Journal of thoracic imaging
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Comparative Study
MDCT of the central airways: comparison with bronchoscopy in the evaluation of complications of endotracheal and tracheostomy tubes.
To evaluate the accuracy of multidetector row computed tomography (MDCT) compared with bronchoscopy in the assessment of airway complications related to endotracheal and tracheostomy tubes. ⋯ MDCT of the central airways is highly accurate for detecting symptomatic airway complications of endotracheal and tracheostomy tubes, particularly when technical limitations to the performance of CT are minimized.
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Case Reports
Atypical CT findings of isolated pulmonary Langerhans cell histiocytosis in a 4-year-old boy.
A 4-year old boy was admitted to hospital with progressive respiratory failure. A chest roentgenogram revealed hyperinflated lungs and a diffuse reticular pattern. There was no smoking history in the family environment. ⋯ No other organs were involved. Despite treatment initiation the boy succumbed to his pulmonary insufficiency 3 weeks later. Isolated pulmonary Langerhans cell histiocytosis in children may have an unfavorable prognosis and in contrast with adults, it may present on computed tomography with lower lobe predominance and without sparing the lung bases or the anterior parts of middle lobe and lingula.
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We report a case of complete tracheal rings diagnosed by computed tomography (CT) in a 34-year-old woman with history of congenital heart disease who presented with long-standing shortness of breath and chest tightness. CT of the trachea revealed concentric narrowing of the distal trachea, with an "O"-shaped lumen and absence of wall thickening. ⋯ To our knowledge, the CT findings of this condition have not been previously described. CT with 3-dimensional reconstructions has the potential to noninvasively aid in the diagnosis and monitoring of patients with this condition.
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Case Reports
CT radiographic findings: atrio-esophageal fistula after transcatheter percutaneous ablation of atrial fibrillation.
Radio-frequency catheter ablation (RFCA) is an ever increasing modality for treating refractory atrial fibrillation. Radiologists should not only be able to interpret and convey anatomic variations of pulmonary veins and left atrium to referring electrophysiologists, but also should be aware of all the post-RFCA complications and their radiographic findings including this rare, but often fatal complication. This report describes a fatal atrio-esophageal fistula (AEF) involving a normal variant single left common pulmonary vein after transcatheter ablation. ⋯ Patients who present with signs and symptoms of endocarditis, and particularly with new neurologic symptom after RFCA should be promptly evaluated for AEF. In our case, radiographic findings in correlation with clinical history and high suspicion strongly suggested this rare, often fatal complication. During review of the chest CT, particular vigilance should be made to the left pulmonary vein/posterior left atrium junction at which site fistulous tracts tend to occur. Prompt diagnosis necessitates emergent cardiac and esophageal surgery to prevent rapid deterioration and death.
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The evaluation of patients presenting with chest pain to the emergency department remains a significant challenge. The primary goal is to distinguish clinically insignificant etiologies from life-threatening causes such as myocardial ischemia, aortic dissection, and pulmonary embolism. The conventional evaluation consisting of history, electrocardiography, and biochemical markers is often inconclusive and noninvasive imaging techniques may prove valuable. This article describes some of the available options and focuses on the potential role of CT angiography to assess indeterminate chest pain.