Chest CT Angiography Research Articles

Improving culprit artery identification with intraprocedural cone-beam CT aortography and its clinical impact in bronchial artery embolization.

To evaluate the impact of intraprocedural cone-beam CT (CBCT) aortography on culprit artery identification and clinical outcomes in patients undergoing bronchial artery embolization (BAE). Two hundred eighty-two patients with 317 BAE procedures were retrospectively reviewed. Patients who underwent preprocedural chest CT angiography (CTA) without intraprocedural CBCT aortography were categorized as Group A (n = 177). Patients who underwent both preprocedural chest CTA and intraprocedural CBCT aortography were categorized as Group B (n = 105). Whether CBCT can provide improved culprit artery identification and whether this improvement has a clinical impact were evaluated by comparing the two Groups. In Group B, CBCT aortography detected more culprit non-bronchial systemic arteries originating from the subclavian arteries compared to chest CTA (16 vs 3, p = 0.026), and the average number of embolized vessels was significantly higher than in Group A (2.47 ± 1.61 vs 2.03 ± 1.17, p = 0.016), while the procedure time was shorter (37.4 ± 22.0 vs 43.6 ± 22.7 min, p = 0.024). The recurrent hemoptysis rate was lower in Group B (17.5% vs 8.7%, p = 0.041), and the proportion of patients requiring subsequent procedures was significantly lower (12.4% vs 4.8%, p = 0.035). The changes in estimated glomerular filtration rate before and 3 days after the procedure (0.1 ± 12.8 vs 0.3 ± 11.0 mL/min/1.73 m2, p = 0.909) and total dose area product (DAP, 6119.5 ± 5725.7 vs 6906.2 ± 5978.6 uGym2, p = 0.279) were not significantly different between the two groups. BAE with intraprocedural CBCT aortography enabled the embolization of more culprit arteries, leading to lower recurrent hemoptysis rates without increasing the risk of renal deterioration and radiation hazards when compared to procedures without it. Question Does intraprocedural CBCT aortography improve culprit artery detection and clinical outcomes in BAE for hemoptysis? Findings CBCT aortography significantly improved the detection of additional culprit arteries, especially from non-bronchial systemic arteries, increasing the number of vessels treated during BAE. Clinical relevance Using CBCT aortography during BAE results in better long-term outcomes by reducing recurrent hemoptysis and the need for additional procedures, without increasing the risk of renal impairment.

8194 Extramedullary Hematopoiesis Involving Bilateral Adrenal Glands In A Patient With Sickle Cell Anemia

Abstract Disclosure: V.T. Pham: None. L.N. Sendos: None. Title: Extramedullary hematopoiesis involving bilateral adrenal glands in a patient with sickle cell anemia Background: Extramedullary hematopoiesis refers to blood cell production occurring outside the bone marrow. It is a reactive process caused by inadequate production or excessive destruction of blood cells typically seen in patients with hereditary anemias or infiltrative bone marrow disorders. Extramedullary hematopoiesis usually occurs in the spleen, liver and lymph nodes, but it can also very rarely arise from the adrenal glands. Case Presentation:We present a case of a 42-year-old male with a history of sickle cell anemia who presented with chest pain and shortness of breath and had a chest CT angiography which incidentally showed a 5.6 x 3.8 cm left adrenal mass and a 2.9 x 2.1 cm right adrenal mass. Further evaluation with an MRI abdomen with and without contrast revealed a 5.5 cm lobulated left adrenal mass with patchy areas of microscopic fat and faint delayed heterogeneous enhancement as well as a 2.2 cm right adrenal nodule. The nodules were described as markedly T2 hypointense with heterogeneous T1 hyperintense/isointense signal on MRI with a broad differential diagnosis including extramedullary hematopoiesis in bilateral adrenal glands, lipid poor adenoma or neoplasm. Regarding his sickle cell disease history, the patient was diagnosed as an infant and had very rare episodes of sickle cell pain crisis as a child. However, once he entered adulthood, he began to have multiple episodes of sickle cell pain crisis requiring hospitalizations and transfusions. On further review of patient’s prior imaging scans during these previous hospitalizations, he was first noted to have bilateral sub centimeter adrenal nodules on a CT Abdomen without contrast done almost a decade prior to his current presentation. We ordered biochemical evaluation which did not show any evidence of adrenal hormonal hypersecretion. His case was discussed at our multidisciplinary conference with the radiology and surgery team and it was concluded that the imaging characteristics were most consistent with extramedullary hematopoiesis in the setting of bilateral adrenal gland involvement and patient’s history of sickle cell anemia. Therefore, no immediate surgical resection was recommended. Given the size of the left adrenal mass being greater than 4 cm in size, we advised follow-up imaging for surveillance. Discussion:There has been a rise in detection of adrenal incidentalomas due to the increased use of advanced diagnostic imaging in healthcare settings. When patients with hematologic diseases are found to have adrenal incidentalomas, it is important to consider extramedullary hematopoiesis in the differential diagnosis to avoid unnecessary invasive procedures and surgeries. Presentation: 6/2/2024

