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(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung and multiple satellite lesions scattering around. (c) CT scanning of the mediastinal window demonstrates lymphadenectasis of aortic window, subcutaneous soft tissue mass shadow in the left anterior chest wall with central low density shadow as well as right axilliary lymphadenectasis | 313891_1_En_17_Fig34a_HTML | 7 | dabd5722ad3f66eee67ca59ba24417ffb086d4591f3bff2446f2a3490c676e78 | 313891_1_En_17_Fig34a_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
782,
232
] | [{'image_id': '313891_1_En_17_Fig115b_HTML', 'image_file_name': '313891_1_En_17_Fig115b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig115b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lung cancer. (a–f) CT scanning demonstrates diffuse soft tissue density shadows in left upper lung, round liked mass shadows in the middle lung field, thickened pleura in the lateral chest wall with adhesion, and strip liked liquid density shadows', 'hash': '37ffef88f4c6dffdd2849b9994419efe1bf8f369ad111d82071f2f004a9fa43f'}, {'image_id': '313891_1_En_17_Fig106a_HTML', 'image_file_name': '313891_1_En_17_Fig106a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig106a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related lymphoma. (a–b) DR demonstrates enlarged and thickened left hilum in a huge mass shadow. High KV demonstrates a huge mass shadow in the hilum. (c–h) CT scanning of the pulmonary window demonstrates a huge high density mass shadow in the left hilum, surrounding nodular fusion shadows in the lung tissues. CT scanning of the mediastinal window demonstrates a huge high density mass shadow in the left hilum, with air bronchogram sign in the shadow', 'hash': '1ff6a74f6517ed666fda8da1eb38cd58b7d92c3687c533350df4caf4cb7ba7d7'}, {'image_id': '313891_1_En_17_Fig67a_HTML', 'image_file_name': '313891_1_En_17_Fig67a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig67a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows. (e–h) Reexamination of the pulmonary window after 3 months treatment demonstrates multiple scattered round liked nodular shadows and thick wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows which obviously increase and enlarge compared to previous lesions, with accompanying infiltration shadows around the lesions', 'hash': '75b2dd5456ce09da0ace0b9787ea5a36d49c80e174314762343564032297b51c'}, {'image_id': '313891_1_En_17_Fig14_HTML', 'image_file_name': '313891_1_En_17_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig14_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, mass and flakes of parenchymal shadows in the posterior segment of the right upper lobe and in the dorsal segment of both lower lobes which is more obvious in the right lung, and bronchial shadows in them', 'hash': 'bc4343d2071f380a05855c1e658dc05d90d8ae123e988cfe12c3e65526b3336c'}, {'image_id': '313891_1_En_17_Fig104_HTML', 'image_file_name': '313891_1_En_17_Fig104_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig104_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymphoid interstitial pneumonia. (a–f) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs in reticular appearance, with accompanying multiple small nodular shadows, fusion of some nodules into flaky shadows, and ground glass liked changes in the lung fields', 'hash': '4883f041ed6e05ad0ce9ee6734fea4171aae151209ba36cbce94c8434c86f174'}, {'image_id': '313891_1_En_17_Fig98b_HTML', 'image_file_name': '313891_1_En_17_Fig98b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig98b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates thickened lung markings in both lungs, which extend to the outer zone of the lungs. (b) DR demonstrates thickened and deranged lung markings in both lungs with nodular blurry shadows; and cloudy shadows in lung fields. (c, d) CT scanning demonstrates thickened lung markings in both lungs, with diffuse nodular shadows; and cloudy changes in lung fields. (e) HE staining demonstrates cytomegalovirus inclusions', 'hash': '489286db9d367c09fbc842e4d1ba093d9caa6ded75760e9e1a70e05a86f43979'}, {'image_id': '313891_1_En_17_Fig53_HTML', 'image_file_name': '313891_1_En_17_Fig53_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig53_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) Anteroposterior and lateral DR demonstrates enlarged and thickened left hilum, and large flaky blurry shadows with increased density in the left lower lung. (c, d) Reexamination demonstrates normal lungs after antibiotic treatment', 'hash': 'd9cd861c21f1100d02e20014901c7e4a9a9bcad2e4ddcd3c731b50168d8782be'}, {'image_id': '313891_1_En_17_Fig114b_HTML', 'image_file_name': '313891_1_En_17_Fig114b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig114b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related Kaposi’s sarcoma. (a–d) CT scanning demonstrates scattered cloudy mass and flakes liked or nodular shadows with increased density in both lungs with uneven density and unclear boundaries, fusion and parenchymal changes of some lesions, more lesions in the lower lobe of both lungs and mostly with parenchymal changes. (e, f) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large and thick stained nucleoli, which are in line with the manifestations of Kaposi’s sarcoma. (g, h) Immunohistochemical demonstrates positive of C3 and C4', 'hash': '586be9acfd2434fad0db1a2ffaba9ac72eb8eb799b76acdaeac2730c48c45020'}, {'image_id': '313891_1_En_17_Fig107a_HTML', 'image_file_name': '313891_1_En_17_Fig107a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig107a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related lymphoma. (a–e) CT scanning of the pulmonary and mediastinal windows demonstrates multiple round liked nodular shadows with increased density in both lung fields, with clear boundaries; large soft tissue mass shadows in the right lower lung, with slightly lobulated boundaries and spikes. (f–i) CT scanning of the pulmonary and mediastinal windows for reexamination after radiation therapy demonstrates shrinkage of intrapulmonary nodules and masses', 'hash': '4ca6acd1461c3d7b80869d7d33bd1a3d91ecd1a0dc1b5c7baecc0bfbcf817449'}, {'image_id': '313891_1_En_17_Fig75b_HTML', 'image_file_name': '313891_1_En_17_Fig75b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig75b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval or sphere shaped nodular shadows in the cavities with smooth boundaries. (e, f) Reexamination after treatment demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval nodular shadows in the cavity with smooth boundaries. Compared to the previous imaging findings, the lesions are shrunk, with improved surrounding infiltration', 'hash': 'b1a96158009afcb5e673cf31f9243ca598c763c294bbdc7479a918fb36b031e8'}, {'image_id': '313891_1_En_17_Fig25d_HTML', 'image_file_name': '313891_1_En_17_Fig25d_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25d_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '1e7425ad1ac60b1c612434d02bbe7d48ba0fb82e0642b09b8771b4fea9a7a4c2'}, {'image_id': '313891_1_En_17_Fig66a_HTML', 'image_file_name': '313891_1_En_17_Fig66a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig66a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates large flaky shadows with increased density in the right upper lung, with blurry boundaries; round liked or sphere shaped mass shadows in the right lower lung, with uneven density. (b–e) CT scanning of the pulmonary window demonstrates multiple round liked thick-wall cavities in the dorsal segment of the right lower lung, with small nodular shadow adhering on the cavity wall; and surrounding small nodular shadows and infi ltration shadows. (f, g) Coronal CT scanning reconstruction demonstrates a huge thick-wall cavity in the right upper lung, with irregular thickness of the wall; round liked cavity shadows in the right lower lung, with thick and multilocular walls; and flaky shadows with increased density in the outer zone of the left lower lung', 'hash': 'efec688fc6d0fd9fc9188edcc4a4bb040754e9c9e3261fcacec068f3bfd0252f'}, {'image_id': '313891_1_En_17_Fig63_HTML', 'image_file_name': '313891_1_En_17_Fig63_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig63_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Rhodococcus equi pneumonia. (a) Pulmonary CT scanning demonstrates a mass shadow in the lateral segment of the right middle lobe in size of 4.7\u2009×\u20093.7\u2009×\u20093.2 cm with uneven density and lace liked boundary, and small bubbles shadows in it. By both sputum culture and lung tissue culture, Rhodococcus equi can be detected. (b, c) Pathological biopsy and HE staining demonstrate inflammatory pseudotumor. (d, e) Immunohistochemistry demonstrates Rhodococcus equi antibody positive. (f) Reexamination after treatment demonstrates obvious shrinkage of the original lung lesions', 'hash': 'ac97b316499d751a48d8b861962da376a39c7ff11d2554ed957c226224dc65b6'}, {'image_id': '313891_1_En_17_Fig2a_HTML', 'image_file_name': '313891_1_En_17_Fig2a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig2a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered miliary increased density shadows in both lungs, with even size, density and distribution. The shadows of both hila are dense, with sharp both costophrenic angles. (b–f) CT scanning demonstrates scattered miliary nodular shadows in both lungs, which is more obviously in the middle pulmonary strip and with quite even size and density. Trachea and bronchi are unblocked', 'hash': 'ec4f2f75b5bb59b2cb13f016c2ea6714bdc3c908077c2697af2218aa485876b7'}, {'image_id': '313891_1_En_17_Fig13a_HTML', 'image_file_name': '313891_1_En_17_Fig13a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig13a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, transparent areas in them and unblocked trachea and bronchi', 'hash': '7d26c2f94a34f3ff7c4f64d485fe29e114936d0f4db53489ee88148a1a6fc8bf'}, {'image_id': '313891_1_En_17_Fig65a_HTML', 'image_file_name': '313891_1_En_17_Fig65a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig65a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related allergic pulmonary Aspergillus infection. (a–f) CT scanning of the pulmonary window demonstrates thickened central pulmonary markings in both lungs, which is turtuous and deranged with fingertip infiltration shadows. (g) DR demonstrates hyperinflation of the right lung, increased and thickened pulmonary markings and ground glass liked shadows with increased density in the right lower lung and left lung lobe', 'hash': '6fa5ade163d7465c0dc3eb89ebc58d57b98674fc2680824cc5a81c478b81fbc4'}, {'image_id': '313891_1_En_17_Fig76b_HTML', 'image_file_name': '313891_1_En_17_Fig76b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig76b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning demonstrates diffuse scattered thin ground glass liked, patchy, flaky blurry shadows and cords liked shadows in both lungs, with blurry boundaries and uneven density; scattered nodular shadows in different sizes; more lesions in both upper lobes and the right middle lobe; flaky parenchyma shadows in the apical and posterior segments of right upper lobe, with air bronchogram sign in them; unobstructed opening of bronchi as well as lobar and segmental bronchi without stenosis and obstruction; lymphadenectasis in the right hilar region; detected Aspergillus fumigatus by sputum culture. (e, f) Culture for 72 h, lactic acid gossypol blue staining and microscopic observation at ×200 and ×400 demonstrate short column liked conidial head, smooth wall of conidiophores, flask-shaped top capsule and monolayer microconidiophores. (g) Culture in Paul’s medium demonstrates dark green colored colonies', 'hash': 'af925cb00cbd4eed9e67dc49fd012909ecdfe48493ac645d8b2185eb4f351655'}, {'image_id': '313891_1_En_17_Fig105a_HTML', 'image_file_name': '313891_1_En_17_Fig105a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig105a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary toxoplasmosis. (a–d) CT scanning demonstrates thickened pulmonary markings in both lungs, which can be enhanced to extend into the middle and outer zones of lungs, in grid liked appearance that is more obvious in the dorsal segment of the lungs. (e) It is demonstrated to have clustering toxoplasma tachyzoites', 'hash': '30f16a35256e45c89dfcd68adf661507960a5b978db88cc531a7605d9fff53df'}, {'image_id': '313891_1_En_17_Fig95_HTML', 'image_file_name': '313891_1_En_17_Fig95_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig95_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a) CT scanning of the pulmonary window demonstrates irregular large flaky shadows with increased density in the dorsal segment of both lower lobes; enlarged hilum in both lungs, cords liked thickening of the vascular vessels. (b) CT scanning of the mediastinal window demonstrates flaky parenchyma shadows in the left lower lung, thickening of both pleura, enlarged hilum shadows in both lungs, thickened right lower bronchial wall. (c) Microscopy after culture at 25 °C demonstrates branches and separated hyphae and its string of small spores, with typical penicillus but no sporangium (Medan staining, ×400). (d) Bone marrow smear demonstrates round or oval cells like the yeast phase within the macrophages; longer cells like the yeast phase outside the macrophages. The two kinds of cells have slightly curved ends in sausages liked appearance (HE staining, ×400)', 'hash': '636de07e02ba7cf1f73f2a03bccf4fdaac68bc4a122b7fbfe2febe72dd42f139'}, {'image_id': '313891_1_En_17_Fig3a_HTML', 'image_file_name': '313891_1_En_17_Fig3a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig3a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy and scattered miliary increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of the lower lung field, with some fused in thin cloudy shadows', 'hash': 'e655c40874d38beaa8a8e9f0e82c1eb12a6756b09bee559229354b3756010a18'}, {'image_id': '313891_1_En_17_Fig73_HTML', 'image_file_name': '313891_1_En_17_Fig73_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig73_HTML.jpg', 'caption': '(a–c) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates diffuse dense shadows in both lower lung fields which is in a arcuate surface with exterior high and interior low (pleural effusion). (b, c) CT scanning of the mediastinal window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavities; thickened pleura of the lateral chest wall, with accompanying encapsulated effusion', 'hash': '9ad36ea5213bea731770658b27be87e1af9e34bced02cda664a7f485e40f2315'}, {'image_id': '313891_1_En_17_Fig54_HTML', 'image_file_name': '313891_1_En_17_Fig54_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig54_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates round liked large flaky shadows with increased density in the left lower lung, enlarged and thickened hilus. (c, d) DR reexamination after treatment demonstrates flocculent shadows in the left lower lung, with improved conditions than previous findings before treatment (a, b)', 'hash': 'f9b4f22920ef55d9110380df6f64a6a508ecea9ca3192877a2d47400e781c58d'}, {'image_id': '313891_1_En_17_Fig58b_HTML', 'image_file_name': '313891_1_En_17_Fig58b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig58b_HTML.jpg', 'caption': '(a–i) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) CT scanning of the pulmonary window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (c, d) CT scanning of the mediastinal window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, pulmonary atelectasis and pleural effusion, with ventilation shadows in them. (e) CT scanning of the pulmonary window after the treatment demonstrates absence of the mass shadows in the left lower lung with transverse stripes shadows, obviously improved than previous findings (a, b). (f) HE staining demonstrates thickened alveolar septa and exudates from the alveolar cavity. (g) HE staining demonstrates massive bleeding in the alveolar cavity, large quantity erythrocytes and intact cell walls. (h) HE staining demonstrates phagocytized basophilic granules in the leukocytes. (i) HP staining demonstrates purplish red Rhodococcus equi in a shape of crescent in orange red sputum', 'hash': 'ca8456a79f660fc4faa5eb9342f84a14bbe25eedd8fb237ac65bd96b8de6e5b9'}, {'image_id': '313891_1_En_17_Fig25c_HTML', 'image_file_name': '313891_1_En_17_Fig25c_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25c_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '64e0ceda545f1684d11c717eef852c6576036d711540954850cc018aadfefa87'}, {'image_id': '313891_1_En_17_Fig44_HTML', 'image_file_name': '313891_1_En_17_Fig44_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig44_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary nontuberculous mycobacterial infection. (a–d) CT scanning demonstrates multiple cavities in the left lung field, bilateral multiple lobular central nodules and extensive branches liked linear shadows in tree buds sign. There are also large flaky parenchymal changes of the lung tissues in the left lower lung field in high density shadows, with accompanying air bronchogram sign. (e) HE staining demonstrates avium intracellular complex mycobacteria infection of lung tissues in atypical tuberculous nodular changes. (HE\u2009×\u2009200)', 'hash': '8f8697761c60c3cb27c0b413c2e19433df26ba07a74ea0a0cc0b6f2b4acc7b65'}, {'image_id': '313891_1_En_17_Fig103_HTML', 'image_file_name': '313891_1_En_17_Fig103_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig103_HTML.jpg', 'caption': '(a–d) HIV/AIDS related lymphoid interstitial pneumonia. (a–d) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs, in reticular appearance; with accompanying multiple small nodular shadows', 'hash': '8d52c3bac6fb07e3eaf12386767e159f762db3072e09365be542c937697babe7'}, {'image_id': '313891_1_En_17_Fig110b_HTML', 'image_file_name': '313891_1_En_17_Fig110b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110b_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '5526a48dae3face516d842ba229b164bac3062f56c5e811bb1e725778fd20823'}, {'image_id': '313891_1_En_17_Fig5a_HTML', 'image_file_name': '313891_1_En_17_Fig5a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig5a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates patchy shadows with increased density in both lungs, with thickened hilar shadows in both lungs. (b–g) CT scanning demonstrates flaky ground glass liked density shadows in upper lungs and dorsal segment of both lungs, which is more obvious in the middle inner strips. There are extrapulmonary stripes transparent shadows, with some bronchial walls thickened and enlarged hilar shadows in both lungs', 'hash': '5d6ab0400e0331b0fcb3a3679023a44fa81b7b9c9eedc00c0ddb6d85208c3512'}, {'image_id': '313891_1_En_17_Fig74_HTML', 'image_file_name': '313891_1_En_17_Fig74_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig74_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates round liked uneven density shadows in the medial segments of both middle and lower lungs, multilocular hollow holes in the cavities, surrounding multiple round liked thick-wall small cavity shadows and ground grass liked infiltration shadows. (b–d) CT scanning of the pulmonary window demonstrates scattered round liked uneven density shadows in the right hilum and lower lung, multilocular hollow holes in the cavities; and surrounding multiple round liked thick-wall small cavity shadows and ground grass liked infiltration shadows', 'hash': 'e4c42cc0cb1f1bdfa8b2cc1f3c8eab7223c4be368a808e8b6c4b01af78dfb04a'}, {'image_id': '313891_1_En_17_Fig23_HTML', 'image_file_name': '313891_1_En_17_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig23_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymph node tuberculosis. (a–c) CT scanning of the pulmonary window demonstrates dense mass shadow beside the right aortic arch, and thinner right bronchus due to compression. (d–f) CT scanning of the mediastinal window demonstrates low density mass shadow besied the right aortic arch with clear boundary', 'hash': '8d135ce7e96005006343dc3305be0f8c77d0828bccccf1726226c09fd47c365f'}, {'image_id': '313891_1_En_17_Fig6a_HTML', 'image_file_name': '313891_1_En_17_Fig6a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig6a_HTML.jpg', 'caption': '(a-d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates flaky ground glass liked density shadows in upper lobes of both lungs, with bronchial shadows in them; flaky parenchymal shadows in the subpleural apical segment; and thickened bronchial walls in the anterior and posterior segments of the right upper lobe', 'hash': '235548456c9bf72727a05a91fa6893d8a478f8f715c022d6b579d4a9188da366'}, {'image_id': '313891_1_En_17_Fig17a_HTML', 'image_file_name': '313891_1_En_17_Fig17a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig17a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchymal shadows and fibrous cords liked shadows in both lungs which are more obvious in both lower lungs. The trachea and bronchi are unblocked, with enlarged hilar shadows in both lungs', 'hash': '9c1c59095291dcf6a7b6dec786ec58ba44e9b83badfe4bbf121b7c677476f4d5'}, {'image_id': '313891_1_En_17_Fig113b_HTML', 'image_file_name': '313891_1_En_17_Fig113b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig113b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Kaposi’s sarcoma. (a–d) Chest CT scanning demonstrates scattered cloudy, mass and flake liked or nodular shadows with increased density. (e) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large thick stained nucleoli, which are in line with the diagnosis of Kaposi’s sarcoma. (f–i) Cured HIV/AIDS related Kaposi’s sarcoma. (f–i) Reexamination after treatment demonstrates absent lesions in both lungs, with clear lung fields', 'hash': '88e574b2d5ff4ee4ce28f38025d5345c8cf6b50386f752ae12083b05fe7af9de'}, {'image_id': '313891_1_En_17_Fig82_HTML', 'image_file_name': '313891_1_En_17_Fig82_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig82_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a, b) DR demonstrates enlarged blurry hilum in both lungs and thickened pulmonary markings. (c, d) CT scanning demonstrates mediastinal lymphadenectasis, narrowed trachea due to compression with liquefactive necrosis. Enhanced scanning demonstrates marginal enhancement and no central enhancement', 'hash': '18312183daaefbc6c48e05e67fab210a1109c24a6f94311ffb11ffdace007a49'}, {'image_id': '313891_1_En_17_Fig64_HTML', 'image_file_name': '313891_1_En_17_Fig64_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig64_HTML.jpg', 'caption': '(a) Gross observation demonstrates dark brown lungs in appearance. (b, c) Thology demonstrates hemorrhage and edema of the lung tissue and focal necrosis, with large quantity Aspergillus hyphae and spores in the surrounding area of the necrosis (Combined with pulmonary CMV infection)', 'hash': '104850f2999da711317f4e4f07e590bd8f73a93731daf090ece6023192606e90'}, {'image_id': '313891_1_En_17_Fig7a_HTML', 'image_file_name': '313891_1_En_17_Fig7a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig7a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates diffusely distributed shadows with increased density in both lungs that is more obvious in the middle and lower lungs. The hilar shadows in both lungs are enlarged. Both diaphragmatic surfaces and phrenic angles are blurry. (b–d) CT scanning demonstrates flaky shadows with increased density in both lungs, with parenchymal shadows in the lingular segment of left upper lobe and in the dorsal segments of both lower lobes and bronchial shadows in them. There are also thickened bronchial walls and enlarged hilar shadows in both lungs', 'hash': '431aab0770a1915c719095cc2bab91736f1ffda7b5649cdca5d8b7516003049c'}, {'image_id': '313891_1_En_17_Fig33_HTML', 'image_file_name': '313891_1_En_17_Fig33_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig33_HTML.jpg', 'caption': '(a, b) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates scattering patchy and cords liked blurry density shadows in the right middle and upper lung fields as well as enlarged and thickened hilum. (b) DR demonstrates that the lungs lesions are almost absent compared to (a), after anti-TB treatment for 5 months', 'hash': 'e710598bbbc8286721136f2a803716198a712c55253c4232d3ee33b2e33e188b'}, {'image_id': '313891_1_En_17_Fig62_HTML', 'image_file_name': '313891_1_En_17_Fig62_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig62_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) Anteroposterior and lateral DR demonstrates huge sphere liked mass shadow in the right hilum, with cavities shadows and liquid gas level in it. (c) HE staining demonstrates bleeding in the lung tissues and aggregation of large quantity lymphocytes. (d) Masson staining demonstrates branches liked purplish red Rhodococcus equi', 'hash': '261a4aca9e146cc16957c6280cd4795d7c2c5732d9a19006b6e398a1ae410af0'}, {'image_id': '313891_1_En_17_Fig84_HTML', 'image_file_name': '313891_1_En_17_Fig84_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig84_HTML.jpg', 'caption': '(a, b) HIV/AIDS related pulmonary cryptococcus infection. (a) CT scanning demonstrates round liked cavity shadows in the left upper and lower lung, with uneven thickness of the cavity wall and surrounding infiltrative shadows. (b) CT scanning demonstrates round liked dense mass shadows in the right upper lung, with clear boundaries and bulky drainage vessel shadows', 'hash': 'ecc614167ec536dcb80c2739886c957ff2f182dd49ac7f4d6379260497262e60'}, {'image_id': '313891_1_En_17_Fig4_HTML', 'image_file_name': '313891_1_En_17_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig4_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy or ground glass liked increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of lower lungs, with some fused into thin cloudy ground glass liked shadows with increased density, with decreased transparency of both lungs and enlarged hilar shadows in both lungs', 'hash': '636f9fd3d3c20c17e15e1ac70adcdcb6fbe268a70ac64d29317f73045747e226'}, {'image_id': '313891_1_En_17_Fig46a_HTML', 'image_file_name': '313891_1_En_17_Fig46a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig46a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates large flaky dense shadows in the middle-outer zone of the left middle lung field, and narrowed left bronchus. (d–f) CT scanning demonstrates large flaky shadows with uneven density in the left lateral chest wall and even lower density shadow in them', 'hash': 'afdfc2c33070f1d3b8616a542d989e0f908d9638327227057dfdf5ed59169359'}, {'image_id': '313891_1_En_17_Fig72_HTML', 'image_file_name': '313891_1_En_17_Fig72_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig72_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and cavity shadows in both lungs, with even wall thickness and small nodular shadows in some cavities', 'hash': 'd318b47b9b56854b6bc47081b08712ee9d828a2ae4592aa69451ec7105fd0240'}, {'image_id': '313891_1_En_17_Fig91b_HTML', 'image_file_name': '313891_1_En_17_Fig91b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig91b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–e) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of some lesions into honeycomb likes cavity shadows or plaque liked dense shadows. (f–h) CT scanning demonstrates large thick-wall cavity shadows in the right lung, surrounding plaque and round liked small cavity shadows and inflammatory infiltrative shadows', 'hash': '6b3a934b89abf6f7e8c9593337c0c57fe44161bcbfc546c7e2a3cfa50539f91e'}, {'image_id': '313891_1_En_17_Fig8a_HTML', 'image_file_name': '313891_1_En_17_Fig8a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig8a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates large flaky parenchyma shadows in both lungs which is more obvious in the middle and lower lobes of both lungs. There are also enlarged hilar shadows in both lungs and sharp both costophrenic angles. (b–g) CT scanning demonstrates large flaky parenchyma shadows in concentric and symmetrical distribution, bronchial shadows in them and thickened bronchial walls', 'hash': '7c4f2f4f9120af70727cab6fc69637733e17e807575648a0257b5b03367da625'}, {'image_id': '313891_1_En_17_Fig42_HTML', 'image_file_name': '313891_1_En_17_Fig42_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig42_HTML.jpg', 'caption': 'HIV/AIDS related tuberculous pleuritis. DR demonstrates arch shaped dense shadows with higher exterior density and lower interior density in the left lower lung field and covered right edge of the heart', 'hash': 'f0dfdb1b349a42c7092daeeaef76a8b8762e134b40ae21a6144d9785b9ddcd02'}, {'image_id': '313891_1_En_17_Fig15_HTML', 'image_file_name': '313891_1_En_17_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig15_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy blurry shadows and fibrous cords liked shadows in both lungs which are more obvious in the middle inner parts of both lungs, with transparent areas in them. The bronchial walls are thickened', 'hash': '4d262b5c06f74783c1b6df1f8c9d8c7ecbf235faacd2f2e846544a3e11d88e8b'}, {'image_id': '313891_1_En_17_Fig92b_HTML', 'image_file_name': '313891_1_En_17_Fig92b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig92b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of the lesions in the right lung into plaque liked shadows with clear boundaries, and multiple round liked small cavity shadows and inflammatory infiltrative shadows in both lungs', 'hash': '4613e0bd8bbb013024b2335ae2f7fb1997dab5d93ee1c395c97035d6e7d37750'}, {'image_id': '313891_1_En_17_Fig52_HTML', 'image_file_name': '313891_1_En_17_Fig52_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig52_HTML.jpg', 'caption': '(a, b) HIV/AIDS related staphylococcus aureus pneumonia. (a, b) DR demonstrates diffuse scattered multiple thin-walled transparent areas in both lungs, increased and blurry pulmonary markings, and enlarged heart shadow in flask shape (pericardial effusion)', 'hash': 'b54d395f8405b646839c68cb58c1a811c70fb8c7337443d24b61bfcfa097f5b0'}, {'image_id': '313891_1_En_17_Fig56b_HTML', 'image_file_name': '313891_1_En_17_Fig56b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig56b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates huge round large flaky shadows with increased density in the left lower lung, enlarged and thickened hilum and covered right heart edge. (c, d) DR reexamination after treatment for 1 week demonstrates flocculent shadow in the left lower lung, improved than those before the treatment (a, b). (e) DR reexamination after treatment demonstrates flocculent liked shadows in the left lower lung, obviously improved than before the treatment (c, d)', 'hash': 'e5f534ed9282980e95aaa6bac04091762128cf3e5c46985b190278c5d6396558'}, {'image_id': '313891_1_En_17_Fig93b_HTML', 'image_file_name': '313891_1_En_17_Fig93b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig93b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates diffuse small cavity in honeycomb liked and infiltrative parenchyma shadows, with the hilum as the center to distribute bilaterally symmetric like butterfly wings; multiple honeycomb liked cavity shadows in both lungs. (e–h) CT scanning reexamination demonstrates large irregular thick-wall cavities in the right lung, surrounding scattering nodular, honeycomba liked and infiltrative shadows after anti-PM infection treatment for 3 months', 'hash': '904e5a590c601ab02150f8c2487bbfa6f0282c1eddd547624ce8c549472221d9'}, {'image_id': '313891_1_En_17_Fig51b_HTML', 'image_file_name': '313891_1_En_17_Fig51b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig51b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related staphylococcus aureus pneumonia. (a) Chest X-ray demonstrates large flaky high density shadow in the left middle-lower lung field, with central transparent areas in different sizes and blurry boundaries; parenchyma changes of the left lower lung, predominantly in the posterior and exterior basal segments; unobstructed brounchus and thickened adjacent pleura. (b–d) CT scanning demonstrates large flaky shadows in fan shaped distribution along the bronchus in the left middle-lower lung, with gas containing cavities and high density shadows; and thickened adjacent pleura of the lateral chest wall. (e, f) CT scanning of the mediastinal window demonstrates large flaky fan shaped parenchymal shadows in the left middle-lower lung field, with ventilation shadows in them; and thickened pleura of the lateral chest wall. (g, h) Pathological examination showed staphylococcus aureus', 'hash': '18a6e1202b7b8c4a2d57fe024b7e8039a6dcee0f6f5f078b109a93850977c0f6'}, {'image_id': '313891_1_En_17_Fig94b_HTML', 'image_file_name': '313891_1_En_17_Fig94b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig94b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a–f) CT scanning demonstrates multiple nodules and small cavities in honeycomb liked shadows and infiltrative parenchyma shadows in the right lung; flaky transparent areas (bullae of lung) in the right anterior margin of the heart and in the outer zone of the left lung near lateral chest wall', 'hash': '3ed719abaaaec4ee19332842bd8dcac302eb6fefc73152dfd03a39702260d369'}, {'image_id': '313891_1_En_17_Fig34a_HTML', 'image_file_name': '313891_1_En_17_Fig34a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig34a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung and multiple satellite lesions scattering around. (c) CT scanning of the mediastinal window demonstrates lymphadenectasis of aortic window, subcutaneous soft tissue mass shadow in the left anterior chest wall with central low density shadow as well as right axilliary lymphadenectasis', 'hash': 'dabd5722ad3f66eee67ca59ba24417ffb086d4591f3bff2446f2a3490c676e78'}, {'image_id': '313891_1_En_17_Fig22_HTML', 'image_file_name': '313891_1_En_17_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig22_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates semicircular mass liked dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura of lateral chest wall, and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates narrowed right thorax, thickend pleura of lateral chest wall with encapsulated effusion, uneven density mass in the right hilum, thinner right bronchus due to compression and no obvious abnormalities in the left hilum. (f) DR in Aug. 2008 demonstrates no obvious changes of the lesions after anti-tuberculosis treatment for 1 month', 'hash': '8f3d47e32ff0f306eed49c4101730b02a154f676752c7bb56423c767388d5b82'}, {'image_id': '313891_1_En_17_Fig27b_HTML', 'image_file_name': '313891_1_En_17_Fig27b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig27b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related miliary tuberculosis. (a–b) Anteroposterior and lateral DR demonstrates diffuse miliary shadows in both lungs, which are bilaterally symmetric and in even size and distribution. (c–f) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': 'e272956e522e945d068939f056c637c5a636df520c687deeac9d40f8cb06834e'}, {'image_id': '313891_1_En_17_Fig83_HTML', 'image_file_name': '313891_1_En_17_Fig83_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig83_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates enlarged blurry hilum in both lungs and thickened lung markings. (b–d) CT scanning demonstrates multiple scattered nodular or mass dense shadows in both lungs, with lobulation, rough spikes around and fusion of some shadows into mass; surrounding small flaky infiltrative shadows; and mediastinal lymphadenectasis', 'hash': '6b17ec5d2db4d953c2436bbec29d0a3b1dacf0910df899eaf97e442c4aaad785'}, {'image_id': '313891_1_En_17_Fig43a_HTML', 'image_file_name': '313891_1_En_17_Fig43a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig43a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related tuberculous pleuritis. (a) DR demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (b) CT scanning of the pulmonary window demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (c) CT scanning of the mediastinal window demonstrates encapsulated fluid density shadow in the pleura of the right lateral chest wall', 'hash': 'ac09c8d3e5e4d73b07cd258411b07337ad06b99883f4a0e4573ce220fc1f4574'}, {'image_id': '313891_1_En_17_Fig35a_HTML', 'image_file_name': '313891_1_En_17_Fig35a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig35a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates diffuse large flaky dense shadows in the right upper lung with transparent areas in them. (b–c) CT scanning of the pulmonary window demonstrates large flaky shadows with increased density in the right upper lung, with multiple satellite lesions scattering around. (d, e) CT scanning of the mediastinal window demonstrates large flaky parenchymal shadows in the right upper lung with air bronchogram sign as well as mediastinal lymphadenectasis', 'hash': 'f556b77354da8136691c411ed446865babea0e399d96d2fca89f49639a04c579'}, {'image_id': '313891_1_En_17_Fig26b_HTML', 'image_file_name': '313891_1_En_17_Fig26b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig26b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '1d1f0589c50a11306fce77c217b0a9ac31be645df14f41d021ccf6522873dc6c'}, {'image_id': '313891_1_En_17_Fig32_HTML', 'image_file_name': '313891_1_En_17_Fig32_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig32_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstratesdiffuse scattering miliary shadows with increased density in both lungs, fusion of some military shadows into patchy or mass liked shadows and diffusely distributed lung lesions', 'hash': '7274d90d4f9483c5fb0e44576eeb46beba54850ed218057b6ca5935c31fa396a'}, {'image_id': '313891_1_En_17_Fig96b_HTML', 'image_file_name': '313891_1_En_17_Fig96b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig96b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a) DR demonstrates flaky blurry dense shadows in the right anterior margin of the heart, with surrounding infiltrative shadows. (b, c) CT scanning of the pulmonary window demonstrates nodular dense shadows in the dorsal segment of the right lower lung, with smooth sharp boundaries; large flaky ground glass liked dense shadows in the dorsal segment of both lungs. (d, e) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in red, in different sizes. (f) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in purplish red, in different sizes', 'hash': 'ad87dabd309e8a0c47d5cd58aa485a538556b1218d18c3cb262dc5b8cd5049e9'}, {'image_id': '313891_1_En_17_Fig55_HTML', 'image_file_name': '313891_1_En_17_Fig55_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig55_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates round liked large flaky shadows with increased density in the right lower lung, cords liked and flocculent liked blurry shadows in both middle-upper lung fields and in the right lower lung field, and enlarged and thickened hilus', 'hash': '29c690f04a28629d1c3b0f7b5665833edd78ec61be199fd2f16199400a7c9eeb'}, {'image_id': '313891_1_En_17_Fig85a_HTML', 'image_file_name': '313891_1_En_17_Fig85a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig85a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates round liked thick-wall cavity in the left hilum, with blurred boundary; ground-glass liked shadows with increased density in the left middle and lower lung. (b–d) CT scanning of the pulmonary window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of cavity wall. (e, f) CT scanning of the mediastinal window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of the cavity wall and surrounding thick spikes', 'hash': 'd6bc5b1be05729f5f4ec60a0cda3bec7f7cf437fd39e0d32743e45cfb9e48de2'}, {'image_id': '313891_1_En_17_Fig112_HTML', 'image_file_name': '313891_1_En_17_Fig112_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig112_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Kaposi’s sarcoma. (a, b) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance', 'hash': 'eeb255e4963802d02da7fd85381532153336be33b21e4ceb488be5dc2a483f29'}, {'image_id': '313891_1_En_17_Fig25b_HTML', 'image_file_name': '313891_1_En_17_Fig25b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25b_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '9ceac8f407a9896d7bda0165bceae81a32d5c5c53de3c5d2a295c165b15071e8'}, {'image_id': '313891_1_En_17_Fig36a_HTML', 'image_file_name': '313891_1_En_17_Fig36a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig36a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) Pulmonary CT scanning of the pulmonary window demonstrates parenchymal shadows in the left lingual lobe with surrounding pulmonary acinar nodular shadows. (b) CT guided pucture biopsy of left lingula. (c) The pathology demonstrates granulation tissue and caseous necrosis, being in consistency with tuberculosis changes. HE\u2009×\u2009100', 'hash': '3a48cc084a1fb1943e1411fa65cfdcee0c3c33377b3ae6ab6e24f04ee1caebae'}, {'image_id': '313891_1_En_17_Fig68a_HTML', 'image_file_name': '313891_1_En_17_Fig68a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig68a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in prone posture demonstrates mass shadow and thick wall cavity in the dorsal segment of the right lower lung, small nodular shadows in the cavities, surrounding fused miliary infiltration shadows. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the dorsal segment of the right lower lung, small nodular shadows in the cavities, and involved pleura of partial lateral chest wall', 'hash': '0acc77833f25b70e7e4527a30be9fc6744e19cee48879415a15e648d76923d48'}, {'image_id': '313891_1_En_17_Fig45_HTML', 'image_file_name': '313891_1_En_17_Fig45_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig45_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Staphylococcus aureus pneumonia. (a) Gross specimen observation demonstrates bilateral purplish brown lesions, patchy white infiltration at the base of the lungs. (b) HE staining demonstrates alveolar diffuse lesions, exudation of the serous fluid and inflammatory cells in the alveolar cavity, and alveolar wall congestion', 'hash': 'e530a1df1ead29989d8b3b50161f1926946446bc5cbbcb99691479816876e341'}, {'image_id': '313891_1_En_17_Fig110c_HTML', 'image_file_name': '313891_1_En_17_Fig110c_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110c_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '22d9f8a4fa731c46a738334c9738c267aaa2c43711aa94bd98c4b78483adda8d'}, {'image_id': '313891_1_En_17_Fig24b_HTML', 'image_file_name': '313891_1_En_17_Fig24b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig24b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates circular mass dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura in the lateral chest cavity and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates multiple uneven mass density shadows in right hilum in a size of about 3\u2009×\u20093.5\u2009×\u20093.8 cm. (f–g) Enhanced CT scanning demonstrates slight uneven enhancement of the lesion and no obvious abnormalties in the left hilum', 'hash': '4c7c3a8f7b0bde1c89efcf634beedfd08159b9be03a95299448e388c435edcdc'}, {'image_id': '313891_1_En_17_Fig12_HTML', 'image_file_name': '313891_1_En_17_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig12_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchyma shadows and fibrous cords liked shadows in both lungs which are more obvious in the dorsal segment of both lower lungs, bronchial shadows in them, and thickened bronchial walls in the middle lobe. The hilar shadows in both lungs are enlarged', 'hash': '72a066b603a93a4b8e9a7a8ec1942b2ed87b211dee6ed121b7c56d1cb575c55c'}, {'image_id': '313891_1_En_17_Fig102_HTML', 'image_file_name': '313891_1_En_17_Fig102_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig102_HTML.jpg', 'caption': '(a–d) HIV/AIDS related lymphoid interstitial pneumonia. (a–d) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs, in reticular appearance; with accompanying multiple small nodular shadows', 'hash': '6b569d4d7a5a4f008ea8f7bc4152cd1a576656b8eeee8b7548f00de038815256'}, {'image_id': '313891_1_En_17_Fig111_HTML', 'image_file_name': '313891_1_En_17_Fig111_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig111_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Kaposi’s sarcoma. (a, b) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance, light density flaky shadows in lower lung fields of both lungs. (c) CT scanning demonstrates multiple round liked nodular shadows in both middle lower lung fields with clear boundaries, multiple mediastinal and hilar lymphadenectasis, and small quantity pleural effusion in bilateral thoracic cavities', 'hash': '5dfb9d581ecc41659920bde84bc55d01903bf9f66ec50710fe0465373096ff5f'}, {'image_id': '313891_1_En_17_Fig25a_HTML', 'image_file_name': '313891_1_En_17_Fig25a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25a_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '67db71f0f56d65c929e36f486b4a1a2246ae852aec999328f126ddc09428f814'}, {'image_id': '313891_1_En_17_Fig36b_HTML', 'image_file_name': '313891_1_En_17_Fig36b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig36b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) Pulmonary CT scanning of the pulmonary window demonstrates parenchymal shadows in the left lingual lobe with surrounding pulmonary acinar nodular shadows. (b) CT guided pucture biopsy of left lingula. (c) The pathology demonstrates granulation tissue and caseous necrosis, being in consistency with tuberculosis changes. HE\u2009×\u2009100', 'hash': 'd7d5abe0c9d9bea2e2097dfc72f86922656058f98f8a2360573b04a02e27e5de'}, {'image_id': '313891_1_En_17_Fig68b_HTML', 'image_file_name': '313891_1_En_17_Fig68b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig68b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in prone posture demonstrates mass shadow and thick wall cavity in the dorsal segment of the right lower lung, small nodular shadows in the cavities, surrounding fused miliary infiltration shadows. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the dorsal segment of the right lower lung, small nodular shadows in the cavities, and involved pleura of partial lateral chest wall', 'hash': 'cada0e4684021c74f9b0d4d1bcdb6810379bc035cead748d6de141ebd004f038'}, {'image_id': '313891_1_En_17_Fig96a_HTML', 'image_file_name': '313891_1_En_17_Fig96a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig96a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a) DR demonstrates flaky blurry dense shadows in the right anterior margin of the heart, with surrounding infiltrative shadows. (b, c) CT scanning of the pulmonary window demonstrates nodular dense shadows in the dorsal segment of the right lower lung, with smooth sharp boundaries; large flaky ground glass liked dense shadows in the dorsal segment of both lungs. (d, e) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in red, in different sizes. (f) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in purplish red, in different sizes', 'hash': '020553d48c8545e50d314020ad8dc5004914dca5449aa2b58bc99515f310c3a4'}, {'image_id': '313891_1_En_17_Fig85b_HTML', 'image_file_name': '313891_1_En_17_Fig85b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig85b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates round liked thick-wall cavity in the left hilum, with blurred boundary; ground-glass liked shadows with increased density in the left middle and lower lung. (b–d) CT scanning of the pulmonary window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of cavity wall. (e, f) CT scanning of the mediastinal window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of the cavity wall and surrounding thick spikes', 'hash': '9778eb0d00755e3cd06bd3bcee90d66970730aac4b7fabde0b3e1df25cc067b8'}, {'image_id': '313891_1_En_17_Fig59_HTML', 'image_file_name': '313891_1_En_17_Fig59_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig59_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a–c) CT scanning of the pulmonary window demonstrates thick walled cavities shadows in the dorsal segment of the right lower lung, with irregular wall thickness and liquid gas level in them. (d) CT scanning of the mediastinal window demonstrates thick walled cavities shadows in the dorsal segment of the left lower lung, with irregular wall thickness and liquid gas level in them', 'hash': 'c9ff1150b9c2d245c823a3726a56dc22223fcdc58b24666ee55ee0b01ea0c2d3'}, {'image_id': '313891_1_En_17_Fig24a_HTML', 'image_file_name': '313891_1_En_17_Fig24a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig24a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates circular mass dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura in the lateral chest cavity and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates multiple uneven mass density shadows in right hilum in a size of about 3\u2009×\u20093.5\u2009×\u20093.8 cm. (f–g) Enhanced CT scanning demonstrates slight uneven enhancement of the lesion and no obvious abnormalties in the left hilum', 'hash': 'a3536c779e7c502b855dd3d89ae13854f569bd483ba8038870ac76c68c616c6c'}, {'image_id': '313891_1_En_17_Fig11_HTML', 'image_file_name': '313891_1_En_17_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig11_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered patchy shadows with increased density in both lungs and a few cords liked shadows which are more obvious in the right lung. There are thickened both hilar shadows and sharp both costophrenic angles. (b–e) CT scanning demonstrates flaky and mass liked ground glass density shadows in both lungs and a few cords liked shadows which are more obvious in the right lung. The trachea and bronchi are unblocked', 'hash': 'd4448bd9682d4ae721b1250cec042eecf77787519b1af61ac3b2d7b88b28bd90'}, {'image_id': '313891_1_En_17_Fig101_HTML', 'image_file_name': '313891_1_En_17_Fig101_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig101_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Herpes Simplex Viral Pneumonia. (a) DR demonstrates thickened and deranged lung markings in both lungs with accompanying blurry nodular shadows, and cloudy shadows in the lung fields. (b) PAS staining (400×) demonstrates eosinophilic inclusion. (c) Silver methenamine staining demonstrates herpes viral inclusion', 'hash': '9cfda956483a95dc3a4e487426e884d83e6aa0bde654b2c285ba044cf31b2a1d'}, {'image_id': '313891_1_En_17_Fig49_HTML', 'image_file_name': '313891_1_En_17_Fig49_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig49_HTML.jpg', 'caption': '(a–d) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates fan shaped shadow in the right middle lung field with its apex pointing to the hilar dense shadow, with clear boundaries. (d) CT scanning reexamination demonstrates absence of the lesions in the right lung after anti-bacteria treatment for 2 weeks', 'hash': 'f566a271be67724833f92b19b4f73190cae4216ad698f1d1a51c1d9c7579afa1'}, {'image_id': '313891_1_En_17_Fig34b_HTML', 'image_file_name': '313891_1_En_17_Fig34b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig34b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung and multiple satellite lesions scattering around. (c) CT scanning of the mediastinal window demonstrates lymphadenectasis of aortic window, subcutaneous soft tissue mass shadow in the left anterior chest wall with central low density shadow as well as right axilliary lymphadenectasis', 'hash': 'cd2bbefb6363363a2c860069ded9e79b5fabed794f0777f342cd459e7f745581'}, {'image_id': '313891_1_En_17_Fig21_HTML', 'image_file_name': '313891_1_En_17_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig21_HTML.jpg', 'caption': '(a–c) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates enlarged right hilum in mass liked dense shadow, with peripheral thickened and blurry pulmonary markings, and no obvious abnormalities of the left hilum. (b) DR demonstrates smaller right hilum after anti-tuberculosis therapy for 1 month. (c) DR demonstrates absent tumor in the right hilum and normal left hilum', 'hash': '46a1a9267e1d610faa6450929c11c8d942047467baf49ba4482ce61bb660cb30'}, {'image_id': '313891_1_En_17_Fig27a_HTML', 'image_file_name': '313891_1_En_17_Fig27a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig27a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related miliary tuberculosis. (a–b) Anteroposterior and lateral DR demonstrates diffuse miliary shadows in both lungs, which are bilaterally symmetric and in even size and distribution. (c–f) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '61497bd4be4942d8a1fc4e6710043c9d4099da58ea99f2008d49f04ec973f2b4'}, {'image_id': '313891_1_En_17_Fig79_HTML', 'image_file_name': '313891_1_En_17_Fig79_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig79_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates multiple scattered nodular shadows in both lower lungs. (b–d) Chest CT scanning demonstrates multiple dense nodular shadows with different sizes and mass shadows in both middle and lower lung fields, with clear boundaries. They are more common in the dorsal segments', 'hash': '7f1588a4af3d4fadaf1f33e3bac3f100d4b2003206bd1bc2ae262b602fd3fe79'}, {'image_id': '313891_1_En_17_Fig51a_HTML', 'image_file_name': '313891_1_En_17_Fig51a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig51a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related staphylococcus aureus pneumonia. (a) Chest X-ray demonstrates large flaky high density shadow in the left middle-lower lung field, with central transparent areas in different sizes and blurry boundaries; parenchyma changes of the left lower lung, predominantly in the posterior and exterior basal segments; unobstructed brounchus and thickened adjacent pleura. (b–d) CT scanning demonstrates large flaky shadows in fan shaped distribution along the bronchus in the left middle-lower lung, with gas containing cavities and high density shadows; and thickened adjacent pleura of the lateral chest wall. (e, f) CT scanning of the mediastinal window demonstrates large flaky fan shaped parenchymal shadows in the left middle-lower lung field, with ventilation shadows in them; and thickened pleura of the lateral chest wall. (g, h) Pathological examination showed staphylococcus aureus', 'hash': '00d7fc70edd23ceb6f012159d4bae8563ec20a036cc91fd99d91cdbc08f23126'}, {'image_id': '313891_1_En_17_Fig90_HTML', 'image_file_name': '313891_1_En_17_Fig90_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig90_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows in the lungs that fuse into mass in parenchymal shadows, with the hilum as the center and distributing bilaterally symmetric like butterfly wings. There are also multiple clustering cavities or singular large cavity in both lungs', 'hash': '6742eff5e10355ff74a6fe215cff47247a9d12856c453a35fd6d6742f8f0ac2e'}, {'image_id': '313891_1_En_17_Fig94a_HTML', 'image_file_name': '313891_1_En_17_Fig94a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig94a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a–f) CT scanning demonstrates multiple nodules and small cavities in honeycomb liked shadows and infiltrative parenchyma shadows in the right lung; flaky transparent areas (bullae of lung) in the right anterior margin of the heart and in the outer zone of the left lung near lateral chest wall', 'hash': '4bf177cdb556a837613a60231e962930fcd4acf34d7177f738cb57925ca917e1'}, {'image_id': '313891_1_En_17_Fig35b_HTML', 'image_file_name': '313891_1_En_17_Fig35b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig35b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates diffuse large flaky dense shadows in the right upper lung with transparent areas in them. (b–c) CT scanning of the pulmonary window demonstrates large flaky shadows with increased density in the right upper lung, with multiple satellite lesions scattering around. (d, e) CT scanning of the mediastinal window demonstrates large flaky parenchymal shadows in the right upper lung with air bronchogram sign as well as mediastinal lymphadenectasis', 'hash': '8b68f2c89884110f18b2b9641154ae26362875fb18db9a64b4320edd5c13bba4'}, {'image_id': '313891_1_En_17_Fig26a_HTML', 'image_file_name': '313891_1_En_17_Fig26a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig26a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '1bd3c2b9622fa99531543c1b9d456f58ff2945c6fa4bb44043fadb51fa9c8db6'}, {'image_id': '313891_1_En_17_Fig31_HTML', 'image_file_name': '313891_1_En_17_Fig31_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig31_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, fusion of some military shadows into patchy or mass liked shadow, diffusely distributed lung lesions', 'hash': '3bf8714e005c1ebc72eb46fac228838fd6436f0a1dd5d6a8bd085a14fddd1170'}, {'image_id': '313891_1_En_17_Fig69_HTML', 'image_file_name': '313891_1_En_17_Fig69_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig69_HTML.jpg', 'caption': '(a, b) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the medial basal segment of the right lower lung, irregular nodular shadows in the cavities, and surrounding fused miliary infiltration shadows', 'hash': 'db839a28accf7944530e9940a7c7afb2b7b3c7a4423308b863fae87f0c08c29a'}, {'image_id': '313891_1_En_17_Fig80_HTML', 'image_file_name': '313891_1_En_17_Fig80_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig80_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a, b) Anteroposterior and lateral DR demonstrate a huge dense mass shadow in the left lower lung, with clear boundary. (c) CT scanning of the pulmonary window demonstrates round liked high density shadow in the left lower lung near left chest wall, with even density. (d) CT scanning of the mediastinal window demonstrates round liked soft tissue density shadows in the left lower lung near left chest wall, with even density, lobulation, and surrounding thick spikes', 'hash': 'ea2ef199cee39dce2b4a8a06bcdcce274a6fd8796c2efbfaf940d6d05fe48c40'}, {'image_id': '313891_1_En_17_Fig43b_HTML', 'image_file_name': '313891_1_En_17_Fig43b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig43b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related tuberculous pleuritis. (a) DR demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (b) CT scanning of the pulmonary window demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (c) CT scanning of the mediastinal window demonstrates encapsulated fluid density shadow in the pleura of the right lateral chest wall', 'hash': '582e0f2e161551b97de13a60d6afed8cc613b9b04bfb136458587da830b2ecf0'}, {'image_id': '313891_1_En_17_Fig16_HTML', 'image_file_name': '313891_1_En_17_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig16_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple fibrous cords liked shadows in lungs, multiple patchy parenchyma shadows and ground glass liked density shadows in both upper lobes, with multiple transparent areas in them. The bronchial walls are thickened in the anterior and posterior segments of the right upper lobe as well as in the lingual segment of the left lung', 'hash': '214979f5c447a9b40ebd0772cff663eb275052bf5fe8132456329ffacdc20c9c'}, {'image_id': '313891_1_En_17_Fig109_HTML', 'image_file_name': '313891_1_En_17_Fig109_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig109_HTML.jpg', 'caption': '(a, b) HIV/AIDS related lymphoma. (a, b) CT scanning demonstrates a huge soft tissue mass shadow in the left lateral chest wall, with a maximal size of about 7.7\u2009×\u200913.0 cm and occupying 30 sections with 8 mm in thickness of each section and with the upmost to the supraclavicular area and the bottom in the level of thoracic 12th vertebral body in the lower chest wall. There are also large quantity left pleural effusion and parenchymal changes of the left lower lobe with atelectasis. In the left chest cavity, large quantity liquid density shadows can be found, with compressed lung tissues to the hilum. By puncture and biopsy of the subaxillary mass, the diagnosis is defined as diffuse large B cell lymphoma', 'hash': '6d67a094843ca970dc50c93d50e7d1038c2a389c96e1772f425fa9dbc9d3a3ea'}, {'image_id': '313891_1_En_17_Fig19_HTML', 'image_file_name': '313891_1_En_17_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig19_HTML.jpg', 'caption': '(a) Gross observation in autopsy demonstrates disseminated pulmonary tuberculosis, with grayish white military nodules in diffuse distribution in the lung tissues section. (b) It is demonstrated that mycobacteriumavium-intracellularcomplex infection in the lung tissue, with atypical tuberculosis nodules and acid-fast staining positive (left top). There are a subnodular giant cell, eosinophilic inclusion bodies in the nucleus and bradyzoites in cytoplasm of T. gondii. HE\u2009×\u2009100. (c) HE demonstrates mycobacteriumavium-intracellularcomplex infection, with atypical tuberculosis nodular changes, HE\u2009×\u2009200', 'hash': 'fac712a77d78563a8ebac012fe6c9f2f74ab72b1d36bf9e0c30462450f24c87d'}, {'image_id': '313891_1_En_17_Fig92a_HTML', 'image_file_name': '313891_1_En_17_Fig92a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig92a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of the lesions in the right lung into plaque liked shadows with clear boundaries, and multiple round liked small cavity shadows and inflammatory infiltrative shadows in both lungs', 'hash': '981e19f8709c64fb0f850afd293a3dfdb67ec16a8d75e3f2bf19cd69116366cd'}, {'image_id': '313891_1_En_17_Fig41_HTML', 'image_file_name': '313891_1_En_17_Fig41_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig41_HTML.jpg', 'caption': 'HIV/AIDS related tuberculous pleuritis. DR demonstrates arch shaped dense shadows with higher exterior density and lower interior density in the right lower lung field and covered right edge of the heart', 'hash': '3381f76804304950a36ba44865a5651168e2f9b43c451a23d390d065bfc52e80'}, {'image_id': '313891_1_En_17_Fig56a_HTML', 'image_file_name': '313891_1_En_17_Fig56a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig56a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates huge round large flaky shadows with increased density in the left lower lung, enlarged and thickened hilum and covered right heart edge. (c, d) DR reexamination after treatment for 1 week demonstrates flocculent shadow in the left lower lung, improved than those before the treatment (a, b). (e) DR reexamination after treatment demonstrates flocculent liked shadows in the left lower lung, obviously improved than before the treatment (c, d)', 'hash': '8c2f7c50d0562920efd9257451f8cc2d4dda042eaa3768d3fb1455a7092edf94'}, {'image_id': '313891_1_En_17_Fig93a_HTML', 'image_file_name': '313891_1_En_17_Fig93a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig93a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates diffuse small cavity in honeycomb liked and infiltrative parenchyma shadows, with the hilum as the center to distribute bilaterally symmetric like butterfly wings; multiple honeycomb liked cavity shadows in both lungs. (e–h) CT scanning reexamination demonstrates large irregular thick-wall cavities in the right lung, surrounding scattering nodular, honeycomba liked and infiltrative shadows after anti-PM infection treatment for 3 months', 'hash': 'eb824267db9288c03e6cffae4cde8b6f47b3bda47dcad797ee4964b9011ac598'}, {'image_id': '313891_1_En_17_Fig46b_HTML', 'image_file_name': '313891_1_En_17_Fig46b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig46b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates large flaky dense shadows in the middle-outer zone of the left middle lung field, and narrowed left bronchus. (d–f) CT scanning demonstrates large flaky shadows with uneven density in the left lateral chest wall and even lower density shadow in them', 'hash': '97eaf0337e0212b917644691da5093524803db5d92384afd57bfc5803cb125e0'}, {'image_id': '313891_1_En_17_Fig39_HTML', 'image_file_name': '313891_1_En_17_Fig39_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig39_HTML.jpg', 'caption': '(a–d) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung, periphery crab feet liked or cords liked shadows due to pleural traction and satellite lesions. (c, d) CT scanning of the mediastinal window demonstrates round liked or triangle shaped thick wall cavities in the left upper lung, no nodules in the wall and peripheral nodular satellite lesions', 'hash': '614dd89032a813e240901110905f63b8b8d2530c6c7e27b0e6aab03ce47f7abb'}, {'image_id': '313891_1_En_17_Fig61_HTML', 'image_file_name': '313891_1_En_17_Fig61_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig61_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a) DR demonstrates large flaky shadow in the middle-outer zone of the left upper lung field. (b) DR demonstrates diffuse dense shadow in the left lung field, with round liked cavities shadows in them. (c–d) Reexamination after treatment demonstrates multiple cavities shadows in the middle-outer zone of the left upper lung field', 'hash': '29c84b1869c0cdabc91ee8822b014d024780586503e92fa0fdc6bed1d3b54b73'}, {'image_id': '313891_1_En_17_Fig88_HTML', 'image_file_name': '313891_1_En_17_Fig88_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig88_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a) The gross specimen demonstrates central necrotic pimples on the face. (b) Chest X-ray DR demonstrates cavities in the left upper lung, thickened lung markings in both lower lungs with accompanying multiple spots and flakes shadows. (c) Gastrointestinal barium meal radiology demonstrates left and downwards migration of the intestine due to compression. (d) Enhanced abdominal CT scanning demonstrates retroperitoneal enlarged lymph nodes that fuse into a huge mass, with ring shaped enhancement of the lymph nodes', 'hash': '72d6f61ccf9268cf07530a5a1e56a768d1d614ac854706838e783fa20f2cb2a1'}, {'image_id': '313891_1_En_17_Fig87_HTML', 'image_file_name': '313891_1_En_17_Fig87_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig87_HTML.jpg', 'caption': '(a) HE staining demonstrates lymph nodes, PM in the yeast phase, with sausage liked shape and obvious septa (HE\u2009×\u20091000). (b) GMS staining demonstrates clearly defined PMs (GMS\u2009×\u20091,000)', 'hash': '195e16d569e89c659459764942f07ae44cec9cd1fd8634e716178e34225094ab'}, {'image_id': '313891_1_En_17_Fig91a_HTML', 'image_file_name': '313891_1_En_17_Fig91a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig91a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–e) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of some lesions into honeycomb likes cavity shadows or plaque liked dense shadows. (f–h) CT scanning demonstrates large thick-wall cavity shadows in the right lung, surrounding plaque and round liked small cavity shadows and inflammatory infiltrative shadows', 'hash': '84aa8353e64cbf735c399fa64899ecd1e9b8a13620149a5aa662a21a423c07bf'}, {'image_id': '313891_1_En_17_Fig8b_HTML', 'image_file_name': '313891_1_En_17_Fig8b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig8b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates large flaky parenchyma shadows in both lungs which is more obvious in the middle and lower lobes of both lungs. There are also enlarged hilar shadows in both lungs and sharp both costophrenic angles. (b–g) CT scanning demonstrates large flaky parenchyma shadows in concentric and symmetrical distribution, bronchial shadows in them and thickened bronchial walls', 'hash': '812cc7d7992507bc22a7c06e518ff223d7e9ece757725f478a6f723b8ac030bf'}, {'image_id': '313891_1_En_17_Fig29_HTML', 'image_file_name': '313891_1_En_17_Fig29_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig29_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric and in even size and distribution. There are nodular shadows in the anterior segment of the right middle lung lobe with clear boundary', 'hash': '16cd873b8d84d3bbad635d9facea5407fe900b62efdd6f481449f4a433dfb6a0'}, {'image_id': '313891_1_En_17_Fig71_HTML', 'image_file_name': '313891_1_En_17_Fig71_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig71_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary aspergillosis infection. (a) The gross specimen demonstratesAspergillus abscess in the skin of the forearm. (b–d) CT scanning of the pulmonary window demonstrates multiple round liked nodular shadows and cavity shadows in both lungs, even thickness of cavity wall, and small nodular shadows in some cavities. (e) Pulmonary Aspergillus infection, demonstration purplish blue branches liked or grasses liked growth of hyphae, HE\u2009×\u2009400', 'hash': 'f0586168fbf7b2cd35205e1c807a3343af1ec5bac8dbe4f50308a570cd7d3552'}, {'image_id': '313891_1_En_17_Fig97_HTML', 'image_file_name': '313891_1_En_17_Fig97_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig97_HTML.jpg', 'caption': '(a) Gross observation of the fresh specimen in autopsy demonstrates pulmonary edema and congestion of cytomegalovirus pneumonia. (b) Gross observation of the formalin fixed specimen in autopsy demonstrates dark brown hard pulmonary tissues. (c, d) HE staining demonstrates large quantity cytomegalovirus inclusions in eagle eyes sign. (e) Immunohistochemical demonstrates HIV P24 antigen positive in macrophages of lung tissues (×400)', 'hash': '50e144edf7881be15e502fff23c2613760ac0172fe3ae6c56abf5ca1abf085b5'}, {'image_id': '313891_1_En_17_Fig20_HTML', 'image_file_name': '313891_1_En_17_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig20_HTML.jpg', 'caption': '(a, b) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates enlarged right hilum in nodular dense shadows with peripheral thickened and blurry pulmonary markings, and no obvious abnormalities of the left hilum. (b) DR demonstrates smaller right hilum after treatment for 1 month', 'hash': '27213b483e54de634de857225fc93f6dc05eb5a729bc751141dea3866128c8ec'}, {'image_id': '313891_1_En_17_Fig6b_HTML', 'image_file_name': '313891_1_En_17_Fig6b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig6b_HTML.jpg', 'caption': '(a-d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates flaky ground glass liked density shadows in upper lobes of both lungs, with bronchial shadows in them; flaky parenchymal shadows in the subpleural apical segment; and thickened bronchial walls in the anterior and posterior segments of the right upper lobe', 'hash': 'ba6f221be2db1160358ae94e02b0125159adca1d9ac64bff84883eae8b614970'}, {'image_id': '313891_1_En_17_Fig17b_HTML', 'image_file_name': '313891_1_En_17_Fig17b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig17b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchymal shadows and fibrous cords liked shadows in both lungs which are more obvious in both lower lungs. The trachea and bronchi are unblocked, with enlarged hilar shadows in both lungs', 'hash': 'dba27067e12ab2a752ec8a543537f427156b1a18bdc04bffa3aedbe2d3b6e7bd'}, {'image_id': '313891_1_En_17_Fig113a_HTML', 'image_file_name': '313891_1_En_17_Fig113a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig113a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Kaposi’s sarcoma. (a–d) Chest CT scanning demonstrates scattered cloudy, mass and flake liked or nodular shadows with increased density. (e) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large thick stained nucleoli, which are in line with the diagnosis of Kaposi’s sarcoma. (f–i) Cured HIV/AIDS related Kaposi’s sarcoma. (f–i) Reexamination after treatment demonstrates absent lesions in both lungs, with clear lung fields', 'hash': '192d991df0d417610162aab90c8b0e07b4c19f1436faa752263e85c3efa0f3db'}, {'image_id': '313891_1_En_17_Fig77_HTML', 'image_file_name': '313891_1_En_17_Fig77_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig77_HTML.jpg', 'caption': 'HE staining demonstrates isseminated cryptococci, the Cryptococcus is stained red after mucin carmine staining of cryptococcus neoformans spores in lungs, (HE\u2009×\u2009200)', 'hash': '882060c6f53899fb225a20d7eb5fe410195beed0a7386dc233a4632284f4717f'}, {'image_id': '313891_1_En_17_Fig78_HTML', 'image_file_name': '313891_1_En_17_Fig78_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig78_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates multiple scattered nodular and miliary shadows in both lungs. (b–d) Chest CT scanning demonstrates multiple dense nodular shadows with different sizes in both lungs, with clear boundaries. They are intensively distributed in the dorsal segment and the largest one has a diameter of about 2 cm', 'hash': 'd60cf04886c28c578ee7940f50525d5141254a1a45a5b489d53a7ae5ae27fa53'}, {'image_id': '313891_1_En_17_Fig7b_HTML', 'image_file_name': '313891_1_En_17_Fig7b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig7b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates diffusely distributed shadows with increased density in both lungs that is more obvious in the middle and lower lungs. The hilar shadows in both lungs are enlarged. Both diaphragmatic surfaces and phrenic angles are blurry. (b–d) CT scanning demonstrates flaky shadows with increased density in both lungs, with parenchymal shadows in the lingular segment of left upper lobe and in the dorsal segments of both lower lobes and bronchial shadows in them. There are also thickened bronchial walls and enlarged hilar shadows in both lungs', 'hash': '47bf3b06e99aa6482027b30084d7445e95928d39923c99fd8fe93df39c899b2d'}, {'image_id': '313891_1_En_17_Fig30_HTML', 'image_file_name': '313891_1_En_17_Fig30_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig30_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs and fusion of some military shadows, which are bilaterally symmetric and in even size and distribution', 'hash': 'ab1d4160a6a23300146e331c7eee06edf886ca73ab4514f8a59b22d04d3c303f'}, {'image_id': '313891_1_En_17_Fig1_HTML', 'image_file_name': '313891_1_En_17_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig1_HTML.jpg', 'caption': '(a) Gross specimens’ observation demonstrates foamy liquid filling in the lung tissues. (b) HE demonstrates pneumocystis in the alveolar exudates, which can be stained black by silver methenamine staining, ×400. (c) HE demonstrates the foamy substance in the alveolar space, ×400', 'hash': 'a0082be568f7c995671d0461acf0cfe32c8c36a01dbf7badc28f3cc0ab407b75'}, {'image_id': '313891_1_En_17_Fig81_HTML', 'image_file_name': '313891_1_En_17_Fig81_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig81_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates thickened lung markings in both lungs and flaky blurry shadows in the left lower lung. (b, c) CT scanning demonstrates round liked nodular and small cavity shadows in the left upper and lower lung, with clear boundaries. (d–f) Pathology demonstrates transparent substrate in lung tissues and many bi-capsular cryptococci in cytoplasm', 'hash': '3e767fbaeda72c7b7b49df4ee9daa757367932f7623507185ca8453615c8de74'}, {'image_id': '313891_1_En_17_Fig58a_HTML', 'image_file_name': '313891_1_En_17_Fig58a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig58a_HTML.jpg', 'caption': '(a–i) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) CT scanning of the pulmonary window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (c, d) CT scanning of the mediastinal window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, pulmonary atelectasis and pleural effusion, with ventilation shadows in them. (e) CT scanning of the pulmonary window after the treatment demonstrates absence of the mass shadows in the left lower lung with transverse stripes shadows, obviously improved than previous findings (a, b). (f) HE staining demonstrates thickened alveolar septa and exudates from the alveolar cavity. (g) HE staining demonstrates massive bleeding in the alveolar cavity, large quantity erythrocytes and intact cell walls. (h) HE staining demonstrates phagocytized basophilic granules in the leukocytes. (i) HP staining demonstrates purplish red Rhodococcus equi in a shape of crescent in orange red sputum', 'hash': 'fcd60ca09d86084cb78d6b91f9b3e0a51e9f479a1c27837e18c9af0f809ef13d'}, {'image_id': '313891_1_En_17_Fig57_HTML', 'image_file_name': '313891_1_En_17_Fig57_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig57_HTML.jpg', 'caption': '(a, b)HIV/AIDS related Rhodococcus equi pneumonia. (a) CT scanning of the mediastinal window demonstrates soft tissue mass shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (b) CT scanning of the pulmonary window after the treatment demonstrates absence of the soft tissue mass shadows, and flocculent liked shadow in the left lower lung, obviously improved than previous findings (a)', 'hash': '9ac02a8eb30f8314fea4211fa5a4dbfa3863c422d30e78fcb26e8eaf44e36a42'}, {'image_id': '313891_1_En_17_Fig10_HTML', 'image_file_name': '313891_1_En_17_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig10_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates large flaky and mass liked parenchyma shadows in both lungs which is more obvious in the right lung, bronchial shadows in them, and thickened bronchial walls in the middle lobe of the right lung', 'hash': 'dc81224c041dbc53a26ff01b3414f8c13098126861cf7cc0c7f10d80a7485e0c'}, {'image_id': '313891_1_En_17_Fig100_HTML', 'image_file_name': '313891_1_En_17_Fig100_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig100_HTML.jpg', 'caption': 'The structure of herpes simplex virus', 'hash': 'b0a88fbe1660ab4ddb94799e876d547c23b5686d12e31560768111a38bc71a45'}, {'image_id': '313891_1_En_17_Fig110a_HTML', 'image_file_name': '313891_1_En_17_Fig110a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110a_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '7392286985c0e8fefacf1282d1ef323dd6d64b0b536b667dfffbcbde5be28d3c'}, {'image_id': '313891_1_En_17_Fig5b_HTML', 'image_file_name': '313891_1_En_17_Fig5b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig5b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates patchy shadows with increased density in both lungs, with thickened hilar shadows in both lungs. (b–g) CT scanning demonstrates flaky ground glass liked density shadows in upper lungs and dorsal segment of both lungs, which is more obvious in the middle inner strips. There are extrapulmonary stripes transparent shadows, with some bronchial walls thickened and enlarged hilar shadows in both lungs', 'hash': 'fcd873302d30f9846ba865346820af2a06778c5dad1b50cc634281055ae78468'}, {'image_id': '313891_1_En_17_Fig47_HTML', 'image_file_name': '313891_1_En_17_Fig47_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig47_HTML.jpg', 'caption': '(a–e) HIV/AIDS related staphylococcus aureus pneumonia. (a) DR demonstrates large flaky dense shadows with increased density in the middle-inner zone of the left upper lung field, with blurry boundaries. The lung tissue are atelectatic and the mediastinum migrates leftwards. (b, c) CT scanning demonstrates large flaky dense shadows with increased density in the middle-inner zone of the left upper lung field, with blurry boundaries, with surrounding acinar or particle liked shadows that fuse into flaky shadows. (d, e) CT scanning demonstrates large flaky shadow of parenchymal changes in the middle-inner zone of the left upper lung field, with cyst liked transparent shadows and air bronchogram sign in them, as well as mediastinal lymphadenectasis', 'hash': '8e228a648d0d33ebe1db2bfa2fa7b6209cd113683b027d6ada34f161b809085a'}, {'image_id': '313891_1_En_17_Fig48_HTML', 'image_file_name': '313891_1_En_17_Fig48_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig48_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates broad band liked high density shadows in the right middle lung field, with air bronchogram sign in them. (d–f) CT scanning of the mediastinal window demonstrates broad band liked uneven parenchymal shadows in the right middle lung field, with uneven thickness of air bronchogram sign', 'hash': '6e700dc830efe216b64ed069dfb6440abf50854341b133bf0237be914bd5270f'}, {'image_id': '313891_1_En_17_Fig37_HTML', 'image_file_name': '313891_1_En_17_Fig37_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig37_HTML.jpg', 'caption': '(a, b) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a, b) DR demonstrates diffuse scattering patchy shadows with increased density, and oval thin wall cavity shadows in the right middle lung field', 'hash': 'edc3511f0cc30005fb5999c1fe7033024176b0e1b8fee607763caef6a0d9abe2'}, {'image_id': '313891_1_En_17_Fig38_HTML', 'image_file_name': '313891_1_En_17_Fig38_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig38_HTML.jpg', 'caption': '(a–d) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in both upper lungs, peripheral crab feet liked or cords liked shadows due to pleural traction with cavity shadows in them and periperal satellite lesions. (b–d) CT scanning of the mediastinal window demonstrates round liked mass shadows with high density in the cavities of the left upper lung, surrounding transparent shadows, no nodules in the walls and surrounding nodular satellite lesions. By pathological examination, the diagnosis is defined as chronic fibrous cavity pulmonary tuberculosis complicated by Aspergillus infection', 'hash': '0317a9a78d280af1069a5b797b63c3817f47607eb13976214ed710d247081a7c'}, {'image_id': '313891_1_En_17_Fig65b_HTML', 'image_file_name': '313891_1_En_17_Fig65b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig65b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related allergic pulmonary Aspergillus infection. (a–f) CT scanning of the pulmonary window demonstrates thickened central pulmonary markings in both lungs, which is turtuous and deranged with fingertip infiltration shadows. (g) DR demonstrates hyperinflation of the right lung, increased and thickened pulmonary markings and ground glass liked shadows with increased density in the right lower lung and left lung lobe', 'hash': '44f320a9216b7a9905eaaa045a44b4be59372433c9737f0ee8ded7c443134eaa'}, {'image_id': '313891_1_En_17_Fig9_HTML', 'image_file_name': '313891_1_En_17_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig9_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates large flaky parenchyma shadows in both lungs, with transparent areas in some foci. The trachea and bronchi are unblocked, with thickened bronchial walls in the middle and lower lobes', 'hash': '26b10397cecf70e4665c1abb0f2501e939a6e5d219f395c3484c7a44dae78681'}, {'image_id': '313891_1_En_17_Fig76a_HTML', 'image_file_name': '313891_1_En_17_Fig76a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig76a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning demonstrates diffuse scattered thin ground glass liked, patchy, flaky blurry shadows and cords liked shadows in both lungs, with blurry boundaries and uneven density; scattered nodular shadows in different sizes; more lesions in both upper lobes and the right middle lobe; flaky parenchyma shadows in the apical and posterior segments of right upper lobe, with air bronchogram sign in them; unobstructed opening of bronchi as well as lobar and segmental bronchi without stenosis and obstruction; lymphadenectasis in the right hilar region; detected Aspergillus fumigatus by sputum culture. (e, f) Culture for 72 h, lactic acid gossypol blue staining and microscopic observation at ×200 and ×400 demonstrate short column liked conidial head, smooth wall of conidiophores, flask-shaped top capsule and monolayer microconidiophores. (g) Culture in Paul’s medium demonstrates dark green colored colonies', 'hash': '79dde610127d242cc7f1f29fc98dd50c426df080c95629396102af54f31872c9'}, {'image_id': '313891_1_En_17_Fig86_HTML', 'image_file_name': '313891_1_En_17_Fig86_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig86_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary candida infection. (a–d) CT scanning demonstrates thickened and deranged lung markings in both lungs, diffuse small flaky or patchy shadows, fusion of some small shadows into large flaky dense shadows, with blurry boundaries, enlarged hilum and blurry structures', 'hash': 'bb5525804e3b5cc6588115cd2813109845df9b4314974ab2b55c40298ed6968a'}, {'image_id': '313891_1_En_17_Fig89_HTML', 'image_file_name': '313891_1_En_17_Fig89_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig89_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows in the lungs that fuse into mass with parenchymal shadows, with the hilum as the center and distributing bilaterally symmetric like butterfly wings. There are also multiple clustering cavities or singular large cavity in both lungs', 'hash': 'cfd1927b986a8aba818bf96427711a3743dd07195a83b88e195837af405aae79'}, {'image_id': '313891_1_En_17_Fig60_HTML', 'image_file_name': '313891_1_En_17_Fig60_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig60_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a) DR demonstrates huge sphere liked mass shadow in the middle-outer zone of the right lower lung field, with cavities shdows in them. (b–d) CT scanning demonstrates triangular dense shadow in the middle-outer zone of the right lower lung field, with its apex pointing to the hilum and round liked cavities shadows in them. (e) Reexamination after the treatment demonstrates shrinkage of the huge sphere liked mass shadow in the middle-outer zone of the right lower lung field, with closure of the cavities', 'hash': '9020727e51b9a8522ea37dd579ce73bd9a417d327bcb313836c96e1fa3bd209f'}, {'image_id': '313891_1_En_17_Fig2b_HTML', 'image_file_name': '313891_1_En_17_Fig2b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig2b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered miliary increased density shadows in both lungs, with even size, density and distribution. The shadows of both hila are dense, with sharp both costophrenic angles. (b–f) CT scanning demonstrates scattered miliary nodular shadows in both lungs, which is more obviously in the middle pulmonary strip and with quite even size and density. Trachea and bronchi are unblocked', 'hash': 'ab808d6adb73be9c9efd977cd27ef54cace943f5143068db354c7d287374a50d'}, {'image_id': '313891_1_En_17_Fig13b_HTML', 'image_file_name': '313891_1_En_17_Fig13b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig13b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, transparent areas in them and unblocked trachea and bronchi', 'hash': '2f728d8163ffe4c88ed77f38f8d2e52cb2281b7f3a54af1e9ef328c17a26db3e'}, {'image_id': '313891_1_En_17_Fig28_HTML', 'image_file_name': '313891_1_En_17_Fig28_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig28_HTML.jpg', 'caption': '(a–b) HIV/AIDS related miliary tuberculosis. (a) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric and in even size and distribution. (b) CT scanning of the mediastinal window demonstrates round liked nodular shadows in the right lower lung. CT guided puncture for biopsy is performed to define the diagnosis', 'hash': '1ae71db3f6eebb2e460b8f3b777873d5e7fcf066436bf3a85ef8123aff3f39a9'}, {'image_id': '313891_1_En_17_Fig105b_HTML', 'image_file_name': '313891_1_En_17_Fig105b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig105b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary toxoplasmosis. (a–d) CT scanning demonstrates thickened pulmonary markings in both lungs, which can be enhanced to extend into the middle and outer zones of lungs, in grid liked appearance that is more obvious in the dorsal segment of the lungs. (e) It is demonstrated to have clustering toxoplasma tachyzoites', 'hash': '78ad5a602c243399be530b578f5858d7393984c75f2f978c1dd02f12b26b8836'}, {'image_id': '313891_1_En_17_Fig99_HTML', 'image_file_name': '313891_1_En_17_Fig99_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig99_HTML.jpg', 'caption': '(a, b) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates enlarged right hilus, thickened and deranged lung markings. (b) Plain CT scanning demonstrates mass shadows in the right hilus, spots shadows in the right middle and lower lobes, and patchy shadows in the lingual segment of the left lung', 'hash': '996d2e340f8971525deb4ef2a9312fe4a696f4d7f6bf28ca091e8c767b96b1d4'}, {'image_id': '313891_1_En_17_Fig3b_HTML', 'image_file_name': '313891_1_En_17_Fig3b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig3b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy and scattered miliary increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of the lower lung field, with some fused in thin cloudy shadows', 'hash': '8c1d9dac035274e484303c9deb64a07fed7806c66acaf49b860164feb6d461fc'}, {'image_id': '313891_1_En_17_Fig70_HTML', 'image_file_name': '313891_1_En_17_Fig70_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig70_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window demonstrates a huge cavity shadow in the dorsal segment of the right lower lung, large nodular shadows in it, liquid gas level in the basal cavity, and the evenly thick wall. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates a huge cavity shadow in the dorsal segment of the left lung, multiple large nodular shadows in it, and involved pleura of the lateral chest wall', 'hash': '967426acae68b8d57372efde07d76dd6ad696b10cc5bb64fb67bd9af43a1b0c8'}, {'image_id': '313891_1_En_17_Fig108_HTML', 'image_file_name': '313891_1_En_17_Fig108_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig108_HTML.jpg', 'caption': 'HIV/AIDS related lymphoma. DR demonstrates widened upper middle mediastinum in a dense shadow, enlarged and thickened hilum, thickened and blurry pulmonary markings with diffuse ground glass liked changes', 'hash': '449c992b619237febe63b1617b26f78de511c69c5d1c86ddbd66631790a3e3ce'}, {'image_id': '313891_1_En_17_Fig18_HTML', 'image_file_name': '313891_1_En_17_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig18_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates multiple patchy shadows with increased density in both lungs which are more obvious in both middle and lower lungs. The hilar shadows in both lungs are enlarged, with sharp both costophrenic angles. (b–d) CT scanning demonstrates multiple patchy and mass liked parenchyma shadows in both lungs, ground glass density shadows in the apical segment of both upper lobes, transparent areas in the medial segment of the right middle lobe as well as in the lingual segment of the left upper lobe, and unobstructed trachea and bronchi', 'hash': '18239548bfc8a180d3460173e2f66f27c6ff38e464607d7ec3eb2a837a1382c9'}, {'image_id': '313891_1_En_17_Fig67b_HTML', 'image_file_name': '313891_1_En_17_Fig67b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig67b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows. (e–h) Reexamination of the pulmonary window after 3 months treatment demonstrates multiple scattered round liked nodular shadows and thick wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows which obviously increase and enlarge compared to previous lesions, with accompanying infiltration shadows around the lesions', 'hash': 'f70faec5b814f1fa9555182e0f5414a33838b2496e4da16dc69e0c237676eb30'}, {'image_id': '313891_1_En_17_Fig115a_HTML', 'image_file_name': '313891_1_En_17_Fig115a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig115a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lung cancer. (a–f) CT scanning demonstrates diffuse soft tissue density shadows in left upper lung, round liked mass shadows in the middle lung field, thickened pleura in the lateral chest wall with adhesion, and strip liked liquid density shadows', 'hash': '08de7c80ca9fdc7641723bbb9689498f65631a1a2ee1f499cda653be3ea3d358'}, {'image_id': '313891_1_En_17_Fig40_HTML', 'image_file_name': '313891_1_En_17_Fig40_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig40_HTML.jpg', 'caption': '(a, b) HIV/AIDS related endobronchial tuberculosis. (a, b) Chest CT scanning demonstrates narrowed left major bronchus, irregular thickening of the brounchial wall, multiple irregular flaky, patchy and military shadows in the posterior apical, anterior and lingual segments of the left upper lung. Bronchobierscopy demonstrates narrowed left major bronchus, which is possibly caused by endobronchial tuberculosis', 'hash': '4e416b52d4cb1a2790ee8ad419d525b4e0b37740624cb136f4f5d66c98344651'}, {'image_id': '313891_1_En_17_Fig106b_HTML', 'image_file_name': '313891_1_En_17_Fig106b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig106b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related lymphoma. (a–b) DR demonstrates enlarged and thickened left hilum in a huge mass shadow. High KV demonstrates a huge mass shadow in the hilum. (c–h) CT scanning of the pulmonary window demonstrates a huge high density mass shadow in the left hilum, surrounding nodular fusion shadows in the lung tissues. CT scanning of the mediastinal window demonstrates a huge high density mass shadow in the left hilum, with air bronchogram sign in the shadow', 'hash': '157c65f2ce36513c7bad3d16abf703fde23671a6d95e1da5b62342efd5b516bb'}, {'image_id': '313891_1_En_17_Fig75a_HTML', 'image_file_name': '313891_1_En_17_Fig75a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig75a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval or sphere shaped nodular shadows in the cavities with smooth boundaries. (e, f) Reexamination after treatment demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval nodular shadows in the cavity with smooth boundaries. Compared to the previous imaging findings, the lesions are shrunk, with improved surrounding infiltration', 'hash': 'd2c91d61cbf8a801eed1951a78b54e9b966e9be37aee83d7582af7a496143832'}, {'image_id': '313891_1_En_17_Fig66b_HTML', 'image_file_name': '313891_1_En_17_Fig66b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig66b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates large flaky shadows with increased density in the right upper lung, with blurry boundaries; round liked or sphere shaped mass shadows in the right lower lung, with uneven density. (b–e) CT scanning of the pulmonary window demonstrates multiple round liked thick-wall cavities in the dorsal segment of the right lower lung, with small nodular shadow adhering on the cavity wall; and surrounding small nodular shadows and infi ltration shadows. (f, g) Coronal CT scanning reconstruction demonstrates a huge thick-wall cavity in the right upper lung, with irregular thickness of the wall; round liked cavity shadows in the right lower lung, with thick and multilocular walls; and flaky shadows with increased density in the outer zone of the left lower lung', 'hash': 'fe0cc9e767d47fe24d043db5792869e260b44f40097a6c4d26c923e91ef70b0b'}, {'image_id': '313891_1_En_17_Fig98a_HTML', 'image_file_name': '313891_1_En_17_Fig98a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig98a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates thickened lung markings in both lungs, which extend to the outer zone of the lungs. (b) DR demonstrates thickened and deranged lung markings in both lungs with nodular blurry shadows; and cloudy shadows in lung fields. (c, d) CT scanning demonstrates thickened lung markings in both lungs, with diffuse nodular shadows; and cloudy changes in lung fields. (e) HE staining demonstrates cytomegalovirus inclusions', 'hash': 'adcabf812efa2a551bb7a968e7cf0afcc7677ffb9adf3d1a40a65675496e4552'}, {'image_id': '313891_1_En_17_Fig50_HTML', 'image_file_name': '313891_1_En_17_Fig50_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig50_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Staphylococcus aureus pneumonia. (a) DR demonstrates large flaky dense shadow in the right middle-upper lung field, with blurry boundary. (b, c) CT scanning demonstrates large flaky dense shadow in the right middle upper lung field, with blurry boundary. (d, e) CT scanning demonstrates large flaky dense shadow in the right middle upper lung field, with cystic transparent area in it. (f) Reexamination demonstrates obviously improved pulmonary lesions in the right lung after anti-bacteria treatment for 3 weeks', 'hash': 'bb5e00f8d7a7c6c4308ca4e5024daa75df1bf9a0a88359faa7e2ee91a6c5f156'}, {'image_id': '313891_1_En_17_Fig114a_HTML', 'image_file_name': '313891_1_En_17_Fig114a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig114a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related Kaposi’s sarcoma. (a–d) CT scanning demonstrates scattered cloudy mass and flakes liked or nodular shadows with increased density in both lungs with uneven density and unclear boundaries, fusion and parenchymal changes of some lesions, more lesions in the lower lobe of both lungs and mostly with parenchymal changes. (e, f) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large and thick stained nucleoli, which are in line with the manifestations of Kaposi’s sarcoma. (g, h) Immunohistochemical demonstrates positive of C3 and C4', 'hash': '5d7437deda7758de05e56f8172703b4659fa4eeebdc50c92456867e7bfdb2691'}, {'image_id': '313891_1_En_17_Fig107b_HTML', 'image_file_name': '313891_1_En_17_Fig107b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig107b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related lymphoma. (a–e) CT scanning of the pulmonary and mediastinal windows demonstrates multiple round liked nodular shadows with increased density in both lung fields, with clear boundaries; large soft tissue mass shadows in the right lower lung, with slightly lobulated boundaries and spikes. (f–i) CT scanning of the pulmonary and mediastinal windows for reexamination after radiation therapy demonstrates shrinkage of intrapulmonary nodules and masses', 'hash': 'a7c148d3f71f853c603d1730a516c4b571960bd1e6296b96b6418a73f3663e33'}] | {'313891_1_En_17_Fig1_HTML': ['By naked eyes observation, there are extensive and diffuse invasion of lungs, which is soft like waterlogged sponge and in milky white with black spots. The filled foamy substance in the alveoli and bronchioles is a mixture of necrotic fungus and immunoglobulin. The alveolar septum has infiltration of plasma cells and lymphocytes, resulting in thickened alveolar septa up to 5–20 times as the normal thickness that occupy 3/4 of the entire lung volume. The cysts are firstly located in the macrophage cytoplasm of the alveolar septa. Subsequently, the alveolar cells containing cysts sheds off into the alveolar space. After the rupture of the cystic wall, sporozoite is discharged to turn into free trophozoites, which gains its access into the alveolar space. The alveolar exudates include plasma cells, lymphocytes and histocytes (Fig. <xref rid="313891_1_En_17_Fig1_HTML" ref-type="fig">17.1a–c</xref>).\n).\nFig. 17.1(a) Gross specimens’ observation demonstrates foamy liquid filling in the lung tissues. (b) HE demonstrates pneumocystis in the alveolar exudates, which can be stained black by silver methenamine staining, ×400. (c) HE demonstrates the foamy substance in the alveolar space, ×400\n'], '313891_1_En_17_Fig19_HTML': ['If the necrotic lesions erode the blood vessels, tubercle bacilli can cause systemic miliary tuberculosis along with blood flow, including brain, bones and kidneys. Large quantity sputum containing tubercle bacilli gains its access into the gastrointestinal tract. It can also cause intestinal tuberculosis and peritoneal tuberculosis. Pulmonary tuberculosis can cause tuberculosis pleurisy via direct spreading to the pleura (Fig. <xref rid="313891_1_En_17_Fig19_HTML" ref-type="fig">17.19a–c</xref>).\n).\nFig. 17.19(a) Gross observation in autopsy demonstrates disseminated pulmonary tuberculosis, with grayish white military nodules in diffuse distribution in the lung tissues section. (b) It is demonstrated that mycobacteriumavium-intracellularcomplex infection in the lung tissue, with atypical tuberculosis nodules and acid-fast staining positive (left top). There are a subnodular giant cell, eosinophilic inclusion bodies in the nucleus and bradyzoites in cytoplasm of T. gondii. HE\u2009×\u2009100. (c) HE demonstrates mycobacteriumavium-intracellularcomplex infection, with atypical tuberculosis nodular changes, HE\u2009×\u2009200\n'], '313891_1_En_17_Fig45_HTML': ['Pneumonia caused by inhaled staphylococcus aureus through the respiratory tract often shows lesions in the large lobes or extensive fusion of bronchopneumonia lesions. Bronchial and alveolar rupture allows gas to enter the pulmonary interstitium, which is communicated with the bronchi. In the cases of bronchiolar blockage by necrotic tissues or pus, the one-way valve effect is formed to cause tension pulmonary emphysema. In the cases with superficial pulmonary emphysema with excessively high tension, it ruptures to form pneumothorax or pyopneumothorax, as well as bronchooleural fistula (Fig. <xref rid="313891_1_En_17_Fig45_HTML" ref-type="fig">17.45a, b</xref>).\n).\nFig. 17.45(a, b) HIV/AIDS related Staphylococcus aureus pneumonia. (a) Gross specimen observation demonstrates bilateral purplish brown lesions, patchy white infiltration at the base of the lungs. (b) HE staining demonstrates alveolar diffuse lesions, exudation of the serous fluid and inflammatory cells in the alveolar cavity, and alveolar wall congestion\n'], '313891_1_En_17_Fig64_HTML': ['Aspergillus commonly violates bronchus and lung, with involvements of rhinal sinuses, external auditory canal, eye and skin. Otherwise, it disseminates to organs of the body along with blood flow. The early lesions are diffuse infiltrative and exudative changes. And advanced lesions are necrosis, pyogenesis or granuloma. Large quantity hyphae can be found in the lesions. The hyphae penetrate the blood vessels to cause vasculitis, perivascular inflammation and thrombosis. And thrombosis can cause ischemia and necrosis of the tissue. According to the pathological changes and imaging findings, it can be divided into three major types: vascular invasion type, bronchopneumonia type and allergic bronchopulmonary aspergillosis type. (1) The vascular invasion type is the result caused by toxins released in the process of aspergillus spreading extensively from the primary focus to the lungs. Vascular infiltration of the pulmonary parenchyma and coagulative necrosis are believed to be the cause of vascular occlusion and pulmonary infarction. (2) Bronchopneumonia type is acute bronchitis caused by inhalation of Aspergillus spores. In the cases of hyphae invasion into the lung tissues, extensive infiltrative pneumonia or focal granuloma are resulted in. It can also cause necrosis, pyogenesis and multiple small abscesses. Spherical pulmonary aspergillosis is often secondary to bronchiectasis, tuberculosis, carcinous cavity and other lung diseases. Mycelia multiply and gather in the cavities of the lungs to form a spherical mass with fibrin and mucosal cells, which are called aspergillar glomera, which do not invade the lung tissue. (3) Allergic bronchopulmonary aspergillosis type is the proliferation and germination of inhaled Aspergillus spore in the airway, often showing obvious related mucosal lesions and eventually resulting in bronchiectasis (Fig. <xref rid="313891_1_En_17_Fig64_HTML" ref-type="fig">17.64a–c</xref>).\n).\nFig. 17.64(a) Gross observation demonstrates dark brown lungs in appearance. (b, c) Thology demonstrates hemorrhage and edema of the lung tissue and focal necrosis, with large quantity Aspergillus hyphae and spores in the surrounding area of the necrosis (Combined with pulmonary CMV infection)\n'], '313891_1_En_17_Fig77_HTML': ['In the early stage of cryptococcal infection, only a mild inflammatory reaction or diffuse infiltrative exudative changes occur. But in the advanced stage, necrosis, suppuration or granuloma is formed. Large quantity hyphae can be found in the focus. In the cases with hyphae penetrating the blood vessels, vasculitis, perivascular inflammation and thrombosis occur. And thrombosis leads to ischemia and necrosis of the tissue (Fig. <xref rid="313891_1_En_17_Fig77_HTML" ref-type="fig">17.77</xref>).\n).\nFig. 17.77HE staining demonstrates isseminated cryptococci, the Cryptococcus is stained red after mucin carmine staining of cryptococcus neoformans spores in lungs, (HE\u2009×\u2009200)\n'], '313891_1_En_17_Fig97_HTML': ['Cytomegalovirus pneumonia has extensive pathological changes in the lungs. Pathologically, it shows interstitial pneumonia, with the lesions randomly blood borne distributing in the lungs. The distribution can be diffuse, panlobular or focal. The target cells of pathological changes include alveolar cells and macrophages. Diffused pulmonary interstitial edema and fibrosis as well as alveolar swelling, focal necrosis, bleeding and hyperplasia occur after CMV infections to cause hypoxemia. Gross observation of fresh specimens demonstrates pulmonary surface edema and flaky blooding spots. Fixed specimens demonstrate brown hard lung tissues. Under a microscope, pulmonary interstitial congestion as well as infiltration of lymphocytes and mononuclear cells can be found, with the involved epithelial cells enlarged. In the pulmonary interstitium and alveoli, there are intranuclear inclusions, cytoplasmic inclusions and fluid containing abundant proteins. The classical intranuclear inclusions can be found in the cells, purplish red or purplish blue, round or oval, with surrounding halos in eagle eyes sign. Atypical cytomegalic inclusions in cells are slender, long and round liked with abundant cytoplasm and accentric nucleolus, which are blurry, unclear and atypical (Fig. <xref rid="313891_1_En_17_Fig97_HTML" ref-type="fig">17.97a–e</xref>). Immunohistochemitry demonstrates HIV P24 antigen positive.\n). Immunohistochemitry demonstrates HIV P24 antigen positive.\nFig. 17.97(a) Gross observation of the fresh specimen in autopsy demonstrates pulmonary edema and congestion of cytomegalovirus pneumonia. (b) Gross observation of the formalin fixed specimen in autopsy demonstrates dark brown hard pulmonary tissues. (c, d) HE staining demonstrates large quantity cytomegalovirus inclusions in eagle eyes sign. (e) Immunohistochemical demonstrates HIV P24 antigen positive in macrophages of lung tissues (×400)\n']} | HIV/AIDS Related Respiratory Diseases | [
"HIV/AIDS related pneumocystis carnii pneumonia (PCP)",
"HIV/AIDS related pulmonary bacterial infections",
"HIV/AIDS related pulmonary fungal infections",
"HIV/AIDS related pulmonary virus infections",
"HIV/AIDS related pulmonary parasitic diseases",
"HIV/AIDS related pulmonary neoplasm"
] | None | 1380524400 | None | null | other | PMC7121050 | null | null | [
""
] | Radiology of HIV/AIDS. 2013 Sep 30;:377-535 | NO-CC CODE |
|
(a–f) HIV/AIDS related miliary tuberculosis. (a–b) Anteroposterior and lateral DR demonstrates diffuse miliary shadows in both lungs, which are bilaterally symmetric and in even size and distribution. (c–f) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution | 313891_1_En_17_Fig27b_HTML | 7 | e272956e522e945d068939f056c637c5a636df520c687deeac9d40f8cb06834e | 313891_1_En_17_Fig27b_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
782,
263
] | [{'image_id': '313891_1_En_17_Fig115b_HTML', 'image_file_name': '313891_1_En_17_Fig115b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig115b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lung cancer. (a–f) CT scanning demonstrates diffuse soft tissue density shadows in left upper lung, round liked mass shadows in the middle lung field, thickened pleura in the lateral chest wall with adhesion, and strip liked liquid density shadows', 'hash': '37ffef88f4c6dffdd2849b9994419efe1bf8f369ad111d82071f2f004a9fa43f'}, {'image_id': '313891_1_En_17_Fig106a_HTML', 'image_file_name': '313891_1_En_17_Fig106a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig106a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related lymphoma. (a–b) DR demonstrates enlarged and thickened left hilum in a huge mass shadow. High KV demonstrates a huge mass shadow in the hilum. (c–h) CT scanning of the pulmonary window demonstrates a huge high density mass shadow in the left hilum, surrounding nodular fusion shadows in the lung tissues. CT scanning of the mediastinal window demonstrates a huge high density mass shadow in the left hilum, with air bronchogram sign in the shadow', 'hash': '1ff6a74f6517ed666fda8da1eb38cd58b7d92c3687c533350df4caf4cb7ba7d7'}, {'image_id': '313891_1_En_17_Fig67a_HTML', 'image_file_name': '313891_1_En_17_Fig67a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig67a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows. (e–h) Reexamination of the pulmonary window after 3 months treatment demonstrates multiple scattered round liked nodular shadows and thick wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows which obviously increase and enlarge compared to previous lesions, with accompanying infiltration shadows around the lesions', 'hash': '75b2dd5456ce09da0ace0b9787ea5a36d49c80e174314762343564032297b51c'}, {'image_id': '313891_1_En_17_Fig14_HTML', 'image_file_name': '313891_1_En_17_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig14_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, mass and flakes of parenchymal shadows in the posterior segment of the right upper lobe and in the dorsal segment of both lower lobes which is more obvious in the right lung, and bronchial shadows in them', 'hash': 'bc4343d2071f380a05855c1e658dc05d90d8ae123e988cfe12c3e65526b3336c'}, {'image_id': '313891_1_En_17_Fig104_HTML', 'image_file_name': '313891_1_En_17_Fig104_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig104_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymphoid interstitial pneumonia. (a–f) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs in reticular appearance, with accompanying multiple small nodular shadows, fusion of some nodules into flaky shadows, and ground glass liked changes in the lung fields', 'hash': '4883f041ed6e05ad0ce9ee6734fea4171aae151209ba36cbce94c8434c86f174'}, {'image_id': '313891_1_En_17_Fig98b_HTML', 'image_file_name': '313891_1_En_17_Fig98b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig98b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates thickened lung markings in both lungs, which extend to the outer zone of the lungs. (b) DR demonstrates thickened and deranged lung markings in both lungs with nodular blurry shadows; and cloudy shadows in lung fields. (c, d) CT scanning demonstrates thickened lung markings in both lungs, with diffuse nodular shadows; and cloudy changes in lung fields. (e) HE staining demonstrates cytomegalovirus inclusions', 'hash': '489286db9d367c09fbc842e4d1ba093d9caa6ded75760e9e1a70e05a86f43979'}, {'image_id': '313891_1_En_17_Fig53_HTML', 'image_file_name': '313891_1_En_17_Fig53_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig53_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) Anteroposterior and lateral DR demonstrates enlarged and thickened left hilum, and large flaky blurry shadows with increased density in the left lower lung. (c, d) Reexamination demonstrates normal lungs after antibiotic treatment', 'hash': 'd9cd861c21f1100d02e20014901c7e4a9a9bcad2e4ddcd3c731b50168d8782be'}, {'image_id': '313891_1_En_17_Fig114b_HTML', 'image_file_name': '313891_1_En_17_Fig114b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig114b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related Kaposi’s sarcoma. (a–d) CT scanning demonstrates scattered cloudy mass and flakes liked or nodular shadows with increased density in both lungs with uneven density and unclear boundaries, fusion and parenchymal changes of some lesions, more lesions in the lower lobe of both lungs and mostly with parenchymal changes. (e, f) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large and thick stained nucleoli, which are in line with the manifestations of Kaposi’s sarcoma. (g, h) Immunohistochemical demonstrates positive of C3 and C4', 'hash': '586be9acfd2434fad0db1a2ffaba9ac72eb8eb799b76acdaeac2730c48c45020'}, {'image_id': '313891_1_En_17_Fig107a_HTML', 'image_file_name': '313891_1_En_17_Fig107a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig107a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related lymphoma. (a–e) CT scanning of the pulmonary and mediastinal windows demonstrates multiple round liked nodular shadows with increased density in both lung fields, with clear boundaries; large soft tissue mass shadows in the right lower lung, with slightly lobulated boundaries and spikes. (f–i) CT scanning of the pulmonary and mediastinal windows for reexamination after radiation therapy demonstrates shrinkage of intrapulmonary nodules and masses', 'hash': '4ca6acd1461c3d7b80869d7d33bd1a3d91ecd1a0dc1b5c7baecc0bfbcf817449'}, {'image_id': '313891_1_En_17_Fig75b_HTML', 'image_file_name': '313891_1_En_17_Fig75b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig75b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval or sphere shaped nodular shadows in the cavities with smooth boundaries. (e, f) Reexamination after treatment demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval nodular shadows in the cavity with smooth boundaries. Compared to the previous imaging findings, the lesions are shrunk, with improved surrounding infiltration', 'hash': 'b1a96158009afcb5e673cf31f9243ca598c763c294bbdc7479a918fb36b031e8'}, {'image_id': '313891_1_En_17_Fig25d_HTML', 'image_file_name': '313891_1_En_17_Fig25d_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25d_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '1e7425ad1ac60b1c612434d02bbe7d48ba0fb82e0642b09b8771b4fea9a7a4c2'}, {'image_id': '313891_1_En_17_Fig66a_HTML', 'image_file_name': '313891_1_En_17_Fig66a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig66a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates large flaky shadows with increased density in the right upper lung, with blurry boundaries; round liked or sphere shaped mass shadows in the right lower lung, with uneven density. (b–e) CT scanning of the pulmonary window demonstrates multiple round liked thick-wall cavities in the dorsal segment of the right lower lung, with small nodular shadow adhering on the cavity wall; and surrounding small nodular shadows and infi ltration shadows. (f, g) Coronal CT scanning reconstruction demonstrates a huge thick-wall cavity in the right upper lung, with irregular thickness of the wall; round liked cavity shadows in the right lower lung, with thick and multilocular walls; and flaky shadows with increased density in the outer zone of the left lower lung', 'hash': 'efec688fc6d0fd9fc9188edcc4a4bb040754e9c9e3261fcacec068f3bfd0252f'}, {'image_id': '313891_1_En_17_Fig63_HTML', 'image_file_name': '313891_1_En_17_Fig63_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig63_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Rhodococcus equi pneumonia. (a) Pulmonary CT scanning demonstrates a mass shadow in the lateral segment of the right middle lobe in size of 4.7\u2009×\u20093.7\u2009×\u20093.2 cm with uneven density and lace liked boundary, and small bubbles shadows in it. By both sputum culture and lung tissue culture, Rhodococcus equi can be detected. (b, c) Pathological biopsy and HE staining demonstrate inflammatory pseudotumor. (d, e) Immunohistochemistry demonstrates Rhodococcus equi antibody positive. (f) Reexamination after treatment demonstrates obvious shrinkage of the original lung lesions', 'hash': 'ac97b316499d751a48d8b861962da376a39c7ff11d2554ed957c226224dc65b6'}, {'image_id': '313891_1_En_17_Fig2a_HTML', 'image_file_name': '313891_1_En_17_Fig2a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig2a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered miliary increased density shadows in both lungs, with even size, density and distribution. The shadows of both hila are dense, with sharp both costophrenic angles. (b–f) CT scanning demonstrates scattered miliary nodular shadows in both lungs, which is more obviously in the middle pulmonary strip and with quite even size and density. Trachea and bronchi are unblocked', 'hash': 'ec4f2f75b5bb59b2cb13f016c2ea6714bdc3c908077c2697af2218aa485876b7'}, {'image_id': '313891_1_En_17_Fig13a_HTML', 'image_file_name': '313891_1_En_17_Fig13a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig13a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, transparent areas in them and unblocked trachea and bronchi', 'hash': '7d26c2f94a34f3ff7c4f64d485fe29e114936d0f4db53489ee88148a1a6fc8bf'}, {'image_id': '313891_1_En_17_Fig65a_HTML', 'image_file_name': '313891_1_En_17_Fig65a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig65a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related allergic pulmonary Aspergillus infection. (a–f) CT scanning of the pulmonary window demonstrates thickened central pulmonary markings in both lungs, which is turtuous and deranged with fingertip infiltration shadows. (g) DR demonstrates hyperinflation of the right lung, increased and thickened pulmonary markings and ground glass liked shadows with increased density in the right lower lung and left lung lobe', 'hash': '6fa5ade163d7465c0dc3eb89ebc58d57b98674fc2680824cc5a81c478b81fbc4'}, {'image_id': '313891_1_En_17_Fig76b_HTML', 'image_file_name': '313891_1_En_17_Fig76b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig76b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning demonstrates diffuse scattered thin ground glass liked, patchy, flaky blurry shadows and cords liked shadows in both lungs, with blurry boundaries and uneven density; scattered nodular shadows in different sizes; more lesions in both upper lobes and the right middle lobe; flaky parenchyma shadows in the apical and posterior segments of right upper lobe, with air bronchogram sign in them; unobstructed opening of bronchi as well as lobar and segmental bronchi without stenosis and obstruction; lymphadenectasis in the right hilar region; detected Aspergillus fumigatus by sputum culture. (e, f) Culture for 72 h, lactic acid gossypol blue staining and microscopic observation at ×200 and ×400 demonstrate short column liked conidial head, smooth wall of conidiophores, flask-shaped top capsule and monolayer microconidiophores. (g) Culture in Paul’s medium demonstrates dark green colored colonies', 'hash': 'af925cb00cbd4eed9e67dc49fd012909ecdfe48493ac645d8b2185eb4f351655'}, {'image_id': '313891_1_En_17_Fig105a_HTML', 'image_file_name': '313891_1_En_17_Fig105a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig105a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary toxoplasmosis. (a–d) CT scanning demonstrates thickened pulmonary markings in both lungs, which can be enhanced to extend into the middle and outer zones of lungs, in grid liked appearance that is more obvious in the dorsal segment of the lungs. (e) It is demonstrated to have clustering toxoplasma tachyzoites', 'hash': '30f16a35256e45c89dfcd68adf661507960a5b978db88cc531a7605d9fff53df'}, {'image_id': '313891_1_En_17_Fig95_HTML', 'image_file_name': '313891_1_En_17_Fig95_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig95_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a) CT scanning of the pulmonary window demonstrates irregular large flaky shadows with increased density in the dorsal segment of both lower lobes; enlarged hilum in both lungs, cords liked thickening of the vascular vessels. (b) CT scanning of the mediastinal window demonstrates flaky parenchyma shadows in the left lower lung, thickening of both pleura, enlarged hilum shadows in both lungs, thickened right lower bronchial wall. (c) Microscopy after culture at 25 °C demonstrates branches and separated hyphae and its string of small spores, with typical penicillus but no sporangium (Medan staining, ×400). (d) Bone marrow smear demonstrates round or oval cells like the yeast phase within the macrophages; longer cells like the yeast phase outside the macrophages. The two kinds of cells have slightly curved ends in sausages liked appearance (HE staining, ×400)', 'hash': '636de07e02ba7cf1f73f2a03bccf4fdaac68bc4a122b7fbfe2febe72dd42f139'}, {'image_id': '313891_1_En_17_Fig3a_HTML', 'image_file_name': '313891_1_En_17_Fig3a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig3a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy and scattered miliary increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of the lower lung field, with some fused in thin cloudy shadows', 'hash': 'e655c40874d38beaa8a8e9f0e82c1eb12a6756b09bee559229354b3756010a18'}, {'image_id': '313891_1_En_17_Fig73_HTML', 'image_file_name': '313891_1_En_17_Fig73_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig73_HTML.jpg', 'caption': '(a–c) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates diffuse dense shadows in both lower lung fields which is in a arcuate surface with exterior high and interior low (pleural effusion). (b, c) CT scanning of the mediastinal window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavities; thickened pleura of the lateral chest wall, with accompanying encapsulated effusion', 'hash': '9ad36ea5213bea731770658b27be87e1af9e34bced02cda664a7f485e40f2315'}, {'image_id': '313891_1_En_17_Fig54_HTML', 'image_file_name': '313891_1_En_17_Fig54_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig54_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates round liked large flaky shadows with increased density in the left lower lung, enlarged and thickened hilus. (c, d) DR reexamination after treatment demonstrates flocculent shadows in the left lower lung, with improved conditions than previous findings before treatment (a, b)', 'hash': 'f9b4f22920ef55d9110380df6f64a6a508ecea9ca3192877a2d47400e781c58d'}, {'image_id': '313891_1_En_17_Fig58b_HTML', 'image_file_name': '313891_1_En_17_Fig58b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig58b_HTML.jpg', 'caption': '(a–i) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) CT scanning of the pulmonary window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (c, d) CT scanning of the mediastinal window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, pulmonary atelectasis and pleural effusion, with ventilation shadows in them. (e) CT scanning of the pulmonary window after the treatment demonstrates absence of the mass shadows in the left lower lung with transverse stripes shadows, obviously improved than previous findings (a, b). (f) HE staining demonstrates thickened alveolar septa and exudates from the alveolar cavity. (g) HE staining demonstrates massive bleeding in the alveolar cavity, large quantity erythrocytes and intact cell walls. (h) HE staining demonstrates phagocytized basophilic granules in the leukocytes. (i) HP staining demonstrates purplish red Rhodococcus equi in a shape of crescent in orange red sputum', 'hash': 'ca8456a79f660fc4faa5eb9342f84a14bbe25eedd8fb237ac65bd96b8de6e5b9'}, {'image_id': '313891_1_En_17_Fig25c_HTML', 'image_file_name': '313891_1_En_17_Fig25c_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25c_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '64e0ceda545f1684d11c717eef852c6576036d711540954850cc018aadfefa87'}, {'image_id': '313891_1_En_17_Fig44_HTML', 'image_file_name': '313891_1_En_17_Fig44_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig44_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary nontuberculous mycobacterial infection. (a–d) CT scanning demonstrates multiple cavities in the left lung field, bilateral multiple lobular central nodules and extensive branches liked linear shadows in tree buds sign. There are also large flaky parenchymal changes of the lung tissues in the left lower lung field in high density shadows, with accompanying air bronchogram sign. (e) HE staining demonstrates avium intracellular complex mycobacteria infection of lung tissues in atypical tuberculous nodular changes. (HE\u2009×\u2009200)', 'hash': '8f8697761c60c3cb27c0b413c2e19433df26ba07a74ea0a0cc0b6f2b4acc7b65'}, {'image_id': '313891_1_En_17_Fig103_HTML', 'image_file_name': '313891_1_En_17_Fig103_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig103_HTML.jpg', 'caption': '(a–d) HIV/AIDS related lymphoid interstitial pneumonia. (a–d) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs, in reticular appearance; with accompanying multiple small nodular shadows', 'hash': '8d52c3bac6fb07e3eaf12386767e159f762db3072e09365be542c937697babe7'}, {'image_id': '313891_1_En_17_Fig110b_HTML', 'image_file_name': '313891_1_En_17_Fig110b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110b_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '5526a48dae3face516d842ba229b164bac3062f56c5e811bb1e725778fd20823'}, {'image_id': '313891_1_En_17_Fig5a_HTML', 'image_file_name': '313891_1_En_17_Fig5a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig5a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates patchy shadows with increased density in both lungs, with thickened hilar shadows in both lungs. (b–g) CT scanning demonstrates flaky ground glass liked density shadows in upper lungs and dorsal segment of both lungs, which is more obvious in the middle inner strips. There are extrapulmonary stripes transparent shadows, with some bronchial walls thickened and enlarged hilar shadows in both lungs', 'hash': '5d6ab0400e0331b0fcb3a3679023a44fa81b7b9c9eedc00c0ddb6d85208c3512'}, {'image_id': '313891_1_En_17_Fig74_HTML', 'image_file_name': '313891_1_En_17_Fig74_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig74_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates round liked uneven density shadows in the medial segments of both middle and lower lungs, multilocular hollow holes in the cavities, surrounding multiple round liked thick-wall small cavity shadows and ground grass liked infiltration shadows. (b–d) CT scanning of the pulmonary window demonstrates scattered round liked uneven density shadows in the right hilum and lower lung, multilocular hollow holes in the cavities; and surrounding multiple round liked thick-wall small cavity shadows and ground grass liked infiltration shadows', 'hash': 'e4c42cc0cb1f1bdfa8b2cc1f3c8eab7223c4be368a808e8b6c4b01af78dfb04a'}, {'image_id': '313891_1_En_17_Fig23_HTML', 'image_file_name': '313891_1_En_17_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig23_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymph node tuberculosis. (a–c) CT scanning of the pulmonary window demonstrates dense mass shadow beside the right aortic arch, and thinner right bronchus due to compression. (d–f) CT scanning of the mediastinal window demonstrates low density mass shadow besied the right aortic arch with clear boundary', 'hash': '8d135ce7e96005006343dc3305be0f8c77d0828bccccf1726226c09fd47c365f'}, {'image_id': '313891_1_En_17_Fig6a_HTML', 'image_file_name': '313891_1_En_17_Fig6a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig6a_HTML.jpg', 'caption': '(a-d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates flaky ground glass liked density shadows in upper lobes of both lungs, with bronchial shadows in them; flaky parenchymal shadows in the subpleural apical segment; and thickened bronchial walls in the anterior and posterior segments of the right upper lobe', 'hash': '235548456c9bf72727a05a91fa6893d8a478f8f715c022d6b579d4a9188da366'}, {'image_id': '313891_1_En_17_Fig17a_HTML', 'image_file_name': '313891_1_En_17_Fig17a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig17a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchymal shadows and fibrous cords liked shadows in both lungs which are more obvious in both lower lungs. The trachea and bronchi are unblocked, with enlarged hilar shadows in both lungs', 'hash': '9c1c59095291dcf6a7b6dec786ec58ba44e9b83badfe4bbf121b7c677476f4d5'}, {'image_id': '313891_1_En_17_Fig113b_HTML', 'image_file_name': '313891_1_En_17_Fig113b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig113b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Kaposi’s sarcoma. (a–d) Chest CT scanning demonstrates scattered cloudy, mass and flake liked or nodular shadows with increased density. (e) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large thick stained nucleoli, which are in line with the diagnosis of Kaposi’s sarcoma. (f–i) Cured HIV/AIDS related Kaposi’s sarcoma. (f–i) Reexamination after treatment demonstrates absent lesions in both lungs, with clear lung fields', 'hash': '88e574b2d5ff4ee4ce28f38025d5345c8cf6b50386f752ae12083b05fe7af9de'}, {'image_id': '313891_1_En_17_Fig82_HTML', 'image_file_name': '313891_1_En_17_Fig82_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig82_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a, b) DR demonstrates enlarged blurry hilum in both lungs and thickened pulmonary markings. (c, d) CT scanning demonstrates mediastinal lymphadenectasis, narrowed trachea due to compression with liquefactive necrosis. Enhanced scanning demonstrates marginal enhancement and no central enhancement', 'hash': '18312183daaefbc6c48e05e67fab210a1109c24a6f94311ffb11ffdace007a49'}, {'image_id': '313891_1_En_17_Fig64_HTML', 'image_file_name': '313891_1_En_17_Fig64_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig64_HTML.jpg', 'caption': '(a) Gross observation demonstrates dark brown lungs in appearance. (b, c) Thology demonstrates hemorrhage and edema of the lung tissue and focal necrosis, with large quantity Aspergillus hyphae and spores in the surrounding area of the necrosis (Combined with pulmonary CMV infection)', 'hash': '104850f2999da711317f4e4f07e590bd8f73a93731daf090ece6023192606e90'}, {'image_id': '313891_1_En_17_Fig7a_HTML', 'image_file_name': '313891_1_En_17_Fig7a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig7a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates diffusely distributed shadows with increased density in both lungs that is more obvious in the middle and lower lungs. The hilar shadows in both lungs are enlarged. Both diaphragmatic surfaces and phrenic angles are blurry. (b–d) CT scanning demonstrates flaky shadows with increased density in both lungs, with parenchymal shadows in the lingular segment of left upper lobe and in the dorsal segments of both lower lobes and bronchial shadows in them. There are also thickened bronchial walls and enlarged hilar shadows in both lungs', 'hash': '431aab0770a1915c719095cc2bab91736f1ffda7b5649cdca5d8b7516003049c'}, {'image_id': '313891_1_En_17_Fig33_HTML', 'image_file_name': '313891_1_En_17_Fig33_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig33_HTML.jpg', 'caption': '(a, b) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates scattering patchy and cords liked blurry density shadows in the right middle and upper lung fields as well as enlarged and thickened hilum. (b) DR demonstrates that the lungs lesions are almost absent compared to (a), after anti-TB treatment for 5 months', 'hash': 'e710598bbbc8286721136f2a803716198a712c55253c4232d3ee33b2e33e188b'}, {'image_id': '313891_1_En_17_Fig62_HTML', 'image_file_name': '313891_1_En_17_Fig62_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig62_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) Anteroposterior and lateral DR demonstrates huge sphere liked mass shadow in the right hilum, with cavities shadows and liquid gas level in it. (c) HE staining demonstrates bleeding in the lung tissues and aggregation of large quantity lymphocytes. (d) Masson staining demonstrates branches liked purplish red Rhodococcus equi', 'hash': '261a4aca9e146cc16957c6280cd4795d7c2c5732d9a19006b6e398a1ae410af0'}, {'image_id': '313891_1_En_17_Fig84_HTML', 'image_file_name': '313891_1_En_17_Fig84_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig84_HTML.jpg', 'caption': '(a, b) HIV/AIDS related pulmonary cryptococcus infection. (a) CT scanning demonstrates round liked cavity shadows in the left upper and lower lung, with uneven thickness of the cavity wall and surrounding infiltrative shadows. (b) CT scanning demonstrates round liked dense mass shadows in the right upper lung, with clear boundaries and bulky drainage vessel shadows', 'hash': 'ecc614167ec536dcb80c2739886c957ff2f182dd49ac7f4d6379260497262e60'}, {'image_id': '313891_1_En_17_Fig4_HTML', 'image_file_name': '313891_1_En_17_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig4_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy or ground glass liked increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of lower lungs, with some fused into thin cloudy ground glass liked shadows with increased density, with decreased transparency of both lungs and enlarged hilar shadows in both lungs', 'hash': '636f9fd3d3c20c17e15e1ac70adcdcb6fbe268a70ac64d29317f73045747e226'}, {'image_id': '313891_1_En_17_Fig46a_HTML', 'image_file_name': '313891_1_En_17_Fig46a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig46a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates large flaky dense shadows in the middle-outer zone of the left middle lung field, and narrowed left bronchus. (d–f) CT scanning demonstrates large flaky shadows with uneven density in the left lateral chest wall and even lower density shadow in them', 'hash': 'afdfc2c33070f1d3b8616a542d989e0f908d9638327227057dfdf5ed59169359'}, {'image_id': '313891_1_En_17_Fig72_HTML', 'image_file_name': '313891_1_En_17_Fig72_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig72_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and cavity shadows in both lungs, with even wall thickness and small nodular shadows in some cavities', 'hash': 'd318b47b9b56854b6bc47081b08712ee9d828a2ae4592aa69451ec7105fd0240'}, {'image_id': '313891_1_En_17_Fig91b_HTML', 'image_file_name': '313891_1_En_17_Fig91b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig91b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–e) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of some lesions into honeycomb likes cavity shadows or plaque liked dense shadows. (f–h) CT scanning demonstrates large thick-wall cavity shadows in the right lung, surrounding plaque and round liked small cavity shadows and inflammatory infiltrative shadows', 'hash': '6b3a934b89abf6f7e8c9593337c0c57fe44161bcbfc546c7e2a3cfa50539f91e'}, {'image_id': '313891_1_En_17_Fig8a_HTML', 'image_file_name': '313891_1_En_17_Fig8a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig8a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates large flaky parenchyma shadows in both lungs which is more obvious in the middle and lower lobes of both lungs. There are also enlarged hilar shadows in both lungs and sharp both costophrenic angles. (b–g) CT scanning demonstrates large flaky parenchyma shadows in concentric and symmetrical distribution, bronchial shadows in them and thickened bronchial walls', 'hash': '7c4f2f4f9120af70727cab6fc69637733e17e807575648a0257b5b03367da625'}, {'image_id': '313891_1_En_17_Fig42_HTML', 'image_file_name': '313891_1_En_17_Fig42_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig42_HTML.jpg', 'caption': 'HIV/AIDS related tuberculous pleuritis. DR demonstrates arch shaped dense shadows with higher exterior density and lower interior density in the left lower lung field and covered right edge of the heart', 'hash': 'f0dfdb1b349a42c7092daeeaef76a8b8762e134b40ae21a6144d9785b9ddcd02'}, {'image_id': '313891_1_En_17_Fig15_HTML', 'image_file_name': '313891_1_En_17_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig15_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy blurry shadows and fibrous cords liked shadows in both lungs which are more obvious in the middle inner parts of both lungs, with transparent areas in them. The bronchial walls are thickened', 'hash': '4d262b5c06f74783c1b6df1f8c9d8c7ecbf235faacd2f2e846544a3e11d88e8b'}, {'image_id': '313891_1_En_17_Fig92b_HTML', 'image_file_name': '313891_1_En_17_Fig92b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig92b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of the lesions in the right lung into plaque liked shadows with clear boundaries, and multiple round liked small cavity shadows and inflammatory infiltrative shadows in both lungs', 'hash': '4613e0bd8bbb013024b2335ae2f7fb1997dab5d93ee1c395c97035d6e7d37750'}, {'image_id': '313891_1_En_17_Fig52_HTML', 'image_file_name': '313891_1_En_17_Fig52_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig52_HTML.jpg', 'caption': '(a, b) HIV/AIDS related staphylococcus aureus pneumonia. (a, b) DR demonstrates diffuse scattered multiple thin-walled transparent areas in both lungs, increased and blurry pulmonary markings, and enlarged heart shadow in flask shape (pericardial effusion)', 'hash': 'b54d395f8405b646839c68cb58c1a811c70fb8c7337443d24b61bfcfa097f5b0'}, {'image_id': '313891_1_En_17_Fig56b_HTML', 'image_file_name': '313891_1_En_17_Fig56b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig56b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates huge round large flaky shadows with increased density in the left lower lung, enlarged and thickened hilum and covered right heart edge. (c, d) DR reexamination after treatment for 1 week demonstrates flocculent shadow in the left lower lung, improved than those before the treatment (a, b). (e) DR reexamination after treatment demonstrates flocculent liked shadows in the left lower lung, obviously improved than before the treatment (c, d)', 'hash': 'e5f534ed9282980e95aaa6bac04091762128cf3e5c46985b190278c5d6396558'}, {'image_id': '313891_1_En_17_Fig93b_HTML', 'image_file_name': '313891_1_En_17_Fig93b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig93b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates diffuse small cavity in honeycomb liked and infiltrative parenchyma shadows, with the hilum as the center to distribute bilaterally symmetric like butterfly wings; multiple honeycomb liked cavity shadows in both lungs. (e–h) CT scanning reexamination demonstrates large irregular thick-wall cavities in the right lung, surrounding scattering nodular, honeycomba liked and infiltrative shadows after anti-PM infection treatment for 3 months', 'hash': '904e5a590c601ab02150f8c2487bbfa6f0282c1eddd547624ce8c549472221d9'}, {'image_id': '313891_1_En_17_Fig51b_HTML', 'image_file_name': '313891_1_En_17_Fig51b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig51b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related staphylococcus aureus pneumonia. (a) Chest X-ray demonstrates large flaky high density shadow in the left middle-lower lung field, with central transparent areas in different sizes and blurry boundaries; parenchyma changes of the left lower lung, predominantly in the posterior and exterior basal segments; unobstructed brounchus and thickened adjacent pleura. (b–d) CT scanning demonstrates large flaky shadows in fan shaped distribution along the bronchus in the left middle-lower lung, with gas containing cavities and high density shadows; and thickened adjacent pleura of the lateral chest wall. (e, f) CT scanning of the mediastinal window demonstrates large flaky fan shaped parenchymal shadows in the left middle-lower lung field, with ventilation shadows in them; and thickened pleura of the lateral chest wall. (g, h) Pathological examination showed staphylococcus aureus', 'hash': '18a6e1202b7b8c4a2d57fe024b7e8039a6dcee0f6f5f078b109a93850977c0f6'}, {'image_id': '313891_1_En_17_Fig94b_HTML', 'image_file_name': '313891_1_En_17_Fig94b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig94b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a–f) CT scanning demonstrates multiple nodules and small cavities in honeycomb liked shadows and infiltrative parenchyma shadows in the right lung; flaky transparent areas (bullae of lung) in the right anterior margin of the heart and in the outer zone of the left lung near lateral chest wall', 'hash': '3ed719abaaaec4ee19332842bd8dcac302eb6fefc73152dfd03a39702260d369'}, {'image_id': '313891_1_En_17_Fig34a_HTML', 'image_file_name': '313891_1_En_17_Fig34a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig34a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung and multiple satellite lesions scattering around. (c) CT scanning of the mediastinal window demonstrates lymphadenectasis of aortic window, subcutaneous soft tissue mass shadow in the left anterior chest wall with central low density shadow as well as right axilliary lymphadenectasis', 'hash': 'dabd5722ad3f66eee67ca59ba24417ffb086d4591f3bff2446f2a3490c676e78'}, {'image_id': '313891_1_En_17_Fig22_HTML', 'image_file_name': '313891_1_En_17_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig22_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates semicircular mass liked dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura of lateral chest wall, and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates narrowed right thorax, thickend pleura of lateral chest wall with encapsulated effusion, uneven density mass in the right hilum, thinner right bronchus due to compression and no obvious abnormalities in the left hilum. (f) DR in Aug. 2008 demonstrates no obvious changes of the lesions after anti-tuberculosis treatment for 1 month', 'hash': '8f3d47e32ff0f306eed49c4101730b02a154f676752c7bb56423c767388d5b82'}, {'image_id': '313891_1_En_17_Fig27b_HTML', 'image_file_name': '313891_1_En_17_Fig27b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig27b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related miliary tuberculosis. (a–b) Anteroposterior and lateral DR demonstrates diffuse miliary shadows in both lungs, which are bilaterally symmetric and in even size and distribution. (c–f) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': 'e272956e522e945d068939f056c637c5a636df520c687deeac9d40f8cb06834e'}, {'image_id': '313891_1_En_17_Fig83_HTML', 'image_file_name': '313891_1_En_17_Fig83_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig83_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates enlarged blurry hilum in both lungs and thickened lung markings. (b–d) CT scanning demonstrates multiple scattered nodular or mass dense shadows in both lungs, with lobulation, rough spikes around and fusion of some shadows into mass; surrounding small flaky infiltrative shadows; and mediastinal lymphadenectasis', 'hash': '6b17ec5d2db4d953c2436bbec29d0a3b1dacf0910df899eaf97e442c4aaad785'}, {'image_id': '313891_1_En_17_Fig43a_HTML', 'image_file_name': '313891_1_En_17_Fig43a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig43a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related tuberculous pleuritis. (a) DR demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (b) CT scanning of the pulmonary window demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (c) CT scanning of the mediastinal window demonstrates encapsulated fluid density shadow in the pleura of the right lateral chest wall', 'hash': 'ac09c8d3e5e4d73b07cd258411b07337ad06b99883f4a0e4573ce220fc1f4574'}, {'image_id': '313891_1_En_17_Fig35a_HTML', 'image_file_name': '313891_1_En_17_Fig35a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig35a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates diffuse large flaky dense shadows in the right upper lung with transparent areas in them. (b–c) CT scanning of the pulmonary window demonstrates large flaky shadows with increased density in the right upper lung, with multiple satellite lesions scattering around. (d, e) CT scanning of the mediastinal window demonstrates large flaky parenchymal shadows in the right upper lung with air bronchogram sign as well as mediastinal lymphadenectasis', 'hash': 'f556b77354da8136691c411ed446865babea0e399d96d2fca89f49639a04c579'}, {'image_id': '313891_1_En_17_Fig26b_HTML', 'image_file_name': '313891_1_En_17_Fig26b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig26b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '1d1f0589c50a11306fce77c217b0a9ac31be645df14f41d021ccf6522873dc6c'}, {'image_id': '313891_1_En_17_Fig32_HTML', 'image_file_name': '313891_1_En_17_Fig32_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig32_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstratesdiffuse scattering miliary shadows with increased density in both lungs, fusion of some military shadows into patchy or mass liked shadows and diffusely distributed lung lesions', 'hash': '7274d90d4f9483c5fb0e44576eeb46beba54850ed218057b6ca5935c31fa396a'}, {'image_id': '313891_1_En_17_Fig96b_HTML', 'image_file_name': '313891_1_En_17_Fig96b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig96b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a) DR demonstrates flaky blurry dense shadows in the right anterior margin of the heart, with surrounding infiltrative shadows. (b, c) CT scanning of the pulmonary window demonstrates nodular dense shadows in the dorsal segment of the right lower lung, with smooth sharp boundaries; large flaky ground glass liked dense shadows in the dorsal segment of both lungs. (d, e) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in red, in different sizes. (f) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in purplish red, in different sizes', 'hash': 'ad87dabd309e8a0c47d5cd58aa485a538556b1218d18c3cb262dc5b8cd5049e9'}, {'image_id': '313891_1_En_17_Fig55_HTML', 'image_file_name': '313891_1_En_17_Fig55_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig55_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates round liked large flaky shadows with increased density in the right lower lung, cords liked and flocculent liked blurry shadows in both middle-upper lung fields and in the right lower lung field, and enlarged and thickened hilus', 'hash': '29c690f04a28629d1c3b0f7b5665833edd78ec61be199fd2f16199400a7c9eeb'}, {'image_id': '313891_1_En_17_Fig85a_HTML', 'image_file_name': '313891_1_En_17_Fig85a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig85a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates round liked thick-wall cavity in the left hilum, with blurred boundary; ground-glass liked shadows with increased density in the left middle and lower lung. (b–d) CT scanning of the pulmonary window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of cavity wall. (e, f) CT scanning of the mediastinal window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of the cavity wall and surrounding thick spikes', 'hash': 'd6bc5b1be05729f5f4ec60a0cda3bec7f7cf437fd39e0d32743e45cfb9e48de2'}, {'image_id': '313891_1_En_17_Fig112_HTML', 'image_file_name': '313891_1_En_17_Fig112_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig112_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Kaposi’s sarcoma. (a, b) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance', 'hash': 'eeb255e4963802d02da7fd85381532153336be33b21e4ceb488be5dc2a483f29'}, {'image_id': '313891_1_En_17_Fig25b_HTML', 'image_file_name': '313891_1_En_17_Fig25b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25b_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '9ceac8f407a9896d7bda0165bceae81a32d5c5c53de3c5d2a295c165b15071e8'}, {'image_id': '313891_1_En_17_Fig36a_HTML', 'image_file_name': '313891_1_En_17_Fig36a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig36a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) Pulmonary CT scanning of the pulmonary window demonstrates parenchymal shadows in the left lingual lobe with surrounding pulmonary acinar nodular shadows. (b) CT guided pucture biopsy of left lingula. (c) The pathology demonstrates granulation tissue and caseous necrosis, being in consistency with tuberculosis changes. HE\u2009×\u2009100', 'hash': '3a48cc084a1fb1943e1411fa65cfdcee0c3c33377b3ae6ab6e24f04ee1caebae'}, {'image_id': '313891_1_En_17_Fig68a_HTML', 'image_file_name': '313891_1_En_17_Fig68a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig68a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in prone posture demonstrates mass shadow and thick wall cavity in the dorsal segment of the right lower lung, small nodular shadows in the cavities, surrounding fused miliary infiltration shadows. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the dorsal segment of the right lower lung, small nodular shadows in the cavities, and involved pleura of partial lateral chest wall', 'hash': '0acc77833f25b70e7e4527a30be9fc6744e19cee48879415a15e648d76923d48'}, {'image_id': '313891_1_En_17_Fig45_HTML', 'image_file_name': '313891_1_En_17_Fig45_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig45_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Staphylococcus aureus pneumonia. (a) Gross specimen observation demonstrates bilateral purplish brown lesions, patchy white infiltration at the base of the lungs. (b) HE staining demonstrates alveolar diffuse lesions, exudation of the serous fluid and inflammatory cells in the alveolar cavity, and alveolar wall congestion', 'hash': 'e530a1df1ead29989d8b3b50161f1926946446bc5cbbcb99691479816876e341'}, {'image_id': '313891_1_En_17_Fig110c_HTML', 'image_file_name': '313891_1_En_17_Fig110c_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110c_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '22d9f8a4fa731c46a738334c9738c267aaa2c43711aa94bd98c4b78483adda8d'}, {'image_id': '313891_1_En_17_Fig24b_HTML', 'image_file_name': '313891_1_En_17_Fig24b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig24b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates circular mass dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura in the lateral chest cavity and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates multiple uneven mass density shadows in right hilum in a size of about 3\u2009×\u20093.5\u2009×\u20093.8 cm. (f–g) Enhanced CT scanning demonstrates slight uneven enhancement of the lesion and no obvious abnormalties in the left hilum', 'hash': '4c7c3a8f7b0bde1c89efcf634beedfd08159b9be03a95299448e388c435edcdc'}, {'image_id': '313891_1_En_17_Fig12_HTML', 'image_file_name': '313891_1_En_17_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig12_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchyma shadows and fibrous cords liked shadows in both lungs which are more obvious in the dorsal segment of both lower lungs, bronchial shadows in them, and thickened bronchial walls in the middle lobe. The hilar shadows in both lungs are enlarged', 'hash': '72a066b603a93a4b8e9a7a8ec1942b2ed87b211dee6ed121b7c56d1cb575c55c'}, {'image_id': '313891_1_En_17_Fig102_HTML', 'image_file_name': '313891_1_En_17_Fig102_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig102_HTML.jpg', 'caption': '(a–d) HIV/AIDS related lymphoid interstitial pneumonia. (a–d) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs, in reticular appearance; with accompanying multiple small nodular shadows', 'hash': '6b569d4d7a5a4f008ea8f7bc4152cd1a576656b8eeee8b7548f00de038815256'}, {'image_id': '313891_1_En_17_Fig111_HTML', 'image_file_name': '313891_1_En_17_Fig111_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig111_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Kaposi’s sarcoma. (a, b) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance, light density flaky shadows in lower lung fields of both lungs. (c) CT scanning demonstrates multiple round liked nodular shadows in both middle lower lung fields with clear boundaries, multiple mediastinal and hilar lymphadenectasis, and small quantity pleural effusion in bilateral thoracic cavities', 'hash': '5dfb9d581ecc41659920bde84bc55d01903bf9f66ec50710fe0465373096ff5f'}, {'image_id': '313891_1_En_17_Fig25a_HTML', 'image_file_name': '313891_1_En_17_Fig25a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25a_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '67db71f0f56d65c929e36f486b4a1a2246ae852aec999328f126ddc09428f814'}, {'image_id': '313891_1_En_17_Fig36b_HTML', 'image_file_name': '313891_1_En_17_Fig36b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig36b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) Pulmonary CT scanning of the pulmonary window demonstrates parenchymal shadows in the left lingual lobe with surrounding pulmonary acinar nodular shadows. (b) CT guided pucture biopsy of left lingula. (c) The pathology demonstrates granulation tissue and caseous necrosis, being in consistency with tuberculosis changes. HE\u2009×\u2009100', 'hash': 'd7d5abe0c9d9bea2e2097dfc72f86922656058f98f8a2360573b04a02e27e5de'}, {'image_id': '313891_1_En_17_Fig68b_HTML', 'image_file_name': '313891_1_En_17_Fig68b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig68b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in prone posture demonstrates mass shadow and thick wall cavity in the dorsal segment of the right lower lung, small nodular shadows in the cavities, surrounding fused miliary infiltration shadows. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the dorsal segment of the right lower lung, small nodular shadows in the cavities, and involved pleura of partial lateral chest wall', 'hash': 'cada0e4684021c74f9b0d4d1bcdb6810379bc035cead748d6de141ebd004f038'}, {'image_id': '313891_1_En_17_Fig96a_HTML', 'image_file_name': '313891_1_En_17_Fig96a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig96a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a) DR demonstrates flaky blurry dense shadows in the right anterior margin of the heart, with surrounding infiltrative shadows. (b, c) CT scanning of the pulmonary window demonstrates nodular dense shadows in the dorsal segment of the right lower lung, with smooth sharp boundaries; large flaky ground glass liked dense shadows in the dorsal segment of both lungs. (d, e) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in red, in different sizes. (f) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in purplish red, in different sizes', 'hash': '020553d48c8545e50d314020ad8dc5004914dca5449aa2b58bc99515f310c3a4'}, {'image_id': '313891_1_En_17_Fig85b_HTML', 'image_file_name': '313891_1_En_17_Fig85b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig85b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates round liked thick-wall cavity in the left hilum, with blurred boundary; ground-glass liked shadows with increased density in the left middle and lower lung. (b–d) CT scanning of the pulmonary window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of cavity wall. (e, f) CT scanning of the mediastinal window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of the cavity wall and surrounding thick spikes', 'hash': '9778eb0d00755e3cd06bd3bcee90d66970730aac4b7fabde0b3e1df25cc067b8'}, {'image_id': '313891_1_En_17_Fig59_HTML', 'image_file_name': '313891_1_En_17_Fig59_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig59_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a–c) CT scanning of the pulmonary window demonstrates thick walled cavities shadows in the dorsal segment of the right lower lung, with irregular wall thickness and liquid gas level in them. (d) CT scanning of the mediastinal window demonstrates thick walled cavities shadows in the dorsal segment of the left lower lung, with irregular wall thickness and liquid gas level in them', 'hash': 'c9ff1150b9c2d245c823a3726a56dc22223fcdc58b24666ee55ee0b01ea0c2d3'}, {'image_id': '313891_1_En_17_Fig24a_HTML', 'image_file_name': '313891_1_En_17_Fig24a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig24a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates circular mass dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura in the lateral chest cavity and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates multiple uneven mass density shadows in right hilum in a size of about 3\u2009×\u20093.5\u2009×\u20093.8 cm. (f–g) Enhanced CT scanning demonstrates slight uneven enhancement of the lesion and no obvious abnormalties in the left hilum', 'hash': 'a3536c779e7c502b855dd3d89ae13854f569bd483ba8038870ac76c68c616c6c'}, {'image_id': '313891_1_En_17_Fig11_HTML', 'image_file_name': '313891_1_En_17_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig11_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered patchy shadows with increased density in both lungs and a few cords liked shadows which are more obvious in the right lung. There are thickened both hilar shadows and sharp both costophrenic angles. (b–e) CT scanning demonstrates flaky and mass liked ground glass density shadows in both lungs and a few cords liked shadows which are more obvious in the right lung. The trachea and bronchi are unblocked', 'hash': 'd4448bd9682d4ae721b1250cec042eecf77787519b1af61ac3b2d7b88b28bd90'}, {'image_id': '313891_1_En_17_Fig101_HTML', 'image_file_name': '313891_1_En_17_Fig101_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig101_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Herpes Simplex Viral Pneumonia. (a) DR demonstrates thickened and deranged lung markings in both lungs with accompanying blurry nodular shadows, and cloudy shadows in the lung fields. (b) PAS staining (400×) demonstrates eosinophilic inclusion. (c) Silver methenamine staining demonstrates herpes viral inclusion', 'hash': '9cfda956483a95dc3a4e487426e884d83e6aa0bde654b2c285ba044cf31b2a1d'}, {'image_id': '313891_1_En_17_Fig49_HTML', 'image_file_name': '313891_1_En_17_Fig49_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig49_HTML.jpg', 'caption': '(a–d) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates fan shaped shadow in the right middle lung field with its apex pointing to the hilar dense shadow, with clear boundaries. (d) CT scanning reexamination demonstrates absence of the lesions in the right lung after anti-bacteria treatment for 2 weeks', 'hash': 'f566a271be67724833f92b19b4f73190cae4216ad698f1d1a51c1d9c7579afa1'}, {'image_id': '313891_1_En_17_Fig34b_HTML', 'image_file_name': '313891_1_En_17_Fig34b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig34b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung and multiple satellite lesions scattering around. (c) CT scanning of the mediastinal window demonstrates lymphadenectasis of aortic window, subcutaneous soft tissue mass shadow in the left anterior chest wall with central low density shadow as well as right axilliary lymphadenectasis', 'hash': 'cd2bbefb6363363a2c860069ded9e79b5fabed794f0777f342cd459e7f745581'}, {'image_id': '313891_1_En_17_Fig21_HTML', 'image_file_name': '313891_1_En_17_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig21_HTML.jpg', 'caption': '(a–c) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates enlarged right hilum in mass liked dense shadow, with peripheral thickened and blurry pulmonary markings, and no obvious abnormalities of the left hilum. (b) DR demonstrates smaller right hilum after anti-tuberculosis therapy for 1 month. (c) DR demonstrates absent tumor in the right hilum and normal left hilum', 'hash': '46a1a9267e1d610faa6450929c11c8d942047467baf49ba4482ce61bb660cb30'}, {'image_id': '313891_1_En_17_Fig27a_HTML', 'image_file_name': '313891_1_En_17_Fig27a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig27a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related miliary tuberculosis. (a–b) Anteroposterior and lateral DR demonstrates diffuse miliary shadows in both lungs, which are bilaterally symmetric and in even size and distribution. (c–f) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '61497bd4be4942d8a1fc4e6710043c9d4099da58ea99f2008d49f04ec973f2b4'}, {'image_id': '313891_1_En_17_Fig79_HTML', 'image_file_name': '313891_1_En_17_Fig79_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig79_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates multiple scattered nodular shadows in both lower lungs. (b–d) Chest CT scanning demonstrates multiple dense nodular shadows with different sizes and mass shadows in both middle and lower lung fields, with clear boundaries. They are more common in the dorsal segments', 'hash': '7f1588a4af3d4fadaf1f33e3bac3f100d4b2003206bd1bc2ae262b602fd3fe79'}, {'image_id': '313891_1_En_17_Fig51a_HTML', 'image_file_name': '313891_1_En_17_Fig51a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig51a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related staphylococcus aureus pneumonia. (a) Chest X-ray demonstrates large flaky high density shadow in the left middle-lower lung field, with central transparent areas in different sizes and blurry boundaries; parenchyma changes of the left lower lung, predominantly in the posterior and exterior basal segments; unobstructed brounchus and thickened adjacent pleura. (b–d) CT scanning demonstrates large flaky shadows in fan shaped distribution along the bronchus in the left middle-lower lung, with gas containing cavities and high density shadows; and thickened adjacent pleura of the lateral chest wall. (e, f) CT scanning of the mediastinal window demonstrates large flaky fan shaped parenchymal shadows in the left middle-lower lung field, with ventilation shadows in them; and thickened pleura of the lateral chest wall. (g, h) Pathological examination showed staphylococcus aureus', 'hash': '00d7fc70edd23ceb6f012159d4bae8563ec20a036cc91fd99d91cdbc08f23126'}, {'image_id': '313891_1_En_17_Fig90_HTML', 'image_file_name': '313891_1_En_17_Fig90_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig90_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows in the lungs that fuse into mass in parenchymal shadows, with the hilum as the center and distributing bilaterally symmetric like butterfly wings. There are also multiple clustering cavities or singular large cavity in both lungs', 'hash': '6742eff5e10355ff74a6fe215cff47247a9d12856c453a35fd6d6742f8f0ac2e'}, {'image_id': '313891_1_En_17_Fig94a_HTML', 'image_file_name': '313891_1_En_17_Fig94a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig94a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a–f) CT scanning demonstrates multiple nodules and small cavities in honeycomb liked shadows and infiltrative parenchyma shadows in the right lung; flaky transparent areas (bullae of lung) in the right anterior margin of the heart and in the outer zone of the left lung near lateral chest wall', 'hash': '4bf177cdb556a837613a60231e962930fcd4acf34d7177f738cb57925ca917e1'}, {'image_id': '313891_1_En_17_Fig35b_HTML', 'image_file_name': '313891_1_En_17_Fig35b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig35b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates diffuse large flaky dense shadows in the right upper lung with transparent areas in them. (b–c) CT scanning of the pulmonary window demonstrates large flaky shadows with increased density in the right upper lung, with multiple satellite lesions scattering around. (d, e) CT scanning of the mediastinal window demonstrates large flaky parenchymal shadows in the right upper lung with air bronchogram sign as well as mediastinal lymphadenectasis', 'hash': '8b68f2c89884110f18b2b9641154ae26362875fb18db9a64b4320edd5c13bba4'}, {'image_id': '313891_1_En_17_Fig26a_HTML', 'image_file_name': '313891_1_En_17_Fig26a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig26a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '1bd3c2b9622fa99531543c1b9d456f58ff2945c6fa4bb44043fadb51fa9c8db6'}, {'image_id': '313891_1_En_17_Fig31_HTML', 'image_file_name': '313891_1_En_17_Fig31_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig31_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, fusion of some military shadows into patchy or mass liked shadow, diffusely distributed lung lesions', 'hash': '3bf8714e005c1ebc72eb46fac228838fd6436f0a1dd5d6a8bd085a14fddd1170'}, {'image_id': '313891_1_En_17_Fig69_HTML', 'image_file_name': '313891_1_En_17_Fig69_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig69_HTML.jpg', 'caption': '(a, b) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the medial basal segment of the right lower lung, irregular nodular shadows in the cavities, and surrounding fused miliary infiltration shadows', 'hash': 'db839a28accf7944530e9940a7c7afb2b7b3c7a4423308b863fae87f0c08c29a'}, {'image_id': '313891_1_En_17_Fig80_HTML', 'image_file_name': '313891_1_En_17_Fig80_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig80_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a, b) Anteroposterior and lateral DR demonstrate a huge dense mass shadow in the left lower lung, with clear boundary. (c) CT scanning of the pulmonary window demonstrates round liked high density shadow in the left lower lung near left chest wall, with even density. (d) CT scanning of the mediastinal window demonstrates round liked soft tissue density shadows in the left lower lung near left chest wall, with even density, lobulation, and surrounding thick spikes', 'hash': 'ea2ef199cee39dce2b4a8a06bcdcce274a6fd8796c2efbfaf940d6d05fe48c40'}, {'image_id': '313891_1_En_17_Fig43b_HTML', 'image_file_name': '313891_1_En_17_Fig43b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig43b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related tuberculous pleuritis. (a) DR demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (b) CT scanning of the pulmonary window demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (c) CT scanning of the mediastinal window demonstrates encapsulated fluid density shadow in the pleura of the right lateral chest wall', 'hash': '582e0f2e161551b97de13a60d6afed8cc613b9b04bfb136458587da830b2ecf0'}, {'image_id': '313891_1_En_17_Fig16_HTML', 'image_file_name': '313891_1_En_17_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig16_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple fibrous cords liked shadows in lungs, multiple patchy parenchyma shadows and ground glass liked density shadows in both upper lobes, with multiple transparent areas in them. The bronchial walls are thickened in the anterior and posterior segments of the right upper lobe as well as in the lingual segment of the left lung', 'hash': '214979f5c447a9b40ebd0772cff663eb275052bf5fe8132456329ffacdc20c9c'}, {'image_id': '313891_1_En_17_Fig109_HTML', 'image_file_name': '313891_1_En_17_Fig109_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig109_HTML.jpg', 'caption': '(a, b) HIV/AIDS related lymphoma. (a, b) CT scanning demonstrates a huge soft tissue mass shadow in the left lateral chest wall, with a maximal size of about 7.7\u2009×\u200913.0 cm and occupying 30 sections with 8 mm in thickness of each section and with the upmost to the supraclavicular area and the bottom in the level of thoracic 12th vertebral body in the lower chest wall. There are also large quantity left pleural effusion and parenchymal changes of the left lower lobe with atelectasis. In the left chest cavity, large quantity liquid density shadows can be found, with compressed lung tissues to the hilum. By puncture and biopsy of the subaxillary mass, the diagnosis is defined as diffuse large B cell lymphoma', 'hash': '6d67a094843ca970dc50c93d50e7d1038c2a389c96e1772f425fa9dbc9d3a3ea'}, {'image_id': '313891_1_En_17_Fig19_HTML', 'image_file_name': '313891_1_En_17_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig19_HTML.jpg', 'caption': '(a) Gross observation in autopsy demonstrates disseminated pulmonary tuberculosis, with grayish white military nodules in diffuse distribution in the lung tissues section. (b) It is demonstrated that mycobacteriumavium-intracellularcomplex infection in the lung tissue, with atypical tuberculosis nodules and acid-fast staining positive (left top). There are a subnodular giant cell, eosinophilic inclusion bodies in the nucleus and bradyzoites in cytoplasm of T. gondii. HE\u2009×\u2009100. (c) HE demonstrates mycobacteriumavium-intracellularcomplex infection, with atypical tuberculosis nodular changes, HE\u2009×\u2009200', 'hash': 'fac712a77d78563a8ebac012fe6c9f2f74ab72b1d36bf9e0c30462450f24c87d'}, {'image_id': '313891_1_En_17_Fig92a_HTML', 'image_file_name': '313891_1_En_17_Fig92a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig92a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of the lesions in the right lung into plaque liked shadows with clear boundaries, and multiple round liked small cavity shadows and inflammatory infiltrative shadows in both lungs', 'hash': '981e19f8709c64fb0f850afd293a3dfdb67ec16a8d75e3f2bf19cd69116366cd'}, {'image_id': '313891_1_En_17_Fig41_HTML', 'image_file_name': '313891_1_En_17_Fig41_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig41_HTML.jpg', 'caption': 'HIV/AIDS related tuberculous pleuritis. DR demonstrates arch shaped dense shadows with higher exterior density and lower interior density in the right lower lung field and covered right edge of the heart', 'hash': '3381f76804304950a36ba44865a5651168e2f9b43c451a23d390d065bfc52e80'}, {'image_id': '313891_1_En_17_Fig56a_HTML', 'image_file_name': '313891_1_En_17_Fig56a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig56a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates huge round large flaky shadows with increased density in the left lower lung, enlarged and thickened hilum and covered right heart edge. (c, d) DR reexamination after treatment for 1 week demonstrates flocculent shadow in the left lower lung, improved than those before the treatment (a, b). (e) DR reexamination after treatment demonstrates flocculent liked shadows in the left lower lung, obviously improved than before the treatment (c, d)', 'hash': '8c2f7c50d0562920efd9257451f8cc2d4dda042eaa3768d3fb1455a7092edf94'}, {'image_id': '313891_1_En_17_Fig93a_HTML', 'image_file_name': '313891_1_En_17_Fig93a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig93a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates diffuse small cavity in honeycomb liked and infiltrative parenchyma shadows, with the hilum as the center to distribute bilaterally symmetric like butterfly wings; multiple honeycomb liked cavity shadows in both lungs. (e–h) CT scanning reexamination demonstrates large irregular thick-wall cavities in the right lung, surrounding scattering nodular, honeycomba liked and infiltrative shadows after anti-PM infection treatment for 3 months', 'hash': 'eb824267db9288c03e6cffae4cde8b6f47b3bda47dcad797ee4964b9011ac598'}, {'image_id': '313891_1_En_17_Fig46b_HTML', 'image_file_name': '313891_1_En_17_Fig46b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig46b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates large flaky dense shadows in the middle-outer zone of the left middle lung field, and narrowed left bronchus. (d–f) CT scanning demonstrates large flaky shadows with uneven density in the left lateral chest wall and even lower density shadow in them', 'hash': '97eaf0337e0212b917644691da5093524803db5d92384afd57bfc5803cb125e0'}, {'image_id': '313891_1_En_17_Fig39_HTML', 'image_file_name': '313891_1_En_17_Fig39_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig39_HTML.jpg', 'caption': '(a–d) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung, periphery crab feet liked or cords liked shadows due to pleural traction and satellite lesions. (c, d) CT scanning of the mediastinal window demonstrates round liked or triangle shaped thick wall cavities in the left upper lung, no nodules in the wall and peripheral nodular satellite lesions', 'hash': '614dd89032a813e240901110905f63b8b8d2530c6c7e27b0e6aab03ce47f7abb'}, {'image_id': '313891_1_En_17_Fig61_HTML', 'image_file_name': '313891_1_En_17_Fig61_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig61_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a) DR demonstrates large flaky shadow in the middle-outer zone of the left upper lung field. (b) DR demonstrates diffuse dense shadow in the left lung field, with round liked cavities shadows in them. (c–d) Reexamination after treatment demonstrates multiple cavities shadows in the middle-outer zone of the left upper lung field', 'hash': '29c84b1869c0cdabc91ee8822b014d024780586503e92fa0fdc6bed1d3b54b73'}, {'image_id': '313891_1_En_17_Fig88_HTML', 'image_file_name': '313891_1_En_17_Fig88_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig88_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a) The gross specimen demonstrates central necrotic pimples on the face. (b) Chest X-ray DR demonstrates cavities in the left upper lung, thickened lung markings in both lower lungs with accompanying multiple spots and flakes shadows. (c) Gastrointestinal barium meal radiology demonstrates left and downwards migration of the intestine due to compression. (d) Enhanced abdominal CT scanning demonstrates retroperitoneal enlarged lymph nodes that fuse into a huge mass, with ring shaped enhancement of the lymph nodes', 'hash': '72d6f61ccf9268cf07530a5a1e56a768d1d614ac854706838e783fa20f2cb2a1'}, {'image_id': '313891_1_En_17_Fig87_HTML', 'image_file_name': '313891_1_En_17_Fig87_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig87_HTML.jpg', 'caption': '(a) HE staining demonstrates lymph nodes, PM in the yeast phase, with sausage liked shape and obvious septa (HE\u2009×\u20091000). (b) GMS staining demonstrates clearly defined PMs (GMS\u2009×\u20091,000)', 'hash': '195e16d569e89c659459764942f07ae44cec9cd1fd8634e716178e34225094ab'}, {'image_id': '313891_1_En_17_Fig91a_HTML', 'image_file_name': '313891_1_En_17_Fig91a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig91a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–e) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of some lesions into honeycomb likes cavity shadows or plaque liked dense shadows. (f–h) CT scanning demonstrates large thick-wall cavity shadows in the right lung, surrounding plaque and round liked small cavity shadows and inflammatory infiltrative shadows', 'hash': '84aa8353e64cbf735c399fa64899ecd1e9b8a13620149a5aa662a21a423c07bf'}, {'image_id': '313891_1_En_17_Fig8b_HTML', 'image_file_name': '313891_1_En_17_Fig8b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig8b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates large flaky parenchyma shadows in both lungs which is more obvious in the middle and lower lobes of both lungs. There are also enlarged hilar shadows in both lungs and sharp both costophrenic angles. (b–g) CT scanning demonstrates large flaky parenchyma shadows in concentric and symmetrical distribution, bronchial shadows in them and thickened bronchial walls', 'hash': '812cc7d7992507bc22a7c06e518ff223d7e9ece757725f478a6f723b8ac030bf'}, {'image_id': '313891_1_En_17_Fig29_HTML', 'image_file_name': '313891_1_En_17_Fig29_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig29_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric and in even size and distribution. There are nodular shadows in the anterior segment of the right middle lung lobe with clear boundary', 'hash': '16cd873b8d84d3bbad635d9facea5407fe900b62efdd6f481449f4a433dfb6a0'}, {'image_id': '313891_1_En_17_Fig71_HTML', 'image_file_name': '313891_1_En_17_Fig71_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig71_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary aspergillosis infection. (a) The gross specimen demonstratesAspergillus abscess in the skin of the forearm. (b–d) CT scanning of the pulmonary window demonstrates multiple round liked nodular shadows and cavity shadows in both lungs, even thickness of cavity wall, and small nodular shadows in some cavities. (e) Pulmonary Aspergillus infection, demonstration purplish blue branches liked or grasses liked growth of hyphae, HE\u2009×\u2009400', 'hash': 'f0586168fbf7b2cd35205e1c807a3343af1ec5bac8dbe4f50308a570cd7d3552'}, {'image_id': '313891_1_En_17_Fig97_HTML', 'image_file_name': '313891_1_En_17_Fig97_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig97_HTML.jpg', 'caption': '(a) Gross observation of the fresh specimen in autopsy demonstrates pulmonary edema and congestion of cytomegalovirus pneumonia. (b) Gross observation of the formalin fixed specimen in autopsy demonstrates dark brown hard pulmonary tissues. (c, d) HE staining demonstrates large quantity cytomegalovirus inclusions in eagle eyes sign. (e) Immunohistochemical demonstrates HIV P24 antigen positive in macrophages of lung tissues (×400)', 'hash': '50e144edf7881be15e502fff23c2613760ac0172fe3ae6c56abf5ca1abf085b5'}, {'image_id': '313891_1_En_17_Fig20_HTML', 'image_file_name': '313891_1_En_17_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig20_HTML.jpg', 'caption': '(a, b) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates enlarged right hilum in nodular dense shadows with peripheral thickened and blurry pulmonary markings, and no obvious abnormalities of the left hilum. (b) DR demonstrates smaller right hilum after treatment for 1 month', 'hash': '27213b483e54de634de857225fc93f6dc05eb5a729bc751141dea3866128c8ec'}, {'image_id': '313891_1_En_17_Fig6b_HTML', 'image_file_name': '313891_1_En_17_Fig6b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig6b_HTML.jpg', 'caption': '(a-d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates flaky ground glass liked density shadows in upper lobes of both lungs, with bronchial shadows in them; flaky parenchymal shadows in the subpleural apical segment; and thickened bronchial walls in the anterior and posterior segments of the right upper lobe', 'hash': 'ba6f221be2db1160358ae94e02b0125159adca1d9ac64bff84883eae8b614970'}, {'image_id': '313891_1_En_17_Fig17b_HTML', 'image_file_name': '313891_1_En_17_Fig17b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig17b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchymal shadows and fibrous cords liked shadows in both lungs which are more obvious in both lower lungs. The trachea and bronchi are unblocked, with enlarged hilar shadows in both lungs', 'hash': 'dba27067e12ab2a752ec8a543537f427156b1a18bdc04bffa3aedbe2d3b6e7bd'}, {'image_id': '313891_1_En_17_Fig113a_HTML', 'image_file_name': '313891_1_En_17_Fig113a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig113a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Kaposi’s sarcoma. (a–d) Chest CT scanning demonstrates scattered cloudy, mass and flake liked or nodular shadows with increased density. (e) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large thick stained nucleoli, which are in line with the diagnosis of Kaposi’s sarcoma. (f–i) Cured HIV/AIDS related Kaposi’s sarcoma. (f–i) Reexamination after treatment demonstrates absent lesions in both lungs, with clear lung fields', 'hash': '192d991df0d417610162aab90c8b0e07b4c19f1436faa752263e85c3efa0f3db'}, {'image_id': '313891_1_En_17_Fig77_HTML', 'image_file_name': '313891_1_En_17_Fig77_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig77_HTML.jpg', 'caption': 'HE staining demonstrates isseminated cryptococci, the Cryptococcus is stained red after mucin carmine staining of cryptococcus neoformans spores in lungs, (HE\u2009×\u2009200)', 'hash': '882060c6f53899fb225a20d7eb5fe410195beed0a7386dc233a4632284f4717f'}, {'image_id': '313891_1_En_17_Fig78_HTML', 'image_file_name': '313891_1_En_17_Fig78_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig78_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates multiple scattered nodular and miliary shadows in both lungs. (b–d) Chest CT scanning demonstrates multiple dense nodular shadows with different sizes in both lungs, with clear boundaries. They are intensively distributed in the dorsal segment and the largest one has a diameter of about 2 cm', 'hash': 'd60cf04886c28c578ee7940f50525d5141254a1a45a5b489d53a7ae5ae27fa53'}, {'image_id': '313891_1_En_17_Fig7b_HTML', 'image_file_name': '313891_1_En_17_Fig7b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig7b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates diffusely distributed shadows with increased density in both lungs that is more obvious in the middle and lower lungs. The hilar shadows in both lungs are enlarged. Both diaphragmatic surfaces and phrenic angles are blurry. (b–d) CT scanning demonstrates flaky shadows with increased density in both lungs, with parenchymal shadows in the lingular segment of left upper lobe and in the dorsal segments of both lower lobes and bronchial shadows in them. There are also thickened bronchial walls and enlarged hilar shadows in both lungs', 'hash': '47bf3b06e99aa6482027b30084d7445e95928d39923c99fd8fe93df39c899b2d'}, {'image_id': '313891_1_En_17_Fig30_HTML', 'image_file_name': '313891_1_En_17_Fig30_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig30_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs and fusion of some military shadows, which are bilaterally symmetric and in even size and distribution', 'hash': 'ab1d4160a6a23300146e331c7eee06edf886ca73ab4514f8a59b22d04d3c303f'}, {'image_id': '313891_1_En_17_Fig1_HTML', 'image_file_name': '313891_1_En_17_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig1_HTML.jpg', 'caption': '(a) Gross specimens’ observation demonstrates foamy liquid filling in the lung tissues. (b) HE demonstrates pneumocystis in the alveolar exudates, which can be stained black by silver methenamine staining, ×400. (c) HE demonstrates the foamy substance in the alveolar space, ×400', 'hash': 'a0082be568f7c995671d0461acf0cfe32c8c36a01dbf7badc28f3cc0ab407b75'}, {'image_id': '313891_1_En_17_Fig81_HTML', 'image_file_name': '313891_1_En_17_Fig81_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig81_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates thickened lung markings in both lungs and flaky blurry shadows in the left lower lung. (b, c) CT scanning demonstrates round liked nodular and small cavity shadows in the left upper and lower lung, with clear boundaries. (d–f) Pathology demonstrates transparent substrate in lung tissues and many bi-capsular cryptococci in cytoplasm', 'hash': '3e767fbaeda72c7b7b49df4ee9daa757367932f7623507185ca8453615c8de74'}, {'image_id': '313891_1_En_17_Fig58a_HTML', 'image_file_name': '313891_1_En_17_Fig58a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig58a_HTML.jpg', 'caption': '(a–i) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) CT scanning of the pulmonary window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (c, d) CT scanning of the mediastinal window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, pulmonary atelectasis and pleural effusion, with ventilation shadows in them. (e) CT scanning of the pulmonary window after the treatment demonstrates absence of the mass shadows in the left lower lung with transverse stripes shadows, obviously improved than previous findings (a, b). (f) HE staining demonstrates thickened alveolar septa and exudates from the alveolar cavity. (g) HE staining demonstrates massive bleeding in the alveolar cavity, large quantity erythrocytes and intact cell walls. (h) HE staining demonstrates phagocytized basophilic granules in the leukocytes. (i) HP staining demonstrates purplish red Rhodococcus equi in a shape of crescent in orange red sputum', 'hash': 'fcd60ca09d86084cb78d6b91f9b3e0a51e9f479a1c27837e18c9af0f809ef13d'}, {'image_id': '313891_1_En_17_Fig57_HTML', 'image_file_name': '313891_1_En_17_Fig57_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig57_HTML.jpg', 'caption': '(a, b)HIV/AIDS related Rhodococcus equi pneumonia. (a) CT scanning of the mediastinal window demonstrates soft tissue mass shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (b) CT scanning of the pulmonary window after the treatment demonstrates absence of the soft tissue mass shadows, and flocculent liked shadow in the left lower lung, obviously improved than previous findings (a)', 'hash': '9ac02a8eb30f8314fea4211fa5a4dbfa3863c422d30e78fcb26e8eaf44e36a42'}, {'image_id': '313891_1_En_17_Fig10_HTML', 'image_file_name': '313891_1_En_17_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig10_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates large flaky and mass liked parenchyma shadows in both lungs which is more obvious in the right lung, bronchial shadows in them, and thickened bronchial walls in the middle lobe of the right lung', 'hash': 'dc81224c041dbc53a26ff01b3414f8c13098126861cf7cc0c7f10d80a7485e0c'}, {'image_id': '313891_1_En_17_Fig100_HTML', 'image_file_name': '313891_1_En_17_Fig100_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig100_HTML.jpg', 'caption': 'The structure of herpes simplex virus', 'hash': 'b0a88fbe1660ab4ddb94799e876d547c23b5686d12e31560768111a38bc71a45'}, {'image_id': '313891_1_En_17_Fig110a_HTML', 'image_file_name': '313891_1_En_17_Fig110a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110a_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '7392286985c0e8fefacf1282d1ef323dd6d64b0b536b667dfffbcbde5be28d3c'}, {'image_id': '313891_1_En_17_Fig5b_HTML', 'image_file_name': '313891_1_En_17_Fig5b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig5b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates patchy shadows with increased density in both lungs, with thickened hilar shadows in both lungs. (b–g) CT scanning demonstrates flaky ground glass liked density shadows in upper lungs and dorsal segment of both lungs, which is more obvious in the middle inner strips. There are extrapulmonary stripes transparent shadows, with some bronchial walls thickened and enlarged hilar shadows in both lungs', 'hash': 'fcd873302d30f9846ba865346820af2a06778c5dad1b50cc634281055ae78468'}, {'image_id': '313891_1_En_17_Fig47_HTML', 'image_file_name': '313891_1_En_17_Fig47_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig47_HTML.jpg', 'caption': '(a–e) HIV/AIDS related staphylococcus aureus pneumonia. (a) DR demonstrates large flaky dense shadows with increased density in the middle-inner zone of the left upper lung field, with blurry boundaries. The lung tissue are atelectatic and the mediastinum migrates leftwards. (b, c) CT scanning demonstrates large flaky dense shadows with increased density in the middle-inner zone of the left upper lung field, with blurry boundaries, with surrounding acinar or particle liked shadows that fuse into flaky shadows. (d, e) CT scanning demonstrates large flaky shadow of parenchymal changes in the middle-inner zone of the left upper lung field, with cyst liked transparent shadows and air bronchogram sign in them, as well as mediastinal lymphadenectasis', 'hash': '8e228a648d0d33ebe1db2bfa2fa7b6209cd113683b027d6ada34f161b809085a'}, {'image_id': '313891_1_En_17_Fig48_HTML', 'image_file_name': '313891_1_En_17_Fig48_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig48_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates broad band liked high density shadows in the right middle lung field, with air bronchogram sign in them. (d–f) CT scanning of the mediastinal window demonstrates broad band liked uneven parenchymal shadows in the right middle lung field, with uneven thickness of air bronchogram sign', 'hash': '6e700dc830efe216b64ed069dfb6440abf50854341b133bf0237be914bd5270f'}, {'image_id': '313891_1_En_17_Fig37_HTML', 'image_file_name': '313891_1_En_17_Fig37_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig37_HTML.jpg', 'caption': '(a, b) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a, b) DR demonstrates diffuse scattering patchy shadows with increased density, and oval thin wall cavity shadows in the right middle lung field', 'hash': 'edc3511f0cc30005fb5999c1fe7033024176b0e1b8fee607763caef6a0d9abe2'}, {'image_id': '313891_1_En_17_Fig38_HTML', 'image_file_name': '313891_1_En_17_Fig38_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig38_HTML.jpg', 'caption': '(a–d) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in both upper lungs, peripheral crab feet liked or cords liked shadows due to pleural traction with cavity shadows in them and periperal satellite lesions. (b–d) CT scanning of the mediastinal window demonstrates round liked mass shadows with high density in the cavities of the left upper lung, surrounding transparent shadows, no nodules in the walls and surrounding nodular satellite lesions. By pathological examination, the diagnosis is defined as chronic fibrous cavity pulmonary tuberculosis complicated by Aspergillus infection', 'hash': '0317a9a78d280af1069a5b797b63c3817f47607eb13976214ed710d247081a7c'}, {'image_id': '313891_1_En_17_Fig65b_HTML', 'image_file_name': '313891_1_En_17_Fig65b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig65b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related allergic pulmonary Aspergillus infection. (a–f) CT scanning of the pulmonary window demonstrates thickened central pulmonary markings in both lungs, which is turtuous and deranged with fingertip infiltration shadows. (g) DR demonstrates hyperinflation of the right lung, increased and thickened pulmonary markings and ground glass liked shadows with increased density in the right lower lung and left lung lobe', 'hash': '44f320a9216b7a9905eaaa045a44b4be59372433c9737f0ee8ded7c443134eaa'}, {'image_id': '313891_1_En_17_Fig9_HTML', 'image_file_name': '313891_1_En_17_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig9_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates large flaky parenchyma shadows in both lungs, with transparent areas in some foci. The trachea and bronchi are unblocked, with thickened bronchial walls in the middle and lower lobes', 'hash': '26b10397cecf70e4665c1abb0f2501e939a6e5d219f395c3484c7a44dae78681'}, {'image_id': '313891_1_En_17_Fig76a_HTML', 'image_file_name': '313891_1_En_17_Fig76a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig76a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning demonstrates diffuse scattered thin ground glass liked, patchy, flaky blurry shadows and cords liked shadows in both lungs, with blurry boundaries and uneven density; scattered nodular shadows in different sizes; more lesions in both upper lobes and the right middle lobe; flaky parenchyma shadows in the apical and posterior segments of right upper lobe, with air bronchogram sign in them; unobstructed opening of bronchi as well as lobar and segmental bronchi without stenosis and obstruction; lymphadenectasis in the right hilar region; detected Aspergillus fumigatus by sputum culture. (e, f) Culture for 72 h, lactic acid gossypol blue staining and microscopic observation at ×200 and ×400 demonstrate short column liked conidial head, smooth wall of conidiophores, flask-shaped top capsule and monolayer microconidiophores. (g) Culture in Paul’s medium demonstrates dark green colored colonies', 'hash': '79dde610127d242cc7f1f29fc98dd50c426df080c95629396102af54f31872c9'}, {'image_id': '313891_1_En_17_Fig86_HTML', 'image_file_name': '313891_1_En_17_Fig86_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig86_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary candida infection. (a–d) CT scanning demonstrates thickened and deranged lung markings in both lungs, diffuse small flaky or patchy shadows, fusion of some small shadows into large flaky dense shadows, with blurry boundaries, enlarged hilum and blurry structures', 'hash': 'bb5525804e3b5cc6588115cd2813109845df9b4314974ab2b55c40298ed6968a'}, {'image_id': '313891_1_En_17_Fig89_HTML', 'image_file_name': '313891_1_En_17_Fig89_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig89_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows in the lungs that fuse into mass with parenchymal shadows, with the hilum as the center and distributing bilaterally symmetric like butterfly wings. There are also multiple clustering cavities or singular large cavity in both lungs', 'hash': 'cfd1927b986a8aba818bf96427711a3743dd07195a83b88e195837af405aae79'}, {'image_id': '313891_1_En_17_Fig60_HTML', 'image_file_name': '313891_1_En_17_Fig60_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig60_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a) DR demonstrates huge sphere liked mass shadow in the middle-outer zone of the right lower lung field, with cavities shdows in them. (b–d) CT scanning demonstrates triangular dense shadow in the middle-outer zone of the right lower lung field, with its apex pointing to the hilum and round liked cavities shadows in them. (e) Reexamination after the treatment demonstrates shrinkage of the huge sphere liked mass shadow in the middle-outer zone of the right lower lung field, with closure of the cavities', 'hash': '9020727e51b9a8522ea37dd579ce73bd9a417d327bcb313836c96e1fa3bd209f'}, {'image_id': '313891_1_En_17_Fig2b_HTML', 'image_file_name': '313891_1_En_17_Fig2b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig2b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered miliary increased density shadows in both lungs, with even size, density and distribution. The shadows of both hila are dense, with sharp both costophrenic angles. (b–f) CT scanning demonstrates scattered miliary nodular shadows in both lungs, which is more obviously in the middle pulmonary strip and with quite even size and density. Trachea and bronchi are unblocked', 'hash': 'ab808d6adb73be9c9efd977cd27ef54cace943f5143068db354c7d287374a50d'}, {'image_id': '313891_1_En_17_Fig13b_HTML', 'image_file_name': '313891_1_En_17_Fig13b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig13b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, transparent areas in them and unblocked trachea and bronchi', 'hash': '2f728d8163ffe4c88ed77f38f8d2e52cb2281b7f3a54af1e9ef328c17a26db3e'}, {'image_id': '313891_1_En_17_Fig28_HTML', 'image_file_name': '313891_1_En_17_Fig28_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig28_HTML.jpg', 'caption': '(a–b) HIV/AIDS related miliary tuberculosis. (a) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric and in even size and distribution. (b) CT scanning of the mediastinal window demonstrates round liked nodular shadows in the right lower lung. CT guided puncture for biopsy is performed to define the diagnosis', 'hash': '1ae71db3f6eebb2e460b8f3b777873d5e7fcf066436bf3a85ef8123aff3f39a9'}, {'image_id': '313891_1_En_17_Fig105b_HTML', 'image_file_name': '313891_1_En_17_Fig105b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig105b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary toxoplasmosis. (a–d) CT scanning demonstrates thickened pulmonary markings in both lungs, which can be enhanced to extend into the middle and outer zones of lungs, in grid liked appearance that is more obvious in the dorsal segment of the lungs. (e) It is demonstrated to have clustering toxoplasma tachyzoites', 'hash': '78ad5a602c243399be530b578f5858d7393984c75f2f978c1dd02f12b26b8836'}, {'image_id': '313891_1_En_17_Fig99_HTML', 'image_file_name': '313891_1_En_17_Fig99_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig99_HTML.jpg', 'caption': '(a, b) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates enlarged right hilus, thickened and deranged lung markings. (b) Plain CT scanning demonstrates mass shadows in the right hilus, spots shadows in the right middle and lower lobes, and patchy shadows in the lingual segment of the left lung', 'hash': '996d2e340f8971525deb4ef2a9312fe4a696f4d7f6bf28ca091e8c767b96b1d4'}, {'image_id': '313891_1_En_17_Fig3b_HTML', 'image_file_name': '313891_1_En_17_Fig3b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig3b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy and scattered miliary increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of the lower lung field, with some fused in thin cloudy shadows', 'hash': '8c1d9dac035274e484303c9deb64a07fed7806c66acaf49b860164feb6d461fc'}, {'image_id': '313891_1_En_17_Fig70_HTML', 'image_file_name': '313891_1_En_17_Fig70_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig70_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window demonstrates a huge cavity shadow in the dorsal segment of the right lower lung, large nodular shadows in it, liquid gas level in the basal cavity, and the evenly thick wall. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates a huge cavity shadow in the dorsal segment of the left lung, multiple large nodular shadows in it, and involved pleura of the lateral chest wall', 'hash': '967426acae68b8d57372efde07d76dd6ad696b10cc5bb64fb67bd9af43a1b0c8'}, {'image_id': '313891_1_En_17_Fig108_HTML', 'image_file_name': '313891_1_En_17_Fig108_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig108_HTML.jpg', 'caption': 'HIV/AIDS related lymphoma. DR demonstrates widened upper middle mediastinum in a dense shadow, enlarged and thickened hilum, thickened and blurry pulmonary markings with diffuse ground glass liked changes', 'hash': '449c992b619237febe63b1617b26f78de511c69c5d1c86ddbd66631790a3e3ce'}, {'image_id': '313891_1_En_17_Fig18_HTML', 'image_file_name': '313891_1_En_17_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig18_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates multiple patchy shadows with increased density in both lungs which are more obvious in both middle and lower lungs. The hilar shadows in both lungs are enlarged, with sharp both costophrenic angles. (b–d) CT scanning demonstrates multiple patchy and mass liked parenchyma shadows in both lungs, ground glass density shadows in the apical segment of both upper lobes, transparent areas in the medial segment of the right middle lobe as well as in the lingual segment of the left upper lobe, and unobstructed trachea and bronchi', 'hash': '18239548bfc8a180d3460173e2f66f27c6ff38e464607d7ec3eb2a837a1382c9'}, {'image_id': '313891_1_En_17_Fig67b_HTML', 'image_file_name': '313891_1_En_17_Fig67b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig67b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows. (e–h) Reexamination of the pulmonary window after 3 months treatment demonstrates multiple scattered round liked nodular shadows and thick wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows which obviously increase and enlarge compared to previous lesions, with accompanying infiltration shadows around the lesions', 'hash': 'f70faec5b814f1fa9555182e0f5414a33838b2496e4da16dc69e0c237676eb30'}, {'image_id': '313891_1_En_17_Fig115a_HTML', 'image_file_name': '313891_1_En_17_Fig115a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig115a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lung cancer. (a–f) CT scanning demonstrates diffuse soft tissue density shadows in left upper lung, round liked mass shadows in the middle lung field, thickened pleura in the lateral chest wall with adhesion, and strip liked liquid density shadows', 'hash': '08de7c80ca9fdc7641723bbb9689498f65631a1a2ee1f499cda653be3ea3d358'}, {'image_id': '313891_1_En_17_Fig40_HTML', 'image_file_name': '313891_1_En_17_Fig40_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig40_HTML.jpg', 'caption': '(a, b) HIV/AIDS related endobronchial tuberculosis. (a, b) Chest CT scanning demonstrates narrowed left major bronchus, irregular thickening of the brounchial wall, multiple irregular flaky, patchy and military shadows in the posterior apical, anterior and lingual segments of the left upper lung. Bronchobierscopy demonstrates narrowed left major bronchus, which is possibly caused by endobronchial tuberculosis', 'hash': '4e416b52d4cb1a2790ee8ad419d525b4e0b37740624cb136f4f5d66c98344651'}, {'image_id': '313891_1_En_17_Fig106b_HTML', 'image_file_name': '313891_1_En_17_Fig106b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig106b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related lymphoma. (a–b) DR demonstrates enlarged and thickened left hilum in a huge mass shadow. High KV demonstrates a huge mass shadow in the hilum. (c–h) CT scanning of the pulmonary window demonstrates a huge high density mass shadow in the left hilum, surrounding nodular fusion shadows in the lung tissues. CT scanning of the mediastinal window demonstrates a huge high density mass shadow in the left hilum, with air bronchogram sign in the shadow', 'hash': '157c65f2ce36513c7bad3d16abf703fde23671a6d95e1da5b62342efd5b516bb'}, {'image_id': '313891_1_En_17_Fig75a_HTML', 'image_file_name': '313891_1_En_17_Fig75a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig75a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval or sphere shaped nodular shadows in the cavities with smooth boundaries. (e, f) Reexamination after treatment demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval nodular shadows in the cavity with smooth boundaries. Compared to the previous imaging findings, the lesions are shrunk, with improved surrounding infiltration', 'hash': 'd2c91d61cbf8a801eed1951a78b54e9b966e9be37aee83d7582af7a496143832'}, {'image_id': '313891_1_En_17_Fig66b_HTML', 'image_file_name': '313891_1_En_17_Fig66b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig66b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates large flaky shadows with increased density in the right upper lung, with blurry boundaries; round liked or sphere shaped mass shadows in the right lower lung, with uneven density. (b–e) CT scanning of the pulmonary window demonstrates multiple round liked thick-wall cavities in the dorsal segment of the right lower lung, with small nodular shadow adhering on the cavity wall; and surrounding small nodular shadows and infi ltration shadows. (f, g) Coronal CT scanning reconstruction demonstrates a huge thick-wall cavity in the right upper lung, with irregular thickness of the wall; round liked cavity shadows in the right lower lung, with thick and multilocular walls; and flaky shadows with increased density in the outer zone of the left lower lung', 'hash': 'fe0cc9e767d47fe24d043db5792869e260b44f40097a6c4d26c923e91ef70b0b'}, {'image_id': '313891_1_En_17_Fig98a_HTML', 'image_file_name': '313891_1_En_17_Fig98a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig98a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates thickened lung markings in both lungs, which extend to the outer zone of the lungs. (b) DR demonstrates thickened and deranged lung markings in both lungs with nodular blurry shadows; and cloudy shadows in lung fields. (c, d) CT scanning demonstrates thickened lung markings in both lungs, with diffuse nodular shadows; and cloudy changes in lung fields. (e) HE staining demonstrates cytomegalovirus inclusions', 'hash': 'adcabf812efa2a551bb7a968e7cf0afcc7677ffb9adf3d1a40a65675496e4552'}, {'image_id': '313891_1_En_17_Fig50_HTML', 'image_file_name': '313891_1_En_17_Fig50_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig50_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Staphylococcus aureus pneumonia. (a) DR demonstrates large flaky dense shadow in the right middle-upper lung field, with blurry boundary. (b, c) CT scanning demonstrates large flaky dense shadow in the right middle upper lung field, with blurry boundary. (d, e) CT scanning demonstrates large flaky dense shadow in the right middle upper lung field, with cystic transparent area in it. (f) Reexamination demonstrates obviously improved pulmonary lesions in the right lung after anti-bacteria treatment for 3 weeks', 'hash': 'bb5e00f8d7a7c6c4308ca4e5024daa75df1bf9a0a88359faa7e2ee91a6c5f156'}, {'image_id': '313891_1_En_17_Fig114a_HTML', 'image_file_name': '313891_1_En_17_Fig114a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig114a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related Kaposi’s sarcoma. (a–d) CT scanning demonstrates scattered cloudy mass and flakes liked or nodular shadows with increased density in both lungs with uneven density and unclear boundaries, fusion and parenchymal changes of some lesions, more lesions in the lower lobe of both lungs and mostly with parenchymal changes. (e, f) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large and thick stained nucleoli, which are in line with the manifestations of Kaposi’s sarcoma. (g, h) Immunohistochemical demonstrates positive of C3 and C4', 'hash': '5d7437deda7758de05e56f8172703b4659fa4eeebdc50c92456867e7bfdb2691'}, {'image_id': '313891_1_En_17_Fig107b_HTML', 'image_file_name': '313891_1_En_17_Fig107b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig107b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related lymphoma. (a–e) CT scanning of the pulmonary and mediastinal windows demonstrates multiple round liked nodular shadows with increased density in both lung fields, with clear boundaries; large soft tissue mass shadows in the right lower lung, with slightly lobulated boundaries and spikes. (f–i) CT scanning of the pulmonary and mediastinal windows for reexamination after radiation therapy demonstrates shrinkage of intrapulmonary nodules and masses', 'hash': 'a7c148d3f71f853c603d1730a516c4b571960bd1e6296b96b6418a73f3663e33'}] | {'313891_1_En_17_Fig1_HTML': ['By naked eyes observation, there are extensive and diffuse invasion of lungs, which is soft like waterlogged sponge and in milky white with black spots. The filled foamy substance in the alveoli and bronchioles is a mixture of necrotic fungus and immunoglobulin. The alveolar septum has infiltration of plasma cells and lymphocytes, resulting in thickened alveolar septa up to 5–20 times as the normal thickness that occupy 3/4 of the entire lung volume. The cysts are firstly located in the macrophage cytoplasm of the alveolar septa. Subsequently, the alveolar cells containing cysts sheds off into the alveolar space. After the rupture of the cystic wall, sporozoite is discharged to turn into free trophozoites, which gains its access into the alveolar space. The alveolar exudates include plasma cells, lymphocytes and histocytes (Fig. <xref rid="313891_1_En_17_Fig1_HTML" ref-type="fig">17.1a–c</xref>).\n).\nFig. 17.1(a) Gross specimens’ observation demonstrates foamy liquid filling in the lung tissues. (b) HE demonstrates pneumocystis in the alveolar exudates, which can be stained black by silver methenamine staining, ×400. (c) HE demonstrates the foamy substance in the alveolar space, ×400\n'], '313891_1_En_17_Fig19_HTML': ['If the necrotic lesions erode the blood vessels, tubercle bacilli can cause systemic miliary tuberculosis along with blood flow, including brain, bones and kidneys. Large quantity sputum containing tubercle bacilli gains its access into the gastrointestinal tract. It can also cause intestinal tuberculosis and peritoneal tuberculosis. Pulmonary tuberculosis can cause tuberculosis pleurisy via direct spreading to the pleura (Fig. <xref rid="313891_1_En_17_Fig19_HTML" ref-type="fig">17.19a–c</xref>).\n).\nFig. 17.19(a) Gross observation in autopsy demonstrates disseminated pulmonary tuberculosis, with grayish white military nodules in diffuse distribution in the lung tissues section. (b) It is demonstrated that mycobacteriumavium-intracellularcomplex infection in the lung tissue, with atypical tuberculosis nodules and acid-fast staining positive (left top). There are a subnodular giant cell, eosinophilic inclusion bodies in the nucleus and bradyzoites in cytoplasm of T. gondii. HE\u2009×\u2009100. (c) HE demonstrates mycobacteriumavium-intracellularcomplex infection, with atypical tuberculosis nodular changes, HE\u2009×\u2009200\n'], '313891_1_En_17_Fig45_HTML': ['Pneumonia caused by inhaled staphylococcus aureus through the respiratory tract often shows lesions in the large lobes or extensive fusion of bronchopneumonia lesions. Bronchial and alveolar rupture allows gas to enter the pulmonary interstitium, which is communicated with the bronchi. In the cases of bronchiolar blockage by necrotic tissues or pus, the one-way valve effect is formed to cause tension pulmonary emphysema. In the cases with superficial pulmonary emphysema with excessively high tension, it ruptures to form pneumothorax or pyopneumothorax, as well as bronchooleural fistula (Fig. <xref rid="313891_1_En_17_Fig45_HTML" ref-type="fig">17.45a, b</xref>).\n).\nFig. 17.45(a, b) HIV/AIDS related Staphylococcus aureus pneumonia. (a) Gross specimen observation demonstrates bilateral purplish brown lesions, patchy white infiltration at the base of the lungs. (b) HE staining demonstrates alveolar diffuse lesions, exudation of the serous fluid and inflammatory cells in the alveolar cavity, and alveolar wall congestion\n'], '313891_1_En_17_Fig64_HTML': ['Aspergillus commonly violates bronchus and lung, with involvements of rhinal sinuses, external auditory canal, eye and skin. Otherwise, it disseminates to organs of the body along with blood flow. The early lesions are diffuse infiltrative and exudative changes. And advanced lesions are necrosis, pyogenesis or granuloma. Large quantity hyphae can be found in the lesions. The hyphae penetrate the blood vessels to cause vasculitis, perivascular inflammation and thrombosis. And thrombosis can cause ischemia and necrosis of the tissue. According to the pathological changes and imaging findings, it can be divided into three major types: vascular invasion type, bronchopneumonia type and allergic bronchopulmonary aspergillosis type. (1) The vascular invasion type is the result caused by toxins released in the process of aspergillus spreading extensively from the primary focus to the lungs. Vascular infiltration of the pulmonary parenchyma and coagulative necrosis are believed to be the cause of vascular occlusion and pulmonary infarction. (2) Bronchopneumonia type is acute bronchitis caused by inhalation of Aspergillus spores. In the cases of hyphae invasion into the lung tissues, extensive infiltrative pneumonia or focal granuloma are resulted in. It can also cause necrosis, pyogenesis and multiple small abscesses. Spherical pulmonary aspergillosis is often secondary to bronchiectasis, tuberculosis, carcinous cavity and other lung diseases. Mycelia multiply and gather in the cavities of the lungs to form a spherical mass with fibrin and mucosal cells, which are called aspergillar glomera, which do not invade the lung tissue. (3) Allergic bronchopulmonary aspergillosis type is the proliferation and germination of inhaled Aspergillus spore in the airway, often showing obvious related mucosal lesions and eventually resulting in bronchiectasis (Fig. <xref rid="313891_1_En_17_Fig64_HTML" ref-type="fig">17.64a–c</xref>).\n).\nFig. 17.64(a) Gross observation demonstrates dark brown lungs in appearance. (b, c) Thology demonstrates hemorrhage and edema of the lung tissue and focal necrosis, with large quantity Aspergillus hyphae and spores in the surrounding area of the necrosis (Combined with pulmonary CMV infection)\n'], '313891_1_En_17_Fig77_HTML': ['In the early stage of cryptococcal infection, only a mild inflammatory reaction or diffuse infiltrative exudative changes occur. But in the advanced stage, necrosis, suppuration or granuloma is formed. Large quantity hyphae can be found in the focus. In the cases with hyphae penetrating the blood vessels, vasculitis, perivascular inflammation and thrombosis occur. And thrombosis leads to ischemia and necrosis of the tissue (Fig. <xref rid="313891_1_En_17_Fig77_HTML" ref-type="fig">17.77</xref>).\n).\nFig. 17.77HE staining demonstrates isseminated cryptococci, the Cryptococcus is stained red after mucin carmine staining of cryptococcus neoformans spores in lungs, (HE\u2009×\u2009200)\n'], '313891_1_En_17_Fig97_HTML': ['Cytomegalovirus pneumonia has extensive pathological changes in the lungs. Pathologically, it shows interstitial pneumonia, with the lesions randomly blood borne distributing in the lungs. The distribution can be diffuse, panlobular or focal. The target cells of pathological changes include alveolar cells and macrophages. Diffused pulmonary interstitial edema and fibrosis as well as alveolar swelling, focal necrosis, bleeding and hyperplasia occur after CMV infections to cause hypoxemia. Gross observation of fresh specimens demonstrates pulmonary surface edema and flaky blooding spots. Fixed specimens demonstrate brown hard lung tissues. Under a microscope, pulmonary interstitial congestion as well as infiltration of lymphocytes and mononuclear cells can be found, with the involved epithelial cells enlarged. In the pulmonary interstitium and alveoli, there are intranuclear inclusions, cytoplasmic inclusions and fluid containing abundant proteins. The classical intranuclear inclusions can be found in the cells, purplish red or purplish blue, round or oval, with surrounding halos in eagle eyes sign. Atypical cytomegalic inclusions in cells are slender, long and round liked with abundant cytoplasm and accentric nucleolus, which are blurry, unclear and atypical (Fig. <xref rid="313891_1_En_17_Fig97_HTML" ref-type="fig">17.97a–e</xref>). Immunohistochemitry demonstrates HIV P24 antigen positive.\n). Immunohistochemitry demonstrates HIV P24 antigen positive.\nFig. 17.97(a) Gross observation of the fresh specimen in autopsy demonstrates pulmonary edema and congestion of cytomegalovirus pneumonia. (b) Gross observation of the formalin fixed specimen in autopsy demonstrates dark brown hard pulmonary tissues. (c, d) HE staining demonstrates large quantity cytomegalovirus inclusions in eagle eyes sign. (e) Immunohistochemical demonstrates HIV P24 antigen positive in macrophages of lung tissues (×400)\n']} | HIV/AIDS Related Respiratory Diseases | [
"HIV/AIDS related pneumocystis carnii pneumonia (PCP)",
"HIV/AIDS related pulmonary bacterial infections",
"HIV/AIDS related pulmonary fungal infections",
"HIV/AIDS related pulmonary virus infections",
"HIV/AIDS related pulmonary parasitic diseases",
"HIV/AIDS related pulmonary neoplasm"
] | None | 1380524400 | None | null | other | PMC7121050 | null | null | [
""
] | Radiology of HIV/AIDS. 2013 Sep 30;:377-535 | NO-CC CODE |
|
(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in prone posture demonstrates mass shadow and thick wall cavity in the dorsal segment of the right lower lung, small nodular shadows in the cavities, surrounding fused miliary infiltration shadows. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the dorsal segment of the right lower lung, small nodular shadows in the cavities, and involved pleura of partial lateral chest wall | 313891_1_En_17_Fig68a_HTML | 7 | 0acc77833f25b70e7e4527a30be9fc6744e19cee48879415a15e648d76923d48 | 313891_1_En_17_Fig68a_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
778,
258
] | [{'image_id': '313891_1_En_17_Fig115b_HTML', 'image_file_name': '313891_1_En_17_Fig115b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig115b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lung cancer. (a–f) CT scanning demonstrates diffuse soft tissue density shadows in left upper lung, round liked mass shadows in the middle lung field, thickened pleura in the lateral chest wall with adhesion, and strip liked liquid density shadows', 'hash': '37ffef88f4c6dffdd2849b9994419efe1bf8f369ad111d82071f2f004a9fa43f'}, {'image_id': '313891_1_En_17_Fig106a_HTML', 'image_file_name': '313891_1_En_17_Fig106a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig106a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related lymphoma. (a–b) DR demonstrates enlarged and thickened left hilum in a huge mass shadow. High KV demonstrates a huge mass shadow in the hilum. (c–h) CT scanning of the pulmonary window demonstrates a huge high density mass shadow in the left hilum, surrounding nodular fusion shadows in the lung tissues. CT scanning of the mediastinal window demonstrates a huge high density mass shadow in the left hilum, with air bronchogram sign in the shadow', 'hash': '1ff6a74f6517ed666fda8da1eb38cd58b7d92c3687c533350df4caf4cb7ba7d7'}, {'image_id': '313891_1_En_17_Fig67a_HTML', 'image_file_name': '313891_1_En_17_Fig67a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig67a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows. (e–h) Reexamination of the pulmonary window after 3 months treatment demonstrates multiple scattered round liked nodular shadows and thick wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows which obviously increase and enlarge compared to previous lesions, with accompanying infiltration shadows around the lesions', 'hash': '75b2dd5456ce09da0ace0b9787ea5a36d49c80e174314762343564032297b51c'}, {'image_id': '313891_1_En_17_Fig14_HTML', 'image_file_name': '313891_1_En_17_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig14_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, mass and flakes of parenchymal shadows in the posterior segment of the right upper lobe and in the dorsal segment of both lower lobes which is more obvious in the right lung, and bronchial shadows in them', 'hash': 'bc4343d2071f380a05855c1e658dc05d90d8ae123e988cfe12c3e65526b3336c'}, {'image_id': '313891_1_En_17_Fig104_HTML', 'image_file_name': '313891_1_En_17_Fig104_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig104_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymphoid interstitial pneumonia. (a–f) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs in reticular appearance, with accompanying multiple small nodular shadows, fusion of some nodules into flaky shadows, and ground glass liked changes in the lung fields', 'hash': '4883f041ed6e05ad0ce9ee6734fea4171aae151209ba36cbce94c8434c86f174'}, {'image_id': '313891_1_En_17_Fig98b_HTML', 'image_file_name': '313891_1_En_17_Fig98b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig98b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates thickened lung markings in both lungs, which extend to the outer zone of the lungs. (b) DR demonstrates thickened and deranged lung markings in both lungs with nodular blurry shadows; and cloudy shadows in lung fields. (c, d) CT scanning demonstrates thickened lung markings in both lungs, with diffuse nodular shadows; and cloudy changes in lung fields. (e) HE staining demonstrates cytomegalovirus inclusions', 'hash': '489286db9d367c09fbc842e4d1ba093d9caa6ded75760e9e1a70e05a86f43979'}, {'image_id': '313891_1_En_17_Fig53_HTML', 'image_file_name': '313891_1_En_17_Fig53_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig53_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) Anteroposterior and lateral DR demonstrates enlarged and thickened left hilum, and large flaky blurry shadows with increased density in the left lower lung. (c, d) Reexamination demonstrates normal lungs after antibiotic treatment', 'hash': 'd9cd861c21f1100d02e20014901c7e4a9a9bcad2e4ddcd3c731b50168d8782be'}, {'image_id': '313891_1_En_17_Fig114b_HTML', 'image_file_name': '313891_1_En_17_Fig114b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig114b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related Kaposi’s sarcoma. (a–d) CT scanning demonstrates scattered cloudy mass and flakes liked or nodular shadows with increased density in both lungs with uneven density and unclear boundaries, fusion and parenchymal changes of some lesions, more lesions in the lower lobe of both lungs and mostly with parenchymal changes. (e, f) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large and thick stained nucleoli, which are in line with the manifestations of Kaposi’s sarcoma. (g, h) Immunohistochemical demonstrates positive of C3 and C4', 'hash': '586be9acfd2434fad0db1a2ffaba9ac72eb8eb799b76acdaeac2730c48c45020'}, {'image_id': '313891_1_En_17_Fig107a_HTML', 'image_file_name': '313891_1_En_17_Fig107a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig107a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related lymphoma. (a–e) CT scanning of the pulmonary and mediastinal windows demonstrates multiple round liked nodular shadows with increased density in both lung fields, with clear boundaries; large soft tissue mass shadows in the right lower lung, with slightly lobulated boundaries and spikes. (f–i) CT scanning of the pulmonary and mediastinal windows for reexamination after radiation therapy demonstrates shrinkage of intrapulmonary nodules and masses', 'hash': '4ca6acd1461c3d7b80869d7d33bd1a3d91ecd1a0dc1b5c7baecc0bfbcf817449'}, {'image_id': '313891_1_En_17_Fig75b_HTML', 'image_file_name': '313891_1_En_17_Fig75b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig75b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval or sphere shaped nodular shadows in the cavities with smooth boundaries. (e, f) Reexamination after treatment demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval nodular shadows in the cavity with smooth boundaries. Compared to the previous imaging findings, the lesions are shrunk, with improved surrounding infiltration', 'hash': 'b1a96158009afcb5e673cf31f9243ca598c763c294bbdc7479a918fb36b031e8'}, {'image_id': '313891_1_En_17_Fig25d_HTML', 'image_file_name': '313891_1_En_17_Fig25d_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25d_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '1e7425ad1ac60b1c612434d02bbe7d48ba0fb82e0642b09b8771b4fea9a7a4c2'}, {'image_id': '313891_1_En_17_Fig66a_HTML', 'image_file_name': '313891_1_En_17_Fig66a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig66a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates large flaky shadows with increased density in the right upper lung, with blurry boundaries; round liked or sphere shaped mass shadows in the right lower lung, with uneven density. (b–e) CT scanning of the pulmonary window demonstrates multiple round liked thick-wall cavities in the dorsal segment of the right lower lung, with small nodular shadow adhering on the cavity wall; and surrounding small nodular shadows and infi ltration shadows. (f, g) Coronal CT scanning reconstruction demonstrates a huge thick-wall cavity in the right upper lung, with irregular thickness of the wall; round liked cavity shadows in the right lower lung, with thick and multilocular walls; and flaky shadows with increased density in the outer zone of the left lower lung', 'hash': 'efec688fc6d0fd9fc9188edcc4a4bb040754e9c9e3261fcacec068f3bfd0252f'}, {'image_id': '313891_1_En_17_Fig63_HTML', 'image_file_name': '313891_1_En_17_Fig63_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig63_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Rhodococcus equi pneumonia. (a) Pulmonary CT scanning demonstrates a mass shadow in the lateral segment of the right middle lobe in size of 4.7\u2009×\u20093.7\u2009×\u20093.2 cm with uneven density and lace liked boundary, and small bubbles shadows in it. By both sputum culture and lung tissue culture, Rhodococcus equi can be detected. (b, c) Pathological biopsy and HE staining demonstrate inflammatory pseudotumor. (d, e) Immunohistochemistry demonstrates Rhodococcus equi antibody positive. (f) Reexamination after treatment demonstrates obvious shrinkage of the original lung lesions', 'hash': 'ac97b316499d751a48d8b861962da376a39c7ff11d2554ed957c226224dc65b6'}, {'image_id': '313891_1_En_17_Fig2a_HTML', 'image_file_name': '313891_1_En_17_Fig2a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig2a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered miliary increased density shadows in both lungs, with even size, density and distribution. The shadows of both hila are dense, with sharp both costophrenic angles. (b–f) CT scanning demonstrates scattered miliary nodular shadows in both lungs, which is more obviously in the middle pulmonary strip and with quite even size and density. Trachea and bronchi are unblocked', 'hash': 'ec4f2f75b5bb59b2cb13f016c2ea6714bdc3c908077c2697af2218aa485876b7'}, {'image_id': '313891_1_En_17_Fig13a_HTML', 'image_file_name': '313891_1_En_17_Fig13a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig13a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, transparent areas in them and unblocked trachea and bronchi', 'hash': '7d26c2f94a34f3ff7c4f64d485fe29e114936d0f4db53489ee88148a1a6fc8bf'}, {'image_id': '313891_1_En_17_Fig65a_HTML', 'image_file_name': '313891_1_En_17_Fig65a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig65a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related allergic pulmonary Aspergillus infection. (a–f) CT scanning of the pulmonary window demonstrates thickened central pulmonary markings in both lungs, which is turtuous and deranged with fingertip infiltration shadows. (g) DR demonstrates hyperinflation of the right lung, increased and thickened pulmonary markings and ground glass liked shadows with increased density in the right lower lung and left lung lobe', 'hash': '6fa5ade163d7465c0dc3eb89ebc58d57b98674fc2680824cc5a81c478b81fbc4'}, {'image_id': '313891_1_En_17_Fig76b_HTML', 'image_file_name': '313891_1_En_17_Fig76b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig76b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning demonstrates diffuse scattered thin ground glass liked, patchy, flaky blurry shadows and cords liked shadows in both lungs, with blurry boundaries and uneven density; scattered nodular shadows in different sizes; more lesions in both upper lobes and the right middle lobe; flaky parenchyma shadows in the apical and posterior segments of right upper lobe, with air bronchogram sign in them; unobstructed opening of bronchi as well as lobar and segmental bronchi without stenosis and obstruction; lymphadenectasis in the right hilar region; detected Aspergillus fumigatus by sputum culture. (e, f) Culture for 72 h, lactic acid gossypol blue staining and microscopic observation at ×200 and ×400 demonstrate short column liked conidial head, smooth wall of conidiophores, flask-shaped top capsule and monolayer microconidiophores. (g) Culture in Paul’s medium demonstrates dark green colored colonies', 'hash': 'af925cb00cbd4eed9e67dc49fd012909ecdfe48493ac645d8b2185eb4f351655'}, {'image_id': '313891_1_En_17_Fig105a_HTML', 'image_file_name': '313891_1_En_17_Fig105a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig105a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary toxoplasmosis. (a–d) CT scanning demonstrates thickened pulmonary markings in both lungs, which can be enhanced to extend into the middle and outer zones of lungs, in grid liked appearance that is more obvious in the dorsal segment of the lungs. (e) It is demonstrated to have clustering toxoplasma tachyzoites', 'hash': '30f16a35256e45c89dfcd68adf661507960a5b978db88cc531a7605d9fff53df'}, {'image_id': '313891_1_En_17_Fig95_HTML', 'image_file_name': '313891_1_En_17_Fig95_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig95_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a) CT scanning of the pulmonary window demonstrates irregular large flaky shadows with increased density in the dorsal segment of both lower lobes; enlarged hilum in both lungs, cords liked thickening of the vascular vessels. (b) CT scanning of the mediastinal window demonstrates flaky parenchyma shadows in the left lower lung, thickening of both pleura, enlarged hilum shadows in both lungs, thickened right lower bronchial wall. (c) Microscopy after culture at 25 °C demonstrates branches and separated hyphae and its string of small spores, with typical penicillus but no sporangium (Medan staining, ×400). (d) Bone marrow smear demonstrates round or oval cells like the yeast phase within the macrophages; longer cells like the yeast phase outside the macrophages. The two kinds of cells have slightly curved ends in sausages liked appearance (HE staining, ×400)', 'hash': '636de07e02ba7cf1f73f2a03bccf4fdaac68bc4a122b7fbfe2febe72dd42f139'}, {'image_id': '313891_1_En_17_Fig3a_HTML', 'image_file_name': '313891_1_En_17_Fig3a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig3a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy and scattered miliary increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of the lower lung field, with some fused in thin cloudy shadows', 'hash': 'e655c40874d38beaa8a8e9f0e82c1eb12a6756b09bee559229354b3756010a18'}, {'image_id': '313891_1_En_17_Fig73_HTML', 'image_file_name': '313891_1_En_17_Fig73_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig73_HTML.jpg', 'caption': '(a–c) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates diffuse dense shadows in both lower lung fields which is in a arcuate surface with exterior high and interior low (pleural effusion). (b, c) CT scanning of the mediastinal window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavities; thickened pleura of the lateral chest wall, with accompanying encapsulated effusion', 'hash': '9ad36ea5213bea731770658b27be87e1af9e34bced02cda664a7f485e40f2315'}, {'image_id': '313891_1_En_17_Fig54_HTML', 'image_file_name': '313891_1_En_17_Fig54_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig54_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates round liked large flaky shadows with increased density in the left lower lung, enlarged and thickened hilus. (c, d) DR reexamination after treatment demonstrates flocculent shadows in the left lower lung, with improved conditions than previous findings before treatment (a, b)', 'hash': 'f9b4f22920ef55d9110380df6f64a6a508ecea9ca3192877a2d47400e781c58d'}, {'image_id': '313891_1_En_17_Fig58b_HTML', 'image_file_name': '313891_1_En_17_Fig58b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig58b_HTML.jpg', 'caption': '(a–i) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) CT scanning of the pulmonary window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (c, d) CT scanning of the mediastinal window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, pulmonary atelectasis and pleural effusion, with ventilation shadows in them. (e) CT scanning of the pulmonary window after the treatment demonstrates absence of the mass shadows in the left lower lung with transverse stripes shadows, obviously improved than previous findings (a, b). (f) HE staining demonstrates thickened alveolar septa and exudates from the alveolar cavity. (g) HE staining demonstrates massive bleeding in the alveolar cavity, large quantity erythrocytes and intact cell walls. (h) HE staining demonstrates phagocytized basophilic granules in the leukocytes. (i) HP staining demonstrates purplish red Rhodococcus equi in a shape of crescent in orange red sputum', 'hash': 'ca8456a79f660fc4faa5eb9342f84a14bbe25eedd8fb237ac65bd96b8de6e5b9'}, {'image_id': '313891_1_En_17_Fig25c_HTML', 'image_file_name': '313891_1_En_17_Fig25c_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25c_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '64e0ceda545f1684d11c717eef852c6576036d711540954850cc018aadfefa87'}, {'image_id': '313891_1_En_17_Fig44_HTML', 'image_file_name': '313891_1_En_17_Fig44_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig44_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary nontuberculous mycobacterial infection. (a–d) CT scanning demonstrates multiple cavities in the left lung field, bilateral multiple lobular central nodules and extensive branches liked linear shadows in tree buds sign. There are also large flaky parenchymal changes of the lung tissues in the left lower lung field in high density shadows, with accompanying air bronchogram sign. (e) HE staining demonstrates avium intracellular complex mycobacteria infection of lung tissues in atypical tuberculous nodular changes. (HE\u2009×\u2009200)', 'hash': '8f8697761c60c3cb27c0b413c2e19433df26ba07a74ea0a0cc0b6f2b4acc7b65'}, {'image_id': '313891_1_En_17_Fig103_HTML', 'image_file_name': '313891_1_En_17_Fig103_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig103_HTML.jpg', 'caption': '(a–d) HIV/AIDS related lymphoid interstitial pneumonia. (a–d) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs, in reticular appearance; with accompanying multiple small nodular shadows', 'hash': '8d52c3bac6fb07e3eaf12386767e159f762db3072e09365be542c937697babe7'}, {'image_id': '313891_1_En_17_Fig110b_HTML', 'image_file_name': '313891_1_En_17_Fig110b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110b_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '5526a48dae3face516d842ba229b164bac3062f56c5e811bb1e725778fd20823'}, {'image_id': '313891_1_En_17_Fig5a_HTML', 'image_file_name': '313891_1_En_17_Fig5a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig5a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates patchy shadows with increased density in both lungs, with thickened hilar shadows in both lungs. (b–g) CT scanning demonstrates flaky ground glass liked density shadows in upper lungs and dorsal segment of both lungs, which is more obvious in the middle inner strips. There are extrapulmonary stripes transparent shadows, with some bronchial walls thickened and enlarged hilar shadows in both lungs', 'hash': '5d6ab0400e0331b0fcb3a3679023a44fa81b7b9c9eedc00c0ddb6d85208c3512'}, {'image_id': '313891_1_En_17_Fig74_HTML', 'image_file_name': '313891_1_En_17_Fig74_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig74_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates round liked uneven density shadows in the medial segments of both middle and lower lungs, multilocular hollow holes in the cavities, surrounding multiple round liked thick-wall small cavity shadows and ground grass liked infiltration shadows. (b–d) CT scanning of the pulmonary window demonstrates scattered round liked uneven density shadows in the right hilum and lower lung, multilocular hollow holes in the cavities; and surrounding multiple round liked thick-wall small cavity shadows and ground grass liked infiltration shadows', 'hash': 'e4c42cc0cb1f1bdfa8b2cc1f3c8eab7223c4be368a808e8b6c4b01af78dfb04a'}, {'image_id': '313891_1_En_17_Fig23_HTML', 'image_file_name': '313891_1_En_17_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig23_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymph node tuberculosis. (a–c) CT scanning of the pulmonary window demonstrates dense mass shadow beside the right aortic arch, and thinner right bronchus due to compression. (d–f) CT scanning of the mediastinal window demonstrates low density mass shadow besied the right aortic arch with clear boundary', 'hash': '8d135ce7e96005006343dc3305be0f8c77d0828bccccf1726226c09fd47c365f'}, {'image_id': '313891_1_En_17_Fig6a_HTML', 'image_file_name': '313891_1_En_17_Fig6a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig6a_HTML.jpg', 'caption': '(a-d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates flaky ground glass liked density shadows in upper lobes of both lungs, with bronchial shadows in them; flaky parenchymal shadows in the subpleural apical segment; and thickened bronchial walls in the anterior and posterior segments of the right upper lobe', 'hash': '235548456c9bf72727a05a91fa6893d8a478f8f715c022d6b579d4a9188da366'}, {'image_id': '313891_1_En_17_Fig17a_HTML', 'image_file_name': '313891_1_En_17_Fig17a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig17a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchymal shadows and fibrous cords liked shadows in both lungs which are more obvious in both lower lungs. The trachea and bronchi are unblocked, with enlarged hilar shadows in both lungs', 'hash': '9c1c59095291dcf6a7b6dec786ec58ba44e9b83badfe4bbf121b7c677476f4d5'}, {'image_id': '313891_1_En_17_Fig113b_HTML', 'image_file_name': '313891_1_En_17_Fig113b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig113b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Kaposi’s sarcoma. (a–d) Chest CT scanning demonstrates scattered cloudy, mass and flake liked or nodular shadows with increased density. (e) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large thick stained nucleoli, which are in line with the diagnosis of Kaposi’s sarcoma. (f–i) Cured HIV/AIDS related Kaposi’s sarcoma. (f–i) Reexamination after treatment demonstrates absent lesions in both lungs, with clear lung fields', 'hash': '88e574b2d5ff4ee4ce28f38025d5345c8cf6b50386f752ae12083b05fe7af9de'}, {'image_id': '313891_1_En_17_Fig82_HTML', 'image_file_name': '313891_1_En_17_Fig82_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig82_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a, b) DR demonstrates enlarged blurry hilum in both lungs and thickened pulmonary markings. (c, d) CT scanning demonstrates mediastinal lymphadenectasis, narrowed trachea due to compression with liquefactive necrosis. Enhanced scanning demonstrates marginal enhancement and no central enhancement', 'hash': '18312183daaefbc6c48e05e67fab210a1109c24a6f94311ffb11ffdace007a49'}, {'image_id': '313891_1_En_17_Fig64_HTML', 'image_file_name': '313891_1_En_17_Fig64_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig64_HTML.jpg', 'caption': '(a) Gross observation demonstrates dark brown lungs in appearance. (b, c) Thology demonstrates hemorrhage and edema of the lung tissue and focal necrosis, with large quantity Aspergillus hyphae and spores in the surrounding area of the necrosis (Combined with pulmonary CMV infection)', 'hash': '104850f2999da711317f4e4f07e590bd8f73a93731daf090ece6023192606e90'}, {'image_id': '313891_1_En_17_Fig7a_HTML', 'image_file_name': '313891_1_En_17_Fig7a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig7a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates diffusely distributed shadows with increased density in both lungs that is more obvious in the middle and lower lungs. The hilar shadows in both lungs are enlarged. Both diaphragmatic surfaces and phrenic angles are blurry. (b–d) CT scanning demonstrates flaky shadows with increased density in both lungs, with parenchymal shadows in the lingular segment of left upper lobe and in the dorsal segments of both lower lobes and bronchial shadows in them. There are also thickened bronchial walls and enlarged hilar shadows in both lungs', 'hash': '431aab0770a1915c719095cc2bab91736f1ffda7b5649cdca5d8b7516003049c'}, {'image_id': '313891_1_En_17_Fig33_HTML', 'image_file_name': '313891_1_En_17_Fig33_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig33_HTML.jpg', 'caption': '(a, b) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates scattering patchy and cords liked blurry density shadows in the right middle and upper lung fields as well as enlarged and thickened hilum. (b) DR demonstrates that the lungs lesions are almost absent compared to (a), after anti-TB treatment for 5 months', 'hash': 'e710598bbbc8286721136f2a803716198a712c55253c4232d3ee33b2e33e188b'}, {'image_id': '313891_1_En_17_Fig62_HTML', 'image_file_name': '313891_1_En_17_Fig62_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig62_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) Anteroposterior and lateral DR demonstrates huge sphere liked mass shadow in the right hilum, with cavities shadows and liquid gas level in it. (c) HE staining demonstrates bleeding in the lung tissues and aggregation of large quantity lymphocytes. (d) Masson staining demonstrates branches liked purplish red Rhodococcus equi', 'hash': '261a4aca9e146cc16957c6280cd4795d7c2c5732d9a19006b6e398a1ae410af0'}, {'image_id': '313891_1_En_17_Fig84_HTML', 'image_file_name': '313891_1_En_17_Fig84_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig84_HTML.jpg', 'caption': '(a, b) HIV/AIDS related pulmonary cryptococcus infection. (a) CT scanning demonstrates round liked cavity shadows in the left upper and lower lung, with uneven thickness of the cavity wall and surrounding infiltrative shadows. (b) CT scanning demonstrates round liked dense mass shadows in the right upper lung, with clear boundaries and bulky drainage vessel shadows', 'hash': 'ecc614167ec536dcb80c2739886c957ff2f182dd49ac7f4d6379260497262e60'}, {'image_id': '313891_1_En_17_Fig4_HTML', 'image_file_name': '313891_1_En_17_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig4_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy or ground glass liked increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of lower lungs, with some fused into thin cloudy ground glass liked shadows with increased density, with decreased transparency of both lungs and enlarged hilar shadows in both lungs', 'hash': '636f9fd3d3c20c17e15e1ac70adcdcb6fbe268a70ac64d29317f73045747e226'}, {'image_id': '313891_1_En_17_Fig46a_HTML', 'image_file_name': '313891_1_En_17_Fig46a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig46a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates large flaky dense shadows in the middle-outer zone of the left middle lung field, and narrowed left bronchus. (d–f) CT scanning demonstrates large flaky shadows with uneven density in the left lateral chest wall and even lower density shadow in them', 'hash': 'afdfc2c33070f1d3b8616a542d989e0f908d9638327227057dfdf5ed59169359'}, {'image_id': '313891_1_En_17_Fig72_HTML', 'image_file_name': '313891_1_En_17_Fig72_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig72_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and cavity shadows in both lungs, with even wall thickness and small nodular shadows in some cavities', 'hash': 'd318b47b9b56854b6bc47081b08712ee9d828a2ae4592aa69451ec7105fd0240'}, {'image_id': '313891_1_En_17_Fig91b_HTML', 'image_file_name': '313891_1_En_17_Fig91b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig91b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–e) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of some lesions into honeycomb likes cavity shadows or plaque liked dense shadows. (f–h) CT scanning demonstrates large thick-wall cavity shadows in the right lung, surrounding plaque and round liked small cavity shadows and inflammatory infiltrative shadows', 'hash': '6b3a934b89abf6f7e8c9593337c0c57fe44161bcbfc546c7e2a3cfa50539f91e'}, {'image_id': '313891_1_En_17_Fig8a_HTML', 'image_file_name': '313891_1_En_17_Fig8a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig8a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates large flaky parenchyma shadows in both lungs which is more obvious in the middle and lower lobes of both lungs. There are also enlarged hilar shadows in both lungs and sharp both costophrenic angles. (b–g) CT scanning demonstrates large flaky parenchyma shadows in concentric and symmetrical distribution, bronchial shadows in them and thickened bronchial walls', 'hash': '7c4f2f4f9120af70727cab6fc69637733e17e807575648a0257b5b03367da625'}, {'image_id': '313891_1_En_17_Fig42_HTML', 'image_file_name': '313891_1_En_17_Fig42_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig42_HTML.jpg', 'caption': 'HIV/AIDS related tuberculous pleuritis. DR demonstrates arch shaped dense shadows with higher exterior density and lower interior density in the left lower lung field and covered right edge of the heart', 'hash': 'f0dfdb1b349a42c7092daeeaef76a8b8762e134b40ae21a6144d9785b9ddcd02'}, {'image_id': '313891_1_En_17_Fig15_HTML', 'image_file_name': '313891_1_En_17_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig15_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy blurry shadows and fibrous cords liked shadows in both lungs which are more obvious in the middle inner parts of both lungs, with transparent areas in them. The bronchial walls are thickened', 'hash': '4d262b5c06f74783c1b6df1f8c9d8c7ecbf235faacd2f2e846544a3e11d88e8b'}, {'image_id': '313891_1_En_17_Fig92b_HTML', 'image_file_name': '313891_1_En_17_Fig92b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig92b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of the lesions in the right lung into plaque liked shadows with clear boundaries, and multiple round liked small cavity shadows and inflammatory infiltrative shadows in both lungs', 'hash': '4613e0bd8bbb013024b2335ae2f7fb1997dab5d93ee1c395c97035d6e7d37750'}, {'image_id': '313891_1_En_17_Fig52_HTML', 'image_file_name': '313891_1_En_17_Fig52_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig52_HTML.jpg', 'caption': '(a, b) HIV/AIDS related staphylococcus aureus pneumonia. (a, b) DR demonstrates diffuse scattered multiple thin-walled transparent areas in both lungs, increased and blurry pulmonary markings, and enlarged heart shadow in flask shape (pericardial effusion)', 'hash': 'b54d395f8405b646839c68cb58c1a811c70fb8c7337443d24b61bfcfa097f5b0'}, {'image_id': '313891_1_En_17_Fig56b_HTML', 'image_file_name': '313891_1_En_17_Fig56b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig56b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates huge round large flaky shadows with increased density in the left lower lung, enlarged and thickened hilum and covered right heart edge. (c, d) DR reexamination after treatment for 1 week demonstrates flocculent shadow in the left lower lung, improved than those before the treatment (a, b). (e) DR reexamination after treatment demonstrates flocculent liked shadows in the left lower lung, obviously improved than before the treatment (c, d)', 'hash': 'e5f534ed9282980e95aaa6bac04091762128cf3e5c46985b190278c5d6396558'}, {'image_id': '313891_1_En_17_Fig93b_HTML', 'image_file_name': '313891_1_En_17_Fig93b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig93b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates diffuse small cavity in honeycomb liked and infiltrative parenchyma shadows, with the hilum as the center to distribute bilaterally symmetric like butterfly wings; multiple honeycomb liked cavity shadows in both lungs. (e–h) CT scanning reexamination demonstrates large irregular thick-wall cavities in the right lung, surrounding scattering nodular, honeycomba liked and infiltrative shadows after anti-PM infection treatment for 3 months', 'hash': '904e5a590c601ab02150f8c2487bbfa6f0282c1eddd547624ce8c549472221d9'}, {'image_id': '313891_1_En_17_Fig51b_HTML', 'image_file_name': '313891_1_En_17_Fig51b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig51b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related staphylococcus aureus pneumonia. (a) Chest X-ray demonstrates large flaky high density shadow in the left middle-lower lung field, with central transparent areas in different sizes and blurry boundaries; parenchyma changes of the left lower lung, predominantly in the posterior and exterior basal segments; unobstructed brounchus and thickened adjacent pleura. (b–d) CT scanning demonstrates large flaky shadows in fan shaped distribution along the bronchus in the left middle-lower lung, with gas containing cavities and high density shadows; and thickened adjacent pleura of the lateral chest wall. (e, f) CT scanning of the mediastinal window demonstrates large flaky fan shaped parenchymal shadows in the left middle-lower lung field, with ventilation shadows in them; and thickened pleura of the lateral chest wall. (g, h) Pathological examination showed staphylococcus aureus', 'hash': '18a6e1202b7b8c4a2d57fe024b7e8039a6dcee0f6f5f078b109a93850977c0f6'}, {'image_id': '313891_1_En_17_Fig94b_HTML', 'image_file_name': '313891_1_En_17_Fig94b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig94b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a–f) CT scanning demonstrates multiple nodules and small cavities in honeycomb liked shadows and infiltrative parenchyma shadows in the right lung; flaky transparent areas (bullae of lung) in the right anterior margin of the heart and in the outer zone of the left lung near lateral chest wall', 'hash': '3ed719abaaaec4ee19332842bd8dcac302eb6fefc73152dfd03a39702260d369'}, {'image_id': '313891_1_En_17_Fig34a_HTML', 'image_file_name': '313891_1_En_17_Fig34a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig34a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung and multiple satellite lesions scattering around. (c) CT scanning of the mediastinal window demonstrates lymphadenectasis of aortic window, subcutaneous soft tissue mass shadow in the left anterior chest wall with central low density shadow as well as right axilliary lymphadenectasis', 'hash': 'dabd5722ad3f66eee67ca59ba24417ffb086d4591f3bff2446f2a3490c676e78'}, {'image_id': '313891_1_En_17_Fig22_HTML', 'image_file_name': '313891_1_En_17_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig22_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates semicircular mass liked dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura of lateral chest wall, and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates narrowed right thorax, thickend pleura of lateral chest wall with encapsulated effusion, uneven density mass in the right hilum, thinner right bronchus due to compression and no obvious abnormalities in the left hilum. (f) DR in Aug. 2008 demonstrates no obvious changes of the lesions after anti-tuberculosis treatment for 1 month', 'hash': '8f3d47e32ff0f306eed49c4101730b02a154f676752c7bb56423c767388d5b82'}, {'image_id': '313891_1_En_17_Fig27b_HTML', 'image_file_name': '313891_1_En_17_Fig27b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig27b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related miliary tuberculosis. (a–b) Anteroposterior and lateral DR demonstrates diffuse miliary shadows in both lungs, which are bilaterally symmetric and in even size and distribution. (c–f) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': 'e272956e522e945d068939f056c637c5a636df520c687deeac9d40f8cb06834e'}, {'image_id': '313891_1_En_17_Fig83_HTML', 'image_file_name': '313891_1_En_17_Fig83_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig83_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates enlarged blurry hilum in both lungs and thickened lung markings. (b–d) CT scanning demonstrates multiple scattered nodular or mass dense shadows in both lungs, with lobulation, rough spikes around and fusion of some shadows into mass; surrounding small flaky infiltrative shadows; and mediastinal lymphadenectasis', 'hash': '6b17ec5d2db4d953c2436bbec29d0a3b1dacf0910df899eaf97e442c4aaad785'}, {'image_id': '313891_1_En_17_Fig43a_HTML', 'image_file_name': '313891_1_En_17_Fig43a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig43a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related tuberculous pleuritis. (a) DR demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (b) CT scanning of the pulmonary window demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (c) CT scanning of the mediastinal window demonstrates encapsulated fluid density shadow in the pleura of the right lateral chest wall', 'hash': 'ac09c8d3e5e4d73b07cd258411b07337ad06b99883f4a0e4573ce220fc1f4574'}, {'image_id': '313891_1_En_17_Fig35a_HTML', 'image_file_name': '313891_1_En_17_Fig35a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig35a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates diffuse large flaky dense shadows in the right upper lung with transparent areas in them. (b–c) CT scanning of the pulmonary window demonstrates large flaky shadows with increased density in the right upper lung, with multiple satellite lesions scattering around. (d, e) CT scanning of the mediastinal window demonstrates large flaky parenchymal shadows in the right upper lung with air bronchogram sign as well as mediastinal lymphadenectasis', 'hash': 'f556b77354da8136691c411ed446865babea0e399d96d2fca89f49639a04c579'}, {'image_id': '313891_1_En_17_Fig26b_HTML', 'image_file_name': '313891_1_En_17_Fig26b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig26b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '1d1f0589c50a11306fce77c217b0a9ac31be645df14f41d021ccf6522873dc6c'}, {'image_id': '313891_1_En_17_Fig32_HTML', 'image_file_name': '313891_1_En_17_Fig32_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig32_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstratesdiffuse scattering miliary shadows with increased density in both lungs, fusion of some military shadows into patchy or mass liked shadows and diffusely distributed lung lesions', 'hash': '7274d90d4f9483c5fb0e44576eeb46beba54850ed218057b6ca5935c31fa396a'}, {'image_id': '313891_1_En_17_Fig96b_HTML', 'image_file_name': '313891_1_En_17_Fig96b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig96b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a) DR demonstrates flaky blurry dense shadows in the right anterior margin of the heart, with surrounding infiltrative shadows. (b, c) CT scanning of the pulmonary window demonstrates nodular dense shadows in the dorsal segment of the right lower lung, with smooth sharp boundaries; large flaky ground glass liked dense shadows in the dorsal segment of both lungs. (d, e) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in red, in different sizes. (f) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in purplish red, in different sizes', 'hash': 'ad87dabd309e8a0c47d5cd58aa485a538556b1218d18c3cb262dc5b8cd5049e9'}, {'image_id': '313891_1_En_17_Fig55_HTML', 'image_file_name': '313891_1_En_17_Fig55_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig55_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates round liked large flaky shadows with increased density in the right lower lung, cords liked and flocculent liked blurry shadows in both middle-upper lung fields and in the right lower lung field, and enlarged and thickened hilus', 'hash': '29c690f04a28629d1c3b0f7b5665833edd78ec61be199fd2f16199400a7c9eeb'}, {'image_id': '313891_1_En_17_Fig85a_HTML', 'image_file_name': '313891_1_En_17_Fig85a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig85a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates round liked thick-wall cavity in the left hilum, with blurred boundary; ground-glass liked shadows with increased density in the left middle and lower lung. (b–d) CT scanning of the pulmonary window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of cavity wall. (e, f) CT scanning of the mediastinal window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of the cavity wall and surrounding thick spikes', 'hash': 'd6bc5b1be05729f5f4ec60a0cda3bec7f7cf437fd39e0d32743e45cfb9e48de2'}, {'image_id': '313891_1_En_17_Fig112_HTML', 'image_file_name': '313891_1_En_17_Fig112_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig112_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Kaposi’s sarcoma. (a, b) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance', 'hash': 'eeb255e4963802d02da7fd85381532153336be33b21e4ceb488be5dc2a483f29'}, {'image_id': '313891_1_En_17_Fig25b_HTML', 'image_file_name': '313891_1_En_17_Fig25b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25b_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '9ceac8f407a9896d7bda0165bceae81a32d5c5c53de3c5d2a295c165b15071e8'}, {'image_id': '313891_1_En_17_Fig36a_HTML', 'image_file_name': '313891_1_En_17_Fig36a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig36a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) Pulmonary CT scanning of the pulmonary window demonstrates parenchymal shadows in the left lingual lobe with surrounding pulmonary acinar nodular shadows. (b) CT guided pucture biopsy of left lingula. (c) The pathology demonstrates granulation tissue and caseous necrosis, being in consistency with tuberculosis changes. HE\u2009×\u2009100', 'hash': '3a48cc084a1fb1943e1411fa65cfdcee0c3c33377b3ae6ab6e24f04ee1caebae'}, {'image_id': '313891_1_En_17_Fig68a_HTML', 'image_file_name': '313891_1_En_17_Fig68a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig68a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in prone posture demonstrates mass shadow and thick wall cavity in the dorsal segment of the right lower lung, small nodular shadows in the cavities, surrounding fused miliary infiltration shadows. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the dorsal segment of the right lower lung, small nodular shadows in the cavities, and involved pleura of partial lateral chest wall', 'hash': '0acc77833f25b70e7e4527a30be9fc6744e19cee48879415a15e648d76923d48'}, {'image_id': '313891_1_En_17_Fig45_HTML', 'image_file_name': '313891_1_En_17_Fig45_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig45_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Staphylococcus aureus pneumonia. (a) Gross specimen observation demonstrates bilateral purplish brown lesions, patchy white infiltration at the base of the lungs. (b) HE staining demonstrates alveolar diffuse lesions, exudation of the serous fluid and inflammatory cells in the alveolar cavity, and alveolar wall congestion', 'hash': 'e530a1df1ead29989d8b3b50161f1926946446bc5cbbcb99691479816876e341'}, {'image_id': '313891_1_En_17_Fig110c_HTML', 'image_file_name': '313891_1_En_17_Fig110c_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110c_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '22d9f8a4fa731c46a738334c9738c267aaa2c43711aa94bd98c4b78483adda8d'}, {'image_id': '313891_1_En_17_Fig24b_HTML', 'image_file_name': '313891_1_En_17_Fig24b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig24b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates circular mass dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura in the lateral chest cavity and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates multiple uneven mass density shadows in right hilum in a size of about 3\u2009×\u20093.5\u2009×\u20093.8 cm. (f–g) Enhanced CT scanning demonstrates slight uneven enhancement of the lesion and no obvious abnormalties in the left hilum', 'hash': '4c7c3a8f7b0bde1c89efcf634beedfd08159b9be03a95299448e388c435edcdc'}, {'image_id': '313891_1_En_17_Fig12_HTML', 'image_file_name': '313891_1_En_17_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig12_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchyma shadows and fibrous cords liked shadows in both lungs which are more obvious in the dorsal segment of both lower lungs, bronchial shadows in them, and thickened bronchial walls in the middle lobe. The hilar shadows in both lungs are enlarged', 'hash': '72a066b603a93a4b8e9a7a8ec1942b2ed87b211dee6ed121b7c56d1cb575c55c'}, {'image_id': '313891_1_En_17_Fig102_HTML', 'image_file_name': '313891_1_En_17_Fig102_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig102_HTML.jpg', 'caption': '(a–d) HIV/AIDS related lymphoid interstitial pneumonia. (a–d) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs, in reticular appearance; with accompanying multiple small nodular shadows', 'hash': '6b569d4d7a5a4f008ea8f7bc4152cd1a576656b8eeee8b7548f00de038815256'}, {'image_id': '313891_1_En_17_Fig111_HTML', 'image_file_name': '313891_1_En_17_Fig111_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig111_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Kaposi’s sarcoma. (a, b) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance, light density flaky shadows in lower lung fields of both lungs. (c) CT scanning demonstrates multiple round liked nodular shadows in both middle lower lung fields with clear boundaries, multiple mediastinal and hilar lymphadenectasis, and small quantity pleural effusion in bilateral thoracic cavities', 'hash': '5dfb9d581ecc41659920bde84bc55d01903bf9f66ec50710fe0465373096ff5f'}, {'image_id': '313891_1_En_17_Fig25a_HTML', 'image_file_name': '313891_1_En_17_Fig25a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25a_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '67db71f0f56d65c929e36f486b4a1a2246ae852aec999328f126ddc09428f814'}, {'image_id': '313891_1_En_17_Fig36b_HTML', 'image_file_name': '313891_1_En_17_Fig36b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig36b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) Pulmonary CT scanning of the pulmonary window demonstrates parenchymal shadows in the left lingual lobe with surrounding pulmonary acinar nodular shadows. (b) CT guided pucture biopsy of left lingula. (c) The pathology demonstrates granulation tissue and caseous necrosis, being in consistency with tuberculosis changes. HE\u2009×\u2009100', 'hash': 'd7d5abe0c9d9bea2e2097dfc72f86922656058f98f8a2360573b04a02e27e5de'}, {'image_id': '313891_1_En_17_Fig68b_HTML', 'image_file_name': '313891_1_En_17_Fig68b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig68b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in prone posture demonstrates mass shadow and thick wall cavity in the dorsal segment of the right lower lung, small nodular shadows in the cavities, surrounding fused miliary infiltration shadows. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the dorsal segment of the right lower lung, small nodular shadows in the cavities, and involved pleura of partial lateral chest wall', 'hash': 'cada0e4684021c74f9b0d4d1bcdb6810379bc035cead748d6de141ebd004f038'}, {'image_id': '313891_1_En_17_Fig96a_HTML', 'image_file_name': '313891_1_En_17_Fig96a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig96a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a) DR demonstrates flaky blurry dense shadows in the right anterior margin of the heart, with surrounding infiltrative shadows. (b, c) CT scanning of the pulmonary window demonstrates nodular dense shadows in the dorsal segment of the right lower lung, with smooth sharp boundaries; large flaky ground glass liked dense shadows in the dorsal segment of both lungs. (d, e) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in red, in different sizes. (f) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in purplish red, in different sizes', 'hash': '020553d48c8545e50d314020ad8dc5004914dca5449aa2b58bc99515f310c3a4'}, {'image_id': '313891_1_En_17_Fig85b_HTML', 'image_file_name': '313891_1_En_17_Fig85b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig85b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates round liked thick-wall cavity in the left hilum, with blurred boundary; ground-glass liked shadows with increased density in the left middle and lower lung. (b–d) CT scanning of the pulmonary window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of cavity wall. (e, f) CT scanning of the mediastinal window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of the cavity wall and surrounding thick spikes', 'hash': '9778eb0d00755e3cd06bd3bcee90d66970730aac4b7fabde0b3e1df25cc067b8'}, {'image_id': '313891_1_En_17_Fig59_HTML', 'image_file_name': '313891_1_En_17_Fig59_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig59_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a–c) CT scanning of the pulmonary window demonstrates thick walled cavities shadows in the dorsal segment of the right lower lung, with irregular wall thickness and liquid gas level in them. (d) CT scanning of the mediastinal window demonstrates thick walled cavities shadows in the dorsal segment of the left lower lung, with irregular wall thickness and liquid gas level in them', 'hash': 'c9ff1150b9c2d245c823a3726a56dc22223fcdc58b24666ee55ee0b01ea0c2d3'}, {'image_id': '313891_1_En_17_Fig24a_HTML', 'image_file_name': '313891_1_En_17_Fig24a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig24a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates circular mass dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura in the lateral chest cavity and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates multiple uneven mass density shadows in right hilum in a size of about 3\u2009×\u20093.5\u2009×\u20093.8 cm. (f–g) Enhanced CT scanning demonstrates slight uneven enhancement of the lesion and no obvious abnormalties in the left hilum', 'hash': 'a3536c779e7c502b855dd3d89ae13854f569bd483ba8038870ac76c68c616c6c'}, {'image_id': '313891_1_En_17_Fig11_HTML', 'image_file_name': '313891_1_En_17_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig11_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered patchy shadows with increased density in both lungs and a few cords liked shadows which are more obvious in the right lung. There are thickened both hilar shadows and sharp both costophrenic angles. (b–e) CT scanning demonstrates flaky and mass liked ground glass density shadows in both lungs and a few cords liked shadows which are more obvious in the right lung. The trachea and bronchi are unblocked', 'hash': 'd4448bd9682d4ae721b1250cec042eecf77787519b1af61ac3b2d7b88b28bd90'}, {'image_id': '313891_1_En_17_Fig101_HTML', 'image_file_name': '313891_1_En_17_Fig101_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig101_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Herpes Simplex Viral Pneumonia. (a) DR demonstrates thickened and deranged lung markings in both lungs with accompanying blurry nodular shadows, and cloudy shadows in the lung fields. (b) PAS staining (400×) demonstrates eosinophilic inclusion. (c) Silver methenamine staining demonstrates herpes viral inclusion', 'hash': '9cfda956483a95dc3a4e487426e884d83e6aa0bde654b2c285ba044cf31b2a1d'}, {'image_id': '313891_1_En_17_Fig49_HTML', 'image_file_name': '313891_1_En_17_Fig49_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig49_HTML.jpg', 'caption': '(a–d) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates fan shaped shadow in the right middle lung field with its apex pointing to the hilar dense shadow, with clear boundaries. (d) CT scanning reexamination demonstrates absence of the lesions in the right lung after anti-bacteria treatment for 2 weeks', 'hash': 'f566a271be67724833f92b19b4f73190cae4216ad698f1d1a51c1d9c7579afa1'}, {'image_id': '313891_1_En_17_Fig34b_HTML', 'image_file_name': '313891_1_En_17_Fig34b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig34b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung and multiple satellite lesions scattering around. (c) CT scanning of the mediastinal window demonstrates lymphadenectasis of aortic window, subcutaneous soft tissue mass shadow in the left anterior chest wall with central low density shadow as well as right axilliary lymphadenectasis', 'hash': 'cd2bbefb6363363a2c860069ded9e79b5fabed794f0777f342cd459e7f745581'}, {'image_id': '313891_1_En_17_Fig21_HTML', 'image_file_name': '313891_1_En_17_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig21_HTML.jpg', 'caption': '(a–c) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates enlarged right hilum in mass liked dense shadow, with peripheral thickened and blurry pulmonary markings, and no obvious abnormalities of the left hilum. (b) DR demonstrates smaller right hilum after anti-tuberculosis therapy for 1 month. (c) DR demonstrates absent tumor in the right hilum and normal left hilum', 'hash': '46a1a9267e1d610faa6450929c11c8d942047467baf49ba4482ce61bb660cb30'}, {'image_id': '313891_1_En_17_Fig27a_HTML', 'image_file_name': '313891_1_En_17_Fig27a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig27a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related miliary tuberculosis. (a–b) Anteroposterior and lateral DR demonstrates diffuse miliary shadows in both lungs, which are bilaterally symmetric and in even size and distribution. (c–f) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '61497bd4be4942d8a1fc4e6710043c9d4099da58ea99f2008d49f04ec973f2b4'}, {'image_id': '313891_1_En_17_Fig79_HTML', 'image_file_name': '313891_1_En_17_Fig79_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig79_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates multiple scattered nodular shadows in both lower lungs. (b–d) Chest CT scanning demonstrates multiple dense nodular shadows with different sizes and mass shadows in both middle and lower lung fields, with clear boundaries. They are more common in the dorsal segments', 'hash': '7f1588a4af3d4fadaf1f33e3bac3f100d4b2003206bd1bc2ae262b602fd3fe79'}, {'image_id': '313891_1_En_17_Fig51a_HTML', 'image_file_name': '313891_1_En_17_Fig51a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig51a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related staphylococcus aureus pneumonia. (a) Chest X-ray demonstrates large flaky high density shadow in the left middle-lower lung field, with central transparent areas in different sizes and blurry boundaries; parenchyma changes of the left lower lung, predominantly in the posterior and exterior basal segments; unobstructed brounchus and thickened adjacent pleura. (b–d) CT scanning demonstrates large flaky shadows in fan shaped distribution along the bronchus in the left middle-lower lung, with gas containing cavities and high density shadows; and thickened adjacent pleura of the lateral chest wall. (e, f) CT scanning of the mediastinal window demonstrates large flaky fan shaped parenchymal shadows in the left middle-lower lung field, with ventilation shadows in them; and thickened pleura of the lateral chest wall. (g, h) Pathological examination showed staphylococcus aureus', 'hash': '00d7fc70edd23ceb6f012159d4bae8563ec20a036cc91fd99d91cdbc08f23126'}, {'image_id': '313891_1_En_17_Fig90_HTML', 'image_file_name': '313891_1_En_17_Fig90_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig90_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows in the lungs that fuse into mass in parenchymal shadows, with the hilum as the center and distributing bilaterally symmetric like butterfly wings. There are also multiple clustering cavities or singular large cavity in both lungs', 'hash': '6742eff5e10355ff74a6fe215cff47247a9d12856c453a35fd6d6742f8f0ac2e'}, {'image_id': '313891_1_En_17_Fig94a_HTML', 'image_file_name': '313891_1_En_17_Fig94a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig94a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a–f) CT scanning demonstrates multiple nodules and small cavities in honeycomb liked shadows and infiltrative parenchyma shadows in the right lung; flaky transparent areas (bullae of lung) in the right anterior margin of the heart and in the outer zone of the left lung near lateral chest wall', 'hash': '4bf177cdb556a837613a60231e962930fcd4acf34d7177f738cb57925ca917e1'}, {'image_id': '313891_1_En_17_Fig35b_HTML', 'image_file_name': '313891_1_En_17_Fig35b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig35b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates diffuse large flaky dense shadows in the right upper lung with transparent areas in them. (b–c) CT scanning of the pulmonary window demonstrates large flaky shadows with increased density in the right upper lung, with multiple satellite lesions scattering around. (d, e) CT scanning of the mediastinal window demonstrates large flaky parenchymal shadows in the right upper lung with air bronchogram sign as well as mediastinal lymphadenectasis', 'hash': '8b68f2c89884110f18b2b9641154ae26362875fb18db9a64b4320edd5c13bba4'}, {'image_id': '313891_1_En_17_Fig26a_HTML', 'image_file_name': '313891_1_En_17_Fig26a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig26a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '1bd3c2b9622fa99531543c1b9d456f58ff2945c6fa4bb44043fadb51fa9c8db6'}, {'image_id': '313891_1_En_17_Fig31_HTML', 'image_file_name': '313891_1_En_17_Fig31_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig31_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, fusion of some military shadows into patchy or mass liked shadow, diffusely distributed lung lesions', 'hash': '3bf8714e005c1ebc72eb46fac228838fd6436f0a1dd5d6a8bd085a14fddd1170'}, {'image_id': '313891_1_En_17_Fig69_HTML', 'image_file_name': '313891_1_En_17_Fig69_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig69_HTML.jpg', 'caption': '(a, b) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the medial basal segment of the right lower lung, irregular nodular shadows in the cavities, and surrounding fused miliary infiltration shadows', 'hash': 'db839a28accf7944530e9940a7c7afb2b7b3c7a4423308b863fae87f0c08c29a'}, {'image_id': '313891_1_En_17_Fig80_HTML', 'image_file_name': '313891_1_En_17_Fig80_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig80_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a, b) Anteroposterior and lateral DR demonstrate a huge dense mass shadow in the left lower lung, with clear boundary. (c) CT scanning of the pulmonary window demonstrates round liked high density shadow in the left lower lung near left chest wall, with even density. (d) CT scanning of the mediastinal window demonstrates round liked soft tissue density shadows in the left lower lung near left chest wall, with even density, lobulation, and surrounding thick spikes', 'hash': 'ea2ef199cee39dce2b4a8a06bcdcce274a6fd8796c2efbfaf940d6d05fe48c40'}, {'image_id': '313891_1_En_17_Fig43b_HTML', 'image_file_name': '313891_1_En_17_Fig43b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig43b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related tuberculous pleuritis. (a) DR demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (b) CT scanning of the pulmonary window demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (c) CT scanning of the mediastinal window demonstrates encapsulated fluid density shadow in the pleura of the right lateral chest wall', 'hash': '582e0f2e161551b97de13a60d6afed8cc613b9b04bfb136458587da830b2ecf0'}, {'image_id': '313891_1_En_17_Fig16_HTML', 'image_file_name': '313891_1_En_17_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig16_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple fibrous cords liked shadows in lungs, multiple patchy parenchyma shadows and ground glass liked density shadows in both upper lobes, with multiple transparent areas in them. The bronchial walls are thickened in the anterior and posterior segments of the right upper lobe as well as in the lingual segment of the left lung', 'hash': '214979f5c447a9b40ebd0772cff663eb275052bf5fe8132456329ffacdc20c9c'}, {'image_id': '313891_1_En_17_Fig109_HTML', 'image_file_name': '313891_1_En_17_Fig109_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig109_HTML.jpg', 'caption': '(a, b) HIV/AIDS related lymphoma. (a, b) CT scanning demonstrates a huge soft tissue mass shadow in the left lateral chest wall, with a maximal size of about 7.7\u2009×\u200913.0 cm and occupying 30 sections with 8 mm in thickness of each section and with the upmost to the supraclavicular area and the bottom in the level of thoracic 12th vertebral body in the lower chest wall. There are also large quantity left pleural effusion and parenchymal changes of the left lower lobe with atelectasis. In the left chest cavity, large quantity liquid density shadows can be found, with compressed lung tissues to the hilum. By puncture and biopsy of the subaxillary mass, the diagnosis is defined as diffuse large B cell lymphoma', 'hash': '6d67a094843ca970dc50c93d50e7d1038c2a389c96e1772f425fa9dbc9d3a3ea'}, {'image_id': '313891_1_En_17_Fig19_HTML', 'image_file_name': '313891_1_En_17_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig19_HTML.jpg', 'caption': '(a) Gross observation in autopsy demonstrates disseminated pulmonary tuberculosis, with grayish white military nodules in diffuse distribution in the lung tissues section. (b) It is demonstrated that mycobacteriumavium-intracellularcomplex infection in the lung tissue, with atypical tuberculosis nodules and acid-fast staining positive (left top). There are a subnodular giant cell, eosinophilic inclusion bodies in the nucleus and bradyzoites in cytoplasm of T. gondii. HE\u2009×\u2009100. (c) HE demonstrates mycobacteriumavium-intracellularcomplex infection, with atypical tuberculosis nodular changes, HE\u2009×\u2009200', 'hash': 'fac712a77d78563a8ebac012fe6c9f2f74ab72b1d36bf9e0c30462450f24c87d'}, {'image_id': '313891_1_En_17_Fig92a_HTML', 'image_file_name': '313891_1_En_17_Fig92a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig92a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of the lesions in the right lung into plaque liked shadows with clear boundaries, and multiple round liked small cavity shadows and inflammatory infiltrative shadows in both lungs', 'hash': '981e19f8709c64fb0f850afd293a3dfdb67ec16a8d75e3f2bf19cd69116366cd'}, {'image_id': '313891_1_En_17_Fig41_HTML', 'image_file_name': '313891_1_En_17_Fig41_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig41_HTML.jpg', 'caption': 'HIV/AIDS related tuberculous pleuritis. DR demonstrates arch shaped dense shadows with higher exterior density and lower interior density in the right lower lung field and covered right edge of the heart', 'hash': '3381f76804304950a36ba44865a5651168e2f9b43c451a23d390d065bfc52e80'}, {'image_id': '313891_1_En_17_Fig56a_HTML', 'image_file_name': '313891_1_En_17_Fig56a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig56a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates huge round large flaky shadows with increased density in the left lower lung, enlarged and thickened hilum and covered right heart edge. (c, d) DR reexamination after treatment for 1 week demonstrates flocculent shadow in the left lower lung, improved than those before the treatment (a, b). (e) DR reexamination after treatment demonstrates flocculent liked shadows in the left lower lung, obviously improved than before the treatment (c, d)', 'hash': '8c2f7c50d0562920efd9257451f8cc2d4dda042eaa3768d3fb1455a7092edf94'}, {'image_id': '313891_1_En_17_Fig93a_HTML', 'image_file_name': '313891_1_En_17_Fig93a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig93a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates diffuse small cavity in honeycomb liked and infiltrative parenchyma shadows, with the hilum as the center to distribute bilaterally symmetric like butterfly wings; multiple honeycomb liked cavity shadows in both lungs. (e–h) CT scanning reexamination demonstrates large irregular thick-wall cavities in the right lung, surrounding scattering nodular, honeycomba liked and infiltrative shadows after anti-PM infection treatment for 3 months', 'hash': 'eb824267db9288c03e6cffae4cde8b6f47b3bda47dcad797ee4964b9011ac598'}, {'image_id': '313891_1_En_17_Fig46b_HTML', 'image_file_name': '313891_1_En_17_Fig46b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig46b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates large flaky dense shadows in the middle-outer zone of the left middle lung field, and narrowed left bronchus. (d–f) CT scanning demonstrates large flaky shadows with uneven density in the left lateral chest wall and even lower density shadow in them', 'hash': '97eaf0337e0212b917644691da5093524803db5d92384afd57bfc5803cb125e0'}, {'image_id': '313891_1_En_17_Fig39_HTML', 'image_file_name': '313891_1_En_17_Fig39_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig39_HTML.jpg', 'caption': '(a–d) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung, periphery crab feet liked or cords liked shadows due to pleural traction and satellite lesions. (c, d) CT scanning of the mediastinal window demonstrates round liked or triangle shaped thick wall cavities in the left upper lung, no nodules in the wall and peripheral nodular satellite lesions', 'hash': '614dd89032a813e240901110905f63b8b8d2530c6c7e27b0e6aab03ce47f7abb'}, {'image_id': '313891_1_En_17_Fig61_HTML', 'image_file_name': '313891_1_En_17_Fig61_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig61_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a) DR demonstrates large flaky shadow in the middle-outer zone of the left upper lung field. (b) DR demonstrates diffuse dense shadow in the left lung field, with round liked cavities shadows in them. (c–d) Reexamination after treatment demonstrates multiple cavities shadows in the middle-outer zone of the left upper lung field', 'hash': '29c84b1869c0cdabc91ee8822b014d024780586503e92fa0fdc6bed1d3b54b73'}, {'image_id': '313891_1_En_17_Fig88_HTML', 'image_file_name': '313891_1_En_17_Fig88_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig88_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a) The gross specimen demonstrates central necrotic pimples on the face. (b) Chest X-ray DR demonstrates cavities in the left upper lung, thickened lung markings in both lower lungs with accompanying multiple spots and flakes shadows. (c) Gastrointestinal barium meal radiology demonstrates left and downwards migration of the intestine due to compression. (d) Enhanced abdominal CT scanning demonstrates retroperitoneal enlarged lymph nodes that fuse into a huge mass, with ring shaped enhancement of the lymph nodes', 'hash': '72d6f61ccf9268cf07530a5a1e56a768d1d614ac854706838e783fa20f2cb2a1'}, {'image_id': '313891_1_En_17_Fig87_HTML', 'image_file_name': '313891_1_En_17_Fig87_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig87_HTML.jpg', 'caption': '(a) HE staining demonstrates lymph nodes, PM in the yeast phase, with sausage liked shape and obvious septa (HE\u2009×\u20091000). (b) GMS staining demonstrates clearly defined PMs (GMS\u2009×\u20091,000)', 'hash': '195e16d569e89c659459764942f07ae44cec9cd1fd8634e716178e34225094ab'}, {'image_id': '313891_1_En_17_Fig91a_HTML', 'image_file_name': '313891_1_En_17_Fig91a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig91a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–e) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of some lesions into honeycomb likes cavity shadows or plaque liked dense shadows. (f–h) CT scanning demonstrates large thick-wall cavity shadows in the right lung, surrounding plaque and round liked small cavity shadows and inflammatory infiltrative shadows', 'hash': '84aa8353e64cbf735c399fa64899ecd1e9b8a13620149a5aa662a21a423c07bf'}, {'image_id': '313891_1_En_17_Fig8b_HTML', 'image_file_name': '313891_1_En_17_Fig8b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig8b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates large flaky parenchyma shadows in both lungs which is more obvious in the middle and lower lobes of both lungs. There are also enlarged hilar shadows in both lungs and sharp both costophrenic angles. (b–g) CT scanning demonstrates large flaky parenchyma shadows in concentric and symmetrical distribution, bronchial shadows in them and thickened bronchial walls', 'hash': '812cc7d7992507bc22a7c06e518ff223d7e9ece757725f478a6f723b8ac030bf'}, {'image_id': '313891_1_En_17_Fig29_HTML', 'image_file_name': '313891_1_En_17_Fig29_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig29_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric and in even size and distribution. There are nodular shadows in the anterior segment of the right middle lung lobe with clear boundary', 'hash': '16cd873b8d84d3bbad635d9facea5407fe900b62efdd6f481449f4a433dfb6a0'}, {'image_id': '313891_1_En_17_Fig71_HTML', 'image_file_name': '313891_1_En_17_Fig71_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig71_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary aspergillosis infection. (a) The gross specimen demonstratesAspergillus abscess in the skin of the forearm. (b–d) CT scanning of the pulmonary window demonstrates multiple round liked nodular shadows and cavity shadows in both lungs, even thickness of cavity wall, and small nodular shadows in some cavities. (e) Pulmonary Aspergillus infection, demonstration purplish blue branches liked or grasses liked growth of hyphae, HE\u2009×\u2009400', 'hash': 'f0586168fbf7b2cd35205e1c807a3343af1ec5bac8dbe4f50308a570cd7d3552'}, {'image_id': '313891_1_En_17_Fig97_HTML', 'image_file_name': '313891_1_En_17_Fig97_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig97_HTML.jpg', 'caption': '(a) Gross observation of the fresh specimen in autopsy demonstrates pulmonary edema and congestion of cytomegalovirus pneumonia. (b) Gross observation of the formalin fixed specimen in autopsy demonstrates dark brown hard pulmonary tissues. (c, d) HE staining demonstrates large quantity cytomegalovirus inclusions in eagle eyes sign. (e) Immunohistochemical demonstrates HIV P24 antigen positive in macrophages of lung tissues (×400)', 'hash': '50e144edf7881be15e502fff23c2613760ac0172fe3ae6c56abf5ca1abf085b5'}, {'image_id': '313891_1_En_17_Fig20_HTML', 'image_file_name': '313891_1_En_17_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig20_HTML.jpg', 'caption': '(a, b) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates enlarged right hilum in nodular dense shadows with peripheral thickened and blurry pulmonary markings, and no obvious abnormalities of the left hilum. (b) DR demonstrates smaller right hilum after treatment for 1 month', 'hash': '27213b483e54de634de857225fc93f6dc05eb5a729bc751141dea3866128c8ec'}, {'image_id': '313891_1_En_17_Fig6b_HTML', 'image_file_name': '313891_1_En_17_Fig6b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig6b_HTML.jpg', 'caption': '(a-d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates flaky ground glass liked density shadows in upper lobes of both lungs, with bronchial shadows in them; flaky parenchymal shadows in the subpleural apical segment; and thickened bronchial walls in the anterior and posterior segments of the right upper lobe', 'hash': 'ba6f221be2db1160358ae94e02b0125159adca1d9ac64bff84883eae8b614970'}, {'image_id': '313891_1_En_17_Fig17b_HTML', 'image_file_name': '313891_1_En_17_Fig17b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig17b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchymal shadows and fibrous cords liked shadows in both lungs which are more obvious in both lower lungs. The trachea and bronchi are unblocked, with enlarged hilar shadows in both lungs', 'hash': 'dba27067e12ab2a752ec8a543537f427156b1a18bdc04bffa3aedbe2d3b6e7bd'}, {'image_id': '313891_1_En_17_Fig113a_HTML', 'image_file_name': '313891_1_En_17_Fig113a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig113a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Kaposi’s sarcoma. (a–d) Chest CT scanning demonstrates scattered cloudy, mass and flake liked or nodular shadows with increased density. (e) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large thick stained nucleoli, which are in line with the diagnosis of Kaposi’s sarcoma. (f–i) Cured HIV/AIDS related Kaposi’s sarcoma. (f–i) Reexamination after treatment demonstrates absent lesions in both lungs, with clear lung fields', 'hash': '192d991df0d417610162aab90c8b0e07b4c19f1436faa752263e85c3efa0f3db'}, {'image_id': '313891_1_En_17_Fig77_HTML', 'image_file_name': '313891_1_En_17_Fig77_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig77_HTML.jpg', 'caption': 'HE staining demonstrates isseminated cryptococci, the Cryptococcus is stained red after mucin carmine staining of cryptococcus neoformans spores in lungs, (HE\u2009×\u2009200)', 'hash': '882060c6f53899fb225a20d7eb5fe410195beed0a7386dc233a4632284f4717f'}, {'image_id': '313891_1_En_17_Fig78_HTML', 'image_file_name': '313891_1_En_17_Fig78_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig78_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates multiple scattered nodular and miliary shadows in both lungs. (b–d) Chest CT scanning demonstrates multiple dense nodular shadows with different sizes in both lungs, with clear boundaries. They are intensively distributed in the dorsal segment and the largest one has a diameter of about 2 cm', 'hash': 'd60cf04886c28c578ee7940f50525d5141254a1a45a5b489d53a7ae5ae27fa53'}, {'image_id': '313891_1_En_17_Fig7b_HTML', 'image_file_name': '313891_1_En_17_Fig7b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig7b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates diffusely distributed shadows with increased density in both lungs that is more obvious in the middle and lower lungs. The hilar shadows in both lungs are enlarged. Both diaphragmatic surfaces and phrenic angles are blurry. (b–d) CT scanning demonstrates flaky shadows with increased density in both lungs, with parenchymal shadows in the lingular segment of left upper lobe and in the dorsal segments of both lower lobes and bronchial shadows in them. There are also thickened bronchial walls and enlarged hilar shadows in both lungs', 'hash': '47bf3b06e99aa6482027b30084d7445e95928d39923c99fd8fe93df39c899b2d'}, {'image_id': '313891_1_En_17_Fig30_HTML', 'image_file_name': '313891_1_En_17_Fig30_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig30_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs and fusion of some military shadows, which are bilaterally symmetric and in even size and distribution', 'hash': 'ab1d4160a6a23300146e331c7eee06edf886ca73ab4514f8a59b22d04d3c303f'}, {'image_id': '313891_1_En_17_Fig1_HTML', 'image_file_name': '313891_1_En_17_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig1_HTML.jpg', 'caption': '(a) Gross specimens’ observation demonstrates foamy liquid filling in the lung tissues. (b) HE demonstrates pneumocystis in the alveolar exudates, which can be stained black by silver methenamine staining, ×400. (c) HE demonstrates the foamy substance in the alveolar space, ×400', 'hash': 'a0082be568f7c995671d0461acf0cfe32c8c36a01dbf7badc28f3cc0ab407b75'}, {'image_id': '313891_1_En_17_Fig81_HTML', 'image_file_name': '313891_1_En_17_Fig81_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig81_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates thickened lung markings in both lungs and flaky blurry shadows in the left lower lung. (b, c) CT scanning demonstrates round liked nodular and small cavity shadows in the left upper and lower lung, with clear boundaries. (d–f) Pathology demonstrates transparent substrate in lung tissues and many bi-capsular cryptococci in cytoplasm', 'hash': '3e767fbaeda72c7b7b49df4ee9daa757367932f7623507185ca8453615c8de74'}, {'image_id': '313891_1_En_17_Fig58a_HTML', 'image_file_name': '313891_1_En_17_Fig58a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig58a_HTML.jpg', 'caption': '(a–i) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) CT scanning of the pulmonary window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (c, d) CT scanning of the mediastinal window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, pulmonary atelectasis and pleural effusion, with ventilation shadows in them. (e) CT scanning of the pulmonary window after the treatment demonstrates absence of the mass shadows in the left lower lung with transverse stripes shadows, obviously improved than previous findings (a, b). (f) HE staining demonstrates thickened alveolar septa and exudates from the alveolar cavity. (g) HE staining demonstrates massive bleeding in the alveolar cavity, large quantity erythrocytes and intact cell walls. (h) HE staining demonstrates phagocytized basophilic granules in the leukocytes. (i) HP staining demonstrates purplish red Rhodococcus equi in a shape of crescent in orange red sputum', 'hash': 'fcd60ca09d86084cb78d6b91f9b3e0a51e9f479a1c27837e18c9af0f809ef13d'}, {'image_id': '313891_1_En_17_Fig57_HTML', 'image_file_name': '313891_1_En_17_Fig57_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig57_HTML.jpg', 'caption': '(a, b)HIV/AIDS related Rhodococcus equi pneumonia. (a) CT scanning of the mediastinal window demonstrates soft tissue mass shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (b) CT scanning of the pulmonary window after the treatment demonstrates absence of the soft tissue mass shadows, and flocculent liked shadow in the left lower lung, obviously improved than previous findings (a)', 'hash': '9ac02a8eb30f8314fea4211fa5a4dbfa3863c422d30e78fcb26e8eaf44e36a42'}, {'image_id': '313891_1_En_17_Fig10_HTML', 'image_file_name': '313891_1_En_17_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig10_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates large flaky and mass liked parenchyma shadows in both lungs which is more obvious in the right lung, bronchial shadows in them, and thickened bronchial walls in the middle lobe of the right lung', 'hash': 'dc81224c041dbc53a26ff01b3414f8c13098126861cf7cc0c7f10d80a7485e0c'}, {'image_id': '313891_1_En_17_Fig100_HTML', 'image_file_name': '313891_1_En_17_Fig100_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig100_HTML.jpg', 'caption': 'The structure of herpes simplex virus', 'hash': 'b0a88fbe1660ab4ddb94799e876d547c23b5686d12e31560768111a38bc71a45'}, {'image_id': '313891_1_En_17_Fig110a_HTML', 'image_file_name': '313891_1_En_17_Fig110a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110a_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '7392286985c0e8fefacf1282d1ef323dd6d64b0b536b667dfffbcbde5be28d3c'}, {'image_id': '313891_1_En_17_Fig5b_HTML', 'image_file_name': '313891_1_En_17_Fig5b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig5b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates patchy shadows with increased density in both lungs, with thickened hilar shadows in both lungs. (b–g) CT scanning demonstrates flaky ground glass liked density shadows in upper lungs and dorsal segment of both lungs, which is more obvious in the middle inner strips. There are extrapulmonary stripes transparent shadows, with some bronchial walls thickened and enlarged hilar shadows in both lungs', 'hash': 'fcd873302d30f9846ba865346820af2a06778c5dad1b50cc634281055ae78468'}, {'image_id': '313891_1_En_17_Fig47_HTML', 'image_file_name': '313891_1_En_17_Fig47_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig47_HTML.jpg', 'caption': '(a–e) HIV/AIDS related staphylococcus aureus pneumonia. (a) DR demonstrates large flaky dense shadows with increased density in the middle-inner zone of the left upper lung field, with blurry boundaries. The lung tissue are atelectatic and the mediastinum migrates leftwards. (b, c) CT scanning demonstrates large flaky dense shadows with increased density in the middle-inner zone of the left upper lung field, with blurry boundaries, with surrounding acinar or particle liked shadows that fuse into flaky shadows. (d, e) CT scanning demonstrates large flaky shadow of parenchymal changes in the middle-inner zone of the left upper lung field, with cyst liked transparent shadows and air bronchogram sign in them, as well as mediastinal lymphadenectasis', 'hash': '8e228a648d0d33ebe1db2bfa2fa7b6209cd113683b027d6ada34f161b809085a'}, {'image_id': '313891_1_En_17_Fig48_HTML', 'image_file_name': '313891_1_En_17_Fig48_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig48_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates broad band liked high density shadows in the right middle lung field, with air bronchogram sign in them. (d–f) CT scanning of the mediastinal window demonstrates broad band liked uneven parenchymal shadows in the right middle lung field, with uneven thickness of air bronchogram sign', 'hash': '6e700dc830efe216b64ed069dfb6440abf50854341b133bf0237be914bd5270f'}, {'image_id': '313891_1_En_17_Fig37_HTML', 'image_file_name': '313891_1_En_17_Fig37_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig37_HTML.jpg', 'caption': '(a, b) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a, b) DR demonstrates diffuse scattering patchy shadows with increased density, and oval thin wall cavity shadows in the right middle lung field', 'hash': 'edc3511f0cc30005fb5999c1fe7033024176b0e1b8fee607763caef6a0d9abe2'}, {'image_id': '313891_1_En_17_Fig38_HTML', 'image_file_name': '313891_1_En_17_Fig38_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig38_HTML.jpg', 'caption': '(a–d) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in both upper lungs, peripheral crab feet liked or cords liked shadows due to pleural traction with cavity shadows in them and periperal satellite lesions. (b–d) CT scanning of the mediastinal window demonstrates round liked mass shadows with high density in the cavities of the left upper lung, surrounding transparent shadows, no nodules in the walls and surrounding nodular satellite lesions. By pathological examination, the diagnosis is defined as chronic fibrous cavity pulmonary tuberculosis complicated by Aspergillus infection', 'hash': '0317a9a78d280af1069a5b797b63c3817f47607eb13976214ed710d247081a7c'}, {'image_id': '313891_1_En_17_Fig65b_HTML', 'image_file_name': '313891_1_En_17_Fig65b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig65b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related allergic pulmonary Aspergillus infection. (a–f) CT scanning of the pulmonary window demonstrates thickened central pulmonary markings in both lungs, which is turtuous and deranged with fingertip infiltration shadows. (g) DR demonstrates hyperinflation of the right lung, increased and thickened pulmonary markings and ground glass liked shadows with increased density in the right lower lung and left lung lobe', 'hash': '44f320a9216b7a9905eaaa045a44b4be59372433c9737f0ee8ded7c443134eaa'}, {'image_id': '313891_1_En_17_Fig9_HTML', 'image_file_name': '313891_1_En_17_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig9_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates large flaky parenchyma shadows in both lungs, with transparent areas in some foci. The trachea and bronchi are unblocked, with thickened bronchial walls in the middle and lower lobes', 'hash': '26b10397cecf70e4665c1abb0f2501e939a6e5d219f395c3484c7a44dae78681'}, {'image_id': '313891_1_En_17_Fig76a_HTML', 'image_file_name': '313891_1_En_17_Fig76a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig76a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning demonstrates diffuse scattered thin ground glass liked, patchy, flaky blurry shadows and cords liked shadows in both lungs, with blurry boundaries and uneven density; scattered nodular shadows in different sizes; more lesions in both upper lobes and the right middle lobe; flaky parenchyma shadows in the apical and posterior segments of right upper lobe, with air bronchogram sign in them; unobstructed opening of bronchi as well as lobar and segmental bronchi without stenosis and obstruction; lymphadenectasis in the right hilar region; detected Aspergillus fumigatus by sputum culture. (e, f) Culture for 72 h, lactic acid gossypol blue staining and microscopic observation at ×200 and ×400 demonstrate short column liked conidial head, smooth wall of conidiophores, flask-shaped top capsule and monolayer microconidiophores. (g) Culture in Paul’s medium demonstrates dark green colored colonies', 'hash': '79dde610127d242cc7f1f29fc98dd50c426df080c95629396102af54f31872c9'}, {'image_id': '313891_1_En_17_Fig86_HTML', 'image_file_name': '313891_1_En_17_Fig86_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig86_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary candida infection. (a–d) CT scanning demonstrates thickened and deranged lung markings in both lungs, diffuse small flaky or patchy shadows, fusion of some small shadows into large flaky dense shadows, with blurry boundaries, enlarged hilum and blurry structures', 'hash': 'bb5525804e3b5cc6588115cd2813109845df9b4314974ab2b55c40298ed6968a'}, {'image_id': '313891_1_En_17_Fig89_HTML', 'image_file_name': '313891_1_En_17_Fig89_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig89_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows in the lungs that fuse into mass with parenchymal shadows, with the hilum as the center and distributing bilaterally symmetric like butterfly wings. There are also multiple clustering cavities or singular large cavity in both lungs', 'hash': 'cfd1927b986a8aba818bf96427711a3743dd07195a83b88e195837af405aae79'}, {'image_id': '313891_1_En_17_Fig60_HTML', 'image_file_name': '313891_1_En_17_Fig60_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig60_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a) DR demonstrates huge sphere liked mass shadow in the middle-outer zone of the right lower lung field, with cavities shdows in them. (b–d) CT scanning demonstrates triangular dense shadow in the middle-outer zone of the right lower lung field, with its apex pointing to the hilum and round liked cavities shadows in them. (e) Reexamination after the treatment demonstrates shrinkage of the huge sphere liked mass shadow in the middle-outer zone of the right lower lung field, with closure of the cavities', 'hash': '9020727e51b9a8522ea37dd579ce73bd9a417d327bcb313836c96e1fa3bd209f'}, {'image_id': '313891_1_En_17_Fig2b_HTML', 'image_file_name': '313891_1_En_17_Fig2b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig2b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered miliary increased density shadows in both lungs, with even size, density and distribution. The shadows of both hila are dense, with sharp both costophrenic angles. (b–f) CT scanning demonstrates scattered miliary nodular shadows in both lungs, which is more obviously in the middle pulmonary strip and with quite even size and density. Trachea and bronchi are unblocked', 'hash': 'ab808d6adb73be9c9efd977cd27ef54cace943f5143068db354c7d287374a50d'}, {'image_id': '313891_1_En_17_Fig13b_HTML', 'image_file_name': '313891_1_En_17_Fig13b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig13b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, transparent areas in them and unblocked trachea and bronchi', 'hash': '2f728d8163ffe4c88ed77f38f8d2e52cb2281b7f3a54af1e9ef328c17a26db3e'}, {'image_id': '313891_1_En_17_Fig28_HTML', 'image_file_name': '313891_1_En_17_Fig28_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig28_HTML.jpg', 'caption': '(a–b) HIV/AIDS related miliary tuberculosis. (a) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric and in even size and distribution. (b) CT scanning of the mediastinal window demonstrates round liked nodular shadows in the right lower lung. CT guided puncture for biopsy is performed to define the diagnosis', 'hash': '1ae71db3f6eebb2e460b8f3b777873d5e7fcf066436bf3a85ef8123aff3f39a9'}, {'image_id': '313891_1_En_17_Fig105b_HTML', 'image_file_name': '313891_1_En_17_Fig105b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig105b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary toxoplasmosis. (a–d) CT scanning demonstrates thickened pulmonary markings in both lungs, which can be enhanced to extend into the middle and outer zones of lungs, in grid liked appearance that is more obvious in the dorsal segment of the lungs. (e) It is demonstrated to have clustering toxoplasma tachyzoites', 'hash': '78ad5a602c243399be530b578f5858d7393984c75f2f978c1dd02f12b26b8836'}, {'image_id': '313891_1_En_17_Fig99_HTML', 'image_file_name': '313891_1_En_17_Fig99_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig99_HTML.jpg', 'caption': '(a, b) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates enlarged right hilus, thickened and deranged lung markings. (b) Plain CT scanning demonstrates mass shadows in the right hilus, spots shadows in the right middle and lower lobes, and patchy shadows in the lingual segment of the left lung', 'hash': '996d2e340f8971525deb4ef2a9312fe4a696f4d7f6bf28ca091e8c767b96b1d4'}, {'image_id': '313891_1_En_17_Fig3b_HTML', 'image_file_name': '313891_1_En_17_Fig3b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig3b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy and scattered miliary increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of the lower lung field, with some fused in thin cloudy shadows', 'hash': '8c1d9dac035274e484303c9deb64a07fed7806c66acaf49b860164feb6d461fc'}, {'image_id': '313891_1_En_17_Fig70_HTML', 'image_file_name': '313891_1_En_17_Fig70_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig70_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window demonstrates a huge cavity shadow in the dorsal segment of the right lower lung, large nodular shadows in it, liquid gas level in the basal cavity, and the evenly thick wall. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates a huge cavity shadow in the dorsal segment of the left lung, multiple large nodular shadows in it, and involved pleura of the lateral chest wall', 'hash': '967426acae68b8d57372efde07d76dd6ad696b10cc5bb64fb67bd9af43a1b0c8'}, {'image_id': '313891_1_En_17_Fig108_HTML', 'image_file_name': '313891_1_En_17_Fig108_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig108_HTML.jpg', 'caption': 'HIV/AIDS related lymphoma. DR demonstrates widened upper middle mediastinum in a dense shadow, enlarged and thickened hilum, thickened and blurry pulmonary markings with diffuse ground glass liked changes', 'hash': '449c992b619237febe63b1617b26f78de511c69c5d1c86ddbd66631790a3e3ce'}, {'image_id': '313891_1_En_17_Fig18_HTML', 'image_file_name': '313891_1_En_17_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig18_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates multiple patchy shadows with increased density in both lungs which are more obvious in both middle and lower lungs. The hilar shadows in both lungs are enlarged, with sharp both costophrenic angles. (b–d) CT scanning demonstrates multiple patchy and mass liked parenchyma shadows in both lungs, ground glass density shadows in the apical segment of both upper lobes, transparent areas in the medial segment of the right middle lobe as well as in the lingual segment of the left upper lobe, and unobstructed trachea and bronchi', 'hash': '18239548bfc8a180d3460173e2f66f27c6ff38e464607d7ec3eb2a837a1382c9'}, {'image_id': '313891_1_En_17_Fig67b_HTML', 'image_file_name': '313891_1_En_17_Fig67b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig67b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows. (e–h) Reexamination of the pulmonary window after 3 months treatment demonstrates multiple scattered round liked nodular shadows and thick wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows which obviously increase and enlarge compared to previous lesions, with accompanying infiltration shadows around the lesions', 'hash': 'f70faec5b814f1fa9555182e0f5414a33838b2496e4da16dc69e0c237676eb30'}, {'image_id': '313891_1_En_17_Fig115a_HTML', 'image_file_name': '313891_1_En_17_Fig115a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig115a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lung cancer. (a–f) CT scanning demonstrates diffuse soft tissue density shadows in left upper lung, round liked mass shadows in the middle lung field, thickened pleura in the lateral chest wall with adhesion, and strip liked liquid density shadows', 'hash': '08de7c80ca9fdc7641723bbb9689498f65631a1a2ee1f499cda653be3ea3d358'}, {'image_id': '313891_1_En_17_Fig40_HTML', 'image_file_name': '313891_1_En_17_Fig40_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig40_HTML.jpg', 'caption': '(a, b) HIV/AIDS related endobronchial tuberculosis. (a, b) Chest CT scanning demonstrates narrowed left major bronchus, irregular thickening of the brounchial wall, multiple irregular flaky, patchy and military shadows in the posterior apical, anterior and lingual segments of the left upper lung. Bronchobierscopy demonstrates narrowed left major bronchus, which is possibly caused by endobronchial tuberculosis', 'hash': '4e416b52d4cb1a2790ee8ad419d525b4e0b37740624cb136f4f5d66c98344651'}, {'image_id': '313891_1_En_17_Fig106b_HTML', 'image_file_name': '313891_1_En_17_Fig106b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig106b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related lymphoma. (a–b) DR demonstrates enlarged and thickened left hilum in a huge mass shadow. High KV demonstrates a huge mass shadow in the hilum. (c–h) CT scanning of the pulmonary window demonstrates a huge high density mass shadow in the left hilum, surrounding nodular fusion shadows in the lung tissues. CT scanning of the mediastinal window demonstrates a huge high density mass shadow in the left hilum, with air bronchogram sign in the shadow', 'hash': '157c65f2ce36513c7bad3d16abf703fde23671a6d95e1da5b62342efd5b516bb'}, {'image_id': '313891_1_En_17_Fig75a_HTML', 'image_file_name': '313891_1_En_17_Fig75a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig75a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval or sphere shaped nodular shadows in the cavities with smooth boundaries. (e, f) Reexamination after treatment demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval nodular shadows in the cavity with smooth boundaries. Compared to the previous imaging findings, the lesions are shrunk, with improved surrounding infiltration', 'hash': 'd2c91d61cbf8a801eed1951a78b54e9b966e9be37aee83d7582af7a496143832'}, {'image_id': '313891_1_En_17_Fig66b_HTML', 'image_file_name': '313891_1_En_17_Fig66b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig66b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates large flaky shadows with increased density in the right upper lung, with blurry boundaries; round liked or sphere shaped mass shadows in the right lower lung, with uneven density. (b–e) CT scanning of the pulmonary window demonstrates multiple round liked thick-wall cavities in the dorsal segment of the right lower lung, with small nodular shadow adhering on the cavity wall; and surrounding small nodular shadows and infi ltration shadows. (f, g) Coronal CT scanning reconstruction demonstrates a huge thick-wall cavity in the right upper lung, with irregular thickness of the wall; round liked cavity shadows in the right lower lung, with thick and multilocular walls; and flaky shadows with increased density in the outer zone of the left lower lung', 'hash': 'fe0cc9e767d47fe24d043db5792869e260b44f40097a6c4d26c923e91ef70b0b'}, {'image_id': '313891_1_En_17_Fig98a_HTML', 'image_file_name': '313891_1_En_17_Fig98a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig98a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates thickened lung markings in both lungs, which extend to the outer zone of the lungs. (b) DR demonstrates thickened and deranged lung markings in both lungs with nodular blurry shadows; and cloudy shadows in lung fields. (c, d) CT scanning demonstrates thickened lung markings in both lungs, with diffuse nodular shadows; and cloudy changes in lung fields. (e) HE staining demonstrates cytomegalovirus inclusions', 'hash': 'adcabf812efa2a551bb7a968e7cf0afcc7677ffb9adf3d1a40a65675496e4552'}, {'image_id': '313891_1_En_17_Fig50_HTML', 'image_file_name': '313891_1_En_17_Fig50_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig50_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Staphylococcus aureus pneumonia. (a) DR demonstrates large flaky dense shadow in the right middle-upper lung field, with blurry boundary. (b, c) CT scanning demonstrates large flaky dense shadow in the right middle upper lung field, with blurry boundary. (d, e) CT scanning demonstrates large flaky dense shadow in the right middle upper lung field, with cystic transparent area in it. (f) Reexamination demonstrates obviously improved pulmonary lesions in the right lung after anti-bacteria treatment for 3 weeks', 'hash': 'bb5e00f8d7a7c6c4308ca4e5024daa75df1bf9a0a88359faa7e2ee91a6c5f156'}, {'image_id': '313891_1_En_17_Fig114a_HTML', 'image_file_name': '313891_1_En_17_Fig114a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig114a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related Kaposi’s sarcoma. (a–d) CT scanning demonstrates scattered cloudy mass and flakes liked or nodular shadows with increased density in both lungs with uneven density and unclear boundaries, fusion and parenchymal changes of some lesions, more lesions in the lower lobe of both lungs and mostly with parenchymal changes. (e, f) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large and thick stained nucleoli, which are in line with the manifestations of Kaposi’s sarcoma. (g, h) Immunohistochemical demonstrates positive of C3 and C4', 'hash': '5d7437deda7758de05e56f8172703b4659fa4eeebdc50c92456867e7bfdb2691'}, {'image_id': '313891_1_En_17_Fig107b_HTML', 'image_file_name': '313891_1_En_17_Fig107b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig107b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related lymphoma. (a–e) CT scanning of the pulmonary and mediastinal windows demonstrates multiple round liked nodular shadows with increased density in both lung fields, with clear boundaries; large soft tissue mass shadows in the right lower lung, with slightly lobulated boundaries and spikes. (f–i) CT scanning of the pulmonary and mediastinal windows for reexamination after radiation therapy demonstrates shrinkage of intrapulmonary nodules and masses', 'hash': 'a7c148d3f71f853c603d1730a516c4b571960bd1e6296b96b6418a73f3663e33'}] | {'313891_1_En_17_Fig1_HTML': ['By naked eyes observation, there are extensive and diffuse invasion of lungs, which is soft like waterlogged sponge and in milky white with black spots. The filled foamy substance in the alveoli and bronchioles is a mixture of necrotic fungus and immunoglobulin. The alveolar septum has infiltration of plasma cells and lymphocytes, resulting in thickened alveolar septa up to 5–20 times as the normal thickness that occupy 3/4 of the entire lung volume. The cysts are firstly located in the macrophage cytoplasm of the alveolar septa. Subsequently, the alveolar cells containing cysts sheds off into the alveolar space. After the rupture of the cystic wall, sporozoite is discharged to turn into free trophozoites, which gains its access into the alveolar space. The alveolar exudates include plasma cells, lymphocytes and histocytes (Fig. <xref rid="313891_1_En_17_Fig1_HTML" ref-type="fig">17.1a–c</xref>).\n).\nFig. 17.1(a) Gross specimens’ observation demonstrates foamy liquid filling in the lung tissues. (b) HE demonstrates pneumocystis in the alveolar exudates, which can be stained black by silver methenamine staining, ×400. (c) HE demonstrates the foamy substance in the alveolar space, ×400\n'], '313891_1_En_17_Fig19_HTML': ['If the necrotic lesions erode the blood vessels, tubercle bacilli can cause systemic miliary tuberculosis along with blood flow, including brain, bones and kidneys. Large quantity sputum containing tubercle bacilli gains its access into the gastrointestinal tract. It can also cause intestinal tuberculosis and peritoneal tuberculosis. Pulmonary tuberculosis can cause tuberculosis pleurisy via direct spreading to the pleura (Fig. <xref rid="313891_1_En_17_Fig19_HTML" ref-type="fig">17.19a–c</xref>).\n).\nFig. 17.19(a) Gross observation in autopsy demonstrates disseminated pulmonary tuberculosis, with grayish white military nodules in diffuse distribution in the lung tissues section. (b) It is demonstrated that mycobacteriumavium-intracellularcomplex infection in the lung tissue, with atypical tuberculosis nodules and acid-fast staining positive (left top). There are a subnodular giant cell, eosinophilic inclusion bodies in the nucleus and bradyzoites in cytoplasm of T. gondii. HE\u2009×\u2009100. (c) HE demonstrates mycobacteriumavium-intracellularcomplex infection, with atypical tuberculosis nodular changes, HE\u2009×\u2009200\n'], '313891_1_En_17_Fig45_HTML': ['Pneumonia caused by inhaled staphylococcus aureus through the respiratory tract often shows lesions in the large lobes or extensive fusion of bronchopneumonia lesions. Bronchial and alveolar rupture allows gas to enter the pulmonary interstitium, which is communicated with the bronchi. In the cases of bronchiolar blockage by necrotic tissues or pus, the one-way valve effect is formed to cause tension pulmonary emphysema. In the cases with superficial pulmonary emphysema with excessively high tension, it ruptures to form pneumothorax or pyopneumothorax, as well as bronchooleural fistula (Fig. <xref rid="313891_1_En_17_Fig45_HTML" ref-type="fig">17.45a, b</xref>).\n).\nFig. 17.45(a, b) HIV/AIDS related Staphylococcus aureus pneumonia. (a) Gross specimen observation demonstrates bilateral purplish brown lesions, patchy white infiltration at the base of the lungs. (b) HE staining demonstrates alveolar diffuse lesions, exudation of the serous fluid and inflammatory cells in the alveolar cavity, and alveolar wall congestion\n'], '313891_1_En_17_Fig64_HTML': ['Aspergillus commonly violates bronchus and lung, with involvements of rhinal sinuses, external auditory canal, eye and skin. Otherwise, it disseminates to organs of the body along with blood flow. The early lesions are diffuse infiltrative and exudative changes. And advanced lesions are necrosis, pyogenesis or granuloma. Large quantity hyphae can be found in the lesions. The hyphae penetrate the blood vessels to cause vasculitis, perivascular inflammation and thrombosis. And thrombosis can cause ischemia and necrosis of the tissue. According to the pathological changes and imaging findings, it can be divided into three major types: vascular invasion type, bronchopneumonia type and allergic bronchopulmonary aspergillosis type. (1) The vascular invasion type is the result caused by toxins released in the process of aspergillus spreading extensively from the primary focus to the lungs. Vascular infiltration of the pulmonary parenchyma and coagulative necrosis are believed to be the cause of vascular occlusion and pulmonary infarction. (2) Bronchopneumonia type is acute bronchitis caused by inhalation of Aspergillus spores. In the cases of hyphae invasion into the lung tissues, extensive infiltrative pneumonia or focal granuloma are resulted in. It can also cause necrosis, pyogenesis and multiple small abscesses. Spherical pulmonary aspergillosis is often secondary to bronchiectasis, tuberculosis, carcinous cavity and other lung diseases. Mycelia multiply and gather in the cavities of the lungs to form a spherical mass with fibrin and mucosal cells, which are called aspergillar glomera, which do not invade the lung tissue. (3) Allergic bronchopulmonary aspergillosis type is the proliferation and germination of inhaled Aspergillus spore in the airway, often showing obvious related mucosal lesions and eventually resulting in bronchiectasis (Fig. <xref rid="313891_1_En_17_Fig64_HTML" ref-type="fig">17.64a–c</xref>).\n).\nFig. 17.64(a) Gross observation demonstrates dark brown lungs in appearance. (b, c) Thology demonstrates hemorrhage and edema of the lung tissue and focal necrosis, with large quantity Aspergillus hyphae and spores in the surrounding area of the necrosis (Combined with pulmonary CMV infection)\n'], '313891_1_En_17_Fig77_HTML': ['In the early stage of cryptococcal infection, only a mild inflammatory reaction or diffuse infiltrative exudative changes occur. But in the advanced stage, necrosis, suppuration or granuloma is formed. Large quantity hyphae can be found in the focus. In the cases with hyphae penetrating the blood vessels, vasculitis, perivascular inflammation and thrombosis occur. And thrombosis leads to ischemia and necrosis of the tissue (Fig. <xref rid="313891_1_En_17_Fig77_HTML" ref-type="fig">17.77</xref>).\n).\nFig. 17.77HE staining demonstrates isseminated cryptococci, the Cryptococcus is stained red after mucin carmine staining of cryptococcus neoformans spores in lungs, (HE\u2009×\u2009200)\n'], '313891_1_En_17_Fig97_HTML': ['Cytomegalovirus pneumonia has extensive pathological changes in the lungs. Pathologically, it shows interstitial pneumonia, with the lesions randomly blood borne distributing in the lungs. The distribution can be diffuse, panlobular or focal. The target cells of pathological changes include alveolar cells and macrophages. Diffused pulmonary interstitial edema and fibrosis as well as alveolar swelling, focal necrosis, bleeding and hyperplasia occur after CMV infections to cause hypoxemia. Gross observation of fresh specimens demonstrates pulmonary surface edema and flaky blooding spots. Fixed specimens demonstrate brown hard lung tissues. Under a microscope, pulmonary interstitial congestion as well as infiltration of lymphocytes and mononuclear cells can be found, with the involved epithelial cells enlarged. In the pulmonary interstitium and alveoli, there are intranuclear inclusions, cytoplasmic inclusions and fluid containing abundant proteins. The classical intranuclear inclusions can be found in the cells, purplish red or purplish blue, round or oval, with surrounding halos in eagle eyes sign. Atypical cytomegalic inclusions in cells are slender, long and round liked with abundant cytoplasm and accentric nucleolus, which are blurry, unclear and atypical (Fig. <xref rid="313891_1_En_17_Fig97_HTML" ref-type="fig">17.97a–e</xref>). Immunohistochemitry demonstrates HIV P24 antigen positive.\n). Immunohistochemitry demonstrates HIV P24 antigen positive.\nFig. 17.97(a) Gross observation of the fresh specimen in autopsy demonstrates pulmonary edema and congestion of cytomegalovirus pneumonia. (b) Gross observation of the formalin fixed specimen in autopsy demonstrates dark brown hard pulmonary tissues. (c, d) HE staining demonstrates large quantity cytomegalovirus inclusions in eagle eyes sign. (e) Immunohistochemical demonstrates HIV P24 antigen positive in macrophages of lung tissues (×400)\n']} | HIV/AIDS Related Respiratory Diseases | [
