra-arterial Metastasis o Hepato-pulmonary Syndrome o Talc Granulomatosis · Conclusion · Teaching points Summary of Content: PMD is a heterogeneous collection of diseases with differing causes, pathogenic mechanisms, and physiological effects. Advances in the understanding of the natural history and pathophysiology of PMD over a period of time, has led to the development of effective treatment strategies. However, limited radiology literature is available on PMD and only few case reports are published. A comprehensive accurate and precise terminology is needed to address the complexity of the diseases causing PMD is proposed. Cross sectional imaging provides accurate anatomy and morphology with information on etiology, location, mass effect and severity of PMO. Recognizing typical imaging manifestations with adequate clinical correlation is essential for timely and accurate diagnosis as well as guiding treatment. Imaging plays a critical role in the patient management. In this exhibit, we discuss the etiopathogenesis and characteristic multimodality imaging findings of PMD. Increased awareness of such entities will contribute to optimized care of cancer patients. null
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EEE 05-11 Fatty Lesions of the Chest: a Pictorial Review
V. Cardinal S. Rubin, H. J. Lee, M. V. Y. Sawamura, R. M. Guerrini
Instituto de Radiologia- Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, BRAZIL. Learning Objectives/Outcomes:Describe common and uncommon fat-containing lesions of the mediastinum, lung, pleura, chest wall and diaphragm; Narrow the differential diagnosis of fatty lesions based on its location, imaging features, associated findings and clinical data Summary of Content: The presence of fatty tissue within a thoracic lesion significantly narrows its differential diagnosis, and can easily be depicted by CT and MR. Lipoma is a common benign mesenchymal tumor that originates from adipose tissue, and can be encountered in various locations of the thorax, such as chest wall, pleura, lung, within mediastinal fat or mediastinal structures. Some diseases are characterized by multiple non-encapsulated fatty tissues, called lipomatosis, that can be located in chest wall, as in Madelung disease and Familial multiple lipomatosis; fat accumulation can also occur in the mediastinum (mediastinal lipomatosis) or heart (lipomatous hypertrophy of the interatrial septum). Some benign and malignant neoplasms have fatty tissue as part of its composition; in mediastinum, germ cell tumors, especially teratoma, and thymolipoma are the most common; although rare, liposarcomas can be located in esophagus or heart; hamartomas are benign tumors of the lung, and its most typical imaging features are fat-containing nodules with “popcorn” calcification. Lipoid pneumonia usually occurs as result of chronic aspiration of oils and is characterized by lung consolidation with fat attenuation. Finally, diaphragmatic hernias are a common cause of abnormal fatty tissue in the chest. The knowledge of the most common fat-containing lesions of each thoracic compartment and its specific imaging features are indispensable for narrowing differential diagnosis. null
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EEE 05-12 Inhalation of Foreign Bodies in the Multislice CT Era
P. P. Santana1, G. S. Meirelles2, C. G. Y. Verrastro2, I. Missrie2, A. P. Gomes1
1Fleury Group and H. Beneficencia Portuguesa de Sao Paulo, Sao Paulo, BRAZIL, 2Fleury Group, Sao Paulo, BRAZIL, 3H. Beneficencia Portuguesa de Sao Paulo, Sao Paulo, BRAZIL. Learning Objectives: To illustrate the spectrum of foreign bodies inhaled into the lungs, using post processed images to demonstrate its precise location, morphology, size and consistence, helping planning bronchoscopy. Outcomes: Identify the different types of bronchial foreign bodies and its complications. Summary of Content: Inhalation of foreign bodies is more common in children, usually in the first three years of life. Although the diagnosis is established immediately or within 2-3 days of the event, it may not be made for weeks or months even in adults. The condition is often clinically silent and symptomatology includes cough or wheezing. Prolonged irritation may lead to intermittent infections resulting in hemoptysis, sometimes life-threatening. Multislice CT is the imaging modality of choice to confirm the diagnosis and demonstrate its precise location. When clinically suspected, the patient usually refer the kind of material was inhaled. But there are non-suspect cases in which CT was performed to investigate related symptoms or complications, especially pneumonia or atelectasis. Air trapping may also be seen. The most common foreign bodies are food, including bone fragments, and broken pieces of teeth or dental material. Multislice CT permit characterize the morphology, size and consistence of the foreign body, differentiating soft tissue, calcified and metallic densities, and sometimes warning for delicate circumstances before bronchoscopy. null
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EEE 05-13 Review of CT findings of pulmonary cryptococcosis innon-HIV individuals
H. Sugiura, M. Jinzaki