7659 Iodinated Contrast Induced Thyrotoxicosis Leading to Takotsubu Cardiomyopathy

Abstract Disclosure: A. Jain: None. E. Naous: None. S. Sedrakyan: None. A.T. Sweeney: None. Background: Thyrotoxicosis may cause many cardiovascular manifestations including tachycardia, hypertension, atrial fibrillation and heart failure. Iatrogenic exposure to iodinated contrast media (ICM) precipitating iodine induced thyrotoxicosis (or the Jod-Basedow phenomenon) is often overlooked. Here, we describe a case of iodine induced thyrotoxicosis leading to takotsubu cardiomyopathy, following multiple exposures to ICM. Case Presentation: An 88-year-old male with a history of hypertension, dyslipidemia, chronic obstructive pulmonary disease, and an ED visit one month ago for hemoptysis for which a CT Angiography (CTA) of the chest was obtained (which excluded Pulmonary Embolism(PE)), presented with fever and shortness of breath. On physical examination his temperature was 100.3F, heart rate was 104bpm, blood pressure 130/62mmHg, respiratory rate was 20/min and saturation was 88% (room air). He was frail but his examination was otherwise unremarkable. Electrocardiogram (EKG) revealed sinus tachycardia. Chest CTA excluded PE. Transthoracic echocardiogram (TTE) showed an ejection fraction (EF) of 73% and no wall motion abnormalities. He was admitted to the hospital for a viral upper respiratory infection and was treated conservatively with bronchodilators. Odynophagia prompted a CT with contrast of the neck soft tissue, which was unrevealing. He was planned to be discharged the next day, but overnight developed severe abdominal pain, and atrial fibrillation with a rapid ventricular response (Troponin t was 191 ng/L (normal {nl}: <9 ng/L)). EKG showed new T-wave inversions in the anterolateral leads, raising a suspicion of myocardial ischemia. A repeated TTE revealed a new drop in EF from 73 to 41%, with new apical akinesis, suspicious for takotsubo cardiomyopathy. CT of the abdomen with contrast was unrevealing. Lab results showed a suppressed TSH of <0.01uIU/mL (nl: 0.34-5.60 uIU/mL), elevated FT4 of 13ng/dL (nl: 0.93-1.70 ng/dL), and TSI 4.97 IU/ L (nl: 0-0.55 IU/ L). Endocrinology was consulted. His thyroid examination was normal, and he had no eye findings. Neck ultrasound revealed a homogeneous thyroid gland without any nodules. His clinical course was consistent with the diagnosis of acute thyrotoxicosis precipitating takotsubu cardiomyopathy. He likely developed iodine induced thyrotoxicosis from multiple exposures to ICM, in a background of previously undiagnosed Graves’ disease. Discussion: Screening for thyroid disease is critical in patients with new onset tachyarrhythmias and stress cardiomyopathy. Iodine induced thyrotoxicosis typically presents after patients with underlying thyroid disease are exposed to iodinated contrast. Prior to ordering studies requiring ICM, it is important to thoroughly evaluate patients for possible pre-existing thyroid disease. Presentation: 6/2/2024

Diagnostic Performance of a Deep Learning-Powered Application for Aortic Dissection Triage Prioritization and Classification.

This multicenter retrospective study evaluated the diagnostic performance of a deep learning (DL)-based application for detecting, classifying, and highlighting suspected aortic dissections (ADs) on chest and thoraco-abdominal CT angiography (CTA) scans. CTA scans from over 200 U.S. and European cities acquired on 52 scanner models from six manufacturers were retrospectively collected and processed by CINA-CHEST (AD) (Avicenna.AI, La Ciotat, France) device. The diagnostic performance of the device was compared with the ground truth established by the majority agreement of three U.S. board-certified radiologists. Furthermore, the DL algorithm's time to notification was evaluated to demonstrate clinical effectiveness. The study included 1303 CTAs (mean age 58.8 ± 16.4 years old, 46.7% male, 10.5% positive). The device demonstrated a sensitivity of 94.2% [95% CI: 88.8-97.5%] and a specificity of 97.3% [95% CI: 96.2-98.1%]. The application classified positive cases by the AD type with an accuracy of 99.5% [95% CI: 98.9-99.8%] for type A and 97.5 [95% CI: 96.4-98.3%] for type B. The application did not miss any type A cases. The device flagged 32 cases incorrectly, primarily due to acquisition artefacts and aortic pathologies mimicking AD. The mean time to process and notify of potential AD cases was 27.9 ± 8.7 s. This deep learning-based application demonstrated a strong performance in detecting and classifying aortic dissection cases, potentially enabling faster triage of these urgent cases in clinical settings.