"HIV/AIDS related pneumocystis carnii pneumonia (PCP)",
"HIV/AIDS related pulmonary bacterial infections",
"HIV/AIDS related pulmonary fungal infections",
"HIV/AIDS related pulmonary virus infections",
"HIV/AIDS related pulmonary parasitic diseases",
"HIV/AIDS related pulmonary neoplasm"
] | None | 1380524400 | None | null | other | PMC7121050 | null | null | [
""
] | Radiology of HIV/AIDS. 2013 Sep 30;:377-535 | NO-CC CODE |
|
(a–f) HIV/AIDS related penicillium marneffei infection. (a–f) CT scanning demonstrates multiple nodules and small cavities in honeycomb liked shadows and infiltrative parenchyma shadows in the right lung; flaky transparent areas (bullae of lung) in the right anterior margin of the heart and in the outer zone of the left lung near lateral chest wall | 313891_1_En_17_Fig94a_HTML | 7 | 4bf177cdb556a837613a60231e962930fcd4acf34d7177f738cb57925ca917e1 | 313891_1_En_17_Fig94a_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
782,
235
] | [{'image_id': '313891_1_En_17_Fig115b_HTML', 'image_file_name': '313891_1_En_17_Fig115b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig115b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lung cancer. (a–f) CT scanning demonstrates diffuse soft tissue density shadows in left upper lung, round liked mass shadows in the middle lung field, thickened pleura in the lateral chest wall with adhesion, and strip liked liquid density shadows', 'hash': '37ffef88f4c6dffdd2849b9994419efe1bf8f369ad111d82071f2f004a9fa43f'}, {'image_id': '313891_1_En_17_Fig106a_HTML', 'image_file_name': '313891_1_En_17_Fig106a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig106a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related lymphoma. (a–b) DR demonstrates enlarged and thickened left hilum in a huge mass shadow. High KV demonstrates a huge mass shadow in the hilum. (c–h) CT scanning of the pulmonary window demonstrates a huge high density mass shadow in the left hilum, surrounding nodular fusion shadows in the lung tissues. CT scanning of the mediastinal window demonstrates a huge high density mass shadow in the left hilum, with air bronchogram sign in the shadow', 'hash': '1ff6a74f6517ed666fda8da1eb38cd58b7d92c3687c533350df4caf4cb7ba7d7'}, {'image_id': '313891_1_En_17_Fig67a_HTML', 'image_file_name': '313891_1_En_17_Fig67a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig67a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows. (e–h) Reexamination of the pulmonary window after 3 months treatment demonstrates multiple scattered round liked nodular shadows and thick wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows which obviously increase and enlarge compared to previous lesions, with accompanying infiltration shadows around the lesions', 'hash': '75b2dd5456ce09da0ace0b9787ea5a36d49c80e174314762343564032297b51c'}, {'image_id': '313891_1_En_17_Fig14_HTML', 'image_file_name': '313891_1_En_17_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig14_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, mass and flakes of parenchymal shadows in the posterior segment of the right upper lobe and in the dorsal segment of both lower lobes which is more obvious in the right lung, and bronchial shadows in them', 'hash': 'bc4343d2071f380a05855c1e658dc05d90d8ae123e988cfe12c3e65526b3336c'}, {'image_id': '313891_1_En_17_Fig104_HTML', 'image_file_name': '313891_1_En_17_Fig104_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig104_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymphoid interstitial pneumonia. (a–f) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs in reticular appearance, with accompanying multiple small nodular shadows, fusion of some nodules into flaky shadows, and ground glass liked changes in the lung fields', 'hash': '4883f041ed6e05ad0ce9ee6734fea4171aae151209ba36cbce94c8434c86f174'}, {'image_id': '313891_1_En_17_Fig98b_HTML', 'image_file_name': '313891_1_En_17_Fig98b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig98b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates thickened lung markings in both lungs, which extend to the outer zone of the lungs. (b) DR demonstrates thickened and deranged lung markings in both lungs with nodular blurry shadows; and cloudy shadows in lung fields. (c, d) CT scanning demonstrates thickened lung markings in both lungs, with diffuse nodular shadows; and cloudy changes in lung fields. (e) HE staining demonstrates cytomegalovirus inclusions', 'hash': '489286db9d367c09fbc842e4d1ba093d9caa6ded75760e9e1a70e05a86f43979'}, {'image_id': '313891_1_En_17_Fig53_HTML', 'image_file_name': '313891_1_En_17_Fig53_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig53_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) Anteroposterior and lateral DR demonstrates enlarged and thickened left hilum, and large flaky blurry shadows with increased density in the left lower lung. (c, d) Reexamination demonstrates normal lungs after antibiotic treatment', 'hash': 'd9cd861c21f1100d02e20014901c7e4a9a9bcad2e4ddcd3c731b50168d8782be'}, {'image_id': '313891_1_En_17_Fig114b_HTML', 'image_file_name': '313891_1_En_17_Fig114b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig114b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related Kaposi’s sarcoma. (a–d) CT scanning demonstrates scattered cloudy mass and flakes liked or nodular shadows with increased density in both lungs with uneven density and unclear boundaries, fusion and parenchymal changes of some lesions, more lesions in the lower lobe of both lungs and mostly with parenchymal changes. (e, f) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large and thick stained nucleoli, which are in line with the manifestations of Kaposi’s sarcoma. (g, h) Immunohistochemical demonstrates positive of C3 and C4', 'hash': '586be9acfd2434fad0db1a2ffaba9ac72eb8eb799b76acdaeac2730c48c45020'}, {'image_id': '313891_1_En_17_Fig107a_HTML', 'image_file_name': '313891_1_En_17_Fig107a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig107a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related lymphoma. (a–e) CT scanning of the pulmonary and mediastinal windows demonstrates multiple round liked nodular shadows with increased density in both lung fields, with clear boundaries; large soft tissue mass shadows in the right lower lung, with slightly lobulated boundaries and spikes. (f–i) CT scanning of the pulmonary and mediastinal windows for reexamination after radiation therapy demonstrates shrinkage of intrapulmonary nodules and masses', 'hash': '4ca6acd1461c3d7b80869d7d33bd1a3d91ecd1a0dc1b5c7baecc0bfbcf817449'}, {'image_id': '313891_1_En_17_Fig75b_HTML', 'image_file_name': '313891_1_En_17_Fig75b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig75b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval or sphere shaped nodular shadows in the cavities with smooth boundaries. (e, f) Reexamination after treatment demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval nodular shadows in the cavity with smooth boundaries. Compared to the previous imaging findings, the lesions are shrunk, with improved surrounding infiltration', 'hash': 'b1a96158009afcb5e673cf31f9243ca598c763c294bbdc7479a918fb36b031e8'}, {'image_id': '313891_1_En_17_Fig25d_HTML', 'image_file_name': '313891_1_En_17_Fig25d_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25d_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '1e7425ad1ac60b1c612434d02bbe7d48ba0fb82e0642b09b8771b4fea9a7a4c2'}, {'image_id': '313891_1_En_17_Fig66a_HTML', 'image_file_name': '313891_1_En_17_Fig66a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig66a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates large flaky shadows with increased density in the right upper lung, with blurry boundaries; round liked or sphere shaped mass shadows in the right lower lung, with uneven density. (b–e) CT scanning of the pulmonary window demonstrates multiple round liked thick-wall cavities in the dorsal segment of the right lower lung, with small nodular shadow adhering on the cavity wall; and surrounding small nodular shadows and infi ltration shadows. (f, g) Coronal CT scanning reconstruction demonstrates a huge thick-wall cavity in the right upper lung, with irregular thickness of the wall; round liked cavity shadows in the right lower lung, with thick and multilocular walls; and flaky shadows with increased density in the outer zone of the left lower lung', 'hash': 'efec688fc6d0fd9fc9188edcc4a4bb040754e9c9e3261fcacec068f3bfd0252f'}, {'image_id': '313891_1_En_17_Fig63_HTML', 'image_file_name': '313891_1_En_17_Fig63_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig63_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Rhodococcus equi pneumonia. (a) Pulmonary CT scanning demonstrates a mass shadow in the lateral segment of the right middle lobe in size of 4.7\u2009×\u20093.7\u2009×\u20093.2 cm with uneven density and lace liked boundary, and small bubbles shadows in it. By both sputum culture and lung tissue culture, Rhodococcus equi can be detected. (b, c) Pathological biopsy and HE staining demonstrate inflammatory pseudotumor. (d, e) Immunohistochemistry demonstrates Rhodococcus equi antibody positive. (f) Reexamination after treatment demonstrates obvious shrinkage of the original lung lesions', 'hash': 'ac97b316499d751a48d8b861962da376a39c7ff11d2554ed957c226224dc65b6'}, {'image_id': '313891_1_En_17_Fig2a_HTML', 'image_file_name': '313891_1_En_17_Fig2a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig2a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered miliary increased density shadows in both lungs, with even size, density and distribution. The shadows of both hila are dense, with sharp both costophrenic angles. (b–f) CT scanning demonstrates scattered miliary nodular shadows in both lungs, which is more obviously in the middle pulmonary strip and with quite even size and density. Trachea and bronchi are unblocked', 'hash': 'ec4f2f75b5bb59b2cb13f016c2ea6714bdc3c908077c2697af2218aa485876b7'}, {'image_id': '313891_1_En_17_Fig13a_HTML', 'image_file_name': '313891_1_En_17_Fig13a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig13a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, transparent areas in them and unblocked trachea and bronchi', 'hash': '7d26c2f94a34f3ff7c4f64d485fe29e114936d0f4db53489ee88148a1a6fc8bf'}, {'image_id': '313891_1_En_17_Fig65a_HTML', 'image_file_name': '313891_1_En_17_Fig65a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig65a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related allergic pulmonary Aspergillus infection. (a–f) CT scanning of the pulmonary window demonstrates thickened central pulmonary markings in both lungs, which is turtuous and deranged with fingertip infiltration shadows. (g) DR demonstrates hyperinflation of the right lung, increased and thickened pulmonary markings and ground glass liked shadows with increased density in the right lower lung and left lung lobe', 'hash': '6fa5ade163d7465c0dc3eb89ebc58d57b98674fc2680824cc5a81c478b81fbc4'}, {'image_id': '313891_1_En_17_Fig76b_HTML', 'image_file_name': '313891_1_En_17_Fig76b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig76b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning demonstrates diffuse scattered thin ground glass liked, patchy, flaky blurry shadows and cords liked shadows in both lungs, with blurry boundaries and uneven density; scattered nodular shadows in different sizes; more lesions in both upper lobes and the right middle lobe; flaky parenchyma shadows in the apical and posterior segments of right upper lobe, with air bronchogram sign in them; unobstructed opening of bronchi as well as lobar and segmental bronchi without stenosis and obstruction; lymphadenectasis in the right hilar region; detected Aspergillus fumigatus by sputum culture. (e, f) Culture for 72 h, lactic acid gossypol blue staining and microscopic observation at ×200 and ×400 demonstrate short column liked conidial head, smooth wall of conidiophores, flask-shaped top capsule and monolayer microconidiophores. (g) Culture in Paul’s medium demonstrates dark green colored colonies', 'hash': 'af925cb00cbd4eed9e67dc49fd012909ecdfe48493ac645d8b2185eb4f351655'}, {'image_id': '313891_1_En_17_Fig105a_HTML', 'image_file_name': '313891_1_En_17_Fig105a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig105a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary toxoplasmosis. (a–d) CT scanning demonstrates thickened pulmonary markings in both lungs, which can be enhanced to extend into the middle and outer zones of lungs, in grid liked appearance that is more obvious in the dorsal segment of the lungs. (e) It is demonstrated to have clustering toxoplasma tachyzoites', 'hash': '30f16a35256e45c89dfcd68adf661507960a5b978db88cc531a7605d9fff53df'}, {'image_id': '313891_1_En_17_Fig95_HTML', 'image_file_name': '313891_1_En_17_Fig95_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig95_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a) CT scanning of the pulmonary window demonstrates irregular large flaky shadows with increased density in the dorsal segment of both lower lobes; enlarged hilum in both lungs, cords liked thickening of the vascular vessels. (b) CT scanning of the mediastinal window demonstrates flaky parenchyma shadows in the left lower lung, thickening of both pleura, enlarged hilum shadows in both lungs, thickened right lower bronchial wall. (c) Microscopy after culture at 25 °C demonstrates branches and separated hyphae and its string of small spores, with typical penicillus but no sporangium (Medan staining, ×400). (d) Bone marrow smear demonstrates round or oval cells like the yeast phase within the macrophages; longer cells like the yeast phase outside the macrophages. The two kinds of cells have slightly curved ends in sausages liked appearance (HE staining, ×400)', 'hash': '636de07e02ba7cf1f73f2a03bccf4fdaac68bc4a122b7fbfe2febe72dd42f139'}, {'image_id': '313891_1_En_17_Fig3a_HTML', 'image_file_name': '313891_1_En_17_Fig3a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig3a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy and scattered miliary increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of the lower lung field, with some fused in thin cloudy shadows', 'hash': 'e655c40874d38beaa8a8e9f0e82c1eb12a6756b09bee559229354b3756010a18'}, {'image_id': '313891_1_En_17_Fig73_HTML', 'image_file_name': '313891_1_En_17_Fig73_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig73_HTML.jpg', 'caption': '(a–c) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates diffuse dense shadows in both lower lung fields which is in a arcuate surface with exterior high and interior low (pleural effusion). (b, c) CT scanning of the mediastinal window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavities; thickened pleura of the lateral chest wall, with accompanying encapsulated effusion', 'hash': '9ad36ea5213bea731770658b27be87e1af9e34bced02cda664a7f485e40f2315'}, {'image_id': '313891_1_En_17_Fig54_HTML', 'image_file_name': '313891_1_En_17_Fig54_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig54_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates round liked large flaky shadows with increased density in the left lower lung, enlarged and thickened hilus. (c, d) DR reexamination after treatment demonstrates flocculent shadows in the left lower lung, with improved conditions than previous findings before treatment (a, b)', 'hash': 'f9b4f22920ef55d9110380df6f64a6a508ecea9ca3192877a2d47400e781c58d'}, {'image_id': '313891_1_En_17_Fig58b_HTML', 'image_file_name': '313891_1_En_17_Fig58b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig58b_HTML.jpg', 'caption': '(a–i) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) CT scanning of the pulmonary window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (c, d) CT scanning of the mediastinal window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, pulmonary atelectasis and pleural effusion, with ventilation shadows in them. (e) CT scanning of the pulmonary window after the treatment demonstrates absence of the mass shadows in the left lower lung with transverse stripes shadows, obviously improved than previous findings (a, b). (f) HE staining demonstrates thickened alveolar septa and exudates from the alveolar cavity. (g) HE staining demonstrates massive bleeding in the alveolar cavity, large quantity erythrocytes and intact cell walls. (h) HE staining demonstrates phagocytized basophilic granules in the leukocytes. (i) HP staining demonstrates purplish red Rhodococcus equi in a shape of crescent in orange red sputum', 'hash': 'ca8456a79f660fc4faa5eb9342f84a14bbe25eedd8fb237ac65bd96b8de6e5b9'}, {'image_id': '313891_1_En_17_Fig25c_HTML', 'image_file_name': '313891_1_En_17_Fig25c_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25c_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '64e0ceda545f1684d11c717eef852c6576036d711540954850cc018aadfefa87'}, {'image_id': '313891_1_En_17_Fig44_HTML', 'image_file_name': '313891_1_En_17_Fig44_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig44_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary nontuberculous mycobacterial infection. (a–d) CT scanning demonstrates multiple cavities in the left lung field, bilateral multiple lobular central nodules and extensive branches liked linear shadows in tree buds sign. There are also large flaky parenchymal changes of the lung tissues in the left lower lung field in high density shadows, with accompanying air bronchogram sign. (e) HE staining demonstrates avium intracellular complex mycobacteria infection of lung tissues in atypical tuberculous nodular changes. (HE\u2009×\u2009200)', 'hash': '8f8697761c60c3cb27c0b413c2e19433df26ba07a74ea0a0cc0b6f2b4acc7b65'}, {'image_id': '313891_1_En_17_Fig103_HTML', 'image_file_name': '313891_1_En_17_Fig103_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig103_HTML.jpg', 'caption': '(a–d) HIV/AIDS related lymphoid interstitial pneumonia. (a–d) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs, in reticular appearance; with accompanying multiple small nodular shadows', 'hash': '8d52c3bac6fb07e3eaf12386767e159f762db3072e09365be542c937697babe7'}, {'image_id': '313891_1_En_17_Fig110b_HTML', 'image_file_name': '313891_1_En_17_Fig110b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110b_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '5526a48dae3face516d842ba229b164bac3062f56c5e811bb1e725778fd20823'}, {'image_id': '313891_1_En_17_Fig5a_HTML', 'image_file_name': '313891_1_En_17_Fig5a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig5a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates patchy shadows with increased density in both lungs, with thickened hilar shadows in both lungs. (b–g) CT scanning demonstrates flaky ground glass liked density shadows in upper lungs and dorsal segment of both lungs, which is more obvious in the middle inner strips. There are extrapulmonary stripes transparent shadows, with some bronchial walls thickened and enlarged hilar shadows in both lungs', 'hash': '5d6ab0400e0331b0fcb3a3679023a44fa81b7b9c9eedc00c0ddb6d85208c3512'}, {'image_id': '313891_1_En_17_Fig74_HTML', 'image_file_name': '313891_1_En_17_Fig74_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig74_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates round liked uneven density shadows in the medial segments of both middle and lower lungs, multilocular hollow holes in the cavities, surrounding multiple round liked thick-wall small cavity shadows and ground grass liked infiltration shadows. (b–d) CT scanning of the pulmonary window demonstrates scattered round liked uneven density shadows in the right hilum and lower lung, multilocular hollow holes in the cavities; and surrounding multiple round liked thick-wall small cavity shadows and ground grass liked infiltration shadows', 'hash': 'e4c42cc0cb1f1bdfa8b2cc1f3c8eab7223c4be368a808e8b6c4b01af78dfb04a'}, {'image_id': '313891_1_En_17_Fig23_HTML', 'image_file_name': '313891_1_En_17_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig23_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymph node tuberculosis. (a–c) CT scanning of the pulmonary window demonstrates dense mass shadow beside the right aortic arch, and thinner right bronchus due to compression. (d–f) CT scanning of the mediastinal window demonstrates low density mass shadow besied the right aortic arch with clear boundary', 'hash': '8d135ce7e96005006343dc3305be0f8c77d0828bccccf1726226c09fd47c365f'}, {'image_id': '313891_1_En_17_Fig6a_HTML', 'image_file_name': '313891_1_En_17_Fig6a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig6a_HTML.jpg', 'caption': '(a-d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates flaky ground glass liked density shadows in upper lobes of both lungs, with bronchial shadows in them; flaky parenchymal shadows in the subpleural apical segment; and thickened bronchial walls in the anterior and posterior segments of the right upper lobe', 'hash': '235548456c9bf72727a05a91fa6893d8a478f8f715c022d6b579d4a9188da366'}, {'image_id': '313891_1_En_17_Fig17a_HTML', 'image_file_name': '313891_1_En_17_Fig17a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig17a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchymal shadows and fibrous cords liked shadows in both lungs which are more obvious in both lower lungs. The trachea and bronchi are unblocked, with enlarged hilar shadows in both lungs', 'hash': '9c1c59095291dcf6a7b6dec786ec58ba44e9b83badfe4bbf121b7c677476f4d5'}, {'image_id': '313891_1_En_17_Fig113b_HTML', 'image_file_name': '313891_1_En_17_Fig113b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig113b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Kaposi’s sarcoma. (a–d) Chest CT scanning demonstrates scattered cloudy, mass and flake liked or nodular shadows with increased density. (e) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large thick stained nucleoli, which are in line with the diagnosis of Kaposi’s sarcoma. (f–i) Cured HIV/AIDS related Kaposi’s sarcoma. (f–i) Reexamination after treatment demonstrates absent lesions in both lungs, with clear lung fields', 'hash': '88e574b2d5ff4ee4ce28f38025d5345c8cf6b50386f752ae12083b05fe7af9de'}, {'image_id': '313891_1_En_17_Fig82_HTML', 'image_file_name': '313891_1_En_17_Fig82_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig82_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a, b) DR demonstrates enlarged blurry hilum in both lungs and thickened pulmonary markings. (c, d) CT scanning demonstrates mediastinal lymphadenectasis, narrowed trachea due to compression with liquefactive necrosis. Enhanced scanning demonstrates marginal enhancement and no central enhancement', 'hash': '18312183daaefbc6c48e05e67fab210a1109c24a6f94311ffb11ffdace007a49'}, {'image_id': '313891_1_En_17_Fig64_HTML', 'image_file_name': '313891_1_En_17_Fig64_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig64_HTML.jpg', 'caption': '(a) Gross observation demonstrates dark brown lungs in appearance. (b, c) Thology demonstrates hemorrhage and edema of the lung tissue and focal necrosis, with large quantity Aspergillus hyphae and spores in the surrounding area of the necrosis (Combined with pulmonary CMV infection)', 'hash': '104850f2999da711317f4e4f07e590bd8f73a93731daf090ece6023192606e90'}, {'image_id': '313891_1_En_17_Fig7a_HTML', 'image_file_name': '313891_1_En_17_Fig7a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig7a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates diffusely distributed shadows with increased density in both lungs that is more obvious in the middle and lower lungs. The hilar shadows in both lungs are enlarged. Both diaphragmatic surfaces and phrenic angles are blurry. (b–d) CT scanning demonstrates flaky shadows with increased density in both lungs, with parenchymal shadows in the lingular segment of left upper lobe and in the dorsal segments of both lower lobes and bronchial shadows in them. There are also thickened bronchial walls and enlarged hilar shadows in both lungs', 'hash': '431aab0770a1915c719095cc2bab91736f1ffda7b5649cdca5d8b7516003049c'}, {'image_id': '313891_1_En_17_Fig33_HTML', 'image_file_name': '313891_1_En_17_Fig33_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig33_HTML.jpg', 'caption': '(a, b) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates scattering patchy and cords liked blurry density shadows in the right middle and upper lung fields as well as enlarged and thickened hilum. (b) DR demonstrates that the lungs lesions are almost absent compared to (a), after anti-TB treatment for 5 months', 'hash': 'e710598bbbc8286721136f2a803716198a712c55253c4232d3ee33b2e33e188b'}, {'image_id': '313891_1_En_17_Fig62_HTML', 'image_file_name': '313891_1_En_17_Fig62_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig62_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) Anteroposterior and lateral DR demonstrates huge sphere liked mass shadow in the right hilum, with cavities shadows and liquid gas level in it. (c) HE staining demonstrates bleeding in the lung tissues and aggregation of large quantity lymphocytes. (d) Masson staining demonstrates branches liked purplish red Rhodococcus equi', 'hash': '261a4aca9e146cc16957c6280cd4795d7c2c5732d9a19006b6e398a1ae410af0'}, {'image_id': '313891_1_En_17_Fig84_HTML', 'image_file_name': '313891_1_En_17_Fig84_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig84_HTML.jpg', 'caption': '(a, b) HIV/AIDS related pulmonary cryptococcus infection. (a) CT scanning demonstrates round liked cavity shadows in the left upper and lower lung, with uneven thickness of the cavity wall and surrounding infiltrative shadows. (b) CT scanning demonstrates round liked dense mass shadows in the right upper lung, with clear boundaries and bulky drainage vessel shadows', 'hash': 'ecc614167ec536dcb80c2739886c957ff2f182dd49ac7f4d6379260497262e60'}, {'image_id': '313891_1_En_17_Fig4_HTML', 'image_file_name': '313891_1_En_17_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig4_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy or ground glass liked increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of lower lungs, with some fused into thin cloudy ground glass liked shadows with increased density, with decreased transparency of both lungs and enlarged hilar shadows in both lungs', 'hash': '636f9fd3d3c20c17e15e1ac70adcdcb6fbe268a70ac64d29317f73045747e226'}, {'image_id': '313891_1_En_17_Fig46a_HTML', 'image_file_name': '313891_1_En_17_Fig46a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig46a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates large flaky dense shadows in the middle-outer zone of the left middle lung field, and narrowed left bronchus. (d–f) CT scanning demonstrates large flaky shadows with uneven density in the left lateral chest wall and even lower density shadow in them', 'hash': 'afdfc2c33070f1d3b8616a542d989e0f908d9638327227057dfdf5ed59169359'}, {'image_id': '313891_1_En_17_Fig72_HTML', 'image_file_name': '313891_1_En_17_Fig72_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig72_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and cavity shadows in both lungs, with even wall thickness and small nodular shadows in some cavities', 'hash': 'd318b47b9b56854b6bc47081b08712ee9d828a2ae4592aa69451ec7105fd0240'}, {'image_id': '313891_1_En_17_Fig91b_HTML', 'image_file_name': '313891_1_En_17_Fig91b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig91b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–e) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of some lesions into honeycomb likes cavity shadows or plaque liked dense shadows. (f–h) CT scanning demonstrates large thick-wall cavity shadows in the right lung, surrounding plaque and round liked small cavity shadows and inflammatory infiltrative shadows', 'hash': '6b3a934b89abf6f7e8c9593337c0c57fe44161bcbfc546c7e2a3cfa50539f91e'}, {'image_id': '313891_1_En_17_Fig8a_HTML', 'image_file_name': '313891_1_En_17_Fig8a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig8a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates large flaky parenchyma shadows in both lungs which is more obvious in the middle and lower lobes of both lungs. There are also enlarged hilar shadows in both lungs and sharp both costophrenic angles. (b–g) CT scanning demonstrates large flaky parenchyma shadows in concentric and symmetrical distribution, bronchial shadows in them and thickened bronchial walls', 'hash': '7c4f2f4f9120af70727cab6fc69637733e17e807575648a0257b5b03367da625'}, {'image_id': '313891_1_En_17_Fig42_HTML', 'image_file_name': '313891_1_En_17_Fig42_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig42_HTML.jpg', 'caption': 'HIV/AIDS related tuberculous pleuritis. DR demonstrates arch shaped dense shadows with higher exterior density and lower interior density in the left lower lung field and covered right edge of the heart', 'hash': 'f0dfdb1b349a42c7092daeeaef76a8b8762e134b40ae21a6144d9785b9ddcd02'}, {'image_id': '313891_1_En_17_Fig15_HTML', 'image_file_name': '313891_1_En_17_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig15_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy blurry shadows and fibrous cords liked shadows in both lungs which are more obvious in the middle inner parts of both lungs, with transparent areas in them. The bronchial walls are thickened', 'hash': '4d262b5c06f74783c1b6df1f8c9d8c7ecbf235faacd2f2e846544a3e11d88e8b'}, {'image_id': '313891_1_En_17_Fig92b_HTML', 'image_file_name': '313891_1_En_17_Fig92b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig92b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of the lesions in the right lung into plaque liked shadows with clear boundaries, and multiple round liked small cavity shadows and inflammatory infiltrative shadows in both lungs', 'hash': '4613e0bd8bbb013024b2335ae2f7fb1997dab5d93ee1c395c97035d6e7d37750'}, {'image_id': '313891_1_En_17_Fig52_HTML', 'image_file_name': '313891_1_En_17_Fig52_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig52_HTML.jpg', 'caption': '(a, b) HIV/AIDS related staphylococcus aureus pneumonia. (a, b) DR demonstrates diffuse scattered multiple thin-walled transparent areas in both lungs, increased and blurry pulmonary markings, and enlarged heart shadow in flask shape (pericardial effusion)', 'hash': 'b54d395f8405b646839c68cb58c1a811c70fb8c7337443d24b61bfcfa097f5b0'}, {'image_id': '313891_1_En_17_Fig56b_HTML', 'image_file_name': '313891_1_En_17_Fig56b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig56b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates huge round large flaky shadows with increased density in the left lower lung, enlarged and thickened hilum and covered right heart edge. (c, d) DR reexamination after treatment for 1 week demonstrates flocculent shadow in the left lower lung, improved than those before the treatment (a, b). (e) DR reexamination after treatment demonstrates flocculent liked shadows in the left lower lung, obviously improved than before the treatment (c, d)', 'hash': 'e5f534ed9282980e95aaa6bac04091762128cf3e5c46985b190278c5d6396558'}, {'image_id': '313891_1_En_17_Fig93b_HTML', 'image_file_name': '313891_1_En_17_Fig93b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig93b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates diffuse small cavity in honeycomb liked and infiltrative parenchyma shadows, with the hilum as the center to distribute bilaterally symmetric like butterfly wings; multiple honeycomb liked cavity shadows in both lungs. (e–h) CT scanning reexamination demonstrates large irregular thick-wall cavities in the right lung, surrounding scattering nodular, honeycomba liked and infiltrative shadows after anti-PM infection treatment for 3 months', 'hash': '904e5a590c601ab02150f8c2487bbfa6f0282c1eddd547624ce8c549472221d9'}, {'image_id': '313891_1_En_17_Fig51b_HTML', 'image_file_name': '313891_1_En_17_Fig51b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig51b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related staphylococcus aureus pneumonia. (a) Chest X-ray demonstrates large flaky high density shadow in the left middle-lower lung field, with central transparent areas in different sizes and blurry boundaries; parenchyma changes of the left lower lung, predominantly in the posterior and exterior basal segments; unobstructed brounchus and thickened adjacent pleura. (b–d) CT scanning demonstrates large flaky shadows in fan shaped distribution along the bronchus in the left middle-lower lung, with gas containing cavities and high density shadows; and thickened adjacent pleura of the lateral chest wall. (e, f) CT scanning of the mediastinal window demonstrates large flaky fan shaped parenchymal shadows in the left middle-lower lung field, with ventilation shadows in them; and thickened pleura of the lateral chest wall. (g, h) Pathological examination showed staphylococcus aureus', 'hash': '18a6e1202b7b8c4a2d57fe024b7e8039a6dcee0f6f5f078b109a93850977c0f6'}, {'image_id': '313891_1_En_17_Fig94b_HTML', 'image_file_name': '313891_1_En_17_Fig94b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig94b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a–f) CT scanning demonstrates multiple nodules and small cavities in honeycomb liked shadows and infiltrative parenchyma shadows in the right lung; flaky transparent areas (bullae of lung) in the right anterior margin of the heart and in the outer zone of the left lung near lateral chest wall', 'hash': '3ed719abaaaec4ee19332842bd8dcac302eb6fefc73152dfd03a39702260d369'}, {'image_id': '313891_1_En_17_Fig34a_HTML', 'image_file_name': '313891_1_En_17_Fig34a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig34a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung and multiple satellite lesions scattering around. (c) CT scanning of the mediastinal window demonstrates lymphadenectasis of aortic window, subcutaneous soft tissue mass shadow in the left anterior chest wall with central low density shadow as well as right axilliary lymphadenectasis', 'hash': 'dabd5722ad3f66eee67ca59ba24417ffb086d4591f3bff2446f2a3490c676e78'}, {'image_id': '313891_1_En_17_Fig22_HTML', 'image_file_name': '313891_1_En_17_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig22_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates semicircular mass liked dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura of lateral chest wall, and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates narrowed right thorax, thickend pleura of lateral chest wall with encapsulated effusion, uneven density mass in the right hilum, thinner right bronchus due to compression and no obvious abnormalities in the left hilum. (f) DR in Aug. 2008 demonstrates no obvious changes of the lesions after anti-tuberculosis treatment for 1 month', 'hash': '8f3d47e32ff0f306eed49c4101730b02a154f676752c7bb56423c767388d5b82'}, {'image_id': '313891_1_En_17_Fig27b_HTML', 'image_file_name': '313891_1_En_17_Fig27b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig27b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related miliary tuberculosis. (a–b) Anteroposterior and lateral DR demonstrates diffuse miliary shadows in both lungs, which are bilaterally symmetric and in even size and distribution. (c–f) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': 'e272956e522e945d068939f056c637c5a636df520c687deeac9d40f8cb06834e'}, {'image_id': '313891_1_En_17_Fig83_HTML', 'image_file_name': '313891_1_En_17_Fig83_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig83_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates enlarged blurry hilum in both lungs and thickened lung markings. (b–d) CT scanning demonstrates multiple scattered nodular or mass dense shadows in both lungs, with lobulation, rough spikes around and fusion of some shadows into mass; surrounding small flaky infiltrative shadows; and mediastinal lymphadenectasis', 'hash': '6b17ec5d2db4d953c2436bbec29d0a3b1dacf0910df899eaf97e442c4aaad785'}, {'image_id': '313891_1_En_17_Fig43a_HTML', 'image_file_name': '313891_1_En_17_Fig43a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig43a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related tuberculous pleuritis. (a) DR demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (b) CT scanning of the pulmonary window demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (c) CT scanning of the mediastinal window demonstrates encapsulated fluid density shadow in the pleura of the right lateral chest wall', 'hash': 'ac09c8d3e5e4d73b07cd258411b07337ad06b99883f4a0e4573ce220fc1f4574'}, {'image_id': '313891_1_En_17_Fig35a_HTML', 'image_file_name': '313891_1_En_17_Fig35a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig35a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates diffuse large flaky dense shadows in the right upper lung with transparent areas in them. (b–c) CT scanning of the pulmonary window demonstrates large flaky shadows with increased density in the right upper lung, with multiple satellite lesions scattering around. (d, e) CT scanning of the mediastinal window demonstrates large flaky parenchymal shadows in the right upper lung with air bronchogram sign as well as mediastinal lymphadenectasis', 'hash': 'f556b77354da8136691c411ed446865babea0e399d96d2fca89f49639a04c579'}, {'image_id': '313891_1_En_17_Fig26b_HTML', 'image_file_name': '313891_1_En_17_Fig26b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig26b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '1d1f0589c50a11306fce77c217b0a9ac31be645df14f41d021ccf6522873dc6c'}, {'image_id': '313891_1_En_17_Fig32_HTML', 'image_file_name': '313891_1_En_17_Fig32_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig32_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstratesdiffuse scattering miliary shadows with increased density in both lungs, fusion of some military shadows into patchy or mass liked shadows and diffusely distributed lung lesions', 'hash': '7274d90d4f9483c5fb0e44576eeb46beba54850ed218057b6ca5935c31fa396a'}, {'image_id': '313891_1_En_17_Fig96b_HTML', 'image_file_name': '313891_1_En_17_Fig96b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig96b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a) DR demonstrates flaky blurry dense shadows in the right anterior margin of the heart, with surrounding infiltrative shadows. (b, c) CT scanning of the pulmonary window demonstrates nodular dense shadows in the dorsal segment of the right lower lung, with smooth sharp boundaries; large flaky ground glass liked dense shadows in the dorsal segment of both lungs. (d, e) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in red, in different sizes. (f) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in purplish red, in different sizes', 'hash': 'ad87dabd309e8a0c47d5cd58aa485a538556b1218d18c3cb262dc5b8cd5049e9'}, {'image_id': '313891_1_En_17_Fig55_HTML', 'image_file_name': '313891_1_En_17_Fig55_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig55_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates round liked large flaky shadows with increased density in the right lower lung, cords liked and flocculent liked blurry shadows in both middle-upper lung fields and in the right lower lung field, and enlarged and thickened hilus', 'hash': '29c690f04a28629d1c3b0f7b5665833edd78ec61be199fd2f16199400a7c9eeb'}, {'image_id': '313891_1_En_17_Fig85a_HTML', 'image_file_name': '313891_1_En_17_Fig85a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig85a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates round liked thick-wall cavity in the left hilum, with blurred boundary; ground-glass liked shadows with increased density in the left middle and lower lung. (b–d) CT scanning of the pulmonary window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of cavity wall. (e, f) CT scanning of the mediastinal window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of the cavity wall and surrounding thick spikes', 'hash': 'd6bc5b1be05729f5f4ec60a0cda3bec7f7cf437fd39e0d32743e45cfb9e48de2'}, {'image_id': '313891_1_En_17_Fig112_HTML', 'image_file_name': '313891_1_En_17_Fig112_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig112_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Kaposi’s sarcoma. (a, b) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance', 'hash': 'eeb255e4963802d02da7fd85381532153336be33b21e4ceb488be5dc2a483f29'}, {'image_id': '313891_1_En_17_Fig25b_HTML', 'image_file_name': '313891_1_En_17_Fig25b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25b_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '9ceac8f407a9896d7bda0165bceae81a32d5c5c53de3c5d2a295c165b15071e8'}, {'image_id': '313891_1_En_17_Fig36a_HTML', 'image_file_name': '313891_1_En_17_Fig36a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig36a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) Pulmonary CT scanning of the pulmonary window demonstrates parenchymal shadows in the left lingual lobe with surrounding pulmonary acinar nodular shadows. (b) CT guided pucture biopsy of left lingula. (c) The pathology demonstrates granulation tissue and caseous necrosis, being in consistency with tuberculosis changes. HE\u2009×\u2009100', 'hash': '3a48cc084a1fb1943e1411fa65cfdcee0c3c33377b3ae6ab6e24f04ee1caebae'}, {'image_id': '313891_1_En_17_Fig68a_HTML', 'image_file_name': '313891_1_En_17_Fig68a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig68a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in prone posture demonstrates mass shadow and thick wall cavity in the dorsal segment of the right lower lung, small nodular shadows in the cavities, surrounding fused miliary infiltration shadows. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the dorsal segment of the right lower lung, small nodular shadows in the cavities, and involved pleura of partial lateral chest wall', 'hash': '0acc77833f25b70e7e4527a30be9fc6744e19cee48879415a15e648d76923d48'}, {'image_id': '313891_1_En_17_Fig45_HTML', 'image_file_name': '313891_1_En_17_Fig45_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig45_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Staphylococcus aureus pneumonia. (a) Gross specimen observation demonstrates bilateral purplish brown lesions, patchy white infiltration at the base of the lungs. (b) HE staining demonstrates alveolar diffuse lesions, exudation of the serous fluid and inflammatory cells in the alveolar cavity, and alveolar wall congestion', 'hash': 'e530a1df1ead29989d8b3b50161f1926946446bc5cbbcb99691479816876e341'}, {'image_id': '313891_1_En_17_Fig110c_HTML', 'image_file_name': '313891_1_En_17_Fig110c_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110c_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '22d9f8a4fa731c46a738334c9738c267aaa2c43711aa94bd98c4b78483adda8d'}, {'image_id': '313891_1_En_17_Fig24b_HTML', 'image_file_name': '313891_1_En_17_Fig24b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig24b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates circular mass dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura in the lateral chest cavity and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates multiple uneven mass density shadows in right hilum in a size of about 3\u2009×\u20093.5\u2009×\u20093.8 cm. (f–g) Enhanced CT scanning demonstrates slight uneven enhancement of the lesion and no obvious abnormalties in the left hilum', 'hash': '4c7c3a8f7b0bde1c89efcf634beedfd08159b9be03a95299448e388c435edcdc'}, {'image_id': '313891_1_En_17_Fig12_HTML', 'image_file_name': '313891_1_En_17_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig12_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchyma shadows and fibrous cords liked shadows in both lungs which are more obvious in the dorsal segment of both lower lungs, bronchial shadows in them, and thickened bronchial walls in the middle lobe. The hilar shadows in both lungs are enlarged', 'hash': '72a066b603a93a4b8e9a7a8ec1942b2ed87b211dee6ed121b7c56d1cb575c55c'}, {'image_id': '313891_1_En_17_Fig102_HTML', 'image_file_name': '313891_1_En_17_Fig102_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig102_HTML.jpg', 'caption': '(a–d) HIV/AIDS related lymphoid interstitial pneumonia. (a–d) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs, in reticular appearance; with accompanying multiple small nodular shadows', 'hash': '6b569d4d7a5a4f008ea8f7bc4152cd1a576656b8eeee8b7548f00de038815256'}, {'image_id': '313891_1_En_17_Fig111_HTML', 'image_file_name': '313891_1_En_17_Fig111_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig111_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Kaposi’s sarcoma. (a, b) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance, light density flaky shadows in lower lung fields of both lungs. (c) CT scanning demonstrates multiple round liked nodular shadows in both middle lower lung fields with clear boundaries, multiple mediastinal and hilar lymphadenectasis, and small quantity pleural effusion in bilateral thoracic cavities', 'hash': '5dfb9d581ecc41659920bde84bc55d01903bf9f66ec50710fe0465373096ff5f'}, {'image_id': '313891_1_En_17_Fig25a_HTML', 'image_file_name': '313891_1_En_17_Fig25a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25a_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '67db71f0f56d65c929e36f486b4a1a2246ae852aec999328f126ddc09428f814'}, {'image_id': '313891_1_En_17_Fig36b_HTML', 'image_file_name': '313891_1_En_17_Fig36b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig36b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) Pulmonary CT scanning of the pulmonary window demonstrates parenchymal shadows in the left lingual lobe with surrounding pulmonary acinar nodular shadows. (b) CT guided pucture biopsy of left lingula. (c) The pathology demonstrates granulation tissue and caseous necrosis, being in consistency with tuberculosis changes. HE\u2009×\u2009100', 'hash': 'd7d5abe0c9d9bea2e2097dfc72f86922656058f98f8a2360573b04a02e27e5de'}, {'image_id': '313891_1_En_17_Fig68b_HTML', 'image_file_name': '313891_1_En_17_Fig68b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig68b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in prone posture demonstrates mass shadow and thick wall cavity in the dorsal segment of the right lower lung, small nodular shadows in the cavities, surrounding fused miliary infiltration shadows. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the dorsal segment of the right lower lung, small nodular shadows in the cavities, and involved pleura of partial lateral chest wall', 'hash': 'cada0e4684021c74f9b0d4d1bcdb6810379bc035cead748d6de141ebd004f038'}, {'image_id': '313891_1_En_17_Fig96a_HTML', 'image_file_name': '313891_1_En_17_Fig96a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig96a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a) DR demonstrates flaky blurry dense shadows in the right anterior margin of the heart, with surrounding infiltrative shadows. (b, c) CT scanning of the pulmonary window demonstrates nodular dense shadows in the dorsal segment of the right lower lung, with smooth sharp boundaries; large flaky ground glass liked dense shadows in the dorsal segment of both lungs. (d, e) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in red, in different sizes. (f) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in purplish red, in different sizes', 'hash': '020553d48c8545e50d314020ad8dc5004914dca5449aa2b58bc99515f310c3a4'}, {'image_id': '313891_1_En_17_Fig85b_HTML', 'image_file_name': '313891_1_En_17_Fig85b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig85b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates round liked thick-wall cavity in the left hilum, with blurred boundary; ground-glass liked shadows with increased density in the left middle and lower lung. (b–d) CT scanning of the pulmonary window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of cavity wall. (e, f) CT scanning of the mediastinal window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of the cavity wall and surrounding thick spikes', 'hash': '9778eb0d00755e3cd06bd3bcee90d66970730aac4b7fabde0b3e1df25cc067b8'}, {'image_id': '313891_1_En_17_Fig59_HTML', 'image_file_name': '313891_1_En_17_Fig59_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig59_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a–c) CT scanning of the pulmonary window demonstrates thick walled cavities shadows in the dorsal segment of the right lower lung, with irregular wall thickness and liquid gas level in them. (d) CT scanning of the mediastinal window demonstrates thick walled cavities shadows in the dorsal segment of the left lower lung, with irregular wall thickness and liquid gas level in them', 'hash': 'c9ff1150b9c2d245c823a3726a56dc22223fcdc58b24666ee55ee0b01ea0c2d3'}, {'image_id': '313891_1_En_17_Fig24a_HTML', 'image_file_name': '313891_1_En_17_Fig24a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig24a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates circular mass dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura in the lateral chest cavity and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates multiple uneven mass density shadows in right hilum in a size of about 3\u2009×\u20093.5\u2009×\u20093.8 cm. (f–g) Enhanced CT scanning demonstrates slight uneven enhancement of the lesion and no obvious abnormalties in the left hilum', 'hash': 'a3536c779e7c502b855dd3d89ae13854f569bd483ba8038870ac76c68c616c6c'}, {'image_id': '313891_1_En_17_Fig11_HTML', 'image_file_name': '313891_1_En_17_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig11_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered patchy shadows with increased density in both lungs and a few cords liked shadows which are more obvious in the right lung. There are thickened both hilar shadows and sharp both costophrenic angles. (b–e) CT scanning demonstrates flaky and mass liked ground glass density shadows in both lungs and a few cords liked shadows which are more obvious in the right lung. The trachea and bronchi are unblocked', 'hash': 'd4448bd9682d4ae721b1250cec042eecf77787519b1af61ac3b2d7b88b28bd90'}, {'image_id': '313891_1_En_17_Fig101_HTML', 'image_file_name': '313891_1_En_17_Fig101_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig101_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Herpes Simplex Viral Pneumonia. (a) DR demonstrates thickened and deranged lung markings in both lungs with accompanying blurry nodular shadows, and cloudy shadows in the lung fields. (b) PAS staining (400×) demonstrates eosinophilic inclusion. (c) Silver methenamine staining demonstrates herpes viral inclusion', 'hash': '9cfda956483a95dc3a4e487426e884d83e6aa0bde654b2c285ba044cf31b2a1d'}, {'image_id': '313891_1_En_17_Fig49_HTML', 'image_file_name': '313891_1_En_17_Fig49_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig49_HTML.jpg', 'caption': '(a–d) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates fan shaped shadow in the right middle lung field with its apex pointing to the hilar dense shadow, with clear boundaries. (d) CT scanning reexamination demonstrates absence of the lesions in the right lung after anti-bacteria treatment for 2 weeks', 'hash': 'f566a271be67724833f92b19b4f73190cae4216ad698f1d1a51c1d9c7579afa1'}, {'image_id': '313891_1_En_17_Fig34b_HTML', 'image_file_name': '313891_1_En_17_Fig34b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig34b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung and multiple satellite lesions scattering around. (c) CT scanning of the mediastinal window demonstrates lymphadenectasis of aortic window, subcutaneous soft tissue mass shadow in the left anterior chest wall with central low density shadow as well as right axilliary lymphadenectasis', 'hash': 'cd2bbefb6363363a2c860069ded9e79b5fabed794f0777f342cd459e7f745581'}, {'image_id': '313891_1_En_17_Fig21_HTML', 'image_file_name': '313891_1_En_17_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig21_HTML.jpg', 'caption': '(a–c) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates enlarged right hilum in mass liked dense shadow, with peripheral thickened and blurry pulmonary markings, and no obvious abnormalities of the left hilum. (b) DR demonstrates smaller right hilum after anti-tuberculosis therapy for 1 month. (c) DR demonstrates absent tumor in the right hilum and normal left hilum', 'hash': '46a1a9267e1d610faa6450929c11c8d942047467baf49ba4482ce61bb660cb30'}, {'image_id': '313891_1_En_17_Fig27a_HTML', 'image_file_name': '313891_1_En_17_Fig27a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig27a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related miliary tuberculosis. (a–b) Anteroposterior and lateral DR demonstrates diffuse miliary shadows in both lungs, which are bilaterally symmetric and in even size and distribution. (c–f) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '61497bd4be4942d8a1fc4e6710043c9d4099da58ea99f2008d49f04ec973f2b4'}, {'image_id': '313891_1_En_17_Fig79_HTML', 'image_file_name': '313891_1_En_17_Fig79_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig79_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates multiple scattered nodular shadows in both lower lungs. (b–d) Chest CT scanning demonstrates multiple dense nodular shadows with different sizes and mass shadows in both middle and lower lung fields, with clear boundaries. They are more common in the dorsal segments', 'hash': '7f1588a4af3d4fadaf1f33e3bac3f100d4b2003206bd1bc2ae262b602fd3fe79'}, {'image_id': '313891_1_En_17_Fig51a_HTML', 'image_file_name': '313891_1_En_17_Fig51a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig51a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related staphylococcus aureus pneumonia. (a) Chest X-ray demonstrates large flaky high density shadow in the left middle-lower lung field, with central transparent areas in different sizes and blurry boundaries; parenchyma changes of the left lower lung, predominantly in the posterior and exterior basal segments; unobstructed brounchus and thickened adjacent pleura. (b–d) CT scanning demonstrates large flaky shadows in fan shaped distribution along the bronchus in the left middle-lower lung, with gas containing cavities and high density shadows; and thickened adjacent pleura of the lateral chest wall. (e, f) CT scanning of the mediastinal window demonstrates large flaky fan shaped parenchymal shadows in the left middle-lower lung field, with ventilation shadows in them; and thickened pleura of the lateral chest wall. (g, h) Pathological examination showed staphylococcus aureus', 'hash': '00d7fc70edd23ceb6f012159d4bae8563ec20a036cc91fd99d91cdbc08f23126'}, {'image_id': '313891_1_En_17_Fig90_HTML', 'image_file_name': '313891_1_En_17_Fig90_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig90_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows in the lungs that fuse into mass in parenchymal shadows, with the hilum as the center and distributing bilaterally symmetric like butterfly wings. There are also multiple clustering cavities or singular large cavity in both lungs', 'hash': '6742eff5e10355ff74a6fe215cff47247a9d12856c453a35fd6d6742f8f0ac2e'}, {'image_id': '313891_1_En_17_Fig94a_HTML', 'image_file_name': '313891_1_En_17_Fig94a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig94a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a–f) CT scanning demonstrates multiple nodules and small cavities in honeycomb liked shadows and infiltrative parenchyma shadows in the right lung; flaky transparent areas (bullae of lung) in the right anterior margin of the heart and in the outer zone of the left lung near lateral chest wall', 'hash': '4bf177cdb556a837613a60231e962930fcd4acf34d7177f738cb57925ca917e1'}, {'image_id': '313891_1_En_17_Fig35b_HTML', 'image_file_name': '313891_1_En_17_Fig35b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig35b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates diffuse large flaky dense shadows in the right upper lung with transparent areas in them. (b–c) CT scanning of the pulmonary window demonstrates large flaky shadows with increased density in the right upper lung, with multiple satellite lesions scattering around. (d, e) CT scanning of the mediastinal window demonstrates large flaky parenchymal shadows in the right upper lung with air bronchogram sign as well as mediastinal lymphadenectasis', 'hash': '8b68f2c89884110f18b2b9641154ae26362875fb18db9a64b4320edd5c13bba4'}, {'image_id': '313891_1_En_17_Fig26a_HTML', 'image_file_name': '313891_1_En_17_Fig26a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig26a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '1bd3c2b9622fa99531543c1b9d456f58ff2945c6fa4bb44043fadb51fa9c8db6'}, {'image_id': '313891_1_En_17_Fig31_HTML', 'image_file_name': '313891_1_En_17_Fig31_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig31_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, fusion of some military shadows into patchy or mass liked shadow, diffusely distributed lung lesions', 'hash': '3bf8714e005c1ebc72eb46fac228838fd6436f0a1dd5d6a8bd085a14fddd1170'}, {'image_id': '313891_1_En_17_Fig69_HTML', 'image_file_name': '313891_1_En_17_Fig69_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig69_HTML.jpg', 'caption': '(a, b) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the medial basal segment of the right lower lung, irregular nodular shadows in the cavities, and surrounding fused miliary infiltration shadows', 'hash': 'db839a28accf7944530e9940a7c7afb2b7b3c7a4423308b863fae87f0c08c29a'}, {'image_id': '313891_1_En_17_Fig80_HTML', 'image_file_name': '313891_1_En_17_Fig80_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig80_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a, b) Anteroposterior and lateral DR demonstrate a huge dense mass shadow in the left lower lung, with clear boundary. (c) CT scanning of the pulmonary window demonstrates round liked high density shadow in the left lower lung near left chest wall, with even density. (d) CT scanning of the mediastinal window demonstrates round liked soft tissue density shadows in the left lower lung near left chest wall, with even density, lobulation, and surrounding thick spikes', 'hash': 'ea2ef199cee39dce2b4a8a06bcdcce274a6fd8796c2efbfaf940d6d05fe48c40'}, {'image_id': '313891_1_En_17_Fig43b_HTML', 'image_file_name': '313891_1_En_17_Fig43b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig43b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related tuberculous pleuritis. (a) DR demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (b) CT scanning of the pulmonary window demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (c) CT scanning of the mediastinal window demonstrates encapsulated fluid density shadow in the pleura of the right lateral chest wall', 'hash': '582e0f2e161551b97de13a60d6afed8cc613b9b04bfb136458587da830b2ecf0'}, {'image_id': '313891_1_En_17_Fig16_HTML', 'image_file_name': '313891_1_En_17_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig16_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple fibrous cords liked shadows in lungs, multiple patchy parenchyma shadows and ground glass liked density shadows in both upper lobes, with multiple transparent areas in them. The bronchial walls are thickened in the anterior and posterior segments of the right upper lobe as well as in the lingual segment of the left lung', 'hash': '214979f5c447a9b40ebd0772cff663eb275052bf5fe8132456329ffacdc20c9c'}, {'image_id': '313891_1_En_17_Fig109_HTML', 'image_file_name': '313891_1_En_17_Fig109_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig109_HTML.jpg', 'caption': '(a, b) HIV/AIDS related lymphoma. (a, b) CT scanning demonstrates a huge soft tissue mass shadow in the left lateral chest wall, with a maximal size of about 7.7\u2009×\u200913.0 cm and occupying 30 sections with 8 mm in thickness of each section and with the upmost to the supraclavicular area and the bottom in the level of thoracic 12th vertebral body in the lower chest wall. There are also large quantity left pleural effusion and parenchymal changes of the left lower lobe with atelectasis. In the left chest cavity, large quantity liquid density shadows can be found, with compressed lung tissues to the hilum. By puncture and biopsy of the subaxillary mass, the diagnosis is defined as diffuse large B cell lymphoma', 'hash': '6d67a094843ca970dc50c93d50e7d1038c2a389c96e1772f425fa9dbc9d3a3ea'}, {'image_id': '313891_1_En_17_Fig19_HTML', 'image_file_name': '313891_1_En_17_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig19_HTML.jpg', 'caption': '(a) Gross observation in autopsy demonstrates disseminated pulmonary tuberculosis, with grayish white military nodules in diffuse distribution in the lung tissues section. (b) It is demonstrated that mycobacteriumavium-intracellularcomplex infection in the lung tissue, with atypical tuberculosis nodules and acid-fast staining positive (left top). There are a subnodular giant cell, eosinophilic inclusion bodies in the nucleus and bradyzoites in cytoplasm of T. gondii. HE\u2009×\u2009100. (c) HE demonstrates mycobacteriumavium-intracellularcomplex infection, with atypical tuberculosis nodular changes, HE\u2009×\u2009200', 'hash': 'fac712a77d78563a8ebac012fe6c9f2f74ab72b1d36bf9e0c30462450f24c87d'}, {'image_id': '313891_1_En_17_Fig92a_HTML', 'image_file_name': '313891_1_En_17_Fig92a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig92a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of the lesions in the right lung into plaque liked shadows with clear boundaries, and multiple round liked small cavity shadows and inflammatory infiltrative shadows in both lungs', 'hash': '981e19f8709c64fb0f850afd293a3dfdb67ec16a8d75e3f2bf19cd69116366cd'}, {'image_id': '313891_1_En_17_Fig41_HTML', 'image_file_name': '313891_1_En_17_Fig41_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig41_HTML.jpg', 'caption': 'HIV/AIDS related tuberculous pleuritis. DR demonstrates arch shaped dense shadows with higher exterior density and lower interior density in the right lower lung field and covered right edge of the heart', 'hash': '3381f76804304950a36ba44865a5651168e2f9b43c451a23d390d065bfc52e80'}, {'image_id': '313891_1_En_17_Fig56a_HTML', 'image_file_name': '313891_1_En_17_Fig56a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig56a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates huge round large flaky shadows with increased density in the left lower lung, enlarged and thickened hilum and covered right heart edge. (c, d) DR reexamination after treatment for 1 week demonstrates flocculent shadow in the left lower lung, improved than those before the treatment (a, b). (e) DR reexamination after treatment demonstrates flocculent liked shadows in the left lower lung, obviously improved than before the treatment (c, d)', 'hash': '8c2f7c50d0562920efd9257451f8cc2d4dda042eaa3768d3fb1455a7092edf94'}, {'image_id': '313891_1_En_17_Fig93a_HTML', 'image_file_name': '313891_1_En_17_Fig93a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig93a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates diffuse small cavity in honeycomb liked and infiltrative parenchyma shadows, with the hilum as the center to distribute bilaterally symmetric like butterfly wings; multiple honeycomb liked cavity shadows in both lungs. (e–h) CT scanning reexamination demonstrates large irregular thick-wall cavities in the right lung, surrounding scattering nodular, honeycomba liked and infiltrative shadows after anti-PM infection treatment for 3 months', 'hash': 'eb824267db9288c03e6cffae4cde8b6f47b3bda47dcad797ee4964b9011ac598'}, {'image_id': '313891_1_En_17_Fig46b_HTML', 'image_file_name': '313891_1_En_17_Fig46b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig46b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates large flaky dense shadows in the middle-outer zone of the left middle lung field, and narrowed left bronchus. (d–f) CT scanning demonstrates large flaky shadows with uneven density in the left lateral chest wall and even lower density shadow in them', 'hash': '97eaf0337e0212b917644691da5093524803db5d92384afd57bfc5803cb125e0'}, {'image_id': '313891_1_En_17_Fig39_HTML', 'image_file_name': '313891_1_En_17_Fig39_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig39_HTML.jpg', 'caption': '(a–d) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung, periphery crab feet liked or cords liked shadows due to pleural traction and satellite lesions. (c, d) CT scanning of the mediastinal window demonstrates round liked or triangle shaped thick wall cavities in the left upper lung, no nodules in the wall and peripheral nodular satellite lesions', 'hash': '614dd89032a813e240901110905f63b8b8d2530c6c7e27b0e6aab03ce47f7abb'}, {'image_id': '313891_1_En_17_Fig61_HTML', 'image_file_name': '313891_1_En_17_Fig61_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig61_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a) DR demonstrates large flaky shadow in the middle-outer zone of the left upper lung field. (b) DR demonstrates diffuse dense shadow in the left lung field, with round liked cavities shadows in them. (c–d) Reexamination after treatment demonstrates multiple cavities shadows in the middle-outer zone of the left upper lung field', 'hash': '29c84b1869c0cdabc91ee8822b014d024780586503e92fa0fdc6bed1d3b54b73'}, {'image_id': '313891_1_En_17_Fig88_HTML', 'image_file_name': '313891_1_En_17_Fig88_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig88_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a) The gross specimen demonstrates central necrotic pimples on the face. (b) Chest X-ray DR demonstrates cavities in the left upper lung, thickened lung markings in both lower lungs with accompanying multiple spots and flakes shadows. (c) Gastrointestinal barium meal radiology demonstrates left and downwards migration of the intestine due to compression. (d) Enhanced abdominal CT scanning demonstrates retroperitoneal enlarged lymph nodes that fuse into a huge mass, with ring shaped enhancement of the lymph nodes', 'hash': '72d6f61ccf9268cf07530a5a1e56a768d1d614ac854706838e783fa20f2cb2a1'}, {'image_id': '313891_1_En_17_Fig87_HTML', 'image_file_name': '313891_1_En_17_Fig87_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig87_HTML.jpg', 'caption': '(a) HE staining demonstrates lymph nodes, PM in the yeast phase, with sausage liked shape and obvious septa (HE\u2009×\u20091000). (b) GMS staining demonstrates clearly defined PMs (GMS\u2009×\u20091,000)', 'hash': '195e16d569e89c659459764942f07ae44cec9cd1fd8634e716178e34225094ab'}, {'image_id': '313891_1_En_17_Fig91a_HTML', 'image_file_name': '313891_1_En_17_Fig91a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig91a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–e) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of some lesions into honeycomb likes cavity shadows or plaque liked dense shadows. (f–h) CT scanning demonstrates large thick-wall cavity shadows in the right lung, surrounding plaque and round liked small cavity shadows and inflammatory infiltrative shadows', 'hash': '84aa8353e64cbf735c399fa64899ecd1e9b8a13620149a5aa662a21a423c07bf'}, {'image_id': '313891_1_En_17_Fig8b_HTML', 'image_file_name': '313891_1_En_17_Fig8b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig8b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates large flaky parenchyma shadows in both lungs which is more obvious in the middle and lower lobes of both lungs. There are also enlarged hilar shadows in both lungs and sharp both costophrenic angles. (b–g) CT scanning demonstrates large flaky parenchyma shadows in concentric and symmetrical distribution, bronchial shadows in them and thickened bronchial walls', 'hash': '812cc7d7992507bc22a7c06e518ff223d7e9ece757725f478a6f723b8ac030bf'}, {'image_id': '313891_1_En_17_Fig29_HTML', 'image_file_name': '313891_1_En_17_Fig29_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig29_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric and in even size and distribution. There are nodular shadows in the anterior segment of the right middle lung lobe with clear boundary', 'hash': '16cd873b8d84d3bbad635d9facea5407fe900b62efdd6f481449f4a433dfb6a0'}, {'image_id': '313891_1_En_17_Fig71_HTML', 'image_file_name': '313891_1_En_17_Fig71_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig71_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary aspergillosis infection. (a) The gross specimen demonstratesAspergillus abscess in the skin of the forearm. (b–d) CT scanning of the pulmonary window demonstrates multiple round liked nodular shadows and cavity shadows in both lungs, even thickness of cavity wall, and small nodular shadows in some cavities. (e) Pulmonary Aspergillus infection, demonstration purplish blue branches liked or grasses liked growth of hyphae, HE\u2009×\u2009400', 'hash': 'f0586168fbf7b2cd35205e1c807a3343af1ec5bac8dbe4f50308a570cd7d3552'}, {'image_id': '313891_1_En_17_Fig97_HTML', 'image_file_name': '313891_1_En_17_Fig97_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig97_HTML.jpg', 'caption': '(a) Gross observation of the fresh specimen in autopsy demonstrates pulmonary edema and congestion of cytomegalovirus pneumonia. (b) Gross observation of the formalin fixed specimen in autopsy demonstrates dark brown hard pulmonary tissues. (c, d) HE staining demonstrates large quantity cytomegalovirus inclusions in eagle eyes sign. (e) Immunohistochemical demonstrates HIV P24 antigen positive in macrophages of lung tissues (×400)', 'hash': '50e144edf7881be15e502fff23c2613760ac0172fe3ae6c56abf5ca1abf085b5'}, {'image_id': '313891_1_En_17_Fig20_HTML', 'image_file_name': '313891_1_En_17_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig20_HTML.jpg', 'caption': '(a, b) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates enlarged right hilum in nodular dense shadows with peripheral thickened and blurry pulmonary markings, and no obvious abnormalities of the left hilum. (b) DR demonstrates smaller right hilum after treatment for 1 month', 'hash': '27213b483e54de634de857225fc93f6dc05eb5a729bc751141dea3866128c8ec'}, {'image_id': '313891_1_En_17_Fig6b_HTML', 'image_file_name': '313891_1_En_17_Fig6b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig6b_HTML.jpg', 'caption': '(a-d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates flaky ground glass liked density shadows in upper lobes of both lungs, with bronchial shadows in them; flaky parenchymal shadows in the subpleural apical segment; and thickened bronchial walls in the anterior and posterior segments of the right upper lobe', 'hash': 'ba6f221be2db1160358ae94e02b0125159adca1d9ac64bff84883eae8b614970'}, {'image_id': '313891_1_En_17_Fig17b_HTML', 'image_file_name': '313891_1_En_17_Fig17b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig17b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchymal shadows and fibrous cords liked shadows in both lungs which are more obvious in both lower lungs. The trachea and bronchi are unblocked, with enlarged hilar shadows in both lungs', 'hash': 'dba27067e12ab2a752ec8a543537f427156b1a18bdc04bffa3aedbe2d3b6e7bd'}, {'image_id': '313891_1_En_17_Fig113a_HTML', 'image_file_name': '313891_1_En_17_Fig113a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig113a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Kaposi’s sarcoma. (a–d) Chest CT scanning demonstrates scattered cloudy, mass and flake liked or nodular shadows with increased density. (e) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large thick stained nucleoli, which are in line with the diagnosis of Kaposi’s sarcoma. (f–i) Cured HIV/AIDS related Kaposi’s sarcoma. (f–i) Reexamination after treatment demonstrates absent lesions in both lungs, with clear lung fields', 'hash': '192d991df0d417610162aab90c8b0e07b4c19f1436faa752263e85c3efa0f3db'}, {'image_id': '313891_1_En_17_Fig77_HTML', 'image_file_name': '313891_1_En_17_Fig77_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig77_HTML.jpg', 'caption': 'HE staining demonstrates isseminated cryptococci, the Cryptococcus is stained red after mucin carmine staining of cryptococcus neoformans spores in lungs, (HE\u2009×\u2009200)', 'hash': '882060c6f53899fb225a20d7eb5fe410195beed0a7386dc233a4632284f4717f'}, {'image_id': '313891_1_En_17_Fig78_HTML', 'image_file_name': '313891_1_En_17_Fig78_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig78_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates multiple scattered nodular and miliary shadows in both lungs. (b–d) Chest CT scanning demonstrates multiple dense nodular shadows with different sizes in both lungs, with clear boundaries. They are intensively distributed in the dorsal segment and the largest one has a diameter of about 2 cm', 'hash': 'd60cf04886c28c578ee7940f50525d5141254a1a45a5b489d53a7ae5ae27fa53'}, {'image_id': '313891_1_En_17_Fig7b_HTML', 'image_file_name': '313891_1_En_17_Fig7b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig7b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates diffusely distributed shadows with increased density in both lungs that is more obvious in the middle and lower lungs. The hilar shadows in both lungs are enlarged. Both diaphragmatic surfaces and phrenic angles are blurry. (b–d) CT scanning demonstrates flaky shadows with increased density in both lungs, with parenchymal shadows in the lingular segment of left upper lobe and in the dorsal segments of both lower lobes and bronchial shadows in them. There are also thickened bronchial walls and enlarged hilar shadows in both lungs', 'hash': '47bf3b06e99aa6482027b30084d7445e95928d39923c99fd8fe93df39c899b2d'}, {'image_id': '313891_1_En_17_Fig30_HTML', 'image_file_name': '313891_1_En_17_Fig30_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig30_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs and fusion of some military shadows, which are bilaterally symmetric and in even size and distribution', 'hash': 'ab1d4160a6a23300146e331c7eee06edf886ca73ab4514f8a59b22d04d3c303f'}, {'image_id': '313891_1_En_17_Fig1_HTML', 'image_file_name': '313891_1_En_17_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig1_HTML.jpg', 'caption': '(a) Gross specimens’ observation demonstrates foamy liquid filling in the lung tissues. (b) HE demonstrates pneumocystis in the alveolar exudates, which can be stained black by silver methenamine staining, ×400. (c) HE demonstrates the foamy substance in the alveolar space, ×400', 'hash': 'a0082be568f7c995671d0461acf0cfe32c8c36a01dbf7badc28f3cc0ab407b75'}, {'image_id': '313891_1_En_17_Fig81_HTML', 'image_file_name': '313891_1_En_17_Fig81_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig81_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates thickened lung markings in both lungs and flaky blurry shadows in the left lower lung. (b, c) CT scanning demonstrates round liked nodular and small cavity shadows in the left upper and lower lung, with clear boundaries. (d–f) Pathology demonstrates transparent substrate in lung tissues and many bi-capsular cryptococci in cytoplasm', 'hash': '3e767fbaeda72c7b7b49df4ee9daa757367932f7623507185ca8453615c8de74'}, {'image_id': '313891_1_En_17_Fig58a_HTML', 'image_file_name': '313891_1_En_17_Fig58a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig58a_HTML.jpg', 'caption': '(a–i) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) CT scanning of the pulmonary window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (c, d) CT scanning of the mediastinal window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, pulmonary atelectasis and pleural effusion, with ventilation shadows in them. (e) CT scanning of the pulmonary window after the treatment demonstrates absence of the mass shadows in the left lower lung with transverse stripes shadows, obviously improved than previous findings (a, b). (f) HE staining demonstrates thickened alveolar septa and exudates from the alveolar cavity. (g) HE staining demonstrates massive bleeding in the alveolar cavity, large quantity erythrocytes and intact cell walls. (h) HE staining demonstrates phagocytized basophilic granules in the leukocytes. (i) HP staining demonstrates purplish red Rhodococcus equi in a shape of crescent in orange red sputum', 'hash': 'fcd60ca09d86084cb78d6b91f9b3e0a51e9f479a1c27837e18c9af0f809ef13d'}, {'image_id': '313891_1_En_17_Fig57_HTML', 'image_file_name': '313891_1_En_17_Fig57_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig57_HTML.jpg', 'caption': '(a, b)HIV/AIDS related Rhodococcus equi pneumonia. (a) CT scanning of the mediastinal window demonstrates soft tissue mass shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (b) CT scanning of the pulmonary window after the treatment demonstrates absence of the soft tissue mass shadows, and flocculent liked shadow in the left lower lung, obviously improved than previous findings (a)', 'hash': '9ac02a8eb30f8314fea4211fa5a4dbfa3863c422d30e78fcb26e8eaf44e36a42'}, {'image_id': '313891_1_En_17_Fig10_HTML', 'image_file_name': '313891_1_En_17_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig10_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates large flaky and mass liked parenchyma shadows in both lungs which is more obvious in the right lung, bronchial shadows in them, and thickened bronchial walls in the middle lobe of the right lung', 'hash': 'dc81224c041dbc53a26ff01b3414f8c13098126861cf7cc0c7f10d80a7485e0c'}, {'image_id': '313891_1_En_17_Fig100_HTML', 'image_file_name': '313891_1_En_17_Fig100_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig100_HTML.jpg', 'caption': 'The structure of herpes simplex virus', 'hash': 'b0a88fbe1660ab4ddb94799e876d547c23b5686d12e31560768111a38bc71a45'}, {'image_id': '313891_1_En_17_Fig110a_HTML', 'image_file_name': '313891_1_En_17_Fig110a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110a_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '7392286985c0e8fefacf1282d1ef323dd6d64b0b536b667dfffbcbde5be28d3c'}, {'image_id': '313891_1_En_17_Fig5b_HTML', 'image_file_name': '313891_1_En_17_Fig5b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig5b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates patchy shadows with increased density in both lungs, with thickened hilar shadows in both lungs. (b–g) CT scanning demonstrates flaky ground glass liked density shadows in upper lungs and dorsal segment of both lungs, which is more obvious in the middle inner strips. There are extrapulmonary stripes transparent shadows, with some bronchial walls thickened and enlarged hilar shadows in both lungs', 'hash': 'fcd873302d30f9846ba865346820af2a06778c5dad1b50cc634281055ae78468'}, {'image_id': '313891_1_En_17_Fig47_HTML', 'image_file_name': '313891_1_En_17_Fig47_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig47_HTML.jpg', 'caption': '(a–e) HIV/AIDS related staphylococcus aureus pneumonia. (a) DR demonstrates large flaky dense shadows with increased density in the middle-inner zone of the left upper lung field, with blurry boundaries. The lung tissue are atelectatic and the mediastinum migrates leftwards. (b, c) CT scanning demonstrates large flaky dense shadows with increased density in the middle-inner zone of the left upper lung field, with blurry boundaries, with surrounding acinar or particle liked shadows that fuse into flaky shadows. (d, e) CT scanning demonstrates large flaky shadow of parenchymal changes in the middle-inner zone of the left upper lung field, with cyst liked transparent shadows and air bronchogram sign in them, as well as mediastinal lymphadenectasis', 'hash': '8e228a648d0d33ebe1db2bfa2fa7b6209cd113683b027d6ada34f161b809085a'}, {'image_id': '313891_1_En_17_Fig48_HTML', 'image_file_name': '313891_1_En_17_Fig48_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig48_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates broad band liked high density shadows in the right middle lung field, with air bronchogram sign in them. (d–f) CT scanning of the mediastinal window demonstrates broad band liked uneven parenchymal shadows in the right middle lung field, with uneven thickness of air bronchogram sign', 'hash': '6e700dc830efe216b64ed069dfb6440abf50854341b133bf0237be914bd5270f'}, {'image_id': '313891_1_En_17_Fig37_HTML', 'image_file_name': '313891_1_En_17_Fig37_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig37_HTML.jpg', 'caption': '(a, b) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a, b) DR demonstrates diffuse scattering patchy shadows with increased density, and oval thin wall cavity shadows in the right middle lung field', 'hash': 'edc3511f0cc30005fb5999c1fe7033024176b0e1b8fee607763caef6a0d9abe2'}, {'image_id': '313891_1_En_17_Fig38_HTML', 'image_file_name': '313891_1_En_17_Fig38_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig38_HTML.jpg', 'caption': '(a–d) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in both upper lungs, peripheral crab feet liked or cords liked shadows due to pleural traction with cavity shadows in them and periperal satellite lesions. (b–d) CT scanning of the mediastinal window demonstrates round liked mass shadows with high density in the cavities of the left upper lung, surrounding transparent shadows, no nodules in the walls and surrounding nodular satellite lesions. By pathological examination, the diagnosis is defined as chronic fibrous cavity pulmonary tuberculosis complicated by Aspergillus infection', 'hash': '0317a9a78d280af1069a5b797b63c3817f47607eb13976214ed710d247081a7c'}, {'image_id': '313891_1_En_17_Fig65b_HTML', 'image_file_name': '313891_1_En_17_Fig65b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig65b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related allergic pulmonary Aspergillus infection. (a–f) CT scanning of the pulmonary window demonstrates thickened central pulmonary markings in both lungs, which is turtuous and deranged with fingertip infiltration shadows. (g) DR demonstrates hyperinflation of the right lung, increased and thickened pulmonary markings and ground glass liked shadows with increased density in the right lower lung and left lung lobe', 'hash': '44f320a9216b7a9905eaaa045a44b4be59372433c9737f0ee8ded7c443134eaa'}, {'image_id': '313891_1_En_17_Fig9_HTML', 'image_file_name': '313891_1_En_17_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig9_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates large flaky parenchyma shadows in both lungs, with transparent areas in some foci. The trachea and bronchi are unblocked, with thickened bronchial walls in the middle and lower lobes', 'hash': '26b10397cecf70e4665c1abb0f2501e939a6e5d219f395c3484c7a44dae78681'}, {'image_id': '313891_1_En_17_Fig76a_HTML', 'image_file_name': '313891_1_En_17_Fig76a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig76a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning demonstrates diffuse scattered thin ground glass liked, patchy, flaky blurry shadows and cords liked shadows in both lungs, with blurry boundaries and uneven density; scattered nodular shadows in different sizes; more lesions in both upper lobes and the right middle lobe; flaky parenchyma shadows in the apical and posterior segments of right upper lobe, with air bronchogram sign in them; unobstructed opening of bronchi as well as lobar and segmental bronchi without stenosis and obstruction; lymphadenectasis in the right hilar region; detected Aspergillus fumigatus by sputum culture. (e, f) Culture for 72 h, lactic acid gossypol blue staining and microscopic observation at ×200 and ×400 demonstrate short column liked conidial head, smooth wall of conidiophores, flask-shaped top capsule and monolayer microconidiophores. (g) Culture in Paul’s medium demonstrates dark green colored colonies', 'hash': '79dde610127d242cc7f1f29fc98dd50c426df080c95629396102af54f31872c9'}, {'image_id': '313891_1_En_17_Fig86_HTML', 'image_file_name': '313891_1_En_17_Fig86_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig86_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary candida infection. (a–d) CT scanning demonstrates thickened and deranged lung markings in both lungs, diffuse small flaky or patchy shadows, fusion of some small shadows into large flaky dense shadows, with blurry boundaries, enlarged hilum and blurry structures', 'hash': 'bb5525804e3b5cc6588115cd2813109845df9b4314974ab2b55c40298ed6968a'}, {'image_id': '313891_1_En_17_Fig89_HTML', 'image_file_name': '313891_1_En_17_Fig89_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig89_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows in the lungs that fuse into mass with parenchymal shadows, with the hilum as the center and distributing bilaterally symmetric like butterfly wings. There are also multiple clustering cavities or singular large cavity in both lungs', 'hash': 'cfd1927b986a8aba818bf96427711a3743dd07195a83b88e195837af405aae79'}, {'image_id': '313891_1_En_17_Fig60_HTML', 'image_file_name': '313891_1_En_17_Fig60_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig60_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a) DR demonstrates huge sphere liked mass shadow in the middle-outer zone of the right lower lung field, with cavities shdows in them. (b–d) CT scanning demonstrates triangular dense shadow in the middle-outer zone of the right lower lung field, with its apex pointing to the hilum and round liked cavities shadows in them. (e) Reexamination after the treatment demonstrates shrinkage of the huge sphere liked mass shadow in the middle-outer zone of the right lower lung field, with closure of the cavities', 'hash': '9020727e51b9a8522ea37dd579ce73bd9a417d327bcb313836c96e1fa3bd209f'}, {'image_id': '313891_1_En_17_Fig2b_HTML', 'image_file_name': '313891_1_En_17_Fig2b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig2b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered miliary increased density shadows in both lungs, with even size, density and distribution. The shadows of both hila are dense, with sharp both costophrenic angles. (b–f) CT scanning demonstrates scattered miliary nodular shadows in both lungs, which is more obviously in the middle pulmonary strip and with quite even size and density. Trachea and bronchi are unblocked', 'hash': 'ab808d6adb73be9c9efd977cd27ef54cace943f5143068db354c7d287374a50d'}, {'image_id': '313891_1_En_17_Fig13b_HTML', 'image_file_name': '313891_1_En_17_Fig13b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig13b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, transparent areas in them and unblocked trachea and bronchi', 'hash': '2f728d8163ffe4c88ed77f38f8d2e52cb2281b7f3a54af1e9ef328c17a26db3e'}, {'image_id': '313891_1_En_17_Fig28_HTML', 'image_file_name': '313891_1_En_17_Fig28_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig28_HTML.jpg', 'caption': '(a–b) HIV/AIDS related miliary tuberculosis. (a) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric and in even size and distribution. (b) CT scanning of the mediastinal window demonstrates round liked nodular shadows in the right lower lung. CT guided puncture for biopsy is performed to define the diagnosis', 'hash': '1ae71db3f6eebb2e460b8f3b777873d5e7fcf066436bf3a85ef8123aff3f39a9'}, {'image_id': '313891_1_En_17_Fig105b_HTML', 'image_file_name': '313891_1_En_17_Fig105b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig105b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary toxoplasmosis. (a–d) CT scanning demonstrates thickened pulmonary markings in both lungs, which can be enhanced to extend into the middle and outer zones of lungs, in grid liked appearance that is more obvious in the dorsal segment of the lungs. (e) It is demonstrated to have clustering toxoplasma tachyzoites', 'hash': '78ad5a602c243399be530b578f5858d7393984c75f2f978c1dd02f12b26b8836'}, {'image_id': '313891_1_En_17_Fig99_HTML', 'image_file_name': '313891_1_En_17_Fig99_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig99_HTML.jpg', 'caption': '(a, b) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates enlarged right hilus, thickened and deranged lung markings. (b) Plain CT scanning demonstrates mass shadows in the right hilus, spots shadows in the right middle and lower lobes, and patchy shadows in the lingual segment of the left lung', 'hash': '996d2e340f8971525deb4ef2a9312fe4a696f4d7f6bf28ca091e8c767b96b1d4'}, {'image_id': '313891_1_En_17_Fig3b_HTML', 'image_file_name': '313891_1_En_17_Fig3b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig3b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy and scattered miliary increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of the lower lung field, with some fused in thin cloudy shadows', 'hash': '8c1d9dac035274e484303c9deb64a07fed7806c66acaf49b860164feb6d461fc'}, {'image_id': '313891_1_En_17_Fig70_HTML', 'image_file_name': '313891_1_En_17_Fig70_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig70_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window demonstrates a huge cavity shadow in the dorsal segment of the right lower lung, large nodular shadows in it, liquid gas level in the basal cavity, and the evenly thick wall. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates a huge cavity shadow in the dorsal segment of the left lung, multiple large nodular shadows in it, and involved pleura of the lateral chest wall', 'hash': '967426acae68b8d57372efde07d76dd6ad696b10cc5bb64fb67bd9af43a1b0c8'}, {'image_id': '313891_1_En_17_Fig108_HTML', 'image_file_name': '313891_1_En_17_Fig108_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig108_HTML.jpg', 'caption': 'HIV/AIDS related lymphoma. DR demonstrates widened upper middle mediastinum in a dense shadow, enlarged and thickened hilum, thickened and blurry pulmonary markings with diffuse ground glass liked changes', 'hash': '449c992b619237febe63b1617b26f78de511c69c5d1c86ddbd66631790a3e3ce'}, {'image_id': '313891_1_En_17_Fig18_HTML', 'image_file_name': '313891_1_En_17_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig18_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates multiple patchy shadows with increased density in both lungs which are more obvious in both middle and lower lungs. The hilar shadows in both lungs are enlarged, with sharp both costophrenic angles. (b–d) CT scanning demonstrates multiple patchy and mass liked parenchyma shadows in both lungs, ground glass density shadows in the apical segment of both upper lobes, transparent areas in the medial segment of the right middle lobe as well as in the lingual segment of the left upper lobe, and unobstructed trachea and bronchi', 'hash': '18239548bfc8a180d3460173e2f66f27c6ff38e464607d7ec3eb2a837a1382c9'}, {'image_id': '313891_1_En_17_Fig67b_HTML', 'image_file_name': '313891_1_En_17_Fig67b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig67b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows. (e–h) Reexamination of the pulmonary window after 3 months treatment demonstrates multiple scattered round liked nodular shadows and thick wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows which obviously increase and enlarge compared to previous lesions, with accompanying infiltration shadows around the lesions', 'hash': 'f70faec5b814f1fa9555182e0f5414a33838b2496e4da16dc69e0c237676eb30'}, {'image_id': '313891_1_En_17_Fig115a_HTML', 'image_file_name': '313891_1_En_17_Fig115a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig115a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lung cancer. (a–f) CT scanning demonstrates diffuse soft tissue density shadows in left upper lung, round liked mass shadows in the middle lung field, thickened pleura in the lateral chest wall with adhesion, and strip liked liquid density shadows', 'hash': '08de7c80ca9fdc7641723bbb9689498f65631a1a2ee1f499cda653be3ea3d358'}, {'image_id': '313891_1_En_17_Fig40_HTML', 'image_file_name': '313891_1_En_17_Fig40_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig40_HTML.jpg', 'caption': '(a, b) HIV/AIDS related endobronchial tuberculosis. (a, b) Chest CT scanning demonstrates narrowed left major bronchus, irregular thickening of the brounchial wall, multiple irregular flaky, patchy and military shadows in the posterior apical, anterior and lingual segments of the left upper lung. Bronchobierscopy demonstrates narrowed left major bronchus, which is possibly caused by endobronchial tuberculosis', 'hash': '4e416b52d4cb1a2790ee8ad419d525b4e0b37740624cb136f4f5d66c98344651'}, {'image_id': '313891_1_En_17_Fig106b_HTML', 'image_file_name': '313891_1_En_17_Fig106b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig106b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related lymphoma. (a–b) DR demonstrates enlarged and thickened left hilum in a huge mass shadow. High KV demonstrates a huge mass shadow in the hilum. (c–h) CT scanning of the pulmonary window demonstrates a huge high density mass shadow in the left hilum, surrounding nodular fusion shadows in the lung tissues. CT scanning of the mediastinal window demonstrates a huge high density mass shadow in the left hilum, with air bronchogram sign in the shadow', 'hash': '157c65f2ce36513c7bad3d16abf703fde23671a6d95e1da5b62342efd5b516bb'}, {'image_id': '313891_1_En_17_Fig75a_HTML', 'image_file_name': '313891_1_En_17_Fig75a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig75a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval or sphere shaped nodular shadows in the cavities with smooth boundaries. (e, f) Reexamination after treatment demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval nodular shadows in the cavity with smooth boundaries. Compared to the previous imaging findings, the lesions are shrunk, with improved surrounding infiltration', 'hash': 'd2c91d61cbf8a801eed1951a78b54e9b966e9be37aee83d7582af7a496143832'}, {'image_id': '313891_1_En_17_Fig66b_HTML', 'image_file_name': '313891_1_En_17_Fig66b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig66b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates large flaky shadows with increased density in the right upper lung, with blurry boundaries; round liked or sphere shaped mass shadows in the right lower lung, with uneven density. (b–e) CT scanning of the pulmonary window demonstrates multiple round liked thick-wall cavities in the dorsal segment of the right lower lung, with small nodular shadow adhering on the cavity wall; and surrounding small nodular shadows and infi ltration shadows. (f, g) Coronal CT scanning reconstruction demonstrates a huge thick-wall cavity in the right upper lung, with irregular thickness of the wall; round liked cavity shadows in the right lower lung, with thick and multilocular walls; and flaky shadows with increased density in the outer zone of the left lower lung', 'hash': 'fe0cc9e767d47fe24d043db5792869e260b44f40097a6c4d26c923e91ef70b0b'}, {'image_id': '313891_1_En_17_Fig98a_HTML', 'image_file_name': '313891_1_En_17_Fig98a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig98a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates thickened lung markings in both lungs, which extend to the outer zone of the lungs. (b) DR demonstrates thickened and deranged lung markings in both lungs with nodular blurry shadows; and cloudy shadows in lung fields. (c, d) CT scanning demonstrates thickened lung markings in both lungs, with diffuse nodular shadows; and cloudy changes in lung fields. (e) HE staining demonstrates cytomegalovirus inclusions', 'hash': 'adcabf812efa2a551bb7a968e7cf0afcc7677ffb9adf3d1a40a65675496e4552'}, {'image_id': '313891_1_En_17_Fig50_HTML', 'image_file_name': '313891_1_En_17_Fig50_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig50_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Staphylococcus aureus pneumonia. (a) DR demonstrates large flaky dense shadow in the right middle-upper lung field, with blurry boundary. (b, c) CT scanning demonstrates large flaky dense shadow in the right middle upper lung field, with blurry boundary. (d, e) CT scanning demonstrates large flaky dense shadow in the right middle upper lung field, with cystic transparent area in it. (f) Reexamination demonstrates obviously improved pulmonary lesions in the right lung after anti-bacteria treatment for 3 weeks', 'hash': 'bb5e00f8d7a7c6c4308ca4e5024daa75df1bf9a0a88359faa7e2ee91a6c5f156'}, {'image_id': '313891_1_En_17_Fig114a_HTML', 'image_file_name': '313891_1_En_17_Fig114a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig114a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related Kaposi’s sarcoma. (a–d) CT scanning demonstrates scattered cloudy mass and flakes liked or nodular shadows with increased density in both lungs with uneven density and unclear boundaries, fusion and parenchymal changes of some lesions, more lesions in the lower lobe of both lungs and mostly with parenchymal changes. (e, f) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large and thick stained nucleoli, which are in line with the manifestations of Kaposi’s sarcoma. (g, h) Immunohistochemical demonstrates positive of C3 and C4', 'hash': '5d7437deda7758de05e56f8172703b4659fa4eeebdc50c92456867e7bfdb2691'}, {'image_id': '313891_1_En_17_Fig107b_HTML', 'image_file_name': '313891_1_En_17_Fig107b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig107b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related lymphoma. (a–e) CT scanning of the pulmonary and mediastinal windows demonstrates multiple round liked nodular shadows with increased density in both lung fields, with clear boundaries; large soft tissue mass shadows in the right lower lung, with slightly lobulated boundaries and spikes. (f–i) CT scanning of the pulmonary and mediastinal windows for reexamination after radiation therapy demonstrates shrinkage of intrapulmonary nodules and masses', 'hash': 'a7c148d3f71f853c603d1730a516c4b571960bd1e6296b96b6418a73f3663e33'}] | {'313891_1_En_17_Fig1_HTML': ['By naked eyes observation, there are extensive and diffuse invasion of lungs, which is soft like waterlogged sponge and in milky white with black spots. The filled foamy substance in the alveoli and bronchioles is a mixture of necrotic fungus and immunoglobulin. The alveolar septum has infiltration of plasma cells and lymphocytes, resulting in thickened alveolar septa up to 5–20 times as the normal thickness that occupy 3/4 of the entire lung volume. The cysts are firstly located in the macrophage cytoplasm of the alveolar septa. Subsequently, the alveolar cells containing cysts sheds off into the alveolar space. After the rupture of the cystic wall, sporozoite is discharged to turn into free trophozoites, which gains its access into the alveolar space. The alveolar exudates include plasma cells, lymphocytes and histocytes (Fig. <xref rid="313891_1_En_17_Fig1_HTML" ref-type="fig">17.1a–c</xref>).\n).\nFig. 17.1(a) Gross specimens’ observation demonstrates foamy liquid filling in the lung tissues. (b) HE demonstrates pneumocystis in the alveolar exudates, which can be stained black by silver methenamine staining, ×400. (c) HE demonstrates the foamy substance in the alveolar space, ×400\n'], '313891_1_En_17_Fig19_HTML': ['If the necrotic lesions erode the blood vessels, tubercle bacilli can cause systemic miliary tuberculosis along with blood flow, including brain, bones and kidneys. Large quantity sputum containing tubercle bacilli gains its access into the gastrointestinal tract. It can also cause intestinal tuberculosis and peritoneal tuberculosis. Pulmonary tuberculosis can cause tuberculosis pleurisy via direct spreading to the pleura (Fig. <xref rid="313891_1_En_17_Fig19_HTML" ref-type="fig">17.19a–c</xref>).\n).\nFig. 17.19(a) Gross observation in autopsy demonstrates disseminated pulmonary tuberculosis, with grayish white military nodules in diffuse distribution in the lung tissues section. (b) It is demonstrated that mycobacteriumavium-intracellularcomplex infection in the lung tissue, with atypical tuberculosis nodules and acid-fast staining positive (left top). There are a subnodular giant cell, eosinophilic inclusion bodies in the nucleus and bradyzoites in cytoplasm of T. gondii. HE\u2009×\u2009100. (c) HE demonstrates mycobacteriumavium-intracellularcomplex infection, with atypical tuberculosis nodular changes, HE\u2009×\u2009200\n'], '313891_1_En_17_Fig45_HTML': ['Pneumonia caused by inhaled staphylococcus aureus through the respiratory tract often shows lesions in the large lobes or extensive fusion of bronchopneumonia lesions. Bronchial and alveolar rupture allows gas to enter the pulmonary interstitium, which is communicated with the bronchi. In the cases of bronchiolar blockage by necrotic tissues or pus, the one-way valve effect is formed to cause tension pulmonary emphysema. In the cases with superficial pulmonary emphysema with excessively high tension, it ruptures to form pneumothorax or pyopneumothorax, as well as bronchooleural fistula (Fig. <xref rid="313891_1_En_17_Fig45_HTML" ref-type="fig">17.45a, b</xref>).\n).\nFig. 17.45(a, b) HIV/AIDS related Staphylococcus aureus pneumonia. (a) Gross specimen observation demonstrates bilateral purplish brown lesions, patchy white infiltration at the base of the lungs. (b) HE staining demonstrates alveolar diffuse lesions, exudation of the serous fluid and inflammatory cells in the alveolar cavity, and alveolar wall congestion\n'], '313891_1_En_17_Fig64_HTML': ['Aspergillus commonly violates bronchus and lung, with involvements of rhinal sinuses, external auditory canal, eye and skin. Otherwise, it disseminates to organs of the body along with blood flow. The early lesions are diffuse infiltrative and exudative changes. And advanced lesions are necrosis, pyogenesis or granuloma. Large quantity hyphae can be found in the lesions. The hyphae penetrate the blood vessels to cause vasculitis, perivascular inflammation and thrombosis. And thrombosis can cause ischemia and necrosis of the tissue. According to the pathological changes and imaging findings, it can be divided into three major types: vascular invasion type, bronchopneumonia type and allergic bronchopulmonary aspergillosis type. (1) The vascular invasion type is the result caused by toxins released in the process of aspergillus spreading extensively from the primary focus to the lungs. Vascular infiltration of the pulmonary parenchyma and coagulative necrosis are believed to be the cause of vascular occlusion and pulmonary infarction. (2) Bronchopneumonia type is acute bronchitis caused by inhalation of Aspergillus spores. In the cases of hyphae invasion into the lung tissues, extensive infiltrative pneumonia or focal granuloma are resulted in. It can also cause necrosis, pyogenesis and multiple small abscesses. Spherical pulmonary aspergillosis is often secondary to bronchiectasis, tuberculosis, carcinous cavity and other lung diseases. Mycelia multiply and gather in the cavities of the lungs to form a spherical mass with fibrin and mucosal cells, which are called aspergillar glomera, which do not invade the lung tissue. (3) Allergic bronchopulmonary aspergillosis type is the proliferation and germination of inhaled Aspergillus spore in the airway, often showing obvious related mucosal lesions and eventually resulting in bronchiectasis (Fig. <xref rid="313891_1_En_17_Fig64_HTML" ref-type="fig">17.64a–c</xref>).\n).\nFig. 17.64(a) Gross observation demonstrates dark brown lungs in appearance. (b, c) Thology demonstrates hemorrhage and edema of the lung tissue and focal necrosis, with large quantity Aspergillus hyphae and spores in the surrounding area of the necrosis (Combined with pulmonary CMV infection)\n'], '313891_1_En_17_Fig77_HTML': ['In the early stage of cryptococcal infection, only a mild inflammatory reaction or diffuse infiltrative exudative changes occur. But in the advanced stage, necrosis, suppuration or granuloma is formed. Large quantity hyphae can be found in the focus. In the cases with hyphae penetrating the blood vessels, vasculitis, perivascular inflammation and thrombosis occur. And thrombosis leads to ischemia and necrosis of the tissue (Fig. <xref rid="313891_1_En_17_Fig77_HTML" ref-type="fig">17.77</xref>).\n).\nFig. 17.77HE staining demonstrates isseminated cryptococci, the Cryptococcus is stained red after mucin carmine staining of cryptococcus neoformans spores in lungs, (HE\u2009×\u2009200)\n'], '313891_1_En_17_Fig97_HTML': ['Cytomegalovirus pneumonia has extensive pathological changes in the lungs. Pathologically, it shows interstitial pneumonia, with the lesions randomly blood borne distributing in the lungs. The distribution can be diffuse, panlobular or focal. The target cells of pathological changes include alveolar cells and macrophages. Diffused pulmonary interstitial edema and fibrosis as well as alveolar swelling, focal necrosis, bleeding and hyperplasia occur after CMV infections to cause hypoxemia. Gross observation of fresh specimens demonstrates pulmonary surface edema and flaky blooding spots. Fixed specimens demonstrate brown hard lung tissues. Under a microscope, pulmonary interstitial congestion as well as infiltration of lymphocytes and mononuclear cells can be found, with the involved epithelial cells enlarged. In the pulmonary interstitium and alveoli, there are intranuclear inclusions, cytoplasmic inclusions and fluid containing abundant proteins. The classical intranuclear inclusions can be found in the cells, purplish red or purplish blue, round or oval, with surrounding halos in eagle eyes sign. Atypical cytomegalic inclusions in cells are slender, long and round liked with abundant cytoplasm and accentric nucleolus, which are blurry, unclear and atypical (Fig. <xref rid="313891_1_En_17_Fig97_HTML" ref-type="fig">17.97a–e</xref>). Immunohistochemitry demonstrates HIV P24 antigen positive.\n). Immunohistochemitry demonstrates HIV P24 antigen positive.\nFig. 17.97(a) Gross observation of the fresh specimen in autopsy demonstrates pulmonary edema and congestion of cytomegalovirus pneumonia. (b) Gross observation of the formalin fixed specimen in autopsy demonstrates dark brown hard pulmonary tissues. (c, d) HE staining demonstrates large quantity cytomegalovirus inclusions in eagle eyes sign. (e) Immunohistochemical demonstrates HIV P24 antigen positive in macrophages of lung tissues (×400)\n']} | HIV/AIDS Related Respiratory Diseases | [
"HIV/AIDS related pneumocystis carnii pneumonia (PCP)",
"HIV/AIDS related pulmonary bacterial infections",
"HIV/AIDS related pulmonary fungal infections",
"HIV/AIDS related pulmonary virus infections",
"HIV/AIDS related pulmonary parasitic diseases",
"HIV/AIDS related pulmonary neoplasm"
] | None | 1380524400 | None | null | other | PMC7121050 | null | null | [
""
] | Radiology of HIV/AIDS. 2013 Sep 30;:377-535 | NO-CC CODE |
|
(a, b) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the medial basal segment of the right lower lung, irregular nodular shadows in the cavities, and surrounding fused miliary infiltration shadows | 313891_1_En_17_Fig69_HTML | 7 | db839a28accf7944530e9940a7c7afb2b7b3c7a4423308b863fae87f0c08c29a | 313891_1_En_17_Fig69_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
782,
293
] | [{'image_id': '313891_1_En_17_Fig115b_HTML', 'image_file_name': '313891_1_En_17_Fig115b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig115b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lung cancer. (a–f) CT scanning demonstrates diffuse soft tissue density shadows in left upper lung, round liked mass shadows in the middle lung field, thickened pleura in the lateral chest wall with adhesion, and strip liked liquid density shadows', 'hash': '37ffef88f4c6dffdd2849b9994419efe1bf8f369ad111d82071f2f004a9fa43f'}, {'image_id': '313891_1_En_17_Fig106a_HTML', 'image_file_name': '313891_1_En_17_Fig106a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig106a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related lymphoma. (a–b) DR demonstrates enlarged and thickened left hilum in a huge mass shadow. High KV demonstrates a huge mass shadow in the hilum. (c–h) CT scanning of the pulmonary window demonstrates a huge high density mass shadow in the left hilum, surrounding nodular fusion shadows in the lung tissues. CT scanning of the mediastinal window demonstrates a huge high density mass shadow in the left hilum, with air bronchogram sign in the shadow', 'hash': '1ff6a74f6517ed666fda8da1eb38cd58b7d92c3687c533350df4caf4cb7ba7d7'}, {'image_id': '313891_1_En_17_Fig67a_HTML', 'image_file_name': '313891_1_En_17_Fig67a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig67a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows. (e–h) Reexamination of the pulmonary window after 3 months treatment demonstrates multiple scattered round liked nodular shadows and thick wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows which obviously increase and enlarge compared to previous lesions, with accompanying infiltration shadows around the lesions', 'hash': '75b2dd5456ce09da0ace0b9787ea5a36d49c80e174314762343564032297b51c'}, {'image_id': '313891_1_En_17_Fig14_HTML', 'image_file_name': '313891_1_En_17_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig14_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, mass and flakes of parenchymal shadows in the posterior segment of the right upper lobe and in the dorsal segment of both lower lobes which is more obvious in the right lung, and bronchial shadows in them', 'hash': 'bc4343d2071f380a05855c1e658dc05d90d8ae123e988cfe12c3e65526b3336c'}, {'image_id': '313891_1_En_17_Fig104_HTML', 'image_file_name': '313891_1_En_17_Fig104_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig104_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymphoid interstitial pneumonia. (a–f) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs in reticular appearance, with accompanying multiple small nodular shadows, fusion of some nodules into flaky shadows, and ground glass liked changes in the lung fields', 'hash': '4883f041ed6e05ad0ce9ee6734fea4171aae151209ba36cbce94c8434c86f174'}, {'image_id': '313891_1_En_17_Fig98b_HTML', 'image_file_name': '313891_1_En_17_Fig98b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig98b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates thickened lung markings in both lungs, which extend to the outer zone of the lungs. (b) DR demonstrates thickened and deranged lung markings in both lungs with nodular blurry shadows; and cloudy shadows in lung fields. (c, d) CT scanning demonstrates thickened lung markings in both lungs, with diffuse nodular shadows; and cloudy changes in lung fields. (e) HE staining demonstrates cytomegalovirus inclusions', 'hash': '489286db9d367c09fbc842e4d1ba093d9caa6ded75760e9e1a70e05a86f43979'}, {'image_id': '313891_1_En_17_Fig53_HTML', 'image_file_name': '313891_1_En_17_Fig53_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig53_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) Anteroposterior and lateral DR demonstrates enlarged and thickened left hilum, and large flaky blurry shadows with increased density in the left lower lung. (c, d) Reexamination demonstrates normal lungs after antibiotic treatment', 'hash': 'd9cd861c21f1100d02e20014901c7e4a9a9bcad2e4ddcd3c731b50168d8782be'}, {'image_id': '313891_1_En_17_Fig114b_HTML', 'image_file_name': '313891_1_En_17_Fig114b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig114b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related Kaposi’s sarcoma. (a–d) CT scanning demonstrates scattered cloudy mass and flakes liked or nodular shadows with increased density in both lungs with uneven density and unclear boundaries, fusion and parenchymal changes of some lesions, more lesions in the lower lobe of both lungs and mostly with parenchymal changes. (e, f) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large and thick stained nucleoli, which are in line with the manifestations of Kaposi’s sarcoma. (g, h) Immunohistochemical demonstrates positive of C3 and C4', 'hash': '586be9acfd2434fad0db1a2ffaba9ac72eb8eb799b76acdaeac2730c48c45020'}, {'image_id': '313891_1_En_17_Fig107a_HTML', 'image_file_name': '313891_1_En_17_Fig107a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig107a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related lymphoma. (a–e) CT scanning of the pulmonary and mediastinal windows demonstrates multiple round liked nodular shadows with increased density in both lung fields, with clear boundaries; large soft tissue mass shadows in the right lower lung, with slightly lobulated boundaries and spikes. (f–i) CT scanning of the pulmonary and mediastinal windows for reexamination after radiation therapy demonstrates shrinkage of intrapulmonary nodules and masses', 'hash': '4ca6acd1461c3d7b80869d7d33bd1a3d91ecd1a0dc1b5c7baecc0bfbcf817449'}, {'image_id': '313891_1_En_17_Fig75b_HTML', 'image_file_name': '313891_1_En_17_Fig75b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig75b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval or sphere shaped nodular shadows in the cavities with smooth boundaries. (e, f) Reexamination after treatment demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval nodular shadows in the cavity with smooth boundaries. Compared to the previous imaging findings, the lesions are shrunk, with improved surrounding infiltration', 'hash': 'b1a96158009afcb5e673cf31f9243ca598c763c294bbdc7479a918fb36b031e8'}, {'image_id': '313891_1_En_17_Fig25d_HTML', 'image_file_name': '313891_1_En_17_Fig25d_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25d_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '1e7425ad1ac60b1c612434d02bbe7d48ba0fb82e0642b09b8771b4fea9a7a4c2'}, {'image_id': '313891_1_En_17_Fig66a_HTML', 'image_file_name': '313891_1_En_17_Fig66a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig66a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates large flaky shadows with increased density in the right upper lung, with blurry boundaries; round liked or sphere shaped mass shadows in the right lower lung, with uneven density. (b–e) CT scanning of the pulmonary window demonstrates multiple round liked thick-wall cavities in the dorsal segment of the right lower lung, with small nodular shadow adhering on the cavity wall; and surrounding small nodular shadows and infi ltration shadows. (f, g) Coronal CT scanning reconstruction demonstrates a huge thick-wall cavity in the right upper lung, with irregular thickness of the wall; round liked cavity shadows in the right lower lung, with thick and multilocular walls; and flaky shadows with increased density in the outer zone of the left lower lung', 'hash': 'efec688fc6d0fd9fc9188edcc4a4bb040754e9c9e3261fcacec068f3bfd0252f'}, {'image_id': '313891_1_En_17_Fig63_HTML', 'image_file_name': '313891_1_En_17_Fig63_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig63_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Rhodococcus equi pneumonia. (a) Pulmonary CT scanning demonstrates a mass shadow in the lateral segment of the right middle lobe in size of 4.7\u2009×\u20093.7\u2009×\u20093.2 cm with uneven density and lace liked boundary, and small bubbles shadows in it. By both sputum culture and lung tissue culture, Rhodococcus equi can be detected. (b, c) Pathological biopsy and HE staining demonstrate inflammatory pseudotumor. (d, e) Immunohistochemistry demonstrates Rhodococcus equi antibody positive. (f) Reexamination after treatment demonstrates obvious shrinkage of the original lung lesions', 'hash': 'ac97b316499d751a48d8b861962da376a39c7ff11d2554ed957c226224dc65b6'}, {'image_id': '313891_1_En_17_Fig2a_HTML', 'image_file_name': '313891_1_En_17_Fig2a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig2a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered miliary increased density shadows in both lungs, with even size, density and distribution. The shadows of both hila are dense, with sharp both costophrenic angles. (b–f) CT scanning demonstrates scattered miliary nodular shadows in both lungs, which is more obviously in the middle pulmonary strip and with quite even size and density. Trachea and bronchi are unblocked', 'hash': 'ec4f2f75b5bb59b2cb13f016c2ea6714bdc3c908077c2697af2218aa485876b7'}, {'image_id': '313891_1_En_17_Fig13a_HTML', 'image_file_name': '313891_1_En_17_Fig13a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig13a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, transparent areas in them and unblocked trachea and bronchi', 'hash': '7d26c2f94a34f3ff7c4f64d485fe29e114936d0f4db53489ee88148a1a6fc8bf'}, {'image_id': '313891_1_En_17_Fig65a_HTML', 'image_file_name': '313891_1_En_17_Fig65a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig65a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related allergic pulmonary Aspergillus infection. (a–f) CT scanning of the pulmonary window demonstrates thickened central pulmonary markings in both lungs, which is turtuous and deranged with fingertip infiltration shadows. (g) DR demonstrates hyperinflation of the right lung, increased and thickened pulmonary markings and ground glass liked shadows with increased density in the right lower lung and left lung lobe', 'hash': '6fa5ade163d7465c0dc3eb89ebc58d57b98674fc2680824cc5a81c478b81fbc4'}, {'image_id': '313891_1_En_17_Fig76b_HTML', 'image_file_name': '313891_1_En_17_Fig76b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig76b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning demonstrates diffuse scattered thin ground glass liked, patchy, flaky blurry shadows and cords liked shadows in both lungs, with blurry boundaries and uneven density; scattered nodular shadows in different sizes; more lesions in both upper lobes and the right middle lobe; flaky parenchyma shadows in the apical and posterior segments of right upper lobe, with air bronchogram sign in them; unobstructed opening of bronchi as well as lobar and segmental bronchi without stenosis and obstruction; lymphadenectasis in the right hilar region; detected Aspergillus fumigatus by sputum culture. (e, f) Culture for 72 h, lactic acid gossypol blue staining and microscopic observation at ×200 and ×400 demonstrate short column liked conidial head, smooth wall of conidiophores, flask-shaped top capsule and monolayer microconidiophores. (g) Culture in Paul’s medium demonstrates dark green colored colonies', 'hash': 'af925cb00cbd4eed9e67dc49fd012909ecdfe48493ac645d8b2185eb4f351655'}, {'image_id': '313891_1_En_17_Fig105a_HTML', 'image_file_name': '313891_1_En_17_Fig105a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig105a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary toxoplasmosis. (a–d) CT scanning demonstrates thickened pulmonary markings in both lungs, which can be enhanced to extend into the middle and outer zones of lungs, in grid liked appearance that is more obvious in the dorsal segment of the lungs. (e) It is demonstrated to have clustering toxoplasma tachyzoites', 'hash': '30f16a35256e45c89dfcd68adf661507960a5b978db88cc531a7605d9fff53df'}, {'image_id': '313891_1_En_17_Fig95_HTML', 'image_file_name': '313891_1_En_17_Fig95_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig95_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a) CT scanning of the pulmonary window demonstrates irregular large flaky shadows with increased density in the dorsal segment of both lower lobes; enlarged hilum in both lungs, cords liked thickening of the vascular vessels. (b) CT scanning of the mediastinal window demonstrates flaky parenchyma shadows in the left lower lung, thickening of both pleura, enlarged hilum shadows in both lungs, thickened right lower bronchial wall. (c) Microscopy after culture at 25 °C demonstrates branches and separated hyphae and its string of small spores, with typical penicillus but no sporangium (Medan staining, ×400). (d) Bone marrow smear demonstrates round or oval cells like the yeast phase within the macrophages; longer cells like the yeast phase outside the macrophages. The two kinds of cells have slightly curved ends in sausages liked appearance (HE staining, ×400)', 'hash': '636de07e02ba7cf1f73f2a03bccf4fdaac68bc4a122b7fbfe2febe72dd42f139'}, {'image_id': '313891_1_En_17_Fig3a_HTML', 'image_file_name': '313891_1_En_17_Fig3a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig3a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy and scattered miliary increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of the lower lung field, with some fused in thin cloudy shadows', 'hash': 'e655c40874d38beaa8a8e9f0e82c1eb12a6756b09bee559229354b3756010a18'}, {'image_id': '313891_1_En_17_Fig73_HTML', 'image_file_name': '313891_1_En_17_Fig73_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig73_HTML.jpg', 'caption': '(a–c) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates diffuse dense shadows in both lower lung fields which is in a arcuate surface with exterior high and interior low (pleural effusion). (b, c) CT scanning of the mediastinal window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavities; thickened pleura of the lateral chest wall, with accompanying encapsulated effusion', 'hash': '9ad36ea5213bea731770658b27be87e1af9e34bced02cda664a7f485e40f2315'}, {'image_id': '313891_1_En_17_Fig54_HTML', 'image_file_name': '313891_1_En_17_Fig54_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig54_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates round liked large flaky shadows with increased density in the left lower lung, enlarged and thickened hilus. (c, d) DR reexamination after treatment demonstrates flocculent shadows in the left lower lung, with improved conditions than previous findings before treatment (a, b)', 'hash': 'f9b4f22920ef55d9110380df6f64a6a508ecea9ca3192877a2d47400e781c58d'}, {'image_id': '313891_1_En_17_Fig58b_HTML', 'image_file_name': '313891_1_En_17_Fig58b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig58b_HTML.jpg', 'caption': '(a–i) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) CT scanning of the pulmonary window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (c, d) CT scanning of the mediastinal window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, pulmonary atelectasis and pleural effusion, with ventilation shadows in them. (e) CT scanning of the pulmonary window after the treatment demonstrates absence of the mass shadows in the left lower lung with transverse stripes shadows, obviously improved than previous findings (a, b). (f) HE staining demonstrates thickened alveolar septa and exudates from the alveolar cavity. (g) HE staining demonstrates massive bleeding in the alveolar cavity, large quantity erythrocytes and intact cell walls. (h) HE staining demonstrates phagocytized basophilic granules in the leukocytes. (i) HP staining demonstrates purplish red Rhodococcus equi in a shape of crescent in orange red sputum', 'hash': 'ca8456a79f660fc4faa5eb9342f84a14bbe25eedd8fb237ac65bd96b8de6e5b9'}, {'image_id': '313891_1_En_17_Fig25c_HTML', 'image_file_name': '313891_1_En_17_Fig25c_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25c_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '64e0ceda545f1684d11c717eef852c6576036d711540954850cc018aadfefa87'}, {'image_id': '313891_1_En_17_Fig44_HTML', 'image_file_name': '313891_1_En_17_Fig44_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig44_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary nontuberculous mycobacterial infection. (a–d) CT scanning demonstrates multiple cavities in the left lung field, bilateral multiple lobular central nodules and extensive branches liked linear shadows in tree buds sign. There are also large flaky parenchymal changes of the lung tissues in the left lower lung field in high density shadows, with accompanying air bronchogram sign. (e) HE staining demonstrates avium intracellular complex mycobacteria infection of lung tissues in atypical tuberculous nodular changes. (HE\u2009×\u2009200)', 'hash': '8f8697761c60c3cb27c0b413c2e19433df26ba07a74ea0a0cc0b6f2b4acc7b65'}, {'image_id': '313891_1_En_17_Fig103_HTML', 'image_file_name': '313891_1_En_17_Fig103_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig103_HTML.jpg', 'caption': '(a–d) HIV/AIDS related lymphoid interstitial pneumonia. (a–d) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs, in reticular appearance; with accompanying multiple small nodular shadows', 'hash': '8d52c3bac6fb07e3eaf12386767e159f762db3072e09365be542c937697babe7'}, {'image_id': '313891_1_En_17_Fig110b_HTML', 'image_file_name': '313891_1_En_17_Fig110b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110b_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '5526a48dae3face516d842ba229b164bac3062f56c5e811bb1e725778fd20823'}, {'image_id': '313891_1_En_17_Fig5a_HTML', 'image_file_name': '313891_1_En_17_Fig5a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig5a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates patchy shadows with increased density in both lungs, with thickened hilar shadows in both lungs. (b–g) CT scanning demonstrates flaky ground glass liked density shadows in upper lungs and dorsal segment of both lungs, which is more obvious in the middle inner strips. There are extrapulmonary stripes transparent shadows, with some bronchial walls thickened and enlarged hilar shadows in both lungs', 'hash': '5d6ab0400e0331b0fcb3a3679023a44fa81b7b9c9eedc00c0ddb6d85208c3512'}, {'image_id': '313891_1_En_17_Fig74_HTML', 'image_file_name': '313891_1_En_17_Fig74_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig74_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates round liked uneven density shadows in the medial segments of both middle and lower lungs, multilocular hollow holes in the cavities, surrounding multiple round liked thick-wall small cavity shadows and ground grass liked infiltration shadows. (b–d) CT scanning of the pulmonary window demonstrates scattered round liked uneven density shadows in the right hilum and lower lung, multilocular hollow holes in the cavities; and surrounding multiple round liked thick-wall small cavity shadows and ground grass liked infiltration shadows', 'hash': 'e4c42cc0cb1f1bdfa8b2cc1f3c8eab7223c4be368a808e8b6c4b01af78dfb04a'}, {'image_id': '313891_1_En_17_Fig23_HTML', 'image_file_name': '313891_1_En_17_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig23_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymph node tuberculosis. (a–c) CT scanning of the pulmonary window demonstrates dense mass shadow beside the right aortic arch, and thinner right bronchus due to compression. (d–f) CT scanning of the mediastinal window demonstrates low density mass shadow besied the right aortic arch with clear boundary', 'hash': '8d135ce7e96005006343dc3305be0f8c77d0828bccccf1726226c09fd47c365f'}, {'image_id': '313891_1_En_17_Fig6a_HTML', 'image_file_name': '313891_1_En_17_Fig6a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig6a_HTML.jpg', 'caption': '(a-d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates flaky ground glass liked density shadows in upper lobes of both lungs, with bronchial shadows in them; flaky parenchymal shadows in the subpleural apical segment; and thickened bronchial walls in the anterior and posterior segments of the right upper lobe', 'hash': '235548456c9bf72727a05a91fa6893d8a478f8f715c022d6b579d4a9188da366'}, {'image_id': '313891_1_En_17_Fig17a_HTML', 'image_file_name': '313891_1_En_17_Fig17a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig17a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchymal shadows and fibrous cords liked shadows in both lungs which are more obvious in both lower lungs. The trachea and bronchi are unblocked, with enlarged hilar shadows in both lungs', 'hash': '9c1c59095291dcf6a7b6dec786ec58ba44e9b83badfe4bbf121b7c677476f4d5'}, {'image_id': '313891_1_En_17_Fig113b_HTML', 'image_file_name': '313891_1_En_17_Fig113b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig113b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Kaposi’s sarcoma. (a–d) Chest CT scanning demonstrates scattered cloudy, mass and flake liked or nodular shadows with increased density. (e) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large thick stained nucleoli, which are in line with the diagnosis of Kaposi’s sarcoma. (f–i) Cured HIV/AIDS related Kaposi’s sarcoma. (f–i) Reexamination after treatment demonstrates absent lesions in both lungs, with clear lung fields', 'hash': '88e574b2d5ff4ee4ce28f38025d5345c8cf6b50386f752ae12083b05fe7af9de'}, {'image_id': '313891_1_En_17_Fig82_HTML', 'image_file_name': '313891_1_En_17_Fig82_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig82_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a, b) DR demonstrates enlarged blurry hilum in both lungs and thickened pulmonary markings. (c, d) CT scanning demonstrates mediastinal lymphadenectasis, narrowed trachea due to compression with liquefactive necrosis. Enhanced scanning demonstrates marginal enhancement and no central enhancement', 'hash': '18312183daaefbc6c48e05e67fab210a1109c24a6f94311ffb11ffdace007a49'}, {'image_id': '313891_1_En_17_Fig64_HTML', 'image_file_name': '313891_1_En_17_Fig64_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig64_HTML.jpg', 'caption': '(a) Gross observation demonstrates dark brown lungs in appearance. (b, c) Thology demonstrates hemorrhage and edema of the lung tissue and focal necrosis, with large quantity Aspergillus hyphae and spores in the surrounding area of the necrosis (Combined with pulmonary CMV infection)', 'hash': '104850f2999da711317f4e4f07e590bd8f73a93731daf090ece6023192606e90'}, {'image_id': '313891_1_En_17_Fig7a_HTML', 'image_file_name': '313891_1_En_17_Fig7a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig7a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates diffusely distributed shadows with increased density in both lungs that is more obvious in the middle and lower lungs. The hilar shadows in both lungs are enlarged. Both diaphragmatic surfaces and phrenic angles are blurry. (b–d) CT scanning demonstrates flaky shadows with increased density in both lungs, with parenchymal shadows in the lingular segment of left upper lobe and in the dorsal segments of both lower lobes and bronchial shadows in them. There are also thickened bronchial walls and enlarged hilar shadows in both lungs', 'hash': '431aab0770a1915c719095cc2bab91736f1ffda7b5649cdca5d8b7516003049c'}, {'image_id': '313891_1_En_17_Fig33_HTML', 'image_file_name': '313891_1_En_17_Fig33_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig33_HTML.jpg', 'caption': '(a, b) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates scattering patchy and cords liked blurry density shadows in the right middle and upper lung fields as well as enlarged and thickened hilum. (b) DR demonstrates that the lungs lesions are almost absent compared to (a), after anti-TB treatment for 5 months', 'hash': 'e710598bbbc8286721136f2a803716198a712c55253c4232d3ee33b2e33e188b'}, {'image_id': '313891_1_En_17_Fig62_HTML', 'image_file_name': '313891_1_En_17_Fig62_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig62_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) Anteroposterior and lateral DR demonstrates huge sphere liked mass shadow in the right hilum, with cavities shadows and liquid gas level in it. (c) HE staining demonstrates bleeding in the lung tissues and aggregation of large quantity lymphocytes. (d) Masson staining demonstrates branches liked purplish red Rhodococcus equi', 'hash': '261a4aca9e146cc16957c6280cd4795d7c2c5732d9a19006b6e398a1ae410af0'}, {'image_id': '313891_1_En_17_Fig84_HTML', 'image_file_name': '313891_1_En_17_Fig84_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig84_HTML.jpg', 'caption': '(a, b) HIV/AIDS related pulmonary cryptococcus infection. (a) CT scanning demonstrates round liked cavity shadows in the left upper and lower lung, with uneven thickness of the cavity wall and surrounding infiltrative shadows. (b) CT scanning demonstrates round liked dense mass shadows in the right upper lung, with clear boundaries and bulky drainage vessel shadows', 'hash': 'ecc614167ec536dcb80c2739886c957ff2f182dd49ac7f4d6379260497262e60'}, {'image_id': '313891_1_En_17_Fig4_HTML', 'image_file_name': '313891_1_En_17_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig4_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy or ground glass liked increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of lower lungs, with some fused into thin cloudy ground glass liked shadows with increased density, with decreased transparency of both lungs and enlarged hilar shadows in both lungs', 'hash': '636f9fd3d3c20c17e15e1ac70adcdcb6fbe268a70ac64d29317f73045747e226'}, {'image_id': '313891_1_En_17_Fig46a_HTML', 'image_file_name': '313891_1_En_17_Fig46a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig46a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates large flaky dense shadows in the middle-outer zone of the left middle lung field, and narrowed left bronchus. (d–f) CT scanning demonstrates large flaky shadows with uneven density in the left lateral chest wall and even lower density shadow in them', 'hash': 'afdfc2c33070f1d3b8616a542d989e0f908d9638327227057dfdf5ed59169359'}, {'image_id': '313891_1_En_17_Fig72_HTML', 'image_file_name': '313891_1_En_17_Fig72_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig72_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and cavity shadows in both lungs, with even wall thickness and small nodular shadows in some cavities', 'hash': 'd318b47b9b56854b6bc47081b08712ee9d828a2ae4592aa69451ec7105fd0240'}, {'image_id': '313891_1_En_17_Fig91b_HTML', 'image_file_name': '313891_1_En_17_Fig91b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig91b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–e) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of some lesions into honeycomb likes cavity shadows or plaque liked dense shadows. (f–h) CT scanning demonstrates large thick-wall cavity shadows in the right lung, surrounding plaque and round liked small cavity shadows and inflammatory infiltrative shadows', 'hash': '6b3a934b89abf6f7e8c9593337c0c57fe44161bcbfc546c7e2a3cfa50539f91e'}, {'image_id': '313891_1_En_17_Fig8a_HTML', 'image_file_name': '313891_1_En_17_Fig8a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig8a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates large flaky parenchyma shadows in both lungs which is more obvious in the middle and lower lobes of both lungs. There are also enlarged hilar shadows in both lungs and sharp both costophrenic angles. (b–g) CT scanning demonstrates large flaky parenchyma shadows in concentric and symmetrical distribution, bronchial shadows in them and thickened bronchial walls', 'hash': '7c4f2f4f9120af70727cab6fc69637733e17e807575648a0257b5b03367da625'}, {'image_id': '313891_1_En_17_Fig42_HTML', 'image_file_name': '313891_1_En_17_Fig42_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig42_HTML.jpg', 'caption': 'HIV/AIDS related tuberculous pleuritis. DR demonstrates arch shaped dense shadows with higher exterior density and lower interior density in the left lower lung field and covered right edge of the heart', 'hash': 'f0dfdb1b349a42c7092daeeaef76a8b8762e134b40ae21a6144d9785b9ddcd02'}, {'image_id': '313891_1_En_17_Fig15_HTML', 'image_file_name': '313891_1_En_17_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig15_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy blurry shadows and fibrous cords liked shadows in both lungs which are more obvious in the middle inner parts of both lungs, with transparent areas in them. The bronchial walls are thickened', 'hash': '4d262b5c06f74783c1b6df1f8c9d8c7ecbf235faacd2f2e846544a3e11d88e8b'}, {'image_id': '313891_1_En_17_Fig92b_HTML', 'image_file_name': '313891_1_En_17_Fig92b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig92b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of the lesions in the right lung into plaque liked shadows with clear boundaries, and multiple round liked small cavity shadows and inflammatory infiltrative shadows in both lungs', 'hash': '4613e0bd8bbb013024b2335ae2f7fb1997dab5d93ee1c395c97035d6e7d37750'}, {'image_id': '313891_1_En_17_Fig52_HTML', 'image_file_name': '313891_1_En_17_Fig52_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig52_HTML.jpg', 'caption': '(a, b) HIV/AIDS related staphylococcus aureus pneumonia. (a, b) DR demonstrates diffuse scattered multiple thin-walled transparent areas in both lungs, increased and blurry pulmonary markings, and enlarged heart shadow in flask shape (pericardial effusion)', 'hash': 'b54d395f8405b646839c68cb58c1a811c70fb8c7337443d24b61bfcfa097f5b0'}, {'image_id': '313891_1_En_17_Fig56b_HTML', 'image_file_name': '313891_1_En_17_Fig56b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig56b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates huge round large flaky shadows with increased density in the left lower lung, enlarged and thickened hilum and covered right heart edge. (c, d) DR reexamination after treatment for 1 week demonstrates flocculent shadow in the left lower lung, improved than those before the treatment (a, b). (e) DR reexamination after treatment demonstrates flocculent liked shadows in the left lower lung, obviously improved than before the treatment (c, d)', 'hash': 'e5f534ed9282980e95aaa6bac04091762128cf3e5c46985b190278c5d6396558'}, {'image_id': '313891_1_En_17_Fig93b_HTML', 'image_file_name': '313891_1_En_17_Fig93b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig93b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates diffuse small cavity in honeycomb liked and infiltrative parenchyma shadows, with the hilum as the center to distribute bilaterally symmetric like butterfly wings; multiple honeycomb liked cavity shadows in both lungs. (e–h) CT scanning reexamination demonstrates large irregular thick-wall cavities in the right lung, surrounding scattering nodular, honeycomba liked and infiltrative shadows after anti-PM infection treatment for 3 months', 'hash': '904e5a590c601ab02150f8c2487bbfa6f0282c1eddd547624ce8c549472221d9'}, {'image_id': '313891_1_En_17_Fig51b_HTML', 'image_file_name': '313891_1_En_17_Fig51b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig51b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related staphylococcus aureus pneumonia. (a) Chest X-ray demonstrates large flaky high density shadow in the left middle-lower lung field, with central transparent areas in different sizes and blurry boundaries; parenchyma changes of the left lower lung, predominantly in the posterior and exterior basal segments; unobstructed brounchus and thickened adjacent pleura. (b–d) CT scanning demonstrates large flaky shadows in fan shaped distribution along the bronchus in the left middle-lower lung, with gas containing cavities and high density shadows; and thickened adjacent pleura of the lateral chest wall. (e, f) CT scanning of the mediastinal window demonstrates large flaky fan shaped parenchymal shadows in the left middle-lower lung field, with ventilation shadows in them; and thickened pleura of the lateral chest wall. (g, h) Pathological examination showed staphylococcus aureus', 'hash': '18a6e1202b7b8c4a2d57fe024b7e8039a6dcee0f6f5f078b109a93850977c0f6'}, {'image_id': '313891_1_En_17_Fig94b_HTML', 'image_file_name': '313891_1_En_17_Fig94b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig94b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a–f) CT scanning demonstrates multiple nodules and small cavities in honeycomb liked shadows and infiltrative parenchyma shadows in the right lung; flaky transparent areas (bullae of lung) in the right anterior margin of the heart and in the outer zone of the left lung near lateral chest wall', 'hash': '3ed719abaaaec4ee19332842bd8dcac302eb6fefc73152dfd03a39702260d369'}, {'image_id': '313891_1_En_17_Fig34a_HTML', 'image_file_name': '313891_1_En_17_Fig34a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig34a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung and multiple satellite lesions scattering around. (c) CT scanning of the mediastinal window demonstrates lymphadenectasis of aortic window, subcutaneous soft tissue mass shadow in the left anterior chest wall with central low density shadow as well as right axilliary lymphadenectasis', 'hash': 'dabd5722ad3f66eee67ca59ba24417ffb086d4591f3bff2446f2a3490c676e78'}, {'image_id': '313891_1_En_17_Fig22_HTML', 'image_file_name': '313891_1_En_17_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig22_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates semicircular mass liked dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura of lateral chest wall, and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates narrowed right thorax, thickend pleura of lateral chest wall with encapsulated effusion, uneven density mass in the right hilum, thinner right bronchus due to compression and no obvious abnormalities in the left hilum. (f) DR in Aug. 2008 demonstrates no obvious changes of the lesions after anti-tuberculosis treatment for 1 month', 'hash': '8f3d47e32ff0f306eed49c4101730b02a154f676752c7bb56423c767388d5b82'}, {'image_id': '313891_1_En_17_Fig27b_HTML', 'image_file_name': '313891_1_En_17_Fig27b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig27b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related miliary tuberculosis. (a–b) Anteroposterior and lateral DR demonstrates diffuse miliary shadows in both lungs, which are bilaterally symmetric and in even size and distribution. (c–f) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': 'e272956e522e945d068939f056c637c5a636df520c687deeac9d40f8cb06834e'}, {'image_id': '313891_1_En_17_Fig83_HTML', 'image_file_name': '313891_1_En_17_Fig83_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig83_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates enlarged blurry hilum in both lungs and thickened lung markings. (b–d) CT scanning demonstrates multiple scattered nodular or mass dense shadows in both lungs, with lobulation, rough spikes around and fusion of some shadows into mass; surrounding small flaky infiltrative shadows; and mediastinal lymphadenectasis', 'hash': '6b17ec5d2db4d953c2436bbec29d0a3b1dacf0910df899eaf97e442c4aaad785'}, {'image_id': '313891_1_En_17_Fig43a_HTML', 'image_file_name': '313891_1_En_17_Fig43a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig43a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related tuberculous pleuritis. (a) DR demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (b) CT scanning of the pulmonary window demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (c) CT scanning of the mediastinal window demonstrates encapsulated fluid density shadow in the pleura of the right lateral chest wall', 'hash': 'ac09c8d3e5e4d73b07cd258411b07337ad06b99883f4a0e4573ce220fc1f4574'}, {'image_id': '313891_1_En_17_Fig35a_HTML', 'image_file_name': '313891_1_En_17_Fig35a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig35a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates diffuse large flaky dense shadows in the right upper lung with transparent areas in them. (b–c) CT scanning of the pulmonary window demonstrates large flaky shadows with increased density in the right upper lung, with multiple satellite lesions scattering around. (d, e) CT scanning of the mediastinal window demonstrates large flaky parenchymal shadows in the right upper lung with air bronchogram sign as well as mediastinal lymphadenectasis', 'hash': 'f556b77354da8136691c411ed446865babea0e399d96d2fca89f49639a04c579'}, {'image_id': '313891_1_En_17_Fig26b_HTML', 'image_file_name': '313891_1_En_17_Fig26b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig26b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '1d1f0589c50a11306fce77c217b0a9ac31be645df14f41d021ccf6522873dc6c'}, {'image_id': '313891_1_En_17_Fig32_HTML', 'image_file_name': '313891_1_En_17_Fig32_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig32_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstratesdiffuse scattering miliary shadows with increased density in both lungs, fusion of some military shadows into patchy or mass liked shadows and diffusely distributed lung lesions', 'hash': '7274d90d4f9483c5fb0e44576eeb46beba54850ed218057b6ca5935c31fa396a'}, {'image_id': '313891_1_En_17_Fig96b_HTML', 'image_file_name': '313891_1_En_17_Fig96b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig96b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a) DR demonstrates flaky blurry dense shadows in the right anterior margin of the heart, with surrounding infiltrative shadows. (b, c) CT scanning of the pulmonary window demonstrates nodular dense shadows in the dorsal segment of the right lower lung, with smooth sharp boundaries; large flaky ground glass liked dense shadows in the dorsal segment of both lungs. (d, e) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in red, in different sizes. (f) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in purplish red, in different sizes', 'hash': 'ad87dabd309e8a0c47d5cd58aa485a538556b1218d18c3cb262dc5b8cd5049e9'}, {'image_id': '313891_1_En_17_Fig55_HTML', 'image_file_name': '313891_1_En_17_Fig55_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig55_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates round liked large flaky shadows with increased density in the right lower lung, cords liked and flocculent liked blurry shadows in both middle-upper lung fields and in the right lower lung field, and enlarged and thickened hilus', 'hash': '29c690f04a28629d1c3b0f7b5665833edd78ec61be199fd2f16199400a7c9eeb'}, {'image_id': '313891_1_En_17_Fig85a_HTML', 'image_file_name': '313891_1_En_17_Fig85a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig85a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates round liked thick-wall cavity in the left hilum, with blurred boundary; ground-glass liked shadows with increased density in the left middle and lower lung. (b–d) CT scanning of the pulmonary window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of cavity wall. (e, f) CT scanning of the mediastinal window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of the cavity wall and surrounding thick spikes', 'hash': 'd6bc5b1be05729f5f4ec60a0cda3bec7f7cf437fd39e0d32743e45cfb9e48de2'}, {'image_id': '313891_1_En_17_Fig112_HTML', 'image_file_name': '313891_1_En_17_Fig112_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig112_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Kaposi’s sarcoma. (a, b) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance', 'hash': 'eeb255e4963802d02da7fd85381532153336be33b21e4ceb488be5dc2a483f29'}, {'image_id': '313891_1_En_17_Fig25b_HTML', 'image_file_name': '313891_1_En_17_Fig25b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25b_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '9ceac8f407a9896d7bda0165bceae81a32d5c5c53de3c5d2a295c165b15071e8'}, {'image_id': '313891_1_En_17_Fig36a_HTML', 'image_file_name': '313891_1_En_17_Fig36a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig36a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) Pulmonary CT scanning of the pulmonary window demonstrates parenchymal shadows in the left lingual lobe with surrounding pulmonary acinar nodular shadows. (b) CT guided pucture biopsy of left lingula. (c) The pathology demonstrates granulation tissue and caseous necrosis, being in consistency with tuberculosis changes. HE\u2009×\u2009100', 'hash': '3a48cc084a1fb1943e1411fa65cfdcee0c3c33377b3ae6ab6e24f04ee1caebae'}, {'image_id': '313891_1_En_17_Fig68a_HTML', 'image_file_name': '313891_1_En_17_Fig68a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig68a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in prone posture demonstrates mass shadow and thick wall cavity in the dorsal segment of the right lower lung, small nodular shadows in the cavities, surrounding fused miliary infiltration shadows. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the dorsal segment of the right lower lung, small nodular shadows in the cavities, and involved pleura of partial lateral chest wall', 'hash': '0acc77833f25b70e7e4527a30be9fc6744e19cee48879415a15e648d76923d48'}, {'image_id': '313891_1_En_17_Fig45_HTML', 'image_file_name': '313891_1_En_17_Fig45_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig45_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Staphylococcus aureus pneumonia. (a) Gross specimen observation demonstrates bilateral purplish brown lesions, patchy white infiltration at the base of the lungs. (b) HE staining demonstrates alveolar diffuse lesions, exudation of the serous fluid and inflammatory cells in the alveolar cavity, and alveolar wall congestion', 'hash': 'e530a1df1ead29989d8b3b50161f1926946446bc5cbbcb99691479816876e341'}, {'image_id': '313891_1_En_17_Fig110c_HTML', 'image_file_name': '313891_1_En_17_Fig110c_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110c_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '22d9f8a4fa731c46a738334c9738c267aaa2c43711aa94bd98c4b78483adda8d'}, {'image_id': '313891_1_En_17_Fig24b_HTML', 'image_file_name': '313891_1_En_17_Fig24b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig24b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates circular mass dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura in the lateral chest cavity and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates multiple uneven mass density shadows in right hilum in a size of about 3\u2009×\u20093.5\u2009×\u20093.8 cm. (f–g) Enhanced CT scanning demonstrates slight uneven enhancement of the lesion and no obvious abnormalties in the left hilum', 'hash': '4c7c3a8f7b0bde1c89efcf634beedfd08159b9be03a95299448e388c435edcdc'}, {'image_id': '313891_1_En_17_Fig12_HTML', 'image_file_name': '313891_1_En_17_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig12_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchyma shadows and fibrous cords liked shadows in both lungs which are more obvious in the dorsal segment of both lower lungs, bronchial shadows in them, and thickened bronchial walls in the middle lobe. The hilar shadows in both lungs are enlarged', 'hash': '72a066b603a93a4b8e9a7a8ec1942b2ed87b211dee6ed121b7c56d1cb575c55c'}, {'image_id': '313891_1_En_17_Fig102_HTML', 'image_file_name': '313891_1_En_17_Fig102_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig102_HTML.jpg', 'caption': '(a–d) HIV/AIDS related lymphoid interstitial pneumonia. (a–d) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs, in reticular appearance; with accompanying multiple small nodular shadows', 'hash': '6b569d4d7a5a4f008ea8f7bc4152cd1a576656b8eeee8b7548f00de038815256'}, {'image_id': '313891_1_En_17_Fig111_HTML', 'image_file_name': '313891_1_En_17_Fig111_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig111_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Kaposi’s sarcoma. (a, b) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance, light density flaky shadows in lower lung fields of both lungs. (c) CT scanning demonstrates multiple round liked nodular shadows in both middle lower lung fields with clear boundaries, multiple mediastinal and hilar lymphadenectasis, and small quantity pleural effusion in bilateral thoracic cavities', 'hash': '5dfb9d581ecc41659920bde84bc55d01903bf9f66ec50710fe0465373096ff5f'}, {'image_id': '313891_1_En_17_Fig25a_HTML', 'image_file_name': '313891_1_En_17_Fig25a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25a_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '67db71f0f56d65c929e36f486b4a1a2246ae852aec999328f126ddc09428f814'}, {'image_id': '313891_1_En_17_Fig36b_HTML', 'image_file_name': '313891_1_En_17_Fig36b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig36b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) Pulmonary CT scanning of the pulmonary window demonstrates parenchymal shadows in the left lingual lobe with surrounding pulmonary acinar nodular shadows. (b) CT guided pucture biopsy of left lingula. (c) The pathology demonstrates granulation tissue and caseous necrosis, being in consistency with tuberculosis changes. HE\u2009×\u2009100', 'hash': 'd7d5abe0c9d9bea2e2097dfc72f86922656058f98f8a2360573b04a02e27e5de'}, {'image_id': '313891_1_En_17_Fig68b_HTML', 'image_file_name': '313891_1_En_17_Fig68b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig68b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in prone posture demonstrates mass shadow and thick wall cavity in the dorsal segment of the right lower lung, small nodular shadows in the cavities, surrounding fused miliary infiltration shadows. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the dorsal segment of the right lower lung, small nodular shadows in the cavities, and involved pleura of partial lateral chest wall', 'hash': 'cada0e4684021c74f9b0d4d1bcdb6810379bc035cead748d6de141ebd004f038'}, {'image_id': '313891_1_En_17_Fig96a_HTML', 'image_file_name': '313891_1_En_17_Fig96a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig96a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a) DR demonstrates flaky blurry dense shadows in the right anterior margin of the heart, with surrounding infiltrative shadows. (b, c) CT scanning of the pulmonary window demonstrates nodular dense shadows in the dorsal segment of the right lower lung, with smooth sharp boundaries; large flaky ground glass liked dense shadows in the dorsal segment of both lungs. (d, e) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in red, in different sizes. (f) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in purplish red, in different sizes', 'hash': '020553d48c8545e50d314020ad8dc5004914dca5449aa2b58bc99515f310c3a4'}, {'image_id': '313891_1_En_17_Fig85b_HTML', 'image_file_name': '313891_1_En_17_Fig85b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig85b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates round liked thick-wall cavity in the left hilum, with blurred boundary; ground-glass liked shadows with increased density in the left middle and lower lung. (b–d) CT scanning of the pulmonary window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of cavity wall. (e, f) CT scanning of the mediastinal window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of the cavity wall and surrounding thick spikes', 'hash': '9778eb0d00755e3cd06bd3bcee90d66970730aac4b7fabde0b3e1df25cc067b8'}, {'image_id': '313891_1_En_17_Fig59_HTML', 'image_file_name': '313891_1_En_17_Fig59_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig59_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a–c) CT scanning of the pulmonary window demonstrates thick walled cavities shadows in the dorsal segment of the right lower lung, with irregular wall thickness and liquid gas level in them. (d) CT scanning of the mediastinal window demonstrates thick walled cavities shadows in the dorsal segment of the left lower lung, with irregular wall thickness and liquid gas level in them', 'hash': 'c9ff1150b9c2d245c823a3726a56dc22223fcdc58b24666ee55ee0b01ea0c2d3'}, {'image_id': '313891_1_En_17_Fig24a_HTML', 'image_file_name': '313891_1_En_17_Fig24a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig24a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates circular mass dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura in the lateral chest cavity and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates multiple uneven mass density shadows in right hilum in a size of about 3\u2009×\u20093.5\u2009×\u20093.8 cm. (f–g) Enhanced CT scanning demonstrates slight uneven enhancement of the lesion and no obvious abnormalties in the left hilum', 'hash': 'a3536c779e7c502b855dd3d89ae13854f569bd483ba8038870ac76c68c616c6c'}, {'image_id': '313891_1_En_17_Fig11_HTML', 'image_file_name': '313891_1_En_17_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig11_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered patchy shadows with increased density in both lungs and a few cords liked shadows which are more obvious in the right lung. There are thickened both hilar shadows and sharp both costophrenic angles. (b–e) CT scanning demonstrates flaky and mass liked ground glass density shadows in both lungs and a few cords liked shadows which are more obvious in the right lung. The trachea and bronchi are unblocked', 'hash': 'd4448bd9682d4ae721b1250cec042eecf77787519b1af61ac3b2d7b88b28bd90'}, {'image_id': '313891_1_En_17_Fig101_HTML', 'image_file_name': '313891_1_En_17_Fig101_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig101_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Herpes Simplex Viral Pneumonia. (a) DR demonstrates thickened and deranged lung markings in both lungs with accompanying blurry nodular shadows, and cloudy shadows in the lung fields. (b) PAS staining (400×) demonstrates eosinophilic inclusion. (c) Silver methenamine staining demonstrates herpes viral inclusion', 'hash': '9cfda956483a95dc3a4e487426e884d83e6aa0bde654b2c285ba044cf31b2a1d'}, {'image_id': '313891_1_En_17_Fig49_HTML', 'image_file_name': '313891_1_En_17_Fig49_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig49_HTML.jpg', 'caption': '(a–d) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates fan shaped shadow in the right middle lung field with its apex pointing to the hilar dense shadow, with clear boundaries. (d) CT scanning reexamination demonstrates absence of the lesions in the right lung after anti-bacteria treatment for 2 weeks', 'hash': 'f566a271be67724833f92b19b4f73190cae4216ad698f1d1a51c1d9c7579afa1'}, {'image_id': '313891_1_En_17_Fig34b_HTML', 'image_file_name': '313891_1_En_17_Fig34b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig34b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung and multiple satellite lesions scattering around. (c) CT scanning of the mediastinal window demonstrates lymphadenectasis of aortic window, subcutaneous soft tissue mass shadow in the left anterior chest wall with central low density shadow as well as right axilliary lymphadenectasis', 'hash': 'cd2bbefb6363363a2c860069ded9e79b5fabed794f0777f342cd459e7f745581'}, {'image_id': '313891_1_En_17_Fig21_HTML', 'image_file_name': '313891_1_En_17_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig21_HTML.jpg', 'caption': '(a–c) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates enlarged right hilum in mass liked dense shadow, with peripheral thickened and blurry pulmonary markings, and no obvious abnormalities of the left hilum. (b) DR demonstrates smaller right hilum after anti-tuberculosis therapy for 1 month. (c) DR demonstrates absent tumor in the right hilum and normal left hilum', 'hash': '46a1a9267e1d610faa6450929c11c8d942047467baf49ba4482ce61bb660cb30'}, {'image_id': '313891_1_En_17_Fig27a_HTML', 'image_file_name': '313891_1_En_17_Fig27a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig27a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related miliary tuberculosis. (a–b) Anteroposterior and lateral DR demonstrates diffuse miliary shadows in both lungs, which are bilaterally symmetric and in even size and distribution. (c–f) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '61497bd4be4942d8a1fc4e6710043c9d4099da58ea99f2008d49f04ec973f2b4'}, {'image_id': '313891_1_En_17_Fig79_HTML', 'image_file_name': '313891_1_En_17_Fig79_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig79_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates multiple scattered nodular shadows in both lower lungs. (b–d) Chest CT scanning demonstrates multiple dense nodular shadows with different sizes and mass shadows in both middle and lower lung fields, with clear boundaries. They are more common in the dorsal segments', 'hash': '7f1588a4af3d4fadaf1f33e3bac3f100d4b2003206bd1bc2ae262b602fd3fe79'}, {'image_id': '313891_1_En_17_Fig51a_HTML', 'image_file_name': '313891_1_En_17_Fig51a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig51a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related staphylococcus aureus pneumonia. (a) Chest X-ray demonstrates large flaky high density shadow in the left middle-lower lung field, with central transparent areas in different sizes and blurry boundaries; parenchyma changes of the left lower lung, predominantly in the posterior and exterior basal segments; unobstructed brounchus and thickened adjacent pleura. (b–d) CT scanning demonstrates large flaky shadows in fan shaped distribution along the bronchus in the left middle-lower lung, with gas containing cavities and high density shadows; and thickened adjacent pleura of the lateral chest wall. (e, f) CT scanning of the mediastinal window demonstrates large flaky fan shaped parenchymal shadows in the left middle-lower lung field, with ventilation shadows in them; and thickened pleura of the lateral chest wall. (g, h) Pathological examination showed staphylococcus aureus', 'hash': '00d7fc70edd23ceb6f012159d4bae8563ec20a036cc91fd99d91cdbc08f23126'}, {'image_id': '313891_1_En_17_Fig90_HTML', 'image_file_name': '313891_1_En_17_Fig90_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig90_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows in the lungs that fuse into mass in parenchymal shadows, with the hilum as the center and distributing bilaterally symmetric like butterfly wings. There are also multiple clustering cavities or singular large cavity in both lungs', 'hash': '6742eff5e10355ff74a6fe215cff47247a9d12856c453a35fd6d6742f8f0ac2e'}, {'image_id': '313891_1_En_17_Fig94a_HTML', 'image_file_name': '313891_1_En_17_Fig94a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig94a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a–f) CT scanning demonstrates multiple nodules and small cavities in honeycomb liked shadows and infiltrative parenchyma shadows in the right lung; flaky transparent areas (bullae of lung) in the right anterior margin of the heart and in the outer zone of the left lung near lateral chest wall', 'hash': '4bf177cdb556a837613a60231e962930fcd4acf34d7177f738cb57925ca917e1'}, {'image_id': '313891_1_En_17_Fig35b_HTML', 'image_file_name': '313891_1_En_17_Fig35b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig35b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates diffuse large flaky dense shadows in the right upper lung with transparent areas in them. (b–c) CT scanning of the pulmonary window demonstrates large flaky shadows with increased density in the right upper lung, with multiple satellite lesions scattering around. (d, e) CT scanning of the mediastinal window demonstrates large flaky parenchymal shadows in the right upper lung with air bronchogram sign as well as mediastinal lymphadenectasis', 'hash': '8b68f2c89884110f18b2b9641154ae26362875fb18db9a64b4320edd5c13bba4'}, {'image_id': '313891_1_En_17_Fig26a_HTML', 'image_file_name': '313891_1_En_17_Fig26a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig26a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '1bd3c2b9622fa99531543c1b9d456f58ff2945c6fa4bb44043fadb51fa9c8db6'}, {'image_id': '313891_1_En_17_Fig31_HTML', 'image_file_name': '313891_1_En_17_Fig31_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig31_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, fusion of some military shadows into patchy or mass liked shadow, diffusely distributed lung lesions', 'hash': '3bf8714e005c1ebc72eb46fac228838fd6436f0a1dd5d6a8bd085a14fddd1170'}, {'image_id': '313891_1_En_17_Fig69_HTML', 'image_file_name': '313891_1_En_17_Fig69_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig69_HTML.jpg', 'caption': '(a, b) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the medial basal segment of the right lower lung, irregular nodular shadows in the cavities, and surrounding fused miliary infiltration shadows', 'hash': 'db839a28accf7944530e9940a7c7afb2b7b3c7a4423308b863fae87f0c08c29a'}, {'image_id': '313891_1_En_17_Fig80_HTML', 'image_file_name': '313891_1_En_17_Fig80_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig80_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a, b) Anteroposterior and lateral DR demonstrate a huge dense mass shadow in the left lower lung, with clear boundary. (c) CT scanning of the pulmonary window demonstrates round liked high density shadow in the left lower lung near left chest wall, with even density. (d) CT scanning of the mediastinal window demonstrates round liked soft tissue density shadows in the left lower lung near left chest wall, with even density, lobulation, and surrounding thick spikes', 'hash': 'ea2ef199cee39dce2b4a8a06bcdcce274a6fd8796c2efbfaf940d6d05fe48c40'}, {'image_id': '313891_1_En_17_Fig43b_HTML', 'image_file_name': '313891_1_En_17_Fig43b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig43b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related tuberculous pleuritis. (a) DR demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (b) CT scanning of the pulmonary window demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (c) CT scanning of the mediastinal window demonstrates encapsulated fluid density shadow in the pleura of the right lateral chest wall', 'hash': '582e0f2e161551b97de13a60d6afed8cc613b9b04bfb136458587da830b2ecf0'}, {'image_id': '313891_1_En_17_Fig16_HTML', 'image_file_name': '313891_1_En_17_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig16_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple fibrous cords liked shadows in lungs, multiple patchy parenchyma shadows and ground glass liked density shadows in both upper lobes, with multiple transparent areas in them. The bronchial walls are thickened in the anterior and posterior segments of the right upper lobe as well as in the lingual segment of the left lung', 'hash': '214979f5c447a9b40ebd0772cff663eb275052bf5fe8132456329ffacdc20c9c'}, {'image_id': '313891_1_En_17_Fig109_HTML', 'image_file_name': '313891_1_En_17_Fig109_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig109_HTML.jpg', 'caption': '(a, b) HIV/AIDS related lymphoma. (a, b) CT scanning demonstrates a huge soft tissue mass shadow in the left lateral chest wall, with a maximal size of about 7.7\u2009×\u200913.0 cm and occupying 30 sections with 8 mm in thickness of each section and with the upmost to the supraclavicular area and the bottom in the level of thoracic 12th vertebral body in the lower chest wall. There are also large quantity left pleural effusion and parenchymal changes of the left lower lobe with atelectasis. In the left chest cavity, large quantity liquid density shadows can be found, with compressed lung tissues to the hilum. By puncture and biopsy of the subaxillary mass, the diagnosis is defined as diffuse large B cell lymphoma', 'hash': '6d67a094843ca970dc50c93d50e7d1038c2a389c96e1772f425fa9dbc9d3a3ea'}, {'image_id': '313891_1_En_17_Fig19_HTML', 'image_file_name': '313891_1_En_17_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig19_HTML.jpg', 'caption': '(a) Gross observation in autopsy demonstrates disseminated pulmonary tuberculosis, with grayish white military nodules in diffuse distribution in the lung tissues section. (b) It is demonstrated that mycobacteriumavium-intracellularcomplex infection in the lung tissue, with atypical tuberculosis nodules and acid-fast staining positive (left top). There are a subnodular giant cell, eosinophilic inclusion bodies in the nucleus and bradyzoites in cytoplasm of T. gondii. HE\u2009×\u2009100. (c) HE demonstrates mycobacteriumavium-intracellularcomplex infection, with atypical tuberculosis nodular changes, HE\u2009×\u2009200', 'hash': 'fac712a77d78563a8ebac012fe6c9f2f74ab72b1d36bf9e0c30462450f24c87d'}, {'image_id': '313891_1_En_17_Fig92a_HTML', 'image_file_name': '313891_1_En_17_Fig92a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig92a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of the lesions in the right lung into plaque liked shadows with clear boundaries, and multiple round liked small cavity shadows and inflammatory infiltrative shadows in both lungs', 'hash': '981e19f8709c64fb0f850afd293a3dfdb67ec16a8d75e3f2bf19cd69116366cd'}, {'image_id': '313891_1_En_17_Fig41_HTML', 'image_file_name': '313891_1_En_17_Fig41_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig41_HTML.jpg', 'caption': 'HIV/AIDS related tuberculous pleuritis. DR demonstrates arch shaped dense shadows with higher exterior density and lower interior density in the right lower lung field and covered right edge of the heart', 'hash': '3381f76804304950a36ba44865a5651168e2f9b43c451a23d390d065bfc52e80'}, {'image_id': '313891_1_En_17_Fig56a_HTML', 'image_file_name': '313891_1_En_17_Fig56a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig56a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates huge round large flaky shadows with increased density in the left lower lung, enlarged and thickened hilum and covered right heart edge. (c, d) DR reexamination after treatment for 1 week demonstrates flocculent shadow in the left lower lung, improved than those before the treatment (a, b). (e) DR reexamination after treatment demonstrates flocculent liked shadows in the left lower lung, obviously improved than before the treatment (c, d)', 'hash': '8c2f7c50d0562920efd9257451f8cc2d4dda042eaa3768d3fb1455a7092edf94'}, {'image_id': '313891_1_En_17_Fig93a_HTML', 'image_file_name': '313891_1_En_17_Fig93a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig93a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates diffuse small cavity in honeycomb liked and infiltrative parenchyma shadows, with the hilum as the center to distribute bilaterally symmetric like butterfly wings; multiple honeycomb liked cavity shadows in both lungs. (e–h) CT scanning reexamination demonstrates large irregular thick-wall cavities in the right lung, surrounding scattering nodular, honeycomba liked and infiltrative shadows after anti-PM infection treatment for 3 months', 'hash': 'eb824267db9288c03e6cffae4cde8b6f47b3bda47dcad797ee4964b9011ac598'}, {'image_id': '313891_1_En_17_Fig46b_HTML', 'image_file_name': '313891_1_En_17_Fig46b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig46b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates large flaky dense shadows in the middle-outer zone of the left middle lung field, and narrowed left bronchus. (d–f) CT scanning demonstrates large flaky shadows with uneven density in the left lateral chest wall and even lower density shadow in them', 'hash': '97eaf0337e0212b917644691da5093524803db5d92384afd57bfc5803cb125e0'}, {'image_id': '313891_1_En_17_Fig39_HTML', 'image_file_name': '313891_1_En_17_Fig39_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig39_HTML.jpg', 'caption': '(a–d) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung, periphery crab feet liked or cords liked shadows due to pleural traction and satellite lesions. (c, d) CT scanning of the mediastinal window demonstrates round liked or triangle shaped thick wall cavities in the left upper lung, no nodules in the wall and peripheral nodular satellite lesions', 'hash': '614dd89032a813e240901110905f63b8b8d2530c6c7e27b0e6aab03ce47f7abb'}, {'image_id': '313891_1_En_17_Fig61_HTML', 'image_file_name': '313891_1_En_17_Fig61_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig61_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a) DR demonstrates large flaky shadow in the middle-outer zone of the left upper lung field. (b) DR demonstrates diffuse dense shadow in the left lung field, with round liked cavities shadows in them. (c–d) Reexamination after treatment demonstrates multiple cavities shadows in the middle-outer zone of the left upper lung field', 'hash': '29c84b1869c0cdabc91ee8822b014d024780586503e92fa0fdc6bed1d3b54b73'}, {'image_id': '313891_1_En_17_Fig88_HTML', 'image_file_name': '313891_1_En_17_Fig88_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig88_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a) The gross specimen demonstrates central necrotic pimples on the face. (b) Chest X-ray DR demonstrates cavities in the left upper lung, thickened lung markings in both lower lungs with accompanying multiple spots and flakes shadows. (c) Gastrointestinal barium meal radiology demonstrates left and downwards migration of the intestine due to compression. (d) Enhanced abdominal CT scanning demonstrates retroperitoneal enlarged lymph nodes that fuse into a huge mass, with ring shaped enhancement of the lymph nodes', 'hash': '72d6f61ccf9268cf07530a5a1e56a768d1d614ac854706838e783fa20f2cb2a1'}, {'image_id': '313891_1_En_17_Fig87_HTML', 'image_file_name': '313891_1_En_17_Fig87_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig87_HTML.jpg', 'caption': '(a) HE staining demonstrates lymph nodes, PM in the yeast phase, with sausage liked shape and obvious septa (HE\u2009×\u20091000). (b) GMS staining demonstrates clearly defined PMs (GMS\u2009×\u20091,000)', 'hash': '195e16d569e89c659459764942f07ae44cec9cd1fd8634e716178e34225094ab'}, {'image_id': '313891_1_En_17_Fig91a_HTML', 'image_file_name': '313891_1_En_17_Fig91a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig91a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–e) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of some lesions into honeycomb likes cavity shadows or plaque liked dense shadows. (f–h) CT scanning demonstrates large thick-wall cavity shadows in the right lung, surrounding plaque and round liked small cavity shadows and inflammatory infiltrative shadows', 'hash': '84aa8353e64cbf735c399fa64899ecd1e9b8a13620149a5aa662a21a423c07bf'}, {'image_id': '313891_1_En_17_Fig8b_HTML', 'image_file_name': '313891_1_En_17_Fig8b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig8b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates large flaky parenchyma shadows in both lungs which is more obvious in the middle and lower lobes of both lungs. There are also enlarged hilar shadows in both lungs and sharp both costophrenic angles. (b–g) CT scanning demonstrates large flaky parenchyma shadows in concentric and symmetrical distribution, bronchial shadows in them and thickened bronchial walls', 'hash': '812cc7d7992507bc22a7c06e518ff223d7e9ece757725f478a6f723b8ac030bf'}, {'image_id': '313891_1_En_17_Fig29_HTML', 'image_file_name': '313891_1_En_17_Fig29_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig29_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric and in even size and distribution. There are nodular shadows in the anterior segment of the right middle lung lobe with clear boundary', 'hash': '16cd873b8d84d3bbad635d9facea5407fe900b62efdd6f481449f4a433dfb6a0'}, {'image_id': '313891_1_En_17_Fig71_HTML', 'image_file_name': '313891_1_En_17_Fig71_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig71_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary aspergillosis infection. (a) The gross specimen demonstratesAspergillus abscess in the skin of the forearm. (b–d) CT scanning of the pulmonary window demonstrates multiple round liked nodular shadows and cavity shadows in both lungs, even thickness of cavity wall, and small nodular shadows in some cavities. (e) Pulmonary Aspergillus infection, demonstration purplish blue branches liked or grasses liked growth of hyphae, HE\u2009×\u2009400', 'hash': 'f0586168fbf7b2cd35205e1c807a3343af1ec5bac8dbe4f50308a570cd7d3552'}, {'image_id': '313891_1_En_17_Fig97_HTML', 'image_file_name': '313891_1_En_17_Fig97_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig97_HTML.jpg', 'caption': '(a) Gross observation of the fresh specimen in autopsy demonstrates pulmonary edema and congestion of cytomegalovirus pneumonia. (b) Gross observation of the formalin fixed specimen in autopsy demonstrates dark brown hard pulmonary tissues. (c, d) HE staining demonstrates large quantity cytomegalovirus inclusions in eagle eyes sign. (e) Immunohistochemical demonstrates HIV P24 antigen positive in macrophages of lung tissues (×400)', 'hash': '50e144edf7881be15e502fff23c2613760ac0172fe3ae6c56abf5ca1abf085b5'}, {'image_id': '313891_1_En_17_Fig20_HTML', 'image_file_name': '313891_1_En_17_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig20_HTML.jpg', 'caption': '(a, b) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates enlarged right hilum in nodular dense shadows with peripheral thickened and blurry pulmonary markings, and no obvious abnormalities of the left hilum. (b) DR demonstrates smaller right hilum after treatment for 1 month', 'hash': '27213b483e54de634de857225fc93f6dc05eb5a729bc751141dea3866128c8ec'}, {'image_id': '313891_1_En_17_Fig6b_HTML', 'image_file_name': '313891_1_En_17_Fig6b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig6b_HTML.jpg', 'caption': '(a-d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates flaky ground glass liked density shadows in upper lobes of both lungs, with bronchial shadows in them; flaky parenchymal shadows in the subpleural apical segment; and thickened bronchial walls in the anterior and posterior segments of the right upper lobe', 'hash': 'ba6f221be2db1160358ae94e02b0125159adca1d9ac64bff84883eae8b614970'}, {'image_id': '313891_1_En_17_Fig17b_HTML', 'image_file_name': '313891_1_En_17_Fig17b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig17b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchymal shadows and fibrous cords liked shadows in both lungs which are more obvious in both lower lungs. The trachea and bronchi are unblocked, with enlarged hilar shadows in both lungs', 'hash': 'dba27067e12ab2a752ec8a543537f427156b1a18bdc04bffa3aedbe2d3b6e7bd'}, {'image_id': '313891_1_En_17_Fig113a_HTML', 'image_file_name': '313891_1_En_17_Fig113a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig113a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Kaposi’s sarcoma. (a–d) Chest CT scanning demonstrates scattered cloudy, mass and flake liked or nodular shadows with increased density. (e) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large thick stained nucleoli, which are in line with the diagnosis of Kaposi’s sarcoma. (f–i) Cured HIV/AIDS related Kaposi’s sarcoma. (f–i) Reexamination after treatment demonstrates absent lesions in both lungs, with clear lung fields', 'hash': '192d991df0d417610162aab90c8b0e07b4c19f1436faa752263e85c3efa0f3db'}, {'image_id': '313891_1_En_17_Fig77_HTML', 'image_file_name': '313891_1_En_17_Fig77_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig77_HTML.jpg', 'caption': 'HE staining demonstrates isseminated cryptococci, the Cryptococcus is stained red after mucin carmine staining of cryptococcus neoformans spores in lungs, (HE\u2009×\u2009200)', 'hash': '882060c6f53899fb225a20d7eb5fe410195beed0a7386dc233a4632284f4717f'}, {'image_id': '313891_1_En_17_Fig78_HTML', 'image_file_name': '313891_1_En_17_Fig78_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig78_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates multiple scattered nodular and miliary shadows in both lungs. (b–d) Chest CT scanning demonstrates multiple dense nodular shadows with different sizes in both lungs, with clear boundaries. They are intensively distributed in the dorsal segment and the largest one has a diameter of about 2 cm', 'hash': 'd60cf04886c28c578ee7940f50525d5141254a1a45a5b489d53a7ae5ae27fa53'}, {'image_id': '313891_1_En_17_Fig7b_HTML', 'image_file_name': '313891_1_En_17_Fig7b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig7b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates diffusely distributed shadows with increased density in both lungs that is more obvious in the middle and lower lungs. The hilar shadows in both lungs are enlarged. Both diaphragmatic surfaces and phrenic angles are blurry. (b–d) CT scanning demonstrates flaky shadows with increased density in both lungs, with parenchymal shadows in the lingular segment of left upper lobe and in the dorsal segments of both lower lobes and bronchial shadows in them. There are also thickened bronchial walls and enlarged hilar shadows in both lungs', 'hash': '47bf3b06e99aa6482027b30084d7445e95928d39923c99fd8fe93df39c899b2d'}, {'image_id': '313891_1_En_17_Fig30_HTML', 'image_file_name': '313891_1_En_17_Fig30_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig30_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs and fusion of some military shadows, which are bilaterally symmetric and in even size and distribution', 'hash': 'ab1d4160a6a23300146e331c7eee06edf886ca73ab4514f8a59b22d04d3c303f'}, {'image_id': '313891_1_En_17_Fig1_HTML', 'image_file_name': '313891_1_En_17_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig1_HTML.jpg', 'caption': '(a) Gross specimens’ observation demonstrates foamy liquid filling in the lung tissues. (b) HE demonstrates pneumocystis in the alveolar exudates, which can be stained black by silver methenamine staining, ×400. (c) HE demonstrates the foamy substance in the alveolar space, ×400', 'hash': 'a0082be568f7c995671d0461acf0cfe32c8c36a01dbf7badc28f3cc0ab407b75'}, {'image_id': '313891_1_En_17_Fig81_HTML', 'image_file_name': '313891_1_En_17_Fig81_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig81_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates thickened lung markings in both lungs and flaky blurry shadows in the left lower lung. (b, c) CT scanning demonstrates round liked nodular and small cavity shadows in the left upper and lower lung, with clear boundaries. (d–f) Pathology demonstrates transparent substrate in lung tissues and many bi-capsular cryptococci in cytoplasm', 'hash': '3e767fbaeda72c7b7b49df4ee9daa757367932f7623507185ca8453615c8de74'}, {'image_id': '313891_1_En_17_Fig58a_HTML', 'image_file_name': '313891_1_En_17_Fig58a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig58a_HTML.jpg', 'caption': '(a–i) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) CT scanning of the pulmonary window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (c, d) CT scanning of the mediastinal window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, pulmonary atelectasis and pleural effusion, with ventilation shadows in them. (e) CT scanning of the pulmonary window after the treatment demonstrates absence of the mass shadows in the left lower lung with transverse stripes shadows, obviously improved than previous findings (a, b). (f) HE staining demonstrates thickened alveolar septa and exudates from the alveolar cavity. (g) HE staining demonstrates massive bleeding in the alveolar cavity, large quantity erythrocytes and intact cell walls. (h) HE staining demonstrates phagocytized basophilic granules in the leukocytes. (i) HP staining demonstrates purplish red Rhodococcus equi in a shape of crescent in orange red sputum', 'hash': 'fcd60ca09d86084cb78d6b91f9b3e0a51e9f479a1c27837e18c9af0f809ef13d'}, {'image_id': '313891_1_En_17_Fig57_HTML', 'image_file_name': '313891_1_En_17_Fig57_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig57_HTML.jpg', 'caption': '(a, b)HIV/AIDS related Rhodococcus equi pneumonia. (a) CT scanning of the mediastinal window demonstrates soft tissue mass shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (b) CT scanning of the pulmonary window after the treatment demonstrates absence of the soft tissue mass shadows, and flocculent liked shadow in the left lower lung, obviously improved than previous findings (a)', 'hash': '9ac02a8eb30f8314fea4211fa5a4dbfa3863c422d30e78fcb26e8eaf44e36a42'}, {'image_id': '313891_1_En_17_Fig10_HTML', 'image_file_name': '313891_1_En_17_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig10_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates large flaky and mass liked parenchyma shadows in both lungs which is more obvious in the right lung, bronchial shadows in them, and thickened bronchial walls in the middle lobe of the right lung', 'hash': 'dc81224c041dbc53a26ff01b3414f8c13098126861cf7cc0c7f10d80a7485e0c'}, {'image_id': '313891_1_En_17_Fig100_HTML', 'image_file_name': '313891_1_En_17_Fig100_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig100_HTML.jpg', 'caption': 'The structure of herpes simplex virus', 'hash': 'b0a88fbe1660ab4ddb94799e876d547c23b5686d12e31560768111a38bc71a45'}, {'image_id': '313891_1_En_17_Fig110a_HTML', 'image_file_name': '313891_1_En_17_Fig110a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110a_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '7392286985c0e8fefacf1282d1ef323dd6d64b0b536b667dfffbcbde5be28d3c'}, {'image_id': '313891_1_En_17_Fig5b_HTML', 'image_file_name': '313891_1_En_17_Fig5b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig5b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates patchy shadows with increased density in both lungs, with thickened hilar shadows in both lungs. (b–g) CT scanning demonstrates flaky ground glass liked density shadows in upper lungs and dorsal segment of both lungs, which is more obvious in the middle inner strips. There are extrapulmonary stripes transparent shadows, with some bronchial walls thickened and enlarged hilar shadows in both lungs', 'hash': 'fcd873302d30f9846ba865346820af2a06778c5dad1b50cc634281055ae78468'}, {'image_id': '313891_1_En_17_Fig47_HTML', 'image_file_name': '313891_1_En_17_Fig47_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig47_HTML.jpg', 'caption': '(a–e) HIV/AIDS related staphylococcus aureus pneumonia. (a) DR demonstrates large flaky dense shadows with increased density in the middle-inner zone of the left upper lung field, with blurry boundaries. The lung tissue are atelectatic and the mediastinum migrates leftwards. (b, c) CT scanning demonstrates large flaky dense shadows with increased density in the middle-inner zone of the left upper lung field, with blurry boundaries, with surrounding acinar or particle liked shadows that fuse into flaky shadows. (d, e) CT scanning demonstrates large flaky shadow of parenchymal changes in the middle-inner zone of the left upper lung field, with cyst liked transparent shadows and air bronchogram sign in them, as well as mediastinal lymphadenectasis', 'hash': '8e228a648d0d33ebe1db2bfa2fa7b6209cd113683b027d6ada34f161b809085a'}, {'image_id': '313891_1_En_17_Fig48_HTML', 'image_file_name': '313891_1_En_17_Fig48_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig48_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates broad band liked high density shadows in the right middle lung field, with air bronchogram sign in them. (d–f) CT scanning of the mediastinal window demonstrates broad band liked uneven parenchymal shadows in the right middle lung field, with uneven thickness of air bronchogram sign', 'hash': '6e700dc830efe216b64ed069dfb6440abf50854341b133bf0237be914bd5270f'}, {'image_id': '313891_1_En_17_Fig37_HTML', 'image_file_name': '313891_1_En_17_Fig37_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig37_HTML.jpg', 'caption': '(a, b) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a, b) DR demonstrates diffuse scattering patchy shadows with increased density, and oval thin wall cavity shadows in the right middle lung field', 'hash': 'edc3511f0cc30005fb5999c1fe7033024176b0e1b8fee607763caef6a0d9abe2'}, {'image_id': '313891_1_En_17_Fig38_HTML', 'image_file_name': '313891_1_En_17_Fig38_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig38_HTML.jpg', 'caption': '(a–d) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in both upper lungs, peripheral crab feet liked or cords liked shadows due to pleural traction with cavity shadows in them and periperal satellite lesions. (b–d) CT scanning of the mediastinal window demonstrates round liked mass shadows with high density in the cavities of the left upper lung, surrounding transparent shadows, no nodules in the walls and surrounding nodular satellite lesions. By pathological examination, the diagnosis is defined as chronic fibrous cavity pulmonary tuberculosis complicated by Aspergillus infection', 'hash': '0317a9a78d280af1069a5b797b63c3817f47607eb13976214ed710d247081a7c'}, {'image_id': '313891_1_En_17_Fig65b_HTML', 'image_file_name': '313891_1_En_17_Fig65b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig65b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related allergic pulmonary Aspergillus infection. (a–f) CT scanning of the pulmonary window demonstrates thickened central pulmonary markings in both lungs, which is turtuous and deranged with fingertip infiltration shadows. (g) DR demonstrates hyperinflation of the right lung, increased and thickened pulmonary markings and ground glass liked shadows with increased density in the right lower lung and left lung lobe', 'hash': '44f320a9216b7a9905eaaa045a44b4be59372433c9737f0ee8ded7c443134eaa'}, {'image_id': '313891_1_En_17_Fig9_HTML', 'image_file_name': '313891_1_En_17_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig9_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates large flaky parenchyma shadows in both lungs, with transparent areas in some foci. The trachea and bronchi are unblocked, with thickened bronchial walls in the middle and lower lobes', 'hash': '26b10397cecf70e4665c1abb0f2501e939a6e5d219f395c3484c7a44dae78681'}, {'image_id': '313891_1_En_17_Fig76a_HTML', 'image_file_name': '313891_1_En_17_Fig76a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig76a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning demonstrates diffuse scattered thin ground glass liked, patchy, flaky blurry shadows and cords liked shadows in both lungs, with blurry boundaries and uneven density; scattered nodular shadows in different sizes; more lesions in both upper lobes and the right middle lobe; flaky parenchyma shadows in the apical and posterior segments of right upper lobe, with air bronchogram sign in them; unobstructed opening of bronchi as well as lobar and segmental bronchi without stenosis and obstruction; lymphadenectasis in the right hilar region; detected Aspergillus fumigatus by sputum culture. (e, f) Culture for 72 h, lactic acid gossypol blue staining and microscopic observation at ×200 and ×400 demonstrate short column liked conidial head, smooth wall of conidiophores, flask-shaped top capsule and monolayer microconidiophores. (g) Culture in Paul’s medium demonstrates dark green colored colonies', 'hash': '79dde610127d242cc7f1f29fc98dd50c426df080c95629396102af54f31872c9'}, {'image_id': '313891_1_En_17_Fig86_HTML', 'image_file_name': '313891_1_En_17_Fig86_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig86_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary candida infection. (a–d) CT scanning demonstrates thickened and deranged lung markings in both lungs, diffuse small flaky or patchy shadows, fusion of some small shadows into large flaky dense shadows, with blurry boundaries, enlarged hilum and blurry structures', 'hash': 'bb5525804e3b5cc6588115cd2813109845df9b4314974ab2b55c40298ed6968a'}, {'image_id': '313891_1_En_17_Fig89_HTML', 'image_file_name': '313891_1_En_17_Fig89_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig89_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows in the lungs that fuse into mass with parenchymal shadows, with the hilum as the center and distributing bilaterally symmetric like butterfly wings. There are also multiple clustering cavities or singular large cavity in both lungs', 'hash': 'cfd1927b986a8aba818bf96427711a3743dd07195a83b88e195837af405aae79'}, {'image_id': '313891_1_En_17_Fig60_HTML', 'image_file_name': '313891_1_En_17_Fig60_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig60_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a) DR demonstrates huge sphere liked mass shadow in the middle-outer zone of the right lower lung field, with cavities shdows in them. (b–d) CT scanning demonstrates triangular dense shadow in the middle-outer zone of the right lower lung field, with its apex pointing to the hilum and round liked cavities shadows in them. (e) Reexamination after the treatment demonstrates shrinkage of the huge sphere liked mass shadow in the middle-outer zone of the right lower lung field, with closure of the cavities', 'hash': '9020727e51b9a8522ea37dd579ce73bd9a417d327bcb313836c96e1fa3bd209f'}, {'image_id': '313891_1_En_17_Fig2b_HTML', 'image_file_name': '313891_1_En_17_Fig2b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig2b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered miliary increased density shadows in both lungs, with even size, density and distribution. The shadows of both hila are dense, with sharp both costophrenic angles. (b–f) CT scanning demonstrates scattered miliary nodular shadows in both lungs, which is more obviously in the middle pulmonary strip and with quite even size and density. Trachea and bronchi are unblocked', 'hash': 'ab808d6adb73be9c9efd977cd27ef54cace943f5143068db354c7d287374a50d'}, {'image_id': '313891_1_En_17_Fig13b_HTML', 'image_file_name': '313891_1_En_17_Fig13b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig13b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, transparent areas in them and unblocked trachea and bronchi', 'hash': '2f728d8163ffe4c88ed77f38f8d2e52cb2281b7f3a54af1e9ef328c17a26db3e'}, {'image_id': '313891_1_En_17_Fig28_HTML', 'image_file_name': '313891_1_En_17_Fig28_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig28_HTML.jpg', 'caption': '(a–b) HIV/AIDS related miliary tuberculosis. (a) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric and in even size and distribution. (b) CT scanning of the mediastinal window demonstrates round liked nodular shadows in the right lower lung. CT guided puncture for biopsy is performed to define the diagnosis', 'hash': '1ae71db3f6eebb2e460b8f3b777873d5e7fcf066436bf3a85ef8123aff3f39a9'}, {'image_id': '313891_1_En_17_Fig105b_HTML', 'image_file_name': '313891_1_En_17_Fig105b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig105b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary toxoplasmosis. (a–d) CT scanning demonstrates thickened pulmonary markings in both lungs, which can be enhanced to extend into the middle and outer zones of lungs, in grid liked appearance that is more obvious in the dorsal segment of the lungs. (e) It is demonstrated to have clustering toxoplasma tachyzoites', 'hash': '78ad5a602c243399be530b578f5858d7393984c75f2f978c1dd02f12b26b8836'}, {'image_id': '313891_1_En_17_Fig99_HTML', 'image_file_name': '313891_1_En_17_Fig99_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig99_HTML.jpg', 'caption': '(a, b) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates enlarged right hilus, thickened and deranged lung markings. (b) Plain CT scanning demonstrates mass shadows in the right hilus, spots shadows in the right middle and lower lobes, and patchy shadows in the lingual segment of the left lung', 'hash': '996d2e340f8971525deb4ef2a9312fe4a696f4d7f6bf28ca091e8c767b96b1d4'}, {'image_id': '313891_1_En_17_Fig3b_HTML', 'image_file_name': '313891_1_En_17_Fig3b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig3b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy and scattered miliary increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of the lower lung field, with some fused in thin cloudy shadows', 'hash': '8c1d9dac035274e484303c9deb64a07fed7806c66acaf49b860164feb6d461fc'}, {'image_id': '313891_1_En_17_Fig70_HTML', 'image_file_name': '313891_1_En_17_Fig70_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig70_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window demonstrates a huge cavity shadow in the dorsal segment of the right lower lung, large nodular shadows in it, liquid gas level in the basal cavity, and the evenly thick wall. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates a huge cavity shadow in the dorsal segment of the left lung, multiple large nodular shadows in it, and involved pleura of the lateral chest wall', 'hash': '967426acae68b8d57372efde07d76dd6ad696b10cc5bb64fb67bd9af43a1b0c8'}, {'image_id': '313891_1_En_17_Fig108_HTML', 'image_file_name': '313891_1_En_17_Fig108_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig108_HTML.jpg', 'caption': 'HIV/AIDS related lymphoma. DR demonstrates widened upper middle mediastinum in a dense shadow, enlarged and thickened hilum, thickened and blurry pulmonary markings with diffuse ground glass liked changes', 'hash': '449c992b619237febe63b1617b26f78de511c69c5d1c86ddbd66631790a3e3ce'}, {'image_id': '313891_1_En_17_Fig18_HTML', 'image_file_name': '313891_1_En_17_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig18_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates multiple patchy shadows with increased density in both lungs which are more obvious in both middle and lower lungs. The hilar shadows in both lungs are enlarged, with sharp both costophrenic angles. (b–d) CT scanning demonstrates multiple patchy and mass liked parenchyma shadows in both lungs, ground glass density shadows in the apical segment of both upper lobes, transparent areas in the medial segment of the right middle lobe as well as in the lingual segment of the left upper lobe, and unobstructed trachea and bronchi', 'hash': '18239548bfc8a180d3460173e2f66f27c6ff38e464607d7ec3eb2a837a1382c9'}, {'image_id': '313891_1_En_17_Fig67b_HTML', 'image_file_name': '313891_1_En_17_Fig67b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig67b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows. (e–h) Reexamination of the pulmonary window after 3 months treatment demonstrates multiple scattered round liked nodular shadows and thick wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows which obviously increase and enlarge compared to previous lesions, with accompanying infiltration shadows around the lesions', 'hash': 'f70faec5b814f1fa9555182e0f5414a33838b2496e4da16dc69e0c237676eb30'}, {'image_id': '313891_1_En_17_Fig115a_HTML', 'image_file_name': '313891_1_En_17_Fig115a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig115a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lung cancer. (a–f) CT scanning demonstrates diffuse soft tissue density shadows in left upper lung, round liked mass shadows in the middle lung field, thickened pleura in the lateral chest wall with adhesion, and strip liked liquid density shadows', 'hash': '08de7c80ca9fdc7641723bbb9689498f65631a1a2ee1f499cda653be3ea3d358'}, {'image_id': '313891_1_En_17_Fig40_HTML', 'image_file_name': '313891_1_En_17_Fig40_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig40_HTML.jpg', 'caption': '(a, b) HIV/AIDS related endobronchial tuberculosis. (a, b) Chest CT scanning demonstrates narrowed left major bronchus, irregular thickening of the brounchial wall, multiple irregular flaky, patchy and military shadows in the posterior apical, anterior and lingual segments of the left upper lung. Bronchobierscopy demonstrates narrowed left major bronchus, which is possibly caused by endobronchial tuberculosis', 'hash': '4e416b52d4cb1a2790ee8ad419d525b4e0b37740624cb136f4f5d66c98344651'}, {'image_id': '313891_1_En_17_Fig106b_HTML', 'image_file_name': '313891_1_En_17_Fig106b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig106b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related lymphoma. (a–b) DR demonstrates enlarged and thickened left hilum in a huge mass shadow. High KV demonstrates a huge mass shadow in the hilum. (c–h) CT scanning of the pulmonary window demonstrates a huge high density mass shadow in the left hilum, surrounding nodular fusion shadows in the lung tissues. CT scanning of the mediastinal window demonstrates a huge high density mass shadow in the left hilum, with air bronchogram sign in the shadow', 'hash': '157c65f2ce36513c7bad3d16abf703fde23671a6d95e1da5b62342efd5b516bb'}, {'image_id': '313891_1_En_17_Fig75a_HTML', 'image_file_name': '313891_1_En_17_Fig75a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig75a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval or sphere shaped nodular shadows in the cavities with smooth boundaries. (e, f) Reexamination after treatment demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval nodular shadows in the cavity with smooth boundaries. Compared to the previous imaging findings, the lesions are shrunk, with improved surrounding infiltration', 'hash': 'd2c91d61cbf8a801eed1951a78b54e9b966e9be37aee83d7582af7a496143832'}, {'image_id': '313891_1_En_17_Fig66b_HTML', 'image_file_name': '313891_1_En_17_Fig66b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig66b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates large flaky shadows with increased density in the right upper lung, with blurry boundaries; round liked or sphere shaped mass shadows in the right lower lung, with uneven density. (b–e) CT scanning of the pulmonary window demonstrates multiple round liked thick-wall cavities in the dorsal segment of the right lower lung, with small nodular shadow adhering on the cavity wall; and surrounding small nodular shadows and infi ltration shadows. (f, g) Coronal CT scanning reconstruction demonstrates a huge thick-wall cavity in the right upper lung, with irregular thickness of the wall; round liked cavity shadows in the right lower lung, with thick and multilocular walls; and flaky shadows with increased density in the outer zone of the left lower lung', 'hash': 'fe0cc9e767d47fe24d043db5792869e260b44f40097a6c4d26c923e91ef70b0b'}, {'image_id': '313891_1_En_17_Fig98a_HTML', 'image_file_name': '313891_1_En_17_Fig98a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig98a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates thickened lung markings in both lungs, which extend to the outer zone of the lungs. (b) DR demonstrates thickened and deranged lung markings in both lungs with nodular blurry shadows; and cloudy shadows in lung fields. (c, d) CT scanning demonstrates thickened lung markings in both lungs, with diffuse nodular shadows; and cloudy changes in lung fields. (e) HE staining demonstrates cytomegalovirus inclusions', 'hash': 'adcabf812efa2a551bb7a968e7cf0afcc7677ffb9adf3d1a40a65675496e4552'}, {'image_id': '313891_1_En_17_Fig50_HTML', 'image_file_name': '313891_1_En_17_Fig50_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig50_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Staphylococcus aureus pneumonia. (a) DR demonstrates large flaky dense shadow in the right middle-upper lung field, with blurry boundary. (b, c) CT scanning demonstrates large flaky dense shadow in the right middle upper lung field, with blurry boundary. (d, e) CT scanning demonstrates large flaky dense shadow in the right middle upper lung field, with cystic transparent area in it. (f) Reexamination demonstrates obviously improved pulmonary lesions in the right lung after anti-bacteria treatment for 3 weeks', 'hash': 'bb5e00f8d7a7c6c4308ca4e5024daa75df1bf9a0a88359faa7e2ee91a6c5f156'}, {'image_id': '313891_1_En_17_Fig114a_HTML', 'image_file_name': '313891_1_En_17_Fig114a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig114a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related Kaposi’s sarcoma. (a–d) CT scanning demonstrates scattered cloudy mass and flakes liked or nodular shadows with increased density in both lungs with uneven density and unclear boundaries, fusion and parenchymal changes of some lesions, more lesions in the lower lobe of both lungs and mostly with parenchymal changes. (e, f) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large and thick stained nucleoli, which are in line with the manifestations of Kaposi’s sarcoma. (g, h) Immunohistochemical demonstrates positive of C3 and C4', 'hash': '5d7437deda7758de05e56f8172703b4659fa4eeebdc50c92456867e7bfdb2691'}, {'image_id': '313891_1_En_17_Fig107b_HTML', 'image_file_name': '313891_1_En_17_Fig107b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig107b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related lymphoma. (a–e) CT scanning of the pulmonary and mediastinal windows demonstrates multiple round liked nodular shadows with increased density in both lung fields, with clear boundaries; large soft tissue mass shadows in the right lower lung, with slightly lobulated boundaries and spikes. (f–i) CT scanning of the pulmonary and mediastinal windows for reexamination after radiation therapy demonstrates shrinkage of intrapulmonary nodules and masses', 'hash': 'a7c148d3f71f853c603d1730a516c4b571960bd1e6296b96b6418a73f3663e33'}] | {'313891_1_En_17_Fig1_HTML': ['By naked eyes observation, there are extensive and diffuse invasion of lungs, which is soft like waterlogged sponge and in milky white with black spots. The filled foamy substance in the alveoli and bronchioles is a mixture of necrotic fungus and immunoglobulin. The alveolar septum has infiltration of plasma cells and lymphocytes, resulting in thickened alveolar septa up to 5–20 times as the normal thickness that occupy 3/4 of the entire lung volume. The cysts are firstly located in the macrophage cytoplasm of the alveolar septa. Subsequently, the alveolar cells containing cysts sheds off into the alveolar space. After the rupture of the cystic wall, sporozoite is discharged to turn into free trophozoites, which gains its access into the alveolar space. The alveolar exudates include plasma cells, lymphocytes and histocytes (Fig. <xref rid="313891_1_En_17_Fig1_HTML" ref-type="fig">17.1a–c</xref>).\n).\nFig. 17.1(a) Gross specimens’ observation demonstrates foamy liquid filling in the lung tissues. (b) HE demonstrates pneumocystis in the alveolar exudates, which can be stained black by silver methenamine staining, ×400. (c) HE demonstrates the foamy substance in the alveolar space, ×400\n'], '313891_1_En_17_Fig19_HTML': ['If the necrotic lesions erode the blood vessels, tubercle bacilli can cause systemic miliary tuberculosis along with blood flow, including brain, bones and kidneys. Large quantity sputum containing tubercle bacilli gains its access into the gastrointestinal tract. It can also cause intestinal tuberculosis and peritoneal tuberculosis. Pulmonary tuberculosis can cause tuberculosis pleurisy via direct spreading to the pleura (Fig. <xref rid="313891_1_En_17_Fig19_HTML" ref-type="fig">17.19a–c</xref>).\n).\nFig. 17.19(a) Gross observation in autopsy demonstrates disseminated pulmonary tuberculosis, with grayish white military nodules in diffuse distribution in the lung tissues section. (b) It is demonstrated that mycobacteriumavium-intracellularcomplex infection in the lung tissue, with atypical tuberculosis nodules and acid-fast staining positive (left top). There are a subnodular giant cell, eosinophilic inclusion bodies in the nucleus and bradyzoites in cytoplasm of T. gondii. HE\u2009×\u2009100. (c) HE demonstrates mycobacteriumavium-intracellularcomplex infection, with atypical tuberculosis nodular changes, HE\u2009×\u2009200\n'], '313891_1_En_17_Fig45_HTML': ['Pneumonia caused by inhaled staphylococcus aureus through the respiratory tract often shows lesions in the large lobes or extensive fusion of bronchopneumonia lesions. Bronchial and alveolar rupture allows gas to enter the pulmonary interstitium, which is communicated with the bronchi. In the cases of bronchiolar blockage by necrotic tissues or pus, the one-way valve effect is formed to cause tension pulmonary emphysema. In the cases with superficial pulmonary emphysema with excessively high tension, it ruptures to form pneumothorax or pyopneumothorax, as well as bronchooleural fistula (Fig. <xref rid="313891_1_En_17_Fig45_HTML" ref-type="fig">17.45a, b</xref>).\n).\nFig. 17.45(a, b) HIV/AIDS related Staphylococcus aureus pneumonia. (a) Gross specimen observation demonstrates bilateral purplish brown lesions, patchy white infiltration at the base of the lungs. (b) HE staining demonstrates alveolar diffuse lesions, exudation of the serous fluid and inflammatory cells in the alveolar cavity, and alveolar wall congestion\n'], '313891_1_En_17_Fig64_HTML': ['Aspergillus commonly violates bronchus and lung, with involvements of rhinal sinuses, external auditory canal, eye and skin. Otherwise, it disseminates to organs of the body along with blood flow. The early lesions are diffuse infiltrative and exudative changes. And advanced lesions are necrosis, pyogenesis or granuloma. Large quantity hyphae can be found in the lesions. The hyphae penetrate the blood vessels to cause vasculitis, perivascular inflammation and thrombosis. And thrombosis can cause ischemia and necrosis of the tissue. According to the pathological changes and imaging findings, it can be divided into three major types: vascular invasion type, bronchopneumonia type and allergic bronchopulmonary aspergillosis type. (1) The vascular invasion type is the result caused by toxins released in the process of aspergillus spreading extensively from the primary focus to the lungs. Vascular infiltration of the pulmonary parenchyma and coagulative necrosis are believed to be the cause of vascular occlusion and pulmonary infarction. (2) Bronchopneumonia type is acute bronchitis caused by inhalation of Aspergillus spores. In the cases of hyphae invasion into the lung tissues, extensive infiltrative pneumonia or focal granuloma are resulted in. It can also cause necrosis, pyogenesis and multiple small abscesses. Spherical pulmonary aspergillosis is often secondary to bronchiectasis, tuberculosis, carcinous cavity and other lung diseases. Mycelia multiply and gather in the cavities of the lungs to form a spherical mass with fibrin and mucosal cells, which are called aspergillar glomera, which do not invade the lung tissue. (3) Allergic bronchopulmonary aspergillosis type is the proliferation and germination of inhaled Aspergillus spore in the airway, often showing obvious related mucosal lesions and eventually resulting in bronchiectasis (Fig. <xref rid="313891_1_En_17_Fig64_HTML" ref-type="fig">17.64a–c</xref>).\n).\nFig. 17.64(a) Gross observation demonstrates dark brown lungs in appearance. (b, c) Thology demonstrates hemorrhage and edema of the lung tissue and focal necrosis, with large quantity Aspergillus hyphae and spores in the surrounding area of the necrosis (Combined with pulmonary CMV infection)\n'], '313891_1_En_17_Fig77_HTML': ['In the early stage of cryptococcal infection, only a mild inflammatory reaction or diffuse infiltrative exudative changes occur. But in the advanced stage, necrosis, suppuration or granuloma is formed. Large quantity hyphae can be found in the focus. In the cases with hyphae penetrating the blood vessels, vasculitis, perivascular inflammation and thrombosis occur. And thrombosis leads to ischemia and necrosis of the tissue (Fig. <xref rid="313891_1_En_17_Fig77_HTML" ref-type="fig">17.77</xref>).\n).\nFig. 17.77HE staining demonstrates isseminated cryptococci, the Cryptococcus is stained red after mucin carmine staining of cryptococcus neoformans spores in lungs, (HE\u2009×\u2009200)\n'], '313891_1_En_17_Fig97_HTML': ['Cytomegalovirus pneumonia has extensive pathological changes in the lungs. Pathologically, it shows interstitial pneumonia, with the lesions randomly blood borne distributing in the lungs. The distribution can be diffuse, panlobular or focal. The target cells of pathological changes include alveolar cells and macrophages. Diffused pulmonary interstitial edema and fibrosis as well as alveolar swelling, focal necrosis, bleeding and hyperplasia occur after CMV infections to cause hypoxemia. Gross observation of fresh specimens demonstrates pulmonary surface edema and flaky blooding spots. Fixed specimens demonstrate brown hard lung tissues. Under a microscope, pulmonary interstitial congestion as well as infiltration of lymphocytes and mononuclear cells can be found, with the involved epithelial cells enlarged. In the pulmonary interstitium and alveoli, there are intranuclear inclusions, cytoplasmic inclusions and fluid containing abundant proteins. The classical intranuclear inclusions can be found in the cells, purplish red or purplish blue, round or oval, with surrounding halos in eagle eyes sign. Atypical cytomegalic inclusions in cells are slender, long and round liked with abundant cytoplasm and accentric nucleolus, which are blurry, unclear and atypical (Fig. <xref rid="313891_1_En_17_Fig97_HTML" ref-type="fig">17.97a–e</xref>). Immunohistochemitry demonstrates HIV P24 antigen positive.\n). Immunohistochemitry demonstrates HIV P24 antigen positive.\nFig. 17.97(a) Gross observation of the fresh specimen in autopsy demonstrates pulmonary edema and congestion of cytomegalovirus pneumonia. (b) Gross observation of the formalin fixed specimen in autopsy demonstrates dark brown hard pulmonary tissues. (c, d) HE staining demonstrates large quantity cytomegalovirus inclusions in eagle eyes sign. (e) Immunohistochemical demonstrates HIV P24 antigen positive in macrophages of lung tissues (×400)\n']} | HIV/AIDS Related Respiratory Diseases | [
"HIV/AIDS related pneumocystis carnii pneumonia (PCP)",
"HIV/AIDS related pulmonary bacterial infections",
"HIV/AIDS related pulmonary fungal infections",
"HIV/AIDS related pulmonary virus infections",
"HIV/AIDS related pulmonary parasitic diseases",
"HIV/AIDS related pulmonary neoplasm"
] | None | 1380524400 | None | null | other | PMC7121050 | null | null | [
""
] | Radiology of HIV/AIDS. 2013 Sep 30;:377-535 | NO-CC CODE |
|
(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates diffusely distributed shadows with increased density in both lungs that is more obvious in the middle and lower lungs. The hilar shadows in both lungs are enlarged. Both diaphragmatic surfaces and phrenic angles are blurry. (b–d) CT scanning demonstrates flaky shadows with increased density in both lungs, with parenchymal shadows in the lingular segment of left upper lobe and in the dorsal segments of both lower lobes and bronchial shadows in them. There are also thickened bronchial walls and enlarged hilar shadows in both lungs | 313891_1_En_17_Fig7b_HTML | 7 | 47bf3b06e99aa6482027b30084d7445e95928d39923c99fd8fe93df39c899b2d | 313891_1_En_17_Fig7b_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
782,
282
] | [{'image_id': '313891_1_En_17_Fig115b_HTML', 'image_file_name': '313891_1_En_17_Fig115b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig115b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lung cancer. (a–f) CT scanning demonstrates diffuse soft tissue density shadows in left upper lung, round liked mass shadows in the middle lung field, thickened pleura in the lateral chest wall with adhesion, and strip liked liquid density shadows', 'hash': '37ffef88f4c6dffdd2849b9994419efe1bf8f369ad111d82071f2f004a9fa43f'}, {'image_id': '313891_1_En_17_Fig106a_HTML', 'image_file_name': '313891_1_En_17_Fig106a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig106a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related lymphoma. (a–b) DR demonstrates enlarged and thickened left hilum in a huge mass shadow. High KV demonstrates a huge mass shadow in the hilum. (c–h) CT scanning of the pulmonary window demonstrates a huge high density mass shadow in the left hilum, surrounding nodular fusion shadows in the lung tissues. CT scanning of the mediastinal window demonstrates a huge high density mass shadow in the left hilum, with air bronchogram sign in the shadow', 'hash': '1ff6a74f6517ed666fda8da1eb38cd58b7d92c3687c533350df4caf4cb7ba7d7'}, {'image_id': '313891_1_En_17_Fig67a_HTML', 'image_file_name': '313891_1_En_17_Fig67a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig67a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows. (e–h) Reexamination of the pulmonary window after 3 months treatment demonstrates multiple scattered round liked nodular shadows and thick wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows which obviously increase and enlarge compared to previous lesions, with accompanying infiltration shadows around the lesions', 'hash': '75b2dd5456ce09da0ace0b9787ea5a36d49c80e174314762343564032297b51c'}, {'image_id': '313891_1_En_17_Fig14_HTML', 'image_file_name': '313891_1_En_17_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig14_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, mass and flakes of parenchymal shadows in the posterior segment of the right upper lobe and in the dorsal segment of both lower lobes which is more obvious in the right lung, and bronchial shadows in them', 'hash': 'bc4343d2071f380a05855c1e658dc05d90d8ae123e988cfe12c3e65526b3336c'}, {'image_id': '313891_1_En_17_Fig104_HTML', 'image_file_name': '313891_1_En_17_Fig104_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig104_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymphoid interstitial pneumonia. (a–f) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs in reticular appearance, with accompanying multiple small nodular shadows, fusion of some nodules into flaky shadows, and ground glass liked changes in the lung fields', 'hash': '4883f041ed6e05ad0ce9ee6734fea4171aae151209ba36cbce94c8434c86f174'}, {'image_id': '313891_1_En_17_Fig98b_HTML', 'image_file_name': '313891_1_En_17_Fig98b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig98b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates thickened lung markings in both lungs, which extend to the outer zone of the lungs. (b) DR demonstrates thickened and deranged lung markings in both lungs with nodular blurry shadows; and cloudy shadows in lung fields. (c, d) CT scanning demonstrates thickened lung markings in both lungs, with diffuse nodular shadows; and cloudy changes in lung fields. (e) HE staining demonstrates cytomegalovirus inclusions', 'hash': '489286db9d367c09fbc842e4d1ba093d9caa6ded75760e9e1a70e05a86f43979'}, {'image_id': '313891_1_En_17_Fig53_HTML', 'image_file_name': '313891_1_En_17_Fig53_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig53_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) Anteroposterior and lateral DR demonstrates enlarged and thickened left hilum, and large flaky blurry shadows with increased density in the left lower lung. (c, d) Reexamination demonstrates normal lungs after antibiotic treatment', 'hash': 'd9cd861c21f1100d02e20014901c7e4a9a9bcad2e4ddcd3c731b50168d8782be'}, {'image_id': '313891_1_En_17_Fig114b_HTML', 'image_file_name': '313891_1_En_17_Fig114b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig114b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related Kaposi’s sarcoma. (a–d) CT scanning demonstrates scattered cloudy mass and flakes liked or nodular shadows with increased density in both lungs with uneven density and unclear boundaries, fusion and parenchymal changes of some lesions, more lesions in the lower lobe of both lungs and mostly with parenchymal changes. (e, f) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large and thick stained nucleoli, which are in line with the manifestations of Kaposi’s sarcoma. (g, h) Immunohistochemical demonstrates positive of C3 and C4', 'hash': '586be9acfd2434fad0db1a2ffaba9ac72eb8eb799b76acdaeac2730c48c45020'}, {'image_id': '313891_1_En_17_Fig107a_HTML', 'image_file_name': '313891_1_En_17_Fig107a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig107a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related lymphoma. (a–e) CT scanning of the pulmonary and mediastinal windows demonstrates multiple round liked nodular shadows with increased density in both lung fields, with clear boundaries; large soft tissue mass shadows in the right lower lung, with slightly lobulated boundaries and spikes. (f–i) CT scanning of the pulmonary and mediastinal windows for reexamination after radiation therapy demonstrates shrinkage of intrapulmonary nodules and masses', 'hash': '4ca6acd1461c3d7b80869d7d33bd1a3d91ecd1a0dc1b5c7baecc0bfbcf817449'}, {'image_id': '313891_1_En_17_Fig75b_HTML', 'image_file_name': '313891_1_En_17_Fig75b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig75b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval or sphere shaped nodular shadows in the cavities with smooth boundaries. (e, f) Reexamination after treatment demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval nodular shadows in the cavity with smooth boundaries. Compared to the previous imaging findings, the lesions are shrunk, with improved surrounding infiltration', 'hash': 'b1a96158009afcb5e673cf31f9243ca598c763c294bbdc7479a918fb36b031e8'}, {'image_id': '313891_1_En_17_Fig25d_HTML', 'image_file_name': '313891_1_En_17_Fig25d_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25d_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '1e7425ad1ac60b1c612434d02bbe7d48ba0fb82e0642b09b8771b4fea9a7a4c2'}, {'image_id': '313891_1_En_17_Fig66a_HTML', 'image_file_name': '313891_1_En_17_Fig66a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig66a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates large flaky shadows with increased density in the right upper lung, with blurry boundaries; round liked or sphere shaped mass shadows in the right lower lung, with uneven density. (b–e) CT scanning of the pulmonary window demonstrates multiple round liked thick-wall cavities in the dorsal segment of the right lower lung, with small nodular shadow adhering on the cavity wall; and surrounding small nodular shadows and infi ltration shadows. (f, g) Coronal CT scanning reconstruction demonstrates a huge thick-wall cavity in the right upper lung, with irregular thickness of the wall; round liked cavity shadows in the right lower lung, with thick and multilocular walls; and flaky shadows with increased density in the outer zone of the left lower lung', 'hash': 'efec688fc6d0fd9fc9188edcc4a4bb040754e9c9e3261fcacec068f3bfd0252f'}, {'image_id': '313891_1_En_17_Fig63_HTML', 'image_file_name': '313891_1_En_17_Fig63_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig63_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Rhodococcus equi pneumonia. (a) Pulmonary CT scanning demonstrates a mass shadow in the lateral segment of the right middle lobe in size of 4.7\u2009×\u20093.7\u2009×\u20093.2 cm with uneven density and lace liked boundary, and small bubbles shadows in it. By both sputum culture and lung tissue culture, Rhodococcus equi can be detected. (b, c) Pathological biopsy and HE staining demonstrate inflammatory pseudotumor. (d, e) Immunohistochemistry demonstrates Rhodococcus equi antibody positive. (f) Reexamination after treatment demonstrates obvious shrinkage of the original lung lesions', 'hash': 'ac97b316499d751a48d8b861962da376a39c7ff11d2554ed957c226224dc65b6'}, {'image_id': '313891_1_En_17_Fig2a_HTML', 'image_file_name': '313891_1_En_17_Fig2a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig2a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered miliary increased density shadows in both lungs, with even size, density and distribution. The shadows of both hila are dense, with sharp both costophrenic angles. (b–f) CT scanning demonstrates scattered miliary nodular shadows in both lungs, which is more obviously in the middle pulmonary strip and with quite even size and density. Trachea and bronchi are unblocked', 'hash': 'ec4f2f75b5bb59b2cb13f016c2ea6714bdc3c908077c2697af2218aa485876b7'}, {'image_id': '313891_1_En_17_Fig13a_HTML', 'image_file_name': '313891_1_En_17_Fig13a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig13a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, transparent areas in them and unblocked trachea and bronchi', 'hash': '7d26c2f94a34f3ff7c4f64d485fe29e114936d0f4db53489ee88148a1a6fc8bf'}, {'image_id': '313891_1_En_17_Fig65a_HTML', 'image_file_name': '313891_1_En_17_Fig65a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig65a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related allergic pulmonary Aspergillus infection. (a–f) CT scanning of the pulmonary window demonstrates thickened central pulmonary markings in both lungs, which is turtuous and deranged with fingertip infiltration shadows. (g) DR demonstrates hyperinflation of the right lung, increased and thickened pulmonary markings and ground glass liked shadows with increased density in the right lower lung and left lung lobe', 'hash': '6fa5ade163d7465c0dc3eb89ebc58d57b98674fc2680824cc5a81c478b81fbc4'}, {'image_id': '313891_1_En_17_Fig76b_HTML', 'image_file_name': '313891_1_En_17_Fig76b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig76b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning demonstrates diffuse scattered thin ground glass liked, patchy, flaky blurry shadows and cords liked shadows in both lungs, with blurry boundaries and uneven density; scattered nodular shadows in different sizes; more lesions in both upper lobes and the right middle lobe; flaky parenchyma shadows in the apical and posterior segments of right upper lobe, with air bronchogram sign in them; unobstructed opening of bronchi as well as lobar and segmental bronchi without stenosis and obstruction; lymphadenectasis in the right hilar region; detected Aspergillus fumigatus by sputum culture. (e, f) Culture for 72 h, lactic acid gossypol blue staining and microscopic observation at ×200 and ×400 demonstrate short column liked conidial head, smooth wall of conidiophores, flask-shaped top capsule and monolayer microconidiophores. (g) Culture in Paul’s medium demonstrates dark green colored colonies', 'hash': 'af925cb00cbd4eed9e67dc49fd012909ecdfe48493ac645d8b2185eb4f351655'}, {'image_id': '313891_1_En_17_Fig105a_HTML', 'image_file_name': '313891_1_En_17_Fig105a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig105a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary toxoplasmosis. (a–d) CT scanning demonstrates thickened pulmonary markings in both lungs, which can be enhanced to extend into the middle and outer zones of lungs, in grid liked appearance that is more obvious in the dorsal segment of the lungs. (e) It is demonstrated to have clustering toxoplasma tachyzoites', 'hash': '30f16a35256e45c89dfcd68adf661507960a5b978db88cc531a7605d9fff53df'}, {'image_id': '313891_1_En_17_Fig95_HTML', 'image_file_name': '313891_1_En_17_Fig95_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig95_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a) CT scanning of the pulmonary window demonstrates irregular large flaky shadows with increased density in the dorsal segment of both lower lobes; enlarged hilum in both lungs, cords liked thickening of the vascular vessels. (b) CT scanning of the mediastinal window demonstrates flaky parenchyma shadows in the left lower lung, thickening of both pleura, enlarged hilum shadows in both lungs, thickened right lower bronchial wall. (c) Microscopy after culture at 25 °C demonstrates branches and separated hyphae and its string of small spores, with typical penicillus but no sporangium (Medan staining, ×400). (d) Bone marrow smear demonstrates round or oval cells like the yeast phase within the macrophages; longer cells like the yeast phase outside the macrophages. The two kinds of cells have slightly curved ends in sausages liked appearance (HE staining, ×400)', 'hash': '636de07e02ba7cf1f73f2a03bccf4fdaac68bc4a122b7fbfe2febe72dd42f139'}, {'image_id': '313891_1_En_17_Fig3a_HTML', 'image_file_name': '313891_1_En_17_Fig3a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig3a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy and scattered miliary increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of the lower lung field, with some fused in thin cloudy shadows', 'hash': 'e655c40874d38beaa8a8e9f0e82c1eb12a6756b09bee559229354b3756010a18'}, {'image_id': '313891_1_En_17_Fig73_HTML', 'image_file_name': '313891_1_En_17_Fig73_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig73_HTML.jpg', 'caption': '(a–c) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates diffuse dense shadows in both lower lung fields which is in a arcuate surface with exterior high and interior low (pleural effusion). (b, c) CT scanning of the mediastinal window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavities; thickened pleura of the lateral chest wall, with accompanying encapsulated effusion', 'hash': '9ad36ea5213bea731770658b27be87e1af9e34bced02cda664a7f485e40f2315'}, {'image_id': '313891_1_En_17_Fig54_HTML', 'image_file_name': '313891_1_En_17_Fig54_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig54_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates round liked large flaky shadows with increased density in the left lower lung, enlarged and thickened hilus. (c, d) DR reexamination after treatment demonstrates flocculent shadows in the left lower lung, with improved conditions than previous findings before treatment (a, b)', 'hash': 'f9b4f22920ef55d9110380df6f64a6a508ecea9ca3192877a2d47400e781c58d'}, {'image_id': '313891_1_En_17_Fig58b_HTML', 'image_file_name': '313891_1_En_17_Fig58b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig58b_HTML.jpg', 'caption': '(a–i) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) CT scanning of the pulmonary window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (c, d) CT scanning of the mediastinal window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, pulmonary atelectasis and pleural effusion, with ventilation shadows in them. (e) CT scanning of the pulmonary window after the treatment demonstrates absence of the mass shadows in the left lower lung with transverse stripes shadows, obviously improved than previous findings (a, b). (f) HE staining demonstrates thickened alveolar septa and exudates from the alveolar cavity. (g) HE staining demonstrates massive bleeding in the alveolar cavity, large quantity erythrocytes and intact cell walls. (h) HE staining demonstrates phagocytized basophilic granules in the leukocytes. (i) HP staining demonstrates purplish red Rhodococcus equi in a shape of crescent in orange red sputum', 'hash': 'ca8456a79f660fc4faa5eb9342f84a14bbe25eedd8fb237ac65bd96b8de6e5b9'}, {'image_id': '313891_1_En_17_Fig25c_HTML', 'image_file_name': '313891_1_En_17_Fig25c_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25c_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '64e0ceda545f1684d11c717eef852c6576036d711540954850cc018aadfefa87'}, {'image_id': '313891_1_En_17_Fig44_HTML', 'image_file_name': '313891_1_En_17_Fig44_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig44_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary nontuberculous mycobacterial infection. (a–d) CT scanning demonstrates multiple cavities in the left lung field, bilateral multiple lobular central nodules and extensive branches liked linear shadows in tree buds sign. There are also large flaky parenchymal changes of the lung tissues in the left lower lung field in high density shadows, with accompanying air bronchogram sign. (e) HE staining demonstrates avium intracellular complex mycobacteria infection of lung tissues in atypical tuberculous nodular changes. (HE\u2009×\u2009200)', 'hash': '8f8697761c60c3cb27c0b413c2e19433df26ba07a74ea0a0cc0b6f2b4acc7b65'}, {'image_id': '313891_1_En_17_Fig103_HTML', 'image_file_name': '313891_1_En_17_Fig103_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig103_HTML.jpg', 'caption': '(a–d) HIV/AIDS related lymphoid interstitial pneumonia. (a–d) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs, in reticular appearance; with accompanying multiple small nodular shadows', 'hash': '8d52c3bac6fb07e3eaf12386767e159f762db3072e09365be542c937697babe7'}, {'image_id': '313891_1_En_17_Fig110b_HTML', 'image_file_name': '313891_1_En_17_Fig110b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110b_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '5526a48dae3face516d842ba229b164bac3062f56c5e811bb1e725778fd20823'}, {'image_id': '313891_1_En_17_Fig5a_HTML', 'image_file_name': '313891_1_En_17_Fig5a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig5a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates patchy shadows with increased density in both lungs, with thickened hilar shadows in both lungs. (b–g) CT scanning demonstrates flaky ground glass liked density shadows in upper lungs and dorsal segment of both lungs, which is more obvious in the middle inner strips. There are extrapulmonary stripes transparent shadows, with some bronchial walls thickened and enlarged hilar shadows in both lungs', 'hash': '5d6ab0400e0331b0fcb3a3679023a44fa81b7b9c9eedc00c0ddb6d85208c3512'}, {'image_id': '313891_1_En_17_Fig74_HTML', 'image_file_name': '313891_1_En_17_Fig74_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig74_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates round liked uneven density shadows in the medial segments of both middle and lower lungs, multilocular hollow holes in the cavities, surrounding multiple round liked thick-wall small cavity shadows and ground grass liked infiltration shadows. (b–d) CT scanning of the pulmonary window demonstrates scattered round liked uneven density shadows in the right hilum and lower lung, multilocular hollow holes in the cavities; and surrounding multiple round liked thick-wall small cavity shadows and ground grass liked infiltration shadows', 'hash': 'e4c42cc0cb1f1bdfa8b2cc1f3c8eab7223c4be368a808e8b6c4b01af78dfb04a'}, {'image_id': '313891_1_En_17_Fig23_HTML', 'image_file_name': '313891_1_En_17_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig23_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymph node tuberculosis. (a–c) CT scanning of the pulmonary window demonstrates dense mass shadow beside the right aortic arch, and thinner right bronchus due to compression. (d–f) CT scanning of the mediastinal window demonstrates low density mass shadow besied the right aortic arch with clear boundary', 'hash': '8d135ce7e96005006343dc3305be0f8c77d0828bccccf1726226c09fd47c365f'}, {'image_id': '313891_1_En_17_Fig6a_HTML', 'image_file_name': '313891_1_En_17_Fig6a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig6a_HTML.jpg', 'caption': '(a-d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates flaky ground glass liked density shadows in upper lobes of both lungs, with bronchial shadows in them; flaky parenchymal shadows in the subpleural apical segment; and thickened bronchial walls in the anterior and posterior segments of the right upper lobe', 'hash': '235548456c9bf72727a05a91fa6893d8a478f8f715c022d6b579d4a9188da366'}, {'image_id': '313891_1_En_17_Fig17a_HTML', 'image_file_name': '313891_1_En_17_Fig17a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig17a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchymal shadows and fibrous cords liked shadows in both lungs which are more obvious in both lower lungs. The trachea and bronchi are unblocked, with enlarged hilar shadows in both lungs', 'hash': '9c1c59095291dcf6a7b6dec786ec58ba44e9b83badfe4bbf121b7c677476f4d5'}, {'image_id': '313891_1_En_17_Fig113b_HTML', 'image_file_name': '313891_1_En_17_Fig113b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig113b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Kaposi’s sarcoma. (a–d) Chest CT scanning demonstrates scattered cloudy, mass and flake liked or nodular shadows with increased density. (e) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large thick stained nucleoli, which are in line with the diagnosis of Kaposi’s sarcoma. (f–i) Cured HIV/AIDS related Kaposi’s sarcoma. (f–i) Reexamination after treatment demonstrates absent lesions in both lungs, with clear lung fields', 'hash': '88e574b2d5ff4ee4ce28f38025d5345c8cf6b50386f752ae12083b05fe7af9de'}, {'image_id': '313891_1_En_17_Fig82_HTML', 'image_file_name': '313891_1_En_17_Fig82_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig82_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a, b) DR demonstrates enlarged blurry hilum in both lungs and thickened pulmonary markings. (c, d) CT scanning demonstrates mediastinal lymphadenectasis, narrowed trachea due to compression with liquefactive necrosis. Enhanced scanning demonstrates marginal enhancement and no central enhancement', 'hash': '18312183daaefbc6c48e05e67fab210a1109c24a6f94311ffb11ffdace007a49'}, {'image_id': '313891_1_En_17_Fig64_HTML', 'image_file_name': '313891_1_En_17_Fig64_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig64_HTML.jpg', 'caption': '(a) Gross observation demonstrates dark brown lungs in appearance. (b, c) Thology demonstrates hemorrhage and edema of the lung tissue and focal necrosis, with large quantity Aspergillus hyphae and spores in the surrounding area of the necrosis (Combined with pulmonary CMV infection)', 'hash': '104850f2999da711317f4e4f07e590bd8f73a93731daf090ece6023192606e90'}, {'image_id': '313891_1_En_17_Fig7a_HTML', 'image_file_name': '313891_1_En_17_Fig7a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig7a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates diffusely distributed shadows with increased density in both lungs that is more obvious in the middle and lower lungs. The hilar shadows in both lungs are enlarged. Both diaphragmatic surfaces and phrenic angles are blurry. (b–d) CT scanning demonstrates flaky shadows with increased density in both lungs, with parenchymal shadows in the lingular segment of left upper lobe and in the dorsal segments of both lower lobes and bronchial shadows in them. There are also thickened bronchial walls and enlarged hilar shadows in both lungs', 'hash': '431aab0770a1915c719095cc2bab91736f1ffda7b5649cdca5d8b7516003049c'}, {'image_id': '313891_1_En_17_Fig33_HTML', 'image_file_name': '313891_1_En_17_Fig33_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig33_HTML.jpg', 'caption': '(a, b) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates scattering patchy and cords liked blurry density shadows in the right middle and upper lung fields as well as enlarged and thickened hilum. (b) DR demonstrates that the lungs lesions are almost absent compared to (a), after anti-TB treatment for 5 months', 'hash': 'e710598bbbc8286721136f2a803716198a712c55253c4232d3ee33b2e33e188b'}, {'image_id': '313891_1_En_17_Fig62_HTML', 'image_file_name': '313891_1_En_17_Fig62_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig62_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) Anteroposterior and lateral DR demonstrates huge sphere liked mass shadow in the right hilum, with cavities shadows and liquid gas level in it. (c) HE staining demonstrates bleeding in the lung tissues and aggregation of large quantity lymphocytes. (d) Masson staining demonstrates branches liked purplish red Rhodococcus equi', 'hash': '261a4aca9e146cc16957c6280cd4795d7c2c5732d9a19006b6e398a1ae410af0'}, {'image_id': '313891_1_En_17_Fig84_HTML', 'image_file_name': '313891_1_En_17_Fig84_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig84_HTML.jpg', 'caption': '(a, b) HIV/AIDS related pulmonary cryptococcus infection. (a) CT scanning demonstrates round liked cavity shadows in the left upper and lower lung, with uneven thickness of the cavity wall and surrounding infiltrative shadows. (b) CT scanning demonstrates round liked dense mass shadows in the right upper lung, with clear boundaries and bulky drainage vessel shadows', 'hash': 'ecc614167ec536dcb80c2739886c957ff2f182dd49ac7f4d6379260497262e60'}, {'image_id': '313891_1_En_17_Fig4_HTML', 'image_file_name': '313891_1_En_17_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig4_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy or ground glass liked increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of lower lungs, with some fused into thin cloudy ground glass liked shadows with increased density, with decreased transparency of both lungs and enlarged hilar shadows in both lungs', 'hash': '636f9fd3d3c20c17e15e1ac70adcdcb6fbe268a70ac64d29317f73045747e226'}, {'image_id': '313891_1_En_17_Fig46a_HTML', 'image_file_name': '313891_1_En_17_Fig46a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig46a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates large flaky dense shadows in the middle-outer zone of the left middle lung field, and narrowed left bronchus. (d–f) CT scanning demonstrates large flaky shadows with uneven density in the left lateral chest wall and even lower density shadow in them', 'hash': 'afdfc2c33070f1d3b8616a542d989e0f908d9638327227057dfdf5ed59169359'}, {'image_id': '313891_1_En_17_Fig72_HTML', 'image_file_name': '313891_1_En_17_Fig72_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig72_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and cavity shadows in both lungs, with even wall thickness and small nodular shadows in some cavities', 'hash': 'd318b47b9b56854b6bc47081b08712ee9d828a2ae4592aa69451ec7105fd0240'}, {'image_id': '313891_1_En_17_Fig91b_HTML', 'image_file_name': '313891_1_En_17_Fig91b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig91b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–e) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of some lesions into honeycomb likes cavity shadows or plaque liked dense shadows. (f–h) CT scanning demonstrates large thick-wall cavity shadows in the right lung, surrounding plaque and round liked small cavity shadows and inflammatory infiltrative shadows', 'hash': '6b3a934b89abf6f7e8c9593337c0c57fe44161bcbfc546c7e2a3cfa50539f91e'}, {'image_id': '313891_1_En_17_Fig8a_HTML', 'image_file_name': '313891_1_En_17_Fig8a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig8a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates large flaky parenchyma shadows in both lungs which is more obvious in the middle and lower lobes of both lungs. There are also enlarged hilar shadows in both lungs and sharp both costophrenic angles. (b–g) CT scanning demonstrates large flaky parenchyma shadows in concentric and symmetrical distribution, bronchial shadows in them and thickened bronchial walls', 'hash': '7c4f2f4f9120af70727cab6fc69637733e17e807575648a0257b5b03367da625'}, {'image_id': '313891_1_En_17_Fig42_HTML', 'image_file_name': '313891_1_En_17_Fig42_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig42_HTML.jpg', 'caption': 'HIV/AIDS related tuberculous pleuritis. DR demonstrates arch shaped dense shadows with higher exterior density and lower interior density in the left lower lung field and covered right edge of the heart', 'hash': 'f0dfdb1b349a42c7092daeeaef76a8b8762e134b40ae21a6144d9785b9ddcd02'}, {'image_id': '313891_1_En_17_Fig15_HTML', 'image_file_name': '313891_1_En_17_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig15_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy blurry shadows and fibrous cords liked shadows in both lungs which are more obvious in the middle inner parts of both lungs, with transparent areas in them. The bronchial walls are thickened', 'hash': '4d262b5c06f74783c1b6df1f8c9d8c7ecbf235faacd2f2e846544a3e11d88e8b'}, {'image_id': '313891_1_En_17_Fig92b_HTML', 'image_file_name': '313891_1_En_17_Fig92b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig92b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of the lesions in the right lung into plaque liked shadows with clear boundaries, and multiple round liked small cavity shadows and inflammatory infiltrative shadows in both lungs', 'hash': '4613e0bd8bbb013024b2335ae2f7fb1997dab5d93ee1c395c97035d6e7d37750'}, {'image_id': '313891_1_En_17_Fig52_HTML', 'image_file_name': '313891_1_En_17_Fig52_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig52_HTML.jpg', 'caption': '(a, b) HIV/AIDS related staphylococcus aureus pneumonia. (a, b) DR demonstrates diffuse scattered multiple thin-walled transparent areas in both lungs, increased and blurry pulmonary markings, and enlarged heart shadow in flask shape (pericardial effusion)', 'hash': 'b54d395f8405b646839c68cb58c1a811c70fb8c7337443d24b61bfcfa097f5b0'}, {'image_id': '313891_1_En_17_Fig56b_HTML', 'image_file_name': '313891_1_En_17_Fig56b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig56b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates huge round large flaky shadows with increased density in the left lower lung, enlarged and thickened hilum and covered right heart edge. (c, d) DR reexamination after treatment for 1 week demonstrates flocculent shadow in the left lower lung, improved than those before the treatment (a, b). (e) DR reexamination after treatment demonstrates flocculent liked shadows in the left lower lung, obviously improved than before the treatment (c, d)', 'hash': 'e5f534ed9282980e95aaa6bac04091762128cf3e5c46985b190278c5d6396558'}, {'image_id': '313891_1_En_17_Fig93b_HTML', 'image_file_name': '313891_1_En_17_Fig93b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig93b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates diffuse small cavity in honeycomb liked and infiltrative parenchyma shadows, with the hilum as the center to distribute bilaterally symmetric like butterfly wings; multiple honeycomb liked cavity shadows in both lungs. (e–h) CT scanning reexamination demonstrates large irregular thick-wall cavities in the right lung, surrounding scattering nodular, honeycomba liked and infiltrative shadows after anti-PM infection treatment for 3 months', 'hash': '904e5a590c601ab02150f8c2487bbfa6f0282c1eddd547624ce8c549472221d9'}, {'image_id': '313891_1_En_17_Fig51b_HTML', 'image_file_name': '313891_1_En_17_Fig51b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig51b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related staphylococcus aureus pneumonia. (a) Chest X-ray demonstrates large flaky high density shadow in the left middle-lower lung field, with central transparent areas in different sizes and blurry boundaries; parenchyma changes of the left lower lung, predominantly in the posterior and exterior basal segments; unobstructed brounchus and thickened adjacent pleura. (b–d) CT scanning demonstrates large flaky shadows in fan shaped distribution along the bronchus in the left middle-lower lung, with gas containing cavities and high density shadows; and thickened adjacent pleura of the lateral chest wall. (e, f) CT scanning of the mediastinal window demonstrates large flaky fan shaped parenchymal shadows in the left middle-lower lung field, with ventilation shadows in them; and thickened pleura of the lateral chest wall. (g, h) Pathological examination showed staphylococcus aureus', 'hash': '18a6e1202b7b8c4a2d57fe024b7e8039a6dcee0f6f5f078b109a93850977c0f6'}, {'image_id': '313891_1_En_17_Fig94b_HTML', 'image_file_name': '313891_1_En_17_Fig94b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig94b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a–f) CT scanning demonstrates multiple nodules and small cavities in honeycomb liked shadows and infiltrative parenchyma shadows in the right lung; flaky transparent areas (bullae of lung) in the right anterior margin of the heart and in the outer zone of the left lung near lateral chest wall', 'hash': '3ed719abaaaec4ee19332842bd8dcac302eb6fefc73152dfd03a39702260d369'}, {'image_id': '313891_1_En_17_Fig34a_HTML', 'image_file_name': '313891_1_En_17_Fig34a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig34a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung and multiple satellite lesions scattering around. (c) CT scanning of the mediastinal window demonstrates lymphadenectasis of aortic window, subcutaneous soft tissue mass shadow in the left anterior chest wall with central low density shadow as well as right axilliary lymphadenectasis', 'hash': 'dabd5722ad3f66eee67ca59ba24417ffb086d4591f3bff2446f2a3490c676e78'}, {'image_id': '313891_1_En_17_Fig22_HTML', 'image_file_name': '313891_1_En_17_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig22_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates semicircular mass liked dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura of lateral chest wall, and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates narrowed right thorax, thickend pleura of lateral chest wall with encapsulated effusion, uneven density mass in the right hilum, thinner right bronchus due to compression and no obvious abnormalities in the left hilum. (f) DR in Aug. 2008 demonstrates no obvious changes of the lesions after anti-tuberculosis treatment for 1 month', 'hash': '8f3d47e32ff0f306eed49c4101730b02a154f676752c7bb56423c767388d5b82'}, {'image_id': '313891_1_En_17_Fig27b_HTML', 'image_file_name': '313891_1_En_17_Fig27b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig27b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related miliary tuberculosis. (a–b) Anteroposterior and lateral DR demonstrates diffuse miliary shadows in both lungs, which are bilaterally symmetric and in even size and distribution. (c–f) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': 'e272956e522e945d068939f056c637c5a636df520c687deeac9d40f8cb06834e'}, {'image_id': '313891_1_En_17_Fig83_HTML', 'image_file_name': '313891_1_En_17_Fig83_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig83_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates enlarged blurry hilum in both lungs and thickened lung markings. (b–d) CT scanning demonstrates multiple scattered nodular or mass dense shadows in both lungs, with lobulation, rough spikes around and fusion of some shadows into mass; surrounding small flaky infiltrative shadows; and mediastinal lymphadenectasis', 'hash': '6b17ec5d2db4d953c2436bbec29d0a3b1dacf0910df899eaf97e442c4aaad785'}, {'image_id': '313891_1_En_17_Fig43a_HTML', 'image_file_name': '313891_1_En_17_Fig43a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig43a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related tuberculous pleuritis. (a) DR demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (b) CT scanning of the pulmonary window demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (c) CT scanning of the mediastinal window demonstrates encapsulated fluid density shadow in the pleura of the right lateral chest wall', 'hash': 'ac09c8d3e5e4d73b07cd258411b07337ad06b99883f4a0e4573ce220fc1f4574'}, {'image_id': '313891_1_En_17_Fig35a_HTML', 'image_file_name': '313891_1_En_17_Fig35a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig35a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates diffuse large flaky dense shadows in the right upper lung with transparent areas in them. (b–c) CT scanning of the pulmonary window demonstrates large flaky shadows with increased density in the right upper lung, with multiple satellite lesions scattering around. (d, e) CT scanning of the mediastinal window demonstrates large flaky parenchymal shadows in the right upper lung with air bronchogram sign as well as mediastinal lymphadenectasis', 'hash': 'f556b77354da8136691c411ed446865babea0e399d96d2fca89f49639a04c579'}, {'image_id': '313891_1_En_17_Fig26b_HTML', 'image_file_name': '313891_1_En_17_Fig26b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig26b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '1d1f0589c50a11306fce77c217b0a9ac31be645df14f41d021ccf6522873dc6c'}, {'image_id': '313891_1_En_17_Fig32_HTML', 'image_file_name': '313891_1_En_17_Fig32_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig32_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstratesdiffuse scattering miliary shadows with increased density in both lungs, fusion of some military shadows into patchy or mass liked shadows and diffusely distributed lung lesions', 'hash': '7274d90d4f9483c5fb0e44576eeb46beba54850ed218057b6ca5935c31fa396a'}, {'image_id': '313891_1_En_17_Fig96b_HTML', 'image_file_name': '313891_1_En_17_Fig96b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig96b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a) DR demonstrates flaky blurry dense shadows in the right anterior margin of the heart, with surrounding infiltrative shadows. (b, c) CT scanning of the pulmonary window demonstrates nodular dense shadows in the dorsal segment of the right lower lung, with smooth sharp boundaries; large flaky ground glass liked dense shadows in the dorsal segment of both lungs. (d, e) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in red, in different sizes. (f) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in purplish red, in different sizes', 'hash': 'ad87dabd309e8a0c47d5cd58aa485a538556b1218d18c3cb262dc5b8cd5049e9'}, {'image_id': '313891_1_En_17_Fig55_HTML', 'image_file_name': '313891_1_En_17_Fig55_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig55_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates round liked large flaky shadows with increased density in the right lower lung, cords liked and flocculent liked blurry shadows in both middle-upper lung fields and in the right lower lung field, and enlarged and thickened hilus', 'hash': '29c690f04a28629d1c3b0f7b5665833edd78ec61be199fd2f16199400a7c9eeb'}, {'image_id': '313891_1_En_17_Fig85a_HTML', 'image_file_name': '313891_1_En_17_Fig85a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig85a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates round liked thick-wall cavity in the left hilum, with blurred boundary; ground-glass liked shadows with increased density in the left middle and lower lung. (b–d) CT scanning of the pulmonary window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of cavity wall. (e, f) CT scanning of the mediastinal window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of the cavity wall and surrounding thick spikes', 'hash': 'd6bc5b1be05729f5f4ec60a0cda3bec7f7cf437fd39e0d32743e45cfb9e48de2'}, {'image_id': '313891_1_En_17_Fig112_HTML', 'image_file_name': '313891_1_En_17_Fig112_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig112_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Kaposi’s sarcoma. (a, b) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance', 'hash': 'eeb255e4963802d02da7fd85381532153336be33b21e4ceb488be5dc2a483f29'}, {'image_id': '313891_1_En_17_Fig25b_HTML', 'image_file_name': '313891_1_En_17_Fig25b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25b_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '9ceac8f407a9896d7bda0165bceae81a32d5c5c53de3c5d2a295c165b15071e8'}, {'image_id': '313891_1_En_17_Fig36a_HTML', 'image_file_name': '313891_1_En_17_Fig36a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig36a_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) Pulmonary CT scanning of the pulmonary window demonstrates parenchymal shadows in the left lingual lobe with surrounding pulmonary acinar nodular shadows. (b) CT guided pucture biopsy of left lingula. (c) The pathology demonstrates granulation tissue and caseous necrosis, being in consistency with tuberculosis changes. HE\u2009×\u2009100', 'hash': '3a48cc084a1fb1943e1411fa65cfdcee0c3c33377b3ae6ab6e24f04ee1caebae'}, {'image_id': '313891_1_En_17_Fig68a_HTML', 'image_file_name': '313891_1_En_17_Fig68a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig68a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in prone posture demonstrates mass shadow and thick wall cavity in the dorsal segment of the right lower lung, small nodular shadows in the cavities, surrounding fused miliary infiltration shadows. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the dorsal segment of the right lower lung, small nodular shadows in the cavities, and involved pleura of partial lateral chest wall', 'hash': '0acc77833f25b70e7e4527a30be9fc6744e19cee48879415a15e648d76923d48'}, {'image_id': '313891_1_En_17_Fig45_HTML', 'image_file_name': '313891_1_En_17_Fig45_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig45_HTML.jpg', 'caption': '(a, b) HIV/AIDS related Staphylococcus aureus pneumonia. (a) Gross specimen observation demonstrates bilateral purplish brown lesions, patchy white infiltration at the base of the lungs. (b) HE staining demonstrates alveolar diffuse lesions, exudation of the serous fluid and inflammatory cells in the alveolar cavity, and alveolar wall congestion', 'hash': 'e530a1df1ead29989d8b3b50161f1926946446bc5cbbcb99691479816876e341'}, {'image_id': '313891_1_En_17_Fig110c_HTML', 'image_file_name': '313891_1_En_17_Fig110c_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110c_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '22d9f8a4fa731c46a738334c9738c267aaa2c43711aa94bd98c4b78483adda8d'}, {'image_id': '313891_1_En_17_Fig24b_HTML', 'image_file_name': '313891_1_En_17_Fig24b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig24b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates circular mass dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura in the lateral chest cavity and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates multiple uneven mass density shadows in right hilum in a size of about 3\u2009×\u20093.5\u2009×\u20093.8 cm. (f–g) Enhanced CT scanning demonstrates slight uneven enhancement of the lesion and no obvious abnormalties in the left hilum', 'hash': '4c7c3a8f7b0bde1c89efcf634beedfd08159b9be03a95299448e388c435edcdc'}, {'image_id': '313891_1_En_17_Fig12_HTML', 'image_file_name': '313891_1_En_17_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig12_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchyma shadows and fibrous cords liked shadows in both lungs which are more obvious in the dorsal segment of both lower lungs, bronchial shadows in them, and thickened bronchial walls in the middle lobe. The hilar shadows in both lungs are enlarged', 'hash': '72a066b603a93a4b8e9a7a8ec1942b2ed87b211dee6ed121b7c56d1cb575c55c'}, {'image_id': '313891_1_En_17_Fig102_HTML', 'image_file_name': '313891_1_En_17_Fig102_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig102_HTML.jpg', 'caption': '(a–d) HIV/AIDS related lymphoid interstitial pneumonia. (a–d) CT scanning demonstrates thickened and deranged pulmonary markings in both lungs, in reticular appearance; with accompanying multiple small nodular shadows', 'hash': '6b569d4d7a5a4f008ea8f7bc4152cd1a576656b8eeee8b7548f00de038815256'}, {'image_id': '313891_1_En_17_Fig111_HTML', 'image_file_name': '313891_1_En_17_Fig111_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig111_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Kaposi’s sarcoma. (a, b) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance, light density flaky shadows in lower lung fields of both lungs. (c) CT scanning demonstrates multiple round liked nodular shadows in both middle lower lung fields with clear boundaries, multiple mediastinal and hilar lymphadenectasis, and small quantity pleural effusion in bilateral thoracic cavities', 'hash': '5dfb9d581ecc41659920bde84bc55d01903bf9f66ec50710fe0465373096ff5f'}, {'image_id': '313891_1_En_17_Fig25a_HTML', 'image_file_name': '313891_1_En_17_Fig25a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig25a_HTML.jpg', 'caption': '(a–m) HIV/AIDS related lymph node tuberculosis. (a–f) MR imaging demonstrates multiple round liked long T1WI long T2WI signal adjacent to the right sternocleidomastoid as well as in the supraclavicular fossa and the right upper mediastinum. (g–j) Sagittal MR imaging demonstrates multiple round liked sugar-coated haws liked masses in the entrance of the thorax and right upper mediastinum, with central long T1WI signal and unclear boundary. (k, l) Axial MR imaging demonstrates round liked long T1WI long T2WI signal in the right cardiophrenic angle (arrow). (m) Coronal MR imaging demonstrates round liked equal signal shadow', 'hash': '67db71f0f56d65c929e36f486b4a1a2246ae852aec999328f126ddc09428f814'}, {'image_id': '313891_1_En_17_Fig36b_HTML', 'image_file_name': '313891_1_En_17_Fig36b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig36b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) Pulmonary CT scanning of the pulmonary window demonstrates parenchymal shadows in the left lingual lobe with surrounding pulmonary acinar nodular shadows. (b) CT guided pucture biopsy of left lingula. (c) The pathology demonstrates granulation tissue and caseous necrosis, being in consistency with tuberculosis changes. HE\u2009×\u2009100', 'hash': 'd7d5abe0c9d9bea2e2097dfc72f86922656058f98f8a2360573b04a02e27e5de'}, {'image_id': '313891_1_En_17_Fig68b_HTML', 'image_file_name': '313891_1_En_17_Fig68b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig68b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in prone posture demonstrates mass shadow and thick wall cavity in the dorsal segment of the right lower lung, small nodular shadows in the cavities, surrounding fused miliary infiltration shadows. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the dorsal segment of the right lower lung, small nodular shadows in the cavities, and involved pleura of partial lateral chest wall', 'hash': 'cada0e4684021c74f9b0d4d1bcdb6810379bc035cead748d6de141ebd004f038'}, {'image_id': '313891_1_En_17_Fig96a_HTML', 'image_file_name': '313891_1_En_17_Fig96a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig96a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a) DR demonstrates flaky blurry dense shadows in the right anterior margin of the heart, with surrounding infiltrative shadows. (b, c) CT scanning of the pulmonary window demonstrates nodular dense shadows in the dorsal segment of the right lower lung, with smooth sharp boundaries; large flaky ground glass liked dense shadows in the dorsal segment of both lungs. (d, e) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in red, in different sizes. (f) HE staining demonstrates spores and round liked, long circular or sausage shaped corpuscles in purplish red, in different sizes', 'hash': '020553d48c8545e50d314020ad8dc5004914dca5449aa2b58bc99515f310c3a4'}, {'image_id': '313891_1_En_17_Fig85b_HTML', 'image_file_name': '313891_1_En_17_Fig85b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig85b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates round liked thick-wall cavity in the left hilum, with blurred boundary; ground-glass liked shadows with increased density in the left middle and lower lung. (b–d) CT scanning of the pulmonary window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of cavity wall. (e, f) CT scanning of the mediastinal window demonstrates thick-wall cavity in the dorsal segment of the left lower lung, with uneven thickness of the cavity wall and surrounding thick spikes', 'hash': '9778eb0d00755e3cd06bd3bcee90d66970730aac4b7fabde0b3e1df25cc067b8'}, {'image_id': '313891_1_En_17_Fig59_HTML', 'image_file_name': '313891_1_En_17_Fig59_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig59_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a–c) CT scanning of the pulmonary window demonstrates thick walled cavities shadows in the dorsal segment of the right lower lung, with irregular wall thickness and liquid gas level in them. (d) CT scanning of the mediastinal window demonstrates thick walled cavities shadows in the dorsal segment of the left lower lung, with irregular wall thickness and liquid gas level in them', 'hash': 'c9ff1150b9c2d245c823a3726a56dc22223fcdc58b24666ee55ee0b01ea0c2d3'}, {'image_id': '313891_1_En_17_Fig24a_HTML', 'image_file_name': '313891_1_En_17_Fig24a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig24a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates circular mass dense shadow in the right hilum that protrudes to the lung field with peripheral thickened and blurry pulmonary markings, thickened pleura in the lateral chest cavity and blunt costophrenic angle in Jan. 2008. (b–e) CT scanning demonstrates multiple uneven mass density shadows in right hilum in a size of about 3\u2009×\u20093.5\u2009×\u20093.8 cm. (f–g) Enhanced CT scanning demonstrates slight uneven enhancement of the lesion and no obvious abnormalties in the left hilum', 'hash': 'a3536c779e7c502b855dd3d89ae13854f569bd483ba8038870ac76c68c616c6c'}, {'image_id': '313891_1_En_17_Fig11_HTML', 'image_file_name': '313891_1_En_17_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig11_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered patchy shadows with increased density in both lungs and a few cords liked shadows which are more obvious in the right lung. There are thickened both hilar shadows and sharp both costophrenic angles. (b–e) CT scanning demonstrates flaky and mass liked ground glass density shadows in both lungs and a few cords liked shadows which are more obvious in the right lung. The trachea and bronchi are unblocked', 'hash': 'd4448bd9682d4ae721b1250cec042eecf77787519b1af61ac3b2d7b88b28bd90'}, {'image_id': '313891_1_En_17_Fig101_HTML', 'image_file_name': '313891_1_En_17_Fig101_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig101_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Herpes Simplex Viral Pneumonia. (a) DR demonstrates thickened and deranged lung markings in both lungs with accompanying blurry nodular shadows, and cloudy shadows in the lung fields. (b) PAS staining (400×) demonstrates eosinophilic inclusion. (c) Silver methenamine staining demonstrates herpes viral inclusion', 'hash': '9cfda956483a95dc3a4e487426e884d83e6aa0bde654b2c285ba044cf31b2a1d'}, {'image_id': '313891_1_En_17_Fig49_HTML', 'image_file_name': '313891_1_En_17_Fig49_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig49_HTML.jpg', 'caption': '(a–d) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates fan shaped shadow in the right middle lung field with its apex pointing to the hilar dense shadow, with clear boundaries. (d) CT scanning reexamination demonstrates absence of the lesions in the right lung after anti-bacteria treatment for 2 weeks', 'hash': 'f566a271be67724833f92b19b4f73190cae4216ad698f1d1a51c1d9c7579afa1'}, {'image_id': '313891_1_En_17_Fig34b_HTML', 'image_file_name': '313891_1_En_17_Fig34b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig34b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related infiltrative pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung and multiple satellite lesions scattering around. (c) CT scanning of the mediastinal window demonstrates lymphadenectasis of aortic window, subcutaneous soft tissue mass shadow in the left anterior chest wall with central low density shadow as well as right axilliary lymphadenectasis', 'hash': 'cd2bbefb6363363a2c860069ded9e79b5fabed794f0777f342cd459e7f745581'}, {'image_id': '313891_1_En_17_Fig21_HTML', 'image_file_name': '313891_1_En_17_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig21_HTML.jpg', 'caption': '(a–c) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates enlarged right hilum in mass liked dense shadow, with peripheral thickened and blurry pulmonary markings, and no obvious abnormalities of the left hilum. (b) DR demonstrates smaller right hilum after anti-tuberculosis therapy for 1 month. (c) DR demonstrates absent tumor in the right hilum and normal left hilum', 'hash': '46a1a9267e1d610faa6450929c11c8d942047467baf49ba4482ce61bb660cb30'}, {'image_id': '313891_1_En_17_Fig27a_HTML', 'image_file_name': '313891_1_En_17_Fig27a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig27a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related miliary tuberculosis. (a–b) Anteroposterior and lateral DR demonstrates diffuse miliary shadows in both lungs, which are bilaterally symmetric and in even size and distribution. (c–f) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '61497bd4be4942d8a1fc4e6710043c9d4099da58ea99f2008d49f04ec973f2b4'}, {'image_id': '313891_1_En_17_Fig79_HTML', 'image_file_name': '313891_1_En_17_Fig79_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig79_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates multiple scattered nodular shadows in both lower lungs. (b–d) Chest CT scanning demonstrates multiple dense nodular shadows with different sizes and mass shadows in both middle and lower lung fields, with clear boundaries. They are more common in the dorsal segments', 'hash': '7f1588a4af3d4fadaf1f33e3bac3f100d4b2003206bd1bc2ae262b602fd3fe79'}, {'image_id': '313891_1_En_17_Fig51a_HTML', 'image_file_name': '313891_1_En_17_Fig51a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig51a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related staphylococcus aureus pneumonia. (a) Chest X-ray demonstrates large flaky high density shadow in the left middle-lower lung field, with central transparent areas in different sizes and blurry boundaries; parenchyma changes of the left lower lung, predominantly in the posterior and exterior basal segments; unobstructed brounchus and thickened adjacent pleura. (b–d) CT scanning demonstrates large flaky shadows in fan shaped distribution along the bronchus in the left middle-lower lung, with gas containing cavities and high density shadows; and thickened adjacent pleura of the lateral chest wall. (e, f) CT scanning of the mediastinal window demonstrates large flaky fan shaped parenchymal shadows in the left middle-lower lung field, with ventilation shadows in them; and thickened pleura of the lateral chest wall. (g, h) Pathological examination showed staphylococcus aureus', 'hash': '00d7fc70edd23ceb6f012159d4bae8563ec20a036cc91fd99d91cdbc08f23126'}, {'image_id': '313891_1_En_17_Fig90_HTML', 'image_file_name': '313891_1_En_17_Fig90_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig90_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows in the lungs that fuse into mass in parenchymal shadows, with the hilum as the center and distributing bilaterally symmetric like butterfly wings. There are also multiple clustering cavities or singular large cavity in both lungs', 'hash': '6742eff5e10355ff74a6fe215cff47247a9d12856c453a35fd6d6742f8f0ac2e'}, {'image_id': '313891_1_En_17_Fig94a_HTML', 'image_file_name': '313891_1_En_17_Fig94a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig94a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related penicillium marneffei infection. (a–f) CT scanning demonstrates multiple nodules and small cavities in honeycomb liked shadows and infiltrative parenchyma shadows in the right lung; flaky transparent areas (bullae of lung) in the right anterior margin of the heart and in the outer zone of the left lung near lateral chest wall', 'hash': '4bf177cdb556a837613a60231e962930fcd4acf34d7177f738cb57925ca917e1'}, {'image_id': '313891_1_En_17_Fig35b_HTML', 'image_file_name': '313891_1_En_17_Fig35b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig35b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related infiltrative pulmonary tuberculosis. (a) DR demonstrates diffuse large flaky dense shadows in the right upper lung with transparent areas in them. (b–c) CT scanning of the pulmonary window demonstrates large flaky shadows with increased density in the right upper lung, with multiple satellite lesions scattering around. (d, e) CT scanning of the mediastinal window demonstrates large flaky parenchymal shadows in the right upper lung with air bronchogram sign as well as mediastinal lymphadenectasis', 'hash': '8b68f2c89884110f18b2b9641154ae26362875fb18db9a64b4320edd5c13bba4'}, {'image_id': '313891_1_En_17_Fig26a_HTML', 'image_file_name': '313891_1_En_17_Fig26a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig26a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric as well as in even size and distribution', 'hash': '1bd3c2b9622fa99531543c1b9d456f58ff2945c6fa4bb44043fadb51fa9c8db6'}, {'image_id': '313891_1_En_17_Fig31_HTML', 'image_file_name': '313891_1_En_17_Fig31_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig31_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, fusion of some military shadows into patchy or mass liked shadow, diffusely distributed lung lesions', 'hash': '3bf8714e005c1ebc72eb46fac228838fd6436f0a1dd5d6a8bd085a14fddd1170'}, {'image_id': '313891_1_En_17_Fig69_HTML', 'image_file_name': '313891_1_En_17_Fig69_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig69_HTML.jpg', 'caption': '(a, b) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window in the prone posture demonstrates mass shadow and thick wall cavity shadows in the medial basal segment of the right lower lung, irregular nodular shadows in the cavities, and surrounding fused miliary infiltration shadows', 'hash': 'db839a28accf7944530e9940a7c7afb2b7b3c7a4423308b863fae87f0c08c29a'}, {'image_id': '313891_1_En_17_Fig80_HTML', 'image_file_name': '313891_1_En_17_Fig80_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig80_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a, b) Anteroposterior and lateral DR demonstrate a huge dense mass shadow in the left lower lung, with clear boundary. (c) CT scanning of the pulmonary window demonstrates round liked high density shadow in the left lower lung near left chest wall, with even density. (d) CT scanning of the mediastinal window demonstrates round liked soft tissue density shadows in the left lower lung near left chest wall, with even density, lobulation, and surrounding thick spikes', 'hash': 'ea2ef199cee39dce2b4a8a06bcdcce274a6fd8796c2efbfaf940d6d05fe48c40'}, {'image_id': '313891_1_En_17_Fig43b_HTML', 'image_file_name': '313891_1_En_17_Fig43b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig43b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related tuberculous pleuritis. (a) DR demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (b) CT scanning of the pulmonary window demonstrates thickened pleura in the right lateral chest wall in spindle liked dense shadows. (c) CT scanning of the mediastinal window demonstrates encapsulated fluid density shadow in the pleura of the right lateral chest wall', 'hash': '582e0f2e161551b97de13a60d6afed8cc613b9b04bfb136458587da830b2ecf0'}, {'image_id': '313891_1_En_17_Fig16_HTML', 'image_file_name': '313891_1_En_17_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig16_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple fibrous cords liked shadows in lungs, multiple patchy parenchyma shadows and ground glass liked density shadows in both upper lobes, with multiple transparent areas in them. The bronchial walls are thickened in the anterior and posterior segments of the right upper lobe as well as in the lingual segment of the left lung', 'hash': '214979f5c447a9b40ebd0772cff663eb275052bf5fe8132456329ffacdc20c9c'}, {'image_id': '313891_1_En_17_Fig109_HTML', 'image_file_name': '313891_1_En_17_Fig109_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig109_HTML.jpg', 'caption': '(a, b) HIV/AIDS related lymphoma. (a, b) CT scanning demonstrates a huge soft tissue mass shadow in the left lateral chest wall, with a maximal size of about 7.7\u2009×\u200913.0 cm and occupying 30 sections with 8 mm in thickness of each section and with the upmost to the supraclavicular area and the bottom in the level of thoracic 12th vertebral body in the lower chest wall. There are also large quantity left pleural effusion and parenchymal changes of the left lower lobe with atelectasis. In the left chest cavity, large quantity liquid density shadows can be found, with compressed lung tissues to the hilum. By puncture and biopsy of the subaxillary mass, the diagnosis is defined as diffuse large B cell lymphoma', 'hash': '6d67a094843ca970dc50c93d50e7d1038c2a389c96e1772f425fa9dbc9d3a3ea'}, {'image_id': '313891_1_En_17_Fig19_HTML', 'image_file_name': '313891_1_En_17_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig19_HTML.jpg', 'caption': '(a) Gross observation in autopsy demonstrates disseminated pulmonary tuberculosis, with grayish white military nodules in diffuse distribution in the lung tissues section. (b) It is demonstrated that mycobacteriumavium-intracellularcomplex infection in the lung tissue, with atypical tuberculosis nodules and acid-fast staining positive (left top). There are a subnodular giant cell, eosinophilic inclusion bodies in the nucleus and bradyzoites in cytoplasm of T. gondii. HE\u2009×\u2009100. (c) HE demonstrates mycobacteriumavium-intracellularcomplex infection, with atypical tuberculosis nodular changes, HE\u2009×\u2009200', 'hash': 'fac712a77d78563a8ebac012fe6c9f2f74ab72b1d36bf9e0c30462450f24c87d'}, {'image_id': '313891_1_En_17_Fig92a_HTML', 'image_file_name': '313891_1_En_17_Fig92a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig92a_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of the lesions in the right lung into plaque liked shadows with clear boundaries, and multiple round liked small cavity shadows and inflammatory infiltrative shadows in both lungs', 'hash': '981e19f8709c64fb0f850afd293a3dfdb67ec16a8d75e3f2bf19cd69116366cd'}, {'image_id': '313891_1_En_17_Fig41_HTML', 'image_file_name': '313891_1_En_17_Fig41_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig41_HTML.jpg', 'caption': 'HIV/AIDS related tuberculous pleuritis. DR demonstrates arch shaped dense shadows with higher exterior density and lower interior density in the right lower lung field and covered right edge of the heart', 'hash': '3381f76804304950a36ba44865a5651168e2f9b43c451a23d390d065bfc52e80'}, {'image_id': '313891_1_En_17_Fig56a_HTML', 'image_file_name': '313891_1_En_17_Fig56a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig56a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) DR demonstrates huge round large flaky shadows with increased density in the left lower lung, enlarged and thickened hilum and covered right heart edge. (c, d) DR reexamination after treatment for 1 week demonstrates flocculent shadow in the left lower lung, improved than those before the treatment (a, b). (e) DR reexamination after treatment demonstrates flocculent liked shadows in the left lower lung, obviously improved than before the treatment (c, d)', 'hash': '8c2f7c50d0562920efd9257451f8cc2d4dda042eaa3768d3fb1455a7092edf94'}, {'image_id': '313891_1_En_17_Fig93a_HTML', 'image_file_name': '313891_1_En_17_Fig93a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig93a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates diffuse small cavity in honeycomb liked and infiltrative parenchyma shadows, with the hilum as the center to distribute bilaterally symmetric like butterfly wings; multiple honeycomb liked cavity shadows in both lungs. (e–h) CT scanning reexamination demonstrates large irregular thick-wall cavities in the right lung, surrounding scattering nodular, honeycomba liked and infiltrative shadows after anti-PM infection treatment for 3 months', 'hash': 'eb824267db9288c03e6cffae4cde8b6f47b3bda47dcad797ee4964b9011ac598'}, {'image_id': '313891_1_En_17_Fig46b_HTML', 'image_file_name': '313891_1_En_17_Fig46b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig46b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates large flaky dense shadows in the middle-outer zone of the left middle lung field, and narrowed left bronchus. (d–f) CT scanning demonstrates large flaky shadows with uneven density in the left lateral chest wall and even lower density shadow in them', 'hash': '97eaf0337e0212b917644691da5093524803db5d92384afd57bfc5803cb125e0'}, {'image_id': '313891_1_En_17_Fig39_HTML', 'image_file_name': '313891_1_En_17_Fig39_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig39_HTML.jpg', 'caption': '(a–d) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a, b) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in the right upper lung, periphery crab feet liked or cords liked shadows due to pleural traction and satellite lesions. (c, d) CT scanning of the mediastinal window demonstrates round liked or triangle shaped thick wall cavities in the left upper lung, no nodules in the wall and peripheral nodular satellite lesions', 'hash': '614dd89032a813e240901110905f63b8b8d2530c6c7e27b0e6aab03ce47f7abb'}, {'image_id': '313891_1_En_17_Fig61_HTML', 'image_file_name': '313891_1_En_17_Fig61_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig61_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Rhodococcus equi pneumonia. (a) DR demonstrates large flaky shadow in the middle-outer zone of the left upper lung field. (b) DR demonstrates diffuse dense shadow in the left lung field, with round liked cavities shadows in them. (c–d) Reexamination after treatment demonstrates multiple cavities shadows in the middle-outer zone of the left upper lung field', 'hash': '29c84b1869c0cdabc91ee8822b014d024780586503e92fa0fdc6bed1d3b54b73'}, {'image_id': '313891_1_En_17_Fig88_HTML', 'image_file_name': '313891_1_En_17_Fig88_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig88_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a) The gross specimen demonstrates central necrotic pimples on the face. (b) Chest X-ray DR demonstrates cavities in the left upper lung, thickened lung markings in both lower lungs with accompanying multiple spots and flakes shadows. (c) Gastrointestinal barium meal radiology demonstrates left and downwards migration of the intestine due to compression. (d) Enhanced abdominal CT scanning demonstrates retroperitoneal enlarged lymph nodes that fuse into a huge mass, with ring shaped enhancement of the lymph nodes', 'hash': '72d6f61ccf9268cf07530a5a1e56a768d1d614ac854706838e783fa20f2cb2a1'}, {'image_id': '313891_1_En_17_Fig87_HTML', 'image_file_name': '313891_1_En_17_Fig87_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig87_HTML.jpg', 'caption': '(a) HE staining demonstrates lymph nodes, PM in the yeast phase, with sausage liked shape and obvious septa (HE\u2009×\u20091000). (b) GMS staining demonstrates clearly defined PMs (GMS\u2009×\u20091,000)', 'hash': '195e16d569e89c659459764942f07ae44cec9cd1fd8634e716178e34225094ab'}, {'image_id': '313891_1_En_17_Fig91a_HTML', 'image_file_name': '313891_1_En_17_Fig91a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig91a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related penicillium marneffei infection. (a–e) CT scanning demonstrates multiple small nodular shadows and small cavity shadows in the lungs, fusion of some lesions into honeycomb likes cavity shadows or plaque liked dense shadows. (f–h) CT scanning demonstrates large thick-wall cavity shadows in the right lung, surrounding plaque and round liked small cavity shadows and inflammatory infiltrative shadows', 'hash': '84aa8353e64cbf735c399fa64899ecd1e9b8a13620149a5aa662a21a423c07bf'}, {'image_id': '313891_1_En_17_Fig8b_HTML', 'image_file_name': '313891_1_En_17_Fig8b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig8b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates large flaky parenchyma shadows in both lungs which is more obvious in the middle and lower lobes of both lungs. There are also enlarged hilar shadows in both lungs and sharp both costophrenic angles. (b–g) CT scanning demonstrates large flaky parenchyma shadows in concentric and symmetrical distribution, bronchial shadows in them and thickened bronchial walls', 'hash': '812cc7d7992507bc22a7c06e518ff223d7e9ece757725f478a6f723b8ac030bf'}, {'image_id': '313891_1_En_17_Fig29_HTML', 'image_file_name': '313891_1_En_17_Fig29_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig29_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric and in even size and distribution. There are nodular shadows in the anterior segment of the right middle lung lobe with clear boundary', 'hash': '16cd873b8d84d3bbad635d9facea5407fe900b62efdd6f481449f4a433dfb6a0'}, {'image_id': '313891_1_En_17_Fig71_HTML', 'image_file_name': '313891_1_En_17_Fig71_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig71_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary aspergillosis infection. (a) The gross specimen demonstratesAspergillus abscess in the skin of the forearm. (b–d) CT scanning of the pulmonary window demonstrates multiple round liked nodular shadows and cavity shadows in both lungs, even thickness of cavity wall, and small nodular shadows in some cavities. (e) Pulmonary Aspergillus infection, demonstration purplish blue branches liked or grasses liked growth of hyphae, HE\u2009×\u2009400', 'hash': 'f0586168fbf7b2cd35205e1c807a3343af1ec5bac8dbe4f50308a570cd7d3552'}, {'image_id': '313891_1_En_17_Fig97_HTML', 'image_file_name': '313891_1_En_17_Fig97_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig97_HTML.jpg', 'caption': '(a) Gross observation of the fresh specimen in autopsy demonstrates pulmonary edema and congestion of cytomegalovirus pneumonia. (b) Gross observation of the formalin fixed specimen in autopsy demonstrates dark brown hard pulmonary tissues. (c, d) HE staining demonstrates large quantity cytomegalovirus inclusions in eagle eyes sign. (e) Immunohistochemical demonstrates HIV P24 antigen positive in macrophages of lung tissues (×400)', 'hash': '50e144edf7881be15e502fff23c2613760ac0172fe3ae6c56abf5ca1abf085b5'}, {'image_id': '313891_1_En_17_Fig20_HTML', 'image_file_name': '313891_1_En_17_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig20_HTML.jpg', 'caption': '(a, b) HIV/AIDS related lymph node tuberculosis. (a) DR demonstrates enlarged right hilum in nodular dense shadows with peripheral thickened and blurry pulmonary markings, and no obvious abnormalities of the left hilum. (b) DR demonstrates smaller right hilum after treatment for 1 month', 'hash': '27213b483e54de634de857225fc93f6dc05eb5a729bc751141dea3866128c8ec'}, {'image_id': '313891_1_En_17_Fig6b_HTML', 'image_file_name': '313891_1_En_17_Fig6b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig6b_HTML.jpg', 'caption': '(a-d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates flaky ground glass liked density shadows in upper lobes of both lungs, with bronchial shadows in them; flaky parenchymal shadows in the subpleural apical segment; and thickened bronchial walls in the anterior and posterior segments of the right upper lobe', 'hash': 'ba6f221be2db1160358ae94e02b0125159adca1d9ac64bff84883eae8b614970'}, {'image_id': '313891_1_En_17_Fig17b_HTML', 'image_file_name': '313891_1_En_17_Fig17b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig17b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates multiple patchy parenchymal shadows and fibrous cords liked shadows in both lungs which are more obvious in both lower lungs. The trachea and bronchi are unblocked, with enlarged hilar shadows in both lungs', 'hash': 'dba27067e12ab2a752ec8a543537f427156b1a18bdc04bffa3aedbe2d3b6e7bd'}, {'image_id': '313891_1_En_17_Fig113a_HTML', 'image_file_name': '313891_1_En_17_Fig113a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig113a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Kaposi’s sarcoma. (a–d) Chest CT scanning demonstrates scattered cloudy, mass and flake liked or nodular shadows with increased density. (e) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large thick stained nucleoli, which are in line with the diagnosis of Kaposi’s sarcoma. (f–i) Cured HIV/AIDS related Kaposi’s sarcoma. (f–i) Reexamination after treatment demonstrates absent lesions in both lungs, with clear lung fields', 'hash': '192d991df0d417610162aab90c8b0e07b4c19f1436faa752263e85c3efa0f3db'}, {'image_id': '313891_1_En_17_Fig77_HTML', 'image_file_name': '313891_1_En_17_Fig77_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig77_HTML.jpg', 'caption': 'HE staining demonstrates isseminated cryptococci, the Cryptococcus is stained red after mucin carmine staining of cryptococcus neoformans spores in lungs, (HE\u2009×\u2009200)', 'hash': '882060c6f53899fb225a20d7eb5fe410195beed0a7386dc233a4632284f4717f'}, {'image_id': '313891_1_En_17_Fig78_HTML', 'image_file_name': '313891_1_En_17_Fig78_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig78_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates multiple scattered nodular and miliary shadows in both lungs. (b–d) Chest CT scanning demonstrates multiple dense nodular shadows with different sizes in both lungs, with clear boundaries. They are intensively distributed in the dorsal segment and the largest one has a diameter of about 2 cm', 'hash': 'd60cf04886c28c578ee7940f50525d5141254a1a45a5b489d53a7ae5ae27fa53'}, {'image_id': '313891_1_En_17_Fig7b_HTML', 'image_file_name': '313891_1_En_17_Fig7b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig7b_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates diffusely distributed shadows with increased density in both lungs that is more obvious in the middle and lower lungs. The hilar shadows in both lungs are enlarged. Both diaphragmatic surfaces and phrenic angles are blurry. (b–d) CT scanning demonstrates flaky shadows with increased density in both lungs, with parenchymal shadows in the lingular segment of left upper lobe and in the dorsal segments of both lower lobes and bronchial shadows in them. There are also thickened bronchial walls and enlarged hilar shadows in both lungs', 'hash': '47bf3b06e99aa6482027b30084d7445e95928d39923c99fd8fe93df39c899b2d'}, {'image_id': '313891_1_En_17_Fig30_HTML', 'image_file_name': '313891_1_En_17_Fig30_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig30_HTML.jpg', 'caption': '(a–d) HIV/AIDS related miliary tuberculosis. (a–d) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs and fusion of some military shadows, which are bilaterally symmetric and in even size and distribution', 'hash': 'ab1d4160a6a23300146e331c7eee06edf886ca73ab4514f8a59b22d04d3c303f'}, {'image_id': '313891_1_En_17_Fig1_HTML', 'image_file_name': '313891_1_En_17_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig1_HTML.jpg', 'caption': '(a) Gross specimens’ observation demonstrates foamy liquid filling in the lung tissues. (b) HE demonstrates pneumocystis in the alveolar exudates, which can be stained black by silver methenamine staining, ×400. (c) HE demonstrates the foamy substance in the alveolar space, ×400', 'hash': 'a0082be568f7c995671d0461acf0cfe32c8c36a01dbf7badc28f3cc0ab407b75'}, {'image_id': '313891_1_En_17_Fig81_HTML', 'image_file_name': '313891_1_En_17_Fig81_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig81_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary cryptococcus infection. (a) DR demonstrates thickened lung markings in both lungs and flaky blurry shadows in the left lower lung. (b, c) CT scanning demonstrates round liked nodular and small cavity shadows in the left upper and lower lung, with clear boundaries. (d–f) Pathology demonstrates transparent substrate in lung tissues and many bi-capsular cryptococci in cytoplasm', 'hash': '3e767fbaeda72c7b7b49df4ee9daa757367932f7623507185ca8453615c8de74'}, {'image_id': '313891_1_En_17_Fig58a_HTML', 'image_file_name': '313891_1_En_17_Fig58a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig58a_HTML.jpg', 'caption': '(a–i) HIV/AIDS related Rhodococcus equi pneumonia. (a, b) CT scanning of the pulmonary window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (c, d) CT scanning of the mediastinal window before the treatment demonstrates flaky dense shadows in the dorsal segment of the left lower lung, pulmonary atelectasis and pleural effusion, with ventilation shadows in them. (e) CT scanning of the pulmonary window after the treatment demonstrates absence of the mass shadows in the left lower lung with transverse stripes shadows, obviously improved than previous findings (a, b). (f) HE staining demonstrates thickened alveolar septa and exudates from the alveolar cavity. (g) HE staining demonstrates massive bleeding in the alveolar cavity, large quantity erythrocytes and intact cell walls. (h) HE staining demonstrates phagocytized basophilic granules in the leukocytes. (i) HP staining demonstrates purplish red Rhodococcus equi in a shape of crescent in orange red sputum', 'hash': 'fcd60ca09d86084cb78d6b91f9b3e0a51e9f479a1c27837e18c9af0f809ef13d'}, {'image_id': '313891_1_En_17_Fig57_HTML', 'image_file_name': '313891_1_En_17_Fig57_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig57_HTML.jpg', 'caption': '(a, b)HIV/AIDS related Rhodococcus equi pneumonia. (a) CT scanning of the mediastinal window demonstrates soft tissue mass shadows in the dorsal segment of the left lower lung, with ventilation shadows in them. (b) CT scanning of the pulmonary window after the treatment demonstrates absence of the soft tissue mass shadows, and flocculent liked shadow in the left lower lung, obviously improved than previous findings (a)', 'hash': '9ac02a8eb30f8314fea4211fa5a4dbfa3863c422d30e78fcb26e8eaf44e36a42'}, {'image_id': '313891_1_En_17_Fig10_HTML', 'image_file_name': '313891_1_En_17_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig10_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates large flaky and mass liked parenchyma shadows in both lungs which is more obvious in the right lung, bronchial shadows in them, and thickened bronchial walls in the middle lobe of the right lung', 'hash': 'dc81224c041dbc53a26ff01b3414f8c13098126861cf7cc0c7f10d80a7485e0c'}, {'image_id': '313891_1_En_17_Fig100_HTML', 'image_file_name': '313891_1_En_17_Fig100_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig100_HTML.jpg', 'caption': 'The structure of herpes simplex virus', 'hash': 'b0a88fbe1660ab4ddb94799e876d547c23b5686d12e31560768111a38bc71a45'}, {'image_id': '313891_1_En_17_Fig110a_HTML', 'image_file_name': '313891_1_En_17_Fig110a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig110a_HTML.jpg', 'caption': '(a–k) HIV/AIDS related Kaposi’s sarcoma. (a–c) DR demonstrates enlarged hilum in both lungs with deranged structure in bird nest liked appearance; light density flaky shadows in the lower lung fields of both lungs and small quantity pleural effusion. (d–h) CT scanning demonstrates multiple round liked nodular shadows in the middle and lower lung fields of both lungs with clear boundaries, multiple mediastinal and hilar enlarged lymph nodes. (i, j) HE staining demonstrates large quantity spindle cells or fusiform cells as well as thick stained nucleoli also in spindle shape. (k) Reexamination after treatment demonstrates no abnormalities in both lungs', 'hash': '7392286985c0e8fefacf1282d1ef323dd6d64b0b536b667dfffbcbde5be28d3c'}, {'image_id': '313891_1_En_17_Fig5b_HTML', 'image_file_name': '313891_1_En_17_Fig5b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig5b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates patchy shadows with increased density in both lungs, with thickened hilar shadows in both lungs. (b–g) CT scanning demonstrates flaky ground glass liked density shadows in upper lungs and dorsal segment of both lungs, which is more obvious in the middle inner strips. There are extrapulmonary stripes transparent shadows, with some bronchial walls thickened and enlarged hilar shadows in both lungs', 'hash': 'fcd873302d30f9846ba865346820af2a06778c5dad1b50cc634281055ae78468'}, {'image_id': '313891_1_En_17_Fig47_HTML', 'image_file_name': '313891_1_En_17_Fig47_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig47_HTML.jpg', 'caption': '(a–e) HIV/AIDS related staphylococcus aureus pneumonia. (a) DR demonstrates large flaky dense shadows with increased density in the middle-inner zone of the left upper lung field, with blurry boundaries. The lung tissue are atelectatic and the mediastinum migrates leftwards. (b, c) CT scanning demonstrates large flaky dense shadows with increased density in the middle-inner zone of the left upper lung field, with blurry boundaries, with surrounding acinar or particle liked shadows that fuse into flaky shadows. (d, e) CT scanning demonstrates large flaky shadow of parenchymal changes in the middle-inner zone of the left upper lung field, with cyst liked transparent shadows and air bronchogram sign in them, as well as mediastinal lymphadenectasis', 'hash': '8e228a648d0d33ebe1db2bfa2fa7b6209cd113683b027d6ada34f161b809085a'}, {'image_id': '313891_1_En_17_Fig48_HTML', 'image_file_name': '313891_1_En_17_Fig48_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig48_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Staphylococcus aureus pneumonia. (a–c) CT scanning demonstrates broad band liked high density shadows in the right middle lung field, with air bronchogram sign in them. (d–f) CT scanning of the mediastinal window demonstrates broad band liked uneven parenchymal shadows in the right middle lung field, with uneven thickness of air bronchogram sign', 'hash': '6e700dc830efe216b64ed069dfb6440abf50854341b133bf0237be914bd5270f'}, {'image_id': '313891_1_En_17_Fig37_HTML', 'image_file_name': '313891_1_En_17_Fig37_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig37_HTML.jpg', 'caption': '(a, b) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a, b) DR demonstrates diffuse scattering patchy shadows with increased density, and oval thin wall cavity shadows in the right middle lung field', 'hash': 'edc3511f0cc30005fb5999c1fe7033024176b0e1b8fee607763caef6a0d9abe2'}, {'image_id': '313891_1_En_17_Fig38_HTML', 'image_file_name': '313891_1_En_17_Fig38_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig38_HTML.jpg', 'caption': '(a–d) HIV/AIDS related chronic fibrous cavity pulmonary tuberculosis. (a) CT scanning of the pulmonary window demonstrates patchy shadows with increased density in both upper lungs, peripheral crab feet liked or cords liked shadows due to pleural traction with cavity shadows in them and periperal satellite lesions. (b–d) CT scanning of the mediastinal window demonstrates round liked mass shadows with high density in the cavities of the left upper lung, surrounding transparent shadows, no nodules in the walls and surrounding nodular satellite lesions. By pathological examination, the diagnosis is defined as chronic fibrous cavity pulmonary tuberculosis complicated by Aspergillus infection', 'hash': '0317a9a78d280af1069a5b797b63c3817f47607eb13976214ed710d247081a7c'}, {'image_id': '313891_1_En_17_Fig65b_HTML', 'image_file_name': '313891_1_En_17_Fig65b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig65b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related allergic pulmonary Aspergillus infection. (a–f) CT scanning of the pulmonary window demonstrates thickened central pulmonary markings in both lungs, which is turtuous and deranged with fingertip infiltration shadows. (g) DR demonstrates hyperinflation of the right lung, increased and thickened pulmonary markings and ground glass liked shadows with increased density in the right lower lung and left lung lobe', 'hash': '44f320a9216b7a9905eaaa045a44b4be59372433c9737f0ee8ded7c443134eaa'}, {'image_id': '313891_1_En_17_Fig9_HTML', 'image_file_name': '313891_1_En_17_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig9_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a–d) CT scanning demonstrates large flaky parenchyma shadows in both lungs, with transparent areas in some foci. The trachea and bronchi are unblocked, with thickened bronchial walls in the middle and lower lobes', 'hash': '26b10397cecf70e4665c1abb0f2501e939a6e5d219f395c3484c7a44dae78681'}, {'image_id': '313891_1_En_17_Fig76a_HTML', 'image_file_name': '313891_1_En_17_Fig76a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig76a_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning demonstrates diffuse scattered thin ground glass liked, patchy, flaky blurry shadows and cords liked shadows in both lungs, with blurry boundaries and uneven density; scattered nodular shadows in different sizes; more lesions in both upper lobes and the right middle lobe; flaky parenchyma shadows in the apical and posterior segments of right upper lobe, with air bronchogram sign in them; unobstructed opening of bronchi as well as lobar and segmental bronchi without stenosis and obstruction; lymphadenectasis in the right hilar region; detected Aspergillus fumigatus by sputum culture. (e, f) Culture for 72 h, lactic acid gossypol blue staining and microscopic observation at ×200 and ×400 demonstrate short column liked conidial head, smooth wall of conidiophores, flask-shaped top capsule and monolayer microconidiophores. (g) Culture in Paul’s medium demonstrates dark green colored colonies', 'hash': '79dde610127d242cc7f1f29fc98dd50c426df080c95629396102af54f31872c9'}, {'image_id': '313891_1_En_17_Fig86_HTML', 'image_file_name': '313891_1_En_17_Fig86_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig86_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary candida infection. (a–d) CT scanning demonstrates thickened and deranged lung markings in both lungs, diffuse small flaky or patchy shadows, fusion of some small shadows into large flaky dense shadows, with blurry boundaries, enlarged hilum and blurry structures', 'hash': 'bb5525804e3b5cc6588115cd2813109845df9b4314974ab2b55c40298ed6968a'}, {'image_id': '313891_1_En_17_Fig89_HTML', 'image_file_name': '313891_1_En_17_Fig89_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig89_HTML.jpg', 'caption': '(a–d) HIV/AIDS related penicillium marneffei infection. (a–d) CT scanning demonstrates multiple small nodular shadows in the lungs that fuse into mass with parenchymal shadows, with the hilum as the center and distributing bilaterally symmetric like butterfly wings. There are also multiple clustering cavities or singular large cavity in both lungs', 'hash': 'cfd1927b986a8aba818bf96427711a3743dd07195a83b88e195837af405aae79'}, {'image_id': '313891_1_En_17_Fig60_HTML', 'image_file_name': '313891_1_En_17_Fig60_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig60_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Rhodococcus equi pneumonia. (a) DR demonstrates huge sphere liked mass shadow in the middle-outer zone of the right lower lung field, with cavities shdows in them. (b–d) CT scanning demonstrates triangular dense shadow in the middle-outer zone of the right lower lung field, with its apex pointing to the hilum and round liked cavities shadows in them. (e) Reexamination after the treatment demonstrates shrinkage of the huge sphere liked mass shadow in the middle-outer zone of the right lower lung field, with closure of the cavities', 'hash': '9020727e51b9a8522ea37dd579ce73bd9a417d327bcb313836c96e1fa3bd209f'}, {'image_id': '313891_1_En_17_Fig2b_HTML', 'image_file_name': '313891_1_En_17_Fig2b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig2b_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates scattered miliary increased density shadows in both lungs, with even size, density and distribution. The shadows of both hila are dense, with sharp both costophrenic angles. (b–f) CT scanning demonstrates scattered miliary nodular shadows in both lungs, which is more obviously in the middle pulmonary strip and with quite even size and density. Trachea and bronchi are unblocked', 'hash': 'ab808d6adb73be9c9efd977cd27ef54cace943f5143068db354c7d287374a50d'}, {'image_id': '313891_1_En_17_Fig13b_HTML', 'image_file_name': '313891_1_En_17_Fig13b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig13b_HTML.jpg', 'caption': '(a–c) HIV/AIDS related Pneumocystis carinii pneumonia. (a–c) CT scanning demonstrates multiple ground glass liked density shadows in both lungs, transparent areas in them and unblocked trachea and bronchi', 'hash': '2f728d8163ffe4c88ed77f38f8d2e52cb2281b7f3a54af1e9ef328c17a26db3e'}, {'image_id': '313891_1_En_17_Fig28_HTML', 'image_file_name': '313891_1_En_17_Fig28_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig28_HTML.jpg', 'caption': '(a–b) HIV/AIDS related miliary tuberculosis. (a) CT scanning demonstrates diffuse scattering miliary shadows with increased density in both lungs, which are bilaterally symmetric and in even size and distribution. (b) CT scanning of the mediastinal window demonstrates round liked nodular shadows in the right lower lung. CT guided puncture for biopsy is performed to define the diagnosis', 'hash': '1ae71db3f6eebb2e460b8f3b777873d5e7fcf066436bf3a85ef8123aff3f39a9'}, {'image_id': '313891_1_En_17_Fig105b_HTML', 'image_file_name': '313891_1_En_17_Fig105b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig105b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related pulmonary toxoplasmosis. (a–d) CT scanning demonstrates thickened pulmonary markings in both lungs, which can be enhanced to extend into the middle and outer zones of lungs, in grid liked appearance that is more obvious in the dorsal segment of the lungs. (e) It is demonstrated to have clustering toxoplasma tachyzoites', 'hash': '78ad5a602c243399be530b578f5858d7393984c75f2f978c1dd02f12b26b8836'}, {'image_id': '313891_1_En_17_Fig99_HTML', 'image_file_name': '313891_1_En_17_Fig99_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig99_HTML.jpg', 'caption': '(a, b) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates enlarged right hilus, thickened and deranged lung markings. (b) Plain CT scanning demonstrates mass shadows in the right hilus, spots shadows in the right middle and lower lobes, and patchy shadows in the lingual segment of the left lung', 'hash': '996d2e340f8971525deb4ef2a9312fe4a696f4d7f6bf28ca091e8c767b96b1d4'}, {'image_id': '313891_1_En_17_Fig3b_HTML', 'image_file_name': '313891_1_En_17_Fig3b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig3b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates cloudy and scattered miliary increased density shadows in both lungs, with enlarged and thickened hilum of both lungs. (b–e) CT scanning demonstrates even miliary increased density shadows in the middle and upper lungs as well as the dorsal segment of the lower lung field, with some fused in thin cloudy shadows', 'hash': '8c1d9dac035274e484303c9deb64a07fed7806c66acaf49b860164feb6d461fc'}, {'image_id': '313891_1_En_17_Fig70_HTML', 'image_file_name': '313891_1_En_17_Fig70_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig70_HTML.jpg', 'caption': '(a–d) HIV/AIDS related pulmonary aspergillosis infection. (a, b) CT scanning of the pulmonary window demonstrates a huge cavity shadow in the dorsal segment of the right lower lung, large nodular shadows in it, liquid gas level in the basal cavity, and the evenly thick wall. (c, d) CT scanning of the mediastinal window in the prone posture demonstrates a huge cavity shadow in the dorsal segment of the left lung, multiple large nodular shadows in it, and involved pleura of the lateral chest wall', 'hash': '967426acae68b8d57372efde07d76dd6ad696b10cc5bb64fb67bd9af43a1b0c8'}, {'image_id': '313891_1_En_17_Fig108_HTML', 'image_file_name': '313891_1_En_17_Fig108_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig108_HTML.jpg', 'caption': 'HIV/AIDS related lymphoma. DR demonstrates widened upper middle mediastinum in a dense shadow, enlarged and thickened hilum, thickened and blurry pulmonary markings with diffuse ground glass liked changes', 'hash': '449c992b619237febe63b1617b26f78de511c69c5d1c86ddbd66631790a3e3ce'}, {'image_id': '313891_1_En_17_Fig18_HTML', 'image_file_name': '313891_1_En_17_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig18_HTML.jpg', 'caption': '(a–d) HIV/AIDS related Pneumocystis carinii pneumonia. (a) DR demonstrates multiple patchy shadows with increased density in both lungs which are more obvious in both middle and lower lungs. The hilar shadows in both lungs are enlarged, with sharp both costophrenic angles. (b–d) CT scanning demonstrates multiple patchy and mass liked parenchyma shadows in both lungs, ground glass density shadows in the apical segment of both upper lobes, transparent areas in the medial segment of the right middle lobe as well as in the lingual segment of the left upper lobe, and unobstructed trachea and bronchi', 'hash': '18239548bfc8a180d3460173e2f66f27c6ff38e464607d7ec3eb2a837a1382c9'}, {'image_id': '313891_1_En_17_Fig67b_HTML', 'image_file_name': '313891_1_En_17_Fig67b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig67b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and thick-wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows. (e–h) Reexamination of the pulmonary window after 3 months treatment demonstrates multiple scattered round liked nodular shadows and thick wall cavity shadows in both lungs, with small nodular shadows in the cavity shadows which obviously increase and enlarge compared to previous lesions, with accompanying infiltration shadows around the lesions', 'hash': 'f70faec5b814f1fa9555182e0f5414a33838b2496e4da16dc69e0c237676eb30'}, {'image_id': '313891_1_En_17_Fig115a_HTML', 'image_file_name': '313891_1_En_17_Fig115a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig115a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related lung cancer. (a–f) CT scanning demonstrates diffuse soft tissue density shadows in left upper lung, round liked mass shadows in the middle lung field, thickened pleura in the lateral chest wall with adhesion, and strip liked liquid density shadows', 'hash': '08de7c80ca9fdc7641723bbb9689498f65631a1a2ee1f499cda653be3ea3d358'}, {'image_id': '313891_1_En_17_Fig40_HTML', 'image_file_name': '313891_1_En_17_Fig40_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig40_HTML.jpg', 'caption': '(a, b) HIV/AIDS related endobronchial tuberculosis. (a, b) Chest CT scanning demonstrates narrowed left major bronchus, irregular thickening of the brounchial wall, multiple irregular flaky, patchy and military shadows in the posterior apical, anterior and lingual segments of the left upper lung. Bronchobierscopy demonstrates narrowed left major bronchus, which is possibly caused by endobronchial tuberculosis', 'hash': '4e416b52d4cb1a2790ee8ad419d525b4e0b37740624cb136f4f5d66c98344651'}, {'image_id': '313891_1_En_17_Fig106b_HTML', 'image_file_name': '313891_1_En_17_Fig106b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig106b_HTML.jpg', 'caption': '(a–h) HIV/AIDS related lymphoma. (a–b) DR demonstrates enlarged and thickened left hilum in a huge mass shadow. High KV demonstrates a huge mass shadow in the hilum. (c–h) CT scanning of the pulmonary window demonstrates a huge high density mass shadow in the left hilum, surrounding nodular fusion shadows in the lung tissues. CT scanning of the mediastinal window demonstrates a huge high density mass shadow in the left hilum, with air bronchogram sign in the shadow', 'hash': '157c65f2ce36513c7bad3d16abf703fde23671a6d95e1da5b62342efd5b516bb'}, {'image_id': '313891_1_En_17_Fig75a_HTML', 'image_file_name': '313891_1_En_17_Fig75a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig75a_HTML.jpg', 'caption': '(a–f) HIV/AIDS related pulmonary aspergillosis infection. (a–d) CT scanning of the pulmonary window demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval or sphere shaped nodular shadows in the cavities with smooth boundaries. (e, f) Reexamination after treatment demonstrates multiple scattered round liked nodular shadows and irregular thick-wall cavity shadows in both lungs, oval nodular shadows in the cavity with smooth boundaries. Compared to the previous imaging findings, the lesions are shrunk, with improved surrounding infiltration', 'hash': 'd2c91d61cbf8a801eed1951a78b54e9b966e9be37aee83d7582af7a496143832'}, {'image_id': '313891_1_En_17_Fig66b_HTML', 'image_file_name': '313891_1_En_17_Fig66b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig66b_HTML.jpg', 'caption': '(a–g) HIV/AIDS related pulmonary aspergillosis infection. (a) DR demonstrates large flaky shadows with increased density in the right upper lung, with blurry boundaries; round liked or sphere shaped mass shadows in the right lower lung, with uneven density. (b–e) CT scanning of the pulmonary window demonstrates multiple round liked thick-wall cavities in the dorsal segment of the right lower lung, with small nodular shadow adhering on the cavity wall; and surrounding small nodular shadows and infi ltration shadows. (f, g) Coronal CT scanning reconstruction demonstrates a huge thick-wall cavity in the right upper lung, with irregular thickness of the wall; round liked cavity shadows in the right lower lung, with thick and multilocular walls; and flaky shadows with increased density in the outer zone of the left lower lung', 'hash': 'fe0cc9e767d47fe24d043db5792869e260b44f40097a6c4d26c923e91ef70b0b'}, {'image_id': '313891_1_En_17_Fig98a_HTML', 'image_file_name': '313891_1_En_17_Fig98a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig98a_HTML.jpg', 'caption': '(a–e) HIV/AIDS related cytomegalovirus pneumonia. (a) DR demonstrates thickened lung markings in both lungs, which extend to the outer zone of the lungs. (b) DR demonstrates thickened and deranged lung markings in both lungs with nodular blurry shadows; and cloudy shadows in lung fields. (c, d) CT scanning demonstrates thickened lung markings in both lungs, with diffuse nodular shadows; and cloudy changes in lung fields. (e) HE staining demonstrates cytomegalovirus inclusions', 'hash': 'adcabf812efa2a551bb7a968e7cf0afcc7677ffb9adf3d1a40a65675496e4552'}, {'image_id': '313891_1_En_17_Fig50_HTML', 'image_file_name': '313891_1_En_17_Fig50_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig50_HTML.jpg', 'caption': '(a–f) HIV/AIDS related Staphylococcus aureus pneumonia. (a) DR demonstrates large flaky dense shadow in the right middle-upper lung field, with blurry boundary. (b, c) CT scanning demonstrates large flaky dense shadow in the right middle upper lung field, with blurry boundary. (d, e) CT scanning demonstrates large flaky dense shadow in the right middle upper lung field, with cystic transparent area in it. (f) Reexamination demonstrates obviously improved pulmonary lesions in the right lung after anti-bacteria treatment for 3 weeks', 'hash': 'bb5e00f8d7a7c6c4308ca4e5024daa75df1bf9a0a88359faa7e2ee91a6c5f156'}, {'image_id': '313891_1_En_17_Fig114a_HTML', 'image_file_name': '313891_1_En_17_Fig114a_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig114a_HTML.jpg', 'caption': '(a–h) HIV/AIDS related Kaposi’s sarcoma. (a–d) CT scanning demonstrates scattered cloudy mass and flakes liked or nodular shadows with increased density in both lungs with uneven density and unclear boundaries, fusion and parenchymal changes of some lesions, more lesions in the lower lobe of both lungs and mostly with parenchymal changes. (e, f) Pathological biopsy demonstrates large quantity heteromorphological spindle cells with large and thick stained nucleoli, which are in line with the manifestations of Kaposi’s sarcoma. (g, h) Immunohistochemical demonstrates positive of C3 and C4', 'hash': '5d7437deda7758de05e56f8172703b4659fa4eeebdc50c92456867e7bfdb2691'}, {'image_id': '313891_1_En_17_Fig107b_HTML', 'image_file_name': '313891_1_En_17_Fig107b_HTML.jpg', 'image_path': '../data/media_files/PMC7121050/313891_1_En_17_Fig107b_HTML.jpg', 'caption': '(a–e) HIV/AIDS related lymphoma. (a–e) CT scanning of the pulmonary and mediastinal windows demonstrates multiple round liked nodular shadows with increased density in both lung fields, with clear boundaries; large soft tissue mass shadows in the right lower lung, with slightly lobulated boundaries and spikes. (f–i) CT scanning of the pulmonary and mediastinal windows for reexamination after radiation therapy demonstrates shrinkage of intrapulmonary nodules and masses', 'hash': 'a7c148d3f71f853c603d1730a516c4b571960bd1e6296b96b6418a73f3663e33'}] | {'313891_1_En_17_Fig1_HTML': ['By naked eyes observation, there are extensive and diffuse invasion of lungs, which is soft like waterlogged sponge and in milky white with black spots. The filled foamy substance in the alveoli and bronchioles is a mixture of necrotic fungus and immunoglobulin. The alveolar septum has infiltration of plasma cells and lymphocytes, resulting in thickened alveolar septa up to 5–20 times as the normal thickness that occupy 3/4 of the entire lung volume. The cysts are firstly located in the macrophage cytoplasm of the alveolar septa. Subsequently, the alveolar cells containing cysts sheds off into the alveolar space. After the rupture of the cystic wall, sporozoite is discharged to turn into free trophozoites, which gains its access into the alveolar space. The alveolar exudates include plasma cells, lymphocytes and histocytes (Fig. <xref rid="313891_1_En_17_Fig1_HTML" ref-type="fig">17.1a–c</xref>).\n).\nFig. 17.1(a) Gross specimens’ observation demonstrates foamy liquid filling in the lung tissues. (b) HE demonstrates pneumocystis in the alveolar exudates, which can be stained black by silver methenamine staining, ×400. (c) HE demonstrates the foamy substance in the alveolar space, ×400\n'], '313891_1_En_17_Fig19_HTML': ['If the necrotic lesions erode the blood vessels, tubercle bacilli can cause systemic miliary tuberculosis along with blood flow, including brain, bones and kidneys. Large quantity sputum containing tubercle bacilli gains its access into the gastrointestinal tract. It can also cause intestinal tuberculosis and peritoneal tuberculosis. Pulmonary tuberculosis can cause tuberculosis pleurisy via direct spreading to the pleura (Fig. <xref rid="313891_1_En_17_Fig19_HTML" ref-type="fig">17.19a–c</xref>).\n).\nFig. 17.19(a) Gross observation in autopsy demonstrates disseminated pulmonary tuberculosis, with grayish white military nodules in diffuse distribution in the lung tissues section. (b) It is demonstrated that mycobacteriumavium-intracellularcomplex infection in the lung tissue, with atypical tuberculosis nodules and acid-fast staining positive (left top). There are a subnodular giant cell, eosinophilic inclusion bodies in the nucleus and bradyzoites in cytoplasm of T. gondii. HE\u2009×\u2009100. (c) HE demonstrates mycobacteriumavium-intracellularcomplex infection, with atypical tuberculosis nodular changes, HE\u2009×\u2009200\n'], '313891_1_En_17_Fig45_HTML': ['Pneumonia caused by inhaled staphylococcus aureus through the respiratory tract often shows lesions in the large lobes or extensive fusion of bronchopneumonia lesions. Bronchial and alveolar rupture allows gas to enter the pulmonary interstitium, which is communicated with the bronchi. In the cases of bronchiolar blockage by necrotic tissues or pus, the one-way valve effect is formed to cause tension pulmonary emphysema. In the cases with superficial pulmonary emphysema with excessively high tension, it ruptures to form pneumothorax or pyopneumothorax, as well as bronchooleural fistula (Fig. <xref rid="313891_1_En_17_Fig45_HTML" ref-type="fig">17.45a, b</xref>).\n).\nFig. 17.45(a, b) HIV/AIDS related Staphylococcus aureus pneumonia. (a) Gross specimen observation demonstrates bilateral purplish brown lesions, patchy white infiltration at the base of the lungs. (b) HE staining demonstrates alveolar diffuse lesions, exudation of the serous fluid and inflammatory cells in the alveolar cavity, and alveolar wall congestion\n'], '313891_1_En_17_Fig64_HTML': ['Aspergillus commonly violates bronchus and lung, with involvements of rhinal sinuses, external auditory canal, eye and skin. Otherwise, it disseminates to organs of the body along with blood flow. The early lesions are diffuse infiltrative and exudative changes. And advanced lesions are necrosis, pyogenesis or granuloma. Large quantity hyphae can be found in the lesions. The hyphae penetrate the blood vessels to cause vasculitis, perivascular inflammation and thrombosis. And thrombosis can cause ischemia and necrosis of the tissue. According to the pathological changes and imaging findings, it can be divided into three major types: vascular invasion type, bronchopneumonia type and allergic bronchopulmonary aspergillosis type. (1) The vascular invasion type is the result caused by toxins released in the process of aspergillus spreading extensively from the primary focus to the lungs. Vascular infiltration of the pulmonary parenchyma and coagulative necrosis are believed to be the cause of vascular occlusion and pulmonary infarction. (2) Bronchopneumonia type is acute bronchitis caused by inhalation of Aspergillus spores. In the cases of hyphae invasion into the lung tissues, extensive infiltrative pneumonia or focal granuloma are resulted in. It can also cause necrosis, pyogenesis and multiple small abscesses. Spherical pulmonary aspergillosis is often secondary to bronchiectasis, tuberculosis, carcinous cavity and other lung diseases. Mycelia multiply and gather in the cavities of the lungs to form a spherical mass with fibrin and mucosal cells, which are called aspergillar glomera, which do not invade the lung tissue. (3) Allergic bronchopulmonary aspergillosis type is the proliferation and germination of inhaled Aspergillus spore in the airway, often showing obvious related mucosal lesions and eventually resulting in bronchiectasis (Fig. <xref rid="313891_1_En_17_Fig64_HTML" ref-type="fig">17.64a–c</xref>).\n).\nFig. 17.64(a) Gross observation demonstrates dark brown lungs in appearance. (b, c) Thology demonstrates hemorrhage and edema of the lung tissue and focal necrosis, with large quantity Aspergillus hyphae and spores in the surrounding area of the necrosis (Combined with pulmonary CMV infection)\n'], '313891_1_En_17_Fig77_HTML': ['In the early stage of cryptococcal infection, only a mild inflammatory reaction or diffuse infiltrative exudative changes occur. But in the advanced stage, necrosis, suppuration or granuloma is formed. Large quantity hyphae can be found in the focus. In the cases with hyphae penetrating the blood vessels, vasculitis, perivascular inflammation and thrombosis occur. And thrombosis leads to ischemia and necrosis of the tissue (Fig. <xref rid="313891_1_En_17_Fig77_HTML" ref-type="fig">17.77</xref>).\n).\nFig. 17.77HE staining demonstrates isseminated cryptococci, the Cryptococcus is stained red after mucin carmine staining of cryptococcus neoformans spores in lungs, (HE\u2009×\u2009200)\n'], '313891_1_En_17_Fig97_HTML': ['Cytomegalovirus pneumonia has extensive pathological changes in the lungs. Pathologically, it shows interstitial pneumonia, with the lesions randomly blood borne distributing in the lungs. The distribution can be diffuse, panlobular or focal. The target cells of pathological changes include alveolar cells and macrophages. Diffused pulmonary interstitial edema and fibrosis as well as alveolar swelling, focal necrosis, bleeding and hyperplasia occur after CMV infections to cause hypoxemia. Gross observation of fresh specimens demonstrates pulmonary surface edema and flaky blooding spots. Fixed specimens demonstrate brown hard lung tissues. Under a microscope, pulmonary interstitial congestion as well as infiltration of lymphocytes and mononuclear cells can be found, with the involved epithelial cells enlarged. In the pulmonary interstitium and alveoli, there are intranuclear inclusions, cytoplasmic inclusions and fluid containing abundant proteins. The classical intranuclear inclusions can be found in the cells, purplish red or purplish blue, round or oval, with surrounding halos in eagle eyes sign. Atypical cytomegalic inclusions in cells are slender, long and round liked with abundant cytoplasm and accentric nucleolus, which are blurry, unclear and atypical (Fig. <xref rid="313891_1_En_17_Fig97_HTML" ref-type="fig">17.97a–e</xref>). Immunohistochemitry demonstrates HIV P24 antigen positive.\n). Immunohistochemitry demonstrates HIV P24 antigen positive.\nFig. 17.97(a) Gross observation of the fresh specimen in autopsy demonstrates pulmonary edema and congestion of cytomegalovirus pneumonia. (b) Gross observation of the formalin fixed specimen in autopsy demonstrates dark brown hard pulmonary tissues. (c, d) HE staining demonstrates large quantity cytomegalovirus inclusions in eagle eyes sign. (e) Immunohistochemical demonstrates HIV P24 antigen positive in macrophages of lung tissues (×400)\n']} | HIV/AIDS Related Respiratory Diseases | [
"HIV/AIDS related pneumocystis carnii pneumonia (PCP)",
"HIV/AIDS related pulmonary bacterial infections",
"HIV/AIDS related pulmonary fungal infections",
"HIV/AIDS related pulmonary virus infections",
"HIV/AIDS related pulmonary parasitic diseases",
"HIV/AIDS related pulmonary neoplasm"
] | None | 1380524400 | None | null | other | PMC7121050 | null | null | [
""
] | Radiology of HIV/AIDS. 2013 Sep 30;:377-535 | NO-CC CODE |
|
(a, b) A 33-year-old woman with BOLT in 2007 for cystic fibrosis . CT during inspiration (a) and expiration (b) shows patchy areas of air trapping (asterisks in b), consistent with BOS | 339803_1_En_19_Fig19_HTML | 7 | 974a829935609e78862441629ba728c72cddd7f8ab996e5c7656c05cb344f09d | 339803_1_En_19_Fig19_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
627,
238
] | [{'image_id': '339803_1_En_19_Fig17_HTML', 'image_file_name': '339803_1_En_19_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig17_HTML.jpg', 'caption': '(a, b) A 34-year-old man with BOLT in 2009 for pulmonary fibrosis after hematopoietic stem cell transplantation for acute lymphoblastic leukemia. CT shows multiple irregular nodules with peripheral ground-glass halo (arrows in a and b). BAL fluid grew Aspergillus Fumigatus', 'hash': '6459c03cca3c05fde5735d13bdf2e7accf03cc8c43da6b9c85acbd77419e6ac0'}, {'image_id': '339803_1_En_19_Fig18_HTML', 'image_file_name': '339803_1_En_19_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig18_HTML.jpg', 'caption': '(a, b) A 59-year-old man with BOLT in 2015 for IPF. CT shows patchy ground-glass opacity (arrows in a and b) and centrilobular nodules (circle in a and b). Viral PCR panel was positive for coronavirus and adenovirus. Note bilateral pleural effusions (asterisks in a and b)', 'hash': '6f1cb8b868a9b1090604419c33a3e222a5269dcda0be230037edc7541cf865ad'}, {'image_id': '339803_1_En_19_Fig2_HTML', 'image_file_name': '339803_1_En_19_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig2_HTML.jpg', 'caption': 'A 43-year-old man with bilateral orthotropic lung transplant (BOLT) in 2010 for ciliary dyskinesia . Frontal chest radiograph obtained 4 days after transplantation shows diffuse lung disease, likely representing primary graft dysfunction or reperfusion pulmonary edema', 'hash': '0029bfa73594dc6b2e69ce8f51cb30e6db1a8f14f0bcf4a1a7ac7ce8328ce3bc'}, {'image_id': '339803_1_En_19_Fig10_HTML', 'image_file_name': '339803_1_En_19_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig10_HTML.jpg', 'caption': '(a–c) A 57-year-old woman with BOLT in 2015 for alpha-1 antitrypsin deficiency. CT obtained 6 weeks after transplantation showed small pocket of extra-luminal air (arrows in a and b) adjacent to right mainstem bronchus, consistent with bronchial anastomotic dehiscence. This was confirmed on bronchoscopy that shows necrotic plaque on medial right mainstem bronchus (arrow in c)', 'hash': 'd8e2c0f970b2927575c18e696d99eaee08da99c43a3a5ce4c41768e6e9138ed0'}, {'image_id': '339803_1_En_19_Fig20_HTML', 'image_file_name': '339803_1_En_19_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig20_HTML.jpg', 'caption': '(a, b) A 72-year-old woman with BOLT in 2013 for IPF . CT shows bronchiectasis (arrows in a and b) and mosaic attenuation, consistent with obliterative bronchiolitis indicating chronic lung allograft dysfunction of the BOS variety', 'hash': 'b54311ecbd6f5a7d8adaf322f0f25d940cce1c666b9fcccd70a916828ba8a2c7'}, {'image_id': '339803_1_En_19_Fig5_HTML', 'image_file_name': '339803_1_En_19_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig5_HTML.jpg', 'caption': '(a, b) A 72-year-old woman with BOLT in 2013 for IPF. CT obtained 2 weeks after transplantation shows bilateral pleural effusions (asterisks a and b) with associated compressive atelectasis in lower lobes. Small pericardial effusion is also present (arrows in a and b)', 'hash': 'd089e181b77c36e20503094cdcda924a138a57ed697da9646eec3ef05e104344'}, {'image_id': '339803_1_En_19_Fig3_HTML', 'image_file_name': '339803_1_En_19_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig3_HTML.jpg', 'caption': 'A 30-year-old woman status post double lung transplant for cystic fibrosis. CT obtained 9 days after transplantation shows diffuse ground-glass opacity and consolidation, consistent with primary graft dysfunction. Bilateral chest tubes are in place', 'hash': 'a86d6bde304d850dbfe8e64f75bdaced1fc4db0fada11d0a315a01d980470d24'}, {'image_id': '339803_1_En_19_Fig19_HTML', 'image_file_name': '339803_1_En_19_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig19_HTML.jpg', 'caption': '(a, b) A 33-year-old woman with BOLT in 2007 for cystic fibrosis . CT during inspiration (a) and expiration (b) shows patchy areas of air trapping (asterisks in b), consistent with BOS', 'hash': '974a829935609e78862441629ba728c72cddd7f8ab996e5c7656c05cb344f09d'}, {'image_id': '339803_1_En_19_Fig16_HTML', 'image_file_name': '339803_1_En_19_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig16_HTML.jpg', 'caption': '(a, b) A 71-year-old man with BOLT in 2013 for COPD. CT shows bilateral peribronchial consolidation . BAL fluid grew Pseudomonas and MSSA', 'hash': '9cc3263cef7d5a941d2ec0d03696b36b4063708447e9ec1187eba87c6ecb5bf8'}, {'image_id': '339803_1_En_19_Fig21_HTML', 'image_file_name': '339803_1_En_19_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig21_HTML.jpg', 'caption': 'A 59-year-old woman with BOLT in 2013 for scleroderma-associated ILD. CT shows peripheral (arrowheads) and peribronchial (arrow) consolidation. Transbronchial biopsy showed organizing pneumonia pattern without infection', 'hash': '5056c4f1aa28592399c3e86cedc2cef3aea0b57d1111edf464b0bf17b85ecda2'}, {'image_id': '339803_1_En_19_Fig4_HTML', 'image_file_name': '339803_1_En_19_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig4_HTML.jpg', 'caption': '(a, b) A 69-year-old man with single orthotropic lung transplant (SOLT) in 2015 for IPF. CT obtained 4 days after transplantation shows pneumomediastinum (black arrows in a), pneumothorax (curved arrow in b), pneumopericardium (arrowheads in b), and subcutaneous emphysema (white arrow in a). The bronchial anastomosis was intact. Right chest tube is in place. Note fibrosis in native left lung', 'hash': 'b578bc52ba8bd9f363ec114a1ce732c9406ae92cd6ae9d134cecc1faf3268fdc'}, {'image_id': '339803_1_En_19_Fig11_HTML', 'image_file_name': '339803_1_En_19_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig11_HTML.jpg', 'caption': '(a, b) A 62-year-old man status post double lung transplant for sarcoidosis. CT obtained 3 weeks after transplantation shows air tracking from the left mainstem bronchus (arrows in a and b), consistent with dehiscence. Note collapse of left lower lobe', 'hash': '8bf6ce6a3fabbb6397a46c2309d1afa25dd92054b160517a46a50a346162bbf9'}, {'image_id': '339803_1_En_19_Fig12_HTML', 'image_file_name': '339803_1_En_19_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig12_HTML.jpg', 'caption': '(a, b) A 65-year-old man status post double lung transplant for IPF. CT obtained 3 weeks after transplantation showed right mainstem bronchus dehiscence (arrows in a and b) tracking into the right pleural space suggestive of bronchopleural fistula (arrowhead in b)', 'hash': 'f78f1379ee9b000d86669ecda0e3babcb1e13eff3a88f440fcfa9e7bdaafcea8'}, {'image_id': '339803_1_En_19_Fig22_HTML', 'image_file_name': '339803_1_En_19_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig22_HTML.jpg', 'caption': '(a, b) A 23-year-old woman with BOLT in 2010 for CF. CT shows mass-like consolidation in left upper lobe (arrow in a). CT-guided biopsy was obtained, and histopathology was consistent with post-transplant lymphoproliferative disorder (PTLD). CT also shows bronchiectasis (arrow in b) and air trapping, consistent with chronic lung allograft dysfunction', 'hash': 'e1c693a81f9bed3d091d27bf1c78c7a347e0bb346fe07ee9fb02c4e12f381c46'}, {'image_id': '339803_1_En_19_Fig7_HTML', 'image_file_name': '339803_1_En_19_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig7_HTML.jpg', 'caption': '(a, b) A 55-year-old woman with BOLT in 2013 for COPD. CT obtained 8 months after transplantation showed patchy ground-glass opacities (arrows in a and b) bilaterally. Although a nonspecific pattern, the transbronchial biopsy was consistent with A0B1 ACR with all infectious testing negative', 'hash': '3c7ef62c99753a570c27865b4b4851ba59d43985209dc84161ba55689a79769e'}, {'image_id': '339803_1_En_19_Fig8_HTML', 'image_file_name': '339803_1_En_19_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig8_HTML.jpg', 'caption': 'A 69-year-old woman status post left lung transplant for chronic hypersensitivity pneumonitis. CT obtained 4 months after transplantation showed patchy ground-glass opacities in the allograft. Although a nonspecific pattern, the transbronchial biopsies revealed A2B0 acute cellular rejection. Note fibrosis in the native right lung', 'hash': 'aaf195ea2d563d3c4eda98397cb1db0fdb9c5509c8fb29793e05735a5af787c9'}, {'image_id': '339803_1_En_19_Fig15_HTML', 'image_file_name': '339803_1_En_19_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig15_HTML.jpg', 'caption': '(a, b) A 34-year-old woman with BOLT in 2006 for CF. CT during inspiration (a) and expiration (b) shows severe collapse of the bronchus intermedius during expiration (arrow in b) indicating bronchomalacia. Note air trapping in both lower lobes (asterisks in b)', 'hash': '86f8747605e6b0c3f726aa600f135ae7f7e576c8564c0af2c8d605e00ac7b6ca'}, {'image_id': '339803_1_En_19_Fig23_HTML', 'image_file_name': '339803_1_En_19_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig23_HTML.jpg', 'caption': '(a, b) A 73-year-old man with BOLT in 2005 for COPD. CT shows low-density soft tissue masses in the spleen (black arrows in a and b), liver (arrowhead in b), and perisplenic (white arrow in b) region. Histopathology was consistent with PTLD', 'hash': '5e43d1ff11e2bed046e106a9211f24648bd6ce7a232628a03fbb2eb646415bfe'}, {'image_id': '339803_1_En_19_Fig9_HTML', 'image_file_name': '339803_1_En_19_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig9_HTML.jpg', 'caption': '(a, b) A 34-year-old woman status post BOLT for PAH. CT obtained 4 months after transplantation showed ground-glass opacity and consolidation bilaterally predominantly in the lower lobes. Although a nonspecific pattern, transbronchial biopsies revealed A3B1R acute cellular rejection', 'hash': '25fab931bf7d7536f7ec7cdc160bf54c32405ac685d9abbef5383d864bdadfab'}, {'image_id': '339803_1_En_19_Fig6_HTML', 'image_file_name': '339803_1_En_19_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig6_HTML.jpg', 'caption': '(a, b) A 33-year-old woman with BOLT in 2015 for pulmonary arterial hypertension. CT obtained 2 days after transplantation shows high density material in right pleural space (arrowheads in a and b), consistent with hemothorax. Consolidation in both lower lobes was presumably due to aspiration (arrows)', 'hash': 'bcb4f6843ea9682882f3135f08c900de43af6ee8e8b74e10524e34477cba54a8'}, {'image_id': '339803_1_En_19_Fig13_HTML', 'image_file_name': '339803_1_En_19_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig13_HTML.jpg', 'caption': '(a–d) A 69-year-old man with BOLT in 2009 for IPF. Axial MinIP (a) shows anastomotic narrowing of right mainstem bronchus . Coronal reformation (b) shows narrowing of the left mainstem bronchus distal to anastomosis. Bronchoscopic images confirming narrowing of the right (c) and left (d) mainstem bronchi', 'hash': '07635e904bc25745e35f07c2d3bb8a576f58a4676f492877a93d69cc41821a64'}, {'image_id': '339803_1_En_19_Fig1_HTML', 'image_file_name': '339803_1_En_19_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig1_HTML.jpg', 'caption': '(a, b) A 73-year-old woman status post left lung transplant for severe COPD. CT chest obtained 11 years after transplantation (a) showed hyperinflation of native right lung herniating to left hemithorax. The patient had restrictive pulmonary impairment and developed squamous cell lung cancer in the right lower lobe (not shown), for which she underwent right lower lobectomy. Post lobectomy CT (b) showed an improvement in hyperinflation of the right lung', 'hash': '0e6ce6e877bef309e91727cdf06a860a71abe37a3196a06ce697a2b2dba34ad8'}, {'image_id': '339803_1_En_19_Fig24_HTML', 'image_file_name': '339803_1_En_19_Fig24_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig24_HTML.jpg', 'caption': '(a, b) A 41-year-old man with BOLT in 2005 for CF . CT shows bilateral upper lung fibrosis (arrows in a and b) indicating chronic lung allograft dysfunction (CLAD) of the restrictive physiology', 'hash': '5aa87049d0476f0a94c2efccb1280bc31b52001896b7e7dbbe63fe35d6d0993c'}, {'image_id': '339803_1_En_19_Fig14_HTML', 'image_file_name': '339803_1_En_19_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC7121182/339803_1_En_19_Fig14_HTML.jpg', 'caption': '(a, b) A 62-year-old man with BOLT in 2014 for COPD. CT shows diffuse stenosis of bronchus intermedius (arrow in a). Patient underwent bronchial dilation and stenting (arrow in b)', 'hash': '4c1561b2d987c02a8b5b8db99bcdfa681df210b5661a50cbf5f81dd38b3d64b6'}] | {'339803_1_En_19_Fig1_HTML': ['Size mismatch between the donor lung and recipient thoracic cavity may result in mechanical complications. Most centers accept a size difference ranging from 10 to 25% [2]. If the donor lung is too large for recipient thoracic cavity, atelectasis and impaired ventilation may result. Atelectasis may be evident on immediate postoperative radiograph. On the other hand, when a small allograft lung is used in single lung transplantation for emphysema, the hyperexpanded native lung may compress the allograft, resulting in restrictive pulmonary function (Fig. <xref rid="339803_1_En_19_Fig1_HTML" ref-type="fig">19.1a, b</xref>). Native lung volume reduction surgery performed at the time of, or after, transplantation may help prevent this complication [). Native lung volume reduction surgery performed at the time of, or after, transplantation may help prevent this complication [3].Fig. 19.1(a, b) A 73-year-old woman status post left lung transplant for severe COPD. CT chest obtained 11 years after transplantation (a) showed hyperinflation of native right lung herniating to left hemithorax. The patient had restrictive pulmonary impairment and developed squamous cell lung cancer in the right lower lobe (not shown), for which she underwent right lower lobectomy. Post lobectomy CT (b) showed an improvement in hyperinflation of the right lung\n'], '339803_1_En_19_Fig2_HTML': ['Chest radiography and CT manifestations are nonspecific and include perihilar and lower lobe predominant ground-glass opacity, and/or consolidation, interlobular septal thickening, and peribronchial air-space opacities (Figs. <xref rid="339803_1_En_19_Fig2_HTML" ref-type="fig">19.2</xref> and and <xref rid="339803_1_En_19_Fig3_HTML" ref-type="fig">19.3</xref>).).Fig. 19.2A 43-year-old man with bilateral orthotropic lung transplant (BOLT) in 2010 for ciliary dyskinesia . Frontal chest radiograph obtained 4 days after transplantation shows diffuse lung disease, likely representing primary graft dysfunction or reperfusion pulmonary edema\nFig. 19.3A 30-year-old woman status post double lung transplant for cystic fibrosis. CT obtained 9 days after transplantation shows diffuse ground-glass opacity and consolidation, consistent with primary graft dysfunction. Bilateral chest tubes are in place\n'], '339803_1_En_19_Fig4_HTML': ['\nPleural complications\n—including pleural effusion, hemothorax, pneumothorax, and empyema—occur in 22–34% of patients after transplantation [6, 7]. Existing pleural abnormalities before lung transplantation can predispose to pleural complications. For instance, pleural infection or inflammation can result from end-stage lung diseases for which lung transplantation is required such as cystic fibrosis. Invasive procedures required to diagnose (wedge biopsy) or treat (pleurodesis or pleural drain for pneumothorax or pleural effusion) end-stage lung disease may result in pleural abnormalities. Pneumothorax is the most common pleural complication [7] (Fig. <xref rid="339803_1_En_19_Fig4_HTML" ref-type="fig">19.4a, b</xref>). Airway anastomotic complications should be suspected if pneumothorax persists or enlarges after the early postoperative period (>7 days after transplantation). Pleural effusion is also a common complication secondary to increased capillary permeability and impaired lymphatic drainage of the allograft lung during the early postoperative period (Fig. ). Airway anastomotic complications should be suspected if pneumothorax persists or enlarges after the early postoperative period (>7 days after transplantation). Pleural effusion is also a common complication secondary to increased capillary permeability and impaired lymphatic drainage of the allograft lung during the early postoperative period (Fig. <xref rid="339803_1_En_19_Fig5_HTML" ref-type="fig">19.5a, b</xref>). Pleural fluid in the immediate postoperative period is often hemorrhagic and becomes progressively less hemorrhagic by 7 days. Pleural effusion usually resolves by 2 weeks. Persistent or enlarging pleural effusion should raise suspicion for empyema or left heart failure. Hemothorax usually results from surgical complications (Fig. ). Pleural fluid in the immediate postoperative period is often hemorrhagic and becomes progressively less hemorrhagic by 7 days. Pleural effusion usually resolves by 2 weeks. Persistent or enlarging pleural effusion should raise suspicion for empyema or left heart failure. Hemothorax usually results from surgical complications (Fig. <xref rid="339803_1_En_19_Fig6_HTML" ref-type="fig">19.6a, b</xref>). Persistent air leak, empyema, and hemothorax are associated with increased mortality and should be promptly recognized and managed [). Persistent air leak, empyema, and hemothorax are associated with increased mortality and should be promptly recognized and managed [7, 8].Fig. 19.4(a, b) A 69-year-old man with single orthotropic lung transplant (SOLT) in 2015 for IPF. CT obtained 4 days after transplantation shows pneumomediastinum (black arrows in a), pneumothorax (curved arrow in b), pneumopericardium (arrowheads in b), and subcutaneous emphysema (white arrow in a). The bronchial anastomosis was intact. Right chest tube is in place. Note fibrosis in native left lung\nFig. 19.5(a, b) A 72-year-old woman with BOLT in 2013 for IPF. CT obtained 2 weeks after transplantation shows bilateral pleural effusions (asterisks a and b) with associated compressive atelectasis in lower lobes. Small pericardial effusion is also present (arrows in a and b)\nFig. 19.6(a, b) A 33-year-old woman with BOLT in 2015 for pulmonary arterial hypertension. CT obtained 2 days after transplantation shows high density material in right pleural space (arrowheads in a and b), consistent with hemothorax. Consolidation in both lower lobes was presumably due to aspiration (arrows)\n'], '339803_1_En_19_Fig7_HTML': ['When present, radiographic manifestations are nonspecific and similar to primary graft dysfunction including ground-glass opacities, consolidation, interlobular septal thickening, and pleural effusion (Figs. <xref rid="339803_1_En_19_Fig7_HTML" ref-type="fig">19.7a, b</xref>, , <xref rid="339803_1_En_19_Fig8_HTML" ref-type="fig">19.8</xref>, and , and <xref rid="339803_1_En_19_Fig9_HTML" ref-type="fig">19.9a, b</xref>). Radiographic improvement within 48\xa0h of administration of intravenous corticosteroids favors the diagnosis of acute rejection [). Radiographic improvement within 48\xa0h of administration of intravenous corticosteroids favors the diagnosis of acute rejection [9].Fig. 19.7(a, b) A 55-year-old woman with BOLT in 2013 for COPD. CT obtained 8 months after transplantation showed patchy ground-glass opacities (arrows in a and b) bilaterally. Although a nonspecific pattern, the transbronchial biopsy was consistent with A0B1 ACR with all infectious testing negative\nFig. 19.8A 69-year-old woman status post left lung transplant for chronic hypersensitivity pneumonitis. CT obtained 4 months after transplantation showed patchy ground-glass opacities in the allograft. Although a nonspecific pattern, the transbronchial biopsies revealed A2B0 acute cellular rejection. Note fibrosis in the native right lung\nFig. 19.9(a, b) A 34-year-old woman status post BOLT for PAH. CT obtained 4 months after transplantation showed ground-glass opacity and consolidation bilaterally predominantly in the lower lobes. Although a nonspecific pattern, transbronchial biopsies revealed A3B1R acute cellular rejection\n'], '339803_1_En_19_Fig10_HTML': ['\nBronchial dehiscence usually occurs in the first 2–4 weeks after transplantation affecting 2–3% patients [9]. CT usually shows extraluminal foci of air in perianastomotic region, and occasionally bronchial defects can be visualized (Figs. <xref rid="339803_1_En_19_Fig10_HTML" ref-type="fig">19.10a–c</xref>, , <xref rid="339803_1_En_19_Fig11_HTML" ref-type="fig">19.11a, b</xref>, and , and <xref rid="339803_1_En_19_Fig12_HTML" ref-type="fig">19.12a, b</xref>). Indirect signs include persistent or enlarging air leak, pneumothorax, or pneumomediastinum. Bronchial dehiscence may resolve spontaneously or progress to bronchial stenosis.). Indirect signs include persistent or enlarging air leak, pneumothorax, or pneumomediastinum. Bronchial dehiscence may resolve spontaneously or progress to bronchial stenosis.Fig. 19.10(a–c) A 57-year-old woman with BOLT in 2015 for alpha-1 antitrypsin deficiency. CT obtained 6 weeks after transplantation showed small pocket of extra-luminal air (arrows in a and b) adjacent to right mainstem bronchus, consistent with bronchial anastomotic dehiscence. This was confirmed on bronchoscopy that shows necrotic plaque on medial right mainstem bronchus (arrow in c)\nFig. 19.11(a, b) A 62-year-old man status post double lung transplant for sarcoidosis. CT obtained 3 weeks after transplantation shows air tracking from the left mainstem bronchus (arrows in a and b), consistent with dehiscence. Note collapse of left lower lobe\nFig. 19.12(a, b) A 65-year-old man status post double lung transplant for IPF. CT obtained 3 weeks after transplantation showed right mainstem bronchus dehiscence (arrows in a and b) tracking into the right pleural space suggestive of bronchopleural fistula (arrowhead in b)\n'], '339803_1_En_19_Fig13_HTML': ['\nBronchial stenosis and bronchomalacia are late complications usually occurring at least 2–4 months after transplantation. Bronchial stenosis occurs in 10% of subjects and is usually seen at the anastomotic site or distally [13]. CT shows bronchial irregularity and focal stenosis (Figs. <xref rid="339803_1_En_19_Fig13_HTML" ref-type="fig">19.13a–d</xref> and and <xref rid="339803_1_En_19_Fig14_HTML" ref-type="fig">19.14a, b</xref>). Management includes resection of the granulation tissue and balloon dilation with or without stenting. Bronchomalacia or transient airway narrowing can be diagnosed with bronchoscopy or CT. Inspiratory and expiratory CT images are invaluable in the diagnosis of bronchomalacia (Fig. ). Management includes resection of the granulation tissue and balloon dilation with or without stenting. Bronchomalacia or transient airway narrowing can be diagnosed with bronchoscopy or CT. Inspiratory and expiratory CT images are invaluable in the diagnosis of bronchomalacia (Fig. <xref rid="339803_1_En_19_Fig15_HTML" ref-type="fig">19.15a, b</xref>). A diagnosis is suggested when there is more than 50 (liberal) to 70% (conservative) dynamic narrowing of the airway or lunate shape of the airway on expiration.). A diagnosis is suggested when there is more than 50 (liberal) to 70% (conservative) dynamic narrowing of the airway or lunate shape of the airway on expiration.Fig. 19.13(a–d) A 69-year-old man with BOLT in 2009 for IPF. Axial MinIP (a) shows anastomotic narrowing of right mainstem bronchus . Coronal reformation (b) shows narrowing of the left mainstem bronchus distal to anastomosis. Bronchoscopic images confirming narrowing of the right (c) and left (d) mainstem bronchi\nFig. 19.14(a, b) A 62-year-old man with BOLT in 2014 for COPD. CT shows diffuse stenosis of bronchus intermedius (arrow in a). Patient underwent bronchial dilation and stenting (arrow in b)\nFig. 19.15(a, b) A 34-year-old woman with BOLT in 2006 for CF. CT during inspiration (a) and expiration (b) shows severe collapse of the bronchus intermedius during expiration (arrow in b) indicating bronchomalacia. Note air trapping in both lower lobes (asterisks in b)\n'], '339803_1_En_19_Fig16_HTML': ['Infectious risks vary based on factors which include the time elapsed since transplantation. Bacterial infections are the most common cause of pneumonia with incidence highest in the first 4 weeks after lung transplantation [15]. Gram-negative organisms such as Klebsiella species and Pseudomonas aeruginosa are common causative agents. Infection by gram-positive organisms including Staphylococcus aureus is also observed. During the first postoperative month, 35–70% recipients develop bacterial pneumonia [16]. Imaging features are similar to the non-transplant population and include lobar or multifocal consolidation, ground-glass opacity, nodules, and pleural effusion [13, 15, 17] (Fig. <xref rid="339803_1_En_19_Fig16_HTML" ref-type="fig">19.16a, b</xref>).).Fig. 19.16(a, b) A 71-year-old man with BOLT in 2013 for COPD. CT shows bilateral peribronchial consolidation . BAL fluid grew Pseudomonas and MSSA\n'], '339803_1_En_19_Fig17_HTML': ['\nFungal infections are caused by Aspergillus and less commonly by the Candida species. Pneumocystis pneumonia is uncommon these days because of routine chemoprophylaxis. Fungal infections can occur at any time but usually peak between 10 and 60 days after transplantation. These are less common but carry higher mortality compared to bacterial or viral infections. Patterns of fungal infection include angioinvasive pulmonary infection, ulcerative tracheobronchitis, and bronchial anastomosis infection [16]. CT in angioinvasive fungal infection shows ill-defined nodules or mass-like consolidation with surrounding ground-glass opacity (halo sign) indicating hemorrhage [13, 15] (Fig. <xref rid="339803_1_En_19_Fig17_HTML" ref-type="fig">19.17a, b</xref>). On CT tracheobronchitis shows diffuse central airway wall thickening and surrounding mediastinal fat stranding. Bronchial anastomosis infection can cause bronchial dehiscence and show small foci of extra-luminal air adjacent to the airways.). On CT tracheobronchitis shows diffuse central airway wall thickening and surrounding mediastinal fat stranding. Bronchial anastomosis infection can cause bronchial dehiscence and show small foci of extra-luminal air adjacent to the airways.Fig. 19.17(a, b) A 34-year-old man with BOLT in 2009 for pulmonary fibrosis after hematopoietic stem cell transplantation for acute lymphoblastic leukemia. CT shows multiple irregular nodules with peripheral ground-glass halo (arrows in a and b). BAL fluid grew Aspergillus Fumigatus\n\n'], '339803_1_En_19_Fig18_HTML': ['Cytomegalovirus (CMV ) is the most common opportunistic infection and the second most common cause of pneumonia in lung transplantation patients. CMV pneumonia usually occurs between 1 and 6 months from transplantation [13]. CMV-seronegative recipients who receive CMV-seropositive donor lungs are at increased risk for developing primary infection. CT shows varying patterns including ground-glass opacity, centrilobular nodules with tree-in-bud pattern, consolidation, and interlobular septal thickening [13, 17] (Fig. <xref rid="339803_1_En_19_Fig18_HTML" ref-type="fig">19.18a, b</xref>). In addition to CMV, other community acquired viruses such as adenovirus, respiratory syncytial virus (RSV), and influenza and parainfluenza viruses may infect lung transplant recipients. Viral infections can\xa0predispose lung transplant recipients to obliterative bronchiolitis [). In addition to CMV, other community acquired viruses such as adenovirus, respiratory syncytial virus (RSV), and influenza and parainfluenza viruses may infect lung transplant recipients. Viral infections can\xa0predispose lung transplant recipients to obliterative bronchiolitis [18, 19], a manifestation of chronic rejection.Fig. 19.18(a, b) A 59-year-old man with BOLT in 2015 for IPF. CT shows patchy ground-glass opacity (arrows in a and b) and centrilobular nodules (circle in a and b). Viral PCR panel was positive for coronavirus and adenovirus. Note bilateral pleural effusions (asterisks in a and b)\n'], '339803_1_En_19_Fig19_HTML': ['\nChronic rejection is a clinicopathologic syndrome most often characterized by obliterative bronchiolitis, affecting 50% of lung transplant recipients at 5 years [20], and the term bronchiolitis obliterans syndrome ( BOS) is used to describe the clinical situation. It is a major factor limiting the long-term survival in lung transplant recipients. It usually occurs 6 months after transplantation, and risk factors include prior episodes of recurrent acute rejection or infections, particularly CMV pneumonia. Obliterative bronchiolitis is the most common histologic pattern seen in BOS and manifests as eosinophilic hyaline fibrosis in respiratory bronchiolar walls with luminal occlusion [20]. Due to patchy distribution of the disease, transbronchial biopsy may be negative. In such cases diagnosis is made clinically on the basis of otherwise unexplained, persistent decrease in FEV1 indicative of small airway disease. Pulmonary function tests classically show an obstructive pattern, but combined obstruction and restriction may be seen [21]. High-resolution CT shows bronchial wall thickening, bronchiectasis, and heterogeneous areas of hyperlucent (dark) interspersed with adjacent normal lung parenchyma (mosaic attenuation) that is accentuated in exhalation images. Thus, it is very important to obtain paired inspiratory and expiratory HRCT images when chronic rejection is suspected clinically. On expiration HRCT, normal lung parenchyma becomes greyer, and hyperlucent (pathologic) lung remains dark indicating air trapping (Figs. <xref rid="339803_1_En_19_Fig19_HTML" ref-type="fig">19.19a, b</xref> and and <xref rid="339803_1_En_19_Fig20_HTML" ref-type="fig">19.20a, b</xref>). Thus, the differentiation between normal and abnormal lung\xa0becomes more pronounced on expiration CT\xa0[). Thus, the differentiation between normal and abnormal lung\xa0becomes more pronounced on expiration CT\xa0[13, 22].Fig. 19.19(a, b) A 33-year-old woman with BOLT in 2007 for cystic fibrosis . CT during inspiration (a) and expiration (b) shows patchy areas of air trapping (asterisks in b), consistent with BOS\nFig. 19.20(a, b) A 72-year-old woman with BOLT in 2013 for IPF . CT shows bronchiectasis (arrows in a and b) and mosaic attenuation, consistent with obliterative bronchiolitis indicating chronic lung allograft dysfunction of the BOS variety\n'], '339803_1_En_19_Fig21_HTML': ['Organizing pneumonia pattern similar to patients with cryptogenic organizing pneumonia occurs in 10–28% of patients after lung transplantation and may be associated with both acute and chronic rejection [15, 23] or may represent infection. It is characterized by the presence of inflammatory granulation tissues within the alveoli, alveolar sacs, and ducts. It responds rapidly to high-dose corticosteroids. Bronchoscopy is often done to exclude infection before starting on high-dose corticosteroids. CT shows peripheral, peribronchovascular, or perilobular consolidation (Fig. <xref rid="339803_1_En_19_Fig21_HTML" ref-type="fig">19.21</xref>). Frequently, peripheral arc-like consolidation with central ground-glass opacity (reverse halo/atoll sign) is seen [). Frequently, peripheral arc-like consolidation with central ground-glass opacity (reverse halo/atoll sign) is seen [15, 24].Fig. 19.21A 59-year-old woman with BOLT in 2013 for scleroderma-associated ILD. CT shows peripheral (arrowheads) and peribronchial (arrow) consolidation. Transbronchial biopsy showed organizing pneumonia pattern without infection\n'], '339803_1_En_19_Fig22_HTML': ['Post-transplant lymphoproliferative disorder\nis a spectrum of disease varying from benign lymphoid hyperplasia to high-grade lymphoma. It typically manifests within 1 year after transplantation but can be seen from 1 month to several years after transplantation. PTLD risk is increased significantly in Epstein-Barr virus (EBV) seronegative recipients receiving lungs from seropositive donors. The other major risk factor is augmented immunosuppression. Incidence varies between 2.8 and 6% at 1 year after transplantation [25, 26]. It is more common with lung transplantation than with other solid organ transplantation. The majority of cases of PTLD is of B cell origin and associated with EBV primary infection. A much smaller proportion of PTLDs are of T cell origin, Hodgkin’s type, or, rarely, plasma cell type such as multiple myeloma. These categories are more likely to be EBV-negative. EBV-associated PTLD presents early (within 1 year), usually has a benign course and is intrathoracic, whereas EBV-negative PTLD presents late (median onset 50–60 months post-transplant), generally more aggressive and extrathoracic. Early disease responds to antiviral therapy and reduction in immunosuppression. Late disease generally requires chemotherapy and radiation therapy [25]. CT shows solitary or multiple nodules with peripheral and basal predominant distribution (Figs. <xref rid="339803_1_En_19_Fig22_HTML" ref-type="fig">19.22a, b</xref> and and <xref rid="339803_1_En_19_Fig23_HTML" ref-type="fig">19.23a, b</xref>). Mass-like consolidation and mediastinal and hilar lymphadenopathy are also commonly seen. Rarely, interlobular septal thickening can be seen. Pleural and chest wall masses with or without pleural effusion and/or pericardial effusion have been described [). Mass-like consolidation and mediastinal and hilar lymphadenopathy are also commonly seen. Rarely, interlobular septal thickening can be seen. Pleural and chest wall masses with or without pleural effusion and/or pericardial effusion have been described [27, 28]. Biopsy is often needed to differentiate PTLD from infection [29, 30].Fig. 19.22(a, b) A 23-year-old woman with BOLT in 2010 for CF. CT shows mass-like consolidation in left upper lobe (arrow in a). CT-guided biopsy was obtained, and histopathology was consistent with post-transplant lymphoproliferative disorder (PTLD). CT also shows bronchiectasis (arrow in b) and air trapping, consistent with chronic lung allograft dysfunction\nFig. 19.23(a, b) A 73-year-old man with BOLT in 2005 for COPD. CT shows low-density soft tissue masses in the spleen (black arrows in a and b), liver (arrowhead in b), and perisplenic (white arrow in b) region. Histopathology was consistent with PTLD\n'], '339803_1_En_19_Fig24_HTML': ['\nUpper lobe fibrosis\nis uncommon and occurs 1–4 years after transplantation. The exact cause for this is unknown but is described as a component of chronic allograft dysfunction (CLAD) demonstrating restrictive physiology hypothesized to be a variant of chronic rejection [21, 31]. Clinically, patients present with restrictive allograft syndrome (RAS), which is marked by restrictive pulmonary function testing and often demonstrates a more aggressive and treatment-refractory course compared to obliterative bronchiolitis. CT shows interlobular septal thickening , traction bronchiectasis, volume loss, and architectural distortion [31] (Fig. <xref rid="339803_1_En_19_Fig24_HTML" ref-type="fig">19.24a, b</xref>).).Fig. 19.24(a, b) A 41-year-old man with BOLT in 2005 for CF . CT shows bilateral upper lung fibrosis (arrows in a and b) indicating chronic lung allograft dysfunction (CLAD) of the restrictive physiology\n']} | Imaging of Lung Transplantation | [
"Lung",
"Transplantation",
"Complication",
"Infection",
"Imaging",
"Rejection"
] | Lung Transplantation | 1524553200 | None | null | other | PMC7121182 | null | null | [
""
] | Lung Transplantation. 2018 Apr 24;:313-326 | NO-CC CODE |
|
Thoracic CT showing bilateral ground-glass opacities associated with Covid-19 pneumonia. | gr1_lrg | 7 | 275527621ee8190107ac99d8c651744f8df1ad627436a483316f11034d680ade | gr1_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
705,
705
] | [{'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC7834075/gr3_lrg.jpg', 'caption': '(A) Contrast-enhanced CT showing thrombus in the external iliac artery. (B) Three-dimensional reconstruction showing thrombus extending from the external iliac artery to the peripheral arteries. CT scan was not continued to the foot as thrombus in below-the-knee arteries was evident in Doppler ultrasonography.', 'hash': 'bbd0a0e333e262c5a22865429a46a00853faa507df50fb52d885f9170f01e437'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7834075/gr2_lrg.jpg', 'caption': 'Ischemia of the left leg with ischemic discoloration in the foot and mottling of the skin below the knee.', 'hash': 'd1ec3491af7146a3d40248bd8e18d5f9cd95151b9a4dbd258423ce99b30573b7'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7834075/gr1_lrg.jpg', 'caption': 'Thoracic CT showing bilateral ground-glass opacities associated with Covid-19 pneumonia.', 'hash': '275527621ee8190107ac99d8c651744f8df1ad627436a483316f11034d680ade'}] | {'gr1_lrg': ['A 55-year-old male presented to the emergency department with malaise and shortness of breath. Patient history was remarkable only for diabetes mellitus on insulin treatment. He was evaluated for a Covid-19 infection. His lung computed tomography (CT) showed ground-glass opacities on both lungs (<xref rid="gr1_lrg" ref-type="fig">Fig.\xa01</xref>\n), and the reverse–transcriptase polymerase chain reaction (RT-PCR) test was positive for Covid-19. The patient was admitted to the infectious diseases ward and started on chloroquine, favipiravir, meropenem, levofloxacin, intravenous methylprednisolone, and prophylactic anticoagulation, with a single dose daily enoxaparin. Initially, the patient was supported with oxygen via a face mask. The patient\'s oxygenation improved after 6 days, and he no longer required supplemental oxygen. The patient was discharged in one week, at which time, the second RT-PCR test returned negative for Covid-19. The patient discontinued his medications, including prophylactic low–molecular–weight heparin, and was advised home isolation.\n), and the reverse–transcriptase polymerase chain reaction (RT-PCR) test was positive for Covid-19. The patient was admitted to the infectious diseases ward and started on chloroquine, favipiravir, meropenem, levofloxacin, intravenous methylprednisolone, and prophylactic anticoagulation, with a single dose daily enoxaparin. Initially, the patient was supported with oxygen via a face mask. The patient\'s oxygenation improved after 6 days, and he no longer required supplemental oxygen. The patient was discharged in one week, at which time, the second RT-PCR test returned negative for Covid-19. The patient discontinued his medications, including prophylactic low–molecular–weight heparin, and was advised home isolation.Fig.\xa01Thoracic CT showing bilateral ground-glass opacities associated with Covid-19 pneumonia.'], 'gr2_lrg': ['Four days after discharge from the hospital, the patient presented to the emergency department with gradual onset pain and numbness on the left leg that started one day prior. On examination, the left lower extremity was cold, the distal foot appeared ischemic, and mottling of the skin was evident below the knee (<xref rid="gr2_lrg" ref-type="fig">Fig.\xa02</xref>\n). Sensory loss below the knee and paralysis of the calf muscles were observed. All pulses in the left leg were absent. The patient corresponded to Rutherford Stage IIb for acute limb ischemia. Doppler ultrasound revealed acute thrombus in the main, superficial, and deep femoral arteries, anterior tibial, posterior tibial, and peroneal arteries. He was started on a heparin drip, and a CT scan was performed to assess the large vessels, which showed thrombus also in the left external iliac artery (\n). Sensory loss below the knee and paralysis of the calf muscles were observed. All pulses in the left leg were absent. The patient corresponded to Rutherford Stage IIb for acute limb ischemia. Doppler ultrasound revealed acute thrombus in the main, superficial, and deep femoral arteries, anterior tibial, posterior tibial, and peroneal arteries. He was started on a heparin drip, and a CT scan was performed to assess the large vessels, which showed thrombus also in the left external iliac artery (<xref rid="gr3_lrg" ref-type="fig">Fig.\xa03</xref>\n). No thrombus was evident in the patient\'s thoracic or abdominal aorta. No evidence of peripheral arterial disease was observed in the thrombosed or contralateral leg arteries, nor wall thickening associated with vessel wall inflammation could be seen in CT.\n). No thrombus was evident in the patient\'s thoracic or abdominal aorta. No evidence of peripheral arterial disease was observed in the thrombosed or contralateral leg arteries, nor wall thickening associated with vessel wall inflammation could be seen in CT.Fig.\xa02Ischemia of the left leg with ischemic discoloration in the foot and mottling of the skin below the knee.Fig.\xa03(A) Contrast-enhanced CT showing thrombus in the external iliac artery. (B) Three-dimensional reconstruction showing thrombus extending from the external iliac artery to the peripheral arteries. CT scan was not continued to the foot as thrombus in below-the-knee arteries was evident in Doppler ultrasonography.']} | Extensive Arterial Thrombus Following Discharge after a Covid-19 Infection | null | Ann Vasc Surg | 1618383600 | [] | other | PMC7834075 | null | 6 | [
"{'Citation': 'Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. 2020. [acceso 20 Ene 2021]. Disponible en: https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125'}",
"{'Citation': 'Cordovilla R., Álvarez S., Llanos L., Nuñez Ares A., Cases Viedma E., Díaz-Pérez D. SEPAR and AEER consensus recommendations on the Use of Bronchoscopy and Airway Sampling in Patients with Suspected or Confirmed COVID-19 Infection. Arch Bronconeumol. 2020;56:19–26.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '0'}}}",
"{'Citation': 'Torrego A., Pajares V., Fernández-Arias C., Vera P., Mancebo J. Bronchoscopy in COVID-19 Patients with Invasive Mechanical Ventilation: A Center Experience. Am J Respir Crit Care Med. 2020;202:284–287.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7365381'}, {'@IdType': 'pubmed', '#text': '32412787'}]}}",
"{'Citation': 'Bruyneel M., Gabrovska M., Rummens P., Roman A., Claus M., Stevens E. Bronchoscopy in COVID-19 intensive care unit patients. Respirology. 2020;25:1313–1315.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7460941'}, {'@IdType': 'pubmed', '#text': '32844524'}]}}",
"{'Citation': 'Torrego A., Pajares V., Fernández-Arias C., Vera P., Mancebo J. Bronchoscopy in Patients with COVID-19 with Invasive Mechanical Ventilation: A Single-Center Experience. Am J Respir Crit Care Med. 2020;202:284–287.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7365381'}, {'@IdType': 'pubmed', '#text': '32412787'}]}}",
"{'Citation': 'Ministerio de Sanidad Centro de Coordinación de Alertas y Emergencias Sanitarias Manejo clínico de pacientes con enfermedad por el nuevo coronavirus (COVID-19) Madrid. 2020 [Acceso 20 Ene 2021]. Disponible en: https://www.sedar.es/images/site/NOTICIAS/coronavirus/Protocolo-manejo-clinico-COVID-19.pdf.'}"
] | Ann Vasc Surg. 2021 Apr 14; 72:205-208 | NO-CC CODE |
||
A, A 54-year-old man with infarction in right middle cerebral arterial territory. CT angiography showed right cervical internal carotid artery dissection with nearly total occlusion (arrow). B, CT angiography showed total occlusion of right internal carotid artery. Vascular angulation with significant stenosis at right MCA origin is shown (arrow). CT indicates computed tomography. | gox-3-e372-g010 | 7 | 7359ac40a1639d3a2f8324c3ad9a9791dd79a94c13af15d5119fcb0a5d3b19e7 | gox-3-e372-g010.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
800,
413
] | [{'image_id': 'gox-3-e372-g010', 'image_file_name': 'gox-3-e372-g010.jpg', 'image_path': '../data/media_files/PMC4422203/gox-3-e372-g010.jpg', 'caption': 'A, A 54-year-old man with infarction in right middle cerebral arterial territory. CT angiography showed right cervical internal carotid artery dissection with nearly total occlusion (arrow). B, CT angiography showed total occlusion of right internal carotid artery. Vascular angulation with significant stenosis at right MCA origin is shown (arrow). CT indicates computed tomography.', 'hash': '7359ac40a1639d3a2f8324c3ad9a9791dd79a94c13af15d5119fcb0a5d3b19e7'}, {'image_id': 'gox-3-e372-g001', 'image_file_name': 'gox-3-e372-g001.jpg', 'image_path': '../data/media_files/PMC4422203/gox-3-e372-g001.jpg', 'caption': 'Demography, Type of Procedure, and Functional Outcome of 28 Consecutive Patients Who Underwent Extracranial-to-intracranial Arterial Bypass', 'hash': '05afdd963b3ab9af176c22e37397527442fe989c1a88f6b11b891345fbe3aa0c'}, {'image_id': 'gox-3-e372-g006', 'image_file_name': 'gox-3-e372-g006.jpg', 'image_path': '../data/media_files/PMC4422203/gox-3-e372-g006.jpg', 'caption': 'A, Preoperative CT angiography of a 48-year-old woman with infarction in right middle cerebral arterial territory. Note tiny right anterior cerebral artery A1 segment (arrow) and significant focal stenosis of tiny anterior communicating artery (arrowhead). B, Preoperative CT angiography of a 46-year-old woman with infarction in right middle cerebral arterial territory. Note significant focal stenosis of tiny right posterior communicating artery (arrow). CT indicates computed tomography.', 'hash': 'e1a9396ed88f9ee745385984d7c1803716f4912baa2e5dcc0ea451d9f7716011'}, {'image_id': 'gox-3-e372-g008', 'image_file_name': 'gox-3-e372-g008.jpg', 'image_path': '../data/media_files/PMC4422203/gox-3-e372-g008.jpg', 'caption': 'Status of 48-year-old woman with prior left common carotid arterial stenting and infarction in right middle cerebral arterial territory post EC-IC bypass. Contrast-enhanced MRA showed total occlusion of right vertebral artery V4 segment, right common carotid artery and right cervical internal carotid artery, high grade stenosis of right middle cerebral artery distal M1 segment, and hypoplastic anterior communicating artery and right anterior cerebral artery A1 segment. Collateral perfusion to right middle cerebral artery is shown via right thyrocervical trunk, deep cervical artery, right external carotid artery, right superficial temporal artery, and EC-IC bypass (arrow) and then to right middle cerebral artery, intracranial internal carotid artery, and anterior cerebral artery. MRA indicates magnetic resonance angiography.', 'hash': '44b3491592b16c59a00f61555abe065ae3e6130bf2eb636235df1bd2c73ab18a'}, {'image_id': 'gox-3-e372-g011', 'image_file_name': 'gox-3-e372-g011.jpg', 'image_path': '../data/media_files/PMC4422203/gox-3-e372-g011.jpg', 'caption': 'A, The MCA M4 (green arrow), which was 1.2\u2009mm in diameter, was used as the recipient vessel, and the superficial temporal artery with good sprouting (yellow arrow), which was 2\u2009mm in diameter, was prepared as the donor vessel. B, The area immediately after microsurgical anastomosis was performed in an end-to-side fashion using double microclamp. C, Good perfusion of MCA M4 after anastomosis and the release of microclamp.', 'hash': '4604c55fb1b7db6ea67a0ce9942e9ff8c407ad4fcb78284dac5712d384accd95'}, {'image_id': 'gox-3-e372-g009', 'image_file_name': 'gox-3-e372-g009.jpg', 'image_path': '../data/media_files/PMC4422203/gox-3-e372-g009.jpg', 'caption': 'See video, Supplemental Digital Content 1, which displays how an indocyanine green (25\u2009mg in 5\u2009mL) was intravenously injected after the completion of anastomosis during the end-to-side EC-IC arterial bypass. The video angiography was recorded by the infrared lens of the Leica Microscope FL720 (Wetzlar, Germany) with a 820-nm filter. Fluorescence began at the superficial temporal artery at 10 seconds post indocyanine green injection and then traveled through the EC-IC arterial bypass to perfuse the ischemic middle cerebral artery territory, http://links.lww.com/PRSGO/A95.', 'hash': 'f98f520760dd95ceec7b89b17f31d805f102243e77bf93ad2f0e40baae5d3fbc'}, {'image_id': 'gox-3-e372-g007', 'image_file_name': 'gox-3-e372-g007.jpg', 'image_path': '../data/media_files/PMC4422203/gox-3-e372-g007.jpg', 'caption': 'A, Vein graft from right lesser saphenous vein (yellow arrow), which was 8\u2009cm in length and 3\u2009mm in diameter, was anastomosed to the MCA M3 (green arrow), which was 1\u2009mm in diameter, with 10-0 nylon in an end-to-side fashion. B, Right superficial temporal artery (green arrow), which was 2.5\u2009mm in diameter, was anastomosed to the vein graft (yellow arrow) in an end-to-end fashion.', 'hash': '822c26367e4b7b57430d35407e466352a96daabd91f6f79abc814284a56f435f'}, {'image_id': 'gox-3-e372-g003', 'image_file_name': 'gox-3-e372-g003.jpg', 'image_path': '../data/media_files/PMC4422203/gox-3-e372-g003.jpg', 'caption': 'Detailed Surgical Procedure Performed on Donor and Recipient Vessels with or without Vein Grafts and Location of Middle Cerebral Artery Used according to Availability', 'hash': 'd483cdbf441f2c16acca7f44215d8dc86cb442b2441a73aef427dbff2953aec9'}, {'image_id': 'gox-3-e372-g004', 'image_file_name': 'gox-3-e372-g004.jpg', 'image_path': '../data/media_files/PMC4422203/gox-3-e372-g004.jpg', 'caption': 'Outcome Analysis of 28 Consecutive Patients Who Underwent Either Prophylactic or Therapeutic Extracranial-to-intracranial Arterial Bypass', 'hash': 'ba0cfd02ee18036961ebe7ef4e5fcfc1d709944e5f09df3311b71b99d60fafff'}, {'image_id': 'gox-3-e372-g012', 'image_file_name': 'gox-3-e372-g012.jpg', 'image_path': '../data/media_files/PMC4422203/gox-3-e372-g012.jpg', 'caption': 'Status of 54-year-old man with infarction in right middle cerebral arterial territory post EC-IC bypass. Contrast-enhanced MR angiography showed total occlusion of right internal carotid artery and hypoplastic right anterior cerebral artery A1 segment. Collateral perfusion to right middle cerebral artery is shown via right external carotid artery, right superficial temporal artery, and EC-IC bypass (arrow) and then to right middle cerebral artery. MR indicates magnetic resonance.', 'hash': 'dc8c8d3b7b18054ea086f26e68e8a59c30f5bde49f6f8768546cb82f8a6a22f9'}, {'image_id': 'gox-3-e372-g005', 'image_file_name': 'gox-3-e372-g005.jpg', 'image_path': '../data/media_files/PMC4422203/gox-3-e372-g005.jpg', 'caption': 'Comparisons of Outcomes and Complications for Extracranial-to-intracranial Arterial Bypass with and without the Use of Vein Grafts', 'hash': '1304d9b370dee60b2ef1a03b29996d9307983f6ce79ee3d12d9b128d70dc4d7a'}, {'image_id': 'gox-3-e372-g002', 'image_file_name': 'gox-3-e372-g002.jpg', 'image_path': '../data/media_files/PMC4422203/gox-3-e372-g002.jpg', 'caption': 'Preoperative Neurological Symptoms in 12 Patients Who Underwent Therapeutic Extracranial-to-intracranial Arterial Bypass', 'hash': '18917c1c5a836a9bba70b642d4b5cb872b04613fac23d48524d489eb58d7594e'}] | {'gox-3-e372-g006': ['A 48-year-old woman presented with symptoms of acute cerebral infarction with acute onset of limb weakness and moderate dysarthria and dysphagia. Emergent preoperative computed tomographic angiography demonstrated right temporal infarction with right MCA occlusion (Fig. <xref ref-type="fig" rid="gox-3-e372-g006">1</xref>). Right STA-MCA bypass (M3 segment) was performed with an 8-cm great saphenous vein graft (Fig. ). Right STA-MCA bypass (M3 segment) was performed with an 8-cm great saphenous vein graft (Fig. <xref ref-type="fig" rid="gox-3-e372-g007">2</xref>). Perioperative indocyanine green video angiography provided imaging of the patent anastomosis and the restoration of brain perfusion [). Perioperative indocyanine green video angiography provided imaging of the patent anastomosis and the restoration of brain perfusion [See Video <xref ref-type="fig" rid="gox-3-e372-g006">1</xref>, , Supplemental Digital Content 1, which displays how an indocyanine green (25\u2009mg in 5\u2009mL) was intravenously injected after the completion of anastomosis during the end-to-side EC-IC arterial bypass, http://links.lww.com/PRSGO/A95]. Postoperatively, the patient was neurologically stable, and the remaining hospital stay was uneventful. At the 8-month follow-up evaluation, the patient had resumed her normal lifestyle, and angiography showed collateral perfusion to the right MCA via the right thyrocervical trunk, deep cervical artery, right ECA, right STA, and EC-IC bypass and then to the right MCA, intracranial ICA, and ACA (Fig. <xref ref-type="fig" rid="gox-3-e372-g008">3</xref>).).'], 'gox-3-e372-g010': ['A 54-year-old man with right neck internal carotid dissection experiencing nearly total MCA occlusion for 1 month underwent EC-IC bypass (Fig. <xref ref-type="fig" rid="gox-3-e372-g010">4</xref>). A right STA of 2\u2009mm in diameter was prepared with good sprouting and was directly anastomosed to the MCA M4, which was 1.2\u2009mm in diameter (Fig. ). A right STA of 2\u2009mm in diameter was prepared with good sprouting and was directly anastomosed to the MCA M4, which was 1.2\u2009mm in diameter (Fig. <xref ref-type="fig" rid="gox-3-e372-g011">5</xref>). At the 6-month follow-up evaluation, magnetic resonance angiography revealed collateral perfusion to the right MCA via the right ECA, right STA, and EC-IC bypass and then to the right MCA (Fig. ). At the 6-month follow-up evaluation, magnetic resonance angiography revealed collateral perfusion to the right MCA via the right ECA, right STA, and EC-IC bypass and then to the right MCA (Fig. <xref ref-type="fig" rid="gox-3-e372-g012">6</xref>).).']} | Indications and Outcomes of Prophylactic and Therapeutic Extracranial-to-intracranial Arterial Bypass for Cerebral Revascularization | null | Plast Reconstr Surg Glob Open | 1430982000 | Against a background of globalization and medical migration, issues have been raised regarding training outside the clinician's own context. Fellowship was not commonly used as a career step, or a means of migration, but as a process of professional and personal development. Taking Chang Gung Memorial Hospital Microsurgery Fellowship as the case study, I would like to highlight an example of a long-running successful training program in a special field such as plastic surgery. | [] | other | PMC4422203 | null | 18 | [
"{'Citation': 'Mitchell RD, Jamieson JC, Parker J, et al. Global health training and postgraduate medical education in Australia: the case for greater integration. Med J Aust. 2013;198:316–319.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '23545029'}}}",
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"{'Citation': 'Rosen JM, Long SA, McGrath DM, et al. Simulation in plastic surgery training and education: the path forward. Plast Reconstr Surg. 2009;123:729–738; discussion 739–740.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19182636'}}}",
"{'Citation': 'Janis JE, Hatef DA. Resident selection protocols in plastic surgery: a national survey of plastic surgery program directors. Plast Reconstr Surg. 2008;122:1929–1939; discussion 1940–1941.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19050546'}}}",
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] | Plast Reconstr Surg Glob Open. 2015 May 7; 3(4):e372 | NO-CC CODE |
|
Nuclear Magnetic Ressonâncio. 2006. | 10-7162-s-1809-97772013000100018-i170118-2 | 7 | d78775619f6a44daf9a15c5882487bc8f5fa08c79a4f89016a0bc2e5c5825bd1 | 10-7162-s-1809-97772013000100018-i170118-2.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
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"computerized tomography"
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450,
469
] | [{'image_id': '10-7162-s-1809-97772013000100018-i170118-3', 'image_file_name': '10-7162-s-1809-97772013000100018-i170118-3.jpg', 'image_path': '../data/media_files/PMC4423335/10-7162-s-1809-97772013000100018-i170118-3.jpg', 'caption': 'Surgical removal of the cyst. Capsule integrates. HC / UFG 2008.', 'hash': '27670254d1e710bec840944980ba76362e68afc2df8a9380067dff8f90f83792'}, {'image_id': '10-7162-s-1809-97772013000100018-i170118-2', 'image_file_name': '10-7162-s-1809-97772013000100018-i170118-2.jpg', 'image_path': '../data/media_files/PMC4423335/10-7162-s-1809-97772013000100018-i170118-2.jpg', 'caption': 'Nuclear Magnetic Ressonâncio. 2006.', 'hash': 'd78775619f6a44daf9a15c5882487bc8f5fa08c79a4f89016a0bc2e5c5825bd1'}, {'image_id': '10-7162-s-1809-97772013000100018-i170118-1', 'image_file_name': '10-7162-s-1809-97772013000100018-i170118-1.jpg', 'image_path': '../data/media_files/PMC4423335/10-7162-s-1809-97772013000100018-i170118-1.jpg', 'caption': 'Patient with bulky lesion bulging floor of the mouth HC / UFG 2006.', 'hash': '2593c16c0502ca2d1b5fc7bc08ed76278f69206c2781493b673d371068c23778'}] | {'10-7162-s-1809-97772013000100018-i170118-1': ['In the previous clinical evaluation, both rhinolaryngoscopy and otoscopy revealed no changes. Via oropharyngoscopy, we observed a large mass of the cystic aspect occupying the entire floor of the mouth (<xref rid="10-7162-s-1809-97772013000100018-i170118-1" ref-type="fig">Figure 1</xref>), with compression of the tongue toward the craniodorsal direction and without visualization of Wharton\'s duct papillae.), with compression of the tongue toward the craniodorsal direction and without visualization of Wharton\'s duct papillae.'], '10-7162-s-1809-97772013000100018-i170118-2': ['Computed tomography (CT) scanning of the hemiface revealed a benign cystic lesion in the mouth floor with a hypodense, rounded appearance causing the posterior-superior displacement of the tongue. Magnetic resonance imaging (MRI) identified a bulky cystic mass in the supramandibular region (<xref rid="10-7162-s-1809-97772013000100018-i170118-2" ref-type="fig">Figure 2</xref>).).'], '10-7162-s-1809-97772013000100018-i170118-3': ['In 2008, after prolonged hematologic treatment of anemia, the patient underwent surgery. With the diagnosis of a cystic lesion in the mouth floor, we opted for an intraoral surgical approach. After performing an accurate anterior incision in the mucosa of the mouth floor with careful dissection of the cystic capsule and complete excision of the lesion (<xref rid="10-7162-s-1809-97772013000100018-i170118-3" ref-type="fig">Figure 3</xref>), approximation of the partially separated muscles and suture of the mucosa were performed with the placement of a drain for 24\u2009h and a nasogastric tube for 3 days. In the immediate postoperative period, the patient displayed mild sublingual edema that was treated with prednisone 20 mg/day for 5 days.), approximation of the partially separated muscles and suture of the mucosa were performed with the placement of a drain for 24\u2009h and a nasogastric tube for 3 days. In the immediate postoperative period, the patient displayed mild sublingual edema that was treated with prednisone 20 mg/day for 5 days.']} | Giant cystadenoma of the floor of the mouth: A case report | [
"salivary glands",
"minor",
"mouth",
"mouth mucosa",
"exocrine glands"
] | Int Arch Otorhinolaryngol | 1357027200 | None | null | other | PMC4423335 | null | null | [
""
] | Int Arch Otorhinolaryngol. 2013 Jan; 17(1):101-104 | NO-CC CODE |
|
Pulmonary and pleural metastases in a 14-year-old girl with synovial cell sarcoma of the left knee. (a) Coronal non-enhanced T2-weighted fat-suppressed MR image shows metastatic nodules in the right lung (white arrow) and pleura (black arrow) and pleural effusion (E). (b) Axial non-enhanced T2-weighted fat-suppressed MR image shows metastatic nodules in the right lung (white arrows), pleural effusion (E), and septations (black arrowheads) in the pleura. (c) Axial enhanced T1-weighted fat-suppressed MR image shows central hypoenhancement within metastatic nodules in the right lung (white arrows) and pleural effusion (E) with enhancement of the pleura (arrowheads) | 469524_1_En_1_Fig30_HTML | 7 | d85367697587fb754247840a6f83a4097551edc538e6e64ab36768a1c28466fb | 469524_1_En_1_Fig30_HTML.jpg | multiple | multiple panels: images | [
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(b) Axial non-enhanced T2-weighted fat-suppressed MR image shows hyperintense pulmonary nodules (white arrowheads) and consolidation (C)', 'hash': '93e82262cd625a8e171e55b912482706f6be4e7a5cf427e2b88a7fdafcb3e974'}, {'image_id': '469524_1_En_1_Fig1_HTML', 'image_file_name': '469524_1_En_1_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig1_HTML.jpg', 'caption': 'Diagram showing prenatal lung development', 'hash': '5fe258e1bc080891263c41854de0e09343f53d33b65678d7942e6c205aca1732'}, {'image_id': '469524_1_En_1_Fig24_HTML', 'image_file_name': '469524_1_En_1_Fig24_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig24_HTML.jpg', 'caption': 'Bronchopneumonia causing ground-glass signal abnormality in a 13-year-old boy who presented with fever and cough. Axial non-enhanced bright-blood T2-weighted MR image shows peribronchial ground-glass signal abnormality (arrows) in the left upper and left lower lobe and bilateral pleural effusions (arrowheads)', 'hash': '5c8c8dfaf4dc62f83fb363910cf45f67329cfff7a0dadc331592f8230a16231b'}, {'image_id': '469524_1_En_1_Fig13_HTML', 'image_file_name': '469524_1_En_1_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig13_HTML.jpg', 'caption': 'Intralobar pulmonary sequestration on prenatal imaging. (a) Coronal non-enhanced T2-weighted MR image shows hyperintense lesion (S) replacing the right lower lobe and crossing the midline. (b) Sagittal non-enhanced T2-weighted MR image shows hyperintense lesion (S) replacing the right lower lobe. (c) Sagittal ultrasound image with color Doppler shows an anomalous systemic artery (arrow) arising from the descending thoracic aorta. (d) 3D reconstructed ultrasound image shows an anomalous systemic artery (arrow) arising from the descending thoracic aorta', 'hash': '871ff3425bdfd12ea37b1328d650af813f2f18acfdf622372f0e52341018f690'}, {'image_id': '469524_1_En_1_Fig9_HTML', 'image_file_name': '469524_1_En_1_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig9_HTML.jpg', 'caption': 'Esophageal duplication cyst in a 12-year-old boy. (a) Axial enhanced soft tissue window setting CT image shows a cyst (C) adjacent to the esophagus which is greater than simple fluid density due to proteinaceous contents. (b) Axial non-enhanced SSFSE T2-weighted MR image shows hyperintense signal within the cyst (C). (c) Axial non-enhanced black-blood T2-weighted MR image shows hyperintense signal within the cyst (C). (d) Axial enhanced T1-weighted fat-suppressed MR image shows the cyst (C) with internal hyperintensity due to intrinsically hyperintense proteinaceous material rather than due to enhancement', 'hash': '6697ece8d07ebcac2bd6d5b51e4177f9d9d10fc53b28e6bb44bae3508581d3bb'}, {'image_id': '469524_1_En_1_Fig6_HTML', 'image_file_name': '469524_1_En_1_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig6_HTML.jpg', 'caption': 'Diagram of pleural anatomy: parietal and visceral pleura', 'hash': '523cd1dbd674eab09138196abba12a823d161bac78b82879abad837c0697d1db'}, {'image_id': '469524_1_En_1_Fig23_HTML', 'image_file_name': '469524_1_En_1_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig23_HTML.jpg', 'caption': 'Aspiration-related bilateral lower lobe consolidation in a 3-year-old boy with esophageal atresia repair. (a) Axial non-enhanced T2-weighted fat-suppressed MR image shows bilateral lower lobe consolidation (arrows). (b) Axial non-enhanced T2-weighted fat-suppressed MR image shows a dilated fluid-filled esophagus (E)', 'hash': '1420db0fe41d21d459bd48b3e13fe606eafde004fb6be4488dcb3c2af186a83b'}, {'image_id': '469524_1_En_1_Fig33_HTML', 'image_file_name': '469524_1_En_1_Fig33_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig33_HTML.jpg', 'caption': 'Pulmonary edema in an 8-day-old girl with coarctation of aorta. (a) Frontal chest radiograph shows hazy bilateral pulmonary opacities due to pulmonary edema. (b) Axial non-enhanced T1-weighted MR image shows ground-glass signal intensity throughout both lungs. (c) Posterior projection from 3D reformatted MR image of the mediastinal vessels shows focal narrowing (arrow) of the aorta distal to the origin of the left subclavian artery', 'hash': 'f1b36e00e3e6f9b8f19877c86dbef60bf5b8171c40ca38be24ce6f59c9a56354'}, {'image_id': '469524_1_En_1_Fig25_HTML', 'image_file_name': '469524_1_En_1_Fig25_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig25_HTML.jpg', 'caption': 'Pulmonary abscess in a 17-year-old girl with cystic fibrosis, fever, and cough. Axial non-enhanced bright-blood MR image shows a cavity (arrow) containing an air-fluid level within the right upper lobe and bilateral bronchiectasis (arrowheads) with bronchial wall thickening', 'hash': '274eca14315226e089151e118fdbaeb7df90141c36a754e9c1f485b03fe0ac92'}, {'image_id': '469524_1_En_1_Fig15_HTML', 'image_file_name': '469524_1_En_1_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig15_HTML.jpg', 'caption': 'Aspiration pneumonia in a 3-week-old girl who presented with fever and respiratory distress. Axial non-enhanced T2-weighted fat-suppressed MR image shows left lower lobe consolidation (arrow)', 'hash': 'c920508fb7e0d4b1389ac6843f98bf31ff19a8e865cc8175c9a4f96273f83bb9'}, {'image_id': '469524_1_En_1_Fig7_HTML', 'image_file_name': '469524_1_En_1_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig7_HTML.jpg', 'caption': 'Heterotaxy syndrome in a 4-year-old girl. (a) Frontal chest radiograph shows a right-sided heart (H) and stomach (S). (b) Coronal oblique non-enhanced bright-blood MR image shows right-sided heart (H) and left-sided liver (L). (c) Axial non-enhanced bright-blood MR image shows right-sided heart (H) and left-sided descending thoracic aorta (A). (d) Axial non-enhanced bright-blood MR image shows left-sided liver (L), right-sided stomach (S), right-sided spleen (Sp), and midline abdominal aorta (A)', 'hash': '7cc3338714ce334f7a93419cce45bbf8968ba5beb639295b3d0d8e01b5e42393'}, {'image_id': '469524_1_En_1_Fig8_HTML', 'image_file_name': '469524_1_En_1_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig8_HTML.jpg', 'caption': 'Bronchogenic cyst in a 7-year-old girl. (a) Axial enhanced soft tissue window setting CT image shows a thin-walled cyst (C) in the right posterior mediastinum containing simple fluid density. (b) Coronal enhanced lung window setting CT image shows the thin-walled cyst (C). (c) Axial non-enhanced bright-blood short tau inversion recovery (STIR) MR image shows hyperintense signal within the cyst (C). (d) Axial enhanced T1-weighted fat-suppressed MR image shows the cyst (C) with a thin enhancing wall and no central enhancement', 'hash': '93f537d152f89e75c8e5b49a55b58412d559bd65dafb7817a8cd7efa05591b64'}, {'image_id': '469524_1_En_1_Fig22_HTML', 'image_file_name': '469524_1_En_1_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig22_HTML.jpg', 'caption': 'Pulmonary hydatid disease in a 10-year-old boy who presented with chest pain and cough. (Courtesy of Kushaljit Singh Sodhi, MD, PhD, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India). (a) Axial enhanced soft tissue window setting CT image shows cystic lesion (H) with peripheral enhancement in the right upper lobe. (b) Axial non-enhanced T2-HASTE-weighted MR image shows internal folded membranes (arrows) within the cystic lesion. (c) Axial non-enhanced T2-BLADE-weighted MR image shows internal folded membranes (arrows) within the cystic lesion', 'hash': 'cd712d7770156af8da11f6f1d0f5dd6c3d2e4122f3daae1d15cadd79850d2e0b'}, {'image_id': '469524_1_En_1_Fig32_HTML', 'image_file_name': '469524_1_En_1_Fig32_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig32_HTML.jpg', 'caption': 'Pulmonary edema in a 17-year-old girl with congenital heart disease. Axial non-enhanced T2-weighted MR image shows interlobular septal thickening (arrowheads), small region of consolidation (C), and small right pleural effusion (E). Cardiomegaly is also seen', 'hash': 'c4c2cfa1a6dba73d8594b4dc44e9f81a919b4381d95ccc1a9ed2d677da5f15be'}, {'image_id': '469524_1_En_1_Fig12_HTML', 'image_file_name': '469524_1_En_1_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig12_HTML.jpg', 'caption': 'Congenital pulmonary airway malformation (CPAM) type 2 in a boy at 7\xa0months old and 9\xa0years old. (a) Axial enhanced lung window setting CT image at 7\xa0months of age shows multiple cysts (arrow) measuring <2 cm in the left lower lobe. (b) Axial enhanced T1-weighted fat-suppressed PROPELLER MR image at 9 years of age shows multiple cysts (arrow) measuring <2 cm in the left lower lobe', 'hash': 'aa5aeba8f461115964050d797a46c8df7d2effd11b1ed91dc5532c10d9e0a148'}, {'image_id': '469524_1_En_1_Fig11_HTML', 'image_file_name': '469524_1_En_1_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig11_HTML.jpg', 'caption': 'Macrocystic congenital pulmonary airway malformation (CPAM) on prenatal MR imaging. (a) Coronal non-enhanced T2-weighted MR image shows several hyperintense cysts (arrows) in the right lung. A left pleural effusion (arrowhead) is also present. (b) Sagittal non-enhanced T2-weighted MR image shows several hyperintense cysts (arrows) in the lung. (c) Sagittal ultrasound image shows several hypoechoic cysts (arrows) in the lung', 'hash': '5a5df4ebe454e15af560deb4dd34dcc553f335a54b0d4c7c97a29f43e2ca2211'}, {'image_id': '469524_1_En_1_Fig21_HTML', 'image_file_name': '469524_1_En_1_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig21_HTML.jpg', 'caption': 'Mycobacterium tuberculosis infection in 13-year-old boy with immunosuppression. Axial non-enhanced T2-weighted MR image shows multiple hyperintense and ground-glass pulmonary nodules (black arrows), bilateral interstitial thickening (white arrows), and small right pleural effusion (arrowheads)', 'hash': 'cbaa60df4a2a42115022617fa6fad5c3e207b0666805a3c91e25c840d303e657'}, {'image_id': '469524_1_En_1_Fig4_HTML', 'image_file_name': '469524_1_En_1_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig4_HTML.jpg', 'caption': 'Diagram of lung parenchyma: secondary pulmonary lobule', 'hash': '2ccd63d6f75f9fade69bdbed7a482febf544a8d06099447cff336cb0942a13b0'}, {'image_id': '469524_1_En_1_Fig31_HTML', 'image_file_name': '469524_1_En_1_Fig31_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig31_HTML.jpg', 'caption': 'Lymphangitic spread of metastatic disease and pleural effusion in a 12-year-old girl with metastatic renal cell carcinoma. Axial non-enhanced T2-weighted fat-suppressed MR image shows bilateral interlobular septal thickening (white arrowheads) due to lymphangitic spread of metastatic disease and bilateral pleural effusions containing septations (black arrowheads)', 'hash': 'f95d8667f69228196fea5bc1d4c73d1d7ba5920aa5af5b7d661bb4af93a71da5'}, {'image_id': '469524_1_En_1_Fig19_HTML', 'image_file_name': '469524_1_En_1_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig19_HTML.jpg', 'caption': 'Pulmonary coccidioidomycosis infection in a 5-year-old girl who presented with fever, cough, and headache. (a) Axial non-enhanced T2-weighted fat-suppressed MR image shows numerous bilateral hyperintense pulmonary nodules. (b) Coronal enhanced T1-weighted fat-suppressed MR image shows numerous bilateral hyperintense pulmonary nodules', 'hash': '560781e914955ace7b5f2d12739d29f7d32c9a5b36b6b92767fd6f80969ced2d'}, {'image_id': '469524_1_En_1_Fig16_HTML', 'image_file_name': '469524_1_En_1_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig16_HTML.jpg', 'caption': 'Bacterial bronchopneumonia in a 16-year-old girl who presented with fever and cough. Coronal non-enhanced TruFISP/FIESTA MR image shows peribronchial ground-glass signal abnormality in the left upper and left lower lobes (asterisks) and a simple left pleural effusion (arrow)', 'hash': 'b75acfc2a0d455dee107c4ffbaf9e73a48503dbcd9681451769225f584498098'}, {'image_id': '469524_1_En_1_Fig29_HTML', 'image_file_name': '469524_1_En_1_Fig29_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig29_HTML.jpg', 'caption': 'Epithelioid hemangioendothelioma in a 16-year-old girl. (a) Coronal non-enhanced T2-weighted fat-suppressed MR image shows multiple bilateral hyperintense pulmonary nodules. (b) Axial non-enhanced T2-weighted fat-suppressed MR image shows multiple bilateral hyperintense pulmonary nodules', 'hash': '6388a19b34ddf2a55766061a56b95c105ad35d44004a5b6afaf9f53371a5e511'}, {'image_id': '469524_1_En_1_Fig26_HTML', 'image_file_name': '469524_1_En_1_Fig26_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig26_HTML.jpg', 'caption': 'Pulmonary hamartoma in a 13-year-old girl. Coronal non-enhanced T2-weighted fat-suppressed MR image shows a right perihilar hyperintense solitary pulmonary nodule (arrow) with a smooth margin', 'hash': '73e427f124cfdc35412754992591354a758f8334088b426e598011951b2335ee'}, {'image_id': '469524_1_En_1_Fig3_HTML', 'image_file_name': '469524_1_En_1_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig3_HTML.jpg', 'caption': 'Diagram of lobar anatomy: sections of normal lung', 'hash': '523ef1b974763a275e4954ddbf2c7c88bfcea26f5f482a28123473989ad3a2c4'}, {'image_id': '469524_1_En_1_Fig20_HTML', 'image_file_name': '469524_1_En_1_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig20_HTML.jpg', 'caption': 'Pulmonary Aspergillus infection in 14-year-old girl with cystic fibrosis. (a) Axial enhanced lung window setting CT image shows tree-in-bud nodularity (black arrows) in bilateral lower lobes, a larger nodule (white arrow) with ground-glass halo in the left upper lobe, and left hilar adenopathy (arrowhead). (b) Axial non-enhanced SSFP T2/T1-weighted MR image shows left upper lobe nodule (arrow) and left hilar adenopathy (arrowhead)', 'hash': '1e97a429502c71f8228f0486b6d94db38764557a5e11a82209aac0ce0693c4ab'}, {'image_id': '469524_1_En_1_Fig5_HTML', 'image_file_name': '469524_1_En_1_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig5_HTML.jpg', 'caption': 'Diagram of acini and alveoli: structure of the lung', 'hash': 'b412cc1881d5e9b798a61b6e9782b8541921f996ae12ada282b1a49fa2cea89b'}, {'image_id': '469524_1_En_1_Fig30_HTML', 'image_file_name': '469524_1_En_1_Fig30_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig30_HTML.jpg', 'caption': 'Pulmonary and pleural metastases in a 14-year-old girl with synovial cell sarcoma of the left knee. (a) Coronal non-enhanced T2-weighted fat-suppressed MR image shows metastatic nodules in the right lung (white arrow) and pleura (black arrow) and pleural effusion (E). (b) Axial non-enhanced T2-weighted fat-suppressed MR image shows metastatic nodules in the right lung (white arrows), pleural effusion (E), and septations (black arrowheads) in the pleura. (c) Axial enhanced T1-weighted fat-suppressed MR image shows central hypoenhancement within metastatic nodules in the right lung (white arrows) and pleural effusion (E) with enhancement of the pleura (arrowheads)', 'hash': 'd85367697587fb754247840a6f83a4097551edc538e6e64ab36768a1c28466fb'}, {'image_id': '469524_1_En_1_Fig10_HTML', 'image_file_name': '469524_1_En_1_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig10_HTML.jpg', 'caption': 'Bronchogenic cyst on prenatal MR imaging.\xa0Coronal non-enhanced T2-weighted image shows a thin-walled cyst (arrow) adjacent to the left bronchus', 'hash': 'd644c16bc3643e3a7d32a4074f648efe47b1092d70ea27d3483a579ffb031992'}, {'image_id': '469524_1_En_1_Fig27_HTML', 'image_file_name': '469524_1_En_1_Fig27_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig27_HTML.jpg', 'caption': 'Pulmonary inflammatory myofibroblastic tumor in a 5-year-old boy. (a) Frontal chest radiograph shows a large right upper lobe mass (M). (b) Axial enhanced soft tissue window setting CT image shows the right upper lobe mass (M) demonstrating heterogeneous enhancement. (c) Axial non-enhanced SSFSE T2-weighted MR image shows the right upper lobe mass (M) demonstrating heterogeneous signal intensity. (d) Axial enhanced T1-weighted fat-suppressed MR image shows regions of non-enhancement (arrows) within the mass, indicating necrosis', 'hash': '36e5e8821fa0bd6b07381204560bbfbf99079eab54014fdbd5ccd7dd6c71a8c3'}, {'image_id': '469524_1_En_1_Fig28_HTML', 'image_file_name': '469524_1_En_1_Fig28_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig28_HTML.jpg', 'caption': 'Type III pleuropulmonary blastoma in a 5-year-old girl. (a) Axial non-enhanced T2-weighted fat-suppressed MR image shows a large heterogeneously hyperintense left upper lobe mass which exerts mass effect on the mediastinum. Regions of greater hyperintensity (asterisks) within the mass correspond to regions of necrosis. (b) Axial enhanced T1-weighted fat-suppressed MR image shows heterogenous enhancement within the mass with several non-enhancing regions (asterisks), indicating necrosis', 'hash': 'e76c8fe4853e869a61c8785628d450ff95ad04db674454c2ab44bd8ac516176c'}, {'image_id': '469524_1_En_1_Fig2_HTML', 'image_file_name': '469524_1_En_1_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig2_HTML.jpg', 'caption': 'Diagram showing pleural development', 'hash': 'a8ae83896de84e00d422fa3cfefad3aa77e4dbb79b808fb8db9db114d4dedf78'}, {'image_id': '469524_1_En_1_Fig17_HTML', 'image_file_name': '469524_1_En_1_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig17_HTML.jpg', 'caption': 'Empyema necessitans in a 17-year-old boy who presented with fever and chest swelling. (a) Axial enhanced soft tissue window setting CT image shows consolidation (C) in the lingua, dense pleural fluid and soft tissue density (arrow), and left chest wall soft tissue thickening and inflammation (asterisk) with periosteal reaction (arrowhead) in the adjacent rib. (b) Axial enhanced T1-weighted fat-suppressed MR image shows consolidation (C) in the lingua, pleural soft tissue thickening (arrow), and left chest wall soft tissue thickening and inflammation (asterisk)', 'hash': '434c6940bb68e78eff57395c8b49af485d6057ffed7e6aa5497c203a53abcdd2'}, {'image_id': '469524_1_En_1_Fig18_HTML', 'image_file_name': '469524_1_En_1_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC7245516/469524_1_En_1_Fig18_HTML.jpg', 'caption': 'Respiratory syncytial virus infection in a 1-week-old girl who presented with respiratory distress. Axial non-enhanced T2-weighted fat-suppressed MR image shows bilateral peribronchial interstitial thickening (asterisks)', 'hash': '263e6d0fb203548b98dbcaadc2e3818413208802686f5ec37fd2e34f46e4ffa5'}] | {'469524_1_En_1_Fig1_HTML': ['During the fourth week of gestation, lung development begins when the laryngotracheal groove arises from the foregut endoderm and forms the lung bud. The embryonic phase begins when the lung bud divides into the right and left bronchial buds [12]. In the embryonic phase, the bronchial buds lengthen and divide into three branches on the right and two branches on the left and further subdivide into the pulmonary segments. By the end of the embryonic phase , a vascular plexus begins to form within the lung mesenchyme [13] (Fig. <xref rid="469524_1_En_1_Fig1_HTML" ref-type="fig">1.1</xref>).).Fig. 1.1Diagram showing prenatal lung development', 'The pseudoglandular phase begins at week 5 and ends at week 17. In this phase, the bronchi further divide, and by week 17, the entire air-conducting portion of the lung has developed to the level of the terminal bronchiole. On the cellular level, ciliated, goblet, and neuroendocrine cells develop, and the terminal bronchioles contain cuboid columnar cells (see Fig. <xref rid="469524_1_En_1_Fig1_HTML" ref-type="fig">1.1</xref>).).', 'The canalicular phase begins at week 17 and ends at week 28. The portion of the lung involved in oxygen exchange develops during this phase, including the respiratory bronchioles, alveolar ducts, and alveoli. Type I pneumocytes begin to develop in this phase, and Type II pneumocytes contain surfactant proteins but do not secrete them. The alveolar capillary bed begins to form at this stage. By the end of the canalicular phase , gas exchange is possible, and survival outside the uterus is feasible, but only with intensive medical care, exogenous surfactant therapy, and mechanical ventilation (see Fig. <xref rid="469524_1_En_1_Fig1_HTML" ref-type="fig">1.1</xref>).).', 'The saccular phase begins at week 29 and ends at week 36. Alveolar sacculi proliferate during this phase, and the basal lamina of the distal respiratory epithelium fuses with the basal lamina of the alveolar capillary endothelium, allowing for improved gas exchange. Surfactant begins to be excreted during this phase, but its production is not yet at the levels of a full-term newborn, and children born at this phase usually require exogenous surfactant therapy [14] (see Fig. <xref rid="469524_1_En_1_Fig1_HTML" ref-type="fig">1.1</xref>).).', 'The alveolar phase begins at week 36 and continues through 18\xa0months of age. Throughout this phase, more alveoli form, leading to approximately 50 million alveoli soon after birth and 300 million alveoli by the time the lung is fully mature. With alveolar development, the pulmonary alveolar capillary network also grows, leading to increased capacity for gas exchange [15] (see Fig. <xref rid="469524_1_En_1_Fig1_HTML" ref-type="fig">1.1</xref>).).'], '469524_1_En_1_Fig2_HTML': ['The pleura begins development before the lungs at 3\xa0weeks gestation. At this time, the pleura begins to form from the mesoderm along with the pericardium and peritoneum [21]. At 9\xa0weeks gestation, the pleura separates from the pericardium and peritoneum. The pleura is comprised of the visceral pleural, which covers the lung, and the parietal pleura, which covers the chest wall and diaphragm [21] (Fig. <xref rid="469524_1_En_1_Fig2_HTML" ref-type="fig">1.2</xref>).).Fig. 1.2Diagram showing pleural development'], '469524_1_En_1_Fig3_HTML': ['The right lung is composed of three lobes (upper, middle, and lower), and the left lung is composed of two lobes (upper, which includes the lingua, and lower) (Fig. <xref rid="469524_1_En_1_Fig3_HTML" ref-type="fig">1.3</xref>). Each lobe is separated by a pleura-lined fissure. Each lobe is further divided into segments, which are defined by segmental bronchi and not divided by fissures. Table ). Each lobe is separated by a pleura-lined fissure. Each lobe is further divided into segments, which are defined by segmental bronchi and not divided by fissures. Table 1.2 describes the segments in each lobe.Fig. 1.3Diagram of lobar anatomy: sections of normal lungTable 1.2Lung lobes and segmentsLobesSegmentsRight upperApical, posterior, and anteriorRight middleLateral and medialRight lowerSuperior, medial basal, anterior basal, lateral basal, and posterior basalLeft upperApicoposterior, anterior, superior lingular, and inferior lingularLeft lowerSuperior, medial basal, anterior basal, lateral basal, and posterior basal'], '469524_1_En_1_Fig4_HTML': ['Secondary Pulmonary Lobule\u2003The secondary pulmonary lobule is the smallest structural unit of the lung that may be visible on MR imaging; smaller structures such as the pulmonary acini and alveoli are too small to be visualized as discrete structures. Each secondary pulmonary lobule has a polyhedral shape and is bordered by connective tissue septations called interlobular septa (Fig. <xref rid="469524_1_En_1_Fig4_HTML" ref-type="fig">1.4</xref>). At birth, secondary pulmonary lobules have a mean diameter of 3 mm and are therefore not visible on most conventional MR imaging sequences. However, they are visible in older children and adults on MR imaging, and they reach a diameter of 13–20 mm in adulthood [). At birth, secondary pulmonary lobules have a mean diameter of 3 mm and are therefore not visible on most conventional MR imaging sequences. However, they are visible in older children and adults on MR imaging, and they reach a diameter of 13–20 mm in adulthood [22]. A lobular bronchiole is in the center of each secondary pulmonary lobule and communicates with up to 25 terminal bronchioles and their acini [23, 24].Fig. 1.4Diagram of lung parenchyma: secondary pulmonary lobule'], '469524_1_En_1_Fig5_HTML': [' Acini and alveoli are the functional units of the lung where gas exchange occurs. These structures are too small to be visualized as discrete structures on MR imaging.\xa0Each lobular bronchiole communicates with up to 25 terminal bronchioles, which communicate with acini and alveoli [23, 24] (Fig. <xref rid="469524_1_En_1_Fig5_HTML" ref-type="fig">1.5</xref>). When filled with air, groups of acini and alveoli appear uniformly hypointense, and when filled with fluid or other material, they appear uniformly intense because the alveolar walls are beyond the spatial resolution of MR imaging.). When filled with air, groups of acini and alveoli appear uniformly hypointense, and when filled with fluid or other material, they appear uniformly intense because the alveolar walls are beyond the spatial resolution of MR imaging.Fig. 1.5Diagram of acini and alveoli: structure of the lung'], '469524_1_En_1_Fig6_HTML': ['\nParietal and Visceral PleuraThe pleural space is formed by two pleural membranes: the parietal pleura and the visceral pleura (Fig. <xref rid="469524_1_En_1_Fig6_HTML" ref-type="fig">1.6</xref>). Each is comprised of a single layer of mesothelial cells, a basement membrane, and a layer of connective tissue which contains blood vessels and lymphatics [). Each is comprised of a single layer of mesothelial cells, a basement membrane, and a layer of connective tissue which contains blood vessels and lymphatics [21]. The arterial supply to the parietal pleura is via the intercostal arteries, and the visceral pleura is supplied by bronchial arteries. Normal pleural fluid is produced from systemic pleural arteries in both the visceral and parietal pleura [21].Fig. 1.6Diagram of pleural anatomy: parietal and visceral pleura', 'The visceral pleura is tightly adherent to the surface of the lung parenchyma and forms the pleural fissures where it invaginates between lobes of the lung (see Fig. <xref rid="469524_1_En_1_Fig6_HTML" ref-type="fig">1.6</xref>). The right lung contains a major fissure which separates the right lower lobe from the right upper and middle lobes and a minor fissure, which separates the right upper lobe and the right middle lobe. The left lung contains only a major fissure , which separates the left upper lobe and left lower lobe.). The right lung contains a major fissure which separates the right lower lobe from the right upper and middle lobes and a minor fissure, which separates the right upper lobe and the right middle lobe. The left lung contains only a major fissure , which separates the left upper lobe and left lower lobe.'], '469524_1_En_1_Fig7_HTML': [' Heterotaxy syndromes are a group of conditions in which the location and laterality of structures is altered (Fig. <xref rid="469524_1_En_1_Fig7_HTML" ref-type="fig">1.7</xref>). The simplest example is situs inversus totalis, where all structures are flipped from left to right. In the lungs, situs inversus totalis manifests as a three-lobed left lung and two-lobed right lung. More complex heterotaxy syndromes may occur in which both lungs have three lobes (right isomerism) or both lungs have two lobes (left isomerism). Right isomerism is associated with asplenia and left isomerism is associated with polysplenia.). The simplest example is situs inversus totalis, where all structures are flipped from left to right. In the lungs, situs inversus totalis manifests as a three-lobed left lung and two-lobed right lung. More complex heterotaxy syndromes may occur in which both lungs have three lobes (right isomerism) or both lungs have two lobes (left isomerism). Right isomerism is associated with asplenia and left isomerism is associated with polysplenia.Fig. 1.7 Heterotaxy syndrome in a 4-year-old girl. (a) Frontal chest radiograph shows a right-sided heart (H) and stomach (S). (b) Coronal oblique non-enhanced bright-blood MR image shows right-sided heart (H) and left-sided liver (L). (c) Axial non-enhanced bright-blood MR image shows right-sided heart (H) and left-sided descending thoracic aorta (A). (d) Axial non-enhanced bright-blood MR image shows left-sided liver (L), right-sided stomach (S), right-sided spleen (Sp), and midline abdominal aorta (A)'], '469524_1_En_1_Fig8_HTML': [' Bronchogenic cysts are a type of foregut duplication cyst that occurs due to abnormal budding of the ventral lung bud or abnormal branching of the tracheobronchial tree during lung development. Most bronchogenic cysts develop in close proximity to the central tracheobronchial tree, and most are located within the mediastinum, but approximately 15% are located within the lung parenchyma (Fig. <xref rid="469524_1_En_1_Fig8_HTML" ref-type="fig">1.8</xref>) [) [35]. Esophageal duplication cysts and neurenteric cysts are other types of foregut duplication cysts, which are related to bronchogenic cysts (Fig. <xref rid="469524_1_En_1_Fig9_HTML" ref-type="fig">1.9</xref>). Esophageal duplication cysts arise from the dorsal bud of the primitive foregut, and neurenteric cysts occur due to incomplete separation of the endoderm and notochord. Although often treated as distinct lesions, foregut duplication cysts frequently contain elements of more than one foregut tissue, and hybrid lesions are common.). Esophageal duplication cysts arise from the dorsal bud of the primitive foregut, and neurenteric cysts occur due to incomplete separation of the endoderm and notochord. Although often treated as distinct lesions, foregut duplication cysts frequently contain elements of more than one foregut tissue, and hybrid lesions are common.Fig. 1.8 Bronchogenic cyst in a 7-year-old girl. (a) Axial enhanced soft tissue window setting CT image shows a thin-walled cyst (C) in the right posterior mediastinum containing simple fluid density. (b) Coronal enhanced lung window setting CT image shows the thin-walled cyst (C). (c) Axial non-enhanced bright-blood short tau inversion recovery (STIR) MR image shows hyperintense signal within the cyst (C). (d) Axial enhanced T1-weighted fat-suppressed MR image shows the cyst (C) with a thin enhancing wall and no central enhancementFig. 1.9 Esophageal duplication cyst in a 12-year-old boy. (a) Axial enhanced soft tissue window setting CT image shows a cyst (C) adjacent to the esophagus which is greater than simple fluid density due to proteinaceous contents. (b) Axial non-enhanced SSFSE T2-weighted MR image shows hyperintense signal within the cyst (C). (c) Axial non-enhanced black-blood T2-weighted MR image shows hyperintense signal within the cyst (C). (d) Axial enhanced T1-weighted fat-suppressed MR image shows the cyst (C) with internal hyperintensity due to intrinsically hyperintense proteinaceous material rather than due to enhancement'], '469524_1_En_1_Fig10_HTML': ['Bronchogenic and other foregut duplication cysts are most often detected as incidental findings in asymptomatic infants and children. They may be diagnosed on prenatal imaging, and fetal MR imaging typically demonstrates a unilocular thin-walled hyperintense cyst within the mediastinum on T2-weighted sequences (Fig. <xref rid="469524_1_En_1_Fig10_HTML" ref-type="fig">1.10</xref>) [) [36–38]. If not detected prenatally, bronchogenic and other foregut duplication cysts may be detected on chest radiograph as a mediastinal or pulmonary mass. Cross-sectional imaging is often performed to evaluate the finding of a mass. Although this is most typically achieved with CT, MR imaging is an excellent modality to characterize bronchogenic and other foregut duplication cysts. MR imaging typically demonstrates a cyst that is hyperintense on T2-weighted images and has variable intensity on T1-weighted images and does not enhance on contrast-enhanced images, except for a thin rim of wall enhancement [34]. Bronchogenic cysts within the mediastinum rarely communicate with the airway, but more peripheral cysts may communicate with the airway and contain an air-fluid level [39]. Bronchogenic cysts may become infected, especially when there is communication with the airway. When superinfected, cysts may develop a thick enhancing wall with irregular borders [40].Fig. 1.10 Bronchogenic cyst on prenatal MR imaging.\xa0Coronal non-enhanced T2-weighted image shows a thin-walled cyst (arrow) adjacent to the left bronchus'], '469524_1_En_1_Fig11_HTML': ['CPAMs may be first diagnosed on prenatal imaging. On fetal MR imaging, CPAMs appear as hyperintense lung lesions, and depending on the type discrete cysts may or may not be visible (Fig. <xref rid="469524_1_En_1_Fig11_HTML" ref-type="fig">1.11</xref>) [) [48]. Categorization of CPAMs on fetal imaging is slightly different than on postnatal imaging, largely due to the smaller size of the fetus. On fetal imaging, CPAMS are categorized as macrocystic when cysts are ≥5 mm or microcystic when cysts are <5 mm [49]. Macrocystic (≥5\xa0mm) lesions on fetal imaging correspond to Stocker Type 1 lesions, and microcystic (<5\xa0mm) lesions on fetal imaging correspond to Stocker Type 2 lesions [40, 48]. If not detected on prenatal imaging, CPAM may be first visualized on chest radiograph as an air-filled cystic lesion or a solid mass, depending on the type [48].Fig. 1.11 Macrocystic congenital pulmonary airway malformation (CPAM) on prenatal MR imaging. (a) Coronal non-enhanced T2-weighted MR image shows several hyperintense cysts (arrows) in the right lung. A left pleural effusion (arrowhead) is also present. (b) Sagittal non-enhanced T2-weighted MR image shows several hyperintense cysts (arrows) in the lung. (c) Sagittal ultrasound image shows several hypoechoic cysts (arrows) in the lung'], '469524_1_En_1_Fig12_HTML': ['Postnatal cross-sectional imaging is indicated to further assess CPAM especially when surgical resection is considered. Currently, CT is the modality most often utilized for this indication, but MR imaging can be utilized as an alternative. Because pulmonary sequestration and hybrid lesions are often a differential consideration, MR angiography is indicated to evaluate the vascular supply. MR imaging findings of CPAMs depend on the type. Cysts in type 1, 2, and 4 lesions are air-filled or fluid-filled and have a thin hyperintense wall that enhances on contrast-enhanced images (Fig. <xref rid="469524_1_En_1_Fig12_HTML" ref-type="fig">1.12</xref>) [) [31]. Type 3 lesions appear as solid enhancing masses on contrast-enhanced MR images.Fig. 1.12 Congenital pulmonary airway malformation (CPAM) type 2 in a boy at 7\xa0months old and 9\xa0years old. (a) Axial enhanced lung window setting CT image at 7\xa0months of age shows multiple cysts (arrow) measuring <2 cm in the left lower lobe. (b) Axial enhanced T1-weighted fat-suppressed PROPELLER MR image at 9 years of age shows multiple cysts (arrow) measuring <2 cm in the left lower lobe'], '469524_1_En_1_Fig13_HTML': ['Sequestration is often diagnosed on prenatal ultrasound. Fetal MR imaging may be performed to further characterize lesions, which typically demonstrates a lesion that is hyperintense on T2-weighted images (Figs. <xref rid="469524_1_En_1_Fig13_HTML" ref-type="fig">1.13</xref> and and <xref rid="469524_1_En_1_Fig14_HTML" ref-type="fig">1.14</xref>). A flow-void might be seen arising from the aorta, indicating the systemic arterial supply, but this is often difficult to visualize. Therefore, the MR imaging appearance may be similar to other lesions including CPAM, bronchial atresia, and congenital lobar emphysema [). A flow-void might be seen arising from the aorta, indicating the systemic arterial supply, but this is often difficult to visualize. Therefore, the MR imaging appearance may be similar to other lesions including CPAM, bronchial atresia, and congenital lobar emphysema [48, 49, 57].Fig. 1.13 Intralobar pulmonary sequestration on prenatal imaging. (a) Coronal non-enhanced T2-weighted MR image shows hyperintense lesion (S) replacing the right lower lobe and crossing the midline. (b) Sagittal non-enhanced T2-weighted MR image shows hyperintense lesion (S) replacing the right lower lobe. (c) Sagittal ultrasound image with color Doppler shows an anomalous systemic artery (arrow) arising from the descending thoracic aorta. (d) 3D reconstructed ultrasound image shows an anomalous systemic artery (arrow) arising from the descending thoracic aortaFig. 1.14 Extralobar infradiaphragmatic pulmonary sequestration on prenatal MR imaging. Coronal non-enhanced T2-weighted MR image shows hyperintense lesion (arrow) inferior to the left diaphragm'], '469524_1_En_1_Fig15_HTML': ['Three main patterns have been recognized in bacterial pneumonia . These include pulmonary consolidation, bronchopneumonia, and atypical pneumonia. Pulmonary consolidation occurs when alveoli fill with exudate, inflammatory cells, and fibrin (Fig. <xref rid="469524_1_En_1_Fig15_HTML" ref-type="fig">1.15</xref>) [) [62]. In children consolidation may be lobar or spherical, resulting in “round pneumonia” [63, 64]. Bronchopneumonia describes a pulmonary infection characterized by peribronchial inflammation affecting multiple lobes and may result in patchy peribronchial consolidation and ground-glass signal (Fig. <xref rid="469524_1_En_1_Fig16_HTML" ref-type="fig">1.16</xref>). Atypical pneumonia is a condition in which imaging may show only mild pulmonary findings such as mild reticular or patchy opacities without a focal region of consolidation, and symptoms may include headache and sore throat [). Atypical pneumonia is a condition in which imaging may show only mild pulmonary findings such as mild reticular or patchy opacities without a focal region of consolidation, and symptoms may include headache and sore throat [65]. In current clinical practice, these three patterns are most often seen on chest radiograph or CT, but the findings may also be seen on MR imaging.\xa0Detailed descriptions of the specific MR imaging findings (e.g., consolidation and ground-glass signal) are covered in a subsequent section.Fig. 1.15 Aspiration pneumonia in a 3-week-old girl who presented with fever and respiratory distress. Axial non-enhanced T2-weighted fat-suppressed MR image shows left lower lobe consolidation (arrow)Fig. 1.16 Bacterial bronchopneumonia in a 16-year-old girl who presented with fever and cough. Coronal non-enhanced TruFISP/FIESTA MR image shows peribronchial ground-glass signal abnormality in the left upper and left lower lobes (asterisks) and a simple left pleural effusion (arrow)'], '469524_1_En_1_Fig16_HTML': [' Pleural effusion may occur in association with bacterial pneumonia and is called parapneumonic effusion (see Fig. <xref rid="469524_1_En_1_Fig16_HTML" ref-type="fig">1.16</xref>). Empyema occurs when infection spreads to the pleural space, resulting in thickening and hyperemia of the pleural membranes, complex fluid within the pleural space, and loculated pockets of infected fluid. These findings may be appreciated on MR imaging and include hyperintense non-enhancing complex fluid within the pleural space and hyperenhancing thickened parietal and visceral pleura. Rarely, a condition called empyema necessitans can occur when empyema spreads from the pleural space to the chest wall (Fig. ). Empyema occurs when infection spreads to the pleural space, resulting in thickening and hyperemia of the pleural membranes, complex fluid within the pleural space, and loculated pockets of infected fluid. These findings may be appreciated on MR imaging and include hyperintense non-enhancing complex fluid within the pleural space and hyperenhancing thickened parietal and visceral pleura. Rarely, a condition called empyema necessitans can occur when empyema spreads from the pleural space to the chest wall (Fig. <xref rid="469524_1_En_1_Fig17_HTML" ref-type="fig">1.17</xref>). Empyema necessitans is most often caused by ). Empyema necessitans is most often caused by Actinomyces israelii or Mycobacterium tuberculosis infection.Fig. 1.17 Empyema necessitans in a 17-year-old boy who presented with fever and chest swelling. (a) Axial enhanced soft tissue window setting CT image shows consolidation (C) in the lingua, dense pleural fluid and soft tissue density (arrow), and left chest wall soft tissue thickening and inflammation (asterisk) with periosteal reaction (arrowhead) in the adjacent rib. (b) Axial enhanced T1-weighted fat-suppressed MR image shows consolidation (C) in the lingua, pleural soft tissue thickening (arrow), and left chest wall soft tissue thickening and inflammation (asterisk)', 'Simple pleural effusions may occur in cases of pulmonary infection. In these cases, infection may not spread to the pleural space, but the pleural effusion is reactive to the adjacent inflammatory process. In these cases, pleural fluid is homogenous and hyperintense on T2-weighted images and hypointense on T1-weighted images, and pleural membranes are thin without thickening or hyperenhancement on contrast-enhanced MR images (see Figs. <xref rid="469524_1_En_1_Fig16_HTML" ref-type="fig">1.16</xref> and and <xref rid="469524_1_En_1_Fig24_HTML" ref-type="fig">1.24</xref>) [) [97]. Thoracentesis and chest tube placement may be performed for symptom relief when simple effusions are large or to sample fluid in cases of suspected empyema.', ' Pleural effusions may form when excess production or decreased absorption of pleural fluid leads to accumulation within the pleural space. The most common causes of pleural effusion are infection, congestive heart failure, and malignancy (see Figs. <xref rid="469524_1_En_1_Fig16_HTML" ref-type="fig">1.16</xref>,\n<xref rid="469524_1_En_1_Fig17_HTML" ref-type="fig">1.17</xref>,\n<xref rid="469524_1_En_1_Fig24_HTML" ref-type="fig">1.24</xref>,\n<xref rid="469524_1_En_1_Fig30_HTML" ref-type="fig">1.30</xref>, , <xref rid="469524_1_En_1_Fig31_HTML" ref-type="fig">1.31</xref>, and , and <xref rid="469524_1_En_1_Fig32_HTML" ref-type="fig">1.32</xref>). Exudative pleural effusions are composed of simple clear fluid. On MR imaging, exudative pleural effusions appear as homogenous fluid that is hyperintense on T2-weighted images and hypointense on T1-weighted images. If causing symptoms, exudative pleural effusions can be treated with chest tube placement. Fibrinopurulent pleural effusions occur when infection spreads to the pleural space and cause empyema (see Fig. ). Exudative pleural effusions are composed of simple clear fluid. On MR imaging, exudative pleural effusions appear as homogenous fluid that is hyperintense on T2-weighted images and hypointense on T1-weighted images. If causing symptoms, exudative pleural effusions can be treated with chest tube placement. Fibrinopurulent pleural effusions occur when infection spreads to the pleural space and cause empyema (see Fig. <xref rid="469524_1_En_1_Fig17_HTML" ref-type="fig">1.17</xref>). Empyema is described in detail in an earlier section.). Empyema is described in detail in an earlier section.'], '469524_1_En_1_Fig18_HTML': [' Viral respiratory infections include bronchiolitis and viral pneumonia and occur when airborne viruses infect the respiratory mucosa. Infection leads to bronchial wall thickening, inflammation, and mucous production. Mucous plugging and bronchial wall thickening often lead to air trapping and atelectasis. Pleural effusions may accompany viral lower respiratory tract infection. Although these imaging findings are more often described on chest radiograph and CT, the finding may also be appreciated on MR imaging (Fig. <xref rid="469524_1_En_1_Fig18_HTML" ref-type="fig">1.18</xref>).).Fig. 1.18 Respiratory syncytial virus infection in a 1-week-old girl who presented with respiratory distress. Axial non-enhanced T2-weighted fat-suppressed MR image shows bilateral peribronchial interstitial thickening (asterisks)', 'A large number of different viruses may cause lower respiratory tract infection in children. Respiratory syncytial virus (RSV) is the most common cause of viral bronchiolitis in infants and young children (see Fig. <xref rid="469524_1_En_1_Fig18_HTML" ref-type="fig">1.18</xref>). Other viruses that may result in lower respiratory tract infection include human metapneumovirus, parainfluenza virus, rhinovirus, influenza, adenovirus, and cytomegalovirus, among others.). Other viruses that may result in lower respiratory tract infection include human metapneumovirus, parainfluenza virus, rhinovirus, influenza, adenovirus, and cytomegalovirus, among others.'], '469524_1_En_1_Fig19_HTML': [' Fungal infection of the lungs is uncommon in immunocompetent children but is relatively frequent in immunocompromised children [66]. The most common pulmonary fungal infections are aspergillosis, coccidioidomycosis, and histoplasmosis in the pediatric population. Pulmonary infection most often occurs when airborne fungi enter and disseminate through the lung via endobronchial spread, resulting in multiple pulmonary nodules distributed in a tree-in-bud pattern (Figs. <xref rid="469524_1_En_1_Fig19_HTML" ref-type="fig">1.19</xref> and and <xref rid="469524_1_En_1_Fig20_HTML" ref-type="fig">1.20</xref>) [) [65]. Hematogenous spread also occurs, leading to a pattern of small randomly distributed pulmonary nodules in a “miliary” pattern. Pulmonary nodules in fungal infection often have a solid center (which may cavitate) surrounded by a rim of ground-glass signal intensity, producing a “halo” sign [67]. These findings are most often described on chest radiograph and CT, but they can also be seen on MR imaging as described in a following section.Fig. 1.19Pulmonary coccidioidomycosis infection in a 5-year-old girl who presented with fever, cough, and headache. (a) Axial non-enhanced T2-weighted fat-suppressed MR image shows numerous bilateral hyperintense pulmonary nodules. (b) Coronal enhanced T1-weighted fat-suppressed MR image shows numerous bilateral hyperintense pulmonary nodulesFig. 1.20Pulmonary Aspergillus infection in 14-year-old girl with cystic fibrosis. (a) Axial enhanced lung window setting CT image shows tree-in-bud nodularity (black arrows) in bilateral lower lobes, a larger nodule (white arrow) with ground-glass halo in the left upper lobe, and left hilar adenopathy (arrowhead). (b) Axial non-enhanced SSFP T2/T1-weighted MR image shows left upper lobe nodule (arrow) and left hilar adenopathy (arrowhead)'], '469524_1_En_1_Fig21_HTML': ['In the developing world, tuberculosis (TB) continues to be a significant cause of community-acquired illness and, in the developed world, TB primarily affects patients who are immunocompromised or patients who emigrate from the developing world (Fig. <xref rid="469524_1_En_1_Fig21_HTML" ref-type="fig">1.21</xref>) [) [68–70]. Although chest radiograph and CT are the most commonly used imaging modalities to assess TB infection, MR imaging may be considered in certain scenarios. For example, MR imaging may be utilized in immunocompromised pediatric patients receiving multiple imaging studies in order to mitigate exposure to ionizing radiation.Fig. 1.21 Mycobacterium tuberculosis infection in 13-year-old boy with immunosuppression. Axial non-enhanced T2-weighted MR image shows multiple hyperintense and ground-glass pulmonary nodules (black arrows), bilateral interstitial thickening (white arrows), and small right pleural effusion (arrowheads)', 'The most common primary mode of transmission for TB infection is through inhalation of infected droplets, and the initial infection is termed primary TB. In children, primary infection most often causes mild symptoms with no findings on imaging studies [71]. Less often, primary infection may cause more significant symptoms and be accompanied by mediastinal and hilar lymphadenopathy and pulmonary parenchymal opacity (see Fig. <xref rid="469524_1_En_1_Fig21_HTML" ref-type="fig">1.21</xref>) [) [72, 73]. Lymphadenopathy is most often mild, but in a minority of cases, lymph nodes can become significantly enlarged and cause significant bronchial obstruction [74, 75]. Pleural effusion occurs in approximately 22% of children with primary TB infection (see Fig. <xref rid="469524_1_En_1_Fig21_HTML" ref-type="fig">1.21</xref>) [) [76]. In primary infection, MR imaging may be normal or demonstrate pulmonary consolidation, pulmonary nodules, pleural effusion, or lymphadenopathy (see Fig. <xref rid="469524_1_En_1_Fig21_HTML" ref-type="fig">1.21</xref>) [) [77, 78].'], '469524_1_En_1_Fig22_HTML': [' Pulmonary hydatid disease may first be detected on chest radiograph as a single (81%) or multiple (19%) round densities ranging in size from 1 to 20 cm [83–85]. On CT, these lesions demonstrate internal fluid density and a smooth wall that is higher density than fluid (Fig. <xref rid="469524_1_En_1_Fig22_HTML" ref-type="fig">1.22</xref>). If cyst communicates with the airway an “air-crescent” sign may be seen and a “water lilly” sign may be seen when a collapsed endocyst floats within a cyst [). If cyst communicates with the airway an “air-crescent” sign may be seen and a “water lilly” sign may be seen when a collapsed endocyst floats within a cyst [85, 86]. MR imaging may help differentiate pulmonary hydatid disease from other cystic lung lesions by showing characteristic hypointense folded membrane within the cyst and a hypointense rim surrounding the cyst (see Fig. <xref rid="469524_1_En_1_Fig22_HTML" ref-type="fig">1.22</xref>) [) [81]. Recent prospective study which compared MR and contrast-enhanced MDCT for evaluation of pediatric pulmonary hydatid disease showed that fast MR imaging without contrast material is comparable to contrast-enhanced MDCT for accurately diagnosing lung cysts in pediatric patients with pulmonary hydatid disease. However, added diagnostic value demonstrating internal membranes of cysts, which is specific to pulmonary hydatid disease, was provided by MR imaging in comparison to MDCT [87].Fig. 1.22 Pulmonary hydatid disease in a 10-year-old boy who presented with chest pain and cough. (Courtesy of Kushaljit Singh Sodhi, MD, PhD, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India). (a) Axial enhanced soft tissue window setting CT image shows cystic lesion (H) with peripheral enhancement in the right upper lobe. (b) Axial non-enhanced T2-HASTE-weighted MR image shows internal folded membranes (arrows) within the cystic lesion. (c) Axial non-enhanced T2-BLADE-weighted MR image shows internal folded membranes (arrows) within the cystic lesion', ' Hydatid cysts are composed of three layers: the outermost pericyst, the middle laminated layer sometimes called the ectocyst, and the innermost germinal layer also known as the endocyst [82]. Each of these layers is separated by a membrane, and visualization of these membranes may aid in the diagnosis of pulmonary hydatid disease (see Fig. <xref rid="469524_1_En_1_Fig22_HTML" ref-type="fig">1.22</xref>).).', ' Pulmonary hydatid cysts appear as smooth-walled cystic masses, which contain fluid that is hyperintense on T2-weighted images and does not enhance on contrast-enhanced images. MR imaging may be helpful for differentiating hydatid cysts from other cystic masses by demonstrating a characteristic hypointense rim surrounding the cyst and a folded hypointense membrane within the cyst (see Fig. <xref rid="469524_1_En_1_Fig22_HTML" ref-type="fig">1.22</xref>) [) [81, 87].'], '469524_1_En_1_Fig23_HTML': [' Pulmonary consolidation is common in bacterial pneumonia. On CT, pulmonary consolidation appears as opacified lung which obscures pulmonary vessels, often with air bronchograms [88]. On MR imaging, homogenous signal intensity fills the normally hypointense lung and obscures pulmonary vessels (Fig. <xref rid="469524_1_En_1_Fig23_HTML" ref-type="fig">1.23</xref> and see Fig. and see Fig. <xref rid="469524_1_En_1_Fig15_HTML" ref-type="fig">1.15</xref>) [) [88]. On T2-weighted sequences, the signal within pulmonary consolidation is typically greater than the signal in skeletal muscle. On contrast-enhanced T1-weigthed images with fat suppression, the region of consolidation typically enhances homogenously, unless there is necrosis.Fig. 1.23 Aspiration-related bilateral lower lobe consolidation in a 3-year-old boy with esophageal atresia repair. (a) Axial non-enhanced T2-weighted fat-suppressed MR image shows bilateral lower lobe consolidation (arrows). (b) Axial non-enhanced T2-weighted fat-suppressed MR image shows a dilated fluid-filled esophagus (E)'], '469524_1_En_1_Fig24_HTML': ['Pulmonary infection may lead to ground-glass abnormalities within the lungs. On CT, ground-glass opacities are defined as opacities which are denser than the air-filled lung, but not dense enough to obscure the pulmonary vasculature. On MR imaging, ground-glass signal is defined as hyperintense signal within the lungs that is more intense than the air-filled lung but does not obscure the pulmonary vasculature (Fig. <xref rid="469524_1_En_1_Fig24_HTML" ref-type="fig">1.24</xref> and see Fig. and see Fig. <xref rid="469524_1_En_1_Fig16_HTML" ref-type="fig">1.16</xref>) [) [88]. Pulmonary infection may lead to ground-glass signal within the lungs, or areas of mixed consolidation and ground-glass signal. Ground-glass signal can also be seen surrounding a central nodule, producing a “halo” sign seen in fungal and other infections [67].Fig. 1.24Bronchopneumonia causing ground-glass signal abnormality in a 13-year-old boy who presented with fever and cough. Axial non-enhanced bright-blood T2-weighted MR image shows peribronchial ground-glass signal abnormality (arrows) in the left upper and left lower lobe and bilateral pleural effusions (arrowheads)'], '469524_1_En_1_Fig25_HTML': ['Pulmonary infection can progress from consolidation and ground-glass abnormalities to pulmonary necrosis and abscess if there is interruption of the blood supply to the lung. Pulmonary necrosis describes devitalized lung which loses its normal architecture and often contains irregularly shaped pockets of air and coalescing fluid. Pulmonary necrosis evolves into pulmonary abscess when a wall forms around a region of devitalized lung (Fig. <xref rid="469524_1_En_1_Fig25_HTML" ref-type="fig">1.25</xref>) [) [65, 89, 90]. On MR imaging, pulmonary necrosis is defined as an area of lung consolidation without enhancement on contrast-enhanced images. On T2-weighted images, necrosis may be appreciated as a region of lower signal centered within a higher-signal region of consolidation. Like on chest radiograph and CT, irregularly shaped locules of air may be seen within a region of pulmonary necrosis, and an air-filled cavity or a cavity with an air-fluid level may be seen in pulmonary abscess (see Fig. <xref rid="469524_1_En_1_Fig25_HTML" ref-type="fig">1.25</xref>) [) [91].Fig. 1.25 Pulmonary abscess in a 17-year-old girl with cystic fibrosis, fever, and cough. Axial non-enhanced bright-blood MR image shows a cavity (arrow) containing an air-fluid level within the right upper lobe and bilateral bronchiectasis (arrowheads) with bronchial wall thickening', ' Bronchiectasis may occur as a complication of pulmonary infection and is defined as irreversible dilation of a bronchus or bronchiole. Bronchiectasis may also occur in the setting of cystic fibrosis or ciliary dyskinesia [86, 92–96]. Bronchiectasis can be diagnosed on MR imaging when the diameter of a bronchus is greater than the diameter of the pulmonary artery adjacent to it [65]. Because bronchi are air-filled structures surrounded by a thin wall, CT is often better at depicting bronchiectasis than MR imaging.\xa0However, the bronchial walls are often thickened and inflamed in bronchiectasis, and these bronchial walls are often hyperintense and visible on T2-weighted MR images (see Fig. <xref rid="469524_1_En_1_Fig25_HTML" ref-type="fig">1.25</xref>).).'], '469524_1_En_1_Fig17_HTML': ['When infection spreads from the lung into the pleural space, an empyema occurs. The appearance of an empyema differs from the appearance of a simple pleural effusion. In empyema, MR imaging may show heterogeneous signal within the pleural space on T2-weighted images due to septations or complex material (see Fig. <xref rid="469524_1_En_1_Fig17_HTML" ref-type="fig">1.17</xref>) [) [91]. On contrast-enhanced images, the pleural membranes are typically thickened and hyperenhancing. Empyema may be treated with one of two strategies: antibiotics, chest tube placement, and infusion of fibrinolytics to the pleural space or video-assisted thoracoscopic surgery (VATS)-assisted drainage [98, 99].'], '469524_1_En_1_Fig26_HTML': [' Pulmonary hamartomas are smooth or slightly lobulated solitary pulmonary nodules which may contain fat or calcification. On MR imaging, hamartomas demonstrate hyperintensity on T2-weighted images and early peripheral enhancement that becomes homogenous on delay-phase images (Fig. <xref rid="469524_1_En_1_Fig26_HTML" ref-type="fig">1.26</xref>) [) [104]. Cleft-like structures separating small cystic spaces have been described within pulmonary hamartomas on T2-weighted and contrast-enhanced images [104, 105], and chemical shift MR imaging can aid in detection of fat within lesions [106].Fig. 1.26 Pulmonary hamartoma in a 13-year-old girl. Coronal non-enhanced T2-weighted fat-suppressed MR image shows a right perihilar hyperintense solitary pulmonary nodule (arrow) with a smooth margin'], '469524_1_En_1_Fig27_HTML': [' Inflammatory myofibroblastic tumors are low-grade mesenchymal tumors that may present as solitary circumscribed pulmonary nodules or masses or can be infiltrative [107]. In the limited literature describing the MR imaging appearance, inflammatory myofibroblastic tumors may be heterogeneous on T2-weighted images with heterogeneous enhancement and necrosis on contrast-enhanced imaging (Fig. <xref rid="469524_1_En_1_Fig27_HTML" ref-type="fig">1.27</xref>) [) [108].Fig. 1.27 Pulmonary inflammatory myofibroblastic tumor in a 5-year-old boy. (a) Frontal chest radiograph shows a large right upper lobe mass (M). (b) Axial enhanced soft tissue window setting CT image shows the right upper lobe mass (M) demonstrating heterogeneous enhancement. (c) Axial non-enhanced SSFSE T2-weighted MR image shows the right upper lobe mass (M) demonstrating heterogeneous signal intensity. (d) Axial enhanced T1-weighted fat-suppressed MR image shows regions of non-enhancement (arrows) within the mass, indicating necrosis'], '469524_1_En_1_Fig28_HTML': ['PPB is an aggressive embryonal tumor that arises from the lung or less often from the pleura. PPB is associated with a hereditary tumor predisposition syndrome which includes cystic nephroma, stromal sex-cord ovarian tumors, seminomas or dysgerminomas, intestinal polyps, thyroid hyperplasias, hamartomas, and medulloblastoma [109]. PBB and this hereditary tumor predisposition syndrome are associated with a mutation in the DICER1 gene [110]. There are three types of PPB: type I is purely cystic, type II is cystic and solid, and type III is completely solid. The median age at diagnosis for type I is 8\xa0months, type II is 35\xa0months, and type III is 41\xa0months [111]. The MR imaging appearance depends on the type. In type III, masses are typically large and heterogeneous on T1- and T2-weighted images and often contain regions of necrosis which do not enhance on contrast-enhanced images (Fig. <xref rid="469524_1_En_1_Fig28_HTML" ref-type="fig">1.28</xref>) [) [112].Fig. 1.28 Type III pleuropulmonary blastoma in a 5-year-old girl. (a) Axial non-enhanced T2-weighted fat-suppressed MR image shows a large heterogeneously hyperintense left upper lobe mass which exerts mass effect on the mediastinum. Regions of greater hyperintensity (asterisks) within the mass correspond to regions of necrosis. (b) Axial enhanced T1-weighted fat-suppressed MR image shows heterogenous enhancement within the mass with several non-enhancing regions (asterisks), indicating necrosis'], '469524_1_En_1_Fig29_HTML': [' Epithelioid hemangioendothelioma is a rare vascular sarcoma that can occur at any age and any organ in the body including the lung and pleura [113–115]. Three patterns on imaging are described with thoracic epithelioid hemangioendothelioma: multiple pulmonary nodules, multiple pulmonary reticulonodular opacities, or diffuse infiltrative pleural thickening [116]. Although these findings have been described on CT, similar findings are seen on MR imaging (Fig. <xref rid="469524_1_En_1_Fig29_HTML" ref-type="fig">1.29</xref>).).Fig. 1.29 Epithelioid hemangioendothelioma in a 16-year-old girl. (a) Coronal non-enhanced T2-weighted fat-suppressed MR image shows multiple bilateral hyperintense pulmonary nodules. (b) Axial non-enhanced T2-weighted fat-suppressed MR image shows multiple bilateral hyperintense pulmonary nodules'], '469524_1_En_1_Fig30_HTML': ['On MR imaging, metastatic pulmonary nodules typically appear isointense to skeletal muscle on T1-weighted images, slightly hyperintense to skeletal muscle on T2- weighted images and demonstrate variable enhancement on contrast-enhanced images (Fig. <xref rid="469524_1_En_1_Fig30_HTML" ref-type="fig">1.30</xref>). Because pulmonary nodules contain signal-producing protons, they are typically easily detectible on the background of hypointense aerated lung, although respiratory motion artifact can obscure small nodules. Pulmonary metastatic disease is most often characterized by multiple pulmonary nodules but can also disseminate within the lung via the lymphatic system, in a process called lymphangitic spread (Fig. ). Because pulmonary nodules contain signal-producing protons, they are typically easily detectible on the background of hypointense aerated lung, although respiratory motion artifact can obscure small nodules. Pulmonary metastatic disease is most often characterized by multiple pulmonary nodules but can also disseminate within the lung via the lymphatic system, in a process called lymphangitic spread (Fig. <xref rid="469524_1_En_1_Fig31_HTML" ref-type="fig">1.31</xref>).).Fig. 1.30 Pulmonary and pleural metastases in a 14-year-old girl with synovial cell sarcoma of the left knee. (a) Coronal non-enhanced T2-weighted fat-suppressed MR image shows metastatic nodules in the right lung (white arrow) and pleura (black arrow) and pleural effusion (E). (b) Axial non-enhanced T2-weighted fat-suppressed MR image shows metastatic nodules in the right lung (white arrows), pleural effusion (E), and septations (black arrowheads) in the pleura. (c) Axial enhanced T1-weighted fat-suppressed MR image shows central hypoenhancement within metastatic nodules in the right lung (white arrows) and pleural effusion (E) with enhancement of the pleura (arrowheads)Fig. 1.31Lymphangitic spread of metastatic disease and pleural effusion in a 12-year-old girl with metastatic renal cell carcinoma. Axial non-enhanced T2-weighted fat-suppressed MR image shows bilateral interlobular septal thickening (white arrowheads) due to lymphangitic spread of metastatic disease and bilateral pleural effusions containing septations (black arrowheads)', ' Pleural effusions may also occur in metastatic disease. In cases of pulmonary metastasis with reactive pleural effusions, the pleural effusions typically contain simple fluid that is hypointense on T1-weighted images and hyperintense on T2-weighted images without associated enhancement. In cases of metastatic spread to the pleura, pleural effusions are accompanied by pleural nodularity, pleural enhancement, and pleural fluid may be complex and contain septations (see Fig. <xref rid="469524_1_En_1_Fig30_HTML" ref-type="fig">1.30</xref>).).'], '469524_1_En_1_Fig32_HTML': ['MR imaging findings of pulmonary edema are best appreciated on T2-weighted sequences. The interlobular septa are normally not visible on MR imaging, but, in cases of interstitial pulmonary edema, the septa become visible and hyperintense on T2-weighted images (Fig. <xref rid="469524_1_En_1_Fig32_HTML" ref-type="fig">1.32</xref>). When fluid fills the alveoli, ground-glass signal and consolidation may be seen (Fig. ). When fluid fills the alveoli, ground-glass signal and consolidation may be seen (Fig. <xref rid="469524_1_En_1_Fig33_HTML" ref-type="fig">1.33</xref> and see Fig. and see Fig. <xref rid="469524_1_En_1_Fig32_HTML" ref-type="fig">1.32</xref>). MR imaging may also show pleural effusion and cardiomegaly in cases of cardiogenic pulmonary edema.). MR imaging may also show pleural effusion and cardiomegaly in cases of cardiogenic pulmonary edema.Fig. 1.32 Pulmonary edema in a 17-year-old girl with congenital heart disease. Axial non-enhanced T2-weighted MR image shows interlobular septal thickening (arrowheads), small region of consolidation (C), and small right pleural effusion (E). Cardiomegaly is also seenFig. 1.33 Pulmonary edema in an 8-day-old girl with coarctation of aorta. (a) Frontal chest radiograph shows hazy bilateral pulmonary opacities due to pulmonary edema. (b) Axial non-enhanced T1-weighted MR image shows ground-glass signal intensity throughout both lungs. (c) Posterior projection from 3D reformatted MR image of the mediastinal vessels shows focal narrowing (arrow) of the aorta distal to the origin of the left subclavian artery'], '469524_1_En_1_Fig34_HTML': ['Imaging is utilized in CF to evaluate superimposed infection but is also an important tool for monitoring disease progression. Although CT has historically filled this role, MR imaging has gained attention as an attractive alternative because repeated used of CT throughout the life of a patient with CF can lead to large cumulative radiation doses over time [122]. Many of the key imaging findings in CF produce increased signal on T2-weighted images, facilitating their detection on MR imaging (Fig. <xref rid="469524_1_En_1_Fig34_HTML" ref-type="fig">1.34</xref>). For example, bronchiectasis with bronchial wall thickening, mucus plugs, and consolidation are detected on MR imaging with sensitivity comparable to CT [). For example, bronchiectasis with bronchial wall thickening, mucus plugs, and consolidation are detected on MR imaging with sensitivity comparable to CT [121, 123–125].Fig. 1.34Cystic fibrosis in a 17-year-old girl. (a) Axial non-enhanced T2-weighted fat-suppressed MR image shows bronchiectasis with bronchial wall thickening (white arrows) and hyperintense pulmonary nodules (white arrowheads). (b) Axial non-enhanced T2-weighted fat-suppressed MR image shows hyperintense pulmonary nodules (white arrowheads) and consolidation (C)']} | Lung and Pleura | [
"Magnetic resonance imaging (MRI)",
"Pediatric",
"Congenital pulmonary lesions",
"Pulmonary infections",
"Pulmonary neoplasms"
] | Pediatric Body MRI | 1590303600 | None | null | other | PMC7245516 | null | null | [
""
] | Pediatric Body MRI. 2020 May 24;:1-28 | NO-CC CODE |
|
a). Lung HRCT at admission shows multi focal peripheral ground glass opacity in both lungs highly suggestive of COVID 19 pneumonia. b). Lung HRCT before IVIG administration shows increased ground glass opacity associated with patchy dense sub pleural consolidation in both lungs and bilateral pleural effusion mostly in the Rt. side. c). Lung HRCT after IVIG treatment shows minimally decreased dense patchy consolidation in the Rt. lung. | gr3_lrg | 7 | 6a4becd61a161a3756cdd663c0f9da07bf66331f4c8fb6f438623372107826c7 | gr3_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
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761,
276
] | [{'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7247490/gr2_lrg.jpg', 'caption': 'A). Lung HRCT at admission demonstrates multi-focal peripheral ground glass opacity in both lungs highly suggestive of COVID 19 pneumonia. b). Lung HRCT before IVIG treatment shows increased in ground glass opacity with central progression in both lungs, (mostly in Rt. side). c). Lung HRCT after IVIG treatment shows decreased ground glass opacity in both lungs associated with small patchy sub pleural consolidations in both sides.', 'hash': '63d08984510d4c6d3f24d296c661fd05c4dfbf4a663e28f26f63b3b15694a7b2'}, {'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC7247490/gr3_lrg.jpg', 'caption': 'a). Lung HRCT at admission shows multi focal peripheral ground glass opacity in both lungs highly suggestive of COVID 19 pneumonia. b). Lung HRCT before IVIG administration shows increased ground glass opacity associated with patchy dense sub pleural consolidation in both lungs and bilateral pleural effusion mostly in the Rt. side. c). Lung HRCT after IVIG treatment shows minimally decreased dense patchy consolidation in the Rt. lung.', 'hash': '6a4becd61a161a3756cdd663c0f9da07bf66331f4c8fb6f438623372107826c7'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7247490/gr1_lrg.jpg', 'caption': 'a).Lung HRCT (on admission day) shows diffuse ground glass opacity mostly in sub pleural spaces of both lower lobes; these can be suggestive for COVID 19 infection. b). Lung HRCT (11 days after the admission) showing increased peripheral ground glass opacity associated with patchy dense consolidation in both lungs. c). CXR before IVIG therapy (the day of intubation) demonstrated diffused ground glass opacity in both lungs with sub pleural opacities in both sides that can be due to alveolar pattern in favor of consolidation. d). CXR after IVIG therapy demonstrated ground glass opacity with sub pleural alveolar pattern in favor of consolidation in both lungs; however, in comparison with the previous image, there were obviously decreased ground glass opacity and sub pleural consolidation (mostly in Lt. side).', 'hash': 'fb3ed9523cea1ba132450b319cde960b163a611d1aefbf3dbf789cc7687ecc60'}, {'image_id': 'gr5_lrg', 'image_file_name': 'gr5_lrg.jpg', 'image_path': '../data/media_files/PMC7247490/gr5_lrg.jpg', 'caption': 'A). Lung HRCT at admission shows multi focal peripheral ground glass opacity in both lungs indicating COVID 19 pneumonia. b). Lung HRCT before IVIG therapy shows increased ground glass opacity associated with patchy sub pleural dense consolidation and mild bilateral pleural effusion in both lungs. c).Lung HRCT in comparison with previous examination after treatment with IVIG shows mildly decreased dense patchy sub pleural consolidation.', 'hash': 'dfd4916c85940de8e8869136a9fbb4930e73f0892d0412272ff457a3eff7b647'}, {'image_id': 'gr4_lrg', 'image_file_name': 'gr4_lrg.jpg', 'image_path': '../data/media_files/PMC7247490/gr4_lrg.jpg', 'caption': 'a). Lung HRCT upon hospitalization shows multi focal peripheral ground glass opacity in both lungs recommending COVID 19 pneumonia. b). Lung HRCT before IVIG therapy shows increased ground glass opacity associated with patchy dense consolidation in both lungs. c). Lung HRCT after IVIG therapy shows decreased ground glass opacity and dense patchy consolidation.', 'hash': '3f8ee517afd08d09fdda65329e092456caaa06e0c989ca5a3998d1742c98f74c'}] | {'gr1_lrg': ['The patient was also treated with hydrocortisone and IVIG (25\xa0g) for 5 days. The patient was extubated andclinical symptoms gradually improved on the 5th day receiving treatment. Finally, the patient was discharged with sat. O2\xa0=\xa093% and stable vital signs after two weeks. <xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>\nshows Computed tomography (CT) Scans and chest X-ray before and after IVIG treatment.\nshows Computed tomography (CT) Scans and chest X-ray before and after IVIG treatment.Fig. 1a).Lung HRCT (on admission day) shows diffuse ground glass opacity mostly in sub pleural spaces of both lower lobes; these can be suggestive for COVID 19 infection. b). Lung HRCT (11 days after the admission) showing increased peripheral ground glass opacity associated with patchy dense consolidation in both lungs. c). CXR before IVIG therapy (the day of intubation) demonstrated diffused ground glass opacity in both lungs with sub pleural opacities in both sides that can be due to alveolar pattern in favor of consolidation. d). CXR after IVIG therapy demonstrated ground glass opacity with sub pleural alveolar pattern in favor of consolidation in both lungs; however, in comparison with the previous image, there were obviously decreased ground glass opacity and sub pleural consolidation (mostly in Lt. side).Fig. 1'], 'gr2_lrg': ['She was hospitalized as a COVID-19 case and treated with hydroxychloroquine, Kaletra, ceftriaxone and azithromycin. During hospitalization, Sat.O2gradually descended (83% and 68% with and without oxygen, respectively) and pulmonarylesions progressed (as evidenced in computed tomography scan) on the day 16th after admission. Antibiotic treatment was changed to vancomycin, meropenem and azithromycin. Daily IVIG was also started at the dose of 30\xa0g for 5 days. Gradually, the patient\'s respiratory condition improved, Sat. O2 faced upward (94% and 84% with and without oxygen, respectively), and pulmonary involvement was mitigated in CT scan on the last day of IVIG therapy. Three days later, the patient was discharged with Sat.O2\xa0=\xa093% and stable vital signs. <xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>\nshows chest CT scans before and after IVIG treatment.\nshows chest CT scans before and after IVIG treatment.Fig. 2A). Lung HRCT at admission demonstrates multi-focal peripheral ground glass opacity in both lungs highly suggestive of COVID 19 pneumonia. b). Lung HRCT before IVIG treatment shows increased in ground glass opacity with central progression in both lungs, (mostly in Rt. side). c). Lung HRCT after IVIG treatment shows decreased ground glass opacity in both lungs associated with small patchy sub pleural consolidations in both sides.Fig. 2'], 'gr3_lrg': ['The case was a 65-year-old man with a history of diabetes complaining of deteriorating weakness and lethargy for the past two days. Upon entering into the emergency department, he had BP\xa0=\xa0120/80, PR\xa0=\xa095, RR\xa0=\xa014, BT\xa0=\xa036.6, and sat O2\xa0=\xa082% (without oxygen) and 95% (with oxygen). Based on the pulmonary involvement observed in CT scan, his nasopharyngeal swab was positive for COVID-19 by Real Time PCR, so he was hospitalized with COVID-19 diagnosis and treated with hydroxychloroquine, Kaletra, oseltamivir, vancomycin and imipenem. Despite receiving these treatments, Sat.O2remained at low level (84% without oxygen). Progression of pulmonary lesions was evident in HRCT performed on the6th after hospitalization. Therefore, IVIG at the daily dose of 25\xa0g was initiated and continued for 5 days. The patient\'s respiratory status gradually improved and Sat.O2 rebounded. At the end of IVIG therapy, pulmonary involvement was improved in HRCT and Sat.O2boosted to 93% (without oxygen). The patient was discharged with a good general condition and stable vital signs a few days later. <xref rid="gr3_lrg" ref-type="fig">Fig. 3</xref>\ndemonstrates the patient\'s chest CT scans before and after IVIG administration.\ndemonstrates the patient\'s chest CT scans before and after IVIG administration.Fig. 3a). Lung HRCT at admission shows multi focal peripheral ground glass opacity in both lungs highly suggestive of COVID 19 pneumonia. b). Lung HRCT before IVIG administration shows increased ground glass opacity associated with patchy dense sub pleural consolidation in both lungs and bilateral pleural effusion mostly in the Rt. side. c). Lung HRCT after IVIG treatment shows minimally decreased dense patchy consolidation in the Rt. lung.Fig. 3'], 'gr4_lrg': ['A 50-year-old woman with a history of hypertension experiencing fever, chills, and weakness for the past 10 days admitted to the emergency department with BP\xa0=\xa0130/80, PR\xa0=\xa080, RR\xa0=\xa013, BT\xa0=\xa036.6, andSat.O2 (without oxygen)\xa0=\xa078%. CT scan showed characteristic pulmonary involvement, and her nasopharyngeal swab was positive for COVOD-19 by Real Time PCR, so she was hospitalized as a COVID-19 case and treated with hydroxychloroquine, Kaletra, vancomycin and imipenem. On the day 9thafter hospitalization, Sat.O2 level was still lower than desirable (90% with and 86% without oxygen). On this day, HRCT evidenced progression of pulmonary lesions. IVIG was administrated at a daily dose of 25\xa0g for 5 days which resulted in gradual improvement of respiratory status and Sat.O2level. After IVIG treatment, HRCT was performed showing evident alleviation of pulmonary lesions. The Sat.O2level also increased to 93% without oxygen. She was finally discharged the next day with a good clinical condition and stable vital signs. The patient\'s CT scans before and after IVIG treatment has been shown in <xref rid="gr4_lrg" ref-type="fig">Fig. 4</xref>\n.\n.Fig. 4a). Lung HRCT upon hospitalization shows multi focal peripheral ground glass opacity in both lungs recommending COVID 19 pneumonia. b). Lung HRCT before IVIG therapy shows increased ground glass opacity associated with patchy dense consolidation in both lungs. c). Lung HRCT after IVIG therapy shows decreased ground glass opacity and dense patchy consolidation.Fig. 4'], 'gr5_lrg': ['This was a 64-year-old woman without any history of a specific illness. She had suffered from fever and chills since about 2 weeks ago. The symptoms gradually worsened, so she referred to the emergency department with BP\xa0=\xa0140/80, PR\xa0=\xa062, RR\xa0=\xa019, BT\xa0=\xa036.6, and Sat.O2 (without oxygen)\xa0=\xa078%. She was provisionally diagnosed with COVID-19 based on the pulmonary involvement observed in CT scan. Her nasopharyngeal swab was positive for COVOD-19by Real Time PCR. Treatment was started with hydroxychloroquine, Kaletra, vancomycin, and imipenem; nevertheless, Sat.O2level was still low (87% without oxygen), and pulmonary lesions progressed as evidenced in CT scan after 6 days of hospitalization. After IVIG therapy (25\xa0g daily for 5 days); however, lung involvement improved, and the Sat.O2 level increased to 93% without oxygen. Two days later, the patient was discharged with a good general condition and stable vital signs. The patient\'s chest CT scans before and after IVIG therapy has been shown in <xref rid="gr5_lrg" ref-type="fig">Fig. 5</xref>\n.\n.Fig. 5A). Lung HRCT at admission shows multi focal peripheral ground glass opacity in both lungs indicating COVID 19 pneumonia. b). Lung HRCT before IVIG therapy shows increased ground glass opacity associated with patchy sub pleural dense consolidation and mild bilateral pleural effusion in both lungs. c).Lung HRCT in comparison with previous examination after treatment with IVIG shows mildly decreased dense patchy sub pleural consolidation.Fig. 5']} | Recovery of severely ill COVID-19 patients by intravenous immunoglobulin (IVIG) treatment: A case series | [
"IVIG",
"COVID-19",
"Improvement"
] | Virology | 1601017200 | [
"Betacoronavirus",
"COVID-19",
"Coronavirus Infections",
"Humans",
"Hyperesthesia",
"Pandemics",
"Pneumonia, Viral",
"SARS-CoV-2",
"Severe Acute Respiratory Syndrome"
] | other | PMC7247490 | null | 4 | [
"{'Citation': 'Liguori C., Pierantozzi M., Spanetta M., Sarmati L., Cesta N., Iannetta M. Subjective neurological symptoms frequently occur in patients with SARS-CoV2 infection. Brain Behav. Immun. 2020', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7235586'}, {'@IdType': 'pubmed', '#text': '32416289'}]}}",
"{'Citation': 'Merskey, H., 2002. International Association for the Study of P, Task Force on T. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Seattle: IASP.'}",
"{'Citation': 'Hadley G.R., Gayle J.A., Ripoll J., Jones M.R., Argoff C.E., Kaye R.J. Post-herpetic Neuralgia: a review. Curr. Pain Headache Rep. 2016;20(3):17.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '26879875'}}}",
"{'Citation': 'Yamada K., Kubota Y., Shimizu Y., Cui R., Mori Y., Okuno Y. Sleep shortage is associated with postherpetic neuralgia development through hyperesthesia and acute pain intensity: a community-based prospective cohort study. Pain Pract. 2019;19(5):476–483.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '30659740'}}}"
] | Virology. 2020 Sep 25; 548:1-5 | NO-CC CODE |
||
A 45-year-old man. A barium esophagram showed an irregular mass in the distal esophagus (a, arrows) and a small hiatal hernia. CT scans showed thickening of the distal esophagus (b, arrow) and an enlarged lymph node in the region of the gastrohepatic ligament, extending to the celiac axis (c,d, arrows). Both the distal esophagus and the lymph node were intensely FDG avid at PET scanning (SUV 6.2 and 8.3, respectively) (e,f, arrows). | ci13003003 | 7 | 133389d80371d0949aff46234d7ec9edef2b1976bbfaef4e415b5411aeaa8ea2 | ci13003003.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
700,
1000
] | [{'image_id': 'ci13003003', 'image_file_name': 'ci13003003.jpg', 'image_path': '../data/media_files/PMC3858864/ci13003003.jpg', 'caption': 'A 45-year-old man. A barium esophagram showed an irregular mass in the distal esophagus (a, arrows) and a small hiatal hernia. CT scans showed thickening of the distal esophagus (b, arrow) and an enlarged lymph node in the region of the gastrohepatic ligament, extending to the celiac axis (c,d, arrows). Both the distal esophagus and the lymph node were intensely FDG avid at PET scanning (SUV 6.2 and 8.3, respectively) (e,f, arrows).', 'hash': '133389d80371d0949aff46234d7ec9edef2b1976bbfaef4e415b5411aeaa8ea2'}, {'image_id': 'ci13003002', 'image_file_name': 'ci13003002.jpg', 'image_path': '../data/media_files/PMC3858864/ci13003002.jpg', 'caption': 'A 74-year-old man. Chest CT showed a 2.6-cm diameter irregular nodular opacity along the pleural surface of the right upper lobe (a, arrow) and a separate 4-cm diameter right upper lobe perihilar mass (b, arrow). Both lesions showed intense FDG avidity at PET scanning (c,d, arrows).', 'hash': '02a23519b31db7cb1840fc52e011619e7b4823931431938b9870d7945a29b44a'}, {'image_id': 'ci13003001', 'image_file_name': 'ci13003001.jpg', 'image_path': '../data/media_files/PMC3858864/ci13003001.jpg', 'caption': 'A 67-year-old woman. Chest radiograph (a) showed a lobulated anterior mediastinal mass (yellow arrow) with mild elevation of the left hemidiaphragm (black arrow). CT scan (b) demonstrated a lobulated, left-sided anterior mediastinal mass (yellow arrow) and a 1-cm left-sided pleural nodule (white arrow).', 'hash': '9854e9834a667b09914ab25f76edd8a4cf4de768777030ab3a574bb0a1cc8de0'}] | {'ci13003001': ['A 67-year-old woman with a 6-year history of myasthenia gravis presented to the emergency room with worsening dyspnea on exertion. Her past medical history included coronary artery disease with coronary stent placement, diabetes, and intermittent shortness of breath with previous oxygen dependence due to her myasthenia gravis. Her family history was notable for a sister who recently died from complications of myasthenia gravis. She had a 60 pack-year smoking history, although she quit 10 years ago. She presented with poor pulmonary function tests, including an FEV1 (forced expiratory volume in the first second of expiration) of 1.16\u2009L (49% predicted) and a Dlco (diffusing capacity of lung for carbon monoxide) of 47% predicted. A chest radiograph showed a lobulated anterior mediastinal mass; mild elevation of the left hemidiaphragm suggested involvement of the ipsilateral phrenic nerve (<xref ref-type="fig" rid="ci13003001">Fig. 1</xref>a). A computed tomography (CT) scan of the chest from an outside hospital revealed a lobulated 8-cm diameter left-sided anterior mediastinal mass (a). A computed tomography (CT) scan of the chest from an outside hospital revealed a lobulated 8-cm diameter left-sided anterior mediastinal mass (<xref ref-type="fig" rid="ci13003001">Fig. 1</xref>b). On subsequent re-evaluation of the scan by the Tumor Board, a 1-cm left-sided pleural nodule was noted, consistent with a drop metastasis in the pleural space.\nb). On subsequent re-evaluation of the scan by the Tumor Board, a 1-cm left-sided pleural nodule was noted, consistent with a drop metastasis in the pleural space.\nFigure 1A 67-year-old woman. Chest radiograph (a) showed a lobulated anterior mediastinal mass (yellow arrow) with mild elevation of the left hemidiaphragm (black arrow). CT scan (b) demonstrated a lobulated, left-sided anterior mediastinal mass (yellow arrow) and a 1-cm left-sided pleural nodule (white arrow).'], 'ci13003002': ['A 74-year-old man with a 60 pack-year history of cigarette smoking presented with a 3-month history of unintentional weight loss, exertional dyspnea, and occasional non-productive cough. Chest CT at an outside hospital showed a 2.6-cm diameter irregular nodular opacity along the pleural surface of the right upper lobe (<xref ref-type="fig" rid="ci13003002">Fig. 2</xref>a) that was slightly larger compared with a scan from 3 years earlier, as well as a new, separate, 4-cm diameter right upper lobe perihilar mass (a) that was slightly larger compared with a scan from 3 years earlier, as well as a new, separate, 4-cm diameter right upper lobe perihilar mass (<xref ref-type="fig" rid="ci13003002">Fig. 2</xref>b). Both lesions showed intense fluorodeoxyglucose (FDG) avidity at PET scanning (b). Both lesions showed intense fluorodeoxyglucose (FDG) avidity at PET scanning (<xref ref-type="fig" rid="ci13003002">Fig. 2</xref>c,d). Endobronchial ultrasound-guided biopsy of the right hilar mass revealed SCLC (TTF-1, CD5/6, synaptophysin positive, and chromogranin A, napsin A negative).\nc,d). Endobronchial ultrasound-guided biopsy of the right hilar mass revealed SCLC (TTF-1, CD5/6, synaptophysin positive, and chromogranin A, napsin A negative).\nFigure 2A 74-year-old man. Chest CT showed a 2.6-cm diameter irregular nodular opacity along the pleural surface of the right upper lobe (a, arrow) and a separate 4-cm diameter right upper lobe perihilar mass (b, arrow). Both lesions showed intense FDG avidity at PET scanning (c,d, arrows).'], 'ci13003003': ['A barium esophagram showed an irregular mass in the distal esophagus and a small hiatal hernia (<xref ref-type="fig" rid="ci13003003">Fig. 3</xref>a). CT scans showed thickening of the distal esophagus (a). CT scans showed thickening of the distal esophagus (<xref ref-type="fig" rid="ci13003003">Fig. 3</xref>b) and an enlarged lymph node in the region of the gastrohepatic ligament, extending to the border of the celiac axis (b) and an enlarged lymph node in the region of the gastrohepatic ligament, extending to the border of the celiac axis (<xref ref-type="fig" rid="ci13003003">Fig. 3</xref>c,d). Both the distal esophagus and the lymph node were intensely FDG avid at PET scanning (SUV 6.2 and 8.3, respectively) (c,d). Both the distal esophagus and the lymph node were intensely FDG avid at PET scanning (SUV 6.2 and 8.3, respectively) (<xref ref-type="fig" rid="ci13003003">Fig. 3</xref>e,f).\ne,f).\nFigure 3A 45-year-old man. A barium esophagram showed an irregular mass in the distal esophagus (a, arrows) and a small hiatal hernia. CT scans showed thickening of the distal esophagus (b, arrow) and an enlarged lymph node in the region of the gastrohepatic ligament, extending to the celiac axis (c,d, arrows). Both the distal esophagus and the lymph node were intensely FDG avid at PET scanning (SUV 6.2 and 8.3, respectively) (e,f, arrows).']} | Imaging in thoracic oncology: case studies from Multidisciplinary Thoracic Tumor Board | [
"Lung cancer",
"small cell lung cancer",
"non-small cell lung cancer",
"esophageal cancer",
"invasive thymoma",
"tumor board"
] | Cancer Imaging | 1386316800 | Multidisciplinary tumor board conferences foster collaboration among health care providers from a variety of specialties and help to facilitate optimal patient care. Generally, the clinical questions revolve around the best options for establishing a diagnosis, staging the disease and directing treatment. This article describes and illustrates the clinical scenarios of three patients who were presented at our thoracic Tumor Board, focusing on management issues and the role of imaging. These patients had invasive thymoma; concurrent small cell lung cancer and non-small cell lung cancer; and esophageal cancer with celiac lymph node metastases, respectively. | [
"Aged",
"Esophageal Neoplasms",
"Female",
"Humans",
"Lung Neoplasms",
"Lymphatic Metastasis",
"Male",
"Positron-Emission Tomography",
"Thymoma",
"Thymus Neoplasms",
"Tomography, X-Ray Computed"
] | other | PMC3858864 | null | 22 | [
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] | Cancer Imaging. 2013 Dec 6; 13(3):440-447 | NO-CC CODE |
|
Sagittal (a) and axial (b) CT images of Patient 1 demonstrate a compression fracture of T12 with anterior column. | ebsj03043-001 | 7 | 998b39ca7505f51c3dba2a531abecc8289bca30f8a7e0a2abb1379ae2d504e05 | ebsj03043-001.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
730,
356
] | [{'image_id': 'ebsj03043-001', 'image_file_name': 'ebsj03043-001.jpg', 'image_path': '../data/media_files/PMC3516458/ebsj03043-001.jpg', 'caption': 'Sagittal (a) and axial (b) CT images of Patient 1 demonstrate a compression fracture of T12 with anterior column.', 'hash': '998b39ca7505f51c3dba2a531abecc8289bca30f8a7e0a2abb1379ae2d504e05'}, {'image_id': 'ebsj03043-002', 'image_file_name': 'ebsj03043-002.jpg', 'image_path': '../data/media_files/PMC3516458/ebsj03043-002.jpg', 'caption': 'Sagittal (a) and axial (b) CT images of Patient 2 demonstrate a burst fracture of T12 with <10% canal stenosis, normal spinal alignment, and no posterior column involvement.', 'hash': '58448101be4301dfd654b0c3115df976b044e97b8c6a49fb3e8b506095574d07'}] | {'ebsj03043-001': ['X-rays and computed tomographic (CT) images revealed that patient 1 had an isolated T12 compression fracture (<xref rid="ebsj03043-001" ref-type="fig">Fig. 1</xref>) and patient 2 had an isolated T12 burst fracture () and patient 2 had an isolated T12 burst fracture (<xref rid="ebsj03043-002" ref-type="fig">Fig. 2</xref>). The burst fracture was associated with less than 10% canal compromise, no sagittal or coronal deformity, and an intact posterior ligamentous complex. Injuries were classified according to the Thoracolumbar Injury Classification and Severity Score (TLICS).). The burst fracture was associated with less than 10% canal compromise, no sagittal or coronal deformity, and an intact posterior ligamentous complex. Injuries were classified according to the Thoracolumbar Injury Classification and Severity Score (TLICS).6,7 The TLICS scores for patient 1 and patient 2 was 1 and 2, respectively. They were both treated nonoperatively with the use of a thoracolumbar orthosis (TLSO).']} | Spinal fractures in recreational bobsledders: an unexpected mechanism of injury | null | Evid Based Spine Care J | 1335855600 | None | null | other | PMC3516458 | null | null | [
""
] | Evid Based Spine Care J. 2012 May; 3(2):43-48 | NO-CC CODE |
|
(A, B) CT scan showing the PA originated in the Y graft of the transplanted pancreas in the right iliac fossa, associated with a collection in the regions adjacent to the PA measuring 100 cc. | amjcaserep-18-198-g001 | 7 | e076f6222e9ab95e9339d3449c6e14044424895078f0b38918d5416f379cba81 | amjcaserep-18-198-g001.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
780,
324
] | [{'image_id': 'amjcaserep-18-198-g004', 'image_file_name': 'amjcaserep-18-198-g004.jpg', 'image_path': '../data/media_files/PMC5335644/amjcaserep-18-198-g004.jpg', 'caption': '(A) CT angiography showing the stent into the right external iliac artery without the PA. (B) The small amount of fluid in the right iliac fossa.', 'hash': 'fb15363883c02cef1c17a8b4ba53c50029a4edbd8862a126a3676e80d9f68d46'}, {'image_id': 'amjcaserep-18-198-g003', 'image_file_name': 'amjcaserep-18-198-g003.jpg', 'image_path': '../data/media_files/PMC5335644/amjcaserep-18-198-g003.jpg', 'caption': '(A) CT angiography showing the stent into the right external iliac artery. (B) Three-dimensional reconstruction showing the PA treated.', 'hash': 'a81db96d02d68a3fa76a098c4df31f5ac61d684e4306c992c29104b5479b6aff'}, {'image_id': 'amjcaserep-18-198-g002', 'image_file_name': 'amjcaserep-18-198-g002.jpg', 'image_path': '../data/media_files/PMC5335644/amjcaserep-18-198-g002.jpg', 'caption': 'Three-dimensional reconstruction showing the PA origin in the Y graft of the transplanted pancreas.', 'hash': '6d2bb3d4cca47482f94326430de7488cf3b27daf74fd1b7a28783db12d67229c'}, {'image_id': 'amjcaserep-18-198-g001', 'image_file_name': 'amjcaserep-18-198-g001.jpg', 'image_path': '../data/media_files/PMC5335644/amjcaserep-18-198-g001.jpg', 'caption': '(A, B) CT scan showing the PA originated in the Y graft of the transplanted pancreas in the right iliac fossa, associated with a collection in the regions adjacent to the PA measuring 100 cc.', 'hash': 'e076f6222e9ab95e9339d3449c6e14044424895078f0b38918d5416f379cba81'}] | {'amjcaserep-18-198-g001': ['A CT angiography was performed and an arterial pancreas transplant PA located in the pancreatic Y graft was observed. Associated with the PA, a peri-pancreatic collection measuring 6.2×3.5×9.1 cm (100 cc) was found and no enhancement in the transplanted pancreas was observed (<xref ref-type="fig" rid="amjcaserep-18-198-g001">Figures 1</xref>, , <xref ref-type="fig" rid="amjcaserep-18-198-g002">2</xref>).).'], 'amjcaserep-18-198-g003': ['We decided to use a combined endovascular and surgical approach, aiming for safety vascular control for the surgical procedure. Initially, an incision was made in the upper part of the thigh; the right femoral artery was dissected and repaired carefully, working to maintain distal vascular control of the PA. Thereafter, an endovascular prosthesis was located into the right iliac artery by using an interventional radiology approach, occluding the PA (<xref ref-type="fig" rid="amjcaserep-18-198-g003">Figure 3</xref>).).'], 'amjcaserep-18-198-g004': ['On day six post-procedure, a control CT angiography was performed and it showed the stent located inside the right external iliac artery with no more PA evidenced and a small amount of fluid in the right iliac fossa, anterior to the external iliac artery, measuring about 4.5×3.0×4.0 cm (vol: 25.0 cc). A decision was made for a conservative approach this small collection of fluid (<xref ref-type="fig" rid="amjcaserep-18-198-g004">Figure 4</xref>).).']} | Arterial Pseudoaneurysm Associated with Pancreas and Kidney Transplantation: A Case Report | [
"Aneurysm, False",
"Endovascular Procedures",
"Pancreas Transplantation"
] | Am J Case Rep | 1487923200 | We present an atomistic understanding of the evolution of the size distribution with temperature and number of cycles in atomic layer deposition (ALD) of Pt nanoparticles (NPs). Atomistic modeling of our experiments teaches us that the NPs grow mostly via NP diffusion and coalescence rather than through single-atom processes such as precursor chemisorption, atom attachment, and Ostwald ripening. In particular, our analysis shows that the NP aggregation takes place during the oxygen half-reaction and that the NP mobility exhibits a size- and temperature-dependent scaling. Finally, we show that contrary to what has been widely reported, in general, one cannot simply control the NP size by the number of cycles alone. Instead, while the amount of Pt deposited can be precisely controlled over a wide range of temperatures, ALD-like precision over the NP size requires low deposition temperatures (e.g., T < 100 °C) when growth is dominated by atom attachment. | [] | other | PMC5335644 | null | 60 | [
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] | Am J Case Rep. 2017 Feb 24; 18:198-202 | NO-CC CODE |
|
Coronal MPR image showing a small peripheral wedge-shaped hypodense lesion in the spleen suggestive of an infarct. Left pleural effusion and free fluid in the peri-hepatic space are also present. | poljradiol-82-106-g003 | 7 | 731a748b1f6d779a6e729fd423cf3861baf01ba9e441fa2835bf9dba3dceecc2 | poljradiol-82-106-g003.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
600,
640
] | [{'image_id': 'poljradiol-82-106-g004', 'image_file_name': 'poljradiol-82-106-g004.jpg', 'image_path': '../data/media_files/PMC5335783/poljradiol-82-106-g004.jpg', 'caption': '(A) MPR images showing a partial thrombus. Ascites and sub-centimetre granulomas in the spleen are seen as well. (B) Curved MPR images showing a linear hypodense filling defect in the location of the splenic vein thrombus.', 'hash': 'a3e4a0d52d492a1b6439da671a3afc389b778a4f7190f5351c585f7d2c2e9c64'}, {'image_id': 'poljradiol-82-106-g003', 'image_file_name': 'poljradiol-82-106-g003.jpg', 'image_path': '../data/media_files/PMC5335783/poljradiol-82-106-g003.jpg', 'caption': 'Coronal MPR image showing a small peripheral wedge-shaped hypodense lesion in the spleen suggestive of an infarct. Left pleural effusion and free fluid in the peri-hepatic space are also present.', 'hash': '731a748b1f6d779a6e729fd423cf3861baf01ba9e441fa2835bf9dba3dceecc2'}, {'image_id': 'poljradiol-82-106-g002', 'image_file_name': 'poljradiol-82-106-g002.jpg', 'image_path': '../data/media_files/PMC5335783/poljradiol-82-106-g002.jpg', 'caption': 'Multiple non-enhancing granulomatous lesions of varying sizes in the spleen, ascites and lesser omental nodes. Also seen are few sub-centimetre granulomatous lesions in the liver.', 'hash': 'dca93b8e23e26b831a890493fcfbe3dc158f81dddea17785526d798a010cd4e0'}, {'image_id': 'poljradiol-82-106-g001', 'image_file_name': 'poljradiol-82-106-g001.jpg', 'image_path': '../data/media_files/PMC5335783/poljradiol-82-106-g001.jpg', 'caption': '(A) Conglomerate necrotic mediastinal lymph nodes and a left pleural effusion. (B) Corresponding lung windows showing miliary nodules scattered throughout both lungs.', 'hash': '0492234884bf925a7fec06aad1854a03a0111f7ee7147849cb17e6b9eecde398'}] | {'poljradiol-82-106-g001': ['CECT of the thorax and the abdomen was performed to assess the burden of the disease in the chest and also to evaluate the splenic vein. Eighty ml of 350 mg% Omnipaque was used to perform the CECT examination after a delay of 35 seconds, from the root of the neck down to the iliac crest. CECT revealed a left pleural effusion with miliary nodules scattered throughout both lungs along with necrotic mediastinal lymph nodes (<xref ref-type="fig" rid="poljradiol-82-106-g001">Figure 1A, 1B</xref>))'], 'poljradiol-82-106-g002': ['CT confirmed hepato-splenomegaly with multiple non-enhancing hypodense lesions suggestive of granulomas, as shown in <xref ref-type="fig" rid="poljradiol-82-106-g002">Figure 2</xref>. In addition, a 1×1 cm wedge-shaped area was seen with the base abutting the lateral border of the spleen, suggestive of a small infarct, as shown in . In addition, a 1×1 cm wedge-shaped area was seen with the base abutting the lateral border of the spleen, suggestive of a small infarct, as shown in <xref ref-type="fig" rid="poljradiol-82-106-g003">Figure 3</xref>..'], 'poljradiol-82-106-g004': ['A partial linear filling defect was seen in the splenic vein which confirmed the presence of a partial thrombus, as shown in <xref ref-type="fig" rid="poljradiol-82-106-g004">Figure 4A, 4B</xref>..']} | Splenic Vein Thrombosis as a Rare Complication of Disseminated Tuberculosis – Imaging Diagnosis and Case Report | [
"Splenic Vein",
"Tuberculosis",
"Venous Thrombosis"
] | Pol J Radiol | 1487750400 | Cells use the post-translational modification ADP-ribosylation to control a host of biological activities. In some pathogenic bacteria, an operon-encoded mono-ADP-ribosylation cycle mediates response to host-induced oxidative stress. In this system, reversible mono ADP-ribosylation of a lipoylated target protein represses oxidative stress response. An NAD(+) -dependent sirtuin catalyzes the single ADP-ribose (ADPr) addition, while a linked macrodomain-containing protein removes the ADPr. Here we report the crystal structure of the sitruin-linked macrodomain protein from Staphylococcus aureus, SauMacro (also known as SAV0325) to 1.75-Å resolution. The monomeric SauMacro bears a previously unidentified Zn(2+) -binding site that putatively aids in substrate recognition and catalysis. An amino-terminal three-helix bundle motif unique to this class of macrodomain proteins provides a structural scaffold for the Zn(2+) site. Structural features of the enzyme further indicate a cleft proximal to the Zn(2+) binding site appears well suited for ADPr binding, while a deep hydrophobic channel in the protein core is suitable for binding the lipoate of the lipoylated protein target. | [
"Bacterial Proteins",
"Crystallography, X-Ray",
"Protein Domains",
"Sirtuins",
"Staphylococcus aureus",
"Zinc"
] | other | PMC5335783 | null | 37 | [
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] | Pol J Radiol. 2017 Feb 22; 82:106-109 | NO-CC CODE |
|
MR imaging shows a heterogeneous hypointense lesion hilus in the liver on coronal T1 fat-suppressed sequences. | poljradiol-82-110-g004 | 7 | 322463088b1eb6aa20fe8a580061fd5b2d4111ce6fbfb9ce022391ad597c73f1 | poljradiol-82-110-g004.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
600,
500
] | [{'image_id': 'poljradiol-82-110-g005', 'image_file_name': 'poljradiol-82-110-g005.jpg', 'image_path': '../data/media_files/PMC5338872/poljradiol-82-110-g005.jpg', 'caption': 'MRCP images show a high-signal lesion, focal dilatation in the intrahepatic bile ducts, and fluid (in the right) around the gallbladder.', 'hash': 'e12d43a55ac1381761c8d4bed8848a73126c5a1732ac6745daa89002b059d8a3'}, {'image_id': 'poljradiol-82-110-g002', 'image_file_name': 'poljradiol-82-110-g002.jpg', 'image_path': '../data/media_files/PMC5338872/poljradiol-82-110-g002.jpg', 'caption': 'MR imaging shows a heterogeneous hypointense lesion at the level of the portal hilus in the liver on axial T1 fat-suppressed sequences.', 'hash': '4b4bd5b5ae3fae715a2e6e3e419eebd3bc1366f826f0f98ff6fe85dbe39a701b'}, {'image_id': 'poljradiol-82-110-g003', 'image_file_name': 'poljradiol-82-110-g003.jpg', 'image_path': '../data/media_files/PMC5338872/poljradiol-82-110-g003.jpg', 'caption': 'MR imaging shows a heterogeneous hyperintense lesion at the level of the portal hilus in the liver on axial T2 fat-suppressed sequences.', 'hash': '150e79b98ec7c8450e8ee1b8b05aeb4bdbe6402150879c1dcc64e628f62bc989'}, {'image_id': 'poljradiol-82-110-g004', 'image_file_name': 'poljradiol-82-110-g004.jpg', 'image_path': '../data/media_files/PMC5338872/poljradiol-82-110-g004.jpg', 'caption': 'MR imaging shows a heterogeneous hypointense lesion hilus in the liver on coronal T1 fat-suppressed sequences.', 'hash': '322463088b1eb6aa20fe8a580061fd5b2d4111ce6fbfb9ce022391ad597c73f1'}, {'image_id': 'poljradiol-82-110-g007', 'image_file_name': 'poljradiol-82-110-g007.jpg', 'image_path': '../data/media_files/PMC5338872/poljradiol-82-110-g007.jpg', 'caption': 'Axial and coronal contrast-enhanced fat-suppressed T1 MRI sequences show no contrast enhancement in the lesion, a fine fistula (black arrow) between the lesion and the intrahepatic bile ducts at the level of segment V, and mild dilatation in the intrahepatic bile ducts.', 'hash': 'eb4c883190be4eb83f70b48c2cfd371bbb25d7552c940dc1b63bd6b8455afb1e'}, {'image_id': 'poljradiol-82-110-g001', 'image_file_name': 'poljradiol-82-110-g001.jpg', 'image_path': '../data/media_files/PMC5338872/poljradiol-82-110-g001.jpg', 'caption': 'US examination shows a hypoechoic lesion with solid and cystic components having millimetric calcifications (arrow) at the level of the portal hilus in the liver (A, B). It also shows a mild dilation of the intrahepatic bile ducts at segment V of the liver, increased periportal thickness, and decreased echogenicity in the adjacent parenchyma (arrow) (C, D).', 'hash': 'fe01db1c98875994515d9d0f4675da88ed4deae4f3d8b30199915b2b25b37280'}, {'image_id': 'poljradiol-82-110-g006', 'image_file_name': 'poljradiol-82-110-g006.jpg', 'image_path': '../data/media_files/PMC5338872/poljradiol-82-110-g006.jpg', 'caption': 'MR imaging shows a heterogeneous hyperintense lesion with a low signal in its periphery and mildly dilated adjacent intrahepatic bile ducts at the level of segment V on coronal T2 fat-suppressed sequences.', 'hash': '09135625468137828f700699cd464fdeeeb4f869a228b32ab3f1a855b506c32e'}] | {'poljradiol-82-110-g001': ['A 48-year-old female patient was admitted to the emergency department of our hospital with complaints of abdominal pain and jaundice. Physical examination showed tenderness in the right upper quadrant and jaundice in association with no abnormal laboratory findings, except for a slight increase in the bilirubin level. The patient was referred to our department for abdominal ultrasonography (US), which revealed a 4×3 cm heterogeneous, hypoechoic lesion in the liver, adjacent to the portal hilus; cystic and solid components and millimetric calcifications were also observed (<xref ref-type="fig" rid="poljradiol-82-110-g001">Figure 1A, 1B</xref>). Intrahepatic bile ducts in the area from the portal hilus to segment V were slightly dilated with an increased periportal thickness and decreased echogenicity in the adjacent parenchyma (). Intrahepatic bile ducts in the area from the portal hilus to segment V were slightly dilated with an increased periportal thickness and decreased echogenicity in the adjacent parenchyma (<xref ref-type="fig" rid="poljradiol-82-110-g001">Figure 1C, 1D</xref>). In contrast to previous studies of ruptured hydatid cysts, an atypical heterogeneous liver mass was found, but the patient had no previous history of a hydatid cyst. A ruptured hydatid cyst was nevertheless considered because of the focal dilation of intrahepatic bile ducts and the decreased echogenicity in the periportal parenchyma. Magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) was recommended, with an initial diagnosis of primary bile duct tumor or intrabiliary ruptured hydatid cyst. Tumor markers and serology showed no abnormalities. MRI/MRCP revealed a lesion at the level of the portal hilus, which was heterogeneous and hypointense on T1A sequences as well as heterogeneous and hyperintense with low-signal areas on T2A sequences with no contrast-enhancement (). In contrast to previous studies of ruptured hydatid cysts, an atypical heterogeneous liver mass was found, but the patient had no previous history of a hydatid cyst. A ruptured hydatid cyst was nevertheless considered because of the focal dilation of intrahepatic bile ducts and the decreased echogenicity in the periportal parenchyma. Magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) was recommended, with an initial diagnosis of primary bile duct tumor or intrabiliary ruptured hydatid cyst. Tumor markers and serology showed no abnormalities. MRI/MRCP revealed a lesion at the level of the portal hilus, which was heterogeneous and hypointense on T1A sequences as well as heterogeneous and hyperintense with low-signal areas on T2A sequences with no contrast-enhancement (<xref ref-type="fig" rid="poljradiol-82-110-g002">Figures 2</xref><xref ref-type="fig" rid="poljradiol-82-110-g003" /><xref ref-type="fig" rid="poljradiol-82-110-g004" />––<xref ref-type="fig" rid="poljradiol-82-110-g005">5</xref>). A slight dilation was observed in the intrahepatic bile ducts at the level of segment V, as well as a signal change in adjacent parenchyma on T2A and contrast sequences (). A slight dilation was observed in the intrahepatic bile ducts at the level of segment V, as well as a signal change in adjacent parenchyma on T2A and contrast sequences (<xref ref-type="fig" rid="poljradiol-82-110-g005">Figures 5</xref><xref ref-type="fig" rid="poljradiol-82-110-g006" />––<xref ref-type="fig" rid="poljradiol-82-110-g007">7</xref>). A fine fistula between the mass lesion and the adjacent intrahepatic bile duct was hardly distinguishible on thinner sections (). A fine fistula between the mass lesion and the adjacent intrahepatic bile duct was hardly distinguishible on thinner sections (<xref ref-type="fig" rid="poljradiol-82-110-g007">Figure 7</xref>). In addition to these findings, US and MRI revealed a diffusely thickened gallbladder wall with pericholestatic fluid. The initial diagnosis s of intrabiliary rupture of hydatid cyst was confirmed by the surgery and pathology results.). In addition to these findings, US and MRI revealed a diffusely thickened gallbladder wall with pericholestatic fluid. The initial diagnosis s of intrabiliary rupture of hydatid cyst was confirmed by the surgery and pathology results.']} | Focal Biliary System Obstruction and Atypical Liver Mass: Intrabiliary Ruptured Cyst Hydatid Case Report | [
"Bile Ducts, Intrahepatic",
"Cholangiopancreatography, Magnetic Resonance",
"Echinococcosis, Hepatic",
"Jaundice"
] | Pol J Radiol | 1488009600 | None | null | other | PMC5338872 | null | null | [
""
] | Pol J Radiol. 2017 Feb 25; 82:110-113 | NO-CC CODE |
|
MR imaging shows a heterogeneous hyperintense lesion with a low signal in its periphery and mildly dilated adjacent intrahepatic bile ducts at the level of segment V on coronal T2 fat-suppressed sequences. | poljradiol-82-110-g006 | 7 | 09135625468137828f700699cd464fdeeeb4f869a228b32ab3f1a855b506c32e | poljradiol-82-110-g006.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
600,
500
] | [{'image_id': 'poljradiol-82-110-g005', 'image_file_name': 'poljradiol-82-110-g005.jpg', 'image_path': '../data/media_files/PMC5338872/poljradiol-82-110-g005.jpg', 'caption': 'MRCP images show a high-signal lesion, focal dilatation in the intrahepatic bile ducts, and fluid (in the right) around the gallbladder.', 'hash': 'e12d43a55ac1381761c8d4bed8848a73126c5a1732ac6745daa89002b059d8a3'}, {'image_id': 'poljradiol-82-110-g002', 'image_file_name': 'poljradiol-82-110-g002.jpg', 'image_path': '../data/media_files/PMC5338872/poljradiol-82-110-g002.jpg', 'caption': 'MR imaging shows a heterogeneous hypointense lesion at the level of the portal hilus in the liver on axial T1 fat-suppressed sequences.', 'hash': '4b4bd5b5ae3fae715a2e6e3e419eebd3bc1366f826f0f98ff6fe85dbe39a701b'}, {'image_id': 'poljradiol-82-110-g003', 'image_file_name': 'poljradiol-82-110-g003.jpg', 'image_path': '../data/media_files/PMC5338872/poljradiol-82-110-g003.jpg', 'caption': 'MR imaging shows a heterogeneous hyperintense lesion at the level of the portal hilus in the liver on axial T2 fat-suppressed sequences.', 'hash': '150e79b98ec7c8450e8ee1b8b05aeb4bdbe6402150879c1dcc64e628f62bc989'}, {'image_id': 'poljradiol-82-110-g004', 'image_file_name': 'poljradiol-82-110-g004.jpg', 'image_path': '../data/media_files/PMC5338872/poljradiol-82-110-g004.jpg', 'caption': 'MR imaging shows a heterogeneous hypointense lesion hilus in the liver on coronal T1 fat-suppressed sequences.', 'hash': '322463088b1eb6aa20fe8a580061fd5b2d4111ce6fbfb9ce022391ad597c73f1'}, {'image_id': 'poljradiol-82-110-g007', 'image_file_name': 'poljradiol-82-110-g007.jpg', 'image_path': '../data/media_files/PMC5338872/poljradiol-82-110-g007.jpg', 'caption': 'Axial and coronal contrast-enhanced fat-suppressed T1 MRI sequences show no contrast enhancement in the lesion, a fine fistula (black arrow) between the lesion and the intrahepatic bile ducts at the level of segment V, and mild dilatation in the intrahepatic bile ducts.', 'hash': 'eb4c883190be4eb83f70b48c2cfd371bbb25d7552c940dc1b63bd6b8455afb1e'}, {'image_id': 'poljradiol-82-110-g001', 'image_file_name': 'poljradiol-82-110-g001.jpg', 'image_path': '../data/media_files/PMC5338872/poljradiol-82-110-g001.jpg', 'caption': 'US examination shows a hypoechoic lesion with solid and cystic components having millimetric calcifications (arrow) at the level of the portal hilus in the liver (A, B). It also shows a mild dilation of the intrahepatic bile ducts at segment V of the liver, increased periportal thickness, and decreased echogenicity in the adjacent parenchyma (arrow) (C, D).', 'hash': 'fe01db1c98875994515d9d0f4675da88ed4deae4f3d8b30199915b2b25b37280'}, {'image_id': 'poljradiol-82-110-g006', 'image_file_name': 'poljradiol-82-110-g006.jpg', 'image_path': '../data/media_files/PMC5338872/poljradiol-82-110-g006.jpg', 'caption': 'MR imaging shows a heterogeneous hyperintense lesion with a low signal in its periphery and mildly dilated adjacent intrahepatic bile ducts at the level of segment V on coronal T2 fat-suppressed sequences.', 'hash': '09135625468137828f700699cd464fdeeeb4f869a228b32ab3f1a855b506c32e'}] | {'poljradiol-82-110-g001': ['A 48-year-old female patient was admitted to the emergency department of our hospital with complaints of abdominal pain and jaundice. Physical examination showed tenderness in the right upper quadrant and jaundice in association with no abnormal laboratory findings, except for a slight increase in the bilirubin level. The patient was referred to our department for abdominal ultrasonography (US), which revealed a 4×3 cm heterogeneous, hypoechoic lesion in the liver, adjacent to the portal hilus; cystic and solid components and millimetric calcifications were also observed (<xref ref-type="fig" rid="poljradiol-82-110-g001">Figure 1A, 1B</xref>). Intrahepatic bile ducts in the area from the portal hilus to segment V were slightly dilated with an increased periportal thickness and decreased echogenicity in the adjacent parenchyma (). Intrahepatic bile ducts in the area from the portal hilus to segment V were slightly dilated with an increased periportal thickness and decreased echogenicity in the adjacent parenchyma (<xref ref-type="fig" rid="poljradiol-82-110-g001">Figure 1C, 1D</xref>). In contrast to previous studies of ruptured hydatid cysts, an atypical heterogeneous liver mass was found, but the patient had no previous history of a hydatid cyst. A ruptured hydatid cyst was nevertheless considered because of the focal dilation of intrahepatic bile ducts and the decreased echogenicity in the periportal parenchyma. Magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) was recommended, with an initial diagnosis of primary bile duct tumor or intrabiliary ruptured hydatid cyst. Tumor markers and serology showed no abnormalities. MRI/MRCP revealed a lesion at the level of the portal hilus, which was heterogeneous and hypointense on T1A sequences as well as heterogeneous and hyperintense with low-signal areas on T2A sequences with no contrast-enhancement (). In contrast to previous studies of ruptured hydatid cysts, an atypical heterogeneous liver mass was found, but the patient had no previous history of a hydatid cyst. A ruptured hydatid cyst was nevertheless considered because of the focal dilation of intrahepatic bile ducts and the decreased echogenicity in the periportal parenchyma. Magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) was recommended, with an initial diagnosis of primary bile duct tumor or intrabiliary ruptured hydatid cyst. Tumor markers and serology showed no abnormalities. MRI/MRCP revealed a lesion at the level of the portal hilus, which was heterogeneous and hypointense on T1A sequences as well as heterogeneous and hyperintense with low-signal areas on T2A sequences with no contrast-enhancement (<xref ref-type="fig" rid="poljradiol-82-110-g002">Figures 2</xref><xref ref-type="fig" rid="poljradiol-82-110-g003" /><xref ref-type="fig" rid="poljradiol-82-110-g004" />––<xref ref-type="fig" rid="poljradiol-82-110-g005">5</xref>). A slight dilation was observed in the intrahepatic bile ducts at the level of segment V, as well as a signal change in adjacent parenchyma on T2A and contrast sequences (). A slight dilation was observed in the intrahepatic bile ducts at the level of segment V, as well as a signal change in adjacent parenchyma on T2A and contrast sequences (<xref ref-type="fig" rid="poljradiol-82-110-g005">Figures 5</xref><xref ref-type="fig" rid="poljradiol-82-110-g006" />––<xref ref-type="fig" rid="poljradiol-82-110-g007">7</xref>). A fine fistula between the mass lesion and the adjacent intrahepatic bile duct was hardly distinguishible on thinner sections (). A fine fistula between the mass lesion and the adjacent intrahepatic bile duct was hardly distinguishible on thinner sections (<xref ref-type="fig" rid="poljradiol-82-110-g007">Figure 7</xref>). In addition to these findings, US and MRI revealed a diffusely thickened gallbladder wall with pericholestatic fluid. The initial diagnosis s of intrabiliary rupture of hydatid cyst was confirmed by the surgery and pathology results.). In addition to these findings, US and MRI revealed a diffusely thickened gallbladder wall with pericholestatic fluid. The initial diagnosis s of intrabiliary rupture of hydatid cyst was confirmed by the surgery and pathology results.']} | Focal Biliary System Obstruction and Atypical Liver Mass: Intrabiliary Ruptured Cyst Hydatid Case Report | [
"Bile Ducts, Intrahepatic",
"Cholangiopancreatography, Magnetic Resonance",
"Echinococcosis, Hepatic",
"Jaundice"
] | Pol J Radiol | 1488009600 | None | null | other | PMC5338872 | null | null | [
""
] | Pol J Radiol. 2017 Feb 25; 82:110-113 | NO-CC CODE |
|
Lateral view of the right cerebral hemisphere. The lateral ventricle has been opened so the hippocampus proper is fully exposed and the caudate nucleus has been removed from the cranial floor of the lateral ventricle. T (thalamus), HP (hippocampus proper). | june-9-43f2 | 7 | 1a313989d998508178533c69355dcad08545b71508eaa10ce8272957112d37b9 | june-9-43f2.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
704,
429
] | [{'image_id': 'june-9-43f2', 'image_file_name': 'june-9-43f2.jpg', 'image_path': '../data/media_files/PMC3597426/june-9-43f2.jpg', 'caption': 'Lateral view of the right cerebral hemisphere. The lateral ventricle has been opened so the hippocampus proper is fully exposed and the caudate nucleus has been removed from the cranial floor of the lateral ventricle. T (thalamus), HP (hippocampus proper).', 'hash': '1a313989d998508178533c69355dcad08545b71508eaa10ce8272957112d37b9'}, {'image_id': 'june-9-43f4', 'image_file_name': 'june-9-43f4.jpg', 'image_path': '../data/media_files/PMC3597426/june-9-43f4.jpg', 'caption': 'The lateral ventricles have been completely opened to provide a dorsal view of the hippocampus proper and the caudate nucleus. HP (hippocampus proper), CN (caudate nucleus), CF (crus of the fornix), B (body of the fornix).', 'hash': 'a02dfb81c152f16601a18a03f63fd51922d89248295fa51de2987d4b173aa6a3'}, {'image_id': 'june-9-43f3', 'image_file_name': 'june-9-43f3.jpg', 'image_path': '../data/media_files/PMC3597426/june-9-43f3.jpg', 'caption': 'Dorsal view of the hippocampus proper within the lateral ventricle. HP (hippocampus proper), CN (caudate nucleus), CP (Choroid plexus).', 'hash': '4cc24748b8cadd24363f485f37f600a8f7576fbac73f57f9270fe824e746dad7'}, {'image_id': 'june-9-43f1', 'image_file_name': 'june-9-43f1.jpg', 'image_path': '../data/media_files/PMC3597426/june-9-43f1.jpg', 'caption': 'Lateral portion of the right cerebral hemisphere has been partially removed so the hippocampus proper (HP), thalamus and fimbria are partially exposed.', 'hash': 'ce971adf20ab6851d441a2f427d4983897966a2285f9a0efce5df6cc3af8f666'}] | {'june-9-43f1': ['To expose the hippocampus proper from the lateral aspect, the pyriform lobe on the lateral side of either the right or left cerebral hemisphere was identified. Then using a sharp smooth-edged knife, thin slices approximately 1–2 centimeters thick were sliced off the end of the pyriform lobe until the rounded end of the hippocampus proper could be seen. At this point, a pair of curved scissors was used to continue removing the pyriform lobe and exposing the ventral most portion of the hippocampus proper. At this point, thin sections of the lateral side of the cerebral hemisphere from the occipital to the temporal lobe were removed until the caudal portion of the lateral ventricle was opened and the arched portion of the hippocampus proper was exposed (<xref ref-type="fig" rid="june-9-43f1">Figure 1</xref>). However, care must be taken when removing this region of the cerebral hemisphere because it is very easy to inadvertently slice off a portion of the hippocampus proper with the cerebral hemisphere. Once this step is completed the hippocampus proper from its ventral most portion within the pyriform lobe to the arched portion within the caudal portion of the lateral ventricle was exposed. The fimbria, beginning of the crus of the fornix and the thalamus will also be exposed at this point. To expose the remainder of the hippocampus proper and the crus of the fornix, curved scissors or a small scalpel were used to continue removing thin sections from the temporal and frontal lobes along with a significant portion of the caudate nucleus (). However, care must be taken when removing this region of the cerebral hemisphere because it is very easy to inadvertently slice off a portion of the hippocampus proper with the cerebral hemisphere. Once this step is completed the hippocampus proper from its ventral most portion within the pyriform lobe to the arched portion within the caudal portion of the lateral ventricle was exposed. The fimbria, beginning of the crus of the fornix and the thalamus will also be exposed at this point. To expose the remainder of the hippocampus proper and the crus of the fornix, curved scissors or a small scalpel were used to continue removing thin sections from the temporal and frontal lobes along with a significant portion of the caudate nucleus (<xref ref-type="fig" rid="june-9-43f2">Figure 2</xref>).).'], 'june-9-43f3': ['To provide the students with a dorsal view of the hippocampus proper and some of the associated structures, a sharp smooth edged knife was used to remove horizontal slices (1–2 centimeters thick) of the cerebral hemispheres from the occipital lobe to the frontal lobe. This process opens a small window into the caudal most portion of the lateral ventricle within both cerebral hemispheres. At this point using a small scalpel or curved scissors, the opening into the lateral ventricle was lengthened so that the entire dorsal surface of the hippocampus proper was fully exposed along with a portion of the choroid plexus and caudate nucleus (<xref ref-type="fig" rid="june-9-43f3">Figure 3</xref>).).'], 'june-9-43f4': ['The next step after exposing the dorsal surface of the hippocampus proper was widening the opening so that the caudate nucleus, crura of the fornix and body of the fornix were more visible. To accomplish this, forceps were used to gently remove the choroid plexus from each lateral ventricle. Then a small scalpel was used to remove thin horizontal sections from each internal capsule until the head and body of the caudate nucleus was exposed and the crura could be easily identified on the lateral side of each hippocampus proper (<xref ref-type="fig" rid="june-9-43f4">Figure 4</xref>). During this step, it is very important that attention be paid to the close proximity of the caudate nucleus and the internal capsule and thin sections be gradually removed in order to avoid damage to the caudate nucleus. Then a fine pair of scissors were used to trim the corpus callosum and the septum pellucidum so that the crura of the fornix could be seen converging into the body of the fornix (). During this step, it is very important that attention be paid to the close proximity of the caudate nucleus and the internal capsule and thin sections be gradually removed in order to avoid damage to the caudate nucleus. Then a fine pair of scissors were used to trim the corpus callosum and the septum pellucidum so that the crura of the fornix could be seen converging into the body of the fornix (<xref ref-type="fig" rid="june-9-43f4">Figure 4</xref>).).']} | Dissection of the Hippocampus Proper and the Associated Structures in Preserved Horse Brains | [
"hippocampus proper",
"fimbria",
"fornix",
"limbic system",
"neuroanatomy specimen"
] | J Undergrad Neurosci Educ | 1287126000 | This article describes a neuroscience outreach program developed by college undergraduates and aimed at second graders. Over a period of four weeks, twenty-five Denison students enrolled in a non-majors course on gender and the brain visited twenty-four second grade classrooms to engage a total of 464 students. We had a mission to both promote college awareness and to specifically bring some brain science into the classroom. The desire to engage students with the brain was in part a wish to celebrate brain awareness week and in part a wish to follow a feminist tenet of bridging theory and practice via activism. The college students chose six activities: a brain puzzle, a sock content guessing game, a jelly bean olfaction and taste test, mystery noises, a message transmission game, and a version of tag. During our outreach with the second graders, my students monitored student engagement and compared engagement between male and female second graders. Engagement was high for nearly all activities but girls were more engaged than boys during the brain puzzle and jelly bean activities. Effect sizes measured as Cohen's "d" statistics were small to large (0.2 to 0.93). The other four activities (mystery socks, mystery noises, message transmission and neuron chain tag) showed no difference in engagement between male and female second graders. Our program benefited the Denison students as well, introducing many to community involvement and awakening in them an interest in teaching or working with kids. | [] | other | PMC3597426 | null | 15 | [
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"{'Citation': 'Mead KS. Sex, gender, and the brain: a non-majors course linking neuroscience and women’s studies. J Undergrad Neurosci Educ. 2009;8:A5–A9.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3592696'}, {'@IdType': 'pubmed', '#text': '23493514'}]}}",
"{'Citation': 'Ruble DN, Martin CL, Berenbaum SA. Gender development. In: Eisenburg N, editor. Handbook of child psychology. Volume 3. Social, emotional, and personality development. 6th ed. New York: Wiley; 2006. pp. 858–932.'}",
"{'Citation': 'Sandberg DE, Meyer-Bahlburg HF, Ehrhardt AA, Yager TJ. The prevalence of gender-atypical behavior in elementary school children. J Am Acad Child Adolesc Psychiatry. 1993;32:306–314.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8444758'}}}",
"{'Citation': 'Snow ME, Jacklin CN, Maccoby EE. Sex of child differences in father-child interaction at one year of age. Child Dev. 1983;54:227–232.'}",
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] | J Undergrad Neurosci Educ. 2010 Oct 15; 9(1):A43-A46 | NO-CC CODE |
|
(A) A 17-year-old boy with an asymmetric nasopharynx mass which extends to the right parapharyngeal (arrow head) and masticator area (arrow) and which involves the right half of the clivus (star) (case 1) and which is monitored in the hyperintense signal characteristics on T2-weighted images compared to the muscle. (B) Extension of the mass to the nasal cavity and oropharynx posterior wall in sagittal T2-weighted images with clivus destruction is (arrow). | poljradiol-80-555-g002 | 7 | d878a55284c4159d018f4110033538b3cda51cc5fcef86b4080797f8559e6181 | poljradiol-80-555-g002.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
720,
332
] | [{'image_id': 'poljradiol-80-555-g001', 'image_file_name': 'poljradiol-80-555-g001.jpg', 'image_path': '../data/media_files/PMC4694707/poljradiol-80-555-g001.jpg', 'caption': '(A) A 15-year-old girl admitted to hospital with bilateral cervical swelling (case 8). A nasopharyngeal mass lesion which extended to the right posterior region of the nasal cavity (star) and the left masseter space (arrow), hyperintense compared to the muscle on axial T1-weighted images. (B) The mass which is hyperintense compared to the muscle and hypointense compared to the cerebellar gray matter on T2-weighted images spreads to the left pterygopalatine fossa and masseter space (arrow). Pterigoid muscles hyperintense on T2-weighted images (star). Signal changes consistent with mastoiditis are observed on both sides. (C) The mass showing homogenous enhancement on a post-contrast axial T1-weighted image extends to the parapharyngeal area on both sides by obliterating both lateral recesses (star). (D) A sagittal T2-weighted image shows sphenoid sinus invasion of the mass (arrow). (E) Bilaterally enlarged level IIA and Va lymph nodes observed on sagittal STIR sequence.', 'hash': 'b566cd6084a376cf490e88be8cab1df4f4e2efc902a57a3b49e77d0afb7c64ef'}, {'image_id': 'poljradiol-80-555-g004', 'image_file_name': 'poljradiol-80-555-g004.jpg', 'image_path': '../data/media_files/PMC4694707/poljradiol-80-555-g004.jpg', 'caption': '(A) In lumbar MR images of a 17-year-old male patient with nasopharynx cancer, mass lesions at L1 and L4 vertebral corpora which are hypointense on T1-weighted images, and (B) minimal enhancement observed after contrast administration.', 'hash': 'f3036b0dc099af2e4448c1f9723476d27f588dcee88767bcf2b3acbd47b7833b'}, {'image_id': 'poljradiol-80-555-g003', 'image_file_name': 'poljradiol-80-555-g003.jpg', 'image_path': '../data/media_files/PMC4694707/poljradiol-80-555-g003.jpg', 'caption': 'A 7-year-old boy with a huge nasopharyngeal mass (case 10) extending to the sphenoid/ethmoid sinus (star) on the anterior side, to the left orbit (arrow head) and prepontine cystern (blue arrow) on the posterior side, cavernous sinus, and the middle fossa (arrow head) on the lateral side. Carotid encasement is also seen (white arrow). The mass is slight hyperintense compared to the muscle on T1-weighted images (A) and showing intense homogenous enhancement after contrast administration (B).', 'hash': 'a4f9ee6ac2830724e0a3c4d72e6b41387a3fd7b2bf21d851f603b74c6ba7008c'}, {'image_id': 'poljradiol-80-555-g002', 'image_file_name': 'poljradiol-80-555-g002.jpg', 'image_path': '../data/media_files/PMC4694707/poljradiol-80-555-g002.jpg', 'caption': '(A) A 17-year-old boy with an asymmetric nasopharynx mass which extends to the right parapharyngeal (arrow head) and masticator area (arrow) and which involves the right half of the clivus (star) (case 1) and which is monitored in the hyperintense signal characteristics on T2-weighted images compared to the muscle. (B) Extension of the mass to the nasal cavity and oropharynx posterior wall in sagittal T2-weighted images with clivus destruction is (arrow).', 'hash': 'd878a55284c4159d018f4110033538b3cda51cc5fcef86b4080797f8559e6181'}] | {'poljradiol-80-555-g001': ['All the patients had masses that narrowed the nasopharyngeal air column. Unilateral mastoid opacification was observed in all cases (<xref ref-type="fig" rid="poljradiol-80-555-g001">Figure 1A, 1B</xref>). In 6 cases (80%), the mass extended into the nasal cavity and 2 cases of the mass extended into both the nasal cavity and the oropharyngeal posterior wall (). In 6 cases (80%), the mass extended into the nasal cavity and 2 cases of the mass extended into both the nasal cavity and the oropharyngeal posterior wall (<xref ref-type="fig" rid="poljradiol-80-555-g002">Figure 2B</xref>). In 9 cases (90%), there was an parapharyngeal extension (). In 9 cases (90%), there was an parapharyngeal extension (<xref ref-type="fig" rid="poljradiol-80-555-g001">Figures 1C</xref>, , <xref ref-type="fig" rid="poljradiol-80-555-g002">2A</xref>). In 5 cases (50%), there was an involvement of the skull base (). In 5 cases (50%), there was an involvement of the skull base (<xref ref-type="fig" rid="poljradiol-80-555-g003">Figure 3A, 3B</xref>). In 3 patients (30%), there was an extension into the masticator space (). In 3 patients (30%), there was an extension into the masticator space (<xref ref-type="fig" rid="poljradiol-80-555-g001">Figure 1A</xref>, , <xref ref-type="fig" rid="poljradiol-80-555-g002">2A</xref>) and the pterygopalatine fossa () and the pterygopalatine fossa (<xref ref-type="fig" rid="poljradiol-80-555-g001">Figure 1B</xref>). In 2 cases (20%), there was cavernous sinus invasion and carotid encasement (). In 2 cases (20%), there was cavernous sinus invasion and carotid encasement (<xref ref-type="fig" rid="poljradiol-80-555-g003">Figure 3A, 3B</xref>). In 5 cases (50%), there was sphenoid sinus invasion and clivus involvement (). In 5 cases (50%), there was sphenoid sinus invasion and clivus involvement (<xref ref-type="fig" rid="poljradiol-80-555-g001">Figure 1D</xref>, , <xref ref-type="fig" rid="poljradiol-80-555-g002">2B</xref>). In 10 cases (100%), there was bilateral cervical lymph node enlargement (). In 10 cases (100%), there was bilateral cervical lymph node enlargement (<xref ref-type="fig" rid="poljradiol-80-555-g001">Figure 1E</xref>). In 4 cases (40%), lateral retropharyngeal lymph node was detected. Only one case had cervical lymphadenopathy which was 7 cm in greatest dimension. The others were smaller than 6 cm in greatest dimension. The supraclavicular lymph node was not detected. All of the cases had level VA lymph node, nine of them had level IIB lymp node, two of them had level IIA (case 8 and 10) and one of them had level III lymph node (case 8).). In 4 cases (40%), lateral retropharyngeal lymph node was detected. Only one case had cervical lymphadenopathy which was 7 cm in greatest dimension. The others were smaller than 6 cm in greatest dimension. The supraclavicular lymph node was not detected. All of the cases had level VA lymph node, nine of them had level IIB lymp node, two of them had level IIA (case 8 and 10) and one of them had level III lymph node (case 8).'], 'poljradiol-80-555-g004': ['Three patient had distant metastases. While there was bone metastasis in 3 cases (30%), 1 patient had lung metastasis (10%) (case 5). One patient had tibia and right ileum metastases (case 5), one patient had lumbar vertebra and ileum metastases (case8), one patient had humerus and femur metastases. Bone metastases were lytic metastases in T1-hypointense, T2-hyperintense and post-contrast images and showed minimal enhancement (<xref ref-type="fig" rid="poljradiol-80-555-g004">Figure 4A, 4B</xref>). In 1 patient, there was a solid parenchymal nodule in the lung (case5).). In 1 patient, there was a solid parenchymal nodule in the lung (case5).']} | Magnetic Resonance Imaging Findings in Childhood Period Nasopharynx Cancer | [
"Magnetic Resonance Imaging",
"Nasopharyngeal Neoplasms",
"Nasopharynx"
] | Pol J Radiol | 1451030400 | [{'@Label': 'BACKGROUND AND OBJECTIVES', '@NlmCategory': 'OBJECTIVE', '#text': 'The oprD mutation and AmpC overproduction are the main mechanisms of intrinsic resistance to carbapenems such as imipenem and meropenem in Pseudomonas aeruginosa.'}, {'@Label': 'MATERIALS AND METHODS', '@NlmCategory': 'METHODS', '#text': 'In this study, we investigated intrinsic resistance to carbapenems including mutation of oprD and AmpC overproduction in a carbapenem-resistant P. aeruginosa isolated from a burn patient by phenotypic and molecular methods.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'In our study, the carbapenem-resistant P. aeruginosa isolate was resistant to imipenem, meropenem, cefepime, gentamicin, ceftriaxone, carbenicillin, aztreonam and ciprofloxacin but was susceptible to ceftazidime and polymyxin B. The minimum inhibitory concentrations (MICs) against imipenem, meropenem and ceftazidime were 64 μg/ml, 16 μg/ml and 2μg/ml, respectively. The isolate was ESBLs and AmpC overproducer. No carbapenemase activity was detected by Modified Hodge test (MHT). This isolate was carrying only bla OXA-10 . PCR amplification and sequencing of oprD performed on isolate resulted in PCR product of 2647bp. Sequence analysis of the 2647bp product revealed insertion of a sequence of 1232 bp at position 8 in coding region of oprD.'}, {'@Label': 'CONCLUSION', '@NlmCategory': 'CONCLUSIONS', '#text': 'According to the results of this study, oprD mutation and AmpC overproduction can cause the main mechanism of resistance of P. aeruginosa to carbapenems.'}] | [] | other | PMC4694707 | null | 15 | [
"{'Citation': 'Fadeyibi OI, Raji MA, Ibrahim NA, Ugburo AO, Ademiluyi S. Bacteriology of infected burn wounds in the burn wards of a teaching hospital in Southwest Nigeria. Burns 2013; 39: 168– 173.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '22386976'}}}",
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"{'Citation': 'Diene MS, L’homme T, Bellulo S, Stremler N, Dubus JC, Mely L, et al. ISPa46, a novel insertion sequence in the oprD porin gene of an imipenem-resistant Pseudomonas aeruginosa isolate from a cystic fibrosis patient in Marseille, France. Int J Antimicrob Agents 2013; 42: 268– 271.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '23880169'}}}",
"{'Citation': 'Doi Y, Paterson LD. Detection of plasmid-mediated class C β-lactamases. Int J Infect Dis 2007; 11: 191– 197.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17339123'}}}",
"{'Citation': 'Willems E, Verhaegen J, Magerman K, Nys S, Cartuyvels R. Towards a phenotypic screening strategy for emerging β-lactamase in Gram-negative bacilli. Int J Antimicrob Agents 2013; 41: 99– 109.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '23280443'}}}",
"{'Citation': 'Mahon CR, Lehman DC, Manuselis G. Text book of diagnostic microbiology. 3rd ed Philadelphia, PA, USA; 2007; 564– 86.'}",
"{'Citation': 'Clinical and Laboratory Standards Institute Performance standards for antimicrobial susceptibility testing. Twenty-Third Inform Suppl. 2013; 33(1): M100– S23.'}",
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] | Pol J Radiol. 2015 Dec 25; 80:555-560 | NO-CC CODE |
|
Chest computed tomography (postoperative day 22) revealing bilateral ground glass opacity. (A) Transverse plane. (B) Coronal plane. | gr3_lrg | 7 | 9ab278541d1df019ef821648e79368d66605056b52f9a8af08570e42a840c0ed | gr3_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
759,
337
] | [{'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC8285367/gr3_lrg.jpg', 'caption': 'Chest computed tomography (postoperative day 22) revealing bilateral ground glass opacity. (A) Transverse plane. (B) Coronal plane.', 'hash': '9ab278541d1df019ef821648e79368d66605056b52f9a8af08570e42a840c0ed'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC8285367/gr2_lrg.jpg', 'caption': 'Chest roentgenogram on (A) postoperative day 1 and (B) postoperative day 7.', 'hash': 'a8774b2ba2fabe8f2fb203c95fc924165a749798a4b86b440779f982d9c3579a'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC8285367/gr1_lrg.jpg', 'caption': 'Biochemical analysis. (CRP, C-reactive protein; LDH, lactate dehydrogenase; mcg, microgram; PCR, polymerase chain reaction; POD, postoperative day; TBC, thrombocytes; U, units.)', 'hash': '92103c501a6e9c2146a0af38803ef24d075c0382dfbf8e6ebc0e12ae75b3f46c'}] | {'gr1_lrg': ['A 60-year-old male patient with lamin A/C gene mutation causing atrioventricular conduction pathology with subsequent tachy-arrhythmia evolved towards terminal heart failure and was listed for heart transplantation. A suitable donor was found, COVID-19 screening through polymerase chain reaction for both donor and recipient was negative. An uneventful orthotopic heart transplantation (HTX) was performed, with a total ischemia time of 147 minutes. Postoperative echocardiography revealed a good biventricular function, with a trace of mitral and tricuspid valve regurgitation, and a pulmonary pressure of 25 mm Hg. According to institutional protocol, mycophenolate mofetil (1 g) and methylprednisolone (250 mg after induction and 250 mg during reperfusion) was administered intraoperatively. On the intensive care unit, antithymocyte globulin was started 12 hours after surgery (2-3 mg/kg) together with mycophenolate mofetil (1 g/12 h). Methylprednisolone was continued 8 hours after induction (125 mg/8 h). Because of renal insufficiency, initiation of tacrolimus was delayed. The patient was extubated on the second postoperative day (POD), and received 3 L/min oxygen with nasal cannula. One day later, kidney function improved and tacrolimus was started. On POD 6, there was a rise in body temperature to 37.8°C. Escherichia coli and Klebsiella pneumoniae was cultured from the mouth swab and antibiotics (amoxicillin with clavulanic acid) were started. A new COVID-19 test was positive. Respiratory deterioration with tachypnea was treated with noninvasive positive pressure ventilation (NIPPV). Serial biochemical analysis is shown in <xref rid="gr1_lrg" ref-type="fig">Figure\xa01</xref>\n. Additionally, remdesivir was given for 10 days. Because of thrombopenia, antithymocyte globulin was stopped. On POD 11, 5 days after COVID-19 diagnosis, NIPPV could be stopped. On POD 13, the patient was discharged from the intensive care unit and sent to a step-down respiratory unit for COVID-19 patients. His clinical condition improved further. However, on POD 22, 16 days after the COVID-19 diagnosis, we observed a new respiratory deterioration, with lower saturation levels and the need for NIPPV. Subsequent chest computed tomography showed bilateral ground glass opacification with multilobar involvement (\n. Additionally, remdesivir was given for 10 days. Because of thrombopenia, antithymocyte globulin was stopped. On POD 11, 5 days after COVID-19 diagnosis, NIPPV could be stopped. On POD 13, the patient was discharged from the intensive care unit and sent to a step-down respiratory unit for COVID-19 patients. His clinical condition improved further. However, on POD 22, 16 days after the COVID-19 diagnosis, we observed a new respiratory deterioration, with lower saturation levels and the need for NIPPV. Subsequent chest computed tomography showed bilateral ground glass opacification with multilobar involvement (<xref rid="gr2_lrg" ref-type="fig">Figure\xa02</xref>\n). The computed tomography severity score index was 10 out of 25.\n). The computed tomography severity score index was 10 out of 25.5 A new polymerase chain reaction test remained positive, no immunoglobulin G antibodies were found. Therefore, remdesivir was readministered. His clinical condition did not show improvement, however, with ongoing need for noninvasive ventilation. Five days later, after careful deliberation within the team, convalescent plasma was given. The evolution was favorable and 2 weeks later, the patient could be discharged to a medical rehabilitation unit. Six months after HTX, the patient shows a satisfactory clinical condition, with a normal biventricular function and increasing respiratory capacity, enabling resumption of work.Figure\xa01Biochemical analysis. (CRP, C-reactive protein; LDH, lactate dehydrogenase; mcg, microgram; PCR, polymerase chain reaction; POD, postoperative day; TBC, thrombocytes; U, units.)Figure\xa02Chest roentgenogram on (A) postoperative day 1 and (B) postoperative day 7.'], 'gr3_lrg': ['The clinical course of our patient revealed 2 distinct phases. Infection was confirmed on POD 6, with low-grade fever and moderate respiratory symptoms. Improvement was seen with NIPPV and remdesivir. A second, clinically more serious phase was seen on POD 22, with multilobar involvement on computed tomography (<xref rid="gr3_lrg" ref-type="fig">Figure\xa03</xref>\n). After 5 days of remdesivir without clinical improvement, it was decided to administer convalescent plasma. The evidence for efficacy of convalescent plasma was low, but a recent study confirmed reduction of disease progression in older patients.\n). After 5 days of remdesivir without clinical improvement, it was decided to administer convalescent plasma. The evidence for efficacy of convalescent plasma was low, but a recent study confirmed reduction of disease progression in older patients.8 Our report suggests possible benefit of this strategy in immunocompromised HTX patients. This patient did not need invasive mechanical ventilation and showed a full recovery.Figure\xa03Chest computed tomography (postoperative day 22) revealing bilateral ground glass opacity. (A) Transverse plane. (B) Coronal plane.']} | Heart Transplantation Complicated by COVID-19 Infection | null | Ann Thorac Surg | 1650178800 | None | null | other | PMC8285367 | null | null | [
""
] | Ann Thorac Surg. 2022 Apr 17; 113(4):e267-e269 | NO-CC CODE |
|
Sinusitis in patient with COVID-19. Interim FDG-PET/CT in this 79-year-old male with diffuse large B-cell lymphoma and COVID-19 pneumonia demonstrated new FDG-avid mucosal thickening and secretions in the maxillary sinuses. | gr4_lrg | 7 | 0db1afd22a4ba3cae87f63f4fbe5e1ce213fba1e955b4a8c73c955fd6a174401 | gr4_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
677,
754
] | [{'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC10081937/gr2_lrg.jpg', 'caption': 'Subacute thyroiditis. Thyroid scan in a 52-year-old male demonstrating diffusely low technetium-99\xa0m pertechnetate uptake in the thyroid gland 2\xa0months after COVID-19 infection. This patient had new suppression of TSH. The imaging and laboratory findings suggested subacute thyroiditis.', 'hash': '226b0c207762fe20590d0fc7dd04bde06229aa9ad663c0452eaa070eccceb5e9'}, {'image_id': 'gr6_lrg', 'image_file_name': 'gr6_lrg.jpg', 'image_path': '../data/media_files/PMC10081937/gr6_lrg.jpg', 'caption': 'Radiation recall pneumonitis following COVID-19 vaccination. A) Axial fused PET/CT image in a 67-year-old male with lung adenocarcinoma 4\xa0days after receiving the 2nd dose of the mRNA-1273 vaccine demonstrates FDG-avid right subpectoral lymph nodes (arrowheads), FDG uptake in the right deltoid muscle (not shown) and FDG-avid consolidative opacities in the right upper and paramediastinal left upper lobes (arrows). B) FDG-PET/CT 2\xa0months before when these findings were not present. C) Treatment plan of intensity modulated radiation therapy (IMRT) completed 19\xa0months before presentation.', 'hash': '6bb7a72bdb59778737f1972fb3353f3bf4e8d7e0b92c2e662ad76169dcc306c9'}, {'image_id': 'gr11_lrg', 'image_file_name': 'gr11_lrg.jpg', 'image_path': '../data/media_files/PMC10081937/gr11_lrg.jpg', 'caption': 'Panniculitis in patient with COVID-19. Fused axial FDG-PET/CT images in a 68-year-old male with melanoma and COVID-19 pneumonia who developed FDG-avid lung consolidative opacities (arrow), as well as multifocal areas of intense FDG uptake in the subcutaneous tissues of the torso (arrowheads), correlating with areas of fat stranding on CT, in keeping with panniculitis.', 'hash': 'e2f7a0983f6345b904684b5e4e8b6b3452231362f0b60331fe5ea1b8ea1d5c3c'}, {'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC10081937/gr3_lrg.jpg', 'caption': 'Tonsillitis and COVID-19 pneumonia. FDG-PET/CT axial fused images of a 61-year-old male with history of esophageal cancer and COVID-19. There is intense FDG uptake in the palatine tonsils (arrowheads). There were also FDG-avid subpleural ground glass opacities (arrows).', 'hash': '2d799b3d8153f242d4c1d25018b347cbc08d81af8688140f6be64122291e43cf'}, {'image_id': 'gr7_lrg', 'image_file_name': 'gr7_lrg.jpg', 'image_path': '../data/media_files/PMC10081937/gr7_lrg.jpg', 'caption': 'Pulmonary embolism and COVID-19 pneumonia. FDG-PET/CT of a 64-year-old male with marginal zone lymphoma demonstrated FDG-avid subpleural consolidative and ground glass opacities (arrowheads, left image), as well as FDG uptake in the right lower lobar artery (arrow, left image), with corresponding filling defect noted on contrast-enhanced CT 4\xa0days before (arrow, right image), consistent with acute pulmonary embolism, which also involved additional pulmonary arterial branches bilaterally.', 'hash': 'be6299eeb6923bdf19bdb9cfb127e02cd8ab8493002f11606134bbbe6f3a02ad'}, {'image_id': 'gr10_lrg', 'image_file_name': 'gr10_lrg.jpg', 'image_path': '../data/media_files/PMC10081937/gr10_lrg.jpg', 'caption': 'Deltoid uptake in following COVID-19 vaccination. FDG-PET/CT axial fused and sagittal MIP images of a 49-year-old female with history of metastatic breast cancer demonstrating characteristic elongated uptake in the left deltoid muscle 2\xa0days after administration of the third mRNA-1273 vaccine dose (arrows).', 'hash': 'cb5919c53c9e6eca4fca7bdee12d3a570c1f27a698f2a717bfa0e7a65d319b55'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC10081937/gr1_lrg.jpg', 'caption': 'Frontal cortical hypometabolism. 73-year-old male complaining of cognitive impairment after being hospitalized with severe COVID-19 pneumonia in the preceding year. Axial FDG-PET image demonstrated hypometabolism in the left greater than right frontal lobes (arrows).', 'hash': '999b7c800cf9c032b07ae03c030632ccc4ff75f100d45f5e0a6c0325d404fcde'}, {'image_id': 'gr5_lrg', 'image_file_name': 'gr5_lrg.jpg', 'image_path': '../data/media_files/PMC10081937/gr5_lrg.jpg', 'caption': 'COVID-19 pneumonia on PSMA-PET. MIP (left), axial fused (top right) and CT lung reconstruction (bottom right) images of F18-piflufolastat-PET/CT in a 76-year-old male with metastatic prostate cancer and COVID-19 pneumonia. There were extensive tracer-avid subpleural consolidative opacities in both lungs (arrows). PSMA-avid abdominal lymph nodes represented metastatic prostate cancer.', 'hash': 'c70f3d2fb20d6b16bf6d74b62aad298fd362ea99f0261a96dedba36c010b738d'}, {'image_id': 'gr9_lrg', 'image_file_name': 'gr9_lrg.jpg', 'image_path': '../data/media_files/PMC10081937/gr9_lrg.jpg', 'caption': 'Hypermetabolic lymphadenopathy following COVID vaccination. A) MIP and axial fused images of a 73-year-old female with lung adenocarcinoma demonstrating 18F-FDG-avid left axillary lymphadenopathy 3\xa0days after receiving the second mRNA-1273 vaccine dose on the left arm. B) MIP and axial fused images of a 57-year-old female with well-differentiated appendiceal neuroendocrine tumor and 68Ga-DOTATATE-avid right axillary lymphadenopathy 7\xa0days after receiving the second BNT162b2 mRNA vaccine dose on the right arm. C) MIP and axial fused images of a 63-year-old male with recently diagnosed prostate cancer presenting with 18F-fluciclovine-avid right axillary lymphadenopathy 3\xa0days after receiving the third dose of mRNA-1273 vaccine on the right arm.', 'hash': 'c9b5c075d738d278238f30a879fc60ce0bdd6edfbc17c4be48d463f21d0f41c5'}, {'image_id': 'gr8_lrg', 'image_file_name': 'gr8_lrg.jpg', 'image_path': '../data/media_files/PMC10081937/gr8_lrg.jpg', 'caption': 'COVID-19 and pulmonary embolism. 72-year-old female who presented to the ED with shortness of breath and tested positive for SARS-CoV-2. Chest radiograph confirmed multifocal airspace opacification predominantly involving the peripheral right lung and lower left lung. Due to an extremely elevated D-dimer (>20\xa0μg/mL) and renal insufficiency, a V/Q scan was ordered. Given that the patient had COVID-19, only perfusion imaging was obtained. Anterior and LAO projections demonstrated a wedge-shaped perfusion defect in the left midlung (black arrows), corresponding to an area which was relatively spared of opacification in the radiograph when compared to the rest of the lung parenchyma.', 'hash': 'cd816623f066064c4cc67f394d8d509577cd1b686160eb42313f261678caf9b2'}, {'image_id': 'gr4_lrg', 'image_file_name': 'gr4_lrg.jpg', 'image_path': '../data/media_files/PMC10081937/gr4_lrg.jpg', 'caption': 'Sinusitis in patient with COVID-19. Interim FDG-PET/CT in this 79-year-old male with diffuse large B-cell lymphoma and COVID-19 pneumonia demonstrated new FDG-avid mucosal thickening and secretions in the maxillary sinuses.', 'hash': '0db1afd22a4ba3cae87f63f4fbe5e1ce213fba1e955b4a8c73c955fd6a174401'}] | {'gr1_lrg': ['Brain metabolism abnormalities have also been observed on 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in association with COVID-19. Imaging findings during the acute phase of COVID-19 include orbitofrontal cortical hypometabolism associated with anosmia12, as well as frontal lobe hypometabolism and cerebellar hypermetabolism in encephalopathic patients 13. In patients with cognitive impairment in the subacute stage of COVID-19, Hosp et al. found that FDG-PET scans yielded abnormal results in two-thirds of cases, with the predominant finding being frontoparietal hypometabolism 14. Furthermore, Guedj et al. reported hypometabolism in multiple brain regions on FDG-PET, including the olfactory gyrus, hippocampus, and cerebellum in patients with persistent functional complaints >3\xa0weeks after their first symptoms of COVID-1915. Similar patterns of hypometabolism were also found in pediatric patients 16. The long-term evolution of these findings remains unclear. In a longitudinal study where patients were explored thrice with brain FDG-PET/CT (acute phase, at 1\xa0month and 6\xa0months after COVID-19 onset), some patients returned to normal brain metabolism, while frontal hypometabolism persisted in others at 6\xa0months 17 (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>\n).\n).Fig. 1Frontal cortical hypometabolism. 73-year-old male complaining of cognitive impairment after being hospitalized with severe COVID-19 pneumonia in the preceding year. Axial FDG-PET image demonstrated hypometabolism in the left greater than right frontal lobes (arrows).Fig. 1'], 'gr2_lrg': ['Subacute thyroiditis is an inflammatory disorder causing thyrotoxicosis often associated with viral infection19. It is a recognized complication of COVID-19, which can be frequently difficult to diagnose clinically due to the absence of classic symptoms such as neck tenderness 20. Subacute thyroiditis may be incidentally detected on FDG-PET/CT. Thyroid scintigraphy is useful in the evaluation of thyrotoxicosis to differentiate subacute thyroiditis, including that manifest from COVID-19, from Graves\' disease (<xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>\n).\n).Fig. 2Subacute thyroiditis. Thyroid scan in a 52-year-old male demonstrating diffusely low technetium-99\xa0m pertechnetate uptake in the thyroid gland 2\xa0months after COVID-19 infection. This patient had new suppression of TSH. The imaging and laboratory findings suggested subacute thyroiditis.Fig. 2'], 'gr3_lrg': ['Upper respiratory tract symptoms such as rhinorrhea, sneezing and sore throat are common symptoms of COVID-19. These symptoms are more frequently seen with the Omicron variant 25. For this reason, in January 2022 the Society of Nuclear Medicine and Molecular Imaging (SNMMI) issued a statement highlighting a characteristic pattern of FDG uptake on PET/CT with Omicron infections: prominent, symmetric uptake throughout the nasopharynx, oropharynx, and tonsils, with or without associated FDG-avid cervical lymphadenopathy 26 (<xref rid="gr3_lrg" ref-type="fig">Fig. 3</xref>, , <xref rid="gr4_lrg" ref-type="fig">Fig. 4</xref>\n).\n).Fig. 3Tonsillitis and COVID-19 pneumonia. FDG-PET/CT axial fused images of a 61-year-old male with history of esophageal cancer and COVID-19. There is intense FDG uptake in the palatine tonsils (arrowheads). There were also FDG-avid subpleural ground glass opacities (arrows).Fig. 3Fig. 4Sinusitis in patient with COVID-19. Interim FDG-PET/CT in this 79-year-old male with diffuse large B-cell lymphoma and COVID-19 pneumonia demonstrated new FDG-avid mucosal thickening and secretions in the maxillary sinuses.Fig. 4'], 'gr5_lrg': ['Although not routinely obtained for pneumonia evaluation, FDG-PET/CT can demonstrate characteristic and early imaging findings of COVID-19 pneumonia even with a lower dose, non-diagnostic, CT scan techniques38 in compliment with the metabolic information provided by FDG39. Increased metabolic activity associated with ground glass opacification and consolidation as assessed by FDG-PET/CT has been observed in patients admitted with COVID-19 pneumonia 40, as well as in asymptomatic patients in hotspot areas having FDG-PET/CT for other clinical indications 41. These findings are likely attributable to the infiltration of inflammatory cells within lung parenchyma 42. Although the level of tracer uptake in COVID pneumonia has been most pronounced with FDG, increased uptake has also been reported with other PET tracers, including PSMA (<xref rid="gr5_lrg" ref-type="fig">Fig. 5</xref>\n), \n), 18F-fluciclovine and 68Ga-DOTATATE 43., 44..45.Fig. 5COVID-19 pneumonia on PSMA-PET. MIP (left), axial fused (top right) and CT lung reconstruction (bottom right) images of F18-piflufolastat-PET/CT in a 76-year-old male with metastatic prostate cancer and COVID-19 pneumonia. There were extensive tracer-avid subpleural consolidative opacities in both lungs (arrows). PSMA-avid abdominal lymph nodes represented metastatic prostate cancer.Fig. 5'], 'gr6_lrg': ['Oncologic patients are at increased risk from COVID-19 infection-related complications49. Prompt recognition of infection in this population is crucial50 and should be differentiated from other conditions such as progressive malignancy, drug- and radiation-related pneumonitis due to significantly different implications on patient management51. The differentiation of these conditions on imaging, may be challenging due to overlapping imaging appearances of the entities. Radiation recall pneumonitis, defined as pneumonitis confined to the areas of irradiated lung parenchyma following a triggering event, has also been described in association with SARS-CoV-2 infection (<xref rid="gr6_lrg" ref-type="fig">Fig. 6</xref>\n) and with COVID-19 vaccination \n) and with COVID-19 vaccination 52., 53. – this condition poses a particular management challenge in patients with lung cancer who received radiation therapy.Fig. 6Radiation recall pneumonitis following COVID-19 vaccination. A) Axial fused PET/CT image in a 67-year-old male with lung adenocarcinoma 4\xa0days after receiving the 2nd dose of the mRNA-1273 vaccine demonstrates FDG-avid right subpectoral lymph nodes (arrowheads), FDG uptake in the right deltoid muscle (not shown) and FDG-avid consolidative opacities in the right upper and paramediastinal left upper lobes (arrows). B) FDG-PET/CT 2\xa0months before when these findings were not present. C) Treatment plan of intensity modulated radiation therapy (IMRT) completed 19\xa0months before presentation.Fig. 6'], 'gr7_lrg': ['Thromboembolic complications are common in critically ill patients with COVID-19 54 (<xref rid="gr7_lrg" ref-type="fig">Fig. 7</xref>\n). Lung perfusion and ventilation scintigraphy (V/Q scan) continues to have a role in the diagnosis of pulmonary embolism (PE), particularly in cases where radiation exposure is of particular concern, or when iodinated contrast is contraindicated (e.g., allergy or renal disease) \n). Lung perfusion and ventilation scintigraphy (V/Q scan) continues to have a role in the diagnosis of pulmonary embolism (PE), particularly in cases where radiation exposure is of particular concern, or when iodinated contrast is contraindicated (e.g., allergy or renal disease) 55., 56. (<xref rid="gr8_lrg" ref-type="fig">Fig. 8</xref>\n). As a result of the pandemic, the ventilation component of lung scintigraphy for assessment of PE has been omitted in many centers to decrease the risk of infection to healthcare professionals and other patients in nuclear medicine departments\n). As a result of the pandemic, the ventilation component of lung scintigraphy for assessment of PE has been omitted in many centers to decrease the risk of infection to healthcare professionals and other patients in nuclear medicine departments57. However, given the likelihood of COVID-19 patients with respiratory symptoms having an abnormal perfusion scan, some authors argue that the ventilation component is vital to reduce false-positive exams, if adequate aerosol precautions for technologists are available 58. A multicenter study retrospective analysis of 145 patients with COVID-19 who received both ventilation and perfusion SPECT/CT due to suspicion of PE showed that PE was confidently excluded in only 57% of patients with perfusion scans alone; ventilation images were required to confidently exclude (31%) or diagnose (12%) PE in a sizable portion of exams 59. Other authors have proposed a reasonable intermediate approach whereby the perfusion study is first obtained and analyzed, and ventilation examination performed only if perfusion is abnormal 60. In June 2021, the SNMMI released a statement recommending that ventilation scans be increasingly reincorporated into practice, with local and institutional COVID-19 policies and procedures serving as the primary source of guidance 61.Fig. 7Pulmonary embolism and COVID-19 pneumonia. FDG-PET/CT of a 64-year-old male with marginal zone lymphoma demonstrated FDG-avid subpleural consolidative and ground glass opacities (arrowheads, left image), as well as FDG uptake in the right lower lobar artery (arrow, left image), with corresponding filling defect noted on contrast-enhanced CT 4\xa0days before (arrow, right image), consistent with acute pulmonary embolism, which also involved additional pulmonary arterial branches bilaterally.Fig. 7Fig. 8COVID-19 and pulmonary embolism. 72-year-old female who presented to the ED with shortness of breath and tested positive for SARS-CoV-2. Chest radiograph confirmed multifocal airspace opacification predominantly involving the peripheral right lung and lower left lung. Due to an extremely elevated D-dimer (>20\xa0μg/mL) and renal insufficiency, a V/Q scan was ordered. Given that the patient had COVID-19, only perfusion imaging was obtained. Anterior and LAO projections demonstrated a wedge-shaped perfusion defect in the left midlung (black arrows), corresponding to an area which was relatively spared of opacification in the radiograph when compared to the rest of the lung parenchyma.Fig. 8'], 'gr9_lrg': ['Radiotracer uptake in lymph nodes has also been described with 68Ga-DOTATATE, 18F-fluciclovine, and PSMA 86., 87. (<xref rid="gr9_lrg" ref-type="fig">Fig. 9</xref>\n). The exact mechanisms for nodal uptake of these non-FDG-tracers remain unclear. Intense proliferation of immune cells in activated lymph nodes could explain the increased uptake of \n). The exact mechanisms for nodal uptake of these non-FDG-tracers remain unclear. Intense proliferation of immune cells in activated lymph nodes could explain the increased uptake of 18F-fluciclovine, while the presence of neovascularization could explain the uptake of PSMA 86.Fig. 9Hypermetabolic lymphadenopathy following COVID vaccination. A) MIP and axial fused images of a 73-year-old female with lung adenocarcinoma demonstrating 18F-FDG-avid left axillary lymphadenopathy 3\xa0days after receiving the second mRNA-1273 vaccine dose on the left arm. B) MIP and axial fused images of a 57-year-old female with well-differentiated appendiceal neuroendocrine tumor and 68Ga-DOTATATE-avid right axillary lymphadenopathy 7\xa0days after receiving the second BNT162b2 mRNA vaccine dose on the right arm. C) MIP and axial fused images of a 63-year-old male with recently diagnosed prostate cancer presenting with 18F-fluciclovine-avid right axillary lymphadenopathy 3\xa0days after receiving the third dose of mRNA-1273 vaccine on the right arm.Fig. 9'], 'gr10_lrg': ['Despite myalgia and arthralgia being common symptoms associated with COVID-19, muscular and joint pathology directly caused by SARS-CoV-2 is much less common, and includes myositis/rhabdomyolysis, critical illness myopathy, muscle denervation secondary to infectious peripheral neuropathy, exacerbation of chronic rheumatologic diseases and gangrene secondary to COVID-19 coagulopathy 95. Only a few case reports of myositis on FDG-PET/CT have been published in the literature in patients recovering from COVID-19 96., 97.. Nevertheless, myositis involving the deltoid muscle is a relatively common finding following COVID-19 vaccination, as discussed earlier. Schroeder et al. documented deltoid uptake (defined as a deltoid SUVmax greater than blood pool) in 14.5% of patients following vaccination, with most cases demonstrating a characteristically elongated morphology of the uptake that followed the muscular striations 80 (<xref rid="gr10_lrg" ref-type="fig">Fig. 10</xref>\n). Analogous features were also described on post-vaccination MRI of the shoulder \n). Analogous features were also described on post-vaccination MRI of the shoulder 98.Fig. 10Deltoid uptake in following COVID-19 vaccination. FDG-PET/CT axial fused and sagittal MIP images of a 49-year-old female with history of metastatic breast cancer demonstrating characteristic elongated uptake in the left deltoid muscle 2\xa0days after administration of the third mRNA-1273 vaccine dose (arrows).Fig. 10'], 'gr11_lrg': ['Inflammatory involvement of the subcutaneous tissues has also been described (<xref rid="gr11_lrg" ref-type="fig">Fig. 11</xref>\n), including cases of erythema nodosum, a form of septal panniculitis which is frequently associated with streptococcal and viral infections \n), including cases of erythema nodosum, a form of septal panniculitis which is frequently associated with streptococcal and viral infections 100. Pereira et al. reported a case of biopsy-proven lobular panniculitis developing one week after recovery from COVID-19 with FDG-PET/CT demonstrating tracer uptake in the subcutaneous tissues diffusely 96.Fig. 11Panniculitis in patient with COVID-19. Fused axial FDG-PET/CT images in a 68-year-old male with melanoma and COVID-19 pneumonia who developed FDG-avid lung consolidative opacities (arrow), as well as multifocal areas of intense FDG uptake in the subcutaneous tissues of the torso (arrowheads), correlating with areas of fat stranding on CT, in keeping with panniculitis.Fig. 11']} | COVID-19: Findings in nuclear medicine from head to toe | [
"COVID-19",
"SARS-CoV-2",
"Vaccination",
"PET-CT",
"Nuclear medicine"
] | Clin Imaging | 1688799600 | Previous studies have shown that self-affirmation increases acceptance of a message and motivates health behavior change. The present study investigated whether self-affirmation increases the acceptance of persuasive messages on COVID-19 vaccines and promotes vaccination intention. A total of 144 participants were randomly assigned to the self-affirmation (n = 72) or control (n = 72) groups before reading a persuasive message on COVID-19 vaccines. The results revealed that the self-affirmation group showed significantly higher acceptance of persuasive information on COVID-19 vaccines than the control group. Additionally, the self-affirmation group also showed significantly higher post-experiment vaccination intention than the control group. Mediation analysis indicated that increased acceptance of persuasive information significantly mediated the beneficial effects of self-affirmation on post-experiment vaccination intention. The present study demonstrated that self-affirmation could be an effective strategy for increasing the acceptance of persuasive messages on COVID-19 vaccines and promoting vaccination intention. | [
"Humans",
"Intention",
"Health Promotion",
"COVID-19 Vaccines",
"COVID-19",
"Health Behavior",
"Vaccination"
] | other | PMC10081937 | null | 46 | [
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"{'Citation': 'Sallam M. COVID-19 vaccine hesitancy worldwide: A concise systematic review of vaccine acceptance rates. Vaccines. 2021;9:160. doi: 10.3390/vaccines9020160.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.3390/vaccines9020160'}, {'@IdType': 'pmc', '#text': 'PMC7920465'}, {'@IdType': 'pubmed', '#text': '33669441'}]}}",
"{'Citation': 'Scheres J, Kuszewski K. The ten threats to global health in 2018 and 2019. A welcome and informative communication of WHO to everybody. Zeszyty Naukowe Ochrony Zdrowia. Zdrowie Publicznei Zarzadzanie. 2019;17:2–8. doi: 10.4467/20842627OZ.19.001.11297.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.4467/20842627OZ.19.001.11297'}}}",
"{'Citation': 'Schwarzinger M, Watson V, Arwidson P, Alla F, Luchini S. COVID-19 vaccine hesitancy in a representative working-age population in France: A survey experiment based on vaccine characteristics. The Lancet Public Health. 2021;6:e210–e221. doi: 10.1016/S2468-2667(21)00012-8.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S2468-2667(21)00012-8'}, {'@IdType': 'pmc', '#text': 'PMC7864787'}, {'@IdType': 'pubmed', '#text': '33556325'}]}}",
"{'Citation': 'Science_China. (2021). Is vaccination hesitation widespread? https://mp.weixin.qq.com/s/z5Jxao0OH3hAj1tSu_Kmjw.'}",
"{'Citation': 'Sherman DK. Self-affirmation: Understanding the effects. Social and Personality Psychology Compass. 2013;7:834–845. doi: 10.1111/spc3.12072.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1111/spc3.12072'}}}",
"{'Citation': 'Sherman DK, Cohen GL. Accepting threatening information: Self-affirmation and the reduction of defensive biases. Current Directions in Psychological Science. 2002;11:119–123. doi: 10.1111/1467-8721.00182.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1111/1467-8721.00182'}}}",
"{'Citation': 'Sherman DK, Cohen GL. The psychology of self-defense: Self-affirmation theory. In: Zanna MP, editor. Advances in experimental social psychology. Academic Press; 2006. pp. 183–242.'}",
"{'Citation': 'Sherman DA, Nelson LD, Steele CM. Do messages about health risks threaten the self? Increasing the acceptance of threatening health messages via self-affirmation. Personality and Social Psychology Bulletin. 2000;26:1046–1058. doi: 10.1177/01461672002611003.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1177/01461672002611003'}}}",
"{'Citation': 'Si H, Shi JG, Tang D, Wu G, Lan J. Understanding intention and behavior toward sustainable usage of bike sharing by extending the theory of planned behavior. Resources, Conservation and Recycling. 2020;152:104513. doi: 10.1016/j.resconrec.2019.104513.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1016/j.resconrec.2019.104513'}}}",
"{'Citation': 'Steele CM. The psychology of self-affirmation: Sustaining the integrity of the self. In: Berkowitz L, editor. Advances in Experimental Social Psychology. Academic Press; 1988. pp. 261–302.'}",
"{'Citation': 'Van Koningsbruggen GM, Das E, Roskos-Ewoldsen DR. How self-affirmation reduces defensive processing of threatening health information: Evidence at the implicit level. Health Psychology. 2009;28:563–568. doi: 10.1037/a0015610.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1037/a0015610'}, {'@IdType': 'pubmed', '#text': '19751082'}]}}",
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] | Clin Imaging. 2023 Jul 8; 99:10-18 | NO-CC CODE |
|
Preoperative computed tomography scan of a 66-year-old man with COVID-19-related pneumonia and acute limb ischemia. Transverse and coronal thin-section scans show extensive ground-glass opacities of both lungs. | gr1_lrg | 7 | 489d4cb5f50b80554d84922f11a0a7624c3a81aad3d7d85e5a9c5a6c2224311a | gr1_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
711,
329
] | [{'image_id': 'gr4_lrg', 'image_file_name': 'gr4_lrg.jpg', 'image_path': '../data/media_files/PMC7188654/gr4_lrg.jpg', 'caption': 'Estimated projection of patients with acute limb ischemia (ALI) in 2020 compared with those treated in 2019 at the same center.', 'hash': '70b6e021358ec54d284852865d0855de509b826419c68b9f840e1399f1bd2bfb'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7188654/gr1_lrg.jpg', 'caption': 'Preoperative computed tomography scan of a 66-year-old man with COVID-19-related pneumonia and acute limb ischemia. Transverse and coronal thin-section scans show extensive ground-glass opacities of both lungs.', 'hash': '489d4cb5f50b80554d84922f11a0a7624c3a81aad3d7d85e5a9c5a6c2224311a'}, {'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC7188654/gr3_lrg.jpg', 'caption': 'Thrombus (A and B) specimen after aortoiliac-femoropopliteal thrombectomy and bilateral selective tibial artery thrombectomy.', 'hash': 'b9a79165cb5ea5077412dc75381c400e5514bfc1d0f3ae4745ab5f95e7d6ce95'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7188654/gr2_lrg.jpg', 'caption': 'Preoperative computed tomography angiography with volume rendering 3-dimensional reconstruction (A) showing the presence of intraluminal thrombus (B) at the infrarenal aorta (white arrow), total occlusion of the popliteal segment (white dotted arrows), and the absence of tibial vessels, bilaterally. Final completion angiogram showing the morphological aspect of “desert foot” after large amount of thrombus removal for femoral-popliteal-tibial occlusion that required selective thrombectomy of all tibial vessels bilaterally.', 'hash': 'a5488a52cce69ece7f86789407411a66b439e8bc66996c12ed2372323abe6768'}] | {'gr1_lrg': ['According to our standardized program, all patients with a clinical suspicion for aortoiliac and/or infrainguinal ALI and/or upper limb ischemia underwent routine preoperative screening blood tests, including creatine phosphokinase and D-dimer, and chest radiographs and electrocardiography. Preoperative computed tomography was performed to identify COVID-19-related pneumonia (<xref rid="gr1_lrg" ref-type="fig">Fig\xa01</xref>\n). These studies were performed in the emergency room to avoid cross-contamination and unnecessary risk of viral spread. Patients with suspected aortoiliac occlusion underwent computed tomography angiography to assess the extent of disease and vessel size (\n). These studies were performed in the emergency room to avoid cross-contamination and unnecessary risk of viral spread. Patients with suspected aortoiliac occlusion underwent computed tomography angiography to assess the extent of disease and vessel size (<xref rid="gr2_lrg" ref-type="fig">Fig\xa02</xref>\n, \n, A and B). Those patients who had presented with infrainguinal and/or upper limb occlusive disease underwent echocardiographic color Doppler evaluation of both the arterial and the venous systems. Also, during the course of hospitalization, all patients were screened for the identification of eventual cardiac emboli sources using transthoracic echocardiography. The operative risk profile was determined using a multidisciplinary evaluation, which included the physical examination and laboratory blood test results.Fig\xa01Preoperative computed tomography scan of a 66-year-old man with COVID-19-related pneumonia and acute limb ischemia. Transverse and coronal thin-section scans show extensive ground-glass opacities of both lungs.Fig\xa02Preoperative computed tomography angiography with volume rendering 3-dimensional reconstruction (A) showing the presence of intraluminal thrombus (B) at the infrarenal aorta (white arrow), total occlusion of the popliteal segment (white dotted arrows), and the absence of tibial vessels, bilaterally. Final completion angiogram showing the morphological aspect of “desert foot” after large amount of thrombus removal for femoral-popliteal-tibial occlusion that required selective thrombectomy of all tibial vessels bilaterally.'], 'gr2_lrg': ['Open surgical intervention was performed in the operating room with the patient under locoregional or local anesthesia and intravenous sedation, using 80 U/kg of intravenous heparin at arterial clamping and routine antibiotic prophylaxis. All patients received oxygen support. At the time of the present analysis, no patient had required preemptive intubation because of COVID-19-related pneumonia. In the patients with aortoiliac or femoropopliteal occlusion, a standard groin incision was used to expose the femoral bifurcation. We selectively used a below-the-knee incision to expose the popliteal artery in patients with isolated popliteal-tibial occlusion. Upper limb ischemia was treated through direct open brachial artery exposure. Thromboembolectomy was performed using standard embolectomy catheters (Le Maitre, Burlington, Mass), sized according to the location of the occlusion. In all cases, completion angiography was performed through the surgical access (<xref rid="gr2_lrg" ref-type="fig">Fig\xa02</xref>, , C). Tibial arteries and/or forearm vessels were approached selectively in cases of distal occlusion. Fasciotomy was not routinely performed. In those with distal occlusion, especially those with the typical aspect of a desert foot, our protocol has been augmented with intra-arterial locoregional thrombolysis using alteplase (Actilyse; Boehringer Ingelheim Italia SpA, Milan, Italy) at 20\xa0mg/20\xa0minutes. The postoperative antithrombotic regimen has been standardized, with the most recent patients receiving an anticoagulation regimen consisting of continuous intravenous heparin infusion. In the case of a less than 80% basal level of antithrombin III, 500 U of antithrombin III was infused for 10\xa0minutes before starting the continuous intravenous heparin to reach an activated partial thromboplastin time of 2.5\xa0seconds. The thrombi retrieved from each patient were sent for histologic evaluation (<xref rid="gr2_lrg" ref-type="fig">Fig\xa02</xref>). Postoperative surveillance was performed with physical examinations every hour and full blood panel tests every 8\xa0hours. Transfusions of packed red blood cells were given only if the hemoglobin level had decreased to less than 8\xa0g/dL. An infectious disease specialist evaluated each patient regularly during the entire hospitalization course to optimize the type, dosage, and duration of antibiotic and antiretroviral therapy. At discharge, all patients were given enoxaparin sodium injections (Clexane; Sanofi SpA, Milan, Italy) for home use at a therapeutic dosage. Follow-up and surveillance imaging will include clinical visits with determination of the ankle-brachial index and duplex ultrasound examination at 1, 6, and 12\xa0months after treatment and then annually. Any change in the examination findings or ankle-brachial index or suspicion of a loss of patency will be confirmed using duplex ultrasonography and computed tomography angiography.). Postoperative surveillance was performed with physical examinations every hour and full blood panel tests every 8\xa0hours. Transfusions of packed red blood cells were given only if the hemoglobin level had decreased to less than 8\xa0g/dL. An infectious disease specialist evaluated each patient regularly during the entire hospitalization course to optimize the type, dosage, and duration of antibiotic and antiretroviral therapy. At discharge, all patients were given enoxaparin sodium injections (Clexane; Sanofi SpA, Milan, Italy) for home use at a therapeutic dosage. Follow-up and surveillance imaging will include clinical visits with determination of the ankle-brachial index and duplex ultrasound examination at 1, 6, and 12\xa0months after treatment and then annually. Any change in the examination findings or ankle-brachial index or suspicion of a loss of patency will be confirmed using duplex ultrasonography and computed tomography angiography.'], 'gr3_lrg': ['Three patients (15%) did not undergo revascularization. These patients had had severe COVID-19-related pneumonia, and intervention was not performed owing to their moribund condition (mean oxygen pressure, 47\xa0mm Hg; mean SVS score, 8.3; and Rutherford stage III [2 patients]). Operative treatment was performed in 17 patients (85%). Local anesthesia with sedation was used for 15 patients (88.2%) and locoregional anesthesia for two patients (11.8%). Thromboembolectomy was performed for infrainguinal occlusion in 11 patients (64.7%), bilateral aortoiliac occlusion in 3 patients (17.6%), and upper limb occlusion in 1 patient (5.9%). Below-the-knee femoropopliteal bypass was performed in two patients (11.8%). Selective tibial vessel thrombectomy was performed in five patients (29.4%) and additional intraoperative thrombolysis in four patients (23.5%). Adjunctive procedures included placement of aortoiliac kissing stents in 2 patients because of nondetachable residual clots, femoral endarterectomy in 1 patient, and below-the-knee popliteal percutaneous transluminal angioplasty in 1 patient. At completion angiography, no critical chronic atherosclerotic obstructive lesion was observed and no anastomotic defects were observed in the surgical or endovascular graft already implanted. Postoperatively, all patients received systemic anticoagulation with a weight-adjusted therapeutic regimen of low-molecular-weight heparin (n\xa0= 11) or intravenous heparin infusion (n\xa0= 6). No bleeding complications were observed. All the patients had macroscopic evidence of black- and gray-striped thrombus (<xref rid="gr3_lrg" ref-type="fig">Fig 3</xref>\n). All thrombi were sent for histologic examination.\n). All thrombi were sent for histologic examination.Fig\xa03Thrombus (A and B) specimen after aortoiliac-femoropopliteal thrombectomy and bilateral selective tibial artery thrombectomy.'], 'gr4_lrg': ['We believe, from our direct experience, that patients who test positive for COVID-19 could experience a hypercoagulable state that could increase the incidence and extension of native arterial occlusion. Previous (pre–COVID-19) studies have reported that the overall incidence of ALI has declined significantly in the past decade and that the presence of a hypercoagulable state is an uncommon etiology among the broad population presenting with ALI.2\n,\n10 However, in our early experience, we have evaluated a significantly greater number of patients with from ALI compared with the same period in 2019 before COVID-19. If the pandemic continues as predicted, this emergency will extend until the end of the calendar year. Undoubtedly, this will translate into the evaluation and surgical intervention of ∼171 cases. This would be greater than 30% of the projected total interventions or a fivefold increase if compared with all of 2019 (<xref rid="gr4_lrg" ref-type="fig">Fig\xa04</xref>\n). Additionally, although a hypercoagulable state has been preferentially associated with venous thromboembolism, our patients with COVID-19 had both arterial and venous vascular system involvement.\n). Additionally, although a hypercoagulable state has been preferentially associated with venous thromboembolism, our patients with COVID-19 had both arterial and venous vascular system involvement.2 Multiple patients had a diagnosis of extensive deep venous thrombosis, in addition to ALI, and massive pulmonary embolism has been reported to be frequently found during autopsy in these patients (Chen, unpublished data, 2020). Third, we are expecting to perform better analyses of the thrombus specimens. However, macroscopically, they appear quite different from specimens before COVID-19, with a typical gelatinous consistence. Finally, although young age and female gender have been found to be more frequently associated with known hypercoagulable disorders, in our series, this hypercoagulability state was observed in both younger and older patients, with a male predominance. These latter two findings suggest that the hypercoagulability in our patients is not related to well-known blood disorders but, rather, that native arterial thrombosis might be triggered by COVID-19 infection. This is only a preliminary, although totally new, observation. Viral-related ALI has been described anecdotally in reported studies but was not associated with venous thromboembolism or hypercoagulability.11\nFig\xa04Estimated projection of patients with acute limb ischemia (ALI) in 2020 compared with those treated in 2019 at the same center.']} | Acute limb ischemia in patients with COVID-19 pneumonia | [
"Acute limb ischemia",
"COVID-19"
] | J Vasc Surg | 1609228800 | COVID-19 is a rapidly evolving public health emergency that has largely impacted the provision of healthcare services around the world. The challenge for electrophysiology teams is double; on one side preventing disease spread by limiting all nonessential face-to-face interactions, but at the same time ensuring continued care for patients who need it. These guidelines contain recommendations regarding triaging in order to define what procedures, device checks and clinic visits can be postponed during the pandemic. We also discuss best practices to protect patients and healthcare workers and provide guidance for the management of COVID-19 patients with arrhythmic conditions. | [
"Argentina",
"Arrhythmias, Cardiac",
"Brazil",
"COVID-19",
"Cardiac Electrophysiology",
"Catheter Ablation",
"Colombia",
"Coronavirus Infections",
"Delivery of Health Care",
"Elective Surgical Procedures",
"Electrophysiologic Techniques, Cardiac",
"Female",
"Humans",
"Infection Control",
"Latin America",
"Male",
"Mexico",
"Pandemics",
"Pneumonia, Viral",
"Practice Guidelines as Topic",
"Safety Management",
"Societies, Medical"
] | other | PMC7188654 | null | 16 | [
"{'Citation': 'Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7092819'}, {'@IdType': 'pubmed', '#text': '32109013'}]}}",
"{'Citation': 'Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72\\xa0314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '32091533'}}}",
"{'Citation': 'Zhongnan Hospital of Wuhan University Novel Coronavirus Management and Research Team. Evidence-Based Medicine Chapter of China International Exchange and Promotive Association for Medical and Health Care (CPAM) A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version) Mil Med Res. 2020;7(1):4.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7003341'}, {'@IdType': 'pubmed', '#text': '32029004'}]}}",
"{'Citation': 'Bedford J, Enria D, Giesecke J, Heymann DL, Ihekweazu C, Kobinger G, Lane HC, Memish Z, Oh MD, Sall AA, Schuchat A, Ungchusak K, Wieler LH, WHO Strategic and Technical Advisory Group for Infectious Hazards COVID-19: towards controlling of a pandemic. Lancet. 2020;395(10229):1015–1018. doi: 10.1016/S0140-6736(20)30673-5.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S0140-6736(20)30673-5'}, {'@IdType': 'pmc', '#text': 'PMC7270596'}, {'@IdType': 'pubmed', '#text': '32197103'}]}}",
"{'Citation': 'Stefanini GG, Azzolini E, Condorelli G. Critical Organizational Issues for Cardiologists in the COVID-19 Outbreak: A Frontline Experience From Milan, Italy. Circulation. 2020.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '32207994'}}}",
"{'Citation': \"Welt FGP, Shah PB, Aronow HD, Bortnick AE, Henry TD, Sherwood MW, et al. Catheterization Laboratory Considerations During the Coronavirus (COVID-19) Pandemic: From ACC's Interventional Council and SCAI. J Am Coll Cardiol. 2020.\", 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7270593'}, {'@IdType': 'pubmed', '#text': '32199938'}]}}",
"{'Citation': 'Centers for Disease Control and Prevention (CDC). Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. 2020.'}",
"{'Citation': 'Smith AC, Thomas E, Snoswell CL, et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare. 2020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7140977'}, {'@IdType': 'pubmed', '#text': '32196391'}]}}",
"{'Citation': 'McConnell MV, Turakhia MP, Harrington RA, King AC, Ashley EA. Mobile Health Advances in Physical Activity, Fitness, and Atrial Fibrillation: Moving Hearts. J Am Coll Cardiol. 2018;71(23):2691–2701. doi: 10.1016/j.jacc.2018.04.030.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.jacc.2018.04.030'}, {'@IdType': 'pubmed', '#text': '29880130'}]}}",
"{'Citation': 'Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7042881'}, {'@IdType': 'pubmed', '#text': '32031570'}]}}",
"{'Citation': 'Driggin E, Madhavan MV, Bikdeli B, et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic. J Am Coll Cardiol. 2020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7198856'}, {'@IdType': 'pubmed', '#text': '32201335'}]}}",
"{'Citation': 'Clerkin KJ, Fried JA, Raikhelkar J, et al. Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease. Circulation. 2020.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '32200663'}}}",
"{'Citation': 'Xiong TY, Redwood S, Prendergast B, et al. Coronaviruses and the cardiovascular system: acute and long-term implications. Eur Heart J. 2020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7454513'}, {'@IdType': 'pubmed', '#text': '32186331'}]}}",
"{'Citation': 'Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7102549'}, {'@IdType': 'pubmed', '#text': '32205204'}]}}",
"{'Citation': 'Giudicessi J, Noseworthy P, Friedman P, Ackerman M. Urgent Guidance for Navigating and Circumventing the QTc Prolonging and Torsadogenic Potential of Possible Pharmacotherapies for COVID19. Mayo Clin Proc. 2020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7141471'}, {'@IdType': 'pubmed', '#text': '32359771'}]}}",
