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Preoperative MRI of the patient showing lt sided (meningioma plaque) | OAMJMS-7-2093-g004 | 7 | 52eb7db98168a636e33bbe0439eb765fc8cff54a754e0af7ef3bae6c43e86bec | OAMJMS-7-2093-g004.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
505,
397
] | [{'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 |
|
Preoperative CT brain showing growing skull fracture and post-operative ct brain showing repair of the defect by bone cement and mini plates | OAMJMS-7-2093-g012 | 7 | 9d90aae567dc5ab87f0f95faedb9f9787c0b8f6084112a21bf03d0d83f7095c0 | OAMJMS-7-2093-g012.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
555,
335
] | [{'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 |
|
Preoperative MRI showing lt sided meningioma en-plaque | OAMJMS-7-2093-g010 | 7 | 60267983d8207dd226343df69b1af84eda3ad9b368116a7a2acf93f0c3888858 | OAMJMS-7-2093-g010.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
556,
302
] | [{'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 |
|
Preoperative MRI and CT bone window of the brain showing parasagittal meningioma | OAMJMS-7-2093-g006 | 7 | 0dc41ae01647932186f85e63be59943cc2f3016cf5ed22d8b0931919a065f10a | OAMJMS-7-2093-g006.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
522,
275
] | [{'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 |
|
Coronal and axial without contrast-enhanced Magnetic resonance imaging (MRI) image showing a Ovarian vein thrombosis (OVT). yellow arrows show ovarian vein thrombosis, red arrows show aorta artery, blue arrows show inferior vena cava and green arrows show inferior vena cava bifurcation; Ovarian vein thrombosis (OVT), gestational sac (GS), kidney(KI) and inferior vena cava (IVC) in the abdominal and pelvic sections | 11239_2020_2177_Fig2_HTML | 7 | 3da00109d6d2b0fbf48033509e6fd57ee68677a7f96cfb740506bb1383b0c4e4 | 11239_2020_2177_Fig2_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
750,
518
] | [{'image_id': '11239_2020_2177_Fig2_HTML', 'image_file_name': '11239_2020_2177_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC7278233/11239_2020_2177_Fig2_HTML.jpg', 'caption': 'Coronal and axial without contrast-enhanced Magnetic resonance imaging (MRI) image showing a Ovarian vein thrombosis (OVT). yellow arrows show ovarian vein thrombosis, red arrows show aorta artery, blue arrows show inferior vena cava and green arrows show inferior vena cava bifurcation; Ovarian vein thrombosis (OVT), gestational sac (GS), kidney(KI) and inferior vena cava (IVC) in the abdominal and pelvic sections', 'hash': '3da00109d6d2b0fbf48033509e6fd57ee68677a7f96cfb740506bb1383b0c4e4'}, {'image_id': '11239_2020_2177_Fig1_HTML', 'image_file_name': '11239_2020_2177_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7278233/11239_2020_2177_Fig1_HTML.jpg', 'caption': 'Coronal and axial without contrast-enhanced computed tomography (CT) image showing a coronavirus disease (COVID-19) infection', 'hash': '781a4b6f03383f946a4c26a8f628b9c97360682baed3936d16aba083c5fbba53'}] | {'11239_2020_2177_Fig1_HTML': ['On 2 May 2020, a 26-year-old female, who was 8\xa0weeks pregnant, presented to Besat Hospital in Sanandaj with abdominal pain, nausea and vomiting for 1\xa0week. She revealed that none of the health protocols on corona virus has complied. On 5 may, the hospital laboratory reported that the patient’s oropharyngeal swab test results of SARS-CoV-2 by qualitative real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) method was positive. CT scans also show the effects of coronavirus in this patient (Fig.\xa0<xref rid="11239_2020_2177_Fig1_HTML" ref-type="fig">1</xref>). Based on diagnostic protocols, she was confirmed as a patient with coronavirus.). Based on diagnostic protocols, she was confirmed as a patient with coronavirus.Fig. 1Coronal and axial without contrast-enhanced computed tomography (CT) image showing a coronavirus disease (COVID-19) infection'], '11239_2020_2177_Fig2_HTML': ['As the patient continued his treatment and more detailed examinations, the MRI was taken from the abdomen and pelvis area. In the examination of T2 MR Images in the axial sections, the distal part of the inferior vena cava was quite prominent with an abnormal signal which to some extent represents the partial vena cava inferior vein thrombosis (Fig.\xa0<xref rid="11239_2020_2177_Fig2_HTML" ref-type="fig">2</xref>c). In these studies, the right and left iliac veins were clearly visible, which could indicate thrombosis in this area. The appearance of a right ovarian vein in MRI images was permanent with signs of increased signal in this area, which indicates ovarian vein thrombosis (OVT) (Fig.\xa0c). In these studies, the right and left iliac veins were clearly visible, which could indicate thrombosis in this area. The appearance of a right ovarian vein in MRI images was permanent with signs of increased signal in this area, which indicates ovarian vein thrombosis (OVT) (Fig.\xa0<xref rid="11239_2020_2177_Fig2_HTML" ref-type="fig">2</xref>a and b).Also, seeing a gestational sac in the coronal section of Fig.\xa0a and b).Also, seeing a gestational sac in the coronal section of Fig.\xa0<xref rid="11239_2020_2177_Fig2_HTML" ref-type="fig">2</xref> indicates that the patient is pregnant (Fig.\xa0 indicates that the patient is pregnant (Fig.\xa0<xref rid="11239_2020_2177_Fig2_HTML" ref-type="fig">2</xref>a).a).Fig. 2Coronal and axial without contrast-enhanced Magnetic resonance imaging (MRI) image showing a Ovarian vein thrombosis (OVT). yellow arrows show ovarian vein thrombosis, red arrows show aorta artery, blue arrows show inferior vena cava and green arrows show inferior vena cava bifurcation; Ovarian vein thrombosis (OVT), gestational sac (GS), kidney(KI) and inferior vena cava (IVC) in the abdominal and pelvic sections']} | Ovarian vein thrombosis after coronavirus disease (COVID-19) infection in a pregnant woman: case report | [
"Deep vein thrombosis",
"Coronavirus",
"Pregnant women",
"Case reports",
"COVID-19"
] | J Thromb Thrombolysis | 1591599600 | None | null | other | PMC7278233 | null | null | [
""
] | J Thromb Thrombolysis. 2020 Jun 8; 50(3):604-607 | NO-CC CODE |
|
CT scan showing mass in the parotid region with erosion of the base of skull, suggestive of a malignant parotid neoplasm. | 1471-2407-4-7-3 | 7 | e6ecc20df939cb5c7f9baa11b9d8e3427be93804c620b2222db33562b5a857cb | 1471-2407-4-7-3.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
413,
302
] | [{'image_id': '1471-2407-4-7-1', 'image_file_name': '1471-2407-4-7-1.jpg', 'image_path': '../data/media_files/PMC375533/1471-2407-4-7-1.jpg', 'caption': 'Clinical photograph of the patient at initial presentation showing the parotid swelling.', 'hash': 'fd2bd03fb65ecd871c33003603e57d7c2237d78ee16908bdcdc1b49c66b67d41'}, {'image_id': '1471-2407-4-7-6', 'image_file_name': '1471-2407-4-7-6.jpg', 'image_path': '../data/media_files/PMC375533/1471-2407-4-7-6.jpg', 'caption': 'Clinical photograph (left profile) of the patient after completion of the treatment showing the healed sinuses.', 'hash': 'e201401a22274eb6634ac7cd341e30e861e1a20502b0c7df1064c7f9ec97c753'}, {'image_id': '1471-2407-4-7-3', 'image_file_name': '1471-2407-4-7-3.jpg', 'image_path': '../data/media_files/PMC375533/1471-2407-4-7-3.jpg', 'caption': 'CT scan showing mass in the parotid region with erosion of the base of skull, suggestive of a malignant parotid neoplasm.', 'hash': 'e6ecc20df939cb5c7f9baa11b9d8e3427be93804c620b2222db33562b5a857cb'}, {'image_id': '1471-2407-4-7-4', 'image_file_name': '1471-2407-4-7-4.jpg', 'image_path': '../data/media_files/PMC375533/1471-2407-4-7-4.jpg', 'caption': 'CT scan showing the mass lesion in the parotid region with extension into left parapharyngeal space and thinning of lateral wall of maxilla.', 'hash': '63be996719746df94013c69b73ed37f2863082477408ffc5dde4cae7d4dcad24'}, {'image_id': '1471-2407-4-7-5', 'image_file_name': '1471-2407-4-7-5.jpg', 'image_path': '../data/media_files/PMC375533/1471-2407-4-7-5.jpg', 'caption': 'Clinical photograph showing the full face of the patient after completion of the treatment, Regression of the parotid swelling can be appreciated', 'hash': '75870bce322b6e48cd025d60818b4b5e641b22a9bcd080df7522583f0ad8ed54'}, {'image_id': '1471-2407-4-7-2', 'image_file_name': '1471-2407-4-7-2.jpg', 'image_path': '../data/media_files/PMC375533/1471-2407-4-7-2.jpg', 'caption': 'Clinical photograph of the patient (left profile) at presentation showing parotid swelling and the draining sinuses.', 'hash': 'a6c2cd583ab07b931aebbdb3f4ade84e2ae49b51ca3da01a4fe5a316de457ab4'}] | {'1471-2407-4-7-1': ['A 38-year-old man presented with a 5 × 4 cm rapidly progressive, firm swelling in the left parotid region with discharging sinuses on the overlying skin. The swelling was not painful and its size did not change with meals. There was no history of fever, malaise, cough, breathlessness, haemoptysis, trauma, surgery, recent tooth extraction, or dental infection. There was no history suggestive of Hansen\'s disease or sexual contact. He was not diabetic or immunocompromised. The swelling was confined to the parotid region (Fig <xref ref-type="fig" rid="1471-2407-4-7-1">1</xref>, , <xref ref-type="fig" rid="1471-2407-4-7-2">2</xref>) rest of the face including submandibular region appeared normal. A 1.5 × 1.5 cm firm jugulodiagastric lymph node was palpable in the neck. Oral cavity, oropharynx, and indirect laryngoscopic examinations were normal. Mouth opening was adequate and there was no facial nerve palsy. Routine investigations including blood counts, erythrocyte sedimentation rate and chest X-ray were normal. ELISA test for HIV antibody was negative. The computerized tomographic (CT) scan showed a large parotid swelling extending to the base of skull with involvement of the skull bone (Figure ) rest of the face including submandibular region appeared normal. A 1.5 × 1.5 cm firm jugulodiagastric lymph node was palpable in the neck. Oral cavity, oropharynx, and indirect laryngoscopic examinations were normal. Mouth opening was adequate and there was no facial nerve palsy. Routine investigations including blood counts, erythrocyte sedimentation rate and chest X-ray were normal. ELISA test for HIV antibody was negative. The computerized tomographic (CT) scan showed a large parotid swelling extending to the base of skull with involvement of the skull bone (Figure <xref ref-type="fig" rid="1471-2407-4-7-3">3</xref>). The mass lesion was seen extending into the parapharangeal space with thinning of the lateral wall of the maxilla on the left side (figure ). The mass lesion was seen extending into the parapharangeal space with thinning of the lateral wall of the maxilla on the left side (figure <xref ref-type="fig" rid="1471-2407-4-7-4">4</xref>). The picture was suggestive of malignant neoplasm of the parotid gland.). The picture was suggestive of malignant neoplasm of the parotid gland.'], '1471-2407-4-7-5': ['Based on the clinical, radiological and pathological findings a provisional diagnosis of chronic inflammatory pathology, probably actinomycosis was arrived at and the patient was started empirically on oral penicillin 500 mg 6 hourly for three weeks with complete clinical response (Fig <xref ref-type="fig" rid="1471-2407-4-7-5">5</xref>, , <xref ref-type="fig" rid="1471-2407-4-7-6">6</xref>). The patient is disease free after and on regular follow-up after 2 1/2 years.). The patient is disease free after and on regular follow-up after 2 1/2 years.']} | Actinomycosis of the parotid masquerading as malignant neoplasm. | [
"Actinomycosis",
"salivary gland",
"parotid",
"infection",
"tumour",
"pseudotumour"
] | BMC Cancer | 1078387200 | [{'@Label': 'BACKGROUND', '@NlmCategory': 'BACKGROUND', '#text': 'Primary actinomycosis of the parotid gland is of rare occurrence and can mimic a malignant neoplasm both clinically as well as radiologically.'}, {'@Label': 'CASE PRESENTATION', '@NlmCategory': 'METHODS', '#text': 'We present here a case of primary actinomycosis of the parotid gland presenting with a parotid mass lesion with erosion of skull bones.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'Clinical presentation of cervico-facial actinomycosis is characterized by the presence of a suppurative or indurative mass with discharging sinuses. The lesion demonstrates characteristic features on fine needle aspiration cytology and histology, however at times the findings are equivocal.'}] | [
"Actinomycosis",
"Adult",
"Diagnosis, Differential",
"Humans",
"Male",
"Parotid Gland",
"Parotid Neoplasms",
"Salivary Gland Diseases"
] | other | PMC375533 | null | 11 | [
"{'Citation': 'Boyd W. Henry Kempton. 8. 1970. A textbook of Pathology; pp. 401–404.'}",
"{'Citation': 'Robbins SL, Cotran RS, Kumar V. WB Saunders Company, Philadelphia. 3. 1984. Pathologic Basis of Disease; pp. 349–350.'}",
"{'Citation': 'Lang-Roth R, Schippers C, Eckel HE. [Cervical actinomycosis. A rare differential diagnosis of parotid tumour] HNO. 1998;46:354–358. doi: 10.1007/s001060050252.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s001060050252'}, {'@IdType': 'pubmed', '#text': '9606651'}]}}",
"{'Citation': 'Ermis I, Topalan M, Aydin A, Erer M. Actinomycosis of the frontal and parotid regions. Ann Plast Surg. 2001;46:55–58. doi: 10.1097/00000637-200101000-00012.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00000637-200101000-00012'}, {'@IdType': 'pubmed', '#text': '11192037'}]}}",
"{'Citation': 'Mullins JE Jr, Ogle O, Cottrell DA. Painless mass in the parotid region. J Oral Maxillofac Surg. 2000;58:316–319.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10716116'}}}",
"{'Citation': 'Parkin JL, Stevens MH. Unusual parotid tumours. Laryngoscope. 1977;87:317–325.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '190495'}}}",
"{'Citation': \"Mair S. Curschmann's spirals and actinomycosis in a fine needle aspirate of the parotid. Acta Cytol. 1989;33:903–906.\", 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2588922'}}}",
"{'Citation': \"Sa'do B, Yoshiura K, Yuasa K, Ariji Y, Kanda S, Oka M, Katsuki T. Multimodality imaging of cervicofacial actinomycosis. Oral Surg Oral Med Oral Pathol. 1993;76:772–782.\", 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8284085'}}}",
"{'Citation': 'Hensher R, Bowerman J. Actinomycosis of the parotid gland. Br J Oral Maxillofac Surg. 1985;23:128–134.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '3158334'}}}",
"{'Citation': 'Hopkins R. Primary actinomycosis of the parotid gland. Br J Oral Surg. 1973;11:131–138.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '4522523'}}}",
"{'Citation': \"Russo TA. Actinomycosis. In: Fauci AS, Braunwald E, Isselbacker KJ, editor. Harrison's Principles of Internal Medicine. 10. New York Mc Grew-Hill; 1983. p. 185.\"}"
] | BMC Cancer. 2004 Mar 4; 4:7 | NO-CC CODE |
|
Cervical and thoracic spinal cord MRI of Covid-19 related ischemic myelopathy, obtained 37 days after onset of symptoms. T2-weighted sagittal section showing anterior spinal cord hyper-intensity extending from C6 to T1 (a). T2-weighted axial section at the T1 level showing anterior spinal cord hyper-intensity (b). No evidence of osteoarthritis | 415_2021_10574_Fig1_HTML | 7 | d9ba1093a29837ab42ed0cfda103a4f1c624a56e002f6581d3f384410722d3b8 | 415_2021_10574_Fig1_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
749,
372
] | [{'image_id': '415_2021_10574_Fig1_HTML', 'image_file_name': '415_2021_10574_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC8080085/415_2021_10574_Fig1_HTML.jpg', 'caption': 'Cervical and thoracic spinal cord MRI of Covid-19 related ischemic myelopathy, obtained 37\xa0days after onset of symptoms. T2-weighted sagittal section showing anterior spinal cord hyper-intensity extending from C6 to T1 (a). T2-weighted axial section at the T1 level showing anterior spinal cord hyper-intensity (b). No evidence of osteoarthritis', 'hash': 'd9ba1093a29837ab42ed0cfda103a4f1c624a56e002f6581d3f384410722d3b8'}] | {'415_2021_10574_Fig1_HTML': ['On day 43, the patient was transferred to Neurorehabilitation Unit, able to move upper limbs against little resistance and lower limbs on a flat surface, while bilateral brisk patellar reflexes (+\u2009+\u2009+) and Babinski sign became evident. Follow-up spinal MRI scan is shown in Fig.\xa0<xref rid="415_2021_10574_Fig1_HTML" ref-type="fig">1</xref>..Fig. 1Cervical and thoracic spinal cord MRI of Covid-19 related ischemic myelopathy, obtained 37\xa0days after onset of symptoms. T2-weighted sagittal section showing anterior spinal cord hyper-intensity extending from C6 to T1 (a). T2-weighted axial section at the T1 level showing anterior spinal cord hyper-intensity (b). No evidence of osteoarthritis']} | Spontaneous spinal cord ischemia during COVID-19 infection | null | J Neurol | 1619593200 | None | null | other | PMC8080085 | null | null | [
""
] | J Neurol. 2021 Apr 28; 268(11):4000-4001 | NO-CC CODE |
|
(A) Axial, (B) coronal reformatted abdominal CT images obtained 40 s after administration of 80 mL of intravenous iodinated contrast medium demonstrate apparent wall thickening in the cecum and ascending colon (arrowheads) with pericecal fat stranding (arrows). | gr1_lrg | 7 | 3f4105129b60b296569101d7680d4fe0e4becad3b41732688040e14efee68cfe | gr1_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
737,
404
] | [{'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7831735/gr1_lrg.jpg', 'caption': '(A) Axial, (B) coronal reformatted abdominal CT images obtained 40\xa0s after administration of 80\xa0mL of intravenous iodinated contrast medium demonstrate apparent wall thickening in the cecum and ascending colon (arrowheads) with pericecal fat stranding (arrows).', 'hash': '3f4105129b60b296569101d7680d4fe0e4becad3b41732688040e14efee68cfe'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7831735/gr2_lrg.jpg', 'caption': '(A) Axial, (B) coronal reformatted CT images of the chest obtained without administrating contrast medium show peripheral, multifocal, and patchy ground-glass opacities in both lungs (red rectangles). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)', 'hash': 'aef2920d8a9b4f889c45061eb8de705b4575e977efb8a1fc2dc2e8cb2f08e816'}] | {'gr1_lrg': ['Contrast-enhanced abdominal computed tomography (CT) was obtained with a suspicion of acute abdomen. Abdominal CT showed bowel wall thickening in the cecum and ascending colon and increased mucosal contrast enhancement in these segments. There were apparent pericecal fat stranding, mild abdominal free fluid, and multiple lymph nodes in the pericecal area (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>\n). The superior and inferior mesenteric arteries and veins were patent, and no thrombus was detected on CT. Moreover, CT sections passing through the lung bases showed peripheral, multifocal, patchy ground-glass opacities (GGO) in both lungs, highly suspicious of COVID-19 pneumonia during the COVID-19 pandemic. Then, Chest CT was obtained without intravenous contrast medium, and CT demonstrated that the GGO areas were widely distributed in both lungs (\n). The superior and inferior mesenteric arteries and veins were patent, and no thrombus was detected on CT. Moreover, CT sections passing through the lung bases showed peripheral, multifocal, patchy ground-glass opacities (GGO) in both lungs, highly suspicious of COVID-19 pneumonia during the COVID-19 pandemic. Then, Chest CT was obtained without intravenous contrast medium, and CT demonstrated that the GGO areas were widely distributed in both lungs (<xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>\n). The patient was accepted as typhlitis (neutropenic enterocolitis) with clinical and imaging findings, broad-spectrum antibiotic therapy (intravenous meropenem 3\xa0g/day, metronidazole 2\xa0mg/day, and teicoplanin 800\xa0mg/day) was initiated. A few hours after the CT exam, the patient\'s general condition deteriorated, and hypoxia, hypercarbia was detected in the arterial blood gas. No malignant cells were observed in the peripheral smear, and in the serum protein electrophoresis, gammopathy was not detected. The oropharyngeal swab test was positive for COVID-19, and \n). The patient was accepted as typhlitis (neutropenic enterocolitis) with clinical and imaging findings, broad-spectrum antibiotic therapy (intravenous meropenem 3\xa0g/day, metronidazole 2\xa0mg/day, and teicoplanin 800\xa0mg/day) was initiated. A few hours after the CT exam, the patient\'s general condition deteriorated, and hypoxia, hypercarbia was detected in the arterial blood gas. No malignant cells were observed in the peripheral smear, and in the serum protein electrophoresis, gammopathy was not detected. The oropharyngeal swab test was positive for COVID-19, and Escherichia coli was found in the blood culture obtained from the patient, and the patient died on the third day of hospitalization.Fig. 1(A) Axial, (B) coronal reformatted abdominal CT images obtained 40\xa0s after administration of 80\xa0mL of intravenous iodinated contrast medium demonstrate apparent wall thickening in the cecum and ascending colon (arrowheads) with pericecal fat stranding (arrows).Fig. 1Fig. 2(A) Axial, (B) coronal reformatted CT images of the chest obtained without administrating contrast medium show peripheral, multifocal, and patchy ground-glass opacities in both lungs (red rectangles). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)Fig. 2']} | COVID-19-associated pancytopenia and typhlitis | [
"COVID-19",
"Pancytopenia",
"Computed tomography",
"Enterocolitis",
"Pneumonia"
] | Am J Emerg Med | 1625382000 | [] | other | PMC7831735 | null | 0 | [] | Am J Emerg Med. 2021 Jul 4; 45:685.e1-685.e3 | NO-CC CODE |
||
Post contrast CT scan axial (A) and coronal (B) shows right mandibular angle osteolytic destructive lesion with buckle side soft tissue mass infiltrating the masseter muscle and ventrally indenting the right parotid salivary gland (block arrows). | amjcaserep-15-343-g003 | 7 | fe9a382e8f8e51fdf421f9b9c5c830981cfd0b890fcdaf30bf47d5e7c13506ce | amjcaserep-15-343-g003.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
720,
298
] | [{'image_id': 'amjcaserep-15-343-g002', 'image_file_name': 'amjcaserep-15-343-g002.jpg', 'image_path': '../data/media_files/PMC4144943/amjcaserep-15-343-g002.jpg', 'caption': 'CT scan of the upper abdomen in arterial (A) and venous (B) phases revealed a small cirrhotic liver with wide spread infiltrative type of hepatocellular carcinoma involving almost the whole right lobe and segment IV of the left lobe which showed patchy areas of arterial enhancement (arrows) with washout in venous phase. Splenomegaly and portal hypertension associated with spleno-renal shunt and extensive varicose veins formation is seen as well as bilateral pleural effusion and ascites.', 'hash': '94ba1937dddb0334035c29483be29814a38385e4bd0e93825c8be5a5fa3e8cec'}, {'image_id': 'amjcaserep-15-343-g003', 'image_file_name': 'amjcaserep-15-343-g003.jpg', 'image_path': '../data/media_files/PMC4144943/amjcaserep-15-343-g003.jpg', 'caption': 'Post contrast CT scan axial (A) and coronal (B) shows right mandibular angle osteolytic destructive lesion with buckle side soft tissue mass infiltrating the masseter muscle and ventrally indenting the right parotid salivary gland (block arrows).', 'hash': 'fe9a382e8f8e51fdf421f9b9c5c830981cfd0b890fcdaf30bf47d5e7c13506ce'}, {'image_id': 'amjcaserep-15-343-g004', 'image_file_name': 'amjcaserep-15-343-g004.jpg', 'image_path': '../data/media_files/PMC4144943/amjcaserep-15-343-g004.jpg', 'caption': '(A) Microscopic appearance of the tumor to the left side (black arrow) adjacent to the salivary gland tissue in the right half of the picture (blue arrow) (H&E ×100). (B) Details of the tumor cells which are arranged in trabeculae and nests (arrow) with sinusoidal cells covering the tumor cells (H&E ×400).', 'hash': '300b1962009d4f4f03a1b9820a055f311054a9cd25b15cbaee031f08c1a71da7'}, {'image_id': 'amjcaserep-15-343-g001', 'image_file_name': 'amjcaserep-15-343-g001.jpg', 'image_path': '../data/media_files/PMC4144943/amjcaserep-15-343-g001.jpg', 'caption': 'The right facial swelling.', 'hash': '6e552d488534bb1b549fbb101c3223df0cfb4758659555710b565790cb3af25c'}] | {'amjcaserep-15-343-g001': ['A 66-year-old male Sudanese patient with a background of type 2 diabetes mellitus and post-alcoholic liver cirrhosis presented with a progressively enlarging painful right facial swelling for 2 months (<xref ref-type="fig" rid="amjcaserep-15-343-g001">Figure 1</xref>). He also reported a history of significant weight loss and progressive abdominal distention and discomfort. His past medical history was significant for 1 episode of variceal bleeding that was treated with sclerotherapy and a history of heavy alcohol intake. Physical examination revealed right-sided swelling in the face of about 7×7 cm on the upper part of the right mandible extending to the right ear that was firm and mildly tender to palpation, as well as hepatosplenomegaly. Shifting dullness was positive by percussion and hepatic bruit was present on auscultation.). He also reported a history of significant weight loss and progressive abdominal distention and discomfort. His past medical history was significant for 1 episode of variceal bleeding that was treated with sclerotherapy and a history of heavy alcohol intake. Physical examination revealed right-sided swelling in the face of about 7×7 cm on the upper part of the right mandible extending to the right ear that was firm and mildly tender to palpation, as well as hepatosplenomegaly. Shifting dullness was positive by percussion and hepatic bruit was present on auscultation.'], 'amjcaserep-15-343-g002': ['Abdominal ultrasound showed cirrhotic liver with a heterogeneous mass in the right upper lobe, signs of portal hypertension, splenomegaly, and ascites. A tri-phasic CT scan of the abdomen showed a cirrhotic liver, portal hypertension, and multicenter hepatocellular carcinoma of the right lobe of the liver; the largest mass was 7×10 cm and another smaller mass was 3 cm in diameter. The lesion showed hypo-attenuation in the venous phase and delayed phase with iso-dense arterial phase (<xref ref-type="fig" rid="amjcaserep-15-343-g002">Figure 2A, 2B</xref>). There was no evidence of lung metastasis. The result of ascetic fluid examination for cytology was negative for malignant cells. CT scan of the neck showed right mandibular angle osteolytic destructive lesion with buckle side soft tissue mass infiltrating the masseter muscle and ventrally indenting the right parotid salivary gland (). There was no evidence of lung metastasis. The result of ascetic fluid examination for cytology was negative for malignant cells. CT scan of the neck showed right mandibular angle osteolytic destructive lesion with buckle side soft tissue mass infiltrating the masseter muscle and ventrally indenting the right parotid salivary gland (<xref ref-type="fig" rid="amjcaserep-15-343-g003">Figure 3A, 3B</xref>), findings indicating a malignant tumor lesion, most likely metastatic (considering the patient history and CT-scan abdomen findings). A bone scan showed increased uptake in the right mandible, representing reactive hyperemia to the soft-tissue tumor or bone involvement. There was no evidence of metastatic lesion.), findings indicating a malignant tumor lesion, most likely metastatic (considering the patient history and CT-scan abdomen findings). A bone scan showed increased uptake in the right mandible, representing reactive hyperemia to the soft-tissue tumor or bone involvement. There was no evidence of metastatic lesion.'], 'amjcaserep-15-343-g004': ['Fine-needle aspiration from the right parotid showed sheets and single malignant cells that were interpreted as carcinoma not otherwise specific. Tru-cut biopsy from the right parotid gland was then performed and histopathology examination showed metastatic hepatocellular carcinoma into parotid gland tissue (<xref ref-type="fig" rid="amjcaserep-15-343-g004">Figure 4A, 4B</xref>). The metastatic deposits are formed of cords and acinar structures with moderate nuclear atypia and immunohistochemical profile indicating hepatocellular origin: positive CK18, HepPar 1, and canalicular pattern staining for pCEA.). The metastatic deposits are formed of cords and acinar structures with moderate nuclear atypia and immunohistochemical profile indicating hepatocellular origin: positive CK18, HepPar 1, and canalicular pattern staining for pCEA.']} | Metastatic Hepatocellular Carcinoma to Parotid Glands | [
"Carcinoma, Hepatocellular",
"Gastrointestinal Neoplasms",
"Neoplasm Metastasis",
"Neoplasm Metastasis",
"Parotid Gland"
] | Am J Case Rep | 1408258800 | [{'@Label': 'BACKGROUND', '@NlmCategory': 'BACKGROUND', '#text': 'The aim of this study was to investigate the degree of impact of obstructive sleep apnea hypopnea syndrome (OSAHS) severity on pediatric psychological and behavioral abnormalities.'}, {'@Label': 'MATERIAL AND METHODS', '@NlmCategory': 'METHODS', '#text': 'Fifty-one children aged 5-12 years with a confirmed diagnosis of OSAHS were divided into 3 groups according to the severity of OSAHS. They underwent bilateral tonsillectomy plus adenoidectomy or adenoidectomy alone. Repeated polysomnography and integrated visual and auditory continuous performance testing (-IVA-CPT) was performed to assess full-scale response control quotient (FRCQ), full-scale attention quotient (FAQ), and hyperactivity (HYP) before surgery and 3 and 6 months after surgery.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'Mean FRCQ, FAQ, and HYP significantly improved over time in the 3 groups (FRCQ, F=292.05; FAQ, F=258.27; HYP, F=295.10, all P<0.001). FRCQ and HYP were not significantly different among the groups at the 3 time points. FAQ was significantly different among the groups (F=3.89, P<0.05). For FRCQ, FAQ, and HYP, there was no interaction between time and disease severity. Within groups, the effect of time on the apnea-hypopnea index (AHI) and lowest oxygen saturation (LaSO2) were significant for each group and they were significantly different among the 3 groups at each time point (all P<0.001).'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'These results suggest that OSAHS may have a significant impact on self-control, attention, and hyperactivity in children, which is gradually alleviated after surgery. Disease severity was not closely related to preoperative mental and psychological function or postoperative recovery. Thus, we find it difficult to determine the impact degree of OSAHS severity on mental and psychological function or predict postoperative recovery by using OSAHS severity alone in children.'}] | [
"Adenoidectomy",
"Analysis of Variance",
"Attention",
"Child",
"China",
"Executive Function",
"Humans",
"Motor Activity",
"Polysomnography",
"Sleep Apnea Syndromes",
"Tonsillectomy"
] | other | PMC4144943 | null | 20 | [
"{'Citation': 'Hiscock H, Canterford L, Ukoumunne OC, Wake M. Adverse associations of sleep problems in Australian preschoolers: National population study. Pediatrics. 2007;119:86–93.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17200274'}}}",
"{'Citation': 'Ray RM, Bower CM. Pediatric obstructive sleep apnea: The year in review. Curr Opin Otolaryngol Head Neck Surg. 2005;13:360–65.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16282765'}}}",
"{'Citation': 'Brunetti L, Rana S, Lospalluti ML, et al. Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children of southern Italy. Chest. 2001;120:1930–35.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11742924'}}}",
"{'Citation': 'Kurnatowski P, Putynski L, Lapienis M, Kowalska B. Neurocognitive abilities in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 2006;70:419–24.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16216342'}}}",
"{'Citation': 'Ali NJ, Pitson DJ, Stradling JR. Snoring, sleep disturbance, and behaviour in 4–5 year olds. Arch Dis Child. 1993;68:360–66.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC1793886'}, {'@IdType': 'pubmed', '#text': '8280201'}]}}",
"{'Citation': 'Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics. 1998;102:616–20.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9738185'}}}",
"{'Citation': 'Rosen CL, Palermo TM, Larkin EK, Redline S. Health-related quality of life and sleep-disordered breathing in children. Sleep. 2002;25:657–66.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12224844'}}}",
"{'Citation': 'Ali NJ, Pitson D, Stradling JR. Sleep disordered breathing: Effects of adenotonsillectomy on behaviour and psychological functioning. Eur J Pediatr. 1996;155:56–62.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8750813'}}}",
"{'Citation': 'Youssef NA, Ege M, Angly SS, et al. Is obstructive sleep apnea associated with ADHD. Ann Clin Psychiatry. 2011;23:213–24.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21808754'}}}",
"{'Citation': 'Tinius TP. The Integrated Visual and Auditory Continuous Performance Test as a neuropsychological measure. Arch Clin Neuropsychol. 2003;18:439–54.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14591441'}}}",
"{'Citation': 'Gruber R, Grizenko N, Schwartz G, et al. Performance on the continuous performance test in children with ADHD is associated with sleep efficiency. Sleep. 2007;30:1003–9.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC1978386'}, {'@IdType': 'pubmed', '#text': '17702270'}]}}",
"{'Citation': 'Editorial Board of Chinese Journal of Otorhinolaryngology and Head and Neck Surgery, Otolaryngology Branch of Chinese Medical Association. Draft guideline for the diagnosis and treatment of OSAHS in children (Urumqi) Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2007;42:83–84.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17633247'}}}",
"{'Citation': 'Edwards G. Determining the role of a new continuous performance test in the diagnostic evaluation for ADHD. ADHD Report. 1998;6:11–13.'}",
"{'Citation': 'Nelson R. Obstructive sleep apnoea in children might impair cognition and behaviour. Lancet. 2002;359:1754.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12049870'}}}",
"{'Citation': 'Owens J, Opipari L, Nobile C, Spirito A. Sleep and daytime behavior in children with obstructive sleep apnea and behavioral sleep disorders. Pediatrics. 1998;102:1178–84.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9794951'}}}",
"{'Citation': 'Stewart MG, Glaze DG, Friedman EM, et al. Quality of life and sleep study findings after adenotonsillectomy in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2005;131:308–14.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15837898'}}}",
"{'Citation': 'Goldstein NA, Post JC, Rosenfeld RM, Campbell TF. Impact of tonsillectomy and adenoidectomy on child behavior. Arch Otolaryngol Head Neck Surg. 2000;126:494–98.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10772303'}}}",
"{'Citation': 'Goldstein NA, Fatim AM, Campbell TF, Rosenfeld RM. Child behavior and quality of life before and after tonsillectomy and adenoidectomy. Arch Otolaryngol Head Neck Surg. 2002;128:770–75.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12117332'}}}",
"{'Citation': 'Avior G, Fishman G, Leor A, et al. The effect of tonsillectomy and adenoidectomy on inattention and impulsivity as measured by the Test of Variables of Attention (TOVA) in children with obstructive sleep apnea syndrome. Arch Otolaryngol Head Neck Surg. 2004;131:367–71.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15467601'}}}",
"{'Citation': 'Quinn CA. Detection of malingering in assessment of adult ADHD. Arch Clin Neuropsychol. 2003;18:379–95.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14591453'}}}"
] | Am J Case Rep. 2014 Aug 17; 15:343-347 | NO-CC CODE |
|
MRI image of the abdomen.Note: Axial T2-weighted MRI image shows an anterior wall dominant placenta previa totalis and suspected placenta accrete of lower posterior wall (arrow). | ccrep-5-2012-093f1 | 7 | 92f03472fc73e113fecc51fb53e0d131447ee29031306644b2d2bbc9a449854a | ccrep-5-2012-093f1.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
730,
880
] | [{'image_id': 'ccrep-5-2012-093f4', 'image_file_name': 'ccrep-5-2012-093f4.jpg', 'image_path': '../data/media_files/PMC3399425/ccrep-5-2012-093f4.jpg', 'caption': 'MRI image of the one month after operation.Note: MRI shows almost normal uterine involution except small myoma located posterior wall.', 'hash': 'd45cf5803784869759aa05b15531fe72c5a9826e0e94709bbddbe8aa884dbb9d'}, {'image_id': 'ccrep-5-2012-093f3', 'image_file_name': 'ccrep-5-2012-093f3.jpg', 'image_path': '../data/media_files/PMC3399425/ccrep-5-2012-093f3.jpg', 'caption': 'Fluoroscopic shows the endovascular balloons.Note: Fluoroscopy shows the inflation of the balloons occluded in the common iliac arteries bilaterally (A: right and B: left).', 'hash': '90d35fdfaffec3291459dec6728839fcf7e500f54c287d926b9dd7af580c1250'}, {'image_id': 'ccrep-5-2012-093f2', 'image_file_name': 'ccrep-5-2012-093f2.jpg', 'image_path': '../data/media_files/PMC3399425/ccrep-5-2012-093f2.jpg', 'caption': 'Figure of uterus during operation (left) and schematic model (right).Notes: Line A shows a marking at edge of placenta guided by ultrasonography. Line B, short dashed line, shows a transverse uterine fundus incision line along line A which part approximately 1 cm.', 'hash': 'cf83d204a41ba5017b063523723c90dc85787a6ac04d8bc67478dd8bec6807fd'}, {'image_id': 'ccrep-5-2012-093f1', 'image_file_name': 'ccrep-5-2012-093f1.jpg', 'image_path': '../data/media_files/PMC3399425/ccrep-5-2012-093f1.jpg', 'caption': 'MRI image of the abdomen.Note: Axial T2-weighted MRI image shows an anterior wall dominant placenta previa totalis and suspected placenta accrete of lower posterior wall (arrow).', 'hash': '92f03472fc73e113fecc51fb53e0d131447ee29031306644b2d2bbc9a449854a'}] | {'ccrep-5-2012-093f1': ['A 37-year-old primigravida, who was diagnosed with a placenta previa totalis, was referred and admitted to our hospital due to threatened premature labor at 33 weeks gestation. She married at 32-year-old and had a history of a hysteroscopic examination for fertility. An initial ultrasonography and MRI image showed that the placenta, which completely covered the internal os, was located mainly on the anterior uterine wall to the level of the maternal umbilicus and suspected placenta accrete located lower posterior uterine wall (<xref ref-type="fig" rid="ccrep-5-2012-093f1">Fig. 1</xref>). At 35 weeks and 2 days of gestation, because of continuous genital bleeding, cesarean section (transverse fundal uterine incision) assisted temporary balloon occlusion procedure was planed. Both the patient and her family agreed to the possible risk of hysterectomy and blood transfusion, if medically necessary. However, they did not desire subsequent pregnancy. In the operation room, at first, bilateral femoral arteries punctures were performed and 5-Fr vascular sheaths (Terumo Corporation, Tokyo, Japan) were inserted under local anesthesia with subcutaneous injection of lidocaine by radiologist and vascular specialist. Under fluoroscopy guidance, selective catheterization of the bilateral common iliac arteries was performed using 5-Fr MOIYAN catheters (Miyano Medical, Co, Ltd, Kobe, Japan), with the tips positioned in the proximal parts of the common iliac arteries. This procedure was completed in about 15 minutes. After that, prior to marking incision line (Line A, ). At 35 weeks and 2 days of gestation, because of continuous genital bleeding, cesarean section (transverse fundal uterine incision) assisted temporary balloon occlusion procedure was planed. Both the patient and her family agreed to the possible risk of hysterectomy and blood transfusion, if medically necessary. However, they did not desire subsequent pregnancy. In the operation room, at first, bilateral femoral arteries punctures were performed and 5-Fr vascular sheaths (Terumo Corporation, Tokyo, Japan) were inserted under local anesthesia with subcutaneous injection of lidocaine by radiologist and vascular specialist. Under fluoroscopy guidance, selective catheterization of the bilateral common iliac arteries was performed using 5-Fr MOIYAN catheters (Miyano Medical, Co, Ltd, Kobe, Japan), with the tips positioned in the proximal parts of the common iliac arteries. This procedure was completed in about 15 minutes. After that, prior to marking incision line (Line A, <xref ref-type="fig" rid="ccrep-5-2012-093f2">Fig. 2</xref>) guided by ultrasonography, an emergency cesarean section was performed via a transverse fundal uterine incision (Line B, ) guided by ultrasonography, an emergency cesarean section was performed via a transverse fundal uterine incision (Line B, <xref ref-type="fig" rid="ccrep-5-2012-093f2">Fig. 2</xref>) under general anesthesia. A female infant weighing 3,138 g was born with Apgar scores of 7 and 8 at 1 and 5 min, respectively. Immediately after baby was delivered, bilateral common iliac arteries were occluded by inflation of the balloons through the catheters already in place () under general anesthesia. A female infant weighing 3,138 g was born with Apgar scores of 7 and 8 at 1 and 5 min, respectively. Immediately after baby was delivered, bilateral common iliac arteries were occluded by inflation of the balloons through the catheters already in place (<xref ref-type="fig" rid="ccrep-5-2012-093f3">Fig. 3</xref>). Manual removal of the placenta revealed a moderate adhesion of a lower posterior part of the uterus. Fortunately, removal was performed almost completely without a large amount of blood loss. The operation wound at fundus of the uterus was single sutured almost 1 cm intervals in first layer. The one occluding balloon was deflated before closure of the wound and careful confirmation of hemostasis of bleeding. Interlocked suture was performed in second layer and the other occluding balloon was deflated finally without any abnormal uterine wound and genital bleeding. An adhesion barrier was used to cover the uterine incision site to reduce the likelihood of bowel adhesions. The total operative time was 67 minutes including preoperative preparing for catheter. The estimated blood loss was about 760-mL and returned 400-mL of autologous blood. The postoperative course was uneventful. The patient was discharged from the hospital on 7th postoperative day without any complication. The MRI image, which was checked one month after operation, was confirmed almost normal uterus (). Manual removal of the placenta revealed a moderate adhesion of a lower posterior part of the uterus. Fortunately, removal was performed almost completely without a large amount of blood loss. The operation wound at fundus of the uterus was single sutured almost 1 cm intervals in first layer. The one occluding balloon was deflated before closure of the wound and careful confirmation of hemostasis of bleeding. Interlocked suture was performed in second layer and the other occluding balloon was deflated finally without any abnormal uterine wound and genital bleeding. An adhesion barrier was used to cover the uterine incision site to reduce the likelihood of bowel adhesions. The total operative time was 67 minutes including preoperative preparing for catheter. The estimated blood loss was about 760-mL and returned 400-mL of autologous blood. The postoperative course was uneventful. The patient was discharged from the hospital on 7th postoperative day without any complication. The MRI image, which was checked one month after operation, was confirmed almost normal uterus (<xref ref-type="fig" rid="ccrep-5-2012-093f4">Fig. 4</xref>).).']} | Transfundal Uterine Incision Performed with Prophylactic Common Iliac Artery Balloon Occlusion for Patient with Placenta Previa Totalis | [
"transfundal uterine incision",
"placenta previa",
"common iliac artery balloon occlusion"
] | Clin Med Insights Case Rep | 1341385200 | Missing heritability is still a challenge for Genome Wide Association Studies (GWAS). Gene-gene interactions may partially explain this residual genetic influence and contribute broadly to complex disease. To analyze the gene-gene interactions in case-control studies of complex disease, we propose a simple, non-parametric method that utilizes the F-statistic. This approach consists of three steps. First, we examine the joint distribution of a pair of SNPs in cases and controls separately. Second, an F-test is used to evaluate the ratio of dependence in cases to that of controls. Finally, results are adjusted for multiple tests. This method was used to evaluate gene-gene interactions that are associated with risk of Type 2 Diabetes among African Americans in the Howard University Family Study. We identified 18 gene-gene interactions (P < 0.0001). Compared with the commonly-used logistical regression method, we demonstrate that the F-ratio test is an efficient approach to measuring gene-gene interactions, especially for studies with limited sample size. | [] | other | PMC3399425 | null | 28 | [
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] | Clin Med Insights Case Rep. 2012 Jul 4; 5:93-97 | NO-CC CODE |
|
Reconstructed axial computed tomography scans illustrating the ability of the iO-Flex® system to decompress the lateral recess and foramen effectively while maintaining facet joint integrity. Images are provided for nondiseased preoperative (A) and postoperative (B) specimens as well as stenotic preoperative (C) and postoperative (D) specimens. | cia-7-257f7 | 7 | fae2d9892e944e3dc24862a2c0a5fb28b33aad53583ce3c58c8c8860c170d243 | cia-7-257f7.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
696,
922
] | [{'image_id': 'cia-7-257f3', 'image_file_name': 'cia-7-257f3.jpg', 'image_path': '../data/media_files/PMC3413168/cia-7-257f3.jpg', 'caption': 'After the probe has been properly inserted and the wire has been delivered, the iO-Flex® MicroBlade Shaver® is passed through the epidural space and out of the lateral foramen.Note: Tissue is removed using a bimanual reciprocating motion.', 'hash': 'e38101f6fbc9d4b59b7e598c36957b66629679b350baa0a8dd282aaaa3b2800d'}, {'image_id': 'cia-7-257f4', 'image_file_name': 'cia-7-257f4.jpg', 'image_path': '../data/media_files/PMC3413168/cia-7-257f4.jpg', 'caption': 'Preoperative and postoperative assessment of decompression using fluoroscopy and a Woodson probe (lateral images [left to right]: pretreatment with MicroBlade Shaver® instrument, post-treatment with MicroBlade Shaver instrument, and post-treatment assessment with Woodson probe).', 'hash': '1915a821fecdb4c897eddfaa64f175becb30b23a117a662f9a83b616b6f8c10d'}, {'image_id': 'cia-7-257f5', 'image_file_name': 'cia-7-257f5.jpg', 'image_path': '../data/media_files/PMC3413168/cia-7-257f5.jpg', 'caption': 'Example of measurements made from reconstructed parasagittal computed tomography slices bisecting the cranial and caudal pedicles at the level of interest. (A) Foraminal width, measured at the narrowest part of the foramen and (B) foraminal area.', 'hash': '2b97dacebc34fc41d91a8bab6976bc17efb05d4ab1e32701352f0f979638673d'}, {'image_id': 'cia-7-257f2', 'image_file_name': 'cia-7-257f2.jpg', 'image_path': '../data/media_files/PMC3413168/cia-7-257f2.jpg', 'caption': 'The iO-Flex® system consists of (from top to bottom) a distal handle, a MicroBlade Shaver® instrument (available in 5.5 mm, 7.5 mm [shown], 10 mm, and 12 mm widths), the Neuro Check® device, and a probe (ipsilateral [shown], contralateral [not shown]).Note: The wire is not shown.', 'hash': 'ba0cb9611012105788fc85032b6ec5760b444f0e5a93b76bf7e83b638aad162f'}, {'image_id': 'cia-7-257f1', 'image_file_name': 'cia-7-257f1.jpg', 'image_path': '../data/media_files/PMC3413168/cia-7-257f1.jpg', 'caption': 'Posterior spine indicating the four nerve roots traversing and exiting on the ipsilateral and contralateral side, decompressed through a single interlaminar access point.', 'hash': 'd416a0644f5161bbc581722e6fa2edf07bef9d40dc7016663efcc5a5a4aff329'}, {'image_id': 'cia-7-257f6', 'image_file_name': 'cia-7-257f6.jpg', 'image_path': '../data/media_files/PMC3413168/cia-7-257f6.jpg', 'caption': 'Example of measurements made from reconstructed axial slices through the center of the intervertebral disc space aligned with the inferior endplate at the level of interest. (A) Bony canal area, (B) soft tissue canal area, (C) ligamentum flavum area, (D) lateral recess diameter, (E) facet area, and (F) facet width.Notes: The spinal canal was defined to have a width equal to one-third of the left to right width of the intervertebral disc to avoid large variations in measurements. Left and right canal measurements were taken from the midline.', 'hash': '8e4dca78ed146da4cd6d848a10eff82f263730384dbb6cbb41434bc1c5f41fcc'}, {'image_id': 'cia-7-257f7', 'image_file_name': 'cia-7-257f7.jpg', 'image_path': '../data/media_files/PMC3413168/cia-7-257f7.jpg', 'caption': 'Reconstructed axial computed tomography scans illustrating the ability of the iO-Flex® system to decompress the lateral recess and foramen effectively while maintaining facet joint integrity. Images are provided for nondiseased preoperative (A) and postoperative (B) specimens as well as stenotic preoperative (C) and postoperative (D) specimens.', 'hash': 'fae2d9892e944e3dc24862a2c0a5fb28b33aad53583ce3c58c8c8860c170d243'}] | {'cia-7-257f1': ['The iO-Flex system is a set of over-the-wire instruments that allows ventral-to-dorsal decompression of impinged neural elements in the lumbar spine while sparing uninvolved bone and soft tissue with controlled bimanual reciprocations. Specifically, the MicroBlade Shaver instrument allows for “inside-out” decompression by removing the ligamentum flavum and shaving bony overgrowth on the superior articular process and under the pars interarticularis, while requiring minimal resection of the facet joints and midline structures. Up to four nerve roots (traversing and exiting roots on the ipsilateral and contralateral side) may be decompressed via a single interlaminar access point using the MicroBlade Shaver (<xref ref-type="fig" rid="cia-7-257f1">Figure 1</xref>). The procedural steps for the iO-Flex system consist of an iO-Flex probe to gain access, the Neuro Check). The procedural steps for the iO-Flex system consist of an iO-Flex probe to gain access, the Neuro Check® device for localization of neural structures, and the MicroBlade Shaver instrument for targeted tissue removal and decompression (<xref ref-type="fig" rid="cia-7-257f2">Figure 2</xref>).).'], 'cia-7-257f3': ['After the laminotomy, the probe, with its cannulated catheter in the retracted position, is passed out of the neural foramen, just rostral to the caudal pedicle. The position of the probe inside the foramen is confirmed using lateral fluoroscopy and the inner catheter is then deployed. A nitinol wire is passed through the probe and out through the dorsal skin where it is locked into a distal handle. The catheter is then retracted and the probe removed, leaving the wire in place. In a clinical setting, the neural localization step with the Neuro Check device would follow next, but was not performed in this cadaver study. The MicroBlade Shaver instrument is then attached to the wire via a proximal exchange tip and pulled into the lateral recess and foramen using a distal handle (<xref ref-type="fig" rid="cia-7-257f3">Figure 3</xref>). The dorsal side of the instrument has small cutting teeth designed to excise bone and ligament, while the ventral side is smooth to protect the neural structures. Decompression is achieved using gentle upward tension and a bimanual reciprocating motion with the handle of the MicroBlade Shaver instrument and the distal handle. Tissue removal and completeness of decompression is assessed using foraminal probes and lateral fluoroscopy (). The dorsal side of the instrument has small cutting teeth designed to excise bone and ligament, while the ventral side is smooth to protect the neural structures. Decompression is achieved using gentle upward tension and a bimanual reciprocating motion with the handle of the MicroBlade Shaver instrument and the distal handle. Tissue removal and completeness of decompression is assessed using foraminal probes and lateral fluoroscopy (<xref ref-type="fig" rid="cia-7-257f4">Figure 4</xref>). When the surgeon deems that decompression is complete, all instruments are removed.). When the surgeon deems that decompression is complete, all instruments are removed.'], 'cia-7-257f5': ['Reconstructed left and right parasagittal images were used to measure anteroposterior foramen width and area (<xref ref-type="fig" rid="cia-7-257f5">Figure 5</xref>). Reconstructed mid-disc axial images were used to measure the spinal canal area, soft tissue canal area, ligamentum flavum area, laminar width (medial to lateral distance), lateral recess diameter (anterior-posterior diameter of lateral recess), and facet width (medial to lateral articulation distance), as shown in ). Reconstructed mid-disc axial images were used to measure the spinal canal area, soft tissue canal area, ligamentum flavum area, laminar width (medial to lateral distance), lateral recess diameter (anterior-posterior diameter of lateral recess), and facet width (medial to lateral articulation distance), as shown in <xref ref-type="fig" rid="cia-7-257f6">Figure 6</xref>. Joint (articulation) cross-sectional area was measured from a plane bisecting the facet joint at each level. The magnitude of laminar removal was measured as a change in width from an axial slice or as a change in area from a coronal slice.. Joint (articulation) cross-sectional area was measured from a plane bisecting the facet joint at each level. The magnitude of laminar removal was measured as a change in width from an axial slice or as a change in area from a coronal slice.'], 'cia-7-257f7': ['The iO-Flex system is a minimally invasive, facet-sparing approach that allows for direct decompression of impinging tissue via a ventral-to-dorsal action of the MicroBlade Shaver. In contrast, traditional decompression procedures utilize an invasive medial-to-lateral approach that removes a significant portion of the posterior elements at the treated level. Another advantage of the iO-Flex system is that, unlike open laminectomy that utilizes fixed-angle tools with a limited ability to address lateral recess and foraminal stenosis, the iO-Flex System uses low-profile flexible instrumentation that targets impinging tissue in the spinal canal, lateral recess, and foramen (<xref ref-type="fig" rid="cia-7-257f7">Figure 7</xref>). This cadaver study demonstrated that the iO-Flex system allows for decompression of the spinal canal with limited resection of structural posterior elements and with selective resection of compressing structures in the lateral recess and foraminal regions.). This cadaver study demonstrated that the iO-Flex system allows for decompression of the spinal canal with limited resection of structural posterior elements and with selective resection of compressing structures in the lateral recess and foraminal regions.']} | ® Facet-sparing lumbar decompression with a minimally invasive flexible MicroBlade Shaver versus traditional decompression: quantitative radiographic assessment | [
"decompression",
"laminectomy",
"lumbar",
"minimally invasive",
"stenosis",
"MicroBlade Shaver",
"iO-Flex system"
] | Clin Interv Aging | 1342767600 | Members of the 14-3-3 eukaryotic protein family predominantly function as dimers. The dimeric form can be converted into monomers upon phosphorylation of Ser(58) located at the subunit interface. Monomers are less stable than dimers and have been considered to be either less active or even inactive during binding and regulation of phosphorylated client proteins. However, like dimers, monomers contain the phosphoserine-binding site and therefore can retain some functions of the dimeric 14-3-3. Furthermore, 14-3-3 monomers may possess additional functional roles owing to their exposed intersubunit surfaces. Previously we have found that the monomeric mutant of 14-3-3ζ (14-3-3ζ(m)), like the wild type protein, is able to bind phosphorylated small heat shock protein HspB6 (pHspB6), which is involved in the regulation of smooth muscle contraction and cardioprotection. Here we report characterization of the 14-3-3ζ(m)/pHspB6 complex by biophysical and biochemical techniques. We find that formation of the complex retards proteolytic degradation and increases thermal stability of the monomeric 14-3-3, indicating that interaction with phosphorylated targets could be a general mechanism of 14-3-3 monomers stabilization. Furthermore, by using myosin subfragment 1 (S1) as a model substrate we find that the monomer has significantly higher chaperone-like activity than either the dimeric 14-3-3ζ protein or even HspB6 itself. These observations indicate that 14-3-3ζ and possibly other 14-3-3 isoforms may have additional functional roles conducted by the monomeric state. | [
"14-3-3 Proteins",
"Chymotrypsin",
"HSP20 Heat-Shock Proteins",
"Hot Temperature",
"Humans",
"Mutagenesis, Site-Directed",
"Mutation",
"Myosin Subfragments",
"Phosphates",
"Phosphoproteins",
"Phosphorylation",
"Protein Multimerization",
"Protein Stability",
"Protein Structure, Quaternary",
"Proteolysis"
] | other | PMC3413168 | null | 54 | [
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] | Clin Interv Aging. 2012 Jul 20; 7:257-266 | NO-CC CODE |
|
Aliasing artifact (“wrap around”) on brain MRI with FOV=24×18 cm (A). The same patient, examination with FOV=24×24 cm (B). | poljradiol-80-93-g007 | 7 | 0fac50d1c09fb8cf144ea8211fbc6612f3785c6af23e6354326b80debada2391 | poljradiol-80-93-g007.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
720,
450
] | [{'image_id': 'poljradiol-80-93-g008', 'image_file_name': 'poljradiol-80-93-g008.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g008.jpg', 'caption': 'Examples of chemical shift artifacts in the out-of-phase image (A) and in FIESTA/2D sequence (B).', 'hash': '24f67818231a62a3db6da8ecadbe8c643acbf3653cc2ea95af27d6a90166343a'}, {'image_id': 'poljradiol-80-93-g006', 'image_file_name': 'poljradiol-80-93-g006.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g006.jpg', 'caption': 'Motion artifacts caused by the peristalsis produce a blurry image of the uterus in pelvic MRI (A). Reduction of the artifacts after intramuscular or intravenous administration of buscolysin (B).', 'hash': '4f7897074d648bfd25b76071db471fca6d33c674575dadb850aa80fdea8dddfd'}, {'image_id': 'poljradiol-80-93-g001', 'image_file_name': 'poljradiol-80-93-g001.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g001.jpg', 'caption': 'Typical syrinx-like manifestation of truncation artifact in the spinal cord.', 'hash': 'ce35ca26119a5c58711d69254d6879cfa583de8ccf8a186209884709e6b60784'}, {'image_id': 'poljradiol-80-93-g010', 'image_file_name': 'poljradiol-80-93-g010.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g010.jpg', 'caption': 'This artifact from clothing ornament – hyperintense signal on FLAIR sequence – may raise the suspicion of subarachnoid hemorrhage. (A). Gradient echo sequences (B) and DWI (C) are very sensitive to artifacts, especially those produced by metallic objects. The artifacts are almost invisible in SE/T1-weighted sequence (D) and in FSE/T2 (E – note that only the lens in the right eye ball shows abnormal signal intensity). Sagittal projection shows directly the source of the artifact located on the arm (F – FSE/T2, sag).', 'hash': 'f6dd047eb7d109bb67f759908691e27d739974b3025a1961410b422f1e9eb33f'}, {'image_id': 'poljradiol-80-93-g017', 'image_file_name': 'poljradiol-80-93-g017.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g017.jpg', 'caption': '(A, B) Ventricular shunt in the frontal horn of the left lateral ventricle – without artifacts.', 'hash': '6445c9aa3a2423aae731ef132278ebf16468c1ee4c27d76a94e3f854a38b5468'}, {'image_id': 'poljradiol-80-93-g019', 'image_file_name': 'poljradiol-80-93-g019.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g019.jpg', 'caption': 'Vertebroplasty after Th12 fracture. STIR, sag (A), FSE/T1, sag (B).', 'hash': '4cc365f05a3f2b07aeb619f7040fbd482d749ad394c569fc07aa9e0f1b0eebdc'}, {'image_id': 'poljradiol-80-93-g022', 'image_file_name': 'poljradiol-80-93-g022.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g022.jpg', 'caption': 'No artifacts in case of polymer biodegradable interference screws.', 'hash': 'ef8985aacca82db1d5b0c688c6a46a7ca425be65c9306e698e4e471d735fac11'}, {'image_id': 'poljradiol-80-93-g025', 'image_file_name': 'poljradiol-80-93-g025.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g025.jpg', 'caption': 'Patient with a history of enucleation due to melanoma. FSE/T1 + fatsat, ax (A), FSE/T2, sag (B).', 'hash': '53e5f75f44f3ee38ca3b1c7c436fb6b2ae77264b137445f25d0b869820472984'}, {'image_id': 'poljradiol-80-93-g007', 'image_file_name': 'poljradiol-80-93-g007.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g007.jpg', 'caption': 'Aliasing artifact (“wrap around”) on brain MRI with FOV=24×18 cm (A). The same patient, examination with FOV=24×24 cm (B).', 'hash': '0fac50d1c09fb8cf144ea8211fbc6612f3785c6af23e6354326b80debada2391'}, {'image_id': 'poljradiol-80-93-g009', 'image_file_name': 'poljradiol-80-93-g009.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g009.jpg', 'caption': 'FLAIR-hyperintense signal in the frontal horns of the lateral ventricles (A), third ventricle (B) and in the fourth ventricle (C).', 'hash': '3c318daa81e283ad74144ac23548649a8760b477873f76738d0943329d6c3c59'}, {'image_id': 'poljradiol-80-93-g024', 'image_file_name': 'poljradiol-80-93-g024.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g024.jpg', 'caption': 'Right hip prosthesis. FSE/T1, ax (A), FSE/T1+fatsat, ax (B).', 'hash': 'e58cf83a667854a3013dfa5224c50aad9232773e251ef2489d23ac220cf1a43d'}, {'image_id': 'poljradiol-80-93-g023', 'image_file_name': 'poljradiol-80-93-g023.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g023.jpg', 'caption': 'Metallic surgical clip in the abdominal wall, almost harmful in FSE/T2-weighted image in the sagittal plane (A) but disturbing the assessment of the uterus in that 44-year-old woman with cervical cancer (LAVA, post Gad, ax – B, FSE/T1+fatsat, ax – C).', 'hash': 'ae3ddd4e3c82bded89199264176e9838d5393355f47c10e4a1a7abba5df70c25'}, {'image_id': 'poljradiol-80-93-g018', 'image_file_name': 'poljradiol-80-93-g018.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g018.jpg', 'caption': 'Artifacts caused by an intervertebral implant are less pronounced in FSE/T2-sequence (A) than in GRE sequence (MERGE/2D, T2, ax – B) at the operated level of C5/C6.', 'hash': 'a10dded12c9256eaa1718515996ffb692f80c8c5fcfd447a97d343521ff8e1ae'}, {'image_id': 'poljradiol-80-93-g016', 'image_file_name': 'poljradiol-80-93-g016.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g016.jpg', 'caption': 'Artifacts produced by neurosurgical clips. FLAIR, ax (A), SE/T1, ax (B).', 'hash': '4c41b472d249bdde46bfe024573b895900d251e889bfbe73cf973db97f8860b9'}, {'image_id': 'poljradiol-80-93-g011', 'image_file_name': 'poljradiol-80-93-g011.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g011.jpg', 'caption': 'Hearing aid forgotten by the patient – pilot sequence.', 'hash': '481c16f4a65f5db4bde3573e87a9296a0034e06750e44623eefe80bf796042ea'}, {'image_id': 'poljradiol-80-93-g020', 'image_file_name': 'poljradiol-80-93-g020.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g020.jpg', 'caption': 'MR-angiography, raw data. Aneurysm at the bifurcation of the left ICA (A). “Black hole” in the treated aneurysm after embolization (B).', 'hash': 'ad770ff4e9a8d3c2e21866436a71d65c1aa0ee2e2b255e006515d7ada5cbd7b5'}, {'image_id': 'poljradiol-80-93-g012', 'image_file_name': 'poljradiol-80-93-g012.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g012.jpg', 'caption': 'Artifacts in the eye ball region caused by the make-up. Artifacts caused by a dental implant in the maxillary sinus region are also seen.', 'hash': '49bf5d8bda622eba431e436529c132be65de2b366b51946e29e0633e5bca0686'}, {'image_id': 'poljradiol-80-93-g015', 'image_file_name': 'poljradiol-80-93-g015.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g015.jpg', 'caption': 'Artifact caused by a dental implant in the right temporal lobe can be easily misinterpreted as a focal lesion on FLAIR images (A) but its typical rounded hyperintense appearance on T1-weighted images (B) enables proper interpretation of this finding.', 'hash': '11d28b4d1424e67d15b0f3f503b6bf48776ccc701b706b86656ad82733b0497e'}, {'image_id': 'poljradiol-80-93-g004', 'image_file_name': 'poljradiol-80-93-g004.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g004.jpg', 'caption': 'SE/T1-weighted images after intravenous administration of the contrast material – hyperintense signal caused by arterial pulsation imitates a cerebellar, contrast-enhanced lesion (A – axial plane, B – sagittal plane, C – coronal plane).', 'hash': '609d084ff1b4d7d48580fbce9efb79d59f65cf43b837b8b13941da28b2787a9c'}, {'image_id': 'poljradiol-80-93-g003', 'image_file_name': 'poljradiol-80-93-g003.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g003.jpg', 'caption': 'Multiple images of the aorta – ghosting artifact caused by aortal pulsation.', 'hash': '23c38b034274451e9347011594850c5750c520052a53473ac2a00d4ebf0b13e0'}, {'image_id': 'poljradiol-80-93-g014', 'image_file_name': 'poljradiol-80-93-g014.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g014.jpg', 'caption': 'Orthodontic braces. Typical T1-hyperintense artifacts (A). Loss of signal in GRE/T2*-weighted images (B) makes it impossible to see the anterior part of the brain in this patient with seizures but band heterotopia can be appreciated if the radiologist is familiar with this kind of neuronal migration defect.Figure 14C. Orthodontic braces. FSE/T2-sequence is less sensitive and band heterotopia can be diagnosed more easily.', 'hash': '8c885f224bebe0033ed6c15ac0bfe0552c2e9b4215ce499b6fe1e06f9b87d7c9'}, {'image_id': 'poljradiol-80-93-g013', 'image_file_name': 'poljradiol-80-93-g013.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g013.jpg', 'caption': 'Tattoo-induced artifacts making it impossible to visualize the whole fetal head.', 'hash': 'aa63c7630c0ccf0d1409fd8d64e77c75c2b42d37eeb48436909b95b4a7e21667'}, {'image_id': 'poljradiol-80-93-g021', 'image_file_name': 'poljradiol-80-93-g021.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g021.jpg', 'caption': 'Excessive artifacts in the MRI (FSE, PD + fatsat) of the knee after the reconstruction of the anterior cruciate ligament with the use of stainless steel screws.', 'hash': '3ce60ad82f59c3e85b7350e43d5629c706b2b3aafb66af674361bc318d5e5e2c'}, {'image_id': 'poljradiol-80-93-g002', 'image_file_name': 'poljradiol-80-93-g002.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g002.jpg', 'caption': 'CSF pulsation imitates intradural spinal hemangioma.', 'hash': '8c8552c628bdc97736a082346fbbd850a977af0dc397ab350f8cc3cb5760cf4e'}, {'image_id': 'poljradiol-80-93-g005', 'image_file_name': 'poljradiol-80-93-g005.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g005.jpg', 'caption': 'Motion artifacts caused by breathing (A). Saturation band (B) reduces the artifacts and improves image quality.', 'hash': '571c52213de1d034a653665503f2535024a0774dd6d7acc58de9649f332025ef'}] | {'poljradiol-80-93-g001': ['Truncation artifacts which occur near sharp high-contrast boundaries and are also known as the Gibbs phenomenon. They appear as multiple, alternating bright and dark lines – “ringing”. They can be misinterpreted as a syrinx in the spinal cord (<xref ref-type="fig" rid="poljradiol-80-93-g001">Figure 1</xref>) [) [3] or a meniscal tear in the knee.'], 'poljradiol-80-93-g002': ['Motion artifacts caused by breathing, cardiac movement, CSF pulsation/blood flow, patient’s movement, which create ghost artifacts (<xref ref-type="fig" rid="poljradiol-80-93-g002">Figures 2</xref>––<xref ref-type="fig" rid="poljradiol-80-93-g006">6</xref>). They can be reduced by patient immobilization, cardiac/respiratory gating, saturation bands, or drugs that slow down the intestinal peristalsis. One can also reduce motion artifacts by using echo-planar imaging (EPI), a very fast MR imaging technique [). They can be reduced by patient immobilization, cardiac/respiratory gating, saturation bands, or drugs that slow down the intestinal peristalsis. One can also reduce motion artifacts by using echo-planar imaging (EPI), a very fast MR imaging technique [4].'], 'poljradiol-80-93-g007': ['Aliasing artifacts occur when the anatomical structures located outside the field of view are mapped at the opposite end of the image. One can eliminate them by increasing the field of view (FOV) [3] (<xref ref-type="fig" rid="poljradiol-80-93-g007">Figure 7A, 7B</xref>).).'], 'poljradiol-80-93-g008': ['Chemical shift artifacts appear as dark or bright bands at the lipid-water interface and are seen especially in case of fluid-filled structures surrounded by fat (e.g. eye balls in the orbits, bladder). They tend to by less prominent on T1-weighted images than on T2-weighted images. Interestingly, these artifacts have been used as a diagnostic aid [3], to confirm the presence of fat within lesions, e.g. in adrenal adenomas (Dual echo sequences/out-of-phase images – <xref ref-type="fig" rid="poljradiol-80-93-g008">Figure 8A</xref>) or to accentuate the fat-water interfaces at visceral margins ) or to accentuate the fat-water interfaces at visceral margins <xref ref-type="fig" rid="poljradiol-80-93-g008">Figure 8B</xref>), thus helping in the evaluation of peripheral tumors for possible extravisceral extension [), thus helping in the evaluation of peripheral tumors for possible extravisceral extension [5].'], 'poljradiol-80-93-g009': ['An abnormally hyperintense signal on FLAIR images can result from CSF/vascular pulsation (<xref ref-type="fig" rid="poljradiol-80-93-g009">Figure 9</xref>), magnetic susceptibility artifact (), magnetic susceptibility artifact (<xref ref-type="fig" rid="poljradiol-80-93-g010">Figure 10</xref>), motion, but also in patients undergoing MRI examinations while receiving supplemental oxygen [), motion, but also in patients undergoing MRI examinations while receiving supplemental oxygen [6].'], 'poljradiol-80-93-g010': ['Metallic objects, not only within the patient’s body but also on the patient, e.g. in the clothes, may result in FLAIR-hyperintensity due to a magnetic susceptibility artifact. In brain MRI such artificial FLAIR-hyperintensity in the subarachnoid space may lead to a false diagnosis of subarachnoid hemorrhage (<xref ref-type="fig" rid="poljradiol-80-93-g010">Figure 10A</xref>). Sometimes it is not necessarily a visible metallic element like in the case presented in ). Sometimes it is not necessarily a visible metallic element like in the case presented in <xref ref-type="fig" rid="poljradiol-80-93-g010">Figure 10</xref>. We had a case of a patient who wore only a white singlet during the examination which seemed to be made of cotton (!) and the artifact disappeared after she had taken it off.. We had a case of a patient who wore only a white singlet during the examination which seemed to be made of cotton (!) and the artifact disappeared after she had taken it off.', 'Different sequences are sensitive to these objects to various degrees (<xref ref-type="fig" rid="poljradiol-80-93-g010">Figure 10</xref>).).'], 'poljradiol-80-93-g011': ['The newborns, especially before the era of MR-compatible incubators, were usually examined dressed up from toes to head to keep them warm during their stay in the scanner room. Probably, the metallic thread in the labels in the newborns’ caps was the reason why the brain images were completely illegible when the cap had remained on the baby’s head. Similarly, an elastic left in the patient’s hair or a hearing aid forgotten in the ear (<xref ref-type="fig" rid="poljradiol-80-93-g011">Figure 11</xref>) can produce the same effect of signal loss and “black hole” in the head.) can produce the same effect of signal loss and “black hole” in the head.'], 'poljradiol-80-93-g012': ['Cosmetics can produce severe distortion of the magnetic field and make the contents of the orbits difficult to assess. The distortion results from the presence of iron oxide in the pigments used to produce dark shades of the make-up [12] (<xref ref-type="fig" rid="poljradiol-80-93-g012">Figure 12</xref>). Tattoo pigments contain metallic elements which also distort the magnetic field and sometimes make MR imaging impossible (). Tattoo pigments contain metallic elements which also distort the magnetic field and sometimes make MR imaging impossible (<xref ref-type="fig" rid="poljradiol-80-93-g013">Figure 13</xref>), not to mention possible heating up and burning the patient during the study, or the carcinogenic ingredients.), not to mention possible heating up and burning the patient during the study, or the carcinogenic ingredients.'], 'poljradiol-80-93-g014': ['Excessive artifacts make it very difficult, and sometimes impossible, to recognize an important intracerebral pathology (<xref ref-type="fig" rid="poljradiol-80-93-g014">Figure 14</xref>). Such excessive artifacts are caused by orthodontic braces, more and more frequently encountered not only in children and adolescents. Dental materials interfere not only with brain MRI but also with orofacial and neck imaging [). Such excessive artifacts are caused by orthodontic braces, more and more frequently encountered not only in children and adolescents. Dental materials interfere not only with brain MRI but also with orofacial and neck imaging [14].'], 'poljradiol-80-93-g015': ['The knowledge of the influence of dental implants on various sequences and of different kinds of signal alterations they cause is extremely important in order not to mistake them for brain lesions (<xref ref-type="fig" rid="poljradiol-80-93-g015">Figure 15</xref>).).'], 'poljradiol-80-93-g016': ['Neurosurgical clips produce similar artifacts (<xref ref-type="fig" rid="poljradiol-80-93-g016">Figure 16</xref>).).', 'Sternal wires after thoracic procedures are of less concern as they distort the magnetic field but usually allow to image the thorax. Their MR appearance is similar to that produced by neurosurgical clips presented in <xref ref-type="fig" rid="poljradiol-80-93-g016">Figure 16</xref>..'], 'poljradiol-80-93-g017': ['Ventricular shunt valves can also generate considerable artifacts due to distortion of the MR image, especially in GRE sequences [17]. However, nowadays they are most often visible as low signal intensity lines only and do not disturb MR images (<xref ref-type="fig" rid="poljradiol-80-93-g017">Figure 17</xref>).).'], 'poljradiol-80-93-g018': ['Disc prostheses and other elements used for spinal surgery (e.g. interspinous process spacers) also induce significant artifacts in MRI which may complicate radiological follow-up after surgery [18]. Stainless steel is known to produce large amounts of artifacts, whereas titanium is known to produce significantly less of them [19]. These artifacts make interpretation of the spinal cord difficult and visualization of the root canals impossible at the operated levels (<xref ref-type="fig" rid="poljradiol-80-93-g018">Figure 18</xref>). Magnesium and carbon-fiber-reinforced polymers produce fewer artifacts than titanium [). Magnesium and carbon-fiber-reinforced polymers produce fewer artifacts than titanium [20].'], 'poljradiol-80-93-g019': ['Image-guided application of cement for kyphoplasty or vertebroplasty results in the presence of low signal intensity material in the treated vertebral body in all sequences and does not produce artifacts (<xref ref-type="fig" rid="poljradiol-80-93-g019">Figure 19</xref>).).'], 'poljradiol-80-93-g020': ['Intracranial aneurysms treated by coiling may be difficult to assess after the procedure because of MR imaging artifacts. On the other hand, intracranial aneurysms occluded with the liquid polymer Onyx are hypointense, probably because of its tantalum content, and do not create artifacts [21] (<xref ref-type="fig" rid="poljradiol-80-93-g020">Figure 20</xref>).).'], 'poljradiol-80-93-g021': ['Medical implants can make it impossible to examine the abdomen and pelvis - like a stent graft in the aorta and both common iliac arteries in our patient who forgot to mention in the questionnaire that he had undergone stent graft implantation in the past. A pilot sequence clearly showed that pelvic MRI cannot be performed due to a large “black hole” mentioned above. The joint that was operated on with the use of screws can pose a similar problem due to signal loss in some sequences and to the artifacts caused by screws (the so called pile-up artifacts and imperfect fat suppression) which may be so extensive that the interpretation of the images may turn out to be impossible [15] (<xref ref-type="fig" rid="poljradiol-80-93-g021">Figure 21</xref>). On the other hand, like in case of materials used in spine surgery, orthopedic materials may produce no artifacts if they are made of polymers blend, e.g. biodegradable interference screws which are not visible on plain films and degrade completely after 2–4 years and only the bone tunnel is visible on MRI (). On the other hand, like in case of materials used in spine surgery, orthopedic materials may produce no artifacts if they are made of polymers blend, e.g. biodegradable interference screws which are not visible on plain films and degrade completely after 2–4 years and only the bone tunnel is visible on MRI (<xref ref-type="fig" rid="poljradiol-80-93-g022">Figure 22</xref>).).'], 'poljradiol-80-93-g023': ['Metallic surgical clips can be almost harmless for imaging in some sequences and projections (<xref ref-type="fig" rid="poljradiol-80-93-g023">Figure 23A</xref>) but can distort the examination severely making it impossible to read the most affected slices in the same patient depending on the kind of sequence () but can distort the examination severely making it impossible to read the most affected slices in the same patient depending on the kind of sequence (<xref ref-type="fig" rid="poljradiol-80-93-g023">Figure 23B, 23C</xref>).).'], 'poljradiol-80-93-g024': ['Pelvic MRI can also be disturbed by hip prostheses (<xref ref-type="fig" rid="poljradiol-80-93-g024">Figure 24</xref>).).'], 'poljradiol-80-93-g025': ['Sometimes the patient does not know what exactly is placed in his orbit after enucleation like in one of our cases in which the patient removed the removable eye ball prosthesis before MRI but there was still some part of it in the orbit (<xref ref-type="fig" rid="poljradiol-80-93-g025">Figure 25</xref>).).']} | Artifacts in Magnetic Resonance Imaging | [
"Artifacts",
"Image Interpretation, Computer-Assisted",
"Magnetic Resonance Imaging"
] | Pol J Radiol | 1424678400 | Artifacts in magnetic resonance imaging and foreign bodies within the patient's body may be confused with a pathology or may reduce the quality of examinations. Radiologists are frequently not informed about the medical history of patients and face postoperative/other images they are not familiar with. A gallery of such images was presented in this manuscript. A truncation artifact in the spinal cord could be misinterpreted as a syrinx. Motion artifacts caused by breathing, cardiac movement, CSF pulsation/blood flow create a ghost artifact which can be reduced by patient immobilization, or cardiac/respiratory gating. Aliasing artifacts can be eliminated by increasing the field of view. An artificially hyperintense signal on FLAIR images can result from magnetic susceptibility artifacts, CSF/vascular pulsation, motion, but can also be found in patients undergoing MRI examinations while receiving supplemental oxygen. Metallic and other foreign bodies which may be found on and in patients' bodies are the main group of artifacts and these are the focus of this study: e.g. make-up, tattoos, hairbands, clothes, endovascular embolization, prostheses, surgical clips, intraorbital and other medical implants, etc. Knowledge of different types of artifacts and their origin, and of possible foreign bodies is necessary to eliminate them or to reduce their negative influence on MR images by adjusting acquisition parameters. It is also necessary to take them into consideration when interpreting the images. Some proposals of reducing artifacts have been mentioned. Describing in detail the procedures to avoid or limit the artifacts would go beyond the scope of this paper but technical ways to reduce them can be found in the cited literature. | [] | other | PMC4340093 | null | 21 | [
"{'Citation': 'Graves MJ, Mitchell DG. Body MRI artifacts in clinical practice: a physicist’s and radiologist’s perspective. J Magn Reson Imaging. 2013;38:269–87.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '23960007'}}}",
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] | Pol J Radiol. 2015 Feb 23; 80:93-106 | NO-CC CODE |
|
Motion artifacts caused by breathing (A). Saturation band (B) reduces the artifacts and improves image quality. | poljradiol-80-93-g005 | 7 | 571c52213de1d034a653665503f2535024a0774dd6d7acc58de9649f332025ef | poljradiol-80-93-g005.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
720,
497
] | [{'image_id': 'poljradiol-80-93-g008', 'image_file_name': 'poljradiol-80-93-g008.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g008.jpg', 'caption': 'Examples of chemical shift artifacts in the out-of-phase image (A) and in FIESTA/2D sequence (B).', 'hash': '24f67818231a62a3db6da8ecadbe8c643acbf3653cc2ea95af27d6a90166343a'}, {'image_id': 'poljradiol-80-93-g006', 'image_file_name': 'poljradiol-80-93-g006.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g006.jpg', 'caption': 'Motion artifacts caused by the peristalsis produce a blurry image of the uterus in pelvic MRI (A). Reduction of the artifacts after intramuscular or intravenous administration of buscolysin (B).', 'hash': '4f7897074d648bfd25b76071db471fca6d33c674575dadb850aa80fdea8dddfd'}, {'image_id': 'poljradiol-80-93-g001', 'image_file_name': 'poljradiol-80-93-g001.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g001.jpg', 'caption': 'Typical syrinx-like manifestation of truncation artifact in the spinal cord.', 'hash': 'ce35ca26119a5c58711d69254d6879cfa583de8ccf8a186209884709e6b60784'}, {'image_id': 'poljradiol-80-93-g010', 'image_file_name': 'poljradiol-80-93-g010.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g010.jpg', 'caption': 'This artifact from clothing ornament – hyperintense signal on FLAIR sequence – may raise the suspicion of subarachnoid hemorrhage. (A). Gradient echo sequences (B) and DWI (C) are very sensitive to artifacts, especially those produced by metallic objects. The artifacts are almost invisible in SE/T1-weighted sequence (D) and in FSE/T2 (E – note that only the lens in the right eye ball shows abnormal signal intensity). Sagittal projection shows directly the source of the artifact located on the arm (F – FSE/T2, sag).', 'hash': 'f6dd047eb7d109bb67f759908691e27d739974b3025a1961410b422f1e9eb33f'}, {'image_id': 'poljradiol-80-93-g017', 'image_file_name': 'poljradiol-80-93-g017.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g017.jpg', 'caption': '(A, B) Ventricular shunt in the frontal horn of the left lateral ventricle – without artifacts.', 'hash': '6445c9aa3a2423aae731ef132278ebf16468c1ee4c27d76a94e3f854a38b5468'}, {'image_id': 'poljradiol-80-93-g019', 'image_file_name': 'poljradiol-80-93-g019.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g019.jpg', 'caption': 'Vertebroplasty after Th12 fracture. STIR, sag (A), FSE/T1, sag (B).', 'hash': '4cc365f05a3f2b07aeb619f7040fbd482d749ad394c569fc07aa9e0f1b0eebdc'}, {'image_id': 'poljradiol-80-93-g022', 'image_file_name': 'poljradiol-80-93-g022.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g022.jpg', 'caption': 'No artifacts in case of polymer biodegradable interference screws.', 'hash': 'ef8985aacca82db1d5b0c688c6a46a7ca425be65c9306e698e4e471d735fac11'}, {'image_id': 'poljradiol-80-93-g025', 'image_file_name': 'poljradiol-80-93-g025.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g025.jpg', 'caption': 'Patient with a history of enucleation due to melanoma. FSE/T1 + fatsat, ax (A), FSE/T2, sag (B).', 'hash': '53e5f75f44f3ee38ca3b1c7c436fb6b2ae77264b137445f25d0b869820472984'}, {'image_id': 'poljradiol-80-93-g007', 'image_file_name': 'poljradiol-80-93-g007.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g007.jpg', 'caption': 'Aliasing artifact (“wrap around”) on brain MRI with FOV=24×18 cm (A). The same patient, examination with FOV=24×24 cm (B).', 'hash': '0fac50d1c09fb8cf144ea8211fbc6612f3785c6af23e6354326b80debada2391'}, {'image_id': 'poljradiol-80-93-g009', 'image_file_name': 'poljradiol-80-93-g009.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g009.jpg', 'caption': 'FLAIR-hyperintense signal in the frontal horns of the lateral ventricles (A), third ventricle (B) and in the fourth ventricle (C).', 'hash': '3c318daa81e283ad74144ac23548649a8760b477873f76738d0943329d6c3c59'}, {'image_id': 'poljradiol-80-93-g024', 'image_file_name': 'poljradiol-80-93-g024.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g024.jpg', 'caption': 'Right hip prosthesis. FSE/T1, ax (A), FSE/T1+fatsat, ax (B).', 'hash': 'e58cf83a667854a3013dfa5224c50aad9232773e251ef2489d23ac220cf1a43d'}, {'image_id': 'poljradiol-80-93-g023', 'image_file_name': 'poljradiol-80-93-g023.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g023.jpg', 'caption': 'Metallic surgical clip in the abdominal wall, almost harmful in FSE/T2-weighted image in the sagittal plane (A) but disturbing the assessment of the uterus in that 44-year-old woman with cervical cancer (LAVA, post Gad, ax – B, FSE/T1+fatsat, ax – C).', 'hash': 'ae3ddd4e3c82bded89199264176e9838d5393355f47c10e4a1a7abba5df70c25'}, {'image_id': 'poljradiol-80-93-g018', 'image_file_name': 'poljradiol-80-93-g018.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g018.jpg', 'caption': 'Artifacts caused by an intervertebral implant are less pronounced in FSE/T2-sequence (A) than in GRE sequence (MERGE/2D, T2, ax – B) at the operated level of C5/C6.', 'hash': 'a10dded12c9256eaa1718515996ffb692f80c8c5fcfd447a97d343521ff8e1ae'}, {'image_id': 'poljradiol-80-93-g016', 'image_file_name': 'poljradiol-80-93-g016.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g016.jpg', 'caption': 'Artifacts produced by neurosurgical clips. FLAIR, ax (A), SE/T1, ax (B).', 'hash': '4c41b472d249bdde46bfe024573b895900d251e889bfbe73cf973db97f8860b9'}, {'image_id': 'poljradiol-80-93-g011', 'image_file_name': 'poljradiol-80-93-g011.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g011.jpg', 'caption': 'Hearing aid forgotten by the patient – pilot sequence.', 'hash': '481c16f4a65f5db4bde3573e87a9296a0034e06750e44623eefe80bf796042ea'}, {'image_id': 'poljradiol-80-93-g020', 'image_file_name': 'poljradiol-80-93-g020.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g020.jpg', 'caption': 'MR-angiography, raw data. Aneurysm at the bifurcation of the left ICA (A). “Black hole” in the treated aneurysm after embolization (B).', 'hash': 'ad770ff4e9a8d3c2e21866436a71d65c1aa0ee2e2b255e006515d7ada5cbd7b5'}, {'image_id': 'poljradiol-80-93-g012', 'image_file_name': 'poljradiol-80-93-g012.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g012.jpg', 'caption': 'Artifacts in the eye ball region caused by the make-up. Artifacts caused by a dental implant in the maxillary sinus region are also seen.', 'hash': '49bf5d8bda622eba431e436529c132be65de2b366b51946e29e0633e5bca0686'}, {'image_id': 'poljradiol-80-93-g015', 'image_file_name': 'poljradiol-80-93-g015.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g015.jpg', 'caption': 'Artifact caused by a dental implant in the right temporal lobe can be easily misinterpreted as a focal lesion on FLAIR images (A) but its typical rounded hyperintense appearance on T1-weighted images (B) enables proper interpretation of this finding.', 'hash': '11d28b4d1424e67d15b0f3f503b6bf48776ccc701b706b86656ad82733b0497e'}, {'image_id': 'poljradiol-80-93-g004', 'image_file_name': 'poljradiol-80-93-g004.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g004.jpg', 'caption': 'SE/T1-weighted images after intravenous administration of the contrast material – hyperintense signal caused by arterial pulsation imitates a cerebellar, contrast-enhanced lesion (A – axial plane, B – sagittal plane, C – coronal plane).', 'hash': '609d084ff1b4d7d48580fbce9efb79d59f65cf43b837b8b13941da28b2787a9c'}, {'image_id': 'poljradiol-80-93-g003', 'image_file_name': 'poljradiol-80-93-g003.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g003.jpg', 'caption': 'Multiple images of the aorta – ghosting artifact caused by aortal pulsation.', 'hash': '23c38b034274451e9347011594850c5750c520052a53473ac2a00d4ebf0b13e0'}, {'image_id': 'poljradiol-80-93-g014', 'image_file_name': 'poljradiol-80-93-g014.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g014.jpg', 'caption': 'Orthodontic braces. Typical T1-hyperintense artifacts (A). Loss of signal in GRE/T2*-weighted images (B) makes it impossible to see the anterior part of the brain in this patient with seizures but band heterotopia can be appreciated if the radiologist is familiar with this kind of neuronal migration defect.Figure 14C. Orthodontic braces. FSE/T2-sequence is less sensitive and band heterotopia can be diagnosed more easily.', 'hash': '8c885f224bebe0033ed6c15ac0bfe0552c2e9b4215ce499b6fe1e06f9b87d7c9'}, {'image_id': 'poljradiol-80-93-g013', 'image_file_name': 'poljradiol-80-93-g013.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g013.jpg', 'caption': 'Tattoo-induced artifacts making it impossible to visualize the whole fetal head.', 'hash': 'aa63c7630c0ccf0d1409fd8d64e77c75c2b42d37eeb48436909b95b4a7e21667'}, {'image_id': 'poljradiol-80-93-g021', 'image_file_name': 'poljradiol-80-93-g021.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g021.jpg', 'caption': 'Excessive artifacts in the MRI (FSE, PD + fatsat) of the knee after the reconstruction of the anterior cruciate ligament with the use of stainless steel screws.', 'hash': '3ce60ad82f59c3e85b7350e43d5629c706b2b3aafb66af674361bc318d5e5e2c'}, {'image_id': 'poljradiol-80-93-g002', 'image_file_name': 'poljradiol-80-93-g002.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g002.jpg', 'caption': 'CSF pulsation imitates intradural spinal hemangioma.', 'hash': '8c8552c628bdc97736a082346fbbd850a977af0dc397ab350f8cc3cb5760cf4e'}, {'image_id': 'poljradiol-80-93-g005', 'image_file_name': 'poljradiol-80-93-g005.jpg', 'image_path': '../data/media_files/PMC4340093/poljradiol-80-93-g005.jpg', 'caption': 'Motion artifacts caused by breathing (A). Saturation band (B) reduces the artifacts and improves image quality.', 'hash': '571c52213de1d034a653665503f2535024a0774dd6d7acc58de9649f332025ef'}] | {'poljradiol-80-93-g001': ['Truncation artifacts which occur near sharp high-contrast boundaries and are also known as the Gibbs phenomenon. They appear as multiple, alternating bright and dark lines – “ringing”. They can be misinterpreted as a syrinx in the spinal cord (<xref ref-type="fig" rid="poljradiol-80-93-g001">Figure 1</xref>) [) [3] or a meniscal tear in the knee.'], 'poljradiol-80-93-g002': ['Motion artifacts caused by breathing, cardiac movement, CSF pulsation/blood flow, patient’s movement, which create ghost artifacts (<xref ref-type="fig" rid="poljradiol-80-93-g002">Figures 2</xref>––<xref ref-type="fig" rid="poljradiol-80-93-g006">6</xref>). They can be reduced by patient immobilization, cardiac/respiratory gating, saturation bands, or drugs that slow down the intestinal peristalsis. One can also reduce motion artifacts by using echo-planar imaging (EPI), a very fast MR imaging technique [). They can be reduced by patient immobilization, cardiac/respiratory gating, saturation bands, or drugs that slow down the intestinal peristalsis. One can also reduce motion artifacts by using echo-planar imaging (EPI), a very fast MR imaging technique [4].'], 'poljradiol-80-93-g007': ['Aliasing artifacts occur when the anatomical structures located outside the field of view are mapped at the opposite end of the image. One can eliminate them by increasing the field of view (FOV) [3] (<xref ref-type="fig" rid="poljradiol-80-93-g007">Figure 7A, 7B</xref>).).'], 'poljradiol-80-93-g008': ['Chemical shift artifacts appear as dark or bright bands at the lipid-water interface and are seen especially in case of fluid-filled structures surrounded by fat (e.g. eye balls in the orbits, bladder). They tend to by less prominent on T1-weighted images than on T2-weighted images. Interestingly, these artifacts have been used as a diagnostic aid [3], to confirm the presence of fat within lesions, e.g. in adrenal adenomas (Dual echo sequences/out-of-phase images – <xref ref-type="fig" rid="poljradiol-80-93-g008">Figure 8A</xref>) or to accentuate the fat-water interfaces at visceral margins ) or to accentuate the fat-water interfaces at visceral margins <xref ref-type="fig" rid="poljradiol-80-93-g008">Figure 8B</xref>), thus helping in the evaluation of peripheral tumors for possible extravisceral extension [), thus helping in the evaluation of peripheral tumors for possible extravisceral extension [5].'], 'poljradiol-80-93-g009': ['An abnormally hyperintense signal on FLAIR images can result from CSF/vascular pulsation (<xref ref-type="fig" rid="poljradiol-80-93-g009">Figure 9</xref>), magnetic susceptibility artifact (), magnetic susceptibility artifact (<xref ref-type="fig" rid="poljradiol-80-93-g010">Figure 10</xref>), motion, but also in patients undergoing MRI examinations while receiving supplemental oxygen [), motion, but also in patients undergoing MRI examinations while receiving supplemental oxygen [6].'], 'poljradiol-80-93-g010': ['Metallic objects, not only within the patient’s body but also on the patient, e.g. in the clothes, may result in FLAIR-hyperintensity due to a magnetic susceptibility artifact. In brain MRI such artificial FLAIR-hyperintensity in the subarachnoid space may lead to a false diagnosis of subarachnoid hemorrhage (<xref ref-type="fig" rid="poljradiol-80-93-g010">Figure 10A</xref>). Sometimes it is not necessarily a visible metallic element like in the case presented in ). Sometimes it is not necessarily a visible metallic element like in the case presented in <xref ref-type="fig" rid="poljradiol-80-93-g010">Figure 10</xref>. We had a case of a patient who wore only a white singlet during the examination which seemed to be made of cotton (!) and the artifact disappeared after she had taken it off.. We had a case of a patient who wore only a white singlet during the examination which seemed to be made of cotton (!) and the artifact disappeared after she had taken it off.', 'Different sequences are sensitive to these objects to various degrees (<xref ref-type="fig" rid="poljradiol-80-93-g010">Figure 10</xref>).).'], 'poljradiol-80-93-g011': ['The newborns, especially before the era of MR-compatible incubators, were usually examined dressed up from toes to head to keep them warm during their stay in the scanner room. Probably, the metallic thread in the labels in the newborns’ caps was the reason why the brain images were completely illegible when the cap had remained on the baby’s head. Similarly, an elastic left in the patient’s hair or a hearing aid forgotten in the ear (<xref ref-type="fig" rid="poljradiol-80-93-g011">Figure 11</xref>) can produce the same effect of signal loss and “black hole” in the head.) can produce the same effect of signal loss and “black hole” in the head.'], 'poljradiol-80-93-g012': ['Cosmetics can produce severe distortion of the magnetic field and make the contents of the orbits difficult to assess. The distortion results from the presence of iron oxide in the pigments used to produce dark shades of the make-up [12] (<xref ref-type="fig" rid="poljradiol-80-93-g012">Figure 12</xref>). Tattoo pigments contain metallic elements which also distort the magnetic field and sometimes make MR imaging impossible (). Tattoo pigments contain metallic elements which also distort the magnetic field and sometimes make MR imaging impossible (<xref ref-type="fig" rid="poljradiol-80-93-g013">Figure 13</xref>), not to mention possible heating up and burning the patient during the study, or the carcinogenic ingredients.), not to mention possible heating up and burning the patient during the study, or the carcinogenic ingredients.'], 'poljradiol-80-93-g014': ['Excessive artifacts make it very difficult, and sometimes impossible, to recognize an important intracerebral pathology (<xref ref-type="fig" rid="poljradiol-80-93-g014">Figure 14</xref>). Such excessive artifacts are caused by orthodontic braces, more and more frequently encountered not only in children and adolescents. Dental materials interfere not only with brain MRI but also with orofacial and neck imaging [). Such excessive artifacts are caused by orthodontic braces, more and more frequently encountered not only in children and adolescents. Dental materials interfere not only with brain MRI but also with orofacial and neck imaging [14].'], 'poljradiol-80-93-g015': ['The knowledge of the influence of dental implants on various sequences and of different kinds of signal alterations they cause is extremely important in order not to mistake them for brain lesions (<xref ref-type="fig" rid="poljradiol-80-93-g015">Figure 15</xref>).).'], 'poljradiol-80-93-g016': ['Neurosurgical clips produce similar artifacts (<xref ref-type="fig" rid="poljradiol-80-93-g016">Figure 16</xref>).).', 'Sternal wires after thoracic procedures are of less concern as they distort the magnetic field but usually allow to image the thorax. Their MR appearance is similar to that produced by neurosurgical clips presented in <xref ref-type="fig" rid="poljradiol-80-93-g016">Figure 16</xref>..'], 'poljradiol-80-93-g017': ['Ventricular shunt valves can also generate considerable artifacts due to distortion of the MR image, especially in GRE sequences [17]. However, nowadays they are most often visible as low signal intensity lines only and do not disturb MR images (<xref ref-type="fig" rid="poljradiol-80-93-g017">Figure 17</xref>).).'], 'poljradiol-80-93-g018': ['Disc prostheses and other elements used for spinal surgery (e.g. interspinous process spacers) also induce significant artifacts in MRI which may complicate radiological follow-up after surgery [18]. Stainless steel is known to produce large amounts of artifacts, whereas titanium is known to produce significantly less of them [19]. These artifacts make interpretation of the spinal cord difficult and visualization of the root canals impossible at the operated levels (<xref ref-type="fig" rid="poljradiol-80-93-g018">Figure 18</xref>). Magnesium and carbon-fiber-reinforced polymers produce fewer artifacts than titanium [). Magnesium and carbon-fiber-reinforced polymers produce fewer artifacts than titanium [20].'], 'poljradiol-80-93-g019': ['Image-guided application of cement for kyphoplasty or vertebroplasty results in the presence of low signal intensity material in the treated vertebral body in all sequences and does not produce artifacts (<xref ref-type="fig" rid="poljradiol-80-93-g019">Figure 19</xref>).).'], 'poljradiol-80-93-g020': ['Intracranial aneurysms treated by coiling may be difficult to assess after the procedure because of MR imaging artifacts. On the other hand, intracranial aneurysms occluded with the liquid polymer Onyx are hypointense, probably because of its tantalum content, and do not create artifacts [21] (<xref ref-type="fig" rid="poljradiol-80-93-g020">Figure 20</xref>).).'], 'poljradiol-80-93-g021': ['Medical implants can make it impossible to examine the abdomen and pelvis - like a stent graft in the aorta and both common iliac arteries in our patient who forgot to mention in the questionnaire that he had undergone stent graft implantation in the past. A pilot sequence clearly showed that pelvic MRI cannot be performed due to a large “black hole” mentioned above. The joint that was operated on with the use of screws can pose a similar problem due to signal loss in some sequences and to the artifacts caused by screws (the so called pile-up artifacts and imperfect fat suppression) which may be so extensive that the interpretation of the images may turn out to be impossible [15] (<xref ref-type="fig" rid="poljradiol-80-93-g021">Figure 21</xref>). On the other hand, like in case of materials used in spine surgery, orthopedic materials may produce no artifacts if they are made of polymers blend, e.g. biodegradable interference screws which are not visible on plain films and degrade completely after 2–4 years and only the bone tunnel is visible on MRI (). On the other hand, like in case of materials used in spine surgery, orthopedic materials may produce no artifacts if they are made of polymers blend, e.g. biodegradable interference screws which are not visible on plain films and degrade completely after 2–4 years and only the bone tunnel is visible on MRI (<xref ref-type="fig" rid="poljradiol-80-93-g022">Figure 22</xref>).).'], 'poljradiol-80-93-g023': ['Metallic surgical clips can be almost harmless for imaging in some sequences and projections (<xref ref-type="fig" rid="poljradiol-80-93-g023">Figure 23A</xref>) but can distort the examination severely making it impossible to read the most affected slices in the same patient depending on the kind of sequence () but can distort the examination severely making it impossible to read the most affected slices in the same patient depending on the kind of sequence (<xref ref-type="fig" rid="poljradiol-80-93-g023">Figure 23B, 23C</xref>).).'], 'poljradiol-80-93-g024': ['Pelvic MRI can also be disturbed by hip prostheses (<xref ref-type="fig" rid="poljradiol-80-93-g024">Figure 24</xref>).).'], 'poljradiol-80-93-g025': ['Sometimes the patient does not know what exactly is placed in his orbit after enucleation like in one of our cases in which the patient removed the removable eye ball prosthesis before MRI but there was still some part of it in the orbit (<xref ref-type="fig" rid="poljradiol-80-93-g025">Figure 25</xref>).).']} | Artifacts in Magnetic Resonance Imaging | [
"Artifacts",
"Image Interpretation, Computer-Assisted",
"Magnetic Resonance Imaging"