Keio University School of Medicine, Tokyo, JAPAN. Learning Objectives: To know the imaging spectrum of CT findings of pulmonary cryptococcosis in non-HIV individuals Outcomes: The radiologists could be familiar with the CT findings of pulmonary cryptococcosis and be able to include this uncommon but important fungal infectious disease in the differential diagnosis. Summary of Content: Pulmonary cryptococcosis is a well-known fungal infection caused by cryptococcus neoformans which is a ubiquitous fungus found worldwide. The organism may cause isolated pulmonary infection or may progress to disseminated disease, particularly in patients with AIDS or other causes of impaired T cell-mediated immunity. Although cryptococcal infection commonly occur in immunocompromised hosts, it rarely occur in immunocompetent individuals and may be asymptomatic. Infection occurs via inhalation of cryptococcal particles into the lungs, although pneumonia is relatively uncommon in infected individuals. Central nervous system infection after hematogenous dissemination is more common than pneumonia. The most common CT manifestations of pulmonary cryptococcosis consists of single or multiple pulmonary nodules or masses, patchy consolidation or ground-glass opacities. The parenchymal abnormalities tend to be peripherally located, whereas they have no significant lobar predilection. Additional findings include cavitation, lymphadenopathy, and pleural effusion. Cavitation may occur in about 40% of cases. It is important to distinguish from other granulomatous infection such as pulmonary tuberculosis and nontuberculous mycobacteriosis. Compared with immunocompromised patients, lymphadenopathy and pleural effusion are rare in immunocompetent individuals. null
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EEE 05-14 New Cases of an Old Disease: Acute and Accelerated Silicosis
V. Buroviene, J. Zaveckiene
Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, LITHUANIA. Learning Objectives: ? To present two rare variants of silicosis - acute and accelerated disease; ? To overview typical imaging findings; ? To illustrate these subtypes with cases from our hospital.Outcomes: Silicosis is the most common and oldest recognized occupational lung disease. It is usually only thought of as a chronic, long-standing illness. Two less often occurring forms are acute and accelerated silicosis. These subtypes develop within short period after relatively short exposure to high levels of fine particulate silica. All three patients were young males. They developed acute (1) or accelerated (2) silicosis while working in the same workplace - a company manufacturing stone concrete kitchen sinks. Patient that developed acute silicosis died 14 months after the onset of symptoms, one patient’s with accelerated silicosis radiologic and clinical symptoms are worsening, condition of the third patient is stable. In a typical case of acute silicosis patient’s condition worsens quickly and the disease results in patient’s death within a year. Radiologic findings differ substantially from those of chronic silicosis and resemble those of alveolar proteinosis. Accelerated silicosis radiologically may be similar to chronic form, but disease progresses more rapidly.Summary of Content:Silicosis is not only a chronic disease. Radiologic findings are not specific, a valid diagnosis can only be made in the context of appropriate occupational history. Possibility of occupational lung disease should not be excluded: ? In a case of acute disease, ? In a young patient, ? Atypical occupation. null
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EEE 05-15 Pulmonary Perfusion Imaging Techniques
C. Y. Verrastro1, A. E. Rodrigues2, R. P. Ramos2, E. V. M. Ferreira2, G. Szarf1, B. Hochhegger3, P. R. P. Santana1, J. S. O. Arakaki2
1Grupo Fleury, Sao Paulo, BRAZIL, 2UNIFESP, Sao Paulo, BRAZIL, 3Santa Casa de Porto Alegre e PUC/RS, Porto Alegre, BRAZIL. Learning Objectives: To become familiar with lung perfusion imaging techniques. Outcomes: To demonstrate the main lung perfusion imaging techniques, including dual source CT, MRI and nuclear medicine studies. Summary of Content: Nuclear medicine is an already known and well established technique for studying lung perfusion. Before the era of dual source CT whole lung perfusion imaging was generally not possible due to high radiation dose. MRI perfusion is broadly used in the central nervous system but still considered an experimental method for the lungs. Scintigraphy remains as the workhorse method for lung perfusion, especially when acute or chronic pulmonary thromboembolism is suspected; however, this method is seldom available in emergency situations, has low resolution and do not provide alternative diagnoses. Cross sectional imaging, like CT and MRI, have additional capabilities to study lungs, heart, systemic and pulmonary vasculature. Modern CT and MRI techniques can show angiographic views and perfusion maps at the same time; MRI can even be performed without IV contrast. MRI is the gold standard for evaluating the right heart function and in the near future may be the one stop shop for vascular cardiopulmonary disease. null
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EEE 05-16 Spectrum of Pulmonary Calcifications