"{'Citation': 'Garabelli P, Stavrakis S, Albert M, Koomson E, Parwani P, Chohan J, Smith L, Albert D, Xie R, Xie Q, Reynolds D, Po S. Comparison of QT Interval Readings in Normal Sinus Rhythm Between a Smartphone Heart Monitor and a 12-Lead ECG for Healthy Volunteers and Inpatients Receiving Sotalol or Dofetilide. J Cardiovasc Electrophysiol. 2016;27(7):827–832. doi: 10.1111/jce.12976.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1111/jce.12976'}, {'@IdType': 'pubmed', '#text': '27027653'}]}}"
] | J Vasc Surg. 2020 Dec 29; 72(6):1864-1872 | NO-CC CODE |
|
CT scan showing a large homogeneous cystic mass (34x17x25cm) | jscr-2012-6-4fig1 | 7 | b73e24e2e8a3e9304d0d9003facd891fe854cf7e211657d35e30fce49c7db094 | jscr-2012-6-4fig1.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
709,
494
] | [{'image_id': 'jscr-2012-6-4fig3', 'image_file_name': 'jscr-2012-6-4fig3.jpg', 'image_path': '../data/media_files/PMC3862254/jscr-2012-6-4fig3.jpg', 'caption': 'Histology showing immunohistochemistry by marker D2-40 identifying the lymphatic endothelium', 'hash': '429f83dd6cf9205ffae90ff96beace75c1657fdd6696bd85a32475c4dfc9e139'}, {'image_id': 'jscr-2012-6-4fig2', 'image_file_name': 'jscr-2012-6-4fig2.jpg', 'image_path': '../data/media_files/PMC3862254/jscr-2012-6-4fig2.jpg', 'caption': 'Macroscopic specimen showing mesenteric cystic wall following aspiration of the fluid', 'hash': '6c5ba99676b6fe92f179b5c66b28f2ba3c904df1702d3cde2b2b18a83032c04c'}, {'image_id': 'jscr-2012-6-4fig1', 'image_file_name': 'jscr-2012-6-4fig1.jpg', 'image_path': '../data/media_files/PMC3862254/jscr-2012-6-4fig1.jpg', 'caption': 'CT scan showing a large homogeneous cystic mass (34x17x25cm)', 'hash': 'b73e24e2e8a3e9304d0d9003facd891fe854cf7e211657d35e30fce49c7db094'}] | {'jscr-2012-6-4fig1': ['A 34-year-old patient was scheduled for minimal invasive mitral valve reconstruction to treat a Barlow syndrome with a prolapse of the posterior mitral leaflet. The patient’s medication consisted of a Proton pump inhibitor due to a chronic gastro-esophagial reflux disease. Otherwise the patient had no other digestive symptoms, in particular there was no history of pancreatic disease. Preoperative computed tomography (CT) incidentally showed a huge abdominal cystic lesion of 34x17x25cm (<xref ref-type="fig" rid="jscr-2012-6-4fig1">Fig. 1</xref>).).'], 'jscr-2012-6-4fig2': ['Echinoccus serology was negative and the aspiration of the fluid showed normal levels of amylase and no cytological signs of malignancy. A laparoscopic resection was attempted; however, because of lack of exposure due to the large size of the cyst, a conversion to a median laparotomy was necessary. After emptying of the cyst by aspiration of 3 litres of fluid, an “en bloc” resection of the cyst, originating from the mesocolon, was performed (<xref ref-type="fig" rid="jscr-2012-6-4fig2">Fig. 2</xref>).).'], 'jscr-2012-6-4fig3': ['The postoperative course was uneventful and the patient was discharged at postoperative day 5. Macroscopic examination found a unilocular cyst with fibrotic wall. Microscopically, prominent giant cells and xanthomatous inflammation reaction were present in the wall. Further light brown histiocytes with focal expression of CD31 and D2-40 were found in the specimen (<xref ref-type="fig" rid="jscr-2012-6-4fig3">Fig. 3</xref>), favouring lymphangioma with cystic-regressive changes.), favouring lymphangioma with cystic-regressive changes.']} | Giant mesenteric cystic lymphangioma of mesocolic origin in an asymptomatic adult patient | null | J Surg Case Rep | 1338534000 | The V617F mutation in the Jak2 pseudokinase domain causes myeloproliferative neoplasms, and the equivalent mutation in Jak1 (V658F) is found in T-cell leukemias. Crystal structures of wild-type and V658F-mutant human Jak1 pseudokinase reveal a conformational switch that remodels a linker segment encoded by exon 12, which is also a site of mutations in Jak2. This switch is required for V617F-mediated Jak2 activation and possibly for physiologic Jak activation. | [
"Enzyme Activation",
"Humans",
"Janus Kinases",
"Models, Molecular",
"Oncogenes",
"Protein Conformation"
] | other | PMC3862254 | null | 31 | [
"{'Citation': 'Baker SJ, Rane SG, Reddy EP. Hematopoietic cytokine receptor signaling. Oncogene. 2007;26:6724–37.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17934481'}}}",
"{'Citation': \"Ghoreschi K, Laurence A, O'Shea JJ. Janus kinases in immune cell signaling. Immunol Rev. 2009;228:273–87.\", 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2782696'}, {'@IdType': 'pubmed', '#text': '19290934'}]}}",
"{'Citation': 'Saharinen P, Takaluoma K, Silvennoinen O. Regulation of the Jak2 tyrosine kinase by its pseudokinase domain. Mol Cell Biol. 2000;20:3387–95.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC85631'}, {'@IdType': 'pubmed', '#text': '10779328'}]}}",
"{'Citation': 'Ihle JN, Gilliland DG. Jak2: normal function and role in hematopoietic disorders. Curr Opin Genet Dev. 2007;17:8–14.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17208428'}}}",
"{'Citation': 'Haan C, Behrmann I, Haan S. Perspectives for the use of structural information and chemical genetics to develop inhibitors of Janus kinases. J Cell Mol Med. 2010;14:504–27.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3823453'}, {'@IdType': 'pubmed', '#text': '20132407'}]}}",
"{'Citation': 'James C, et al. A unique clonal JAK2 mutation leading to constitutive signalling causes polycythaemia vera. Nature. 2005;434:1144–8.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15793561'}}}",
"{'Citation': 'Kralovics R, et al. A gain-of-function mutation of JAK2 in myeloproliferative disorders. N Engl J Med. 2005;352:1779–90.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15858187'}}}",
"{'Citation': 'Levine RL, et al. Activating mutation in the tyrosine kinase JAK2 in polycythemia vera, essential thrombocythemia, and myeloid metaplasia with myelofibrosis. Cancer Cell. 2005;7:387–97.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15837627'}}}",
"{'Citation': 'Baxter EJ, et al. Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders. Lancet. 2005;365:1054–61.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15781101'}}}",
"{'Citation': 'Tefferi A, Vainchenker W. Myeloproliferative neoplasms: molecular pathophysiology, essential clinical understanding, and treatment strategies. J Clin Oncol. 2011;29:573–82.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21220604'}}}",
"{'Citation': 'Jeong EG, et al. Somatic mutations of JAK1 and JAK3 in acute leukemias and solid cancers. Clin Cancer Res. 2008;14:3716–21.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18559588'}}}",
"{'Citation': 'Staerk J, Kallin A, Demoulin JB, Vainchenker W, Constantinescu SN. JAK1 and Tyk2 activation by the homologous polycythemia vera JAK2 V617F mutation: cross-talk with IGF1 receptor. J Biol Chem. 2005;280:41893–9.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16239216'}}}",
"{'Citation': 'Scott LM. The JAK2 exon 12 mutations: a comprehensive review. Am J Hematol. 2011;86:668–76.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21674578'}}}",
"{'Citation': 'Scott LM, et al. JAK2 exon 12 mutations in polycythemia vera and idiopathic erythrocytosis. N Engl J Med. 2007;356:459–68.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2873834'}, {'@IdType': 'pubmed', '#text': '17267906'}]}}",
"{'Citation': 'Bandaranayake RM, et al. Crystal structures of the JAK2 pseudokinase domain and the pathogenic mutant V617F. Nat Struct Mol Biol. 2012;19:754–9.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3414675'}, {'@IdType': 'pubmed', '#text': '22820988'}]}}",
"{'Citation': 'Wernig G, et al. The Jak2V617F oncogene associated with myeloproliferative diseases requires a functional FERM domain for transformation and for expression of the Myc and Pim proto-oncogenes. Blood. 2008;111:3751–9.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2275031'}, {'@IdType': 'pubmed', '#text': '18216297'}]}}",
"{'Citation': 'Gnanasambandan K, Magis A, Sayeski PP. The constitutive activation of Jak2-V617F is mediated by a pi stacking mechanism involving phenylalanines 595 and 617. Biochemistry. 2010;49:9972–84.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2982877'}, {'@IdType': 'pubmed', '#text': '20958061'}]}}",
"{'Citation': 'Dusa A, Mouton C, Pecquet C, Herman M, Constantinescu SN. JAK2 V617F constitutive activation requires JH2 residue F595: a pseudokinase domain target for specific inhibitors. PLoS One. 2010;5:e11157.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2886835'}, {'@IdType': 'pubmed', '#text': '20585391'}]}}",
"{'Citation': 'Zhao L, et al. A JAK2 interdomain linker relays Epo receptor engagement signals to kinase activation. J Biol Chem. 2009;284:26988–98.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2785384'}, {'@IdType': 'pubmed', '#text': '19638629'}]}}",
"{'Citation': 'Ungureanu D, et al. The pseudokinase domain of JAK2 is a dual-specificity protein kinase that negatively regulates cytokine signaling. Nat Struct Mol Biol. 2011;18:971–6.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC4504201'}, {'@IdType': 'pubmed', '#text': '21841788'}]}}",
"{'Citation': 'Valiev M, Yang J, Adams JA, Taylor SS, Weare JH. Phosphorylation reaction in cAPK protein kinase-free energy quantum mechanical/molecular mechanics simulations. J Phys Chem B. 2007;111:13455–64.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17983217'}}}",
"{'Citation': 'Flex E, et al. Somatically acquired JAK1 mutations in adult acute lymphoblastic leukemia. J Exp Med. 2008;205:751–8.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2292215'}, {'@IdType': 'pubmed', '#text': '18362173'}]}}",
"{'Citation': \"Bercovich D, et al. Mutations of JAK2 in acute lymphoblastic leukaemias associated with Down's syndrome. Lancet. 2008;372:1484–92.\", 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18805579'}}}",
"{'Citation': 'Mullighan CG, et al. JAK mutations in high-risk childhood acute lymphoblastic leukemia. Proc Natl Acad Sci U S A. 2009;106:9414–8.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2695045'}, {'@IdType': 'pubmed', '#text': '19470474'}]}}",
"{'Citation': 'Kearney L, et al. Specific JAK2 mutation (JAK2R683) and multiple gene deletions in Down syndrome acute lymphoblastic leukemia. Blood. 2009;113:646–8.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18927438'}}}",
"{'Citation': 'Ashkenazy H, Erez E, Martz E, Pupko T, Ben-Tal N. ConSurf 2010: calculating evolutionary conservation in sequence and structure of proteins and nucleic acids. Nucleic Acids Res. 2010;38:W529–33.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2896094'}, {'@IdType': 'pubmed', '#text': '20478830'}]}}",
"{'Citation': 'Jin J, Pawson T. Modular evolution of phosphorylation-based signalling systems. Philos Trans R Soc Lond B Biol Sci. 2012;367:2540–55.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3415845'}, {'@IdType': 'pubmed', '#text': '22889906'}]}}",
"{'Citation': 'Pawson T, Kofler M. Kinome signaling through regulated protein-protein interactions in normal and cancer cells. Curr Opin Cell Biol. 2009;21:147–53.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19299117'}}}",
"{'Citation': 'Manning G, Whyte DB, Martinez R, Hunter T, Sudarsanam S. The protein kinase complement of the human genome. Science. 2002;298:1912–34.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12471243'}}}",
"{'Citation': 'Zhang Z, Marshall AG. A universal algorithm for fast and automated charge state deconvolution of electrospray mass-to-charge ratio spectra. Journal of the American Society for Mass Spectrometry. 1998;9:225–233.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9879360'}}}",
"{'Citation': 'Deshpande A, et al. Kinase domain mutations confer resistance to novel inhibitors targeting JAK2V617F in myeloproliferative neoplasms. Leukemia. 2011', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3974504'}, {'@IdType': 'pubmed', '#text': '21926964'}]}}"
] | J Surg Case Rep. 2012 Jun 1; 2012(6):4 | NO-CC CODE |
|
A Coronal section on CT scan demonstrating left parotid mass. | jscr-2012-6-7fig2 | 7 | 25c1da5b54c425dd273fc548910107af0395045b4e7ddc270a7f4343a4bdf40a | jscr-2012-6-7fig2.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
312,
287
] | [{'image_id': 'jscr-2012-6-7fig2', 'image_file_name': 'jscr-2012-6-7fig2.jpg', 'image_path': '../data/media_files/PMC3862464/jscr-2012-6-7fig2.jpg', 'caption': 'A Coronal section on CT scan demonstrating left parotid mass.', 'hash': '25c1da5b54c425dd273fc548910107af0395045b4e7ddc270a7f4343a4bdf40a'}, {'image_id': 'jscr-2012-6-7fig4', 'image_file_name': 'jscr-2012-6-7fig4.jpg', 'image_path': '../data/media_files/PMC3862464/jscr-2012-6-7fig4.jpg', 'caption': 'An Immunohistochemistry stain shows s100 protein deposition within the histiocytes. S100 immunohistochemistry stain of Paraffin embedded surgically removed parotid mass tissue viewed at 400x.', 'hash': '8d59865b88788471d111e77a76fb5f6efd3313fe481ec8174ca893e8970190b8'}, {'image_id': 'jscr-2012-6-7fig3', 'image_file_name': 'jscr-2012-6-7fig3.jpg', 'image_path': '../data/media_files/PMC3862464/jscr-2012-6-7fig3.jpg', 'caption': 'Left parotidectomy specimen showing histiocytes with marked emperiopolesis of leukocytes. Hematoxylin and Eosin stain of Paraffin embedded surgically removed parotid mass tissue viewed at 600x.', 'hash': '91fcd703927c00f743b0beb786d0228fdcfff8e96c9c88a98084f71418eb46d5'}, {'image_id': 'jscr-2012-6-7fig1', 'image_file_name': 'jscr-2012-6-7fig1.jpg', 'image_path': '../data/media_files/PMC3862464/jscr-2012-6-7fig1.jpg', 'caption': 'An Axial CT scan demonstrating diffuse left parotid mass.', 'hash': '2d48a36eca58af239941c80c9fc97020e266939272b4aea0bb0bca111bfaa49d'}] | {'jscr-2012-6-7fig1': ['Postoperative prednisone taper treatment successfully decreased the size of the mass and was administered periodically as observation required. A repeat CT scan in July 2009 revealed a diffusely enlarged left parotid gland with complete resolution of the discrete mass (<xref ref-type="fig" rid="jscr-2012-6-7fig1">Fig.1</xref>––<xref ref-type="fig" rid="jscr-2012-6-7fig2">2</xref>). He was conservatively managed with periodic steroids until April 2010, when he complained of pain in the region and a feeling of gradual increase in size. A left parotidectomy was performed in May 2010, with removal of both the superficial and deep lobes of the parotid gland along with identification and preservation of the facial nerve.). He was conservatively managed with periodic steroids until April 2010, when he complained of pain in the region and a feeling of gradual increase in size. A left parotidectomy was performed in May 2010, with removal of both the superficial and deep lobes of the parotid gland along with identification and preservation of the facial nerve.'], 'jscr-2012-6-7fig3': ['Histologic examination on hematoxylin and eosin stained paraffin-embedded tissue revealed replacement of the parotid gland with sheets of large histiocytic cells containing abundant clear to eosinophilic cytoplasm and large vesicular nuclei. Many histiocytes showed emperipolesis, with engulfed and partially digested plasma cells, lymphocytes and neutrophils (<xref ref-type="fig" rid="jscr-2012-6-7fig3">Fig.3</xref>). Immunohistochemistry stains for s100 protein were strongly positive in the histiocytes (). Immunohistochemistry stains for s100 protein were strongly positive in the histiocytes (<xref ref-type="fig" rid="jscr-2012-6-7fig4">Fig.4</xref>) and stains for CD1a were diffusely negative. Interestingly, in-situ hybridization for kappa and lambda proteins showed a marked kappa-predominance within the plasma cells with Russell Bodies, though definitive light-chain restriction was not identified.) and stains for CD1a were diffusely negative. Interestingly, in-situ hybridization for kappa and lambda proteins showed a marked kappa-predominance within the plasma cells with Russell Bodies, though definitive light-chain restriction was not identified.']} | Rosai Dorfman Disease presenting as unilateral chronic parotitis | null | J Surg Case Rep | 1338534000 | [{'@Label': 'PATIENT', '@NlmCategory': 'METHODS', '#text': 'Female, 58 FINAL DIAGNOSIS: Solitary paraganglioma of the hypoglossal nerve Symptoms: Neck pain Medication: - Clinical Procedure: Surgical resection Specialty: Otolaryngology.'}, {'@Label': 'OBJECTIVE', '@NlmCategory': 'OBJECTIVE', '#text': 'Rare disease.'}, {'@Label': 'BACKGROUND', '@NlmCategory': 'BACKGROUND', '#text': 'Paragangliomas are rare neuroendocrine tumors originating in the neural crest. Only a few cases of hypoglossal paraganglioma have been reported in the published literature. The localization of hypoglossal paragangliomas close to the carotid artery precludes determination of tumor origin preoperatively.'}, {'@Label': 'CASE REPORT', '@NlmCategory': 'METHODS', '#text': 'A 58-year-old female patient was admitted due to neck pain. During physical examination, a significant mass could not be palpated in the upper left part of the neck, despite sensitivity during palpation. Atrophy and left deviation of the left half of the tongue was observed. MRI of the neck revealed a lesion located superior to the carotid bifurcation between the left internal carotid artery and external carotid artery. There was atrophy in the left half of the tongue. The neck mass displaced the left internal carotid artery anteriorly and medially. The operation was performed with left lateral cervical access. This lesion, which derived from the hypoglossal nerve, was excised. Following histopathological evaluation, the lesion was diagnosed as paraganglioma.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'Hypoglossal paraganglioma is quite rare and there are no established criteria for preoperative diagnosis. Hypoglossal paraganglioma must be considered to determine treatment options if a lateral neck mass and ipsilateral tongue atrophy are present at the level of the 12th cranial nerve tract.'}] | [] | other | PMC3862464 | null | 10 | [
"{'Citation': 'Raza K, Kaliaperumal C, Farrell M, et al. Solitary paraganglioma of the hypoglossal nerve: case report. Neurosurgery. 2011;68:1170–74.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21792092'}}}",
"{'Citation': 'Santovito D, Conforti M, Varetto G, Rispoli P. Paraganglioma of the hypoglossal nerve. J Vasc Surg. 2009;49:1053–55.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19341894'}}}",
"{'Citation': 'Farr MR, Martin TP, Walsh AR, Irving RM. A case of paraganglioma of the hypoglossal nerve. J Laryngol Otol. 2010;124:e3.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '20403225'}}}",
"{'Citation': 'Bademci G, Yaşargil MG. Microsurgical anatomy of the hypoglossal nerve. J Clin Neurosci. 2006;3:841–47.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16935514'}}}",
"{'Citation': 'Fink DS, Benoit MM, Lamuraglia GM, Deschler DG. Paraganglioma of the hypoglossal nerve. Laryngoscope. 2010;120:S147.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21225745'}}}",
"{'Citation': 'Thabet MH, Kotob H. Cervical paragangliomas: diagnosis, management and complications. J Laryngol Otol. 2001;115:467–74.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11429070'}}}",
"{'Citation': 'Netterville JL, Jackson CG, Miller FR, et al. Vagal paraganglioma: a review of 46 patients treated during a 20-year period. Arch Otolaryngol Head Neck Surg. 1998;124:1133–40.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9776192'}}}",
"{'Citation': 'Olsen WL, Dillon WP, Kelly WM, et al. MR imaging of paragangliomas. AJR Am J Roentgenol. 1987;148:201–4.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '3024473'}}}",
"{'Citation': 'Shintani T, Oyake D, Kanayama R, et al. Rare localization of paraganglioma in head and neck. Auris Nasus Larynx. 2003;30:149–52.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12543183'}}}",
"{'Citation': 'Hafez RF, Morgan MS, Fahmy OM. The safety and efficacy of gamma knife surgery in management of glomus jugulare tumor. World J Surg Oncol. 2010;8:76.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2942884'}, {'@IdType': 'pubmed', '#text': '20819207'}]}}"
] | J Surg Case Rep. 2012 Jun 1; 2012(6):7 | NO-CC CODE |
|
MRI scan showing cystic lesion within lateral neck | jscr-2012-6-8fig1 | 7 | fc886025e2adae580fc794456d222cba1d150563dbadd10a5dd18993c059ce7f | jscr-2012-6-8fig1.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
590,
590
] | [{'image_id': 'jscr-2012-6-8fig1', 'image_file_name': 'jscr-2012-6-8fig1.jpg', 'image_path': '../data/media_files/PMC3862607/jscr-2012-6-8fig1.jpg', 'caption': 'MRI scan showing cystic lesion within lateral neck', 'hash': 'fc886025e2adae580fc794456d222cba1d150563dbadd10a5dd18993c059ce7f'}, {'image_id': 'jscr-2012-6-8fig2', 'image_file_name': 'jscr-2012-6-8fig2.jpg', 'image_path': '../data/media_files/PMC3862607/jscr-2012-6-8fig2.jpg', 'caption': 'Intraoperative photograph of the excised submandibular gland mucocele', 'hash': '32341e6d15ba0a4f78dd86c1bb268585a85ebfc0b7af929777aa85e69cdce073'}] | {'jscr-2012-6-8fig1': ['Examination of the oral cavity and oropharynx was unremarkable. Palpation of the neck mass revealed a soft, fluctuant, non-tender swelling approximately 6cm in diameter arising superficially within the right submandibular region. There was no associated cervical lymphadenopathy. A magnetic resonance imaging (MRI) scan revealed a large cystic structure in the right lateral neck involving the submandibular space (<xref ref-type="fig" rid="jscr-2012-6-8fig1">Fig 1</xref>). There was no ‘tail’ sign. No other abnormalities were demonstrated. Fine needle aspiration biopsy revealed abundant cystic fluid. The sample proved inadequate for cytological assessment, however was found to have a raised amylase and protein content suggesting salivary origin. Routine blood tests were all normal.). There was no ‘tail’ sign. No other abnormalities were demonstrated. Fine needle aspiration biopsy revealed abundant cystic fluid. The sample proved inadequate for cytological assessment, however was found to have a raised amylase and protein content suggesting salivary origin. Routine blood tests were all normal.'], 'jscr-2012-6-8fig2': ['Under general anaesthesia the cystic mass was meticulously excised intact via a low submandibular incision. It was found to be in continuity with the ipsilateral submandibular gland (<xref ref-type="fig" rid="jscr-2012-6-8fig2">Fig 2</xref>). Histolopathology of the specimen confirmed a fibrous-walled retention cyst associated with a submandibular gland showing chronic obstructive changes. The patient made an uneventful post-operative recovery with no evidence of recurrence at six months.). Histolopathology of the specimen confirmed a fibrous-walled retention cyst associated with a submandibular gland showing chronic obstructive changes. The patient made an uneventful post-operative recovery with no evidence of recurrence at six months.']} | Submandibular gland mucocele presenting as a lateral neck swelling | null | J Surg Case Rep | 1338534000 | Radiotherapy plays an important role in the treatment of rectal cancer. Three-dimensional conformal radiotherapy and intensity-modulated radiotherapy are mainstay techniques of radiotherapy for rectal cancer. However, the success of these techniques is heavily reliant on accurate target delineation and treatment planning. Computed tomography simulation is a cornerstone of rectal cancer radiotherapy, but there are limitations, such as poor soft-tissue contrast between pelvic structures and partial volume effects. Magnetic resonance imaging and positron emission tomography (PET) can overcome these limitations and provide additional information for rectal cancer treatment planning. PET can also reduce the interobserver variation in the definition of rectal tumor volume. However, there is a long way to go before these image modalities are routinely used in the clinical setting. This review summarizes the most promising studies on clinical applications of multimodality imaging in target delineation and treatment planning for rectal cancer radiotherapy. | [
"Humans",
"Magnetic Resonance Imaging",
"Multimodal Imaging",
"Positron-Emission Tomography",
"Radiotherapy Planning, Computer-Assisted",
"Rectal Neoplasms",
"Tomography, X-Ray Computed"
] | other | PMC3862607 | null | 48 | [
"{'Citation': 'Kosinski L, Habr-Gama A, Ludwig K, Perez R. Shifting concepts in rectal cancer management: a review of contemporary primary rectal cancer treatment strategies. CA Cancer J Clin. 2012;62:173–202.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '22488575'}}}",
"{'Citation': 'Glimelius B, Grönberg H, Järhult J, Wallgren A, Cavallin-Ståhl E. A systematic overview of radiation therapy effects in rectal cancer. Acta Oncol. 2003;42:476–492.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14596508'}}}",
"{'Citation': 'Sauer R, Fietkau R, Wittekind C, et al. German Rectal Cancer Group. Adjuvant vs. neoadjuvant radiochemotherapy for locally advanced rectal cancer: the German trial CAO/ARO/AIO-94. Colorectal Dis. 2003;5:406–415.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12925071'}}}",
"{'Citation': 'Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–646.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11547717'}}}",
"{'Citation': 'Sebag-Montefiore D, Steele R, Quirke P, Grieve R, Khanna S, Monson J. Routine short course pre-op radiotherapy or selective post-op chemoradiotherapy for resectable rectal cancer? Preliminary results of the MRC CR07 randomised trial. J Clin Oncol. 2006;24:3511.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '0'}}}",
"{'Citation': 'Valentini V, Beets-Tan R, Borras JM, et al. Evidence and research in rectal cancer. Radiother Oncol. 2008;87:449–474.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18534701'}}}",
"{'Citation': 'Gwynne S, Mukherjee S, Webster R, Spezi E, Staffurth J, Coles B, Adams R. Imaging for target volume delineation in rectal cancer radiotherapy—a systematic review. Clin Oncol (R Coll Radiol) 2012;24:52–63.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '22035634'}}}",
"{'Citation': 'Cella L, Ciscognetti N, Martin G, et al. Preoperative radiation treatment for rectal cancer: comparison of target coverage and small bowel NTCP in conventional vs. 3D-conformal planning. Med Dosim. 2009;34:75–81.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19181259'}}}",
"{'Citation': 'Borger JH, van den Bogaard J, de Haas DF, et al. Evaluation of three different CT simulation and planning procedures for the preoperative irradiation of operable rectal cancer. Radiother Oncol. 2008;87:350–356.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18453024'}}}",
"{'Citation': 'Khoo VS, Joon DL. New developments in MRI for target volume delineation in radiotherapy. Br J Radiol. 2006;79:S2–S15.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16980682'}}}",
"{'Citation': 'Myerson R, Drzymala R. Technical aspects of image-based treatment planning of rectal carcinoma. Semin Radiat Oncol. 2003;13:433–440.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14586832'}}}",
"{'Citation': 'Blomqvist L, Rubio C, Holm T, Machado M, Hindmarsh T. Rectal adenocarcinoma: assessment of tumour involvement of the lateral resection margin by MRI of resected specimen. Br J Radiol. 1999;72:18–23.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10341684'}}}",
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"{'Citation': 'Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg. 2003;90:355–364.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12594673'}}}",
"{'Citation': 'MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ. 2006;333:779.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC1602032'}, {'@IdType': 'pubmed', '#text': '16984925'}]}}",
"{'Citation': 'Beets-Tan RG, Beets GL, Vliegen RF, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet. 2001;357:497–504.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11229667'}}}",
"{'Citation': 'Kulkarni T, Gollins S, Maw A, Hobson P, Byrne R, Widdowson D. Magnetic resonance imaging in rectal cancer downstaged using neoadjuvant chemoradiation: accuracy of prediction of tumour stage and circumferential resection margin status. Colorectal Dis. 2008;10:479–489.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18318754'}}}",
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"{'Citation': 'Rao SX, Zeng MS, Chen CZ, et al. The value of diffusion-weighted imaging in combination with T2-weighted imaging for rectal cancer detection. Eur J Radiol. 2008;65:299–303.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17498902'}}}",
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"{'Citation': 'Myerson RJ, Garofalo MC, El Naqa I, et al. Elective clinical target volumes for conformal therapy in anorectal cancer: a Radiation Therapy Oncology Group consensus panel contouring atlas. Int J Radiat Oncol Biol Phys. 2009;74:824–830.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2709288'}, {'@IdType': 'pubmed', '#text': '19117696'}]}}",
"{'Citation': 'Pandharipande PV, Mora JT, Uppot RN, et al. Lymphotropic nanoparticle-enhanced MRI for independent prediction of lymph node malignancy: a logistic regression model. Am J Roentgenol. 2009;193:W230–W237.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19696264'}}}",
"{'Citation': 'Froehlich JM, Triantafyllou M, Fleischmann A, Vermathen P, Thalmann GN, Thoeny HC. Does quantification of USPIO uptake-related signal loss allow differentiation of benign and malignant normal-sized pelvic lymph nodes? Contrast Media Mol Imaging. 2012;7:346–355.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '22539405'}}}",
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] | J Surg Case Rep. 2012 Jun 1; 2012(6):8 | NO-CC CODE |
|
Cervical spine magnetic resonance imaging. Cervical cord has a normal diameter and signal without evidence for compression. Cervical vertebrae have normal height without fractures or pathological lesions. Cervical canal has a normal diameter without any congenital or acquired stenosis. The alignment of the cervical spine is normal without any evidence for disc herniation. Tonsillar herniation to the cervical spine is seen. | f00029-2 | 7 | 28bafcb702a9e1e16b5c3e519e19160a28deace3ce582f53eeb2fbe0db41f302 | f00029-2.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
420,
800
] | [{'image_id': 'f00029-2', 'image_file_name': 'f00029-2.jpg', 'image_path': '../data/media_files/PMC3864413/f00029-2.jpg', 'caption': 'Cervical spine magnetic resonance imaging. Cervical cord has a normal diameter and signal without evidence for compression. Cervical vertebrae have normal height without fractures or pathological lesions. Cervical canal has a normal diameter without any congenital or acquired stenosis. The alignment of the cervical spine is normal without any evidence for disc herniation. Tonsillar herniation to the cervical spine is seen.', 'hash': '28bafcb702a9e1e16b5c3e519e19160a28deace3ce582f53eeb2fbe0db41f302'}, {'image_id': 'f00029-3', 'image_file_name': 'f00029-3.jpg', 'image_path': '../data/media_files/PMC3864413/f00029-3.jpg', 'caption': 'Spiral chest computed tomography. Pulmonary parenchyma and vessels are normal. There is no nodule or occupied lesion in the parenchyma. Mediastinum and pulmonary hila are normal. No pleural lesion or pleural effusion is seen. Pericardium is normal. Mediastinal vessels do not show any pathology. Lungs are relatively hyperinflated.', 'hash': 'ae6bf1772db4410db3813076972b81e4ded5651ae15af062c9bfc8bd7baab4c8'}, {'image_id': 'f00029-1', 'image_file_name': 'f00029-1.jpg', 'image_path': '../data/media_files/PMC3864413/f00029-1.jpg', 'caption': 'Brain magnetic resonance imaging. A hypointense signal mass in the left hemisphere of the cerebellum causing mass effects on the fourth ventricle, which shifted it, accompanied with dilation of third and lateral ventricles.', 'hash': '3e0d381454d7f54db543bbc90b9b31f7e1f7507e3a6e5d617f013a437c5bb39e'}] | {'f00029-1': ['Brain magnetic resonance imaging (MRI) confirmed a hypointense-signal mass in the left hemisphere of the cerebellum causing mass effects on the fourth ventricle, which shifted it, accompanied with dilation of third and lateral ventricles. Hypertensive cerebrospinal fluid (CSF) form of hydrocephaly was seen in the supratentorial region, but the fourth ventricle was normal. Subependymal CSF diffusion around lateral ventricles was found. The possibility of aqueduct stenosis or obstruction was mentioned (<xref rid="f00029-1" ref-type="fig">\n<bold>Fig. 1</bold>\n</xref>). Cervical spine MRI revealed a normal spinal column with herniation of the cerebellar tonsil (Fig. 1\n). Cervical spine MRI revealed a normal spinal column with herniation of the cerebellar tonsil (<xref rid="f00029-2" ref-type="fig">\n<bold>Fig. 2</bold>\n</xref>).Fig. 2\n).'], 'f00029-3': ['Postoperative spiral chest computed tomography (CT) scan showed a normal pulmonary parenchyma without evidence for pulmonary tuberculosis, Thus, the patient had a primary extrapulmonary cerebellar tuberculoma (<xref rid="f00029-3" ref-type="fig">\n<bold>Fig. 3</bold>\n</xref>). The patient has been followed to now; the neurological symptoms were alleviated 6 months subsequent to the surgery.Fig. 3\n). The patient has been followed to now; the neurological symptoms were alleviated 6 months subsequent to the surgery.']} | Primary Cerebellar Tuberculoma in Arnold-Chiari Malformation Mimicking Posterior Cranial Fossa Tumor: The First Report | [
"cerebellar tuberculoma",
"Arnold-Chiari malformation",
"cranial fossa tumor"
] | Global Spine J | 1322726400 | Despite promising advances in basic spinal cord repair research, no effective therapy resulting in major neurological or functional recovery after traumatic spinal cord injury (tSCI) is available to date. The neurological examination according to the International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients (International Standards) has become the cornerstone in the assessment of the severity and level of the injury. Based on parameters from the International Standards, physicians are able to inform patients about the predicted long-term outcomes, including the ability to walk, with high accuracy. In those patients who cannot participate in a reliable physical neurological examination, magnetic resonance imaging and electrophysiological examinations may provide useful diagnostic and prognostic information. As clinical research on this topic continues, the prognostic value of the reviewed diagnostic assessments will become more accurate in the near future. These advances will provide useful information for physicians to counsel tSCI patients and their families during the catastrophic initial phase after the injury. | [] | other | PMC3864413 | null | 37 | [
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"{'Citation': 'Kwon BK, Stammers AM, Belanger LM. et al.Cerebrospinal fluid inflammatory cytokines and biomarkers of injury severity in acute human spinal cord injury. J Neurotrauma. 2010;27:669–682.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '20038240'}}}"
] | Global Spine J. 2011 Dec; 1(1):19-22 | NO-CC CODE |
|
Caudal extent of contrast dispersion is shown (most caudal extent that was scanned). | f00001-2 | 7 | 75909055d4a6c7d414c9d52ab1bcda0f236469cbfc310f6fff63494db0d3a64e | f00001-2.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
742,
800
] | [{'image_id': 'f00001-2', 'image_file_name': 'f00001-2.jpg', 'image_path': '../data/media_files/PMC3864458/f00001-2.jpg', 'caption': 'Caudal extent of contrast dispersion is shown (most caudal extent that was scanned).', 'hash': '75909055d4a6c7d414c9d52ab1bcda0f236469cbfc310f6fff63494db0d3a64e'}, {'image_id': 'f00001-3', 'image_file_name': 'f00001-3.jpg', 'image_path': '../data/media_files/PMC3864458/f00001-3.jpg', 'caption': 'Bilateral foraminal extension is shown at the level of T12–L1.', 'hash': '968497e3f9b355383317fbc1ee96407c44b59536be48347befb7782b6c620eb5'}, {'image_id': 'f00001-1', 'image_file_name': 'f00001-1.jpg', 'image_path': '../data/media_files/PMC3864458/f00001-1.jpg', 'caption': 'Superior extent of contrast dispersion is shown at the level of T11 (the most superior extent that was scanned). All images are from an 82-year-old man with lumbar stenosis who received an L4–5 lumbar interlaminar epidural steroid injection.', 'hash': '4468cef0a19186d3a181584a40d3fb434522fad211046cdee3b7c6ea39514fdb'}] | {'f00001-1': ['Data were obtained from 10 patients (six women and four men) with a mean age of 69.3 (38 to 84) years. Seven of the included patients had lumbar stenosis, and the other three patients had herniated discs. The mean diffusion in the rostral direction from the injection site was 9.8 cm with a standard deviation of 4.0 cm and a range of 4.0 to 15.0 cm (<xref rid="f00001-1" ref-type="fig">Fig. 1</xref>). The mean diffusion in the caudal direction was 5.4 cm with a standard deviation of 1.4 cm and a range of 3.0 to 8.0 cm (). The mean diffusion in the caudal direction was 5.4 cm with a standard deviation of 1.4 cm and a range of 3.0 to 8.0 cm (<xref rid="f00001-2" ref-type="fig">Fig. 2</xref>). Both rostral and caudal flow dispersion had a ). Both rostral and caudal flow dispersion had a p value <0.001 with a null value of 3.0 cm (Table 1). We used 3.0 cm for our null value as prior studies determined one vertebral level of diffusion to be significant (~3.0 cm).7\n12 Ultimately, the authors felt as though measuring by centimeters would be more objectively reproducible than measuring by vertebral levels. The circumferential flow was 360 degrees in 9 of 10 patients (90%; <xref rid="f00001-3" ref-type="fig">Fig. 3</xref>). The one patient without circumferential flow had displayed contrast diffusion of 270 degrees.). The one patient without circumferential flow had displayed contrast diffusion of 270 degrees.']} | Dispersal Pattern of Injectate after Lumbar Interlaminar Epidural Spinal Injection Evaluated with Computerized Tomography | [
"spine related conditions",
"lumbar",
"interlaminar",
"epidural",
"steroid",
"injection",
"epidurogram",
"computerized tomography"
] | Global Spine J | 1330588800 | None | null | other | PMC3864458 | null | null | [
""
] | Global Spine J. 2012 Mar; 2(1):27-32 | NO-CC CODE |
|
Extensive right paravertebral osteogenic sarcoma L2 vertebra. | f120011-21 | 7 | 95421f340514b635dfc754ae78f5f07a25da296f15ddc1c08432507ede7c73a4 | f120011-21.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
800,
424
] | [{'image_id': 'f120011-15', 'image_file_name': 'f120011-15.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-15.jpg', 'caption': 'Large chordoma emanating from the left side of C3–4 intervertebral foramen.', 'hash': '6aa2ca2a53b36009d938804b8c41f4b28bba7483adc10e94d6e172747a33f936'}, {'image_id': 'f120011-12', 'image_file_name': 'f120011-12.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-12.jpg', 'caption': 'Large posterior cervical solitary fibrous tumor in a 37-year-old man.', 'hash': 'ca8da9b2f74749045c7065f73c17801d92920d8679812c59d9a924db85eea171'}, {'image_id': 'f120011-20', 'image_file_name': 'f120011-20.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-20.jpg', 'caption': 'Resected specimen involving T6–8 vertebral bodies and ribs 5–9.', 'hash': '17ea75d4fe3c7971d207ffeeb64834517572613d9afdb6fcbc29148592fc64b5'}, {'image_id': 'f120011-3', 'image_file_name': 'f120011-3.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-3.jpg', 'caption': 'Advanced osteoporosis postchemotherapy causing “fish spine” in a 16-year-old male.', 'hash': '1fcbba8626a21ed0d44538e056026c3bd2727f72477e5c374bbe2c378c382ebc'}, {'image_id': 'f120011-4', 'image_file_name': 'f120011-4.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-4.jpg', 'caption': "Tomita's surgical classification of spinal tumors.", 'hash': 'bf0faaa90ecfd949f93692b08bccc8ebab52d772395d400d95e971e2fe6988ce'}, {'image_id': 'f120011-21', 'image_file_name': 'f120011-21.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-21.jpg', 'caption': 'Extensive right paravertebral osteogenic sarcoma L2 vertebra.', 'hash': '95421f340514b635dfc754ae78f5f07a25da296f15ddc1c08432507ede7c73a4'}, {'image_id': 'f120011-13', 'image_file_name': 'f120011-13.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-13.jpg', 'caption': 'Schematic representation of technique of pedicular division to facilitate wide excision of tumor extending to the dorsal surface of the cervical laminae.', 'hash': 'cbb0822234838ebbf5c190dc8aad4ff0a9de47e3c02ace3256d633edaccaa52e'}, {'image_id': 'f120011-14', 'image_file_name': 'f120011-14.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-14.jpg', 'caption': 'Postoperative image after resection of cervical benign fibrous tumor.', 'hash': '749d552db39e60d8826c5d028de7e29d4fbcaab76a9dfbf3e03060e0cfe56bf8'}, {'image_id': 'f120011-5', 'image_file_name': 'f120011-5.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-5.jpg', 'caption': "Tomita's view of transpedicular tumor division in the technique of total en bloc spondylectomy (TES).", 'hash': '40d99c80fe8da555e0a3a606d2064e8048480337b02820e49fe788ce44de9d39'}, {'image_id': 'f120011-2', 'image_file_name': 'f120011-2.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-2.jpg', 'caption': "The “owl eye sign” (arrow) in a patient with a left L3 Ewing's sarcoma.", 'hash': '5d98e5997a90d0495fd014f98a3d8014dcc6ed11fb245b619a7727c4e3164f3e'}, {'image_id': 'f120011-8', 'image_file_name': 'f120011-8.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-8.jpg', 'caption': 'Postoperative images (case 1).', 'hash': '666158da238150d316e72ffca6653f73173005ea6f98696a4db364427f6d56fc'}, {'image_id': 'f120011-1', 'image_file_name': 'f120011-1.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-1.jpg', 'caption': 'This radiological appearance was considered likely to be a neural sheath tumor. Biopsy revealed chordoma.', 'hash': 'c48dfb48f1ad40fcf8ad3a8fbcb9920804cfdaacbb2e8a70cc8e306e433ad750'}, {'image_id': 'f120011-6', 'image_file_name': 'f120011-6.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-6.jpg', 'caption': 'Osteoid osteoma left L3 pedicle with hypertrophic transverse process (arrow).', 'hash': 'be7f7ae6a3b56a8b602ea36d7961ea7622f4f74638f2789d06c4fa200dfe8ca3'}, {'image_id': 'f120011-22', 'image_file_name': 'f120011-22.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-22.jpg', 'caption': 'Resected specimen: osteogenic sarcoma L2 vertebra. Note extensive resection of right paravertebral muscle column.', 'hash': '22a92427412a708aabe5a2611180b37ce87623d80f53c7345ae0b62d49070a96'}, {'image_id': 'f120011-19', 'image_file_name': 'f120011-19.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-19.jpg', 'caption': 'Large chondrosarcoma involving the left fifth rib and posterior chest wall.', 'hash': 'b32240f8ae56df115ca5c9235d8e8e117b76e2e154f7d756fc7b2a9e03f0a65c'}, {'image_id': 'f120011-17', 'image_file_name': 'f120011-17.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-17.jpg', 'caption': "Reconstruction following en bloc excision of L3 Ewing's sarcoma.", 'hash': 'a73d7a7fafe857f045853d2a6bdf8a246d212b83e1169efb51df65e230230230'}, {'image_id': 'f120011-10', 'image_file_name': 'f120011-10.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-10.jpg', 'caption': 'C2 pathological fracture through fibrous dysplasia. Note the congenital fusion of C2 and C3. Congenital fusion is a common association of cervical fibrous dysplasia.', 'hash': 'c567e6d0c4cb0928ded50f9a72be6df7e35eba9da720155ab68b18e3b654f201'}, {'image_id': 'f120011-7', 'image_file_name': 'f120011-7.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-7.jpg', 'caption': 'T11 hemangioma with pathological fracture.', 'hash': 'bf33464569fb23083833d10a3e59dfa8c1a4a6cf9a476e116868efe95ceab972'}, {'image_id': 'f120011-9', 'image_file_name': 'f120011-9.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-9.jpg', 'caption': 'Intraoperative view T10 hemangioma showing typical cavernous appearance of the involved bone (arrow).', 'hash': '269a4bf1b201b336cb9da6ea9972a91fe50ffff32663039fac7f710e25e6735a'}, {'image_id': 'f120011-11', 'image_file_name': 'f120011-11.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-11.jpg', 'caption': 'Postoperative reconstruction after excision of C2 fibrous dysplasia.', 'hash': 'b151dfbeca35b69d230d4c073ef8d6bdd25e63845217cbdc58fc84e98cf34022'}, {'image_id': 'f120011-16', 'image_file_name': 'f120011-16.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-16.jpg', 'caption': "Marked reduction in Ewing's tumor volume following neoadjuvant chemotherapy.", 'hash': '5b8d972c52ab4c70b7faacd535b5d0db2ce3b815011566813c4e523bd60e72f6'}, {'image_id': 'f120011-18', 'image_file_name': 'f120011-18.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-18.jpg', 'caption': 'Large left thoracic mass lesion.', 'hash': 'd3e6fd25db5db3d1836b068dd13a7c4af933864317e3f67ddfc8e63e7342d9c0'}, {'image_id': 'f120011-23', 'image_file_name': 'f120011-23.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-23.jpg', 'caption': 'Loss of sagittal and coronal balance 12 months after massive resection of L1 vertebral osteogenic sarcoma. Note that the deformity occurred inferior to the resected/reconstructed segment.', 'hash': '4d44ac4a0b26a8d3dd83a5a64ec266bb71b53e42fb538815374aff9766dff870'}, {'image_id': 'f120011-24', 'image_file_name': 'f120011-24.jpg', 'image_path': '../data/media_files/PMC3864485/f120011-24.jpg', 'caption': 'Rebalancing procedure in case 7.', 'hash': 'd2c4b5a1d628b57d2ca1dd1458fad689561fcfc0ef316b59780e42b7893f50aa'}] | {'f120011-1': ['Despite radiological appearance, diagnosis needs to be confirmed by biopsy. Even the most typical radiological appearance lacks the scientific veracity of histological diagnosis, and the latter is mandatory in successful tumor management (<xref rid="f120011-1" ref-type="fig">Fig. 1</xref>). Biopsy may be percutaneous, open, or excisional.). Biopsy may be percutaneous, open, or excisional.'], 'f120011-2': ['Radiological evaluation is critical in staging and in preoperative planning. In terms of the evaluation of the identified lesion, plain radiographs will indicate overt osteolysis and postural abnormalities including sagittal imbalance. In selected cases, pedicular osteolysis may be evident on anteroposterior view of the thoracolumbar spine as the so-called “owl\'s eye” sign with loss of the typical elliptical appearance of the pedicle on the affected side (<xref rid="f120011-2" ref-type="fig">Fig. 2</xref>). Computed tomography (CT) demonstrates bony tumoral content and extent and MRI depicts the local environment of the lesion, including soft tissue infiltration or expansion, tumor extent and internal consistency, level of hydration, and potential for neurological compromise. On occasion, angiography may be required, particularly when resection of cervical lesions is contemplated, to assess the course and patency of the vertebral arteries.). Computed tomography (CT) demonstrates bony tumoral content and extent and MRI depicts the local environment of the lesion, including soft tissue infiltration or expansion, tumor extent and internal consistency, level of hydration, and potential for neurological compromise. On occasion, angiography may be required, particularly when resection of cervical lesions is contemplated, to assess the course and patency of the vertebral arteries.'], 'f120011-3': ['At the completion of local and systemic staging, neoadjuvant therapy may be considered. Tumor size reduction with neoadjuvant chemotherapy may be dramatic, depending on the histological origins of the tumor. Chemotherapy prior to surgery is often used in both Ewing\'s sarcoma and OGS. Despite its well-demonstrated effects in these malignancies, chemotherapy has numerous musculoskeletal effects that adversely affect future surgical treatment. Foremost among these is a profound effect on bone mineralization (<xref rid="f120011-3" ref-type="fig">Fig. 3</xref>), whereby spinal stabilization may be difficult to achieve with standard techniques of instrumentation. Neoadjuvant therapy may also compromise the patient\'s general physical condition as a significant perioperative comorbidity, particularly with respect to long-standing immunosuppression. Long-term chemotherapy may cause peripheral neuropathy in relation to altered vitamin B metabolism among other causes, and, when present, these symptoms need be differentiated from signs of evolving neurological compromise within the spine.), whereby spinal stabilization may be difficult to achieve with standard techniques of instrumentation. Neoadjuvant therapy may also compromise the patient\'s general physical condition as a significant perioperative comorbidity, particularly with respect to long-standing immunosuppression. Long-term chemotherapy may cause peripheral neuropathy in relation to altered vitamin B metabolism among other causes, and, when present, these symptoms need be differentiated from signs of evolving neurological compromise within the spine.'], 'f120011-4': ['Local staging and biological potential of the tumor will guide surgical approach. A useful guide to deciding on the required approach has been described by Tomita et al (<xref rid="f120011-4" ref-type="fig">Figs. 4</xref>, , <xref rid="f120011-5" ref-type="fig">5</xref>).).43 Options to be considered are posterior, anterior, and combined approaches. In general, a posterior approach alone may be considered when the anterior margin of the tumor is contained within the vertebral body. Involvement of anterior structures beyond the vertebrae may necessitate a combined approach: posteriorly to remove involved posterior elements and to obtain stability and anteriorly to dissect vital structures free of the tumor with a clear margin. Simultaneous, combined anteroposterior surgery using a tri-star incision may be feasible for extensive or multiple-level resection. The patient is typically supported in the lateral position, allowing tumor manipulation from both anterior and posterior directions simultaneously. The latter is particularly useful in the en bloc excision of unilaterally disposed malignant lesions where the operative specimen may be lifted safely away from the thecal sac after contralateral osteotomy, although placement of pedicular instrumentation with the patient in the lateral position can be somewhat challenging and may be assisted by image guidance techniques.'], 'f120011-6': ['Clinical features of osteoid osteoma are typical with older children or adolescents commonly presenting with a painful postural scoliosis (60 to 70%), which is readily relieved by aspirin. Radiological appearances are also characteristic with the lesion often detectable on close inspection of plain radiographs. In children and adolescents, the transverse process immediately adjacent to the lesion is often hypertrophic, possibly as a result of local osseous hyperemia (<xref rid="f120011-6" ref-type="fig">Fig. 6</xref>). The intense osteoblastic activity of the lesion is markedly avid to radioisotope.). The intense osteoblastic activity of the lesion is markedly avid to radioisotope.21\n'], 'f120011-7': ['Imaging workup included CT and MRI (<xref rid="f120011-7" ref-type="fig">Fig. 7</xref>) for both local and systemic staging as well as a protocol battery of blood tests. Following a detailed explanation of her condition and the possible treatment options, she elected to have the lesion treated surgically. An open biopsy confirmed the nature of the lesion as a hemangioma.) for both local and systemic staging as well as a protocol battery of blood tests. Following a detailed explanation of her condition and the possible treatment options, she elected to have the lesion treated surgically. An open biopsy confirmed the nature of the lesion as a hemangioma.'], 'f120011-8': ['At 3-year follow-up the patient has a pleasing recovery to motor level L3 ASIA category D. The construct remains sound (<xref rid="f120011-8" ref-type="fig">Fig. 8</xref>).).'], 'f120011-9': ['In this case, the patient was positioned prone on the operating table with a central bed break to facilitate correction of sagittal alignment using the “closing-opening wedge” correction technique.25 As depicted in <xref rid="f120011-9" ref-type="fig">Fig. 9</xref>, adequate exposure necessitated resection of two rib heads to the rib angles bilaterally in the same manner as may be employed in performing total en bloc spondylectomy. After a three-segment laminectomy, both pedicles of the involved vertebral body were amputated. The segmental vascular bundle on each side of the affected vertebra must be isolated and divided as a specific step as these vessels cross the plane of access to the anterior vertebral body., adequate exposure necessitated resection of two rib heads to the rib angles bilaterally in the same manner as may be employed in performing total en bloc spondylectomy. After a three-segment laminectomy, both pedicles of the involved vertebral body were amputated. The segmental vascular bundle on each side of the affected vertebra must be isolated and divided as a specific step as these vessels cross the plane of access to the anterior vertebral body.', 'Following successful embolization, the hemangioma can be resected piecemeal with a minimum of bleeding (<xref rid="f120011-9" ref-type="fig">Fig. 9</xref>). The intervertebral discs above and below the involved vertebra were resected and the vertebral body was cleared to the level of the anterior longitudinal ligament. After complete resection, the sagittal deformity was corrected according to the principles described by Kawahara et al,). The intervertebral discs above and below the involved vertebra were resected and the vertebral body was cleared to the level of the anterior longitudinal ligament. After complete resection, the sagittal deformity was corrected according to the principles described by Kawahara et al,24 to avoid spinal cord shortening and potential neurological compromise. In a modification of this technique, we prefer to divide the anterior longitudinal ligament from posteriorly to facilitate lengthening of the anterior column.'], 'f120011-10': ['A 34-year-old man presented with axial neck pain and occipital headache 6 weeks following a rugby tackle. He displayed no neurological symptoms, but he required regular paracetamol and struggled to work due to constant nagging pain. Examination revealed a symmetrically reduced range of rotation and a severely reduced range of flexion such that he could bring his chin to within four fingerbreadths from his chest. CT demonstrated a C2 pathological fracture with underlying fibrous dysplasia (<xref rid="f120011-10" ref-type="fig">Fig. 10</xref>).).'], 'f120011-11': ['After piecemeal excision of the lesion, a devascularized fibular graft was harvested to bridge the tumor bed from the C1 anterior arch to C4. This bridging technique was employed due to the tendency of the lesion to resorb even the most robust bone graft reconstruction. The upper end of the graft was fashioned into a “saddle” shape to optimize contact with C1. The lower end of the fibular strut was secured with an interference screw in the C4 vertebral body, and the patient was immobilized in a postoperative halothoracic vest until evidence of bony union was demonstrated on postoperative reconstructed CT (<xref rid="f120011-11" ref-type="fig">Fig. 11</xref>).).'], 'f120011-12': ['A 37-year-old man presented with 14 months of an insidious onset and slowly progressive axial neck pain. His partner had noticed a lump in the month prior to presentation. He had no neurological symptoms. Regular analgesia in the form of paracetamol and tramadol provided limited relief. Examination revealed a large mass deep to fascia. Neurology was normal. Imaging studies revealed a lesion located in the left paraspinal muscles adjacent to the lamina (<xref rid="f120011-12" ref-type="fig">Fig. 12</xref>). Following routine local and systemic staging, a CT-guided core needle biopsy was performed. Histological diagnosis and multidisciplinary musculoskeletal oncology panel review resulted in an en bloc excision with a wide margin being performed.). Following routine local and systemic staging, a CT-guided core needle biopsy was performed. Histological diagnosis and multidisciplinary musculoskeletal oncology panel review resulted in an en bloc excision with a wide margin being performed.'], 'f120011-13': ['The tumor extended onto the dorsal surfaces of several contiguous cervical laminae, so that a wide margin around the deep extent of the lesion necessitated removal of these laminae. To facilitate this, a complete laminectomy was performed at the level immediately subjacent to the resection to access the spinal canal deep to the tumor. In sequence then, working from inferiorly to superiorly, the pedicles of each vertebra were transacted from within the spinal canal using a 5-mm osteotome, enabling the tumor to be gradually elevated from the spine level by level (<xref rid="f120011-13" ref-type="fig">Fig. 13</xref>).).'], 'f120011-14': ['The dynamic balance of the head was defunctioned after such extensive cervical muscle resection, and a long posterior construct utilizing pedicle screws over the cervical segments where the lateral masses had been resected (<xref rid="f120011-14" ref-type="fig">Fig. 14</xref>) was required.) was required.'], 'f120011-15': ['A 29-year-old woman presented with a 9-month history of an enlarging mass in the left side of her neck. She reported 1\u2009month of rapid increase in size and pain at night worsening over 3 months, radiating into the occiput as well as progressive difficulty swallowing. On examination she had a nontender deep mass at the apex of her left posterior triangle. Central and peripheral neurological examinations were normal (<xref rid="f120011-15" ref-type="fig">Fig. 15</xref>).).'], 'f120011-16': ['The patient was a 16-year-old male with 3 months\' back pain, weight loss, and fevers. He displayed left-sided paraspinal muscle spasm and grade II power of hip flexors and knee extensors on the left side. His medical history was unremarkable. He underwent radiotherapy followed by 14 cycles of etoposide and ifosfamide, during which he developed ifosfamide encephalopathy, systemic Candida albicans infection, and osteoporosis (<xref rid="f120011-16" ref-type="fig">Figs. 16</xref>, , <xref rid="f120011-17" ref-type="fig">17</xref>), although with drastic reduction in tumor volume.), although with drastic reduction in tumor volume.'], 'f120011-17': ['For anterior column reconstruction, we prefer to use banked structural allograft for its biological healing capacity and low cost (<xref rid="f120011-17" ref-type="fig">Fig. 17</xref>). Biological reconstructive materials also allow superior postoperative monitoring of both the state of bony union). Biological reconstructive materials also allow superior postoperative monitoring of both the state of bony union36 and local tumor recurrence.'], 'f120011-18': ['A 60-year-old man presented with 6 months\' duration of worsening left chest wall pain and weight loss. Pain was typically worse at night. There was a history of well-controlled hypertension. On examination, he had altered sensation on the left chest wall below the nipple and above the xiphisternum. Motor examination was unremarkable (<xref rid="f120011-18" ref-type="fig">Figs. 18</xref>, , <xref rid="f120011-19" ref-type="fig">19</xref>).).'], 'f120011-20': ['The guidance of an assisting musculoskeletal oncology surgeon is critical in avoiding breech of the tumor. In this case, three contiguous thoracic vertebral segments and five attached ribs were excised to achieve clearance of a high-grade chondrosarcoma (<xref rid="f120011-20" ref-type="fig">Fig. 20</xref>).).'], 'f120011-21': ['A 49-year-old man presented with an 8-month history of lumbar spinal pain and weight loss. MRI revealed a large right-sided lesions emanating from the L1 vertebra (<xref rid="f120011-21" ref-type="fig">Fig. 21</xref>). Biopsy proved OGS. The patient proceeded to single-stage multilevel total en bloc spondylectomy (). Biopsy proved OGS. The patient proceeded to single-stage multilevel total en bloc spondylectomy (<xref rid="f120011-22" ref-type="fig">Fig. 22</xref>).).'], 'f120011-23': ['At ∼12 months after extensive three-level resection of a large L1 level OGS, the patient rapidly lost both sagittal and coronal spinal balance leading to difficulty in mobilization and lower back pain (<xref rid="f120011-23" ref-type="fig">Fig. 23</xref>). Initial surgery had included right-sided paravertebral muscle column resection, interrupting the balancing “check rein” of paraspinal soft tissues. Note that decompensation occurred below the instrumented segment, implying failure of soft tissue supports outside the zone of the reconstruction. Using a corrective biplanar pedicle subtraction osteotomy technique, balance was restored and fixation was extended to the ilia (). Initial surgery had included right-sided paravertebral muscle column resection, interrupting the balancing “check rein” of paraspinal soft tissues. Note that decompensation occurred below the instrumented segment, implying failure of soft tissue supports outside the zone of the reconstruction. Using a corrective biplanar pedicle subtraction osteotomy technique, balance was restored and fixation was extended to the ilia (<xref rid="f120011-24" ref-type="fig">Fig. 24</xref>).).']} | Strategy in the Surgical Treatment of Primary Spinal Tumors | [
"spinal tumors",
"primary tumors"
] | Global Spine J | 1356595200 | None | null | other | PMC3864485 | null | null | [
""
] | Global Spine J. 2012 Dec 27; 2(4):249-266 | NO-CC CODE |
|
Examples of CT slices. | 11086_2021_3601_Fig1_HTML | 7 | 8902cbb2046f9b0b3e8ee297fe9b325bc411e0d6849e6578b149dfb64c7bbf97 | 11086_2021_3601_Fig1_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
614,
205
] | [{'image_id': '11086_2021_3601_Fig4_HTML', 'image_file_name': '11086_2021_3601_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC8322634/11086_2021_3601_Fig4_HTML.jpg', 'caption': 'Architecture of the network with RCCA module.', 'hash': '5646fac9039d4aec1dcb78cdb13a1c60d7bddaa8f8ef46fd3224710638152fa9'}, {'image_id': '11086_2021_3601_Fig3_HTML', 'image_file_name': '11086_2021_3601_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC8322634/11086_2021_3601_Fig3_HTML.jpg', 'caption': 'The example of a slice masked with filling constants corresponding to air (left) and tissue (right).', 'hash': '743d4082741d94a433b90615eb625ad0b537ca70404dce2822f6667f36dc4597'}, {'image_id': '11086_2021_3601_Fig5_HTML', 'image_file_name': '11086_2021_3601_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC8322634/11086_2021_3601_Fig5_HTML.jpg', 'caption': 'Architecture of the network with auxiliary loss.', 'hash': '300f00aa3eeaf44ef6d053b3641cd7c6ac9b4225e4635de5863a8330d5180408'}, {'image_id': '11086_2021_3601_Fig2_HTML', 'image_file_name': '11086_2021_3601_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC8322634/11086_2021_3601_Fig2_HTML.jpg', 'caption': 'Baseline architecture of the network.', 'hash': '73dec52c0aa3c646b296c3c15bf2caa87d40d198a5550d4e6a0aff38485a56fe'}, {'image_id': '11086_2021_3601_Fig1_HTML', 'image_file_name': '11086_2021_3601_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC8322634/11086_2021_3601_Fig1_HTML.jpg', 'caption': 'Examples of CT slices.', 'hash': '8902cbb2046f9b0b3e8ee297fe9b325bc411e0d6849e6578b149dfb64c7bbf97'}, {'image_id': '11086_2021_3601_Fig6_HTML', 'image_file_name': '11086_2021_3601_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC8322634/11086_2021_3601_Fig6_HTML.jpg', 'caption': 'Architecture of the network with RCCA module and auxiliary loss.', 'hash': '063a8d63abf19073aaf60d7017e3cff159a373829a7900f2be52ea529b7528cf'}, {'image_id': '11086_2021_3601_Fig7_HTML', 'image_file_name': '11086_2021_3601_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC8322634/11086_2021_3601_Fig7_HTML.jpg', 'caption': 'Example of work on the slice with pleural effusion.', 'hash': 'dce54bd8714626a382b1bb68d3239988af094292eca015ac44922465e9681463'}] | {'11086_2021_3601_Fig1_HTML': ['The dataset was provided by Third Opinion Platform [6]. It contained 938 studies of patients with Covid-19. Studies were stored in dicom format. Preprocessing was not performed. Examples of slices can be seen on <xref rid="11086_2021_3601_Fig1_HTML" ref-type="fig">Fig. 1</xref>..'], '11086_2021_3601_Fig2_HTML': ['In this work we achieved the aim of reducing the number of blobs outside the lungs, by suggesting methods of decreasing the number of such components. The baseline is a U-Net-like [7] neural network. The architecture is shown on <xref rid="11086_2021_3601_Fig2_HTML" ref-type="fig">Fig. 2</xref>. It was trained on classes “background”, “lung”, “pathology”, “pleural effusion” with cross-entropy loss function.. It was trained on classes “background”, “lung”, “pathology”, “pleural effusion” with cross-entropy loss function.'], '11086_2021_3601_Fig3_HTML': ['One of the approaches is to segment lungs and then segment pathologies inside masked lungs. Segmentation can also be performed on smaller images that will improve the quality of segmentation, because lungs occupy a larger part of a slice than pathologies.But in this case pleural effusion would be masked as it is not the part of lungs. Also this approach results in additional computational effort and time cost. One of the questions of this approach is which constant to use for filling the masked area. On one hand it can be filled with value corresponding to air, but on other hand with value, corresponding to surrounding tissue. Both ways were tried. Examples of different constant usage can be seen on <xref rid="11086_2021_3601_Fig3_HTML" ref-type="fig">Fig. 3</xref>..'], '11086_2021_3601_Fig4_HTML': ['This module was introduced in the paper CCNet: Criss-Cross Attention for Semantic Segmentation [8]. The main idea of the module is to distribute information within the whole image, so the network could better differentiate pathologies and lungs from similar structures, using the context from the whole image. In this work the rcca module is placed between the encoder and the decoder of the baseline network as shown in <xref rid="11086_2021_3601_Fig4_HTML" ref-type="fig">Fig. 4</xref>..'], '11086_2021_3601_Fig7_HTML': ['Comparing the values of metrics, we conclude that the usage of auxiliary loss reduces the number of blobs outside the lungs and slightly decreases the quality in studies with pathologies of small size, but increases the quality in studies with pathologies of big size. Also, despite the decrease of the segmentation quality due to the usage of the RCCA module, if the auxiliary loss is applied afterwards, it gives benefits to the studies with big size pathologies and reduces the number of blobs outside, while slightly decreasing values of general metrics in studies with a small number of pathologies. Examples of how the model works can be seen on <xref rid="11086_2021_3601_Fig7_HTML" ref-type="fig">Fig. 7</xref>. In the upper row in the left corner radiological assessment is shown, on the right corner there is the model prediction. In the bottom row there is an original slice with different display settings.. In the upper row in the left corner radiological assessment is shown, on the right corner there is the model prediction. In the bottom row there is an original slice with different display settings.']} | The Improvement of Segmentation of Lung Pathologies and Pleural Effusion on CT-scans of Patients with Covid-19 | null | Program Comput Soft | 1627628400 | None | null | other | PMC8322634 | null | null | [
""
] | Program Comput Soft. 2021 Jul 30; 47(4):327-333 | NO-CC CODE |
|
A 13-year-old girl with suspected organising pneumonia (BOOP) in both lungs. Transverse T2-weighted TSE images (a) were acquired with the navigator technique (sample volume placed on the dome of the right liver lobe). The open arrow indicates an oval-shaped consolidation with pleural contact in the lower left lobe and moderate signal intensity. Coronal contrast-enhanced fat-saturated T1-weighted GRE images (b) were acquired with the breathhold technique. The open arrow indicates the oval-shaped consolidation in the lower left lobe with contrast enhancement; this is interpreted as an indicator of an active inflammatory process | 13244_2011_142_Fig4_HTML | 7 | 57ad0203b27619a6de9ff1bd3d50f721c1954971f5d41825807a9688bf60361a | 13244_2011_142_Fig4_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
793,
1348
] | [{'image_id': '13244_2011_142_Fig4_HTML', 'image_file_name': '13244_2011_142_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3481076/13244_2011_142_Fig4_HTML.jpg', 'caption': 'A 13-year-old girl with suspected organising pneumonia (BOOP) in both lungs. Transverse T2-weighted TSE images (a) were acquired with the navigator technique (sample volume placed on the dome of the right liver lobe). The open arrow indicates an oval-shaped consolidation with pleural contact in the lower left lobe and moderate signal intensity. Coronal contrast-enhanced fat-saturated T1-weighted GRE images (b) were acquired with the breathhold technique. The open arrow indicates the oval-shaped consolidation in the lower left lobe with contrast enhancement; this is interpreted as an indicator of an active inflammatory process', 'hash': '57ad0203b27619a6de9ff1bd3d50f721c1954971f5d41825807a9688bf60361a'}, {'image_id': '13244_2011_142_Fig3_HTML', 'image_file_name': '13244_2011_142_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3481076/13244_2011_142_Fig3_HTML.jpg', 'caption': 'A 56-year-old female patient with small cell lung cancer. The transverse T2-weighted fat-saturated (a) and T1-weighted contrast-enhanced fat-saturated 3D-GRE images (b, c) show a large, centrally necrotic mass in the left upper lobe with large peri-hilar lymph node metastases. Note the high soft tissue contrast between alelectatic lung (open arrow), small rim of solid tumour (filled arrow) and colliquated central portion of the mass (asterisk)', 'hash': '1822385705d34633c04ab8b93d9badd3e21adca92692f9cf9793b0a38484de15'}, {'image_id': '13244_2011_142_Fig5_HTML', 'image_file_name': '13244_2011_142_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3481076/13244_2011_142_Fig5_HTML.jpg', 'caption': 'Infiltrative disorder of the lung. Typical fibrotic changes in a patient with interstitial pulmonary fibrosis. Extensive reticulation and architectural distortion predominant in the subpleural regions of the lung are well demonstrated by the axial (a, b) and coronal (c–e) MR images obtained using the half-Fourier single-shot fast spin echo (a, c, e) and post-constrast volume interpolated T1-weighted GRE (b, e) sequences', 'hash': 'be4a9af0d2f8b093ed2401b50402db218c9efe9309cbb44324b49007d56c9111'}, {'image_id': '13244_2011_142_Fig2_HTML', 'image_file_name': '13244_2011_142_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3481076/13244_2011_142_Fig2_HTML.jpg', 'caption': 'A 55-year-old patient with acute pulmonary embolism. Coronal steady-state free precession images acquired during free breathing (a) and contrast-enhanced coronal 3d flash angiogram acquired in breathhold (b; embolus inside the right lower lobe artery circled); c series of subtracted images from the first pass perfusion study, perfusion deficits marked with open arrows at the image obtained at peak lung enhancement; 1.5-T MRI scanner', 'hash': '424da356942cfba04beda4da959a8932a602394f7db4ff029ddffbb39bea7997'}, {'image_id': '13244_2011_142_Fig1_HTML', 'image_file_name': '13244_2011_142_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3481076/13244_2011_142_Fig1_HTML.jpg', 'caption': 'A 29-year-old female with cystic fibrosis. The axial T2-weighted (BLADE; a) and the volumetric contrast-enhanced 3D-GRE (VIBE; b) breath-hold acquisitions show severe bronchiectasis, bronchial wall thickening, mucus plugging, pleural effusion as well as a destructed middle lobe. The perfusion subtraction image (c) shows a severely impaired perfusion pattern with loss of perfusion in several areas. The maximum enhancement (MAX) and time to peak anhancement (TTP maps) allow for a further characterisation of the perfusion impairment. Most areas with impaired perfusion show a reduced (MAX map) and delaid (TTP map) perfusion. Notice the area in the left upper lobe with reduced but not delayed perfusion (arrowhead)', 'hash': 'b433d64becd146c4e64de7649c6781faa872e14c3ece7126852c5044ab7b53b6'}, {'image_id': '13244_2011_142_Fig6_HTML', 'image_file_name': '13244_2011_142_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3481076/13244_2011_142_Fig6_HTML.jpg', 'caption': 'Subtle subpleural reticulation in a patient with fibrotic-predominant NSIP. The interlobular reticulation (thin arrows) is more evident after contrast administration (c and f). A perfusion defect (arrowhead in e) is associated to the peripheral fibrotic changes at the left lateral costo-phrenic angle (arrowheads in d and f)', 'hash': '7d403e14ea7e45c940c4c832a41147cd44790eff8c8addf4747c98a8c5bbdeb3'}, {'image_id': '13244_2011_142_Fig9_HTML', 'image_file_name': '13244_2011_142_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3481076/13244_2011_142_Fig9_HTML.jpg', 'caption': 'Twenty-three year-old female with acute pulmonary embolism at the time point of diagnosis (a, b) and at follow-up study after 6 months (c, d). The initial dynamic contrast enhanced (DCE) study (a) as well as the perfusion-weighted Fourier-decomposition (FD) image (b) demonstrate multiple perfusion defects (open arrows). In the follow up study, both techniques (DCE; c and FD; d) demonstrate an almost homogeneous lung perfusion after effective anticoagulation', 'hash': 'f846d4cfbc1aa0650d0d5bdab4fbc311ed81381c0e86736e35c0b8b766622234'}, {'image_id': '13244_2011_142_Fig8_HTML', 'image_file_name': '13244_2011_142_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3481076/13244_2011_142_Fig8_HTML.jpg', 'caption': 'Bilateral hilar and mediastinal adenomegalies in sarcoidosis. Node enlargement (arrows) is demonstrated with gradient echo images before (a) and after administration of contrast material (b). Coronal perfusion images indicate vascular compression at the right hilum (arrow, c) and a wedge-shaped perfusion defect (asterisk, d)', 'hash': 'af40c884d7d8772100b3b14320bf7218e11cb50c02d497e4eade58e685ad81a0'}, {'image_id': '13244_2011_142_Fig7_HTML', 'image_file_name': '13244_2011_142_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3481076/13244_2011_142_Fig7_HTML.jpg', 'caption': 'Fibrosis associated with rounded consolidation. a) Subpleural reticular changes are visualised at the periphery of the lungs (thin arrows). b) After contrast administration the subtle linear enhancement at the pulmonary-chest wall interface indicates abnormal findings related to subpleural fibrosis (thin arrows). A rounded consolidation is present on the left in the lingula suspected for lung tumour in ILD (asterisk)', 'hash': 'e3787429a48827af57aa23f91e8331c19d9408004a8e15ff9bb7a0c91c5dba97'}] | {'13244_2011_142_Fig1_HTML': ['Magnetic resonance imaging (MRI) is reported to be comparable to CT with regard to the detection of morphological changes in the CF lung [13–15]. At the same time MRI is superior to CT when it comes to the assessment of functional changes such as altered pulmonary perfusion [16]. Moreover, using the described MR protocols, it is possible to visualise bronchiectasis, bronchial wall thickening, mucus plugging, air fluid levels, consolidation and segmental consolidation and destruction [13], (Fig.\xa0<xref rid="13244_2011_142_Fig1_HTML" ref-type="fig">1a, b</xref>).).Fig.\xa01A 29-year-old female with cystic fibrosis. The axial T2-weighted (BLADE; a) and the volumetric contrast-enhanced 3D-GRE (VIBE; b) breath-hold acquisitions show severe bronchiectasis, bronchial wall thickening, mucus plugging, pleural effusion as well as a destructed middle lobe. The perfusion subtraction image (c) shows a severely impaired perfusion pattern with loss of perfusion in several areas. The maximum enhancement (MAX) and time to peak anhancement (TTP maps) allow for a further characterisation of the perfusion impairment. Most areas with impaired perfusion show a reduced (MAX map) and delaid (TTP map) perfusion. Notice the area in the left upper lobe with reduced but not delayed perfusion (arrowhead)', 'Compared to CT, the strength of MRI is the additional assessment of “function”, i.e. perfusion, pulmonary hemodynamics and ventilation. In CF, regional ventilatory defects cause changes in regional lung perfusion due to the hypoxic vasoconstriction response or tissue destruction. Using MRI, lung perfusion can be assessed by contrast-enhanced lung perfusion imaging [19]. Using contrast-enhanced 3D MRI, perfusion defects in 11 children with CF were reported to correlate well with the degree of tissue destruction [16]. Furthermore it was shown that at the age of 0–6\xa0years lung perfusion changes were more prominent than morphological changes. However, establishing quantitative assessment tools for lung morphology is challenging for several reasons. First, signal intensities as derived from MRI are not calibrated as compared to CT. Second, the signal-to-noise ratio (SNR) in the lung is low and heterogeneous due to several physical circumstances [20]. Moreover, due to the lack of linearity between the MR signal and the concentration of applied contrast media, quantification of pulmonary perfusion using MRI is challenging [21]. Nevertheless, Risse et al. [22] described the importance of the qualitative assessment of the contrast time course component when analysing contrast-enhanced 3D MRI to categorise perfusion changes as normal, delayed, reduced, reduced and delayed as well as perfusion loss [22]. Using dedicated post-processing tools, these data can be displayed in 3D [23], (Fig.\xa0<xref rid="13244_2011_142_Fig1_HTML" ref-type="fig">1c, d, e</xref>).).'], '13244_2011_142_Fig2_HTML': ['Although MR angiography has been demonstrated as an excellent tool in dedicated centres [31], more recent data from a large multicentre study suggest that the technique in isolation produced unsatisfactory results [32]. Therefore, combinations of different available MRI techniques for the detection of pulmonary embolism may be of better value [33]. This protocol was further modified and extended into a two-step algorithm [9]. As a first step, a steady-state GRE sequence acquired in two or three planes during free breathing would serve for an early detection of large central emboli within the first 5 min of the examination—according to the literature with a sensitivity of 90% and a specificity of close to 100% [33–35]. Any patient with a massive, central embolism detected at this point could be directly referred to intensive care and treatment; the time to diagnosis would be at least as short as with contrast-enhanced helical CT. If this first step of the examination produces a negative or unclear result, the protocol would be continued with the contrast-enhanced steps including first pass perfusion imaging, high spatial resolution contrast-enhanced (CE) MRA and a final acquisition with a volumetric interpolated 3D FLASH sequence in transverse orientation (Fig.\xa0<xref rid="13244_2011_142_Fig2_HTML" ref-type="fig">2</xref>). Despite its composition of multiple sequences, the two-step examination could be completed within 15\xa0min in-room time, which makes it feasible as a quick test for daily clinical routine. In many cases, such as in pregnant woman, when administration of contrast material or radiation exposure is contra-indicated, the examination can be limited to the first step, the free breathing or breathhold acquisition of steady-state GRE sequences alone. Furthermore, since these steps are partially redundant, at least one acquisition would be expected to be diagnostic even in non-compliant patients.). Despite its composition of multiple sequences, the two-step examination could be completed within 15\xa0min in-room time, which makes it feasible as a quick test for daily clinical routine. In many cases, such as in pregnant woman, when administration of contrast material or radiation exposure is contra-indicated, the examination can be limited to the first step, the free breathing or breathhold acquisition of steady-state GRE sequences alone. Furthermore, since these steps are partially redundant, at least one acquisition would be expected to be diagnostic even in non-compliant patients.Fig.\xa02A 55-year-old patient with acute pulmonary embolism. Coronal steady-state free precession images acquired during free breathing (a) and contrast-enhanced coronal 3d flash angiogram acquired in breathhold (b; embolus inside the right lower lobe artery circled); c series of subtracted images from the first pass perfusion study, perfusion deficits marked with open arrows at the image obtained at peak lung enhancement; 1.5-T MRI scanner'], '13244_2011_142_Fig3_HTML': ['Undoubtedly, contrast-enhanced multiple detector row computed tomography is the method of first choice in imaging thoracic malignancies. MRI is considered as an alternative method, e.g. when the application of iodinated contrast media is contraindicated. For this purpose, MRI with dedicated standard protocols can provide a comprehensive morphologic TNM evaluation [36]. A contrast-enhanced examination can be achieved within 25\xa0min in-room time. Intra-pulmonary masses larger than the clinically relevant size of 4–5\xa0mm in diameter can be easily detected. The extent of mediastinal, hilar and supraclavicular lymph node enlargment can be assessed with excellent soft tissue contrast. Metastatic disease involving the liver, the adrenal glands and the skeleton of the thorax are fully covered. The feasibility of extending the examination to whole-body staging with comparable results as achieved by PET/CT has been demonstrated [37–40]. The only limitation compared to CT is the detection of nodules smaller than the clinically relevant size of 4–5\xa0mm. Beyond being just a surrogate for a CT scan in some cases, MRI can offer additional advantages. In large pulmonary masses, the excellent soft tissue contrast of MRI allows for the distinction of tumour from atelectasis and pleural effusion, e.g. for image-guided radiotherapy planning. Administration of T1-shortening contrast material specifically contributes to detecting tumour necrosis, chest wall or mediastinal invasion, and pleural reaction/carcinomatosis [8] (Fig.\xa0<xref rid="13244_2011_142_Fig3_HTML" ref-type="fig">3</xref>). Furthermore, MRI contributes comprehensive functional information on respiratory mechanics, tumour mobility [). Furthermore, MRI contributes comprehensive functional information on respiratory mechanics, tumour mobility [41] and lung perfusion [42, 43]. The clinical value of complementing the purely morphologic staging by imaging of perfusion and tumour motion in specific clinical settings and situations has been demonstrated and is subject to further investigation.Fig.\xa03A 56-year-old female patient with small cell lung cancer. The transverse T2-weighted fat-saturated (a) and T1-weighted contrast-enhanced fat-saturated 3D-GRE images (b, c) show a large, centrally necrotic mass in the left upper lobe with large peri-hilar lymph node metastases. Note the high soft tissue contrast between alelectatic lung (open arrow), small rim of solid tumour (filled arrow) and colliquated central portion of the mass (asterisk)'], '13244_2011_142_Fig4_HTML': ['The potential of MRI to replace chest radiography, particularly in very young children, was already investigated several years ago [18, 44–46]. Much of this work was conducted on low-field MRI (mainly 0.2-T scanners) using steady-state free precession sequences [47]. On average, three thick slices are acquired in coronal orientation with a mean breathhold time of 4–5\xa0s. However, nowadays, only a few institutions regularly use low-field lung MRI in paediatric radiology. Nevertheless, the experience from this work may be considered valid for the suggested protocols for 1.5-T scanners since image quality has significantly improved. Therefore, T2-weighted fat-suppressed as well as dynamic contrast-enhanced T1-GRE sequences are applied with a slice thickness between 5 and 6\xa0mm [48]. Disease entities encompassing community-acquired pneumonia, empyema, fungal infections and chronic bronchitis are detectable [49] (Fig.\xa0<xref rid="13244_2011_142_Fig4_HTML" ref-type="fig">4</xref>).).Fig.\xa04A 13-year-old girl with suspected organising pneumonia (BOOP) in both lungs. Transverse T2-weighted TSE images (a) were acquired with the navigator technique (sample volume placed on the dome of the right liver lobe). The open arrow indicates an oval-shaped consolidation with pleural contact in the lower left lobe and moderate signal intensity. Coronal contrast-enhanced fat-saturated T1-weighted GRE images (b) were acquired with the breathhold technique. The open arrow indicates the oval-shaped consolidation in the lower left lobe with contrast enhancement; this is interpreted as an indicator of an active inflammatory process'], '13244_2011_142_Fig5_HTML': ['The essential morphologic findings in ILD include air-space disease, interstitial abnormalities or a combination of the two. Because MR signal increases proportionally to proton density, air-space infiltrates appear on the T2-weighted images as hyperintense areas against the dark background of the normal lung parenchyma. When pulmonary vascular markings are not obscured, these areas can be assimilated to the ground-glass opacities detected by CT [17, 77]. More dense opacities appear as consolidations, which can be easily assessed by MRI [78]. Similar to consolidations, interstitial abnormalities increase signal intensity presenting with curvilinear bands, nodules and reticulations, which can be associated to a variable degree of parenchymal distortion [50, 79, 80]. Fibrotic changes that extensively involve both peripheral and perihilar portions of the lung are generally well demonstrated on T2-weighted images, albeit that one needs to consider extracellular interstitial water as a potential differential diagnosis in patients with suspected congestive heart failure. Subtle changes in the subpleural regions may become more difficult to visualise, notably when parenchymal distortion is not present, demonstrating the superiority of CT in this respect. T1-weighted VIBE images offer higher spatial resolution, and post-contrast acquisition with fat-suppression is recommended to increase the signal of altered subpleural lung tissue against a background represented by chest wall muscles, ribs and normal lung parenchyma. Honeycombing, which manifests with reticular changes and irregular cystic transformation of the lung, can also be assessed using this technique [50] (Figs.\xa0<xref rid="13244_2011_142_Fig5_HTML" ref-type="fig">5</xref>, , <xref rid="13244_2011_142_Fig6_HTML" ref-type="fig">6</xref>, , <xref rid="13244_2011_142_Fig7_HTML" ref-type="fig">7</xref> and and <xref rid="13244_2011_142_Fig8_HTML" ref-type="fig">8</xref>).).Fig.\xa05Infiltrative disorder of the lung. Typical fibrotic changes in a patient with interstitial pulmonary fibrosis. Extensive reticulation and architectural distortion predominant in the subpleural regions of the lung are well demonstrated by the axial (a, b) and coronal (c–e) MR images obtained using the half-Fourier single-shot fast spin echo (a, c, e) and post-constrast volume interpolated T1-weighted GRE (b, e) sequencesFig.\xa06Subtle subpleural reticulation in a patient with fibrotic-predominant NSIP. The interlobular reticulation (thin arrows) is more evident after contrast administration (c and f). A perfusion defect (arrowhead in e) is associated to the peripheral fibrotic changes at the left lateral costo-phrenic angle (arrowheads in d and f)Fig.\xa07Fibrosis associated with rounded consolidation. a) Subpleural reticular changes are visualised at the periphery of the lungs (thin arrows). b) After contrast administration the subtle linear enhancement at the pulmonary-chest wall interface indicates abnormal findings related to subpleural fibrosis (thin arrows). A rounded consolidation is present on the left in the lingula suspected for lung tumour in ILD (asterisk)Fig.\xa08Bilateral hilar and mediastinal adenomegalies in sarcoidosis. Node enlargement (arrows) is demonstrated with gradient echo images before (a) and after administration of contrast material (b). Coronal perfusion images indicate vascular compression at the right hilum (arrow, c) and a wedge-shaped perfusion defect (asterisk, d)'], '13244_2011_142_Fig9_HTML': ['One of the latest developments in the field of proton-based lung MRI appears to be a very promising technology for non-contrast-enhanced ventilation and perfusion scanning. This novel approach, known as Fourier decomposition MRI [89], utilises a short echo dynamic SSFP acquisition of lung images with subsequent compensation for respiratory motion by using nonrigid image registration [90]. Spectral analysis of the image time series allows for identification of peaks at the respiratory and cardiac frequencies. Amplitude of these peaks is related to regional proton density change caused by deformation of lung parenchyma (highest signal with lowest pulmonary air content in expiration) and pulmonary blood flow (lowest signal with maximum blood flow in systole) [91]. Further image post-processing produces ventilation- and perfusion-weighted maps for regional assessment of lung function from a single acquisition series. However, the quantitative validation remains subject to further investigation (Fig.\xa0<xref rid="13244_2011_142_Fig9_HTML" ref-type="fig">9</xref>) [) [92]. Nevertheless, there is a perspective that the method of choice for morphologic and functional assessment of acute pulmonary embolism in the very near future might be a non-contrast-enhanced free breathing MR scan of 10–15\xa0min.Fig.\xa09Twenty-three year-old female with acute pulmonary embolism at the time point of diagnosis (a, b) and at follow-up study after 6 months (c, d). The initial dynamic contrast enhanced (DCE) study (a) as well as the perfusion-weighted Fourier-decomposition (FD) image (b) demonstrate multiple perfusion defects (open arrows). In the follow up study, both techniques (DCE; c and FD; d) demonstrate an almost homogeneous lung perfusion after effective anticoagulation']} | MRI of the lung (3/3)—current applications and future perspectives | [
"Magnetic resonance imaging",
"Cystic fibrosis",
"Pulmonary embolism",
"Tumor",
"Infiltrate",
"Functional imaging"
] | Insights Imaging | 1326614400 | Identifying significant determinants of groundwater nitrate contamination is critical in order to define sensible agri-environmental indicators that support the design, enforcement, and monitoring of regulatory policies. We use data from approximately 1200 Austrian municipalities to provide a detailed statistical analysis of (1) the factors influencing groundwater nitrate contamination and (2) the predictive capacity of the Gross Nitrogen Balance, one of the most commonly used agri-environmental indicators. We find that the percentage of cropland in a given region correlates positively with nitrate concentration in groundwater. Additionally, environmental characteristics such as temperature and precipitation are important co-factors. Higher average temperatures result in lower nitrate contamination of groundwater, possibly due to increased evapotranspiration. Higher average precipitation dilutes nitrates in the soil, further reducing groundwater nitrate concentration. Finally, we assess whether the Gross Nitrogen Balance is a valid predictor of groundwater nitrate contamination. Our regression analysis reveals that the Gross Nitrogen Balance is a statistically significant predictor for nitrate contamination. We also show that its predictive power can be improved if we account for average regional precipitation. The Gross Nitrogen Balance predicts nitrate contamination in groundwater more precisely in regions with higher average precipitation. | [
"Austria",
"Environmental Monitoring",
"Groundwater",
"Nitrates",
"Nitrogen",
"Regression Analysis",
"Seasons",
"Water Pollution, Chemical"
] | other | PMC3481076 | null | 39 | [
"{'Citation': 'Addiscott T.M., Whitmore A.P., Powlson D.S. CAB International; Oxford, UK: 1991. Farming, Fertilisers and the Nitrate Problem.'}",
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] | Insights Imaging. 2012 Jan 15; 3(4):373-386 | NO-CC CODE |
|
A 6-year-old child with lung metastases of osteosarcoma. Both acquisitions, the free breathing steady state free precession series (a) and the respiration triggered (navigator triggered) series (b) show a large mass with high signal intensity in the right upper lung lobe in expiration | 13244_2011_146_Fig6_HTML | 7 | 4b396e76caf349a0b4be3c01d8d599ea3349611dbc4c9eba92156cbb44ecdedc | 13244_2011_146_Fig6_HTML.jpg | multiple | multiple panels: images | [
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"computerized tomography"
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742,
433
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Both acquisitions, the free breathing steady state free precession series (a) and the respiration triggered (navigator triggered) series (b) show a large mass with high signal intensity in the right upper lung lobe in expiration', 'hash': '4b396e76caf349a0b4be3c01d8d599ea3349611dbc4c9eba92156cbb44ecdedc'}, {'image_id': '13244_2011_146_Fig9_HTML', 'image_file_name': '13244_2011_146_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig9_HTML.jpg', 'caption': 'A 77-year-old male patient with adenocarcinoma in segment 6 of the right lower lung lobe (arrow; transverse contrast-enhanced breath-hold 3D GRE study)', 'hash': '0c5b79f1bbe23444cccf60a42cd0ad26c4654ac127874772a97fb54528a30b2d'}, {'image_id': '13244_2011_146_Fig1_HTML', 'image_file_name': '13244_2011_146_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig1_HTML.jpg', 'caption': 'A 66-year-old male patient with fever and coughing, clinically suspected pneumonia. The plain chest X-ray (a) demonstrates a dense infiltrate in the left lower lung lobe which is confirmed on non-contrast-enhanced low dose CT (b; arrows). The patient volunteered to undergo MRI on the same day. Multi-breath-hold coronal T2-weighted fast spin echo (c) and single breath-hold T1-weighted 3D GRE imaging (d) as well as free breathing coronal steady state SSFP (e) and multi-breath-hold fat-saturated T2-weighted fast spin echo series (f) clearly demonstrate the infiltrates with particularly high signal on T2-weighted images', 'hash': 'aa99311f557c6cb9eeba10e85bdc313ca61ee04ed1ac349cbb9c4519b01fe1ac'}, {'image_id': '13244_2011_146_Fig8_HTML', 'image_file_name': '13244_2011_146_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig8_HTML.jpg', 'caption': 'Recent fracture of the left 5th rib as incidental finding in a 29-year-old female volunteer with left chest pain, hardly visible on the non-contrast enhanced T1-weighteg breath-hold 3D GRE series (a) but with bright signal on the T2-weighted fat saturated image from an multiple breath-hold series (b, arrow)', 'hash': '1e4351f241881465247ba43f816e2a2089f45bb55b8eb85d4222f4ff21f6d1b5'}, {'image_id': '13244_2011_146_Fig7_HTML', 'image_file_name': '13244_2011_146_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig7_HTML.jpg', 'caption': 'Pneumonia (asterisk), chambered pleural effusion (arrowheads) and abscess (arrow) in the right lower chest of a 6-year-old child, images acquired in T2-weighted triggered fast spin echo technique', 'hash': '33012e10800825460aa19fa3aab289a08ae91e5d69c045901050e82872a40be0'}, {'image_id': '13244_2011_146_Fig3_HTML', 'image_file_name': '13244_2011_146_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig3_HTML.jpg', 'caption': 'Diffusion-weighted imaging highlighting pleural metastases of hepatocellular carcinoma at the right diaphragm (left, open arrow). The same spots are only hardly visible on the post-contrast fat-saturated breath-hold T1-weighted 3D GRE sequence (right).', 'hash': 'aca4d494c060302087e2e3a23c8a9e733f86547360797b3b47bbacb7053fed4c'}, {'image_id': '13244_2011_146_Fig4_HTML', 'image_file_name': '13244_2011_146_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig4_HTML.jpg', 'caption': 'An 18-year-old male cystic fibrosis patient, coronal T2-weighted half Fourier fast spin echo sequence (a) and coronal subtraction perfusion image (b). Notice the severe mucus plugging in the morphological T2-weighted image. The subtraction perfusion image shows correspoding areas with perfusion loss due to hypoxic vasoconstriction. Due to redistribution of perfusion both lower lobes show a high perfusion signal', 'hash': 'e413eb09cda368c0698e86f0b7b915305d3d500439d098d852d85d62aef5ef26'}, {'image_id': '13244_2011_146_Fig10_HTML', 'image_file_name': '13244_2011_146_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig10_HTML.jpg', 'caption': 'An 18-year-old female patient with clinical suspicion (dyspnoea and elevated D-dimers) of acute pulmonary embolism. The steady state free precession study shows an embolus inside the right pulmonary artery (a, arrow) that is also clearly depicted in the subtraction images form the contrast enhanced 3D flash MRA (b). The subtraction of the first pass perfusion study (c) confirm large perfusion deficits in the right lower lobe and a posterior segment of the left upper lobe (arrowheads)', 'hash': '534a59d5d857b855ba2265720eeed6ebc77dd163b19eb3da5161b9adf50a4579'}, {'image_id': '13244_2011_146_Fig2_HTML', 'image_file_name': '13244_2011_146_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig2_HTML.jpg', 'caption': 'A 64-year-old woman with the incidental finding of an unspecific, 4-mm nodule in the right middle lobe. The nodule (open arrow) is clearly depicted on the coronal multi-breath-hold T2-weighted (a) and transverse contrast-enhanced, fat-saturated 3D GRE images (b)', 'hash': 'bf1d40227ab553aa9ec00f51dddb1419a89db91e7428798100ef245db5dc7226'}, {'image_id': '13244_2011_146_Fig5_HTML', 'image_file_name': '13244_2011_146_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig5_HTML.jpg', 'caption': 'Lung MRI of a 37-year-old male patient with cystic fibrosis. Coronal T2-weighted, respiration triggered and transverse breath-hold T1-weighted 3D GRE images show peripheral airways with enhanced signal due to mucus plugging. Note the “tree-in-bud” sign similar to the typical appearance on CT (dashed circles)', 'hash': 'ba47113abb017ec2d2a17e8df388159b2086098995fe9d3a12bc30346d750e35'}] | {'13244_2011_146_Fig1_HTML': ['Quite a lot of experience exists for detection of pathological conditions that result in an increase of lung proton density. Experimental work has shown the high sensitivity of MRI with T2-weighted and proton-density weighted sequences for fluid accumulation inside the lung [12–14]. One can conclude that the sensitivity of MRI for pulmonary infiltrates is at least as good as with chest radiography and CT [2, 12, 15–17]. The majority of the applied protocols are based on T2-weighted or proton-density-weighted fast spin echo sequences, either with respiration gating or triggering or in breath-hold acquisition modes (Fig.\xa0<xref rid="13244_2011_146_Fig1_HTML" ref-type="fig">1</xref>).).Fig. 1A 66-year-old male patient with fever and coughing, clinically suspected pneumonia. The plain chest X-ray (a) demonstrates a dense infiltrate in the left lower lung lobe which is confirmed on non-contrast-enhanced low dose CT (b; arrows). The patient volunteered to undergo MRI on the same day. Multi-breath-hold coronal T2-weighted fast spin echo (c) and single breath-hold T1-weighted 3D GRE imaging (d) as well as free breathing coronal steady state SSFP (e) and multi-breath-hold fat-saturated T2-weighted fast spin echo series (f) clearly demonstrate the infiltrates with particularly high signal on T2-weighted images'], '13244_2011_146_Fig2_HTML': ['Another key clinical demand is the detection of small solid or soft tissue lesions (“nodules”). The sensitivity of MRI for lung nodules larger than 4\xa0mm ranges between 80 and 90% and reaches 100% for lesions larger than 8\xa0mm [18]. Depending on the sequence technique and the signal intensity of the lesions and given that conditions are optimal (i.e. patient can keep a breath-hold for 20\xa0s or perfect gating/triggering), a threshold size of 3-4\xa0mm can be assumed for lung nodule detection with MRI [19, 20]. In comparison with CT, it might be even faster and more efficient to read lung MRI for pulmonary nodules, since they appear with bright signal against the dark background of the healthy lung tissue [21] (Fig.\xa0<xref rid="13244_2011_146_Fig2_HTML" ref-type="fig">2</xref>). Calcified nodules tend to disappear in the background, as they have no inherent signal, whereas contrast-filled vascular lesions will be highly visible on T1-weighted images [). Calcified nodules tend to disappear in the background, as they have no inherent signal, whereas contrast-filled vascular lesions will be highly visible on T1-weighted images [22]. So far, a variety of sequence types has been evaluated for lung nodule detection with MRI. The spectrum comprises T2-weighted fast spin echo imaging with and without fat saturation [23–26], inversion recovery techniques [27], T1-spin echo [26, 28] and gradient echo sequences [29, 30].Fig. 2A 64-year-old woman with the incidental finding of an unspecific, 4-mm nodule in the right middle lobe. The nodule (open arrow) is clearly depicted on the coronal multi-breath-hold T2-weighted (a) and transverse contrast-enhanced, fat-saturated 3D GRE images (b)'], '13244_2011_146_Fig3_HTML': ['Not yet clarified is the role of diffusion-weighted imaging (DWI) of lung lesions. DWI is recommended for the whole-body staging of lung cancer, including mediastinal metastases [31, 32]; however, in the chest a clear advantage of DWI over other MRI protocols has not been confirmed so far [33, 34]. STIR sequences might be even more sensitive for the detection and classification of lung cancer and mediastinal metastases than DWI [35–37]. One potential role of DWI might be to predict tumour invasiveness for clinical stage IA non-small-cell lung cancer and to separate the mass from atelectasis [38, 39]. The role of DWI sequences for the differentiation of malignant or benign lung lesions or for the discrimination of subtypes of lung cancer remains controversial [37, 40–42]. In the authors’ own experience, DWI helps to demarcate lesions adjacent to the pleura (Fig.\xa0<xref rid="13244_2011_146_Fig3_HTML" ref-type="fig">3</xref>), assess mediastinal extension and may serve as a “second reader” for detection of small nodules. Thus, it makes sense to include a fast DWI acquisition in the protocol recommendations for MRI of the lung [), assess mediastinal extension and may serve as a “second reader” for detection of small nodules. Thus, it makes sense to include a fast DWI acquisition in the protocol recommendations for MRI of the lung [43, 44].Fig. 3Diffusion-weighted imaging highlighting pleural metastases of hepatocellular carcinoma at the right diaphragm (left, open arrow). The same spots are only hardly visible on the post-contrast fat-saturated breath-hold T1-weighted 3D GRE sequence (right).'], '13244_2011_146_Fig4_HTML': ['The visual evaluation of 4D MRI image sets is facilitated by subtraction of the non-enhanced from the contrast-enhanced image signal, which results in a bright display of the contrast-enhanced lung vessels and parenchyma. The clinical value of lung perfusion studies with visual and semi-quantitative evaluation is being tested in the assessment of lung perfusion deficits in cystic fibrosis patients who suffer from mucus retention and hypoxic vasoconstriction (Fig.\xa0<xref rid="13244_2011_146_Fig4_HTML" ref-type="fig">4</xref>) [) [62–64]. The perfusion series allows indirect visualisation of lung parenchyma abnormalities due to emphysema or conditions such as pneumothorax due to the absence of perfused lung tissue.Fig. 4An 18-year-old male cystic fibrosis patient, coronal T2-weighted half Fourier fast spin echo sequence (a) and coronal subtraction perfusion image (b). Notice the severe mucus plugging in the morphological T2-weighted image. The subtraction perfusion image shows correspoding areas with perfusion loss due to hypoxic vasoconstriction. Due to redistribution of perfusion both lower lobes show a high perfusion signal'], '13244_2011_146_Fig5_HTML': ['Direct visualisation of the airways with MRI is limited to airways in excess of 3\xa0mm diameter, unless filled with bright materials such as retained mucus in cystic fibrosis patients [65, 66] (Fig.\xa0<xref rid="13244_2011_146_Fig5_HTML" ref-type="fig">5</xref>). In young healthy subjects, lung MRI depicted airways down to the first subsegmental level; however, in parts of the lung subject to cardiac pulsation, detection rates were significantly lower [). In young healthy subjects, lung MRI depicted airways down to the first subsegmental level; however, in parts of the lung subject to cardiac pulsation, detection rates were significantly lower [67]. As expected from the higher spatial resolution, high resolution CT is still superior to MRI in the depiction of small peripheral airways.Fig. 5Lung MRI of a 37-year-old male patient with cystic fibrosis. Coronal T2-weighted, respiration triggered and transverse breath-hold T1-weighted 3D GRE images show peripheral airways with enhanced signal due to mucus plugging. Note the “tree-in-bud” sign similar to the typical appearance on CT (dashed circles)'], '13244_2011_146_Fig6_HTML': ['Two basic strategies have been pursued for motion compensation: fast single shot imaging with very short acquisition time and respiratory gating/triggering of fast spin echo techniques. For the first approach, steady state (SSFP) or partial Fourier single shot sequences (e.g. HASTE) have been successfully implemented [80]. SSFP sequences allow for a rapid acquisition of ten slices with breath-hold times below 10\xa0s, even on low-field MRI systems. Alternatively, they can be performed during free breathing [81, 82]. Typically, these fast and robust sequences would be used for an initial overview with further high-resolution acquisitions in the second part of the examination. The second approach, gated or triggered acquisition, increases imaging time but provides better spatial resolution and soft tissue contrast (Figs.\xa0<xref rid="13244_2011_146_Fig6_HTML" ref-type="fig">6</xref>, , <xref rid="13244_2011_146_Fig7_HTML" ref-type="fig">7</xref>) [) [79, 83]. The higher respiration frequencies of young children are of a certain advantage since they help speeding up the acquisition. In most cases, the difference to non-gated acquisitions is much less than in adult subjects with low respiration rates. T2-weighted fast spin echo sequences can be applied with repetition times of 2000\xa0ms or less, usually triggered to the expiratory phase, which is around 2\xa0s, depending on the individual respiration frequency. This time frame allows for excellent T2-weighted images without relevant motion artefacts [84]. Depending on the available hardware and specific experience of the team, both mechanical (respiratory belt or cushion technique [84]) or image-based (e.g. navigator) devices for the detection of respiratory motion can be applied with good results. A radial read-out scheme of the k-space further improves the robustness against motion artefacts. The application of additional cardiac triggering may be helpful in specific cases, but paid for with a significant increase of acquisition time [85].Fig. 6A 6-year-old child with lung metastases of osteosarcoma. Both acquisitions, the free breathing steady state free precession series (a) and the respiration triggered (navigator triggered) series (b) show a large mass with high signal intensity in the right upper lung lobe in expirationFig. 7Pneumonia (asterisk), chambered pleural effusion (arrowheads) and abscess (arrow) in the right lower chest of a 6-year-old child, images acquired in T2-weighted triggered fast spin echo technique'], '13244_2011_146_Fig8_HTML': ['A basic or general study combines T1-weighted and T2-weighted images based on gradient echo and fast spin echo sequences, respectively [90]. T1-GRE sequences are available as 3D acquisitions and may, therefore, be limited to a volume acquisition of the chest in one breath-hold. Fast T2-weighted spin echo sequences should cover at least two planes, e.g. with a half Fourier breath-hold acquisition in coronal and a transverse orientation. This results in a high sensitivity of the protocol for infiltrates and small nodular lesions. To improve the sensitivity of the protocol for mediastinal lymph nodes and bone lesions (e.g. metastases), a STIR or fat saturated T2-fast spin echo sequence should be added. Since rib metastases are easier to detect on transverse slices, this orientation should be preferred (Fig.\xa0<xref rid="13244_2011_146_Fig8_HTML" ref-type="fig">8</xref>). The list of “must” sequences (in the table indicated by ). The list of “must” sequences (in the table indicated by G for “general protocol”) is concluded with a coronal steady-state free precession sequence in free breathing, which contributes to a high sensitivity for central pulmonary embolism and gross cardiac or respiratory dysfunction. As an option (but at the cost of additional imaging time exceeding the intended limitation to 15\xa0min), motion-compensated T2-weighted fast spin echo sequences can be added to improve the depiction of masses with chest-wall invasion [1, 5].Fig. 8Recent fracture of the left 5th rib as incidental finding in a 29-year-old female volunteer with left chest pain, hardly visible on the non-contrast enhanced T1-weighteg breath-hold 3D GRE series (a) but with bright signal on the T2-weighted fat saturated image from an multiple breath-hold series (b, arrow)'], '13244_2011_146_Fig9_HTML': ['With this selection of non-contrast-enhanced sequences, the study covers some of the most common potential findings, including pneumonia, atelectasis, pulmonary nodules or masses, mediastinal masses (lymphoma, goiter, cyst, thymoma) and acute pulmonary embolism [5]. Depending on the initial findings following the basic protocol, additional contrast-enhanced acquisitions may be required, which would use the same type of volume interpolated 3D-GRE sequence, but now with fat saturation to improve the visibility of contrast-enhanced tissues and mediastinal lymph nodes (T “tumour protocol”). Although the 3D sequences cover the whole chest, in-plane resolution is optimised in either transverse or coronal section (Fig.\xa0<xref rid="13244_2011_146_Fig9_HTML" ref-type="fig">9</xref>). Since acquisition times are just one breath-hold, it appears to be feasible to acquire the 3D GRE studies in at least transverse and coronal planes. In particular for the staging of lung cancer, it might be helpful for the detection of small lymph nodes metastases to add a diffusion-weighted sequence as well. Both sequences extend the total imaging time by approximately 5 min [). Since acquisition times are just one breath-hold, it appears to be feasible to acquire the 3D GRE studies in at least transverse and coronal planes. In particular for the staging of lung cancer, it might be helpful for the detection of small lymph nodes metastases to add a diffusion-weighted sequence as well. Both sequences extend the total imaging time by approximately 5 min [1].Fig. 9A 77-year-old male patient with adenocarcinoma in segment 6 of the right lower lung lobe (arrow; transverse contrast-enhanced breath-hold 3D GRE study)'], '13244_2011_146_Fig10_HTML': ['The available options for imaging disorders of lung vasculature comprise three components: First of all, the free breathing steady state gradient echo (SSFP-GRE) study which is also part of the general protocol. Then two variations of 3D gradient echo based contrast enhanced MRA: (1) a time-resolved, low spatial resolution acquisition for first pass perfusion imaging and (2) a high spatial resolution acquisition for a breath-hold angiogram (Fig.\xa0<xref rid="13244_2011_146_Fig10_HTML" ref-type="fig">10</xref>). Depending on the performance of the MR scanner, the dynamic study produces a comprehensive lung perfusion study with excellent temporal resolution and at the same time serves for the determination of optimum contrast bolus timing for the acquisition of the high resolution angiogram. The “vessel protocol” (). Depending on the performance of the MR scanner, the dynamic study produces a comprehensive lung perfusion study with excellent temporal resolution and at the same time serves for the determination of optimum contrast bolus timing for the acquisition of the high resolution angiogram. The “vessel protocol” (V in Table\xa01) optimises the sensitivity for acute and chronic pulmonary embolism, arterio-venous (AV) malformation (e.g. Osler’s disease), lung sequestration, pulmonary arterial aneurysm, abnormalities of pulmonary venous drainage and any other pathology of lung vasculature [5]. As in other parts of the protocol recommendations, it is suggested to combine different fast imaging sequences to increase sensitivity and specificity of the examination [93]. Therefore, Kluge et al. [94] suggested combinations of different available MRI techniques for the detection of pulmonary embolism [5]. The lung vessel imaging branch of the protocol tree can be used just for a study of vascular pathology, e.g. in suspected acute pulmonary embolism or in combination with the tumour protocol for the comprehensive evaluation of a central mass with vessel invasion.Fig. 10An 18-year-old female patient with clinical suspicion (dyspnoea and elevated D-dimers) of acute pulmonary embolism. The steady state free precession study shows an embolus inside the right pulmonary artery (a, arrow) that is also clearly depicted in the subtraction images form the contrast enhanced 3D flash MRA (b). The subtraction of the first pass perfusion study (c) confirm large perfusion deficits in the right lower lobe and a posterior segment of the left upper lobe (arrowheads)']} | MRI of the lung (2/3). Why … when … how? | [
"Magnetic resonance imaging",
"Lung, sequence",
"Imaging protocol"
] | Insights Imaging | 1329120000 | None | null | other | PMC3481084 | null | null | [
""
] | Insights Imaging. 2012 Feb 13; 3(4):355-371 | NO-CC CODE |
|
A 66-year-old male patient with fever and coughing, clinically suspected pneumonia. The plain chest X-ray (a) demonstrates a dense infiltrate in the left lower lung lobe which is confirmed on non-contrast-enhanced low dose CT (b; arrows). The patient volunteered to undergo MRI on the same day. Multi-breath-hold coronal T2-weighted fast spin echo (c) and single breath-hold T1-weighted 3D GRE imaging (d) as well as free breathing coronal steady state SSFP (e) and multi-breath-hold fat-saturated T2-weighted fast spin echo series (f) clearly demonstrate the infiltrates with particularly high signal on T2-weighted images | 13244_2011_146_Fig1_HTML | 7 | aa99311f557c6cb9eeba10e85bdc313ca61ee04ed1ac349cbb9c4519b01fe1ac | 13244_2011_146_Fig1_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
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"computerized tomography"
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738,
972
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Both acquisitions, the free breathing steady state free precession series (a) and the respiration triggered (navigator triggered) series (b) show a large mass with high signal intensity in the right upper lung lobe in expiration', 'hash': '4b396e76caf349a0b4be3c01d8d599ea3349611dbc4c9eba92156cbb44ecdedc'}, {'image_id': '13244_2011_146_Fig9_HTML', 'image_file_name': '13244_2011_146_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig9_HTML.jpg', 'caption': 'A 77-year-old male patient with adenocarcinoma in segment 6 of the right lower lung lobe (arrow; transverse contrast-enhanced breath-hold 3D GRE study)', 'hash': '0c5b79f1bbe23444cccf60a42cd0ad26c4654ac127874772a97fb54528a30b2d'}, {'image_id': '13244_2011_146_Fig1_HTML', 'image_file_name': '13244_2011_146_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig1_HTML.jpg', 'caption': 'A 66-year-old male patient with fever and coughing, clinically suspected pneumonia. The plain chest X-ray (a) demonstrates a dense infiltrate in the left lower lung lobe which is confirmed on non-contrast-enhanced low dose CT (b; arrows). The patient volunteered to undergo MRI on the same day. Multi-breath-hold coronal T2-weighted fast spin echo (c) and single breath-hold T1-weighted 3D GRE imaging (d) as well as free breathing coronal steady state SSFP (e) and multi-breath-hold fat-saturated T2-weighted fast spin echo series (f) clearly demonstrate the infiltrates with particularly high signal on T2-weighted images', 'hash': 'aa99311f557c6cb9eeba10e85bdc313ca61ee04ed1ac349cbb9c4519b01fe1ac'}, {'image_id': '13244_2011_146_Fig8_HTML', 'image_file_name': '13244_2011_146_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig8_HTML.jpg', 'caption': 'Recent fracture of the left 5th rib as incidental finding in a 29-year-old female volunteer with left chest pain, hardly visible on the non-contrast enhanced T1-weighteg breath-hold 3D GRE series (a) but with bright signal on the T2-weighted fat saturated image from an multiple breath-hold series (b, arrow)', 'hash': '1e4351f241881465247ba43f816e2a2089f45bb55b8eb85d4222f4ff21f6d1b5'}, {'image_id': '13244_2011_146_Fig7_HTML', 'image_file_name': '13244_2011_146_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig7_HTML.jpg', 'caption': 'Pneumonia (asterisk), chambered pleural effusion (arrowheads) and abscess (arrow) in the right lower chest of a 6-year-old child, images acquired in T2-weighted triggered fast spin echo technique', 'hash': '33012e10800825460aa19fa3aab289a08ae91e5d69c045901050e82872a40be0'}, {'image_id': '13244_2011_146_Fig3_HTML', 'image_file_name': '13244_2011_146_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig3_HTML.jpg', 'caption': 'Diffusion-weighted imaging highlighting pleural metastases of hepatocellular carcinoma at the right diaphragm (left, open arrow). The same spots are only hardly visible on the post-contrast fat-saturated breath-hold T1-weighted 3D GRE sequence (right).', 'hash': 'aca4d494c060302087e2e3a23c8a9e733f86547360797b3b47bbacb7053fed4c'}, {'image_id': '13244_2011_146_Fig4_HTML', 'image_file_name': '13244_2011_146_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig4_HTML.jpg', 'caption': 'An 18-year-old male cystic fibrosis patient, coronal T2-weighted half Fourier fast spin echo sequence (a) and coronal subtraction perfusion image (b). Notice the severe mucus plugging in the morphological T2-weighted image. The subtraction perfusion image shows correspoding areas with perfusion loss due to hypoxic vasoconstriction. Due to redistribution of perfusion both lower lobes show a high perfusion signal', 'hash': 'e413eb09cda368c0698e86f0b7b915305d3d500439d098d852d85d62aef5ef26'}, {'image_id': '13244_2011_146_Fig10_HTML', 'image_file_name': '13244_2011_146_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig10_HTML.jpg', 'caption': 'An 18-year-old female patient with clinical suspicion (dyspnoea and elevated D-dimers) of acute pulmonary embolism. The steady state free precession study shows an embolus inside the right pulmonary artery (a, arrow) that is also clearly depicted in the subtraction images form the contrast enhanced 3D flash MRA (b). The subtraction of the first pass perfusion study (c) confirm large perfusion deficits in the right lower lobe and a posterior segment of the left upper lobe (arrowheads)', 'hash': '534a59d5d857b855ba2265720eeed6ebc77dd163b19eb3da5161b9adf50a4579'}, {'image_id': '13244_2011_146_Fig2_HTML', 'image_file_name': '13244_2011_146_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig2_HTML.jpg', 'caption': 'A 64-year-old woman with the incidental finding of an unspecific, 4-mm nodule in the right middle lobe. The nodule (open arrow) is clearly depicted on the coronal multi-breath-hold T2-weighted (a) and transverse contrast-enhanced, fat-saturated 3D GRE images (b)', 'hash': 'bf1d40227ab553aa9ec00f51dddb1419a89db91e7428798100ef245db5dc7226'}, {'image_id': '13244_2011_146_Fig5_HTML', 'image_file_name': '13244_2011_146_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig5_HTML.jpg', 'caption': 'Lung MRI of a 37-year-old male patient with cystic fibrosis. Coronal T2-weighted, respiration triggered and transverse breath-hold T1-weighted 3D GRE images show peripheral airways with enhanced signal due to mucus plugging. Note the “tree-in-bud” sign similar to the typical appearance on CT (dashed circles)', 'hash': 'ba47113abb017ec2d2a17e8df388159b2086098995fe9d3a12bc30346d750e35'}] | {'13244_2011_146_Fig1_HTML': ['Quite a lot of experience exists for detection of pathological conditions that result in an increase of lung proton density. Experimental work has shown the high sensitivity of MRI with T2-weighted and proton-density weighted sequences for fluid accumulation inside the lung [12–14]. One can conclude that the sensitivity of MRI for pulmonary infiltrates is at least as good as with chest radiography and CT [2, 12, 15–17]. The majority of the applied protocols are based on T2-weighted or proton-density-weighted fast spin echo sequences, either with respiration gating or triggering or in breath-hold acquisition modes (Fig.\xa0<xref rid="13244_2011_146_Fig1_HTML" ref-type="fig">1</xref>).).Fig. 1A 66-year-old male patient with fever and coughing, clinically suspected pneumonia. The plain chest X-ray (a) demonstrates a dense infiltrate in the left lower lung lobe which is confirmed on non-contrast-enhanced low dose CT (b; arrows). The patient volunteered to undergo MRI on the same day. Multi-breath-hold coronal T2-weighted fast spin echo (c) and single breath-hold T1-weighted 3D GRE imaging (d) as well as free breathing coronal steady state SSFP (e) and multi-breath-hold fat-saturated T2-weighted fast spin echo series (f) clearly demonstrate the infiltrates with particularly high signal on T2-weighted images'], '13244_2011_146_Fig2_HTML': ['Another key clinical demand is the detection of small solid or soft tissue lesions (“nodules”). The sensitivity of MRI for lung nodules larger than 4\xa0mm ranges between 80 and 90% and reaches 100% for lesions larger than 8\xa0mm [18]. Depending on the sequence technique and the signal intensity of the lesions and given that conditions are optimal (i.e. patient can keep a breath-hold for 20\xa0s or perfect gating/triggering), a threshold size of 3-4\xa0mm can be assumed for lung nodule detection with MRI [19, 20]. In comparison with CT, it might be even faster and more efficient to read lung MRI for pulmonary nodules, since they appear with bright signal against the dark background of the healthy lung tissue [21] (Fig.\xa0<xref rid="13244_2011_146_Fig2_HTML" ref-type="fig">2</xref>). Calcified nodules tend to disappear in the background, as they have no inherent signal, whereas contrast-filled vascular lesions will be highly visible on T1-weighted images [). Calcified nodules tend to disappear in the background, as they have no inherent signal, whereas contrast-filled vascular lesions will be highly visible on T1-weighted images [22]. So far, a variety of sequence types has been evaluated for lung nodule detection with MRI. The spectrum comprises T2-weighted fast spin echo imaging with and without fat saturation [23–26], inversion recovery techniques [27], T1-spin echo [26, 28] and gradient echo sequences [29, 30].Fig. 2A 64-year-old woman with the incidental finding of an unspecific, 4-mm nodule in the right middle lobe. The nodule (open arrow) is clearly depicted on the coronal multi-breath-hold T2-weighted (a) and transverse contrast-enhanced, fat-saturated 3D GRE images (b)'], '13244_2011_146_Fig3_HTML': ['Not yet clarified is the role of diffusion-weighted imaging (DWI) of lung lesions. DWI is recommended for the whole-body staging of lung cancer, including mediastinal metastases [31, 32]; however, in the chest a clear advantage of DWI over other MRI protocols has not been confirmed so far [33, 34]. STIR sequences might be even more sensitive for the detection and classification of lung cancer and mediastinal metastases than DWI [35–37]. One potential role of DWI might be to predict tumour invasiveness for clinical stage IA non-small-cell lung cancer and to separate the mass from atelectasis [38, 39]. The role of DWI sequences for the differentiation of malignant or benign lung lesions or for the discrimination of subtypes of lung cancer remains controversial [37, 40–42]. In the authors’ own experience, DWI helps to demarcate lesions adjacent to the pleura (Fig.\xa0<xref rid="13244_2011_146_Fig3_HTML" ref-type="fig">3</xref>), assess mediastinal extension and may serve as a “second reader” for detection of small nodules. Thus, it makes sense to include a fast DWI acquisition in the protocol recommendations for MRI of the lung [), assess mediastinal extension and may serve as a “second reader” for detection of small nodules. Thus, it makes sense to include a fast DWI acquisition in the protocol recommendations for MRI of the lung [43, 44].Fig. 3Diffusion-weighted imaging highlighting pleural metastases of hepatocellular carcinoma at the right diaphragm (left, open arrow). The same spots are only hardly visible on the post-contrast fat-saturated breath-hold T1-weighted 3D GRE sequence (right).'], '13244_2011_146_Fig4_HTML': ['The visual evaluation of 4D MRI image sets is facilitated by subtraction of the non-enhanced from the contrast-enhanced image signal, which results in a bright display of the contrast-enhanced lung vessels and parenchyma. The clinical value of lung perfusion studies with visual and semi-quantitative evaluation is being tested in the assessment of lung perfusion deficits in cystic fibrosis patients who suffer from mucus retention and hypoxic vasoconstriction (Fig.\xa0<xref rid="13244_2011_146_Fig4_HTML" ref-type="fig">4</xref>) [) [62–64]. The perfusion series allows indirect visualisation of lung parenchyma abnormalities due to emphysema or conditions such as pneumothorax due to the absence of perfused lung tissue.Fig. 4An 18-year-old male cystic fibrosis patient, coronal T2-weighted half Fourier fast spin echo sequence (a) and coronal subtraction perfusion image (b). Notice the severe mucus plugging in the morphological T2-weighted image. The subtraction perfusion image shows correspoding areas with perfusion loss due to hypoxic vasoconstriction. Due to redistribution of perfusion both lower lobes show a high perfusion signal'], '13244_2011_146_Fig5_HTML': ['Direct visualisation of the airways with MRI is limited to airways in excess of 3\xa0mm diameter, unless filled with bright materials such as retained mucus in cystic fibrosis patients [65, 66] (Fig.\xa0<xref rid="13244_2011_146_Fig5_HTML" ref-type="fig">5</xref>). In young healthy subjects, lung MRI depicted airways down to the first subsegmental level; however, in parts of the lung subject to cardiac pulsation, detection rates were significantly lower [). In young healthy subjects, lung MRI depicted airways down to the first subsegmental level; however, in parts of the lung subject to cardiac pulsation, detection rates were significantly lower [67]. As expected from the higher spatial resolution, high resolution CT is still superior to MRI in the depiction of small peripheral airways.Fig. 5Lung MRI of a 37-year-old male patient with cystic fibrosis. Coronal T2-weighted, respiration triggered and transverse breath-hold T1-weighted 3D GRE images show peripheral airways with enhanced signal due to mucus plugging. Note the “tree-in-bud” sign similar to the typical appearance on CT (dashed circles)'], '13244_2011_146_Fig6_HTML': ['Two basic strategies have been pursued for motion compensation: fast single shot imaging with very short acquisition time and respiratory gating/triggering of fast spin echo techniques. For the first approach, steady state (SSFP) or partial Fourier single shot sequences (e.g. HASTE) have been successfully implemented [80]. SSFP sequences allow for a rapid acquisition of ten slices with breath-hold times below 10\xa0s, even on low-field MRI systems. Alternatively, they can be performed during free breathing [81, 82]. Typically, these fast and robust sequences would be used for an initial overview with further high-resolution acquisitions in the second part of the examination. The second approach, gated or triggered acquisition, increases imaging time but provides better spatial resolution and soft tissue contrast (Figs.\xa0<xref rid="13244_2011_146_Fig6_HTML" ref-type="fig">6</xref>, , <xref rid="13244_2011_146_Fig7_HTML" ref-type="fig">7</xref>) [) [79, 83]. The higher respiration frequencies of young children are of a certain advantage since they help speeding up the acquisition. In most cases, the difference to non-gated acquisitions is much less than in adult subjects with low respiration rates. T2-weighted fast spin echo sequences can be applied with repetition times of 2000\xa0ms or less, usually triggered to the expiratory phase, which is around 2\xa0s, depending on the individual respiration frequency. This time frame allows for excellent T2-weighted images without relevant motion artefacts [84]. Depending on the available hardware and specific experience of the team, both mechanical (respiratory belt or cushion technique [84]) or image-based (e.g. navigator) devices for the detection of respiratory motion can be applied with good results. A radial read-out scheme of the k-space further improves the robustness against motion artefacts. The application of additional cardiac triggering may be helpful in specific cases, but paid for with a significant increase of acquisition time [85].Fig. 6A 6-year-old child with lung metastases of osteosarcoma. Both acquisitions, the free breathing steady state free precession series (a) and the respiration triggered (navigator triggered) series (b) show a large mass with high signal intensity in the right upper lung lobe in expirationFig. 7Pneumonia (asterisk), chambered pleural effusion (arrowheads) and abscess (arrow) in the right lower chest of a 6-year-old child, images acquired in T2-weighted triggered fast spin echo technique'], '13244_2011_146_Fig8_HTML': ['A basic or general study combines T1-weighted and T2-weighted images based on gradient echo and fast spin echo sequences, respectively [90]. T1-GRE sequences are available as 3D acquisitions and may, therefore, be limited to a volume acquisition of the chest in one breath-hold. Fast T2-weighted spin echo sequences should cover at least two planes, e.g. with a half Fourier breath-hold acquisition in coronal and a transverse orientation. This results in a high sensitivity of the protocol for infiltrates and small nodular lesions. To improve the sensitivity of the protocol for mediastinal lymph nodes and bone lesions (e.g. metastases), a STIR or fat saturated T2-fast spin echo sequence should be added. Since rib metastases are easier to detect on transverse slices, this orientation should be preferred (Fig.\xa0<xref rid="13244_2011_146_Fig8_HTML" ref-type="fig">8</xref>). The list of “must” sequences (in the table indicated by ). The list of “must” sequences (in the table indicated by G for “general protocol”) is concluded with a coronal steady-state free precession sequence in free breathing, which contributes to a high sensitivity for central pulmonary embolism and gross cardiac or respiratory dysfunction. As an option (but at the cost of additional imaging time exceeding the intended limitation to 15\xa0min), motion-compensated T2-weighted fast spin echo sequences can be added to improve the depiction of masses with chest-wall invasion [1, 5].Fig. 8Recent fracture of the left 5th rib as incidental finding in a 29-year-old female volunteer with left chest pain, hardly visible on the non-contrast enhanced T1-weighteg breath-hold 3D GRE series (a) but with bright signal on the T2-weighted fat saturated image from an multiple breath-hold series (b, arrow)'], '13244_2011_146_Fig9_HTML': ['With this selection of non-contrast-enhanced sequences, the study covers some of the most common potential findings, including pneumonia, atelectasis, pulmonary nodules or masses, mediastinal masses (lymphoma, goiter, cyst, thymoma) and acute pulmonary embolism [5]. Depending on the initial findings following the basic protocol, additional contrast-enhanced acquisitions may be required, which would use the same type of volume interpolated 3D-GRE sequence, but now with fat saturation to improve the visibility of contrast-enhanced tissues and mediastinal lymph nodes (T “tumour protocol”). Although the 3D sequences cover the whole chest, in-plane resolution is optimised in either transverse or coronal section (Fig.\xa0<xref rid="13244_2011_146_Fig9_HTML" ref-type="fig">9</xref>). Since acquisition times are just one breath-hold, it appears to be feasible to acquire the 3D GRE studies in at least transverse and coronal planes. In particular for the staging of lung cancer, it might be helpful for the detection of small lymph nodes metastases to add a diffusion-weighted sequence as well. Both sequences extend the total imaging time by approximately 5 min [). Since acquisition times are just one breath-hold, it appears to be feasible to acquire the 3D GRE studies in at least transverse and coronal planes. In particular for the staging of lung cancer, it might be helpful for the detection of small lymph nodes metastases to add a diffusion-weighted sequence as well. Both sequences extend the total imaging time by approximately 5 min [1].Fig. 9A 77-year-old male patient with adenocarcinoma in segment 6 of the right lower lung lobe (arrow; transverse contrast-enhanced breath-hold 3D GRE study)'], '13244_2011_146_Fig10_HTML': ['The available options for imaging disorders of lung vasculature comprise three components: First of all, the free breathing steady state gradient echo (SSFP-GRE) study which is also part of the general protocol. Then two variations of 3D gradient echo based contrast enhanced MRA: (1) a time-resolved, low spatial resolution acquisition for first pass perfusion imaging and (2) a high spatial resolution acquisition for a breath-hold angiogram (Fig.\xa0<xref rid="13244_2011_146_Fig10_HTML" ref-type="fig">10</xref>). Depending on the performance of the MR scanner, the dynamic study produces a comprehensive lung perfusion study with excellent temporal resolution and at the same time serves for the determination of optimum contrast bolus timing for the acquisition of the high resolution angiogram. The “vessel protocol” (). Depending on the performance of the MR scanner, the dynamic study produces a comprehensive lung perfusion study with excellent temporal resolution and at the same time serves for the determination of optimum contrast bolus timing for the acquisition of the high resolution angiogram. The “vessel protocol” (V in Table\xa01) optimises the sensitivity for acute and chronic pulmonary embolism, arterio-venous (AV) malformation (e.g. Osler’s disease), lung sequestration, pulmonary arterial aneurysm, abnormalities of pulmonary venous drainage and any other pathology of lung vasculature [5]. As in other parts of the protocol recommendations, it is suggested to combine different fast imaging sequences to increase sensitivity and specificity of the examination [93]. Therefore, Kluge et al. [94] suggested combinations of different available MRI techniques for the detection of pulmonary embolism [5]. The lung vessel imaging branch of the protocol tree can be used just for a study of vascular pathology, e.g. in suspected acute pulmonary embolism or in combination with the tumour protocol for the comprehensive evaluation of a central mass with vessel invasion.Fig. 10An 18-year-old female patient with clinical suspicion (dyspnoea and elevated D-dimers) of acute pulmonary embolism. The steady state free precession study shows an embolus inside the right pulmonary artery (a, arrow) that is also clearly depicted in the subtraction images form the contrast enhanced 3D flash MRA (b). The subtraction of the first pass perfusion study (c) confirm large perfusion deficits in the right lower lobe and a posterior segment of the left upper lobe (arrowheads)']} | MRI of the lung (2/3). Why … when … how? | [
"Magnetic resonance imaging",
"Lung, sequence",
"Imaging protocol"
] | Insights Imaging | 1329120000 | None | null | other | PMC3481084 | null | null | [
""
] | Insights Imaging. 2012 Feb 13; 3(4):355-371 | NO-CC CODE |
|
An 18-year-old female patient with clinical suspicion (dyspnoea and elevated D-dimers) of acute pulmonary embolism. The steady state free precession study shows an embolus inside the right pulmonary artery (a, arrow) that is also clearly depicted in the subtraction images form the contrast enhanced 3D flash MRA (b). The subtraction of the first pass perfusion study (c) confirm large perfusion deficits in the right lower lobe and a posterior segment of the left upper lobe (arrowheads) | 13244_2011_146_Fig10_HTML | 7 | 534a59d5d857b855ba2265720eeed6ebc77dd163b19eb3da5161b9adf50a4579 | 13244_2011_146_Fig10_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
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"computerized tomography"
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787,
285
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Both acquisitions, the free breathing steady state free precession series (a) and the respiration triggered (navigator triggered) series (b) show a large mass with high signal intensity in the right upper lung lobe in expiration', 'hash': '4b396e76caf349a0b4be3c01d8d599ea3349611dbc4c9eba92156cbb44ecdedc'}, {'image_id': '13244_2011_146_Fig9_HTML', 'image_file_name': '13244_2011_146_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig9_HTML.jpg', 'caption': 'A 77-year-old male patient with adenocarcinoma in segment 6 of the right lower lung lobe (arrow; transverse contrast-enhanced breath-hold 3D GRE study)', 'hash': '0c5b79f1bbe23444cccf60a42cd0ad26c4654ac127874772a97fb54528a30b2d'}, {'image_id': '13244_2011_146_Fig1_HTML', 'image_file_name': '13244_2011_146_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig1_HTML.jpg', 'caption': 'A 66-year-old male patient with fever and coughing, clinically suspected pneumonia. The plain chest X-ray (a) demonstrates a dense infiltrate in the left lower lung lobe which is confirmed on non-contrast-enhanced low dose CT (b; arrows). The patient volunteered to undergo MRI on the same day. Multi-breath-hold coronal T2-weighted fast spin echo (c) and single breath-hold T1-weighted 3D GRE imaging (d) as well as free breathing coronal steady state SSFP (e) and multi-breath-hold fat-saturated T2-weighted fast spin echo series (f) clearly demonstrate the infiltrates with particularly high signal on T2-weighted images', 'hash': 'aa99311f557c6cb9eeba10e85bdc313ca61ee04ed1ac349cbb9c4519b01fe1ac'}, {'image_id': '13244_2011_146_Fig8_HTML', 'image_file_name': '13244_2011_146_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig8_HTML.jpg', 'caption': 'Recent fracture of the left 5th rib as incidental finding in a 29-year-old female volunteer with left chest pain, hardly visible on the non-contrast enhanced T1-weighteg breath-hold 3D GRE series (a) but with bright signal on the T2-weighted fat saturated image from an multiple breath-hold series (b, arrow)', 'hash': '1e4351f241881465247ba43f816e2a2089f45bb55b8eb85d4222f4ff21f6d1b5'}, {'image_id': '13244_2011_146_Fig7_HTML', 'image_file_name': '13244_2011_146_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig7_HTML.jpg', 'caption': 'Pneumonia (asterisk), chambered pleural effusion (arrowheads) and abscess (arrow) in the right lower chest of a 6-year-old child, images acquired in T2-weighted triggered fast spin echo technique', 'hash': '33012e10800825460aa19fa3aab289a08ae91e5d69c045901050e82872a40be0'}, {'image_id': '13244_2011_146_Fig3_HTML', 'image_file_name': '13244_2011_146_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig3_HTML.jpg', 'caption': 'Diffusion-weighted imaging highlighting pleural metastases of hepatocellular carcinoma at the right diaphragm (left, open arrow). The same spots are only hardly visible on the post-contrast fat-saturated breath-hold T1-weighted 3D GRE sequence (right).', 'hash': 'aca4d494c060302087e2e3a23c8a9e733f86547360797b3b47bbacb7053fed4c'}, {'image_id': '13244_2011_146_Fig4_HTML', 'image_file_name': '13244_2011_146_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig4_HTML.jpg', 'caption': 'An 18-year-old male cystic fibrosis patient, coronal T2-weighted half Fourier fast spin echo sequence (a) and coronal subtraction perfusion image (b). Notice the severe mucus plugging in the morphological T2-weighted image. The subtraction perfusion image shows correspoding areas with perfusion loss due to hypoxic vasoconstriction. Due to redistribution of perfusion both lower lobes show a high perfusion signal', 'hash': 'e413eb09cda368c0698e86f0b7b915305d3d500439d098d852d85d62aef5ef26'}, {'image_id': '13244_2011_146_Fig10_HTML', 'image_file_name': '13244_2011_146_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig10_HTML.jpg', 'caption': 'An 18-year-old female patient with clinical suspicion (dyspnoea and elevated D-dimers) of acute pulmonary embolism. The steady state free precession study shows an embolus inside the right pulmonary artery (a, arrow) that is also clearly depicted in the subtraction images form the contrast enhanced 3D flash MRA (b). The subtraction of the first pass perfusion study (c) confirm large perfusion deficits in the right lower lobe and a posterior segment of the left upper lobe (arrowheads)', 'hash': '534a59d5d857b855ba2265720eeed6ebc77dd163b19eb3da5161b9adf50a4579'}, {'image_id': '13244_2011_146_Fig2_HTML', 'image_file_name': '13244_2011_146_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig2_HTML.jpg', 'caption': 'A 64-year-old woman with the incidental finding of an unspecific, 4-mm nodule in the right middle lobe. The nodule (open arrow) is clearly depicted on the coronal multi-breath-hold T2-weighted (a) and transverse contrast-enhanced, fat-saturated 3D GRE images (b)', 'hash': 'bf1d40227ab553aa9ec00f51dddb1419a89db91e7428798100ef245db5dc7226'}, {'image_id': '13244_2011_146_Fig5_HTML', 'image_file_name': '13244_2011_146_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3481084/13244_2011_146_Fig5_HTML.jpg', 'caption': 'Lung MRI of a 37-year-old male patient with cystic fibrosis. Coronal T2-weighted, respiration triggered and transverse breath-hold T1-weighted 3D GRE images show peripheral airways with enhanced signal due to mucus plugging. Note the “tree-in-bud” sign similar to the typical appearance on CT (dashed circles)', 'hash': 'ba47113abb017ec2d2a17e8df388159b2086098995fe9d3a12bc30346d750e35'}] | {'13244_2011_146_Fig1_HTML': ['Quite a lot of experience exists for detection of pathological conditions that result in an increase of lung proton density. Experimental work has shown the high sensitivity of MRI with T2-weighted and proton-density weighted sequences for fluid accumulation inside the lung [12–14]. One can conclude that the sensitivity of MRI for pulmonary infiltrates is at least as good as with chest radiography and CT [2, 12, 15–17]. The majority of the applied protocols are based on T2-weighted or proton-density-weighted fast spin echo sequences, either with respiration gating or triggering or in breath-hold acquisition modes (Fig.\xa0<xref rid="13244_2011_146_Fig1_HTML" ref-type="fig">1</xref>).).Fig. 1A 66-year-old male patient with fever and coughing, clinically suspected pneumonia. The plain chest X-ray (a) demonstrates a dense infiltrate in the left lower lung lobe which is confirmed on non-contrast-enhanced low dose CT (b; arrows). The patient volunteered to undergo MRI on the same day. Multi-breath-hold coronal T2-weighted fast spin echo (c) and single breath-hold T1-weighted 3D GRE imaging (d) as well as free breathing coronal steady state SSFP (e) and multi-breath-hold fat-saturated T2-weighted fast spin echo series (f) clearly demonstrate the infiltrates with particularly high signal on T2-weighted images'], '13244_2011_146_Fig2_HTML': ['Another key clinical demand is the detection of small solid or soft tissue lesions (“nodules”). The sensitivity of MRI for lung nodules larger than 4\xa0mm ranges between 80 and 90% and reaches 100% for lesions larger than 8\xa0mm [18]. Depending on the sequence technique and the signal intensity of the lesions and given that conditions are optimal (i.e. patient can keep a breath-hold for 20\xa0s or perfect gating/triggering), a threshold size of 3-4\xa0mm can be assumed for lung nodule detection with MRI [19, 20]. In comparison with CT, it might be even faster and more efficient to read lung MRI for pulmonary nodules, since they appear with bright signal against the dark background of the healthy lung tissue [21] (Fig.\xa0<xref rid="13244_2011_146_Fig2_HTML" ref-type="fig">2</xref>). Calcified nodules tend to disappear in the background, as they have no inherent signal, whereas contrast-filled vascular lesions will be highly visible on T1-weighted images [). Calcified nodules tend to disappear in the background, as they have no inherent signal, whereas contrast-filled vascular lesions will be highly visible on T1-weighted images [22]. So far, a variety of sequence types has been evaluated for lung nodule detection with MRI. The spectrum comprises T2-weighted fast spin echo imaging with and without fat saturation [23–26], inversion recovery techniques [27], T1-spin echo [26, 28] and gradient echo sequences [29, 30].Fig. 2A 64-year-old woman with the incidental finding of an unspecific, 4-mm nodule in the right middle lobe. The nodule (open arrow) is clearly depicted on the coronal multi-breath-hold T2-weighted (a) and transverse contrast-enhanced, fat-saturated 3D GRE images (b)'], '13244_2011_146_Fig3_HTML': ['Not yet clarified is the role of diffusion-weighted imaging (DWI) of lung lesions. DWI is recommended for the whole-body staging of lung cancer, including mediastinal metastases [31, 32]; however, in the chest a clear advantage of DWI over other MRI protocols has not been confirmed so far [33, 34]. STIR sequences might be even more sensitive for the detection and classification of lung cancer and mediastinal metastases than DWI [35–37]. One potential role of DWI might be to predict tumour invasiveness for clinical stage IA non-small-cell lung cancer and to separate the mass from atelectasis [38, 39]. The role of DWI sequences for the differentiation of malignant or benign lung lesions or for the discrimination of subtypes of lung cancer remains controversial [37, 40–42]. In the authors’ own experience, DWI helps to demarcate lesions adjacent to the pleura (Fig.\xa0<xref rid="13244_2011_146_Fig3_HTML" ref-type="fig">3</xref>), assess mediastinal extension and may serve as a “second reader” for detection of small nodules. Thus, it makes sense to include a fast DWI acquisition in the protocol recommendations for MRI of the lung [), assess mediastinal extension and may serve as a “second reader” for detection of small nodules. Thus, it makes sense to include a fast DWI acquisition in the protocol recommendations for MRI of the lung [43, 44].Fig. 3Diffusion-weighted imaging highlighting pleural metastases of hepatocellular carcinoma at the right diaphragm (left, open arrow). The same spots are only hardly visible on the post-contrast fat-saturated breath-hold T1-weighted 3D GRE sequence (right).'], '13244_2011_146_Fig4_HTML': ['The visual evaluation of 4D MRI image sets is facilitated by subtraction of the non-enhanced from the contrast-enhanced image signal, which results in a bright display of the contrast-enhanced lung vessels and parenchyma. The clinical value of lung perfusion studies with visual and semi-quantitative evaluation is being tested in the assessment of lung perfusion deficits in cystic fibrosis patients who suffer from mucus retention and hypoxic vasoconstriction (Fig.\xa0<xref rid="13244_2011_146_Fig4_HTML" ref-type="fig">4</xref>) [) [62–64]. The perfusion series allows indirect visualisation of lung parenchyma abnormalities due to emphysema or conditions such as pneumothorax due to the absence of perfused lung tissue.Fig. 4An 18-year-old male cystic fibrosis patient, coronal T2-weighted half Fourier fast spin echo sequence (a) and coronal subtraction perfusion image (b). Notice the severe mucus plugging in the morphological T2-weighted image. The subtraction perfusion image shows correspoding areas with perfusion loss due to hypoxic vasoconstriction. Due to redistribution of perfusion both lower lobes show a high perfusion signal'], '13244_2011_146_Fig5_HTML': ['Direct visualisation of the airways with MRI is limited to airways in excess of 3\xa0mm diameter, unless filled with bright materials such as retained mucus in cystic fibrosis patients [65, 66] (Fig.\xa0<xref rid="13244_2011_146_Fig5_HTML" ref-type="fig">5</xref>). In young healthy subjects, lung MRI depicted airways down to the first subsegmental level; however, in parts of the lung subject to cardiac pulsation, detection rates were significantly lower [). In young healthy subjects, lung MRI depicted airways down to the first subsegmental level; however, in parts of the lung subject to cardiac pulsation, detection rates were significantly lower [67]. As expected from the higher spatial resolution, high resolution CT is still superior to MRI in the depiction of small peripheral airways.Fig. 5Lung MRI of a 37-year-old male patient with cystic fibrosis. Coronal T2-weighted, respiration triggered and transverse breath-hold T1-weighted 3D GRE images show peripheral airways with enhanced signal due to mucus plugging. Note the “tree-in-bud” sign similar to the typical appearance on CT (dashed circles)'], '13244_2011_146_Fig6_HTML': ['Two basic strategies have been pursued for motion compensation: fast single shot imaging with very short acquisition time and respiratory gating/triggering of fast spin echo techniques. For the first approach, steady state (SSFP) or partial Fourier single shot sequences (e.g. HASTE) have been successfully implemented [80]. SSFP sequences allow for a rapid acquisition of ten slices with breath-hold times below 10\xa0s, even on low-field MRI systems. Alternatively, they can be performed during free breathing [81, 82]. Typically, these fast and robust sequences would be used for an initial overview with further high-resolution acquisitions in the second part of the examination. The second approach, gated or triggered acquisition, increases imaging time but provides better spatial resolution and soft tissue contrast (Figs.\xa0<xref rid="13244_2011_146_Fig6_HTML" ref-type="fig">6</xref>, , <xref rid="13244_2011_146_Fig7_HTML" ref-type="fig">7</xref>) [) [79, 83]. The higher respiration frequencies of young children are of a certain advantage since they help speeding up the acquisition. In most cases, the difference to non-gated acquisitions is much less than in adult subjects with low respiration rates. T2-weighted fast spin echo sequences can be applied with repetition times of 2000\xa0ms or less, usually triggered to the expiratory phase, which is around 2\xa0s, depending on the individual respiration frequency. This time frame allows for excellent T2-weighted images without relevant motion artefacts [84]. Depending on the available hardware and specific experience of the team, both mechanical (respiratory belt or cushion technique [84]) or image-based (e.g. navigator) devices for the detection of respiratory motion can be applied with good results. A radial read-out scheme of the k-space further improves the robustness against motion artefacts. The application of additional cardiac triggering may be helpful in specific cases, but paid for with a significant increase of acquisition time [85].Fig. 6A 6-year-old child with lung metastases of osteosarcoma. Both acquisitions, the free breathing steady state free precession series (a) and the respiration triggered (navigator triggered) series (b) show a large mass with high signal intensity in the right upper lung lobe in expirationFig. 7Pneumonia (asterisk), chambered pleural effusion (arrowheads) and abscess (arrow) in the right lower chest of a 6-year-old child, images acquired in T2-weighted triggered fast spin echo technique'], '13244_2011_146_Fig8_HTML': ['A basic or general study combines T1-weighted and T2-weighted images based on gradient echo and fast spin echo sequences, respectively [90]. T1-GRE sequences are available as 3D acquisitions and may, therefore, be limited to a volume acquisition of the chest in one breath-hold. Fast T2-weighted spin echo sequences should cover at least two planes, e.g. with a half Fourier breath-hold acquisition in coronal and a transverse orientation. This results in a high sensitivity of the protocol for infiltrates and small nodular lesions. To improve the sensitivity of the protocol for mediastinal lymph nodes and bone lesions (e.g. metastases), a STIR or fat saturated T2-fast spin echo sequence should be added. Since rib metastases are easier to detect on transverse slices, this orientation should be preferred (Fig.\xa0<xref rid="13244_2011_146_Fig8_HTML" ref-type="fig">8</xref>). The list of “must” sequences (in the table indicated by ). The list of “must” sequences (in the table indicated by G for “general protocol”) is concluded with a coronal steady-state free precession sequence in free breathing, which contributes to a high sensitivity for central pulmonary embolism and gross cardiac or respiratory dysfunction. As an option (but at the cost of additional imaging time exceeding the intended limitation to 15\xa0min), motion-compensated T2-weighted fast spin echo sequences can be added to improve the depiction of masses with chest-wall invasion [1, 5].Fig. 8Recent fracture of the left 5th rib as incidental finding in a 29-year-old female volunteer with left chest pain, hardly visible on the non-contrast enhanced T1-weighteg breath-hold 3D GRE series (a) but with bright signal on the T2-weighted fat saturated image from an multiple breath-hold series (b, arrow)'], '13244_2011_146_Fig9_HTML': ['With this selection of non-contrast-enhanced sequences, the study covers some of the most common potential findings, including pneumonia, atelectasis, pulmonary nodules or masses, mediastinal masses (lymphoma, goiter, cyst, thymoma) and acute pulmonary embolism [5]. Depending on the initial findings following the basic protocol, additional contrast-enhanced acquisitions may be required, which would use the same type of volume interpolated 3D-GRE sequence, but now with fat saturation to improve the visibility of contrast-enhanced tissues and mediastinal lymph nodes (T “tumour protocol”). Although the 3D sequences cover the whole chest, in-plane resolution is optimised in either transverse or coronal section (Fig.\xa0<xref rid="13244_2011_146_Fig9_HTML" ref-type="fig">9</xref>). Since acquisition times are just one breath-hold, it appears to be feasible to acquire the 3D GRE studies in at least transverse and coronal planes. In particular for the staging of lung cancer, it might be helpful for the detection of small lymph nodes metastases to add a diffusion-weighted sequence as well. Both sequences extend the total imaging time by approximately 5 min [). Since acquisition times are just one breath-hold, it appears to be feasible to acquire the 3D GRE studies in at least transverse and coronal planes. In particular for the staging of lung cancer, it might be helpful for the detection of small lymph nodes metastases to add a diffusion-weighted sequence as well. Both sequences extend the total imaging time by approximately 5 min [1].Fig. 9A 77-year-old male patient with adenocarcinoma in segment 6 of the right lower lung lobe (arrow; transverse contrast-enhanced breath-hold 3D GRE study)'], '13244_2011_146_Fig10_HTML': ['The available options for imaging disorders of lung vasculature comprise three components: First of all, the free breathing steady state gradient echo (SSFP-GRE) study which is also part of the general protocol. Then two variations of 3D gradient echo based contrast enhanced MRA: (1) a time-resolved, low spatial resolution acquisition for first pass perfusion imaging and (2) a high spatial resolution acquisition for a breath-hold angiogram (Fig.\xa0<xref rid="13244_2011_146_Fig10_HTML" ref-type="fig">10</xref>). Depending on the performance of the MR scanner, the dynamic study produces a comprehensive lung perfusion study with excellent temporal resolution and at the same time serves for the determination of optimum contrast bolus timing for the acquisition of the high resolution angiogram. The “vessel protocol” (). Depending on the performance of the MR scanner, the dynamic study produces a comprehensive lung perfusion study with excellent temporal resolution and at the same time serves for the determination of optimum contrast bolus timing for the acquisition of the high resolution angiogram. The “vessel protocol” (V in Table\xa01) optimises the sensitivity for acute and chronic pulmonary embolism, arterio-venous (AV) malformation (e.g. Osler’s disease), lung sequestration, pulmonary arterial aneurysm, abnormalities of pulmonary venous drainage and any other pathology of lung vasculature [5]. As in other parts of the protocol recommendations, it is suggested to combine different fast imaging sequences to increase sensitivity and specificity of the examination [93]. Therefore, Kluge et al. [94] suggested combinations of different available MRI techniques for the detection of pulmonary embolism [5]. The lung vessel imaging branch of the protocol tree can be used just for a study of vascular pathology, e.g. in suspected acute pulmonary embolism or in combination with the tumour protocol for the comprehensive evaluation of a central mass with vessel invasion.Fig. 10An 18-year-old female patient with clinical suspicion (dyspnoea and elevated D-dimers) of acute pulmonary embolism. The steady state free precession study shows an embolus inside the right pulmonary artery (a, arrow) that is also clearly depicted in the subtraction images form the contrast enhanced 3D flash MRA (b). The subtraction of the first pass perfusion study (c) confirm large perfusion deficits in the right lower lobe and a posterior segment of the left upper lobe (arrowheads)']} | MRI of the lung (2/3). Why … when … how? | [
"Magnetic resonance imaging",
"Lung, sequence",
"Imaging protocol"
] | Insights Imaging | 1329120000 | None | null | other | PMC3481084 | null | null | [
""
] | Insights Imaging. 2012 Feb 13; 3(4):355-371 | NO-CC CODE |
|
Coronal lung window image of a COVID-19-positive patient showing patchy areas of peripherally distributed ground-glass opacities in bilateral lungs, more so in the lower lobes consistent with COVID-19 Reporting and Data System (CORADS) 6. | bcr-2020-240932f05 | 7 | d499f6508d5faf1489817c588ddf2b2ea1c9be8de41dc63c9d5b2b9bc6cbf7e2 | bcr-2020-240932f05.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
622,
600
] | [{'image_id': 'bcr-2020-240932f03', 'image_file_name': 'bcr-2020-240932f03.jpg', 'image_path': '../data/media_files/PMC7813340/bcr-2020-240932f03.jpg', 'caption': 'Axial (A) and coronal (B) pulmonary angiography images of a COVID-19-positive patient who developed deep vein thrombosis in the lower limb and presented with sudden onset breathlessness showing a hypodense filling defect (arrows) in the left inferior pulmonary artery suggestive of acute pulmonary thromboembolism.', 'hash': 'fb8bcbec9cd4e71ba1750ed7997daacaee087f65508f1acfc3ad52dc719a8a59'}, {'image_id': 'bcr-2020-240932f04', 'image_file_name': 'bcr-2020-240932f04.jpg', 'image_path': '../data/media_files/PMC7813340/bcr-2020-240932f04.jpg', 'caption': 'Axial CT images of the venous phase of the lower limbs of a COVID-19-positive patient showing hypodense filling defect in the common femoral (A) and the popliteal (B) veins of the left lower limb indicating deep vein thrombosis. These veins appear distended.', 'hash': '9e8a768619df649e4d091fc27643d5904faf210d0f3b3fc58594e366cb6db8f6'}, {'image_id': 'bcr-2020-240932f05', 'image_file_name': 'bcr-2020-240932f05.jpg', 'image_path': '../data/media_files/PMC7813340/bcr-2020-240932f05.jpg', 'caption': 'Coronal lung window image of a COVID-19-positive patient showing patchy areas of peripherally distributed ground-glass opacities in bilateral lungs, more so in the lower lobes consistent with COVID-19 Reporting and Data System (CORADS) 6.', 'hash': 'd499f6508d5faf1489817c588ddf2b2ea1c9be8de41dc63c9d5b2b9bc6cbf7e2'}, {'image_id': 'bcr-2020-240932f02', 'image_file_name': 'bcr-2020-240932f02.jpg', 'image_path': '../data/media_files/PMC7813340/bcr-2020-240932f02.jpg', 'caption': 'Frontal chest radiograph of a COVID-19-positive patient showing bilateral peripheral ground-glass opacities predominantly affecting the lower lobes.', 'hash': 'a99e35d251a744cf788ec643441b138750d037b7292e646ff2d4018f27caf9e8'}, {'image_id': 'bcr-2020-240932f01', 'image_file_name': 'bcr-2020-240932f01.jpg', 'image_path': '../data/media_files/PMC7813340/bcr-2020-240932f01.jpg', 'caption': 'Left lower limb of a COVID-19-positive patient with deep vein thrombosis appears swollen and inflamed.', 'hash': '6a22cd12fae803aa7425a5332343f5580f2572b527367181b1ccbee7611d0a89'}] | {'bcr-2020-240932f01': ['A 53-year-old man who was a known case of type 2 diabetes mellitus, presented to the emergency department with a history of fever and dry cough for 5\u2009days, swelling of the left leg for 2\u2009days, and shortness of breath and chest pain for 1\u2009hour. On examination, his pulse rate was 138 beats/min, with blood pressure of 138/70\u2009mm Hg, respiratory rate of 30 breaths/min, and oxygen saturation was 64% on room air with a temperature of 98.6℉. His left leg was swollen, and tenderness was present over the calf region (<xref ref-type="fig" rid="bcr-2020-240932f01">figure 1</xref>). A difference of 5\u2009cm was observed between the left and right calf diameters. On auscultation, bilateral basal crepitation was found. The abdominal, neurological and cardiovascular systems were within normal limits.). A difference of 5\u2009cm was observed between the left and right calf diameters. On auscultation, bilateral basal crepitation was found. The abdominal, neurological and cardiovascular systems were within normal limits.'], 'bcr-2020-240932f02': ['Laboratory tests showed haemoglobin of 1.41 g/L, total leucocyte count of 10×109 cells/L (with neutrophils of 81% and lymphocyte of 13%), total platelet count of 234× 109 cells/L, random blood sugar level of 481\u2009mg/dL, elevated D-dimer of 35.2\u2009µg/L, lactate dehydrogenase of 724\u2009U/L, with normal liver and kidney functions test. The nasal swab for COVID-19 real-time PCR test was positive. A Chest X-ray revealed GGOs on bilateral lung fields attributed to COVID-19 disease (<xref ref-type="fig" rid="bcr-2020-240932f02">figure 2</xref>).).'], 'bcr-2020-240932f03': ['Colour Doppler study of the left lower limb showed distended, non-compressible common femoral, superficial femoral and popliteal veins, which did not show colour filling or spectral waveform. No flow was seen even in the augmentation test by distal compression. These grey-scale and colour Doppler features were suggestive of acute deep venous thrombosis. CT pulmonary angiography (CTPA) was done to rule out pulmonary thromboembolism (PTE) as the patient has DVT with sudden-onset breathlessness, raised D-dimer and positive PCR test for COVID-19, which itself is now thought to incite inflammation and thrombosis. The CTPA showed a non-enhancing hypodense filling defect in the left main pulmonary artery extending into left lingular and superior basal segmental arteries suggestive of acute PTE (<xref ref-type="fig" rid="bcr-2020-240932f03">figure 3A, B</xref>). The CT sections of the lower limb in the venous phase also revealed the DVT as a hypodense filling defect in the expanded common femoral, superficial femoral and popliteal veins (). The CT sections of the lower limb in the venous phase also revealed the DVT as a hypodense filling defect in the expanded common femoral, superficial femoral and popliteal veins (<xref ref-type="fig" rid="bcr-2020-240932f04">figure 4A, B</xref>). Diffuse GGO and interlobular septal thickening were noted, predominantly involving peripheral zones of bilateral lungs, more so in the lower lobes consistent with COVID-19 Reporting and Data System (CORADS) 6 (). Diffuse GGO and interlobular septal thickening were noted, predominantly involving peripheral zones of bilateral lungs, more so in the lower lobes consistent with COVID-19 Reporting and Data System (CORADS) 6 (<xref ref-type="fig" rid="bcr-2020-240932f05">figure 5</xref>). The scoring on CT was 12/25, almost affecting 48% of the lung parenchyma.). The scoring on CT was 12/25, almost affecting 48% of the lung parenchyma.']} | Deep vein thrombosis with pulmonary thromboembolism in a case of severe COVID-19 pneumonia | [
"venous thromboembolism",
"COVID-19",
"radiology (diagnostics)"
] | BMJ Case Rep | 1610697600 | [{'@Label': 'INTRODUCTION', '@NlmCategory': 'BACKGROUND', '#text': 'Invasive pulmonary aspergillosis is a well-known complication of acute respiratory distress syndrome, the most serious manifestation of COVID-19. Four recent studies have reported its incidence among ICU COVID-19 patients. However, they do not share the same case definition, and have provided conflicting results. In this paper we have aimed at reported the incidence of invasive pulmonary aspergillosis for COVID-19 patients in our ICU, and at comparing the different definitions in order to assess their respective relevance.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'Retrospective cohort study of critically ill patients with severe COVID-19 requiring ICU management between 1st March and 30th April 2020.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'Our results showed significantly lower incidence of invasive pulmonary aspergillosis (1.8%;1/53), compared to three out of four previous studies, and wide variation in the numbers of cases with regard to the different definitions.'}, {'@Label': 'CONCLUSION', '@NlmCategory': 'CONCLUSIONS', '#text': 'Large-scale studies are needed for a better definition and a more accurate estimation of invasive pulmonary aspergillosis coinfection during COVID-19.'}] | [
"Aged",
"COVID-19",
"Cohort Studies",
"Critical Illness",
"Female",
"Humans",
"Incidence",
"Invasive Pulmonary Aspergillosis",
"Male",
"Middle Aged",
"Retrospective Studies"
] | other | PMC7813340 | null | 14 | [
"{'Citation': 'Blot S.I., Taccone F.S., Van den Abeele A.-M., et al. A clinical algorithm to diagnose invasive pulmonary Aspergillosis in critically ill patients. Am J Respir Crit Care Med. 2012;186:56–64. doi: 10.1164/rccm.201111-1978OC.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1164/rccm.201111-1978OC'}, {'@IdType': 'pubmed', '#text': '22517788'}]}}",
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"{'Citation': 'van Arkel A.L.E., Rijpstra T.A., Belderbos H.N.A., et al. COVID-19 associated pulmonary aspergillosis. Am J Respir Crit Care Med. 2020 doi: 10.1164/rccm.202004-1038LE.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1164/rccm.202004-1038LE'}, {'@IdType': 'pmc', '#text': 'PMC7328331'}, {'@IdType': 'pubmed', '#text': '32396381'}]}}",
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"{'Citation': 'Bassetti M., Kollef M.H., Timsit J.-F. Bacterial and fungal superinfections in critically ill patients with COVID-19. Intensive Care Med. 2020;46:2071–2074. doi: 10.1007/s00134-020-06219-8.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s00134-020-06219-8'}, {'@IdType': 'pmc', '#text': 'PMC7479998'}, {'@IdType': 'pubmed', '#text': '32902729'}]}}",
"{'Citation': 'Verweij P.E., Gangneux J.-P., Bassetti M., et al. Diagnosing COVID-19-associated pulmonary aspergillosis. The Lancet Microbe 0. 2020 doi: 10.1016/S2666-5247(20)30027-6.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S2666-5247(20)30027-6'}, {'@IdType': 'pmc', '#text': 'PMC7211496'}, {'@IdType': 'pubmed', '#text': '32835328'}]}}"
] | BMJ Case Rep. 2021 Jan 15; 14(1):e240932 | NO-CC CODE |
|
Brain activations in the pre- and post-training conditions. Patient M.E. on the left. Patient S.R. on the right. | fnhum-05-00146-g003 | 7 | f1ac550d419810b8983fa6dc5dd2594a7c53ac4078e6ea9f9f665d05bdf8e882 | fnhum-05-00146-g003.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
454,
197
] | [{'image_id': 'fnhum-05-00146-g002', 'image_file_name': 'fnhum-05-00146-g002.jpg', 'image_path': '../data/media_files/PMC3254199/fnhum-05-00146-g002.jpg', 'caption': 'Details of hip (A) and knee (B) actuation system. (Source, Li et al., 2008).', 'hash': 'b9db532dbc59516ab4eefc590483f368483584c73c341e8732a0ad39bea4f470'}, {'image_id': 'fnhum-05-00146-g005', 'image_file_name': 'fnhum-05-00146-g005.jpg', 'image_path': '../data/media_files/PMC3254199/fnhum-05-00146-g005.jpg', 'caption': 'Brain connectivity in the pre- and post-training conditions: patient S.R.', 'hash': '311ba11693a1e862b52e2928d7ef253e80b8fdfd7696600b3aa081d4b0a38716'}, {'image_id': 'fnhum-05-00146-g004', 'image_file_name': 'fnhum-05-00146-g004.jpg', 'image_path': '../data/media_files/PMC3254199/fnhum-05-00146-g004.jpg', 'caption': 'Brain activations in the pre- and post-training conditions, 3D cortex reconstruction of the left hemisphere. Patient M.E. on the left. Patient S.R. on the right.', 'hash': '5813ece65a1f42707a58b6e90965dfc3fc92b1297eb8316551b9a548b3226bf9'}, {'image_id': 'fnhum-05-00146-g003', 'image_file_name': 'fnhum-05-00146-g003.jpg', 'image_path': '../data/media_files/PMC3254199/fnhum-05-00146-g003.jpg', 'caption': 'Brain activations in the pre- and post-training conditions. Patient M.E. on the left. Patient S.R. on the right.', 'hash': 'f1ac550d419810b8983fa6dc5dd2594a7c53ac4078e6ea9f9f665d05bdf8e882'}, {'image_id': 'fnhum-05-00146-g001', 'image_file_name': 'fnhum-05-00146-g001.jpg', 'image_path': '../data/media_files/PMC3254199/fnhum-05-00146-g001.jpg', 'caption': 'Active RGO used for training, alone (A) and worn by subject (B).', 'hash': '1281db480aef78a326a8b12cdf4a33c21233276b1f93dd0552eb909d7157a65c'}] | {'fnhum-05-00146-g001': ['In the last decade, many robotic devices for lower limb rehabilitations have been developed (for a recent review see Waldner et al., 2009). The robotic gait orthosis we used is a prototype developed by our group for TBI gait rehabilitation purposes (differences from the existing devices are described below). It consists of a modified reciprocating gait orthosis (RGO) integrated with a pneumatic actuation system for knee and hip joints. Hinges that enable rotation in the sagittal plane replace the RGO’s original locked joints. The hip angle ranges from −20° flexion to 20° extension and the knee angle from 0° extension to 90° flexion. Joint actuation is provided by double acting pneumatic cylinders that are positioned on the passive RGO structure and controlled by a PLC (Programmable Logic Controller) and a group of electrovalves. See Figure <xref ref-type="fig" rid="fnhum-05-00146-g001">1</xref>..'], 'fnhum-05-00146-g002': ['For the hip actuation (Figure <xref ref-type="fig" rid="fnhum-05-00146-g002">2</xref>A), a cylindrical tube is fixed to the rear RGO tube, whereas the rod is hinged on a metal plate that is integral with the femoral segment of the orthosis. A cable connects the two hips and makes their movement reciprocal, that is the extension of one hip achieves flexion in the opposite hip. This enables a crossed hip joint actuation strategy and a simple control of the neutral trunk position with respect to the legs. Knee actuation (Figure A), a cylindrical tube is fixed to the rear RGO tube, whereas the rod is hinged on a metal plate that is integral with the femoral segment of the orthosis. A cable connects the two hips and makes their movement reciprocal, that is the extension of one hip achieves flexion in the opposite hip. This enables a crossed hip joint actuation strategy and a simple control of the neutral trunk position with respect to the legs. Knee actuation (Figure <xref ref-type="fig" rid="fnhum-05-00146-g002">2</xref>B) is based on the same principle: a double acting pneumatic cylinder has its tube fixed to the orthosis’s femoral segment whereas its rod is hinged on a metal plate that is integral with the tibial segment. The suitably positioned hinge helps create the necessary lever arm action to generate appropriate torque on the joint. The ankle joint is passive: the foot and calf are fixed to an ankle foot orthosis (AFO) and elastic elements keep the foot in slight dorsiflexion so to prevent it dropping. The robotic orthosis is able to reproduce a gait cycle according to two different modes: B) is based on the same principle: a double acting pneumatic cylinder has its tube fixed to the orthosis’s femoral segment whereas its rod is hinged on a metal plate that is integral with the tibial segment. The suitably positioned hinge helps create the necessary lever arm action to generate appropriate torque on the joint. The ankle joint is passive: the foot and calf are fixed to an ankle foot orthosis (AFO) and elastic elements keep the foot in slight dorsiflexion so to prevent it dropping. The robotic orthosis is able to reproduce a gait cycle according to two different modes: step-by-step or continuous. Step-by-step mode requires user consent after each step in order to proceed to the following step, whereas in the continuous mode the orthosis imposes the gait cycle according to established parameters.'], 'fnhum-05-00146-g003': ['In both patients, comparing the spatial distribution of patterns of brain activation pre- and post-RCGR revealed extended bilateral activations in the SMA, as well as activations in the cingulate motor cortex, and in the foot somatosensory motor area (S1). In patient S.R. activations in the cerebellum also emerged. Figure <xref ref-type="fig" rid="fnhum-05-00146-g003">3</xref> shows pre- and post-training activations on a sagittal view, for each patient. Figure shows pre- and post-training activations on a sagittal view, for each patient. Figure <xref ref-type="fig" rid="fnhum-05-00146-g004">4</xref> represents three-dimensional cortex reconstructions of the dominant hemisphere, for each patient: “green” indicates activations in the pre-training condition; “yellow” indicates activations in the post-training condition. All statistical comparisons were computed at a statistical threshold of represents three-dimensional cortex reconstructions of the dominant hemisphere, for each patient: “green” indicates activations in the pre-training condition; “yellow” indicates activations in the post-training condition. All statistical comparisons were computed at a statistical threshold of p\u2009<\u20090.05, corrected for multiple comparisons using Bonferroni correction.'], 'fnhum-05-00146-g005': ['As far as functional connectivity is concerned, it could not be computed on patient M.E. due to technical problems. It was, however, possible for S.R.: here, the seed voxel correlation analysis demonstrated an increase in functional connectivity. Figure <xref ref-type="fig" rid="fnhum-05-00146-g005">5</xref> shows the pre- and post-connectivity patterns of S. R.: “yellow” indicates connectivity in the pre-training condition; “blue” indicates connectivity in the post-training condition. All statistical comparisons were computed at a statistical threshold of shows the pre- and post-connectivity patterns of S. R.: “yellow” indicates connectivity in the pre-training condition; “blue” indicates connectivity in the post-training condition. All statistical comparisons were computed at a statistical threshold of p\u2009<\u20090.05, corrected for multiple comparisons using Bonferroni correction.']} | A Combined Robotic and Cognitive Training for Locomotor Rehabilitation: Evidences of Cerebral Functional Reorganization in Two Chronic Traumatic Brain Injured Patients | [
"motor training",
"cognitive training",
"motor imagery",
"locomotor rehabilitation",
"brain injury",
"robotic gait orthosis",
"functional magnetic resonance imaging",
"brain plasticity"
] | Front Hum Neurosci | 1322035200 | None | null | other | PMC3254199 | null | null | [
""
] | Front Hum Neurosci. 2011 Nov 23; 5:146 | NO-CC CODE |
|
Magnetic resonance images of the right hand of the patient in T2-weighted sequences showing that the lobulated mass is hyperintense to muscle signals, with displacement of little finger flexors | 11751_2009_61_Fig2_HTML | 7 | 2dc25c3202f77a53ec02c83259bc9f28b882381ffc6c71beaa1c10e34d7bb922 | 11751_2009_61_Fig2_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
484,
447
] | [{'image_id': '11751_2009_61_Fig2_HTML', 'image_file_name': '11751_2009_61_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC2746272/11751_2009_61_Fig2_HTML.jpg', 'caption': 'Magnetic resonance images of the right hand of the patient in T2-weighted sequences showing that the lobulated mass is hyperintense to muscle signals, with displacement of little finger flexors', 'hash': '2dc25c3202f77a53ec02c83259bc9f28b882381ffc6c71beaa1c10e34d7bb922'}, {'image_id': '11751_2009_61_Fig5_HTML', 'image_file_name': '11751_2009_61_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC2746272/11751_2009_61_Fig5_HTML.jpg', 'caption': 'The tumor infiltrates into the surrounding skeletal muscle separating individual fibers (×100)', 'hash': '557dc42fe6f8cc546dc626efcf0ecbdab2d75515daa9feaffea621855a60babd'}, {'image_id': '11751_2009_61_Fig3_HTML', 'image_file_name': '11751_2009_61_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC2746272/11751_2009_61_Fig3_HTML.jpg', 'caption': 'A sagittal T2-weighted MR image shows a lobulated hyperintense mass in the hypothenar muscles with no bony involvement', 'hash': '852039316b5d56c94afec5b5c9d950052abff8e1673169d994974aae9bcfb2fb'}, {'image_id': '11751_2009_61_Fig4_HTML', 'image_file_name': '11751_2009_61_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC2746272/11751_2009_61_Fig4_HTML.jpg', 'caption': 'Bland spindle and stellate cells separated by extracellular myxoid matrix (×400)', 'hash': '05d0b47a976dc717f8aaef4d0ff40da543d7463ab32ac92bad3b9bcef6832bc1'}, {'image_id': '11751_2009_61_Fig1_HTML', 'image_file_name': '11751_2009_61_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC2746272/11751_2009_61_Fig1_HTML.jpg', 'caption': 'A transverse coronal T1-weighted spin-echo MR image shows a lobular homogeneous low-signal intensity mass in the hypothenar muscles, with a rim of tissue of higher signal intensity on the ulnar side', 'hash': '530ad462557ffae557ae87fb5d77b218320561fe48dc4d806d4c4407a902e054'}] | {'11751_2009_61_Fig1_HTML': ['A 35-year-old female patient presented with a 4\xa0months history of a slowly growing swelling in the hypothenar area of the right hand. The patient could not recall a history of trauma to the extremity and had no constitutional symptoms. Her medical history was unremarkable. Physical examination of the right hand revealed a firm, well-circumscribed, mobile, non-tender mass measuring 3\xa0×\xa03\xa0cm, in the volar surface of the hypothenar muscles, with normal appearance of the skin overlying the mass, and there was no regional lymphadenopathy. The range of motion of the hand joints was not restricted and there was no neurovascular impairment. The plain anterior posterior radiograph of the hand showed nonspecific soft tissue swelling in the ulnar side of the hand in relation to fifth metacarpal bone with no obvious osseous involvement. Magnetic resonance imaging (MRI) of the right hand showed a well-circumscribed mass, lobulated, measuring approximately 3\xa0×\xa03\xa0cm inside the opponens digiti minimi and flexor digiti minimi muscles exhibiting low-signal intensity relative to muscle on the T1-weighted images (Fig.\xa0<xref rid="11751_2009_61_Fig1_HTML" ref-type="fig">1</xref>) and hyperintense to muscle on T2-weighted images. The tumor causing lateral displacement of flexors of little finger, with no infiltration of the adjacent structures or bony involvement, but replacing and compressing the hypothenar muscles (Figs.\xa0) and hyperintense to muscle on T2-weighted images. The tumor causing lateral displacement of flexors of little finger, with no infiltration of the adjacent structures or bony involvement, but replacing and compressing the hypothenar muscles (Figs.\xa0<xref rid="11751_2009_61_Fig2_HTML" ref-type="fig">2</xref>, , <xref rid="11751_2009_61_Fig3_HTML" ref-type="fig">3</xref>). There was no infiltration of ulnar neurovascular bundle.). There was no infiltration of ulnar neurovascular bundle.Fig.\xa01A transverse coronal T1-weighted spin-echo MR image shows a lobular homogeneous low-signal intensity mass in the hypothenar muscles, with a rim of tissue of higher signal intensity on the ulnar sideFig.\xa02Magnetic resonance images of the right hand of the patient in T2-weighted sequences showing that the lobulated mass is hyperintense to muscle signals, with displacement of little finger flexorsFig.\xa03A sagittal T2-weighted MR image shows a lobulated hyperintense mass in the hypothenar muscles with no bony involvement'], '11751_2009_61_Fig4_HTML': ['Laboratory findings were within normal limits. A lazy s-shaped incision was made on volar aspect of the hypothenar eminence and the tumor was found within the opponens digiti minimi and flexor digiti minimi muscles, but it did not infiltrate them. An intraoperative frozen section was obtained and the results consistent with a benign myxomatous lesion; the tumor was removed by marginal excision. The gross specimen consisted of a well-circumscribed, lobulated, gray brown mass with gelatinous consistency. Histological examination (Fig.\xa0<xref rid="11751_2009_61_Fig4_HTML" ref-type="fig">4</xref>) showed the lesion composed of uniform, cytological bland spindle, stellate shaped cells with tapering eosinophilic cytoplasm and small nuclei. The cells are separated by abundant myxoid extracellular stroma containing capillary-sized blood vessels. In some areas the tumor is surrounded by fibrous capsule. The periphery of the tumor shows infiltration in between muscle fibers (Fig.\xa0) showed the lesion composed of uniform, cytological bland spindle, stellate shaped cells with tapering eosinophilic cytoplasm and small nuclei. The cells are separated by abundant myxoid extracellular stroma containing capillary-sized blood vessels. In some areas the tumor is surrounded by fibrous capsule. The periphery of the tumor shows infiltration in between muscle fibers (Fig.\xa0<xref rid="11751_2009_61_Fig5_HTML" ref-type="fig">5</xref>). No nuclear pleomorphism, necrosis, or mitotic activity was evident, but there was no infiltration either in MRI or intraoperatively. Radiographic images of the axial and appendicular skeleton were negative for fibrous dysplasia, and endocrine studies were within normal limits. Follow-up for 8\xa0years revealed no evidence of recurrence.). No nuclear pleomorphism, necrosis, or mitotic activity was evident, but there was no infiltration either in MRI or intraoperatively. Radiographic images of the axial and appendicular skeleton were negative for fibrous dysplasia, and endocrine studies were within normal limits. Follow-up for 8\xa0years revealed no evidence of recurrence.Fig.\xa04Bland spindle and stellate cells separated by extracellular myxoid matrix (×400)Fig.\xa05The tumor infiltrates into the surrounding skeletal muscle separating individual fibers (×100)']} | Intramuscular myxoma of the hypothenar muscles | [
"Myxoma",
"Hand",
"Neoplasm",
"Hypothenar"
] | Strategies Trauma Limb Reconstr | 1255935600 | The need for reaming and the number of locking screws to be used in intramedullary (IM) tibial nailing of acute fractures as well as routine bone grafting of tibial aseptic nonunions have not been clearly defined. We describe the results of reamed interlocked IM nails in 233 patients with 247 tibial fractures (190 closed, 27 open and 30 nonunions). Ninety-six percent of the fractures were united at review after an average of 4.9 years. No correlation was found between union and nail diameter (P = 0.501) or the number of locking screws used (P = 0.287). Nail dynamization was effective in 82% of fractures. Locking screw(s) breakage was associated with nonunion in 25% of cases. Bone grafting during IM nailing was found not to increase the healing rate in tibial nonunions (P = 0.623). None of the IM nails were removed or revised due to infection. A dropped hallux and postoperative compartment syndrome were found in 0.8 and 1.6% of cases, respectively. Anterior knee pain was reported in 42% of patients but nail removal did not alleviate the symptoms in almost half. This series confirms the place of reamed intramedullary nailing for the vast majority of tibial diaphyseal fractures. It provides an optimum outcome and minimizes the need for supplementary bone grafting in aseptic nonunions. | [] | other | PMC2746272 | null | 50 | [
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"{'Citation': 'Robinson CM, O’Donnell J, Will E, Keating JF (1999) Dropped hallux after the intramedullary nailing of tibial fractures. J Bone Joint Surg Br 81:481–484', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10872371'}}}",
"{'Citation': None, 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11940618'}}}",
"{'Citation': 'Toivanen JA, Vaisto O, Kannus P, Latvala K, Honkonen SE, Jarvinen MJ (2002) Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques. J Bone Joint Surg Am 84:580–585', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11940618'}}}",
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"{'Citation': 'Bhattacharyya T, Seng K, Nassif NA, Freedman I (2006) Knee pain after tibial nailing: the role of nail prominence. Clin Orthop Relat Res 449:303–307', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16702914'}}}",
"{'Citation': None, 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/BOT.0b013e3180caa138'}, {'@IdType': 'pubmed', '#text': '17620996'}]}}",
"{'Citation': 'Cartwright-Terry M, Snow M, Nalwad H (2007) The severity and prediction of anterior knee pain post tibial nail insertion. J Orthop Trauma 21:381–385', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17620996'}}}",
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"{'Citation': 'Brinker MR, O’Connor DP (2007) Exchange nailing of ununited fractures. J Bone Joint Surg Am 89:177–188', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17200326'}}}"
] | Strategies Trauma Limb Reconstr. 2009 Oct 19; 4(2):103-106 | NO-CC CODE |
|
a, b 23-year-old female patient at 6 months (a) and 12 months (b) after ACL reconstruction. MR image (DESS sequence) shows the tibial screw is still visible at 6 months but at 12 months, only traces of the screw are detectable. Moreover, bone ingrowth into the screw was observed. through ingrowth of bone, the tunnel enlargement was reduced after 12 months | 11751_2009_63_Fig3_HTML | 7 | b50191949456c5bbc51e6fdca428140bb8606c55d1db43d11107da1be159ec4b | 11751_2009_63_Fig3_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
486,
253
] | [{'image_id': '11751_2009_63_Fig6_HTML', 'image_file_name': '11751_2009_63_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC2746274/11751_2009_63_Fig6_HTML.jpg', 'caption': 'Tibial and femoral tunnel enlargement at 3, 6 and 12\xa0months', 'hash': 'f1a042de5700884beb75a20cbc063340f06fe02c140851e63899243b17d63c50'}, {'image_id': '11751_2009_63_Fig1_HTML', 'image_file_name': '11751_2009_63_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC2746274/11751_2009_63_Fig1_HTML.jpg', 'caption': 'Milagro™ interference screw (7\xa0×\xa023\xa0mm)', 'hash': '8b029e95356fbc2cd6bb00b45d1101b6ae329bc89fa6d379b50f6beeed5e4823'}, {'image_id': '11751_2009_63_Fig3_HTML', 'image_file_name': '11751_2009_63_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC2746274/11751_2009_63_Fig3_HTML.jpg', 'caption': 'a, b 23-year-old female patient at 6\xa0months (a) and 12\xa0months (b) after ACL reconstruction. MR image (DESS sequence) shows the tibial screw is still visible at 6\xa0months but at 12\xa0months, only traces of the screw are detectable. Moreover, bone ingrowth into the screw was observed. through ingrowth of bone, the tunnel enlargement was reduced after 12\xa0months', 'hash': 'b50191949456c5bbc51e6fdca428140bb8606c55d1db43d11107da1be159ec4b'}, {'image_id': '11751_2009_63_Fig4_HTML', 'image_file_name': '11751_2009_63_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC2746274/11751_2009_63_Fig4_HTML.jpg', 'caption': 'MR image shows volume loss of the tibial and femoral Milagro™ screws measured at 3, 6 and 12\xa0months. The femoral screws show significantly faster resorption than the tibial screws (P\xa0<\xa00.05). At 12\xa0months, only traces of the screws are detectable', 'hash': '7e7d73590b7a023464b6f729435e82a365633b5264b49b1a65a9cc4bddd6f1eb'}, {'image_id': '11751_2009_63_Fig2_HTML', 'image_file_name': '11751_2009_63_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC2746274/11751_2009_63_Fig2_HTML.jpg', 'caption': 'The position of the radiopaque Milagro™ screw can be examined on the postoperative radiograph. The dorsal position of the graft relating to the screw should be noted in the lateral view', 'hash': '149fb85d45dcc5eb44a4365709eb6ed3e37346ccde0baedfaf264ba07bb4171b'}, {'image_id': '11751_2009_63_Fig5_HTML', 'image_file_name': '11751_2009_63_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC2746274/11751_2009_63_Fig5_HTML.jpg', 'caption': 'a, b MR images (DESS sequence) of the femoral bone tunnel at 6 and 12\xa0months. The plane was chosen parallel to the femoral tunnel. Figures show the three mentioned measurements of the femoral bone tunnel. Distinct bone tunnel enlargement was first observed at 6\xa0months and remained almost constant until 12\xa0months. The Milagro™ screw showed clear resorption signs at 6\xa0months and was barely detectable after 12\xa0months', 'hash': 'e9505a9069b333e1fd11f3d5955fc9eac6b4eca7bc6d716c20b16ad15e647add'}] | {'11751_2009_63_Fig1_HTML': ['The Milagro™ interference screw is made of 30% ß-TCP (TriCalcium phosphate) and 70% PLGA (Poly-lactic-co-glycolic acid). It is available in diameters of 7–12\xa0mm and 23, 30 or 35\xa0mm in length (Fig.\xa0<xref rid="11751_2009_63_Fig1_HTML" ref-type="fig">1</xref>). The cannulated screw can be introduced precisely over a guide wire and is inserted with a specific screwdriver.). The cannulated screw can be introduced precisely over a guide wire and is inserted with a specific screwdriver.Fig.\xa01Milagro™ interference screw (7\xa0×\xa023\xa0mm)'], '11751_2009_63_Fig2_HTML': ['All the patients had postoperative radiographs of their knee joint taken in two planes. The positions of the bone tunnels and the Milagro™ screws were evaluated to exclude potential screw malalignment or dislocation (Fig.\xa0<xref rid="11751_2009_63_Fig2_HTML" ref-type="fig">2</xref>).).Fig.\xa02The position of the radiopaque Milagro™ screw can be examined on the postoperative radiograph. The dorsal position of the graft relating to the screw should be noted in the lateral view', 'In this study, a bioabsorbable interference screw with a different chemical composition was used for both femoral and tibial graft fixation. We believe the bioabsorbable interference screws for graft fixation have three advantages: First, the screw prevents early motion of the graft within the tunnel, a feature important for a stable healing [13]; Second, it reduces synovial fluid reflux into the bone tunnel, thus reducing possible negative effects of cytokines that may enhance bone tunnel enlargement [14]; Third, it allows fixation of the transplant close to the tunnel entrance avoiding the so-called bungee-effect [14]. Moreover, the Milagro™ screw has the advantage of being detectable using conventional radiography so that its position can be documented and monitored on the postoperative radiograph as demonstrated in this study (Fig.\xa0<xref rid="11751_2009_63_Fig2_HTML" ref-type="fig">2</xref>). However, according to the literature [). However, according to the literature [12, 28] and confirmed by our own experience, the introduction of the femoral screw can easily cause graft irritation.'], '11751_2009_63_Fig3_HTML': ['MRI is able to show the screws in clear negative contrast to bone and soft tissues thereby facilitating screw measurement (Fig.\xa0<xref rid="11751_2009_63_Fig3_HTML" ref-type="fig">3</xref>a and b). Only in the immediate postoperative period and at 3\xa0months was marrow edema observed around the bone tunnels in all the patients, and the same had disappeared after 6\xa0months. There were no fluid lines around the screws at any time. The graft was also confirmed in all the patients to lie in the normal graft position.a and b). Only in the immediate postoperative period and at 3\xa0months was marrow edema observed around the bone tunnels in all the patients, and the same had disappeared after 6\xa0months. There were no fluid lines around the screws at any time. The graft was also confirmed in all the patients to lie in the normal graft position.Fig.\xa03a, b 23-year-old female patient at 6\xa0months (a) and 12\xa0months (b) after ACL reconstruction. MR image (DESS sequence) shows the tibial screw is still visible at 6\xa0months but at 12\xa0months, only traces of the screw are detectable. Moreover, bone ingrowth into the screw was observed. through ingrowth of bone, the tunnel enlargement was reduced after 12\xa0months'], '11751_2009_63_Fig4_HTML': ['All the patients showed bone ingrowth into the resorbing screws, but no screw was completely replaced by bone. The tibial screws showed an average volume loss of 8.1% (±7.9%) at 6\xa0months and 82.6% (±17.2%; P\xa0<\xa00.05) at 12\xa0months (Fig.\xa0<xref rid="11751_2009_63_Fig4_HTML" ref-type="fig">4</xref>). The femoral screws showed an average volume loss of 31.26% (±21.6%) at 6\xa0months and 92.02% (±6.3%; ). The femoral screws showed an average volume loss of 31.26% (±21.6%) at 6\xa0months and 92.02% (±6.3%; P\xa0<\xa00.05) at 12\xa0months. Volume loss was significantly higher in the femoral than in the tibial screws after 6\xa0months (Fig.\xa0<xref rid="11751_2009_63_Fig4_HTML" ref-type="fig">4</xref>).).Fig.\xa04MR image shows volume loss of the tibial and femoral Milagro™ screws measured at 3, 6 and 12\xa0months. The femoral screws show significantly faster resorption than the tibial screws (P\xa0<\xa00.05). At 12\xa0months, only traces of the screws are detectable', 'Tunnel enlargement was already observed 6\xa0weeks after ACL reconstruction [6]. The extent of tunnel enlargement depends on the type of graft fixation [6]. Surprisingly, the most extensive tunnel enlargement was observed in anatomic graft fixation [6–8]. However, the extent of the tunnel enlargement has no impact on the clinical results [6, 8]. Nevertheless, it can cause significant problems during revision surgery. We therefore measured not only the proximal parts of the tibial tunnel and the distal parts of the femoral tunnel, but also the other parts of the tunnels. In our experience, the central and peripheral parts of the tunnels are as important for revision surgery as the parts of the tunnels close to the joint line. In comparing our results with those of other studies, one has to be aware of the different techniques for measuring the bone tunnels [6–8, 18]. In order to facilitate a better comparison with other studies, we also present the results of the tunnel enlargement in the areas close to the joint. The big differences in the values of tunnel enlargement close to the joint and the enlargement of the whole tunnel is based on the fact that the tunnel in the proximal third of the tibia and the distal third of the femur is enlarged compared to the original tunnel volume. In contrast, after 12\xa0months, the tunnel volume in the peripheral thirds especially in the tibia is reduced because Milagro™ screws were almost completely resorbed and partially replaced by bone tissue (Fig.\xa0<xref rid="11751_2009_63_Fig4_HTML" ref-type="fig">4</xref>). As demonstrated in this study, Milagro screws could not prevent tunnel enlargement in the first 6\xa0months, but ingrowth of bone tissue in the screws reduced the tunnel volume significantly after 1\xa0year. Despite bone ingrowth, enlargement could not be avoided in the tunnel region close to the joint line, even if the screw was placed close to the joint line. Data found in the literature support MRI values of tunnel enlargement of up to 75% of the original tunnel volume after a few weeks [). As demonstrated in this study, Milagro screws could not prevent tunnel enlargement in the first 6\xa0months, but ingrowth of bone tissue in the screws reduced the tunnel volume significantly after 1\xa0year. Despite bone ingrowth, enlargement could not be avoided in the tunnel region close to the joint line, even if the screw was placed close to the joint line. Data found in the literature support MRI values of tunnel enlargement of up to 75% of the original tunnel volume after a few weeks [6] and up to 100% of the original volume at 6\xa0months [6]. Other authors also confirm duplication of tunnel volume in MR imaging at 6\xa0months with an increase in volume of the femoral bone tunnel of 100.4% and an increase in volume of the tibial bone tunnel of 73.9% [8]. Comparing values of tunnel enlargement found in the literature with those in this study, similar values are found for the proximal parts of the tibial bone tunnel and the distal parts of the femoral bone tunnel [6–8].'], '11751_2009_63_Fig5_HTML': ['Tibial tunnel enlargement (mean value of the whole tunnel) was 43.5% (±26.1%) at 3\xa0months, 62.7% (±30.0%) at 6\xa0months and −9.5% (±58.1%) of the original tunnel at 12\xa0months. Femoral tunnel enlargement (mean value of the whole tunnel) was 71.2% (±56.9%) at 3\xa0months, 62.9% (±41.5%) at 6\xa0months and 47.4% (±43.7%) of the original tunnel at 12\xa0months. After 12\xa0months, the tibial tunnel enlargement was significantly reduced compared to the channel size after 3 and 6\xa0months (P\xa0<\xa00.05). After 12\xa0months, tibial tunnel enlargement was significantly reduced compared to the femoral tunnel (P\xa0<\xa00.05) (Figs.\xa0<xref rid="11751_2009_63_Fig5_HTML" ref-type="fig">5</xref> and and <xref rid="11751_2009_63_Fig6_HTML" ref-type="fig">6</xref>).).Fig.\xa05a, b MR images (DESS sequence) of the femoral bone tunnel at 6 and 12\xa0months. The plane was chosen parallel to the femoral tunnel. Figures show the three mentioned measurements of the femoral bone tunnel. Distinct bone tunnel enlargement was first observed at 6\xa0months and remained almost constant until 12\xa0months. The Milagro™ screw showed clear resorption signs at 6\xa0months and was barely detectable after 12\xa0monthsFig.\xa06Tibial and femoral tunnel enlargement at 3, 6 and 12\xa0months'], '11751_2009_63_Fig6_HTML': ['The enlargement of the proximal third of the tibial tunnel was 85.2% (±72.6%) and in the distal third of the femoral tunnel it was 78.7% (±50.9%) (Fig.\xa0<xref rid="11751_2009_63_Fig6_HTML" ref-type="fig">6</xref>). In these regions close to the joint line, there was no significant decrease in the tunnel diameter over time (). In these regions close to the joint line, there was no significant decrease in the tunnel diameter over time (P\xa0>\xa00.05). There was a significant difference in the reduction of the tunnel diameter over time between the proximal third of the tibial tunnel and the whole tibial tunnel (P\xa0<\xa00.05) as well as between the distal third of the femoral tunnel and the whole femoral tunnel (P\xa0<\xa00.05).']} | Magnetic resonance imaging analysis of the bioabsorbable Milagro™ interference screw for graft fixation in anterior cruciate ligament reconstruction | [
"Anterior cruciate ligament",
"Graft fixation",
"Interference screw",
"Milagro™ screw",
"Magnetic resonance imaging"
] | Strategies Trauma Limb Reconstr | 1256108400 | Hyperhomocysteinemia and factors of homocysteine metabolism, S-adenosylhomocysteine (AdoHcy) and S-adenosylmethionine (AdoMet), may play a role in Alzheimer's disease (AD). With liquid-chromatography-tandem-mass-spectrometry AdoMet and AdoHcy were determined in brains of 8- and 15-month-old APP/PS1 Alzheimer mice, and their possible roles in AD brains investigated. The finding that AdoMet levels do not differ between the genotypes in (young) 8-month-old mice, but are different in (older) 15-month-old APP/PS1 mice compared to their wild-type littermates, suggests that alterations in AdoMet are a consequence of AD pathology rather than a cause. During aging, AdoMet levels decreased in the brains of wild-type mice, whereas AdoHcy levels diminished in both wild type and APP/PS1 mice. The finding that AdoMet levels in APP/PS1 mice are not decreased during aging (in contrast to wild-type mice), is probably related to less demand due to neurodegeneration. No effect of the omega-3 fatty acid docosahexaenoic acid (DHA) or cholesterol-enriched diets on AdoMet or AdoHcy levels were found. | [
"Age Factors",
"Aging",
"Alzheimer Disease",
"Amyloid beta-Protein Precursor",
"Analysis of Variance",
"Animals",
"Brain",
"Chromatography, Liquid",
"Disease Models, Animal",
"Humans",
"Mice",
"Mice, Transgenic",
"Presenilin-1",
"S-Adenosylhomocysteine",
"S-Adenosylmethionine",
"Tandem Mass Spectrometry"
] | other | PMC2746274 | null | 65 | [
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] | Strategies Trauma Limb Reconstr. 2009 Oct 21; 4(2):73-79 | NO-CC CODE |
|
Normal anatomy of the gracilis muscle. Coronal reformat CECT showing the normal anatomy of the gracilis muscle in the medial aspect of the thigh (arrows). It arises from the symphysis pubis and superior pubic ramus to insert into the medial aspect of the proximal tibia | 13244_2011_70_Fig4_HTML | 7 | 51f7e964a24ffe6fb24e3bc699271bfaefd8b70d419fe83e2963e4287a95d8f3 | 13244_2011_70_Fig4_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
767,
1272
] | [{'image_id': '13244_2011_70_Fig11_HTML', 'image_file_name': '13244_2011_70_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig11_HTML.jpg', 'caption': 'Recipient site complication. CECT showing a perineal rim enhancing fluid collection (arrow) associated with a VRAM flap reconstruction for rectal cancer', 'hash': '28b42f50fdc71c76b895bdad7e24a40a3037dd60549454b750fb3cfcf6049186'}, {'image_id': '13244_2011_70_Fig4_HTML', 'image_file_name': '13244_2011_70_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig4_HTML.jpg', 'caption': 'Normal anatomy of the gracilis muscle. Coronal reformat CECT showing the normal anatomy of the gracilis muscle in the medial aspect of the thigh (arrows). It arises from the symphysis pubis and superior pubic ramus to insert into the medial aspect of the proximal tibia', 'hash': '51f7e964a24ffe6fb24e3bc699271bfaefd8b70d419fe83e2963e4287a95d8f3'}, {'image_id': '13244_2011_70_Fig3_HTML', 'image_file_name': '13244_2011_70_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig3_HTML.jpg', 'caption': 'Normal VRAM flap appearances on MRI. Sagittal T2-weighted images show (a) a strip of muscle signal intensity extending posteriorly from the anterior abdominal wall, corresponding to the rectus abdominis flap (arrow) and (b) muscle flap terminating presacrally (arrow) with the subcutaneous fat component seen filling the pelvis and perineal defect (asterisk). c Coronal T2-weighted image of the same patient shows the muscle flap passing into the right hemipelvis (arrow) with subcutaneous fat component of the flap again well demonstrated (asterisk)', 'hash': 'dc9c359741f3c1270c36b78d0785c2e8b6c621dd460b67e62d182eb35d2d29d3'}, {'image_id': '13244_2011_70_Fig5_HTML', 'image_file_name': '13244_2011_70_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig5_HTML.jpg', 'caption': 'Normal gracilis flap donor site appearances on CT. Coronal CECT showing absence of the normally sited gracilis muscle in the upper thigh (arrows) in a patient with bilateral gracilis flap reconstruction. Surgical clips and fat stranding is noted at the donor sites', 'hash': 'c7e33da0bac8fb46bb545dd126813bdf6fb40faa96bd8043f3d78de83921904b'}, {'image_id': '13244_2011_70_Fig10_HTML', 'image_file_name': '13244_2011_70_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig10_HTML.jpg', 'caption': 'Recipient site complication. CECT showing an example of a flap breakdown (arrow) in a patient following TPE and gracilis flap reconstruction', 'hash': '269236c508c70f790602f7d3a9094536b5f410db12ca52d583b7b69933223c8d'}, {'image_id': '13244_2011_70_Fig2_HTML', 'image_file_name': '13244_2011_70_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig2_HTML.jpg', 'caption': 'Normal VRAM flap appearances on CT. Axial CECT of the abdomen shows absent right rectus abdominis muscle in keeping with the donor site (arrowhead). The flap passes posteriorly from the right linea alba into the pelvis. The fat density within the pelvis corresponds to the subcutaneous fat component of the flap (asterisk), whilst the strip of muscle density seen in the right hemipelvis corresponds to the donor rectus abdominis muscle (short arrow). Note the inferior epigastric artery is seen as an enhancing linear structure arising from the external iliac vessels lateral to the muscle component of the flap (long arrow)', 'hash': '5782e090ed9b3f846393755a9ef599695d9c6d76e85d5cb4f2436036705f9358'}, {'image_id': '13244_2011_70_Fig14_HTML', 'image_file_name': '13244_2011_70_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig14_HTML.jpg', 'caption': 'Other post-operative complications. CECT showing a parastomal hernia containing loops of small bowel (arrow), herniating alongside the colostomy in a patient who underwent APE, VRAM flap reconstruction and stoma formation', 'hash': '53cec4a8f4111ae4122c652be8012f11f728f3128102eefebc6efc05dcd9662d'}, {'image_id': '13244_2011_70_Fig1_HTML', 'image_file_name': '13244_2011_70_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig1_HTML.jpg', 'caption': 'Normal VRAM flap donor site appearances on CT. Coronal reformat contrast-enhanced CT (CECT), in a patient who underwent APE and right VRAM flap reconstruction, shows colostomy in the left iliac fossa (short arrow) in association with a normal left rectus abdominis muscle (long arrow). The right rectus abdominis muscle flap is seen passing into the pelvis (arrowhead)', 'hash': '03ad7a4f6556ea793b8c5d04461f6b3f2a29da1a18eef4505f186c31824517d0'}, {'image_id': '13244_2011_70_Fig13_HTML', 'image_file_name': '13244_2011_70_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig13_HTML.jpg', 'caption': 'Recipient site complications. a CECT showing an enterocutaneous fistula in a patient following APE, anterior exenteration and IGAP flap reconstruction—oral contrast is seen tracking to the skin surface and pockets of gas are noted in the soft tissues (arrow). b Sagittal STIR MRI in a different patient who underwent APE and VRAM flap reconstruction for rectal cancer shows the presence of high signal perineal sinus tracts around the flap (arrows)', 'hash': '65caeabc55f7ac9e15308919ba6737814d4c041fd0ecb3c5b1166914e96dee72'}, {'image_id': '13244_2011_70_Fig9_HTML', 'image_file_name': '13244_2011_70_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig9_HTML.jpg', 'caption': 'Donor site complication in a patient who underwent APE and VRAM flap reconstruction. CECT showing a large incisional hernia containing loops of small and large bowel (arrow) following previous abdominal wound dehiscence in a patient with right VRAM flap reconstruction; this patient also had a recurrent tumour seen as enhancing soft tissue along the right pelvic side wall (asterisk)', 'hash': 'cebcfaf5ef42c5b3ad43f09d2c2e1a34b69b4241e0276575cf4482518e31d66f'}, {'image_id': '13244_2011_70_Fig6_HTML', 'image_file_name': '13244_2011_70_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig6_HTML.jpg', 'caption': 'Normal gracilis flap recipient site appearances on CT and MRI. Patient has had a total pelvic exenteration and bilateral gracilis flap reconstruction: (a) axial CT shows bilateral gracilis flaps in the perineum as laterally placed strips of muscle with central fat density; (b) axial and (c) corresponding coronal T2-weighted MRI shows bilateral gracilis flaps (arrows) with small seroma on the right-sided flap', 'hash': '76c2ecf795162d8b1e3f792f7335679907ddefac605a8f01a6578abe2da26869'}, {'image_id': '13244_2011_70_Fig15_HTML', 'image_file_name': '13244_2011_70_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig15_HTML.jpg', 'caption': 'Axial T2-weighted MRI in a patient following total pelvic exenteration (TPE) and gracilis flap reconstruction for rectal cancer shows intermediate signal intensity in an expanded left obturator internus (arrow), which on biopsy was confirmed to be tumour recurrence', 'hash': '2e7ddfebb84f433c5aa60b59985dde7aa9580174e344ba555bef10c86d959dc3'}, {'image_id': '13244_2011_70_Fig7_HTML', 'image_file_name': '13244_2011_70_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig7_HTML.jpg', 'caption': 'Normal inferior gluteal artery perforator (IGAP) flap appearances on CECT in a patient following APE and IGAP flap reconstruction for rectal cancer. Axial CECT shows surgical clips and stranding/loss of volume of the subcutaneous fat overlying the gluteus maximus bilaterally (arrows), corresponding to the donor sites. The transposed flap is seen as central fat density (asterisk)', 'hash': '3d591cbf87f76b0bb3dc93bd10772fd6942030d9decc67e2ce78f9606a5b2096'}, {'image_id': '13244_2011_70_Fig8_HTML', 'image_file_name': '13244_2011_70_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig8_HTML.jpg', 'caption': 'Donor site complication in a patient who underwent APE and VRAM flap reconstruction. CECT showing stomach prolapsing into an incisional hernia (arrow) associated with a small seroma at the donor site (arrowhead)', 'hash': '5bb83df815c905afbe83fa9cf13d77c5145c499a4ddfcd8cb6526ce2c29e5b1a'}, {'image_id': '13244_2011_70_Fig12_HTML', 'image_file_name': '13244_2011_70_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259312/13244_2011_70_Fig12_HTML.jpg', 'caption': 'Recipient site complication. CECT showing an example of a perineal hernia (arrow) with prolapsing loops of small bowel into the perineum in a patient following APE and IGAP flap reconstruction for rectal cancer', 'hash': '4ee4ff4def70d3cf138ad41172ad1db1ff7af86c83e44739a8409d697cf96ea9'}] | {'13244_2011_70_Fig1_HTML': ['On cross-sectional imaging, the VRAM flap is the easiest of the three flaps to recognise. The donor site (usually the right side of the anterior abdominal wall) is thinner than the contralateral side due to mobilisation of the rectus flap (Figs.\xa0<xref rid="13244_2011_70_Fig1_HTML" ref-type="fig">1</xref>, , <xref rid="13244_2011_70_Fig2_HTML" ref-type="fig">2</xref>). This flap reconstruction is usually performed in conjunction with an APE, with the creation of a colostomy in the left iliac fossa. Within the pelvis, the flap is seen orientated obliquely, extending from the linea alba (usually to the right of the midline), posteriorly to the concavity of the sacrum (Figs.\xa0). This flap reconstruction is usually performed in conjunction with an APE, with the creation of a colostomy in the left iliac fossa. Within the pelvis, the flap is seen orientated obliquely, extending from the linea alba (usually to the right of the midline), posteriorly to the concavity of the sacrum (Figs.\xa0<xref rid="13244_2011_70_Fig2_HTML" ref-type="fig">2</xref>, , <xref rid="13244_2011_70_Fig3_HTML" ref-type="fig">3</xref>). In the case of an anterior exenteration, the flap extends posteriorly to the peri-rectal fascia. The vascular pedicle can often be seen, especially following administration of intravenous contrast. It will arise from the external iliac vessels and turn posteromedially into the pelvis lateral to the flap (Fig.\xa0). In the case of an anterior exenteration, the flap extends posteriorly to the peri-rectal fascia. The vascular pedicle can often be seen, especially following administration of intravenous contrast. It will arise from the external iliac vessels and turn posteromedially into the pelvis lateral to the flap (Fig.\xa0<xref rid="13244_2011_70_Fig2_HTML" ref-type="fig">2</xref>). The bulk of the flap is of fat density corresponding to the subcutaneous fat, with a strip of muscle density noted within it, corresponding to the rectus abdominis muscle. With time, this muscle component can undergo atrophy due to denervation [). The bulk of the flap is of fat density corresponding to the subcutaneous fat, with a strip of muscle density noted within it, corresponding to the rectus abdominis muscle. With time, this muscle component can undergo atrophy due to denervation [6], eventually appearing reduced in size, and showing fatty infiltration. Atrophy may lead to an increased signal intensity of the muscle component on both T1- and T2-weighted MRI. If a neovagina is present, it is formed from the flap skin, which is completely encircled by subcutaneous fat. Air within the neovagina is a normal finding. Pre-sacral soft tissue thickening may also be a normal post-operative finding and should remain stable or become less prominent on subsequent imaging.\nFig.\xa01Normal VRAM flap donor site appearances on CT. Coronal reformat contrast-enhanced CT (CECT), in a patient who underwent APE and right VRAM flap reconstruction, shows colostomy in the left iliac fossa (short arrow) in association with a normal left rectus abdominis muscle (long arrow). The right rectus abdominis muscle flap is seen passing into the pelvis (arrowhead)Fig.\xa02Normal VRAM flap appearances on CT. Axial CECT of the abdomen shows absent right rectus abdominis muscle in keeping with the donor site (arrowhead). The flap passes posteriorly from the right linea alba into the pelvis. The fat density within the pelvis corresponds to the subcutaneous fat component of the flap (asterisk), whilst the strip of muscle density seen in the right hemipelvis corresponds to the donor rectus abdominis muscle (short arrow). Note the inferior epigastric artery is seen as an enhancing linear structure arising from the external iliac vessels lateral to the muscle component of the flap (long arrow)Fig.\xa03Normal VRAM flap appearances on MRI. Sagittal T2-weighted images show (a) a strip of muscle signal intensity extending posteriorly from the anterior abdominal wall, corresponding to the rectus abdominis flap (arrow) and (b) muscle flap terminating presacrally (arrow) with the subcutaneous fat component seen filling the pelvis and perineal defect (asterisk). c Coronal T2-weighted image of the same patient shows the muscle flap passing into the right hemipelvis (arrow) with subcutaneous fat component of the flap again well demonstrated (asterisk)'], '13244_2011_70_Fig4_HTML': ['The gracilis muscle is a slim superficial muscle on the medial aspect of the thigh (Fig.\xa0<xref rid="13244_2011_70_Fig4_HTML" ref-type="fig">4</xref>), originating from the symphysis pubis and superior pubic ramus and inserting into the medial aspect of the proximal tibia. The flap is designed by drawing a line from the pubic tubercle to the medial condyle of the distal femur, and a skin paddle is designed to overlie this. Its size is tailored to that of the surgical defect. An elliptically shaped skin paddle is outlined, and the marked skin paddle is incised to the level of the gracilis fascia. The gracilis muscle is identified beneath this and transected just proximal to its distal insertion. The flap is then raised from distal to proximal, retaining the perforating vessels from the muscle to the skin. A subcutaneous tunnel is created proximally in the thigh to gain access to the surgical defect. The flap is rotated on its vascular pedicle (which is usually a branch of the medial femoral circumflex artery) and inserted into the surgical defect. As with the VRAM flap, the skin paddle is used to reconstruct the posterior vaginal wall when necessary.\n), originating from the symphysis pubis and superior pubic ramus and inserting into the medial aspect of the proximal tibia. The flap is designed by drawing a line from the pubic tubercle to the medial condyle of the distal femur, and a skin paddle is designed to overlie this. Its size is tailored to that of the surgical defect. An elliptically shaped skin paddle is outlined, and the marked skin paddle is incised to the level of the gracilis fascia. The gracilis muscle is identified beneath this and transected just proximal to its distal insertion. The flap is then raised from distal to proximal, retaining the perforating vessels from the muscle to the skin. A subcutaneous tunnel is created proximally in the thigh to gain access to the surgical defect. The flap is rotated on its vascular pedicle (which is usually a branch of the medial femoral circumflex artery) and inserted into the surgical defect. As with the VRAM flap, the skin paddle is used to reconstruct the posterior vaginal wall when necessary.\nFig.\xa04Normal anatomy of the gracilis muscle. Coronal reformat CECT showing the normal anatomy of the gracilis muscle in the medial aspect of the thigh (arrows). It arises from the symphysis pubis and superior pubic ramus to insert into the medial aspect of the proximal tibia'], '13244_2011_70_Fig5_HTML': ['On cross-sectional imaging the normally sited gracilis muscle, along the medial aspect of the thigh, is not visualised due to mobilisation of the gracilis myocutaneous flap. Surgical clips or inflammatory change may denote the donor site (Fig.\xa0<xref rid="13244_2011_70_Fig5_HTML" ref-type="fig">5</xref>). Instead, the transposed flap is seen within the perineum, with the muscle belly situated laterally and the subcutaneous fat component of the flap seen medially (Fig.\xa0). Instead, the transposed flap is seen within the perineum, with the muscle belly situated laterally and the subcutaneous fat component of the flap seen medially (Fig.\xa0<xref rid="13244_2011_70_Fig6_HTML" ref-type="fig">6a-c</xref>). Bilateral flaps will give a symmetrical appearance on either side of the midline. The skin of the flap can form the vaginal lining when a vaginal reconstruction is carried out. This flap is usually performed in the context of a total pelvic exenteration (comprising a cystectomy, APE, removal of the urogenital organs, and pelvic lymphadenectomy). The patient will have both an ileal conduit for urinary diversion (within the right iliac fossa) and a colostomy (within the left iliac fossa).\n). Bilateral flaps will give a symmetrical appearance on either side of the midline. The skin of the flap can form the vaginal lining when a vaginal reconstruction is carried out. This flap is usually performed in the context of a total pelvic exenteration (comprising a cystectomy, APE, removal of the urogenital organs, and pelvic lymphadenectomy). The patient will have both an ileal conduit for urinary diversion (within the right iliac fossa) and a colostomy (within the left iliac fossa).\nFig.\xa05Normal gracilis flap donor site appearances on CT. Coronal CECT showing absence of the normally sited gracilis muscle in the upper thigh (arrows) in a patient with bilateral gracilis flap reconstruction. Surgical clips and fat stranding is noted at the donor sitesFig.\xa06Normal gracilis flap recipient site appearances on CT and MRI. Patient has had a total pelvic exenteration and bilateral gracilis flap reconstruction: (a) axial CT shows bilateral gracilis flaps in the perineum as laterally placed strips of muscle with central fat density; (b) axial and (c) corresponding coronal T2-weighted MRI shows bilateral gracilis flaps (arrows) with small seroma on the right-sided flap'], '13244_2011_70_Fig7_HTML': ['The IGAP flap is the most difficult of the three flaps to appreciate on cross-sectional imaging. At the donor site, the subcutaneous fat of the gluteal region on one or both sides may be reduced in bulk compared with any preoperative imaging (Fig.\xa0<xref rid="13244_2011_70_Fig7_HTML" ref-type="fig">7</xref>). Yet again, surgical clips or stranding of the subcutaneous fat may denote the donor site. The pelvic floor reconstruction will be seen chiefly of fat density. As with the other flaps, the skin of the flap is used to reconstruct the lining of the neovagina with gas sometimes seen internally.\n). Yet again, surgical clips or stranding of the subcutaneous fat may denote the donor site. The pelvic floor reconstruction will be seen chiefly of fat density. As with the other flaps, the skin of the flap is used to reconstruct the lining of the neovagina with gas sometimes seen internally.\nFig.\xa07Normal inferior gluteal artery perforator (IGAP) flap appearances on CECT in a patient following APE and IGAP flap reconstruction for rectal cancer. Axial CECT shows surgical clips and stranding/loss of volume of the subcutaneous fat overlying the gluteus maximus bilaterally (arrows), corresponding to the donor sites. The transposed flap is seen as central fat density (asterisk)'], '13244_2011_70_Fig8_HTML': ['Donor site complications that have been described include wound infection, skin edge necrosis, wound dehiscence, seromas (Fig.\xa0<xref rid="13244_2011_70_Fig8_HTML" ref-type="fig">8</xref>) and incisional hernias (Figs.\xa0) and incisional hernias (Figs.\xa0<xref rid="13244_2011_70_Fig8_HTML" ref-type="fig">8</xref>, , <xref rid="13244_2011_70_Fig9_HTML" ref-type="fig">9</xref>) [) [16, 17]. Donor site seromas appear as small, thin-walled fluid collections of varying sizes associated with the resected anterior abdominal wall that usually resolve on subsequent imaging. The VRAM flap leaves a weakened anterior abdominal wall, and therefore predisposes to abdominal wall dehiscence and incisional hernia formation in approximately 5% of patients [18]. Wound dehiscence is made more likely if there is increased wound tension (e.g. when a large defect has to be closed) or in the presence of a wound infection. In order to reduce the incidence of incisional hernias, the posterior rectus sheath is left intact at the donor site. A mesh is used to repair the anterior rectus sheath and strengthen the abdominal wall.\nFig.\xa08Donor site complication in a patient who underwent APE and VRAM flap reconstruction. CECT showing stomach prolapsing into an incisional hernia (arrow) associated with a small seroma at the donor site (arrowhead)Fig.\xa09Donor site complication in a patient who underwent APE and VRAM flap reconstruction. CECT showing a large incisional hernia containing loops of small and large bowel (arrow) following previous abdominal wound dehiscence in a patient with right VRAM flap reconstruction; this patient also had a recurrent tumour seen as enhancing soft tissue along the right pelvic side wall (asterisk)'], '13244_2011_70_Fig10_HTML': ['Flap recipient site complications that have been reported include flap necrosis, perineal or pelvic collections or abscesses, perineal hernia and fistula formation [16, 19, 20]. Total flap loss may result from an arterial or venous thrombosis or poor arterial inflow due to excess traction or kinking of the pedicle and requires full debridement and reconstruction. Partial flap loss may sometimes be managed by debridement alone. Assessment of impaired perfusion and early flap failure can be made with dynamic contrast-enhanced (DCE) MRI, although this is not standard practice. It has been shown that there is a decreased enhancement curve within a failing flap on DCE-MRI compared with that of the surrounding tissues [21]. On cross-sectional imaging, flap loss is manifest by either minor loss of skin and subcutaneous tissue from the margins of the flap to complete loss of the whole flap, resulting in a large defect at the recipient site (Fig.\xa0<xref rid="13244_2011_70_Fig10_HTML" ref-type="fig">10</xref>). The VRAM flap is more reliable than the gracilis flap, with a total flap loss rate of less than 5% [). The VRAM flap is more reliable than the gracilis flap, with a total flap loss rate of less than 5% [22]. There is a higher rate of flap loss in patients with prior stomas on the side of the rectus flap and in patients with multiple previous abdominal incisions due to disruption of part of the deep inferior epigastric artery [23]. Flap necrosis and loss occurs in up to 20% of patients with gracilis flap reconstructions [12]. The site of the perforating vessels from the muscle to the overlying skin paddle can be unpredictable and the correct positioning of the skin paddle (especially in patients who are obese with sagging inner skin of the thigh) may be inaccurate. Another possible explanation for increased flap loss with the gracilis flap is compression of the vascular pedicle as the flap is rotated through the subfascial tunnel under the pubic ramus. In comparison, the VRAM flap has a larger vascular pedicle and is rotated medially into the pelvis without directly crossing any bony structures. Other risk factors that may compromise the blood supply include smoking, other co-morbidities associated with small vessel disease, or prior chemoradiation.\nFig.\xa010Recipient site complication. CECT showing an example of a flap breakdown (arrow) in a patient following TPE and gracilis flap reconstruction'], '13244_2011_70_Fig11_HTML': ['Pelvic and perineal abscess collections have been shown to be significantly less in patients undergoing a VRAM flap reconstruction compared with a primary closure [19] (Fig.\xa0<xref rid="13244_2011_70_Fig11_HTML" ref-type="fig">11</xref>) [) [24]. Perineal hernias are a recognised complication due to weakness of the pelvic floor, usually seen as loops of prolapsing small bowel into the perineum (Fig.\xa0<xref rid="13244_2011_70_Fig12_HTML" ref-type="fig">12</xref>). The risk of bowel fistula formation has been reported in up to 5% of patients with flap reconstructions following exenteration [). The risk of bowel fistula formation has been reported in up to 5% of patients with flap reconstructions following exenteration [25]. It is more likely if there is underlying sepsis or iatrogenic injury. Entero-perineal, entero-vaginal and peritoneo-perioneal fistulas may occur, as can chronic perineal sinuses from necrotic flaps. Fistulas are best imaged using CT with oral contrast (if an enteric fistula is suspected) or with a pelvic MRI with short tau inversion recovery (STIR) sequence (Fig.\xa0<xref rid="13244_2011_70_Fig13_HTML" ref-type="fig">13a, b</xref>). Fistulas are either treated conservatively or by surgical resection.\n). Fistulas are either treated conservatively or by surgical resection.\nFig.\xa011Recipient site complication. CECT showing a perineal rim enhancing fluid collection (arrow) associated with a VRAM flap reconstruction for rectal cancerFig.\xa012Recipient site complication. CECT showing an example of a perineal hernia (arrow) with prolapsing loops of small bowel into the perineum in a patient following APE and IGAP flap reconstruction for rectal cancerFig.\xa013Recipient site complications. a CECT showing an enterocutaneous fistula in a patient following APE, anterior exenteration and IGAP flap reconstruction—oral contrast is seen tracking to the skin surface and pockets of gas are noted in the soft tissues (arrow). b Sagittal STIR MRI in a different patient who underwent APE and VRAM flap reconstruction for rectal cancer shows the presence of high signal perineal sinus tracts around the flap (arrows)'], '13244_2011_70_Fig14_HTML': ['Parastomal hernias (Fig.\xa0<xref rid="13244_2011_70_Fig14_HTML" ref-type="fig">14</xref>) are a recognised complication with usually part of the small or large bowel herniating out alongside the colostomy.\n) are a recognised complication with usually part of the small or large bowel herniating out alongside the colostomy.\nFig.\xa014Other post-operative complications. CECT showing a parastomal hernia containing loops of small bowel (arrow), herniating alongside the colostomy in a patient who underwent APE, VRAM flap reconstruction and stoma formation'], '13244_2011_70_Fig9_HTML': ['Although not strictly a post-operative complication, recurrent tumour (Figs.\xa0<xref rid="13244_2011_70_Fig9_HTML" ref-type="fig">9</xref>, , <xref rid="13244_2011_70_Fig15_HTML" ref-type="fig">15</xref>) is just as likely to occur in flap reconstruction as with primary surgical closure. Tumour recurrence is not uncommon and early recognition is very important since re-operation after total exenteration is extremely difficult. It is more likely in patients with positive resection margins. Clearly, the development of a new pelvic soft tissue mass on serial post-operative imaging is suggestive of a recurrence. MRI, with its better contrast resolution compared with CT, allows for easier detection of recurrent tumour, with an increased signal on T2-weighted imaging noted within the lesion. Following intravenous contrast administration, recurrent tumour usually enhances. Tumour recurrence should be confirmed histologically with biopsy.\n) is just as likely to occur in flap reconstruction as with primary surgical closure. Tumour recurrence is not uncommon and early recognition is very important since re-operation after total exenteration is extremely difficult. It is more likely in patients with positive resection margins. Clearly, the development of a new pelvic soft tissue mass on serial post-operative imaging is suggestive of a recurrence. MRI, with its better contrast resolution compared with CT, allows for easier detection of recurrent tumour, with an increased signal on T2-weighted imaging noted within the lesion. Following intravenous contrast administration, recurrent tumour usually enhances. Tumour recurrence should be confirmed histologically with biopsy.\nFig.\xa015Axial T2-weighted MRI in a patient following total pelvic exenteration (TPE) and gracilis flap reconstruction for rectal cancer shows intermediate signal intensity in an expanded left obturator internus (arrow), which on biopsy was confirmed to be tumour recurrence']} | Pelvi-perineal flap reconstruction: normal imaging appearances and post-operative complications on cross-sectional imaging | [
"Surgical flaps",
"Computed tomography",
"Magnetic resonance imaging",
"Post-operative complications",
"Pelvic exenteration"
] | Insights Imaging | 1296633600 | BACKGROUND: Omental cakes typically are associated with ovarian carcinoma, as this is the most common malignant aetiology. Nonetheless, numerous other neoplasms, as well as infectious and benign processes, can produce omental cakes. METHODS: A broader knowledge of the various causes of omental cakes is valuable diagnostically and to direct appropriate clinical management. RESULTS: We present a spectrum of both common and unusual aetiologies that demonstrate the variable computed tomographic appearances of omental cakes. CONCLUSION: The anatomy and embryology are discussed, as well as the importance of biopsy when the aetiology of omental cakes is uncertain. | [] | other | PMC3259312 | null | 27 | [
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] | Insights Imaging. 2011 Feb 2; 2(3):215-223 | NO-CC CODE |
|
MRI of a woman with intracapsular rupture of a single-lumen silicone implant. (a) Axial T2-weighted turbo spin-echo and (b) axial silicone-excited sequence. The study shows a hypointense subcapsular line at the anterior margin of the implant (solid arrow); the “teardrop sign” and “key-hole sign” are also present (open arrows). Focal change in signal at the anterior margin of the implant (white open arrow) can also be observed | 13244_2011_122_Fig7_HTML | 7 | c7e4833f7d02241f0882bb30a6e029ee0a30b31350f0f2eaa1d4cd8aed0fe7ff | 13244_2011_122_Fig7_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
787,
320
] | [{'image_id': '13244_2011_122_Fig27_HTML', 'image_file_name': '13244_2011_122_Fig27_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig27_HTML.jpg', 'caption': '(Left) Metallic clip placed in the microcalcifications site after biopsy. (Right) Real-time ultrasound is used to guide the needle tip (arrow)', 'hash': 'f26cb88ed30cf1ee57f313b2f6f51c8113b7bdf4d58b9d507abeeec26445fdc9'}, {'image_id': '13244_2011_122_Fig5_HTML', 'image_file_name': '13244_2011_122_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig5_HTML.jpg', 'caption': 'MRI of a 61-year-old woman with bilateral implants: a single-lumen implant (right breast) and a double-lumen implant (left breast). (a) Axial silicone-suppression and (b) axial T2-weighted turbo spin echo sequences. The right implant has homogeneous signal intensity, representing a single lumen with silicone gel (*). The left implant has an inner lumen (open arrow) of low-signal-intensity or high-signal-intensity silicone surrounded by a smaller outer lumen (solid arrow) that contains saline', 'hash': '0b09abe7af79263ae78808936d3a62e59a548ba8d7dda1c38fbd6e39003c57dd'}, {'image_id': '13244_2011_122_Fig17_HTML', 'image_file_name': '13244_2011_122_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig17_HTML.jpg', 'caption': 'Implant position is an important factor when studying the breasts. Patients with submammary implants have fewer visualised area compared to patients with submuscular implants. The displacement technique introduced by Eklund facilitates mammography in women with implants. Slightly more tissue is visualised with displacement (below) than with standard compression mammography (above)', 'hash': 'ea6afe0e354c5bb9b02411b99e2fa78fb4c8e47066110beb13ade69cf0d2889f'}, {'image_id': '13244_2011_122_Fig18_HTML', 'image_file_name': '13244_2011_122_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig18_HTML.jpg', 'caption': 'a and b Ultrasonography of a woman with an intact implant. Breast gland (black asterisk), pectoralis major muscle (black arrow), and implant shell (white arrow) visualised as a thin and continuous echogenic line at the parenchymal tissue-implant interface, and silicone implant (white asterisk). (c) A small fluid collection around the implant (arrowhead) and (d) a simple infolding of the shell silicone implant (arrowhead)', 'hash': '0d1c97a459f9f72f5ced1c2d8840979b00fc5c4e98b9c7408d95ea98f563846b'}, {'image_id': '13244_2011_122_Fig20_HTML', 'image_file_name': '13244_2011_122_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig20_HTML.jpg', 'caption': 'a Coronal silicone-excited sequence and (b) coronal contrast-enhanced fat-suppressed T1-weighted image of the previous patient show multiple nodules of free silicone (“siliconomas”) in the gluteal muscles', 'hash': 'e309e1b986eee6d799b2e144e94b25d4af5b548f5c49c199908720e5a5d33f0b'}, {'image_id': '13244_2011_122_Fig2_HTML', 'image_file_name': '13244_2011_122_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig2_HTML.jpg', 'caption': 'Localisation of breast implants. (Left) Submammary implant located in front of the pectoralis major muscle and (right) submuscular implant located behind the pectoralis major muscle, visualised by mammography', 'hash': '93e733b8f350c3977b5bb76b009d5d5ee3391aa52a319ebe0b1ee0ab2344fe6e'}, {'image_id': '13244_2011_122_Fig10_HTML', 'image_file_name': '13244_2011_122_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig10_HTML.jpg', 'caption': 'Chest plain film of a woman with capsule calcification (arrowheads) adjacent to the implant. Many augmented patients develop capsular contracture', 'hash': 'c38e728d579b5431d1dbaa0e61ff03237a4d79d4f00ad0b70e83df0c12365414'}, {'image_id': '13244_2011_122_Fig4_HTML', 'image_file_name': '13244_2011_122_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig4_HTML.jpg', 'caption': 'Our MRI examination protocol includes a 1.5-T superconducting MR system (Philips MR Systems Gyroscan NT) with a SENSE-body coil, with the following sequences. We always include a post-contrast study to detect possible malignant lesions', 'hash': 'dc32219291c898273fcbf95c24a334b5b7e39507205c5f796726d1666a1db3dc'}, {'image_id': '13244_2011_122_Fig19_HTML', 'image_file_name': '13244_2011_122_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig19_HTML.jpg', 'caption': '(Above) A coronal maximum intensity projection from a silicone-excited sequence in a transsexual (Fig. 16) demonstrating multiple nodules with high signal throughout both breasts representing free silicone (arrows). (Below) It is extremely difficult to evaluate the silicone implants by ultrasonography because of attenuation of the ultrasound beam by the free injected silicone and granuloma formation in the subcutaneous tissue', 'hash': '5c72e4bc87c02cdef8e276c2c466b74a62dad8531c58ea23a0959262ce2f5588'}, {'image_id': '13244_2011_122_Fig16_HTML', 'image_file_name': '13244_2011_122_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig16_HTML.jpg', 'caption': 'Oblique mammograms in a 29-year-old transsexual with subglandular implants and silicone injections. Diffuse areas of increased density are visualised adjacent to the implant (arrows)', 'hash': '1be1eb32cfddc504f809a51c3deec2280b52469bd28dae6a1638640dd9e793b9'}, {'image_id': '13244_2011_122_Fig26_HTML', 'image_file_name': '13244_2011_122_Fig26_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig26_HTML.jpg', 'caption': 'An oblique mammogram of a 57-year-old woman with a submammary implant (a). A cluster of suspicious microcalcifications can be identified in the breast gland (arrows). A magnified mammogram (b) confirms the presence of malignant microcalcifications (arrows)', 'hash': '7a423f638a972dc650bb00ab9558f72476cd72f6b653d92b91e9033afe29dd82'}, {'image_id': '13244_2011_122_Fig3_HTML', 'image_file_name': '13244_2011_122_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig3_HTML.jpg', 'caption': 'Magnetic resonance imaging scan of a woman with bilateral breast silicone implants. Right implant with extracapsular rupture exhibiting the typical “linguine sign” at the posterior margin of the implant. Intact left silicone implant', 'hash': 'd9b7ef0ac3d94b17ce4be1eb55acccc6aec6193534241eddcb93075ccc315dad'}, {'image_id': '13244_2011_122_Fig11_HTML', 'image_file_name': '13244_2011_122_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig11_HTML.jpg', 'caption': 'a Sagittal silicone-excited MRI sequence and (b) axial T2-weighted turbo spin-echo image of a 64-year-old woman with changes in the signal intensity of the silicone gel (black arrows). The margins of the implant are slightly irregular and a small amount of fluid surrounds the prosthesis (white arrow). A ruptured implant was confirmed at surgery.', 'hash': '0a548e86496d9b087c8639ccdf18cbffa8ebcc350116e0feabbababc68fb0dc3'}, {'image_id': '13244_2011_122_Fig21_HTML', 'image_file_name': '13244_2011_122_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig21_HTML.jpg', 'caption': 'Extracapsular silicone implant rupture in a 52-year-old woman with a history of breast cancer who presented with a palpable lesion in the supraclavicular right region. Mammogram shows an irregular lump from the implant (arrowhead) and ultrasonography demonstrates the presence of a nodular lesion with typical inhomogeneity (the “snowstorm sign”) at the posterior margin, suspicious for a lymph node containing silicone', 'hash': '52205c3165fac260a2a6e8695f8ff04deaf1f4d8fbb154226d2e42b0d8436c10'}, {'image_id': '13244_2011_122_Fig22_HTML', 'image_file_name': '13244_2011_122_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig22_HTML.jpg', 'caption': 'Cytology of the node shows multinucleated foreign-body giant cells (arrowhead) with abundant birefringent particles inside and outside the cytoplasm, compatible with gel silicone (arrows). Axial T2-weighted turbo spin-echo MRI study corroborated an extracapsular rupture of the implant', 'hash': '97dbcbae329f0d3a9923dd5c05a76a1c216ce0af0fa1ca77c47b2a235f9c1923'}, {'image_id': '13244_2011_122_Fig12_HTML', 'image_file_name': '13244_2011_122_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig12_HTML.jpg', 'caption': 'MRI of a 54-year-old woman with a ruptured breast implant confirmed at surgery. a Axial silicone suppression. b Axial silicone-excited sequence. c Axial T2-weighted turbo spin echo. d Axial T1-weighted turbo spin echo. Silicone gel (white asterisks) inside and outside the implant. A moderate amount of water and probably serum is mixed in the silicone gel around the implant (black asterisks). Note also the punctuate changes in signal intensity—droplets within the implant (arrows) and punctuate and hyperintense images due to calcifications in the implant periphery (arrowheads)', 'hash': '2a8f1da7a9ab9cd542de8dec2ad20826fd460a08c7aa12532123651a5e1df66f'}, {'image_id': '13244_2011_122_Fig25_HTML', 'image_file_name': '13244_2011_122_Fig25_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig25_HTML.jpg', 'caption': 'Breast ultrasonography of a 39-year-old (a) and a 30-year-old (b) augmented women. In both studies there are two lesions (arrows) considered BIRADS III under follow-up. c Ultrasonography of a 46-year-old augmented woman with a history of breast cancer. US shows a lesion suspicious of recurrent tumor (arrow) that was confirmed by histology. Breast implant (asterisk)', 'hash': 'd0ef421494dee62a0bd86dbafe5c57be163ea69a827ea6b8d17f30190f812032'}, {'image_id': '13244_2011_122_Fig15_HTML', 'image_file_name': '13244_2011_122_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig15_HTML.jpg', 'caption': 'Definitive findings of breast implant rupture. a Subcapsular lines. Lines running almost parallel to the fibrous capsule and just beneath it. The beginning and the end of the line can be followed to the surface of the implant. b Siliconomas and free silicone. Disruption of the shell and fibrous capsule will allow silicone to extravasate into surrounding breast tissue. c “Linguine sign”. Folded wavy multidirectional lines within the silicone gel, representing the collapsed implant shell. d “Railroad track sign”. Two parallel lines in close proximity forming a double-contoured subcapsular line within the silicone gel', 'hash': '234981e0b6f195812d301a964bfa599394dee4e103b279837b062a96454ed73b'}, {'image_id': '13244_2011_122_Fig7_HTML', 'image_file_name': '13244_2011_122_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig7_HTML.jpg', 'caption': 'MRI of a woman with intracapsular rupture of a single-lumen silicone implant. (a) Axial T2-weighted turbo spin-echo and (b) axial silicone-excited sequence. The study shows a hypointense subcapsular line at the anterior margin of the implant (solid arrow); the “teardrop sign” and “key-hole sign” are also present (open arrows). Focal change in signal at the anterior margin of the implant (white open arrow) can also be observed', 'hash': 'c7e4833f7d02241f0882bb30a6e029ee0a30b31350f0f2eaa1d4cd8aed0fe7ff'}, {'image_id': '13244_2011_122_Fig8_HTML', 'image_file_name': '13244_2011_122_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig8_HTML.jpg', 'caption': 'MRI of a woman with an extracapsular rupture of a single-lumen silicone implant. a and b Sagittal silicone-excited sequences demonstrate the presence of free silicone gel around the implant (white arrows). (c) Axial silicone-excited sequence shows free silicone gel located in the internal mammary chain (black arrow)', 'hash': 'aaeae1256b9ffdbf6a3566463e15598f80aea731897b3bf1d7347b6178e45fae'}, {'image_id': '13244_2011_122_Fig13_HTML', 'image_file_name': '13244_2011_122_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig13_HTML.jpg', 'caption': 'Variants of normal breast implants. a Intact implant has an uninterrupted shell and fibrous capsule adjacent to the breast parenchyma. b Periprosthetic fluid. Presence of a small-to-moderate amount of reactive fluid surrounding the implant. c Simple or complex radial folds. Lines extending from the surface of the implant and inwards in a rather perpendicular manner. d Calcification and thickening of the fibrous capsule', 'hash': 'ee410578d38a7bd3a783df1114893585e7c25814d96d4f131f7d226b6cb83908'}, {'image_id': '13244_2011_122_Fig1_HTML', 'image_file_name': '13244_2011_122_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig1_HTML.jpg', 'caption': 'Different implant types. a and b Breast tissue expander with metallic component visualised by computed tomography scan. Silicone gel implants with textured surface (c) and with smooth surface (d)', 'hash': '2ea7806a96d2235bdf2a9d0193b6fa31f0750fc030d53027885b9baa966b0d61'}, {'image_id': '13244_2011_122_Fig23_HTML', 'image_file_name': '13244_2011_122_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig23_HTML.jpg', 'caption': 'Bilateral ruptured implants in a woman with primary lung cancer (asterisk). a Axial CT scan shows a severe deformity of the right implant surface representing a collapsed ruptured prosthesis (arrow). b Sagittal multiplanar reconstruction and (c) axial CT scan of the left implant show high-density curvilinear lines within the implant (“linguine sign”, arrows)', 'hash': 'ddf8c3c8710a635ff0994a401afc9b8d2fa6e6b68482834419b88a33be614df1'}, {'image_id': '13244_2011_122_Fig14_HTML', 'image_file_name': '13244_2011_122_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig14_HTML.jpg', 'caption': 'Findings of possible breast implant rupture. a Deformity in contour. The border of the implant is bulging more than usual (called the “rat-tail sign” when very pronounced). Sometimes rupture cannot be differentiated from herniation. b Irregular margin. The border of the implant is blurry. Frequently seen with calcification of the fibrous capsule. c Changes in the signal intensity of the silicone gel. Water/serum mixed in the silicone gel through a defect in membrane. d “Noose sign” or “key-hole sign”. Small invagination of the shell where the two membranes do not touch. e “Teardrop sign”. Invagination of the shell containing a droplet of silicone. The last two images represent silicone gel leakage through a small focal implant shell tear', 'hash': '857445ca4fdaf3bf3f3a0f943dc4bc8cd38b311d19fb3227d25c5dfb3cacbd8c'}, {'image_id': '13244_2011_122_Fig9_HTML', 'image_file_name': '13244_2011_122_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig9_HTML.jpg', 'caption': 'Axial T2-weighted turbo spin-echo image (a) and axial CT scan (c) of single-lumen implants show small amount of reactive fluid (arrows). (b) Axial T1-weighted turbo spin-echo image demonstrates normal radial folds of the membrane (arrowhead). Simple or complex folds are not in themselves indicative of rupture', 'hash': 'a293a9ebf570fd9ee849cfbe8646555dbc8639f074ef2c3d3b2030dcab9abacc'}, {'image_id': '13244_2011_122_Fig6_HTML', 'image_file_name': '13244_2011_122_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig6_HTML.jpg', 'caption': 'Magnetic resonance imaging scan of a woman with bilateral ruptured implants. Typical “linguine sign” within implants representing collapsed implant shell', 'hash': '66cb05c9adfcd660d693865b72850c08ca41dfcbfcd8c6446a598c17caeb08ab'}, {'image_id': '13244_2011_122_Fig24_HTML', 'image_file_name': '13244_2011_122_Fig24_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig24_HTML.jpg', 'caption': 'Unilateral implant rupture. (a) Axial CT scan shows small high-density lines within the silicone gel in the right implant, suggestive of collapsed rupture (arrow). (b) Axial silicone-excited MRI sequence confirmed intracapsular rupture, showing hypointense wavy lines at the posterior margin of the right implant (“linguine sign”) and subcapsular line at the anterior margin (arrows). Normal infoldings in the left implant (arrowhead)', 'hash': 'd911970b2fdab154697d514d3243bd68b5c966eb72be30b7b036975fdd726531'}] | {'13244_2011_122_Fig1_HTML': ['Breast reconstruction may involve the insertion of various types of implant or the modelling of autologous myocutaneous flaps. According to the literature, breast implants can be categorised into five implant generations reflecting product development over time. The recent generations of silicone gel implants have a cohesive viscous silicone gel. As a result of this feature, these implants will rarely have a totally collapsed implant shell, differing from the older generations. Moreover, most of them have gel leakage and silicone migration. The third and fourth implant generations offered models of breast implants with textured or uniformly smooth surfaces (Fig.\xa0<xref rid="13244_2011_122_Fig1_HTML" ref-type="fig">1</xref>), and it seems that capsular contracture rarely occurs in women with recent generations of breast implants. All implants in this article are silicone breast implants including single-lumen implants (the majority) and less commonly double-lumen implants (Fig.\xa0), and it seems that capsular contracture rarely occurs in women with recent generations of breast implants. All implants in this article are silicone breast implants including single-lumen implants (the majority) and less commonly double-lumen implants (Fig.\xa0<xref rid="13244_2011_122_Fig5_HTML" ref-type="fig">5</xref>). Single-lumen implants have a single lumen of silicone gel delimited by a multilayer shell, while double-lumen implants have a fixed amount of saline and silicone within them, or a fixed outer lumen usually filled with silicone and an inner lumen that can be expanded, as necessary, with saline (inverse double-lumen) [). Single-lumen implants have a single lumen of silicone gel delimited by a multilayer shell, while double-lumen implants have a fixed amount of saline and silicone within them, or a fixed outer lumen usually filled with silicone and an inner lumen that can be expanded, as necessary, with saline (inverse double-lumen) [10].Fig. 1Different implant types. a and b Breast tissue expander with metallic component visualised by computed tomography scan. Silicone gel implants with textured surface (c) and with smooth surface (d)', 'Before implant insertion, especially in oncoplastic breast reconstruction, a tissue expander (Fig.\xa0<xref rid="13244_2011_122_Fig1_HTML" ref-type="fig">1</xref>) is usually placed in the mastectomy site to stretch the remaining skin in preparation for the placement of a permanent implant later. The expander is like an inflatable breast implant that is inserted into a pocket under the skin and muscle of the chest. The expander is usually placed in its collapsed form at the time of mastectomy and then, after surgery, fluid is introduced into the tissue expander to slowly inflate it. It is important to realise that, as their function is to expand, they might not be fully inflated and thus may appear to have multiple folds or wrinkles on the surface. This should not be interpreted as rupture [) is usually placed in the mastectomy site to stretch the remaining skin in preparation for the placement of a permanent implant later. The expander is like an inflatable breast implant that is inserted into a pocket under the skin and muscle of the chest. The expander is usually placed in its collapsed form at the time of mastectomy and then, after surgery, fluid is introduced into the tissue expander to slowly inflate it. It is important to realise that, as their function is to expand, they might not be fully inflated and thus may appear to have multiple folds or wrinkles on the surface. This should not be interpreted as rupture [10]. Depending on the type of expander, the fluid is either introduced directly into the expander (magnetic marker) or is injected into a distant port. This process continues for several weeks until the tissue expander is filled to an optimal volume, when a permanent breast implant can be inserted.'], '13244_2011_122_Fig2_HTML': ['Breast implants may be placed in a subglandular (anterior to the pectoralis major muscle) or subpectoral (posterior to the pectoralis major muscle) location (Fig.\xa0<xref rid="13244_2011_122_Fig2_HTML" ref-type="fig">2</xref>).).Fig. 2Localisation of breast implants. (Left) Submammary implant located in front of the pectoralis major muscle and (right) submuscular implant located behind the pectoralis major muscle, visualised by mammography'], '13244_2011_122_Fig3_HTML': ['Magnetic resonance imaging (MRI) is the most accurate technique in the evaluation of implant integrity. Its sensitivity for rupture is between 80% and 90%, and its specificity is between 90% and 97% [3, 5–16] (Fig.\xa0<xref rid="13244_2011_122_Fig3_HTML" ref-type="fig">3</xref>).).Fig. 3Magnetic resonance imaging scan of a woman with bilateral breast silicone implants. Right implant with extracapsular rupture exhibiting the typical “linguine sign” at the posterior margin of the implant. Intact left silicone implant'], '13244_2011_122_Fig4_HTML': ['Multiplanar dedicated T1- and T2-weighted MRI techniques are used for evaluating implant integrity [11]. The lack of ionising radiation is another advantage of MRI. Figure\xa0<xref rid="13244_2011_122_Fig4_HTML" ref-type="fig">4</xref> shows the MRI sequences used at our institution for breast implant study. The use of contrast agents in MRI studies for assessment of breast implant integrity is not recommended. However, when the priority is the detection of recurrence or residual tumors, contrast-enhanced MRI of the breast is useful for characterising parenchymal lesions [ shows the MRI sequences used at our institution for breast implant study. The use of contrast agents in MRI studies for assessment of breast implant integrity is not recommended. However, when the priority is the detection of recurrence or residual tumors, contrast-enhanced MRI of the breast is useful for characterising parenchymal lesions [11, 13]. High-field-strength magnets of at least 1.5 T are preferred when imaging patients with silicone breast implants because of the ability to use magnetic resonance sequences that can more readily suppress or emphasise the signal from water, fat or silicone. Turbo-spin-echo T2-weighted images, short-time inversion recovery silicone excited (silicone hyperintense, water suppressed), and silicone-saturated (water hyperintense, silicone suppressed) are the most common and most important sequences in silicone breast implant assessment. A single-lumen silicone implant has an outer shell containing homogeneous high-signal-intensity viscous silicone on T2-weighted images. A double-lumen silicone implant typically has an inner lumen of high-signal-intensity silicone surrounded by a smaller outer lumen that contains saline and has different signal intensities, depending on the pulse sequence (Fig.\xa0<xref rid="13244_2011_122_Fig5_HTML" ref-type="fig">5</xref>).).Fig. 4Our MRI examination protocol includes a 1.5-T superconducting MR system (Philips MR Systems Gyroscan NT) with a SENSE-body coil, with the following sequences. We always include a post-contrast study to detect possible malignant lesionsFig. 5MRI of a 61-year-old woman with bilateral implants: a single-lumen implant (right breast) and a double-lumen implant (left breast). (a) Axial silicone-suppression and (b) axial T2-weighted turbo spin echo sequences. The right implant has homogeneous signal intensity, representing a single lumen with silicone gel (*). The left implant has an inner lumen (open arrow) of low-signal-intensity or high-signal-intensity silicone surrounded by a smaller outer lumen (solid arrow) that contains saline'], '13244_2011_122_Fig6_HTML': ['Breast implant ruptures can be divided into two major categories: intracapsular implant rupture and extracapsular implant rupture, which is less common [1, 3–10, 12, 15–18]. Up to half of all ruptures in women with augmented breasts occur within 12 years [1]. Intracapsular implant rupture is defined as rupture of the implant shell with silicone leakage that does not macroscopically extend beyond the fibrous capsule. The most reliable MRI criterion for intracapsular rupture is the presence of multiple curvilinear low-signal-intensity lines within the high-signal-intensity silicone gel, the so-called “linguine sign”. These curvilinear lines represent the collapsed implant shell floating within the silicone gel [5, 7, 9, 10, 12, 13, 16] (Fig.\xa0<xref rid="13244_2011_122_Fig6_HTML" ref-type="fig">6</xref>). The linguine sign will not be present in an uncollapsed rupture. In an uncollapsed rupture, MRI shows free silicone outside the implant shell but still contained by the fibrous capsule. Focal silicone invagination between the inner shell and fibrous capsule are common, resulting in the “teardrop sign” and the “key-hole sign” [). The linguine sign will not be present in an uncollapsed rupture. In an uncollapsed rupture, MRI shows free silicone outside the implant shell but still contained by the fibrous capsule. Focal silicone invagination between the inner shell and fibrous capsule are common, resulting in the “teardrop sign” and the “key-hole sign” [5, 7, 9]. An uncollapsed silicone implant rupture is defined as a tear of the silicone implant shell and is considered an intracapsular rupture (Fig.\xa0<xref rid="13244_2011_122_Fig7_HTML" ref-type="fig">7</xref>). Only these more subtle findings will be present in up to 52% of ruptured implants [). Only these more subtle findings will be present in up to 52% of ruptured implants [15].Fig. 6Magnetic resonance imaging scan of a woman with bilateral ruptured implants. Typical “linguine sign” within implants representing collapsed implant shellFig. 7MRI of a woman with intracapsular rupture of a single-lumen silicone implant. (a) Axial T2-weighted turbo spin-echo and (b) axial silicone-excited sequence. The study shows a hypointense subcapsular line at the anterior margin of the implant (solid arrow); the “teardrop sign” and “key-hole sign” are also present (open arrows). Focal change in signal at the anterior margin of the implant (white open arrow) can also be observed'], '13244_2011_122_Fig8_HTML': ['Extracapsular silicone implant rupture is defined as rupture of both the implant shell and the fibrous capsule, with macroscopic silicone leakage that extends beyond the fibrous capsule into surrounding tissues. Focal areas of high signal intensity in sequences that enhance only the silicone represent free silicone [5, 9, 12, 16] (Fig.\xa0<xref rid="13244_2011_122_Fig8_HTML" ref-type="fig">8</xref>). The linguine sign is often present with extracapsular ruptures.). The linguine sign is often present with extracapsular ruptures.Fig. 8MRI of a woman with an extracapsular rupture of a single-lumen silicone implant. a and b Sagittal silicone-excited sequences demonstrate the presence of free silicone gel around the implant (white arrows). (c) Axial silicone-excited sequence shows free silicone gel located in the internal mammary chain (black arrow)'], '13244_2011_122_Fig9_HTML': ['MRI often shows radial folds or normal infoldings of the shell extending to the periphery of the implant. These folds may appear prominent and complex, but should not be confused with implant rupture or leak. This is one of the major pitfalls and causes of false positives on MRI, mimicking the total collapse of the implant shell [9, 10, 13, 16]. Radial folds and periprosthetic fluid are considered normal variants of breast implants (Fig.\xa0<xref rid="13244_2011_122_Fig9_HTML" ref-type="fig">9</xref>). This reactive fluid probably results from an inflammatory response and is not indicative of implant rupture.). This reactive fluid probably results from an inflammatory response and is not indicative of implant rupture.Fig. 9Axial T2-weighted turbo spin-echo image (a) and axial CT scan (c) of single-lumen implants show small amount of reactive fluid (arrows). (b) Axial T1-weighted turbo spin-echo image demonstrates normal radial folds of the membrane (arrowhead). Simple or complex folds are not in themselves indicative of rupture'], '13244_2011_122_Fig10_HTML': ['Radial folds are frequently observed in patients with capsular contracture. Capsular contracture is the most common complication. It is caused by excessive scar tissue around the implant that tightens and squeezes the implant. Occasionally, the capsule tears, allowing part of the implant to herniate into adjacent parenchyma. The capsule sometimes calcifies, and rigid calcium deposits may be palpated immediately adjacent to the implant (Fig.\xa0<xref rid="13244_2011_122_Fig10_HTML" ref-type="fig">10</xref>) [) [18].Fig. 10Chest plain film of a woman with capsule calcification (arrowheads) adjacent to the implant. Many augmented patients develop capsular contracture'], '13244_2011_122_Fig11_HTML': ['Rarely, intracapsular rupture will show multiple hyperintense foci on T2-weighted images or multiple hypointense foci on water-suppression images within the implant lumen; these findings are referred to as the “salad oil sign” or “droplet sign”. Without other MRI evidence of implant rupture, like the identification of the collapsed implant shell or free silicone within the breast parenchyma (with no previous history of implant rupture), water droplets or small amounts of air within a silicone implant are not reliable signs of implant rupture [9, 10, 16]. However, this sign should prompt the search for subtle signs of intracapsular rupture [16] (Figs.\xa0<xref rid="13244_2011_122_Fig11_HTML" ref-type="fig">11</xref> and and <xref rid="13244_2011_122_Fig12_HTML" ref-type="fig">12</xref>). The entire spectrum of MRI findings for silicone breast implants is illustrated in Figs.\xa0). The entire spectrum of MRI findings for silicone breast implants is illustrated in Figs.\xa0<xref rid="13244_2011_122_Fig13_HTML" ref-type="fig">13</xref>, , <xref rid="13244_2011_122_Fig14_HTML" ref-type="fig">14</xref> and and <xref rid="13244_2011_122_Fig15_HTML" ref-type="fig">15</xref>..Fig.\xa011a Sagittal silicone-excited MRI sequence and (b) axial T2-weighted turbo spin-echo image of a 64-year-old woman with changes in the signal intensity of the silicone gel (black arrows). The margins of the implant are slightly irregular and a small amount of fluid surrounds the prosthesis (white arrow). A ruptured implant was confirmed at surgery.Fig.\xa012MRI of a 54-year-old woman with a ruptured breast implant confirmed at surgery. a Axial silicone suppression. b Axial silicone-excited sequence. c Axial T2-weighted turbo spin echo. d Axial T1-weighted turbo spin echo. Silicone gel (white asterisks) inside and outside the implant. A moderate amount of water and probably serum is mixed in the silicone gel around the implant (black asterisks). Note also the punctuate changes in signal intensity—droplets within the implant (arrows) and punctuate and hyperintense images due to calcifications in the implant periphery (arrowheads)Fig. 13Variants of normal breast implants. a Intact implant has an uninterrupted shell and fibrous capsule adjacent to the breast parenchyma. b Periprosthetic fluid. Presence of a small-to-moderate amount of reactive fluid surrounding the implant. c Simple or complex radial folds. Lines extending from the surface of the implant and inwards in a rather perpendicular manner. d Calcification and thickening of the fibrous capsuleFig. 14Findings of possible breast implant rupture. a Deformity in contour. The border of the implant is bulging more than usual (called the “rat-tail sign” when very pronounced). Sometimes rupture cannot be differentiated from herniation. b Irregular margin. The border of the implant is blurry. Frequently seen with calcification of the fibrous capsule. c Changes in the signal intensity of the silicone gel. Water/serum mixed in the silicone gel through a defect in membrane. d “Noose sign” or “key-hole sign”. Small invagination of the shell where the two membranes do not touch. e “Teardrop sign”. Invagination of the shell containing a droplet of silicone. The last two images represent silicone gel leakage through a small focal implant shell tearFig. 15Definitive findings of breast implant rupture. a Subcapsular lines. Lines running almost parallel to the fibrous capsule and just beneath it. The beginning and the end of the line can be followed to the surface of the implant. b Siliconomas and free silicone. Disruption of the shell and fibrous capsule will allow silicone to extravasate into surrounding breast tissue. c “Linguine sign”. Folded wavy multidirectional lines within the silicone gel, representing the collapsed implant shell. d “Railroad track sign”. Two parallel lines in close proximity forming a double-contoured subcapsular line within the silicone gel'], '13244_2011_122_Fig16_HTML': ['Mammography is of little value in the assessment of implant integrity, although it may be useful for the assessment of the surrounding breast tissue [10]. Silicone implants should be evaluated on a yearly basis to detect any change in configuration or identify any new free silicone within the breast parenchyma. Mammographic features that are not specific to implant rupture include a measurable periprosthetic dense band, periprosthetic calcification, asymmetry of implant size or shape, and focal herniation of the implant. Periprosthetic hyperdensity (Fig.\xa0<xref rid="13244_2011_122_Fig16_HTML" ref-type="fig">16</xref>) is significantly associated with extracapsular rupture (p\u2009≤\u20090.05) and inhomogeneous, reduced radiopacity seems to indicate rupture, without discriminating the type of rupture (p\u2009≤\u20090.05) [) is significantly associated with extracapsular rupture (p\u2009≤\u20090.05) and inhomogeneous, reduced radiopacity seems to indicate rupture, without discriminating the type of rupture (p\u2009≤\u20090.05) [16]. Specific mammographic evidence of implant rupture is extravasation of silicone outside the implant shell [9].Fig. 16Oblique mammograms in a 29-year-old transsexual with subglandular implants and silicone injections. Diffuse areas of increased density are visualised adjacent to the implant (arrows)'], '13244_2011_122_Fig17_HTML': ['The best mammograms are obtained when the breast is maximally compressed so the X-ray beam penetrates the thinnest possible layer of tissue. In 1988, Eklund et al. [13, 15] introduced the displacement technique to facilitate mammography in augmented women (Fig.\xa0<xref rid="13244_2011_122_Fig17_HTML" ref-type="fig">17</xref>). A thorough clinical history should be obtained before mammography to ensure that the patient has not had a previous implant rupture or has not had direct silicone injections.). A thorough clinical history should be obtained before mammography to ensure that the patient has not had a previous implant rupture or has not had direct silicone injections.Fig. 17Implant position is an important factor when studying the breasts. Patients with submammary implants have fewer visualised area compared to patients with submuscular implants. The displacement technique introduced by Eklund facilitates mammography in women with implants. Slightly more tissue is visualised with displacement (below) than with standard compression mammography (above)'], '13244_2011_122_Fig18_HTML': ['Assessments of the usefulness of ultrasonography (US) for detecting implant ruptures vary widely. Although US does not use ionising radiation, it is operator dependent. Typically, US breast implant examination involves evaluation of morphology, contour and contents, periimplant tissues and axillae. Thus, the transversal-to-longitudinal ratio of the implants is calculated, the regularity of implant margins (radial folds) and the homogeneity of the implant lumen are checked, and signs of free silicone or granulomas in the breast or in the axillary lymph nodes are sought (Fig.\xa0<xref rid="13244_2011_122_Fig18_HTML" ref-type="fig">18</xref>) [) [17]. The most reliable sign of an intact implant is an anechoic interior [9]. A completely negative US examination strongly supports implant integrity, limiting the application of mammography or MRI to cases suspicious at US [1, 10].Fig. 18a and b Ultrasonography of a woman with an intact implant. Breast gland (black asterisk), pectoralis major muscle (black arrow), and implant shell (white arrow) visualised as a thin and continuous echogenic line at the parenchymal tissue-implant interface, and silicone implant (white asterisk). (c) A small fluid collection around the implant (arrowhead) and (d) a simple infolding of the shell silicone implant (arrowhead)'], '13244_2011_122_Fig19_HTML': ['Reverberation artefacts are commonly encountered in the anterior aspect of the implant and should not be confused with abnormalities. One limitation of US is that marked attenuation of the ultrasound beam by silicone hinders the evaluation of the back wall of an implant and the tissue posterior to it. Similarly, residual silicone granulomas from extracapsular rupture or from previous direct silicone injections compromise the evaluation of a new implant (Figs.\xa0<xref rid="13244_2011_122_Fig19_HTML" ref-type="fig">19</xref> and and <xref rid="13244_2011_122_Fig20_HTML" ref-type="fig">20</xref>).).Fig. 19(Above) A coronal maximum intensity projection from a silicone-excited sequence in a transsexual (Fig. <xref rid="13244_2011_122_Fig16_HTML" ref-type="fig">16</xref>) demonstrating multiple nodules with high signal throughout both breasts representing free silicone ) demonstrating multiple nodules with high signal throughout both breasts representing free silicone (arrows). (Below) It is extremely difficult to evaluate the silicone implants by ultrasonography because of attenuation of the ultrasound beam by the free injected silicone and granuloma formation in the subcutaneous tissueFig. 20a Coronal silicone-excited sequence and (b) coronal contrast-enhanced fat-suppressed T1-weighted image of the previous patient show multiple nodules of free silicone (“siliconomas”) in the gluteal muscles'], '13244_2011_122_Fig21_HTML': ['Radial folds present as echogenic lines that extend from the periphery to the interior of the implant. These folds are normal infoldings of the implant membrane into the silicone gel. Small amounts of free silicone mixed within the surrounding breast tissues give rise to the characteristic echogenic “snowstorm” (statistically significant for extracapsular rupture, p\u2009≤\u20090.05 and the most sensitive and specific sign at US [16]). This sign is the most reliable sign of extracapsular rupture [12] and consists of a group of focal nodules with a generalised increase in echogenicity of the breast tissue and loss of normal parenchymal interfaces resulting from dispersion of the ultrasound beam. The nodules represent silicone granulomas, composed of free silicone and surrounding fibrous tissue reaction, lying outside the confines of the fibrous capsule. Many silicone granulomas are located in the axillae (Figs.\xa0<xref rid="13244_2011_122_Fig21_HTML" ref-type="fig">21</xref> and and <xref rid="13244_2011_122_Fig22_HTML" ref-type="fig">22</xref>).).Fig. 21Extracapsular silicone implant rupture in a 52-year-old woman with a history of breast cancer who presented with a palpable lesion in the supraclavicular right region. Mammogram shows an irregular lump from the implant (arrowhead) and ultrasonography demonstrates the presence of a nodular lesion with typical inhomogeneity (the “snowstorm sign”) at the posterior margin, suspicious for a lymph node containing siliconeFig. 22Cytology of the node shows multinucleated foreign-body giant cells (arrowhead) with abundant birefringent particles inside and outside the cytoplasm, compatible with gel silicone (arrows). Axial T2-weighted turbo spin-echo MRI study corroborated an extracapsular rupture of the implant'], '13244_2011_122_Fig23_HTML': ['At CT, an intact silicone implant is characterised by an oval shape and homogeneous grey density within a surrounding high-density ring. The implant often has contour deformities or implant bulges or hernias. The CT findings of intracapsular silicone implant rupture are similar to the MRI findings, and the linguine sign can also be seen at CT [8]. The collapsed implant shell can usually be easily identified (Figs.\xa0<xref rid="13244_2011_122_Fig23_HTML" ref-type="fig">23</xref> and and <xref rid="13244_2011_122_Fig24_HTML" ref-type="fig">24</xref>). Because silicone and soft tissues have similar radiodensities, extracapsular silicone can be difficult to identify on CT. However, in most cases of extracapsular silicone implant ruptures, CT can detect the collapsed implant shell, so the ruptured implant is not usually missed.). Because silicone and soft tissues have similar radiodensities, extracapsular silicone can be difficult to identify on CT. However, in most cases of extracapsular silicone implant ruptures, CT can detect the collapsed implant shell, so the ruptured implant is not usually missed.Fig. 23Bilateral ruptured implants in a woman with primary lung cancer (asterisk). a Axial CT scan shows a severe deformity of the right implant surface representing a collapsed ruptured prosthesis (arrow). b Sagittal multiplanar reconstruction and (c) axial CT scan of the left implant show high-density curvilinear lines within the implant (“linguine sign”, arrows)Fig. 24Unilateral implant rupture. (a) Axial CT scan shows small high-density lines within the silicone gel in the right implant, suggestive of collapsed rupture (arrow). (b) Axial silicone-excited MRI sequence confirmed intracapsular rupture, showing hypointense wavy lines at the posterior margin of the right implant (“linguine sign”) and subcapsular line at the anterior margin (arrows). Normal infoldings in the left implant (arrowhead)'], '13244_2011_122_Fig25_HTML': ['All breast diseases can also occur in women with implants; among these, the most important for its prognosis and treatment is breast cancer. The risk of breast cancer is not increased in augmented women [11, 16], and there is no significant difference in breast cancer survival rates between women with and those without implants [11, 12]. However, because augmented women will sometimes develop breast cancer, there should be persistent precautions concerning cancer detection. Implants might interfere with the earliest possible detection of a cancer by altering physical examination of the breast or impairing various imaging techniques [18] (Figs.\xa0<xref rid="13244_2011_122_Fig25_HTML" ref-type="fig">25</xref> and and <xref rid="13244_2011_122_Fig26_HTML" ref-type="fig">26</xref>). The sensitivity of mammography and US for cancer detection may be reduced in augmented woman [). The sensitivity of mammography and US for cancer detection may be reduced in augmented woman [1]. However, the presence of the implant does not seem to decrease the sensitivity of breast MRI [11, 14]. When evaluating these patients, physical and mammographic findings should be correlated. Any palpable abnormalities should be studied with ultrasound or contrast-enhanced MRI.Fig. 25Breast ultrasonography of a 39-year-old (a) and a 30-year-old (b) augmented women. In both studies there are two lesions (arrows) considered BIRADS III under follow-up. c Ultrasonography of a 46-year-old augmented woman with a history of breast cancer. US shows a lesion suspicious of recurrent tumor (arrow) that was confirmed by histology. Breast implant (asterisk)Fig. 26An oblique mammogram of a 57-year-old woman with a submammary implant (a). A cluster of suspicious microcalcifications can be identified in the breast gland (arrows). A magnified mammogram (b) confirms the presence of malignant microcalcifications (arrows)'], '13244_2011_122_Fig27_HTML': ['MRI is clearly recommended in augmented woman with suspicion of a tumor [1]. All suspicious lesions should be analysed by fine-needle aspiration or core needle biopsy with maximum caution to avoid damaging the implant (Fig.\xa0<xref rid="13244_2011_122_Fig27_HTML" ref-type="fig">27</xref>).).Fig. 27(Left) Metallic clip placed in the microcalcifications site after biopsy. (Right) Real-time ultrasound is used to guide the needle tip (arrow)']} | Imaging of breast implants—a pictorial review | [
"Breast implants",
"Implant rupture",
"Magnetic resonance imaging",
"Mammography",
"Ultrasonography"
] | Insights Imaging | 1312700400 | This paper re-emphasises the important role of diagnostic ultrasound. It underlines the importance of ultrasound as a non-invasive imaging procedure which does not use ionising radiation. The paper also illustrates how ultrasound is often the cornerstone of the work up of the patient and the need for radiology departments to be able to offer expert ultrasound on a 24/7 basis. Some aspects related to turf battles and education are discussed. Finally the way in which these issues will be addressed by the European Society of Radiology is outlined. | [] | other | PMC3259319 | null | 0 | [] | Insights Imaging. 2011 Aug 7; 2(6):653-670 | NO-CC CODE |
|
MRI of a woman with an extracapsular rupture of a single-lumen silicone implant. a and b Sagittal silicone-excited sequences demonstrate the presence of free silicone gel around the implant (white arrows). (c) Axial silicone-excited sequence shows free silicone gel located in the internal mammary chain (black arrow) | 13244_2011_122_Fig8_HTML | 7 | aaeae1256b9ffdbf6a3566463e15598f80aea731897b3bf1d7347b6178e45fae | 13244_2011_122_Fig8_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
787,
292