] | Pol J Radiol | 1424678400 | Artifacts in magnetic resonance imaging and foreign bodies within the patient's body may be confused with a pathology or may reduce the quality of examinations. Radiologists are frequently not informed about the medical history of patients and face postoperative/other images they are not familiar with. A gallery of such images was presented in this manuscript. A truncation artifact in the spinal cord could be misinterpreted as a syrinx. Motion artifacts caused by breathing, cardiac movement, CSF pulsation/blood flow create a ghost artifact which can be reduced by patient immobilization, or cardiac/respiratory gating. Aliasing artifacts can be eliminated by increasing the field of view. An artificially hyperintense signal on FLAIR images can result from magnetic susceptibility artifacts, CSF/vascular pulsation, motion, but can also be found in patients undergoing MRI examinations while receiving supplemental oxygen. Metallic and other foreign bodies which may be found on and in patients' bodies are the main group of artifacts and these are the focus of this study: e.g. make-up, tattoos, hairbands, clothes, endovascular embolization, prostheses, surgical clips, intraorbital and other medical implants, etc. Knowledge of different types of artifacts and their origin, and of possible foreign bodies is necessary to eliminate them or to reduce their negative influence on MR images by adjusting acquisition parameters. It is also necessary to take them into consideration when interpreting the images. Some proposals of reducing artifacts have been mentioned. Describing in detail the procedures to avoid or limit the artifacts would go beyond the scope of this paper but technical ways to reduce them can be found in the cited literature. | [] | other | PMC4340093 | null | 21 | [
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] | Pol J Radiol. 2015 Feb 23; 80:93-106 | NO-CC CODE |
|
Axial, coronal, and sagittal views of comparative plans between photon deep inspiratory breath-hold (Ph-DIBH) versus proton (Pr) DIBH. The dose color wash shows sparing of the left ventricle and the left anterior descending coronary artery (LADCA) with proton therapy. In addition, note the significant reduction of irradiated lung volume with Pr-DIBH. Blue circle indicates LADCA, and yellow indicates the left ventricle. | i2331-5180-7-3-24-f02 | 7 | f61c2fb21e6d75b77f49c3c4a865e99f04d3e7172cb6a457c4756d7b5e4ef5fe | i2331-5180-7-3-24-f02.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
784,
378
] | [{'image_id': 'i2331-5180-7-3-24-f02', 'image_file_name': 'i2331-5180-7-3-24-f02.jpg', 'image_path': '../data/media_files/PMC7886268/i2331-5180-7-3-24-f02.jpg', 'caption': 'Axial, coronal, and sagittal views of comparative plans between photon deep inspiratory breath-hold (Ph-DIBH) versus proton (Pr) DIBH. The dose color wash shows sparing of the left ventricle and the left anterior descending coronary artery (LADCA) with proton therapy. In addition, note the significant reduction of irradiated lung volume with Pr-DIBH. Blue circle indicates LADCA, and yellow indicates the left ventricle.', 'hash': 'f61c2fb21e6d75b77f49c3c4a865e99f04d3e7172cb6a457c4756d7b5e4ef5fe'}, {'image_id': 'i2331-5180-7-3-24-f01', 'image_file_name': 'i2331-5180-7-3-24-f01.jpg', 'image_path': '../data/media_files/PMC7886268/i2331-5180-7-3-24-f01.jpg', 'caption': 'Contouring of different subunits of the heart as organs at risk.', 'hash': '57fb526f8d2649c3b1c683f117d3944690aa912d18e027d27add28c91ec7526b'}] | {} | Proton versus Photon Breath-Hold Radiation for Left-Sided Breast Cancer after Breast-Conserving Surgery: A Dosimetric Comparison | [
"breast radiation",
"proton",
"photon",
"breath hold"
] | Int J Part Ther | 1609401600 | [{'@Label': 'PURPOSE', '@NlmCategory': 'OBJECTIVE', '#text': 'adolescence is a time of change and it generally entails a greater family vulnerability thus; the aim of this study was to identify the risk factors for poor emotional adjustment to COVID among parents of adolescents.'}, {'@Label': 'DESIGN AND METHODS', '@NlmCategory': 'METHODS', '#text': '94 parents of adolescents (11-18\xa0years old, M\xa0=\xa013.90, SD\xa0=\xa01.85) participated at different times during the state of alert in Spain. 91.5% were mothers. Their ages ranged from 35 to 63\xa0years (M\xa0=\xa046.54; SD\xa0=\xa05.09). The variables assessed were anxiety, depression and stress (DASS), moods (MOOD), somatization (SCL) and resilience (CD-RISC). Descriptive analyses, t-tests, ANOVAs, correlations, and hierarchical regressions were performed. All this by means of a cross-sectional and longitudinal study design.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'at the beginning of the confinement parents showed low levels of emotional distress and moderate levels of positive emotionality and resilience. However, those with a prior psychological problem, who had lost their job, or had lost someone to the pandemic, showed worse emotional adjustment. Resilience was relevant in predicting anxiety-depressive symptoms, and a low level of happiness was relevant in predicting stress. Emotional symptoms improved over time, and resilience remained stable.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'the emotional impact of COVID over time is influenced by mood, mental health, and resilience. In addition, parents who had a previous health problem, had lost their job or a loved one, had a worse adjustment.'}, {'@Label': 'PRACTICAL IMPLICATIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'it is important to carry out intervention programs that increase resilience, treating parents who require it, since their emotional adjustment has repercussions on the emotional adjustment of family system.'}] | [
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"Emotional Adjustment",
"Female",
"Humans",
"Longitudinal Studies",
"Middle Aged",
"Pandemics",
"Parents",
"SARS-CoV-2",
"Spain"
] | other | PMC7886268 | null | 46 | [
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"{'Citation': 'Zhai Y., Du X. Addressing collegiate mental health amid COVID-19 pandemic. Psychiatry Research. 2020;288:113003. doi: 10.1016/j.psychres.2020.113003.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.psychres.2020.113003'}, {'@IdType': 'pmc', '#text': 'PMC7162776'}, {'@IdType': 'pubmed', '#text': '32315885'}]}}"
] | Int J Part Ther. 2020 Dec 31; 7(3):24-33 | NO-CC CODE |
|
Cystic parenchymal destruction and bilateral tube thoracostomy drainage (arrows) in a 38-year-old patient with severe COVID-19 disease. (A) Coronal computed tomography image. (B) Axial computed tomography image. | gr1_lrg | 7 | 720a43b20d5f539e270a20828fb220a85e8c535183f5dda20917ed1cb4f70f97 | gr1_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
737,
351
] | [{'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC8413091/gr2_lrg.jpg', 'caption': 'Anterior-posterior chest radiographs of a 58-year-old patient with COVID-19 disease. (A) Left pneumothorax after placement of a left internal jugular central venous catheter. The patient developed tension physiology which resolved after (B) placement of a left pleural 28 F tube thoracostomy.', 'hash': '282301f237079fb6fc0c6129edacdbf5df0efc16fb4402401e820bb786871043'}, {'image_id': 'ga1_lrg', 'image_file_name': 'ga1_lrg.jpg', 'image_path': '../data/media_files/PMC8413091/ga1_lrg.jpg', 'caption': 'No caption found', 'hash': '6e32c7b18b68f4cdc8090e16f260225cd29bc308ef1360c98da668593e7ce18b'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC8413091/gr1_lrg.jpg', 'caption': 'Cystic parenchymal destruction and bilateral tube thoracostomy drainage (arrows) in a 38-year-old patient with severe COVID-19 disease. (A) Coronal computed tomography image. (B) Axial computed tomography image.', 'hash': '720a43b20d5f539e270a20828fb220a85e8c535183f5dda20917ed1cb4f70f97'}] | {'gr1_lrg': ['The majority of patients who developed a pneumothorax were supported with mechanical ventilation with high positive inspiratory pressure, positive end-expiratory pressure and had a low P:F ratio, suggesting barotrauma and/or hyperinflation as a potential mechanism of injury in the setting of inflamed lung parenchyma with cystic degeneration from COVID-19 (<xref rid="gr1_lrg" ref-type="fig">Figure\xa01</xref>\n). Equally, a secondary mechanism of disease is suggested by the fact that only a minority of patients who developed a pneumothorax had a preadmission diagnosis of COPD (11 patients, 9.3%) and no patients who developed a pneumothorax had evidence of pulmonary blebs or bullous emphysema on initial chest radiograph. Barotrauma in patients on mechanical ventilation for COVID-19 has been associated with prolonged hospitalization and higher mortality.\n). Equally, a secondary mechanism of disease is suggested by the fact that only a minority of patients who developed a pneumothorax had a preadmission diagnosis of COPD (11 patients, 9.3%) and no patients who developed a pneumothorax had evidence of pulmonary blebs or bullous emphysema on initial chest radiograph. Barotrauma in patients on mechanical ventilation for COVID-19 has been associated with prolonged hospitalization and higher mortality.10 Furthermore, critically ill patients with COVID-19 required invasive procedures, which resulted in a 14% rate of iatrogenic pneumothorax, most commonly occurring after placement of a central venous catheter (65%).Figure\xa01Cystic parenchymal destruction and bilateral tube thoracostomy drainage (arrows) in a 38-year-old patient with severe COVID-19 disease. (A) Coronal computed tomography image. (B) Axial computed tomography image.'], 'gr2_lrg': ['In the setting of high ventilator pressures and volumes, a significant number of patients with pneumothorax developed tension physiology (21%) and 2 patients subsequently sustained cardiopulmonary arrest (<xref rid="gr2_lrg" ref-type="fig">Figure\xa02</xref>\n). The incidence of tension pneumothorax is unknown, but is relatively rare, most often reported after visceral pleural injury from chest trauma and is more common in ventilated than awake patients.\n). The incidence of tension pneumothorax is unknown, but is relatively rare, most often reported after visceral pleural injury from chest trauma and is more common in ventilated than awake patients.11 Given that patients with COVID-19 often manifested symptoms similar to those with pneumothorax—hypoxia, tachycardia, tachypnea, and decreased breath sounds by auscultation—the high incidence of tension physiology may have reflected a delay in diagnosis, allowing continued egress of air through a pleural defect leading to more severe respiratory and hemodynamic compromise. In ventilated patients, this process was likely accelerated by high driving pressures, tidal volumes, and/or positive end-expiratory pressure.Figure\xa02Anterior-posterior chest radiographs of a 58-year-old patient with COVID-19 disease. (A) Left pneumothorax after placement of a left internal jugular central venous catheter. The patient developed tension physiology which resolved after (B) placement of a left pleural 28 F tube thoracostomy.']} | Incidence, Management, and Outcomes of Patients With COVID-19 and Pneumothorax | null | Ann Thorac Surg | 1659510000 | To monitor the levels of protecting antibodies raised in the population in response to infection and/or to immunization with SARS-CoV-2, we need a technique that allows high throughput and low-cost quantitative analysis of human IgG antibodies reactive against viral antigens. Here we describe an ultra-fast, high throughput and inexpensive assay to detect SARS-CoV-2 seroconversion in humans. The assay is based on Ni magnetic particles coated with His tagged SARS-CoV-2 antigens. A simple and inexpensive 96 well plate magnetic extraction/homogenization process is described which allows the simultaneous analysis of 96 samples and delivers results in 7 min with high accuracy. | [
"Antibodies, Viral",
"Antigens, Viral",
"COVID-19",
"COVID-19 Serological Testing",
"Enzyme-Linked Immunosorbent Assay",
"Humans",
"Immunoglobulin G",
"Magnets",
"Nickel",
"SARS-CoV-2",
"Sensitivity and Specificity",
"Seroconversion",
"Time Factors"
] | other | PMC8413091 | null | 11 | [
"{'Citation': 'Hu B., Guo H., Zhou P., Shi Z.L. Characteristics of SARS-CoV-2 and COVID-19. Nat. Rev. Microbiol. 2021 doi: 10.1038/s41579-020-00459-7.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1038/s41579-020-00459-7'}, {'@IdType': 'pmc', '#text': 'PMC7537588'}, {'@IdType': 'pubmed', '#text': '33024307'}]}}",
"{'Citation': 'Carter L.J., Garner L.V., Smoot J.W., Li Y., Zhou Q., Saveson C.J., Sasso J.M., Gregg A.C., Soares D.J., Beskid T.R., Jervey S.R., Liu C. Assay techniques and test development for COVID-19 diagnosis. ACS Cent. Sci. 2020 doi: 10.1021/acscentsci.0c00501.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1021/acscentsci.0c00501'}, {'@IdType': 'pmc', '#text': 'PMC7197457'}, {'@IdType': 'pubmed', '#text': '32382657'}]}}",
"{'Citation': \"Ainsworth M., Andersson M., Auckland K., Baillie J.K., Barnes E., Beer S., Beveridge A., Bibi S., Blackwell L., Borak M., Bown A., Brooks T., Burgess-Brown N.A., Camara S., Catton M., Chau K.K., Christott T., Clutterbuck E., Coker J., Cornall R.J., Cox S., Crawford-Jones D., Crook D.W., D'Arcangelo S., Dejnirattsai W., Dequaire J.M.M., Dimitriadis S., Dingle K.E., Doherty G., Dold C., Dong T., Dunachie S.J., Ebner D., Emmenegger M., Espinosa A., Eyre D.W., Fairhead R., Fassih S., Feehily C., Felle S., Fernandez-Cid A., Fernandez Mendoza M., Foord T.H., Fordwoh T., Fox McKee D., Frater J., Gallardo Sanchez V., Gent N., Georgiou D., Groves C.J., Hallis B., Hammond P.M., Hatch S.B., Harvala H.J., Hill J., Hoosdally S.J., Horsington B., Howarth A., James T., Jeffery K., Jones E., Justice A., Karpe F., Kavanagh J., Kim D.S., Kirton R., Klenerman P., Knight J.C., Koukouflis L., Kwok A., Leuschner U., Levin R., Linder A., Lockett T., Lumley S.F., Marinou S., Marsden B.D., Martinez J., Martins Ferreira L., Mason L., Matthews P.C., Mentzer A.J., Mobbs A., Mongkolsapaya J., Morrow J., Mukhopadhyay S.M.M., Neville M.J., Oakley S., Oliveira M., Otter A., Paddon K., Pascoe J., Peng Y., Perez E., Perumal P.K., Peto T.E.A., Pickford H., Ploeg R.J., Pollard A.J., Richardson A., Ritter T.G., Roberts D.J., Rodger G., Rollier C.S., Rowe C., Rudkin J.K., Screaton G., Semple M.G., Sienkiewicz A., Silva-Reyes L., Skelly D.T., Sobrino Diaz A., Stafford L., Stockdale L., Stoesser N., Street T., Stuart D.I., Sweed A., Taylor A., Thraves H., Tsang H.P., Verheul M.K., Vipond R., Walker T.M., Wareing S., Warren Y., Wells C., Wilson C., Withycombe K., Young R.K. Performance characteristics of five immunoassays for SARS-CoV-2: a head-to-head benchmark comparison. Lancet Infect. Dis. 2020;20(12) doi: 10.1016/S1473-3099(20)30634-4.\", 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S1473-3099(20)30634-4'}, {'@IdType': 'pmc', '#text': 'PMC7511171'}, {'@IdType': 'pubmed', '#text': '32979318'}]}}",
"{'Citation': 'Huang A.T., Garcia-Carreras B., Hitchings M.D.T., Yang B., Katzelnick L.C., Rattigan S.M., Borgert B.A., Moreno C.A., Solomon B.D., Trimmer-Smith L., Etienne V., Rodriguez-Barraquer I., Lessler J., Salje H., Burke D.S., Wesolowski A., Cummings D.A.T. A systematic Review of antibody mediated immunity to coronaviruses: kinetics, correlates of protection, and association with severity. Nat. Commun. 2020 doi: 10.1038/s41467-020-18450-4.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1038/s41467-020-18450-4'}, {'@IdType': 'pmc', '#text': 'PMC7499300'}, {'@IdType': 'pubmed', '#text': '32943637'}]}}",
"{'Citation': 'Huergo L.F., Selim K.A., Conzentino M.S., Gerhardt E.C.M., Santos A.R.S., Wagner B., Alford J.T., Deobald N., Pedrosa F.O., De Souza E.M., Nogueira M.B., Raboni S.M., Souto D., Rego F.G.M., Zanette D.L., Aoki M.N., Nardin J.M., Fornazari B., Morales H.M.P., Borges V.A., Nelde A., Walz J.S., Becker M., Schneiderhan-Marra N., Rothbauer U., Reis R.A., Forchhammer K. Magnetic bead-based immunoassay allows rapid, inexpensive, and quantitative detection of human SARS-CoV-2 antibodies. ACS Sens. 2021 doi: 10.1021/acssensors.0c02544.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1021/acssensors.0c02544'}, {'@IdType': 'pubmed', '#text': '33496577'}]}}",
"{'Citation': 'Conzentino M.S., Forchhammer K., Souza E.M., Pedrosa F.O., Nogueira M.B., Raboni S.M., Rego F.G.M., Zanette D.L., Aoki M.N., Nardin J.M., Fornazari B., Morales H.M.P., Celedon P.A.F., Lima C.V.P., Mattar S.B., Lin V.H., Morello L.G., Marchini F.K., Reis R.A., Huergo L.F. Antigen production and development of an indirect ELISA based on the nucleocapsid protein to detect human SARS-CoV-2 seroconversion. Braz. J. Microbiol. 2021:1–5. doi: 10.1007/s42770-021-00556-6.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1007/s42770-021-00556-6'}, {'@IdType': 'pmc', '#text': 'PMC8329412'}, {'@IdType': 'pubmed', '#text': '34342836'}]}}",
"{'Citation': 'Becker M., Strengert M., Junker D., Kerrinnes T., Kaiser P.D., Traenkle B., Dinter H., Haering J., Zeck A., Weise F., Peter A., Hoerber S., Fink S., Ruoff F., Bakchoul T., Baillot A., Lohse S., Cornberg M., Illig T., Gottlieb J., Smola S., Karch A., Berger K., Rammensee H.-G., Schenke-Layland K., Nelde A., Maerklin M., Heitmann J.S., Walz J.S., Templin M.F., Joos T.O., Rothbauer U., Krause G.G., Schneiderhan-Marra N. Going beyond clinical routine in SARS-CoV-2 antibody testing - a multiplex corona virus antibody test for the evaluation of cross-reactivity to endemic coronavirus antigens. medRxiv. 2020 doi: 10.1101/2020.07.17.20156000.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1101/2020.07.17.20156000'}}}",
"{'Citation': 'Alvim R.G.F., Lima T.M., Rodrigues D.A.S., Marsili F.F., Bozza V.B.T., Higa L.M., Monteiro F.L., Abreu D.P.B., Leitão I.C., Carvalho R.S., Galliez R.M., Castineiras T.M.P.P., Nobrega A., Travassos L.H., Tanuri A., Ferreira O.C., Vale A.M., Castilho L.R. An affordable anti-SARS-COV-2 Spike protein ELISA test for early detection of IgG seroconversion suited for large-scale surveillance studies in low-income countries. medRxiv. 2020 doi: 10.1101/2020.07.13.20152884.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1101/2020.07.13.20152884'}}}",
"{'Citation': 'Okba N., Muller M., Li W., Wang C., GeurtsvanKessel C., Corman V., Lamers M., Sikkema R., de Bruin E., Chandler F., Yazdanpanah Y., Le Hingrat Q., Descamps D., Houhou-Fidouh N., Reusken C., Bosch B.-J., Drosten C., Koopmans M., Haagmans B. SARS-CoV-2 specific antibody responses in COVID-19 patients. Emerg. Infect. Dis. 2020 doi: 10.1101/2020.03.18.20038059.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1101/2020.03.18.20038059'}, {'@IdType': 'pmc', '#text': 'PMC7323511'}, {'@IdType': 'pubmed', '#text': '32267220'}]}}",
"{'Citation': 'den Hartog G., Schepp R.M., Kuijer M., GeurtsvanKessel C., van Beek J., Rots N., Koopmans M.P.G., van der Klis F.R.M., van Binnendijk R.S. SARS-CoV-2–Specific antibody detection for seroepidemiology: a multiplex analysis approach accounting for accurate seroprevalence. J. Infect. Dis. 2020 doi: 10.1093/infdis/jiaa479.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1093/infdis/jiaa479'}, {'@IdType': 'pmc', '#text': 'PMC7454740'}, {'@IdType': 'pubmed', '#text': '32766833'}]}}",
"{'Citation': 'Klein S., Müller T.G., Khalid D., Sonntag-Buck V., Heuser A.M., Glass B., Meurer M., Morales I., Schillak A., Freistaedter A., Ambiel I., Winter S.L., Zimmermann L., Naumoska T., Bubeck F., Kirrmaier D., Ullrich S., Miranda I.B., Anders S., Grimm D., Schnitzler P., Knop M., Kräusslich H.G., Thi V.L.D., Börner K., Chlanda P. SARS-CoV-2 RNA extraction using magnetic beads for rapid large-scale testing by RT-QPCR and RT-LAMP. Viruses. 2020;12(8) doi: 10.3390/v12080863.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.3390/v12080863'}, {'@IdType': 'pmc', '#text': 'PMC7472728'}, {'@IdType': 'pubmed', '#text': '32784757'}]}}"
] | Ann Thorac Surg. 2022 Aug 3; 114(2):401-407 | NO-CC CODE |
|
T2W coronal image showing dilated tortuous abdominal aortic aneurysm (arrowheads) with a focal saccular aneurysm in the right iliac artery (arrows) and intraperitoneal extension of the hematoma (thick arrows) into the paracolic gutters and into the pelvis. | qmj-2013-016-g002 | 7 | ba87e9f9944f0c57dc3b94a15e3c2b28cf0fce9428657f07e9457850e3f7afe4 | qmj-2013-016-g002.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
786,
894
] | [{'image_id': 'qmj-2013-016-g002', 'image_file_name': 'qmj-2013-016-g002.jpg', 'image_path': '../data/media_files/PMC4080494/qmj-2013-016-g002.jpg', 'caption': 'T2W coronal image showing dilated tortuous abdominal aortic aneurysm (arrowheads) with a focal saccular aneurysm in the right iliac artery (arrows) and intraperitoneal extension of the hematoma (thick arrows) into the paracolic gutters and into the pelvis.', 'hash': 'ba87e9f9944f0c57dc3b94a15e3c2b28cf0fce9428657f07e9457850e3f7afe4'}, {'image_id': 'qmj-2013-016-g001', 'image_file_name': 'qmj-2013-016-g001.jpg', 'image_path': '../data/media_files/PMC4080494/qmj-2013-016-g001.jpg', 'caption': 'T2W axial image showing hyperintense (arrows) retroperitoneal hematoma. Saccular aneurysm is also seen in the right iliac artery with a focal defect in the intima (thick arrow) signifying site of rupture.', 'hash': 'c0624b53488af77cdd9749b4c486b9985fffb9cc7ef09a7bb522d3cf4081342e'}] | {'qmj-2013-016-g001': ['There was proximal extension of the aneurysm into the thoracic aorta. The aneurysm was fusiform type with a distal extension into both the iliac arteries. The right iliac artery was also showing another saccular dilatation (<xref ref-type="fig" rid="qmj-2013-016-g001">Figure 1</xref>). The true lumen was significantly compressed in both the iliac arteries. In addition, there was a focal defect seen in the right iliac artery aneurysm signifying rupture (). The true lumen was significantly compressed in both the iliac arteries. In addition, there was a focal defect seen in the right iliac artery aneurysm signifying rupture (<xref ref-type="fig" rid="qmj-2013-016-g002">Figure 2</xref>). A large hyperacute hematoma was seen in the retroperitoneum. There was extension of this hematoma into bilateral paracolic gutters and also into the pelvis.). A large hyperacute hematoma was seen in the retroperitoneum. There was extension of this hematoma into bilateral paracolic gutters and also into the pelvis.']} | Ruptured abdominal aortic aneurysm diagnosed through non-contrast MRI | [
"aneurysm",
"abdominal aorta",
"rupture"
] | Qatar Med J | 1387785600 | The genome of Agrobacterium tumefaciens C58 encodes 12 members of the enolase superfamily (ENS), eight of which are members of the mandelate racemase (MR) subgroup and, therefore, likely to be acid sugar dehydratases. Using a library of 77 acid sugars for high-throughput screening, one protein (UniProt entry A9CG74; locus tag Atu4196) showed activity with both m-galactarate and d-galacturonate. Two families of galactarate dehydratases had been discovered previously in the ENS, GalrD/TalrD [Yew, W. S., et al. (2007) Biochemistry 46, 9564-9577] and GalrD-II [Rakus, J. F., et al. (2009) Biochemistry 48, 11546-11558]; these have different active site acid/base catalysis and have no activity with d-galacturonate. A9CG74 dehydrates m-galactarate to form 2-keto-3-deoxy-galactarate but does not dehydrate d-galacturonate as expected. Instead, when A9CG74 is incubated with d-galacturonate, 3-deoxy-d-xylo-hexarate or 3-deoxy-d-lyxo-hexarate is formed. In this reaction, instead of abstracting the C5 proton α to the carboxylate group, the expected reaction for a member of the ENS, the enzyme apparently abstracts the proton α to the aldehyde group to form 3-deoxy-d-threo-hexulosuronate that undergoes a 1,2-hydride shift similar to the benzylic acid rearrangement to form the observed product. A. tumefaciens C58 does not utilize m-galactarate as a carbon source under the conditions tested in this study, although it does utilize d-galacturonate, which is a likely precursor to m-galactarate. The gene encoding A9CG74 and several genome proximal genes were upregulated with d-galacturonate as the carbon source. One of these, a member of the dihydrodipicolinate synthase superfamily, catalyzes the dehydration and subsequent decarboxylation of 2-keto-3-deoxy-d-galactarate to α-ketoglutarate semialdehyde, thereby providing a pathway for the conversion of m-galactarate to α-ketoglutarate semialdehyde. | [
"Agrobacterium tumefaciens",
"Amino Acid Sequence",
"Bacterial Proteins",
"Crystallography, X-Ray",
"Genome, Bacterial",
"Hexuronic Acids",
"Hydro-Lyases",
"Molecular Docking Simulation",
"Molecular Sequence Data",
"Mutation",
"Stereoisomerism",
"Sugar Acids"
] | other | PMC4080494 | null | 23 | [
"{'Citation': 'Boer H.; Maaheimo H.; Koivula A.; Penttila M.; Richard P. (2010) Identification in Agrobacterium tumefaciens of the d-galacturonic acid dehydrogenase gene. Appl. Microbiol. Biotechnol. 86, 901–909.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19921179'}}}",
"{'Citation': 'Bouvier J. T.; Groninger-Poe F. P.; Vetting M.; Almo S. C.; Gerlt J. A. (2014) Galactaro δ-Lactone Isomerase: Lactone Isomerization by a Member of the Amidohydrolase Superfamily. Biochemistry 53, 614–616.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3977579'}, {'@IdType': 'pubmed', '#text': '24450804'}]}}",
"{'Citation': 'Akiva E.; Brown S.; Almonacid D. E.; Barber A. E. II; Custer A. F.; Hicks M. A.; Huang C. C.; Lauck F.; Mashiyama S. T.; Meng E. C.; Mischel D.; Morris J. H.; Ojha S.; Schnoes A. M.; Stryke D.; Yunes J. M.; Ferrin T. E.; Holliday G. L.; Babbitt P. C. (2014) The Structure-Function Linkage Database. Nucleic Acids Res. 42, D521–D530.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3965090'}, {'@IdType': 'pubmed', '#text': '24271399'}]}}",
"{'Citation': 'Gerlt J. A.; Babbitt P. C.; Jacobson M. P.; Almo S. C. (2012) Divergent Evolution in Enolase Superfamily: Strategies for Assigning Functions. J. Biol. Chem. 287, 29–34.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3249080'}, {'@IdType': 'pubmed', '#text': '22069326'}]}}",
"{'Citation': 'Gerlt J. A. (2006) Discovering new functions in the enolase superfamily. Abstracts of Papers, p 884, 232nd National Meeting of the American Chemical Society, San Francisco, CA, Sept 10–14, 2006, American Chemical Society, Washington, DC.'}",
"{'Citation': 'Gerlt J. A.; Babbitt P. C. (1997) The enolase superfamily: Different reactions catalyzed by similar active sites. FASEB J. 11, A1007.'}",
"{'Citation': 'Babbitt P. C.; Hasson M. S.; Wedekind J. E.; Palmer D. R. J.; Barrett W. C.; Reed G. H.; Rayment I.; Ringe D.; Kenyon G. L.; Gerlt J. A. (1996) The enolase superfamily: A general strategy for enzyme-catalyzed abstraction of the α-protons of carboxylic acids. Biochemistry 35, 16489–16501.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8987982'}}}",
"{'Citation': 'Rakus J. F.; Kalyanaraman C.; Fedorov A. A.; Fedorov E. V.; Mills-Groninger F. P.; Toro R.; Bonanno J.; Bain K.; Sauder J. M.; Burley S. K.; Almo S. C.; Jacobson M. P.; Gerlt J. A. (2009) Computation-facilitated assignment of the function in the enolase superfamily: A regiochemically distinct galactarate dehydratase from Oceanobacillus iheyensis. Biochemistry 48, 11546–11558.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2787699'}, {'@IdType': 'pubmed', '#text': '19883118'}]}}",
"{'Citation': 'Yew W. S.; Fedorov A. A.; Fedorov E. V.; Almo S. C.; Gerlt J. A. (2007) Evolution of enzymatic activities in the enolase superfamily: l-Talarate/galactarate dehydratase from Salmonella typhimurium LT2. Biochemistry 46, 9564–9577.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17649980'}}}",
"{'Citation': 'Gibson D. G.; Young L.; Chuang R. Y.; Venter J. C.; Hutchison C. A. III; Smith H. O. (2009) Enzymatic assembly of DNA molecules up to several hundred kilobases. Nat. Methods 6, 343–345.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19363495'}}}",
"{'Citation': 'Leslie A. G. (2006) The integration of macromolecular diffraction data. Acta Crystallogr. D62, 48–57.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16369093'}}}",
"{'Citation': 'Evans P. (2006) Scaling and assessment of data quality. Acta Crystallogr. D62, 72–82.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16369096'}}}",
"{'Citation': 'Long F.; Vagin A. A.; Young P.; Murshudov G. N. (2008) BALBES: A molecular-replacement pipeline. Acta Crystallogr. 64, 125–132.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2394813'}, {'@IdType': 'pubmed', '#text': '18094476'}]}}",
"{'Citation': 'Morris R. J.; Perrakis A.; Lamzin V. S. (2003) ARP/wARP and automatic interpretation of protein electron density maps. Methods Enzymol. 374, 229–244.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14696376'}}}",
"{'Citation': 'Emsley P.; Cowtan K. (2004) Coot: Model-building tools for molecular graphics. Acta Crystallogr. D60, 2126–2132.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15572765'}}}",
"{'Citation': 'Adams P. D.; Gopal K.; Grosse-Kunstleve R. W.; Hung L. W.; Ioerger T. R.; McCoy A. J.; Moriarty N. W.; Pai R. K.; Read R. J.; Romo T. D.; Sacchettini J. C.; Sauter N. K.; Storoni L. C.; Terwilliger T. C. (2004) Recent developments in the PHENIX software for automated crystallographic structure determination. J. Synchrotron Radiat. 11, 53–55.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14646133'}}}",
"{'Citation': 'Davis I. W.; Murray L. W.; Richardson J. S.; Richardson D. C. (2004) MOLPROBITY: Structure validation and all-atom contact analysis for nucleic acids and their complexes. Nucleic Acids Res. 32, W615–W619.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC441536'}, {'@IdType': 'pubmed', '#text': '15215462'}]}}",
"{'Citation': 'Rapp C.; Kalyanaraman C.; Schiffmiller A.; Schoenbrun E. L.; Jacobson M. P. (2011) A molecular mechanics approach to modeling protein-ligand interactions: Relative binding affinities in congeneric series. J. Chem. Inf. Model. 51, 2082–2089.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3183355'}, {'@IdType': 'pubmed', '#text': '21780805'}]}}",
"{'Citation': 'Chang Y. F.; Feingold D. S. (1970) d-Glucaric acid and galactaric acid catabolism by Agrobacterium tumefaciens. J. Bacteriol. 102, 85–96.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC284973'}, {'@IdType': 'pubmed', '#text': '4314480'}]}}",
"{'Citation': 'Chang Y. F.; Feingold D. S. (1969) Hexuronic acid dehydrogenase of Agrobacterium tumefaciens. J. Bacteriol. 99, 667–673.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC250079'}, {'@IdType': 'pubmed', '#text': '4313130'}]}}",
"{'Citation': 'Niemelä K.; Sjöström E. (1985) Non-oxidative and oxidative degradation of d-galacturonic acid with alkali. Carbohydr. Res. 144, 93–99.'}",
"{'Citation': 'Hubbard B. K.; Koch M.; Palmer D. R. J.; Babbitt P. C.; Gerlt J. A. (1998) Evolution of enzymatic activities in the enolase superfamily: Characterization of the d-glucarate/galactarate catabolic pathway in Escherichia coli. Biochemistry 37, 14369–14375.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9772162'}}}",
"{'Citation': 'Gulick A. M.; Palmer D. R. J.; Babbitt P. C.; Gerlt J. A.; Rayment I. (1998) Evolution of enzymatic activities in the enolase superfamily: Crystal structure of d-glucarate dehydratase from Pseudomonas putida. Biochemistry 37, 14358–14368.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9772161'}}}"
] | Qatar Med J. 2013 Dec 23; 2013(2):45-49 | NO-CC CODE |
|
Computerized tomography of chest- lung window (axial section) showing patchy consolidation and ground glass opacities in bilateral lower lobes suggestive of viral pneumonia. | gr1_lrg | 7 | 8d083166ae49ad27e1774a4e003f5390381c41cb8a66694f51e74ca3a2c8f789 | gr1_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
600,
547
] | [{'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC9189293/gr1_lrg.jpg', 'caption': 'Computerized tomography of chest- lung window (axial section) showing patchy consolidation and ground glass opacities in bilateral lower lobes suggestive of viral pneumonia.', 'hash': '8d083166ae49ad27e1774a4e003f5390381c41cb8a66694f51e74ca3a2c8f789'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC9189293/gr2_lrg.jpg', 'caption': 'Conceptual timeline depicting course from initial diagnosis of COVID-19 to kidney transplantation and most recent follow-up of both recipients (labelled in red) and live donor to second recipient (labelled in purple). (abbreviations: S- in the box refers to days with symptoms, DDTx: deceased donor transplant (recipient 1), eGFR: estimated glomerular filtration rate in ml/min/m2).', 'hash': '196fc480ae9ec7a2e42b557e9aef59dd9f7c8c5dbc16edd02ee6948c87d0551b'}] | {'gr1_lrg': ['We hereby report two successful kidney transplants done during the pandemic of COVID-19. The first case was a 44-year-old male chronic kidney disease stage 5 secondary to diabetic nephropathy on haemodialysis, with left arteriovenous fistula as vascular access, who presented with myalgias for one day. There was no associated cough, sputum, fever or loss of smell. He was diagnosed to be positive for COVID-19 reverse transcriptase polymerase chain reaction (RT-PCR, cobas® SARS-CoV-2 test, Roche Diagnostics). Subsequently, he was diagnosed to have COVID-19 pneumonia (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>\n) and was treated for same with dexamethasone, oxygen support (oxygen saturations 87% at the time of oxygen initiation) and other symptomatic treatment. He improved clinically and was tested negative for COVID-19 PCR twice over next two weeks. Subsequently, serum IgG titres against SARS-CoV-2 (done at 2 weeks after the initial diagnosis) by chemiluminescence enzyme immunoassay (CLIA, CPC Diagnostics) were positive. A deceased donor kidney was offered and a calculated and explained risk was taken considering his recent recovery from COVID-19 pneumonia and the severe nature of his condition. The patient underwent a successful deceased donor kidney transplant after 4 weeks of initial diagnosis of COVID-19 with a negative pre-operative RT-PCR for SARS-CoV-2 and did not require any additional dialysis post-transplant. Basiliximab induction with triple drug immunosuppression consisting of prednisone, tacrolimus and mycophenolate mofetil was used. His post-operative period was uneventful and was discharged with a good graft function. He remains well at last updated follow-up of 15 weeks (at the time of writing this report) post-transplant with an eGFR of 91\xa0ml/min/1.73\xa0m\n) and was treated for same with dexamethasone, oxygen support (oxygen saturations 87% at the time of oxygen initiation) and other symptomatic treatment. He improved clinically and was tested negative for COVID-19 PCR twice over next two weeks. Subsequently, serum IgG titres against SARS-CoV-2 (done at 2 weeks after the initial diagnosis) by chemiluminescence enzyme immunoassay (CLIA, CPC Diagnostics) were positive. A deceased donor kidney was offered and a calculated and explained risk was taken considering his recent recovery from COVID-19 pneumonia and the severe nature of his condition. The patient underwent a successful deceased donor kidney transplant after 4 weeks of initial diagnosis of COVID-19 with a negative pre-operative RT-PCR for SARS-CoV-2 and did not require any additional dialysis post-transplant. Basiliximab induction with triple drug immunosuppression consisting of prednisone, tacrolimus and mycophenolate mofetil was used. His post-operative period was uneventful and was discharged with a good graft function. He remains well at last updated follow-up of 15 weeks (at the time of writing this report) post-transplant with an eGFR of 91\xa0ml/min/1.73\xa0m2 (<xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>\n). His current daily immunosuppression included prednisolone 10\xa0mg, mycophenolate mofetil 1500\xa0mg and tacrolimus 7\xa0mg.\n). His current daily immunosuppression included prednisolone 10\xa0mg, mycophenolate mofetil 1500\xa0mg and tacrolimus 7\xa0mg.Fig. 1Computerized tomography of chest- lung window (axial section) showing patchy consolidation and ground glass opacities in bilateral lower lobes suggestive of viral pneumonia.Fig. 2Conceptual timeline depicting course from initial diagnosis of COVID-19 to kidney transplantation and most recent follow-up of both recipients (labelled in red) and live donor to second recipient (labelled in purple). (abbreviations: S- in the box refers to days with symptoms, DDTx: deceased donor transplant (recipient 1), eGFR: estimated glomerular filtration rate in ml/min/m2).'], 'gr2_lrg': ['The second case was a 35-year-old female, on haemodialysis and was being worked up for live related kidney transplant, with her sister as prospective donor. Unfortunately, both the donor and the recipient developed fever, sore throat, myalgia and tested positive for COVID-19 by RT-PCR. Luckily, the disease course was not severe, and they only required quarantine and symptomatic treatment. Both donor and recipient were negative for COVID-19 RT-PCR done at 1, 2 and 6 weeks. However, both of them were positive for IgG titres against SARS-CoV-2 (by CLIA) at 6 weeks. A laparoscopic left kidney donor nephrectomy was then performed followed by a successful graft anastomosis. Induction was not given and standard triple drug immunosuppressive regime was prescribed. Post-operative period was uneventful and graft functions remained good at the last follow-up (at 14 weeks, at the time of writing this report, eGFR of 83\xa0ml/min/1.73\xa0m2) (<xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>). Her present immunosuppression included prednisolone 10\xa0mg, mycophenolate mofetil 1500\xa0mg and tacrolimus 3\xa0mg daily.). Her present immunosuppression included prednisolone 10\xa0mg, mycophenolate mofetil 1500\xa0mg and tacrolimus 3\xa0mg daily.']} | Successful kidney transplantation after COVID-19 infection in two cases | null | Nefrologia (Engl Ed) | 1655103600 | The COVID-19 pandemic has affected everyday life, including physical activity behavior. This study examined the role of the five factor model of personality traits on leisure time physical activity during the pandemic in a sample (n = 168) of 61 year-old Finnish men and women, participating in a larger longitudinal study, between April 2020 and April 2021. Frequency of participation and changes in leisure time physical activity were self-reported. Personality traits and facets were assessed with the 181-item NEO-PI. Openness was the only factor positively associated with leisure time physical activity frequency. Participants scoring higher in extraversion (particularly the activity-facet) and lower in openness to values were more likely to report change in their physical activity. In conclusion, individual differences in traits appear to have played a role in physical activity behavior during the pandemic. | [] | other | PMC9189293 | null | 15 | [
"{'Citation': 'Castañeda-Babarro A., Arbillaga-Etxarri A., Gutiérrez-Santamaría B., Coca A. Physical activity change during COVID-19 confinement. International Journal of Environmental Research and Public Health. 2020;17(18):6878. doi: 10.3390/ijerph17186878.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.3390/ijerph17186878'}, {'@IdType': 'pmc', '#text': 'PMC7558959'}, {'@IdType': 'pubmed', '#text': '32967091'}]}}",
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"{'Citation': 'Galasso V., Pons V., Profeta P., Becher M., Brouard S., Foucault M. Evidence from a panel survey in eight OECD countries. No. w27359. National Bureau of Economic Research; 2020. Gender differences in COVID-19 related attitudes and behavior.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.3386/w27359'}, {'@IdType': 'pmc', '#text': 'PMC7959517'}, {'@IdType': 'pubmed', '#text': '33060298'}]}}",
"{'Citation': 'Götz F.M., Gvirtz A., Galinsky A.D., Jachimowicz J.M. How personality and policy predict pandemic behavior: Understanding sheltering-in-place in 55 countries at the onset of COVID-19. American Psychologist. 2021;76(1):39–49. doi: 10.1037/amp0000740.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1037/amp0000740'}, {'@IdType': 'pubmed', '#text': '33475389'}]}}",
"{'Citation': 'Karvonen J., Törmäkangas T., Pulkkinen L., Kokko K. Associations of temperament and personality traits with frequency of physical activity in adulthood. Journal of Research in Personality. 2020;84 doi: 10.1016/j.jrp.2019.103887.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1016/j.jrp.2019.103887'}}}",
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"{'Citation': 'McAdams D.P. What do we know when we know a person? Journal of Personality. 1995;63(2):365–396.'}",
"{'Citation': 'Okely J.A., Corley J., Welstead M., Taylor A.M., Page D., Skarabela B.…Russ T.C. Change in physical activity, sleep quality, and psychosocial variables during COVID-19 lockdown: Evidence from the Lothian Birth Cohort 1936. International Journal of Environmental Research and Public Health. 2021;18(1):210. doi: 10.3390/ijerph18010210.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.3390/ijerph18010210'}, {'@IdType': 'pmc', '#text': 'PMC7795040'}, {'@IdType': 'pubmed', '#text': '33396611'}]}}",
"{'Citation': 'Paunonen S.V., Ashton M.C. Big Five factors and facets and the prediction of behavior. Journal of Personality and Social Psychology. 2001;81(3):524–539. doi: 10.1037/0022-3514.81.3.524.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1037/0022-3514.81.3.524'}, {'@IdType': 'pubmed', '#text': '11554651'}]}}",
"{'Citation': 'Pulkkinen L. Routledge; 2017. Human development from middle childhood to middle adulthood: Growing up to the middle-aged (in collaboration with Katja Kokko)'}",
"{'Citation': 'Pulver A., Allik J., Pulkkinen L., Hämäläinen M. A Big Five personality inventory in two non-Indo-European languages. European Journal of Personality. 1995;9(2):109–124. doi: 10.1002/per.2410090205.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1002/per.2410090205'}}}",
"{'Citation': 'Rhodes R.E., Courneya K.S., Jones L.W. Personality and social cognitive influences on exercise behavior: Adding the activity trait to the theory of planned behavior. Psychology of Sport and Exercise. 2004;5(3):243–254. doi: 10.1016/S1469-0292(03)00004-9.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1016/S1469-0292(03)00004-9'}}}",
"{'Citation': 'Rhodes R.E., Liu S., Lithopoulos A., Zhang C.-Q., Garcia-Barrera M.A. Correlates of perceived physical activity transitions during the COVID-19 pandemic among Canadian adults. Applied Psychology. Health and Well-Being. 2020;12(4):1157–1182. doi: 10.1111/aphw.12236.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1111/aphw.12236'}, {'@IdType': 'pmc', '#text': 'PMC7537295'}, {'@IdType': 'pubmed', '#text': '33006279'}]}}",
"{'Citation': 'Stephan Y., Terracciano A., Luchetti M., Aschwanden D., Lee J.H., Sesker A.A.…Sutin A.R. Physical activity and sedentary behavior during COVID-19: Trajectory and moderation by personality. Social Psychological and Personality Science. 2020 doi: 10.1177/1948550620962945.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1177/1948550620962945'}}}",
"{'Citation': 'Wilson K.E., Dishman R.K. Personality and physical activity: A systematic review and meta-analysis. Personality and Individual Differences. 2015;72:230–242. doi: 10.1016/j.paid.2014.08.023.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1016/j.paid.2014.08.023'}}}"
] | Nefrologia (Engl Ed). 2022 Jun 13 March-April; 42(2):217-219 | NO-CC CODE |
|
Right displacement of aortic arcus with computerized tomography | 1471-2334-4-2-2 | 7 | 395448eb042036a0cc1e6224871c0c7a406f9e7cf3e98472103596f0163e493b | 1471-2334-4-2-2.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
600,
503
] | [{'image_id': '1471-2334-4-2-1', 'image_file_name': '1471-2334-4-2-1.jpg', 'image_path': '../data/media_files/PMC343279/1471-2334-4-2-1.jpg', 'caption': 'Right displacement of aortic arcus imaging with plain chest radiography', 'hash': 'd014979030590da0d06ae214fc098fca2eb58bb9f2e7748ed3cd168e8f95a0fc'}, {'image_id': '1471-2334-4-2-2', 'image_file_name': '1471-2334-4-2-2.jpg', 'image_path': '../data/media_files/PMC343279/1471-2334-4-2-2.jpg', 'caption': 'Right displacement of aortic arcus with computerized tomography', 'hash': '395448eb042036a0cc1e6224871c0c7a406f9e7cf3e98472103596f0163e493b'}, {'image_id': '1471-2334-4-2-3', 'image_file_name': '1471-2334-4-2-3.jpg', 'image_path': '../data/media_files/PMC343279/1471-2334-4-2-3.jpg', 'caption': 'Bronchiectasis on both lower lobes of lungs with computerized tomography', 'hash': '5e4cd7b399f0b30d135f90d9bb3a2514e300c2c69765ba8f34bcdc4b634d2334'}] | {'1471-2334-4-2-1': ['The patient was seronegative for HbsAg, HCV, HIV-1, and HIV-2. Sputum culture revealed Pseudomonas aeruginosa. Throat culture and stool examination was normal. The right displacement of aortic arcus was noticed on plain chest radiography (Figure <xref ref-type="fig" rid="1471-2334-4-2-1">1</xref>) and high-resolution computerized tomography (CT) scanning of the thorax revealed right aortic arch, aberrant left subclavian artery (Figure ) and high-resolution computerized tomography (CT) scanning of the thorax revealed right aortic arch, aberrant left subclavian artery (Figure <xref ref-type="fig" rid="1471-2334-4-2-2">2</xref>), and bronchiectasis on both lower lobes of lungs (Figure ), and bronchiectasis on both lower lobes of lungs (Figure <xref ref-type="fig" rid="1471-2334-4-2-3">3</xref>). With magnetic resonance (MR) angiography, right aortic arch and aberrant left subclavian artery was confirmed. In CT scanning of the face, bilateral chronic maxillary sinusitis was detected.). With magnetic resonance (MR) angiography, right aortic arch and aberrant left subclavian artery was confirmed. In CT scanning of the face, bilateral chronic maxillary sinusitis was detected.']} | Common variable immunodeficiency syndrome with right aortic arch: a case report | null | BMC Infect Dis | 1075968000 | BACKGROUND: The association between cerebral palsy in very preterm infants and clinical, histopathologic and microbiological indicators of chorioamnionitis, including the identification of specific micro-organisms in the placenta, was evaluated in a case-cohort study. METHODS: Children with a diagnosis of cerebral palsy at five years of age were identified from amongst participants in a long-term follow-up program of preterm infants. The comparison group was a subcohort of infants randomly selected from all infants enrolled in the program. The placentas were examined histopathologically for chorioamnionitis and funisitis, and the chorioamnionic interface was aseptically swabbed and comprehensively cultured for aerobic and anaerobic bacteria, yeast and genital mycoplasmas. Associations between obstetric and demographic variables, indicators of chorioamnionitis and cerebral palsy status were examined by univariate analysis. RESULTS: Eighty-two infants with cerebral palsy were compared with the subcohort of 207 infants. Threatened preterm labor was nearly twice as common among the cases as in the subcohort (p < 0.01). Recorded clinical choroamnionitis was similar in the two groups and there was no difference in histopathologic evidence of infection between the two groups. E. coli was cultured from the placenta in 6/30 (20%) of cases as compared with 4/85 (5%) of subcohort (p = 0.01). Group B Streptococcus was more frequent among the cases, but the difference was not statistically significant. CONCLUSIONS: The association between E. coli in the chorioamnion and cerebral palsy in preterm infants identified in this study requires confirmation in larger multicenter studies which include microbiological study of placentas. | [] | other | PMC343279 | null | 28 | [
"{'Citation': 'Stanley FJ. Survival and cerebral palsy in low birthweight infants: implications for perinatal care. Paediatr Perinat Epidemiol. 1992;6:298–310.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1584730'}}}",
"{'Citation': 'Kuban KCK, Leviton A. Cerebral Palsy. New Engl J Med. 1994;330:188–195. doi: 10.1056/NEJM199401203300308.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1056/NEJM199401203300308'}, {'@IdType': 'pubmed', '#text': '8264743'}]}}",
"{'Citation': 'Alexander JM, Gilstrap LC, Cox SM, McIntire DM, Leveno KJ. Clinical chorioamnionitis and the prognosis for very low birthweight infants. Obstet Gynecol. 1998;91:725–729. doi: 10.1016/S0029-7844(98)00056-8.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S0029-7844(98)00056-8'}, {'@IdType': 'pubmed', '#text': '9572219'}]}}",
"{'Citation': 'Baud O, Ville Y, Zupan V, Boithias C, Lacaze-Masmonteil T, Gabilan JC, et al. Are neonatal brain lesions due to intrauterine infection related to mode of delivery? Br J Obstet Gynaecol. 1998;105:121–124.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9442175'}}}",
"{'Citation': 'Murphy DJ, Sellers S, MacKenzie IZ, Yudkin PL, Johnson AM. Case-control study of antenatal and intrapartum risk factors for cerebral palsy in very preterm singleton babies. Lancet. 1995;346:1449–1454. doi: 10.1016/S0140-6736(95)92471-X.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S0140-6736(95)92471-X'}, {'@IdType': 'pubmed', '#text': '7490990'}]}}",
"{'Citation': \"O'Shea TM, Klinepeter KL, Meis PJ, Dillard RG. Intrauterine infection and the risk of cerebral palsy in very low birthweight infants. Paediatr Perinat Epidemiol. 1998;12:72–83. doi: 10.1046/j.1365-3016.1998.00081.x.\", 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1046/j.1365-3016.1998.00081.x'}, {'@IdType': 'pubmed', '#text': '9483618'}]}}",
"{'Citation': 'Wu YW, Colford JM., Jr Chorioamnionitis as a risk factor for cerebral palsy. A meta-analysis. JAMA. 2000;284:1417–1424. doi: 10.1001/jama.284.11.1417.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1001/jama.284.11.1417'}, {'@IdType': 'pubmed', '#text': '10989405'}]}}",
"{'Citation': 'Adinolfi M. Infectious diseases in pregnancy, cytokines and neurological impairment: an hypothesis. Dev Med Child Neurol. 1993;35:549–558.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8504898'}}}",
"{'Citation': 'Dammann O, Leviton A. Maternal intrauterine infection, cytokines, and brain damage in the preterm newborn. Pediatr Res. 1997;42:1–8.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9212029'}}}",
"{'Citation': 'Leviton A, Paneth N, Reuss ML, Susser M, Allred EN, Dammann O, et al. Maternal infection, fetal inflammatory response, and brain damage in very low birthweight infants. Pediatr Res. 1999;46:566–575.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10541320'}}}",
"{'Citation': 'Yoon BH, Kim CJ, Romero R, Jun JK, Park KH, Choi ST, et al. Experimentally induced intrauterine infection causes fetal brain white matter lesions in rabbits. Am J Obstet Gynecol. 1997;177:792–802.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9369822'}}}",
"{'Citation': 'Wacholder S, Gail M, Pee D. Selecting an efficient design for assessing exposure-disease relationships in an assembled cohort. Biometrics. 1991;47:63–76.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2049514'}}}",
"{'Citation': 'McDonald HM, Chambers HM. Intrauterine infection and spontaneous mid-gestation abortion: Is the spectrum of micro-organisms similar to that in preterm labour? Infect Dis Obstet Gynecol. 2000;8:220–227. doi: 10.1002/1098-0997(2000)8:5<220::AID-IDOG1022>3.3.CO;2-9.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1002/1098-0997(2000)8:5<220::AID-IDOG1022>3.3.CO;2-9'}, {'@IdType': 'pmc', '#text': 'PMC1784699'}, {'@IdType': 'pubmed', '#text': '11220481'}]}}",
"{'Citation': 'Khong TY. Swabbing placenta accessed 10 October 2002.'}",
"{'Citation': 'Benirschke K, Kaufmann P. In Pathology of the Human Placenta. 4. New York: Springer; 2000. Infectious Diseases; pp. 591–684.'}",
"{'Citation': 'Stanley F, Blair E, Alberman E. In Cerebral Palsies Epidemiology & Causal Pathways. London: Mac Keith Press; 2000. Pathways To Cerebral Palsy Involving Very Preterm Birth; pp. 60–82.'}",
"{'Citation': 'Mittendorf R, Covert R, Kohn J, Roizen N, Khoshnood B, Lee K-S. The association of coagulase-negative staphylococci isolated from the chorioamnion at delivery and subsequent development of cerebral palsy. J Perinatol. 2001;21:3–8. doi: 10.1038/sj.jp.7200474.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1038/sj.jp.7200474'}, {'@IdType': 'pubmed', '#text': '11268865'}]}}",
"{'Citation': 'Spencer MK, Khong TY. Conformity to guidelines for pathologic examination of the placenta. Arch Pathol Lab Med. 2003;127:205–207.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12562236'}}}",
"{'Citation': 'Booth VJ, Nelson KB, Dambrosia JM, Grether JK. What factors influence whether placentas are submitted for pathologic examination? Am J Obstet Gynecol. 1997;176:567–571.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9077608'}}}",
"{'Citation': 'Badawi N, Kurinczuk JJ, Keogh JM, Chambers HM, Stanley FJ. Why is the placenta being ignored? Aust N Z J Obstet Gynaecol. 2000;40:343–346.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11065046'}}}",
"{'Citation': 'Wright C, Cameron H, Lamb W. A study of the quality of perinatal autopsy in the former northern region. The Northern Perinatal Mortality Survey Steering Group. Br J Obstet Gynaecol. 1998;105:24–28.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9442157'}}}",
"{'Citation': 'Hillier SL, Martius J, Krohn M, Kiviat N, Holmes KK, Eschenbach DA. A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. New Engl J Med. 1988;319:972–978.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '3262199'}}}",
"{'Citation': 'Zhang J, Kraus FT, Aquino TI. Chorioamnionitis: A comparative histologic, bacteriologic, and clinical study. Int J Gynecol Pathol. 1985;4:1–10.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '3880150'}}}",
"{'Citation': 'Pankuch GA, Appelbaum PC, Lorenz RP, Botti JJ, Schachter J, Naeye RL. Placental microbiology and histology and the pathogenesis of chorioamnionitis. Obstet Gynecol. 1984;64:802–806.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '6390279'}}}",
"{'Citation': 'Singer D. Infection of fetuses and neonates. In: Wigglesworth JS, Singer DB, editor. In Textbook of Fetal and Perinatal Pathology. 2nd. Malden, Massachusetts: Blackwell Science; 1998. pp. 454–511.'}",
"{'Citation': \"Dammann O, Leviton A. Does pre-pregnancy bacterial vaginosis increase a mother's risk of having a preterm infant with cerebal palsy? Dev Med Child Neurol. 1997;39:836–840.\", 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9433862'}}}",
"{'Citation': 'Dammann O, Allred EN, Genest DR, Kundsin RB, Leviton A. Antenatal mycoplasma infection, the fetal inflammatory response and cerebral white matter damage in very-low-birthweight infants. Paediatr Perinat Epidemiol. 2003;17:49–57. doi: 10.1046/j.1365-3016.2003.00470.x.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1046/j.1365-3016.2003.00470.x'}, {'@IdType': 'pubmed', '#text': '12562472'}]}}",
"{'Citation': 'Krohn MA, Thwin SS, Rabe LK, Brown Z, Hillier SL. Vaginal colonization by Escherichia coli as a risk factor for very low birthweight delivery and other perinatal complications. J Infect Dis. 1997;175:606–610.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9041332'}}}"
] | BMC Infect Dis. 2004 Feb 5; 4:2 | NO-CC CODE |
|
MRI with contrast (coronal image [short-tau inversion recovery]), which depicts a nondisplaced waist fracture of the scaphoid. | 10.1177_1941738112464762-fig2 | 7 | 9cdbb2502b470ecddea62d8db539d674be376513702fb131703462777f89bb26 | 10.1177_1941738112464762-fig2.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
800,
702
] | [{'image_id': '10.1177_1941738112464762-fig1', 'image_file_name': '10.1177_1941738112464762-fig1.jpg', 'image_path': '../data/media_files/PMC3658385/10.1177_1941738112464762-fig1.jpg', 'caption': 'A posterior/anterior radiograph of the left wrist with navicular view taken the day after the injury and was read as normal.', 'hash': '61f5d7b8a1018a9dc6e4ce5c9b510b42712d358aecd602ff17160651423d2682'}, {'image_id': '10.1177_1941738112464762-fig3', 'image_file_name': '10.1177_1941738112464762-fig3.jpg', 'image_path': '../data/media_files/PMC3658385/10.1177_1941738112464762-fig3.jpg', 'caption': 'A posterior/anterior radiograph of the right wrist with navicular view, demonstrating a nondisplaced fracture of the proximal pole of the scaphoid, taken approximately 4 weeks after injury.', 'hash': 'f365b888e4324eca1fdaac2c5f1e1381709b3b4b3ca47abb95bf9d76a27e4c16'}, {'image_id': '10.1177_1941738112464762-fig2', 'image_file_name': '10.1177_1941738112464762-fig2.jpg', 'image_path': '../data/media_files/PMC3658385/10.1177_1941738112464762-fig2.jpg', 'caption': 'MRI with contrast (coronal image [short-tau inversion recovery]), which depicts a nondisplaced waist fracture of the scaphoid.', 'hash': '9cdbb2502b470ecddea62d8db539d674be376513702fb131703462777f89bb26'}] | {'10.1177_1941738112464762-fig1': ['Because of a possible fracture, he was placed in a thumb spica splint and referred for plain radiographs (posterior/anterior, lateral, and scaphoid views), which were normal (<xref ref-type="fig" rid="10.1177_1941738112464762-fig1">Figure 1</xref>). A wrist sprain appeared most likely at this time. An occult scaphoid fracture was not likely given the non-FOOSH mechanism of injury and lack of tenderness in the snuff-box region. Initial management was a thumb spica splint for 1 week.). A wrist sprain appeared most likely at this time. An occult scaphoid fracture was not likely given the non-FOOSH mechanism of injury and lack of tenderness in the snuff-box region. Initial management was a thumb spica splint for 1 week.'], '10.1177_1941738112464762-fig2': ['Approximately 4 weeks later, he completed his physical education course with minimal difficulty but was unable to do push-ups secondary to wrist pain. He still lacked 10° to 12° of wrist extension due to pain. He did not have pain to palpation over the snuff-box region. MRI was obtained to assess scapholunate injury and showed a waist fracture of the scaphoid (<xref ref-type="fig" rid="10.1177_1941738112464762-fig2">Figure 2</xref>). He was placed in a thumb spica cast for 6 weeks but showed limited healing, requiring continued immobilization and a bone stimulator for 30 minutes daily for an additional 6 weeks. Subsequent bone healing was evident on CT scan following 12 weeks of immobilization without surgical fixation.). He was placed in a thumb spica cast for 6 weeks but showed limited healing, requiring continued immobilization and a bone stimulator for 30 minutes daily for an additional 6 weeks. Subsequent bone healing was evident on CT scan following 12 weeks of immobilization without surgical fixation.'], '10.1177_1941738112464762-fig3': ['He did not have localized edema and had full wrist ROM except for an 8° to 10° loss of wrist extension due to wrist pain. The only objective test that reproduced his wrist pain was the push-up. Plain radiographs demonstrated a nondisplaced fracture of the proximal pole of the scaphoid (<xref ref-type="fig" rid="10.1177_1941738112464762-fig3">Figure 3</xref>). Following 6 weeks of immobilization, healing was present.). Following 6 weeks of immobilization, healing was present.']} | Non-FOOSH Scaphoid Fractures in Young Athletes | [
"scaphoid",
"fracture",
"evaluation"
] | Sports Health | 1362124800 | [{'@Label': 'BACKGROUND', '@NlmCategory': 'BACKGROUND', '#text': 'With the incidence of Little League elbow increasing, pitch limit recommendations for preventing throwing injuries have been developed in both the United States and Japan. However, levels of knowledge of and compliance with these recommendations among coaches of young baseball teams in Japan remain unknown. The relationship between these levels and elbow pain among players has not been adequately studied.'}, {'@Label': 'HYPOTHESIS', '@NlmCategory': 'OBJECTIVE', '#text': 'Knowledge of and compliance with these recommendations is similar in the United States and Japan. Greater knowledge and higher levels of compliance have a significant correlation with reduced elbow pain in Little League baseball players.'}, {'@Label': 'STUDY DESIGN', '@NlmCategory': 'METHODS', '#text': 'Cross-sectional study.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'Coaches of youth baseball teams in Kyoto, Japan, completed a questionnaire assessing knowledge of and compliance with recommendations. Team variables and coach-related factors concerning elbow pain among young baseball players were surveyed, and the questionnaire investigated demographic data and elbow pain history in the previous 12 months.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': "In total, 123 baseball coaches and 654 baseball players aged 6 to 12 years participated in this study; data were analyzed for 113 coaches and 339 players. Among coaches, 39.8% had accurate knowledge of the recommendations (similar to the US data) and 28.3% complied with them (lower than the US data). There was no correlation between elbow pain and knowledge of and compliance with the recommendations, but coaches' opinions on the number of games were indicated as a significant risk factor for elbow pain; the more coaches considered the number of games played, the fewer the number of players who experienced elbow pain."}, {'@Label': 'CONCLUSION', '@NlmCategory': 'CONCLUSIONS', '#text': 'The level of knowledge of recommendations in Japan was similar to that in the United States, but compliance levels were far lower. There was no correlation between elbow pain and knowledge and compliance.'}, {'@Label': 'CLINICAL RELEVANCE', '@NlmCategory': 'CONCLUSIONS', '#text': 'The Little League elbow problem should be addressed at global and national levels.'}] | [] | other | PMC3658385 | null | 13 | [
"{'Citation': 'Fazarale JJ, Magnussen RA, Pedroza AD, et al. Knowledge of and compliance with pitch count recommendations: a survey of youth baseball coaches. Sports Health. 2012;4(3):202-204', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3435927'}, {'@IdType': 'pubmed', '#text': '23016087'}]}}",
"{'Citation': 'Fleisig GS, Andrews JR. Prevention of elbow injuries in youth baseball pitchers. Sports Health. 2012;4(5):419-424', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3435945'}, {'@IdType': 'pubmed', '#text': '23016115'}]}}",
"{'Citation': 'Fleisig GS, Andrews JR, Cutter GR, et al. Risk of serious injury for young baseball pitchers: a 10-year prospective study. Am J Sports Med. 2011;39(2):253-257', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21098816'}}}",
"{'Citation': 'Fleisig GS, Weber A, Hassell N, et al. Prevention of elbow injuries in youth baseball pitchers. Curr Sports Med Rep. 2009;8(5):250-254', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19741352'}}}",
"{'Citation': 'Harada M, Takahara M, Mura N, et al. Risk factors for elbow injuries among young baseball players. J Shoulder Elbow Surg. 2010;19(4):502-507', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '20189835'}}}",
"{'Citation': 'Harada M, Takahara M, Sasaki J, et al. Using sonography for the early detection of elbow injuries among young baseball players. AJR Am J Roentgenol. 2006;187(6):1436-1441', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17114533'}}}",
"{'Citation': 'Japan Softball Baseball Association. [Accessed October 17, 2012]. http://jsbb.or.jp/outline/teams'}",
"{'Citation': 'Japanese Society of Clinical Sports Medicine. [Accessed October 17, 2012]. http://www.rinspo.jp/proposal_03-1.pdf'}",
"{'Citation': 'Kerut EK, Kerut DG, Fleisig GS, et al. Prevention of arm injury in youth baseball pitchers. J La State Med Soc. 2008;160(2):95-98', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18681352'}}}",
"{'Citation': 'Lyman S, Fleisig GS, Waterbor JW, et al. Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc. 2001;33(11):1803-1810', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11689728'}}}",
"{'Citation': 'Olsen SJ, Fleisig GS, Dun S, et al. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med. 2006;34(6): 905-912', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16452269'}}}",
"{'Citation': 'USA Baseball. [Accessed October 17, 2012]. http://web.usabaseball.com/news/article.jsp?ymd=20080618&content_id=33889&vkey=news_usab&gid='}",
"{'Citation': 'Yamamoto N, Itoi E, Minagawa H, et al. Why is the humeral retroversion of throwing athletes greater in dominant shoulders than in nondominant shoulders? J Shoulder Elbow Surg. 2006;15(5):571-575', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16979051'}}}"
] | Sports Health. 2013 Mar; 5(2):183-185 | NO-CC CODE |
|
Sagittal fat-saturated T2-weighted image showing a defect of the right pars interarticularis at L4. Adjacent high signal in the marrow and soft tissues on the image reflects acute or subacute fracture. | 10.1177_1941738113480936-fig1 | 7 | b097b696353cab4e65907ccb4538217a0ee2f02ac19d8829c996737a1f77e92e | 10.1177_1941738113480936-fig1.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
534,
831
] | [{'image_id': '10.1177_1941738113480936-fig3', 'image_file_name': '10.1177_1941738113480936-fig3.jpg', 'image_path': '../data/media_files/PMC3658408/10.1177_1941738113480936-fig3.jpg', 'caption': 'Flow diagram of study.', 'hash': 'a9ef25b7c5bc5e377118b88f61bad11cd3db0dffcd2ca093f346b0fdff495f6b'}, {'image_id': '10.1177_1941738113480936-img1', 'image_file_name': '10.1177_1941738113480936-img1.jpg', 'image_path': '../data/media_files/PMC3658408/10.1177_1941738113480936-img1.jpg', 'caption': None, 'hash': '7615158da9126f59ffd4625af9a5740e7208a15ab8ff7fca59185a6a66fcd132'}, {'image_id': '10.1177_1941738113480936-fig2', 'image_file_name': '10.1177_1941738113480936-fig2.jpg', 'image_path': '../data/media_files/PMC3658408/10.1177_1941738113480936-fig2.jpg', 'caption': 'Radiograph of fracture of pars interarticularis (yellow arrow) with grade II spondylolisthesis demonstrating slippage (black lines).', 'hash': '9e3bf27bbd19b9de7d7db7342d35c60f4c22b23298e0a04726f5a0caea75240f'}, {'image_id': '10.1177_1941738113480936-fig1', 'image_file_name': '10.1177_1941738113480936-fig1.jpg', 'image_path': '../data/media_files/PMC3658408/10.1177_1941738113480936-fig1.jpg', 'caption': 'Sagittal fat-saturated T2-weighted image showing a defect of the right pars interarticularis at L4. Adjacent high signal in the marrow and soft tissues on the image reflects acute or subacute fracture.', 'hash': 'b097b696353cab4e65907ccb4538217a0ee2f02ac19d8829c996737a1f77e92e'}] | {'10.1177_1941738113480936-fig1': ['Instability of the lumbar spine is one of multiple pathologic causes of low back pain (LBP).19,20 It can be defined as a loss of motion stiffness such that forces applied to a given segment produce greater displacement than would occur normally.22 Spondylolysis and spondylolisthesis can cause LBP because of instability. Spondylolysis is a bony defect, possibly a stress fracture, of one or both pars interarticularis and most commonly occurs in the lower lumbar spine (<xref ref-type="fig" rid="10.1177_1941738113480936-fig1">Figure 1</xref>).).3 Prevalence of spondylolysis ranges from approximately 6% to 11.5% in the general population9 and approximately 7% to 8% in elite athletes; this percentage is grossly underreported.12,26,27 Nearly 50% of LBP cases in adolescent athletes have been attributed to spondylolysis.21\n', 'An article was excluded if (1) other pathologies were present, (2) nonoperative treatment was omitted, and (3) subjects were infants or toddlers. Criteria were independently applied by 2 reviewers (MG, JS). A third author (MR) was consulted to resolve disagreements. This screening resulted in 10 full-text articles for data extraction (Table 1 and <xref ref-type="fig" rid="10.1177_1941738113480936-fig1">Figure 3</xref>).).'], '10.1177_1941738113480936-fig3': ['Spondylolisthesis is displacement of a vertebra due to a defect in the pars (<xref ref-type="fig" rid="10.1177_1941738113480936-fig3">Figure 2</xref>).).14 Spondylolysis is a precipitating factor and can be classified as isthmic, dysplastic, degenerative, traumatic, and pathologic.7,31,32 Spondylolisthesis severity can be graded I through IV. Grade I is displacement of 0% to 25%; grade II, 26% to 50%; and grade III, up to 75%. Displacement of 75% to 100% is grade IV.16\n']} | Nonoperative Treatment in Lumbar Spondylolysis and Spondylolisthesis | [
"spondylolysis",
"spondylolisthesis",
"nonoperative treatment"
] | Sports Health | 1367391600 | [{'@Label': 'BACKGROUND', '@NlmCategory': 'BACKGROUND', '#text': 'The posterior shoulder muscles play key roles in maintaining shoulder function in throwing. Arm fatigue has been identified as a risk factor for shoulder and elbow pain in youth baseball pitchers. However, endurance of the posterior shoulder muscles in overhead athletes is not routinely examined or conditioned.'}, {'@Label': 'HYPOTHESIS', '@NlmCategory': 'OBJECTIVE', '#text': 'Upper extremity muscular endurance can be improved in adolescent baseball players during a 20-week preseason training program. Secondarily, strength will be improved. Finally, these improvements will be associated with maintenance of range of motion.'}, {'@Label': 'STUDY DESIGN', '@NlmCategory': 'METHODS', '#text': 'Cohort study.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'Fourteen baseball players (age, 16 ± 2 years) attended 3 supervised training sessions per week for 20 weeks. Strengthening of the upper extremity was performed with a specific progression that utilized readily available equipment. Testing was completed at baseline and at 4, 8, and 20 weeks. The posterior shoulder endurance test was performed to assess muscular endurance. Glenohumeral internal and external rotation range of motion and strength were measured.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'Posterior shoulder endurance improved from 30 ± 14 repetitions at baseline to 66 ± 26 at 4 weeks and 88 ± 36 at 20 weeks (P < 0.05). Glenohumeral internal rotation range of motion and the glenohumeral internal/external rotation strength ratio remained similar over the course of the program.'}, {'@Label': 'CONCLUSION', '@NlmCategory': 'CONCLUSIONS', '#text': 'Implementation of a preseason training program effectively increased shoulder muscular endurance while maintaining strength ratios and range of motion throughout the 20-week program.'}, {'@Label': 'CLINICAL RELEVANCE', '@NlmCategory': 'CONCLUSIONS', '#text': 'This program improved a key parameter known to be associated with shoulder function and injury risk. This study describes a simple clinical tool to assess muscular endurance of the posterior shoulder.'}] | [] | other | PMC3658408 | null | 32 | [
"{'Citation': 'American College of Sports Medicine position stand: progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41:687-708', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19204579'}}}",
"{'Citation': 'Awan R, Smith J, Boon AJ. Measuring shoulder internal rotation range of motion: a comparison of 3 techniques. Arch Phys Med Rehabil. 2002;83:1229-1234', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12235602'}}}",
"{'Citation': 'Blackburn TA, McLeod WD, White B, Wofford L. EMG analysis of posterior rotator cuff exercises. Athl Train. 1990;25:40, 42-45'}",
"{'Citation': 'Boon AJ, Smith J. Manual scapular stabilization: its effect on shoulder rotational range of motion. Arch Phys Med Rehabil. 2000;81:978-983', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10896016'}}}",
"{'Citation': 'Canadian Society for Exercise Physiology The Canadian physical activity, fitness and lifestyle approach. In: The Canadian Physical Activity, Fitness and Lifestyle Approach. Ottawa, Canada: Canadian Society for Exercise Physiology; 2004:41-42'}",
"{'Citation': 'Collins CL, Comstock RD. Epidemiological features of high school baseball injuries in the United States, 2005-2007. Pediatrics. 2008;121:1181-1187', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18519488'}}}",
"{'Citation': 'Cools AM, Dewitte V, Lanszweert F, et al. Rehabilitation of scapular muscle balance: which exercises to prescribe? Am J Sports Med. 2007;35:1744-1751', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17606671'}}}",
"{'Citation': 'Escamilla RF, Fleisig GS, Yamashiro K, et al. Effects of a 4-week youth baseball conditioning program on throwing velocity. J Strength Cond Res. 2010;24:3247-3254', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21068687'}}}",
"{'Citation': 'Escamilla RF, Ionno M, deMahy MS, et al. Comparison of three baseball-specific 6-week training programs on throwing velocity in high school baseball players. J Strength Cond Res. 2012;26:1767-1781', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '22549085'}}}",
"{'Citation': 'Hayes K, Walton JR, Szomor ZL, Murrell GA. Reliability of 3 methods for assessing shoulder strength. J Shoulder Elbow Surg. 2002;11:33-39', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11845146'}}}",
"{'Citation': 'Hinton RY. Isokinetic evaluation of shoulder rotational strength in high school baseball pitchers. Am J Sports Med. 1988;16:274-279', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '3381986'}}}",
"{'Citation': 'Huang T, Wei S, Jung-Chi C, Hsu M, Chang H. Isokinetic evaluation of shoulder internal and external rotators concentric strength and endurance in baseball players: variations from pre-pubescence to adulthood. Isokinet Exer Sci. 2005;13:237-241'}",
"{'Citation': 'Kaplan KM, Elattrache NS, Jobe FW, Morrey BF, Kaufman KR, Hurd WJ. Comparison of shoulder range of motion, strength, and playing time in uninjured high school baseball pitchers who reside in warm- and cold-weather climates. Am J Sports Med. 2011;39:320-328', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3923316'}, {'@IdType': 'pubmed', '#text': '21051421'}]}}",
"{'Citation': 'Kibler W, Kuhn J, Wilk K, et al. The disabled throwing shoulder: spectrum of pathology—10 year update. Arthroscopy. 2013;29:141-161', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '23276418'}}}",
"{'Citation': 'Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002;30:463-468', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12130397'}}}",
"{'Citation': 'Lyman S, Fleisig GS, Waterbor JW, et al. Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc. 2001;33:1803-1810', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11689728'}}}",
"{'Citation': 'McHugh MP. Recent advances in the understanding of the repeated bout effect: the protective effect against muscle damage from a single bout of eccentric exercise. Scand J Med Sci Sports. 2003;13:88-97', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12641640'}}}",
"{'Citation': 'Moseley JB, Jobe FW, Pink M, Perry J, Tibone J. EMG analysis of the scapular muscles during a shoulder rehabilitation program. Am J Sports Med. 1992;20:128-134', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1558238'}}}",
"{'Citation': 'Mulligan IJ, Biddington WB, Barnhart BD, Ellenbecker TS. Isokinetic profile of shoulder internal and external rotators of high school aged baseball pitchers. J Strength Cond Res. 2004;18:861-866', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15574094'}}}",
"{'Citation': 'Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med. 2006;34:905-912', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16452269'}}}",
"{'Citation': 'Oyama S, Myers JB, Wassinger CA, Lephart SM. Three-dimensional scapular and clavicular kinematics and scapular muscle activity during retraction exercises. J Orthop Sports Phys Ther. 2010;40:169-179', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '20195020'}}}",
"{'Citation': 'Potteiger JA, Blessing DL, Wilson GD. The physiological responses to a single game of baseball pitching. J Appl Sport Sci Res. 1992;6:11-18'}",
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"{'Citation': 'Sashika H, Matsuba Y, Watanabe Y. Home program of physical therapy: effect on disabilities of patients with total hip arthroplasty. Arch Phys Med Rehabil. 1996;77:273-277', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8600871'}}}",
"{'Citation': 'Shanley E, Rauh MJ, Michener LA, Ellenbecker TS, Garrison JC, Thigpen CA. Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players. Am J Sports Med. 2011;39:1997-2006', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21685316'}}}",
"{'Citation': 'Shumway-Cook A, Gruber W, Baldwin M, Liao S. The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults. Phys Ther. 1997;77:46-57', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8996463'}}}",
"{'Citation': 'Sparling PB, Millard-Stafford M, Snow TK. Development of a cadence curl-up test for college students. Res Q Exerc Sport. 1997;68:309-316', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9421843'}}}",
"{'Citation': 'Taylor DC, Krasinski KL. Adolescent shoulder injuries: consensus and controversies. J Bone Joint Surg Am. 2009;91:462-473', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19181993'}}}",
"{'Citation': 'Thomas SJ, Swanik CB, Higginson JS, et al. Neuromuscular and stiffness adaptations in division I collegiate baseball players. J Electromyogr Kinesiol. 2013;23:102-109', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '22898532'}}}",
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"{'Citation': 'Valovich McLeod TC, Decoster LC, Loud KJ, et al. National Athletic Trainers’ Association position statement: prevention of pediatric overuse injuries. J Athl Train. 2011;46:206-220', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3070508'}, {'@IdType': 'pubmed', '#text': '21391806'}]}}",
"{'Citation': 'Wilk K, Reinold M, Andrews JR. The Athlete’s Shoulder. Philadelphia, PA: Churchill Livingstone; 2009'}"
] | Sports Health. 2013 May; 5(3):225-232 | NO-CC CODE |
|
Preoperative magnetic resonance imaging of the craniocervical junction revealing an enhancing mass (a–c) with a significant cord compression and cord edema (d). The white arrows point at the dural base mass arising from the anterolateral dural location at the foramen magnum (a–d). White arrowheads point at the location of laterally displaced right vertebral artery (a, b). A black arrowhead points to the superior displacement of the vertebral artery (d). | jnlsr73009-1 | 7 | e08b2543c5b20a778458919e3a1e76852156a9fa3cccdb387918dad8ca75ef0c | jnlsr73009-1.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
736,
663
] | [{'image_id': 'jnlsr73009-1', 'image_file_name': 'jnlsr73009-1.jpg', 'image_path': '../data/media_files/PMC3658650/jnlsr73009-1.jpg', 'caption': 'Preoperative magnetic resonance imaging of the craniocervical junction revealing an enhancing mass (a–c) with a significant cord compression and cord edema (d). The white arrows point at the dural base mass arising from the anterolateral dural location at the foramen magnum (a–d). White arrowheads point at the location of laterally displaced right vertebral artery (a, b). A black arrowhead points to the superior displacement of the vertebral artery (d).', 'hash': 'e08b2543c5b20a778458919e3a1e76852156a9fa3cccdb387918dad8ca75ef0c'}, {'image_id': 'jnlsr73009-3', 'image_file_name': 'jnlsr73009-3.jpg', 'image_path': '../data/media_files/PMC3658650/jnlsr73009-3.jpg', 'caption': 'Postoperative magnetic resonance imaging showing a good resection of the foramen magnum mass (a, b). The medulla oblongata and the upper cervical spinal cord do not appear to be under compression (c, d). A white arrowhead points to the dural base of the grossly removed tumor (a, d).', 'hash': '8f768dd79cd98296cf480596636bd02cfae7d4fc2b794b45342893be4d953873'}, {'image_id': 'jnlsr73009-2', 'image_file_name': 'jnlsr73009-2.jpg', 'image_path': '../data/media_files/PMC3658650/jnlsr73009-2.jpg', 'caption': 'Intraoperative images showing a tumor adherent to the arachnoid and the neurovascular structure at the foramen magnum (a). Hemorrhagic tumor was resected using surgical corridors between the lower cranial nerves (b). Using the minimally invasive far lateral approached described by senior author (A.N.), a small “S”-shaped incision is used to approach the tumors at foramen magnum (d). Additionally, partial unilateral laminectomy of C1 is performed (c). A black arrowhead points at the tumor capsule (a). A white arrowhead points at the lower cranial nerve complex (cranial nerves XI and XII) splayed out over the expansile mass (a). The edge of partially removed C1 lamina is pointed with a white arrow (c).', 'hash': 'c0bfbf25557b2a3ad630cc83818f837f670ef60d81b04672c37980c22061106b'}] | {'jnlsr73009-1': ['This 73-year-old man presented to our institution with a history of generalized weakness in July 2010. He reported having several falls in the previous year and progressive difficulty ambulating over the past month requiring the use of a cane. Neurological examination revealed a right-sided hemiparesis and hyper-reflexia of the upper extremities. Cervical magnetic resonance imaging (MRI) performed at that time revealed contrast-enhancing mass measuring ~2\u2009×\u20091.4\u2009×\u20091.2 cm at the level of the foramen magnum. The mass appeared intradural and extramedullary in location and severe displacement of the spinal cord was noted (<xref rid="jnlsr73009-1" ref-type="fig">Fig. 1</xref>). Magnetic resonance angiography performed at that time did not reveal any displacement or invasion of the vertebral artery. Given the location of the mass, the patient was consented for a right-sided far lateral skull base approach for resection.). Magnetic resonance angiography performed at that time did not reveal any displacement or invasion of the vertebral artery. Given the location of the mass, the patient was consented for a right-sided far lateral skull base approach for resection.'], 'jnlsr73009-2': ['The patient was placed in a left lateral decubitus position and the head was fixed with Mayfield three-point fixation. The head was positioned such that the saggital sinus was parallel to the floor and the neck was flexed slightly toward the left shoulder. The skin incision was marked ~4 cm posterior to the posterior pinna and the tip of the mastoid (<xref rid="jnlsr73009-2" ref-type="fig">Fig. 2d</xref>). A 3-inch lazy S-shaped skin incision was made, extending from level of external auditory meatus down to the level of C2-lateral-mass prominence. Following the muscular layer dissection, the vertebral artery was identified at the level of C1. Further exposure was extended to the foramen magnum and occipital bone. Next, a partial laminectomy of C1 (). A 3-inch lazy S-shaped skin incision was made, extending from level of external auditory meatus down to the level of C2-lateral-mass prominence. Following the muscular layer dissection, the vertebral artery was identified at the level of C1. Further exposure was extended to the foramen magnum and occipital bone. Next, a partial laminectomy of C1 (<xref rid="jnlsr73009-2" ref-type="fig">Fig. 2c</xref>) was performed along with a small occipital craniotomy and the dura was opened in a trap-door fashion. Following this, a soft, hemorrhagic mass was encountered with adhesions to the vertebral artery, posterior inferior cerebellar artery, and the lower cranial nerves () was performed along with a small occipital craniotomy and the dura was opened in a trap-door fashion. Following this, a soft, hemorrhagic mass was encountered with adhesions to the vertebral artery, posterior inferior cerebellar artery, and the lower cranial nerves (<xref rid="jnlsr73009-2" ref-type="fig">Fig. 2a</xref> and and <xref rid="jnlsr73009-2" ref-type="fig">2b</xref>). Following meticulous dissection a gross total resection of the tumor (). Following meticulous dissection a gross total resection of the tumor (<xref rid="jnlsr73009-3" ref-type="fig">Fig. 3</xref>) was achieved and the closure was performed in a layered fashion.) was achieved and the closure was performed in a layered fashion.']} | Metastatic Prostate Mass to the Intradural Foramen Magnum Region: A Case Report | [
"foramen magnum",
"prostate",
"metastatic tumor",
"intradural",
"far lateral"
] | J Neurol Surg Rep | 1350802800 | Introduction Primary cerebellopontine angle melanocytomas (PCPAMs) are very rare. Their natural history and prognosis are not fully understood. We reviewed the literature and add a new case to analyze PCPAM's presentation, radiological features, and outcome of treatment. Methods We performed a literature review using Medline, Embase, PubMed, and Cochrane databases. We searched for melanocytoma, melanoma, and pigmented tumors in the posterior cranial fossa and CPA to identify PCPAM. We have also searched our institution's neuro-oncology database. Results We identified 23 PCPAM from the literature and one case of our own. The mean age at presentation was 44.4 years with slight male preponderance. PCPAM presented with cerebellopontine angle (CPA) syndrome with or without hydrocephalus. Preoperative diagnosis was difficult; they appeared hyperintense on T1 and isointense on T2 magnetic resonance imaging (MRI) and enhanced with gadolinium. However, the final diagnosis was only made by immunohistochemical examination. Total surgical resection of PCPAM was associated with prolonged survival while subtotal excision was associated with frequent recurrence. Conclusion PCPAM are very rare and should be considered in the differential diagnosis of all CPA lesions that appear hyperintense on T1 and isointense on T2 MRI images. Patients with PCPAM should undergo total surgical resection to avoid fatal recurrences. | [] | other | PMC3658650 | null | 30 | [
"{'Citation': 'Keegan H R, Mullan S. Pigmented meningiomas: an unusual variant. Report of a case with review of the litera ure. J Neurosurg. 1962;19:696–698.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14454773'}}}",
"{'Citation': 'Limas C, Tio F O. Meningeal melanocytoma (“melanotic meningioma”). Its melanocytic origin as revealed by electron microscopy. Cancer. 1972;30(5):1286–1294.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '4343293'}}}",
"{'Citation': 'Portugal J R, Alencar A, Brito Lira L C, Carvalho P. Melanotic meningioma complicated by disseminated intravascular coagulation. Surg Neurol. 1984;21(3):275–281.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '6695324'}}}",
"{'Citation': 'Lesoin F, Leys D, Pasquier F. et al.Melanotic meningiomas. Report of a case and review of the literature. Neurochir. 1985;28(5):205–207.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '4058637'}}}",
"{'Citation': 'Winston K R, Sotrel A, Schnitt S J. Meningeal melanocytoma. Case report and review of the clinical and histological features. J Neurosurg. 1987;66(1):50–57.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '3783260'}}}",
"{'Citation': 'Naul L G, Hise J H, Bauserman S C, Todd F DCT. CT and MR of meningeal melanocytoma. AJNR Am J Neuroradiol. 1991;12(2):315–316.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC8331439'}, {'@IdType': 'pubmed', '#text': '1902034'}]}}",
"{'Citation': 'Litofsky N S, Zee C S, Breeze R E, Chandrasoma P T. Meningeal melanocytoma: diagnostic criteria for a rare lesion. Neurosurgery. 1992;31(5):945–948.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1436422'}}}",
"{'Citation': 'Uematsu Y, Yukawa S, Yokote H, Itakura T, Hayashi S, Komai N. Meningeal melanocytoma: magnetic resonance imaging characteristics and pathological features. Case report. J Neurosurg. 1992;76(4):705–709.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1545267'}}}",
"{'Citation': 'Brat D J, Giannini C, Scheithauer B W, Burger P C. Primary melanocytic neoplasms of the central nervous systems. Am J Surg Pathol. 1999;23(7):745–754.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10403296'}}}",
"{'Citation': 'Gupta A, Ahmad F U, Sharma M C, Garg A, Mehta V S. Cerebellopontine angle meningeal melanocytoma: a rare tumor in an uncommon location. Case report. J Neurosurg. 2007;106(6):1094–1097.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17564187'}}}",
"{'Citation': \"O'Brien T F, Moran M, Miller J H, Hensley S D. Meningeal melanocytoma. An uncommon diagnostic pitfall in surgical neuropathology. Arch Pathol Lab Med. 1995;119(6):542–546.\", 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '7605172'}}}",
"{'Citation': 'Tatagiba M, Böker D K, Brandis A, Samii M, Ostertag H, Babu R. Meningeal melanocytoma of the C8 nerve root: case report. Neurosurgery. 1992;31(5):958–961.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1436425'}}}",
"{'Citation': 'Nestor S L Perry A Kurtkaya O et al.Melanocytic colonization of a meningothelial meningioma: histopathological and ultrastructural findings with immunohistochemical and genetic correlation: case report Neurosurgery 2003531211–214., discussion 214–215', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12823892'}}}",
"{'Citation': 'Gardiman M, Altavilla G, Marchioro L, Boscolo L, Alessio L, Piazza M. Meningeal melanocytoma: a rare lesion of the central nervous system. Tumori. 1996;82(5):494–496.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9063532'}}}",
"{'Citation': 'Hirose T, Horiguchi H, Kaneko F. et al.Melanocytoma of the foramen magnum. Pathol Int. 1997;47(2–3):155–160.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9088033'}}}",
"{'Citation': 'Clarke D B, Leblanc R, Bertrand G, Quartey G RC, Snipes G J. Meningeal melanocytoma. Report of a case and a historical comparison. J Neurosurg. 1998;88(1):116–121.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9420082'}}}",
"{'Citation': 'Ahluwalia S, Ashkan K, Casey A T. Meningeal melanocytoma: clinical features and review of the literature. Br J Neurosurg. 2003;17(4):347–351.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14579901'}}}",
"{'Citation': 'Kan P, Shelton C, Townsend J, Jensen R. Primary malignant cerebellopontine angle melanoma presenting as meningioma: case report and review of the literature. Skull Base. 2003;13(3):159–166.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC1131845'}, {'@IdType': 'pubmed', '#text': '15912173'}]}}",
"{'Citation': 'Fagundes-Pereyra W J de Sousa L Carvalho G T Pittella J E de Sousa A A Meningeal melanocytoma of the posterior fossa: case report and literature review Surg Neurol 2005633269–273., discussion 273–274', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15734524'}}}",
"{'Citation': 'Koenigsmann M, Jautzke G, Unger M, Théallier-Janko A, Wiegel T, Stoltenburg-Didinger G. June 2002: 57-year-old male with leptomeningeal and liver tumors. Brain Pathol. 2002;12(4):519–521.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC8096015'}, {'@IdType': 'pubmed', '#text': '12408241'}]}}",
"{'Citation': 'Córdoba A, Tuñón T, Vázquez J J. [Meningeal melanocytoma. Presentation of a case and review of the literature] Arch Neurobiol (Madr) 1989;52(2):93–99.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2667490'}}}",
"{'Citation': 'Rades D, Heidenreich F, Tatagiba M, Brandis A, Karstens J H. Therapeutic options for meningeal melanocytoma. Case report. J Neurosurg. 2001;95(2, Suppl):225–231.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11599841'}}}",
"{'Citation': 'Bydon A, Gutierrez J A, Mahmood A. Meningeal melanocytoma: an aggressive course for a benign tumor. J Neurooncol. 2003;64(3):259–263.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14558602'}}}",
"{'Citation': 'Ali Y, Rahme R, Moussa R, Abadjian G, Menassa-Moussa L, Samaha E. Multifocal meningeal melanocytoma: a new pathological entity or the result of leptomeningeal seeding? J Neurosurg. 2009;111(3):488–491.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19361258'}}}",
"{'Citation': 'Prabhu S S, Lynch P G, Keogh A J, Parekh H C. Intracranial meningeal melanocytoma: a report of two cases and a review of the literature. Surg Neurol. 1993;40(6):516–521.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8235978'}}}",
"{'Citation': 'Chow M, Clarke D B, Maloney W J, Sangalang V. Meningeal melanocytoma of the planum sphenoidale. Case report and review of the literature. J Neurosurg. 2001;94(5):841–845.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11354421'}}}",
"{'Citation': 'Maiuri F, Iaconetta G, Benvenuti D, Lamaida E, De Caro M L. Intracranial meningeal melanocytoma: case report. Surg Neurol. 1995;44(6):556–561.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8669032'}}}",
"{'Citation': 'Hamasaki O Nakahara T Sakamoto S Kutsuna M Sakoda K Intracranial meningeal melanocytoma Neurol Med Chir (Tokyo) 20024211504–509. (Tokyo)', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12472216'}}}",
"{'Citation': 'Kurita H, Segawa H, Shin M. et al.Radiosurgery of meningeal melanocytoma. J Neurooncol. 2000;46(1):57–61.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10896205'}}}",
"{'Citation': 'Verma D S, Spitzer G, Legha S, McCredie K B. Chemoimmunotherapy for meningeal melanocytoma of the thoracic spinal cord. Report of a case. JAMA. 1979;242(22):2435–2436.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '490860'}}}"
] | J Neurol Surg Rep. 2012 Oct 21; 73(1):9-13 | NO-CC CODE |
|
Postoperative magnetic resonance imaging showing a good resection of the foramen magnum mass (a, b). The medulla oblongata and the upper cervical spinal cord do not appear to be under compression (c, d). A white arrowhead points to the dural base of the grossly removed tumor (a, d). | jnlsr73009-3 | 7 | 8f768dd79cd98296cf480596636bd02cfae7d4fc2b794b45342893be4d953873 | jnlsr73009-3.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
735,
655
] | [{'image_id': 'jnlsr73009-1', 'image_file_name': 'jnlsr73009-1.jpg', 'image_path': '../data/media_files/PMC3658650/jnlsr73009-1.jpg', 'caption': 'Preoperative magnetic resonance imaging of the craniocervical junction revealing an enhancing mass (a–c) with a significant cord compression and cord edema (d). The white arrows point at the dural base mass arising from the anterolateral dural location at the foramen magnum (a–d). White arrowheads point at the location of laterally displaced right vertebral artery (a, b). A black arrowhead points to the superior displacement of the vertebral artery (d).', 'hash': 'e08b2543c5b20a778458919e3a1e76852156a9fa3cccdb387918dad8ca75ef0c'}, {'image_id': 'jnlsr73009-3', 'image_file_name': 'jnlsr73009-3.jpg', 'image_path': '../data/media_files/PMC3658650/jnlsr73009-3.jpg', 'caption': 'Postoperative magnetic resonance imaging showing a good resection of the foramen magnum mass (a, b). The medulla oblongata and the upper cervical spinal cord do not appear to be under compression (c, d). A white arrowhead points to the dural base of the grossly removed tumor (a, d).', 'hash': '8f768dd79cd98296cf480596636bd02cfae7d4fc2b794b45342893be4d953873'}, {'image_id': 'jnlsr73009-2', 'image_file_name': 'jnlsr73009-2.jpg', 'image_path': '../data/media_files/PMC3658650/jnlsr73009-2.jpg', 'caption': 'Intraoperative images showing a tumor adherent to the arachnoid and the neurovascular structure at the foramen magnum (a). Hemorrhagic tumor was resected using surgical corridors between the lower cranial nerves (b). Using the minimally invasive far lateral approached described by senior author (A.N.), a small “S”-shaped incision is used to approach the tumors at foramen magnum (d). Additionally, partial unilateral laminectomy of C1 is performed (c). A black arrowhead points at the tumor capsule (a). A white arrowhead points at the lower cranial nerve complex (cranial nerves XI and XII) splayed out over the expansile mass (a). The edge of partially removed C1 lamina is pointed with a white arrow (c).', 'hash': 'c0bfbf25557b2a3ad630cc83818f837f670ef60d81b04672c37980c22061106b'}] | {'jnlsr73009-1': ['This 73-year-old man presented to our institution with a history of generalized weakness in July 2010. He reported having several falls in the previous year and progressive difficulty ambulating over the past month requiring the use of a cane. Neurological examination revealed a right-sided hemiparesis and hyper-reflexia of the upper extremities. Cervical magnetic resonance imaging (MRI) performed at that time revealed contrast-enhancing mass measuring ~2\u2009×\u20091.4\u2009×\u20091.2 cm at the level of the foramen magnum. The mass appeared intradural and extramedullary in location and severe displacement of the spinal cord was noted (<xref rid="jnlsr73009-1" ref-type="fig">Fig. 1</xref>). Magnetic resonance angiography performed at that time did not reveal any displacement or invasion of the vertebral artery. Given the location of the mass, the patient was consented for a right-sided far lateral skull base approach for resection.). Magnetic resonance angiography performed at that time did not reveal any displacement or invasion of the vertebral artery. Given the location of the mass, the patient was consented for a right-sided far lateral skull base approach for resection.'], 'jnlsr73009-2': ['The patient was placed in a left lateral decubitus position and the head was fixed with Mayfield three-point fixation. The head was positioned such that the saggital sinus was parallel to the floor and the neck was flexed slightly toward the left shoulder. The skin incision was marked ~4 cm posterior to the posterior pinna and the tip of the mastoid (<xref rid="jnlsr73009-2" ref-type="fig">Fig. 2d</xref>). A 3-inch lazy S-shaped skin incision was made, extending from level of external auditory meatus down to the level of C2-lateral-mass prominence. Following the muscular layer dissection, the vertebral artery was identified at the level of C1. Further exposure was extended to the foramen magnum and occipital bone. Next, a partial laminectomy of C1 (). A 3-inch lazy S-shaped skin incision was made, extending from level of external auditory meatus down to the level of C2-lateral-mass prominence. Following the muscular layer dissection, the vertebral artery was identified at the level of C1. Further exposure was extended to the foramen magnum and occipital bone. Next, a partial laminectomy of C1 (<xref rid="jnlsr73009-2" ref-type="fig">Fig. 2c</xref>) was performed along with a small occipital craniotomy and the dura was opened in a trap-door fashion. Following this, a soft, hemorrhagic mass was encountered with adhesions to the vertebral artery, posterior inferior cerebellar artery, and the lower cranial nerves () was performed along with a small occipital craniotomy and the dura was opened in a trap-door fashion. Following this, a soft, hemorrhagic mass was encountered with adhesions to the vertebral artery, posterior inferior cerebellar artery, and the lower cranial nerves (<xref rid="jnlsr73009-2" ref-type="fig">Fig. 2a</xref> and and <xref rid="jnlsr73009-2" ref-type="fig">2b</xref>). Following meticulous dissection a gross total resection of the tumor (). Following meticulous dissection a gross total resection of the tumor (<xref rid="jnlsr73009-3" ref-type="fig">Fig. 3</xref>) was achieved and the closure was performed in a layered fashion.) was achieved and the closure was performed in a layered fashion.']} | Metastatic Prostate Mass to the Intradural Foramen Magnum Region: A Case Report | [
"foramen magnum",
"prostate",
"metastatic tumor",
"intradural",
"far lateral"
] | J Neurol Surg Rep | 1350802800 | Introduction Primary cerebellopontine angle melanocytomas (PCPAMs) are very rare. Their natural history and prognosis are not fully understood. We reviewed the literature and add a new case to analyze PCPAM's presentation, radiological features, and outcome of treatment. Methods We performed a literature review using Medline, Embase, PubMed, and Cochrane databases. We searched for melanocytoma, melanoma, and pigmented tumors in the posterior cranial fossa and CPA to identify PCPAM. We have also searched our institution's neuro-oncology database. Results We identified 23 PCPAM from the literature and one case of our own. The mean age at presentation was 44.4 years with slight male preponderance. PCPAM presented with cerebellopontine angle (CPA) syndrome with or without hydrocephalus. Preoperative diagnosis was difficult; they appeared hyperintense on T1 and isointense on T2 magnetic resonance imaging (MRI) and enhanced with gadolinium. However, the final diagnosis was only made by immunohistochemical examination. Total surgical resection of PCPAM was associated with prolonged survival while subtotal excision was associated with frequent recurrence. Conclusion PCPAM are very rare and should be considered in the differential diagnosis of all CPA lesions that appear hyperintense on T1 and isointense on T2 MRI images. Patients with PCPAM should undergo total surgical resection to avoid fatal recurrences. | [] | other | PMC3658650 | null | 30 | [
"{'Citation': 'Keegan H R, Mullan S. Pigmented meningiomas: an unusual variant. Report of a case with review of the litera ure. J Neurosurg. 1962;19:696–698.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14454773'}}}",
"{'Citation': 'Limas C, Tio F O. Meningeal melanocytoma (“melanotic meningioma”). Its melanocytic origin as revealed by electron microscopy. Cancer. 1972;30(5):1286–1294.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '4343293'}}}",
"{'Citation': 'Portugal J R, Alencar A, Brito Lira L C, Carvalho P. Melanotic meningioma complicated by disseminated intravascular coagulation. Surg Neurol. 1984;21(3):275–281.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '6695324'}}}",
"{'Citation': 'Lesoin F, Leys D, Pasquier F. et al.Melanotic meningiomas. Report of a case and review of the literature. Neurochir. 1985;28(5):205–207.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '4058637'}}}",
"{'Citation': 'Winston K R, Sotrel A, Schnitt S J. Meningeal melanocytoma. Case report and review of the clinical and histological features. J Neurosurg. 1987;66(1):50–57.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '3783260'}}}",
"{'Citation': 'Naul L G, Hise J H, Bauserman S C, Todd F DCT. CT and MR of meningeal melanocytoma. AJNR Am J Neuroradiol. 1991;12(2):315–316.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC8331439'}, {'@IdType': 'pubmed', '#text': '1902034'}]}}",
"{'Citation': 'Litofsky N S, Zee C S, Breeze R E, Chandrasoma P T. Meningeal melanocytoma: diagnostic criteria for a rare lesion. Neurosurgery. 1992;31(5):945–948.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1436422'}}}",
"{'Citation': 'Uematsu Y, Yukawa S, Yokote H, Itakura T, Hayashi S, Komai N. Meningeal melanocytoma: magnetic resonance imaging characteristics and pathological features. Case report. J Neurosurg. 1992;76(4):705–709.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1545267'}}}",
"{'Citation': 'Brat D J, Giannini C, Scheithauer B W, Burger P C. Primary melanocytic neoplasms of the central nervous systems. Am J Surg Pathol. 1999;23(7):745–754.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10403296'}}}",
"{'Citation': 'Gupta A, Ahmad F U, Sharma M C, Garg A, Mehta V S. Cerebellopontine angle meningeal melanocytoma: a rare tumor in an uncommon location. Case report. J Neurosurg. 2007;106(6):1094–1097.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17564187'}}}",
