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3.  Right and left ventricular function and myocardial scarring in adult patients with sickle cell disease: a comprehensive magnetic resonance assessment of hepatic and myocardial iron overload 
Patients with Sickle cell disease (SCD) who receive regular transfusions are at risk for developing cardiac toxicity from iron overload. The aim of this study was to assess right and left cardiac volumes and function, late gadolinium enhancement (LGE) and iron deposits in patients with SCD using CMR, correlating these values with transfusion burden, ferritin and hemoglobin levels.
Thirty patients with SCD older than 20 years of age were studied in a 1.5 T scanner and compared to age- and sex-matched normal controls. Patients underwent analysis of biventricular volumes and function, LGE and T2* assessment of the liver and heart.
When compared to controls, patients with SCD presented higher left ventricular (LV) volumes with decreased ejection fraction (EF) with an increase in stroke volume (SV) and LV hypertrophy. The right ventricle (RV) also presented with a decreased EF and hypertrophy, with an increased end-systolic volume. Although twenty-six patients had increased liver iron concentrations (median liver iron concentration value was 11.83 ± 9.66 mg/g), only one patient demonstrated an abnormal heart T2* < 20 msec. Only four patients (13%) LGE, with only one patient with an ischemic pattern.
Abnormal heart iron levels and myocardial scars are not a common finding in SCD despite increased liver iron overload. The significantly different ventricular function seen in SCD compared to normal suggests the changes in RV and LV function may not be due to the anemia alone. Future studies are necessary to confirm this association.
PMCID: PMC3848779  PMID: 24050721
5.  Multisystemic Langerhans Cell Histiocytosis with advanced lung involvement 
Langerhans cell histiocytosis is a rare disease of unknown cause, characterized by the proliferation of histiocytic cells (Langerhans cells), that can sometimes be especially difficult to diagnose due to its wide clinical spectrum, ranging from a single lesion to a multisystemic disorder. Appropriate disease staging is fundamental, since treatment depends upon the severity of the disease, and imaging methods play a fundamental role not only in diagnosing and assessing the extent of Langerhans cell histiocytosis, as well as guiding the appropriate treatment for the patient and their monitoring.
PMCID: PMC3558261  PMID: 23372865
Langerhans cell histiocytosis; computed tomography; lung; skin diseases
6.  Pseudoaneurysm of the mitral–aortic intervalvular fibrosa presenting after chest trauma and diagnosed by cardiac magnetic resonance: a case report 
Annular subvalvular pseudoaneurysm is a rare example of left ventricle aneurysm described predominantly in young African people. These aneurysms are divided into two different types, namely, submitral or subaortic, with subaortic being the less frequent kind. The subaortic type is most often localized in the mitral–aortic intervalvular fibrosa. To the best of our knowledge, this is the first report of a mitral–aortic intervalvular fibrosa pseudoaneurysm associated with coarctation of the aorta, anomalous pulmonary venous return, bicuspid aortic valve and patent ductus arteriosus diagnosed by cardiovascular magnetic resonance.
Case presentation
We report the case of a 15-year-old African-American boy with a history of mild chest trauma who underwent echocardiographic evaluation as part of an out-patient work up. The echocardiogram was suspicious for the presence of mitral-aortic intervalvular fibrosa pseudoaneurysm and cardiovascular magnetic resonance was then performed to better characterize this finding. In addition to confirming the presence of the aneurysm, cardiovascular magnetic resonance also revealed coarctation of the aorta, a bicuspid aortic valve, and anomalous pulmonary venous return.
In our case, cardiovascular magnetic resonance was helpful in: (a) making a definite diagnosis of mitral–aortic intervalvular fibrosa pseudoaneurysm and its borders, which was not clear with an echocardiogram examination; and (b) illustrating additional associated congenital anomalies including the anomalous pulmonary venous return.
PMCID: PMC3492094  PMID: 23083215
Heart defects; Congenital; Magnetic resonance imaging; Aneurysm
7.  Chest computed tomography findings in severe influenza pneumonia occurring in neutropenic cancer patients 
Clinics  2012;67(4):313-318.
To describe the chest computed tomography findings for severe influenza H1N1 infection in a series of hospitalized neutropenic cancer patients.
We performed a retrospective systematic analysis of chest computed tomography scans for eight hospitalized patients with fever, neutropenia, and confirmed diagnoses of influenza H1N1. The clinical data had been prospectively collected.
Six of eight patients (75%) developed respiratory failure and required intensive care. Prolonged H1N1 shedding was observed in the three mechanically ventilated patients, and overall hospital mortality in our series was 25%. The most frequent computed tomography findings were ground-glass opacity (all patients), consolidation (7/8 cases), and airspace nodules (6/8 cases) that were frequently moderate or severe. Other parenchymal findings were not common. Five patients had features of pneumonia, two had computed tomography findings compatible with bronchitis and/or bronchiolitis, and one had tomographic signs of chronicity.
