Journal of thoracic imaging
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The solitary pulmonary nodule (SPN) is a common medical problem for which management can be quite complex. Imaging remains at the center of management of SPNs, and computed tomography is the primary modality by which SPNs are characterized and followed up for stability. ⋯ The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Cardiac involvement is an important prognostic factor in sarcoidosis, and cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) can facilitate the identification of cardiac sarcoidosis (CS). In patients with CS, we investigated LGE characteristics and their relationship with left ventricular (LV) function to identify those characteristics unique to severely reduced LV function. We also investigated the relationship between LGE and duration of sarcoidosis. ⋯ Demonstration of a characteristic LGE pattern and location allows diagnosis of CS, and CMR imaging with LGE aids in prediction of LV function.
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Case Reports
Role of volume rendered 3-D computed tomography in conservative management of trauma-related thoracic injuries.
Pneumatic nail guns are a tool used commonly in the construction industry and are widely available. Accidental injuries from nail guns are common, and several cases of suicide using a nail gun have been reported. Computed tomographic (CT) imaging, together with echocardiography, has been shown to be the gold standard for investigation of these cases. ⋯ Volume-rendered CT of the thorax allowed an accurate assessment of the thoracic injuries sustained by this patient. As there was no evidence of any acute life-threatening injury, a sternotomy was avoided and the patient was observed closely until discharge. In conclusion, volume-rendered 3-dimensional CT can greatly help in the decision to avoid an unnecessary sternotomy in patients with a thoracic nail gun injury.
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Diffuse dendriform pulmonary ossification is a rare disorder characterized by widespread pulmonary ossification distributed in a characteristic branching pattern. It is usually associated with chronic interstitial inflammation and fibrosis but may occasionally be idiopathic. ⋯ Computed tomography findings characteristically show fine branching heterotopic bone formation within the lungs, often in a lower lobe distribution. A case of idiopathic dendriform ossification is described in a 34-year-old man who presented for investigation of hemoptysis.
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This manuscript is a review of the recently published ACR Appropriateness Criteria Radiologic Management of Thoracic Nodules and Masses. Presented are best practice guidelines for the imaging evaluation and biopsy recommendations for pulmonary nodules, mediastinal masses, and pleural abnormalities. ⋯ The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.