"{'Citation': \"O'Brien T F, Moran M, Miller J H, Hensley S D. Meningeal melanocytoma. An uncommon diagnostic pitfall in surgical neuropathology. Arch Pathol Lab Med. 1995;119(6):542–546.\", 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '7605172'}}}",
"{'Citation': 'Tatagiba M, Böker D K, Brandis A, Samii M, Ostertag H, Babu R. Meningeal melanocytoma of the C8 nerve root: case report. Neurosurgery. 1992;31(5):958–961.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1436425'}}}",
"{'Citation': 'Nestor S L Perry A Kurtkaya O et al.Melanocytic colonization of a meningothelial meningioma: histopathological and ultrastructural findings with immunohistochemical and genetic correlation: case report Neurosurgery 2003531211–214., discussion 214–215', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12823892'}}}",
"{'Citation': 'Gardiman M, Altavilla G, Marchioro L, Boscolo L, Alessio L, Piazza M. Meningeal melanocytoma: a rare lesion of the central nervous system. Tumori. 1996;82(5):494–496.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9063532'}}}",
"{'Citation': 'Hirose T, Horiguchi H, Kaneko F. et al.Melanocytoma of the foramen magnum. Pathol Int. 1997;47(2–3):155–160.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9088033'}}}",
"{'Citation': 'Clarke D B, Leblanc R, Bertrand G, Quartey G RC, Snipes G J. Meningeal melanocytoma. Report of a case and a historical comparison. J Neurosurg. 1998;88(1):116–121.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9420082'}}}",
"{'Citation': 'Ahluwalia S, Ashkan K, Casey A T. Meningeal melanocytoma: clinical features and review of the literature. Br J Neurosurg. 2003;17(4):347–351.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14579901'}}}",
"{'Citation': 'Kan P, Shelton C, Townsend J, Jensen R. Primary malignant cerebellopontine angle melanoma presenting as meningioma: case report and review of the literature. Skull Base. 2003;13(3):159–166.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC1131845'}, {'@IdType': 'pubmed', '#text': '15912173'}]}}",
"{'Citation': 'Fagundes-Pereyra W J de Sousa L Carvalho G T Pittella J E de Sousa A A Meningeal melanocytoma of the posterior fossa: case report and literature review Surg Neurol 2005633269–273., discussion 273–274', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15734524'}}}",
"{'Citation': 'Koenigsmann M, Jautzke G, Unger M, Théallier-Janko A, Wiegel T, Stoltenburg-Didinger G. June 2002: 57-year-old male with leptomeningeal and liver tumors. Brain Pathol. 2002;12(4):519–521.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC8096015'}, {'@IdType': 'pubmed', '#text': '12408241'}]}}",
"{'Citation': 'Córdoba A, Tuñón T, Vázquez J J. [Meningeal melanocytoma. Presentation of a case and review of the literature] Arch Neurobiol (Madr) 1989;52(2):93–99.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2667490'}}}",
"{'Citation': 'Rades D, Heidenreich F, Tatagiba M, Brandis A, Karstens J H. Therapeutic options for meningeal melanocytoma. Case report. J Neurosurg. 2001;95(2, Suppl):225–231.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11599841'}}}",
"{'Citation': 'Bydon A, Gutierrez J A, Mahmood A. Meningeal melanocytoma: an aggressive course for a benign tumor. J Neurooncol. 2003;64(3):259–263.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14558602'}}}",
"{'Citation': 'Ali Y, Rahme R, Moussa R, Abadjian G, Menassa-Moussa L, Samaha E. Multifocal meningeal melanocytoma: a new pathological entity or the result of leptomeningeal seeding? J Neurosurg. 2009;111(3):488–491.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19361258'}}}",
"{'Citation': 'Prabhu S S, Lynch P G, Keogh A J, Parekh H C. Intracranial meningeal melanocytoma: a report of two cases and a review of the literature. Surg Neurol. 1993;40(6):516–521.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8235978'}}}",
"{'Citation': 'Chow M, Clarke D B, Maloney W J, Sangalang V. Meningeal melanocytoma of the planum sphenoidale. Case report and review of the literature. J Neurosurg. 2001;94(5):841–845.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11354421'}}}",
"{'Citation': 'Maiuri F, Iaconetta G, Benvenuti D, Lamaida E, De Caro M L. Intracranial meningeal melanocytoma: case report. Surg Neurol. 1995;44(6):556–561.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8669032'}}}",
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"{'Citation': 'Verma D S, Spitzer G, Legha S, McCredie K B. Chemoimmunotherapy for meningeal melanocytoma of the thoracic spinal cord. Report of a case. JAMA. 1979;242(22):2435–2436.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '490860'}}}"
] | J Neurol Surg Rep. 2012 Oct 21; 73(1):9-13 | NO-CC CODE |
|
Magnetic resonance venogram demonstrating complete occlusion of the left transverse-sigmoid junction (arrow). | jnlsr73014-3 | 7 | edd49c6e3693921c7df29152db3df6c6def135b5d1e0b60826b22597de1c9813 | jnlsr73014-3.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
629,
610
] | [{'image_id': 'jnlsr73014-2', 'image_file_name': 'jnlsr73014-2.jpg', 'image_path': '../data/media_files/PMC3658657/jnlsr73014-2.jpg', 'caption': 'Cranial computed tomography scan demonstrating osteolytic destruction of the left petrous bone extending into the jugular foramen and occipital condyle.', 'hash': 'dc0fb04526867790741fada378e71d8f08492edfbdb49d58129c1b77100ad20f'}, {'image_id': 'jnlsr73014-3', 'image_file_name': 'jnlsr73014-3.jpg', 'image_path': '../data/media_files/PMC3658657/jnlsr73014-3.jpg', 'caption': 'Magnetic resonance venogram demonstrating complete occlusion of the left transverse-sigmoid junction (arrow).', 'hash': 'edd49c6e3693921c7df29152db3df6c6def135b5d1e0b60826b22597de1c9813'}, {'image_id': 'jnlsr73014-1', 'image_file_name': 'jnlsr73014-1.jpg', 'image_path': '../data/media_files/PMC3658657/jnlsr73014-1.jpg', 'caption': 'Patients showing cranial nerve XII involvement: left tongue atrophy and deviation to the left.', 'hash': '9ccaca003199c881cb3d3b27552fca118b05c27b36ce7be840379683a8644182'}] | {'jnlsr73014-1': ['Three months later, he presented to the emergency department at the same outside facility with progressively worsening headache, dysarthria, inability to eat solids or expectorate his own oral secretions, lancinating left ear and left mastoid pain, decreased hearing, gait instability, vertigo, vomiting, and a 20-lb weight loss. On examination, he was noted to have left-side hearing loss, uvular deviation to the right from a paretic left palate, a decreased left gag response, left tongue deviation, and a wide-based, unsteady gait (<xref rid="jnlsr73014-1" ref-type="fig">Fig. 1</xref>). MRI of the head demonstrated a left 2.5\xa0×\xa03.8\xa0×\xa04.0 cm T1/T2 hypointense, heterogeneously enhancing skull base mass involving the petrous apex, jugular bulb, cochlear aqueduct, hypoglossal canal, and occipital condyle (). MRI of the head demonstrated a left 2.5\xa0×\xa03.8\xa0×\xa04.0 cm T1/T2 hypointense, heterogeneously enhancing skull base mass involving the petrous apex, jugular bulb, cochlear aqueduct, hypoglossal canal, and occipital condyle (<xref rid="jnlsr73014-2" ref-type="fig">Fig. 2A, B</xref>). The mass had eroded into and thrombosed the left transverse-sigmoid sinus junction (). The mass had eroded into and thrombosed the left transverse-sigmoid sinus junction (<xref rid="jnlsr73014-3" ref-type="fig">Fig. 3</xref>). At this time, the patient was transferred to our institution for tertiary care.). At this time, the patient was transferred to our institution for tertiary care.']} | Jugular Foramen Syndrome as Initial Presentation of Metastatic Lung Cancer | [
"skull base metastasis",
"cranial nerve palsy",
"Collet–Sicard syndrome",
"soil and seed hypothesis"
] | J Neurol Surg Rep | 1350457200 | [{'@Label': 'BACKGROUND', '@NlmCategory': 'BACKGROUND', '#text': 'The purpose of this study was to examine the effects of carvedilol therapy on autonomic control of the heart and QT-interval dispersion (QTd) among children with idiopathic dilated cardiomyopathy (DCM) whose symptoms were not adequately controlled with standard congestive heart failure therapy.'}, {'@Label': 'MATERIAL AND METHODS', '@NlmCategory': 'METHODS', '#text': 'Patients with DCM who were treated with carvedilol were enrolled in the study. All patients had undergone carvedilol therapy in addition to standard therapy for at least 6 months. Clinical, echocardiographic, and electrocardiographic parameters, and 24-h Holter records of patients were retrospectively evaluated before and after carvedilol treatment.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'A total 34 patients (mean age: 7.4 ± 4.3 years) with DCM were analyzed in the study. The median follow-up period was 9.5 months. After the 6 months of carvedilol therapy the clinical score significantly improved, left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) significantly increased, and left ventricle end-diastolic dimensions and end-systolic dimensions significantly decreased. There were statistically significant increases in mean SDNN, SDANN, rMSSD, and pNN50 (p = 0.002, p = 0.001, p = 0.008, and p = 0.026, respectively). After the carvedilol therapy, SDNN was correlated with the clinical score, heart rate, LVEF, LVFS, and total premature ventricular contractions (PVCs). In addition, rMSSD and pNN50 were correlated with heart rate, LVEF and LVFS. A significant reduction was observed in QTc-minimum, QTc-maximum, and QTd values (434.9 ± 40.7 vs. 416.1 ± 36.5, 497.8 ± 43.6 vs. 456.3 ± 41.7, 58.6 ± 17.1 vs. 49.3 ± 15.6; p < 0.001, p = 0.001, and p = 0.008, respectively). QTd was significantly related to PVCs (r = 0.62, p = 0.02).'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'We conclude that the addition of carvedilol to standard therapy can improve clinical symptoms and heart rate variability, and reduce in arrhythmia markers in children with DCM.'}] | [
"Arrhythmias, Cardiac",
"Autonomic Nervous System",
"Carbazoles",
"Cardiomyopathy, Dilated",
"Carvedilol",
"Child",
"Electrocardiography",
"Female",
"Heart",
"Heart Rate",
"Humans",
"Male",
"Propanolamines"
] | other | PMC3658657 | null | 34 | [
"{'Citation': 'Arola A, Jokinen E, Ruuskanen O, et al. Epidemiology of idiopathic cardiomyopathies in children and adolescents. Am J Epidemiol. 1997;146:385–93.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9290498'}}}",
"{'Citation': 'Doughty RN, Whalley GA, Gamble G, et al. Left ventricular remodeling with carvedilol in patients with congestive heart failure due to ischemic heart disease. J Am Coll Cardiol. 1997;29:1060–66.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9120160'}}}",
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"{'Citation': 'Rusconi P, Gómez-Marín O, Rossique-González M, et al. Carvedilol in children with cardiomyopathy: 3-year experience at a single institution. J Heart Lung Transplant. 2004;23:832–38.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15261177'}}}",
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] | J Neurol Surg Rep. 2012 Oct 17; 73(1):14-18 | NO-CC CODE |
|
(A) Sagittal T2-weighted axial images showing a patchy diffuse area of hyperintensity from C3 to T5. (B) Sagittal T1-weighted image obtained after intravenous administration of gadolinium showing minimal enhancement. | ndt-9-1023Fig1 | 7 | 9a0b0ec82b37d6370b21a8e96d3ffd7b1d3fad83c6b872559ef9972968770b9e | ndt-9-1023Fig1.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
634,
459
] | [{'image_id': 'ndt-9-1023Fig2', 'image_file_name': 'ndt-9-1023Fig2.jpg', 'image_path': '../data/media_files/PMC3735335/ndt-9-1023Fig2.jpg', 'caption': 'Intrathecal morphine pump implanted subcutaneously with tube insertion into the dural sac through the L3–4 space.', 'hash': 'd750db74f9fd781f71d8ce5cb729ae9d5caadd68287ada6fd42a2e053731dd73'}, {'image_id': 'ndt-9-1023Fig1', 'image_file_name': 'ndt-9-1023Fig1.jpg', 'image_path': '../data/media_files/PMC3735335/ndt-9-1023Fig1.jpg', 'caption': '(A) Sagittal T2-weighted axial images showing a patchy diffuse area of hyperintensity from C3 to T5. (B) Sagittal T1-weighted image obtained after intravenous administration of gadolinium showing minimal enhancement.', 'hash': '9a0b0ec82b37d6370b21a8e96d3ffd7b1d3fad83c6b872559ef9972968770b9e'}] | {'ndt-9-1023Fig1': ['On admission, laboratory data showed mildly increased white cells and neutrophils. Electrolytes, renal and hepatic function, vitamin B12, and folate were normal. A lumbar puncture was performed, and showed lymphocyte-predominant pleocytosis and elevation of microproteins and glucose, but her white cell count was normal. No specific laboratory findings indicating tuberculosis, or bacterial or fungal infection were noted, and polymerase chain reaction results were negative for cytomegalovirus, herpes simplex virus, and Epstein-Barr virus. No malignant cells were apparent, and no positive findings of antibodies such as SS-A, SS-B, RA, C3, C4, or antinuclear antibody were noted. T2 weighted axial images on spinal magnetic resonance imaging revealed a patchy diffuse area of hyperintensity extending from C3 to T5, so the patient was diagnosed with transverse myelitis (<xref ref-type="fig" rid="ndt-9-1023Fig1">Figure 1</xref>). Given that neuromyelitis optica and optic neuritis should also be suspected even if the visual field is normal, we arranged for visual evoked potentials, which were negative. Her right upper limb and bilateral lower limb weakness and incontinence of urine and stool was unresponsive to treatment.). Given that neuromyelitis optica and optic neuritis should also be suspected even if the visual field is normal, we arranged for visual evoked potentials, which were negative. Her right upper limb and bilateral lower limb weakness and incontinence of urine and stool was unresponsive to treatment.'], 'ndt-9-1023Fig2': ['Six weeks after starting the patient on medical treatment for her neuropathic pain, we resorted to an intrathecal morphine pump to maintain the lowest dose of morphine able to keep the therapeutic effects and side effects in balance. A catheter was inserted into the dural sac via the L4/5 space, with the morphine dosage maintained at 0.2 mL (0.5 mg) per hour. Her pain was relieved immediately during a preimplantation trial, so an intrathecal pump (<xref ref-type="fig" rid="ndt-9-1023Fig2">Figure 2</xref>) was implanted and set to deliver a morphine dosage of 1.3 mL (3.25 mg) per hour during the day and 1.0 mL (2.5 mg) per hour at night. Her visual analog score decreased to 2–3, and the muscle cramps ascending from the leg to the chest became mild, lasting for about 10–15 seconds and appearing at intervals of about 30–60 minutes. Previous medication was stopped, with only tizanidine 4 mg three times daily being administered after implantation of the pump. Her pain, numbness and tingling, and cold, burning, and cramping sensations were relieved significantly and she was able to return to her rehabilitation program.) was implanted and set to deliver a morphine dosage of 1.3 mL (3.25 mg) per hour during the day and 1.0 mL (2.5 mg) per hour at night. Her visual analog score decreased to 2–3, and the muscle cramps ascending from the leg to the chest became mild, lasting for about 10–15 seconds and appearing at intervals of about 30–60 minutes. Previous medication was stopped, with only tizanidine 4 mg three times daily being administered after implantation of the pump. Her pain, numbness and tingling, and cold, burning, and cramping sensations were relieved significantly and she was able to return to her rehabilitation program.']} | Effective management of intractable neuropathic pain using an intrathecal morphine pump in a patient with acute transverse myelitis | [
"intrathecal morphine pump",
"neuropathic pain",
"rehabilitation",
"transverse myelitis"
] | Neuropsychiatr Dis Treat | 1375081200 | Gastrointestinal stromal tumors (GISTs) are the most common sarcoma of the gastrointestinal tract, with transformation typically driven by activating mutations of c-KIT and less commonly platelet-derived growth factor receptor alpha (PDGFRA). Successful targeting of c-KIT and PDGFRA with imatinib, a tyrosine kinase inhibitor (TKI), has had a major impact in advanced GIST and as an adjuvant and neoadjuvant treatment. If treatment with imatinib fails, further lines of TKI therapy have a role, but disease response is usually only measured in months, so strategies to maximize the benefit from imatinib are paramount. Here, we provide an overview of the structure and signaling of c-KIT coupled with a review of the clinical trials of imatinib in GIST. In doing so, we make recommendations about the duration of imatinib therapy and suggest how best to utilize imatinib in order to improve patient outcomes in the future. | [] | other | PMC3735335 | null | 91 | [
"{'Citation': 'Gatta G, van der Zwan JM, Casali PG, et al. Rare cancers are not so rare: the rare cancer burden in Europe. Eur J Cancer. 2011;47(17):2493–2511.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '22033323'}}}",
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"{'Citation': 'Mol CD, Fabbro D, Hosfield DJ. Structural insights into the conformational selectivity of STI-571 and related kinase inhibitors. Curr Opin Drug Discov Devel. 2004;7(5):639–648.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15503866'}}}",
"{'Citation': 'Mol CD, Dougan DR, Schneider TR, et al. Structural basis for the autoinhibition and STI-571 inhibition of c-Kit tyrosine kinase. J Biol Chem. 2004;279(30):31655–31663.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15123710'}}}",
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750,
364
] | [{'image_id': '12070_2022_3367_Fig2_HTML', 'image_file_name': '12070_2022_3367_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC9758674/12070_2022_3367_Fig2_HTML.jpg', 'caption': 'a–c Coronal and axial Gadolinium enhanced magnetic resonance imaging scans of paranasal sinus, orbit and brain showing involvement of all sinuses along with extension into orbit and brain', 'hash': 'ede8c1ec9647da78b57ecbd94a646528b6051c13056d0b569cd5d0401e025ebb'}, {'image_id': '12070_2022_3367_Fig1_HTML', 'image_file_name': '12070_2022_3367_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC9758674/12070_2022_3367_Fig1_HTML.jpg', 'caption': 'a–c Coronal, non-contrast computed tomography scans of the paranasal sinuses, showing involvement of the sinuses', 'hash': '253e8168bfd23343c322fcd85af47f57f436128138f3430db44c2acd423205f6'}] | {'12070_2022_3367_Fig1_HTML': ['Among patients with COVID-19 associated fungal infections, the timely administration of antifungal therapy is paramount for a favorable outcome, particularly for aspergillosis. Accurate diagnosis of the disease can be determined by the existence of consistent clinical symptoms, specific radiological aspects and mycological data [20]. Both magnetic resonance imaging [MRI] and CT scan are of utmost importance to establish a diagnosis of invasive fungal sinusitis. Opacity of the sinus with or without destruction may be seen in the invasive form. Bone erosion and extrasinus extension are the classic CT findings highly suggestive of invasive fungal sinusitis found in later part of disease course (Fig.\xa0<xref rid="12070_2022_3367_Fig1_HTML" ref-type="fig">1</xref>a–c) The most common early sign is severe unilateral nasal cavity mucosal and soft tissue edema [a–c) The most common early sign is severe unilateral nasal cavity mucosal and soft tissue edema [24]. Bone involvement and erosion is more delineated on CT, while soft tissue extensions, vascular invasion and cavernous sinus involvement are more appreciated on MRI [17] (Fig.\xa0<xref rid="12070_2022_3367_Fig2_HTML" ref-type="fig">2</xref>a–c). Surgical debridement of abnormal tissue in the sinus is recommended for antifungal therapy to reach the infected area. Surgery may improve the control of fungal disease and patient survival.a–c). Surgical debridement of abnormal tissue in the sinus is recommended for antifungal therapy to reach the infected area. Surgery may improve the control of fungal disease and patient survival.Fig. 1a–c Coronal, non-contrast computed tomography scans of the paranasal sinuses, showing involvement of the sinusesFig. 2a–c Coronal and axial Gadolinium enhanced magnetic resonance imaging scans of paranasal sinus, orbit and brain showing involvement of all sinuses along with extension into orbit and brain']} | COVID Associated Invasive Aspergillosis | [
"COVID associated aspergillosis",
"COVID-19",
"Paranasal sinuses",
"Aspergillosis",
"Diabetes mellitus",
"Steroid"
] | Indian J Otolaryngol Head Neck Surg | 1686985200 | SARS-COV-2 can cause retropharyngeal edema for which literature on optimal management is sparse. Prompt identification and treatment of the condition is vital to successful recovery. This report presents such a case and offers support for conservative management in treatment of retropharyngeal edema. | [] | other | PMC9758674 | null | 4 | [
"{'Citation': 'Hoang JK, Branstetter BF, Eastwood JD, et al. Multiplanar CT and MRI of collections in the retropharyngeal space: Is it an abscess? AJR Am J Roentgenol. 2011;196:W426–W432. doi: 10.2214/AJR.10.5116.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.2214/AJR.10.5116'}, {'@IdType': 'pubmed', '#text': '21427307'}]}}",
"{'Citation': 'Jenkins E, Sherry W, Smith AGC, Rostad BS, Rostad CA, Jones K, Jaggi P. Retropharyngeal edema and neck pain in multisystem inflammatory syndrome in children (MIS-c) J Pediatric Infect Dis Soc. 2021;10(9):922–925. doi: 10.1093/jpids/piab050.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1093/jpids/piab050'}, {'@IdType': 'pmc', '#text': 'PMC8557366'}, {'@IdType': 'pubmed', '#text': '34173667'}]}}",
"{'Citation': 'Steehler AJ, Ballestas SA, Scarola D, Henriquez OA, Moore CE. Observation of retropharyngeal fluid collection in 2 COVID-19 positive patients. Ear Nose Throat J. 2020;6:145561320971370. doi: 10.1177/0145561320971370.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1177/0145561320971370'}, {'@IdType': 'pmc', '#text': 'PMC7649650'}, {'@IdType': 'pubmed', '#text': '33155845'}]}}",
"{'Citation': 'Yousef M, Abdelazeem B, Kalantary A, Pratiti R. Late-term complications of COVID-19: retropharyngeal infection and myocarditis in a 26-year-old patient. Eur J Case Rep Intern Med. 2021;8(10):002759. doi: 10.12890/2021_002759.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.12890/2021_002759'}, {'@IdType': 'pmc', '#text': 'PMC8592664'}, {'@IdType': 'pubmed', '#text': '34790619'}]}}"
] | Indian J Otolaryngol Head Neck Surg. 2023 Jun 17; 75(2):557-562 | NO-CC CODE |
|
Coronal, T1-weighted image after administration of gadolinium contrast demonstrates marked enhancement within the lesion. | poljradiol-79-228-g006 | 7 | 4c2548e3aec1619bbb265198f3314eec496bbcbd7358991497c7b737248e3bde | poljradiol-79-228-g006.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
600,
600
] | [{'image_id': 'poljradiol-79-228-g001', 'image_file_name': 'poljradiol-79-228-g001.jpg', 'image_path': '../data/media_files/PMC4114761/poljradiol-79-228-g001.jpg', 'caption': 'Ultrasound scan demonstrates peripherally calcified, hypoechoic lesion, with increased partial peripheral vascularity in color Doppler examination.', 'hash': '75ae7b9b2dc53c3e8e89f6a28a8456340b58bbad46fe4a1c3a4d34a4cfdca595'}, {'image_id': 'poljradiol-79-228-g006', 'image_file_name': 'poljradiol-79-228-g006.jpg', 'image_path': '../data/media_files/PMC4114761/poljradiol-79-228-g006.jpg', 'caption': 'Coronal, T1-weighted image after administration of gadolinium contrast demonstrates marked enhancement within the lesion.', 'hash': '4c2548e3aec1619bbb265198f3314eec496bbcbd7358991497c7b737248e3bde'}, {'image_id': 'poljradiol-79-228-g005', 'image_file_name': 'poljradiol-79-228-g005.jpg', 'image_path': '../data/media_files/PMC4114761/poljradiol-79-228-g005.jpg', 'caption': 'Sagittal, T2-weighted image shows intermediate SI of the lesion with a low-SI rim. There are perilesional areas of high SI along adjacent muscle fibers – edema.', 'hash': 'f6763d9e8f0ebe6aa07c576fdadc7559f22c8f2c6d34044cfe5d0a0966c7e1ba'}, {'image_id': 'poljradiol-79-228-g002', 'image_file_name': 'poljradiol-79-228-g002.jpg', 'image_path': '../data/media_files/PMC4114761/poljradiol-79-228-g002.jpg', 'caption': 'Axial, non-contrast computed tomography scan shows lesion with a rim of calcification at the periphery (“zonal phenomenon”).', 'hash': '44a4ef237532f32b6435b1a05494c606b403ab653f0625e657876c1462502d2f'}, {'image_id': 'poljradiol-79-228-g003', 'image_file_name': 'poljradiol-79-228-g003.jpg', 'image_path': '../data/media_files/PMC4114761/poljradiol-79-228-g003.jpg', 'caption': 'Axial, T1-weighted image reveals hyperintense SI of the lesion with a low-SI rim.', 'hash': '6ff2a8e98506e610ba3b1aede984e12d9ba67d45fd106a39d47d5467af3bdd31'}, {'image_id': 'poljradiol-79-228-g004', 'image_file_name': 'poljradiol-79-228-g004.jpg', 'image_path': '../data/media_files/PMC4114761/poljradiol-79-228-g004.jpg', 'caption': 'Axial, T2-weighted FS image shows intermediate- to high-SI of the lesion with a low-SI rim.', 'hash': 'f9961fdf61bcaec14c279c7f5cbe2f05984e14deab0ccf75eca25ea442710dba'}] | {'poljradiol-79-228-g001': ['Ultrasound examination: (<xref ref-type="fig" rid="poljradiol-79-228-g001">Figure 1</xref>) of the neck revealed hypoechoic lesion located medially to the sternocleidomastoid muscle and inside trapezoid muscle. The tumor size was 47×20 mm. Calcification and increased vasculature were seen in tumor’s periphery.) of the neck revealed hypoechoic lesion located medially to the sternocleidomastoid muscle and inside trapezoid muscle. The tumor size was 47×20 mm. Calcification and increased vasculature were seen in tumor’s periphery.'], 'poljradiol-79-228-g002': ['Computed tomography: (<xref ref-type="fig" rid="poljradiol-79-228-g002">Figure 2</xref>) scans demonstrated a low-attenuating soft tissue mass, 30×28 mm in size, with peripheral calcification, located within left splenius colli and medially to levator scapulae muscle, displacing the semispinalis capitis and semispinalis colli muscles,. The lesion was extensively vascularized, especially at its periphery, by left vertebral artery. No cervical lymph node enlargement was noted.) scans demonstrated a low-attenuating soft tissue mass, 30×28 mm in size, with peripheral calcification, located within left splenius colli and medially to levator scapulae muscle, displacing the semispinalis capitis and semispinalis colli muscles,. The lesion was extensively vascularized, especially at its periphery, by left vertebral artery. No cervical lymph node enlargement was noted.'], 'poljradiol-79-228-g003': ['Magnetic Resonance Imaging with angiography: (<xref ref-type="fig" rid="poljradiol-79-228-g003">Figures 3</xref>––<xref ref-type="fig" rid="poljradiol-79-228-g006">6</xref>) revealed a relatively well – defined left-sided mass measuring 28×24×26 mm in diameter. The lesion was hyperintense on T1-WI and heterogeneous, isointense to hyperintense on T2-WI. Low-SI rim was seen in all sequences. T2-WI also demonstrated high-SI perilesional edema along muscle fibers. There was diffuse enhancement of the tumor and surrounding edematous region on post-contrast T1-WI.) revealed a relatively well – defined left-sided mass measuring 28×24×26 mm in diameter. The lesion was hyperintense on T1-WI and heterogeneous, isointense to hyperintense on T2-WI. Low-SI rim was seen in all sequences. T2-WI also demonstrated high-SI perilesional edema along muscle fibers. There was diffuse enhancement of the tumor and surrounding edematous region on post-contrast T1-WI.']} | Myositis Ossificans Mimicking Sarcoma, the Importance of Diagnostic Imaging – Case Report | [
"Computer Tomography",
"Myositis Ossificans",
"Sarcoma",
"Magnetic Resonance Imaging"
] | Pol J Radiol | 1406530800 | [{'@Label': 'OBJECTIVE', '@NlmCategory': 'OBJECTIVE', '#text': 'To examine changes in depressive symptoms and treatment in the first 3 years following bariatric surgery.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'The longitudinal assessment of bariatric surgery-2 (LABS-2) is an observational cohort study of adults (n\u2009=\u20092,458) who underwent a bariatric surgical procedure at 1 of 10 US hospitals between 2006 and 2009. This study includes 2,148 participants who completed the Beck depression inventory (BDI) at baseline and\u2009≥\u2009one follow-up visit in years 1-3.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'At baseline, 40.4% self-reported treatment for depression. At least mild depressive symptoms (BDI score\u2009≥\u200910) were reported by 28.3%; moderate (BDI score 19-29) and severe (BDI score ≥30) symptoms were uncommon (4.2 and 0.5%, respectively). Mild-to-severe depressive symptoms independently increased the odds (OR\u2009=\u20091.75; P\u2009=\u20090.03) of a major adverse event within 30 days of surgery. Compared with baseline, symptom severity was significantly lower at all follow-up time points (e.g., mild-to-severe symptomatology was 8.9%, 6 months; 8.4%, 1year; 12.2%, 2 years; 15.6%, 3 years; ps\u2009<\u20090.001), but increased between 1 and 3 years postoperatively (P\u2009<\u20090.01). Change in depressive symptoms was significantly related to change in body mass index (r\u2009=\u20090.42; P\u2009<\u20090001).'}, {'@Label': 'CONCLUSION', '@NlmCategory': 'CONCLUSIONS', '#text': 'Bariatric surgery has a positive impact on depressive features. However, data suggest some deterioration in improvement after the first postoperative year. LABS-2, #NCT00465829, http://www.clinicaltrials.gov/ct2/show/NCT00465829.'}] | [
"Adolescent",
"Adult",
"Aged",
"Antidepressive Agents",
"Bariatric Surgery",
"Body Mass Index",
"Depression",
"Female",
"Hospitalization",
"Humans",
"Linear Models",
"Longitudinal Studies",
"Male",
"Middle Aged",
"Postoperative Period",
"Weight Loss",
"Young Adult"
] | other | PMC4114761 | null | 35 | [
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"{'Citation': 'Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the peri-operative nutritional, metabolic, and non-surgical support of the bariatric surgery patient-2013 update. Obesity. 2013;21:1–27.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '0'}}}",
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"{'Citation': 'Roerig JL, Steffen KJ, Zimmerman C, Mitchell JE, Crosby RD, Cao L. A comparison of duloxetine plasma levels in post-bariatric surgery patients versus matched non-surgical control subjects. J Clin Psychopharm. 2013;33:479–484.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '23771193'}}}"
] | Pol J Radiol. 2014 Jul 28; 79:228-232 | NO-CC CODE |
|
MRI image showing the measurements used for SNQ calculation. The signal intensity (SI) of ACL graft was calculated using the signal-to-noise quotient (SNQ). The SI of the graft was measured at three different regions of interest (upper, middle and lower third), and the mean was normalized by measuring the SI of the distal quadriceps tendon (QT) “Media”= Mean, “Deviazione” = Standard Deviation | 167_2021_6785_Fig1_HTML | 7 | b44ea909258f2b5627871faeb509e412f6b289240e5a2859629198d485169766 | 167_2021_6785_Fig1_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
644,
537
] | [{'image_id': '167_2021_6785_Fig1_HTML', 'image_file_name': '167_2021_6785_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC8592808/167_2021_6785_Fig1_HTML.jpg', 'caption': 'MRI image showing the measurements used for SNQ calculation. The signal intensity (SI) of ACL graft was calculated using the signal-to-noise quotient (SNQ).\u2009The SI of the graft was measured at three different regions of interest (upper, middle and lower third), and the mean was normalized by measuring the SI of the distal quadriceps tendon (QT) “Media”=\u2009Mean, “Deviazione”\u2009= Standard Deviation', 'hash': 'b44ea909258f2b5627871faeb509e412f6b289240e5a2859629198d485169766'}, {'image_id': '167_2021_6785_Fig6_HTML', 'image_file_name': '167_2021_6785_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC8592808/167_2021_6785_Fig6_HTML.jpg', 'caption': 'Correlations between SNQ at 12\xa0months and Cincinnati score (A), Lysholm score (B) and Tegner Activity Scale (C) at 60\xa0months. While the SNQ score at 6\xa0months did not correlate with any of the clinical and functional score, the 12-month SNQ values significantly correlated with 60-month Cincinnati (p\u2009=\u20090.003, r\u2009=\u20090.442), Lysholm (p\u2009=\u20090.027, r\u2009=\u2009\xa0−\xa00.334) and Tegner activity scale (p\u2009=\u20090.018, r\u2009=\u2009\xa0−\xa00.357)', 'hash': '4eaf6d25d58e8ad5d293896616950fa14bd0dd39062f5553ecdb8d3eb756fa01'}, {'image_id': '167_2021_6785_Fig5_HTML', 'image_file_name': '167_2021_6785_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC8592808/167_2021_6785_Fig5_HTML.jpg', 'caption': 'Comparison of the SNQ score between Allo and Auto groups. Data are presented as mean\u2009±\u2009SD; *p\u2009<\u20090.05. At 6\xa0months the mean SNQ index was significantly higher in the Auto group than in the Allo group (p\u2009=\u20090.038), whereas at 12\xa0months the values were comparable. The two-way ANOVA analysis indicated a different behavior during time depending on the graft type', 'hash': '3533075f448dd6fbc51b471fbe2ff1506736b45933ea2a9b4adac2c85e99d99b'}, {'image_id': '167_2021_6785_Fig2_HTML', 'image_file_name': '167_2021_6785_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC8592808/167_2021_6785_Fig2_HTML.jpg', 'caption': 'Methods used to measure the mean width of the graft on sagittal MRI at femoral, intraarticular and tibial level', 'hash': '068f82d070cc7628e7447a467f0d08dcf58a91ca03ee9970ecc18ed88f06c297'}, {'image_id': '167_2021_6785_Fig4_HTML', 'image_file_name': '167_2021_6785_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC8592808/167_2021_6785_Fig4_HTML.jpg', 'caption': 'ACL-RSI score at the 60-month follow-up in the Allo and Auto groups, showing no difference between the two groups', 'hash': 'eab9975ba3759e668a19aa002f0cb1bed633c837143f05b8904b4a64c565250b'}, {'image_id': '167_2021_6785_Fig3_HTML', 'image_file_name': '167_2021_6785_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC8592808/167_2021_6785_Fig3_HTML.jpg', 'caption': 'Functional, pain and activity scores at the different time points in Allograft and Autograft groups. Lysholm Score (A); Cincinnati Score (B); Tegner Activity Scale (C); Visual Analogue Score-Pain (D). With the exception of VAS that only improved at 12-month follow-up, significant differences were observed for all the other parameters between either baseline levels and/or 6-month follow-up with respect to each time point. No difference was observed between the two groups. *p\u2009<\u20090.05, ***p\u2009<\u20090.001 vs baseline; #p\u2009<\u20090.05, ##p\u2009<\u20090.01, ###p\u2009<\u20090.001 vs 6\xa0months', 'hash': 'a50bf9d297252dd81e4eeb77b99ceabe2ba2603c42cdf388b0d4935d2b7ee6d6'}] | {'167_2021_6785_Fig1_HTML': ['Image analysis was focused on several parameters: The signal intensity (SI) of ACL graft\xa0was evaluated by calculating the signal-to-noise quotient (SNQ) [31]. The SI of the graft was measured at three different regions of interest (upper, middle and lower third), and the mean was normalized by measuring the SI of the distal quadriceps tendon (QT) (Fig.\xa0<xref rid="167_2021_6785_Fig1_HTML" ref-type="fig">1</xref>).).Fig. 1MRI image showing the measurements used for SNQ calculation. The signal intensity (SI) of ACL graft was calculated using the signal-to-noise quotient (SNQ).\u2009The SI of the graft was measured at three different regions of interest (upper, middle and lower third), and the mean was normalized by measuring the SI of the distal quadriceps tendon (QT) “Media”=\u2009Mean, “Deviazione”\u2009= Standard Deviation\u2009'], '167_2021_6785_Fig2_HTML': ['The SNQ is capable of normalizing the SI of each graft in this study; therefore, in this study, the SNQ value was used to quantify the signal intensity emitted by the neo-ligament. The SNQ evaluates the tendon graft maturation, with low values indicating a greater maturation of the graft. Position of the tibial tunnel, orientation of the neo-ACL estimated using the sagittal angle, angle between the ACL and the Blumensaat line, edematous condition of the graft based on the short tau inversion recovery (STIR) sequence, using three different grades (grade I: normal signal, grade II: possible edema, grade III: 100% of edema), and mean width of the graft, were also measured in all sequences at three different sites (distal, intermediate, proximal) (Fig.\xa0<xref rid="167_2021_6785_Fig2_HTML" ref-type="fig">2</xref>).).Fig. 2Methods used to measure the mean width of the graft on sagittal MRI at femoral, intraarticular and tibial level'], '167_2021_6785_Fig3_HTML': ['The Lysholm score improved over time, with no differences between the study groups (n.s.; interaction n.s.) (Fig.\xa0<xref rid="167_2021_6785_Fig3_HTML" ref-type="fig">3</xref>A). The same behaviour was observed for the Cincinnati score (Fig.\xa0A). The same behaviour was observed for the Cincinnati score (Fig.\xa0<xref rid="167_2021_6785_Fig3_HTML" ref-type="fig">3</xref>B) and Tegner activity scale (Fig.\xa0B) and Tegner activity scale (Fig.\xa0<xref rid="167_2021_6785_Fig3_HTML" ref-type="fig">3</xref>C). Tegner Actvity Scale showed particularly relevant reductions at 6-month follow-up, due to the activity restrictions in\xa0both groups during the rehabilitation period.C). Tegner Actvity Scale showed particularly relevant reductions at 6-month follow-up, due to the activity restrictions in\xa0both groups during the rehabilitation period.Fig. 3Functional, pain and activity scores at the different time points in Allograft and Autograft groups. Lysholm Score (A); Cincinnati Score (B); Tegner Activity Scale (C); Visual Analogue Score-Pain (D). With the exception of VAS that only improved at 12-month follow-up, significant differences were observed for all the other parameters between either baseline levels and/or 6-month follow-up with respect to each time point. No difference was observed between the two groups. *p\u2009<\u20090.05, ***p\u2009<\u20090.001 vs baseline; #p\u2009<\u20090.05, ##p\u2009<\u20090.01, ###p\u2009<\u20090.001 vs 6\xa0months', 'VAS showed a decrease during the first year in both groups, reaching\xa0a significant difference at 12\xa0months (p\u2009=\u20090.014), with new non-significant increases at 60-month follow-up with respect to 12-month (Fig.\xa0<xref rid="167_2021_6785_Fig3_HTML" ref-type="fig">3</xref>D).D).'], '167_2021_6785_Fig4_HTML': ['The ACL-RSI collected 60\xa0months after surgery did not differ between patients in the autograft and allograft groups (n.s.) (Fig.\xa0<xref rid="167_2021_6785_Fig4_HTML" ref-type="fig">4</xref>).).Fig. 4ACL-RSI score at the 60-month follow-up in the Allo and Auto groups, showing no difference between the two groups'], '167_2021_6785_Fig5_HTML': ['At 6\xa0months, the mean SNQ index was significantly higher in the Auto group (12.9\u2009±\u20098.6) than in the Allo group (7.9\u2009±\u20096.3) (p\u2009=\u20090.038), whereas at 12\xa0months the values were comparable (9.8\u2009±\u20097.1 and 10.4\u2009±\u20098.0 for the Auto and Allo group, respectively) (Fig.\xa0<xref rid="167_2021_6785_Fig5_HTML" ref-type="fig">5</xref>).).Fig. 5Comparison of the SNQ score between Allo and Auto groups. Data are presented as mean\u2009±\u2009SD; *p\u2009<\u20090.05. At 6\xa0months the mean SNQ index was significantly higher in the Auto group than in the Allo group (p\u2009=\u20090.038), whereas at 12\xa0months the values were comparable. The two-way ANOVA analysis indicated a different behavior during time depending on the graft type'], '167_2021_6785_Fig6_HTML': ['SNQ score at 6\xa0months did not correlate with Tegner activity scale, ACL-RSI, Cincinnati, VAS or Lysholm score at any of the analysed time-points. The 12-month SNQ values significantly correlate with 60-month Cincinnati (p\u2009=\u20090.003, r\u2009=\u20090.442), Lysholm (p\u2009=\u20090.027, r\u2009=\u2009\xa0−\xa00.334) and Tegner activity scale (p\u2009=\u20090.018, r\u2009=\u2009\xa0−\xa00.357) (Fig.\xa0<xref rid="167_2021_6785_Fig6_HTML" ref-type="fig">6</xref>). No correlation was found between 12-month SNQ values and VAS or ACL-RSI 60-month scores.). No correlation was found between 12-month SNQ values and VAS or ACL-RSI 60-month scores.Fig. 6Correlations between SNQ at 12\xa0months and Cincinnati score (A), Lysholm score (B) and Tegner Activity Scale (C) at 60\xa0months. While the SNQ score at 6\xa0months did not correlate with any of the clinical and functional score, the 12-month SNQ values significantly correlated with 60-month Cincinnati (p\u2009=\u20090.003, r\u2009=\u20090.442), Lysholm (p\u2009=\u20090.027, r\u2009=\u2009\xa0−\xa00.334) and Tegner activity scale (p\u2009=\u20090.018, r\u2009=\u2009\xa0−\xa00.357)']} | Different timing in allograft and autograft maturation after primary anterior cruciate ligament reconstruction does not influence the clinical outcome at mid-long-term follow-up | [
"ACL",
"Anterior cruciate ligament",
"Reconstruction",
"Autograft",
"Allograft",
"SNQ",
"MRI",
"Graft Maturation"
] | Knee Surg Sports Traumatol Arthrosc | 1668585600 | Operations researchers worldwide rely extensively on quantitative simulations to model alternative aspects of the COVID-19 pandemic. Proper uncertainty quantification and sensitivity analysis are fundamental to enrich the modeling process and communicate correctly informed insights to decision-makers. We develop a methodology to obtain insights on key uncertainty drivers, trend analysis and interaction quantification through an innovative combination of probabilistic sensitivity techniques and machine learning tools. We illustrate the approach by applying it to a representative of the family of susceptible-infectious-recovered (SIR) models recently used in the context of the COVID-19 pandemic. We focus on data of the early pandemic progression in Italy and the United States (the U.S.). We perform the analysis for both cases of correlated and uncorrelated inputs. Results show that quarantine rate and intervention time are the key uncertainty drivers, have opposite effects on the number of total infected individuals and are involved in the most relevant interactions. | [] | other | PMC8592808 | null | 107 | [
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] | Knee Surg Sports Traumatol Arthrosc. 2022 Nov 16; 30(7):2281-2290 | NO-CC CODE |
|
(A) Sagittal 3T MRI short tau-inversion recovery (STIR) image shows longitudinally extensive hyperintense signal in the cervical and thoracic spinal cord at arrival. Red arrow indicates the preservation of area postrema. (B) Magnified thoracic spinal cord. (C) Axial STIR image of spinal cord at level of T3. (D) Sagittal T2 weighted image shows increased thickening of optic nerves bilaterally, predominantly in the retrobulbar segmentat arrival, measuring 5 mm (right eye) and 5.2 mm (left eye). (E) Fundoscopic exam shows poorly defined optic nerve definition in both eyes, more severe in the left eye (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article). | gr1_lrg | 7 | fe3652aba93f2bdacba36a233befe058fea96e6fad9a42d30b87333a89af25fa | gr1_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
729,
444
] | [{'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC8592852/gr1_lrg.jpg', 'caption': '(A) Sagittal 3T MRI short tau-inversion recovery (STIR) image shows longitudinally extensive hyperintense signal in the cervical and thoracic spinal cord at arrival. Red arrow indicates the preservation of area postrema. (B) Magnified thoracic spinal cord. (C) Axial STIR image of spinal cord at level of T3. (D) Sagittal T2 weighted image shows increased thickening of optic nerves bilaterally, predominantly in the retrobulbar segmentat arrival, measuring 5\xa0mm (right eye) and 5.2\xa0mm (left eye). (E) Fundoscopic exam shows poorly defined optic nerve definition in both eyes, more severe in the left eye (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article).', 'hash': 'fe3652aba93f2bdacba36a233befe058fea96e6fad9a42d30b87333a89af25fa'}] | {'gr1_lrg': ['In admission, he presented left eye blindness and markedly reduced visual acuity (20/400) in his right eye. He also had mild proximal weakness in lower limbs (Strength grade ⅘ on MRC scale) and a thoracic sensory level at Th8. There was no fever or other signs of systemic infection and nasopharyngeal swab was negative for SARS-CoV-2-RT-PCR. Magnetic resonance imaging (MRI) revealed bilateral optic nerve thickening associated with longitudinally extensive hyperintense lesion in T2/FLAIR (<xref rid="gr1_lrg" ref-type="fig">Fig.\xa01</xref>\nA, B). Cerebrospinal fluid (CSF) analysis showed 80 leukocytes, with lymphocyte predominance (97%), increased proteins (60.8\xa0mg/dL) with normal glucose level. Bacterial culture of CSF and blood were negative, while his blood tests were unremarkable, including infectious screening (syphilis, HIV, HCV, HBV), B12, antinuclear antibody, Reactive C Protein, Erythrocyte sedimentation rate and serum complement levels. Due to NMOSD suspicion, he was evaluated for Anti-myelin oligodendrocyte glycoprotein (Anti-MOG) and Anti-Aquaporin-4 (Anti-AQP4) antibodies by cell-based assay (CBA), which were both negatives. Oligoclonal bands and CSF viral panel were negative, as well as IgG and IgM antibodies for SARS-CoV-2.\nA, B). Cerebrospinal fluid (CSF) analysis showed 80 leukocytes, with lymphocyte predominance (97%), increased proteins (60.8\xa0mg/dL) with normal glucose level. Bacterial culture of CSF and blood were negative, while his blood tests were unremarkable, including infectious screening (syphilis, HIV, HCV, HBV), B12, antinuclear antibody, Reactive C Protein, Erythrocyte sedimentation rate and serum complement levels. Due to NMOSD suspicion, he was evaluated for Anti-myelin oligodendrocyte glycoprotein (Anti-MOG) and Anti-Aquaporin-4 (Anti-AQP4) antibodies by cell-based assay (CBA), which were both negatives. Oligoclonal bands and CSF viral panel were negative, as well as IgG and IgM antibodies for SARS-CoV-2.Fig. 1(A) Sagittal 3T MRI short tau-inversion recovery (STIR) image shows longitudinally extensive hyperintense signal in the cervical and thoracic spinal cord at arrival. Red arrow indicates the preservation of area postrema. (B) Magnified thoracic spinal cord. (C) Axial STIR image of spinal cord at level of T3. (D) Sagittal T2 weighted image shows increased thickening of optic nerves bilaterally, predominantly in the retrobulbar segmentat arrival, measuring 5\xa0mm (right eye) and 5.2\xa0mm (left eye). (E) Fundoscopic exam shows poorly defined optic nerve definition in both eyes, more severe in the left eye (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article).Fig. 1', 'Due to the severity of visual symptoms, the patient immediately received high-dose intravenous methylprednisolone (1\xa0g) for the 5 following days. He had a dramatic improvement of visual acuity, motor and sensory symptoms. He was discharged on day 10 with complete motor recovery and visual acuity of 20/30 in his left eye and 20/40 in his right eye, with mild left papilledema and bilateral euchromatopsia (<xref rid="gr1_lrg" ref-type="fig">Fig.\xa01</xref>C). An oral corticoid tapering scheme and a rehabilitation program were prescribed.C). An oral corticoid tapering scheme and a rehabilitation program were prescribed.']} | Simultaneous bilateral optic neuritis and longitudinally extensive transverse myelitis following vaccination against COVID-19: A case report | [
"Optic neuritis",
"Longitudinally extensive myelitis",
"Case report",
"COVID-19"
] | None | None | None | null | other | PMC8592852 | null | null | [
""
] | 2021 Dec 16; 1:100041 | NO-CC CODE |
|
CT-pulmonary angiogram demonstrating bi-lateral pulmonary embolism. | gr3_lrg | 7 | 40c3d6e5c615dec6ff0f1ab828a97d7049a14644ff19fe41916ff1cf8612cd10 | gr3_lrg.jpg | multiple | multiple panels: images | [
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] | [
"computerized tomography"
] | [
754,
587
] | [{'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC7825839/gr3_lrg.jpg', 'caption': 'CT-pulmonary angiogram demonstrating bi-lateral pulmonary embolism.', 'hash': '40c3d6e5c615dec6ff0f1ab828a97d7049a14644ff19fe41916ff1cf8612cd10'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7825839/gr2_lrg.jpg', 'caption': 'X-Ray chest revealing bi-lateral opacities with prominant right pulmonary trunk.', 'hash': '8a1d261258a060630dd4ce00429ba9c30244082555b22761fa29b8f3f430ecda'}, {'image_id': 'gr4_lrg', 'image_file_name': 'gr4_lrg.jpg', 'image_path': '../data/media_files/PMC7825839/gr4_lrg.jpg', 'caption': 'CT-pulmonary angiogram demonstrating ground glass opacities suggestive of COVID-19 pneumonitis.', 'hash': 'c21fcb244e84f20050df9987436bf049771d10e77055af8b6f742c2cec975c0b'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7825839/gr1_lrg.jpg', 'caption': 'ECG showing sinus tachycardia with right bundle branch block and ectopics.', 'hash': '4c808967dc282e6c787f148509baca544679b6915cf590030b064fcad92e552e'}] | {'gr1_lrg': ['During a general examination, the patient was noted to have pleuritic sounding chest pain and was markedly dyspnoeic, tachycardic and tachypnoeic, and had an oxygen saturation of 92–95% on a 15 L non-rebreathing mask. She was unable to speak in full sentences due to breathlessness. Auscultation during chest examination revealed pleural rub along with bi-basal crackles without any wheeze. Other systemic examinations were normal. A 12 lead electrocardiogram showed a right bundle branch block (RBBB) with sinus tachycardia (<xref rid="gr1_lrg" ref-type="fig">Figure 1</xref>\n). A bedside echocardiogram ruled out right ventricular strain. Arterial blood gas showed hypoxic respiratory failure.\n). A bedside echocardiogram ruled out right ventricular strain. Arterial blood gas showed hypoxic respiratory failure.Figure 1ECG showing sinus tachycardia with right bundle branch block and ectopics.Figure 1'], 'gr2_lrg': ['Blood results showed a deranged clotting screen with a prothrombin time (PT) of 65 s (12–16 s), an activated partial thromboplastin time (APTT) of 105 s (22–35 s), and fibrinogen level of 1.6 g/L (1.9–4.3 g/L). She had a haemoglobin level of 140 g/L (110−150 g/L) with an elevated white cell count of 12.4 × 10^9/l (4.0−11 × 10^9/l) showing marked lymphopenia at 0.6 × 10^9/l (1.5–4.0 × 10^9/l). Her platelet count was 32 × 10^9/l (150–400,10^9/l) and the d-dimer level was elevated at 6.35 mg/L. C-reactive protein (CRP) was 125 mg/L (0.0−10 mg/L). Her liver and renal function were unremarkable. Her International Society of Thrombosis and Haemostasis disseminated intravascular coagulation (DIC) score was 6. The prolongation of clotting factors makes the case for an overt DIC. Her chest x-ray revealed bilateral opacities with prominent right pulmonary trunk highly suspicious for COVID-19 pneumonitis (<xref rid="gr2_lrg" ref-type="fig">Figure 2</xref>). These symptoms and signs such as pleuritic chest pain, tachycardia, and shortness of breath along with an elevated ). These symptoms and signs such as pleuritic chest pain, tachycardia, and shortness of breath along with an elevated d-dimer level placed her Wells score for pulmonary embolism (PE) at 4.5, prompting a CT Pulmonary Angiogram which revealed bilateral ground-glass opacities along with bilateral pulmonary embolism as the diagnosis (<xref rid="gr3_lrg" ref-type="fig">Figure 3</xref>, , <xref rid="gr4_lrg" ref-type="fig">Figure 4</xref>)\n.)\n.Figure 2X-Ray chest revealing bi-lateral opacities with prominant right pulmonary trunk.Figure 2Figure 3CT-pulmonary angiogram demonstrating bi-lateral pulmonary embolism.Figure 3Figure 4CT-pulmonary angiogram demonstrating ground glass opacities suggestive of COVID-19 pneumonitis.Figure 4']} | A unique tale of COVID-19 induced concomitant overt disseminated intravascular coagulation and acute bilateral pulmonary embolism | [
"Thromboembolism",
"Disseminated intravascular coagulation",
"SARS-COV-2",
"Covid-19"
] | Int J Infect Dis | 1616310000 | None | null | other | PMC7825839 | null | null | [
""
] | Int J Infect Dis. 2021 Mar 21; 104:568-571 | NO-CC CODE |
|
MRI (T2WI) sagittal spine showing hyperintensities (arrows) in the spinal cord corresponding to T5 and T7 vertebra suggestive of acute transverse myelitis | 43678_2021_104_Fig1_HTML | 7 | 4ecb6342cd605b0b784a7a60806795bb58a8a366d2eda60c9461e8c5a1776d20 | 43678_2021_104_Fig1_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
589,
883
] | [{'image_id': '43678_2021_104_Fig1_HTML', 'image_file_name': '43678_2021_104_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7917167/43678_2021_104_Fig1_HTML.jpg', 'caption': 'MRI (T2WI) sagittal spine showing hyperintensities (arrows) in the spinal cord corresponding to T5 and T7 vertebra suggestive of acute transverse myelitis', 'hash': '4ecb6342cd605b0b784a7a60806795bb58a8a366d2eda60c9461e8c5a1776d20'}] | {'43678_2021_104_Fig1_HTML': ['A nasopharyngeal swab was sent for detection of SARS-CoV-2 as a routine measure for all patients admitted to hospital. The swab came back positive 3 days after the patient was originally assessed in the ED. A lumbar puncture was performed by neurology which demonstrated an elevated CSF WBC count of 50\u2009×\u2009106/L, a lymphocyte count of 41\u2009×\u2009106/L, a neutrophil count of 3\u2009×\u2009106/L, an elevated protein of 502\xa0mg/L and a normal glucose. The culture did not demonstrate any growth and viral PCR for HSV and VZV was negative. A thorough infectious disease and autoimmune work up was also completed to rule out other etiologies and was non-contributory. Due to progression of symptoms, a repeat MRI was done on day 3 of admission, which demonstrated extension in the degree of T2/FLAIR signal change within the cord which now extended from the upper cervical spine to the conus medullaris (see Fig.\xa0<xref rid="43678_2021_104_Fig1_HTML" ref-type="fig">1</xref>). A presumptive diagnosis of TM due to SARS-CoV-2 was made and the patient was started on Methylprednisolone 1\xa0g IV for 5 days.). A presumptive diagnosis of TM due to SARS-CoV-2 was made and the patient was started on Methylprednisolone 1\xa0g IV for 5 days.Fig. 1MRI (T2WI) sagittal spine showing hyperintensities (arrows) in the spinal cord corresponding to T5 and T7 vertebra suggestive of acute transverse myelitis']} | Acute transverse myelitis attributed to SARS-CoV-2 infection presenting as impaired mobility: a case report | [
"Transverse myelitis",
"COVID-19",
"SARS-CoV-2",
"Neurologic dysfunction"
] | CJEM | 1614585600 | The purpose of this study is to examine whether college belonging and social support mediate the association between childhood psychological maltreatment and spiritual wellbeing among college young adults. The sample of the present study included 493 college young adults (33% male), ranging in age between 18 and 39 years (M = 21.35, SD = 2.56). The results showed that psychological maltreatment not only had a direct predictive effect on spiritual wellbeing but also an indirect predictive effect on spiritual wellbeing through college belonging and social support. These findings present important implications for research and practices by providing an in-depth understanding of the association between psychological maltreatment and spiritual wellbeing among Turkish college students. | [
"Adolescent",
"Adult",
"Child",
"Female",
"Humans",
"Male",
"Social Support",
"Students",
"Universities",
"Young Adult"
] | other | PMC7917167 | null | 92 | [
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] | CJEM. 2021 Mar 1; 23(4):551-552 | NO-CC CODE |
|
Adrenal CT scan revealing left adrenal adenomas and atrophic right adrenal gland. | cmed-9-2016-031f1 | 7 | 2cdf89d515ddc55b083105c2956ad634d216f781591614da6b8cd8df1c8d5794 | cmed-9-2016-031f1.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
622,
446
] | [{'image_id': 'cmed-9-2016-031f2', 'image_file_name': 'cmed-9-2016-031f2.jpg', 'image_path': '../data/media_files/PMC4962955/cmed-9-2016-031f2.jpg', 'caption': 'HbA1c levels (%) before and after surgery, with corresponding insulin glargine and mifepristone dosing.', 'hash': '58a964823b86b8dfb4049d02343d3199538786c4eea96ea913016263cb409ca7'}, {'image_id': 'cmed-9-2016-031f3', 'image_file_name': 'cmed-9-2016-031f3.jpg', 'image_path': '../data/media_files/PMC4962955/cmed-9-2016-031f3.jpg', 'caption': 'ACTH, cortisol, and DHEA-S levels before and after surgery. Mifepristone dosing is also shown.Abbreviations: ACTH, adrenocorticotropic hormone; DHEA-S, dehydroepiandrosterone sulfate.', 'hash': '6b901fd9bc268e85833c5902a20246eb6c4ff570fcac8250a71c9d54dede5454'}, {'image_id': 'cmed-9-2016-031f1', 'image_file_name': 'cmed-9-2016-031f1.jpg', 'image_path': '../data/media_files/PMC4962955/cmed-9-2016-031f1.jpg', 'caption': 'Adrenal CT scan revealing left adrenal adenomas and atrophic right adrenal gland.', 'hash': '2cdf89d515ddc55b083105c2956ad634d216f781591614da6b8cd8df1c8d5794'}] | {'cmed-9-2016-031f1': ['The patient is a 66-year-old Caucasian man with a past medical history significant for type 2 diabetes mellitus, proteinuria, hyperlipidemia, hypertension, obesity, prostate cancer, depression, and hypogonadism. The patient was hospitalized for Fournier’s gangrene and sepsis, which required multiple perineal soft-tissue debridements and rounds of intravenous antibiotics. Concurrent with the episode of Fournier’s gangrene, the patient was treated for a right axillary abscess that was methicillin-resistant S. aureus positive. A computed tomography (CT) scan of the abdomen revealed three lipid-rich adenomas measuring 1.4, 2.1, and 1.2 cm on the left adrenal gland and an atrophic right adrenal gland (<xref ref-type="fig" rid="cmed-9-2016-031f1">Fig. 1</xref>). Hormonal work-up was negative for pheochromocytoma and primary aldosteronism, but revealed an elevated urinary free cortisol (UFC) level (237 µg/24 hours, reference range 0–50 µg/24 hours; ). Hormonal work-up was negative for pheochromocytoma and primary aldosteronism, but revealed an elevated urinary free cortisol (UFC) level (237 µg/24 hours, reference range 0–50 µg/24 hours; Table 1).'], 'cmed-9-2016-031f2': ['Soon after the initiation of mifepristone, his glycemic profile improved dramatically, as evidenced by a decrease in HbA1c (<xref ref-type="fig" rid="cmed-9-2016-031f2">Fig. 2</xref>). Ten weeks after starting mifepristone, insulin was discontinued. Glycemic control was achieved after 18 weeks of mifepristone therapy. The patient remained on liraglutide 1.8 mg daily, metformin 1000 mg twice daily, and canagliflozin was increased to 300 mg daily until surgery.). Ten weeks after starting mifepristone, insulin was discontinued. Glycemic control was achieved after 18 weeks of mifepristone therapy. The patient remained on liraglutide 1.8 mg daily, metformin 1000 mg twice daily, and canagliflozin was increased to 300 mg daily until surgery.'], 'cmed-9-2016-031f3': ['Clinical improvement was also associated with hormonal changes indicative of HPA axis recovery. Specifically, at 18 weeks of mifepristone therapy, his ACTH level increased to 22.5 pg/mL (previously suppressed). Further increases of ACTH were noted with increasing doses of mifepristone (<xref ref-type="fig" rid="cmed-9-2016-031f3">Fig. 3</xref>). The rise in ACTH was accompanied by an increase in DHEA-S levels, indicating recovery of the atrophic adrenal tissue. After five months of treatment with mifepristone, levels of ACTH, DHEA-S, and a random cortisol two days prior to surgery were 85.5 pg/mL, 94.9 µg/dL, and 63.4 µg/dL, respectively (). The rise in ACTH was accompanied by an increase in DHEA-S levels, indicating recovery of the atrophic adrenal tissue. After five months of treatment with mifepristone, levels of ACTH, DHEA-S, and a random cortisol two days prior to surgery were 85.5 pg/mL, 94.9 µg/dL, and 63.4 µg/dL, respectively (<xref ref-type="fig" rid="cmed-9-2016-031f3">Fig. 3</xref>). Mild cortisol withdrawal symptoms were reported early in the course of therapy with mifepristone that resolved with ongoing therapy. No hypokalemia was noted during therapy with mifepristone. In addition, the patient’s weight decreased by 4.8% (from a baseline of 105 kg) and he exhibited less facial ruddiness. Mifepristone was discontinued one week prior to surgery.). Mild cortisol withdrawal symptoms were reported early in the course of therapy with mifepristone that resolved with ongoing therapy. No hypokalemia was noted during therapy with mifepristone. In addition, the patient’s weight decreased by 4.8% (from a baseline of 105 kg) and he exhibited less facial ruddiness. Mifepristone was discontinued one week prior to surgery.', 'Laparoscopic left adrenalectomy was performed. The patient received one standard intraoperative intravenous dose of hydrocortisone 100 mg. As the patient exhibited no signs or symptoms of adrenal insufficiency, the typical postoperative use of glucocorticoid replacement therapy was not ordered, and the patient was closely monitored. Two days after surgery, the patient had an ACTH level of 843 pg/mL and a cortisol level of 44.8 µg/dL (not shown in <xref ref-type="fig" rid="cmed-9-2016-031f3">Fig. 3</xref>), indicating an appropriate HPA axis response to the stress of surgery. Four weeks postoperatively, an overnight DST was normal, and six months after surgery, his ACTH levels were within normal limits and serum cortisol was approaching normal. Twelve months postoperatively, the patient had not experienced any signs or symptoms of recurrent CS and his HbA1c level was 7.54%. The patient’s diabetes medications at that time included liraglutide 1.8 mg daily, canagliflozin/metformin 150/1000 twice daily, and insulin glargine 4 units daily (which was previously discontinued while taking mifepristone).), indicating an appropriate HPA axis response to the stress of surgery. Four weeks postoperatively, an overnight DST was normal, and six months after surgery, his ACTH levels were within normal limits and serum cortisol was approaching normal. Twelve months postoperatively, the patient had not experienced any signs or symptoms of recurrent CS and his HbA1c level was 7.54%. The patient’s diabetes medications at that time included liraglutide 1.8 mg daily, canagliflozin/metformin 150/1000 twice daily, and insulin glargine 4 units daily (which was previously discontinued while taking mifepristone).']} | No Postoperative Adrenal Insufficiency in a Patient with Unilateral Cortisol-Secreting Adenomas Treated with Mifepristone Before Surgery | [
"mifepristone",
"Cushing’s syndrome",
"cortisol",
"adrenal adenoma",
"adrenalectomy",
"adrenal insufficiency",
"adrenocorticotropic hormone"
] | Clin Med Insights Endocrinol Diabetes | 1469516400 | Protein tyrosine phosphatase 1B (PTP1B) has anti-inflammatory potential but PTP1B responses are desensitized in the lung by prolonged cigarette smoke exposure. Here we investigate whether PTP1B expression affects lung disease severity during respiratory syncytial viral (RSV) exacerbations of chronic obstructive pulmonary disease (COPD). Ptp1b(-/-) mice infected with RSV exhibit exaggerated immune cell infiltration, damaged epithelial cell barriers, cytokine production, and increased apoptosis. Elevated expression of S100A9, a damage-associated molecular pattern molecule, was observed in the lungs of Ptp1b(-/-) mice during RSV infection. Utilizing a neutralizing anti-S100A9 IgG antibody, it was determined that extracellular S100A9 signaling significantly affects lung damage during RSV infection. Preexposure to cigarette smoke desensitized PTP1B activity that coincided with enhanced S100A9 secretion and inflammation in wild-type animals during RSV infection. S100A9 levels in human bronchoalveolar lavage fluid had an inverse relationship with lung function in healthy subjects, smokers, and COPD subjects. Fully differentiated human bronchial epithelial cells isolated from COPD donors cultured at the air liquid interface secreted more S100A9 than cells from healthy donors or smokers following RSV infection. Together, these findings show that reduced PTP1B responses contribute to disease symptoms in part by enhancing S100A9 expression during viral-associated COPD exacerbations. | [
"Animals",
"Antibodies, Neutralizing",
"Bronchoalveolar Lavage Fluid",
"Calgranulin B",
"Case-Control Studies",
"Disease Models, Animal",
"Female",
"Gene Expression Regulation",
"Humans",
"Macrophages, Alveolar",
"Mice",
"Mice, Knockout",
"Primary Cell Culture",
"Protein Tyrosine Phosphatase, Non-Receptor Type 1",
"Pulmonary Disease, Chronic Obstructive",
"Respiratory Syncytial Virus Infections",
"Respiratory Syncytial Viruses",
"Signal Transduction",
"Smoking",
"Tobacco Smoke Pollution"
] | other | PMC4962955 | null | 50 | [
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"{'Citation': 'Lee MJ, Lee JK, Choi JW, Lee CS, Sim JH, Cho CH, et al. Interleukin-6 induces S100A9 expression in colonic epithelial cells through STAT3 activation in experimental ulcerative colitis. PloS one. 2012;7(9):e38801.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3433486'}, {'@IdType': 'pubmed', '#text': '22962574'}]}}",
"{'Citation': 'Cheng P, Corzo CA, Luetteke N, Yu B, Nagaraj S, Bui MM, et al. Inhibition of dendritic cell differentiation and accumulation of myeloid-derived suppressor cells in cancer is regulated by S100A9 protein. J Exp Med. 2008;205(10):2235–2249.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2556797'}, {'@IdType': 'pubmed', '#text': '18809714'}]}}",
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"{'Citation': 'Nlend MC, Bookman RJ, Conner GE, Salathe M. Regulator of G-protein signaling protein 2 modulates purinergic calcium and ciliary beat frequency responses in airway epithelia. Am J Respir Cell Mol Biol. 2002;27(4):436–445.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12356577'}}}"
] | Clin Med Insights Endocrinol Diabetes. 2016 Jul 26; 9:31-36 | NO-CC CODE |
|
Axial CECT thorax shows a mixed density mass lesion occupying the entire left hemithorax. | ci07002102 | 7 | a914e8140a1d8b2695ac7c6374de754a09af98cb2386ceec676f49a13a6c0eae | ci07002102.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
471,
628
] | [{'image_id': 'ci07002104', 'image_file_name': 'ci07002104.jpg', 'image_path': '../data/media_files/PMC2072088/ci07002104.jpg', 'caption': '(a) Cut section of the gross specimen showing lobulated yellow appearance with myxoid areas. (b) Microscopic appearance showing typical lipoblasts with branching capillaries and myxoid areas.', 'hash': '4dffd3c52cd7ed99f8e2c70d5b633de7f61ee5b72e8575f5b5ca50cf798c03bd'}, {'image_id': 'ci07002103', 'image_file_name': 'ci07002103.jpg', 'image_path': '../data/media_files/PMC2072088/ci07002103.jpg', 'caption': 'Postoperative chest posteroanterior radiograph showing good expansion of left lung with chest drain in situ.', 'hash': '54ba0e1509ccb4781bcfbf34eb9502923e366b8202ddf5be76a1aae0c79dfc2c'}, {'image_id': 'ci07002102', 'image_file_name': 'ci07002102.jpg', 'image_path': '../data/media_files/PMC2072088/ci07002102.jpg', 'caption': 'Axial CECT thorax shows a mixed density mass lesion occupying the entire left hemithorax.', 'hash': 'a914e8140a1d8b2695ac7c6374de754a09af98cb2386ceec676f49a13a6c0eae'}, {'image_id': 'ci07002101', 'image_file_name': 'ci07002101.jpg', 'image_path': '../data/media_files/PMC2072088/ci07002101.jpg', 'caption': 'Plain chest posteroanterior radiograph shows a mass of homogenous opacity occupying the entire left hemithorax.', 'hash': '5f975c50f0a2b58c5e6f4968e4944969f0d1715e35b4167389cf197a66050ae3'}] | {'ci07002101': ['Right lung field and costophrenic angle were normal. Rib cage was also normal (<xref ref-type="fig" rid="ci07002101">Fig. 1</xref>). CT scan of the thorax (plain followed by contrast by administering 100\u2009ml of IV non-ionic contrast) was done (Somatom Art, Siemens, Germany; parameters: 120\u2009kV, 100\u2009mA, slice thickness 8\u2009mm). Non-enhanced computed tomography (NECT) showed a large mixed density mass occupying almost the entire left hemithorax. This mass consisted of predominantly soft tissue densities (+30 to +40 HU) embedded within peripheral circumferential fatty tissue (−70\u2009HU average) (). CT scan of the thorax (plain followed by contrast by administering 100\u2009ml of IV non-ionic contrast) was done (Somatom Art, Siemens, Germany; parameters: 120\u2009kV, 100\u2009mA, slice thickness 8\u2009mm). Non-enhanced computed tomography (NECT) showed a large mixed density mass occupying almost the entire left hemithorax. This mass consisted of predominantly soft tissue densities (+30 to +40 HU) embedded within peripheral circumferential fatty tissue (−70\u2009HU average) (<xref ref-type="fig" rid="ci07002102">Fig. 2</xref>). A speck of calcification was noted in this mass. No evidence of cavitation was noted in this mass. Mild shift of the mediastinum was noted to the right. On contrast-enhanced CT (CECT) there was no contrast enhancement of the mass lesion. The mass was found to abut the chest wall anteriorly and posteriorly. The mass was found to abut the arch of the aorta and the main pulmonary artery, however no infiltration of the same was seen. There was no mediastinal/hilar lymphadenopathy and pleural/pericardial effusion. There was no chest wall invasion. Ultrasound of the abdomen and pelvis was normal. CT guided fine needle biopsy was performed which yielded only fibroadipose tissue. The patient then underwent thoracotomy.\n). A speck of calcification was noted in this mass. No evidence of cavitation was noted in this mass. Mild shift of the mediastinum was noted to the right. On contrast-enhanced CT (CECT) there was no contrast enhancement of the mass lesion. The mass was found to abut the chest wall anteriorly and posteriorly. The mass was found to abut the arch of the aorta and the main pulmonary artery, however no infiltration of the same was seen. There was no mediastinal/hilar lymphadenopathy and pleural/pericardial effusion. There was no chest wall invasion. Ultrasound of the abdomen and pelvis was normal. CT guided fine needle biopsy was performed which yielded only fibroadipose tissue. The patient then underwent thoracotomy.\nFigure 1Plain chest posteroanterior radiograph shows a mass of homogenous opacity occupying the entire left hemithorax.\nFigure 2Axial CECT thorax shows a mixed density mass lesion occupying the entire left hemithorax.'], 'ci07002103': ['At thoracotomy, a posterior mediastinal mass of soft tissue consistency was found to push the entire left lung anteriorly. The mass was found to have minimal adhesions with the left atrium, aorta and the main pulmonary artery which were released. There was no involvement of the left lung or chest wall. No pleural effusion was detected. There was no evidence of mediastinal or hilar lymphadenopathy. The mass was excised and delivered in toto. Postoperatively the left lung showed complete expansion (<xref ref-type="fig" rid="ci07002103">Fig. 3</xref>).\n).\nFigure 3Postoperative chest posteroanterior radiograph showing good expansion of left lung with chest drain in situ.'], 'ci07002104': ['Gross examination of the operative specimen showed a well-encapsulated gray white tumour with intact external capsule. Cut section showed lobulated yellow appearance with myxoid areas. On microscopic examination lipoblasts in varying stages of proliferation with a branching capillary network and myxoid cells were noted. No cellular atypia, mitosis or necrosis was found. These features were consistent with myxoid LPS (<xref ref-type="fig" rid="ci07002104">Fig. 4</xref>).\n).\nFigure 4(a) Cut section of the gross specimen showing lobulated yellow appearance with myxoid areas. (b) Microscopic appearance showing typical lipoblasts with branching capillaries and myxoid areas.']} | Posterior mediastinal liposarcoma simulating a lung mass: an unusual case report | [
"Liposarcoma",
"myxoid",
"mediastinal"
] | Cancer Imaging | 1193036400 | None | null | other | PMC2072088 | null | null | [
""
] | Cancer Imaging. 2007 Oct 22; 7(1):141-144 | NO-CC CODE |
|
Coronal reformat unenhanced chest CT scan of a 45-year-old man who died of COVID-19 pneumonia. Chest CT score was measured 18, and all five pulmonary lobes were affected. | gr1_lrg | 7 | ebfd92a097c7ab98ccc15c44bdec4ecdbc96a3acca207e4c61dcfea499820b35 | gr1_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
670,
499
] | [{'image_id': 'pl1_lrg', 'image_file_name': 'pl1_lrg.jpg', 'image_path': '../data/media_files/PMC7505070/pl1_lrg.jpg', 'caption': 'ROC curve of CT severity core in predicting mortality.', 'hash': 'a33def1f58e3ed32806dcce3b676bce5b7f4e2062389a01c21f0099bbcfcced5'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7505070/gr2_lrg.jpg', 'caption': 'Coronal reformat unenhanced chest CT scan of a 41-year-old man with COVID-19 pneumonia who was discharged from the hospital following clinical improvement. There were four lobes involved, and CT severity score was 5.', 'hash': '720bd8b522aa74adc2cc98a5f6d5d543a7bb3e764743311cb145f713459b3adc'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7505070/gr1_lrg.jpg', 'caption': 'Coronal reformat unenhanced chest CT scan of a 45-year-old man who died of COVID-19 pneumonia. Chest CT score was measured 18, and all five pulmonary lobes were affected.', 'hash': 'ebfd92a097c7ab98ccc15c44bdec4ecdbc96a3acca207e4c61dcfea499820b35'}] | {'pl1_lrg': ['To assess the power of the CT severity score, as a continuous variable, to predict mortality, the ROC curve was depicted (<xref rid="pl1_lrg" ref-type="fig">Graph 1</xref>\n). The graph showed acceptable predictive power of variable with AUC\u202f=\u202f0.89 (CI; 0.81−0.97). The ROC curve analysis revealed a score of 7.5 as the cut-off point of CT severity score with the highest sensitivity (0.83) and specificity (0.87). Therefore, score ≥ 7.5 cut-off point could distinguish 83 % of patients who will expire, and score ≤7.5 could distinguish 87 % who would get discharged in a 30-day follow-up.\n). The graph showed acceptable predictive power of variable with AUC\u202f=\u202f0.89 (CI; 0.81−0.97). The ROC curve analysis revealed a score of 7.5 as the cut-off point of CT severity score with the highest sensitivity (0.83) and specificity (0.87). Therefore, score ≥ 7.5 cut-off point could distinguish 83 % of patients who will expire, and score ≤7.5 could distinguish 87 % who would get discharged in a 30-day follow-up.Graph 1ROC curve of CT severity core in predicting mortality.Graph 1'], 'gr1_lrg': ['Our study shows that the CT severity score, a representative of the extent of the lung parenchymal involvement, can reliably predict mortality in healthy younger individuals with COVID-19 pneumonia (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>, , <xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>\n). This finding emphasizes the fact that a CT report of COVID-19 pneumonia should include the number of involved lobes and degree of the extension in addition to the morphological and locational (peripheral/central and anterior/posterior) patterns. The extent of the disease can be qualitatively reported as mild, moderate, or severe disease, or by means of a semi-quantitative method as we have described.\n). This finding emphasizes the fact that a CT report of COVID-19 pneumonia should include the number of involved lobes and degree of the extension in addition to the morphological and locational (peripheral/central and anterior/posterior) patterns. The extent of the disease can be qualitatively reported as mild, moderate, or severe disease, or by means of a semi-quantitative method as we have described.Fig. 1Coronal reformat unenhanced chest CT scan of a 45-year-old man who died of COVID-19 pneumonia. Chest CT score was measured 18, and all five pulmonary lobes were affected.Fig. 1Fig. 2Coronal reformat unenhanced chest CT scan of a 41-year-old man with COVID-19 pneumonia who was discharged from the hospital following clinical improvement. There were four lobes involved, and CT severity score was 5.Fig. 2']} | Predictive value of CT in the short-term mortality of Coronavirus Disease 2019 (COVID-19) pneumonia in nonelderly patients: A case-control study | [
"COVID-19",
"Pneumonia",
"CT",
"Predictor mortality",
"Nonelderly",
"Case-control"
] | Eur J Radiol | 1605945600 | [Figure: see text] | [
"Cardiometabolic Risk Factors",
"Cohort Studies",
"Heart Diseases",
"Humans",
"India",
"Urbanization"
] | other | PMC7505070 | null | 8 | [
"{'Citation': 'Lonely Planet. 2019. \\nHyderabad travel. https://www.lonelyplanet.com/india/andhra-pradesh/hyderabad-and-secunderabad [accessed 13 September 2020].'}",
"{'Citation': 'Das D. 2015. Hyderabad: visioning, restructuring and making of a high-tech city. Cities 43:48–58, 10.1016/j.cities.2014.11.008.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1016/j.cities.2014.11.008'}}}",
"{'Citation': 'Iyer SR.\\nHyderabad second slowest average traffic speed. Times of India. December 30, 2017. https://timesofindia.indiatimes.com/city/hyderabad/hyderabad-second-slowest-average-traffic-speed/articleshow/62300961.cms [accessed 13 September 2020].'}",
"{'Citation': 'Milà C, Ranzani O, Sanchez M, Ambrós A, Bhogadi S, Kinra S, et al. . 2020. Land-use change and cardiometabolic risk factors in an urbanizing area of south India: a population-based cohort study. Environ Health Perspect 128(4):47003, PMID: 32243204, 10.1289/EHP5445.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1289/EHP5445'}, {'@IdType': 'pmc', '#text': 'PMC7228094'}, {'@IdType': 'pubmed', '#text': '32243204'}]}}",
"{'Citation': 'Kinra S, Radha Krishna KV, Kuper H, Rameshwar Sarma KV, Prabhakaran P, Gupta V, et al. . 2014. Cohort profile: Andhra Pradesh Children and Parents Study (APCAPS). Int J Epidemiol 43(5):1417–1424, PMID: 24019421, 10.1093/ije/dyt128.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1093/ije/dyt128'}, {'@IdType': 'pmc', '#text': 'PMC4190511'}, {'@IdType': 'pubmed', '#text': '24019421'}]}}",
"{'Citation': 'Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. . 2009. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120(16):1640–1645, PMID: 19805654, 10.1161/CIRCULATIONAHA.109.192644.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1161/CIRCULATIONAHA.109.192644'}, {'@IdType': 'pubmed', '#text': '19805654'}]}}",
"{'Citation': 'Sanchez M, Ambros A, Salmon M, Bhogadi S, Wilson RT, Kinra S, et al. . 2017. Predictors of daily mobility of adults in peri-urban south India. Int J Environ Res Public Health 14(7):783, PMID: 28708095, 10.3390/ijerph14070783.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.3390/ijerph14070783'}, {'@IdType': 'pmc', '#text': 'PMC5551221'}, {'@IdType': 'pubmed', '#text': '28708095'}]}}",
"{'Citation': 'Gascon M, Triguero-Mas M, Martínez D, Dadvand P, Rojas-Rueda D, Plasència A, et al. . 2016. Residential green spaces and mortality: a systematic review. Environ Int 86:60–67, PMID: 26540085, 10.1016/j.envint.2015.10.013.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.envint.2015.10.013'}, {'@IdType': 'pubmed', '#text': '26540085'}]}}"
] | Eur J Radiol. 2020 Nov 21; 132:109298 | NO-CC CODE |
|
Coronal cut abdominal pelvic CT of case 1 showing a transition zone in the small bowel. | amjcaserep-17-712-g001 | 7 | 2226a3b7744b1323894eb62f93d1afe2ebb8bb69f35220e89d57dea35ab35b16 | amjcaserep-17-712-g001.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
640,
640
] | [{'image_id': 'amjcaserep-17-712-g008', 'image_file_name': 'amjcaserep-17-712-g008.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g008.jpg', 'caption': 'Case 3 band causing obstruction of the small bowel at the level of the jejunum.', 'hash': 'fba5f5a73fd81af9c51fa26b665705ea2885a41e18b20f8569426020f7c62185'}, {'image_id': 'amjcaserep-17-712-g001', 'image_file_name': 'amjcaserep-17-712-g001.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g001.jpg', 'caption': 'Coronal cut abdominal pelvic CT of case 1 showing a transition zone in the small bowel.', 'hash': '2226a3b7744b1323894eb62f93d1afe2ebb8bb69f35220e89d57dea35ab35b16'}, {'image_id': 'amjcaserep-17-712-g006', 'image_file_name': 'amjcaserep-17-712-g006.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g006.jpg', 'caption': 'Transverse cut abdominal pelvic CT of case 3 showing transition zone in the small bowel.', 'hash': 'd75d709e1705ab6a9e9ceeee2289731e49ab289c00d072c7915d23f945b573f5'}, {'image_id': 'amjcaserep-17-712-g007', 'image_file_name': 'amjcaserep-17-712-g007.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g007.jpg', 'caption': 'Sagittal cut abdominal pelvic CT of case 3 showing a transition zone in the small bowel.', 'hash': 'c94382ed75524bbfd5df82c145f3d334e436bac1eb93c2c6e0cae58459735053'}, {'image_id': 'amjcaserep-17-712-g009', 'image_file_name': 'amjcaserep-17-712-g009.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g009.jpg', 'caption': 'Case 3 band causing small bowel obstruction at the level of the terminal ileum.', 'hash': '587532bb8b292ee224b5567c7464569f29165d2dc32e92648211aa98d16a4fa0'}, {'image_id': 'amjcaserep-17-712-g003', 'image_file_name': 'amjcaserep-17-712-g003.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g003.jpg', 'caption': 'Transverse cut abdominal pelvic CT of case 1 showing a transition zone in the small bowel.', 'hash': '1776ce788756232e4ee2531f716d714c93b33771f040ef663ec97eb9cf5b6b30'}, {'image_id': 'amjcaserep-17-712-g004', 'image_file_name': 'amjcaserep-17-712-g004.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g004.jpg', 'caption': 'Transverse cut abdominal pelvic CT of case 2 showing a whirl sign in the small bowel.', 'hash': '12a1e09355529781549320029b003d2f9491885b88720d2a7b0c8b2cd5ebecdd'}, {'image_id': 'amjcaserep-17-712-g005', 'image_file_name': 'amjcaserep-17-712-g005.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g005.jpg', 'caption': 'Coronal cut abdominal pelvic CT of case 2 showing small bowel obstruction.', 'hash': '03583bb8a9f3395b4f9e52b91b7c6b0048a906efd372ff57ccc0a342d5b8e975'}, {'image_id': 'amjcaserep-17-712-g002', 'image_file_name': 'amjcaserep-17-712-g002.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g002.jpg', 'caption': 'Sagittal cut abdominal pelvic CT of case 1 showing whirl sign in the small bowel.', 'hash': '78331dd7e3902ea726b8acd595cb18d6a1cf1557c99ffcec0e62bbbcde510dac'}] | {'amjcaserep-17-712-g001': ['A computed tomography (CT) scan was ordered the same day, showing the presence of a significant gastric and duodenal distension proximal to a magma containing small bowel (<xref ref-type="fig" rid="amjcaserep-17-712-g001">Figures 1</xref><xref ref-type="fig" rid="amjcaserep-17-712-g002" />––<xref ref-type="fig" rid="amjcaserep-17-712-g003">3</xref>). No significant retroperitoneal or mesenteric lymph nodes were noted. The picture is compatible with a volvulus, internal hernia, or the presence of a band at this level. Additionally, fluid was noted in the Douglas pouch.). No significant retroperitoneal or mesenteric lymph nodes were noted. The picture is compatible with a volvulus, internal hernia, or the presence of a band at this level. Additionally, fluid was noted in the Douglas pouch.'], 'amjcaserep-17-712-g004': ['A CT scan of the abdomen and pelvis with intravenous contrast showed the presence of mesenteric fat infiltration in the left upper quadrant, associated with multiple nodes and a “whirlpool “ sign, as well as some jejunal dilation distally (<xref ref-type="fig" rid="amjcaserep-17-712-g004">Figures 4</xref>, , <xref ref-type="fig" rid="amjcaserep-17-712-g005">5</xref>). This was compatible with an internal hernia, to be correlated with clinical findings. Presence of liquid in the Douglas pouch was also noted.). This was compatible with an internal hernia, to be correlated with clinical findings. Presence of liquid in the Douglas pouch was also noted.'], 'amjcaserep-17-712-g006': ['A CT scan of the abdomen and pelvis with intravenous contrast was done and showed small bowel dilatation of the middle third and distal third of the jejunum. There was also, to a lesser degree, an ileal dilation that did not extend to the terminal ileum (<xref ref-type="fig" rid="amjcaserep-17-712-g006">Figures 6</xref>, , <xref ref-type="fig" rid="amjcaserep-17-712-g007">7</xref>). Additionally, a moderate effusion was noted in the cul-de-sac.). Additionally, a moderate effusion was noted in the cul-de-sac.'], 'amjcaserep-17-712-g008': ['The procedure was begun with a midline infraumbilical laparotomy incision. Dilated small bowel loops were identified from the mid jejunum until the terminal ileum. Two mesenteric bands were identified. One band was identified in the mid jejunum and the other in the terminal ileum (<xref ref-type="fig" rid="amjcaserep-17-712-g008">Figures 8</xref>, , <xref ref-type="fig" rid="amjcaserep-17-712-g009">9</xref>). Enterolysis was performed to liberate the bowel loops. Afterwards the bowels were cleared via retrograde emptying by milking and gastric aspiration. The abdomen was then washed well and closed.). Enterolysis was performed to liberate the bowel loops. Afterwards the bowels were cleared via retrograde emptying by milking and gastric aspiration. The abdomen was then washed well and closed.']} | Diagnosis and Treatment of Small Bowel Strangulation Due To Congenital Band: Three Cases of Congenital Band in Adults Lacking a History of Trauma or Surgery | [
"General Surgery",
"Hand-Assisted Laparoscopy",
"Laparotomy"
] | Am J Case Rep | 1475823600 | [{'@Label': 'UNLABELLED', '#text': 'On the basis of total temperature increase, normal dehydration, and maturity, the odor compositions of surface and internal piles in a well-run sewage sludge compost plant were analyzed using gas chromatography-mass spectrometry with a liquid nitrogen cooling system and a portable odor detector. Approximately 80 types of substances were detected, including 2 volatile inorganic compounds, 4 sulfur organic compounds, 16 benzenes, 27 alkanes, 15 alkenes, and 19 halogenated compounds. Most pollutants were mainly produced in the mesophilic and pre-thermophilic periods. The sulfur volatile organic compounds contributed significantly to odor and should be controlled primarily. Treatment strategies should be based on the properties of sulfur organic compounds. Hydrogen sulfide, methyl mercaptan, dimethyl disulfide, dimethyl sulfide, ammonia, and carbon disulfide were selected as core indicators. Ammonia, hydrogen sulfide, carbon disulfide, dimethyl disulfide, methyl mercaptan, dimethylbenzene, phenylpropane, and isopentane were designated as concentration indicators. Benzene, m-xylene, p-xylene, dimethylbenzene, dichloromethane, toluene, chlorobenzene, trichloromethane, carbon tetrachloride, and ethylbenzene were selected as health indicators. According to the principle of odor pollution indicator selection, dimethyl disulfide was selected as an odor pollution indicator of sewage sludge composting. Monitoring dimethyl disulfide provides a highly scientific method for modeling and evaluating odor pollution from sewage sludge composting facilities.'}, {'@Label': 'IMPLICATIONS', '#text': 'Composting is one of the most important methods for sewage sludge treatment and improving the low organic matter content of many agricultural soils. However, odors are inevitably produced during the composting process. Understanding the production and emission patterns of odors is important for odor control and treatment. Core indicators, concentration indicators, and health indicators provide an index system to odor evaluation. An odor pollution indicator provides theoretical support for further modelling and evaluating odor pollution from sewage sludge composting facilities.'}] | [
"Air Pollutants",
"Air Pollution",
"Environmental Monitoring",
"Gas Chromatography-Mass Spectrometry",
"Odorants",
"Sewage",
"Soil"
] | other | PMC5058432 | null | 39 | [
"{'Citation': 'Aggelides S.M., Londra P.A. Effects of compost produced from town wastes and sewage sludge on the physical properties of a loamy and a clay soil. Bioresource Technol. 2000;71::253–259. doi: 10.1016/S0960-8524(99)00074-7.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1016/S0960-8524(99)00074-7'}}}",
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] | Am J Case Rep. 2016 Oct 7; 17:712-719 | NO-CC CODE |
|
Coronal cut abdominal pelvic CT of case 2 showing small bowel obstruction. | amjcaserep-17-712-g005 | 7 | 03583bb8a9f3395b4f9e52b91b7c6b0048a906efd372ff57ccc0a342d5b8e975 | amjcaserep-17-712-g005.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
640,
640
] | [{'image_id': 'amjcaserep-17-712-g008', 'image_file_name': 'amjcaserep-17-712-g008.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g008.jpg', 'caption': 'Case 3 band causing obstruction of the small bowel at the level of the jejunum.', 'hash': 'fba5f5a73fd81af9c51fa26b665705ea2885a41e18b20f8569426020f7c62185'}, {'image_id': 'amjcaserep-17-712-g001', 'image_file_name': 'amjcaserep-17-712-g001.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g001.jpg', 'caption': 'Coronal cut abdominal pelvic CT of case 1 showing a transition zone in the small bowel.', 'hash': '2226a3b7744b1323894eb62f93d1afe2ebb8bb69f35220e89d57dea35ab35b16'}, {'image_id': 'amjcaserep-17-712-g006', 'image_file_name': 'amjcaserep-17-712-g006.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g006.jpg', 'caption': 'Transverse cut abdominal pelvic CT of case 3 showing transition zone in the small bowel.', 'hash': 'd75d709e1705ab6a9e9ceeee2289731e49ab289c00d072c7915d23f945b573f5'}, {'image_id': 'amjcaserep-17-712-g007', 'image_file_name': 'amjcaserep-17-712-g007.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g007.jpg', 'caption': 'Sagittal cut abdominal pelvic CT of case 3 showing a transition zone in the small bowel.', 'hash': 'c94382ed75524bbfd5df82c145f3d334e436bac1eb93c2c6e0cae58459735053'}, {'image_id': 'amjcaserep-17-712-g009', 'image_file_name': 'amjcaserep-17-712-g009.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g009.jpg', 'caption': 'Case 3 band causing small bowel obstruction at the level of the terminal ileum.', 'hash': '587532bb8b292ee224b5567c7464569f29165d2dc32e92648211aa98d16a4fa0'}, {'image_id': 'amjcaserep-17-712-g003', 'image_file_name': 'amjcaserep-17-712-g003.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g003.jpg', 'caption': 'Transverse cut abdominal pelvic CT of case 1 showing a transition zone in the small bowel.', 'hash': '1776ce788756232e4ee2531f716d714c93b33771f040ef663ec97eb9cf5b6b30'}, {'image_id': 'amjcaserep-17-712-g004', 'image_file_name': 'amjcaserep-17-712-g004.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g004.jpg', 'caption': 'Transverse cut abdominal pelvic CT of case 2 showing a whirl sign in the small bowel.', 'hash': '12a1e09355529781549320029b003d2f9491885b88720d2a7b0c8b2cd5ebecdd'}, {'image_id': 'amjcaserep-17-712-g005', 'image_file_name': 'amjcaserep-17-712-g005.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g005.jpg', 'caption': 'Coronal cut abdominal pelvic CT of case 2 showing small bowel obstruction.', 'hash': '03583bb8a9f3395b4f9e52b91b7c6b0048a906efd372ff57ccc0a342d5b8e975'}, {'image_id': 'amjcaserep-17-712-g002', 'image_file_name': 'amjcaserep-17-712-g002.jpg', 'image_path': '../data/media_files/PMC5058432/amjcaserep-17-712-g002.jpg', 'caption': 'Sagittal cut abdominal pelvic CT of case 1 showing whirl sign in the small bowel.', 'hash': '78331dd7e3902ea726b8acd595cb18d6a1cf1557c99ffcec0e62bbbcde510dac'}] | {'amjcaserep-17-712-g001': ['A computed tomography (CT) scan was ordered the same day, showing the presence of a significant gastric and duodenal distension proximal to a magma containing small bowel (<xref ref-type="fig" rid="amjcaserep-17-712-g001">Figures 1</xref><xref ref-type="fig" rid="amjcaserep-17-712-g002" />––<xref ref-type="fig" rid="amjcaserep-17-712-g003">3</xref>). No significant retroperitoneal or mesenteric lymph nodes were noted. The picture is compatible with a volvulus, internal hernia, or the presence of a band at this level. Additionally, fluid was noted in the Douglas pouch.). No significant retroperitoneal or mesenteric lymph nodes were noted. The picture is compatible with a volvulus, internal hernia, or the presence of a band at this level. Additionally, fluid was noted in the Douglas pouch.'], 'amjcaserep-17-712-g004': ['A CT scan of the abdomen and pelvis with intravenous contrast showed the presence of mesenteric fat infiltration in the left upper quadrant, associated with multiple nodes and a “whirlpool “ sign, as well as some jejunal dilation distally (<xref ref-type="fig" rid="amjcaserep-17-712-g004">Figures 4</xref>, , <xref ref-type="fig" rid="amjcaserep-17-712-g005">5</xref>). This was compatible with an internal hernia, to be correlated with clinical findings. Presence of liquid in the Douglas pouch was also noted.). This was compatible with an internal hernia, to be correlated with clinical findings. Presence of liquid in the Douglas pouch was also noted.'], 'amjcaserep-17-712-g006': ['A CT scan of the abdomen and pelvis with intravenous contrast was done and showed small bowel dilatation of the middle third and distal third of the jejunum. There was also, to a lesser degree, an ileal dilation that did not extend to the terminal ileum (<xref ref-type="fig" rid="amjcaserep-17-712-g006">Figures 6</xref>, , <xref ref-type="fig" rid="amjcaserep-17-712-g007">7</xref>). Additionally, a moderate effusion was noted in the cul-de-sac.). Additionally, a moderate effusion was noted in the cul-de-sac.'], 'amjcaserep-17-712-g008': ['The procedure was begun with a midline infraumbilical laparotomy incision. Dilated small bowel loops were identified from the mid jejunum until the terminal ileum. Two mesenteric bands were identified. One band was identified in the mid jejunum and the other in the terminal ileum (<xref ref-type="fig" rid="amjcaserep-17-712-g008">Figures 8</xref>, , <xref ref-type="fig" rid="amjcaserep-17-712-g009">9</xref>). Enterolysis was performed to liberate the bowel loops. Afterwards the bowels were cleared via retrograde emptying by milking and gastric aspiration. The abdomen was then washed well and closed.). Enterolysis was performed to liberate the bowel loops. Afterwards the bowels were cleared via retrograde emptying by milking and gastric aspiration. The abdomen was then washed well and closed.']} | Diagnosis and Treatment of Small Bowel Strangulation Due To Congenital Band: Three Cases of Congenital Band in Adults Lacking a History of Trauma or Surgery | [
"General Surgery",
"Hand-Assisted Laparoscopy",
"Laparotomy"
] | Am J Case Rep | 1475823600 | [{'@Label': 'UNLABELLED', '#text': 'On the basis of total temperature increase, normal dehydration, and maturity, the odor compositions of surface and internal piles in a well-run sewage sludge compost plant were analyzed using gas chromatography-mass spectrometry with a liquid nitrogen cooling system and a portable odor detector. Approximately 80 types of substances were detected, including 2 volatile inorganic compounds, 4 sulfur organic compounds, 16 benzenes, 27 alkanes, 15 alkenes, and 19 halogenated compounds. Most pollutants were mainly produced in the mesophilic and pre-thermophilic periods. The sulfur volatile organic compounds contributed significantly to odor and should be controlled primarily. Treatment strategies should be based on the properties of sulfur organic compounds. Hydrogen sulfide, methyl mercaptan, dimethyl disulfide, dimethyl sulfide, ammonia, and carbon disulfide were selected as core indicators. Ammonia, hydrogen sulfide, carbon disulfide, dimethyl disulfide, methyl mercaptan, dimethylbenzene, phenylpropane, and isopentane were designated as concentration indicators. Benzene, m-xylene, p-xylene, dimethylbenzene, dichloromethane, toluene, chlorobenzene, trichloromethane, carbon tetrachloride, and ethylbenzene were selected as health indicators. According to the principle of odor pollution indicator selection, dimethyl disulfide was selected as an odor pollution indicator of sewage sludge composting. Monitoring dimethyl disulfide provides a highly scientific method for modeling and evaluating odor pollution from sewage sludge composting facilities.'}, {'@Label': 'IMPLICATIONS', '#text': 'Composting is one of the most important methods for sewage sludge treatment and improving the low organic matter content of many agricultural soils. However, odors are inevitably produced during the composting process. Understanding the production and emission patterns of odors is important for odor control and treatment. Core indicators, concentration indicators, and health indicators provide an index system to odor evaluation. An odor pollution indicator provides theoretical support for further modelling and evaluating odor pollution from sewage sludge composting facilities.'}] | [
"Air Pollutants",
"Air Pollution",
"Environmental Monitoring",
"Gas Chromatography-Mass Spectrometry",
"Odorants",
"Sewage",
"Soil"
] | other | PMC5058432 | null | 39 | [
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"{'Citation': 'Ahn H., Richard T., Choi H. Mass and thermal balance during composting of a poultry manure-wood shavings mixture at different aeration rates. Process Biochem. 2007;42(2):215–223. doi: 10.1016/j.procbio.2006.08.005.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1016/j.procbio.2006.08.005'}}}",
"{'Citation': 'Akdeniz N., Koziel J.A., Ahn H.K., Glanville T.D., Crawford B.P. Field scale evaluation of volatile organic compound production inside biosecure swine mortality composts. Waste Manage. 2010;30:1981–1988. doi: 10.1016/j.wasman.2010.05.022.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.wasman.2010.05.022'}, {'@IdType': 'pubmed', '#text': '20646921'}]}}",
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] | Am J Case Rep. 2016 Oct 7; 17:712-719 | NO-CC CODE |
|
Preoperative MRI showing prone positioning of the ureter at the level of L3/L4 and dilated ureter at this level. | fig-4 | 7 | 23ea4f321986c219c7660067ce3ff7d729d1653c0a053c18ede2363bf260e5fa | fig-4.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
788,
657
] | [{'image_id': 'fig-1', 'image_file_name': 'fig-1.jpg', 'image_path': '../data/media_files/PMC5684662/fig-1.jpg', 'caption': 'CT scan of abdomen and pelvis. (a) Large lobulated fluid-filled retroperitoneal mass surrounding the left psoas muscle with left hydronephrosis. (b) Left renal pelvis and ureter with contrast entering the mass at the level of L3.', 'hash': '637a6a6e9129f1c4f63ca8ab36e277f577c88a9b1c619eeb5ea1b05606f88e80'}, {'image_id': 'fig-4', 'image_file_name': 'fig-4.jpg', 'image_path': '../data/media_files/PMC5684662/fig-4.jpg', 'caption': 'Preoperative MRI showing prone positioning of the ureter at the level of L3/L4 and dilated ureter at this level.', 'hash': '23ea4f321986c219c7660067ce3ff7d729d1653c0a053c18ede2363bf260e5fa'}, {'image_id': 'fig-3', 'image_file_name': 'fig-3.jpg', 'image_path': '../data/media_files/PMC5684662/fig-3.jpg', 'caption': 'Left retrograde ureterogram with simultaneous nephrostogram. (a) Retrograde left ureteral leak at the level of L3 interdisk space. (b) Lack of contrast flowing in the proximal and distal ureter with a 5\u2009cm defect.', 'hash': 'c6aeb50facd6d8b0cc009135d1015d0c315be33e18179f1040d01f751548acec'}, {'image_id': 'fig-2', 'image_file_name': 'fig-2.jpg', 'image_path': '../data/media_files/PMC5684662/fig-2.jpg', 'caption': 'Left nephrostogram showing a blind-ending ureter.', 'hash': '67b97497ae08561d2904c23e521c0b9078563308e53a2fbf01067a28bf6fe935'}] | {'fig-1': ['The patient underwent a CT scan of his abdomen and pelvis with intravenous contrast. This showed a large lobulated fluid-filled retroperitoneal mass surrounding the left psoas muscle with left hydronephrosis (<xref ref-type="fig" rid="fig-1">Fig. 1a</xref>). Contrast was seen in the left renal pelvis and ureter with contrast entering the mass at the level of L3 (). Contrast was seen in the left renal pelvis and ureter with contrast entering the mass at the level of L3 (<xref ref-type="fig" rid="fig-1">Fig. 1b</xref>). His right kidney appeared normal and no other abnormalities were identified.). His right kidney appeared normal and no other abnormalities were identified.'], 'fig-2': ['A percutaneous drain was placed into the urinoma and a left-sided nephrostomy tube in renal pelvis. Antegrade nephrostogram shows a blind-ending proximal ureter (<xref ref-type="fig" rid="fig-2">Fig. 2</xref>). Insertion of a nephroureterostomy tube (NUT) was not attempted at this time. The patient underwent cystoscopy and left retrograde ureterogram with simultaneous nephrostogram, which showed a retrograde left ureteral injury at the level of L3–L4 (). Insertion of a nephroureterostomy tube (NUT) was not attempted at this time. The patient underwent cystoscopy and left retrograde ureterogram with simultaneous nephrostogram, which showed a retrograde left ureteral injury at the level of L3–L4 (<xref ref-type="fig" rid="fig-3">Fig. 3a</xref>). The lack of contrast flowing between the proximal and distal ureter confirmed a complete ureteral disruption with a 5\u2009cm defect (). The lack of contrast flowing between the proximal and distal ureter confirmed a complete ureteral disruption with a 5\u2009cm defect (<xref ref-type="fig" rid="fig-3">Fig. 3b</xref>). Attempts to simultaneously pass a retrograde hydrophilic guidewire and an antegrade NUT were unsuccessful.). Attempts to simultaneously pass a retrograde hydrophilic guidewire and an antegrade NUT were unsuccessful.'], 'fig-4': ['In the limited previous reports, ureteral injury tends to be on the contralateral side to discectomy.4 This has been described because of tangential passage of instruments. In our case, the injury was also contralateral and at the level of L3–L4 where the ureter is anterior to the psoas muscle and moving medial toward the vertebrae. Also, our patient was lean with BMI of 23\u2009kg/m2, placed in prone position with bolsters at the time of discectomy. Furthermore, preoperative MRI indicates a dilated ureter at this level, which would increase the likelihood of injury and possible mechanism contributing to continued leakage (<xref ref-type="fig" rid="fig-4">Fig. 4</xref>). Factors such as large disk herniation and excessive bleeding likely further contribute to occurrence of this complication.). Factors such as large disk herniation and excessive bleeding likely further contribute to occurrence of this complication.4 As with most iatrogenic ureteral injuries, these can be prevented with more experience, careful planning, and patient positioning, along with review of preoperative imaging.']} | A Rare Ureteral Injury Following Posterior Approach Lumbar Discectomy | [
