Seminars in ultrasound, CT, and MR
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Lung cancer is the leading cause of cancer death in both men and women in the United States. The National Lung Screening Trial (NLST) demonstrated that low-dose computed tomography (CT) screening reduces lung cancer mortality by 20% compared to screening with chest radiography. Currently, many institutions in the US are implementing lung cancer screening programs. ⋯ Lung-RADS will also facilitate outcome monitoring and future auditing of lung cancer screening programs, assist research, and consequently refine and improve lung cancer screening practices. Familiarity with lung-RADS version 1.0 is essential not only for radiologists interpreting low-dose computed tomography screening studies, but all medical personnel involved in multidisciplinary lung cancer screening programs. This article reviews the Lung-RADS categories and management recommendations using a case-based approach.
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The incidental pulmonary nodule is commonly encountered when interpreting chest CTs. The management of pulmonary nodules requires a multidisciplinary approach entailing integration of nodule size and features, clinical risk factors, and patient preference and comorbidities. Guidelines have been issued for the management of both solid and subsolid nodules, with the Fleischner Society issuing revised guidelines in 2017. This article focuses on the CT imaging characteristics and clinical behavior of pulmonary nodules, with review of the current management guidelines that reflect this knowledge.
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Oncologic emergencies can be either the result of the primary tumor, its metastasis, a paraneoplastic syndrome or reaction to the chemotherapy. Imaging plays a crucial role in ensuring a prompt diagnosis as well as assisting in the therapeutic management. In this article, we discuss the common thoracic and abdominal oncological emergencies that may be encountered in an emergency department.
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Semin. Ultrasound CT MR · Dec 2017
ReviewMediastinal (Epipericardial) Fat Necrosis: An Overlooked and Little Known Cause of Acute Chest Pain Mimicking Acute Coronary Syndrome.
Necrosis of the fat adjacent to the heart, referred to as pericardial fat necrosis, epipericardial fat necrosis, and mediastinal fat necrosis, is a rare, self-limited condition. It presents as a sudden onset of severe chest pain that mimics symptoms of pulmonary embolism and acute coronary syndrome. Computed tomography (CT) findings are quite typical and consist of a round- or oval-shaped mass-like lesion containing soft tissue and fat density components in the cardiophrenic space. ⋯ However, the observation that the CT findings of the paracardiac mass resemble fat necrosis seen in other parts of the body and its involution on follow-up CT has led to the realization that the process is a benign and self-limiting one. A dramatic shift in the paradigm of treatment has ensued and surgical treatment is no longer advocated. Awareness of this condition is, therefore, vital so as to diagnose it accurately and avoid unnecessary future surgical interventions.
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Semin. Ultrasound CT MR · Apr 2017
ReviewCord Cystic Cavities: Syringomyelia and Prominent Central Canal.
Syringomyelia is the term given to cystic cavities in the spinal cord, most of which are associated with congenital malformations of the craniocervical junction and represent dilation of the central canal of the cord. As such, syrinxes can be considered analogous to hydrocephalus. ⋯ The chances that a syrinx will progress over time are much greater when they are associated with a causative lesion (Chiari malformation, tumor, infection, and trauma), but asymptomatic central canal dilation may be a stable incidental finding. Although spinal cord neoplasms are a recognized etiology for syrinx formation, especially in adults, it is not always necessary to administer contrast when evaluating a syrinx for the first time with magnetic resonance imaging.