M. K. Kumaran, D. J. Murphy, M. M. Hammer
Brigham and Women's Hospital, Boston, MA. Learning Objectives: 1. List the differential for calcified pulmonary nodules and describe associated findings that can help distinguish these possibilities. 2. Describe the fibrotic lung diseases associated with calcification. 3. Distinguish mimics of calcification from true calcified pulmonary nodules. Summary of Content: 1. Nodules - Healed granulomatous infections, Hamartoma, Carcinoid, Metastases and Lung cancer, Amyloidosis 2. Fibrosis - Sarcoidosis and silicosis, Dendriform pulmonary ossification 3. Other patterns - Metastatic pulmonary calcification, Amyloidosis 4. Mimics of Calcification - Lymphangiographic contrast, Aspirated barium, Vertebroplasty cement null
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EEE 05-17 Where is the bubble: Atypical and unusual thoracic air
D. Varona Porres, O. Persiva, E. Pallisa, J. Andreu
Hospital Vall d´Hebron, Barcelona, SPAIN. Learning Objectives: 1. To review unusual and atypical conditions with presence of air in the thorax. 2. To describe the radiological findings that allows diagnosis on chest radiography and multislice CT in these patients. 3. To emphasize the importance of diagnosis for management of these patients and its clinical impact. Summary of Content: There are many clinical conditions that may occur with the presence of air in the chest out of its anatomical localization. In this presentation we review a serie of cases collected from our database that manifest with chest air, with special attention to unusual or atypical causes. The exhibit is organized by anatomic areas: 1. Mediastinal: Spontaneous pneumomediastinum extending to spinal canal, post-pulmonary biopsy, mediastinitis, post-traumatic and spontaneous esophagic or tracheobronchial rupture, spontaneous pneumomediastinum related to interstitial lung disease, and bronchial or esophageal fistula post-lymph node perforation. 2. Pericardial: Related to progression of lung neoplasm or lung transplant ion. 3. Cardiovascular: Air embolism. 4. Pleural: Related to interstitial lung disease, lung neoplasm or mesothelioma, and infections. 5. Chest wall: Intercostal hernias with pulmonary or gastrointestinal content, infections, or subcutaneous emphysema of unusual causes (post-pulmonary biopsy). null
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EEE 05-18 Collapse, Crowding, Consolidation and Contrast: Imaging Findings of Atelectasis on Computed Tomography
S. H. Garrana1, S. L. Desouches1, M. L. Rosado-de-Christenson2, T. S. Henry3, J. R. Kunin2, C. M. Walker2
1University of Missouri-Kansas CIty, Kansas City, MO, 2Department of Radiology, Saint Luke's Hospital of Kansas City and University of Missouri-Kansas City School of Medicine, Kansas City, MO, 3Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA. Learning Objectives/Outcomes: 1) Describe the direct and indirect imaging findings of atelectatic lung on contrast-enhanced and unenhanced chest CT. 2) Define the different types of atelectasis including; resorptive, relaxation, gravity dependent, adhesive, rounded, and cicatricial with discussion of common causative pathologies. 3) Illustrate pathology that may be hidden within or obscured by atelectatic lung (e.g., neoplasm, infarct, pneumonia, abscess) and provide tips for making the diagnosis on chest CT. 4) Distinguish common and uncommon mimics of atelectasis including infectious/inflammatory consolidations, aspiration, edema and neoplasms, with discussion of differentiating signs on chest CT. Summary of Content: Accurate diagnosis of atelectasis remains a diagnostic dilemma. Important imaging features may be overlooked or misinterpreted, resulting in unindicated therapeutic intervention. Recognition of the imaging features of atelectasis in conjunction with review of the patient’s clinical history can facilitate differentiation of atelectasis from other common mimics by the interpreting radiologist. Furthermore, careful assessment of the atelectatic lung is crucial to exclude underlying abnormalities that may be the cause of atelectasis or may be obscured by it. null
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EEE 05-19 Radiologists toolbox to differentiate alveolar versus interstitial lung diseases
KHOO TECK PUAT HOSPITAL, ALEXANDRA HEALTH SYSTEM, Singapore, SINGAPORE. Learning Objectives:1) To describe the anatomical definitions of alveolar and interstitial lung disease.2) To enumerate differential diagnosis of alveolar and interstitial diseases.3) Differentiating alveolar & interstitial lung diseases based on their morphology, distribution and pattern on radiographs.4) Correlate HRCT findings of the same to formulate appropriate differentials. Summary of Content:Alveolar and interstitial lung diseases encompass a wide spectrum of pathologies. Knowledge of the different presentations, radiographic patterns and key signs help to formulate the most suitable diagnostic hypotheses taking into account the clinical and laboratory context and also paves way to CT as next diagnostic tool in selected cases. null
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EEE 06-01 A Horse of a Different Color: A Pictorial Review of Organizing Pneumonia.