"ureter",
"discectomy",
"intraoperative complication",
"urinoma"
] | J Endourol Case Rep | 1509519600 | Despite the known benefits of regular physical activity, research shows a significant decline in physical activity participation and an increase in sedentary behavior during young adulthood during the college years. Studies examining the relationship between academic outcomes and fitness/physical activity have not extensively examined this among college students. Therefore, the purpose of this study was to examine the relationship between fitness measures (cardiovascular endurance, muscular endurance, flexibility and body composition), physical activity, and academic outcomes in college students. This cross-sectional study had college students complete a one-time fitness assessment and survey examining their physical activity and academic factors (GPA, study habits, course load). Correlations examined relationships between fitness, physical activity and academic outcomes, t-tests compared differences for fitness and behavioral outcomes between groups by academic factors. The final sample (n=512) was 50.4% male, 78% Non-Hispanic White, and 67% upperclassmen. The majority (76%) of participants reported meeting current PA guidelines. Hours of studying and social media use were both positively associated with body fat. Course load was negatively associated with vigorous activity. Study time was negatively associated with cardiovascular endurance, positively associated with hip flexibility and sedentary behavior. Higher GPA was associated with a higher BMI and a higher credit load was associated with less vigorous physical activity. These findings indicated that academic outcomes and physical activity may have a different relationship among college students compared with younger age groups. This study provides insight for the development of future campus-based health initiatives to have a shared focus of academic outcomes and physical activity. | [] | other | PMC5684662 | null | 21 | [
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"{'Citation': 'Van Dyck D, De Bourdeaudhuij I, Deliens T, Deforche B. Can changes in psychosocial factors and residency explain the decrease in physical activity during the transition from high school to college or university? Int J Behav Med. 2015;22(2):178–186.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '25031186'}}}"
] | J Endourol Case Rep. 2017 Nov 1; 3(1):158-161 | NO-CC CODE |
|
Coronal section of CT of chest showing “fallen lung sign” | 12245_2009_155_Fig3_HTML | 7 | e415d2411e79ab1170797cc0b2aba361009fe7909fceccbe47b2de937e95937f | 12245_2009_155_Fig3_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
496,
496
] | [{'image_id': '12245_2009_155_Fig3_HTML', 'image_file_name': '12245_2009_155_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC2926876/12245_2009_155_Fig3_HTML.jpg', 'caption': 'Coronal section of CT of chest showing “fallen lung sign”', 'hash': 'e415d2411e79ab1170797cc0b2aba361009fe7909fceccbe47b2de937e95937f'}, {'image_id': '12245_2009_155_Fig2_HTML', 'image_file_name': '12245_2009_155_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC2926876/12245_2009_155_Fig2_HTML.jpg', 'caption': 'Coronal section of CT of chest showing ruptured lateral wall of right main bronchus, collapsed lung and severe pneumothorax', 'hash': '70eeb86e0bcac109123a6494d4174a0e6504f2c74f1854d8eba7f3b9b6282390'}, {'image_id': '12245_2009_155_Fig1_HTML', 'image_file_name': '12245_2009_155_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC2926876/12245_2009_155_Fig1_HTML.jpg', 'caption': 'Plain chest radiograph showing right-sided tension pneumothorax, collapsed right lung, ICD in situ, mediastinum and tracheal shift to left', 'hash': '06a73287f93a2174ea35964654b8f317a656b7dc80adfc24ed555e324d0a4629'}] | {'12245_2009_155_Fig1_HTML': ['On arrival to our emergency department (ED) the patient was conscious and oriented, haemodynamically stable, but very dyspnoeic and his oxygen saturation was 80% on non-rebreathing mask. The patient’s ICD on the right side was patent and functioning well. There was continuous and profuse bubbling noted in the ICD bag. There was extensive subcutaneous emphysema and absent breath sounds on the right side, with tracheal deviation to the left. A bedside chest radiograph was done immediately, which showed features of right-sided tension pneumothorax with completely collapsed right lung (Fig.\xa0<xref rid="12245_2009_155_Fig1_HTML" ref-type="fig">1</xref>). There was no change as compared with the previous chest radiographs.\n). There was no change as compared with the previous chest radiographs.\nFig.\xa01Plain chest radiograph showing right-sided tension pneumothorax, collapsed right lung, ICD in situ, mediastinum and tracheal shift to left'], '12245_2009_155_Fig2_HTML': ['When the ICD tube was connected to low-pressure suction the patient had symptomatic relief transiently. Hence, the possibility of bronchial injury was suspected and computed tomography (CT) of the chest was done, which showed right-sided tension pneumothorax, with ICD in situ, a large tear in the right main bronchus, multiple traumatic contusions of the left lung and multiple rib fractures (Fig.\xa0<xref rid="12245_2009_155_Fig2_HTML" ref-type="fig">2</xref>). Cardiothoracic surgeons’ opinion was sought and they advised immediate surgical repair with a possibility of right pneumonectomy as the bronchial defect was large. It was a case with high risk and poor prognosis, as the left lung too was contused extensively. The need for emergency surgery and prognosis were explained to the patient’s relatives, but they were not willing to give consent for further management; hence, the patient was discharged against medical advice.\n). Cardiothoracic surgeons’ opinion was sought and they advised immediate surgical repair with a possibility of right pneumonectomy as the bronchial defect was large. It was a case with high risk and poor prognosis, as the left lung too was contused extensively. The need for emergency surgery and prognosis were explained to the patient’s relatives, but they were not willing to give consent for further management; hence, the patient was discharged against medical advice.\nFig.\xa02Coronal section of CT of chest showing ruptured lateral wall of right main bronchus, collapsed lung and severe pneumothorax'], '12245_2009_155_Fig3_HTML': ['The “fallen lung sign” is specific for complete bronchial transection. This sign describes the lung falling dependently, rather than collapsing centrally toward the hilum in the presence of a pneumothorax (Fig.\xa0<xref rid="12245_2009_155_Fig3_HTML" ref-type="fig">3</xref>).).']} | Traumatic bronchial rupture: an unusual cause of tension pneumothorax | [
"Traumatic bronchial rupture",
"Tracheobronchial tear",
"Blunt airway injury"
] | Int J Emerg Med | 1270796400 | The axonal targets of perisomatic targeting interneurons make them ideally suited to synchronize excitatory neurons. As such they have been implicated in rhythm generation of network activity in many brain regions including the hippocampus. However, several recent publications indicate that their roles extend beyond that of rhythm generation. Firstly, it has been shown that, in addition to rhythm generation, GABAergic perisomatic inhibition also serves as a current generator contributing significantly to hippocampal oscillatory EEG signals. Furthermore, GABAergic interneurons have a previously unrecognized role in the initiation of hippocampal population bursts, both in the developing and adult hippocampus. In this review, we describe these new observations in detail and discuss the implications they have for our understanding of the mechanisms underlying physiological and pathological hippocampal network activities. This review is part of the Frontiers in Cellular Neuroscience's special topic entitled "GABA signaling in health and disease" based on the meeting at the CNCR Amsterdam. | [] | other | PMC2926876 | null | 138 | [
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] | Int J Emerg Med. 2010 Apr 9; 3(3):193-195 | NO-CC CODE |
|
Axial, enhanced computed tomography image of the pelvis demonstrates a mass in the anatomic region of the right ovary, corresponding to the ovary’s schwannoma.Note: The enlarged ovary is well delineated, with internal low density and enhanced peripherally.Abbreviations: UT, uterus; BL, urinary bladder; RE, rectum. | ijgm-6-123f1 | 7 | 99e898711cf1c8299a62e9c026110d92c8c8e7ed6fcfa7859b7999d85b6bdf07 | ijgm-6-123f1.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
654,
421
] | [{'image_id': 'ijgm-6-123f1', 'image_file_name': 'ijgm-6-123f1.jpg', 'image_path': '../data/media_files/PMC3598498/ijgm-6-123f1.jpg', 'caption': 'Axial, enhanced computed tomography image of the pelvis demonstrates a mass in the anatomic region of the right ovary, corresponding to the ovary’s schwannoma.Note: The enlarged ovary is well delineated, with internal low density and enhanced peripherally.Abbreviations: UT, uterus; BL, urinary bladder; RE, rectum.', 'hash': '99e898711cf1c8299a62e9c026110d92c8c8e7ed6fcfa7859b7999d85b6bdf07'}, {'image_id': 'ijgm-6-123f3', 'image_file_name': 'ijgm-6-123f3.jpg', 'image_path': '../data/media_files/PMC3598498/ijgm-6-123f3.jpg', 'caption': 'Histological findings. (A) Biphasic pattern mainly with Antoni A and few hypocellular, Antoni B, areas (x100). (B–C) Higher magnification of Antoni A areas (x200). (D) S-100 protein positivity of the elongated tumor cells (x200).', 'hash': '91d3f9198f6b9a2e39f8165c861be97dc75134209215e52af6e93d1140430a27'}, {'image_id': 'ijgm-6-123f2', 'image_file_name': 'ijgm-6-123f2.jpg', 'image_path': '../data/media_files/PMC3598498/ijgm-6-123f2.jpg', 'caption': 'Surgically resected lesion, which was noted in the right parametrium measuring 6.5 × 5.5 cm.', 'hash': '7248e9acb93e96f4395f69bfd0157bb6640cfc0560832032cd63c6a30c90ac27'}] | {'ijgm-6-123f1': ['A 58-year-old Caucasian woman was admitted to the gynecology out-patient department for management of increasing abdominal distension and sustained pain in the right bottom quadrant of her abdomen that had been ongoing for 3 months, was independent of activities, and was without any signs of neurovascular deficit. She also mentioned a 1-week history of vomiting and nausea. Around that time she also started to suffer from increased frequency of minor urinary incontinence. In the last 48 hours the pain was located in the right iliac fossa. Her medical history and family history were unremarkable. Her surgical history included only an appendectomy as a child, while her obstetric history was remarkable only for five natural childbirths. A bimanual pelvic exam revealed an agile cervix and a large, solid, ovoid, palpable mass in the right parametrium, which was particularly sensitive to touch. Her routine hematological investigation and urine analysis as well as examination of several tumor markers, including carcinoembryonic antigen, α-fetoprotein, and carbohydrate antigen 19.9, were all within normal limits. Initial radiographs failed to reveal tumor-like masses. A gynecologic ultrasonography was performed, which revealed an increase in the size of the right ovary (56.6 × 35 mm) and the possible presence of a cystic formation measuring 32.5 mm. Computer tomography confirmed the presence of a mass in the anatomic region of the right ovary, corresponding to the ovary’s schwannoma (<xref ref-type="fig" rid="ijgm-6-123f1">Figure 1</xref>).).'], 'ijgm-6-123f2': ['The preoperative findings showed we had to deal with a retroperitoneal tumor of unknown pathology in a menopausal woman. In order to ensure the optimum treatment and survival for our patient, we performed laparotomy with total abdominal hysterectomy and en-block tumor excision. The abdomen was opened through a lower midline incision. A large retroperitoneal mass, measuring 6.5 × 5.5 cm, was noted in the right parametrium and was in close proximity to the interal-iliac vein, which was ligated (<xref ref-type="fig" rid="ijgm-6-123f2">Figure 2</xref>). A frozen section was taken during the surgery before complete resection of the mass, which was ambiguous. Because of the possibility of malignancy, complete excision of the mass was performed with pelvic blunt dissection. Histological examination showed a benign neoplasm originating from the cells of the peripheral nerve sheath; diagnosis was a schwannoma. The tumor showed a biphasic pattern consisting mainly of cellular areas with nuclear palisading (Antoni A) and few hypocellular areas with loose texture (Antoni B) (Figure A, B and C). The tumor cells were spindle-shaped with spindle nuclei without atypia.). A frozen section was taken during the surgery before complete resection of the mass, which was ambiguous. Because of the possibility of malignancy, complete excision of the mass was performed with pelvic blunt dissection. Histological examination showed a benign neoplasm originating from the cells of the peripheral nerve sheath; diagnosis was a schwannoma. The tumor showed a biphasic pattern consisting mainly of cellular areas with nuclear palisading (Antoni A) and few hypocellular areas with loose texture (Antoni B) (Figure A, B and C). The tumor cells were spindle-shaped with spindle nuclei without atypia.']} | Pelvic schwannoma in the right parametrium | [
"pelvis",
"schwannoma",
"laparoscopy",
"neoplasm"
] | Int J Gen Med | 1362729600 | Neurilemomas are benign usually encapsulated nerve sheath tumors derived from the Schwann cells. These tumors commonly arise from the cranial nerves as acoustic neurinomas but they are extremely rare in the pelvis and the retroperitoneal area (less than 0.5% of reported cases), unless they are combined with von Recklinghausen disease (type 1 neurofibromatosis). We report the case of a 58-year-old female with pelvic schwannoma, 6.5 × 5.5 cm in size, in the right parametrium. This is the first case reported in the literature. Based on the rarity of this tumor and in order to ensure optimum treatment and survival for our patient, we performed laparotomy with total abdominal hysterectomy and en-block tumor excision. A frozen section was taken during the surgery before complete resection of the mass, which was ambiguous. Because of the possibility of malignancy, complete excision of the mass was performed, with pelvic blunt dissection. Histological examination showed a benign neoplasm, originating from the cells of peripheral nerve sheaths; diagnosis was a schwannoma. There were degenerative areas, including cystic degeneration, hemorrhagic infiltrations, ischemic foci with pycnotic cells, and collagen replacement. Pelvic schwannomas are rare neoplasms that can be misdiagnosed. Laparoscopy is a safe and efficient option for approaching benign pelvic tumors and might offer the advantage of better visualization of structures due to the magnification in laparoscopic view, especially in narrow anatomic spaces. | [] | other | PMC3598498 | null | 24 | [
"{'Citation': 'Rao W, Wang G, Xiu D. Laparoscopic resection of a retroperitoneal schwannoma adherent to vital vessels. Surg Laparosc Endosc Percutan Tech. 2009;19(1):e21–e23.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19238051'}}}",
"{'Citation': 'Funamizu N, Sasaki A, Matsumoto T, Inomata M, Shiraishi N, Kitano S. Laparoscopic resection of a retroperitoneal schwannoma behind the lesser omental sac. Surg Laparosc Endosc Percutan Tech. 2004;14(3):175–177.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15471028'}}}",
"{'Citation': 'Mehta M, Thurston WA, Merchant N, Murphy KJ. Obturator nerve schwannoma presenting as an adnexal mass: case report. Can Assoc Radiol J. 1999;50(1):20–22.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10047744'}}}",
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"{'Citation': 'Dawley B. A retroperitoneal femoral nerve schwannoma as a cause of chronic pelvic pain. J Minim Invasive Gynecol. 2008;15(4):491–493.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18602049'}}}",
"{'Citation': 'Strauss DC, Qureshi YA, Hayes AJ, Thomas JM. Management of benign retroperitoneal schwannomas: a single-center experience. Am J Surg. 2011;202(2):194–198.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21810500'}}}",
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"{'Citation': 'Sinha R, Sundaram M, Hegde A, Mahajan C. Pelvic schwannoma masquerading as broad ligament myoma. J Minim Invasive Gynecol. 2008;15(2):217–219.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18312995'}}}",
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"{'Citation': 'Shoher A, Arbab F, Lucci A., Jr Giant pelvic schwannoma with ancient change. J Am Coll Surg. 2003;197(1):163.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12831937'}}}",
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"{'Citation': 'Ibraheim M, Ikomi A, Khan F. A pelvic retroperitoneal schwannoma mimicking an ovarian dermoid cyst in pregnancy. J Obstet Gynaecol. 2005;25(6):620–621.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16234165'}}}",
"{'Citation': 'Aran T, Guven S, Gocer S, Ersoz S, Bozkaya H. Large retroperitoneal schwannoma mimicking ovarian carcinoma: case report and literature review. Eur J Gynaecol Oncol. 2009;30(4):446–448.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19761143'}}}",
"{'Citation': 'Song JY, Kim SY, Park EG, et al. Schwannoma in the retroperitoneum. J Obstet Gynaecol Res. 2007;33(3):371–375.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17578370'}}}",
"{'Citation': 'Duran B, Guvenal T, Yildiz E, Cetin M, Erden O, Demirkoprulu N. An unusual cause of adnexal mass: fallopian tube schwannoma. Gynecol Oncol. 2004;92(1):343–346.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14751182'}}}",
"{'Citation': 'Lallas TA, Mehaffey PC, Lager DJ, Van Voorhis BJ, Sorosky JI. Malignant cervical schwannoma: An unusual pelvic tumor. Gynecol Oncol. 1999;72(2):238–242.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10021307'}}}",
"{'Citation': 'Yadav Y, Onon T, Sukumar S. Conservative management of a pelvic Schwannoma presenting as an adnexal mass. J Obstet Gynaecol. 2008;28(3):364–365.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18569501'}}}",
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"{'Citation': 'Ningshu L, Min Y, Xieqiao Y, Yuanqing Y, Xiaoqiang M, Rubing L. Laparoscopic management of obturator nerve schwannomas: experiences with 6 cases and review of the literature. Surg Laparosc Endosc Percutan Tech. 2012;22(2):143–147.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '22487629'}}}",
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"{'Citation': 'Wolpert A, Beer–Gabel M, Lifschitz O, Zbar AP. The management of presacral masses in the adult. Tech Coloproctol. 2002;6(1):43–49.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12077641'}}}"
] | Int J Gen Med. 2013 Mar 8; 6:123-126 | NO-CC CODE |
|
Choanal atresia. This disorder frequently presents at birth with respiratory distress. | f55-03-9780323072557 | 7 | 607b2ba755d56c16fe7b264b21665bebfadcca5fcde76e214f8317a33d42c42d | f55-03-9780323072557.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
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357,
354
] | [{'image_id': 'f55-07-9780323072557', 'image_file_name': 'f55-07-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-07-9780323072557.jpg', 'caption': 'Tonsillar hypertrophy. Tonsillar hypertrophy is rated on a scale of 1 to 4. Grade 1+ tonsils are hypertrophic, grade 2+ tonsils extend slightly beyond the tonsillar pillars, grade 3+ tonsils extend in a medial direction beyond the anterior tonsillar pillars, and grade 4+ tonsils touch in the midline.', 'hash': 'f98240d7b26d35a28fa558914ba08d3a95e4b1882239ddfc35895e230c29df35'}, {'image_id': 'f55-12-9780323072557', 'image_file_name': 'f55-12-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-12-9780323072557.jpg', 'caption': 'Laryngomalacia. This disorder classically presents as an omega-shaped epiglottis. The arytenoid mucosa is redundant, and the aryepiglottic folds are foreshortened. The result is a hooding of tissue over the glottic inlet that leads to airway obstruction on inspiration.', 'hash': '9ca19b34868832da9963599b919ce3b5fd494acbd50d1356cfaa6405ec70d589'}, {'image_id': 'f55-01-9780323072557', 'image_file_name': 'f55-01-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-01-9780323072557.jpg', 'caption': 'Acute mastoiditis. Extension of the acute inflammatory process from the middle ear and mastoid air cell systems to the overlying soft tissues displaces the auricle in an inferior and lateral direction from the side of the head. Fluctuance may be palpated over the mastoid cortex, and a defect in the cortical bone can frequently be appreciated. Surgical drainage with mastoidectomy is required.', 'hash': '3c4d2e4aafe0dc1d84395c0e4f19186c006d78ec7c39d55fc165b0e5d414d256'}, {'image_id': 'f55-14-9780323072557', 'image_file_name': 'f55-14-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-14-9780323072557.jpg', 'caption': 'Subglottic hemangiomas typically arise from the posterior lateral aspect of the larynx. Small lesions may be managed conservatively, whereas lesions with aggressive growth patterns that do not respond to propranolol or steroids require tracheotomy to bypass the laryngeal obstruction.', 'hash': '98d893eb7d34f0c093722f6477eb892ca2ad3f64bf38f93964a344314d9d4414'}, {'image_id': 'f55-06-9780323072557', 'image_file_name': 'f55-06-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-06-9780323072557.jpg', 'caption': 'A, Retropharyngeal abscess. Computed tomography of the cervical area demonstrates fluid loculated in the retropharyngeal space. The abscess is typically unilateral and frequently extends into the medial aspect of the peripharyngeal space. In the absence of associated complications, drainage can be done intraorally (arrow). B, Lateral neck abscess on the left side (arrow).', 'hash': '4b9d36caa79e4a7f3d10d09be6005091a793675f73327560e8db337f3d5b63f7'}, {'image_id': 'f55-13-9780323072557', 'image_file_name': 'f55-13-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-13-9780323072557.jpg', 'caption': 'Subglottic stenosis. Congenital and acquired stenosis create airway obstruction, depending on the severity and type of stenosis. Various forms of reconstruction are available (see Chapter 65).', 'hash': 'f984456662ebd5cd42998427fefbf34a8600b4bd92db83dcbe169b3801302127'}, {'image_id': 'f55-15-9780323072557', 'image_file_name': 'f55-15-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-15-9780323072557.jpg', 'caption': 'Recurrent respiratory papillomatosis. Severe papillomatosis may completely obstruct the larynx. Papillomas are characterized by malignant degeneration and aggressive growth patterns.', 'hash': '650e51216de70eb35825a173b6e2846c9856301c8086de4db4ec0778ee3c426e'}, {'image_id': 'f55-10-9780323072557', 'image_file_name': 'f55-10-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-10-9780323072557.jpg', 'caption': 'Congenital epulis. The congenital epulis is an unusual benign lesion that frequently arises from the anterior maxillary alveolar ridge. Airway and feeding difficulties may develop secondary to large lesions. Surgical excision is required.', 'hash': '646515f1a473ce549bca7a1030d33b89726cce7132f74a146817657f0688e147'}, {'image_id': 'f55-05-9780323072557', 'image_file_name': 'f55-05-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-05-9780323072557.jpg', 'caption': 'Nasal dermoid. These lesions typically present on the nasal dorsum as a single midline pit, often with a hair extruding from the depths of the pit. The pits may also be found on the columella. The dermoid will then tract through the septum toward the cranial base.', 'hash': 'e902452719ab070c3faf1545bfb2cec4d2e080a960b6d5e5a57f9a142946ae4f'}, {'image_id': 'f55-08-9780323072557', 'image_file_name': 'f55-08-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-08-9780323072557.jpg', 'caption': 'Adenoid hypertrophy. Hypertrophy of the adenoids may cause the nasopharynx to be obstructed with tissue. Smaller amounts of tissue are also able to obstruct nasal respiration by growing into the posterior choana as shown in this photograph.', 'hash': 'bd486994f713379e4e9b12cdf200d53f3b9f89e7f5796a2d77455bd58762e4d3'}, {'image_id': 'f55-03-9780323072557', 'image_file_name': 'f55-03-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-03-9780323072557.jpg', 'caption': 'Choanal atresia. This disorder frequently presents at birth with respiratory distress.', 'hash': '607b2ba755d56c16fe7b264b21665bebfadcca5fcde76e214f8317a33d42c42d'}, {'image_id': 'f55-11-9780323072557', 'image_file_name': 'f55-11-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-11-9780323072557.jpg', 'caption': 'A ranula is a pseudocyst caused by obstruction of a sublingual gland. It generally presents as a unilateral, painless swelling in the floor of the mouth.', 'hash': 'aebb53af7d23a27fdc46070c22c943fb7b821969c2baec338f3eb736bd7a7ebe'}, {'image_id': 'f55-04-9780323072557', 'image_file_name': 'f55-04-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-04-9780323072557.jpg', 'caption': 'Nasal dermoid presenting in the midline as a pit.', 'hash': '43ef53c688bdb2484473dd5cfdd2e3d08ba6c2adc1f2851c44343147296688c7'}, {'image_id': 'f55-02-9780323072557', 'image_file_name': 'f55-02-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-02-9780323072557.jpg', 'caption': 'A, Longitudinal temporal bone fracture. These fractures run parallel to the petrous pyramid. The otic capsule is generally not affected by the fracture lines. Balance, hearing, and facial function are generally preserved. B, Transverse temporal bone fracture. These fractures generally extend through the cochlea and facial canal and result in deafness, vertigo, and facial nerve paralysis of immediate onset. Facial nerve exploration with repair should always be considered in these cases.', 'hash': '963a5db1c8089993df8b19992e4d8ccc479595da71fd1560af5d293bd6e6560d'}, {'image_id': 'f55-09-9780323072557', 'image_file_name': 'f55-09-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-09-9780323072557.jpg', 'caption': 'Ankyloglossia. Abnormal development of the lingual frenulum that limits extension of the tongue tip beyond the mandibular incisors frequently causes articulation disorders and should be corrected.', 'hash': 'e96dda5868f9f201b5d64fb2c2c49949ac9c5c48987f6731d7e31f1bcd4edc50'}] | {'f55-01-9780323072557': ['Acute coalescent mastoiditis occurs when infection erodes the bony mastoid cortex and destroys bony septae within the mastoid. A subperiosteal abscess may also develop over the mastoid process. There is usually postauricular erythema and edema over the mastoid area. The auricle is displaced laterally and forward (<xref rid="f55-01-9780323072557" ref-type="fig">Fig. 55-1</xref>\n). Otoscopy reveals forward displacement of the posterior superior skin of the ear canal.\n). Otoscopy reveals forward displacement of the posterior superior skin of the ear canal.Figure 55-1Acute mastoiditis. Extension of the acute inflammatory process from the middle ear and mastoid air cell systems to the overlying soft tissues displaces the auricle in an inferior and lateral direction from the side of the head. Fluctuance may be palpated over the mastoid cortex, and a defect in the cortical bone can frequently be appreciated. Surgical drainage with mastoidectomy is required.Figure 55-1'], 'f55-02-9780323072557': ['Blunt head trauma may disrupt the inner ear membranes causing sensorineural hearing loss and vertigo. No treatment is required, and the injury and symptoms may resolve spontaneously, but the sensorineural hearing loss may persist. Severe head trauma may cause fracture of the temporal bone of the skull. Temporal bone fractures can be classified as longitudinal, transverse, or mixed (<xref rid="f55-02-9780323072557" ref-type="fig">Fig. 55-2</xref>\n) but are often complex and do not neatly fit into one category or another. A high-resolution, thin-section CT scan of the temporal bone will define the extent of the fracture. The middle ear and mastoid are filled with blood when a fracture is present. The blood causes a conductive hearing loss that resolves when the ear clears.\n) but are often complex and do not neatly fit into one category or another. A high-resolution, thin-section CT scan of the temporal bone will define the extent of the fracture. The middle ear and mastoid are filled with blood when a fracture is present. The blood causes a conductive hearing loss that resolves when the ear clears.Figure 55-2A, Longitudinal temporal bone fracture. These fractures run parallel to the petrous pyramid. The otic capsule is generally not affected by the fracture lines. Balance, hearing, and facial function are generally preserved. B, Transverse temporal bone fracture. These fractures generally extend through the cochlea and facial canal and result in deafness, vertigo, and facial nerve paralysis of immediate onset. Facial nerve exploration with repair should always be considered in these cases.Figure 55-2'], 'f55-03-9780323072557': ['Choanal atresia may be successfully treated by removing the obstructing tissue transnasally. Curettes, lasers, microdebriders, bone punches, and drills may all be effective to remove the atresia plate. However, when the bony plate is very thick and there is an extremely narrow posterior nasal cavity, a transpalatal repair is more direct. A transpalatal repair provides better access for more effective removal of the bony plate and posterior septum (<xref rid="f55-03-9780323072557" ref-type="fig">Fig. 55-3</xref>\n). Stents fashioned from endotracheal tubes are placed and secured with sutures to the septum. They are removed after several weeks. The stents must be moistened with saline and suctioned several times daily to prevent mucus plugging and acute respiratory distress. Transpalatal repair of choanal atresia has a lower incidence of restenosis.\n). Stents fashioned from endotracheal tubes are placed and secured with sutures to the septum. They are removed after several weeks. The stents must be moistened with saline and suctioned several times daily to prevent mucus plugging and acute respiratory distress. Transpalatal repair of choanal atresia has a lower incidence of restenosis.11\nFigure 55-3Choanal atresia. This disorder frequently presents at birth with respiratory distress.Figure 55-3'], 'f55-04-9780323072557': ['Nasal dermoid cysts or sinuses present in the midline of the nasal dorsum (<xref rid="f55-04-9780323072557" ref-type="fig">Fig. 55-4</xref>\n). They usually appear as a round bump or a pit with hair present in the pit (\n). They usually appear as a round bump or a pit with hair present in the pit (<xref rid="f55-05-9780323072557" ref-type="fig">Fig. 55-5</xref>\n). They also may become infected. Nasal dermoid sinuses may extend through the nasal bones into the nasofrontal area and have an intracranial component. Both CT and MRI may be necessary to demonstrate the extent of the dermoid. Surgical removal is required to prevent infection and recurrence. This may be done between ages 3 and 5 years if prior infection has not occurred. Dermoids confined to the nose are resected completely using a midline incision with an ellipse around the sinus tract. The tract is followed to its termination, and the nasal bones may need to be separated to reach the end of the tract.\n). They also may become infected. Nasal dermoid sinuses may extend through the nasal bones into the nasofrontal area and have an intracranial component. Both CT and MRI may be necessary to demonstrate the extent of the dermoid. Surgical removal is required to prevent infection and recurrence. This may be done between ages 3 and 5 years if prior infection has not occurred. Dermoids confined to the nose are resected completely using a midline incision with an ellipse around the sinus tract. The tract is followed to its termination, and the nasal bones may need to be separated to reach the end of the tract.11 If an intracranial component is present, a combined craniotomy and nasal approach with a neurosurgeon is recommended.Figure 55-4Nasal dermoid presenting in the midline as a pit.Figure 55-4Figure 55-5Nasal dermoid. These lesions typically present on the nasal dorsum as a single midline pit, often with a hair extruding from the depths of the pit. The pits may also be found on the columella. The dermoid will then tract through the septum toward the cranial base.Figure 55-5'], 'f55-06-9780323072557': ['In suspected cases, the diagnosis of a retropharyngeal/parapharyngeal space infection is confirmed with either contrast medium–enhanced CT or MRI. Widening of the retropharynx on a lateral neck radiograph suggests a retropharyngeal infection. Although ultrasonography can detect the presence of an abscess cavity, CT or MRI are most helpful in demonstrating the extent of infection and the location of surrounding structures of importance, specifically the great vessels. Contrast medium–enhanced CT is particularly useful in distinguishing a phlegmon (cellulitis) from cases of frank suppuration. Demonstration of a hypodense region with surrounding rim enhancement has been shown to correlate with an abscess in 92% of cases (<xref rid="f55-06-9780323072557" ref-type="fig">Fig. 55-6</xref>\n).\n).Figure 55-6A, Retropharyngeal abscess. Computed tomography of the cervical area demonstrates fluid loculated in the retropharyngeal space. The abscess is typically unilateral and frequently extends into the medial aspect of the peripharyngeal space. In the absence of associated complications, drainage can be done intraorally (arrow). B, Lateral neck abscess on the left side (arrow).Figure 55-6', 'The usual source of bacterial cervical adenitis is the pharynx. Causative organisms are often streptococcal or staphylococcal species. Patients present with systemic symptoms of fever and malaise in addition to a neck mass that is diffusely swollen, erythematous, and tender. In contrast to viral adenitis, which is frequently bilateral, bacterial infections of the neck are usually unilateral. CT with contrast medium enhancement may be helpful in the evaluation of large infectious neck masses that may contain an abscess cavity (<xref rid="f55-06-9780323072557" ref-type="fig">Fig. 55-6</xref>, , B), although ultrasound examination can provide similar information without radiation. Needle aspiration of suspected infectious masses may provide material for culture and decompress the mass.'], 'f55-07-9780323072557': ['The major group at risk for SDB includes children with adenotonsillar hypertrophy secondary to lymphoid hyperplasia (<xref rid="f55-07-9780323072557" ref-type="fig">Figs. 55-7</xref>\nand \nand <xref rid="f55-08-9780323072557" ref-type="fig">55-8</xref>\n). Whereas the age of affected children ranges from 2 years through adolescence, the prevalence mirrors the age of greatest lymphoid hyperplasia, 2 to 6 years, the age the tonsils and adenoids are largest in size. Other at-risk groups include syndromic children with Down syndrome who also have relative macroglossia and tend to have larger tonsils and adenoids, children with craniofacial disorders, and patients with cleft palate or storage diseases (Hunter and Hurler syndromes). Adverse effects of obstructive sleep apnea on children include poor school performance, failure to thrive, facial and dental maldevelopment, and, rarely, severe cardiac impairment, including systemic hypertension, cardiac arrhythmias, and cor pulmonale with heart failure.\n). Whereas the age of affected children ranges from 2 years through adolescence, the prevalence mirrors the age of greatest lymphoid hyperplasia, 2 to 6 years, the age the tonsils and adenoids are largest in size. Other at-risk groups include syndromic children with Down syndrome who also have relative macroglossia and tend to have larger tonsils and adenoids, children with craniofacial disorders, and patients with cleft palate or storage diseases (Hunter and Hurler syndromes). Adverse effects of obstructive sleep apnea on children include poor school performance, failure to thrive, facial and dental maldevelopment, and, rarely, severe cardiac impairment, including systemic hypertension, cardiac arrhythmias, and cor pulmonale with heart failure.Figure 55-7Tonsillar hypertrophy. Tonsillar hypertrophy is rated on a scale of 1 to 4. Grade 1+ tonsils are hypertrophic, grade 2+ tonsils extend slightly beyond the tonsillar pillars, grade 3+ tonsils extend in a medial direction beyond the anterior tonsillar pillars, and grade 4+ tonsils touch in the midline.Figure 55-7Figure 55-8Adenoid hypertrophy. Hypertrophy of the adenoids may cause the nasopharynx to be obstructed with tissue. Smaller amounts of tissue are also able to obstruct nasal respiration by growing into the posterior choana as shown in this photograph.Figure 55-8'], 'f55-09-9780323072557': ['Ankyloglossia or tongue-tie is a common congenital disorder involving the lingual frenulum (<xref rid="f55-09-9780323072557" ref-type="fig">Fig. 55-9</xref>\n). Neonates with diminished tongue mobility resulting from a foreshortened frenulum may have problems in sucking and feeding. Because the frenulum is thin and relatively avascular in neonates and young infants, it can often be incised as an office procedure. In older children the greatest effect of ankyloglossia is on speech and it can lead to dental caries because it may be difficult to clean the lower teeth. Because the tip of the tongue curls under on protrusion and has limited lateral and superior movement, speech articulation may be affected. Surgical treatment in these patients may require a short general anesthetic because the frenulum is thicker and more vascular, requiring surgical correction that includes simple division either with or without a Z-plasty repair.\n). Neonates with diminished tongue mobility resulting from a foreshortened frenulum may have problems in sucking and feeding. Because the frenulum is thin and relatively avascular in neonates and young infants, it can often be incised as an office procedure. In older children the greatest effect of ankyloglossia is on speech and it can lead to dental caries because it may be difficult to clean the lower teeth. Because the tip of the tongue curls under on protrusion and has limited lateral and superior movement, speech articulation may be affected. Surgical treatment in these patients may require a short general anesthetic because the frenulum is thicker and more vascular, requiring surgical correction that includes simple division either with or without a Z-plasty repair.Figure 55-9Ankyloglossia. Abnormal development of the lingual frenulum that limits extension of the tongue tip beyond the mandibular incisors frequently causes articulation disorders and should be corrected.Figure 55-9'], 'f55-10-9780323072557': ['Epulis is a congenital granular cell tumor that typically presents as a soft, pink submucosal mass on the anterior alveolar ridge of the maxilla (<xref rid="f55-10-9780323072557" ref-type="fig">Fig. 55-10</xref>\n). Females are more commonly affected, and symptoms are usually confined to feeding problems. Surgical excision is curative.\n). Females are more commonly affected, and symptoms are usually confined to feeding problems. Surgical excision is curative.Figure 55-10Congenital epulis. The congenital epulis is an unusual benign lesion that frequently arises from the anterior maxillary alveolar ridge. Airway and feeding difficulties may develop secondary to large lesions. Surgical excision is required.Figure 55-10'], 'f55-11-9780323072557': ['Ranula is a pseudocyst located in the floor of the mouth that may occur congenitally or result from intraoral trauma (<xref rid="f55-11-9780323072557" ref-type="fig">Fig. 55-11</xref>\n). Large ranulas may extend through the mylohyoid musculature and present in the neck as a “plunging ranula.” Treatment of ranulas is by excision or marsupialization of the pseudocyst, often in conjunction with excision of the sublingual gland. Mucoceles are also pseudocysts of minor salivary gland origin and frequently rupture spontaneously. Recurrent or symptomatic mucoceles respond to surgical excision.\n). Large ranulas may extend through the mylohyoid musculature and present in the neck as a “plunging ranula.” Treatment of ranulas is by excision or marsupialization of the pseudocyst, often in conjunction with excision of the sublingual gland. Mucoceles are also pseudocysts of minor salivary gland origin and frequently rupture spontaneously. Recurrent or symptomatic mucoceles respond to surgical excision.Figure 55-11A ranula is a pseudocyst caused by obstruction of a sublingual gland. It generally presents as a unilateral, painless swelling in the floor of the mouth.Figure 55-11'], 'f55-12-9780323072557': ['Laryngomalacia is the most common cause of newborn stridor and is caused by prolapse of the supraglottic structures (arytenoid cartilages, aryepiglottic folds) during inspiration (<xref rid="f55-12-9780323072557" ref-type="fig">Fig. 55-12</xref>\n). Symptoms typically appear at birth or soon thereafter and include high-pitched inspiratory stridor, feeding difficulties, and, rarely, apnea or signs of severe airway obstruction. Gastroesophageal reflux disease (GERD) is common in children with laryngomalacia and tends to worsen the airway symptoms, because it creates swelling of the posterior cricoid region of the larynx. The diagnosis of laryngomalacia is confirmed by flexible endoscopy of the larynx, and other airway pathology can be excluded with lateral neck, chest, and airway fluoroscopy. Barium swallow radiography is helpful to identify the presence of GERD. In most cases, laryngomalacia is self-limited and resolves by 18 months of age. Changes in positioning and feeding, treatment of reflux, and, in some neonates, use of monitoring may be necessary. In severe cases, surgical intervention with either a supraglottoplasty (surgical division with or without partial resection of the aryepiglottic folds) or a tracheostomy may be necessary.\n). Symptoms typically appear at birth or soon thereafter and include high-pitched inspiratory stridor, feeding difficulties, and, rarely, apnea or signs of severe airway obstruction. Gastroesophageal reflux disease (GERD) is common in children with laryngomalacia and tends to worsen the airway symptoms, because it creates swelling of the posterior cricoid region of the larynx. The diagnosis of laryngomalacia is confirmed by flexible endoscopy of the larynx, and other airway pathology can be excluded with lateral neck, chest, and airway fluoroscopy. Barium swallow radiography is helpful to identify the presence of GERD. In most cases, laryngomalacia is self-limited and resolves by 18 months of age. Changes in positioning and feeding, treatment of reflux, and, in some neonates, use of monitoring may be necessary. In severe cases, surgical intervention with either a supraglottoplasty (surgical division with or without partial resection of the aryepiglottic folds) or a tracheostomy may be necessary.Figure 55-12Laryngomalacia. This disorder classically presents as an omega-shaped epiglottis. The arytenoid mucosa is redundant, and the aryepiglottic folds are foreshortened. The result is a hooding of tissue over the glottic inlet that leads to airway obstruction on inspiration.Figure 55-12'], 'f55-13-9780323072557': ['Congenital subglottic stenosis is the third most common congenital laryngeal anomaly and is defined as a neonatal larynx in a term baby without a history of prior instrumentation or intubation who fails to admit a 3.5-mm endotracheal tube (<xref rid="f55-13-9780323072557" ref-type="fig">Fig. 55-13</xref>\n). The underlying abnormality is a cricoid cartilage that is either small or deformed. Children with Down syndrome are at higher risk for this condition. Infants with congenital subglottic stenosis present with inspiratory or biphasic stridor, barking cough, and other symptoms of airway obstruction. The diagnosis is often suggested by narrowing of the subglottis on a lateral neck radiograph and confirmed by endoscopy. Treatment depends on the severity of symptoms and ranges from observation to laryngeal reconstruction to tracheostomy.\n). The underlying abnormality is a cricoid cartilage that is either small or deformed. Children with Down syndrome are at higher risk for this condition. Infants with congenital subglottic stenosis present with inspiratory or biphasic stridor, barking cough, and other symptoms of airway obstruction. The diagnosis is often suggested by narrowing of the subglottis on a lateral neck radiograph and confirmed by endoscopy. Treatment depends on the severity of symptoms and ranges from observation to laryngeal reconstruction to tracheostomy.Figure 55-13Subglottic stenosis. Congenital and acquired stenosis create airway obstruction, depending on the severity and type of stenosis. Various forms of reconstruction are available (see Chapter 65).Figure 55-13'], 'f55-14-9780323072557': ['A child with a subglottic hemangioma presents with the onset of progressive stridor during the first few months of life (<xref rid="f55-14-9780323072557" ref-type="fig">Fig. 55-14</xref>\n). Hemangiomas are proliferative endothelial lesions that can form in the submucosa of the posterior and lateral subglottis. Occasionally, they may involve the subglottis in a circumferential pattern. Associated cutaneous hemangiomas may be found in approximately 50% of patients, but only 1% of patients with cutaneous lesions have airway lesions. Symptoms are dependent on the amount of airway compromise and include biphasic stridor, barking cough, difficulty feeding, and other symptoms and signs of airway obstruction. The diagnosis may be suggested on a lateral neck radiograph but is confirmed with endoscopy. Nonsurgical management of infants with a subglottic hemangioma includes observation or treatment with systemic corticosteroids or propranolol. Surgical therapy includes laser excision, open excision through a laryngofissure, or a tracheostomy.\n). Hemangiomas are proliferative endothelial lesions that can form in the submucosa of the posterior and lateral subglottis. Occasionally, they may involve the subglottis in a circumferential pattern. Associated cutaneous hemangiomas may be found in approximately 50% of patients, but only 1% of patients with cutaneous lesions have airway lesions. Symptoms are dependent on the amount of airway compromise and include biphasic stridor, barking cough, difficulty feeding, and other symptoms and signs of airway obstruction. The diagnosis may be suggested on a lateral neck radiograph but is confirmed with endoscopy. Nonsurgical management of infants with a subglottic hemangioma includes observation or treatment with systemic corticosteroids or propranolol. Surgical therapy includes laser excision, open excision through a laryngofissure, or a tracheostomy.Figure 55-14Subglottic hemangiomas typically arise from the posterior lateral aspect of the larynx. Small lesions may be managed conservatively, whereas lesions with aggressive growth patterns that do not respond to propranolol or steroids require tracheotomy to bypass the laryngeal obstruction.Figure 55-14'], 'f55-15-9780323072557': ['Children afflicted with RRP present initially with hoarseness but may also have symptoms and signs of airway obstruction, including stridor. Lateral neck radiography may suggest laryngeal involvement, but the diagnosis is confirmed by direct laryngoscopy and biopsy (<xref rid="f55-15-9780323072557" ref-type="fig">Fig. 55-15</xref>\n). In addition to the trachea and bronchi, squamous papillomas may also be found in the oral cavity.\n). In addition to the trachea and bronchi, squamous papillomas may also be found in the oral cavity.Figure 55-15Recurrent respiratory papillomatosis. Severe papillomatosis may completely obstruct the larynx. Papillomas are characterized by malignant degeneration and aggressive growth patterns.Figure 55-15']} | Otolaryngologic Disorders | null | Pediatric Surgery | 1329465600 | None | null | other | PMC7158341 | null | null | [
""
] | Pediatric Surgery. 2012 Feb 17;:707-728 | NO-CC CODE |
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A, Longitudinal temporal bone fracture. These fractures run parallel to the petrous pyramid. The otic capsule is generally not affected by the fracture lines. Balance, hearing, and facial function are generally preserved. B, Transverse temporal bone fracture. These fractures generally extend through the cochlea and facial canal and result in deafness, vertigo, and facial nerve paralysis of immediate onset. Facial nerve exploration with repair should always be considered in these cases. | f55-02-9780323072557 | 7 | 963a5db1c8089993df8b19992e4d8ccc479595da71fd1560af5d293bd6e6560d | f55-02-9780323072557.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
749,
351
] | [{'image_id': 'f55-07-9780323072557', 'image_file_name': 'f55-07-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-07-9780323072557.jpg', 'caption': 'Tonsillar hypertrophy. Tonsillar hypertrophy is rated on a scale of 1 to 4. Grade 1+ tonsils are hypertrophic, grade 2+ tonsils extend slightly beyond the tonsillar pillars, grade 3+ tonsils extend in a medial direction beyond the anterior tonsillar pillars, and grade 4+ tonsils touch in the midline.', 'hash': 'f98240d7b26d35a28fa558914ba08d3a95e4b1882239ddfc35895e230c29df35'}, {'image_id': 'f55-12-9780323072557', 'image_file_name': 'f55-12-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-12-9780323072557.jpg', 'caption': 'Laryngomalacia. This disorder classically presents as an omega-shaped epiglottis. The arytenoid mucosa is redundant, and the aryepiglottic folds are foreshortened. The result is a hooding of tissue over the glottic inlet that leads to airway obstruction on inspiration.', 'hash': '9ca19b34868832da9963599b919ce3b5fd494acbd50d1356cfaa6405ec70d589'}, {'image_id': 'f55-01-9780323072557', 'image_file_name': 'f55-01-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-01-9780323072557.jpg', 'caption': 'Acute mastoiditis. Extension of the acute inflammatory process from the middle ear and mastoid air cell systems to the overlying soft tissues displaces the auricle in an inferior and lateral direction from the side of the head. Fluctuance may be palpated over the mastoid cortex, and a defect in the cortical bone can frequently be appreciated. Surgical drainage with mastoidectomy is required.', 'hash': '3c4d2e4aafe0dc1d84395c0e4f19186c006d78ec7c39d55fc165b0e5d414d256'}, {'image_id': 'f55-14-9780323072557', 'image_file_name': 'f55-14-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-14-9780323072557.jpg', 'caption': 'Subglottic hemangiomas typically arise from the posterior lateral aspect of the larynx. Small lesions may be managed conservatively, whereas lesions with aggressive growth patterns that do not respond to propranolol or steroids require tracheotomy to bypass the laryngeal obstruction.', 'hash': '98d893eb7d34f0c093722f6477eb892ca2ad3f64bf38f93964a344314d9d4414'}, {'image_id': 'f55-06-9780323072557', 'image_file_name': 'f55-06-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-06-9780323072557.jpg', 'caption': 'A, Retropharyngeal abscess. Computed tomography of the cervical area demonstrates fluid loculated in the retropharyngeal space. The abscess is typically unilateral and frequently extends into the medial aspect of the peripharyngeal space. In the absence of associated complications, drainage can be done intraorally (arrow). B, Lateral neck abscess on the left side (arrow).', 'hash': '4b9d36caa79e4a7f3d10d09be6005091a793675f73327560e8db337f3d5b63f7'}, {'image_id': 'f55-13-9780323072557', 'image_file_name': 'f55-13-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-13-9780323072557.jpg', 'caption': 'Subglottic stenosis. Congenital and acquired stenosis create airway obstruction, depending on the severity and type of stenosis. Various forms of reconstruction are available (see Chapter 65).', 'hash': 'f984456662ebd5cd42998427fefbf34a8600b4bd92db83dcbe169b3801302127'}, {'image_id': 'f55-15-9780323072557', 'image_file_name': 'f55-15-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-15-9780323072557.jpg', 'caption': 'Recurrent respiratory papillomatosis. Severe papillomatosis may completely obstruct the larynx. Papillomas are characterized by malignant degeneration and aggressive growth patterns.', 'hash': '650e51216de70eb35825a173b6e2846c9856301c8086de4db4ec0778ee3c426e'}, {'image_id': 'f55-10-9780323072557', 'image_file_name': 'f55-10-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-10-9780323072557.jpg', 'caption': 'Congenital epulis. The congenital epulis is an unusual benign lesion that frequently arises from the anterior maxillary alveolar ridge. Airway and feeding difficulties may develop secondary to large lesions. Surgical excision is required.', 'hash': '646515f1a473ce549bca7a1030d33b89726cce7132f74a146817657f0688e147'}, {'image_id': 'f55-05-9780323072557', 'image_file_name': 'f55-05-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-05-9780323072557.jpg', 'caption': 'Nasal dermoid. These lesions typically present on the nasal dorsum as a single midline pit, often with a hair extruding from the depths of the pit. The pits may also be found on the columella. The dermoid will then tract through the septum toward the cranial base.', 'hash': 'e902452719ab070c3faf1545bfb2cec4d2e080a960b6d5e5a57f9a142946ae4f'}, {'image_id': 'f55-08-9780323072557', 'image_file_name': 'f55-08-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-08-9780323072557.jpg', 'caption': 'Adenoid hypertrophy. Hypertrophy of the adenoids may cause the nasopharynx to be obstructed with tissue. Smaller amounts of tissue are also able to obstruct nasal respiration by growing into the posterior choana as shown in this photograph.', 'hash': 'bd486994f713379e4e9b12cdf200d53f3b9f89e7f5796a2d77455bd58762e4d3'}, {'image_id': 'f55-03-9780323072557', 'image_file_name': 'f55-03-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-03-9780323072557.jpg', 'caption': 'Choanal atresia. This disorder frequently presents at birth with respiratory distress.', 'hash': '607b2ba755d56c16fe7b264b21665bebfadcca5fcde76e214f8317a33d42c42d'}, {'image_id': 'f55-11-9780323072557', 'image_file_name': 'f55-11-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-11-9780323072557.jpg', 'caption': 'A ranula is a pseudocyst caused by obstruction of a sublingual gland. It generally presents as a unilateral, painless swelling in the floor of the mouth.', 'hash': 'aebb53af7d23a27fdc46070c22c943fb7b821969c2baec338f3eb736bd7a7ebe'}, {'image_id': 'f55-04-9780323072557', 'image_file_name': 'f55-04-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-04-9780323072557.jpg', 'caption': 'Nasal dermoid presenting in the midline as a pit.', 'hash': '43ef53c688bdb2484473dd5cfdd2e3d08ba6c2adc1f2851c44343147296688c7'}, {'image_id': 'f55-02-9780323072557', 'image_file_name': 'f55-02-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-02-9780323072557.jpg', 'caption': 'A, Longitudinal temporal bone fracture. These fractures run parallel to the petrous pyramid. The otic capsule is generally not affected by the fracture lines. Balance, hearing, and facial function are generally preserved. B, Transverse temporal bone fracture. These fractures generally extend through the cochlea and facial canal and result in deafness, vertigo, and facial nerve paralysis of immediate onset. Facial nerve exploration with repair should always be considered in these cases.', 'hash': '963a5db1c8089993df8b19992e4d8ccc479595da71fd1560af5d293bd6e6560d'}, {'image_id': 'f55-09-9780323072557', 'image_file_name': 'f55-09-9780323072557.jpg', 'image_path': '../data/media_files/PMC7158341/f55-09-9780323072557.jpg', 'caption': 'Ankyloglossia. Abnormal development of the lingual frenulum that limits extension of the tongue tip beyond the mandibular incisors frequently causes articulation disorders and should be corrected.', 'hash': 'e96dda5868f9f201b5d64fb2c2c49949ac9c5c48987f6731d7e31f1bcd4edc50'}] | {'f55-01-9780323072557': ['Acute coalescent mastoiditis occurs when infection erodes the bony mastoid cortex and destroys bony septae within the mastoid. A subperiosteal abscess may also develop over the mastoid process. There is usually postauricular erythema and edema over the mastoid area. The auricle is displaced laterally and forward (<xref rid="f55-01-9780323072557" ref-type="fig">Fig. 55-1</xref>\n). Otoscopy reveals forward displacement of the posterior superior skin of the ear canal.\n). Otoscopy reveals forward displacement of the posterior superior skin of the ear canal.Figure 55-1Acute mastoiditis. Extension of the acute inflammatory process from the middle ear and mastoid air cell systems to the overlying soft tissues displaces the auricle in an inferior and lateral direction from the side of the head. Fluctuance may be palpated over the mastoid cortex, and a defect in the cortical bone can frequently be appreciated. Surgical drainage with mastoidectomy is required.Figure 55-1'], 'f55-02-9780323072557': ['Blunt head trauma may disrupt the inner ear membranes causing sensorineural hearing loss and vertigo. No treatment is required, and the injury and symptoms may resolve spontaneously, but the sensorineural hearing loss may persist. Severe head trauma may cause fracture of the temporal bone of the skull. Temporal bone fractures can be classified as longitudinal, transverse, or mixed (<xref rid="f55-02-9780323072557" ref-type="fig">Fig. 55-2</xref>\n) but are often complex and do not neatly fit into one category or another. A high-resolution, thin-section CT scan of the temporal bone will define the extent of the fracture. The middle ear and mastoid are filled with blood when a fracture is present. The blood causes a conductive hearing loss that resolves when the ear clears.\n) but are often complex and do not neatly fit into one category or another. A high-resolution, thin-section CT scan of the temporal bone will define the extent of the fracture. The middle ear and mastoid are filled with blood when a fracture is present. The blood causes a conductive hearing loss that resolves when the ear clears.Figure 55-2A, Longitudinal temporal bone fracture. These fractures run parallel to the petrous pyramid. The otic capsule is generally not affected by the fracture lines. Balance, hearing, and facial function are generally preserved. B, Transverse temporal bone fracture. These fractures generally extend through the cochlea and facial canal and result in deafness, vertigo, and facial nerve paralysis of immediate onset. Facial nerve exploration with repair should always be considered in these cases.Figure 55-2'], 'f55-03-9780323072557': ['Choanal atresia may be successfully treated by removing the obstructing tissue transnasally. Curettes, lasers, microdebriders, bone punches, and drills may all be effective to remove the atresia plate. However, when the bony plate is very thick and there is an extremely narrow posterior nasal cavity, a transpalatal repair is more direct. A transpalatal repair provides better access for more effective removal of the bony plate and posterior septum (<xref rid="f55-03-9780323072557" ref-type="fig">Fig. 55-3</xref>\n). Stents fashioned from endotracheal tubes are placed and secured with sutures to the septum. They are removed after several weeks. The stents must be moistened with saline and suctioned several times daily to prevent mucus plugging and acute respiratory distress. Transpalatal repair of choanal atresia has a lower incidence of restenosis.\n). Stents fashioned from endotracheal tubes are placed and secured with sutures to the septum. They are removed after several weeks. The stents must be moistened with saline and suctioned several times daily to prevent mucus plugging and acute respiratory distress. Transpalatal repair of choanal atresia has a lower incidence of restenosis.11\nFigure 55-3Choanal atresia. This disorder frequently presents at birth with respiratory distress.Figure 55-3'], 'f55-04-9780323072557': ['Nasal dermoid cysts or sinuses present in the midline of the nasal dorsum (<xref rid="f55-04-9780323072557" ref-type="fig">Fig. 55-4</xref>\n). They usually appear as a round bump or a pit with hair present in the pit (\n). They usually appear as a round bump or a pit with hair present in the pit (<xref rid="f55-05-9780323072557" ref-type="fig">Fig. 55-5</xref>\n). They also may become infected. Nasal dermoid sinuses may extend through the nasal bones into the nasofrontal area and have an intracranial component. Both CT and MRI may be necessary to demonstrate the extent of the dermoid. Surgical removal is required to prevent infection and recurrence. This may be done between ages 3 and 5 years if prior infection has not occurred. Dermoids confined to the nose are resected completely using a midline incision with an ellipse around the sinus tract. The tract is followed to its termination, and the nasal bones may need to be separated to reach the end of the tract.\n). They also may become infected. Nasal dermoid sinuses may extend through the nasal bones into the nasofrontal area and have an intracranial component. Both CT and MRI may be necessary to demonstrate the extent of the dermoid. Surgical removal is required to prevent infection and recurrence. This may be done between ages 3 and 5 years if prior infection has not occurred. Dermoids confined to the nose are resected completely using a midline incision with an ellipse around the sinus tract. The tract is followed to its termination, and the nasal bones may need to be separated to reach the end of the tract.11 If an intracranial component is present, a combined craniotomy and nasal approach with a neurosurgeon is recommended.Figure 55-4Nasal dermoid presenting in the midline as a pit.Figure 55-4Figure 55-5Nasal dermoid. These lesions typically present on the nasal dorsum as a single midline pit, often with a hair extruding from the depths of the pit. The pits may also be found on the columella. The dermoid will then tract through the septum toward the cranial base.Figure 55-5'], 'f55-06-9780323072557': ['In suspected cases, the diagnosis of a retropharyngeal/parapharyngeal space infection is confirmed with either contrast medium–enhanced CT or MRI. Widening of the retropharynx on a lateral neck radiograph suggests a retropharyngeal infection. Although ultrasonography can detect the presence of an abscess cavity, CT or MRI are most helpful in demonstrating the extent of infection and the location of surrounding structures of importance, specifically the great vessels. Contrast medium–enhanced CT is particularly useful in distinguishing a phlegmon (cellulitis) from cases of frank suppuration. Demonstration of a hypodense region with surrounding rim enhancement has been shown to correlate with an abscess in 92% of cases (<xref rid="f55-06-9780323072557" ref-type="fig">Fig. 55-6</xref>\n).\n).Figure 55-6A, Retropharyngeal abscess. Computed tomography of the cervical area demonstrates fluid loculated in the retropharyngeal space. The abscess is typically unilateral and frequently extends into the medial aspect of the peripharyngeal space. In the absence of associated complications, drainage can be done intraorally (arrow). B, Lateral neck abscess on the left side (arrow).Figure 55-6', 'The usual source of bacterial cervical adenitis is the pharynx. Causative organisms are often streptococcal or staphylococcal species. Patients present with systemic symptoms of fever and malaise in addition to a neck mass that is diffusely swollen, erythematous, and tender. In contrast to viral adenitis, which is frequently bilateral, bacterial infections of the neck are usually unilateral. CT with contrast medium enhancement may be helpful in the evaluation of large infectious neck masses that may contain an abscess cavity (<xref rid="f55-06-9780323072557" ref-type="fig">Fig. 55-6</xref>, , B), although ultrasound examination can provide similar information without radiation. Needle aspiration of suspected infectious masses may provide material for culture and decompress the mass.'], 'f55-07-9780323072557': ['The major group at risk for SDB includes children with adenotonsillar hypertrophy secondary to lymphoid hyperplasia (<xref rid="f55-07-9780323072557" ref-type="fig">Figs. 55-7</xref>\nand \nand <xref rid="f55-08-9780323072557" ref-type="fig">55-8</xref>\n). Whereas the age of affected children ranges from 2 years through adolescence, the prevalence mirrors the age of greatest lymphoid hyperplasia, 2 to 6 years, the age the tonsils and adenoids are largest in size. Other at-risk groups include syndromic children with Down syndrome who also have relative macroglossia and tend to have larger tonsils and adenoids, children with craniofacial disorders, and patients with cleft palate or storage diseases (Hunter and Hurler syndromes). Adverse effects of obstructive sleep apnea on children include poor school performance, failure to thrive, facial and dental maldevelopment, and, rarely, severe cardiac impairment, including systemic hypertension, cardiac arrhythmias, and cor pulmonale with heart failure.\n). Whereas the age of affected children ranges from 2 years through adolescence, the prevalence mirrors the age of greatest lymphoid hyperplasia, 2 to 6 years, the age the tonsils and adenoids are largest in size. Other at-risk groups include syndromic children with Down syndrome who also have relative macroglossia and tend to have larger tonsils and adenoids, children with craniofacial disorders, and patients with cleft palate or storage diseases (Hunter and Hurler syndromes). Adverse effects of obstructive sleep apnea on children include poor school performance, failure to thrive, facial and dental maldevelopment, and, rarely, severe cardiac impairment, including systemic hypertension, cardiac arrhythmias, and cor pulmonale with heart failure.Figure 55-7Tonsillar hypertrophy. Tonsillar hypertrophy is rated on a scale of 1 to 4. Grade 1+ tonsils are hypertrophic, grade 2+ tonsils extend slightly beyond the tonsillar pillars, grade 3+ tonsils extend in a medial direction beyond the anterior tonsillar pillars, and grade 4+ tonsils touch in the midline.Figure 55-7Figure 55-8Adenoid hypertrophy. Hypertrophy of the adenoids may cause the nasopharynx to be obstructed with tissue. Smaller amounts of tissue are also able to obstruct nasal respiration by growing into the posterior choana as shown in this photograph.Figure 55-8'], 'f55-09-9780323072557': ['Ankyloglossia or tongue-tie is a common congenital disorder involving the lingual frenulum (<xref rid="f55-09-9780323072557" ref-type="fig">Fig. 55-9</xref>\n). Neonates with diminished tongue mobility resulting from a foreshortened frenulum may have problems in sucking and feeding. Because the frenulum is thin and relatively avascular in neonates and young infants, it can often be incised as an office procedure. In older children the greatest effect of ankyloglossia is on speech and it can lead to dental caries because it may be difficult to clean the lower teeth. Because the tip of the tongue curls under on protrusion and has limited lateral and superior movement, speech articulation may be affected. Surgical treatment in these patients may require a short general anesthetic because the frenulum is thicker and more vascular, requiring surgical correction that includes simple division either with or without a Z-plasty repair.\n). Neonates with diminished tongue mobility resulting from a foreshortened frenulum may have problems in sucking and feeding. Because the frenulum is thin and relatively avascular in neonates and young infants, it can often be incised as an office procedure. In older children the greatest effect of ankyloglossia is on speech and it can lead to dental caries because it may be difficult to clean the lower teeth. Because the tip of the tongue curls under on protrusion and has limited lateral and superior movement, speech articulation may be affected. Surgical treatment in these patients may require a short general anesthetic because the frenulum is thicker and more vascular, requiring surgical correction that includes simple division either with or without a Z-plasty repair.Figure 55-9Ankyloglossia. Abnormal development of the lingual frenulum that limits extension of the tongue tip beyond the mandibular incisors frequently causes articulation disorders and should be corrected.Figure 55-9'], 'f55-10-9780323072557': ['Epulis is a congenital granular cell tumor that typically presents as a soft, pink submucosal mass on the anterior alveolar ridge of the maxilla (<xref rid="f55-10-9780323072557" ref-type="fig">Fig. 55-10</xref>\n). Females are more commonly affected, and symptoms are usually confined to feeding problems. Surgical excision is curative.\n). Females are more commonly affected, and symptoms are usually confined to feeding problems. Surgical excision is curative.Figure 55-10Congenital epulis. The congenital epulis is an unusual benign lesion that frequently arises from the anterior maxillary alveolar ridge. Airway and feeding difficulties may develop secondary to large lesions. Surgical excision is required.Figure 55-10'], 'f55-11-9780323072557': ['Ranula is a pseudocyst located in the floor of the mouth that may occur congenitally or result from intraoral trauma (<xref rid="f55-11-9780323072557" ref-type="fig">Fig. 55-11</xref>\n). Large ranulas may extend through the mylohyoid musculature and present in the neck as a “plunging ranula.” Treatment of ranulas is by excision or marsupialization of the pseudocyst, often in conjunction with excision of the sublingual gland. Mucoceles are also pseudocysts of minor salivary gland origin and frequently rupture spontaneously. Recurrent or symptomatic mucoceles respond to surgical excision.\n). Large ranulas may extend through the mylohyoid musculature and present in the neck as a “plunging ranula.” Treatment of ranulas is by excision or marsupialization of the pseudocyst, often in conjunction with excision of the sublingual gland. Mucoceles are also pseudocysts of minor salivary gland origin and frequently rupture spontaneously. Recurrent or symptomatic mucoceles respond to surgical excision.Figure 55-11A ranula is a pseudocyst caused by obstruction of a sublingual gland. It generally presents as a unilateral, painless swelling in the floor of the mouth.Figure 55-11'], 'f55-12-9780323072557': ['Laryngomalacia is the most common cause of newborn stridor and is caused by prolapse of the supraglottic structures (arytenoid cartilages, aryepiglottic folds) during inspiration (<xref rid="f55-12-9780323072557" ref-type="fig">Fig. 55-12</xref>\n). Symptoms typically appear at birth or soon thereafter and include high-pitched inspiratory stridor, feeding difficulties, and, rarely, apnea or signs of severe airway obstruction. Gastroesophageal reflux disease (GERD) is common in children with laryngomalacia and tends to worsen the airway symptoms, because it creates swelling of the posterior cricoid region of the larynx. The diagnosis of laryngomalacia is confirmed by flexible endoscopy of the larynx, and other airway pathology can be excluded with lateral neck, chest, and airway fluoroscopy. Barium swallow radiography is helpful to identify the presence of GERD. In most cases, laryngomalacia is self-limited and resolves by 18 months of age. Changes in positioning and feeding, treatment of reflux, and, in some neonates, use of monitoring may be necessary. In severe cases, surgical intervention with either a supraglottoplasty (surgical division with or without partial resection of the aryepiglottic folds) or a tracheostomy may be necessary.\n). Symptoms typically appear at birth or soon thereafter and include high-pitched inspiratory stridor, feeding difficulties, and, rarely, apnea or signs of severe airway obstruction. Gastroesophageal reflux disease (GERD) is common in children with laryngomalacia and tends to worsen the airway symptoms, because it creates swelling of the posterior cricoid region of the larynx. The diagnosis of laryngomalacia is confirmed by flexible endoscopy of the larynx, and other airway pathology can be excluded with lateral neck, chest, and airway fluoroscopy. Barium swallow radiography is helpful to identify the presence of GERD. In most cases, laryngomalacia is self-limited and resolves by 18 months of age. Changes in positioning and feeding, treatment of reflux, and, in some neonates, use of monitoring may be necessary. In severe cases, surgical intervention with either a supraglottoplasty (surgical division with or without partial resection of the aryepiglottic folds) or a tracheostomy may be necessary.Figure 55-12Laryngomalacia. This disorder classically presents as an omega-shaped epiglottis. The arytenoid mucosa is redundant, and the aryepiglottic folds are foreshortened. The result is a hooding of tissue over the glottic inlet that leads to airway obstruction on inspiration.Figure 55-12'], 'f55-13-9780323072557': ['Congenital subglottic stenosis is the third most common congenital laryngeal anomaly and is defined as a neonatal larynx in a term baby without a history of prior instrumentation or intubation who fails to admit a 3.5-mm endotracheal tube (<xref rid="f55-13-9780323072557" ref-type="fig">Fig. 55-13</xref>\n). The underlying abnormality is a cricoid cartilage that is either small or deformed. Children with Down syndrome are at higher risk for this condition. Infants with congenital subglottic stenosis present with inspiratory or biphasic stridor, barking cough, and other symptoms of airway obstruction. The diagnosis is often suggested by narrowing of the subglottis on a lateral neck radiograph and confirmed by endoscopy. Treatment depends on the severity of symptoms and ranges from observation to laryngeal reconstruction to tracheostomy.\n). The underlying abnormality is a cricoid cartilage that is either small or deformed. Children with Down syndrome are at higher risk for this condition. Infants with congenital subglottic stenosis present with inspiratory or biphasic stridor, barking cough, and other symptoms of airway obstruction. The diagnosis is often suggested by narrowing of the subglottis on a lateral neck radiograph and confirmed by endoscopy. Treatment depends on the severity of symptoms and ranges from observation to laryngeal reconstruction to tracheostomy.Figure 55-13Subglottic stenosis. Congenital and acquired stenosis create airway obstruction, depending on the severity and type of stenosis. Various forms of reconstruction are available (see Chapter 65).Figure 55-13'], 'f55-14-9780323072557': ['A child with a subglottic hemangioma presents with the onset of progressive stridor during the first few months of life (<xref rid="f55-14-9780323072557" ref-type="fig">Fig. 55-14</xref>\n). Hemangiomas are proliferative endothelial lesions that can form in the submucosa of the posterior and lateral subglottis. Occasionally, they may involve the subglottis in a circumferential pattern. Associated cutaneous hemangiomas may be found in approximately 50% of patients, but only 1% of patients with cutaneous lesions have airway lesions. Symptoms are dependent on the amount of airway compromise and include biphasic stridor, barking cough, difficulty feeding, and other symptoms and signs of airway obstruction. The diagnosis may be suggested on a lateral neck radiograph but is confirmed with endoscopy. Nonsurgical management of infants with a subglottic hemangioma includes observation or treatment with systemic corticosteroids or propranolol. Surgical therapy includes laser excision, open excision through a laryngofissure, or a tracheostomy.\n). Hemangiomas are proliferative endothelial lesions that can form in the submucosa of the posterior and lateral subglottis. Occasionally, they may involve the subglottis in a circumferential pattern. Associated cutaneous hemangiomas may be found in approximately 50% of patients, but only 1% of patients with cutaneous lesions have airway lesions. Symptoms are dependent on the amount of airway compromise and include biphasic stridor, barking cough, difficulty feeding, and other symptoms and signs of airway obstruction. The diagnosis may be suggested on a lateral neck radiograph but is confirmed with endoscopy. Nonsurgical management of infants with a subglottic hemangioma includes observation or treatment with systemic corticosteroids or propranolol. Surgical therapy includes laser excision, open excision through a laryngofissure, or a tracheostomy.Figure 55-14Subglottic hemangiomas typically arise from the posterior lateral aspect of the larynx. Small lesions may be managed conservatively, whereas lesions with aggressive growth patterns that do not respond to propranolol or steroids require tracheotomy to bypass the laryngeal obstruction.Figure 55-14'], 'f55-15-9780323072557': ['Children afflicted with RRP present initially with hoarseness but may also have symptoms and signs of airway obstruction, including stridor. Lateral neck radiography may suggest laryngeal involvement, but the diagnosis is confirmed by direct laryngoscopy and biopsy (<xref rid="f55-15-9780323072557" ref-type="fig">Fig. 55-15</xref>\n). In addition to the trachea and bronchi, squamous papillomas may also be found in the oral cavity.\n). In addition to the trachea and bronchi, squamous papillomas may also be found in the oral cavity.Figure 55-15Recurrent respiratory papillomatosis. Severe papillomatosis may completely obstruct the larynx. Papillomas are characterized by malignant degeneration and aggressive growth patterns.Figure 55-15']} | Otolaryngologic Disorders | null | Pediatric Surgery | 1329465600 | None | null | other | PMC7158341 | null | null | [
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] | Pediatric Surgery. 2012 Feb 17;:707-728 | NO-CC CODE |
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Choanal atresia. This disorder frequently presents at birth with respiratory distress. | gr3 | 7 | 3dc8320758e61c09b63d7bcadb72edaeb8df34690609dbbba04e9d0ef811eb11 | gr3.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
357,
354
] | [{'image_id': 'gr7', 'image_file_name': 'gr7.jpg', 'image_path': '../data/media_files/PMC7158348/gr7.jpg', 'caption': 'Tonsillar hypertrophy. Tonsillar hypertrophy is rated on a scale of 1 to 4. Grade 1+ tonsils are hypertrophic, grade 2+ tonsils extend slightly beyond the tonsillar pillars, grade 3+ tonsils extend in a medial direction beyond the anterior tonsillar pillars, and grade 4+ tonsils touch in the midline.', 'hash': '484f1008f0156d3f65c5210eb3411d87013964a8926180b8ca970284d05bda3d'}, {'image_id': 'gr9', 'image_file_name': 'gr9.jpg', 'image_path': '../data/media_files/PMC7158348/gr9.jpg', 'caption': 'Ankyloglossia. Abnormal development of the lingual frenulum that limits extension of the tongue tip beyond the mandibular incisors frequently causes articulation disorders and should be corrected.', 'hash': '7f751377a8905dd31f5634622c3a0c378ed6a3a04688fb049f0d58eec0b083ca'}, {'image_id': 'gr11', 'image_file_name': 'gr11.jpg', 'image_path': '../data/media_files/PMC7158348/gr11.jpg', 'caption': 'A ranula is a pseudocyst caused by obstruction of a sublingual gland. It generally presents as a unilateral, painless swelling in the floor of the mouth.', 'hash': '1b3b58821283a818e35e8c47608a7d65b599f7755dccc82bd36464b958ae7834'}, {'image_id': 'gr10', 'image_file_name': 'gr10.jpg', 'image_path': '../data/media_files/PMC7158348/gr10.jpg', 'caption': 'Congenital epulis. The congenital epulis is an unusual benign lesion that frequently arises from the anterior maxillary alveolar ridge. Airway and feeding difficulties may develop secondary to large lesions. Surgical excision is required.', 'hash': 'c11e44928cae528f4e13d37330884a0ceb10722a6136a7dcbb29e08e9d8c618d'}, {'image_id': 'gr8', 'image_file_name': 'gr8.jpg', 'image_path': '../data/media_files/PMC7158348/gr8.jpg', 'caption': 'Adenoid hypertrophy. Hypertrophy of the adenoids may cause the nasopharynx to be obstructed with tissue. Smaller amounts of tissue are also able to obstruct nasal respiration by growing into the posterior choana as shown in this photograph.', 'hash': 'cc23974974ee9a78f80b05ef78afdae47fbc1328e3671f103ddb4618e8bed9f8'}, {'image_id': 'gr1', 'image_file_name': 'gr1.jpg', 'image_path': '../data/media_files/PMC7158348/gr1.jpg', 'caption': 'Acute mastoiditis. Extension of the acute inflammatory process from the middle ear and mastoid air cell systems to the overlying soft tissues displaces the auricle in an inferior and lateral direction from the side of the head. Fluctuance may be palpated over the mastoid cortex, and a defect in the cortical bone can frequently be appreciated. Surgical drainage with mastoidectomy is required.', 'hash': '5c2c9bec6fe01c8563e2b9c43a0300b39c6c55de8a9b3f012c5f3c9ee2f7b11a'}, {'image_id': 'gr6', 'image_file_name': 'gr6.jpg', 'image_path': '../data/media_files/PMC7158348/gr6.jpg', 'caption': 'Retropharyngeal abscess. Computed tomography of the cervical area demonstrates fluid loculated in the retropharyngeal space. The abscess is typically unilateral and frequently extends into the medial aspect of the peripharyngeal space. In the absence of associated complications, drainage can be done intraorally.', 'hash': '939405f61272815db4ee8bfc35e9ec6948e9703076fb4e591fa55b8fb7f5c9df'}, {'image_id': 'gr13', 'image_file_name': 'gr13.jpg', 'image_path': '../data/media_files/PMC7158348/gr13.jpg', 'caption': 'Subglottic stenosis. Congenital and acquired stenosis create airway obstruction, depending on the severity and type of stenosis. Various forms of reconstruction are available (see Chapter 63).', 'hash': '6f8505743f37b39363b267b66f416bd659c7f6881dd7ab91ebdc5e614ccd44a1'}, {'image_id': 'gr14', 'image_file_name': 'gr14.jpg', 'image_path': '../data/media_files/PMC7158348/gr14.jpg', 'caption': 'Subglottic hemangiomas typically arise from the posterior lateral aspect of the larynx. Small lesions may be managed conservatively, whereas lesions with aggressive growth patterns require tracheotomy to bypass the laryngeal obstruction.', 'hash': '78576f5192e338464d5b866dd7e8d38128fe0fb35a763bfdc1ab9d0368c74059'}, {'image_id': 'gr5', 'image_file_name': 'gr5.jpg', 'image_path': '../data/media_files/PMC7158348/gr5.jpg', 'caption': 'Nasal dermoid. These lesions typically present on the nasal dorsum as a single midline pit, often with a hair extruding from the depths of the pit. The pits may also be found on the columella. The dermoid will then tract through the septum toward the cranial base.', 'hash': '5823a229ed9a9395d03ec1d42fb59ff7acff7d7f31ad753dbcb6547ebf72a692'}, {'image_id': 'gr2', 'image_file_name': 'gr2.jpg', 'image_path': '../data/media_files/PMC7158348/gr2.jpg', 'caption': 'A, Longitudinal temporal bone fracture. These fractures run parallel to the petrous pyramid. The otic capsule is generally not affected by the fracture lines. Balance, hearing, and facial function are generally preserved. B, Transverse temporal bone fracture. These fractures generally extend through the cochlea and facial canal and result in deafness, vertigo, and facial nerve paralysis of immediate onset. Facial nerve exploration with repair should always be considered in these cases.', 'hash': '0f4e9d04924dc44d0f3ab5c03a62cca19af8c5747b2d4f72fa95f8d6a7e71284'}, {'image_id': 'gr3', 'image_file_name': 'gr3.jpg', 'image_path': '../data/media_files/PMC7158348/gr3.jpg', 'caption': 'Choanal atresia. This disorder frequently presents at birth with respiratory distress.', 'hash': '3dc8320758e61c09b63d7bcadb72edaeb8df34690609dbbba04e9d0ef811eb11'}, {'image_id': 'gr4', 'image_file_name': 'gr4.jpg', 'image_path': '../data/media_files/PMC7158348/gr4.jpg', 'caption': 'Nasal dermoid presenting in the midline as a pit.', 'hash': 'b3f64dca1f119ac28fe53b5779287fb51fea87f9afd5494dad179e1e26cce0a5'}, {'image_id': 'gr15', 'image_file_name': 'gr15.jpg', 'image_path': '../data/media_files/PMC7158348/gr15.jpg', 'caption': 'Recurrent respiratory papillomatosis. Severe papillomatosis may completely obstruct the larynx. Papillomas are characterized by malignant degeneration and aggressive growth patterns.', 'hash': 'ac090c6c3005fa44b0194a256537f3820ca54f6babf6f009db3bb62c7ebbc861'}, {'image_id': 'gr12', 'image_file_name': 'gr12.jpg', 'image_path': '../data/media_files/PMC7158348/gr12.jpg', 'caption': 'Laryngomalacia. This disorder classically presents as an omega-shaped epiglottis. The arytenoid mucosa is redundant, and the aryepiglottic folds are foreshortened. The result is a hooding of tissue over the glottic inlet that leads to airway obstruction on inspiration.', 'hash': '5c03063a891d1c17bbd722f763205bbeff30fbbc4cca19c1ae7ec94733d67ff3'}] | {'gr1': ['Acute coalescent mastoiditis occurs when infection erodes the bony mastoid cortex and destroys bony septa within the mastoid. A subperiosteal abscess may also be present. There is usually postauricular erythema and edema over the mastoid area. The auricle is displaced laterally and forward (<xref rid="gr1" ref-type="fig">Fig. 52-1</xref>). Otoscopy reveals forward displacement of the posterior superior skin of the ear canal.\n). Otoscopy reveals forward displacement of the posterior superior skin of the ear canal.\nFigure 52-1Acute mastoiditis. Extension of the acute inflammatory process from the middle ear and mastoid air cell systems to the overlying soft tissues displaces the auricle in an inferior and lateral direction from the side of the head. Fluctuance may be palpated over the mastoid cortex, and a defect in the cortical bone can frequently be appreciated. Surgical drainage with mastoidectomy is required.'], 'gr2': ['Blunt head trauma may disrupt the inner ear membranes causing sensorineural hearing loss and vertigo. No treatment is required, and the injury and symptoms may resolve spontaneously, but the sensorineural hearing loss may persist. Severe head trauma may cause fracture of the temporal bone of the skull. Temporal bone fractures can be classified as longitudinal, transverse, or mixed (<xref rid="gr2" ref-type="fig">Fig. 52-2</xref>) but are often complex and do not neatly fit into one category or another. A high-resolution, thin section CT scan of the temporal bone will define the extent of the fracture. The middle ear and mastoid are filled with blood when a fracture is present. The blood causes a conductive hearing loss that resolves when the ear clears.\n) but are often complex and do not neatly fit into one category or another. A high-resolution, thin section CT scan of the temporal bone will define the extent of the fracture. The middle ear and mastoid are filled with blood when a fracture is present. The blood causes a conductive hearing loss that resolves when the ear clears.\nFigure 52-2A, Longitudinal temporal bone fracture. These fractures run parallel to the petrous pyramid. The otic capsule is generally not affected by the fracture lines. Balance, hearing, and facial function are generally preserved. B, Transverse temporal bone fracture. These fractures generally extend through the cochlea and facial canal and result in deafness, vertigo, and facial nerve paralysis of immediate onset. Facial nerve exploration with repair should always be considered in these cases.'], 'gr3': ['Choanal atresia may be successfully treated by removing the obstructing tissue transnasally. Curets, bone punches, and drills may all be effective to remove the atresia plate. However, when the bony plate is very thick and there is an extremely narrow posterior nasal cavity, a transpalatal repair is more direct. A transpalatal repair provides better access for more effective removal of the bony plate and posterior septum (<xref rid="gr3" ref-type="fig">Fig. 52-3</xref>). Stents fashioned from endotracheal tubes are placed and secured with sutures to the septum. They are removed in several weeks. The stents must be moistened with saline and suctioned several times daily to prevent mucus plugging and acute respiratory distress. Transpalatal repair of choanal atresia has a lower incidence of restenosis.). Stents fashioned from endotracheal tubes are placed and secured with sutures to the septum. They are removed in several weeks. The stents must be moistened with saline and suctioned several times daily to prevent mucus plugging and acute respiratory distress. Transpalatal repair of choanal atresia has a lower incidence of restenosis.27[pp 196-205]\nFigure 52-3Choanal atresia. This disorder frequently presents at birth with respiratory distress.'], 'gr4': ['Nasal dermoid cysts or sinuses present in the midline of the nasal dorsum (<xref rid="gr4" ref-type="fig">Fig. 52-4</xref>). They usually appear as a round bump or a pit with hair present in the pit (). They usually appear as a round bump or a pit with hair present in the pit (<xref rid="gr5" ref-type="fig">Fig. 52-5</xref>). They also may become infected. Nasal dermoid sinuses may extend through the nasal bones into the nasofrontal area and have an intracranial component. Both CT and MRI may be necessary to demonstrate the extent of the dermoid. Surgical removal is required to prevent infection and recurrence. This may be done between ages 3 and 5 years if prior infection has not occurred. Dermoids confined to the nose are resected completely using a midline incision with an ellipse around the sinus tract. The tract is followed to its termination, and the nasal bones may need to be separated to reach the end of the tract.). They also may become infected. Nasal dermoid sinuses may extend through the nasal bones into the nasofrontal area and have an intracranial component. Both CT and MRI may be necessary to demonstrate the extent of the dermoid. Surgical removal is required to prevent infection and recurrence. This may be done between ages 3 and 5 years if prior infection has not occurred. Dermoids confined to the nose are resected completely using a midline incision with an ellipse around the sinus tract. The tract is followed to its termination, and the nasal bones may need to be separated to reach the end of the tract.27[pp 188-191] If an intracranial component is present, a combined craniotomy and nasal approach with a neurosurgeon is recommended.\nFigure 52-4Nasal dermoid presenting in the midline as a pit.Figure 52-5Nasal dermoid. These lesions typically present on the nasal dorsum as a single midline pit, often with a hair extruding from the depths of the pit. The pits may also be found on the columella. The dermoid will then tract through the septum toward the cranial base.'], 'gr6': ['In suspected cases, the diagnosis of a retropharyngeal/parapharyngeal space infection is confirmed with either contrast medium–enhanced CT or MRI. Widening of the retropharynx on a lateral neck radiograph suggests a retropharyngeal infection. While ultrasound can detect the presence of an abscess cavity, CT or MRI are most helpful in demonstrating the extent of infection and the location of surrounding structures of importance, specifically the great vessels. Contrast medium–enhanced CT is particularly useful in distinguishing a phlegmon (cellulitis) from cases of frank suppuration. Demonstration of a hypodense region with surrounding rim enhancement has been shown to correlate with an abscess in 92% of cases (<xref rid="gr6" ref-type="fig">Fig. 52-6</xref>).\n).\nFigure 52-6Retropharyngeal abscess. Computed tomography of the cervical area demonstrates fluid loculated in the retropharyngeal space. The abscess is typically unilateral and frequently extends into the medial aspect of the peripharyngeal space. In the absence of associated complications, drainage can be done intraorally.'], 'gr7': ['The major group at risk for SDB includes children with adenotonsillar hypertrophy secondary to lymphoid hyperplasia (<xref rid="gr7" ref-type="fig">Figure 52-7</xref>, , <xref rid="gr8" ref-type="fig">Figure 52-8</xref>). Whereas the age of affected children ranges from 2 years through adolescence, the prevalence mirrors the age of greatest lymphoid hyperplasia, 2 to 6 years, the age the tonsils and adenoids are largest in size. Other at-risk groups include syndromic children with Down syndrome, children with craniofacial disorders, and patients with cleft palate or storage diseases (Hunter\'s, Hurler\'s syndromes). Adverse effects of obstructive sleep apnea on children include poor school performance, failure to thrive, facial and dental maldevelopment, and, rarely, severe cardiac impairment, including systemic hypertension, cardiac arrhythmias, and cor pulmonale.\n). Whereas the age of affected children ranges from 2 years through adolescence, the prevalence mirrors the age of greatest lymphoid hyperplasia, 2 to 6 years, the age the tonsils and adenoids are largest in size. Other at-risk groups include syndromic children with Down syndrome, children with craniofacial disorders, and patients with cleft palate or storage diseases (Hunter\'s, Hurler\'s syndromes). Adverse effects of obstructive sleep apnea on children include poor school performance, failure to thrive, facial and dental maldevelopment, and, rarely, severe cardiac impairment, including systemic hypertension, cardiac arrhythmias, and cor pulmonale.\nFigure 52-7Tonsillar hypertrophy. Tonsillar hypertrophy is rated on a scale of 1 to 4. Grade 1+ tonsils are hypertrophic, grade 2+ tonsils extend slightly beyond the tonsillar pillars, grade 3+ tonsils extend in a medial direction beyond the anterior tonsillar pillars, and grade 4+ tonsils touch in the midline.Figure 52-8Adenoid hypertrophy. Hypertrophy of the adenoids may cause the nasopharynx to be obstructed with tissue. Smaller amounts of tissue are also able to obstruct nasal respiration by growing into the posterior choana as shown in this photograph.'], 'gr9': ['Ankyloglossia or tongue-tie is a common congenital disorder involving the lingual frenulum (<xref rid="gr9" ref-type="fig">Fig. 52-9</xref>). Neonates with diminished tongue mobility due to a foreshortened frenulum may have problems in sucking and feeding. Because the frenulum is thin and relatively avascular in neonates and young infants, it can often be incised as an office procedure. In older children the greatest effect of ankyloglossia is on speech. Because the tip of the tongue curls under on extrusion and has limited lateral and superior movement, speech articulation may be affected. Surgical treatment in these patients may require a short general anesthetic as the frenulum is thicker and more vascular, requiring surgical correction that includes either simple division with or without a Z-plasty repair.\n). Neonates with diminished tongue mobility due to a foreshortened frenulum may have problems in sucking and feeding. Because the frenulum is thin and relatively avascular in neonates and young infants, it can often be incised as an office procedure. In older children the greatest effect of ankyloglossia is on speech. Because the tip of the tongue curls under on extrusion and has limited lateral and superior movement, speech articulation may be affected. Surgical treatment in these patients may require a short general anesthetic as the frenulum is thicker and more vascular, requiring surgical correction that includes either simple division with or without a Z-plasty repair.\nFigure 52-9Ankyloglossia. Abnormal development of the lingual frenulum that limits extension of the tongue tip beyond the mandibular incisors frequently causes articulation disorders and should be corrected.'], 'gr10': ['\nEpulis is a congenital granular cell tumor that typically presents as a soft, pink submucosal mass on the anterior alveolar ridge of the maxilla (<xref rid="gr10" ref-type="fig">Fig. 52-10</xref>). Females are more commonly affected, and symptoms are usually confined to feeding problems. Surgical excision is curative.\n). Females are more commonly affected, and symptoms are usually confined to feeding problems. Surgical excision is curative.\nFigure 52-10Congenital epulis. The congenital epulis is an unusual benign lesion that frequently arises from the anterior maxillary alveolar ridge. Airway and feeding difficulties may develop secondary to large lesions. Surgical excision is required.'], 'gr11': ['\nRanula is a pseudocyst located in the floor of the mouth that may occur congenitally or result from intraoral trauma (<xref rid="gr11" ref-type="fig">Fig. 52-11</xref>). Large ranulas may extend through the mylohyoid musculature and present in the neck as a “plunging ranula.” Treatment of ranulas is by excision or marsupialization of the pseudocyst, often in conjunction with excision of the sublingual gland. ). Large ranulas may extend through the mylohyoid musculature and present in the neck as a “plunging ranula.” Treatment of ranulas is by excision or marsupialization of the pseudocyst, often in conjunction with excision of the sublingual gland. Mucoceles are also pseudocysts of minor salivary gland origin and frequently rupture spontaneously. Recurrent or symptomatic mucoceles respond to surgical excision.\nFigure 52-11A ranula is a pseudocyst caused by obstruction of a sublingual gland. It generally presents as a unilateral, painless swelling in the floor of the mouth.'], 'gr12': ['\nLaryngomalacia is the most common cause of newborn stridor and is caused by prolapse of the supraglottic structures (arytenoid cartilages, aryepiglottic folds) during inspiration (<xref rid="gr12" ref-type="fig">Fig. 52-12</xref>). Symptoms typically appear at birth or soon thereafter and include inspiratory stridor, feeding difficulties, and, rarely, apnea or signs of severe airway obstruction. Gastroesophageal reflux disease tends to worsen symptoms of laryngomalacia. The diagnosis is confirmed by flexible endoscopy of the larynx, and other airway pathology can be excluded with lateral neck, chest, and barium swallow radiography. In most cases, laryngomalacia is self-limited and resolves by 18 months of age. Changes in positioning and feeding, treatment of reflux, and, in some neonates, use of monitoring may be necessary. In severe cases, surgical intervention with either a supraglottoplasy (surgical division of the aryepiglottic folds) or a tracheostomy may be necessary.\n). Symptoms typically appear at birth or soon thereafter and include inspiratory stridor, feeding difficulties, and, rarely, apnea or signs of severe airway obstruction. Gastroesophageal reflux disease tends to worsen symptoms of laryngomalacia. The diagnosis is confirmed by flexible endoscopy of the larynx, and other airway pathology can be excluded with lateral neck, chest, and barium swallow radiography. In most cases, laryngomalacia is self-limited and resolves by 18 months of age. Changes in positioning and feeding, treatment of reflux, and, in some neonates, use of monitoring may be necessary. In severe cases, surgical intervention with either a supraglottoplasy (surgical division of the aryepiglottic folds) or a tracheostomy may be necessary.\nFigure 52-12Laryngomalacia. This disorder classically presents as an omega-shaped epiglottis. The arytenoid mucosa is redundant, and the aryepiglottic folds are foreshortened. The result is a hooding of tissue over the glottic inlet that leads to airway obstruction on inspiration.'], 'gr13': ['\nCongenital subglottic stenosis is the third most common congenital laryngeal anomaly and is defined as a neonatal larynx that fails to admit a 3.5-mm endotracheal tube without a history of prior instrumentation or intubation (<xref rid="gr13" ref-type="fig">Fig. 52-13</xref>). The underlying abnormality is a cricoid cartilage that is either small or deformed. Infants with congenital subglottic stenosis present with inspiratory or biphasic stridor, barking cough, and other symptoms of airway obstruction. The diagnosis is often suggested by narrowing of the subglottis on a lateral neck radiograph and confirmed by endoscopy. Treatment depends on the severity of symptoms and ranges from observation to laryngeal reconstruction to tracheostomy.\n). The underlying abnormality is a cricoid cartilage that is either small or deformed. Infants with congenital subglottic stenosis present with inspiratory or biphasic stridor, barking cough, and other symptoms of airway obstruction. The diagnosis is often suggested by narrowing of the subglottis on a lateral neck radiograph and confirmed by endoscopy. Treatment depends on the severity of symptoms and ranges from observation to laryngeal reconstruction to tracheostomy.\nFigure 52-13Subglottic stenosis. Congenital and acquired stenosis create airway obstruction, depending on the severity and type of stenosis. Various forms of reconstruction are available (see Chapter 63).'], 'gr14': ['\nA child with a subglottic hemangioma presents with the onset of progressive stridor during the first few months of life (<xref rid="gr14" ref-type="fig">Fig 52-14</xref>). Hemangiomas are proliferative endothelial lesions that can form in the submucosa of the posterior subglottis. Occasionally, they may involve the subglottis in a circumferential pattern. Associated cutaneous hemangiomas may be found in approximately 50% of patients. Symptoms are dependent on the amount of airway compromise and include biphasic stridor, barking cough, difficulty feeding, and other symptoms and signs of airway obstruction. The diagnosis may be suggested on a lateral neck radiograph but is confirmed with endoscopy. Nonsurgical management of infants with a subglottic hemangioma includes observation or treatment with systemic corticosteroids. Surgical therapy includes laser excision, open excision through a laryngofissure, or a tracheostomy.\n). Hemangiomas are proliferative endothelial lesions that can form in the submucosa of the posterior subglottis. Occasionally, they may involve the subglottis in a circumferential pattern. Associated cutaneous hemangiomas may be found in approximately 50% of patients. Symptoms are dependent on the amount of airway compromise and include biphasic stridor, barking cough, difficulty feeding, and other symptoms and signs of airway obstruction. The diagnosis may be suggested on a lateral neck radiograph but is confirmed with endoscopy. Nonsurgical management of infants with a subglottic hemangioma includes observation or treatment with systemic corticosteroids. Surgical therapy includes laser excision, open excision through a laryngofissure, or a tracheostomy.\nFigure 52-14Subglottic hemangiomas typically arise from the posterior lateral aspect of the larynx. Small lesions may be managed conservatively, whereas lesions with aggressive growth patterns require tracheotomy to bypass the laryngeal obstruction.'], 'gr15': ['Children afflicted with recurrent respiratory papillomatosis present initially with hoarseness but may also have symptoms and signs of airway obstruction, including stridor. Lateral neck radiography may suggest laryngeal involvement, but the diagnosis is confirmed by direct laryngoscopy and biopsy (<xref rid="gr15" ref-type="fig">Fig. 52-15</xref>). In addition to the trachea and bronchi, squamous papillomas may also be found in the oral cavity.\n). In addition to the trachea and bronchi, squamous papillomas may also be found in the oral cavity.\nFigure 52-15Recurrent respiratory papillomatosis. Severe papillomatosis may completely obstruct the larynx. Papillomas are characterized by malignant degeneration and aggressive growth patterns.']} | Otolaryngologic Disorders | null | Pediatric Surgery | 1142928000 | None | null | other | PMC7158348 | null | null | [