Acute pulmonary embolism pretest probability estimation by d-dimer test, our modified, new ECG score and clinical prediction rules

ObjectivesWe investigated whether a sufficiently sensitive D-dimer test could exclude acute pulmonary embolism (acPE) as a stand-alone diagnostic test and compared our previously published, modified ECG score with the Wells and Geneva scores in the estimation of acPE pretest probability. MethodsWe retrospectively evaluated 345 patients who underwent chest CT angiography (CTA) for the suspicion of acPE. The pretest probability of acPE was assessed in 120 D-dimer negative [DD (−)] and 225 D-dimer positive [DD (+)] patients. ResultsChest CTA verified acPE in 57/345 (16.5 %) patients and in 1/120 (0.8 %) DD (−) patient. In DD (−) patients the test accuracy (TA) and specificity (SP) of the ECG score (98 %, 99 %) were better than those of the Wells score (92.5 %, 92.4 %) (p = 0.063 and p < 0.05 respectively) and the Geneva score (76.7 %, 76.5 %) (p < 0.001 for both), the Wells score TA and SP were greater than those of the Geneva score (p < 0.001 for both). In DD (+) patients the SPs, TAs and positive predictive values (PPV) of the ECG score (94 %, 78.6 %, 69 %) and the Wells score (91.8 %, 75.1 %, 48 %) were greater than those of the Geneva score (71.3 %, 64.9 %, 38.2 %) (p < 0.001 for both SP and TA respectively, and p < 0.001 for PPV of the ECG score vs. the Geneva score and p < 0.05 for PPV of the Wells score vs. Geneva score), their sensitivities (SE) (36.4 %, 23.6 %) were less than that of the Geneva score (47.5 %) (p < 0.05 and p < 0.001 respectively). The ECG score's TA in a trend, its SE and PPV were significantly (p < 0.01 and p < 0.001) better than those of the Wells score. ConclusionIn contrast to the current guidelines, a stand-alone high sensitivity DD (−) test, without prediction rules, could reliably exclude acPE. Our ECG score slightly outperformed the Wells score, the ECG score and Wells score far outperformed the Geneva score in the estimation of acPE pretest probability. An acPE diagnosis with the ECG score, in addition to the supportive diagnosis with the clinical prediction rules, may further increase the chance of true DD positivity.

BILATERAL PULMONARY EMBOLISM MIMICKING ACUTE CHEST SYNDROME IN A PATIENT WITH SICKLE CELL DISEASE: ACASE REPORT AND REVIEW OF THE LITERATURE

Abstract This case report discusses a 24-year-old female with sickle cell disease (SCD) who developed bilateral pulmonary embolism (PE), mimicking acute chest syndrome (ACS) following a cholecystectomy. Despite initial treatment for ACS, the patient\\\'s condition deteriorated, leading to a diagnosis of massive bilateral PE via chest CT angiography. The report underscores the importance of considering PE in SCD patients with respiratory symptoms unresponsive to standard ACS treatment. It highlights the hypercoagulable state in SCD, which increases the risk of venous thromboembolism, including PE. The case emphasizes the necessity for heightened clinical suspicion and appropriate diagnostic measures to improve patient outcomes. Unfortunately, the patient succumbed to septic shock despite aggressive management. This report advocates for comprehensive evaluation strategies in similar clinical scenarios to prevent misdiagnosis and improve survival rates.

Pulmonary embolism: Epidemiological and radiological aspects at the Niamey general reference hospital.