] | [{'image_id': '13244_2011_122_Fig27_HTML', 'image_file_name': '13244_2011_122_Fig27_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig27_HTML.jpg', 'caption': '(Left) Metallic clip placed in the microcalcifications site after biopsy. (Right) Real-time ultrasound is used to guide the needle tip (arrow)', 'hash': 'f26cb88ed30cf1ee57f313b2f6f51c8113b7bdf4d58b9d507abeeec26445fdc9'}, {'image_id': '13244_2011_122_Fig5_HTML', 'image_file_name': '13244_2011_122_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig5_HTML.jpg', 'caption': 'MRI of a 61-year-old woman with bilateral implants: a single-lumen implant (right breast) and a double-lumen implant (left breast). (a) Axial silicone-suppression and (b) axial T2-weighted turbo spin echo sequences. The right implant has homogeneous signal intensity, representing a single lumen with silicone gel (*). The left implant has an inner lumen (open arrow) of low-signal-intensity or high-signal-intensity silicone surrounded by a smaller outer lumen (solid arrow) that contains saline', 'hash': '0b09abe7af79263ae78808936d3a62e59a548ba8d7dda1c38fbd6e39003c57dd'}, {'image_id': '13244_2011_122_Fig17_HTML', 'image_file_name': '13244_2011_122_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig17_HTML.jpg', 'caption': 'Implant position is an important factor when studying the breasts. Patients with submammary implants have fewer visualised area compared to patients with submuscular implants. The displacement technique introduced by Eklund facilitates mammography in women with implants. Slightly more tissue is visualised with displacement (below) than with standard compression mammography (above)', 'hash': 'ea6afe0e354c5bb9b02411b99e2fa78fb4c8e47066110beb13ade69cf0d2889f'}, {'image_id': '13244_2011_122_Fig18_HTML', 'image_file_name': '13244_2011_122_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig18_HTML.jpg', 'caption': 'a and b Ultrasonography of a woman with an intact implant. Breast gland (black asterisk), pectoralis major muscle (black arrow), and implant shell (white arrow) visualised as a thin and continuous echogenic line at the parenchymal tissue-implant interface, and silicone implant (white asterisk). (c) A small fluid collection around the implant (arrowhead) and (d) a simple infolding of the shell silicone implant (arrowhead)', 'hash': '0d1c97a459f9f72f5ced1c2d8840979b00fc5c4e98b9c7408d95ea98f563846b'}, {'image_id': '13244_2011_122_Fig20_HTML', 'image_file_name': '13244_2011_122_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig20_HTML.jpg', 'caption': 'a Coronal silicone-excited sequence and (b) coronal contrast-enhanced fat-suppressed T1-weighted image of the previous patient show multiple nodules of free silicone (“siliconomas”) in the gluteal muscles', 'hash': 'e309e1b986eee6d799b2e144e94b25d4af5b548f5c49c199908720e5a5d33f0b'}, {'image_id': '13244_2011_122_Fig2_HTML', 'image_file_name': '13244_2011_122_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig2_HTML.jpg', 'caption': 'Localisation of breast implants. (Left) Submammary implant located in front of the pectoralis major muscle and (right) submuscular implant located behind the pectoralis major muscle, visualised by mammography', 'hash': '93e733b8f350c3977b5bb76b009d5d5ee3391aa52a319ebe0b1ee0ab2344fe6e'}, {'image_id': '13244_2011_122_Fig10_HTML', 'image_file_name': '13244_2011_122_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig10_HTML.jpg', 'caption': 'Chest plain film of a woman with capsule calcification (arrowheads) adjacent to the implant. Many augmented patients develop capsular contracture', 'hash': 'c38e728d579b5431d1dbaa0e61ff03237a4d79d4f00ad0b70e83df0c12365414'}, {'image_id': '13244_2011_122_Fig4_HTML', 'image_file_name': '13244_2011_122_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig4_HTML.jpg', 'caption': 'Our MRI examination protocol includes a 1.5-T superconducting MR system (Philips MR Systems Gyroscan NT) with a SENSE-body coil, with the following sequences. We always include a post-contrast study to detect possible malignant lesions', 'hash': 'dc32219291c898273fcbf95c24a334b5b7e39507205c5f796726d1666a1db3dc'}, {'image_id': '13244_2011_122_Fig19_HTML', 'image_file_name': '13244_2011_122_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig19_HTML.jpg', 'caption': '(Above) A coronal maximum intensity projection from a silicone-excited sequence in a transsexual (Fig. 16) demonstrating multiple nodules with high signal throughout both breasts representing free silicone (arrows). (Below) It is extremely difficult to evaluate the silicone implants by ultrasonography because of attenuation of the ultrasound beam by the free injected silicone and granuloma formation in the subcutaneous tissue', 'hash': '5c72e4bc87c02cdef8e276c2c466b74a62dad8531c58ea23a0959262ce2f5588'}, {'image_id': '13244_2011_122_Fig16_HTML', 'image_file_name': '13244_2011_122_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig16_HTML.jpg', 'caption': 'Oblique mammograms in a 29-year-old transsexual with subglandular implants and silicone injections. Diffuse areas of increased density are visualised adjacent to the implant (arrows)', 'hash': '1be1eb32cfddc504f809a51c3deec2280b52469bd28dae6a1638640dd9e793b9'}, {'image_id': '13244_2011_122_Fig26_HTML', 'image_file_name': '13244_2011_122_Fig26_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig26_HTML.jpg', 'caption': 'An oblique mammogram of a 57-year-old woman with a submammary implant (a). A cluster of suspicious microcalcifications can be identified in the breast gland (arrows). A magnified mammogram (b) confirms the presence of malignant microcalcifications (arrows)', 'hash': '7a423f638a972dc650bb00ab9558f72476cd72f6b653d92b91e9033afe29dd82'}, {'image_id': '13244_2011_122_Fig3_HTML', 'image_file_name': '13244_2011_122_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig3_HTML.jpg', 'caption': 'Magnetic resonance imaging scan of a woman with bilateral breast silicone implants. Right implant with extracapsular rupture exhibiting the typical “linguine sign” at the posterior margin of the implant. Intact left silicone implant', 'hash': 'd9b7ef0ac3d94b17ce4be1eb55acccc6aec6193534241eddcb93075ccc315dad'}, {'image_id': '13244_2011_122_Fig11_HTML', 'image_file_name': '13244_2011_122_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig11_HTML.jpg', 'caption': 'a Sagittal silicone-excited MRI sequence and (b) axial T2-weighted turbo spin-echo image of a 64-year-old woman with changes in the signal intensity of the silicone gel (black arrows). The margins of the implant are slightly irregular and a small amount of fluid surrounds the prosthesis (white arrow). A ruptured implant was confirmed at surgery.', 'hash': '0a548e86496d9b087c8639ccdf18cbffa8ebcc350116e0feabbababc68fb0dc3'}, {'image_id': '13244_2011_122_Fig21_HTML', 'image_file_name': '13244_2011_122_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig21_HTML.jpg', 'caption': 'Extracapsular silicone implant rupture in a 52-year-old woman with a history of breast cancer who presented with a palpable lesion in the supraclavicular right region. Mammogram shows an irregular lump from the implant (arrowhead) and ultrasonography demonstrates the presence of a nodular lesion with typical inhomogeneity (the “snowstorm sign”) at the posterior margin, suspicious for a lymph node containing silicone', 'hash': '52205c3165fac260a2a6e8695f8ff04deaf1f4d8fbb154226d2e42b0d8436c10'}, {'image_id': '13244_2011_122_Fig22_HTML', 'image_file_name': '13244_2011_122_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig22_HTML.jpg', 'caption': 'Cytology of the node shows multinucleated foreign-body giant cells (arrowhead) with abundant birefringent particles inside and outside the cytoplasm, compatible with gel silicone (arrows). Axial T2-weighted turbo spin-echo MRI study corroborated an extracapsular rupture of the implant', 'hash': '97dbcbae329f0d3a9923dd5c05a76a1c216ce0af0fa1ca77c47b2a235f9c1923'}, {'image_id': '13244_2011_122_Fig12_HTML', 'image_file_name': '13244_2011_122_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig12_HTML.jpg', 'caption': 'MRI of a 54-year-old woman with a ruptured breast implant confirmed at surgery. a Axial silicone suppression. b Axial silicone-excited sequence. c Axial T2-weighted turbo spin echo. d Axial T1-weighted turbo spin echo. Silicone gel (white asterisks) inside and outside the implant. A moderate amount of water and probably serum is mixed in the silicone gel around the implant (black asterisks). Note also the punctuate changes in signal intensity—droplets within the implant (arrows) and punctuate and hyperintense images due to calcifications in the implant periphery (arrowheads)', 'hash': '2a8f1da7a9ab9cd542de8dec2ad20826fd460a08c7aa12532123651a5e1df66f'}, {'image_id': '13244_2011_122_Fig25_HTML', 'image_file_name': '13244_2011_122_Fig25_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig25_HTML.jpg', 'caption': 'Breast ultrasonography of a 39-year-old (a) and a 30-year-old (b) augmented women. In both studies there are two lesions (arrows) considered BIRADS III under follow-up. c Ultrasonography of a 46-year-old augmented woman with a history of breast cancer. US shows a lesion suspicious of recurrent tumor (arrow) that was confirmed by histology. Breast implant (asterisk)', 'hash': 'd0ef421494dee62a0bd86dbafe5c57be163ea69a827ea6b8d17f30190f812032'}, {'image_id': '13244_2011_122_Fig15_HTML', 'image_file_name': '13244_2011_122_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig15_HTML.jpg', 'caption': 'Definitive findings of breast implant rupture. a Subcapsular lines. Lines running almost parallel to the fibrous capsule and just beneath it. The beginning and the end of the line can be followed to the surface of the implant. b Siliconomas and free silicone. Disruption of the shell and fibrous capsule will allow silicone to extravasate into surrounding breast tissue. c “Linguine sign”. Folded wavy multidirectional lines within the silicone gel, representing the collapsed implant shell. d “Railroad track sign”. Two parallel lines in close proximity forming a double-contoured subcapsular line within the silicone gel', 'hash': '234981e0b6f195812d301a964bfa599394dee4e103b279837b062a96454ed73b'}, {'image_id': '13244_2011_122_Fig7_HTML', 'image_file_name': '13244_2011_122_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig7_HTML.jpg', 'caption': 'MRI of a woman with intracapsular rupture of a single-lumen silicone implant. (a) Axial T2-weighted turbo spin-echo and (b) axial silicone-excited sequence. The study shows a hypointense subcapsular line at the anterior margin of the implant (solid arrow); the “teardrop sign” and “key-hole sign” are also present (open arrows). Focal change in signal at the anterior margin of the implant (white open arrow) can also be observed', 'hash': 'c7e4833f7d02241f0882bb30a6e029ee0a30b31350f0f2eaa1d4cd8aed0fe7ff'}, {'image_id': '13244_2011_122_Fig8_HTML', 'image_file_name': '13244_2011_122_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig8_HTML.jpg', 'caption': 'MRI of a woman with an extracapsular rupture of a single-lumen silicone implant. a and b Sagittal silicone-excited sequences demonstrate the presence of free silicone gel around the implant (white arrows). (c) Axial silicone-excited sequence shows free silicone gel located in the internal mammary chain (black arrow)', 'hash': 'aaeae1256b9ffdbf6a3566463e15598f80aea731897b3bf1d7347b6178e45fae'}, {'image_id': '13244_2011_122_Fig13_HTML', 'image_file_name': '13244_2011_122_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig13_HTML.jpg', 'caption': 'Variants of normal breast implants. a Intact implant has an uninterrupted shell and fibrous capsule adjacent to the breast parenchyma. b Periprosthetic fluid. Presence of a small-to-moderate amount of reactive fluid surrounding the implant. c Simple or complex radial folds. Lines extending from the surface of the implant and inwards in a rather perpendicular manner. d Calcification and thickening of the fibrous capsule', 'hash': 'ee410578d38a7bd3a783df1114893585e7c25814d96d4f131f7d226b6cb83908'}, {'image_id': '13244_2011_122_Fig1_HTML', 'image_file_name': '13244_2011_122_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig1_HTML.jpg', 'caption': 'Different implant types. a and b Breast tissue expander with metallic component visualised by computed tomography scan. Silicone gel implants with textured surface (c) and with smooth surface (d)', 'hash': '2ea7806a96d2235bdf2a9d0193b6fa31f0750fc030d53027885b9baa966b0d61'}, {'image_id': '13244_2011_122_Fig23_HTML', 'image_file_name': '13244_2011_122_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig23_HTML.jpg', 'caption': 'Bilateral ruptured implants in a woman with primary lung cancer (asterisk). a Axial CT scan shows a severe deformity of the right implant surface representing a collapsed ruptured prosthesis (arrow). b Sagittal multiplanar reconstruction and (c) axial CT scan of the left implant show high-density curvilinear lines within the implant (“linguine sign”, arrows)', 'hash': 'ddf8c3c8710a635ff0994a401afc9b8d2fa6e6b68482834419b88a33be614df1'}, {'image_id': '13244_2011_122_Fig14_HTML', 'image_file_name': '13244_2011_122_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig14_HTML.jpg', 'caption': 'Findings of possible breast implant rupture. a Deformity in contour. The border of the implant is bulging more than usual (called the “rat-tail sign” when very pronounced). Sometimes rupture cannot be differentiated from herniation. b Irregular margin. The border of the implant is blurry. Frequently seen with calcification of the fibrous capsule. c Changes in the signal intensity of the silicone gel. Water/serum mixed in the silicone gel through a defect in membrane. d “Noose sign” or “key-hole sign”. Small invagination of the shell where the two membranes do not touch. e “Teardrop sign”. Invagination of the shell containing a droplet of silicone. The last two images represent silicone gel leakage through a small focal implant shell tear', 'hash': '857445ca4fdaf3bf3f3a0f943dc4bc8cd38b311d19fb3227d25c5dfb3cacbd8c'}, {'image_id': '13244_2011_122_Fig9_HTML', 'image_file_name': '13244_2011_122_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig9_HTML.jpg', 'caption': 'Axial T2-weighted turbo spin-echo image (a) and axial CT scan (c) of single-lumen implants show small amount of reactive fluid (arrows). (b) Axial T1-weighted turbo spin-echo image demonstrates normal radial folds of the membrane (arrowhead). Simple or complex folds are not in themselves indicative of rupture', 'hash': 'a293a9ebf570fd9ee849cfbe8646555dbc8639f074ef2c3d3b2030dcab9abacc'}, {'image_id': '13244_2011_122_Fig6_HTML', 'image_file_name': '13244_2011_122_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig6_HTML.jpg', 'caption': 'Magnetic resonance imaging scan of a woman with bilateral ruptured implants. Typical “linguine sign” within implants representing collapsed implant shell', 'hash': '66cb05c9adfcd660d693865b72850c08ca41dfcbfcd8c6446a598c17caeb08ab'}, {'image_id': '13244_2011_122_Fig24_HTML', 'image_file_name': '13244_2011_122_Fig24_HTML.jpg', 'image_path': '../data/media_files/PMC3259319/13244_2011_122_Fig24_HTML.jpg', 'caption': 'Unilateral implant rupture. (a) Axial CT scan shows small high-density lines within the silicone gel in the right implant, suggestive of collapsed rupture (arrow). (b) Axial silicone-excited MRI sequence confirmed intracapsular rupture, showing hypointense wavy lines at the posterior margin of the right implant (“linguine sign”) and subcapsular line at the anterior margin (arrows). Normal infoldings in the left implant (arrowhead)', 'hash': 'd911970b2fdab154697d514d3243bd68b5c966eb72be30b7b036975fdd726531'}] | {'13244_2011_122_Fig1_HTML': ['Breast reconstruction may involve the insertion of various types of implant or the modelling of autologous myocutaneous flaps. According to the literature, breast implants can be categorised into five implant generations reflecting product development over time. The recent generations of silicone gel implants have a cohesive viscous silicone gel. As a result of this feature, these implants will rarely have a totally collapsed implant shell, differing from the older generations. Moreover, most of them have gel leakage and silicone migration. The third and fourth implant generations offered models of breast implants with textured or uniformly smooth surfaces (Fig.\xa0<xref rid="13244_2011_122_Fig1_HTML" ref-type="fig">1</xref>), and it seems that capsular contracture rarely occurs in women with recent generations of breast implants. All implants in this article are silicone breast implants including single-lumen implants (the majority) and less commonly double-lumen implants (Fig.\xa0), and it seems that capsular contracture rarely occurs in women with recent generations of breast implants. All implants in this article are silicone breast implants including single-lumen implants (the majority) and less commonly double-lumen implants (Fig.\xa0<xref rid="13244_2011_122_Fig5_HTML" ref-type="fig">5</xref>). Single-lumen implants have a single lumen of silicone gel delimited by a multilayer shell, while double-lumen implants have a fixed amount of saline and silicone within them, or a fixed outer lumen usually filled with silicone and an inner lumen that can be expanded, as necessary, with saline (inverse double-lumen) [). Single-lumen implants have a single lumen of silicone gel delimited by a multilayer shell, while double-lumen implants have a fixed amount of saline and silicone within them, or a fixed outer lumen usually filled with silicone and an inner lumen that can be expanded, as necessary, with saline (inverse double-lumen) [10].Fig. 1Different implant types. a and b Breast tissue expander with metallic component visualised by computed tomography scan. Silicone gel implants with textured surface (c) and with smooth surface (d)', 'Before implant insertion, especially in oncoplastic breast reconstruction, a tissue expander (Fig.\xa0<xref rid="13244_2011_122_Fig1_HTML" ref-type="fig">1</xref>) is usually placed in the mastectomy site to stretch the remaining skin in preparation for the placement of a permanent implant later. The expander is like an inflatable breast implant that is inserted into a pocket under the skin and muscle of the chest. The expander is usually placed in its collapsed form at the time of mastectomy and then, after surgery, fluid is introduced into the tissue expander to slowly inflate it. It is important to realise that, as their function is to expand, they might not be fully inflated and thus may appear to have multiple folds or wrinkles on the surface. This should not be interpreted as rupture [) is usually placed in the mastectomy site to stretch the remaining skin in preparation for the placement of a permanent implant later. The expander is like an inflatable breast implant that is inserted into a pocket under the skin and muscle of the chest. The expander is usually placed in its collapsed form at the time of mastectomy and then, after surgery, fluid is introduced into the tissue expander to slowly inflate it. It is important to realise that, as their function is to expand, they might not be fully inflated and thus may appear to have multiple folds or wrinkles on the surface. This should not be interpreted as rupture [10]. Depending on the type of expander, the fluid is either introduced directly into the expander (magnetic marker) or is injected into a distant port. This process continues for several weeks until the tissue expander is filled to an optimal volume, when a permanent breast implant can be inserted.'], '13244_2011_122_Fig2_HTML': ['Breast implants may be placed in a subglandular (anterior to the pectoralis major muscle) or subpectoral (posterior to the pectoralis major muscle) location (Fig.\xa0<xref rid="13244_2011_122_Fig2_HTML" ref-type="fig">2</xref>).).Fig. 2Localisation of breast implants. (Left) Submammary implant located in front of the pectoralis major muscle and (right) submuscular implant located behind the pectoralis major muscle, visualised by mammography'], '13244_2011_122_Fig3_HTML': ['Magnetic resonance imaging (MRI) is the most accurate technique in the evaluation of implant integrity. Its sensitivity for rupture is between 80% and 90%, and its specificity is between 90% and 97% [3, 5–16] (Fig.\xa0<xref rid="13244_2011_122_Fig3_HTML" ref-type="fig">3</xref>).).Fig. 3Magnetic resonance imaging scan of a woman with bilateral breast silicone implants. Right implant with extracapsular rupture exhibiting the typical “linguine sign” at the posterior margin of the implant. Intact left silicone implant'], '13244_2011_122_Fig4_HTML': ['Multiplanar dedicated T1- and T2-weighted MRI techniques are used for evaluating implant integrity [11]. The lack of ionising radiation is another advantage of MRI. Figure\xa0<xref rid="13244_2011_122_Fig4_HTML" ref-type="fig">4</xref> shows the MRI sequences used at our institution for breast implant study. The use of contrast agents in MRI studies for assessment of breast implant integrity is not recommended. However, when the priority is the detection of recurrence or residual tumors, contrast-enhanced MRI of the breast is useful for characterising parenchymal lesions [ shows the MRI sequences used at our institution for breast implant study. The use of contrast agents in MRI studies for assessment of breast implant integrity is not recommended. However, when the priority is the detection of recurrence or residual tumors, contrast-enhanced MRI of the breast is useful for characterising parenchymal lesions [11, 13]. High-field-strength magnets of at least 1.5 T are preferred when imaging patients with silicone breast implants because of the ability to use magnetic resonance sequences that can more readily suppress or emphasise the signal from water, fat or silicone. Turbo-spin-echo T2-weighted images, short-time inversion recovery silicone excited (silicone hyperintense, water suppressed), and silicone-saturated (water hyperintense, silicone suppressed) are the most common and most important sequences in silicone breast implant assessment. A single-lumen silicone implant has an outer shell containing homogeneous high-signal-intensity viscous silicone on T2-weighted images. A double-lumen silicone implant typically has an inner lumen of high-signal-intensity silicone surrounded by a smaller outer lumen that contains saline and has different signal intensities, depending on the pulse sequence (Fig.\xa0<xref rid="13244_2011_122_Fig5_HTML" ref-type="fig">5</xref>).).Fig. 4Our MRI examination protocol includes a 1.5-T superconducting MR system (Philips MR Systems Gyroscan NT) with a SENSE-body coil, with the following sequences. We always include a post-contrast study to detect possible malignant lesionsFig. 5MRI of a 61-year-old woman with bilateral implants: a single-lumen implant (right breast) and a double-lumen implant (left breast). (a) Axial silicone-suppression and (b) axial T2-weighted turbo spin echo sequences. The right implant has homogeneous signal intensity, representing a single lumen with silicone gel (*). The left implant has an inner lumen (open arrow) of low-signal-intensity or high-signal-intensity silicone surrounded by a smaller outer lumen (solid arrow) that contains saline'], '13244_2011_122_Fig6_HTML': ['Breast implant ruptures can be divided into two major categories: intracapsular implant rupture and extracapsular implant rupture, which is less common [1, 3–10, 12, 15–18]. Up to half of all ruptures in women with augmented breasts occur within 12 years [1]. Intracapsular implant rupture is defined as rupture of the implant shell with silicone leakage that does not macroscopically extend beyond the fibrous capsule. The most reliable MRI criterion for intracapsular rupture is the presence of multiple curvilinear low-signal-intensity lines within the high-signal-intensity silicone gel, the so-called “linguine sign”. These curvilinear lines represent the collapsed implant shell floating within the silicone gel [5, 7, 9, 10, 12, 13, 16] (Fig.\xa0<xref rid="13244_2011_122_Fig6_HTML" ref-type="fig">6</xref>). The linguine sign will not be present in an uncollapsed rupture. In an uncollapsed rupture, MRI shows free silicone outside the implant shell but still contained by the fibrous capsule. Focal silicone invagination between the inner shell and fibrous capsule are common, resulting in the “teardrop sign” and the “key-hole sign” [). The linguine sign will not be present in an uncollapsed rupture. In an uncollapsed rupture, MRI shows free silicone outside the implant shell but still contained by the fibrous capsule. Focal silicone invagination between the inner shell and fibrous capsule are common, resulting in the “teardrop sign” and the “key-hole sign” [5, 7, 9]. An uncollapsed silicone implant rupture is defined as a tear of the silicone implant shell and is considered an intracapsular rupture (Fig.\xa0<xref rid="13244_2011_122_Fig7_HTML" ref-type="fig">7</xref>). Only these more subtle findings will be present in up to 52% of ruptured implants [). Only these more subtle findings will be present in up to 52% of ruptured implants [15].Fig. 6Magnetic resonance imaging scan of a woman with bilateral ruptured implants. Typical “linguine sign” within implants representing collapsed implant shellFig. 7MRI of a woman with intracapsular rupture of a single-lumen silicone implant. (a) Axial T2-weighted turbo spin-echo and (b) axial silicone-excited sequence. The study shows a hypointense subcapsular line at the anterior margin of the implant (solid arrow); the “teardrop sign” and “key-hole sign” are also present (open arrows). Focal change in signal at the anterior margin of the implant (white open arrow) can also be observed'], '13244_2011_122_Fig8_HTML': ['Extracapsular silicone implant rupture is defined as rupture of both the implant shell and the fibrous capsule, with macroscopic silicone leakage that extends beyond the fibrous capsule into surrounding tissues. Focal areas of high signal intensity in sequences that enhance only the silicone represent free silicone [5, 9, 12, 16] (Fig.\xa0<xref rid="13244_2011_122_Fig8_HTML" ref-type="fig">8</xref>). The linguine sign is often present with extracapsular ruptures.). The linguine sign is often present with extracapsular ruptures.Fig. 8MRI of a woman with an extracapsular rupture of a single-lumen silicone implant. a and b Sagittal silicone-excited sequences demonstrate the presence of free silicone gel around the implant (white arrows). (c) Axial silicone-excited sequence shows free silicone gel located in the internal mammary chain (black arrow)'], '13244_2011_122_Fig9_HTML': ['MRI often shows radial folds or normal infoldings of the shell extending to the periphery of the implant. These folds may appear prominent and complex, but should not be confused with implant rupture or leak. This is one of the major pitfalls and causes of false positives on MRI, mimicking the total collapse of the implant shell [9, 10, 13, 16]. Radial folds and periprosthetic fluid are considered normal variants of breast implants (Fig.\xa0<xref rid="13244_2011_122_Fig9_HTML" ref-type="fig">9</xref>). This reactive fluid probably results from an inflammatory response and is not indicative of implant rupture.). This reactive fluid probably results from an inflammatory response and is not indicative of implant rupture.Fig. 9Axial T2-weighted turbo spin-echo image (a) and axial CT scan (c) of single-lumen implants show small amount of reactive fluid (arrows). (b) Axial T1-weighted turbo spin-echo image demonstrates normal radial folds of the membrane (arrowhead). Simple or complex folds are not in themselves indicative of rupture'], '13244_2011_122_Fig10_HTML': ['Radial folds are frequently observed in patients with capsular contracture. Capsular contracture is the most common complication. It is caused by excessive scar tissue around the implant that tightens and squeezes the implant. Occasionally, the capsule tears, allowing part of the implant to herniate into adjacent parenchyma. The capsule sometimes calcifies, and rigid calcium deposits may be palpated immediately adjacent to the implant (Fig.\xa0<xref rid="13244_2011_122_Fig10_HTML" ref-type="fig">10</xref>) [) [18].Fig. 10Chest plain film of a woman with capsule calcification (arrowheads) adjacent to the implant. Many augmented patients develop capsular contracture'], '13244_2011_122_Fig11_HTML': ['Rarely, intracapsular rupture will show multiple hyperintense foci on T2-weighted images or multiple hypointense foci on water-suppression images within the implant lumen; these findings are referred to as the “salad oil sign” or “droplet sign”. Without other MRI evidence of implant rupture, like the identification of the collapsed implant shell or free silicone within the breast parenchyma (with no previous history of implant rupture), water droplets or small amounts of air within a silicone implant are not reliable signs of implant rupture [9, 10, 16]. However, this sign should prompt the search for subtle signs of intracapsular rupture [16] (Figs.\xa0<xref rid="13244_2011_122_Fig11_HTML" ref-type="fig">11</xref> and and <xref rid="13244_2011_122_Fig12_HTML" ref-type="fig">12</xref>). The entire spectrum of MRI findings for silicone breast implants is illustrated in Figs.\xa0). The entire spectrum of MRI findings for silicone breast implants is illustrated in Figs.\xa0<xref rid="13244_2011_122_Fig13_HTML" ref-type="fig">13</xref>, , <xref rid="13244_2011_122_Fig14_HTML" ref-type="fig">14</xref> and and <xref rid="13244_2011_122_Fig15_HTML" ref-type="fig">15</xref>..Fig.\xa011a Sagittal silicone-excited MRI sequence and (b) axial T2-weighted turbo spin-echo image of a 64-year-old woman with changes in the signal intensity of the silicone gel (black arrows). The margins of the implant are slightly irregular and a small amount of fluid surrounds the prosthesis (white arrow). A ruptured implant was confirmed at surgery.Fig.\xa012MRI of a 54-year-old woman with a ruptured breast implant confirmed at surgery. a Axial silicone suppression. b Axial silicone-excited sequence. c Axial T2-weighted turbo spin echo. d Axial T1-weighted turbo spin echo. Silicone gel (white asterisks) inside and outside the implant. A moderate amount of water and probably serum is mixed in the silicone gel around the implant (black asterisks). Note also the punctuate changes in signal intensity—droplets within the implant (arrows) and punctuate and hyperintense images due to calcifications in the implant periphery (arrowheads)Fig. 13Variants of normal breast implants. a Intact implant has an uninterrupted shell and fibrous capsule adjacent to the breast parenchyma. b Periprosthetic fluid. Presence of a small-to-moderate amount of reactive fluid surrounding the implant. c Simple or complex radial folds. Lines extending from the surface of the implant and inwards in a rather perpendicular manner. d Calcification and thickening of the fibrous capsuleFig. 14Findings of possible breast implant rupture. a Deformity in contour. The border of the implant is bulging more than usual (called the “rat-tail sign” when very pronounced). Sometimes rupture cannot be differentiated from herniation. b Irregular margin. The border of the implant is blurry. Frequently seen with calcification of the fibrous capsule. c Changes in the signal intensity of the silicone gel. Water/serum mixed in the silicone gel through a defect in membrane. d “Noose sign” or “key-hole sign”. Small invagination of the shell where the two membranes do not touch. e “Teardrop sign”. Invagination of the shell containing a droplet of silicone. The last two images represent silicone gel leakage through a small focal implant shell tearFig. 15Definitive findings of breast implant rupture. a Subcapsular lines. Lines running almost parallel to the fibrous capsule and just beneath it. The beginning and the end of the line can be followed to the surface of the implant. b Siliconomas and free silicone. Disruption of the shell and fibrous capsule will allow silicone to extravasate into surrounding breast tissue. c “Linguine sign”. Folded wavy multidirectional lines within the silicone gel, representing the collapsed implant shell. d “Railroad track sign”. Two parallel lines in close proximity forming a double-contoured subcapsular line within the silicone gel'], '13244_2011_122_Fig16_HTML': ['Mammography is of little value in the assessment of implant integrity, although it may be useful for the assessment of the surrounding breast tissue [10]. Silicone implants should be evaluated on a yearly basis to detect any change in configuration or identify any new free silicone within the breast parenchyma. Mammographic features that are not specific to implant rupture include a measurable periprosthetic dense band, periprosthetic calcification, asymmetry of implant size or shape, and focal herniation of the implant. Periprosthetic hyperdensity (Fig.\xa0<xref rid="13244_2011_122_Fig16_HTML" ref-type="fig">16</xref>) is significantly associated with extracapsular rupture (p\u2009≤\u20090.05) and inhomogeneous, reduced radiopacity seems to indicate rupture, without discriminating the type of rupture (p\u2009≤\u20090.05) [) is significantly associated with extracapsular rupture (p\u2009≤\u20090.05) and inhomogeneous, reduced radiopacity seems to indicate rupture, without discriminating the type of rupture (p\u2009≤\u20090.05) [16]. Specific mammographic evidence of implant rupture is extravasation of silicone outside the implant shell [9].Fig. 16Oblique mammograms in a 29-year-old transsexual with subglandular implants and silicone injections. Diffuse areas of increased density are visualised adjacent to the implant (arrows)'], '13244_2011_122_Fig17_HTML': ['The best mammograms are obtained when the breast is maximally compressed so the X-ray beam penetrates the thinnest possible layer of tissue. In 1988, Eklund et al. [13, 15] introduced the displacement technique to facilitate mammography in augmented women (Fig.\xa0<xref rid="13244_2011_122_Fig17_HTML" ref-type="fig">17</xref>). A thorough clinical history should be obtained before mammography to ensure that the patient has not had a previous implant rupture or has not had direct silicone injections.). A thorough clinical history should be obtained before mammography to ensure that the patient has not had a previous implant rupture or has not had direct silicone injections.Fig. 17Implant position is an important factor when studying the breasts. Patients with submammary implants have fewer visualised area compared to patients with submuscular implants. The displacement technique introduced by Eklund facilitates mammography in women with implants. Slightly more tissue is visualised with displacement (below) than with standard compression mammography (above)'], '13244_2011_122_Fig18_HTML': ['Assessments of the usefulness of ultrasonography (US) for detecting implant ruptures vary widely. Although US does not use ionising radiation, it is operator dependent. Typically, US breast implant examination involves evaluation of morphology, contour and contents, periimplant tissues and axillae. Thus, the transversal-to-longitudinal ratio of the implants is calculated, the regularity of implant margins (radial folds) and the homogeneity of the implant lumen are checked, and signs of free silicone or granulomas in the breast or in the axillary lymph nodes are sought (Fig.\xa0<xref rid="13244_2011_122_Fig18_HTML" ref-type="fig">18</xref>) [) [17]. The most reliable sign of an intact implant is an anechoic interior [9]. A completely negative US examination strongly supports implant integrity, limiting the application of mammography or MRI to cases suspicious at US [1, 10].Fig. 18a and b Ultrasonography of a woman with an intact implant. Breast gland (black asterisk), pectoralis major muscle (black arrow), and implant shell (white arrow) visualised as a thin and continuous echogenic line at the parenchymal tissue-implant interface, and silicone implant (white asterisk). (c) A small fluid collection around the implant (arrowhead) and (d) a simple infolding of the shell silicone implant (arrowhead)'], '13244_2011_122_Fig19_HTML': ['Reverberation artefacts are commonly encountered in the anterior aspect of the implant and should not be confused with abnormalities. One limitation of US is that marked attenuation of the ultrasound beam by silicone hinders the evaluation of the back wall of an implant and the tissue posterior to it. Similarly, residual silicone granulomas from extracapsular rupture or from previous direct silicone injections compromise the evaluation of a new implant (Figs.\xa0<xref rid="13244_2011_122_Fig19_HTML" ref-type="fig">19</xref> and and <xref rid="13244_2011_122_Fig20_HTML" ref-type="fig">20</xref>).).Fig. 19(Above) A coronal maximum intensity projection from a silicone-excited sequence in a transsexual (Fig. <xref rid="13244_2011_122_Fig16_HTML" ref-type="fig">16</xref>) demonstrating multiple nodules with high signal throughout both breasts representing free silicone ) demonstrating multiple nodules with high signal throughout both breasts representing free silicone (arrows). (Below) It is extremely difficult to evaluate the silicone implants by ultrasonography because of attenuation of the ultrasound beam by the free injected silicone and granuloma formation in the subcutaneous tissueFig. 20a Coronal silicone-excited sequence and (b) coronal contrast-enhanced fat-suppressed T1-weighted image of the previous patient show multiple nodules of free silicone (“siliconomas”) in the gluteal muscles'], '13244_2011_122_Fig21_HTML': ['Radial folds present as echogenic lines that extend from the periphery to the interior of the implant. These folds are normal infoldings of the implant membrane into the silicone gel. Small amounts of free silicone mixed within the surrounding breast tissues give rise to the characteristic echogenic “snowstorm” (statistically significant for extracapsular rupture, p\u2009≤\u20090.05 and the most sensitive and specific sign at US [16]). This sign is the most reliable sign of extracapsular rupture [12] and consists of a group of focal nodules with a generalised increase in echogenicity of the breast tissue and loss of normal parenchymal interfaces resulting from dispersion of the ultrasound beam. The nodules represent silicone granulomas, composed of free silicone and surrounding fibrous tissue reaction, lying outside the confines of the fibrous capsule. Many silicone granulomas are located in the axillae (Figs.\xa0<xref rid="13244_2011_122_Fig21_HTML" ref-type="fig">21</xref> and and <xref rid="13244_2011_122_Fig22_HTML" ref-type="fig">22</xref>).).Fig. 21Extracapsular silicone implant rupture in a 52-year-old woman with a history of breast cancer who presented with a palpable lesion in the supraclavicular right region. Mammogram shows an irregular lump from the implant (arrowhead) and ultrasonography demonstrates the presence of a nodular lesion with typical inhomogeneity (the “snowstorm sign”) at the posterior margin, suspicious for a lymph node containing siliconeFig. 22Cytology of the node shows multinucleated foreign-body giant cells (arrowhead) with abundant birefringent particles inside and outside the cytoplasm, compatible with gel silicone (arrows). Axial T2-weighted turbo spin-echo MRI study corroborated an extracapsular rupture of the implant'], '13244_2011_122_Fig23_HTML': ['At CT, an intact silicone implant is characterised by an oval shape and homogeneous grey density within a surrounding high-density ring. The implant often has contour deformities or implant bulges or hernias. The CT findings of intracapsular silicone implant rupture are similar to the MRI findings, and the linguine sign can also be seen at CT [8]. The collapsed implant shell can usually be easily identified (Figs.\xa0<xref rid="13244_2011_122_Fig23_HTML" ref-type="fig">23</xref> and and <xref rid="13244_2011_122_Fig24_HTML" ref-type="fig">24</xref>). Because silicone and soft tissues have similar radiodensities, extracapsular silicone can be difficult to identify on CT. However, in most cases of extracapsular silicone implant ruptures, CT can detect the collapsed implant shell, so the ruptured implant is not usually missed.). Because silicone and soft tissues have similar radiodensities, extracapsular silicone can be difficult to identify on CT. However, in most cases of extracapsular silicone implant ruptures, CT can detect the collapsed implant shell, so the ruptured implant is not usually missed.Fig. 23Bilateral ruptured implants in a woman with primary lung cancer (asterisk). a Axial CT scan shows a severe deformity of the right implant surface representing a collapsed ruptured prosthesis (arrow). b Sagittal multiplanar reconstruction and (c) axial CT scan of the left implant show high-density curvilinear lines within the implant (“linguine sign”, arrows)Fig. 24Unilateral implant rupture. (a) Axial CT scan shows small high-density lines within the silicone gel in the right implant, suggestive of collapsed rupture (arrow). (b) Axial silicone-excited MRI sequence confirmed intracapsular rupture, showing hypointense wavy lines at the posterior margin of the right implant (“linguine sign”) and subcapsular line at the anterior margin (arrows). Normal infoldings in the left implant (arrowhead)'], '13244_2011_122_Fig25_HTML': ['All breast diseases can also occur in women with implants; among these, the most important for its prognosis and treatment is breast cancer. The risk of breast cancer is not increased in augmented women [11, 16], and there is no significant difference in breast cancer survival rates between women with and those without implants [11, 12]. However, because augmented women will sometimes develop breast cancer, there should be persistent precautions concerning cancer detection. Implants might interfere with the earliest possible detection of a cancer by altering physical examination of the breast or impairing various imaging techniques [18] (Figs.\xa0<xref rid="13244_2011_122_Fig25_HTML" ref-type="fig">25</xref> and and <xref rid="13244_2011_122_Fig26_HTML" ref-type="fig">26</xref>). The sensitivity of mammography and US for cancer detection may be reduced in augmented woman [). The sensitivity of mammography and US for cancer detection may be reduced in augmented woman [1]. However, the presence of the implant does not seem to decrease the sensitivity of breast MRI [11, 14]. When evaluating these patients, physical and mammographic findings should be correlated. Any palpable abnormalities should be studied with ultrasound or contrast-enhanced MRI.Fig. 25Breast ultrasonography of a 39-year-old (a) and a 30-year-old (b) augmented women. In both studies there are two lesions (arrows) considered BIRADS III under follow-up. c Ultrasonography of a 46-year-old augmented woman with a history of breast cancer. US shows a lesion suspicious of recurrent tumor (arrow) that was confirmed by histology. Breast implant (asterisk)Fig. 26An oblique mammogram of a 57-year-old woman with a submammary implant (a). A cluster of suspicious microcalcifications can be identified in the breast gland (arrows). A magnified mammogram (b) confirms the presence of malignant microcalcifications (arrows)'], '13244_2011_122_Fig27_HTML': ['MRI is clearly recommended in augmented woman with suspicion of a tumor [1]. All suspicious lesions should be analysed by fine-needle aspiration or core needle biopsy with maximum caution to avoid damaging the implant (Fig.\xa0<xref rid="13244_2011_122_Fig27_HTML" ref-type="fig">27</xref>).).Fig. 27(Left) Metallic clip placed in the microcalcifications site after biopsy. (Right) Real-time ultrasound is used to guide the needle tip (arrow)']} | Imaging of breast implants—a pictorial review | [
"Breast implants",
"Implant rupture",
"Magnetic resonance imaging",
"Mammography",
"Ultrasonography"
] | Insights Imaging | 1312700400 | This paper re-emphasises the important role of diagnostic ultrasound. It underlines the importance of ultrasound as a non-invasive imaging procedure which does not use ionising radiation. The paper also illustrates how ultrasound is often the cornerstone of the work up of the patient and the need for radiology departments to be able to offer expert ultrasound on a 24/7 basis. Some aspects related to turf battles and education are discussed. Finally the way in which these issues will be addressed by the European Society of Radiology is outlined. | [] | other | PMC3259319 | null | 0 | [] | Insights Imaging. 2011 Aug 7; 2(6):653-670 | NO-CC CODE |
|
Lipoma with fat necrosis and fibrous tissue in the left gluteal region of a 50-year-old woman (arrow). a Axial T2-WI. b Coronal T1-WI. c Axial CE FS T1-WI. The tumour has fatty content with a hypointense curvilinear area at the medial aspect of the lesion. There is subtle enhancement of this area | 13244_2011_107_Fig2_HTML | 7 | dbe04531a24a0985355380d60b3abc95e6db1313049eca5e1bdae3a9609f1251 | 13244_2011_107_Fig2_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
787,
246
] | [{'image_id': '13244_2011_107_Fig6_HTML', 'image_file_name': '13244_2011_107_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259327/13244_2011_107_Fig6_HTML.jpg', 'caption': 'Well-differentiated liposarcoma in the right upper arm of a 46-year-old man (arrow). a Axial T1-WI. b Axial CE FS T1-WI. c Axial T2-WI. Subcutaneous oval-shaped mass with heterogeneous SI on T1-WI and T2-WI. Parts of the tumour have lower T1 SI than the SI of subcutaneous fat and enhance with a nodular pattern', 'hash': 'c4b8ab9b34a206af4fdbd0ca9c3628a37a4248fb70bec6540f9d335724f8eb4b'}, {'image_id': '13244_2011_107_Fig9_HTML', 'image_file_name': '13244_2011_107_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259327/13244_2011_107_Fig9_HTML.jpg', 'caption': 'Diagnostic and therapeutic algorithm for T1-hyperintense lesions. SI signal intensity, FS fat-saturated, STT soft-tissue tumour, SLSTT subcutaneous lipomatous soft-tissue tumour', 'hash': '8d2e0ab99e263a6566fbe1a67b7b6a111486d3b70a87ffc00f96c0b3792c7802'}, {'image_id': '13244_2011_107_Fig1_HTML', 'image_file_name': '13244_2011_107_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259327/13244_2011_107_Fig1_HTML.jpg', 'caption': 'Usual lipoma in the right scapular region of a 49-year-old man (arrow). a Axial T1-WI. b Axial FS T1-WI. c Axial CE FS T1-WI. d Axial T2-WI. e Axial FS T2-WI. The lesion has an SI identical to that of subcutaneous fat on all sequences. On FS sequences the SI of the lesion is homogeneously suppressed. No enhancement is seen', 'hash': '7ad268ee9d1f7f5b932518f001475e493fb74de5769486c888a71a9bc68c7b59'}, {'image_id': '13244_2011_107_Fig8_HTML', 'image_file_name': '13244_2011_107_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259327/13244_2011_107_Fig8_HTML.jpg', 'caption': 'Pleomorphic liposarcoma in the left elbow of a 65-year-old man (arrow). a Sagittal T1-WI. b Sagittal CE T1-WI. c Sagittal STIR image. d Axial T2-WI. The mass is heterogeneous on all pulse sequences. Macroscopically, no lipomatous component could be identified. Marked heterogeneous enhancement was seen', 'hash': 'ef2701d4719fd8ea4f03c358f4fb9e832efc4ed29ab7f4f236bac233dbb1a3f7'}, {'image_id': '13244_2011_107_Fig7_HTML', 'image_file_name': '13244_2011_107_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259327/13244_2011_107_Fig7_HTML.jpg', 'caption': 'Myxoid liposarcoma in the left buttock of a 47-year-old man (arrow). a Coronal T1-WI. b Axial FS T2-WI. c Sagittal FS T2-WI. Large polylobular lesion of low SI on T1-WI and high SI on T2-WI. Notice the presence of intralesional septa and intrapelvine extension. Macroscopically, no fatty components can be identified on different pulse sequences', 'hash': '49e29364944e3edcab820605993b0486ed69aa7dec674643befe8309c15fcac6'}, {'image_id': '13244_2011_107_Fig3_HTML', 'image_file_name': '13244_2011_107_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259327/13244_2011_107_Fig3_HTML.jpg', 'caption': 'Pleomorphic lipoma in the neck of a 61-year-old man (arrow). a Axial T1-WI. b Sagittal FS T1-WI. c Axial contrast-enhanced FS T1-WI. d Axial FS T2-WI. Heterogeneous mass with fatty and enhancing non-fatty components. Parts of the lesion remain hyperintense on T2-WI with fat suppression indicating the non-adipose components', 'hash': 'deb3b285f0f407fc16e62813075cc0f174550bffc9d9b0baa6e6f8b3858c3560'}, {'image_id': '13244_2011_107_Fig4_HTML', 'image_file_name': '13244_2011_107_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259327/13244_2011_107_Fig4_HTML.jpg', 'caption': 'Lipoma-like hibernoma in the anterior aspect of the left thigh in a 39-year-old woman (arrow). a Axial T1-WI. b Axial T2-WI. c Axial FS T1-WI. d Axial CE FS T1-WI. e Coronal STIR image. The mass is isointense to subcutaneous fat on T1-WI and T2-WI and shows subtle peripheral contrast enhancement. The lesion contains thin intralesional septa and has a peripheral capsule. STIR images show incomplete signal suppression', 'hash': '8818fede96b361ed6d613b71e5e2edf52c4caf9e7a1298c1b322d2098f08fa93'}, {'image_id': '13244_2011_107_Fig2_HTML', 'image_file_name': '13244_2011_107_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259327/13244_2011_107_Fig2_HTML.jpg', 'caption': 'Lipoma with fat necrosis and fibrous tissue in the left gluteal region of a 50-year-old woman (arrow). a Axial T2-WI. b Coronal T1-WI. c Axial CE FS T1-WI. The tumour has fatty content with a hypointense curvilinear area at the medial aspect of the lesion. There is subtle enhancement of this area', 'hash': 'dbe04531a24a0985355380d60b3abc95e6db1313049eca5e1bdae3a9609f1251'}, {'image_id': '13244_2011_107_Fig5_HTML', 'image_file_name': '13244_2011_107_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259327/13244_2011_107_Fig5_HTML.jpg', 'caption': 'Non-lipoma-like hibernoma in the right scapular region in a 63-year-old woman (arrow). a Sagittal T1-WI. b Axial T2-WI. c Sagittal STIR image. d Sagittal CE T1-WI. e Axial CE FS T1-WI. The mass is hypointense compared with subcutaneous fat on T1-WI and T2-WI, hyperintense on STIR images and shows marked diffuse contrast enhancement', 'hash': 'f838d3c59a6283c6aa2c61a1d7f5499987ef181557b8e556ea7cf2e4378aa6d8'}] | {'13244_2011_107_Fig1_HTML': ['Fifteen lipomas had a homogeneous T1-SI identical to the SI of subcutaneous fat. If available SI on T2-WI was also homogeneous and identical to the SI of subcutaneous fat and the SI on FS T1-WI and T2-WI was homogeneously suppressed. Figure\xa0<xref rid="13244_2011_107_Fig1_HTML" ref-type="fig">1</xref> shows a typical example of a usual lipoma.\n shows a typical example of a usual lipoma.\nFig.\xa01Usual lipoma in the right scapular region of a 49-year-old man (arrow). a Axial T1-WI. b Axial FS T1-WI. c Axial CE FS T1-WI. d Axial T2-WI. e Axial FS T2-WI. The lesion has an SI identical to that of subcutaneous fat on all sequences. On FS sequences the SI of the lesion is homogeneously suppressed. No enhancement is seen'], '13244_2011_107_Fig2_HTML': ['Three out of the 22 lipomas contained histopathologically proven fat necrosis. The fat necrosis in one case presented on MRI with T1-WI and T2-WI hypointense, peripheral, curvilinear strands that enhanced after injection of gadolinium contrast medium (Fig.\xa0<xref rid="13244_2011_107_Fig2_HTML" ref-type="fig">2</xref>). In a second case it presented as a nodular component at the periphery of the lesion. This component was hypointense on T1-WI and hyperintense on T2-WI and showed subtle enhancement. Histopathology showed non-specific surrounding inflammation with fibrosis and calcification. Two other lipomas contained non-lipomatous components on MRI. These non-lipomatous components presented as rounded intralesional areas on T1-WI, consisting of a slightly hypointense centre surrounded by a peripheral hypointense rim, or as cloudlike T1-WI hypointense stranding. Based on these findings, we retrospectively considered these two cases to be lipomas with fat necrosis.\n). In a second case it presented as a nodular component at the periphery of the lesion. This component was hypointense on T1-WI and hyperintense on T2-WI and showed subtle enhancement. Histopathology showed non-specific surrounding inflammation with fibrosis and calcification. Two other lipomas contained non-lipomatous components on MRI. These non-lipomatous components presented as rounded intralesional areas on T1-WI, consisting of a slightly hypointense centre surrounded by a peripheral hypointense rim, or as cloudlike T1-WI hypointense stranding. Based on these findings, we retrospectively considered these two cases to be lipomas with fat necrosis.\nFig.\xa02Lipoma with fat necrosis and fibrous tissue in the left gluteal region of a 50-year-old woman (arrow). a Axial T2-WI. b Coronal T1-WI. c Axial CE FS T1-WI. The tumour has fatty content with a hypointense curvilinear area at the medial aspect of the lesion. There is subtle enhancement of this area'], '13244_2011_107_Fig3_HTML': ['Pleomorphic lipomas (n\u2009=\u20096) presented as heterogeneous masses in the neck (67%) or shoulder (33%) with fatty and non-fatty signal characteristics. Four pleomorphic lipomas were found in men and the mean age was 55\xa0years. The mean diameter was 63\xa0mm (range 32-100\xa0mm). Most (four) lesions were oval and touched the dermis and fascia. The lesions were of heterogeneous signal on T1-WI, T2-WI and FS sequences. The masses enhanced in a subtle to moderate way after contrast medium injection (Fig.\xa0<xref rid="13244_2011_107_Fig3_HTML" ref-type="fig">3</xref>).\n).\nFig.\xa03Pleomorphic lipoma in the neck of a 61-year-old man (arrow). a Axial T1-WI. b Sagittal FS T1-WI. c Axial contrast-enhanced FS T1-WI. d Axial FS T2-WI. Heterogeneous mass with fatty and enhancing non-fatty components. Parts of the lesion remain hyperintense on T2-WI with fat suppression indicating the non-adipose components'], '13244_2011_107_Fig4_HTML': ['Hibernoma (n\u2009=\u20093) was found in three women. The mean age was 44\xa0years and mean diameter 79\xa0mm (range 48-110\xa0mm). These sharply defined, oval/polylobular lesions were found in the neck, shoulder and thigh. All lesions were deeply located in the subcutaneous compartment and touched the fascia. The MR characteristics varied depending on the proportion of brown fat within the lesion. One hibernoma was isointense to fat on T1-WI and T2-WI, compatible with a lipoma-like hibernoma because it could not be distinguished from a usual lipoma based on these MR sequences. STIR images could identify the small brown lipomatous component with incomplete fat saturation (Fig.\xa0<xref rid="13244_2011_107_Fig4_HTML" ref-type="fig">4</xref>). The lesion showed a small component with subtle enhancement. Two hibernomas were of lower SI compared with fat on T1-WI and T2-WI, and were hyperintense on STIR images and enhanced markedly. Histopathologically, these lesions were classified as non-lipoma-like hibernomas and contained relatively more brown fat (Fig.\xa0). The lesion showed a small component with subtle enhancement. Two hibernomas were of lower SI compared with fat on T1-WI and T2-WI, and were hyperintense on STIR images and enhanced markedly. Histopathologically, these lesions were classified as non-lipoma-like hibernomas and contained relatively more brown fat (Fig.\xa0<xref rid="13244_2011_107_Fig5_HTML" ref-type="fig">5</xref>).\n).\nFig.\xa04Lipoma-like hibernoma in the anterior aspect of the left thigh in a 39-year-old woman (arrow). a Axial T1-WI. b Axial T2-WI. c Axial FS T1-WI. d Axial CE FS T1-WI. e Coronal STIR image. The mass is isointense to subcutaneous fat on T1-WI and T2-WI and shows subtle peripheral contrast enhancement. The lesion contains thin intralesional septa and has a peripheral capsule. STIR images show incomplete signal suppressionFig.\xa05Non-lipoma-like hibernoma in the right scapular region in a 63-year-old woman (arrow). a Sagittal T1-WI. b Axial T2-WI. c Sagittal STIR image. d Sagittal CE T1-WI. e Axial CE FS T1-WI. The mass is hypointense compared with subcutaneous fat on T1-WI and T2-WI, hyperintense on STIR images and shows marked diffuse contrast enhancement'], '13244_2011_107_Fig6_HTML': ['Well-differentiated liposarcomas (n\u2009=\u20093) were found in three men aged between 19 and 62\xa0years, in the shoulder, thigh and paraspinal region (Fig.\xa0<xref rid="13244_2011_107_Fig6_HTML" ref-type="fig">6</xref>). The mean diameter was 30\xa0mm (range 19-41\xa0mm). These oval/polylobular lesions had variable locations in the subcutaneous compartment. The MR appearances were also highly variable, with different SI on available pulse sequences. The only characteristic they had in common was heterogeneous SI on all pulse sequences.\n). The mean diameter was 30\xa0mm (range 19-41\xa0mm). These oval/polylobular lesions had variable locations in the subcutaneous compartment. The MR appearances were also highly variable, with different SI on available pulse sequences. The only characteristic they had in common was heterogeneous SI on all pulse sequences.\nFig.\xa06Well-differentiated liposarcoma in the right upper arm of a 46-year-old man (arrow). a Axial T1-WI. b Axial CE FS T1-WI. c Axial T2-WI. Subcutaneous oval-shaped mass with heterogeneous SI on T1-WI and T2-WI. Parts of the tumour have lower T1 SI than the SI of subcutaneous fat and enhance with a nodular pattern'], '13244_2011_107_Fig7_HTML': ['Myxoid liposarcoma (n\u2009=\u20094) was found in four men, with a mean age of 41\xa0years. All presented as sharply delineated, polylobular lesions (Fig.\xa0<xref rid="13244_2011_107_Fig7_HTML" ref-type="fig">7</xref>). Two lesions were located in the pelvic region, one in the thigh and one in the foot. The mean diameter was 70\xa0mm (range 24-123\xa0mm). All lesions were deeply located in the subcutaneous compartment. The lesions were hypointense on T1-WI and hyperintense on T2-WI, corresponding to myxoid matrix on histopathology. No lesion contained macroscopically visible fat on MRI. Three lesions enhanced markedly after contrast medium administration, two with a peripheral pattern and one with a central pattern.\n). Two lesions were located in the pelvic region, one in the thigh and one in the foot. The mean diameter was 70\xa0mm (range 24-123\xa0mm). All lesions were deeply located in the subcutaneous compartment. The lesions were hypointense on T1-WI and hyperintense on T2-WI, corresponding to myxoid matrix on histopathology. No lesion contained macroscopically visible fat on MRI. Three lesions enhanced markedly after contrast medium administration, two with a peripheral pattern and one with a central pattern.\nFig.\xa07Myxoid liposarcoma in the left buttock of a 47-year-old man (arrow). a Coronal T1-WI. b Axial FS T2-WI. c Sagittal FS T2-WI. Large polylobular lesion of low SI on T1-WI and high SI on T2-WI. Notice the presence of intralesional septa and intrapelvine extension. Macroscopically, no fatty components can be identified on different pulse sequences'], '13244_2011_107_Fig8_HTML': ['Pleomorphic liposarcoma (n\u2009=\u20091) presented as a large, non-sharply delineated, polylobular mass in the left elbow in a 65-year-old man. The lesion had a diameter of 110\xa0mm and touched the dermis and fascia. The SI of this tumour was heterogeneous on all pulse sequences (Fig.\xa0<xref rid="13244_2011_107_Fig8_HTML" ref-type="fig">8</xref>). We could not identify any macroscopically fatty component. Marked heterogeneous contrast enhancement was seen.\n). We could not identify any macroscopically fatty component. Marked heterogeneous contrast enhancement was seen.\nFig.\xa08Pleomorphic liposarcoma in the left elbow of a 65-year-old man (arrow). a Sagittal T1-WI. b Sagittal CE T1-WI. c Sagittal STIR image. d Axial T2-WI. The mass is heterogeneous on all pulse sequences. Macroscopically, no lipomatous component could be identified. Marked heterogeneous enhancement was seen'], '13244_2011_107_Fig9_HTML': ['This leads us to the following diagnostic approach (Fig.\xa0<xref rid="13244_2011_107_Fig9_HTML" ref-type="fig">9</xref>):\n):\nIf a subcutaneous lesion has a homogeneous T1-SI identical to the SI of subcutaneous fat, the first differential diagnosis is a benign SLSTT. In our study, only usual lipoma, lipoblastoma, lipomatosis or lipoma-like hibernomas had this homogeneous hyperintensity on T1-WI [13]. This may have important therapeutic consequences. Either a watchful waiting policy or a marginal lesion resection for aesthetic reasons may be considered. Theoretically, other subcutaneous lesions with high T1-SI should be excluded: lesions containing methaemoglobin, melanin or proteinaceous material [14]. The lipomatous origin can definitively be determined if the signal of the lesion is suppressed on FS T1-WI [15]. Nevertheless, the probability of a non-lipomatous subcutaneous STT being homogeneously isointense with subcutaneous fat on T1-WI is very low in our opinion. An important consequence of this finding is that contrast medium administration is needless in these cases.If a subcutaneous fatty lesion contains non-adipose components, additional MR sequences are mandatory (T2-WI, fat suppression, contrast medium administration). In distinguishing lipoma from well-differentiated liposarcoma Galant et al. [16] advocated the use of FS T2-WI or STIR sequences. The presence of hyperintense septa or nodules on FS T2/STIR sequences would be more specific for well-differentiated liposarcoma than using the presence of thick septa or nodules on T1-WI as criteria of malignancy. In our study, we cannot confirm or reject this hypothesis due to an insufficient number of well-differentiated liposarcomas. However, even with an extended MR protocol, tissue characterisation of these lesions is often not possible. Referral to an oncological centre is important to define the best therapeutic strategy. A biopsy will be often necessary and should be performed under computed tomography (or MR) guidance in order to obtain specimens of both components.This strategy should be the same for lesions without macroscopically visible lipomatous components.Fig.\xa09Diagnostic and therapeutic algorithm for T1-hyperintense lesions. SI signal intensity, FS fat-saturated, STT soft-tissue tumour, SLSTT subcutaneous lipomatous soft-tissue tumour']} | A comparison between histopathology and findings on magnetic resonance imaging of subcutaneous lipomatous soft-tissue tumors | [
"Magnetic resonance imaging",
"Lipoma",
"Liposarcoma",
"Subcutaneous fat",
"Histopathology"
] | Insights Imaging | 1306220400 | [] | other | PMC3259327 | null | 1 | [
"Citation"
] | Insights Imaging. 2011 May 24; 2(5):599-607 | NO-CC CODE |
||
Reformatted axial (a, b) and coronal (c) T2-weighted images based on three-dimensional (3D) volume-based imaging. The fistula tract does not show any high signal intensity (white arrows) and this is indicative of fibrotic rest | 13244_2010_22_Fig10_HTML | 7 | ba4a152e4059564fe868ef50db5abf5fb62e8b3db9c88545ef289eb9a4bc1598 | 13244_2010_22_Fig10_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
747,
216
] | [{'image_id': '13244_2010_22_Fig5_HTML', 'image_file_name': '13244_2010_22_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig5_HTML.jpg', 'caption': 'Two axial T2-weighted images (a, b) demonstrate thick fistula tracks (black arrows) lying between rectal muscular wall and the pelvic floor just above the puborectalis muscle. The internal opening is seen as a large opening into the dorsal aspect of anorectal junction (white arrow)', 'hash': '8430fc0d0ee9d102a1cb32a361661c561cf8f5dcf134c631ff32780cec5fe727'}, {'image_id': '13244_2010_22_Fig11_HTML', 'image_file_name': '13244_2010_22_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig11_HTML.jpg', 'caption': 'Sagittal T2-weighted image with fat-saturation. The ischioanal abscess (arrowheads) is communicating via a fistula (dotted arrow) to another fistula (hatched arrow). The peri-prostatic vessels and other structures with high-signal intensity on T2-weighted images (solid arrows) can cause confusion if mistaken for fistulas', 'hash': '70a1415408e6dbbed5eac401d8b81caa920b7ec5238e670a4579914b8e0a0a24'}, {'image_id': '13244_2010_22_Fig2_HTML', 'image_file_name': '13244_2010_22_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig2_HTML.jpg', 'caption': 'Schematic representation of the anal canal and pelvic musculature in black corresponding to Fig.\xa01b. The fistulas, as described by Parks, are represented by differently colored shaded areas: red for inter-sphincteric, green for trans-sphincteric, yellow for supra-sphincteric, and blue for extra-sphincteric', 'hash': '44253ac71f2f455ec8720b95a897f97c7ca891408d76fe3325d31430ba8b91a2'}, {'image_id': '13244_2010_22_Fig4_HTML', 'image_file_name': '13244_2010_22_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig4_HTML.jpg', 'caption': 'Complex fistula with both inter-sphincteric and trans-sphincteric components. An axial T2-weighted and three consecutive thin slice (1\xa0mm) T1-weighted images with fat-saturation after gadolinium contrast. Images show inter-sphincteric fistula (white arrows). There is a thin communicating fistula stretching in the inter-sphincteric plane (thin hatched arrow), going through the external sphincter to reach the fistula lying outside the external sphincter (dotted arrow)', 'hash': '4d53265dbe1b153104309ef7db28afd367c33c7927703d59d64750bdc8bfea01'}, {'image_id': '13244_2010_22_Fig3_HTML', 'image_file_name': '13244_2010_22_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig3_HTML.jpg', 'caption': 'Axial T2-weighted images with fat suppression (STIR) at two different levels (a, b). The dotted arrows demonstrate the inter-sphincteric fistula and its extension to the skin (solid arrow)', 'hash': 'fd707e4119e036141f5b35855669cc09a09cef234994bf4a817ec1826d557221'}, {'image_id': '13244_2010_22_Fig10_HTML', 'image_file_name': '13244_2010_22_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig10_HTML.jpg', 'caption': 'Reformatted axial (a, b) and coronal (c) T2-weighted images based on three-dimensional (3D) volume-based imaging. The fistula tract does not show any high signal intensity (white arrows) and this is indicative of fibrotic rest', 'hash': 'ba4a152e4059564fe868ef50db5abf5fb62e8b3db9c88545ef289eb9a4bc1598'}, {'image_id': '13244_2010_22_Fig13_HTML', 'image_file_name': '13244_2010_22_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig13_HTML.jpg', 'caption': 'Patient with abscess behind the root of the scrotum. Axial STIR (a) and T1-weighted with contrast-enhancement (b) show an abscess (white arrows) with central cavity. The extension of the inflammation seems larger on contrast-enhanced images compared with STIR (hatched arrows). Also note the nonuniform fat saturation on b compared with a (small dotted arrows)', 'hash': '456795794eaccfb3e80ea93f46efc43f55298ff26a7d2d4ec4e249bbfcddacd2'}, {'image_id': '13244_2010_22_Fig14_HTML', 'image_file_name': '13244_2010_22_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig14_HTML.jpg', 'caption': 'Simple fistula (white arrows) shown on TSE T2-weighted (a) and STIR (b) images. The axial T1-weighted image after gadolinium contrast (c) shows avid contrast enhancement of the fistula (white arrow) but to lesser degree the anal sphincter. The sagittal T1-weighted image (d) a few minutes later (note the filling of the urinary bladder) demonstrates decreased distinction in degree of contrast enhancement between the fistula (white arrow) and the anal sphincter (hatched arrow), consistent with time intensity curve characteristics described by Horsthuis et al. [13]', 'hash': 'ff544d55681ddff0d5220312954a64bca5863b99e5da186f115725a6ae1e37c7'}, {'image_id': '13244_2010_22_Fig8_HTML', 'image_file_name': '13244_2010_22_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig8_HTML.jpg', 'caption': 'T1-weighted image with fat-saturation after gadolinium contrast enhancement. Inflammation around a fistula is depicted by avid contrast enhancement (white arrow). The entire abdomen and pelvis of patient had been imaged, and therefore a simpler protocol had been applied without TSE T2-weigted images over the pelvic area', 'hash': '2ec87bd806e77b31be0533af4bb54a6269c1dd41b7c6eb7181c92577d995aa9c'}, {'image_id': '13244_2010_22_Fig7_HTML', 'image_file_name': '13244_2010_22_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig7_HTML.jpg', 'caption': 'Horseshoe fistula in the intersphincteric plane on an axial T2-weighted image. The internal opening is located at 5–6 o’ clock as a thin white extension (white arrow). The left fistula is more an abscess with debris and extension beyond the external sphincter (black arrow)', 'hash': '6c5d8442a244239b964d7ee7f2087b71968d9c09606e2f342675826c637c26a5'}, {'image_id': '13244_2010_22_Fig12_HTML', 'image_file_name': '13244_2010_22_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig12_HTML.jpg', 'caption': 'The internal sphincter and anal mucosa (white arrow) normally show marked contrast enhancement (as shown on this axial T1-weighted image with fat-saturation) and higher signal on T2-weighted images. The external sphincter does not demonstrate the same amount of contrast enhancement', 'hash': '042c0fdb0da33dcc824c615413fe43c937d7801833332b7caee5a9dc3dd6c64e'}, {'image_id': '13244_2010_22_Fig1_HTML', 'image_file_name': '13244_2010_22_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig1_HTML.jpg', 'caption': 'Coronal T2-weighted image of the pelvic floor obtained by surface coil (a), and schematic representation (b). Coronal T2-weighted image obtain by endoanal coil (c) and its schematic representation (d). Axial T2-weigted image at the level of sphincters (e) and the corresponding schematic image (f). Axial T2-weighted image at the level higher than the dentate line (g) and corresponding schematic image (h). On all schematic images the black lines represent levator ani muscle; the blue dotted line represents muscular propria and internal sphincter; the red areas represent external sphincter; and the green areas represent the external sphincter', 'hash': '49352332fbcadf202997ecd60e5a49faeea0f7709a3f6d4eae700d6b89f3ed7c'}, {'image_id': '13244_2010_22_Fig6_HTML', 'image_file_name': '13244_2010_22_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig6_HTML.jpg', 'caption': 'Sagittal T2-weighted image (a) and T2-weighted coronal image with fat-saturation (b) show an abscess (thick white arrows on a and b) at the level of anorectal junction. There is blind sinus (thin white arrow) extending upward above the pelvic floor. Consecutive coronal T2-weighted images (c–f) show extension of the abscess in the inter-sphincteric planes bilaterally down', 'hash': 'e77b7c8317254291e3d4b459494f0801d9c2d67812a1d85d5159da865d66c16d'}, {'image_id': '13244_2010_22_Fig9_HTML', 'image_file_name': '13244_2010_22_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig9_HTML.jpg', 'caption': 'Sagittal (a) and coronal (b) T2-weighted images of a patient treated with seton at follow-up. The seton is seen as a dark inner structure in the middle of the fistula (white arrows)', 'hash': 'acf92874fa3998ee0856faf29a2e04d6f44f6204bf37e20ea64399eed62b0eda'}, {'image_id': '13244_2010_22_Fig15_HTML', 'image_file_name': '13244_2010_22_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC3259332/13244_2010_22_Fig15_HTML.jpg', 'caption': 'Patient with healed peri-anal fistula shown in Fig.\xa010. The larger field of view with surface coil enabled even demonstration of pathology in the pelvis. Axial T2-weighted image (a) and reformatted coronal image (b) demonstrate ovaries (small black arrows) drawn medially due to retraction of a healed abscess in the Douglas pouch. There is also fibrosis of right pelvic fascia (black arrows) retracted medially. Finally a small fistula is evident stretching from rectosigmoid junction (white arrow)', 'hash': '6b8e2e12b1c2851751edb6384b5db5d2b5ccd73fa8a0923cd07c331cee76932f'}] | {'13244_2010_22_Fig1_HTML': ['The anal clock is a transversal view of the canal, which corresponds to the radiologic view as well. At 12 o’clock, therefore, is the ventral portion of the anal canal, and at 3 o’clock is the left lateral part, and so on (Fig.\xa0<xref rid="13244_2010_22_Fig1_HTML" ref-type="fig">1</xref>).\n).\nFig.\xa01Coronal T2-weighted image of the pelvic floor obtained by surface coil (a), and schematic representation (b). Coronal T2-weighted image obtain by endoanal coil (c) and its schematic representation (d). Axial T2-weigted image at the level of sphincters (e) and the corresponding schematic image (f). Axial T2-weighted image at the level higher than the dentate line (g) and corresponding schematic image (h). On all schematic images the black lines represent levator ani muscle; the blue dotted line represents muscular propria and internal sphincter; the red areas represent external sphincter; and the green areas represent the external sphincter'], '13244_2010_22_Fig2_HTML': ['The most common classification is that of Parks (Fig.\xa0<xref rid="13244_2010_22_Fig2_HTML" ref-type="fig">2</xref>), which is based on extensive study of 400 consecutive cases, many of which were more complex and severe than those seen at the practice of a general surgeon [), which is based on extensive study of 400 consecutive cases, many of which were more complex and severe than those seen at the practice of a general surgeon [16]. Parks described the primary tracts as following four patterns. The most common group is the intersphincteric type, where the primary track reaches the perianal skin through the intersphincteric plane (Fig.\xa0<xref rid="13244_2010_22_Fig3_HTML" ref-type="fig">3</xref>).\n).\nFig.\xa02Schematic representation of the anal canal and pelvic musculature in black corresponding to Fig.\xa0<xref rid="13244_2010_22_Fig1_HTML" ref-type="fig">1b</xref>. The fistulas, as described by Parks, are represented by differently colored shaded areas: . The fistulas, as described by Parks, are represented by differently colored shaded areas: red for inter-sphincteric, green for trans-sphincteric, yellow for supra-sphincteric, and blue for extra-sphinctericFig.\xa03Axial T2-weighted images with fat suppression (STIR) at two different levels (a, b). The dotted arrows demonstrate the inter-sphincteric fistula and its extension to the skin (solid arrow)'], '13244_2010_22_Fig4_HTML': ['The next common type, or trans-sphincteric type, occurs when the track courses through the external sphincter muscle, usually involving the ischioanal fossa (Fig.\xa0<xref rid="13244_2010_22_Fig4_HTML" ref-type="fig">4</xref>). The external opening can be further away from the anus, meaning that the most distal part of the ischioanal fossa is involved. This should not necessarily mean that that the fistula has traversed the external sphincter. The level at which the external sphincter complex is traversed is most often at the mid-anal canal level and the internal opening is usually at around 6 o’clock, at the level of dentate line. This is, however, not invariable.\n). The external opening can be further away from the anus, meaning that the most distal part of the ischioanal fossa is involved. This should not necessarily mean that that the fistula has traversed the external sphincter. The level at which the external sphincter complex is traversed is most often at the mid-anal canal level and the internal opening is usually at around 6 o’clock, at the level of dentate line. This is, however, not invariable.\nFig.\xa04Complex fistula with both inter-sphincteric and trans-sphincteric components. An axial T2-weighted and three consecutive thin slice (1\xa0mm) T1-weighted images with fat-saturation after gadolinium contrast. Images show inter-sphincteric fistula (white arrows). There is a thin communicating fistula stretching in the inter-sphincteric plane (thin hatched arrow), going through the external sphincter to reach the fistula lying outside the external sphincter (dotted arrow)'], '13244_2010_22_Fig5_HTML': ['In the suprasphincteric fistula, in contrast to intersphincteric fistula, the fistula courses initially upward above the sphincter muscles (Fig.\xa0<xref rid="13244_2010_22_Fig5_HTML" ref-type="fig">5</xref>), and then coursing down to the perianal skin (Fig.\xa0), and then coursing down to the perianal skin (Fig.\xa0<xref rid="13244_2010_22_Fig6_HTML" ref-type="fig">6</xref>).\n).\nFig.\xa05Two axial T2-weighted images (a, b) demonstrate thick fistula tracks (black arrows) lying between rectal muscular wall and the pelvic floor just above the puborectalis muscle. The internal opening is seen as a large opening into the dorsal aspect of anorectal junction (white arrow)Fig.\xa06Sagittal T2-weighted image (a) and T2-weighted coronal image with fat-saturation (b) show an abscess (thick white arrows on a and b) at the level of anorectal junction. There is blind sinus (thin white arrow) extending upward above the pelvic floor. Consecutive coronal T2-weighted images (c–f) show extension of the abscess in the inter-sphincteric planes bilaterally down'], '13244_2010_22_Fig7_HTML': ['The primary tracks described above can be complicated by secondary tracks. Supralevator, ischioanal and horseshoe extensions are common. Horseshoe extensions are circular extensions to both sides of the internal opening (Fig.\xa0<xref rid="13244_2010_22_Fig7_HTML" ref-type="fig">7</xref>). Any type of fistula may show a circumferential spread, but a typical horseshoe-shaped fistula has two tracts and one internal opening, often in the midline posteriorly at the level of the inferior border of the puborectalis muscle. Horseshoe fistulas can extend in the intersphincteric, ischioanal, or supralevator directions. A fistula medial to the levator plate or puborectalis muscle is supralevator, and a fistula lateral to these muscles is infralevator.\n). Any type of fistula may show a circumferential spread, but a typical horseshoe-shaped fistula has two tracts and one internal opening, often in the midline posteriorly at the level of the inferior border of the puborectalis muscle. Horseshoe fistulas can extend in the intersphincteric, ischioanal, or supralevator directions. A fistula medial to the levator plate or puborectalis muscle is supralevator, and a fistula lateral to these muscles is infralevator.\nFig.\xa07Horseshoe fistula in the intersphincteric plane on an axial T2-weighted image. The internal opening is located at 5–6 o’ clock as a thin white extension (white arrow). The left fistula is more an abscess with debris and extension beyond the external sphincter (black arrow)'], '13244_2010_22_Fig8_HTML': ['Occasionally, nonsurgical specialists, e.g., gastroenterologists and general physicians wish to know if there are any fistulas present. Occasionally the external opening may heal but with a deeply located abscess or fistula tract remaining, making diagnosis of fistula difficult clinically. This has become relevant since treatment of perianal Crohn’s disease with anti-TNF-alpha drugs is contraindicated in the presence of an abscess [23]. For this indication, the pelvic anatomy is not important and therefore a simpler protocol might be sufficient (Fig.\xa0<xref rid="13244_2010_22_Fig8_HTML" ref-type="fig">8</xref>).\n).\nFig.\xa08T1-weighted image with fat-saturation after gadolinium contrast enhancement. Inflammation around a fistula is depicted by avid contrast enhancement (white arrow). The entire abdomen and pelvis of patient had been imaged, and therefore a simpler protocol had been applied without TSE T2-weigted images over the pelvic area'], '13244_2010_22_Fig9_HTML': ['Another indication for imaging could be follow-up of fistulas (Fig.\xa0<xref rid="13244_2010_22_Fig9_HTML" ref-type="fig">9</xref>) treated with nonsurgical methods, especially in Crohn’s disease [) treated with nonsurgical methods, especially in Crohn’s disease [13]. For the above-mentioned indications, perhaps a simpler protocol would be enough. Understandably, disappearance of areas with high signal on T2-weighted imaging (Fig.\xa0<xref rid="13244_2010_22_Fig10_HTML" ref-type="fig">10</xref>) and normalization of enhancement on postgadolinium T1-weighted imaging are signs of fistula healing.\n) and normalization of enhancement on postgadolinium T1-weighted imaging are signs of fistula healing.\nFig.\xa09Sagittal (a) and coronal (b) T2-weighted images of a patient treated with seton at follow-up. The seton is seen as a dark inner structure in the middle of the fistula (white arrows)Fig.\xa010Reformatted axial (a, b) and coronal (c) T2-weighted images based on three-dimensional (3D) volume-based imaging. The fistula tract does not show any high signal intensity (white arrows) and this is indicative of fibrotic rest'], '13244_2010_22_Fig11_HTML': ['Fat-suppression should be employed if using turbo-spin-echo (TSE) T2-sequences, which could cause confusion as the high signal of the fistula could easily be missed due to high signal of surrounding fat. Therefore, most authors favor STIR (short-inversion-time inversion recovery) imaging since it combines fat-suppression and structural delineation [25]. With experience and time, however, TSE images are quite adequate, with the advantage of higher structural delineation. Therefore, we prefer, in contrast, TSE images for the delineation of fistulas. We have seen inexperienced radiologists interpret other high-signal findings due to fat for fistulas (Fig.\xa0<xref rid="13244_2010_22_Fig11_HTML" ref-type="fig">11</xref>).\n).\nFig.\xa011Sagittal T2-weighted image with fat-saturation. The ischioanal abscess (arrowheads) is communicating via a fistula (dotted arrow) to another fistula (hatched arrow). The peri-prostatic vessels and other structures with high-signal intensity on T2-weighted images (solid arrows) can cause confusion if mistaken for fistulas'], '13244_2010_22_Fig12_HTML': ['T1-weighted imaging may not always be necessary. It has, however, been sometimes beneficial to have these images [26]. Unenhanced T1-weighted imaging may help diagnose postoperative hemorrhage or fat-containing grafts. The tracks enhance vividly after gadolinium administration. Some normal structures (Fig.\xa0<xref rid="13244_2010_22_Fig12_HTML" ref-type="fig">12</xref>) and structures close to a fistula (Fig.\xa0) and structures close to a fistula (Fig.\xa0<xref rid="13244_2010_22_Fig13_HTML" ref-type="fig">13</xref>) can cause confusion since they can have avid contrast enhancement. This could be at least partially explained by the timing of imaging (Fig.\xa0) can cause confusion since they can have avid contrast enhancement. This could be at least partially explained by the timing of imaging (Fig.\xa0<xref rid="13244_2010_22_Fig14_HTML" ref-type="fig">14</xref>). We have not found any reports questioning the usefulness of postcontrast imaging, but only publications about more time-consuming measurements showing intensity curves correlating with degree of inflammation or, more commonly, patient’s symptoms. Those who have demonstrated the positive effect of contrast enhancement have usually used dynamic imaging looking at time intensity curves. There is a possibility that the timing of the contrast enhancement plays a role in the assessment of degree of inflammation (Fig.\xa0). We have not found any reports questioning the usefulness of postcontrast imaging, but only publications about more time-consuming measurements showing intensity curves correlating with degree of inflammation or, more commonly, patient’s symptoms. Those who have demonstrated the positive effect of contrast enhancement have usually used dynamic imaging looking at time intensity curves. There is a possibility that the timing of the contrast enhancement plays a role in the assessment of degree of inflammation (Fig.\xa0<xref rid="13244_2010_22_Fig14_HTML" ref-type="fig">14</xref>). Moreover, we are not aware of any studies evaluating the additive value of contrast enhancement to other sequences. Some radiologists, therefore, do not use contrast enhancement; whenever only surgery is planned, T2-weighted imaging is adequate. The parameters for T1-weighted imaging are very similar to other pelvic imaging protocols, with TR 9\xa0ms, TE 4–5\xa0ms, FOV 20–26\xa0cm, matrix 256, flip angle 10, slice thickness 1\xa0mm and number of slices 100. We use 3D-volume T1-weighted imaging with fat suppression (THRIVE in Philips, VIBE in Siemens and FAME in GE). Using volume imaging enables us to image in only one plane. Not all the authors use the same parameters, and there is no clear advantage of any of these. However, it seems prudent to use the same sequence before and after contrast enhancement for most reliable comparisons.\n). Moreover, we are not aware of any studies evaluating the additive value of contrast enhancement to other sequences. Some radiologists, therefore, do not use contrast enhancement; whenever only surgery is planned, T2-weighted imaging is adequate. The parameters for T1-weighted imaging are very similar to other pelvic imaging protocols, with TR 9\xa0ms, TE 4–5\xa0ms, FOV 20–26\xa0cm, matrix 256, flip angle 10, slice thickness 1\xa0mm and number of slices 100. We use 3D-volume T1-weighted imaging with fat suppression (THRIVE in Philips, VIBE in Siemens and FAME in GE). Using volume imaging enables us to image in only one plane. Not all the authors use the same parameters, and there is no clear advantage of any of these. However, it seems prudent to use the same sequence before and after contrast enhancement for most reliable comparisons.\nFig.\xa012The internal sphincter and anal mucosa (white arrow) normally show marked contrast enhancement (as shown on this axial T1-weighted image with fat-saturation) and higher signal on T2-weighted images. The external sphincter does not demonstrate the same amount of contrast enhancementFig.\xa013Patient with abscess behind the root of the scrotum. Axial STIR (a) and T1-weighted with contrast-enhancement (b) show an abscess (white arrows) with central cavity. The extension of the inflammation seems larger on contrast-enhanced images compared with STIR (hatched arrows). Also note the nonuniform fat saturation on b compared with a (small dotted arrows)Fig.\xa014Simple fistula (white arrows) shown on TSE T2-weighted (a) and STIR (b) images. The axial T1-weighted image after gadolinium contrast (c) shows avid contrast enhancement of the fistula (white arrow) but to lesser degree the anal sphincter. The sagittal T1-weighted image (d) a few minutes later (note the filling of the urinary bladder) demonstrates decreased distinction in degree of contrast enhancement between the fistula (white arrow) and the anal sphincter (hatched arrow), consistent with time intensity curve characteristics described by Horsthuis et al. [13]'], '13244_2010_22_Fig15_HTML': ['Most authors use pelvic surface coils, the same that is used for almost all pelvic imaging. Endorectal and, more appropriately, endoanal probes are less commonly used. Though endoanal probes provide better depiction of internal opening than surface coils, their limited field of view is a problem (Fig.\xa0<xref rid="13244_2010_22_Fig15_HTML" ref-type="fig">15</xref>). Also, placement of these probes is not always easy or possible. Combining both coils probably provides the best diagnostic accuracy, yet is cumbersome to employ [). Also, placement of these probes is not always easy or possible. Combining both coils probably provides the best diagnostic accuracy, yet is cumbersome to employ [29]. In our practice, we do not use anal probes for depiction of fistula anymore.\nFig.\xa015Patient with healed peri-anal fistula shown in Fig.\xa0<xref rid="13244_2010_22_Fig10_HTML" ref-type="fig">10</xref>. The larger field of view with surface coil enabled even demonstration of pathology in the pelvis. Axial T2-weighted image (. The larger field of view with surface coil enabled even demonstration of pathology in the pelvis. Axial T2-weighted image (a) and reformatted coronal image (b) demonstrate ovaries (small black arrows) drawn medially due to retraction of a healed abscess in the Douglas pouch. There is also fibrosis of right pelvic fascia (black arrows) retracted medially. Finally a small fistula is evident stretching from rectosigmoid junction (white arrow)']} | MRI for assessment of anal fistula | [
"Anus",
"MRI",
"Fistula",
"Crohn’s disease"
] | Insights Imaging | 1274943600 | In the past decade, the medical effective dose per caput has increased in most European countries because of CT; it now ranges between 0.4 and 2 mSv/year. The biological impact of diagnostic imaging exposure is dominated by stochastic effects: based on the linear-no-threshold hypothesis, the risk of cancer induction is estimated to increase proportionally to organ dose, reaching around 0.5% at an effective dose of 100 mSv. The risk is higher the younger the age at the time of exposure, it is different for different organs, and women are more susceptible than men. Fluoroscopy-based imaging, above all intervention, may reach the dose threshold for deterministic effects, observed most often at the skin above around 3 Gy, and it is also the major source of occupational exposure in radiology. This white paper discusses the role of justification, evidence-based referral guidelines, optimization, diagnostic reference levels, clinical audits and quality assurance programs. The ESR strongly supports education and training of the medical staff involved in imaging by ionizing radiation. It disseminates information regarding radiation protection, takes initiatives, cooperates with partners and supports projects in justification as well as optimization. To reach these aims, the ESR cooperates with other organizations involved in radiation protection. | [] | other | PMC3259332 | null | 4 | [
"{'Citation': 'International Commission on Radiological Protection (2007) ICRP Publication 105. 2007. Radiological Protection in Medicine. Ann. ICRP 37(6)'}",
"{'Citation': 'European Society of Radiology European commission guidelines for clinical audit: statement by the European Society of Radiology. Insights Imaging. 2011;2:97–98. doi: 10.1007/s13244-011-0065-8.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s13244-011-0065-8'}, {'@IdType': 'pmc', '#text': 'PMC3259394'}, {'@IdType': 'pubmed', '#text': '22347938'}]}}",
"{'Citation': 'Neofotistou V, Vano E, Padovani R, et al. Preliminary reference levels in interventional cardiology. Eur Radiol. 2003;13:2259–2263. doi: 10.1007/s00330-003-1831-x.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s00330-003-1831-x'}, {'@IdType': 'pubmed', '#text': '14534803'}]}}",
"{'Citation': 'Marshall NW, Chapple CL, Kotre CJ. Diagnostic reference levels in interventional radiology. Phys Med Biol. 2000;45:3833–3846. doi: 10.1088/0031-9155/45/12/323.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1088/0031-9155/45/12/323'}, {'@IdType': 'pubmed', '#text': '11131203'}]}}"
] | Insights Imaging. 2010 May 27; 1(2):62-71 | NO-CC CODE |
|
a–d A patient with right lobe and left lateral segmental atrophy associated with cholangiocarcinoma. a Diagram representing a variant segment IV duct draining into the common hepatic duct (CHD) (RASD right anterior sectoral duct, RPSD right posterior sectoral duct, RHD right hepatic duct, LHD left hepatic duct, IV segment four duct). b Endoscopic retrograde cholangiopancreatogram (ERCP) demonstrates the normal calibre segment IV duct (arrow) draining into the common hepatic duct, inferior to the hilar stricture. c, d CT demonstrates atrophy of the right lobe and left lateral segments, and hypertrophy of segment IV | 13244_2011_100_Fig6_HTML | 7 | 9e4228b16297cb628d6d3a889da9511eb59590ac1cdd195ff889d2e0686e3768 | 13244_2011_100_Fig6_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
747,
161
] | [{'image_id': '13244_2011_100_Fig6_HTML', 'image_file_name': '13244_2011_100_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259339/13244_2011_100_Fig6_HTML.jpg', 'caption': 'a–d A patient with right lobe and left lateral segmental atrophy associated with cholangiocarcinoma. a Diagram representing a variant segment IV duct draining into the common hepatic duct (CHD) (RASD right anterior sectoral duct, RPSD right posterior sectoral duct, RHD right hepatic duct, LHD left hepatic duct, IV segment four duct). b Endoscopic retrograde cholangiopancreatogram (ERCP) demonstrates the normal calibre segment IV duct (arrow) draining into the common hepatic duct, inferior to the hilar stricture. c, d CT demonstrates atrophy of the right lobe and left lateral segments, and hypertrophy of segment IV', 'hash': '9e4228b16297cb628d6d3a889da9511eb59590ac1cdd195ff889d2e0686e3768'}, {'image_id': '13244_2011_100_Fig1_HTML', 'image_file_name': '13244_2011_100_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259339/13244_2011_100_Fig1_HTML.jpg', 'caption': 'a–e A patient with right lobe atrophy associated with cholangiocarcinoma. a–c Contrast-enhanced CT; d, e T2-weighted magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatogram (MRCP). a The right lobe is atrophied, and lies posteriorly with markedly dilated ducts. b The caudate lobe is probably hypertrophied (black arrow), and there is definite hypertrophy of segment IV (white arrow) and the left lateral segments (curved arrow). c The hypertrophied left lobe (segment III) extends inferiorly (white arrow). d, e Within the atrophied lobe, the ducts are markedly dilated and crowded (white arrow). e The ducts of the hypertrophied lobe are mildly dilated and spread out (arrowhead)', 'hash': 'a3278b0c0315d4d99244a6b2856e00906ad3f6b3340079f81dffeadb4361406d'}, {'image_id': '13244_2011_100_Fig8_HTML', 'image_file_name': '13244_2011_100_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259339/13244_2011_100_Fig8_HTML.jpg', 'caption': 'a–d A patient with segmental atrophy associated with cholangiocarcinoma; the right posterior sectoral duct drained into the left hepatic duct. a Diagram representing a variant right posterior sectoral duct (RPSD) draining into the left hepatic duct (LHD) (RASD right anterior sectoral duct, CHD common hepatic duct). b CT demonstrates atrophy of the left lobe (black arrow) and right posterior segments (white arrow), and hypertrophy of the right anterior segments. c Note the “step” in the contour between the left lobe/right anterior segments (arrow), and between the right anterior segments/ right posterior segments (arrowhead). d Note the “bulbous” contour of the visceral surface of the hypertrophied right anterior segments inferiorly (arrow)', 'hash': '5c838130f48e647c104947dbfd54fb348c1c199165a521831052be9fc00926ba'}, {'image_id': '13244_2011_100_Fig7_HTML', 'image_file_name': '13244_2011_100_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259339/13244_2011_100_Fig7_HTML.jpg', 'caption': 'a–d A patient with left lobe and right anterior segmental atrophy associated with cholangiocarcinoma. a Diagram representing a variant right anterior sectoral duct (RASD) draining into the left hepatic duct (LHD) (RPSD right posterior sectoral duct, CHD common hepatic duct). b Percutaneous transjejunal cholangiogram demonstrates a variant RASD (straight arrow) draining into the LHD (arrowhead). The RPSD (curved arrow) is seen. c, d CT demonstrates atrophy of the left lobe and right anterior segments, and hypertrophy of the right posterior segments. Note the convex (“bulbous”) visceral surface of the hypertrophied right posterior segments inferiorly (curved arrows)', 'hash': 'f30be04960e3fa925651b71ef9650a20269ceb21d6ce19be49a5091fba91b7f9'}, {'image_id': '13244_2011_100_Fig3_HTML', 'image_file_name': '13244_2011_100_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259339/13244_2011_100_Fig3_HTML.jpg', 'caption': 'a–c A patient with left lobe atrophy and right lobe hypertrophy associated with cholangiocarcinoma. a, b CT demonstrates a “step” in the contour between the atrophied and non-atrophied lobes (curved arrow). The ducts within the atrophied left lobe appear crowded and markedly dilated (arrowhead). The caudate lobe is clearly hypertrophied (arrow). c The hypertrophied right lobe has a “bulbous” visceral contour inferiorly (arrows)', 'hash': '1121a9be8791d6fd2596aa7854025a5a4785664304e0be65fd1d72359db56376'}, {'image_id': '13244_2011_100_Fig4_HTML', 'image_file_name': '13244_2011_100_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259339/13244_2011_100_Fig4_HTML.jpg', 'caption': 'a–c A patient with atrophy of the left lobe and hypertrophy of the right lobe associated with cholangiocarcinoma. a–c Portal venous phase contrast-enhanced CT. a, b A small portion of the atrophied left lobe is visible (a); the visceral surface of the hypertrophied right lobe appears “bulbous” (curved arrows). c The increase in dimensions and inferior extent of the hypertrophied right lobe is more apparent in the coronal plane. The bulbous visceral surface of the hypertrophied right lobe is again demonstrated (arrow)', 'hash': 'ee763c24b82c7adb97c561e8adb58aa9af748ce018efcf71e15b8ea53522148d'}, {'image_id': '13244_2011_100_Fig2_HTML', 'image_file_name': '13244_2011_100_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259339/13244_2011_100_Fig2_HTML.jpg', 'caption': 'a–c A patient with right lobar atrophy and left lobar hypertrophy associated with cholangiocarcinoma. a The right lobe is atrophic with markedly dilated ducts (arrow) on computed tomography (CT). The left lobe, and probably the caudate lobe (arrowhead), are hypertrophied. A stent is in place (curved arrow). b The atrophied lobe (arrow) shows lower attenuation relative to the non-atrophied lobe on CT-IVC. c CT-IVC surface-rendered reformat. The ducts draining segments II and III in the hypertrophied lobe are spread out (arrow), relative to the ducts of the atrophied lobe', 'hash': '8ac1082a680faf805448d6857f22820d70d53bfc51a1a26fd4e0eadda4ef6613'}, {'image_id': '13244_2011_100_Fig5_HTML', 'image_file_name': '13244_2011_100_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259339/13244_2011_100_Fig5_HTML.jpg', 'caption': 'a–c A patient with left lobe atrophy associated with malignant hilar biliary obstruction due to metastasis of colorectal origin. The left portal vein branch is occluded. a Non-contrast-enhanced CT. The atrophied lobe shows lower attenuation than the non-atrophied lobe. b, c T1-weighted MRI. The atrophied left lobe shows lower signal intensity than the hypertrophied right lobe', 'hash': '31b0246224278efe1e8498a6300b1c0359b870497bb802aeefc14e8e02783e17'}] | {'13244_2011_100_Fig1_HTML': ['On cross-sectional imaging, lobar atrophy is usually defined as a reduction in the size of that lobe by at least 50% [8], or the presence of obvious ductal crowding on sectional imaging or cholangiography [1–3, 8–10] (Figs.\xa0<xref rid="13244_2011_100_Fig1_HTML" ref-type="fig">1</xref>, , <xref rid="13244_2011_100_Fig2_HTML" ref-type="fig">2 </xref>and and <xref rid="13244_2011_100_Fig3_HTML" ref-type="fig">3</xref>).\n).\nFig.\xa01a–e A patient with right lobe atrophy associated with cholangiocarcinoma. a–c Contrast-enhanced CT; d, e T2-weighted magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatogram (MRCP). a The right lobe is atrophied, and lies posteriorly with markedly dilated ducts. b The caudate lobe is probably hypertrophied (black arrow), and there is definite hypertrophy of segment IV (white arrow) and the left lateral segments (curved arrow). c The hypertrophied left lobe (segment III) extends inferiorly (white arrow). d, e Within the atrophied lobe, the ducts are markedly dilated and crowded (white arrow). e The ducts of the hypertrophied lobe are mildly dilated and spread out (arrowhead)Fig.\xa02a–c A patient with right lobar atrophy and left lobar hypertrophy associated with cholangiocarcinoma. a The right lobe is atrophic with markedly dilated ducts (arrow) on computed tomography (CT). The left lobe, and probably the caudate lobe (arrowhead), are hypertrophied. A stent is in place (curved arrow). b The atrophied lobe (arrow) shows lower attenuation relative to the non-atrophied lobe on CT-IVC. c CT-IVC surface-rendered reformat. The ducts draining segments II and III in the hypertrophied lobe are spread out (arrow), relative to the ducts of the atrophied lobeFig.\xa03a–c A patient with left lobe atrophy and right lobe hypertrophy associated with cholangiocarcinoma. a, b CT demonstrates a “step” in the contour between the atrophied and non-atrophied lobes (curved arrow). The ducts within the atrophied left lobe appear crowded and markedly dilated (arrowhead). The caudate lobe is clearly hypertrophied (arrow). c The hypertrophied right lobe has a “bulbous” visceral contour inferiorly (arrows)', 'There is a reduction in the volume of hepatic parenchyma between the dilated bile ducts, so the actual parenchymal reduction is frequently greater than the overall lobar volume reduction. The dilated ducts consequently become more crowded and they appear to extend more peripherally towards the liver capsule, somewhat analogous to bronchial dilatation in bronchiectasis (Fig.\xa0<xref rid="13244_2011_100_Fig1_HTML" ref-type="fig">1</xref>).).', 'With right lobe atrophy, the atrophic lobe tends to “rotate” more superiorly and posteriorly (Fig.\xa0<xref rid="13244_2011_100_Fig1_HTML" ref-type="fig">1</xref>). In left lobe atrophy, the lobe is smaller but otherwise not appreciably displaced (Fig.\xa0). In left lobe atrophy, the lobe is smaller but otherwise not appreciably displaced (Fig.\xa0<xref rid="13244_2011_100_Fig3_HTML" ref-type="fig">3</xref>).).', 'In patients with lobar or segmental liver atrophy, the non-atrophied parenchyma may undergo compensatory hyperplasia (more often referred to as hypertrophy, even though histologically the volume increase results from hyperplasia) (Figs.\xa0<xref rid="13244_2011_100_Fig1_HTML" ref-type="fig">1</xref>, , <xref rid="13244_2011_100_Fig2_HTML" ref-type="fig">2</xref>, , <xref rid="13244_2011_100_Fig3_HTML" ref-type="fig">3</xref>, , <xref rid="13244_2011_100_Fig4_HTML" ref-type="fig">4</xref>, , <xref rid="13244_2011_100_Fig6_HTML" ref-type="fig">6</xref>, , <xref rid="13244_2011_100_Fig7_HTML" ref-type="fig">7</xref>, , <xref rid="13244_2011_100_Fig8_HTML" ref-type="fig">8</xref>) [) [3, 5]. Compensatory hypertrophy is common [4, 8] and is important to recognise as it helps with recognition of contralateral atrophy, and has critical importance in planning surgical resection or interventional approaches to biliary decompression [3, 7].\nFig.\xa06a–d A patient with right lobe and left lateral segmental atrophy associated with cholangiocarcinoma. a Diagram representing a variant segment IV duct draining into the common hepatic duct (CHD) (RASD right anterior sectoral duct, RPSD right posterior sectoral duct, RHD right hepatic duct, LHD left hepatic duct, IV segment four duct). b Endoscopic retrograde cholangiopancreatogram (ERCP) demonstrates the normal calibre segment IV duct (arrow) draining into the common hepatic duct, inferior to the hilar stricture. c, d CT demonstrates atrophy of the right lobe and left lateral segments, and hypertrophy of segment IVFig.\xa07a–d A patient with left lobe and right anterior segmental atrophy associated with cholangiocarcinoma. a Diagram representing a variant right anterior sectoral duct (RASD) draining into the left hepatic duct (LHD) (RPSD right posterior sectoral duct, CHD common hepatic duct). b Percutaneous transjejunal cholangiogram demonstrates a variant RASD (straight arrow) draining into the LHD (arrowhead). The RPSD (curved arrow) is seen. c, d CT demonstrates atrophy of the left lobe and right anterior segments, and hypertrophy of the right posterior segments. Note the convex (“bulbous”) visceral surface of the hypertrophied right posterior segments inferiorly (curved arrows)Fig.\xa08a–d A patient with segmental atrophy associated with cholangiocarcinoma; the right posterior sectoral duct drained into the left hepatic duct. a Diagram representing a variant right posterior sectoral duct (RPSD) draining into the left hepatic duct (LHD) (RASD right anterior sectoral duct, CHD common hepatic duct). b CT demonstrates atrophy of the left lobe (black arrow) and right posterior segments (white arrow), and hypertrophy of the right anterior segments. c Note the “step” in the contour between the left lobe/right anterior segments (arrow), and between the right anterior segments/ right posterior segments (arrowhead). d Note the “bulbous” contour of the visceral surface of the hypertrophied right anterior segments inferiorly (arrow)', 'Contrary to the crowded appearance of bile ducts in an atrophic lobe, those in a hypertrophied lobe appear relatively spread out (Figs.\xa0<xref rid="13244_2011_100_Fig1_HTML" ref-type="fig">1</xref>, , <xref rid="13244_2011_100_Fig2_HTML" ref-type="fig">2</xref>). This spreading is most obvious when it affects the left lateral segments with resulting increased separation of the segment II and III ducts (Fig.\xa0). This spreading is most obvious when it affects the left lateral segments with resulting increased separation of the segment II and III ducts (Fig.\xa0<xref rid="13244_2011_100_Fig2_HTML" ref-type="fig">2</xref>c).c).', 'In left lobe hypertrophy, the main increase in dimensions occurs in the axial plane on CT, which is the standard imaging plane (Figs.\xa0<xref rid="13244_2011_100_Fig1_HTML" ref-type="fig">1</xref>, , <xref rid="13244_2011_100_Fig2_HTML" ref-type="fig">2</xref>). Normally, as mentioned above, the left liver lobe is substantially smaller than the right. Therefore, left lobe hypertrophy as a percentage change from baseline volume may be more substantial and therefore more obvious. Left lobe hypertrophy extends towards the left (Fig.\xa0). Normally, as mentioned above, the left liver lobe is substantially smaller than the right. Therefore, left lobe hypertrophy as a percentage change from baseline volume may be more substantial and therefore more obvious. Left lobe hypertrophy extends towards the left (Fig.\xa0<xref rid="13244_2011_100_Fig2_HTML" ref-type="fig">2a</xref>), and the left lateral segments tend to extend inferiorly into the central abdomen (Fig.\xa0), and the left lateral segments tend to extend inferiorly into the central abdomen (Fig.\xa0<xref rid="13244_2011_100_Fig1_HTML" ref-type="fig">1</xref>c).c).', 'In the presence of right or left lobe atrophy the caudate lobe may be atrophied or hypertrophied or neither (Figs.\xa0<xref rid="13244_2011_100_Fig1_HTML" ref-type="fig">1</xref>, , <xref rid="13244_2011_100_Fig2_HTML" ref-type="fig">2</xref>, , <xref rid="13244_2011_100_Fig3_HTML" ref-type="fig">3</xref>). In our experience the latter is the most common.). In our experience the latter is the most common.'], '13244_2011_100_Fig3_HTML': ['There is often a change in hepatic contour, or a “step”, between the atrophied and non-atrophied parts (Figs.\xa0<xref rid="13244_2011_100_Fig3_HTML" ref-type="fig">3</xref> and and <xref rid="13244_2011_100_Fig8_HTML" ref-type="fig">8</xref>). This “step” sign, when present, allows more confident diagnosis of atrophy and is a useful sign when determining the lobar or segmental distribution of atrophy.\n). This “step” sign, when present, allows more confident diagnosis of atrophy and is a useful sign when determining the lobar or segmental distribution of atrophy.\nFig.\xa04a–c A patient with atrophy of the left lobe and hypertrophy of the right lobe associated with cholangiocarcinoma. a–c Portal venous phase contrast-enhanced CT. a, b A small portion of the atrophied left lobe is visible (a); the visceral surface of the hypertrophied right lobe appears “bulbous” (curved arrows). c The increase in dimensions and inferior extent of the hypertrophied right lobe is more apparent in the coronal plane. The bulbous visceral surface of the hypertrophied right lobe is again demonstrated (arrow)'], '13244_2011_100_Fig5_HTML': ['Some of these features are illustrated in Fig.\xa0<xref rid="13244_2011_100_Fig5_HTML" ref-type="fig">5</xref>, where the atrophied parenchyma shows lower attenuation on pre-contrast CT, and lower signal intensity on T1-weighted MRI.\n, where the atrophied parenchyma shows lower attenuation on pre-contrast CT, and lower signal intensity on T1-weighted MRI.\nFig.\xa05a–c A patient with left lobe atrophy associated with malignant hilar biliary obstruction due to metastasis of colorectal origin. The left portal vein branch is occluded. a Non-contrast-enhanced CT. The atrophied lobe shows lower attenuation than the non-atrophied lobe. b, c T1-weighted MRI. The atrophied left lobe shows lower signal intensity than the hypertrophied right lobe'], '13244_2011_100_Fig2_HTML': ['The atrophic liver parenchyma may also show lower attenuation on CT intravenous cholangiography (CT-IVC) (Fig.\xa0<xref rid="13244_2011_100_Fig2_HTML" ref-type="fig">2</xref>). This finding is explained by the reduced hepatocyte function and/or number, and consequently decreased contrast medium uptake and excretion by the atrophic parenchyma.). This finding is explained by the reduced hepatocyte function and/or number, and consequently decreased contrast medium uptake and excretion by the atrophic parenchyma.'], '13244_2011_100_Fig4_HTML': ['In cases of right lobe hypertrophy, the increase in dimensions is more obvious in the coronal plane (Fig.\xa0<xref rid="13244_2011_100_Fig4_HTML" ref-type="fig">4</xref>c). In the axial plane the hypertrophied right lobe (or segments) tends to show a prominent convex or “bulbous” contour of the visceral surface (Figs.\xa0c). In the axial plane the hypertrophied right lobe (or segments) tends to show a prominent convex or “bulbous” contour of the visceral surface (Figs.\xa0<xref rid="13244_2011_100_Fig3_HTML" ref-type="fig">3</xref>, , <xref rid="13244_2011_100_Fig4_HTML" ref-type="fig">4</xref>, , <xref rid="13244_2011_100_Fig7_HTML" ref-type="fig">7</xref>, , <xref rid="13244_2011_100_Fig8_HTML" ref-type="fig">8</xref>). To our knowledge, this finding has not previously been described. As the right lobe is normally larger than the left the degree of hypertrophy has to be more marked for it to be conspicuous. The recognition of the “bulbous” contour sign as well as the use of coronal CT or MRI should allow more ready recognition of right lobe hypertrophy.). To our knowledge, this finding has not previously been described. As the right lobe is normally larger than the left the degree of hypertrophy has to be more marked for it to be conspicuous. The recognition of the “bulbous” contour sign as well as the use of coronal CT or MRI should allow more ready recognition of right lobe hypertrophy.'], '13244_2011_100_Fig6_HTML': ['Unilateral biliary obstruction tends to result in a pattern of lobar atrophy with contralateral lobar hypertrophy [6]. In at least some cases of lobar atrophy associated with cholangiocarcinoma, the tumour arises more peripherally, at which stage it is often asymptomatic, before it extends to the confluence of the right and left ducts causing jaundice [3–5]. During this time the atrophy and hypertrophy processes are occurring [6]. With standard hilar biliary anatomy this process results in lobar atrophy with or without compensatory hypertrophy of the contralateral lobe [3, 4, 6]. Variations in hilar biliary anatomy, however, have the potential to change the results of this progression so that the distribution of atrophy and hypertrophy may be more complex (Figs.\xa0<xref rid="13244_2011_100_Fig6_HTML" ref-type="fig">6</xref>, , <xref rid="13244_2011_100_Fig7_HTML" ref-type="fig">7</xref>, , <xref rid="13244_2011_100_Fig8_HTML" ref-type="fig">8</xref>). Such variations are common [). Such variations are common [22, 23]. Two of the most common variations are drainage of either the right posterior or right anterior sectoral ducts to the left hepatic duct (Figs.\xa0<xref rid="13244_2011_100_Fig7_HTML" ref-type="fig">7</xref>, , <xref rid="13244_2011_100_Fig8_HTML" ref-type="fig">8</xref>). To our knowledge, there has been only one case report describing the complex pattern of atrophy and hypertrophy resulting from such anatomical variations in patients with cholangiocarcinoma [). To our knowledge, there has been only one case report describing the complex pattern of atrophy and hypertrophy resulting from such anatomical variations in patients with cholangiocarcinoma [24].', 'Three patterns of segmental atrophy/hypertrophy associated with hilar biliary anatomical variations are illustrated in Figs.\xa0<xref rid="13244_2011_100_Fig6_HTML" ref-type="fig">6</xref>, , <xref rid="13244_2011_100_Fig7_HTML" ref-type="fig">7</xref>, , <xref rid="13244_2011_100_Fig8_HTML" ref-type="fig">8</xref>, all in patients with cholangiocarcinoma., all in patients with cholangiocarcinoma.']} | Lobar and segmental liver atrophy associated with hilar cholangiocarcinoma and the impact of hilar biliary anatomical variants: a pictorial essay | [
"Atrophy",
"Cholestasis",
"Bile duct diseases",
"Liver",
"Hypertrophy"
] | Insights Imaging | 1306393200 | OBJECTIVES: This study assessed students' awareness of radiation exposures and determined the impact a curriculum in clinical radiology (CICR) had on awareness. METHODS: Six hundred seventy medical students at one medical school were studied. CICR was delivered in yearly modules over the 5-year programme. Five hundred twenty-three students (years 1-5), exposed to increasing numbers of CICR modules and 147 students beginning medical school (year 0), represented the study and control groups, respectively. Students completed a multiple choice questionnaire assessing radiation knowledge and radiology teaching. RESULTS: Most students in the study population received CICR but 87% considered they had not received radiation protection instruction. The percentage of correctly answered questions was significantly higher in the study population than the control group (59.7% versus 38%, p < 0.001). Students who received CICR achieved higher scores than those who did not (61.3% compared with 42.8%, p < 0.001). Increasing exposure to CICR with each year of medical education was associated with improved performance. CONCLUSIONS: Assessment of students' awareness of radiation exposures in diagnostic imaging demonstrates improved performance with increasing years in medical school and/or increasing exposure to CICR. Findings support the Euroatom 97 directive position, advocating implementation of radiation protection instruction into the undergraduate medical curriculum. | [] | other | PMC3259339 | null | 22 | [
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] | Insights Imaging. 2011 May 26; 2(5):525-531 | NO-CC CODE |
|
HRCT of a patient with LAM and right pneumothorax. Coronal reformat demonstrates cystic involvement of the juxtraphrenic recesses, but sparing of the extreme apices | 13244_2010_50_Fig5_HTML | 7 | e27df9bb045c89cd88b2a8ad98d1964d02fd9b48e3f7c13d9d6f6f36b8d2f434 | 13244_2010_50_Fig5_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
661,
660
] | [{'image_id': '13244_2010_50_Fig2_HTML', 'image_file_name': '13244_2010_50_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259352/13244_2010_50_Fig2_HTML.jpg', 'caption': 'HRCT shows a thick-walled cavity in the left lung adjacent to the oblique fissure (arrow) in a patient with a pneumonia. Note the thick wall and ragged edges to the cavity', 'hash': 'cfde40c011748a9e89ae4d0c51fe878de30bfdd57c0bf66e841cbbd4db445696'}, {'image_id': '13244_2010_50_Fig12_HTML', 'image_file_name': '13244_2010_50_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259352/13244_2010_50_Fig12_HTML.jpg', 'caption': 'Coronal reformat CT thorax shows multiple thin-walled cysts with a lower lobe predominance in a patient with Birt-Hogg-Dube. The cysts have irregular shapes (arrow) and a right apical pneumothorax is present (arrowhead). The patient had a family history of pneumothoraces', 'hash': '87dae9e577f5f097e26bd17f126a7ec577ec0e6644c1e2e0f44134b7f0ce4ef4'}, {'image_id': '13244_2010_50_Fig5_HTML', 'image_file_name': '13244_2010_50_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259352/13244_2010_50_Fig5_HTML.jpg', 'caption': 'HRCT of a patient with LAM and right pneumothorax. Coronal reformat demonstrates cystic involvement of the juxtraphrenic recesses, but sparing of the extreme apices', 'hash': 'e27df9bb045c89cd88b2a8ad98d1964d02fd9b48e3f7c13d9d6f6f36b8d2f434'}, {'image_id': '13244_2010_50_Fig3_HTML', 'image_file_name': '13244_2010_50_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259352/13244_2010_50_Fig3_HTML.jpg', 'caption': 'HRCT demonstrates sparing of the medial segment of the middle lobe and lingula in a patient with LCH (arrows)', 'hash': '05d2d1547163047a632f59a2dbf8b8bbbeb721574723616e9a263602330cf40f'}, {'image_id': '13244_2010_50_Fig13_HTML', 'image_file_name': '13244_2010_50_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3259352/13244_2010_50_Fig13_HTML.jpg', 'caption': 'Multiple cystic lesions are present in the left lung (arrow) with a small pneumothorax (arrowhead). The patient had a known history a previous oropharyngeal squamous cell carcinoma and the lesions were confirmed as cystic squamous cell carcinoma metastases', 'hash': 'c92369c1c96777d853331ed785b6e8fab0b53e1032b81c434d34d266bb7db2d9'}, {'image_id': '13244_2010_50_Fig4_HTML', 'image_file_name': '13244_2010_50_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259352/13244_2010_50_Fig4_HTML.jpg', 'caption': 'HRCT of a patient with LCH. Multiple cysts are present of varying sizes and shapes (arrow)', 'hash': '6f23d7952de194c12448a4fdedeff0cf419c916ad15374357ceed02d1f1fb0e4'}, {'image_id': '13244_2010_50_Fig8_HTML', 'image_file_name': '13244_2010_50_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259352/13244_2010_50_Fig8_HTML.jpg', 'caption': 'HRCT shows thin walled cysts (arrow) and ground-glass opacities (*) in a patient with LIP. The cysts have a random distribution', 'hash': 'ee9ebd2b0065a623634bacef920bdda890b49859046bc67e3fd21fda7f19d06d'}, {'image_id': '13244_2010_50_Fig7_HTML', 'image_file_name': '13244_2010_50_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259352/13244_2010_50_Fig7_HTML.jpg', 'caption': 'Coronal reformat CT thorax in a patient with CLE demonstrates a cyst with a wall in the left lower lobe (arrow). More classical CLE with a core centrilobular artery and a much less perceptible wall is seen more superiorly (arrowhead)', 'hash': '8faa1c9030070bbee9a2a07673c352ea3a1a71871b50460b0b3f18e1963cce82'}, {'image_id': '13244_2010_50_Fig10_HTML', 'image_file_name': '13244_2010_50_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259352/13244_2010_50_Fig10_HTML.jpg', 'caption': 'HRCT showing widespread ground glass opacities and several small cysts in a patient with a strong smoking history, who was subsequently diagnosed with DIP', 'hash': '06412df0e7732955b88c53e47790070604bf8963c6645bc33297c02b519ecc9f'}, {'image_id': '13244_2010_50_Fig6_HTML', 'image_file_name': '13244_2010_50_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259352/13244_2010_50_Fig6_HTML.jpg', 'caption': 'HRCT shows three cysts in the right lung of a patient with LAM. Note the regular conformity of the cysts (arrow) with a thin wall', 'hash': '3a239ebc98a10cb1452af6821b0cb8bcba9c708fc41eeb5a951529e7c9790898'}, {'image_id': '13244_2010_50_Fig9_HTML', 'image_file_name': '13244_2010_50_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259352/13244_2010_50_Fig9_HTML.jpg', 'caption': 'HRCT from a patient with subacute HP. Small cysts are present (arrow) on a background of widespread ground glass opacity and mosaic attenuation in the anterior segment of the left upper lobe (*)', 'hash': 'd00a3fdba36e14d03a962ad004717d5fc84d916e4c835bdf8e546ce40b3ba588'}, {'image_id': '13244_2010_50_Fig11_HTML', 'image_file_name': '13244_2010_50_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259352/13244_2010_50_Fig11_HTML.jpg', 'caption': 'HRCT of a patient presenting with a pneumothorax (arrowhead). The only parenchymal abnormality was the presence of a few small cysts, such as the one in the posterior segment of the right upper lobe (arrow). The patient was later diagnosed with LAM', 'hash': 'ea4f498e397b98adb6b66a1f83d76561fc69e6ca08a9ceb3064b544e75020af5'}, {'image_id': '13244_2010_50_Fig1_HTML', 'image_file_name': '13244_2010_50_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259352/13244_2010_50_Fig1_HTML.jpg', 'caption': 'HRCT image showing thin-walled cysts in the right lung (arrow) in a patient with LAM', 'hash': 'ca2400bab95b42c068215f15aa2a1bcdc8093c753bec6dfd84cfe0324fb0e064'}] | {'13244_2010_50_Fig1_HTML': ['Pulmonary cysts should first of all be differentiated from pulmonary cavities because these two entities have very different aetiologies. The definition of a lung cyst is a round parenchymal lucency or area of low attenuation, usually thin walled (less than 2-3\xa0mm thick) and containing air, but occasionally fluid or solid material (Fig.\xa0<xref rid="13244_2010_50_Fig1_HTML" ref-type="fig">1</xref>) [) [1]. A cavity, on the other hand, is defined as a gas-filled space which develops in an area of pulmonary consolidation, mass or nodule (Fig.\xa0<xref rid="13244_2010_50_Fig2_HTML" ref-type="fig">2</xref>) [) [1]. Additionally, in comparison with a lung cyst, the wall of a cavity is usually relatively thick (>4\xa0mm). When assessing lung cysts on HRCT, the most important feature that allows differentiation between diseases is their distribution. Careful scrutiny of cyst shape and size, as well as for the presence of any ancillary findings, may help refine the differential diagnosis. Frequently, a confident diagnosis cannot be made based on CT alone and integration with clinical information is critical. Ultimately in many cases, correlation with histopathology is also required.\nFig.\xa01HRCT image showing thin-walled cysts in the right lung (arrow) in a patient with LAMFig.\xa02HRCT shows a thick-walled cavity in the left lung adjacent to the oblique fissure (arrow) in a patient with a pneumonia. Note the thick wall and ragged edges to the cavity'], '13244_2010_50_Fig3_HTML': ['The cysts in LCH also have certain relatively unique features which allow a confident distinction to be made from LAM and emphysema. The cysts are typically diffusely distributed, with a predominance in the lung apices and relative sparing of the lung bases [7]. Another helpful clue is observation of sparing of the medial tips of the middle lobe and lingula (Fig.\xa0<xref rid="13244_2010_50_Fig3_HTML" ref-type="fig">3</xref>). The cysts can have bizarre shapes and unequal sizes (Fig.\xa0). The cysts can have bizarre shapes and unequal sizes (Fig.\xa0<xref rid="13244_2010_50_Fig4_HTML" ref-type="fig">4</xref>). At this stage the cysts probably reflect LC granuloma induced fibrosis rather than bronchial dilatation.\n). At this stage the cysts probably reflect LC granuloma induced fibrosis rather than bronchial dilatation.\nFig.\xa03HRCT demonstrates sparing of the medial segment of the middle lobe and lingula in a patient with LCH (arrows)Fig.\xa04HRCT of a patient with LCH. Multiple cysts are present of varying sizes and shapes (arrow)'], '13244_2010_50_Fig5_HTML': ['There are some key signs that help in differentiating LAM from LCH. Perhaps the most useful differentiating sign is the distribution of cysts. Unlike in LCH, cysts may involve the juxtaphrenic recesses. On the other hand, there is tendency for LAM cysts to spare the extreme apices (Fig.\xa0<xref rid="13244_2010_50_Fig5_HTML" ref-type="fig">5</xref>) [) [11]. In contrast to LCH, the intervening lung parenchyma is usually normal, although super-added ground glass opacities have been reported [7]. The cysts in LAM are typically thin walled and round in shape (Fig.\xa0<xref rid="13244_2010_50_Fig6_HTML" ref-type="fig">6</xref>). Bizarre shaped cysts are less common in LAM than LCH and tend to be seen in more end-stage disease [). Bizarre shaped cysts are less common in LAM than LCH and tend to be seen in more end-stage disease [12].\nFig.\xa05HRCT of a patient with LAM and right pneumothorax. Coronal reformat demonstrates cystic involvement of the juxtraphrenic recesses, but sparing of the extreme apicesFig.\xa06HRCT shows three cysts in the right lung of a patient with LAM. Note the regular conformity of the cysts (arrow) with a thin wall'], '13244_2010_50_Fig7_HTML': ['Areas of CLE are typically not surrounded by a wall and the diagnosis of CLE on CT is usually not challenging. However, CLE may appear as thin walled cysts and on occasion can be very difficult to distinguish from LAM [11]. Looking for certain CT features may help discriminate between these conditions. CLE is characterised by the presence of multiple rounded areas of low attenuation, which have diameters of several millimetres and usually have an upper lobe predominance [13]. The presence of a central core vessel (centrilobular artery) in the low attenuation cystic air space is classical of CLE (Fig.\xa0<xref rid="13244_2010_50_Fig7_HTML" ref-type="fig">7</xref>), whereas the cysts in LAM are devoid of intracystic structures [), whereas the cysts in LAM are devoid of intracystic structures [6]. The converse, however, does not hold true, i.e. the absence of a core structure does not exclude CLE.\nFig.\xa07Coronal reformat CT thorax in a patient with CLE demonstrates a cyst with a wall in the left lower lobe (arrow). More classical CLE with a core centrilobular artery and a much less perceptible wall is seen more superiorly (arrowhead)', 'Scrutiny of the cyst wall may also help. As already mentioned, CLE characteristically has no cyst wall, whereas the cyst walls in LAM are typically 1-2\xa0mm thick [7]. However, this sign is not sufficiently robust to be relied upon in isolation. Perceptible cyst walls in CLE are well recognised (Fig.\xa0<xref rid="13244_2010_50_Fig7_HTML" ref-type="fig">7</xref>), while the cysts in LAM may on rare occasions have no discernible wall [), while the cysts in LAM may on rare occasions have no discernible wall [7]. Clearly, clinical history is of paramount importance in cases where CT is equivocal.'], '13244_2010_50_Fig8_HTML': ['Ground-glass opacities and nodules are almost universal features in LIP, with cysts seen in about two-thirds of patients [16]. Interlobular sepal thickening and reticular opacities have also been reported [7, 16]. The lung cysts are usually small (less than 3\xa0cm), thin walled and distributed in a scattered, random distribution (Fig.\xa0<xref rid="13244_2010_50_Fig8_HTML" ref-type="fig">8</xref>), though much larger cysts are also recognised [), though much larger cysts are also recognised [17].\nFig.\xa08HRCT shows thin walled cysts (arrow) and ground-glass opacities (*) in a patient with LIP. The cysts have a random distribution'], '13244_2010_50_Fig9_HTML': ['Cysts on HRCT are seen in approximately 10% of patients with subacute HP and are usually few in number and random in distribution (Fig.\xa0<xref rid="13244_2010_50_Fig9_HTML" ref-type="fig">9</xref>) [) [19]. Despite their low frequency, the presence of cysts can be a helpful clue in making a radiological diagnosis of HP, when identified in conjunction with the more classical signs of the disease: these are centrilobular ground glass nodules and a mosaic attenuation pattern. Furthermore, all of these signs of sub-acute HP can be seen in the more chronic fibrotic form of hypersensitivity pneumonitis [19].\nFig.\xa09HRCT from a patient with subacute HP. Small cysts are present (arrow) on a background of widespread ground glass opacity and mosaic attenuation in the anterior segment of the left upper lobe (*)'], '13244_2010_50_Fig10_HTML': ['DIP is an uncommon disorder characterised by macrophage accumulation within the alveoli [21]. It causes dyspnoea or cough and occurs almost exclusively in individuals exposed to cigarette smoke. Consequently, knowledge of the smoking history is mandatory before suggesting the diagnosis on radiological grounds. On HRCT, diffuse ground glass opacification is an expected finding in all patients [22]. By itself, diffuse ground-glass opacification has a wide differential diagnosis, but the identification of small cysts admixed within the ground glass opacity is a unique feature to DIP, seen in about a third of patients (Fig.\xa0<xref rid="13244_2010_50_Fig10_HTML" ref-type="fig">10</xref>) [) [23, 24].\nFig.\xa010HRCT showing widespread ground glass opacities and several small cysts in a patient with a strong smoking history, who was subsequently diagnosed with DIP'], '13244_2010_50_Fig11_HTML': ['When HRCT shows just a few scattered cysts with no other abnormal features, it can be difficult to determine whether there is a true underlying cystic lung disease, or whether the cysts represent an incidental and unimportant finding. Certain aspects of the clinical history may point towards a diagnosis, but ultimately lung biopsy will be required if a particular condition is suspected. For example, in a female patient who presents with a pneumothorax, a few scattered cysts may signify an early form of LAM (Fig.\xa0<xref rid="13244_2010_50_Fig11_HTML" ref-type="fig">11</xref>). If a family history of recurrent pneumothoraces is elicited, a diagnosis of Birt-Hogg-Dube syndrome may be suggested. This is a very rare condition that is associated with pneumothoraces, renal cell carcinomas and skin fibrofolliculomas [). If a family history of recurrent pneumothoraces is elicited, a diagnosis of Birt-Hogg-Dube syndrome may be suggested. This is a very rare condition that is associated with pneumothoraces, renal cell carcinomas and skin fibrofolliculomas [25]. Reports suggest that there is a lower zone preponderance for cysts in Birt-Hogg-Dube (Fig.\xa0<xref rid="13244_2010_50_Fig12_HTML" ref-type="fig">12</xref>) [) [26].\nFig.\xa011HRCT of a patient presenting with a pneumothorax (arrowhead). The only parenchymal abnormality was the presence of a few small cysts, such as the one in the posterior segment of the right upper lobe (arrow). The patient was later diagnosed with LAMFig.\xa012Coronal reformat CT thorax shows multiple thin-walled cysts with a lower lobe predominance in a patient with Birt-Hogg-Dube. The cysts have irregular shapes (arrow) and a right apical pneumothorax is present (arrowhead). The patient had a family history of pneumothoraces'], '13244_2010_50_Fig13_HTML': ['Another rare cause of lung cysts is malignancy. While cavitating malignant lung nodules are readily identified as such and do not normally pose diagnostic difficulties, very occasionally cystic metastases may present as exquisitely thin-walled cysts. Such a diagnosis should be considered if there is a history of primary squamous cell carcinoma, adenocarcinoma or sarcoma malignancies elsewhere, and in this scenario it is important not to dismiss new cystic opacities as an incidental finding (Fig.\xa0<xref rid="13244_2010_50_Fig13_HTML" ref-type="fig">13</xref>) [) [27, 28].\nFig.\xa013Multiple cystic lesions are present in the left lung (arrow) with a small pneumothorax (arrowhead). The patient had a known history a previous oropharyngeal squamous cell carcinoma and the lesions were confirmed as cystic squamous cell carcinoma metastases']} | A practical approach to cystic lung disease on HRCT | [
"Lung cyst",
"HRCT",
"Cystic lung disease",
"Diagnostic approach"
] | Insights Imaging | 1289548800 | Cardiac magnetic resonance imaging and echocardiography are often the primary imaging techniques for many patients with congenital heart disease (CHD). However, with modern generations of CT systems and recent advances in temporal and spatial resolution, cardiac CT has been gaining an increasing reputation in the field of cardiac imaging and in the evaluation of patients with congenital heart disease. The CT imaging protocol depends on the suspected cardiac defect, the type of previous surgical repair, and the patient's age and level of cooperation. Various strategies are available for reducing radiation exposure, which is of utmost importance particularly in paediatric patients. A sequential segmental analysis is a commonly used approach to analysing congenital heart defects. Familiarity of the performing radiologist with dedicated CT protocols, the complex anatomy, morphology and terminology of CHD, as well as with the surgical procedures used to correct congenital abnormalities is a prerequisite for correct diagnosis. | [] | other | PMC3259352 | null | 25 | [
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] | Insights Imaging. 2010 Nov 12; 2(1):1-7 | NO-CC CODE |
|
CT detection of costo-vertebral changes in AS. Axial CT slices showing erosive changes (a) and ankylosis of costo-vertebral joints (b), respectively (arrows) | 13244_2010_61_Fig15_HTML | 7 | 40765bde0623b81cfc89da47965208f47e740755f5717ee70405c89147d39a66 | 13244_2010_61_Fig15_HTML.jpg | multiple | multiple panels: images | [
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"computerized tomography"
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324
] | [{'image_id': '13244_2010_61_Fig10_HTML', 'image_file_name': '13244_2010_61_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig10_HTML.jpg', 'caption': 'Relatively early changes in ankylosing spondylitis (AS). (a) AP radiograph of the sacroiliac joints in a 28-year-old man presenting with typical definite bilateral AS sacroiliitis (grade 3) in the form of bilateral joint erosion accompanied by subchondral sclerosis. (b) Initial spinal changes consisting of erosion of vertebral corners (Romanus lesion) with vertebral squaring corresponding to Th11, Th12, L4 and L5 accompanied by condensation of the vertebral corners—shiny corners (arrows)', 'hash': '737a40a3393d23efa141c88988e366793737ae233d73ec3da8eebedd1423b06f'}, {'image_id': '13244_2010_61_Fig20_HTML', 'image_file_name': '13244_2010_61_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig20_HTML.jpg', 'caption': 'Lumbar PsA. (a) AP and (b) lateral radiograph in a 50-year-old man show voluminous paravertebral ossifications anteriorly and at the right side of the third lumbar vertebra and adjacent iv spaces. MRI, (c) sagittal STIR, (d) T1 and (e) post-contrast T1-weighted images, demonstrates manifest osseous inflammation (osteitis) in the form of oedema and enhancement of the vertebral body, slight enhancement in the paravertebral new bone formation and erosion of the upper vertebral plate compatible with a mixture of osteitis, enthesitis and erosive changes', 'hash': '110c21022849a9934b809fb9a98cd0f3f93bbc6a52c8c74d48da596ab6974c2f'}, {'image_id': '13244_2010_61_Fig17_HTML', 'image_file_name': '13244_2010_61_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig17_HTML.jpg', 'caption': 'Chronic changes in AS by MRI. Sagittal T1 of (a) the cervico-thoracic and (b) the lumbar spine of the patients shown in Fig.\xa010. There are multiple fatty marrow depositions at vertebral corners and also posteriorly in thoracic vertebral bodies (b, arrows). This was observed to have developed since the MRI performed 3\xa0years previously (shown in Fig.\xa016a-d) and corresponds to areas of previous inflammation', 'hash': 'a318ec8fe238707b591bb9669959f4670cd3bc144653212536549d049091f3f3'}, {'image_id': '13244_2010_61_Fig18_HTML', 'image_file_name': '13244_2010_61_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig18_HTML.jpg', 'caption': 'Psoriatic arthritis (PsA), paravertebral ossifications. (a) AP and (b) lateral radiograph of the lumbar spine in a 48-year-old man with PsA showing voluminous paravertebral new bone formation (arrows) in addition to fusion of the second and third vertebral bodies. There was no concomitant sacroiliitis. (c) AP radiograph of the thoraco-lumbar junction in a female patient with axial PsA demonstrating coalescing paravertebral ossifications (arrows)', 'hash': 'f68370f2440f63e80a450d0819212072e35b7a9642cd98acaa1daaa26822c8e5'}, {'image_id': '13244_2010_61_Fig8_HTML', 'image_file_name': '13244_2010_61_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig8_HTML.jpg', 'caption': 'Non-radiographic MR findings. MRI in a 41-year-old woman with peripheral erosive RA and neck pain, but normal cervical radiography. (a) Post-contrast axial and (b) coronal TIFS images show signs of active arthritis with synovial contrast enhancement at the left atlanto-axial joint in addition to enhancing pannus tissue at the left side of the dens (white arrows). There is also a subchondral enhancing area in the axis (black arrow) compatible with a pre-erosive lesion', 'hash': 'c6408351977f22f23937731e6f8701fe198b32bc86d08f5a40ca1c3e75bafe3c'}, {'image_id': '13244_2010_61_Fig7_HTML', 'image_file_name': '13244_2010_61_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig7_HTML.jpg', 'caption': 'Advantages of CT and MRI. (a) Supplementary CT and (b-f) MRI of the patient shown in Fig.\xa01. CT demonstrates erosion not only at the base of the dens, but also at the tip and at the atlanto-axial and atlanto-occipital joints, which are difficult to visualise by radiography. MRI, (b) sagittal STIR and (c) sagittal T1 of the entire cervical spine and post-contrast T1FS images of the atlanto-axial region, (d) sagittal, (e) coronal and (f) axial. Oedematous voluminous pannus surrounding the dens is seen on the STIR and T1 images (black arrows) in addition to C4/5 and C5/6 disc degeneration with posterior protrusion of the disc at C4/5. The post-contrast T1FS images confirm the presence of vascularised enhancing pannus around the dens (white arrows) and demonstrate improved anatomical delineation compared with the STIR image. There is no sign of spinal cord compression', 'hash': '241779a42edea5a60654fa3961b510ad8e4a0d0106fe94573d994c58b4c77828'}, {'image_id': '13244_2010_61_Fig1_HTML', 'image_file_name': '13244_2010_61_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig1_HTML.jpg', 'caption': 'Standard radiography of the cervical spine in rheumatoid arthritis (RA). (a) Lateral radiographs in neutral position and (b) during flexion in addition to (c) lateral and (d) anterior-posterior (AP) open-mouth view of the atlanto-axial region (45-year-old woman). The flexion view (b) shows abnormal distance (>3\xa0mm) between the posterior aspect of the anterior arc of the atlas and the anterior aspect of the dens (black line). Note that the spino-laminar line of the atlas (arrow) does not align with that of the other vertebrae, confirming the presence of anterior subluxation, but there is no stenosis of the atlanto-axial canal; the posterior atlanto-dental interval (white line) is >14\xa0mm. The open-mouth view (d) shows erosion at the base of the dens (arrow). (a) and (b) show concomitant disc degenerative changes at the C4–C6 level', 'hash': '5a948e0f225bc21975be2c5d0898512d68ad11f4481e2a4fb8e6b76c9c657e3d'}, {'image_id': '13244_2010_61_Fig21_HTML', 'image_file_name': '13244_2010_61_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig21_HTML.jpg', 'caption': 'Enteropathic SpA. Sagittal STIR image of the lumbar spine in a 27-year-old man with ulcerative colitis demonstrates oedema corresponding to the interspinous ligaments (arrows) and spinous processes as signs of inflammation. There are only minimal activity changes corresponding to the vertebral bodies, located to the anterior vertebral corners', 'hash': '25c1a2c0bd183a1931072052847034c8ebd6f1c4ae502fb061effdf3dc340f01'}, {'image_id': '13244_2010_61_Fig11_HTML', 'image_file_name': '13244_2010_61_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig11_HTML.jpg', 'caption': 'Syndesmophytes and erosions in AS. (a) Lateral radiograph in a 29-year-old man with the characteristic slim ossification (syndesmophytes) at the periphery of the annulus fibrosus (black arrows) in addition to erosion of the endplates at the intervertebral (iv) space between L3 and L4 (white arrow). Supplementary MRI, (b) sagittal STIR and (c) T1-weighted images show small oedematous areas in the erosion at iv L3/4 on the STIR image and surrounding fatty marrow deposition on T1 as a sign of previous osseous inflammation. There are additional erosive changes (black arrows, c) not clearly delineated by radiography and slight oedema at the vertebral corners (white arrows, b). Note that the syndesmophytes demonstrated by radiography are not visible on MRI', 'hash': '79895ca6a868c9639a57a6d7fa01b186dd884ae7a0469b4df7f4ac7cde969f77'}, {'image_id': '13244_2010_61_Fig6_HTML', 'image_file_name': '13244_2010_61_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig6_HTML.jpg', 'caption': 'Subaxial instability. (a) Flexion view in a 64-year-old woman with advanced peripheral RA showing anterior atlanto-axial instability as well as subaxial instability at multiple levels. (b) Flexion view 2\xa0years later after surgical stabilisation of the atlanto-axial region demonstrates progression of the subaxial instability, especially between C3 and C4 (white arrow). There is a characteristic “stepladder” appearance, which also occurred on the initial radiographs (a), but is less pronounced', 'hash': '8149bbace0a624bc0c6d5e12971afc4fcdc6747ea46a5c3d420f94aea2694bba'}, {'image_id': '13244_2010_61_Fig9_HTML', 'image_file_name': '13244_2010_61_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig9_HTML.jpg', 'caption': 'Diagnostic strategy. According to Younes et al. [3] radiography of the cervical spine is indicated in all RA patients with disease duration >2\xa0years. It should at least include open-mouth and lateral views in neutral and flexed positions. Because of the occurrence of asymptomatic cervical involvement in 17% of RA patients, it is recommended to monitor patients with intervals of 2–5\xa0years depending on positivity for the rheumatoid factor. MRI is indicated in patients with neurological deficit, radiographic instability, atlanto-axial impaction and subaxial stenosis. CT may add information in rotatory and lateral subluxation because of the possibility of secondary reconstruction in arbitrary planes and a clear visualisation of the atlanto-occipital joints [6]', 'hash': 'd6345a0b5afd84973cea2391990a403b651d5805e1a8301a0915a0d9fd82afa7'}, {'image_id': '13244_2010_61_Fig19_HTML', 'image_file_name': '13244_2010_61_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig19_HTML.jpg', 'caption': 'Cervical PsA. (a) Lateral radiographs in the neutral position and (b) during flexion in a 61-year-old woman show atlanto-axial instability with a 4-mm distance between the anterior arc and the dens (white line). Additionally, ankylosis of the apophyseal joints (black arrows) and new bone formation anterior to the C4-7 vertebral bodies (white arrows). CT, (c) axial slice and coronal reconstruction of the dens area, demonstrates new bone formation in the atlanto-axial region (arrows); (d) coronal reconstruction of the lower cervical region shows voluminous new bone formation on the right side of the vertebral bodies (arrows). MRI, (e) sagittal STIR and (f) T1-weighted images, shows homogeneous osseous inflammation corresponding to the dens (arrows) with surrounding irregular oedema compatible with a mixture of osteitis and enthesitis. Note that the anterior new bone formation visualised by radiography is difficult to detect on MRI', 'hash': 'c5366e5d711761c7f19618ae682c2d81fc48b27967d17a8ef64a88cb3f48653c'}, {'image_id': '13244_2010_61_Fig16_HTML', 'image_file_name': '13244_2010_61_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig16_HTML.jpg', 'caption': 'Activity changes in AS by MRI. Sagittal STIR of (a) the cervico-thoracic and (b) the lumbar spine of the patients shown in Fig.\xa010 obtained 3\xa0years before the radiography. There are multiple high signal intensity areas corresponding to vertebral corners (white arrows). Additionally, osseous oedema of the costo-vertebral joints (a, black arrows) seen on the lateral sagittal slice of the thoracic spine. (c) Axial post-contrast T1FS of an inflamed costo-vertebral joint confirmed the presence of joint inflammation in the form of osseous enhancement in both the vertebra and the rib (arrows) in addition to joint erosion. (d) Midline sagittal post-contrast T1FS shows an enhancing syndesmophyte. (e) Inflammatory changes at the apophyseal joint in a 27-year-old man; sagittal STIR image of the lumbar region showing subchondral osseous oedema in the lower thoracic region (white arrows), and both osseous and soft tissue oedema corresponding to the lumbar apophyseal joints (black arrows). Note that the osseous oedema in the pedicle of Th12 extends to the region of the costo-vertebral joint. (f) Coronal post-contrast T1FS of the lumbar spine shows additional enhancement corresponding to the interspinous ligament between L2 and L3 (arrows)', 'hash': 'ad635629d133696664ab64c38a0a15880516140653e93ba99dbc1640e8c1d19d'}, {'image_id': '13244_2010_61_Fig15_HTML', 'image_file_name': '13244_2010_61_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig15_HTML.jpg', 'caption': 'CT detection of costo-vertebral changes in AS. Axial CT slices showing erosive changes (a) and ankylosis of costo-vertebral joints (b), respectively (arrows)', 'hash': '40765bde0623b81cfc89da47965208f47e740755f5717ee70405c89147d39a66'}, {'image_id': '13244_2010_61_Fig5_HTML', 'image_file_name': '13244_2010_61_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig5_HTML.jpg', 'caption': 'Vertical subluxation with spinal cord compression. MRI of the cervical spine in a 69-year-old woman with advanced peripheral RA, neck pain and clinical signs of myelopathy. (a) Sagittal STIR, (b) sagittal T1 and (c) axial T2 fat-saturated (FS) images show erosion of the dens and protrusion of the tip into the occipital foramen causing compression of the spinal cord, which exhibits irregular signal intensity (white arrows). The osseous spinal canal has a width of approximately 7\xa0mm (black line). There is heterogeneous signal intensity pannus surrounding the dens compatible with a mixture of fibrotic and oedematous pannus tissue (black arrows) in the widened space between the dens and the anterior arc of the atlas', 'hash': 'f2c2ef0b0a33f28c079a69a02e3e8ab2037b3bf31cc1b3c9504f07ee6ae5e326'}, {'image_id': '13244_2010_61_Fig12_HTML', 'image_file_name': '13244_2010_61_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig12_HTML.jpg', 'caption': 'Advanced AS. (a) AP and (b) lateral radiograph in a 55-year-old man showing vertebral fusion due to syndesmophytes crossing the intervertebral spaces in addition to fusion of the apophyseal joints (bamboo spine). The interspinous ligaments are ossified, presenting as a slim ossified streak on the frontal radiograph (dagger sign; arrows). MRI, sagittal T1-weighted images of (c) the cervico-thoracic and (d) lumbar region, respectively, shows a general narrowing of the intervertebral discs with partial osseous fusion of the vertebral bodies, especially in the lumbar region (arrows). In addition a characteristic AS deformity with reduced lumbar lordosis and thoracic kyphosis', 'hash': 'ad763cc791a78f926c01a2af2e45a78ceaef6a5e0f884bf57042add09b79daf0'}, {'image_id': '13244_2010_61_Fig2_HTML', 'image_file_name': '13244_2010_61_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig2_HTML.jpg', 'caption': 'Lateral and rotatory atlanto-axial subluxation. AP open-mouth view in a 53-year-old man with RA. There is narrowing of the atlanto-axial joints with superficial erosions (black arrow) and lateral displacement of the axis with respect to the lateral masses of the atlas (white arrow); in addition signs indicating rotatory displacement with asymmetry of the distance between the dens and the lateral masses of the atlas', 'hash': '5da5ed255d6ee095f700d91022be99e242878d09a1a5801f8fb8942f14a035cf'}, {'image_id': '13244_2010_61_Fig4_HTML', 'image_file_name': '13244_2010_61_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig4_HTML.jpg', 'caption': 'Vertical subluxation. (a) Lateral radiograph with McGregor’s line (black line; 61-year-old man with RA). The tip of the dens is difficult to define, but measurement according to Redlund-Johnell’s method (white line) results in a distance of 27\xa0mm, which is below the normal limit. In accordance with this, the anterior arc of the atlas is level with the middle third of the axis. (b) Ranawat’s method, the distance between the centre of the second cervical pedicle and the transverse axis of the atlas is below the normal limit (9\xa0mm). Thus, all measurements indicate vertical subluxation. Supplementary MRI, (c) sagittal STIR and (d) T1-weighted images show erosion of the dens and protrusion of the tip into the occipital foramen causing narrowing of the spinal canal to 9\xa0mm, but persistence of cerebrospinal fluid around the cord. There is a 9-mm-thick mass of pannus tissue between the dens and anterior arc (black line) exhibiting small areas with high signal intensity on the STIR image (arrow) compatible with slight activity, but signal void fibrous pannus tissue predominates', 'hash': '8e272af71c9619ea5bf2d50dd21f159b0a5d9ca5640050c23d217dfdd867462a'}, {'image_id': '13244_2010_61_Fig14_HTML', 'image_file_name': '13244_2010_61_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig14_HTML.jpg', 'caption': 'Spinal fracture in AS. (a) AP and (b) lateral radiograph of the thoracic spine in a 64-year-old man with advanced AS and increasing back pain over 4\xa0weeks. The lateral view demonstrates a slight malalignment at the anterior aspects of the vertebral bodies of Th9 and Th10, and the iv is irregularly narrowed on the AP view, all suggesting fracture (arrows). CT, (c) sagittal and (d) coronal reconstruction, shows fracture through the iv space and the posterior structures (arrows). There is widening of the intervertebral space anteriorly in the supine position used for CT compared with the upright position used during radiography', 'hash': '97c112b496575f28042d5803f128ee1f3efc1a4c1387ba30949f7d50049dfe46'}, {'image_id': '13244_2010_61_Fig3_HTML', 'image_file_name': '13244_2010_61_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig3_HTML.jpg', 'caption': 'Vertical atlanto-axial subluxation, measurement methods. (a) Lateral normal radiograph in neutral position showing the location of McGregor’s line (black) between the postero-superior aspect of the hard palate and the most caudal point of the occipital curve. Migration of the tip of the dens >4.5\xa0mm above McGregor’s line indicates vertical subluxation. The distance indicated by the white line between McGregor’s line and the midpoint of the inferior margin of the body of axis is used to evaluate vertical subluxation according to Redlund-Johnell and Pettersson’s method. A distance less than 34\xa0mm in men and 29\xa0mm in women indicates vertical subluxation. (b) Sagittal CT reconstruction of a normal cervical spine showing the location of McRae’s line corresponding to the occipital foramen and the division of the axis into three equal portions used by Clark’s method for diagnosing vertical subluxation. If the anterior arc of the atlas is in level with the middle or caudal third of the axis there is slight and pronounced vertical subluxation, respectively. (c) Ranawat’s method includes determination of the distance between the centre of the second cervical pedicle and the transverse axis of the atlas. A distance less than 15\xa0mm in males and 13\xa0mm in females indicates vertical subluxation [4]', 'hash': 'b295e7587d021091cb06b42db791629bc57741585fadbcbf923b2d6110498077'}, {'image_id': '13244_2010_61_Fig13_HTML', 'image_file_name': '13244_2010_61_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3259357/13244_2010_61_Fig13_HTML.jpg', 'caption': 'Pseudo-arthrosis-like changes in AS. (a) AP and (b) lateral radiograph showing vertebral fusion except at iv Th10/11. There is surrounding osteophyte formation at this iv space (arrows). Supplementary CT, (c) sagittal and (d) coronal 2D reconstruction, demonstrates lack of fusion of the vertebral bodies and apophyseal joints at this level (arrows). (e) 3D reconstruction clearly demonstrates the exuberant surrounding reactive osteophytes', 'hash': 'd2af4bb247d1bf970abf1a4319f08e7d9adbe654027c32c4a3756d37015bd779'}] | {'13244_2010_61_Fig1_HTML': ['Radiography of the cervical spine is mandatory in RA patients with neck pain [3]. It should always include a lateral view in a flexed position compared with a neutral position in addition to special views of the dens area to detect any lesions and/or instability (Fig.\xa0<xref rid="13244_2010_61_Fig1_HTML" ref-type="fig">1</xref>). A supplementary lateral view during extension can be useful to assess reducibility of atlanto-axial subluxation possibly limited by pannus tissue between the anterior arc of the atlas and dens.\n). A supplementary lateral view during extension can be useful to assess reducibility of atlanto-axial subluxation possibly limited by pannus tissue between the anterior arc of the atlas and dens.\nFig.\xa01Standard radiography of the cervical spine in rheumatoid arthritis (RA). (a) Lateral radiographs in neutral position and (b) during flexion in addition to (c) lateral and (d) anterior-posterior (AP) open-mouth view of the atlanto-axial region (45-year-old woman). The flexion view (b) shows abnormal distance (>3\xa0mm) between the posterior aspect of the anterior arc of the atlas and the anterior aspect of the dens (black line). Note that the spino-laminar line of the atlas (arrow) does not align with that of the other vertebrae, confirming the presence of anterior subluxation, but there is no stenosis of the atlanto-axial canal; the posterior atlanto-dental interval (white line) is >14\xa0mm. The open-mouth view (d) shows erosion at the base of the dens (arrow). (a) and (b) show concomitant disc degenerative changes at the C4–C6 level', 'Distance between the posterior aspect of the anterior arc of the atlas and the anterior aspect of the dens exceeding 3\xa0mm in a neutral position and/or during flexion (Fig.\xa0<xref rid="13244_2010_61_Fig1_HTML" ref-type="fig">1</xref>). It may cause ). It may cause stenosis of the atlanto-axial canal presenting as a posterior atlanto-dental interval\u2009<14\xa0mm (Fig.\xa0<xref rid="13244_2010_61_Fig1_HTML" ref-type="fig">1</xref>).).', 'Discitis-like changes and spinous process erosion may also be detected by radiography in RA, but are relatively rare, whereas concomitant degenerative changes occur occasionally (Fig.\xa0<xref rid="13244_2010_61_Fig1_HTML" ref-type="fig">1</xref>).).'], '13244_2010_61_Fig2_HTML': ['Displacement of the lateral masses of the atlas more than 2\xa0mm in relation to that of the axis and asymmetry of the lateral masses relative to the dens, respectively (Fig.\xa0<xref rid="13244_2010_61_Fig2_HTML" ref-type="fig">2</xref>). Rotatory and lateral subluxation is diagnosed on open-mouth anterior-posterior (AP) radiographs. Anterior subluxation often coexists because of the close anatomical relation between the atlas and the axis.\n). Rotatory and lateral subluxation is diagnosed on open-mouth anterior-posterior (AP) radiographs. Anterior subluxation often coexists because of the close anatomical relation between the atlas and the axis.\nFig.\xa02Lateral and rotatory atlanto-axial subluxation. AP open-mouth view in a 53-year-old man with RA. There is narrowing of the atlanto-axial joints with superficial erosions (black arrow) and lateral displacement of the axis with respect to the lateral masses of the atlas (white arrow); in addition signs indicating rotatory displacement with asymmetry of the distance between the dens and the lateral masses of the atlas'], '13244_2010_61_Fig3_HTML': ['is also referred to as atlanto-axial impaction, basilar invagination or cranial setting, and is defined as migration of the odontoid tip proximal to McRae’s line corresponding to the occipital foramen. This line can be difficult to define on radiographs, and vertical subluxation has therefore also been defined by several other methods. Migration of the tip of the odontoid process >4.5\xa0mm above McGregor’s line (between the postero-superior aspect of the hard palate and the most caudal point of the occipital curve) indicates vertical subluxation (Fig.\xa0<xref rid="13244_2010_61_Fig3_HTML" ref-type="fig">3</xref>).\n).\nFig.\xa03Vertical atlanto-axial subluxation, measurement methods. (a) Lateral normal radiograph in neutral position showing the location of McGregor’s line (black) between the postero-superior aspect of the hard palate and the most caudal point of the occipital curve. Migration of the tip of the dens >4.5\xa0mm above McGregor’s line indicates vertical subluxation. The distance indicated by the white line between McGregor’s line and the midpoint of the inferior margin of the body of axis is used to evaluate vertical subluxation according to Redlund-Johnell and Pettersson’s method. A distance less than 34\xa0mm in men and 29\xa0mm in women indicates vertical subluxation. (b) Sagittal CT reconstruction of a normal cervical spine showing the location of McRae’s line corresponding to the occipital foramen and the division of the axis into three equal portions used by Clark’s method for diagnosing vertical subluxation. If the anterior arc of the atlas is in level with the middle or caudal third of the axis there is slight and pronounced vertical subluxation, respectively. (c) Ranawat’s method includes determination of the distance between the centre of the second cervical pedicle and the transverse axis of the atlas. A distance less than 15\xa0mm in males and 13\xa0mm in females indicates vertical subluxation [4]', 'The occurrence of dens erosion can, however, make this measurement difficult to obtain. The Redlund-Johnell method is therefore based on the minimum distance between McGregor’s line and the midpoint of the inferior margin of the body of the axis on a lateral radiograph in a neutral position (Fig.\xa0<xref rid="13244_2010_61_Fig3_HTML" ref-type="fig">3</xref>) [) [4]. Visualisation of the palate may not always be obtained. Methods without dens and/or the palate as landmarks have therefore been introduced [4]. The method described by Clark et al. (described in [4]) includes assessment of the location of the atlas by dividing the axis into three equal portions on a lateral radiograph. Location of the anterior arc of the atlas in level with the middle or caudal third of the axis indicates vertical subluxation (Fig.\xa0<xref rid="13244_2010_61_Fig3_HTML" ref-type="fig">3</xref>). Ranawat et al. have proposed using the distance between the centre of the second cervical pedicle and the transverse axis of the atlas at the odontoid process (Fig.\xa0). Ranawat et al. have proposed using the distance between the centre of the second cervical pedicle and the transverse axis of the atlas at the odontoid process (Fig.\xa0<xref rid="13244_2010_61_Fig3_HTML" ref-type="fig">3</xref>) [) [4]. To obtain the diagnosis of vertical subluxation a combination of the Redlund-Johnell, Clark and Ranawat methods has been recommended (described in [4]). If any of these methods suggests vertical subluxation MRI should be performed to visualise the spinal cord (Fig.\xa0<xref rid="13244_2010_61_Fig4_HTML" ref-type="fig">4</xref>). Using this combination of methods vertical subluxation will be missed in only 6% of patients [). Using this combination of methods vertical subluxation will be missed in only 6% of patients [4]. It is mandatory to diagnose vertical subluxation; this can be fatal because of the proximity of the dens to the medulla oblongata and the proximal portion of the spinal cord. Risk of cord compression/injury occurs, especially in patients with flexion instability accompanied by erosive changes in the atlanto-axial and/or atlanto-occipital joints, causing the vertical subluxation with protrusion of the dens into the occipital foramen (Figs.\xa0<xref rid="13244_2010_61_Fig4_HTML" ref-type="fig">4</xref>, , <xref rid="13244_2010_61_Fig5_HTML" ref-type="fig">5</xref>).\n).\nFig.\xa04Vertical subluxation. (a) Lateral radiograph with McGregor’s line (black line; 61-year-old man with RA). The tip of the dens is difficult to define, but measurement according to Redlund-Johnell’s method (white line) results in a distance of 27\xa0mm, which is below the normal limit. In accordance with this, the anterior arc of the atlas is level with the middle third of the axis. (b) Ranawat’s method, the distance between the centre of the second cervical pedicle and the transverse axis of the atlas is below the normal limit (9\xa0mm). Thus, all measurements indicate vertical subluxation. Supplementary MRI, (c) sagittal STIR and (d) T1-weighted images show erosion of the dens and protrusion of the tip into the occipital foramen causing narrowing of the spinal canal to 9\xa0mm, but persistence of cerebrospinal fluid around the cord. There is a 9-mm-thick mass of pannus tissue between the dens and anterior arc (black line) exhibiting small areas with high signal intensity on the STIR image (arrow) compatible with slight activity, but signal void fibrous pannus tissue predominatesFig.\xa05Vertical subluxation with spinal cord compression. MRI of the cervical spine in a 69-year-old woman with advanced peripheral RA, neck pain and clinical signs of myelopathy. (a) Sagittal STIR, (b) sagittal T1 and (c) axial T2 fat-saturated (FS) images show erosion of the dens and protrusion of the tip into the occipital foramen causing compression of the spinal cord, which exhibits irregular signal intensity (white arrows). The osseous spinal canal has a width of approximately 7\xa0mm (black line). There is heterogeneous signal intensity pannus surrounding the dens compatible with a mixture of fibrotic and oedematous pannus tissue (black arrows) in the widened space between the dens and the anterior arc of the atlas'], '13244_2010_61_Fig6_HTML': ['also occur in the form of arthritis of the apophyseal and/or uncovertebral joints, appearing as narrowing and superficial erosions by radiography. It can cause instability in the C2-Th1 region, which is mainly seen in patients with severe chronic peripheral arthritis. Anterior subluxation is far more frequent than posterior subluxation. It is defined as at least 3\xa0mm forward slippage of a vertebra relative to the underlying vertebra by radiography including a flexion view (Fig.\xa0<xref rid="13244_2010_61_Fig6_HTML" ref-type="fig">6</xref>). Changes are particularly characteristic at the C3–4 and C4–5 level, but multiple levels may be involved, producing a typical “stepladder” appearance on lateral radiographs. The condition is serious if the subaxial sagittal spinal canal diameter is <14\xa0mm, implying a possibility of spinal cord compression [). Changes are particularly characteristic at the C3–4 and C4–5 level, but multiple levels may be involved, producing a typical “stepladder” appearance on lateral radiographs. The condition is serious if the subaxial sagittal spinal canal diameter is <14\xa0mm, implying a possibility of spinal cord compression [2]. The instability may progress over time, especially if the C1–C2 region is stabilised surgically (Fig.\xa0<xref rid="13244_2010_61_Fig6_HTML" ref-type="fig">6</xref>) [) [5].\nFig.\xa06Subaxial instability. (a) Flexion view in a 64-year-old woman with advanced peripheral RA showing anterior atlanto-axial instability as well as subaxial instability at multiple levels. (b) Flexion view 2\xa0years later after surgical stabilisation of the atlanto-axial region demonstrates progression of the subaxial instability, especially between C3 and C4 (white arrow). There is a characteristic “stepladder” appearance, which also occurred on the initial radiographs (a), but is less pronounced'], '13244_2010_61_Fig7_HTML': ['Cross-sectional imaging in the form of CT and MRI eliminates overprojecting structures and can improve the detection of RA changes. Osseous changes (erosions, etc.) can be clearly delineated by CT [6]. Additionally, MRI visualises soft tissue structures (pannus; spinal cord, etc.), signs of disease activity and sequelae of inflammation in the form of fibrous pannus. These advantages of CT and MRI in patients with atlanto-axial involvement are illustrated in Figs.\xa0<xref rid="13244_2010_61_Fig7_HTML" ref-type="fig">7</xref> and and <xref rid="13244_2010_61_Fig8_HTML" ref-type="fig">8</xref>, including the possibility of detecting signs of arthritis by MRI before the occurrence of erosive changes (Fig.\xa0, including the possibility of detecting signs of arthritis by MRI before the occurrence of erosive changes (Fig.\xa0<xref rid="13244_2010_61_Fig8_HTML" ref-type="fig">8</xref>) [) [3].\nFig.\xa07Advantages of CT and MRI. (a) Supplementary CT and (b-f) MRI of the patient shown in Fig.\xa0<xref rid="13244_2010_61_Fig1_HTML" ref-type="fig">1</xref>. CT demonstrates erosion not only at the base of the dens, but also at the tip and at the atlanto-axial and atlanto-occipital joints, which are difficult to visualise by radiography. MRI, (. CT demonstrates erosion not only at the base of the dens, but also at the tip and at the atlanto-axial and atlanto-occipital joints, which are difficult to visualise by radiography. MRI, (b) sagittal STIR and (c) sagittal T1 of the entire cervical spine and post-contrast T1FS images of the atlanto-axial region, (d) sagittal, (e) coronal and (f) axial. Oedematous voluminous pannus surrounding the dens is seen on the STIR and T1 images (black arrows) in addition to C4/5 and C5/6 disc degeneration with posterior protrusion of the disc at C4/5. The post-contrast T1FS images confirm the presence of vascularised enhancing pannus around the dens (white arrows) and demonstrate improved anatomical delineation compared with the STIR image. There is no sign of spinal cord compressionFig.\xa08Non-radiographic MR findings. MRI in a 41-year-old woman with peripheral erosive RA and neck pain, but normal cervical radiography. (a) Post-contrast axial and (b) coronal TIFS images show signs of active arthritis with synovial contrast enhancement at the left atlanto-axial joint in addition to enhancing pannus tissue at the left side of the dens (white arrows). There is also a subchondral enhancing area in the axis (black arrow) compatible with a pre-erosive lesion'], '13244_2010_61_Fig9_HTML': ['A diagnostic strategy according to Younes et al. [3] is recommended (Fig.\xa0<xref rid="13244_2010_61_Fig9_HTML" ref-type="fig">9</xref>). This includes an indication for radiography in all RA patients with disease duration\u2009>2\xa0years as cervical involvement may occur in over 70% of patients and has been reported to be asymptomatic in 17% of RA patients. It is recommended to monitor patients with manifest peripheral erosions accompanied by RF (rheumatoid factor) and antiCCP (antibodies to cyclic citrullinated peptide) positivity every second year and patients with few peripheral erosions and RF negativity at 5-year intervals. MRI is indicated in patients with neurological deficit, radiographic instability, vertical subluxation and subaxial stenosis [). This includes an indication for radiography in all RA patients with disease duration\u2009>2\xa0years as cervical involvement may occur in over 70% of patients and has been reported to be asymptomatic in 17% of RA patients. It is recommended to monitor patients with manifest peripheral erosions accompanied by RF (rheumatoid factor) and antiCCP (antibodies to cyclic citrullinated peptide) positivity every second year and patients with few peripheral erosions and RF negativity at 5-year intervals. MRI is indicated in patients with neurological deficit, radiographic instability, vertical subluxation and subaxial stenosis [2, 3]. Visualisation of the spinal cord is especially important to detect cord injury or risk of injury. MRI should therefore always be performed in RA patients with neck pain and/or neurological symptoms [3, 7].\nFig.\xa09Diagnostic strategy. According to Younes et al. [3] radiography of the cervical spine is indicated in all RA patients with disease duration >2\xa0years. It should at least include open-mouth and lateral views in neutral and flexed positions. Because of the occurrence of asymptomatic cervical involvement in 17% of RA patients, it is recommended to monitor patients with intervals of 2–5\xa0years depending on positivity for the rheumatoid factor. MRI is indicated in patients with neurological deficit, radiographic instability, atlanto-axial impaction and subaxial stenosis. CT may add information in rotatory and lateral subluxation because of the possibility of secondary reconstruction in arbitrary planes and a clear visualisation of the atlanto-occipital joints [6]'], '13244_2010_61_Fig10_HTML': ['Ankylosing spondylitis is the most frequent and usually the most disabling form of SpA. It has a genetic predisposition in the form of a frequent association with the human leukocyte antigen (HLA) B27 [10]. AS often starts in early adulthood and has a chronic progressive course. It is therefore important to diagnose this disorder. According to the modified New York Criteria [11], the diagnosis of definite AS requires the following: manifest sacroiliitis by radiography (grade ≥2 bilateral or unilateral grade 3–4 sacroiliitis; Fig.\xa0<xref rid="13244_2010_61_Fig10_HTML" ref-type="fig">10</xref>) and at least one of the following clinical criteria: (1) low back pain and stiffness for more than 3\xa0months improving with activity, (2) limited movement of the lumbar spine and (3) reduced chest expansion. These criteria are still used in the diagnosis of AS despite the increasing use of MRI to detect the disease early. It is therefore important to know both the characteristic radiographic features and the MR features of AS.\n) and at least one of the following clinical criteria: (1) low back pain and stiffness for more than 3\xa0months improving with activity, (2) limited movement of the lumbar spine and (3) reduced chest expansion. These criteria are still used in the diagnosis of AS despite the increasing use of MRI to detect the disease early. It is therefore important to know both the characteristic radiographic features and the MR features of AS.\nFig.\xa010Relatively early changes in ankylosing spondylitis (AS). (a) AP radiograph of the sacroiliac joints in a 28-year-old man presenting with typical definite bilateral AS sacroiliitis (grade 3) in the form of bilateral joint erosion accompanied by subchondral sclerosis. (b) Initial spinal changes consisting of erosion of vertebral corners (Romanus lesion) with vertebral squaring corresponding to Th11, Th12, L4 and L5 accompanied by condensation of the vertebral corners—shiny corners (arrows)', 'Early radiographic spinal changes encompass erosion of vertebral corners (Romanus lesions) causing vertebral squaring and eliciting reactive sclerosis appearing as condensation of vertebral corners (shiny corners; Fig.\xa0<xref rid="13244_2010_61_Fig10_HTML" ref-type="fig">10</xref>). These changes are caused by inflammation at the insertion of the annulus fibrosus (enthesitis) at vertebral corners provoking reactive bone formation [). These changes are caused by inflammation at the insertion of the annulus fibrosus (enthesitis) at vertebral corners provoking reactive bone formation [12]. Later on slim ossifications appear in the annulus fibrosus (syndesmophytes) (Fig.\xa0<xref rid="13244_2010_61_Fig11_HTML" ref-type="fig">11</xref>) [) [13]. With disease progression the spine gradually fuses because of syndesmophytes crossing the intervertebral spaces in addition to fusion of apophyseal joints, resulting in complete spinal fusion (bamboo spine; Fig.\xa0<xref rid="13244_2010_61_Fig12_HTML" ref-type="fig">12</xref>). In advanced disease the supra- and interspinous ligaments may ossify and be visible on frontal radiographs as a slim ossified streak (Fig.\xa0). In advanced disease the supra- and interspinous ligaments may ossify and be visible on frontal radiographs as a slim ossified streak (Fig.\xa0<xref rid="13244_2010_61_Fig12_HTML" ref-type="fig">12</xref>). The occurrence of a single central radiodense streak has been named the “dagger sign”. When the ligamentous ossification occurs together with ossification of apophyseal joint capsules, there are three vertical radiodense lines on frontal radiography (trolley-track sign).\n). The occurrence of a single central radiodense streak has been named the “dagger sign”. When the ligamentous ossification occurs together with ossification of apophyseal joint capsules, there are three vertical radiodense lines on frontal radiography (trolley-track sign).\nFig.\xa011Syndesmophytes and erosions in AS. (a) Lateral radiograph in a 29-year-old man with the characteristic slim ossification (syndesmophytes) at the periphery of the annulus fibrosus (black arrows) in addition to erosion of the endplates at the intervertebral (iv) space between L3 and L4 (white arrow). Supplementary MRI, (b) sagittal STIR and (c) T1-weighted images show small oedematous areas in the erosion at iv L3/4 on the STIR image and surrounding fatty marrow deposition on T1 as a sign of previous osseous inflammation. There are additional erosive changes (black arrows, c) not clearly delineated by radiography and slight oedema at the vertebral corners (white arrows, b). Note that the syndesmophytes demonstrated by radiography are not visible on MRIFig.\xa012Advanced AS. (a) AP and (b) lateral radiograph in a 55-year-old man showing vertebral fusion due to syndesmophytes crossing the intervertebral spaces in addition to fusion of the apophyseal joints (bamboo spine). The interspinous ligaments are ossified, presenting as a slim ossified streak on the frontal radiograph (dagger sign; arrows). MRI, sagittal T1-weighted images of (c) the cervico-thoracic and (d) lumbar region, respectively, shows a general narrowing of the intervertebral discs with partial osseous fusion of the vertebral bodies, especially in the lumbar region (arrows). In addition a characteristic AS deformity with reduced lumbar lordosis and thoracic kyphosis'], '13244_2010_61_Fig11_HTML': ['Erosive changes within intervertebral spaces (Andersson lesions) have been detected by radiography in approximately 5% of patients with AS [14], but more frequently by MRI (Fig.\xa0<xref rid="13244_2010_61_Fig11_HTML" ref-type="fig">11</xref>) [) [15].'], '13244_2010_61_Fig13_HTML': ['Persistent movement at single intervertebral spaces may occur in an otherwise ankylosed spine, sometimes caused by non-diagnosed fractures. This can result in pseudo-arthrosis-like changes with the formation of surrounding reactive osteophytes due to excessive mechanical load at single movable intervertebral spaces [14]. The diagnosis of such changes may require a CT examination to obtain adequate visualisation (Fig.\xa0<xref rid="13244_2010_61_Fig13_HTML" ref-type="fig">13</xref>).\n).\nFig.\xa013Pseudo-arthrosis-like changes in AS. (a) AP and (b) lateral radiograph showing vertebral fusion except at iv Th10/11. There is surrounding osteophyte formation at this iv space (arrows). Supplementary CT, (c) sagittal and (d) coronal 2D reconstruction, demonstrates lack of fusion of the vertebral bodies and apophyseal joints at this level (arrows). (e) 3D reconstruction clearly demonstrates the exuberant surrounding reactive osteophytes', 'Cross-sectional CT or MR imaging can be advantageous in the diagnosis of AS changes. CT providing a clear delineation of osseous structures is the preferred technique for visualising pseudo-arthrosis and detecting fractures (Figs.\xa0<xref rid="13244_2010_61_Fig13_HTML" ref-type="fig">13</xref>, , <xref rid="13244_2010_61_Fig14_HTML" ref-type="fig">14</xref>). CT is superior to MRI in detecting minor osseous lesions such as erosion and ankylosis of the apophyseal, costo-vertebral and costo-transversal joints (Fig.\xa0). CT is superior to MRI in detecting minor osseous lesions such as erosion and ankylosis of the apophyseal, costo-vertebral and costo-transversal joints (Fig.\xa0<xref rid="13244_2010_61_Fig15_HTML" ref-type="fig">15</xref>). MRI can visualise signs of active inflammation in the form of bone marrow and soft tissue oedema and/or contrast enhancement. It has therefore gained a central role in the evaluation of disease activity [). MRI can visualise signs of active inflammation in the form of bone marrow and soft tissue oedema and/or contrast enhancement. It has therefore gained a central role in the evaluation of disease activity [15]. MRI can, however, also detect sequelae of inflammation consisting of fatty deposition in the bone marrow and chronic structural changes such as erosion and fusion of vertebral bodies [15].\nFig.\xa015CT detection of costo-vertebral changes in AS. Axial CT slices showing erosive changes (a) and ankylosis of costo-vertebral joints (b), respectively (arrows)'], '13244_2010_61_Fig14_HTML': ['One of the life-threatening complications of AS is spinal fracture. Non-fatal fractures have been reported to occur in up to 6% of AS patients, especially in patients with long disease duration [16]. Fractures may occur after minor trauma because of the spinal stiffness and frequently accompanying osteoporosis. Fractures often occur at intervertebral spaces, but usually involve the ankylosed posterior structures and are thereby unstable (Fig.\xa0<xref rid="13244_2010_61_Fig14_HTML" ref-type="fig">14</xref>). Obvious fractures can be diagnosed by radiography, but fractures may be obscured. It is therefore mandatory to supplement a negative radiography with CT if fracture is suspected (in the case of trauma history or a change in spinal symptoms). The occurrence of cervico-thoracic fractures may cause spinal cord injury and be lethal even following minor trauma [). Obvious fractures can be diagnosed by radiography, but fractures may be obscured. It is therefore mandatory to supplement a negative radiography with CT if fracture is suspected (in the case of trauma history or a change in spinal symptoms). The occurrence of cervico-thoracic fractures may cause spinal cord injury and be lethal even following minor trauma [17].\nFig.\xa014Spinal fracture in AS. (a) AP and (b) lateral radiograph of the thoracic spine in a 64-year-old man with advanced AS and increasing back pain over 4\xa0weeks. The lateral view demonstrates a slight malalignment at the anterior aspects of the vertebral bodies of Th9 and Th10, and the iv is irregularly narrowed on the AP view, all suggesting fracture (arrows). CT, (c) sagittal and (d) coronal reconstruction, shows fracture through the iv space and the posterior structures (arrows). There is widening of the intervertebral space anteriorly in the supine position used for CT compared with the upright position used during radiography'], '13244_2010_61_Fig16_HTML': ['Characteristic MR findings early in the disease are activity changes mainly consisting of oedema at vertebral corners and/or costo-vertebral joints (Fig.\xa0<xref rid="13244_2010_61_Fig16_HTML" ref-type="fig">16</xref>) [) [13]. The inflammatory changes at vertebral corners are characteristic of AS. Based on the occurrence of severe or multiple (≥3) lesions in young patients, AS changes can be distinguished from degenerative changes with a high reliability [18]. During the disease course signs of activity can also occur at syndesmophytes, apophyseal joints and interspinous ligaments (Fig.\xa0<xref rid="13244_2010_61_Fig16_HTML" ref-type="fig">16</xref>). Detection of inflammation at apophyseal joints by MRI, however, demands pronounced involvement histopathologically [). Detection of inflammation at apophyseal joints by MRI, however, demands pronounced involvement histopathologically [19]. The inflammation at vertebral corners is the most valid feature and has been observed related to the development of syndesmophytes by radiography [12], establishing a link between signs of disease activity and chronic structural changes.\nFig.\xa016Activity changes in AS by MRI. Sagittal STIR of (a) the cervico-thoracic and (b) the lumbar spine of the patients shown in Fig.\xa0<xref rid="13244_2010_61_Fig10_HTML" ref-type="fig">10</xref> obtained 3\xa0years before the radiography. There are multiple high signal intensity areas corresponding to vertebral corners (white arrows). Additionally, osseous oedema of the costo-vertebral joints ( obtained 3\xa0years before the radiography. There are multiple high signal intensity areas corresponding to vertebral corners (white arrows). Additionally, osseous oedema of the costo-vertebral joints (a, black arrows) seen on the lateral sagittal slice of the thoracic spine. (c) Axial post-contrast T1FS of an inflamed costo-vertebral joint confirmed the presence of joint inflammation in the form of osseous enhancement in both the vertebra and the rib (arrows) in addition to joint erosion. (d) Midline sagittal post-contrast T1FS shows an enhancing syndesmophyte. (e) Inflammatory changes at the apophyseal joint in a 27-year-old man; sagittal STIR image of the lumbar region showing subchondral osseous oedema in the lower thoracic region (white arrows), and both osseous and soft tissue oedema corresponding to the lumbar apophyseal joints (black arrows). Note that the osseous oedema in the pedicle of Th12 extends to the region of the costo-vertebral joint. (f) Coronal post-contrast T1FS of the lumbar spine shows additional enhancement corresponding to the interspinous ligament between L2 and L3 (arrows)', 'The possibility of visualising disease activity by MRI has increased its use to monitor AS, especially during anti-TNF (anti-tumour necrosis factor) therapy [21, 22]. Several studies have shown that MR changes are frequent in the thoracic spine (Fig.\xa0<xref rid="13244_2010_61_Fig16_HTML" ref-type="fig">16</xref>) [) [15, 23]. It is therefore important to examine the entire spine using sagittal STIR or T2 fat-saturated (FS) and T1-weighted sequences. Supplementary axial slices can be necessary for visualising involvement of apophyseal, costo-vertebral and costo-transversal joints (Fig.\xa0<xref rid="13244_2010_61_Fig16_HTML" ref-type="fig">16</xref>) [) [24, 25]. Post-contrast T1FS sequences can sometimes be advantageous as they provide better anatomical delineation [26]. Additionally, dynamic contrast-enhanced MRI may be superior to static MRI in monitoring disease activity during anti-TNF therapy [27]. Whole-body MRI gives the possibility of detecting involvement in other areas without losing important information about spinal and sacroiliac joint involvement [28, 29].'], '13244_2010_61_Fig17_HTML': ['Chronic AS changes detectable by MRI mainly consist of fatty marrow deposition at vertebral corners (Fig.\xa0<xref rid="13244_2010_61_Fig17_HTML" ref-type="fig">17</xref>), erosion (Fig.\xa0), erosion (Fig.\xa0<xref rid="13244_2010_61_Fig11_HTML" ref-type="fig">11</xref>) and vertebral fusion in advanced disease (Fig.\xa0) and vertebral fusion in advanced disease (Fig.\xa0<xref rid="13244_2010_61_Fig12_HTML" ref-type="fig">12</xref>). Fatty marrow deposition seems to be an important sign of chronicity being significantly correlated with radiographic changes, in particular vertebral squaring [). Fatty marrow deposition seems to be an important sign of chronicity being significantly correlated with radiographic changes, in particular vertebral squaring [15]. Erosions are more frequently detected by MRI than by radiography (Fig.\xa0<xref rid="13244_2010_61_Fig11_HTML" ref-type="fig">11</xref>) [) [15] and can present with signs of active inflammation and/or surrounding fatty marrow deposition compatible with sequels of osseous inflammation. Syndesmophytes, however, may not always be visible by MRI because they may be difficult to distinguish from fibrous tissue unless there is concomitant active inflammation or fatty deposition (Figs.\xa0<xref rid="13244_2010_61_Fig11_HTML" ref-type="fig">11</xref>, , <xref rid="13244_2010_61_Fig16_HTML" ref-type="fig">16</xref>) [) [15, 20].\nFig.\xa017Chronic changes in AS by MRI. Sagittal T1 of (a) the cervico-thoracic and (b) the lumbar spine of the patients shown in Fig.\xa0<xref rid="13244_2010_61_Fig10_HTML" ref-type="fig">10</xref>. There are multiple fatty marrow depositions at vertebral corners and also posteriorly in thoracic vertebral bodies (. There are multiple fatty marrow depositions at vertebral corners and also posteriorly in thoracic vertebral bodies (b, arrows). This was observed to have developed since the MRI performed 3\xa0years previously (shown in Fig.\xa0<xref rid="13244_2010_61_Fig16_HTML" ref-type="fig">16</xref>a-d) and corresponds to areas of previous inflammation'], '13244_2010_61_Fig18_HTML': ['Radiographic changes in reactive and psoriatic arthritis are often characterised by voluminous non-marginal syndesmophytes (parasyndesmophytes) or coalescing ossification of the paravertebral ligaments in addition to asymmetrical sacroiliitis (Fig.\xa0<xref rid="13244_2010_61_Fig18_HTML" ref-type="fig">18</xref>) [) [30].\nFig.\xa018Psoriatic arthritis (PsA), paravertebral ossifications. (a) AP and (b) lateral radiograph of the lumbar spine in a 48-year-old man with PsA showing voluminous paravertebral new bone formation (arrows) in addition to fusion of the second and third vertebral bodies. There was no concomitant sacroiliitis. (c) AP radiograph of the thoraco-lumbar junction in a female patient with axial PsA demonstrating coalescing paravertebral ossifications (arrows)'], '13244_2010_61_Fig19_HTML': ['Axial psoriatic arthritis (PsA) occurs in approximately 50% of patients with peripheral PsA [31]. It differs radiographically from AS by the voluminous paravertebral ossifications and the occurrence of spinal changes without concomitant sacroiliitis in 10% of patients [32]. Axial PsA may be clinically silent [33], and involvement of the cervical spine is frequent (atlanto-axial or apophyseal joint changes). The cervical changes may include atlanto-axial instability as seen in RA (Fig.\xa0<xref rid="13244_2010_61_Fig19_HTML" ref-type="fig">19</xref>), but the pathogenesis and thereby imaging findings are different. In PsA radiography and CT usually visualise new bone formation in the region of the dens. This is elicited by osseous inflammation (osteitis) and/or inflammation at ligament/tendon attachments (enthesitis) detectable by MRI (Fig.\xa0), but the pathogenesis and thereby imaging findings are different. In PsA radiography and CT usually visualise new bone formation in the region of the dens. This is elicited by osseous inflammation (osteitis) and/or inflammation at ligament/tendon attachments (enthesitis) detectable by MRI (Fig.\xa0<xref rid="13244_2010_61_Fig19_HTML" ref-type="fig">19</xref>). Osteitis is often a feature of spinal PsA and can occur together with paravertebral ossification/parasyndesmophytes and erosion of vertebral plates (Fig.\xa0). Osteitis is often a feature of spinal PsA and can occur together with paravertebral ossification/parasyndesmophytes and erosion of vertebral plates (Fig.\xa0<xref rid="13244_2010_61_Fig20_HTML" ref-type="fig">20</xref>). The above-mentioned and illustrated MR findings in PsA are based on personal observations and seem to reflect the radiographic changes encompassing a mixture of osteitis, enthesitis and erosion. Unfortunately, there is a lack of systematic description of spinal changes in PsA by MRI. Some of the patients described under the term SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome may have PsA. SAPHO is a collective term often used for inflammatory disorders primarily presenting with osseous hyperostosis and sclerosis, and they are frequently associated with skin disorders. The most commonly affected site in SAPHO is the anterior chest followed by the spine [). The above-mentioned and illustrated MR findings in PsA are based on personal observations and seem to reflect the radiographic changes encompassing a mixture of osteitis, enthesitis and erosion. Unfortunately, there is a lack of systematic description of spinal changes in PsA by MRI. Some of the patients described under the term SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome may have PsA. SAPHO is a collective term often used for inflammatory disorders primarily presenting with osseous hyperostosis and sclerosis, and they are frequently associated with skin disorders. The most commonly affected site in SAPHO is the anterior chest followed by the spine [34]. The PsA changes shown in Fig.\xa0<xref rid="13244_2010_61_Fig20_HTML" ref-type="fig">20</xref> are characterised by hyperostosis and sclerosis, both main features of SAPHO. However, this patient did not have anterior chest involvement.\n are characterised by hyperostosis and sclerosis, both main features of SAPHO. However, this patient did not have anterior chest involvement.\nFig.\xa019Cervical PsA. (a) Lateral radiographs in the neutral position and (b) during flexion in a 61-year-old woman show atlanto-axial instability with a 4-mm distance between the anterior arc and the dens (white line). Additionally, ankylosis of the apophyseal joints (black arrows) and new bone formation anterior to the C4-7 vertebral bodies (white arrows). CT, (c) axial slice and coronal reconstruction of the dens area, demonstrates new bone formation in the atlanto-axial region (arrows); (d) coronal reconstruction of the lower cervical region shows voluminous new bone formation on the right side of the vertebral bodies (arrows). MRI, (e) sagittal STIR and (f) T1-weighted images, shows homogeneous osseous inflammation corresponding to the dens (arrows) with surrounding irregular oedema compatible with a mixture of osteitis and enthesitis. Note that the anterior new bone formation visualised by radiography is difficult to detect on MRIFig.\xa020Lumbar PsA. (a) AP and (b) lateral radiograph in a 50-year-old man show voluminous paravertebral ossifications anteriorly and at the right side of the third lumbar vertebra and adjacent iv spaces. MRI, (c) sagittal STIR, (d) T1 and (e) post-contrast T1-weighted images, demonstrates manifest osseous inflammation (osteitis) in the form of oedema and enhancement of the vertebral body, slight enhancement in the paravertebral new bone formation and erosion of the upper vertebral plate compatible with a mixture of osteitis, enthesitis and erosive changes'], '13244_2010_61_Fig21_HTML': ['In patients with enteropathic arthritis associated with Crohn’s disease or ulcerative colitis, the spine is often osteoporotic with various accompanying SpA features by radiography, mostly AS-like changes. However, by MRI there may be more pronounced inflammation in the posterior ligaments than seen in the other forms of SpA (Fig.\xa0<xref rid="13244_2010_61_Fig21_HTML" ref-type="fig">21</xref>).\n).\nFig.\xa021Enteropathic SpA. Sagittal STIR image of the lumbar spine in a 27-year-old man with ulcerative colitis demonstrates oedema corresponding to the interspinous ligaments (arrows) and spinous processes as signs of inflammation. There are only minimal activity changes corresponding to the vertebral bodies, located to the anterior vertebral corners']} | Imaging the spine in arthritis—a pictorial review | [
"Spine",
"Arthritis",
"Arthritis, rheumatoid",
"Spondyloarthropathies"
] | Insights Imaging | 1294473600 | Digitalisation of medical data makes it possible to share images and workflows between related parties. In addition to linear data flow where healthcare professionals or patients are the information carriers, a new type of matrix of many-to-many connections is emerging. Implementation of shared workflow brings challenges of interoperability and legal clarity. Sharing images or workflows can be implemented on different levels with different challenges: inside the organisation, between organisations, across country borders, or between healthcare institutions and citizens. Interoperability issues vary according to the level of sharing and are either technical or semantic, including language. Legal uncertainty increases when crossing national borders. Teleradiology is regulated by multiple European Union (EU) directives and legal documents, which makes interpretation of the legal system complex. To achieve wider use of eHealth and teleradiology several strategic documents were published recently by the EU. Despite EU activities, responsibility for organising, providing and funding healthcare systems remains with the Member States. Therefore, the implementation of new solutions requires strong co-operation between radiologists, societies of radiology, healthcare administrators, politicians and relevant EU authorities. The aim of this article is to describe different dimensions of image and workflow sharing and to analyse legal acts concerning teleradiology in the EU. | [] | other | PMC3259357 | null | 33 | [
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] | Insights Imaging. 2011 Jan 8; 2(2):177-191 | NO-CC CODE |
|
Synchronous multifocal diverticulitis with three “inflamed diverticula” visible on the same CT examination: two of them are located in the right ascending colon (white and black arrows) and one in the left descending colon (arrowhead) | 13244_2010_51_Fig12_HTML | 7 | 1f3677d7eb794e1c8bcb7ce2fb42117c4d3c0713bead597533c86a5f43b743fb | 13244_2010_51_Fig12_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
762,
555
] | [{'image_id': '13244_2010_51_Fig20_HTML', 'image_file_name': '13244_2010_51_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig20_HTML.jpg', 'caption': 'A 68-year-old man with abdominal pain and fever. Abdominal contrast-enhanced CT demonstrated a superior mesenteric vein thrombosis (white arrows), with no regional source identified on this first CT scan (a, b). The septic source of this pylephlebitis was diverticulitis of the right colon (black arrow) detected by a second CT examination performed later with colonic opacification (c)', 'hash': '32c6be39641c8e83d4fb10b1b93f0ee456e59f7476f2e8abf7743d8086ec5818'}, {'image_id': '13244_2010_51_Fig10_HTML', 'image_file_name': '13244_2010_51_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig10_HTML.jpg', 'caption': 'Contrast-enhanced abdominal CT performed for acute left-sided abdominal pain in a 56-year-old woman. a Upper sections show perirenal fat stranding (white arrows). Bilateral incidental parapyelic cysts are present. b Lower sections revealed “inflamed diverticulum” within the posterior wall of the descending colon (black arrow) confirming the diagnosis of left colonic diverticulitis with almost purely retroperitoneal involvement', 'hash': '85f48974dc7cc577e469ff6bf10ee57b71be16b4de2b9e727f38b452eb95a50f'}, {'image_id': '13244_2010_51_Fig7_HTML', 'image_file_name': '13244_2010_51_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig7_HTML.jpg', 'caption': 'A 49-year-old patient, presented with acute pain of the upper right quadrant of the abdomen. CT showed a significant fat densification of the upper right quadrant (white arrows) mimicking segmental omental infarction. However, thickening of the right transverse colon associated with a typical “inflamed diverticulum” (black arrow) were diagnostic for diverticulitis of the transverse colon', 'hash': 'ae7af246662eee41c9c9ebc9b70e4f5dd5d5a34ea045fb5c30d13adee80ac05b'}, {'image_id': '13244_2010_51_Fig8_HTML', 'image_file_name': '13244_2010_51_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig8_HTML.jpg', 'caption': 'Diverticulitis of the descending colon with an anterior “inflamed diverticulum” (white arrows) associated with intraperitoneal paracolic inflammation', 'hash': '22584b8fe0451f5c2f1055d5f29af8fc016e0cfa20ce58025ddb93648ed688f6'}, {'image_id': '13244_2010_51_Fig27_HTML', 'image_file_name': '13244_2010_51_Fig27_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig27_HTML.jpg', 'caption': 'Abdominal CT in an 80-year-old patient admitted for acute abdominal pain and fever, demonstrating sigmoid thickening suggesting colonic cancer (white arrows) associated with the CT finding of upstream diverticulitis (black arrows). Evidence of the association between these two pathological conditions was surgically proven', 'hash': 'd1830319b33d0b0e0a752c8e137fec2574cbe773b9fed362d4e44877e7c8a19f'}, {'image_id': '13244_2010_51_Fig17_HTML', 'image_file_name': '13244_2010_51_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig17_HTML.jpg', 'caption': 'Chronic inflammatory narrowing of the sigmoid colon (black arrows), due to recurrent diverticulitis and responsible for large bowel obstruction and retraction of small bowel loops around an inflammatory mass (white arrows)', 'hash': '4661905382ef42945e6ae899d8061c9370162cee48a39e0f53b3bd520321f5d3'}, {'image_id': '13244_2010_51_Fig18_HTML', 'image_file_name': '13244_2010_51_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig18_HTML.jpg', 'caption': 'Contrast-enhanced abdominal CT demonstrating features of sigmoid “inflamed diverticulum” (black arrows) adjacent to a thickened bladder wall associated with free air within the bladder (white arrows), establishing the diagnosis of sigmoid diverticulitis with bladder fistulisation', 'hash': 'f6c8fc7b89a465c1b55ab6401bcc36e2e328af2bbb77dab29b331ac1d9c8ae82'}, {'image_id': '13244_2010_51_Fig11_HTML', 'image_file_name': '13244_2010_51_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig11_HTML.jpg', 'caption': 'Sigmoid diverticulitis in a 29-year-old patient with a sigmoid loop lying in the right iliac fossa masquerading clinically as appendicitis. Inflamed diverticulum (white arrow). Pericolic abscess (black arrow)', 'hash': '41f273f55637de9f49f8db9edc93febe8f624a7733852b8540e5885aa06b00e6'}, {'image_id': '13244_2010_51_Fig9_HTML', 'image_file_name': '13244_2010_51_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig9_HTML.jpg', 'caption': 'Diverticulitis of the descending colon with a posterior “inflamed diverticulum” (arrowhead) associated with retroperitoneal inflammation (arrows)', 'hash': '200c8f9fb3f820f2e80275eb300e3913ab735e488028ed45fbe041c2aa3bcac5'}, {'image_id': '13244_2010_51_Fig6_HTML', 'image_file_name': '13244_2010_51_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig6_HTML.jpg', 'caption': 'Diverticulitis of the right colon with an inflamed anterior diverticulum (white arrow) and thickening of the caecal wall, demonstrating the “arrowhead sign” (black arrow)', 'hash': '8e5e0ac3c71e583455fd069a3dfc6a3f1fe44113e4ebc8f6c8eae4e4362f1b22'}, {'image_id': '13244_2010_51_Fig21_HTML', 'image_file_name': '13244_2010_51_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig21_HTML.jpg', 'caption': 'Contrast-enhanced CT demonstrating hepatic abscess (black arrow) and pylephlebitis with intravenous free air (white arrowhead) in the superior mesenteric vein. The lower CT sections revealed the septic source which was sigmoid diverticulitis with a small paracolic abscess (white arrows)', 'hash': 'dd9d1d0781673cdae61e8c77bdefccad7836de2b2c7c4e64f9eb6c8bb9944ea7'}, {'image_id': '13244_2010_51_Fig19_HTML', 'image_file_name': '13244_2010_51_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig19_HTML.jpg', 'caption': 'Sigmoid diverticulitis with abscess formation (black arrow) and left adnexal extension of the inflammatory process (white arrow)', 'hash': 'b80d9853d0c37bd5f6018bf8bf1e6fd3483a375ef45421a3b171f2fda3178846'}, {'image_id': '13244_2010_51_Fig16_HTML', 'image_file_name': '13244_2010_51_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig16_HTML.jpg', 'caption': 'Sigmoid diverticulitis with abscess formation (black arrows) associated with thickening of adjacent small bowel wall (white arrowhead) responsible for intestinal obstruction (white arrows)', 'hash': '91cd5705c4de251917808b9350f827cd76bad3990bc12601dd126c178a0413ff'}, {'image_id': '13244_2010_51_Fig1_HTML', 'image_file_name': '13244_2010_51_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig1_HTML.jpg', 'caption': 'Abdominal CT performed within 24 h of symptoms onset demonstrating typical features of sigmoid diverticulitis (a, b), with colonic wall thickening (black arrow) and paracolic inflammation (white arrow). CT performed three weeks later, does not show any suggestion of diverticulitis', 'hash': '1eaab397c7757289ff3c7843c1ddb6c2d606558363b403baf1afecc2b9f9a0e4'}, {'image_id': '13244_2010_51_Fig26_HTML', 'image_file_name': '13244_2010_51_Fig26_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig26_HTML.jpg', 'caption': 'Sigmoid diverticulitis mimicking a sigmoid cancer (white arrows) with left ureteral involvement resulting in hydronephrosis (white arrowheads)', 'hash': 'df3dfbb88359638ae423b68c38d2d5c38465dfb792aeffc944c34a7cec5f48bf'}, {'image_id': '13244_2010_51_Fig25_HTML', 'image_file_name': '13244_2010_51_Fig25_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig25_HTML.jpg', 'caption': 'An 81-year-old man presenting with acute abdominal pain. Abdominal CT demonstrates extensive wall thickening of a diverticular left colon (arrowheads) with “disproportionate” pericolic fat standing (arrows) and no identified “inflamed diverticulum”, suggesting the diagnosis of ischaemic colitis rather than diverticulitis', 'hash': '0e0554718245ff9b3fb2a34f14f9f632b7c192d40befe918a8c003a6524356dd'}, {'image_id': '13244_2010_51_Fig2_HTML', 'image_file_name': '13244_2010_51_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig2_HTML.jpg', 'caption': 'Stercolith within a diverticulum of the right colon is more clearly identified on non-contrast-enhanced CT (a) (white arrow) than on contrast-enhanced CT (b). The association with mild paracolic inflammation (black arrows) is diagnostic for diverticulitis of the right colon', 'hash': 'e51ca233e818b01aba7e8f929db31c19b9dc5203ccc87c75095a0b0bd4270147'}, {'image_id': '13244_2010_51_Fig15_HTML', 'image_file_name': '13244_2010_51_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig15_HTML.jpg', 'caption': 'Diverticular perforation complicating sigmoid diverticulitis in a 35-year-old man. CT demonstrated free gas within the mesosigmoid inflamed fat (white arrows)', 'hash': 'f702a0b1a9445d6598e4b6c63fb116067244a62f5f85cc7fe5d0aa11b964ca51'}, {'image_id': '13244_2010_51_Fig22_HTML', 'image_file_name': '13244_2010_51_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig22_HTML.jpg', 'caption': 'Paracolic abscess with thickening of the adjacent sigmoid wall was very suggestive of sigmoid diverticulitis (white arrows). Curved MPR revealed a mild thickening of the extremity of the appendix (black arrows), which was pointing to the paracolic abscess. A final diagnosis of a perforated appendicitis was confirmed at surgery', 'hash': '23cd19b9cb338efc6fe35a3286c8be162f61e7faa1d62918d0ccf62e381099e9'}, {'image_id': '13244_2010_51_Fig5_HTML', 'image_file_name': '13244_2010_51_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig5_HTML.jpg', 'caption': 'Diverticulitis of the right colon, with an inflamed diverticulum of the posterior wall of the caecum with fat stranding (arrow). MPR showing adjacent normal appendix (arrowheads) confirmed the diagnosis', 'hash': '111e03fba011a4dbab68dea4c869d0d64919efcf239190d4a5475b70dd315c90'}, {'image_id': '13244_2010_51_Fig12_HTML', 'image_file_name': '13244_2010_51_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig12_HTML.jpg', 'caption': 'Synchronous multifocal diverticulitis with three “inflamed diverticula” visible on the same CT examination: two of them are located in the right ascending colon (white and black arrows) and one in the left descending colon (arrowhead)', 'hash': '1f3677d7eb794e1c8bcb7ce2fb42117c4d3c0713bead597533c86a5f43b743fb'}, {'image_id': '13244_2010_51_Fig3_HTML', 'image_file_name': '13244_2010_51_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig3_HTML.jpg', 'caption': 'Diverticulitis of the right colon in a 67-year-old woman with a history of renal failure. Only non-contrast-enhanced CT was performed in this patient and the assessment of CT features of diverticulitis (white arrows) was feasible thanks to colonic opacification', 'hash': 'b200749b4bca5cdca4e6d75b37dad99a14b7a095269f8342d6827aca6bbab235'}, {'image_id': '13244_2010_51_Fig14_HTML', 'image_file_name': '13244_2010_51_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig14_HTML.jpg', 'caption': 'Complicated sigmoid diverticulitis with two paracolic abscesses (white arrows)', 'hash': '06ae2d4d33b9f1df33323ef1c8354d59d0190ad6f03eada3a5ad4f23e6383001'}, {'image_id': '13244_2010_51_Fig24_HTML', 'image_file_name': '13244_2010_51_Fig24_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig24_HTML.jpg', 'caption': 'Non-contrast-enhanced and contrast-enhanced CT revealing typical features of sigmoid diverticulitis associated with secondary appendagitis (white arrows)', 'hash': '773d9e7ce14ed15148551ecdbb6336d1fd4634abc1981fb00a9c7fe8e894bab9'}, {'image_id': '13244_2010_51_Fig4_HTML', 'image_file_name': '13244_2010_51_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig4_HTML.jpg', 'caption': 'Abdominal CT in a 63-year-old woman, demonstrating typical features of non-complicated sigmoid diverticulitis (arrowheads). However, left uterine vein thrombosis with vein enlargement and filling defect (white arrows) was detected on portal phase contrast-enhanced CT', 'hash': 'a93efa6f6034532d32931abc23df269d81c8c26019f75dcdf2ddca4aba298cfb'}, {'image_id': '13244_2010_51_Fig13_HTML', 'image_file_name': '13244_2010_51_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig13_HTML.jpg', 'caption': 'a A 61-year-old patient was admitted to hospital in December 2004 with acute abdominal pain. Abdominal CT was diagnostic for diverticulitis of the right transverse colon. The patient was scheduled for surgery and right colonic resection was performed two months after recovery. b The patient was readmitted in September 2006, for similar clinical symptoms. The diagnosis of sigmoid diverticulitis was made on CT. Conservative treatment was performed. c The patient was readmitted in June 2007 for similar clinical symptoms. CT revealed diverticulitis involving the descending colon. Conservative treatment was performed. d The patient was readmitted in July 2007, with a fourth episode of diverticulitis involving the sigmoid colon', 'hash': '0621ff364cf798f366d1af87bb4adac23d57315ae2d3571e610d7841214e0094'}, {'image_id': '13244_2010_51_Fig23_HTML', 'image_file_name': '13244_2010_51_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC3259374/13244_2010_51_Fig23_HTML.jpg', 'caption': 'Primary appendagitis of the descending colon with a fatty oval-shaped nodule (white arrow) located antero-laterally to the colon associated with mild thickening of the parietal peritoneum (white arrowhead)', 'hash': '7e4355d7031f3fa78d6bf6c9968a3bdb0b754f185ed58fbca82e7e7f59004b0c'}] | {'13244_2010_51_Fig1_HTML': ['Timing of CT: The most common reason for CT failure in diagnosing CD is an excessively long interval between antibiotic therapy initiation and CT [5]. CT should be done within 48 h after onset of the symptoms suggesting CD (Fig.\xa0<xref rid="13244_2010_51_Fig1_HTML" ref-type="fig">1</xref>) [) [1].\nFig.\xa01Abdominal CT performed within 24 h of symptoms onset demonstrating typical features of sigmoid diverticulitis (a, b), with colonic wall thickening (black arrow) and paracolic inflammation (white arrow). CT performed three weeks later, does not show any suggestion of diverticulitis'], '13244_2010_51_Fig2_HTML': ['Non-contrast-enhanced CT: This is the first step in CT examination. Performed before any opacification, it may demonstrate free-air perforation and/or severe intestinal occlusion, which are relative contra-indications of digestive opacification [6]. Sometimes it gives additional arguments in favour of the diagnosis, such as an intradiverticular stercolith that may be less visible on a contrast-enhanced phase (Fig.\xa0<xref rid="13244_2010_51_Fig2_HTML" ref-type="fig">2</xref>) [) [7].\nFig.\xa02Stercolith within a diverticulum of the right colon is more clearly identified on non-contrast-enhanced CT (a) (white arrow) than on contrast-enhanced CT (b). The association with mild paracolic inflammation (black arrows) is diagnostic for diverticulitis of the right colon'], '13244_2010_51_Fig3_HTML': ['Colonic opacification: Although colonic opacification is not mandatory for the diagnosis of CD, it helps prevent confusion between collapsed bowel and mural thickening due to inflammation by distending the rectum and colon, and provides better images of the colon wall and pericolic abnormalities [8]. In a few cases, failure to opacify the colonic lumen may hinder the diagnosis of CD. Furthermore, colonic opacification could be diagnostic even without intravenous contrast-enhanced CT, which is of great interest in patients with renal failure or proven allergy to contrast material (Fig.\xa0<xref rid="13244_2010_51_Fig3_HTML" ref-type="fig">3</xref>) [) [9]. Some authors use oral contrast material but it should not be advised because of the increased patient preparation time and an often insufficient anterograde colonic opacification [10].\nFig.\xa03Diverticulitis of the right colon in a 67-year-old woman with a history of renal failure. Only non-contrast-enhanced CT was performed in this patient and the assessment of CT features of diverticulitis (white arrows) was feasible thanks to colonic opacification'], '13244_2010_51_Fig4_HTML': ['Contrast-enhanced CT: Intravenous contrast material administration is crucial for CT examination [11]. Portal venous phase performed after a 70- to 80-s delay, usually sufficient for arterial visualisation and excellent for venous opacification, is critical for enabling detection of subtle bowel wall abnormalities and vascular complications that otherwise might not be visible (Fig.\xa0<xref rid="13244_2010_51_Fig4_HTML" ref-type="fig">4</xref>).\n).\nFig.\xa04Abdominal CT in a 63-year-old woman, demonstrating typical features of non-complicated sigmoid diverticulitis (arrowheads). However, left uterine vein thrombosis with vein enlargement and filling defect (white arrows) was detected on portal phase contrast-enhanced CT'], '13244_2010_51_Fig5_HTML': ['Multiplanar reformations (MPRs): MPRs are not actually technical pitfalls but insufficiencies of the interpretation methodology. MPRs improve advantageously the assessment of colic and pericolic abnormalities, especially in the case of unusual anatomical location or complications (Fig.\xa0<xref rid="13244_2010_51_Fig5_HTML" ref-type="fig">5</xref>). They are widely used and recommended in the assessment of acute abdominal conditions [). They are widely used and recommended in the assessment of acute abdominal conditions [13–15].\nFig.\xa05Diverticulitis of the right colon, with an inflamed diverticulum of the posterior wall of the caecum with fat stranding (arrow). MPR showing adjacent normal appendix (arrowheads) confirmed the diagnosis', 'Diverticulitis of the right colon: The incidence of this form is low in Western countries (1.5%) but is significantly higher (55–70%) in Asian countries. It can present a significant diagnostic challenge, especially with acute appendicitis (Fig.\xa0<xref rid="13244_2010_51_Fig5_HTML" ref-type="fig">5</xref>) [) [17, 18]. Actually, the clinical preoperative diagnosis rate of right CD is as low as 5–35% [17, 19]. Performing CT improves significantly the diagnosis accuracy in right CD by showing typical features of an “inflamed diverticulum” (Fig.\xa0<xref rid="13244_2010_51_Fig6_HTML" ref-type="fig">6</xref>), which is defined as a rounded, paracolic outpouching centred within paracolic inflammation, with a measured soft tissue attenuation [), which is defined as a rounded, paracolic outpouching centred within paracolic inflammation, with a measured soft tissue attenuation [20]. Therefore, CT may prevent the patient from undergoing unnecessary surgery.\nFig.\xa06Diverticulitis of the right colon with an inflamed anterior diverticulum (white arrow) and thickening of the caecal wall, demonstrating the “arrowhead sign” (black arrow)'], '13244_2010_51_Fig7_HTML': ['Diverticulitis of the transverse colon: This represents a very unusual location of CD with only a few reports in the medical literature [21, 22]. It can masquerade clinically as cholecystitis, appendicitis, hepatic abscess, gastroduodenal perforation, pancreatitis, splenic and renal infection or infarction (Fig.\xa0<xref rid="13244_2010_51_Fig7_HTML" ref-type="fig">7</xref>).\n).\nFig.\xa07A 49-year-old patient, presented with acute pain of the upper right quadrant of the abdomen. CT showed a significant fat densification of the upper right quadrant (white arrows) mimicking segmental omental infarction. However, thickening of the right transverse colon associated with a typical “inflamed diverticulum” (black arrow) were diagnostic for diverticulitis of the transverse colon'], '13244_2010_51_Fig8_HTML': ['Diverticulitis of the descending colon: Much more common than the previous location, it is actually similar to sigmoid diverticulitis in its uncomplicated form (Fig.\xa0<xref rid="13244_2010_51_Fig8_HTML" ref-type="fig">8</xref>). Nevertheless, in its complicated forms and because of its close anatomical connection with the retroperitoneum, it becomes closer to “retroperitoneal” forms [). Nevertheless, in its complicated forms and because of its close anatomical connection with the retroperitoneum, it becomes closer to “retroperitoneal” forms [23, 24]. Thus, the differential diagnosis with any kind of retroperitoneal disease may arise, even if it is less likely because left-sided symptoms are often suggestive.\nFig.\xa08Diverticulitis of the descending colon with an anterior “inflamed diverticulum” (white arrows) associated with intraperitoneal paracolic inflammation'], '13244_2010_51_Fig9_HTML': ['“Retroperitoneal” diverticulitis: Diverticula in the posterior colon wall that are in close contact with the posterior peritoneum may produce retroperitoneal abnormalities [23, 24]. Most of these patients also have intraperitoneal lesions (Fig.\xa0<xref rid="13244_2010_51_Fig9_HTML" ref-type="fig">9</xref>). Purely retroperitoneal forms are exceedingly rare but raise formidable diagnostic challenges (Fig.\xa0). Purely retroperitoneal forms are exceedingly rare but raise formidable diagnostic challenges (Fig.\xa0<xref rid="13244_2010_51_Fig10_HTML" ref-type="fig">10</xref>).\n).\nFig.\xa09Diverticulitis of the descending colon with a posterior “inflamed diverticulum” (arrowhead) associated with retroperitoneal inflammation (arrows)Fig.\xa010Contrast-enhanced abdominal CT performed for acute left-sided abdominal pain in a 56-year-old woman. a Upper sections show perirenal fat stranding (white arrows). Bilateral incidental parapyelic cysts are present. b Lower sections revealed “inflamed diverticulum” within the posterior wall of the descending colon (black arrow) confirming the diagnosis of left colonic diverticulitis with almost purely retroperitoneal involvement'], '13244_2010_51_Fig11_HTML': ['“Ectopic” diverticulitis: This term encompasses CD in a long sigmoid loop lying in the right iliac fossa (Fig.\xa0<xref rid="13244_2010_51_Fig11_HTML" ref-type="fig">11</xref>) and the few cases of CD within inguinal or parietal herniation [) and the few cases of CD within inguinal or parietal herniation [25].\nFig.\xa011Sigmoid diverticulitis in a 29-year-old patient with a sigmoid loop lying in the right iliac fossa masquerading clinically as appendicitis. Inflamed diverticulum (white arrow). Pericolic abscess (black arrow)'], '13244_2010_51_Fig12_HTML': ['Synchronous multifocal diverticulitis: Multiplicity is a characteristic of diverticular disease. However, the occurrence of CD in distinct colonic sites at the same time is quite exceptional and may be misdiagnosed if the entire colon is not thoroughly analysed (Fig.\xa0<xref rid="13244_2010_51_Fig12_HTML" ref-type="fig">12</xref>) [) [28, 29].\nFig.\xa012Synchronous multifocal diverticulitis with three “inflamed diverticula” visible on the same CT examination: two of them are located in the right ascending colon (white and black arrows) and one in the left descending colon (arrowhead)'], '13244_2010_51_Fig13_HTML': ['Recurrent multifocal diverticulitis: Recurrence is characteristic of CD, usually occurring more or less at the same location as the previous episode, which is most often the sigmoid colon, justifying, in some reference centres, elective surgery after the second episode of acute CD [30]. Recurrence of CD at a different location in the colon (e.g. right or transverse colon) is quite a rare condition, raising controversy about the most appropriate management of patients following two episodes of acute CD (Fig.\xa0<xref rid="13244_2010_51_Fig13_HTML" ref-type="fig">13</xref>) [) [31, 32].\nFig.\xa013a A 61-year-old patient was admitted to hospital in December 2004 with acute abdominal pain. Abdominal CT was diagnostic for diverticulitis of the right transverse colon. The patient was scheduled for surgery and right colonic resection was performed two months after recovery. b The patient was readmitted in September 2006, for similar clinical symptoms. The diagnosis of sigmoid diverticulitis was made on CT. Conservative treatment was performed. c The patient was readmitted in June 2007 for similar clinical symptoms. CT revealed diverticulitis involving the descending colon. Conservative treatment was performed. d The patient was readmitted in July 2007, with a fourth episode of diverticulitis involving the sigmoid colon'], '13244_2010_51_Fig14_HTML': ['Perforation and abscess formation: CT evidence of a pericolic abscess or extraluminal air or contrast material is a well-established risk factor for failure of non-surgical treatment (Figs.\xa0<xref rid="13244_2010_51_Fig14_HTML" ref-type="fig">14</xref> and and <xref rid="13244_2010_51_Fig15_HTML" ref-type="fig">15</xref>) [) [33]. Even in the case of successful medical treatment, presence of extraluminal air or pericolic abscess indicates a need for prophylactic surgery [33, 34]. Wide windows settings should be used to look for extraluminal air.\nFig.\xa014Complicated sigmoid diverticulitis with two paracolic abscesses (white arrows)Fig.\xa015Diverticular perforation complicating sigmoid diverticulitis in a 35-year-old man. CT demonstrated free gas within the mesosigmoid inflamed fat (white arrows)'], '13244_2010_51_Fig16_HTML': ['Small bowel obstruction: CD is an uncommon cause of small bowel obstruction and may be overlooked as a cause. Small bowel obstruction occurs when diverticular inflammation, most often located at the antimesocolic side of a sigmoid loop, comes into contact with the mesenteric side of the small bowel (Fig.\xa0<xref rid="13244_2010_51_Fig16_HTML" ref-type="fig">16</xref>). Preoperative CT diagnosis is of first interest to rule out organic small bowel obstruction and prevent unnecessary surgery because inflammation can usually be healed with medical treatment, secondarily relieving the small bowel obstruction [). Preoperative CT diagnosis is of first interest to rule out organic small bowel obstruction and prevent unnecessary surgery because inflammation can usually be healed with medical treatment, secondarily relieving the small bowel obstruction [35].\nFig.\xa016Sigmoid diverticulitis with abscess formation (black arrows) associated with thickening of adjacent small bowel wall (white arrowhead) responsible for intestinal obstruction (white arrows)'], '13244_2010_51_Fig17_HTML': ['Large bowel obstruction: CD is supposed to be the cause of 10% of large bowel obstructions [11]. The large bowel can be obstructed in two ways: acute inflammation and oedema of the affected segment of bowel, with perhaps a pericolic abscess narrowing the lumen, or chronic inflammation, after recurrent attacks of diverticulitis, can result in fibrous bands across the bowel lumen causing obstruction (Fig.\xa0<xref rid="13244_2010_51_Fig17_HTML" ref-type="fig">17</xref>). A stricture resulting from CD can be difficult to differentiate from an obstructing neoplasm [). A stricture resulting from CD can be difficult to differentiate from an obstructing neoplasm [36]. CT alone may not distinguish the benign from the malignant causes of luminal narrowing and colonoscopy or sometimes surgery is required where diagnostic uncertainty remains.\nFig.\xa017Chronic inflammatory narrowing of the sigmoid colon (black arrows), due to recurrent diverticulitis and responsible for large bowel obstruction and retraction of small bowel loops around an inflammatory mass (white arrows)'], '13244_2010_51_Fig18_HTML': ['Fistulisation: Fistulisation most frequently involves the bladder in men (Fig.\xa0<xref rid="13244_2010_51_Fig18_HTML" ref-type="fig">18</xref>), which is less frequently involved in women when the uterus is present [), which is less frequently involved in women when the uterus is present [11, 37]. Uterine or adnexal or vaginal fistulisation may occur (Fig.\xa0<xref rid="13244_2010_51_Fig19_HTML" ref-type="fig">19</xref>) [) [38]. In other cases, fistulisation concerns the abdominal wall or the retroperitoneum and may have several presentations varying with the organ involved (hydronephrosis, psoas abscess, spondylodiscitis, etc.) [24, 39]. The diagnostic difficulty remains, proving the relationship between fistula and CD in the case of mild or absent colonic abnormalities.\nFig.\xa018Contrast-enhanced abdominal CT demonstrating features of sigmoid “inflamed diverticulum” (black arrows) adjacent to a thickened bladder wall associated with free air within the bladder (white arrows), establishing the diagnosis of sigmoid diverticulitis with bladder fistulisationFig.\xa019Sigmoid diverticulitis with abscess formation (black arrow) and left adnexal extension of the inflammatory process (white arrow)'], '13244_2010_51_Fig20_HTML': ['Pylephlebitis: Pylephlebitis is the result of the extension of the septic process into the venous drainage of the affected portion of the colon [40]. Spontaneous hyperdensity of the inferior mesenteric vein may be seen on non-contrast-enhanced CT. Narrowing CT windows is required when looking for this hyperdensity which may be unseen with a large window which are more adapted to analysis of peritoneal abnormalities. Luminal filling defect is usually present and can be associated with intraluminal air [41]. Luminal filling defect may be missed on contrast-enhanced CT if the injection delay is not optimal (<70–80\xa0s) for portal vein assessment (Figs.\xa0<xref rid="13244_2010_51_Fig20_HTML" ref-type="fig">20</xref> and and <xref rid="13244_2010_51_Fig21_HTML" ref-type="fig">21</xref>).\n).\nFig.\xa020A 68-year-old man with abdominal pain and fever. Abdominal contrast-enhanced CT demonstrated a superior mesenteric vein thrombosis (white arrows), with no regional source identified on this first CT scan (a, b). The septic source of this pylephlebitis was diverticulitis of the right colon (black arrow) detected by a second CT examination performed later with colonic opacification (c)Fig.\xa021Contrast-enhanced CT demonstrating hepatic abscess (black arrow) and pylephlebitis with intravenous free air (white arrowhead) in the superior mesenteric vein. The lower CT sections revealed the septic source which was sigmoid diverticulitis with a small paracolic abscess (white arrows)'], '13244_2010_51_Fig21_HTML': ['Liver abscesses: These are rare complications of CD. Therefore, CD must be considered within the aetiological diagnosis of liver abscesses [42]. A colonic septic source sometimes paucisymptomatic or hidden by an immunosuppressive treatment must be sought, especially when biliary tract disease is ruled out and no other septic origin is identified (Fig.\xa0<xref rid="13244_2010_51_Fig21_HTML" ref-type="fig">21</xref>).).'], '13244_2010_51_Fig22_HTML': ['Acute appendicitis: As the most frequent abdominal emergency, appendicitis is important to consider systematically because of its extraordinary variability in clinical presentation, until or unless a normal appendix is visualised. Appendicitis and diverticulitis of the right colon share a younger patient population than sigmoid diverticulitis and clinical presentation is usually about the right lower quadrant. However, therapeutic issues diverge with emergency surgery for appendicitis and medical treatment for CD if uncomplicated, which make the differential diagnosis crucial [44]. On CT, differentiating appendicitis and right CD can be very challenging in the case of (1) pericaecal inflammatory stranding in the absence of a visualised appendix, (2) both thickened diverticular caecal wall and appendix with fat stranding or (3) appendicitis in a medial or pelvic location may simulate CD if the distal part of the appendix is in contact with a sigmoid loop (Fig.\xa0<xref rid="13244_2010_51_Fig22_HTML" ref-type="fig">22</xref>) [) [45, 46]. Factors that may contribute to a missed diagnosis include a misleading clinical history, paucity of intra-abdominal fat, incomplete contrast material filling of the caecum and small bowel ileus [47].\nFig.\xa022Paracolic abscess with thickening of the adjacent sigmoid wall was very suggestive of sigmoid diverticulitis (white arrows). Curved MPR revealed a mild thickening of the extremity of the appendix (black arrows), which was pointing to the paracolic abscess. A final diagnosis of a perforated appendicitis was confirmed at surgery'], '13244_2010_51_Fig23_HTML': ['Appendagitis: Epiploic appendagitis is a rare condition that consists of inflammatory and ischaemic changes related to torsion or spontaneous venous thrombosis of one the epiploic appendices. Clinically, it is most often mistaken for CD. The two conditions are largely indistinguishable on the basis of clinical manifestations alone. However, management and therapeutic issues of these two pathological conditions are different. A misdiagnosis of acute appendagitis as CD may result in unnecessary hospital admission and antibiotic therapy [48]. Because the CT appearance (well-defined oval or round area of fat with an enhancing rim located immediately adjacent to the colon) usually suggests the correct diagnosis non-invasively, most cases can be managed conservatively (Fig.\xa0<xref rid="13244_2010_51_Fig23_HTML" ref-type="fig">23</xref>). Approximately 7.1% of patients investigated to exclude CD have imaging findings of primary epiploic appendagitis. Although the differential diagnosis is often easy, appendagitis may simulate CD including mild thickening of the colonic wall which is a rare but classically reported finding [). Approximately 7.1% of patients investigated to exclude CD have imaging findings of primary epiploic appendagitis. Although the differential diagnosis is often easy, appendagitis may simulate CD including mild thickening of the colonic wall which is a rare but classically reported finding [49]. On the other hand, inflammation from CD may extend to involve secondarily epiploic appendages, which is a common finding in the case of CD, with the resultant increased difficulty of diagnosis on the basis of CT images [48, 50]. “Secondary” appendagitis should not be misdiagnosed as primary acute appendagitis (Fig.\xa0<xref rid="13244_2010_51_Fig24_HTML" ref-type="fig">24</xref>). Actually, extraluminal air, a lengthy segment of thickened colonic wall, fistula, abscess formation and bowel obstruction are extremely rare in primary acute appendagitis [). Actually, extraluminal air, a lengthy segment of thickened colonic wall, fistula, abscess formation and bowel obstruction are extremely rare in primary acute appendagitis [48].\nFig.\xa023Primary appendagitis of the descending colon with a fatty oval-shaped nodule (white arrow) located antero-laterally to the colon associated with mild thickening of the parietal peritoneum (white arrowhead)Fig.\xa024Non-contrast-enhanced and contrast-enhanced CT revealing typical features of sigmoid diverticulitis associated with secondary appendagitis (white arrows)'], '13244_2010_51_Fig25_HTML': ['Colitis: Most acute inflammatory diseases of the colon, including infectious, non-infectious, and ischaemic disorders, are centred in the colon wall. For these diseases, the degree of colonic wall thickening typically exceeds the degree of associated fat stranding, and not uncommonly; fat stranding may be subtle despite marked mural abnormality [10, 51]. In CD, however, fat stranding is described as “disproportionate” (i.e. stranding more severe than expected for the degree of bowel wall thickening present), which is considered to be a reliable sign for the diagnosis of CD in patients with acute abdominal pain (Fig.\xa0<xref rid="13244_2010_51_Fig25_HTML" ref-type="fig">25</xref>) [) [51].\nFig.\xa025An 81-year-old man presenting with acute abdominal pain. Abdominal CT demonstrates extensive wall thickening of a diverticular left colon (arrowheads) with “disproportionate” pericolic fat standing (arrows) and no identified “inflamed diverticulum”, suggesting the diagnosis of ischaemic colitis rather than diverticulitis'], '13244_2010_51_Fig26_HTML': ['Colon cancer: The most important entity in the differential diagnosis of CD to exclude is colon cancer. Several studies have described the CT features differentiating CD from colon cancer, and have found statistically significant differences in the frequency of different CT findings in patients with colon cancer and those with CD [4, 52–54]. The CT signs that are most suggestive of CD are (1) a stenosis longer than 10\xa0cm, (2) sloping transition zones, (3) colon wall thickness less than 1\xa0cm, (4) fluid in the colonic mesentery, (5) engorgement of mesenteric vessels and (6) absence of enlarged pericolonic lymph nodes (Figs.\xa0<xref rid="13244_2010_51_Fig26_HTML" ref-type="fig">26</xref> and and <xref rid="13244_2010_51_Fig27_HTML" ref-type="fig">27</xref>). In spite of this good correlation, many authors reported a considerable overlap in the CT diagnosis of these two conditions, reaching 50% of cases [). In spite of this good correlation, many authors reported a considerable overlap in the CT diagnosis of these two conditions, reaching 50% of cases [52]. By using strict criteria, however, one can make a correct unequivocal diagnosis of CD or cancer in approximately 50% of cases. In those cases, the patients need not undergo further diagnostic evaluation, and further evaluation may be carried out for surgical planning. Besides, the diagnosis may be twice as misleading when ischaemic colitis occurs, which is a classical associated feature in both colonic cancer and CD with mechanical obstruction [55]. Nevertheless, making the diagnosis on the basis of only imaging findings can be very difficult in approximately half of the patients, and colonoscopy at a distance from the acute flare is strongly recommended. Recently, a few studies have reported that functional CT perfusion measurements may facilitate differentiation and discrimination, in combination with morphological criteria, between cancer and CD [56].\nFig.\xa026Sigmoid diverticulitis mimicking a sigmoid cancer (white arrows) with left ureteral involvement resulting in hydronephrosis (white arrowheads)Fig.\xa027Abdominal CT in an 80-year-old patient admitted for acute abdominal pain and fever, demonstrating sigmoid thickening suggesting colonic cancer (white arrows) associated with the CT finding of upstream diverticulitis (black arrows). Evidence of the association between these two pathological conditions was surgically proven']} | CT findings of misleading features of colonic diverticulitis | [
"Colonic diverticulitis",
"CT",
"Computed tomography"
] | Insights Imaging | 1291276800 | Cardiovascular magnetic resonance (CMR), a valuable non-invasive technique for the evaluation of the cardiovascular system, has already been accepted as the "gold standard" for the assessment of systolic function. The assessment of diastolic function is important not only for diagnosis purposes, but also in terms of prognosis. ECG-triggering phase-contrast (PC) CMR allows the routine assessment of diastolic function by measuring the transmitral and pulmonary venous flow with high accuracy and reproducibility, using morphological and quantitative parameters similar to those obtained by transthoracic echocardiography, which are so familiar to general cardiologists. Therefore, the increasing role of CMR in the assessment of the cardiovascular system requires a greater awareness and knowledge of this condition by radiologists. The aim of this study is to review the main mechanisms and common causes of left ventricle diastolic dysfunction, provide a practical approach for the assessment of LV diastolic function and illustrate the different degrees of diastolic dysfunction. | [] | other | PMC3259374 | null | 42 | [
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] | Insights Imaging. 2010 Dec 2; 2(1):69-84 | NO-CC CODE |
|
A 46-year-old man with progressive heart failure and known Becker’s muscular dystrophy. a Short-axis SSFP sequence showed dilation of the left ventricle (end-diastolic diameter = 70 mm). b Late-enhanced sequence showed extensive transmural high signal throughout the lateral segments (arrows) | 13244_2010_45_Fig6_HTML | 7 | 218200924d2501de358ab7a0dca128ad197b37b3c60138333414eb0a53ad08b6 | 13244_2010_45_Fig6_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
767,
1517
] | [{'image_id': '13244_2010_45_Fig12_HTML', 'image_file_name': '13244_2010_45_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259378/13244_2010_45_Fig12_HTML.jpg', 'caption': 'A 54-year-old woman admitted with acute onset chest pain following a road traffic accident. Vertical long-axis SSFP sequence in (a) diastole and (b) systole showed akinesis of LV myocardial segments at the midventricular level. The basal and apical segments showed vigorous contraction. (c) Late-enhanced short-axis sequence showed an absence of scar, excluding significant infarction', 'hash': '600f8ed931f496b2d3992ed82697c3ba15db58c93a354ebf2379d3bc6ec141cf'}, {'image_id': '13244_2010_45_Fig3_HTML', 'image_file_name': '13244_2010_45_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259378/13244_2010_45_Fig3_HTML.jpg', 'caption': 'A 46-year-old man with known Noonan’s syndrome. a Horizontal long axis SSFP sequence showed septal hypertrophy (arrow) and a dilated left atrium secondary to mitral regurgitation. b Late-enhanced short axis sequence showed extensive high signal involving the antero- and infero-septal myocardial segments (arrow)', 'hash': 'aa540d4fa16404eeed93a61c373ab1e85464a86f4a9ce0c42e2c18d57f6e59d6'}, {'image_id': '13244_2010_45_Fig4_HTML', 'image_file_name': '13244_2010_45_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259378/13244_2010_45_Fig4_HTML.jpg', 'caption': 'A 21-year-old man with known Danon’s glycogen storage disorder. a Short-axis SSFP sequence showed hypertrophy of the interventricular septum (arrow). b Late-enhanced short axis sequence showed circumferential high signal in the LV', 'hash': '7df3929bc4359b7c04cfa5613ca86da87b9f7ad32c3840012d1b530081e9a97b'}, {'image_id': '13244_2010_45_Fig2_HTML', 'image_file_name': '13244_2010_45_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259378/13244_2010_45_Fig2_HTML.jpg', 'caption': 'A 19-year-old man with Friedrichs ataxia who presented with acute chest pain. a Short-axis SSFP sequence showed circumferential hypertrophy of the left ventricle. b Late-enhanced sequence showed an absence of high signal. Late-enhancement has not been described in FA', 'hash': 'a286340392a752f506f2d7610c33ce2f17ed689309964817ac461fa4637c9298'}, {'image_id': '13244_2010_45_Fig5_HTML', 'image_file_name': '13244_2010_45_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259378/13244_2010_45_Fig5_HTML.jpg', 'caption': 'A 34-year-old woman with progressive shortness of breath 1\xa0week following post-partum. a Short-axis SSFP sequence showed mild dilation of the left ventricle (end-diastolic diameter\u2009=\u200962\xa0mm). b Late-enhanced sequence showed an absence of high signal in this case', 'hash': '1e3744691808d33b6e6c04e79b3eb2e540d8c8fe8bfd1d5ec8d30212f994ee64'}, {'image_id': '13244_2010_45_Fig6_HTML', 'image_file_name': '13244_2010_45_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259378/13244_2010_45_Fig6_HTML.jpg', 'caption': 'A 46-year-old man with progressive heart failure and known Becker’s muscular dystrophy. a Short-axis SSFP sequence showed dilation of the left ventricle (end-diastolic diameter\u2009=\u200970\xa0mm). b Late-enhanced sequence showed extensive transmural high signal throughout the lateral segments (arrows)', 'hash': '218200924d2501de358ab7a0dca128ad197b37b3c60138333414eb0a53ad08b6'}, {'image_id': '13244_2010_45_Fig9_HTML', 'image_file_name': '13244_2010_45_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259378/13244_2010_45_Fig9_HTML.jpg', 'caption': 'A 38-year-old man with hypereosinophilic syndrome presented with progressive shortness of breath. Serum measurements showed a white cell count of 45,000, 41,000 of which were eosinophils. a Horizontal long-axis SSFP sequence showed mild circumferential hypertrophy of the left ventricle. b Late-enhanced short-axis sequence showed extensive high signal in the interventricular septum and lateral wall. c Late-enhanced horizontal long-axis view confirms extensive high signal throughout the septum and lateral basal segments (arrows)', 'hash': '97cae9697874eca19573627fcb4eb985363a74027485208ab0b22b1342d9a204'}, {'image_id': '13244_2010_45_Fig10_HTML', 'image_file_name': '13244_2010_45_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259378/13244_2010_45_Fig10_HTML.jpg', 'caption': 'A 46-year-old man with progressive shortness of breath. He was diagnosed with HIV and endomyocardial biopsy revealed cardiac lymphoma. Echocardiography suggested diastolic heart failure. a Short-axis SSFP sequence showed circumferential infiltration of the basal segments of the right and left ventricle. b Pre-contrast T1-weighted horizontal long-axis sequence showed extensive lymphomatous infiltration of all four heart chambers. c Post-contrast T1-weighted horizontal long-axis sequence showed marked enhancement of the extensive lymphomatous infiltrating masses throughout the heart', 'hash': '474c9d3f8427f5699de6e68f635910501d32a15aea75d587a696507545d2c44a'}, {'image_id': '13244_2010_45_Fig1_HTML', 'image_file_name': '13244_2010_45_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259378/13244_2010_45_Fig1_HTML.jpg', 'caption': 'A 78-year-old man who presented with progressive heart failure. RV endomyocardial biopsy showed cardiac amyloid. a Horizontal long axis SSFP sequence showed hypetrophy of the basal segments of the LV (straight arrow), biatrial enlargement and thickening of the interatrial septum (curved arrow). Note the small pericardial effusion. b Late-enhanced sequence showed circumferential subendocardial high signal. Note the high signal on the RV side of the interventricular septum resulting in the tram track sign (straight arrow). Note also the small pericardial effusion (curved arrow)', 'hash': 'd1c729702e3b3206550e4fc17876a88eb15cd7c380cd9b1d27579e38c38f9f97'}, {'image_id': '13244_2010_45_Fig8_HTML', 'image_file_name': '13244_2010_45_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259378/13244_2010_45_Fig8_HTML.jpg', 'caption': 'A 55-year-old man who presented with progressive shortness of breath. He had a background history of severe systemic sclerosis. Late-enhanced short-axis sequence showed extensive high signal in the interventricular septum (arrows)', 'hash': '0a5481326730f7e25c04c0f68a7b042ce7f3281d62f870bf350e83f63637aa72'}, {'image_id': '13244_2010_45_Fig7_HTML', 'image_file_name': '13244_2010_45_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259378/13244_2010_45_Fig7_HTML.jpg', 'caption': 'A 21-year-old man admitted with severe central chest pain 12 h after orally ingesting mephedrone. a T2-weighted sequence showed high signal in the lateral segments consistent with myocardial edema (arrow). b Late-enhanced short-axis sequence showed high signal in the mid-wall lateral segment consistent with acute myocardial inflammation (arrow)', 'hash': '28066414974325d50828e3cf0fbfa7836db9d9872a09623a056d7b0a0616a546'}, {'image_id': '13244_2010_45_Fig11_HTML', 'image_file_name': '13244_2010_45_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259378/13244_2010_45_Fig11_HTML.jpg', 'caption': 'A 38-year-old woman with progressive shortness of breath. a Vertical long-axis SSFP sequence showed increased trabeculations at the apical ventricular level. (arrow) b Short-axis SSFP sequence showing the importance of precise image planes when evaluating LVNC. Radial image planes with the placed through the centrepoint of the LV cavity avoids the risk of prescribing oblique planes. c Late-enhanced vertical long-axis sequence showed high signal throughout the trabeculae consistent with trabecular fibrosis (arrow)', 'hash': '2eeaba269a6658500f260324000ebcef43b60de779c50f34bd8bd3cd1a925c69'}] | {'13244_2010_45_Fig1_HTML': ['Cardiac amyloid typically demonstrates a diffuse decrease in signal intensity on T1 weighted FSE images [9, 10]. It generally causes diffuse hypertrophy of both the left and right ventricles (Fig.\xa0<xref rid="13244_2010_45_Fig1_HTML" ref-type="fig">1a</xref>), in contradistinction to HCM, which typically causes more focal hypertrophy. Thickening of the interatrial septum (Fig.\xa0), in contradistinction to HCM, which typically causes more focal hypertrophy. Thickening of the interatrial septum (Fig.\xa0<xref rid="13244_2010_45_Fig1_HTML" ref-type="fig">1a</xref>) and posterior right atrial wall >6\xa0mm is also seen in cardiac amyloidosis [) and posterior right atrial wall >6\xa0mm is also seen in cardiac amyloidosis [11]. Late gadolinium enhancement (LGE) is another hallmark of cardiac amyloidosis on CMR. In a study by Vogelsberg et al. [12], LGE was demonstrated in 79% of patients with cardiac amyloidosis. Several different patterns of LGE were seen. There was LGE of the entire subendocardial circumference, extending in various degrees into neighbouring myocardium (Fig.\xa0<xref rid="13244_2010_45_Fig1_HTML" ref-type="fig">1b</xref>). Late gadolinium enhancement was also distributed in large areas in the left ventricle, mainly involving subendocardial areas circumferentially. Subepicardial myocardium was typically less affected. Late gadolinium enhancement in the papillary muscles was also seen in approximately 40% of patients (Fig.\xa0). Late gadolinium enhancement was also distributed in large areas in the left ventricle, mainly involving subendocardial areas circumferentially. Subepicardial myocardium was typically less affected. Late gadolinium enhancement in the papillary muscles was also seen in approximately 40% of patients (Fig.\xa0<xref rid="13244_2010_45_Fig1_HTML" ref-type="fig">1b</xref>). Ejection fractions, left ventricular end-diastolic volume and myocardial mass were not significantly different between the cardiac amyloid group and the other group of patients with various cardiac disorders. The average interventricular septum was 17 ± 4\xa0mm in the amyloid group compared with 13 ± 3\xa0mm in the non-amyloid group [). Ejection fractions, left ventricular end-diastolic volume and myocardial mass were not significantly different between the cardiac amyloid group and the other group of patients with various cardiac disorders. The average interventricular septum was 17 ± 4\xa0mm in the amyloid group compared with 13 ± 3\xa0mm in the non-amyloid group [12]. A more recent study by Syed et al. [13] of CMR appearances in 120 patients with cardiac amyloidosis demonstrated LGE in 97% of patients and increased left ventricular wall thickness in 91%. Global transmural or subendocardial LGE was the most common pattern seen in 83% of patients and this was associated with greater interstitial amyloid deposition. In a study of CMR appearances in 16 patients with amyloidosis, a mild or moderate pericardial effusion was seen in 46% of patients and a pleural effusion in 50% [14].\nFig.\xa01A 78-year-old man who presented with progressive heart failure. RV endomyocardial biopsy showed cardiac amyloid. a Horizontal long axis SSFP sequence showed hypetrophy of the basal segments of the LV (straight arrow), biatrial enlargement and thickening of the interatrial septum (curved arrow). Note the small pericardial effusion. b Late-enhanced sequence showed circumferential subendocardial high signal. Note the high signal on the RV side of the interventricular septum resulting in the tram track sign (straight arrow). Note also the small pericardial effusion (curved arrow)'], '13244_2010_45_Fig2_HTML': ['Rajagopalan et al. [19] demonstrated a correlation between increasing GAA1 repeat numbers and increasing LV mass (Fig.\xa0<xref rid="13244_2010_45_Fig2_HTML" ref-type="fig">2a, b</xref>). Left ventricular mass was higher in patients with larger GAA1 (>600) repeat sizes. Left ventricle mass positively correlated with the genetic severity of the disease and is seen in earlier onset disease and short disease duration. Longer disease duration is associated with smaller LV mass. Septal and posterior wall thickness showed similar changes with greater thickness seen in patient groups with >600 GAA1 repeats [). Left ventricular mass was higher in patients with larger GAA1 (>600) repeat sizes. Left ventricle mass positively correlated with the genetic severity of the disease and is seen in earlier onset disease and short disease duration. Longer disease duration is associated with smaller LV mass. Septal and posterior wall thickness showed similar changes with greater thickness seen in patient groups with >600 GAA1 repeats [19]. The number of patients with severe hypertrophy was relatively small and overt hypertrophy relatively greater in patients with larger GAA1 repeats [18, 20].\nFig.\xa02A 19-year-old man with Friedrichs ataxia who presented with acute chest pain. a Short-axis SSFP sequence showed circumferential hypertrophy of the left ventricle. b Late-enhanced sequence showed an absence of high signal. Late-enhancement has not been described in FA'], '13244_2010_45_Fig3_HTML': ['The most common cardiac defect is pulmonary valve stenosis, which affects approximately 50% of patients with Noonan syndrome [26]. Pulmonary stenosis is more common in patients with PTPN11 mutations. Atrial septal defects occur in approximately 10%, persistent ductus arteriosus in 3% and ventricular septal defects in 5% [21]. Asymmetric septal hypertrophy is present in 20% of patients (Fig.\xa0<xref rid="13244_2010_45_Fig3_HTML" ref-type="fig">3a, b</xref>) [) [27, 28]. A case report by Hudsmith et al. [28] described the CMR appearances in a woman with Noonan syndrome. The patient underwent open pulmonary valvotomy and secundum atrial septal defect closure as a child. There was asymmetrical septal hypertrophy detected on CMR with an increased LV mass. Following gadolinium, there was patchy increased signal in the anterior, anteroseptal and lateral walls. Myocardial hypertrophy associated with Noonan syndrome is not strongly associated with sudden death or rhythm disturbances though it is histologically similar to non-syndromic HCM [26].\nFig.\xa03A 46-year-old man with known Noonan’s syndrome. a Horizontal long axis SSFP sequence showed septal hypertrophy (arrow) and a dilated left atrium secondary to mitral regurgitation. b Late-enhanced short axis sequence showed extensive high signal involving the antero- and infero-septal myocardial segments (arrow)'], '13244_2010_45_Fig4_HTML': ['The glycogen storage disorders generally induce myocardial hypertrophy. CMR is useful for assessing the severity of hypertrophy and assessing function. Either concentric or asymmetric hypertrophy is present in most male patients, although some present with late-stage dilated cardiomyopathy (Fig.\xa0<xref rid="13244_2010_45_Fig4_HTML" ref-type="fig">4a, b</xref>). Female patients usually present with dilated cardiomyopathy [). Female patients usually present with dilated cardiomyopathy [33].\nFig.\xa04A 21-year-old man with known Danon’s glycogen storage disorder. a Short-axis SSFP sequence showed hypertrophy of the interventricular septum (arrow). b Late-enhanced short axis sequence showed circumferential high signal in the LV'], '13244_2010_45_Fig5_HTML': ['Reports of the CMR appearances in PPCM show conflicting results. Generally, patients present with a dilated left ventricle (Fig.\xa0<xref rid="13244_2010_45_Fig5_HTML" ref-type="fig">5a, b</xref>). Results following the administration of gadolinium are conflicting. Kawano et al. [). Results following the administration of gadolinium are conflicting. Kawano et al. [36] described a case of peripartum cardiomyopathy in which CMR at 2\xa0months demonstrated diffuse epicardial and mid-wall late gadolinium enhancement in the left ventricle. The late gadolinium enhancement decreased on follow up CMR performed at 10 months. Caballero-Borrego et al. [37] described a case of PPCM imaged with CMR in the chronic phase. CMR demonstrated extensive linear LGE at the septal segments. In contrast, a case report by Leurent et al. [38] in a patient with PPCM failed to show any LGE on CMR 8 days after the onset of symptoms. A series of eight patients by Mouquet et al. [39] evaluating the CMR appearances in PPCM also failed to demonstrate myocardial LGE, even in patients imaged within 2 weeks of symptoms. No specific CMR characteristics were demonstrated between the patients who regained LV function and those who did not. Marmursztein et al. [40] described two patients with PPCM imaged with CMR. One patient demonstrated no CMR abnormality. The second patient had several areas of myocardial LGE. At clinical follow-up, the patient with a normal CMR had full recovery of cardiac function and was asymptomatic. The patient with LGE on CMR had persistent LV dysfunction.\nFig.\xa05A 34-year-old woman with progressive shortness of breath 1\xa0week following post-partum. a Short-axis SSFP sequence showed mild dilation of the left ventricle (end-diastolic diameter\u2009=\u200962\xa0mm). b Late-enhanced sequence showed an absence of high signal in this case'], '13244_2010_45_Fig6_HTML': ['Early cardiac evaluation of patients with BMD and DMD is required to assess those with early signs of cardiac abnormalities who may benefit from early intervention. Cardiac involvement in BMD begins at the subepicardium of the inferolateral wall in the third decade of life and increases in extent with age. Progressive myocardial damage causes regional loss of contractility and a progressive decrease in LV systolic function (Fig.\xa0<xref rid="13244_2010_45_Fig6_HTML" ref-type="fig">6a</xref>). Yilmaz et al. [). Yilmaz et al. [44] studied 15 patients with BMD. Twelve patients had evidence of cardiac involvement by CMR. Patients with reduced left ventricular ejection fraction were older, with heavier hearts and regional wall motion abnormalities. Late gadolinium enhancement was seen on CMR in DMD involving predominantly the inferolateral free wall, the basal inferior and anterolateral region of the left ventricle (Fig.\xa0<xref rid="13244_2010_45_Fig6_HTML" ref-type="fig">6b</xref>). There was sparing of the right ventricle and interventricular septum [). There was sparing of the right ventricle and interventricular septum [45, 46]. Cardiac involvement in BMD is uncommon under the age of 16\xa0years, increasing to approximately 70% by 40\xa0years of age [44, 47].\nFig.\xa06A 46-year-old man with progressive heart failure and known Becker’s muscular dystrophy. a Short-axis SSFP sequence showed dilation of the left ventricle (end-diastolic diameter\u2009=\u200970\xa0mm). b Late-enhanced sequence showed extensive transmural high signal throughout the lateral segments (arrows)'], '13244_2010_45_Fig7_HTML': ['Drug–induced myocarditis CMR typically shows high signal on T2-weighted sequences, an increased global enhancement ratio and high signal on delayed enhanced sequences (Fig.\xa0<xref rid="13244_2010_45_Fig7_HTML" ref-type="fig">7a</xref> and and <xref rid="13244_2010_45_Fig7_HTML" ref-type="fig">b</xref>). There is often regional wall motion hypokinesis in the lateral segments. The abnormal enhancement typically affects the lateral segments.\n). There is often regional wall motion hypokinesis in the lateral segments. The abnormal enhancement typically affects the lateral segments.\nFig.\xa07A 21-year-old man admitted with severe central chest pain 12 h after orally ingesting mephedrone. a T2-weighted sequence showed high signal in the lateral segments consistent with myocardial edema (arrow). b Late-enhanced short-axis sequence showed high signal in the mid-wall lateral segment consistent with acute myocardial inflammation (arrow)'], '13244_2010_45_Fig8_HTML': ['Tzelepis et al. [62] reviewed the CMR appearances of 41 patients with SSc; 24 of 36 (66%) demonstrated LGE characteristically midwall LGE with sparing of the subendocardium (Fig.\xa0<xref rid="13244_2010_45_Fig8_HTML" ref-type="fig">8</xref>). There was a linear pattern in all patients that was infrequently interrupted or spiculated. The LGE predominantly involved the basal and mid ventricular LV segments with less common involvement of the apices. Patchy nodular enhancement was seen in the lower or upper right ventricular insertion points in 17% of patients. Myocardial fibrosis appears to progress from base to apex. All patients with LGE had involvement of the basal segments. Midcavity involvement was always associated with basal involvement and apical involvement was associated with basal and midcavity fibrosis. Apical segment was seen in patients with a greater duration of Raynaud’s phenomenon. Myocardial fibrosis was similar between diffuse and localized SSc and was more severe in patients with abnormal Holter results [). There was a linear pattern in all patients that was infrequently interrupted or spiculated. The LGE predominantly involved the basal and mid ventricular LV segments with less common involvement of the apices. Patchy nodular enhancement was seen in the lower or upper right ventricular insertion points in 17% of patients. Myocardial fibrosis appears to progress from base to apex. All patients with LGE had involvement of the basal segments. Midcavity involvement was always associated with basal involvement and apical involvement was associated with basal and midcavity fibrosis. Apical segment was seen in patients with a greater duration of Raynaud’s phenomenon. Myocardial fibrosis was similar between diffuse and localized SSc and was more severe in patients with abnormal Holter results [62].\nFig.\xa08A 55-year-old man who presented with progressive shortness of breath. He had a background history of severe systemic sclerosis. Late-enhanced short-axis sequence showed extensive high signal in the interventricular septum (arrows)'], '13244_2010_45_Fig9_HTML': ['Several case reports have documented the CMR appearances of HES (Fig.\xa0<xref rid="13244_2010_45_Fig9_HTML" ref-type="fig">9a–c</xref>) [) [64–67]. Syed el al. [67] describe extensive thickening of the LV myocardium and partial obliteration of the LV cavity on systole. Following contrast, a three-layered appearance on CMR was identified, consisting of the normal uninfiltrated myocardium, a hyperintense subendocardium and a linear hypointense layer of thrombus found inside the endocardium. Similar hyperenhancement of the endocardium compared with the myocardium was seen on CMR by Salanitri [65].\nFig.\xa09A 38-year-old man with hypereosinophilic syndrome presented with progressive shortness of breath. Serum measurements showed a white cell count of 45,000, 41,000 of which were eosinophils. a Horizontal long-axis SSFP sequence showed mild circumferential hypertrophy of the left ventricle. b Late-enhanced short-axis sequence showed extensive high signal in the interventricular septum and lateral wall. c Late-enhanced horizontal long-axis view confirms extensive high signal throughout the septum and lateral basal segments (arrows)'], '13244_2010_45_Fig10_HTML': ['Most cardiac tumours are low signal intensity on T1 sequences and brighter on T2 sequences (Fig.\xa0<xref rid="13244_2010_45_Fig10_HTML" ref-type="fig">10a, b</xref>) [) [75]. Malignant disease enhances post contrast administration (Fig.\xa0<xref rid="13244_2010_45_Fig10_HTML" ref-type="fig">10c</xref>). A case reported by Rathi et al. [). A case reported by Rathi et al. [76] described the CMR appearances of ‘charcoal heart’. There was nodularity of the LV myocardium with varying penetration into the endocardium and epicardium. On SSFP cine sequences, the nodular deposits were isointense to bright when compared with normal myocardium. There were also multiple mass-like deposits lining the right atrial and left atrial wall with similar imaging signal characteristics to the LV myocardium. These nodular deposits were high signal on both T1 and T2 sequences. Masses with high melanin content are hyperintense on T1 sequences due to shortening of the T1 relaxation time. Hyperintensity on T2 reflects high increased proton density or water content of the tumour. A case report by Deetjen et al. [77] described a cardiac metastasis from a renal cell adenocarcinoma, which also demonstrated a nodular enhancing mass. There was heterogeneous signal in the nodular mass on T1 and T2 sequences. Osteogenic sarcoma involving the heart is rare but merits mention as the metastasis contains bone. These calcific areas of increased opacity may be visible on chest X-ray but are better characterized on CT. Calcification is shown as a signal void on CMR.\nFig.\xa010a–cA 46-year-old man with progressive shortness of breath. He was diagnosed with HIV and endomyocardial biopsy revealed cardiac lymphoma. Echocardiography suggested diastolic heart failure. a Short-axis SSFP sequence showed circumferential infiltration of the basal segments of the right and left ventricle. b Pre-contrast T1-weighted horizontal long-axis sequence showed extensive lymphomatous infiltration of all four heart chambers. c Post-contrast T1-weighted horizontal long-axis sequence showed marked enhancement of the extensive lymphomatous infiltrating masses throughout the heart'], '13244_2010_45_Fig11_HTML': ['The end diastolic non-compacted to compacted ratio (NC/C) is higher in patients with LVNC (Fig.\xa0<xref rid="13244_2010_45_Fig11_HTML" ref-type="fig">11a</xref>). A compaction ratio can be quantitatively assessed by measuring thickness in millimeters of the noncompacted to the compacted myocardium. This can be done on a myocardial segmental basis using the standard 17-segment cardiac AHA model [). A compaction ratio can be quantitatively assessed by measuring thickness in millimeters of the noncompacted to the compacted myocardium. This can be done on a myocardial segmental basis using the standard 17-segment cardiac AHA model [91]. The NC/C parameter is able to distinguish pathological noncompaction from lesser forms of noncompaction. Most centres measure this parameter on SSFP sequences, and use high-resolution thin slices to do so (4-5\xa0mm). It is also useful to utilise radial slice projections, with the fulcrum passing through the centre of the LV (Fig.\xa0<xref rid="13244_2010_45_Fig11_HTML" ref-type="fig">11b</xref>). In this way, the risk of measuring the NC/C ratio from an oblique slice is minimised. The diastolic ratio of >2.3 on CMR demonstrates high diagnostic accuracy in identifying pathological LVNC and is now widely regarded as the gold-standard.\n). In this way, the risk of measuring the NC/C ratio from an oblique slice is minimised. The diastolic ratio of >2.3 on CMR demonstrates high diagnostic accuracy in identifying pathological LVNC and is now widely regarded as the gold-standard.\nFig.\xa011A 38-year-old woman with progressive shortness of breath. a Vertical long-axis SSFP sequence showed increased trabeculations at the apical ventricular level. (arrow) b Short-axis SSFP sequence showing the importance of precise image planes when evaluating LVNC. Radial image planes with the placed through the centrepoint of the LV cavity avoids the risk of prescribing oblique planes. c Late-enhanced vertical long-axis sequence showed high signal throughout the trabeculae consistent with trabecular fibrosis (arrow)', 'Fibrosis may be observed in LVNC on CMR, which correlates with histological findings (Fig.\xa0<xref rid="13244_2010_45_Fig11_HTML" ref-type="fig">11c</xref>). Delayed enhancement is usually found in a subendocardial distribution. Delayed enhancement can also be found in some compacted normal segments indicating that fibrosis is also present in these normal appearing areas [). Delayed enhancement is usually found in a subendocardial distribution. Delayed enhancement can also be found in some compacted normal segments indicating that fibrosis is also present in these normal appearing areas [89].'], '13244_2010_45_Fig12_HTML': ['The imaging appearances of TTC are currently evolving. Cine SSFP sequences in vertical long axis and short axis views allow the optimal assessment of left ventricular function, ventricular size and regional wall abnormalities. Several patterns of regional wall motion abnormalities have been described [95]. (1) Apical ballooning variant, which is characterized by apical akinesis with sparing of the base; (2) midventricular ballooning variant with midventricular akinesis with sparing of the apex and base (Fig.\xa0<xref rid="13244_2010_45_Fig12_HTML" ref-type="fig">12a, b</xref>); (3) basal ballooning variant with midventricular and basal akinesis with normal apical contractility. Right ventricular akinesia can also be seen in some patients. In this subgroup, it has been suggested that such patients may also have lower LV ejection fractions [); (3) basal ballooning variant with midventricular and basal akinesis with normal apical contractility. Right ventricular akinesia can also be seen in some patients. In this subgroup, it has been suggested that such patients may also have lower LV ejection fractions [97].\nFig.\xa012A 54-year-old woman admitted with acute onset chest pain following a road traffic accident. Vertical long-axis SSFP sequence in (a) diastole and (b) systole showed akinesis of LV myocardial segments at the midventricular level. The basal and apical segments showed vigorous contraction. (c) Late-enhanced short-axis sequence showed an absence of scar, excluding significant infarction', 'Eitel et al. [98] have highlighted the discriminating ability of CMR in patients presenting with acute chest pain syndromes. Late gadolinium enhancement (LGE) was seen in patients with myocardial infarctions and myocarditis, but not in patients with TTC (Fig.\xa0<xref rid="13244_2010_45_Fig12_HTML" ref-type="fig">12c</xref>). One study has demonstrated LGE in patients with TTC, though the LGE was of lower signal intensity than seen in myocardial infarction or myocarditis and the extent of tissue involvement was minimal [). One study has demonstrated LGE in patients with TTC, though the LGE was of lower signal intensity than seen in myocardial infarction or myocarditis and the extent of tissue involvement was minimal [99].']} | Uncharted waters: rare and unclassified cardiomyopathies characterized on cardiac magnetic resonance imaging | [
"Humans",
"Magnetic resonance imaging",
"Cardiomyopathies/diagnosis",
"Ventricular dysfunction/classification"
] | Insights Imaging | 1287471600 | The crazy-paving pattern is a linear pattern superimposed on a background of ground-glass opacity, resembling irregularly shaped paving stones. The crazy-paving pattern is initially described as the pathognomonic sign of alveolar proteinosis. Nowadays this pattern is a common finding on high-resolution CT imaging, and can be seen in a number of acute and chronic diseases. The purpose of this paper is to illustrate different diseases that cause this crazy-paving pattern and to correlate the radiological findings from computed tomography with the histopathological findings. | [] | other | PMC3259378 | null | 32 | [
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] | Insights Imaging. 2010 Oct 19; 1(5-6):293-308 | NO-CC CODE |
|
a and b Status post repair of type A dissection with a mechanical aortic valve (white arrowhead) at the aortic annulus and a tube graft (white arrow) of the ascending aorta above the native aortic root. A dissection flap is present beyond the tube graft (black arrowheads) with visible communication between the true lumen and false lumen | 13244_2010_38_Fig12_HTML | 7 | 758473202153c8195b09537eeda8165eb452a93b0867ba9d5cf9ff356613b7f2 | 13244_2010_38_Fig12_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
762,
318
] | [{'image_id': '13244_2010_38_Fig23_HTML', 'image_file_name': '13244_2010_38_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig23_HTML.jpg', 'caption': 'Post-infarct ventricular septal defect. a Four-chamber view demonstrates a defect in the distal portion of the interventricular septum (arrowhead). Trabeculations within the right ventricle overlie the defect. b Short axis view demonstrates that the defect is larger than appreciated on the four-chamber view and extends through the inferior half of the distal septum (arrowhead)', 'hash': 'be9f04b28cdbc2d5d0c6486f346f2c93ff0dd20b9630b7350b124a46ab200dae'}, {'image_id': '13244_2010_38_Fig4_HTML', 'image_file_name': '13244_2010_38_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig4_HTML.jpg', 'caption': 'Moderate stenosis of the proximal left anterior descending artery (LAD). a Curved MIP demonstrates calcified plaque in the proximal LAD (arrow). b Straightened lumen MIP demonstrates the presence of non-calcified plaque at this level with diameter reduction in the range of 50–70%', 'hash': '9692432db51322cf44f8d9cda0887f2b2b6990790848cf092924caaf1274c2e7'}, {'image_id': '13244_2010_38_Fig13_HTML', 'image_file_name': '13244_2010_38_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig13_HTML.jpg', 'caption': 'Interruption of the aortic arch with collateral circulation and graft. Mild coronary disease is identified without a hemodynamically significant lesion. a Sagittal MIP demonstrates the interruption (arrow) with a large left common carotid exiting the aortic arch just proximal to the interruption. There is decreased opacification of the distal thoracic aorta relative to the ascending aorta. An aorto-femoral graft extends caudally from the ascending aorta and is visualized in the retrosternal space (arrowhead). b Coronal MIP demonstrates a large, tortuous collateral branch (arrow) extending down from the left external carotid artery to the aortic arch, just beyond the interruption. A mild coarctation is visible in the proximal descending aorta (black arrowhead). This collateral branch and the coarctation were not visible in the sagittal MIP. c Four-chamber view of the heart demonstrates the aorto-femoral graft anteriorly (arrowhead). There is an unusual contour to the right ventricle, which appears to be narrowed in its mid-portion (arrow). d Curved MIP view of the LAD demonstrates non-calcified plaque in the proximal portion of this vessel with mild-moderate—approximately 50%—narrowing (arrow). e Curved MIP view of the LCX demonstrates eccentric calcified plaque in the mid portion of this vessel without narrowing (arrow)', 'hash': '9d438256355e188891abe508f555d68d315f66835e2d672df5b59aafbbfb7a3b'}, {'image_id': '13244_2010_38_Fig24_HTML', 'image_file_name': '13244_2010_38_Fig24_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig24_HTML.jpg', 'caption': 'Ebstein’s anomaly with apical displacement of the septal leaflet of the tricuspid valve (arrowhead), a large, redundant “sail-like” anterior tricuspid leaflet (arrow) and marked enlargement of the right heart. a Four-chamber view. b Short axis view', 'hash': 'dbc5d95f8a3014dd2f78906962f2b37fec09514d0702a12c89436a02ec50c066'}, {'image_id': '13244_2010_38_Fig14_HTML', 'image_file_name': '13244_2010_38_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig14_HTML.jpg', 'caption': 'Normal aortic valve in short axis. a Closed aortic valve demonstrates normal coaptation of the leaflets in diastole at 70% of the R-R interval. Three raphe lines are visible within the valve (arrowheads). b Aortic valve opens with a triangular shape, demonstrating three independent leaflets at 30% of the R-R interval. The presence of a trileaflet valve can only be confirmed by demonstrating this normal systolic opening', 'hash': '6126e5a694285305d33e95d5449c9136ef0d3d2298cc73dd39f9d4ea338e9dea'}, {'image_id': '13244_2010_38_Fig3_HTML', 'image_file_name': '13244_2010_38_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig3_HTML.jpg', 'caption': 'Severe stenosis of the proximal circumflex artery (LCX) in a patient complaining of chest pain. a Curved MIP demonstrates greater than 70% narrowing in the proximal LCX (arrow). b Curved MIP in an orthogonal projection again demonstrates greater than 70% narrowing in the proximal LCX (arrow). c Straightened lumen MIP confirms the severe stenosis just proximal to the first obtuse marginal branch (arrow)', 'hash': '3b689d92c085857f022452b5cb616a36a3505068108b11e6235a84299e474b21'}, {'image_id': '13244_2010_38_Fig5_HTML', 'image_file_name': '13244_2010_38_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig5_HTML.jpg', 'caption': 'Minimal calcified plaque in the proximal left anterior descending artery (arrowheads) with no significant stenosis. Although the calcified plaque overlies the vessel in the globe MIP view (bottom right), the curved MIP and straightened lumen views are rotated to project the calcium off the vessel lumen and demonstrate that there is no significant stenosis', 'hash': '10bbcd25f3409510d45a920cf068bec66f2af5af18dbbc722f1cf657c73aa6ba'}, {'image_id': '13244_2010_38_Fig12_HTML', 'image_file_name': '13244_2010_38_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig12_HTML.jpg', 'caption': 'a and b Status post repair of type A dissection with a mechanical aortic valve (white arrowhead) at the aortic annulus and a tube graft (white arrow) of the ascending aorta above the native aortic root. A dissection flap is present beyond the tube graft (black arrowheads) with visible communication between the true lumen and false lumen', 'hash': '758473202153c8195b09537eeda8165eb452a93b0867ba9d5cf9ff356613b7f2'}, {'image_id': '13244_2010_38_Fig22_HTML', 'image_file_name': '13244_2010_38_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig22_HTML.jpg', 'caption': 'Atrial septal defect (ASD) with left to right shunt. a Sagittal MIP demonstrates a posterior left atrium (LA), with a more anterior right atrium (RA). The superior vena cava (SVC) is identified as it enters the right atrium. A jet of contrast material (arrowhead) extends from the left atrium through an ASD into the right atrium, just below the orifice of the SVC. The proximity of the ASD to the SVC is clearly demonstrated. b Axial MIP demonstrates the ASD with left to right shunting of contrast (arrowhead). The proximity of the ASD to the aortic root (Ao) is clearly demonstrated. The location of the ASD and the presence of a rim of tissue must be ascertained prior to attempted percutaneous closure. If the ASD is too close to the aortic root, the closure device may clamp the root with a possible long-term complication of erosion into the aortic root', 'hash': '4a1bcc8b80bc813136f804034bc014bedbe9af3e0dc64f6c561df3082cff9333'}, {'image_id': '13244_2010_38_Fig15_HTML', 'image_file_name': '13244_2010_38_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig15_HTML.jpg', 'caption': 'Mildly thickened aortic valve with normal motion pattern. a Closed aortic valve demonstrates normal coaptation of the leaflets at the three raphe lines (arrowheads). b Systolic image demonstrates a normal-size opening with mild myxomatous thickening and redundancy of the leaflets', 'hash': '78e1da0e2d9a2eceba656881740dd92ff649aa2024913f00f4b446002ef9e46c'}, {'image_id': '13244_2010_38_Fig2_HTML', 'image_file_name': '13244_2010_38_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig2_HTML.jpg', 'caption': 'Severe stenosis of the proximal left anterior descending artery (LAD) in a patient presenting with chest pain. a Curved MIP demonstrates greater than 70% narrowing in the proximal LAD (arrow). b Straightened lumen MIP again demonstrates severe stenosis of the proximal LAD (arrow). Cross-sectional images of the LAD are presented above the straightened vessel view. The lumen disappears in the middle image at the site of maximum narrowing', 'hash': 'c9cfada939147d9c0c389e716e0dd9a61bd1b00dcf14f42c0e4f2a6bc8925bdc'}, {'image_id': '13244_2010_38_Fig25_HTML', 'image_file_name': '13244_2010_38_Fig25_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig25_HTML.jpg', 'caption': 'Curved MIP of the right coronary artery and posterior descending artery. A patent stent is visualized in the distal RCA (arrowhead). There is no significant narrowing of the RCA', 'hash': 'c5427fc0ba75840151da9ea97570faf6b0137536588c241c263c377b4bd46ed5'}, {'image_id': '13244_2010_38_Fig26_HTML', 'image_file_name': '13244_2010_38_Fig26_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig26_HTML.jpg', 'caption': 'Slab MIP of the proximal to mid-right coronary artery demonstrates an ulcerated plaque at the origin of the RCA (arrowhead) as well as an occluded stent in the mid-portion of the RCA (arrow)', 'hash': '1c1f71eacf976a5bdf9f82d98929493025d13b75834a523bb964cf87b39df230'}, {'image_id': '13244_2010_38_Fig19_HTML', 'image_file_name': '13244_2010_38_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig19_HTML.jpg', 'caption': 'Pulmonary venous mapping of the left atrium demonstrates a compound right inferior pulmonary vein. a Volumetric surface rendering of the left atrium from a posterior vantage point demonstrates four pulmonary veins. The right inferior vein consists of several small branches that unite at the level of the left atrium (arrow). This information is important when performing an ablation procedure, as these branches have small orifices that might be damaged with resulting pulmonary vein stenosis. b Endoluminal rendering demonstrates multiple small branches entering the left atrium in the location of the right inferior pulmonary vein (arrow). The orifice of the left atrial appendage (*) is separated from the two left-sided pulmonary veins by the warfarin ridge', 'hash': '3a6073ae34b71a3568c9699dfc66bd5535682df1e96a52c27febc6f7490cd622'}, {'image_id': '13244_2010_38_Fig16_HTML', 'image_file_name': '13244_2010_38_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig16_HTML.jpg', 'caption': 'Bicuspid aortic valve with regurgitation and minimal restriction of motion. a Diastolic image in short axis of the aortic valve demonstrates a linear closure of the aortic valve with only two leaflets (arrowheads). A small regurgitant orifice is visible between the mildly thick leaflets. The more anterior leaflet is in the position that would typically be occupied by the right and left coronary leaflets. b Systolic image in short axis of the aortic valve demonstrates a “fish-mouth”-shaped opening of the two leaflets (arrowheads) that is typical for a bicuspid valve. The overall aortic valve area is minimally restricted (2 cm² by planimetry)', 'hash': '1337aa187a1a3cdeb043f395d1d60c224c7a9c40c9cff3bd858b0c2e55e56197'}, {'image_id': '13244_2010_38_Fig1_HTML', 'image_file_name': '13244_2010_38_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig1_HTML.jpg', 'caption': 'Volumetric rendering of a left dominant coronary circulation from cCTA. a Left anterior oblique view demonstrates the left anterior descending artery coursing down the anterior interventricular groove (black arrowhead) and the circumflex artery coursing in the left atrioventricular groove (white arrowhead). b View of the base of the heart from the left side demonstrates the continuation of the circumflex artery in the posterior left atrioventricular groove (arrowhead), extending to the crux of the heart where it continues as the posterior descending artery (white arrow)', 'hash': '507a8e1dedcef291a80a803f0ad13ed585d066c1f9abe7db68b6ed8d4d13e987'}, {'image_id': '13244_2010_38_Fig21_HTML', 'image_file_name': '13244_2010_38_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig21_HTML.jpg', 'caption': 'Left atrial myxoma in a patient with a recent transient ischemic episode. a Axial image demonstrates a small focal mass within the left atrium (arrowhead). The more common location for a left atrial appendage would be along the interatrial septum. b Sagittal image demonstrates that this mass (arrowhead) extends from the roof of the left atrium adjacent to the orifice of the left atrial appendage', 'hash': '8bcfd42b37d5706407625c4fb42fe9140e06736bedcca7407694a69b8c32641f'}, {'image_id': '13244_2010_38_Fig6_HTML', 'image_file_name': '13244_2010_38_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig6_HTML.jpg', 'caption': 'Heavily calcified plaque in the right coronary artery. a and b Orthogonal curved MIP views of the right coronary artery. Because of the large amount of calcified plaque, the vessel lumen is not visualized on curved MIP projections. cCTA was not able to clear this vessel, even though conventional cardiac catheterization did not demonstrate an area of high-grade stenosis', 'hash': '2475abd187ceb8b907d30dac246cd4d05775de59de0f2e8c375581b29bb75f07'}, {'image_id': '13244_2010_38_Fig9_HTML', 'image_file_name': '13244_2010_38_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig9_HTML.jpg', 'caption': 'Anomalous origin of the circumflex artery from the right coronary artery with a “benign” course posterior to the aorta. a Volumetric-rendering demonstrates the right coronary artery (white arrowhead) as it courses in the right atrioventricular groove. The circumflex artery (black arrowhead) branches off the right coronary artery and courses posterior to the aorta. b Volumetric rendering from a more superior projection again demonstrates the right coronary artery (white arrowhead) as it courses in the right atrioventricular groove. The circumflex artery (black arrowhead) courses between the aorta (Ao) and left atrium (LA). c Globe MIP again demonstrates the circumflex artery (black arrowhead), which courses between the aorta (Ao) and left atrium (LA)', 'hash': '0a258a4d698ed793e0014f09968502319b4e60141c5fc383ed7d363a215a647a'}, {'image_id': '13244_2010_38_Fig11_HTML', 'image_file_name': '13244_2010_38_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig11_HTML.jpg', 'caption': 'Type A dissection of the ascending aorta with extension into the aortic root. a Oblique MIP demonstrates a dissection flap in the ascending aorta (black arrowheads). The dissection extends down to the right coronary artery (white arrow). A metallic stent is present in the proximal right coronary artery, obscuring the underlying vessel. b Oblique MIP again demonstrates a dissection flap in the ascending aorta (black arrowheads). The communication between the true lumen and false lumen is visualized as a defect in the dissection flap (black arrow). The proximal right coronary artery is again visualized (white arrow)', 'hash': '0ee9183125057d6efc9c0076be7b066ad19e73badba70c9b3a9a5bf50fd1a92a'}, {'image_id': '13244_2010_38_Fig17_HTML', 'image_file_name': '13244_2010_38_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig17_HTML.jpg', 'caption': 'Bicurpid aortic valve with moderate aortic insufficiency and focal thickening, likely related to endocarditis. a Diastolic image in short axis of the aortic valve demonstrates incomplete coaptation of the valve leaflets with a regurgitant orifice (*). Just anterior to this regurgitant orifice, there is a focal thickening of the valve, representing a vegetation. b Systolic image in short axis demonstrates a “fish-mouth” opening of the aortic valve with a visible raphe (arrowhead) within the anterior leaflet. This raphe is actually a “pseudoraphe” as it does not open as a normal raphe, but can mimic the appearance of a trileaflet aortic valve on diastolic imaging. The regurgitant orifice in diastole appears to be related to the free edge of this pseudoraphae. c Three-chamber view in diastole demonstrates incomplete coaptation of the aortic valve (black arrowhead), with focal thickening (a vegetation) associated with the free edge of the anterior leaflet', 'hash': '9fd323ed894ccfff40f165b992fbfe837e3d5aaa114ed8f5d3d927fbeff6be77'}, {'image_id': '13244_2010_38_Fig18_HTML', 'image_file_name': '13244_2010_38_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig18_HTML.jpg', 'caption': "Pseudoaneurysm of the left ventricular outflow tract following prosthetic valve endocarditis. a Three-chamber view during diastole demonstrates an open St. Jude's valve in the mitral position and a closed St. Jude's valve in the aortic position. A pocket of contrast just anterior to the aortic prosthesis (arrowheads) represents a pseudoaneurysm of the left ventricular outflow tract. b Axial image during systole demonstrates an open aortic prosthesis in short axis. The pseudoaneurysm is visualized to extend as a tubular structure into the aorto-pulmonary window (arrowheads)", 'hash': 'dc98f9f4a59eb8dc897368bc9464471b5dbf857b4532edc0882163eeb08a2e3d'}, {'image_id': '13244_2010_38_Fig27_HTML', 'image_file_name': '13244_2010_38_Fig27_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig27_HTML.jpg', 'caption': 'Iterative reconstruction illustrated for a curved MIP of a normal RCA scanned with very low dose technique. a Standard reconstruction with filtered back projection demonstrates a noisey image related to inadequate signal-to-noise characteristics. b Iterative reconstruction using iDose (Philips Medical Systems) with the same raw data demonstrates improved signal-to-noise characteristics with improved definition of the smaller distal RCA branches', 'hash': '844fff571bd58c30067ff137ecbe416d4adbb552d35671233d9f036430bfc30a'}, {'image_id': '13244_2010_38_Fig8_HTML', 'image_file_name': '13244_2010_38_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig8_HTML.jpg', 'caption': 'Anomalous left coronary artery with a “malignant” course between the aorta (Ao) and the right ventricular outflow tract (RVOT). a Globe MIP demonstrates the course of the left coronary artery (arrowhead), which originates from the right sinus of Valsalva and travels between the aorta (Ao) and right ventricular outflow tract (RVOT). The left coronary artery is seen to branch into the left anterior descending (LAD) and circumflex (LCX) arteries. b Sagittal MIP demonstrates compression of the left coronary artery (arrowhead) into an ovoid shape as it courses between the aorta (Ao) and right ventricular outflow tract (RVOT)', 'hash': 'bbaf80eff4aa72686665e99df9d16e959d200017eab7c6d96fba1604e578e8cd'}, {'image_id': '13244_2010_38_Fig7_HTML', 'image_file_name': '13244_2010_38_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig7_HTML.jpg', 'caption': 'Triple rule-out study with opacification of the aorta, coronary arteries and pulmonary arteries. a Oblique sagittal MIP demonstrates the thoracic aorta (Ao) as well as the bifurcation of the pulmonary arteries (PA). This scan was acquired in four steps using prospective ECG-gating to reduce patient dose. A linear artifact is apparent between each step. b Left anterior oblique coronal MIP demonstrates the origins of the right coronary artery (arrowhead) and left coronary artery (arrow). The aortic valve is identified between the left ventricle and the ascending aorta. c Slightly steeper left anterior oblique projection demonstrates the classic “C” shape of the right coronary artery', 'hash': '48338458de65904f43413282cda28dd17d19c0bdec21b41e26bfacd23f2efe55'}, {'image_id': '13244_2010_38_Fig10_HTML', 'image_file_name': '13244_2010_38_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig10_HTML.jpg', 'caption': 'Patent bypass grafts with narrowing at the origin of the vein graft to the circumflex distribution. a Volumetric-rendering in the right anterior oblique demonstrates a vein graft (black arrowhead) coursing from the aorta to the distal right coronary artery. The superior portion of the left internal mammary artery (LIMA) bypass is also visible (white arrowhead). b Volumetric rendering in the left anterior oblique again demonstrates the vein graft (black arrowhead) from the aorta to the distal right coronary artery. The left internal mammary artery (LIMA) bypass (white arrowhead) is seen to course into the anterior interventricular groove where is anastamoses with the left anterior descending artery. A second vein graft (arrow) extends from the aorta to the circumflex territory. c Volumetric rendering in the left lateral projection viewed from a more inferior approach again demonstrates the left internal mammary artery (LIMA) bypass (white arrowhead) to its anastamosis. The anastamosis of a vein graft (arrow) to an obtuse marginal branch of the circumflex artery is visualized. d Curved MIP of the vein bypass to the circumflex artery territory. There is greater than 50% narrowing at the origin of this vein graft (arrow)', 'hash': 'e4dbd1da74b1e9498c0281ba1a3d90f1562ba80b8a6f4bc2cdc0206445ba2a95'}, {'image_id': '13244_2010_38_Fig20_HTML', 'image_file_name': '13244_2010_38_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC3259381/13244_2010_38_Fig20_HTML.jpg', 'caption': 'Partial absence of the pericardium with herniation of the left atrial appendage. a Four-chamber view of the heart demonstrates a mass along the left heart border (arrowheads) adjacent to the left atrium (LA) and left ventricle (LV). A small amount of contrast material enters this mass. b Coronal view of the left atrium (LA) demonstrates that this mass (arrowheads) corresponds to the typical location of the left atrial applendage. Stagnant flow within the mass results in slow filling, but no thrombus was visible on delayed views. c Four-chamber view in a delayed phase demonstrates contrast filling of the mass. d Coronal view in a delayed phase also demonstrates homogeneous enhancement of the mass that represents a herniated and dilated left atrial appendage. e PA view of the chest demonstrates a bulge in the left cardiac contour. f Lateral view of the chest again demonstrates the mass corresponding to the herniated and enlarged left atrial appendage', 'hash': 'ac8144a2537109202d7d6c5b400e808a6047ac21d1c971c87a13ad4fa13119d0'}] | {'13244_2010_38_Fig1_HTML': ['Despite clinical advances in diagnosis and treatment, heart disease remains the leading cause of death for both men and women, and is responsible for 26% of all deaths in the United States [1]. Atherosclerotic disease of the coronary arteries remains the most important etiology of heart disease. Coronary computed tomographic angiography (cCTA) provides a non-invasive alternative to cardiac catheterization for direct visualization of coronary anatomy (Fig.\xa0<xref rid="13244_2010_38_Fig1_HTML" ref-type="fig">1</xref>). Recent meta-analyses of cCTA studies have demonstrated high sensitivity (96–99%) and specificity (88–91%) for the anatomic presence of CAD [). Recent meta-analyses of cCTA studies have demonstrated high sensitivity (96–99%) and specificity (88–91%) for the anatomic presence of CAD [2–5]. Although functional information about wall motion can be obtained during cCTA, the primary utility of cCTA is for imaging of the coronary arteries to define the presence of CAD (Figs.\xa0<xref rid="13244_2010_38_Fig2_HTML" ref-type="fig">2</xref>, , <xref rid="13244_2010_38_Fig3_HTML" ref-type="fig">3</xref>, , <xref rid="13244_2010_38_Fig4_HTML" ref-type="fig">4</xref>). The high sensitivity of cCTA for CAD results in an extremely high negative predictive value, especially in patients with low to intermediate risk of coronary disease. A negative cCTA study in this population effectively excludes the diagnosis of CAD. Although the specificity of cCTA is limited by arterial calcification, post-processing techniques using vessel tracking and curved multiplanar reconstructions are often useful for evaluation of calcified vessels (Fig.\xa0). The high sensitivity of cCTA for CAD results in an extremely high negative predictive value, especially in patients with low to intermediate risk of coronary disease. A negative cCTA study in this population effectively excludes the diagnosis of CAD. Although the specificity of cCTA is limited by arterial calcification, post-processing techniques using vessel tracking and curved multiplanar reconstructions are often useful for evaluation of calcified vessels (Fig.\xa0<xref rid="13244_2010_38_Fig5_HTML" ref-type="fig">5</xref>). Nonetheless, blooming artifact associated with densely calcified plaque may preclude visualization of the underlying vascular lumen in the absence of significant stenosis (Fig.\xa0). Nonetheless, blooming artifact associated with densely calcified plaque may preclude visualization of the underlying vascular lumen in the absence of significant stenosis (Fig.\xa0<xref rid="13244_2010_38_Fig6_HTML" ref-type="fig">6</xref>).\n).\nFig.\xa01Volumetric rendering of a left dominant coronary circulation from cCTA. a Left anterior oblique view demonstrates the left anterior descending artery coursing down the anterior interventricular groove (black arrowhead) and the circumflex artery coursing in the left atrioventricular groove (white arrowhead). b View of the base of the heart from the left side demonstrates the continuation of the circumflex artery in the posterior left atrioventricular groove (arrowhead), extending to the crux of the heart where it continues as the posterior descending artery (white arrow)Fig.\xa02Severe stenosis of the proximal left anterior descending artery (LAD) in a patient presenting with chest pain. a Curved MIP demonstrates greater than 70% narrowing in the proximal LAD (arrow). b Straightened lumen MIP again demonstrates severe stenosis of the proximal LAD (arrow). Cross-sectional images of the LAD are presented above the straightened vessel view. The lumen disappears in the middle image at the site of maximum narrowingFig.\xa03Severe stenosis of the proximal circumflex artery (LCX) in a patient complaining of chest pain. a Curved MIP demonstrates greater than 70% narrowing in the proximal LCX (arrow). b Curved MIP in an orthogonal projection again demonstrates greater than 70% narrowing in the proximal LCX (arrow). c Straightened lumen MIP confirms the severe stenosis just proximal to the first obtuse marginal branch (arrow)Fig.\xa04Moderate stenosis of the proximal left anterior descending artery (LAD). a Curved MIP demonstrates calcified plaque in the proximal LAD (arrow). b Straightened lumen MIP demonstrates the presence of non-calcified plaque at this level with diameter reduction in the range of 50–70%Fig.\xa05Minimal calcified plaque in the proximal left anterior descending artery (arrowheads) with no significant stenosis. Although the calcified plaque overlies the vessel in the globe MIP view (bottom right), the curved MIP and straightened lumen views are rotated to project the calcium off the vessel lumen and demonstrate that there is no significant stenosisFig.\xa06Heavily calcified plaque in the right coronary artery. a and b Orthogonal curved MIP views of the right coronary artery. Because of the large amount of calcified plaque, the vessel lumen is not visualized on curved MIP projections. cCTA was not able to clear this vessel, even though conventional cardiac catheterization did not demonstrate an area of high-grade stenosis'], '13244_2010_38_Fig7_HTML': ['cCTA examinations are usually performed as a dedicated study of the coronary arteries, tailored to image the coronary arteries with a minimum dose of iodinated contrast and radiation exposure. However, in the setting of a patient who presents with acute chest pain, the differential diagnosis often includes other potentially life-threatening processes such as pulmonary embolism and aortic dissection. A dedicated cCTA will not include the aortic arch. Furthermore, contrast injection for a dedicated cCTA is usually timed with a saline bolus to wash out the right heart during imaging. In order to optimize imaging of the coronary arteries, thoracic aorta and pulmonary arteries, a triple rule-out protocol may be applied [13]. When performed with proper attention to technique, the triple rule-out study provides excellent opacification of the aorta and pulmonary arteries without loss of coronary artery image quality, although there is an increased radiation dose proportional to the increased scan length (Fig.\xa0<xref rid="13244_2010_38_Fig7_HTML" ref-type="fig">7</xref>) [) [14].\nFig.\xa07Triple rule-out study with opacification of the aorta, coronary arteries and pulmonary arteries. a Oblique sagittal MIP demonstrates the thoracic aorta (Ao) as well as the bifurcation of the pulmonary arteries (PA). This scan was acquired in four steps using prospective ECG-gating to reduce patient dose. A linear artifact is apparent between each step. b Left anterior oblique coronal MIP demonstrates the origins of the right coronary artery (arrowhead) and left coronary artery (arrow). The aortic valve is identified between the left ventricle and the ascending aorta. c Slightly steeper left anterior oblique projection demonstrates the classic “C” shape of the right coronary artery', 'Prospective ECG-gating with an axial “step and shoot” technique has been introduced to further reduce radiation dose. This technique acquires images in axial mode during a single, short (usually mid-diastolic) interval. The entire heart is acquired in one or more axial steps (Fig.\xa0<xref rid="13244_2010_38_Fig7_HTML" ref-type="fig">7</xref>). The prospective gating technique relies on a stable heart rate to predict the time for mid-diastole and to trigger the x-ray tube only during that interval for imaging. Evaluation of cardiac motion is not possible with standard step-and-shoot acquisition since image data are not obtained during the systolic portion of the cardiac cycle. Furthermore, image quality may be adversely impacted if a variable heart rhythm results in image acquisition during a suboptimal phase of the cardiac cycle. Nonetheless, a recent multicenter international study included 685 patients, with 99 patients evaluated using prospective ECG-gating and 586 patients evaluated with a standard helical approach. Mean radiation dose was reduced by 68%, from 11.2\xa0mSv for the helical mode to 3.6\xa0mSv for the step-and-shoot technique, without loss of image quality [). The prospective gating technique relies on a stable heart rate to predict the time for mid-diastole and to trigger the x-ray tube only during that interval for imaging. Evaluation of cardiac motion is not possible with standard step-and-shoot acquisition since image data are not obtained during the systolic portion of the cardiac cycle. Furthermore, image quality may be adversely impacted if a variable heart rhythm results in image acquisition during a suboptimal phase of the cardiac cycle. Nonetheless, a recent multicenter international study included 685 patients, with 99 patients evaluated using prospective ECG-gating and 586 patients evaluated with a standard helical approach. Mean radiation dose was reduced by 68%, from 11.2\xa0mSv for the helical mode to 3.6\xa0mSv for the step-and-shoot technique, without loss of image quality [55].'], '13244_2010_38_Fig2_HTML': ['An overwhelming majority of patients presenting with acute coronary syndrome have calcification in the coronary circulation. Several large retrospective studies of asymptomatic patients have demonstrated that the presence of coronary calcium is a predictor of cardiac events [17] and risk of death [18, 19]. Prospective studies have confirmed these results and demonstrated that coronary calcium scoring provides additional prognostic information beyond standard risk assessment based upon clinical and laboratory tests [20, 21]. Nonetheless, calcium scores are not recommended to evaluate the patient who presents with acute symptoms. Coronary calcium imaging does not detect the presence of non-calcified plaque, and a minority of patients experience coronary events in the absence of coronary calcification (Fig.\xa0<xref rid="13244_2010_38_Fig2_HTML" ref-type="fig">2</xref>) [) [22, 23].'], '13244_2010_38_Fig8_HTML': ['cCTA provides clear definition of the anatomic course of the coronary arteries, even when image quality is limited with respect to assessment of coronary stenosis. Although the coronary arteries are clearly visualized by conventional cardiac catheterization, cCTA more clearly demonstrates the relationship between coronary arteries and adjacent anatomical structures such as the pulmonary artery. For this reason, cCTA is an excellent study to demonstrate various coronary anomalies (Figs.\xa0<xref rid="13244_2010_38_Fig8_HTML" ref-type="fig">8</xref>, , <xref rid="13244_2010_38_Fig9_HTML" ref-type="fig">9</xref>). cCTA is often superior to conventional arteriography for the diagnosis of coronary variations [). cCTA is often superior to conventional arteriography for the diagnosis of coronary variations [39].\nFig.\xa08Anomalous left coronary artery with a “malignant” course between the aorta (Ao) and the right ventricular outflow tract (RVOT). a Globe MIP demonstrates the course of the left coronary artery (arrowhead), which originates from the right sinus of Valsalva and travels between the aorta (Ao) and right ventricular outflow tract (RVOT). The left coronary artery is seen to branch into the left anterior descending (LAD) and circumflex (LCX) arteries. b Sagittal MIP demonstrates compression of the left coronary artery (arrowhead) into an ovoid shape as it courses between the aorta (Ao) and right ventricular outflow tract (RVOT)Fig.\xa09Anomalous origin of the circumflex artery from the right coronary artery with a “benign” course posterior to the aorta. a Volumetric-rendering demonstrates the right coronary artery (white arrowhead) as it courses in the right atrioventricular groove. The circumflex artery (black arrowhead) branches off the right coronary artery and courses posterior to the aorta. b Volumetric rendering from a more superior projection again demonstrates the right coronary artery (white arrowhead) as it courses in the right atrioventricular groove. The circumflex artery (black arrowhead) courses between the aorta (Ao) and left atrium (LA). c Globe MIP again demonstrates the circumflex artery (black arrowhead), which courses between the aorta (Ao) and left atrium (LA)'], '13244_2010_38_Fig10_HTML': ['cCTA provides a useful roadmap in preoperative planning for bypass surgery as well as in post-surgical assessment. In addition to localizing the site of coronary stenosis, cCTA can be used to assess whether a more distal segment of a coronary vessel is epicardial in location and is accessible for bypass grafting [40]. In the postoperative patient, cCTA can be used to assess the patency of bypass grafts that may be difficult to cannulate by conventional arteriography (Fig.\xa0<xref rid="13244_2010_38_Fig10_HTML" ref-type="fig">10</xref>). Injury to existing bypass grafts is a major risk of reoperation. cCTA clearly demonstrates the position of bypass grafts relative to other structures and is therefore useful for planning of reoperation bypass procedures [). Injury to existing bypass grafts is a major risk of reoperation. cCTA clearly demonstrates the position of bypass grafts relative to other structures and is therefore useful for planning of reoperation bypass procedures [41].\nFig.\xa010Patent bypass grafts with narrowing at the origin of the vein graft to the circumflex distribution. a Volumetric-rendering in the right anterior oblique demonstrates a vein graft (black arrowhead) coursing from the aorta to the distal right coronary artery. The superior portion of the left internal mammary artery (LIMA) bypass is also visible (white arrowhead). b Volumetric rendering in the left anterior oblique again demonstrates the vein graft (black arrowhead) from the aorta to the distal right coronary artery. The left internal mammary artery (LIMA) bypass (white arrowhead) is seen to course into the anterior interventricular groove where is anastamoses with the left anterior descending artery. A second vein graft (arrow) extends from the aorta to the circumflex territory. c Volumetric rendering in the left lateral projection viewed from a more inferior approach again demonstrates the left internal mammary artery (LIMA) bypass (white arrowhead) to its anastamosis. The anastamosis of a vein graft (arrow) to an obtuse marginal branch of the circumflex artery is visualized. d Curved MIP of the vein bypass to the circumflex artery territory. There is greater than 50% narrowing at the origin of this vein graft (arrow)'], '13244_2010_38_Fig11_HTML': ['The stable patient with a suspected thoracic aortic injury, dissection or aneurysm is often evaluated with a CT for preoperative planning as well as a cardiac catheterization to assess patency of the coronary arteries. cCTA can provide simultaneous evaluation of pathology in the aorta as well as assessment of the coronary arteries for preoperative planning (Fig.\xa0<xref rid="13244_2010_38_Fig11_HTML" ref-type="fig">11</xref>). Following repair of an aortic aneurysm, cCTA can provide clear anatomic definition of prosthetic valves, aortic grafts and residual dissection flaps (Fig.\xa0). Following repair of an aortic aneurysm, cCTA can provide clear anatomic definition of prosthetic valves, aortic grafts and residual dissection flaps (Fig.\xa0<xref rid="13244_2010_38_Fig12_HTML" ref-type="fig">12</xref>). cCTA is also useful for evaluation of complex aortic anomalies such as coarctation, interruption of the aortic arch and collateral vascular supply (Fig.\xa0). cCTA is also useful for evaluation of complex aortic anomalies such as coarctation, interruption of the aortic arch and collateral vascular supply (Fig.\xa0<xref rid="13244_2010_38_Fig13_HTML" ref-type="fig">13</xref>).\n).\nFig.\xa011Type A dissection of the ascending aorta with extension into the aortic root. a Oblique MIP demonstrates a dissection flap in the ascending aorta (black arrowheads). The dissection extends down to the right coronary artery (white arrow). A metallic stent is present in the proximal right coronary artery, obscuring the underlying vessel. b Oblique MIP again demonstrates a dissection flap in the ascending aorta (black arrowheads). The communication between the true lumen and false lumen is visualized as a defect in the dissection flap (black arrow). The proximal right coronary artery is again visualized (white arrow)Fig.\xa012a and b Status post repair of type A dissection with a mechanical aortic valve (white arrowhead) at the aortic annulus and a tube graft (white arrow) of the ascending aorta above the native aortic root. A dissection flap is present beyond the tube graft (black arrowheads) with visible communication between the true lumen and false lumenFig.\xa013Interruption of the aortic arch with collateral circulation and graft. Mild coronary disease is identified without a hemodynamically significant lesion. a Sagittal MIP demonstrates the interruption (arrow) with a large left common carotid exiting the aortic arch just proximal to the interruption. There is decreased opacification of the distal thoracic aorta relative to the ascending aorta. An aorto-femoral graft extends caudally from the ascending aorta and is visualized in the retrosternal space (arrowhead). b Coronal MIP demonstrates a large, tortuous collateral branch (arrow) extending down from the left external carotid artery to the aortic arch, just beyond the interruption. A mild coarctation is visible in the proximal descending aorta (black arrowhead). This collateral branch and the coarctation were not visible in the sagittal MIP. c Four-chamber view of the heart demonstrates the aorto-femoral graft anteriorly (arrowhead). There is an unusual contour to the right ventricle, which appears to be narrowed in its mid-portion (arrow). d Curved MIP view of the LAD demonstrates non-calcified plaque in the proximal portion of this vessel with mild-moderate—approximately 50%—narrowing (arrow). e Curved MIP view of the LCX demonstrates eccentric calcified plaque in the mid portion of this vessel without narrowing (arrow)'], '13244_2010_38_Fig14_HTML': ['Preoperative planning for aortic valve replacement surgery requires assessment of the ascending aorta for morphology and calcification, assessment of the aortic valve annulus for appropriate sizing of the replacement valve and evaluation of the coronary arteries. cCTA is an excellent modality to assess simultaneously the thoracic aorta, the aortic valve and the coronary arteries (Figs.\xa0<xref rid="13244_2010_38_Fig14_HTML" ref-type="fig">14</xref>, , <xref rid="13244_2010_38_Fig15_HTML" ref-type="fig">15</xref>). cCTA can provide accurate imaging and measurements of the aortic annulus and valve for preoperative planning of aortic valve replacement [). cCTA can provide accurate imaging and measurements of the aortic annulus and valve for preoperative planning of aortic valve replacement [42]. Percutaneous valve replacement procedures are poised to revolutionize the therapy of aortic valve disease [43]. cCTA provides essential information prior to percutaneous valve replacement, especially with respect to the location and extent of aortic root and valve calcifications and the location of the coronary ostia relative to the valve plane [44]. The diagnosis of bicuspid valve is readily apparent on cCTA (Fig.\xa0<xref rid="13244_2010_38_Fig16_HTML" ref-type="fig">16</xref>), and the presence of aortic valve thickening and insufficiency may also be visible (Fig.\xa0), and the presence of aortic valve thickening and insufficiency may also be visible (Fig.\xa0<xref rid="13244_2010_38_Fig17_HTML" ref-type="fig">17</xref>).\n).\nFig.\xa014Normal aortic valve in short axis. a Closed aortic valve demonstrates normal coaptation of the leaflets in diastole at 70% of the R-R interval. Three raphe lines are visible within the valve (arrowheads). b Aortic valve opens with a triangular shape, demonstrating three independent leaflets at 30% of the R-R interval. The presence of a trileaflet valve can only be confirmed by demonstrating this normal systolic openingFig.\xa015Mildly thickened aortic valve with normal motion pattern. a Closed aortic valve demonstrates normal coaptation of the leaflets at the three raphe lines (arrowheads). b Systolic image demonstrates a normal-size opening with mild myxomatous thickening and redundancy of the leafletsFig.\xa016Bicuspid aortic valve with regurgitation and minimal restriction of motion. a Diastolic image in short axis of the aortic valve demonstrates a linear closure of the aortic valve with only two leaflets (arrowheads). A small regurgitant orifice is visible between the mildly thick leaflets. The more anterior leaflet is in the position that would typically be occupied by the right and left coronary leaflets. b Systolic image in short axis of the aortic valve demonstrates a “fish-mouth”-shaped opening of the two leaflets (arrowheads) that is typical for a bicuspid valve. The overall aortic valve area is minimally restricted (2 cm² by planimetry)Fig.\xa017Bicurpid aortic valve with moderate aortic insufficiency and focal thickening, likely related to endocarditis. a Diastolic image in short axis of the aortic valve demonstrates incomplete coaptation of the valve leaflets with a regurgitant orifice (*). Just anterior to this regurgitant orifice, there is a focal thickening of the valve, representing a vegetation. b Systolic image in short axis demonstrates a “fish-mouth” opening of the aortic valve with a visible raphe (arrowhead) within the anterior leaflet. This raphe is actually a “pseudoraphe” as it does not open as a normal raphe, but can mimic the appearance of a trileaflet aortic valve on diastolic imaging. The regurgitant orifice in diastole appears to be related to the free edge of this pseudoraphae. c Three-chamber view in diastole demonstrates incomplete coaptation of the aortic valve (black arrowhead), with focal thickening (a vegetation) associated with the free edge of the anterior leaflet'], '13244_2010_38_Fig18_HTML': ['When reoperation is required for a prosthetic aortic valve that has failed, coronary angiography is often contraindicated, especially in the setting of endocarditis when catheter angiography carries an increased risk of embolization [45]. cCTA can provide high-resolution functional imaging of prosthetic valves with simultaneous evaluation of the coronary arteries for preoperative planning. Prosthetic endocarditis may also be associated with additional complications including valve malfunction and pseudoaneurysms, which may be clearly defined by cCTA (Fig.\xa0<xref rid="13244_2010_38_Fig18_HTML" ref-type="fig">18</xref>).\n).\nFig.\xa018Pseudoaneurysm of the left ventricular outflow tract following prosthetic valve endocarditis. a Three-chamber view during diastole demonstrates an open St. Jude\'s valve in the mitral position and a closed St. Jude\'s valve in the aortic position. A pocket of contrast just anterior to the aortic prosthesis (arrowheads) represents a pseudoaneurysm of the left ventricular outflow tract. b Axial image during systole demonstrates an open aortic prosthesis in short axis. The pseudoaneurysm is visualized to extend as a tubular structure into the aorto-pulmonary window (arrowheads)'], '13244_2010_38_Fig19_HTML': ['MRI is generally considered the test of choice for evaluation of cardiac morphology since this technique does not require ionizing radiation. However, cCTA has been used extensively in preoperative planning for ablation procedures in the left atrium. The pulmonary veins and the intricate details of the left atrial anatomy are more clearly visualized by cCTA, which provides superior spatial resolution as compared to MRI, and their location can be mapped into a three-dimensional volume that is used during the ablation procedure (Fig.\xa0<xref rid="13244_2010_38_Fig19_HTML" ref-type="fig">19</xref>). Integration of CTA image data during ablation in the left atrium is often useful to shorten procedure times and improve patient outcome [). Integration of CTA image data during ablation in the left atrium is often useful to shorten procedure times and improve patient outcome [46]. Although echocardiography and MRI are generally preferred for evaluation of cardiac morphology, changes in cardiac morphology (Fig.\xa0<xref rid="13244_2010_38_Fig20_HTML" ref-type="fig">20</xref>) and the presence of mass lesions (Fig.\xa0) and the presence of mass lesions (Fig.\xa0<xref rid="13244_2010_38_Fig21_HTML" ref-type="fig">21</xref>) can be evaluated by cCTA.\n) can be evaluated by cCTA.\nFig.\xa019Pulmonary venous mapping of the left atrium demonstrates a compound right inferior pulmonary vein. a Volumetric surface rendering of the left atrium from a posterior vantage point demonstrates four pulmonary veins. The right inferior vein consists of several small branches that unite at the level of the left atrium (arrow). This information is important when performing an ablation procedure, as these branches have small orifices that might be damaged with resulting pulmonary vein stenosis. b Endoluminal rendering demonstrates multiple small branches entering the left atrium in the location of the right inferior pulmonary vein (arrow). The orifice of the left atrial appendage (*) is separated from the two left-sided pulmonary veins by the warfarin ridgeFig.\xa020Partial absence of the pericardium with herniation of the left atrial appendage. a Four-chamber view of the heart demonstrates a mass along the left heart border (arrowheads) adjacent to the left atrium (LA) and left ventricle (LV). A small amount of contrast material enters this mass. b Coronal view of the left atrium (LA) demonstrates that this mass (arrowheads) corresponds to the typical location of the left atrial applendage. Stagnant flow within the mass results in slow filling, but no thrombus was visible on delayed views. c Four-chamber view in a delayed phase demonstrates contrast filling of the mass. d Coronal view in a delayed phase also demonstrates homogeneous enhancement of the mass that represents a herniated and dilated left atrial appendage. e PA view of the chest demonstrates a bulge in the left cardiac contour. f Lateral view of the chest again demonstrates the mass corresponding to the herniated and enlarged left atrial appendageFig.\xa021Left atrial myxoma in a patient with a recent transient ischemic episode. a Axial image demonstrates a small focal mass within the left atrium (arrowhead). The more common location for a left atrial appendage would be along the interatrial septum. b Sagittal image demonstrates that this mass (arrowhead) extends from the roof of the left atrium adjacent to the orifice of the left atrial appendage'], '13244_2010_38_Fig22_HTML': ['Enlargement of the right heart is often related to intracardiac shunts. cCTA is an excellent test for identification of anomalous pulmonary veins that are not visualized by echocardiography. Furthermore, we have found cCTA to be a useful study in the pre-procedure planning for percutaneous closure of atrial septal defects (Fig.\xa0<xref rid="13244_2010_38_Fig22_HTML" ref-type="fig">22</xref>) and ventricular septal defects (Fig.\xa0) and ventricular septal defects (Fig.\xa0<xref rid="13244_2010_38_Fig23_HTML" ref-type="fig">23</xref>). The superb three-dimensional anatomical definition provided by CT imaging allows assessment of the size and location of the defect relative to adjacent structures such as the aortic root.\n). The superb three-dimensional anatomical definition provided by CT imaging allows assessment of the size and location of the defect relative to adjacent structures such as the aortic root.\nFig.\xa022Atrial septal defect (ASD) with left to right shunt. a Sagittal MIP demonstrates a posterior left atrium (LA), with a more anterior right atrium (RA). The superior vena cava (SVC) is identified as it enters the right atrium. A jet of contrast material (arrowhead) extends from the left atrium through an ASD into the right atrium, just below the orifice of the SVC. The proximity of the ASD to the SVC is clearly demonstrated. b Axial MIP demonstrates the ASD with left to right shunting of contrast (arrowhead). The proximity of the ASD to the aortic root (Ao) is clearly demonstrated. The location of the ASD and the presence of a rim of tissue must be ascertained prior to attempted percutaneous closure. If the ASD is too close to the aortic root, the closure device may clamp the root with a possible long-term complication of erosion into the aortic rootFig.\xa023Post-infarct ventricular septal defect. a Four-chamber view demonstrates a defect in the distal portion of the interventricular septum (arrowhead). Trabeculations within the right ventricle overlie the defect. b Short axis view demonstrates that the defect is larger than appreciated on the four-chamber view and extends through the inferior half of the distal septum (arrowhead)'], '13244_2010_38_Fig24_HTML': ['Evaluation of the right heart by cCTA is limited by the mixing of opacified blood from the SVC with unopacified blood from the IVC. Nonetheless, with appropriate modifications of the contrast injection protocol, cCTA may be used successfully to evaluate right ventricular morphology, as well as for evaluation of the tricuspid valve (Fig.\xa0<xref rid="13244_2010_38_Fig24_HTML" ref-type="fig">24</xref>) [) [14].\nFig.\xa024Ebstein’s anomaly with apical displacement of the septal leaflet of the tricuspid valve (arrowhead), a large, redundant “sail-like” anterior tricuspid leaflet (arrow) and marked enlargement of the right heart. a Four-chamber view. b Short axis view'], '13244_2010_38_Fig6_HTML': ['cCTA is a powerful diagnostic tool, but necessitates injection of intravenous contrast material as well as exposure to ionizing radiation. cCTA is often limited by image quality in obese patients as well as patients with elevated or irregular heart rates. The presence of blooming artifact from dense arterial calcification limits the quality of cCTA and results in overestimation of the degree of stenosis (Fig.\xa0<xref rid="13244_2010_38_Fig6_HTML" ref-type="fig">6</xref>). Evaluation of metallic stents is also limited by blooming artifacts from the stent struts, though cCTA has been increasingly successful for evaluation of coronary stents, especially with stent diameters above 3\xa0mm (Figs.\xa0). Evaluation of metallic stents is also limited by blooming artifacts from the stent struts, though cCTA has been increasingly successful for evaluation of coronary stents, especially with stent diameters above 3\xa0mm (Figs.\xa0<xref rid="13244_2010_38_Fig25_HTML" ref-type="fig">25</xref>, , <xref rid="13244_2010_38_Fig26_HTML" ref-type="fig">26</xref>). Although a normal cCTA effectively excludes the presence of CAD, the finding of moderate disease by cCTA is often of uncertain clinical significance as it may not be obvious whether the patient’s symptoms are related to the visualized CAD. Because of these limitations, competing technologies for evaluation of suspected CAD—including ECG-stress testing, stress testing with echocardiography, stress testing with nuclear perfusion imaging and MRI—may be more appropriate in specific clinical scenarios. Functional stress testing may be appropriate to evaluate the clinical significance of CAD detected by cCTA.\n). Although a normal cCTA effectively excludes the presence of CAD, the finding of moderate disease by cCTA is often of uncertain clinical significance as it may not be obvious whether the patient’s symptoms are related to the visualized CAD. Because of these limitations, competing technologies for evaluation of suspected CAD—including ECG-stress testing, stress testing with echocardiography, stress testing with nuclear perfusion imaging and MRI—may be more appropriate in specific clinical scenarios. Functional stress testing may be appropriate to evaluate the clinical significance of CAD detected by cCTA.\nFig.\xa025Curved MIP of the right coronary artery and posterior descending artery. A patent stent is visualized in the distal RCA (arrowhead). There is no significant narrowing of the RCAFig.\xa026Slab MIP of the proximal to mid-right coronary artery demonstrates an ulcerated plaque at the origin of the RCA (arrowhead) as well as an occluded stent in the mid-portion of the RCA (arrow)'], '13244_2010_38_Fig27_HTML': ['Most contemporary CT scanners utilize a mathematical technique called filtered back projection to reconstruct CT images. Iterative reconstruction is another category of techniques that has recently gained popularity for reconstruction of CT images with decreased image noise. Iterative reconstruction techniques employ an initial estimate of voxel attenuation to predict projection data; estimates of voxel attenuation are iteratively adjusted to minimize the difference between the predicted projection data and the measured projection data. These techniques are more computationally intensive as compared to filtered back projection, but can result in reduced image noise; alternatively, iterative techniques may be used to maintain an acceptable signal-to-noise ratio and image quality with reduced radiation (Fig.\xa0<xref rid="13244_2010_38_Fig27_HTML" ref-type="fig">27</xref>). A recent study suggests that iterative techniques may allow a reduction in effective radiation exposure by approximately 50% [). A recent study suggests that iterative techniques may allow a reduction in effective radiation exposure by approximately 50% [57]. Based upon the doses recorded from studies of prospective ECG-gating and high pitch helical technique, new acquisition techniques combined with iterative reconstruction should routinely provide cCTA imaging with effective radiation exposures of 1\xa0mSv or less.\nFig.\xa027Iterative reconstruction illustrated for a curved MIP of a normal RCA scanned with very low dose technique. a Standard reconstruction with filtered back projection demonstrates a noisey image related to inadequate signal-to-noise characteristics. b Iterative reconstruction using iDose (Philips Medical Systems) with the same raw data demonstrates improved signal-to-noise characteristics with improved definition of the smaller distal RCA branches']} | Clinical applications of cardiac CT angiography | [