""
] | Pediatric Surgery. 2006 Mar 21;:813-834 | NO-CC CODE |
|
MRI. T2-weighted image, frontal plane. Mirizzi syndrome. Markedly enlarged, kinked gallbladder (asterisk). Main intrahepatic biliary trunks dilated (arrowhead). | poljradiol-79-315-g005 | 7 | bfe57f92d851f6440f1ea0dd37ba872d227f44f52a6c6b5e90d7155b37a6ca9f | poljradiol-79-315-g005.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
600,
617
] | [{'image_id': 'poljradiol-79-315-g003', 'image_file_name': 'poljradiol-79-315-g003.jpg', 'image_path': '../data/media_files/PMC4167505/poljradiol-79-315-g003.jpg', 'caption': 'MRI. (A) MRCP. (B) T2-weighted image, coronal plane. Tumor of hepatic hilum. Prosthesis in the biliary tract. Dilated intra- and extrahepatic biliary ducts. Lack of signal in the distal sections of intrahepatic biliary tract, common hepatic duct as well as the proximal part of common bile duct (asterisk). A nondemarcated area of neoplastic infiltration around the prosthesis, within hepatic hilum and in the adjacent liver parenchyma (arrow).', 'hash': '6aac7916db07fd06f3c80824983985d7348ab31a0dd67859328135ef63bc2bb4'}, {'image_id': 'poljradiol-79-315-g004', 'image_file_name': 'poljradiol-79-315-g004.jpg', 'image_path': '../data/media_files/PMC4167505/poljradiol-79-315-g004.jpg', 'caption': 'MRCP. Carcinoma of the ampulla of Vater. Dilated intra- and extrahepatic biliary tract as well as pancreatic duct.', 'hash': '6c86b65c7565ff37f2d201e583cae80ac812497e1624b5394d46482e9cb9d8ab'}, {'image_id': 'poljradiol-79-315-g005', 'image_file_name': 'poljradiol-79-315-g005.jpg', 'image_path': '../data/media_files/PMC4167505/poljradiol-79-315-g005.jpg', 'caption': 'MRI. T2-weighted image, frontal plane. Mirizzi syndrome. Markedly enlarged, kinked gallbladder (asterisk). Main intrahepatic biliary trunks dilated (arrowhead).', 'hash': 'bfe57f92d851f6440f1ea0dd37ba872d227f44f52a6c6b5e90d7155b37a6ca9f'}, {'image_id': 'poljradiol-79-315-g002', 'image_file_name': 'poljradiol-79-315-g002.jpg', 'image_path': '../data/media_files/PMC4167505/poljradiol-79-315-g002.jpg', 'caption': 'MRCP (A, B). Low origin of elongated cystic duct (arrow). Short common bile duct. Dilated common hepatic duct with signal loss equivalent to concretions (arrowhead). Liver cysts.', 'hash': 'fd8ad95c42c8a6c1759d89fcbdb64a5fe5fdafcce2c89cbf57622c26f71f25b8'}, {'image_id': 'poljradiol-79-315-g001', 'image_file_name': 'poljradiol-79-315-g001.jpg', 'image_path': '../data/media_files/PMC4167505/poljradiol-79-315-g001.jpg', 'caption': 'Causes of biliary dilatation in the examined subgroups of patients.', 'hash': 'b13f362051b9a41572028db95f123150803bed4a167f18ed4e5d1cac5a28fe45'}, {'image_id': 'poljradiol-79-315-g006', 'image_file_name': 'poljradiol-79-315-g006.jpg', 'image_path': '../data/media_files/PMC4167505/poljradiol-79-315-g006.jpg', 'caption': 'MRI. (A) MRCP. (B) T2-weighted image, transverse plane. Inflammatory tumor of the head of pancreas. Dilated intra- and extrahepatic biliary tract (arrow). Irregularly enlarged pancreatic duct with dilated secondary ducts.', 'hash': 'f613812879b92409f0752a1f9ed78a58fd5349c57bceedf3d9343ddadc1c8098'}, {'image_id': 'poljradiol-79-315-g007', 'image_file_name': 'poljradiol-79-315-g007.jpg', 'image_path': '../data/media_files/PMC4167505/poljradiol-79-315-g007.jpg', 'caption': 'MRI. (A) MRCP. (B) T2-weighted image, coronal plane. Dysfunction of the ampulla of Vater due to its anatomical location – ampullary diverticulum. Dilated intra- and extrahepatic biliary tract. Pancreatic duct not dilated.', 'hash': 'ede8649d23e264089bdd91e5789ebc6ae7e166e32b1d589203e350b95399640c'}] | {'poljradiol-79-315-g001': ['Study group included 48 patients after cholecystectomy, 55 patients with gallbladder stones and 45 patients without concretions. In the studied subgroups biliary tract dilatation was noted in 27 (56.2%), 20 (36.4%) and 20 (44.4%) subjects, respectively (Table 1). ERCP was performed in 28 patients with biliary tract dilatation (41%). In the remaining patients diagnosis was stated based on clinical picture, laboratory studies and other imaging examinations (ultrasound, computed tomography) or the cause of biliary duct dilatation was never found. Areas of signal loss raising suspicion of concretions were noted in 34 cases, while in 24 (70.6%) cases suspicion was confirmed (by ERCP in 20 cases and intraoperatively in 4 patients). The causes of biliary tree dilatation in the studied subgroups included concretions (a total of 23 cases confirmed in MRCP and ERCP) in 40.7%, 45% and 15% of cases, respectively (<xref ref-type="fig" rid="poljradiol-79-315-g001">Figure 1</xref>). In the remaining cases (10 in total) where presence of concretions was suspected based on MRCP examinations, in 1 case suspected concretion turned out to be a malignant process, in 1 case biliary sludge was identified and in 1 one case presence of concretions was ruled out. In the remaining cases (7) ERCP was not performed for such reasons as: lack of patient consent, comorbidities or technical reasons. The most common (45%) cause of biliary tract dilatation in a subgroup of patients with biliary stones was choledocholithiasis (). In the remaining cases (10 in total) where presence of concretions was suspected based on MRCP examinations, in 1 case suspected concretion turned out to be a malignant process, in 1 case biliary sludge was identified and in 1 one case presence of concretions was ruled out. In the remaining cases (7) ERCP was not performed for such reasons as: lack of patient consent, comorbidities or technical reasons. The most common (45%) cause of biliary tract dilatation in a subgroup of patients with biliary stones was choledocholithiasis (<xref ref-type="fig" rid="poljradiol-79-315-g001">Figure 1</xref>). In patients with undilated biliary tract areas of signal loss demonstrated by MRCP suspected of consisting concretions were noted in 4 cases only, including 1 case where this diagnosis was ruled out and 1 confirmed case, while ERCP was not performed in 2 remaining cases. Malignant causes of biliary tract dilatation were identified in 9 (13.4%) people (1 pancreatic head tumor, 4 cases of neoplastic infiltration, 3 tumors of hepatic hilum, 1 carcinoma of the ampulla of Vater). MRCP picture was typical in 4 (44.4%) cases (). In patients with undilated biliary tract areas of signal loss demonstrated by MRCP suspected of consisting concretions were noted in 4 cases only, including 1 case where this diagnosis was ruled out and 1 confirmed case, while ERCP was not performed in 2 remaining cases. Malignant causes of biliary tract dilatation were identified in 9 (13.4%) people (1 pancreatic head tumor, 4 cases of neoplastic infiltration, 3 tumors of hepatic hilum, 1 carcinoma of the ampulla of Vater). MRCP picture was typical in 4 (44.4%) cases (Table 2). Malignancy was the most common (20%) cause of biliary tree dilatation in a subgroup of patients without cholelithiasis (<xref ref-type="fig" rid="poljradiol-79-315-g001">Figure 1</xref>). Aside from choledocholithiasis, benign causes of biliary tract dilatation were identified in 16 (23.8) subjects (1 inflammatory tumor of pancreatic head, 5 cases of cholangitis, 1 gallbladder empyema and cholangitis, 1 case of Mirizzi syndrome, 1 case of dysfunction of the sphincter of Oddi, 1 autoimmune hepatitis, 1 primary sclerosing cholangitis, 2 cases of chronic pancreatitis, 1 case of dysfunction of the papilla of Vater, 1 biliary tree anomaly, 1 vascular band). Benign causes of biliary tract dilatation other than choledocholithiasis were identified using MRCP in 4 (25%) patients and included: chronic pancreatitis, cholecystitis and cholangitis, presence of vascular band modeling the common hepatic duct (CHD) and Mirizzi syndrome (). Aside from choledocholithiasis, benign causes of biliary tract dilatation were identified in 16 (23.8) subjects (1 inflammatory tumor of pancreatic head, 5 cases of cholangitis, 1 gallbladder empyema and cholangitis, 1 case of Mirizzi syndrome, 1 case of dysfunction of the sphincter of Oddi, 1 autoimmune hepatitis, 1 primary sclerosing cholangitis, 2 cases of chronic pancreatitis, 1 case of dysfunction of the papilla of Vater, 1 biliary tree anomaly, 1 vascular band). Benign causes of biliary tract dilatation other than choledocholithiasis were identified using MRCP in 4 (25%) patients and included: chronic pancreatitis, cholecystitis and cholangitis, presence of vascular band modeling the common hepatic duct (CHD) and Mirizzi syndrome (Table 2). In the remaining 12 cases (75%) ERCP examination, laboratory studies and clinical picture played a decisive role in stating the diagnosis. Benign causes of biliary tract dilatation other than choledocholithiasis were most often (20%) diagnosed in a subgroup of patients without gallstone disease (<xref ref-type="fig" rid="poljradiol-79-315-g001">Figure 1</xref>). No cause of biliary tract dilatation was found in 13 (19.4%) patients with biliary dilatation, mostly (22%) in a subgroup of patients who had undergone cholecystectomy in the past and in those cases ERCP was not performed for various reasons. Sensitivity and specificity as well as positive and negative predictive value of MRCP in the diagnostics of biliary tract dilatation are presented in ). No cause of biliary tract dilatation was found in 13 (19.4%) patients with biliary dilatation, mostly (22%) in a subgroup of patients who had undergone cholecystectomy in the past and in those cases ERCP was not performed for various reasons. Sensitivity and specificity as well as positive and negative predictive value of MRCP in the diagnostics of biliary tract dilatation are presented in Table 3.', 'Biliary tree dilatation is demonstrated with abdominal ultrasound and, less often, in computed tomography (CT) of the abdomen in both symptomatic as well as asymptomatic patients and is one of the most common reasons for referral to ERCP or MRCP. Van Hoe noted an increase in common biliary tract diameter in people over 50 years of age and estimated it at about 1 mm/decade. According to this author, this phenomenon is caused by atrophy of elastic fibers within bile duct walls [3]. In MRCP images undilated intrahepatic biliary ducts are visualized up to the point of the second division into secondary ducts, the so-called subsegmental ducts. Visualizing further divisions is the evidence of anomaly and suggests bile stasis [4]. In the studied material bile duct dilatation was noted in 56.2% of patients after cholecystectomy, 36.4% patients with cholelithiasis and 44.4% of patients without gallstones (Table 1). Choledocholithiasis is one of the most common causes of bile duct dilatation. Choledocholithiasis occurs in 15% of gallstone disease cases, up to 20% of acute cholecystitis cases and in nearly 15% of patients after cholecystectomy (mainly open procedures). Primary choledocholithiasis constitutes about 5% of choledocholithiasis cases in Western countries and secondary choledocholithiasis – about 95% of cases [5]. Biliary stones are visualized in MR imaging as areas of signal loss/foci of signal attenuation in T2-weighted images surrounded by bile, which is characterized by increased signal intensity. However, they may exhibit higher signal in T2-weighted images due to presence of bile within the stone [2]. In the studied material areas of signal loss suspected in MRCP as concretions were demonstrated only in 34 cases, including 24 (70.6%) confirmed cases (20 in ERCP and 4 intraoperatively). In one case only concretion was identified in undilated biliary tract. The most common (45%) cause of biliary duct dilatation was choledocholithiasis in a subgroup of patients with gallbladder stones (<xref ref-type="fig" rid="poljradiol-79-315-g001">Figure 1</xref>). Literature contains discrepancies regarding sensitivity and specificity of MRCP in detection of choledocholithiasis. Moon et al. determined sensitivity of MRCP at 80% and specificity at 83% [). Literature contains discrepancies regarding sensitivity and specificity of MRCP in detection of choledocholithiasis. Moon et al. determined sensitivity of MRCP at 80% and specificity at 83% [6]. Zidi et al. also assessed the role of MRCP in diagnosis of choledocholithiasis. Among 45 patients with bile stones MRCP visualized concretions in 28 cases only (sensitivity – 57%, specificity – 100%) [7]. Such low sensitivity could be due to the presence of minute concretions less than 3 mm in diameter. As also noted by other authors, small concretions may be overlooked in MRCP [6,8]. In their publication Calvo et al. emphasize that small concretions (3–5 mm) may pose a problem for those who evaluate MRCP, particularly if they become impacted [9]. On the other hand, according to Becker et al., MRCP allows for detection of stones as little as 2 mm in diameter, also in patients with undilated bile ducts [10]. In the analyzed cases the smallest concretion was 2 mm and the largest 30 mm in diameter. The majority of concretions detected in the biliary tract were 8–12 in diameter (<xref ref-type="fig" rid="poljradiol-79-315-g002">Figure 2A, 2B</xref>). In our material sensitivity of MRCP in detection of concretions in dilated biliary tract was high and amounted to 100% with specificity of 88.8% and PPV and NPV values 88.4% and 100% respectively (). In our material sensitivity of MRCP in detection of concretions in dilated biliary tract was high and amounted to 100% with specificity of 88.8% and PPV and NPV values 88.4% and 100% respectively (Table 3). High sensitivity probably resulted from relatively easy visualization of areas of signal loss within dilated bile ducts. Single-shot fast spin-echo sequences in T2-weighted images were considered superior in detection of gallstones, as most gallstones are isointense in T1-weighted images [11]. In an in vitro study, Ukaji et al. demonstrated that hyperintense signal from biliary concretions in T1-weighted images is produced by the presence of metal ions with paramagnetic properties that shorten T1 relaxation time of water protons [12]. T2-weighted imaging indirectly detects gallstones through imaging of corresponding areas of signal loss, which is associated with several diagnostic pitfalls. Areas of intraductal signal loss caused by presence of neoplasms, thrombi or gas bubbles (pneumobilia) may mimic gallstones and are difficult to differentiate. On the other hand, small concretions located in peripapillary region may be omitted in T2-weighted imaging due to the absence of surrounding bile, thus lack of signal loss [13]. This is why Hong-Ming et al. recommend to routinely combine 3D fast spoiled gradient-echo technique in T1-weighted images and single-shot fast spin-echo in T2-weighted images for magnetic resonance imaging of gallstones [14].', 'Malignant causes of dilatation (a total of 9 cases) in studied subgroups constituted 14.8%, 5% and 20% (<xref ref-type="fig" rid="poljradiol-79-315-g001">Figure 1</xref>) of cases, respectively. MRCP picture unequivocally corresponded to malignant etiology in 4 cases () of cases, respectively. MRCP picture unequivocally corresponded to malignant etiology in 4 cases (Table 2) (pancreatic head tumor, two tumors of hepatic hilum and infiltration of common bile duct). Contrast medium was administered in three of these four studies. Contrast medium was not used in any of the five remaining cases of biliary tract dilatation due to malignancy. In three cases of malignancy MRCP raised only a suspicion of a neoplastic process, which was later confirmed. MRCP image unequivocally corresponded to a malignant cause in another 4 cases (Table 2) (pancreatic head tumor, 2 tumors of hepatic hilum and common bile duct infiltration). Typical features of pancreatic head tumor noted in MRCP include sudden obstruction of the lumen of intrapancreatic segment of common bile duct and a “double duct sign” related to concomitant dilatation of the pancreatic duct. Obstructed or narrowed segment is usually of medium length, has irregular margins and transverse sequences demonstrate a presence of a pathological mass within pancreatic head, weakly hyperintense in T2-weighted images and strongly hypointense in T1-weighted images following intravenous administration of contrast medium [3,11]. In the studied material pancreatic head tumor was visible as a poorly demarcated area with somewhat heterogeneous and slightly increased signal in T2-weighted images. Pancreatic duct was 1.5 mm in diameter and modeled into an arch from the anterior side. Common hepatic duct was dilated to 13.5 mm. Common biliary duct was narrowed to 2 mm. In the peripheral form of intrahepatic cholangiocarcinoma MRCP picture demonstrates segmental obstruction or narrowing of duct lumen, presence of intraductal mass presenting as loss of signal within the lumen, proximal ductal dilatation away from the infiltrated site. Adjuvant gradient echo T1-weighted sequences with contrast demonstrate signal enhancement following intravenous administration of contrast medium (low tumor signal in overview T1-weighted sequences compared to normal liver parenchyma), central changes persisting also in the delayed phase [3,15,16]. Extrahepatic form of cholangiocarcinoma usually develops from the middle part of common bile duct. Signal from the infiltration is usually weakly hyperintense in T2-weighted images. Above the lesion biliary tree dilatation is observed. Klatskin tumor usually develops from the proximal part of common hepatic duct. In MRCP projection sequences we observe segmental duct narrowing, usually 1–3 cm in diameter, with smooth or irregular internal margins. There are often areas of signal loss within duct lumen. Transverse images show a high-signal (well demarcated forms with high mucin content) or intermediate-signal mass (fibrous forms) within liver hilum. In adjuvant sequences we observe heterogeneous signal enhancement after intravenous administration of contrast with dominance in the delayed phase [17]. There were 3 cases of Klatskin tumor in the studied material. The picture was typical in two cases. In the first case MRI picture was concordant with the above description (<xref ref-type="fig" rid="poljradiol-79-315-g003">Figure 3A, 3B</xref>), while ERCP showed a tight, organic narrowing at the level of common bile duct and common hepatic duct. In the second case MRCP showed dilatation of extra- and intrahepatic biliary tracts and loss of lumen signal from the confluence of right and left hepatic duct. In case of a tumor of the liver hilum and carcinoma of the papilla of Vater MRCP examination, laboratory studies and ERCP did not unequivocally indicate a malignant cause of dilatation, which was identified in later studies. In the first one of these cases MRI showed only slight common hepatic duct dilatation and loss of signal from the proximal part of common biliary duct, which was related to the presence of post-cholecystectomy clips. CT image was unequivocal in this case, while ERCP demonstrated biliary duct obstruction at the level of cystic duct stump. In the end (intraoperatively), tumor of liver hilum was diagnosed. In case of carcinoma of papilla of Vater MRCP showed slight dilatation of main stems of intrahepatic bile ducts, extrahepatic bile ducts and pancreatic duct (), while ERCP showed a tight, organic narrowing at the level of common bile duct and common hepatic duct. In the second case MRCP showed dilatation of extra- and intrahepatic biliary tracts and loss of lumen signal from the confluence of right and left hepatic duct. In case of a tumor of the liver hilum and carcinoma of the papilla of Vater MRCP examination, laboratory studies and ERCP did not unequivocally indicate a malignant cause of dilatation, which was identified in later studies. In the first one of these cases MRI showed only slight common hepatic duct dilatation and loss of signal from the proximal part of common biliary duct, which was related to the presence of post-cholecystectomy clips. CT image was unequivocal in this case, while ERCP demonstrated biliary duct obstruction at the level of cystic duct stump. In the end (intraoperatively), tumor of liver hilum was diagnosed. In case of carcinoma of papilla of Vater MRCP showed slight dilatation of main stems of intrahepatic bile ducts, extrahepatic bile ducts and pancreatic duct (<xref ref-type="fig" rid="poljradiol-79-315-g004">Figure 4</xref>). However, the examination was performed after evacuation of concretions and bile duct dilatation was thought to be related to recent procedure. Further CT study prompted a suspicion of obstruction at the level of papilla of Vater, which was confirmed by ERCP examination (egzophytic lesion within the papilla). Sensitivity of MRCP in detection of malignant causes of biliary tract dilatation in the studied material amounted to 60% with specificity of 100% (). However, the examination was performed after evacuation of concretions and bile duct dilatation was thought to be related to recent procedure. Further CT study prompted a suspicion of obstruction at the level of papilla of Vater, which was confirmed by ERCP examination (egzophytic lesion within the papilla). Sensitivity of MRCP in detection of malignant causes of biliary tract dilatation in the studied material amounted to 60% with specificity of 100% (Table 3). Relatively low sensitivity could be due to lack of contrast administration in most of these examinations (6/9).', 'Benign causes of biliary tract dilatation other than choledocholithiasis (16 cases altogether) constituted respectively 14.8%, 10% and 50% of the study subgroups (<xref ref-type="fig" rid="poljradiol-79-315-g001">Figure 1</xref>). In bacterial cholangitis we observe only slight dilatation of bile tracts in the initial phase of illness, while irregular margins of external duct walls, loss of lumen signal due to the presence of biliary stones, sludge or pus as well as intrahepatic abscesses (irregular areas with signal similar to bile) communicating with the biliary tree are visualized at later stages [). In bacterial cholangitis we observe only slight dilatation of bile tracts in the initial phase of illness, while irregular margins of external duct walls, loss of lumen signal due to the presence of biliary stones, sludge or pus as well as intrahepatic abscesses (irregular areas with signal similar to bile) communicating with the biliary tree are visualized at later stages [4]. In the studied material such picture was not observed in MRCP examination. No case of cholangitis was unequivocally identified based on MRCP examination. These studies were performed without administration of contrast. On the other hand, in cases of bile duct dilatation due to chronic pancreatitis, cholecystitis and cholangitis, as well as presence of a vascular band modeling common hepatic duct and Mirizi syndrome MRCP was typical in our material (4 cases) (Table 2). MRI examination visualized significantly enlarged, kinked gallbladder with unthickened wall and dilated main intrahepatic biliary stems. However, common biliary and common hepatic ducts were not visualized (<xref ref-type="fig" rid="poljradiol-79-315-g005">Figure 5</xref>). In cholelithiasis and cholangitis (confirmed intraoperatively) MRCP examination showed irregular thickening of gallbladder wall with numerous areas of signal loss typical of concretions and an irregular fluid collection constricting and modeling the duodenum, as well as dilated intrahepatic bile ducts. The following features suggest fibrotic changes in MRCP examinations: short segment of stenosis in the biliary duct, smooth margins of the stricture and absence of pathological masses near the stenotic segment in transverse images [). In cholelithiasis and cholangitis (confirmed intraoperatively) MRCP examination showed irregular thickening of gallbladder wall with numerous areas of signal loss typical of concretions and an irregular fluid collection constricting and modeling the duodenum, as well as dilated intrahepatic bile ducts. The following features suggest fibrotic changes in MRCP examinations: short segment of stenosis in the biliary duct, smooth margins of the stricture and absence of pathological masses near the stenotic segment in transverse images [15]. In 4 cases of postinflammatory scarring that caused biliary tract dilatation MRCP picture was uncharacteristic, as it was in the remaining 8 cases (1 inflammatory tumor of pancreatic head (<xref ref-type="fig" rid="poljradiol-79-315-g006">Figure 6A, 6B</xref>), 1 cholangitis, 1 dysfunction of sphincter of Oddi, 1 autoimmune hepatitis, 1 case of primary sclerosing cholangitis, 1 chronic pancreatitis, 1 case of dysfunction of papilla of Vater, 1 bile duct anomaly). ERCP examination and other (laboratory and imaging) studies proved to be complementary to the final diagnosis. In case of sphincter of Oddi dysfunction, which was demonstrated in ERCP examination and was supported by overall clinical picture, MRCP examination showed dilatation of extrahepatic bile tracts and narrowing of proximal common bile duct without pancreatic duct dilatation. The picture was similar in dysfunction of papilla of Vater caused by its anatomical location within a recess (), 1 cholangitis, 1 dysfunction of sphincter of Oddi, 1 autoimmune hepatitis, 1 case of primary sclerosing cholangitis, 1 chronic pancreatitis, 1 case of dysfunction of papilla of Vater, 1 bile duct anomaly). ERCP examination and other (laboratory and imaging) studies proved to be complementary to the final diagnosis. In case of sphincter of Oddi dysfunction, which was demonstrated in ERCP examination and was supported by overall clinical picture, MRCP examination showed dilatation of extrahepatic bile tracts and narrowing of proximal common bile duct without pancreatic duct dilatation. The picture was similar in dysfunction of papilla of Vater caused by its anatomical location within a recess (<xref ref-type="fig" rid="poljradiol-79-315-g007">Figure 7A, 7B</xref>). Sensitivity of MRCP in detection of benign causes of biliary tract dilatation other than choledocholithiasis in the studied material was low and amounted to 25% with specificity of 100% (). Sensitivity of MRCP in detection of benign causes of biliary tract dilatation other than choledocholithiasis in the studied material was low and amounted to 25% with specificity of 100% (Table 3).']} | Diagnostics of Biliary Dilatation by Means of Magnetic Resonance Cholangiopancreatography | [
"Cholangiopancreatography",
"Magnetic Resonance",
"Cholecystectomy",
"Dilatation"
] | Pol J Radiol | 1410850800 | Molecular 'assembly lines', in which organic molecules undergo iterative processes such as chain elongation and functional group manipulation, are found in many natural systems, including polyketide biosynthesis. Here we report the creation of such an assembly line using the iterative, reagent-controlled homologation of a boronic ester. This process relies on the reactivity of α-lithioethyl tri-isopropylbenzoate, which inserts into carbon-boron bonds with exceptionally high fidelity and stereocontrol; each chain-extension step generates a new boronic ester, which is immediately ready for further homologation. We used this method to generate organic molecules that contain ten contiguous, stereochemically defined methyl groups. Several stereoisomers were synthesized and shown to adopt different shapes-helical or linear-depending on the stereochemistry of the methyl groups. This work should facilitate the rational design of molecules with predictable shapes, which could have an impact in areas of molecular sciences in which bespoke molecules are required. | [
"Chemistry Techniques, Synthetic",
"Magnetic Resonance Spectroscopy",
"Molecular Conformation",
"Polyketides"
] | other | PMC4167505 | null | 50 | [
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"{'Citation': 'Butts CP, Jones CR, Harvey JN. High precision NOEs as a probe for low level conformers – a second conformation of strychnine. Chem. Commun. 2011;47:1193–1195.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21109870'}}}",
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] | Pol J Radiol. 2014 Sep 16; 79:315-322 | NO-CC CODE |
|
Extensive calcifications, warranting aggressive medical management for atherosclerosis. | vhrm0402-315-04 | 7 | f38270af6a45c6c6107bd1eaa36eb6640ceaeccf17ad797a717f8e9b445dba9f | vhrm0402-315-04.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
480,
483
] | [{'image_id': 'vhrm0402-315-05', 'image_file_name': 'vhrm0402-315-05.jpg', 'image_path': '../data/media_files/PMC2496978/vhrm0402-315-05.jpg', 'caption': 'Ten-year follow up for all cause mortality. Patients with scores > 1000 had a 26% mortality rate, multiples higher than patients without coronary calcification.', 'hash': '4eba7d321aa27d2373268291a7ee64d21e245800436a8cfb7194160d4867d27d'}, {'image_id': 'vhrm0402-315-02', 'image_file_name': 'vhrm0402-315-02.jpg', 'image_path': '../data/media_files/PMC2496978/vhrm0402-315-02.jpg', 'caption': '56-year-old male with family history of heart disease, found to have no coronary calcification. This person was subsequently not treated with statin therapy, after being assessed as low risk by CT imaging.', 'hash': '59e695f13c60df9aee4428ae44438d289b1291c6757f11fb005584af09c1a053'}, {'image_id': 'vhrm0402-315-03', 'image_file_name': 'vhrm0402-315-03.jpg', 'image_path': '../data/media_files/PMC2496978/vhrm0402-315-03.jpg', 'caption': '62-year-old sister of patient from Figure 2, found to have moderate calcifications and started on statin and aspirin therapy, in addition to lifestyle modification counseling.', 'hash': '7bd9a15dee89a83569821c9a5aa9915e0ae9b8fabd65033cbb4d671c91b75b1a'}, {'image_id': 'vhrm0402-315-04', 'image_file_name': 'vhrm0402-315-04.jpg', 'image_path': '../data/media_files/PMC2496978/vhrm0402-315-04.jpg', 'caption': 'Extensive calcifications, warranting aggressive medical management for atherosclerosis.', 'hash': 'f38270af6a45c6c6107bd1eaa36eb6640ceaeccf17ad797a717f8e9b445dba9f'}, {'image_id': 'vhrm0402-315-01', 'image_file_name': 'vhrm0402-315-01.jpg', 'image_path': '../data/media_files/PMC2496978/vhrm0402-315-01.jpg', 'caption': 'The Algorithm recommended by SHAPE (Screening for Heart Attack and Prevention). Patients with higher calcium scores get increasing therapies, as well as more diagnostic workup.', 'hash': 'f3dca984ccc079024c679877dc10c16fba813730ec6f410f3e9762e57a302c8d'}] | {'vhrm0402-315-01': ['Screening studies to detect occult cancers, such as breast and colon cancer, are recommended in appropriate risk adults to help improve survival in these life-threatening conditions (Smith et al 2005). Although atherosclerotic vascular disease accounts for more death and disability than all types of cancer, a screening tool to detect subclinical atherosclerosis (such as coronary artery calcium) and target prevention of future cardiovascular events is only now starting to be adopted. New guidelines are calling for use of a screening test to identify high risk cohorts. The Screening for Heart Attack Prevention and Education –SHAPE Guidelines are the most recent national guidelines calling for use of atherosclerosis imaging to assist physicians in risk stratification (<xref ref-type="fig" rid="vhrm0402-315-01">Figure 1</xref>) () (Naghavi et al 2006).'], 'vhrm0402-315-02': ['The presence of calcium in coronary arteries is pathognomonic of atherosclerosis (Budoff et al 2006). The close correlation between the atherosclerotic plaque burden and the extent of CAC has been confirmed both by histopathology and intravascular ultrasound (Mintz et al 1997; Baumgart et al 1998). The total CAC score measured represents an anatomic measure of overall cardiac plaque burden (<xref ref-type="fig" rid="vhrm0402-315-02">Figures 2</xref>--<xref ref-type="fig" rid="vhrm0402-315-04">4</xref>) () (Rumberger et al 1995; Baumgart et al 1997; Mintz et al 1997; Budoff et al 2006.', '62-year-old sister of patient from <xref ref-type="fig" rid="vhrm0402-315-02">Figure 2</xref>, found to have moderate calcifications and started on statin and aspirin therapy, in addition to lifestyle modification counseling., found to have moderate calcifications and started on statin and aspirin therapy, in addition to lifestyle modification counseling.'], 'vhrm0402-315-05': ['In 2003, Shaw and colleagues reported the relationship of CAC to all-cause mortality in the largest cohort studied to date, consisting of 10,377 asymptomatic individuals (40% women), followed for an average of 5 ± 3.5 years. In both men and women, CAC was an independent predictor of death (p < 0.001), and the risk increased proportionally to the baseline calcium scores (risk factor adjusted relative risk of 1.6, 1.7, 2.5, and 4 for CAC 11–100, 101–400, 401–1000, and greater than 1000 respectively) (Shaw et al 2003). This large observational data series shows that coronary calcium provides independent incremental information in addition to traditional risk factors in the prediction of all-cause mortality. Further follow up in another cohort of 25,000 persons demonstrates increasing mortality rates with increasing calcium scores (<xref ref-type="fig" rid="vhrm0402-315-05">Figure 5</xref>).).'], 'vhrm0402-315-04': ['The vast majority of heart attacks (60%–83%) occur at the site of a non-obstructive plaque (Giroud et al 1992). Exercise testing or pharmacologic cardiac imaging (nuclear or echo) will only diagnose high grade coronary stenoses. They will fail to identify a vast number of asymptomatic patients at risk because an obstructive coronary plaque (stenosis in the artery of >50% severity) is most often NOT the site of the cardiovascular event (MI or sudden cardiac death) (Little et al 1988). Framingham models miss a significant portion of patients, inappropriately stratified to intermediate or low risk. New scientific statements from the AHA (Budoff et al 2006) and SHAPE (Naghavi et al 2006) support the statement from the AHA perspective paper (Greenland et al 2001), which stated, “…with a prior probability of a coronary event in the intermediate range (≥6% in 10 years but ≤20% in 10 years), a calcium score of >100 would yield a post-test probability in virtually all such patients greater than 2% per year, that is, a level similar to that in secondary prevention, or a ‘coronary risk equivalent.’” Therefore, all patients with CAC scores >100 should (<xref ref-type="fig" rid="vhrm0402-315-04">Figure 4</xref>) be considered for statin therapy, aspirin and possibly ACE inhibition, given the increased cardiovascular risk associated with this level of coronary atherosclerosis, concurring with the current NCEP Adult Treatment Panel (ATP) III guidelines. This will support the conclusions of the Prevention Conference V and the AHA report that high coronary calcium scores confirm increased risk for future cardiac events: “measurement of coronary calcium is an option for advanced risk assessment in appropriately selected persons. In persons with multiple risk factors, high coronary calcium scores (eg, >75th percentile for age and sex) denote advanced coronary atherosclerosis and provide a rationale for intensified LDL lowering therapy.” By identifying high-risk patients, CAC may help select those patients who would benefit most from additional testing (εγ non-invasive stress imaging) and intensification of medical therapy. Furthermore, the AHA (American Heart Association) scientific statement states, “A negative test (score = 0) makes the presence of atherosclerotic plaque, including unstable or vulnerable plaque, highly unlikely, and is consistent with a low risk (0.1% per year) of a cardiovascular event in the next 2–5 years”. CAC can be used as an effective filter before considering invasive angiography.) be considered for statin therapy, aspirin and possibly ACE inhibition, given the increased cardiovascular risk associated with this level of coronary atherosclerosis, concurring with the current NCEP Adult Treatment Panel (ATP) III guidelines. This will support the conclusions of the Prevention Conference V and the AHA report that high coronary calcium scores confirm increased risk for future cardiac events: “measurement of coronary calcium is an option for advanced risk assessment in appropriately selected persons. In persons with multiple risk factors, high coronary calcium scores (eg, >75th percentile for age and sex) denote advanced coronary atherosclerosis and provide a rationale for intensified LDL lowering therapy.” By identifying high-risk patients, CAC may help select those patients who would benefit most from additional testing (εγ non-invasive stress imaging) and intensification of medical therapy. Furthermore, the AHA (American Heart Association) scientific statement states, “A negative test (score = 0) makes the presence of atherosclerotic plaque, including unstable or vulnerable plaque, highly unlikely, and is consistent with a low risk (0.1% per year) of a cardiovascular event in the next 2–5 years”. CAC can be used as an effective filter before considering invasive angiography.']} | Expert review on coronary calcium | [
"computed tomography",
"electron beam",
"prognosis",
"review",
"coronary artery calcification",
"calcium score",
"atherosclerosis",
"multi-detector computed tomography"
] | Vasc Health Risk Manag | 1207033200 | [{'@Label': 'OBJECTIVES', '@NlmCategory': 'OBJECTIVE', '#text': 'Patients with dilated cardiomyopathy (DCM) may have a high incidence of clinically asymptomatic silent cerebral infarction (SCI). Prevalence of SCI and its risk factors may differ between ischemic and nonischemic DCM. The purpose of this study was to evaluate prevalence and related parameters of silent cerebral infarction in patients with ischemic and nonischemic DCM.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'Patients with ischemic and nonischemic DCM (53 male, 19 female, aged 62 +/- 12 years) were included in the study. Etiology of DCM was ischemic in 46 and nonischemic in 26 patients. Fifty-six age- and gender-matched healthy volunteers served as a control group for comparison of SCI prevalence.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'Prevalence of SCI was 39%, 27%, and 3.6% in ischemic, nonischemic DCM, and control group, respectively (ischemic DCM vs control group, p < 0.001, nonischemic DCM vs control group, p = 002). In patients with nonischemic DCM, the mean age of the subjects with SCI was significantly higher than that of subjects without lesions (67 +/- 5 years vs 53 +/- 13, p < 0.001), whereas in ischemic DCM NHYA Functional Class was statistically higher in patients with SCI than without SCI (p = 0.03). In both groups, patients with SCI had lower systolic functions than patients with normal MRI findings. In multivariable logistic regression analysis, restrictive type of diastolic filling pattern was found as an independent factor for SCI occurrence on the whole patient population (OR: 16.5, 95% CI: 4.4-61.8, p < 0.001).'}, {'@Label': 'CONCLUSION', '@NlmCategory': 'CONCLUSIONS', '#text': 'SCI is common in patients with both ischemic and nonischemic DCM. In univariate analysis, both groups have similar systolic and diastolic characteristics in the occurrence of SCI. Logistic regression analysis revealed that restrictive diastolic filling pattern is an independent risk factor in the occurrence of SCI for the whole patient population.'}] | [
"Adult",
"Aged",
"Cardiomyopathy, Dilated",
"Case-Control Studies",
"Cerebral Infarction",
"Chronic Disease",
"Female",
"Heart Failure",
"Humans",
"Logistic Models",
"Male",
"Middle Aged",
"Myocardial Ischemia",
"Odds Ratio",
"Prevalence",
"Research Design",
"Risk Assessment",
"Risk Factors",
"Ventricular Function, Left"
] | other | PMC2496978 | null | 32 | [
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] | Vasc Health Risk Manag. 2008 Apr; 4(2):315-324 | NO-CC CODE |
|
(A, B) A 40-year-old female who had been involved as a passenger in a motor vehicle accident. CT images show a dangling diaphragm sign and herniation of the stomach. Right-sided pneumothorax and fractured ribs and pelvis were also demonstrated (not shown). Left hemidiaphragmatic rupture was confirmed during surgery; the tear was about 12–15 cm long. Stomach and small intestine loops were herniated into the thorax. | poljradiol-81-522-g002 | 7 | d770606dd608900cb9d0635c26142f421894d628bf932b10253c5db62de86a6b | poljradiol-81-522-g002.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
720,
384
] | [{'image_id': 'poljradiol-81-522-g003', 'image_file_name': 'poljradiol-81-522-g003.jpg', 'image_path': '../data/media_files/PMC5098930/poljradiol-81-522-g003.jpg', 'caption': 'A 34-year-old patient after blunt trauma. Coronal reformatted CT image shows constriction of the herniated stomach at the level of the ruptured diaphragm (collar sign).', 'hash': 'a033b61eb6db047ef81884f01783f09faa0f1244e62180c0f62cd989878f9f8c'}, {'image_id': 'poljradiol-81-522-g004', 'image_file_name': 'poljradiol-81-522-g004.jpg', 'image_path': '../data/media_files/PMC5098930/poljradiol-81-522-g004.jpg', 'caption': 'A 45-year-old female after severe blunt trauma. CT image shows rapture of the left hemidiaphragm. Stomach was herniated into the thorax and is located near the posterior chest wall, without interposition of the lung (dependent viscera sign). A 10-cm-long tear on the anterior-medial border of the central tendon of the left diaphragm was found at surgery. Almost the whole of the stomach, a large part of the omentum and a loop of the large intestine were herniated into the thorax. Other post-traumatic findings included multiple fractures of the pelvis.', 'hash': 'ca371d1a010974565e821c403e6577c91e72e8a1296ade54c1c885823f4503ab'}, {'image_id': 'poljradiol-81-522-g005', 'image_file_name': 'poljradiol-81-522-g005.jpg', 'image_path': '../data/media_files/PMC5098930/poljradiol-81-522-g005.jpg', 'caption': '(A, B) A 56-year-old female pedestrian hit by a car. Right-sided diaphragmatic tear was suspected because of hump sign and band sign. Rupture was confirmed at surgery. Other post-traumatic findings included fracture of the left scapula, retroperitoneal hematoma, fractures of the pelvis.', 'hash': '4d70f312f50af37776af1ecb2445c15eab9d247e18115477f634bcefa698d1e3'}, {'image_id': 'poljradiol-81-522-g002', 'image_file_name': 'poljradiol-81-522-g002.jpg', 'image_path': '../data/media_files/PMC5098930/poljradiol-81-522-g002.jpg', 'caption': '(A, B) A 40-year-old female who had been involved as a passenger in a motor vehicle accident. CT images show a dangling diaphragm sign and herniation of the stomach. Right-sided pneumothorax and fractured ribs and pelvis were also demonstrated (not shown). Left hemidiaphragmatic rupture was confirmed during surgery; the tear was about 12–15 cm long. Stomach and small intestine loops were herniated into the thorax.', 'hash': 'd770606dd608900cb9d0635c26142f421894d628bf932b10253c5db62de86a6b'}, {'image_id': 'poljradiol-81-522-g001', 'image_file_name': 'poljradiol-81-522-g001.jpg', 'image_path': '../data/media_files/PMC5098930/poljradiol-81-522-g001.jpg', 'caption': 'Left hemidiaphragmatic rupture in a 29-year-old man after a motor vehicle accident. Sagittal reformatted CT image shows segmental diaphragmatic defect with thickening of the diaphragm (arrow) and herniation. Left hemidiaphragmatic rupture was confirmed during surgery, with almost 75% of the hemidiaphragm being thorn. Large intestine loops, stomach, part of the left lobe of the liver and omentum were herniated into the thorax. Coexisting post-traumatic changes included: subdural hematoma, fractures of the facial skeleton, instable fracture of the dens of C2, fractures of the pelvis.', 'hash': '6cf91fa4bfdde2586b7fc732f3d40debb3864e0025927e6aa2aec9a65a535de0'}, {'image_id': 'poljradiol-81-522-g006', 'image_file_name': 'poljradiol-81-522-g006.jpg', 'image_path': '../data/media_files/PMC5098930/poljradiol-81-522-g006.jpg', 'caption': '(A, B) A 25-year-old man admitted to ER with gradually worsening left-sided abdominal and chest pain, which started after exercises of the abdomen. Patient’s history revealed a blunt abdominal trauma 5 years earlier. CT images show left-sided diaphragm defect with herniation of the stomach, spleen and part of the large intestine into the thorax. Radiological diagnosis was not confirmed at surgery – there was no rupture of the diaphragm, only diaphragmatic relaxation and dilatation of esophageal hiatus.', 'hash': '573920a6e737801dce4bc6bde39c0bcc1b41cdda9b9dbffdb32fa13bc993238f'}] | {'poljradiol-81-522-g001': ['Diaphragmatic continuity defects accompanied by hernias entrapping abdominal organs (<xref ref-type="fig" rid="poljradiol-81-522-g001">Figure 1</xref>) were observed in all cases. Organ dislocation is explained by the difference in pressures within the thoracic and the abdominal cavity. It may occur either immediately after the trauma, or in the later course of the disorder.) were observed in all cases. Organ dislocation is explained by the difference in pressures within the thoracic and the abdominal cavity. It may occur either immediately after the trauma, or in the later course of the disorder.'], 'poljradiol-81-522-g002': ['The dangling diaphragm sign consists in the broken part of the diaphragm being folded, thickened, and hanging gravitationally [10]. In our study material, this sign was observed in 2 patients (<xref ref-type="fig" rid="poljradiol-81-522-g002">Figure 2A</xref>, , <xref ref-type="fig" rid="poljradiol-81-522-g002">2B</xref>). No cases of complete lack of diaphragmatic dome within the CT image were observed in either of the cases.). No cases of complete lack of diaphragmatic dome within the CT image were observed in either of the cases.'], 'poljradiol-81-522-g003': ['The collar sign consists in segmental narrowing of the displaced organ at the site of crossing the damaged diaphragm (<xref ref-type="fig" rid="poljradiol-81-522-g003">Figure 3</xref>). Most common is the “sand-clock”-like narrowing of stomach being displaced into the thoracic cavity. Also encountered are cases of dislocated intestinal loops, spleen, or omentum.). Most common is the “sand-clock”-like narrowing of stomach being displaced into the thoracic cavity. Also encountered are cases of dislocated intestinal loops, spleen, or omentum.'], 'poljradiol-81-522-g004': ['The dependent viscera sign is defined as the displaced abdominal organs being located adjacent to the posterior wall of the thoracic cavity (<xref ref-type="fig" rid="poljradiol-81-522-g004">Figure 4</xref>). It is observed in patients with left-sided damage of the posterior part of the diaphragm and evident displacement of abdominal organs into the thoracic cavity. The symptom may also be visible in case of extensive injury of the right hemidiaphragm and hernia involving a large part of the liver of an intestine loop. The symptom is not observed in case of small hernias and injuries to the anterior part of the diaphragm including small hernias. It should be noted that the symptom may also be evident in case of large congenital hernias and therefore should not be considered the only exponent of the diagnosis of diaphragmatic injury. In case of large quantities of fluid (blood) within the pleura, the displaced organs would not be located adjacent to the posterior thoracic wall. If the pleural fluid is visualized medially in relation to the displaced organs or is divided by these organs, the presentation is referred to as sinus cut-off sign [). It is observed in patients with left-sided damage of the posterior part of the diaphragm and evident displacement of abdominal organs into the thoracic cavity. The symptom may also be visible in case of extensive injury of the right hemidiaphragm and hernia involving a large part of the liver of an intestine loop. The symptom is not observed in case of small hernias and injuries to the anterior part of the diaphragm including small hernias. It should be noted that the symptom may also be evident in case of large congenital hernias and therefore should not be considered the only exponent of the diagnosis of diaphragmatic injury. In case of large quantities of fluid (blood) within the pleura, the displaced organs would not be located adjacent to the posterior thoracic wall. If the pleural fluid is visualized medially in relation to the displaced organs or is divided by these organs, the presentation is referred to as sinus cut-off sign [7].'], 'poljradiol-81-522-g005': ['In case of the injuries of the right hemidiaphragm it may be difficult to visualize the entire diaphragmatic continuity defect due to the fact that the tracking of this continuity is difficult as a result of the vicinity of the liver. Also the presence of abnormal solid lesions within the adjacent pulmonary parenchyma may cause difficulties in accurate tracking of diaphragmatic continuity. Correct diagnosis of diaphragmatic injury can be made easier by a part of the liver being embossed by the continuity defect. This is best visualized in multiplanar reconstructions and referred to as the hump sign. It is similar to the collar sign observed in the injuries of the left diaphragm. The term “band sign” refers to a thin band of poorer enhancement of liver parenchyma at the narrowing (reduced perfusion due to segmental impingement). Since the band sign may be misdiagnosed as a result of motion artifacts [4], the diagnosis of right-sided hemidiaphragmatic injury should be confirmed by the coexistence of the hump sign. In our study material, the band sign and the hump sign were reported in two patients (<xref ref-type="fig" rid="poljradiol-81-522-g005">Figure 5A</xref>, , <xref ref-type="fig" rid="poljradiol-81-522-g005">5B</xref>).).'], 'poljradiol-81-522-g006': ['In one case, the radiological diagnosis of diaphragmatic injury was not confirmed intraoperatively (<xref ref-type="fig" rid="poljradiol-81-522-g006">Figure 6A</xref>, , <xref ref-type="fig" rid="poljradiol-81-522-g006">6B</xref>). The diagnosis was made in a patient who had been admitted to the hospital due to strong pain within the left epigastrium and chest. According to medical history data, the culprit factor was the distant blunt thoraco-abdominal trauma and exercise of abdominal muscles. Diaphragmatic relaxation with no rupture was observed intraoperatively.). The diagnosis was made in a patient who had been admitted to the hospital due to strong pain within the left epigastrium and chest. According to medical history data, the culprit factor was the distant blunt thoraco-abdominal trauma and exercise of abdominal muscles. Diaphragmatic relaxation with no rupture was observed intraoperatively.']} | The Role of Computed Tomography in the Diagnostics of Diaphragmatic Injury After Blunt Thoraco-Abdominal Trauma | [
"Diaphragm",
"Hernia, Diaphragmatic, Traumatic",
"Wounds, Nonpenetrating"
] | Pol J Radiol | 1478242800 | [{'@Label': 'BACKGROUND', '@NlmCategory': 'BACKGROUND', '#text': 'Diaphragmatic injuries occur in 0.8-8% of patients with blunt trauma. The clinical diagnosis of diaphragmatic rupture is difficult and may be overshadowed by associated injuries. Diaphragmatic rupture does not resolve spontaneously and may cause life-threatening complications. The aim of this study was to present radiological findings in patients with diaphragmatic injury.'}, {'@Label': 'MATERIAL/METHODS', '@NlmCategory': 'METHODS', '#text': 'The analysis of computed tomography examinations performed between 2007 and 2012 revealed 200 patients after blunt thoraco-abdominal trauma. Diaphragmatic rupture was diagnosed in 13 patients. Twelve of these patients had suffered traumatic injuries and underwent a surgical procedure that confirmed the rupture of the diaphragm. Most of diaphragmatic ruptures were left-sided (10) while only 2 of them were right-sided. In addition to those 12 patients there, another patient was admitted to the emergency department with left-sided abdominal and chest pain. That patient had undergone a blunt thoracoabdominal trauma 5 years earlier and complained of recurring pain. During surgery there was only partial relaxation of the diaphragm, without rupture. The most important signs of the diaphragmatic rupture in computed tomography include: segmental discontinuity of the diaphragm with herniation through the rupture, dependent viscera sign, collar sign and other signs (sinus cut-off sign, hump sign, band sign).'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'In our study blunt diaphragmatic rupture occurred in 6% of cases as confirmed intraoperatively. In all patients, coronal and sagittal reformatted images showed herniation through the diaphragmatic rupture. In left-sided ruptures, herniation was accompanied by segmental discontinuity of the diaphragm and collar sign. In right-sided ruptures, predominance of hump sign and band sign was observed. Other signs were less common.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'The knowledge of the CT findings suggesting diaphragmatic rupture improves the detection of injuries in thoraco-abdominal trauma patients.'}] | [] | other | PMC5098930 | null | 10 | [
"{'Citation': 'Desir A, MD, Ghaye B., MD CT of blunt diaphragmatic rupture. Radiographics. 2012;32:477–98.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '22411944'}}}",
"{'Citation': 'Shanmuganathan K, Mirvis SE. CT diagnosis of diaphragm injuries. Emerg Radiol. 2001;8:6–14.'}",
"{'Citation': 'Boccini G, Guida F, Sica G, et al. Diaphragmatic injuries after blunt trauma: Are they still a challenge? Am Soc Emergency Radiol. 2012;19:225–35.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '22362421'}}}",
"{'Citation': 'Iochum S, Ludig T, Walter F, et al. Imaging of diaphragmatic injury: A diagnostic challenge? Radiographics. 2002;22:S103–16.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12376604'}}}",
"{'Citation': 'Mirvis SE, Shanmuganathan K. Imaging hemidiaphragmatic injury. Eur Radiol. 2007;17:1411–21.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17308925'}}}",
"{'Citation': 'Nchimi A, Szapiro D, Ghaye B, et al. Helical CT of blunt diaphragmatic rupture. Am J Roentgenol. 2005;184:24–30.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15615945'}}}",
"{'Citation': 'Kaya SO, Karabulut N, Yuncu G, et al. Sinus cut-off sign: A helpful sign in the CT diagnosis of diaphragmatic rupture associated with pleural effusion. Eur J of Radiol. 2006;59:253–56.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16762521'}}}",
"{'Citation': 'Shackleton KL, Stewart ET, Taylor AJ. Traumatic diaphragmatic Injuries: Spectrum of radiographic findings. Radiographics. 1998;18:49–59.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9460108'}}}",
"{'Citation': 'Oikonomou A, Prassopoulus P. CT imaging of blunt chest trauma. Insights Imaging. 2011;2:281–95.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3259405'}, {'@IdType': 'pubmed', '#text': '22347953'}]}}",
"{'Citation': 'Desser TS, Edwards B, Hunt S, et al. The dangling diaphragm sign: Sensitivity and comparison with existing CT signs of blunt traumatic diaphragmatic rupture. Emerg Radiol. 2010;17:37–44.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19449046'}}}"
] | Pol J Radiol. 2016 Nov 4; 81:522-528 | NO-CC CODE |
|
Coronal T2 weighted MRI showing a thoracolumbar dumbbell-shaped RMS causing compression of the spinal cord. | ci08001401 | 7 | d984d1441bc6e724ae59bdfcf8cd29add4ea772dd733b1b04d2954b8880dfdb5 | ci08001401.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
468,
485
] | [{'image_id': 'ci08001402', 'image_file_name': 'ci08001402.jpg', 'image_path': '../data/media_files/PMC2365455/ci08001402.jpg', 'caption': '(a) Chest X-ray demonstrating a rhabdoid tumour involving the soft tissues of the left side of the neck and chest wall. (b) Coronal T2 weighted MRI of the same patient.', 'hash': '10e7aee00f21cb62453d7481289dfca25659e80958a0d1584950b11ae0de866f'}, {'image_id': 'ci08001405', 'image_file_name': 'ci08001405.jpg', 'image_path': '../data/media_files/PMC2365455/ci08001405.jpg', 'caption': 'Axial CT of a right orbital RMS extending through the infraorbital fossa.', 'hash': '789f47e8a10076e2db9fcd4c6f474094cdd95ff72f116fe8214855c10ad2372f'}, {'image_id': 'ci08001404', 'image_file_name': 'ci08001404.jpg', 'image_path': '../data/media_files/PMC2365455/ci08001404.jpg', 'caption': '(a) Coronal CT of nasopharyngeal RMS extending into the left ethmoid and maxillary sinuses and the orbital fossa. (b) Axial T1 weighted MRI demonstrating intracranial extension of the tumour in the same patient.', 'hash': 'faba8ffc3b3a8aae8182050159579f152d19fe3998d84c94b41846dfc00c01d0'}, {'image_id': 'ci08001403', 'image_file_name': 'ci08001403.jpg', 'image_path': '../data/media_files/PMC2365455/ci08001403.jpg', 'caption': '(a) Axial T1 weighted MRI of a right temporalis muscle RMS. (b) Coronal T2 weighted MRI of the same lesion.', 'hash': '03c7b9ad5dfe4af457fd6b7140599a6e619339591a79d8b2376fd306e27fd8fb'}, {'image_id': 'ci08001409', 'image_file_name': 'ci08001409.jpg', 'image_path': '../data/media_files/PMC2365455/ci08001409.jpg', 'caption': 'Contrast enhanced axial CT of a thoracic synovial cell carcinoma.', 'hash': '9dc717ac02666d1d221e13c8ce14c39d706e09a1c021463bc08face94612fe8a'}, {'image_id': 'ci08001407', 'image_file_name': 'ci08001407.jpg', 'image_path': '../data/media_files/PMC2365455/ci08001407.jpg', 'caption': 'Coronal post-contrast CT showing a large, heterogeneously enhancing left thoracic RMS.', 'hash': '1ccc3853ac2a43d710e9d11395ca868849bd7bd2b2b83073b70ae500c78893e9'}, {'image_id': 'ci08001410', 'image_file_name': 'ci08001410.jpg', 'image_path': '../data/media_files/PMC2365455/ci08001410.jpg', 'caption': 'Coronal T1 weighted MRI of a congenital fibrosarcoma in the lateral compartment of the right thigh.', 'hash': '255feb9cffbb7739d8f29f26b34068dec2da4998e5d3f07c9395e7ab7e154aa1'}, {'image_id': 'ci08001406', 'image_file_name': 'ci08001406.jpg', 'image_path': '../data/media_files/PMC2365455/ci08001406.jpg', 'caption': 'Axial T1 weighted fat-saturated MRI showing a left sided RMS confined to the orbit.', 'hash': '3112e53e857b4ac883f69adf72c2687a2751682c5a5bc5bd96205c37effecfae'}, {'image_id': 'ci08001401', 'image_file_name': 'ci08001401.jpg', 'image_path': '../data/media_files/PMC2365455/ci08001401.jpg', 'caption': 'Coronal T2 weighted MRI showing a thoracolumbar dumbbell-shaped RMS causing compression of the spinal cord.', 'hash': 'd984d1441bc6e724ae59bdfcf8cd29add4ea772dd733b1b04d2954b8880dfdb5'}, {'image_id': 'ci08001408', 'image_file_name': 'ci08001408.jpg', 'image_path': '../data/media_files/PMC2365455/ci08001408.jpg', 'caption': '(a) Sagittal T1 weighted MRI of a bladder RMS with surrounding hypointense urine. (b) Ultrasound of the bladder in the same patient.', 'hash': 'ab9ecd36b14ed7b8ca40c3f2783d4cf67a0aae9566ee52b3e1e0741f6d272bd8'}] | {'ci08001401': ['In the majority of patients presentation is either the discovery of a mass lesion in any body region or with disturbance of body function by the enlarging tumour or involved lymph nodes[8] (<xref ref-type="fig" rid="ci08001401">Fig. 1</xref>). Anatomical location, as reported from the first three IRS trials was 35–40% head and neck, 25% genitourinary tract, 20% extremities, 10% truncal and 10% other sites.\n). Anatomical location, as reported from the first three IRS trials was 35–40% head and neck, 25% genitourinary tract, 20% extremities, 10% truncal and 10% other sites.\nFigure 1Coronal T2 weighted MRI showing a thoracolumbar dumbbell-shaped RMS causing compression of the spinal cord.'], 'ci08001402': ['NRSTS can arise anywhere in the body but are most common in the extremities and trunk[25]. Presentation is usually with a painless mass but symptoms may occur secondary to local invasion or mass effect (<xref ref-type="fig" rid="ci08001402">Fig. 2</xref>). Systemic symptoms such as fever, night sweats or weight loss are rare but have been observed with widespread metastatic disease. MPNST may present with motor and sensory involvement. Rarely patients may present with metabolic disturbances). Systemic symptoms such as fever, night sweats or weight loss are rare but have been observed with widespread metastatic disease. MPNST may present with motor and sensory involvement. Rarely patients may present with metabolic disturbances[31,32]. Dillon et al.[25] looked at the anatomical location of a cohort of 75 cases of paediatric NRSTS and found 65% in the extremities, 28% in the trunk and 7% in the head and neck. Metastases at time of presentation were more common in the truncal tumours than those in the extremities. All upper limb tumours were localised at the time of presentation, whereas 78% of abdominal tumours had metastatic disease at the time of presentation.\nFigure 2(a) Chest X-ray demonstrating a rhabdoid tumour involving the soft tissues of the left side of the neck and chest wall. (b) Coronal T2 weighted MRI of the same patient.'], 'ci08001403': ['RMS of the head and neck grows insidiously and often invades the intracranial space through the numerous foramina leading to the brain. Imaging using MRI is mandatory because of the capability of assessing local and intracranial extension. It typically has a loose stromal network and high overall water content resulting in high signal intensity on long TR/TE images. The masses are also typically isointense or near isointense to muscle on T1 weighted images. Consequently, they are easily distinguished from benign lesions in the head and neck of children, for example, branchial cleft or thyroglossal duct cysts, which are generally of lower intensity than muscle on T1 images (<xref ref-type="fig" rid="ci08001403">Fig. 3</xref>a,b). Specific parameningeal sites include the nasal cavity, paranasal sinuses, pterygoid fossa, nasopharynx and middle ear (a,b). Specific parameningeal sites include the nasal cavity, paranasal sinuses, pterygoid fossa, nasopharynx and middle ear (<xref ref-type="fig" rid="ci08001404">Fig. 4</xref>a,b). Tumours at these locations tend to be large and invasivea,b). Tumours at these locations tend to be large and invasive[47]. Orbital tumours with intracranial invasion or bone destruction are also treated as parameningeal disease (<xref ref-type="fig" rid="ci08001405">Fig. 5</xref>). As surgery is often not feasible, all parameningeal tumours merit irradiation. From the information provided by imaging, the radiotherapist will include the full margins of the tumour plus a 2–3\u2009cm margin). As surgery is often not feasible, all parameningeal tumours merit irradiation. From the information provided by imaging, the radiotherapist will include the full margins of the tumour plus a 2–3\u2009cm margin[48].\nFigure 3(a) Axial T1 weighted MRI of a right temporalis muscle RMS. (b) Coronal T2 weighted MRI of the same lesion.\nFigure 4(a) Coronal CT of nasopharyngeal RMS extending into the left ethmoid and maxillary sinuses and the orbital fossa. (b) Axial T1 weighted MRI demonstrating intracranial extension of the tumour in the same patient.\nFigure 5Axial CT of a right orbital RMS extending through the infraorbital fossa.'], 'ci08001406': ['Orbital RMS generally is non-invasive and confined to the bony orbit (<xref ref-type="fig" rid="ci08001406">Fig. 6</xref>). Tumour mass at presentation is commonly of similar size to the globe and the mass may be intra- or extra-conal). Tumour mass at presentation is commonly of similar size to the globe and the mass may be intra- or extra-conal[52]. Regional lymph node extension is rare, believed to be due to a paucity of orbital lymphatics. Excellent survival rates in excess of 90% have been reported[47]. When performing MRI of the orbit, fat saturation techniques are recommended to reduce the signal from normal orbital fat. Even for a site as favourable as the orbit, chemotherapy alone is generally not sufficient in terms of local control or overall survival[47]. Despite varied long term sequelae of local irradiation, combined radiation therapy and chemotherapy provide an excellent outcome and good quality of life.\nFigure 6Axial T1 weighted fat-saturated MRI showing a left sided RMS confined to the orbit.'], 'ci08001407': ['Approximately 10% of RMS is truncal (<xref ref-type="fig" rid="ci08001407">Fig. 7</xref>). A few reports exist of RMS arising from congenital cystic lesions of the lung including cystic adenomatoid malformation but it is likely these alleged RMS tumours were actually pleuropulmonary blastomas rather than thoracic RMS). A few reports exist of RMS arising from congenital cystic lesions of the lung including cystic adenomatoid malformation but it is likely these alleged RMS tumours were actually pleuropulmonary blastomas rather than thoracic RMS[53].\nFigure 7Coronal post-contrast CT showing a large, heterogeneously enhancing left thoracic RMS.'], 'ci08001408': ['Genitourinary (GU) RMS accounts for a quarter of all childhood RMS cases and RMS is the most common malignant neoplasm of the pelvis in children. Tumours in the bladder and prostate have a worse prognosis compared to other GU RMS. Prostatic tumours commonly spread laterally to the peri-urethral tissues and posteriorly to the perivesical tissues often invading the bladder base. Tumour extension can also occur superiorly and anteriorly to the bladder into the retropubic space of Retzius[55]. MRI in the coronal and sagittal planes, particularly T1 weighted sequences in which the urine within the bladder is hypointense, can give useful information on which to base clinical decisions (<xref ref-type="fig" rid="ci08001408">Fig. 8</xref>a,b). On T2 weighted sequences urine in the bladder can obscure hyperintense bladder wall tumour tissue. Fat-saturated T1 weighted images after gadolinium administration can usually define tumour extent initially. At the end of treatment, however, residual bladder wall thickening due to fibrosis can be extremely difficult to differentiate from residual tumour. A biopsy may be necessary and the role of PET-CT in this context is as yet unproven. The goal of therapy in bladder or bladder/prostate RMS is now survival with an intact and functioning bladdera,b). On T2 weighted sequences urine in the bladder can obscure hyperintense bladder wall tumour tissue. Fat-saturated T1 weighted images after gadolinium administration can usually define tumour extent initially. At the end of treatment, however, residual bladder wall thickening due to fibrosis can be extremely difficult to differentiate from residual tumour. A biopsy may be necessary and the role of PET-CT in this context is as yet unproven. The goal of therapy in bladder or bladder/prostate RMS is now survival with an intact and functioning bladder[56].\nFigure 8(a) Sagittal T1 weighted MRI of a bladder RMS with surrounding hypointense urine. (b) Ultrasound of the bladder in the same patient.'], 'ci08001409': ['MRI is the modality of choice when evaluating synovial cell sarcoma, providing greater contrast between tumour and normal tissue than CT (<xref ref-type="fig" rid="ci08001409">Fig. 9</xref>). On MR the tumours tend to be sharply marginated and may appear largely cystic which can lead to misdiagnosis as a haematoma, ganglion cyst, Baker\'s cyst, or other benign cystic mass. A mixed pattern of signal intensity described as the triple signal is seen in about a third of synovial sarcomas with high signal intensity similar to that of fluid, intermediate signal intensity iso- or slightly hyper-intense to fat and slightly lower signal intensity that resembles fibrous tissue. Fluid–fluid levels are seen in 18%. Tumours smaller than 5\u2009cm have a homogeneously low signal intensity on T1 weighted sequences and marked heterogeneity on T2 weighted sequences. There is a variable degree of internal septation. About three-quarters of the tumours are intimately related to bone, with 50% abutting bone and 21% showing cortical thinning or medullary invasion. Approximately 30% of synovial sarcomas contain calcification). On MR the tumours tend to be sharply marginated and may appear largely cystic which can lead to misdiagnosis as a haematoma, ganglion cyst, Baker\'s cyst, or other benign cystic mass. A mixed pattern of signal intensity described as the triple signal is seen in about a third of synovial sarcomas with high signal intensity similar to that of fluid, intermediate signal intensity iso- or slightly hyper-intense to fat and slightly lower signal intensity that resembles fibrous tissue. Fluid–fluid levels are seen in 18%. Tumours smaller than 5\u2009cm have a homogeneously low signal intensity on T1 weighted sequences and marked heterogeneity on T2 weighted sequences. There is a variable degree of internal septation. About three-quarters of the tumours are intimately related to bone, with 50% abutting bone and 21% showing cortical thinning or medullary invasion. Approximately 30% of synovial sarcomas contain calcification[58].\nFigure 9Contrast enhanced axial CT of a thoracic synovial cell carcinoma.'], 'ci08001410': ['Congenital fibrosarcoma has very non-specific imaging appearances which reflect the non-aggressive behaviour of the lesion and may lead to incorrect diagnosis, for example, of a benign vascular malformation[59]. The commonest radiographic finding is of a soft tissue mass, which may cause a mass effect leading to deformity of adjacent bony structures. Bone destruction is unusual and best assessed with CT. The fibrosarcoma itself is best imaged with MRI with medium signal intensity on T1 and high signal intensity on T2 weighted images (<xref ref-type="fig" rid="ci08001410">Fig. 10</xref>). Areas of necrosis may be seen within it although homogenous appearances are also possible particularly with tumours in infancy. On US, a solid, vascular mass is seen). Areas of necrosis may be seen within it although homogenous appearances are also possible particularly with tumours in infancy. On US, a solid, vascular mass is seen[60].\nFigure 10Coronal T1 weighted MRI of a congenital fibrosarcoma in the lateral compartment of the right thigh.']} | The role of radiology in paediatric soft tissue sarcomas | [
"Rhabdomyosarcoma",
"paediatric soft tissue sarcoma",
"diagnostic imaging",
"non-rhabdomyomatous soft tissue sarcoma"
] | Cancer Imaging | 1208847600 | Paediatric soft tissue sarcomas (STS) are a group of malignant tumours that originate from primitive mesenchymal tissue and account for 7% of all childhood tumours. Rhabdomyosarcomas (RMS) and undifferentiated sarcomas account for approximately 50% of soft tissue sarcomas in children and non-rhabdomyomatous soft tissue sarcomas (NRSTS) the remainder. The prognosis and biology of STS tumours vary greatly depending on the age of the patient, the primary site, tumour size, tumour invasiveness, histologic grade, depth of invasion, and extent of disease at diagnosis. Over recent years, there has been a marked improvement in survival rates in children and adolescents with soft tissue sarcoma and ongoing international studies continue to aim to improve these survival rates whilst attempting to reduce the morbidity associated with treatment. Radiology plays a crucial role in the initial diagnosis and staging of STS, in the long term follow-up and in the assessment of many treatment related complications. We review the epidemiology, histology, clinical presentation, staging and prognosis of soft tissue sarcomas and discuss the role of radiology in their management. | [
"Biopsy",
"Child",
"Diagnostic Imaging",
"Fibrosarcoma",
"Histiocytoma, Malignant Fibrous",
"Humans",
"Magnetic Resonance Imaging",
"Neoplasm Staging",
"Nerve Sheath Neoplasms",
"Positron-Emission Tomography",
"Prognosis",
"Rhabdomyosarcoma",
"Sarcoma",
"Sarcoma, Synovial",
"Tomography, X-Ray Computed"
] | other | PMC2365455 | null | 70 | [
"{'Citation': 'Crist WM, Anderson JR, Meza JL, et al. Intergroup rhabdomyosarcoma study-IV: results for patients with nonmetastatic disease. J Clin Oncol. 2001;19:3091–102.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11408506'}}}",
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] | Cancer Imaging. 2008 Apr 22; 8(1):102-115 | NO-CC CODE |
|
A 22-month-old boy with a mass in the right groin. MRI shows a heterogeneous lesion adjacent to the gracilis muscle (open arrow). Histopathology: extraosseous Ewing sarcoma | 247_2008_751_Fig21_HTML | 7 | 7b31a906abc2b3261150a4b6a9760e07be193c3a365c5d8f0ae109495b1cebea | 247_2008_751_Fig21_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
768,
667
] | [{'image_id': '247_2008_751_Fig14_HTML', 'image_file_name': '247_2008_751_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig14_HTML.jpg', 'caption': 'A 4-year-old boy presenting with a mass on the right chest wall. a US image shows a heterogeneous mass in the pectoralis major muscle (the pectoralis minor is not involved; asterisk). b T1-W MR image of the chest shows a mass of intermediate signal intensity. c After intravenous contrast medium administration the lesion shows homogeneous enhancement. Histopathology: alveolar RMS', 'hash': '49db53c1af00240fd28b6e65299acdfb2bc2420a773f16919651bd5e9dd5b398'}, {'image_id': '247_2008_751_Fig7_HTML', 'image_file_name': '247_2008_751_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig7_HTML.jpg', 'caption': 'An 8-year-old girl with haemolysis, fever and a mass underneath the scapula. a Coronal STIR image shows a lesion with mixed signal intensity (open arrow) and multiple enlarged lymph nodes in the neck (solid arrow). b Axial T2-W image shows multiple cystic lesions with fluid-fluid levels (open arrow). Histopathology: stage IV embryonal RMS', 'hash': '474bdbdf31e8bfd50be938c94b3e0bbcd3cf8b1e9eddee744055722582fe35f6'}, {'image_id': '247_2008_751_Fig8_HTML', 'image_file_name': '247_2008_751_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig8_HTML.jpg', 'caption': 'A 19-year-old boy with a history of treated metastatic RMS presented with low back pain. The PET-CT image shows intense 18F-FDG uptake in the spinal canal (open arrow). Physiological excretion of the radiopharmaceutical via the kidneys is visible (solid arrows). Histopathology: embryonal RMS', 'hash': '3b110b406d634cb2904bc83c13c9d0acdf1c6a2825df11bb8146c1dc4f81fb2d'}, {'image_id': '247_2008_751_Fig23_HTML', 'image_file_name': '247_2008_751_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig23_HTML.jpg', 'caption': 'Flow chart for posttreatment lesions found on MRI. SI signal intensity, CE contrast-enhanced [114]', 'hash': '75ae08e4ead9c73b785090ff55bb79b68bd0471878a7435c5ff2b0e86a89bda5'}, {'image_id': '247_2008_751_Fig13_HTML', 'image_file_name': '247_2008_751_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig13_HTML.jpg', 'caption': 'A 2-month-old boy with a mass in the third ray of the left foot. T1-W MR image shows a discrete lesion (open arrow) of intermediate signal intensity. Histopathology: embryonal RMS', 'hash': 'a6b81812299f3cc27f44ea95b89b5fe8324c612bdf351041b2e398fb8e1ad54d'}, {'image_id': '247_2008_751_Fig15_HTML', 'image_file_name': '247_2008_751_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig15_HTML.jpg', 'caption': 'A 3-year-old boy with dyspnoea. Chest CT image shows displacement of the trachea (open arrow) and oesophagus (solid arrow) to the right due to a large mass (asterisk) with accompanying pleural effusion. Histopathology: embryonal RMS', 'hash': 'fb885f11b9b11fc712e3062f146543c06cf6949c7bd61c82fbb4897a4903bc02'}, {'image_id': '247_2008_751_Fig1_HTML', 'image_file_name': '247_2008_751_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig1_HTML.jpg', 'caption': 'Embryonal RMS: small cells and primitive spindle-shaped cells resembling the first stages of developing normal skeletal muscle (H&E, original magnification 10×20)', 'hash': 'a8240b988053be38644c94e840c50b141d47be8e5e90aad6295026b2f6f5f1c5'}, {'image_id': '247_2008_751_Fig12_HTML', 'image_file_name': '247_2008_751_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig12_HTML.jpg', 'caption': 'A 4-year-old girl presenting with a mass in the left lower leg. a Axial T1-W contrast-enhanced MR image shows an ill-defined mass circumferential to the fibula. Note the cortical thinning (open arrow) of the fibula. b Sagittal PD-weighted image shows diffuse bone marrow metastases. Histopathology: embryonal RMS', 'hash': 'c2c285c08ff1703f07daf6843d941526f38843b9c2c61cb86c8eaa643b2e98f1'}, {'image_id': '247_2008_751_Fig9_HTML', 'image_file_name': '247_2008_751_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig9_HTML.jpg', 'caption': 'Two years after initial diagnosis the patient shown in Fig.\xa06 presented at the outpatient clinic complaining of back pain. a Coronal STIR image of the pelvis shows discrete increased signal intensity in the left ischium (open arrow). b Subsequently acquired PET-CT image confirms the presence of recurrent disease in the same location (open arrow). Note excretion of tracer into the urinary bladder (solid arrow). c PET-CT image also shows a second lesion in the thoracic spine (open arrow). Additional rib and pleural metastases were also visible (not visible on this image)', 'hash': 'b410831c14a2096fa53a4d26662775113f56ff4e39a8b479bc84daff76117196'}, {'image_id': '247_2008_751_Fig6_HTML', 'image_file_name': '247_2008_751_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig6_HTML.jpg', 'caption': 'A 13-year-old girl who noticed a small lump near the anus. a T1-W MR image shows a well-defined pararectal lesion (arrow). b After intravenous gadolinium administration the lesion shows homogeneous enhancement (arrow) Histopathology: alveolar RMS', 'hash': 'bedd6bdc5b38f0cc2e5d0f96360c0d9c4f2b288dc316e892db3434f65e85dca0'}, {'image_id': '247_2008_751_Fig22_HTML', 'image_file_name': '247_2008_751_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig22_HTML.jpg', 'caption': 'A 6-year-old boy with a history of treated bladder RMS. At surgical resection the urethra was damaged leading to a persistent urinoma in, after RT, nonvital tissue. MRI image after treatment shows a mass (asterisk) between the urethra (open arrow) and the rectum (solid arrow). This mass is a vascularized gracilis muscle flap used to repair the defect. Without proper knowledge of the surgical history of the patient, this might have been interpreted as tumour recurrence. Histopathology: embryonal RMS', 'hash': '588b64a6e8adb1aaec95ea135aa8ff8f43eecf39e355ecccdf6e70c15d214a9a'}, {'image_id': '247_2008_751_Fig5_HTML', 'image_file_name': '247_2008_751_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig5_HTML.jpg', 'caption': 'A 6-year-old boy with a mass in the left scrotum. US image shows an ill-defined heterogeneous mass surrounding the testis (open arrow). The mass shows increased flow (solid arrow). Histopathology: embryonal RMS', 'hash': 'e6a80c4bcff2c19429b5f129c17f084f9530d2df63b11d88a23d82f1cf4f8803'}, {'image_id': '247_2008_751_Fig21_HTML', 'image_file_name': '247_2008_751_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig21_HTML.jpg', 'caption': 'A 22-month-old boy with a mass in the right groin. MRI shows a heterogeneous lesion adjacent to the gracilis muscle (open arrow). Histopathology: extraosseous Ewing sarcoma', 'hash': '7b31a906abc2b3261150a4b6a9760e07be193c3a365c5d8f0ae109495b1cebea'}, {'image_id': '247_2008_751_Fig11_HTML', 'image_file_name': '247_2008_751_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig11_HTML.jpg', 'caption': 'A 2-year-old girl presented with a mass in the vagina. a Axial T1-W contrast-enhanced image shows the mass with heterogeneous enhancement. The tumour has both solid (asterisk) and fluid (open arrow) compartments. b Sagittal T2-W MR image shows the mass with mixed signal intensity. The bladder is displaced anteriorly and the uterus cannot be visualized. Histopathology: embryonal RMS', 'hash': 'ac1943421ee9978f3feda79e5fd724dd36044faaeb32b157fbcdb645513a38a6'}, {'image_id': '247_2008_751_Fig2_HTML', 'image_file_name': '247_2008_751_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig2_HTML.jpg', 'caption': 'Embryonal RMS, spindle-cell type: closely packed spindle cells arranged in perpendicular crossing fascicles giving a leiomyosarcoma-like appearance (H&E, original magnification 10×20)', 'hash': '65eb0bfa2b2411b837c277634c7905b0b49db89d555a75508c4e151a9d51fe49'}, {'image_id': '247_2008_751_Fig19_HTML', 'image_file_name': '247_2008_751_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig19_HTML.jpg', 'caption': 'A 45-year-old man with a mass in the thigh. T1-W contrast-enhanced MR image shows a heterogeneous circumscribed mass in the vastus lateralis muscle of the right leg. Histopathology: alveolar RMS', 'hash': '1ff152eb49c88ce89400fffe182ef9a2de4d8d8d893de791933598f3c31508af'}, {'image_id': '247_2008_751_Fig16_HTML', 'image_file_name': '247_2008_751_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig16_HTML.jpg', 'caption': 'An 8-year-old boy presented with abdominal pain and jaundice. a US image shows a central process in the liver hilum (open arrow) and dilatation of the intrahepatic bile ducts (solid arrow). b T2-W MR image shows a circumscribed lesion with increased signal intensity (open arrow). c MRCP image shows intrahepatic bile duct dilatation. Note that the right and left duct systems do not communicate (open arrow). d ERCP image (ERCP performed in order to insert a stent in the common bile duct). Histopathology: embryonal RMS', 'hash': 'f9fa75cb7b98a7d9c5c0c7e30dcf17197c4608083325c45a314b8489f1aa16c7'}, {'image_id': '247_2008_751_Fig10_HTML', 'image_file_name': '247_2008_751_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig10_HTML.jpg', 'caption': 'A 3-year-old boy with RMS of the prostate. The sagittal T1-W contrast-enhanced MR image shows the lesion invading the bladder wall. A transurethral catheter has been inserted (open arrow). Histopathology: botryoid RMS', 'hash': '57aeb007985026196fa851862605946846c2e15a36a63bb5549b30ae7647fdfc'}, {'image_id': '247_2008_751_Fig4_HTML', 'image_file_name': '247_2008_751_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig4_HTML.jpg', 'caption': 'Sclerosing RMS: small cells, primitive spindle-shaped cells and eosinophilic rhabdomyoblasts in a background of hyaline sclerosis (H&E, original magnification 10×20)', 'hash': '69af1b0e25cf5b6f08709207576a0457c53f0a79a7ab8e71a898278a55ffbae2'}, {'image_id': '247_2008_751_Fig20_HTML', 'image_file_name': '247_2008_751_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig20_HTML.jpg', 'caption': 'A 1-year-old girl with a mass on the left buttock. a Duplex US image shows a highly vascularized, well-delineated heterogeneous mass that was initially thought be a haemangioma. b Coronal STIR image shows a circumscribed solid lesion that invades the pelvis via the greater sciatic foramen (open arrow). c After initial resection, with incomplete margins, tumour recurrence was seen. MR image 2.6\xa0years after initial diagnosis shows progression of disease extending to the abdominal wall (open arrow). Histopathology: alveolar RMS', 'hash': '28d529a095a129f8b3b4efc2bbf5c9cafe27c102018820cd03aafe92f8bae080'}, {'image_id': '247_2008_751_Fig17_HTML', 'image_file_name': '247_2008_751_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig17_HTML.jpg', 'caption': 'A 4-year-old boy was shown to have a right-sided pleural effusion on a chest radiograph. Balanced FFE sagittal MR image shows a mass (open arrow) arising from the diaphragm (courtesy of S.G.F. Robben, Academic Hospital Maastricht, The Netherlands)', 'hash': '5e0fd41c07b2eaba0662be19652ec97fb2fc2da312418f420c0c680444de904a'}, {'image_id': '247_2008_751_Fig18_HTML', 'image_file_name': '247_2008_751_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig18_HTML.jpg', 'caption': 'A 4-day-old girl born with a lump on the left foot. Antenatal ultrasonography at 20\xa0weeks showed no abnormalities. a T1-W MR image shows a large inhomogeneous mass arising from the left foot. b Abdominal US image shows popliteal and inguinal nodal invasion, and hepatic and pancreatic metastases (open arrow). Due to the poor prognosis, no therapy was given, and the child died several weeks later. Histopathology: poorly differentiated soft-tissue sarcoma without distinct translocations', 'hash': 'fbac2fe671fc373c0bf6642666ee470749b1d8f292d73f50bc9026211374eae3'}, {'image_id': '247_2008_751_Fig3_HTML', 'image_file_name': '247_2008_751_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig3_HTML.jpg', 'caption': 'Alveolar RMS: cluster of primitive cells with loss of cellular cohesion and bordered by dense fibrous septa, resulting in an alveolar pattern (H&E, original magnification 10×20)', 'hash': 'ad2b8a7e1d788710d6d450c082fec64eaea34c3e2408c87e3fd8ee1e6a94cd24'}] | {'247_2008_751_Fig1_HTML': ['Based on morphology, RMS is traditionally subdivided into embryonal, alveolar and pleomorphic. Pleomorphic RMS, in contrast to embryonal and alveolar RMS, almost exclusively occurs in adults (median age sixth decade), and is therefore not discussed further. Embryonal RMS is the most common type (60–70% of all RMS). The cells show a close resemblance to various stages in the embryogenesis of normal skeletal muscle (Fig.\xa0<xref rid="247_2008_751_Fig1_HTML" ref-type="fig">1</xref>). Subtypes are botryoid RMS and spindle-cell RMS (Fig.\xa0). Subtypes are botryoid RMS and spindle-cell RMS (Fig.\xa0<xref rid="247_2008_751_Fig2_HTML" ref-type="fig">2</xref>). When arising in the submucosa, embryonal RMS may present as a fast-growing exophytic, polypoid mass. This macroscopic variant is called botryoid RMS (grape-like) and, due to its growth pattern (primary exophytic and not invasive), has a better prognosis.\n). When arising in the submucosa, embryonal RMS may present as a fast-growing exophytic, polypoid mass. This macroscopic variant is called botryoid RMS (grape-like) and, due to its growth pattern (primary exophytic and not invasive), has a better prognosis.\nFig.\xa01Embryonal RMS: small cells and primitive spindle-shaped cells resembling the first stages of developing normal skeletal muscle (H&E, original magnification 10×20)Fig.\xa02Embryonal RMS, spindle-cell type: closely packed spindle cells arranged in perpendicular crossing fascicles giving a leiomyosarcoma-like appearance (H&E, original magnification 10×20)'], '247_2008_751_Fig3_HTML': ['Alveolar RMS is composed of ill-defined, dense aggregates of poorly differentiated round or oval tumour cells that frequently show loss of cohesion (Fig.\xa0<xref rid="247_2008_751_Fig3_HTML" ref-type="fig">3</xref>). This loss of cohesion and the presence of thin fibrous septa result in an alveolar pattern. In cases where the tumour cells do not show loss of cohesion, the term ‘solid alveolar RMS’ is used. Alveolar RMS represents about 20% of all RMS and has two specific translocations with specific fusion transcripts that can be detected by RT-PCR. The majority (about 55%) show a t(2;13)(q35;q14) translocation with the corresponding fusion transcript PAX3-FKHR [). This loss of cohesion and the presence of thin fibrous septa result in an alveolar pattern. In cases where the tumour cells do not show loss of cohesion, the term ‘solid alveolar RMS’ is used. Alveolar RMS represents about 20% of all RMS and has two specific translocations with specific fusion transcripts that can be detected by RT-PCR. The majority (about 55%) show a t(2;13)(q35;q14) translocation with the corresponding fusion transcript PAX3-FKHR [8]. In about 22% a t(1;13)(p36;q14) translocation is found with fusion transcript PAX7-FKHR. In rare cases, RMS with a more or less alveolar pattern lacks these translocations.\nFig.\xa03Alveolar RMS: cluster of primitive cells with loss of cellular cohesion and bordered by dense fibrous septa, resulting in an alveolar pattern (H&E, original magnification 10×20)'], '247_2008_751_Fig4_HTML': ['Both embryonal and alveolar RMS may show rhabdoid tumour-like features and anaplasia (focal or diffuse) [9, 10]. More recently, under the heading sclerosing RMS, a variant with hyalin sclerosis has been described (Fig.\xa0<xref rid="247_2008_751_Fig4_HTML" ref-type="fig">4</xref>) [) [11]. It is unclear whether this is a distinct subtype.\nFig.\xa04Sclerosing RMS: small cells, primitive spindle-shaped cells and eosinophilic rhabdomyoblasts in a background of hyaline sclerosis (H&E, original magnification 10×20)'], '247_2008_751_Fig5_HTML': ['On US, RMS in general shows as a well-defined, slightly hypoechoic inhomogeneous mass that can show significantly increased flow (Fig.\xa0<xref rid="247_2008_751_Fig5_HTML" ref-type="fig">5</xref>). In the particular case of paratesticular RMS, US is the imaging modality of choice, although CT of the abdomen is also necessary to evaluate for retroperitoneal lymphadenopathy. In all other RMS locations additional imaging using CT or MRI is mandatory.\n). In the particular case of paratesticular RMS, US is the imaging modality of choice, although CT of the abdomen is also necessary to evaluate for retroperitoneal lymphadenopathy. In all other RMS locations additional imaging using CT or MRI is mandatory.\nFig.\xa05A 6-year-old boy with a mass in the left scrotum. US image shows an ill-defined heterogeneous mass surrounding the testis (open arrow). The mass shows increased flow (solid arrow). Histopathology: embryonal RMS'], '247_2008_751_Fig6_HTML': ['The imaging characteristics of RMS are relatively nonspecific. Like most soft-tissue tumours they have intermediate signal intensity on T1-W images (Fig.\xa0<xref rid="247_2008_751_Fig6_HTML" ref-type="fig">6</xref>). On T2-W images they tend to be of intermediate-to-high signal intensity. If the tumour contains a high number of septa it may have a lobular shape. RMS in general show strong enhancement on postcontrast imaging (Fig.\xa0). On T2-W images they tend to be of intermediate-to-high signal intensity. If the tumour contains a high number of septa it may have a lobular shape. RMS in general show strong enhancement on postcontrast imaging (Fig.\xa0<xref rid="247_2008_751_Fig6_HTML" ref-type="fig">6</xref>). In very rare instances the tumour may show a predominantly cystic appearance (Fig.\xa0). In very rare instances the tumour may show a predominantly cystic appearance (Fig.\xa0<xref rid="247_2008_751_Fig7_HTML" ref-type="fig">7</xref>). Dynamic series are useful in order to assess tumour vascularity, and to differentiate between postchemotherapy/surgery residual disease and fibrosis.\n). Dynamic series are useful in order to assess tumour vascularity, and to differentiate between postchemotherapy/surgery residual disease and fibrosis.\nFig.\xa06A 13-year-old girl who noticed a small lump near the anus. a T1-W MR image shows a well-defined pararectal lesion (arrow). b After intravenous gadolinium administration the lesion shows homogeneous enhancement (arrow) Histopathology: alveolar RMSFig.\xa07An 8-year-old girl with haemolysis, fever and a mass underneath the scapula. a Coronal STIR image shows a lesion with mixed signal intensity (open arrow) and multiple enlarged lymph nodes in the neck (solid arrow). b Axial T2-W image shows multiple cystic lesions with fluid-fluid levels (open arrow). Histopathology: stage IV embryonal RMS'], '247_2008_751_Fig8_HTML': ['In PET-CT studies fluorine-18 fluorodeoxyglucose (18F-FDG), a radiolabelled glucose analogue, is used [22]. As 18F-FDG is a glucose analogue, it shows uptake in metabolically active cells, which most malignant tumour cells are. The combination of PET with CT, without moving the relative position of the patient, yields a higher diagnostic accuracy than PET alone (Fig.\xa0<xref rid="247_2008_751_Fig8_HTML" ref-type="fig">8</xref>). In general, the CT scan will be low-dose CT scan only meant to identify anatomical structures. However, as the CT scanners in modern PET-CT systems are of high diagnostic quality, it is also possible to combine a diagnostic CT scan, e.g. for the depiction of pulmonary metastases, with a PET scan.\n). In general, the CT scan will be low-dose CT scan only meant to identify anatomical structures. However, as the CT scanners in modern PET-CT systems are of high diagnostic quality, it is also possible to combine a diagnostic CT scan, e.g. for the depiction of pulmonary metastases, with a PET scan.\nFig.\xa08A 19-year-old boy with a history of treated metastatic RMS presented with low back pain. The PET-CT image shows intense 18F-FDG uptake in the spinal canal (open arrow). Physiological excretion of the radiopharmaceutical via the kidneys is visible (solid arrows). Histopathology: embryonal RMS'], '247_2008_751_Fig7_HTML': ['The main staging system is the postsurgical staging system developed by the IRSG. This is currently used by study groups both in the USA and now in Europe also (Table\xa03). The IRSG was formed in 1972 and consisted of surgeons, pathologists, oncologists, and radiation oncologists. The absence of radiologists is striking, and paediatric radiologists are still infrequently involved in development of paediatric oncology study protocols, although in the EpSSG RMS 2005, paediatric radiologists were involved in the development of the protocol. For staging regional nodes it is important to be familiar with the regional node stations. Lymph node involvement has a negative impact on prognosis, as has been shown in the SIOP Malignant Mesenchymal Tumor 89 trial [25]. Overall 5-year survival was 60% for N1 patients versus 73% in N0 patients (P\u2009=\u20090.03). Distant lymph node involvement upgrades a patient to stage IV disease (Fig.\xa0<xref rid="247_2008_751_Fig7_HTML" ref-type="fig">7</xref>), having an adverse impact on prognosis: overall 5-year survival becomes 24% [), having an adverse impact on prognosis: overall 5-year survival becomes 24% [26].\nTable\xa03IRSG classificationStageCharacteristicsILocalized disease completely resected (regional nodes not involved)A: Tumour confined to muscle or organ of originB: Tumour infiltrating outside organ of (muscle of) originIILocalized or regional disease with total resection of gross tumourA: Primary tumour grossly resected, with microscopic residual disease (negative findings in local nodes)B: Primary tumour and positive nodes completely resectedC: Primary tumour and positive nodes resected, with evidence of microscopic residual diseaseIIIIncomplete resection of tumour or biopsy, with gross residual diseaseIVDistant metastatic disease present at diagnosis'], '247_2008_751_Fig9_HTML': ['Tumour relapse in patients most commonly presents with locoregional disease (51%) compared to distant relapse (41%) [32] (Fig.\xa0<xref rid="247_2008_751_Fig9_HTML" ref-type="fig">9</xref>). In a retrospective case-based study the use of PET-CT was advocated; this, however, needs to be evaluated in larger prospective studies [). In a retrospective case-based study the use of PET-CT was advocated; this, however, needs to be evaluated in larger prospective studies [33].\nFig.\xa09Two years after initial diagnosis the patient shown in Fig.\xa0<xref rid="247_2008_751_Fig6_HTML" ref-type="fig">6</xref> presented at the outpatient clinic complaining of back pain. presented at the outpatient clinic complaining of back pain. a Coronal STIR image of the pelvis shows discrete increased signal intensity in the left ischium (open arrow). b Subsequently acquired PET-CT image confirms the presence of recurrent disease in the same location (open arrow). Note excretion of tracer into the urinary bladder (solid arrow). c PET-CT image also shows a second lesion in the thoracic spine (open arrow). Additional rib and pleural metastases were also visible (not visible on this image)'], '247_2008_751_Fig10_HTML': ['Approximately 25% of all RMS are GU RMS [34, 35]. As mentioned above, GU RMS can simply be subdivided into two subgroups based on different prognosis and subsequent treatment strategy, GU bladder/prostate (GU-BP) being an unfavourable location (Fig.\xa0<xref rid="247_2008_751_Fig10_HTML" ref-type="fig">10</xref>). Tumours at other GU non-bladder/prostate (GU-NBP) sites, such as a paratesticular location (testes, epididymis and spermatic cord; Fig.\xa0). Tumours at other GU non-bladder/prostate (GU-NBP) sites, such as a paratesticular location (testes, epididymis and spermatic cord; Fig.\xa0<xref rid="247_2008_751_Fig5_HTML" ref-type="fig">5</xref>), vagina or uterus (Fig.\xa0), vagina or uterus (Fig.\xa0<xref rid="247_2008_751_Fig11_HTML" ref-type="fig">11</xref>), have a favourable prognosis, and thus require less-intensive treatment [), have a favourable prognosis, and thus require less-intensive treatment [36–48]. There is a caveat to MRI of the bladder in RMS: after intravenous contrast medium administration, layering of contrast medium can occur making it difficult to appreciate bladder wall enhancement [49]. T2-W sequences can be particularly useful in this setting to assess bladder wall thickening. Additional cystoscopy is often warranted [50]. At the end of treatment, some residual soft-tissue thickening may persist, and on MRI it is impossible to decide whether this is residual scarring or tumour; in these cases endoscopic biopsy is mandatory.\nFig.\xa010A 3-year-old boy with RMS of the prostate. The sagittal T1-W contrast-enhanced MR image shows the lesion invading the bladder wall. A transurethral catheter has been inserted (open arrow). Histopathology: botryoid RMSFig.\xa011A 2-year-old girl presented with a mass in the vagina. a Axial T1-W contrast-enhanced image shows the mass with heterogeneous enhancement. The tumour has both solid (asterisk) and fluid (open arrow) compartments. b Sagittal T2-W MR image shows the mass with mixed signal intensity. The bladder is displaced anteriorly and the uterus cannot be visualized. Histopathology: embryonal RMS'], '247_2008_751_Fig12_HTML': ['RMS of the extremities (Figs.\xa0<xref rid="247_2008_751_Fig12_HTML" ref-type="fig">12</xref> and and <xref rid="247_2008_751_Fig13_HTML" ref-type="fig">13</xref>) is almost always of alveolar histology, tends to occur in older children and young adults, is often present with positive regional lymph nodes, and has a propensity to metastasize to unusual sites; these negative prognostic factors contribute to the relatively poor prognosis of RMS in this location [) is almost always of alveolar histology, tends to occur in older children and young adults, is often present with positive regional lymph nodes, and has a propensity to metastasize to unusual sites; these negative prognostic factors contribute to the relatively poor prognosis of RMS in this location [51, 52]. In approximately 12% of patients, nodal involvement is seen on imaging; however, when nodal dissection is performed the rate of nodal involvement increases to almost 50% [53]. This discrepancy between imaging findings and nodal dissection might be reduced by using high-quality state-of-the-art US. In current treatment protocols systematic biopsy of regional nodes is advocated, even if the nodes are not palpable or enlarged on imaging; sentinel node procedures are recommended whenever feasible, although the value of upgrading a patient to a higher risk group based merely on a positive sentinel node has not been studied yet. As in all tumours of the extremities, preoperative imaging plays a vital role in the depiction of the relationship between neurovascular bundles and the tumour.\nFig.\xa012A 4-year-old girl presenting with a mass in the left lower leg. a Axial T1-W contrast-enhanced MR image shows an ill-defined mass circumferential to the fibula. Note the cortical thinning (open arrow) of the fibula. b Sagittal PD-weighted image shows diffuse bone marrow metastases. Histopathology: embryonal RMSFig.\xa013A 2-month-old boy with a mass in the third ray of the left foot. T1-W MR image shows a discrete lesion (open arrow) of intermediate signal intensity. Histopathology: embryonal RMS'], '247_2008_751_Fig14_HTML': ['Chest wall RMS (Fig.\xa0<xref rid="247_2008_751_Fig14_HTML" ref-type="fig">14</xref>) is a relatively rare finding with a reported incidence of 3.7% in the IRSG II and IRSG III studies [) is a relatively rare finding with a reported incidence of 3.7% in the IRSG II and IRSG III studies [54]. Most of the reports of chest wall involvement are either case reports or small series [55–57]. In a retrospective analysis of 15 patients, Saenz et al. [57] found a 5-year survival of 67%.\nFig.\xa014A 4-year-old boy presenting with a mass on the right chest wall. a US image shows a heterogeneous mass in the pectoralis major muscle (the pectoralis minor is not involved; asterisk). b T1-W MR image of the chest shows a mass of intermediate signal intensity. c After intravenous contrast medium administration the lesion shows homogeneous enhancement. Histopathology: alveolar RMS'], '247_2008_751_Fig15_HTML': ['There is an ongoing debate and controversy whether congenital cystic anomalies predispose children to intralesional development of RMS [58–62]. It has been reported that pleuropulmonary blastoma (PPB) has been mistaken for or classified as RMS arising in congenital cystic adenomatoid malformation (CCAM) on a number of occasions [63]. Despite the fact that the exact incidence in CCAM is unknown, it has prompted paediatric surgeons to resect even small pulmonary cystic lesions (Fig.\xa0<xref rid="247_2008_751_Fig15_HTML" ref-type="fig">15</xref>) [) [64, 65].\nFig.\xa015A 3-year-old boy with dyspnoea. Chest CT image shows displacement of the trachea (open arrow) and oesophagus (solid arrow) to the right due to a large mass (asterisk) with accompanying pleural effusion. Histopathology: embryonal RMS'], '247_2008_751_Fig16_HTML': ['RMS is the most common tumour of the biliary tree in childhood, although it only accounts for approximately 0.04% of all childhood tumours [66]. The initial diagnosis will, in most patients, be made on US, which may show a solid or cystic mass situated in the liver hilum, and intrahepatic bile duct dilatation (Fig.\xa0<xref rid="247_2008_751_Fig16_HTML" ref-type="fig">16</xref>). MRI is mandatory for presurgical evaluation, where magnetic resonance cholangiopancreatography (MRCP) can depict the biliary tree (Fig.\xa0). MRI is mandatory for presurgical evaluation, where magnetic resonance cholangiopancreatography (MRCP) can depict the biliary tree (Fig.\xa0<xref rid="247_2008_751_Fig16_HTML" ref-type="fig">16</xref>). In many patients, however, endoscopic retrograde cholangiopancreatography (ERCP) will have to be performed in order to depict intraductal irregularities (Fig.\xa0). In many patients, however, endoscopic retrograde cholangiopancreatography (ERCP) will have to be performed in order to depict intraductal irregularities (Fig.\xa0<xref rid="247_2008_751_Fig16_HTML" ref-type="fig">16</xref>). Biliary tree RMS is a tumour that does not necessarily need to be fully resected in order to achieve long-term survival, as long as adequate radiotherapy is added [). Biliary tree RMS is a tumour that does not necessarily need to be fully resected in order to achieve long-term survival, as long as adequate radiotherapy is added [67]. Intraperitoneal metastases, which can also be found on follow-up, should also be born in mind.\nFig.\xa016An 8-year-old boy presented with abdominal pain and jaundice. a US image shows a central process in the liver hilum (open arrow) and dilatation of the intrahepatic bile ducts (solid arrow). b T2-W MR image shows a circumscribed lesion with increased signal intensity (open arrow). c MRCP image shows intrahepatic bile duct dilatation. Note that the right and left duct systems do not communicate (open arrow). d ERCP image (ERCP performed in order to insert a stent in the common bile duct). Histopathology: embryonal RMS'], '247_2008_751_Fig17_HTML': ['In extremely rare instances RMS can be found in other organs such as the heart, the diaphragm (Fig.\xa0<xref rid="247_2008_751_Fig17_HTML" ref-type="fig">17</xref>), the omentum, the urachus and the digestive tract [), the omentum, the urachus and the digestive tract [68–76].\nFig.\xa017A 4-year-old boy was shown to have a right-sided pleural effusion on a chest radiograph. Balanced FFE sagittal MR image shows a mass (open arrow) arising from the diaphragm (courtesy of S.G.F. Robben, Academic Hospital Maastricht, The Netherlands)'], '247_2008_751_Fig18_HTML': ['RMS has been reported to occur as a congenital tumour (Fig.\xa0<xref rid="247_2008_751_Fig18_HTML" ref-type="fig">18</xref>) [) [77–81]. In congenital alveolar RMS the prognosis is reported to be extremely poor, despite otherwise adequate treatment [79]. Orbach et al. [82] reported the SIOP data on soft-tissue sarcoma in the first year of life. In their study population of 16 newborns, with a follow-up of 1.8–10.0\xa0years, 3 out of 5 newborns with RMS survived. It has been noted that in congenital RMS the disease may be metastatic at the time of birth, with metastases described in a number of organs and in the placenta [81].\nFig.\xa018A 4-day-old girl born with a lump on the left foot. Antenatal ultrasonography at 20\xa0weeks showed no abnormalities. a T1-W MR image shows a large inhomogeneous mass arising from the left foot. b Abdominal US image shows popliteal and inguinal nodal invasion, and hepatic and pancreatic metastases (open arrow). Due to the poor prognosis, no therapy was given, and the child died several weeks later. Histopathology: poorly differentiated soft-tissue sarcoma without distinct translocations'], '247_2008_751_Fig19_HTML': ['Every once in a while paediatric radiologists and paediatric oncologists receive a request for help in the management of an adult patient (Fig.\xa0<xref rid="247_2008_751_Fig19_HTML" ref-type="fig">19</xref>). RMS, although seen as a soft-tissue tumour of childhood, can also occur later in life [). RMS, although seen as a soft-tissue tumour of childhood, can also occur later in life [83–86]. Compared to childhood RMS, adult RMS has a poor outcome. In a large retrospective study of 171 patients 5-year overall survival was only 40% [85]. However, the patients in this series treated according to the guidelines for treatment of childhood RMS showed survival figures comparable to those seen in children. This suggests that treatment of adult RMS should be based on paediatric protocols tailored to adults, to increase survival in this age group. In the Academic Medical Centre Amsterdam we have a working group on childhood tumours in (often young) adults that specifically deals with this challenging population. This working group consists of medical oncologists, paediatric oncologists, radiation oncologists, (orthopaedic) surgeons and a paediatric radiologist. Imaging features will in general not be of help, as the pretest likelihood of RMS in an adolescent or adult is extremely low.\nFig.\xa019A 45-year-old man with a mass in the thigh. T1-W contrast-enhanced MR image shows a heterogeneous circumscribed mass in the vastus lateralis muscle of the right leg. Histopathology: alveolar RMS'], '247_2008_751_Fig20_HTML': ['Given the wide variety of locations in which RMS can be found it is difficult to give a concise list of differential diagnoses. The site of the primary lesion determines the differential diagnosis. Keeping location out of the equation there are, however, certain tumours, such as haemangiomas/vascular malformations (Fig.\xa0<xref rid="247_2008_751_Fig20_HTML" ref-type="fig">20</xref>), adult-type soft-tissue sarcomas, peripheral neuroectodermal tumours (PNET), infantile fibrosarcoma, aggressive fibromatosis, desmoplastic small round-cell tumours and rhabdoid tumours, and other more even rarer soft-tissue tumours such as nonosseous Ewing sarcoma (Fig.\xa0), adult-type soft-tissue sarcomas, peripheral neuroectodermal tumours (PNET), infantile fibrosarcoma, aggressive fibromatosis, desmoplastic small round-cell tumours and rhabdoid tumours, and other more even rarer soft-tissue tumours such as nonosseous Ewing sarcoma (Fig.\xa0<xref rid="247_2008_751_Fig21_HTML" ref-type="fig">21</xref>), that should be kept in mind when performing US or reading CT or MRI studies of soft-tissue tumours in childhood.\n), that should be kept in mind when performing US or reading CT or MRI studies of soft-tissue tumours in childhood.\nFig.\xa020A 1-year-old girl with a mass on the left buttock. a Duplex US image shows a highly vascularized, well-delineated heterogeneous mass that was initially thought be a haemangioma. b Coronal STIR image shows a circumscribed solid lesion that invades the pelvis via the greater sciatic foramen (open arrow). c After initial resection, with incomplete margins, tumour recurrence was seen. MR image 2.6\xa0years after initial diagnosis shows progression of disease extending to the abdominal wall (open arrow). Histopathology: alveolar RMSFig.\xa021A 22-month-old boy with a mass in the right groin. MRI shows a heterogeneous lesion adjacent to the gracilis muscle (open arrow). Histopathology: extraosseous Ewing sarcoma'], '247_2008_751_Fig22_HTML': ['Image interpretation and management of the patient after surgery and often RT are challenges (Fig.\xa0<xref rid="247_2008_751_Fig22_HTML" ref-type="fig">22</xref>). Most important is proper knowledge of the surgical procedure and/or the radiation field. The following postoperative changes can be encountered in children treated for RMS:\n). Most important is proper knowledge of the surgical procedure and/or the radiation field. The following postoperative changes can be encountered in children treated for RMS:\nHaematomaOedemaSoft-tissue infection/abscessCalcificationForeign bodiesMuscle flaps/fat padsDistorted anatomyRadiation effect Figure\xa0<xref rid="247_2008_751_Fig23_HTML" ref-type="fig">23</xref> shows a possible decision tree to manage postoperative findings on follow-up imaging.\n shows a possible decision tree to manage postoperative findings on follow-up imaging.\nFig.\xa022A 6-year-old boy with a history of treated bladder RMS. At surgical resection the urethra was damaged leading to a persistent urinoma in, after RT, nonvital tissue. MRI image after treatment shows a mass (asterisk) between the urethra (open arrow) and the rectum (solid arrow). This mass is a vascularized gracilis muscle flap used to repair the defect. Without proper knowledge of the surgical history of the patient, this might have been interpreted as tumour recurrence. Histopathology: embryonal RMSFig.\xa023Flow chart for posttreatment lesions found on MRI. SI signal intensity, CE contrast-enhanced [114]']} | Imaging findings in noncraniofacial childhood rhabdomyosarcoma | [