In this series of neutropenic patients with severe influenza H1N1 infection, chest computed tomography demonstrated mainly moderate or severe parenchymatous disease, but bronchiolitis was not a common feature. These findings associated with febrile neutropenia should elicit a diagnosis of severe viral infection.
PMCID: PMC3317247  PMID: 22522755
H1N1; Viral pneumonia; Neutropenia; Cancer; Computed tomography
9.  Reconstruction Algorithms Influence the Follow-Up Variability in the Longitudinal CT Emphysema Index Measurements 
Korean Journal of Radiology  2011;12(2):169-175.
We wanted to compare the variability in the longitudinal emphysema index (EI) measurements that were computed with standard and high resolution (HR) reconstruction algorithms (RAs).
Materials and Methods
We performed a retrospective review of 475 patients who underwent CT for surveillance of lung nodules. From this cohort, 50 patients (28 male) were included in the study. For these patients, the baseline and follow-up scans were acquired on the same multidetector CT scanner and using the same acquisition protocol. The CT scans were reconstructed with HR and standard RAs. We determined the difference in the EI between CT1 and CT2 for the HR and standard RAs, and we compared the variance of these differences.
The mean of the variation of the total lung volume was 0.14 L (standard deviation [SD] = 0.13 L) for the standard RA and 0.16 L (SD = 0.15 L) for the HR RA. These differences were not significant. For the standard RA, the mean variation was 0.13% (SD = 0.44%) for EI -970 and 0.4% (SD = 0.88%) for EI -950; for the HR RA, the mean variation was 1.9% (SD = 2.2%) for EI -970 and 3.6% (SD = 3.7%) for EI -950. These differences were significant.
Using an HR RA appears to increase the variability of the CT measurements of the EI.
PMCID: PMC3052607  PMID: 21430933
Reconstruction algorithm; Emphysema; Computed tomography (CT)
12.  Double-chambered left ventricle in an adult: diagnosis by CMRI 
Clinics  2010;65(12):1393-1395.
PMCID: PMC3020356  PMID: 21340234
15.  Cavitated Conglomerate Mass in Silicosis Indicating Associated Tuberculosis 
Case Reports in Medicine  2010;2010:293730.
Silicosis is the most common occupational lung disease worldwide. It leads to respiratory impairment and may have associated infections that decrease pulmonary function. We describe the case of a 55-year-old man with chronic silicosis who presented with hemoptysis and a cavitated conglomerate mass. The final diagnosis was silicotuberculosis.
PMCID: PMC2929613  PMID: 20811560
16.  Pulmonary Alveolar Microlithiasis: A Case Report with Emphasis on Imaging Findings 
Case Reports in Medicine  2010;2010:819242.
Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by the presence of small calculi in the alveolar space. The authors report a case of a 21-year-old man with a 2-year history of shortness of breath on exertion and dry cough. Physical examination was altered only for crackles at auscultation. Pulmonary function revealed a mild restrictive ventilatory defect and the chest radiograph demonstrated paracardiac confluence of dense micronodular infiltrate. High-resolution CT scan revealed diffuse ground glass attenuation and septal thickening, more pronounced in lower pulmonary regions, with calcifications along the interlobar septa and subpleural regions. A transbronchial lung biopsy confirmed the diagnosis of PAM.
PMCID: PMC2910500  PMID: 20671919
17.  Sclerosing Variant of the Bronchioloalveolar Carcinoma: Imaging Findings in an Atypical Case 
Case Reports in Medicine  2010;2010:361265.
Bronchioloalveolar carcinoma remains one of the most enigmatic lung cancers, demonstrating varied growth patterns, mixed histological features, and confusing clinical manifestations. This paper reports a case of an unusual form of presentation: a sclerosing type associated with desmoplastic reaction and cicatrization. A 75-year-old woman was admitted with persistent dry cough and progressive dyspnea. Physical examination showed bilateral inspiratory crackles. A chest radiograph and high-resolution computed tomography demonstrated confluent airspace nodules, forming areas of consolidation in both lungs, with signs of architectural distortion. The lung biopsy revealed a nonmucinous sclerosing bronchioloalveolar carcinoma.
PMCID: PMC2892667  PMID: 20589217
18.  Spontaneous Pneumothorax as an Atypical Presentation of Pulmonary Paracoccidioidomycosis: A Case Report with Emphasis on the Imaging Findings 
Case Reports in Medicine  2010;2010:961984.
We describe the case of a 45-year-old male with pulmonary paracoccidioidomycosis and spontaneous pneumothorax. The patient presented to the hospital with sudden and intense chest pain accompanied by dyspnea and had a six-month history of dry cough, weight loss, and progressive dyspnea on exertion. Chest X-ray showed a small right pneumothorax, bilateral nonhomogeneous opacities, and emphysematous areas in the lung base. Chest computed tomography showed consolidation in both lungs, with architectural distortion, nodules, interlobular septal thickening, and emphysema, in addition to the right pneumothorax. A lung biopsy revealed yeast consistent with Paracoccidioides brasiliensis. No drainage was needed, and the lung was re-expanded. The patient was treated with antifungal drugs, showed mild improvement, and was referred to outpatient care.