"CT angiography",
"Cardiac imaging"
] | Insights Imaging | 1281682800 | There are many disorders that may involve the left ventricular (LV) apex; however, they are sometimes difficult to differentiate. In this setting cardiac imaging methods can provide the clue to obtaining the diagnosis. The purpose of this review is to illustrate the spectrum of diseases that most frequently affect the apex of the LV including Tako-Tsubo cardiomyopathy, LV aneurysms and pseudoaneurysms, apical diverticula, apical ventricular remodelling, apical hypertrophic cardiomyopathy, LV non-compaction, arrhythmogenic right ventricular dysplasia with LV involvement and LV false tendons, with an emphasis on the diagnostic criteria and imaging features. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13244-011-0091-6) contains supplementary material, which is available to authorized users. | [] | other | PMC3259381 | null | 53 | [
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] | Insights Imaging. 2010 Aug 13; 1(4):205-222 | NO-CC CODE |
|
a Conventional angiogram reveals a stenosis (black arrow) within the ‘Y graft’, near anastomoses with the donor common iliac artery. b CT angiogram demonstrates stenosis within the arterial supply (white arrow) | 13244_2010_46_Fig9_HTML | 7 | 6a9879beefe75423667df777187957591fc91a913c93da2296dc51a117e62d43 | 13244_2010_46_Fig9_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
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"computerized tomography"
] | [
742,
447
] | [{'image_id': '13244_2010_46_Fig14_HTML', 'image_file_name': '13244_2010_46_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig14_HTML.jpg', 'caption': 'Axial CT image on “lung windows” reveals extensive pneumatosis coli, secondary to small bowel obstruction at the level of the entero-enterostomy', 'hash': 'f8abffe0821ce6c3bb0454064c80634e112032c4c87576ba6a0c4daf57ad3119'}, {'image_id': '13244_2010_46_Fig1_HTML', 'image_file_name': '13244_2010_46_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig1_HTML.jpg', 'caption': 'Schematic diagram of SPK transplant, with enteric drainage', 'hash': '742356012f65ae1bc0641a22b9537250b9a36ca339f3f7057f3e24f353543acc'}, {'image_id': '13244_2010_46_Fig13_HTML', 'image_file_name': '13244_2010_46_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig13_HTML.jpg', 'caption': 'Axial CT demonstrates a large collection (white asterisk) posterior to the head of the pancreas graft (black asterisk) and donor duodenal loop (white arrowhead). Surgical exploration confirmed a leak at the donor duodenal staple line', 'hash': 'c5cc680e3b43ba06d8f856521c5f60e4750b94ef0c65e96637528c1a814c576b'}, {'image_id': '13244_2010_46_Fig6_HTML', 'image_file_name': '13244_2010_46_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig6_HTML.jpg', 'caption': 'a Unenhanced coronal CT reformat demonstrating high attenuation thrombus within the donor splenic vein (white arrow). b CT in the portal venous phase reveals a thrombus within the donor splenic vein (white arrow)', 'hash': '5378ba9d53aeae6c53cbcf321890b18fdeeaa7c5ff227d413de4e15c68f188b5'}, {'image_id': '13244_2010_46_Fig9_HTML', 'image_file_name': '13244_2010_46_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig9_HTML.jpg', 'caption': 'a Conventional angiogram reveals a stenosis (black arrow) within the ‘Y graft’, near anastomoses with the donor common iliac artery. b CT angiogram demonstrates stenosis within the arterial supply (white arrow)', 'hash': '6a9879beefe75423667df777187957591fc91a913c93da2296dc51a117e62d43'}, {'image_id': '13244_2010_46_Fig15_HTML', 'image_file_name': '13244_2010_46_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig15_HTML.jpg', 'caption': 'Axial CT image at the level of the atrophic native kidneys demonstrates multiple soft tissue nodules (white arrows) within the retroperitoneum and subcutaneous tissues. Biopsy confirmed post-transplantation lymphoproliferative disorder', 'hash': '138d1598293075d9f48e0c330625297eba6cfa553036319d9b20227d4f57c1d3'}, {'image_id': '13244_2010_46_Fig8_HTML', 'image_file_name': '13244_2010_46_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig8_HTML.jpg', 'caption': '111Indium-labelled white cell scintigraphy. Uptake of radio-isotope is seen in the right iliac fossa (black arrow), within the infected pancreatic graft', 'hash': '638247b21d122dfca5ff9f251fc66ff5c45c76a29848c1d485a15879d2c1b89a'}, {'image_id': '13244_2010_46_Fig7_HTML', 'image_file_name': '13244_2010_46_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig7_HTML.jpg', 'caption': 'Conventional angiogram confirming the presence of arterial thrombosis within the pancreatic graft. Only a short segment of the donor common iliac artery (black arrow) is patent', 'hash': 'ef80b5c738148e07e3b02752a76e3c5eb00ce7608ac4cde4ff4f56ac7a69b843'}, {'image_id': '13244_2010_46_Fig12_HTML', 'image_file_name': '13244_2010_46_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig12_HTML.jpg', 'caption': 'CT fistulogram reveals an entero-cutaneous fistula post-pancreatitis. Contrast medium instilled via the cutaneous fistula demarcates the fistulous tract (white arrows) to the pancreatic head (black asterisk)', 'hash': '4dd4e6691e8ab392f498ddb6ea1347157b09e484faf4175872cad56c3af53622'}, {'image_id': '13244_2010_46_Fig11_HTML', 'image_file_name': '13244_2010_46_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig11_HTML.jpg', 'caption': 'Conventional angiogram shows a small blush near the head of the pancreatic graft, representing a pseudoaneurysm (white arrow)', 'hash': 'd580c968d3067c630e0e2c8184ad0accbfa046bd6df7ae2ec14f81e88e3c2b1b'}, {'image_id': '13244_2010_46_Fig4_HTML', 'image_file_name': '13244_2010_46_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig4_HTML.jpg', 'caption': 'CT arteriogram demonstrating the ‘Y graft’ (white asterisk) of the donor splenic artery and SMA anastomosed to donor iliac artery bifurcation (white arrow), which is in turn anastomosed to the recipient external iliac artery (white arrowhead)', 'hash': '88fb954f5ff97b0a44e003ececaac4e7a429dd38709e6eda9ae4b3527d79d101'}, {'image_id': '13244_2010_46_Fig3_HTML', 'image_file_name': '13244_2010_46_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig3_HTML.jpg', 'caption': 'Coronal multiplanar reformat of SPK transplant, in the portal venous phase of enhancement. Duodenal staple line (black arrows), ureteric stent (grey arrow), renal (grey asterisk) and pancreatic transplant (white asterisk), donor portal vein anastomosed to IVC (black asterisk), splenic artery (white arrow)', 'hash': '385fee7753ffd129c82b25dd3176606b91c1aa004284bccba0eefecef7196329'}, {'image_id': '13244_2010_46_Fig5_HTML', 'image_file_name': '13244_2010_46_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig5_HTML.jpg', 'caption': 'CT-guided biopsy of pancreatic transplant (white asterisk). Renal transplant seen in left iliac fossa', 'hash': '67484aa22c3d5893b583d77f8693bd0cb25858625d61b9959a0b84618e5b3d5b'}, {'image_id': '13244_2010_46_Fig10_HTML', 'image_file_name': '13244_2010_46_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig10_HTML.jpg', 'caption': 'Axial CT image demonstrating a swollen pancreatic graft (white asterisk), with marked peri-pancreatic fat stranding. Appearances are consistent with graft pancreatitis', 'hash': '3ecbb029c76b8ac18027a22496a111b40799c18bc6d072154e59b44a6447f6fe'}, {'image_id': '13244_2010_46_Fig2_HTML', 'image_file_name': '13244_2010_46_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259388/13244_2010_46_Fig2_HTML.jpg', 'caption': 'US image revealing normal homogeneous echotexture of the pancreatic graft (white asterisk) in the right iliac fossa, with normal vascularity on power Doppler', 'hash': '857721005dcf66408575895e709516e2e30089a61859ba97366ba03ec6590e95'}] | {'13244_2010_46_Fig1_HTML': ['At our institution, the pancreas transplant is placed intra-peritoneally, lying on the right side of the pelvis; the kidney is placed in the left iliac fossa and is extra peritoneal to facilitate biopsy (Fig.\xa0<xref rid="13244_2010_46_Fig1_HTML" ref-type="fig">1</xref>).\n).\nFig.\xa01Schematic diagram of SPK transplant, with enteric drainage'], '13244_2010_46_Fig2_HTML': ['US is of limited value in the initial assessment of the pancreatic parenchyma, as the transplant margins are often poorly defined. In addition, views may be limited by overlying bowel gas due to the intra-peritoneal position of the transplant pancreas. Assuming good views are obtained, Doppler US may be of great use in evaluating the patency and calibre of the arterial and venous grafts (Fig.\xa0<xref rid="13244_2010_46_Fig2_HTML" ref-type="fig">2</xref>). The resistive index has been shown to be an unreliable indicator of rejection and therefore biopsy is the diagnostic “gold standard” [). The resistive index has been shown to be an unreliable indicator of rejection and therefore biopsy is the diagnostic “gold standard” [11, 12]. US-guided biopsies have a high success rate [13], ensuring the modality’s continued application in this field. There is, however, an increased risk of bleeding associated with pancreas biopsy compared with transplant kidney biopsy as the pancreas is intraperitoneal, thus bleeding will not be tamponaded by either the peritoneum or by the organ capsule. Pancreatic leaks are the other complication which deters clinicians, and for these reasons biopsy of the renal transplant may be used as a surrogate marker for pancreatic rejection [14], although asynchronous rejection may occur.\nFig.\xa02US image revealing normal homogeneous echotexture of the pancreatic graft (white asterisk) in the right iliac fossa, with normal vascularity on power Doppler'], '13244_2010_46_Fig3_HTML': ['CT images should be acquired in three phases: unenhanced, arterial and venous. The unenhanced images are used to locate the pancreas transplant and to identify vascular thromboses and haematomas, due to their increased attenuation. The arterial-phase study should be performed in an early angiographic phase, focused on the pancreas transplant. In our institution this is achieved by bolus tracking over the abdominal aorta and imaging at 7\u2009s after the arrival of contrast medium. The arterial phase often demonstrates parenchymal enhancement and early venous drainage, depending on the transit time across the graft pancreas. The venous phase obtained 50\u2009s post-injection (Fig.\xa0<xref rid="13244_2010_46_Fig3_HTML" ref-type="fig">3</xref>) of the whole abdomen and pelvis demonstrates graft venous drainage, parenchymal enhancement and fluid collections. Multi-detector CT (MDCT) enables 3D reconstructions (Fig.\xa0) of the whole abdomen and pelvis demonstrates graft venous drainage, parenchymal enhancement and fluid collections. Multi-detector CT (MDCT) enables 3D reconstructions (Fig.\xa0<xref rid="13244_2010_46_Fig4_HTML" ref-type="fig">4</xref>) of the vascular structures, which may enhance the detection of vascular complications.\n) of the vascular structures, which may enhance the detection of vascular complications.\nFig.\xa03Coronal multiplanar reformat of SPK transplant, in the portal venous phase of enhancement. Duodenal staple line (black arrows), ureteric stent (grey arrow), renal (grey asterisk) and pancreatic transplant (white asterisk), donor portal vein anastomosed to IVC (black asterisk), splenic artery (white arrow)Fig.\xa04CT arteriogram demonstrating the ‘Y graft’ (white asterisk) of the donor splenic artery and SMA anastomosed to donor iliac artery bifurcation (white arrow), which is in turn anastomosed to the recipient external iliac artery (white arrowhead)'], '13244_2010_46_Fig5_HTML': ['Rejection is a common cause of pancreatic graft failure [17]. For the period 2000-2004, the IPTR reported acute rejection to be the cause of graft failure in 7-25% of cases. Chronic rejection was reported to be the cause of graft failure in 2-33% of cases [18]. Rejection has no specific imaging features. The cause of early graft failure is often difficult to determine clinically. Imaging therefore has a vital role in the exclusion of other causes of pancreatic graft failure and in guiding biopsy (Fig.\xa0<xref rid="13244_2010_46_Fig5_HTML" ref-type="fig">5</xref>).\n).\nFig.\xa05CT-guided biopsy of pancreatic transplant (white asterisk). Renal transplant seen in left iliac fossa'], '13244_2010_46_Fig6_HTML': ['In venous thrombosis, US Doppler imaging demonstrates absent venous flow, and a high resistance arterial waveform, with reversed diastolic flow, may also be seen occasionally. Unenhanced CT may show thrombus as a high attenuation portal vein or splenic vein (Fig.\xa0<xref rid="13244_2010_46_Fig6_HTML" ref-type="fig">6a</xref>). A filling defect may be seen following the adminstration of intravenous contrast medium (Fig.\xa0). A filling defect may be seen following the adminstration of intravenous contrast medium (Fig.\xa0<xref rid="13244_2010_46_Fig6_HTML" ref-type="fig">6b</xref>); but subtle thromboses may be obscured following parenchymal enhancement. Side-branch venous thromboses may be seen where small venous side branches have been ligated during retrieval. These are commonly of no clinical significance but are monitored to exclude the presence of thrombus propagation. Venous-graft thrombosis may result in pancreatic necrosis or duodenal stump breakdown, which usually necessitates graft pancreatectomy. Prompt diagnosis and immediate thrombectomy may be successful.\n); but subtle thromboses may be obscured following parenchymal enhancement. Side-branch venous thromboses may be seen where small venous side branches have been ligated during retrieval. These are commonly of no clinical significance but are monitored to exclude the presence of thrombus propagation. Venous-graft thrombosis may result in pancreatic necrosis or duodenal stump breakdown, which usually necessitates graft pancreatectomy. Prompt diagnosis and immediate thrombectomy may be successful.\nFig.\xa06a Unenhanced coronal CT reformat demonstrating high attenuation thrombus within the donor splenic vein (white arrow). b CT in the portal venous phase reveals a thrombus within the donor splenic vein (white arrow)'], '13244_2010_46_Fig7_HTML': ['Graft arterial thrombosis is much less common than venous thrombosis, and can occur in the early or late phase post-transplantation. The thrombosis may also be seen as a hyperdense vessel on unenhanced CT, with subsequent non-enhancement following intravenous contrast medium (Fig.\xa0<xref rid="13244_2010_46_Fig7_HTML" ref-type="fig">7</xref>). Early arterial thrombosis may occur spontaneously at any of the anastomotic sites, or as a consequence of vascular rejection, and results in non-enhancement and subsequent necrosis of the pancreatic graft. Late arterial occlusion may represent the end point of graft rejection. This initially involves the smaller vessels and progresses to involve the larger ones [). Early arterial thrombosis may occur spontaneously at any of the anastomotic sites, or as a consequence of vascular rejection, and results in non-enhancement and subsequent necrosis of the pancreatic graft. Late arterial occlusion may represent the end point of graft rejection. This initially involves the smaller vessels and progresses to involve the larger ones [30].\nFig.\xa07Conventional angiogram confirming the presence of arterial thrombosis within the pancreatic graft. Only a short segment of the donor common iliac artery (black arrow) is patent'], '13244_2010_46_Fig8_HTML': ['Emphysematous transformation may occur within a necrotic graft. This is demonstrated on CT as gas locules within the pancreatic graft [31]. It is impossible to differentiate between emphysematous transformation and gas-forming infection on CT. Scintigraphy with radioisotope-labelled white blood cells may be used as a suitable non invasive alternative, where there is clinical uncertainty regarding the presence of graft associated infection (Fig.\xa0<xref rid="13244_2010_46_Fig8_HTML" ref-type="fig">8</xref>). However, in this situation, surgical graft exploration is usually indicated.\n). However, in this situation, surgical graft exploration is usually indicated.\nFig.\xa08111Indium-labelled white cell scintigraphy. Uptake of radio-isotope is seen in the right iliac fossa (black arrow), within the infected pancreatic graft'], '13244_2010_46_Fig9_HTML': ['Pseudoaneurysms, arteriovenous fistulae, arterial dissection and arterial stenosis represent some rarer vascular complications. Pseudoaneurysms may be the result of surgical technique (particularly if the mesenteric pedicle has been divided with a linear stapling device), infection, severe pancreatitis, or allograft biopsy. Arteriovenous fistulae may be the result of vascular injury, either at surgery or post-biopsy; they are common in the stapled edge of the mesentery where the superior mesenteric vessels have been divided. Arterial stenosis can arise at any anastomosis and may ultimately lead to reduced graft perfusion (Fig.\xa0<xref rid="13244_2010_46_Fig9_HTML" ref-type="fig">9</xref>). Occasionally, the arterial “Y graft” conduit may kink; this can result in significant haemodynamic compromise and graft dysfunction. Furthermore, the donor portal vein may appear kinked proximal to the anastomosis with the recipient IVC. It is yet to be determined whether this is clinically significant. Our experience suggests that this does not cause graft dysfunction.\n). Occasionally, the arterial “Y graft” conduit may kink; this can result in significant haemodynamic compromise and graft dysfunction. Furthermore, the donor portal vein may appear kinked proximal to the anastomosis with the recipient IVC. It is yet to be determined whether this is clinically significant. Our experience suggests that this does not cause graft dysfunction.\nFig.\xa09a Conventional angiogram reveals a stenosis (black arrow) within the ‘Y graft’, near anastomoses with the donor common iliac artery. b CT angiogram demonstrates stenosis within the arterial supply (white arrow)'], '13244_2010_46_Fig10_HTML': ['Early graft pancreatitis is often due to reperfusion injury and usually involves the whole graft (Fig.\xa0<xref rid="13244_2010_46_Fig10_HTML" ref-type="fig">10</xref>). In the early post-operative period, ill-defined fat planes around the pancreatic graft are commonly seen. The graft may appear as an enhancing ‘mass’ surrounded by an omental wrap in the right iliac fossa. At an early stage it may be difficult to distinguish radiologically between the appearance of the normal post operative pancreatic graft and early graft pancreatitis. Furthermore, focal oedema of the donor’s mesenteric fat attached to the SMA stump, presumably the result of donor lymphatic vessel ligation, should not be misinterpreted as focal oedematous pancreatitis [). In the early post-operative period, ill-defined fat planes around the pancreatic graft are commonly seen. The graft may appear as an enhancing ‘mass’ surrounded by an omental wrap in the right iliac fossa. At an early stage it may be difficult to distinguish radiologically between the appearance of the normal post operative pancreatic graft and early graft pancreatitis. Furthermore, focal oedema of the donor’s mesenteric fat attached to the SMA stump, presumably the result of donor lymphatic vessel ligation, should not be misinterpreted as focal oedematous pancreatitis [36]. MDCT is valuable in evaluating the complications of pancreatitis, such as parenchymal necrosis and abscess formation. Collections may be amenable to image-guided drainage to alleviate the pressure effect on the vascular supply and drainage of the pancreatic graft.\nFig.\xa010Axial CT image demonstrating a swollen pancreatic graft (white asterisk), with marked peri-pancreatic fat stranding. Appearances are consistent with graft pancreatitis'], '13244_2010_46_Fig11_HTML': ['Pseudocysts form at a later stage as a result of graft pancreatitis. They may occur inside or outside the graft and have the potential to become infected. This may result in vascular pseudoaneurysm formation. The diagnosis should be considered in patients with a pulsatile abdominal mass, unexplained anaemia and/or haemodynamic instability, and when there is rapid enlargement of a pseudocyst. CT angiography is used to evaluate this possibility. Formal angiography is subsequently used to confirm the presence of a pseudoaneurysm (Fig.\xa0<xref rid="13244_2010_46_Fig11_HTML" ref-type="fig">11</xref>) and permit embolisation.\n) and permit embolisation.\nFig.\xa011Conventional angiogram shows a small blush near the head of the pancreatic graft, representing a pseudoaneurysm (white arrow)'], '13244_2010_46_Fig12_HTML': ['Another potential complication of pancreatitis is fistula formation. Fistulae may form between the pancreatic graft and the skin or the peritoneal cavity (Fig.\xa0<xref rid="13244_2010_46_Fig12_HTML" ref-type="fig">12</xref>). Sinus tracts may also develop. Fistulae connecting to the skin are best assessed with CT fistulograms. Internal fistulae are best assessed with MRI.\n). Sinus tracts may also develop. Fistulae connecting to the skin are best assessed with CT fistulograms. Internal fistulae are best assessed with MRI.\nFig.\xa012CT fistulogram reveals an entero-cutaneous fistula post-pancreatitis. Contrast medium instilled via the cutaneous fistula demarcates the fistulous tract (white arrows) to the pancreatic head (black asterisk)'], '13244_2010_46_Fig13_HTML': ['Duodenal segment leaks may occur at the duodenojejunostomy, but are more common at the staple line of the duodenal stump (Fig.\xa0<xref rid="13244_2010_46_Fig13_HTML" ref-type="fig">13</xref>). These occur early due to ischaemia, or late (>4\xa0weeks) secondary to infection or rejection. Free air around the graft is common in the early post-operative period, but seen late may indicate an anastomotic leak. Free fluid may also be seen and collections may form adjacent to the leaking point.\n). These occur early due to ischaemia, or late (>4\xa0weeks) secondary to infection or rejection. Free air around the graft is common in the early post-operative period, but seen late may indicate an anastomotic leak. Free fluid may also be seen and collections may form adjacent to the leaking point.\nFig.\xa013Axial CT demonstrates a large collection (white asterisk) posterior to the head of the pancreas graft (black asterisk) and donor duodenal loop (white arrowhead). Surgical exploration confirmed a leak at the donor duodenal staple line'], '13244_2010_46_Fig14_HTML': ['Small bowel obstruction is most commonly secondary to adhesions, a generic risk of abdominal surgery (Fig.\xa0<xref rid="13244_2010_46_Fig14_HTML" ref-type="fig">14</xref>). Another potential cause is internal herniation of jejunal loops posterior to the pancreatic graft, through a mesenteric defect related to the Roux loop formation [). Another potential cause is internal herniation of jejunal loops posterior to the pancreatic graft, through a mesenteric defect related to the Roux loop formation [37].\nFig.\xa014Axial CT image on “lung windows” reveals extensive pneumatosis coli, secondary to small bowel obstruction at the level of the entero-enterostomy'], '13244_2010_46_Fig15_HTML': ['The common complications secondary to immunosuppression seen in solid organ transplantation are generally categorised as related to either infection or tumour. We would like to highlight the specific complication of post-transplant lymphoproliferative disorder (PTLD) that can be diagnosed using cross-sectional imaging. PTLD is a serious but rare complication of pancreas transplantation. It has a reported incidence after pancreatic transplantation of 3-12% [38, 39]. It is associated with the higher levels of immunosuppression needed in SPK transplants compared with other solid organ transplants. It is associated with a donor acquired EBV infection and is therefore commoner in younger previously EBV-naive transplant recipients, for example, type I DM recipients of SPK grafts. Diffuse enlargement of the pancreatic graft is a common manifestation, which is indistinguishable from oedematous pancreatitis or transplant rejection. Less commonly focal intra- or extra-allograft masses may develop (Fig.\xa0<xref rid="13244_2010_46_Fig15_HTML" ref-type="fig">15</xref>), and lymphadenopathy and other organomegaly may also occur [), and lymphadenopathy and other organomegaly may also occur [40]. A tissue diagnosis is essential as the treatment modalities include a reduction in immunosuppression and consideration of chemotherapy.\nFig.\xa015Axial CT image at the level of the atrophic native kidneys demonstrates multiple soft tissue nodules (white arrows) within the retroperitoneum and subcutaneous tissues. Biopsy confirmed post-transplantation lymphoproliferative disorder']} | Pancreatic transplantation: surgical technique, normal radiological appearances and complications | [
"Simultaneous pancreas kidney transplantation",
"Imaging"
] | Insights Imaging | 1288422000 | Pneumatosis intestinalis is defined as the presence of gas within the wall of the gastrointestinal tract. Originally described on plain abdominal radiographs, it is an imaging sign rather than a specific diagnosis and it is associated with both benign and life-threatening clinical conditions. The most common life-threatening cause of pneumatosis intestinalis is bowel ischaemia. Computed tomography (CT) is usually requested to detect underlying disease. The presence of pneumatosis intestinalis often leads physicians to make a diagnosis of serious disease. However, an erroneous diagnosis of pneumatosis intestinalis may be made (i.e. pseudo-pneumatosis) when intraluminal beads of gas are trapped within or between faeces and adjacent mucosal folds. The purpose of this pictorial essay is to review and describe the CT imaging findings of pneumatosis and pseudo-pneumatosis intestinalis and to discuss key discriminatory imaging features. | [] | other | PMC3259388 | null | 19 | [
"{'Citation': 'Pear BL. Pneumatosis intestinalis: a review. Radiology. 1998;207:13–19.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9530294'}}}",
"{'Citation': 'Peter SD, Abbas MA, Kelly KA. The spectrum of pneumatosis intestinalis. Arch Surg. 2003;138:68–75. doi: 10.1001/archsurg.138.1.68.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1001/archsurg.138.1.68'}, {'@IdType': 'pubmed', '#text': '12511155'}]}}",
"{'Citation': 'Morris MS, Gee AC, Cho SD, Limbaugh K, Underwood S, Ham B, Schreiber MA. Management and outcome of pneumatosis intestinalis. Am J Surg. 2008;195:679–682. doi: 10.1016/j.amjsurg.2008.01.011.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.amjsurg.2008.01.011'}, {'@IdType': 'pubmed', '#text': '18424288'}]}}",
"{'Citation': 'Ho LM, Paulson EK, Thompson WM. Pneumatosis intestinalis in the adult: benign to life-threatening causes. AJR Am J Roentgenol. 2007;188:1604–1613. doi: 10.2214/AJR.06.1309.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.2214/AJR.06.1309'}, {'@IdType': 'pubmed', '#text': '17515383'}]}}",
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"{'Citation': 'Olson DE, Kim YW, Ying J, Donnelly LF. CT predictors for differentiating benign and clinically worrisome pneumatosis intestinalis in children beyond the neonatal period. Radiology. 2009;253:513–519. doi: 10.1148/radiol.2532090168.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1148/radiol.2532090168'}, {'@IdType': 'pubmed', '#text': '19710000'}]}}",
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"{'Citation': 'Wiesner W, Mortele KJ, Glickman JN, Ji H, Ros PR. Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. AJR Am J Roentgenol. 2001;177:1319–1323.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11717075'}}}",
"{'Citation': 'Schindera ST, Triller J, Vock P, Hoppe H. Detection of hepatic portal venous gas: its clinical impact and outcome. Emerg Radiol. 2006;12:164–170. doi: 10.1007/s10140-006-0467-y.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s10140-006-0467-y'}, {'@IdType': 'pubmed', '#text': '16547739'}]}}",
"{'Citation': 'Wiesner W, Mortele KJ, Glickman JN, Ji H, Ros PR. Portal-venous gas unrelated to mesenteric ischemia. Eur Radiol. 2002;12:1432–1437. doi: 10.1007/s00330-001-1159-3.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s00330-001-1159-3'}, {'@IdType': 'pubmed', '#text': '12042950'}]}}",
"{'Citation': 'Sebastia C, Quiroga S, Espin E, Boye R, Alvarez-Castells A, Armengol M. Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis. Radiographics. 2000;20:1213–1224.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10992012'}}}",
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"{'Citation': 'Pickhardt PJ, Kim DH, Taylor AJ. Asymptomatic pneumatosis at CT colonography: a benign self-limited imaging finding distinct from perforation. AJR Am J Roentgenol. 2008;190:W112–W117. doi: 10.2214/AJR.07.2843.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.2214/AJR.07.2843'}, {'@IdType': 'pubmed', '#text': '18212192'}]}}",
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] | Insights Imaging. 2010 Oct 30; 1(5-6):339-347 | NO-CC CODE |
|
A 22-year-old woman with surgically proven perforated Meckel’s diverticulitis and Crohn’s disease. Intravenous- and oral-enhanced CT shows the collection due to the perforated Meckel’s diverticulum (arrow) in the right lower quadrant. Thickened-wall ileal loops (arrowheads) and prominently dilated mesenteric vessels (asterisk), proving active Crohn’s disease are also demonstrated. | 13244_2010_17_Fig7_HTML | 7 | 41efc131c70d77502643a6735d054e5d7da7f1cc5e718de7373ca02138ebde0c | 13244_2010_17_Fig7_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
793,
643
] | [{'image_id': '13244_2010_17_Fig9_HTML', 'image_file_name': '13244_2010_17_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259399/13244_2010_17_Fig9_HTML.jpg', 'caption': 'A 63-year-old patient with small bowel obstruction due to inflammation of the Meckel’s diverticulum (surgery proven). Intravenous abdominal CT shows the diverticulum as an enhancing, blind-ending digestive structure, with thick wall and fluid content (arrow); this finding was demonstrated to be an inflamed Meckel’s diverticulum situated at the transition point with the dilated small bowel loops and surrounded by inflammatory changes in the mesenteric fat.', 'hash': 'a2850acd72b977210b9c610e238be2b70274d8559ebaefee2333da6fc7224e14'}, {'image_id': '13244_2010_17_Fig6_HTML', 'image_file_name': '13244_2010_17_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259399/13244_2010_17_Fig6_HTML.jpg', 'caption': 'A 32-year-old woman with surgically proven Meckel’s diverticulitis. a Intravenous- and oral-enhanced CT shows the inflamed diverticulum as a round, contrast-filled, thickened-wall collection (arrowheads) in continuation with an ileal loop; associated fat stranding (asterisk) is also demonstrated. b CT scan at a higher level than a shows the peridiverticular inflammatory changes (arrowheads) along with normal aspect of the appendix (arrow) and of the ileal loops proximal to the inflamed diverticulum (double arrows).', 'hash': '9db50eae345928aaf77418d764eed934601ffe0d45cbcfc84696f8aecc47d0e0'}, {'image_id': '13244_2010_17_Fig1_HTML', 'image_file_name': '13244_2010_17_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259399/13244_2010_17_Fig1_HTML.jpg', 'caption': 'A 76-year-old patient with surgically proven Meckel’s diverticulitis. Intravenous contrast-enhanced CT shows the Meckel’s diverticulum as a fluid-filled, blind-ending digestive structure (arrow), arising from a distal ileal loop, along with peridiverticular mesenteric fat stranding (asterisk), suggestive of inflammation.', 'hash': '438f7d6f3564d09f71166751efbdbc75b3960d045abddf08a93914c9636014d3'}, {'image_id': '13244_2010_17_Fig11_HTML', 'image_file_name': '13244_2010_17_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259399/13244_2010_17_Fig11_HTML.jpg', 'caption': 'A 20-year-old woman with surgically proven needle retention in a giant Meckel’s diverticulum. Oral-enhanced CT shows the needle (arrow) located at the collar of a fluid-filled, blind-ended tubular structure (asterisk) that is the Meckel’s diverticulum.', 'hash': '2b0afcc2e406dec3b00608afe587fb73e29dd591bdbe7ca58d3eca713495f898'}, {'image_id': '13244_2010_17_Fig7_HTML', 'image_file_name': '13244_2010_17_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259399/13244_2010_17_Fig7_HTML.jpg', 'caption': 'A 22-year-old woman with surgically proven perforated Meckel’s diverticulitis and Crohn’s disease. Intravenous- and oral-enhanced CT shows the collection due to the perforated Meckel’s diverticulum (arrow) in the right lower quadrant. Thickened-wall ileal loops (arrowheads) and prominently dilated mesenteric vessels (asterisk), proving active Crohn’s disease are also demonstrated.', 'hash': '41efc131c70d77502643a6735d054e5d7da7f1cc5e718de7373ca02138ebde0c'}, {'image_id': '13244_2010_17_Fig8_HTML', 'image_file_name': '13244_2010_17_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259399/13244_2010_17_Fig8_HTML.jpg', 'caption': 'A 22-year-old man with massive gastrointestinal bleeding due to heterotopic gastric mucosa in a Meckel’s diverticulum (surgery proven). a Nonenhanced CT scan at the same level as b shows no spontaneously dense material in the bowel lumen. b Intravenous-enhanced CT scan shows contrast extravasation seen as linear hyperattenuating pooling of contrast at the neck of the Meckel’s diverticulum (arrow), arising from a distal ileal loop.', 'hash': '08cc48a671e22a34db94eedcd9079b3250e9bde6b76275ca52a51f21d1549871'}, {'image_id': '13244_2010_17_Fig10_HTML', 'image_file_name': '13244_2010_17_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259399/13244_2010_17_Fig10_HTML.jpg', 'caption': 'A 39-year-old woman with surgically proven ileal intussusception related to the Meckel’s diverticulum as the lead point. a Intravenous- and oral-enhanced CT scan shows the intussusception of the ileum (arrow) along with its mesentery (asterisk), creating the “target sign.” b Image at a lower level than a demonstrates the invaginated mesenteric fat (arrow), along with thickening of the intussuscepted ileum (arrowhead).', 'hash': '4dc4b1d91c289c05fa9285acfe0a09380cf05a5cc96c48b972c64d5d349496b9'}, {'image_id': '13244_2010_17_Fig3_HTML', 'image_file_name': '13244_2010_17_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259399/13244_2010_17_Fig3_HTML.jpg', 'caption': 'A 33-year-old woman with surgically proven perforated Meckel’s diverticulum. a Intravenous- and oral-enhanced CT shows the perforated Meckel’s diverticulum as a gas-containing collection in the right lower quadrant (asterisk), situated between the ileal loops and surrounded by fat stranding (arrow). b Coronal reconstructed CT demonstrates the perforated diverticulum (asterisk), contiguous with a thickened ileal loop (arrow).', 'hash': '1800ac92cc32e64b0b7bb0b6fb37a60b0bab1edc3b6539458914edd57f62c4a1'}, {'image_id': '13244_2010_17_Fig4_HTML', 'image_file_name': '13244_2010_17_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259399/13244_2010_17_Fig4_HTML.jpg', 'caption': 'A 71-year-old woman with surgically proven inflamed Meckel’s diverticulum with tip perforation. Intravenous- and oral-enhanced CT shows the diverticulum as a tubular, thickened-wall, blind-ending digestive structure (asterisk) surrounded by an important fat infiltration (arrowheads); the diverticulum is situated in the right lower quadrant. Caecum and terminal ileum are normal (arrow).', 'hash': 'd44ad8c4aa7d04350a74e80ceff02235d908271f6ef002134abeabb3ab5cc030'}, {'image_id': '13244_2010_17_Fig2_HTML', 'image_file_name': '13244_2010_17_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259399/13244_2010_17_Fig2_HTML.jpg', 'caption': 'A 37-year-old man with inflamed Meckel’s diverticulum and abscess formation (surgery proven). Intravenous- and oral-enhanced CT scan shows a contrast-filled tubular diverticulum with a “mucosal triangular plateau” pattern at its ileal attachment (curved arrow); there is a fluid-filled collection at the diverticulum’s tip and associated fat stranding (arrowhead).', 'hash': 'e44a863603e7c7f1d89dfa0d21b179b697c0fbd6876548cb51868d8aa03a7222'}, {'image_id': '13244_2010_17_Fig5_HTML', 'image_file_name': '13244_2010_17_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259399/13244_2010_17_Fig5_HTML.jpg', 'caption': 'A 44-year-old man with surgically proven necrotic Meckel’s diverticulum (images courtesy of Dr. K. Bider and Dr. C. Beynon). a Intravenous-enhanced CT shows the inflamed diverticulum as an air-fluid collection (arrow) with thin, nonenhancing wall adjacent to an ileal loop. b Photograph taken during surgery before opening the specimen shows a 7\xa0cm large, necrotic Meckel’s diverticulum.', 'hash': 'e853e64d326012b69c356ae30c042dca114cf6f448475939b86d447c8ac17af3'}] | {'13244_2010_17_Fig1_HTML': ['According to our observations, the most straightforwardly recognizable CT scan appearance of Meckel’s diverticulitis was that of a tubular or rounded blind-ending digestive structure, attached to a distal ileal loop and surrounded by mesenteric fat infiltration (Fig.\xa0<xref rid="13244_2010_17_Fig1_HTML" ref-type="fig">1</xref>). The diverticulum may be fluid, air-fluid, or contrast filled and is situated either in the right lower quadrant or in the lower abdomen, with normal ileum distal and proximal to its attachment point.\n). The diverticulum may be fluid, air-fluid, or contrast filled and is situated either in the right lower quadrant or in the lower abdomen, with normal ileum distal and proximal to its attachment point.\nFig.\xa01A 76-year-old patient with surgically proven Meckel’s diverticulitis. Intravenous contrast-enhanced CT shows the Meckel’s diverticulum as a fluid-filled, blind-ending digestive structure (arrow), arising from a distal ileal loop, along with peridiverticular mesenteric fat stranding (asterisk), suggestive of inflammation.'], '13244_2010_17_Fig2_HTML': ['The identification of the attachment point of the diverticulum to the distal ileum allowed us to recognize with an important degree of certainty the presence of Meckel’s diverticulum on CT scan. For this purpose, the presence of oral contrast inside the diverticulum provides a better characterization of its ileal attachment, by allowing a good visualization of the pattern of the mucosal folds on the junction region. The continuation of the mucosal folds from the ileum into the diverticulum may form a “triradiate” mucosal pattern, if ileal loops are collapsed, or may look like a “triangular plateau,” if ileal loops are distended by the oral contrast. This appearance has already been described on gastrointestinal contrast examination of the small bowel [2, 5] and is considered pathognomonic for the diagnosis of Meckel’s diverticulum; herein, for the first time, we report its aspect on a CT scan examination (Fig.\xa0<xref rid="13244_2010_17_Fig2_HTML" ref-type="fig">2</xref>).\n).\nFig.\xa02A 37-year-old man with inflamed Meckel’s diverticulum and abscess formation (surgery proven). Intravenous- and oral-enhanced CT scan shows a contrast-filled tubular diverticulum with a “mucosal triangular plateau” pattern at its ileal attachment (curved arrow); there is a fluid-filled collection at the diverticulum’s tip and associated fat stranding (arrowhead).'], '13244_2010_17_Fig3_HTML': ['More severe instances of Meckel’s diverticulitis may appear as an abscess (Fig.\xa0<xref rid="13244_2010_17_Fig3_HTML" ref-type="fig">3</xref>) or as an inflammatory mass (Fig.\xa0) or as an inflammatory mass (Fig.\xa0<xref rid="13244_2010_17_Fig4_HTML" ref-type="fig">4</xref>) in contact with the terminal ileum [) in contact with the terminal ileum [20, 21]. An air-fluid collection, with nonenhancing walls, in direct contact with the terminal ileum is highly suggestive of a necrotic Meckel’s diverticulum (Fig.\xa0<xref rid="13244_2010_17_Fig5_HTML" ref-type="fig">5</xref>).\n).\nFig.\xa03a, bA 33-year-old woman with surgically proven perforated Meckel’s diverticulum. a Intravenous- and oral-enhanced CT shows the perforated Meckel’s diverticulum as a gas-containing collection in the right lower quadrant (asterisk), situated between the ileal loops and surrounded by fat stranding (arrow). b Coronal reconstructed CT demonstrates the perforated diverticulum (asterisk), contiguous with a thickened ileal loop (arrow).Fig.\xa04A 71-year-old woman with surgically proven inflamed Meckel’s diverticulum with tip perforation. Intravenous- and oral-enhanced CT shows the diverticulum as a tubular, thickened-wall, blind-ending digestive structure (asterisk) surrounded by an important fat infiltration (arrowheads); the diverticulum is situated in the right lower quadrant. Caecum and terminal ileum are normal (arrow).Fig.\xa05a, bA 44-year-old man with surgically proven necrotic Meckel’s diverticulum (images courtesy of Dr. K. Bider and Dr. C. Beynon). a Intravenous-enhanced CT shows the inflamed diverticulum as an air-fluid collection (arrow) with thin, nonenhancing wall adjacent to an ileal loop. b Photograph taken during surgery before opening the specimen shows a 7\xa0cm large, necrotic Meckel’s diverticulum.'], '13244_2010_17_Fig6_HTML': ['The inflamed Meckel’s diverticulum is always centered on a loop of terminal ileum, with locally surrounding mesenteric inflammatory changes. Other helpful signs in suggesting a Meckel’s diverticulum abscess, rather than an abscess of appendicular origin, are the normal aspect of the caecum and appendix, delineated by oral contrast material (Fig.\xa0<xref rid="13244_2010_17_Fig6_HTML" ref-type="fig">6</xref>).\n).\nFig.\xa06a, bA 32-year-old woman with surgically proven Meckel’s diverticulitis. a Intravenous- and oral-enhanced CT shows the inflamed diverticulum as a round, contrast-filled, thickened-wall collection (arrowheads) in continuation with an ileal loop; associated fat stranding (asterisk) is also demonstrated. b CT scan at a higher level than a shows the peridiverticular inflammatory changes (arrowheads) along with normal aspect of the appendix (arrow) and of the ileal loops proximal to the inflamed diverticulum (double arrows).'], '13244_2010_17_Fig7_HTML': ['Ileal Crohn’s disease with its complications (inflammation, perforation, obstruction) may present with clinical signs similar to complicated Meckel’s diverticulum. CT scan of patients with Crohn’s disease demonstrates extensive involvement of small bowel proximal and distal to the site of complication, whether it is an abscess or a perforation with the presence of extra-digestive air in the mesentery. Moreover, Crohn’s disease will induce fibro-fatty modification of the mesentery, which is not found in patients with an inflamed Meckel’s diverticulum [22]. Rarely, Crohn’s disease and Meckel diverticulum may coexist, with involvement of the diverticulum by terminal ileitis causing diverticulitis, which may progress towards abscess and perforation [23] (Fig.\xa0<xref rid="13244_2010_17_Fig7_HTML" ref-type="fig">7</xref>).\n).\nFig.\xa07A 22-year-old woman with surgically proven perforated Meckel’s diverticulitis and Crohn’s disease. Intravenous- and oral-enhanced CT shows the collection due to the perforated Meckel’s diverticulum (arrow) in the right lower quadrant. Thickened-wall ileal loops (arrowheads) and prominently dilated mesenteric vessels (asterisk), proving active Crohn’s disease are also demonstrated.'], '13244_2010_17_Fig8_HTML': ['A definitive diagnosis of active bleeding into a Meckel’s diverticulum is made when intravenous-enhanced CT shows extravasation of the contrast at the diverticular neck (Fig.\xa0<xref rid="13244_2010_17_Fig8_HTML" ref-type="fig">8</xref>), with delayed contrast accumulation into the saccular structure attached to the terminal ileum [), with delayed contrast accumulation into the saccular structure attached to the terminal ileum [16].\nFig.\xa08a, bA 22-year-old man with massive gastrointestinal bleeding due to heterotopic gastric mucosa in a Meckel’s diverticulum (surgery proven). a Nonenhanced CT scan at the same level as b shows no spontaneously dense material in the bowel lumen. b Intravenous-enhanced CT scan shows contrast extravasation seen as linear hyperattenuating pooling of contrast at the neck of the Meckel’s diverticulum (arrow), arising from a distal ileal loop.'], '13244_2010_17_Fig9_HTML': ['Meckel’s diverticulum may lead to bowel obstruction by several mechanisms: mesodiverticular bands, volvulus from umbilical attachment, hernia, or intussusception. In addition, different complications may coexist. For example, Meckel’s diverticulitis may lead to small bowel obstruction; in this situation, CT scan demonstrates associated signs of diverticular and mesenteric inflammation at the transition point of the dilated small bowel loops (Fig.\xa0<xref rid="13244_2010_17_Fig9_HTML" ref-type="fig">9</xref>).\n).\nFig.\xa09A 63-year-old patient with small bowel obstruction due to inflammation of the Meckel’s diverticulum (surgery proven). Intravenous abdominal CT shows the diverticulum as an enhancing, blind-ending digestive structure, with thick wall and fluid content (arrow); this finding was demonstrated to be an inflamed Meckel’s diverticulum situated at the transition point with the dilated small bowel loops and surrounded by inflammatory changes in the mesenteric fat.'], '13244_2010_17_Fig10_HTML': ['Obstruction related to intussusception is a rare condition in adults, and an underlying pathology is found in 70–90% of cases [27]. A Meckel’s diverticulum that is invaginated into the small bowel may occasionally be the cause of intussusception [28, 29]. In these cases, CT scan examination shows an abnormal multi-layered, targetlike image, with a diameter larger than the normal bowel, consistent with the intussusception (Fig.\xa0<xref rid="13244_2010_17_Fig10_HTML" ref-type="fig">10</xref>); however, as previously reported [); however, as previously reported [2], the direct visualization of the Meckel’s diverticulum as the lead point is often difficult to assess, and the differential diagnosis includes intussusception produced by benign (lipoma) or malignant (metastasis, lymphoma) tumors [28].\nFig.\xa010a, bA 39-year-old woman with surgically proven ileal intussusception related to the Meckel’s diverticulum as the lead point. a Intravenous- and oral-enhanced CT scan shows the intussusception of the ileum (arrow) along with its mesentery (asterisk), creating the “target sign.” b Image at a lower level than a demonstrates the invaginated mesenteric fat (arrow), along with thickening of the intussuscepted ileum (arrowhead).'], '13244_2010_17_Fig11_HTML': ['In our series, we document for the first time by CT scan examination the presence of a swallowed needle inside a Meckel’s diverticulum (Fig.\xa0<xref rid="13244_2010_17_Fig11_HTML" ref-type="fig">11</xref>). In this case, the Meckel’s diverticulum is recognizable as a long, tubular blind-ending structure, in continuation with an ileal loop. Presence of the needle at the collar of the diverticulum supports the hypothesis that the diverticular ileal attachment could act as a fixation point in the intestinal progression of different foreign bodies. Therefore, in these particular cases, the possible presence of a Meckel’s diverticulum should be carefully sought between the distal ileal loops.\n). In this case, the Meckel’s diverticulum is recognizable as a long, tubular blind-ending structure, in continuation with an ileal loop. Presence of the needle at the collar of the diverticulum supports the hypothesis that the diverticular ileal attachment could act as a fixation point in the intestinal progression of different foreign bodies. Therefore, in these particular cases, the possible presence of a Meckel’s diverticulum should be carefully sought between the distal ileal loops.\nFig.\xa011A 20-year-old woman with surgically proven needle retention in a giant Meckel’s diverticulum. Oral-enhanced CT shows the needle (arrow) located at the collar of a fluid-filled, blind-ended tubular structure (asterisk) that is the Meckel’s diverticulum.']} | Computed tomography of complicated Meckel’s diverticulum in adults: a pictorial review | [
"Meckel’s diverticulum",
"Computed tomography",
"Acute abdomen",
"Complications",
"Bowel"
] | Insights Imaging | 1271228400 | The past, present and future status of the practice of cardiac imaging is discussed, especially as it relates to cardiac imaging research. Recommendations for the future development are given; these emphasize the importance of multidisciplinary collaboration. | [] | other | PMC3259399 | null | 13 | [
"{'Citation': 'Higgins CH. Cardiac imaging. Radiology. 2000;217:4–10.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11012416'}}}",
"{'Citation': 'Gunderman RB, Weinreb JC, Borgstede JP, et al. The 2006 ACR forum: cardiovascular imaging: learning from the past, strategies for the future. J Am Coll Radiol. 2007;4:24–31. doi: 10.1016/j.jacr.2006.08.020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.jacr.2006.08.020'}, {'@IdType': 'pubmed', '#text': '17412221'}]}}",
"{'Citation': 'ESR Executive Council 2009 & European Society of Radiology The professional and organizational future of imaging. Insights Imaging. 2010;1:12–20. doi: 10.1007/s13244-009-0008-9.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s13244-009-0008-9'}, {'@IdType': 'pmc', '#text': 'PMC3288829'}, {'@IdType': 'pubmed', '#text': '23100121'}]}}",
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"{'Citation': 'European School of Radiology http://www.myecr.org/esor'}",
"{'Citation': 'European Society of Radiology (Education) http://www.myecr.org/education'}",
"{'Citation': 'European Society of Cardiac Radiology http://www.escr.org'}",
"{'Citation': 'European Institute for Biomedical Imaging Research http://www.eibir.org'}",
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"{'Citation': 'European Society of Pediatric Radiology http://www.espr.org'}"
] | Insights Imaging. 2010 Apr 14; 1(2):53-61 | NO-CC CODE |
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Minimal aortic injury. Coronal MIP CT image of the thorax shows minimal aortic injury at the aortic isthmus (black arrow) involving only the intima, surrounded by periaortic haematoma | 13244_2011_72_Fig17_HTML | 7 | 1958201094f9c29442682caf6a857f4c0872629139b35be0206ba5e6313311a5 | 13244_2011_72_Fig17_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
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"computerized tomography"
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767,
764
] | [{'image_id': '13244_2011_72_Fig6_HTML', 'image_file_name': '13244_2011_72_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig6_HTML.jpg', 'caption': 'Lung laceration, type IV. Axial CT image of the left lung at lung window shows a small peripheral laceration (white arrow) beneath a rib fracture (black arrow) surrounded by ground-glass opacity (lung contusion) and associated with a small ipsilateral pneumothorax', 'hash': '5863242acc3b6e21133123bf2957bab5f97c21ffceea84365475d12f424f0216'}, {'image_id': '13244_2011_72_Fig26_HTML', 'image_file_name': '13244_2011_72_Fig26_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig26_HTML.jpg', 'caption': 'Anterior sternoclavicular dislocation. Axial CT image shows clavicular fracture and anterior sternoclavicular dislocation (dotted arrows)', 'hash': '9b831dd8840c2891bf3536a4290f02ecdc98874580bf611e4ecc6623543ac9e8'}, {'image_id': '13244_2011_72_Fig29_HTML', 'image_file_name': '13244_2011_72_Fig29_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig29_HTML.jpg', 'caption': 'Thoracic spine fracture. Coronal (a) and sagittal (b) CT reconstructed images of two different patients show fractures of the upper thoracic vertebrae with great detail', 'hash': 'ed56231066f1d4acb06d74211dce565b29deb3edd1e9d22c033f352c41e989fb'}, {'image_id': '13244_2011_72_Fig9_HTML', 'image_file_name': '13244_2011_72_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig9_HTML.jpg', 'caption': 'Pneumomediastinum. Axial CT images at wide lung window show pneumomediastinum with the presence of septae within the air in the anterior mediastinum (black arrows) (a), and in the middle and posterior mediastinum (black arrows) (b). Note also a right pneumothorax, bilateral lower lobe atelectases and subcutaneous emphysema (a) and a right haemopneumothorax and left pneumothorax (b)', 'hash': 'e3315009e28d187756fed04bd73e52aa7a66e88852e0fa95bd3198339ea7893f'}, {'image_id': '13244_2011_72_Fig16_HTML', 'image_file_name': '13244_2011_72_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig16_HTML.jpg', 'caption': 'Axial contrast-enhanced CT image shows thrombus protruding into the lumen of the descending thoracic aorta (black arrows), indicating aortic injury surrounded by periaortic haematoma (white arrow)', 'hash': 'd0e96e0ad0009a48be94efa9392e2a5e78f6d4a6690fae78dcfe55586128d2f2'}, {'image_id': '13244_2011_72_Fig19_HTML', 'image_file_name': '13244_2011_72_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig19_HTML.jpg', 'caption': 'Dependent viscera sign. Axial contrast-enhanced CT at the level of the lower lobes, at mediastinal window, shows intrathoracic presence of the stomach abutting the left posterior thoracic wall without intervening in the left hemidiaphragm (black arrows)', 'hash': 'dd2bfec04ea0d87a06d80a092eb0f33fae6ab3af9709ce550f5a542b3501e95a'}, {'image_id': '13244_2011_72_Fig21_HTML', 'image_file_name': '13244_2011_72_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig21_HTML.jpg', 'caption': 'Reformatted coronal contrast-enhanced CT image of the thorax shows intrathoracic herniation of intraperitoneal fat through the large defect of the left hemidiaphragm (white arrows)', 'hash': '0a402083af039e9a88a2e385bb7fe255e23b2bbf3efbb7a9b81e6d54542ce814'}, {'image_id': '13244_2011_72_Fig1_HTML', 'image_file_name': '13244_2011_72_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig1_HTML.jpg', 'caption': 'Occult pneumothorax. Axial CT at lung window shows a small occult pneumothorax (missed on chest radiography) at the anteromedial part of the left upper lobe (white arrow). There are also bilateral ground-glass opacities and areas of consolidation in both upper lobes consistent with lung contusions. Note the presence of numerous small confluent pneumatoceles (Swiss cheese appearance) in the anterior segment of the left upper lobe, consistent with lung laceration (black arrow). Note also the presence of small pneumomediastinum (dotted white arrow)', 'hash': 'df55f512f4486e19d06a1b6cc03a1d9974ae5172b34c6563a5bc65fecfbe6813'}, {'image_id': '13244_2011_72_Fig11_HTML', 'image_file_name': '13244_2011_72_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig11_HTML.jpg', 'caption': 'Pneumopericardium. Axial CT image at lung window shows extensive pneumopericardium (white arrow), pneumomediastinum (black arrows), haemopneumothorax (black dotted arrows), collapsed left lung with ipsilateral shift of the mediastinum and collapse of the right lower lobe', 'hash': 'adb33f13ecacbdd4b2fd4739cdad52f67d1efd2ed9f523bcb12de93bfb7ff966'}, {'image_id': '13244_2011_72_Fig18_HTML', 'image_file_name': '13244_2011_72_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig18_HTML.jpg', 'caption': 'Axial contrast-enhanced CT image shows presence of an intimal flap at the aortic arch (black arrow) surrounded by mediastinal haematoma with no preserved fat plane with the aorta (white arrows). Bilateral pleural haemothoraces are also seen', 'hash': '323e8295c1260636c4d8698d6b81268f50739c220094327e06b7760ed57fe14e'}, {'image_id': '13244_2011_72_Fig17_HTML', 'image_file_name': '13244_2011_72_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig17_HTML.jpg', 'caption': 'Minimal aortic injury. Coronal MIP CT image of the thorax shows minimal aortic injury at the aortic isthmus (black arrow) involving only the intima, surrounded by periaortic haematoma', 'hash': '1958201094f9c29442682caf6a857f4c0872629139b35be0206ba5e6313311a5'}, {'image_id': '13244_2011_72_Fig28_HTML', 'image_file_name': '13244_2011_72_Fig28_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig28_HTML.jpg', 'caption': 'Scapular fracture. Sagittal reconstructed CT image shows multiple fractures of the left scapula (arrows)', 'hash': '0943d81e51026828b04bc0d5e508683c800616d624334f0ef2506c3ea24933db'}, {'image_id': '13244_2011_72_Fig8_HTML', 'image_file_name': '13244_2011_72_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig8_HTML.jpg', 'caption': 'Bronchial transection. A 22-year-old man involved in a car accident. Volume-rendered image of the tracheobronchial tree showing complete transection of the right intermediate bronchus (two-way arrow). (Courtesy of Dr Montserrat Bret, University Hospital La Paz, Madrid)', 'hash': '240792afcb56505bda44effeef2a2c701f31a156c5d2fab6d00eea28505a6def'}, {'image_id': '13244_2011_72_Fig7_HTML', 'image_file_name': '13244_2011_72_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig7_HTML.jpg', 'caption': 'Blast lung injury. Twenty-two-year-old patient who experienced the explosion of a grenade in his hands. Coronal CT reformatted contrast-enhanced CT image at mediastinal window shows bilateral perilar consolidations mimicking a butterfly or bat-wing appearance, consistent with blast lung. The left lung is almost completely collapsed, and there are bilateral haemothoraces', 'hash': '67e53dd43a059c1a1c75f728ce4c647c8beeb90350a2f9ceddab7367c3e667cc'}, {'image_id': '13244_2011_72_Fig27_HTML', 'image_file_name': '13244_2011_72_Fig27_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig27_HTML.jpg', 'caption': 'Posterior sternoclavicular dislocation. Axial CT image shows posterior sternoclavicular dislocation (black arrow) associated with compression of the left innominate vein (black dotted arrow)', 'hash': '65861d0ff5bcca7557977d36133e676dc920d29bfce85e793b3498293463ecb5'}, {'image_id': '13244_2011_72_Fig10_HTML', 'image_file_name': '13244_2011_72_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig10_HTML.jpg', 'caption': 'Haemopericardium. Axial contrast-enhanced CT of the lower thorax at mediastinal window shows haemopericardium that may represent an indirect sign of pericardial or heart injury in a polytraumatised patient after a motor vehicle accident. There is also a small right haemothorax', 'hash': '796092bf0ef0acb33a101431cc1aa7f4994330eebaf6ecd1b7c09b6075bb5cf0'}, {'image_id': '13244_2011_72_Fig30_HTML', 'image_file_name': '13244_2011_72_Fig30_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig30_HTML.jpg', 'caption': 'Thoracic spine fracture and compressive myelopathy. Sagittal T2-weighted MRI of the cervicothoracic spine undertaken 1\xa0week after a motor vehicle accident verifies the presence of extensive compressive myelopathy (between the two white arrows with black outline) due to fractures of the second and the third thoracic vertebrae (white arrows)', 'hash': '5eed45d58046af966704e6e8bac002147a98491e3206949eb9fd8d0e49fd60e3'}, {'image_id': '13244_2011_72_Fig20_HTML', 'image_file_name': '13244_2011_72_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig20_HTML.jpg', 'caption': 'The “hourglass” or “collar” sign of diaphragmatic rupture. Reformatted coronal contrast-enhanced CT image of the thorax shows waist-like stricture of the herniated left colon intrathoracically through the small defect of the left hemidiaphragm (black arrows)', 'hash': 'cbdac9d2d072d59f6023905369f608422082c3366a479b57784becb3330c6ee4'}, {'image_id': '13244_2011_72_Fig3_HTML', 'image_file_name': '13244_2011_72_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig3_HTML.jpg', 'caption': 'Tension haemopneumothorax. Axial contrast-enhanced CT at mediastinal window shows a right tension haemopneumothorax with heterogeneous increased density due to presence of blood clots and a significant shift of the mediastinum contralaterally', 'hash': '5d60ee3c870f1facdf0afcf993a9144d5bb6d95ca2f9b9a287c6ccb26ffa433a'}, {'image_id': '13244_2011_72_Fig23_HTML', 'image_file_name': '13244_2011_72_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig23_HTML.jpg', 'caption': 'Coronal (a) and sagittal (b) reconstructed CT images show fractures of three contiguous right ribs (arrows) that were associated with paradox motion of the chest during respiration. Flail chest was suspected clinically and verified on imaging', 'hash': 'e0dfac45308f42c94f933fee9460f1b447c0fe8d307b3d1a0f19ba2aa7de8e60'}, {'image_id': '13244_2011_72_Fig13_HTML', 'image_file_name': '13244_2011_72_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig13_HTML.jpg', 'caption': 'Traumatic aortic pseudoaneurysm. Sagittal reformatted contrast-enhanced CT image of the thoracic aorta reveals a pseudoaneurysm of the greater curve of the mid-descending thoracic aorta (black arrow)', 'hash': '4237e854d56f72b45f3b320a6a558dd23499f9f25cc7c1efdd4defaacdbcdf95'}, {'image_id': '13244_2011_72_Fig24_HTML', 'image_file_name': '13244_2011_72_Fig24_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig24_HTML.jpg', 'caption': 'Sternal fracture. Sagittal reconstructed CT image shows multiple fractures of the manubrium and the body of the sternum (white arrows) accompanied by extensive retrosternal haematoma (black ball arrows). Note also fracture of a thoracic vertebra (black arrow)', 'hash': 'c4e5bd451afe2ef323c0df62eb0db1ed8cea7ae08f5726ebcf40a7f84fff306a'}, {'image_id': '13244_2011_72_Fig4_HTML', 'image_file_name': '13244_2011_72_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig4_HTML.jpg', 'caption': 'Lung contusion. Axial (a, b) and coronal (c) CT images at lung window show nodular opacities of ground-glass opacity that do not respect the lung boundaries of the right upper lobe (white arrows) (a), diffuse areas of ground-glass opacity in the upper lobes bilaterally with subpleural sparing (white arrows) (b) and multiple areas of consolidation with air bronchograms (white arrows) and small lacerations (black arrows) in both lungs consistent with lung contusions. Note small bilateral pneumothorax in both lung apices (black dotted arrows) and cardiophrenic angles (black dotted arrows) (c)', 'hash': '518a80e912404d1905c831a59546db0ea3b905e1a0fc2dd6bbf9c99104c7734e'}, {'image_id': '13244_2011_72_Fig14_HTML', 'image_file_name': '13244_2011_72_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig14_HTML.jpg', 'caption': 'Traumatic aortic pseudoaneurysm. Three-dimensional reconstructed CT image of the thoracic aorta shows a pseudoaneurysm of the inferior curve of the thoracic aorta immediately distal to the isthmus (arrow)', 'hash': '1d459cf7dcd092b86beae1556894170b0aa90efc397ea72e210484aaf48562ee'}, {'image_id': '13244_2011_72_Fig12_HTML', 'image_file_name': '13244_2011_72_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig12_HTML.jpg', 'caption': 'Traumatic oesophageal rupture. A 12-year-old boy traumatised during a fall from a tree. Oesophagogram with per os administration of water-soluble contrast medium (a) shows leakage of contrast medium into both pleural spaces. Axial CT image of the thorax at the level of the lung bases (b) verifies the leakage of the contrast medium into the left and right pleural spaces. (Image reproduced from: Arora A, Puri SK, Upreti L, et al (2010). Oesophageal rupture: a rare complication of blunt trauma, {Online}. URL: http://www.eurorad.org/case.php?id=8447)', 'hash': 'd47462d598424f89df9f4e5ae040b61e07119ba4b4c57b7eb0e846411142da0c'}, {'image_id': '13244_2011_72_Fig2_HTML', 'image_file_name': '13244_2011_72_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig2_HTML.jpg', 'caption': 'Tension pneumothorax. Sagittal reformatted CT image at lung window showing tension pneumothorax with significantly collapsed lung at the posterior part of the hemithorax associated with ipsilateral pleural effusion', 'hash': 'd4b61666e21d0661d57813f25b420d7fd63d87bcf2112d66be41fa1c3d6ccf77'}, {'image_id': '13244_2011_72_Fig22_HTML', 'image_file_name': '13244_2011_72_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig22_HTML.jpg', 'caption': 'Coronal MIP CT image showing multiple contiguous left rib fractures (arrows)', 'hash': '394b48689201be58e198a0b418785c92c1a55b1baf83c42fe655d9e703696717'}, {'image_id': '13244_2011_72_Fig15_HTML', 'image_file_name': '13244_2011_72_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig15_HTML.jpg', 'caption': 'Traumatic aortic dissection. Coronal contrast-enhanced CT reformatted image of the thorax and abdomen shows a traumatic dissection of the ascending thoracic aorta (Stanford type A)', 'hash': 'a8eb58fb5b00b6ab7ea3a407c2bee50281cdf66c1a2f81f450fc2c6dd42d541d'}, {'image_id': '13244_2011_72_Fig25_HTML', 'image_file_name': '13244_2011_72_Fig25_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig25_HTML.jpg', 'caption': 'Sternal fracture. Axial CT image at mediastinal window shows sternal fracture associated with retrosternal haematoma (black arrow). Note the preserved fat plane with the aorta, excluding the presence of aortic injury (white arrows)', 'hash': '9ce77177efc53682247ab4e68a79bb9d83542c1f94d3cf90164d1d3a5f83717f'}, {'image_id': '13244_2011_72_Fig5_HTML', 'image_file_name': '13244_2011_72_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig5_HTML.jpg', 'caption': 'Lung laceration, type II. Coronal reformatted CT image at lung window (a) shows a lobulated paraspinal pneumatocele (arrow) surrounded by ground-glass opacity (contusion) in the right lung consistent with lung laceration (type II?). On mediastinal window lung laceration is seen to have been complicated by acute pulmonary embolism (dotted arrow)', 'hash': '61b15cbe2e3575a49b0ed2c0698d0e8ee470ea0a5f0bc520a030cac64a91176c'}] | {'13244_2011_72_Fig1_HTML': ['Trauma-related pneumothorax occurs in 30–40% of cases, and it is most commonly associated with rib fractures that lacerate the lung. Less commonly, pneumothorax may be caused by a disruption of closed airway spaces, such as the alveoli, due to a sudden increase in intrathoracic pressure or to a direct impact or deceleration force to the chest wall. Tracheobronchial injuries are also always associated with pneumothorax [5, 7, 16, 17]. CT is more sensitive in detecting pneumothoraces (Fig.\xa0<xref rid="13244_2011_72_Fig1_HTML" ref-type="fig">1</xref>), as 78% of them are nowadays believed to be missed on chest radiograph (occult pneumothoraces) [), as 78% of them are nowadays believed to be missed on chest radiograph (occult pneumothoraces) [18, 19]. Pneumothorax in supine polytrauma patients tends to accumulate at the anterior and medial aspect of the lung, rendering it difficult to recognise on a supine chest radiograph, although it might be visible on an upright chest radiograph. Radiographic signs that may be present in the case of an occult pneumothorax include:\nIncreased lucency at the affected hemidiaphragm,An abnormally deep costophrenic sulcus sign,A sharply defined radiolucent border of the mediastinum or heart, andThe “double diaphragm sign” caused by the presence of air outlining the dome and insertion of the diaphragm [7, 20].Fig.\xa01Occult pneumothorax. Axial CT at lung window shows a small occult pneumothorax (missed on chest radiography) at the anteromedial part of the left upper lobe (white arrow). There are also bilateral ground-glass opacities and areas of consolidation in both upper lobes consistent with lung contusions. Note the presence of numerous small confluent pneumatoceles (Swiss cheese appearance) in the anterior segment of the left upper lobe, consistent with lung laceration (black arrow). Note also the presence of small pneumomediastinum (dotted white arrow)', 'The adhesion tear is seen adjacent to a previous pleuropulmonary adhesion and is almost always seen at surgery or at autopsy. Lung tissue surrounding a laceration retracts—because of the lung elastic recoil—leaving a round or oval cavity that may be filled with air (pneumatocele), blood (haematocele or haematoma) or both, creating an air-fluid level (haematopneumatocele). A laceration, although it may be filled with air, is usually surrounded by lung contusion and therefore is hidden on a chest radiograph during the first 2–3\xa0days, until the contusion begins to resolve. CT, on the other hand, is significantly superior to chest radiography in detecting even a small laceration and in revealing the overall extent of the lacerations [27]. Lacerations (Fig.\xa0<xref rid="13244_2011_72_Fig1_HTML" ref-type="fig">1</xref>) may range from a solitary lesion to multiple confluent small ones presenting a “Swiss cheese appearance” [) may range from a solitary lesion to multiple confluent small ones presenting a “Swiss cheese appearance” [20]. Lacerations resolve more slowly than contusions, and clearance may take weeks or even months, and they may end in residual scarring [13]. Uncommonly, lacerations may be complicated by a pulmonary abscess, enlarge through a ball-valve mechanism or form a bronchopleural fistula [17], or it may be associated with acute pulmonary embolism (Fig.\xa0<xref rid="13244_2011_72_Fig5_HTML" ref-type="fig">5</xref>).).'], '13244_2011_72_Fig2_HTML': ['Tension pneumothorax is an urgent clinical diagnosis where progressive accumulation of air—due to the one-valve mechanism—increases the intrathoracic pressure of the hemithorax involved, causing a contralateral shift of the mediastinum, compression of the superior vena cava and loss of venous return to the heart with resultant haemodynamic impairment. Chest radiography and CT will both show a contralateral shift in the mediastinum, hyperexpansion and hyperlucency of the ipsilateral lung with lung collapse towards the hilum, and inversion of the ipsilateral diaphragm (Fig.\xa0<xref rid="13244_2011_72_Fig2_HTML" ref-type="fig">2</xref>). Sudden evacuation of a large pneumothorax with tube drainage can be complicated by re-expansion pulmonary oedema, presenting the corresponding radiological signs. The complication is more common in younger patients (20–50\xa0years of age) and occurs more often than was previously believed, and although it may be entirely asymptomatic, it has a reported variable mortality rate reaching 20% [). Sudden evacuation of a large pneumothorax with tube drainage can be complicated by re-expansion pulmonary oedema, presenting the corresponding radiological signs. The complication is more common in younger patients (20–50\xa0years of age) and occurs more often than was previously believed, and although it may be entirely asymptomatic, it has a reported variable mortality rate reaching 20% [22].\nFig.\xa02Tension pneumothorax. Sagittal reformatted CT image at lung window showing tension pneumothorax with significantly collapsed lung at the posterior part of the hemithorax associated with ipsilateral pleural effusion'], '13244_2011_72_Fig3_HTML': ['Haemothorax occurs in 50% of chest trauma cases, with blood pooling into the pleural space from variable sources: the lung parenchyma, the chest wall, the great vessels, the heart or even the liver and spleen through diaphragmatic rupture [20]. Arterial bleeding (more commonly from the intercostal arteries, and the subclavian and internal mammary arteries) causes a more significant progressive increase in volume and mass effect compared with a venous origin of haemorrhage [23]. Massive haemothorax occurs when the accumulation of blood in the pleural space exceeds 1 l and is accompanied by haemodynamic impairment (Fig.\xa0<xref rid="13244_2011_72_Fig3_HTML" ref-type="fig">3</xref>) [) [2]. CT is very sensitive in detecting even a small haemothorax and can further characterise it by measuring accurately the Hounsfield (HU) units attenuation values of the pleural fluid. A reactive pleural effusion will have values not higher than 15 HU, while liquid blood will measure 30 to 45 HU, and the clotted blood should measure around 50–90 HU units [20, 24]. Occasionally a “haematocrit effect” is caused by the layering of different ages and statuses of coagulation of pleural blood products. In the case of active bleeding the fresh extravasated blood in contrast-enhanced CT may have attenuation values similar to the adjacent enhanced thoracic vessels (±10 HU) [17].\nFig.\xa03Tension haemopneumothorax. Axial contrast-enhanced CT at mediastinal window shows a right tension haemopneumothorax with heterogeneous increased density due to presence of blood clots and a significant shift of the mediastinum contralaterally'], '13244_2011_72_Fig4_HTML': ['Lung contusion is a focal parenchymal injury caused by disruption of the capillaries of the alveolar walls and septa, and leakage of blood into the alveolar spaces and interstitium [25]. It is the most common type of lung injury in blunt chest trauma with a reported prevalence of 17–70% [26]. The main mechanism is compression and tearing of the lung parenchyma at the site of impact (it may also occur contralaterally “contre-coup”) against osseous structures, rib fractures or pre-existing pleural adhesions [27]. Lung contusion occurs at the time of injury, but it may be undetectable on chest radiography for the first 6 h after trauma. The pooling of haemorrhage and oedema will blossom at 24 h, rendering the contusion radiographically more evident, although CT may readily reveal it from the initial imaging [28]. The appearance of consolidation on chest radiography after the first 24 h should raise suspicion of other pathological conditions such as aspiration, pneumonia and fat embolism [2]. Contusions appear as geographic, non-segmental areas of ground-glass or nodular opacities or consolidation on CT that do not respect the lobar boundaries and may manifest air bronchograms if the bronchioles are not filled with blood (Fig.\xa0<xref rid="13244_2011_72_Fig4_HTML" ref-type="fig">4</xref>) [) [17]. Subpleural sparing of 1–2\xa0mm may be seen, especially in children (Fig.\xa0<xref rid="13244_2011_72_Fig4_HTML" ref-type="fig">4b</xref>) [) [29]. Clearance of an uncomplicated contusion begins at 24 to 48 h with complete resolution after 3 to 14\xa0days [9]. Lack of resolution within the expected time frame should raise the suspicion of complications such as pneumonia, abscess or ARDS. Pulmonary contusion—despite the advances in prompt diagnosis with imaging and supportive management with critical care medicine—remains a predictor of ARDS and has a high mortality rate (10–25%) [30].\nFig.\xa04Lung contusion. Axial (a, b) and coronal (c) CT images at lung window show nodular opacities of ground-glass opacity that do not respect the lung boundaries of the right upper lobe (white arrows) (a), diffuse areas of ground-glass opacity in the upper lobes bilaterally with subpleural sparing (white arrows) (b) and multiple areas of consolidation with air bronchograms (white arrows) and small lacerations (black arrows) in both lungs consistent with lung contusions. Note small bilateral pneumothorax in both lung apices (black dotted arrows) and cardiophrenic angles (black dotted arrows) (c)'], '13244_2011_72_Fig5_HTML': ['Compression shear injury is produced when the lower lobes are suddenly squeezed against the spine. It is located paraspinally and may be tubular in morphology (Fig.\xa0<xref rid="13244_2011_72_Fig5_HTML" ref-type="fig">5</xref>).).'], '13244_2011_72_Fig6_HTML': ['Rib penetration tear is peripherally located, is small and round and is usually associated with pneumothorax (Fig.\xa0<xref rid="13244_2011_72_Fig6_HTML" ref-type="fig">6</xref>).).'], '13244_2011_72_Fig7_HTML': ['Blast lung is the most common fatal injury among initial survivors of explosions; 17–47% of people who die from explosions have had primary blast lung injury [8, 9]. However, the in-hospital mortality rate for these patients ranges from 3.4 to 25% because of prompt diagnosis and aggressive treatment. The blast wave causes thoracic acceleration and propagates through lung parenchyma with subsequent severe disruption at the capillary-alveolar interface. This results in parenchymal haemorrhage and contusions, pulmonary oedema, pneumothorax, barotrauma and air embolism from arteriovenous fistulas, causing substantial immediate and delayed injury. Chest radiography and CT (Fig.\xa0<xref rid="13244_2011_72_Fig7_HTML" ref-type="fig">7</xref>) will reveal the “butterfly or batwing” pattern, representing central bilateral perihilar air space consolidation and ground-glass opacities that may contain air bronchograms [) will reveal the “butterfly or batwing” pattern, representing central bilateral perihilar air space consolidation and ground-glass opacities that may contain air bronchograms [32].\nFig.\xa07Blast lung injury. Twenty-two-year-old patient who experienced the explosion of a grenade in his hands. Coronal CT reformatted contrast-enhanced CT image at mediastinal window shows bilateral perilar consolidations mimicking a butterfly or bat-wing appearance, consistent with blast lung. The left lung is almost completely collapsed, and there are bilateral haemothoraces'], '13244_2011_72_Fig8_HTML': ['Tracheobronchial injuries are rare, occurring in 0.2–8% of all cases of chest trauma. It is anticipated that the prevalence is higher, as 50% of patients die at the trauma scene within the first 2 h from associated injuries and respiratory insufficiency [2, 33]. They have a mortality rate of 30%, and in two thirds of cases the diagnosis is delayed with subsequent serious complications, such as pneumonia, abscess, empyema, mediastinitis, sepsis, airway obstruction or atelectasis. Bronchial injuries occur more commonly than tracheal, usually on the right side and within 2.5\xa0cm from the carina [5, 24], while 85% of tracheal lacerations occur 2\xa0cm above the carina. Bronchial lacerations are usually parallel to the cartilage rings as opposed to tracheal ones that are vertical to the cartilage rings. A direct CT finding of tracheobronchial injuries is the cutoff of the tracheal and bronchial wall with extraluminal air surrounding the airway (Fig.\xa0<xref rid="13244_2011_72_Fig8_HTML" ref-type="fig">8</xref>). Indirect findings are the “fallen lung” sign, corresponding to the collapsed lung resting away from the hilum towards the dependent portion of the hemithorax [). Indirect findings are the “fallen lung” sign, corresponding to the collapsed lung resting away from the hilum towards the dependent portion of the hemithorax [34], persistent pneumothorax after chest tube placement and herniation or overdistention of an endotracheal balloon if this is placed at the same level as the tracheal laceration [33]. Tracheal lacerations are usually associated with cervical subcutaneous emphysema. Tracheobronchial injuries in general are accompanied by pneumothorax and pneumomediastinum.\nFig.\xa08Bronchial transection. A 22-year-old man involved in a car accident. Volume-rendered image of the tracheobronchial tree showing complete transection of the right intermediate bronchus (two-way arrow). (Courtesy of Dr Montserrat Bret, University Hospital La Paz, Madrid)'], '13244_2011_72_Fig9_HTML': ['Pneumomediastinum occurs in 10% of patients with blunt chest trauma, with less than 2% caused by blunt tracheobronchial injuries. Other sources of air originate from lung parenchymal injury, oesophageal injury, chest wall, neck and retroperitoneal injury. In a number of patients pneumomediastinum is attributed to the Macklin effect caused by alveolar ruptures that lead to air dissecting along bronchovascular bundles and spreading of the pulmonary interstitial emphysema into the mediastinum. Streaks of air surrounding and paralleling the bronchovascular bundles associated with pneumomediastinum may be observed on CT [35]. Pneumomediastinum may be mistaken for pneumothorax, but the presence of septae within it—delineated on wide lung window—may help in differentiating the two findings, especially if they coexist (Fig.\xa0<xref rid="13244_2011_72_Fig9_HTML" ref-type="fig">9</xref>).\n).\nFig.\xa09Pneumomediastinum. Axial CT images at wide lung window show pneumomediastinum with the presence of septae within the air in the anterior mediastinum (black arrows) (a), and in the middle and posterior mediastinum (black arrows) (b). Note also a right pneumothorax, bilateral lower lobe atelectases and subcutaneous emphysema (a) and a right haemopneumothorax and left pneumothorax (b)'], '13244_2011_72_Fig10_HTML': ['Cardiac injuries are the most lethal in chest trauma patients. They are more common in penetrating trauma, but they can occasionly occur in motor vehicle accidents and from severe blows to the anterior chest wall. Cardiac injury may be difficult to depict acutely in those who survive and should be treated with a high degree of clinical suspicion. It may range from a small focal contusion to a frank rupture of the heart, which is rare (<2%), affecting mainly the right atrium [12]. CT has low sensitivity in detecting cardiac injury and may show haemo-pneumopericardium, cardiac contusion as a hypodense, non-enhancing focal area in the myocardium, contrast medium extravasation in the pericardial sac or the mediastinum, coronary artery laceration or valve injury [36]. Pericardial tears occur extremely rarely (0.11%) and may range from tiny to the entire length of the pericardium. They usually manifest at the diaphragmatic surface of the pericardium on the left side. In cases of a large tear, intrapericardial cardiac herniation may occur, leading to death. Occasionally, there may also be intrapericardial bowel herniation [2]. On CT, the most common findings are haemopericardium (Fig.\xa0<xref rid="13244_2011_72_Fig10_HTML" ref-type="fig">10</xref>) and pneumopericardium (Fig.\xa0) and pneumopericardium (Fig.\xa0<xref rid="13244_2011_72_Fig11_HTML" ref-type="fig">11</xref>).\n).\nFig.\xa010Haemopericardium. Axial contrast-enhanced CT of the lower thorax at mediastinal window shows haemopericardium that may represent an indirect sign of pericardial or heart injury in a polytraumatised patient after a motor vehicle accident. There is also a small right haemothoraxFig.\xa011Pneumopericardium. Axial CT image at lung window shows extensive pneumopericardium (white arrow), pneumomediastinum (black arrows), haemopneumothorax (black dotted arrows), collapsed left lung with ipsilateral shift of the mediastinum and collapse of the right lower lobe'], '13244_2011_72_Fig12_HTML': ['Oesophageal injury is far more common in penetrating or iatrogenic injury and occurs only in 1% of cases of blunt chest trauma. The main mechanisms are a direct blow to the neck mainly affecting the cervical oesophagus, burst-type force or hyperextension injury affecting the distal oesophagus, or rupture by a vertebral body fracture [12]. On CT there will be mainly indirect findings of oesophageal rupture such as pneumomediastinum and peri-oesophageal air or abnormal mediastinal contour secondary to leakage of fluid, haematoma or mediastinitis. Hydropneumothorax is usually seen on the left side. Diagnosis can be confirmed (Fig.\xa0<xref rid="13244_2011_72_Fig12_HTML" ref-type="fig">12</xref>) by water-soluble contrast oesophagography showing leakage of contrast medium into the mediastinal or pleural space [) by water-soluble contrast oesophagography showing leakage of contrast medium into the mediastinal or pleural space [37].\nFig.\xa012Traumatic oesophageal rupture. A 12-year-old boy traumatised during a fall from a tree. Oesophagogram with per os administration of water-soluble contrast medium (a) shows leakage of contrast medium into both pleural spaces. Axial CT image of the thorax at the level of the lung bases (b) verifies the leakage of the contrast medium into the left and right pleural spaces. (Image reproduced from: Arora A, Puri SK, Upreti L, et al (2010). Oesophageal rupture: a rare complication of blunt trauma, {Online}. URL: http://www.eurorad.org/case.php?id=8447)'], '13244_2011_72_Fig13_HTML': ['Aortic injury occurs in 0.5%–2% of all non-lethal MVAs and is responsible for 10–20% of deaths in MVAs. Aortic injuries have a high morbidity and mortality; 90% of the patients die at the trauma scene, while 90% of initial survivors die within 4\xa0months if the injury is undetected and untreated [38]. In the remaining 20% of cases, aortic injury is caused by falls and pedestrian injuries. Mechanisms of injury are variable and may overlap, including rapid deceleration, shearing forces, increased intravascular pressure caused by compression exceeding 2,000\xa0mmHg (the water-hammer effect) or the “osseous pinch”, which represents direct compression of the aorta between the anterior chest wall and the spine [38]. The most common site of injury is the isthmus, corresponding to 90–95% of cases. Uncommon sites include the aortic root-ascending aorta, the aortic arch-branch vessels and the mid-distal descending aorta. The injury may be partial (65%), involving only the intima and media, or transmural (35%), also affecting the adventitia, which is lethal in almost all cases. The injury may be circumferential (45% of cases) or segmental (in 55% of cases), involving either the greater (Fig.\xa0<xref rid="13244_2011_72_Fig13_HTML" ref-type="fig">13</xref>) or the inferior curve (Fig.\xa0) or the inferior curve (Fig.\xa0<xref rid="13244_2011_72_Fig14_HTML" ref-type="fig">14</xref>). CT may show direct and indirect signs. Direct signs include active contrast medium extravasation, dissection (Fig.\xa0). CT may show direct and indirect signs. Direct signs include active contrast medium extravasation, dissection (Fig.\xa0<xref rid="13244_2011_72_Fig15_HTML" ref-type="fig">15</xref>), pseudoaneurysm (Figs.\xa0), pseudoaneurysm (Figs.\xa0<xref rid="13244_2011_72_Fig13_HTML" ref-type="fig">13</xref> and and <xref rid="13244_2011_72_Fig14_HTML" ref-type="fig">14</xref>), intimal tear/flap (Fig.\xa0), intimal tear/flap (Fig.\xa0<xref rid="13244_2011_72_Fig16_HTML" ref-type="fig">16</xref>), thrombus protruding into the lumen (Fig.\xa0), thrombus protruding into the lumen (Fig.\xa0<xref rid="13244_2011_72_Fig17_HTML" ref-type="fig">17</xref>), and abrupt change in calibre (pseudocoarctation). Indirect CT signs are indistinctness of mediastinal flat planes, periaortic haematoma and mediastinal haematoma (Figs.\xa0), and abrupt change in calibre (pseudocoarctation). Indirect CT signs are indistinctness of mediastinal flat planes, periaortic haematoma and mediastinal haematoma (Figs.\xa0<xref rid="13244_2011_72_Fig16_HTML" ref-type="fig">16</xref>––<xref rid="13244_2011_72_Fig18_HTML" ref-type="fig">18</xref>). Mediastinal haematoma is less than 20% predictive of aortic injury. In the absence of aortic injury, mediastinal haematoma may originate from venous injuries. In such cases the fat plane with the aorta is preserved, contrary to thoracic aortic injury, where haematoma develops in close contact with the aortic wall (Fig.\xa0). Mediastinal haematoma is less than 20% predictive of aortic injury. In the absence of aortic injury, mediastinal haematoma may originate from venous injuries. In such cases the fat plane with the aorta is preserved, contrary to thoracic aortic injury, where haematoma develops in close contact with the aortic wall (Fig.\xa0<xref rid="13244_2011_72_Fig16_HTML" ref-type="fig">16</xref>––<xref rid="13244_2011_72_Fig18_HTML" ref-type="fig">18</xref>). Minimal aortic injuries affect only the intima. They are diagnosed with increasing frequency—because of improved MDCT technology—and constitute a diagnostic dilemma [). Minimal aortic injuries affect only the intima. They are diagnosed with increasing frequency—because of improved MDCT technology—and constitute a diagnostic dilemma [39], as most of them remain stable or resolve on follow-up (Fig.\xa0<xref rid="13244_2011_72_Fig18_HTML" ref-type="fig">18</xref>). MDCT has very high sensitivity and specificity, reaching 98% and 100% accordingly for diagnosing aortic trauma. However, in studies where the presence of mediastinal haematoma (an indirect sign of aortic injury) was considered as a positive criterion for aortic injury, a significant number of false-positive diagnoses occurred, and the specificity for aortic injury dropped significantly by up to 62%. Nevertheless, MDCT has become the gold standard for ruling out aortic injury, and in those patients with unequivocal evidence of aortic injury, no further imaging is required [). MDCT has very high sensitivity and specificity, reaching 98% and 100% accordingly for diagnosing aortic trauma. However, in studies where the presence of mediastinal haematoma (an indirect sign of aortic injury) was considered as a positive criterion for aortic injury, a significant number of false-positive diagnoses occurred, and the specificity for aortic injury dropped significantly by up to 62%. Nevertheless, MDCT has become the gold standard for ruling out aortic injury, and in those patients with unequivocal evidence of aortic injury, no further imaging is required [40]. No further workup is indicated if there is no direct evidence of aortic injury and no mediastinal haematoma on CT [38].\nFig.\xa013Traumatic aortic pseudoaneurysm. Sagittal reformatted contrast-enhanced CT image of the thoracic aorta reveals a pseudoaneurysm of the greater curve of the mid-descending thoracic aorta (black arrow)Fig.\xa014Traumatic aortic pseudoaneurysm. Three-dimensional reconstructed CT image of the thoracic aorta shows a pseudoaneurysm of the inferior curve of the thoracic aorta immediately distal to the isthmus (arrow)Fig.\xa015Traumatic aortic dissection. Coronal contrast-enhanced CT reformatted image of the thorax and abdomen shows a traumatic dissection of the ascending thoracic aorta (Stanford type A)Fig.\xa016Axial contrast-enhanced CT image shows thrombus protruding into the lumen of the descending thoracic aorta (black arrows), indicating aortic injury surrounded by periaortic haematoma (white arrow)Fig.\xa017Minimal aortic injury. Coronal MIP CT image of the thorax shows minimal aortic injury at the aortic isthmus (black arrow) involving only the intima, surrounded by periaortic haematomaFig.\xa018Axial contrast-enhanced CT image shows presence of an intimal flap at the aortic arch (black arrow) surrounded by mediastinal haematoma with no preserved fat plane with the aorta (white arrows). Bilateral pleural haemothoraces are also seen'], '13244_2011_72_Fig19_HTML': ['Diaphragmatic injury occurs in 0.16% to 5% of blunt trauma cases, and it is more common in abdominal than in chest trauma. It is three times more common on the left side than on the right side, and the main mechanism is thought to be the sudden increase in intra-abdominal-thoracic pressure against a fixed diaphragm. The most common site of rupture is at the posterolateral surface, at the site of embryonic diaphragmatic fusion. Through the diaphragmatic defect, depending on its size, there may be intrathoracic herniation of intra-abdominal visceral organs, which may be incarcerated, strangulated or perforated. CT findings of diaphragmatic rupture include [41] the diaphragmatic discontinuation and defect, the “collar sign” or “hourglass sign” formed by the waist-like stricture of partial intrathoracic herniation of the stomach or bowel (Fig.\xa0<xref rid="13244_2011_72_Fig19_HTML" ref-type="fig">19</xref>), and the “dependent viscera sign”, which is formed by the posterior fall of the viscera towards and abutting the posterior dependent thoracic wall (with the patient supine) without the support of the intervening diaphragm (Fig.\xa0), and the “dependent viscera sign”, which is formed by the posterior fall of the viscera towards and abutting the posterior dependent thoracic wall (with the patient supine) without the support of the intervening diaphragm (Fig.\xa0<xref rid="13244_2011_72_Fig20_HTML" ref-type="fig">20</xref>). Contrast-enhanced CT may reveal contrast material extravasation at the site of diaphragmatic rupture. Occasionally, there may be only peritoneal fat intrathoracically herniated through the defect (Fig.\xa0). Contrast-enhanced CT may reveal contrast material extravasation at the site of diaphragmatic rupture. Occasionally, there may be only peritoneal fat intrathoracically herniated through the defect (Fig.\xa0<xref rid="13244_2011_72_Fig21_HTML" ref-type="fig">21</xref>). Diaphragmatic injury is usually a delayed diagnosis because of other associated serious injuries that may mask the clinical symptoms. It has a high mortality rate (30%) if it remains unrecognised [). Diaphragmatic injury is usually a delayed diagnosis because of other associated serious injuries that may mask the clinical symptoms. It has a high mortality rate (30%) if it remains unrecognised [42]. The high-resolution coronal and sagittal reformations routinely produced with MDCT—compared with single-spiral CT—allow detection with high sensitivity, even of a small diaphragmatic defect.\nFig.\xa019Dependent viscera sign. Axial contrast-enhanced CT at the level of the lower lobes, at mediastinal window, shows intrathoracic presence of the stomach abutting the left posterior thoracic wall without intervening in the left hemidiaphragm (black arrows)Fig.\xa020The “hourglass” or “collar” sign of diaphragmatic rupture. Reformatted coronal contrast-enhanced CT image of the thorax shows waist-like stricture of the herniated left colon intrathoracically through the small defect of the left hemidiaphragm (black arrows)Fig.\xa021Reformatted coronal contrast-enhanced CT image of the thorax shows intrathoracic herniation of intraperitoneal fat through the large defect of the left hemidiaphragm (white arrows)'], '13244_2011_72_Fig22_HTML': ['Rib fractures are the most common injury in blunt chest trauma, occurring in 50% of cases. A single rib fracture is usually not clinically significant, whereas multiple rib fractures indicate severe injury. Fractures of the first three ribs imply high-energy trauma that may be associated with injury of the brachial plexus or subclavian vessels. Fractures of the fourth up to the eighth ribs are the most common, while fractures of the last four ribs are usually associated with intra-abdominal injury. Reconstructed MIP and volume-rendered CT images depict with great detail the number and sites of rib fractures (Fig.\xa0<xref rid="13244_2011_72_Fig22_HTML" ref-type="fig">22</xref>). Flail chest is a marker of significant intrathoracic injury with increased morbidity, in which three or more contiguous ribs are fractured in two or more sites (Fig.\xa0). Flail chest is a marker of significant intrathoracic injury with increased morbidity, in which three or more contiguous ribs are fractured in two or more sites (Fig.\xa0<xref rid="13244_2011_72_Fig23_HTML" ref-type="fig">23</xref>). The diagnosis is clinical based on the paradoxical motion during respiration, which may result in ventilatory compromise. More than 50% of cases require surgical treatment and prolonged mechanical ventilation [). The diagnosis is clinical based on the paradoxical motion during respiration, which may result in ventilatory compromise. More than 50% of cases require surgical treatment and prolonged mechanical ventilation [9].\nFig.\xa022Coronal MIP CT image showing multiple contiguous left rib fractures (arrows)Fig.\xa023Coronal (a) and sagittal (b) reconstructed CT images show fractures of three contiguous right ribs (arrows) that were associated with paradox motion of the chest during respiration. Flail chest was suspected clinically and verified on imaging'], '13244_2011_72_Fig24_HTML': ['Sternal fractures have a prevalence of 3–8% in blunt chest trauma. The main mechanism is deceleration injury or a direct blow to the anterior chest wall. It is considered a marker of cardiac contusion (1.5%–6%). Sternal fractures are difficult to detect on lateral chest radiographs and even on axial CT images, as opposed to sagittal and coronal MDCT reformats, which have significant superiority (Fig.\xa0<xref rid="13244_2011_72_Fig24_HTML" ref-type="fig">24</xref>). It is almost always accompanied by anterior mediastinal haemorrhage, which has a preserved fat plane with the aorta (Fig.\xa0). It is almost always accompanied by anterior mediastinal haemorrhage, which has a preserved fat plane with the aorta (Fig.\xa0<xref rid="13244_2011_72_Fig25_HTML" ref-type="fig">25</xref>), as opposed to an anterior mediastinal haemorrhage secondary to aortic injury, which will present with a lost fat plane with the aorta [), as opposed to an anterior mediastinal haemorrhage secondary to aortic injury, which will present with a lost fat plane with the aorta [17].\nFig.\xa024Sternal fracture. Sagittal reconstructed CT image shows multiple fractures of the manubrium and the body of the sternum (white arrows) accompanied by extensive retrosternal haematoma (black ball arrows). Note also fracture of a thoracic vertebra (black arrow)Fig.\xa025Sternal fracture. Axial CT image at mediastinal window shows sternal fracture associated with retrosternal haematoma (black arrow). Note the preserved fat plane with the aorta, excluding the presence of aortic injury (white arrows)'], '13244_2011_72_Fig26_HTML': ['Sternoclavicular dislocation is rare and occurs in 1–3% of all types of dislocation. Anterior sternoclavicular dislocation is more common and easily detectable, as it is palpable (Fig.\xa0<xref rid="13244_2011_72_Fig26_HTML" ref-type="fig">26</xref>). It usually has a benign course, but it implies a high-energy trauma and may be associated with haemopneumothorax, rib fractures or pulmonary contusion [). It usually has a benign course, but it implies a high-energy trauma and may be associated with haemopneumothorax, rib fractures or pulmonary contusion [43]. Posterior sternoclavicular dislocation is clinically and radiographically silent and carries serious morbidity, as it is associated with injuries of the mediastinal vessels, nerves, trachea and oesophagus (Fig.\xa0<xref rid="13244_2011_72_Fig27_HTML" ref-type="fig">27</xref>).\n).\nFig.\xa026Anterior sternoclavicular dislocation. Axial CT image shows clavicular fracture and anterior sternoclavicular dislocation (dotted arrows)Fig.\xa027Posterior sternoclavicular dislocation. Axial CT image shows posterior sternoclavicular dislocation (black arrow) associated with compression of the left innominate vein (black dotted arrow)'], '13244_2011_72_Fig28_HTML': ['Scapular fracture is uncommon, occurring in 3.7% of cases of blunt chest trauma. It is easily detected on initial radiographs and may be masked clinically by other associated serious injuries (Fig.\xa0<xref rid="13244_2011_72_Fig28_HTML" ref-type="fig">28</xref>). It indicates a high-energy force trauma with a direct blow to the scapula or force transmitted through the humerus. Associated injuries are pneumothorax, haemothorax, clavicular fracture and injuries of the lung parenchyma, subclavian vessels, brachial plexus or spine [). It indicates a high-energy force trauma with a direct blow to the scapula or force transmitted through the humerus. Associated injuries are pneumothorax, haemothorax, clavicular fracture and injuries of the lung parenchyma, subclavian vessels, brachial plexus or spine [44].\nFig.\xa028Scapular fracture. Sagittal reconstructed CT image shows multiple fractures of the left scapula (arrows)'], '13244_2011_72_Fig29_HTML': ['Thoracic spine fractures account for up to 30% of all spine fractures. Sixty-two percent of spine fractures will result in neurological deficits. The most vulnerable site is between the ninth and twelfth vertebra. The main mechanism is hyperflexion and axial loading. Plain radiographs may miss fractures of the spine and therefore may be unnecessary in those patients scheduled for CT [45]. Sagittal and coronal MDCT reformats (Fig.\xa0<xref rid="13244_2011_72_Fig29_HTML" ref-type="fig">29</xref>) readily reveal even small spinal fractures, whereas volume-rendered images are not helpful [) readily reveal even small spinal fractures, whereas volume-rendered images are not helpful [12]. MDCT of the spine is highly indicated for spinal survey for possible fractures. However, in the case of suspected compressive myelopathy, MRI is the method of choice (Fig.\xa0<xref rid="13244_2011_72_Fig30_HTML" ref-type="fig">30</xref>).\n).\nFig.\xa029Thoracic spine fracture. Coronal (a) and sagittal (b) CT reconstructed images of two different patients show fractures of the upper thoracic vertebrae with great detailFig.\xa030Thoracic spine fracture and compressive myelopathy. Sagittal T2-weighted MRI of the cervicothoracic spine undertaken 1\xa0week after a motor vehicle accident verifies the presence of extensive compressive myelopathy (between the two white arrows with black outline) due to fractures of the second and the third thoracic vertebrae (white arrows)']} | CT imaging of blunt chest trauma | [
"Blunt trauma",
"Lungs",
"CT"
] | Insights Imaging | 1297411200 | PURPOSE: The objective of this study was to describe the sonographic features of deep-seated lipomas. METHODS: A retrospective review of the sonographic features of 64 deep seated lipomas in 64 patients (43 females, 21 males, mean age 46.5, range 16-77 years) seen over an 8-year period (1998-2006) was undertaken. RESULTS: Features evaluated were location, size, shape, marginal definition, internal echogenicity, including the presence of intermingled muscle fibres and linear internal echoes, acoustic transmission and vascularity. Confirmation was histological in 37 (58%) cases and by typical magnetic resonance imaging (MRI) appearance in 27 (42%) cases. CONCLUSION: The results show that although the features of deep-seated lipoma are more variable than those reported for subcutaneous lipomas, the presence of thin internal echoes in conjunction with other less specific features should enable a correct diagnosis. | [] | other | PMC3259405 | null | 18 | [
"{'Citation': 'Bancroft LW, Kransdorf MJ, Peterson JJ, O’Connor MI. Benign fatty tumors: classification, clinical course, imaging appearance, and treatment. Skeletal Radiol. 2006;35(10):719–733. doi: 10.1007/s00256-006-0189-y.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s00256-006-0189-y'}, {'@IdType': 'pubmed', '#text': '16927086'}]}}",
"{'Citation': 'Ahuja AT, King AD, Kew J, King W, Metreweli C. Head and neck lipomas: sonographic appearance. AJNR Am J Neuroradiol. 1998;19(3):505–508.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC8338272'}, {'@IdType': 'pubmed', '#text': '9541308'}]}}",
"{'Citation': 'Salam GA. Lipoma excision. Am Fam Physician. 2002;65(5):901–904.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11898962'}}}",
"{'Citation': 'Fornage BD, Tassin GB. Sonographic appearances of superficial soft tissue lipomas. J Clin Ultrasound. 1991;19(4):215–220. doi: 10.1002/jcu.1870190405.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1002/jcu.1870190405'}, {'@IdType': 'pubmed', '#text': '1646225'}]}}",
"{'Citation': 'Rydholm A, Berg NO. Size, site and clinical incidence of lipoma. Factors in the differential diagnosis of lipoma and sarcoma. Acta Orthop Scand. 1983;54(6):929–934. doi: 10.3109/17453678308992936.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.3109/17453678308992936'}, {'@IdType': 'pubmed', '#text': '6670522'}]}}",
"{'Citation': 'Terzioglu A, Tuncali D, Yuksel A, Bingul F, Aslan G. Giant lipomas: a series of 12 consecutive cases and a giant liposarcoma of the thigh. Dermatol Surg. 2004;30(3):463–467. doi: 10.1111/j.1524-4725.2004.30022.x.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1111/j.1524-4725.2004.30022.x'}, {'@IdType': 'pubmed', '#text': '15008886'}]}}",
"{'Citation': 'Kransdorf MJ, Bancroft LW, Peterson JJ, Murphey MD, Foster WC, Temple HT. Imaging of fatty tumors: distinction of lipoma and well-differentiated liposarcoma. Radiology. 2002;224(1):99–104. doi: 10.1148/radiol.2241011113.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1148/radiol.2241011113'}, {'@IdType': 'pubmed', '#text': '12091667'}]}}",
"{'Citation': 'Al-Qattan MM, Weinberg M, Clarke HM. Two rapidly growing fatty tumors of the upper limb in children: lipoblastoma and infiltrating lipoma. J Hand Surg Am. 1995;20(1):20–23. doi: 10.1016/S0363-5023(05)80051-6.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S0363-5023(05)80051-6'}, {'@IdType': 'pubmed', '#text': '7722258'}]}}",
"{'Citation': 'Inampudi P, Jacobson JA, Fessell DP, Carlos RC, Patel SV, Delaney-Sathy LO, et al. Soft-tissue lipomas: accuracy of sonography in diagnosis with pathologic correlation. Radiology. 2004;233(3):763–767. doi: 10.1148/radiol.2333031410.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1148/radiol.2333031410'}, {'@IdType': 'pubmed', '#text': '15486212'}]}}",
"{'Citation': 'Lin J, Fessell DP, Jacobson JA, Weadock WJ, Hayes CW. An illustrated tutorial of musculoskeletal sonography: part I, introduction and general principles. AJR Am J Roentgenol. 2000;175(3):637–645.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10954443'}}}",
"{'Citation': 'Murphey MD, Carroll JF, Flemming DJ, Pope TL, Gannon FH, Kransdorf MJ. From the archives of the AFIP: benign musculoskeletal lipomatous lesions. Radiographics. 2004;24(5):1433–1466. doi: 10.1148/rg.245045120.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1148/rg.245045120'}, {'@IdType': 'pubmed', '#text': '15371618'}]}}",
"{'Citation': 'Kransdorf MJ, Moser RP, Jr, Meis JM, Meyer CA. Fat-containing soft-tissue masses of the extremities. Radiographics. 1991;11(1):81–106.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1996399'}}}",
"{'Citation': 'Ohguri T, Aoki T, Hisaoka M, et al. Differential diagnosis of benign peripheral lipoma from well-differentiated liposarcoma on MR imaging: is comparison of margins and internal characteristics useful? AJR Am J Roentgenol. 2003;180:1689–1694.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12760945'}}}",
"{'Citation': 'Ha TV, Kleinman PK, Fraire A, et al. MR imaging of benign fatty tumors in children: report of four cases and review of the literature. Skeletal Radiol. 1994;23:361–367. doi: 10.1007/BF02416994.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/BF02416994'}, {'@IdType': 'pubmed', '#text': '7939836'}]}}",
"{'Citation': 'Hosono M, Kobayashi H, Fujimoto R, et al. Septum- like structures in lipoma and liposarcoma: MR imaging and pathologic correlation. Skeletal Radiol. 1997;26:150–154. doi: 10.1007/s002560050211.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s002560050211'}, {'@IdType': 'pubmed', '#text': '9108224'}]}}",
"{'Citation': 'Gaskin CM, Helms CA. Lipomas, lipoma variants, and well-differentiated liposarcomas (atypical lipomas): results of MRI evaluations of 126 consecutive fatty masses. AJR Am J Roentgenol. 2004;182:733–739.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14975977'}}}",
"{'Citation': 'Kransdorf MJ, Meis JM, Jelinek JS. Dedifferentiated liposarcoma of the extremities: imaging findings in four patients. AJR Am J Roentgenol. 1993;161:127–130.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8517290'}}}",
"{'Citation': 'Kransdorf MJ, Murphey MD (1997) Imaging of soft tissue tumors. Saunders, Philadelphia, pp 57–101'}"
] | Insights Imaging. 2011 Feb 11; 2(3):281-295 | NO-CC CODE |
|
Blast lung injury. Twenty-two-year-old patient who experienced the explosion of a grenade in his hands. Coronal CT reformatted contrast-enhanced CT image at mediastinal window shows bilateral perilar consolidations mimicking a butterfly or bat-wing appearance, consistent with blast lung. The left lung is almost completely collapsed, and there are bilateral haemothoraces | 13244_2011_72_Fig7_HTML | 7 | 67e53dd43a059c1a1c75f728ce4c647c8beeb90350a2f9ceddab7367c3e667cc | 13244_2011_72_Fig7_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
768,
634
] | [{'image_id': '13244_2011_72_Fig6_HTML', 'image_file_name': '13244_2011_72_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig6_HTML.jpg', 'caption': 'Lung laceration, type IV. Axial CT image of the left lung at lung window shows a small peripheral laceration (white arrow) beneath a rib fracture (black arrow) surrounded by ground-glass opacity (lung contusion) and associated with a small ipsilateral pneumothorax', 'hash': '5863242acc3b6e21133123bf2957bab5f97c21ffceea84365475d12f424f0216'}, {'image_id': '13244_2011_72_Fig26_HTML', 'image_file_name': '13244_2011_72_Fig26_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig26_HTML.jpg', 'caption': 'Anterior sternoclavicular dislocation. Axial CT image shows clavicular fracture and anterior sternoclavicular dislocation (dotted arrows)', 'hash': '9b831dd8840c2891bf3536a4290f02ecdc98874580bf611e4ecc6623543ac9e8'}, {'image_id': '13244_2011_72_Fig29_HTML', 'image_file_name': '13244_2011_72_Fig29_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig29_HTML.jpg', 'caption': 'Thoracic spine fracture. Coronal (a) and sagittal (b) CT reconstructed images of two different patients show fractures of the upper thoracic vertebrae with great detail', 'hash': 'ed56231066f1d4acb06d74211dce565b29deb3edd1e9d22c033f352c41e989fb'}, {'image_id': '13244_2011_72_Fig9_HTML', 'image_file_name': '13244_2011_72_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig9_HTML.jpg', 'caption': 'Pneumomediastinum. Axial CT images at wide lung window show pneumomediastinum with the presence of septae within the air in the anterior mediastinum (black arrows) (a), and in the middle and posterior mediastinum (black arrows) (b). Note also a right pneumothorax, bilateral lower lobe atelectases and subcutaneous emphysema (a) and a right haemopneumothorax and left pneumothorax (b)', 'hash': 'e3315009e28d187756fed04bd73e52aa7a66e88852e0fa95bd3198339ea7893f'}, {'image_id': '13244_2011_72_Fig16_HTML', 'image_file_name': '13244_2011_72_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig16_HTML.jpg', 'caption': 'Axial contrast-enhanced CT image shows thrombus protruding into the lumen of the descending thoracic aorta (black arrows), indicating aortic injury surrounded by periaortic haematoma (white arrow)', 'hash': 'd0e96e0ad0009a48be94efa9392e2a5e78f6d4a6690fae78dcfe55586128d2f2'}, {'image_id': '13244_2011_72_Fig19_HTML', 'image_file_name': '13244_2011_72_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig19_HTML.jpg', 'caption': 'Dependent viscera sign. Axial contrast-enhanced CT at the level of the lower lobes, at mediastinal window, shows intrathoracic presence of the stomach abutting the left posterior thoracic wall without intervening in the left hemidiaphragm (black arrows)', 'hash': 'dd2bfec04ea0d87a06d80a092eb0f33fae6ab3af9709ce550f5a542b3501e95a'}, {'image_id': '13244_2011_72_Fig21_HTML', 'image_file_name': '13244_2011_72_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig21_HTML.jpg', 'caption': 'Reformatted coronal contrast-enhanced CT image of the thorax shows intrathoracic herniation of intraperitoneal fat through the large defect of the left hemidiaphragm (white arrows)', 'hash': '0a402083af039e9a88a2e385bb7fe255e23b2bbf3efbb7a9b81e6d54542ce814'}, {'image_id': '13244_2011_72_Fig1_HTML', 'image_file_name': '13244_2011_72_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig1_HTML.jpg', 'caption': 'Occult pneumothorax. Axial CT at lung window shows a small occult pneumothorax (missed on chest radiography) at the anteromedial part of the left upper lobe (white arrow). There are also bilateral ground-glass opacities and areas of consolidation in both upper lobes consistent with lung contusions. Note the presence of numerous small confluent pneumatoceles (Swiss cheese appearance) in the anterior segment of the left upper lobe, consistent with lung laceration (black arrow). Note also the presence of small pneumomediastinum (dotted white arrow)', 'hash': 'df55f512f4486e19d06a1b6cc03a1d9974ae5172b34c6563a5bc65fecfbe6813'}, {'image_id': '13244_2011_72_Fig11_HTML', 'image_file_name': '13244_2011_72_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig11_HTML.jpg', 'caption': 'Pneumopericardium. Axial CT image at lung window shows extensive pneumopericardium (white arrow), pneumomediastinum (black arrows), haemopneumothorax (black dotted arrows), collapsed left lung with ipsilateral shift of the mediastinum and collapse of the right lower lobe', 'hash': 'adb33f13ecacbdd4b2fd4739cdad52f67d1efd2ed9f523bcb12de93bfb7ff966'}, {'image_id': '13244_2011_72_Fig18_HTML', 'image_file_name': '13244_2011_72_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig18_HTML.jpg', 'caption': 'Axial contrast-enhanced CT image shows presence of an intimal flap at the aortic arch (black arrow) surrounded by mediastinal haematoma with no preserved fat plane with the aorta (white arrows). Bilateral pleural haemothoraces are also seen', 'hash': '323e8295c1260636c4d8698d6b81268f50739c220094327e06b7760ed57fe14e'}, {'image_id': '13244_2011_72_Fig17_HTML', 'image_file_name': '13244_2011_72_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig17_HTML.jpg', 'caption': 'Minimal aortic injury. Coronal MIP CT image of the thorax shows minimal aortic injury at the aortic isthmus (black arrow) involving only the intima, surrounded by periaortic haematoma', 'hash': '1958201094f9c29442682caf6a857f4c0872629139b35be0206ba5e6313311a5'}, {'image_id': '13244_2011_72_Fig28_HTML', 'image_file_name': '13244_2011_72_Fig28_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig28_HTML.jpg', 'caption': 'Scapular fracture. Sagittal reconstructed CT image shows multiple fractures of the left scapula (arrows)', 'hash': '0943d81e51026828b04bc0d5e508683c800616d624334f0ef2506c3ea24933db'}, {'image_id': '13244_2011_72_Fig8_HTML', 'image_file_name': '13244_2011_72_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig8_HTML.jpg', 'caption': 'Bronchial transection. A 22-year-old man involved in a car accident. Volume-rendered image of the tracheobronchial tree showing complete transection of the right intermediate bronchus (two-way arrow). (Courtesy of Dr Montserrat Bret, University Hospital La Paz, Madrid)', 'hash': '240792afcb56505bda44effeef2a2c701f31a156c5d2fab6d00eea28505a6def'}, {'image_id': '13244_2011_72_Fig7_HTML', 'image_file_name': '13244_2011_72_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig7_HTML.jpg', 'caption': 'Blast lung injury. Twenty-two-year-old patient who experienced the explosion of a grenade in his hands. Coronal CT reformatted contrast-enhanced CT image at mediastinal window shows bilateral perilar consolidations mimicking a butterfly or bat-wing appearance, consistent with blast lung. The left lung is almost completely collapsed, and there are bilateral haemothoraces', 'hash': '67e53dd43a059c1a1c75f728ce4c647c8beeb90350a2f9ceddab7367c3e667cc'}, {'image_id': '13244_2011_72_Fig27_HTML', 'image_file_name': '13244_2011_72_Fig27_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig27_HTML.jpg', 'caption': 'Posterior sternoclavicular dislocation. Axial CT image shows posterior sternoclavicular dislocation (black arrow) associated with compression of the left innominate vein (black dotted arrow)', 'hash': '65861d0ff5bcca7557977d36133e676dc920d29bfce85e793b3498293463ecb5'}, {'image_id': '13244_2011_72_Fig10_HTML', 'image_file_name': '13244_2011_72_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig10_HTML.jpg', 'caption': 'Haemopericardium. Axial contrast-enhanced CT of the lower thorax at mediastinal window shows haemopericardium that may represent an indirect sign of pericardial or heart injury in a polytraumatised patient after a motor vehicle accident. There is also a small right haemothorax', 'hash': '796092bf0ef0acb33a101431cc1aa7f4994330eebaf6ecd1b7c09b6075bb5cf0'}, {'image_id': '13244_2011_72_Fig30_HTML', 'image_file_name': '13244_2011_72_Fig30_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig30_HTML.jpg', 'caption': 'Thoracic spine fracture and compressive myelopathy. Sagittal T2-weighted MRI of the cervicothoracic spine undertaken 1\xa0week after a motor vehicle accident verifies the presence of extensive compressive myelopathy (between the two white arrows with black outline) due to fractures of the second and the third thoracic vertebrae (white arrows)', 'hash': '5eed45d58046af966704e6e8bac002147a98491e3206949eb9fd8d0e49fd60e3'}, {'image_id': '13244_2011_72_Fig20_HTML', 'image_file_name': '13244_2011_72_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig20_HTML.jpg', 'caption': 'The “hourglass” or “collar” sign of diaphragmatic rupture. Reformatted coronal contrast-enhanced CT image of the thorax shows waist-like stricture of the herniated left colon intrathoracically through the small defect of the left hemidiaphragm (black arrows)', 'hash': 'cbdac9d2d072d59f6023905369f608422082c3366a479b57784becb3330c6ee4'}, {'image_id': '13244_2011_72_Fig3_HTML', 'image_file_name': '13244_2011_72_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig3_HTML.jpg', 'caption': 'Tension haemopneumothorax. Axial contrast-enhanced CT at mediastinal window shows a right tension haemopneumothorax with heterogeneous increased density due to presence of blood clots and a significant shift of the mediastinum contralaterally', 'hash': '5d60ee3c870f1facdf0afcf993a9144d5bb6d95ca2f9b9a287c6ccb26ffa433a'}, {'image_id': '13244_2011_72_Fig23_HTML', 'image_file_name': '13244_2011_72_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig23_HTML.jpg', 'caption': 'Coronal (a) and sagittal (b) reconstructed CT images show fractures of three contiguous right ribs (arrows) that were associated with paradox motion of the chest during respiration. Flail chest was suspected clinically and verified on imaging', 'hash': 'e0dfac45308f42c94f933fee9460f1b447c0fe8d307b3d1a0f19ba2aa7de8e60'}, {'image_id': '13244_2011_72_Fig13_HTML', 'image_file_name': '13244_2011_72_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig13_HTML.jpg', 'caption': 'Traumatic aortic pseudoaneurysm. Sagittal reformatted contrast-enhanced CT image of the thoracic aorta reveals a pseudoaneurysm of the greater curve of the mid-descending thoracic aorta (black arrow)', 'hash': '4237e854d56f72b45f3b320a6a558dd23499f9f25cc7c1efdd4defaacdbcdf95'}, {'image_id': '13244_2011_72_Fig24_HTML', 'image_file_name': '13244_2011_72_Fig24_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig24_HTML.jpg', 'caption': 'Sternal fracture. Sagittal reconstructed CT image shows multiple fractures of the manubrium and the body of the sternum (white arrows) accompanied by extensive retrosternal haematoma (black ball arrows). Note also fracture of a thoracic vertebra (black arrow)', 'hash': 'c4e5bd451afe2ef323c0df62eb0db1ed8cea7ae08f5726ebcf40a7f84fff306a'}, {'image_id': '13244_2011_72_Fig4_HTML', 'image_file_name': '13244_2011_72_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig4_HTML.jpg', 'caption': 'Lung contusion. Axial (a, b) and coronal (c) CT images at lung window show nodular opacities of ground-glass opacity that do not respect the lung boundaries of the right upper lobe (white arrows) (a), diffuse areas of ground-glass opacity in the upper lobes bilaterally with subpleural sparing (white arrows) (b) and multiple areas of consolidation with air bronchograms (white arrows) and small lacerations (black arrows) in both lungs consistent with lung contusions. Note small bilateral pneumothorax in both lung apices (black dotted arrows) and cardiophrenic angles (black dotted arrows) (c)', 'hash': '518a80e912404d1905c831a59546db0ea3b905e1a0fc2dd6bbf9c99104c7734e'}, {'image_id': '13244_2011_72_Fig14_HTML', 'image_file_name': '13244_2011_72_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig14_HTML.jpg', 'caption': 'Traumatic aortic pseudoaneurysm. Three-dimensional reconstructed CT image of the thoracic aorta shows a pseudoaneurysm of the inferior curve of the thoracic aorta immediately distal to the isthmus (arrow)', 'hash': '1d459cf7dcd092b86beae1556894170b0aa90efc397ea72e210484aaf48562ee'}, {'image_id': '13244_2011_72_Fig12_HTML', 'image_file_name': '13244_2011_72_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig12_HTML.jpg', 'caption': 'Traumatic oesophageal rupture. A 12-year-old boy traumatised during a fall from a tree. Oesophagogram with per os administration of water-soluble contrast medium (a) shows leakage of contrast medium into both pleural spaces. Axial CT image of the thorax at the level of the lung bases (b) verifies the leakage of the contrast medium into the left and right pleural spaces. (Image reproduced from: Arora A, Puri SK, Upreti L, et al (2010). Oesophageal rupture: a rare complication of blunt trauma, {Online}. URL: http://www.eurorad.org/case.php?id=8447)', 'hash': 'd47462d598424f89df9f4e5ae040b61e07119ba4b4c57b7eb0e846411142da0c'}, {'image_id': '13244_2011_72_Fig2_HTML', 'image_file_name': '13244_2011_72_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig2_HTML.jpg', 'caption': 'Tension pneumothorax. Sagittal reformatted CT image at lung window showing tension pneumothorax with significantly collapsed lung at the posterior part of the hemithorax associated with ipsilateral pleural effusion', 'hash': 'd4b61666e21d0661d57813f25b420d7fd63d87bcf2112d66be41fa1c3d6ccf77'}, {'image_id': '13244_2011_72_Fig22_HTML', 'image_file_name': '13244_2011_72_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig22_HTML.jpg', 'caption': 'Coronal MIP CT image showing multiple contiguous left rib fractures (arrows)', 'hash': '394b48689201be58e198a0b418785c92c1a55b1baf83c42fe655d9e703696717'}, {'image_id': '13244_2011_72_Fig15_HTML', 'image_file_name': '13244_2011_72_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig15_HTML.jpg', 'caption': 'Traumatic aortic dissection. Coronal contrast-enhanced CT reformatted image of the thorax and abdomen shows a traumatic dissection of the ascending thoracic aorta (Stanford type A)', 'hash': 'a8eb58fb5b00b6ab7ea3a407c2bee50281cdf66c1a2f81f450fc2c6dd42d541d'}, {'image_id': '13244_2011_72_Fig25_HTML', 'image_file_name': '13244_2011_72_Fig25_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig25_HTML.jpg', 'caption': 'Sternal fracture. Axial CT image at mediastinal window shows sternal fracture associated with retrosternal haematoma (black arrow). Note the preserved fat plane with the aorta, excluding the presence of aortic injury (white arrows)', 'hash': '9ce77177efc53682247ab4e68a79bb9d83542c1f94d3cf90164d1d3a5f83717f'}, {'image_id': '13244_2011_72_Fig5_HTML', 'image_file_name': '13244_2011_72_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig5_HTML.jpg', 'caption': 'Lung laceration, type II. Coronal reformatted CT image at lung window (a) shows a lobulated paraspinal pneumatocele (arrow) surrounded by ground-glass opacity (contusion) in the right lung consistent with lung laceration (type II?). On mediastinal window lung laceration is seen to have been complicated by acute pulmonary embolism (dotted arrow)', 'hash': '61b15cbe2e3575a49b0ed2c0698d0e8ee470ea0a5f0bc520a030cac64a91176c'}] | {'13244_2011_72_Fig1_HTML': ['Trauma-related pneumothorax occurs in 30–40% of cases, and it is most commonly associated with rib fractures that lacerate the lung. Less commonly, pneumothorax may be caused by a disruption of closed airway spaces, such as the alveoli, due to a sudden increase in intrathoracic pressure or to a direct impact or deceleration force to the chest wall. Tracheobronchial injuries are also always associated with pneumothorax [5, 7, 16, 17]. CT is more sensitive in detecting pneumothoraces (Fig.\xa0<xref rid="13244_2011_72_Fig1_HTML" ref-type="fig">1</xref>), as 78% of them are nowadays believed to be missed on chest radiograph (occult pneumothoraces) [), as 78% of them are nowadays believed to be missed on chest radiograph (occult pneumothoraces) [18, 19]. Pneumothorax in supine polytrauma patients tends to accumulate at the anterior and medial aspect of the lung, rendering it difficult to recognise on a supine chest radiograph, although it might be visible on an upright chest radiograph. Radiographic signs that may be present in the case of an occult pneumothorax include:\nIncreased lucency at the affected hemidiaphragm,An abnormally deep costophrenic sulcus sign,A sharply defined radiolucent border of the mediastinum or heart, andThe “double diaphragm sign” caused by the presence of air outlining the dome and insertion of the diaphragm [7, 20].Fig.\xa01Occult pneumothorax. Axial CT at lung window shows a small occult pneumothorax (missed on chest radiography) at the anteromedial part of the left upper lobe (white arrow). There are also bilateral ground-glass opacities and areas of consolidation in both upper lobes consistent with lung contusions. Note the presence of numerous small confluent pneumatoceles (Swiss cheese appearance) in the anterior segment of the left upper lobe, consistent with lung laceration (black arrow). Note also the presence of small pneumomediastinum (dotted white arrow)', 'The adhesion tear is seen adjacent to a previous pleuropulmonary adhesion and is almost always seen at surgery or at autopsy. Lung tissue surrounding a laceration retracts—because of the lung elastic recoil—leaving a round or oval cavity that may be filled with air (pneumatocele), blood (haematocele or haematoma) or both, creating an air-fluid level (haematopneumatocele). A laceration, although it may be filled with air, is usually surrounded by lung contusion and therefore is hidden on a chest radiograph during the first 2–3\xa0days, until the contusion begins to resolve. CT, on the other hand, is significantly superior to chest radiography in detecting even a small laceration and in revealing the overall extent of the lacerations [27]. Lacerations (Fig.\xa0<xref rid="13244_2011_72_Fig1_HTML" ref-type="fig">1</xref>) may range from a solitary lesion to multiple confluent small ones presenting a “Swiss cheese appearance” [) may range from a solitary lesion to multiple confluent small ones presenting a “Swiss cheese appearance” [20]. Lacerations resolve more slowly than contusions, and clearance may take weeks or even months, and they may end in residual scarring [13]. Uncommonly, lacerations may be complicated by a pulmonary abscess, enlarge through a ball-valve mechanism or form a bronchopleural fistula [17], or it may be associated with acute pulmonary embolism (Fig.\xa0<xref rid="13244_2011_72_Fig5_HTML" ref-type="fig">5</xref>).).'], '13244_2011_72_Fig2_HTML': ['Tension pneumothorax is an urgent clinical diagnosis where progressive accumulation of air—due to the one-valve mechanism—increases the intrathoracic pressure of the hemithorax involved, causing a contralateral shift of the mediastinum, compression of the superior vena cava and loss of venous return to the heart with resultant haemodynamic impairment. Chest radiography and CT will both show a contralateral shift in the mediastinum, hyperexpansion and hyperlucency of the ipsilateral lung with lung collapse towards the hilum, and inversion of the ipsilateral diaphragm (Fig.\xa0<xref rid="13244_2011_72_Fig2_HTML" ref-type="fig">2</xref>). Sudden evacuation of a large pneumothorax with tube drainage can be complicated by re-expansion pulmonary oedema, presenting the corresponding radiological signs. The complication is more common in younger patients (20–50\xa0years of age) and occurs more often than was previously believed, and although it may be entirely asymptomatic, it has a reported variable mortality rate reaching 20% [). Sudden evacuation of a large pneumothorax with tube drainage can be complicated by re-expansion pulmonary oedema, presenting the corresponding radiological signs. The complication is more common in younger patients (20–50\xa0years of age) and occurs more often than was previously believed, and although it may be entirely asymptomatic, it has a reported variable mortality rate reaching 20% [22].\nFig.\xa02Tension pneumothorax. Sagittal reformatted CT image at lung window showing tension pneumothorax with significantly collapsed lung at the posterior part of the hemithorax associated with ipsilateral pleural effusion'], '13244_2011_72_Fig3_HTML': ['Haemothorax occurs in 50% of chest trauma cases, with blood pooling into the pleural space from variable sources: the lung parenchyma, the chest wall, the great vessels, the heart or even the liver and spleen through diaphragmatic rupture [20]. Arterial bleeding (more commonly from the intercostal arteries, and the subclavian and internal mammary arteries) causes a more significant progressive increase in volume and mass effect compared with a venous origin of haemorrhage [23]. Massive haemothorax occurs when the accumulation of blood in the pleural space exceeds 1 l and is accompanied by haemodynamic impairment (Fig.\xa0<xref rid="13244_2011_72_Fig3_HTML" ref-type="fig">3</xref>) [) [2]. CT is very sensitive in detecting even a small haemothorax and can further characterise it by measuring accurately the Hounsfield (HU) units attenuation values of the pleural fluid. A reactive pleural effusion will have values not higher than 15 HU, while liquid blood will measure 30 to 45 HU, and the clotted blood should measure around 50–90 HU units [20, 24]. Occasionally a “haematocrit effect” is caused by the layering of different ages and statuses of coagulation of pleural blood products. In the case of active bleeding the fresh extravasated blood in contrast-enhanced CT may have attenuation values similar to the adjacent enhanced thoracic vessels (±10 HU) [17].\nFig.\xa03Tension haemopneumothorax. Axial contrast-enhanced CT at mediastinal window shows a right tension haemopneumothorax with heterogeneous increased density due to presence of blood clots and a significant shift of the mediastinum contralaterally'], '13244_2011_72_Fig4_HTML': ['Lung contusion is a focal parenchymal injury caused by disruption of the capillaries of the alveolar walls and septa, and leakage of blood into the alveolar spaces and interstitium [25]. It is the most common type of lung injury in blunt chest trauma with a reported prevalence of 17–70% [26]. The main mechanism is compression and tearing of the lung parenchyma at the site of impact (it may also occur contralaterally “contre-coup”) against osseous structures, rib fractures or pre-existing pleural adhesions [27]. Lung contusion occurs at the time of injury, but it may be undetectable on chest radiography for the first 6 h after trauma. The pooling of haemorrhage and oedema will blossom at 24 h, rendering the contusion radiographically more evident, although CT may readily reveal it from the initial imaging [28]. The appearance of consolidation on chest radiography after the first 24 h should raise suspicion of other pathological conditions such as aspiration, pneumonia and fat embolism [2]. Contusions appear as geographic, non-segmental areas of ground-glass or nodular opacities or consolidation on CT that do not respect the lobar boundaries and may manifest air bronchograms if the bronchioles are not filled with blood (Fig.\xa0<xref rid="13244_2011_72_Fig4_HTML" ref-type="fig">4</xref>) [) [17]. Subpleural sparing of 1–2\xa0mm may be seen, especially in children (Fig.\xa0<xref rid="13244_2011_72_Fig4_HTML" ref-type="fig">4b</xref>) [) [29]. Clearance of an uncomplicated contusion begins at 24 to 48 h with complete resolution after 3 to 14\xa0days [9]. Lack of resolution within the expected time frame should raise the suspicion of complications such as pneumonia, abscess or ARDS. Pulmonary contusion—despite the advances in prompt diagnosis with imaging and supportive management with critical care medicine—remains a predictor of ARDS and has a high mortality rate (10–25%) [30].\nFig.\xa04Lung contusion. Axial (a, b) and coronal (c) CT images at lung window show nodular opacities of ground-glass opacity that do not respect the lung boundaries of the right upper lobe (white arrows) (a), diffuse areas of ground-glass opacity in the upper lobes bilaterally with subpleural sparing (white arrows) (b) and multiple areas of consolidation with air bronchograms (white arrows) and small lacerations (black arrows) in both lungs consistent with lung contusions. Note small bilateral pneumothorax in both lung apices (black dotted arrows) and cardiophrenic angles (black dotted arrows) (c)'], '13244_2011_72_Fig5_HTML': ['Compression shear injury is produced when the lower lobes are suddenly squeezed against the spine. It is located paraspinally and may be tubular in morphology (Fig.\xa0<xref rid="13244_2011_72_Fig5_HTML" ref-type="fig">5</xref>).).'], '13244_2011_72_Fig6_HTML': ['Rib penetration tear is peripherally located, is small and round and is usually associated with pneumothorax (Fig.\xa0<xref rid="13244_2011_72_Fig6_HTML" ref-type="fig">6</xref>).).'], '13244_2011_72_Fig7_HTML': ['Blast lung is the most common fatal injury among initial survivors of explosions; 17–47% of people who die from explosions have had primary blast lung injury [8, 9]. However, the in-hospital mortality rate for these patients ranges from 3.4 to 25% because of prompt diagnosis and aggressive treatment. The blast wave causes thoracic acceleration and propagates through lung parenchyma with subsequent severe disruption at the capillary-alveolar interface. This results in parenchymal haemorrhage and contusions, pulmonary oedema, pneumothorax, barotrauma and air embolism from arteriovenous fistulas, causing substantial immediate and delayed injury. Chest radiography and CT (Fig.\xa0<xref rid="13244_2011_72_Fig7_HTML" ref-type="fig">7</xref>) will reveal the “butterfly or batwing” pattern, representing central bilateral perihilar air space consolidation and ground-glass opacities that may contain air bronchograms [) will reveal the “butterfly or batwing” pattern, representing central bilateral perihilar air space consolidation and ground-glass opacities that may contain air bronchograms [32].\nFig.\xa07Blast lung injury. Twenty-two-year-old patient who experienced the explosion of a grenade in his hands. Coronal CT reformatted contrast-enhanced CT image at mediastinal window shows bilateral perilar consolidations mimicking a butterfly or bat-wing appearance, consistent with blast lung. The left lung is almost completely collapsed, and there are bilateral haemothoraces'], '13244_2011_72_Fig8_HTML': ['Tracheobronchial injuries are rare, occurring in 0.2–8% of all cases of chest trauma. It is anticipated that the prevalence is higher, as 50% of patients die at the trauma scene within the first 2 h from associated injuries and respiratory insufficiency [2, 33]. They have a mortality rate of 30%, and in two thirds of cases the diagnosis is delayed with subsequent serious complications, such as pneumonia, abscess, empyema, mediastinitis, sepsis, airway obstruction or atelectasis. Bronchial injuries occur more commonly than tracheal, usually on the right side and within 2.5\xa0cm from the carina [5, 24], while 85% of tracheal lacerations occur 2\xa0cm above the carina. Bronchial lacerations are usually parallel to the cartilage rings as opposed to tracheal ones that are vertical to the cartilage rings. A direct CT finding of tracheobronchial injuries is the cutoff of the tracheal and bronchial wall with extraluminal air surrounding the airway (Fig.\xa0<xref rid="13244_2011_72_Fig8_HTML" ref-type="fig">8</xref>). Indirect findings are the “fallen lung” sign, corresponding to the collapsed lung resting away from the hilum towards the dependent portion of the hemithorax [). Indirect findings are the “fallen lung” sign, corresponding to the collapsed lung resting away from the hilum towards the dependent portion of the hemithorax [34], persistent pneumothorax after chest tube placement and herniation or overdistention of an endotracheal balloon if this is placed at the same level as the tracheal laceration [33]. Tracheal lacerations are usually associated with cervical subcutaneous emphysema. Tracheobronchial injuries in general are accompanied by pneumothorax and pneumomediastinum.\nFig.\xa08Bronchial transection. A 22-year-old man involved in a car accident. Volume-rendered image of the tracheobronchial tree showing complete transection of the right intermediate bronchus (two-way arrow). (Courtesy of Dr Montserrat Bret, University Hospital La Paz, Madrid)'], '13244_2011_72_Fig9_HTML': ['Pneumomediastinum occurs in 10% of patients with blunt chest trauma, with less than 2% caused by blunt tracheobronchial injuries. Other sources of air originate from lung parenchymal injury, oesophageal injury, chest wall, neck and retroperitoneal injury. In a number of patients pneumomediastinum is attributed to the Macklin effect caused by alveolar ruptures that lead to air dissecting along bronchovascular bundles and spreading of the pulmonary interstitial emphysema into the mediastinum. Streaks of air surrounding and paralleling the bronchovascular bundles associated with pneumomediastinum may be observed on CT [35]. Pneumomediastinum may be mistaken for pneumothorax, but the presence of septae within it—delineated on wide lung window—may help in differentiating the two findings, especially if they coexist (Fig.\xa0<xref rid="13244_2011_72_Fig9_HTML" ref-type="fig">9</xref>).\n).\nFig.\xa09Pneumomediastinum. Axial CT images at wide lung window show pneumomediastinum with the presence of septae within the air in the anterior mediastinum (black arrows) (a), and in the middle and posterior mediastinum (black arrows) (b). Note also a right pneumothorax, bilateral lower lobe atelectases and subcutaneous emphysema (a) and a right haemopneumothorax and left pneumothorax (b)'], '13244_2011_72_Fig10_HTML': ['Cardiac injuries are the most lethal in chest trauma patients. They are more common in penetrating trauma, but they can occasionly occur in motor vehicle accidents and from severe blows to the anterior chest wall. Cardiac injury may be difficult to depict acutely in those who survive and should be treated with a high degree of clinical suspicion. It may range from a small focal contusion to a frank rupture of the heart, which is rare (<2%), affecting mainly the right atrium [12]. CT has low sensitivity in detecting cardiac injury and may show haemo-pneumopericardium, cardiac contusion as a hypodense, non-enhancing focal area in the myocardium, contrast medium extravasation in the pericardial sac or the mediastinum, coronary artery laceration or valve injury [36]. Pericardial tears occur extremely rarely (0.11%) and may range from tiny to the entire length of the pericardium. They usually manifest at the diaphragmatic surface of the pericardium on the left side. In cases of a large tear, intrapericardial cardiac herniation may occur, leading to death. Occasionally, there may also be intrapericardial bowel herniation [2]. On CT, the most common findings are haemopericardium (Fig.\xa0<xref rid="13244_2011_72_Fig10_HTML" ref-type="fig">10</xref>) and pneumopericardium (Fig.\xa0) and pneumopericardium (Fig.\xa0<xref rid="13244_2011_72_Fig11_HTML" ref-type="fig">11</xref>).\n).\nFig.\xa010Haemopericardium. Axial contrast-enhanced CT of the lower thorax at mediastinal window shows haemopericardium that may represent an indirect sign of pericardial or heart injury in a polytraumatised patient after a motor vehicle accident. There is also a small right haemothoraxFig.\xa011Pneumopericardium. Axial CT image at lung window shows extensive pneumopericardium (white arrow), pneumomediastinum (black arrows), haemopneumothorax (black dotted arrows), collapsed left lung with ipsilateral shift of the mediastinum and collapse of the right lower lobe'], '13244_2011_72_Fig12_HTML': ['Oesophageal injury is far more common in penetrating or iatrogenic injury and occurs only in 1% of cases of blunt chest trauma. The main mechanisms are a direct blow to the neck mainly affecting the cervical oesophagus, burst-type force or hyperextension injury affecting the distal oesophagus, or rupture by a vertebral body fracture [12]. On CT there will be mainly indirect findings of oesophageal rupture such as pneumomediastinum and peri-oesophageal air or abnormal mediastinal contour secondary to leakage of fluid, haematoma or mediastinitis. Hydropneumothorax is usually seen on the left side. Diagnosis can be confirmed (Fig.\xa0<xref rid="13244_2011_72_Fig12_HTML" ref-type="fig">12</xref>) by water-soluble contrast oesophagography showing leakage of contrast medium into the mediastinal or pleural space [) by water-soluble contrast oesophagography showing leakage of contrast medium into the mediastinal or pleural space [37].\nFig.\xa012Traumatic oesophageal rupture. A 12-year-old boy traumatised during a fall from a tree. Oesophagogram with per os administration of water-soluble contrast medium (a) shows leakage of contrast medium into both pleural spaces. Axial CT image of the thorax at the level of the lung bases (b) verifies the leakage of the contrast medium into the left and right pleural spaces. (Image reproduced from: Arora A, Puri SK, Upreti L, et al (2010). Oesophageal rupture: a rare complication of blunt trauma, {Online}. URL: http://www.eurorad.org/case.php?id=8447)'], '13244_2011_72_Fig13_HTML': ['Aortic injury occurs in 0.5%–2% of all non-lethal MVAs and is responsible for 10–20% of deaths in MVAs. Aortic injuries have a high morbidity and mortality; 90% of the patients die at the trauma scene, while 90% of initial survivors die within 4\xa0months if the injury is undetected and untreated [38]. In the remaining 20% of cases, aortic injury is caused by falls and pedestrian injuries. Mechanisms of injury are variable and may overlap, including rapid deceleration, shearing forces, increased intravascular pressure caused by compression exceeding 2,000\xa0mmHg (the water-hammer effect) or the “osseous pinch”, which represents direct compression of the aorta between the anterior chest wall and the spine [38]. The most common site of injury is the isthmus, corresponding to 90–95% of cases. Uncommon sites include the aortic root-ascending aorta, the aortic arch-branch vessels and the mid-distal descending aorta. The injury may be partial (65%), involving only the intima and media, or transmural (35%), also affecting the adventitia, which is lethal in almost all cases. The injury may be circumferential (45% of cases) or segmental (in 55% of cases), involving either the greater (Fig.\xa0<xref rid="13244_2011_72_Fig13_HTML" ref-type="fig">13</xref>) or the inferior curve (Fig.\xa0) or the inferior curve (Fig.\xa0<xref rid="13244_2011_72_Fig14_HTML" ref-type="fig">14</xref>). CT may show direct and indirect signs. Direct signs include active contrast medium extravasation, dissection (Fig.\xa0). CT may show direct and indirect signs. Direct signs include active contrast medium extravasation, dissection (Fig.\xa0<xref rid="13244_2011_72_Fig15_HTML" ref-type="fig">15</xref>), pseudoaneurysm (Figs.\xa0), pseudoaneurysm (Figs.\xa0<xref rid="13244_2011_72_Fig13_HTML" ref-type="fig">13</xref> and and <xref rid="13244_2011_72_Fig14_HTML" ref-type="fig">14</xref>), intimal tear/flap (Fig.\xa0), intimal tear/flap (Fig.\xa0<xref rid="13244_2011_72_Fig16_HTML" ref-type="fig">16</xref>), thrombus protruding into the lumen (Fig.\xa0), thrombus protruding into the lumen (Fig.\xa0<xref rid="13244_2011_72_Fig17_HTML" ref-type="fig">17</xref>), and abrupt change in calibre (pseudocoarctation). Indirect CT signs are indistinctness of mediastinal flat planes, periaortic haematoma and mediastinal haematoma (Figs.\xa0), and abrupt change in calibre (pseudocoarctation). Indirect CT signs are indistinctness of mediastinal flat planes, periaortic haematoma and mediastinal haematoma (Figs.\xa0<xref rid="13244_2011_72_Fig16_HTML" ref-type="fig">16</xref>––<xref rid="13244_2011_72_Fig18_HTML" ref-type="fig">18</xref>). Mediastinal haematoma is less than 20% predictive of aortic injury. In the absence of aortic injury, mediastinal haematoma may originate from venous injuries. In such cases the fat plane with the aorta is preserved, contrary to thoracic aortic injury, where haematoma develops in close contact with the aortic wall (Fig.\xa0). Mediastinal haematoma is less than 20% predictive of aortic injury. In the absence of aortic injury, mediastinal haematoma may originate from venous injuries. In such cases the fat plane with the aorta is preserved, contrary to thoracic aortic injury, where haematoma develops in close contact with the aortic wall (Fig.\xa0<xref rid="13244_2011_72_Fig16_HTML" ref-type="fig">16</xref>––<xref rid="13244_2011_72_Fig18_HTML" ref-type="fig">18</xref>). Minimal aortic injuries affect only the intima. They are diagnosed with increasing frequency—because of improved MDCT technology—and constitute a diagnostic dilemma [). Minimal aortic injuries affect only the intima. They are diagnosed with increasing frequency—because of improved MDCT technology—and constitute a diagnostic dilemma [39], as most of them remain stable or resolve on follow-up (Fig.\xa0<xref rid="13244_2011_72_Fig18_HTML" ref-type="fig">18</xref>). MDCT has very high sensitivity and specificity, reaching 98% and 100% accordingly for diagnosing aortic trauma. However, in studies where the presence of mediastinal haematoma (an indirect sign of aortic injury) was considered as a positive criterion for aortic injury, a significant number of false-positive diagnoses occurred, and the specificity for aortic injury dropped significantly by up to 62%. Nevertheless, MDCT has become the gold standard for ruling out aortic injury, and in those patients with unequivocal evidence of aortic injury, no further imaging is required [). MDCT has very high sensitivity and specificity, reaching 98% and 100% accordingly for diagnosing aortic trauma. However, in studies where the presence of mediastinal haematoma (an indirect sign of aortic injury) was considered as a positive criterion for aortic injury, a significant number of false-positive diagnoses occurred, and the specificity for aortic injury dropped significantly by up to 62%. Nevertheless, MDCT has become the gold standard for ruling out aortic injury, and in those patients with unequivocal evidence of aortic injury, no further imaging is required [40]. No further workup is indicated if there is no direct evidence of aortic injury and no mediastinal haematoma on CT [38].\nFig.\xa013Traumatic aortic pseudoaneurysm. Sagittal reformatted contrast-enhanced CT image of the thoracic aorta reveals a pseudoaneurysm of the greater curve of the mid-descending thoracic aorta (black arrow)Fig.\xa014Traumatic aortic pseudoaneurysm. Three-dimensional reconstructed CT image of the thoracic aorta shows a pseudoaneurysm of the inferior curve of the thoracic aorta immediately distal to the isthmus (arrow)Fig.\xa015Traumatic aortic dissection. Coronal contrast-enhanced CT reformatted image of the thorax and abdomen shows a traumatic dissection of the ascending thoracic aorta (Stanford type A)Fig.\xa016Axial contrast-enhanced CT image shows thrombus protruding into the lumen of the descending thoracic aorta (black arrows), indicating aortic injury surrounded by periaortic haematoma (white arrow)Fig.\xa017Minimal aortic injury. Coronal MIP CT image of the thorax shows minimal aortic injury at the aortic isthmus (black arrow) involving only the intima, surrounded by periaortic haematomaFig.\xa018Axial contrast-enhanced CT image shows presence of an intimal flap at the aortic arch (black arrow) surrounded by mediastinal haematoma with no preserved fat plane with the aorta (white arrows). Bilateral pleural haemothoraces are also seen'], '13244_2011_72_Fig19_HTML': ['Diaphragmatic injury occurs in 0.16% to 5% of blunt trauma cases, and it is more common in abdominal than in chest trauma. It is three times more common on the left side than on the right side, and the main mechanism is thought to be the sudden increase in intra-abdominal-thoracic pressure against a fixed diaphragm. The most common site of rupture is at the posterolateral surface, at the site of embryonic diaphragmatic fusion. Through the diaphragmatic defect, depending on its size, there may be intrathoracic herniation of intra-abdominal visceral organs, which may be incarcerated, strangulated or perforated. CT findings of diaphragmatic rupture include [41] the diaphragmatic discontinuation and defect, the “collar sign” or “hourglass sign” formed by the waist-like stricture of partial intrathoracic herniation of the stomach or bowel (Fig.\xa0<xref rid="13244_2011_72_Fig19_HTML" ref-type="fig">19</xref>), and the “dependent viscera sign”, which is formed by the posterior fall of the viscera towards and abutting the posterior dependent thoracic wall (with the patient supine) without the support of the intervening diaphragm (Fig.\xa0), and the “dependent viscera sign”, which is formed by the posterior fall of the viscera towards and abutting the posterior dependent thoracic wall (with the patient supine) without the support of the intervening diaphragm (Fig.\xa0<xref rid="13244_2011_72_Fig20_HTML" ref-type="fig">20</xref>). Contrast-enhanced CT may reveal contrast material extravasation at the site of diaphragmatic rupture. Occasionally, there may be only peritoneal fat intrathoracically herniated through the defect (Fig.\xa0). Contrast-enhanced CT may reveal contrast material extravasation at the site of diaphragmatic rupture. Occasionally, there may be only peritoneal fat intrathoracically herniated through the defect (Fig.\xa0<xref rid="13244_2011_72_Fig21_HTML" ref-type="fig">21</xref>). Diaphragmatic injury is usually a delayed diagnosis because of other associated serious injuries that may mask the clinical symptoms. It has a high mortality rate (30%) if it remains unrecognised [). Diaphragmatic injury is usually a delayed diagnosis because of other associated serious injuries that may mask the clinical symptoms. It has a high mortality rate (30%) if it remains unrecognised [42]. The high-resolution coronal and sagittal reformations routinely produced with MDCT—compared with single-spiral CT—allow detection with high sensitivity, even of a small diaphragmatic defect.\nFig.\xa019Dependent viscera sign. Axial contrast-enhanced CT at the level of the lower lobes, at mediastinal window, shows intrathoracic presence of the stomach abutting the left posterior thoracic wall without intervening in the left hemidiaphragm (black arrows)Fig.\xa020The “hourglass” or “collar” sign of diaphragmatic rupture. Reformatted coronal contrast-enhanced CT image of the thorax shows waist-like stricture of the herniated left colon intrathoracically through the small defect of the left hemidiaphragm (black arrows)Fig.\xa021Reformatted coronal contrast-enhanced CT image of the thorax shows intrathoracic herniation of intraperitoneal fat through the large defect of the left hemidiaphragm (white arrows)'], '13244_2011_72_Fig22_HTML': ['Rib fractures are the most common injury in blunt chest trauma, occurring in 50% of cases. A single rib fracture is usually not clinically significant, whereas multiple rib fractures indicate severe injury. Fractures of the first three ribs imply high-energy trauma that may be associated with injury of the brachial plexus or subclavian vessels. Fractures of the fourth up to the eighth ribs are the most common, while fractures of the last four ribs are usually associated with intra-abdominal injury. Reconstructed MIP and volume-rendered CT images depict with great detail the number and sites of rib fractures (Fig.\xa0<xref rid="13244_2011_72_Fig22_HTML" ref-type="fig">22</xref>). Flail chest is a marker of significant intrathoracic injury with increased morbidity, in which three or more contiguous ribs are fractured in two or more sites (Fig.\xa0). Flail chest is a marker of significant intrathoracic injury with increased morbidity, in which three or more contiguous ribs are fractured in two or more sites (Fig.\xa0<xref rid="13244_2011_72_Fig23_HTML" ref-type="fig">23</xref>). The diagnosis is clinical based on the paradoxical motion during respiration, which may result in ventilatory compromise. More than 50% of cases require surgical treatment and prolonged mechanical ventilation [). The diagnosis is clinical based on the paradoxical motion during respiration, which may result in ventilatory compromise. More than 50% of cases require surgical treatment and prolonged mechanical ventilation [9].\nFig.\xa022Coronal MIP CT image showing multiple contiguous left rib fractures (arrows)Fig.\xa023Coronal (a) and sagittal (b) reconstructed CT images show fractures of three contiguous right ribs (arrows) that were associated with paradox motion of the chest during respiration. Flail chest was suspected clinically and verified on imaging'], '13244_2011_72_Fig24_HTML': ['Sternal fractures have a prevalence of 3–8% in blunt chest trauma. The main mechanism is deceleration injury or a direct blow to the anterior chest wall. It is considered a marker of cardiac contusion (1.5%–6%). Sternal fractures are difficult to detect on lateral chest radiographs and even on axial CT images, as opposed to sagittal and coronal MDCT reformats, which have significant superiority (Fig.\xa0<xref rid="13244_2011_72_Fig24_HTML" ref-type="fig">24</xref>). It is almost always accompanied by anterior mediastinal haemorrhage, which has a preserved fat plane with the aorta (Fig.\xa0). It is almost always accompanied by anterior mediastinal haemorrhage, which has a preserved fat plane with the aorta (Fig.\xa0<xref rid="13244_2011_72_Fig25_HTML" ref-type="fig">25</xref>), as opposed to an anterior mediastinal haemorrhage secondary to aortic injury, which will present with a lost fat plane with the aorta [), as opposed to an anterior mediastinal haemorrhage secondary to aortic injury, which will present with a lost fat plane with the aorta [17].\nFig.\xa024Sternal fracture. Sagittal reconstructed CT image shows multiple fractures of the manubrium and the body of the sternum (white arrows) accompanied by extensive retrosternal haematoma (black ball arrows). Note also fracture of a thoracic vertebra (black arrow)Fig.\xa025Sternal fracture. Axial CT image at mediastinal window shows sternal fracture associated with retrosternal haematoma (black arrow). Note the preserved fat plane with the aorta, excluding the presence of aortic injury (white arrows)'], '13244_2011_72_Fig26_HTML': ['Sternoclavicular dislocation is rare and occurs in 1–3% of all types of dislocation. Anterior sternoclavicular dislocation is more common and easily detectable, as it is palpable (Fig.\xa0<xref rid="13244_2011_72_Fig26_HTML" ref-type="fig">26</xref>). It usually has a benign course, but it implies a high-energy trauma and may be associated with haemopneumothorax, rib fractures or pulmonary contusion [). It usually has a benign course, but it implies a high-energy trauma and may be associated with haemopneumothorax, rib fractures or pulmonary contusion [43]. Posterior sternoclavicular dislocation is clinically and radiographically silent and carries serious morbidity, as it is associated with injuries of the mediastinal vessels, nerves, trachea and oesophagus (Fig.\xa0<xref rid="13244_2011_72_Fig27_HTML" ref-type="fig">27</xref>).\n).\nFig.\xa026Anterior sternoclavicular dislocation. Axial CT image shows clavicular fracture and anterior sternoclavicular dislocation (dotted arrows)Fig.\xa027Posterior sternoclavicular dislocation. Axial CT image shows posterior sternoclavicular dislocation (black arrow) associated with compression of the left innominate vein (black dotted arrow)'], '13244_2011_72_Fig28_HTML': ['Scapular fracture is uncommon, occurring in 3.7% of cases of blunt chest trauma. It is easily detected on initial radiographs and may be masked clinically by other associated serious injuries (Fig.\xa0<xref rid="13244_2011_72_Fig28_HTML" ref-type="fig">28</xref>). It indicates a high-energy force trauma with a direct blow to the scapula or force transmitted through the humerus. Associated injuries are pneumothorax, haemothorax, clavicular fracture and injuries of the lung parenchyma, subclavian vessels, brachial plexus or spine [). It indicates a high-energy force trauma with a direct blow to the scapula or force transmitted through the humerus. Associated injuries are pneumothorax, haemothorax, clavicular fracture and injuries of the lung parenchyma, subclavian vessels, brachial plexus or spine [44].\nFig.\xa028Scapular fracture. Sagittal reconstructed CT image shows multiple fractures of the left scapula (arrows)'], '13244_2011_72_Fig29_HTML': ['Thoracic spine fractures account for up to 30% of all spine fractures. Sixty-two percent of spine fractures will result in neurological deficits. The most vulnerable site is between the ninth and twelfth vertebra. The main mechanism is hyperflexion and axial loading. Plain radiographs may miss fractures of the spine and therefore may be unnecessary in those patients scheduled for CT [45]. Sagittal and coronal MDCT reformats (Fig.\xa0<xref rid="13244_2011_72_Fig29_HTML" ref-type="fig">29</xref>) readily reveal even small spinal fractures, whereas volume-rendered images are not helpful [) readily reveal even small spinal fractures, whereas volume-rendered images are not helpful [12]. MDCT of the spine is highly indicated for spinal survey for possible fractures. However, in the case of suspected compressive myelopathy, MRI is the method of choice (Fig.\xa0<xref rid="13244_2011_72_Fig30_HTML" ref-type="fig">30</xref>).\n).\nFig.\xa029Thoracic spine fracture. Coronal (a) and sagittal (b) CT reconstructed images of two different patients show fractures of the upper thoracic vertebrae with great detailFig.\xa030Thoracic spine fracture and compressive myelopathy. Sagittal T2-weighted MRI of the cervicothoracic spine undertaken 1\xa0week after a motor vehicle accident verifies the presence of extensive compressive myelopathy (between the two white arrows with black outline) due to fractures of the second and the third thoracic vertebrae (white arrows)']} | CT imaging of blunt chest trauma | [
"Blunt trauma",
"Lungs",
"CT"
] | Insights Imaging | 1297411200 | PURPOSE: The objective of this study was to describe the sonographic features of deep-seated lipomas. METHODS: A retrospective review of the sonographic features of 64 deep seated lipomas in 64 patients (43 females, 21 males, mean age 46.5, range 16-77 years) seen over an 8-year period (1998-2006) was undertaken. RESULTS: Features evaluated were location, size, shape, marginal definition, internal echogenicity, including the presence of intermingled muscle fibres and linear internal echoes, acoustic transmission and vascularity. Confirmation was histological in 37 (58%) cases and by typical magnetic resonance imaging (MRI) appearance in 27 (42%) cases. CONCLUSION: The results show that although the features of deep-seated lipoma are more variable than those reported for subcutaneous lipomas, the presence of thin internal echoes in conjunction with other less specific features should enable a correct diagnosis. | [] | other | PMC3259405 | null | 18 | [
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"{'Citation': 'Lin J, Fessell DP, Jacobson JA, Weadock WJ, Hayes CW. An illustrated tutorial of musculoskeletal sonography: part I, introduction and general principles. AJR Am J Roentgenol. 2000;175(3):637–645.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10954443'}}}",
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"{'Citation': 'Ha TV, Kleinman PK, Fraire A, et al. MR imaging of benign fatty tumors in children: report of four cases and review of the literature. Skeletal Radiol. 1994;23:361–367. doi: 10.1007/BF02416994.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/BF02416994'}, {'@IdType': 'pubmed', '#text': '7939836'}]}}",
"{'Citation': 'Hosono M, Kobayashi H, Fujimoto R, et al. Septum- like structures in lipoma and liposarcoma: MR imaging and pathologic correlation. Skeletal Radiol. 1997;26:150–154. doi: 10.1007/s002560050211.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s002560050211'}, {'@IdType': 'pubmed', '#text': '9108224'}]}}",
"{'Citation': 'Gaskin CM, Helms CA. Lipomas, lipoma variants, and well-differentiated liposarcomas (atypical lipomas): results of MRI evaluations of 126 consecutive fatty masses. AJR Am J Roentgenol. 2004;182:733–739.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14975977'}}}",
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] | Insights Imaging. 2011 Feb 11; 2(3):281-295 | NO-CC CODE |
|
Lung laceration, type II. Coronal reformatted CT image at lung window (a) shows a lobulated paraspinal pneumatocele (arrow) surrounded by ground-glass opacity (contusion) in the right lung consistent with lung laceration (type II?). On mediastinal window lung laceration is seen to have been complicated by acute pulmonary embolism (dotted arrow) | 13244_2011_72_Fig5_HTML | 7 | 61b15cbe2e3575a49b0ed2c0698d0e8ee470ea0a5f0bc520a030cac64a91176c | 13244_2011_72_Fig5_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
761,
321
] | [{'image_id': '13244_2011_72_Fig6_HTML', 'image_file_name': '13244_2011_72_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig6_HTML.jpg', 'caption': 'Lung laceration, type IV. Axial CT image of the left lung at lung window shows a small peripheral laceration (white arrow) beneath a rib fracture (black arrow) surrounded by ground-glass opacity (lung contusion) and associated with a small ipsilateral pneumothorax', 'hash': '5863242acc3b6e21133123bf2957bab5f97c21ffceea84365475d12f424f0216'}, {'image_id': '13244_2011_72_Fig26_HTML', 'image_file_name': '13244_2011_72_Fig26_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig26_HTML.jpg', 'caption': 'Anterior sternoclavicular dislocation. Axial CT image shows clavicular fracture and anterior sternoclavicular dislocation (dotted arrows)', 'hash': '9b831dd8840c2891bf3536a4290f02ecdc98874580bf611e4ecc6623543ac9e8'}, {'image_id': '13244_2011_72_Fig29_HTML', 'image_file_name': '13244_2011_72_Fig29_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig29_HTML.jpg', 'caption': 'Thoracic spine fracture. Coronal (a) and sagittal (b) CT reconstructed images of two different patients show fractures of the upper thoracic vertebrae with great detail', 'hash': 'ed56231066f1d4acb06d74211dce565b29deb3edd1e9d22c033f352c41e989fb'}, {'image_id': '13244_2011_72_Fig9_HTML', 'image_file_name': '13244_2011_72_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig9_HTML.jpg', 'caption': 'Pneumomediastinum. Axial CT images at wide lung window show pneumomediastinum with the presence of septae within the air in the anterior mediastinum (black arrows) (a), and in the middle and posterior mediastinum (black arrows) (b). Note also a right pneumothorax, bilateral lower lobe atelectases and subcutaneous emphysema (a) and a right haemopneumothorax and left pneumothorax (b)', 'hash': 'e3315009e28d187756fed04bd73e52aa7a66e88852e0fa95bd3198339ea7893f'}, {'image_id': '13244_2011_72_Fig16_HTML', 'image_file_name': '13244_2011_72_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig16_HTML.jpg', 'caption': 'Axial contrast-enhanced CT image shows thrombus protruding into the lumen of the descending thoracic aorta (black arrows), indicating aortic injury surrounded by periaortic haematoma (white arrow)', 'hash': 'd0e96e0ad0009a48be94efa9392e2a5e78f6d4a6690fae78dcfe55586128d2f2'}, {'image_id': '13244_2011_72_Fig19_HTML', 'image_file_name': '13244_2011_72_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig19_HTML.jpg', 'caption': 'Dependent viscera sign. Axial contrast-enhanced CT at the level of the lower lobes, at mediastinal window, shows intrathoracic presence of the stomach abutting the left posterior thoracic wall without intervening in the left hemidiaphragm (black arrows)', 'hash': 'dd2bfec04ea0d87a06d80a092eb0f33fae6ab3af9709ce550f5a542b3501e95a'}, {'image_id': '13244_2011_72_Fig21_HTML', 'image_file_name': '13244_2011_72_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig21_HTML.jpg', 'caption': 'Reformatted coronal contrast-enhanced CT image of the thorax shows intrathoracic herniation of intraperitoneal fat through the large defect of the left hemidiaphragm (white arrows)', 'hash': '0a402083af039e9a88a2e385bb7fe255e23b2bbf3efbb7a9b81e6d54542ce814'}, {'image_id': '13244_2011_72_Fig1_HTML', 'image_file_name': '13244_2011_72_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig1_HTML.jpg', 'caption': 'Occult pneumothorax. Axial CT at lung window shows a small occult pneumothorax (missed on chest radiography) at the anteromedial part of the left upper lobe (white arrow). There are also bilateral ground-glass opacities and areas of consolidation in both upper lobes consistent with lung contusions. Note the presence of numerous small confluent pneumatoceles (Swiss cheese appearance) in the anterior segment of the left upper lobe, consistent with lung laceration (black arrow). Note also the presence of small pneumomediastinum (dotted white arrow)', 'hash': 'df55f512f4486e19d06a1b6cc03a1d9974ae5172b34c6563a5bc65fecfbe6813'}, {'image_id': '13244_2011_72_Fig11_HTML', 'image_file_name': '13244_2011_72_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig11_HTML.jpg', 'caption': 'Pneumopericardium. Axial CT image at lung window shows extensive pneumopericardium (white arrow), pneumomediastinum (black arrows), haemopneumothorax (black dotted arrows), collapsed left lung with ipsilateral shift of the mediastinum and collapse of the right lower lobe', 'hash': 'adb33f13ecacbdd4b2fd4739cdad52f67d1efd2ed9f523bcb12de93bfb7ff966'}, {'image_id': '13244_2011_72_Fig18_HTML', 'image_file_name': '13244_2011_72_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig18_HTML.jpg', 'caption': 'Axial contrast-enhanced CT image shows presence of an intimal flap at the aortic arch (black arrow) surrounded by mediastinal haematoma with no preserved fat plane with the aorta (white arrows). Bilateral pleural haemothoraces are also seen', 'hash': '323e8295c1260636c4d8698d6b81268f50739c220094327e06b7760ed57fe14e'}, {'image_id': '13244_2011_72_Fig17_HTML', 'image_file_name': '13244_2011_72_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig17_HTML.jpg', 'caption': 'Minimal aortic injury. Coronal MIP CT image of the thorax shows minimal aortic injury at the aortic isthmus (black arrow) involving only the intima, surrounded by periaortic haematoma', 'hash': '1958201094f9c29442682caf6a857f4c0872629139b35be0206ba5e6313311a5'}, {'image_id': '13244_2011_72_Fig28_HTML', 'image_file_name': '13244_2011_72_Fig28_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig28_HTML.jpg', 'caption': 'Scapular fracture. Sagittal reconstructed CT image shows multiple fractures of the left scapula (arrows)', 'hash': '0943d81e51026828b04bc0d5e508683c800616d624334f0ef2506c3ea24933db'}, {'image_id': '13244_2011_72_Fig8_HTML', 'image_file_name': '13244_2011_72_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig8_HTML.jpg', 'caption': 'Bronchial transection. A 22-year-old man involved in a car accident. Volume-rendered image of the tracheobronchial tree showing complete transection of the right intermediate bronchus (two-way arrow). (Courtesy of Dr Montserrat Bret, University Hospital La Paz, Madrid)', 'hash': '240792afcb56505bda44effeef2a2c701f31a156c5d2fab6d00eea28505a6def'}, {'image_id': '13244_2011_72_Fig7_HTML', 'image_file_name': '13244_2011_72_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig7_HTML.jpg', 'caption': 'Blast lung injury. Twenty-two-year-old patient who experienced the explosion of a grenade in his hands. Coronal CT reformatted contrast-enhanced CT image at mediastinal window shows bilateral perilar consolidations mimicking a butterfly or bat-wing appearance, consistent with blast lung. The left lung is almost completely collapsed, and there are bilateral haemothoraces', 'hash': '67e53dd43a059c1a1c75f728ce4c647c8beeb90350a2f9ceddab7367c3e667cc'}, {'image_id': '13244_2011_72_Fig27_HTML', 'image_file_name': '13244_2011_72_Fig27_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig27_HTML.jpg', 'caption': 'Posterior sternoclavicular dislocation. Axial CT image shows posterior sternoclavicular dislocation (black arrow) associated with compression of the left innominate vein (black dotted arrow)', 'hash': '65861d0ff5bcca7557977d36133e676dc920d29bfce85e793b3498293463ecb5'}, {'image_id': '13244_2011_72_Fig10_HTML', 'image_file_name': '13244_2011_72_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig10_HTML.jpg', 'caption': 'Haemopericardium. Axial contrast-enhanced CT of the lower thorax at mediastinal window shows haemopericardium that may represent an indirect sign of pericardial or heart injury in a polytraumatised patient after a motor vehicle accident. There is also a small right haemothorax', 'hash': '796092bf0ef0acb33a101431cc1aa7f4994330eebaf6ecd1b7c09b6075bb5cf0'}, {'image_id': '13244_2011_72_Fig30_HTML', 'image_file_name': '13244_2011_72_Fig30_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig30_HTML.jpg', 'caption': 'Thoracic spine fracture and compressive myelopathy. Sagittal T2-weighted MRI of the cervicothoracic spine undertaken 1\xa0week after a motor vehicle accident verifies the presence of extensive compressive myelopathy (between the two white arrows with black outline) due to fractures of the second and the third thoracic vertebrae (white arrows)', 'hash': '5eed45d58046af966704e6e8bac002147a98491e3206949eb9fd8d0e49fd60e3'}, {'image_id': '13244_2011_72_Fig20_HTML', 'image_file_name': '13244_2011_72_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig20_HTML.jpg', 'caption': 'The “hourglass” or “collar” sign of diaphragmatic rupture. Reformatted coronal contrast-enhanced CT image of the thorax shows waist-like stricture of the herniated left colon intrathoracically through the small defect of the left hemidiaphragm (black arrows)', 'hash': 'cbdac9d2d072d59f6023905369f608422082c3366a479b57784becb3330c6ee4'}, {'image_id': '13244_2011_72_Fig3_HTML', 'image_file_name': '13244_2011_72_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig3_HTML.jpg', 'caption': 'Tension haemopneumothorax. Axial contrast-enhanced CT at mediastinal window shows a right tension haemopneumothorax with heterogeneous increased density due to presence of blood clots and a significant shift of the mediastinum contralaterally', 'hash': '5d60ee3c870f1facdf0afcf993a9144d5bb6d95ca2f9b9a287c6ccb26ffa433a'}, {'image_id': '13244_2011_72_Fig23_HTML', 'image_file_name': '13244_2011_72_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig23_HTML.jpg', 'caption': 'Coronal (a) and sagittal (b) reconstructed CT images show fractures of three contiguous right ribs (arrows) that were associated with paradox motion of the chest during respiration. Flail chest was suspected clinically and verified on imaging', 'hash': 'e0dfac45308f42c94f933fee9460f1b447c0fe8d307b3d1a0f19ba2aa7de8e60'}, {'image_id': '13244_2011_72_Fig13_HTML', 'image_file_name': '13244_2011_72_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig13_HTML.jpg', 'caption': 'Traumatic aortic pseudoaneurysm. Sagittal reformatted contrast-enhanced CT image of the thoracic aorta reveals a pseudoaneurysm of the greater curve of the mid-descending thoracic aorta (black arrow)', 'hash': '4237e854d56f72b45f3b320a6a558dd23499f9f25cc7c1efdd4defaacdbcdf95'}, {'image_id': '13244_2011_72_Fig24_HTML', 'image_file_name': '13244_2011_72_Fig24_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig24_HTML.jpg', 'caption': 'Sternal fracture. Sagittal reconstructed CT image shows multiple fractures of the manubrium and the body of the sternum (white arrows) accompanied by extensive retrosternal haematoma (black ball arrows). Note also fracture of a thoracic vertebra (black arrow)', 'hash': 'c4e5bd451afe2ef323c0df62eb0db1ed8cea7ae08f5726ebcf40a7f84fff306a'}, {'image_id': '13244_2011_72_Fig4_HTML', 'image_file_name': '13244_2011_72_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig4_HTML.jpg', 'caption': 'Lung contusion. Axial (a, b) and coronal (c) CT images at lung window show nodular opacities of ground-glass opacity that do not respect the lung boundaries of the right upper lobe (white arrows) (a), diffuse areas of ground-glass opacity in the upper lobes bilaterally with subpleural sparing (white arrows) (b) and multiple areas of consolidation with air bronchograms (white arrows) and small lacerations (black arrows) in both lungs consistent with lung contusions. Note small bilateral pneumothorax in both lung apices (black dotted arrows) and cardiophrenic angles (black dotted arrows) (c)', 'hash': '518a80e912404d1905c831a59546db0ea3b905e1a0fc2dd6bbf9c99104c7734e'}, {'image_id': '13244_2011_72_Fig14_HTML', 'image_file_name': '13244_2011_72_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig14_HTML.jpg', 'caption': 'Traumatic aortic pseudoaneurysm. Three-dimensional reconstructed CT image of the thoracic aorta shows a pseudoaneurysm of the inferior curve of the thoracic aorta immediately distal to the isthmus (arrow)', 'hash': '1d459cf7dcd092b86beae1556894170b0aa90efc397ea72e210484aaf48562ee'}, {'image_id': '13244_2011_72_Fig12_HTML', 'image_file_name': '13244_2011_72_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig12_HTML.jpg', 'caption': 'Traumatic oesophageal rupture. A 12-year-old boy traumatised during a fall from a tree. Oesophagogram with per os administration of water-soluble contrast medium (a) shows leakage of contrast medium into both pleural spaces. Axial CT image of the thorax at the level of the lung bases (b) verifies the leakage of the contrast medium into the left and right pleural spaces. (Image reproduced from: Arora A, Puri SK, Upreti L, et al (2010). Oesophageal rupture: a rare complication of blunt trauma, {Online}. URL: http://www.eurorad.org/case.php?id=8447)', 'hash': 'd47462d598424f89df9f4e5ae040b61e07119ba4b4c57b7eb0e846411142da0c'}, {'image_id': '13244_2011_72_Fig2_HTML', 'image_file_name': '13244_2011_72_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig2_HTML.jpg', 'caption': 'Tension pneumothorax. Sagittal reformatted CT image at lung window showing tension pneumothorax with significantly collapsed lung at the posterior part of the hemithorax associated with ipsilateral pleural effusion', 'hash': 'd4b61666e21d0661d57813f25b420d7fd63d87bcf2112d66be41fa1c3d6ccf77'}, {'image_id': '13244_2011_72_Fig22_HTML', 'image_file_name': '13244_2011_72_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig22_HTML.jpg', 'caption': 'Coronal MIP CT image showing multiple contiguous left rib fractures (arrows)', 'hash': '394b48689201be58e198a0b418785c92c1a55b1baf83c42fe655d9e703696717'}, {'image_id': '13244_2011_72_Fig15_HTML', 'image_file_name': '13244_2011_72_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig15_HTML.jpg', 'caption': 'Traumatic aortic dissection. Coronal contrast-enhanced CT reformatted image of the thorax and abdomen shows a traumatic dissection of the ascending thoracic aorta (Stanford type A)', 'hash': 'a8eb58fb5b00b6ab7ea3a407c2bee50281cdf66c1a2f81f450fc2c6dd42d541d'}, {'image_id': '13244_2011_72_Fig25_HTML', 'image_file_name': '13244_2011_72_Fig25_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig25_HTML.jpg', 'caption': 'Sternal fracture. Axial CT image at mediastinal window shows sternal fracture associated with retrosternal haematoma (black arrow). Note the preserved fat plane with the aorta, excluding the presence of aortic injury (white arrows)', 'hash': '9ce77177efc53682247ab4e68a79bb9d83542c1f94d3cf90164d1d3a5f83717f'}, {'image_id': '13244_2011_72_Fig5_HTML', 'image_file_name': '13244_2011_72_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259405/13244_2011_72_Fig5_HTML.jpg', 'caption': 'Lung laceration, type II. Coronal reformatted CT image at lung window (a) shows a lobulated paraspinal pneumatocele (arrow) surrounded by ground-glass opacity (contusion) in the right lung consistent with lung laceration (type II?). On mediastinal window lung laceration is seen to have been complicated by acute pulmonary embolism (dotted arrow)', 'hash': '61b15cbe2e3575a49b0ed2c0698d0e8ee470ea0a5f0bc520a030cac64a91176c'}] | {'13244_2011_72_Fig1_HTML': ['Trauma-related pneumothorax occurs in 30–40% of cases, and it is most commonly associated with rib fractures that lacerate the lung. Less commonly, pneumothorax may be caused by a disruption of closed airway spaces, such as the alveoli, due to a sudden increase in intrathoracic pressure or to a direct impact or deceleration force to the chest wall. Tracheobronchial injuries are also always associated with pneumothorax [5, 7, 16, 17]. CT is more sensitive in detecting pneumothoraces (Fig.\xa0<xref rid="13244_2011_72_Fig1_HTML" ref-type="fig">1</xref>), as 78% of them are nowadays believed to be missed on chest radiograph (occult pneumothoraces) [), as 78% of them are nowadays believed to be missed on chest radiograph (occult pneumothoraces) [18, 19]. Pneumothorax in supine polytrauma patients tends to accumulate at the anterior and medial aspect of the lung, rendering it difficult to recognise on a supine chest radiograph, although it might be visible on an upright chest radiograph. Radiographic signs that may be present in the case of an occult pneumothorax include:\nIncreased lucency at the affected hemidiaphragm,An abnormally deep costophrenic sulcus sign,A sharply defined radiolucent border of the mediastinum or heart, andThe “double diaphragm sign” caused by the presence of air outlining the dome and insertion of the diaphragm [7, 20].Fig.\xa01Occult pneumothorax. Axial CT at lung window shows a small occult pneumothorax (missed on chest radiography) at the anteromedial part of the left upper lobe (white arrow). There are also bilateral ground-glass opacities and areas of consolidation in both upper lobes consistent with lung contusions. Note the presence of numerous small confluent pneumatoceles (Swiss cheese appearance) in the anterior segment of the left upper lobe, consistent with lung laceration (black arrow). Note also the presence of small pneumomediastinum (dotted white arrow)', 'The adhesion tear is seen adjacent to a previous pleuropulmonary adhesion and is almost always seen at surgery or at autopsy. Lung tissue surrounding a laceration retracts—because of the lung elastic recoil—leaving a round or oval cavity that may be filled with air (pneumatocele), blood (haematocele or haematoma) or both, creating an air-fluid level (haematopneumatocele). A laceration, although it may be filled with air, is usually surrounded by lung contusion and therefore is hidden on a chest radiograph during the first 2–3\xa0days, until the contusion begins to resolve. CT, on the other hand, is significantly superior to chest radiography in detecting even a small laceration and in revealing the overall extent of the lacerations [27]. Lacerations (Fig.\xa0<xref rid="13244_2011_72_Fig1_HTML" ref-type="fig">1</xref>) may range from a solitary lesion to multiple confluent small ones presenting a “Swiss cheese appearance” [) may range from a solitary lesion to multiple confluent small ones presenting a “Swiss cheese appearance” [20]. Lacerations resolve more slowly than contusions, and clearance may take weeks or even months, and they may end in residual scarring [13]. Uncommonly, lacerations may be complicated by a pulmonary abscess, enlarge through a ball-valve mechanism or form a bronchopleural fistula [17], or it may be associated with acute pulmonary embolism (Fig.\xa0<xref rid="13244_2011_72_Fig5_HTML" ref-type="fig">5</xref>).).'], '13244_2011_72_Fig2_HTML': ['Tension pneumothorax is an urgent clinical diagnosis where progressive accumulation of air—due to the one-valve mechanism—increases the intrathoracic pressure of the hemithorax involved, causing a contralateral shift of the mediastinum, compression of the superior vena cava and loss of venous return to the heart with resultant haemodynamic impairment. Chest radiography and CT will both show a contralateral shift in the mediastinum, hyperexpansion and hyperlucency of the ipsilateral lung with lung collapse towards the hilum, and inversion of the ipsilateral diaphragm (Fig.\xa0<xref rid="13244_2011_72_Fig2_HTML" ref-type="fig">2</xref>). Sudden evacuation of a large pneumothorax with tube drainage can be complicated by re-expansion pulmonary oedema, presenting the corresponding radiological signs. The complication is more common in younger patients (20–50\xa0years of age) and occurs more often than was previously believed, and although it may be entirely asymptomatic, it has a reported variable mortality rate reaching 20% [). Sudden evacuation of a large pneumothorax with tube drainage can be complicated by re-expansion pulmonary oedema, presenting the corresponding radiological signs. The complication is more common in younger patients (20–50\xa0years of age) and occurs more often than was previously believed, and although it may be entirely asymptomatic, it has a reported variable mortality rate reaching 20% [22].\nFig.\xa02Tension pneumothorax. Sagittal reformatted CT image at lung window showing tension pneumothorax with significantly collapsed lung at the posterior part of the hemithorax associated with ipsilateral pleural effusion'], '13244_2011_72_Fig3_HTML': ['Haemothorax occurs in 50% of chest trauma cases, with blood pooling into the pleural space from variable sources: the lung parenchyma, the chest wall, the great vessels, the heart or even the liver and spleen through diaphragmatic rupture [20]. Arterial bleeding (more commonly from the intercostal arteries, and the subclavian and internal mammary arteries) causes a more significant progressive increase in volume and mass effect compared with a venous origin of haemorrhage [23]. Massive haemothorax occurs when the accumulation of blood in the pleural space exceeds 1 l and is accompanied by haemodynamic impairment (Fig.\xa0<xref rid="13244_2011_72_Fig3_HTML" ref-type="fig">3</xref>) [) [2]. CT is very sensitive in detecting even a small haemothorax and can further characterise it by measuring accurately the Hounsfield (HU) units attenuation values of the pleural fluid. A reactive pleural effusion will have values not higher than 15 HU, while liquid blood will measure 30 to 45 HU, and the clotted blood should measure around 50–90 HU units [20, 24]. Occasionally a “haematocrit effect” is caused by the layering of different ages and statuses of coagulation of pleural blood products. In the case of active bleeding the fresh extravasated blood in contrast-enhanced CT may have attenuation values similar to the adjacent enhanced thoracic vessels (±10 HU) [17].\nFig.\xa03Tension haemopneumothorax. Axial contrast-enhanced CT at mediastinal window shows a right tension haemopneumothorax with heterogeneous increased density due to presence of blood clots and a significant shift of the mediastinum contralaterally'], '13244_2011_72_Fig4_HTML': ['Lung contusion is a focal parenchymal injury caused by disruption of the capillaries of the alveolar walls and septa, and leakage of blood into the alveolar spaces and interstitium [25]. It is the most common type of lung injury in blunt chest trauma with a reported prevalence of 17–70% [26]. The main mechanism is compression and tearing of the lung parenchyma at the site of impact (it may also occur contralaterally “contre-coup”) against osseous structures, rib fractures or pre-existing pleural adhesions [27]. Lung contusion occurs at the time of injury, but it may be undetectable on chest radiography for the first 6 h after trauma. The pooling of haemorrhage and oedema will blossom at 24 h, rendering the contusion radiographically more evident, although CT may readily reveal it from the initial imaging [28]. The appearance of consolidation on chest radiography after the first 24 h should raise suspicion of other pathological conditions such as aspiration, pneumonia and fat embolism [2]. Contusions appear as geographic, non-segmental areas of ground-glass or nodular opacities or consolidation on CT that do not respect the lobar boundaries and may manifest air bronchograms if the bronchioles are not filled with blood (Fig.\xa0<xref rid="13244_2011_72_Fig4_HTML" ref-type="fig">4</xref>) [) [17]. Subpleural sparing of 1–2\xa0mm may be seen, especially in children (Fig.\xa0<xref rid="13244_2011_72_Fig4_HTML" ref-type="fig">4b</xref>) [) [29]. Clearance of an uncomplicated contusion begins at 24 to 48 h with complete resolution after 3 to 14\xa0days [9]. Lack of resolution within the expected time frame should raise the suspicion of complications such as pneumonia, abscess or ARDS. Pulmonary contusion—despite the advances in prompt diagnosis with imaging and supportive management with critical care medicine—remains a predictor of ARDS and has a high mortality rate (10–25%) [30].\nFig.\xa04Lung contusion. Axial (a, b) and coronal (c) CT images at lung window show nodular opacities of ground-glass opacity that do not respect the lung boundaries of the right upper lobe (white arrows) (a), diffuse areas of ground-glass opacity in the upper lobes bilaterally with subpleural sparing (white arrows) (b) and multiple areas of consolidation with air bronchograms (white arrows) and small lacerations (black arrows) in both lungs consistent with lung contusions. Note small bilateral pneumothorax in both lung apices (black dotted arrows) and cardiophrenic angles (black dotted arrows) (c)'], '13244_2011_72_Fig5_HTML': ['Compression shear injury is produced when the lower lobes are suddenly squeezed against the spine. It is located paraspinally and may be tubular in morphology (Fig.\xa0<xref rid="13244_2011_72_Fig5_HTML" ref-type="fig">5</xref>).).'], '13244_2011_72_Fig6_HTML': ['Rib penetration tear is peripherally located, is small and round and is usually associated with pneumothorax (Fig.\xa0<xref rid="13244_2011_72_Fig6_HTML" ref-type="fig">6</xref>).).'], '13244_2011_72_Fig7_HTML': ['Blast lung is the most common fatal injury among initial survivors of explosions; 17–47% of people who die from explosions have had primary blast lung injury [8, 9]. However, the in-hospital mortality rate for these patients ranges from 3.4 to 25% because of prompt diagnosis and aggressive treatment. The blast wave causes thoracic acceleration and propagates through lung parenchyma with subsequent severe disruption at the capillary-alveolar interface. This results in parenchymal haemorrhage and contusions, pulmonary oedema, pneumothorax, barotrauma and air embolism from arteriovenous fistulas, causing substantial immediate and delayed injury. Chest radiography and CT (Fig.\xa0<xref rid="13244_2011_72_Fig7_HTML" ref-type="fig">7</xref>) will reveal the “butterfly or batwing” pattern, representing central bilateral perihilar air space consolidation and ground-glass opacities that may contain air bronchograms [) will reveal the “butterfly or batwing” pattern, representing central bilateral perihilar air space consolidation and ground-glass opacities that may contain air bronchograms [32].\nFig.\xa07Blast lung injury. Twenty-two-year-old patient who experienced the explosion of a grenade in his hands. Coronal CT reformatted contrast-enhanced CT image at mediastinal window shows bilateral perilar consolidations mimicking a butterfly or bat-wing appearance, consistent with blast lung. The left lung is almost completely collapsed, and there are bilateral haemothoraces'], '13244_2011_72_Fig8_HTML': ['Tracheobronchial injuries are rare, occurring in 0.2–8% of all cases of chest trauma. It is anticipated that the prevalence is higher, as 50% of patients die at the trauma scene within the first 2 h from associated injuries and respiratory insufficiency [2, 33]. They have a mortality rate of 30%, and in two thirds of cases the diagnosis is delayed with subsequent serious complications, such as pneumonia, abscess, empyema, mediastinitis, sepsis, airway obstruction or atelectasis. Bronchial injuries occur more commonly than tracheal, usually on the right side and within 2.5\xa0cm from the carina [5, 24], while 85% of tracheal lacerations occur 2\xa0cm above the carina. Bronchial lacerations are usually parallel to the cartilage rings as opposed to tracheal ones that are vertical to the cartilage rings. A direct CT finding of tracheobronchial injuries is the cutoff of the tracheal and bronchial wall with extraluminal air surrounding the airway (Fig.\xa0<xref rid="13244_2011_72_Fig8_HTML" ref-type="fig">8</xref>). Indirect findings are the “fallen lung” sign, corresponding to the collapsed lung resting away from the hilum towards the dependent portion of the hemithorax [). Indirect findings are the “fallen lung” sign, corresponding to the collapsed lung resting away from the hilum towards the dependent portion of the hemithorax [34], persistent pneumothorax after chest tube placement and herniation or overdistention of an endotracheal balloon if this is placed at the same level as the tracheal laceration [33]. Tracheal lacerations are usually associated with cervical subcutaneous emphysema. Tracheobronchial injuries in general are accompanied by pneumothorax and pneumomediastinum.\nFig.\xa08Bronchial transection. A 22-year-old man involved in a car accident. Volume-rendered image of the tracheobronchial tree showing complete transection of the right intermediate bronchus (two-way arrow). (Courtesy of Dr Montserrat Bret, University Hospital La Paz, Madrid)'], '13244_2011_72_Fig9_HTML': ['Pneumomediastinum occurs in 10% of patients with blunt chest trauma, with less than 2% caused by blunt tracheobronchial injuries. Other sources of air originate from lung parenchymal injury, oesophageal injury, chest wall, neck and retroperitoneal injury. In a number of patients pneumomediastinum is attributed to the Macklin effect caused by alveolar ruptures that lead to air dissecting along bronchovascular bundles and spreading of the pulmonary interstitial emphysema into the mediastinum. Streaks of air surrounding and paralleling the bronchovascular bundles associated with pneumomediastinum may be observed on CT [35]. Pneumomediastinum may be mistaken for pneumothorax, but the presence of septae within it—delineated on wide lung window—may help in differentiating the two findings, especially if they coexist (Fig.\xa0<xref rid="13244_2011_72_Fig9_HTML" ref-type="fig">9</xref>).\n).\nFig.\xa09Pneumomediastinum. Axial CT images at wide lung window show pneumomediastinum with the presence of septae within the air in the anterior mediastinum (black arrows) (a), and in the middle and posterior mediastinum (black arrows) (b). Note also a right pneumothorax, bilateral lower lobe atelectases and subcutaneous emphysema (a) and a right haemopneumothorax and left pneumothorax (b)'], '13244_2011_72_Fig10_HTML': ['Cardiac injuries are the most lethal in chest trauma patients. They are more common in penetrating trauma, but they can occasionly occur in motor vehicle accidents and from severe blows to the anterior chest wall. Cardiac injury may be difficult to depict acutely in those who survive and should be treated with a high degree of clinical suspicion. It may range from a small focal contusion to a frank rupture of the heart, which is rare (<2%), affecting mainly the right atrium [12]. CT has low sensitivity in detecting cardiac injury and may show haemo-pneumopericardium, cardiac contusion as a hypodense, non-enhancing focal area in the myocardium, contrast medium extravasation in the pericardial sac or the mediastinum, coronary artery laceration or valve injury [36]. Pericardial tears occur extremely rarely (0.11%) and may range from tiny to the entire length of the pericardium. They usually manifest at the diaphragmatic surface of the pericardium on the left side. In cases of a large tear, intrapericardial cardiac herniation may occur, leading to death. Occasionally, there may also be intrapericardial bowel herniation [2]. On CT, the most common findings are haemopericardium (Fig.\xa0<xref rid="13244_2011_72_Fig10_HTML" ref-type="fig">10</xref>) and pneumopericardium (Fig.\xa0) and pneumopericardium (Fig.\xa0<xref rid="13244_2011_72_Fig11_HTML" ref-type="fig">11</xref>).\n).\nFig.\xa010Haemopericardium. Axial contrast-enhanced CT of the lower thorax at mediastinal window shows haemopericardium that may represent an indirect sign of pericardial or heart injury in a polytraumatised patient after a motor vehicle accident. There is also a small right haemothoraxFig.\xa011Pneumopericardium. Axial CT image at lung window shows extensive pneumopericardium (white arrow), pneumomediastinum (black arrows), haemopneumothorax (black dotted arrows), collapsed left lung with ipsilateral shift of the mediastinum and collapse of the right lower lobe'], '13244_2011_72_Fig12_HTML': ['Oesophageal injury is far more common in penetrating or iatrogenic injury and occurs only in 1% of cases of blunt chest trauma. The main mechanisms are a direct blow to the neck mainly affecting the cervical oesophagus, burst-type force or hyperextension injury affecting the distal oesophagus, or rupture by a vertebral body fracture [12]. On CT there will be mainly indirect findings of oesophageal rupture such as pneumomediastinum and peri-oesophageal air or abnormal mediastinal contour secondary to leakage of fluid, haematoma or mediastinitis. Hydropneumothorax is usually seen on the left side. Diagnosis can be confirmed (Fig.\xa0<xref rid="13244_2011_72_Fig12_HTML" ref-type="fig">12</xref>) by water-soluble contrast oesophagography showing leakage of contrast medium into the mediastinal or pleural space [) by water-soluble contrast oesophagography showing leakage of contrast medium into the mediastinal or pleural space [37].\nFig.\xa012Traumatic oesophageal rupture. A 12-year-old boy traumatised during a fall from a tree. Oesophagogram with per os administration of water-soluble contrast medium (a) shows leakage of contrast medium into both pleural spaces. Axial CT image of the thorax at the level of the lung bases (b) verifies the leakage of the contrast medium into the left and right pleural spaces. (Image reproduced from: Arora A, Puri SK, Upreti L, et al (2010). Oesophageal rupture: a rare complication of blunt trauma, {Online}. URL: http://www.eurorad.org/case.php?id=8447)'], '13244_2011_72_Fig13_HTML': ['Aortic injury occurs in 0.5%–2% of all non-lethal MVAs and is responsible for 10–20% of deaths in MVAs. Aortic injuries have a high morbidity and mortality; 90% of the patients die at the trauma scene, while 90% of initial survivors die within 4\xa0months if the injury is undetected and untreated [38]. In the remaining 20% of cases, aortic injury is caused by falls and pedestrian injuries. Mechanisms of injury are variable and may overlap, including rapid deceleration, shearing forces, increased intravascular pressure caused by compression exceeding 2,000\xa0mmHg (the water-hammer effect) or the “osseous pinch”, which represents direct compression of the aorta between the anterior chest wall and the spine [38]. The most common site of injury is the isthmus, corresponding to 90–95% of cases. Uncommon sites include the aortic root-ascending aorta, the aortic arch-branch vessels and the mid-distal descending aorta. The injury may be partial (65%), involving only the intima and media, or transmural (35%), also affecting the adventitia, which is lethal in almost all cases. The injury may be circumferential (45% of cases) or segmental (in 55% of cases), involving either the greater (Fig.\xa0<xref rid="13244_2011_72_Fig13_HTML" ref-type="fig">13</xref>) or the inferior curve (Fig.\xa0) or the inferior curve (Fig.\xa0<xref rid="13244_2011_72_Fig14_HTML" ref-type="fig">14</xref>). CT may show direct and indirect signs. Direct signs include active contrast medium extravasation, dissection (Fig.\xa0). CT may show direct and indirect signs. Direct signs include active contrast medium extravasation, dissection (Fig.\xa0<xref rid="13244_2011_72_Fig15_HTML" ref-type="fig">15</xref>), pseudoaneurysm (Figs.\xa0), pseudoaneurysm (Figs.\xa0<xref rid="13244_2011_72_Fig13_HTML" ref-type="fig">13</xref> and and <xref rid="13244_2011_72_Fig14_HTML" ref-type="fig">14</xref>), intimal tear/flap (Fig.\xa0), intimal tear/flap (Fig.\xa0<xref rid="13244_2011_72_Fig16_HTML" ref-type="fig">16</xref>), thrombus protruding into the lumen (Fig.\xa0), thrombus protruding into the lumen (Fig.\xa0<xref rid="13244_2011_72_Fig17_HTML" ref-type="fig">17</xref>), and abrupt change in calibre (pseudocoarctation). Indirect CT signs are indistinctness of mediastinal flat planes, periaortic haematoma and mediastinal haematoma (Figs.\xa0), and abrupt change in calibre (pseudocoarctation). Indirect CT signs are indistinctness of mediastinal flat planes, periaortic haematoma and mediastinal haematoma (Figs.\xa0<xref rid="13244_2011_72_Fig16_HTML" ref-type="fig">16</xref>––<xref rid="13244_2011_72_Fig18_HTML" ref-type="fig">18</xref>). Mediastinal haematoma is less than 20% predictive of aortic injury. In the absence of aortic injury, mediastinal haematoma may originate from venous injuries. In such cases the fat plane with the aorta is preserved, contrary to thoracic aortic injury, where haematoma develops in close contact with the aortic wall (Fig.\xa0). Mediastinal haematoma is less than 20% predictive of aortic injury. In the absence of aortic injury, mediastinal haematoma may originate from venous injuries. In such cases the fat plane with the aorta is preserved, contrary to thoracic aortic injury, where haematoma develops in close contact with the aortic wall (Fig.\xa0<xref rid="13244_2011_72_Fig16_HTML" ref-type="fig">16</xref>––<xref rid="13244_2011_72_Fig18_HTML" ref-type="fig">18</xref>). Minimal aortic injuries affect only the intima. They are diagnosed with increasing frequency—because of improved MDCT technology—and constitute a diagnostic dilemma [). Minimal aortic injuries affect only the intima. They are diagnosed with increasing frequency—because of improved MDCT technology—and constitute a diagnostic dilemma [39], as most of them remain stable or resolve on follow-up (Fig.\xa0<xref rid="13244_2011_72_Fig18_HTML" ref-type="fig">18</xref>). MDCT has very high sensitivity and specificity, reaching 98% and 100% accordingly for diagnosing aortic trauma. However, in studies where the presence of mediastinal haematoma (an indirect sign of aortic injury) was considered as a positive criterion for aortic injury, a significant number of false-positive diagnoses occurred, and the specificity for aortic injury dropped significantly by up to 62%. Nevertheless, MDCT has become the gold standard for ruling out aortic injury, and in those patients with unequivocal evidence of aortic injury, no further imaging is required [). MDCT has very high sensitivity and specificity, reaching 98% and 100% accordingly for diagnosing aortic trauma. However, in studies where the presence of mediastinal haematoma (an indirect sign of aortic injury) was considered as a positive criterion for aortic injury, a significant number of false-positive diagnoses occurred, and the specificity for aortic injury dropped significantly by up to 62%. Nevertheless, MDCT has become the gold standard for ruling out aortic injury, and in those patients with unequivocal evidence of aortic injury, no further imaging is required [40]. No further workup is indicated if there is no direct evidence of aortic injury and no mediastinal haematoma on CT [38].\nFig.\xa013Traumatic aortic pseudoaneurysm. Sagittal reformatted contrast-enhanced CT image of the thoracic aorta reveals a pseudoaneurysm of the greater curve of the mid-descending thoracic aorta (black arrow)Fig.\xa014Traumatic aortic pseudoaneurysm. Three-dimensional reconstructed CT image of the thoracic aorta shows a pseudoaneurysm of the inferior curve of the thoracic aorta immediately distal to the isthmus (arrow)Fig.\xa015Traumatic aortic dissection. Coronal contrast-enhanced CT reformatted image of the thorax and abdomen shows a traumatic dissection of the ascending thoracic aorta (Stanford type A)Fig.\xa016Axial contrast-enhanced CT image shows thrombus protruding into the lumen of the descending thoracic aorta (black arrows), indicating aortic injury surrounded by periaortic haematoma (white arrow)Fig.\xa017Minimal aortic injury. Coronal MIP CT image of the thorax shows minimal aortic injury at the aortic isthmus (black arrow) involving only the intima, surrounded by periaortic haematomaFig.\xa018Axial contrast-enhanced CT image shows presence of an intimal flap at the aortic arch (black arrow) surrounded by mediastinal haematoma with no preserved fat plane with the aorta (white arrows). Bilateral pleural haemothoraces are also seen'], '13244_2011_72_Fig19_HTML': ['Diaphragmatic injury occurs in 0.16% to 5% of blunt trauma cases, and it is more common in abdominal than in chest trauma. It is three times more common on the left side than on the right side, and the main mechanism is thought to be the sudden increase in intra-abdominal-thoracic pressure against a fixed diaphragm. The most common site of rupture is at the posterolateral surface, at the site of embryonic diaphragmatic fusion. Through the diaphragmatic defect, depending on its size, there may be intrathoracic herniation of intra-abdominal visceral organs, which may be incarcerated, strangulated or perforated. CT findings of diaphragmatic rupture include [41] the diaphragmatic discontinuation and defect, the “collar sign” or “hourglass sign” formed by the waist-like stricture of partial intrathoracic herniation of the stomach or bowel (Fig.\xa0<xref rid="13244_2011_72_Fig19_HTML" ref-type="fig">19</xref>), and the “dependent viscera sign”, which is formed by the posterior fall of the viscera towards and abutting the posterior dependent thoracic wall (with the patient supine) without the support of the intervening diaphragm (Fig.\xa0), and the “dependent viscera sign”, which is formed by the posterior fall of the viscera towards and abutting the posterior dependent thoracic wall (with the patient supine) without the support of the intervening diaphragm (Fig.\xa0<xref rid="13244_2011_72_Fig20_HTML" ref-type="fig">20</xref>). Contrast-enhanced CT may reveal contrast material extravasation at the site of diaphragmatic rupture. Occasionally, there may be only peritoneal fat intrathoracically herniated through the defect (Fig.\xa0). Contrast-enhanced CT may reveal contrast material extravasation at the site of diaphragmatic rupture. Occasionally, there may be only peritoneal fat intrathoracically herniated through the defect (Fig.\xa0<xref rid="13244_2011_72_Fig21_HTML" ref-type="fig">21</xref>). Diaphragmatic injury is usually a delayed diagnosis because of other associated serious injuries that may mask the clinical symptoms. It has a high mortality rate (30%) if it remains unrecognised [). Diaphragmatic injury is usually a delayed diagnosis because of other associated serious injuries that may mask the clinical symptoms. It has a high mortality rate (30%) if it remains unrecognised [42]. The high-resolution coronal and sagittal reformations routinely produced with MDCT—compared with single-spiral CT—allow detection with high sensitivity, even of a small diaphragmatic defect.\nFig.\xa019Dependent viscera sign. Axial contrast-enhanced CT at the level of the lower lobes, at mediastinal window, shows intrathoracic presence of the stomach abutting the left posterior thoracic wall without intervening in the left hemidiaphragm (black arrows)Fig.\xa020The “hourglass” or “collar” sign of diaphragmatic rupture. Reformatted coronal contrast-enhanced CT image of the thorax shows waist-like stricture of the herniated left colon intrathoracically through the small defect of the left hemidiaphragm (black arrows)Fig.\xa021Reformatted coronal contrast-enhanced CT image of the thorax shows intrathoracic herniation of intraperitoneal fat through the large defect of the left hemidiaphragm (white arrows)'], '13244_2011_72_Fig22_HTML': ['Rib fractures are the most common injury in blunt chest trauma, occurring in 50% of cases. A single rib fracture is usually not clinically significant, whereas multiple rib fractures indicate severe injury. Fractures of the first three ribs imply high-energy trauma that may be associated with injury of the brachial plexus or subclavian vessels. Fractures of the fourth up to the eighth ribs are the most common, while fractures of the last four ribs are usually associated with intra-abdominal injury. Reconstructed MIP and volume-rendered CT images depict with great detail the number and sites of rib fractures (Fig.\xa0<xref rid="13244_2011_72_Fig22_HTML" ref-type="fig">22</xref>). Flail chest is a marker of significant intrathoracic injury with increased morbidity, in which three or more contiguous ribs are fractured in two or more sites (Fig.\xa0). Flail chest is a marker of significant intrathoracic injury with increased morbidity, in which three or more contiguous ribs are fractured in two or more sites (Fig.\xa0<xref rid="13244_2011_72_Fig23_HTML" ref-type="fig">23</xref>). The diagnosis is clinical based on the paradoxical motion during respiration, which may result in ventilatory compromise. More than 50% of cases require surgical treatment and prolonged mechanical ventilation [). The diagnosis is clinical based on the paradoxical motion during respiration, which may result in ventilatory compromise. More than 50% of cases require surgical treatment and prolonged mechanical ventilation [9].\nFig.\xa022Coronal MIP CT image showing multiple contiguous left rib fractures (arrows)Fig.\xa023Coronal (a) and sagittal (b) reconstructed CT images show fractures of three contiguous right ribs (arrows) that were associated with paradox motion of the chest during respiration. Flail chest was suspected clinically and verified on imaging'], '13244_2011_72_Fig24_HTML': ['Sternal fractures have a prevalence of 3–8% in blunt chest trauma. The main mechanism is deceleration injury or a direct blow to the anterior chest wall. It is considered a marker of cardiac contusion (1.5%–6%). Sternal fractures are difficult to detect on lateral chest radiographs and even on axial CT images, as opposed to sagittal and coronal MDCT reformats, which have significant superiority (Fig.\xa0<xref rid="13244_2011_72_Fig24_HTML" ref-type="fig">24</xref>). It is almost always accompanied by anterior mediastinal haemorrhage, which has a preserved fat plane with the aorta (Fig.\xa0). It is almost always accompanied by anterior mediastinal haemorrhage, which has a preserved fat plane with the aorta (Fig.\xa0<xref rid="13244_2011_72_Fig25_HTML" ref-type="fig">25</xref>), as opposed to an anterior mediastinal haemorrhage secondary to aortic injury, which will present with a lost fat plane with the aorta [), as opposed to an anterior mediastinal haemorrhage secondary to aortic injury, which will present with a lost fat plane with the aorta [17].\nFig.\xa024Sternal fracture. Sagittal reconstructed CT image shows multiple fractures of the manubrium and the body of the sternum (white arrows) accompanied by extensive retrosternal haematoma (black ball arrows). Note also fracture of a thoracic vertebra (black arrow)Fig.\xa025Sternal fracture. Axial CT image at mediastinal window shows sternal fracture associated with retrosternal haematoma (black arrow). Note the preserved fat plane with the aorta, excluding the presence of aortic injury (white arrows)'], '13244_2011_72_Fig26_HTML': ['Sternoclavicular dislocation is rare and occurs in 1–3% of all types of dislocation. Anterior sternoclavicular dislocation is more common and easily detectable, as it is palpable (Fig.\xa0<xref rid="13244_2011_72_Fig26_HTML" ref-type="fig">26</xref>). It usually has a benign course, but it implies a high-energy trauma and may be associated with haemopneumothorax, rib fractures or pulmonary contusion [). It usually has a benign course, but it implies a high-energy trauma and may be associated with haemopneumothorax, rib fractures or pulmonary contusion [43]. Posterior sternoclavicular dislocation is clinically and radiographically silent and carries serious morbidity, as it is associated with injuries of the mediastinal vessels, nerves, trachea and oesophagus (Fig.\xa0<xref rid="13244_2011_72_Fig27_HTML" ref-type="fig">27</xref>).\n).\nFig.\xa026Anterior sternoclavicular dislocation. Axial CT image shows clavicular fracture and anterior sternoclavicular dislocation (dotted arrows)Fig.\xa027Posterior sternoclavicular dislocation. Axial CT image shows posterior sternoclavicular dislocation (black arrow) associated with compression of the left innominate vein (black dotted arrow)'], '13244_2011_72_Fig28_HTML': ['Scapular fracture is uncommon, occurring in 3.7% of cases of blunt chest trauma. It is easily detected on initial radiographs and may be masked clinically by other associated serious injuries (Fig.\xa0<xref rid="13244_2011_72_Fig28_HTML" ref-type="fig">28</xref>). It indicates a high-energy force trauma with a direct blow to the scapula or force transmitted through the humerus. Associated injuries are pneumothorax, haemothorax, clavicular fracture and injuries of the lung parenchyma, subclavian vessels, brachial plexus or spine [). It indicates a high-energy force trauma with a direct blow to the scapula or force transmitted through the humerus. Associated injuries are pneumothorax, haemothorax, clavicular fracture and injuries of the lung parenchyma, subclavian vessels, brachial plexus or spine [44].\nFig.\xa028Scapular fracture. Sagittal reconstructed CT image shows multiple fractures of the left scapula (arrows)'], '13244_2011_72_Fig29_HTML': ['Thoracic spine fractures account for up to 30% of all spine fractures. Sixty-two percent of spine fractures will result in neurological deficits. The most vulnerable site is between the ninth and twelfth vertebra. The main mechanism is hyperflexion and axial loading. Plain radiographs may miss fractures of the spine and therefore may be unnecessary in those patients scheduled for CT [45]. Sagittal and coronal MDCT reformats (Fig.\xa0<xref rid="13244_2011_72_Fig29_HTML" ref-type="fig">29</xref>) readily reveal even small spinal fractures, whereas volume-rendered images are not helpful [) readily reveal even small spinal fractures, whereas volume-rendered images are not helpful [12]. MDCT of the spine is highly indicated for spinal survey for possible fractures. However, in the case of suspected compressive myelopathy, MRI is the method of choice (Fig.\xa0<xref rid="13244_2011_72_Fig30_HTML" ref-type="fig">30</xref>).\n).\nFig.\xa029Thoracic spine fracture. Coronal (a) and sagittal (b) CT reconstructed images of two different patients show fractures of the upper thoracic vertebrae with great detailFig.\xa030Thoracic spine fracture and compressive myelopathy. Sagittal T2-weighted MRI of the cervicothoracic spine undertaken 1\xa0week after a motor vehicle accident verifies the presence of extensive compressive myelopathy (between the two white arrows with black outline) due to fractures of the second and the third thoracic vertebrae (white arrows)']} | CT imaging of blunt chest trauma | [
"Blunt trauma",
"Lungs",
"CT"
] | Insights Imaging | 1297411200 | PURPOSE: The objective of this study was to describe the sonographic features of deep-seated lipomas. METHODS: A retrospective review of the sonographic features of 64 deep seated lipomas in 64 patients (43 females, 21 males, mean age 46.5, range 16-77 years) seen over an 8-year period (1998-2006) was undertaken. RESULTS: Features evaluated were location, size, shape, marginal definition, internal echogenicity, including the presence of intermingled muscle fibres and linear internal echoes, acoustic transmission and vascularity. Confirmation was histological in 37 (58%) cases and by typical magnetic resonance imaging (MRI) appearance in 27 (42%) cases. CONCLUSION: The results show that although the features of deep-seated lipoma are more variable than those reported for subcutaneous lipomas, the presence of thin internal echoes in conjunction with other less specific features should enable a correct diagnosis. | [] | other | PMC3259405 | null | 18 | [
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] | Insights Imaging. 2011 Feb 11; 2(3):281-295 | NO-CC CODE |
|
Mid-sagittal plane turbo spin echo (TSE) image (a) (1.5 T) demonstrating lower part of the external sphincter merging toward the midline (arrows). The close-up TSE image (b) shows the anal verge (white line) | 13244_2010_37_Fig1_HTML | 7 | 6599187c2166dbfb9a220c1e9ab16b62a364601d50cad5c0de1e45367f026bb8 | 13244_2010_37_Fig1_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
761,
453
] | [{'image_id': '13244_2010_37_Fig9_HTML', 'image_file_name': '13244_2010_37_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig9_HTML.jpg', 'caption': 'Tumour (solid arrow) in the upper rectum shown on traditional TSE on sagittal plane (a) and thin-slice 3D T2-weighted sagittal image (b) both on 3\xa0T MRI. The anterior lymph node (hatched) is more clearly depicted on the thinner slice (1\xa0mm). Additionally, one can see that this node is irregular in contour and involves the peritoneum (dotted arrows) behind the uterus', 'hash': 'f74b22a2a9618d90a68eae3ebef0cb79459232d10bf56f0caefaeec7a7b8ccb9'}, {'image_id': '13244_2010_37_Fig6_HTML', 'image_file_name': '13244_2010_37_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig6_HTML.jpg', 'caption': 'Axial (a) and sagittal (b) plane reformatted images from original sagittal three-dimensional (3D) T2-weighted images (3\xa0T) show a rectal cancer (white arrow) growing into an adjacent small bowel loop', 'hash': 'e2c1e2d59b8c06a48af0e2105463f78c046e02d59b5f1bce3d66a827508406d0'}, {'image_id': '13244_2010_37_Fig11_HTML', 'image_file_name': '13244_2010_37_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig11_HTML.jpg', 'caption': 'Coronal images of two low rectal tumours. In one case (a, reformatted from original sagittal 3D T2-weighted image, 3\xa0T), the tumour obliterates the intervening fat (black arrow) between the pelvic floor and the rectal lumen. In the other case (b, TSE image, 1.5\xa0T), the intervening fat is preserved (white arrow)', 'hash': '05cc661e1fb550adc77c3049c586b9d8f5c3b66646e1231209ee019b25f3873d'}, {'image_id': '13244_2010_37_Fig1_HTML', 'image_file_name': '13244_2010_37_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig1_HTML.jpg', 'caption': 'Mid-sagittal plane turbo spin echo (TSE) image (a) (1.5\xa0T) demonstrating lower part of the external sphincter merging toward the midline (arrows). The close-up TSE image (b) shows the anal verge (white line)', 'hash': '6599187c2166dbfb9a220c1e9ab16b62a364601d50cad5c0de1e45367f026bb8'}, {'image_id': '13244_2010_37_Fig19_HTML', 'image_file_name': '13244_2010_37_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig19_HTML.jpg', 'caption': 'Axial (a) and parasagittal (b) TSE images (1.5\xa0T) of a tumour recurrence (arrows). The tumour is an expansive mass located asymmetrically in front of the sacrum, lying against the piriformis muscle (black arrow) and the pelvic floor dorsally (dotted arrow)', 'hash': '7d1c0fe18c1f45294edd1aacf1c75ce3a32c8bc0d6850365aedeef056b3007c4'}, {'image_id': '13244_2010_37_Fig16_HTML', 'image_file_name': '13244_2010_37_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig16_HTML.jpg', 'caption': 'Extensive large tumour (white arrow) on sagittal TSE (a) and axial TSE (b) images (1.5\xa0T). The tumour extends to several important structures (dotted arrows). After neo-adjuvant treatment, on TSE imaging (c, d) the tumor has shrunk considerably. The extension to nearby structures remains unaltered on the TSE image. Surgery therefore cannot be limited based on imaging after neo-adjuvant therapy', 'hash': '7add38f3c1f7f53f518b4c540d1bdba600a93b09e91824b73555f26025446fd6'}, {'image_id': '13244_2010_37_Fig20_HTML', 'image_file_name': '13244_2010_37_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig20_HTML.jpg', 'caption': 'Axial images (1.5\xa0T) with T2-weighted image with fat saturation (a), and T1-weighted image after contrast enhancement with fat saturation (b). The tumour is barely visible in a, and more clearly in b. Axial high-resolution TSE, however, depicts the tumour best, also showing its growth pattern and relation to neighbouring structures', 'hash': 'e286099cceacb303f0aa0b9a74a69e2d21770f4b01b961d113a238b2a56e9a4b'}, {'image_id': '13244_2010_37_Fig10_HTML', 'image_file_name': '13244_2010_37_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig10_HTML.jpg', 'caption': 'Axial TSE images (1.5\xa0T) of a rectal cancer originating from the right rectal wall (white arrow). There is a malignant lymph node (black arrow) in the obturator fossa on the left side. The cause of the malignant lymph node is the prostate cancer (dotted arrow)', 'hash': '62a6b85b6a9b0e0a820cbc8f8a7d8bb7252361385bc470935eeba512d57e5e9e'}, {'image_id': '13244_2010_37_Fig7_HTML', 'image_file_name': '13244_2010_37_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig7_HTML.jpg', 'caption': 'Semi-coronal plane TSE image (1.5\xa0T) showing tumour (solid arrow) growing along the side mesorectal fascia (dotted arrow)', 'hash': 'ae1dddb073a9c38c7e8c8cf1ef8e70e703db655d1efd665fd919c210d3816e08'}, {'image_id': '13244_2010_37_Fig8_HTML', 'image_file_name': '13244_2010_37_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig8_HTML.jpg', 'caption': 'Axial (a) and semi-axial (b) TSE images (1.5\xa0T) of a mucin-producing tumour. The first image (a) with higher TE (120\xa0ms) produces a stark contrast between fluid/mucin (stars) and fat. Both the urine in the urinary bladder (large star) and the tumour mucin (small star) have higher signal than the surrounding fat. The urinary bladder was emptied and the patient imaged with lower TE (80\xa0ms). There is very little contrast between mucin and fat, or between urine and fat', 'hash': '530f86deb2960573512cce877e24b915b097e3dd60041cc5ccf28852c9b8deb5'}, {'image_id': '13244_2010_37_Fig17_HTML', 'image_file_name': '13244_2010_37_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig17_HTML.jpg', 'caption': 'Axial TSE images (1.5\xa0T) of a large tumour (white solid arrow) before (a) and after (b) neo-adjuvant therapy. The tumour has shrunk tremendously, yet the extension to the uterus (dotted white arrow), the fasciae (black solid arrows) and the small intestine (dotted black arrows) are visible in the form of low-signal bands. The bands are composed of fibrosis, yet based on MRI, it is difficult to negate remaining tumour in the fibrotic strands', 'hash': '2db6206ab29c4829cdfc95a941681a87fd31cf0fa1324ac68d28297c8c39f380'}, {'image_id': '13244_2010_37_Fig18_HTML', 'image_file_name': '13244_2010_37_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig18_HTML.jpg', 'caption': 'Axial (a), sagittal (b) and axial (c) TSE images (1.5\xa0T) of a rectosigmoid cancer after neoadjuvant therapy. There is remaining thickening of the peritoneal reflection (white arrows) and low signal infiltration (black arrows) in the perirectal fat. No tumour signal has returned. The tumour was a T1 at histopathology', 'hash': '1949d242a28b7f559294f2fa8de1cead5ea3b82c797c140c01ccb75e0e2d0836'}, {'image_id': '13244_2010_37_Fig14_HTML', 'image_file_name': '13244_2010_37_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig14_HTML.jpg', 'caption': 'Value of imaging in other planes. The axial TSE image (1.5\xa0T) (a) shows a tumour that might be interpreted as a small T3. The coronal TSE image, however, shows no extramural tumour growth. The tumour was a T2 at histopathology', 'hash': '52984df8d72f29d380f71aa0e19b473bc79bdfdf9ab28e89e6f2a5bca9f56380'}, {'image_id': '13244_2010_37_Fig3_HTML', 'image_file_name': '13244_2010_37_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig3_HTML.jpg', 'caption': 'Axial TSE image (a) (1.5\xa0T) shows separation of the mesorectal fascia (white solid arrow), otherwise known as the perirectal visceral fascia, from the parietal pelvic fascia (dotted arrow). This is due to tumour in the upper portion of the uterosacral ligament (black arrow) shown on the higher axial TSE image (b)', 'hash': 'defdf9e01564bbd941670c9952dcb0e3824bb6cb629adc24d240030008b779ce'}, {'image_id': '13244_2010_37_Fig13_HTML', 'image_file_name': '13244_2010_37_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig13_HTML.jpg', 'caption': 'Measurement of extramural tumour growth is dependent on the plane of imaging. True transverse TSE (a, 3\xa0T) image shows the extramural tumour growth to be 9\xa0mm (white line). Reformatted image from original 3D T2-weighted images with plane reconstructed perpendicular to the rectal wall (b, 3\xa0T) shows that the extramural tumour component can be 20\xa0mm (dotted line)', 'hash': 'eee423afa8469bff845bc1a7a57093be790d2137d6289e787509cb6f007746db'}, {'image_id': '13244_2010_37_Fig4_HTML', 'image_file_name': '13244_2010_37_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig4_HTML.jpg', 'caption': 'Axial TSE image (1.5\xa0T) of the pelvis at the level of a mid-rectal cancer. The intact muscularis propria is seen as a thin dark band on the left side where no tumour is present (solid arrow). The mesorectal fascia is also marked by the dotted arrows. Both the muscularis propria and the mesorectal fascia are visible as a thin low-signal layer and line, respectively. However the imaging plane should meet these structures perpendicularly for optimal demonstration', 'hash': '10b2ca6bbfbd1d491d78b0c89a2d7c66ae22d9f7d2a05689410fd67fa7362650'}, {'image_id': '13244_2010_37_Fig2_HTML', 'image_file_name': '13244_2010_37_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig2_HTML.jpg', 'caption': 'TSE image (1.5\xa0T) demonstrates alternating protruding mucosa and impressions corresponding to anal columns (white arrows)', 'hash': '5a97fd36b0c6561fd44fef41e8758740cab1a3ca813bfbdfa124cf2d14cd91e8'}, {'image_id': '13244_2010_37_Fig15_HTML', 'image_file_name': '13244_2010_37_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig15_HTML.jpg', 'caption': 'Mucin-producing tumours are particularly difficult to evaluate after neo-adjuvant treatment. The difference between sagittal TSE images before (a) and after treatment (b) (1.5\xa0T) can only be seen in findings such as mucosal oedema of the lower rectum (white arrow), and presacral oedema (black arrow). The tumour itself and it extension outside the rectum (hatched arrows) are virtually unchanged', 'hash': '72eaaeef2ae8cf479c00db97be235e8c41025c2e2c560ab21d39a6b8077fba02'}, {'image_id': '13244_2010_37_Fig5_HTML', 'image_file_name': '13244_2010_37_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig5_HTML.jpg', 'caption': 'True transversal TSE image of the pelvis (a) (1.5\xa0T) demonstrates a small tumour (arrow). High-resolution TSE image with thin slice (3\xa0mm) perpendicular to the muscular wall (black arrow) shows a T1 tumour (b)', 'hash': '612f06dad6eebaa2e30b46dbaa57c17239fd42a158db1dacd607ad53dd572801'}, {'image_id': '13244_2010_37_Fig12_HTML', 'image_file_name': '13244_2010_37_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig12_HTML.jpg', 'caption': 'Sagittal plane TSE image (3\xa0T) showing rectal tumour with intravascular growth (arrow). The vessel is expanded, irregular, showing tumour signal and is close to the tumour', 'hash': '089c3279056a0d8d65c9aa8a989f5a184bdc20882e52c379548dfd7e06ff75d8'}] | {'13244_2010_37_Fig1_HTML': ['The anal verge marks the lowermost portion of the anal canal and begins where the skin stops and where the anal mucosa (anoderm) starts [21]. The anal verge is best recognised in the sagittal plane (Fig.\xa0<xref rid="13244_2010_37_Fig1_HTML" ref-type="fig">1</xref>). It can be recognised as the lowermost portion of the anal sphincter complex. This can, however, be different on MRI compared with when the patient is examined by a surgeon who separates the buttocks.\n). It can be recognised as the lowermost portion of the anal sphincter complex. This can, however, be different on MRI compared with when the patient is examined by a surgeon who separates the buttocks.\nFig.\xa01Mid-sagittal plane turbo spin echo (TSE) image (a) (1.5\xa0T) demonstrating lower part of the external sphincter merging toward the midline (arrows). The close-up TSE image (b) shows the anal verge (white line)'], '13244_2010_37_Fig2_HTML': ['The dentate line is located about 1.5-2\xa0cm upwards from the anal verge. The dentate line is not visible on MRI, but occasionally the anal columns can be seen, the lowermost portion of which corresponds to the dentate line (Fig.\xa0<xref rid="13244_2010_37_Fig2_HTML" ref-type="fig">2</xref>) [) [22]. The dentate line corresponds approximately to the upper portion of the external sphincter muscle, which can be inferred on coronally oriented MRI.\nFig.\xa02TSE image (1.5\xa0T) demonstrates alternating protruding mucosa and impressions corresponding to anal columns (white arrows)'], '13244_2010_37_Fig3_HTML': ['Surrounding the rectum, there is a layer of fat, the perirectal or the mesorectal fat. There is less fat anterior and caudal to the rectum than to the other sides [24]. The amount of perirectal fat is larger in men and correlates with the visceral compartment area, but not the body’s cross-sectional area, body mass index or age [25]. Although the total amount of fat has not been shown to influence the accuracy of tumour staging [26], it is conceivable that the small distance between structures ventral to the rectum can make analysis of tumour growth assessment ventrally difficult [27]. The perirectal fat is often referred to as “mesorectum”. The mesorectum is carpeted behind and laterally by a postero-lateral fibrous envelope belonging to the pelvic visceral fascia and ventrally by a recto-genital membrane of variable nature corresponding to “Denonvilliers’ fascia” [28]. Denonvilliers’ fascia covers the dorsal aspect of the prostate and seminal vesicles in men [29]. This fascia is fused to the mesorectal fascia as it concerns MRI. The mesorectal or perirectal visceral fascia (Fig.\xa0<xref rid="13244_2010_37_Fig3_HTML" ref-type="fig">3</xref>) has gained great importance as it pertains to rectal cancer surgery when ) has gained great importance as it pertains to rectal cancer surgery when total mesorectal excision (TME) was introduced. Tumours located close to this fascia are considered to threaten the fascia [30]. What constitutes a safe distance is, however, not ascertained. A distance <1\xa0mm is definitely associated with risk of involvement of the surgical circumferential resection margin (CRM). Distance <2-5\xa0mm has also been suggested as indicative of a threatened margin with a greater risk of recurrence. Obviously, the larger the safe margin the less likelihood of false-negative results, however at the expense of low specificity. Also, adopting a larger safe margin would lead to classifying most anterior and low tumours as potentially threatening the fascia. At most centres, 1\xa0mm is considered the safe distance. Care should be exercised not to confuse the CRM and mesorectal fascia with one another. CRM is a surgical term and can be intentionally or inadvertently inside or outside the mesorectal fascia.\nFig.\xa03Axial TSE image (a) (1.5\xa0T) shows separation of the mesorectal fascia (white solid arrow), otherwise known as the perirectal visceral fascia, from the parietal pelvic fascia (dotted arrow). This is due to tumour in the upper portion of the uterosacral ligament (black arrow) shown on the higher axial TSE image (b)'], '13244_2010_37_Fig4_HTML': ['T-staging is based on the tumour relationship to the muscularis propria layer, and invasion of neighbouring organs. The muscularis propria is demonstrated as a thin lower signal layer surrounding the rectum (Fig.\xa0<xref rid="13244_2010_37_Fig4_HTML" ref-type="fig">4</xref>).\n).\nFig.\xa04Axial TSE image (1.5\xa0T) of the pelvis at the level of a mid-rectal cancer. The intact muscularis propria is seen as a thin dark band on the left side where no tumour is present (solid arrow). The mesorectal fascia is also marked by the dotted arrows. Both the muscularis propria and the mesorectal fascia are visible as a thin low-signal layer and line, respectively. However the imaging plane should meet these structures perpendicularly for optimal demonstration'], '13244_2010_37_Fig5_HTML': ['T1: submucosal tumour only (Fig.\xa0<xref rid="13244_2010_37_Fig5_HTML" ref-type="fig">5</xref>))'], '13244_2010_37_Fig6_HTML': ['T4: growth into neighbouring organs, or perforation (Fig.\xa0<xref rid="13244_2010_37_Fig6_HTML" ref-type="fig">6</xref>)\n)\n(a) Other organs, excluding peritoneum(b) Peritoneum (T4 a and T4b are reversed in TNM versions 6 and 7)'], '13244_2010_37_Fig7_HTML': ['Small tumour spiculations can contain tumour cells. Tumours have a tendency to grow along fasciae and nerves stretching to other structures not primarily close to the tumour (Fig.\xa0<xref rid="13244_2010_37_Fig7_HTML" ref-type="fig">7</xref>). Tumours with high mucin content can also cause problems. Occasionally, mucin fills out and replaces the whole mesorectal fat. On T2 weighted imaging, especially with ). Tumours with high mucin content can also cause problems. Occasionally, mucin fills out and replaces the whole mesorectal fat. On T2 weighted imaging, especially with shorter echo time (TE), the contrast between the fluid-like signal of the mucin and fat could be lost (Fig.\xa0<xref rid="13244_2010_37_Fig8_HTML" ref-type="fig">8</xref>). In our experience, T1-weighted imaging, simultaneous CT or great experience of the radiologist can overcome this problem. Another solution could be higher TE with TSE images, which leads to larger T2 weighting and thus makes mucin appear brighter than fat (Fig.\xa0). In our experience, T1-weighted imaging, simultaneous CT or great experience of the radiologist can overcome this problem. Another solution could be higher TE with TSE images, which leads to larger T2 weighting and thus makes mucin appear brighter than fat (Fig.\xa0<xref rid="13244_2010_37_Fig8_HTML" ref-type="fig">8</xref>). It is, therefore, wise to have one plane of imaging with higher TE.\n). It is, therefore, wise to have one plane of imaging with higher TE.\nFig.\xa07Semi-coronal plane TSE image (1.5\xa0T) showing tumour (solid arrow) growing along the side mesorectal fascia (dotted arrow)Fig.\xa08Axial (a) and semi-axial (b) TSE images (1.5\xa0T) of a mucin-producing tumour. The first image (a) with higher TE (120\xa0ms) produces a stark contrast between fluid/mucin (stars) and fat. Both the urine in the urinary bladder (large star) and the tumour mucin (small star) have higher signal than the surrounding fat. The urinary bladder was emptied and the patient imaged with lower TE (80\xa0ms). There is very little contrast between mucin and fat, or between urine and fat'], '13244_2010_37_Fig9_HTML': ['New hope is emerging for ultra-thin T2-weighted imaging (Fig.\xa0<xref rid="13244_2010_37_Fig9_HTML" ref-type="fig">9</xref>). Studies using this method are ongoing at our centre with initial promising results. The basis of this method is basically the same as above regarding lymph node morphology. We have been able to assess even smaller nodes using the same criteria and find malignant nodes with more confidence. It is not known if the diagnostic accuracy regarding N-staging will significantly increase.\n). Studies using this method are ongoing at our centre with initial promising results. The basis of this method is basically the same as above regarding lymph node morphology. We have been able to assess even smaller nodes using the same criteria and find malignant nodes with more confidence. It is not known if the diagnostic accuracy regarding N-staging will significantly increase.\nFig.\xa09Tumour (solid arrow) in the upper rectum shown on traditional TSE on sagittal plane (a) and thin-slice 3D T2-weighted sagittal image (b) both on 3\xa0T MRI. The anterior lymph node (hatched) is more clearly depicted on the thinner slice (1\xa0mm). Additionally, one can see that this node is irregular in contour and involves the peritoneum (dotted arrows) behind the uterus'], '13244_2010_37_Fig10_HTML': ['There is some controversy regarding how to handle metastatic lymph nodes in the pelvic side walls. In Japan, removal of these nodes is considered essential in the curative treatment of selected patients, whereas in Western Europe these sites are covered by radiation. In Western Europe, involved nodes are generally considered as signs of distant metastatic disease [59–61], at least in tumours above the peritoneal recess. Not infrequently, we see malignant lateral pelvic lymph nodes clearly along the drainage of the middle rectal and obturator vessels. Malignancy in the lateral pelvic nodes in the absence of a low locally advanced rectal cancer should lead to a search for other malignancies (e.g. prostate, Fig.\xa0<xref rid="13244_2010_37_Fig10_HTML" ref-type="fig">10</xref>).\n).\nFig.\xa010Axial TSE images (1.5\xa0T) of a rectal cancer originating from the right rectal wall (white arrow). There is a malignant lymph node (black arrow) in the obturator fossa on the left side. The cause of the malignant lymph node is the prostate cancer (dotted arrow)'], '13244_2010_37_Fig11_HTML': ['A tumour that begins within 5-6\xa0cm of the anal verge is considered a low rectal cancer and is associated with a higher risk of recurrence [39, 63]. Low rectal tumours can be difficult to assess on MRI and, therefore, a novel staging system for these tumours is suggested (Fig.\xa0<xref rid="13244_2010_37_Fig11_HTML" ref-type="fig">11</xref>) [) [64]. This classification is based on the fact that tumours growing into or beyond the intersphincteric plane on MRI have a higher likelihood of positive CRM even after preoperative treatment [65]. The more simplified approach could improve reproducibility.\nFig.\xa011Coronal images of two low rectal tumours. In one case (a, reformatted from original sagittal 3D T2-weighted image, 3\xa0T), the tumour obliterates the intervening fat (black arrow) between the pelvic floor and the rectal lumen. In the other case (b, TSE image, 1.5\xa0T), the intervening fat is preserved (white arrow)'], '13244_2010_37_Fig12_HTML': ['Intravascular extension is, however, easier for the radiologist to diagnose (Fig.\xa0<xref rid="13244_2010_37_Fig12_HTML" ref-type="fig">12</xref>). Tumours usually grow along vessels. However, this ). Tumours usually grow along vessels. However, this perivascular growth is not always equal to intravascular growth. A new system has been proposed for the assessment of intravascular growth [67, 68]. According to this scoring system for intravascular growth assessment, the more signs present the higher likelihood of intravascular growth. These signs are nodular growth at the site of extramural growth, vessel in proximity to the tumour, vascular enlargement and vessel signal heterogeneity. The authors of the mentioned studies have found that when more than two signs are present, the prognosis is similar to when tumours have intravascular growth histopathologically.\nFig.\xa012Sagittal plane TSE image (3\xa0T) showing rectal tumour with intravascular growth (arrow). The vessel is expanded, irregular, showing tumour signal and is close to the tumour'], '13244_2010_37_Fig13_HTML': ['The MERCURY study [14] showed that MRI provides a non-biased estimation of EMD, the latter being an important prognostic factor [69]. The 95% range of over- and underestimation of EMD was about 4-5\xa0mm compared with histopathology [70, 71]. It is possible that the figure of 4 mm is a reflection of slice thickness [72]. Another smaller study has also demonstrated good correspondence between histopathology and MRI for measurement of EMD (Fig.\xa0<xref rid="13244_2010_37_Fig13_HTML" ref-type="fig">13</xref>) [) [73].\nFig.\xa013Measurement of extramural tumour growth is dependent on the plane of imaging. True transverse TSE (a, 3\xa0T) image shows the extramural tumour growth to be 9\xa0mm (white line). Reformatted image from original 3D T2-weighted images with plane reconstructed perpendicular to the rectal wall (b, 3\xa0T) shows that the extramural tumour component can be 20\xa0mm (dotted line)'], '13244_2010_37_Fig14_HTML': ['The basis for local assessment of rectal cancer is T2-weighted imaging with turbo spin echo (TSE) [75]. This imaging should be performed in appropriate planes (Fig.\xa0<xref rid="13244_2010_37_Fig14_HTML" ref-type="fig">14</xref>). There is, however, no consensus about what are the essential planes, yet two requirements should be fulfilled: wherever distinction among T1, T2 and minimal T3 is important the imaging should preferably be perpendicular to the rectal wall, and whenever growth into neighbouring organs/tissues is not certain the imaging plane should be such as to show the smallest intervening fat (Table\xa0). There is, however, no consensus about what are the essential planes, yet two requirements should be fulfilled: wherever distinction among T1, T2 and minimal T3 is important the imaging should preferably be perpendicular to the rectal wall, and whenever growth into neighbouring organs/tissues is not certain the imaging plane should be such as to show the smallest intervening fat (Table\xa01).\nFig.\xa014Value of imaging in other planes. The axial TSE image (1.5\xa0T) (a) shows a tumour that might be interpreted as a small T3. The coronal TSE image, however, shows no extramural tumour growth. The tumour was a T2 at histopathologyTable\xa01Different imaging planesPlaneAdvantageDisadvantageUsageSagittal (orthogonal)Easy for measuring tumor height and length. Best for assessment of involvement of midline organs and structuresStructures slightly lateral to midline not easily assessed especially in female patientsEasily reproducible. RecommendedAxial (orthogonal)Easily recognizable by clinicians. Easy for comparison with MRI or other imaging modalities, especially comparison of lymph nodes. Often best view of inguinal lymph nodesDue to funnel-shaped form of pelvic floor and anterior curve of rectosigmoid, not enough for adequate detailed analysis in many casesEasily reproducible. RecommendedCoronal orthogonalNoneTakes time of more important imagesNot recommendedSemi-coronally parallel to anal canalVisually informative for surgeons in low rectal tumorsCan be the same as perpendicular to pelvic floorNot essentialPerpendicular to rectal wallProvides best differential of T1, T2 and minimal T3. Has to be repeated at all areas where distinction between T3 and T1-2 is importantNeeds either capable technicians or presence of radiologists at the time of imagingEssentialPerpendicular to anterior mesorectal fasciaFor anterior tumors or tumors with anterior component, especially in female subjectsSometimes not necessary in cases of obvious tumor growth into anterior structuresImportant in selected casesPerpendicular to pelvic floorFor tumors growing dorsally and laterally close to pelvic floor. Can provide coverage of mesorectal lymph nodesNot necessary in all casesImportant in selected casesPerpendicular to anal canalMost important plane for low tumors at the level of pelvic floor or lower downNot essential for tumors completely above the pelvic floorNot essential for tumors completely above the pelvic floor'], '13244_2010_37_Fig15_HTML': ['Most radiological studies have concentrated on the correlation between MRI2 and histopathology and have shown moderate correlation varying between 67 and 84% [106–109], being worst for mucin-producing tumours (Fig.\xa0<xref rid="13244_2010_37_Fig15_HTML" ref-type="fig">15</xref>). The basis of most of these has been tumour volume measurements [). The basis of most of these has been tumour volume measurements [110, 111].\nFig.\xa015Mucin-producing tumours are particularly difficult to evaluate after neo-adjuvant treatment. The difference between sagittal TSE images before (a) and after treatment (b) (1.5\xa0T) can only be seen in findings such as mucosal oedema of the lower rectum (white arrow), and presacral oedema (black arrow). The tumour itself and it extension outside the rectum (hatched arrows) are virtually unchanged'], '13244_2010_37_Fig16_HTML': ['Aim 2, treatment modification: if a tumour responds in such a way that surgical treatment can be altered or in practice is less extensive than primarily decided upon based on MRI1, then MRI2 is indicated (Figs.\xa0<xref rid="13244_2010_37_Fig16_HTML" ref-type="fig">16</xref>, , <xref rid="13244_2010_37_Fig17_HTML" ref-type="fig">17</xref>). The surgical treatment for pretreated rectal cancer can be:\n). The surgical treatment for pretreated rectal cancer can be:\nNo surgeryLocal excisionStandard TMEExtended TMEFig.\xa016Extensive large tumour (white arrow) on sagittal TSE (a) and axial TSE (b) images (1.5\xa0T). The tumour extends to several important structures (dotted arrows). After neo-adjuvant treatment, on TSE imaging (c, d) the tumor has shrunk considerably. The extension to nearby structures remains unaltered on the TSE image. Surgery therefore cannot be limited based on imaging after neo-adjuvant therapyFig.\xa017Axial TSE images (1.5\xa0T) of a large tumour (white solid arrow) before (a) and after (b) neo-adjuvant therapy. The tumour has shrunk tremendously, yet the extension to the uterus (dotted white arrow), the fasciae (black solid arrows) and the small intestine (dotted black arrows) are visible in the form of low-signal bands. The bands are composed of fibrosis, yet based on MRI, it is difficult to negate remaining tumour in the fibrotic strands'], '13244_2010_37_Fig18_HTML': ['In one study of restaging irradiated tumours, MRI2 had an accuracy of 52% in T-staging and 68% in N-staging. Poor agreement between post-combined chemo-radiotherapy MRI2 and pathological staging was observed in both T- (k\u2009=\u20090.017) and N-staging (k = 0.031). Most of the inaccuracy in T- and N-staging is caused by over-staging [123]. The problem with MRI is believed to be that it cannot completely differentiate fibrosis from viable residual tumours. Though fibrosis shows lower signal than tumour on T2-weighted imaging, there is still considerable overlap between normal viable tumour tissue and fibrosis (Fig.\xa0<xref rid="13244_2010_37_Fig18_HTML" ref-type="fig">18</xref>) [) [124]. In a recent retrospective study [111], the authors used a combination of tumour volume reduction rate and original tumour volume to predict ypT0-2 in 67 patients. They found that with an initial tumour volume of ≤50\xa0cm3 at MRI1 and a reduction rate ≥75%, the excised tumour was always ypT0-2. Figures\xa0<xref rid="13244_2010_37_Fig17_HTML" ref-type="fig">17</xref> and and <xref rid="13244_2010_37_Fig18_HTML" ref-type="fig">18</xref> both demonstrate these cases. Tiny strands and smooth slight thickening of fascia with very low signal on T2-weighted imaging are most commonly associated with absence of tumour at histopathology.\n both demonstrate these cases. Tiny strands and smooth slight thickening of fascia with very low signal on T2-weighted imaging are most commonly associated with absence of tumour at histopathology.\nFig.\xa018Axial (a), sagittal (b) and axial (c) TSE images (1.5\xa0T) of a rectosigmoid cancer after neoadjuvant therapy. There is remaining thickening of the peritoneal reflection (white arrows) and low signal infiltration (black arrows) in the perirectal fat. No tumour signal has returned. The tumour was a T1 at histopathology'], '13244_2010_37_Fig19_HTML': ['The local recurrence rate has decreased greatly. In the post-TME era, most recurrences occur at the anastomotic site, presacrally or at the level of the pelvic floor, with very few at the lateral pelvic side walls in the European material (Fig.\xa0<xref rid="13244_2010_37_Fig19_HTML" ref-type="fig">19</xref>) [) [133, 134]. The best sequence for imaging is TSE, although contrast enhancement can be useful at times (Fig.\xa0<xref rid="13244_2010_37_Fig20_HTML" ref-type="fig">20</xref>).\n).\nFig.\xa019Axial (a) and parasagittal (b) TSE images (1.5\xa0T) of a tumour recurrence (arrows). The tumour is an expansive mass located asymmetrically in front of the sacrum, lying against the piriformis muscle (black arrow) and the pelvic floor dorsally (dotted arrow)Fig.\xa020Axial images (1.5\xa0T) with T2-weighted image with fat saturation (a), and T1-weighted image after contrast enhancement with fat saturation (b). The tumour is barely visible in a, and more clearly in b. Axial high-resolution TSE, however, depicts the tumour best, also showing its growth pattern and relation to neighbouring structures']} | Magnetic resonance imaging (MRI) in rectal cancer: a comprehensive review | [
"MRI",
"CT",
"Rectum",
"Cancer"
] | Insights Imaging | 1281855600 | OBJECTIVE: The development of morphological and functional imaging techniques has improved the diagnosis of muscular disorders. METHODS: With the use of whole-body magnetic resonance imaging (MRI) the possibility of imaging the entire body has been introduced. In patients with suspected myositis, oedematous and inflammatory changed muscles can be sufficiently depicted and therefore biopsies become more precise. RESULTS: Functional MR methods visualise different aspects of muscular (patho)physiology: muscular sodium (Na(+)) homeostasis can be monitored with (23)Na MRI; the muscular energy and lipid metabolism can be monitored using (31)P and (1)H MR spectroscopy. (23)Na MRI has reached an acceptable value in the diagnosis and follow-up of patients with muscular Na(+) channelopathies that are characterised by myocellular Na(+) overload and consecutive muscle weakness. Besides MRI, low mechanical index contrast-enhanced ultrasound (CEUS) methods have also been introduced. For evaluation of myositis, CEUS is more efficient in the diagnostic work-up than usual b-mode ultrasound, because CEUS can detect the inflammatory-induced muscular hyperperfusion in acute myositis. Moreover, the arterial perfusion reserve in peripheral arterial disease can be adequately examined using CEUS. CONCLUSION: Modern muscular imaging techniques offer deeper insights in muscular (patho)physiology than just illustrating unspecific myopathic manifestations like oedematous or lipomatous changes, hypertrophy or atrophy. | [] | other | PMC3259411 | null | 61 | [
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] | Insights Imaging. 2010 Aug 15; 1(4):245-267 | NO-CC CODE |
|
Mucin-producing tumours are particularly difficult to evaluate after neo-adjuvant treatment. The difference between sagittal TSE images before (a) and after treatment (b) (1.5 T) can only be seen in findings such as mucosal oedema of the lower rectum (white arrow), and presacral oedema (black arrow). The tumour itself and it extension outside the rectum (hatched arrows) are virtually unchanged | 13244_2010_37_Fig15_HTML | 7 | 72eaaeef2ae8cf479c00db97be235e8c41025c2e2c560ab21d39a6b8077fba02 | 13244_2010_37_Fig15_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
761,
421
] | [{'image_id': '13244_2010_37_Fig9_HTML', 'image_file_name': '13244_2010_37_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig9_HTML.jpg', 'caption': 'Tumour (solid arrow) in the upper rectum shown on traditional TSE on sagittal plane (a) and thin-slice 3D T2-weighted sagittal image (b) both on 3\xa0T MRI. The anterior lymph node (hatched) is more clearly depicted on the thinner slice (1\xa0mm). Additionally, one can see that this node is irregular in contour and involves the peritoneum (dotted arrows) behind the uterus', 'hash': 'f74b22a2a9618d90a68eae3ebef0cb79459232d10bf56f0caefaeec7a7b8ccb9'}, {'image_id': '13244_2010_37_Fig6_HTML', 'image_file_name': '13244_2010_37_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig6_HTML.jpg', 'caption': 'Axial (a) and sagittal (b) plane reformatted images from original sagittal three-dimensional (3D) T2-weighted images (3\xa0T) show a rectal cancer (white arrow) growing into an adjacent small bowel loop', 'hash': 'e2c1e2d59b8c06a48af0e2105463f78c046e02d59b5f1bce3d66a827508406d0'}, {'image_id': '13244_2010_37_Fig11_HTML', 'image_file_name': '13244_2010_37_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig11_HTML.jpg', 'caption': 'Coronal images of two low rectal tumours. In one case (a, reformatted from original sagittal 3D T2-weighted image, 3\xa0T), the tumour obliterates the intervening fat (black arrow) between the pelvic floor and the rectal lumen. In the other case (b, TSE image, 1.5\xa0T), the intervening fat is preserved (white arrow)', 'hash': '05cc661e1fb550adc77c3049c586b9d8f5c3b66646e1231209ee019b25f3873d'}, {'image_id': '13244_2010_37_Fig1_HTML', 'image_file_name': '13244_2010_37_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig1_HTML.jpg', 'caption': 'Mid-sagittal plane turbo spin echo (TSE) image (a) (1.5\xa0T) demonstrating lower part of the external sphincter merging toward the midline (arrows). The close-up TSE image (b) shows the anal verge (white line)', 'hash': '6599187c2166dbfb9a220c1e9ab16b62a364601d50cad5c0de1e45367f026bb8'}, {'image_id': '13244_2010_37_Fig19_HTML', 'image_file_name': '13244_2010_37_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig19_HTML.jpg', 'caption': 'Axial (a) and parasagittal (b) TSE images (1.5\xa0T) of a tumour recurrence (arrows). The tumour is an expansive mass located asymmetrically in front of the sacrum, lying against the piriformis muscle (black arrow) and the pelvic floor dorsally (dotted arrow)', 'hash': '7d1c0fe18c1f45294edd1aacf1c75ce3a32c8bc0d6850365aedeef056b3007c4'}, {'image_id': '13244_2010_37_Fig16_HTML', 'image_file_name': '13244_2010_37_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig16_HTML.jpg', 'caption': 'Extensive large tumour (white arrow) on sagittal TSE (a) and axial TSE (b) images (1.5\xa0T). The tumour extends to several important structures (dotted arrows). After neo-adjuvant treatment, on TSE imaging (c, d) the tumor has shrunk considerably. The extension to nearby structures remains unaltered on the TSE image. Surgery therefore cannot be limited based on imaging after neo-adjuvant therapy', 'hash': '7add38f3c1f7f53f518b4c540d1bdba600a93b09e91824b73555f26025446fd6'}, {'image_id': '13244_2010_37_Fig20_HTML', 'image_file_name': '13244_2010_37_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig20_HTML.jpg', 'caption': 'Axial images (1.5\xa0T) with T2-weighted image with fat saturation (a), and T1-weighted image after contrast enhancement with fat saturation (b). The tumour is barely visible in a, and more clearly in b. Axial high-resolution TSE, however, depicts the tumour best, also showing its growth pattern and relation to neighbouring structures', 'hash': 'e286099cceacb303f0aa0b9a74a69e2d21770f4b01b961d113a238b2a56e9a4b'}, {'image_id': '13244_2010_37_Fig10_HTML', 'image_file_name': '13244_2010_37_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig10_HTML.jpg', 'caption': 'Axial TSE images (1.5\xa0T) of a rectal cancer originating from the right rectal wall (white arrow). There is a malignant lymph node (black arrow) in the obturator fossa on the left side. The cause of the malignant lymph node is the prostate cancer (dotted arrow)', 'hash': '62a6b85b6a9b0e0a820cbc8f8a7d8bb7252361385bc470935eeba512d57e5e9e'}, {'image_id': '13244_2010_37_Fig7_HTML', 'image_file_name': '13244_2010_37_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig7_HTML.jpg', 'caption': 'Semi-coronal plane TSE image (1.5\xa0T) showing tumour (solid arrow) growing along the side mesorectal fascia (dotted arrow)', 'hash': 'ae1dddb073a9c38c7e8c8cf1ef8e70e703db655d1efd665fd919c210d3816e08'}, {'image_id': '13244_2010_37_Fig8_HTML', 'image_file_name': '13244_2010_37_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig8_HTML.jpg', 'caption': 'Axial (a) and semi-axial (b) TSE images (1.5\xa0T) of a mucin-producing tumour. The first image (a) with higher TE (120\xa0ms) produces a stark contrast between fluid/mucin (stars) and fat. Both the urine in the urinary bladder (large star) and the tumour mucin (small star) have higher signal than the surrounding fat. The urinary bladder was emptied and the patient imaged with lower TE (80\xa0ms). There is very little contrast between mucin and fat, or between urine and fat', 'hash': '530f86deb2960573512cce877e24b915b097e3dd60041cc5ccf28852c9b8deb5'}, {'image_id': '13244_2010_37_Fig17_HTML', 'image_file_name': '13244_2010_37_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig17_HTML.jpg', 'caption': 'Axial TSE images (1.5\xa0T) of a large tumour (white solid arrow) before (a) and after (b) neo-adjuvant therapy. The tumour has shrunk tremendously, yet the extension to the uterus (dotted white arrow), the fasciae (black solid arrows) and the small intestine (dotted black arrows) are visible in the form of low-signal bands. The bands are composed of fibrosis, yet based on MRI, it is difficult to negate remaining tumour in the fibrotic strands', 'hash': '2db6206ab29c4829cdfc95a941681a87fd31cf0fa1324ac68d28297c8c39f380'}, {'image_id': '13244_2010_37_Fig18_HTML', 'image_file_name': '13244_2010_37_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig18_HTML.jpg', 'caption': 'Axial (a), sagittal (b) and axial (c) TSE images (1.5\xa0T) of a rectosigmoid cancer after neoadjuvant therapy. There is remaining thickening of the peritoneal reflection (white arrows) and low signal infiltration (black arrows) in the perirectal fat. No tumour signal has returned. The tumour was a T1 at histopathology', 'hash': '1949d242a28b7f559294f2fa8de1cead5ea3b82c797c140c01ccb75e0e2d0836'}, {'image_id': '13244_2010_37_Fig14_HTML', 'image_file_name': '13244_2010_37_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig14_HTML.jpg', 'caption': 'Value of imaging in other planes. The axial TSE image (1.5\xa0T) (a) shows a tumour that might be interpreted as a small T3. The coronal TSE image, however, shows no extramural tumour growth. The tumour was a T2 at histopathology', 'hash': '52984df8d72f29d380f71aa0e19b473bc79bdfdf9ab28e89e6f2a5bca9f56380'}, {'image_id': '13244_2010_37_Fig3_HTML', 'image_file_name': '13244_2010_37_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig3_HTML.jpg', 'caption': 'Axial TSE image (a) (1.5\xa0T) shows separation of the mesorectal fascia (white solid arrow), otherwise known as the perirectal visceral fascia, from the parietal pelvic fascia (dotted arrow). This is due to tumour in the upper portion of the uterosacral ligament (black arrow) shown on the higher axial TSE image (b)', 'hash': 'defdf9e01564bbd941670c9952dcb0e3824bb6cb629adc24d240030008b779ce'}, {'image_id': '13244_2010_37_Fig13_HTML', 'image_file_name': '13244_2010_37_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig13_HTML.jpg', 'caption': 'Measurement of extramural tumour growth is dependent on the plane of imaging. True transverse TSE (a, 3\xa0T) image shows the extramural tumour growth to be 9\xa0mm (white line). Reformatted image from original 3D T2-weighted images with plane reconstructed perpendicular to the rectal wall (b, 3\xa0T) shows that the extramural tumour component can be 20\xa0mm (dotted line)', 'hash': 'eee423afa8469bff845bc1a7a57093be790d2137d6289e787509cb6f007746db'}, {'image_id': '13244_2010_37_Fig4_HTML', 'image_file_name': '13244_2010_37_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig4_HTML.jpg', 'caption': 'Axial TSE image (1.5\xa0T) of the pelvis at the level of a mid-rectal cancer. The intact muscularis propria is seen as a thin dark band on the left side where no tumour is present (solid arrow). The mesorectal fascia is also marked by the dotted arrows. Both the muscularis propria and the mesorectal fascia are visible as a thin low-signal layer and line, respectively. However the imaging plane should meet these structures perpendicularly for optimal demonstration', 'hash': '10b2ca6bbfbd1d491d78b0c89a2d7c66ae22d9f7d2a05689410fd67fa7362650'}, {'image_id': '13244_2010_37_Fig2_HTML', 'image_file_name': '13244_2010_37_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig2_HTML.jpg', 'caption': 'TSE image (1.5\xa0T) demonstrates alternating protruding mucosa and impressions corresponding to anal columns (white arrows)', 'hash': '5a97fd36b0c6561fd44fef41e8758740cab1a3ca813bfbdfa124cf2d14cd91e8'}, {'image_id': '13244_2010_37_Fig15_HTML', 'image_file_name': '13244_2010_37_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig15_HTML.jpg', 'caption': 'Mucin-producing tumours are particularly difficult to evaluate after neo-adjuvant treatment. The difference between sagittal TSE images before (a) and after treatment (b) (1.5\xa0T) can only be seen in findings such as mucosal oedema of the lower rectum (white arrow), and presacral oedema (black arrow). The tumour itself and it extension outside the rectum (hatched arrows) are virtually unchanged', 'hash': '72eaaeef2ae8cf479c00db97be235e8c41025c2e2c560ab21d39a6b8077fba02'}, {'image_id': '13244_2010_37_Fig5_HTML', 'image_file_name': '13244_2010_37_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig5_HTML.jpg', 'caption': 'True transversal TSE image of the pelvis (a) (1.5\xa0T) demonstrates a small tumour (arrow). High-resolution TSE image with thin slice (3\xa0mm) perpendicular to the muscular wall (black arrow) shows a T1 tumour (b)', 'hash': '612f06dad6eebaa2e30b46dbaa57c17239fd42a158db1dacd607ad53dd572801'}, {'image_id': '13244_2010_37_Fig12_HTML', 'image_file_name': '13244_2010_37_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3259411/13244_2010_37_Fig12_HTML.jpg', 'caption': 'Sagittal plane TSE image (3\xa0T) showing rectal tumour with intravascular growth (arrow). The vessel is expanded, irregular, showing tumour signal and is close to the tumour', 'hash': '089c3279056a0d8d65c9aa8a989f5a184bdc20882e52c379548dfd7e06ff75d8'}] | {'13244_2010_37_Fig1_HTML': ['The anal verge marks the lowermost portion of the anal canal and begins where the skin stops and where the anal mucosa (anoderm) starts [21]. The anal verge is best recognised in the sagittal plane (Fig.\xa0<xref rid="13244_2010_37_Fig1_HTML" ref-type="fig">1</xref>). It can be recognised as the lowermost portion of the anal sphincter complex. This can, however, be different on MRI compared with when the patient is examined by a surgeon who separates the buttocks.\n). It can be recognised as the lowermost portion of the anal sphincter complex. This can, however, be different on MRI compared with when the patient is examined by a surgeon who separates the buttocks.\nFig.\xa01Mid-sagittal plane turbo spin echo (TSE) image (a) (1.5\xa0T) demonstrating lower part of the external sphincter merging toward the midline (arrows). The close-up TSE image (b) shows the anal verge (white line)'], '13244_2010_37_Fig2_HTML': ['The dentate line is located about 1.5-2\xa0cm upwards from the anal verge. The dentate line is not visible on MRI, but occasionally the anal columns can be seen, the lowermost portion of which corresponds to the dentate line (Fig.\xa0<xref rid="13244_2010_37_Fig2_HTML" ref-type="fig">2</xref>) [) [22]. The dentate line corresponds approximately to the upper portion of the external sphincter muscle, which can be inferred on coronally oriented MRI.\nFig.\xa02TSE image (1.5\xa0T) demonstrates alternating protruding mucosa and impressions corresponding to anal columns (white arrows)'], '13244_2010_37_Fig3_HTML': ['Surrounding the rectum, there is a layer of fat, the perirectal or the mesorectal fat. There is less fat anterior and caudal to the rectum than to the other sides [24]. The amount of perirectal fat is larger in men and correlates with the visceral compartment area, but not the body’s cross-sectional area, body mass index or age [25]. Although the total amount of fat has not been shown to influence the accuracy of tumour staging [26], it is conceivable that the small distance between structures ventral to the rectum can make analysis of tumour growth assessment ventrally difficult [27]. The perirectal fat is often referred to as “mesorectum”. The mesorectum is carpeted behind and laterally by a postero-lateral fibrous envelope belonging to the pelvic visceral fascia and ventrally by a recto-genital membrane of variable nature corresponding to “Denonvilliers’ fascia” [28]. Denonvilliers’ fascia covers the dorsal aspect of the prostate and seminal vesicles in men [29]. This fascia is fused to the mesorectal fascia as it concerns MRI. The mesorectal or perirectal visceral fascia (Fig.\xa0<xref rid="13244_2010_37_Fig3_HTML" ref-type="fig">3</xref>) has gained great importance as it pertains to rectal cancer surgery when ) has gained great importance as it pertains to rectal cancer surgery when total mesorectal excision (TME) was introduced. Tumours located close to this fascia are considered to threaten the fascia [30]. What constitutes a safe distance is, however, not ascertained. A distance <1\xa0mm is definitely associated with risk of involvement of the surgical circumferential resection margin (CRM). Distance <2-5\xa0mm has also been suggested as indicative of a threatened margin with a greater risk of recurrence. Obviously, the larger the safe margin the less likelihood of false-negative results, however at the expense of low specificity. Also, adopting a larger safe margin would lead to classifying most anterior and low tumours as potentially threatening the fascia. At most centres, 1\xa0mm is considered the safe distance. Care should be exercised not to confuse the CRM and mesorectal fascia with one another. CRM is a surgical term and can be intentionally or inadvertently inside or outside the mesorectal fascia.\nFig.\xa03Axial TSE image (a) (1.5\xa0T) shows separation of the mesorectal fascia (white solid arrow), otherwise known as the perirectal visceral fascia, from the parietal pelvic fascia (dotted arrow). This is due to tumour in the upper portion of the uterosacral ligament (black arrow) shown on the higher axial TSE image (b)'], '13244_2010_37_Fig4_HTML': ['T-staging is based on the tumour relationship to the muscularis propria layer, and invasion of neighbouring organs. The muscularis propria is demonstrated as a thin lower signal layer surrounding the rectum (Fig.\xa0<xref rid="13244_2010_37_Fig4_HTML" ref-type="fig">4</xref>).\n).\nFig.\xa04Axial TSE image (1.5\xa0T) of the pelvis at the level of a mid-rectal cancer. The intact muscularis propria is seen as a thin dark band on the left side where no tumour is present (solid arrow). The mesorectal fascia is also marked by the dotted arrows. Both the muscularis propria and the mesorectal fascia are visible as a thin low-signal layer and line, respectively. However the imaging plane should meet these structures perpendicularly for optimal demonstration'], '13244_2010_37_Fig5_HTML': ['T1: submucosal tumour only (Fig.\xa0<xref rid="13244_2010_37_Fig5_HTML" ref-type="fig">5</xref>))'], '13244_2010_37_Fig6_HTML': ['T4: growth into neighbouring organs, or perforation (Fig.\xa0<xref rid="13244_2010_37_Fig6_HTML" ref-type="fig">6</xref>)\n)\n(a) Other organs, excluding peritoneum(b) Peritoneum (T4 a and T4b are reversed in TNM versions 6 and 7)'], '13244_2010_37_Fig7_HTML': ['Small tumour spiculations can contain tumour cells. Tumours have a tendency to grow along fasciae and nerves stretching to other structures not primarily close to the tumour (Fig.\xa0<xref rid="13244_2010_37_Fig7_HTML" ref-type="fig">7</xref>). Tumours with high mucin content can also cause problems. Occasionally, mucin fills out and replaces the whole mesorectal fat. On T2 weighted imaging, especially with ). Tumours with high mucin content can also cause problems. Occasionally, mucin fills out and replaces the whole mesorectal fat. On T2 weighted imaging, especially with shorter echo time (TE), the contrast between the fluid-like signal of the mucin and fat could be lost (Fig.\xa0<xref rid="13244_2010_37_Fig8_HTML" ref-type="fig">8</xref>). In our experience, T1-weighted imaging, simultaneous CT or great experience of the radiologist can overcome this problem. Another solution could be higher TE with TSE images, which leads to larger T2 weighting and thus makes mucin appear brighter than fat (Fig.\xa0). In our experience, T1-weighted imaging, simultaneous CT or great experience of the radiologist can overcome this problem. Another solution could be higher TE with TSE images, which leads to larger T2 weighting and thus makes mucin appear brighter than fat (Fig.\xa0<xref rid="13244_2010_37_Fig8_HTML" ref-type="fig">8</xref>). It is, therefore, wise to have one plane of imaging with higher TE.\n). It is, therefore, wise to have one plane of imaging with higher TE.\nFig.\xa07Semi-coronal plane TSE image (1.5\xa0T) showing tumour (solid arrow) growing along the side mesorectal fascia (dotted arrow)Fig.\xa08Axial (a) and semi-axial (b) TSE images (1.5\xa0T) of a mucin-producing tumour. The first image (a) with higher TE (120\xa0ms) produces a stark contrast between fluid/mucin (stars) and fat. Both the urine in the urinary bladder (large star) and the tumour mucin (small star) have higher signal than the surrounding fat. The urinary bladder was emptied and the patient imaged with lower TE (80\xa0ms). There is very little contrast between mucin and fat, or between urine and fat'], '13244_2010_37_Fig9_HTML': ['New hope is emerging for ultra-thin T2-weighted imaging (Fig.\xa0<xref rid="13244_2010_37_Fig9_HTML" ref-type="fig">9</xref>). Studies using this method are ongoing at our centre with initial promising results. The basis of this method is basically the same as above regarding lymph node morphology. We have been able to assess even smaller nodes using the same criteria and find malignant nodes with more confidence. It is not known if the diagnostic accuracy regarding N-staging will significantly increase.\n). Studies using this method are ongoing at our centre with initial promising results. The basis of this method is basically the same as above regarding lymph node morphology. We have been able to assess even smaller nodes using the same criteria and find malignant nodes with more confidence. It is not known if the diagnostic accuracy regarding N-staging will significantly increase.\nFig.\xa09Tumour (solid arrow) in the upper rectum shown on traditional TSE on sagittal plane (a) and thin-slice 3D T2-weighted sagittal image (b) both on 3\xa0T MRI. The anterior lymph node (hatched) is more clearly depicted on the thinner slice (1\xa0mm). Additionally, one can see that this node is irregular in contour and involves the peritoneum (dotted arrows) behind the uterus'], '13244_2010_37_Fig10_HTML': ['There is some controversy regarding how to handle metastatic lymph nodes in the pelvic side walls. In Japan, removal of these nodes is considered essential in the curative treatment of selected patients, whereas in Western Europe these sites are covered by radiation. In Western Europe, involved nodes are generally considered as signs of distant metastatic disease [59–61], at least in tumours above the peritoneal recess. Not infrequently, we see malignant lateral pelvic lymph nodes clearly along the drainage of the middle rectal and obturator vessels. Malignancy in the lateral pelvic nodes in the absence of a low locally advanced rectal cancer should lead to a search for other malignancies (e.g. prostate, Fig.\xa0<xref rid="13244_2010_37_Fig10_HTML" ref-type="fig">10</xref>).\n).\nFig.\xa010Axial TSE images (1.5\xa0T) of a rectal cancer originating from the right rectal wall (white arrow). There is a malignant lymph node (black arrow) in the obturator fossa on the left side. The cause of the malignant lymph node is the prostate cancer (dotted arrow)'], '13244_2010_37_Fig11_HTML': ['A tumour that begins within 5-6\xa0cm of the anal verge is considered a low rectal cancer and is associated with a higher risk of recurrence [39, 63]. Low rectal tumours can be difficult to assess on MRI and, therefore, a novel staging system for these tumours is suggested (Fig.\xa0<xref rid="13244_2010_37_Fig11_HTML" ref-type="fig">11</xref>) [) [64]. This classification is based on the fact that tumours growing into or beyond the intersphincteric plane on MRI have a higher likelihood of positive CRM even after preoperative treatment [65]. The more simplified approach could improve reproducibility.\nFig.\xa011Coronal images of two low rectal tumours. In one case (a, reformatted from original sagittal 3D T2-weighted image, 3\xa0T), the tumour obliterates the intervening fat (black arrow) between the pelvic floor and the rectal lumen. In the other case (b, TSE image, 1.5\xa0T), the intervening fat is preserved (white arrow)'], '13244_2010_37_Fig12_HTML': ['Intravascular extension is, however, easier for the radiologist to diagnose (Fig.\xa0<xref rid="13244_2010_37_Fig12_HTML" ref-type="fig">12</xref>). Tumours usually grow along vessels. However, this ). Tumours usually grow along vessels. However, this perivascular growth is not always equal to intravascular growth. A new system has been proposed for the assessment of intravascular growth [67, 68]. According to this scoring system for intravascular growth assessment, the more signs present the higher likelihood of intravascular growth. These signs are nodular growth at the site of extramural growth, vessel in proximity to the tumour, vascular enlargement and vessel signal heterogeneity. The authors of the mentioned studies have found that when more than two signs are present, the prognosis is similar to when tumours have intravascular growth histopathologically.\nFig.\xa012Sagittal plane TSE image (3\xa0T) showing rectal tumour with intravascular growth (arrow). The vessel is expanded, irregular, showing tumour signal and is close to the tumour'], '13244_2010_37_Fig13_HTML': ['The MERCURY study [14] showed that MRI provides a non-biased estimation of EMD, the latter being an important prognostic factor [69]. The 95% range of over- and underestimation of EMD was about 4-5\xa0mm compared with histopathology [70, 71]. It is possible that the figure of 4 mm is a reflection of slice thickness [72]. Another smaller study has also demonstrated good correspondence between histopathology and MRI for measurement of EMD (Fig.\xa0<xref rid="13244_2010_37_Fig13_HTML" ref-type="fig">13</xref>) [) [73].\nFig.\xa013Measurement of extramural tumour growth is dependent on the plane of imaging. True transverse TSE (a, 3\xa0T) image shows the extramural tumour growth to be 9\xa0mm (white line). Reformatted image from original 3D T2-weighted images with plane reconstructed perpendicular to the rectal wall (b, 3\xa0T) shows that the extramural tumour component can be 20\xa0mm (dotted line)'], '13244_2010_37_Fig14_HTML': ['The basis for local assessment of rectal cancer is T2-weighted imaging with turbo spin echo (TSE) [75]. This imaging should be performed in appropriate planes (Fig.\xa0<xref rid="13244_2010_37_Fig14_HTML" ref-type="fig">14</xref>). There is, however, no consensus about what are the essential planes, yet two requirements should be fulfilled: wherever distinction among T1, T2 and minimal T3 is important the imaging should preferably be perpendicular to the rectal wall, and whenever growth into neighbouring organs/tissues is not certain the imaging plane should be such as to show the smallest intervening fat (Table\xa0). There is, however, no consensus about what are the essential planes, yet two requirements should be fulfilled: wherever distinction among T1, T2 and minimal T3 is important the imaging should preferably be perpendicular to the rectal wall, and whenever growth into neighbouring organs/tissues is not certain the imaging plane should be such as to show the smallest intervening fat (Table\xa01).\nFig.\xa014Value of imaging in other planes. The axial TSE image (1.5\xa0T) (a) shows a tumour that might be interpreted as a small T3. The coronal TSE image, however, shows no extramural tumour growth. The tumour was a T2 at histopathologyTable\xa01Different imaging planesPlaneAdvantageDisadvantageUsageSagittal (orthogonal)Easy for measuring tumor height and length. Best for assessment of involvement of midline organs and structuresStructures slightly lateral to midline not easily assessed especially in female patientsEasily reproducible. RecommendedAxial (orthogonal)Easily recognizable by clinicians. Easy for comparison with MRI or other imaging modalities, especially comparison of lymph nodes. Often best view of inguinal lymph nodesDue to funnel-shaped form of pelvic floor and anterior curve of rectosigmoid, not enough for adequate detailed analysis in many casesEasily reproducible. RecommendedCoronal orthogonalNoneTakes time of more important imagesNot recommendedSemi-coronally parallel to anal canalVisually informative for surgeons in low rectal tumorsCan be the same as perpendicular to pelvic floorNot essentialPerpendicular to rectal wallProvides best differential of T1, T2 and minimal T3. Has to be repeated at all areas where distinction between T3 and T1-2 is importantNeeds either capable technicians or presence of radiologists at the time of imagingEssentialPerpendicular to anterior mesorectal fasciaFor anterior tumors or tumors with anterior component, especially in female subjectsSometimes not necessary in cases of obvious tumor growth into anterior structuresImportant in selected casesPerpendicular to pelvic floorFor tumors growing dorsally and laterally close to pelvic floor. Can provide coverage of mesorectal lymph nodesNot necessary in all casesImportant in selected casesPerpendicular to anal canalMost important plane for low tumors at the level of pelvic floor or lower downNot essential for tumors completely above the pelvic floorNot essential for tumors completely above the pelvic floor'], '13244_2010_37_Fig15_HTML': ['Most radiological studies have concentrated on the correlation between MRI2 and histopathology and have shown moderate correlation varying between 67 and 84% [106–109], being worst for mucin-producing tumours (Fig.\xa0<xref rid="13244_2010_37_Fig15_HTML" ref-type="fig">15</xref>). The basis of most of these has been tumour volume measurements [). The basis of most of these has been tumour volume measurements [110, 111].\nFig.\xa015Mucin-producing tumours are particularly difficult to evaluate after neo-adjuvant treatment. The difference between sagittal TSE images before (a) and after treatment (b) (1.5\xa0T) can only be seen in findings such as mucosal oedema of the lower rectum (white arrow), and presacral oedema (black arrow). The tumour itself and it extension outside the rectum (hatched arrows) are virtually unchanged'], '13244_2010_37_Fig16_HTML': ['Aim 2, treatment modification: if a tumour responds in such a way that surgical treatment can be altered or in practice is less extensive than primarily decided upon based on MRI1, then MRI2 is indicated (Figs.\xa0<xref rid="13244_2010_37_Fig16_HTML" ref-type="fig">16</xref>, , <xref rid="13244_2010_37_Fig17_HTML" ref-type="fig">17</xref>). The surgical treatment for pretreated rectal cancer can be:\n). The surgical treatment for pretreated rectal cancer can be:\nNo surgeryLocal excisionStandard TMEExtended TMEFig.\xa016Extensive large tumour (white arrow) on sagittal TSE (a) and axial TSE (b) images (1.5\xa0T). The tumour extends to several important structures (dotted arrows). After neo-adjuvant treatment, on TSE imaging (c, d) the tumor has shrunk considerably. The extension to nearby structures remains unaltered on the TSE image. Surgery therefore cannot be limited based on imaging after neo-adjuvant therapyFig.\xa017Axial TSE images (1.5\xa0T) of a large tumour (white solid arrow) before (a) and after (b) neo-adjuvant therapy. The tumour has shrunk tremendously, yet the extension to the uterus (dotted white arrow), the fasciae (black solid arrows) and the small intestine (dotted black arrows) are visible in the form of low-signal bands. The bands are composed of fibrosis, yet based on MRI, it is difficult to negate remaining tumour in the fibrotic strands'], '13244_2010_37_Fig18_HTML': ['In one study of restaging irradiated tumours, MRI2 had an accuracy of 52% in T-staging and 68% in N-staging. Poor agreement between post-combined chemo-radiotherapy MRI2 and pathological staging was observed in both T- (k\u2009=\u20090.017) and N-staging (k = 0.031). Most of the inaccuracy in T- and N-staging is caused by over-staging [123]. The problem with MRI is believed to be that it cannot completely differentiate fibrosis from viable residual tumours. Though fibrosis shows lower signal than tumour on T2-weighted imaging, there is still considerable overlap between normal viable tumour tissue and fibrosis (Fig.\xa0<xref rid="13244_2010_37_Fig18_HTML" ref-type="fig">18</xref>) [) [124]. In a recent retrospective study [111], the authors used a combination of tumour volume reduction rate and original tumour volume to predict ypT0-2 in 67 patients. They found that with an initial tumour volume of ≤50\xa0cm3 at MRI1 and a reduction rate ≥75%, the excised tumour was always ypT0-2. Figures\xa0<xref rid="13244_2010_37_Fig17_HTML" ref-type="fig">17</xref> and and <xref rid="13244_2010_37_Fig18_HTML" ref-type="fig">18</xref> both demonstrate these cases. Tiny strands and smooth slight thickening of fascia with very low signal on T2-weighted imaging are most commonly associated with absence of tumour at histopathology.\n both demonstrate these cases. Tiny strands and smooth slight thickening of fascia with very low signal on T2-weighted imaging are most commonly associated with absence of tumour at histopathology.\nFig.\xa018Axial (a), sagittal (b) and axial (c) TSE images (1.5\xa0T) of a rectosigmoid cancer after neoadjuvant therapy. There is remaining thickening of the peritoneal reflection (white arrows) and low signal infiltration (black arrows) in the perirectal fat. No tumour signal has returned. The tumour was a T1 at histopathology'], '13244_2010_37_Fig19_HTML': ['The local recurrence rate has decreased greatly. In the post-TME era, most recurrences occur at the anastomotic site, presacrally or at the level of the pelvic floor, with very few at the lateral pelvic side walls in the European material (Fig.\xa0<xref rid="13244_2010_37_Fig19_HTML" ref-type="fig">19</xref>) [) [133, 134]. The best sequence for imaging is TSE, although contrast enhancement can be useful at times (Fig.\xa0<xref rid="13244_2010_37_Fig20_HTML" ref-type="fig">20</xref>).\n).\nFig.\xa019Axial (a) and parasagittal (b) TSE images (1.5\xa0T) of a tumour recurrence (arrows). The tumour is an expansive mass located asymmetrically in front of the sacrum, lying against the piriformis muscle (black arrow) and the pelvic floor dorsally (dotted arrow)Fig.\xa020Axial images (1.5\xa0T) with T2-weighted image with fat saturation (a), and T1-weighted image after contrast enhancement with fat saturation (b). The tumour is barely visible in a, and more clearly in b. Axial high-resolution TSE, however, depicts the tumour best, also showing its growth pattern and relation to neighbouring structures']} | Magnetic resonance imaging (MRI) in rectal cancer: a comprehensive review | [
"MRI",
"CT",
"Rectum",
"Cancer"
] | Insights Imaging | 1281855600 | OBJECTIVE: The development of morphological and functional imaging techniques has improved the diagnosis of muscular disorders. METHODS: With the use of whole-body magnetic resonance imaging (MRI) the possibility of imaging the entire body has been introduced. In patients with suspected myositis, oedematous and inflammatory changed muscles can be sufficiently depicted and therefore biopsies become more precise. RESULTS: Functional MR methods visualise different aspects of muscular (patho)physiology: muscular sodium (Na(+)) homeostasis can be monitored with (23)Na MRI; the muscular energy and lipid metabolism can be monitored using (31)P and (1)H MR spectroscopy. (23)Na MRI has reached an acceptable value in the diagnosis and follow-up of patients with muscular Na(+) channelopathies that are characterised by myocellular Na(+) overload and consecutive muscle weakness. Besides MRI, low mechanical index contrast-enhanced ultrasound (CEUS) methods have also been introduced. For evaluation of myositis, CEUS is more efficient in the diagnostic work-up than usual b-mode ultrasound, because CEUS can detect the inflammatory-induced muscular hyperperfusion in acute myositis. Moreover, the arterial perfusion reserve in peripheral arterial disease can be adequately examined using CEUS. CONCLUSION: Modern muscular imaging techniques offer deeper insights in muscular (patho)physiology than just illustrating unspecific myopathic manifestations like oedematous or lipomatous changes, hypertrophy or atrophy. | [] | other | PMC3259411 | null | 61 | [
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] | Insights Imaging. 2010 Aug 15; 1(4):245-267 | NO-CC CODE |
|
A T2-weighted sagittal image demonstrating the cranial-most vertebral level (C5) and caudal-most vertebral level (C6) of edema involvement | 41394_2019_164_Fig1_HTML | 7 | ce1642aac26fd0d26ffe8b31c632f38c662c0477f16ba1748690cf5f69d8ec82 | 41394_2019_164_Fig1_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
630,
595
] | [{'image_id': '41394_2019_164_Fig1_HTML', 'image_file_name': '41394_2019_164_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC6461921/41394_2019_164_Fig1_HTML.jpg', 'caption': 'A T2-weighted sagittal image demonstrating the cranial-most vertebral level (C5) and caudal-most vertebral level (C6) of edema involvement', 'hash': 'ce1642aac26fd0d26ffe8b31c632f38c662c0477f16ba1748690cf5f69d8ec82'}, {'image_id': '41394_2019_164_Fig2_HTML', 'image_file_name': '41394_2019_164_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC6461921/41394_2019_164_Fig2_HTML.jpg', 'caption': 'a An example of the edema length manual measurement. b The midsagittal tissue bridge ratio was calculated as the sum of the anterior and posterior tissue bridges (green) divided by the diameter of the cord (red). c The axial damage ratio was quantified as the maximal edema cross-sectional area (green) divided by the surrounding spinal cord cross-sectional area (red)', 'hash': '52ffe086ef51a0c7903cdb42bf0ec1129d2194a9e2218f77a9b88604645295aa'}, {'image_id': '41394_2019_164_Fig3_HTML', 'image_file_name': '41394_2019_164_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC6461921/41394_2019_164_Fig3_HTML.jpg', 'caption': 'Edema volume was calculated using consecutive axial edema cross-sectional areas multiplied by the axial slice thickness', 'hash': '896efa42ccd6dd503521e7201aede2c48ab63557a7bffb998342d4978ce18893'}, {'image_id': '41394_2019_164_Fig4_HTML', 'image_file_name': '41394_2019_164_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC6461921/41394_2019_164_Fig4_HTML.jpg', 'caption': 'A chart demonstrating the reliability values for all five measures: cranial/caudal levels of involvement (CCI), edema length (EL), midsagittal tissue bridge (MTB) ratios, axial damage ratios (ADR), and edema volume. The green bars represent one-dimensional measures, the blue bars represent two-dimensional measures, and the red bar represents the three-dimensional measure. The green line represents the cut-off of high inter-rater reliability at 0.75', 'hash': '784c358b38b3b792371ecb120567f4d9eef1a78759125a496674fdb7f02cfd7a'}] | {'41394_2019_164_Fig1_HTML': ['MRI data were analyzed using a medical image viewer software program, OsiriX (Pixmeo Sarl, Geneva, Switzerland). The segmental levels of both cranial and caudal involvement (CCI) were determined by identifying the cranial-most and caudal-most vertebral body where edema was present (see Fig. <xref rid="41394_2019_164_Fig1_HTML" ref-type="fig">1</xref>).).Fig. 1A T2-weighted sagittal image demonstrating the cranial-most vertebral level (C5) and caudal-most vertebral level (C6) of edema involvement'], '41394_2019_164_Fig2_HTML': ['Edema length (EL) was measured using the sagittal slice with the maximal extent of edema, as the distance between the most cranial and caudal portions while keeping the measuring line parallel to the spinal cord (see Fig. <xref rid="41394_2019_164_Fig2_HTML" ref-type="fig">2a</xref>).).Fig. 2a An example of the edema length manual measurement. b The midsagittal tissue bridge ratio was calculated as the sum of the anterior and posterior tissue bridges (green) divided by the diameter of the cord (red). c The axial damage ratio was quantified as the maximal edema cross-sectional area (green) divided by the surrounding spinal cord cross-sectional area (red)', 'To quantify MTB, the midsagittal slice was used. Tissue bridges were calculated as the minimum distance from cerebrospinal fluid to the edema, on both the anterior and posterior sides of edema. The MTB ratio was quantified as the sum of anterior and posterior tissue bridges divided by the spinal cord diameter (see Fig. <xref rid="41394_2019_164_Fig2_HTML" ref-type="fig">2b</xref>).).', 'For each patient, edema and surrounding spinal cord cross-sectional area (CSA) were measured for each axial slice where the edema was visibly present (see Fig. <xref rid="41394_2019_164_Fig2_HTML" ref-type="fig">2c</xref>). Edema volumes were calculated as the measured CSA multiplied by slice thickness: volume\u2009=\u2009∑CSA). Edema volumes were calculated as the measured CSA multiplied by slice thickness: volume\u2009=\u2009∑CSAeachslice\u2009×\u2009slice thickness (see Fig. <xref rid="41394_2019_164_Fig3_HTML" ref-type="fig">3</xref>). For axial damage ratio (ADR) measure, the axial slice with the largest CSA of edema was identified. ADR was calculated as the maximum CSA of edema divided by its corresponding spinal cord CSA: ADR\u2009=\u2009CSA). For axial damage ratio (ADR) measure, the axial slice with the largest CSA of edema was identified. ADR was calculated as the maximum CSA of edema divided by its corresponding spinal cord CSA: ADR\u2009=\u2009CSAmaxedema/CSAspinalcord (see Fig. <xref rid="41394_2019_164_Fig2_HTML" ref-type="fig">2c</xref>).).Fig. 3Edema volume was calculated using consecutive axial edema cross-sectional areas multiplied by the axial slice thickness'], '41394_2019_164_Fig4_HTML': ['ICC values for one-dimensional measurements (CCI, EL), two-dimensional measurements (MTB, ADR), and the three-dimensional measurement (edema volume) demonstrated high-to-excellent inter-rater reliability (0.99, 0.98, 0.90, 0.84, and 0.93, respectively) at a significance value of p\u2009<\u20090.05 (see Fig. <xref rid="41394_2019_164_Fig4_HTML" ref-type="fig">4</xref>).).Fig. 4A chart demonstrating the reliability values for all five measures: cranial/caudal levels of involvement (CCI), edema length (EL), midsagittal tissue bridge (MTB) ratios, axial damage ratios (ADR), and edema volume. The green bars represent one-dimensional measures, the blue bars represent two-dimensional measures, and the red bar represents the three-dimensional measure. The green line represents the cut-off of high inter-rater reliability at 0.75']} | Establishing the inter-rater reliability of spinal cord damage manual measurement using magnetic resonance imaging | [
"Preclinical research",
"Translational research"
] | Spinal Cord Ser Cases | 1550476800 | [{'@Label': 'STUDY DESIGN', '#text': 'Retrospective study.'}, {'@Label': 'OBJECTIVES', '#text': 'To establish the inter-rater reliability in the quantitative evaluation of spinal cord damage following cervical incomplete spinal cord injury (SCI) utilizing magnetic resonance imaging (MRI). MRI was used to perform manual measurements of the cranial and caudal boundaries of edema, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume in 10 participants with cervical incomplete SCI.'}, {'@Label': 'SETTING', '#text': 'Academic university setting.'}, {'@Label': 'METHODS', '#text': "Structural MRIs of 10 participants with SCI were collected from Northwestern University's Neuromuscular Imaging and Research Lab. All manual measures were performed using OsiriX (Pixmeo Sarl, Geneva, Switzerland). Intraclass correlation coefficients (ICC) were used to determine inter-rater reliability across seven raters of varying experience."}, {'@Label': 'RESULTS', '#text': 'High-to-excellent inter-rater reliability was found for all measures. ICC values for cranial/caudal levels of involvement, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume were 0.99, 0.98, 0.90, 0.84, and 0.93, respectively.'}, {'@Label': 'CONCLUSIONS', '#text': 'Manual MRI measures of spinal cord damage are reliable between raters. Researchers and clinicians may confidently utilize manual MRI measures to quantify cord damage. Future research to predict functional recovery following SCI and better inform clinical management is warranted.'}] | [
"Adult",
"Cervical Vertebrae",
"Edema",
"Female",
"Humans",
"Imaging, Three-Dimensional",
"Magnetic Resonance Imaging",
"Male",
"Middle Aged",
"Observer Variation",
"Reproducibility of Results",
"Retrospective Studies",
"Spinal Cord",
"Spinal Cord Injuries"
] | other | PMC6461921 | null | 22 | [
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] | Spinal Cord Ser Cases. 2019 Feb 18; 5:20 | NO-CC CODE |
|
Pelvic abscess. (A–D) CT and (E) US after multivisceral transplantation show a 10-cm pelvic abscess, with thick enhancing walls, containing air bubbles (arrows in C, D). Free abdominal fluid is also visible. | 261_2004_288_f10 | 7 | 35003fda120248c6e0b7f9e2477f52c45b0ce6dbb19d4e04a7ac0f62dc3cc941 | 261_2004_288_f10.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
450,
268