"Rhabdomyosarcoma",
"Imaging",
"Children"
] | Pediatr Radiol | 1212822000 | Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma of childhood. This paper is focuses on imaging for diagnosis, staging, and follow-up of noncraniofacial RMS. | [
"Adult",
"Child",
"Humans",
"Magnetic Resonance Imaging",
"Muscle Neoplasms",
"Positron-Emission Tomography",
"Radiography",
"Rhabdomyosarcoma",
"Thoracic Neoplasms",
"Tomography, X-Ray Computed",
"Ultrasonography",
"Urogenital Neoplasms"
] | other | PMC2367394 | null | 226 | [
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] | Pediatr Radiol. 2008 Jun 7; 38(6):617-634 | NO-CC CODE |
|
A 2-year-old girl presented with a mass in the vagina. a Axial T1-W contrast-enhanced image shows the mass with heterogeneous enhancement. The tumour has both solid (asterisk) and fluid (open arrow) compartments. b Sagittal T2-W MR image shows the mass with mixed signal intensity. The bladder is displaced anteriorly and the uterus cannot be visualized. Histopathology: embryonal RMS | 247_2008_751_Fig11_HTML | 7 | ac1943421ee9978f3feda79e5fd724dd36044faaeb32b157fbcdb645513a38a6 | 247_2008_751_Fig11_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
488,
232
] | [{'image_id': '247_2008_751_Fig14_HTML', 'image_file_name': '247_2008_751_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig14_HTML.jpg', 'caption': 'A 4-year-old boy presenting with a mass on the right chest wall. a US image shows a heterogeneous mass in the pectoralis major muscle (the pectoralis minor is not involved; asterisk). b T1-W MR image of the chest shows a mass of intermediate signal intensity. c After intravenous contrast medium administration the lesion shows homogeneous enhancement. Histopathology: alveolar RMS', 'hash': '49db53c1af00240fd28b6e65299acdfb2bc2420a773f16919651bd5e9dd5b398'}, {'image_id': '247_2008_751_Fig7_HTML', 'image_file_name': '247_2008_751_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig7_HTML.jpg', 'caption': 'An 8-year-old girl with haemolysis, fever and a mass underneath the scapula. a Coronal STIR image shows a lesion with mixed signal intensity (open arrow) and multiple enlarged lymph nodes in the neck (solid arrow). b Axial T2-W image shows multiple cystic lesions with fluid-fluid levels (open arrow). Histopathology: stage IV embryonal RMS', 'hash': '474bdbdf31e8bfd50be938c94b3e0bbcd3cf8b1e9eddee744055722582fe35f6'}, {'image_id': '247_2008_751_Fig8_HTML', 'image_file_name': '247_2008_751_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig8_HTML.jpg', 'caption': 'A 19-year-old boy with a history of treated metastatic RMS presented with low back pain. The PET-CT image shows intense 18F-FDG uptake in the spinal canal (open arrow). Physiological excretion of the radiopharmaceutical via the kidneys is visible (solid arrows). Histopathology: embryonal RMS', 'hash': '3b110b406d634cb2904bc83c13c9d0acdf1c6a2825df11bb8146c1dc4f81fb2d'}, {'image_id': '247_2008_751_Fig23_HTML', 'image_file_name': '247_2008_751_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig23_HTML.jpg', 'caption': 'Flow chart for posttreatment lesions found on MRI. SI signal intensity, CE contrast-enhanced [114]', 'hash': '75ae08e4ead9c73b785090ff55bb79b68bd0471878a7435c5ff2b0e86a89bda5'}, {'image_id': '247_2008_751_Fig13_HTML', 'image_file_name': '247_2008_751_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig13_HTML.jpg', 'caption': 'A 2-month-old boy with a mass in the third ray of the left foot. T1-W MR image shows a discrete lesion (open arrow) of intermediate signal intensity. Histopathology: embryonal RMS', 'hash': 'a6b81812299f3cc27f44ea95b89b5fe8324c612bdf351041b2e398fb8e1ad54d'}, {'image_id': '247_2008_751_Fig15_HTML', 'image_file_name': '247_2008_751_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig15_HTML.jpg', 'caption': 'A 3-year-old boy with dyspnoea. Chest CT image shows displacement of the trachea (open arrow) and oesophagus (solid arrow) to the right due to a large mass (asterisk) with accompanying pleural effusion. Histopathology: embryonal RMS', 'hash': 'fb885f11b9b11fc712e3062f146543c06cf6949c7bd61c82fbb4897a4903bc02'}, {'image_id': '247_2008_751_Fig1_HTML', 'image_file_name': '247_2008_751_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig1_HTML.jpg', 'caption': 'Embryonal RMS: small cells and primitive spindle-shaped cells resembling the first stages of developing normal skeletal muscle (H&E, original magnification 10×20)', 'hash': 'a8240b988053be38644c94e840c50b141d47be8e5e90aad6295026b2f6f5f1c5'}, {'image_id': '247_2008_751_Fig12_HTML', 'image_file_name': '247_2008_751_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig12_HTML.jpg', 'caption': 'A 4-year-old girl presenting with a mass in the left lower leg. a Axial T1-W contrast-enhanced MR image shows an ill-defined mass circumferential to the fibula. Note the cortical thinning (open arrow) of the fibula. b Sagittal PD-weighted image shows diffuse bone marrow metastases. Histopathology: embryonal RMS', 'hash': 'c2c285c08ff1703f07daf6843d941526f38843b9c2c61cb86c8eaa643b2e98f1'}, {'image_id': '247_2008_751_Fig9_HTML', 'image_file_name': '247_2008_751_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig9_HTML.jpg', 'caption': 'Two years after initial diagnosis the patient shown in Fig.\xa06 presented at the outpatient clinic complaining of back pain. a Coronal STIR image of the pelvis shows discrete increased signal intensity in the left ischium (open arrow). b Subsequently acquired PET-CT image confirms the presence of recurrent disease in the same location (open arrow). Note excretion of tracer into the urinary bladder (solid arrow). c PET-CT image also shows a second lesion in the thoracic spine (open arrow). Additional rib and pleural metastases were also visible (not visible on this image)', 'hash': 'b410831c14a2096fa53a4d26662775113f56ff4e39a8b479bc84daff76117196'}, {'image_id': '247_2008_751_Fig6_HTML', 'image_file_name': '247_2008_751_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig6_HTML.jpg', 'caption': 'A 13-year-old girl who noticed a small lump near the anus. a T1-W MR image shows a well-defined pararectal lesion (arrow). b After intravenous gadolinium administration the lesion shows homogeneous enhancement (arrow) Histopathology: alveolar RMS', 'hash': 'bedd6bdc5b38f0cc2e5d0f96360c0d9c4f2b288dc316e892db3434f65e85dca0'}, {'image_id': '247_2008_751_Fig22_HTML', 'image_file_name': '247_2008_751_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig22_HTML.jpg', 'caption': 'A 6-year-old boy with a history of treated bladder RMS. At surgical resection the urethra was damaged leading to a persistent urinoma in, after RT, nonvital tissue. MRI image after treatment shows a mass (asterisk) between the urethra (open arrow) and the rectum (solid arrow). This mass is a vascularized gracilis muscle flap used to repair the defect. Without proper knowledge of the surgical history of the patient, this might have been interpreted as tumour recurrence. Histopathology: embryonal RMS', 'hash': '588b64a6e8adb1aaec95ea135aa8ff8f43eecf39e355ecccdf6e70c15d214a9a'}, {'image_id': '247_2008_751_Fig5_HTML', 'image_file_name': '247_2008_751_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig5_HTML.jpg', 'caption': 'A 6-year-old boy with a mass in the left scrotum. US image shows an ill-defined heterogeneous mass surrounding the testis (open arrow). The mass shows increased flow (solid arrow). Histopathology: embryonal RMS', 'hash': 'e6a80c4bcff2c19429b5f129c17f084f9530d2df63b11d88a23d82f1cf4f8803'}, {'image_id': '247_2008_751_Fig21_HTML', 'image_file_name': '247_2008_751_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig21_HTML.jpg', 'caption': 'A 22-month-old boy with a mass in the right groin. MRI shows a heterogeneous lesion adjacent to the gracilis muscle (open arrow). Histopathology: extraosseous Ewing sarcoma', 'hash': '7b31a906abc2b3261150a4b6a9760e07be193c3a365c5d8f0ae109495b1cebea'}, {'image_id': '247_2008_751_Fig11_HTML', 'image_file_name': '247_2008_751_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig11_HTML.jpg', 'caption': 'A 2-year-old girl presented with a mass in the vagina. a Axial T1-W contrast-enhanced image shows the mass with heterogeneous enhancement. The tumour has both solid (asterisk) and fluid (open arrow) compartments. b Sagittal T2-W MR image shows the mass with mixed signal intensity. The bladder is displaced anteriorly and the uterus cannot be visualized. Histopathology: embryonal RMS', 'hash': 'ac1943421ee9978f3feda79e5fd724dd36044faaeb32b157fbcdb645513a38a6'}, {'image_id': '247_2008_751_Fig2_HTML', 'image_file_name': '247_2008_751_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig2_HTML.jpg', 'caption': 'Embryonal RMS, spindle-cell type: closely packed spindle cells arranged in perpendicular crossing fascicles giving a leiomyosarcoma-like appearance (H&E, original magnification 10×20)', 'hash': '65eb0bfa2b2411b837c277634c7905b0b49db89d555a75508c4e151a9d51fe49'}, {'image_id': '247_2008_751_Fig19_HTML', 'image_file_name': '247_2008_751_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig19_HTML.jpg', 'caption': 'A 45-year-old man with a mass in the thigh. T1-W contrast-enhanced MR image shows a heterogeneous circumscribed mass in the vastus lateralis muscle of the right leg. Histopathology: alveolar RMS', 'hash': '1ff152eb49c88ce89400fffe182ef9a2de4d8d8d893de791933598f3c31508af'}, {'image_id': '247_2008_751_Fig16_HTML', 'image_file_name': '247_2008_751_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig16_HTML.jpg', 'caption': 'An 8-year-old boy presented with abdominal pain and jaundice. a US image shows a central process in the liver hilum (open arrow) and dilatation of the intrahepatic bile ducts (solid arrow). b T2-W MR image shows a circumscribed lesion with increased signal intensity (open arrow). c MRCP image shows intrahepatic bile duct dilatation. Note that the right and left duct systems do not communicate (open arrow). d ERCP image (ERCP performed in order to insert a stent in the common bile duct). Histopathology: embryonal RMS', 'hash': 'f9fa75cb7b98a7d9c5c0c7e30dcf17197c4608083325c45a314b8489f1aa16c7'}, {'image_id': '247_2008_751_Fig10_HTML', 'image_file_name': '247_2008_751_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig10_HTML.jpg', 'caption': 'A 3-year-old boy with RMS of the prostate. The sagittal T1-W contrast-enhanced MR image shows the lesion invading the bladder wall. A transurethral catheter has been inserted (open arrow). Histopathology: botryoid RMS', 'hash': '57aeb007985026196fa851862605946846c2e15a36a63bb5549b30ae7647fdfc'}, {'image_id': '247_2008_751_Fig4_HTML', 'image_file_name': '247_2008_751_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig4_HTML.jpg', 'caption': 'Sclerosing RMS: small cells, primitive spindle-shaped cells and eosinophilic rhabdomyoblasts in a background of hyaline sclerosis (H&E, original magnification 10×20)', 'hash': '69af1b0e25cf5b6f08709207576a0457c53f0a79a7ab8e71a898278a55ffbae2'}, {'image_id': '247_2008_751_Fig20_HTML', 'image_file_name': '247_2008_751_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig20_HTML.jpg', 'caption': 'A 1-year-old girl with a mass on the left buttock. a Duplex US image shows a highly vascularized, well-delineated heterogeneous mass that was initially thought be a haemangioma. b Coronal STIR image shows a circumscribed solid lesion that invades the pelvis via the greater sciatic foramen (open arrow). c After initial resection, with incomplete margins, tumour recurrence was seen. MR image 2.6\xa0years after initial diagnosis shows progression of disease extending to the abdominal wall (open arrow). Histopathology: alveolar RMS', 'hash': '28d529a095a129f8b3b4efc2bbf5c9cafe27c102018820cd03aafe92f8bae080'}, {'image_id': '247_2008_751_Fig17_HTML', 'image_file_name': '247_2008_751_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig17_HTML.jpg', 'caption': 'A 4-year-old boy was shown to have a right-sided pleural effusion on a chest radiograph. Balanced FFE sagittal MR image shows a mass (open arrow) arising from the diaphragm (courtesy of S.G.F. Robben, Academic Hospital Maastricht, The Netherlands)', 'hash': '5e0fd41c07b2eaba0662be19652ec97fb2fc2da312418f420c0c680444de904a'}, {'image_id': '247_2008_751_Fig18_HTML', 'image_file_name': '247_2008_751_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig18_HTML.jpg', 'caption': 'A 4-day-old girl born with a lump on the left foot. Antenatal ultrasonography at 20\xa0weeks showed no abnormalities. a T1-W MR image shows a large inhomogeneous mass arising from the left foot. b Abdominal US image shows popliteal and inguinal nodal invasion, and hepatic and pancreatic metastases (open arrow). Due to the poor prognosis, no therapy was given, and the child died several weeks later. Histopathology: poorly differentiated soft-tissue sarcoma without distinct translocations', 'hash': 'fbac2fe671fc373c0bf6642666ee470749b1d8f292d73f50bc9026211374eae3'}, {'image_id': '247_2008_751_Fig3_HTML', 'image_file_name': '247_2008_751_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC2367394/247_2008_751_Fig3_HTML.jpg', 'caption': 'Alveolar RMS: cluster of primitive cells with loss of cellular cohesion and bordered by dense fibrous septa, resulting in an alveolar pattern (H&E, original magnification 10×20)', 'hash': 'ad2b8a7e1d788710d6d450c082fec64eaea34c3e2408c87e3fd8ee1e6a94cd24'}] | {'247_2008_751_Fig1_HTML': ['Based on morphology, RMS is traditionally subdivided into embryonal, alveolar and pleomorphic. Pleomorphic RMS, in contrast to embryonal and alveolar RMS, almost exclusively occurs in adults (median age sixth decade), and is therefore not discussed further. Embryonal RMS is the most common type (60–70% of all RMS). The cells show a close resemblance to various stages in the embryogenesis of normal skeletal muscle (Fig.\xa0<xref rid="247_2008_751_Fig1_HTML" ref-type="fig">1</xref>). Subtypes are botryoid RMS and spindle-cell RMS (Fig.\xa0). Subtypes are botryoid RMS and spindle-cell RMS (Fig.\xa0<xref rid="247_2008_751_Fig2_HTML" ref-type="fig">2</xref>). When arising in the submucosa, embryonal RMS may present as a fast-growing exophytic, polypoid mass. This macroscopic variant is called botryoid RMS (grape-like) and, due to its growth pattern (primary exophytic and not invasive), has a better prognosis.\n). When arising in the submucosa, embryonal RMS may present as a fast-growing exophytic, polypoid mass. This macroscopic variant is called botryoid RMS (grape-like) and, due to its growth pattern (primary exophytic and not invasive), has a better prognosis.\nFig.\xa01Embryonal RMS: small cells and primitive spindle-shaped cells resembling the first stages of developing normal skeletal muscle (H&E, original magnification 10×20)Fig.\xa02Embryonal RMS, spindle-cell type: closely packed spindle cells arranged in perpendicular crossing fascicles giving a leiomyosarcoma-like appearance (H&E, original magnification 10×20)'], '247_2008_751_Fig3_HTML': ['Alveolar RMS is composed of ill-defined, dense aggregates of poorly differentiated round or oval tumour cells that frequently show loss of cohesion (Fig.\xa0<xref rid="247_2008_751_Fig3_HTML" ref-type="fig">3</xref>). This loss of cohesion and the presence of thin fibrous septa result in an alveolar pattern. In cases where the tumour cells do not show loss of cohesion, the term ‘solid alveolar RMS’ is used. Alveolar RMS represents about 20% of all RMS and has two specific translocations with specific fusion transcripts that can be detected by RT-PCR. The majority (about 55%) show a t(2;13)(q35;q14) translocation with the corresponding fusion transcript PAX3-FKHR [). This loss of cohesion and the presence of thin fibrous septa result in an alveolar pattern. In cases where the tumour cells do not show loss of cohesion, the term ‘solid alveolar RMS’ is used. Alveolar RMS represents about 20% of all RMS and has two specific translocations with specific fusion transcripts that can be detected by RT-PCR. The majority (about 55%) show a t(2;13)(q35;q14) translocation with the corresponding fusion transcript PAX3-FKHR [8]. In about 22% a t(1;13)(p36;q14) translocation is found with fusion transcript PAX7-FKHR. In rare cases, RMS with a more or less alveolar pattern lacks these translocations.\nFig.\xa03Alveolar RMS: cluster of primitive cells with loss of cellular cohesion and bordered by dense fibrous septa, resulting in an alveolar pattern (H&E, original magnification 10×20)'], '247_2008_751_Fig4_HTML': ['Both embryonal and alveolar RMS may show rhabdoid tumour-like features and anaplasia (focal or diffuse) [9, 10]. More recently, under the heading sclerosing RMS, a variant with hyalin sclerosis has been described (Fig.\xa0<xref rid="247_2008_751_Fig4_HTML" ref-type="fig">4</xref>) [) [11]. It is unclear whether this is a distinct subtype.\nFig.\xa04Sclerosing RMS: small cells, primitive spindle-shaped cells and eosinophilic rhabdomyoblasts in a background of hyaline sclerosis (H&E, original magnification 10×20)'], '247_2008_751_Fig5_HTML': ['On US, RMS in general shows as a well-defined, slightly hypoechoic inhomogeneous mass that can show significantly increased flow (Fig.\xa0<xref rid="247_2008_751_Fig5_HTML" ref-type="fig">5</xref>). In the particular case of paratesticular RMS, US is the imaging modality of choice, although CT of the abdomen is also necessary to evaluate for retroperitoneal lymphadenopathy. In all other RMS locations additional imaging using CT or MRI is mandatory.\n). In the particular case of paratesticular RMS, US is the imaging modality of choice, although CT of the abdomen is also necessary to evaluate for retroperitoneal lymphadenopathy. In all other RMS locations additional imaging using CT or MRI is mandatory.\nFig.\xa05A 6-year-old boy with a mass in the left scrotum. US image shows an ill-defined heterogeneous mass surrounding the testis (open arrow). The mass shows increased flow (solid arrow). Histopathology: embryonal RMS'], '247_2008_751_Fig6_HTML': ['The imaging characteristics of RMS are relatively nonspecific. Like most soft-tissue tumours they have intermediate signal intensity on T1-W images (Fig.\xa0<xref rid="247_2008_751_Fig6_HTML" ref-type="fig">6</xref>). On T2-W images they tend to be of intermediate-to-high signal intensity. If the tumour contains a high number of septa it may have a lobular shape. RMS in general show strong enhancement on postcontrast imaging (Fig.\xa0). On T2-W images they tend to be of intermediate-to-high signal intensity. If the tumour contains a high number of septa it may have a lobular shape. RMS in general show strong enhancement on postcontrast imaging (Fig.\xa0<xref rid="247_2008_751_Fig6_HTML" ref-type="fig">6</xref>). In very rare instances the tumour may show a predominantly cystic appearance (Fig.\xa0). In very rare instances the tumour may show a predominantly cystic appearance (Fig.\xa0<xref rid="247_2008_751_Fig7_HTML" ref-type="fig">7</xref>). Dynamic series are useful in order to assess tumour vascularity, and to differentiate between postchemotherapy/surgery residual disease and fibrosis.\n). Dynamic series are useful in order to assess tumour vascularity, and to differentiate between postchemotherapy/surgery residual disease and fibrosis.\nFig.\xa06A 13-year-old girl who noticed a small lump near the anus. a T1-W MR image shows a well-defined pararectal lesion (arrow). b After intravenous gadolinium administration the lesion shows homogeneous enhancement (arrow) Histopathology: alveolar RMSFig.\xa07An 8-year-old girl with haemolysis, fever and a mass underneath the scapula. a Coronal STIR image shows a lesion with mixed signal intensity (open arrow) and multiple enlarged lymph nodes in the neck (solid arrow). b Axial T2-W image shows multiple cystic lesions with fluid-fluid levels (open arrow). Histopathology: stage IV embryonal RMS'], '247_2008_751_Fig8_HTML': ['In PET-CT studies fluorine-18 fluorodeoxyglucose (18F-FDG), a radiolabelled glucose analogue, is used [22]. As 18F-FDG is a glucose analogue, it shows uptake in metabolically active cells, which most malignant tumour cells are. The combination of PET with CT, without moving the relative position of the patient, yields a higher diagnostic accuracy than PET alone (Fig.\xa0<xref rid="247_2008_751_Fig8_HTML" ref-type="fig">8</xref>). In general, the CT scan will be low-dose CT scan only meant to identify anatomical structures. However, as the CT scanners in modern PET-CT systems are of high diagnostic quality, it is also possible to combine a diagnostic CT scan, e.g. for the depiction of pulmonary metastases, with a PET scan.\n). In general, the CT scan will be low-dose CT scan only meant to identify anatomical structures. However, as the CT scanners in modern PET-CT systems are of high diagnostic quality, it is also possible to combine a diagnostic CT scan, e.g. for the depiction of pulmonary metastases, with a PET scan.\nFig.\xa08A 19-year-old boy with a history of treated metastatic RMS presented with low back pain. The PET-CT image shows intense 18F-FDG uptake in the spinal canal (open arrow). Physiological excretion of the radiopharmaceutical via the kidneys is visible (solid arrows). Histopathology: embryonal RMS'], '247_2008_751_Fig7_HTML': ['The main staging system is the postsurgical staging system developed by the IRSG. This is currently used by study groups both in the USA and now in Europe also (Table\xa03). The IRSG was formed in 1972 and consisted of surgeons, pathologists, oncologists, and radiation oncologists. The absence of radiologists is striking, and paediatric radiologists are still infrequently involved in development of paediatric oncology study protocols, although in the EpSSG RMS 2005, paediatric radiologists were involved in the development of the protocol. For staging regional nodes it is important to be familiar with the regional node stations. Lymph node involvement has a negative impact on prognosis, as has been shown in the SIOP Malignant Mesenchymal Tumor 89 trial [25]. Overall 5-year survival was 60% for N1 patients versus 73% in N0 patients (P\u2009=\u20090.03). Distant lymph node involvement upgrades a patient to stage IV disease (Fig.\xa0<xref rid="247_2008_751_Fig7_HTML" ref-type="fig">7</xref>), having an adverse impact on prognosis: overall 5-year survival becomes 24% [), having an adverse impact on prognosis: overall 5-year survival becomes 24% [26].\nTable\xa03IRSG classificationStageCharacteristicsILocalized disease completely resected (regional nodes not involved)A: Tumour confined to muscle or organ of originB: Tumour infiltrating outside organ of (muscle of) originIILocalized or regional disease with total resection of gross tumourA: Primary tumour grossly resected, with microscopic residual disease (negative findings in local nodes)B: Primary tumour and positive nodes completely resectedC: Primary tumour and positive nodes resected, with evidence of microscopic residual diseaseIIIIncomplete resection of tumour or biopsy, with gross residual diseaseIVDistant metastatic disease present at diagnosis'], '247_2008_751_Fig9_HTML': ['Tumour relapse in patients most commonly presents with locoregional disease (51%) compared to distant relapse (41%) [32] (Fig.\xa0<xref rid="247_2008_751_Fig9_HTML" ref-type="fig">9</xref>). In a retrospective case-based study the use of PET-CT was advocated; this, however, needs to be evaluated in larger prospective studies [). In a retrospective case-based study the use of PET-CT was advocated; this, however, needs to be evaluated in larger prospective studies [33].\nFig.\xa09Two years after initial diagnosis the patient shown in Fig.\xa0<xref rid="247_2008_751_Fig6_HTML" ref-type="fig">6</xref> presented at the outpatient clinic complaining of back pain. presented at the outpatient clinic complaining of back pain. a Coronal STIR image of the pelvis shows discrete increased signal intensity in the left ischium (open arrow). b Subsequently acquired PET-CT image confirms the presence of recurrent disease in the same location (open arrow). Note excretion of tracer into the urinary bladder (solid arrow). c PET-CT image also shows a second lesion in the thoracic spine (open arrow). Additional rib and pleural metastases were also visible (not visible on this image)'], '247_2008_751_Fig10_HTML': ['Approximately 25% of all RMS are GU RMS [34, 35]. As mentioned above, GU RMS can simply be subdivided into two subgroups based on different prognosis and subsequent treatment strategy, GU bladder/prostate (GU-BP) being an unfavourable location (Fig.\xa0<xref rid="247_2008_751_Fig10_HTML" ref-type="fig">10</xref>). Tumours at other GU non-bladder/prostate (GU-NBP) sites, such as a paratesticular location (testes, epididymis and spermatic cord; Fig.\xa0). Tumours at other GU non-bladder/prostate (GU-NBP) sites, such as a paratesticular location (testes, epididymis and spermatic cord; Fig.\xa0<xref rid="247_2008_751_Fig5_HTML" ref-type="fig">5</xref>), vagina or uterus (Fig.\xa0), vagina or uterus (Fig.\xa0<xref rid="247_2008_751_Fig11_HTML" ref-type="fig">11</xref>), have a favourable prognosis, and thus require less-intensive treatment [), have a favourable prognosis, and thus require less-intensive treatment [36–48]. There is a caveat to MRI of the bladder in RMS: after intravenous contrast medium administration, layering of contrast medium can occur making it difficult to appreciate bladder wall enhancement [49]. T2-W sequences can be particularly useful in this setting to assess bladder wall thickening. Additional cystoscopy is often warranted [50]. At the end of treatment, some residual soft-tissue thickening may persist, and on MRI it is impossible to decide whether this is residual scarring or tumour; in these cases endoscopic biopsy is mandatory.\nFig.\xa010A 3-year-old boy with RMS of the prostate. The sagittal T1-W contrast-enhanced MR image shows the lesion invading the bladder wall. A transurethral catheter has been inserted (open arrow). Histopathology: botryoid RMSFig.\xa011A 2-year-old girl presented with a mass in the vagina. a Axial T1-W contrast-enhanced image shows the mass with heterogeneous enhancement. The tumour has both solid (asterisk) and fluid (open arrow) compartments. b Sagittal T2-W MR image shows the mass with mixed signal intensity. The bladder is displaced anteriorly and the uterus cannot be visualized. Histopathology: embryonal RMS'], '247_2008_751_Fig12_HTML': ['RMS of the extremities (Figs.\xa0<xref rid="247_2008_751_Fig12_HTML" ref-type="fig">12</xref> and and <xref rid="247_2008_751_Fig13_HTML" ref-type="fig">13</xref>) is almost always of alveolar histology, tends to occur in older children and young adults, is often present with positive regional lymph nodes, and has a propensity to metastasize to unusual sites; these negative prognostic factors contribute to the relatively poor prognosis of RMS in this location [) is almost always of alveolar histology, tends to occur in older children and young adults, is often present with positive regional lymph nodes, and has a propensity to metastasize to unusual sites; these negative prognostic factors contribute to the relatively poor prognosis of RMS in this location [51, 52]. In approximately 12% of patients, nodal involvement is seen on imaging; however, when nodal dissection is performed the rate of nodal involvement increases to almost 50% [53]. This discrepancy between imaging findings and nodal dissection might be reduced by using high-quality state-of-the-art US. In current treatment protocols systematic biopsy of regional nodes is advocated, even if the nodes are not palpable or enlarged on imaging; sentinel node procedures are recommended whenever feasible, although the value of upgrading a patient to a higher risk group based merely on a positive sentinel node has not been studied yet. As in all tumours of the extremities, preoperative imaging plays a vital role in the depiction of the relationship between neurovascular bundles and the tumour.\nFig.\xa012A 4-year-old girl presenting with a mass in the left lower leg. a Axial T1-W contrast-enhanced MR image shows an ill-defined mass circumferential to the fibula. Note the cortical thinning (open arrow) of the fibula. b Sagittal PD-weighted image shows diffuse bone marrow metastases. Histopathology: embryonal RMSFig.\xa013A 2-month-old boy with a mass in the third ray of the left foot. T1-W MR image shows a discrete lesion (open arrow) of intermediate signal intensity. Histopathology: embryonal RMS'], '247_2008_751_Fig14_HTML': ['Chest wall RMS (Fig.\xa0<xref rid="247_2008_751_Fig14_HTML" ref-type="fig">14</xref>) is a relatively rare finding with a reported incidence of 3.7% in the IRSG II and IRSG III studies [) is a relatively rare finding with a reported incidence of 3.7% in the IRSG II and IRSG III studies [54]. Most of the reports of chest wall involvement are either case reports or small series [55–57]. In a retrospective analysis of 15 patients, Saenz et al. [57] found a 5-year survival of 67%.\nFig.\xa014A 4-year-old boy presenting with a mass on the right chest wall. a US image shows a heterogeneous mass in the pectoralis major muscle (the pectoralis minor is not involved; asterisk). b T1-W MR image of the chest shows a mass of intermediate signal intensity. c After intravenous contrast medium administration the lesion shows homogeneous enhancement. Histopathology: alveolar RMS'], '247_2008_751_Fig15_HTML': ['There is an ongoing debate and controversy whether congenital cystic anomalies predispose children to intralesional development of RMS [58–62]. It has been reported that pleuropulmonary blastoma (PPB) has been mistaken for or classified as RMS arising in congenital cystic adenomatoid malformation (CCAM) on a number of occasions [63]. Despite the fact that the exact incidence in CCAM is unknown, it has prompted paediatric surgeons to resect even small pulmonary cystic lesions (Fig.\xa0<xref rid="247_2008_751_Fig15_HTML" ref-type="fig">15</xref>) [) [64, 65].\nFig.\xa015A 3-year-old boy with dyspnoea. Chest CT image shows displacement of the trachea (open arrow) and oesophagus (solid arrow) to the right due to a large mass (asterisk) with accompanying pleural effusion. Histopathology: embryonal RMS'], '247_2008_751_Fig16_HTML': ['RMS is the most common tumour of the biliary tree in childhood, although it only accounts for approximately 0.04% of all childhood tumours [66]. The initial diagnosis will, in most patients, be made on US, which may show a solid or cystic mass situated in the liver hilum, and intrahepatic bile duct dilatation (Fig.\xa0<xref rid="247_2008_751_Fig16_HTML" ref-type="fig">16</xref>). MRI is mandatory for presurgical evaluation, where magnetic resonance cholangiopancreatography (MRCP) can depict the biliary tree (Fig.\xa0). MRI is mandatory for presurgical evaluation, where magnetic resonance cholangiopancreatography (MRCP) can depict the biliary tree (Fig.\xa0<xref rid="247_2008_751_Fig16_HTML" ref-type="fig">16</xref>). In many patients, however, endoscopic retrograde cholangiopancreatography (ERCP) will have to be performed in order to depict intraductal irregularities (Fig.\xa0). In many patients, however, endoscopic retrograde cholangiopancreatography (ERCP) will have to be performed in order to depict intraductal irregularities (Fig.\xa0<xref rid="247_2008_751_Fig16_HTML" ref-type="fig">16</xref>). Biliary tree RMS is a tumour that does not necessarily need to be fully resected in order to achieve long-term survival, as long as adequate radiotherapy is added [). Biliary tree RMS is a tumour that does not necessarily need to be fully resected in order to achieve long-term survival, as long as adequate radiotherapy is added [67]. Intraperitoneal metastases, which can also be found on follow-up, should also be born in mind.\nFig.\xa016An 8-year-old boy presented with abdominal pain and jaundice. a US image shows a central process in the liver hilum (open arrow) and dilatation of the intrahepatic bile ducts (solid arrow). b T2-W MR image shows a circumscribed lesion with increased signal intensity (open arrow). c MRCP image shows intrahepatic bile duct dilatation. Note that the right and left duct systems do not communicate (open arrow). d ERCP image (ERCP performed in order to insert a stent in the common bile duct). Histopathology: embryonal RMS'], '247_2008_751_Fig17_HTML': ['In extremely rare instances RMS can be found in other organs such as the heart, the diaphragm (Fig.\xa0<xref rid="247_2008_751_Fig17_HTML" ref-type="fig">17</xref>), the omentum, the urachus and the digestive tract [), the omentum, the urachus and the digestive tract [68–76].\nFig.\xa017A 4-year-old boy was shown to have a right-sided pleural effusion on a chest radiograph. Balanced FFE sagittal MR image shows a mass (open arrow) arising from the diaphragm (courtesy of S.G.F. Robben, Academic Hospital Maastricht, The Netherlands)'], '247_2008_751_Fig18_HTML': ['RMS has been reported to occur as a congenital tumour (Fig.\xa0<xref rid="247_2008_751_Fig18_HTML" ref-type="fig">18</xref>) [) [77–81]. In congenital alveolar RMS the prognosis is reported to be extremely poor, despite otherwise adequate treatment [79]. Orbach et al. [82] reported the SIOP data on soft-tissue sarcoma in the first year of life. In their study population of 16 newborns, with a follow-up of 1.8–10.0\xa0years, 3 out of 5 newborns with RMS survived. It has been noted that in congenital RMS the disease may be metastatic at the time of birth, with metastases described in a number of organs and in the placenta [81].\nFig.\xa018A 4-day-old girl born with a lump on the left foot. Antenatal ultrasonography at 20\xa0weeks showed no abnormalities. a T1-W MR image shows a large inhomogeneous mass arising from the left foot. b Abdominal US image shows popliteal and inguinal nodal invasion, and hepatic and pancreatic metastases (open arrow). Due to the poor prognosis, no therapy was given, and the child died several weeks later. Histopathology: poorly differentiated soft-tissue sarcoma without distinct translocations'], '247_2008_751_Fig19_HTML': ['Every once in a while paediatric radiologists and paediatric oncologists receive a request for help in the management of an adult patient (Fig.\xa0<xref rid="247_2008_751_Fig19_HTML" ref-type="fig">19</xref>). RMS, although seen as a soft-tissue tumour of childhood, can also occur later in life [). RMS, although seen as a soft-tissue tumour of childhood, can also occur later in life [83–86]. Compared to childhood RMS, adult RMS has a poor outcome. In a large retrospective study of 171 patients 5-year overall survival was only 40% [85]. However, the patients in this series treated according to the guidelines for treatment of childhood RMS showed survival figures comparable to those seen in children. This suggests that treatment of adult RMS should be based on paediatric protocols tailored to adults, to increase survival in this age group. In the Academic Medical Centre Amsterdam we have a working group on childhood tumours in (often young) adults that specifically deals with this challenging population. This working group consists of medical oncologists, paediatric oncologists, radiation oncologists, (orthopaedic) surgeons and a paediatric radiologist. Imaging features will in general not be of help, as the pretest likelihood of RMS in an adolescent or adult is extremely low.\nFig.\xa019A 45-year-old man with a mass in the thigh. T1-W contrast-enhanced MR image shows a heterogeneous circumscribed mass in the vastus lateralis muscle of the right leg. Histopathology: alveolar RMS'], '247_2008_751_Fig20_HTML': ['Given the wide variety of locations in which RMS can be found it is difficult to give a concise list of differential diagnoses. The site of the primary lesion determines the differential diagnosis. Keeping location out of the equation there are, however, certain tumours, such as haemangiomas/vascular malformations (Fig.\xa0<xref rid="247_2008_751_Fig20_HTML" ref-type="fig">20</xref>), adult-type soft-tissue sarcomas, peripheral neuroectodermal tumours (PNET), infantile fibrosarcoma, aggressive fibromatosis, desmoplastic small round-cell tumours and rhabdoid tumours, and other more even rarer soft-tissue tumours such as nonosseous Ewing sarcoma (Fig.\xa0), adult-type soft-tissue sarcomas, peripheral neuroectodermal tumours (PNET), infantile fibrosarcoma, aggressive fibromatosis, desmoplastic small round-cell tumours and rhabdoid tumours, and other more even rarer soft-tissue tumours such as nonosseous Ewing sarcoma (Fig.\xa0<xref rid="247_2008_751_Fig21_HTML" ref-type="fig">21</xref>), that should be kept in mind when performing US or reading CT or MRI studies of soft-tissue tumours in childhood.\n), that should be kept in mind when performing US or reading CT or MRI studies of soft-tissue tumours in childhood.\nFig.\xa020A 1-year-old girl with a mass on the left buttock. a Duplex US image shows a highly vascularized, well-delineated heterogeneous mass that was initially thought be a haemangioma. b Coronal STIR image shows a circumscribed solid lesion that invades the pelvis via the greater sciatic foramen (open arrow). c After initial resection, with incomplete margins, tumour recurrence was seen. MR image 2.6\xa0years after initial diagnosis shows progression of disease extending to the abdominal wall (open arrow). Histopathology: alveolar RMSFig.\xa021A 22-month-old boy with a mass in the right groin. MRI shows a heterogeneous lesion adjacent to the gracilis muscle (open arrow). Histopathology: extraosseous Ewing sarcoma'], '247_2008_751_Fig22_HTML': ['Image interpretation and management of the patient after surgery and often RT are challenges (Fig.\xa0<xref rid="247_2008_751_Fig22_HTML" ref-type="fig">22</xref>). Most important is proper knowledge of the surgical procedure and/or the radiation field. The following postoperative changes can be encountered in children treated for RMS:\n). Most important is proper knowledge of the surgical procedure and/or the radiation field. The following postoperative changes can be encountered in children treated for RMS:\nHaematomaOedemaSoft-tissue infection/abscessCalcificationForeign bodiesMuscle flaps/fat padsDistorted anatomyRadiation effect Figure\xa0<xref rid="247_2008_751_Fig23_HTML" ref-type="fig">23</xref> shows a possible decision tree to manage postoperative findings on follow-up imaging.\n shows a possible decision tree to manage postoperative findings on follow-up imaging.\nFig.\xa022A 6-year-old boy with a history of treated bladder RMS. At surgical resection the urethra was damaged leading to a persistent urinoma in, after RT, nonvital tissue. MRI image after treatment shows a mass (asterisk) between the urethra (open arrow) and the rectum (solid arrow). This mass is a vascularized gracilis muscle flap used to repair the defect. Without proper knowledge of the surgical history of the patient, this might have been interpreted as tumour recurrence. Histopathology: embryonal RMSFig.\xa023Flow chart for posttreatment lesions found on MRI. SI signal intensity, CE contrast-enhanced [114]']} | Imaging findings in noncraniofacial childhood rhabdomyosarcoma | [
"Rhabdomyosarcoma",
"Imaging",
"Children"
] | Pediatr Radiol | 1212822000 | Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma of childhood. This paper is focuses on imaging for diagnosis, staging, and follow-up of noncraniofacial RMS. | [
"Adult",
"Child",
"Humans",
"Magnetic Resonance Imaging",
"Muscle Neoplasms",
"Positron-Emission Tomography",
"Radiography",
"Rhabdomyosarcoma",
"Thoracic Neoplasms",
"Tomography, X-Ray Computed",
"Ultrasonography",
"Urogenital Neoplasms"
] | other | PMC2367394 | null | 226 | [
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] | Pediatr Radiol. 2008 Jun 7; 38(6):617-634 | NO-CC CODE |
|
CT scan of bilateral kidney lesions, coronal reformatted A) and axial B) images. On abdominal CT scan after intravenous contrast administration there are large lesions within both kidneys, which are less enhancing than the surrounding cortex (arrows). On the distal pole of the right kidney 6 cm large lesion is present (craniocaudal diameter). The deformation of the contour of the left kidney (arrows) A) and distal pole enlargement of the left kidney due to 12 cm large lesion causing compression of the pyelocaliceal system. Both lesions are inhomogeneously isodense on the native scan, and show enhancement of the central parts at the arterial phase followed by mild inhomogeneous enhancement of the entire lesion in the delayed phase B). A thrombotic mass was present within the left renal vein extending within the inferior caval vein (not shown) | OAMJMS-7-4082-g002 | 7 | 4ff9e489ad8231face71e8abb68e69c17b4d52224f8e0d087f770d74f03309b6 | OAMJMS-7-4082-g002.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
555,
211
] | [{'image_id': 'OAMJMS-7-4082-g007', 'image_file_name': 'OAMJMS-7-4082-g007.jpg', 'image_path': '../data/media_files/PMC7061405/OAMJMS-7-4082-g007.jpg', 'caption': 'Microphotographs of various immunostaining (A); h-Caldesmon positive cells surrounding blood vessel (B); The same antibody labeling glomus cells in areas of solid growth; some of them lining small lumina (upper part of the microphoto) (C) CD34', 'hash': '16d95592e412582edfa9e3f6b13abdb5084f1c329d5b4494c3b0d820a0fb699c'}, {'image_id': 'OAMJMS-7-4082-g006', 'image_file_name': 'OAMJMS-7-4082-g006.jpg', 'image_path': '../data/media_files/PMC7061405/OAMJMS-7-4082-g006.jpg', 'caption': 'Histology of surgical specimen of the resected thigh mass. A lobular architecture of the tumor (HE x 40) (A); small irregular lumina are present within rich cellular lobules. SMA positivity (x 100) (arrows) (B)', 'hash': '06b5c2f7979935813a0095ed2c1d3e11a17da9b0983d4ee03018c1d51b5c3dae'}, {'image_id': 'OAMJMS-7-4082-g001', 'image_file_name': 'OAMJMS-7-4082-g001.jpg', 'image_path': '../data/media_files/PMC7061405/OAMJMS-7-4082-g001.jpg', 'caption': 'CT scan and Magnetic Resonance Imaging of the left thigh and corresponding histopathology of the core biopsy; A) pre contrast; B) after intravenous iodine contrast administration, early arterial phase; C) T1WI, axial plane; D) T2WI coronal plane; e) T1WI, axial plane, after intravenous gadolinium based contrast administration; F) Core biopsy specimen. The lesion is slightly hypodense compared to the normal muscle and is located within the left vastus lateralis muscle belly (arrows) A). On CT after contrast administration B) there is mild inhomogeneous peripheral enhancement of the lesion on early arterial phase (arrows), followed by subtle homogenous enhancement of the entire lesion in the delayed phase. On MR, within the left vastus lateralis muscle, there is a well-circumscribed lobulated mass, iso-intense to muscle on T1WI (arrow) C), and of heterogeneous signal on T2WI (arrow) D). The maximum craniocaudal diameter of the lesion is 6 cm . Note also mild peritumoral edema above upper and below lower pole of the lesion (arrows) D). After intravenous Gd administration, there was marked inhomogeneous enhancement of the lesion E). Core biopsy specimen shows highly cellular neoplastic tissue composed of relatively uniform, small to medium sized cells in diffuse-solid arrangement and foci of vaguely lobular architecture (HE x100) F)', 'hash': '15775a39a8c39c3b642e18bf6b3a2bc4174288a2a18464e4261fe3cdfce33118'}, {'image_id': 'OAMJMS-7-4082-g002', 'image_file_name': 'OAMJMS-7-4082-g002.jpg', 'image_path': '../data/media_files/PMC7061405/OAMJMS-7-4082-g002.jpg', 'caption': 'CT scan of bilateral kidney lesions, coronal reformatted A) and axial B) images. On abdominal CT scan after intravenous contrast administration there are large lesions within both kidneys, which are less enhancing than the surrounding cortex (arrows). On the distal pole of the right kidney 6 cm large lesion is present (craniocaudal diameter). The deformation of the contour of the left kidney (arrows) A) and distal pole enlargement of the left kidney due to 12 cm large lesion causing compression of the pyelocaliceal system. Both lesions are inhomogeneously isodense on the native scan, and show enhancement of the central parts at the arterial phase followed by mild inhomogeneous enhancement of the entire lesion in the delayed phase B). A thrombotic mass was present within the left renal vein extending within the inferior caval vein (not shown)', 'hash': '4ff9e489ad8231face71e8abb68e69c17b4d52224f8e0d087f770d74f03309b6'}, {'image_id': 'OAMJMS-7-4082-g005', 'image_file_name': 'OAMJMS-7-4082-g005.jpg', 'image_path': '../data/media_files/PMC7061405/OAMJMS-7-4082-g005.jpg', 'caption': 'Follow-up MR images on the thigh, after three months; A) Axial T1WI after intravenous contrast (Gd) administration; B) Coronal FS T1WI after intravenous contrast (Gd) administration. There is slight enlargement of the primary lesion and occurrence of new small intramuscular lesions in the same and in contralateral leg (arrows)', 'hash': '102a64b3d005d284f030ba9440c653c1b129b0b131f232dd44984141e877ff73'}, {'image_id': 'OAMJMS-7-4082-g004', 'image_file_name': 'OAMJMS-7-4082-g004.jpg', 'image_path': '../data/media_files/PMC7061405/OAMJMS-7-4082-g004.jpg', 'caption': 'Imaging of glomus tumor on the left breast; A) Mammography; B) CT scan late venous phase. At mammography, craniocaudal view there is a retro-areolar dense lobulated lesion (arrow) A). On the chest CT scan after intravenous contrast material administration the lesion is highly vascular with homogenous enhancement on late venous phase B) presented as well-delineated lobulated lesion measuring 1,5 cm in diameter (arrow)', 'hash': '50384a4efc4c690c71a2d584d259d6ba20c90ddf8e5dcf02f6d207fe99ae5594'}, {'image_id': 'OAMJMS-7-4082-g003', 'image_file_name': 'OAMJMS-7-4082-g003.jpg', 'image_path': '../data/media_files/PMC7061405/OAMJMS-7-4082-g003.jpg', 'caption': 'Cardiac glomus tumor presented on CT scan. On chest CT scans after intravenous contrast administration a lobulated isodense masses are seen in the left ventricle and anterior aspect of the mitral valve with thickened left wall of the left ventricle (arrows) A); On venous phase there is inhomogeneous mild enhancement of the lesion of the left ventricle wall (arrow) B)', 'hash': '56605660b3565130eba66113b85a9d0256d29603bcb84c87f36bc293f7f3519e'}] | {'OAMJMS-7-4082-g001': ['A 38-year-old woman contacted her physician after she noticed two weeks previously, a mass at the anterior aspect of the left thigh. On CT, the lesion was slightly hypodense and located within vastus lateralis muscle, without intralesional calcifications or signs for hemorrhage (<xref ref-type="fig" rid="OAMJMS-7-4082-g001">Figure 1A</xref>). After contrast administration there was a mild inhomogeneous peripheral enhancement in the early arterial phase, followed by subtle homogenous enhancement of the entire lesion in the delayed phase (). After contrast administration there was a mild inhomogeneous peripheral enhancement in the early arterial phase, followed by subtle homogenous enhancement of the entire lesion in the delayed phase (<xref ref-type="fig" rid="OAMJMS-7-4082-g001">Figure 1B</xref>). Magnetic resonance imaging showed a well-circumscribed lobulated mass with the largest diameter of 6 cm (craniocaudal), isointense to muscle on T1-weighted image (WI), inhomogeneous high signal on T2WI and with presence of mild peritumoral edema. After Gadolinium (Gd) contrast administration, there was inhomogeneous enhancement of the lesion (). Magnetic resonance imaging showed a well-circumscribed lobulated mass with the largest diameter of 6 cm (craniocaudal), isointense to muscle on T1-weighted image (WI), inhomogeneous high signal on T2WI and with presence of mild peritumoral edema. After Gadolinium (Gd) contrast administration, there was inhomogeneous enhancement of the lesion (<xref ref-type="fig" rid="OAMJMS-7-4082-g001">Figure 1C</xref>, , <xref ref-type="fig" rid="OAMJMS-7-4082-g001">1D</xref>, and , and <xref ref-type="fig" rid="OAMJMS-7-4082-g001">1E</xref>). Histopathological examination of the core biopsy specimen showed a small round cell tumor, in keeping with a sarcoma due to diffuse immunoreactivity with Vimentin, excluding Lymphoma, epithelial malignant neoplasm, but not excluding Ewing’s sarcoma due to focal imunoreactivity with CD99 antibody. A suggestion for further cytogenetic examination was given (). Histopathological examination of the core biopsy specimen showed a small round cell tumor, in keeping with a sarcoma due to diffuse immunoreactivity with Vimentin, excluding Lymphoma, epithelial malignant neoplasm, but not excluding Ewing’s sarcoma due to focal imunoreactivity with CD99 antibody. A suggestion for further cytogenetic examination was given (<xref ref-type="fig" rid="OAMJMS-7-4082-g001">Figure 1F</xref>).).'], 'OAMJMS-7-4082-g002': ['Abdominal CT showed bilateral lesions of the kidneys, a 6 cm large lesion in the lower pole of the right kidney and 12 cm large lesion in the lower pole of the left kidney. Both lesions were isodense on the precontrast image, with enhancement of the central part of the lesions at the arterial phase followed by mild inhomogeneous enhancement in the delayed phase (<xref ref-type="fig" rid="OAMJMS-7-4082-g002">Figure 2</xref>).).'], 'OAMJMS-7-4082-g003': ['A thrombotic mass within the left renal vein and inferior caval vein extended within the right atrium. On chest CT scans after intravenous contrast administration lobulated isodense masses were seen in the left ventricle and anterior aspect of the mitral valve with thickened left wall of the left ventricle which enhanced inhomogeneously on venous phase (<xref ref-type="fig" rid="OAMJMS-7-4082-g003">Figure 3</xref>).).', 'Urgent cardiac surgery was done, due to deterioration of cardiac symptoms (hypotension, dyspnea, shortness of breath, paroxysmal atrial fibrillation, decrease of ejection fraction under 30%) before any other therapeutic treatment. Preoperative cardiac ultrasound, which was six weeks after initial cardiac CT examination (<xref ref-type="fig" rid="OAMJMS-7-4082-g003">Figure 3</xref>), showed a fibrillary mass within the left ventricle, with a diameter of 3.5 cm, located near the thickened anterior mitral valve. During systole the mass extends to the aortic valve. A mobile hyperechoic mass with similar ultrasound characteristic is seen in the right atrium, with a maximum length of 5 cm, extending within the right ventricle during diastole. Cardiac surgery was performed, with thrombectomy and mitral valve replacement and placement of inferior vena cava filter, in suprarenal position.), showed a fibrillary mass within the left ventricle, with a diameter of 3.5 cm, located near the thickened anterior mitral valve. During systole the mass extends to the aortic valve. A mobile hyperechoic mass with similar ultrasound characteristic is seen in the right atrium, with a maximum length of 5 cm, extending within the right ventricle during diastole. Cardiac surgery was performed, with thrombectomy and mitral valve replacement and placement of inferior vena cava filter, in suprarenal position.'], 'OAMJMS-7-4082-g004': ['An additional lesion was found in the left breast (<xref ref-type="fig" rid="OAMJMS-7-4082-g004">Figure 4</xref>) and two lesions within the subcutaneous fat of anterior abdominal wall (diameter 1 cm each).) and two lesions within the subcutaneous fat of anterior abdominal wall (diameter 1 cm each).'], 'OAMJMS-7-4082-g005': ['Three months later the follow-up images of the thigh lesion showed enlargement of the lesion and occurrence of small intramuscular lesions with similar MR appearance located in the same and in opposite leg (<xref ref-type="fig" rid="OAMJMS-7-4082-g005">Figure 5</xref>). The main thigh lesion and nearby satellite nodule was removed with free surgical margins.). The main thigh lesion and nearby satellite nodule was removed with free surgical margins.'], 'OAMJMS-7-4082-g006': ['Fourth diagnostic procedure was done in Macedonia. The surgical specimen consisted of skin fragment measuring 7 x 0.5 x 0.1 cm, with subcutaneous fat (8 x 3.5 x 0.7 cm) underlying skeletal muscle fragment (10 x 10 x 4 cm) and fragment of fascia (8 x 2 x 0.1 cm). On serial sections, a white-yellowish poorly demarcated tumor nodule (7 x 5.5 x 4 cm) was found in the muscle. The central part of the tumor consisted of dilated blood vessels filled with partially clotted blood. Another nodular lesion with the same macroscopic appearance was found subcutaneously. On light microscopy the tumor had a predominantly lobular architecture, composed of small-to medium-sized cells with moderate amount of eosinophilic or pale cytoplasm and relatively uniform nuclei with inconspicuous nucleoli (<xref ref-type="fig" rid="OAMJMS-7-4082-g006">Figure 6</xref>), dispersed in scant collagen IV positive stroma with increased vascularity and foci of hemorrhage (), dispersed in scant collagen IV positive stroma with increased vascularity and foci of hemorrhage (<xref ref-type="fig" rid="OAMJMS-7-4082-g007">Figure 7D</xref>). The cells had perivascular arrangement in many areas. Only one regular mitotic figure per 50 HPF (high power fields) was detected. Marked nuclear atypia and atypical mitotic figures were not found.). The cells had perivascular arrangement in many areas. Only one regular mitotic figure per 50 HPF (high power fields) was detected. Marked nuclear atypia and atypical mitotic figures were not found.'], 'OAMJMS-7-4082-g007': ['The positive immunohistochemical findings were to the antibodies to smooth muscle activity (SMA), Vimentin, Caldesmon and Collagen IV, shown in Table 1. The Ki-67 was expressed in less than 5% of tumor cells, and only one mitotic figure per 50 hpf was detected (<xref ref-type="fig" rid="OAMJMS-7-4082-g007">Figure 7A</xref>, 7B, 7C, 7D, 7E, and 7F). Tumor cells were negative for immunostaining against Desmin, S-100 protein, EMA, HMB45, CD31 and CD34. The diagnosis of glomus tumor of uncertain malignant potential was made due to histological features, tumor size and subfascial localization., 7B, 7C, 7D, 7E, and 7F). Tumor cells were negative for immunostaining against Desmin, S-100 protein, EMA, HMB45, CD31 and CD34. The diagnosis of glomus tumor of uncertain malignant potential was made due to histological features, tumor size and subfascial localization.']} | Low-Grade Malignancy Glomus Tumor in a Setting of Multiple Glomus Tumors – Case Report | [
"Glomus tumor",
"Multiple localization",
"Low grade malignancy",
"Intramuscular",
"Kidney",
"Cardiac",
"Breast"
] | Open Access Maced J Med Sci | 1575964800 | [{'@Label': 'BACKGROUND', '@NlmCategory': 'BACKGROUND', '#text': 'Glomus tumors are rare neoplasms accounting for less than 2% of all soft tissue tumors but multiple lesions may be seen in up to 10% of the patients. Solitary glomus tumor (GT) most frequently appears as small nodule in specific locations such as subungual region or deep dermis. However, rarely these entities have been observed in extracutaneous locations such as the gastrointestinal, cardiovascular, respiratory tracts, and other visceral organs. A small fraction of the GTs may present as tumors of uncertain malignant potential or as malignant glomus tumors.'}, {'@Label': 'CASE PRESENTATION', '@NlmCategory': 'METHODS', '#text': 'We report a patient with multiple glomus tumors on the time of diagnosis, which was histologically diagnosed as an atypical glomus tumor following resection of a tumor thrombus in the left renal vein, inferior vena cava trombus with intracardial extension, and mitral valve specimen. The intramuscular lesion from the thigh was diagnosed as a glomus tumor of uncertain malignant potential. Further examinations revealed multiple lesions trough her body: kidneys, breast, heart and subcutaneous tissue. The diagnosis of glomus tumor of uncertain malignant potential versus glomus tumor with low malignant potential could be quite challenging, and the clinical course may be as a determining factor for final diagnosis.'}, {'@Label': 'CONCLUSION', '@NlmCategory': 'CONCLUSIONS', '#text': 'To our knowledge, this is the only known case of glomus tumor with multiple organ involvement and aggressive biological behavior at presentation.'}] | [] | other | PMC7061405 | null | 52 | [
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] | Open Access Maced J Med Sci. 2019 Dec 10; 7(23):4082-4088 | NO-CC CODE |
|
Tomografía axial computarizada (TAC) pulmonar de paciente con COVID grave. Destacan los extensos infiltrados bilaterales en vidrio deslustrado con engrosamiento de los septos interlobulillares. | gr2_lrg | 7 | 62f4479fc2969ec53b9636d9ede38d652c1024c70a4540ab76cc10506a8914c7 | gr2_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
677,
579
] | [{'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC9097969/gr2_lrg.jpg', 'caption': 'Tomografía axial computarizada (TAC) pulmonar de paciente con COVID grave. Destacan los extensos infiltrados bilaterales en vidrio deslustrado con engrosamiento de los septos interlobulillares.', 'hash': '62f4479fc2969ec53b9636d9ede38d652c1024c70a4540ab76cc10506a8914c7'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC9097969/gr1_lrg.jpg', 'caption': 'Radiografía de paciente con COVID. Obsérvese los extensos infiltrados intersticiales bilaterales.', 'hash': '69102f8893ead07fdcfda38be82bd810e9cec1e94607c3d36bb20b48f4535876'}] | {'gr1_lrg': ['Las pruebas de imagen radiológicas son muy heterogéneas, desde una radiografía de tórax normal en casos leves a pequeños infiltrados localizados en casos moderados, o los característicos infiltrados intersticiales bilaterales, periféricos y parcheados en casos moderados y graves (<xref rid="gr1_lrg" ref-type="fig">fig. 1</xref>\n). En las imágenes de tomografía computarizada (TC) se suelen observar infiltrados periféricos parcheados en vidrio deslustrado en el parénquima pulmonar (\n). En las imágenes de tomografía computarizada (TC) se suelen observar infiltrados periféricos parcheados en vidrio deslustrado en el parénquima pulmonar (<xref rid="gr2_lrg" ref-type="fig">fig. 2</xref>\n). Los hallazgos analíticos principales son linfopenia, leucocitosis o leucopenia, trombocitosis o trombocitopenia en casos graves, elevación de reactantes de fase aguda (PCR, ferritina, dímero D, LDH), hipoxemia con o sin hipercapnia, alteraciones de las enzimas hepáticas y alteración de la función renal. En casos leves pueden no encontrarse estos hallazgos.\n). Los hallazgos analíticos principales son linfopenia, leucocitosis o leucopenia, trombocitosis o trombocitopenia en casos graves, elevación de reactantes de fase aguda (PCR, ferritina, dímero D, LDH), hipoxemia con o sin hipercapnia, alteraciones de las enzimas hepáticas y alteración de la función renal. En casos leves pueden no encontrarse estos hallazgos.Fig. 1Radiografía de paciente con COVID. Obsérvese los extensos infiltrados intersticiales bilaterales.Fig. 2Tomografía axial computarizada (TAC) pulmonar de paciente con COVID grave. Destacan los extensos infiltrados bilaterales en vidrio deslustrado con engrosamiento de los septos interlobulillares.']} | Neumonía vírica. Neumonía en la COVID-19 | null | Medicine (Madr) | 1652338800 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) provoked a pandemic of acute respiratory disease, namely coronavirus disease 2019 (COVID-19). Currently, effective drugs for this disease are urgently warranted. Anisodamine is a traditional Chinese medicine that is predicted as a potential therapeutic drug for the treatment of COVID-19. Therefore, this study aimed to investigate its antiviral activity and crucial targets in SARS-CoV-2 infection. SARS-CoV-2 and anisodamine were co-cultured in Vero E6 cells, and the antiviral activity of anisodamine was assessed by immunofluorescence assay. The antiviral activity of anisodamine was further measured by pseudovirus entry assay in HEK293/hACE2 cells. Finally, the predictions of crucial targets of anisodamine on SARS-CoV-2 were analyzed by molecular docking studies. We discovered that anisodamine suppressed SARS-CoV-2 infection in Vero E6 cells, and reduced the SARS-CoV-2 pseudovirus entry to HEK293/hACE2 cells. Furthermore, molecular docking studies indicated that anisodamine may target SARS-CoV-2 main protease (M) with the docking score of -6.63 kcal/mol and formed three H-bonds with Gly143, Cys145, and Cys44 amino acid residues at the predicted active site of M. This study suggests that anisodamine is a potent antiviral agent for treating COVID-19. | [
"Antiviral Agents",
"COVID-19",
"Coronavirus 3C Proteases",
"HEK293 Cells",
"Humans",
"Molecular Docking Simulation",
"Peptide Hydrolases",
"Protease Inhibitors",
"SARS-CoV-2",
"Solanaceous Alkaloids",
"Viral Nonstructural Proteins",
"COVID-19 Drug Treatment"
] | other | PMC9097969 | null | 29 | [
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"{'Citation': 'WHO coronavirus (COVID-19) dashboard. https://covid19.who.int/'}",
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"{'Citation': 'Cabanillas B., Novak N. Allergy to COVID-19 vaccines: a current update. Allergol. Int. 2021;70:313–318.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC8062405'}, {'@IdType': 'pubmed', '#text': '33962863'}]}}",
"{'Citation': 'Huang Y., Yang C., Xu X.F., Xu W., Liu S.W. Structural and functional properties of SARS-CoV-2 spike protein: potential antivirus drug development for COVID-19. Acta Pharmacol. Sin. 2020;41:1141–1149.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7396720'}, {'@IdType': 'pubmed', '#text': '32747721'}]}}",
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"{'Citation': 'Macias A.T., Williamson D.S., Allen N., Borgognoni J., Clay A., Daniels Z., et al. Adenosine-derived inhibitors of 78 kDa glucose regulated protein (Grp78) ATPase: insights into isoform selectivity. J.\\xa0Med. Chem. 2011;54:4034–4041.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21526763'}}}",
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"{'Citation': 'Sanders D.A. No false start for novel pseudotyped vectors. Curr. Opin. Biotechnol. 2002;13:437–442.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12459334'}}}",
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] | Medicine (Madr). 2022 May 12; 13(55):3224-3234 | NO-CC CODE |
|
Thorax CT showing bilateral multiple ground glass opacities on 10th day. | gr1_lrg | 7 | 7f6c5ffc28da69a3ffd883f44a0969d0863b477635a72fb7c5c0346dfa4ed11f | gr1_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
750,
501
] | [{'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7446620/gr1_lrg.jpg', 'caption': 'Thorax CT showing bilateral multiple ground glass opacities on 10th day.', 'hash': '7f6c5ffc28da69a3ffd883f44a0969d0863b477635a72fb7c5c0346dfa4ed11f'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7446620/gr2_lrg.jpg', 'caption': 'Thorax CT showing bilateral multiple consolidations on 14th day.', 'hash': '027d9f6843dd5f9fe5f89642c1250e712f2ca5f84bfbc08e409b218abe023eb7'}] | {'gr1_lrg': ['We want to emphasize the role of plasmapheresis by a critically ill Covid-19 patient whose clinical status worsen despite antiviral and tocilizumab treatments and who was successfully managed via performing plasmapheresis. A 65\u2009year old female patient complaining of cough, myalgia and fatigue was admitted to our clinic who had a history of contact with a confirmed Covid-19 case. She had 3 comorbities: asthma, hypertension and type 2 Diabetes Mellitus. Her SARS-CoV-2 PCR test resulted negative, but her chest computed thomography(CT) revealed two small ground glass opacities in both lungs, which indicated COVID-19 pneumonia. According to our national Covid-19 treatment guidelines provided by the Ministry of Health, she was given hydroxychloroquine, azitromycine and oseltamivir. During hospital follow up, her maximum body temperature was 37.8\u2009°C; all other vital signs were normal. Laboratory findings are summarized in Table 1\n. She completed the treatment schedule and was discharged from hospital after 5 days. On 10th day of the symptom onset she was readmitted to hospital with fever, cough, sputum and shortness of breath. Her fever was 38.5\u2009°C, hearth rate was 118beats/min, respiratory rate was 26/min, blood pressure was 156/84\u2009mmHg and oxygen saturation was 88 % at room air with intermittent prone positioning. Her thorax CT revealed bilateral multiple ground glass infiltrations (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>\n). Favipravir, enoxaparine prophylaxis, ceftriaxone and oxygen supplementation of 3\u2009L/min were initiated. Laboratory tests showed elevated inflammation indicating cytokine storm with C-reactive protein 70\u2009mg/L(reference 0−5) and IL-6 45.4\u2009pg/mL(reference <7). Tocilizumab(8\u2009mg/kg total dose) and prednisolone(1\u2009mg/kg for five days) were also initiated. On the 14th day, patient complained of ongoing fever, dyspnea, haemoptyzis and became tachypneic(30 breaths/min), the oxygen need increased to 8\u2009L/min to maintain oxygen saturation above 90 %. The patient was transferred to the intensive care unit (ICU). The D-dimer level increased to 1238\u2009ng/mL. Chest CT-angiography showed that ground glass opacites were enlarged and turned to consolidation areas without thromboembolism (\n). Favipravir, enoxaparine prophylaxis, ceftriaxone and oxygen supplementation of 3\u2009L/min were initiated. Laboratory tests showed elevated inflammation indicating cytokine storm with C-reactive protein 70\u2009mg/L(reference 0−5) and IL-6 45.4\u2009pg/mL(reference <7). Tocilizumab(8\u2009mg/kg total dose) and prednisolone(1\u2009mg/kg for five days) were also initiated. On the 14th day, patient complained of ongoing fever, dyspnea, haemoptyzis and became tachypneic(30 breaths/min), the oxygen need increased to 8\u2009L/min to maintain oxygen saturation above 90 %. The patient was transferred to the intensive care unit (ICU). The D-dimer level increased to 1238\u2009ng/mL. Chest CT-angiography showed that ground glass opacites were enlarged and turned to consolidation areas without thromboembolism (<xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>\n). Plasmapheresis was performed to control excessive inflammation by using 10 units of fresh frozen plasma. The plasmapheresis process was conducted with a Fresenius Medical Care device of Multifiltrate model with 7ML62939 serial number. The set used was Multifiltrate-Kit 16 MPS P2dry. On the following days tachypnea and fever were dissolved gradually. Significant improvement in the general health status of the patient was observed and transferred to standard care ward. Favipravir and prednisolone were terminated at 5th day, ceftriaxone was given for 10 days. Oxygen supplementation was decreased gradually and stopped. She was discharged from the hospital 24 days after first admission.\n). Plasmapheresis was performed to control excessive inflammation by using 10 units of fresh frozen plasma. The plasmapheresis process was conducted with a Fresenius Medical Care device of Multifiltrate model with 7ML62939 serial number. The set used was Multifiltrate-Kit 16 MPS P2dry. On the following days tachypnea and fever were dissolved gradually. Significant improvement in the general health status of the patient was observed and transferred to standard care ward. Favipravir and prednisolone were terminated at 5th day, ceftriaxone was given for 10 days. Oxygen supplementation was decreased gradually and stopped. She was discharged from the hospital 24 days after first admission.Table 1Changes in laboratory parameters according to days after admission.Table 1Lab parameters (reference values)Day1Day 10Day 14Day 24Day 38WBC (X1000)/uL88103920280065405950Lymphocyte (X1000)/uL2300166043027702200CRP (0−5)mg/L9.5708.70.20.3Procalcitonin (0−0.5) ng/mL0.20.10.10.10.1LDH (125−220) U/L154272453208170D-dimer (0−300)ng/mL3383181218498193Ferritin (4.6−204)ng/mL211661063713ALT (0−55) U/L2133613619AST (5−34) U/L1332561912Fig. 1Thorax CT showing bilateral multiple ground glass opacities on 10th day.Fig. 1Fig. 2Thorax CT showing bilateral multiple consolidations on 14th day.Fig. 2']} | The successful management of an elderly Covid-19 infected patient by plasmapheresis | null | Transfus Apher Sci | 1608883200 | [
"COVID-19",
"Family Characteristics",
"Humans",
"SARS-CoV-2"
] | other | PMC7446620 | null | 10 | [
"{'Citation': 'Wang Z., Ma W., Zheng X., Wu G., Zhang R. Household transmission of SARS-CoV-2. J Infect. 2020;81(1):179–182.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7151261'}, {'@IdType': 'pubmed', '#text': '32283139'}]}}",
"{'Citation': 'Chen S., Zhang Z., Yang J., et al. Fangcang shelter hospitals: a novel concept for responding to public health emergencies. Lancet. 2020;395:1305–1314.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7270591'}, {'@IdType': 'pubmed', '#text': '32247320'}]}}",
"{'Citation': 'Lau L.L.H., Nishiura H., Kelly H., et al. Household transmission of 2009 pandemic influenza A(H1N1): a systematic review and meta-analysis. Epidemiol. 2012;23(4):531–542.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3367058'}, {'@IdType': 'pubmed', '#text': '22561117'}]}}",
"{'Citation': 'Zhang J., Litvinova M., Liang Y., et al. Changes in contact patterns shape the dynamics of the COVID-19 outbreak in China. Science. 2020 DOI: 11.1126/science.abb8001.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7199529'}, {'@IdType': 'pubmed', '#text': '32350060'}]}}",
"{'Citation': 'Li J., Gong X., Wang Z., et al. Clinical features of familial clustering in patients infected with 2019 novel coronavirus in Wuhan, China. Virus Res. 2020;286', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7265838'}, {'@IdType': 'pubmed', '#text': '32502551'}]}}",
"{'Citation': 'China C.D.C. Efficiency of quarantine during an epidemic of severe acute respiratory syndrome—Beijing, China, 2003. MMWR Morb Mortal Wkly Rep. 2003;52:1037.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14586295'}}}",
"{'Citation': 'Wilson-Clark S.D., Deeks S.L., Gournis E., et al. Household transmission of SARS, 2003. CMAJ. 2006;175(10):1219–1223.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC1626520'}, {'@IdType': 'pubmed', '#text': '17098951'}]}}",
"{'Citation': 'Goh D.L.M., Lee B.W., Chia K.S., et al. Secondary Household transmission of SARS, Singapore. Emerg Infect Dis. 2004;10(2):232–234.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3322927'}, {'@IdType': 'pubmed', '#text': '15030688'}]}}",
"{'Citation': 'Drosten C., Meyer B., Müller M.A., et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828–835.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '25162889'}}}",
"{'Citation': 'Ferretti L., Wymant C., Kendall M., et al. Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing. Science. 2020;368(619):eabb6936.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7164555'}, {'@IdType': 'pubmed', '#text': '32234805'}]}}"
] | Transfus Apher Sci. 2020 Dec 25; 59(6):102924 | NO-CC CODE |
||
Continued degeneration of the involved L4-L5 disc before treatment. | ebsj02025-3a | 7 | 468828abbbb1c6e2ffda09cd0d3ac9ac98409fcca7390f1bbaa41ac028d11120 | ebsj02025-3a.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
781,
537
] | [{'image_id': 'ebsj02025-2', 'image_file_name': 'ebsj02025-2.jpg', 'image_path': '../data/media_files/PMC3604749/ebsj02025-2.jpg', 'caption': 'SF-36 parameters at follow-up.', 'hash': '13b7b85c50c22e7a8521c625b083efcd4be66ed38659d997bb44148b1a05b18c'}, {'image_id': 'ebsj02025-3b', 'image_file_name': 'ebsj02025-3b.jpg', 'image_path': '../data/media_files/PMC3604749/ebsj02025-3b.jpg', 'caption': 'Continued degeneration of the involved L4-L5 disc 3 years after discectomy and dynamic stabilization.', 'hash': 'c2c3d85ab1803413c44b79fee3208a104ac7efd7fcb3295483560ce5e2b10d2e'}, {'image_id': 'ebsj02025-3a', 'image_file_name': 'ebsj02025-3a.jpg', 'image_path': '../data/media_files/PMC3604749/ebsj02025-3a.jpg', 'caption': 'Continued degeneration of the involved L4-L5 disc before treatment.', 'hash': '468828abbbb1c6e2ffda09cd0d3ac9ac98409fcca7390f1bbaa41ac028d11120'}, {'image_id': 'ebsj02025-1', 'image_file_name': 'ebsj02025-1.jpg', 'image_path': '../data/media_files/PMC3604749/ebsj02025-1.jpg', 'caption': 'Patient sampling and selection.', 'hash': 'f8415caaa3af8f4e26dd92dfab767e429bf8566ab6604ec37b961cde5f153ce0'}] | {'ebsj02025-1': ['Exclusion criteria (<xref rid="ebsj02025-1" ref-type="fig">Fig. 1</xref>): Patients with deformities, eg, spondylolisthesis or scoliosis, and without preoperative documentation available at the final follow-up.', 'Patient population and intervention compared (<xref rid="ebsj02025-1" ref-type="fig">Fig. 1</xref>)'], 'ebsj02025-2': ['Health-related quality of life: No significant differences were seen in any of the SF-36 parameters (Table 4) (<xref rid="ebsj02025-2" ref-type="fig">Fig. 2</xref>).).'], 'ebsj02025-3a': ['Radiological outcomes: The involved discs in the dynamic group continued to degenerate (Table 3) (<xref rid="ebsj02025-3a" ref-type="fig">Fig. 3a</xref>, , <xref rid="ebsj02025-3b" ref-type="fig">Fig. 3b</xref>). Adjacent segments showed loss of disc height in both groups but only loss of upper adjacent discs in the rigid group was statistically significant (). Adjacent segments showed loss of disc height in both groups but only loss of upper adjacent discs in the rigid group was statistically significant (Table 3). Solid fusion was undoubtedly determined in seven patients (58%) from the rigid group. No obvious signs of non-fusion, eg, screw breakage or loosening, were noted on x-rays.']} | Dynamic versus rigid stabilization for the treatment of disc degeneration in the lumbar spine | null | Evid Based Spine Care J | 1312182000 | [{'@Label': 'STUDY DESIGN', '@NlmCategory': 'METHODS', '#text': 'Comparative effectiveness review.'}, {'@Label': 'STUDY RATIONALE', '@NlmCategory': 'OBJECTIVE', '#text': 'Spinal fusion is believed to accelerate the degeneration of the vertebral segment above or below the fusion site, a condition called adjacent segment disease (ASD). The premise of dynamic stabilization is that motion preservation allows for less loading on the discs and facet joints at the adjacent, non-fused segments. In theory, this should decrease the rate of ASD. However, clinical evidence of this theoretical decrease in ASD is still lacking. We performed a systematic review to evaluate the evidence in the literature comparing dynamic stabilization with fusion.'}, {'@Label': 'CLINICAL QUESTION', '@NlmCategory': 'OBJECTIVE', '#text': 'In patients 18 years or older with degenerative disease of the cervical or lumbar spine, does dynamic stabilization lead to better outcomes and fewer complications, including ASD, than fusion in the short-term and the long-term?'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'A systematic search and review of the literature was undertaken to identify studies published through March 7, 2011. PubMed, Cochrane, and National Guideline Clearinghouse Databases as well as bibliographies of key articles were searched. Two individuals independently reviewed articles based on inclusion and exclusion criteria which were set a priori. Each article was evaluated using a predefined quality-rating scheme.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'No significant differences were identified between fusion and dynamic stabilization with regard to VAS, ODI, complications, and reoperations. There are no long-term data available to show whether dynamic stabilization decreases the rate of ASD.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'There are no clinical data from comparative studies supporting the use of dynamic stabilization devices over standard fusion techniques.'}] | [] | other | PMC3604749 | null | 8 | [
"{'Citation': 'Hilibrand A S, Carlson G D, Palumbo M A. et al.Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am. 1999;81(4):519–528.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10225797'}}}",
"{'Citation': 'Korovessis P, Papazisis Z, Koureas G. et al.Rigid, semirigid versus dynamic instrumentation for degenerative lumbar spinal stenosis: a correlative radiological and clinical analysis of short-term results. Spine. 2004;29(7):735–742.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15087795'}}}",
"{'Citation': 'Korovessis P, Papazisis Z, Lambiris E. The role of rigid vs. dynamic instrumentation for stabilization of the degenerative lumbosacral spine. Stud Health Technol Inform. 2002;91:457–461.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15457776'}}}",
"{'Citation': 'Kaner T, Dalbayrak S, Oktenoglu T. et al.Comparison of posterior dynamic and posterior rigid transpedicular stabilization with fusion to treat degenerative spondylolisthesis. Orthopedics. 2010;33(5):309.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '20506953'}}}",
"{'Citation': 'Ozer A F, Crawford N R, Sasani M. et al.Dynamic lumbar pedicle screw-rod stabilization: two-year follow-up and comparison with fusion. Open Orthop J. 2010;4:137–141.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2864427'}, {'@IdType': 'pubmed', '#text': '20448815'}]}}",
"{'Citation': 'Lee S H, Lee J H, Hong S W. et al.Spinopelvic alignment after interspinous soft stabilization with a tension band system in grade 1 degenerative lumbar spondylolisthesis. Spine. 2010;35(15):E691–701.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '20535045'}}}",
"{'Citation': \"FDA Orthopedic and Rehabilitation Devices Panel FDA Executive Summary for Zimmer Spine's Dynesys Spinal SystemAvailable atwww.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/medicaldevices/medicaldevicesadvisorycommittee/orthopaedicandrehabilitationdevicespanel/ucm188734.pdfAccessed 2009\"}",
"{'Citation': 'FDA News Release. FDA Orders Postmarket Surveillance Studies on Certain Spinal Systems - FDA to request premarket clinical data for new versions of these devicesAvailable atwww.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm185312.htmAccessed October 5, 2009'}"
] | Evid Based Spine Care J. 2011 Aug; 2(3):25-31 | NO-CC CODE |
|
A 41-year old male with history of travel to Wuhan, presenting with fever. (a) The fine reticular pattern (white arrow heads) was seen in the axial CT image. The center artery of lobular (black arrow heads) was seen in it. (b) The enlarged blood vessel (black arrow head) and bronchograms (white arrow heads) were seen in the CT image. | gr2_lrg | 7 | 3e405b8a1fb76ce7a9817ce00f58f35cdaf97bb058bdbb3f94104f40e4cc1fa9 | gr2_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
790,
383
] | [{'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7229931/gr2_lrg.jpg', 'caption': 'A 41-year old male with history of travel to Wuhan, presenting with fever. (a) The fine reticular pattern (white arrow heads) was seen in the axial CT image. The center artery of lobular (black arrow heads) was seen in it. (b) The enlarged blood vessel (black arrow head) and bronchograms (white arrow heads) were seen in the CT image.', 'hash': '3e405b8a1fb76ce7a9817ce00f58f35cdaf97bb058bdbb3f94104f40e4cc1fa9'}, {'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC7229931/gr3_lrg.jpg', 'caption': 'An 88-year-old female presenting with fever and cough. (a) Ground-glass and consolidative opacities are seen in the bilateral lungs. (b) The lesion was enlarged and increased, and presented as “Crazy-paving” pattern after 3\xa0days follow up.', 'hash': 'd24e27d846978416db67689da77a8a7d7fa5e92401a6e9baf9dcd4988bdd3f4c'}, {'image_id': 'gr5_lrg', 'image_file_name': 'gr5_lrg.jpg', 'image_path': '../data/media_files/PMC7229931/gr5_lrg.jpg', 'caption': 'The lesions are distributed in the lung periphery. (a) At the right lower lung in a 44\xa0years old male, (b) at the left lower lung in a 49\xa0years old female.', 'hash': '2f889bc1c6f3e95c514f5ae2c0ece5b566846ada51795c312ed988255f6804af'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7229931/gr1_lrg.jpg', 'caption': 'A 35-year-old man infected with COVID-19. (a) CT shows a ground-glass opacity lesion with one tiny solid nodule inside it in the left lower lung lobe. (b) The lesion was increased after 5\xa0days, and the enlarged blood vessel sign and bronchogram sign were seen in it (black arrow).', 'hash': '13a8ecc084733d8dd11b814d8cb3006c05dcb1e4938a06515b913f5a18a12ad4'}, {'image_id': 'gr4_lrg', 'image_file_name': 'gr4_lrg.jpg', 'image_path': '../data/media_files/PMC7229931/gr4_lrg.jpg', 'caption': 'CT images in a 20-year-old man with a travel history to Wuhan, China. (a) A ground-glass opacity (GGO, white arrows) is shown in right lower lung and the bronchogram (black arrow) and interlobular septal thickening (black arrow head) are seen. (b) The GGO is increased after four days follow up. The “Crazy-paving” pattern (white arrows), enlarged blood vessel (black arrow) and intralesional vacuole sign (black arrow heads) are seen. (c) The intralesional vacuole sign (black arrow heads) and enlarged alveolar ducts (black arrow) are seen in the sagittal CT image.', 'hash': 'a8e2e408d88abe6f2587e8f708db085eb166ae773a4138f32801afcb286f7da1'}] | {'gr1_lrg': ['All but one of the 34 patients presented as GGO and consolidation, or both in the first CT scanning (Table 2\n). There were pure GGO in 18/34 (52.94%) patients, GGO with consolidation in 12/34 (35.29%) patients (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>\n), full consolidation in 3/34 (8.82%) patients. The lesions with fine reticular pattern were found in 4/34 (11.77%) patients (\n), full consolidation in 3/34 (8.82%) patients. The lesions with fine reticular pattern were found in 4/34 (11.77%) patients (<xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>\n), air bronchogram in 14/34 (41.18%) patients (\n), air bronchogram in 14/34 (41.18%) patients (<xref rid="gr1_lrg" ref-type="fig">Figs. 1</xref>a and a and <xref rid="gr2_lrg" ref-type="fig">2</xref>), 17/34 (50.00%) with enlarged blood vessel (), 17/34 (50.00%) with enlarged blood vessel (<xref rid="gr1_lrg" ref-type="fig">Figs. 1</xref>b and b and <xref rid="gr2_lrg" ref-type="fig">2</xref>), 8/34 (23.53%) with crazy-paving pattern (), 8/34 (23.53%) with crazy-paving pattern (<xref rid="gr3_lrg" ref-type="fig">Fig. 3</xref>, , <xref rid="gr4_lrg" ref-type="fig">Fig. 4</xref>\n), and 6/34 (17.65%) with intralesional vacuole sign (\n), and 6/34 (17.65%) with intralesional vacuole sign (<xref rid="gr4_lrg" ref-type="fig">Fig. 4</xref>). The pleural effusions were seen in one patient. Lung cavitation was absent. One CT scan was normal.). The pleural effusions were seen in one patient. Lung cavitation was absent. One CT scan was normal.Table 2CT features in 34 patients infected with COVID-19.Table 2Main CT findingsNo. of patients (%)GGO30/34 (88.24%)\xa0Pure GGO18/34 (52.94%)\xa0GGO with consolidation12/34 (35.29%)Full consolidation3/34 (8.82%)Air bronchogram14/34 (41.18%)Enlarged blood vessel17/34 (50.00%)Fine reticular pattern4/34 (11.77%)Crazy-paving pattern8/34 (23.53%)Intralesional vacuole sign6/34 (17.65%)Pleural effusion1/34 (2.94%)Lung Cavitation(–)Fig. 1A 35-year-old man infected with COVID-19. (a) CT shows a ground-glass opacity lesion with one tiny solid nodule inside it in the left lower lung lobe. (b) The lesion was increased after 5\xa0days, and the enlarged blood vessel sign and bronchogram sign were seen in it (black arrow).Fig. 1Fig. 2A 41-year old male with history of travel to Wuhan, presenting with fever. (a) The fine reticular pattern (white arrow heads) was seen in the axial CT image. The center artery of lobular (black arrow heads) was seen in it. (b) The enlarged blood vessel (black arrow head) and bronchograms (white arrow heads) were seen in the CT image.Fig. 2Fig. 3An 88-year-old female presenting with fever and cough. (a) Ground-glass and consolidative opacities are seen in the bilateral lungs. (b) The lesion was enlarged and increased, and presented as “Crazy-paving” pattern after 3\xa0days follow up.Fig. 3Fig. 4CT images in a 20-year-old man with a travel history to Wuhan, China. (a) A ground-glass opacity (GGO, white arrows) is shown in right lower lung and the bronchogram (black arrow) and interlobular septal thickening (black arrow head) are seen. (b) The GGO is increased after four days follow up. The “Crazy-paving” pattern (white arrows), enlarged blood vessel (black arrow) and intralesional vacuole sign (black arrow heads) are seen. (c) The intralesional vacuole sign (black arrow heads) and enlarged alveolar ducts (black arrow) are seen in the sagittal CT image.Fig. 4', 'The 33 cases were cured except one death. All cured patients were performed with CT scanning to confirm that the inflammation had disappeared or significantly decreased when they were cured and allowed to discharge. Nineteen patients underwent a second CT examination within 3 to 5\xa0days as their symptoms worsened. One of the nineteen patients (13%) had normal initial and follow-up chest CT examinations, with no interval change. Five of the 19 patients demonstrated mild progression (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>, , <xref rid="gr3_lrg" ref-type="fig">Fig. 3</xref>), and 8 patients demonstrated moderate progression and advanced from pure GGO to crazy-paving pattern (), and 8 patients demonstrated moderate progression and advanced from pure GGO to crazy-paving pattern (<xref rid="gr3_lrg" ref-type="fig">Fig. 3</xref>) and appeared intralesional vacuole sign () and appeared intralesional vacuole sign (<xref rid="gr4_lrg" ref-type="fig">Fig. 4</xref>). An 88-year-old woman demonstrated severe progression and was died of respiratory failure 14\xa0days later after being found going worse (). An 88-year-old woman demonstrated severe progression and was died of respiratory failure 14\xa0days later after being found going worse (<xref rid="gr3_lrg" ref-type="fig">Fig. 3</xref>). The CT manifestations of 4 asymptomatic patients became worse after one week, but they were also asymptomatic until they were cured. The qualitative changes at follow-up CT examination in 19 patients were seen in ). The CT manifestations of 4 asymptomatic patients became worse after one week, but they were also asymptomatic until they were cured. The qualitative changes at follow-up CT examination in 19 patients were seen in Table 4\n.Table 4Qualitative change at follow-up CT examination in 19 patients.Table 4FindingNo. of patients (n\xa0=\xa019)No change1 (5.26%)Disease improvement0 (0)Disease progressionMild5 (26.32%)Moderate8 (42.11%)Severe5 (26.32%)'], 'gr5_lrg': ['Data of initial chest thin-section CT imaging findings in 34 patients with COVID-19 pneumonia are presented in Tables 3\n. There were 24/34 (70.59%) patients with a total of 127/166 (76.51%) lesions involving both lungs, and 17/34 (50.00%) patients with 105/166 (63.25%) lesions involving 4 to 5 lobes. 29/34 (85.29%) patients with 149/166 (89.76%) lesions distributed in the lung periphery (<xref rid="gr5_lrg" ref-type="fig">Fig. 5</xref>\n).\n).Table 3Distribution of the lobes and lesions affected with COVID-19 (n\xa0=\xa034).Table 3Main CT findingsNo. of patients (%)No. of lesions (%)Bilateral24 (70.59%)127 (76.51%)Unilateral10 (29.41%)39 (23.49%)Frequency of lobes involved\xa01 lobe3 (8.82%)8 (4.82%)\xa02 lobes4 (11.76%)22(13.25%)\xa03 lobes7 (20.59%)31 (18.67%)\xa04 lobes14 (41.18%)76 (45.78)\xa05 lobes3 (8.82%)29 (17.47%)There are 166 lesions in 34 patients of COVID-19.Fig. 5The lesions are distributed in the lung periphery. (a) At the right lower lung in a 44\xa0years old male, (b) at the left lower lung in a 49\xa0years old female.Fig. 5']} | CT imaging features of 34 patients infected with COVID-19 | [
"COVID-19",
"Ground glass opacity",
"Consolidation",
"Crazy-paving pattern",
"CT"
] | Clin Imaging | 1608105600 | [
"Anesthetics",
"Betacoronavirus",
"COVID-19",
"Coronavirus Infections",
"Humans",
"Operating Rooms",
"Pandemics",
"Pneumonia, Viral",
"SARS-CoV-2"
] | other | PMC7229931 | null | 9 | [
"{'Citation': 'Wong W.-Y., Kong Y.-C., See J.-J. Anaesthetic management of patients with COVID-19: infection prevention and control measures in the operating theatre. Br J Anaesth. 2020;125:e239–e241.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7174186'}, {'@IdType': 'pubmed', '#text': '32362338'}]}}",
"{'Citation': 'Zhou F., Yu T., Du R. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–1062.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7270627'}, {'@IdType': 'pubmed', '#text': '32171076'}]}}",
"{'Citation': 'COVID-19 tracheostomy guidelines. British Laryngological Association; April 2020. https://www.britishlaryngological.org/sites/default/files/BLA%20Tracheostomy%20guideline%20-BLA%20April%202020%20FINAL.pdf Available from: Web April 30, 2020.'}",
"{'Citation': 'Sommer D.D., Engels P.T., Usaf C.E.K.W. Recommendations from the CSO–HNS Taskforce on performance of tracheotomy during the COVID-19 pandemic. J\\xa0Otolaryngol Head Neck Surg. 2020;49:23.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7184547'}, {'@IdType': 'pubmed', '#text': '32340627'}]}}",
"{'Citation': 'Yang X., Yu Y., Xu J. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475–481.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7102538'}, {'@IdType': 'pubmed', '#text': '32105632'}]}}",
"{'Citation': 'Adly A., Youssef T.A., El-Begermy M.M. Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. Eur Arch Otorhinolaryngol. 2018;275:679–690.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '29255970'}}}",
"{'Citation': 'Chao T.N., Braslow B.M., Martin N.D. Tracheotomy in ventilated patients with COVID-19: guidelines from the COVID-19 tracheotomy task force, a working group of the airway safety committee of the university of Pennsylvania health system. Ann Surg. May 5, 2020 doi: 10.1097/SLA.0000000000003956. Advance Access published on.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/SLA.0000000000003956'}, {'@IdType': 'pubmed', '#text': '0'}]}}",
"{'Citation': 'Checketts M.R., Alladi R., Ferguson K. Recommendations for standards of monitoring during anaesthesia and recovery 2015: association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2016;71:85–93.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC5063182'}, {'@IdType': 'pubmed', '#text': '26582586'}]}}",
"{'Citation': 'Guidance for industry and Food and Drug administration staff. 2020. https://www.fda.gov/media/136533/download Available from: Web April 30, 2020.'}"
] | Clin Imaging. 2020 Dec 16; 68:226-231 | NO-CC CODE |
||
MRI 1 year later: normal MRI | 586_2005_23_Fig4_HTML | 7 | 46921320116ccd6893d6f370fbff54a83fc22c78460ad71e8ca1bb68058c488b | 586_2005_23_Fig4_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
706,
424
] | [{'image_id': '586_2005_23_Fig1_HTML', 'image_file_name': '586_2005_23_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC1602183/586_2005_23_Fig1_HTML.jpg', 'caption': 'MRI 2\xa0days after the onset of symptoms. Posterolateral placement of the haematoma at C4–C5 level. a, c Isointense appearance of the haematoma on the MRI T1-weighted sagittal and axial images. b, d Hyperintense appearance of the haematoma on the MRI T2-weighted sagittal and axial images', 'hash': 'e1e7d15c87f25a56d1b1527e1150e49991352fc81619994a95b672d560c88ca8'}, {'image_id': '586_2005_23_Fig2_HTML', 'image_file_name': '586_2005_23_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC1602183/586_2005_23_Fig2_HTML.jpg', 'caption': 'MRI performed 7\xa0days later. The haematoma is smaller nevertheless it is located at the same C4–C5 level', 'hash': 'e424fea582209728435dcd76d843132c57d723d2aa3911c6497190fefbe9032b'}, {'image_id': '586_2005_23_Fig4_HTML', 'image_file_name': '586_2005_23_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC1602183/586_2005_23_Fig4_HTML.jpg', 'caption': 'MRI 1\xa0year later: normal MRI', 'hash': '46921320116ccd6893d6f370fbff54a83fc22c78460ad71e8ca1bb68058c488b'}, {'image_id': '586_2005_23_Fig3_HTML', 'image_file_name': '586_2005_23_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC1602183/586_2005_23_Fig3_HTML.jpg', 'caption': 'MRI 1\xa0month later: disappearance of the haematoma', 'hash': '8bf8b14d6d4a5582f692d64d1de4a44a469535579205be4f494a0fa51929865d'}] | {'586_2005_23_Fig1_HTML': ['Based on the suspicion that it was a case of disc herniation with left C5 root involvement, symptomatic treatment by means of non-steroid anti-inflammatory drugs and painkillers was indicated. A cervical MRI was scheduled and the patient was invited to undergo further examination at the Spinal Surgery Unit. Owing to the fact that the first physician was not a spinal surgeon and therefore not aware of the relationship between anticoagulation and SSEH, discontinuation of anticoagulant therapy was not indicated. Two days later, when the patient was examined by the Spinal Surgery Unit, the pain had been completely relieved and the weakness had also decreased. The MRI revealed a left posterolateral ovoid mass compatible with a haematoma extending from C4 to C5 (Fig.\xa0<xref rid="586_2005_23_Fig1_HTML" ref-type="fig">1</xref>). Symptomatic medical treatment was interrupted. Once the specialist knew the real cause of the radicular syndrome, the haematologist was consulted and they preferred not to suspend the anticoagulant therapy (despite an adequate level of anticoagulation, INR 2,7) in order to prevent thromboembolism.\n). Symptomatic medical treatment was interrupted. Once the specialist knew the real cause of the radicular syndrome, the haematologist was consulted and they preferred not to suspend the anticoagulant therapy (despite an adequate level of anticoagulation, INR 2,7) in order to prevent thromboembolism.\nFig.\xa01MRI 2\xa0days after the onset of symptoms. Posterolateral placement of the haematoma at C4–C5 level. a, c Isointense appearance of the haematoma on the MRI T1-weighted sagittal and axial images. b, d Hyperintense appearance of the haematoma on the MRI T2-weighted sagittal and axial images', 'Although the spreading of the haematoma throughout the epidural space is the most likely hypothesis proposed for spontaneous recovery in case of neurological impairment [7, 14], our case does not support that theory because the haematoma did not spread throughout the epidural space. (Figs.\xa0<xref rid="586_2005_23_Fig1_HTML" ref-type="fig">1</xref>, , <xref rid="586_2005_23_Fig2_HTML" ref-type="fig">2</xref>))'], '586_2005_23_Fig2_HTML': ['Seven days later, the patient was free of weakness and the MRI showed a decrease in the haematoma size (Fig.\xa0<xref rid="586_2005_23_Fig2_HTML" ref-type="fig">2</xref>). Successive MRI results were obtained 1\xa0month (Fig.\xa0). Successive MRI results were obtained 1\xa0month (Fig.\xa0<xref rid="586_2005_23_Fig3_HTML" ref-type="fig">3</xref>) and 1\xa0year later on (Fig.\xa0) and 1\xa0year later on (Fig.\xa0<xref rid="586_2005_23_Fig4_HTML" ref-type="fig">4</xref>) to document the resolution of the haematoma. One year on, the patient remains asymptomatic.) to document the resolution of the haematoma. One year on, the patient remains asymptomatic.Fig.\xa02MRI performed 7\xa0days later. The haematoma is smaller nevertheless it is located at the same C4–C5 levelFig.\xa03MRI 1\xa0month later: disappearance of the haematomaFig.\xa04MRI 1\xa0year later: normal MRI']} | Pure cervical radiculopathy due to spontaneous spinal epidural haematoma (SSEH): report of a case solved conservatively | [