PMCID: PMC2892705  PMID: 20592996
19.  Hyalinizing Granuloma: An Unusual Case of a Pulmonary Mass 
Case Reports in Medicine  2010;2010:984765.
We describe the case of pulmonary hyalinizing granuloma in a 34-year-old asymptomatic man who presented with a pulmonary nodule apparent by chest radiography and computed tomography (CT). He had a history of previous treatment for tuberculosis. His laboratory data were normal. Bronchoscopy and CT-guided percutaneous transthoracic fine needle aspiration cytology were inconclusive. The diagnosis was revealed after the histopathological examination of an open lung biopsy.
PMCID: PMC2892707  PMID: 20592998
20.  Medullary Thyroid Carcinoma with Micronodular Lung Metastases: A Case Report with an Emphasis on the Imaging Findings 
Case Reports in Medicine  2010;2010:616580.
Medullary thyroid carcinoma is a rare malignancy that arises from calcitonin-producing C-cells and frequently metastasizes to lymph nodes in the neck. Distant metastases may involve bone, lung, and liver. The infrequent number of cases limits the clinical nature and ability to optimize diagnostic tools. Here, we present a case of a micronodular radiographic pattern in metastatic medullary thyroid cancer in order to enhance awareness of the disease process. A case discussion and relevant review of the literature are provided.
PMCID: PMC2872764  PMID: 20490356
21.  Colon Mucinous Adenocarcinoma in Childhood: A Case Report with Emphasis on Image Findings 
Case Reports in Medicine  2010;2010:327634.
Colorectal cancer is extremely rare in children. We report a case of a 12-year-old boy who presented with a five-month history of weight loss and anorexia, associated with vomiting episodes, dizziness, fatigue, and dyspnea. On physical examination, a palpable abdominal mass was noticed on the right hypochondrium and flank. An imaging study was performed, which showed a solid mass on the right colon. The patient underwent incisional surgical biopsy, and subsequent histopathologic analysis revealed a colon mucinous adenocarcinoma.
PMCID: PMC2847379  PMID: 20369060
22.  Paravertebral Mass in a Patient with Hemolytic Anemia: Computed Tomographic Findings 
Case Reports in Medicine  2010;2010:724279.
Extramedullary hematopoiesis is characterized by the presence of hematopoietic tissue outside of the bone marrow and is typically associated with chronic hemolytic anemias. Intrathoracic extramedullary hematopoiesis is a rare and usually asymptomatic condition. The authors report a case of a 57-year-old man with intrathoracic extramedullary hematopoiesis and hereditary spherocytosis. Clinical and laboratory evaluation, together with radiological findings, are described. The diagnosis of the disease was confirmed by tissue biopsy.
PMCID: PMC2846347  PMID: 20368781
24.  Tuberous sclerosis with pulmonary lymphangioleiomyomatosis and renal angiomyolipomas. Computed tomographic findings: a case report 
Cases Journal  2009;2:9124.
The authors describe a case of a 31-year-old female with tuberous sclerosis, a genetic, rare, variably expressed disease. Clinical symptoms were chest pain, and progressive dyspnea. Computed tomography scan of the chest showed bilateral, diffuse, small thin-walled cysts scattered throughout the lungs characteristic for pulmonary lymphangioleiomyomatosis. Computed tomography scan of the abdomen revealed enlarged, heterogeneous kidneys, with low density tumors corresponding to angiomyolipomas. Pulmonary lymphangioleiomyomatosis and bilateral renal angiomyolipomas are some presentations of tuberous sclerosis and the coexistence of both conditions may cause devastating morbidity and mortality.
PMCID: PMC2803921  PMID: 20062701
25.  Computed tomographic findings of tuberous sclerosis with pulmonary lymphangioleiomyomatosis and renal angiomyolipomas: a case report 
Cases Journal  2009;2:9238.
The authors describe a case of a 31-year-old female with tuberous sclerosis, a genetic, rare, variably expressed disease. Clinical symptoms were chest pain, and progressive dyspnea. Computed tomography scan of the chest showed bilateral, diffuse, small thin-walled cysts scattered throughout the lungs characteristic for pulmonary lymphangioleiomyomatosis. Computed tomography scan of the abdomen revealed enlarged, heterogeneous kidneys, with low density tumors corresponding to angiomyolipomas. Pulmonary lymphangioleiomyomatosis and bilateral renal angiomyolipomas are some presentations of tuberous sclerosis and the coexistence of both conditions may cause devastating morbidity and mortality.
PMCID: PMC2827144  PMID: 20184711

Results 1-25 (39)