] | [{'image_id': '261_2004_288_f11', 'image_file_name': '261_2004_288_f11.jpg', 'image_path': '../data/media_files/PMC7102087/261_2004_288_f11.jpg', 'caption': 'Recurrent desmoid tumors in a patient affected by Gardner syndrome who underwent multivisceral transplantation. Some solid, round, or ovoid masses (arrows) are visible in the (A, B) upper and (C) lower abdomen. Masses display clear edges and strong contrast enhancement. D The pelvic tumor shows nonhomogeneous enhancement (arrow); because it was not radically resectable, it was controlled with radiofrequency ablation and partial necrosis of tumor tissue.', 'hash': 'aab443a4567420c6fd757e378616a0b568c405592b9d53cdc2c64aee83b6d3b5'}, {'image_id': '261_2004_288_f8', 'image_file_name': '261_2004_288_f8.jpg', 'image_path': '../data/media_files/PMC7102087/261_2004_288_f8.jpg', 'caption': 'Acute respiratory distress syndrome. A Chest radio- graphy clearly depicts several wide parenchymal opacities with blurred edges. B, C CT shows wide, confluent areas of parenchymal consolidation with air bronchogram. Pleural effusion is also visible.', 'hash': '7d0610a25fd46cfa738b78c8e62adf48fac37de28e4df93522d65d6efc6e20cb'}, {'image_id': '261_2004_288_f1', 'image_file_name': '261_2004_288_f1.jpg', 'image_path': '../data/media_files/PMC7102087/261_2004_288_f1.jpg', 'caption': 'Oral contrast radiologic study of the transplanted bowel. On direct examination of the abdomen, no significant distention of the intestinal loops is visible. Esophageal transit appears regular and the cardia is patent. The time of gastric emptying is normal. Small bowel loops are normally represented and have regular morphology and fold pattern. Peristaltic activity is present, with normal transit of the contrast agent.', 'hash': '67323d5aeffcb0fcc4dd61804c1fba6a31744138b407ec23c0f5ed8a726afdbd'}, {'image_id': '261_2004_288_f6', 'image_file_name': '261_2004_288_f6.jpg', 'image_path': '../data/media_files/PMC7102087/261_2004_288_f6.jpg', 'caption': 'A–F CT in a patient who underwent multivisceral transplantation. In arterial phase images, under the origin of the renal arteries, vascular arterial anastomosis between a short tract of the donor’s aorta and the receiver’s aorta is visible (arrows). G, H A wide laparocele involving ileojejunal loops is clearly visible in a central position.', 'hash': '58f4602b7ccfb1c5af31fd64a77175299863d42ea0d4ef6e900e673376778972'}, {'image_id': '261_2004_288_f10', 'image_file_name': '261_2004_288_f10.jpg', 'image_path': '../data/media_files/PMC7102087/261_2004_288_f10.jpg', 'caption': 'Pelvic abscess. (A–D) CT and (E) US after multivisceral transplantation show a 10-cm pelvic abscess, with thick enhancing walls, containing air bubbles (arrows in C, D). Free abdominal fluid is also visible.', 'hash': '35003fda120248c6e0b7f9e2477f52c45b0ce6dbb19d4e04a7ac0f62dc3cc941'}, {'image_id': '261_2004_288_f7', 'image_file_name': '261_2004_288_f7.jpg', 'image_path': '../data/media_files/PMC7102087/261_2004_288_f7.jpg', 'caption': 'Chylous ascites. CT after transplantation shows abundant ascites in the supra- and inframesocolic spaces. Bowel loops are displaced and the urinary tracts are dilated. An ileal loop linked to the abdominal wall is clearly visible in the right iliac fossa (arrow).', 'hash': '0995ba3bf3cac3f48ab8addce61525aa6d9feeb953f0552df87fe4501d7f969c'}, {'image_id': '261_2004_288_f9', 'image_file_name': '261_2004_288_f9.jpg', 'image_path': '../data/media_files/PMC7102087/261_2004_288_f9.jpg', 'caption': 'Abdominal abscess. (A–C) CT and (D) US after transplantation show a huge, water-density mass, with thick, mildly enhancing walls extending from the upper abdomen to the supravesical space.', 'hash': '6f59619dc8125a9f2b51d36b4fd0cfd9bb1ef6f7785e5484b67383f68c5d9a7f'}, {'image_id': '261_2004_288_f3', 'image_file_name': '261_2004_288_f3.jpg', 'image_path': '../data/media_files/PMC7102087/261_2004_288_f3.jpg', 'caption': 'Idiopathic intestinal pseudo-obstruction. Evaluation of transit time with radiopaque markers after intestinal transplantation. A First radiography of the abdomen obtained few minutes after oral administration of radiopaque markers. B Twenty-four hours after intake of markers, four markers can be observed in the pelvic cavity in the rectosigmoid site; two markers remain in the proximal ileojejunal loop. C After 29 h, the markers previously situated in the proximal ileal loops are projected into the pelvic cavity, apparently in the rectosigmoid site. Those previously present at that site have been expelled. Transit occurred with normal times.', 'hash': '42d9ba36d76b0071565a3f2bc20f8125dc215ace79f569997999290179974b48'}, {'image_id': '261_2004_288_f4', 'image_file_name': '261_2004_288_f4.jpg', 'image_path': '../data/media_files/PMC7102087/261_2004_288_f4.jpg', 'caption': 'US of the bowel in a transplanted patient. A, B Fluid in some intestinal loops permits clearer US identification of intestinal loops. Clearly visible are the wall thickness and valves. Doppler US displays arterial flows (C) in the mesenteric artery and (D) at the level of the intestinal wall. E Normal echoic features and mural stratification of transplanted loops are visible.', 'hash': '65731f0fde5398c811affe4f06b353889a2da9205899ed35b542f78d3403975b'}, {'image_id': '261_2004_288_f13', 'image_file_name': '261_2004_288_f13.jpg', 'image_path': '../data/media_files/PMC7102087/261_2004_288_f13.jpg', 'caption': 'Posttransplantation MR imaging. (A) Coronal SSFSE T2-weighted sequence, (B) coronal FMPSPGR sequence, (C) sagittal SSFSE T2-weighted sequences, and (D, E) coronal FMPSPGR sequence performed 30, 60, 120, and 300 s after intravenous injection of gadolinium DOTA, and (F) compressed images after dynamic evaluation. Superparamagnetic contrast agent was orally administered about 1 h before examination (white arrow in A). The coronal plane clearly displays intestinal loops and vascular axes. SSFSE sequences, after orally administered superparamagnetic contrast agent, allowed careful evaluation of the transplanted loops by visualizing normal loops with dark intraluminal signal (due to contrast agent) and abnormal loops with white intraluminal signal (due to intestinal fluids, without contrast agent; black arrow in A). FMPSPGR sequences accurately display vascular axes, intestinal walls, and their contrast enhancement (white arrows in D, E).', 'hash': '52fca0b5028a3936797cc0b4dcaab7302dc2231b3ea4c405a3a93d8f41c1dea5'}, {'image_id': '261_2004_288_f5', 'image_file_name': '261_2004_288_f5.jpg', 'image_path': '../data/media_files/PMC7102087/261_2004_288_f5.jpg', 'caption': 'A–D CT examination 1 month after transplantation. Intestinal loops are in a midabdominal position. A minimum quantity of perihepatic fluid is present, as is wall thickening of some ileal loops (arrows).', 'hash': '3bfdce1d0a526b96e99e11f2ed83a35a6566128bf882539b05461b0689c10e12'}, {'image_id': '261_2004_288_f2', 'image_file_name': '261_2004_288_f2.jpg', 'image_path': '../data/media_files/PMC7102087/261_2004_288_f2.jpg', 'caption': 'Retractile mesenteritis with ileal loop trapped by adhesion. About 10 days after transplantation, an upper obstruction was apparent. A Radiologic study with oral contrast agent indicated preferential opacification of the loop, without passage of contrast agent to the efferent loop or visualization of ileal loops. B CT examination highlights mesenteric thickening and the presence of some lymph nodes that are larger than normal. C Postoperative radiologic examination displays transit recovery with rapid opacification of the loop and passage of contrast agent into the small bowel.', 'hash': 'feb346ff26e504b122dbe8a329eccd978afa36491ce3aee3aa5aa7f5c9137de0'}, {'image_id': '261_2004_288_f12', 'image_file_name': '261_2004_288_f12.jpg', 'image_path': '../data/media_files/PMC7102087/261_2004_288_f12.jpg', 'caption': 'PTLD. Large-cell rhinopharyngeal and thoracic malignant lymphoma developed about 1 year after isolated bowel transplantation. A Solid nonhomogeneous tissue of the rhinopharynx wall spreads toward the parapharyngeal and prevertebral spaces (white arrows) and toward the nasal fossa (black arrow). B In the lung, several confluent areas of parenchymal consolidation, some of which are round, are visible (white arrows). C These lesions are larger at 2-month follow-up on CT.', 'hash': '0c47a88a6785a9f06883cafca111ae50ea310060dc763897b4734e3f54fae682'}] | {'261_2004_288_f1': ['Traditional radiologic evaluation of the gastrointestinal tract with radiopaque contrast agent allowed anatomic and morphologic examinations of the graft, proximal and distal anastomoses, and tone and motility of transplanted loops in all patients (Fig.\xa0<xref rid="261_2004_288_f1" ref-type="fig">1</xref>). This method identified some complications reported by our patients (Table\xa0 2; Fig.\xa0). This method identified some complications reported by our patients (Table\xa0 2; Fig.\xa0<xref rid="261_2004_288_f2" ref-type="fig">2</xref>).\n).\nFig.\xa01.Oral contrast radiologic study of the transplanted bowel. On direct examination of the abdomen, no significant distention of the intestinal loops is visible. Esophageal transit appears regular and the cardia is patent. The time of gastric emptying is normal. Small bowel loops are normally represented and have regular morphology and fold pattern. Peristaltic activity is present, with normal transit of the contrast agent.\nFig.\xa02.Retractile mesenteritis with ileal loop trapped by adhesion. About 10 days after transplantation, an upper obstruction was apparent. A Radiologic study with oral contrast agent indicated preferential opacification of the loop, without passage of contrast agent to the efferent loop or visualization of ileal loops. B CT examination highlights mesenteric thickening and the presence of some lymph nodes that are larger than normal. C Postoperative radiologic examination displays transit recovery with rapid opacification of the loop and passage of contrast agent into the small bowel.'], '261_2004_288_f3': ['The study of transit time showed restoration of some graft motility in all five transplanted patients. However, different transit times were found: 24 to 30 h in three patients (Fig.\xa0<xref rid="261_2004_288_f3" ref-type="fig">3</xref>) and about 6 hours in the remaining two patients. Considering the graft length and the type of proximal and distal anastomoses, we concluded that the transit time was normal in the first three patients and accelerated in the remaining two. In these two patients, there were clinical signs of malabsorption and lack of weight increase. In all four patients with skin stoma, exit of markers did not follow a preferred path because it occurred through the stoma and the physiologic transit.\n) and about 6 hours in the remaining two patients. Considering the graft length and the type of proximal and distal anastomoses, we concluded that the transit time was normal in the first three patients and accelerated in the remaining two. In these two patients, there were clinical signs of malabsorption and lack of weight increase. In all four patients with skin stoma, exit of markers did not follow a preferred path because it occurred through the stoma and the physiologic transit.\nFig.\xa03.Idiopathic intestinal pseudo-obstruction. Evaluation of transit time with radiopaque markers after intestinal transplantation. A First radiography of the abdomen obtained few minutes after oral administration of radiopaque markers. B Twenty-four hours after intake of markers, four markers can be observed in the pelvic cavity in the rectosigmoid site; two markers remain in the proximal ileojejunal loop. C After 29 h, the markers previously situated in the proximal ileal loops are projected into the pelvic cavity, apparently in the rectosigmoid site. Those previously present at that site have been expelled. Transit occurred with normal times.'], '261_2004_288_f4': ['US study of the transplanted loops, carried out on five patients, showed a midabdominal location of loops, with no visible changes in the wall. In all patients, wall thickness at the level of the sampled loops appeared normal at 2 to 6 mm. Further, echographic stratification of the wall appeared normal and was characterized by five different layers that were alternately hyperechoic and hypoechoic. In two patients, US demonstrated fluid in the abdomen that was clearly visible between intestinal loops. In one patient, intestinal peristalsis appeared marked, which was consistent with clinical evidence of diarrhea. Color Doppler evaluation was used to calculate the resistance indexes of the mesenteric artery and a wall arteriole. The parameters are listed in Table\xa01 (Fig.\xa0<xref rid="261_2004_288_f4" ref-type="fig">4</xref>).\n).\nTable\xa01Color Doppler parameters: resistance indexResistance indexPatient no.Mesenteric arteryLoop-wall small artery11.731.2421.340.5431.251.1940.550.8551.200.85\nFig.\xa04.US of the bowel in a transplanted patient. A, B Fluid in some intestinal loops permits clearer US identification of intestinal loops. Clearly visible are the wall thickness and valves. Doppler US displays arterial flows (C) in the mesenteric artery and (D) at the level of the intestinal wall. E Normal echoic features and mural stratification of transplanted loops are visible.'], '261_2004_288_f5': ['CT allowed systematic evaluation of the site, caliber, and wall thickness of the transplanted loops and the identification and evaluation of the integrity of the anastomoses. CT examination also suggested some findings that were considered “normal” in the early postoperative phase, such as some fluid between loops, slight distention of the loops, mesenteric thickening, and slightly increased lymph nodes in the mesenteric fat (Figs.\xa0<xref rid="261_2004_288_f5" ref-type="fig">5</xref>, , <xref rid="261_2004_288_f6" ref-type="fig">6</xref>). CT played a crucial role in the identification of most complications (Table\xa0). CT played a crucial role in the identification of most complications (Table\xa02; Figs\xa0<xref rid="261_2004_288_f2" ref-type="fig">2</xref>, , <xref rid="261_2004_288_f7" ref-type="fig">7</xref>, , <xref rid="261_2004_288_f8" ref-type="fig">8</xref>, , <xref rid="261_2004_288_f9" ref-type="fig">9</xref>, , <xref rid="261_2004_288_f10" ref-type="fig">10</xref>, , <xref rid="261_2004_288_f11" ref-type="fig">11</xref>, , <xref rid="261_2004_288_f12" ref-type="fig">12</xref>).\n).\nFig.\xa05.A–D CT examination 1 month after transplantation. Intestinal loops are in a midabdominal position. A minimum quantity of perihepatic fluid is present, as is wall thickening of some ileal loops (arrows).\nFig.\xa06.A–F CT in a patient who underwent multivisceral transplantation. In arterial phase images, under the origin of the renal arteries, vascular arterial anastomosis between a short tract of the donor’s aorta and the receiver’s aorta is visible (arrows). G, H A wide laparocele involving ileojejunal loops is clearly visible in a central position.\nTable\xa02Posttransplantation complicationsComplicationNo. of casesDiagnostic techniqueIntestinal occlusion3 AdhesionsWater-soluble contrast radiographic1 Ileal volvulusevaluation1 Rectosigmoid postradiation stenosis1 Duodenojejunal anastomosis stenosisAcute rejection2HistologyMesenteric acute ischemia1 After graft resectionCTIntestinal perforation with1CTfistulous tract and abscessFistulous tracts and abscess8CTPeritoneal hemorrhage1 Hepatic hematoma1 Rectal vein ruptureCT1 Small epigastric artery bleedingHemothorax1CTSpontaneous pneumothorax1CTPleural effusion11Chest radiography, CTIDC1 Death during surgeryRecurrence of Gardner disease1CTChylous ascites1CT, USARDS1CTPTLD2CTLung consolidation11Chest radiography, CTAscites6CT, USLaparocele1CTARDS, acute respiratory distress syndrome; CT, computed tomography; IDC, intravascular disseminated coagulation; PTLD, posttransplantation lymphoproliferative disorder; US, ultrasonography\nFig.\xa07.Chylous ascites. CT after transplantation shows abundant ascites in the supra- and inframesocolic spaces. Bowel loops are displaced and the urinary tracts are dilated. An ileal loop linked to the abdominal wall is clearly visible in the right iliac fossa (arrow).\nFig.\xa08.Acute respiratory distress syndrome. A Chest radio- graphy clearly depicts several wide parenchymal opacities with blurred edges. B, C CT shows wide, confluent areas of parenchymal consolidation with air bronchogram. Pleural effusion is also visible.\nFig.\xa09.Abdominal abscess. (A–C) CT and (D) US after transplantation show a huge, water-density mass, with thick, mildly enhancing walls extending from the upper abdomen to the supravesical space.\nFig.\xa010.Pelvic abscess. (A–D) CT and (E) US after multivisceral transplantation show a 10-cm pelvic abscess, with thick enhancing walls, containing air bubbles (arrows in C, D). Free abdominal fluid is also visible.\nFig.\xa011.Recurrent desmoid tumors in a patient affected by Gardner syndrome who underwent multivisceral transplantation. Some solid, round, or ovoid masses (arrows) are visible in the (A, B) upper and (C) lower abdomen. Masses display clear edges and strong contrast enhancement. D The pelvic tumor shows nonhomogeneous enhancement (arrow); because it was not radically resectable, it was controlled with radiofrequency ablation and partial necrosis of tumor tissue.\nFig.\xa012.PTLD. Large-cell rhinopharyngeal and thoracic malignant lymphoma developed about 1 year after isolated bowel transplantation. A Solid nonhomogeneous tissue of the rhinopharynx wall spreads toward the parapharyngeal and prevertebral spaces (white arrows) and toward the nasal fossa (black arrow). B In the lung, several confluent areas of parenchymal consolidation, some of which are round, are visible (white arrows). C These lesions are larger at 2-month follow-up on CT.'], '261_2004_288_f13': ['In all patients, MR allowed evaluation of the morphology, transit, and wall enhancement of transplanted loops. Moreover, dynamic sequences permitted angiographic study of vascular axes (Fig.\xa0<xref rid="261_2004_288_f13" ref-type="fig">13</xref>).\n).\nFig.\xa013.Posttransplantation MR imaging. (A) Coronal SSFSE T2-weighted sequence, (B) coronal FMPSPGR sequence, (C) sagittal SSFSE T2-weighted sequences, and (D, E) coronal FMPSPGR sequence performed 30, 60, 120, and 300 s after intravenous injection of gadolinium DOTA, and (F) compressed images after dynamic evaluation. Superparamagnetic contrast agent was orally administered about 1 h before examination (white arrow in A). The coronal plane clearly displays intestinal loops and vascular axes. SSFSE sequences, after orally administered superparamagnetic contrast agent, allowed careful evaluation of the transplanted loops by visualizing normal loops with dark intraluminal signal (due to contrast agent) and abnormal loops with white intraluminal signal (due to intestinal fluids, without contrast agent; black arrow in A). FMPSPGR sequences accurately display vascular axes, intestinal walls, and their contrast enhancement (white arrows in D, E).']} | Radiologic imaging of the transplanted bowel | [
"Intestinal transplantation",
"Traditional ra- diologic evaluation",
"Radiopaque markers",
"Computed tomography",
"Ultrasound",
"Magnetic resonance"
] | Abdom Imaging | 1109923200 | [{'@Label': 'PURPOSE', '@NlmCategory': 'OBJECTIVE', '#text': 'The aim of this study was to investigate the changes in oxidative stress and antioxidants in lung tissue under different tidal volume ventilation conditions.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'Forty-eight male Wistar rats were randomized into four groups, namely, group C, the control group, which was not ventilated, and groups C1, C2 and C3, the treatment groups, which were ventilated for 2 h with tidal volumes of 8, 30 and 42 ml/kg, respectively. The right middle lobe was assayed for malondialdehyde (MDA), the right posterior lobe was assayed using Western blotting for Nrf2, GCLm and SrX1 and the left lobe was assayed for Nrf2, GCLm and SrX1 mRNA.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'The MDA levels were increased in the three treatment groups, with MDA levels highest in group C3 and lowest in group C1 (C3 > C2 > C1) (all P < 0.05). The mRNA expression of Nrf2, GCLm and SrX1 was highest in group C3 and lowest in group 1 (C3 > C2 > C1) (all P < 0.05). No significant difference was observed between group C1 and group C (P > 0.05). A Western blot analysis showed that Nrf2, GCLm and SrX1 expression was highest in group C3 and lowest in group C1 (C3 > C2 > C1) (all P < 0.05). No significant difference was observed between group C1 and group C (P > 0.05).'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'Oxidative stress and antioxidant enzyme levels in the lungs of rats were positively associated with the tidal volumes of mechanical ventilation, suggesting that higher tidal volumes cause more severe oxidative stress and increased antioxidant responses.'}] | [
"Animals",
"Antioxidants",
"Lung",
"Male",
"Malondialdehyde",
"Oxidative Stress",
"Rats",
"Rats, Wistar",
"Respiration, Artificial",
"Tidal Volume"
] | other | PMC7102087 | null | 23 | [
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] | Abdom Imaging. 2005 Mar 4; 30(5):548-563 | NO-CC CODE |
|
CT Angiography shows the free-floating thrombus of the left common carotid artery before (A) and after (C) systemic thrombolytic therapy at a three-day follow-up. Diffusion-weighted imaging showed multilocular cortical ischemic areas in the left ACM territory caused by ruptured thrombus material (B) | 42399_2023_1465_Fig1_HTML | 7 | 7460e3dcd3421c8e77aee8b848b297ac9773d7ab54d4a3528ed838aed34e3b56 | 42399_2023_1465_Fig1_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
708,
517
] | [{'image_id': '42399_2023_1465_Fig1_HTML', 'image_file_name': '42399_2023_1465_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC10140722/42399_2023_1465_Fig1_HTML.jpg', 'caption': 'CT Angiography shows the free-floating thrombus of the left common carotid artery before (A) and after (C) systemic thrombolytic therapy at a three-day follow-up. Diffusion-weighted imaging showed multilocular cortical ischemic areas in the left ACM territory caused by ruptured thrombus material (B)', 'hash': '7460e3dcd3421c8e77aee8b848b297ac9773d7ab54d4a3528ed838aed34e3b56'}, {'image_id': '42399_2023_1465_Fig2_HTML', 'image_file_name': '42399_2023_1465_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC10140722/42399_2023_1465_Fig2_HTML.jpg', 'caption': 'Course of stroke, platelet count, and COVID-19 disease progression. SARS-CoV-2 infection was associated with fever and overall weakness for 5 days (full bar). At admission, the platelet count was 892 × 109/l, and the patient tested positive for COVID-19 without any related pulmonary symptoms (transparent bar). The patient had her first positive SARS-CoV-2 test 14 days before the stroke onset', 'hash': '3a5ca8fd330e6d5ab2a583b23ef6f533ed61476067e4a8ed1685a3a15c98f0eb'}] | {'42399_2023_1465_Fig1_HTML': ['At admission, platelet count was significantly increased at 896 × 109/l, and anemia with hemoglobin 8.1 g/dl and leukocytosis 16.5 × 109/l were also apparent. Eight days prior to the onset of symptoms, the platelet count was measured at 26 × 109/l. Initial brain imaging by computer tomography (CT) was unremarkable, but CT angiography (CTA) of the head and neck revealed a nearly occluding intraluminal thrombus (0.7 × 0.9 cm) in the distal left common carotid artery (CCA) extending into the carotid bifurcation and left internal carotid artery (ICA), leading to a >80% stenosis as per NASCET criteria. A second thrombus was detected within the left ICA (0.3 × 0.3 × 0.4) without stenotic effect (Fig. <xref rid="42399_2023_1465_Fig1_HTML" ref-type="fig">1</xref>A). Due to the risk of further embolization of more distal regions by mechanical intervention, a systemic lysis therapy with 70 mg recombinant tissue plasminogen activator (rt-PA) was immediately initiated at a body weight of 78 kg (receiving 0.9 mg/kg dose), followed by continuous anticoagulation with heparin 24000 IE/24 h after 24 h. Diffusion-based imaging revealed multilocular cortical ischemic areas in the left middle cerebral artery (MCA) territory (Fig. A). Due to the risk of further embolization of more distal regions by mechanical intervention, a systemic lysis therapy with 70 mg recombinant tissue plasminogen activator (rt-PA) was immediately initiated at a body weight of 78 kg (receiving 0.9 mg/kg dose), followed by continuous anticoagulation with heparin 24000 IE/24 h after 24 h. Diffusion-based imaging revealed multilocular cortical ischemic areas in the left middle cerebral artery (MCA) territory (Fig. <xref rid="42399_2023_1465_Fig1_HTML" ref-type="fig">1</xref>B). CT angiographic follow-up imaging three days after admission showed complete lysis of the thrombotic material in the left CCA and ICA bifurcation (Fig. B). CT angiographic follow-up imaging three days after admission showed complete lysis of the thrombotic material in the left CCA and ICA bifurcation (Fig. <xref rid="42399_2023_1465_Fig1_HTML" ref-type="fig">1</xref>C). Eltrombopag was paused upon admission and resumed at a reduced dosage of 25 mg/24 h after the patient’s platelet count reached a cut-off platelet count <500 × 10C). Eltrombopag was paused upon admission and resumed at a reduced dosage of 25 mg/24 h after the patient’s platelet count reached a cut-off platelet count <500 × 109/l, which occurred five days after stroke onset.Fig. 1CT Angiography shows the free-floating thrombus of the left common carotid artery before (A) and after (C) systemic thrombolytic therapy at a three-day follow-up. Diffusion-weighted imaging showed multilocular cortical ischemic areas in the left ACM territory caused by ruptured thrombus material (B)'], '42399_2023_1465_Fig2_HTML': ['At discharge, the patient showed very mild sensorimotor paresis of the right side, NIHSS 2, mRS 1. The patient was discharged with lifelong secondary prophylaxis of acetylsalicylic acid 100 mg/24 h and Simvastatin 40 mg/24 h. No antiviral treatment was administered due to the absence of pulmonary symptoms and the fact that the COVID-19 infection had been progressing for 10 days before admission. The patient’s platelet count was monitored daily after discharge. Two months after discharge, the patient’s platelet count remained unstable, ranging between 5 and 419 × 109/l (Fig. <xref rid="42399_2023_1465_Fig2_HTML" ref-type="fig">2</xref>). As a result, the referral doctor adjusted the patient’s eltrombopag dosage, and acetylsalicylic acid was temporarily paused.). As a result, the referral doctor adjusted the patient’s eltrombopag dosage, and acetylsalicylic acid was temporarily paused.Fig. 2Course of stroke, platelet count, and COVID-19 disease progression. SARS-CoV-2 infection was associated with fever and overall weakness for 5 days (full bar). At admission, the platelet count was 892 × 109/l, and the patient tested positive for COVID-19 without any related pulmonary symptoms (transparent bar). The patient had her first positive SARS-CoV-2 test 14 days before the stroke onset']} | Successful Systemic Lysis Therapy of a Floating Carotid Thrombus in an Acute Stroke Patient with Known Immune Thrombocytopenia (ITP) on Ongoing Eltrombopag Therapy and Acute COVID-19 Infection: a Case Report | [
"Stroke",
"Systemic lysis",
"Immune thrombocytopenia (ITP)",
"Thrombopoietin receptor agonist (TPO-RA)",
"Eltrombopag",
"COVID-19 infection"
] | SN Compr Clin Med | 1682665200 | [{'@Label': 'BACKGROUND', '@NlmCategory': 'UNASSIGNED', '#text': 'The current study aimed at assessing the levels of perinatal depression (i.e., both antenatal and postnatal) during the fourth wave of the COVID-19 outbreak in a group of Italian women, as well as to evaluate the role of loneliness, anxiety, and lack of maternal support in cumulatively predicting perinatal depression.'}, {'@Label': 'METHODS', '@NlmCategory': 'UNASSIGNED', '#text': "A cross-sectional study was conducted with 200 Italian women recruited during a peak of the COVID-19 pandemic in Italy (i.e., from September to December 2021) from a single prenatal clinic in Southern Italy. A non-parametric binomial test was conducted to assess whether the perinatal depression frequencies of the current sample differed from those found in a pre-Covid reference group. Additionally, hierarchical multiple linear regression analyses assessing whether loneliness, anxiety, and maternal support affected women's perinatal depression were also conducted."}, {'@Label': 'RESULTS', '@NlmCategory': 'UNASSIGNED', '#text': 'The general prevalence of perinatal depression was significantly higher in participants recruited during the fourth wave of the COVID-19 pandemic compared to the pre-Covid reference group (29% vs. 9.2%). However, results showed that, contrary to postnatal depression (18.2% vs. 19.9%), only the prevalence of antenatal depression was significantly higher compared to the pre-Covid reference group (39.6% vs. 6.4%). Furthermore, loneliness and anxiety, but not maternal support, were associated with higher levels of PD.'}, {'@Label': 'LIMITATIONS', '@NlmCategory': 'UNASSIGNED', '#text': 'Limitations concerned the cross-sectional nature of the study and the relatively small sample size.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'UNASSIGNED', '#text': 'This study sheds light on the need to address perinatal mental health of women during major stressful events, such as the COVID-19 pandemic.'}] | [] | other | PMC10140722 | null | 73 | [
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] | SN Compr Clin Med. 2023 Apr 28; 5(1):133 | NO-CC CODE |
|
Pulmonary computed tomography scanning of the patient showed ground glass opacity due to COVID-19. | gr2_lrg | 7 | 929d57f611e80312c6519b937d48f3d841b0aa62e33287dc7c7059f6e0195b40 | gr2_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
750,
684
] | [{'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7184016/gr2_lrg.jpg', 'caption': 'Pulmonary computed tomography scanning of the patient showed ground glass opacity due to COVID-19.', 'hash': '929d57f611e80312c6519b937d48f3d841b0aa62e33287dc7c7059f6e0195b40'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7184016/gr1_lrg.jpg', 'caption': 'Watery eye discharge accompanied by conjunctival follicular reaction and chemosis; lower lid was everted by the examiner to show palpebral conjunctiva.', 'hash': '3ed76f941d1f1da53eef4fd62f85714e3cd440d6985f371961fdd61ab5da0b19'}] | {'gr1_lrg': ['A 65-years-old Caucasian diabetic male patient presented to the ophthalmology clinic complaining of burning eye and discharge for the last two days. He denied having fever, cough, or any other symptoms. His body temperature was 98.2 °F (36.8 °C) and 98.4 °F (36.9 °C) at two separate measures. His past medical history was only significant for diabetes mellitus under treatment with Metformin 500 mg twice daily. He did not have a recent travel history or any illnesses. Slit lamp examination yielded mucoid discharge and follicular conjunctivitis (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>\n). Establishing a diagnosis of viral conjunctivitis, symptomatic treatment with artificial tear was prescribed. Two days later, the patient visited emergency room with a sudden-onset fever of 101.4 °F, dry cough, and shortness of breath. A computed tomography (CT) scanning of the chest revealed bilateral ground glass opacity of the lungs (\n). Establishing a diagnosis of viral conjunctivitis, symptomatic treatment with artificial tear was prescribed. Two days later, the patient visited emergency room with a sudden-onset fever of 101.4 °F, dry cough, and shortness of breath. A computed tomography (CT) scanning of the chest revealed bilateral ground glass opacity of the lungs (<xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>\n). The real-time reverse transcription polymerase chain reaction (RT-PCR) of the nasopharyngeal swab confirmed the diagnosis of COVID-19. Subsequently, another RT-PCR testing of the conjunctival secretion was positive for COVID-19 at two separate occasions. Patient received supportive care with nasal 100 % O\n). The real-time reverse transcription polymerase chain reaction (RT-PCR) of the nasopharyngeal swab confirmed the diagnosis of COVID-19. Subsequently, another RT-PCR testing of the conjunctival secretion was positive for COVID-19 at two separate occasions. Patient received supportive care with nasal 100 % O2 along with oral administration of Oseltamivir capsule 75 mg bid and Hydroxychloroquine tablet 200 mg bid. Following improvement of symptoms, he was discharged home uneventfully.Fig. 1Watery eye discharge accompanied by conjunctival follicular reaction and chemosis; lower lid was everted by the examiner to show palpebral conjunctiva.Fig. 1Fig. 2Pulmonary computed tomography scanning of the patient showed ground glass opacity due to COVID-19.Fig. 2']} | Corona virus disease-19 (COVID-19) presenting as conjunctivitis: atypically high-risk during a pandemic | [
"Conjunctivitis",
"Covid-19",
"Corona virus-related conjunctivitis"
] | Cont Lens Anterior Eye | 1593241200 | The rapid spread of a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to an ongoing pandemic of coronavirus disease 2019 (COVID-19). Recently, angiotensin-converting enzyme 2 (ACE2) has been shown to be a functional receptor for SARS-CoV-2 to enter host target cells. Given that angiotensin receptor blockers (ARBs) and an ACE inhibitor (ACEI) upregulated ACE2 expression in animal studies, the concern might arise regarding whether ARBs and ACEIs would increase the morbidity and mortality of COVID-19. On the other hand, animal data suggested a potential protective effect of ARBs against COVID-19 pneumonia because an ARB prevented the aggravation of acute lung injury in mice infected with SARS-CoV, which is closely related to SARS-CoV-2. Importantly, however, there is no clinical or experimental evidence supporting that ARBs and ACEIs either augment the susceptibility to SARS-CoV-2 or aggravate the severity and outcomes of COVID-19 at present. Until further data are available, it is recommended that ARB and ACEI medications be continued for the treatment of patients with cardiovascular disease and hypertension, especially those at high risk, according to guideline-directed medical therapy based on the currently available evidence. | [
"Angiotensin II",
"Angiotensin Receptor Antagonists",
"Angiotensin-Converting Enzyme 2",
"Angiotensin-Converting Enzyme Inhibitors",
"Animals",
"Betacoronavirus",
"COVID-19",
"Coronavirus Infections",
"Humans",
"Pandemics",
"Peptidyl-Dipeptidase A",
"Pneumonia, Viral",
"SARS-CoV-2"
] | other | PMC7184016 | null | 45 | [
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] | Cont Lens Anterior Eye. 2020 Jun 27; 43(3):211-212 | NO-CC CODE |
|
Radio-anatomie TDM des cavités nasosinusiennes.A. Reconstruction frontale pour les sinus frontaux. B. Reconstruction frontale pour les méats moyens. C. Reconstruction frontale pour les méats supérieurs. D. Reconstruction sagittale par le toit ethmoïdo-frontal. E. Reconstruction axiale par les méats moyens. F. Reconstruction axiale par les masses ethmoïdales latérales. 1 : sinus maxillaire ; 2 : canal lacrymo-nasal ; 3 : cellule unciformienne ; 4 : sinus frontal ; 5 : cellule méatique ; 6 : tête du cornet moyen ; 7 : foramen infra-orbitaire ; 8 : cornet inférieur ; 9 : méat inférieur ; 10 : méat moyen ; 11 : racine d’attache du cornet moyen ; 12 : bulle ; 13 : fente olfactive ; 14 : toit ethmoïdo-frontal ; 15 : lame criblée ; 16 : canal infundibulaire ; 17 : ostium maxillaire ; 18 : processus unciformien ; 19 : cellule ethmoïdale postérieure ; 20 : cornet supérieur ; 21 : méat supérieur ; 22 : ostium sphénoïdal ; 23 : sinus sphénoïdal ; 24 : racine cloisonnante du méat moyen ; 25 : racine de la bulle ; 26 : canal nasofrontal ; 27 : racine de l’unciforme. | f10-03-9782294745034 | 7 | f7af7475946a301d18ff3d384dd52b8f9c058b47c2e02ca093137ec15bf952e2 | f10-03-9782294745034.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
623,
410
] | [{'image_id': 'f10-09-9782294745034', 'image_file_name': 'f10-09-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-09-9782294745034.jpg', 'caption': 'Pathologies rhinosinusiennes rares.A. Concha bullosa bilatérale. Pneumatisation des cornets moyens chez un sujet asymptomatique (astérisques). B.\xa0Infection d’une concha bullosa gauche (astérisque) chez un patient présentant de violentes algies nasales. C. Mucocèle du sinus maxillaire gauche. D. Granulomatose de Wegener droite (encadré\xa010.2).', 'hash': 'f4d4a393f9372c1034ab6d60479efbce10454e9b8d7dcca54f4531ec490603ea'}, {'image_id': 'u10-01-9782294745034', 'image_file_name': 'u10-01-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-01-9782294745034.jpg', 'caption': 'Classification de Chandler.A. Stade I\xa0: œdème palpébral seul avec cellulite péri-orbitaire préseptale. B. Stade II\xa0: cellulite orbitaire avec exophtalmie réductible. C. Stade III\xa0: abcès orbitaire sous-périosté avec exophtalmie non réductible et\xa0ophtalmoplégie partielle. Stade IV\xa0: exophtalmie importante, ophtalmoplégie et abcès orbitaire nécessitant un\xa0drainage.', 'hash': '3c434c5d12e1cad6f022d9e09cb88ce42efb66afa4eeec92c2ce022c460ac2b9'}, {'image_id': 'f10-02-9782294745034', 'image_file_name': 'f10-02-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-02-9782294745034.jpg', 'caption': 'Masse latérale de l’ethmoïde gauche après\xa0ablation du cornet moyen.1\xa0: cellule méatique et cellule uncinée\xa0; 2\xa0: cellule bullaire\xa0; 3\xa0: racine cloisonnante du cornet moyen\xa0; 4\xa0: cellules ethmoïdales postérieures\xa0; 5\xa0: ostium du sinus maxillaire\xa0; 6\xa0: sphénoïde et son ostium\xa0; CI\xa0: cornet inférieur\xa0; GUB\xa0: gouttière uncibullaire\xa0; NF\xa0: canal nasofrontal (flèche) se prolongeant par la gouttière uncibullaire.', 'hash': '2746fdda2a56d4f48eeb02e38705f716754152f3a875e11d1d83a0fd1e01fe5b'}, {'image_id': 'f10-11-9782294745034', 'image_file_name': 'f10-11-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-11-9782294745034.jpg', 'caption': 'Résultats endoscopiques de la chirurgie endonasale.A. Élargissement de l’ostium du sinus maxillaire gauche (méatotomie) avec conservation partielle du cornet moyen et retour à la normale de la muqueuse du sinus. B. Méatotomie du sinus maxillaire droit avec persistance d’une inflammation diffuse et phénomène de la cuvette désignant le fait que le bas-fond sinusien est devenu le réceptacle des sécrétions nasales. C. Bons résultats d’un évidement ethmoïdo-maxillaire droit avec quelques sécrétions dans la méatotomie. D. Résultat d’évidement ethmoïdo-maxillaire gauche. CL\xa0: cloison\xa0; B\xa0: toit de la bulle\xa0; RC\xa0: racine cloisonnante\xa0; SP\xa0: cellule ethmoïdale postérieure\xa0; CH\xa0: choane et rhinopharynx\xa0; SM\xa0: sinus maxillaire.', 'hash': '26331484cbb96020267c2eb0c9b5e19f70c8a8d75fb7f36c306073d06ef9281b'}, {'image_id': 'f10-04-9782294745034', 'image_file_name': 'f10-04-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-04-9782294745034.jpg', 'caption': 'Rhinite vestibulaire.Surinfection de la portion cutanée de fosse nasale à\xa0staphylocoque aureus, à traiter par des applications d’acide fusidique crème.', 'hash': 'a7a18f48be8034fa80c77d3044ed4d083cf96d83bf22c39641d9cabfc77a4f49'}, {'image_id': 'f10-03-9782294745034', 'image_file_name': 'f10-03-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-03-9782294745034.jpg', 'caption': 'Radio-anatomie TDM des cavités nasosinusiennes.A. Reconstruction frontale pour les sinus frontaux. B. Reconstruction frontale pour les méats moyens. C. Reconstruction frontale pour les méats supérieurs. D. Reconstruction sagittale par le toit ethmoïdo-frontal. E. Reconstruction axiale par les méats moyens. F. Reconstruction axiale par les masses ethmoïdales latérales. 1\xa0: sinus maxillaire\xa0; 2\xa0: canal lacrymo-nasal\xa0; 3\xa0: cellule unciformienne\xa0; 4\xa0: sinus frontal\xa0; 5\xa0: cellule méatique\xa0; 6\xa0: tête du cornet moyen\xa0; 7\xa0: foramen infra-orbitaire\xa0; 8\xa0: cornet inférieur\xa0; 9\xa0: méat inférieur\xa0; 10\xa0: méat moyen\xa0; 11\xa0: racine d’attache du cornet moyen\xa0; 12\xa0: bulle\xa0; 13\xa0: fente olfactive\xa0; 14\xa0: toit ethmoïdo-frontal\xa0; 15\xa0: lame criblée\xa0; 16\xa0: canal infundibulaire\xa0; 17\xa0: ostium maxillaire\xa0; 18\xa0: processus unciformien\xa0; 19\xa0: cellule ethmoïdale postérieure\xa0; 20\xa0: cornet supérieur\xa0; 21\xa0: méat supérieur\xa0; 22\xa0: ostium sphénoïdal\xa0; 23\xa0: sinus sphénoïdal\xa0; 24\xa0: racine cloisonnante du méat moyen\xa0; 25\xa0: racine de la bulle\xa0; 26\xa0: canal nasofrontal\xa0; 27\xa0: racine de l’unciforme.', 'hash': 'f7af7475946a301d18ff3d384dd52b8f9c058b47c2e02ca093137ec15bf952e2'}, {'image_id': 'f10-08-9782294745034', 'image_file_name': 'f10-08-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-08-9782294745034.jpg', 'caption': 'Formes cliniques de RSC.A. Opacité de tout le sinus frontal gauche en coupe coronale. B. Opacité du sinus sphénoïdal droit en coupe axiale. En avant, le canal optique rejoint l’orbite. En arrière, le canal carotidien vu en coupe est intact. C. Sinusite aspergillaireSinusiteaspergillaire gauche typique avec lyse osseuse et petits mycétomes opaques disséminés dans l’opacité. D. Sinusite maxillaire d’origine dentaire avec lyse alvéolaire.', 'hash': '5515a3121692cd6c1d8bc5eb7949cf24d609e73b9ae1b97e3809bd76e49828f9'}, {'image_id': 'f10-10-9782294745034', 'image_file_name': 'f10-10-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-10-9782294745034.jpg', 'caption': 'Indications chirurgicales indiscutables.A. Clou de LermoyezClou de Lermoyez pour drainage et lavage du sinus frontal. B. Cure d’une fistule buccosinusienne. Cathétérisme. C.\xa0Abord du sinus maxillaire droit par voie de Caldwell-Luc. D. Découverte de la truffe aspergillaire.', 'hash': '31e27956c0cf89d51a494a5df876ba32a26229756f4473df0d63fb70b45d4046'}, {'image_id': 'f10-05-9782294745034', 'image_file_name': 'f10-05-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-05-9782294745034.jpg', 'caption': 'Incidence de Blondeau.A. Opacité d’une sinusite maxillaire droite. B. Niveau liquide d’une sinusite maxillaire gauche. C. Kyste muqueux rétentionnel du bas-fond sinusien, séquelle d’une sinusite maxillaire ancienne (image dite en coucher de soleil). D. Aspect de faux niveaux liquides donné par la projection des os temporaux dans le sinus maxillaire lorsque la tête est insuffisamment défléchie.', 'hash': 'aede2f22f3d31f411a00db7a8693863f85abf069ef4de5f452146ec5214a106d'}, {'image_id': 'u10-06-9782294745034', 'image_file_name': 'u10-06-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-06-9782294745034.jpg', 'caption': 'Truffe aspergillaire sphénoïdale.Patient souffrant de violentes céphalées depuis plusieurs mois. Un scanner en coupes axiales montre une opacité complète du sinus sphénoïdal gauche, avec en coupe coronale une opacité évoquant un mycétome aspergillaire. Il n’y a pas d’érosions osseuses. L’intervention commence par une section de la lame verticale du cornet moyen puis de sa racine cloisonnante horizontale. Le cornet moyen vient ainsi en deux morceaux. On découvre alors l’orifice sphénoïdal gauche rempli par une balle fungique noirâtre. Il est élargi à la pince emporte-pièce et la totalité de la truffe peut être enlevée. Les céphalées ne se reproduisent plus.', 'hash': 'e280199dfb4225f9d230705a8f873f6f6de7b93d1281760f860fd001b89355fb'}, {'image_id': 'u10-03-9782294745034', 'image_file_name': 'u10-03-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-03-9782294745034.jpg', 'caption': 'Formes extensives caricaturales.A.\xa0Cette patiente se coupe les polypes avec des ciseaux. B.\xa0Syndrome de Woakes\xa0: les polypes déforment les os propres du nez (flèches).', 'hash': '3806775d5f1523ce0b4f963a4efc72f3fb71e1cf97805f7158e6cc0d9fd430fe'}, {'image_id': 'f10-06-9782294745034', 'image_file_name': 'f10-06-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-06-9782294745034.jpg', 'caption': 'Endoscopie nasale au cours d’une rhinosinusite chronique.A. Suppuration dans le méat moyen droit. B. Suppuration ethmoïdale. C. Sinusite frontale chronique avec pus dans le\xa0méat moyen et bourrelet de Kaufman (hyperplasie de l’apophyse uncinée). D. Polype luisant et transparent de la fosse nasale gauche.', 'hash': 'a10dfead464cad1b140c33ed13738d2ba3d5669c96a93b3338cb99e8ea276265'}, {'image_id': 'u10-05-9782294745034', 'image_file_name': 'u10-05-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-05-9782294745034.jpg', 'caption': 'Résultat d’une chirurgie endoscopique ethmoïdo-sphénoïdo-maxillaire.Cette patiente a été prise en charge pour une polypose nasosinusienne bilatérale comportant des mycétomes aspergillaires. Du côté droit, les cavités ont bien cicatrisé. On aperçoit le reliquat de cornet moyen (CM), l’ethmoïde antérieur et postérieur (EA et EP), les sinus maxillaire et sphénoïdal (SM et SP). On pénètre dans le sinus sphénoïdal avec ses deux reliefs caractéristiques\xa0: le nerf optique horizontal et la carotide interne verticale. Du côté gauche, c’est la même chose avec les ouvertures béantes du sinus maxillaire sur la droite et du sinus sphénoïdal en\xa0arrière.', 'hash': '801c6e7fa2015963250007c8be6afe623c21bc5c8bb90f59517a205272438cfa'}, {'image_id': 'u10-02-9782294745034', 'image_file_name': 'u10-02-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-02-9782294745034.jpg', 'caption': 'Abcès sous-périosté sur ethmoïdite.TDM axiale en fenêtre parenchymateuse\xa0: comblement des cellules ethmoïdales gauches avec abcès sous-périosté en regard, refoulant le muscle droit médial (flèche) avec en arrière des zones denses d’inflammation au sein de la graisse hypodense.', 'hash': '302e6605e9bd0e62fbabce24484d996d5e6d3f40ed801fe08beabc1a8584870c'}, {'image_id': 'f10-01-9782294745034', 'image_file_name': 'f10-01-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-01-9782294745034.jpg', 'caption': 'Vues endoscopiques de la fosse nasale droite.A. Vestibule nasal. 1\xa0: cornet inférieur\xa0; 2\xa0: septum nasal\xa0; 3\xa0: plancher de la cavité nasale. B. Valve septo-turbinale. 1\xa0: cornet inférieur\xa0; 2\xa0: cornet moyen\xa0; 3\xa0: septum nasal. C. Partie antérieure du plancher de la fosse nasale. 1\xa0: corps du cornet inférieur\xa0; 2\xa0: plancher de la cavité nasale\xa0; 3\xa0: septum nasal. D. Partie postérieure du plancher de la fosse nasale. 1\xa0: cornet moyen\xa0; 2\xa0: cornet inférieur\xa0; 3\xa0: septum nasal\xa0; 4\xa0: orifice choanal. E. Crête septale. 1\xa0: cornet moyen\xa0; 2\xa0: articulation chondro-vomérienne. F. Cornet inférieur. 1\xa0: sa tête\xa0; 2\xa0: septum nasal.', 'hash': '080b78130664151d8d8c9b471f9950445b7c949a45023a38042be4fe1c151a7f'}, {'image_id': 'u10-04-9782294745034', 'image_file_name': 'u10-04-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-04-9782294745034.jpg', 'caption': 'Chirurgie endoscopique pour polypose nasosinusienne.Le shaver est un aspirateur grignotant les polypes dans ses mâchoires rotatives. Ce patient présente une polypose nasosinusienne floride et handicapante bilatérale. Avec le shaver, on se fraye facilement un chemin vers le cornet moyen, dans le méat moyen, et on rentre dans l’ethmoïde, ce qui permet de réaliser un évidement ethmoïdal complet. Cet instrument est efficace et atraumatique, mais l’intervention ne dispense pas de la prise en charge médicale. On entre ensuite dans le sinus maxillaire pour\xa0détruire les polypes qu’il contient.', 'hash': 'b1fa5a3d48db44b51d89e2d9c7518c67078ffdaa074a29fc22df96c8940c5b28'}, {'image_id': 'f10-07-9782294745034', 'image_file_name': 'f10-07-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-07-9782294745034.jpg', 'caption': 'TDM de rhinosinusites chroniques ethmoïdo-maxillaires.A et B. Forme antérieure gauche avec opacité des cellules ethmoïdales antérieures en coupe axiale (A) et ostéolyse en coupe coronale (B). C. RSC invasive avec image en bissac d’un polype antrochoanal. D. Polypose nasosinusienne. Opacité diffuse de toutes les cellules ethmoïdales en coupe coronale.', 'hash': '54efa1d99392ac9eb68e85aa421e4a6b2c93dffd243fe87a990f8707de7d7c6a'}, {'image_id': 'f10-12-9782294745034', 'image_file_name': 'f10-12-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-12-9782294745034.jpg', 'caption': 'Résultats TDM de vidéochirurgies endonasales.A. Méatotomie droite en coupe coronale (flèche). B et C. Avant et après méatotomie (flèche) en coupes axiales. D et E. Coupe axiale et coupe coronale postopératoires chez un patient ayant subi une ethmoïdectomie unilatérale gauche (astérisques). F. Grand évidement maxillo-ethmoïdo-frontal droit (astérisque\xa0: emplacement de l’ex-canal nasofrontal).', 'hash': 'cc7cce248465c44d1c14de6b16e85fafb4677abee2c9c9c0bd7d20d6a2f7b5aa'}] | {'f10-01-9782294745034': ['Elle se fait à l’optique 0° après mise en place de cotonnettes imbibées de xylocaïne et de vasoconstricteur (naphtazoline) pour anesthésier et rétracter les cornets. On explore ainsi les méats moyen et inférieur, le cavum avec son bourrelet tubaire et la fente olfactive en remontant le long du cornet moyen (<xref rid="f10-01-9782294745034" ref-type="fig">fig.\xa010.1</xref>\n). Avec une spatule fine, il faut\npalper les petits polypes dissimulés sous l’auvent du cornet moyen, pour provoquer l’issue de sécrétions purulentes qu’on pourra prélever pour étude bactériologique.\n). Avec une spatule fine, il faut\npalper les petits polypes dissimulés sous l’auvent du cornet moyen, pour provoquer l’issue de sécrétions purulentes qu’on pourra prélever pour étude bactériologique.Figure 10.1Vues endoscopiques de la fosse nasale droite.A. Vestibule nasal. 1\xa0: cornet inférieur\xa0; 2\xa0: septum nasal\xa0; 3\xa0: plancher de la cavité nasale. B. Valve septo-turbinale. 1\xa0: cornet inférieur\xa0; 2\xa0: cornet moyen\xa0; 3\xa0: septum nasal. C. Partie antérieure du plancher de la fosse nasale. 1\xa0: corps du cornet inférieur\xa0; 2\xa0: plancher de la cavité nasale\xa0; 3\xa0: septum nasal. D. Partie postérieure du plancher de la fosse nasale. 1\xa0: cornet moyen\xa0; 2\xa0: cornet inférieur\xa0; 3\xa0: septum nasal\xa0; 4\xa0: orifice choanal. E. Crête septale. 1\xa0: cornet moyen\xa0; 2\xa0: articulation chondro-vomérienne. F. Cornet inférieur. 1\xa0: sa tête\xa0; 2\xa0: septum nasal.Jean-Michel Klossek, Catherine Desmons, Elie Serrano, et al. Anatomie des cavités nasosinusiennes. EMC, Paris (Elsevier Masson), ORL, 1997\xa0: 1-0 [Article 20-265-A-10].'], 'f10-02-9782294745034': ['La masse latérale de l’ethmoïde est au centre des cavités sinusiennes. Son atteinte retentit sur tous les sinus du groupe antérieur. Elle est divisée par des lames osseuses frontales ou obliques (<xref rid="f10-02-9782294745034" ref-type="fig">fig.\xa010.2</xref>\n). La plus importante est appelée racine cloisonnante du cornet moyen. C’est elle qui divise l’ethmoïde en une partie antérieure et une partie postérieure. La partie antérieure est composée de de trois cellules\xa0: en avant, deux sont côte à côte, la cellule méatique et la cellule uncinée\xa0; la troisième est la cellule bullaire occupant toute la largeur de la masse latérale. Elle est située en arrière des précédentes et séparée d’elles par la gouttière uncibullaire. C’est dans cette gouttière arciforme que se drainent tous les sinus du groupe antérieur. Le sinus frontal se draine par le canal nasofrontal prolongeant la gouttière en haut. Le sinus maxillaire se draine par un ostium situé tout à l’arrière.\n). La plus importante est appelée racine cloisonnante du cornet moyen. C’est elle qui divise l’ethmoïde en une partie antérieure et une partie postérieure. La partie antérieure est composée de de trois cellules\xa0: en avant, deux sont côte à côte, la cellule méatique et la cellule uncinée\xa0; la troisième est la cellule bullaire occupant toute la largeur de la masse latérale. Elle est située en arrière des précédentes et séparée d’elles par la gouttière uncibullaire. C’est dans cette gouttière arciforme que se drainent tous les sinus du groupe antérieur. Le sinus frontal se draine par le canal nasofrontal prolongeant la gouttière en haut. Le sinus maxillaire se draine par un ostium situé tout à l’arrière.Figure 10.2Masse latérale de l’ethmoïde gauche après\xa0ablation du cornet moyen.1\xa0: cellule méatique et cellule uncinée\xa0; 2\xa0: cellule bullaire\xa0; 3\xa0: racine cloisonnante du cornet moyen\xa0; 4\xa0: cellules ethmoïdales postérieures\xa0; 5\xa0: ostium du sinus maxillaire\xa0; 6\xa0: sphénoïde et son ostium\xa0; CI\xa0: cornet inférieur\xa0; GUB\xa0: gouttière uncibullaire\xa0; NF\xa0: canal nasofrontal (flèche) se prolongeant par la gouttière uncibullaire.'], 'f10-03-9782294745034': ['Sur une coupe coronale, les repères morphologiques sont le cornet moyen, le méat moyen et l’ostium du sinus maxillaire (<xref rid="f10-03-9782294745034" ref-type="fig">fig.\xa010.3</xref>\n). La lame criblée de l’ethmoïde est à un niveau inférieur de celui du toit de l’ethmoïde. Sur une coupe axiale, il est possible d’évaluer la qualité de la lame papyracée qui représente la paroi interne de l’orbite séparant l’œil des cellules ethmoïdales.\n). La lame criblée de l’ethmoïde est à un niveau inférieur de celui du toit de l’ethmoïde. Sur une coupe axiale, il est possible d’évaluer la qualité de la lame papyracée qui représente la paroi interne de l’orbite séparant l’œil des cellules ethmoïdales.Figure 10.3Radio-anatomie TDM des cavités nasosinusiennes.A. Reconstruction frontale pour les sinus frontaux. B. Reconstruction frontale pour les méats moyens. C. Reconstruction frontale pour les méats supérieurs. D. Reconstruction sagittale par le toit ethmoïdo-frontal. E. Reconstruction axiale par les méats moyens. F. Reconstruction axiale par les masses ethmoïdales latérales. 1\xa0: sinus maxillaire\xa0; 2\xa0: canal lacrymo-nasal\xa0; 3\xa0: cellule unciformienne\xa0; 4\xa0: sinus frontal\xa0; 5\xa0: cellule méatique\xa0; 6\xa0: tête du cornet moyen\xa0; 7\xa0: foramen infra-orbitaire\xa0; 8\xa0: cornet inférieur\xa0; 9\xa0: méat inférieur\xa0; 10\xa0: méat moyen\xa0; 11\xa0: racine d’attache du cornet moyen\xa0; 12\xa0: bulle\xa0; 13\xa0: fente olfactive\xa0; 14\xa0: toit ethmoïdo-frontal\xa0; 15\xa0: lame criblée\xa0; 16\xa0: canal infundibulaire\xa0; 17\xa0: ostium maxillaire\xa0; 18\xa0: processus unciformien\xa0; 19\xa0: cellule ethmoïdale postérieure\xa0; 20\xa0: cornet supérieur\xa0; 21\xa0: méat supérieur\xa0; 22\xa0: ostium sphénoïdal\xa0; 23\xa0: sinus sphénoïdal\xa0; 24\xa0: racine cloisonnante du méat moyen\xa0; 25\xa0: racine de la bulle\xa0; 26\xa0: canal nasofrontal\xa0; 27\xa0: racine de l’unciforme.Ferrie J.-C, Fontanel J.-P, Delagranda A., et al. Imagerie radiologique des cavités sinusiennes et nasales. EMC, Paris (Elsevier Masson), ORL, 2007 [Article 20-422-A-10].'], 'f10-04-9782294745034': ['La rhinite aiguë commence par des frissons avec asthénie et courbatures. Le patient ressent une sécheresse du rhinopharynx avec sensation de cuisson. L’obstruction nasale s’installe avec des éternuements, de la rhinorrhée et un larmoiement. À l’examen, il existe une rougeur et un œdème de la tête des cornets inférieurs. L’exsudat inflammatoire est d’abord clair, puis les sécrétions s’épaississent, deviennent verdâtres et striées de sang lors du mouchage. Le vestibule narinaire se surinfecte (<xref rid="f10-04-9782294745034" ref-type="fig">fig.\xa010.4</xref>\n). Les symptômes régressent en cinq jours. La prise en charge repose sur le paracétamol, l’augmentation de la chaleur ambiante et sur un mouchage atraumatique, une fosse nasale l’une après l’autre.\n). Les symptômes régressent en cinq jours. La prise en charge repose sur le paracétamol, l’augmentation de la chaleur ambiante et sur un mouchage atraumatique, une fosse nasale l’une après l’autre.Figure 10.4Rhinite vestibulaire.Surinfection de la portion cutanée de fosse nasale à\xa0staphylocoque aureus, à traiter par des applications d’acide fusidique crème.'], 'f10-05-9782294745034': ['incidence de Blondeau (face basse ou nez-menton-plaque) mettant en évidence le sinus maxillaire (<xref rid="f10-05-9782294745034" ref-type="fig">fig.\xa010.5</xref>\n)\xa0;\n)\xa0;Figure 10.5Incidence de Blondeau.A. Opacité d’une sinusite maxillaire droite. B. Niveau liquide d’une sinusite maxillaire gauche. C. Kyste muqueux rétentionnel du bas-fond sinusien, séquelle d’une sinusite maxillaire ancienne (image dite en coucher de soleil). D. Aspect de faux niveaux liquides donné par la projection des os temporaux dans le sinus maxillaire lorsque la tête est insuffisamment défléchie.'], 'f10-06-9782294745034': ['Elle recherche la présence d’un drainage mucopurulent, d’une congestion œdémateuse des méats moyens, voire de polypes obstruant les fosses nasales (<xref rid="f10-06-9782294745034" ref-type="fig">fig.\xa010.6</xref>\n).\n).Figure 10.6Endoscopie nasale au cours d’une rhinosinusite chronique.A. Suppuration dans le méat moyen droit. B. Suppuration ethmoïdale. C. Sinusite frontale chronique avec pus dans le\xa0méat moyen et bourrelet de Kaufman (hyperplasie de l’apophyse uncinée). D. Polype luisant et transparent de la fosse nasale gauche.'], 'f10-07-9782294745034': ['Elle montre des épaississements muqueux localisés ou diffus, des opacités s’accompagnant parfois de niveaux liquides et d’érosions osseuses (<xref rid="f10-07-9782294745034" ref-type="fig">Figure 10.7</xref>, , <xref rid="f10-08-9782294745034" ref-type="fig">Figure 10.8</xref>, , <xref rid="f10-09-9782294745034" ref-type="fig">Figure 10.9</xref>\n).\n).Figure 10.7TDM de rhinosinusites chroniques ethmoïdo-maxillaires.A et B. Forme antérieure gauche avec opacité des cellules ethmoïdales antérieures en coupe axiale (A) et ostéolyse en coupe coronale (B). C. RSC invasive avec image en bissac d’un polype antrochoanal. D. Polypose nasosinusienne. Opacité diffuse de toutes les cellules ethmoïdales en coupe coronale.Figure 10.8Formes cliniques de RSC.A. Opacité de tout le sinus frontal gauche en coupe coronale. B. Opacité du sinus sphénoïdal droit en coupe axiale. En avant, le canal optique rejoint l’orbite. En arrière, le canal carotidien vu en coupe est intact. C. Sinusite aspergillaireSinusiteaspergillaire gauche typique avec lyse osseuse et petits mycétomes opaques disséminés dans l’opacité. D. Sinusite maxillaire d’origine dentaire avec lyse alvéolaire.Figure 10.9Pathologies rhinosinusiennes rares.A. Concha bullosa bilatérale. Pneumatisation des cornets moyens chez un sujet asymptomatique (astérisques). B.\xa0Infection d’une concha bullosa gauche (astérisque) chez un patient présentant de violentes algies nasales. C. Mucocèle du sinus maxillaire gauche. D. Granulomatose de Wegener droite (encadré\xa010.2).', 'Sa prévalence est de 1 à 4\xa0% de la population (cf.\n<xref rid="f10-07-9782294745034" ref-type="fig">fig.\xa010.7</xref>D et figure de l’D et figure de l’encadré\xa010.3). Par ordre de fréquence, on en distingue quatre formes\xa0:•la forme isolée ou associée à une poly-allergie\xa0;•la forme avec asthme\xa0;•la forme avec asthme et intolérance à l’aspirine (maladie métabolique de WidalMaladiemétabolique de Widal)\xa0;•mucoviscidose.\n'], 'f10-09-9782294745034': ['Outre les complications orbitaires et méningo-encéphaliques citées plus haut, il faut connaître l’existence des mucocèles. Dans sa forme extensive, c’est un kyste ethmoïdo-frontal ou maxillaire endosinusien se développant par blocage de l’ostium nasofrontal ou maxillaire. Il érode et amincit progressivement les parois osseuses jusqu’à bomber dans l’orbite au niveau de l’angle interne de l’œil (cf.\n<xref rid="f10-09-9782294745034" ref-type="fig">fig.\xa010.9</xref>C). Il contient un mucus épais et souvent aseptique.C). Il contient un mucus épais et souvent aseptique.'], 'f10-08-9782294745034': ['La TDM montre plusieurs aspects. Les petites opacités représentent des mycétomes disséminés au sein de l’opacité sinusienne (cf.\n<xref rid="f10-08-9782294745034" ref-type="fig">fig.\xa010.8</xref>C). L’aspect de balle fungique aspergillaire réalise une opacité unique au sein du sinus maxillaire. Il n’est pas rare de constater la présence de mycétome au sein d’une polypose.C). L’aspect de balle fungique aspergillaire réalise une opacité unique au sein du sinus maxillaire. Il n’est pas rare de constater la présence de mycétome au sein d’une polypose.'], 'f10-10-9782294745034': ['Dans le cas des sinusites frontales, le drainage et les lavages de sinus par un clou de Lermoyez sont efficaces (<xref rid="f10-10-9782294745034" ref-type="fig">fig.\xa010.10</xref>\nA). Il en est de même des lavages du sinus maxillaire par drain d’Albertini, modifié par Orsel.\nA). Il en est de même des lavages du sinus maxillaire par drain d’Albertini, modifié par Orsel.Figure 10.10Indications chirurgicales indiscutables.A. Clou de LermoyezClou de Lermoyez pour drainage et lavage du sinus frontal. B. Cure d’une fistule buccosinusienne. Cathétérisme. C.\xa0Abord du sinus maxillaire droit par voie de Caldwell-Luc. D. Découverte de la truffe aspergillaire.', 'Une grosse balle fungique reste même parfois l’indication d’une chirurgie de Caldwell-Luc (<xref rid="f10-10-9782294745034" ref-type="fig">fig.\xa010.10</xref>C et D).C et D).'], 'f10-11-9782294745034': ['\nDans les formes unilatérales de RSC, cette chirurgie donne d’excellents résultats, surtout s’il y a un facteur fungique de type Aspergillus (<xref rid="f10-11-9782294745034" ref-type="fig">Figure 10.11</xref>, , <xref rid="f10-12-9782294745034" ref-type="fig">Figure 10.12</xref>\n).\n).Figure 10.11Résultats endoscopiques de la chirurgie endonasale.A. Élargissement de l’ostium du sinus maxillaire gauche (méatotomie) avec conservation partielle du cornet moyen et retour à la normale de la muqueuse du sinus. B. Méatotomie du sinus maxillaire droit avec persistance d’une inflammation diffuse et phénomène de la cuvette désignant le fait que le bas-fond sinusien est devenu le réceptacle des sécrétions nasales. C. Bons résultats d’un évidement ethmoïdo-maxillaire droit avec quelques sécrétions dans la méatotomie. D. Résultat d’évidement ethmoïdo-maxillaire gauche. CL\xa0: cloison\xa0; B\xa0: toit de la bulle\xa0; RC\xa0: racine cloisonnante\xa0; SP\xa0: cellule ethmoïdale postérieure\xa0; CH\xa0: choane et rhinopharynx\xa0; SM\xa0: sinus maxillaire.Figure 10.12Résultats TDM de vidéochirurgies endonasales.A. Méatotomie droite en coupe coronale (flèche). B et C. Avant et après méatotomie (flèche) en coupes axiales. D et E. Coupe axiale et coupe coronale postopératoires chez un patient ayant subi une ethmoïdectomie unilatérale gauche (astérisques). F. Grand évidement maxillo-ethmoïdo-frontal droit (astérisque\xa0: emplacement de l’ex-canal nasofrontal).'], 'u10-04-9782294745034': ['\nDans les formes bilatérales, chez certains patients, un traitement local ne peut pas être entrepris, du fait de l’obstruction nasale en rapport avec les déformations septales, l’hyperplasie turbinale ou de l’importance de la polypose. Dans ces cas, la situation peut être débloquée par une vidéochirurgie endoscopique bilatérale. L’objectif est seulement de permettre le traitement local par lavages et corticoïdes locaux. Mais il ne faut pas promettre de miracle (<xref rid="u10-04-9782294745034" ref-type="fig">Vidéo e10.1</xref>, , <xref rid="u10-05-9782294745034" ref-type="fig">Vidéo e10.2</xref>, , <xref rid="u10-06-9782294745034" ref-type="fig">Vidéo e10.3</xref>\xa0\xa0).\nVidéo e10.1Chirurgie endoscopique pour polypose nasosinusienne.Le shaver est un aspirateur grignotant les polypes dans ses mâchoires rotatives. Ce patient présente une polypose nasosinusienne floride et handicapante bilatérale. Avec le shaver, on se fraye facilement un chemin vers le cornet moyen, dans le méat moyen, et on rentre dans l’ethmoïde, ce qui permet de réaliser un évidement ethmoïdal complet. Cet instrument est efficace et atraumatique, mais l’intervention ne dispense pas de la prise en charge médicale. On entre ensuite dans le sinus maxillaire pour\xa0détruire les polypes qu’il contient.Vidéo e10.2Résultat d’une chirurgie endoscopique ethmoïdo-sphénoïdo-maxillaire.Cette patiente a été prise en charge pour une polypose nasosinusienne bilatérale comportant des mycétomes aspergillaires. Du côté droit, les cavités ont bien cicatrisé. On aperçoit le reliquat de cornet moyen (CM), l’ethmoïde antérieur et postérieur (EA et EP), les sinus maxillaire et sphénoïdal (SM et SP). On pénètre dans le sinus sphénoïdal avec ses deux reliefs caractéristiques\xa0: le nerf optique horizontal et la carotide interne verticale. Du côté gauche, c’est la même chose avec les ouvertures béantes du sinus maxillaire sur la droite et du sinus sphénoïdal en\xa0arrière.Vidéo e10.3Truffe aspergillaire sphénoïdale.Patient souffrant de violentes céphalées depuis plusieurs mois. Un scanner en coupes axiales montre une opacité complète du sinus sphénoïdal gauche, avec en coupe coronale une opacité évoquant un mycétome aspergillaire. Il n’y a pas d’érosions osseuses. L’intervention commence par une section de la lame verticale du cornet moyen puis de sa racine cloisonnante horizontale. Le cornet moyen vient ainsi en deux morceaux. On découvre alors l’orifice sphénoïdal gauche rempli par une balle fungique noirâtre. Il est élargi à la pince emporte-pièce et la totalité de la truffe peut être enlevée. Les céphalées ne se reproduisent plus.']} | Rhinites, sinusites et rhinosinusites | null | None | 1474614000 | None | null | other | PMC7184226 | null | null | [
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Formes cliniques de RSC.A. Opacité de tout le sinus frontal gauche en coupe coronale. B. Opacité du sinus sphénoïdal droit en coupe axiale. En avant, le canal optique rejoint l’orbite. En arrière, le canal carotidien vu en coupe est intact. C. Sinusite aspergillaireSinusiteaspergillaire gauche typique avec lyse osseuse et petits mycétomes opaques disséminés dans l’opacité. D. Sinusite maxillaire d’origine dentaire avec lyse alvéolaire. | f10-08-9782294745034 | 7 | 5515a3121692cd6c1d8bc5eb7949cf24d609e73b9ae1b97e3809bd76e49828f9 | f10-08-9782294745034.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
605,
404
] | [{'image_id': 'f10-09-9782294745034', 'image_file_name': 'f10-09-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-09-9782294745034.jpg', 'caption': 'Pathologies rhinosinusiennes rares.A. Concha bullosa bilatérale. Pneumatisation des cornets moyens chez un sujet asymptomatique (astérisques). B.\xa0Infection d’une concha bullosa gauche (astérisque) chez un patient présentant de violentes algies nasales. C. Mucocèle du sinus maxillaire gauche. D. Granulomatose de Wegener droite (encadré\xa010.2).', 'hash': 'f4d4a393f9372c1034ab6d60479efbce10454e9b8d7dcca54f4531ec490603ea'}, {'image_id': 'u10-01-9782294745034', 'image_file_name': 'u10-01-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-01-9782294745034.jpg', 'caption': 'Classification de Chandler.A. Stade I\xa0: œdème palpébral seul avec cellulite péri-orbitaire préseptale. B. Stade II\xa0: cellulite orbitaire avec exophtalmie réductible. C. Stade III\xa0: abcès orbitaire sous-périosté avec exophtalmie non réductible et\xa0ophtalmoplégie partielle. Stade IV\xa0: exophtalmie importante, ophtalmoplégie et abcès orbitaire nécessitant un\xa0drainage.', 'hash': '3c434c5d12e1cad6f022d9e09cb88ce42efb66afa4eeec92c2ce022c460ac2b9'}, {'image_id': 'f10-02-9782294745034', 'image_file_name': 'f10-02-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-02-9782294745034.jpg', 'caption': 'Masse latérale de l’ethmoïde gauche après\xa0ablation du cornet moyen.1\xa0: cellule méatique et cellule uncinée\xa0; 2\xa0: cellule bullaire\xa0; 3\xa0: racine cloisonnante du cornet moyen\xa0; 4\xa0: cellules ethmoïdales postérieures\xa0; 5\xa0: ostium du sinus maxillaire\xa0; 6\xa0: sphénoïde et son ostium\xa0; CI\xa0: cornet inférieur\xa0; GUB\xa0: gouttière uncibullaire\xa0; NF\xa0: canal nasofrontal (flèche) se prolongeant par la gouttière uncibullaire.', 'hash': '2746fdda2a56d4f48eeb02e38705f716754152f3a875e11d1d83a0fd1e01fe5b'}, {'image_id': 'f10-11-9782294745034', 'image_file_name': 'f10-11-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-11-9782294745034.jpg', 'caption': 'Résultats endoscopiques de la chirurgie endonasale.A. Élargissement de l’ostium du sinus maxillaire gauche (méatotomie) avec conservation partielle du cornet moyen et retour à la normale de la muqueuse du sinus. B. Méatotomie du sinus maxillaire droit avec persistance d’une inflammation diffuse et phénomène de la cuvette désignant le fait que le bas-fond sinusien est devenu le réceptacle des sécrétions nasales. C. Bons résultats d’un évidement ethmoïdo-maxillaire droit avec quelques sécrétions dans la méatotomie. D. Résultat d’évidement ethmoïdo-maxillaire gauche. CL\xa0: cloison\xa0; B\xa0: toit de la bulle\xa0; RC\xa0: racine cloisonnante\xa0; SP\xa0: cellule ethmoïdale postérieure\xa0; CH\xa0: choane et rhinopharynx\xa0; SM\xa0: sinus maxillaire.', 'hash': '26331484cbb96020267c2eb0c9b5e19f70c8a8d75fb7f36c306073d06ef9281b'}, {'image_id': 'f10-04-9782294745034', 'image_file_name': 'f10-04-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-04-9782294745034.jpg', 'caption': 'Rhinite vestibulaire.Surinfection de la portion cutanée de fosse nasale à\xa0staphylocoque aureus, à traiter par des applications d’acide fusidique crème.', 'hash': 'a7a18f48be8034fa80c77d3044ed4d083cf96d83bf22c39641d9cabfc77a4f49'}, {'image_id': 'f10-03-9782294745034', 'image_file_name': 'f10-03-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-03-9782294745034.jpg', 'caption': 'Radio-anatomie TDM des cavités nasosinusiennes.A. Reconstruction frontale pour les sinus frontaux. B. Reconstruction frontale pour les méats moyens. C. Reconstruction frontale pour les méats supérieurs. D. Reconstruction sagittale par le toit ethmoïdo-frontal. E. Reconstruction axiale par les méats moyens. F. Reconstruction axiale par les masses ethmoïdales latérales. 1\xa0: sinus maxillaire\xa0; 2\xa0: canal lacrymo-nasal\xa0; 3\xa0: cellule unciformienne\xa0; 4\xa0: sinus frontal\xa0; 5\xa0: cellule méatique\xa0; 6\xa0: tête du cornet moyen\xa0; 7\xa0: foramen infra-orbitaire\xa0; 8\xa0: cornet inférieur\xa0; 9\xa0: méat inférieur\xa0; 10\xa0: méat moyen\xa0; 11\xa0: racine d’attache du cornet moyen\xa0; 12\xa0: bulle\xa0; 13\xa0: fente olfactive\xa0; 14\xa0: toit ethmoïdo-frontal\xa0; 15\xa0: lame criblée\xa0; 16\xa0: canal infundibulaire\xa0; 17\xa0: ostium maxillaire\xa0; 18\xa0: processus unciformien\xa0; 19\xa0: cellule ethmoïdale postérieure\xa0; 20\xa0: cornet supérieur\xa0; 21\xa0: méat supérieur\xa0; 22\xa0: ostium sphénoïdal\xa0; 23\xa0: sinus sphénoïdal\xa0; 24\xa0: racine cloisonnante du méat moyen\xa0; 25\xa0: racine de la bulle\xa0; 26\xa0: canal nasofrontal\xa0; 27\xa0: racine de l’unciforme.', 'hash': 'f7af7475946a301d18ff3d384dd52b8f9c058b47c2e02ca093137ec15bf952e2'}, {'image_id': 'f10-08-9782294745034', 'image_file_name': 'f10-08-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-08-9782294745034.jpg', 'caption': 'Formes cliniques de RSC.A. Opacité de tout le sinus frontal gauche en coupe coronale. B. Opacité du sinus sphénoïdal droit en coupe axiale. En avant, le canal optique rejoint l’orbite. En arrière, le canal carotidien vu en coupe est intact. C. Sinusite aspergillaireSinusiteaspergillaire gauche typique avec lyse osseuse et petits mycétomes opaques disséminés dans l’opacité. D. Sinusite maxillaire d’origine dentaire avec lyse alvéolaire.', 'hash': '5515a3121692cd6c1d8bc5eb7949cf24d609e73b9ae1b97e3809bd76e49828f9'}, {'image_id': 'f10-10-9782294745034', 'image_file_name': 'f10-10-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-10-9782294745034.jpg', 'caption': 'Indications chirurgicales indiscutables.A. Clou de LermoyezClou de Lermoyez pour drainage et lavage du sinus frontal. B. Cure d’une fistule buccosinusienne. Cathétérisme. C.\xa0Abord du sinus maxillaire droit par voie de Caldwell-Luc. D. Découverte de la truffe aspergillaire.', 'hash': '31e27956c0cf89d51a494a5df876ba32a26229756f4473df0d63fb70b45d4046'}, {'image_id': 'f10-05-9782294745034', 'image_file_name': 'f10-05-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-05-9782294745034.jpg', 'caption': 'Incidence de Blondeau.A. Opacité d’une sinusite maxillaire droite. B. Niveau liquide d’une sinusite maxillaire gauche. C. Kyste muqueux rétentionnel du bas-fond sinusien, séquelle d’une sinusite maxillaire ancienne (image dite en coucher de soleil). D. Aspect de faux niveaux liquides donné par la projection des os temporaux dans le sinus maxillaire lorsque la tête est insuffisamment défléchie.', 'hash': 'aede2f22f3d31f411a00db7a8693863f85abf069ef4de5f452146ec5214a106d'}, {'image_id': 'u10-06-9782294745034', 'image_file_name': 'u10-06-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-06-9782294745034.jpg', 'caption': 'Truffe aspergillaire sphénoïdale.Patient souffrant de violentes céphalées depuis plusieurs mois. Un scanner en coupes axiales montre une opacité complète du sinus sphénoïdal gauche, avec en coupe coronale une opacité évoquant un mycétome aspergillaire. Il n’y a pas d’érosions osseuses. L’intervention commence par une section de la lame verticale du cornet moyen puis de sa racine cloisonnante horizontale. Le cornet moyen vient ainsi en deux morceaux. On découvre alors l’orifice sphénoïdal gauche rempli par une balle fungique noirâtre. Il est élargi à la pince emporte-pièce et la totalité de la truffe peut être enlevée. Les céphalées ne se reproduisent plus.', 'hash': 'e280199dfb4225f9d230705a8f873f6f6de7b93d1281760f860fd001b89355fb'}, {'image_id': 'u10-03-9782294745034', 'image_file_name': 'u10-03-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-03-9782294745034.jpg', 'caption': 'Formes extensives caricaturales.A.\xa0Cette patiente se coupe les polypes avec des ciseaux. B.\xa0Syndrome de Woakes\xa0: les polypes déforment les os propres du nez (flèches).', 'hash': '3806775d5f1523ce0b4f963a4efc72f3fb71e1cf97805f7158e6cc0d9fd430fe'}, {'image_id': 'f10-06-9782294745034', 'image_file_name': 'f10-06-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-06-9782294745034.jpg', 'caption': 'Endoscopie nasale au cours d’une rhinosinusite chronique.A. Suppuration dans le méat moyen droit. B. Suppuration ethmoïdale. C. Sinusite frontale chronique avec pus dans le\xa0méat moyen et bourrelet de Kaufman (hyperplasie de l’apophyse uncinée). D. Polype luisant et transparent de la fosse nasale gauche.', 'hash': 'a10dfead464cad1b140c33ed13738d2ba3d5669c96a93b3338cb99e8ea276265'}, {'image_id': 'u10-05-9782294745034', 'image_file_name': 'u10-05-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-05-9782294745034.jpg', 'caption': 'Résultat d’une chirurgie endoscopique ethmoïdo-sphénoïdo-maxillaire.Cette patiente a été prise en charge pour une polypose nasosinusienne bilatérale comportant des mycétomes aspergillaires. Du côté droit, les cavités ont bien cicatrisé. On aperçoit le reliquat de cornet moyen (CM), l’ethmoïde antérieur et postérieur (EA et EP), les sinus maxillaire et sphénoïdal (SM et SP). On pénètre dans le sinus sphénoïdal avec ses deux reliefs caractéristiques\xa0: le nerf optique horizontal et la carotide interne verticale. Du côté gauche, c’est la même chose avec les ouvertures béantes du sinus maxillaire sur la droite et du sinus sphénoïdal en\xa0arrière.', 'hash': '801c6e7fa2015963250007c8be6afe623c21bc5c8bb90f59517a205272438cfa'}, {'image_id': 'u10-02-9782294745034', 'image_file_name': 'u10-02-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-02-9782294745034.jpg', 'caption': 'Abcès sous-périosté sur ethmoïdite.TDM axiale en fenêtre parenchymateuse\xa0: comblement des cellules ethmoïdales gauches avec abcès sous-périosté en regard, refoulant le muscle droit médial (flèche) avec en arrière des zones denses d’inflammation au sein de la graisse hypodense.', 'hash': '302e6605e9bd0e62fbabce24484d996d5e6d3f40ed801fe08beabc1a8584870c'}, {'image_id': 'f10-01-9782294745034', 'image_file_name': 'f10-01-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-01-9782294745034.jpg', 'caption': 'Vues endoscopiques de la fosse nasale droite.A. Vestibule nasal. 1\xa0: cornet inférieur\xa0; 2\xa0: septum nasal\xa0; 3\xa0: plancher de la cavité nasale. B. Valve septo-turbinale. 1\xa0: cornet inférieur\xa0; 2\xa0: cornet moyen\xa0; 3\xa0: septum nasal. C. Partie antérieure du plancher de la fosse nasale. 1\xa0: corps du cornet inférieur\xa0; 2\xa0: plancher de la cavité nasale\xa0; 3\xa0: septum nasal. D. Partie postérieure du plancher de la fosse nasale. 1\xa0: cornet moyen\xa0; 2\xa0: cornet inférieur\xa0; 3\xa0: septum nasal\xa0; 4\xa0: orifice choanal. E. Crête septale. 1\xa0: cornet moyen\xa0; 2\xa0: articulation chondro-vomérienne. F. Cornet inférieur. 1\xa0: sa tête\xa0; 2\xa0: septum nasal.', 'hash': '080b78130664151d8d8c9b471f9950445b7c949a45023a38042be4fe1c151a7f'}, {'image_id': 'u10-04-9782294745034', 'image_file_name': 'u10-04-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-04-9782294745034.jpg', 'caption': 'Chirurgie endoscopique pour polypose nasosinusienne.Le shaver est un aspirateur grignotant les polypes dans ses mâchoires rotatives. Ce patient présente une polypose nasosinusienne floride et handicapante bilatérale. Avec le shaver, on se fraye facilement un chemin vers le cornet moyen, dans le méat moyen, et on rentre dans l’ethmoïde, ce qui permet de réaliser un évidement ethmoïdal complet. Cet instrument est efficace et atraumatique, mais l’intervention ne dispense pas de la prise en charge médicale. On entre ensuite dans le sinus maxillaire pour\xa0détruire les polypes qu’il contient.', 'hash': 'b1fa5a3d48db44b51d89e2d9c7518c67078ffdaa074a29fc22df96c8940c5b28'}, {'image_id': 'f10-07-9782294745034', 'image_file_name': 'f10-07-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-07-9782294745034.jpg', 'caption': 'TDM de rhinosinusites chroniques ethmoïdo-maxillaires.A et B. Forme antérieure gauche avec opacité des cellules ethmoïdales antérieures en coupe axiale (A) et ostéolyse en coupe coronale (B). C. RSC invasive avec image en bissac d’un polype antrochoanal. D. Polypose nasosinusienne. Opacité diffuse de toutes les cellules ethmoïdales en coupe coronale.', 'hash': '54efa1d99392ac9eb68e85aa421e4a6b2c93dffd243fe87a990f8707de7d7c6a'}, {'image_id': 'f10-12-9782294745034', 'image_file_name': 'f10-12-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-12-9782294745034.jpg', 'caption': 'Résultats TDM de vidéochirurgies endonasales.A. Méatotomie droite en coupe coronale (flèche). B et C. Avant et après méatotomie (flèche) en coupes axiales. D et E. Coupe axiale et coupe coronale postopératoires chez un patient ayant subi une ethmoïdectomie unilatérale gauche (astérisques). F. Grand évidement maxillo-ethmoïdo-frontal droit (astérisque\xa0: emplacement de l’ex-canal nasofrontal).', 'hash': 'cc7cce248465c44d1c14de6b16e85fafb4677abee2c9c9c0bd7d20d6a2f7b5aa'}] | {'f10-01-9782294745034': ['Elle se fait à l’optique 0° après mise en place de cotonnettes imbibées de xylocaïne et de vasoconstricteur (naphtazoline) pour anesthésier et rétracter les cornets. On explore ainsi les méats moyen et inférieur, le cavum avec son bourrelet tubaire et la fente olfactive en remontant le long du cornet moyen (<xref rid="f10-01-9782294745034" ref-type="fig">fig.\xa010.1</xref>\n). Avec une spatule fine, il faut\npalper les petits polypes dissimulés sous l’auvent du cornet moyen, pour provoquer l’issue de sécrétions purulentes qu’on pourra prélever pour étude bactériologique.\n). Avec une spatule fine, il faut\npalper les petits polypes dissimulés sous l’auvent du cornet moyen, pour provoquer l’issue de sécrétions purulentes qu’on pourra prélever pour étude bactériologique.Figure 10.1Vues endoscopiques de la fosse nasale droite.A. Vestibule nasal. 1\xa0: cornet inférieur\xa0; 2\xa0: septum nasal\xa0; 3\xa0: plancher de la cavité nasale. B. Valve septo-turbinale. 1\xa0: cornet inférieur\xa0; 2\xa0: cornet moyen\xa0; 3\xa0: septum nasal. C. Partie antérieure du plancher de la fosse nasale. 1\xa0: corps du cornet inférieur\xa0; 2\xa0: plancher de la cavité nasale\xa0; 3\xa0: septum nasal. D. Partie postérieure du plancher de la fosse nasale. 1\xa0: cornet moyen\xa0; 2\xa0: cornet inférieur\xa0; 3\xa0: septum nasal\xa0; 4\xa0: orifice choanal. E. Crête septale. 1\xa0: cornet moyen\xa0; 2\xa0: articulation chondro-vomérienne. F. Cornet inférieur. 1\xa0: sa tête\xa0; 2\xa0: septum nasal.Jean-Michel Klossek, Catherine Desmons, Elie Serrano, et al. Anatomie des cavités nasosinusiennes. EMC, Paris (Elsevier Masson), ORL, 1997\xa0: 1-0 [Article 20-265-A-10].'], 'f10-02-9782294745034': ['La masse latérale de l’ethmoïde est au centre des cavités sinusiennes. Son atteinte retentit sur tous les sinus du groupe antérieur. Elle est divisée par des lames osseuses frontales ou obliques (<xref rid="f10-02-9782294745034" ref-type="fig">fig.\xa010.2</xref>\n). La plus importante est appelée racine cloisonnante du cornet moyen. C’est elle qui divise l’ethmoïde en une partie antérieure et une partie postérieure. La partie antérieure est composée de de trois cellules\xa0: en avant, deux sont côte à côte, la cellule méatique et la cellule uncinée\xa0; la troisième est la cellule bullaire occupant toute la largeur de la masse latérale. Elle est située en arrière des précédentes et séparée d’elles par la gouttière uncibullaire. C’est dans cette gouttière arciforme que se drainent tous les sinus du groupe antérieur. Le sinus frontal se draine par le canal nasofrontal prolongeant la gouttière en haut. Le sinus maxillaire se draine par un ostium situé tout à l’arrière.\n). La plus importante est appelée racine cloisonnante du cornet moyen. C’est elle qui divise l’ethmoïde en une partie antérieure et une partie postérieure. La partie antérieure est composée de de trois cellules\xa0: en avant, deux sont côte à côte, la cellule méatique et la cellule uncinée\xa0; la troisième est la cellule bullaire occupant toute la largeur de la masse latérale. Elle est située en arrière des précédentes et séparée d’elles par la gouttière uncibullaire. C’est dans cette gouttière arciforme que se drainent tous les sinus du groupe antérieur. Le sinus frontal se draine par le canal nasofrontal prolongeant la gouttière en haut. Le sinus maxillaire se draine par un ostium situé tout à l’arrière.Figure 10.2Masse latérale de l’ethmoïde gauche après\xa0ablation du cornet moyen.1\xa0: cellule méatique et cellule uncinée\xa0; 2\xa0: cellule bullaire\xa0; 3\xa0: racine cloisonnante du cornet moyen\xa0; 4\xa0: cellules ethmoïdales postérieures\xa0; 5\xa0: ostium du sinus maxillaire\xa0; 6\xa0: sphénoïde et son ostium\xa0; CI\xa0: cornet inférieur\xa0; GUB\xa0: gouttière uncibullaire\xa0; NF\xa0: canal nasofrontal (flèche) se prolongeant par la gouttière uncibullaire.'], 'f10-03-9782294745034': ['Sur une coupe coronale, les repères morphologiques sont le cornet moyen, le méat moyen et l’ostium du sinus maxillaire (<xref rid="f10-03-9782294745034" ref-type="fig">fig.\xa010.3</xref>\n). La lame criblée de l’ethmoïde est à un niveau inférieur de celui du toit de l’ethmoïde. Sur une coupe axiale, il est possible d’évaluer la qualité de la lame papyracée qui représente la paroi interne de l’orbite séparant l’œil des cellules ethmoïdales.\n). La lame criblée de l’ethmoïde est à un niveau inférieur de celui du toit de l’ethmoïde. Sur une coupe axiale, il est possible d’évaluer la qualité de la lame papyracée qui représente la paroi interne de l’orbite séparant l’œil des cellules ethmoïdales.Figure 10.3Radio-anatomie TDM des cavités nasosinusiennes.A. Reconstruction frontale pour les sinus frontaux. B. Reconstruction frontale pour les méats moyens. C. Reconstruction frontale pour les méats supérieurs. D. Reconstruction sagittale par le toit ethmoïdo-frontal. E. Reconstruction axiale par les méats moyens. F. Reconstruction axiale par les masses ethmoïdales latérales. 1\xa0: sinus maxillaire\xa0; 2\xa0: canal lacrymo-nasal\xa0; 3\xa0: cellule unciformienne\xa0; 4\xa0: sinus frontal\xa0; 5\xa0: cellule méatique\xa0; 6\xa0: tête du cornet moyen\xa0; 7\xa0: foramen infra-orbitaire\xa0; 8\xa0: cornet inférieur\xa0; 9\xa0: méat inférieur\xa0; 10\xa0: méat moyen\xa0; 11\xa0: racine d’attache du cornet moyen\xa0; 12\xa0: bulle\xa0; 13\xa0: fente olfactive\xa0; 14\xa0: toit ethmoïdo-frontal\xa0; 15\xa0: lame criblée\xa0; 16\xa0: canal infundibulaire\xa0; 17\xa0: ostium maxillaire\xa0; 18\xa0: processus unciformien\xa0; 19\xa0: cellule ethmoïdale postérieure\xa0; 20\xa0: cornet supérieur\xa0; 21\xa0: méat supérieur\xa0; 22\xa0: ostium sphénoïdal\xa0; 23\xa0: sinus sphénoïdal\xa0; 24\xa0: racine cloisonnante du méat moyen\xa0; 25\xa0: racine de la bulle\xa0; 26\xa0: canal nasofrontal\xa0; 27\xa0: racine de l’unciforme.Ferrie J.-C, Fontanel J.-P, Delagranda A., et al. Imagerie radiologique des cavités sinusiennes et nasales. EMC, Paris (Elsevier Masson), ORL, 2007 [Article 20-422-A-10].'], 'f10-04-9782294745034': ['La rhinite aiguë commence par des frissons avec asthénie et courbatures. Le patient ressent une sécheresse du rhinopharynx avec sensation de cuisson. L’obstruction nasale s’installe avec des éternuements, de la rhinorrhée et un larmoiement. À l’examen, il existe une rougeur et un œdème de la tête des cornets inférieurs. L’exsudat inflammatoire est d’abord clair, puis les sécrétions s’épaississent, deviennent verdâtres et striées de sang lors du mouchage. Le vestibule narinaire se surinfecte (<xref rid="f10-04-9782294745034" ref-type="fig">fig.\xa010.4</xref>\n). Les symptômes régressent en cinq jours. La prise en charge repose sur le paracétamol, l’augmentation de la chaleur ambiante et sur un mouchage atraumatique, une fosse nasale l’une après l’autre.\n). Les symptômes régressent en cinq jours. La prise en charge repose sur le paracétamol, l’augmentation de la chaleur ambiante et sur un mouchage atraumatique, une fosse nasale l’une après l’autre.Figure 10.4Rhinite vestibulaire.Surinfection de la portion cutanée de fosse nasale à\xa0staphylocoque aureus, à traiter par des applications d’acide fusidique crème.'], 'f10-05-9782294745034': ['incidence de Blondeau (face basse ou nez-menton-plaque) mettant en évidence le sinus maxillaire (<xref rid="f10-05-9782294745034" ref-type="fig">fig.\xa010.5</xref>\n)\xa0;\n)\xa0;Figure 10.5Incidence de Blondeau.A. Opacité d’une sinusite maxillaire droite. B. Niveau liquide d’une sinusite maxillaire gauche. C. Kyste muqueux rétentionnel du bas-fond sinusien, séquelle d’une sinusite maxillaire ancienne (image dite en coucher de soleil). D. Aspect de faux niveaux liquides donné par la projection des os temporaux dans le sinus maxillaire lorsque la tête est insuffisamment défléchie.'], 'f10-06-9782294745034': ['Elle recherche la présence d’un drainage mucopurulent, d’une congestion œdémateuse des méats moyens, voire de polypes obstruant les fosses nasales (<xref rid="f10-06-9782294745034" ref-type="fig">fig.\xa010.6</xref>\n).\n).Figure 10.6Endoscopie nasale au cours d’une rhinosinusite chronique.A. Suppuration dans le méat moyen droit. B. Suppuration ethmoïdale. C. Sinusite frontale chronique avec pus dans le\xa0méat moyen et bourrelet de Kaufman (hyperplasie de l’apophyse uncinée). D. Polype luisant et transparent de la fosse nasale gauche.'], 'f10-07-9782294745034': ['Elle montre des épaississements muqueux localisés ou diffus, des opacités s’accompagnant parfois de niveaux liquides et d’érosions osseuses (<xref rid="f10-07-9782294745034" ref-type="fig">Figure 10.7</xref>, , <xref rid="f10-08-9782294745034" ref-type="fig">Figure 10.8</xref>, , <xref rid="f10-09-9782294745034" ref-type="fig">Figure 10.9</xref>\n).\n).Figure 10.7TDM de rhinosinusites chroniques ethmoïdo-maxillaires.A et B. Forme antérieure gauche avec opacité des cellules ethmoïdales antérieures en coupe axiale (A) et ostéolyse en coupe coronale (B). C. RSC invasive avec image en bissac d’un polype antrochoanal. D. Polypose nasosinusienne. Opacité diffuse de toutes les cellules ethmoïdales en coupe coronale.Figure 10.8Formes cliniques de RSC.A. Opacité de tout le sinus frontal gauche en coupe coronale. B. Opacité du sinus sphénoïdal droit en coupe axiale. En avant, le canal optique rejoint l’orbite. En arrière, le canal carotidien vu en coupe est intact. C. Sinusite aspergillaireSinusiteaspergillaire gauche typique avec lyse osseuse et petits mycétomes opaques disséminés dans l’opacité. D. Sinusite maxillaire d’origine dentaire avec lyse alvéolaire.Figure 10.9Pathologies rhinosinusiennes rares.A. Concha bullosa bilatérale. Pneumatisation des cornets moyens chez un sujet asymptomatique (astérisques). B.\xa0Infection d’une concha bullosa gauche (astérisque) chez un patient présentant de violentes algies nasales. C. Mucocèle du sinus maxillaire gauche. D. Granulomatose de Wegener droite (encadré\xa010.2).', 'Sa prévalence est de 1 à 4\xa0% de la population (cf.\n<xref rid="f10-07-9782294745034" ref-type="fig">fig.\xa010.7</xref>D et figure de l’D et figure de l’encadré\xa010.3). Par ordre de fréquence, on en distingue quatre formes\xa0:•la forme isolée ou associée à une poly-allergie\xa0;•la forme avec asthme\xa0;•la forme avec asthme et intolérance à l’aspirine (maladie métabolique de WidalMaladiemétabolique de Widal)\xa0;•mucoviscidose.\n'], 'f10-09-9782294745034': ['Outre les complications orbitaires et méningo-encéphaliques citées plus haut, il faut connaître l’existence des mucocèles. Dans sa forme extensive, c’est un kyste ethmoïdo-frontal ou maxillaire endosinusien se développant par blocage de l’ostium nasofrontal ou maxillaire. Il érode et amincit progressivement les parois osseuses jusqu’à bomber dans l’orbite au niveau de l’angle interne de l’œil (cf.\n<xref rid="f10-09-9782294745034" ref-type="fig">fig.\xa010.9</xref>C). Il contient un mucus épais et souvent aseptique.C). Il contient un mucus épais et souvent aseptique.'], 'f10-08-9782294745034': ['La TDM montre plusieurs aspects. Les petites opacités représentent des mycétomes disséminés au sein de l’opacité sinusienne (cf.\n<xref rid="f10-08-9782294745034" ref-type="fig">fig.\xa010.8</xref>C). L’aspect de balle fungique aspergillaire réalise une opacité unique au sein du sinus maxillaire. Il n’est pas rare de constater la présence de mycétome au sein d’une polypose.C). L’aspect de balle fungique aspergillaire réalise une opacité unique au sein du sinus maxillaire. Il n’est pas rare de constater la présence de mycétome au sein d’une polypose.'], 'f10-10-9782294745034': ['Dans le cas des sinusites frontales, le drainage et les lavages de sinus par un clou de Lermoyez sont efficaces (<xref rid="f10-10-9782294745034" ref-type="fig">fig.\xa010.10</xref>\nA). Il en est de même des lavages du sinus maxillaire par drain d’Albertini, modifié par Orsel.\nA). Il en est de même des lavages du sinus maxillaire par drain d’Albertini, modifié par Orsel.Figure 10.10Indications chirurgicales indiscutables.A. Clou de LermoyezClou de Lermoyez pour drainage et lavage du sinus frontal. B. Cure d’une fistule buccosinusienne. Cathétérisme. C.\xa0Abord du sinus maxillaire droit par voie de Caldwell-Luc. D. Découverte de la truffe aspergillaire.', 'Une grosse balle fungique reste même parfois l’indication d’une chirurgie de Caldwell-Luc (<xref rid="f10-10-9782294745034" ref-type="fig">fig.\xa010.10</xref>C et D).C et D).'], 'f10-11-9782294745034': ['\nDans les formes unilatérales de RSC, cette chirurgie donne d’excellents résultats, surtout s’il y a un facteur fungique de type Aspergillus (<xref rid="f10-11-9782294745034" ref-type="fig">Figure 10.11</xref>, , <xref rid="f10-12-9782294745034" ref-type="fig">Figure 10.12</xref>\n).\n).Figure 10.11Résultats endoscopiques de la chirurgie endonasale.A. Élargissement de l’ostium du sinus maxillaire gauche (méatotomie) avec conservation partielle du cornet moyen et retour à la normale de la muqueuse du sinus. B. Méatotomie du sinus maxillaire droit avec persistance d’une inflammation diffuse et phénomène de la cuvette désignant le fait que le bas-fond sinusien est devenu le réceptacle des sécrétions nasales. C. Bons résultats d’un évidement ethmoïdo-maxillaire droit avec quelques sécrétions dans la méatotomie. D. Résultat d’évidement ethmoïdo-maxillaire gauche. CL\xa0: cloison\xa0; B\xa0: toit de la bulle\xa0; RC\xa0: racine cloisonnante\xa0; SP\xa0: cellule ethmoïdale postérieure\xa0; CH\xa0: choane et rhinopharynx\xa0; SM\xa0: sinus maxillaire.Figure 10.12Résultats TDM de vidéochirurgies endonasales.A. Méatotomie droite en coupe coronale (flèche). B et C. Avant et après méatotomie (flèche) en coupes axiales. D et E. Coupe axiale et coupe coronale postopératoires chez un patient ayant subi une ethmoïdectomie unilatérale gauche (astérisques). F. Grand évidement maxillo-ethmoïdo-frontal droit (astérisque\xa0: emplacement de l’ex-canal nasofrontal).'], 'u10-04-9782294745034': ['\nDans les formes bilatérales, chez certains patients, un traitement local ne peut pas être entrepris, du fait de l’obstruction nasale en rapport avec les déformations septales, l’hyperplasie turbinale ou de l’importance de la polypose. Dans ces cas, la situation peut être débloquée par une vidéochirurgie endoscopique bilatérale. L’objectif est seulement de permettre le traitement local par lavages et corticoïdes locaux. Mais il ne faut pas promettre de miracle (<xref rid="u10-04-9782294745034" ref-type="fig">Vidéo e10.1</xref>, , <xref rid="u10-05-9782294745034" ref-type="fig">Vidéo e10.2</xref>, , <xref rid="u10-06-9782294745034" ref-type="fig">Vidéo e10.3</xref>\xa0\xa0).\nVidéo e10.1Chirurgie endoscopique pour polypose nasosinusienne.Le shaver est un aspirateur grignotant les polypes dans ses mâchoires rotatives. Ce patient présente une polypose nasosinusienne floride et handicapante bilatérale. Avec le shaver, on se fraye facilement un chemin vers le cornet moyen, dans le méat moyen, et on rentre dans l’ethmoïde, ce qui permet de réaliser un évidement ethmoïdal complet. Cet instrument est efficace et atraumatique, mais l’intervention ne dispense pas de la prise en charge médicale. On entre ensuite dans le sinus maxillaire pour\xa0détruire les polypes qu’il contient.Vidéo e10.2Résultat d’une chirurgie endoscopique ethmoïdo-sphénoïdo-maxillaire.Cette patiente a été prise en charge pour une polypose nasosinusienne bilatérale comportant des mycétomes aspergillaires. Du côté droit, les cavités ont bien cicatrisé. On aperçoit le reliquat de cornet moyen (CM), l’ethmoïde antérieur et postérieur (EA et EP), les sinus maxillaire et sphénoïdal (SM et SP). On pénètre dans le sinus sphénoïdal avec ses deux reliefs caractéristiques\xa0: le nerf optique horizontal et la carotide interne verticale. Du côté gauche, c’est la même chose avec les ouvertures béantes du sinus maxillaire sur la droite et du sinus sphénoïdal en\xa0arrière.Vidéo e10.3Truffe aspergillaire sphénoïdale.Patient souffrant de violentes céphalées depuis plusieurs mois. Un scanner en coupes axiales montre une opacité complète du sinus sphénoïdal gauche, avec en coupe coronale une opacité évoquant un mycétome aspergillaire. Il n’y a pas d’érosions osseuses. L’intervention commence par une section de la lame verticale du cornet moyen puis de sa racine cloisonnante horizontale. Le cornet moyen vient ainsi en deux morceaux. On découvre alors l’orifice sphénoïdal gauche rempli par une balle fungique noirâtre. Il est élargi à la pince emporte-pièce et la totalité de la truffe peut être enlevée. Les céphalées ne se reproduisent plus.']} | Rhinites, sinusites et rhinosinusites | null | None | 1474614000 | None | null | other | PMC7184226 | null | null | [
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] | Guide D'orl. 2016 Sep 23;:173-193 | NO-CC CODE |
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TDM de rhinosinusites chroniques ethmoïdo-maxillaires.A et B. Forme antérieure gauche avec opacité des cellules ethmoïdales antérieures en coupe axiale (A) et ostéolyse en coupe coronale (B). C. RSC invasive avec image en bissac d’un polype antrochoanal. D. Polypose nasosinusienne. Opacité diffuse de toutes les cellules ethmoïdales en coupe coronale. | f10-07-9782294745034 | 7 | 54efa1d99392ac9eb68e85aa421e4a6b2c93dffd243fe87a990f8707de7d7c6a | f10-07-9782294745034.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
605,
407
] | [{'image_id': 'f10-09-9782294745034', 'image_file_name': 'f10-09-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-09-9782294745034.jpg', 'caption': 'Pathologies rhinosinusiennes rares.A. Concha bullosa bilatérale. Pneumatisation des cornets moyens chez un sujet asymptomatique (astérisques). B.\xa0Infection d’une concha bullosa gauche (astérisque) chez un patient présentant de violentes algies nasales. C. Mucocèle du sinus maxillaire gauche. D. Granulomatose de Wegener droite (encadré\xa010.2).', 'hash': 'f4d4a393f9372c1034ab6d60479efbce10454e9b8d7dcca54f4531ec490603ea'}, {'image_id': 'u10-01-9782294745034', 'image_file_name': 'u10-01-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-01-9782294745034.jpg', 'caption': 'Classification de Chandler.A. Stade I\xa0: œdème palpébral seul avec cellulite péri-orbitaire préseptale. B. Stade II\xa0: cellulite orbitaire avec exophtalmie réductible. C. Stade III\xa0: abcès orbitaire sous-périosté avec exophtalmie non réductible et\xa0ophtalmoplégie partielle. Stade IV\xa0: exophtalmie importante, ophtalmoplégie et abcès orbitaire nécessitant un\xa0drainage.', 'hash': '3c434c5d12e1cad6f022d9e09cb88ce42efb66afa4eeec92c2ce022c460ac2b9'}, {'image_id': 'f10-02-9782294745034', 'image_file_name': 'f10-02-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-02-9782294745034.jpg', 'caption': 'Masse latérale de l’ethmoïde gauche après\xa0ablation du cornet moyen.1\xa0: cellule méatique et cellule uncinée\xa0; 2\xa0: cellule bullaire\xa0; 3\xa0: racine cloisonnante du cornet moyen\xa0; 4\xa0: cellules ethmoïdales postérieures\xa0; 5\xa0: ostium du sinus maxillaire\xa0; 6\xa0: sphénoïde et son ostium\xa0; CI\xa0: cornet inférieur\xa0; GUB\xa0: gouttière uncibullaire\xa0; NF\xa0: canal nasofrontal (flèche) se prolongeant par la gouttière uncibullaire.', 'hash': '2746fdda2a56d4f48eeb02e38705f716754152f3a875e11d1d83a0fd1e01fe5b'}, {'image_id': 'f10-11-9782294745034', 'image_file_name': 'f10-11-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-11-9782294745034.jpg', 'caption': 'Résultats endoscopiques de la chirurgie endonasale.A. Élargissement de l’ostium du sinus maxillaire gauche (méatotomie) avec conservation partielle du cornet moyen et retour à la normale de la muqueuse du sinus. B. Méatotomie du sinus maxillaire droit avec persistance d’une inflammation diffuse et phénomène de la cuvette désignant le fait que le bas-fond sinusien est devenu le réceptacle des sécrétions nasales. C. Bons résultats d’un évidement ethmoïdo-maxillaire droit avec quelques sécrétions dans la méatotomie. D. Résultat d’évidement ethmoïdo-maxillaire gauche. CL\xa0: cloison\xa0; B\xa0: toit de la bulle\xa0; RC\xa0: racine cloisonnante\xa0; SP\xa0: cellule ethmoïdale postérieure\xa0; CH\xa0: choane et rhinopharynx\xa0; SM\xa0: sinus maxillaire.', 'hash': '26331484cbb96020267c2eb0c9b5e19f70c8a8d75fb7f36c306073d06ef9281b'}, {'image_id': 'f10-04-9782294745034', 'image_file_name': 'f10-04-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-04-9782294745034.jpg', 'caption': 'Rhinite vestibulaire.Surinfection de la portion cutanée de fosse nasale à\xa0staphylocoque aureus, à traiter par des applications d’acide fusidique crème.', 'hash': 'a7a18f48be8034fa80c77d3044ed4d083cf96d83bf22c39641d9cabfc77a4f49'}, {'image_id': 'f10-03-9782294745034', 'image_file_name': 'f10-03-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-03-9782294745034.jpg', 'caption': 'Radio-anatomie TDM des cavités nasosinusiennes.A. Reconstruction frontale pour les sinus frontaux. B. Reconstruction frontale pour les méats moyens. C. Reconstruction frontale pour les méats supérieurs. D. Reconstruction sagittale par le toit ethmoïdo-frontal. E. Reconstruction axiale par les méats moyens. F. Reconstruction axiale par les masses ethmoïdales latérales. 1\xa0: sinus maxillaire\xa0; 2\xa0: canal lacrymo-nasal\xa0; 3\xa0: cellule unciformienne\xa0; 4\xa0: sinus frontal\xa0; 5\xa0: cellule méatique\xa0; 6\xa0: tête du cornet moyen\xa0; 7\xa0: foramen infra-orbitaire\xa0; 8\xa0: cornet inférieur\xa0; 9\xa0: méat inférieur\xa0; 10\xa0: méat moyen\xa0; 11\xa0: racine d’attache du cornet moyen\xa0; 12\xa0: bulle\xa0; 13\xa0: fente olfactive\xa0; 14\xa0: toit ethmoïdo-frontal\xa0; 15\xa0: lame criblée\xa0; 16\xa0: canal infundibulaire\xa0; 17\xa0: ostium maxillaire\xa0; 18\xa0: processus unciformien\xa0; 19\xa0: cellule ethmoïdale postérieure\xa0; 20\xa0: cornet supérieur\xa0; 21\xa0: méat supérieur\xa0; 22\xa0: ostium sphénoïdal\xa0; 23\xa0: sinus sphénoïdal\xa0; 24\xa0: racine cloisonnante du méat moyen\xa0; 25\xa0: racine de la bulle\xa0; 26\xa0: canal nasofrontal\xa0; 27\xa0: racine de l’unciforme.', 'hash': 'f7af7475946a301d18ff3d384dd52b8f9c058b47c2e02ca093137ec15bf952e2'}, {'image_id': 'f10-08-9782294745034', 'image_file_name': 'f10-08-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-08-9782294745034.jpg', 'caption': 'Formes cliniques de RSC.A. Opacité de tout le sinus frontal gauche en coupe coronale. B. Opacité du sinus sphénoïdal droit en coupe axiale. En avant, le canal optique rejoint l’orbite. En arrière, le canal carotidien vu en coupe est intact. C. Sinusite aspergillaireSinusiteaspergillaire gauche typique avec lyse osseuse et petits mycétomes opaques disséminés dans l’opacité. D. Sinusite maxillaire d’origine dentaire avec lyse alvéolaire.', 'hash': '5515a3121692cd6c1d8bc5eb7949cf24d609e73b9ae1b97e3809bd76e49828f9'}, {'image_id': 'f10-10-9782294745034', 'image_file_name': 'f10-10-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-10-9782294745034.jpg', 'caption': 'Indications chirurgicales indiscutables.A. Clou de LermoyezClou de Lermoyez pour drainage et lavage du sinus frontal. B. Cure d’une fistule buccosinusienne. Cathétérisme. C.\xa0Abord du sinus maxillaire droit par voie de Caldwell-Luc. D. Découverte de la truffe aspergillaire.', 'hash': '31e27956c0cf89d51a494a5df876ba32a26229756f4473df0d63fb70b45d4046'}, {'image_id': 'f10-05-9782294745034', 'image_file_name': 'f10-05-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-05-9782294745034.jpg', 'caption': 'Incidence de Blondeau.A. Opacité d’une sinusite maxillaire droite. B. Niveau liquide d’une sinusite maxillaire gauche. C. Kyste muqueux rétentionnel du bas-fond sinusien, séquelle d’une sinusite maxillaire ancienne (image dite en coucher de soleil). D. Aspect de faux niveaux liquides donné par la projection des os temporaux dans le sinus maxillaire lorsque la tête est insuffisamment défléchie.', 'hash': 'aede2f22f3d31f411a00db7a8693863f85abf069ef4de5f452146ec5214a106d'}, {'image_id': 'u10-06-9782294745034', 'image_file_name': 'u10-06-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-06-9782294745034.jpg', 'caption': 'Truffe aspergillaire sphénoïdale.Patient souffrant de violentes céphalées depuis plusieurs mois. Un scanner en coupes axiales montre une opacité complète du sinus sphénoïdal gauche, avec en coupe coronale une opacité évoquant un mycétome aspergillaire. Il n’y a pas d’érosions osseuses. L’intervention commence par une section de la lame verticale du cornet moyen puis de sa racine cloisonnante horizontale. Le cornet moyen vient ainsi en deux morceaux. On découvre alors l’orifice sphénoïdal gauche rempli par une balle fungique noirâtre. Il est élargi à la pince emporte-pièce et la totalité de la truffe peut être enlevée. Les céphalées ne se reproduisent plus.', 'hash': 'e280199dfb4225f9d230705a8f873f6f6de7b93d1281760f860fd001b89355fb'}, {'image_id': 'u10-03-9782294745034', 'image_file_name': 'u10-03-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-03-9782294745034.jpg', 'caption': 'Formes extensives caricaturales.A.\xa0Cette patiente se coupe les polypes avec des ciseaux. B.\xa0Syndrome de Woakes\xa0: les polypes déforment les os propres du nez (flèches).', 'hash': '3806775d5f1523ce0b4f963a4efc72f3fb71e1cf97805f7158e6cc0d9fd430fe'}, {'image_id': 'f10-06-9782294745034', 'image_file_name': 'f10-06-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-06-9782294745034.jpg', 'caption': 'Endoscopie nasale au cours d’une rhinosinusite chronique.A. Suppuration dans le méat moyen droit. B. Suppuration ethmoïdale. C. Sinusite frontale chronique avec pus dans le\xa0méat moyen et bourrelet de Kaufman (hyperplasie de l’apophyse uncinée). D. Polype luisant et transparent de la fosse nasale gauche.', 'hash': 'a10dfead464cad1b140c33ed13738d2ba3d5669c96a93b3338cb99e8ea276265'}, {'image_id': 'u10-05-9782294745034', 'image_file_name': 'u10-05-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-05-9782294745034.jpg', 'caption': 'Résultat d’une chirurgie endoscopique ethmoïdo-sphénoïdo-maxillaire.Cette patiente a été prise en charge pour une polypose nasosinusienne bilatérale comportant des mycétomes aspergillaires. Du côté droit, les cavités ont bien cicatrisé. On aperçoit le reliquat de cornet moyen (CM), l’ethmoïde antérieur et postérieur (EA et EP), les sinus maxillaire et sphénoïdal (SM et SP). On pénètre dans le sinus sphénoïdal avec ses deux reliefs caractéristiques\xa0: le nerf optique horizontal et la carotide interne verticale. Du côté gauche, c’est la même chose avec les ouvertures béantes du sinus maxillaire sur la droite et du sinus sphénoïdal en\xa0arrière.', 'hash': '801c6e7fa2015963250007c8be6afe623c21bc5c8bb90f59517a205272438cfa'}, {'image_id': 'u10-02-9782294745034', 'image_file_name': 'u10-02-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-02-9782294745034.jpg', 'caption': 'Abcès sous-périosté sur ethmoïdite.TDM axiale en fenêtre parenchymateuse\xa0: comblement des cellules ethmoïdales gauches avec abcès sous-périosté en regard, refoulant le muscle droit médial (flèche) avec en arrière des zones denses d’inflammation au sein de la graisse hypodense.', 'hash': '302e6605e9bd0e62fbabce24484d996d5e6d3f40ed801fe08beabc1a8584870c'}, {'image_id': 'f10-01-9782294745034', 'image_file_name': 'f10-01-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-01-9782294745034.jpg', 'caption': 'Vues endoscopiques de la fosse nasale droite.A. Vestibule nasal. 1\xa0: cornet inférieur\xa0; 2\xa0: septum nasal\xa0; 3\xa0: plancher de la cavité nasale. B. Valve septo-turbinale. 1\xa0: cornet inférieur\xa0; 2\xa0: cornet moyen\xa0; 3\xa0: septum nasal. C. Partie antérieure du plancher de la fosse nasale. 1\xa0: corps du cornet inférieur\xa0; 2\xa0: plancher de la cavité nasale\xa0; 3\xa0: septum nasal. D. Partie postérieure du plancher de la fosse nasale. 1\xa0: cornet moyen\xa0; 2\xa0: cornet inférieur\xa0; 3\xa0: septum nasal\xa0; 4\xa0: orifice choanal. E. Crête septale. 1\xa0: cornet moyen\xa0; 2\xa0: articulation chondro-vomérienne. F. Cornet inférieur. 1\xa0: sa tête\xa0; 2\xa0: septum nasal.', 'hash': '080b78130664151d8d8c9b471f9950445b7c949a45023a38042be4fe1c151a7f'}, {'image_id': 'u10-04-9782294745034', 'image_file_name': 'u10-04-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/u10-04-9782294745034.jpg', 'caption': 'Chirurgie endoscopique pour polypose nasosinusienne.Le shaver est un aspirateur grignotant les polypes dans ses mâchoires rotatives. Ce patient présente une polypose nasosinusienne floride et handicapante bilatérale. Avec le shaver, on se fraye facilement un chemin vers le cornet moyen, dans le méat moyen, et on rentre dans l’ethmoïde, ce qui permet de réaliser un évidement ethmoïdal complet. Cet instrument est efficace et atraumatique, mais l’intervention ne dispense pas de la prise en charge médicale. On entre ensuite dans le sinus maxillaire pour\xa0détruire les polypes qu’il contient.', 'hash': 'b1fa5a3d48db44b51d89e2d9c7518c67078ffdaa074a29fc22df96c8940c5b28'}, {'image_id': 'f10-07-9782294745034', 'image_file_name': 'f10-07-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-07-9782294745034.jpg', 'caption': 'TDM de rhinosinusites chroniques ethmoïdo-maxillaires.A et B. Forme antérieure gauche avec opacité des cellules ethmoïdales antérieures en coupe axiale (A) et ostéolyse en coupe coronale (B). C. RSC invasive avec image en bissac d’un polype antrochoanal. D. Polypose nasosinusienne. Opacité diffuse de toutes les cellules ethmoïdales en coupe coronale.', 'hash': '54efa1d99392ac9eb68e85aa421e4a6b2c93dffd243fe87a990f8707de7d7c6a'}, {'image_id': 'f10-12-9782294745034', 'image_file_name': 'f10-12-9782294745034.jpg', 'image_path': '../data/media_files/PMC7184226/f10-12-9782294745034.jpg', 'caption': 'Résultats TDM de vidéochirurgies endonasales.A. Méatotomie droite en coupe coronale (flèche). B et C. Avant et après méatotomie (flèche) en coupes axiales. D et E. Coupe axiale et coupe coronale postopératoires chez un patient ayant subi une ethmoïdectomie unilatérale gauche (astérisques). F. Grand évidement maxillo-ethmoïdo-frontal droit (astérisque\xa0: emplacement de l’ex-canal nasofrontal).', 'hash': 'cc7cce248465c44d1c14de6b16e85fafb4677abee2c9c9c0bd7d20d6a2f7b5aa'}] | {'f10-01-9782294745034': ['Elle se fait à l’optique 0° après mise en place de cotonnettes imbibées de xylocaïne et de vasoconstricteur (naphtazoline) pour anesthésier et rétracter les cornets. On explore ainsi les méats moyen et inférieur, le cavum avec son bourrelet tubaire et la fente olfactive en remontant le long du cornet moyen (<xref rid="f10-01-9782294745034" ref-type="fig">fig.\xa010.1</xref>\n). Avec une spatule fine, il faut\npalper les petits polypes dissimulés sous l’auvent du cornet moyen, pour provoquer l’issue de sécrétions purulentes qu’on pourra prélever pour étude bactériologique.\n). Avec une spatule fine, il faut\npalper les petits polypes dissimulés sous l’auvent du cornet moyen, pour provoquer l’issue de sécrétions purulentes qu’on pourra prélever pour étude bactériologique.Figure 10.1Vues endoscopiques de la fosse nasale droite.A. Vestibule nasal. 1\xa0: cornet inférieur\xa0; 2\xa0: septum nasal\xa0; 3\xa0: plancher de la cavité nasale. B. Valve septo-turbinale. 1\xa0: cornet inférieur\xa0; 2\xa0: cornet moyen\xa0; 3\xa0: septum nasal. C. Partie antérieure du plancher de la fosse nasale. 1\xa0: corps du cornet inférieur\xa0; 2\xa0: plancher de la cavité nasale\xa0; 3\xa0: septum nasal. D. Partie postérieure du plancher de la fosse nasale. 1\xa0: cornet moyen\xa0; 2\xa0: cornet inférieur\xa0; 3\xa0: septum nasal\xa0; 4\xa0: orifice choanal. E. Crête septale. 1\xa0: cornet moyen\xa0; 2\xa0: articulation chondro-vomérienne. F. Cornet inférieur. 1\xa0: sa tête\xa0; 2\xa0: septum nasal.Jean-Michel Klossek, Catherine Desmons, Elie Serrano, et al. Anatomie des cavités nasosinusiennes. EMC, Paris (Elsevier Masson), ORL, 1997\xa0: 1-0 [Article 20-265-A-10].'], 'f10-02-9782294745034': ['La masse latérale de l’ethmoïde est au centre des cavités sinusiennes. Son atteinte retentit sur tous les sinus du groupe antérieur. Elle est divisée par des lames osseuses frontales ou obliques (<xref rid="f10-02-9782294745034" ref-type="fig">fig.\xa010.2</xref>\n). La plus importante est appelée racine cloisonnante du cornet moyen. C’est elle qui divise l’ethmoïde en une partie antérieure et une partie postérieure. La partie antérieure est composée de de trois cellules\xa0: en avant, deux sont côte à côte, la cellule méatique et la cellule uncinée\xa0; la troisième est la cellule bullaire occupant toute la largeur de la masse latérale. Elle est située en arrière des précédentes et séparée d’elles par la gouttière uncibullaire. C’est dans cette gouttière arciforme que se drainent tous les sinus du groupe antérieur. Le sinus frontal se draine par le canal nasofrontal prolongeant la gouttière en haut. Le sinus maxillaire se draine par un ostium situé tout à l’arrière.\n). La plus importante est appelée racine cloisonnante du cornet moyen. C’est elle qui divise l’ethmoïde en une partie antérieure et une partie postérieure. La partie antérieure est composée de de trois cellules\xa0: en avant, deux sont côte à côte, la cellule méatique et la cellule uncinée\xa0; la troisième est la cellule bullaire occupant toute la largeur de la masse latérale. Elle est située en arrière des précédentes et séparée d’elles par la gouttière uncibullaire. C’est dans cette gouttière arciforme que se drainent tous les sinus du groupe antérieur. Le sinus frontal se draine par le canal nasofrontal prolongeant la gouttière en haut. Le sinus maxillaire se draine par un ostium situé tout à l’arrière.Figure 10.2Masse latérale de l’ethmoïde gauche après\xa0ablation du cornet moyen.1\xa0: cellule méatique et cellule uncinée\xa0; 2\xa0: cellule bullaire\xa0; 3\xa0: racine cloisonnante du cornet moyen\xa0; 4\xa0: cellules ethmoïdales postérieures\xa0; 5\xa0: ostium du sinus maxillaire\xa0; 6\xa0: sphénoïde et son ostium\xa0; CI\xa0: cornet inférieur\xa0; GUB\xa0: gouttière uncibullaire\xa0; NF\xa0: canal nasofrontal (flèche) se prolongeant par la gouttière uncibullaire.'], 'f10-03-9782294745034': ['Sur une coupe coronale, les repères morphologiques sont le cornet moyen, le méat moyen et l’ostium du sinus maxillaire (<xref rid="f10-03-9782294745034" ref-type="fig">fig.\xa010.3</xref>\n). La lame criblée de l’ethmoïde est à un niveau inférieur de celui du toit de l’ethmoïde. Sur une coupe axiale, il est possible d’évaluer la qualité de la lame papyracée qui représente la paroi interne de l’orbite séparant l’œil des cellules ethmoïdales.\n). La lame criblée de l’ethmoïde est à un niveau inférieur de celui du toit de l’ethmoïde. Sur une coupe axiale, il est possible d’évaluer la qualité de la lame papyracée qui représente la paroi interne de l’orbite séparant l’œil des cellules ethmoïdales.Figure 10.3Radio-anatomie TDM des cavités nasosinusiennes.A. Reconstruction frontale pour les sinus frontaux. B. Reconstruction frontale pour les méats moyens. C. Reconstruction frontale pour les méats supérieurs. D. Reconstruction sagittale par le toit ethmoïdo-frontal. E. Reconstruction axiale par les méats moyens. F. Reconstruction axiale par les masses ethmoïdales latérales. 1\xa0: sinus maxillaire\xa0; 2\xa0: canal lacrymo-nasal\xa0; 3\xa0: cellule unciformienne\xa0; 4\xa0: sinus frontal\xa0; 5\xa0: cellule méatique\xa0; 6\xa0: tête du cornet moyen\xa0; 7\xa0: foramen infra-orbitaire\xa0; 8\xa0: cornet inférieur\xa0; 9\xa0: méat inférieur\xa0; 10\xa0: méat moyen\xa0; 11\xa0: racine d’attache du cornet moyen\xa0; 12\xa0: bulle\xa0; 13\xa0: fente olfactive\xa0; 14\xa0: toit ethmoïdo-frontal\xa0; 15\xa0: lame criblée\xa0; 16\xa0: canal infundibulaire\xa0; 17\xa0: ostium maxillaire\xa0; 18\xa0: processus unciformien\xa0; 19\xa0: cellule ethmoïdale postérieure\xa0; 20\xa0: cornet supérieur\xa0; 21\xa0: méat supérieur\xa0; 22\xa0: ostium sphénoïdal\xa0; 23\xa0: sinus sphénoïdal\xa0; 24\xa0: racine cloisonnante du méat moyen\xa0; 25\xa0: racine de la bulle\xa0; 26\xa0: canal nasofrontal\xa0; 27\xa0: racine de l’unciforme.Ferrie J.-C, Fontanel J.-P, Delagranda A., et al. Imagerie radiologique des cavités sinusiennes et nasales. EMC, Paris (Elsevier Masson), ORL, 2007 [Article 20-422-A-10].'], 'f10-04-9782294745034': ['La rhinite aiguë commence par des frissons avec asthénie et courbatures. Le patient ressent une sécheresse du rhinopharynx avec sensation de cuisson. L’obstruction nasale s’installe avec des éternuements, de la rhinorrhée et un larmoiement. À l’examen, il existe une rougeur et un œdème de la tête des cornets inférieurs. L’exsudat inflammatoire est d’abord clair, puis les sécrétions s’épaississent, deviennent verdâtres et striées de sang lors du mouchage. Le vestibule narinaire se surinfecte (<xref rid="f10-04-9782294745034" ref-type="fig">fig.\xa010.4</xref>\n). Les symptômes régressent en cinq jours. La prise en charge repose sur le paracétamol, l’augmentation de la chaleur ambiante et sur un mouchage atraumatique, une fosse nasale l’une après l’autre.\n). Les symptômes régressent en cinq jours. La prise en charge repose sur le paracétamol, l’augmentation de la chaleur ambiante et sur un mouchage atraumatique, une fosse nasale l’une après l’autre.Figure 10.4Rhinite vestibulaire.Surinfection de la portion cutanée de fosse nasale à\xa0staphylocoque aureus, à traiter par des applications d’acide fusidique crème.'], 'f10-05-9782294745034': ['incidence de Blondeau (face basse ou nez-menton-plaque) mettant en évidence le sinus maxillaire (<xref rid="f10-05-9782294745034" ref-type="fig">fig.\xa010.5</xref>\n)\xa0;\n)\xa0;Figure 10.5Incidence de Blondeau.A. Opacité d’une sinusite maxillaire droite. B. Niveau liquide d’une sinusite maxillaire gauche. C. Kyste muqueux rétentionnel du bas-fond sinusien, séquelle d’une sinusite maxillaire ancienne (image dite en coucher de soleil). D. Aspect de faux niveaux liquides donné par la projection des os temporaux dans le sinus maxillaire lorsque la tête est insuffisamment défléchie.'], 'f10-06-9782294745034': ['Elle recherche la présence d’un drainage mucopurulent, d’une congestion œdémateuse des méats moyens, voire de polypes obstruant les fosses nasales (<xref rid="f10-06-9782294745034" ref-type="fig">fig.\xa010.6</xref>\n).\n).Figure 10.6Endoscopie nasale au cours d’une rhinosinusite chronique.A. Suppuration dans le méat moyen droit. B. Suppuration ethmoïdale. C. Sinusite frontale chronique avec pus dans le\xa0méat moyen et bourrelet de Kaufman (hyperplasie de l’apophyse uncinée). D. Polype luisant et transparent de la fosse nasale gauche.'], 'f10-07-9782294745034': ['Elle montre des épaississements muqueux localisés ou diffus, des opacités s’accompagnant parfois de niveaux liquides et d’érosions osseuses (<xref rid="f10-07-9782294745034" ref-type="fig">Figure 10.7</xref>, , <xref rid="f10-08-9782294745034" ref-type="fig">Figure 10.8</xref>, , <xref rid="f10-09-9782294745034" ref-type="fig">Figure 10.9</xref>\n).\n).Figure 10.7TDM de rhinosinusites chroniques ethmoïdo-maxillaires.A et B. Forme antérieure gauche avec opacité des cellules ethmoïdales antérieures en coupe axiale (A) et ostéolyse en coupe coronale (B). C. RSC invasive avec image en bissac d’un polype antrochoanal. D. Polypose nasosinusienne. Opacité diffuse de toutes les cellules ethmoïdales en coupe coronale.Figure 10.8Formes cliniques de RSC.A. Opacité de tout le sinus frontal gauche en coupe coronale. B. Opacité du sinus sphénoïdal droit en coupe axiale. En avant, le canal optique rejoint l’orbite. En arrière, le canal carotidien vu en coupe est intact. C. Sinusite aspergillaireSinusiteaspergillaire gauche typique avec lyse osseuse et petits mycétomes opaques disséminés dans l’opacité. D. Sinusite maxillaire d’origine dentaire avec lyse alvéolaire.Figure 10.9Pathologies rhinosinusiennes rares.A. Concha bullosa bilatérale. Pneumatisation des cornets moyens chez un sujet asymptomatique (astérisques). B.\xa0Infection d’une concha bullosa gauche (astérisque) chez un patient présentant de violentes algies nasales. C. Mucocèle du sinus maxillaire gauche. D. Granulomatose de Wegener droite (encadré\xa010.2).', 'Sa prévalence est de 1 à 4\xa0% de la population (cf.\n<xref rid="f10-07-9782294745034" ref-type="fig">fig.\xa010.7</xref>D et figure de l’D et figure de l’encadré\xa010.3). Par ordre de fréquence, on en distingue quatre formes\xa0:•la forme isolée ou associée à une poly-allergie\xa0;•la forme avec asthme\xa0;•la forme avec asthme et intolérance à l’aspirine (maladie métabolique de WidalMaladiemétabolique de Widal)\xa0;•mucoviscidose.\n'], 'f10-09-9782294745034': ['Outre les complications orbitaires et méningo-encéphaliques citées plus haut, il faut connaître l’existence des mucocèles. Dans sa forme extensive, c’est un kyste ethmoïdo-frontal ou maxillaire endosinusien se développant par blocage de l’ostium nasofrontal ou maxillaire. Il érode et amincit progressivement les parois osseuses jusqu’à bomber dans l’orbite au niveau de l’angle interne de l’œil (cf.\n<xref rid="f10-09-9782294745034" ref-type="fig">fig.\xa010.9</xref>C). Il contient un mucus épais et souvent aseptique.C). Il contient un mucus épais et souvent aseptique.'], 'f10-08-9782294745034': ['La TDM montre plusieurs aspects. Les petites opacités représentent des mycétomes disséminés au sein de l’opacité sinusienne (cf.\n<xref rid="f10-08-9782294745034" ref-type="fig">fig.\xa010.8</xref>C). L’aspect de balle fungique aspergillaire réalise une opacité unique au sein du sinus maxillaire. Il n’est pas rare de constater la présence de mycétome au sein d’une polypose.C). L’aspect de balle fungique aspergillaire réalise une opacité unique au sein du sinus maxillaire. Il n’est pas rare de constater la présence de mycétome au sein d’une polypose.'], 'f10-10-9782294745034': ['Dans le cas des sinusites frontales, le drainage et les lavages de sinus par un clou de Lermoyez sont efficaces (<xref rid="f10-10-9782294745034" ref-type="fig">fig.\xa010.10</xref>\nA). Il en est de même des lavages du sinus maxillaire par drain d’Albertini, modifié par Orsel.\nA). Il en est de même des lavages du sinus maxillaire par drain d’Albertini, modifié par Orsel.Figure 10.10Indications chirurgicales indiscutables.A. Clou de LermoyezClou de Lermoyez pour drainage et lavage du sinus frontal. B. Cure d’une fistule buccosinusienne. Cathétérisme. C.\xa0Abord du sinus maxillaire droit par voie de Caldwell-Luc. D. Découverte de la truffe aspergillaire.', 'Une grosse balle fungique reste même parfois l’indication d’une chirurgie de Caldwell-Luc (<xref rid="f10-10-9782294745034" ref-type="fig">fig.\xa010.10</xref>C et D).C et D).'], 'f10-11-9782294745034': ['\nDans les formes unilatérales de RSC, cette chirurgie donne d’excellents résultats, surtout s’il y a un facteur fungique de type Aspergillus (<xref rid="f10-11-9782294745034" ref-type="fig">Figure 10.11</xref>, , <xref rid="f10-12-9782294745034" ref-type="fig">Figure 10.12</xref>\n).\n).Figure 10.11Résultats endoscopiques de la chirurgie endonasale.A. Élargissement de l’ostium du sinus maxillaire gauche (méatotomie) avec conservation partielle du cornet moyen et retour à la normale de la muqueuse du sinus. B. Méatotomie du sinus maxillaire droit avec persistance d’une inflammation diffuse et phénomène de la cuvette désignant le fait que le bas-fond sinusien est devenu le réceptacle des sécrétions nasales. C. Bons résultats d’un évidement ethmoïdo-maxillaire droit avec quelques sécrétions dans la méatotomie. D. Résultat d’évidement ethmoïdo-maxillaire gauche. CL\xa0: cloison\xa0; B\xa0: toit de la bulle\xa0; RC\xa0: racine cloisonnante\xa0; SP\xa0: cellule ethmoïdale postérieure\xa0; CH\xa0: choane et rhinopharynx\xa0; SM\xa0: sinus maxillaire.Figure 10.12Résultats TDM de vidéochirurgies endonasales.A. Méatotomie droite en coupe coronale (flèche). B et C. Avant et après méatotomie (flèche) en coupes axiales. D et E. Coupe axiale et coupe coronale postopératoires chez un patient ayant subi une ethmoïdectomie unilatérale gauche (astérisques). F. Grand évidement maxillo-ethmoïdo-frontal droit (astérisque\xa0: emplacement de l’ex-canal nasofrontal).'], 'u10-04-9782294745034': ['\nDans les formes bilatérales, chez certains patients, un traitement local ne peut pas être entrepris, du fait de l’obstruction nasale en rapport avec les déformations septales, l’hyperplasie turbinale ou de l’importance de la polypose. Dans ces cas, la situation peut être débloquée par une vidéochirurgie endoscopique bilatérale. L’objectif est seulement de permettre le traitement local par lavages et corticoïdes locaux. Mais il ne faut pas promettre de miracle (<xref rid="u10-04-9782294745034" ref-type="fig">Vidéo e10.1</xref>, , <xref rid="u10-05-9782294745034" ref-type="fig">Vidéo e10.2</xref>, , <xref rid="u10-06-9782294745034" ref-type="fig">Vidéo e10.3</xref>\xa0\xa0).\nVidéo e10.1Chirurgie endoscopique pour polypose nasosinusienne.Le shaver est un aspirateur grignotant les polypes dans ses mâchoires rotatives. Ce patient présente une polypose nasosinusienne floride et handicapante bilatérale. Avec le shaver, on se fraye facilement un chemin vers le cornet moyen, dans le méat moyen, et on rentre dans l’ethmoïde, ce qui permet de réaliser un évidement ethmoïdal complet. Cet instrument est efficace et atraumatique, mais l’intervention ne dispense pas de la prise en charge médicale. On entre ensuite dans le sinus maxillaire pour\xa0détruire les polypes qu’il contient.Vidéo e10.2Résultat d’une chirurgie endoscopique ethmoïdo-sphénoïdo-maxillaire.Cette patiente a été prise en charge pour une polypose nasosinusienne bilatérale comportant des mycétomes aspergillaires. Du côté droit, les cavités ont bien cicatrisé. On aperçoit le reliquat de cornet moyen (CM), l’ethmoïde antérieur et postérieur (EA et EP), les sinus maxillaire et sphénoïdal (SM et SP). On pénètre dans le sinus sphénoïdal avec ses deux reliefs caractéristiques\xa0: le nerf optique horizontal et la carotide interne verticale. Du côté gauche, c’est la même chose avec les ouvertures béantes du sinus maxillaire sur la droite et du sinus sphénoïdal en\xa0arrière.Vidéo e10.3Truffe aspergillaire sphénoïdale.Patient souffrant de violentes céphalées depuis plusieurs mois. Un scanner en coupes axiales montre une opacité complète du sinus sphénoïdal gauche, avec en coupe coronale une opacité évoquant un mycétome aspergillaire. Il n’y a pas d’érosions osseuses. L’intervention commence par une section de la lame verticale du cornet moyen puis de sa racine cloisonnante horizontale. Le cornet moyen vient ainsi en deux morceaux. On découvre alors l’orifice sphénoïdal gauche rempli par une balle fungique noirâtre. Il est élargi à la pince emporte-pièce et la totalité de la truffe peut être enlevée. Les céphalées ne se reproduisent plus.']} | Rhinites, sinusites et rhinosinusites | null | None | 1474614000 | None | null | other | PMC7184226 | null | null | [
""
] | Guide D'orl. 2016 Sep 23;:173-193 | NO-CC CODE |
|
Typical treatment plan and dose distribution for carbon ion radiotherapy delivered using the raster-scanning technique in a patients with locally recurrent nasopharyngeal carcinoma. | jcav07p0774g001 | 7 | 50fe826ac86986efa401a5e051367dff9e53d8c4d83264c12cf361052787e4f6 | jcav07p0774g001.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
692,
741
] | [{'image_id': 'jcav07p0774g001', 'image_file_name': 'jcav07p0774g001.jpg', 'image_path': '../data/media_files/PMC4860793/jcav07p0774g001.jpg', 'caption': 'Typical treatment plan and dose distribution for carbon ion radiotherapy delivered using the raster-scanning technique in a patients with locally recurrent nasopharyngeal carcinoma.', 'hash': '50fe826ac86986efa401a5e051367dff9e53d8c4d83264c12cf361052787e4f6'}] | {'jcav07p0774g001': ['CIRT in the form of intensity modulated carbon-ion radiation therapy (IMCT) will be delivered using raster-scanning technology. Patients are treated for once a day, 5 days per week. Treatment interruptions of more than 3 days are not allowed unless severe adverse effects require so. Treatment during weekends are required if a break of 2 or more days occurred during the working days. Patient positioning prior to CIRT will be evaluated by comparison of orthogonal x-rays to the DRRs. Set up deviations >2 mm are corrected prior to treatment delivery. A typical treatment plan is illustrated in Figure <xref ref-type="fig" rid="jcav07p0774g001">1</xref>..']} | Phase I/II Trial Evaluating Carbon Ion Radiotherapy for Salvaging Treatment of Locally Recurrent Nasopharyngeal Carcinoma | [
"Carbon Ion Radiotherapy",
"recurrent nasopharyngeal cancer"
] | J Cancer | 1460271600 | MicroRNAs (miRNAs) represent a class of short endogenous non-coding RNAs that negatively regulate gene expression at the post-transcriptional level in many biological processes, including proliferation, differentiation, stress response and apoptosis. In this study we analyzed a set of seven miRNA molecules in sera of patients with papillary thyroid cancer, multinodular goiter and healthy controls to identify miRNA molecules that may have utility as markers for PTC. MiR-21 serum levels in the preoperative PTC and MG groups were significantly higher than the control group. Likewise, postoperative levels of miR-151-5p, miR-221 and miR-222 were significantly lower in patients with PTC. When serum miRNA levels were evaluated according to stage, postoperative levels of miR-151-5p and miR-222 were significantly lower in patients with advanced stages of the disease. The miRNA levels were also found associated with the size of the primary tumor. Our data imply that specific miRNA molecules which are differentially expressed in thyroid tumors may play role in the development of papillary thyroid carcinoma. | [] | other | PMC4860793 | null | 51 | [
"{'Citation': 'Siegel R, Naishadham D, Jemal A. Cancer Statistics. CA Cancer J Clin. 2012;62:10–29.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '22237781'}}}",
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] | J Cancer. 2016 Apr 10; 7(7):774-783 | NO-CC CODE |
|
54-year-old female with breast cancer on chemotherapy presents for restaging PET/CT. MIP images demonstrate hypermetabolic foci in the lungs and mediastinum (black arrows). Axial PET/CT shows bilateral confluent ground-glass opacities (white arrows) and precarinal lymph node (black arrow). | gr4_lrg | 7 | 79ed34f1c873914c95a54c24c6816e1a2f54962922f274514853dfcbaa35a3cd | gr4_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
714,
333
] | [{'image_id': 'gr4_lrg', 'image_file_name': 'gr4_lrg.jpg', 'image_path': '../data/media_files/PMC7962587/gr4_lrg.jpg', 'caption': '54-year-old female with breast cancer on chemotherapy presents for restaging PET/CT. MIP images demonstrate hypermetabolic foci in the lungs and mediastinum (black arrows). Axial PET/CT shows bilateral confluent ground-glass opacities (white arrows) and precarinal lymph node (black arrow).', 'hash': '79ed34f1c873914c95a54c24c6816e1a2f54962922f274514853dfcbaa35a3cd'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7962587/gr1_lrg.jpg', 'caption': '70-year-old male with lung adenocarcinoma on alectinib presenting for routine PET/CT. (Panel A) MIP image shows hypermetabolic lesions in bilateral lungs (black arrows). Axial CT and fused PET images show multifocal bilateral hypermetabolic ground-glass opacities and consolidation (white arrows) consistent with Covid-19 pneumonia, as confirmed by RT-PCR. Hypermetabolic left lower lobe mass (red arrow) consistent with primary malignancy. (Panel B) PET/CT obtained two months after shows near-complete resolution of bilateral opacities with minimal residual GGO. Subpleural parenchymal bands can be seen in the right lower lobe and left fissure thickening (white arrows). Persistent hypermetabolic left lower lobe mass (red arrow).', 'hash': 'cb662df1ecf036c2573ae3c1c38e4d9433b5566fedac80caa33f8bd647a00513'}, {'image_id': 'gr5_lrg', 'image_file_name': 'gr5_lrg.jpg', 'image_path': '../data/media_files/PMC7962587/gr5_lrg.jpg', 'caption': '54-year-old male with lacrolentiginous melanoma on nivolumab. MIP image shows metastatic left lower lobe nodule and right scapula lesion with mediastinal lymphadenopathy (black arrows). Axial PET/CT shows bilateral upper lobes lung opacities with mild uptake (white arrows). RT-PCR done resulted negative.', 'hash': '4432053ec15be7e0da8ba7f997232b6eb236fa851f06a70d89b31f2fab1e2b05'}, {'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC7962587/gr3_lrg.jpg', 'caption': "56-year-old male with Hodgkin's lymphoma presents for follow-up PET/CT complaining of neck discomfort. (Panel A) MIP image shows uptake in bilateral lungs and mediastinum and bilateral neck, right axilla, right pelvis, and inguinal regions (red arrows). Axial PET/CT shows bilateral ground-glass opacities in the upper lobes and patchy consolidations in the lower lobes (white arrows) with associated mediastinal lymphadenopathy (black arrows). (Panel B) PET/CT obtained four months after shows residual ground-glass opacities and resolution of mediastinal lymphadenopathy. MIP images show persistent cervical and right axillary, pelvic, and inguinal lymphadenopathy (red arrows) related to lymphoma.", 'hash': 'f49f7af06ca6b535c047499caba220eb48e4c61e06118f0333dd4dd81d227555'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7962587/gr2_lrg.jpg', 'caption': '67-year-old female with lung adenocarcinoma on maintenance pemetrexed and bevacizumab presenting for routine PET/CT. (Panel A) MIP image shows foci of uptake in the bilateral chest (black arrows) corresponding to hypermetabolic peripheral ground-glass opacities (white arrows) in axial images. (Panel B) Follow-up PET/CT obtained four months after demonstrating complete resolution of lung opacities.', 'hash': 'ccc7adad5d106cbb37f7cfcf7974701b21c98986263edd4c19dfcb149fcf2961'}] | {'gr1_lrg': ['Retrospective analysis of PET/CT scan performed between March 10, 2020, and April 20, 2020, in a multicenter urban health system during the Covid-19 outbreak. Patients with unknown Covid-19 infection with incidental findings suggestive of infection were included. Clinical and demographics data were extracted from electronic medical records. Real-time polymerase chain reaction (RT-PCR) assays of the nasopharyngeal mucosa were used for microbiologic diagnosis. 18F-FDG PET/CT studies were performed on Biograph Vision system, with an axial PET FOV of 25.6\xa0cm, continuous bed motion 1.2 mm/s, 220\xa0x\xa0220 matrix, using PSF and TOF corrections, and reconstructed using OSEM with 2 iterations and 21 subsets (Siemens Healthcare); and on a Biograph mCT Flow PET/CT system, with an axial PET FOV of 21.6\xa0cm, continuous bed motion 1.1\xa0mm/s, 200\xa0x\xa0200 matrix, using PSF and TOF corrections and reconstructed using OSEM with 4 iteration and 5 subsets (Siemens Healthcare). Images were acquired after a fasting period of at least 6 hours, patients’ blood glucose levels were <200\xa0mg/dL at the time of tracer injection with 4.6-4.8 MBq/Kg of 18F-FDG. Delta time was 50–65\xa0min, the low mA, non-diagnostic CT images from PET/CT were used for attenuation correction and anatomic localization. The PET data were used to calculate the maximum SUV, a semi-quantitative parameter. A region of interest (ROI) was placed over abnormal lung parenchyma consolidations and mediastinal/hilar lymph nodes. The maximal activity in the ROI was calculated as the activity over lung consolidation/lymph node relative to the normal injected activity normalized by body weight. Imaging review was performed by a nuclear medicine physician at an Encore (version 6, MIM Software) workstation. The institutional Ethics Committee approved the study, and patients’ informed consent was waived (<xref rid="gr1_lrg" ref-type="fig">Figure 1</xref>, , <xref rid="gr2_lrg" ref-type="fig">Figure 2</xref>, , <xref rid="gr3_lrg" ref-type="fig">Figure 3</xref>, , <xref rid="gr4_lrg" ref-type="fig">Figure 4</xref>, , <xref rid="gr5_lrg" ref-type="fig">Figure 5</xref>\n).\n).Figure 170-year-old male with lung adenocarcinoma on alectinib presenting for routine PET/CT. (Panel A) MIP image shows hypermetabolic lesions in bilateral lungs (black arrows). Axial CT and fused PET images show multifocal bilateral hypermetabolic ground-glass opacities and consolidation (white arrows) consistent with Covid-19 pneumonia, as confirmed by RT-PCR. Hypermetabolic left lower lobe mass (red arrow) consistent with primary malignancy. (Panel B) PET/CT obtained two months after shows near-complete resolution of bilateral opacities with minimal residual GGO. Subpleural parenchymal bands can be seen in the right lower lobe and left fissure thickening (white arrows). Persistent hypermetabolic left lower lobe mass (red arrow).Fig. 1Figure 267-year-old female with lung adenocarcinoma on maintenance pemetrexed and bevacizumab presenting for routine PET/CT. (Panel A) MIP image shows foci of uptake in the bilateral chest (black arrows) corresponding to hypermetabolic peripheral ground-glass opacities (white arrows) in axial images. (Panel B) Follow-up PET/CT obtained four months after demonstrating complete resolution of lung opacities.Fig. 2Figure 356-year-old male with Hodgkin\'s lymphoma presents for follow-up PET/CT complaining of neck discomfort. (Panel A) MIP image shows uptake in bilateral lungs and mediastinum and bilateral neck, right axilla, right pelvis, and inguinal regions (red arrows). Axial PET/CT shows bilateral ground-glass opacities in the upper lobes and patchy consolidations in the lower lobes (white arrows) with associated mediastinal lymphadenopathy (black arrows). (Panel B) PET/CT obtained four months after shows residual ground-glass opacities and resolution of mediastinal lymphadenopathy. MIP images show persistent cervical and right axillary, pelvic, and inguinal lymphadenopathy (red arrows) related to lymphoma.Fig. 3Figure 454-year-old female with breast cancer on chemotherapy presents for restaging PET/CT. MIP images demonstrate hypermetabolic foci in the lungs and mediastinum (black arrows). Axial PET/CT shows bilateral confluent ground-glass opacities (white arrows) and precarinal lymph node (black arrow).Fig. 4Figure 554-year-old male with lacrolentiginous melanoma on nivolumab. MIP image shows metastatic left lower lobe nodule and right scapula lesion with mediastinal lymphadenopathy (black arrows). Axial PET/CT shows bilateral upper lobes lung opacities with mild uptake (white arrows). RT-PCR done resulted negative.Fig. 5']} | Asymptomatic SARS-CoV-2 infection: Incidental findings on FDG PET/CT | null | J Med Imaging Radiat Sci | 1623826800 | Since the beginning of the COVID-19 pandemic, several service fields have opted for virtual work as much as possible, in order to decrease the spread of the virus. Although several articles have now addressed the key issues in telecommunications and medical education, none have described the digital or virtual functionality of a professional society disease focused panel (DFP) or inter-institutional collaborations. This is extremely important as we believe that the virtual functioning of the DFP will be the new norm for years to come. In this article, we highlight the limitations in the functioning of DFP brought forth due to the ongoing pandemic, while also providing the digital technologic solutions to adapt and also maintain or increase its productivity. | [
"COVID-19",
"Humans",
"Pandemics",
"Societies, Medical",
"Telecommunications"
] | other | PMC7962587 | null | 28 | [
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"{'Citation': 'Porpiglia F, Amparore D, Autorino R, Checcucci E, Cooperberg MR, Ficarra V, et al. Traditional and Virtual Congress Meetings During the COVID-19 Pandemic and the Post-COVID-19 Era: Is it Time to Change the Paradigm? European Urology. 2020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7158826'}, {'@IdType': 'pubmed', '#text': '32334884'}]}}",
"{'Citation': 'Torres MG, Buck C, Gouldin C. Making the Leap from the Traditional to the Virtual Educational Experience. New England Journal of Higher Education. 2020.'}",
"{'Citation': 'Catanzano TM, Nandwana SB, Folio LR. Web-based Conferencing: Tips, Tricks, and Scenario-based Best Practices for Clinicians During a Pandemic Crisis. Journal of Computer Assisted Tomography. 2020;44(4):465–471. doi: 10.1097/RCT.0000000000001072.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/RCT.0000000000001072'}, {'@IdType': 'pubmed', '#text': '32649430'}]}}",
"{'Citation': 'Li CH, Rajamohan AG, Acharya PT, Liu C-SJ, Patel V, Go JL, et al. Virtual read-out: radiology education for the 21st century during the COVID-19 pandemic. Academic Radiology. 2020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7252195'}, {'@IdType': 'pubmed', '#text': '32386950'}]}}",
"{'Citation': 'Slanetz PJ, Parikh U, Chapman T, Motuzas CL. Coronavirus Disease 2019 (COVID-19) and Radiology Education—Strategies for Survival. Journal of the American College of Radiology. 2020;17(6):743. doi: 10.1016/j.jacr.2020.03.034.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.jacr.2020.03.034'}, {'@IdType': 'pmc', '#text': 'PMC7180008'}, {'@IdType': 'pubmed', '#text': '32335184'}]}}",
"{'Citation': 'Henderson D, Woodcock H, Mehta J, Khan N, Shivji V, Richardson C, et al. Keep calm and carry on learning: using Microsoft teams to deliver a medical education programme during the COVID-19 pandemic. Future healthcare journal. 2020;7(3):e67. doi: 10.7861/fhj.2020-0071.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.7861/fhj.2020-0071'}, {'@IdType': 'pmc', '#text': 'PMC7571760'}, {'@IdType': 'pubmed', '#text': '33094260'}]}}",
"{'Citation': 'Martin L, Tapp D. Teaching with Teams: An introduction to teaching an undergraduate law module using Microsoft Teams. Innovative Practice in Higher Education. 2019;3(3).'}",
"{'Citation': 'Shalini Shah M, Sudhir Diwan M, Lynn Kohan M, David Rosenblum M, Christopher Gharibo M, Amol Soin M, et al. The technological impact of COVID-19 on the future of education and health care delivery. Pain physician. 2020;23:S367–S380. doi: 10.36076/ppj.2020/23/S367.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.36076/ppj.2020/23/S367'}, {'@IdType': 'pubmed', '#text': '32942794'}]}}",
"{'Citation': 'Bhargava P, Dhand S, Lackey AE, Pandey T, Moshiri M, Jambhekar K. Radiology education 2.0—on the cusp of change: part 2. eBooks; file sharing and synchronization tools; websites/teaching files; reference management tools and note taking applications. Academic radiology. 2013;20(3):373–81.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '23452484'}}}",
"{'Citation': 'Rayhan RU, Zheng Y, Uddin E, Timbol C, Adewuyi O, Baraniuk JN. Administer and collect medical questionnaires with Google documents: a simple, safe, and free system. Appl Med Inform. 2013;33(3):12–21.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3884902'}, {'@IdType': 'pubmed', '#text': '24415903'}]}}",
"{'Citation': 'Assadi R, Gasparyan AY. Editing, Publishing and Aggregating Video Articles: Do We Need a Scholarly Approach? J Korean Med Sci. 2015;30(9):1211–1212. doi: 10.3346/jkms.2015.30.9.1211.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.3346/jkms.2015.30.9.1211'}, {'@IdType': 'pmc', '#text': 'PMC4553665'}, {'@IdType': 'pubmed', '#text': '26339158'}]}}",
"{'Citation': 'Wijesooriya NR, Mishra V, Brand PL, Rubin BK. COVID-19 and telehealth, education, and research adaptations. Paediatric Respiratory Reviews. 2020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7301824'}, {'@IdType': 'pubmed', '#text': '32653468'}]}}",
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] | J Med Imaging Radiat Sci. 2021 Jun 16; 52(2):179-185 | NO-CC CODE |
|
54-year-old male with lacrolentiginous melanoma on nivolumab. MIP image shows metastatic left lower lobe nodule and right scapula lesion with mediastinal lymphadenopathy (black arrows). Axial PET/CT shows bilateral upper lobes lung opacities with mild uptake (white arrows). RT-PCR done resulted negative. | gr5_lrg | 7 | 4432053ec15be7e0da8ba7f997232b6eb236fa851f06a70d89b31f2fab1e2b05 | gr5_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
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714,
392
] | [{'image_id': 'gr4_lrg', 'image_file_name': 'gr4_lrg.jpg', 'image_path': '../data/media_files/PMC7962587/gr4_lrg.jpg', 'caption': '54-year-old female with breast cancer on chemotherapy presents for restaging PET/CT. MIP images demonstrate hypermetabolic foci in the lungs and mediastinum (black arrows). Axial PET/CT shows bilateral confluent ground-glass opacities (white arrows) and precarinal lymph node (black arrow).', 'hash': '79ed34f1c873914c95a54c24c6816e1a2f54962922f274514853dfcbaa35a3cd'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7962587/gr1_lrg.jpg', 'caption': '70-year-old male with lung adenocarcinoma on alectinib presenting for routine PET/CT. (Panel A) MIP image shows hypermetabolic lesions in bilateral lungs (black arrows). Axial CT and fused PET images show multifocal bilateral hypermetabolic ground-glass opacities and consolidation (white arrows) consistent with Covid-19 pneumonia, as confirmed by RT-PCR. Hypermetabolic left lower lobe mass (red arrow) consistent with primary malignancy. (Panel B) PET/CT obtained two months after shows near-complete resolution of bilateral opacities with minimal residual GGO. Subpleural parenchymal bands can be seen in the right lower lobe and left fissure thickening (white arrows). Persistent hypermetabolic left lower lobe mass (red arrow).', 'hash': 'cb662df1ecf036c2573ae3c1c38e4d9433b5566fedac80caa33f8bd647a00513'}, {'image_id': 'gr5_lrg', 'image_file_name': 'gr5_lrg.jpg', 'image_path': '../data/media_files/PMC7962587/gr5_lrg.jpg', 'caption': '54-year-old male with lacrolentiginous melanoma on nivolumab. MIP image shows metastatic left lower lobe nodule and right scapula lesion with mediastinal lymphadenopathy (black arrows). Axial PET/CT shows bilateral upper lobes lung opacities with mild uptake (white arrows). RT-PCR done resulted negative.', 'hash': '4432053ec15be7e0da8ba7f997232b6eb236fa851f06a70d89b31f2fab1e2b05'}, {'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC7962587/gr3_lrg.jpg', 'caption': "56-year-old male with Hodgkin's lymphoma presents for follow-up PET/CT complaining of neck discomfort. (Panel A) MIP image shows uptake in bilateral lungs and mediastinum and bilateral neck, right axilla, right pelvis, and inguinal regions (red arrows). Axial PET/CT shows bilateral ground-glass opacities in the upper lobes and patchy consolidations in the lower lobes (white arrows) with associated mediastinal lymphadenopathy (black arrows). (Panel B) PET/CT obtained four months after shows residual ground-glass opacities and resolution of mediastinal lymphadenopathy. MIP images show persistent cervical and right axillary, pelvic, and inguinal lymphadenopathy (red arrows) related to lymphoma.", 'hash': 'f49f7af06ca6b535c047499caba220eb48e4c61e06118f0333dd4dd81d227555'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7962587/gr2_lrg.jpg', 'caption': '67-year-old female with lung adenocarcinoma on maintenance pemetrexed and bevacizumab presenting for routine PET/CT. (Panel A) MIP image shows foci of uptake in the bilateral chest (black arrows) corresponding to hypermetabolic peripheral ground-glass opacities (white arrows) in axial images. (Panel B) Follow-up PET/CT obtained four months after demonstrating complete resolution of lung opacities.', 'hash': 'ccc7adad5d106cbb37f7cfcf7974701b21c98986263edd4c19dfcb149fcf2961'}] | {'gr1_lrg': ['Retrospective analysis of PET/CT scan performed between March 10, 2020, and April 20, 2020, in a multicenter urban health system during the Covid-19 outbreak. Patients with unknown Covid-19 infection with incidental findings suggestive of infection were included. Clinical and demographics data were extracted from electronic medical records. Real-time polymerase chain reaction (RT-PCR) assays of the nasopharyngeal mucosa were used for microbiologic diagnosis. 18F-FDG PET/CT studies were performed on Biograph Vision system, with an axial PET FOV of 25.6\xa0cm, continuous bed motion 1.2 mm/s, 220\xa0x\xa0220 matrix, using PSF and TOF corrections, and reconstructed using OSEM with 2 iterations and 21 subsets (Siemens Healthcare); and on a Biograph mCT Flow PET/CT system, with an axial PET FOV of 21.6\xa0cm, continuous bed motion 1.1\xa0mm/s, 200\xa0x\xa0200 matrix, using PSF and TOF corrections and reconstructed using OSEM with 4 iteration and 5 subsets (Siemens Healthcare). Images were acquired after a fasting period of at least 6 hours, patients’ blood glucose levels were <200\xa0mg/dL at the time of tracer injection with 4.6-4.8 MBq/Kg of 18F-FDG. Delta time was 50–65\xa0min, the low mA, non-diagnostic CT images from PET/CT were used for attenuation correction and anatomic localization. The PET data were used to calculate the maximum SUV, a semi-quantitative parameter. A region of interest (ROI) was placed over abnormal lung parenchyma consolidations and mediastinal/hilar lymph nodes. The maximal activity in the ROI was calculated as the activity over lung consolidation/lymph node relative to the normal injected activity normalized by body weight. Imaging review was performed by a nuclear medicine physician at an Encore (version 6, MIM Software) workstation. The institutional Ethics Committee approved the study, and patients’ informed consent was waived (<xref rid="gr1_lrg" ref-type="fig">Figure 1</xref>, , <xref rid="gr2_lrg" ref-type="fig">Figure 2</xref>, , <xref rid="gr3_lrg" ref-type="fig">Figure 3</xref>, , <xref rid="gr4_lrg" ref-type="fig">Figure 4</xref>, , <xref rid="gr5_lrg" ref-type="fig">Figure 5</xref>\n).\n).Figure 170-year-old male with lung adenocarcinoma on alectinib presenting for routine PET/CT. (Panel A) MIP image shows hypermetabolic lesions in bilateral lungs (black arrows). Axial CT and fused PET images show multifocal bilateral hypermetabolic ground-glass opacities and consolidation (white arrows) consistent with Covid-19 pneumonia, as confirmed by RT-PCR. Hypermetabolic left lower lobe mass (red arrow) consistent with primary malignancy. (Panel B) PET/CT obtained two months after shows near-complete resolution of bilateral opacities with minimal residual GGO. Subpleural parenchymal bands can be seen in the right lower lobe and left fissure thickening (white arrows). Persistent hypermetabolic left lower lobe mass (red arrow).Fig. 1Figure 267-year-old female with lung adenocarcinoma on maintenance pemetrexed and bevacizumab presenting for routine PET/CT. (Panel A) MIP image shows foci of uptake in the bilateral chest (black arrows) corresponding to hypermetabolic peripheral ground-glass opacities (white arrows) in axial images. (Panel B) Follow-up PET/CT obtained four months after demonstrating complete resolution of lung opacities.Fig. 2Figure 356-year-old male with Hodgkin\'s lymphoma presents for follow-up PET/CT complaining of neck discomfort. (Panel A) MIP image shows uptake in bilateral lungs and mediastinum and bilateral neck, right axilla, right pelvis, and inguinal regions (red arrows). Axial PET/CT shows bilateral ground-glass opacities in the upper lobes and patchy consolidations in the lower lobes (white arrows) with associated mediastinal lymphadenopathy (black arrows). (Panel B) PET/CT obtained four months after shows residual ground-glass opacities and resolution of mediastinal lymphadenopathy. MIP images show persistent cervical and right axillary, pelvic, and inguinal lymphadenopathy (red arrows) related to lymphoma.Fig. 3Figure 454-year-old female with breast cancer on chemotherapy presents for restaging PET/CT. MIP images demonstrate hypermetabolic foci in the lungs and mediastinum (black arrows). Axial PET/CT shows bilateral confluent ground-glass opacities (white arrows) and precarinal lymph node (black arrow).Fig. 4Figure 554-year-old male with lacrolentiginous melanoma on nivolumab. MIP image shows metastatic left lower lobe nodule and right scapula lesion with mediastinal lymphadenopathy (black arrows). Axial PET/CT shows bilateral upper lobes lung opacities with mild uptake (white arrows). RT-PCR done resulted negative.Fig. 5']} | Asymptomatic SARS-CoV-2 infection: Incidental findings on FDG PET/CT | null | J Med Imaging Radiat Sci | 1623826800 | Since the beginning of the COVID-19 pandemic, several service fields have opted for virtual work as much as possible, in order to decrease the spread of the virus. Although several articles have now addressed the key issues in telecommunications and medical education, none have described the digital or virtual functionality of a professional society disease focused panel (DFP) or inter-institutional collaborations. This is extremely important as we believe that the virtual functioning of the DFP will be the new norm for years to come. In this article, we highlight the limitations in the functioning of DFP brought forth due to the ongoing pandemic, while also providing the digital technologic solutions to adapt and also maintain or increase its productivity. | [
"COVID-19",
"Humans",
"Pandemics",
"Societies, Medical",
"Telecommunications"
] | other | PMC7962587 | null | 28 | [
"{'Citation': 'Tokuç B, Varol G. Medical education in Turkey in time of COVID-19. Balkan medical journal. 2020;37(4):180.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7285660'}, {'@IdType': 'pubmed', '#text': '32364692'}]}}",
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"{'Citation': 'Almarzooq Z, Lopes M, Kochar A. Virtual learning during the COVID-19 pandemic: a disruptive technology in graduate medical education. Journal of the American College of Cardiology; 2020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7159871'}, {'@IdType': 'pubmed', '#text': '32304797'}]}}",
"{'Citation': 'Bhargava P, Lackey AE, Dhand S, Moshiri M, Jambhekar K, Pandey T. Radiology education 2.0—on the cusp of change: part 1. Tablet computers, online curriculums, remote meeting tools and audience response systems. Academic Radiology. 2013;20(3):364–72.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '23452483'}}}",
"{'Citation': 'McRoy C, Patel L, Gaddam DS, Rothenberg S, Herring A, Hamm J, et al. Radiology Education in the Time of COVID-19: A Novel Distance Learning Workstation Experience for Residents. Academic radiology. 2020;27(10):1467–1474. doi: 10.1016/j.acra.2020.08.001.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.acra.2020.08.001'}, {'@IdType': 'pmc', '#text': 'PMC7414323'}, {'@IdType': 'pubmed', '#text': '32800692'}]}}",
"{'Citation': 'Jena PK. Impact of Covid-19 on higher education in India. International Journal of Advanced Education and Research (IJAER). 2020;5.'}",
"{'Citation': 'Mishra K, Boland MV, Woreta FA. Incorporating a virtual curriculum into ophthalmology education in the coronavirus disease-2019 era. Current opinion in ophthalmology. 2020;31(5):380–385. doi: 10.1097/ICU.0000000000000681.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/ICU.0000000000000681'}, {'@IdType': 'pubmed', '#text': '32694267'}]}}",
"{'Citation': 'Porpiglia F, Amparore D, Autorino R, Checcucci E, Cooperberg MR, Ficarra V, et al. Traditional and Virtual Congress Meetings During the COVID-19 Pandemic and the Post-COVID-19 Era: Is it Time to Change the Paradigm? European Urology. 2020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7158826'}, {'@IdType': 'pubmed', '#text': '32334884'}]}}",
"{'Citation': 'Torres MG, Buck C, Gouldin C. Making the Leap from the Traditional to the Virtual Educational Experience. New England Journal of Higher Education. 2020.'}",
"{'Citation': 'Catanzano TM, Nandwana SB, Folio LR. Web-based Conferencing: Tips, Tricks, and Scenario-based Best Practices for Clinicians During a Pandemic Crisis. Journal of Computer Assisted Tomography. 2020;44(4):465–471. doi: 10.1097/RCT.0000000000001072.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/RCT.0000000000001072'}, {'@IdType': 'pubmed', '#text': '32649430'}]}}",
"{'Citation': 'Li CH, Rajamohan AG, Acharya PT, Liu C-SJ, Patel V, Go JL, et al. Virtual read-out: radiology education for the 21st century during the COVID-19 pandemic. Academic Radiology. 2020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7252195'}, {'@IdType': 'pubmed', '#text': '32386950'}]}}",
"{'Citation': 'Slanetz PJ, Parikh U, Chapman T, Motuzas CL. Coronavirus Disease 2019 (COVID-19) and Radiology Education—Strategies for Survival. Journal of the American College of Radiology. 2020;17(6):743. doi: 10.1016/j.jacr.2020.03.034.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.jacr.2020.03.034'}, {'@IdType': 'pmc', '#text': 'PMC7180008'}, {'@IdType': 'pubmed', '#text': '32335184'}]}}",
"{'Citation': 'Henderson D, Woodcock H, Mehta J, Khan N, Shivji V, Richardson C, et al. Keep calm and carry on learning: using Microsoft teams to deliver a medical education programme during the COVID-19 pandemic. Future healthcare journal. 2020;7(3):e67. doi: 10.7861/fhj.2020-0071.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.7861/fhj.2020-0071'}, {'@IdType': 'pmc', '#text': 'PMC7571760'}, {'@IdType': 'pubmed', '#text': '33094260'}]}}",
"{'Citation': 'Martin L, Tapp D. Teaching with Teams: An introduction to teaching an undergraduate law module using Microsoft Teams. Innovative Practice in Higher Education. 2019;3(3).'}",
"{'Citation': 'Shalini Shah M, Sudhir Diwan M, Lynn Kohan M, David Rosenblum M, Christopher Gharibo M, Amol Soin M, et al. The technological impact of COVID-19 on the future of education and health care delivery. Pain physician. 2020;23:S367–S380. doi: 10.36076/ppj.2020/23/S367.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.36076/ppj.2020/23/S367'}, {'@IdType': 'pubmed', '#text': '32942794'}]}}",
"{'Citation': 'Bhargava P, Dhand S, Lackey AE, Pandey T, Moshiri M, Jambhekar K. Radiology education 2.0—on the cusp of change: part 2. eBooks; file sharing and synchronization tools; websites/teaching files; reference management tools and note taking applications. Academic radiology. 2013;20(3):373–81.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '23452484'}}}",
"{'Citation': 'Rayhan RU, Zheng Y, Uddin E, Timbol C, Adewuyi O, Baraniuk JN. Administer and collect medical questionnaires with Google documents: a simple, safe, and free system. Appl Med Inform. 2013;33(3):12–21.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3884902'}, {'@IdType': 'pubmed', '#text': '24415903'}]}}",
"{'Citation': 'Assadi R, Gasparyan AY. Editing, Publishing and Aggregating Video Articles: Do We Need a Scholarly Approach? J Korean Med Sci. 2015;30(9):1211–1212. doi: 10.3346/jkms.2015.30.9.1211.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.3346/jkms.2015.30.9.1211'}, {'@IdType': 'pmc', '#text': 'PMC4553665'}, {'@IdType': 'pubmed', '#text': '26339158'}]}}",
"{'Citation': 'Wijesooriya NR, Mishra V, Brand PL, Rubin BK. COVID-19 and telehealth, education, and research adaptations. Paediatric Respiratory Reviews. 2020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7301824'}, {'@IdType': 'pubmed', '#text': '32653468'}]}}",
"{'Citation': 'Kali A. Reference management: A critical element of scientific writing. J Adv Pharm Technol Res. 2016;7(1):27–29. doi: 10.4103/2231-4040.169875.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.4103/2231-4040.169875'}, {'@IdType': 'pmc', '#text': 'PMC4759983'}, {'@IdType': 'pubmed', '#text': '26952149'}]}}",
"{'Citation': 'Sungur MO, Seyhan TO. Writing references and using citation management software. Turk J Urol. 2013;39(Suppl 1):25–32.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC4548572'}, {'@IdType': 'pubmed', '#text': '26328132'}]}}",
"{'Citation': 'Prior F, Almeida J, Kathiravelu P, Kurc T, Smith K, Fitzgerald TJ, et al. Open access image repositories: high-quality data to enable machine learning research. Clin Radiol. 2020;75(1):7–12. doi: 10.1016/j.crad.2019.04.002.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.crad.2019.04.002'}, {'@IdType': 'pmc', '#text': 'PMC6815686'}, {'@IdType': 'pubmed', '#text': '31040006'}]}}",
"{'Citation': 'Dhawan S. Online learning: A panacea in the time of COVID-19 crisis. Journal of Educational Technology Systems. 2020;49(1):5–22. doi: 10.1177/0047239520934018.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1177/0047239520934018'}}}",
"{'Citation': 'Alpert JB, Young MG, Lala SV, McGuinness G. Medical Student Engagement and Educational Value of a Remote Clinical Radiology Learning Environment: Creation of Virtual Read-Out Sessions in Response to the COVID-19 Pandemic. Academic Radiology. 2020.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '33268209'}}}",
"{'Citation': 'Vardeny O, Hernandez AF, Cohen LW, Franklin A, Baqai M, Palmer S, et al. Transitioning to the National Institutes of Health single institutional review board model: Piloting the use of the Streamlined, Multi-site, Accelerated Resources for Trials IRB Reliance. Clin Trials. 2019;16(3):290–296. doi: 10.1177/1740774519832911.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1177/1740774519832911'}, {'@IdType': 'pmc', '#text': 'PMC7924135'}, {'@IdType': 'pubmed', '#text': '30866676'}]}}",
"{'Citation': 'Christian MC, Goldberg JL, Killen J, Abrams JS, McCabe MS, Mauer JK, et al. A central institutional review board for multi-institutional trials. N Engl J Med. 2002;346(18):1405–1408. doi: 10.1056/NEJM200205023461814.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1056/NEJM200205023461814'}, {'@IdType': 'pubmed', '#text': '11986418'}]}}",
"{'Citation': 'Klinger C, Landeg O, Murray V. Power outages, extreme events and health: a systematic review of the literature from 2011–2012. PLoS Curr. 2014;6.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3879211'}, {'@IdType': 'pubmed', '#text': '24459613'}]}}"
] | J Med Imaging Radiat Sci. 2021 Jun 16; 52(2):179-185 | NO-CC CODE |
|
67-year-old female with lung adenocarcinoma on maintenance pemetrexed and bevacizumab presenting for routine PET/CT. (Panel A) MIP image shows foci of uptake in the bilateral chest (black arrows) corresponding to hypermetabolic peripheral ground-glass opacities (white arrows) in axial images. (Panel B) Follow-up PET/CT obtained four months after demonstrating complete resolution of lung opacities. | gr2_lrg | 7 | ccc7adad5d106cbb37f7cfcf7974701b21c98986263edd4c19dfcb149fcf2961 | gr2_lrg.jpg | multiple | multiple panels: images | [
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Hypermetabolic left lower lobe mass (red arrow) consistent with primary malignancy. (Panel B) PET/CT obtained two months after shows near-complete resolution of bilateral opacities with minimal residual GGO. Subpleural parenchymal bands can be seen in the right lower lobe and left fissure thickening (white arrows). Persistent hypermetabolic left lower lobe mass (red arrow).', 'hash': 'cb662df1ecf036c2573ae3c1c38e4d9433b5566fedac80caa33f8bd647a00513'}, {'image_id': 'gr5_lrg', 'image_file_name': 'gr5_lrg.jpg', 'image_path': '../data/media_files/PMC7962587/gr5_lrg.jpg', 'caption': '54-year-old male with lacrolentiginous melanoma on nivolumab. MIP image shows metastatic left lower lobe nodule and right scapula lesion with mediastinal lymphadenopathy (black arrows). Axial PET/CT shows bilateral upper lobes lung opacities with mild uptake (white arrows). RT-PCR done resulted negative.', 'hash': '4432053ec15be7e0da8ba7f997232b6eb236fa851f06a70d89b31f2fab1e2b05'}, {'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC7962587/gr3_lrg.jpg', 'caption': "56-year-old male with Hodgkin's lymphoma presents for follow-up PET/CT complaining of neck discomfort. (Panel A) MIP image shows uptake in bilateral lungs and mediastinum and bilateral neck, right axilla, right pelvis, and inguinal regions (red arrows). Axial PET/CT shows bilateral ground-glass opacities in the upper lobes and patchy consolidations in the lower lobes (white arrows) with associated mediastinal lymphadenopathy (black arrows). (Panel B) PET/CT obtained four months after shows residual ground-glass opacities and resolution of mediastinal lymphadenopathy. MIP images show persistent cervical and right axillary, pelvic, and inguinal lymphadenopathy (red arrows) related to lymphoma.", 'hash': 'f49f7af06ca6b535c047499caba220eb48e4c61e06118f0333dd4dd81d227555'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7962587/gr2_lrg.jpg', 'caption': '67-year-old female with lung adenocarcinoma on maintenance pemetrexed and bevacizumab presenting for routine PET/CT. (Panel A) MIP image shows foci of uptake in the bilateral chest (black arrows) corresponding to hypermetabolic peripheral ground-glass opacities (white arrows) in axial images. (Panel B) Follow-up PET/CT obtained four months after demonstrating complete resolution of lung opacities.', 'hash': 'ccc7adad5d106cbb37f7cfcf7974701b21c98986263edd4c19dfcb149fcf2961'}] | {'gr1_lrg': ['Retrospective analysis of PET/CT scan performed between March 10, 2020, and April 20, 2020, in a multicenter urban health system during the Covid-19 outbreak. Patients with unknown Covid-19 infection with incidental findings suggestive of infection were included. Clinical and demographics data were extracted from electronic medical records. Real-time polymerase chain reaction (RT-PCR) assays of the nasopharyngeal mucosa were used for microbiologic diagnosis. 18F-FDG PET/CT studies were performed on Biograph Vision system, with an axial PET FOV of 25.6\xa0cm, continuous bed motion 1.2 mm/s, 220\xa0x\xa0220 matrix, using PSF and TOF corrections, and reconstructed using OSEM with 2 iterations and 21 subsets (Siemens Healthcare); and on a Biograph mCT Flow PET/CT system, with an axial PET FOV of 21.6\xa0cm, continuous bed motion 1.1\xa0mm/s, 200\xa0x\xa0200 matrix, using PSF and TOF corrections and reconstructed using OSEM with 4 iteration and 5 subsets (Siemens Healthcare). Images were acquired after a fasting period of at least 6 hours, patients’ blood glucose levels were <200\xa0mg/dL at the time of tracer injection with 4.6-4.8 MBq/Kg of 18F-FDG. Delta time was 50–65\xa0min, the low mA, non-diagnostic CT images from PET/CT were used for attenuation correction and anatomic localization. The PET data were used to calculate the maximum SUV, a semi-quantitative parameter. A region of interest (ROI) was placed over abnormal lung parenchyma consolidations and mediastinal/hilar lymph nodes. The maximal activity in the ROI was calculated as the activity over lung consolidation/lymph node relative to the normal injected activity normalized by body weight. Imaging review was performed by a nuclear medicine physician at an Encore (version 6, MIM Software) workstation. The institutional Ethics Committee approved the study, and patients’ informed consent was waived (<xref rid="gr1_lrg" ref-type="fig">Figure 1</xref>, , <xref rid="gr2_lrg" ref-type="fig">Figure 2</xref>, , <xref rid="gr3_lrg" ref-type="fig">Figure 3</xref>, , <xref rid="gr4_lrg" ref-type="fig">Figure 4</xref>, , <xref rid="gr5_lrg" ref-type="fig">Figure 5</xref>\n).\n).Figure 170-year-old male with lung adenocarcinoma on alectinib presenting for routine PET/CT. (Panel A) MIP image shows hypermetabolic lesions in bilateral lungs (black arrows). Axial CT and fused PET images show multifocal bilateral hypermetabolic ground-glass opacities and consolidation (white arrows) consistent with Covid-19 pneumonia, as confirmed by RT-PCR. Hypermetabolic left lower lobe mass (red arrow) consistent with primary malignancy. (Panel B) PET/CT obtained two months after shows near-complete resolution of bilateral opacities with minimal residual GGO. Subpleural parenchymal bands can be seen in the right lower lobe and left fissure thickening (white arrows). Persistent hypermetabolic left lower lobe mass (red arrow).Fig. 1Figure 267-year-old female with lung adenocarcinoma on maintenance pemetrexed and bevacizumab presenting for routine PET/CT. (Panel A) MIP image shows foci of uptake in the bilateral chest (black arrows) corresponding to hypermetabolic peripheral ground-glass opacities (white arrows) in axial images. (Panel B) Follow-up PET/CT obtained four months after demonstrating complete resolution of lung opacities.Fig. 2Figure 356-year-old male with Hodgkin\'s lymphoma presents for follow-up PET/CT complaining of neck discomfort. (Panel A) MIP image shows uptake in bilateral lungs and mediastinum and bilateral neck, right axilla, right pelvis, and inguinal regions (red arrows). Axial PET/CT shows bilateral ground-glass opacities in the upper lobes and patchy consolidations in the lower lobes (white arrows) with associated mediastinal lymphadenopathy (black arrows). (Panel B) PET/CT obtained four months after shows residual ground-glass opacities and resolution of mediastinal lymphadenopathy. MIP images show persistent cervical and right axillary, pelvic, and inguinal lymphadenopathy (red arrows) related to lymphoma.Fig. 3Figure 454-year-old female with breast cancer on chemotherapy presents for restaging PET/CT. MIP images demonstrate hypermetabolic foci in the lungs and mediastinum (black arrows). Axial PET/CT shows bilateral confluent ground-glass opacities (white arrows) and precarinal lymph node (black arrow).Fig. 4Figure 554-year-old male with lacrolentiginous melanoma on nivolumab. MIP image shows metastatic left lower lobe nodule and right scapula lesion with mediastinal lymphadenopathy (black arrows). Axial PET/CT shows bilateral upper lobes lung opacities with mild uptake (white arrows). RT-PCR done resulted negative.Fig. 5']} | Asymptomatic SARS-CoV-2 infection: Incidental findings on FDG PET/CT | null | J Med Imaging Radiat Sci | 1623826800 | Since the beginning of the COVID-19 pandemic, several service fields have opted for virtual work as much as possible, in order to decrease the spread of the virus. Although several articles have now addressed the key issues in telecommunications and medical education, none have described the digital or virtual functionality of a professional society disease focused panel (DFP) or inter-institutional collaborations. This is extremely important as we believe that the virtual functioning of the DFP will be the new norm for years to come. In this article, we highlight the limitations in the functioning of DFP brought forth due to the ongoing pandemic, while also providing the digital technologic solutions to adapt and also maintain or increase its productivity. | [
"COVID-19",
"Humans",
"Pandemics",
"Societies, Medical",
"Telecommunications"
] | other | PMC7962587 | null | 28 | [
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"{'Citation': 'Dhawan S. Online learning: A panacea in the time of COVID-19 crisis. Journal of Educational Technology Systems. 2020;49(1):5–22. doi: 10.1177/0047239520934018.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1177/0047239520934018'}}}",
"{'Citation': 'Alpert JB, Young MG, Lala SV, McGuinness G. Medical Student Engagement and Educational Value of a Remote Clinical Radiology Learning Environment: Creation of Virtual Read-Out Sessions in Response to the COVID-19 Pandemic. Academic Radiology. 2020.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '33268209'}}}",
"{'Citation': 'Vardeny O, Hernandez AF, Cohen LW, Franklin A, Baqai M, Palmer S, et al. Transitioning to the National Institutes of Health single institutional review board model: Piloting the use of the Streamlined, Multi-site, Accelerated Resources for Trials IRB Reliance. Clin Trials. 2019;16(3):290–296. doi: 10.1177/1740774519832911.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1177/1740774519832911'}, {'@IdType': 'pmc', '#text': 'PMC7924135'}, {'@IdType': 'pubmed', '#text': '30866676'}]}}",
"{'Citation': 'Christian MC, Goldberg JL, Killen J, Abrams JS, McCabe MS, Mauer JK, et al. A central institutional review board for multi-institutional trials. N Engl J Med. 2002;346(18):1405–1408. doi: 10.1056/NEJM200205023461814.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1056/NEJM200205023461814'}, {'@IdType': 'pubmed', '#text': '11986418'}]}}",
"{'Citation': 'Klinger C, Landeg O, Murray V. Power outages, extreme events and health: a systematic review of the literature from 2011–2012. PLoS Curr. 2014;6.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3879211'}, {'@IdType': 'pubmed', '#text': '24459613'}]}}"
] | J Med Imaging Radiat Sci. 2021 Jun 16; 52(2):179-185 | NO-CC CODE |
|
Angio-CT scan at 1 month. | gr2_lrg | 7 | e92137e7eff31ea6dd844f33f8d2c63380a1a438bee5ee9f3d046bfc1b16a237 | gr2_lrg.jpg | multiple | multiple panels: images | [
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595
] | [{'image_id': 'gr6_lrg', 'image_file_name': 'gr6_lrg.jpg', 'image_path': '../data/media_files/PMC8087612/gr6_lrg.jpg', 'caption': 'Not satisfactory improvement of blood flow after mechanical thrombectomy.', 'hash': 'a3a4cd7a392379c3ed0be8a8bc56f1d65d75dcc20c6e6af3b0c60587a63c2203'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC8087612/gr2_lrg.jpg', 'caption': 'Angio-CT scan at 1 month.', 'hash': 'e92137e7eff31ea6dd844f33f8d2c63380a1a438bee5ee9f3d046bfc1b16a237'}, {'image_id': 'gr7_lrg', 'image_file_name': 'gr7_lrg.jpg', 'image_path': '../data/media_files/PMC8087612/gr7_lrg.jpg', 'caption': 'Not satisfactory improvement of blood flow after mechanical thrombectomy.', 'hash': 'ef0320c11ee3803b57011b3f1951540481341b7dd7cbc8c34cc7a925cf94d6e4'}, {'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC8087612/gr3_lrg.jpg', 'caption': 'Arteriograms before treatment.', 'hash': '33d00e0c3f9f9b203fffedaf3b7085b600d80de7a59d08d2454e8f8bff82dc05'}, {'image_id': 'gr9_lrg', 'image_file_name': 'gr9_lrg.jpg', 'image_path': '../data/media_files/PMC8087612/gr9_lrg.jpg', 'caption': 'Angio-CT control after 1 month.', 'hash': '22965e1a3444c0712f9b370f4c2cbde054f446f284f68b85c0a325da504df674'}, {'image_id': 'gr5_lrg', 'image_file_name': 'gr5_lrg.jpg', 'image_path': '../data/media_files/PMC8087612/gr5_lrg.jpg', 'caption': 'Not satisfactory improvement of blood flow after mechanical thrombectomy.', 'hash': '31615d901b9762a2a2327a3c0db2d1216d3910a3d4e570b7a7acbaa1e1337b79'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC8087612/gr1_lrg.jpg', 'caption': 'Floating aortic thrombus.', 'hash': '359735c56f76f8e25c1add4a703d27f069d2c58dee46850e2e2c7ebf9b320671'}, {'image_id': 'gr10_lrg', 'image_file_name': 'gr10_lrg.jpg', 'image_path': '../data/media_files/PMC8087612/gr10_lrg.jpg', 'caption': 'Aortic floating thrombus.', 'hash': 'f1866a6c598c1a76b722e56568976f9940b616219529715afb5e53bd4d10065e'}, {'image_id': 'gr4_lrg', 'image_file_name': 'gr4_lrg.jpg', 'image_path': '../data/media_files/PMC8087612/gr4_lrg.jpg', 'caption': 'Arteriograms before treatment.', 'hash': 'f9fed1b947ec61a6b7b3cc1196cf6da969ffbce88cc64963b5acaf80de9f26a8'}, {'image_id': 'gr8_lrg', 'image_file_name': 'gr8_lrg.jpg', 'image_path': '../data/media_files/PMC8087612/gr8_lrg.jpg', 'caption': 'Angio-CT control after 1 month.', 'hash': '3b7d565cf09a9f666edcaef615230cfba875743e255f1d703aa8e71d7ed8ceb5'}, {'image_id': 'gr11_lrg', 'image_file_name': 'gr11_lrg.jpg', 'image_path': '../data/media_files/PMC8087612/gr11_lrg.jpg', 'caption': 'Angio-CT scan after 3 days of therapy.', 'hash': '29132657b7b725d4e7540ec479ce447501f35fe06b13ea993b5c0106d5c27c6d'}] | {'gr1_lrg': ['A computed tomography angiogram (Angio-CT) of the thoraco-abdominal aorta demonstrated an occlusive thrombosis of the celiac trunk with a floating aortic thrombus immediately above it in an otherwise healthy aorta (<xref rid="gr1_lrg" ref-type="fig">Fig.\xa01</xref>\n). In addition, there were no radiological findings of bowel ischemia and distal branches of the celiac trunk were regularly reperfused.\n). In addition, there were no radiological findings of bowel ischemia and distal branches of the celiac trunk were regularly reperfused.Fig. 1Floating aortic thrombus.Fig 1'], 'gr2_lrg': ['An Angio-CT scan performed after 7 days and at one month, showed a gradual improvement of radiological signs and the complete absence of thrombus at 30 days (<xref rid="gr2_lrg" ref-type="fig">Fig.\xa02</xref>\n).\n).Fig. 2Angio-CT scan at 1 month.Fig 2'], 'gr3_lrg': ['A left leg Duplex ultrasound evaluation, performed at admission, highlighted acute tibio-peroneal and posterior tibial artery occlusions from their origin and an abrupt thrombosis of anterior tibial artery at ankle level without flow into the left foot. These findings were confirmed by an emergent angiography (<xref rid="gr3_lrg" ref-type="fig">Fig. 3</xref>, , <xref rid="gr4_lrg" ref-type="fig">Fig. 4</xref>\n). Considering the extremely peripheral arteries’ involvement, we decided on an endovascular approach: under local anesthesia, antegrade access was achieved using an ultrasound-guided puncture to the left common femoral artery. A 6-Fr sheath was inserted and patient received 100U/Kg of intravenous heparin; a mechanical thrombectomy of the anterior and tibio peroneal arteries was performed with an Indigo CAT6 catheter (Penumbra), but no satisfactory improvement of distal foot flow was achieved (\n). Considering the extremely peripheral arteries’ involvement, we decided on an endovascular approach: under local anesthesia, antegrade access was achieved using an ultrasound-guided puncture to the left common femoral artery. A 6-Fr sheath was inserted and patient received 100U/Kg of intravenous heparin; a mechanical thrombectomy of the anterior and tibio peroneal arteries was performed with an Indigo CAT6 catheter (Penumbra), but no satisfactory improvement of distal foot flow was achieved (<xref rid="gr5_lrg" ref-type="fig">Figs.\xa05</xref>\n,\n,<xref rid="gr6_lrg" ref-type="fig">6</xref> and and <xref rid="gr7_lrg" ref-type="fig">7</xref>\n). A Fountain-infusion catheter was then placed down into the distal left popliteal artery for a catheter-directed thrombolysis and continuous infusion of 1200,000 UI/24h of Urokinase was given for 48 hours. Meanwhile, therapeutic intravenous unfractionated heparin was continued and antiplatelet therapy with Clopidogrel 75 mg/die was set up.\n). A Fountain-infusion catheter was then placed down into the distal left popliteal artery for a catheter-directed thrombolysis and continuous infusion of 1200,000 UI/24h of Urokinase was given for 48 hours. Meanwhile, therapeutic intravenous unfractionated heparin was continued and antiplatelet therapy with Clopidogrel 75 mg/die was set up.Fig. 3Arteriograms before treatment.Fig 3Fig. 4Arteriograms before treatment.Fig 4Fig. 5Not satisfactory improvement of blood flow after mechanical thrombectomy.Fig 5Fig. 6Not satisfactory improvement of blood flow after mechanical thrombectomy.Fig 6Fig 7Not satisfactory improvement of blood flow after mechanical thrombectomy.Fig 7'], 'gr8_lrg': ['After one month an Angio-CT scan demonstrated patency of treated vessels with a lateral plantar artery as the main source for left foot vascularization (<xref rid="gr8_lrg" ref-type="fig">Figs.\xa08</xref>\n, and \n, and <xref rid="gr9_lrg" ref-type="fig">9</xref>\n).\n).Fig. 8Angio-CT control after 1 month.Fig 8Fig. 9Angio-CT control after 1 month.Fig 9'], 'gr10_lrg': ['A 58-year-old man was centralized in our hub vascular Center for acute left forearm paresthesia and motility impairment associated with fingers pain and coldness, appeared about 10 hours before his admission in our department. His main comorbidities were hypertension and diabetes. In addition, patient contracted mild respiratory symptoms of Covid-19 infection approximately 30 days before (confirmed by a former positive nasopharyngeal swab; its negativization occurred 6 days before the admission in our department). A brain CT scan and cardiologic consult were performed during patient\'s permanence in the peripheral spoke Center and any heart or neurological problems were excluded. An Angio-CT thoracic scan was then performed demonstrating a floating thrombus in the aortic arch (<xref rid="gr10_lrg" ref-type="fig">Fig.\xa010</xref>\n): so an empirical treatment with prophylactic dose of low molecular weight heparin was somministrated.\n): so an empirical treatment with prophylactic dose of low molecular weight heparin was somministrated.Fig. 10Aortic floating thrombus.Fig 10:'], 'gr11_lrg': ['An Angio-CT scan performed after 3 days showed aortic thrombus reduction in sizing (<xref rid="gr11_lrg" ref-type="fig">Fig.\xa011</xref>\n).\n).Fig. 11Angio-CT scan after 3 days of therapy.Fig 11:']} | Arterial Thrombotic Sequalae After Covid-19: Mind the Gap | [
"SARS-CoV-2",
"Arterial thrombotic sequalae",
"delayed vascular complication"
] | Ann Vasc Surg | 1627801200 | Autoimmune and autoinflammatory rheumatic disorders (ARD) are treated with antimetabolites, calcineurin inhibitors and biologic agents either neutralizing cytokines [Tumor Necrosis Factor (TNF), Interleukin (IL)-1, IL-6, IL-17, B-cell activating factor] or being directed against B-cells (anti-CD-20), costimulatory molecules or JAK kinases. Similarly for the influenza or pneumococcal vaccines, there is limited data on the effectiveness of vaccination against SARS-CoV-2 infection and COVID-19 prevention for this susceptible patient population. Moreover, preliminary data from vaccinated organ transplanted, inflammatory bowel and connective tissue disease patients suggests only limited immunogenicity after the first vaccine dose, particularly in patients on immunosuppressive regimens. Herein a set of recommendations for the vaccination of immune suppressed patients with the SARS-CoV-2 vaccines is proposed aimed at achieving optimal vaccine benefit without interfering with disease activity status. Moreover, rare autoimmune adverse events related to vaccinations are discussed. | [
"COVID-19",
"COVID-19 Vaccines",
"Cytokines",
"Humans",
"Immunosuppression Therapy",
"Pneumococcal Vaccines",
"Rheumatic Diseases",
"SARS-CoV-2",
"Vaccination"
] | other | PMC8087612 | null | 10 | [
"{'Citation': 'Moutsopoulos H.M., Zampeli E. In: Immunology-Rheumatology in Questions. Moutsopoulos H.M., Zampeli E., editors. Springer-Nature publishers; 2021. Treatment and management of rheumatic diseases.'}",
"{'Citation': 'Park J.K., Lee Y.J., Shin K., et al. Impact of temporary methotrexate discontinuation for 2 weeks on immunogenicity of seasonal influenza vaccination in patients with rheumatoid arthritis: a randomized clinical trial. Ann. Rheum. Dis. 2018;77:898–904.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC5965360'}, {'@IdType': 'pubmed', '#text': '29572291'}]}}",
"{'Citation': 'Kohmer N., Westhaus S., Rühl C., Ciesek S., Rabenau H.F. Brief clinical evaluation of six high-throughput SARS-CoV-2 IgG antibody assays. J. Clin. Virol. 2020;129:104480.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7263247'}, {'@IdType': 'pubmed', '#text': '32505777'}]}}",
"{'Citation': 'April 28, 2021. COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases Developed by the ACR COVID-19 Vaccine Clinical Guidance Task Force. Updated.'}",
"{'Citation': 'Boyarsky B.J., Werbel W.A., Avery R.K., et al. Immunogenicity of a single dose of SARS-CoV-2 messenger RNA vaccine in solid organ transplant recipients. J. Am. Med. Assoc. March 15, 2021 doi: 10.1001/jama.2021.4385. Published online.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1001/jama.2021.4385'}, {'@IdType': 'pmc', '#text': 'PMC7961463'}, {'@IdType': 'pubmed', '#text': '33720292'}]}}",
"{'Citation': 'Kennedy N.A., Lin S., Goodhand J.R., Chanchlani N., Hamilton B., Bewshea C., et al. Infliximab is associated with attenuated immunogenicity to BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines in patients with IBD. Gut. 2021 Apr 26 doi: 10.1136/gutjnl-2021-324789. gutjnl-2021-324789. Epub ahead of print. PMID: 33903149; PMCID: PMC8076631.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1136/gutjnl-2021-324789'}, {'@IdType': 'pubmed', '#text': '33903149'}]}}",
"{'Citation': 'Boyarsky B.J., Ruddy J.A., Connolly C.M., et al. Antibody response to a single dose of SARS-CoV-2 mRNA vaccine in patients with rheumatic and musculoskeletal diseases. Annals of the Rheumatic Diseases Published Online First. 23 March 2021 doi: 10.1136/annrheumdis-2021-220289.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1136/annrheumdis-2021-220289'}, {'@IdType': 'pmc', '#text': 'PMC8822300'}, {'@IdType': 'pubmed', '#text': '33757968'}]}}",
"{'Citation': 'Cines D.B., Bussel J.B. SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia. N. Engl. J. Med. 2021 Apr 16 doi: 10.1056/NEJMe2106315. Epub ahead of print. PMID: 33861524.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1056/NEJMe2106315'}, {'@IdType': 'pmc', '#text': 'PMC8063912'}, {'@IdType': 'pubmed', '#text': '33861524'}]}}",
"{'Citation': 'Sikara M.P., Routsias J.G., Samiotaki M., Panayotou G., Moutsopoulos H.M., Vlachoyiannopoulos P.G. β2 Glycoprotein I (β2GPI) binds platelet factor 4 (PF4): implications for the pathogenesis of antiphospholipid syndrome. Blood. 2010;115:713–723.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19805618'}}}",
"{'Citation': 'Alpert D., Mandl L.A., Erkan D., Yin W., Peerschke E.I., Salmon J. Anti-heparin platelet factor 4 antibodies in systemic lupus erythematosus are associated with IgM antiphospholipid antibodies and the antiphospholipid syndrome. Ann. Rheum. Dis. 2008;67:395–401.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17644539'}}}"
] | Ann Vasc Surg. 2021 Aug 1; 75:128-135 | NO-CC CODE |
|
(A, B) Coronal T2-weighted and TIRM sequence images of patient with transient osteoporosis of the hip. | poljradiol-79-36-g002 | 7 | 80fcc418b3acf07498aca048ec7ea4239e52f2ca463bbff3d35397f75e08fd3f | poljradiol-79-36-g002.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
720,
295
] | [{'image_id': 'poljradiol-79-36-g002', 'image_file_name': 'poljradiol-79-36-g002.jpg', 'image_path': '../data/media_files/PMC3937050/poljradiol-79-36-g002.jpg', 'caption': '(A, B) Coronal T2-weighted and TIRM sequence images of patient with transient osteoporosis of the hip.', 'hash': '80fcc418b3acf07498aca048ec7ea4239e52f2ca463bbff3d35397f75e08fd3f'}, {'image_id': 'poljradiol-79-36-g003', 'image_file_name': 'poljradiol-79-36-g003.jpg', 'image_path': '../data/media_files/PMC3937050/poljradiol-79-36-g003.jpg', 'caption': 'Coronal STIR sequence reveals edema of the bone marrow as high signal intensity.', 'hash': '4f2bf4c7513b36bb04e3bde31de9d1120f54cebfc424ae75f00a3eb3a6aaa856'}, {'image_id': 'poljradiol-79-36-g001', 'image_file_name': 'poljradiol-79-36-g001.jpg', 'image_path': '../data/media_files/PMC3937050/poljradiol-79-36-g001.jpg', 'caption': '(A, B) Transient osteoporosis of the hip in T1-weighted and T1-weighted Turbo Spin Echo imaging.', 'hash': '29e667c8c52a062700ede227d19bbec4bd047aee59b2cc3cfd4a14a5f3e2150e'}] | {'poljradiol-79-36-g001': ['All of these disease entities may be accompanied by edema of the bone marrow presenting on an MRI as low signal intensity on T1-weighted imaging (<xref ref-type="fig" rid="poljradiol-79-36-g001">Figure 1A</xref>), T1-weighted TSE (), T1-weighted TSE (<xref ref-type="fig" rid="poljradiol-79-36-g001">Figure 1B</xref>) and high intensity on T2-weighted () and high intensity on T2-weighted (<xref ref-type="fig" rid="poljradiol-79-36-g002">Figure 2A</xref>), TIRM (), TIRM (<xref ref-type="fig" rid="poljradiol-79-36-g002">Figure 2B</xref>) and STIR sequences () and STIR sequences (<xref ref-type="fig" rid="poljradiol-79-36-g003">Figure 3</xref>), and increased intensity after administration of a paramagnetic contrast [), and increased intensity after administration of a paramagnetic contrast [14–22]. The absence of additional focal lesions in the subchondral bone is a very sensitive and specific sign of transient osteoporosis that differentiates it from chronic conditions. Additionally, T2-weighted imaging may reveal hip joint effusion which commonly accompanies this disorder [21].']} | Evaluation of transient osteoporosis of the hip in magnetic resonance imaging | [
"transient osteoporosis",
"hip joint",
"MRI",
"bone marrow edema"
] | Pol J Radiol | 1392969600 | None | null | other | PMC3937050 | null | null | [
""
] | Pol J Radiol. 2014 Feb 21; 79:36-38 | NO-CC CODE |
|
Coronal STIR sequence reveals edema of the bone marrow as high signal intensity. | poljradiol-79-36-g003 | 7 | 4f2bf4c7513b36bb04e3bde31de9d1120f54cebfc424ae75f00a3eb3a6aaa856 | poljradiol-79-36-g003.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
600,
593
] | [{'image_id': 'poljradiol-79-36-g002', 'image_file_name': 'poljradiol-79-36-g002.jpg', 'image_path': '../data/media_files/PMC3937050/poljradiol-79-36-g002.jpg', 'caption': '(A, B) Coronal T2-weighted and TIRM sequence images of patient with transient osteoporosis of the hip.', 'hash': '80fcc418b3acf07498aca048ec7ea4239e52f2ca463bbff3d35397f75e08fd3f'}, {'image_id': 'poljradiol-79-36-g003', 'image_file_name': 'poljradiol-79-36-g003.jpg', 'image_path': '../data/media_files/PMC3937050/poljradiol-79-36-g003.jpg', 'caption': 'Coronal STIR sequence reveals edema of the bone marrow as high signal intensity.', 'hash': '4f2bf4c7513b36bb04e3bde31de9d1120f54cebfc424ae75f00a3eb3a6aaa856'}, {'image_id': 'poljradiol-79-36-g001', 'image_file_name': 'poljradiol-79-36-g001.jpg', 'image_path': '../data/media_files/PMC3937050/poljradiol-79-36-g001.jpg', 'caption': '(A, B) Transient osteoporosis of the hip in T1-weighted and T1-weighted Turbo Spin Echo imaging.', 'hash': '29e667c8c52a062700ede227d19bbec4bd047aee59b2cc3cfd4a14a5f3e2150e'}] | {'poljradiol-79-36-g001': ['All of these disease entities may be accompanied by edema of the bone marrow presenting on an MRI as low signal intensity on T1-weighted imaging (<xref ref-type="fig" rid="poljradiol-79-36-g001">Figure 1A</xref>), T1-weighted TSE (), T1-weighted TSE (<xref ref-type="fig" rid="poljradiol-79-36-g001">Figure 1B</xref>) and high intensity on T2-weighted () and high intensity on T2-weighted (<xref ref-type="fig" rid="poljradiol-79-36-g002">Figure 2A</xref>), TIRM (), TIRM (<xref ref-type="fig" rid="poljradiol-79-36-g002">Figure 2B</xref>) and STIR sequences () and STIR sequences (<xref ref-type="fig" rid="poljradiol-79-36-g003">Figure 3</xref>), and increased intensity after administration of a paramagnetic contrast [), and increased intensity after administration of a paramagnetic contrast [14–22]. The absence of additional focal lesions in the subchondral bone is a very sensitive and specific sign of transient osteoporosis that differentiates it from chronic conditions. Additionally, T2-weighted imaging may reveal hip joint effusion which commonly accompanies this disorder [21].']} | Evaluation of transient osteoporosis of the hip in magnetic resonance imaging | [
"transient osteoporosis",
"hip joint",
"MRI",
"bone marrow edema"
] | Pol J Radiol | 1392969600 | None | null | other | PMC3937050 | null | null | [
""
] | Pol J Radiol. 2014 Feb 21; 79:36-38 | NO-CC CODE |
|
(A, B) Transient osteoporosis of the hip in T1-weighted and T1-weighted Turbo Spin Echo imaging. | poljradiol-79-36-g001 | 7 | 29e667c8c52a062700ede227d19bbec4bd047aee59b2cc3cfd4a14a5f3e2150e | poljradiol-79-36-g001.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
720,
350
] | [{'image_id': 'poljradiol-79-36-g002', 'image_file_name': 'poljradiol-79-36-g002.jpg', 'image_path': '../data/media_files/PMC3937050/poljradiol-79-36-g002.jpg', 'caption': '(A, B) Coronal T2-weighted and TIRM sequence images of patient with transient osteoporosis of the hip.', 'hash': '80fcc418b3acf07498aca048ec7ea4239e52f2ca463bbff3d35397f75e08fd3f'}, {'image_id': 'poljradiol-79-36-g003', 'image_file_name': 'poljradiol-79-36-g003.jpg', 'image_path': '../data/media_files/PMC3937050/poljradiol-79-36-g003.jpg', 'caption': 'Coronal STIR sequence reveals edema of the bone marrow as high signal intensity.', 'hash': '4f2bf4c7513b36bb04e3bde31de9d1120f54cebfc424ae75f00a3eb3a6aaa856'}, {'image_id': 'poljradiol-79-36-g001', 'image_file_name': 'poljradiol-79-36-g001.jpg', 'image_path': '../data/media_files/PMC3937050/poljradiol-79-36-g001.jpg', 'caption': '(A, B) Transient osteoporosis of the hip in T1-weighted and T1-weighted Turbo Spin Echo imaging.', 'hash': '29e667c8c52a062700ede227d19bbec4bd047aee59b2cc3cfd4a14a5f3e2150e'}] | {'poljradiol-79-36-g001': ['All of these disease entities may be accompanied by edema of the bone marrow presenting on an MRI as low signal intensity on T1-weighted imaging (<xref ref-type="fig" rid="poljradiol-79-36-g001">Figure 1A</xref>), T1-weighted TSE (), T1-weighted TSE (<xref ref-type="fig" rid="poljradiol-79-36-g001">Figure 1B</xref>) and high intensity on T2-weighted () and high intensity on T2-weighted (<xref ref-type="fig" rid="poljradiol-79-36-g002">Figure 2A</xref>), TIRM (), TIRM (<xref ref-type="fig" rid="poljradiol-79-36-g002">Figure 2B</xref>) and STIR sequences () and STIR sequences (<xref ref-type="fig" rid="poljradiol-79-36-g003">Figure 3</xref>), and increased intensity after administration of a paramagnetic contrast [), and increased intensity after administration of a paramagnetic contrast [14–22]. The absence of additional focal lesions in the subchondral bone is a very sensitive and specific sign of transient osteoporosis that differentiates it from chronic conditions. Additionally, T2-weighted imaging may reveal hip joint effusion which commonly accompanies this disorder [21].']} | Evaluation of transient osteoporosis of the hip in magnetic resonance imaging | [
"transient osteoporosis",
"hip joint",
"MRI",
"bone marrow edema"
] | Pol J Radiol | 1392969600 | None | null | other | PMC3937050 | null | null | [
""
] | Pol J Radiol. 2014 Feb 21; 79:36-38 | NO-CC CODE |
|
Four chamber view. TRO study demonstrating mild-to-moderate pericardial effusion surrounding the heart. PE - pleural effusion, RV - right ventricle, LV - left ventricle, LAD - left anterior descending coronary artery | 12245_2010_210_Fig1_HTML | 7 | ec855b478580d4f4e900fd8201738e647acd4575e1d3b7c122cde081770453e0 | 12245_2010_210_Fig1_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
768,
987
] | [{'image_id': '12245_2010_210_Fig1_HTML', 'image_file_name': '12245_2010_210_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3047842/12245_2010_210_Fig1_HTML.jpg', 'caption': 'Four chamber view. TRO study demonstrating mild-to-moderate pericardial effusion surrounding the heart. PE - pleural effusion, RV - right ventricle, LV - left ventricle, LAD - left anterior descending coronary artery', 'hash': 'ec855b478580d4f4e900fd8201738e647acd4575e1d3b7c122cde081770453e0'}, {'image_id': '12245_2010_210_Fig4_HTML', 'image_file_name': '12245_2010_210_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3047842/12245_2010_210_Fig4_HTML.jpg', 'caption': 'Left anterior oblique view optimized to visualize the full length of the RCA (right coronary artery). TRO study demonstrating mild-to-moderate pericardial effusion surrounding the heart. PE - pleural effusion, RV - right ventricle, LV - left ventricle', 'hash': '45debc28ee8b32fafa7963fff5b6f5d1587a45f042b003d299fae59eda1408e8'}, {'image_id': '12245_2010_210_Fig3_HTML', 'image_file_name': '12245_2010_210_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3047842/12245_2010_210_Fig3_HTML.jpg', 'caption': 'Short axis view. TRO study demonstrating mild-to-moderate pericardial effusion surrounding the heart. PE - pleural effusion, RV - right ventricle, LV - left ventricle', 'hash': '2cfcb59736c09fdc3540986c2fa2c36e9ef6c1c95b64310e45701049c7dba0ba'}, {'image_id': '12245_2010_210_Fig2_HTML', 'image_file_name': '12245_2010_210_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3047842/12245_2010_210_Fig2_HTML.jpg', 'caption': 'Two chamber view. TRO study demonstrating mild-to-moderate pericardial effusion surrounding the heart. PE - pleural effusion, LV - left ventricle, LAD - left anterior descending coronary artery', 'hash': 'a886f2f5c6fc86c60531a7edc11f945ec1e948c803dd457c7248fe244c58b230'}] | {'12245_2010_210_Fig1_HTML': ['Laboratory values were WBC count 12,600/mm³, hemoglobin 16.4\xa0g/dl, hematocrit level 46.7%, platelets 223,000/mm³, sodium 138\xa0mEq/l, potassium 5.2\xa0mEq/l, chloride 104\xa0mEq/l, carbon dioxide 24\xa0mEq/l, blood urea nitrogen 18\xa0mg/dl, creatinine level 1.2\xa0mg/dl, glucose concentration 113\xa0mg/dl, myoglobin 13\xa0ng/ml, and troponin <0.05\xa0ng/ml. Chest radiography revealed no abnormalities. An initial electrocardiogram showed a rate of 151\xa0bpm with no significant ST-T wave abnormalities noted. A TRO study was performed, which demonstrated a mild-to-moderate pericardial effusion surrounding the heart (Figs.\xa0<xref rid="12245_2010_210_Fig1_HTML" ref-type="fig">1</xref>, , <xref rid="12245_2010_210_Fig2_HTML" ref-type="fig">2</xref>, , <xref rid="12245_2010_210_Fig3_HTML" ref-type="fig">3</xref> and and <xref rid="12245_2010_210_Fig4_HTML" ref-type="fig">4</xref>) and moderate global hypokinesis with an ejection fraction of 35%. He had normal-sized heart chambers and normal coronary arteries (left anterior descending and right coronary artery shown). The aorta and pulmonary arteries were entirely normal. Given the clinical scenario and TRO findings, the patient was admitted to the hospital with a tentative diagnosis of myopericarditis. The patient had a subsequent transthoracic echocardiogram that demonstrated a small-to-moderate pericardial effusion without evidence of tamponade and mild global left ventricular dysfunction, confirming the diagnosis made by the TRO study.\n) and moderate global hypokinesis with an ejection fraction of 35%. He had normal-sized heart chambers and normal coronary arteries (left anterior descending and right coronary artery shown). The aorta and pulmonary arteries were entirely normal. Given the clinical scenario and TRO findings, the patient was admitted to the hospital with a tentative diagnosis of myopericarditis. The patient had a subsequent transthoracic echocardiogram that demonstrated a small-to-moderate pericardial effusion without evidence of tamponade and mild global left ventricular dysfunction, confirming the diagnosis made by the TRO study.\nFig.\xa01Four chamber view. TRO study demonstrating mild-to-moderate pericardial effusion surrounding the heart. PE - pleural effusion, RV - right ventricle, LV - left ventricle, LAD - left anterior descending coronary arteryFig.\xa02Two chamber view. TRO study demonstrating mild-to-moderate pericardial effusion surrounding the heart. PE - pleural effusion, LV - left ventricle, LAD - left anterior descending coronary arteryFig.\xa03Short axis view. TRO study demonstrating mild-to-moderate pericardial effusion surrounding the heart. PE - pleural effusion, RV - right ventricle, LV - left ventricleFig.\xa04Left anterior oblique view optimized to visualize the full length of the RCA (right coronary artery). TRO study demonstrating mild-to-moderate pericardial effusion surrounding the heart. PE - pleural effusion, RV - right ventricle, LV - left ventricle']} | Myopericarditis diagnosed by a 64-slice coronary CT angiography "triple rule out" protocol | [
"Myopericarditis",
"Myocarditis",
"Pericarditis",
"CT angiography",
"Sixty-four section",
"Triple rule-out"
] | Int J Emerg Med | 1282374000 | We report a case of myopericarditis in a 30-year-old male complaining of shortness of breath. In an emergency department (ED) setting, the symptoms of myopericarditis may overlap with many disease entities and can be a challenging diagnosis to make. However, with the use of a 64-section coronary CT angiography in a "triple rule out" (TRO) protocol, we were able to detect a large pericardial effusion surrounding the heart and moderate global hypokinesis in the setting of normal-sized heart chambers and normal coronary arteries. We were further able to exclude pulmonary embolism and thoracic dissection. This is the first reported case of diagnosing myopericarditis using a TRO protocol. It demonstrates the usefulness of TRO in making an emergent diagnosis of myopericarditis while excluding other life-threatening diseases that can lead to earlier appropriate ED disposition and care. | [] | other | PMC3047842 | null | 10 | [
"{'Citation': 'Magnani JW, Dec GW. Myocarditis: current trends in diagnosis and treatment. Circulation. 2006;113:876–890. doi: 10.1161/CIRCULATIONAHA.105.584532.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1161/CIRCULATIONAHA.105.584532'}, {'@IdType': 'pubmed', '#text': '16476862'}]}}",
"{'Citation': 'Abdel-Aty H, Boye P, Zagrosec A, et al. Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis. J Am Coll Cardiol. 2005;45:1815–1822. doi: 10.1016/j.jacc.2004.11.069.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.jacc.2004.11.069'}, {'@IdType': 'pubmed', '#text': '15936612'}]}}",
"{'Citation': 'Skouri HN, Dec GW, Friedrich MG, Cooper LT. Noninvasive imaging in myocarditis. J Am Coll Cardiol. 2006;48:2085–2093. doi: 10.1016/j.jacc.2006.08.017.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.jacc.2006.08.017'}, {'@IdType': 'pubmed', '#text': '17112998'}]}}",
"{'Citation': 'Pawsat DE, Lee JY. Inflammatory disorders of the heart. Pericarditis, myocarditis, and endocarditis. Emerg Med Clin N Am. 1998;16:665–681. doi: 10.1016/S0733-8627(05)70024-9.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S0733-8627(05)70024-9'}, {'@IdType': 'pubmed', '#text': '9739781'}]}}",
"{'Citation': 'Brady WJ, Ferguson JD, Ullman EA, Perron AD. Myocarditis: emergency department recognition and management. Emerg Med Clin N Am. 2004;22:865–885. doi: 10.1016/j.emc.2004.05.010.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.emc.2004.05.010'}, {'@IdType': 'pubmed', '#text': '15474774'}]}}",
"{'Citation': 'Dec GW, Waldman H, Southern J, Fallon JT, Hutter AM, Jr, Palacios I. Viral myocarditis mimicking acute myocardial infarction. J Am Coll Cardiol. 1992;20:85–89. doi: 10.1016/0735-1097(92)90141-9.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/0735-1097(92)90141-9'}, {'@IdType': 'pubmed', '#text': '1607543'}]}}",
"{'Citation': 'Miklozek CL, Crumpacker CS, Royal HD, Come PC, Sullivan JL, Abelmann WH. Myocarditis presenting as acute myocardial infarction. Am Heart J. 1988;115:768–776. doi: 10.1016/0002-8703(88)90877-0.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/0002-8703(88)90877-0'}, {'@IdType': 'pubmed', '#text': '3354405'}]}}",
"{'Citation': 'Shturman A, Chernihovski A, Goldfeld M, Furer A, Wishniak A, Roguin N. Usefulness of 64 multi-slice computed tomography in acute myopericarditis. IMAJ. 2007;9:333–334.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17491234'}}}",
"{'Citation': 'Brooks MA, Sane DC. CT findings in acute myocarditis: two cases. J Thorac Imaging. 2007;22:277–279. doi: 10.1097/RTI.0b013e31803ecefa.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/RTI.0b013e31803ecefa'}, {'@IdType': 'pubmed', '#text': '17721343'}]}}",
"{'Citation': 'Takakuwa KM, Halpern EJ. Evaluation of a \"triple rule-out\" coronary CT angiography protocol: use of 64-section CT in low-to-moderate risk emergency department patients suspected of having acute coronary syndrome. Radiology. 2008;248:438–446. doi: 10.1148/radiol.2482072169.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1148/radiol.2482072169'}, {'@IdType': 'pubmed', '#text': '18641247'}]}}"
] | Int J Emerg Med. 2010 Aug 21; 3(4):447-449 | NO-CC CODE |
|
A fluid-filled, round structure with mural enhancement is indicated by the arrow. Two small foci of extraluminal free air (arrowheads) are consistent with perforation | 12245_2010_213_Fig3_HTML | 7 | b013e088d798c1ad86b676044351a72d29a6d057a3c2c5ff153b7ea89cd35334 | 12245_2010_213_Fig3_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
496,
334
] | [{'image_id': '12245_2010_213_Fig3_HTML', 'image_file_name': '12245_2010_213_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3047846/12245_2010_213_Fig3_HTML.jpg', 'caption': 'A fluid-filled, round structure with mural enhancement is indicated by the arrow. Two small foci of extraluminal free air (arrowheads) are consistent with perforation', 'hash': 'b013e088d798c1ad86b676044351a72d29a6d057a3c2c5ff153b7ea89cd35334'}, {'image_id': '12245_2010_213_Fig4_HTML', 'image_file_name': '12245_2010_213_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3047846/12245_2010_213_Fig4_HTML.jpg', 'caption': 'Coronal imaging demonstrates a blind-ending, tubular structure (arrow) that is fluid filled and demonstrates mural enhancement. Arrowheads indicate free fluid surrounding opacified bowel loops, confirming ultrasound findings', 'hash': '42ef9c268052ddd72107eb5e5a987102bcb42cde0e4d1bd2192712033b6b71f0'}, {'image_id': '12245_2010_213_Fig2_HTML', 'image_file_name': '12245_2010_213_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3047846/12245_2010_213_Fig2_HTML.jpg', 'caption': 'Enlarged nodes (arrowheads) are seen in the right lower quadrant. A pocket of free air is in the midabdomen (arrow) with surrounding mesenteric inflammation', 'hash': '31bb149becc70c2305f99b8296ad79f496697498ff14f5e168525c526259dd31'}, {'image_id': '12245_2010_213_Fig1_HTML', 'image_file_name': '12245_2010_213_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3047846/12245_2010_213_Fig1_HTML.jpg', 'caption': 'Ultrasound demonstrates an anechoic area in the right lower quadrant indicating a large amount of free fluid', 'hash': '644e7519c4149d41b3f75ee7434199ef4d295ca5de5ef1468bee6878af566eaf'}] | {'12245_2010_213_Fig1_HTML': ['A previously healthy 12-year-old male presented to our emergency department as a transfer from an outside facility for a suspected ruptured appendicitis. He initially presented to the outside facility complaining of a sudden onset of stabbing peri-umbilical pain, 10/10 in severity, with a sudden onset. Up until the onset of the pain he had been in good health, without fever or chills, and had been having normal bowel movements. He denied any associated nausea or vomiting, preceding viral illnesses, diarrhea or bloody stools. Prior to arrival in our department he had been started on broad-spectrum IV antibiotics, and his pain was adequately controlled with IV narcotics (Figs. <xref rid="12245_2010_213_Fig1_HTML" ref-type="fig">1</xref>, , <xref rid="12245_2010_213_Fig2_HTML" ref-type="fig">2</xref>, , <xref rid="12245_2010_213_Fig3_HTML" ref-type="fig">3</xref>, , <xref rid="12245_2010_213_Fig4_HTML" ref-type="fig">4</xref>).\n).\nFig.\xa01Ultrasound demonstrates an anechoic area in the right lower quadrant indicating a large amount of free fluidFig.\xa02Enlarged nodes (arrowheads) are seen in the right lower quadrant. A pocket of free air is in the midabdomen (arrow) with surrounding mesenteric inflammationFig.\xa03A fluid-filled, round structure with mural enhancement is indicated by the arrow. Two small foci of extraluminal free air (arrowheads) are consistent with perforationFig.\xa04Coronal imaging demonstrates a blind-ending, tubular structure (arrow) that is fluid filled and demonstrates mural enhancement. Arrowheads indicate free fluid surrounding opacified bowel loops, confirming ultrasound findings']} | Perforated Meckel diverticulum | [
"Meckel diverticulum",
"Meckel diverticulum complications",
"Perforated Meckel diverticulum, appendicitis mimic"
] | Int J Emerg Med | 1282287600 | Perforation of a Meckel diverticulum (MD) is a rare complication that can often mimic appendicitis. This case report identifies a child who presented to our Emergency Department (ED) with right lower quadrant abdominal pain, free fluid and air in the abdomen and pelvis, and inflammatory changes visualized on Ultrasonography (US) and computer tomography (CT) scan. In our patient, ruptured appendicitis was suspected, and the diagnosis of ruptured MD was ultimately made by laparoscopy. This case demonstrates that a healthy degree of suspicion for complicated MD should be present when dealing with a questionable diagnosis of appendicitis, particularly in the pediatric population. | [] | other | PMC3047846 | null | 8 | [
"{'Citation': 'Sager J, Kumar V, Shah DK. Meckel’s diverticulum: a systemic review. J R Soc Med. 2006;99:501–505. doi: 10.1258/jrsm.99.10.501.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1258/jrsm.99.10.501'}, {'@IdType': 'pmc', '#text': 'PMC1592061'}, {'@IdType': 'pubmed', '#text': '17021300'}]}}",
"{'Citation': 'Menezes M, Tareen F, Saeed A, Khan N, Puri P. Symptomatic Meckel’s diverticulum in children: a 16-year review. Pediatr Surg Int. 2008;24:575–577. doi: 10.1007/s00383-007-2094-4.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s00383-007-2094-4'}, {'@IdType': 'pubmed', '#text': '18322689'}]}}",
"{'Citation': 'Kusumoto H, Yoshida M, Takahashi I, Anai H, Maehara Y, Sugimachi K. Complications and diagnosis of Meckel’s diverticulum in 776 patients. Am J Surg. 1992;164:382–383. doi: 10.1016/S0002-9610(05)80909-2.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S0002-9610(05)80909-2'}, {'@IdType': 'pubmed', '#text': '1415948'}]}}",
"{'Citation': 'Sai Prasad TR, Chui CH, Singaporewella FR, Ong CPC, Low Y, Yap TL, Jacobsen AS. Meckel’s diverticular complications in children: is laparoscopy the order of the day? Pediatr Surg Int. 2007;23:141–147. doi: 10.1007/s00383-006-1844-z.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s00383-006-1844-z'}, {'@IdType': 'pubmed', '#text': '17171378'}]}}",
"{'Citation': 'Ueberruek T, Meyer L, Koch A, Hinkel M, Kube R, Gastinger I. The significance of Meckel’s diverticulum in appendicitis—a retrospective analysis of 233 cases. World J Surg. 2005;29:455–458. doi: 10.1007/s00268-004-7615-x.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s00268-004-7615-x'}, {'@IdType': 'pubmed', '#text': '15776296'}]}}",
"{'Citation': 'Thurley PD, Halliday KE, Somers JM, Al-Daraji WI, Ilyas M, Broderick NJ. Radiological features of Meckel’s diverticulum and its complications. Clin Radiol. 2009;64(2):109–118. doi: 10.1016/j.crad.2008.07.012.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.crad.2008.07.012'}, {'@IdType': 'pubmed', '#text': '19103339'}]}}",
"{'Citation': 'Elsayes KM, Menias CO, Harvin HJ, Francis IR. Imaging manifestations of Meckel’s diverticulum. AJR. 2007;189:625–629. doi: 10.2214/AJR.06.1257.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.2214/AJR.06.1257'}, {'@IdType': 'pubmed', '#text': '17579156'}]}}",
"{'Citation': \"McKay R. High incidence of symptomatic Meckel's diverticulum in patients less than 50 years of age: an indication for resection. Am Surg. 2007;73:271–275.\", 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17375785'}}}"
] | Int J Emerg Med. 2010 Aug 20; 3(4):455-457 | NO-CC CODE |
|
Initial MRI: notice the abnormal spinal cord swelling cervical and at cauda equina | 12245_2010_207_Fig1_HTML | 7 | 107e76cad0ee91bd2b285eadebb2cae7bd59d591ef0a238ec5e1234724c42e62 | 12245_2010_207_Fig1_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
768,
1620
] | [{'image_id': '12245_2010_207_Fig2_HTML', 'image_file_name': '12245_2010_207_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3047888/12245_2010_207_Fig2_HTML.jpg', 'caption': 'Normal F/U study', 'hash': 'c79ec82799d81631e180f1e3e7369b6fd6ea9f5cdcce601542ada77f9f06bddf'}, {'image_id': '12245_2010_207_Fig1_HTML', 'image_file_name': '12245_2010_207_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3047888/12245_2010_207_Fig1_HTML.jpg', 'caption': 'Initial MRI: notice the abnormal spinal cord swelling cervical and at cauda equina', 'hash': '107e76cad0ee91bd2b285eadebb2cae7bd59d591ef0a238ec5e1234724c42e62'}] | {'12245_2010_207_Fig1_HTML': ['Spinal MRI (with and without gadolinium) showed the spinal cord to be abnormally diffuse, with swelling and edema in the cervicothoracic region. Along with the diffuse abnormal hyperintense swelling, the cauda equina had an edematous appearance, and signal intensity was abnormally increased, which is compatible with transverse myelitis (Figs.\xa0<xref rid="12245_2010_207_Fig1_HTML" ref-type="fig">1</xref> and and <xref rid="12245_2010_207_Fig2_HTML" ref-type="fig">2</xref>). Finally, imaging also revealed a focal area of abnormal signal intensity in the ventral inferior pons.\n). Finally, imaging also revealed a focal area of abnormal signal intensity in the ventral inferior pons.\nFig.\xa01Initial MRI: notice the abnormal spinal cord swelling cervical and at cauda equinaFig.\xa02Normal F/U study']} | Spinal cord toxoplasmosis as an unusual presentation of AIDS: case report and review of the literature | [
"AIDS",
"Spinal toxoplasmosis",
"Emergency department"
] | Int J Emerg Med | 1283842800 | Approximately 10% of patients with AIDS present with some neurological deficit as their initial complaint, and up to 80% will have CNS involvement during the course of their disease. Toxoplasmosis is the most common cause of cerebral mass lesions in patients with AIDS, but appears to be an uncommon cause of spinal cord disease. The incidence of myelopathy may be as high as 20%, with 50% of the cases reported post-mortem. We present a unique case of spinal cord disease as the initial presentation of AIDS. We also present a comprehensive literature review of this topic, its diagnosis and treatment. This is a retrospective chart review case report. After a detailed case presentation, several diagnostic and therapeutic aspects of this unique case are thoroughly discussed. Although spinal cord toxoplasmosis is uncommon, it has been suggested that most patients with AIDS that present with evolving myelopathy, characterized by extremity weakness, sensory involvement, spinal cord enlargement, enhancing lesions in brain or spinal cord CT or MRI, have toxoplasmic myelitis. | [] | other | PMC3047888 | null | 15 | [
"{'Citation': 'Daniel R, Christopher C, William W, Julio M, William H, George J. Isolated toxoplasmosis of the thoracic spinal cord in a patient with acquired immunodeficiency syndrome. J Neurosurg. 1995;82:493–496. doi: 10.3171/jns.1995.82.3.0493.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.3171/jns.1995.82.3.0493'}, {'@IdType': 'pubmed', '#text': '7861231'}]}}",
"{'Citation': 'Nag S, Jackson AC. Myelopathy: an unusual presentation of toxoplasmosis. Can J Neurol Sci. 1989;16:422–425.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2804804'}}}",
"{'Citation': 'Quencer RM, Judith D. Spinal cord lesions in patients with AIDS. Neuroimaging Clin N Am. 1997;7(2):359–373.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9113695'}}}",
"{'Citation': 'Rohit V, John E. toxoplasmosis of the spinal cord in a patient with AIDS: case report and review. Clin Infect Dis. 1996;23:1061–1065.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8922803'}}}",
"{'Citation': 'Herskovitz S, Siegel SE, Schneider AT, Nelson SJ, Goodrich JT, Lantos G. Spinal cord toxoplasmosis in AIDS. Neurology. 1989;39:1552–1553.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2812340'}}}",
"{'Citation': 'Gildenberg PL. Evaluation and management of intracranial mass lesions in AIDS: Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1998;50:21–26.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9443452'}}}",
"{'Citation': 'Campo C, Navarro V, Mota JA, Lacruz J, Santos M. Spinal cord lesion in a patient with human immunodeficiency virus infection. Enferm Infecc Microbiol Clín. 2001;19(1):31–33.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11256246'}}}",
"{'Citation': 'Oliver K, Isabel W, Matthias M. Neuroimaging of Infections. NeuroRx. 2005;2(2):324–332. doi: 10.1602/neurorx.2.2.324.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1602/neurorx.2.2.324'}, {'@IdType': 'pmc', '#text': 'PMC1064994'}, {'@IdType': 'pubmed', '#text': '15897953'}]}}",
"{'Citation': 'Todd GJ, Estil V, Peter H, Tanner M. Brain lesion and AIDS. Proc Bayl Univ Med Cen. 2000;13(4):424–429.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC1312248'}, {'@IdType': 'pubmed', '#text': '16389358'}]}}",
"{'Citation': 'Vijay T, Sudha T, Lakshmi V. Neurologic manifestations of HIV infection: An Indian hospital-based study. AIDS Read. 2005;15(3):139–145.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15786577'}}}",
"{'Citation': 'Straathof CS, Kortbeek LM, Roerdink H, Sillevis Smitt PA, Bent MJ. A solitary spinal cord toxoplasma lesion after peripheral stem-cell transplantation. J Neurol. 2001;248(9):814–815. doi: 10.1007/s004150170101.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s004150170101'}, {'@IdType': 'pubmed', '#text': '11596790'}]}}",
"{'Citation': 'Cosan TE, Kabukcuoglu S, Arslantas A, Atasoy MA, Dogan N, Ozgunes I, Kebabci M, Tel E. Spinal toxoplasmic arachnoiditis associated with osteoid formation: a rare presentation of toxoplasmosis. Spine. 2001;26(15):1726–1728. doi: 10.1097/00007632-200108010-00019.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00007632-200108010-00019'}, {'@IdType': 'pubmed', '#text': '11474362'}]}}",
"{'Citation': 'Bowen J, Acute viral infections of the spinal cord. www.myelitis.org/baltimore2001/bowen_handout.pdf'}",
"{'Citation': 'Manelfe C (1992) Imaging of tumoral and non tumoral diseases of the spinal cord. In: Imaging of the spinal cord, vol. 1. Raven Press, NY. Found at www.starrprogram.com/upload/starabstracts_684_2001'}",
"{'Citation': 'HIV Guidelines (2004) New York State Department of Health AIDS Institute: Neurologic complications. www.hivguidelines.org/public_html/a-neuro/a-neuro.htm. March'}"
] | Int J Emerg Med. 2010 Sep 7; 3(4):439-442 | NO-CC CODE |
|
Coronal view of thrombosis in the left gonadal vein with extension to the left renal vein. | bcr-2020-236786f01 | 7 | 70726ab2314ffecb54914c29bef00860458e46d62156230ef40a3ed3e47efbe2 | bcr-2020-236786f01.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
610,
621
] | [{'image_id': 'bcr-2020-236786f01', 'image_file_name': 'bcr-2020-236786f01.jpg', 'image_path': '../data/media_files/PMC7477963/bcr-2020-236786f01.jpg', 'caption': 'Coronal view of thrombosis in the left gonadal vein with extension to the left renal vein.', 'hash': '70726ab2314ffecb54914c29bef00860458e46d62156230ef40a3ed3e47efbe2'}, {'image_id': 'bcr-2020-236786f02', 'image_file_name': 'bcr-2020-236786f02.jpg', 'image_path': '../data/media_files/PMC7477963/bcr-2020-236786f02.jpg', 'caption': 'Axial view of thrombosis in the left gonadal vein with extension to the left renal vein.', 'hash': '2836f0c3dd47ff1e3aca1134fe9cf9d47bb12ff6164efe3ec24b89da3120d786'}, {'image_id': 'bcr-2020-236786f03', 'image_file_name': 'bcr-2020-236786f03.jpg', 'image_path': '../data/media_files/PMC7477963/bcr-2020-236786f03.jpg', 'caption': 'Acute right lower lobe pulmonary embolism—mild bilateral lower lobe consolidations suggestive of COVID-19 pneumonia.', 'hash': '58a7bf7f23be10e63c9619346af9a150e52737e3e3b886425ad05f42677836be'}] | {'bcr-2020-236786f03': ['CT of the abdomen/pelvis with contrast showed left OVT, which extended partially to the renal vein (). Additionally, there was a finding of pulmonary embolism in the posterior branch of pulmonary artery in the right lower lobe (RLL). Pulmonary windows of the CT confirmed presence of bilateral lower lobe consolidations, ground-glass opacities in the right middle lobe and foci of consolidation in the lingula suggestive of COVID-19 pneumonia. Subsequent chest CT angiography confirmed the presence of an acute RLL pulmonary artery thrombosis (<xref ref-type="fig" rid="bcr-2020-236786f03">figure 3</xref>). Deep vein thrombosis (DVT) studies were negative for lower extremity venous clots.). Deep vein thrombosis (DVT) studies were negative for lower extremity venous clots.']} | Left gonadal vein thrombosis in a patient with COVID-19-associated coagulopathy | [
"venous thromboembolism",
"pulmonary embolism",
"haematology (incl blood transfusion)",
"obstetrics",
"gynaecology and fertility",
"infectious diseases"
] | BMJ Case Rep | 1599462000 | Vasculitis is a descriptive term for a wide variety of conditions characterised by inflammation of the blood vessels that may occur as a primary process or secondary to an underlying disease. Occlusive vasculopathy is a different clinical entity characterised by skin changes and ulceration of the lower extremities because of thrombosis of the small vessels of the dermis and is usually associated with pre-thrombotic conditions. Both conditions can be confirmed or excluded by skin biopsy. We report the case of a 63-year-old woman presenting with upper and lower respiratory tract symptoms followed by a vasculitic rash on both legs. The patient underwent extensive radiological and laboratory investigations that were negative apart from positive coronavirus OC43. A biopsy of the skin was performed. Considering the clinical presentation and the investigations performed, the diagnosis of small vessel vasculopathy following coronavirus OC43 has been suggested by the authors. | [
"COVID-19",
"Coronavirus Infections",
"Female",
"Humans",
"Middle Aged",
"Pandemics",
"Pneumonia, Viral",
"Vascular Diseases"
] | other | PMC7477963 | null | 12 | [
"{'Citation': 'Haq SA, Pagnoux C. Infection-Associated vasculitides. Int J Rheum Dis 2019;22:109–15. 10.1111/1756-185X.13287', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1111/1756-185X.13287'}, {'@IdType': 'pubmed', '#text': '29624865'}]}}",
"{'Citation': 'Teng GG, Chatham WW. Vasculitis related to viral and other microbial agents. Best Pract Res Clin Rheumatol 2015;29:226–43. 10.1016/j.berh.2015.05.007', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.berh.2015.05.007'}, {'@IdType': 'pubmed', '#text': '26362741'}]}}",
"{'Citation': 'Jennette JC, Falk RJ, Bacon PA, et al. . 2012 revised international chapel Hill consensus conference Nomenclature of vasculitides. Arthritis Rheum 2013;65:1–11. 10.1002/art.37715', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1002/art.37715'}, {'@IdType': 'pubmed', '#text': '23045170'}]}}",
"{'Citation': 'Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost 2020;18:1559–61. 10.1111/jth.14849', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1111/jth.14849'}, {'@IdType': 'pmc', '#text': 'PMC9770920'}, {'@IdType': 'pubmed', '#text': '32302453'}]}}",
"{'Citation': 'Llamas-Velasco M, Alegría V, Santos-Briz Ángel, et al. . Occlusive Nonvasculitic vasculopathy. Am J Dermatopathol 2017;39:637–62. 10.1097/DAD.0000000000000766', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/DAD.0000000000000766'}, {'@IdType': 'pubmed', '#text': '27759698'}]}}",
"{'Citation': 'Drerup C, Metze D, Ehrchen J, et al. . Evidence for immunoglobulin-mediated vasculitis caused by monoclonal gammopathy in monoclonal gammopathy of unclear significance prompting oncologic treatment. JAAD Case Rep 2019;5:288–91. 10.1016/j.jdcr.2019.01.013', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.jdcr.2019.01.013'}, {'@IdType': 'pmc', '#text': 'PMC6403116'}, {'@IdType': 'pubmed', '#text': '30891483'}]}}",
"{'Citation': 'Su S, Wong G, Shi W, et al. . Epidemiology, genetic recombination, and pathogenesis of coronaviruses. Trends Microbiol 2016;24:490–502. 10.1016/j.tim.2016.03.003', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.tim.2016.03.003'}, {'@IdType': 'pmc', '#text': 'PMC7125511'}, {'@IdType': 'pubmed', '#text': '27012512'}]}}",
"{'Citation': 'Zhu N, Zhang D, Wang W, et al. . A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727–33. 10.1056/NEJMoa2001017', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1056/NEJMoa2001017'}, {'@IdType': 'pmc', '#text': 'PMC7092803'}, {'@IdType': 'pubmed', '#text': '31978945'}]}}",
"{'Citation': 'Esper F, Shapiro ED, Weibel C, et al. . Association between a novel human coronavirus and Kawasaki disease. J Infect Dis 2005;191:499–502. 10.1086/428291', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1086/428291'}, {'@IdType': 'pmc', '#text': 'PMC7199489'}, {'@IdType': 'pubmed', '#text': '15655771'}]}}",
"{'Citation': 'Arbour N, Day R, Newcombe J, et al. . Neuroinvasion by human respiratory coronaviruses. J Virol 2000;74:8913–21. 10.1128/JVI.74.19.8913-8921.2000', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1128/JVI.74.19.8913-8921.2000'}, {'@IdType': 'pmc', '#text': 'PMC102086'}, {'@IdType': 'pubmed', '#text': '10982334'}]}}",
"{'Citation': 'Bouaziz JD, Duong TA, Jachiet M, et al. . Vascular skin symptoms in COVID‐19: a French observational study. J Eur Acad Dermatol Venereol 2020;28 10.1111/jdv.16544', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1111/jdv.16544'}, {'@IdType': 'pmc', '#text': 'PMC7267662'}, {'@IdType': 'pubmed', '#text': '32339344'}]}}",
"{'Citation': 'Magro C, Mulvey JJ, Berlin D, et al. . Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res 2020;220:1–13. 10.1016/j.trsl.2020.04.007', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.trsl.2020.04.007'}, {'@IdType': 'pmc', '#text': 'PMC7158248'}, {'@IdType': 'pubmed', '#text': '32299776'}]}}"
] | BMJ Case Rep. 2020 Sep 7; 13(9):e236786 | NO-CC CODE |
|
The pectoralis muscle area (PMA) measurement on chest computed tomography (CT) image in a 41-year-old male patient with COVID-19. Axial chest CT image just above the arcus aorta level used for PMA measurement. (a) PMA measurement was performed on axial CT image using a predefined attenuation values of -50 and 90 Hounsfield units. Bilateral pectoralis muscles are colored green (pectoralis major and minor muscles). (b) Sagittal reformatted chest CT image shows the level of just above the aortic arch. | gr1_lrg | 7 | fc3f7222dbb29f7a7ff1ee27f7d69b83ce6f8393eca2fc25ba4cfaf9750759b1 | gr1_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
722,
1215
] | [{'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7480333/gr2_lrg.jpg', 'caption': 'Patient selection and inclusion flow diagram of patients with novel coronavirus 19 disease (COVID-19).', 'hash': 'cfc38cf46cfd3c98b2f1b9120d8d920dc68bd50b2405060eeb3af4909e82a6a8'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7480333/gr1_lrg.jpg', 'caption': 'The pectoralis muscle area (PMA) measurement on chest computed tomography (CT) image in a 41-year-old male patient with COVID-19. Axial chest CT image just above the arcus aorta level used for PMA measurement. (a) PMA measurement was performed on axial CT image using a predefined attenuation values of -50 and 90 Hounsfield units. Bilateral pectoralis muscles are colored green (pectoralis major and minor muscles). (b) Sagittal reformatted chest CT image shows the level of just above the aortic arch.', 'hash': 'fc3f7222dbb29f7a7ff1ee27f7d69b83ce6f8393eca2fc25ba4cfaf9750759b1'}] | {'gr1_lrg': ['All CT images were anonymized prior to quantitative evaluation, and all patients were randomly numbered. On a single axial chest CT image just above the aortic arch was selected in each patient, and Pectoralis muscle area (PMA) was measured by a trained radiologist (F.U.) using a free DICOM viewer (Horos software Version 3.3.3; Available at https://horosproject.org/). Both of the pectoralis major and minor muscles were manually shaded using a predefined attenuation range of –50 and 90 Hounsfield unit (HU), and muscle areas were automatically measured between those CT attenuation values, on an axial CT slice just above the aortic arch [19]. PMA value was obtained by summing bilateral pectoralis major and minor muscle areas (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>\n). To investigate the interobserver agreement, PMA measurements were repeated by a second observer (E.S.) from 60 consecutive patients among the whole population, using the same method and blindly to the first measurement results. In the event of insufficient skeletal muscle segmentation, the user replaced the skeletal muscle contours with a manual tool. The axial CT image just above the aortic arch has been selected because it can be easily identified, reproduced in a large population of cases, and has been previously described as successful for estimating skeletal muscle mass [\n). To investigate the interobserver agreement, PMA measurements were repeated by a second observer (E.S.) from 60 consecutive patients among the whole population, using the same method and blindly to the first measurement results. In the event of insufficient skeletal muscle segmentation, the user replaced the skeletal muscle contours with a manual tool. The axial CT image just above the aortic arch has been selected because it can be easily identified, reproduced in a large population of cases, and has been previously described as successful for estimating skeletal muscle mass [19]. Besides, PMA values were normalized by the height of the patient, and the gender specific pectoralis muscle index (cm2/m2, PMI) was calculated by the PMA (cm2) value divided by the square of the patient height (m2).Fig. 1The pectoralis muscle area (PMA) measurement on chest computed tomography (CT) image in a 41-year-old male patient with COVID-19. Axial chest CT image just above the arcus aorta level used for PMA measurement. (a) PMA measurement was performed on axial CT image using a predefined attenuation values of -50 and 90 Hounsfield units. Bilateral pectoralis muscles are colored green (pectoralis major and minor muscles). (b) Sagittal reformatted chest CT image shows the level of just above the aortic arch.Fig. 1'], 'gr2_lrg': ['One hundred and thirty patients with COVID-19 were included in the study according to the exclusion and inclusion criteria (<xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>\n). The mean follow-up time of all patients was 40.6 \n). The mean follow-up time of all patients was 40.6 + 6.5 days. There were 76 males (58.5 %) and 54 females (41.5 %) with a median age of 48 years (IQR; 36–64). Fifty-six patients (43.08 %) had at least one comorbidity, and the most common comorbidities were hypertension in 25 patients (19.23 %), diabetes mellitus in 23 patients (17.69 %), and asthma in 17 patients (13.08 %). Fifty-four patients (41.54 %) had a high fever (forehead temperature of > 37.3\u202f°C) at the time of admission. The median body temperature at the time of admission was 36.8 degrees Celsius (°C) (IQR, 36.4–37.8\u202f°C). Thirty-six (27.69 %) patients were smokers (26 patients current, ten patients’ ex-smokers), and the median smoking pack-years were 20 (range; 1–80). The median number of days from symptom onset to the CT examination was four days [IQR; 2–7 days]. (Table 1\n).Fig. 2Patient selection and inclusion flow diagram of patients with novel coronavirus 19 disease (COVID-19).Fig. 2Table 1The descriptive characteristics of the study population.Table 1CharacteristicsTotal Population (n\u202f=\u202f130)Females (n\u202f=\u202f54)Males (n\u202f=\u202f76)p-valueMedian (Range)Median (Range)Median (Range)Age (years)48 (18–86)47 (18–84)48 (20–86)0.765PSS Observer-14 (0–17)4 (0–17)4 (0–14)0.061PSS Observer-24 (0–16)4 (0–15)4 (0–16)0.056PSS Consensus4 (0–17)3 (0–14)5 (0–17)0.058Weight (kg)72 (39−99)70 (39−92)78 (56−99)< 0.001Height (cm)164 (148−191)161 (148−179)170 (149−191)< 0.001Body mass index (BMI)26.9 (17.1−36.5)26.1 (17.1−32.6)27.3 (21−36.5)0.31PMA (cm2)33.7 (17.2−63)27.1 (17.2−39.3)41.6 (21.1−63)< 0.001PMI (cm2/m2)12.4 (5.3−21.6)10.2 (5.3−15.7)14.1 (6.9−21.6)< 0.001Onset to admission time4 (1−12)3 (1−11)5 (1−12)0.016Forehead temperature (oC)36.8 (36.2−39.7)36.7 (36.2−39.6)37.3 (36.5−39.7)0.042PSS; pneumonia severity score, °C; Celsius degree.']} | The prognostic value of pneumonia severity score and pectoralis muscle Area on chest CT in adult COVID-19 patients | [
"Computed tomography",
"COVID-19",
"Pneumonia",
"Sarcopenia",
"Prognosis"
] | Eur J Radiol | 1602226800 | Cities are wrestling with the practical challenges of transitioning urban water services to become water sensitive; capable of enhancing liveability, sustainability, resilience and productivity in the face of climate change, rapid urbanisation, degraded ecosystems and ageing infrastructure. Indicators can be valuable for guiding actions for improvement, but there is not yet an established index that measures the full suite of attributes that constitute water sensitive performance. This paper therefore presents the Water Sensitive Cities (WSC) Index, a new benchmarking and diagnostic tool to assess the water sensitivity of a municipal or metropolitan city, set aspirational targets and inform management responses to improve water sensitive practices. Its 34 indicators are organised into seven goals: ensure good water sensitive governance, increase community capital, achieve equity of essential services, improve productivity and resource efficiency, improve ecological health, ensure quality urban spaces, and promote adaptive infrastructure. The WSC Index design is a quantitative framework based on qualitative rating descriptions and a participatory assessment methodology, enabling local contextual interpretations of the indicators while maintaining a robust universal framework for city comparison and benchmarking. The paper demonstrates its application on three illustrative cases. Rapid uptake of the WSC Index in Australia highlights its value in helping stakeholders develop collective commitment and evidence-based priorities for action to accelerate their city's water sensitive transition. Early testing in cities in Asia, the Pacific and South Africa has also showed the potential of the WSC Index internationally. | [
"Australia",
"Cities",
"Ecosystem",
"South Africa",
"Water"
] | other | PMC7480333 | null | 70 | [
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"{'Citation': 'Arup. (2015). City Resilience Index (CRI): Understanding and Measuring City Resilience. Retrieved from New York, New York:https://www.rockefellerfoundation.org/report/city-resilience-index/'}",
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] | Eur J Radiol. 2020 Oct 9; 131:109271 | NO-CC CODE |
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Coronal STIR images 12 weeks (a), 52 weeks (b) and 2 years (c) after osteochondral transplantation show gradual resolution of severe bone marrow oedema in and around the grafts as bony incorporation occurs | 330_2006_333_Fig3_HTML | 7 | 4cf434d8d1c3657f56b8b239a61a53d8a3b993b077051433e319f2c8b84045d7 | 330_2006_333_Fig3_HTML.jpg | multiple | multiple panels: images | [
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Arrows mark the borders of the implant', 'hash': 'd03362e249c6c6af4b6fae570ffb7f2897334a64d499f9de53cd045eb6e99db0'}, {'image_id': '330_2006_333_Fig2_HTML', 'image_file_name': '330_2006_333_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig2_HTML.jpg', 'caption': 'Cystic cavities in the osteochondral graft area with fissure-like gap (arrow) between cartilage caps of the grafts in a patient 2\xa0years after osteochondral autografts. Both signs are associated with a poor prognosis', 'hash': '7a11fc77354ece14cde5b89d6a066ac060cfcb37faf84cce517cbcdce33ae5f0'}, {'image_id': '330_2006_333_Fig14_HTML', 'image_file_name': '330_2006_333_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig14_HTML.jpg', 'caption': 'Progressive defect filling at the repair site. After matrix-based autologous chondrocyte implantation, significant improvement of filling of the defect at the repair site from (a) 4\xa0weeks to (b) 24\xa0weeks post-operatively, depicted on sagittal FSE images', 'hash': 'dab9dd233eed92f96ad8641d4a42baf1f21cbe472b2854e356a61b08bc209307'}, {'image_id': '330_2006_333_Fig5_HTML', 'image_file_name': '330_2006_333_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig5_HTML.jpg', 'caption': 'Incongruity at the cartilage-cartilage interface on a medial femoral condyle 12\xa0months after osteochondral autografting', 'hash': '92625677ef15457ce13f909c5a89d4dd675b223b963e3194e5ba68bcf359e181'}, {'image_id': '330_2006_333_Fig6_HTML', 'image_file_name': '330_2006_333_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig6_HTML.jpg', 'caption': 'Osteonecrosis of the osteochondral autograft 2\xa0years after surgery shown by marked hypointense signal alteration of the graft on T1-weighted SE image in the sagittal plane (arrows)', 'hash': 'c4204f4ef006da914d12c9580becb90f42a42aa246fb5252f434aa57bc837663'}, {'image_id': '330_2006_333_Fig9_HTML', 'image_file_name': '330_2006_333_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig9_HTML.jpg', 'caption': 'A split-like integration defect, seen on a sagittal FSE image, 52\xa0weeks after surgery. Arrows mark the borders of the implant, the right-hand arrow points to the defect', 'hash': '2fea7f3a56fc64ad22bec2dc12af25c12c3cff81f1c3afbdf15a678453b37933'}, {'image_id': '330_2006_333_Fig1_HTML', 'image_file_name': '330_2006_333_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig1_HTML.jpg', 'caption': 'Normal cartilage integration of osteochondral autografts in the weight bearing region of the femoral condyle in a patient 2\xa0years after osteochondral autografts', 'hash': '4e9767f9f90f6855038c800f9cbeb2409ec52c1b734d152715adc99594dcded0'}, {'image_id': '330_2006_333_Fig10_HTML', 'image_file_name': '330_2006_333_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig10_HTML.jpg', 'caption': 'A sagittal FSE image of incomplete delamination of the repair tissue 24\xa0weeks after MACT surgery. Fluid partially demarcates the bone interface', 'hash': 'a1ff5f5c487b3be34685dd9e2e68350063134b71eb99da3d596cb68062cb8bb1'}, {'image_id': '330_2006_333_Fig8_HTML', 'image_file_name': '330_2006_333_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig8_HTML.jpg', 'caption': 'Severe hypertrophy of cartilage implant 104\xa0weeks after MACT surgery on a sagittal T2-weighted FSE image', 'hash': 'e48e20eb4a4eef1016b9a4d7cdcc02f66b0aa280f18aca26beaefe6a85c9e308'}, {'image_id': '330_2006_333_Fig7_HTML', 'image_file_name': '330_2006_333_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig7_HTML.jpg', 'caption': 'A sagittal FSE image of a stable cartilage implant at 2\xa0years after MACT surgery shows complete filling of the defect (arrows mark the borders of the implant)', 'hash': '101951d1786a9ecac6eddd26f38f3efb9377143fa155ea7ad4591b7790d28cdc'}, {'image_id': '330_2006_333_Fig11_HTML', 'image_file_name': '330_2006_333_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig11_HTML.jpg', 'caption': 'Gradual integration and normalisation of the graft surface and internal structure after MACT surgery from (a) 12\xa0weeks to (b) 24\xa0weeks on sagittal T2-FSE image', 'hash': '1e00ae73986bba6f8fa08f5568059deefc0708c9e23a53e5c45100c526380330'}] | {'330_2006_333_Fig1_HTML': ['When assessing integration and surface congruity following osteochondral grafting cartilage and bone should be considered separately. With respct to the cartilage, Link et al. [59] found only 15% of patients had an incongruity of the cartilage-cartilage interface. Furthermore, no substantial defects or irregularities of the cartilage overlying the bony cylinders were seen on MRI (Fig.\xa0<xref rid="330_2006_333_Fig1_HTML" ref-type="fig">1</xref>). Lastly, gaps between cartilage plugs and between cartilage plugs and adjacent native cartilage were rarely visualised in this study [). Lastly, gaps between cartilage plugs and between cartilage plugs and adjacent native cartilage were rarely visualised in this study [59] (Fig.\xa0<xref rid="330_2006_333_Fig2_HTML" ref-type="fig">2</xref>).\n).\nFig.\xa01Normal cartilage integration of osteochondral autografts in the weight bearing region of the femoral condyle in a patient 2\xa0years after osteochondral autograftsFig.\xa02Cystic cavities in the osteochondral graft area with fissure-like gap (arrow) between cartilage caps of the grafts in a patient 2\xa0years after osteochondral autografts. Both signs are associated with a poor prognosis'], '330_2006_333_Fig3_HTML': ['From 105 osteochondral cylinders in 55 patients (51%) Link et al. [59] reported bone marrow signal intensities consistent with oedema (hypointensity on T1-weighted images and hyperintensity on the fat-suppressed T2-weighted or PD-weighted images), during the first 12\xa0months post-operatively (Fig.\xa0<xref rid="330_2006_333_Fig3_HTML" ref-type="fig">3</xref>). During the 12–24\xa0month period this dropped to 17%. They found cystic changes in the osseous component of the graft in four of 99 cylinders. Furthermore, eight cylinders showed no or partial enhancement after contrast agent was administered and was reported as necrosis. The T2 signal intensities varied depending on whether the osteonecrosis caused a fibro/sclerotic or cystic degeneration. This limits the usefulness of T2-weighted images for diagnosing graft osteonecrosis. Interestingly, only two of the six patients who showed signs of osteonecrosis of one or more cylinders had associated clinical abnormalities [). During the 12–24\xa0month period this dropped to 17%. They found cystic changes in the osseous component of the graft in four of 99 cylinders. Furthermore, eight cylinders showed no or partial enhancement after contrast agent was administered and was reported as necrosis. The T2 signal intensities varied depending on whether the osteonecrosis caused a fibro/sclerotic or cystic degeneration. This limits the usefulness of T2-weighted images for diagnosing graft osteonecrosis. Interestingly, only two of the six patients who showed signs of osteonecrosis of one or more cylinders had associated clinical abnormalities [59]. These osteonecroses of the graft cylinders did not lead to collapse of the bone or pathological changes of the cartilage that could be visualised by the MRI. Since cartilage derives its nutrition almost exclusively from the synovial membrane, this may provide an explanation. By comparison, Sanders et al. [61] and Hangody and Fules [9] reported no cases of osteochondral necrosis in their patient groups.\nFig.\xa03Coronal STIR images 12\xa0weeks (a), 52\xa0weeks (b) and 2\xa0years (c) after osteochondral transplantation show gradual resolution of severe bone marrow oedema in and around the grafts as bony incorporation occurs'], '330_2006_333_Fig4_HTML': ['Subchondral bone marrow oedema is often present in the early post-operative phase but usually resolves as the graft incorporates into the subchondral bone. A normal fatty marrow signal is seen within and around the plugs when solid bony incorporation occurs (Fig.\xa0<xref rid="330_2006_333_Fig4_HTML" ref-type="fig">4</xref>). Herber et al. [). Herber et al. [60] examined ten patients at 3, 6 and 12\xa0months using indirect MR arthrography and noted a high rate of early post-operative subchondral marrow oedema, which settled in most cases by 12\xa0months.\nFig.\xa04a, bSagittal T1-weighted SE images of the normal development of autologous osteochondral transplants. a Marked oedema in and around the osteochondral plugs at the recipient site 12\xa0weeks (arrows) after surgery and b bony incorporation of the grafts with fatty bone marrow in and around the grafts (arrows) and filling of the donor site with cancellous bone after 2\xa0years'], '330_2006_333_Fig5_HTML': ['Complications which can be determined by MRI include graft loosening or migration, incongruencies of the cartilage-cartilage interface, significant gaps between osteochondral plugs and adjacent native cartilage and partial or complete necroses of the grafts (Figs.\xa0<xref rid="330_2006_333_Fig5_HTML" ref-type="fig">5</xref>, , <xref rid="330_2006_333_Fig6_HTML" ref-type="fig">6</xref>). However, it should be noted that over time fibrocartilagenous tissue fills the gaps between osteochondral plugs and adjacent native cartilage thereby improving surface congruity.\n). However, it should be noted that over time fibrocartilagenous tissue fills the gaps between osteochondral plugs and adjacent native cartilage thereby improving surface congruity.\nFig.\xa05Incongruity at the cartilage-cartilage interface on a medial femoral condyle 12\xa0months after osteochondral autograftingFig.\xa06Osteonecrosis of the osteochondral autograft 2\xa0years after surgery shown by marked hypointense signal alteration of the graft on T1-weighted SE image in the sagittal plane (arrows)'], '330_2006_333_Fig7_HTML': ['One of the major goals of ACI and MACT is to ensure the graft cartilage has the same thickness as the adjacent native cartilage in order to restore the smooth contour of the articular cartilage surface (Fig.\xa0<xref rid="330_2006_333_Fig7_HTML" ref-type="fig">7</xref>). When evaluating defect fill MRI has been shown to be effective in detecting cases of incomplete filling, either focally or globally [). When evaluating defect fill MRI has been shown to be effective in detecting cases of incomplete filling, either focally or globally [20, 29, 34, 36].\nFig.\xa07A sagittal FSE image of a stable cartilage implant at 2\xa0years after MACT surgery shows complete filling of the defect (arrows mark the borders of the implant)'], '330_2006_333_Fig8_HTML': ['Graft hypertrophy is often asymptomatic, but may produce pain and catching. It usually occurs between 3 and 7\xa0months and has been reported to complicate between 10% and 39% of cases [15, 18, 65]. Graft hypertrophy is seen on MRI as the ACI graft protruding above the level of the native articular cartilage and may involve part or the full width of the graft (Fig.\xa0<xref rid="330_2006_333_Fig8_HTML" ref-type="fig">8</xref>). It is important to note that hypertrophy of grafts close to the intercondylar notch may cause impingement on the anterior cruciate ligament. Treatment consists of arthroscopic debridement of the hypertrophied tissue.\n). It is important to note that hypertrophy of grafts close to the intercondylar notch may cause impingement on the anterior cruciate ligament. Treatment consists of arthroscopic debridement of the hypertrophied tissue.\nFig.\xa08Severe hypertrophy of cartilage implant 104\xa0weeks after MACT surgery on a sagittal T2-weighted FSE image'], '330_2006_333_Fig9_HTML': ['The interface between ACI and native cartilage should be indiscernible, a fluid-like split, in particular a broad split or one that extends beneath the base of the ACI has been described as pathological [20, 34, 36] (Fig.\xa0<xref rid="330_2006_333_Fig9_HTML" ref-type="fig">9</xref>). Poor graft integration can be identified on high-resolution sequences by fluid signal clefts or ill-defined high signal intensity at the interface between the graft tissue and native cartilage [). Poor graft integration can be identified on high-resolution sequences by fluid signal clefts or ill-defined high signal intensity at the interface between the graft tissue and native cartilage [15, 18, 20, 34, 36, 67].\nFig.\xa09A split-like integration defect, seen on a sagittal FSE image, 52\xa0weeks after surgery. Arrows mark the borders of the implant, the right-hand arrow points to the defect'], '330_2006_333_Fig10_HTML': ['Poor integration of the ACI repair tissue to the bone or to the adjacent native cartilage may result in delamination of the graft from the underlying bone (Fig.\xa0<xref rid="330_2006_333_Fig10_HTML" ref-type="fig">10</xref>). On MRI, a delaminated graft may appear as a loose body in the joint if it has dislocated, or if still in situ at the repair site, a thin rim of fluid between the base of the graft and the subchondral bone plate, resembling a cartilage flap, may be seen [). On MRI, a delaminated graft may appear as a loose body in the joint if it has dislocated, or if still in situ at the repair site, a thin rim of fluid between the base of the graft and the subchondral bone plate, resembling a cartilage flap, may be seen [20, 34]. Clinically, patients may complain of pain, swelling or locking. This complication may occur in between 5% and 14% of cases [15, 18].\nFig.\xa010A sagittal FSE image of incomplete delamination of the repair tissue 24\xa0weeks after MACT surgery. Fluid partially demarcates the bone interface'], '330_2006_333_Fig11_HTML': ['In some patients, we have seen a transition from an initially irregular surface to a regular smooth surface over time (Fig.\xa0<xref rid="330_2006_333_Fig11_HTML" ref-type="fig">11</xref>). We believe this may represent continuous organisation of the graft as it matures. In contrast, the development of surface defects over time should be considered as abnormal [). We believe this may represent continuous organisation of the graft as it matures. In contrast, the development of surface defects over time should be considered as abnormal [62].\nFig.\xa011Gradual integration and normalisation of the graft surface and internal structure after MACT surgery from (a) 12\xa0weeks to (b) 24\xa0weeks on sagittal T2-FSE image'], '330_2006_333_Fig12_HTML': ['In addition to a smooth surface and homogeneous signal layering, the signal intensity of repair tissue should resemble normal hyaline cartilage. The post-operative signal characteristics seen after ACI surgery are clearly affected by the choice of sequence used. In the uncomplicated case, there is a gradual change in the signal characteristics of the repair tissue over time to resemble those of normal articular cartilage [62, 72] (Fig.\xa0<xref rid="330_2006_333_Fig12_HTML" ref-type="fig">12</xref>). Typically, when a FSE sequence is used the signal intensity of the ACI/MACT repair tissue steadily decreases with time. By contrast the signal intensity steadily increases over time with fat-suppressed T1-weighted GRE sequences [). Typically, when a FSE sequence is used the signal intensity of the ACI/MACT repair tissue steadily decreases with time. By contrast the signal intensity steadily increases over time with fat-suppressed T1-weighted GRE sequences [19, 62, 65].\nFig.\xa012a–eChanges of implant signal intensity, on PD and T2-FSE images following MACT. a, b Fluid-like signal after 4\xa0weeks; c, d hypointensity at 24\xa0weeks and e isointensity with native hyaline cartilage after 52\xa0weeks'], '330_2006_333_Fig13_HTML': ['Adhesions are demonstrated on MRI as bands of intermediate to low signal intensity tissue traversing the joint and demonstrating contact to the repair tissue (Fig.\xa0<xref rid="330_2006_333_Fig13_HTML" ref-type="fig">13</xref>). Adhesions most commonly connect to the infra-patellar fat pad, suprapatellar pouch and parapatellar recesses [). Adhesions most commonly connect to the infra-patellar fat pad, suprapatellar pouch and parapatellar recesses [15, 18, 67]. Knee stiffness from intraarticular adhesions requiring arthroscopic release has been reported in up to 10% of ACI patients [15, 67, 73]. Patients who have undergone extensive cartilage repair or have multiple grafts appear to be more at risk [18]. Adhesion to the graft surface may lead to graft tearing or dislocation as the patients activity level increases.\nFig.\xa013An adhesion seen as a thin band-like structure, running from the tibial articular surface to the cartilage implant on a sagittal T2-FSE image. Arrows mark the borders of the implant'], '330_2006_333_Fig14_HTML': ['Serial follow-up MRI scans of MACT patients show that the cartilage repair is a dynamic process that can be non-invasively monitored [62]. High-resolution MRI examinations at 4, 12, 24, 52 and 104\xa0weeks post-operatively revealed characteristic changes in the repair tissue over time, which we believe represent the normal maturation process of the repair tissue. The most significant features were: first, early filling defects showed progressive filling by 6–12\xa0months (Fig.\xa0<xref rid="330_2006_333_Fig14_HTML" ref-type="fig">14</xref>); second, initial graft hypertrophy seen at 3\xa0months resolved by 6\xa0months; third, small surface defects became smooth over time. Finally, signal intensity gradually changes over time from fluid-like appearance in the early post-operative stage to iso-intensity with surrounding native hyaline cartilage by 6–12\xa0months. One may conclude that inverse developments are associated with a poor prognosis.\n); second, initial graft hypertrophy seen at 3\xa0months resolved by 6\xa0months; third, small surface defects became smooth over time. Finally, signal intensity gradually changes over time from fluid-like appearance in the early post-operative stage to iso-intensity with surrounding native hyaline cartilage by 6–12\xa0months. One may conclude that inverse developments are associated with a poor prognosis.\nFig.\xa014a, bProgressive defect filling at the repair site. After matrix-based autologous chondrocyte implantation, significant improvement of filling of the defect at the repair site from (a) 4\xa0weeks to (b) 24\xa0weeks post-operatively, depicted on sagittal FSE images'], '330_2006_333_Fig15_HTML': ['In the near future as the use of clinical high-field (3 Tesla) systems with modern multi-element coil configurations becomes more widespread and new high-resolution isotropic 3D sequences are utilised a further improvement in the morphological analysis of cartilage implants can be expected. Moreover, advanced cartilage imaging techniques which allow the biochemical composition of cartilage to be studied will be possible in vivo (Fig.\xa0<xref rid="330_2006_333_Fig15_HTML" ref-type="fig">15</xref>). This is particularly promising for evaluating the maturation of the graft and whether or not hyaline cartilage has developed. The ability to non-invasively assess graft maturity will help to define the optimal postoperative rehabilitation and to detect the early stages of graft failure.\n). This is particularly promising for evaluating the maturation of the graft and whether or not hyaline cartilage has developed. The ability to non-invasively assess graft maturity will help to define the optimal postoperative rehabilitation and to detect the early stages of graft failure.\nFig.\xa015a, bA dGEMRIC image of a matrix-associated ACT 2\xa0years after surgery. a The cartilage layer of the graft shows different T1 values, representing proteoglycan concentration, compared with hyaline cartilage. b a 3D-GRE image of the same patient, which shows morphology of cartilage implant with hypointense signal alteration of the cartilage implant in comparison with normal hyaline cartilage']} | MR imaging of osteochondral grafts and autologous chondrocyte implantation | [
"MRI",
"Articular cartilage",
"Cartilage repair",
"Autologous osteochondral transplantation",
"Autologous chondrocyte implantation"
] | Eur Radiol | 1169884800 | Acute renal failure (ARF) is uncommon in childhood and there is little consensus on the appropriate treatment modality when renal replacement therapy is required. Members of the European Pediatric Peritoneal Dialysis Working Group have produced the following guidelines in collaboration with nursing staff. Good practice requires early discussion of patients with ARF with pediatric nephrology staff and transfer for investigation and management in those with rapidly deteriorating renal function. Patients with ARF as part of multi-organ failure will be cared for in pediatric intensive care units where there should be access to pediatric nephrology support and advice. The choice of dialysis therapy will therefore depend upon the clinical circumstances, location of the patient, and expertise available. Peritoneal dialysis has generally been the preferred therapy for isolated failure of the kidney and is universally available. Intermittent hemodialysis is frequently used in renal units where nursing expertise is available and hemofiltration is increasingly employed in the intensive care situation. Practical guidelines for and the complications of each therapy are discussed. | [
"Acute Kidney Injury",
"Child",
"Hemofiltration",
"Humans",
"Peritoneal Dialysis",
"Renal Dialysis",
"Renal Replacement Therapy"
] | other | PMC1766022 | null | 131 | [
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] | Eur Radiol. 2007 Jan 27; 17(1):103-118 | NO-CC CODE |
|
Sagittal T1-weighted SE images of the normal development of autologous osteochondral transplants. a Marked oedema in and around the osteochondral plugs at the recipient site 12 weeks (arrows) after surgery and b bony incorporation of the grafts with fatty bone marrow in and around the grafts (arrows) and filling of the donor site with cancellous bone after 2 years | 330_2006_333_Fig4_HTML | 7 | 9fa334e2be71fe58ebf3e72f68d47a0ab7aff84da6f5aceb8ea53945e66c4845 | 330_2006_333_Fig4_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
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709,
355
] | [{'image_id': '330_2006_333_Fig3_HTML', 'image_file_name': '330_2006_333_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig3_HTML.jpg', 'caption': 'Coronal STIR images 12\xa0weeks (a), 52\xa0weeks (b) and 2\xa0years (c) after osteochondral transplantation show gradual resolution of severe bone marrow oedema in and around the grafts as bony incorporation occurs', 'hash': '4cf434d8d1c3657f56b8b239a61a53d8a3b993b077051433e319f2c8b84045d7'}, {'image_id': '330_2006_333_Fig12_HTML', 'image_file_name': '330_2006_333_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig12_HTML.jpg', 'caption': 'Changes of implant signal intensity, on PD and T2-FSE images following MACT. a, b Fluid-like signal after 4\xa0weeks; c, d hypointensity at 24\xa0weeks and e isointensity with native hyaline cartilage after 52\xa0weeks', 'hash': 'cf958831d614a4087b0d67c150e2d5c75b59799e1e4fe5d027f36284bab62c13'}, {'image_id': '330_2006_333_Fig4_HTML', 'image_file_name': '330_2006_333_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig4_HTML.jpg', 'caption': 'Sagittal T1-weighted SE images of the normal development of autologous osteochondral transplants. a Marked oedema in and around the osteochondral plugs at the recipient site 12\xa0weeks (arrows) after surgery and b bony incorporation of the grafts with fatty bone marrow in and around the grafts (arrows) and filling of the donor site with cancellous bone after 2\xa0years', 'hash': '9fa334e2be71fe58ebf3e72f68d47a0ab7aff84da6f5aceb8ea53945e66c4845'}, {'image_id': '330_2006_333_Fig15_HTML', 'image_file_name': '330_2006_333_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig15_HTML.jpg', 'caption': 'A dGEMRIC image of a matrix-associated ACT 2\xa0years after surgery. a The cartilage layer of the graft shows different T1 values, representing proteoglycan concentration, compared with hyaline cartilage. b a 3D-GRE image of the same patient, which shows morphology of cartilage implant with hypointense signal alteration of the cartilage implant in comparison with normal hyaline cartilage', 'hash': '39062fe9cf348db25c483a90ad5b3300627419419dc47306617e2f4623b07172'}, {'image_id': '330_2006_333_Fig13_HTML', 'image_file_name': '330_2006_333_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig13_HTML.jpg', 'caption': 'An adhesion seen as a thin band-like structure, running from the tibial articular surface to the cartilage implant on a sagittal T2-FSE image. Arrows mark the borders of the implant', 'hash': 'd03362e249c6c6af4b6fae570ffb7f2897334a64d499f9de53cd045eb6e99db0'}, {'image_id': '330_2006_333_Fig2_HTML', 'image_file_name': '330_2006_333_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig2_HTML.jpg', 'caption': 'Cystic cavities in the osteochondral graft area with fissure-like gap (arrow) between cartilage caps of the grafts in a patient 2\xa0years after osteochondral autografts. Both signs are associated with a poor prognosis', 'hash': '7a11fc77354ece14cde5b89d6a066ac060cfcb37faf84cce517cbcdce33ae5f0'}, {'image_id': '330_2006_333_Fig14_HTML', 'image_file_name': '330_2006_333_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig14_HTML.jpg', 'caption': 'Progressive defect filling at the repair site. After matrix-based autologous chondrocyte implantation, significant improvement of filling of the defect at the repair site from (a) 4\xa0weeks to (b) 24\xa0weeks post-operatively, depicted on sagittal FSE images', 'hash': 'dab9dd233eed92f96ad8641d4a42baf1f21cbe472b2854e356a61b08bc209307'}, {'image_id': '330_2006_333_Fig5_HTML', 'image_file_name': '330_2006_333_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig5_HTML.jpg', 'caption': 'Incongruity at the cartilage-cartilage interface on a medial femoral condyle 12\xa0months after osteochondral autografting', 'hash': '92625677ef15457ce13f909c5a89d4dd675b223b963e3194e5ba68bcf359e181'}, {'image_id': '330_2006_333_Fig6_HTML', 'image_file_name': '330_2006_333_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig6_HTML.jpg', 'caption': 'Osteonecrosis of the osteochondral autograft 2\xa0years after surgery shown by marked hypointense signal alteration of the graft on T1-weighted SE image in the sagittal plane (arrows)', 'hash': 'c4204f4ef006da914d12c9580becb90f42a42aa246fb5252f434aa57bc837663'}, {'image_id': '330_2006_333_Fig9_HTML', 'image_file_name': '330_2006_333_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig9_HTML.jpg', 'caption': 'A split-like integration defect, seen on a sagittal FSE image, 52\xa0weeks after surgery. Arrows mark the borders of the implant, the right-hand arrow points to the defect', 'hash': '2fea7f3a56fc64ad22bec2dc12af25c12c3cff81f1c3afbdf15a678453b37933'}, {'image_id': '330_2006_333_Fig1_HTML', 'image_file_name': '330_2006_333_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig1_HTML.jpg', 'caption': 'Normal cartilage integration of osteochondral autografts in the weight bearing region of the femoral condyle in a patient 2\xa0years after osteochondral autografts', 'hash': '4e9767f9f90f6855038c800f9cbeb2409ec52c1b734d152715adc99594dcded0'}, {'image_id': '330_2006_333_Fig10_HTML', 'image_file_name': '330_2006_333_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig10_HTML.jpg', 'caption': 'A sagittal FSE image of incomplete delamination of the repair tissue 24\xa0weeks after MACT surgery. Fluid partially demarcates the bone interface', 'hash': 'a1ff5f5c487b3be34685dd9e2e68350063134b71eb99da3d596cb68062cb8bb1'}, {'image_id': '330_2006_333_Fig8_HTML', 'image_file_name': '330_2006_333_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig8_HTML.jpg', 'caption': 'Severe hypertrophy of cartilage implant 104\xa0weeks after MACT surgery on a sagittal T2-weighted FSE image', 'hash': 'e48e20eb4a4eef1016b9a4d7cdcc02f66b0aa280f18aca26beaefe6a85c9e308'}, {'image_id': '330_2006_333_Fig7_HTML', 'image_file_name': '330_2006_333_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig7_HTML.jpg', 'caption': 'A sagittal FSE image of a stable cartilage implant at 2\xa0years after MACT surgery shows complete filling of the defect (arrows mark the borders of the implant)', 'hash': '101951d1786a9ecac6eddd26f38f3efb9377143fa155ea7ad4591b7790d28cdc'}, {'image_id': '330_2006_333_Fig11_HTML', 'image_file_name': '330_2006_333_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC1766022/330_2006_333_Fig11_HTML.jpg', 'caption': 'Gradual integration and normalisation of the graft surface and internal structure after MACT surgery from (a) 12\xa0weeks to (b) 24\xa0weeks on sagittal T2-FSE image', 'hash': '1e00ae73986bba6f8fa08f5568059deefc0708c9e23a53e5c45100c526380330'}] | {'330_2006_333_Fig1_HTML': ['When assessing integration and surface congruity following osteochondral grafting cartilage and bone should be considered separately. With respct to the cartilage, Link et al. [59] found only 15% of patients had an incongruity of the cartilage-cartilage interface. Furthermore, no substantial defects or irregularities of the cartilage overlying the bony cylinders were seen on MRI (Fig.\xa0<xref rid="330_2006_333_Fig1_HTML" ref-type="fig">1</xref>). Lastly, gaps between cartilage plugs and between cartilage plugs and adjacent native cartilage were rarely visualised in this study [). Lastly, gaps between cartilage plugs and between cartilage plugs and adjacent native cartilage were rarely visualised in this study [59] (Fig.\xa0<xref rid="330_2006_333_Fig2_HTML" ref-type="fig">2</xref>).\n).\nFig.\xa01Normal cartilage integration of osteochondral autografts in the weight bearing region of the femoral condyle in a patient 2\xa0years after osteochondral autograftsFig.\xa02Cystic cavities in the osteochondral graft area with fissure-like gap (arrow) between cartilage caps of the grafts in a patient 2\xa0years after osteochondral autografts. Both signs are associated with a poor prognosis'], '330_2006_333_Fig3_HTML': ['From 105 osteochondral cylinders in 55 patients (51%) Link et al. [59] reported bone marrow signal intensities consistent with oedema (hypointensity on T1-weighted images and hyperintensity on the fat-suppressed T2-weighted or PD-weighted images), during the first 12\xa0months post-operatively (Fig.\xa0<xref rid="330_2006_333_Fig3_HTML" ref-type="fig">3</xref>). During the 12–24\xa0month period this dropped to 17%. They found cystic changes in the osseous component of the graft in four of 99 cylinders. Furthermore, eight cylinders showed no or partial enhancement after contrast agent was administered and was reported as necrosis. The T2 signal intensities varied depending on whether the osteonecrosis caused a fibro/sclerotic or cystic degeneration. This limits the usefulness of T2-weighted images for diagnosing graft osteonecrosis. Interestingly, only two of the six patients who showed signs of osteonecrosis of one or more cylinders had associated clinical abnormalities [). During the 12–24\xa0month period this dropped to 17%. They found cystic changes in the osseous component of the graft in four of 99 cylinders. Furthermore, eight cylinders showed no or partial enhancement after contrast agent was administered and was reported as necrosis. The T2 signal intensities varied depending on whether the osteonecrosis caused a fibro/sclerotic or cystic degeneration. This limits the usefulness of T2-weighted images for diagnosing graft osteonecrosis. Interestingly, only two of the six patients who showed signs of osteonecrosis of one or more cylinders had associated clinical abnormalities [59]. These osteonecroses of the graft cylinders did not lead to collapse of the bone or pathological changes of the cartilage that could be visualised by the MRI. Since cartilage derives its nutrition almost exclusively from the synovial membrane, this may provide an explanation. By comparison, Sanders et al. [61] and Hangody and Fules [9] reported no cases of osteochondral necrosis in their patient groups.\nFig.\xa03Coronal STIR images 12\xa0weeks (a), 52\xa0weeks (b) and 2\xa0years (c) after osteochondral transplantation show gradual resolution of severe bone marrow oedema in and around the grafts as bony incorporation occurs'], '330_2006_333_Fig4_HTML': ['Subchondral bone marrow oedema is often present in the early post-operative phase but usually resolves as the graft incorporates into the subchondral bone. A normal fatty marrow signal is seen within and around the plugs when solid bony incorporation occurs (Fig.\xa0<xref rid="330_2006_333_Fig4_HTML" ref-type="fig">4</xref>). Herber et al. [). Herber et al. [60] examined ten patients at 3, 6 and 12\xa0months using indirect MR arthrography and noted a high rate of early post-operative subchondral marrow oedema, which settled in most cases by 12\xa0months.\nFig.\xa04a, bSagittal T1-weighted SE images of the normal development of autologous osteochondral transplants. a Marked oedema in and around the osteochondral plugs at the recipient site 12\xa0weeks (arrows) after surgery and b bony incorporation of the grafts with fatty bone marrow in and around the grafts (arrows) and filling of the donor site with cancellous bone after 2\xa0years'], '330_2006_333_Fig5_HTML': ['Complications which can be determined by MRI include graft loosening or migration, incongruencies of the cartilage-cartilage interface, significant gaps between osteochondral plugs and adjacent native cartilage and partial or complete necroses of the grafts (Figs.\xa0<xref rid="330_2006_333_Fig5_HTML" ref-type="fig">5</xref>, , <xref rid="330_2006_333_Fig6_HTML" ref-type="fig">6</xref>). However, it should be noted that over time fibrocartilagenous tissue fills the gaps between osteochondral plugs and adjacent native cartilage thereby improving surface congruity.\n). However, it should be noted that over time fibrocartilagenous tissue fills the gaps between osteochondral plugs and adjacent native cartilage thereby improving surface congruity.\nFig.\xa05Incongruity at the cartilage-cartilage interface on a medial femoral condyle 12\xa0months after osteochondral autograftingFig.\xa06Osteonecrosis of the osteochondral autograft 2\xa0years after surgery shown by marked hypointense signal alteration of the graft on T1-weighted SE image in the sagittal plane (arrows)'], '330_2006_333_Fig7_HTML': ['One of the major goals of ACI and MACT is to ensure the graft cartilage has the same thickness as the adjacent native cartilage in order to restore the smooth contour of the articular cartilage surface (Fig.\xa0<xref rid="330_2006_333_Fig7_HTML" ref-type="fig">7</xref>). When evaluating defect fill MRI has been shown to be effective in detecting cases of incomplete filling, either focally or globally [). When evaluating defect fill MRI has been shown to be effective in detecting cases of incomplete filling, either focally or globally [20, 29, 34, 36].\nFig.\xa07A sagittal FSE image of a stable cartilage implant at 2\xa0years after MACT surgery shows complete filling of the defect (arrows mark the borders of the implant)'], '330_2006_333_Fig8_HTML': ['Graft hypertrophy is often asymptomatic, but may produce pain and catching. It usually occurs between 3 and 7\xa0months and has been reported to complicate between 10% and 39% of cases [15, 18, 65]. Graft hypertrophy is seen on MRI as the ACI graft protruding above the level of the native articular cartilage and may involve part or the full width of the graft (Fig.\xa0<xref rid="330_2006_333_Fig8_HTML" ref-type="fig">8</xref>). It is important to note that hypertrophy of grafts close to the intercondylar notch may cause impingement on the anterior cruciate ligament. Treatment consists of arthroscopic debridement of the hypertrophied tissue.\n). It is important to note that hypertrophy of grafts close to the intercondylar notch may cause impingement on the anterior cruciate ligament. Treatment consists of arthroscopic debridement of the hypertrophied tissue.\nFig.\xa08Severe hypertrophy of cartilage implant 104\xa0weeks after MACT surgery on a sagittal T2-weighted FSE image'], '330_2006_333_Fig9_HTML': ['The interface between ACI and native cartilage should be indiscernible, a fluid-like split, in particular a broad split or one that extends beneath the base of the ACI has been described as pathological [20, 34, 36] (Fig.\xa0<xref rid="330_2006_333_Fig9_HTML" ref-type="fig">9</xref>). Poor graft integration can be identified on high-resolution sequences by fluid signal clefts or ill-defined high signal intensity at the interface between the graft tissue and native cartilage [). Poor graft integration can be identified on high-resolution sequences by fluid signal clefts or ill-defined high signal intensity at the interface between the graft tissue and native cartilage [15, 18, 20, 34, 36, 67].\nFig.\xa09A split-like integration defect, seen on a sagittal FSE image, 52\xa0weeks after surgery. Arrows mark the borders of the implant, the right-hand arrow points to the defect'], '330_2006_333_Fig10_HTML': ['Poor integration of the ACI repair tissue to the bone or to the adjacent native cartilage may result in delamination of the graft from the underlying bone (Fig.\xa0<xref rid="330_2006_333_Fig10_HTML" ref-type="fig">10</xref>). On MRI, a delaminated graft may appear as a loose body in the joint if it has dislocated, or if still in situ at the repair site, a thin rim of fluid between the base of the graft and the subchondral bone plate, resembling a cartilage flap, may be seen [). On MRI, a delaminated graft may appear as a loose body in the joint if it has dislocated, or if still in situ at the repair site, a thin rim of fluid between the base of the graft and the subchondral bone plate, resembling a cartilage flap, may be seen [20, 34]. Clinically, patients may complain of pain, swelling or locking. This complication may occur in between 5% and 14% of cases [15, 18].\nFig.\xa010A sagittal FSE image of incomplete delamination of the repair tissue 24\xa0weeks after MACT surgery. Fluid partially demarcates the bone interface'], '330_2006_333_Fig11_HTML': ['In some patients, we have seen a transition from an initially irregular surface to a regular smooth surface over time (Fig.\xa0<xref rid="330_2006_333_Fig11_HTML" ref-type="fig">11</xref>). We believe this may represent continuous organisation of the graft as it matures. In contrast, the development of surface defects over time should be considered as abnormal [). We believe this may represent continuous organisation of the graft as it matures. In contrast, the development of surface defects over time should be considered as abnormal [62].\nFig.\xa011Gradual integration and normalisation of the graft surface and internal structure after MACT surgery from (a) 12\xa0weeks to (b) 24\xa0weeks on sagittal T2-FSE image'], '330_2006_333_Fig12_HTML': ['In addition to a smooth surface and homogeneous signal layering, the signal intensity of repair tissue should resemble normal hyaline cartilage. The post-operative signal characteristics seen after ACI surgery are clearly affected by the choice of sequence used. In the uncomplicated case, there is a gradual change in the signal characteristics of the repair tissue over time to resemble those of normal articular cartilage [62, 72] (Fig.\xa0<xref rid="330_2006_333_Fig12_HTML" ref-type="fig">12</xref>). Typically, when a FSE sequence is used the signal intensity of the ACI/MACT repair tissue steadily decreases with time. By contrast the signal intensity steadily increases over time with fat-suppressed T1-weighted GRE sequences [). Typically, when a FSE sequence is used the signal intensity of the ACI/MACT repair tissue steadily decreases with time. By contrast the signal intensity steadily increases over time with fat-suppressed T1-weighted GRE sequences [19, 62, 65].\nFig.\xa012a–eChanges of implant signal intensity, on PD and T2-FSE images following MACT. a, b Fluid-like signal after 4\xa0weeks; c, d hypointensity at 24\xa0weeks and e isointensity with native hyaline cartilage after 52\xa0weeks'], '330_2006_333_Fig13_HTML': ['Adhesions are demonstrated on MRI as bands of intermediate to low signal intensity tissue traversing the joint and demonstrating contact to the repair tissue (Fig.\xa0<xref rid="330_2006_333_Fig13_HTML" ref-type="fig">13</xref>). Adhesions most commonly connect to the infra-patellar fat pad, suprapatellar pouch and parapatellar recesses [). Adhesions most commonly connect to the infra-patellar fat pad, suprapatellar pouch and parapatellar recesses [15, 18, 67]. Knee stiffness from intraarticular adhesions requiring arthroscopic release has been reported in up to 10% of ACI patients [15, 67, 73]. Patients who have undergone extensive cartilage repair or have multiple grafts appear to be more at risk [18]. Adhesion to the graft surface may lead to graft tearing or dislocation as the patients activity level increases.\nFig.\xa013An adhesion seen as a thin band-like structure, running from the tibial articular surface to the cartilage implant on a sagittal T2-FSE image. Arrows mark the borders of the implant'], '330_2006_333_Fig14_HTML': ['Serial follow-up MRI scans of MACT patients show that the cartilage repair is a dynamic process that can be non-invasively monitored [62]. High-resolution MRI examinations at 4, 12, 24, 52 and 104\xa0weeks post-operatively revealed characteristic changes in the repair tissue over time, which we believe represent the normal maturation process of the repair tissue. The most significant features were: first, early filling defects showed progressive filling by 6–12\xa0months (Fig.\xa0<xref rid="330_2006_333_Fig14_HTML" ref-type="fig">14</xref>); second, initial graft hypertrophy seen at 3\xa0months resolved by 6\xa0months; third, small surface defects became smooth over time. Finally, signal intensity gradually changes over time from fluid-like appearance in the early post-operative stage to iso-intensity with surrounding native hyaline cartilage by 6–12\xa0months. One may conclude that inverse developments are associated with a poor prognosis.\n); second, initial graft hypertrophy seen at 3\xa0months resolved by 6\xa0months; third, small surface defects became smooth over time. Finally, signal intensity gradually changes over time from fluid-like appearance in the early post-operative stage to iso-intensity with surrounding native hyaline cartilage by 6–12\xa0months. One may conclude that inverse developments are associated with a poor prognosis.\nFig.\xa014a, bProgressive defect filling at the repair site. After matrix-based autologous chondrocyte implantation, significant improvement of filling of the defect at the repair site from (a) 4\xa0weeks to (b) 24\xa0weeks post-operatively, depicted on sagittal FSE images'], '330_2006_333_Fig15_HTML': ['In the near future as the use of clinical high-field (3 Tesla) systems with modern multi-element coil configurations becomes more widespread and new high-resolution isotropic 3D sequences are utilised a further improvement in the morphological analysis of cartilage implants can be expected. Moreover, advanced cartilage imaging techniques which allow the biochemical composition of cartilage to be studied will be possible in vivo (Fig.\xa0<xref rid="330_2006_333_Fig15_HTML" ref-type="fig">15</xref>). This is particularly promising for evaluating the maturation of the graft and whether or not hyaline cartilage has developed. The ability to non-invasively assess graft maturity will help to define the optimal postoperative rehabilitation and to detect the early stages of graft failure.\n). This is particularly promising for evaluating the maturation of the graft and whether or not hyaline cartilage has developed. The ability to non-invasively assess graft maturity will help to define the optimal postoperative rehabilitation and to detect the early stages of graft failure.\nFig.\xa015a, bA dGEMRIC image of a matrix-associated ACT 2\xa0years after surgery. a The cartilage layer of the graft shows different T1 values, representing proteoglycan concentration, compared with hyaline cartilage. b a 3D-GRE image of the same patient, which shows morphology of cartilage implant with hypointense signal alteration of the cartilage implant in comparison with normal hyaline cartilage']} | MR imaging of osteochondral grafts and autologous chondrocyte implantation | [
"MRI",
"Articular cartilage",
"Cartilage repair",
"Autologous osteochondral transplantation",
"Autologous chondrocyte implantation"
] | Eur Radiol | 1169884800 | Acute renal failure (ARF) is uncommon in childhood and there is little consensus on the appropriate treatment modality when renal replacement therapy is required. Members of the European Pediatric Peritoneal Dialysis Working Group have produced the following guidelines in collaboration with nursing staff. Good practice requires early discussion of patients with ARF with pediatric nephrology staff and transfer for investigation and management in those with rapidly deteriorating renal function. Patients with ARF as part of multi-organ failure will be cared for in pediatric intensive care units where there should be access to pediatric nephrology support and advice. The choice of dialysis therapy will therefore depend upon the clinical circumstances, location of the patient, and expertise available. Peritoneal dialysis has generally been the preferred therapy for isolated failure of the kidney and is universally available. Intermittent hemodialysis is frequently used in renal units where nursing expertise is available and hemofiltration is increasingly employed in the intensive care situation. Practical guidelines for and the complications of each therapy are discussed. | [
"Acute Kidney Injury",
"Child",
"Hemofiltration",
"Humans",
"Peritoneal Dialysis",
"Renal Dialysis",
"Renal Replacement Therapy"
] | other | PMC1766022 | null | 131 | [
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] | Eur Radiol. 2007 Jan 27; 17(1):103-118 | NO-CC CODE |
|
(a) Sagittal T2 weighted fat-suppression image shows carcinoma in the anterior third of the oral tongue (arrow). (b) Sagittal T2 weighted fat-suppression image (same patient) shows tumour invading the floor of the mouth (arrow). | ci06018607 | 7 | 8defa973c277f14666ac6d65c4189d3d53aa10ee41e69a78cc8bafcd8e944731 | ci06018607.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
404,
223
] | [{'image_id': 'ci06018607', 'image_file_name': 'ci06018607.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018607.jpg', 'caption': '(a) Sagittal T2 weighted fat-suppression image shows carcinoma in the anterior third of the oral tongue (arrow). (b) Sagittal T2 weighted fat-suppression image (same patient) shows tumour invading the floor of the mouth (arrow).', 'hash': '8defa973c277f14666ac6d65c4189d3d53aa10ee41e69a78cc8bafcd8e944731'}, {'image_id': 'ci06018609', 'image_file_name': 'ci06018609.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018609.jpg', 'caption': '(a) Axial post-contrast CT image shows a large left-side tongue base carcinoma. Note the extension across the midline (long arrow) and the ipsilateral enlarged jugulodigastric node (short arrow). (b) Axial post-contrast CT image shows tumour extension into the aryepiglottic (short arrow) and hypopharynx (long arrow).', 'hash': '3adf0cc367f0b33e9c9f3b6bf5c4f80b80b2c51e844c0a62fa4be46b209aeafb'}, {'image_id': 'ci06018611', 'image_file_name': 'ci06018611.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018611.jpg', 'caption': '(a) Axial post-contrast CT image shows an exophytic a left-sided vallecular cancer (arrows). (b) Axial post-contrast CT image shows tumour involving the ipsilateral aryepiglottic fold (short white arrow) and the pyriform sinus (long white arrow). Note the enlarged necrotic left jugulodigastric node (black arrow).', 'hash': '01bd49d885313a8de77ac248f9f4da7f26791fb08afab1be64d3498be8e94814'}, {'image_id': 'ci06018608', 'image_file_name': 'ci06018608.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018608.jpg', 'caption': '(a) Coronal T2 weighted fat-suppression image shows a carcinoma in the middle third of the oral tongue with early infiltration (long arrow) of the tongue musculature (genioglossus). Note the ipsilateral submandibular lymphadenopathy (short arrow). (b) Coronal post-contrast T1 weighted fat-suppression image of a more advanced case shows the tumour invading the lateral floor of the mouth (arrow).', 'hash': 'eead6913fc7e00f32c34fc53f5cbdab5e8edd93f5da1cc727383b8e67bc0b357'}, {'image_id': 'ci06018606', 'image_file_name': 'ci06018606.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018606.jpg', 'caption': 'Axial T1 weighted image shows a tongue cancer with mandible invasion. However, early involvement of cortical bones is better seen on CT images.', 'hash': '937f8cd7007633ba69890ec1106b16f6bdc1b479e7222072693d25039c34ba95'}, {'image_id': 'ci06018601', 'image_file_name': 'ci06018601.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018601.jpg', 'caption': '(a) Axial T1 weighted image shows the tongue muscles, genioglossus (long arrow) and hyoglossus (short arrow). (b) Coronal T1 weighted image shows lingual septum (short arrow) and mylohyoid (long arrow), which forms the floor of the mouth.', 'hash': '1e43854eb6e05c20b608fcada0a358a2566a4d8e25ba6fde4ebcdcc4def19808'}, {'image_id': 'ci06018610', 'image_file_name': 'ci06018610.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018610.jpg', 'caption': '(a) Axial post-contrast T1 weighted fat-suppression image shows a large tongue base tumour (opposing arrows). (b) Axial post-contrast T1 weighted fat-suppression image shows inferior extension into the right pyriform fossa (arrow).', 'hash': '6a2f5ceebb359cc24b1b79d7edd68d1ca6385416f6b764442d6ce40e56db110a'}, {'image_id': 'ci06018602', 'image_file_name': 'ci06018602.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018602.jpg', 'caption': '(a) Axial T2 weighted fat-suppression image shows a right-sided tongue cancer extending more than 5 mm from the lateral margin of the tongue. (b) Coronal T2 weighted fat-suppression image shows bilateral submandibular lymphadenopathy (arrows), a result of the lymphatic drainage pathways of the inner two-thirds of the oral tongue.', 'hash': '56b7b2e91e638118b0deae5929db02f987470a6ba258e64532a2da164f695021'}, {'image_id': 'ci06018605', 'image_file_name': 'ci06018605.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018605.jpg', 'caption': '(a) Axial T2 weighted fat-suppression image shows a right-sided tongue base cancer (long arrows). An enlarged right jugulodigastric node is also seen (short arrow), the first echelon node of tongue base carcinoma. (b) Sagittal T2 weighted fat-suppression image of the same patient shows the extent of pharyngeal invasion of the tongue base tumour (arrow).', 'hash': '0a6f52d0a8c38ea6182195a53f69a5e95af87aa977805d09a96fba8275aead63'}, {'image_id': 'ci06018612', 'image_file_name': 'ci06018612.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018612.jpg', 'caption': 'Axial post-contrast CT image shows a tongue base carcinoma (black arrow) with bilateral malignant lymphadenopathy (white arrows), which occurs in up to 30% of patients on presentation.', 'hash': 'f29d454aaee9b8d63bea71365ddd56af880751741320c44495767c559dda2a45'}, {'image_id': 'ci06018604', 'image_file_name': 'ci06018604.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018604.jpg', 'caption': '(a) Axial post-contrast T1 weighted fat-suppression image shows a right-sided oral tongue carcinoma (arrow). (b) Coronal T2 weighted fat-suppression image shows tumour infiltration of the floor of the mouth (long arrow). Note the normal contralateral mylohyoid muscle (short arrow). (c) Coronal T2 weighted fat-suppression image of another patient shows a right-sided oral tongue cancer (short arrow). Note the sublingual glands (long arrows), which should not be confused as tumour infiltration.', 'hash': 'bc672e3474ed2f32be39ac44a694c081d8cba1217fc4c716253b8485fc4322c3'}, {'image_id': 'ci06018603', 'image_file_name': 'ci06018603.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018603.jpg', 'caption': '(a) Axial T1 weighted, (b) post-contrast T1 weighted fat-suppression and (c) T2 weighted fat-suppression images show a left-sided oral tongue carcinoma. Note that the tumour is most conspicuous on T2 weighted fat-suppression sequence.', 'hash': '62c7eeea46f0e368043671cbb7e01ae912ca0960c6754bc9e3990d53f0779072'}] | {'ci06018601': ['The tongue has a supporting fibrous framework consisting of the lingual septum (<xref ref-type="fig" rid="ci06018601">Fig. 1</xref>) and the hyoglossus membrane. The midline fibrous lingual septum divides the tongue into two symmetrical muscular halves. ) and the hyoglossus membrane. The midline fibrous lingual septum divides the tongue into two symmetrical muscular halves. ', 'The anatomy of the tongue is well demonstrated on magnetic resonance imaging (MRI). On axial T1-weighted images, fat with high signal intensity can be seen interspersed between the muscles of intermediate signal intensity (<xref ref-type="fig" rid="ci06018601">Fig. 1</xref>).).', 'Genioglossus is the largest of all the tongue muscles and forms the bulk of the tongue. It arises from the genial tubercle and is easily seen on computed tomography (CT) and MRI (<xref ref-type="fig" rid="ci06018601">Fig. 1</xref>). It fans out widely and inserts inferiorly into the hyoid bone; posteriorly into the tongue base; and superiorly into the entire ventral surface of the tongue. Hyoglossus is a thin quadrilateral sheet of muscle arising from the hyoid bone. It ascends superiorly, interdigitating with the fibres of the styloglossus, and attaches to the side of the tongue. The hyoglossus muscles define the lateral margins of the tongue and are readily identified on CT and MRI (). It fans out widely and inserts inferiorly into the hyoid bone; posteriorly into the tongue base; and superiorly into the entire ventral surface of the tongue. Hyoglossus is a thin quadrilateral sheet of muscle arising from the hyoid bone. It ascends superiorly, interdigitating with the fibres of the styloglossus, and attaches to the side of the tongue. The hyoglossus muscles define the lateral margins of the tongue and are readily identified on CT and MRI (<xref ref-type="fig" rid="ci06018601">Fig. 1</xref>). Both the styloglossus (which arises from the styloid process and stylohyoid ligament) and the palatoglossus (which originates from the palatine aponeurosis) cannot be seen with certainty on imaging studies.). Both the styloglossus (which arises from the styloid process and stylohyoid ligament) and the palatoglossus (which originates from the palatine aponeurosis) cannot be seen with certainty on imaging studies.'], 'ci06018602': ['The tongue has a rich lymphatic network. Unlike the vascular supply that remains largely unilateral, lymph from one side, particularly from the tongue base, drains into nodes on both sides of the neck. Lymph from the tip of the tongue may drain to the submental nodes. Marginal lymphatics from the outer third of the rest of the oral tongue are directed to ipsilateral submandibular and jugulodigastric nodes. Central lymphatics of the inner two-thirds of the oral tongue have pathways to nodes of both sides of the neck. As a clinical guide, tumour extending more than 5 mm from lateral tongue margin has an increased risk of bilateral metastatic lymphadenopathy [2] (<xref ref-type="fig" rid="ci06018602">Fig. 2</xref>). ). '], 'ci06018603': ['MRI is the preferred modality in the evaluation of tongue carcinomas (<xref ref-type="fig" rid="ci06018603">Fig. 3</xref>). The abnormal signals seen on MRI are well correlated with pathological findings [). The abnormal signals seen on MRI are well correlated with pathological findings [4]. Tumour invasion of the floor of the mouth is particularly well seen on coronal images (<xref ref-type="fig" rid="ci06018604">Fig. 4</xref>). Sagittal images provide information on tongue base involvement and the extent of pharyngeal infiltration that cannot be seen on CT (). Sagittal images provide information on tongue base involvement and the extent of pharyngeal infiltration that cannot be seen on CT (<xref ref-type="fig" rid="ci06018605">Fig. 5</xref>). However, cortical bone involvement, notably the mandible is diagnosed with a higher level of certainly on CT (). However, cortical bone involvement, notably the mandible is diagnosed with a higher level of certainly on CT (<xref ref-type="fig" rid="ci06018606">Fig. 6</xref>). ). '], 'ci06018607': ['Nearly all tumours of the oral tongue occur on the lateral and under surface. Dorsal tumours are uncommon but when they do occur, they are usually located near the midline and more posteriorly. Oral tongue tumours tend to remain in the tongue. Tumours in the anterior third of the oral tongue invade the floor of the mouth (<xref ref-type="fig" rid="ci06018607">Fig. 7</xref>). Middle-third lesions infiltrate the musculature of the tongue and later, the lateral floor of the mouth (). Middle-third lesions infiltrate the musculature of the tongue and later, the lateral floor of the mouth (<xref ref-type="fig" rid="ci06018608">Fig. 8</xref>). Carcinomas involving the posterior third of the oral tongue grow into the musculature of the tongue, the floor of the mouth, the anterior tonsillar pillar, the tongue base, the glossotonsillar sulcus and the mandible (). Carcinomas involving the posterior third of the oral tongue grow into the musculature of the tongue, the floor of the mouth, the anterior tonsillar pillar, the tongue base, the glossotonsillar sulcus and the mandible (<xref ref-type="fig" rid="ci06018609">Fig. 9</xref>). ). '], 'ci06018608': ['Up to 35% of patients have nodal metastasis on presentation (<xref ref-type="fig" rid="ci06018608">Fig. 8</xref>(a)). Five percent of these patients have bilateral lymph node involvement ((a)). Five percent of these patients have bilateral lymph node involvement (<xref ref-type="fig" rid="ci06018602">Fig. 2</xref>(b)). The first echelon nodes are the submandibular and jugulodigastric nodes. Submental node involvement is uncommon except in patients with tumour at the tip of tongue. It should be noted that in patients with clinically N0 neck, the overall occult metastatic rate is approximately 30%. Various clinical studies have been performed to correlate the depth of tumour invasion with the likelihood of cervical nodal metastasis [(b)). The first echelon nodes are the submandibular and jugulodigastric nodes. Submental node involvement is uncommon except in patients with tumour at the tip of tongue. It should be noted that in patients with clinically N0 neck, the overall occult metastatic rate is approximately 30%. Various clinical studies have been performed to correlate the depth of tumour invasion with the likelihood of cervical nodal metastasis [6–8]. These studies reveal that the single most important factor in predicting lymph node metastasis is the depth of tumour invasion. '], 'ci06018610': ['This is a clinically silent region and tumours tend to spread with deep infiltration. As a general rule, the extent of these tumours is underestimated during clinical examination. Tongue base tumours tend to remain in the tongue except for laterally placed lesions or late cases [1]. Under such circumstances, tongue base tumours may extend into the tonsillar fossa (<xref ref-type="fig" rid="ci06018610">Fig. 10</xref>). Tonsillar carcinomas, on the other hand, have a tendency to invade the tongue base. ). Tonsillar carcinomas, on the other hand, have a tendency to invade the tongue base. '], 'ci06018611': ['Vallecular lesions are relatively exophytic (<xref ref-type="fig" rid="ci06018611">Fig. 11</xref>) and spread along the mucosa to the lingual surface of the epiglottis, laterally along the pharyngoepiglottic fold and then to the lateral pharyngeal wall and anterior wall of the pyriform sinus [) and spread along the mucosa to the lingual surface of the epiglottis, laterally along the pharyngoepiglottic fold and then to the lateral pharyngeal wall and anterior wall of the pyriform sinus [1]. Anterior infiltration involving the floor of the mouth and sublingual space, as well as invasion of the pre-epiglottic space is best evaluated with imaging [9]. The true extent of tumours in these regions is difficult to ascertain by clinical examination. ', 'For tongue base carcinoma, the first echelon nodes are the jugulodigastric nodes (<xref ref-type="fig" rid="ci06018611">Fig. 11</xref>), followed by mid and lower jugular nodes. Retropharyngeal nodes are occasionally involved. Submandibular nodes may be involved if there is anterior tumour extension. Submental nodes are rarely involved. Seventy-five percent of patients have positive nodes on presentation while 30% have bilateral nodal metastases (), followed by mid and lower jugular nodes. Retropharyngeal nodes are occasionally involved. Submandibular nodes may be involved if there is anterior tumour extension. Submental nodes are rarely involved. Seventy-five percent of patients have positive nodes on presentation while 30% have bilateral nodal metastases (<xref ref-type="fig" rid="ci06018612">Fig. 12</xref>). Patients with clinically N0 neck have a 30%–50% rate of occult metastases. ). Patients with clinically N0 neck have a 30%–50% rate of occult metastases. ']} | Imaging of tongue carcinoma | [
"TNM staging",
"tongue carcinoma",
"computed tomography",
"magnetic resonance imaging"
] | Cancer Imaging | 1166601600 | Magnetic resonance imaging (MRI) is the best technique for bone marrow imaging. The MRI signal of bone marrow depends on the quantity of fat it contains and on its cellularity. Evaluation of marrow of patients treated for cancer is complicated by age and osseous site related changes in the distribution of normal haematopoietic (red) and fatty (yellow) marrow and by the changes induced by treatments: decrease in pathological cellularity, increase in fat proportion, conversion of red marrow to fatty marrow or, conversely, reconversion of fatty marrow in normal haematopoietic red marrow. The treatments used in oncology modify pathological marrow but also normal marrow and may sometimes lead to complications. These modifications may be focal or diffuse, homogeneous or patchy and symmetrical or asymmetric. The knowledge of bone marrow physiological status and post-therapeutic patterns is important for the interpretation of marrow disorders and effects of therapy and to avoid false-positive diagnosis of marrow metastases and tumour progression. The aim of this paper is to recall the MRI patterns of normal bone marrow and normal variations and to show the effects of treatments on bone tissue and normal bone marrow and treatment-related modifications on pathological marrow. | [
"Antineoplastic Agents",
"Bone Marrow",
"Bone Marrow Transplantation",
"Bone Neoplasms",
"Humans",
"Magnetic Resonance Imaging",
"Neoplasms",
"Neoplasms, Radiation-Induced",
"Radiation Injuries"
] | other | PMC1766559 | null | 20 | [
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"{'Citation': 'Manceron V, Guignard S, de Broucker F, Paycha F, Pouchot J, Vinceneux P. Bone marrow reconversion and magnetic resonance imaging: case report. Rev Med Interne. 2003;24:830–4.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14656644'}}}",
"{'Citation': 'Montemurro F, Russo F, Martincich L, et al. Dynamic contrast enhanced magnetic resonance imaging in monitoring bone metastases in breast cancer patients receiving biphosphonates and endocrine therapy. Acta Radiol. 2004;45:71–4.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15164782'}}}",
"{'Citation': 'Richter M. Biphosphonates and maxillo-mandibular osteonecrosis: a ticking bomb. Rev Stomatol Chir Maxillofac. 2005;106:265–6.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16292218'}}}",
"{'Citation': 'Vanel D, Husband JE, Padhani AR. Bone metastases. In: Husband JE, Reznek RH, editors. Imaging in Oncology. 2nd ed. London: Taylor & Francis; 2004. pp. 1041–58.'}",
"{'Citation': 'Brown AL, Middleton G, MacVicar AD, Husband JE. T1-weighted magnetic resonance imaging in breast cancer vertebral metastases: changes on treatment and correlation with response to therapy. Clin Radiol. 1998;53:493–501.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9714388'}}}",
"{'Citation': 'Sugimura K, Kajitani A, Okizuka H, Sugihara M, Mizutani M, Ishida T. Assessing response to therapy of spinal metastases with gadolinium-enhanced MR imaging. J Magn Reson Imaging. 1991;1:481–4.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1665094'}}}",
"{'Citation': 'Husband JE, Koh DM. Leukaemia. In: Husband JE, Reznek RH, editors. Imaging in Oncology. 2nd ed. London: Taylor & Francis; 2004. pp. 891–917.'}",