"Spontaneous spinal epidural hematoma",
"Cervicobrachialgia",
"Anticoagulant therapy",
"Conservative treatment"
] | Eur Spine J | 1160204400 | This report describes a case of spondylodiscitis occurring adjacent to levels at which anterior cervical discectomy and fusion was performed. The objective is to describe a rare cause of spondylodiscitis and discuss its successful management. Post-operative discitis involving the same level is a known occurrence. We report an interesting case of spondylodiscitis occurring at the adjacent level of fusion, and to our knowledge this is the first such case reported in literature. A two-level decompression and fusion was performed at C5-6 and C6-7 levels with PEEK cages and anterior cervical plating in a middle-aged gentleman for persistent axial neck pain and left-sided radiculopathy involving C6 and C7 distribution. After 6 weeks, the patient presented to us with complaints of mild paresthesia in the abdomen and extremities. Radiological investigations including plain radiographs and MRI revealed a surprising finding of discitis at C4-5 level with an associated epidural abscess. In view of the patient's myelopathic symptoms, surgical debridement and decompression of the spinal cord was performed. The plate and screws were removed, the cages were left intact, and the C4-5 disc level was reconstructed with tricortical iliac crest autograft. No further instrumentation was performed. The biopsy specimen from the disc at C4-5 level grew Serratia marcescens. It was contemplated that C4-5 discitis was initiated by inoculation of bacteria at the superior endplate of C5 by contaminated vertebral pins/drill-bit or screws. Adjacent level discitis is a rare but potentially serious complication of anterior cervical fusion. A high index of suspicion of infection is necessary if the patient complains of new symptoms after anterior cervical fusion. Thorough assessment and aggressive treatment is necessary for successful management. | [
"Bone Plates",
"Bone Screws",
"Cervical Vertebrae",
"Debridement",
"Decompression, Surgical",
"Device Removal",
"Discitis",
"Diskectomy",
"Epidural Abscess",
"Humans",
"Ilium",
"Intervertebral Disc",
"Magnetic Resonance Imaging",
"Male",
"Middle Aged",
"Neck Pain",
"Radiculopathy",
"Radiography",
"Serratia Infections",
"Serratia marcescens",
"Spinal Fusion",
"Transplantation, Autologous"
] | other | PMC1602183 | null | 11 | [
"{'Citation': 'Barker FG., II Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Neurosurgery. 2002;51:391–400. doi: 10.1097/00006123-200208000-00017.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00006123-200208000-00017'}, {'@IdType': 'pubmed', '#text': '12182777'}]}}",
"{'Citation': 'Connor PM, Darden BV. Cervical discography complications and clinical efficacy. Spine. 1993;18:2035–2038. doi: 10.1097/00007632-199310001-00018.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00007632-199310001-00018'}, {'@IdType': 'pubmed', '#text': '8272955'}]}}",
"{'Citation': 'Hadjipavlou AG, Gaitanis IN, Papadopoulos CA, et al. Serratia spondylodiscitis after elective lumbar spine surgery: a report of two cases. Spine. 2002;27:E507–E512. doi: 10.1097/00007632-200212010-00018.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00007632-200212010-00018'}, {'@IdType': 'pubmed', '#text': '12461408'}]}}",
"{'Citation': 'Hagadorn B, Smith HW, Rosnagle RS. Cervical spine osteomyelitis. Secondary to a foreign body in the hypopharynx. Arch Otolaryngol. 1972;95:578–580.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '4666429'}}}",
"{'Citation': 'Keiper G, Stambough JL (1998) Complications of cervical spine surgery, 3rd edn. In: The cervical spine. The Cervical Spine Research Society Editorial Committee: Lippincott-Raven Publishers, Philadelphia, pp 891–897'}",
"{'Citation': 'Russo TA (2005) Diseases caused by gram-negative enteric bacilli, 16th edn. In: Harrison’s principles of internal medicine, vol I. McGraw-Hill, pp 884'}",
"{'Citation': 'Ooij A, Manni JJ, Beuls EA, et al. Cervical spondylodiscitis after removal of a fishbone. A case report. Spine. 1999;24:574–577. doi: 10.1097/00007632-199903150-00015.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00007632-199903150-00015'}, {'@IdType': 'pubmed', '#text': '10101822'}]}}",
"{'Citation': 'Weinstein MA, McCabe JP, Cammisa FP. Postoperative spinal wound infection: A review of 2,391 consecutive index procedures. J Spinal Disord. 2000;13:422–426. doi: 10.1097/00002517-200010000-00009.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00002517-200010000-00009'}, {'@IdType': 'pubmed', '#text': '11052352'}]}}",
"{'Citation': 'Wimmer C, Gluch H, Franzreb M, Ogon M. Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord. 1998;11:124–128.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9588468'}}}",
"{'Citation': 'Wimmer C, Nogler M, Frischhut B. Influence of antibiotics on infection in spinal surgery: a prospective study of 110 patients. J Spinal Disord. 1998;11:498–500.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9884294'}}}",
"{'Citation': 'Zeidman SM, Thompson K, Ducker TB. Complications of cervical discography: analysis of 4400 diagnostic disc injections. Neurosurgery. 1995;37:414–417. doi: 10.1097/00006123-199509000-00007.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00006123-199509000-00007'}, {'@IdType': 'pubmed', '#text': '7501104'}]}}"
] | Eur Spine J. 2006 Oct 7; 15(Suppl 5):569-573 | NO-CC CODE |
|
a, b Magnetic resonance imaging scan revealed thoracic disc herniation with spinal cord compression at T8–T9 level (apex of the kyphosis) | 586_2005_53_Fig2_HTML | 7 | 98f445c86e30a5d85464efbe6cfe4c52c6beb2cefec410996056848161e9c40d | 586_2005_53_Fig2_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
647,
592
] | [{'image_id': '586_2005_53_Fig1_HTML', 'image_file_name': '586_2005_53_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC1602190/586_2005_53_Fig1_HTML.jpg', 'caption': 'a, b Anteroposterior and lateral radiographs of the thoracic spine in standing position, at the time of admission. The thoracic kyphosis from T5 to T12 is 66°', 'hash': '09713a7ae1f42a519fdc5914b8629eb9ff85ed74d500814c43816a7b4eefd69a'}, {'image_id': '586_2005_53_Fig4_HTML', 'image_file_name': '586_2005_53_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC1602190/586_2005_53_Fig4_HTML.jpg', 'caption': 'a, b Postoperative anteroposterior and lateral radiographs of the thoracic spine. Note the anterior and posterior spinal fusion', 'hash': '723b7a260b81af53dddf64f54f1fbc8b510fe8961b581a6eccf68c7c91b288a8'}, {'image_id': '586_2005_53_Fig3_HTML', 'image_file_name': '586_2005_53_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC1602190/586_2005_53_Fig3_HTML.jpg', 'caption': 'Three-dimensional reconstruction computed tomography of the thoracic spine preoperatively', 'hash': '00f8d592795458e1bf06a31d284e10fa657e651b7c8e25650813708b9ca73cbf'}, {'image_id': '586_2005_53_Fig2_HTML', 'image_file_name': '586_2005_53_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC1602190/586_2005_53_Fig2_HTML.jpg', 'caption': 'a, b Magnetic resonance imaging scan revealed thoracic disc herniation with spinal cord compression at T8–T9 level (apex of the kyphosis)', 'hash': '98f445c86e30a5d85464efbe6cfe4c52c6beb2cefec410996056848161e9c40d'}] | {'586_2005_53_Fig1_HTML': ['All laboratory findings were normal including an investigation for systemic diseases. Plain radiographs of the spine in standing position revealed anterior wedging of more than 5° of several adjacent vertebrae (T7:12°, T8:14°, T9:17°, T10:15°) at the apex of the kyphosis and vertebral endplate irregularities. The thoracic kyphosis from T5 to T12 measured 66° (Fig.\xa0<xref rid="586_2005_53_Fig1_HTML" ref-type="fig">1</xref>). These findings are in agreement with the criteria for diagnosis of Scheuermann’s disease. A magnetic resonance imaging scan revealed thoracic disc heniation with spinal cord compression at T8–T9 level (apex of the kyphosis). The intervertebral spaces from T6 to T10 were also very narrow and the vertebral bodies had an anterior wedging (Figs.\xa0). These findings are in agreement with the criteria for diagnosis of Scheuermann’s disease. A magnetic resonance imaging scan revealed thoracic disc heniation with spinal cord compression at T8–T9 level (apex of the kyphosis). The intervertebral spaces from T6 to T10 were also very narrow and the vertebral bodies had an anterior wedging (Figs.\xa0<xref rid="586_2005_53_Fig2_HTML" ref-type="fig">2</xref>, , <xref rid="586_2005_53_Fig3_HTML" ref-type="fig">3</xref>).\n).\nFig.\xa01a, b Anteroposterior and lateral radiographs of the thoracic spine in standing position, at the time of admission. The thoracic kyphosis from T5 to T12 is 66°Fig.\xa02a, b Magnetic resonance imaging scan revealed thoracic disc herniation with spinal cord compression at T8–T9 level (apex of the kyphosis)Fig.\xa03Three-dimensional reconstruction computed tomography of the thoracic spine preoperatively'], '586_2005_53_Fig4_HTML': ['Surgical treatment was decided based on the severity of the neurological deficit. A right seventh rib transthoracic approach to the spinal column was performed followed by decompression at T8–T9 level. A disc fragment was found and removed behind the thoracic body of T9. We performed an anterior fusion using plate, screws, an interbody titanium cage and also a posterior fusion from T6 to T12 using a double-rod multihook and transpedicular screws segmental instrumentation system. Bone grafts were applied between T8 and T9 and intertransversaly from T7 to T10 (Fig.\xa0<xref rid="586_2005_53_Fig4_HTML" ref-type="fig">4</xref>).).Fig.\xa04a, b Postoperative anteroposterior and lateral radiographs of the thoracic spine. Note the anterior and posterior spinal fusion']} | Thoracic cord compression caused by disk herniation in Scheuermann’s disease | [
"Scheuermann’s disease",
"Thoracic disc herniation",
"Spinal cord compression",
"Acute myelopathy",
"Spastic paraparesis"
] | Eur Spine J | 1161241200 | Osteoma is a common benign tumor. It occurs dominantly at the skull bone. Outside skull osteoma is rare, and primary intra-canal osteoma is extremely rare. To the author's knowledge, only 14 cases of osteomas of the spine had been reported, in which only seven cases were in English literature. The authors reported two rare cases of intra-canal osteoma of the upper cervical spine with cord compression. Included are pertinent history, physical examination, rontgenographic evaluation before and after operation, surgical interventions, pathological study, and outcome. The available literature is also reviewed. On systemic examination and rontgenographic study, these two cases were found to have bone tumor in the upper cervical canal. Surgical interventions were performed, one with an en bloc excision, the other with a subtotal excision. The pathological study demonstrated a diagnosis of osteoma. After a follow-up with 20 and 15 months, the clinical symptoms of both cases significantly improved. | [
"Cervical Vertebrae",
"Decompression, Surgical",
"Humans",
"Image Processing, Computer-Assisted",
"Imaging, Three-Dimensional",
"Magnetic Resonance Imaging",
"Male",
"Middle Aged",
"Osteoma",
"Spinal Cord Compression",
"Spinal Neoplasms",
"Tomography, X-Ray Computed"
] | other | PMC1602190 | null | 14 | [
"{'Citation': 'Campanacci M (1990) Osteoma. In: Bone and soft tissue tumors. Springer, Berlin Heidelberg New York, pp 349–354'}",
"{'Citation': 'Fechner RE, Mills SE. Tumors of the bones and joints. In: Rosai J, Sobin LH, editors. Atlas of tumor pathology, Maryland: Armed Forces Institute of Pathology; 1993. pp. 26–28.'}",
"{'Citation': 'Fritz Schajowicz (1994) Bone-forming tumors. In: Tumors and tumor like lesions of bone, pathology, radiology, and treatment, 2nd edn. Springer, Berlin Heidelberg New York, p 29'}",
"{'Citation': 'Lantsman IuV Spine osteomas. Vopr Onkol. 1986;32:24–28.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '3765518'}}}",
"{'Citation': 'Laus M, Alfonso C, Laguardia AM, Giunti A. Anterior surgery of the upper part of the cervical spine by prevascular extraoral approach. Chir Organi Mov. 1993;78:65–75.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8344077'}}}",
"{'Citation': 'Laus M, Pignatti G, Malaguti MC, Alfonso C, Zappoli FA, Giunti A. Anterior extraoral surgery to the upper cervical spine. Spine. 1996;21:1687–1693. doi: 10.1097/00007632-199607150-00015.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00007632-199607150-00015'}, {'@IdType': 'pubmed', '#text': '8839473'}]}}",
"{'Citation': 'Mirra JM (1989) Osteoma. In: Bone tumors: clinical, radiologic and pathologic correlations. Lea and Febiger, Philadelphia, pp 174–182'}",
"{'Citation': 'Pecker J, Vallee B, Desplat A, Guegan Y. Lateral interscalenic approach for tumors of the cervical intervertebral foramina. Neurochirurgie. 1980;26:165–170.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '7412981'}}}",
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"{'Citation': 'Cotran RS, Kumar V, Collins T (1999) Robbins pathologic basis of disease, 6 edn. WB Saunders, Philadelphia, pp 1235–1236'}",
"{'Citation': 'Rengachary SS, Sanan A. Ivory osteoma of the cervical spine: case report. Neurosurgery. 1998;42:182–185. doi: 10.1097/00006123-199801000-00041.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00006123-199801000-00041'}, {'@IdType': 'pubmed', '#text': '9442522'}]}}",
"{'Citation': 'Resnick D, Niwayama G (1988) Osteoma. In: Diagnosis of bone and joint disorders. WB Saunders, Philadelphia, pp 4081–4084'}",
"{'Citation': 'Schajowicz F (1981) Osteoma. In: Tumors and tumorlike lesions of bone and joints. Springer, Berlin Heidelberg New York, pp 25–34'}",
"{'Citation': 'Wang W, Kong L, Zhao H, Jia Z. Ossification of the transverse atlantal ligament associated with fluorosis. A report of two cases and review of the literature. Spine. 2004;29:E75–E78. doi: 10.1097/01.BRS.0000109762.46805.63.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/01.BRS.0000109762.46805.63'}, {'@IdType': 'pubmed', '#text': '15094549'}]}}"
] | Eur Spine J. 2006 Oct 19; 15(Suppl 5):553-558 | NO-CC CODE |
|
Axial cranial CT scans (corresponding soft-tissue and bone window setting) revealing severe head injury accompanied by traumatic internal pneumocephalus with air distributed prepontine, perimesencephally and intraventricullary accompanied by skull fractures of the sphenoid, left occipital and petrosal bone leading to PR | 586_2006_160_Fig1_HTML | 7 | fc1c844a9fc8a2ce968f09f3ceb506b3c84db4d63ff5d02f9e13231ba21dc403 | 586_2006_160_Fig1_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
649,
389
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"Pneumorrhachis",
"Intraspinal air",
"Spinal canal"
] | Eur Spine J | 1160636400 | The dilemma of how to treat penetrating wound injuries to the neck, which involve a combination of a common carotid artery rupture and a cervical spinal fracture, is presented in this case report. | [
"Adolescent",
"Angiography",
"Carotid Artery Injuries",
"Carotid Artery, Common",
"Cervical Vertebrae",
"Equipment Design",
"Fractures, Open",
"Humans",
"Male",
"Orthopedic Fixation Devices",
"Stents",
"Tomography, X-Ray Computed",
"Wounds, Gunshot"
] | other | PMC1602196 | null | 13 | [
"{'Citation': 'Biffe WL, Moore EE, Ryn RR. The unrecognized epidemic of blunt carotid arterial injuries. Early diagnosis improves neurologic outcome. Ann Surg. 1998;228:462–470. doi: 10.1097/00000658-199810000-00003.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00000658-199810000-00003'}, {'@IdType': 'pmc', '#text': 'PMC1191517'}, {'@IdType': 'pubmed', '#text': '9790336'}]}}",
"{'Citation': 'Dotter CT. Transluminally-placed coilspring endarterial tube grafts. Long-term patency in canine popliteal artery. Invest Radiol. 1969;4:329–332. doi: 10.1097/00004424-196909000-00008.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00004424-196909000-00008'}, {'@IdType': 'pubmed', '#text': '5346893'}]}}",
"{'Citation': 'du Toit DF, Strauss DC, Blaszczyk M, Villiers R, Warren BL. Endovascular treatment of penetrating thoracic outlet arterial injuries. Eur J Vasc Endovasc Surg. 2000;19:489–495. doi: 10.1053/ejvs.1999.1050.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1053/ejvs.1999.1050'}, {'@IdType': 'pubmed', '#text': '10828229'}]}}",
"{'Citation': 'Khoury G, Hajj H, Khoury SI, Basil A, Speir R. Penetrating trauma of the carotid vessels. Eur J Vasc Surg. 1990;4:607–610. doi: 10.1016/S0950-821X(05)80816-3.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S0950-821X(05)80816-3'}, {'@IdType': 'pubmed', '#text': '2279571'}]}}",
"{'Citation': 'Kramer S, Pamler R, Seifarth H, Brambs HJ, Sunder-Plassmann L, Gorich J. Endovascular grafting of traumatic aortic aneurysms in contaminated fields. J Endovasc Ther. 2001;8:262–267. doi: 10.1583/1545-1550(2001)008<0262:EGOTAA>2.0.CO;2.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1583/1545-1550(2001)008<0262:EGOTAA>2.0.CO;2'}, {'@IdType': 'pubmed', '#text': '11491260'}]}}",
"{'Citation': 'Liekweg WG, Greenfield LJ. Management of penetrating carotid arterial injury. Ann Surg. 1978;188:587–592. doi: 10.1097/00000658-197811000-00001.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00000658-197811000-00001'}, {'@IdType': 'pmc', '#text': 'PMC1396760'}, {'@IdType': 'pubmed', '#text': '718284'}]}}",
"{'Citation': 'Martin ML, Veith FJ. Transluminally-placed endovascular stented graft repair for arterial trauma. J Vasc Surg. 1994;20:466–473.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8084041'}}}",
"{'Citation': 'Martin ML, Veith FJ, Panneta TF. Percutaneous transfemoral insertion of a stented graft to repair a traumatic femoral arteriovenous fistula. J Vasc Surg. 1993;18:299–302. doi: 10.1067/mva.1993.48841.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1067/mva.1993.48841'}, {'@IdType': 'pubmed', '#text': '8350439'}]}}",
"{'Citation': 'McNeil ID, Chion AC, Gunlock MG, Grayson DE, Soares G, Hagiuo RT. Successful endovascular therapy of penetrating zone III internal carotid injury. J Vasc Surg. 2002;36(1):187–190. doi: 10.1067/mva.2002.125020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1067/mva.2002.125020'}, {'@IdType': 'pubmed', '#text': '12096279'}]}}",
"{'Citation': 'Padberg FT, Hobson RW, Jeager RA, Lynch TG. Penetrating carotidarterial trauma. Ann Surg. 1984;50:277–282.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '6721292'}}}",
"{'Citation': 'Perry MO (1994) Vascular injuries in the neck and thoracic outlet. In: Veith FJ, Hobson RW, Williams RA (eds) Vascular surgery: principles and practice, 2nd edn. McGraw-Hill, New York, pp 967–975'}",
"{'Citation': 'Soalea TM, Solafani S. Interventional techniques in vascular trauma. Surg Clin North Am. 2001;81:1–12. doi: 10.1016/S0039-6109(05)70270-X.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S0039-6109(05)70270-X'}, {'@IdType': 'pubmed', '#text': '11766176'}]}}",
"{'Citation': 'Temberlake GA, Rice JC, Kerstein MD, Rush DS, McSwain NE. Penetrating injury to the carotid artery: a reappraisal of management. Ann Surg. 1989;55:154–157.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2919839'}}}"
] | Eur Spine J. 2006 Oct 12; 15(Suppl 5):636-643 | NO-CC CODE |
|
Axial CT scans of the cervical spine (corresponding soft-tissue and bone window setting) showing extradural air collection within the ventral spinal canal | 586_2006_160_Fig3_HTML | 7 | 0f5f57bd042d03603d2e6e9913b9ec94fad622ec5e3775cce297f817085e62aa | 586_2006_160_Fig3_HTML.jpg | multiple | multiple panels: images | [
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"Pneumorrhachis",
"Intraspinal air",
"Spinal canal"
] | Eur Spine J | 1160636400 | The dilemma of how to treat penetrating wound injuries to the neck, which involve a combination of a common carotid artery rupture and a cervical spinal fracture, is presented in this case report. | [
"Adolescent",
"Angiography",
"Carotid Artery Injuries",
"Carotid Artery, Common",
"Cervical Vertebrae",
"Equipment Design",
"Fractures, Open",
"Humans",
"Male",
"Orthopedic Fixation Devices",
"Stents",
"Tomography, X-Ray Computed",
"Wounds, Gunshot"
] | other | PMC1602196 | null | 13 | [
"{'Citation': 'Biffe WL, Moore EE, Ryn RR. The unrecognized epidemic of blunt carotid arterial injuries. Early diagnosis improves neurologic outcome. Ann Surg. 1998;228:462–470. doi: 10.1097/00000658-199810000-00003.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00000658-199810000-00003'}, {'@IdType': 'pmc', '#text': 'PMC1191517'}, {'@IdType': 'pubmed', '#text': '9790336'}]}}",
"{'Citation': 'Dotter CT. Transluminally-placed coilspring endarterial tube grafts. Long-term patency in canine popliteal artery. Invest Radiol. 1969;4:329–332. doi: 10.1097/00004424-196909000-00008.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00004424-196909000-00008'}, {'@IdType': 'pubmed', '#text': '5346893'}]}}",
"{'Citation': 'du Toit DF, Strauss DC, Blaszczyk M, Villiers R, Warren BL. Endovascular treatment of penetrating thoracic outlet arterial injuries. Eur J Vasc Endovasc Surg. 2000;19:489–495. doi: 10.1053/ejvs.1999.1050.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1053/ejvs.1999.1050'}, {'@IdType': 'pubmed', '#text': '10828229'}]}}",
"{'Citation': 'Khoury G, Hajj H, Khoury SI, Basil A, Speir R. Penetrating trauma of the carotid vessels. Eur J Vasc Surg. 1990;4:607–610. doi: 10.1016/S0950-821X(05)80816-3.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S0950-821X(05)80816-3'}, {'@IdType': 'pubmed', '#text': '2279571'}]}}",
"{'Citation': 'Kramer S, Pamler R, Seifarth H, Brambs HJ, Sunder-Plassmann L, Gorich J. Endovascular grafting of traumatic aortic aneurysms in contaminated fields. J Endovasc Ther. 2001;8:262–267. doi: 10.1583/1545-1550(2001)008<0262:EGOTAA>2.0.CO;2.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1583/1545-1550(2001)008<0262:EGOTAA>2.0.CO;2'}, {'@IdType': 'pubmed', '#text': '11491260'}]}}",
"{'Citation': 'Liekweg WG, Greenfield LJ. Management of penetrating carotid arterial injury. Ann Surg. 1978;188:587–592. doi: 10.1097/00000658-197811000-00001.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1097/00000658-197811000-00001'}, {'@IdType': 'pmc', '#text': 'PMC1396760'}, {'@IdType': 'pubmed', '#text': '718284'}]}}",
"{'Citation': 'Martin ML, Veith FJ. Transluminally-placed endovascular stented graft repair for arterial trauma. J Vasc Surg. 1994;20:466–473.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8084041'}}}",
"{'Citation': 'Martin ML, Veith FJ, Panneta TF. Percutaneous transfemoral insertion of a stented graft to repair a traumatic femoral arteriovenous fistula. J Vasc Surg. 1993;18:299–302. doi: 10.1067/mva.1993.48841.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1067/mva.1993.48841'}, {'@IdType': 'pubmed', '#text': '8350439'}]}}",
"{'Citation': 'McNeil ID, Chion AC, Gunlock MG, Grayson DE, Soares G, Hagiuo RT. Successful endovascular therapy of penetrating zone III internal carotid injury. J Vasc Surg. 2002;36(1):187–190. doi: 10.1067/mva.2002.125020.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1067/mva.2002.125020'}, {'@IdType': 'pubmed', '#text': '12096279'}]}}",
"{'Citation': 'Padberg FT, Hobson RW, Jeager RA, Lynch TG. Penetrating carotidarterial trauma. Ann Surg. 1984;50:277–282.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '6721292'}}}",
"{'Citation': 'Perry MO (1994) Vascular injuries in the neck and thoracic outlet. In: Veith FJ, Hobson RW, Williams RA (eds) Vascular surgery: principles and practice, 2nd edn. McGraw-Hill, New York, pp 967–975'}",
"{'Citation': 'Soalea TM, Solafani S. Interventional techniques in vascular trauma. Surg Clin North Am. 2001;81:1–12. doi: 10.1016/S0039-6109(05)70270-X.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S0039-6109(05)70270-X'}, {'@IdType': 'pubmed', '#text': '11766176'}]}}",
"{'Citation': 'Temberlake GA, Rice JC, Kerstein MD, Rush DS, McSwain NE. Penetrating injury to the carotid artery: a reappraisal of management. Ann Surg. 1989;55:154–157.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2919839'}}}"
] | Eur Spine J. 2006 Oct 12; 15(Suppl 5):636-643 | NO-CC CODE |
|
CT scan at the C6 level demonstrating a vertebral body fracture extending into the left vertebral foramen | 586_2006_182_Fig1_HTML | 7 | 3c94d8b76b51248a65aa7613f0a2105ad3cb80a7bb69f621937778a389d3f2be | 586_2006_182_Fig1_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
591,
582
] | [{'image_id': '586_2006_182_Fig3_HTML', 'image_file_name': '586_2006_182_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC1602199/586_2006_182_Fig3_HTML.jpg', 'caption': 'Selective common carotid artery angiography demonstrates endovascular stent—extending proximal and distal to the borders of pseudoaneurysm with complete exclusion of pseudoaneurysm and external carotid artery', 'hash': '3de8c95f8d895e95590e0777d5a7967ec390364b2b37d4e360a3636e28ab5db5'}, {'image_id': '586_2006_182_Fig2_HTML', 'image_file_name': '586_2006_182_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC1602199/586_2006_182_Fig2_HTML.jpg', 'caption': 'Selective left common carotid artery angiography shows traumatic pseudoaneurysm 1\xa0cm below bifurcation', 'hash': '951b5b2ca512aea0097f6968a43ea34f90db35469b748bb470477d3f0a25a9cb'}, {'image_id': '586_2006_182_Fig1_HTML', 'image_file_name': '586_2006_182_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC1602199/586_2006_182_Fig1_HTML.jpg', 'caption': 'CT scan at the C6 level demonstrating a vertebral body fracture extending into the left vertebral foramen', 'hash': '3c94d8b76b51248a65aa7613f0a2105ad3cb80a7bb69f621937778a389d3f2be'}] | {'586_2006_182_Fig1_HTML': ['A 16-year-old adolescent was transferred to our institution from a different hospital for stabilization of a cervical spinal fracture. Six hours prior to his transfer he had sustained an isolated gunshot wound to his neck. He was quadraplegic and unconscious on his admission to the referring hospital and was therefore intubated and ventilated. CT scan of the cervical spine showed a blow-out fracture of the body of C6 with involvement of the left vertebral foramen (Fig.\xa0<xref rid="586_2006_182_Fig1_HTML" ref-type="fig">1</xref>). CT scans of the brain and chest were within normal limits.\n). CT scans of the brain and chest were within normal limits.\nFig.\xa01CT scan at the C6 level demonstrating a vertebral body fracture extending into the left vertebral foramen'], '586_2006_182_Fig2_HTML': ['Upon admission to our institution his hemodynamic condition was stable with a blood pressure of 115/70\xa0mmHg and pulse of 60\xa0beats/minute. He was ventilated and had a SaO2 of 100% with FiO2 of 0.4. Physical examination of his neck area demonstrated an entry wound in the posterior neck to the left of the midline and an exit wound in the left side of his neck. A large hematoma on the left side of the neck was demonstrated and palpated. A duplex scan of the left carotid artery was performed and was interpreted as a probable false aneurysm of common carotid artery. CT angiogram of the neck demonstrated anterior and posterior leak of contrast from the common carotid artery, 1\xa0cm proximal to the bifurcation (Fig.\xa0<xref rid="586_2006_182_Fig2_HTML" ref-type="fig">2</xref>). The left vertebral artery was shown to be intact. The left internal jugular vein was compressed by the hematoma. The patient was transferred to the angiography suite and the presence of false aneurysms was confirmed. Under local anesthesia, through a transfemoral approach a catheter was inserted into the aneurysmatic area. The aneurysms were treated by the insertion of a covered stent (Jostent 8\xa0(×\xa038\xa0mm). The left vertebral artery was shown to be intact. The left internal jugular vein was compressed by the hematoma. The patient was transferred to the angiography suite and the presence of false aneurysms was confirmed. Under local anesthesia, through a transfemoral approach a catheter was inserted into the aneurysmatic area. The aneurysms were treated by the insertion of a covered stent (Jostent 8\xa0(×\xa038\xa0mm2), which also occluded the origin of the external carotid artery (Fig.\xa0<xref rid="586_2006_182_Fig2_HTML" ref-type="fig">2</xref>). No change in his neurological status after the insertion of the stent was seen (Fig.\xa0). No change in his neurological status after the insertion of the stent was seen (Fig.\xa0<xref rid="586_2006_182_Fig3_HTML" ref-type="fig">3</xref>). No anticoagulation was given. His neck fracture was stabilized by an external fixation device and he was transferred back to the referring hospital.\n). No anticoagulation was given. His neck fracture was stabilized by an external fixation device and he was transferred back to the referring hospital.\nFig.\xa02Selective left common carotid artery angiography shows traumatic pseudoaneurysm 1\xa0cm below bifurcationFig.\xa03Selective common carotid artery angiography demonstrates endovascular stent—extending proximal and distal to the borders of pseudoaneurysm with complete exclusion of pseudoaneurysm and external carotid artery']} | Endovascular treatment of an open cervical fracture with carotid artery tear | [
"Carotid artery tear",
"Penetrating injury",
"Cervical fracture",
"Endovascular treatment"
] | Eur Spine J | 1161414000 | [{'@Label': 'UNLABELLED', '#text': "The authors report the successful outcome of a six-level corpectomy across the cervico-thoracic spine with circumferential reconstruction in a patient with extensive osteomyelitis of the cervical and upper thoracic spine. To the authors' knowledge, this is the first report of a corpectomy extending across six levels of the cervico-thoracic spine."}, {'@Label': 'CLINICAL RELEVANCE', '@NlmCategory': 'CONCLUSIONS', '#text': 'the authors recommend anterior cage and plate-assisted reconstruction and additional posterior instrumentation using modern spinal surgical techniques and implants.'}] | [
"Anti-Bacterial Agents",
"Cervical Vertebrae",
"Female",
"Follow-Up Studies",
"Humans",
"Magnetic Resonance Imaging",
"Middle Aged",
"Neurosurgical Procedures",
"Orthopedic Fixation Devices",
"Osteomyelitis",
"Plastic Surgery Procedures",
"Staphylococcal Infections",
"Thoracic Vertebrae",
"Tomography, X-Ray Computed",
"Treatment Outcome"
] | other | PMC1602199 | null | 27 | [
"{'Citation': 'Bilsky MH, Boakye M, Collignon F, Kraus D, Boland P. Operative management of metastatic and malignant primary subaxial cervical tumors. J Neurosurg Spine. 2005;2:256–264. doi: 10.3171/spi.2005.2.3.0256.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.3171/spi.2005.2.3.0256'}, {'@IdType': 'pubmed', '#text': '15796349'}]}}",
"{'Citation': 'Cheng H, Jiang W, Phillips FM, Haydon RC, Peng Y, Zhou L, Luu HH, An N, Breyer B, Vanichakarn P, Szatkowski JP, Park JY, He TC. Osteogenic activity of the fourteen types of human bone morphogenetic proteins (BMPs) J Bone Joint Surg Am. 2003;85:1544–1552.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12925636'}}}",
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] | Eur Spine J. 2006 Oct 21; 15(Suppl 5):650-652 | NO-CC CODE |
|
Coronal abdominal spectral fat saturation inversion recovery (SPIR) MR images showing left suprarenal swelling | 586_2006_205_Fig3_HTML | 7 | 0ee5b1480e0c291c0bceb70d552207b1cea82f0d4406bd44175b8162abc18879 | 586_2006_205_Fig3_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
646,
509
] | [{'image_id': '586_2006_205_Fig1_HTML', 'image_file_name': '586_2006_205_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC1602204/586_2006_205_Fig1_HTML.jpg', 'caption': 'MR images demonstrating a right dumb-bell intra-extradural mass at T9–T10 level extending into the intrathoracic right space for about 2.5\xa0cm. Coronal and axial T1-weighted images with Gd-DTPA enhancement', 'hash': 'f1e9a93f1d337496c7dfe6c153ac7b8365cf82a65024c8f415935b7149e1e696'}, {'image_id': '586_2006_205_Fig3_HTML', 'image_file_name': '586_2006_205_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC1602204/586_2006_205_Fig3_HTML.jpg', 'caption': 'Coronal abdominal spectral fat saturation inversion recovery (SPIR) MR images showing left suprarenal swelling', 'hash': '0ee5b1480e0c291c0bceb70d552207b1cea82f0d4406bd44175b8162abc18879'}, {'image_id': '586_2006_205_Fig2_HTML', 'image_file_name': '586_2006_205_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC1602204/586_2006_205_Fig2_HTML.jpg', 'caption': 'Sagittal T2-weighted MRI showing T9–T10 right intervertebral foramen occupied by the tumor', 'hash': '80106fca7e2893d01867f1e2fe16b1fc1065d5e791777a01c3c77a62c05930a3'}] | {'586_2006_205_Fig1_HTML': ['In January 2003, a 53-year-old salesman, heavy smoker with an elevate level of arterial hypertension, began to complain about pain in his right chest and upper limb. Chest X-ray and thoracic CT scan in the following February revealed a D9–D10 dumb-bell mass extending into the intrathoracic right space for about 2.5\xa0cm. The patient was admitted to our clinic. A spinal dorsal MRI confirmed the presence of the voluminous D9–D10 right paravertebral mass (Figs.\xa0<xref rid="586_2006_205_Fig1_HTML" ref-type="fig">1</xref>, , <xref rid="586_2006_205_Fig2_HTML" ref-type="fig">2</xref>). Abdomen MRI showed an almost 4\xa0cm swelling of the left suprarenal gland, suggesting a pheochromocytoma (Fig.\xa0). Abdomen MRI showed an almost 4\xa0cm swelling of the left suprarenal gland, suggesting a pheochromocytoma (Fig.\xa0<xref rid="586_2006_205_Fig3_HTML" ref-type="fig">3</xref>). The neurologic examination and brain MRI were normal. The renal arterial echodoppler, the dosing of vanilmandelic acid, alpha-fetoprotein, carcinoembryonic antigen, urinary catecholamine and cortisol were normal. The renin activity and the plasmatic level of aldosteron resulted normal in orthostasis and increased in recumbency. The medullar adrenal gland scintigrams (123 IIs MIBG-148 MBqs e.v.) resulted negative for pheochromocytoma. Therefore, we excluded a pheochromocytoma and the patient underwent a surgical procedure for total removal of the dorsal mass by posterior and anterior approach in collaboration with the thoracic surgeons.\n). The neurologic examination and brain MRI were normal. The renal arterial echodoppler, the dosing of vanilmandelic acid, alpha-fetoprotein, carcinoembryonic antigen, urinary catecholamine and cortisol were normal. The renin activity and the plasmatic level of aldosteron resulted normal in orthostasis and increased in recumbency. The medullar adrenal gland scintigrams (123 IIs MIBG-148 MBqs e.v.) resulted negative for pheochromocytoma. Therefore, we excluded a pheochromocytoma and the patient underwent a surgical procedure for total removal of the dorsal mass by posterior and anterior approach in collaboration with the thoracic surgeons.\nFig.\xa01MR images demonstrating a right dumb-bell intra-extradural mass at T9–T10 level extending into the intrathoracic right space for about 2.5\xa0cm. Coronal and axial T1-weighted images with Gd-DTPA enhancementFig.\xa02Sagittal T2-weighted MRI showing T9–T10 right intervertebral foramen occupied by the tumorFig.\xa03Coronal abdominal spectral fat saturation inversion recovery (SPIR) MR images showing left suprarenal swelling']} | Dorsal dumb-bell melanotic schwannoma operated on by posterior and anterior approach: case report and a review of the literature | [
"Dorsal dumb-bell melanotic schwannoma",
"Thoracic nerve sheath tumor",
"Spinal tumor",
"Carney syndrome"
] | Eur Spine J | 1159686000 | Mice infected with the coronavirus mouse hepatitis virus, strain JHM (JHM) develop a disease that shares many histological characteristics with multiple sclerosis. We previously demonstrated that JHM-infected mice that only have CD8 T cells specific for an epitope not in the virus develop demyelination on specific activation of these cells. Herein we show that this process of bystander T-cell-mediated demyelination is interferon-gamma (IFN-gamma)-dependent. The absence of IFN-gamma abrogated demyelination but did not change T-cell infiltration or expression levels of inflammatory cytokines or chemokines in the spinal cord. These results are consistent with models in which IFN-gamma contributes to CD8 T-cell-mediated demyelination by activation of macrophages/microglia, the final effector cells in the disease process. | [
"Animals",
"Bystander Effect",
"CD8-Positive T-Lymphocytes",
"Coronavirus",
"Coronavirus Infections",
"Demyelinating Diseases",
"Encephalomyelitis, Autoimmune, Experimental",
"Flow Cytometry",
"Immunohistochemistry",
"Interferon-gamma",
"Lymphocyte Activation",
"Macrophages",
"Mice",
"Mice, Transgenic",
"Microglia",
"Multiple Sclerosis",
"Spinal Cord",
"Transplantation Chimera"
] | other | PMC1602204 | null | 34 | [
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] | Eur Spine J. 2006 Oct 1; 15(Suppl 5):664-669 | NO-CC CODE |
|
Axial CT image through the lower end-plate of L3 (a) and coronal reformatted CT (b) image show a round hyperdense extraforaminal lesion consistent with far-lateral disc herniation | 586_2006_93_Fig2_HTML | 7 | 673856188c2b602d5b8255f64f1c8dd60c64f5fe8e3c866f7718b91b98a93701 | 586_2006_93_Fig2_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
765,
382
] | [{'image_id': '586_2006_93_Fig1_HTML', 'image_file_name': '586_2006_93_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC1602206/586_2006_93_Fig1_HTML.jpg', 'caption': 'Axial T1-weighted (a) and T2-weighted (b) MR scans through L3-4 interspace show an extraforaminal lesion with questionable continuity with the disc space. The lesion is isointense on both T1- and T2-images. Please note that on T2-weighted axial image (b), the contralateral dorsal root ganglion (DRG) shows intermediate to high signal. c Parasagittal MR scan show L3-4 disk herniation obliterating the left neural foramen anteroinferiorly.Yet the left L3 nerve is of same width as the roots one above or below. d Parasagittal MR scan 5\xa0mm lateral to section c shows that the enlarged DRG (arrows) appears to have been stuck in the distal neural foramen. Please note that the fat plane around the DRG is totally obliterated', 'hash': '21a5da8fb9b2dc4618e0d3eae3ab1a18f0c53226d89fa26e4151e98bb6cd0268'}, {'image_id': '586_2006_93_Fig2_HTML', 'image_file_name': '586_2006_93_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC1602206/586_2006_93_Fig2_HTML.jpg', 'caption': 'Axial CT image through the lower end-plate of L3 (a) and coronal reformatted CT (b) image show a round hyperdense extraforaminal lesion consistent with far-lateral disc herniation', 'hash': '673856188c2b602d5b8255f64f1c8dd60c64f5fe8e3c866f7718b91b98a93701'}, {'image_id': '586_2006_93_Fig3_HTML', 'image_file_name': '586_2006_93_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC1602206/586_2006_93_Fig3_HTML.jpg', 'caption': 'Operative microphotographs show that: a the left L3 root and the DRG are extremely swollen, b after opening the dural nerve sheath, the upper end of a yellow colored tumor is being dissected, c the lower end of the tumor is being dissected with better cleavage, d after the removal of the tumor normal appearing ventral motor rootlets come into view, e root size return to normal after suture closure of the dural sheath (black arrows)', 'hash': '3cc5a2c6dd8fdc3a49e235024c281320d90e795d508beae33cc25fc1d912672f'}, {'image_id': '586_2006_93_Fig4_HTML', 'image_file_name': '586_2006_93_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC1602206/586_2006_93_Fig4_HTML.jpg', 'caption': 'Photomicrographs a with hematoxylin and eosin and b with neurofilament (NF) protein immuno-stain demonstrate axons (left) and ganglion cells dispersed in a cellular stroma consisting of bundles of elongated spindle cells (right) (×200 original magnification). This represents normal DRG morphology', 'hash': '2d021cb196954334ea045a54564348b496815474f8d5be1ae6d1310af772e797'}] | {'586_2006_93_Fig1_HTML': ['In the emergency room, the patient was in extreme pain. Any movement or touch would exacerbate the pain. Right leg-raising test was positive at 60 and left leg-raising test was positive at 20°. Power was normal in both legs, including knee extension. Patellar and the ankle reflexes were normoactive bilaterally. Abdominal examination for a distended bladder was fruitless because of softened subcutaneous fat. Lumbar MR showed disc degeneration and mild bulging at L3-4, L4-5 and L5-S1 levels yet at L3-4 level there was foraminal and a round extraforaminal disc herniation (Fig.\xa0<xref rid="586_2006_93_Fig1_HTML" ref-type="fig">1</xref>a, b). Lumbar MR scan also verified a fully distended bladder (Fig.\xa0a, b). Lumbar MR scan also verified a fully distended bladder (Fig.\xa0<xref rid="586_2006_93_Fig1_HTML" ref-type="fig">1</xref>c). Considering vaque radiological findings in contrast to serious pain and urinary retention, the MR examination was extended to cover the whole cervico-thoracic and thoracic levels. There was no cord compression.\nc). Considering vaque radiological findings in contrast to serious pain and urinary retention, the MR examination was extended to cover the whole cervico-thoracic and thoracic levels. There was no cord compression.\nFig.\xa01Axial T1-weighted (a) and T2-weighted (b) MR scans through L3-4 interspace show an extraforaminal lesion with questionable continuity with the disc space. The lesion is isointense on both T1- and T2-images. Please note that on T2-weighted axial image (b), the contralateral dorsal root ganglion (DRG) shows intermediate to high signal. c Parasagittal MR scan show L3-4 disk herniation obliterating the left neural foramen anteroinferiorly.Yet the left L3 nerve is of same width as the roots one above or below. d Parasagittal MR scan 5\xa0mm lateral to section c shows that the enlarged DRG (arrows) appears to have been stuck in the distal neural foramen. Please note that the fat plane around the DRG is totally obliterated'], '586_2006_93_Fig2_HTML': ['The next morning, urinary retention re-occurred and an indwelling urinary catheter had to be placed. An ultrasound of the abdomen and pelvis was not contributory except identification of few benign adhesions secondary to previous pelvic surgery and a distended gall bladder. Meanwhile the left knee pain and the left sciatica got only a bit better but the patient described additional occasional electric shock like pain radiating medially from the left groin to the left knee. Lumbar computerized tomography (CT) to rule out a small bone chip originating from end-plate attached to a free disc fragment was done next. Axial CT scans showed the presence of a left-sided round hyperdense extraforaminal lesion at L3-4 level that was reported to be consistent with far-lateral disc herniation (Fig.\xa0<xref rid="586_2006_93_Fig2_HTML" ref-type="fig">2</xref>a). Coronal reformatted CT images better demonstrated the lateral extent of the disc herniation (Fig.\xa0a). Coronal reformatted CT images better demonstrated the lateral extent of the disc herniation (Fig.\xa0<xref rid="586_2006_93_Fig2_HTML" ref-type="fig">2</xref>b). After an unsatisfactory 2-day narcotic treatment with codein 60\xa0mg q6h, gabapentin 300\xa0mg twice a day was started. On the third day of admission, a new pain emerged around the left inguinal area. By this time, the left patellar reflex diminished and left knee extension got 20% weaker. IV steroid (80\xa0mg methyl prednisolon as the loading and 40\xa0mg twice a day as the maintenance dose) was then started. Steroid alleviated a significant portion of the pain. Tapering steroid dose immediately caused return of intense pain, so surgery was considered as the last resort.\nb). After an unsatisfactory 2-day narcotic treatment with codein 60\xa0mg q6h, gabapentin 300\xa0mg twice a day was started. On the third day of admission, a new pain emerged around the left inguinal area. By this time, the left patellar reflex diminished and left knee extension got 20% weaker. IV steroid (80\xa0mg methyl prednisolon as the loading and 40\xa0mg twice a day as the maintenance dose) was then started. Steroid alleviated a significant portion of the pain. Tapering steroid dose immediately caused return of intense pain, so surgery was considered as the last resort.\nFig.\xa02Axial CT image through the lower end-plate of L3 (a) and coronal reformatted CT (b) image show a round hyperdense extraforaminal lesion consistent with far-lateral disc herniation'], '586_2006_93_Fig3_HTML': ['The patient was informed to consent for the removal of far-lateral disc herniation at L3-4 level. After medial facetectomy and ligamentous removal, the left L4 nerve and the L3-4 disc space were exposed. The bulging disc was compressing the L4 root from its shoulder. After standard discectomy, the L4 root became mobile. Next, lateral disc space was emptied by angling the rongeur laterally. Yet, disc compression alone was far from explaining the dramatic clinical picture. After total removal of left L3 inferior facet and L4 superior facet and undercutting the L3 pedicle, the left L3 root was identified and traced laterally. L3 nerve was more or less normal sized yet L3 DRG was extremely different than normal. The DRG was 3–4 times bigger than a normal DRG. The L3 root was totally immobile (Fig.\xa0<xref rid="586_2006_93_Fig3_HTML" ref-type="fig">3</xref>a). The DRG felt extremely gritty. The dural sheath of nerve root and the DRG was opened. A yellow-colored firm tissue came into view (Fig.\xa0a). The DRG felt extremely gritty. The dural sheath of nerve root and the DRG was opened. A yellow-colored firm tissue came into view (Fig.\xa0<xref rid="586_2006_93_Fig3_HTML" ref-type="fig">3</xref>b, c). There was good cleavage from the dural sheath and the underlying septum. The healthy ventral rootlets were pushed anteriorly and inferiorly by the mass (Fig.\xa0b, c). There was good cleavage from the dural sheath and the underlying septum. The healthy ventral rootlets were pushed anteriorly and inferiorly by the mass (Fig.\xa0<xref rid="586_2006_93_Fig3_HTML" ref-type="fig">3</xref>d). Overall, the mass lesion within the root sleeve was totally extirpated. Although no cerebrospinal fluid (CSF) was seen in the operative field, the dural sheath was sutured with interrupted prolene sutures and the suture was reinforced with tissue fibrin glue. On postoperative day 1, the urinary catheter was removed and the patient emptied her bladder spontaneously. The original pain was totally gone. The left knee function returned to normal. On third postoperative day, she complained of mild hyperesthesia and hyperalgesia over the left knee which did not affect her daily life. At 4\xa0months postoperatively, she is leading a normal life with gabapentin 300\xa0mg twice a day.\nd). Overall, the mass lesion within the root sleeve was totally extirpated. Although no cerebrospinal fluid (CSF) was seen in the operative field, the dural sheath was sutured with interrupted prolene sutures and the suture was reinforced with tissue fibrin glue. On postoperative day 1, the urinary catheter was removed and the patient emptied her bladder spontaneously. The original pain was totally gone. The left knee function returned to normal. On third postoperative day, she complained of mild hyperesthesia and hyperalgesia over the left knee which did not affect her daily life. At 4\xa0months postoperatively, she is leading a normal life with gabapentin 300\xa0mg twice a day.\nFig.\xa03Operative microphotographs show that: a the left L3 root and the DRG are extremely swollen, b after opening the dural nerve sheath, the upper end of a yellow colored tumor is being dissected, c the lower end of the tumor is being dissected with better cleavage, d after the removal of the tumor normal appearing ventral motor rootlets come into view, e root size return to normal after suture closure of the dural sheath (black arrows)'], '586_2006_93_Fig4_HTML': ['The histopathological specimen was extensively studied and did not reveal anything other than normal DRG tissue with mature ganglion cells, axons and Schwannian stroma supporting the axons (Fig.\xa0<xref rid="586_2006_93_Fig4_HTML" ref-type="fig">4</xref>).\n).\nFig.\xa04Photomicrographs a with hematoxylin and eosin and b with neurofilament (NF) protein immuno-stain demonstrate axons (left) and ganglion cells dispersed in a cellular stroma consisting of bundles of elongated spindle cells (right) (×200 original magnification). This represents normal DRG morphology']} | Dorsal root ganglionectomy for pseudotumor of the L3 dorsal root ganglion: a rare case and a rare treatment | [
"Dorsal root ganglion",
"Ganglionectomy",
"Magnetic resonance imaging",
"Microsurgery"
] | Eur Spine J | 1160290800 | Infection of the central nervous system (CNS) by the neurotropic JHM strain of mouse hepatitis virus (JHMV) induces an acute encephalomyelitis associated with demyelination. To examine the anti-viral and/or regulatory role of interferon-gamma (IFN-gamma) signaling in the cell that synthesizes and maintains the myelin sheath, we analyzed JHMV pathogenesis in transgenic mice expressing a dominant-negative IFN-gamma receptor on oligodendroglia. Defective IFN-gamma signaling was associated with enhanced oligodendroglial tropism and delayed virus clearance. However, the CNS inflammatory cell composition and CD8(+) T-cell effector functions were similar between transgenic and wild-type mice, supporting unimpaired peripheral and CNS immune responses in transgenic mice. Surprisingly, increased viral load in oligodendroglia did not affect the extent of myelin loss, the frequency of oligodendroglial apoptosis, or CNS recruitment of macrophages. These data demonstrate that IFN-gamma receptor signaling is critical for the control of JHMV replication in oligodendroglia. In addition, the absence of a correlation between increased oligodendroglial infection and the extent of demyelination suggests a complex pathobiology of myelin loss in which infection of oligodendroglia is required but not sufficient. | [
"Animals",
"Apoptosis",
"CD8-Positive T-Lymphocytes",
"Central Nervous System Viral Diseases",
"Coronavirus Infections",
"Demyelinating Diseases",
"Interferon-gamma",
"Mice",
"Mice, Transgenic",
"Murine hepatitis virus",
"Oligodendroglia",
"Receptors, Interferon",
"Interferon gamma Receptor"
] | other | PMC1602206 | null | 59 | [
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] | Eur Spine J. 2006 Oct 8; 15(Suppl 5):610-615 | NO-CC CODE |
|
Transverse thin-section serial CT scans from a 77-year-old man(A) Day 5 after symptom onset: patchy ground-glass opacities affecting the bilateral, subpleural lung parenchyma. (B) Day 15: subpleural crescent-shaped ground-glass opacities in both lungs, as well as posterior reticular opacities and subpleural crescent-shaped consolidations. (C) Day 20: expansion of bilateral pulmonary lesions, with enlargement and denser pulmonary consolidations and bilateral pleural effusions (arrows). The patient died 10 days after the final scan. | gr5_lrg | 7 | e7302b29c57cad42690b5911ea7dafed2f003a573e6062962dbf5f55d9cf343e | gr5_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
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733,
184
] | [{'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7159053/gr2_lrg.jpg', 'caption': 'Transverse thin-section CT scans in patients with COVID-19 pneumonia(A) 56-year-old man, day 3 after symptom onset: focal ground-glass opacity associated with smooth interlobular and intralobular septal thickening in the right lower lobes. (B) 74-year-old woman, day 10 after symptom onset: bilateral, peripheral ground-glass opacity associated with smooth interlobular and intralobular septal thickening (crazy-paving pattern). (C) 61-year-old woman, day 20 after symptom onset: bilateral and peripheral predominant consolidation pattern with a round cystic change internally (arrow). (D) 63-year-old woman, day 17 after symptom onset: bilateral, peripheral mixed pattern associated with air bronchograms in both lower and upper lobes, with a small amount of pleural effusion (arrows).', 'hash': '476bbc9fbff7633febbdb37335de29d69cf89960b560153d25430f47c20ed872'}, {'image_id': 'gr6_lrg', 'image_file_name': 'gr6_lrg.jpg', 'image_path': '../data/media_files/PMC7159053/gr6_lrg.jpg', 'caption': 'Transverse thin-section serial CT scans from a 42-year-old woman(A) Day 3 after symptom onset: multifocal consolidations affecting the bilateral, subpleural lung parenchyma. (B) Day 7: the lesions had increased in extent and the density became heterogeneous, with internal bronchovascular bundle thickening. (C) Day 11: previous opacifications being dissipated into ground-glass opacities and irregular linear opacities. (D) Day 18: further resolution of the lesions. The patient was discharged from hospital 2 days after the final scan.', 'hash': '34cc8199cf58c07912649703c4968d93e7f01c9ba57816e411ff8ff702607449'}, {'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC7159053/gr3_lrg.jpg', 'caption': 'Distribution of various patterns of lung changes on CT scans at various timepoints from symptom onsetStacked bars show the proportion of patients in whom the predominant CT pattern was ground-glass opacity, reticular, mixed, or consolidation. Patients were grouped by time from symptom onset: group 1 (scan before symptom onset; n=15), group 2 (scan ≤1 week after symptom onset; n=21), group 3 (scan >1 week to 2 weeks after symptom onset; n=30), and group 4 (scan >2 weeks to 3 weeks after symptom onset; n=15).', 'hash': '941499b093e39247696643ef41e2de8bcc8f68fbeb1723fe189404785cd23c21'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7159053/gr1_lrg.jpg', 'caption': 'Number of involved lung segments at various timepoints from symptom onsetBars show the mean number of involved lung segments on CT scans from patients in group 1 (scan before symptom onset; n=15), group 2 (scan ≤1 week after symptom onset; n=21), group 3 (scan >1 week to 2 weeks after symptom onset; n=30), and group 4 (scan >2 weeks to 3 weeks after symptom onset; n=15).', 'hash': 'ba6d555e8f967dae66f868910180372e8abadaa3fa7f5c8c979b4d4e70021599'}, {'image_id': 'gr5_lrg', 'image_file_name': 'gr5_lrg.jpg', 'image_path': '../data/media_files/PMC7159053/gr5_lrg.jpg', 'caption': 'Transverse thin-section serial CT scans from a 77-year-old man(A) Day 5 after symptom onset: patchy ground-glass opacities affecting the bilateral, subpleural lung parenchyma. (B) Day 15: subpleural crescent-shaped ground-glass opacities in both lungs, as well as posterior reticular opacities and subpleural crescent-shaped consolidations. (C) Day 20: expansion of bilateral pulmonary lesions, with enlargement and denser pulmonary consolidations and bilateral pleural effusions (arrows). The patient died 10 days after the final scan.', 'hash': 'e7302b29c57cad42690b5911ea7dafed2f003a573e6062962dbf5f55d9cf343e'}, {'image_id': 'gr4_lrg', 'image_file_name': 'gr4_lrg.jpg', 'image_path': '../data/media_files/PMC7159053/gr4_lrg.jpg', 'caption': 'Transverse CT scans from a 60-year-old man (day 8 after symptom onset)Selected images from CT scans at different levels. Extensive ground-glass opacities can be seen in both lungs, involving almost the entire lower lobes, and most of the upper lobes and right middle lobe, giving a white lung appearance, with air bronchograms. The patient died 4 days after this scan.', 'hash': '886ecdc7e0beaaf0cfd881174dfef54f75384d31e97b484ddabc4d973d8f2617'}] | {'gr1_lrg': ['All patients had abnormal CT imaging features (appendix 2 pp 5–6). Although all lung segments can be involved, there was a slight predilection for the right lower lobe (225 (27%) of 849 affected segments among all patients). The mean number of segments involved among all groups was 10·5 (SD 6·4; range 1–18; appendix 2 pp 7–8), with significantly more segments involved in groups 2–4 (symptomatic patients) than group 1 (asymptomatic patients; p<0·0001). Group 3 had the highest mean number of involved segments (13·0 [5·7]; <xref rid="gr1_lrg" ref-type="fig">figure 1</xref>\n).\n).Figure 1Number of involved lung segments at various timepoints from symptom onsetBars show the mean number of involved lung segments on CT scans from patients in group 1 (scan before symptom onset; n=15), group 2 (scan ≤1 week after symptom onset; n=21), group 3 (scan >1 week to 2 weeks after symptom onset; n=30), and group 4 (scan >2 weeks to 3 weeks after symptom onset; n=15).'], 'gr2_lrg': ['64 [79%] patients had bilateral lung involvement, 44 [54%] showed peripheral distribution, and 36 [44%] showed diffuse distribution of CT abnormalities (<xref rid="gr2_lrg" ref-type="fig">figure 2</xref>\n). The most common patterns seen on chest CT were ground-glass opacity (53 [65%] patients; \n). The most common patterns seen on chest CT were ground-glass opacity (53 [65%] patients; <xref rid="gr2_lrg" ref-type="fig">figure 2A</xref>), in addition to ill-defined margins (66 [81%]), smooth or irregular interlobular septal thickening (28 [35%] patients; ), in addition to ill-defined margins (66 [81%]), smooth or irregular interlobular septal thickening (28 [35%] patients; <xref rid="gr2_lrg" ref-type="fig">figure 2A</xref>), air bronchogram (38 [47%]; ), air bronchogram (38 [47%]; <xref rid="gr2_lrg" ref-type="fig">figure 2A, D</xref>), crazy-paving pattern (eight [10%]; ), crazy-paving pattern (eight [10%]; <xref rid="gr2_lrg" ref-type="fig">figure 2B</xref>), and thickening of the adjacent pleura (26 [32%]). Less common CT findings were nodules (five [6%] patients), cystic changes (eight [10%]; ), and thickening of the adjacent pleura (26 [32%]). Less common CT findings were nodules (five [6%] patients), cystic changes (eight [10%]; <xref rid="gr2_lrg" ref-type="fig">figure 2C</xref>), bronchiolectasis (nine [11%]), pleural effusion (four [5%]; ), bronchiolectasis (nine [11%]), pleural effusion (four [5%]; <xref rid="gr2_lrg" ref-type="fig">figure 2D</xref>), and lymphadenopathy (five [6%]). Tree-in-bud signs, masses, cavitation, and calcifications were not observed in our case series.), and lymphadenopathy (five [6%]). Tree-in-bud signs, masses, cavitation, and calcifications were not observed in our case series.Figure 2Transverse thin-section CT scans in patients with COVID-19 pneumonia(A) 56-year-old man, day 3 after symptom onset: focal ground-glass opacity associated with smooth interlobular and intralobular septal thickening in the right lower lobes. (B) 74-year-old woman, day 10 after symptom onset: bilateral, peripheral ground-glass opacity associated with smooth interlobular and intralobular septal thickening (crazy-paving pattern). (C) 61-year-old woman, day 20 after symptom onset: bilateral and peripheral predominant consolidation pattern with a round cystic change internally (arrow). (D) 63-year-old woman, day 17 after symptom onset: bilateral, peripheral mixed pattern associated with air bronchograms in both lower and upper lobes, with a small amount of pleural effusion (arrows).'], 'gr3_lrg': ['The typical pattern of CT imaging features from preclinical patients (group 1) comprised unilateral (nine [60%] patients), multifocal (eight [53%]), and ground-glass opacification (14 [93%]). Interlobular septal thickening, thickening of the adjacent pleura, nodules, round cystic changes, bronchiolectasis, pleural effusion, and lymphadenopathy were rarely observed in this group. In group 2 (first week after symptom onset), lesions quickly evolved to become bilateral (19 [90%] patients) and diffuse (11 [52%]), but remained predominantly of ground-glass opacity appearance (17 [81%]). Pleural effusion (one [5%]) and lymphadenopathy (three [14%]) were detected at this stage. In group 3 (second week after symptom onset), as the disease progressed, the ground-glass opacity pattern was still the predominant CT finding (17 [57%]); however, consolidation patterns (nine [30%]) were also noted. In group 4 (third week after symptom onset), ground-glass opacities (five [33%]) and reticular patterns (five [33%]) were the predominant imaging pattern (<xref rid="gr3_lrg" ref-type="fig">figure 3</xref>\n). Bronchiolectasis (two [13%]), thickening of the adjacent pleura (seven [47%]), pleural effusions (two [13%]), and lymphadenopathy (two [13%]) could also be seen at this stage (\n). Bronchiolectasis (two [13%]), thickening of the adjacent pleura (seven [47%]), pleural effusions (two [13%]), and lymphadenopathy (two [13%]) could also be seen at this stage (appendix 2 pp 5–6).Figure 3Distribution of various patterns of lung changes on CT scans at various timepoints from symptom onsetStacked bars show the proportion of patients in whom the predominant CT pattern was ground-glass opacity, reticular, mixed, or consolidation. Patients were grouped by time from symptom onset: group 1 (scan before symptom onset; n=15), group 2 (scan ≤1 week after symptom onset; n=21), group 3 (scan >1 week to 2 weeks after symptom onset; n=30), and group 4 (scan >2 weeks to 3 weeks after symptom onset; n=15).'], 'gr4_lrg': ['By Feb 8, 2020, 62 (77%) patients had been discharged, with a mean interval between symptom onset and discharge of 23·2 days (SD 6; range 12–41). 16 (20%) patients were still in hospital, and three (4%) patients had died (on days 12, 14, and 30, after hospital admission due to ARDS). Patient 1, who died on day 12 after admission, was a 60-year-old man with chronic pulmonary disease (tuberculosis). The CT scan obtained from this patient on day 8 after symptom onset showed extensive ground-glass opacities in both lungs, giving a white lung appearance (<xref rid="gr4_lrg" ref-type="fig">figure 4</xref>\n). The second patient who died (patient 2) was 73-year-old man who had had type 2 diabetes for several years, and showed progressive radiographic deterioration on CT scans taken on days 3, 7, and 11 after symptom onset. Patient 3, who died on day 30 after admission, was a 77-year-old man with hypertension, cardiovascular disease, and cerebrovascular disease. A CT scan showed mild pneumonia on day 5 after symptom onset in this patient (\n). The second patient who died (patient 2) was 73-year-old man who had had type 2 diabetes for several years, and showed progressive radiographic deterioration on CT scans taken on days 3, 7, and 11 after symptom onset. Patient 3, who died on day 30 after admission, was a 77-year-old man with hypertension, cardiovascular disease, and cerebrovascular disease. A CT scan showed mild pneumonia on day 5 after symptom onset in this patient (<xref rid="gr5_lrg" ref-type="fig">figure 5A</xref>\n), and two follow-up CT scans 10 days and 15 days later revealed rapid progression of the lung lesions with bilateral pleural effusions (\n), and two follow-up CT scans 10 days and 15 days later revealed rapid progression of the lung lesions with bilateral pleural effusions (<xref rid="gr5_lrg" ref-type="fig">figure 5B, C</xref>).).Figure 4Transverse CT scans from a 60-year-old man (day 8 after symptom onset)Selected images from CT scans at different levels. Extensive ground-glass opacities can be seen in both lungs, involving almost the entire lower lobes, and most of the upper lobes and right middle lobe, giving a white lung appearance, with air bronchograms. The patient died 4 days after this scan.Figure 5Transverse thin-section serial CT scans from a 77-year-old man(A) Day 5 after symptom onset: patchy ground-glass opacities affecting the bilateral, subpleural lung parenchyma. (B) Day 15: subpleural crescent-shaped ground-glass opacities in both lungs, as well as posterior reticular opacities and subpleural crescent-shaped consolidations. (C) Day 20: expansion of bilateral pulmonary lesions, with enlargement and denser pulmonary consolidations and bilateral pleural effusions (arrows). The patient died 10 days after the final scan.'], 'gr6_lrg': ['Follow-up CT images were obtained from 57 (70%) patients (36 from Wuhan Jinyintan hospital, and 21 from Union Hospital). 23 of these patients had two CT scans, 19 had three scans, and 15 had four scans available. Four patterns of evolution throughout the series of CT scans were observed among these 57 patients: initial progression to peak level, followed by radiographic improvement (type 1), seen in 26 (46%) patients (<xref rid="gr6_lrg" ref-type="fig">figure 6</xref>\n), of whom 24 (92%) patients were discharged from hospital (median stay 25 days [IQR 20–27]); radiographic deterioration (type 2), seen in 18 (32%) patients (\n), of whom 24 (92%) patients were discharged from hospital (median stay 25 days [IQR 20–27]); radiographic deterioration (type 2), seen in 18 (32%) patients (<xref rid="gr5_lrg" ref-type="fig">figure 5</xref>), of whom two (11%) died (patients 2 and 3); radiographic improvement (type 3), seen in eight (14%) patients, of whom five (63%) were discharged from hospital (median stay 19 days [IQR 11–25]); and unchanged radiographic appearance (type 4), seen in five (9%) patients, all of whom were still in hospital at the cutoff date (Feb 8).), of whom two (11%) died (patients 2 and 3); radiographic improvement (type 3), seen in eight (14%) patients, of whom five (63%) were discharged from hospital (median stay 19 days [IQR 11–25]); and unchanged radiographic appearance (type 4), seen in five (9%) patients, all of whom were still in hospital at the cutoff date (Feb 8).Figure 6Transverse thin-section serial CT scans from a 42-year-old woman(A) Day 3 after symptom onset: multifocal consolidations affecting the bilateral, subpleural lung parenchyma. (B) Day 7: the lesions had increased in extent and the density became heterogeneous, with internal bronchovascular bundle thickening. (C) Day 11: previous opacifications being dissipated into ground-glass opacities and irregular linear opacities. (D) Day 18: further resolution of the lesions. The patient was discharged from hospital 2 days after the final scan.']} | Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study | null | Lancet Infect Dis | 1587711600 | None | null | other | PMC7159053 | null | null | [
""
] | Lancet Infect Dis. 2020 Apr 24; 20(4):425-434 | NO-CC CODE |
|
The case of a 65-year-old patient complaining of fever, cough, and fatigue for 4 days, without signs of respiratory failure and showing normal saturation in room air. The CT scan shows bilateral early smooth GGO affecting main part of the lung periphery. The correspondent LUS exam shows the typical interstitial signs with patchy distribution well characterized by the “light beam” in abrupt alternance with “spared areas”. CT computed tomography, LUS lung ultrasound, GGO ground-glass opacity | 134_2021_6373_Fig4_HTML | 7 | 9628a3b974b7c0e1c406cfb77c563f4677a4ef01a8252f4594db2d8b6ebe0b6a | 134_2021_6373_Fig4_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
745,
424
] | [{'image_id': '134_2021_6373_Fig2_HTML', 'image_file_name': '134_2021_6373_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC7980130/134_2021_6373_Fig2_HTML.jpg', 'caption': 'Proposed operative algorithm on the interpretation of LUS signs in the first approach to patients suspected of COVID-19 pneumonia. The algorithm must be considered as a schematic guidance to be always clinically integrated with the overall picture, and never in isolation. Notes: *highly suggestive of bacterial pneumonia with isolated consolidation\xa0of large size and with dynamic air bronchogram; **suggestive of cardiogenic edema when visualized bilaterally with homogeneous and gravity-related distribution; ***when multiple clusters with light beam, coalescent B-lines and pleural irregularities are observed monolaterally (multifocal), it may be still classified HighLUS. HighLUS high-probability lung ultrasound pattern, LowLUS low-probability lung ultrasound pattern, IntLUS intermediate-probability lung ultrasound pattern, AltLUS alternative probability lung ultrasound pattern, COVID-19 Corona Virus Disease 2019.', 'hash': 'e1b116c015cd23ea1b3fd81e28be420f0e5360b03676f3aa04db26fe05efc341'}, {'image_id': '134_2021_6373_Fig3_HTML', 'image_file_name': '134_2021_6373_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC7980130/134_2021_6373_Fig3_HTML.jpg', 'caption': 'Proposed operative flowchart on early management of patients suspected of COVID-19 during a pandemic surge, according to the clinical evaluation at presentation and the assignment of the LUS probability pattern. Final decision should consider that the protocol allows to rule-in or rule-out COVID-19 as the main cause of the presenting symptoms. HighLUS high-probability lung ultrasound pattern, LowLUS low-probability lung ultrasound pattern, IntLUS intermediate-probability lung ultrasound pattern, AltLUS alternative probability lung ultrasound pattern, COVID-19 Corona Virus Disease 2019', 'hash': '5a26505d97875148ce12863d3a401ec0d4ae0da1cae783361e20dfffd9e606ed'}, {'image_id': '134_2021_6373_MOESM4_ESM', 'image_file_name': '134_2021_6373_MOESM4_ESM.jpg', 'image_path': '../data/media_files/PMC7980130/134_2021_6373_MOESM4_ESM.jpg', 'caption': None, 'hash': 'a5c7ed527c96213eb073f72e4ab053aa089b87b9a23d45c9dbe0b775129afd78'}, {'image_id': '134_2021_6373_Fig4_HTML', 'image_file_name': '134_2021_6373_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7980130/134_2021_6373_Fig4_HTML.jpg', 'caption': 'The case of a 65-year-old patient complaining of fever, cough, and fatigue for 4\xa0days, without signs of respiratory failure and showing normal saturation in room air. The CT scan shows bilateral early smooth GGO affecting main part of the lung periphery. The correspondent LUS exam shows the typical interstitial signs with patchy distribution well characterized by the “light beam” in abrupt alternance with “spared areas”. CT computed tomography, LUS lung ultrasound, GGO ground-glass opacity', 'hash': '9628a3b974b7c0e1c406cfb77c563f4677a4ef01a8252f4594db2d8b6ebe0b6a'}, {'image_id': '134_2021_6373_Fig1_HTML', 'image_file_name': '134_2021_6373_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7980130/134_2021_6373_Fig1_HTML.jpg', 'caption': 'Representative images of the four probability patterns in symptomatic patients, showing the distribution of the LUS signs of COVID-19 pneumonia. First row: bilateral distribution of typical LUS interstitial signs (high probability) in a case RT-PCR positive. Second row: monolateral distribution of interstitial LUS signs (intermediate probability) in a case RT-PCR positive. Third row: presence of atypical signs (alternative probability) in a case showing an isolated large consolidation with air bronchograms, due to bacterial pneumonia, and RT-PCR negative. Fourth row: absence of interstitial LUS signs (low probability) in a case RT-PCR negative. LUS lung ultrasound, COVID-19 Corona Virus Disease 2019, RT-PCR reverse transcriptase-polymerase chain reaction', 'hash': '03ddc27634d92799c218eec214e10625f7b46af1d94e28c6e578269e4e9850ce'}] | {'134_2021_6373_Fig1_HTML': ['The prevalence of the four different LUS patterns are shown according to RT-PCR positivity in the overall population and in the different clinical phenotypes (Online Resource 5). Table 2 reports LUS diagnostic accuracy in all subgroups, considering as positive LUS exam HighLUS alone or HighLUS and IntLUS. An example of the 4 LUS probability patterns is shown in Fig.\xa0<xref rid="134_2021_6373_Fig1_HTML" ref-type="fig">1</xref>. Data on the prevalence of the light beam (as a binary variable) in the different clinical subgroups are shown in Online Resource 6.. Data on the prevalence of the light beam (as a binary variable) in the different clinical subgroups are shown in Online Resource 6.Table 2Diagnostic accuracy of LUS in patients suspected of COVID-19 considering HighLUS (positive exam) vs LowLUS/IntLUS/AltLUS (negative exam), or HighLUS/IntLUS (positive exam) vs LowLUS/AltLUS (negative exam) with RT-PCR as gold standardOverall population (n\u2009=\u20091462)Mild phenotype (n\u2009=\u2009402)Mixed phenotype (n\u2009=\u2009335)Severe phenotype (n\u2009=\u2009725)Respiratory failure* (n\u2009=\u2009497)HighLUSHighLUS/IntLUSHighLUSHighLUS/IntLUSHighLUSHighLUS/IntLUSHighLUSHighLUS/IntLUSHighLUSHighLUS/IntLUSSensitivity60.3 (57.2–63.3)90.2 (88.2–92.0)31.5 (25.5–38.1)67.6 (61.0–73.7)67.6 (60.8–74.0)94.7 (90.1–97.3)68.5 (64.6–72.2)97.1 (95.5–98.3)69.2 (64.6–73.5)99.3 (98.0–99.9)Specificity88.9 (85.6–91.7)52.5 (47.7–57.3)94.4 (90.0–97.3)63.9 (56.4–70.9)88.3 (81.4–93.3)50.0 (41.0–59.0)81.8 (74.2–88.0)39.4 (31.0–48.3)82.3 (70.5–90.8)35.5 (23.7–48.7)Positive PV92.6 (90.6–94.3)81.5 (80.0–83.0)87.5 (78.8–93.0)69.8 (65.1–74.1)90.3 (85.2–93.8)75.4 (72.0–78.5)94.4 (92.2–96.1)87.8 (86.3–89.2)96.5 (94.1–97.9)91.5 (90.0–92.9)Negative PV49.1 (47.0–51.1)69.8 (65.3–74.0)52.8 (50.4–55.2)61.5 (56.2–66-5)62.8 (57.8–67.5)85.3 (76.1–91.4)36.6 (33.4–40.0)75.4 (64.7–83.7)27.6 (24.1–31.4)88.0 (69.3–96.0)Accuracy68.9 (66.4–71.3)78.9 (76.7–80.9)59.7 (54.7–64.5)65.9 (61.1–70.6)75.5 (70.6–80.0)77.6 (72.7–82.0)70.9 (67.4–74.2)86.6 (83.9–89.1)70.8 (66.6–74.8)91.4 (88.5–93.7)Results are shown in the overall population and in the four clinical groups. Values are in percentage with 95% confidence intervals (in brackets)LUS lung ultrasound, COVID-19 COrona VIrus Disease 2019, HighLUS high-probability lung ultrasound pattern, IntLUS intermediate-probability lung ultrasound pattern, LowLUS low-probability lung ultrasound pattern, AltLUS alternative probability lung ultrasound pattern, PV predictive value*The respiratory failure group is a subgroup of the severe phenotypeFig. 1Representative images of the four probability patterns in symptomatic patients, showing the distribution of the LUS signs of COVID-19 pneumonia. First row: bilateral distribution of typical LUS interstitial signs (high probability) in a case RT-PCR positive. Second row: monolateral distribution of interstitial LUS signs (intermediate probability) in a case RT-PCR positive. Third row: presence of atypical signs (alternative probability) in a case showing an isolated large consolidation with air bronchograms, due to bacterial pneumonia, and RT-PCR negative. Fourth row: absence of interstitial LUS signs (low probability) in a case RT-PCR negative. LUS lung ultrasound, COVID-19 Corona Virus Disease 2019, RT-PCR reverse transcriptase-polymerase chain reaction'], '134_2021_6373_Fig2_HTML': ['Our findings show that some combinations between LUS patterns of probability for COVID-19 pneumonia and the clinical phenotype at presentation are accurate in predicting the result of the RT-PCR in patients with suspected SARS-CoV-2 infection. This standardized LUS protocol has shown low inter-operator variability among the US and European centers involved. Figure\xa0<xref rid="134_2021_6373_Fig2_HTML" ref-type="fig">2</xref> reports the proposed operative algorithm based on LUS signs, and Fig.\xa0 reports the proposed operative algorithm based on LUS signs, and Fig.\xa0<xref rid="134_2021_6373_Fig3_HTML" ref-type="fig">3</xref> details the main practical conclusions of our study. details the main practical conclusions of our study.Fig. 2Proposed operative algorithm on the interpretation of LUS signs in the first approach to patients suspected of COVID-19 pneumonia. The algorithm must be considered as a schematic guidance to be always clinically integrated with the overall picture, and never in isolation. Notes: *highly suggestive of bacterial pneumonia with isolated consolidation\xa0of large size and with dynamic air bronchogram; **suggestive of cardiogenic edema when visualized bilaterally with homogeneous and gravity-related distribution; ***when multiple clusters with light beam, coalescent B-lines and pleural irregularities are observed monolaterally (multifocal), it may be still classified HighLUS. HighLUS high-probability lung ultrasound pattern, LowLUS low-probability lung ultrasound pattern, IntLUS intermediate-probability lung ultrasound pattern, AltLUS alternative probability lung ultrasound pattern, COVID-19 Corona Virus Disease 2019.Fig. 3Proposed operative flowchart on early management of patients suspected of COVID-19 during a pandemic surge, according to the clinical evaluation at presentation and the assignment of the LUS probability pattern. Final decision should consider that the protocol allows to rule-in or rule-out COVID-19 as the main cause of the presenting symptoms. HighLUS high-probability lung ultrasound pattern, LowLUS low-probability lung ultrasound pattern, IntLUS intermediate-probability lung ultrasound pattern, AltLUS alternative probability lung ultrasound pattern, COVID-19 Corona Virus Disease 2019'], '134_2021_6373_Fig4_HTML': ['The light beam, a relevant sign in the definition of the HighLUS, is also a strong independent predictor of RT-PCR positivity. We speculate that this sign can be the ultrasound representation of the very early interstitial involvement corresponding to the ground-glass opacities that are typically visible on CT studies in the lung periphery during the initial phase of the disease (Fig.\xa0<xref rid="134_2021_6373_Fig4_HTML" ref-type="fig">4</xref>) [) [13–15]. The light beam is not specific for COVID-19, as it can be seen in other conditions not necessarily COVID-related; however, it is a typical feature of the LUS pattern in COVID-19 pneumonia, and its presence during a pandemic surge should prompt high suspicion for COVID-19 pulmonary involvement.Fig. 4The case of a 65-year-old patient complaining of fever, cough, and fatigue for 4\xa0days, without signs of respiratory failure and showing normal saturation in room air. The CT scan shows bilateral early smooth GGO affecting main part of the lung periphery. The correspondent LUS exam shows the typical interstitial signs with patchy distribution well characterized by the “light beam” in abrupt alternance with “spared areas”. CT computed tomography, LUS lung ultrasound, GGO ground-glass opacity']} | Lung ultrasound for the early diagnosis of COVID-19 pneumonia: an international multicenter study | [
"Lung ultrasound",
"SARS-CoV-2",
"COVID-19",
"Interstitial pneumonia"
] | Intensive Care Med | 1616223600 | None | null | other | PMC7980130 | null | null | [
""
] | Intensive Care Med. 2021 Mar 20; 47(4):444-454 | NO-CC CODE |
|
A non-enhanced coronal paranasal CT scan of 36-year-old lady presented only with sudden anosmia and headache showing obstruction of olfactory cleft by kissing mucosal swelling B. Chest CT scan of the same patient, after showing COVID-19 symptoms. The sense of smell was recovered after 8 days of onset | 10072_2020_4590_Fig1_HTML | 7 | 6809cb2f25a768570bad8836178336422c5d14263c0953ab679aaec651a8547c | 10072_2020_4590_Fig1_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
762,
288
] | [{'image_id': '10072_2020_4590_Fig1_HTML', 'image_file_name': '10072_2020_4590_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7354355/10072_2020_4590_Fig1_HTML.jpg', 'caption': 'A non-enhanced coronal paranasal CT scan of 36-year-old lady presented only with sudden anosmia and headache showing obstruction of olfactory cleft by kissing mucosal swelling B. Chest CT scan of the same patient, after showing COVID-19 symptoms. The sense of smell was recovered after 8\xa0days of onset', 'hash': '6809cb2f25a768570bad8836178336422c5d14263c0953ab679aaec651a8547c'}] | {'10072_2020_4590_Fig1_HTML': ['Trotier et al. [29] showed that in some patients with idiopathic olfactory loss, the inflammatory obstruction can be found only in the olfactory clefts, and not in the rest of the nasal cavities and sinuses. Hoffmann et al. [34] showed that the SARS-CoV-2 infects cells through interactions between its spike (S) protein and the ACE2 protein on target cells. This interaction requires cleavage of the S protein by the cell surface protease TMPRSS. Base on analyzing the RNA-sequencing datasets, Brann et al. [33] found that both ACE2 and TMPRSS are expressed by olfactory epithelial supporting cell and stem cells, and not olfactory sensory neurons, per se. Accordingly, they hypothesized that the infection of these cells is the cause of olfactory dysfunction in patients with COVID-19 [34]. We know that the infected cells secret pro-inflammatory cytokines and chemokines, resulting in an influx of inflammatory cells [9]. This reaction can also lead to localized mucosal edema in the narrow olfactory cleft, hindering the odors pass to the olfactory mucosa (Fig.\xa0<xref rid="10072_2020_4590_Fig1_HTML" ref-type="fig">1</xref>) [) [35]. This mechanism can also affect the neurons as bystanders. However, the neuroinvasiveness of some coronaviruses, including SARS-CoV, has demonstrated in both mice and humans [36]. Accordingly, there are imaging studies of the brain by MRI, showing a transient increase in volume or hyperintensity of the olfactory bulb and the brain regions that are associated with olfaction [37, 38]. It seems that more pathologic investigations on the involved nasal mucosa or cadaveric brain specimens are needed to find out the exact responsible mechanisms.Fig. 1A non-enhanced coronal paranasal CT scan of 36-year-old lady presented only with sudden anosmia and headache showing obstruction of olfactory cleft by kissing mucosal swelling B. Chest CT scan of the same patient, after showing COVID-19 symptoms. The sense of smell was recovered after 8\xa0days of onset']} | Frequency and outcome of olfactory impairment and sinonasal involvement in hospitalized patients with COVID-19 | [
"Olfaction disorders",
"Pandemics",
"Smell",
"Taste"
] | Neurol Sci | 1594537200 | None | null | other | PMC7354355 | null | null | [
""
] | Neurol Sci. 2020 Jul 12; 41(9):2331-2338 | NO-CC CODE |
|
Pelvic extraperitoneal hemorrhage. (a) Axial CTA image revealed a large amount of pelvic extraperitoneal hemorrhage, showing blood fluid level (long arrow), the patient also had left rectus sheath hematoma with foci of active bleeding (small arrows). (b) Axial CTA image revealed a large amount of pelvic extraperitoneal hemorrhage, showing foci of active bleeding (arrows). | gr4_lrg | 7 | 07a82a0f7259d3e9f04db8229c33e3b275e4bacb2749db408f2688624e3ef5b8 | gr4_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
791,
319
] | [{'image_id': 'gr5_lrg', 'image_file_name': 'gr5_lrg.jpg', 'image_path': '../data/media_files/PMC8044556/gr5_lrg.jpg', 'caption': 'Arterial thrombosis. (a) Axial CTA image revealed acute thrombus partially occluding the distal abdominal aorta. (b) Axial CTA image at a lower level revealed an extension of the thrombus to the left common iliac and external iliac arteries in (c).', 'hash': '3dcae6d5220dbcb2ab7f88ffde446c1546051501bd9a3b6d87fa8ccb5cfd6c22'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC8044556/gr1_lrg.jpg', 'caption': 'Intramuscular hematoma-Psoas hematoma. (a) Axial non-contrast CT revealed hyperdense fresh hematoma in the right psoas muscle. (b) Axial CTA image revealed sizable left psoas hemorrhage with contrast extravasation suggesting active bleeding.', 'hash': '57a544854266d0909579d8898fb64d946a59bd881c58250734bfe9daf01ae0b5'}, {'image_id': 'gr4_lrg', 'image_file_name': 'gr4_lrg.jpg', 'image_path': '../data/media_files/PMC8044556/gr4_lrg.jpg', 'caption': 'Pelvic extraperitoneal hemorrhage. (a) Axial CTA image revealed a large amount of pelvic extraperitoneal hemorrhage, showing blood fluid level (long arrow), the patient also had left rectus sheath hematoma with foci of active bleeding (small arrows). (b) Axial CTA image revealed a large amount of pelvic extraperitoneal hemorrhage, showing foci of active bleeding (arrows).', 'hash': '07a82a0f7259d3e9f04db8229c33e3b275e4bacb2749db408f2688624e3ef5b8'}, {'image_id': 'gr8_lrg', 'image_file_name': 'gr8_lrg.jpg', 'image_path': '../data/media_files/PMC8044556/gr8_lrg.jpg', 'caption': 'Bowel ischemia. (a) Axial CTA image revealed mural thickening and non- enhancement of the small bowel loops in the left side (white arrows) with a mild intraperitoneal collection. The patient died before surgical exploration. (b) A large wedge-shaped splenic infarct is also noted. (c) Axial CT chest in the same patient revealed features of late COVID-19 pneumonia in the form of predominantly bilateral peripheral consolidations and few ground-glass opacities.', 'hash': '354a5f9bafb5a4e155ec887c6a659227688e7813597c2d3b7f0c25ec21f291ea'}, {'image_id': 'gr6_lrg', 'image_file_name': 'gr6_lrg.jpg', 'image_path': '../data/media_files/PMC8044556/gr6_lrg.jpg', 'caption': 'Venous thrombosis. (a) Coronal CTA image in the venous phase showed filling defect with near-complete occlusion of the infrarenal inferior vena cava (IVC) (arrows). Extracorporeal membrane oxygenation device (ECMO) is inserted. (b) Axial CT chest in the same patient revealed COVID-19 pneumonia in the form of bilateral large consolidations and ground-glass opacities.', 'hash': 'aa28943c7e70911cc1cce026589e561f6e866bd6ffb2fe33347eb8a005f74435'}, {'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC8044556/gr2_lrg.jpg', 'caption': 'Intramuscular hematoma-Bilateral iliopsoas hematoma. (a) Axial CTA image revealed large right psoas compartment hemorrhage, showing blood fluid level (arrow) (b) Follow up in the same patient 3\xa0weeks later revealed sizable bilateral psoas compartment hematomas as well as a large pelvic hematoma. (c) Axial CTV revealed left iliopsoas hematoma and iliacus hematoma on the right side.', 'hash': '0dd630b674eb655027f98e1c9ef8a9fc1a25d9fb88432c38a4eb3e769abf285e'}, {'image_id': 'gr7_lrg', 'image_file_name': 'gr7_lrg.jpg', 'image_path': '../data/media_files/PMC8044556/gr7_lrg.jpg', 'caption': 'Splenic infarction. (a) Axial CTV revealed multiple wedge-shaped areas of hypoattenuation in the spleen indicative of multifocal splenic infarcts. (b) Axial CTA image revealed hypodensity with the spleen suggestive of the splenic infarct.', 'hash': 'b89374ac1581abd482cc39f2b2744aa0b580cfcc5839260bca386ce92385ac54'}, {'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC8044556/gr3_lrg.jpg', 'caption': 'Intramuscular hematoma-Rectus sheath hematoma. (a) Axial CTA image revealed hematoma involving the left rectus sheath, no active bleeding.', 'hash': 'b83092f2f2035ec12467c7ae59ced981478e75d7dce1baf00ad63cf3df9610de'}] | {'gr1_lrg': ['Hemorrhagic complications were diagnosed in 19 patients. The intramuscular hematoma was detected in 17 patients. It involved the iliopsoas compartment unilaterally in 10 patients (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>\n), bilaterally in 2 patients (\n), bilaterally in 2 patients (<xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>\n), and the rectus sheath in 5 cases (\n), and the rectus sheath in 5 cases (<xref rid="gr3_lrg" ref-type="fig">Fig. 3</xref>\n). Out of these 17 patients, 11 patients were admitted to the ICU. On CT scans, fresh hemorrhage was seen as a discrete mass of high attenuation within the muscle (\n). Out of these 17 patients, 11 patients were admitted to the ICU. On CT scans, fresh hemorrhage was seen as a discrete mass of high attenuation within the muscle (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>a). Active contrast extravasation in the arterial phase was detected in 6 patients (a). Active contrast extravasation in the arterial phase was detected in 6 patients (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>b). Pelvic extraperitoneal hemorrhage was found in 3 patients (b). Pelvic extraperitoneal hemorrhage was found in 3 patients (<xref rid="gr4_lrg" ref-type="fig">Fig. 4</xref>\n). CT scan in these patients showed large pelvic blood collection. A fluid-fluid level was found in one patient mostly owing to the hematocrit effect (\n). CT scan in these patients showed large pelvic blood collection. A fluid-fluid level was found in one patient mostly owing to the hematocrit effect (<xref rid="gr4_lrg" ref-type="fig">Fig. 4</xref>a). Active contrast extravasation in the arterial phase was detected in one patient. Out of these 3 patients with pelvic extraperitoneal hemorrhage, 2 patients had associated intramuscular hematoma (one in the rectus sheath and one in iliopsoas compartments bilaterally). The mesenteric hematoma was diagnosed in one ICU patient. Regarding thromboprophylaxis, 5 patients received the standard prophylactic dose, 4 patients (21.1%) received intermediate-dose thromboprophylaxis and 10 patients (52.6%) received therapeutic dose of anticoagulation.a). Active contrast extravasation in the arterial phase was detected in one patient. Out of these 3 patients with pelvic extraperitoneal hemorrhage, 2 patients had associated intramuscular hematoma (one in the rectus sheath and one in iliopsoas compartments bilaterally). The mesenteric hematoma was diagnosed in one ICU patient. Regarding thromboprophylaxis, 5 patients received the standard prophylactic dose, 4 patients (21.1%) received intermediate-dose thromboprophylaxis and 10 patients (52.6%) received therapeutic dose of anticoagulation.Fig. 1Intramuscular hematoma-Psoas hematoma. (a) Axial non-contrast CT revealed hyperdense fresh hematoma in the right psoas muscle. (b) Axial CTA image revealed sizable left psoas hemorrhage with contrast extravasation suggesting active bleeding.Fig. 1Fig. 2Intramuscular hematoma-Bilateral iliopsoas hematoma. (a) Axial CTA image revealed large right psoas compartment hemorrhage, showing blood fluid level (arrow) (b) Follow up in the same patient 3\xa0weeks later revealed sizable bilateral psoas compartment hematomas as well as a large pelvic hematoma. (c) Axial CTV revealed left iliopsoas hematoma and iliacus hematoma on the right side.Fig. 2Fig. 3Intramuscular hematoma-Rectus sheath hematoma. (a) Axial CTA image revealed hematoma involving the left rectus sheath, no active bleeding.Fig. 3Fig. 4Pelvic extraperitoneal hemorrhage. (a) Axial CTA image revealed a large amount of pelvic extraperitoneal hemorrhage, showing blood fluid level (long arrow), the patient also had left rectus sheath hematoma with foci of active bleeding (small arrows). (b) Axial CTA image revealed a large amount of pelvic extraperitoneal hemorrhage, showing foci of active bleeding (arrows).Fig. 4'], 'gr5_lrg': ['Arterial occlusion was diagnosed in 2 patients; both of them were admitted to the ICU. CTA of the abdomen and pelvis in both cases revealed thrombus totally occluding the distal abdominal aorta just before bifurcation, and extending to involve the left common and external iliac arteries (<xref rid="gr5_lrg" ref-type="fig">Fig. 5</xref>\n).\n).Fig. 5Arterial thrombosis. (a) Axial CTA image revealed acute thrombus partially occluding the distal abdominal aorta. (b) Axial CTA image at a lower level revealed an extension of the thrombus to the left common iliac and external iliac arteries in (c).Fig. 5'], 'gr6_lrg': ['Venous thrombosis involving the distal inferior vena cava (IVC) and common iliac veins was diagnosed in 4 patients. Three patients were admitted to the ICU, one of them required extracorporeal membrane oxygenation (ECMO) (<xref rid="gr6_lrg" ref-type="fig">Fig. 6</xref>\n).\n).Fig. 6Venous thrombosis. (a) Coronal CTA image in the venous phase showed filling defect with near-complete occlusion of the infrarenal inferior vena cava (IVC) (arrows). Extracorporeal membrane oxygenation device (ECMO) is inserted. (b) Axial CT chest in the same patient revealed COVID-19 pneumonia in the form of bilateral large consolidations and ground-glass opacities.Fig. 6'], 'gr7_lrg': ['Intra-abdominal organ infarct was diagnosed in 4 patients; 2 patients had splenic infarcts, only 1 patient developed small bowel ischemia, and one patient had both splenic and small bowel infarcts. Splenic infarcts appeared as single large wedge-shaped hypodensity in two cases, and multiple wedge-shaped areas of hypoattenuation in one case (<xref rid="gr7_lrg" ref-type="fig">Fig. 7</xref>\n). Splenic vessels were patent. In both patients with bowel ischemia, CTA revealed the absence of mucosal enhancement, and luminal dilatation (\n). Splenic vessels were patent. In both patients with bowel ischemia, CTA revealed the absence of mucosal enhancement, and luminal dilatation (<xref rid="gr8_lrg" ref-type="fig">Fig. 8</xref>\n), mesenteric vasculature was patent. Two patients had iliac vein thrombosis and in addition, they developed other thrombotic complications (one patient had splenic infarct and the other patient had splenic infarct and ischemic bowel changes).\n), mesenteric vasculature was patent. Two patients had iliac vein thrombosis and in addition, they developed other thrombotic complications (one patient had splenic infarct and the other patient had splenic infarct and ischemic bowel changes).Fig. 7Splenic infarction. (a) Axial CTV revealed multiple wedge-shaped areas of hypoattenuation in the spleen indicative of multifocal splenic infarcts. (b) Axial CTA image revealed hypodensity with the spleen suggestive of the splenic infarct.Fig. 7Fig. 8Bowel ischemia. (a) Axial CTA image revealed mural thickening and non- enhancement of the small bowel loops in the left side (white arrows) with a mild intraperitoneal collection. The patient died before surgical exploration. (b) A large wedge-shaped splenic infarct is also noted. (c) Axial CT chest in the same patient revealed features of late COVID-19 pneumonia in the form of predominantly bilateral peripheral consolidations and few ground-glass opacities.Fig. 8']} | Abdominal Computed Tomography Angiography and Venography in Evaluation of Hemorrhagic and Thrombotic lesions in Hospitalized COVID-19 patients | [
"Coronavirus disease 2019",
"Computed tomography angiography",
"Computed tomography venography"
] | Clin Imaging | 1636876800 | [{'@Label': 'BACKGROUND', '#text': 'The follow-up of recovered COVID-19 patients is still limited. We aimed to evaluate the changes in quality-of-life (QOL) and spirometric alterations in the convalescent phase of 115 patients with at least 30 days post-COVID-19.'}, {'@Label': 'METHODS', '#text': 'We included patients with confirmed COVID-19 infection, available past medical records and at least 30 days after the onset of symptoms. All patients were asked to rate their general health condition before and after COVID-19 using the EQ-5D-5L standardized questionary and perform a spirometry at evaluation.'}, {'@Label': 'RESULTS', '#text': 'In this study, that included 70%(81/115) of patients with mild or moderate COVID-19; there was a severe decrease in QOL up to 56%(64/115). Alterations in usual activities and anxiety/depression were present in 59% of patients with a severe decrease in QOL. The persistence of symptoms was present in 63%(72/115). Restrictive lung impairment was the most common spirometric alteration in 17%(20/115), of whom 65%(13/20) had mild COVID-19.'}, {'@Label': 'CONCLUSIONS', '#text': 'Spirometric alterations are presented even in mild COVID-19, and more remarkably, there is a high rate of alterations in quality of life after the recovery of this disease.'}] | [
"Adult",
"Anxiety",
"COVID-19",
"Depression",
"Female",
"Health Status",
"Humans",
"Lung",
"Male",
"Middle Aged",
"Quality of Life",
"Severity of Illness Index",
"Spirometry",
"Surveys and Questionnaires",
"Time Factors"
] | other | PMC8044556 | null | 10 | [
"{'Citation': 'Carfì A., Bernabei R., Landi F. For the gemelli against COVID-19 post-acute care study group. Persistent symptoms in patients after acute COVID-19. J. Am. Med. Assoc. 2020;324(6):603–605. doi: 10.1001/jama.2020.12603.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1001/jama.2020.12603'}, {'@IdType': 'pmc', '#text': 'PMC7349096'}, {'@IdType': 'pubmed', '#text': '32644129'}]}}",
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"{'Citation': 'EuroQol Research Foundation EQ-5D-5L user guide. 2019. https://euroqol.org/publications/user-guides'}",
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"{'Citation': 'Mo X., Jian W., Su Z., Chen M., Peng H., Peng P., Lei C., Chen R., Zhong N., Li S. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur. Respir. J. 2020;55(6):2001217. doi: 10.1183/13993003.01217-2020. PMID: 32381497; PMCID: PMC7236826.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1183/13993003.01217-2020'}, {'@IdType': 'pmc', '#text': 'PMC7236826'}, {'@IdType': 'pubmed', '#text': '32381497'}]}}",
"{'Citation': 'ou J., Zhang L., Ni-Jia-Ti M.Y., Zhang J., Hu F., Chen L., Dong Y., Yang K., Zhang B., Zhang S. A normal pulmonary function and residual CT abnormalities in rehabilitating COVID-19 patients after discharge. J. Infect. 2020;81(2):e150–e152. doi: 10.1016/j.jinf.2020.06.003. Epub 2020 Jun 05. PMID: 32512021; PMCID: PMC7273134.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/j.jinf.2020.06.003'}, {'@IdType': 'pmc', '#text': 'PMC7273134'}, {'@IdType': 'pubmed', '#text': '32512021'}]}}",
"{'Citation': 'Huang Y., Tan C., Wu J., Chen M., Wang Z., Luo L., Zhou X., Liu X., Huang X., Yuan S., Chen C., Gao F., Huang J., Shan H., Liu J. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respir. Res. 2020;21(1):163. doi: 10.1186/s12931-020-01429-6. PMID: 32600344; PMCID: PMC7323373.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1186/s12931-020-01429-6'}, {'@IdType': 'pmc', '#text': 'PMC7323373'}, {'@IdType': 'pubmed', '#text': '32600344'}]}}",
"{'Citation': 'Rubin R. As their numbers grow, COVID-19 \"long haulers\" stump experts. J. Am. Med. Assoc. 2020 doi: 10.1001/jama.2020.17709. Epub ahead of print.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1001/jama.2020.17709'}, {'@IdType': 'pubmed', '#text': '32965460'}]}}",
"{'Citation': 'Goërtz Y.M.J., Van Herck M., Delbressine J.M., Vaes A.W., Meys R., Machado F.V.C., Houben-Wilke S., Burtin C., Posthuma R., Franssen F.M.E., van Loon N., Hajian B., Spies Y., Vijlbrief H., van ’t Hul A.J., Janssen D.J.A., Spruit M.A. Persistent symptoms 3\\u2005months after a SARS-CoV-2 infection: the post-COVID-19 syndrome? ERJ Open Res. 2020 00542-2020. doi: 10.1183/23120541.00542-2020. PMCID: PMC7491255.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7491255'}, {'@IdType': 'pubmed', '#text': '33257910'}]}}"
] | Clin Imaging. 2021 Nov 14; 79:12-19 | NO-CC CODE |
|
Liver herniation intrathoracicaly (contrast enhanced computed tomography, coronal multi-planar reformatting). | cp-2012-1-e3-g001 | 7 | 99881f450def7311b6a84d2a2096efc46cd55e720cd49f42028b7ad645307b93 | cp-2012-1-e3-g001.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
500,
472
] | [{'image_id': 'cp-2012-1-e3-g001', 'image_file_name': 'cp-2012-1-e3-g001.jpg', 'image_path': '../data/media_files/PMC3981329/cp-2012-1-e3-g001.jpg', 'caption': 'Liver herniation intrathoracicaly (contrast enhanced computed tomography, coronal multi-planar reformatting).', 'hash': '99881f450def7311b6a84d2a2096efc46cd55e720cd49f42028b7ad645307b93'}, {'image_id': 'cp-2012-1-e3-g002', 'image_file_name': 'cp-2012-1-e3-g002.jpg', 'image_path': '../data/media_files/PMC3981329/cp-2012-1-e3-g002.jpg', 'caption': 'Defect in the diaphragma and herniated liver into the thoracic cavity.', 'hash': '692724df5b4367d3eb725aa4789e5116462a28211bdb7c656462af3eea772268'}] | {'cp-2012-1-e3-g001': ['A 11-year-old boy, 35 kg, was involved in a car crash, as the nearside passanger. He was admitted to the Intensive care unit, where he was intubated and ventilated. The patient was hemodynamically stable. Computed tompgraphy (CT) of the chest and abdomen showed a subcapsular liver hematom, right lung contusion and a minor hemothorax. The patient also had a right femur diaphysis fracture, which was resolved by external fixation, and a right acetabulum fracture without dislocation. On the second post-traumatic day, 1 hour after transfering to spontaneous ventilation, the patient underwent a breathing distress. A X-ray and CT of the chest was carried out (<xref ref-type="fig" rid="cp-2012-1-e3-g001">Figure 1</xref>), with the find of thoracicaly herniated liver. A operational revision was indicated. A right sided, subcostal laparotomy was carried out, where the liver was found to be completely herniated intrathoracicaly. The liver was herniated into the chest through a 15 cm diaphragm rupture, like a button through a buttonhole (), with the find of thoracicaly herniated liver. A operational revision was indicated. A right sided, subcostal laparotomy was carried out, where the liver was found to be completely herniated intrathoracicaly. The liver was herniated into the chest through a 15 cm diaphragm rupture, like a button through a buttonhole (<xref ref-type="fig" rid="cp-2012-1-e3-g002">Figure 2</xref>). A suture of the defect was carried out by seperate matress sutures (3–0 Ethibond). The patient was extubated after 24 hours. Due to dyspnoea, and a fluidothorax in the right pleuric cavity, the patient was tubed again, a pleuric drain was also applied. At the 7). A suture of the defect was carried out by seperate matress sutures (3–0 Ethibond). The patient was extubated after 24 hours. Due to dyspnoea, and a fluidothorax in the right pleuric cavity, the patient was tubed again, a pleuric drain was also applied. At the 7th post-traumatic day, the drain was removed. Atelectasis of the bottom right lobe was prevelant. 9th post-traumatic day, a CT was carried out and a thoracoscopic surgery, with the goal of aspirating the fluidothorax and placement of a right side thoracic drain, indicated. After this, the ventilation improved and the patient was extubated on the 14th post-traumatic day. The thoracic drain was removed on the 18th post-traumatic day. The following development was without complication. The patient was released on the 23rd post-traumatic day. No complications were found during the following check ups.']} | Delayed diagnosis of a right-sided traumatic diaphragmatic rupture | [
"diaphragm",
"injury",
"complications."