E. Yushvayev, A. C. Levy, M. Muranaka, R. Perone
Lenox Hill Hospital, New York, NY. Learning Objectives: Organizing pneumonia is a nonspecific response of the lungs to injury that can be provoked by a myriad of insults including infection, drugs, connective tissue disease, and aspiration. The diagnosis of cryptogenic organizing pneumonia is made when no causative factor or association is identified. Known as a great mimicker, organizing pneumonia can present with a wide variety of radiological and CT findings and may be overlooked in the development of a differential diagnosis. Being a highly treatable disease with the appropriate therapy, it is essential that every radiologist be familiar with the spectrum of imaging findings of organizing pneumonia and when its inclusion in a differential diagnosis is appropriate. The objective of this pictorial essay is to familiarize readers with the radiologic and CT findings of organizing pneumonia and associated differential diagnosis. Summary of Content: Both characteristic and unusual imaging findings will be reviewed in addition to a brief discussion of clinical presentations, pathological correlations, imaging pitfalls, differential diagnosis and patient outcome. null
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EEE 06-02 Access Routes to the Mediastinum for Percutaneous Thoracic Biopsies: Protective Capnothorax and Mediastinal Widening with CT Fluoroscopic Guidance
J. Soon, J. Kavanagh, S. Kandel, P. Rogalla
University Health Network, Toronto, ON, CANADA. Learning Objectives/Outcomes Indications for, how to, and limitations of protective capnothorax and hydrodissection assisted mediastinal widening for the access of difficult mediastinal and paramediastinal lung lesions. Summary of Content Mediastinal/paramediastinal lung lesions can be challenging to access due to depth and proximity to vital mediastinal structures. Furthermore, patients with concurrent emphysema, advanced age or oxygen dependency have poor tolerance to complications including pneumothorax. Capnothorax and hydrodissection represent safe and feasible alternatives. Due to its high diffusion coefficient and solubility, capnothorax demonstrates rapid resolution when compared to air pneumothorax. After usual sterile procedure and local anaesthesia, a coaxial needle is advanced into the pleural space with position confirmed by a 30cc test bolus. Insufflation is thereafter via hand titrated 50cc aliquots or continuous insufflation at a rate of 2000cc/minute if larger capnothorax is required. Biopsy can be via the coaxial system or a second entry point as required. Capnothorax resolution occurs spontaneously but can be aided by suction. Intraprocedural low flow oxygen, monitoring of vital signs and post procedural chest radiographs at 1 hour (and at 2 hours if age >70 years) are recommended. Hydrodissection entails widening the mediastinal soft tissue planes in order to allow safe passage of a transthoracic needle. An iodinated contrast:saline solution with concentration 1:7 allows optimal visualization without streak artifact. Post procedural aspiration is not required, although standard monitoring is recommended. null
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EEE 06-03 Chronic lung allograft dysfunction (CLAD) - ChangingConcepts in Pathogenesis & Cross Sectional Imaging Findings
A. J. Baxi, C. Restrepo
UTHSCSA, San Antonio, TX. Learning Objectives: 1. To define, illustrate and discuss taxonomy and etiopathogenesis of CLAD2. To review literature and characteristic multimodality imaging findings of CLAD3. To describe and illustrate imaging findings and discuss imaging based differential diagnosis Outcomes: Introduction Taxonomy Review of literature & pathogenesis Imaging findings of CLAD Differential diagnosis Management Conclusion Teaching points Summary of Content: Chronic rejection is a one of the major cause of morbidity and mortality following lung transplantation. Recently, a broader definition of chronic rejection has been introduced, termed "chronic lung allograft dysfunction"(CLAD), which encompass a more inclusive definition of post-transplant dysfunction and includes bronchiolitis obliterans syndrome (BOS), restrictive allograft syndrome (RAS), recurrence of primary disease, anastomotic stricture, and azithromycin-responsive allograft dysfunction (ARAD), pleuropulmonary fibroelastosis, and specific causes of decline in lung function. Given the potential significant morbidity, it is important to understand and recognize them. Cross sectional imaging over a period to time has evolved significantly to answer these clinical questions.In this exhibit, we will review the challenges for diagnosing CLAD from diagnosis to understanding the pathogenesis. Conclusion: Recent introduction of CLAD has changed the clinical practice in lung transplant recipients. Recognition of characteristic multimodality imaging findings of subgroups within CLAD may allow etiology specific treatment and can significantly reduce morbidity and mortality null
