Faculty Bibliography

The pulmonary vasculature may be involved by different primary and secondary tumors. Poorly differentiated and undifferentiated sarcomas are the most common primary tumors of the pulmonary arteries. They tend to affect the large caliber pulmonary vessels and present with predominantly intraluminal growth. Pulmonary and mediastinal metastasis are common, and prognosis is poor. Clinical and imaging manifestations may mimic those of pulmonary embolism. Dyspnea, chest pain, cough, and hemoptysis are the most common presenting symptoms. Primary sarcomas arising from the central pulmonary veins are less common than their arterial counterpart. Secondary involvement of the pulmonary arteries and veins by primary and metastatic pulmonary malignancies is more common. Tumoral embolism may also affect the pulmonary arteries. They may develop from different intrathoracic and extrathoracic malignancies and may be indistinguishable from venous thromboembolism. It may manifest as cor pulmonale with right cardiac strain and dilated pulmonary arteries. Computed tomography, magnetic resonance imaging, and fluorodeoxyglucose positron emission tomography may help in the differentiation between these 2 conditions.

We present an unusual case of partial anomalous pulmonary venous return draining a subsegmental area of the left upper lobe into the superior vena cava. To our knowledge, this type of partial anomalous pulmonary venous return has not been described previously. We briefly describe embryologic considerations that we believe could help explain the origin of this rare anomaly.

Under typical dark chest radiography reading room conditions, a radiologist's pupils contract and dilate as their visual focus intermittently shifts between the high luminance monitor and the darker background wall, resulting in increased visual fatigue and degradation of diagnostic performance. A controlled increase of ambient lighting may minimize these visual adjustments and potentially improve comfort and accuracy. This study was designed to determine the effect of a controlled increase of ambient lighting on chest radiologist nodule detection performance. Four chest radiologists read 100 radiographs (50 normal and 50 containing a subtle nodule) under low (E=1 lx) and elevated (E=50 lx) ambient lighting levels on a DICOM-calibrated, medical-grade liquid crystal display. Radiologists were asked to identify nodule locations and rate their detection confidence. A receiver operating characteristic (ROC) analysis of radiologist results was performed and area under ROC curve (AUC) values calculated for each ambient lighting level. Additionally, radiologist selection times under both illuminance conditions were determined. Average AUC values did not significantly differ (p>0.05) between ambient lighting levels (estimated mean difference=-0.03; 95% CI, (-0.08, 0.03)). Average selection times decreased or remained constant with increased illuminance. The most considerable decreases occurred for false positive identification times (35.4±18.8 to 26.2±14.9 s) and true positive identification times (29.7±18.3 to 24.5±15.5 s). No performance differences were statistically significant. Study findings suggest that a controlled increase of ambient lighting within darkly lit chest radiology reading rooms, to a level more suitable for performance of common radiological tasks, does not appear to have a statistically significant effect on nodule detection performance.

Increasing use of cross-sectional studies has resulted in a concomitant increase in the number of intravascular and perivascular masses found in patients being studied for a multitude of thoracic conditions. As a consequence, there needs to be an awareness of the imaging findings of certain unusual abnormalities that will help prevent erroneous treatment (eg, anticoagulation) and expedite proper therapy. Although the spectrum of conditions that may present as intravascular, mural, and extravascular abnormalities in and around the aorta is broad, imaging features like contrast enhancement, signal intensity, and metabolic activity may help in making the correct diagnosis. Examples of the imaging presentation of these rare primary tumors and more common secondary tumors that may affect the aorta are presented in this article.

PURPOSE/OBJECTIVE:To evaluate the safety and tolerability of inhaling multiple 1-L volumes of undiluted hyperpolarized xenon 129 ((129)Xe) followed by up to a 16-second breath hold and magnetic resonance (MR) imaging. MATERIALS AND METHODS/METHODS:This study was approved by the institutional review board and was HIPAA compliant. Written informed consent was obtained. Forty-four subjects (19 men, 25 women; mean age, 46.1 years ± 18.8 [standard deviation]) were enrolled, consisting of 24 healthy volunteers, 10 patients with chronic obstructive pulmonary disease (COPD), and 10 age-matched control subjects. All subjects received three or four 1-L volumes of undiluted hyperpolarized (129)Xe, followed by breath-hold MR imaging. Oxygen saturation, heart rate and rhythm, and blood pressure were continuously monitored. These parameters, along with respiratory rate and subjective symptoms, were assessed after each dose. Subjects' serum biochemistry and hematology were recorded at screening and at 24-hour follow-up. A 12-lead electrocardiogram (ECG) was obtained at these times and also within 2 hours prior to and 1 hour after (129)Xe MR imaging. Xenon-related symptoms were evaluated for relationship to subject group by using a χ(2) test and to subject age by using logistic regression. Changes in vital signs were tested for significance across subject group and time by using a repeated-measures multivariate analysis of variance test. RESULTS:The 44 subjects tolerated all xenon inhalations, no subjects withdrew, and no serious adverse events occurred. No significant changes in vital signs (P > .27) were observed, and no subjects exhibited changes in laboratory test or ECG results at follow-up that were deemed clinically important or required intervention. Most subjects (91%) did experience transient xenon-related symptoms, most commonly dizziness (59%), paresthesia (34%), euphoria (30%), and hypoesthesia (30%). All symptoms resolved without clinical intervention in 1.6 minutes ± 0.9. CONCLUSION/CONCLUSIONS:Inhalation of hyperpolarized (129)Xe is well tolerated in healthy subjects and in those with mild or moderate COPD. Subjects do experience mild, transient, xenon-related symptoms, consistent with its known anesthetic properties.