Introduction: Pulmonary Embolism is a diagnostic and therapeutic emergency. It is one of the clinical manifestations of venous thromboembolism (VTE) which is frequent and the most serious of the latter. The aim of our work is to study the characteristics of pulmonary embolism confirmed by chest CT angiography at the General Reference Hospital. More specifically, it is a question of describing the: epidemiological and radiological aspects of PE confirmed by chest CT angiography. Material and methods: This is a retrospective and prospective study, carried out at the Reference General Hospital over a period of 18 months: Retrospective over one (1) year from (July 2018 to June 2019), Prospective over six (6) months from July 2019 to December 2019. The study population included all patients referred to the radiology department for chest CT angiography with suspected pulmonary embolism and whose D-dimer dosage was greater than 500ng/ml. Chest x-ray and duplex ultrasound of the lower limbs were requested as additional basic examinations with the aim of exploring venous thromboembolic disease. Results: During this study, 84 chest CT angioscans were performed and 25 cases of pulmonary embolism were confirmed, representing a prevalence of 29.76%. The patients were classified according to the levels of clinical thromboembolic risk. Chest x-ray was performed in 16 patients or 64%. Cardiac Doppler ultrasound was performed in 16 patients (64%). Doppler ultrasound of the lower limbs was performed in only 3 patients. All patients had undergone chest CT angiography. Conclusion: The advent of chest CT angiography in the diagnostic approach allowed us to note an underestimation of the prevalence of PE in African countries. Thoracic CT angiography provided diagnostic confirmation.

Medium-Term Disability and Long-Term Functional Impairment Persistence in Survivors of Severe COVID-19 ARDS: Clinical and Physiological Insights

BackgroundAlthough the medium- and long-term sequelae of survivor of acute respiratory distress syndrome (ARDS) of any cause have been documented, little is known about the way in which COVID-19-induced ARDS affects functional disability and exercise components. Our aims were to examine the medium-term disability in severe COVID-19-associated ARDS survivors, delineate pathophysiological changes contributing to their exercise intolerance, and explore its utility in predicting long-term functional impairment persistence. MethodsWe studied 108 consecutive subjects with severe COVID-19 ARDS who remained alive 6 months after intensive care unit (ICU) discharge. Lung morphology was assessed with chest non-contrast CT scans and CT angiography. Functional evaluation included spirometry, plethysmography, muscle strength, and diffusion capacity, with assessment of gas exchange components through diffusing capacity of nitric oxide. Disability was assessed through an incremental exercise test, and measurements were repeated 12 and 24 months later in patients with functional impairments. ResultsAt 6 months after ICU discharge, a notable dissociation between morphological and clinical-functional sequelae was identified. Moderate-severe disability was present in 47% of patients and these subjects had greater limitation of ventilatory mechanics and gas exchange, as well as greater symptomatic perception during exercise and a probable associated cardiac limitation. Female sex, hypothyroidism, reduced membrane diffusion component, lower functional residual capacity, and high-attenuation lung volume were independently associated with the presence of moderate-severe functional disability, which in turn was related to higher frequency and greater intensity of dyspnea and worse quality of life. Out of the 71 patients with reduced lung volumes or diffusion capacity at 6 months post-ICU discharge, only 19 maintained a restrictive disorder associated with gas exchange impairment at 24 months post-discharge. In these patients, 6-month values for diffusion membrane component, maximal oxygen uptake, ventilatory equivalent for CO2, and dead space to tidal volume ratio were identified as independent risk factors for persistence of long-term functional sequelae. ConclusionsLess than half of survivors of COVID-19 ARDS have moderate-severe disability in the medium term, identifying several risk factors. In turn, diffusion membrane component and exercise tolerance at 6-month ICU discharge are independently associated with the persistence of long-term functional sequelae.

Pronostic comparé de l'embolie pulmonaire chez les patients infectés au COVID-19 et les patients non infectés au COVID-19 à Ouagadougou

Objectivethe study's objective was to determine impact of COVID-19 on the prognosis of pulmonary embolism. Patients and methodsAn analytical multicenter cross-sectional study with retrospective data collection was carried out in three university hospitals and a private clinic in Ouagadougou from March, 2020 to July 2021. It included consecutive patients hospitalized for PE confirmed on chest CT angiography or by the association an acute cor pulmonale on echocardiography-Doppler with deep vein thrombosis on venous ultrasound-Doppler of the lower limbs and having carried out a COVID-19 test (RT-PCR or rapid diagnostic test). Control cases consisted of all COVID-19 negative PE cases. Data comparison was carried out using the Epi info 7 software. A univariate then multivariate analysis allowed the comparison of the prognosis of the two subpopulations. The significance level retained was p < 0.05. Results96 patients with COVID-19+ and 70 COVID-19- PE were included. The prevalence of PE in patients hospitalized for COVID-19 was 7.05%. The average patient age was 61.5±17 years for COVID-19+ patients and 49.6±15.9 years for COVID-19- patients. Pulmonary condensation syndrome (p=0.007), desaturation (p=0.0003) and respiratory distress syndrome (p=0.006) were more common in COVID-19+ patients. The hospital death rate was 27.1% in COVID-19+ patients and 10% in COVID-19- patients (p=0.0024). Age > 65 years and COVID-19 pneumonia were the independent factors of death. ConclusionCOVID-19 is associated with clinical severity and excess mortality in patients with pulmonary embolism.