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EEE 06-04 Sarcoidosis Mimicking Malignancy and Sarcoid Reactions in the Chest: Collaborative Interpretation of CT and F-18 FDG PET/CT
H. Son, 19141
Einstein healthcare network, Philadelphia, PA. Learning Objectives: Sarcoidosis is a multi-systemic disease characterized by cellular immunity activity with formation of non-caseating granulomas in various organ systems. Lungs are the most common site of disease involvement. Classic imaging findings and patterns of sarcoidosis involving the chest are quite well known. However, uncommon radiographic findings and marked FDG avidity may complicate matters. Sarcoidosis can be a pitfall in FDG PET/CT, which may lead to false-positive results of malignancy. Being familiar with not only common imaging findings but also uncommon findings of sarcoidosis along with PET/CT features is of paramount importance to narrow differential diagnosis as it can occur after chemotherapy in oncologic patients (sarcoid reaction) while being associated with other disease entities such as lymphoma. Outcomes: 1. Describe not only common imaging findings but also uncommon findings of sarcoidosis on axial imaging 2. Identify PET/CT features of sarcoidosis and its added value on other imaging modalities in diagnosis of disease as well as management of patients 3. Recognize sarcoid reactions seen after chemotherapy in oncologic patients and sarcoidosis lymphoma syndrome 4. Describe the importance of collaborative interpretation of CT and FDG PET/CT Summary of Content: It is important for radiologists to recognize the uncommon imaging features and patterns of sarcoidosis in the chest as well as added value of PET/CT in order to raise the possibility in the appropriate clinical setting. null
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EEE 06-05 Percutaneous Direct Embolization of Pulmonary Arterial Pseudoaneurysms: Mixed Bag of Success and Failure!
ALL INDIA INSTITUTE OF MEDICAL SCIENCES (AIIMS), New Delhi, INDIA. Learning Objectives: To demonstrate the feasibility and technique of percutaneous thrombin / glue injection in the management of pulmonary arterial pseudoaneurysms (PAP) as a minimally invasive treatment option. Summary of Content: Percutaneous direct embolization of PAP offers several advantages over surgery and endovascular techniques. We present our experience of 5 cases of PAP which were managed with percutaneous thrombin / glue injection. One was post-traumatic while the rest were mycotic pseudoaneurysms. Thrombin was used in 3 cases while glue injection was done in 2. Technical success could be achieved in all the patients but two patients eventually required surgery. Ultrasound guidance was used in one patient while rest were done under CT guidance. 22G Chiba needle was used in all cases and position was confirmed by blood spurt and contrast injection in CT. No significant immediate / delayed complications were encountered. One patient had severe bout of cough after thrombin injection, resulting in mild aspiration which was clinically silent. Based on existing literature and our experience, practical procedural tips, choice of embolizing agent, patient selection and points of caution shall be discussed. To conclude, percutaneous direct embolization is a safe and effective minimally invasive therapeutic option for pulmonary pseudoaneurysms, especially those surrounded by consolidation. null
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EEE 06-06 Spectrum of Cystic Lung Disease and Its Mimics
K. Jacobs, E. Weihe
UCSD, San Diego, CA. Spectrum of Cystic Lung Disease and its Mimics Educational Exhibit Learning Objectives: Review the pathologic and radiologic definition of a lung cyst Illustrate classic and distinguishing HRCT features of cystic lung disease Review common mimics of cystic lung disease Discuss the underlying pathology of each entity Summary of Contents: Diffuse Cystic Lung Disease Syndromic Neurofibromatosis Tuberous Sclerosis/Lymphangioleiomyomatosis Birt Hogg Dube Smoking-related Pulmonary Langerhans Histiocytosis Desquamative Interstitial Pneumonia Immune-Mediated Chronic Hypersensitivity Pneumonitis Lymphocytic Interstitial Pneumonia Infectious Pneumocystic Carinii Pneumonia Pneumatoceles (ie Staphylococcus) Mimics of Cystic Lung Disease Cystic Bronchiectasis Cystic Metastases Centrilobular or Panlobular Emphysema Honeycombing null
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EEE 06-07 Stereotactic Ablative Radiotherapy (SABR) of lung tumors: A pictorial review.