In the United States, trauma is the leading cause of death among those who are 1-44 years old, with cardiovascular injuries representing the second most common cause of traumatic death after central nervous system injuries. Evaluation of trauma patients with suspected cardiac injury may be complex and include electrocardiography, measurement of cardiac biomarkers, and imaging examinations. Contrast material-enhanced computed tomography (CT) has become one of the most valuable imaging tools available for evaluating hemodynamically stable patients with suspected cardiac injury. The presence of hemopericardium, with or without cardiac tamponade, is one of the most significant findings of cardiac injury. Other complications that result from blunt cardiac injury, such as pericardial rupture and cardiac herniation, may be readily depicted at multidetector CT. Assessment of patients with cardiac injuries, particularly those with penetrating injuries, is a challenging and time-critical matter, with clinical and imaging findings having complementary roles in the formation of an accurate diagnosis. Patients who are hemodynamically stable, particularly those with penetrating cardiac injuries, also may benefit from a timely imaging examination. In addition to chest radiography, other available modalities such as transthoracic and transesophageal echocardiography, nuclear medicine, and magnetic resonance imaging may play a role in selected cases.

A wide spectrum of thoracic tumors have known or suspected viral etiologies. Oncogenic viruses can be classified by the type of genomic material they contain. Neoplastic conditions found to have viral etiologies include post-transplant lymphoproliferative disease, lymphoid granulomatosis, Kaposi's sarcoma, Castleman's disease, recurrent respiratory papillomatosis, lung cancer, malignant mesothelioma, leukemia and lymphomas. Viruses involved in these conditions include Epstein-Barr virus, human herpes virus 8, human papillomavirus, Simian virus 40, human immunodeficiency virus, and Human T-lymphotropic virus. Imaging findings, epidemiology and mechanism of transmission for these diseases are reviewed in detail to gain a more thorough appreciation of disease pathophysiology for the chest radiologist.

OBJECTIVE:The purpose of this article is to present the spectrum of inflammatory bowel disease manifestations in the chest, including the airways, lung parenchyma, pulmonary vasculature, and serosal surfaces. CONCLUSION/CONCLUSIONS:The spectrum of inflammatory bowel disease manifestations in the chest is broad, and the manifestations may mimic other diseases. Knowledge of these manifestations in conjunction with pertinent clinical data is essential for establishing the correct diagnosis and treatment.

Given their high frequency, mediastinal emergencies are often perceived as being a result of external trauma or vascular conditions. However, there is a group of nonvascular, nontraumatic mediastinal emergencies that are less common in clinical practice, are less recognized, and that represent an important source of morbidity and mortality in patients. Nonvascular, nontraumatic mediastinal emergencies have several causes and result from different pathophysiologic mechanisms including infection, internal trauma, malignancy, and postoperative complications, and some may be idiopathic. Some conditions that lead to nonvascular, nontraumatic mediastinal emergencies include acute mediastinitis; esophageal emergencies such as intramural hematoma of the esophagus, Boerhaave syndrome, and acquired esophagorespiratory fistulas; spontaneous mediastinal hematoma; tension pneumomediastinum; and tension pneumopericardium. Although clinical findings of nonvascular, nontraumatic mediastinal emergencies may be nonspecific, imaging findings are often definitive. Awareness of various nonvascular, nontraumatic mediastinal emergencies and their clinical manifestations and imaging findings is crucial for making an accurate and timely diagnosis to facilitate appropriate patient management.

Extracardiac nonsurgical vascular shunts in the thorax are a group of well-recognized heterogeneous conditions, frequently symptomatic, in which there is diversion of blood flow from one vessel to another or from a vessel to a cardiac chamber. The authors describe and classify many of these nonsurgical extracardiac shunts or fistulas according to their source and endpoint (eg, systemic-to-systemic, systemic-to-pulmonic, pulmonic-to-systemic, and pulmonic-to-pulmonic) and to whether the oxygenated blood mixes with deoxygenated systemic venous flow (left-to-right shunts), deoxygenated blood bypasses the pulmonary capillary bed (right-to-left shunts), or oxygenated blood recirculates (left-to-left shunts). Clinical manifestations and imaging appearances of these conditions are highlighted.