Tracheo-innominate fistula as a late complication of prolonged intubation in a patient with mycobacterium tuberculosis: a case report

BackgroundThe tracheo-innominate fistula is a rare and potentially life-threatening entity that occurs in approximately less than 1% of patients after a tracheostomy. It occurs when the anterior wall of the trachea erodes and comes into contact with the posterior wall of the innominate artery or brachiocephalic trunk due to excessive pressure from the hyperinflation of the cuff over the mucosa, creating a fistulous tract. Clinically, it manifests as massive tracheal bleeding that puts the patient's life at imminent risk.Case presentationWe present the case of a 60-year-old Latin American male patient with a history of SARS CoV-2 pneumonia approximately 4 months earlier, who required prolonged orotracheal intubation and tracheostomy due to subglottic stenosis, which required tracheal dilations. The patient was admitted to the emergency department due to hemoptysis associated with hemodynamic instability and later on presented with massive tracheal bleeding. The chest-CT angiography evidenced a tracheo-innominate fistula that required surgical management. A concomitant Mycobacterium Tuberculosis infection was also diagnosed during his hospitalization.ConclusionsThere are currently many gaps in our knowledge about the tracheo-innominate fistula, mainly in terms of its incidence following the SARS-CoV-2 pandemic, as well as the role that concomitant infections and their treatments, such as tuberculosis, play in the development of these events. During the pandemic, the cases of intubated patients and patients with tracheostomies increased, giving way to new and unexpected complications, we have yet to study in depth.

Abstract 15913: Takotsubo Cardiomyopathy, is It Preventable?

Introduction: Takotsubo cardiomyopathy (TCM) is a reversible type of heart failure that occurs mostly in postmenopausal women. There are no definitive preventive measures in literature for this condition. Case: A 75-year-old female with a past medical history of hypertension presented with a new intermittent pressure-like chest pain and dyspnea right after a 1000-miles road trip. she reported that she had been feeling sad after her best friend died. Physical exam showed bilateral lower lung lobes crepitation and hypoxia. Lab work up revealed troponin of 1522 ng/L trending up to 2400 ng/L on serial measurements and elevated BNP. EKG showed ST changes and inverted T wave. Chest x-ray showed pulmonary vascular congestion and small bilateral pleural effusion. TTE showed LVEF 25-30% and mid and apical LV hypokinesis. Chest CT angiography was normal. Left heart catheter showed nonoccluded coronary arteries. LV angiogram portrayed mid and apical hypokinesis. Serology and PCR of EBV, Coxsackie B virus, CMV, HSV, influenza A and B, adenovirus and parvo virus were negative. She was started on a diuretic, a Beta blocker and an ACE inhibitor. Her symptoms improved. A follow up echocardiogram after 1 month showed improved ejection fraction and resolution of LV mid and apical hypokinesis. Recent combined emotional and physical stress of driving a long distance were thought to be the cause of stress cardiomyopathy. Discussion: Approximately 1-2% of patients presenting with symptoms of MI meet the criteria for TCM. A recent systematic review by Nyman et al on triggers of TCM found that physical factors are more common than emotional factors. However, some cases had both emotional and physical stressors. This patient had combined psychological and physical stressors, which may have precipitated TCM. postmenopausal women with recent emotional stressors should be advised to avoid physical stress until emotional issues have been resolved.

Abstract 285: Intraventricular And Subarachnoid Hemorrhage Secondary To Arteriovenous Malformation, A Diagnostic Neurologic Manifestation Of Osler‐Weber‐Rendu Disease