A. Bedayat, 94305, D. Terrone, M. Diehn, B. Loo, A. Leung, H. Guo
Stanford, Stanford, CA. Teaching Points: Review expected evolution of post SABR pulmonary changes as seen on CT and FDG-PET/CT. Discuss pearls and pitfalls in accurately diagnosing residual/recurrent tumors and mimics. Table of contents/Outline: General overview of stereotactic ablative radiotherapy (SABR). Describe the CT and PET/CT features of expected post radiation findings. Identify distinguishing imaging features of recurrent/residual tumors and their mimics. Discuss the diagnostic pitfalls and management of the discussed entities. null
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EEE 06-08 Texture Analysis of Subsolid Nodules - Definitions and applications
L. R. Vimala1, Y. Zhang1, A. Oikonomou2, P. Salazar3, N. Paul1, E. Nguyen1
1Toronto General Hospital, Toronto, ON, CANADA, 2Sunnybrook Healthsciences Centre, Toronto, ON, CANADA, 3Vital images, Toronto, ON, CANADA. Learning Objectives and outcomes The learner should understand: a.Description of terms used in texture and histogram analysis. b.How texture analysis is used to differentiate temporary from subsolid nodules. c. How texture analysis helps to differentiate invasive from pre-invasive adenocarcinoma spectrum lesions. d. Future application of texture and histogram analysis for characterization of lung nodules. Summary of Content: Definitions of various texture analysis terms such as entropy, heterogeneity will be explained. Parameters used in histogram analysis of lung nodules such as kurtosis, skewness and mean density measurements will be explained with examples. Challenges to performing robust and accurate texture analysis including solid and ground glass components of nodules as well as adjacent vascular structures will be explained using a case based approach. Texture analysis has shown promising results to help differentiate transient from persistent subsolid nodules and to differentiate invasive from pre-invasive adenocarcinoma spectrum lesions. Texture analysis of CT images of lung nodules appears to be a promising tool for nodule characterization and risk stratification for invasive malignancy but further research is necessary to fully explore its role in routine clinical practice. null
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EEE 06-09 The Spectrum of HRCT Findings of Idiopathic Pneumonia Syndrome in Patients Who Underwent Hematopoietic Stem Cell Transplantation
N. Tanaka1, Y. Kunihiro2, T. Kobayashi2, T. Matsumoto1
1Saiseikai Yamaguchi Hospital, Yamaguchi, JAPAN, 2Yamaguchi University Graduate School of Medicine, Ube, JAPAN, 3Yamaguchi - Ube Medical Center, Ube, JAPAN. Learning Objectives: Idiopathic pneumonia syndrome (IPS) has been firstly limited to diffuse alveolar damage (DAD) as the pathological finding. Recently, the American Thoracic Society (ATS) updated the concept of IPS and extended the concept to a wider range. The ATS categorized the presumed site of primary tissue injury due to IPS largely into three patterns: pulmonary parenchyma, vascular endothelium and airway epithelium. It is very important to differentiate IPS, especially from several infectious complications. The learning objective of this exhibit is to recognize the imaging findings of these non-infectious diseases. Outcomes: Radiologists can understand the characteristic HRCT findings of each entitiy inculded in IPS, which enable to differentiate among these entities. Summary of Content: Some entities included in the updated ATS statement are discussed in this exhibit. Characteristic HRCT findings of acute interstitial pneumonia include diffuse and extensive ground-glass attenuation (GGA) with or without crazy-paving pattern predominantly distributed in the dorsal lung. Non-cardiogenic capillary leak syndrome shows extensive interlobular septal thickening with or without GGA. The typical HRCT finding of diffuse alveolar hemorrhage is extensive and symmetric GGA with crazy-paving pattern predominantly distributed in the central lung areas. Cryptogenic organizing pneumonia usually shows GGA and/or airspace consolidation with nonsegmental and subpleural distribution. The characteristic HRCT finding of bronchiolitis obliterans syndrome includes bronchial dilatation, mosaic perfusion, and air trapping in expiratory scans. As mentioned above, IPS includes a wide variety of diseases and the HRCT findings overlap with each other. However, some entities will show characteristic HRCT findings. null
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EEE 06-10 Revisiting the basics- Approach to mediastinal masses
Khoo Teck Puat Hospital, SINGAPORE, SINGAPORE. Learning Objectives: To revisit the basics of approach to mediastinal masses. To achieve a higher degree of confidence in localizing mediastinal masses. Outcomes: By diligently following the general guidelines laid down for evaluating mediastinal masses, the reporting radiologist can localize the masses with a higher degree of accuracy before referring patients for cross sectional imaging. Summary of Content: General overview of a radiograph followed by a systematic review, added in together with a dash of time tasted signs, is the perfect recipe for a classic radiograph report. null