"{'Citation': 'Moulopoulos LA, Dimopoulos MA, Alexanian R, Leeds NE, Libshitz HI. Multiple myeloma: MR patterns of response to treatment. Radiology. 1994;193:441–6.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '7972760'}}}",
"{'Citation': 'Collins CD. Multiple myeloma. In: Husband JE, Reznek RH, editors. Imaging in Oncology. 2nd ed. London: Taylor & Francis; 2004. pp. 875–89.'}"
] | Cancer Imaging. 2006 Dec 20; 6(1):186-193 | NO-CC CODE |
|
(a) Coronal T2 weighted fat-suppression image shows a carcinoma in the middle third of the oral tongue with early infiltration (long arrow) of the tongue musculature (genioglossus). Note the ipsilateral submandibular lymphadenopathy (short arrow). (b) Coronal post-contrast T1 weighted fat-suppression image of a more advanced case shows the tumour invading the lateral floor of the mouth (arrow). | ci06018608 | 7 | eead6913fc7e00f32c34fc53f5cbdab5e8edd93f5da1cc727383b8e67bc0b357 | ci06018608.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
408,
203
] | [{'image_id': 'ci06018607', 'image_file_name': 'ci06018607.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018607.jpg', 'caption': '(a) Sagittal T2 weighted fat-suppression image shows carcinoma in the anterior third of the oral tongue (arrow). (b) Sagittal T2 weighted fat-suppression image (same patient) shows tumour invading the floor of the mouth (arrow).', 'hash': '8defa973c277f14666ac6d65c4189d3d53aa10ee41e69a78cc8bafcd8e944731'}, {'image_id': 'ci06018609', 'image_file_name': 'ci06018609.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018609.jpg', 'caption': '(a) Axial post-contrast CT image shows a large left-side tongue base carcinoma. Note the extension across the midline (long arrow) and the ipsilateral enlarged jugulodigastric node (short arrow). (b) Axial post-contrast CT image shows tumour extension into the aryepiglottic (short arrow) and hypopharynx (long arrow).', 'hash': '3adf0cc367f0b33e9c9f3b6bf5c4f80b80b2c51e844c0a62fa4be46b209aeafb'}, {'image_id': 'ci06018611', 'image_file_name': 'ci06018611.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018611.jpg', 'caption': '(a) Axial post-contrast CT image shows an exophytic a left-sided vallecular cancer (arrows). (b) Axial post-contrast CT image shows tumour involving the ipsilateral aryepiglottic fold (short white arrow) and the pyriform sinus (long white arrow). Note the enlarged necrotic left jugulodigastric node (black arrow).', 'hash': '01bd49d885313a8de77ac248f9f4da7f26791fb08afab1be64d3498be8e94814'}, {'image_id': 'ci06018608', 'image_file_name': 'ci06018608.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018608.jpg', 'caption': '(a) Coronal T2 weighted fat-suppression image shows a carcinoma in the middle third of the oral tongue with early infiltration (long arrow) of the tongue musculature (genioglossus). Note the ipsilateral submandibular lymphadenopathy (short arrow). (b) Coronal post-contrast T1 weighted fat-suppression image of a more advanced case shows the tumour invading the lateral floor of the mouth (arrow).', 'hash': 'eead6913fc7e00f32c34fc53f5cbdab5e8edd93f5da1cc727383b8e67bc0b357'}, {'image_id': 'ci06018606', 'image_file_name': 'ci06018606.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018606.jpg', 'caption': 'Axial T1 weighted image shows a tongue cancer with mandible invasion. However, early involvement of cortical bones is better seen on CT images.', 'hash': '937f8cd7007633ba69890ec1106b16f6bdc1b479e7222072693d25039c34ba95'}, {'image_id': 'ci06018601', 'image_file_name': 'ci06018601.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018601.jpg', 'caption': '(a) Axial T1 weighted image shows the tongue muscles, genioglossus (long arrow) and hyoglossus (short arrow). (b) Coronal T1 weighted image shows lingual septum (short arrow) and mylohyoid (long arrow), which forms the floor of the mouth.', 'hash': '1e43854eb6e05c20b608fcada0a358a2566a4d8e25ba6fde4ebcdcc4def19808'}, {'image_id': 'ci06018610', 'image_file_name': 'ci06018610.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018610.jpg', 'caption': '(a) Axial post-contrast T1 weighted fat-suppression image shows a large tongue base tumour (opposing arrows). (b) Axial post-contrast T1 weighted fat-suppression image shows inferior extension into the right pyriform fossa (arrow).', 'hash': '6a2f5ceebb359cc24b1b79d7edd68d1ca6385416f6b764442d6ce40e56db110a'}, {'image_id': 'ci06018602', 'image_file_name': 'ci06018602.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018602.jpg', 'caption': '(a) Axial T2 weighted fat-suppression image shows a right-sided tongue cancer extending more than 5 mm from the lateral margin of the tongue. (b) Coronal T2 weighted fat-suppression image shows bilateral submandibular lymphadenopathy (arrows), a result of the lymphatic drainage pathways of the inner two-thirds of the oral tongue.', 'hash': '56b7b2e91e638118b0deae5929db02f987470a6ba258e64532a2da164f695021'}, {'image_id': 'ci06018605', 'image_file_name': 'ci06018605.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018605.jpg', 'caption': '(a) Axial T2 weighted fat-suppression image shows a right-sided tongue base cancer (long arrows). An enlarged right jugulodigastric node is also seen (short arrow), the first echelon node of tongue base carcinoma. (b) Sagittal T2 weighted fat-suppression image of the same patient shows the extent of pharyngeal invasion of the tongue base tumour (arrow).', 'hash': '0a6f52d0a8c38ea6182195a53f69a5e95af87aa977805d09a96fba8275aead63'}, {'image_id': 'ci06018612', 'image_file_name': 'ci06018612.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018612.jpg', 'caption': 'Axial post-contrast CT image shows a tongue base carcinoma (black arrow) with bilateral malignant lymphadenopathy (white arrows), which occurs in up to 30% of patients on presentation.', 'hash': 'f29d454aaee9b8d63bea71365ddd56af880751741320c44495767c559dda2a45'}, {'image_id': 'ci06018604', 'image_file_name': 'ci06018604.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018604.jpg', 'caption': '(a) Axial post-contrast T1 weighted fat-suppression image shows a right-sided oral tongue carcinoma (arrow). (b) Coronal T2 weighted fat-suppression image shows tumour infiltration of the floor of the mouth (long arrow). Note the normal contralateral mylohyoid muscle (short arrow). (c) Coronal T2 weighted fat-suppression image of another patient shows a right-sided oral tongue cancer (short arrow). Note the sublingual glands (long arrows), which should not be confused as tumour infiltration.', 'hash': 'bc672e3474ed2f32be39ac44a694c081d8cba1217fc4c716253b8485fc4322c3'}, {'image_id': 'ci06018603', 'image_file_name': 'ci06018603.jpg', 'image_path': '../data/media_files/PMC1766559/ci06018603.jpg', 'caption': '(a) Axial T1 weighted, (b) post-contrast T1 weighted fat-suppression and (c) T2 weighted fat-suppression images show a left-sided oral tongue carcinoma. Note that the tumour is most conspicuous on T2 weighted fat-suppression sequence.', 'hash': '62c7eeea46f0e368043671cbb7e01ae912ca0960c6754bc9e3990d53f0779072'}] | {'ci06018601': ['The tongue has a supporting fibrous framework consisting of the lingual septum (<xref ref-type="fig" rid="ci06018601">Fig. 1</xref>) and the hyoglossus membrane. The midline fibrous lingual septum divides the tongue into two symmetrical muscular halves. ) and the hyoglossus membrane. The midline fibrous lingual septum divides the tongue into two symmetrical muscular halves. ', 'The anatomy of the tongue is well demonstrated on magnetic resonance imaging (MRI). On axial T1-weighted images, fat with high signal intensity can be seen interspersed between the muscles of intermediate signal intensity (<xref ref-type="fig" rid="ci06018601">Fig. 1</xref>).).', 'Genioglossus is the largest of all the tongue muscles and forms the bulk of the tongue. It arises from the genial tubercle and is easily seen on computed tomography (CT) and MRI (<xref ref-type="fig" rid="ci06018601">Fig. 1</xref>). It fans out widely and inserts inferiorly into the hyoid bone; posteriorly into the tongue base; and superiorly into the entire ventral surface of the tongue. Hyoglossus is a thin quadrilateral sheet of muscle arising from the hyoid bone. It ascends superiorly, interdigitating with the fibres of the styloglossus, and attaches to the side of the tongue. The hyoglossus muscles define the lateral margins of the tongue and are readily identified on CT and MRI (). It fans out widely and inserts inferiorly into the hyoid bone; posteriorly into the tongue base; and superiorly into the entire ventral surface of the tongue. Hyoglossus is a thin quadrilateral sheet of muscle arising from the hyoid bone. It ascends superiorly, interdigitating with the fibres of the styloglossus, and attaches to the side of the tongue. The hyoglossus muscles define the lateral margins of the tongue and are readily identified on CT and MRI (<xref ref-type="fig" rid="ci06018601">Fig. 1</xref>). Both the styloglossus (which arises from the styloid process and stylohyoid ligament) and the palatoglossus (which originates from the palatine aponeurosis) cannot be seen with certainty on imaging studies.). Both the styloglossus (which arises from the styloid process and stylohyoid ligament) and the palatoglossus (which originates from the palatine aponeurosis) cannot be seen with certainty on imaging studies.'], 'ci06018602': ['The tongue has a rich lymphatic network. Unlike the vascular supply that remains largely unilateral, lymph from one side, particularly from the tongue base, drains into nodes on both sides of the neck. Lymph from the tip of the tongue may drain to the submental nodes. Marginal lymphatics from the outer third of the rest of the oral tongue are directed to ipsilateral submandibular and jugulodigastric nodes. Central lymphatics of the inner two-thirds of the oral tongue have pathways to nodes of both sides of the neck. As a clinical guide, tumour extending more than 5 mm from lateral tongue margin has an increased risk of bilateral metastatic lymphadenopathy [2] (<xref ref-type="fig" rid="ci06018602">Fig. 2</xref>). ). '], 'ci06018603': ['MRI is the preferred modality in the evaluation of tongue carcinomas (<xref ref-type="fig" rid="ci06018603">Fig. 3</xref>). The abnormal signals seen on MRI are well correlated with pathological findings [). The abnormal signals seen on MRI are well correlated with pathological findings [4]. Tumour invasion of the floor of the mouth is particularly well seen on coronal images (<xref ref-type="fig" rid="ci06018604">Fig. 4</xref>). Sagittal images provide information on tongue base involvement and the extent of pharyngeal infiltration that cannot be seen on CT (). Sagittal images provide information on tongue base involvement and the extent of pharyngeal infiltration that cannot be seen on CT (<xref ref-type="fig" rid="ci06018605">Fig. 5</xref>). However, cortical bone involvement, notably the mandible is diagnosed with a higher level of certainly on CT (). However, cortical bone involvement, notably the mandible is diagnosed with a higher level of certainly on CT (<xref ref-type="fig" rid="ci06018606">Fig. 6</xref>). ). '], 'ci06018607': ['Nearly all tumours of the oral tongue occur on the lateral and under surface. Dorsal tumours are uncommon but when they do occur, they are usually located near the midline and more posteriorly. Oral tongue tumours tend to remain in the tongue. Tumours in the anterior third of the oral tongue invade the floor of the mouth (<xref ref-type="fig" rid="ci06018607">Fig. 7</xref>). Middle-third lesions infiltrate the musculature of the tongue and later, the lateral floor of the mouth (). Middle-third lesions infiltrate the musculature of the tongue and later, the lateral floor of the mouth (<xref ref-type="fig" rid="ci06018608">Fig. 8</xref>). Carcinomas involving the posterior third of the oral tongue grow into the musculature of the tongue, the floor of the mouth, the anterior tonsillar pillar, the tongue base, the glossotonsillar sulcus and the mandible (). Carcinomas involving the posterior third of the oral tongue grow into the musculature of the tongue, the floor of the mouth, the anterior tonsillar pillar, the tongue base, the glossotonsillar sulcus and the mandible (<xref ref-type="fig" rid="ci06018609">Fig. 9</xref>). ). '], 'ci06018608': ['Up to 35% of patients have nodal metastasis on presentation (<xref ref-type="fig" rid="ci06018608">Fig. 8</xref>(a)). Five percent of these patients have bilateral lymph node involvement ((a)). Five percent of these patients have bilateral lymph node involvement (<xref ref-type="fig" rid="ci06018602">Fig. 2</xref>(b)). The first echelon nodes are the submandibular and jugulodigastric nodes. Submental node involvement is uncommon except in patients with tumour at the tip of tongue. It should be noted that in patients with clinically N0 neck, the overall occult metastatic rate is approximately 30%. Various clinical studies have been performed to correlate the depth of tumour invasion with the likelihood of cervical nodal metastasis [(b)). The first echelon nodes are the submandibular and jugulodigastric nodes. Submental node involvement is uncommon except in patients with tumour at the tip of tongue. It should be noted that in patients with clinically N0 neck, the overall occult metastatic rate is approximately 30%. Various clinical studies have been performed to correlate the depth of tumour invasion with the likelihood of cervical nodal metastasis [6–8]. These studies reveal that the single most important factor in predicting lymph node metastasis is the depth of tumour invasion. '], 'ci06018610': ['This is a clinically silent region and tumours tend to spread with deep infiltration. As a general rule, the extent of these tumours is underestimated during clinical examination. Tongue base tumours tend to remain in the tongue except for laterally placed lesions or late cases [1]. Under such circumstances, tongue base tumours may extend into the tonsillar fossa (<xref ref-type="fig" rid="ci06018610">Fig. 10</xref>). Tonsillar carcinomas, on the other hand, have a tendency to invade the tongue base. ). Tonsillar carcinomas, on the other hand, have a tendency to invade the tongue base. '], 'ci06018611': ['Vallecular lesions are relatively exophytic (<xref ref-type="fig" rid="ci06018611">Fig. 11</xref>) and spread along the mucosa to the lingual surface of the epiglottis, laterally along the pharyngoepiglottic fold and then to the lateral pharyngeal wall and anterior wall of the pyriform sinus [) and spread along the mucosa to the lingual surface of the epiglottis, laterally along the pharyngoepiglottic fold and then to the lateral pharyngeal wall and anterior wall of the pyriform sinus [1]. Anterior infiltration involving the floor of the mouth and sublingual space, as well as invasion of the pre-epiglottic space is best evaluated with imaging [9]. The true extent of tumours in these regions is difficult to ascertain by clinical examination. ', 'For tongue base carcinoma, the first echelon nodes are the jugulodigastric nodes (<xref ref-type="fig" rid="ci06018611">Fig. 11</xref>), followed by mid and lower jugular nodes. Retropharyngeal nodes are occasionally involved. Submandibular nodes may be involved if there is anterior tumour extension. Submental nodes are rarely involved. Seventy-five percent of patients have positive nodes on presentation while 30% have bilateral nodal metastases (), followed by mid and lower jugular nodes. Retropharyngeal nodes are occasionally involved. Submandibular nodes may be involved if there is anterior tumour extension. Submental nodes are rarely involved. Seventy-five percent of patients have positive nodes on presentation while 30% have bilateral nodal metastases (<xref ref-type="fig" rid="ci06018612">Fig. 12</xref>). Patients with clinically N0 neck have a 30%–50% rate of occult metastases. ). Patients with clinically N0 neck have a 30%–50% rate of occult metastases. ']} | Imaging of tongue carcinoma | [
"TNM staging",
"tongue carcinoma",
"computed tomography",
"magnetic resonance imaging"
] | Cancer Imaging | 1166601600 | Magnetic resonance imaging (MRI) is the best technique for bone marrow imaging. The MRI signal of bone marrow depends on the quantity of fat it contains and on its cellularity. Evaluation of marrow of patients treated for cancer is complicated by age and osseous site related changes in the distribution of normal haematopoietic (red) and fatty (yellow) marrow and by the changes induced by treatments: decrease in pathological cellularity, increase in fat proportion, conversion of red marrow to fatty marrow or, conversely, reconversion of fatty marrow in normal haematopoietic red marrow. The treatments used in oncology modify pathological marrow but also normal marrow and may sometimes lead to complications. These modifications may be focal or diffuse, homogeneous or patchy and symmetrical or asymmetric. The knowledge of bone marrow physiological status and post-therapeutic patterns is important for the interpretation of marrow disorders and effects of therapy and to avoid false-positive diagnosis of marrow metastases and tumour progression. The aim of this paper is to recall the MRI patterns of normal bone marrow and normal variations and to show the effects of treatments on bone tissue and normal bone marrow and treatment-related modifications on pathological marrow. | [
"Antineoplastic Agents",
"Bone Marrow",
"Bone Marrow Transplantation",
"Bone Neoplasms",
"Humans",
"Magnetic Resonance Imaging",
"Neoplasms",
"Neoplasms, Radiation-Induced",
"Radiation Injuries"
] | other | PMC1766559 | null | 20 | [
"{'Citation': 'Foster K, Chapman S, Johnson K. MRI of the marrow in the paediatric skeleton. Clin Radiol. 2004;59:651–73.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15262540'}}}",
"{'Citation': 'Roebuck DJ. Skeletal complications in pediatric oncology patients. Radiographics. 1999;19:873–85.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10464796'}}}",
"{'Citation': 'Tardivon AA, Vanel D, Munck JN, Bosq J. Magnetic resonance imaging of the bone marrow in lymphomas and leukemias. Leuk Lymphoma. 1996;25:55–68.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9130614'}}}",
"{'Citation': 'Fletcher BD. Effects of pediatric cancer therapy on the musculoskeletal system. Pediatr Radiol. 1997;27:623–36.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9252425'}}}",
"{'Citation': 'Mitchell MJ, Logan PM. Radiation-induced changes in bone. Radiographics. 1998;18:1125–36.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9747611'}}}",
"{'Citation': 'Moulopoulos LA. Effect of treatment on normal tissue: bone marrow. In: Husband JE, Reznek RH, editors. Imaging in Oncology. 2nd ed. London: Taylor & Francis; 2004. pp. 1277–87.'}",
"{'Citation': 'Ollivier L, Leclere J, Vanel D, et al. Femoral infarction following intraarterial chemotherapy for osteosarcoma of the leg: a possible pitfall in magnetic resonance imaging. Skeletal Radiol. 1991;20:329–32.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1896872'}}}",
"{'Citation': 'Stevens SK, Moore SG, Kaplan ID. Early and late bone-marrow changes after irradiation: MR evaluation. Am J Roentgenol. 1990;154:745–50.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2107669'}}}",
"{'Citation': 'Hartman RP, Sundaram M, Okuno SH, Sim FH. Effect of granulocyte-stimulating factors on marrow of adult patients with musculoskeletal malignancies: incidence and MR findings. AJR Am J Roentgenol. 2004;183:645–53.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15333351'}}}",
"{'Citation': 'Ryan SP, Weinberger E, White KS, et al. MR imaging of bone marrow in children with osteosarcoma: effect of granulocyte colony-stimulating factor. AJR. 1995;165:915–20.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '7545864'}}}",
"{'Citation': 'Vanel D, Missenard G, Le Cesne A, Guinebretiere JM. Red marrow recolonization induced by growth factors mimicking an increase in tumour volume during pre-operative chemotherapy: MR study. J Comput Assist Tomogr. 1997;21:529–31.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9216756'}}}",
"{'Citation': 'Manceron V, Guignard S, de Broucker F, Paycha F, Pouchot J, Vinceneux P. Bone marrow reconversion and magnetic resonance imaging: case report. Rev Med Interne. 2003;24:830–4.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14656644'}}}",
"{'Citation': 'Montemurro F, Russo F, Martincich L, et al. Dynamic contrast enhanced magnetic resonance imaging in monitoring bone metastases in breast cancer patients receiving biphosphonates and endocrine therapy. Acta Radiol. 2004;45:71–4.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15164782'}}}",
"{'Citation': 'Richter M. Biphosphonates and maxillo-mandibular osteonecrosis: a ticking bomb. Rev Stomatol Chir Maxillofac. 2005;106:265–6.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16292218'}}}",
"{'Citation': 'Vanel D, Husband JE, Padhani AR. Bone metastases. In: Husband JE, Reznek RH, editors. Imaging in Oncology. 2nd ed. London: Taylor & Francis; 2004. pp. 1041–58.'}",
"{'Citation': 'Brown AL, Middleton G, MacVicar AD, Husband JE. T1-weighted magnetic resonance imaging in breast cancer vertebral metastases: changes on treatment and correlation with response to therapy. Clin Radiol. 1998;53:493–501.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9714388'}}}",
"{'Citation': 'Sugimura K, Kajitani A, Okizuka H, Sugihara M, Mizutani M, Ishida T. Assessing response to therapy of spinal metastases with gadolinium-enhanced MR imaging. J Magn Reson Imaging. 1991;1:481–4.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1665094'}}}",
"{'Citation': 'Husband JE, Koh DM. Leukaemia. In: Husband JE, Reznek RH, editors. Imaging in Oncology. 2nd ed. London: Taylor & Francis; 2004. pp. 891–917.'}",
"{'Citation': 'Moulopoulos LA, Dimopoulos MA, Alexanian R, Leeds NE, Libshitz HI. Multiple myeloma: MR patterns of response to treatment. Radiology. 1994;193:441–6.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '7972760'}}}",
"{'Citation': 'Collins CD. Multiple myeloma. In: Husband JE, Reznek RH, editors. Imaging in Oncology. 2nd ed. London: Taylor & Francis; 2004. pp. 875–89.'}"
] | Cancer Imaging. 2006 Dec 20; 6(1):186-193 | NO-CC CODE |
|
Coronal reformatted image shows direct invasion (arrows) of a gastric cancer into the spleen via the gastrosplenic ligament. | ci06021308 | 7 | 9c4fbedac3443b112e25bae437e77e944d4640b45832abc13280c419d9e4c388 | ci06021308.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
472,
569
] | [{'image_id': 'ci06021303', 'image_file_name': 'ci06021303.jpg', 'image_path': '../data/media_files/PMC1766562/ci06021303.jpg', 'caption': 'Schematic showing T staging of oesophageal and gastric cancer. T1, tumour extends into submucosa; T2, tumour extends into muscularis propria; T3, tumour extends through the muscularis propria into the subserosa; T4, tumour extends directly into other organs or tissues.', 'hash': '1db23d3e8bdf1d7172323d90b78c3aed4ac2496586d57fe8a5481f701f60ce7b'}, {'image_id': 'ci06021304', 'image_file_name': 'ci06021304.jpg', 'image_path': '../data/media_files/PMC1766562/ci06021304.jpg', 'caption': 'Endoscopic ultrasound demonstrates a T3 oesophageal neoplasm (T) that has invaded beyond the muscularis propria (arrows).', 'hash': '024f40bf25239950bc59cb0c9ebdd626480ef028738992818d75697e460d0984'}, {'image_id': 'ci06021305', 'image_file_name': 'ci06021305.jpg', 'image_path': '../data/media_files/PMC1766562/ci06021305.jpg', 'caption': 'Sagittal reformatted image discloses a T4 tumour (T) invading the mediastinum and left atrial wall (arrow).', 'hash': 'a9a556cae71947ccba6a410137d1c0d34ea21ca10fe07a5314440baa70b9d927'}, {'image_id': 'ci06021302', 'image_file_name': 'ci06021302.jpg', 'image_path': '../data/media_files/PMC1766562/ci06021302.jpg', 'caption': 'Adenocarcinoma of the stomach. (a) Early gastric cancer with mucosal nodularity. (b) Advanced gastric cancer with narrowing and rigidity of the antral wall due to mural infiltration of scabrous tumour.', 'hash': '95219362071a53e3e1442fb50571f2b514c8d13456d081130b3bd357a1c942a7'}, {'image_id': 'ci06021301', 'image_file_name': 'ci06021301.jpg', 'image_path': '../data/media_files/PMC1766562/ci06021301.jpg', 'caption': 'Carcinoma of the oesophagus on double contrast barium studies. (a) Squamous cell carcinoma showing luminal narrowing, abrupt shelf-like borders, ulceration, circumferential growth and a fistula to the tracheobronchial tree. (b) Adenocarcinoma arising from Barrett’s mucosa causes a benign-appearing stricture associated with a plaque-like tumour of the mid-oesophagus.', 'hash': '57b251ba82d6022bf262244370232b507cdf0d337497dfdbdb0ccab40b55f921'}, {'image_id': 'ci06021306', 'image_file_name': 'ci06021306.jpg', 'image_path': '../data/media_files/PMC1766562/ci06021306.jpg', 'caption': 'Coronal reformatted image of the stomach discloses a T2 tumour that is causing mural thickening of the gastric antrum (arrows) but no penetration beyond the muscularis propria.', 'hash': 'fcc231041f9af01426c36f308344eaa1ac1616e3762c3ce9b5bd12c44039435f'}, {'image_id': 'ci06021308', 'image_file_name': 'ci06021308.jpg', 'image_path': '../data/media_files/PMC1766562/ci06021308.jpg', 'caption': 'Coronal reformatted image shows direct invasion (arrows) of a gastric cancer into the spleen via the gastrosplenic ligament.', 'hash': '9c4fbedac3443b112e25bae437e77e944d4640b45832abc13280c419d9e4c388'}, {'image_id': 'ci06021310', 'image_file_name': 'ci06021310.jpg', 'image_path': '../data/media_files/PMC1766562/ci06021310.jpg', 'caption': 'PET scan showing a tumour of the oesophago-gastric junction with metastatic disease to the chest and neck.', 'hash': 'df7253a7c15503958d7703bb7a3cc9443e149e30662199f0dbfb404056b31c0c'}, {'image_id': 'ci06021309', 'image_file_name': 'ci06021309.jpg', 'image_path': '../data/media_files/PMC1766562/ci06021309.jpg', 'caption': 'Coronal reformatted image shows large Krukenberg tumours of the ovaries (arrows) due to hematogenous metastases from a gastric cancer (T).', 'hash': '05d05c4d2daabeee5d7e6cbec511e909cec559ca3f704fbd0af9ddbc703be631'}, {'image_id': 'ci06021307', 'image_file_name': 'ci06021307.jpg', 'image_path': '../data/media_files/PMC1766562/ci06021307.jpg', 'caption': 'N staging of oesophago-gastric neoplasm. Schematic diagram depicting the common sites of lymph node metastases in oesophageal and gastric cancers.', 'hash': '1527af07e30d44e17637fbf049a220c78f5e22f7d78672e10618a51f66ab30f0'}] | {'ci06021301': ['On double-contrast barium studies (<xref ref-type="fig" rid="ci06021301">Fig. 1</xref>), early squamous cell carcinomas of the oesophagus appear as small, sessile, polypoid lesions, with smooth or slightly lobulated contours; or as plaque-like lesions that often have flat, central ulcers that are best visualized in profile; or as a superficial, spreading lesion with a nodular appearance of the mucosa without a discrete mass. When early oesophageal cancer or superficial spreading cancer is suspected on barium examinations, endoscopic biopsy should be performed. Advanced squamous cell carcinomas may appear infiltrative, ulcerative, polypoid or less commonly varicoid [), early squamous cell carcinomas of the oesophagus appear as small, sessile, polypoid lesions, with smooth or slightly lobulated contours; or as plaque-like lesions that often have flat, central ulcers that are best visualized in profile; or as a superficial, spreading lesion with a nodular appearance of the mucosa without a discrete mass. When early oesophageal cancer or superficial spreading cancer is suspected on barium examinations, endoscopic biopsy should be performed. Advanced squamous cell carcinomas may appear infiltrative, ulcerative, polypoid or less commonly varicoid [3, 4]. Figure 1Carcinoma of the oesophagus on double contrast barium studies. (a) Squamous cell carcinoma showing luminal narrowing, abrupt shelf-like borders, ulceration, circumferential growth and a fistula to the tracheobronchial tree. (b) Adenocarcinoma arising from Barrett’s mucosa causes a benign-appearing stricture associated with a plaque-like tumour of the mid-oesophagus. '], 'ci06021302': ['Early gastric cancer is limited to the mucosa (<xref ref-type="fig" rid="ci06021302">Fig. 2</xref>(a)) and submucosa, regardless of the presence or absence of lymph node involvement. Type 1 early gastric cancers are elevated lesions that protrude more than 5 mm into the lumen. Type 2 tumours appear as plaque-like elevations with mucosal nodularity, or shallow areas of ulceration, singly or severally. Type 3 early gastric cancers are excavated lesions resembling gastric ulcers but with irregular ulcer craters, clubbing, fusion, or amputation of radiating folds, and nodularity of adjacent mucosa [(a)) and submucosa, regardless of the presence or absence of lymph node involvement. Type 1 early gastric cancers are elevated lesions that protrude more than 5 mm into the lumen. Type 2 tumours appear as plaque-like elevations with mucosal nodularity, or shallow areas of ulceration, singly or severally. Type 3 early gastric cancers are excavated lesions resembling gastric ulcers but with irregular ulcer craters, clubbing, fusion, or amputation of radiating folds, and nodularity of adjacent mucosa [2, 5]. Figure 2Adenocarcinoma of the stomach. (a) Early gastric cancer with mucosal nodularity. (b) Advanced gastric cancer with narrowing and rigidity of the antral wall due to mural infiltration of scabrous tumour. ', 'Type 1 advanced gastric cancer is large polypoid or fungating lesion that has irregular lobulation and measures 3 cm or larger in greatest diameter. In Type 2 advanced gastric cancer, the bulk of the tumour has been replaced by ulceration. These tumours have discrete, sharply defined borders. Type 3 advanced gastric cancers have mixed morphology with both infiltrative and ulcerative components. The ulceration does not have discrete borders however. Type 4 advanced gastric cancers are diffusely infiltrating lesions that are associated with marked proliferation of fibrotic tissue and desmoplasia producing the so-called linitis plastica appearance (<xref ref-type="fig" rid="ci06021302">Fig. 2</xref>(b)) [(b)) [2, 5, 6]. '], 'ci06021303': ['T staging (<xref ref-type="fig" rid="ci06021303">Fig. 3</xref>) assesses the depth of tumour invasion into the wall of the oesophagus and stomach, surrounding adventitia, serosa, fat, and adjacent organs. Endoscopic ultrasound is superior to endoscopic MR in depicting the depth of mural invasion () assesses the depth of tumour invasion into the wall of the oesophagus and stomach, surrounding adventitia, serosa, fat, and adjacent organs. Endoscopic ultrasound is superior to endoscopic MR in depicting the depth of mural invasion (<xref ref-type="fig" rid="ci06021304">Fig. 4</xref>) for oesophago–gastric neoplasms and both modalities are superior to MDCT () for oesophago–gastric neoplasms and both modalities are superior to MDCT () and conventional MR. PET and PET/CT have only a limited role in this aspect of tumour staging [7–17]. Figure 3Schematic showing T staging of oesophageal and gastric cancer. T1, tumour extends into submucosa; T2, tumour extends into muscularis propria; T3, tumour extends through the muscularis propria into the subserosa; T4, tumour extends directly into other organs or tissues. Figure 4Endoscopic ultrasound demonstrates a T3 oesophageal neoplasm (T) that has invaded beyond the muscularis propria (arrows). Figure 5Sagittal reformatted image discloses a T4 tumour (T) invading the mediastinum and left atrial wall (arrow). Figure 6Coronal reformatted image of the stomach discloses a T2 tumour that is causing mural thickening of the gastric antrum (arrows) but no penetration beyond the muscularis propria. '], 'ci06021307': ['CT and MR detection of malignant lymphadenopathy has traditionally been based on size criteria. Lymph nodes greater than 1 cm are considered abnormal (<xref ref-type="fig" rid="ci06021307">Fig. 7</xref>). Unfortunately size criteria are based only on statistical probability. In reality, many nodes smaller than 1 cm are malignant, and nodes larger than 1 cm are caused by reaction to a number of benign inflammatory conditions. Accordingly, CT and MR cannot reliably differentiate benign from malignant adenopathy [). Unfortunately size criteria are based only on statistical probability. In reality, many nodes smaller than 1 cm are malignant, and nodes larger than 1 cm are caused by reaction to a number of benign inflammatory conditions. Accordingly, CT and MR cannot reliably differentiate benign from malignant adenopathy [7–17]. Figure 7N staging of oesophago-gastric neoplasm. Schematic diagram depicting the common sites of lymph node metastases in oesophageal and gastric cancers. '], 'ci06021308': ['Once oesophageal and gastric cancer have become invasive, there are five major routes of metastases that can be assessed with imaging: (1) direct invasion (<xref ref-type="fig" rid="ci06021308">Fig. 8</xref>); (2) lymphatic permeation and dissemination; (3) hematogenous embolization (); (2) lymphatic permeation and dissemination; (3) hematogenous embolization (<xref ref-type="fig" rid="ci06021309">Fig. 9</xref>); (4) transperitoneal seeding; (5) intraluminal implantation [); (4) transperitoneal seeding; (5) intraluminal implantation [1, 2]. Figure 8Coronal reformatted image shows direct invasion (arrows) of a gastric cancer into the spleen via the gastrosplenic ligament. Figure 9Coronal reformatted image shows large Krukenberg tumours of the ovaries (arrows) due to hematogenous metastases from a gastric cancer (T). '], 'ci06021310': ['MDCT is the standard means of M staging in most situations. It is superior to MR in depicting mediastinal, hilar, pulmonary, pericardial, pleural, omental, mesenteric and peritoneal disease. PET/CT appears to be the most accurate means of globally evaluating the chest and abdominal cavities for metastatic tumour (<xref ref-type="fig" rid="ci06021310">Fig. 10</xref>). Intraoperative ultrasound appears to be the most sensitive technique in the depiction of liver metastases [). Intraoperative ultrasound appears to be the most sensitive technique in the depiction of liver metastases [18, 19]. Figure 10PET scan showing a tumour of the oesophago-gastric junction with metastatic disease to the chest and neck. ']} | Upper gastrointestinal tumours: diagnosis and staging | [
"Oesophageal neoplasms",
"gastric neoplasms",
"adenocarcinoma",
"CT",
"endoscopic ultrasound",
"PET/CT"
] | Cancer Imaging | 1167379200 | Low temperature, steady-state, optical spectroscopic methods were used to study the spectral features of peridinin-chlorophyll-protein (PCP) complexes in which recombinant apoprotein has been refolded in the presence of peridinin and either chlorophyll a (Chl a), chlorophyll b (Chl b), chlorophyll d (Chl d), 3-acetyl-chlorophyll a (3-acetyl-Chl a) or bacteriochlorophyll a (BChl a). Absorption spectra taken at 10 K provide better resolution of the spectroscopic bands than seen at room temperature and reveal specific pigment-protein interactions responsible for the positions of the Qy bands of the chlorophylls. The study reveals that the functional groups attached to Ring I of the two protein-bound chlorophylls modulate the Qy and Soret transition energies. Fluorescence excitation spectra were used to compute energy transfer efficiencies of the various complexes at room temperature and these were correlated with previously reported ultrafast, time-resolved optical spectroscopic dynamics data. The results illustrate the robust nature and value of the PCP complex, which maintains a high efficiency of antenna function even in the presence of non-native chlorophyll species, as an effective tool for elucidating the molecular details of photosynthetic light-harvesting. | [
"Animals",
"Bacterial Proteins",
"Carotenoids",
"Chlorophyll",
"Eukaryota",
"Freezing",
"Light",
"Models, Molecular",
"Plant Proteins",
"Protein Conformation",
"Protozoan Proteins",
"Spectrophotometry"
] | other | PMC1766562 | null | 110 | [
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] | Cancer Imaging. 2006 Dec 29; 6(1):213-217 | NO-CC CODE |
|
Representative CT images of two cases with COVID-19. A-D: 31-year-old female. E–H: 28-year-old male | 13577_2021_499_Fig1_HTML | 7 | 50ee857e6bb92d579d162d8b69da076a8068eb92522e67bb63bc1dbd4b49cbd6 | 13577_2021_499_Fig1_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
668,
232
] | [{'image_id': '13577_2021_499_Fig1_HTML', 'image_file_name': '13577_2021_499_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7882230/13577_2021_499_Fig1_HTML.jpg', 'caption': 'Representative CT images of two cases with COVID-19. A-D: 31-year-old female. E–H: 28-year-old male', 'hash': '50ee857e6bb92d579d162d8b69da076a8068eb92522e67bb63bc1dbd4b49cbd6'}, {'image_id': '13577_2021_499_Fig2_HTML', 'image_file_name': '13577_2021_499_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC7882230/13577_2021_499_Fig2_HTML.jpg', 'caption': 'Risk factors for invasive mechanical ventilation or ECMO or death as revealed by multivariate Logistic analysis included the case type (severe or nonsevere) (HR 1.126, 95% CI 3.728–39.444), respiratory failure on admission (6.894, 95% CI 1.364–35.748) and grade of lymphocyte proportion (HR 5.519, 95% CI 1.700–17.913)', 'hash': '0c878a3e93456db5ab06334883cba5aa62db896de82878e448b78232d7e83381'}] | {'13577_2021_499_Fig1_HTML': ['According to Fig.\xa0<xref rid="13577_2021_499_Fig1_HTML" ref-type="fig">1</xref> and Table and Table 2, the lesions of 77.3% of all cases were bilaterally distributed, with 65.1% of pure GGO, 5.8% of pure consolidation and 25.6% of a mixed type of GGO and consolidation. 3.5% of all patients were CT-negative on admission. Pleural effusions were documented in 2.9% of all cases, 1.7% unilateral and 1.2% bilateral. Severe cases and those received intensive care have more lobes involved.Fig. 1Representative CT images of two cases with COVID-19. A-D: 31-year-old female. E–H: 28-year-old maleTable 2Laboratory and radiological findings of patients with COVID-19CharacteristicsAll patientsNon-severe group (n\u2009=\u2009121)Severe group (n\u2009=\u200951)P valueIntensive care group (n\u2009=\u200931)Non-intensive care group (n\u2009=\u2009141)P valueWuhan residence (n\u2009=\u200978)No Wuhan residence (n\u2009=\u200994)P valueRadiologic findingsNature of lung abnormalities on CT\xa0Ground-glass opacity112 (65.1)71 (58.7)41 (80.4)0.01625 (80.6)87 (61.7)0.13558 (74.4)54 (57.4)0.002\xa0Consolidation10 (5.8)10 (8.3)0 (0)–0 (0)10 (7.1)–0 (0)10 (10.6)–\xa0Ground-glass opacity and consolidation44 (25.6)34 (28.1)10 (19.6)–6 (19.4)38 (27.0)–20 (25.6)24 (25.5)–Bilateral distribution of the lesions133 (77.3)85 (70.2)48 (94.1)0.00130 (96.8)103 (73.0)0.00462 (79.5)71 (75.5)0.381Lobes involved2.6\u2009±\u20091.02.5\u2009±\u20091.12.9\u2009±\u20090.60.0153.5\u2009±\u20090.72.2\u2009±\u20090.9\u2009<\u20090.0012.6\u2009±\u20091.02.3\u2009±\u20091.00.083\xa002 (1.1)2 (1.7)0 (0)\u2009<\u20090.0010 (0)2 (1.4)\u2009<\u20090.0010 (0)2 (2.1)0.539\xa0136 (20.9)36 (29.8)0 (0)–0 (0)36 (25.5)–13 (16.7)23 (24.5)–\xa0240 (23.3)29 (24.0)11 (21.6)–1 (3.2)39 (27.7)–18 (23.1)22 (23.4)–\xa0373 (42.4)44 (36.4)29 (56.9)–17 (54.8)56 (39.7)–36 (46.2)37 (39.4)–\xa0418 (10.5)10 (8.3)8 (15.7)–10 (32.3)8 (5.7)–9 (11.5)9 (9.6)–\xa053 (1.7)0 (0)3 (5.9)–3 (9.7)0 (0)–2 (2.6)1 (1.1)–Pleural effusions5 (2.9)2 (1.7)3 (5.9)0.1323 (9.7)2 (1.4)0.0131 (1.3)4 (4.3)0.248Laboratory findingsSpO2 or SaO2 (%)§97.0 (71.0, 99.0)97.0 (93.0, 99.0)\u2009<\u20090.00193.0 (71.0, 98.0)97.0 (88.0, 99.0)0.00196.0 (71.0, 99.0)97.0 (78.0, 99.0)0.212PaO2 (mmHg)§79.9\u2009±\u200932.196.9\u2009±\u200931.962.2\u2009±\u200921.0\u2009<\u20090.00161.0\u2009±\u200920.895.3\u2009±\u200931.6\u2009<\u20090.00181.4\u2009±\u200935.276.6\u2009±\u200925.10.584FiO20.25 (0.21, 0.80)0.21 (0.21, 0.41)0.29 (0.21, 0.80)0.0010.21 (0.21, 0.80)0.21 (0.21, 0.41)\u2009<\u20090.0010.29 (0.21, 0.80)0.21 (0.21, 0.80)0.444PaO2/FiO2 (mmHg)259.7 (59.4, 606.9)272.4 (246.1, 606.9)182.4 (59.4, 372.8)0.005175.7 (59.4, 372.8)293.1 (275.8, 606.9)\u2009<\u20090.001262.4 (68.9, 606.9)246.1 (59.4, 585.7)0.548Respiratory failure on admission*28 (16.3)6 (5.0)22 (43.1)\u2009<\u20090.00125 (80.6)3 (2.1)\u2009<\u20090.00112 (15.4)16 (17.0)0.772Elevated lactate level20 (11.6)6 (5.0)14 (27.5)\u2009<\u20090.00111 (35.5)9 (6.4)\u2009<\u20090.00110 (12.8)10 (10.6)0.657Blood white blood cell (WBC) count (×\u2009109/L)5.35\u2009±\u20092.314.93\u2009±\u20092.136.34\u2009±\u20092.45\u2009<\u20090.0017.04\u2009±\u20092.284.97\u2009±\u20092.16\u2009<\u20090.0015.32\u2009±\u20092.455.36\u2009±\u20092.210.896Neutrophil count (×\u2009109/L)3.89\u2009±\u20092.313.43\u2009±\u20092.094.99\u2009±\u20092.45\u2009<\u20090.0016.01\u2009±\u20092.273.42\u2009±\u20092.05\u2009<\u20090.0013.91\u2009±\u20092.443.87\u2009±\u20092.210.912\xa0Normal WBC and neutrophil count96 (55.8)68 (56.2)28 (54.9)0.00318 (58.1)78 (55.3)\u2009<\u20090.00144 (56.4)52 (55.3)0.850\xa0WBC and/or neutrophil count elevated20 (11.6)8 (6.6)12 (23.5)–11 (35.5)9 (6.4)–10 (12.8)10 (10.6)–\xa0WBC and/or neutrophil count decreased56 (32.6)45 (37.2)11 (21.6)–2 (6.5)54 (38.3)–24 (30.8)32 (34.0)–Proportions of lymphocyte23.2\u2009±\u200911.425.7\u2009±\u200910.717.2\u2009±\u200910.6\u2009<\u20090.00110.9\u2009±\u20095.425.9\u2009±\u200910.5\u2009<\u20090.00123.1\u2009±\u200911.723.3\u2009±\u200911.10.916Lymphocyte count1.09\u2009±\u20090.481.15\u2009±\u20090.460.93\u2009±\u20090.500.0070.68\u2009±\u20090.221.17\u2009±\u20090.48\u2009<\u20090.0011.05\u2009±\u20090.471.11\u2009±\u20090.500.436\xa0Lymphopenia (lymphocyte\u2009<\u20091.5\u2009×\u2009109/L)132 (76.7)51 (72.1)44 (88.0)0.04629 (93.5)103 (73.0)0.01464 (82.1)68 (72.3)0.133Platelet count (×\u2009109/L)189.3\u2009±\u200968.0189.4\u2009±\u200957.3189.0\u2009±\u200989.00.972174.5\u2009±\u200985.5192.5\u2009±\u200963.40.182173.3\u2009±\u200956.4202.6\u2009±\u200973.90.005Platelet count\u2009<\u2009100\u2009×\u2009109/L12 (7.0)5 (4.1)7 (13.7)\u2009<\u20090.0246 (19.4)6 (4.3)0.0098 (10.3)4 (4.3)0.124Haemoglobin (Hb) (g/L)131.8\u2009±\u200918.0132.4\u2009±\u200919.1130.2\u2009±\u200915.10.465129.8\u2009±\u200915.6132.2\u2009±\u200918.50.505136.2\u2009±\u200917.6128.1\u2009±\u200917.50.003Anemia33 (19.2)21 (17.4)12 (23.5)0.3487 (22.6)26 (18.4)0.59712 (15.4)21 (22.3)0.249C-reactive protein (CRP) level (mg/L)31.1\u2009±\u200939.022.2\u2009±\u200927.652.4\u2009±\u200952.1\u2009<\u20090.00163.7\u2009±\u200954.924.0\u2009±\u200930.4\u2009<\u20090.00134.0\u2009±\u200942.328.7\u2009±\u200936.00.382\xa0CRP\u2009<\u200910\xa0mg/L58 (33.7)53 (43.8)5 (9.8)\u2009<\u20090.0010 (0)58 (41.1)\u2009<\u20090.00124 (30.8)34 (36.2)0.699\xa010\xa0mg/L\u2009≤\u2009CRP\u2009<\u200950\xa0mg/L86 (49.4)56 (46.3)29 (56.9)–18 (58.1)67 (47.5)–40 (51.3)45 (47.9)–\xa050\xa0mg/L\u2009≤\u2009CRP\u2009<\u2009100\xa0mg/L15 (8.7)7 (5.8)8 (15.7)–5 (16.1)10 (7.1)–6 (7.7)9 (9.6)–\xa0CRP\u2009≥\u2009100\xa0mg/L14 (8.1)5 (4.1)9 (17.6)–8 (25.8)6 (4.3)–8 (10.3)6 (6.4)–Procalcitonin (PCT) level (ng/ml)0.084\u2009±\u20090.0800.073\u2009±\u20090.0590.110\u2009±\u20090.1120.0250.111\u2009±\u20090.0720.078\u2009±\u20090.0810.0420.082\u2009±\u20090.0650.086\u2009±\u20090.0910.745\xa0PCT\u2009≤\u20090.1\xa0ng/ml124 (72.1)94 (77.7)30 (58.8)0.05410 (32.3)114 (80.9)\u2009<\u20090.00158 (74.4)66 (70.2)0.699\xa00.1\u2009<\u2009PCT\u2009<\u20090.25\xa0ng/ml44 (25.6)25 (20.1)19 (37.3)–18 (58.1)26 (18.4)–18 (23.1)26 (27.7)–\xa0PCT\u2009≥\u20090.25\xa0ng/ml4 (2.3)2 (1.7)2 (3.9)–4 (12.9)0 (0)–2 (2.6)2 (2.1)–Aspartate aminotransferase (AST), U/L29.4\u2009±\u200914.027.1\u2009±\u200912.734.9\u2009±\u200915.50.04239.1\u2009±\u200915.927.3\u2009±\u200912.7\u2009<\u20090.00132.6\u2009±\u200916.226.8\u2009±\u200911.40.007Alanine aminotransferase (ALT), U/L28.0\u2009±\u200918.927.3\u2009±\u200920.229.8\u2009±\u200915.50.02932.0\u2009±\u200913.927.2\u2009±\u200919.80.19433.1\u2009±\u200920.923.8\u2009±\u200916.00.001ALT or/and AST elevated32 (18.6)20 (16.5)12 (23.5)0.28110 (32.3)22 (15.6)0.01820 (25.6)12 (12.8)0.031Total bilirubin (TBIL), μmol/L17.3\u2009±\u200937.316.5\u2009±\u200935.419.1\u2009±\u200941.70.68117.5\u2009±\u200910.017.2\u2009±\u200941.00.97311.7\u2009±\u20097.121.9\u2009±\u200949.70.073Hyperbilirubinemia13 (7.6)7 (5.8)6 (11.8)0.1757 (22.6)6 (4.3)\u2009<\u20090.0014 (5.1)9 (9.6)0.272Albumin level, g/L39.7\u2009±\u20095.640.9\u2009±\u20095.237.0\u2009±\u20095.7\u2009<\u20090.00136.9\u2009±\u20096.040.4\u2009±\u20095.40.00239.4\u2009±\u20095.640.0\u2009±\u20095.70.451Hypoproteinemia (albumin\u2009<\u200935\xa0g/L)32 (18.6)16 (13.2)16 (31.4)0.00511 (35.5)21 (14.9)0.00812 (12.8)20 (25.6)0.031Lactose dehydrogenase (LDH), U/L306.0\u2009±\u2009190.0267.1\u2009±\u2009153.9398.5\u2009±\u2009322.9\u2009<\u20090.001461.1\u2009±\u2009272.1271.2\u2009±\u2009147.5\u2009<\u20090.001318.0\u2009±\u2009214.3296.1\u2009±\u2009167.80.452LDH\u2009≥\u2009250 U/L78 (45.3)44 (36.4)34 (66.7)\u2009<\u20090.00123 (74.2)55 (39.0)\u2009<\u20090.00136 (46.2)42 (44.7)0.847CK97.0\u2009±\u200967.086.7\u2009±\u200957.4121.4\u2009±\u200981.20.002129.6\u2009±\u200987.589.8\u2009±\u200959.70.003106.4\u2009±\u200967.789.1\u2009±\u200965.80.092CKMB23.6\u2009±\u200923.324.1\u2009±\u200924.922.5\u2009±\u200919.10.67122.6\u2009±\u200922.523.9\u2009±\u200923.60.78326.9\u2009±\u200930.221.0\u2009±\u200915.10.099CKMB elevated33 (19.2)22 (18.2)11 (21.6)0.6067 (22.6)26 (18.4)0.59718 (23.1)15 (16.0)0.238Creatinine67.4\u2009±\u200920.466.7\u2009±\u200919.00.4980.93966.1\u2009±\u200923.267.7\u2009±\u200919.80.69767.2\u2009±\u200922.567.5\u2009±\u200918.60.913BUN4.7\u2009±\u20092.14.4\u2009±\u20091.75.6\u2009±\u20092/50.0035.2\u2009±\u20092.24.6\u2009±\u20092.00.1164.6\u2009±\u20092.24.9\u2009±\u20091.90.366Fast food serum glucose, mmol/L6.2\u2009±\u20091.86.1\u2009±\u20091.76.5\u2009±\u20092.00.2096.6\u2009±\u20092.26.1\u2009±\u20091.70.1676.5\u2009±\u20091.86.0\u2009±\u20091.80.094Hyperglycemia26 (15.1)15 (12.4)11 (21.6)0.1259 (29.0)17 (12.1)0.03514 (17.9)12 (12.8)0.345Hypokalemia16 (9.3)8 (6.6)8 (15.7)0.0619 (29.0)7 (5.0)\u2009<\u20090.0016 (7.7)10 (10.6)0.508Hyponatremia9 (5.2)5 (4.1)4 (7.8)0.3184 (12.9)5 (3.5)0.0346 (7.7)3 (3.2)0.187BNP/pro-BNP/pro-NTBNP above normal level#25 (14.5)15 (12.4)10 (19.6)0.2209 (29.0)16 (11.3)0.02513 (16.7)12 (12.8)0.470D-dimer, mg/L1.21\u2009±\u20091.350.98\u2009±\u20090.921.75\u2009±\u20091.94\u2009<\u20090.0012.41\u2009±\u20092.310.95\u2009±\u20090.83\u2009<\u20090.0011.11\u2009±\u20090.911.29\u2009±\u20091.630.417D-dimer\u2009≥\u20090.5\xa0mg/L78 (45.3)46 (38.0)32 (62.7)0.00322 (71.0)56 (39.7)0.00238 (48.7)40 (42.6)0.419§Does not distinguish those with room air or with oxygen therapy#Data collected in 0–72\xa0h after admission*Respiratory failure was defined as PaO2\u2009<\u200960\xa0mmHg or SaO2/SpO2\u2009<\u200990% on room air, or PaO2/FiO2\u2009<\u2009300\xa0mmHg either on room air or on oxygen therapy. Some patients were transferred from other medical agencies'], '13577_2021_499_Fig2_HTML': ['As shown in Fig.\xa0<xref rid="13577_2021_499_Fig2_HTML" ref-type="fig">2</xref>, Table , Table 4 and Figure S3–S6, case type (severe or non-severe), proportions of lymphocyte and respiratory failure on admission are key risk factors of the primary endpoint. We did not perform subgroup analysis for death for a limited number of the death group.Fig. 2Risk factors for invasive mechanical ventilation or ECMO or death as revealed by multivariate Logistic analysis included the case type (severe or nonsevere) (HR 1.126, 95% CI 3.728–39.444), respiratory failure on admission (6.894, 95% CI 1.364–35.748) and grade of lymphocyte proportion (HR 5.519, 95% CI 1.700–17.913)Table 4Univariate and multivariate regression analysis of risk factors for NIV/IMV/ECMO/deathUnivariateMultivariateOR95%CIP valueOR95%CIP valueCase type24.1288.442, 68.960\u2009<\u20090.00112.10.01, 0.4320.005Grade of LYM proportion6.0183.291, 11.004\u2009<\u20090.0015.5191.700, 17.9130.004RF on admission40.20013.791, 117.177\u2009<\u20090.0016.9841.364, 35.7480.020Number of lobes infiltrated0.150.072, 0.316\u2009<\u20090.0010.2670.072, 0.9940.267']} | Clinical features and prognostic factors of patients with COVID-19 in Henan Province, China | [
"COVID-19",
"SARS-CoV-2",
"Ground glass opacity",
"Lymphopenia",
"Mortality"
] | Hum Cell | 1613203200 | None | null | other | PMC7882230 | null | null | [
""
] | Hum Cell. 2021 Feb 13; 34(2):419-435 | NO-CC CODE |
|
F Ruysch, ‘Epistola anatomica’ (1721), Tab. 13, drawing by Jan Wandelaar. The letter T (on the left) indexes the rete mirabile. (Herzog August Bibliothek Wolfenbüttel. M: Ma 148.) | medhis5304-05-561-07a | 7 | a0bb983fbde9a1e1d0b7173f7c202af5462b8c6d2f1c84af127c1e095cdc7a2c | medhis5304-05-561-07a.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
360,
475
] | [{'image_id': 'medhis5304-05-561-04a', 'image_file_name': 'medhis5304-05-561-04a.jpg', 'image_path': '../data/media_files/PMC2766140/medhis5304-05-561-04a.jpg', 'caption': 'A van der Spiegel, ‘De humani corporis fabrica’ (1627), Lib. X, Tab. X, p. 93. The rete mirabile is indexed with the letter L. (Herzog August Bibliothek Wolfenbüttel. A: 10 Phys. 2°.)', 'hash': 'e2fa12cf76bada52ab1f1a93570b3a77faadfbea4cb424880807a5db8b4bbd57'}, {'image_id': 'medhis5304-05-561-06b', 'image_file_name': 'medhis5304-05-561-06b.jpg', 'image_path': '../data/media_files/PMC2766140/medhis5304-05-561-06b.jpg', 'caption': 'Enlarged version of Willis’s of Fig. III, representing the rete mirabile in a calf. (Wellcome Library, London.)', 'hash': 'be714fc2159322dd6d0c07596fadba525ebb97d9b944236f6d86ab7373a99d35'}, {'image_id': 'medhis5304-05-561-05', 'image_file_name': 'medhis5304-05-561-05.jpg', 'image_path': '../data/media_files/PMC2766140/medhis5304-05-561-05.jpg', 'caption': 'J Vesling, Syntagma anatomicum (1647), Tab. III, Cap. XIV, Fig. III. The rete mirabile is indexed with the letter P in the middle left of the image. (Herzog August Bibliothek Wolfenbüttel. A: 1.2 Quod. (2).)', 'hash': 'e90629a20c403b615e025e91bec74e4461f84637c090330763df866155a5949c'}, {'image_id': 'medhis5304-05-561-02b', 'image_file_name': 'medhis5304-05-561-02b.jpg', 'image_path': '../data/media_files/PMC2766140/medhis5304-05-561-02b.jpg', 'caption': 'Detail of Figure\u20092a showing the rete mirabile enlarged. (Glasgow University Library, Department of Special Collections.)', 'hash': 'b6c498c146631fb6ecb30d3f260df2e7c73975a8c6dcedc803b22ad89920ac10'}, {'image_id': 'medhis5304-05-561-07b', 'image_file_name': 'medhis5304-05-561-07b.jpg', 'image_path': '../data/media_files/PMC2766140/medhis5304-05-561-07b.jpg', 'caption': 'Detail of Figure 7a, showing the rete mirable to the left and right of the optic nerve. (Herzog August Bibliothek Wolfenbüttel. M: Ma 148.)', 'hash': '9b6df1ea8876854d69363dd022553b8076e236bb3eb61ff89400ed638d98a906'}, {'image_id': 'medhis5304-05-561-03b', 'image_file_name': 'medhis5304-05-561-03b.jpg', 'image_path': '../data/media_files/PMC2766140/medhis5304-05-561-03b.jpg', 'caption': 'Detail of Figure 3a showing the enlarged drawing of the rete mirabile, which bears no resemblance to earlier representations. (Herzog August Bibliothek Wolfenbüttel. A: 3 Phys. 2°.)', 'hash': 'd12f367454af7b738ffd36e399d9275f2635de351a3ec859a5e044f12867aa06'}, {'image_id': 'medhis5304-05-561-07a', 'image_file_name': 'medhis5304-05-561-07a.jpg', 'image_path': '../data/media_files/PMC2766140/medhis5304-05-561-07a.jpg', 'caption': 'F Ruysch, ‘Epistola anatomica’ (1721), Tab. 13, drawing by Jan Wandelaar. The letter T (on the left) indexes the rete mirabile. (Herzog August Bibliothek Wolfenbüttel. M: Ma 148.)', 'hash': 'a0bb983fbde9a1e1d0b7173f7c202af5462b8c6d2f1c84af127c1e095cdc7a2c'}, {'image_id': 'medhis5304-05-561-03a', 'image_file_name': 'medhis5304-05-561-03a.jpg', 'image_path': '../data/media_files/PMC2766140/medhis5304-05-561-03a.jpg', 'caption': 'A Vesalius, De humani corporis fabrica (1543), p. 621. The second figure from the top represents the rete mirabile. (Herzog August Bibliothek Wolfenbüttel. A: 3 Phys. 2°.)', 'hash': '7ebe7a58f0f9333839d81889397599c1af3f1e7bce218525462e800346b570a9'}, {'image_id': 'medhis5304-05-561-06a', 'image_file_name': 'medhis5304-05-561-06a.jpg', 'image_path': '../data/media_files/PMC2766140/medhis5304-05-561-06a.jpg', 'caption': 'T Willis, The remaining medical works of that famous and renowned physician Dr Thomas Willis … VI. The anatomy of the brain (1681), plate after p. 86. Fig. III repre sents the rete mirabile in a calf. (Wellcome Library, London.)', 'hash': '2ae9b3a041a129cb0c5984ce32cb45be6b37ee63e2dbb08d35f61c15dfd20796'}, {'image_id': 'medhis5304-05-561-01', 'image_file_name': 'medhis5304-05-561-01.jpg', 'image_path': '../data/media_files/PMC2766140/medhis5304-05-561-01.jpg', 'caption': 'J Dryander, Anatomiae (1537), fol. 28r. The rete mirabile is represented by the hatched structure above the eyes. (Wellcome Library, London.)', 'hash': '11e17e818964d14aadefea3b5ca8c3ad3a39cb9b8d753cc498d56bfe34e4f46d'}, {'image_id': 'medhis5304-05-561-02a', 'image_file_name': 'medhis5304-05-561-02a.jpg', 'image_path': '../data/media_files/PMC2766140/medhis5304-05-561-02a.jpg', 'caption': 'A Vesalius, Tabulae anatomicae (1538), plate 3. The rete mirabile is represented by the hatched structure in the centre of the head, indexed with the letter B. (Glasgow University Library, Department of Special Collections.)', 'hash': '696afeffbd08f73ad23e6720395c24bb198d10e8392cfc4b04e1025f67d3db7e'}, {'image_id': 'medhis5304-05-561-04b', 'image_file_name': 'medhis5304-05-561-04b.jpg', 'image_path': '../data/media_files/PMC2766140/medhis5304-05-561-04b.jpg', 'caption': 'The difference between Spiegel’s depiction of the rete mirable (indexed with the letter L) and Vesalius’s is evident in this detail of Figure 4a. (Herzog August Bibliothek Wolfenbüttel. A: 10 Phys. 2°.)', 'hash': 'e03de8e5a1ee17b6fa194e1b45511e63b185b3e80db6200b32044f4c38a9672a'}] | {'medhis5304-05-561-01': ['In Galen’s anatomy and physiology the rete mirabile played a crucial role. It was described as a network of fine vessels into which the carotid artery branched out at the base of the cranium.9 For Galen the importance of this delicate structure was obvious: “For wherever Nature wishes material to be completely elaborated, she arranges for it to spend a long time in the instruments concocting it.”10 The function Galen attributed to the rete mirabile was to refine the vital spirit in the blood into the animal spirit, or psychic pneuma, which was seen as a requirement for reasoning, and regarded by Galen also as the driving force behind bodily functions and movement.11 This idea of the rete mirabile as a vital organ remained unchallenged in the western medical tradition until the sixteenth century.12 Visual representations of this important organ from this early period are scarce, and the depiction of a human head in Antropologium de hominis dignitate (1501) by Magnus Hundt of the University of Leipzig is probably the only model for pre-Vesalian depictions of the rete mirabile.13 This rather schematic representation of the human head was still used more than three decades later by Johann Dryander, anatomist at the University of Marburg, for his Anatomiae (1537).14 This illustration showed a human head with the different ventricles of the brain and the different senses mapped and indexed (<xref ref-type="fig" rid="medhis5304-05-561-01">Figure\u20091</xref>). On both Hundt’s and Dryander’s illustrations the rete mirabile was represented by a hatching pattern above the nose. Neither of these illustrations represented the wonderful net in a naturalistic way resembling some organic form. Also, neither gave an indication of its precise topographical location or physiological relations according to the traditional Galenic account.). On both Hundt’s and Dryander’s illustrations the rete mirabile was represented by a hatching pattern above the nose. Neither of these illustrations represented the wonderful net in a naturalistic way resembling some organic form. Also, neither gave an indication of its precise topographical location or physiological relations according to the traditional Galenic account.Figure\u20091J Dryander, Anatomiae (1537), fol. 28r. The rete mirabile is represented by the hatched structure above the eyes. (Wellcome Library, London.)'], 'medhis5304-05-561-02a': ['A year after Dryander, Vesalius published an illustration of the rete mirabile in relation to the vascular system in his Tabulae anatomicae sex (1538). On the third plate Vesalius depicted the wonderful net at the top in the centre, in the middle of the head as a conjuncture of blood vessels (<xref ref-type="fig" rid="medhis5304-05-561-02a">Figures\u20092a</xref> and and <xref ref-type="fig" rid="medhis5304-05-561-02b">2b</xref>).).15 At least until 1540, Vesalius still firmly believed in the existence of a rete mirabile in man, and saw it in the centre of the “noblest” of the three cavities of the body, the skull.16 But only a few years later he dismissed the idea that it existed in man. Comparative dissections of human and animal cadavers had convinced Vesalius that Galen must have been wrong. In 1543, in the Fabrica, Vesalius criticized other physicians for their blind belief in Galen’s account of the “wonderful plexus reticularis” (i.e. the rete mirabile).17 He tried to falsify the Galenic assumptions about the rete mirabile with his own description of the course of the carotid artery into the head, which was based on his own dissections.18 Vesalius still added an illustration to the Fabrica which represented a rete mirabile, but had no resemblance to earlier representations of the organ, except for the hatched structure (<xref ref-type="fig" rid="medhis5304-05-561-03a">Figures\u20093a</xref> and and <xref ref-type="fig" rid="medhis5304-05-561-03b">3b</xref>). Usually in the ). Usually in the Fabrica the organs would be illustrated both individually and within their topographical context. The rete mirabile, however, was only shown on its own and not in relation to the brain. By isolating the wonderful net from the rest of the body, without showing it in situ on any other illustration in the book, Vesalius used the image as an argument. While he demonstrated that he was very familiar with Galenic anatomy, he also made a point by removing Galen’s rete mirabile from human anatomy.19Figure\u20092aA Vesalius, Tabulae anatomicae (1538), plate 3. The rete mirabile is represented by the hatched structure in the centre of the head, indexed with the letter B. (Glasgow University Library, Department of Special Collections.)Figure\u20092bDetail of <xref ref-type="fig" rid="medhis5304-05-561-02a">Figure\u20092a</xref> showing the rete mirabile enlarged. (Glasgow University Library, Department of Special Collections.) showing the rete mirabile enlarged. (Glasgow University Library, Department of Special Collections.)Figure\u20093aA Vesalius, De humani corporis fabrica (1543), p. 621. The second figure from the top represents the rete mirabile. (Herzog August Bibliothek Wolfenbüttel. A: 3 Phys. 2°.)Figure\u20093bDetail of Figure 3a showing the enlarged drawing of the rete mirabile, which bears no resemblance to earlier representations. (Herzog August Bibliothek Wolfenbüttel. A: 3 Phys. 2°.)', 'The uncertainty about the rete mirabile was also reflected in, and aggravated by, its visual representations. In the beginning of the sixteenth century and in Vesalius’s Tabulae anatomicae the rete mirabile was still part of a visual paradigm, where it could not only be represented in situ but also with a function within a physiological system (<xref ref-type="fig" rid="medhis5304-05-561-02a">Figure\u20092</xref>). However, the denial of its existence in human bodies in Vesalius’s ). However, the denial of its existence in human bodies in Vesalius’s Fabrica also visually separated the rete mirabile from the human body. When the rete mirabile was represented in relation to the human brain during the seventeenth and eighteenth centuries, it appeared in different shapes and places. These illustrations failed to become self-evident and standardize the gaze and its object, an ambition seen by Lorraine Daston and Peter Galison in anatomical atlases from the sixteenth to the eighteenth century.95 Because illustrations of the rete mirabile did not develop a consistent iconography, the seventeenth- and eighteenth-century visual representations of this structure carried the uncertainty about its identity forward and did not lead to self-evident and “very normal images”.96 Rather than establishing the rete mirabile as a matter of fact in the anatomical discourse, the iconographic inconsistency and the ambiguous narratives allowed the rete mirabile to survive in human anatomy until there occurred a clear disciplinary division into descriptive anatomy and experimental physiology around the turn of the eighteenth to nineteenth century.97'], 'medhis5304-05-561-04a': ['Vesalius’s illustrations were not the only iconographic model for anatomical representations. Some of the frequently copied anatomical illustrations in the seventeenth century, which also followed a naturalistic approach, were done after the plates in Adriaan van der Spiegel’s De humani corporis fabrica (1627). They were originally the work of his predecessor in the chair of anatomy at the University of Padua, Julius Casserius, and added by Spiegel’s editor.28 Among those included in Spiegel’s anatomical handbook was a new depiction of the rete mirabile, which significantly differed from the Vesalian iconography (<xref ref-type="fig" rid="medhis5304-05-561-04a">Figures\u20094a</xref> and and <xref ref-type="fig" rid="medhis5304-05-561-04b">4b</xref>).).29 In Spiegel’s image the wonderful net was not represented isolated, but in relation to the brain, its nerves and blood vessels. The illustration represented the brain from below after it had been separated from the spinal cord and cleaned from surrounding tissue. The rete mirabile (indexed with the letter “L”) branched out from the carotid artery (indexed with the letter “K”). The branches representing the rete mirabile were depicted in a naturalistic way and resembled the blood vessels surrounding the brain. There was also no similarity to the hatched structure of the rete mirabile in Vesalian and older illustrations. While Spiegel had no doubt that the rete mirabile existed in humans, he admitted that it was difficult to find and more clearly visible in sheep.30Figure\u20094aA van der Spiegel, ‘De humani corporis fabrica’ (1627), Lib. X, Tab. X, p. 93. The rete mirabile is indexed with the letter L. (Herzog August Bibliothek Wolfenbüttel. A: 10 Phys. 2°.)Figure\u20094bThe difference between Spiegel’s depiction of the rete mirable (indexed with the letter L) and Vesalius’s is evident in this detail of Figure 4a. (Herzog August Bibliothek Wolfenbüttel. A: 10 Phys. 2°.)'], 'medhis5304-05-561-05': ['Difficulties in identifying the exact position and appearance of the wonderful net were also reflected in the illustrations to the work of Johan Vesling. Vesling was one of Spiegel’s successors to the chair of anatomy at the University of Padua, and his Syntagma anatomicum (1641) was the most successful anatomical handbook of the second half of the seventeenth century with sixteen editions in Latin, German, Dutch and English. On page 195, figure III represented the brain from below, as in the illustration in Spiegel’s De humani corporis fabrica (<xref ref-type="fig" rid="medhis5304-05-561-05">Figure\u20095</xref>). However, in contrast to that in Spiegel’s work, the rete mirabile (indexed with the letter “P”) did not branch off the carotid artery and merge into the plexus choroides, but was simply represented by branches which came off the carotid artery (indexed with the letter “C”) and then spread over the surface of the brain.). However, in contrast to that in Spiegel’s work, the rete mirabile (indexed with the letter “P”) did not branch off the carotid artery and merge into the plexus choroides, but was simply represented by branches which came off the carotid artery (indexed with the letter “C”) and then spread over the surface of the brain.31Figure\u20095J Vesling, Syntagma anatomicum (1647), Tab. III, Cap. XIV, Fig. III. The rete mirabile is indexed with the letter P in the middle left of the image. (Herzog August Bibliothek Wolfenbüttel. A: 1.2 Quod. (2).)'], 'medhis5304-05-561-06a': ['However, Willis had to admit that horses also lacked a rete mirabile, which he explained with the “noble” nature of this animal. Yet to maintain human superiority, he argued that the brains of horses were still of a weaker constitution than human brains, and, to ease the blood pressure, the carotid artery was split in two interconnected branches in horses.53 To illustrate his point Willis added drawings of the rete mirabile to his account, which represented the carotid artery in man (<xref ref-type="fig" rid="medhis5304-05-561-06a">Figure\u20096</xref><xref ref-type="fig" rid="medhis5304-05-561-06b" />, Fig. I), the carotid arteries in a horse (, Fig. I), the carotid arteries in a horse (<xref ref-type="fig" rid="medhis5304-05-561-06a">Figure\u20096</xref>, Fig. II), and the rete mirabile in a calf (, Fig. II), and the rete mirabile in a calf (<xref ref-type="fig" rid="medhis5304-05-561-06b">Figure\u20096</xref>, Fig. III). Although the caption claimed that the illustration showed the situation of the carotid arteries in man and horses within the skull, they both appeared totally isolated and no hint was given to the relation of these structures to the rest of the body. The representation of the rete mirabile was even more abstract. In the centre, an archway-like shape indexed with the letter C represented the pituitary gland. Alongside the gland were white branches which were indexed on the right with the letter B and represented the “Net-like Infoldings of the Vessels stretched out by that Chanel towards the pituitary Kernel”., Fig. III). Although the caption claimed that the illustration showed the situation of the carotid arteries in man and horses within the skull, they both appeared totally isolated and no hint was given to the relation of these structures to the rest of the body. The representation of the rete mirabile was even more abstract. In the centre, an archway-like shape indexed with the letter C represented the pituitary gland. Alongside the gland were white branches which were indexed on the right with the letter B and represented the “Net-like Infoldings of the Vessels stretched out by that Chanel towards the pituitary Kernel”.54 The said channel was represented by a light vertical line at the right indexed with the letter A and identified as the artery.55 While the representations of the arteries in humans and horses were still naturalistic enough to make them appear as vessels, and they were also accurately indexed, the representation of the rete mirabile was quite abstract and not accurately indexed, which left it without any resemblance to an organic form.Figure\u20096aT Willis, The remaining medical works of that famous and renowned physician Dr Thomas Willis … VI. The anatomy of the brain (1681), plate after p. 86. Fig. III repre sents the rete mirabile in a calf. (Wellcome Library, London.)Figure\u20096bEnlarged version of Willis’s of Fig. III, representing the rete mirabile in a calf. (Wellcome Library, London.)'], 'medhis5304-05-561-07a': ['The controversies about the rete mirabile also puzzled Lorenz Heister. Heister was anatomy professor at the University of Helmstedt and author of the most successful anatomical textbook of the eighteenth century, the Compendium anatomicum (1717), which had more than thirty editions in five languages by 1777.72 Heister even added to the confusion by confirming the existence of this inconspicuous and apparently inconsiderable object, stating that “its use is unknown”.73 In later editions of the Compendium anatomicum he reaffirmed the existence of the rete mirabile in man and bristled at its denial by Frederik Ruysch.74 Although the famous Dutch anatomist “had erstwhile displayed this net with words and etchings, [he] now ranks it among the fairy tales”.75 Heister referred to one of the illustrations in Ruysch’s Epistola anatomica problematica duodecima (1699) (<xref ref-type="fig" rid="medhis5304-05-561-07a">Figures\u20097a</xref> and and <xref ref-type="fig" rid="medhis5304-05-561-06a">7b</xref>).).76 The brain of the subject, according to the caption that of a ten-year-old boy, was represented from below, similar to the illustrations in Spiegel and Vesling. The rete mirabile (indexed on the left with the letter T) featured on this illustration left and right of the optical nerve (indexed with letter D). Jan Wandelaar’s delicate etching in Ruysch’s Epistola anatomica appeared to be the last visual representation of the rete mirabile as part of human anatomy. The appearance and location of the wonderful net in this illustration was different from that in the images in Spiegel and Vesling. It was also less prominent and less noticeable, but shared the manner of a naturalistic representation with the structures of the brain.Figure\u20097aF Ruysch, ‘Epistola anatomica’ (1721), Tab. 13, drawing by Jan Wandelaar. The letter T (on the left) indexes the rete mirabile. (Herzog August Bibliothek Wolfenbüttel. M: Ma 148.)Figure\u20097bDetail of Figure 7a, showing the rete mirable to the left and right of the optic nerve. (Herzog August Bibliothek Wolfenbüttel. M: Ma 148.)']} | “It could be Seen more Clearly in Unreasonable Animals than in Humans”: The Representation of the Rete Mirabile in Early Modern Anatomy | null | Med Hist | 1254380400 | None | null | other | PMC2766140 | null | null | [
""
] | Med Hist. 2009 Oct; 53(4):561-586 | NO-CC CODE |
|
Coronal cross section of CT pulmonary angiogram showing a pneumomediastinum (see red arrows). | bcr-2020-237938f03 | 7 | 178e7ff3c154bf8f18a760fe33bb6ad98314b7a6f01256d79d28b021379ef80a | bcr-2020-237938f03.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
531,
475
] | [{'image_id': 'bcr-2020-237938f02', 'image_file_name': 'bcr-2020-237938f02.jpg', 'image_path': '../data/media_files/PMC7418693/bcr-2020-237938f02.jpg', 'caption': 'Repeat chest X-ray at day 5. Curvilinear opacities seen along superior mediastinum and heart border, suggestive of extraluminal air (see red arrows).', 'hash': '350145f85e7d39e3002b970d5693054d8d867ec0b64197a632ed2b5cb4c711a6'}, {'image_id': 'bcr-2020-237938f03', 'image_file_name': 'bcr-2020-237938f03.jpg', 'image_path': '../data/media_files/PMC7418693/bcr-2020-237938f03.jpg', 'caption': 'Coronal cross section of CT pulmonary angiogram showing a pneumomediastinum (see red arrows).', 'hash': '178e7ff3c154bf8f18a760fe33bb6ad98314b7a6f01256d79d28b021379ef80a'}, {'image_id': 'bcr-2020-237938f04', 'image_file_name': 'bcr-2020-237938f04.jpg', 'image_path': '../data/media_files/PMC7418693/bcr-2020-237938f04.jpg', 'caption': 'Axial cross section of CT pulmonary angiogram showing a pneumomediastinum (see red arrows). Note the patchy opacities and the linear scarring of both lungs due to COVID-19.', 'hash': '84250bddc39ff66650a0af85ae351f6571deff67ec9419c7901067dea01074d0'}, {'image_id': 'bcr-2020-237938f01', 'image_file_name': 'bcr-2020-237938f01.jpg', 'image_path': '../data/media_files/PMC7418693/bcr-2020-237938f01.jpg', 'caption': 'Admission chest X-ray. Subtle bibasal opacities and air bronchograms (more prominent R>L) (see red arrows).', 'hash': '66b0f58d97915631e4a237306d150ec17aef08072d8ee5e988f4031b3d7b7f4b'}] | {'bcr-2020-237938f01': ['An admission chest X-ray (<xref ref-type="fig" rid="bcr-2020-237938f01">figure 1</xref>) displaying bibasal opacities suspicious for COVID-19 infection was confirmed with subsequent positive reverse-transcriptase PCR testing. Despite conflicting evidence for the efficacy of non-invasive ventilation (NIV) in type 1 respiratory failure not attributed to acute cardiogenic pulmonary oedema,) displaying bibasal opacities suspicious for COVID-19 infection was confirmed with subsequent positive reverse-transcriptase PCR testing. Despite conflicting evidence for the efficacy of non-invasive ventilation (NIV) in type 1 respiratory failure not attributed to acute cardiogenic pulmonary oedema,11 based on both national and local guidance,12 the patient was started on continuous positive airway pressure (CPAP) support after failure on supplemental oxygen therapy. The patient received antibiotic cover with coamoxiclav and clarithromycin.', 'The admission chest X-ray (<xref ref-type="fig" rid="bcr-2020-237938f01">figure 1</xref>) showed subtle bibasal air space opacities consistent with COVID-19 pneumonia. When the patient deteriorated on day 5, a repeat chest radiograph was initially reported as being unchanged from admission () showed subtle bibasal air space opacities consistent with COVID-19 pneumonia. When the patient deteriorated on day 5, a repeat chest radiograph was initially reported as being unchanged from admission (<xref ref-type="fig" rid="bcr-2020-237938f02">figure 2</xref>). On further scrutiny of the scan post CTPA, this did show curvilinear lucencies around the mediastinum and heart border, suggesting extraluminal air in the mediastinum and pericardium. This finding was missed by the medical team and radiology.). On further scrutiny of the scan post CTPA, this did show curvilinear lucencies around the mediastinum and heart border, suggesting extraluminal air in the mediastinum and pericardium. This finding was missed by the medical team and radiology.'], 'bcr-2020-237938f02': ['On day 5 of admission, the patient showed signs of acute respiratory distress requiring increasing supplemental oxygen therapy at 10–15\u2009L/min to maintain SpO2 above 90%. This also coincided with worsening blood tests; a lymphocyte count of 0.6×109/L, LDH of 521\u2009U/L, D-dimer of 2.42\u2009mg/L FEU and a CRP of 137\u2009mg/L. A repeat chest X-ray (<xref ref-type="fig" rid="bcr-2020-237938f02">figure 2</xref>) was interpreted and reported as showing no interval change when compared with admission () was interpreted and reported as showing no interval change when compared with admission (<xref ref-type="fig" rid="bcr-2020-237938f01">figure 1</xref>). Subsequently, the patient was restarted on CPAP support with antibiotic therapy escalated to piperacillin–tazobactam.). Subsequently, the patient was restarted on CPAP support with antibiotic therapy escalated to piperacillin–tazobactam.', 'In our case, the patient had no history of trauma or recent instrumentation. Patients with pneumomediastinum most commonly have problem of chest pain followed by dyspnoea18; the former which was absent in our case. Our patient had underlying asthma, which is a very small risk factor pneumomediastinum. The CT chest did not reveal any perforated hollow viscus or oesophageal rupture to explain the aetiology. Typically, with these patients, there is a preceding history of vomiting or retching which our patient did not have problem of. Although reported in the literature, it is uncommon for NIV, particularly for short periods, to cause pneumomediastinum (and is more likely to be seen with mechanical ventilation).19 Indeed, there is a direct correlation between positive airway pressure and the incidence of pneumomediastinum.20 The inspiratory positive airway pressure (IPAP) required to deliver the same tidal volume in NIV is less than that required in invasive mechanical ventilation. Furthermore, in mechanical ventilation, higher IPAP will lead to elevation of the alveolar pressure, ultimately increasing the differential between the alveolar and interstitial pressure, termed the transalveolar pressure, and the threshold for alveolar rupture.21 In essence, pulmonary barotrauma is observed at a far higher incidence with mechanical ventilation. Therefore, it is unlikely that barotrauma secondary to CPAP was the sole cause of the pneumomediastinum in our case, especially in view of the patient only receiving 12\u2009hours of CPAP prior to clinical improvement over the next 3\u2009days. Indeed, the repeat chest X-ray (<xref ref-type="fig" rid="bcr-2020-237938f02">figure 2</xref>) which showed mediastinal air was performed when CPAP was restarted on day 5. We cannot term the patient’s pneumomediastinum as spontaneous; it occurred in the context of lung injury. However, it highlights the likelihood of COVID-19 infection playing a significant contributory role in its development. Emerging literature certainly supports this hypothesis.) which showed mediastinal air was performed when CPAP was restarted on day 5. We cannot term the patient’s pneumomediastinum as spontaneous; it occurred in the context of lung injury. However, it highlights the likelihood of COVID-19 infection playing a significant contributory role in its development. Emerging literature certainly supports this hypothesis.8–10']} | Broadening the differential: pneumomediastinum and COVID-19 infection | [
"respiratory medicine",
"pneumomediastinum"
] | BMJ Case Rep | 1597129200 | The novel coronavirus (COVID-19) has emerged as a new pathogen responsible for an atypical viral pneumonia, with severe cases progressing to an acute respiratory distress syndrome. In our practice, we have observed patients admitted with COVID-19 pneumonia developing worsening hypoxaemic respiratory failure prompting the need for urgent endotracheal intubation. Here, we present a case of a patient admitted with severe COVID-19 pneumonia who required continuous positive airway pressure support following acute deterioration. However, with the patient requiring an increasing fraction of inspired oxygen (FiO), a prompt CT pulmonary angiogram scan was performed to exclude an acute pulmonary embolism. Surprisingly, this revealed a pneumomediastinum. Following a brief admission to the intensive care unit, the patient made a full recovery and was discharged 18 days post admission. | [
"Betacoronavirus",
"COVID-19",
"Computed Tomography Angiography",
"Coronavirus Infections",
"Humans",
"Lung",
"Male",
"Mediastinal Emphysema",
"Middle Aged",
"Pandemics",
"Pneumonia, Viral",
"SARS-CoV-2"
] | other | PMC7418693 | null | 22 | [
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"{'Citation': 'Chen N, Zhou M, Dong X, et al. . Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–13. 10.1016/S0140-6736(20)30211-7', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S0140-6736(20)30211-7'}, {'@IdType': 'pmc', '#text': 'PMC7135076'}, {'@IdType': 'pubmed', '#text': '32007143'}]}}",
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"{'Citation': 'Zhou C, Gao C, Xie Y, et al. . COVID-19 with spontaneous pneumomediastinum. Lancet Infect Dis 2020;20:510. 10.1016/S1473-3099(20)30156-0', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S1473-3099(20)30156-0'}, {'@IdType': 'pmc', '#text': 'PMC7128610'}, {'@IdType': 'pubmed', '#text': '32164830'}]}}",
"{'Citation': 'Mohan V, Tauseen RA. Spontaneous pneumomediastinum in COVID-19. BMJ Case Rep 2020;13:e236519. 10.1136/bcr-2020-236519', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1136/bcr-2020-236519'}, {'@IdType': 'pmc', '#text': 'PMC7252963'}, {'@IdType': 'pubmed', '#text': '32457032'}]}}",
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] | BMJ Case Rep. 2020 Aug 11; 13(8):e237938 | NO-CC CODE |
|
Axial image from the CT pulmonary angiogram (CTPA) demonstrates bilateral proximal pulmonary emboli and large saddle embolus. | bcr-2020-237046f02 | 7 | f548b44752426955f7887971a7dd747c73d3250103f8d4e1cb7e079977156539 | bcr-2020-237046f02.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
707,
506
] | [{'image_id': 'bcr-2020-237046f07', 'image_file_name': 'bcr-2020-237046f07.jpg', 'image_path': '../data/media_files/PMC7418852/bcr-2020-237046f07.jpg', 'caption': 'Fluoroscopic image demonstrates placement of the EkoSonic catheters in the pulmonary arteries.', 'hash': 'c4c393262b79a522b6c5baee4fb2a4a1bfb3981cec18604a4ff827e3776ed3e8'}, {'image_id': 'bcr-2020-237046f06', 'image_file_name': 'bcr-2020-237046f06.jpg', 'image_path': '../data/media_files/PMC7418852/bcr-2020-237046f06.jpg', 'caption': 'Axial lung window images from CT pulmonary angiogram demonstrates slightly denser left-sided basal subpleural consolidation.', 'hash': '338009e62c32603c753c9d92b903f31fce3981d61df8270a8d816842826b00e7'}, {'image_id': 'bcr-2020-237046f01', 'image_file_name': 'bcr-2020-237046f01.jpg', 'image_path': '../data/media_files/PMC7418852/bcr-2020-237046f01.jpg', 'caption': 'Anteroposterior erect chest X-ray shows left mid-lower zone subpleural airspace consolidation and minor right lower zone subpleural subtle airspace consolidation.', 'hash': '3e916defa02744c33b1625b63ea531cd1f0d9f19add70225ed47813496ffd224'}, {'image_id': 'bcr-2020-237046f02', 'image_file_name': 'bcr-2020-237046f02.jpg', 'image_path': '../data/media_files/PMC7418852/bcr-2020-237046f02.jpg', 'caption': 'Axial image from the CT pulmonary angiogram (CTPA) demonstrates bilateral proximal pulmonary emboli and large saddle embolus.', 'hash': 'f548b44752426955f7887971a7dd747c73d3250103f8d4e1cb7e079977156539'}, {'image_id': 'bcr-2020-237046f05', 'image_file_name': 'bcr-2020-237046f05.jpg', 'image_path': '../data/media_files/PMC7418852/bcr-2020-237046f05.jpg', 'caption': 'Axial lung window images from CT pulmonary angiogram demonstrates bilateral subpleural reticulation, associated with bilateral scattered ground glass opacities with a mainly interlobular and subpleural distribution, predominant on the left.', 'hash': 'b951dd1301a35838cb844671b45d2ce39d937f5b3ed0514a335e4fbd1502237a'}, {'image_id': 'bcr-2020-237046f04', 'image_file_name': 'bcr-2020-237046f04.jpg', 'image_path': '../data/media_files/PMC7418852/bcr-2020-237046f04.jpg', 'caption': 'Axial image taken from CT pulmonary angiogram demonstrates dilatation of the right ventricle and mild interventricular septal bowing, in keeping with right heart strain.', 'hash': 'b189f45bb37f6a213fe58a6b52c3e0c849e9231c06a955102202ff2508ad1f0b'}, {'image_id': 'bcr-2020-237046f03', 'image_file_name': 'bcr-2020-237046f03.jpg', 'image_path': '../data/media_files/PMC7418852/bcr-2020-237046f03.jpg', 'caption': 'Coronal reconstruction from the CT pulmonary angiogram demonstrates bilateral proximal pulmonary emboli.', 'hash': 'c5e79d5daff5507fa1c7561128ee63725c78312fa02134caa6d1ad38010c303d'}] | {'bcr-2020-237046f01': ['Chest radiograph on admission demonstrated left-sided mid-lower zone subpleural airspace consolidation and minor right lower zone subpleural subtle airspace consolidation (<xref ref-type="fig" rid="bcr-2020-237046f01">figure 1</xref>).).'], 'bcr-2020-237046f07': ['Infusion catheters were placed in both pulmonary arteries and ultrasound assisted CDT (EkoSonic Endovascular System, Boston Scientific) with alteplase was commenced (<xref ref-type="fig" rid="bcr-2020-237046f07">figure 7</xref>). All members of the IR team wore appropriate personal protective equipment, and the patient was nursed on the COVID-19 ICU. After 24\u2009hours, the infusions were stopped and the catheters removed. The total administered dose of alteplase was 40\u2009mg. The patient was then commenced on split treatment dose dalteparin and converted to apixaban prior to discharge.). All members of the IR team wore appropriate personal protective equipment, and the patient was nursed on the COVID-19 ICU. After 24\u2009hours, the infusions were stopped and the catheters removed. The total administered dose of alteplase was 40\u2009mg. The patient was then commenced on split treatment dose dalteparin and converted to apixaban prior to discharge.']} | Catheter-directed thrombolysis to treat acute pulmonary thrombosis in a patient with COVID-19 pneumonia | [
"haematology (incl blood transfusion)",
"pneumonia (infectious disease)",
"interventional radiology",
"radiology",
"pulmonary embolism"
] | BMJ Case Rep | 1597129200 | Many anatomical details and variants occur in the finger tendons and soft tissue structures. These may lead to misdiagnosis if the radiologist is not well aware of them. We discuss the midhand extensor tendons, dorsal hood, junctura tendinea, conjoint tendons, transverse retinacular ligament, triangular ligament as well as central and distal slip anatomy and ultrasound correlation. The dorsal hood is an important structure to center the tendons at the midportion of the MCP heads, and the sagittal bands are its main components. Two tendons are present at the second digit, and two or more at the fifth digit. The extensor mechanism is anatomically interrelated with the palmar lumbricals and interosseous tendons. At the palmar side, the flexor superficialis and profundus tendons show varying relationships along the finger. The flexor profundus passes through an opening in the flexor superficialis. We also discuss the chiasma crurale, ridges at the flexor superficialis insertions and bifid flexor profundus tendon. Although a typical distribution of annular pulleys can be observed, many variants may be present of which we address some. The volar plate is a midline fibro-cartilaginous meniscus attached proximally to the well-identifiable checkrein ligaments and distally to the base of the phalanges. Knowledge of these details and variations allows for better understanding of the finger and hand ultrasound. Many anatomical details and variants occur in the finger tendons and soft tissue structures. These may lead to misdiagnosis if the radiologist is not well aware of them. We discuss the midhand extensor tendons, dorsal hood, junctura tendinea, conjoint tendons, transverse retinacular ligament, triangular ligament as well as central and distal slip anatomy and ultrasound correlation. The dorsal hood is an important structure to center the tendons at the midportion of the MCP heads, and the sagittal bands are its main components. Two tendons are present at the second digit, and two or more at the fifth digit. The extensor mechanism is anatomically interrelated with the palmar lumbricals and interosseous tendons. At the palmar side, the flexor superficialis and profundus tendons show varying relationships along the finger. The flexor profundus passes through an opening in the flexor superficialis. We also discuss the chiasma crurale, ridges at the flexor superficialis insertions and bifid flexor profundus tendon. Although a typical distribution of annular pulleys can be observed, many variants may be present of which we address some. The volar plate is a midline fibro-cartilaginous meniscus attached proximally to the well-identifiable checkrein ligaments and distally to the base of the phalanges. Knowledge of these details and variations allows for better understanding of the finger and hand ultrasound. | [] | other | PMC7418852 | null | 8 | [
"{'Citation': 'Chiavaras MM, Jacobson JA, Yablon CM, Brigido MK, Girish G: Pitfalls in wrist and hand ultrasound. AJR Am J Roentgenol 2014; 203: 531–540.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '25148155'}}}",
"{'Citation': 'Starr HM Jr, Sedgley MD, Means KR Jr, Murphy MS: Ultrasonography for hand and wrist conditions. J Am Acad Orthop Surg 2016; 24: 544–554.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '27355280'}}}",
"{'Citation': 'Tagliafico A, Rubino M, Autuori A, Bianchi S, Martinoli C: Wrist and hand ultrasound. Semin Musculoskelet Radiol 2007; 11: 95–104.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18095242'}}}",
"{'Citation': 'Bianchi S, Martinoli C, Sureda D, Rizzatto G: Ultrasound of the hand. Eur J Ultrasound 2001; 14: 29–34.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11567852'}}}",
"{'Citation': 'Kichouh M, De Maeseneer M, Jager T, Marcelis S, Van Hedent E, Van Roy P et al. : Ultrasound findings in injuries of dorsal extensor hood: correlation with MR and follow-up findings. Eur J Radiol 2011; 77: 249–253.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '20566255'}}}",
"{'Citation': 'De Maeseneer M, Marcelis S, Jager T, Lenchik L, Pouders C, Van Roy P: Sonography of the finger flexor and extensor system at the hand and wrist level: findings in volunteers and anatomical correlation in cadavers. Eur Radiol 2008; 18: 600–607.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17929023'}}}",
"{'Citation': 'Meng J, Willekens I, Cattrysse E, Vereecke E, Geers C, Van Cauteren T et al. : Bony palmar ridges of the phalanges of the human fingers. Surg Radiol Anat 2014; 36: 587–593.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '24190676'}}}",
"{'Citation': 'McNally EG: Ultrasound of the small joints of the hands and feet: current status. Skeletal Radiol 2008; 37: 99–113.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2141652'}, {'@IdType': 'pubmed', '#text': '17712556'}]}}"
] | BMJ Case Rep. 2020 Aug 11; 13(8):e237046 | NO-CC CODE |
|
(Left) T1-weighted; (right) T1-weighted, contrast-enhanced magnetic resonance images showing an extradural posterior mass at the levels of thoracic vertebrae T2, T3, and T4. Note the bright T1 signal, considered as classic for this pathology. | 10-1055-s-0033-1354251-i1300025-1 | 7 | 2098b4ddee8f22d58a5c0c7c6642ac79739af98ce0d9833b0065441839686040 | 10-1055-s-0033-1354251-i1300025-1.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
800,
472
] | [{'image_id': '10-1055-s-0033-1354251-i1300025-3', 'image_file_name': '10-1055-s-0033-1354251-i1300025-3.jpg', 'image_path': '../data/media_files/PMC3908985/10-1055-s-0033-1354251-i1300025-3.jpg', 'caption': 'Histologic specimen (hematoxylin and eosin); (left) original magnification\u2009×100; (right) original magnification\u2009×200.', 'hash': '287d34323143bc820e5eed6f1f8af34bdccfc6395eda299a0b488d08a7b30264'}, {'image_id': '10-1055-s-0033-1354251-i1300025-2', 'image_file_name': '10-1055-s-0033-1354251-i1300025-2.jpg', 'image_path': '../data/media_files/PMC3908985/10-1055-s-0033-1354251-i1300025-2.jpg', 'caption': 'Axial magnetic resonance image, showing a bilateral tumor extension toward intervertebral foramina.', 'hash': 'f238b5dcecb81b03ce3c23609c8c18ef006d07368defc291518892e841e3583b'}, {'image_id': '10-1055-s-0033-1354251-i1300025-1', 'image_file_name': '10-1055-s-0033-1354251-i1300025-1.jpg', 'image_path': '../data/media_files/PMC3908985/10-1055-s-0033-1354251-i1300025-1.jpg', 'caption': '(Left) T1-weighted; (right) T1-weighted, contrast-enhanced magnetic resonance images showing an extradural posterior mass at the levels of thoracic vertebrae T2, T3, and T4. Note the bright T1 signal, considered as classic for this pathology.', 'hash': '2098b4ddee8f22d58a5c0c7c6642ac79739af98ce0d9833b0065441839686040'}] | {'10-1055-s-0033-1354251-i1300025-1': ['MRI showed an extradural mass situated posteriorly at the level of three thoracic vertebrae (T2 to T4); the mass was isointense on T1-weighted images, hyperintense on T2-weighted images, and enhanced homogenously upon intravenous gadolinium administration (T1-weighted images; <xref rid="10-1055-s-0033-1354251-i1300025-1" ref-type="fig">Fig. 1</xref>). Axial projections showed an extension bilaterally of the mass toward the intervertebral foramina, which involved two spinal levels (). Axial projections showed an extension bilaterally of the mass toward the intervertebral foramina, which involved two spinal levels (<xref rid="10-1055-s-0033-1354251-i1300025-2" ref-type="fig">Fig. 2</xref>).).'], '10-1055-s-0033-1354251-i1300025-3': ['Histologic examination demonstrated a highly vascular tumor, composed of vessels of various calibers (<xref rid="10-1055-s-0033-1354251-i1300025-3" ref-type="fig">Fig. 3</xref>). The vessel walls were internally lined from endothelium with a total lack of smooth muscular elements; continuous basal lamina participated in the lobular architecture of the entire structure. No mitotic activity or cellular atypia was seen. The histologic diagnosis was that of a lobular capillary hemangioma. The lesion presented separated lobules, each of them fed from a vessel by itself.). The vessel walls were internally lined from endothelium with a total lack of smooth muscular elements; continuous basal lamina participated in the lobular architecture of the entire structure. No mitotic activity or cellular atypia was seen. The histologic diagnosis was that of a lobular capillary hemangioma. The lesion presented separated lobules, each of them fed from a vessel by itself.']} | Case Study of a Spinal Epidural Capillary Hemangioma: A 4-Year Postoperative Follow-Up | [
"capillary hemangioma",
"epidural mass",
"spinal cord",
"paraparesis"
] | Global Spine J | 1393056000 | Study Design Case study. Objectives We report the case of a 58-year-old Caucasian man, who presented with a 4-month history of increasing low back pain and gait difficulty. Objective neurologic examination revealed a severe paraparetic symptomatology without any sphincter involvement. Methods Spinal magnetic resonance imaging (MRI) showed an extradural mass formation situated dorsally at the level of thoracic vertebrae T2 to T4. Results A laminectomy was performed with total removal of the mass; histology suggested a highly vascularized lesion with lobular architecture, which seems a very rare case, compatible with a capillary hemangioma. Conclusions A careful follow-up for the next 4 years, including control MRIs every postoperative year, showed a very good neurologic condition of the patient and no recurrence on imaging findings. | [] | other | PMC3908985 | null | 25 | [
"{'Citation': 'Hasan A, Guiot M C, Torres C, Marcoux J. A case of a spinal epidural capillary hemangioma: case report. Neurosurgery. 2011;68:E850–E853.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21311280'}}}",
"{'Citation': 'Bergstrand A, Hoeoek O, Lidvall H. Vascular malformations of the spinal cord. Acta Neurol Scand. 1964;40:169–183.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14131793'}}}",
"{'Citation': \"Garcin R, Laprèsle J. Sur une observation d'angiome de la moelle dorsale s'étant manifesté cliniquement pendant 24 ans sous les traits d'une paraplegie spasmodique d'etiologie indeterminée. Cesk Neurol. 1965;28:95–99.\", 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14328294'}}}",
"{'Citation': 'Abe M, Tabuchi K, Tanaka S. et al.Capillary hemangioma of the central nervous system. J Neurosurg. 2004;101:73–81.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15255254'}}}",
"{'Citation': 'Roncaroli F Scheithauer B W Krauss W E Capillary hemangioma of the spinal cord. Report of four cases J Neurosurg 200093(1, Suppl):148–151.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10879774'}}}",
"{'Citation': 'Kapadia S B, Heffner D K. Pitfalls in the histopathologic diagnosis of pyogenic granuloma. Eur Arch Otorhinolaryngol. 1992;249:195–200.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1642875'}}}",
"{'Citation': 'Badinand B, Morel C, Kopp N, Tran Min V A, Cotton F. Dumbbell-shaped epidural capillary hemangioma. AJNR Am J Neuroradiol. 2003;24:190–192.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7974117'}, {'@IdType': 'pubmed', '#text': '12591632'}]}}",
"{'Citation': 'Holtzman R N Brisson P M Pearl R E Gruber M L Lobular capillary hemangioma of the cauda equina. Case report J Neurosurg 199990(2, Suppl):239–241.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10199255'}}}",
"{'Citation': 'Shilton H, Goldschlager T, Kelman A, Xenos C. Delayed post-traumatic capillary haemangioma of the spine. J Clin Neurosci. 2011;18:1546–1547.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21871810'}}}",
"{'Citation': 'Kasukurthi R, Ray W Z, Blackburn S L, Lusis E A, Santiago P. Intramedullary capillary hemangioma of the thoracic spine: case report and review of the literature. Rare Tumors. 2009;1:e10.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2994437'}, {'@IdType': 'pubmed', '#text': '21139881'}]}}",
"{'Citation': 'Cetinkal A, Colak A, Topuz K, Atabey C, Berber U. Capillary hemangioma of the cervical intervertebral disc. Eur Spine J. 2011;20 02:S157–S160.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3111516'}, {'@IdType': 'pubmed', '#text': '20490869'}]}}",
"{'Citation': 'Miri S M, Habibi Z, Hashemi M, Meybodi A T, Tabatabai S A. Capillary hemangioma of cauda equina: a case report. Cases J. 2009;2:80.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2633326'}, {'@IdType': 'pubmed', '#text': '19161627'}]}}",
"{'Citation': 'Chung S K, Nam T K, Park S W, Hwang S N. Capillary hemangioma of the thoracic spinal cord. J Korean Neurosurg Soc. 2010;48:272–275.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2966732'}, {'@IdType': 'pubmed', '#text': '21082058'}]}}",
"{'Citation': 'Kaneko Y, Yamabe K, Abe M. Rapid regrowth of a capillary hemangioma of the thoracic spinal cord. Neurol Med Chir (Tokyo) 2012;52:665–669.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '23006883'}}}",
"{'Citation': \"Vassal F, Péoc'h M, Nuti C. Epidural capillary hemangioma of the thoracic spine with proximal nerve root involvement and extraforaminal extension. Acta Neurochir (Wien) 2011;153:2279–2281.\", 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21822781'}}}",
"{'Citation': 'Tekin T, Bayrakli F, Simsek H, Colak A, Kutlay M, Demircan M N. Lumbar epidural capillary hemangioma presenting as lumbar disc herniation disease: case report. Spine. 2008;33:E795–E797.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18827685'}}}",
"{'Citation': 'Kang J S Lillehei K O Kleinschmidt-Demasters B K Proximal nerve root capillary hemangioma presenting as a lung mass with bandlike chest pain: case report and review of literature Surg Neurol 200665584–589., discussion 589', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16720181'}}}",
"{'Citation': 'Gupta S, Kumar S, Banerji D, Pandey R, Gujral R. Magnetic resonance imaging features of an epidural spinal haemangioma. Australas Radiol. 1996;40:342–344.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8826748'}}}",
"{'Citation': 'Antunes A, Beck M F, Strapasson A C, Franciscatto A C, Franzoi M. Extradural cavernous hemangioma of thoracic spine. Arq Neuropsiquiatr. 2011;69:720–721.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21877050'}}}",
"{'Citation': 'Hakan T Demir M Aker F Berkman M Pregnancy-related spinal epidural capillary-cavernous haemangioma: magnetic resonance imaging and differential diagnosis Australas Radiol 200751(Spec No):B6–B9.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17875161'}}}",
"{'Citation': 'Akhaddar A, Oukabli M, En-Nouali H, Boucetta M. Acute postpartum paraplegia caused by spinal extradural capillary hemangioma. Int J Gynaecol Obstet. 2010;108:75–76.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19782976'}}}",
"{'Citation': 'Hirsch N P, Child C S, Wijetilleka S A. Paraplegia caused by spinal angioma—possible association with epidural analgesia. Anesth Analg. 1985;64:937–940.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '4025857'}}}",
"{'Citation': 'Iglesias S, Ayerbe J, Sarasa J L, Sousa P, Torres C, Ruiz-Barnés P. Cavernoma raquídeo epidural en reloj de arena. Presentación de un caso y revisión de la literatura. Neurocirugia (Astur) 2008;19:248–253.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18654724'}}}",
"{'Citation': 'Lee J W, Cho E Y, Hong S H. et al.Spinal epidural hemangiomas: various types of MR imaging features with histopathologic correlation. AJNR Am J Neuroradiol. 2007;28:1242–1248.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7977664'}, {'@IdType': 'pubmed', '#text': '17698523'}]}}",
"{'Citation': 'Bloomer C W, Ackerman A, Bhatia R G. Imaging for spine tumors and new applications. Top Magn Reson Imaging. 2006;17:69–87.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17198224'}}}"
] | Global Spine J. 2014 Feb 22; 4(1):55-58 | NO-CC CODE |
|
A case of inhalational anthrax. A 56-year-old male postal worker with a 3-day history of fever, chills, chest heaviness, malaise, and minimally productive cough. a Scout image from a chest CT reveals mediastinal widening and bilateral hilar enlargement. b Unenhanced chest CT (mediastinal window) through the middle lobe reveals enlarged hyperdense hemorrhagic lymph nodes in the subcarinal region (arrow) and the left hilum (arrowhead). There are bilateral pleural effusions. c Chest CT (lung window) through the right upper lobe bronchus shows bilateral pleural effusions and strikingly normal lung parenchyma. d Chest CT (enhanced) obtained 4 days after the first examination reveals massive enlargement of subcarinal (arrow) and left hilar lymph nodes (arrowhead) which distort the left pulmonary artery (images courtesy of Inova Health System/Inova Fairfax Hospital) | 10140_2009_849_Fig2_HTML | 7 | f3a87dc31558923894c1a4e32446965360dae318a70b6ee0aabf96d08c41f6a1 | 10140_2009_849_Fig2_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
548,
403
] | [{'image_id': '10140_2009_849_Fig10_HTML', 'image_file_name': '10140_2009_849_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig10_HTML.jpg', 'caption': 'Work flowchart for imaging of victims of blast injury includes radiography, focused abdominal sonography for trauma (FAST), CT, and angiography. ER emergency room (image courtesy of www.radiology.rsnajnls.org)', 'hash': '46f94a17b884dc80377dadfac2260135fe6d7fda6a24fde237d0ec63201e3735'}, {'image_id': '10140_2009_849_Fig17_HTML', 'image_file_name': '10140_2009_849_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig17_HTML.jpg', 'caption': 'Secondary blast injury. Transverse CT scan of pelvis of a 40-year-old woman after administration of rectal contrast material. Shrapnel is noted on the left (thick arrow); however, it has penetrated and caused a rectal tear, as shown by extraluminal contrast material (thin arrows) (image courtesy of www.radiology.rsnajnls.org)', 'hash': 'edcecb85ff840dfad76a1f8680fb2babb72f40be72d28ad155d723eecd581cb6'}, {'image_id': '10140_2009_849_Fig8_HTML', 'image_file_name': '10140_2009_849_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig8_HTML.jpg', 'caption': 'Smoke inhalation resulting in carbon monoxide poisoning. Unenhanced MRI images of the brain reveal low signal lesions bilaterally within the globus pallidus on T1 imaging (a), with corresponding high signal seen within the same region on the T2 image (b) (images courtesy of Steven Goldstein, MD)', 'hash': 'c2a745bed2851e9f8e2f0a78717e70785fcec9906824d9baaad43abc1d568a4b'}, {'image_id': '10140_2009_849_Fig7_HTML', 'image_file_name': '10140_2009_849_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig7_HTML.jpg', 'caption': 'Chest radiograph of patient with ARDS characterized by inflammation of the lung parenchyma with bilateral alveolar infiltrates (image courtesy of www.en.wikpedia.org; Author: Samir 04:51, 17 September 2007 (UTC), modified by Delldot 07:55, 28 April 2008 (UTC). Permission: GFDL', 'hash': '16f56395934e6ace5377f3cf8bbbbdb0ba96e8b20f82e1e6c358cd903f140c39'}, {'image_id': '10140_2009_849_Fig1_HTML', 'image_file_name': '10140_2009_849_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig1_HTML.jpg', 'caption': 'Blast injury to lungs. a Initial chest radiograph shows bilateral perihilar pulmonary infiltrates in butterfly pattern. b Follow-up radiograph shows further deterioration with complete whitening of the lungs (images courtesy of www.ajronline.org)', 'hash': 'f0e62d888d678d4f6bd9dab85d192fa201cc3de23f1ff7cbc421d1fd61e32713'}, {'image_id': '10140_2009_849_Fig11_HTML', 'image_file_name': '10140_2009_849_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig11_HTML.jpg', 'caption': 'Primary blast injury. Frontal chest radiograph obtained in a 24-year-old woman several hours after blast injury shows bilateral opacities in a butterfly distribution, representing pulmonary contusion (image courtesy of www.radiology.rsnajnls.org)', 'hash': 'bc3754d52db085f5490ad014a0ade127fe60a11b282c1317a814659397771260'}, {'image_id': '10140_2009_849_Fig6_HTML', 'image_file_name': '10140_2009_849_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig6_HTML.jpg', 'caption': 'Pneumonic plague. This anteroposterior X-ray reveals the resolution of a plague infection with clearing of the lungs (image courtesy of CDC Public Health Image Library (ID no. 4135))', 'hash': '38df4e709fddc524dab97131cc634e2a73ee7c0a9098bd9eaaa4170cf9c51dce'}, {'image_id': '10140_2009_849_Fig9_HTML', 'image_file_name': '10140_2009_849_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig9_HTML.jpg', 'caption': 'Chlorine gas exposure resulting in ARDS or pulmonary edema. a Frontal chest radiograph obtained 36\xa0h after an accidental chlorine gas exposure at a community swimming pool showed diffuse small nodular opacities [14]. b Thin-section computed tomogram of the chest demonstrated ill-defined centrilobular nodules along the peribronchovascular structure, particularly in the dependent portions of the lungs, as well as mild air trapping, without bronchial wall thickening or bronchiectasis—findings consistent with diffuse bronchiolitis [14] (image courtesy of Respiratory Care Journal, 2004)', 'hash': 'fa05ced66298fd9c080bac42c756fb11637355cec0a5e02fa1d77a620a1835b6'}, {'image_id': '10140_2009_849_Fig16_HTML', 'image_file_name': '10140_2009_849_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig16_HTML.jpg', 'caption': 'Secondary blast injury. Multiple soft tissue injuries to the left arm and hand of a 40-year-old terror attack victim. a Lateral radiograph of the arm shows shrapnel and comminuted fractures of the humerus, radius, and ulna. b Lateral digital subtraction angiogram of the arm demonstrates spasm (arrows) of the vessels, without bleeding. c Anteroposterior non-subtracted angiogram of the hand shows multiple shrapnel and a thin radial artery (arrow) (images courtesy of www.radiology.rsnajnls.org)', 'hash': 'eef2642729bcdbc076340891e1613e5208110d59556f401d173a1610c687d3ba'}, {'image_id': '10140_2009_849_Fig15_HTML', 'image_file_name': '10140_2009_849_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig15_HTML.jpg', 'caption': 'Secondary blast injury resulting in penetrating neck trauma. a Coronal multiplanar CT reconstruction shows metal object in left side of the neck. b Transverse CT scan at level of the object demonstrates soft tissue damage and fractures of the lamina. Arrow suspected trajectory of the shrapnel (images courtesy of www.radiology.rsnajnls.org)', 'hash': 'faf23b602a9952da02a0f65e1ab55867bcbd814613b7bd82be160ed8ca570e39'}, {'image_id': '10140_2009_849_Fig5_HTML', 'image_file_name': '10140_2009_849_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig5_HTML.jpg', 'caption': 'Pneumonic plague. This anteroposterior X-ray reveals a bilaterally progressive plague infection involving both lungs (image courtesy of CDC Public Health Image Library (ID no. 4136))', 'hash': 'f068760c4e47a2e7ee1784571583107a738e3b537b1a520e7cf89154edf041bb'}, {'image_id': '10140_2009_849_Fig12_HTML', 'image_file_name': '10140_2009_849_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig12_HTML.jpg', 'caption': 'Secondary blast injury. a CT scout view shows metallic object (arrow) projected over the mediastinum in a 35-year-old blast victim. b Sagittal multiplanar CT reconstruction demonstrates that this object (arrows) is located in the deep soft tissues (images courtesy of www.radiology.rsnajnls.org)', 'hash': '10c65060ee1d262b6fa8995ae2d6ec7edef0a565d6ef7a6c1bc7dc7fd36529af'}, {'image_id': '10140_2009_849_Fig2_HTML', 'image_file_name': '10140_2009_849_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig2_HTML.jpg', 'caption': 'A case of inhalational anthrax. A 56-year-old male postal worker with a 3-day history of fever, chills, chest heaviness, malaise, and minimally productive cough. a Scout image from a chest CT reveals mediastinal widening and bilateral hilar enlargement. b Unenhanced chest CT (mediastinal window) through the middle lobe reveals enlarged hyperdense hemorrhagic lymph nodes in the subcarinal region (arrow) and the left hilum (arrowhead). There are bilateral pleural effusions. c Chest CT (lung window) through the right upper lobe bronchus shows bilateral pleural effusions and strikingly normal lung parenchyma. d Chest CT (enhanced) obtained 4\xa0days after the first examination reveals massive enlargement of subcarinal (arrow) and left hilar lymph nodes (arrowhead) which distort the left pulmonary artery (images courtesy of Inova Health System/Inova Fairfax Hospital)', 'hash': 'f3a87dc31558923894c1a4e32446965360dae318a70b6ee0aabf96d08c41f6a1'}, {'image_id': '10140_2009_849_Fig4_HTML', 'image_file_name': '10140_2009_849_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig4_HTML.jpg', 'caption': 'Pneumonic plague. Radiograph shows extensive lobar consolidation in left lower and left mid-lung fields (image from Centers for Disease Control and Prevention, Division of Vector-Borne Infectious Diseases, Fort Collins, CO)', 'hash': '5138d29c4416da5c30d6a145b5a7d8dd36f3f9a03b8fd5335e45519ef3e8af10'}, {'image_id': '10140_2009_849_Fig14_HTML', 'image_file_name': '10140_2009_849_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig14_HTML.jpg', 'caption': 'Secondary blast injury. a Coronal CT scout image of upper abdomen demonstrates a single metal object (arrow) projected over the liver. b, c Transverse CT scan images of the abdomen reveal the anterior-to-posterior trajectory of this shrapnel. The object (arrow in c) is located in posterior paraspinal region after causing liver laceration (arrows in b) (images courtesy of www.radiology.rsnajnls.org)', 'hash': 'b233f260a9580c9cb48decd21aaf1aae73c2954a070c75848efa6d1933c494f6'}, {'image_id': '10140_2009_849_Fig3_HTML', 'image_file_name': '10140_2009_849_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig3_HTML.jpg', 'caption': 'Pandemic influenza. a Initial chest radiograph showed left upper lobe pneumonia. b Follow-up chest radiograph revealed worsening of the left upper lobe consolidation, with new right apical airspace opacities. The patient’s clinical condition fluctuated from day to day, as did his radiological findings, with gradual deterioration until his death (images courtesy of Canadian Medical Association Journal, 1969)', 'hash': 'ae5d36d9e24b4e07f50353e106c6d1811c6535ea86d03db1528b291ad8ae1beb'}, {'image_id': '10140_2009_849_Fig13_HTML', 'image_file_name': '10140_2009_849_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC7101611/10140_2009_849_Fig13_HTML.jpg', 'caption': 'Secondary blast injury. Coronal whole-body CT scout image demonstrates multiple metal objects projected over the chest. Two additional metal objects (arrows) that had not previously been noted on conventional chest radiographs are seen projected over the neck and mid-abdomen (image courtesy of www.radiology.rsnajnls.org)', 'hash': 'e90bf1989d35163bc59bc0f0815fc615698465fc92fd8e57454f5e05c1447714'}] | {'10140_2009_849_Fig1_HTML': ['In the first scenario, a 10-kiloton nuclear device is detonated in the central business district of a large American city. Most of the buildings within 1,000\xa0m (∼3,200\xa0ft) of the detonation will be severely damaged. Subsequent injuries from flying debris (missiles) will possibly be observed out to 6\xa0km (∼3.7\xa0miles) [1]. Patients will present primarily with burns to exposed skin and eyes (flash burns), projectile, crush, and translational injuries (Fig.\xa0<xref rid="10140_2009_849_Fig1_HTML" ref-type="fig">1</xref>) as well as acute radiation syndrome [) as well as acute radiation syndrome [1]. Gas-filled organs such as the ears, lungs, and gastrointestinal tract will be the most vulnerable to the blast effect, with lung injury as the primary cause of morbidity and mortality. Individuals directly exposed to the radiation will result in additional long-term health care sequelae. Many of these victims will have an increased future risk of developing subsequent malignant neoplasms. Of these malignancies, leukemia is the most likely; however, some patients may also develop thyroid, breast, lung, or salivary gland cancer [2]. In addition to providing immediate trauma imaging assistance, radiologists may be asked to provide expert advice in concert with a health physicist (if available) to assist with radiation detection, patient triage, decontamination, and management of the victims of acute radiation syndrome.\nFig.\xa01Blast injury to lungs. a Initial chest radiograph shows bilateral perihilar pulmonary infiltrates in butterfly pattern. b Follow-up radiograph shows further deterioration with complete whitening of the lungs (images courtesy of www.ajronline.org)\n'], '10140_2009_849_Fig2_HTML': ['Assuming more than 300,000 exposures, one could expect the possibility of more than 13,000 infections—almost all which could be fatal. The most common presenting physical symptoms would be malaise, fever, cough, nausea, and vomiting. Night sweats, chest pain, tachycardia, and headache may also be seen in many of the patients [3]. Patients may present with respiratory distress without radiographic findings of pneumonia, a history of trauma, or chronic lung disease. Radiologists would be at the forefront of diagnosing such an anthrax outbreak by detecting abnormal chest radiographic findings such as mediastinal widening, pleural effusions, pulmonary consolidation, and mediastinal or hilar lymphadenopathy (Fig.\xa0<xref rid="10140_2009_849_Fig2_HTML" ref-type="fig">2</xref>). CT findings such as hemorrhagic mediastinitis and lymphadenitis could be additionally observed [). CT findings such as hemorrhagic mediastinitis and lymphadenitis could be additionally observed [4].\nFig.\xa02A case of inhalational anthrax. A 56-year-old male postal worker with a 3-day history of fever, chills, chest heaviness, malaise, and minimally productive cough. a Scout image from a chest CT reveals mediastinal widening and bilateral hilar enlargement. b Unenhanced chest CT (mediastinal window) through the middle lobe reveals enlarged hyperdense hemorrhagic lymph nodes in the subcarinal region (arrow) and the left hilum (arrowhead). There are bilateral pleural effusions. c Chest CT (lung window) through the right upper lobe bronchus shows bilateral pleural effusions and strikingly normal lung parenchyma. d Chest CT (enhanced) obtained 4\xa0days after the first examination reveals massive enlargement of subcarinal (arrow) and left hilar lymph nodes (arrowhead) which distort the left pulmonary artery (images courtesy of Inova Health System/Inova Fairfax Hospital)\n'], '10140_2009_849_Fig3_HTML': ['Using chest radiography and CT scanning, radiologists will be required to provide prompt diagnosis, assist in determining disease extent and severity, help monitor treatment response, and to assist in assessing for treatment complications [5]. Radiographic findings on chest films could include bronchopneumonia, segmental atelectasis, consolidation, or consolidation with effusion (Fig.\xa0<xref rid="10140_2009_849_Fig3_HTML" ref-type="fig">3</xref>) [) [6], with similar findings on CT.\nFig.\xa03Pandemic influenza. a Initial chest radiograph showed left upper lobe pneumonia. b Follow-up chest radiograph revealed worsening of the left upper lobe consolidation, with new right apical airspace opacities. The patient’s clinical condition fluctuated from day to day, as did his radiological findings, with gradual deterioration until his death (images courtesy of Canadian Medical Association Journal, 1969)\n'], '10140_2009_849_Fig4_HTML': ['The presenting symptoms of pneumonic plague include fever, headache, weakness, shortness of breath, chest pain, cough, and sometimes bloody or watery sputum. Pneumonia develops rapidly and eventually progresses after 2 to 4\xa0days into respiratory failure and shock. In contrast to secondary pneumonic plague, a feature of primary pneumonic plague includes the absence of buboes (except, rarely, cervical buboes). On pathologic examination, there is severe pulmonary disease, with areas of profound lobular exudation and bacillary aggregation. Prominent gastrointestinal symptoms may present, to include nausea, vomiting, abdominal pain, and diarrhea [7]. The sudden appearance of a large number of previously healthy patients with fever, cough, shortness of breath, chest pain, and a fulminant fatal course should suggest the possibility of pneumonic plague or inhalational anthrax [7]. Radiographic findings are variable, but most commonly include bilateral parenchymal consolidations, mediastinal, cervical, or hilar adenopathy, all of which may be present in both the bubonic and pneumonic forms of plague (Figs.\xa0<xref rid="10140_2009_849_Fig4_HTML" ref-type="fig">4</xref>, , <xref rid="10140_2009_849_Fig5_HTML" ref-type="fig">5</xref>, and , and <xref rid="10140_2009_849_Fig6_HTML" ref-type="fig">6</xref>) [) [7].\nFig.\xa04Pneumonic plague. Radiograph shows extensive lobar consolidation in left lower and left mid-lung fields (image from Centers for Disease Control and Prevention, Division of Vector-Borne Infectious Diseases, Fort Collins, CO)\nFig.\xa05Pneumonic plague. This anteroposterior X-ray reveals a bilaterally progressive plague infection involving both lungs (image courtesy of CDC Public Health Image Library (ID no. 4136))\nFig.\xa06Pneumonic plague. This anteroposterior X-ray reveals the resolution of a plague infection with clearing of the lungs (image courtesy of CDC Public Health Image Library (ID no. 4135))\n'], '10140_2009_849_Fig7_HTML': ['In addition to the specific radiological findings of blast trauma (which will be discussed later in scenario 12), chest radiographs of patients suffering from primary blast injury often present with symptoms of ARDS, which is usually characterized by bilateral alveolar infiltrates (Fig.\xa0<xref rid="10140_2009_849_Fig7_HTML" ref-type="fig">7</xref>). Smoke inhalation injury may result in carbon monoxide poisoning, with CT and MRI demonstrating characteristic findings. CT scans are usually positive within 24\xa0h, and MRI demonstrates findings even sooner. On MRI, carbon monoxide poisoning produces low or high signal intensity foci on T1-weighted sequences and high intensity foci on T2-weighted sequences within the globus pallidus bilaterally (Fig.\xa0). Smoke inhalation injury may result in carbon monoxide poisoning, with CT and MRI demonstrating characteristic findings. CT scans are usually positive within 24\xa0h, and MRI demonstrates findings even sooner. On MRI, carbon monoxide poisoning produces low or high signal intensity foci on T1-weighted sequences and high intensity foci on T2-weighted sequences within the globus pallidus bilaterally (Fig.\xa0<xref rid="10140_2009_849_Fig8_HTML" ref-type="fig">8</xref>). A characteristic CT finding is bilaterally symmetric low attenuation lesions within the globus palladi. There may also be low-density lesions in the cerebral and cerebellar white matter, with sparing of the subcortical fibers [). A characteristic CT finding is bilaterally symmetric low attenuation lesions within the globus palladi. There may also be low-density lesions in the cerebral and cerebellar white matter, with sparing of the subcortical fibers [8].\nFig.\xa07Chest radiograph of patient with ARDS characterized by inflammation of the lung parenchyma with bilateral alveolar infiltrates (image courtesy of www.en.wikpedia.org; Author: Samir 04:51, 17 September 2007 (UTC), modified by Delldot 07:55, 28 April 2008 (UTC). Permission: GFDL\nFig.\xa08Smoke inhalation resulting in carbon monoxide poisoning. Unenhanced MRI images of the brain reveal low signal lesions bilaterally within the globus pallidus on T1 imaging (a), with corresponding high signal seen within the same region on the T2 image (b) (images courtesy of Steven Goldstein, MD)\n'], '10140_2009_849_Fig9_HTML': ['Patients affected by such an attack will often suffer from ARDS or pulmonary edema. Chest radiographs may show vascular congestion, consolidation, and nodules, as well as pulmonary edema in severe cases (Fig.\xa0<xref rid="10140_2009_849_Fig9_HTML" ref-type="fig">9</xref>). Radiographic changes will often clear within 1\xa0week, however may persist for up to 10\xa0weeks in the more severe of cases. The majority of the injured will recover in approximately 7 to 14\xa0days, with the exception of those with severe lung damage who will require long-term monitoring and treatment [). Radiographic changes will often clear within 1\xa0week, however may persist for up to 10\xa0weeks in the more severe of cases. The majority of the injured will recover in approximately 7 to 14\xa0days, with the exception of those with severe lung damage who will require long-term monitoring and treatment [9, 10].\nFig.\xa09Chlorine gas exposure resulting in ARDS or pulmonary edema. a Frontal chest radiograph obtained 36\xa0h after an accidental chlorine gas exposure at a community swimming pool showed diffuse small nodular opacities [14]. b Thin-section computed tomogram of the chest demonstrated ill-defined centrilobular nodules along the peribronchovascular structure, particularly in the dependent portions of the lungs, as well as mild air trapping, without bronchial wall thickening or bronchiectasis—findings consistent with diffuse bronchiolitis [14] (image courtesy of Respiratory Care Journal, 2004)\n'], '10140_2009_849_Fig12_HTML': ['Of particular interest to this scenario, terrorists and insurgents often add metallic objects to their IEDS in order to inflict more trauma, which may include nails, screws, bolts, and ball bearings (Fig.\xa0<xref rid="10140_2009_849_Fig12_HTML" ref-type="fig">12</xref>). These objects readily penetrate the body at a high speed, lacerating the organs that they pass through as well as producing injury secondary to the associated shock wave as is often seen in bullet injuries. The result of these differing mechanisms is that victims often have combined blast and shrapnel injuries, requiring a multimodality approach to imaging [). These objects readily penetrate the body at a high speed, lacerating the organs that they pass through as well as producing injury secondary to the associated shock wave as is often seen in bullet injuries. The result of these differing mechanisms is that victims often have combined blast and shrapnel injuries, requiring a multimodality approach to imaging [14].', 'Multisection helical CT scans reveal the true course a penetrating object has traveled as well as the full scope of a patient’s injuries (Figs.\xa0<xref rid="10140_2009_849_Fig12_HTML" ref-type="fig">12</xref>, , <xref rid="10140_2009_849_Fig13_HTML" ref-type="fig">13</xref>, and , and <xref rid="10140_2009_849_Fig14_HTML" ref-type="fig">14</xref>) [) [14]. Therefore, it is important to perform CT in all patients with penetrating shrapnel injuries caused by an explosion and is particularly important in patients with penetrating head and neck injuries (Fig.\xa0<xref rid="10140_2009_849_Fig15_HTML" ref-type="fig">15</xref>) due to the potential for extensive devastating injuries. CT angiography may be additionally used if there is a possibility of vascular injury (Fig.\xa0) due to the potential for extensive devastating injuries. CT angiography may be additionally used if there is a possibility of vascular injury (Fig.\xa0<xref rid="10140_2009_849_Fig16_HTML" ref-type="fig">16</xref>), as well as in the case of a foreign body positioned within the neck near a large vessel. CT with contrast should also be used in cases of shrapnel in and around the pelvis in order to evaluate the trajectory of the objects and involvement of adjacent bowel (Fig.\xa0), as well as in the case of a foreign body positioned within the neck near a large vessel. CT with contrast should also be used in cases of shrapnel in and around the pelvis in order to evaluate the trajectory of the objects and involvement of adjacent bowel (Fig.\xa0<xref rid="10140_2009_849_Fig17_HTML" ref-type="fig">17</xref>) [) [14].\nFig.\xa012Secondary blast injury. a CT scout view shows metallic object (arrow) projected over the mediastinum in a 35-year-old blast victim. b Sagittal multiplanar CT reconstruction demonstrates that this object (arrows) is located in the deep soft tissues (images courtesy of www.radiology.rsnajnls.org)\nFig.\xa013Secondary blast injury. Coronal whole-body CT scout image demonstrates multiple metal objects projected over the chest. Two additional metal objects (arrows) that had not previously been noted on conventional chest radiographs are seen projected over the neck and mid-abdomen (image courtesy of www.radiology.rsnajnls.org)\nFig.\xa014Secondary blast injury. a Coronal CT scout image of upper abdomen demonstrates a single metal object (arrow) projected over the liver. b, c Transverse CT scan images of the abdomen reveal the anterior-to-posterior trajectory of this shrapnel. The object (arrow in c) is located in posterior paraspinal region after causing liver laceration (arrows in b) (images courtesy of www.radiology.rsnajnls.org)\nFig.\xa015Secondary blast injury resulting in penetrating neck trauma. a Coronal multiplanar CT reconstruction shows metal object in left side of the neck. b Transverse CT scan at level of the object demonstrates soft tissue damage and fractures of the lamina. Arrow suspected trajectory of the shrapnel (images courtesy of www.radiology.rsnajnls.org)\nFig.\xa016Secondary blast injury. Multiple soft tissue injuries to the left arm and hand of a 40-year-old terror attack victim. a Lateral radiograph of the arm shows shrapnel and comminuted fractures of the humerus, radius, and ulna. b Lateral digital subtraction angiogram of the arm demonstrates spasm (arrows) of the vessels, without bleeding. c Anteroposterior non-subtracted angiogram of the hand shows multiple shrapnel and a thin radial artery (arrow) (images courtesy of www.radiology.rsnajnls.org)\nFig.\xa017Secondary blast injury. Transverse CT scan of pelvis of a 40-year-old woman after administration of rectal contrast material. Shrapnel is noted on the left (thick arrow); however, it has penetrated and caused a rectal tear, as shown by extraluminal contrast material (thin arrows) (image courtesy of www.radiology.rsnajnls.org)\n'], '10140_2009_849_Fig10_HTML': ['The modalities involved in imaging victims of blast injury include conventional radiography, focused abdominal sonography, CT scanning, and angiography (Fig.\xa0<xref rid="10140_2009_849_Fig10_HTML" ref-type="fig">10</xref>). Common radiologic findings within the chest may include pulmonary contusions, which appear as airspace opacities on radiographs and consolidations on CT scans (Fig.\xa0). Common radiologic findings within the chest may include pulmonary contusions, which appear as airspace opacities on radiographs and consolidations on CT scans (Fig.\xa0<xref rid="10140_2009_849_Fig11_HTML" ref-type="fig">11</xref>). These findings generally tend to clear over the course of approximately 1\xa0week. In addition, radiologic findings related to the chest secondary to blast injury would include pneumothorax, hemothorax, and hemopericardium [). These findings generally tend to clear over the course of approximately 1\xa0week. In addition, radiologic findings related to the chest secondary to blast injury would include pneumothorax, hemothorax, and hemopericardium [14].\nFig.\xa010Work flowchart for imaging of victims of blast injury includes radiography, focused abdominal sonography for trauma (FAST), CT, and angiography. ER emergency room (image courtesy of www.radiology.rsnajnls.org)\nFig.\xa011Primary blast injury. Frontal chest radiograph obtained in a 24-year-old woman several hours after blast injury shows bilateral opacities in a butterfly distribution, representing pulmonary contusion (image courtesy of www.radiology.rsnajnls.org)\n']} | Department of Homeland Security national planning scenarios: a spectrum of imaging findings to educate the radiologists | [
"Disaster",
"Homeland security",
"Terrorism",
"Blast injury",
"Nuclear",
"Biological"
] | Emerg Radiol | 1290240000 | The aim of this study was to estimate the prevalence of macrolide-resistant Mycoplasma pneumoniae in Taiwan and to compare the clinical courses of pediatric patients with macrolide-resistant (MR) M. pneumoniae and macrolide-susceptible (MS) M. pneumoniae infection. Patients were among the children admitted to Chang Gung Children's Hospital with mycoplasmal pneumonia between February and December 2011. Detection for macrolide resistance was performed after informed consent was obtained. We retrospectively reviewed medical records and compared the clinical courses of two groups of patients of 73 children enrolled into our study. The rate of macrolide resistance in M. pneumoniae was 12.3 %. Longer hospital stay was observed in the MR patients than MS patients [median, 7 days vs. 5 days (P = 0.019)]. Clinical features or radiographic or laboratory findings are not helpful to differentiate MR from MS mycoplasmal pneumonia. Early diagnosis of MR mycoplasmal pneumonia is crucial for the best management of these patients and obviates the need for extensive etiological searches of these nonresponding cases. | [
"Adolescent",
"Anti-Bacterial Agents",
"Child",
"Child, Preschool",
"DNA, Bacterial",
"Drug Resistance, Bacterial",
"Female",
"Genes, Bacterial",
"Hospitalization",
"Humans",
"Infant",
"Macrolides",
"Male",
"Microbial Sensitivity Tests",
"Mutation",
"Mycoplasma pneumoniae",
"Pharynx",
"Pneumonia, Mycoplasma",
"Prevalence",
"RNA, Ribosomal, 23S",
"Retrospective Studies",
"Taiwan",
"Treatment Outcome"
] | other | PMC7101611 | null | 14 | [
"{'Citation': 'Principi N, Esposito S, Blasi F, Allegra L. Role of Mycoplasma pneumoniae and Chlamydia pneumoniae in children with community-acquired lower respiratory tract infections. Clin Infect Dis. 2001;32:1281–1289. doi: 10.1086/319981.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1086/319981'}, {'@IdType': 'pubmed', '#text': '11303262'}]}}",
"{'Citation': 'Mulholland S, Gavranich JB, Chang AB. Antibiotics for community-acquired lower respiratory tract infections secondary to Mycoplasma pneumoniae in children. Cochrane Database Syst Rev 2010:CD004875.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '20614439'}}}",
"{'Citation': 'Morozumi M, Takahashi T, Ubukata K. Macrolide-resistant Mycoplasma pneumoniae: characteristics of isolates and clinical aspects of community-acquired pneumonia. J Infect Chemother. 2010;16:78–86. doi: 10.1007/s10156-009-0021-4.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s10156-009-0021-4'}, {'@IdType': 'pubmed', '#text': '20094751'}]}}",
"{'Citation': 'Cao B, Zhao CJ, Yin YD, Zhao F, Song SF, Bai L, et al. High prevalence of macrolide resistance in Mycoplasma pneumoniae isolates from adult and adolescent patients with respiratory tract infection in China. Clin Infect Dis. 2010;51:189–194. doi: 10.1086/653535.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1086/653535'}, {'@IdType': 'pubmed', '#text': '20540621'}]}}",
"{'Citation': 'Chironna M, Sallustio A, Esposito S, Perulli M, Chinellato I, Bari CD, et al. Emergence of macrolide-resistant strains during an outbreak of Mycoplasma pneumoniae infections in children. J Antimicrob Chemother. 2011;66:734–737. doi: 10.1093/jac/dkr003.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1093/jac/dkr003'}, {'@IdType': 'pubmed', '#text': '21393214'}]}}",
"{'Citation': 'Yamada M, Buller R, Bledsoe S, Storch GA. Rising rates of macrolide-resistant Mycoplasma pneumoniae in the central United States. Pediatr Infect Dis J. 2012;31:409–411. doi: 10.1097/INF.0b013e318247f3e0.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/INF.0b013e318247f3e0'}, {'@IdType': 'pubmed', '#text': '22209916'}]}}",
"{'Citation': 'Bebear CM, Pereyre S. Mechanisms of drug resistance in Mycoplasma pneumoniae. Curr Drug Targets Infect Disord. 2005;5:263–271. doi: 10.2174/1568005054880109.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.2174/1568005054880109'}, {'@IdType': 'pubmed', '#text': '16181145'}]}}",
"{'Citation': 'Hsieh YC, Tsao KC, Huang CG, Tong S, Winchell JM, Huang YC, et al. Life-threatening pneumonia caused by macrolide-resistant Mycoplasma pneumoniae. Pediatr Infect Dis J. 2011;31:208–209.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21941216'}}}",
"{'Citation': 'Chiou CC, Liu YC, Lin HH, Hsieh KS. Mycoplasma pneumoniae infection complicated by lung abscess, pleural effusion, thrombocytopenia and disseminated intravascular coagulation. Pediatr Infect Dis J. 1997;16:327–329. doi: 10.1097/00006454-199703000-00015.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00006454-199703000-00015'}, {'@IdType': 'pubmed', '#text': '9076825'}]}}",
"{'Citation': 'Wachowski O, Demirakca S, Muller KM, Scheurlen W. Mycoplasma pneumoniae associated organising pneumonia in a 10\\xa0year old boy. Arch Dis Child. 2003;88:270–272. doi: 10.1136/adc.88.3.270.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1136/adc.88.3.270'}, {'@IdType': 'pmc', '#text': 'PMC1719475'}, {'@IdType': 'pubmed', '#text': '12598403'}]}}",
"{'Citation': 'Wang RS, Wang SY, Hsieh KS, Chiou YH, Huang IF, Cheng MF, et al. Necrotizing pneumonitis caused by Mycoplasma pneumoniae in pediatric patients: report of five cases and review of literature. Pediatr Infect Dis J. 2004;23:564–567. doi: 10.1097/01.inf.0000130074.56368.4b.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/01.inf.0000130074.56368.4b'}, {'@IdType': 'pubmed', '#text': '15194841'}]}}",
"{'Citation': 'Wolff BJ, Thacker WL, Schwartz SB, Winchell JM. Detection of macrolide resistance in Mycoplasma pneumoniae by real-time PCR and high-resolution melt analysis. Antimicrob Agents Chemother. 2008;52:3542–3549. doi: 10.1128/AAC.00582-08.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1128/AAC.00582-08'}, {'@IdType': 'pmc', '#text': 'PMC2565909'}, {'@IdType': 'pubmed', '#text': '18644962'}]}}",
"{'Citation': 'Suzuki S, Yamazaki T, Narita M, Okazaki N, Suzuki I, Andoh T, et al. Clinical evaluation of macrolide-resistant Mycoplasma pneumoniae. Antimicrob Agents Chemother. 2006;50:709–712. doi: 10.1128/AAC.50.2.709-712.2006.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1128/AAC.50.2.709-712.2006'}, {'@IdType': 'pmc', '#text': 'PMC1366908'}, {'@IdType': 'pubmed', '#text': '16436730'}]}}",
"{'Citation': 'Matsubara K, Morozumi M, Okada T, Matsushima T, Komiyama O, Shoji M, et al. A comparative clinical study of macrolide-sensitive and macrolide-resistant Mycoplasma pneumoniae infections in pediatric patients. J Infect Chemother. 2009;15:380–383. doi: 10.1007/s10156-009-0715-7.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s10156-009-0715-7'}, {'@IdType': 'pubmed', '#text': '20012728'}]}}"
] | Emerg Radiol. 2010 Nov 20; 17(4):275-284 | NO-CC CODE |
|
C3-C4 and C7-T1 short segment enhancing lesions in central cord, T2 weighted (2.a) and T1 (2.b). | gr2_lrg | 7 | 9aa13568190aa869a7302af6225f32654d07de5deb528ed7e432537b1a179f37 | gr2_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
666,
474
] | [{'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC9273525/gr1_lrg.jpg', 'caption': "Multiple bilateral periventricular supratentorial lesions and sub cortical white matter hyper signal foci in T1 with gadolinium (1.a), FLAIR (1.b) and Dawson's fingers (1.c).", 'hash': 'd1fee71a1f32d07c31565c201edf5e07510bb99fbdad79c0c3b01db8cc680eaf'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC9273525/gr2_lrg.jpg', 'caption': 'C3-C4 and C7-T1 short segment enhancing lesions in central cord, T2 weighted (2.a) and T1 (2.b).', 'hash': '9aa13568190aa869a7302af6225f32654d07de5deb528ed7e432537b1a179f37'}] | {'gr1_lrg': ['With respect to magnetic resonance imaging (MRI) of the brain and cervical spine, multiple bilateral periventricular lesions and subcortical white matter, hyper signal foci were seen in fluid-attenuated inversion recovery (FLAIR) sequence (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>a) with peripheral incomplete ring enhancement in post-contrast images (a) with peripheral incomplete ring enhancement in post-contrast images (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>b). As it has been shown in b). As it has been shown in <xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>c, the lesion showed perpendicular orientation to the callosal axis (Dawson\'s finger). Brain stem and cerebellar hemispheres showed similar lesions. C3-C4 and C7-T1 short segment peripheral enhancing lesions were seen in T1 with gadolinium and T2 (c, the lesion showed perpendicular orientation to the callosal axis (Dawson\'s finger). Brain stem and cerebellar hemispheres showed similar lesions. C3-C4 and C7-T1 short segment peripheral enhancing lesions were seen in T1 with gadolinium and T2 (<xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>\n). Therefore, supratentorial, infratentorial, and cervical cord enhancing plaques confirmed an acute demyelinating process in favor of ADEM. These neuropathologic lesions are primary demyelinating process due to Para infection and no other findings in favor of other pathological processes were observed in imaging.\n). Therefore, supratentorial, infratentorial, and cervical cord enhancing plaques confirmed an acute demyelinating process in favor of ADEM. These neuropathologic lesions are primary demyelinating process due to Para infection and no other findings in favor of other pathological processes were observed in imaging.Figure 1Multiple bilateral periventricular supratentorial lesions and sub cortical white matter hyper signal foci in T1 with gadolinium (1.a), FLAIR (1.b) and Dawson\'s fingers (1.c).Figure 2C3-C4 and C7-T1 short segment enhancing lesions in central cord, T2 weighted (2.a) and T1 (2.b).']} | Acute disseminated encephalomyelitis (ADEM) following SARS-CoV-2 infection: A case report from Iran | null | None | None | None | null | other | PMC9273525 | null | null | [
""
] | 2022 Jul 12; doi: 10.1016/j.sedene.2022.06.003 | NO-CC CODE |
|
Coronal MIP image in the delayed phase showing the intraluminal tumour projection into the urinary bladder through the left vesicoureteric junction (arrow). | poljradiol-81-256-g004 | 7 | 78d53523d04812a141edbbe4b23b0d81b2156fd1aeb47eaf75ae4fd8fc91a84a | poljradiol-81-256-g004.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
600,
600
] | [{'image_id': 'poljradiol-81-256-g001', 'image_file_name': 'poljradiol-81-256-g001.jpg', 'image_path': '../data/media_files/PMC4886614/poljradiol-81-256-g001.jpg', 'caption': 'Axial contrast-enhanced CT image showing a heterogeneous tumour mass replacing the left kidney (arrows)', 'hash': '0026fbb82b9ef66358dd3760391e1edfb38ab8a6630970e8f74a4bb4d33b90bb'}, {'image_id': 'poljradiol-81-256-g006', 'image_file_name': 'poljradiol-81-256-g006.jpg', 'image_path': '../data/media_files/PMC4886614/poljradiol-81-256-g006.jpg', 'caption': 'Haematoxylin and Eosin stain (10×) of a section from the resected margin of the ureter shows luminal dilatation, attenuated transitional cell lining epithelium and presence of tumour in the lumen.', 'hash': 'a2664288b04677a44174e9bf990c547504bb33658821726e89c3e64cbffb72d9'}, {'image_id': 'poljradiol-81-256-g003', 'image_file_name': 'poljradiol-81-256-g003.jpg', 'image_path': '../data/media_files/PMC4886614/poljradiol-81-256-g003.jpg', 'caption': '(A) Coronal MPR image showing the tumour replacing the entire left kidney (arrows) along with a dilated ureter filled with multiple nodular deposits (arrowheads). Enlarged hilar nodes are also visualized (curved arrow). (B) Sagittal MPR image showing ureteric and renal pelvis dilatation with multiple tumour deposits (arrowheads).', 'hash': '909ecd7122d52ccf6b87b94798d6b59d3c01b0fe2b70fda453e28dda4799e767'}, {'image_id': 'poljradiol-81-256-g004', 'image_file_name': 'poljradiol-81-256-g004.jpg', 'image_path': '../data/media_files/PMC4886614/poljradiol-81-256-g004.jpg', 'caption': 'Coronal MIP image in the delayed phase showing the intraluminal tumour projection into the urinary bladder through the left vesicoureteric junction (arrow).', 'hash': '78d53523d04812a141edbbe4b23b0d81b2156fd1aeb47eaf75ae4fd8fc91a84a'}, {'image_id': 'poljradiol-81-256-g005', 'image_file_name': 'poljradiol-81-256-g005.jpg', 'image_path': '../data/media_files/PMC4886614/poljradiol-81-256-g005.jpg', 'caption': 'Haematoxylin and Eosin stain (10×) shows tumour composed of cells with abundant clear cytoplasm and nuclei with moderate pleomorphism. Neutrophils are seen between the tumour cell lobules.', 'hash': '23926cb683119e408d84c14225bb578e08a233d11f96847b5255d02caadcbad1'}, {'image_id': 'poljradiol-81-256-g002', 'image_file_name': 'poljradiol-81-256-g002.jpg', 'image_path': '../data/media_files/PMC4886614/poljradiol-81-256-g002.jpg', 'caption': 'Axial non-contrast CT image showing linear foci of calcifications in the renal mass (arrows).', 'hash': '335ec78ecf5c4be05eb686640523ce4d72bb24267f5b9c6520927d7e73bb4d25'}] | {'poljradiol-81-256-g001': ['A 13-year-old male child presented at the emergency of a peripheral hospital with acute retention of urine, pain on the left side of the abdomen and history of passing blood clots in urine. Patient was catheterised and was referred to the department of surgery of our institution. Abdominal examination revealed a ballotable hard mass in the left lumbar region. The patient was admitted and initial routine laboratory tests were significant for mild anaemia (Hb 9.3 g/dL) and presence of red blood corpuscles in the urine examination. Ultrasound of the abdomen revealed a large, lobulated, heterogeneous echotexture mass replacing almost the entire left kidney. Nodular soft tissue mass was also present in the urinary bladder on the left side. An X-ray of the chest carried out on the same day was found to be normal. A CT of the abdomen was performed on the following day and plain CT sections were acquired followed by contrast-enhanced CT in the corticomedullary and delayed phases. The CT revealed a markedly enlarged left kidney due to replacement by an ill-marginated, heterogeneously enhancing mass of approximate size – 15×6.5×7.0 cm, with CT attenuation ranging 60–75 HU in solid portions and 25–35 HU in necrotic portions. Few punctiform and linear foci of calcification were also identified within the tumour (better appreciated on plain CT images). The corticomedullary demarcation was lost with extension of the mass into the dilated pelvicalyceal system. The tumour was extending through the dilated ureter up to the left vesicoureteric junction with a focal intraluminal projection into the bladder (<xref ref-type="fig" rid="poljradiol-81-256-g001">Figures 1</xref><xref ref-type="fig" rid="poljradiol-81-256-g002" /><xref ref-type="fig" rid="poljradiol-81-256-g003" />––<xref ref-type="fig" rid="poljradiol-81-256-g004">4</xref>). Additionally, there were multiple enlarged lymph nodes in the retroperitoneal and renal hilar locations with the largest node measuring 1.7 cm (). Additionally, there were multiple enlarged lymph nodes in the retroperitoneal and renal hilar locations with the largest node measuring 1.7 cm (<xref ref-type="fig" rid="poljradiol-81-256-g003">Figure 3</xref>). There was no evidence of renal vein or inferior vena cava thrombosis. Keeping in consideration the age of the patient, clinical presentation and radiological findings, we kept a possibility of Wilms’ tumour (stage T). There was no evidence of renal vein or inferior vena cava thrombosis. Keeping in consideration the age of the patient, clinical presentation and radiological findings, we kept a possibility of Wilms’ tumour (stage T4N1M0) or atypical paediatric RCC. A decision was taken by the surgeon to perform radical nephrectomy with partial ureterectomy and to tackle the deposits in the bladder in the second sitting. No neoadjuvant chemotherapy was given. Patient was transfused one unit of blood before surgery. Diseased left kidney was approached by transabdominal subcostal incision. The whole kidney was found to be replaced by nodular tumour and there were multiple lymph nodes in the renal hilum and para-aortic region. There was no extension of tumour in the renal vein. The left ureter was dilated and was filled with tumour. Nephrectomy was performed along with removal of the upper two-third of the ureter and some para-aortic lymph nodes.'], 'poljradiol-81-256-g005': ['On histopathological examination of the specimen, the entire kidney was replaced by a solid tumour with areas of necrosis and haemorrhages. The attached ureter was dilated and filled with tumour. Sections examined showed features consistent with clear cell carcinoma of Fuhrman grade II. The tumour was invading the perinephric fat and lymph nodes. Sections examined from hilar vessels were free from tumour (<xref ref-type="fig" rid="poljradiol-81-256-g005">Figures 5</xref>, , <xref ref-type="fig" rid="poljradiol-81-256-g006">6</xref>).).']} | Pediatric Clear Cell Renal Cell Carcinoma with Pelvicalyceal System Invasion and Contiguous Extension Upto Bladder: Novel and Bizarre Tumor Behaviour | [
"Carcinoma, Renal Cell",
"Kidney Neoplasms",
"Pediatrics",
"Rare Diseases"
] | Pol J Radiol | 1464505200 | Mosquitoes are vectors of several human pathogens, and great attention has recently been placed on insecticides from plant-derived products, in search for mosquito control agents. This study, thus, investigated the potency of Boswellia dalzielii methanol leaf extract and its four fractions as mosquito ovicide, larvicide, and pupicide against Anopheles gambiae and Culex quinquefasciatus. The plant products were tested at the following concentrations: 125, 250, 500, 1000, and 2000 ppm on eggs and 312.5, 625, 1250, and 2500 ppm on the larvae and pupae of the mosquitoes. For results, hatchability of A. gambiae eggs was reduced to 5% with n-hexane fraction at 2000 ppm. Among the plant products tested, n-hexane fraction was most toxic against A. gambiae (LC50 = 385.9 ppm) and C. quinquefasciatus (LC50 = 3394.9 ppm). The n-hexane fraction of B. dalzielii might be used as a mosquitocidal agent in the breeding sites of A. gambiae and C. quinquefasciatus. | [] | other | PMC4886614 | null | 53 | [
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] | Pol J Radiol. 2016 May 29; 81:256-260 | NO-CC CODE |
|
Images in a 49-year-old man who presented to the emergency department with SARS-CoV2 infection. A and B, Non–contrast-enhanced chest CT scans obtained 1 month after the onset of symptoms show multifocal peribronchovascular and peripheral consolidation, relatively sparing the subpleural region, consistent with organizing pneumonia. Follow-up chest CT was performed 6 months after steroid treatment. C, Axial and, D, coronal CT images show multiple micronodular calcifications within faint ground-glass opacities. | ryct.2021200598.fig1 | 7 | e62a7ac7e0d479826aeffe3b144989dd440d43a35a4e6c4cdffa79a94edc1848 | ryct.2021200598.fig1.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
800,
555
] | [{'image_id': 'ryct.2021200598.fig1', 'image_file_name': 'ryct.2021200598.fig1.jpg', 'image_path': '../data/media_files/PMC8026114/ryct.2021200598.fig1.jpg', 'caption': 'Images in a 49-year-old man who presented to the emergency department with SARS-CoV2 infection. A and B, Non–contrast-enhanced chest CT scans obtained 1 month after the onset of symptoms show multifocal peribronchovascular and peripheral consolidation, relatively sparing the subpleural region, consistent with organizing pneumonia. Follow-up chest CT was performed 6 months after steroid treatment. C, Axial and, D, coronal CT images show multiple micronodular calcifications within faint ground-glass opacities.', 'hash': 'e62a7ac7e0d479826aeffe3b144989dd440d43a35a4e6c4cdffa79a94edc1848'}, {'image_id': 'ryct.2021200598.fig2', 'image_file_name': 'ryct.2021200598.fig2.jpg', 'image_path': '../data/media_files/PMC8026114/ryct.2021200598.fig2.jpg', 'caption': 'Bone window images in same patient. Comparison between A, initial and, B, follow-up CT on axial maximum intensity projection images shows interval development of micronodular and branching calcifications, confirmed on C, coronal and, D, magnified axial views. Follow-up lung function testing revealed decreased diffusion capacity.', 'hash': '270b8ffdf5c366ad3a5153c659d8a540044a8bec615ff8cbf4ee124e948e2d36'}] | {'ryct.2021200598.fig1': ['Differential diagnoses include dystrophic calcifications, metastatic calcifications, and pulmonary alveolar microlithiasis. Dystrophic calcifications occur in diseased lung, in the settings of granulomatous infections, sarcoidosis, occupational lung diseases, and metabolic diseases (eg, as amyloidosis). Metastatic calcifications occur in normal lung due to hypercalcemia secondary to end-stage kidney disease. The differential diagnosis also includes nodular ossification seen in patients with chronic venous lung congestion (8). Normal renal function, phosphate calcium homeostasis, and the absence of any relevant past medical history or concomitant diseases excluded other causes of lung calcification/ossification in this case (<xref ref-type="fig" rid="ryct.2021200598.fig1">Figs 1</xref>, , <xref ref-type="fig" rid="ryct.2021200598.fig2">2</xref>).).']} | Accelerated Pulmonary Ossification as a Sequela of SARS-CoV-2 Pneumonia | null | Radiol Cardiothorac Imaging | 1617260400 | [
"Antibodies, Neutralizing",
"COVID-19",
"Humans",
"Mutation",
"SARS-CoV-2",
"Spike Glycoprotein, Coronavirus"
] | other | PMC8026114 | null | 5 | [
"{'Citation': 'Weisblum Y, Schmidt F, Zhang F, et al. Escape from neutralizing antibodies by SARS-CoV-2 spike protein variants. eLife. 2020;9', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7723407'}, {'@IdType': 'pubmed', '#text': '33112236'}]}}",
"{'Citation': 'Greaney AJ, Loes AN, Crawford KHD, et al. Comprehensive mapping of mutations to the SARS-CoV-2 receptor-binding domain that affect recognition by polyclonal human serum antibodies. Cell Host Microbe. 2021;29:463–476.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7869748'}, {'@IdType': 'pubmed', '#text': '33592168'}]}}",
"{'Citation': 'Wang Z, Schmidt F, Weisblum Y, et al. mRNA vaccine-elicited antibodies to SARS-CoV-2 and circulating variants. bioRxiv. 2021 doi: 10.1101/2021.01.15.426911. published online Jan 30. (preprint).', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1101/2021.01.15.426911'}, {'@IdType': 'pmc', '#text': 'PMC8503938'}, {'@IdType': 'pubmed', '#text': '33567448'}]}}",
"{'Citation': 'Wu K, Werner AP, Moliva JI, et al. mRNA-1273 vaccine induces neutralizing antibodies against spike mutants from global SARS-CoV-2 variants. bioRxiv. 2021 doi: 10.1101/2021.01.25.427948. published online Jan 25. (preprint).', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1101/2021.01.25.427948'}}}",
"{'Citation': 'Rathnasinghe R, Jangra S, Cupic A, et al. The N501Y mutation in SARS-CoV-2 spike leads to morbidity in obese and aged mice and is neutralized by convalescent and post-vaccination human sera. medRxiv. 2021 doi: 10.1101/2021.01.19.21249592. published online Jan 20. (preprint).', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1101/2021.01.19.21249592'}}}"
] | Radiol Cardiothorac Imaging. 2021 Apr 1; 3(2):e200598 | NO-CC CODE |
||
Serial chest CT images of the patient. (A) Hospital day 8, Upper lobes (B) Hospital day 8, Lower lobes (C) Hospital day 12, Upper lobes (D) Hospital day 12, Lower lobes (E) Hospital day 56, Upper lobes and (F) Hospital day 56, Lower lobes. (A, B) Bilateral upper and lower areas of ground glass opacities and consolidations at the subpleural and peribronchial legions. (C, D) Increased bilateral ground glass opacities and dorsal consolidations with air bronchogram. (E, F) Improvement in the bilateral ground glass opacities. Slight mediastinal emphysema can be seen. | gr2_lrg | 7 | a46659c02eb1232f5c1250eaac6af6f460531be06bc2f1bdec43f336e5c4056c | gr2_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
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723,
355
] | [{'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC8026269/gr1_lrg.jpg', 'caption': 'Clinical course of the patient. Left axis represents CRP (mg/dL) and PCT (ng/mL). Right axis represents LDH (IU/L).PSL; prednisolone, TAZ/PIPC; tazobactam/piperacillin, SBT/ABPC; sulbactam/ampicillin, CTRX; ceftriaxone, CEZ; cefazoline, MEPM; meropenem, CAZ; ceftazidime, LZD; linezolid, VCM; vancomycin, VV-ECMO; veno-venous extracorporeal membrane oxygenation, N; negative for blood culture, S.\xa0pneumoniae; Streptococcus pneumoniae, E.\xa0cloacae; Enterobacter cloacae, CRP; C-reactive protein, PCT; procalcitonin, LDH; lactate dehydrogenase.', 'hash': '1cd6d3448304bf100ddd29f0e6a066720c05d9707cc2c8bb7284a95a5e717071'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC8026269/gr2_lrg.jpg', 'caption': 'Serial chest CT images of the patient. (A) Hospital day 8, Upper lobes (B) Hospital day 8, Lower lobes (C) Hospital day 12, Upper lobes (D) Hospital day 12, Lower lobes (E) Hospital day 56, Upper lobes and (F) Hospital day 56, Lower lobes. (A, B) Bilateral upper and lower areas of ground glass opacities and consolidations at the subpleural and peribronchial legions. (C, D) Increased bilateral ground glass opacities and dorsal consolidations with air bronchogram. (E, F) Improvement in the bilateral ground glass opacities. Slight mediastinal emphysema can be seen.', 'hash': 'a46659c02eb1232f5c1250eaac6af6f460531be06bc2f1bdec43f336e5c4056c'}] | {'gr1_lrg': ['A 68-year-old man experienced fever and cough. He was subsequently referred to a hospital for COVID-19 patients on day 4. He had a positive result of reverse transcription-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and his oxygen saturation was 96% (room-air) at that time. He was hospitalized on day 7 and required canula oxygen (<xref rid="gr1_lrg" ref-type="fig">Fig.\xa01</xref>\n). On day 8, he was shifted to another hospital because his respiratory condition worsened. Chest computed tomography indicated bilateral upper and lower areas of ground glass opacities and consolidations at the subpleural and peribronchial legions (\n). On day 8, he was shifted to another hospital because his respiratory condition worsened. Chest computed tomography indicated bilateral upper and lower areas of ground glass opacities and consolidations at the subpleural and peribronchial legions (<xref rid="gr2_lrg" ref-type="fig">Fig.\xa02</xref>\nA and B). He was intubated and treated using a ventilator. On day 12, his PaO\nA and B). He was intubated and treated using a ventilator. On day 12, his PaO2/FiO2 ratio worsened to 120, and he was transferred to Sapporo Medical University Hospital to be treated using extracorporeal membrane oxygenation (ECMO). On examination, his body temperature was 37.5\xa0°C, heart rate was 95 beats/min, and respirator setting was FiO2 0.6, positive end-expiratory pressure 12\xa0mmHg, and pressure support 10\xa0mmHg. Favipiravir 3600 mg/day and nafamostat 14 mg/day were started on day 8, and prednisolone 70 mg/day was started on day 11. Prior to being diagnosed with COVID-19, he had been taking candesartan 4 mg/day and amlodipine 5 mg/day for hypertension, and his performance status was 0. He smoked 1 pack/year 20–40 y.o. and drank shochu, a Japanese liquor, 200–300 mL daily. He had no history of admission or operation. He had no history of pneumococcal vaccination either. He lived with 94 y.o. mother, wife and son. He had no contact with children. Blood examination showed the following results: WBC 10.0\xa0×\xa0103/μL (neutrophils 88.7%, lymphocytes 7.1%, eosinophils 0.0%), Hb 9.3 g/dL, platelets 25.1\xa0×\xa0104/μL, Na 136 mEq/L, K 5.3 mEq/L, Cl 103 mEq/L, CRP 37.92 mg/dL, PCT 3.08 mg/dL, BUN 50 mg/dL, Cre 1.45 mg/dL, AST 46 IU/L, ALT 22 IU/L, LDH 393 U/L, and d-dimer 16.6 μg/mL. He tested positive for SARS-CoV-2 by RT-PCR (E-gene 25.72, N-gene 32.01 Crossing point from Roche). Four bottles of venous blood cultures were positive for S.\xa0pneumoniae on day 12. The bacteria were serotype 3, mucoid-type, and penicillin susceptible (Table\xa01\n). Blood cultures on day 8 were negative. Chest computed tomography showed broad bilateral ground-glass opacities and consolidation, which was difficult to indicate if it was bacterial pneumonia (<xref rid="gr2_lrg" ref-type="fig">Fig.\xa02</xref>C and D). He was treated using veno-venous ECMO and was prescribed ciclesonide 800 μg/day, tazobactam/pireracillin 4.5g, q6h, and linezolid 600 mg, q12h. The antibiotics were de-escalated to sulbactam/ampicillin on day 14, and the patient was switched to ceftriaxone 1g, q12h on day18. On day 16, blood cultures were turned to negative. Tracheostomy was performed on day 35. On day 46, he experienced hematochezia. Gastrointestinal endoscopy revealed multiple ulcers in the intestine. Chest computed tomography showed improvement in the bilateral ground glass opacities on day 56 (C and D). He was treated using veno-venous ECMO and was prescribed ciclesonide 800 μg/day, tazobactam/pireracillin 4.5g, q6h, and linezolid 600 mg, q12h. The antibiotics were de-escalated to sulbactam/ampicillin on day 14, and the patient was switched to ceftriaxone 1g, q12h on day18. On day 16, blood cultures were turned to negative. Tracheostomy was performed on day 35. On day 46, he experienced hematochezia. Gastrointestinal endoscopy revealed multiple ulcers in the intestine. Chest computed tomography showed improvement in the bilateral ground glass opacities on day 56 (<xref rid="gr2_lrg" ref-type="fig">Fig.\xa02</xref>E and F). However, he had diarrhea and intestinal hemorrhage from day 44. On day 55, small intestine was surgically resected because of repeated hemorrhage. Pathologically, small intestinal mucosal tissue had epithelial erosion and bleeding without blood clots. On day 57, cholecystectomy due to poor color tone of the swollen gallbladder wall, resulting in acute gangrenous cholangitis. His status was declared as multiple organ failure (MOF) on day 76. He died on day 85 owing to MOF, IPD, acute respiratory distress syndrome (ARDS), and COVID-19.E and F). However, he had diarrhea and intestinal hemorrhage from day 44. On day 55, small intestine was surgically resected because of repeated hemorrhage. Pathologically, small intestinal mucosal tissue had epithelial erosion and bleeding without blood clots. On day 57, cholecystectomy due to poor color tone of the swollen gallbladder wall, resulting in acute gangrenous cholangitis. His status was declared as multiple organ failure (MOF) on day 76. He died on day 85 owing to MOF, IPD, acute respiratory distress syndrome (ARDS), and COVID-19.Fig.\xa01Clinical course of the patient. Left axis represents CRP (mg/dL) and PCT (ng/mL). Right axis represents LDH (IU/L).PSL; prednisolone, TAZ/PIPC; tazobactam/piperacillin, SBT/ABPC; sulbactam/ampicillin, CTRX; ceftriaxone, CEZ; cefazoline, MEPM; meropenem, CAZ; ceftazidime, LZD; linezolid, VCM; vancomycin, VV-ECMO; veno-venous extracorporeal membrane oxygenation, N; negative for blood culture, S.\xa0pneumoniae; Streptococcus pneumoniae, E.\xa0cloacae; Enterobacter cloacae, CRP; C-reactive protein, PCT; procalcitonin, LDH; lactate dehydrogenase.Fig.\xa01Fig.\xa02Serial chest CT images of the patient. (A) Hospital day 8, Upper lobes (B) Hospital day 8, Lower lobes (C) Hospital day 12, Upper lobes (D) Hospital day 12, Lower lobes (E) Hospital day 56, Upper lobes and (F) Hospital day 56, Lower lobes. (A, B) Bilateral upper and lower areas of ground glass opacities and consolidations at the subpleural and peribronchial legions. (C, D) Increased bilateral ground glass opacities and dorsal consolidations with air bronchogram. (E, F) Improvement in the bilateral ground glass opacities. Slight mediastinal emphysema can be seen.Fig.\xa02Table\xa01Table\xa01AntibioticsMICPCG≤0.03ABPC≤0.06AMPC/CVA≤0.25CTM≤0.5CDTR-PI≤0.06CTX≤0.12CTRX≤0.12CZOP≤0.12CFPM≤0.5MEPM≤0.12EM≤0.12AZM≤0.25CLDM≤0.12MINO≤0.5CP≤4VCM0.25LVFX1ST≤0.5RFP≤1']} | Invasive pneumococcal disease affected the fatal outcome in a COVID-19 patient | [
"Severe acute respiratory syndrome coronavirus 2",
"Coronavirus disease 2019",
"COVID-19",
"Invasive pneumococcal disease"
] | J Infect Chemother | 1625727600 | [
"COVID-19",
"Canada",
"Humans",
"Internship and Residency",
"Ophthalmology",
"Students, Medical"
] | other | PMC8026269 | null | 8 | [
"{'Citation': 'Rose S. Medical student education in the time of COVID-19. JAMA. 2020;323:2131–2213.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '32232420'}}}",
"{'Citation': 'Shah M, Knoch D, Waxman E. The state of ophthalmology medical student education in the United States and Canada, 2012 through 2013. Ophthalmology. 2014;121 1160e1163.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '24518616'}}}",
"{'Citation': 'Noble J, Somal K, Gill HS, Lam W. An analysis of undergraduate ophthalmology training in Canada. Can J Ophthalmol. 2009;44:513–518.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19789584'}}}",
"{'Citation': \"Lippa LM, Boker J, Duke A, Amin A. A novel 3-year longitudinal pilot study of medical students' acquisition and retention of screening eye examination skills [published correction appears in Ophthalmology. 2006;113:1056] Ophthalmology. 2006;113:133–139.\", 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16310854'}}}",
"{'Citation': 'Gostimir M, Sharma RA, Bhatti A. Status of Canadian undergraduate medical education in ophthalmology. Can J Ophthalmol. 2018;53:474–479.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '30340714'}}}",
"{'Citation': 'Duong AT, Van Tassel SH, Alzaga Fernandez AG, et al. Medical education and path to residency in ophthalmology in the COVID-19 era: perspective from medical student educators. Ophthalmology. 2020;127:e95–e98.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7376334'}, {'@IdType': 'pubmed', '#text': '32712074'}]}}",
"{'Citation': 'Hunt MR. Strengths and challenges in the use of interpretive description: reflections arising from a study of the moral experience of health professionals in humanitarian work. Qual Health Res. 2009;19:1284–1292.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19690208'}}}",
"{'Citation': 'COS Practice Resource Center. Available at: www.cosprc.ca/topics/resources-for-medical-students/. Accessed September 20, 2020.'}"
] | J Infect Chemother. 2021 Jul 8; 27(7):1108-1111 | NO-CC CODE |
||
Sequence of computed tomography (CT) scans following completion of chemo- and radiotherapy. Coronal view (A) of the first CT scan following completion of therapy showed a fluid collection in the right upper chest (*); axial view (B) showed a fistula (arrow head) extending from the esophagus to the fluid collection (*). Coronal view (C) of the CT scan following placement of an esophageal stent (arrow) showed good placement; axial view (D) showed occlusion of the fistula but severe compression of the trachea (arrow head). The fluid filled cavity is seen in both views (*). Coronal view (E) of the CT scan following palliative chemotherapy and nasogastric feeds showed persistence of the fistula and fluid filled cavity (*); axial view (F) showed persistence of the fistula (arrow head) and fluid filled cavity (*). | amjcaserep-13-128-g002 | 7 | 5e09aa413140bc93b959f879ae47a6891b5a961573ce7feb84da0afc896187e3 | amjcaserep-13-128-g002.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
720,
532
] | [{'image_id': 'amjcaserep-13-128-g001', 'image_file_name': 'amjcaserep-13-128-g001.jpg', 'image_path': '../data/media_files/PMC3616142/amjcaserep-13-128-g001.jpg', 'caption': 'Initial radiological investigation. Chest x-ray (A) showed a mass in the right upper chest (arrow). Computed tomography scan (B) confirmed the mass (*) compressing the trachea (arrow head).', 'hash': '8d7a6aaa11d4daae094d9f093e0faf806f72f7b6b9f4b902ce3c574996a4cea4'}, {'image_id': 'amjcaserep-13-128-g004', 'image_file_name': 'amjcaserep-13-128-g004.jpg', 'image_path': '../data/media_files/PMC3616142/amjcaserep-13-128-g004.jpg', 'caption': 'Upper endoscopy findings. At upper endoscopy a large fistulous opening (arrow head) was seen but could not be closed with endoclips.', 'hash': 'bf4a8bacf0f626219007e3c909d21c21a82f7e61e6df02d08acbe300fe609357'}, {'image_id': 'amjcaserep-13-128-g003', 'image_file_name': 'amjcaserep-13-128-g003.jpg', 'image_path': '../data/media_files/PMC3616142/amjcaserep-13-128-g003.jpg', 'caption': 'Upper gastrointestinal series. An upper gastrointestinal series confirmed a fistulous tract (arrow) from the esophagus to the fluid filled cavity.', 'hash': '1de47f9e5e54729e0f14054651defc3a5df8376b99df441a7ca3706b4374177f'}, {'image_id': 'amjcaserep-13-128-g002', 'image_file_name': 'amjcaserep-13-128-g002.jpg', 'image_path': '../data/media_files/PMC3616142/amjcaserep-13-128-g002.jpg', 'caption': 'Sequence of computed tomography (CT) scans following completion of chemo- and radiotherapy. Coronal view (A) of the first CT scan following completion of therapy showed a fluid collection in the right upper chest (*); axial view (B) showed a fistula (arrow head) extending from the esophagus to the fluid collection (*). Coronal view (C) of the CT scan following placement of an esophageal stent (arrow) showed good placement; axial view (D) showed occlusion of the fistula but severe compression of the trachea (arrow head). The fluid filled cavity is seen in both views (*). Coronal view (E) of the CT scan following palliative chemotherapy and nasogastric feeds showed persistence of the fistula and fluid filled cavity (*); axial view (F) showed persistence of the fistula (arrow head) and fluid filled cavity (*).', 'hash': '5e09aa413140bc93b959f879ae47a6891b5a961573ce7feb84da0afc896187e3'}] | {'amjcaserep-13-128-g001': ['An 11-year-old male presented to his primary care provider with complaints of shortness of breath, wheezing, and cough. He was treated empirically for reactive airway disease with no significant improvement. His symptoms recurred intermittently over 2-months with increasing severity requiring hospitalization. There was no history of weight loss, fever, or night sweats. A chest x-ray was obtained that showed a para-tracheal mass (<xref ref-type="fig" rid="amjcaserep-13-128-g001">Figure 1A</xref>). He was referred to our hospital for further evaluation. Past history was significant for hospitalization for pneumonia at 2 years of age and removal of an enlarged lymph node from his neck at 6 years of age. Chronic medical conditions included asthma, gastroesophageal reflux, and migraine headaches. Family history was non-contributory. Examination showed a thin body habitus. There was no adenopathy. Abdominal examination showed no tenderness, masses, or hepatosplenomegaly. Chest examination revealed good breath sounds without rales, ronchi, or wheezes. Heart examination was normal.). He was referred to our hospital for further evaluation. Past history was significant for hospitalization for pneumonia at 2 years of age and removal of an enlarged lymph node from his neck at 6 years of age. Chronic medical conditions included asthma, gastroesophageal reflux, and migraine headaches. Family history was non-contributory. Examination showed a thin body habitus. There was no adenopathy. Abdominal examination showed no tenderness, masses, or hepatosplenomegaly. Chest examination revealed good breath sounds without rales, ronchi, or wheezes. Heart examination was normal.', 'Computed tomography (CT) scan of the chest showed a large mediastinal mass partially compressing his trachea (<xref ref-type="fig" rid="amjcaserep-13-128-g001">Figure 1B</xref>). The mass was located just above the aortic arch with loose attachments to the right innominate vein, trachea, and esophagus. A right postero-lateral thoracotomy was performed with excision of this mass. It was found to be smooth, covered by the pleural lining, and rubbery in consistency, suspicious for a ganglioneuroma or neuroblastoma. It was felt that microscopic disease likely remained due to inability to obtain clear margins as the tumor was adherent to the sympathetic chain and esophagus. Histological evaluation was consistent with a synovial cell sarcoma. A metastatic work up including bone scan and CT scans of the head, neck, abdomen, and pelvis were negative.). The mass was located just above the aortic arch with loose attachments to the right innominate vein, trachea, and esophagus. A right postero-lateral thoracotomy was performed with excision of this mass. It was found to be smooth, covered by the pleural lining, and rubbery in consistency, suspicious for a ganglioneuroma or neuroblastoma. It was felt that microscopic disease likely remained due to inability to obtain clear margins as the tumor was adherent to the sympathetic chain and esophagus. Histological evaluation was consistent with a synovial cell sarcoma. A metastatic work up including bone scan and CT scans of the head, neck, abdomen, and pelvis were negative.'], 'amjcaserep-13-128-g002': ['Three weeks after completion of radiotherapy the patient developed odynophagia and dysphagia limiting his ability to tolerate all oral intake, including liquids. Upper endoscopy was performed revealing esophagitis and a stricture in the upper portion of the esophagus. Dilation was performed with through-the-scope radial balloon dilators under direct visualization, followed by initiation of acid-blockade with an H2-receptor antagonist. Symptoms improved initially, but within one month the patient again complained of odynophagia resulting in decreased oral intake and weight loss. A barium swallow showed narrowing at the previous stricture site but free passage of barium. Acid blockade was changed to a proton-pump inhibitor to provide better acid suppression with minimal improvement in symptoms. Chest CT scan at the completion of chemotherapy showed that the previous soft tissue mass was replaced by a fluid collection with surrounding right upper lobe parenchymal consolidation and atelectasis, as well as pleural thickening. The changes were consistent with postsurgical change and radiation effect, but residual tumor could not be excluded. Also seen was a fistulous tract extending from a thickened esophagus to the fluid collection (<xref ref-type="fig" rid="amjcaserep-13-128-g002">Figure 2A</xref>, B). An upper gastrointestinal series confirmed the fistula (, B). An upper gastrointestinal series confirmed the fistula (<xref ref-type="fig" rid="amjcaserep-13-128-g003">Figure 3</xref>).).', 'Chemotherapy was continued with vincristine, dactinomycin, cylophosphamide and Mesna. A chest CT scan (<xref ref-type="fig" rid="amjcaserep-13-128-g002">Figure 2E, F</xref>) and esophagram performed 6 weeks later showed persistence of the fistulous tract. It was decided to place a gastrostomy tube and keep the patient NPO to avoid anything passing through the esophagus and potentially entering the fistula. Chemotherapy was continued for 4 months after which a repeat chest CT scan showed no interval change in the mass or fistula. Repeat right thoracotomy was performed with multiple biopsies throughout the right chest cavity showed fibrosis with no residual tumor. Despite being kept NPO and receiving only enteral feeds for another 4 months the fistula persisted. An esophagectomy, gastric pull-up with anastomosis to the cervical esophagus, pyloroplasty, and feeding jejunostomy were performed due to persistence of this esophageal fistula. He did well throughout the early postoperative time-period, tolerating a regular diet. Three months postoperatively the patient developed dysphagia to solid foods, and intermittent chest pain with liquids. An esophagram revealed an anastomotic stricture with a small fistula tract leading into the right chest. The patient has had repeated esophageal dilations and minimally invasive attempts at fistula closure including cauterization and injection with hemostatic matrix compounds. These procedures have relieved his dysphagia and chest pain, but a small fistula tract from the cervical anastomosis to the right chest remains 2 years after esophagectomy. He still tolerates a regular diet and supplements his intake with jejunal feeds at night.) and esophagram performed 6 weeks later showed persistence of the fistulous tract. It was decided to place a gastrostomy tube and keep the patient NPO to avoid anything passing through the esophagus and potentially entering the fistula. Chemotherapy was continued for 4 months after which a repeat chest CT scan showed no interval change in the mass or fistula. Repeat right thoracotomy was performed with multiple biopsies throughout the right chest cavity showed fibrosis with no residual tumor. Despite being kept NPO and receiving only enteral feeds for another 4 months the fistula persisted. An esophagectomy, gastric pull-up with anastomosis to the cervical esophagus, pyloroplasty, and feeding jejunostomy were performed due to persistence of this esophageal fistula. He did well throughout the early postoperative time-period, tolerating a regular diet. Three months postoperatively the patient developed dysphagia to solid foods, and intermittent chest pain with liquids. An esophagram revealed an anastomotic stricture with a small fistula tract leading into the right chest. The patient has had repeated esophageal dilations and minimally invasive attempts at fistula closure including cauterization and injection with hemostatic matrix compounds. These procedures have relieved his dysphagia and chest pain, but a small fistula tract from the cervical anastomosis to the right chest remains 2 years after esophagectomy. He still tolerates a regular diet and supplements his intake with jejunal feeds at night.'], 'amjcaserep-13-128-g004': ['EGD, performed in an attempt to close the fistula, showed narrowing of the esophagus and opening to the fistula to be approximately 3 mm in diameter (<xref ref-type="fig" rid="amjcaserep-13-128-g004">Figure 4</xref>). Two endoclips were placed across the fistula; however, the fistula could not be adequately closed and the endoclips were removed. Next, a covered stent was placed across the opening to occlude the opening and provide time for the fistula to heal. Immediately upon awakening from the procedure the patient developed chest pain and stridor felt to be due to instrumentation during stent placement. The next morning his stridor worsened and was accompanied by increased work of breathing. Emergent chest CT scan was done revealing the stent to be in good position but causing severe tracheal compression (). Two endoclips were placed across the fistula; however, the fistula could not be adequately closed and the endoclips were removed. Next, a covered stent was placed across the opening to occlude the opening and provide time for the fistula to heal. Immediately upon awakening from the procedure the patient developed chest pain and stridor felt to be due to instrumentation during stent placement. The next morning his stridor worsened and was accompanied by increased work of breathing. Emergent chest CT scan was done revealing the stent to be in good position but causing severe tracheal compression (<xref ref-type="fig" rid="amjcaserep-13-128-g002">Figure 2C, D</xref>) requiring removal of the stent. The patient was made ) requiring removal of the stent. The patient was made nil per os (NPO) and a nasogastric tube was placed to provide nutritional support.']} | Synovial sarcoma leading to a paraesophageal abscess in a child | [
"synovial cell sarcoma",
"paraesophageal abscess",
"Esophageal Fistula - complications"
] | Am J Case Rep | 1340953200 | [{'@Label': 'BACKGROUND', '@NlmCategory': 'BACKGROUND', '#text': 'Synovial sarcoma (SS) is an uncommon malignant neoplasm arising from primitive pluripotential mesenchyme primarily affecting the soft tissues of the extremities. Rarely other locations are involved, including the mediastinum.'}, {'@Label': 'CASE REPORT', '@NlmCategory': 'METHODS', '#text': 'After treatment for mediastinal SS by surgical resection, radiation therapy, and chemotherapy, an 11-year-old boy developed an esophageal stricture and fistula, the latter resulting in a paraesophageal abscess. Management of the esophageal stricture and fistula required a multi-disciplinary approach. We report our experience with the management of this difficult complication, as well as a brief review of the literature on SS.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'Rare conditions, particularly those with unusual complications, present therapeutic challenges requiring a multi-disciplinary team approach. Reporting experiences with difficult cases can benefit providers faced with similar problems in the future.'}] | [] | other | PMC3616142 | null | 21 | [
"{'Citation': 'Kaira K, Ishizuka T, Sunaga N, et al. Primary mediastinal synovial sarcoma: a report of 2 cases. J Comput Assist Tomogr. 2008;32:238–41.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18379309'}}}",
"{'Citation': 'Witkin GB, Miettinen M, Rosai J. A biphasic tumor of the mediastinum with features of synovial sarcoma. A report of four cases. Am J Surg Pathol. 1989;13:490–99.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2471414'}}}",
"{'Citation': 'Trupiano JK, Rice TW, Herzog K, et al. Mediastinal synovial sarcoma: report of two cases with molecular genetic analysis. Ann Thorac Surg. 2002;73:628–30.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11845884'}}}",
"{'Citation': 'Cheng LS, Tse GM, Li WW, et al. Mediastinal synovial sarcoma: a case report and literature review. Can Respir J. 2003;10:393–95.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14571292'}}}",
"{'Citation': 'Katakura H, Fukuse T, Shiraishi I, et al. Mediastinal synovial sarcoma. Thorac Cardiovasc Surg. 2009;57:183–85.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19330763'}}}",
"{'Citation': 'Jeganathan R, Davis R, Wilson L, et al. Primary mediastinal synovial sarcoma. Ulster Med J. 2007;76:109–11.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2001131'}, {'@IdType': 'pubmed', '#text': '17476827'}]}}",
"{'Citation': 'Sultan I, Rodriguez-Galindo C, Saab R, et al. Comparing children and adults with synovial sarcoma in the surveillance, epidemiology, and end results program, 1983 to 2005: an analysis of 1268 patients. Cancer. 2009;115:3537–47.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19514087'}}}",
"{'Citation': 'Ferrari A, Gronchi A, Casanova M, et al. Synovial sarcoma: a retrospective analysis of 271 patients of all ages treated at a single institution. Cancer. 2004;101:627–34.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15274077'}}}",
"{'Citation': 'Palmerini E, Staals EL, Alberghini M, et al. Synovial sarcoma: retrospective analysis of 250 patients treated at a single institution. Cancer. 2009;115:2988–98.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19452538'}}}",
"{'Citation': 'Eilber FC, Dry SM. Diagnosis and management of synovial sarcoma. J Surg Oncol. 2008;97:314–20.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18286474'}}}",
"{'Citation': 'Palmer BV, Levene A, Shaw HJ. Synovial sarcoma of the pharynx and oesophagus. J Laryngol Otol. 1983;97:1173–76.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '6315842'}}}",
"{'Citation': 'Amr SS, Shihabi NK, Al Hajj H. Synovial sarcoma of the esophagus. Am J Otolaryngol. 1984;5:266–69.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '6091485'}}}",
"{'Citation': 'Bloch MJ, Iozzo RV, Edmunds LH, Jr, Brooks JJ. Polypoid synovial sarcoma of the esophagus. Gastroenterology. 1987;92:229–33.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '3023165'}}}",
"{'Citation': 'Antón-Pacheco J, Cano I, Cuadros J, et al. Synovial sarcoma of the esophagus. J Pediatr Surg. 1996;31:1703–5.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8986996'}}}",
"{'Citation': 'Habu S, Okamoto E, Toyosaka A, et al. Synovial sarcoma of the esophagus: report of a case. Surg Today. 1998;28:401–4.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9590705'}}}",
"{'Citation': 'Abe K, Maebayashi T, Shizukuishi T, et al. Radiological assessment following thermoradiation therapy for primary pleural synovial sarcoma: case report. Med Oncol. 2010;27:1027–30.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19821063'}}}",
"{'Citation': 'Kawai A, Woodruff J, Healey JH, et al. SYT-SSX gene fusion as a determinant of morphology and prognosis in synovial sarcoma. N Engl J Med. 1998;338:153–60.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9428816'}}}",
"{'Citation': 'Bergh P, Meis-Kindblom JM, Gherlinzoni F, et al. Synovial sarcoma: identification of low and high risk groups. Cancer. 1999;85:2596–607.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10375108'}}}",
"{'Citation': 'Ng TM, Spencer GM, Sargeant IR, et al. Management of strictures after radiotherapy for esophageal cancer. Gastrointest Endosc. 1996;43:584–90.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8781938'}}}",
"{'Citation': 'Wax MK, Amirali A, Ulewicz DE, Lough R. Safety of esophagoscopy in the irradiated esophagus. Ann Otol Rhinol Laryngol. 1997;106:297–300.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9109719'}}}",
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] | Am J Case Rep. 2012 Jun 29; 13:128-132 | NO-CC CODE |
|
Computed tomography images of undifferentiated pleomorphic sarcoma. The left panel depicts a coronal slice image of the left maxillary sinus primary mass. The right panel depicts the left gluteal metastasis. Red arrows point to the tumor. | rt-2013-1-e14-g001 | 7 | 1137249d41583720c3750c09d34ec0ab4b5ec83ece9cb6881879357524540bfa | rt-2013-1-e14-g001.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
500,
310
] | [{'image_id': 'rt-2013-1-e14-g003', 'image_file_name': 'rt-2013-1-e14-g003.jpg', 'image_path': '../data/media_files/PMC3682453/rt-2013-1-e14-g003.jpg', 'caption': 'Telomerase complex regulation of cellular senescence and apoptosis. This figure illustrates how telomerase complex regulation is involved in cellular senescence and apoptosis. Figure derived using the Functional Ontology Enrichment Tool in MetaCore from GeneGo, Inc. (v6.8; Thomson Reuters Business, Philadelphia, PA).', 'hash': 'fd2f8aaea2615c2cc9f56729ab115e112d2ce5a672ec795f78c0c5bb179aebf1'}, {'image_id': 'rt-2013-1-e14-g004', 'image_file_name': 'rt-2013-1-e14-g004.jpg', 'image_path': '../data/media_files/PMC3682453/rt-2013-1-e14-g004.jpg', 'caption': 'Telomerase complex regulation of telomere maintenance and cellular immortalization. This figure illustrates how telomerase complex regulation is involved in telomere maintenance and cellular immortalization. Figure derived using the Functional Ontology Enrichment Tool in MetaCore from GeneGo, Inc. (v6.8; Thomson Reuters Business, Philadelphia, PA).', 'hash': 'e7fdaf012c19264141d66473d773e96fa9215b03ffedadc493af949f1e5bac66'}, {'image_id': 'rt-2013-1-e14-g005', 'image_file_name': 'rt-2013-1-e14-g005.jpg', 'image_path': '../data/media_files/PMC3682453/rt-2013-1-e14-g005.jpg', 'caption': 'Legend for Figures 3 and 4 derived from GeneGo, Inc. (v6.8; Thomson Reuters Business, Philadelphia, PA)', 'hash': '419d735b4aadf0858644969f2e77a1bf7f87f50c8181583a44c48f39a9eae4c5'}, {'image_id': 'rt-2013-1-e14-g002', 'image_file_name': 'rt-2013-1-e14-g002.jpg', 'image_path': '../data/media_files/PMC3682453/rt-2013-1-e14-g002.jpg', 'caption': 'UPS1 (first sample) and UPS2 (second sample) clone comparison. This figure illustrates the presence of unique and shared genetic aberrations between the two populations. A) and B) provide a comparison between the histograms that were generated from flow-sort of each sample. C) and D) indicate which focal aberrations are present in UPS1 and UPS2 respectively and if they are unique or shared between both sample populations.', 'hash': '54baffa3a82aafb7c3ccbc165815fb1b166c23d8b47002e71418c38e88b50f20'}, {'image_id': 'rt-2013-1-e14-g001', 'image_file_name': 'rt-2013-1-e14-g001.jpg', 'image_path': '../data/media_files/PMC3682453/rt-2013-1-e14-g001.jpg', 'caption': 'Computed tomography images of undifferentiated pleomorphic sarcoma. The left panel depicts a coronal slice image of the left maxillary sinus primary mass. The right panel depicts the left gluteal metastasis. Red arrows point to the tumor.', 'hash': '1137249d41583720c3750c09d34ec0ab4b5ec83ece9cb6881879357524540bfa'}] | {'rt-2013-1-e14-g001': ['An initial debulking procedure was performed to remove the 5.1×4.2 cm tumor that was identified by computed tomography (CT) scan (UPS1) and post-operative intensity-modulated radiation therapy (IMRT) at a total dose of 6000 cGy followed (<xref ref-type="fig" rid="rt-2013-1-e14-g001">Figure 1</xref>).).'], 'rt-2013-1-e14-g002': ['We identified a 2.5N aneuploid population in biopsies from UPS1 and UPS2 (<xref ref-type="fig" rid="rt-2013-1-e14-g002">Figure 2</xref>). The histograms of the UPS3 biopsy showed high levels of subcellular debris consistent with excessive tissue degradation. Thus, we did not detect or sort any intact diploid or aneuploid populations in the UPS3 biopsy.). The histograms of the UPS3 biopsy showed high levels of subcellular debris consistent with excessive tissue degradation. Thus, we did not detect or sort any intact diploid or aneuploid populations in the UPS3 biopsy.'], 'rt-2013-1-e14-g003': ['Amplification of TERT is thought to occur through the homozygous deletion of CDKN2A (p16) seen in both UPS1 and UPS, which is an upstream suppressor of TERT and provides an explanation for a proposed pathway leading to cellular immortalization and progression to sarcomagenesis for this instance of UPS. Normally, the famed tumor suppressor p53 induces the transcription of cyclin-dependent kinase inhibitor 1A (CDKN1A aka p21), which binds to CDKN2A and sets off a cascade that suppresses TERT transcription (<xref ref-type="fig" rid="rt-2013-1-e14-g003">Figures 3</xref>––<xref ref-type="fig" rid="rt-2013-1-e14-g005">5</xref>).).23,24 Due to the homozygous deletion of CDKN2A, the CDKN1A/CDKN2A complex, as well as, an alternative p53/p73/CDKN2A transcriptional inhibition complex of TERT cannot form and effectively suppress TERT expression.25 There are other transcriptional and post-translational mechanisms for TERT inhibition but it is believed by our group that the loss of these two complexes in combination with TERT amplification is enough for TERT to play a role in cellular immortalization and work in conjunction with other cancer-promoting factors leading to sarcomagenesis.', 'Legend for <xref ref-type="fig" rid="rt-2013-1-e14-g003">Figures 3</xref> and and <xref ref-type="fig" rid="rt-2013-1-e14-g004">4</xref> derived from GeneGo, Inc. (v6.8; Thomson Reuters Business, Philadelphia, PA) derived from GeneGo, Inc. (v6.8; Thomson Reuters Business, Philadelphia, PA)']} | Elucidating potentially significant genomic regions involved in the initiation and progression of undifferentiated pleomorphic sarcoma | [
"undifferentiated pleomorphic sarcoma",
"flow-sort cytometry",
"array comparative genomic hybridization."
] | Rare Tumors | 1364194800 | A 57-year-old woman presented to her ophthalmologist because of rapid deterioration in vision. Dilated funduscopic examination of the right eye showed an elevated, yellow-orange choroidal mass temporal to the fovea; a complete retinal detachment was present in the left eye. The patient was referred to an oncologist. Computerized tomography of the brain, thorax, abdomen, and pelvis were obtained. They revealed an 11-mm mass in the right parietal lobe, a 30-mm mass in the left temporal lobe, 23-mm mass in the right kidney, and multiple nodules in both lungs. Supported by published experience with intravitreal bevacizumab for choroidal metastasis, the patient was injected into the vitreous through the pars plana of the left eye. The tumor mass did not show signs of regression and the visual acuity was unchanged. The patient suffered from end-state complications tumor metastasis and expired one month after the invitreal injection. | [] | other | PMC3682453 | null | 33 | [
"{'Citation': 'Kuo IC, Haller JA, Maffrand R, et al. Regression of a subfoveal choroidal metastasis of colorectal carcinoma after intravitreous bevacizumab treatment. Arch Ophthalmol. 2008;126:1311–3.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18779499'}}}",
"{'Citation': 'Burger R, Fleming G. Phase III randomized study of carboplatin and paclitaxel versus carboplatin, paclitaxel, and concurrent bevacizumab without versus with extended bevacizumab in patients with stage III or IV ovarian epithelial or primary peritoneal cancer (GOG-0218) [Accessed: September 2012];Nation Cancer Institute, trial NCT00262847. Available from; http://clinicaltrials.gov/ct2/show/record/NCT00262847.'}",
"{'Citation': 'Walker J. A phase III clinical trial of bevacizumab with IV versus IP chemotherapy in ovarian, fallopian tube, and primary peritoneal carcinoma NCI-supplied agent(s): Bevacizumab (NSC #704865, IND #7921. [Accessed: December 2012];National Cancer Institue, Trial NCT00951496. Available from: http://clinicaltrials.gov/ct2/show/record/NCT00951496.'}",
"{'Citation': 'Miller BA, Kolonel LN, Bernstein L, et al., editors. Racial/ethnic patterns of cancer in the United States 1988–1992. Whashington DC: National Cancer Institute; 1996. NIH Pub. No. 96-4104.'}",
"{'Citation': 'Saad AF, Hu W, Sood AK. Microenvironment and pathogenesis of epithelial ovarian cancer. Horm Cancer. 2010;1:277–90.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3199131'}, {'@IdType': 'pubmed', '#text': '21761359'}]}}",
"{'Citation': 'Choi KC, Kang SK, Tai CJ, et al. Follicle-stimulating hormone activates mitogen-activated protein kinase in preneoplastic and neoplastic ovarian surface epithelial cells. J Clin Endocrinol Metab. 2002;87: 2245–53.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11994371'}}}",
"{'Citation': 'Lau MT, Wong AS, Leung PC. Gonadotropins induce tumor cell migration and invasion by increasing cyclooxygenases expression and prostaglandin E(2) production in human ovarian cancer cells. Endocrinology. 2010;151: 2985–93.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '20392831'}}}",
"{'Citation': 'Schiffenbauer YS, Abramovitch R, Meir G, et al. Loss of ovarian function promotes angio-genesis in human ovarian carcinoma. Proc Natl Acad Sci USA. 1997;94:13203–8.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC24287'}, {'@IdType': 'pubmed', '#text': '9371824'}]}}",
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"{'Citation': 'Ness RB, Cottreau C. Possible role of ovarian epithelial inflammation in ovarian cancer. J Natl Cancer Inst. 1999;91:1459–67.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10469746'}}}",
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"{'Citation': 'Burger RA, Brady ML, Bookman MA, et al. Phase III trial of bevacizumab (BEV) in the primary treatment of advanced epithelial ovarian cancer (EOC), primary peritoneal cancer (PPC), or Fallopian tube cancer (FTC): a gynecologic oncology group study. J Clin Oncol. 2010;28((suppl)) abstract LBA1. Available from: http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=52788.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3795907'}, {'@IdType': 'pubmed', '#text': '23906656'}]}}",
"{'Citation': \"Kerbel S, Ellis LM. Devita, Hellman & Rosenberg's Cancer: principles & practice of oncology. Philadelphia, PA: Lippincott Williams & Wilkins; 2008. Molecular biology; pp. 104–115.\"}",
"{'Citation': 'Lee S, Jilani SM, Nikolova GV, et al. Processing of VEGF-A by matrix metalloproteinases regulates bioavailability and vascular patterning in tumors. J Cell Biol. 2005;169:681–91.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2171712'}, {'@IdType': 'pubmed', '#text': '15911882'}]}}",
"{'Citation': 'Hawinkels LJ, Zuidwijk K, Verspaget HW, et al. VEGF release by MMP-9 mediated heparan sulphate cleavage induces colorectal cancer angiogenesis. Eur J Cancer. 2008;44:1904–13.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18691882'}}}",
"{'Citation': 'Ruhrberg C, Gerhardt H, Golding M, et al. Spatially restricted patterning cues provided by heparin-binding VEGF-A control blood vessel branching morphogenesis. Genes Dev. 2002;16:2684–98.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC187458'}, {'@IdType': 'pubmed', '#text': '12381667'}]}}",
"{'Citation': 'Grunstein J, Masbad JJ, Hickey R, et al. Isoforms of vascular endothelial growth factor act in a coordinate fashion To recruit and expand tumor vasculature. Mol Cell Biol. 2000;20:7282–91.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC86282'}, {'@IdType': 'pubmed', '#text': '10982845'}]}}",
"{'Citation': 'Rosenstein JM, Krum JM. New roles for VEGF in nervous tissue-beyond blood vessels. Exp Neurol. 2004;187:246–53.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15144851'}}}",
"{'Citation': 'Williams RS, Annex BH. Plasticity of myocytes and capillaries: a possible coordinating role for VEGF. Circ Res. 2004;95:7–8.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15242980'}}}",
"{'Citation': 'Small AR, Neagu A, Amyot F, et al. Spatial distribution of VEGF isoforms and chemotactic signals in the vicinity of a tumor. J Theor Biol. 2008;252:593–607.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18395755'}}}",
"{'Citation': 'Lima BR, Schoenfield LR, Singh AD. The impact of intravitreal bevacizumab therapy on choroidal melanoma. Am J Ophthalmol. 2011;151:323–8.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21168817'}}}",
"{'Citation': 'Sharma RK, Balaiya S, Chalam KV. Bevacizumab suppression of establishment of micrometastases in experimental ocular melanoma. Invest Ophthalmol Vis Sci. 2010;51:6906.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3055783'}, {'@IdType': 'pubmed', '#text': '21123801'}]}}",
"{'Citation': 'Nakashima C, Keino H, Watanabe T, et al. Intravitreal bevacizumab for iris metastasis of small-cell lung carcinoma with neovascular glaucoma. Jpn J Ophthalmol. 2011;55:80–1.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21331703'}}}",
"{'Citation': 'Sagong M, Lee J, Chang W. Application of intravitreal bevacizumab for circumscribed choroidal hemangioma. Korean J Ophthalmol. 2009;23:127–31.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2694292'}, {'@IdType': 'pubmed', '#text': '19568366'}]}}",
"{'Citation': 'Senger DR. Vascular endothelial growth factor: much more than an angiogenesis factor. Mol Biol Cell. 2010;21:377–9.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2814783'}, {'@IdType': 'pubmed', '#text': '20124007'}]}}",
"{'Citation': 'Dvorak HF. Vascular permeability factor/vascular endothelial growth factor: a critical cytokine in tumor angiogenesis and a potential target for diagnosis and therapy. J Clin Oncol. 2002;20:4368–80.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12409337'}}}",
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] | Rare Tumors. 2013 Mar 25; 5(1):e14 | NO-CC CODE |
|
Two months follow up MRV brain: (a) A-P image. (b) lateral image showing patent all venous sinuses with complete recanalization (case Ι). | gr4b_lrg | 7 | 4ca75a35de4b78c38ce81ca1f7e1b5bf6c1d411d9d6a23c1424620d58a289274 | gr4b_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
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787,
243
] | [{'image_id': 'gr2b_lrg', 'image_file_name': 'gr2b_lrg.jpg', 'image_path': '../data/media_files/PMC9167686/gr2b_lrg.jpg', 'caption': 'MRI brain: (a) axial T2-weighted images, (b) axial T1-weighted images with IV contrast, (c) coronal T1-weighted images with IV contrast showing right cerebral venous infarction, thrombosed superior sagittal, right transverse and right sigmoid sinuses (case Ι).', 'hash': '581631b8086eeebef8fe09ef227ca5e3e2e53d7e5f7734bb4ceb9e431b9752ea'}, {'image_id': 'gr5_lrg', 'image_file_name': 'gr5_lrg.jpg', 'image_path': '../data/media_files/PMC9167686/gr5_lrg.jpg', 'caption': 'MRI brain, axial and sagittal T1-weighted images thrombosed superior sagittal and straight sinuses (case ΙΙ).', 'hash': '325b2fe2216c3fed05a906cca9842fc9f27b098aaa18975aa298b8e8a4f6858c'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC9167686/gr1_lrg.jpg', 'caption': 'CT brain showing hyperdensity at superior sagittal and right transverse sinuses indicating thrombosis (case Ι).', 'hash': 'ad1d8abe56ef0cc2a19cbb4ad1c0b0127dbe12708668a6334115460900b21c63'}, {'image_id': 'gr4b_lrg', 'image_file_name': 'gr4b_lrg.jpg', 'image_path': '../data/media_files/PMC9167686/gr4b_lrg.jpg', 'caption': 'Two months follow up MRV brain: (a) A-P image. (b) lateral image showing patent all venous sinuses with complete recanalization (case Ι).', 'hash': '4ca75a35de4b78c38ce81ca1f7e1b5bf6c1d411d9d6a23c1424620d58a289274'}, {'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC9167686/gr3_lrg.jpg', 'caption': 'MRV brain showing superior sagittal, right transverse, right sigmoid and right internal jugular vein thrombosis (case Ι).', 'hash': '3fa719f85a3bcf30efb40535d062888d4bd845469f130965a00771395abefb8e'}, {'image_id': 'gr2a_lrg', 'image_file_name': 'gr2a_lrg.jpg', 'image_path': '../data/media_files/PMC9167686/gr2a_lrg.jpg', 'caption': 'MRI brain: (a) axial T2-weighted images, (b) axial T1-weighted images with IV contrast, (c) coronal T1-weighted images with IV contrast showing right cerebral venous infarction, thrombosed superior sagittal, right transverse and right sigmoid sinuses (case Ι).', 'hash': 'de2ee7a3d9240981f6f08e0a9d654c13c6c2bfd0b298826083f5a8e5ca696986'}, {'image_id': 'gr4a_lrg', 'image_file_name': 'gr4a_lrg.jpg', 'image_path': '../data/media_files/PMC9167686/gr4a_lrg.jpg', 'caption': 'Two months follow up MRV brain: (a) A-P image. (b) lateral image showing patent all venous sinuses with complete recanalization (case Ι).', 'hash': 'e18155566e6dde4597478476b00f22f26083d3ad034b0880e93e847a5ed64cad'}, {'image_id': 'gr6_lrg', 'image_file_name': 'gr6_lrg.jpg', 'image_path': '../data/media_files/PMC9167686/gr6_lrg.jpg', 'caption': 'Fundus camera showing advanced papilledema with retinal vein tortousity and areas of micro-haemorrhages (case ΙΙ).', 'hash': 'bbb39d1cedaea6d6aad2d08876739b40ec6d32526d69c99fc34a5338d5007444'}] | {'gr1_lrg': ['A 23\xa0years old, female was admitted to intermediate care unit in our isolation hospital with a history of fever, progressive cough, and discomfort during breathing for the last 5\xa0days. There was no previous history of any medical problems, smoking, pregnancy or oral contraceptive pills. On admission she was conscious and alert, her O2 saturation was 90%, body temperature 38.4, blood pressure 126/78\xa0mmHg. Laboratory test showed significant leucocytosis (WBC 41.89\xa0×\xa0103/L), fibrinogen 324\xa0mg/Dl. Rt-PCR test for a nasopharyngeal swab showed positive result for SARS-CoV-2. Chest CT scan confirmed the diagnosis of covid-19 infection as it showed multiple bilateral subpleural ground-glass opacities. Patient received immediate O2 support through mask with a rate of 4\xa0L/min that kept her O2 saturation around 97%. COVID-19 protocol of medications was started including anticoagulation by intravenous heparin. Her general conditions started improvement, fever subsided and O2 support was decreased to minimum with adequate O2 saturation. On the 7th day, anticoagulation was stopped after improvement. Unfortunately, while preparing her for discharge on the 9th day of admission, she suddenly became unconscious with left side weakness, so she was intubated and transferred to ICU. Her Glasgow coma scale (GCS) score reached 5\xa0+\xa0T. Urgent CT brain was done after stabilization of her conditions which showed hyperdensity at superior sagittal and right transverse sinuses (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>\n) associated with right parietal cortical and subcortical hypodense area, suggesting the picture of CVST with venous infarction.. MRI brain was done which revealed right posterior parietal cerebral infarction (\n) associated with right parietal cortical and subcortical hypodense area, suggesting the picture of CVST with venous infarction.. MRI brain was done which revealed right posterior parietal cerebral infarction (<xref rid="gr2a_lrg" ref-type="fig">Fig. 2</xref>\n). MR venography (MRV) has also confirmed CVST at SSS, right TS, right sigmoid sinus and internal jugular vein (\n). MR venography (MRV) has also confirmed CVST at SSS, right TS, right sigmoid sinus and internal jugular vein (<xref rid="gr3_lrg" ref-type="fig">Fig. 3</xref>\n). Due to multi-sinus thrombosis and a very high D-dimer (4563\xa0ng/mL), our decision was to start enoxaparin subcutaneously. After 3\xa0days of this treatment, the patient regained her consciousness gradually, extubated on the 4th day of ICU admission, became fully conscious on 5th day. left hemiparesis started improvement during the next 2\xa0days after regaining consciousness. Patient was discharged on 7th day of ICU admission after a negative Rt-PCR test for a nasopharyngeal swab. On discharge, enoxaparine was replaced by new oral anticoagulants (Apixaban) and patient was advised to start physiotherapy. 2\xa0weeks from discharge patient came to our outpatient department (OPD) ambulating with no residual neurological deficit. The patient came again after 2\xa0months for follow up with no neurological symptoms or signs. MRI and MRV brain were done revealing patent all sinuses with complete recanalization as shown in \n). Due to multi-sinus thrombosis and a very high D-dimer (4563\xa0ng/mL), our decision was to start enoxaparin subcutaneously. After 3\xa0days of this treatment, the patient regained her consciousness gradually, extubated on the 4th day of ICU admission, became fully conscious on 5th day. left hemiparesis started improvement during the next 2\xa0days after regaining consciousness. Patient was discharged on 7th day of ICU admission after a negative Rt-PCR test for a nasopharyngeal swab. On discharge, enoxaparine was replaced by new oral anticoagulants (Apixaban) and patient was advised to start physiotherapy. 2\xa0weeks from discharge patient came to our outpatient department (OPD) ambulating with no residual neurological deficit. The patient came again after 2\xa0months for follow up with no neurological symptoms or signs. MRI and MRV brain were done revealing patent all sinuses with complete recanalization as shown in <xref rid="gr4a_lrg" ref-type="fig">Fig. 4</xref>\n.\n.Fig. 1CT brain showing hyperdensity at superior sagittal and right transverse sinuses indicating thrombosis (case Ι).Fig. 2MRI brain: (a) axial T2-weighted images, (b) axial T1-weighted images with IV contrast, (c) coronal T1-weighted images with IV contrast showing right cerebral venous infarction, thrombosed superior sagittal, right transverse and right sigmoid sinuses (case Ι).Fig. 3MRV brain showing superior sagittal, right transverse, right sigmoid and right internal jugular vein thrombosis (case Ι).Fig. 4Two months follow up MRV brain: (a) A-P image. (b) lateral image showing patent all venous sinuses with complete recanalization (case Ι).'], 'gr5_lrg': ['A 21\xa0years old, woman had a history of high fever, generalized muscle aches, and dry cough. She was screened for COVID-19 by rt-PCR test for a nasal swab on the 2nd day of her symptoms which was\xa0+\xa0ve, so she was advised for home isolation with medical symptomatic treatment as her symptoms were mild and O2 saturation was 99%. Fever began to subside from 4th day and muscle aches gradually became better. Unfortunately, after 7\xa0days from the start of her symptoms she developed a rapidly progressive severe headache, so she was presented to our emergency department asking for medical advice. Headache was described by the patient as bursting pain allover the head associated with repeated vomiting. There was no history of smoking, oral contraceptive pills or any medical problems. On examination, patient was conscious and alert (GCS\xa0=\xa015) but She had bilateral advanced papilledema. Her vital sign were almost normal except mildly increased blood pressure (150/100\xa0mmHg). Urgent CT brain was done showing hyperdense veins and sinuses at the right parietal lobe area, superior sagittal sinus (SSS), and straight sinus together with brain oedema which suggested the presence of CVST. So, she was admitted to isolation department where initial laboratory tests showed increased level of erythrocyte sedimentation rate (ESR) 67\xa0mm/h, high leucocytic count (16\xa0×\xa0103/L) with neutrophil lymphocyte ratio (NLR) of 35, fibrinogen was 546\xa0mg/dL and D-dimer 19546\xa0ng/mL. MRI and MRV brain have confirmed CVST at SSS, straight sinus, bilateral TS, and bilateral sigmoid sinuses (<xref rid="gr5_lrg" ref-type="fig">Fig. 5</xref>\n). Fundus camera showed advanced bilateral papilledema with marked tortuosity of retinal veins and areas of haemorrhages (\n). Fundus camera showed advanced bilateral papilledema with marked tortuosity of retinal veins and areas of haemorrhages (<xref rid="gr6_lrg" ref-type="fig">Fig. 6</xref>\n). Furthermore, the chest CT scan showed subpleural bilateral ground-glass opacities with a fibrotic appearance in the left lung. 80\xa0mg subcutaneous enoxaparin was administered twice daily with acetazolamide TID for papilledema. After 7\xa0days from admission, D-dimer decreased to 1985\xa0ng/ml. So, we continued with enoxaparin until the D-dimer became normal and the patient showed negative rt-PCR test. Headache improved gradually and vomiting stopped. The patient was discharged from the hospital on the 14th day from admission on new oral anticoagulants (Apixaban). When she came for follow up after 2\xa0months in our OPD she was conscious, alert with no neurological symptoms. MRI and MRV brain were done showing complete recanalization of all sinuses with normal brain.\n). Furthermore, the chest CT scan showed subpleural bilateral ground-glass opacities with a fibrotic appearance in the left lung. 80\xa0mg subcutaneous enoxaparin was administered twice daily with acetazolamide TID for papilledema. After 7\xa0days from admission, D-dimer decreased to 1985\xa0ng/ml. So, we continued with enoxaparin until the D-dimer became normal and the patient showed negative rt-PCR test. Headache improved gradually and vomiting stopped. The patient was discharged from the hospital on the 14th day from admission on new oral anticoagulants (Apixaban). When she came for follow up after 2\xa0months in our OPD she was conscious, alert with no neurological symptoms. MRI and MRV brain were done showing complete recanalization of all sinuses with normal brain.Fig. 5MRI brain, axial and sagittal T1-weighted images thrombosed superior sagittal and straight sinuses (case ΙΙ).Fig. 6Fundus camera showing advanced papilledema with retinal vein tortousity and areas of micro-haemorrhages (case ΙΙ).']} | Cerebral venous sinus thrombosis in COVID 19 patients: Report of 2 cases | [
"Corona virus disease 2019 (COVID-19)",
"Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)",
"Cerebral venous sinus thrombosis (CVST)",
"Venous thrombotic events (VTE)",
"Neurologic manifestations"
] | Interdiscip Neurosurg | 1662447600 | [
"COVID-19",
"COVID-19 Vaccines",
"Humans",
"Thyroiditis, Subacute",
"Vaccination"
] | other | PMC9167686 | null | 5 | [
"{'Citation': 'Rebollar A.F. Subacute thyroiditis after anti-SARS-CoV-2 (Ad5-nCoV) vaccine. Enferm Infecc Microbiol Clin. 2021;(November) doi: 10.1016/j.eimc.2021.10.015. [online ahead of print]', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.eimc.2021.10.015'}, {'@IdType': 'pmc', '#text': 'PMC9117402'}, {'@IdType': 'pubmed', '#text': '35637121'}]}}",
"{'Citation': 'Sözen M., Topaloğlu Ö., Çetinarslan B., Selek A., Cantürk Z., Gezer E., et al. COVID-19 mRNA vaccine may trigger subacute thyroiditis. Hum Vaccin Immunother. 2021;10(December):1–6.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC8904015'}, {'@IdType': 'pubmed', '#text': '34893014'}]}}",
"{'Citation': \"Jeeyavudeen M.S., Patrick A.W., Gibb F.W., Dover A.R. COVID-19 vaccine-associated subacute thyroiditis: an unusual suspect for de Quervain's thyroiditis. BMJ Case Rep. 2021;14 e246425.\", 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC8578953'}, {'@IdType': 'pubmed', '#text': '34753732'}]}}",
"{'Citation': 'Mungmunpuntipantip R., Viroj Wiwanitkit V. Abnormal thyroid function following COVID-19 vaccination. Indian J Endocrinol Metab. 2021;25:169.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC8477734'}, {'@IdType': 'pubmed', '#text': '34660248'}]}}",
"{'Citation': 'Joob B., Wiwanitkit V. Expected viscosity after COVID-19 vaccination, hyperviscosity and previous COVID-19. Clin Appl Thromb Hemost. 2021;27 doi: 10.1177/10760296211020833.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1177/10760296211020833'}, {'@IdType': 'pmc', '#text': 'PMC8216419'}, {'@IdType': 'pubmed', '#text': '34142570'}]}}"
] | Interdiscip Neurosurg. 2022 Sep 6; 29:101599 | NO-CC CODE |
||
A: Expanded Superior Mesenteric Vein with decreased contrast enhancement signifying thrombosis. B: CT abdomen and pelvis demonstrating extensive mesenteric portal vein thrombosis. C: Additional thrombosis cutoff. D: Coronal view of SMV occlusion with fat stranding and ischemic changes. E: Coronal view of Portal Vein occlusion with thrombus. | gr1_lrg | 7 | 955ff11e01b6e8bc2dfed19f29a230256a5d2abcea02e7b5e461b7507e16bc5b | gr1_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
790,
1260
] | [{'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC9339080/gr1_lrg.jpg', 'caption': 'A: Expanded Superior Mesenteric Vein with decreased contrast enhancement signifying thrombosis. B: CT abdomen and pelvis demonstrating extensive mesenteric portal vein thrombosis. C: Additional thrombosis cutoff. D: Coronal view of SMV occlusion with fat stranding and ischemic changes. E: Coronal view of Portal Vein occlusion with thrombus.', 'hash': '955ff11e01b6e8bc2dfed19f29a230256a5d2abcea02e7b5e461b7507e16bc5b'}] | {'gr1_lrg': ['CT abdomen and pelvis with contrast revealed loops of jejunum demonstrating moderate circumferential bowel wall thickening, bowel wall edema, prominent mesenteric vessels, and a portal vein thrombus extending to the superior mesenteric, and splenic veins (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>\nA–E). Etiology was unclear; therefore, further interviewing to determine risk factors and deduce culpability was pursued. The patient was notably not a smoker, had no personal history of malignancy, had an unremarkable colonoscopy five years prior and had no prior history of thrombotic events. Notably, his mother had clots in the past, but it was unclear if the instances were arterial or venous in origin. His father had a history of leukemia and skin cancer.\nA–E). Etiology was unclear; therefore, further interviewing to determine risk factors and deduce culpability was pursued. The patient was notably not a smoker, had no personal history of malignancy, had an unremarkable colonoscopy five years prior and had no prior history of thrombotic events. Notably, his mother had clots in the past, but it was unclear if the instances were arterial or venous in origin. His father had a history of leukemia and skin cancer.Fig. 1A: Expanded Superior Mesenteric Vein with decreased contrast enhancement signifying thrombosis. B: CT abdomen and pelvis demonstrating extensive mesenteric portal vein thrombosis. C: Additional thrombosis cutoff. D: Coronal view of SMV occlusion with fat stranding and ischemic changes. E: Coronal view of Portal Vein occlusion with thrombus.Fig. 1']} | COVID-19 vaccine (Ad26.COV2.S), an unlikely culprit of portal vein thrombosis in a middle-aged man | null | None | None | The sudden emergence of the COVID-19 triggered a chain of events in the global education system; suspended onsite instruction; migration to online learning; adoption of mobile technologies for mobile learning, and diverse technological innovations. All this was done with the objective of adhering to COVID-19 lockdown protocols to speed global recovery from the disruptive effect of the COVID-19 crisis. In many countries, online learning became the only legal means to achieve lifelong and progressive education for over 91% of the world's student population whose education was at risk. Stakeholders in higher education (parents, students, teachers, and administrators) across the globe also became "frontline workers" in a collective effort to combat the spread of the virus. The study explores the integral role of these frontline workers in curbing the virus. The researchers draw from qualitative interviews involving twenty (20) tertiary students in Ghana who experienced a physical resumption of school in 2021. Findings suggest that a policy shift by school leaders led to the adoption of a multi-track year-round education (MT-YRE) system to promote social distancing. Students were provided with personal protective equipment (PPEs), teachers educated students on COVID-19 prevention and fostered good relationships with their students. Students adhered to institutional protocols to study. Parents also provided psychological and financial support. Policymakers in education should provide clear guidelines, resources, funds, and recognition to school stakeholders as they collectively tackle the virus to ensure economic, health, and education recovery post-COVID-19. Future studies should focus on how to establish a crisis-management framework for higher education. | [] | other | PMC9339080 | null | 60 | [
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] | 2022 Aug 31; 8:100119 | NO-CC CODE |
|
MDCT coronal reformat demonstrating recurrent neuroblastoma (arrows) in a child aged 3 years. The tumour penetrates two neural foraminae in the lower thoracic region, and extends cranio-caudally within the spinal canal covering almost four segments. | ci06002203 | 7 | 69d04973451141b53514bc5d669113b5e80350eae3ee01907e51339e0129e7d5 | ci06002203.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
458,
598
] | [{'image_id': 'ci06002201', 'image_file_name': 'ci06002201.jpg', 'image_path': '../data/media_files/PMC1805056/ci06002201.jpg', 'caption': 'T2-weighted sagittal sequence demonstrating metastases in several vertebrae. There is complete collapse of the vertebral body at T6 with retropulsion onto the course of the anterior spinal artery. A syndrome of cord compression resulted with dense paraplegia.', 'hash': '7b7c5c52b3080d27d9667e849e436695d2caee328e5610a38ac4b91e6eacb45a'}, {'image_id': 'ci06002206', 'image_file_name': 'ci06002206.jpg', 'image_path': '../data/media_files/PMC1805056/ci06002206.jpg', 'caption': '(a) T2-weighted sagittal image in a patient suspected of having cord compression on clinical grounds. At T8 there is an area of slightly altered signal in the cord (arrow) with high signal cranially and caudally. This was interpreted as a limited syrinx, and precipitated administration of gadolinium in an attempt to confirm intra-axial spinal cord deposits. (b) Following gadolinium there is an enhancing mass in the cord at T8 (arrow). Further small enhancing nodules are present in the upper thoracic and cervical region and also in the cerebellum (metastatic breast carcinoma).', 'hash': 'cad8541564afa53fa81aa8a56846524d8d00aa35b1948dad3e070f3bb01232f6'}, {'image_id': 'ci06002203', 'image_file_name': 'ci06002203.jpg', 'image_path': '../data/media_files/PMC1805056/ci06002203.jpg', 'caption': 'MDCT coronal reformat demonstrating recurrent neuroblastoma (arrows) in a child aged 3 years. The tumour penetrates two neural foraminae in the lower thoracic region, and extends cranio-caudally within the spinal canal covering almost four segments.', 'hash': '69d04973451141b53514bc5d669113b5e80350eae3ee01907e51339e0129e7d5'}, {'image_id': 'ci06002204', 'image_file_name': 'ci06002204.jpg', 'image_path': '../data/media_files/PMC1805056/ci06002204.jpg', 'caption': 'Axial CT scan of a patient with lymphoma and poorly localised back pain. There is soft tissue tumour in the neural foramen (arrows) obliterating the fat plane normally found. Such epidural disease is not rare, and may be found in any type of lymphoma.', 'hash': '764152e0ead030b6b5799563487d9ed0a0fbd4effd2b940e3048cff57a2e9f94'}, {'image_id': 'ci06002205', 'image_file_name': 'ci06002205.jpg', 'image_path': '../data/media_files/PMC1805056/ci06002205.jpg', 'caption': 'Sagittal T1-weighted MRI following gadolinium shows enhancing nodules throughout the spinal meninges consistent with meningeal metastatic disease.', 'hash': '3981ef8b4796ec84285a0817e0856c1bb157f5e24ab831a7701caae3abbc7c76'}, {'image_id': 'ci06002202', 'image_file_name': 'ci06002202.jpg', 'image_path': '../data/media_files/PMC1805056/ci06002202.jpg', 'caption': '(a) T2-weighted sagittal sequence of thoraco-lumbar spine. There is abnormal signal in all bones displayed, due to infiltration by metastatic prostate carcinoma. At T10 (arrow) there is apparent widening of the cord in the midline sagittal plane. This finding should precipitate orthogonal plane imaging. (b) Axial T2-weighted imaging at T10 demonstrates a metastasis infiltrating the vertebral body and expanding the posterior elements so that there is some mechanical distortion of the cord from a lateral direction.', 'hash': '24673928f8069cd28a1dc09105e2ca871e7e38a57df086f2d7f6dda8404f3f90'}] | {'ci06002201': ['This important complication of bony metastatic disease is frequently associated with primaries in breast, lung, prostate and kidney. It is also a well-recognised complication of lymphoma and multiple myeloma, although any primary tumour may be responsible. Local or radicular pain is the most frequent and earliest clinical symptom with subsequent loss of power and sphincter dysfunction; numbness or sensory loss are present in the majority of patients by the time the diagnosis is made. An appreciation of the anatomy of the spinal cord is useful. The most catastrophic effect of cord compression is paraplegia, and the main motor pathways are the lateral cortico-spinal (pyramidal) tract, which is a crossed structure lying in the lateral part of the cord but inside the sensory fibres; the anterior or ventral cortico-spinal tract, carrying direct (uncrossed) fibres, and the anterior reticulo-spinal tract lie anteriorly in the cord. The blood supply of the cord depends on the anterior spinal artery which runs at the anterior end of the ventral median fissure. This artery runs the length of the cord and is fed by the anterior radicular arteries which are branches of the vertebral arteries, posterior intercostal arteries or lumbar arteries depending on the level. The position of the anterior spinal artery makes it vulnerable to direct invasion by tumour in the vertebral body, and mechanical compressive effects if the vertebral body collapses (<xref ref-type="fig" rid="ci06002201">Fig. 1</xref>). Interruption of the anterior spinal artery will cause infarction of the cord resulting in the classical clinical presentation of power loss with upper motor neurone signs, sphincter disturbance and a sensory level [). Interruption of the anterior spinal artery will cause infarction of the cord resulting in the classical clinical presentation of power loss with upper motor neurone signs, sphincter disturbance and a sensory level [3]. However, tumour growth in the posterior elements may compress from a lateral or posterior direction, resulting in a less obvious clinical presentation. Breast and prostate deposits not infrequently expand the posterior elements, impinging first on the lateral spino-thalamic and spino-radicular tracts, which carry sensory fibres. A high index of suspicion is necessary to detect the signs of lateral compression of the cord on sagittal scans (<xref ref-type="fig" rid="ci06002202">Fig. 2</xref>). Apparent widening of the cord at the midline sagittal images is a sign suggesting lateral compression. The neural foramina and peripheral sagittal slices should always be positively scrutinised and if any abnormality is suspected, a set of axial images should be obtained. \n\n). Apparent widening of the cord at the midline sagittal images is a sign suggesting lateral compression. The neural foramina and peripheral sagittal slices should always be positively scrutinised and if any abnormality is suspected, a set of axial images should be obtained. \n\n'], 'ci06002203': ['Soft tissue masses in the paraspinal and epidural spaces may cause back pain and neurological syndromes including cord compression. Bony changes may be subtle or absent, and the pain at presentation is often less severe. Soft tissue extension of tumour (in a ‘dumbbell’ fashion) may occur with a variety of tumours including lymphoma, neurofibroma, neuroblastoma, malignant thymoma, mesothelioma and lung cancer. Neurofibroma and neuroblastoma are the classic dumbbell tumours, but are uncommon. MRI or MDCT with multiplanar reformats can be used for diagnosis (<xref ref-type="fig" rid="ci06002203">Fig. 3</xref>). Bronchial carcinoma can penetrate the intervertebral foramen while causing little bony destruction, particularly in superior sulcus tumours. Malignant thymoma and mesothelioma may also spread through the neural foramen by means of soft tissue extension. One of the most important dumbbell tumours is lymphoma in the posterior mediastinum, retrocrural region and retroperitoneum. The incidence of spinal cord compression by lymphoma reported in the literature varies between 1% and 7%. Epidural masses may be small and subtle, but symptomatology such as back pain with even minimal neurology should be vigorously investigated, since early treatment should result in a favourable response (depending on the overall prognosis of the disease). However, if symptoms are neglected and paraplegia is allowed to develop, it is unlikely to recover. Current practice will usually result in back pain in patients with lymphoma being investigated with MRI. Scrutiny of the neural foramina is necessary to pick up early signs of invasion into the epidural spaces. However, early manifestations of soft tissue spread of disease through the neural foramen can be appreciated on staging CT scans in patients with lymphoma. Subtle signs such as the obliteration of the fat planes in the neural foramen may be detected, and the epidural spaces should be regarded as a ‘check area’ on staging CT scans in lymphoma [). Bronchial carcinoma can penetrate the intervertebral foramen while causing little bony destruction, particularly in superior sulcus tumours. Malignant thymoma and mesothelioma may also spread through the neural foramen by means of soft tissue extension. One of the most important dumbbell tumours is lymphoma in the posterior mediastinum, retrocrural region and retroperitoneum. The incidence of spinal cord compression by lymphoma reported in the literature varies between 1% and 7%. Epidural masses may be small and subtle, but symptomatology such as back pain with even minimal neurology should be vigorously investigated, since early treatment should result in a favourable response (depending on the overall prognosis of the disease). However, if symptoms are neglected and paraplegia is allowed to develop, it is unlikely to recover. Current practice will usually result in back pain in patients with lymphoma being investigated with MRI. Scrutiny of the neural foramina is necessary to pick up early signs of invasion into the epidural spaces. However, early manifestations of soft tissue spread of disease through the neural foramen can be appreciated on staging CT scans in patients with lymphoma. Subtle signs such as the obliteration of the fat planes in the neural foramen may be detected, and the epidural spaces should be regarded as a ‘check area’ on staging CT scans in lymphoma [4] (<xref ref-type="fig" rid="ci06002204">Fig. 4</xref>). \n\n\n). \n\n\n'], 'ci06002205': ['Meningeal carcinomatosis is increasingly recognised, and can be detected by MRI. The presentation differs from cord compression, although back pain, which tends to be poorly localised, is frequent. Isolated peripheral neuropathies and root lesions at various levels combine to produce what is often a confusing clinical presentation. Meningeal disease within the cranial cavity may co-exist and cause headache, cranial neuropathies and cognitive abnormalities, and the presence of such a combination should precipitate a search for meningeal disease. Even with the most up-to-date equipment, MRI is far from 100% sensitive in the detection of meningeal disease. The key sequences are sagittal T1-weighted spin-echo images before and after intravenous gadolinium. Any enhancement of the spinal meninges should be considered abnormal, and primary tumours such as lung, breast and melanoma may produce isolated enhancing lumps or sheets of nodular enhancement in the spinal meninges. Previous intracranial or spinal surgery, radiotherapy to the spine, lumbar puncture and intrathecal chemotherapy can give rise to meningeal enhancement, but the presence of enhancing meningeal masses allows confident diagnosis of metastases (<xref ref-type="fig" rid="ci06002205">Fig. 5</xref>). \n). \n'], 'ci06002206': ['Tumour deposits may be found throughout the neuraxis. Brain deposits are seen relatively frequently, but the same process of haematogenous metastatic spread may result in spinal cord lesions. They may be more frequent than previously recognised, and MRI is becoming increasingly sensitive at picking up such lesions. The clinical presentation is similar to that of meningeal metastatic disease, and a high index of suspicion helps in diagnosis. Neurological symptoms and signs cannot be unified to a single anatomical site. In a patient being investigated for suspected spinal cord compression, the T2-weighted sequence may show high signal within the cord. Sometimes this is the result of a true syrinx, seen cranial to and occasionally caudal to the tumour deposits. Oedema around a deposit may give a similar appearance and recognition of this phenomenon should precipitate administration of gadolinium. As with meningeal metastatic disease, the presence of an enhancing small mass or nodule within the cord should allow confident diagnosis (<xref ref-type="fig" rid="ci06002206">Fig. 6</xref>). Carcinoma of breast and lung and malignant melanoma are the commonest primary tumours associated with this phenomenon [). Carcinoma of breast and lung and malignant melanoma are the commonest primary tumours associated with this phenomenon [7]. \n\n']} | Imaging of the spine in patients with malignancy | [
"Spinal pathology",
"malignancy",
"imaging"
] | Cancer Imaging | 1162281600 | None | null | other | PMC1805056 | null | null | [
""
] | Cancer Imaging. 2006 Oct 31; 6(Spec No A):S22-S26 | NO-CC CODE |
|
Scalp, skull, CSF and brain tissue boundaries for a four-layer MR-based realistic, b four-layer warped MNI, and c four-layer MNI head models plotted on a sagittal slice of subject S1 | 10548_2012_274_Fig3_HTML | 7 | 9d185e3214c349c6ea18cadb0785faf61bfaddf86a2ca938dec7e6321e3699bf | 10548_2012_274_Fig3_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
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"computerized tomography"
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709,
244
] | [{'image_id': '10548_2012_274_Fig5_HTML', 'image_file_name': '10548_2012_274_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig5_HTML.jpg', 'caption': 'Selected coronal and sagittal slices to show localization errors', 'hash': 'dfdebd5fec48b0886ea6ca18f52b8ccdc1230b886d06f762a625b69565510b10'}, {'image_id': '10548_2012_274_Fig15_HTML', 'image_file_name': '10548_2012_274_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig15_HTML.jpg', 'caption': 'Top-row equivalent dipole source localization error directions (arrows) and magnitudes (colors) for a head shape-warped four-layer MNI head model using 192 electrodes (from Fig.\xa03). The lowerthreerows show additional errors introduced by using only 16 uniformly distributed electrodes (subscript 16, second row), or using 16 electrodes covering only right side of the head (subscript R16, bottom rows)', 'hash': '6d397f76ed387c508ccc3fac50e1431a3ea938f552655cbc9540d54f8080eacb'}, {'image_id': '10548_2012_274_Fig2_HTML', 'image_file_name': '10548_2012_274_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig2_HTML.jpg', 'caption': 'Registered (upper row) and head shape-warped (middle row) MNI template model scalp meshes plotted on the scalp surface of the reference head models with co-registered MNI electrode locations. Co-registered electrode locations with the subjects’ scalp surfaces (red dots) and selected electrodes used in MNI and spherical head model source localization (green circles) are shown in the lower row', 'hash': 'd158f6c4dbb14dc6124f3b01ab1183e8c330852e9c672e19dcf1e67788610dcb'}, {'image_id': '10548_2012_274_Fig12_HTML', 'image_file_name': '10548_2012_274_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig12_HTML.jpg', 'caption': 'Equivalent dipole source localization error directions (arrows) and magnitudes (colors) in a four-layer reference BEM head model when the co-registered scalp electrode positions were tilted 5° backwards (top row), or 5° to the left (bottom row) before dipole localization. White arrows in the left most panels show the approximate size of the simulated co-registration error. Other details as in Fig.\xa03', 'hash': '31809e43478556239e05c4e503ebb9e287759a7de855ada52bc9ddb7c099d30e'}, {'image_id': '10548_2012_274_Fig4_HTML', 'image_file_name': '10548_2012_274_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig4_HTML.jpg', 'caption': 'Equivalent dipole source localization error directions (arrows) and magnitudes (colors) for spherical (top row) and four MNI-template based head models computed from source dipole scalp projections computed using a four-layer realistic subject MR image based BEM forward head model (subject S1 in Fig.\xa02). The forward and inverse models are indicated to the left of each row (up arrow forward model, down arrow inverse model). The source space was a regular Cartesian grid of single current dipole sources with 8-mm spacing filling the brain volume. The three columns show the errors for equivalent dipole sources that were oriented in x, y, and z directions, respectively (see insets). Note that, maximum error shown was 25\xa0mm so as to use the same scaling for all the plots while retaining some contrast for the lower-error plots. Maximum localization errors were given in Table\xa03', 'hash': 'af7c392acaa68d51e340f09564d9595e5f12f6bf24ed3cc4673b6c7c13bcc104'}, {'image_id': '10548_2012_274_Fig14_HTML', 'image_file_name': '10548_2012_274_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig14_HTML.jpg', 'caption': 'a 256 sensor locations on the S1 reference head model. b–f 192, 128, 64, 32, and 16 distributed sensor locations on the S1 head shape-warped (wMNI-4) template model. g–h 32 and 16 sensor locations placed only on the right side of the template model', 'hash': 'fbb070a2f4a0cdc2c69842a332807653fef69f6e9a61cce6dcb56b753b802ac8'}, {'image_id': '10548_2012_274_Fig3_HTML', 'image_file_name': '10548_2012_274_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig3_HTML.jpg', 'caption': 'Scalp, skull, CSF and brain tissue boundaries for a four-layer MR-based realistic, b four-layer warped MNI, and c four-layer MNI head models plotted on a sagittal slice of subject S1', 'hash': '9d185e3214c349c6ea18cadb0785faf61bfaddf86a2ca938dec7e6321e3699bf'}, {'image_id': '10548_2012_274_Fig13_HTML', 'image_file_name': '10548_2012_274_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig13_HTML.jpg', 'caption': 'Equivalent dipole source localization error directions (arrows) and magnitudes (colors) for model dipoles in a four-layer realistic BEM head model when the brain-to-skull conductivity ratio was mis-estimated as 80:1 (top row) or as 15:1 (bottom row) instead of the simulated forward-model value (25:1). The middle row shows errors when source localization was performed using a warped four-layer MNI head model and the forward model brain-to-skull ratio was again mis-estimated as 80:1. Note that, maximum error shown was 20\xa0mm for top and bottom rows so as to use the same scaling while retaining some contrast for the lower-error plots. Maximum localization errors were given in Table\xa03. Other details as in Fig.\xa03', 'hash': '03dfa8a0b3f7e1cff2ddbe6979d2b9dd3187aee1a58a45659e681e999012ced9'}, {'image_id': '10548_2012_274_Fig10_HTML', 'image_file_name': '10548_2012_274_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig10_HTML.jpg', 'caption': 'High-resolution white matter segmentation obtained using FreeSurfer (left), and the decimated BEM white matter mesh (right) consisting of 10,240 triangular faces', 'hash': '75d53b4d541d89040033739b83251489c0ecc8d65b2991072bfb55e54f33c22e'}, {'image_id': '10548_2012_274_Fig17_HTML', 'image_file_name': '10548_2012_274_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig17_HTML.jpg', 'caption': 'Cortical regions of subject S1 brain. Segmentation obtained using FreeSurfer', 'hash': '021f4077f8cdf7fa4f3c5829f227bd27970bdba521a32c62d2efbe232a7e59f0'}, {'image_id': '10548_2012_274_Fig7_HTML', 'image_file_name': '10548_2012_274_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig7_HTML.jpg', 'caption': 'Magnitude-sorted localization error distributions in four subjects (S1–S4) for source localization performed using spherical (blue) or MNI template-based head models, each showing best localization performance for the 4-layer electrode position-warped MNI template head model (WMNI-4)', 'hash': 'f3e87725a5d78ad295970da669b48b7041f46d62afe165ea3bbbac8e1ed026d3'}, {'image_id': '10548_2012_274_Fig8_HTML', 'image_file_name': '10548_2012_274_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig8_HTML.jpg', 'caption': 'Histograms of percent residual scalp map variance for source estimates based on spherical or MNI-based head models for the four subjects (S1–S4), each showing best fits for the 4-layer electrode position-warped MNI template head model (WMNI-4) and poorest fits for the spherical head model (SPH)', 'hash': 'f7ed657f3ae91c1d481b5a5d52851d2639ba9d35ae5d7018dd16b276d6d17d99'}, {'image_id': '10548_2012_274_Fig11_HTML', 'image_file_name': '10548_2012_274_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig11_HTML.jpg', 'caption': 'Equivalent dipole source localization error directions (arrows) and magnitudes (colors) relative to simulated dipole projections using a four-layer reference head model (S1) for EEG data simulated using a five-layer BEM head model including a white matter layer. The white matter boundary in the five-layer model is outlined in white. Other details as in Fig.\xa03', 'hash': '06e1e9a7ee4b78761c1c7b602d189cc6773e35ed6ba2283747bead7aa5388075'}, {'image_id': '10548_2012_274_Fig1_HTML', 'image_file_name': '10548_2012_274_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig1_HTML.jpg', 'caption': 'A realistic head model generated from a subject T1-weighted whole head MR image (left) and an MNI template model fit to the same (subject S1) head (right). The four shells of the BEM models (scalp, skull, CSF, and grey matter) are shown to the right of each model', 'hash': 'c97cf973002da823d5881addbe166f26c2088b932de16525b36dc4faa811377c'}, {'image_id': '10548_2012_274_Fig16_HTML', 'image_file_name': '10548_2012_274_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig16_HTML.jpg', 'caption': 'Magnitude-sorted localization error distributions (subject S1) for source localizations performed using the sensor distributions shown in Fig.\xa014c–h and the wMNI-4 template head model', 'hash': '3d6f6a423dfc3b1d259e74e1b0658c8b20972063dfa5856d361dbef0df15fe61'}, {'image_id': '10548_2012_274_Fig9_HTML', 'image_file_name': '10548_2012_274_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig9_HTML.jpg', 'caption': 'Mean dipole source localization error directions (arrows) and magnitudes (colors) for four subjects using spherical and MNI template-based head models to localize equivalent dipole sources simulated in a subject-specific four-layer realistic BEM head model. Other details as in Fig.\xa03', 'hash': '5cf6f2db975474d90451439e8e9d444808fd7096df3fe22b25995165ad45e951'}, {'image_id': '10548_2012_274_Fig6_HTML', 'image_file_name': '10548_2012_274_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC3683142/10548_2012_274_Fig6_HTML.jpg', 'caption': 'Sagittal and coronal slice dipole-error maps showing, for each slice-transversed voxel, the dipole direction with the largest localization error', 'hash': 'db4d20ad7716c22df6ff253e1e6e151e99c2a17e78cd86169b95b4dc2a93c598'}] | {'10548_2012_274_Fig1_HTML': ['We used the NFT toolbox (www.sccn.ucsd.edu/wiki/NFT) (Akalin Acar and Makeig 2010) to generate the head models as illustrated in Fig.\xa0<xref rid="10548_2012_274_Fig1_HTML" ref-type="fig">1</xref>. NFT allows users to generate realistic three- or four-layer head models from a T1-weighted 3-D MR head image. It can also build three- or four-layer template-based head models by warping the template MNI model to the recorded electrode positions. This allows users to obtain a head model closer to the subject’s true head shape when the subject’s MR image is not available. Warping procedure starts with an initial co-registration using three fiducial points: the nasion and left and right preauricular points. After this initial co-registration, 19 landmarks are located on both the head model and sensors. The landmarks on the MNI model are pre-calculated and saved. They are loaded with the MNI head mesh when warping starts. The corresponding landmarks on the sensors are calculated automatically. These landmarks are used to find the best-fitting warping parameters using a non-rigid thin plate spline method (Darvas et al. . NFT allows users to generate realistic three- or four-layer head models from a T1-weighted 3-D MR head image. It can also build three- or four-layer template-based head models by warping the template MNI model to the recorded electrode positions. This allows users to obtain a head model closer to the subject’s true head shape when the subject’s MR image is not available. Warping procedure starts with an initial co-registration using three fiducial points: the nasion and left and right preauricular points. After this initial co-registration, 19 landmarks are located on both the head model and sensors. The landmarks on the MNI model are pre-calculated and saved. They are loaded with the MNI head mesh when warping starts. The corresponding landmarks on the sensors are calculated automatically. These landmarks are used to find the best-fitting warping parameters using a non-rigid thin plate spline method (Darvas et al. 2006; Bookstein 1999). All the surfaces and the source space are warped using the same warping parameters. This results in more realistic head models compared to mapping electrodes to a template mesh. Reverse warping parameters that warp the sensor coordinates to the template mesh are also computed. These parameters can be used to map source localization results to the original template head model (Akalin Acar and Makeig 2010). Co-registration of electrode locations with fixed MNI models also starts with an initial co-registration and locating landmarks, then a rigid transformation is applied, and finally the electrode locations are projected on the MNI scalp surface.Fig.\xa01A realistic head model generated from a subject T1-weighted whole head MR image (left) and an MNI template model fit to the same (subject S1) head (right). The four shells of the BEM models (scalp, skull, CSF, and grey matter) are shown to the right of each model'], '10548_2012_274_Fig2_HTML': ['Here we asked whether warping the model head shape to the measured electrode positions (wMNI) was more accurate than warping the measured electrode positions to the fixed template head model (MNI). Results of the head model warping for the four subjects with co-registered electrode locations are shown in Fig.\xa0<xref rid="10548_2012_274_Fig2_HTML" ref-type="fig">2</xref>. After warping, median sensor distance from the template model scalp mesh decreased by 3–7\xa0mm. Figure\xa0. After warping, median sensor distance from the template model scalp mesh decreased by 3–7\xa0mm. Figure\xa0<xref rid="10548_2012_274_Fig3_HTML" ref-type="fig">3</xref> shows scalp, skull, CSF and brain tissue boundaries for a four-layer MR-based realistic, a four-layer warped MNI, and a four-layer MNI head models plotted on a sagittal slice of subject S1. shows scalp, skull, CSF and brain tissue boundaries for a four-layer MR-based realistic, a four-layer warped MNI, and a four-layer MNI head models plotted on a sagittal slice of subject S1.Fig.\xa02Registered (upper row) and head shape-warped (middle row) MNI template model scalp meshes plotted on the scalp surface of the reference head models with co-registered MNI electrode locations. Co-registered electrode locations with the subjects’ scalp surfaces (red dots) and selected electrodes used in MNI and spherical head model source localization (green circles) are shown in the lower rowFig.\xa03Scalp, skull, CSF and brain tissue boundaries for a four-layer MR-based realistic, b four-layer warped MNI, and c four-layer MNI head models plotted on a sagittal slice of subject S1', 'The analysis described in the previous section was repeated for three more subjects with different head shapes (Fig.\xa0<xref rid="10548_2012_274_Fig2_HTML" ref-type="fig">2</xref>). Figure\xa0). Figure\xa0<xref rid="10548_2012_274_Fig7_HTML" ref-type="fig">7</xref> shows magnitude-sorted localization error distributions for the four subjects (S1–S4). In general, four-layer head-shape warped MNI-template head models gave source location estimates closest to the simulated source locations in the MR-based reference head models. For some subjects (S2 and S4) spherical models produced the largest localization errors, however for other subjects (S1 and S3) the localization errors obtained by using a spherical model were comparable to the MNI template models. For the four-layer warped MNI models, half of the dipole location estimates had errors smaller than 4.1–7.8\xa0mm (depending on subject). shows magnitude-sorted localization error distributions for the four subjects (S1–S4). In general, four-layer head-shape warped MNI-template head models gave source location estimates closest to the simulated source locations in the MR-based reference head models. For some subjects (S2 and S4) spherical models produced the largest localization errors, however for other subjects (S1 and S3) the localization errors obtained by using a spherical model were comparable to the MNI template models. For the four-layer warped MNI models, half of the dipole location estimates had errors smaller than 4.1–7.8\xa0mm (depending on subject).Fig.\xa07Magnitude-sorted localization error distributions in four subjects (S1–S4) for source localization performed using spherical (blue) or MNI template-based head models, each showing best localization performance for the 4-layer electrode position-warped MNI template head model (WMNI-4)', 'Localization errors obtained using SPHs were comparable with localization errors obtained with MNI models in two subjects and were larger for the other two subjects. In general, the distribution of the errors was also similar with the MNI head models, however the errors were larger in the occipital region. We used the same electrodes as in the MNI models (Fig.\xa0<xref rid="10548_2012_274_Fig2_HTML" ref-type="fig">2</xref>, bottom row—green circles) co-registered to the spherical models. When we used all the electrodes in the realistic models (including those positions in Fig.\xa0, bottom row—green circles) co-registered to the spherical models. When we used all the electrodes in the realistic models (including those positions in Fig.\xa0<xref rid="10548_2012_274_Fig2_HTML" ref-type="fig">2</xref> shown using red dots), since the cheek and neck electrode positions were not near their positions in the best-fitting SPHs we obtained higher localization errors (up to 40\xa0mm, 12.4-mm mean). Thus, when SPHs are used for source localization, any cheek and neck electrodes should be omitted for better source localization. We also performed simulations using four-layer SPHs for all four subjects and compared the error magnitudes and distributions with those obtained by using three-layer SPHs. Localization errors obtained using three- and four-layer SPHs were very similar—the average localization error differed by only 1–2\xa0mm, and the error distributions were the same. shown using red dots), since the cheek and neck electrode positions were not near their positions in the best-fitting SPHs we obtained higher localization errors (up to 40\xa0mm, 12.4-mm mean). Thus, when SPHs are used for source localization, any cheek and neck electrodes should be omitted for better source localization. We also performed simulations using four-layer SPHs for all four subjects and compared the error magnitudes and distributions with those obtained by using three-layer SPHs. Localization errors obtained using three- and four-layer SPHs were very similar—the average localization error differed by only 1–2\xa0mm, and the error distributions were the same.'], '10548_2012_274_Fig4_HTML': ['We first present results for one subject (S1). Figure\xa0<xref rid="10548_2012_274_Fig4_HTML" ref-type="fig">4</xref> shows the equivalent dipole source localization error directions and magnitudes for the spherical (top row) and the four MNI-template based head models for this subject, computed from source dipole scalp projections simulated using the reference MR image-based four-layer forward head model. Localization errors for three sets of equivalent source dipoles oriented in the shows the equivalent dipole source localization error directions and magnitudes for the spherical (top row) and the four MNI-template based head models for this subject, computed from source dipole scalp projections simulated using the reference MR image-based four-layer forward head model. Localization errors for three sets of equivalent source dipoles oriented in the x, y, and z directions, respectively, were computed for 7,512 dipoles through the whole brain volume. Localization errors are shown for dipoles in one sagittal slice at y\xa0=\xa087\xa0mm (4\xa0mm from the central sulcus) (Fig.\xa0<xref rid="10548_2012_274_Fig5_HTML" ref-type="fig">5</xref>).).Fig.\xa04Equivalent dipole source localization error directions (arrows) and magnitudes (colors) for spherical (top row) and four MNI-template based head models computed from source dipole scalp projections computed using a four-layer realistic subject MR image based BEM forward head model (subject S1 in Fig.\xa0<xref rid="10548_2012_274_Fig2_HTML" ref-type="fig">2</xref>). The forward and inverse models are indicated to the ). The forward and inverse models are indicated to the left of each row (up arrow forward model, down arrow inverse model). The source space was a regular Cartesian grid of single current dipole sources with 8-mm spacing filling the brain volume. The three columns show the errors for equivalent dipole sources that were oriented in x, y, and z directions, respectively (see insets). Note that, maximum error shown was 25\xa0mm so as to use the same scaling for all the plots while retaining some contrast for the lower-error plots. Maximum localization errors were given in Table\xa03Fig.\xa05Selected coronal and sagittal slices to show localization errors'], '10548_2012_274_Fig6_HTML': ['To obtain a more quantitative analysis, we found the dipole direction with maximum localization error for each grid location. While at 114 of the 314 voxels, x-directed dipoles were localized with largest localization error, this was true for radial dipoles at fewer than 23 voxels. Table\xa01 gives the number of voxels with maximum localization error for each direction. Also Fig.\xa0<xref rid="10548_2012_274_Fig6_HTML" ref-type="fig">6</xref> shows maximal direction errors for voxels in a sagittal and a coronal slice of the brain. shows maximal direction errors for voxels in a sagittal and a coronal slice of the brain.Table\xa01Median error and number of dipole locations with maximum localization errors for nine different dipole orientationspxpypzMedian error (mm)Number of voxels1009.11140107.6200017.058−0.70710.707108.245−0.7071−0.707108.225−0.50.50.70717.823−0.5−0.50.70717.9140.5−0.50.70716.070.50.50.70715.98Columns px, py, and pz represent dipole coordinates in x, y, and z directionsFig.\xa06Sagittal and coronal slice dipole-error maps showing, for each slice-transversed voxel, the dipole direction with the largest localization error'], '10548_2012_274_Fig8_HTML': ['Figure\xa0<xref rid="10548_2012_274_Fig8_HTML" ref-type="fig">8</xref> shows, for each of the four subjects (S1–S4), the histogram of percent residual variance (PRV) over the dipoles in the source space. The PRV measures the residual field in the scalp projections of the simulated dipoles not accounted for by the projections of the source estimates. The histogram is normalized to show the percentage of the dipoles that has the corresponding PRV. Although, all of the head model estimates gave similarly low (~1\xa0%) residual variances, the warped four-layer MNI models (green) produced the least PRV. shows, for each of the four subjects (S1–S4), the histogram of percent residual variance (PRV) over the dipoles in the source space. The PRV measures the residual field in the scalp projections of the simulated dipoles not accounted for by the projections of the source estimates. The histogram is normalized to show the percentage of the dipoles that has the corresponding PRV. Although, all of the head model estimates gave similarly low (~1\xa0%) residual variances, the warped four-layer MNI models (green) produced the least PRV.Fig.\xa08Histograms of percent residual scalp map variance for source estimates based on spherical or MNI-based head models for the four subjects (S1–S4), each showing best fits for the 4-layer electrode position-warped MNI template head model (WMNI-4) and poorest fits for the spherical head model (SPH)'], '10548_2012_274_Fig9_HTML': ['Next, we co-registered the other three subjects MR images to the MR image of subject S1 using FreeSurfer volume registration (www.surfer.nmr.mgh.harvard.edu). Localization error magnitude and orientation maps were interpolated to a 1-mm 3-D grid of source locations from the 8-mm spaced source location grids. These error maps were then transformed to the S1 coordinate system to obtain mean error maps across the four subjects using the same volume registration for the source space. As the subject head shapes were quite different, in some brain regions the co-registered error directions differed, thus partly cancelling each other in the mean error images. Figure\xa0<xref rid="10548_2012_274_Fig9_HTML" ref-type="fig">9</xref> shows the mean dipole source localization error directions (arrows) and magnitudes (colors), and Table\xa0 shows the mean dipole source localization error directions (arrows) and magnitudes (colors), and Table\xa02 the median localization error magnitudes (in mm).Fig.\xa09Mean dipole source localization error directions (arrows) and magnitudes (colors) for four subjects using spherical and MNI template-based head models to localize equivalent dipole sources simulated in a subject-specific four-layer realistic BEM head model. Other details as in Fig.\xa0<xref rid="10548_2012_274_Fig3_HTML" ref-type="fig">3</xref>Table\xa02Median dipole source localization error magnitudes (in mm) for four subjects (plus the mean model) when the inverse problem is solved using spherical and MNI head models adapted to the subject head shapeSPHMNI-3wMNI-3MNI-4wMNI-4S19.510.59.09.37.8S26.65.55.34.34.1S37.010.38.010.06.2S47.87.66.17.35.1Mean8.47.66.57.05.4'], '10548_2012_274_Fig10_HTML': ['To add a WM layer in our BEM model, we used the FreeSurfer WM segmentation (Fig.\xa0<xref rid="10548_2012_274_Fig10_HTML" ref-type="fig">10</xref>, left). We then generated a WM mesh using a FreeSurfer tool by decimating the surface to 10,240 faces (Fig.\xa0, left). We then generated a WM mesh using a FreeSurfer tool by decimating the surface to 10,240 faces (Fig.\xa0<xref rid="10548_2012_274_Fig10_HTML" ref-type="fig">10</xref>, right). Here, we used 0.14\xa0S/m as isotropic WM conductivity (Gullmar et al. , right). Here, we used 0.14\xa0S/m as isotropic WM conductivity (Gullmar et al. 2010). EEG current dipole source scalp potential maps were then simulated in this five-layer reference head model. Finally, dipole source localization was performed using the four-layer reference model and the four-layer warped MNI head model for this subject.Fig.\xa010High-resolution white matter segmentation obtained using FreeSurfer (left), and the decimated BEM white matter mesh (right) consisting of 10,240 triangular faces'], '10548_2012_274_Fig11_HTML': ['Source localization errors produced by the four-layer reference model, ignoring the WM layer, were largest for z-directed dipoles located just below the WM (median error, 2.8\xa0mm; maximum, 18.6\xa0mm). Localization changes for dipole sources above (or within) the WM region were relatively low (Fig.\xa0<xref rid="10548_2012_274_Fig11_HTML" ref-type="fig">11</xref>, top row). The four-layer head-shape warped MNI model (Fig.\xa0, top row). The four-layer head-shape warped MNI model (Fig.\xa0<xref rid="10548_2012_274_Fig11_HTML" ref-type="fig">11</xref>, bottom row), gave localization error distributions similar to those obtained using the four-layer reference model (Fig.\xa0, bottom row), gave localization error distributions similar to those obtained using the four-layer reference model (Fig.\xa0<xref rid="10548_2012_274_Fig4_HTML" ref-type="fig">4</xref>, bottom row)., bottom row).Fig.\xa011Equivalent dipole source localization error directions (arrows) and magnitudes (colors) relative to simulated dipole projections using a four-layer reference head model (S1) for EEG data simulated using a five-layer BEM head model including a white matter layer. The white matter boundary in the five-layer model is outlined in white. Other details as in Fig.\xa0<xref rid="10548_2012_274_Fig3_HTML" ref-type="fig">3</xref>'], '10548_2012_274_Fig12_HTML': ['When it is not feasible to use MR-visible capsules during MR imaging to allow skin landmark-based co-registration of the measured EEG electrode positions to the MR-derived head model, co-registration of electrode positions may depend on an initial visual co-registration. Electrode position measurement in NFT (Akalin Acar and Makeig 2010) consists of two steps. First, a manual co-registration is accomplished using the subject’s head model scalp mesh and digitized electrode positions. This is followed by an automatic co-registration step to find six translation and rotation parameters that minimize the total squared distance between the sensors and the model scalp surface. This process is valid whether fiducial locations are digitized or not. While use of fiducials minimizes co-registration errors, some laboratories do not measure fiducial locations. In these cases the co-registration may depend on an initial visual co-registration. Here, we may expect some tilt in the co-registered electrode positions, especially backwards or forward. Thus, we calculated equivalent dipole source localization error directions and magnitudes for one four-layer reference BEM head model (S1) when the co-registered electrode montage was mistakenly tilted 5° backwards or 5° to the left (Fig.\xa0<xref rid="10548_2012_274_Fig12_HTML" ref-type="fig">12</xref>). Even though random electrode displacements have been reported to not have much effect on EEG source localization (Wang and Gotman ). Even though random electrode displacements have been reported to not have much effect on EEG source localization (Wang and Gotman 2001), here when we shifted the simulated electrode positions in one direction we observed up to 12-mm localization errors that were largest for superficial dipoles closest to the electrode positions.Fig.\xa012Equivalent dipole source localization error directions (arrows) and magnitudes (colors) in a four-layer reference BEM head model when the co-registered scalp electrode positions were tilted 5° backwards (top row), or 5° to the left (bottom row) before dipole localization. White arrows in the left most panels show the approximate size of the simulated co-registration error. Other details as in Fig.\xa0<xref rid="10548_2012_274_Fig3_HTML" ref-type="fig">3</xref>'], '10548_2012_274_Fig13_HTML': ['Here, we used the four-layer reference BEM model for subject S1 and set the forward-model (ground truth) brain-to-skull conductivity ratio to 25:1. We then solved the inverse source localization problem using the same head model incorporating the assumed (and still commonly used) value of 80:1. This produced large equivalent dipole localization errors of up to 31\xa0mm (Fig.\xa0<xref rid="10548_2012_274_Fig13_HTML" ref-type="fig">13</xref>, top row). When we used the four-layer head-shape warped MNI template model to solve the inverse problem (Fig.\xa0, top row). When we used the four-layer head-shape warped MNI template model to solve the inverse problem (Fig.\xa0<xref rid="10548_2012_274_Fig13_HTML" ref-type="fig">13</xref>, middle row) the errors were still larger and more evenly distributed across the cortical region (cf. Fig.\xa0, middle row) the errors were still larger and more evenly distributed across the cortical region (cf. Fig.\xa0<xref rid="10548_2012_274_Fig4_HTML" ref-type="fig">4</xref>, bottom row). The estimated positions of the simulated dipoles generally moved towards the scalp surface. Conversely, when the brain-to-skull conductivity ratio was mis-estimated as 15:1 instead of 25:1 (Fig.\xa0, bottom row). The estimated positions of the simulated dipoles generally moved towards the scalp surface. Conversely, when the brain-to-skull conductivity ratio was mis-estimated as 15:1 instead of 25:1 (Fig.\xa0<xref rid="10548_2012_274_Fig13_HTML" ref-type="fig">13</xref>, bottom row), the estimated dipole locations moved towards the center of the brain, with error magnitudes up to 13\xa0mm. Thus, correct modeling of skull conductivity is an important factor for EEG source localization, quite possibly outweighing the choice of head model., bottom row), the estimated dipole locations moved towards the center of the brain, with error magnitudes up to 13\xa0mm. Thus, correct modeling of skull conductivity is an important factor for EEG source localization, quite possibly outweighing the choice of head model.Fig.\xa013Equivalent dipole source localization error directions (arrows) and magnitudes (colors) for model dipoles in a four-layer realistic BEM head model when the brain-to-skull conductivity ratio was mis-estimated as 80:1 (top row) or as 15:1 (bottom row) instead of the simulated forward-model value (25:1). The middle row shows errors when source localization was performed using a warped four-layer MNI head model and the forward model brain-to-skull ratio was again mis-estimated as 80:1. Note that, maximum error shown was 20\xa0mm for top and bottom rows so as to use the same scaling while retaining some contrast for the lower-error plots. Maximum localization errors were given in Table\xa03. Other details as in Fig.\xa0<xref rid="10548_2012_274_Fig3_HTML" ref-type="fig">3</xref>'], '10548_2012_274_Fig14_HTML': ['Sometimes, scalp electrodes cannot be placed uniformly on the scalp surface (Gunduz et al. 2011). Thus, we also tested localization using 32 and 16 electrodes covering only the right hemisphere. Figure\xa0<xref rid="10548_2012_274_Fig14_HTML" ref-type="fig">14</xref> shows the 256 electrode positions on the reference model scalp surface, the electrode montages for the wMNI models with smaller numbers of electrodes, and 32- and 16-electrode montages over the right hemisphere only (R32 & R16). Figure\xa0 shows the 256 electrode positions on the reference model scalp surface, the electrode montages for the wMNI models with smaller numbers of electrodes, and 32- and 16-electrode montages over the right hemisphere only (R32 & R16). Figure\xa0<xref rid="10548_2012_274_Fig15_HTML" ref-type="fig">15</xref> shows the error magnitude and direction estimates for a four-layer head-shape warped MNI head model using 192 electrodes (from Fig.\xa0 shows the error magnitude and direction estimates for a four-layer head-shape warped MNI head model using 192 electrodes (from Fig.\xa0<xref rid="10548_2012_274_Fig4_HTML" ref-type="fig">4</xref>) and the additional errors introduced by using only 16 uniformly distributed electrodes or using 16 electrodes covering only right side of the head. Figure\xa0) and the additional errors introduced by using only 16 uniformly distributed electrodes or using 16 electrodes covering only right side of the head. Figure\xa0<xref rid="10548_2012_274_Fig16_HTML" ref-type="fig">16</xref> shows magnitude-sorted localization error distributions. Localization errors did not change for 192 or 128 electrodes, but larger source localization errors occurred when the number of electrodes was 64 or less. The maximum and average changes in localization error were 6.3 and 0.6\xa0mm when 64 electrodes were used instead of 192 electrodes, 7.8 and 1.3\xa0mm when 32 electrodes were used, and 8.4 and 2.7\xa0mm when only 16 electrodes were used. Note that, in Fig.\xa0 shows magnitude-sorted localization error distributions. Localization errors did not change for 192 or 128 electrodes, but larger source localization errors occurred when the number of electrodes was 64 or less. The maximum and average changes in localization error were 6.3 and 0.6\xa0mm when 64 electrodes were used instead of 192 electrodes, 7.8 and 1.3\xa0mm when 32 electrodes were used, and 8.4 and 2.7\xa0mm when only 16 electrodes were used. Note that, in Fig.\xa0<xref rid="10548_2012_274_Fig15_HTML" ref-type="fig">15</xref>, maximum error shown was 25\xa0mm so as to use the same scaling for all the plots while retaining some contrast for the lower-error plots. Maximum localization errors were 62\xa0mm for the R16, and 32\xa0mm for the 16 electrode montages (Table\xa0, maximum error shown was 25\xa0mm so as to use the same scaling for all the plots while retaining some contrast for the lower-error plots. Maximum localization errors were 62\xa0mm for the R16, and 32\xa0mm for the 16 electrode montages (Table\xa03). These results are consistent with those reported in (Michel et al. 2004; Mosher et al. 1993).Fig.\xa014a 256 sensor locations on the S1 reference head model. b–f 192, 128, 64, 32, and 16 distributed sensor locations on the S1 head shape-warped (wMNI-4) template model. g–h 32 and 16 sensor locations placed only on the right side of the template modelFig.\xa015Top-row equivalent dipole source localization error directions (arrows) and magnitudes (colors) for a head shape-warped four-layer MNI head model using 192 electrodes (from Fig.\xa0<xref rid="10548_2012_274_Fig3_HTML" ref-type="fig">3</xref>). The ). The lowerthreerows show additional errors introduced by using only 16 uniformly distributed electrodes (subscript 16, second row), or using 16 electrodes covering only right side of the head (subscript R16, bottom rows)Fig.\xa016Magnitude-sorted localization error distributions (subject S1) for source localizations performed using the sensor distributions shown in Fig.\xa0<xref rid="10548_2012_274_Fig14_HTML" ref-type="fig">14</xref>c–h and the wMNI-4 template head modelTable\xa03Average and maximum source localization errors for different sources of forward modeling errors in different brain regionsCortical areasHead modelConductivity ratio (assumed)Co-registration# of sensorsCoverageSPHWarped MNI 4-layer5-Layer model (with w.m.)80:115:15° Back5° Left16 (balanced)16 (imbalanced)RightLeftUpper Frontal\xa0Mean7.75.12.210.64.46.64.97.18.515.9\xa0Max20.914.013.419.17.412.08.320.416.437.8Lower frontal\xa0Mean10.28.03.112.15.16.33.78.810.815.8\xa0Max24.215.013.528.59.412.27.417.621.750.4Temporal\xa0Mean12.39.44.112.85.62.85.011.77.412.8\xa0Max27.920.016.229.912.57.19.423.123.762.4Parietal\xa0Mean10.310.13.612.95.46.22.613.211.618.0\xa0Max20.315.011.719.48.09.18.326.618.233.8Occipital\xa0Mean10.66.12.511.44.55.24.48.611.124.2\xa0Max18.716.915.021.78.211.76.432.017.823.7Sub-cort. cerebellum\xa0Mean10.211.24.213.55.13.93.312.214.420.5\xa0Max27.027.018.631.813.08.97.129.336.154.9Total\xa0Mean10.28.43.412.25.04.94.110.310.818.2\xa0Max27.927.018.631.813.012.29.432.036.162.4'], '10548_2012_274_Fig17_HTML': ['To give an overall quantitative understanding of forward modeling errors, we segmented several cortical regions (Fig.\xa0<xref rid="10548_2012_274_Fig17_HTML" ref-type="fig">17</xref>) using FreeSurfer and present average and maximum equivalent dipole localization errors for different forward models in Table\xa0) using FreeSurfer and present average and maximum equivalent dipole localization errors for different forward models in Table\xa03. Sub-cortical and cerebellar voxels are also grouped into one class. Modeling errors were higher in areas where head model geometry differed most from the actual geometry of the head. The localization errors observed when the assumed skull conductivity ratio was highly inaccurate (80:1 instead of 25:1) were comparable to the relatively large modeling errors arising from use of a spherical model. Sub-cortical and cerebellar regions were less affected by sensor registration errors. Smallest template model errors were obtained using a four-layer warped MNI model with 64 or more near-uniformly distributed sensors. It should be remembered, however, that all our estimates here assume that the source being estimated has a valid single equivalent-dipole model (e.g., represents the projection to the scalp of local field activity wholly or partially synchronous across a single cortical patch), and that the scalp map representing its projection has been captured with ideal SNR.Fig.\xa017Cortical regions of subject S1 brain. Segmentation obtained using FreeSurfer']} | Effects of Forward Model Errors on EEG Source Localization | [
"EEG",
"Head modeling",
"Boundary element method",
"BEM",
"Spherical head model",
"MNI head model",
"White matter",
"Skull conductivity",
"Co-registration",
"Electrode number"
] | Brain Topogr | 1374822000 | Recent molecular studies have shown that, even when derived from a seemingly homogenous population, individual cells can exhibit substantial differences in gene expression, protein levels and phenotypic output, with important functional consequences. Existing studies of cellular heterogeneity, however, have typically measured only a few pre-selected RNAs or proteins simultaneously, because genomic profiling methods could not be applied to single cells until very recently. Here we use single-cell RNA sequencing to investigate heterogeneity in the response of mouse bone-marrow-derived dendritic cells (BMDCs) to lipopolysaccharide. We find extensive, and previously unobserved, bimodal variation in messenger RNA abundance and splicing patterns, which we validate by RNA-fluorescence in situ hybridization for select transcripts. In particular, hundreds of key immune genes are bimodally expressed across cells, surprisingly even for genes that are very highly expressed at the population average. Moreover, splicing patterns demonstrate previously unobserved levels of heterogeneity between cells. Some of the observed bimodality can be attributed to closely related, yet distinct, known maturity states of BMDCs; other portions reflect differences in the usage of key regulatory circuits. For example, we identify a module of 137 highly variable, yet co-regulated, antiviral response genes. Using cells from knockout mice, we show that variability in this module may be propagated through an interferon feedback circuit, involving the transcriptional regulators Stat2 and Irf7. Our study demonstrates the power and promise of single-cell genomics in uncovering functional diversity between cells and in deciphering cell states and circuits. | [
"Animals",
"Bone Marrow Cells",
"Dendritic Cells",
"Gene Expression Profiling",
"Gene Expression Regulation",
"In Situ Hybridization, Fluorescence",
"Interferon Regulatory Factor-7",
"Interferons",
"Lipopolysaccharides",
"Mice",
"Mice, Knockout",
"Protein Isoforms",
"RNA Splicing",
"RNA, Messenger",
"Reproducibility of Results",
"STAT2 Transcription Factor",
"Sequence Analysis, RNA",
"Single-Cell Analysis",
"Transcriptome",
"Viruses"
] | other | PMC3683142 | null | 30 | [
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] | Brain Topogr. 2013 Jul 26; 26(3):378-396 | NO-CC CODE |
|
Computed tomography of the paranasal sinuses, coronal section, in bone window, showing hypodense cystic lesion in the right nasolacrimal duct topography. | 10-1055-s-0034-1366978-i1692cr-2 | 7 | 43604c54fb1bc555575bebe7e4d295b3e9a3338abe319b18e9cee814086253c1 | 10-1055-s-0034-1366978-i1692cr-2.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
546,
800
] | [{'image_id': '10-1055-s-0034-1366978-i1692cr-1', 'image_file_name': '10-1055-s-0034-1366978-i1692cr-1.jpg', 'image_path': '../data/media_files/PMC4392515/10-1055-s-0034-1366978-i1692cr-1.jpg', 'caption': 'Computed tomography of the paranasal sinuses, axial section, in bone window, showing hypodense cystic lesion in the right nasolacrimal duct topography.', 'hash': 'ab5bc200be400971957a0648e2be761943013657ae5babc932b261cf4a391659'}, {'image_id': '10-1055-s-0034-1366978-i1692cr-2', 'image_file_name': '10-1055-s-0034-1366978-i1692cr-2.jpg', 'image_path': '../data/media_files/PMC4392515/10-1055-s-0034-1366978-i1692cr-2.jpg', 'caption': 'Computed tomography of the paranasal sinuses, coronal section, in bone window, showing hypodense cystic lesion in the right nasolacrimal duct topography.', 'hash': '43604c54fb1bc555575bebe7e4d295b3e9a3338abe319b18e9cee814086253c1'}] | {'10-1055-s-0034-1366978-i1692cr-1': ['The patient was a 30-year-old man with a history of bilateral congenital cyst of nasolacrimal duct diagnosed by the presence of a bulge in both lacrimal sac topographies since birth, without associated symptoms. He underwent surgery on the left side at 9 years of age and on the right side at 21 years of age, but the tumor recurred on the right side, without tearing, pain, discharge, or other symptoms. In subsequent evaluation with an ophthalmologist, a lack of upper and lower right lacrimal ducts was identified and indicated reconstruction surgery lacrimal spot, which was done in December 2007. However, he developed ipsilateral epiphora later, requiring another two procedures—dacryocystectomy in July 2011 and August 2011—but without success, leading to recurrent local infections. He denied loss of visual acuity or nasal symptoms during the whole period. After the last procedure, computed tomography (CT) showed a cystic expansion in the right lacrimal sac topography and dilatation of the bony canal of the nasolacrimal duct (<xref rid="10-1055-s-0034-1366978-i1692cr-1" ref-type="fig">Figs. 1</xref> and and <xref rid="10-1055-s-0034-1366978-i1692cr-2" ref-type="fig">2</xref>).).']} | Nasolacrimal Duct Mucocele: Case Report and Literature Review | [
"mucocele",
"nasolacrimal duct",
"dacryocystorhinostomy"
] | Int Arch Otorhinolaryngol | 1421136000 | Introduction Mucoceles are benign expansive cystic formations, composed of a mucus-secreting epithelium (respiratory or pseudostratified epithelium). Nasolacrimal mucocele occurs in a small proportion of children with nasolacrimal duct obstruction and is characterized by a cystic mass in the medial canthus with dilation of the nasolacrimal duct; although dacryocystoceles are rare in adults, they have been reported in patients with trachoma. Objective Discuss clinical aspects, diagnosis, and therapeutic management of mucocele of nasolacrimal duct based on literature review. Resumed Report The authors report a case of bilateral congenital nasolacrimal duct cysts in a 30-year-old man, identified as a tumor in the topography of both lacrimal sacs since birth without associated symptoms. The patient underwent successive surgical treatments, leading to recurrence of the tumor at the right side and recurrent local infections. Conclusion Endoscopic dacryocystorhinostomy has been increasingly used with good results and success rates similar to the external access. | [] | other | PMC4392515 | null | 15 | [
"{'Citation': \"Leonard D S, O'Keefe M, Rowley H, Hughes J P. Neonatal respiratory distress secondary to bilateral intranasal dacryocystocoeles. Int J Pediatr Otorhinolaryngol. 2008;72(12):1873–1877.\", 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18990457'}}}",
"{'Citation': 'Gujar S K Gandhi D Congenital malformations of the orbit Neuroimaging Clin N Am 2011213585–602., viii', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21807313'}}}",
"{'Citation': 'Hulka G F, Kulwin D R, Weeks S M, Cotton R T. Congenital lacrimal sac mucoceles with intranasal extension. Otolaryngol Head Neck Surg. 1995;113(5):651–655.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '7478662'}}}",
"{'Citation': 'Yee S W, Seibert R W, Bower C M, Glasier C M. Congenital nasolacrimal duct mucocele: a cause of respiratory distress. Int J Pediatr Otorhinolaryngol. 1994;29(2):151–158.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8056498'}}}",
"{'Citation': 'Wong R K, VanderVeen D K. Presentation and management of congenital dacryocystocele. Pediatrics. 2008;122(5):e1108–e1112.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18955412'}}}",
"{'Citation': 'Koch B L. Case 73: Nasolacrimal duct mucocele. Radiology. 2004;232(2):370–372.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15286309'}}}",
"{'Citation': 'Bhaya M, Meehan R, Har-El G. Dacryocystocele in an adult: endoscopic management. Am J Otolaryngol. 1997;18(2):131–134.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9074740'}}}",
"{'Citation': 'Castillo B V Jr, Kaufman L. Pediatric tumors of the eye and orbit. Pediatr Clin North Am. 2003;50(1):149–172.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12713110'}}}",
"{'Citation': 'Edmond J C, Keech R V. Congenital nasolacrimal sac mucocele associated with respiratory distress. J Pediatr Ophthalmol Strabismus. 1991;28(5):287–289.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1955967'}}}",
"{'Citation': 'Paysse E A, Coats D K, Bernstein J M, Go C, de Jong A L. Management and complications of congenital dacryocele with concurrent intranasal mucocele. J AAPOS. 2000;4(1):46–53.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10675871'}}}",
"{'Citation': 'Kansu L, Aydin E, Avci S, Kal A, Gedik S. Comparison of surgical outcomes of endonasal dacryocystorhinostomy with or without mucosal flaps. Auris Nasus Larynx. 2009;36(5):555–559.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19297108'}}}",
"{'Citation': 'Lueder G T. Endoscopic treatment of intranasal abnormalities associated with nasolacrimal duct obstruction. J AAPOS. 2004;8(2):128–132.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15088045'}}}",
"{'Citation': 'Fayet B, Racy E, Assouline M. Complications of standardized endonasal dacryocystorhinostomy with unciformectomy. Ophthalmology. 2004;111(4):837–845.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15051221'}}}",
"{'Citation': 'Tsirbas A, Wormald P J. Endonasal dacryocystorhinostomy with mucosal flaps. Am J Ophthalmol. 2003;135(1):76–83.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12504701'}}}",
"{'Citation': 'Çukurova I, Caner Mercan G, Çetinkaya E. et al.Endoscopic dacryocystorhinostomy: outcomes using mucosal flap preserving technique. Eur Arch Otorhinolaryngol. 2013;270(5):1661–1666.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '23179941'}}}"
] | Int Arch Otorhinolaryngol. 2015 Jan 13; 19(1):96-98 | NO-CC CODE |
|
Preoperative CT scan neck sagittal view, Cyst like lesion of the left parotid gland (Arrow) | OAMJMS-7-2142-g004 | 7 | b7ec761552f2992aa8338be4330f4b459ca484655cbf289901c9ebd9235679c9 | OAMJMS-7-2142-g004.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
505,
322
] | [{'image_id': 'OAMJMS-7-2142-g001', 'image_file_name': 'OAMJMS-7-2142-g001.jpg', 'image_path': '../data/media_files/PMC6698116/OAMJMS-7-2142-g001.jpg', 'caption': 'Haematoxylin and eosin staining of parotid cyst showing subepithelial stroma with reactive lymphoid follicles and germinal centres (Magnification x 20)', 'hash': '288bba0ae8706bfedcbecfb89aea07fb48ec070b8f26b68b2fc92896061bd86e'}, {'image_id': 'OAMJMS-7-2142-g002', 'image_file_name': 'OAMJMS-7-2142-g002.jpg', 'image_path': '../data/media_files/PMC6698116/OAMJMS-7-2142-g002.jpg', 'caption': 'of parotid cyst showing reactive lymphoid follicles and germinal centres with adjacent normal salivary glands and fatty tissue (Magnification x 40)', 'hash': '0a1f5be52248ffcb29a752a2676217eb6a803be7c0a43b4b9426ade4d7d6fca5'}, {'image_id': 'OAMJMS-7-2142-g005', 'image_file_name': 'OAMJMS-7-2142-g005.jpg', 'image_path': '../data/media_files/PMC6698116/OAMJMS-7-2142-g005.jpg', 'caption': 'Post-operative specimen (left parotid cyst measuring 4.5 x 2.5 cm)', 'hash': 'c8cbfecc8bbbab65b92a707a6e57c614626fc45ec70825bb385c67080c555fb8'}, {'image_id': 'OAMJMS-7-2142-g004', 'image_file_name': 'OAMJMS-7-2142-g004.jpg', 'image_path': '../data/media_files/PMC6698116/OAMJMS-7-2142-g004.jpg', 'caption': 'Preoperative CT scan neck sagittal view, Cyst like lesion of the left parotid gland (Arrow)', 'hash': 'b7ec761552f2992aa8338be4330f4b459ca484655cbf289901c9ebd9235679c9'}, {'image_id': 'OAMJMS-7-2142-g003', 'image_file_name': 'OAMJMS-7-2142-g003.jpg', 'image_path': '../data/media_files/PMC6698116/OAMJMS-7-2142-g003.jpg', 'caption': 'Preoperative CT scan neck, axial view. Cyst like lesion seen in the left parotid gland (Arrow)', 'hash': '13c6e61146492c35cbfb4d7bf3e3bbf8f6741e058de6ceb9430c1cc7922ec6d8'}] | {'OAMJMS-7-2142-g001': ['Gross specimen revealed a grey/ brown encapsulated cystic lesion, measuring 3.0 cm × 4.5 cm × 2.5 cm, filled with brownish mucinous fluid. Microscopic examination revealed subepithelial stroma with reactive lymphoid follicles and germinal centres. Adjacent normal salivary glands and fatty tissue appeared normal, and there was no oncocytic cell lining or neoplastic tissue (<xref ref-type="fig" rid="OAMJMS-7-2142-g001">Figure 1</xref> and and <xref ref-type="fig" rid="OAMJMS-7-2142-g002">2</xref>). A final diagnosis of BLEC of the left parotid gland was made based on the radiological and histomorphological findings. HIV antibodies were analysed using ELISA, and a negative result was obtained.). A final diagnosis of BLEC of the left parotid gland was made based on the radiological and histomorphological findings. HIV antibodies were analysed using ELISA, and a negative result was obtained.'], 'OAMJMS-7-2142-g003': ['A 48-year-old female presented to our ear, nose, and throat outpatient clinic with a history of persistent swelling of the left cheek for the past 11 years, which had gradually progressed to the current size of 4 cm × 5 cm. The swelling was not associated with pain but was cosmetically disfiguring. Clinical examination revealed a swelling over the left parotid region, measuring 4 cm × 5 cm, which was mobile, soft, and not adherent to the underlying skin. There was no cervical lymphadenopathy, Stenson’s duct was normal with no purulent discharge, and facial nerves were intact. CT revealed a non-enhancing, homogenous lesion involving the superficial lobe of the left parotid gland (<xref ref-type="fig" rid="OAMJMS-7-2142-g003">Figure 3</xref> and and <xref ref-type="fig" rid="OAMJMS-7-2142-g004">4</xref>).).'], 'OAMJMS-7-2142-g005': ['Cut surface shows a large cystic area containing clear fluid (<xref ref-type="fig" rid="OAMJMS-7-2142-g005">Figure 5</xref>). Histopathological analysis revealed cystic structures comprising dense polymorphous and polyclonal lymphoid tissue forming scattered reactive follicles, closely associated with the glandular lining epithelium of the cyst. A final diagnosis of BLEC was made. HIV antibodies were analysed using ELISA, and a negative result was obtained.). Histopathological analysis revealed cystic structures comprising dense polymorphous and polyclonal lymphoid tissue forming scattered reactive follicles, closely associated with the glandular lining epithelium of the cyst. A final diagnosis of BLEC was made. HIV antibodies were analysed using ELISA, and a negative result was obtained.']} | Benign Lymphoepithelial Cyst: An Unusual Cause of Parotid Swelling in Two Immunocompetent Patients | [
"Parotid gland",
"Lymph nodes",
"Differential diagnosis",
"HIV"
] | Open Access Maced J Med Sci | 1563087600 | [{'@Label': 'BACKGROUND', '@NlmCategory': 'BACKGROUND', '#text': 'Lymphoepithelial cysts, which are benign and slow-growing tumours, usually involve the head and neck regions. Benign lymphoepithelial cysts (BLECs) are the most common cause of parotid swelling in human immunodeficiency virus (HIV)-positive patients and are less common in immunocompetent patients.'}, {'@Label': 'CASE PRESENTATION', '@NlmCategory': 'METHODS', '#text': 'Here, we present two cases of immunocompetent patients with long-standing, progressively enlarging parotid swelling. Postoperative histopathological examination of these patients revealed features of BLEC.'}, {'@Label': 'CONCLUSION', '@NlmCategory': 'CONCLUSIONS', '#text': 'Wide surgical excision is the gold standard for treatment and recurrences is rare. These cases are of particular interest because of the rarity of BLEC in HIV-negative patients and highlight an important differential diagnosis of parotid swelling.'}] | [] | other | PMC6698116 | null | 7 | [
"{'Citation': 'Ahamed A, Kannan V, Velaven K, Sathyanarayanan G, Roshni J, Elavarasi E. Lymphoepithelial cyst of the submandibular gland. J Pharm Bioallied Sci. 2014;6:S185–7. https://doi.org/10.4103/0975-7406.137464 PMid:25210369 PMCid:PMC4157265.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC4157265'}, {'@IdType': 'pubmed', '#text': '25210369'}]}}",
"{'Citation': 'Steehler M, Davison S, Steehler M. Benign lymphoepithelial cysts of the parotid:long-term surgical results. HIV AIDS (Auckl) 2012:81–6. https://doi.org/10.2147/HIV.S27755 PMid:22719215 PMCid:PMC3377388.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3377388'}, {'@IdType': 'pubmed', '#text': '22719215'}]}}",
"{'Citation': 'Glosser J, Pires C, Feinberg S. Branchial cleft or cervical lymphoepithelial cysts. The J Am Dent Assoc. 2003;134:81–6. https://doi.org/10.14219/jada.archive.2003.0020 PMid:12555960.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12555960'}}}",
"{'Citation': 'Naidoo M, Singh B, Ramdial P, Moodley J, Allopi L, Lester B. Lymphoepithelial lesions of the parotid gland in the HIV era -A South African experience. S Afr J Surg. 2007;45:136–8. 140.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18069581'}}}",
"{'Citation': 'Ihrler S, Zietz C, Sendelhofert A, Riederer A, Löhrs U. Lymphoepithelial duct lesions in Sjögren-type sialadenitis. Virchows Arch. 1999;434:315–23. https://doi.org/10.1007/s004280050347 PMid:10335942.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10335942'}}}",
"{'Citation': 'Khadilkar M, Prasad V, Santhoor V, Kamath M, Domah H. Lymphoepithelial cyst of parotid in an immunocompetent patient with chronic otitis media. Case Rep Otolaryngol 2017. 2017:1–2. https://doi.org/10.1155/2017/5169364 PMid:28828190 PMCid:PMC5554582.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC5554582'}, {'@IdType': 'pubmed', '#text': '28828190'}]}}",
"{'Citation': 'Layfield L, Gopez E. Cystic lesions of the salivary glands:Cytologic features in fine-needle aspiration biopsies. Diagn Cytopathol. 2002;27:197–204. https://doi.org/10.1002/dc.10168 PMid:12357495.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12357495'}}}"
] | Open Access Maced J Med Sci. 2019 Jul 14; 7(13):2142-2145 | NO-CC CODE |
|
Preoperative MRI showing lt sphenoid wing meningioma | OAMJMS-7-2093-g014 | 7 | 488282211aa13c76a673ec46a05e7a70f7fc4640fc5f3a41987e396e1c447711 | OAMJMS-7-2093-g014.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
556,
341
] | [{'image_id': 'OAMJMS-7-2093-g002', 'image_file_name': 'OAMJMS-7-2093-g002.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g002.jpg', 'caption': 'Overflow of PMMA into the notches', 'hash': '760542fb1c096dccbf1d6e085e140223b68b0840dab8888de7eb7a0650945a1d'}, {'image_id': 'OAMJMS-7-2093-g005', 'image_file_name': 'OAMJMS-7-2093-g005.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g005.jpg', 'caption': 'Postoperative CT brain with 3D reconstruction', 'hash': '4485c2195b652e1d78b3ff72db756720069eac3388817b6617fce1b567525707'}, {'image_id': 'OAMJMS-7-2093-g014', 'image_file_name': 'OAMJMS-7-2093-g014.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g014.jpg', 'caption': 'Preoperative MRI showing lt sphenoid wing meningioma', 'hash': '488282211aa13c76a673ec46a05e7a70f7fc4640fc5f3a41987e396e1c447711'}, {'image_id': 'OAMJMS-7-2093-g013', 'image_file_name': 'OAMJMS-7-2093-g013.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g013.jpg', 'caption': 'Follow up CT showing fracture of CT brain showing titanium mesh replacing Bone cement', 'hash': '7dbefda8bb28f1d41574ca9a7116c489e1ac3fe1c32d5394026564a491f80fac'}, {'image_id': 'OAMJMS-7-2093-g004', 'image_file_name': 'OAMJMS-7-2093-g004.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g004.jpg', 'caption': 'Preoperative MRI of the patient showing lt sided (meningioma plaque)', 'hash': '52eb7db98168a636e33bbe0439eb765fc8cff54a754e0af7ef3bae6c43e86bec'}, {'image_id': 'OAMJMS-7-2093-g003', 'image_file_name': 'OAMJMS-7-2093-g003.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g003.jpg', 'caption': 'Intraoperative picture of methyl methacrylate graft enforced with a titanium mesh', 'hash': '146289924c918befe616da122353af5d45eabc791048d624e3b0c9e5a30fe432'}, {'image_id': 'OAMJMS-7-2093-g012', 'image_file_name': 'OAMJMS-7-2093-g012.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g012.jpg', 'caption': 'Preoperative CT brain showing growing skull fracture and post-operative ct brain showing repair of the defect by bone cement and mini plates', 'hash': '9d90aae567dc5ab87f0f95faedb9f9787c0b8f6084112a21bf03d0d83f7095c0'}, {'image_id': 'OAMJMS-7-2093-g015', 'image_file_name': 'OAMJMS-7-2093-g015.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g015.jpg', 'caption': 'Postoperative CT brain showing tumour excision and replacement of bone by methyl methacrylate using ball and socket technique', 'hash': '76700e188a425c59d68de741807759ed06590744c948626e6c6b590180c17b5c'}, {'image_id': 'OAMJMS-7-2093-g016', 'image_file_name': 'OAMJMS-7-2093-g016.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g016.jpg', 'caption': 'An intraoperative picture showing the details of the ball and socket technique before and after insertion of bone cement', 'hash': 'f54b0459088053948519d480fe00f901542a00c0e03a7361fda19c771ccc5c9e'}, {'image_id': 'OAMJMS-7-2093-g011', 'image_file_name': 'OAMJMS-7-2093-g011.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g011.jpg', 'caption': 'Postoperative CT brain showing excision of tumour and repair of the defect using methyl methacrylate', 'hash': 'b71a41a3271db9b6b3ea5311a8878ea66fcf4dc79703d33028b6d1dd214bd689'}, {'image_id': 'OAMJMS-7-2093-g007', 'image_file_name': 'OAMJMS-7-2093-g007.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g007.jpg', 'caption': 'Postoperative CT brain with 3D reconstruction', 'hash': 'c7fa8e1516d4d6fb61065b04b83dd0acac70a79348d4d4b583c95919525a8e82'}, {'image_id': 'OAMJMS-7-2093-g009', 'image_file_name': 'OAMJMS-7-2093-g009.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g009.jpg', 'caption': 'Postoperative CT brain showing repair of fronto orbital defect with PMMA', 'hash': 'f66099ceaa9cf1e4b9193cb2c037e1696e46d459a37b9421c50c74845e25dfc9'}, {'image_id': 'OAMJMS-7-2093-g010', 'image_file_name': 'OAMJMS-7-2093-g010.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g010.jpg', 'caption': 'Preoperative MRI showing lt sided meningioma en-plaque', 'hash': '60267983d8207dd226343df69b1af84eda3ad9b368116a7a2acf93f0c3888858'}, {'image_id': 'OAMJMS-7-2093-g008', 'image_file_name': 'OAMJMS-7-2093-g008.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g008.jpg', 'caption': 'Preoperative CT of the brain showing Orbital defect', 'hash': '2b8221d209fd3f4e26802c9ce607f9b071bea912a554789186108138167d2c6e'}, {'image_id': 'OAMJMS-7-2093-g006', 'image_file_name': 'OAMJMS-7-2093-g006.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g006.jpg', 'caption': 'Preoperative MRI and CT bone window of the brain showing parasagittal meningioma', 'hash': '0dc41ae01647932186f85e63be59943cc2f3016cf5ed22d8b0931919a065f10a'}, {'image_id': 'OAMJMS-7-2093-g001', 'image_file_name': 'OAMJMS-7-2093-g001.jpg', 'image_path': '../data/media_files/PMC6698120/OAMJMS-7-2093-g001.jpg', 'caption': 'Notches buried in the margins of the surrounding cranium', 'hash': 'b31de894225a35f7a18719174b442ffc520d642e85f3f417dc035d02698839f6'}] | {'OAMJMS-7-2093-g001': ['After obvious bone edges were obtained and watertight closure of any dural openings or tears, several notches were buried in the edge of the surrounding cranium, preserving the inner table (<xref ref-type="fig" rid="OAMJMS-7-2093-g001">Figure 1</xref>).).'], 'OAMJMS-7-2093-g002': ['PMMA flap is designed and applied to the cranial defect preserving the normal cranial contour. Overflow of PMMA into the notches ensures solid fixation with the surrounding cranium (<xref ref-type="fig" rid="OAMJMS-7-2093-g002">Figure 2</xref>). No mesh, mini plates, wires or sutures are required.). No mesh, mini plates, wires or sutures are required.'], 'OAMJMS-7-2093-g003': ['In 18 cases, the skull defects were repaired using methylmethacrylate enforced with titanium mesh, and 4 cases with methylmethacrylate fixed with mini plates (<xref ref-type="fig" rid="OAMJMS-7-2093-g003">Figure 3</xref>).).'], 'OAMJMS-7-2093-g004': ['Case 1:A 43 years old female patient with a history of 11-month protrusion of Lt eyeball, was operated by excision of soft tissue and decompression of the orbit (roof, lat wall and floor of the orbit). And the bone defect was replaced by PMMA (ball and socket technique). There were no neurological deficits present, and pathology revealed meningioma plaque. The drain was removed after two days in the third postoperative day, and there was no collection, the patient received intravenous antibiotic (cefoperazone) for 5 days and discharged on an oral antibiotic (amoxicillin, clavulanate) for ten days, follow up CT with 3D done in the third day post-operative (<xref ref-type="fig" rid="OAMJMS-7-2093-g004">Figure 4</xref> and and <xref ref-type="fig" rid="OAMJMS-7-2093-g005">5</xref>).).'], 'OAMJMS-7-2093-g006': ['There was no collection and, the patient received an intravenous antibiotic for five days (cefoperazone) and discharged on oral antibiotics (amoxicillin + clavulanate) for one week. CT post was done after removal of the drain (<xref ref-type="fig" rid="OAMJMS-7-2093-g006">Figure 6</xref> and and <xref ref-type="fig" rid="OAMJMS-7-2093-g007">7</xref>).).'], 'OAMJMS-7-2093-g008': ['Debridement and removal of bone fragments were done, and closure of skin for later cranioplasty CT bone window and 3D reconstruction was done to outline the defect and show the orbit he was operated through biclonal skin incision and reconstruction was done using PMMA that was fixed by ball and socket technique. There was no neurological deficit pre and post-operative. The drain was removed in the third day, and postoperative CT with 3D reconstruction was done. The patient received intravenous antibiotics (cefoperazone) for 5 days then discharged on oral antibiotics (amoxicillin + clavulanate for ten days. The post-operative recovery was smooth and the patient was discharged in the 5th post-operative day (<xref ref-type="fig" rid="OAMJMS-7-2093-g008">Figure 8</xref> and and <xref ref-type="fig" rid="OAMJMS-7-2093-g009">9</xref>).).'], 'OAMJMS-7-2093-g010': ['The patient was ttt by excision of soft tissue and decompression of the orbit (lat wall, floor and medial wall) then reconstruction of bone defect was done using bone cement that was fixed using ball and socket technique there was no neurological deficit pre and post-operative (<xref ref-type="fig" rid="OAMJMS-7-2093-g010">Figure 10</xref> and and <xref ref-type="fig" rid="OAMJMS-7-2093-g011">11</xref>).).'], 'OAMJMS-7-2093-g012': ['After 6 months follow up CT brain was done showing a fracture of bone cement that was replaced by titanium mesh (<xref ref-type="fig" rid="OAMJMS-7-2093-g012">Figure 12</xref> and and <xref ref-type="fig" rid="OAMJMS-7-2093-g013">13</xref>).).'], 'OAMJMS-7-2093-g014': ['The patient did not have any neurological deficits except visual affection (<xref ref-type="fig" rid="OAMJMS-7-2093-g014">Figure 14</xref>, , <xref ref-type="fig" rid="OAMJMS-7-2093-g015">15</xref>, and , and <xref ref-type="fig" rid="OAMJMS-7-2093-g016">16</xref>).).']} | Cranioplasty: A New Perspective | [
"Cranioplasty",
"Skull defect",
"Head contour"
] | Open Access Maced J Med Sci | 1561878000 | [{'@Label': 'AIM', '@NlmCategory': 'OBJECTIVE', '#text': 'This work aims to present the different indication, benefits, possible complications and methods used for fixation of methyl methacrylate in cranioplasty. Also, 50 cases will be presented demonstrating the different aetiologies of the defects, and the different techniques used for fixation of methyl methacrylate in cranioplasty.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'This investigation included a prospective study to be carried out on 50 patients with cranial defects of different aetiologies, sites and sizes to be operated upon in Cairo University Hospitals starting from August 2016 to April 2017.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'The principal aims of cranioplasty in this study are to restore aesthetic contour and to provide cerebral protection. However, it has been noted that a great improvement occurs in cerebral blood flow and cerebral perfusion after cranioplasty.'}, {'@Label': 'CONCLUSION', '@NlmCategory': 'CONCLUSIONS', '#text': 'Ball and socket technique appear to be a simple, safe economic and efficient method for fixation of cranioplasty flap. The high incidence of development of postoperative seroma suggests the necessity of-of a subgaleal drain placement for 48 hours.'}] | [] | other | PMC6698120 | null | 6 | [
"{'Citation': 'Moreira-Gonzalez A, Jackson IT, Miyawaki T, Barakat K, DiNick V. Clinical outcome in cranioplasty:a critical review in long-term follow-up. Journal of Craniofacial Surgery. 2003;14(2):144–53. https://doi.org/10.1097/00001665-200303000-00003 PMid:12621283.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12621283'}}}",
"{'Citation': 'van Gool AV. Preformedpolymethylmethacrylate cranioplasties: Report of 45 cases. Journal of maxillofacial surgery. 1985;13:2–8. https://doi.org/10.1016/S0301-0503(85)80005-9.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '3856619'}}}",
"{'Citation': 'Eufinger H, Wehmöller M, Machtens E, Heuser L, Harders A, Kruse D. Reconstruction of craniofacial bone defects with individual alloplastic implants based on CAD/CAM-manipulated CT-data. Journal of Cranio-Maxillofacial Surgery. 1995;23(3):175–81. https://doi.org/10.1016/S1010-5182(05)80007-1.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '7673445'}}}",
"{'Citation': 'Chang V, Hartzfeld P, Langlois M, Mahmood A, Seyfried D. Outcomes of cranial repair after craniectomy. Journal of neurosurgery. 2010;112(5):1120–4. https://doi.org/10.3171/2009.6.JNS09133 PMid:19612971.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19612971'}}}",
"{'Citation': 'Jankowitz BT, Kondziolka DS. When the bone flap hits the floor. Neurosurgery. 2006;59(3):585–90. https://doi.org/10.1227/01.NEU.0000231849.12751.B9 PMid:16955041.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16955041'}}}",
"{'Citation': 'Winkler PA, Stummer W, Linke R, Krishnan KG, Tasch K. Influence of cranioplasty on postural Blood Flow Regulation, Cerebrovascular Reserve Capacity and Cerebral Glucose Metabolism. J Neurosurg. 2000;93:53–61. https://doi.org/10.3171/jns.2000.93.1.0053 PMid:10883905.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10883905'}}}"
] | Open Access Maced J Med Sci. 2019 Jun 30; 7(13):2093-2101 | NO-CC CODE |
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