Introduction Osler‐Weber‐Rendu disease, also known as hereditary hemorrhagic telangiectasia (HTT), is a developmental vascular disease characterized by multiple arteriovenous malformations (AVMs) due to genetic defects in endothelial angiogenesis pathways. HHT is a clinical diagnosis based on the fulfillment of the Curacao Diagnostic Criteria, including involvement of internal organs with AVMs, significant recurrent nosebleeds, telangiectasias, and family history of HHT. HHT has a prevalence of 1.5 to 2 people/10,000, although this is considered a falsely low representation due to missed diagnosis and variable penetrance. Autosomal dominantly inherited heterozygous mutations disrupt the TGF‐beta‐mediated pathways causing aberrant blood vessel development with fragility and AVM formation. There are two forms of HHT: (HHT1) has a higher incidence in women and typically involves pulmonary and cerebral arteriovenous malformations (AVM). Mutations in the endoglin gene are thought to be responsible for HTT1 and comprise approximately 61% of the cases. HTT2 is associated with a higher rate of liver AVMs, involves a mutation in Activin A Receptor‐Like Type 1 (ACVRL1), and is responsible for approximately 37% of cases. Other genetic mutations include SMAD4 and GDF2, which are transmitter and binding proteins and occur about 2% of the time. Methods Case report and review of literature Results Case:A 52‐year‐old woman with a large frontoparietal arteriovenous malformation originally found at the age of 17, with a history of frequent epistaxis, mucocutaneous telangiectasias and two children with epistaxis and telangiectasias. Her diagnosis of HHT was made at her third hjospitalization due to a non‐traumatic subarachnoid hemorrhage. A Chest CT angiography and a CT angiography of the intra and extracranial vasculature demonstrated an extensive right holohemispheric cerebral AVM, an unruptured 8‐mm basilar artery aneurysm, and multiple enlarged pulmonary arteries with narrow inlet and outlets concerning for pulmonary AVMs. A subsequent digital subtraction angiogram (DSA) of the brain confirmed the extensive holohemispheric AVM, unruptured basilar artery aneurism with subarachnoid hemorrhage originating from the AVM. On examination she had multiple lingual, and hard/soft palate telangiectasias and an extensive anterior pedal telangiectasia. Given the heavy cerebral AVM burden with multiple cerebral artery feeders, the AVM angiosclerosis and basilar artery aneurysm embolization were deferred. The patient proceeded under medical management alone with a plan for personal and familial genetic testing. Conclusion HHT is a rare cause of cerebral AVMs at high risk of spontaneous bleeding. Managing these AVMs can be a challenge, given the extent and location of these. However, diagnosis of HHT can inform prognosis and guide medical management due to improved prognosis for HHT‐related AVMs and aneurysms compared to non‐HHT AVMs.

“Hospital survival of patients with pulmonary embolism in a country with limited resources case of the city of Kinshasa”

SummaryBackgroundPulmonary embolism is a frequent cause of intra-hospital mortality. The survival of patients depends not only on the speed of diagnosis but also on the treatment initiated.Objectiveto evaluate the intra-hospital survival of patients with pulmonary embolism in the city of Kinshasa.Methodologyanalytical cross-sectional study based on non-probability convenience sampling carried out in the city of Kinshasa; three hospitals selected for convenience on the basis of their technical platforms. The patients were judged to have had a pulmonary embolism after a chest CT angiography proved it. The data recorded on the Kobocollect site were exported in Excel format and analyzed with SPSS software version 23. The comparison of the means was made using the Student test and that frequencies with the Yates Chi-square test. The association was attributed by the calculation of the odds ratio and the survival presented according to the Cox regression.ResultsEighty-nine cases or 63 women and 26 men were analyzed, the mean age was 64.4 ± 15.6 years. Individuals over 65 died more (ß=0.043 and p-Value of 0.01) the female sex multiplied by 1.38 the risk of death (DNS, p-Value = 0.478). Approximately 80% of patients were classified as PESI stage II or III. Starting Rivaroxaban from the outset does not show any difference with enoxaparin in terms of intra-hospital survival.ConclusionPulmonary embolism is a real problem in our environment, the age of more than 65 years and the female sex are factors of poor prognosis and predicted survival.

Agenesis of the Right Pulmonary Artery Associated with Patent Ductus Arteriosus: A Case Report

Introduction: Unilateral pulmonary artery agenesis is a rare congenital malformation that can be the source of serious complications. Its diagnosis must be considered in the presence of recurrent respiratory infections. Adult patients are often asymptomatic, which makes the diagnosis difficult. Chest CT angiography is the reference examination. We report a case of agenesis of the right pulmonary artery associated with patent ductus arteriosus revealed at the age of 50 years on a thoracic CT angiography. Observation: A 50-year-old female patient, treated for pulmonary tuberculosis in childhood, presented with exertional dyspnea. Thoracic CT angiography showed agenesis of the right pulmonary artery with patent ductus arteriosus and right pulmonary hypoplasia. There was significant systemic vascularity with evidence of pulmonary hypertension and right heart failure. Discussion: Unilateral pulmonary artery agenesis has been rarely reported in association with a patent ductus arteriosus. Right pulmonary artery agenesis often presents as an isolated, asymptomatic finding without associated congenital heart defects. CT angiography is used to make the diagnosis. Management is often limited to surveillance. Conclusion: Isolated pulmonary artery agenesis is a rare congenital malformation but its true frequency is not well known because of the inherent difficulties in its diagnosis. The main problem remains the risk of serious complications which requires regular follow-up.

CT-Angiographic Aspects of Pulmonary Embolism on SARS COV-2.