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EEE 06-11 The Breadth of the Diaphragm: Congenital and Acquired Derangements (Including 3D Imaging)
T. Johnson, J. Choe, D. White, J. Matsumoto, R. Kuzo, S. Blackmon, M. Allen, C. Koo
Mayo Clinic, Rochester, MN. Learning Objectives/Outcomes: Review updates in diaphragm development. Discuss congenital and acquired abnormalities of the diaphragm. Illustrate 3D imaging for surgical planning. Summary of Content: The diaphragm is a unique skeletal muscle separating the thoracic and abdominal cavities with primary function of enabling respiration. The diaphragm is steadfast in this duty and typically goes unremarked on in diagnostic imaging. However, when abnormal, the consequences for patients can be severe. Congenital diaphragmatic malformations are common birth defects occurring in up to 1 in 3,000 births. Development of the diaphragm is a complex process that is becoming clearer with recent anatomic and molecular investigations, which offer new insight into congenital abnormalities. We review these advancements to provide an update in embryogenesis in relation to developmental anomalies. Acquired abnormalities of the diaphragm take many forms and can be equally disabling for patients. Traumatic injury of the diaphragm results in a spectrum of injury. Primary benign masses of the diaphragm include cysts and lipomas. Rabdomyosarcoma is the most common primary malignancy of the diaphragm and has the potential to arise anywhere skeletal muscle is located. Physiologic dysfunction related to diaphragm paralysis is not uncommon and is readily assessed by fluoroscopy or MRI in patients where minimizing radiation is necessary. Finally, novel advancements in diagnostic imaging have improved the management of diaphragm malformations. We showcase our experience with 3D modeling and printing to assist in surgical planning for diaphragmatic abnormalities. Increased awareness of these techniques will help imagers uniquely participate in individualized medicine in the future. null
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UNIVERSITY OF CHICAGO, HIGHLAND PARK, IL. Learning Objectives: To depict the array of thoracic emergencies that can develop in patients receiving conventional cytotoxic chemotherapy and those receiving molecular targeted therapy. Outcomes: To appreciate new and unexpected thoracic complications as they relate to molecular targeted therapy and contrast them with those that result from cytotoxic chemotherapy. Summary of Content: The following disorders will be highlighted: SVC syndrome, cardiac tamponade, pulmonary embolism, malignant tension hydrothorax, hemoptysis, central airway obstruction,esophago-respiratory fistulae, and recall pneumonitis. null
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EEE 06-13 Imaging of Heart Transplantation
A. Levey1, N. Goyal1, B. Little1, D. Vega1, V. Mehta2
1Emory University Hospital, Atlanta, GA, 2Staten Island University Hospital, Staten Island, NY." Learning Objectives: (1) Review criteria for heart transplant (tx). (2) Learn basics of how this procedure is performed. (3) Understand the imaging appearance of post heart tx patients on radiographs and CT and (4) Learn imaging appearance of complications associated with heart transplant Outcomes: Discussed items include: orthotopic vs. heterotopic tx, associated post operative hardware, accelerated atherosclerosis, lymphoproliferative disorders, rejection, and infection. Summary of Content: Through schematic diagrams, xray and CT images we demonstrate the appearance of orthotopic allograft placement and its associated complications. null
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EEE 06-14 Lung Lacerations: Rapid Interpretation Using Mechanism of Injury
R. S. Quadri1, K. Batra1, P. Rajiah1, D. Weakley1, A. Baxi2, A. Kandathil1, S. Abbara1, S. S. Saboo1
1University of Texas Southwestern, Dallas, TX, 2University of Texas San Antonio, San Antonio, TX. Learning Objectives: Review anatomy and mechanisms of injury for lung lacerations. Understand the radiographic and Computed Tomographic (CT) appearance of lung lacerations and the associated findings with various types of trauma. Recognize critical imaging findings that must be communicated to clinicians. Outcomes: Improve the interpretation of lung lacerations on CT for surgical triage. Summary of Content: Traumatic thoracic injury is recognized as a poor prognostic marker in the setting of multi-organ system trauma. Damage to the chest wall, pleura, diaphragm, cardiovascular system, tracheobronchial tree and particularly the lungs occurs frequently. Within the lung parenchyma, contusions, lacerations and occasionally lung herniation can be detected on initial chest radiograph and CT. Pulmonary contusions and lacerations often occur in unison given both are caused by traumatic parenchymal injury. Lung lacerations are alveolar tears that are pulled apart into oval cavities by the natural recoil of the chest wall. They can be multi-focal and contain air (pneumatocele) with or without hemorrhage (hemopneumatocele). Four different traumatic mechanisms cause lacerations: blunt compression, blunt shearing across the spine, penetrating injury and tearing of post-surgical pleuropulmonary adhesion. Type 1 compression injuries are the most common, but generally resolve with conservative management. Penetrating Type 3 lacerations are less common, but are associated with increased mortality due to infection and recurrent pneumothoraces from bronchopleural fistulas. These patients require surgical intervention, which is often decided based on imaging findings. This exhibit provides the features necessary to accurately characterize lung lacerations on CT to help correctly guide clinical management. null
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EEE 06-16 Non-invasive method to estimate Pulmonary Vascular resistance on CT Pulmonary angiography
K. Shahir1, K. Fuhrman1, Z. Laste1, S. Baginski1, K. Presberg1, S. Sonavane2, L. Goodman1, D. Baruah1
1Medical College of Wisconsin, Milwaukee, WI, 2University of Alabama, Birmingham, AL." Learning Objectives: 1. Pulmonary vascular resistance (PVR) is an important hemodynamic parameter useful in the management of patients with advanced cardiovascular and pulmonary conditions. It is typically calculated invasively by catheter angiography by the ratio of pulmonary pressure gradient to pulmonary flow.2. In this educational exhibit we sought to demonstrate simple practical CT technique based on the information we get from test bolus imaging used for pulmonary embolism studies, which will help estimate the PVR 3. Implications of PVR. 4. Limitations of CT methods Outcomes: Using this method one can successfully add more helpful dynamic parametric information Summary of Content: The CT bolus images have key information which can give a great insight about the PVR. The information is already available and should be used in a daily practice to add value to CT studies done for pulmonary embolism. null
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EEE 06-17 Systemic Approach to Fat Containing Lesions of the Thorax
E. Yushvayev, R. Perone
Lenox Hill Hospital, New York, NY. Learning Objectives: The objective of this educational exhibit is to illustrate the wide spectrum of thoracic fat containing lesions and demonstrate how their specific location and the presence of fat can assist in narrowing the differential diagnosis and producing a more definitive radiologic diagnosis. Summary of Content: Participants will be presented with a review of relevant anatomy. Cases will then be illustrated and organized into lesions affecting the following areas: endo-bronchial, lung parenchyma, mediastinum, cardiac, pleural and extra-pleural. Forming the differential diagnosis based on these locations will be emphasized. Characteristic imaging findings and clinical pearls will be included for each lesion. The fat containing entities that will be described include lesions of the airways such as endo-bronchial lipoma and hamartoma. Intraparenchymal lesions such as lipoma, lipoid pneumonia and hamartoma. Mediastinal lesions such as lipoma, lipomatosis, thymolipoma, teratoma, teratocarcinoma, lipoblastoma. Cardiac lesions such as lipoma, liposarcoma, lipomatous hypertrophy of the interatrial septum and arrhythmogenic right ventricular dysplasia. Pleural lesions such as extrapleural lipoma. Diaphragmatic lesions such as hernias and juxtacaval fat. null
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EEE 06-18 What's Lurking in the Shadows? A Review of Blind Spots on Chest Radiographs and the Perils of Overlooking Them
S. H. Novak, A. David, B. Zigmund
University of Pennsylvania, Philadelphia, PA. Learning Objectives: Be aware of and understand common misinterpretations on chest radiography to reduce rate of these errors on future interpretations Summary of Content: Chest radiographs remain the most commonly performed radiographic examination and continue to be interpreted by a wide variety of subspecialists, despite a trend toward increasing subspecialization in radiology. Perceptual errors account for 60-80% of radiology errors, and errors in diagnosis are the most common cause of malpractice litigation against radiologists. Common perceptual errors include missed lung cancer, which is among the leading causes of malpractice suits against radiologists overall and is, by far and away, the most common cause in thoracic imaging. We will discuss perceptual errors in chest radiography and their implications for patient care and association with malpractice litigation. Radiologists tend to miss lung cancers in certain locations, particularly the perihilar, retrocardiac, and apical regions.The most common types of misses by radiologists in general are underreading (missing the finding) and satisfaction of search, and these can occur for example in chest radiographs when a lung finding is identified but a lytic rib lesion is missed. The lateral view is less familiar territory to main radiologists in comparison to the frontal, and is a risk for missing particularly hilar lymphadenopathy. The assessment of whether an airspace process represents pneumonia, atelectasis, or neoplasm can also be error prone and is a common source of discrepancies in interpretations. We review these types of errors and how radiologists can avoid the common pitfalls. null



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