To study pulmonary embolism during COVID-19 pneumonia. This was a one-year retrospective and descriptive study of all patients from three imaging sites with SARS-CoV2 infection. Two hundred and thirty-nine patients were included. The prevalence of pulmonary embolism was 18.4%. The average age was 55 years old. The sex ratio was 1.65. Dyspnea (58.6%), cough (56.1%), and chest pain (40.2%) were the most common reasons for consultation. In 151 patients (63.2%), chest computed tomography (CT) angiography was performed without checking level of D-dimer. The level of D-dimers was elevated in 47.8%. Grade 5 of CO-RADS accounted for 62.3%. In 70.5% of cases, the pulmonary embolism was bilateral with subsegmental involvement in 47.7%.Condensation in 'ground glass' with 'crazy paving' were the predominant typical parenchymal lesions with a frequency of 93.7% and 59.4%. In univariate analysis, D-dimers were significantly associated with the occurrence of pulmonary embolism (p < 0.001). Male sex was associated with a non-significantly higher Risk of having a pulmonary embolism (1.18 95% CI: 0.61-2.31, p = 0.622). The critical level increased the risk of pulmonary embolism in a non-significant way. Only the high level of D-dimers was and this, in a significant way. Pulmonary embolism was increased in the context of SARS-CoV2. The chest CT-angiography associated with the dosage of D-dimers constitutes a good diagnostic arsenal.

Capnography derived breath variability analysis feasibility and its importance for pulmonary embolism prediction

Capnography is a method that monitors the concentration of Carbon Dioxide (CO2) in patients’ respiratory gases. Its outcome, i.e., the capnographic curve shows CO2 levels plotted against time. The measurement of the carbon dioxide that is released at the end of an exhaled breath is called end-tidal carbon dioxide (etCO2). Such monitoring provides information about CO2 production and clearance. This paper hypothesizes that the capnographic curve could be useful in everyday clinical practice for differential diagnosis. Specifically, a computational analysis method was developed and a pilot study was conducted to determine if capnography can be used as a predictive indicator for Pulmonary Embolism (PE). To verify whether the respiratory pattern may have clinical significance, an assessment was carried out in patients in whom PE was diagnosed and those in whom PE was suspected but ultimately excluded. The age, gender, end-tidal-CO2 (etCO2), respiratory rate, and symptoms at the admission of patients who had a chest CT angiography were noted. Classification and regression tree analysis were designed and used to identify variables predictive for PE. A total of 120 patients (60 female, 60 males) aged 64.3 +/- 18.0 admitted to the Emergency Department had the computed tomography pulmonary angiography imaging study: 60 with positive PE and 60 with negative PE results. In patients with etCO2>=32 mmHg was a negative predictor for PE. In those with the etCO2 < 32 mmHg was predictive for PE. The developed model indicates that it could assist in predicting PE based on the etCO2 values.

Congenital pleuropulmonary blastoma in a newborn with a variant of uncertain significance in DICER1 evaluated by RNA-sequencing

BackgroundPleuropulmonary blastoma (PPB) is a rare mesenchymal malignancy of the lung and is the most common pulmonary malignancy in infants and children. Cystic PPB, the earliest form of PPB occurring from birth to approximately two years of age, is often mistaken for a congenital pulmonary airway malformation, as the two entities can be difficult to distinguish on imaging and pathology. Diagnosis of PPB should prompt workup for DICER1 syndrome, an autosomal dominant tumor predisposition syndrome. We report a newborn with a congenital PPB presenting with tachypnea and hypoxia, who was found to have variant of uncertain clinical significance (VUS) in DICER1.Case presentationA term female infant developed respiratory distress shortly after birth. Initial imaging was concerning for a congenital pulmonary airway malformation versus congenital diaphragmatic hernia, and she was transferred to a quaternary neonatal intensive care unit for management and workup. Chest CT angiography demonstrated a macrocytic multicystic lesion within the right lower lobe without systemic arterial supply. The pediatric surgery team was consulted, and the neonate underwent right lower lobectomy. Pathology revealed a type I PPB. Oncology and genetics consultants recommended observation without chemotherapy and single gene sequencing of DICER1, which identified a germline VUS in DICER1 predicted to alter splicing. RNA-sequencing from blood demonstrated that the variant resulted in an in-frame deletion of 29 amino acids in a majority of transcripts from the affected allele. Due to the patient’s young age at presentation and high clinical suspicion for DICER1 syndrome, tumor surveillance was initiated. Renal and pelvic ultrasonography were unremarkable.ConclusionWe present the case of a term neonate with respiratory distress and cystic lung mass, found to have a type I PPB with a germline VUS in DICER1 that likely increased her risk of DICER1-related tumors. Nearly 70% of patients with PPB demonstrate germline mutations in DICER1. Review of RNA sequencing data demonstrates the difficulty in classifying splice variants such as this. Penetrance is low, and many patients with pathogenic DICER1 variants do not develop a malignancy. Best practice surgical and oncologic recommendations include an individualized approach and tumor board discussion. This case highlights the importance of a multidisciplinary team approach and the utility of international registries for patients with rare diagnoses.

Multi-Contrast Differentiation by Dual-Energy Spectral CT Angiography in a Patient with Pulmonary Barium Granulomas

Barium inhalation usually relates to accidental aspiration during radiological procedures with an oral contrast agent. When present, barium lung deposits are visible as high-density opacities on chest X-ray or CT scan due to high atomic number, and they may be indistinguishable from calcifications. Dual-layer spectral CT has shown good material differentiation capabilities, due to its increased high-Z element range and smaller spectral separation between low- and high-energy spectral data. We present the case of a 17-year-old female with a history of tracheoesophageal fistula, who underwent chest CT angiography on a dual-layer spectral platform. Despite the close Z numbers and K-edge energy levels of the two different contrast materials, spectral CT was able to identify barium lung deposits from a previous swallowing study and to clearly distinguish them from calcium and the surrounding iodine-containing structures.

THORACIC ANGIO SCANNER IN THE DIAGNOSIS OF PULMONARY EMBOLISM IN BAMAKO

Introduction:Pulmonary embolism is the sudden obliteration (total or partial)of the trunk of the pulmonary artery or one of its branches by a circulating foreign body, most often fibrino-cruoric. Objectives: To study the place of chest CT angiography in the diagnosis of pulmonary embolism Material And Method:This was a descriptive prospective study from February 1, 2020 to January 31, 2021 taking into account all patients referred during this period for clinical suspicion of pulmonary embolism to the medical clinic Marie Curie et les Etoiles. The examinations were performed with a GE 16-bar scanner in helical mode with and without injection of iodinated contrast product by an automatic injector. Results:We diagnosed 43 pulmonary embolisms out of 327 thoracic CT angiography performed by highlighting hypodense gaps inside one or more pulmonary arteries as well as certain branches of division and the sudden interruption of the opacification of certain distal arteries. The prevalence of pulmonary embolism was 13.15%. The female sex predominated with 52% (n=22) and the sex ratio was 1.16. The average age of patients in our series was 45 years with extremes (25 to 85 years). The age group of 41-50 years waspredominant. Dyspnea and chest pain were the most frequent clinical information with44.18% and 18.60% respectively. The seat of the pulmonary embolism concerned the right pulmonary arteries and the seat of the pulmonary embolism concerned the right and left pulmonary arteries in 60.46% and the right side was the most affected. Chronic Obstructive Pulmonary Disease (COPD) Pleurisy and Covid-19 were the lesions most associated with pulmonaryembolism (48.83%, 18.60% and 16.28%) Conclusion: Pulmonary embolism is a serious and life-threatening pathology. Its diagnosis of certainty is made with the thoracic CT angiography, the realization of which must not suffer from any delay.

THE ROLE OF CHEST CT ANGIOGRAPHY AS A DIAGNOSTIC TOOL AND ROAD MAP FOR THE MANAGEMENT OF RASMUSSEN’S ANEURYSM: A CASE REPORT

Rasmussen’s aneurysm is a pulmonary artery pseudoaneurysm, secondary to the invasion of granular tissues to the pulmonary artery wall, causing massive hemoptysis. A 39-year-old male, with a history of pulmonary TB presented with massive hemoptysis, persistent cough, and dyspnea. Chest X-ray and Chest CT depicted active pulmonary tuberculosis and a co-infection with aspergillosis in the form of aspergilloma. Chest CT angiography (CTA) showed narrow-necked Rasmussen’s aneurysm with the feeding artery coming from the pulmonary artery of the apicoposterior segment and the systemic artery from the left thyrocervical trunk branch and left bronchial artery. Fluoroscopy-guided transarterial embolization with polyvinyl alcohol (PVA) and gel foam was performed from the left bronchial artery and thyrocervical trunk branch followed by transcatheter embolization with glue insertion via the pulmonary artery in the aneurysmal site. After the procedures the embolic agent completely filled the aneurysm and there were no complaints of hemoptysis during the follow-up. Appropriate chest CT angiography procedures can help diagnose Rasmussen’s aneurysm and become a road map for embolization. Transarterial catheter embolization from bronchial or non-bronchial systemic artery and pulmonary artery can be used as the treatment modality of choice for Rasmussen’s aneurysm in pulmonary tuberculosis with aspergillosis co-infection in the form of aspergilloma.