] | Clin Pract | 1325232000 | Right-sided traumatic diaphragmatic rupture in childhood is a very rare injury. Diaphragmatic rupture often manifests itself later, after an organ progressively herniates into the pleural cavity. When the patient is tubed, the ventilation pressure does not allow herniation of an organ, which occurs when the patient is ex-tubed. We present a patient with a delayed diagnose of right sided diaphragmatic rupture with a complicated post-operation state. | [] | other | PMC3981329 | null | 10 | [
"{'Citation': 'Rosati C. Acute traumatic injury of the diaphragm. Chest Surg Clin N Am. 1998;8:371–9.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9619310'}}}",
"{'Citation': 'Simpson J, Lobo DN, Shah AB, et al. Traumatic diaphragmatic rupture: associated injury and outcome. Ann R Coll Surg Engl. 2000;82:97–100.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2503527'}, {'@IdType': 'pubmed', '#text': '10743425'}]}}",
"{'Citation': 'Meyers BF, McCabe CJ. Traumatic diaphragmatic hernia. Occult marker of serious injury. Ann Surg. 1993;218:783–90.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC1243075'}, {'@IdType': 'pubmed', '#text': '8257229'}]}}",
"{'Citation': 'Shehata SM, Shabaan BS. Diaphragmatic injuries in children after blunt abdominal trauma. J Pediatr Surg. 2006;41:1727–31.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17011278'}}}",
"{'Citation': 'Steinau G, Bosman D, Dreuw B, et al. [Diaphragmatic injuries -- classification, diagnosis and therapy] Chirurg. 1997;68:509–12. [Article in German]', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9303841'}}}",
"{'Citation': 'Petrone P, Leppaniemi A, Inaba K, et al. Diaphragmatic injuries: challenges in the diagnosis and management. Trauma. 2007;9:227–36.'}",
"{'Citation': 'Yilmaz M, Isik B, Ara C, et al. Gastric perforation during chest tube placement for acute diaphragmatic rupture and review of the literature. Injury Extra. 2006;37:71–5.'}",
"{'Citation': 'Gwely NN. Outcome of blunt diaphragmatic rupture. Analysis of 44 cases. Asian Cardiovasc Thorac Ann. 2010;18:240–3.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '20519291'}}}",
"{'Citation': 'Esme H, Solak O, Sahin DA, Sezer M. Blunt and penetrating traumatic ruptures of the diaphragm. Thorac Cardiovasc Surg. 2006;54:324–7.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16902880'}}}",
"{'Citation': 'Ouazzani A, Guerin E, Capelluto E, et al. A laparoscopic approach to left diaphragmatic rupture after blunt trauma. Acta Chir Belg. 2009;109:228–31.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19499686'}}}"
] | Clin Pract. 2011 Dec 30; 2(1):e3 | NO-CC CODE |
|
Computed tomography scan showing focal destruction of the bone of anterior palate (circled area) to the left anterior maxillary region (arrow). | cp-2012-1-e28-g002 | 7 | b6d407e6edecad898941d045132f40065189336ff0de626d86d99ae200b28195 | cp-2012-1-e28-g002.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
500,
349
] | [{'image_id': 'cp-2012-1-e28-g006', 'image_file_name': 'cp-2012-1-e28-g006.jpg', 'image_path': '../data/media_files/PMC3981330/cp-2012-1-e28-g006.jpg', 'caption': 'Microphotographs showing non-septate, broad, branched fungal hyphae (H & E stain, Original magnification ×400).', 'hash': '6187ba47dfc8372215e58b4844e5ff7f6bf7f453598ba3ee0267444645ff9edd'}, {'image_id': 'cp-2012-1-e28-g001', 'image_file_name': 'cp-2012-1-e28-g001.jpg', 'image_path': '../data/media_files/PMC3981330/cp-2012-1-e28-g001.jpg', 'caption': 'Clinical photograph showing ulcer with necrosis in the anterior palate extending to alveolar bone of left lateral incisor and canine (arrows showing the necrotic bone).', 'hash': 'e998ba1da4fa2975360a58f1a30ab78f1f34384a83da13afcf8c313e374ca51e'}, {'image_id': 'cp-2012-1-e28-g008', 'image_file_name': 'cp-2012-1-e28-g008.jpg', 'image_path': '../data/media_files/PMC3981330/cp-2012-1-e28-g008.jpg', 'caption': 'Photograph showing the obturator for the oro-nasal fistula.', 'hash': '9edfc877cc93ac2aff19b2a55fe5ccff841ea27bd70f9060e3a65bcae31def31'}, {'image_id': 'cp-2012-1-e28-g007', 'image_file_name': 'cp-2012-1-e28-g007.jpg', 'image_path': '../data/media_files/PMC3981330/cp-2012-1-e28-g007.jpg', 'caption': 'Post-operative photograph showing the oro-nasal fistula (arrows).', 'hash': 'c9a97c10c31893ff1017394cbfe88f79d8ec84ed43f46fa9c38e552017ca27d6'}, {'image_id': 'cp-2012-1-e28-g004', 'image_file_name': 'cp-2012-1-e28-g004.jpg', 'image_path': '../data/media_files/PMC3981330/cp-2012-1-e28-g004.jpg', 'caption': 'Photograph showing superior view of surgical specimen with involved teeth.', 'hash': '408a5fbef3a7d097ebd709ca90785799a7ed78ab3aa409d9ad08a4fee21cd014'}, {'image_id': 'cp-2012-1-e28-g003', 'image_file_name': 'cp-2012-1-e28-g003.jpg', 'image_path': '../data/media_files/PMC3981330/cp-2012-1-e28-g003.jpg', 'caption': 'Intra-operative image showing the area after the removal of necrotic bone.', 'hash': 'ea169a4bd3cc0b200aa5c6da988374470202e4f87f4e059df948a3fa5a9b3fd5'}, {'image_id': 'cp-2012-1-e28-g002', 'image_file_name': 'cp-2012-1-e28-g002.jpg', 'image_path': '../data/media_files/PMC3981330/cp-2012-1-e28-g002.jpg', 'caption': 'Computed tomography scan showing focal destruction of the bone of anterior palate (circled area) to the left anterior maxillary region (arrow).', 'hash': 'b6d407e6edecad898941d045132f40065189336ff0de626d86d99ae200b28195'}, {'image_id': 'cp-2012-1-e28-g005', 'image_file_name': 'cp-2012-1-e28-g005.jpg', 'image_path': '../data/media_files/PMC3981330/cp-2012-1-e28-g005.jpg', 'caption': 'Microphotograph showing non-septate branched fungal hyphae in a necrotic tissue (H & E stain, Original magnification ×250).', 'hash': '1d9abb9609b4d527db3a03b79b1cdd7072fc3fb5b393750e7efbcac009b9a9c1'}] | {'cp-2012-1-e28-g001': ['On intraoral examination, an infiltrating ulcer approximately 3×4.5 cm2 with irregular borders was appreciated over the hard palate. Ulcer was covered over by the necrotic slough and on the anterior part of the ulcer; the underlying bone was also exposed. Ulcer was nontender with signs of erythema over the margins (<xref ref-type="fig" rid="cp-2012-1-e28-g001">Figure 1</xref>). Maxillary left lateral incisor and canine were missing.). Maxillary left lateral incisor and canine were missing.'], 'cp-2012-1-e28-g002': ['Later the patient was sent for blood investigations, which revealed raised ESR (34 mm/1st hour) and random blood glucose level 460 mg/100mL. Tridot, HBs test and chest X ray were non-contributory. The computed tomography (CT) scan revealed focal destruction of the bone of anterior palate and in the left anterior maxillary region (<xref ref-type="fig" rid="cp-2012-1-e28-g002">Figure 2</xref>).).'], 'cp-2012-1-e28-g003': ['The patient underwent a partial maxillectomy (<xref ref-type="fig" rid="cp-2012-1-e28-g003">Figure 3</xref>) and the specimen was creamish white, non-vital, measured about 5×3 cm with rough surface () and the specimen was creamish white, non-vital, measured about 5×3 cm with rough surface (<xref ref-type="fig" rid="cp-2012-1-e28-g004">Figure 4</xref>). Microscopic examination of the specimen revealed bony spicules and dead lamellated bone around the fatty marrow showing ischemic necrosis. Numerous non-septate, broad, branching hyphae were seen within the necrotic marrow tissue (). Microscopic examination of the specimen revealed bony spicules and dead lamellated bone around the fatty marrow showing ischemic necrosis. Numerous non-septate, broad, branching hyphae were seen within the necrotic marrow tissue (<xref ref-type="fig" rid="cp-2012-1-e28-g005">Figures 5</xref> and and <xref ref-type="fig" rid="cp-2012-1-e28-g006">6</xref>). Thus, a final diagnosis of mucormycosis was arrived. A strict diabetic control and a course of amphotericin B were advised. He was rehabilitated with an obturator for the oro-nasal fistula (). Thus, a final diagnosis of mucormycosis was arrived. A strict diabetic control and a course of amphotericin B were advised. He was rehabilitated with an obturator for the oro-nasal fistula (<xref ref-type="fig" rid="cp-2012-1-e28-g007">Figures 7</xref> and and <xref ref-type="fig" rid="cp-2012-1-e28-g008">8</xref>) and was being followed up for the past 6 months and has no further complaints.) and was being followed up for the past 6 months and has no further complaints.']} | Mucormycosis of the hard palate masquerading as carcinoma | [
"fungal infection",
"mucormycosis",
"necrotic bone",
"phycomycetes",
"squamous cell carcinoma."
] | Clin Pract | 1329292800 | A growing number of medically compromised patients are encountered by dentists in their practices. Opportunistic fungal infections such as mucormycosis usually occur in immunocompromised patients but can infect healthy individuals as well. Mucormycosis is an acute opportunistic, uncommon, frequently fatal fungal infection, caused by a saprophytic fungus that belongs to the class of phycomycetes. Among the clinical differential diagnosis we can consider squamous cell carcinoma. Such cases present as chronic ulcers with raised margins causing exposure of underlying bone. There is a close histopathological resemblance between mucormycosis and aspergillosis. Microscopically, aspergillosis has septate branching hyphae, which can be distinguished from mucormycotic hyphae by a smaller width and prominent acute angulations of branching hyphae. A definitive diagnosis of mucormycosis can be made by tissue biopsy that identifies the characteristic hyphae, by positive culture or both. The culture of diseased tissue may be negative and histopathologic examination is essential for early diagnosis. Mucormycosis was long regarded as a fatal infection with poor prognosis. However with early medical and surgical management survival rates are now thought to exceed 80%. In the present case, the fungus was identified by hematoxylin and eosin stain and confirmed by Grocott's silver methenamine special staining technique. Removal of the necrotic bone, which acted as a nidus of infection, was done. Post-operatively patient was advised an obturator to prevent oronasal regurgitation. Since mucormycosis occurs infrequently, it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation. | [] | other | PMC3981330 | null | 27 | [
"{'Citation': 'Ruoppi P, Dietz A, Nikanne E, et al. Paranasal sinus mucormycosis: a report of two cases. Acta Otolaryngol. 2001;121:948–52.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11813901'}}}",
"{'Citation': 'Ketenci I, Unlü Y, Sentürk M, Tuncer E. Indolent mucormycosis of the sphenoid sinus. Otolaryngol Head Neck Surg. 2005;132:341–2.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15692554'}}}",
"{'Citation': 'Bhattacharyya AK, Deshpande AR, Nayak SR, et al. Rhinocerebral mucormycosis: an unusual case presentation. J Laryngol Otol. 1992;106:48–9.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1541891'}}}",
"{'Citation': 'Marx RE, Stern D. 1st ed. Hanover Park, IL: Quintessence Publishing Co, Inc; 2006. Oral and maxillofacial pathology: a rationale for diagnosis and treatment; pp. 104–106.'}",
"{'Citation': 'Salisbury PL, 3rd, Caloss R, Jr, Cruz JM, et al. Mucormycosis of the mandible after dental extractions in a patient with acute myelogenus leukemia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83:340–4.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9084196'}}}",
"{'Citation': 'Kim J, Fortson JK, Cook HE. A fatal outcome from rhinocerebral mucormycosis after dental extractions: a case report. J Oral Maxillofac Surg. 2001;59:693–7.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11381399'}}}",
"{'Citation': 'Yousem DM, Galetta SL, Gusnard DA, Goldberg HI. MR findings in rhinocerebral mucormycosis. J Comput Assist Tomogr. 1989;13:878–82.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2778146'}}}",
"{'Citation': 'Shetty SR, Punnya VA. Palatal mucormycosis:a rare clinical dilemma. Oral Surg. 2008;1:145–48.'}",
"{'Citation': 'Auluck A. Maxillary necrosis by mucormycosis. a case report and literature review. Med Oral Patol Oral Cir Bucal. 2007;12:E360–4.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17767099'}}}",
"{'Citation': 'Kyrmizakis DE, Doxas PG, Hajiioannou JK, Papadakis CE. Palate ulcer due to mucormycosis. J Laryngol Otol. 2002;116:146–7.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11827594'}}}",
"{'Citation': 'Succar MB, Nichols RD, Burch KH. Rhinocerebral mucormycosis. Arch Otolaryngol. 1979;105:212–4.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '426711'}}}",
"{'Citation': 'Bhansali A, Bhadada S, Sharma A, et al. Presentation and outcome of rhinoorbital-cerebral mucormycosis in patients with diabetes. Postgrad Med J. 2004;80:670–4.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC1743145'}, {'@IdType': 'pubmed', '#text': '15537854'}]}}",
"{'Citation': 'McNulty JS. Rhinocerebral mucormycosis: predisposing factors. Laryngoscope. 1982;92:1140–3.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '7132514'}}}",
"{'Citation': 'Jones AC, Bentsen TY, Freedman PD. Mucormycosis of the oral cavity. Oral Surg Oral Med Oral Pathol. 1993;75:455–60.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8464609'}}}",
"{'Citation': 'Rosen PP. Opportunistic fungal infections in patients with neoplastic diseases. Pathol Annu. 1976;11:255–315.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '794804'}}}",
"{'Citation': 'Sugar AM. Mucormycosis. Clin Infect Dis. 1992;14(Suppl 1):S126–9.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1562684'}}}",
"{'Citation': 'Tryfon S, Stanopoulos I, Kakavelas E, et al. Rhinocerebral mucormycosis in a patient with latent diabetes mellitus: a case report. J Oral Maxillofac Surg. 2002;60:328–30.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11887153'}}}",
"{'Citation': 'Jayachandran S, Krithika C. Mucor-mycosis presenting as palatal perforation. Indian J Dent Res. 2006;17:139–42.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17176832'}}}",
"{'Citation': 'Damante JH, Fleury RN. Oral and rhinoorbital mucormycosis: case report. J Oral Maxillofac Surg. 1998;56:267–71.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9461159'}}}",
"{'Citation': 'Spellberg B, Walsh TJ, Kontoyiannis DP, et al. Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis. 2009;48:1743–51.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2809216'}, {'@IdType': 'pubmed', '#text': '19435437'}]}}",
"{'Citation': 'Samaranayake LP, Cheung LK, Samaranayake YH. Candidiasis and other fungal diseases of the mouth. Dermatol Ther. 2002;15:252–70.'}",
"{'Citation': 'Breiman A, Sadowsky D, Friedman J. Mucormycosis. Discussion and report of a case involving the maxillary sinus. Oral Surg Oral Med Oral Pathol. 1981;52:375–8.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '6946358'}}}",
"{'Citation': 'Bonifaz A, Macias B, Paredes-Farrera F, et al. Palatal zygomycosis: experience of 21 cases. Oral Dis. 2008;14:569–74.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18248590'}}}",
"{'Citation': 'Tugsel Z, Sezer B, Akalin T. Facial swelling and palatal ulceration in a diabetic patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98:630–6.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15583532'}}}",
"{'Citation': 'Hauman CH, Raubenheimer EJ. Orofacial mucormycosis. Oral Surg Oral Med Oral Pathol. 1989;68:624–7.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2812716'}}}",
"{'Citation': 'Berger CJ, Disque FC, Topazian RG. Rhinocerebral mucormycosis: diagnosis and treatment. Report of two cases. Oral Surg Oral Med Oral Pathol. 1975;40:27–33.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1057138'}}}",
"{'Citation': 'Dogan MC, Leblebisatan G, Haytac MC, et al. Oral mucormycosis in children with leukemia: report of 2 cases. Quintessence Int. 2007 Jun;38:515–20.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17625636'}}}"
] | Clin Pract. 2012 Feb 15; 2(1):e28 | NO-CC CODE |
|
Pneumocystosis: An elderly female patient presented with incidentally detected splenic lesions. a Coronal plane T2W MR image showed hypointense lesions in the spleen (arrows) b Coronal plane postcontrast T1W image demonstrated peripheral enhancement in both lesions (arrows). Image-guided aspiration confirmed Pneumocystis jirovecii | 261_2021_3130_Fig20_HTML | 7 | 186f2deb4a03ca2406d6e277243e464d6f0c9e3a6ef3b323b3c8b51ef550e555 | 261_2021_3130_Fig20_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
707,
275
] | [{'image_id': '261_2021_3130_Fig15_HTML', 'image_file_name': '261_2021_3130_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig15_HTML.jpg', 'caption': 'Leishmaniasis: 25-year-old male patient with a history of unexplained fever, pancytopenia, and increased serum C-reactive protein levels was found to have splenomegaly and parenchymal heterogeneity on US image (not shown). Axial plane postcontrast CT image showed severely enlarged spleen and large hypodense areas (arrows). Histopathologic examination after splenectomy confirmed leishmaniasis', 'hash': '518f7122712241181e6762a11e9f897c299e419f037886b529d815924f761e21'}, {'image_id': '261_2021_3130_Fig3_HTML', 'image_file_name': '261_2021_3130_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig3_HTML.jpg', 'caption': 'Importance of accurate imaging phase in two different patients: a 64-year-old female patient with fever of unknown origin and weight loss. Axial plane postcontrast abdominal CT image showed multiple hypodense nodules in the spleen (arrowheads) due to the inappropriate imaging phase. This pseudonodular appearance completely disappeared on the repeat CT scan performed in the portal venous phase (not shown). b 44-year-old male patient with chronic kidney disease presented with abdominal pain. Axial plane postcontrast abdominal CT showed hypodense infiltrative appearance in the spleen (asterisk), thought to be suspicious for lymphoproliferative disease involvement. c Abdominal CT of the same patient in (b) performed 18 hours after the first CT scan. Control abdominal CT image in a later phase demonstrated homogenization of the spleen parenchyma with no apparent lesion', 'hash': '719d9bca828881e15f5a7b05255c0210cbb900b1412fa4aefccfb5a1ec9abd39'}, {'image_id': '261_2021_3130_Fig25_HTML', 'image_file_name': '261_2021_3130_Fig25_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig25_HTML.jpg', 'caption': 'Histopathologically proven splenic sarcoidosis: 36-year-old male patient with new-onset low-grade fever and cough. Axial plane postcontrast abdominal CT image shows multiple hypodense nodular lesions in both the liver and spleen (arrowheads). Note was also made of multiple enlarged lymph nodes in the paracaval and paraaortic regions (arrows)', 'hash': '8fdbafd5d2f25e0c7c7d1d8c97fa58cee941dfb881d49256d415095d49688cca'}, {'image_id': '261_2021_3130_Fig35_HTML', 'image_file_name': '261_2021_3130_Fig35_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig35_HTML.jpg', 'caption': 'Splenic Gaucheroma. 51-year-old male patient with known long-standing Gaucher disease presented with abdominal pain. Coronal plane T2W-fat-suppressed abdominal MR image showed multiple splenic masses (arrows) with hypointense siderotic walls (white asterisks) and hyperintense cystic centers (black asterisks). Note was also made of massive splenomegaly. US-guided percutaneous biopsy of these masses confirmed Gaucheromas', 'hash': '187d5bca40fdbaa59b416b936034819d001f698638b416eeea45ba01c4ef233a'}, {'image_id': '261_2021_3130_Tab2_HTML', 'image_file_name': '261_2021_3130_Tab2_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Tab2_HTML.jpg', 'caption': 'Imaging features of splenic diseases with differential diagnosis', 'hash': '7a4ce2741c1bcf1f4f9e1f72965ff93bf75aa3049c68d6bc306088279dd5e4d4'}, {'image_id': '261_2021_3130_Fig12_HTML', 'image_file_name': '261_2021_3130_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig12_HTML.jpg', 'caption': 'Cat scratch disease: 16-year-old female with no known past medical history presented with swelling in her right hand, fever, and enlarged spleen on physical exam after being scratched by her domestic cat. a US image showed an enlarged spleen with a small hypoechoic solid lesion within the parenchyma (arrows). b Axial plane T2W image demonstrated the same lesion as hyperintense focus (arrow). Serologic studies confirmed cat scratch disease, and the lesion disappeared on follow-up imaging', 'hash': '6404d97c14773d2b25897c9d2ebe719128f966a959448fe0a6cbc57fa18de2d7'}, {'image_id': '261_2021_3130_Fig32_HTML', 'image_file_name': '261_2021_3130_Fig32_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig32_HTML.jpg', 'caption': 'Chronic hematoma: 47-year-old male patient with a history of non-traumatic splenic rupture due to chronic pancreatitis. Axial plane postcontrast abdominal follow-up CT image shows a large cystic splenic lesion in the subcapsular region (asterisk). Note was also made of a hypodense transparenchymal line corresponding to splenic laceration (arrow). US-guided percutaneous drainage of this cystic lesion confirmed chronic hematoma', 'hash': 'fb4490e85588e98afc467afb064494a98efe69ec48389d853a4f00d0fdd94843'}, {'image_id': '261_2021_3130_Fig4_HTML', 'image_file_name': '261_2021_3130_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig4_HTML.jpg', 'caption': 'Acute Epstein-Barr virus (EBV) infection in two different patients: a 24-year-old male patient with serologically and clinically proven EBV infection. Gray-scale US image showed a hypoechoic solid mass with well-defined borders in the upper pole of the spleen (arrows). Post-treatment follow-up imaging two weeks after the initial study showed the complete disappearance of this lesion (not shown). b 29-year-old female with no past medical history presented with left upper quadrant pain and fever. The serologic evaluation confirmed acute EBV infection. Axial plane postcontrast abdominal CT image demonstrated splenomegaly and peripherally located wedge-shaped hypodense area consistent with splenic infarct (asterisk)', 'hash': 'fe673f2bc190f79558f3bac67d6f38fcd7ef5fef3f44aa3c5a5a7bcf8826e768'}, {'image_id': '261_2021_3130_Fig22_HTML', 'image_file_name': '261_2021_3130_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig22_HTML.jpg', 'caption': 'Histoplasmosis: 62-year-old female patient receiving methotrexate and TNF-alpha antagonist for treatment-resistant rheumatoid arthritis presented with fever and left upper quadrant pain. Axial plane T2W-fat-suppressed MR image showed several subcentimeter hypointense lesions scattered throughout the spleen (not shown). These lesions did not demonstrate any obvious enhancement in axial plane postcontrast T1W image (arrowheads). Percutaneous image-guided biopsy revealed non-necrotizing granulomas associated with budding yeast consistent with Histoplasma capsulatum infection', 'hash': 'c1b9edafd05efe0b9a253bc6cbb2e58339b04391ba64b221b057b864fad26b83'}, {'image_id': '261_2021_3130_Fig2_HTML', 'image_file_name': '261_2021_3130_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig2_HTML.jpg', 'caption': 'Diffuse large B-cell lymphoma: 54-year-old female presented with unintentional weight loss and night sweats. Physical examination revealed massive splenomegaly and enlarged axillary lymph nodes. a Gray-scale US image demonstrated multiple subcentimeter hypoechoic nodules scattered throughout the splenic parenchyma (arrowheads). b Axial plane postcontrast abdominal CT performed the next day after the initial US examination showed only massive splenomegaly (asterisk) with no discernible parenchymal nodules. US-guided percutaneous biopsy confirmed the diagnosis of lymphoma', 'hash': '296fb9a9f58e052593ea7b850e63e761b0e2db74840525ada9a63bddd455a7b8'}, {'image_id': '261_2021_3130_Fig24_HTML', 'image_file_name': '261_2021_3130_Fig24_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig24_HTML.jpg', 'caption': 'Aspergillosis: 59-year-old female patient with a history of chemoradiotherapy for head/neck cancer presented with fever, malaise, and weight loss. a Longitudinal plane gray-scale abdominal US image showed multiple hypoechoic nodular lesions within the spleen (arrows). b Axial plane postcontrast abdominal CT image demonstrated the same lesions as multiple hypoattenuating nodules (arrowheads). US-guided percutaneous biopsy was performed, and histopathological examination revealed branching septate fungal hyphae. Tissue culture grew Aspergillus spp', 'hash': '0635acca5b1b6a66f373420d00ec9f4cef460572cfeaec2e114c6c4bfd4a1085'}, {'image_id': '261_2021_3130_Fig34_HTML', 'image_file_name': '261_2021_3130_Fig34_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig34_HTML.jpg', 'caption': 'Extramedullary hematopoiesis (EMH) of the spleen in two different patients: a 63-year-old female patient with a long-standing history of chronic myeloid leukemia. Axial plane T2W-fat-suppressed MR image shows hypointense EMH nodules. Their hypointensity is likely related to iron deposition in the chronic stage. These lesions were stable over seven years of follow-up (arrows). b and c 57-year-old male patient with primary myelofibrosis. b Axial plane T2W-fat-suppressed shows hyperintense lesions within the spleen (arrowheads). c T1W postcontrast axial plane MR image demonstrated contrast enhancement within these nodules (arrowheads). There was also a large right perirenal mass almost completely encircling the right kidney (asterisks). Percutaneous biopsy of the right perirenal lesion was consistent with extramedullary hematopoiesis. Based on this histopathologic finding, the splenic lesions were also considered to represent EMH foci. The lesions are stable over two years of imaging follow-up', 'hash': '1e6cbea4b87daf368bd6d85ac4ca8555e2f0f2412720aac6f9a0d5ca1051cd40'}, {'image_id': '261_2021_3130_Fig14_HTML', 'image_file_name': '261_2021_3130_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig14_HTML.jpg', 'caption': 'Ruptured splenic hydatid cyst: 15-year-old male presented to ER with sudden onset abdominal pain, diffuse skin rash, dyspnea, and hypotension. After stabilization, thoracoabdominal CT was obtained for further investigation. a–c Consecutive postcontrast abdominal CT slices from superior to inferior showed a large cystic lesion (large white arrows) with a partially calcified wall (small black arrow) in the spleen. a Note was also made of another cystic lesion in the left liver lobe (asterisk). b There was a wall discontinuity in the inferomedial part of the splenic lesion (small white arrows). c In the most inferior slices, the contours of the lesion had a wavy appearance, suggestive of the loss of internal pressure (small white arrows). Extrasplenic extension of the hypodense lesion content (arrowheads) and mild perisplenic free fluid were also noted. With this clinical presentation and radiological findings, anaphylaxis secondary to the splenic hydatid cyst rupture was considered as putative diagnosis. An urgent surgery confirmed the diagnosis', 'hash': 'eea8fefe259cd68caf23d1ebd97d7ff0e9a728fed25678b6585774d93e7a6c67'}, {'image_id': '261_2021_3130_Fig33_HTML', 'image_file_name': '261_2021_3130_Fig33_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig33_HTML.jpg', 'caption': 'Splenic angiosarcoma: 25-year-old male patient presented with relatively recent onset fever, weight loss, palpitations, and localized left upper quadrant abdominal pain. Axial plane postcontrast abdominal CT showed a large, heterogeneously-enhancing, complex-appearing mass (arrows) with cystic (white asterisk) and solid (black asterisk) components. The lesion was also extending beyond the confines of the splenic parenchyma. Findings were found to be highly concerning for a primary splenic malignancy, and the patient underwent splenectomy. Final histopathological examination confirmed splenic angiosarcoma', 'hash': '6890047f4940a08705cf0cd592f306ab1f2cb76ad5fd8a8b98b319bff605bc6f'}, {'image_id': '261_2021_3130_Fig5_HTML', 'image_file_name': '261_2021_3130_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig5_HTML.jpg', 'caption': 'EBV-associated lymphoproliferative disease: 2-year-old boy presented with fever, rash, and intermittent diarrhea. Physical examination revealed severe hepatosplenomegaly. Abdominal US was subsequently performed. Gray-scale US image demonstrated multiple subcentimeter hypoechoic nodules scattered throughout the hepatic (not shown) and splenic parenchymas with no prominent vascularity on color flow Doppler US (arrows). Histopathologic examination of the percutaneously biopsied liver lesions confirmed EBV-associated high-grade B-cell lymphoma', 'hash': 'fb752d9926b53a634a266378f210f65b5b108fe3f2b8114a36de7b3c8b2a364d'}, {'image_id': '261_2021_3130_Fig23_HTML', 'image_file_name': '261_2021_3130_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig23_HTML.jpg', 'caption': 'Cryptococcosis: 35-year-old male patient with poorly-controlled HIV infection presented with high-grade fever and severe fatigue. Abdominal US examination demonstrated several hypoechoic lesions within the spleen (not shown). Axial plane postcontrast T1W MR image showed innumerable hypoenhancing sub-centimeter lesions within the splenic parenchyma (arrows). Percutaneous image-guided biopsy from the spleen confirmed cryptococcal infection', 'hash': '75d295c77b177c15285125877008f1b0470a5122f7d3d1ae2e7ca8a102297342'}, {'image_id': '261_2021_3130_Fig13_HTML', 'image_file_name': '261_2021_3130_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig13_HTML.jpg', 'caption': 'Splenic hydatid disease: 47-year-old female with no significant past medical history presented with left upper quadrant pain and splenomegaly. Axial plane T2W abdominal MR image shows a well-circumscribed distended cystic lesion (arrows) with associated inner membranes (arrowhead) consistent with hydatid cyst. The patient underwent percutaneous treatment', 'hash': '81c1d6f3edb32fb95277206ca1609af965c7cbe082fd4fb5112467b93ed61db6'}, {'image_id': '261_2021_3130_Fig10_HTML', 'image_file_name': '261_2021_3130_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig10_HTML.jpg', 'caption': 'Tuberculoma: 65-year-old male with no known significant past medical history presented with palpable left upper quadrant mass. a Axial plane T2W image showed a semisolid mass with heterogeneous signal intensity (arrows). b Axial plane postcontrast T1W image demonstrated heterogeneous enhancement within the lesion (arrows). As findings were found to be concerning for an angiosarcoma, splenectomy was performed. The final pathologic examination confirmed a giant tuberculoma', 'hash': '5d0dda6fa7c20c4889574e419a34b5c7b1251b6c4a4c5039646b907eb4e11f67'}, {'image_id': '261_2021_3130_Fig30_HTML', 'image_file_name': '261_2021_3130_Fig30_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig30_HTML.jpg', 'caption': 'Gamna-Gandy bodies in two different patients: a 6-month-old girl with a history of recurrent blood transfusions. Longitudinal-oblique plane gray-scale US image showed multiple tiny echogenic foci (arrows). Considering the clinical information, imaging findings were found to be consistent with Gamna-Gandy nodules. b 50-year-old male patient with known long-standing paroxysmal nocturnal hemoglobinuria and Budd-Chiari syndrome. Axial plane T1W postcontrast abdominal MR image showed innumerable Gamna-Gandy nodules (arrows) within the splenic parenchyma', 'hash': 'ff791e7f00f92a72f19978676b0f7f92e2155630b0aa9b7fc96156eef2788071'}, {'image_id': '261_2021_3130_Fig20_HTML', 'image_file_name': '261_2021_3130_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig20_HTML.jpg', 'caption': 'Pneumocystosis: An elderly female patient presented with incidentally detected splenic lesions. a Coronal plane T2W MR image showed hypointense lesions in the spleen (arrows) b Coronal plane postcontrast T1W image demonstrated peripheral enhancement in both lesions (arrows). Image-guided aspiration confirmed Pneumocystis jirovecii', 'hash': '186f2deb4a03ca2406d6e277243e464d6f0c9e3a6ef3b323b3c8b51ef550e555'}, {'image_id': '261_2021_3130_Fig9_HTML', 'image_file_name': '261_2021_3130_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig9_HTML.jpg', 'caption': 'Splenic tuberculosis: 49-year-old female with known poorly controlled HIV infection presented with fever, weight loss, and persistent cough. Chest CT examination (not shown) and laboratory tests, including sputum specimen, confirmed pulmonary tuberculosis. Axial plane postcontrast abdominal CT image shows the miliary pattern, innumerable sub-centimeter hypodense lesions within the splenic parenchyma (arrows). Also noted were several similar lesions within the liver (arrowheads). Percutaneous US-guided aspiration from the splenic lesions confirmed tuberculosis', 'hash': '0418bd85f2087b4d3edd9943d6a332879e54e94f36872e932f6cb2e763b6efb0'}, {'image_id': '261_2021_3130_Fig6_HTML', 'image_file_name': '261_2021_3130_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig6_HTML.jpg', 'caption': 'EBV-associated inflammatory pseudotumor: 45-year-old male with no significant past medical history presented with mild left upper quadrant pain. US study showed a splenic mass (not shown). a Axial postcontrast abdominal CT image showed a heterogeneously-enhancing solid mass with central cystic/necrotic component (arrows). b Coronal plane T2W image showed a hypo-isointense solid mass in the splenic parenchyma (arrows). c Axial plane T1W postcontrast image showed heterogeneous contrast enhancement (arrows). As the imaging findings were not found to be conclusive for a benign process, the patient underwent splenectomy. Final histopathological examination confirmed EBV-related inflammatory pseudotumor', 'hash': '2ee9cb4d0954644e9c3c8bd39c547227013eb81dd4fd63812f0f488215554571'}, {'image_id': '261_2021_3130_Fig17_HTML', 'image_file_name': '261_2021_3130_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig17_HTML.jpg', 'caption': 'Candidiasis in two different patients: a 43-year-old female with acute myeloid leukemia who had been undergoing chemotherapy acutely developed fever and abdominal pain. Axial plane postcontrast abdominal CT image showed multiple sub-centimeter hypodense lesions scattered throughout the liver and the spleen parenchyma (arrowheads). Imaging findings were found to be consistent with opportunistic candida infection. The patient clinically responded well, and the lesions almost completely disappeared on follow-up (not shown). b 62-year-old female with known acute lymphoblastic leukemia presented with neutropenic fever. Axial plane postcontrast abdominal CT showed splenomegaly with heterogeneous parenchyma and multiple hypoattenuating, well-defined nodular lesions within the spleen (arrows). Systemic candidiasis was considered as the leading diagnosis, and IV antifungal treatment was immediately started after obtaining blood culture. The patient improved within a few days. Blood culture grew Candida spp. the day after the CT study', 'hash': '5947a3b20779f09ca9aedbbc40e1b1e5c841e45265e71bf472e4353f0b682d4d'}, {'image_id': '261_2021_3130_Fig18_HTML', 'image_file_name': '261_2021_3130_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig18_HTML.jpg', 'caption': 'Nocardiosis: 57-year-old female who was on high dose steroid for severe nephrotic syndrome presented with fever and abdominal pain. Axial plane postcontrast abdominal CT image showed well-defined hypodense lesions scattered through the splenic parenchyma (arrow). Also noted was a left adrenal mass (asterisk) which was later confirmed to be a large adenoma after laparoscopic resection. Percutaneous US-guided aspiration of splenic cysts revealed Gram-positive branched rods consistent with nocardiosis', 'hash': 'dbe3b597e115954ecadeb96cbf684a32955edf799c7de716b5e4eb253a047e8a'}, {'image_id': '261_2021_3130_Fig27_HTML', 'image_file_name': '261_2021_3130_Fig27_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig27_HTML.jpg', 'caption': 'Histopathologically proven splenic hemangiomatosis in two patients. a 42-year-old female patient with no significant past medical history presented to ER with fever and malaise. Axial plane postcontrast abdominal CT image demonstrated multiple nodular hypodense lesions in the spleen (arrows). Infectious etiologies were considered, and a US-guided percutaneous biopsy was performed. Histopathological examination confirmed splenic hemangiomatosis. b 34-year-old female patient presented with left upper quadrant pain. Axial plane T2W-fat-suppressed abdominal MR image showed multiple hyperintense nodular lesions (arrows) almost completely replacing the splenic parenchyma. Splenectomy was performed, and histopathological examination confirmed splenic hemangiomatosis', 'hash': '19c6e46c60e22a8c52a83ebd620fc59a9d2b5fe006f1ebea3e744507f6ff5bd5'}, {'image_id': '261_2021_3130_Fig28_HTML', 'image_file_name': '261_2021_3130_Fig28_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig28_HTML.jpg', 'caption': 'Histopathologically proven splenic metastases in two different patients: a 35-year-old female patient with newly diagnosed cutaneous malignant melanoma. Initial staging contrast-enhanced abdominal CT showed multiple hypodense nodules in the spleen (arrows). US-guided percutaneous biopsy confirmed metastatic disease. b 55-year-old female patient presenting with widespread peritoneal carcinomatosis. Axial plane post-contrast abdominal CT showed an infiltrative mass located in the splenic hilum (arrowheads) with gastric wall invasion. First-look surgery, with associated splenectomy, confirmed papillary serous tumor of peritoneal surfaces', 'hash': '2d5b84968365ba9d8833c83b7895604cef19392b8b6812be7b49fd6c1223f1d9'}, {'image_id': '261_2021_3130_Fig1_HTML', 'image_file_name': '261_2021_3130_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig1_HTML.jpg', 'caption': 'Hemophagocytic lymphohistiocytosis: 12-year-old male patient presented with high fever, diffuse rash, and jaundice. Physical examination revealed abdominal tenderness and hepatosplenomegaly. The patient was diagnosed with hemophagocytic lymphohistiocytosis after an extensive clinical and laboratory workup. a Gray-scale US image demonstrated multiple hypoechoic nodular lesions of varying sizes in the spleen (arrowheads). b Axial plane T2W and postcontrast T1W (not shown) abdominal MR images obtained the next day after the initial US examination showed only a few of the sonographically detected lesions (arrowheads)', 'hash': 'f23a9bacdb5608fc0102c5be9a0fbeeb93a968aa3fea04b87a05f5eef8757792'}, {'image_id': '261_2021_3130_Fig38_HTML', 'image_file_name': '261_2021_3130_Fig38_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig38_HTML.jpg', 'caption': 'Sickle cell anemia: 19-year-old male patient with known sickle cell anemia. Axial plane non-enhanced abdominal CT showed diffuse punctate calcifications within the parenchyma of the partially shrunken spleen (arrowheads)', 'hash': '3a53b81da36f1c88746661747b5a2b2b0de30d81a57873baef6cb9a89c63bd97'}, {'image_id': '261_2021_3130_Fig37_HTML', 'image_file_name': '261_2021_3130_Fig37_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig37_HTML.jpg', 'caption': 'Calcified splenic granulomas: 41-year-old female patient with a known remote history of pulmonary tuberculosis. Axial plane postcontrast abdominal CT showed multiple calcified nodular lesions in the spleen (arrows), which were thought to represent calcified splenic granulomas. Also, note was made of a calcified lymph node at the liver hilum (arrowhead)', 'hash': 'fc9f9712e1ca24e9f65c3d327bb2c60990c98f7aefeca703d610d45d1d88ec75'}, {'image_id': '261_2021_3130_Fig31_HTML', 'image_file_name': '261_2021_3130_Fig31_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig31_HTML.jpg', 'caption': 'Splenic epidermoid cyst: 11-year-old male patient presented with left upper quadrant pain. a Gray-scale US image showed a thin-walled cystic lesion (arrowheads) with low-level internal echoes. b Axial plane postcontrast abdominal CT image demonstrated the same lesion with well-defined borders and no apparent solid component (arrowheads). The imaging, clinical, and laboratory features of this lesion were considered to be consistent with a splenic epidermoid cyst. The patient was treated with percutaneous drainage and cavity sclerosis for symptomatic relief', 'hash': '3d4ff8aec649864e0e122407e71702eda4cc2fa55e83f1f407101000e498e9b5'}, {'image_id': '261_2021_3130_Fig21_HTML', 'image_file_name': '261_2021_3130_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig21_HTML.jpg', 'caption': 'Actinomycosis in two different patients: a 24-year-old female with a history of chronic granulomatous disease presented with fever and left upper quadrant pain. Her spleen was palpable on physical examination. Gray-scale US exam demonstrated a cystic lesion with septations in the upper pole of the spleen (arrows), which was confirmed to be consistent with an abscess due to Actinomyces israelii. b 30-year-old female patient with acute myeloid leukemia presented with intermittent low-grade fever and abdominal discomfort. Axial plane postcontrast abdominal CT showed hypodense branching lesions (arrow). US-guided aspiration and culture grew gram-positive filamentous branching bacilli consistent with Actinomyces spp', 'hash': 'f032dcc2d121719e1d59e9d38f3c33441a1e092ae9e004590eb7012bc00018dc'}, {'image_id': '261_2021_3130_Fig7_HTML', 'image_file_name': '261_2021_3130_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig7_HTML.jpg', 'caption': 'Splenic abscesses in two different patients: a 31-year-old female with known chronic granulomatous disease presented with left upper quadrant pain and fever. Gray-scale US and color Doppler studies showed a hypoechoic, cystic lesion in the spleen with a thick irregular wall and increased vascularity around the lesion (arrows). Percutaneous drainage revealed pus which grew Gram (+) and Gram (−) bacteria consistent with polymicrobial splenic abscess. The patient’s general condition improved shortly after the procedure. b 63-year-old male with known advanced stage metastatic prostate cancer presented with left upper quadrant pain, fever, chills, and altered mental status. Abdominal MRI demonstrated T2-hyperintense cystic lesion with peripheral contrast enhancement and restricted diffusion (arrows). US-guided percutaneous drainage revealed purulent content, which grew Staphylococcus aureus. The patient’s general condition improved immediately after the procedure and the start of antibiotic therapy', 'hash': '6d96731baf387c50eedf06cbaa8214df5b2744e1b4bf299dd5ed4b5abea78137'}, {'image_id': '261_2021_3130_Fig8_HTML', 'image_file_name': '261_2021_3130_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig8_HTML.jpg', 'caption': 'Splenic brucellosis: 17-year-old male patient with a history of unpasteurized dairy product consumption presented to ER with malaise, prolonged recurrent fever, and dull abdominal pain. Laboratory workup showed anemia and leukopenia with an increase in acute phase reactants. Axial plane postcontrast abdominal CT showed multiple subcentimeter hypodense nodules (arrowheads) in the spleen. With these clinical, radiological, and laboratory findings, brucellosis was considered as putative diagnosis. Subsequently, blood culture grew Brucella spp., and the patient was treated accordingly', 'hash': '9940e9083c967b36532c3213860965eac9d111841cb8840395a56efbef632eac'}, {'image_id': '261_2021_3130_Fig11_HTML', 'image_file_name': '261_2021_3130_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig11_HTML.jpg', 'caption': 'Melioidosis: 43-year-old male refugee from Southeast Asia presented with fever, fatigue, and left upper quadrant pain. Axial plane postcontrast CT image showed enlarged spleen with predominantly perisplenic collections (arrows). Imaging findings and clinical evaluation were found to be consistent with melioidosis. The patient clinically responded well to the treatment', 'hash': 'fdd33fff78dc9980d7cef9fddb24c486601d54e52ec3e2f9e8aa7bebd1f6a97c'}, {'image_id': '261_2021_3130_Fig29_HTML', 'image_file_name': '261_2021_3130_Fig29_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig29_HTML.jpg', 'caption': 'Still’s disease: 34-year-old male patient with no prior significant medical history now presented with fever, rash, polyarthralgia, and diffuse abdominal pain. Physical examination revealed severe splenomegaly. Initial US evaluation detected multiple hypoechoic parenchymal nodules in the spleen (not shown). Subsequent MRI exam showed multiple T2-hypointense splenic nodules (arrows) with associated splenomegaly. Also, note was made of a trace amount of intraperitoneal fluid (arrowhead). Extensive diagnostic workup diagnosed Still’s disease', 'hash': '1d2721c120cfa9d0db53b73f23fd81238f308f5e027d5a329c72e225eae2f933'}, {'image_id': '261_2021_3130_Fig26_HTML', 'image_file_name': '261_2021_3130_Fig26_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig26_HTML.jpg', 'caption': 'Splenic lymphangiomatosis: 21-year-old male patient with histopathologically-proven generalized lymphatic anomaly. Axial plane postcontrast CT showed large peripancreatic lymphangioma extending into the gastrohepatic and gastrosplenic ligaments (asterisk) and multiple hypodense subcentimeter nodules representing lymphangiomas scattered throughout the splenic parenchyma (arrows)', 'hash': '846aa66c5015fe92b7eb44bd59db4ec063099d3aea080ccf05a893c1414a8a33'}, {'image_id': '261_2021_3130_Fig36_HTML', 'image_file_name': '261_2021_3130_Fig36_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig36_HTML.jpg', 'caption': 'MIS-C: 12-year-old boy with a recent history of COVID-19 infection presented to the ER with complaints of fever, malaise, rash, abdominal pain, and vomiting. Physical examination was unremarkable except for mildly enlarged cervical lymph nodes. Thoracoabdominal CT was ordered in order to rule out possible infectious foci. Axial plane postcontrast abdominal CT showed small-sized parenchymal infarcts within the spleen (arrows). The patient was hospitalized immediately after this CT study. Thorough clinical and laboratory evaluation led to the diagnosis of MIS-C', 'hash': '1204040b3c2ae0e9fd6803f01efe737c15acd52075074fe37f44580445ee9974'}, {'image_id': '261_2021_3130_Fig19_HTML', 'image_file_name': '261_2021_3130_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig19_HTML.jpg', 'caption': 'Mycobacterium avium-intracellulare infection: 17-year-old male patient with a known congenital immunodeficiency syndrome presented to ER with complaints of fever, malaise, chest pain, and left upper quadrant abdominal pain. a Chest CT showed bronchiectasis (arrows), mucus plugs, and centrilobular nodules in the lower lobes. Note was also made of airspace consolidation and volume loss in the right middle lobe and lingula (asterisks). Imaging findings were found to be suggestive of pulmonary atypical mycobacterial infection. b Axial plane T2W abdominal MR image of the same patient demonstrated multiple nodular hypointense lesions of varying sizes within the spleen (arrowheads). c In dynamic postcontrast MRI images with hepatospecific contrast agent, these lesions were hypoenhancing in the early phases. However, the signal intensity difference between the lesions and background splenic parenchyma gradually decreased in later phases (arrows). The lesions were more hyperintense than the splenic parenchyma in the hepatobiliary phase (arrows), possibly due to their fibrotic nature causing delayed contrast retention. With these imaging findings, splenic granulomas due to the atypical mycobacterial infection were considered. Sputum culture and PCR confirmed Mycobacterium avium-intracellulare complex infection, and the patient was treated accordingly', 'hash': 'e733a684460326c40ae1dd4d67702c369794a175d7ae3ad3897036fd18938ec9'}, {'image_id': '261_2021_3130_Fig16_HTML', 'image_file_name': '261_2021_3130_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC8160561/261_2021_3130_Fig16_HTML.jpg', 'caption': 'Babesiosis: 83-year-old male with acute babesiosis. Axial plane postcontrast abdominal CT image shows splenomegaly, splenic infarcts (asterisk), and splenic pseudoaneurysms (arrows). The patient was subsequently treated with endovascular embolization of the pseudoaneurysm (not shown)', 'hash': '7b2dc947ee9a9f3a8f2d8fa205abc08f873b44d41b7624f9a0c5b911163afeb8'}] | {'261_2021_3130_Fig1_HTML': ['Although evaluation of the spleen tends to be institutional-dependent, US is generally the first-line imaging modality [3]. Even though operator dependence and patients’ body habitus are the main limitations of US, color Doppler mode may help evaluate certain patients. As it can provide real-time images, US may also be effectively used for percutaneous biopsy of splenic lesions [4]. Additionally, in some cases, US may better demonstrate splenic lesions than the other modalities (Figs.\xa0<xref rid="261_2021_3130_Fig1_HTML" ref-type="fig">1</xref> and and <xref rid="261_2021_3130_Fig2_HTML" ref-type="fig">2</xref>). Despite all its advantages, US is limited in lesion characterization. Splenic lesions typically have a non-specific appearance of hypoechoic nodules in most examinations.). Despite all its advantages, US is limited in lesion characterization. Splenic lesions typically have a non-specific appearance of hypoechoic nodules in most examinations.Fig.\xa01Hemophagocytic lymphohistiocytosis: 12-year-old male patient presented with high fever, diffuse rash, and jaundice. Physical examination revealed abdominal tenderness and hepatosplenomegaly. The patient was diagnosed with hemophagocytic lymphohistiocytosis after an extensive clinical and laboratory workup. a Gray-scale US image demonstrated multiple hypoechoic nodular lesions of varying sizes in the spleen (arrowheads). b Axial plane T2W and postcontrast T1W (not shown) abdominal MR images obtained the next day after the initial US examination showed only a few of the sonographically detected lesions (arrowheads)Fig.\xa02Diffuse large B-cell lymphoma: 54-year-old female presented with unintentional weight loss and night sweats. Physical examination revealed massive splenomegaly and enlarged axillary lymph nodes. a Gray-scale US image demonstrated multiple subcentimeter hypoechoic nodules scattered throughout the splenic parenchyma (arrowheads). b Axial plane postcontrast abdominal CT performed the next day after the initial US examination showed only massive splenomegaly (asterisk) with no discernible parenchymal nodules. US-guided percutaneous biopsy confirmed the diagnosis of lymphoma', 'Systemic inflammatory diseases such as hemophagocytic lymphohistiocytosis (Fig.\xa0<xref rid="261_2021_3130_Fig1_HTML" ref-type="fig">1</xref>) and Still’s disease (Fig.\xa0) and Still’s disease (Fig.\xa0<xref rid="261_2021_3130_Fig29_HTML" ref-type="fig">29</xref>) may also cause parenchymal nodules and may closely mimic splenic infections or lymphoma both clinically and radiologically. Extensive clinical and laboratory workup is needed for differential diagnosis [) may also cause parenchymal nodules and may closely mimic splenic infections or lymphoma both clinically and radiologically. Extensive clinical and laboratory workup is needed for differential diagnosis [20, 85].Fig.\xa029Still’s disease: 34-year-old male patient with no prior significant medical history now presented with fever, rash, polyarthralgia, and diffuse abdominal pain. Physical examination revealed severe splenomegaly. Initial US evaluation detected multiple hypoechoic parenchymal nodules in the spleen (not shown). Subsequent MRI exam showed multiple T2-hypointense splenic nodules (arrows) with associated splenomegaly. Also, note was made of a trace amount of intraperitoneal fluid (arrowhead). Extensive diagnostic workup diagnosed Still’s disease'], '261_2021_3130_Fig3_HTML': ['On post-contrast imaging with CT and MR, different imaging pitfalls may be observed on dynamic imaging due to the unique blood flow pattern of the spleen. Therefore, it is of critical importance to know these pitfalls and avoid them to prevent false diagnoses. The most well-known of these pitfalls is the so-called “zebra pattern”, which is characteristically observed in the early phases. In the early arterial phase, pseudonodular or pseudoinfiltrative lesion appearances may also be seen. All these pseudolesion appearances tend to disappear in the late venous phase with complete homogenization of the splenic parenchyma (Fig.\xa0<xref rid="261_2021_3130_Fig3_HTML" ref-type="fig">3</xref>) [) [3].Fig.\xa03Importance of accurate imaging phase in two different patients: a 64-year-old female patient with fever of unknown origin and weight loss. Axial plane postcontrast abdominal CT image showed multiple hypodense nodules in the spleen (arrowheads) due to the inappropriate imaging phase. This pseudonodular appearance completely disappeared on the repeat CT scan performed in the portal venous phase (not shown). b 44-year-old male patient with chronic kidney disease presented with abdominal pain. Axial plane postcontrast abdominal CT showed hypodense infiltrative appearance in the spleen (asterisk), thought to be suspicious for lymphoproliferative disease involvement. c Abdominal CT of the same patient in (b) performed 18 hours after the first CT scan. Control abdominal CT image in a later phase demonstrated homogenization of the spleen parenchyma with no apparent lesion'], '261_2021_3130_Fig4_HTML': ['There are also publications reporting focal splenic lesions in the acute phase of the disease. Lymphoid hyperplasia and associated splenic infarcts may present as focal nodular lesions in these patients (Fig.\xa0<xref rid="261_2021_3130_Fig4_HTML" ref-type="fig">4</xref>) [) [13, 14].Fig.\xa04Acute Epstein-Barr virus (EBV) infection in two different patients: a 24-year-old male patient with serologically and clinically proven EBV infection. Gray-scale US image showed a hypoechoic solid mass with well-defined borders in the upper pole of the spleen (arrows). Post-treatment follow-up imaging two weeks after the initial study showed the complete disappearance of this lesion (not shown). b 29-year-old female with no past medical history presented with left upper quadrant pain and fever. The serologic evaluation confirmed acute EBV infection. Axial plane postcontrast abdominal CT image demonstrated splenomegaly and peripherally located wedge-shaped hypodense area consistent with splenic infarct (asterisk)'], '261_2021_3130_Fig5_HTML': ['EBV-associated inflammatory pseudotumors (IPTs) are extremely rare, with only sporadic cases reported. Histopathologically, splenic IPTs are typically characterized by spindle cell proliferation detected by specific immunohistochemical markers [15]. EBV is one of the etiologic factors for splenic IPTs in addition to autoimmune, reactive, and neoplastic causes. The most commonly encountered group of splenic IPT related to EBV infection is IPT-like follicular dendritic cell tumor [16]. Meanwhile, it should be borne in mind that Hodgkin lymphoma may also be associated with EBV infection. EBV-related malignant lymphoproliferative disease should also be considered in differential diagnosis, especially in immunocompromised patients (Fig.\xa0<xref rid="261_2021_3130_Fig5_HTML" ref-type="fig">5</xref>) [) [17].Fig.\xa05EBV-associated lymphoproliferative disease: 2-year-old boy presented with fever, rash, and intermittent diarrhea. Physical examination revealed severe hepatosplenomegaly. Abdominal US was subsequently performed. Gray-scale US image demonstrated multiple subcentimeter hypoechoic nodules scattered throughout the hepatic (not shown) and splenic parenchymas with no prominent vascularity on color flow Doppler US (arrows). Histopathologic examination of the percutaneously biopsied liver lesions confirmed EBV-associated high-grade B-cell lymphoma'], '261_2021_3130_Fig6_HTML': ['In cases of splenic IPTs, most patients present with B symptoms, and clinically lymphoma may be considered as the primary diagnosis. On CT, the imaging findings are non-specific, and lymphoma is usually the leading diagnosis. These lesions appear as solid lesions of variable contrast enhancement on CT and MR studies (Fig.\xa0<xref rid="261_2021_3130_Fig6_HTML" ref-type="fig">6</xref>). This enhancement pattern is typically heterogeneous, and primary splenic malignant tumors should also be considered in the differential diagnosis [). This enhancement pattern is typically heterogeneous, and primary splenic malignant tumors should also be considered in the differential diagnosis [14]. Histopathological confirmation is almost always needed for confirmation. Clinically recurrence is rare, and the prognosis is generally benign [16].Fig.\xa06EBV-associated inflammatory pseudotumor: 45-year-old male with no significant past medical history presented with mild left upper quadrant pain. US study showed a splenic mass (not shown). a Axial postcontrast abdominal CT image showed a heterogeneously-enhancing solid mass with central cystic/necrotic component (arrows). b Coronal plane T2W image showed a hypo-isointense solid mass in the splenic parenchyma (arrows). c Axial plane T1W postcontrast image showed heterogeneous contrast enhancement (arrows). As the imaging findings were not found to be conclusive for a benign process, the patient underwent splenectomy. Final histopathological examination confirmed EBV-related inflammatory pseudotumor'], '261_2021_3130_Fig7_HTML': ['Splenic microbial abscesses are uncommon clinical conditions with incidence reported to be between 0.2 and 0.7% in autopsy series [18]. Immunosuppression, trauma, septic emboli, hematologic malignancies, recent surgery, and trauma are common predisposing conditions. Bacteria are the most common etiologic agents, but rarely fungi and protozoa may also cause splenic abscesses. In the majority of abscesses, streptococci or staphylococci are present, and around 50% of the patients’ blood cultures were found to be positive [19]. These abscesses typically appear as hypodense lesions on CT with central fluid attenuation and peripheral contrast enhancement (Fig.\xa0<xref rid="261_2021_3130_Fig7_HTML" ref-type="fig">7</xref>). On MRI, they are mostly seen as T2-hyperintense lesions with peripheral contrast enhancement. However, their T1W and T2W signal intensities can vary depending on the content. Although its use in the spleen is limited, DWI may also be helpful [). On MRI, they are mostly seen as T2-hyperintense lesions with peripheral contrast enhancement. However, their T1W and T2W signal intensities can vary depending on the content. Although its use in the spleen is limited, DWI may also be helpful [20].Fig.\xa07Splenic abscesses in two different patients: a 31-year-old female with known chronic granulomatous disease presented with left upper quadrant pain and fever. Gray-scale US and color Doppler studies showed a hypoechoic, cystic lesion in the spleen with a thick irregular wall and increased vascularity around the lesion (arrows). Percutaneous drainage revealed pus which grew Gram (+) and Gram (−) bacteria consistent with polymicrobial splenic abscess. The patient’s general condition improved shortly after the procedure. b 63-year-old male with known advanced stage metastatic prostate cancer presented with left upper quadrant pain, fever, chills, and altered mental status. Abdominal MRI demonstrated T2-hyperintense cystic lesion with peripheral contrast enhancement and restricted diffusion (arrows). US-guided percutaneous drainage revealed purulent content, which grew Staphylococcus aureus. The patient’s general condition improved immediately after the procedure and the start of antibiotic therapy'], '261_2021_3130_Fig8_HTML': ['In acute hepatosplenic brucellosis, hepatosplenomegaly and elevated liver function tests are common. In patients with chronic splenic infection, splenic abscesses and calcifications may be observed. Splenic abscesses are generally seen in infections with B. melitensis and B. suis species. On CT, they were reported to appear as hypoattenuating nodular lesions (Fig.\xa0<xref rid="261_2021_3130_Fig8_HTML" ref-type="fig">8</xref>). Rare cases of splenic infarcts in the course of splenic brucellosis have also been reported [). Rare cases of splenic infarcts in the course of splenic brucellosis have also been reported [23, 24].Fig.\xa08Splenic brucellosis: 17-year-old male patient with a history of unpasteurized dairy product consumption presented to ER with malaise, prolonged recurrent fever, and dull abdominal pain. Laboratory workup showed anemia and leukopenia with an increase in acute phase reactants. Axial plane postcontrast abdominal CT showed multiple subcentimeter hypodense nodules (arrowheads) in the spleen. With these clinical, radiological, and laboratory findings, brucellosis was considered as putative diagnosis. Subsequently, blood culture grew Brucella spp., and the patient was treated accordingly'], '261_2021_3130_Fig9_HTML': ['Tuberculosis (TB) is still a major health problem, despite all the developments in diagnosis and treatment, in certain parts of the world. Lungs are the most commonly involved organs, but extrapulmonary involvement is seen in around 15%–20% of all cases [25]. Splenic involvement is an uncommon presentation. The symptoms are mostly non-specific, with fever being the most common (in 82%), followed by fatigue, weight loss, and splenomegaly [26]. HIV infection and other causes for immunosuppression may facilitate splenic TB, and it is extremely rare in immunocompetent patients [27]. Splenic involvement may appear as a solitary mass, multiple nodular granulomas, or miliary pattern (Fig.\xa0<xref rid="261_2021_3130_Fig9_HTML" ref-type="fig">9</xref>).).Fig.\xa09Splenic tuberculosis: 49-year-old female with known poorly controlled HIV infection presented with fever, weight loss, and persistent cough. Chest CT examination (not shown) and laboratory tests, including sputum specimen, confirmed pulmonary tuberculosis. Axial plane postcontrast abdominal CT image shows the miliary pattern, innumerable sub-centimeter hypodense lesions within the splenic parenchyma (arrows). Also noted were several similar lesions within the liver (arrowheads). Percutaneous US-guided aspiration from the splenic lesions confirmed tuberculosis'], '261_2021_3130_Fig10_HTML': ['In patients with mass-forming tuberculomas, the differential diagnosis from neoplastic causes may be extremely difficult, and most patients require histopathological diagnosis (Fig.\xa0<xref rid="261_2021_3130_Fig10_HTML" ref-type="fig">10</xref>). The solitary lesions typically appear as hypoechoic focal lesions of variable size on US. With CT, these lesions appear as typically hypodense lesions with heterogeneous internal enhancement. Central necrosis is a common, but again a non-specific, feature of these lesions. Lymphoma is one of the most common initial preliminary diagnoses in these patients as it is a prevalent disease with similar clinical symptoms. In addition to lymphoma, primary aggressive splenic tumors such as angiosarcoma may be considered in the differential diagnosis. Splenic metastases, rare compared to liver metastases, may also mimic mass-forming tuberculomas. The presence of a contrast-enhancing peripheral rind is more suggestive for metastases. Percutaneous image-guided spleen biopsy or splenectomy are the most common approaches for confirming the diagnosis.). The solitary lesions typically appear as hypoechoic focal lesions of variable size on US. With CT, these lesions appear as typically hypodense lesions with heterogeneous internal enhancement. Central necrosis is a common, but again a non-specific, feature of these lesions. Lymphoma is one of the most common initial preliminary diagnoses in these patients as it is a prevalent disease with similar clinical symptoms. In addition to lymphoma, primary aggressive splenic tumors such as angiosarcoma may be considered in the differential diagnosis. Splenic metastases, rare compared to liver metastases, may also mimic mass-forming tuberculomas. The presence of a contrast-enhancing peripheral rind is more suggestive for metastases. Percutaneous image-guided spleen biopsy or splenectomy are the most common approaches for confirming the diagnosis.Fig.\xa010Tuberculoma: 65-year-old male with no known significant past medical history presented with palpable left upper quadrant mass. a Axial plane T2W image showed a semisolid mass with heterogeneous signal intensity (arrows). b Axial plane postcontrast T1W image demonstrated heterogeneous enhancement within the lesion (arrows). As findings were found to be concerning for an angiosarcoma, splenectomy was performed. The final pathologic examination confirmed a giant tuberculoma'], '261_2021_3130_Fig11_HTML': ['Spleen is the most commonly involved extrapulmonary organ in the course of the disease. Splenic abscesses may range from 0.5 to 1.5 cm in size. The lesions may be single or multiple multiloculated lesions, and perisplenic extension may be seen (Fig.\xa0<xref rid="261_2021_3130_Fig11_HTML" ref-type="fig">11</xref>) [) [31]. The presence of concurrent liver abscesses in someone who recently traveled from an endemic area in Southeast Asia or northern Australia should raise the clinical suspicion.Fig.\xa011Melioidosis: 43-year-old male refugee from Southeast Asia presented with fever, fatigue, and left upper quadrant pain. Axial plane postcontrast CT image showed enlarged spleen with predominantly perisplenic collections (arrows). Imaging findings and clinical evaluation were found to be consistent with melioidosis. The patient clinically responded well to the treatment'], '261_2021_3130_Fig12_HTML': ['Imaging findings of splenic involvement are mostly related to granuloma formation. The imaging findings are not specific, and lesions typically appear as hypoechoic focal splenic lesions on US [34]. CT is the primary imaging modality in the abdomen, and the lesions typically appear hypoattenuating relative to the background splenic parenchyma (Fig.\xa0<xref rid="261_2021_3130_Fig12_HTML" ref-type="fig">12</xref>). However, progressive enhancement or rim enhancement has also been observed [). However, progressive enhancement or rim enhancement has also been observed [35]. On MRI, the splenic lesions appear hypointense on T1W images but moderately hyperintense on T2W images [34].Fig.\xa012Cat scratch disease: 16-year-old female with no known past medical history presented with swelling in her right hand, fever, and enlarged spleen on physical exam after being scratched by her domestic cat. a US image showed an enlarged spleen with a small hypoechoic solid lesion within the parenchyma (arrows). b Axial plane T2W image demonstrated the same lesion as hyperintense focus (arrow). Serologic studies confirmed cat scratch disease, and the lesion disappeared on follow-up imaging'], '261_2021_3130_Fig13_HTML': ['On CT and MR, the absence of contrast enhancement, both in the septae and the wall, is typical. On CT, these lesions appear as hypoattenuating lesions. Daughter cysts, when present, may appear as even lower attenuation circular lesions within the cyst. T2W MR images are more helpful for outlining the internal structure of the cyst (Fig.\xa0<xref rid="261_2021_3130_Fig13_HTML" ref-type="fig">13</xref>). The imaging characteristics may generally allow correct diagnosis.). The imaging characteristics may generally allow correct diagnosis.Fig.\xa013Splenic hydatid disease: 47-year-old female with no significant past medical history presented with left upper quadrant pain and splenomegaly. Axial plane T2W abdominal MR image shows a well-circumscribed distended cystic lesion (arrows) with associated inner membranes (arrowhead) consistent with hydatid cyst. The patient underwent percutaneous treatment'], '261_2021_3130_Fig14_HTML': ['Secondary infection, rupture into the peritoneal cavity and fistulization to the adjacent viscera are among the major complications of splenic hydatid disease. Rupture can be seen spontaneously as well as secondary to trauma and may result in a life-threatening anaphylactic reaction (Fig.\xa0<xref rid="261_2021_3130_Fig14_HTML" ref-type="fig">14</xref>) [) [45]. Surgery and percutaneous treatments may both be used for the treatment, and the therapeutic approach mainly depends on the disease stage and local expertise [44]. In the current series, it is emphasized that percutaneous treatment is a safe and reliable approach, and anaphylaxis has not been reported [46, 47]. However, the possibility of an anaphylactic reaction after splenic puncture should be considered during the procedure, and caution should be exercised.Fig.\xa014Ruptured splenic hydatid cyst: 15-year-old male presented to ER with sudden onset abdominal pain, diffuse skin rash, dyspnea, and hypotension. After stabilization, thoracoabdominal CT was obtained for further investigation. a–c Consecutive postcontrast abdominal CT slices from superior to inferior showed a large cystic lesion (large white arrows) with a partially calcified wall (small black arrow) in the spleen. a Note was also made of another cystic lesion in the left liver lobe (asterisk). b There was a wall discontinuity in the inferomedial part of the splenic lesion (small white arrows). c In the most inferior slices, the contours of the lesion had a wavy appearance, suggestive of the loss of internal pressure (small white arrows). Extrasplenic extension of the hypodense lesion content (arrowheads) and mild perisplenic free fluid were also noted. With this clinical presentation and radiological findings, anaphylaxis secondary to the splenic hydatid cyst rupture was considered as putative diagnosis. An urgent surgery confirmed the diagnosis'], '261_2021_3130_Fig15_HTML': ['There is not much information on the imaging findings of splenic involvement in the literature, and only anecdotal case reports have been published [49]. The typical imaging appearance is multiple lesions within the splenic parenchyma which may appear hypodense on CT and hypointense on T2W images on MR images (Fig.\xa0<xref rid="261_2021_3130_Fig15_HTML" ref-type="fig">15</xref>). The T2W hypointensity on MR may help differentiate these lesions from other diseases such as splenic metastases. Rim-like enhancement with central hypo-enhancement was reported in splenic leishmaniasis. The absence of restricted diffusion on MRI may also be a helpful imaging clue [). The T2W hypointensity on MR may help differentiate these lesions from other diseases such as splenic metastases. Rim-like enhancement with central hypo-enhancement was reported in splenic leishmaniasis. The absence of restricted diffusion on MRI may also be a helpful imaging clue [49]. Sarcoidosis and granulomatous infections of the spleen may have similar imaging findings with leishmaniasis and should also be considered in the differential diagnosis.Fig.\xa015Leishmaniasis: 25-year-old male patient with a history of unexplained fever, pancytopenia, and increased serum C-reactive protein levels was found to have splenomegaly and parenchymal heterogeneity on US image (not shown). Axial plane postcontrast CT image showed severely enlarged spleen and large hypodense areas (arrows). Histopathologic examination after splenectomy confirmed leishmaniasis'], '261_2021_3130_Fig16_HTML': ['Splenomegaly seems to be the most common imaging finding, but splenic infarcts and ruptures have also been reported (Fig.\xa0<xref rid="261_2021_3130_Fig16_HTML" ref-type="fig">16</xref>) [) [51]. The underlying pathogenesis of splenic rupture has been proposed to be the degradation and friability of the parenchyma and not the enlargement and elevated intra-capsular pressure [52]. Middle-aged healthy men with intact immune system were reported to be the patient group with the highest risk for splenic rupture [53, 54].Fig.\xa016Babesiosis: 83-year-old male with acute babesiosis. Axial plane postcontrast abdominal CT image shows splenomegaly, splenic infarcts (asterisk), and splenic pseudoaneurysms (arrows). The patient was subsequently treated with endovascular embolization of the pseudoaneurysm (not shown)'], '261_2021_3130_Fig17_HTML': ['Splenic fungal infections, candidiasis being the most common, is primarily the disease of immunocompromised patients. Concurrent infection in the liver is very common in patients with splenic candidiasis. Focal embolic parenchymal abscesses appear as sub-centimeter hypodense lesions on CT (Fig.\xa0<xref rid="261_2021_3130_Fig17_HTML" ref-type="fig">17</xref>). The hypoattenuating nature of these lesions is due to necrosis. Associated parenchymal infarcts may also be observed in the course of the disease.). The hypoattenuating nature of these lesions is due to necrosis. Associated parenchymal infarcts may also be observed in the course of the disease.Fig.\xa017Candidiasis in two different patients: a 43-year-old female with acute myeloid leukemia who had been undergoing chemotherapy acutely developed fever and abdominal pain. Axial plane postcontrast abdominal CT image showed multiple sub-centimeter hypodense lesions scattered throughout the liver and the spleen parenchyma (arrowheads). Imaging findings were found to be consistent with opportunistic candida infection. The patient clinically responded well, and the lesions almost completely disappeared on follow-up (not shown). b 62-year-old female with known acute lymphoblastic leukemia presented with neutropenic fever. Axial plane postcontrast abdominal CT showed splenomegaly with heterogeneous parenchyma and multiple hypoattenuating, well-defined nodular lesions within the spleen (arrows). Systemic candidiasis was considered as the leading diagnosis, and IV antifungal treatment was immediately started after obtaining blood culture. The patient improved within a few days. Blood culture grew Candida spp. the day after the CT study'], '261_2021_3130_Fig18_HTML': ['Nocardia is weakly acid-fast, aerobic, gram-positive, branching, filamentous bacteria. It may cause localized or systemic suppurative infections. Systemic nocardiosis is primarily seen in patients with immune suppression, particularly those with cell-mediated immunity problems [55]. Despite the lungs being the most common infection site, the organism may spread almost anywhere in the body from a pulmonary or cutaneous source [56]. Hypodense, non-enhancing sub-centimeter nodules within the splenic parenchyma appear to be the most common imaging finding (Fig.\xa0<xref rid="261_2021_3130_Fig18_HTML" ref-type="fig">18</xref>). In the presence of known cutaneous or pulmonary infections, the diagnosis may be easier.). In the presence of known cutaneous or pulmonary infections, the diagnosis may be easier.Fig.\xa018Nocardiosis: 57-year-old female who was on high dose steroid for severe nephrotic syndrome presented with fever and abdominal pain. Axial plane postcontrast abdominal CT image showed well-defined hypodense lesions scattered through the splenic parenchyma (arrow). Also noted was a left adrenal mass (asterisk) which was later confirmed to be a large adenoma after laparoscopic resection. Percutaneous US-guided aspiration of splenic cysts revealed Gram-positive branched rods consistent with nocardiosis'], '261_2021_3130_Fig19_HTML': ['In the course of systemic mycobacterial infections, the spleen is a commonly involved organ [57]. Disseminated Mycobacterium avium-intracellulare (MAC) infection is particularly common in HIV/AIDS patients with low CD4 counts [58]. Despite this high rate of splenic infection, imaging findings have not been reported in detail [57]. The imaging findings may be similar to splenic TB and mostly are visualized as non-specific small hypodense structures on CT. On MRI, they appear to have low signal intensity on T1W in-phase imaging and DWI due to the ferromagnetic contents. T2-hypointensity and progressive peripheral contrast enhancement are other considerable imaging findings (Fig.\xa0<xref rid="261_2021_3130_Fig19_HTML" ref-type="fig">19</xref>) [) [58].Fig.\xa019Mycobacterium avium-intracellulare infection: 17-year-old male patient with a known congenital immunodeficiency syndrome presented to ER with complaints of fever, malaise, chest pain, and left upper quadrant abdominal pain. a Chest CT showed bronchiectasis (arrows), mucus plugs, and centrilobular nodules in the lower lobes. Note was also made of airspace consolidation and volume loss in the right middle lobe and lingula (asterisks). Imaging findings were found to be suggestive of pulmonary atypical mycobacterial infection. b Axial plane T2W abdominal MR image of the same patient demonstrated multiple nodular hypointense lesions of varying sizes within the spleen (arrowheads). c In dynamic postcontrast MRI images with hepatospecific contrast agent, these lesions were hypoenhancing in the early phases. However, the signal intensity difference between the lesions and background splenic parenchyma gradually decreased in later phases (arrows). The lesions were more hyperintense than the splenic parenchyma in the hepatobiliary phase (arrows), possibly due to their fibrotic nature causing delayed contrast retention. With these imaging findings, splenic granulomas due to the atypical mycobacterial infection were considered. Sputum culture and PCR confirmed Mycobacterium avium-intracellulare complex infection, and the patient was treated accordingly'], '261_2021_3130_Fig20_HTML': ['On CT, splenic foci appear as hypodense lesions of variable size scattered throughout the splenic parenchyma. However, large size, solid-appearing lesions may also be observed (Fig.\xa0<xref rid="261_2021_3130_Fig20_HTML" ref-type="fig">20</xref>) [) [62].Fig.\xa020Pneumocystosis: An elderly female patient presented with incidentally detected splenic lesions. a Coronal plane T2W MR image showed hypointense lesions in the spleen (arrows) b Coronal plane postcontrast T1W image demonstrated peripheral enhancement in both lesions (arrows). Image-guided aspiration confirmed Pneumocystis jirovecii'], '261_2021_3130_Fig21_HTML': ['Actinomycosis is a chronic granulomatous condition which is caused by Actinomyces species. The cervicofacial region is the most common anatomic compartment affected by systemic infection. However, abdominopelvic involvement may be seen in around 20% of the cases [63]. Immunosuppression is a well-known predisposing risk factor for systemic infection. Splenic abscesses appear to be extremely rare but have been reported in the literature as anecdotal case reports [64]. On imaging, the abscesses appear as cystic lesions with variable internal echotexture a honeycomb appearance (Fig.\xa0<xref rid="261_2021_3130_Fig21_HTML" ref-type="fig">21</xref>) [) [64].Fig.\xa021Actinomycosis in two different patients: a 24-year-old female with a history of chronic granulomatous disease presented with fever and left upper quadrant pain. Her spleen was palpable on physical examination. Gray-scale US exam demonstrated a cystic lesion with septations in the upper pole of the spleen (arrows), which was confirmed to be consistent with an abscess due to Actinomyces israelii. b 30-year-old female patient with acute myeloid leukemia presented with intermittent low-grade fever and abdominal discomfort. Axial plane postcontrast abdominal CT showed hypodense branching lesions (arrow). US-guided aspiration and culture grew gram-positive filamentous branching bacilli consistent with Actinomyces spp'], '261_2021_3130_Fig22_HTML': ['Histoplasma capsulatum is an endemic mycosis and a common infection source in North America, South America, Africa, and Asia. The main route of transmission is via the inhalation of spores from contaminated soil [68]. Lungs are common sites for infection, but disseminated infection may be observed in immunosuppressed individuals. Symptomatic disease is rare in immunocompetent hosts. Splenic involvement is typically seen as small hypoenhancing lesions on CT and MR, similar to other infectious diseases involving the spleen (Fig.\xa0<xref rid="261_2021_3130_Fig22_HTML" ref-type="fig">22</xref>). More commonly, calcified granulomas are incidental findings secondary to previous asymptomatic infection in patients from endemic areas such as the Ohio and Mississippi River Valleys of the northeastern USA [). More commonly, calcified granulomas are incidental findings secondary to previous asymptomatic infection in patients from endemic areas such as the Ohio and Mississippi River Valleys of the northeastern USA [69].Fig.\xa022Histoplasmosis: 62-year-old female patient receiving methotrexate and TNF-alpha antagonist for treatment-resistant rheumatoid arthritis presented with fever and left upper quadrant pain. Axial plane T2W-fat-suppressed MR image showed several subcentimeter hypointense lesions scattered throughout the spleen (not shown). These lesions did not demonstrate any obvious enhancement in axial plane postcontrast T1W image (arrowheads). Percutaneous image-guided biopsy revealed non-necrotizing granulomas associated with budding yeast consistent with Histoplasma capsulatum infection'], '261_2021_3130_Fig23_HTML': ['Cryptococcus neoformans is a cause of infection mostly in immunocompromised patients, particularly in HIV-infected cases. It is commonly found in soil contaminated by bird droppings and human infection is most commonly by inhalation of the yeast spores. Pulmonary infection is common, but splenic microabscesses are rare [70]. On imaging, these microabscesses are similar to other fungal splenic involvements. They appear as low attenuation lesions typically between 5mm- 10mm in diameter with a central area of hypoattenuation (Fig.\xa0<xref rid="261_2021_3130_Fig23_HTML" ref-type="fig">23</xref>) [) [70]. However, as imaging characteristics are similar to other fungal opportunistic infections, biopsy confirmation from the spleen or other involved organs is almost always necessary.Fig.\xa023Cryptococcosis: 35-year-old male patient with poorly-controlled HIV infection presented with high-grade fever and severe fatigue. Abdominal US examination demonstrated several hypoechoic lesions within the spleen (not shown). Axial plane postcontrast T1W MR image showed innumerable hypoenhancing sub-centimeter lesions within the splenic parenchyma (arrows). Percutaneous image-guided biopsy from the spleen confirmed cryptococcal infection'], '261_2021_3130_Fig24_HTML': ['Invasive aspergillosis is an important cause of morbidity and mortality, especially in immunosuppressed patients. The primary infection source is mostly the lungs, and hepatosplenic involvement has been reported in up to 15% of the patients. Disseminated disease has also been reported in immunocompetent patients, although very rarely [71]. On CT, splenic involvement has been mostly reported to be seen as multiple hypoattenuating lesions within the splenic parenchyma (Fig.\xa0<xref rid="261_2021_3130_Fig24_HTML" ref-type="fig">24</xref>). In rare cases, pseudoaneurysms and parenchymal infarcts were also detected [). In rare cases, pseudoaneurysms and parenchymal infarcts were also detected [72]. Radiological findings are not specific, and the presence of branching septate fungal hyphae in the pathological specimen is diagnostic.Fig.\xa024Aspergillosis: 59-year-old female patient with a history of chemoradiotherapy for head/neck cancer presented with fever, malaise, and weight loss. a Longitudinal plane gray-scale abdominal US image showed multiple hypoechoic nodular lesions within the spleen (arrows). b Axial plane postcontrast abdominal CT image demonstrated the same lesions as multiple hypoattenuating nodules (arrowheads). US-guided percutaneous biopsy was performed, and histopathological examination revealed branching septate fungal hyphae. Tissue culture grew Aspergillus spp'], '261_2021_3130_Fig25_HTML': ['Concomitant liver or lung involvement, hepatosplenomegaly, and enlarged lymph nodes in the abdomen may be helpful clues for diagnosing sarcoidosis (Fig.\xa0<xref rid="261_2021_3130_Fig25_HTML" ref-type="fig">25</xref>). The low signal intensity of the parenchymal nodules in all MRI sequences is a well-known imaging feature of sarcoidosis involvement in the spleen [). The low signal intensity of the parenchymal nodules in all MRI sequences is a well-known imaging feature of sarcoidosis involvement in the spleen [79].Fig.\xa025Histopathologically proven splenic sarcoidosis: 36-year-old male patient with new-onset low-grade fever and cough. Axial plane postcontrast abdominal CT image shows multiple hypodense nodular lesions in both the liver and spleen (arrowheads). Note was also made of multiple enlarged lymph nodes in the paracaval and paraaortic regions (arrows)'], '261_2021_3130_Fig2_HTML': ['The imaging and clinical features of abdominal sarcoidosis are very similar to patients with lymphoma. Splenomegaly, multiple small splenic nodules, and conglomerating enlarged lymph nodes are well-known imaging features of lymphoma (Fig.\xa0<xref rid="261_2021_3130_Fig2_HTML" ref-type="fig">2</xref>). On MRI, T2W signal intensity is mostly not very helpful [). On MRI, T2W signal intensity is mostly not very helpful [6, 80].'], '261_2021_3130_Fig26_HTML': ['Lymphangiomatosis, currently known as generalized lymphatic anomaly, is a disease characterized by multiple lymphangiomas with cutaneous, osseous, and visceral involvement and may cause a multinodular pattern in the spleen (Fig.\xa0<xref rid="261_2021_3130_Fig26_HTML" ref-type="fig">26</xref>) [) [81, 82]. Hemangiomatosis and littoral cell angioma are vascular neoplastic pathologies that may also present with the multinodular pattern (Fig.\xa0<xref rid="261_2021_3130_Fig27_HTML" ref-type="fig">27</xref>) [) [83, 84]. T2W hyperintensity is expected in hemangiomas and lymphangiomas, while littoral cell angiomas can be observed as both T2W hyper- or hypointense lesions depending on the iron content [7].Fig.\xa026Splenic lymphangiomatosis: 21-year-old male patient with histopathologically-proven generalized lymphatic anomaly. Axial plane postcontrast CT showed large peripancreatic lymphangioma extending into the gastrohepatic and gastrosplenic ligaments (asterisk) and multiple hypodense subcentimeter nodules representing lymphangiomas scattered throughout the splenic parenchyma (arrows)Fig.\xa027Histopathologically proven splenic hemangiomatosis in two patients. a 42-year-old female patient with no significant past medical history presented to ER with fever and malaise. Axial plane postcontrast abdominal CT image demonstrated multiple nodular hypodense lesions in the spleen (arrows). Infectious etiologies were considered, and a US-guided percutaneous biopsy was performed. Histopathological examination confirmed splenic hemangiomatosis. b 34-year-old female patient presented with left upper quadrant pain. Axial plane T2W-fat-suppressed abdominal MR image showed multiple hyperintense nodular lesions (arrows) almost completely replacing the splenic parenchyma. Splenectomy was performed, and histopathological examination confirmed splenic hemangiomatosis'], '261_2021_3130_Fig28_HTML': ['Splenic metastases may also be seen as parenchymal nodules or bulky masses in the spleen (Fig.\xa0<xref rid="261_2021_3130_Fig28_HTML" ref-type="fig">28</xref>). In the presence of a history of primary malignancy, metastases should also be strongly considered. PET/CT with 18-fluorodeoxyglucose (FDG) can help distinguish metastases from benign lesions, especially in patients with a history of malignancy [). In the presence of a history of primary malignancy, metastases should also be strongly considered. PET/CT with 18-fluorodeoxyglucose (FDG) can help distinguish metastases from benign lesions, especially in patients with a history of malignancy [66]. Close imaging follow-up to determine the temporal evolution of lesion size or histopathological examination may be considered depending on the patient characteristics [76].Fig.\xa028Histopathologically proven splenic metastases in two different patients: a 35-year-old female patient with newly diagnosed cutaneous malignant melanoma. Initial staging contrast-enhanced abdominal CT showed multiple hypodense nodules in the spleen (arrows). US-guided percutaneous biopsy confirmed metastatic disease. b 55-year-old female patient presenting with widespread peritoneal carcinomatosis. Axial plane post-contrast abdominal CT showed an infiltrative mass located in the splenic hilum (arrowheads) with gastric wall invasion. First-look surgery, with associated splenectomy, confirmed papillary serous tumor of peritoneal surfaces'], '261_2021_3130_Fig30_HTML': ['Despite the fact that they generally do not pose diagnostic difficulty, Gamna-Gandy bodies should be considered in the setting of multiple splenic nodules. A history of recurrent blood transfusions, chronic liver disease, and portal hypertension may facilitate the diagnosis. On US, they appear as small hyperechoic nodules with variable posterior acoustic shadowing depending on the amount of calcification. On MRI, these siderotic parenchymal nodules are the main imaging finding [86]. They appear as hypointense in both T2W images and gradient-echo sequences due to the magnetic susceptibility effect of iron. T2*W and gadolinium-enhanced T1W images can be used to increase the lesion conspicuity (Fig.\xa0<xref rid="261_2021_3130_Fig30_HTML" ref-type="fig">30</xref>) [) [8].Fig.\xa030Gamna-Gandy bodies in two different patients: a 6-month-old girl with a history of recurrent blood transfusions. Longitudinal-oblique plane gray-scale US image showed multiple tiny echogenic foci (arrows). Considering the clinical information, imaging findings were found to be consistent with Gamna-Gandy nodules. b 50-year-old male patient with known long-standing paroxysmal nocturnal hemoglobinuria and Budd-Chiari syndrome. Axial plane T1W postcontrast abdominal MR image showed innumerable Gamna-Gandy nodules (arrows) within the splenic parenchyma'], '261_2021_3130_Fig31_HTML': ['In contrast to subcentimeter multiple parenchymal nodules detected during opportunistic fungal infections, pyogenic bacterial abscesses mostly cause solitary, large-sized cysts [1]. Other less common causes of splenic bacterial abscesses are melioidosis, actinomycosis, and nocardiosis, and these abscesses may also appear similar to ordinary pyogenic splenic abscesses. Hydatid cysts should also be kept in mind in the differential diagnosis of splenic cystic lesions, especially in endemic parts of the world. Benign cystic lesions of the spleen (epidermoid cyst, secondary splenic cysts) (Fig.\xa0<xref rid="261_2021_3130_Fig31_HTML" ref-type="fig">31</xref>), chronic hematoma (Fig.\xa0), chronic hematoma (Fig.\xa0<xref rid="261_2021_3130_Fig32_HTML" ref-type="fig">32</xref>), and lymphangioma may also be considered in the differential diagnoses [), and lymphangioma may also be considered in the differential diagnoses [87, 88].Fig.\xa031Splenic epidermoid cyst: 11-year-old male patient presented with left upper quadrant pain. a Gray-scale US image showed a thin-walled cystic lesion (arrowheads) with low-level internal echoes. b Axial plane postcontrast abdominal CT image demonstrated the same lesion with well-defined borders and no apparent solid component (arrowheads). The imaging, clinical, and laboratory features of this lesion were considered to be consistent with a splenic epidermoid cyst. The patient was treated with percutaneous drainage and cavity sclerosis for symptomatic reliefFig.\xa032Chronic hematoma: 47-year-old male patient with a history of non-traumatic splenic rupture due to chronic pancreatitis. Axial plane postcontrast abdominal follow-up CT image shows a large cystic splenic lesion in the subcapsular region (asterisk). Note was also made of a hypodense transparenchymal line corresponding to splenic laceration (arrow). US-guided percutaneous drainage of this cystic lesion confirmed chronic hematoma'], '261_2021_3130_Fig33_HTML': ['Although they are very rare, primary splenic angiosarcomas may present with bulky heterogeneous masses that contain large cystic areas. The thick contrast-enhancing irregular septa, the extension of the mass beyond the confines of the splenic parenchyma with associated nodular implants, and the presence of mural nodules should be alarming signs for malignancy over an infectious process (Fig.\xa0<xref rid="261_2021_3130_Fig33_HTML" ref-type="fig">33</xref>) [) [83].Fig.\xa033Splenic angiosarcoma: 25-year-old male patient presented with relatively recent onset fever, weight loss, palpitations, and localized left upper quadrant abdominal pain. Axial plane postcontrast abdominal CT showed a large, heterogeneously-enhancing, complex-appearing mass (arrows) with cystic (white asterisk) and solid (black asterisk) components. The lesion was also extending beyond the confines of the splenic parenchyma. Findings were found to be highly concerning for a primary splenic malignancy, and the patient underwent splenectomy. Final histopathological examination confirmed splenic angiosarcoma'], '261_2021_3130_Fig34_HTML': ['Caution should be taken in terms of malignant lesions of the spleen (primary or metastases) in the presence of malignancy in other organs or splenic lesions with extrasplenic extension. Hamartoma, angiosarcoma, hemangioendothelioma, and Castleman disease mainly present with hypervascular splenic masses, while hypervascularity is generally not expected in sclerosing angiomatoid nodular transformation (SANT), lymphoma, metastases, EMH, infarctions, and infections [87]. “Spoke wheel” enhancement with a central stellate scar is a finding that may be suggestive of SANT [76, 77]. T2-hypointensity can be seen in SANT and sometimes lymphoma, whereas hamartomas and metastases are generally expected to be T2W hyperintense [6–8, 76]. Splenic EMH nodules are observed as T2W hyperintense and contrast-enhancing lesions in the early period, whereas T2W hypointense and non-enhancing lesions in the later phases (Fig. <xref rid="261_2021_3130_Fig34_HTML" ref-type="fig">34</xref>) [) [7]. Splenic Gaucheromas are generally observed as hypodense lesions on CT and multiple nodular lesions with variable signal intensity on MRI (Fig.\xa0<xref rid="261_2021_3130_Fig35_HTML" ref-type="fig">35</xref>). Imaging findings are non-specific, and knowing the presence of Gaucher disease is helpful in the differential diagnosis [). Imaging findings are non-specific, and knowing the presence of Gaucher disease is helpful in the differential diagnosis [90]. It has been reported in the literature that there may be iron accumulation in these lesions, which may cause the magnetic susceptibility effect [91].Fig.\xa034Extramedullary hematopoiesis (EMH) of the spleen in two different patients: a 63-year-old female patient with a long-standing history of chronic myeloid leukemia. Axial plane T2W-fat-suppressed MR image shows hypointense EMH nodules. Their hypointensity is likely related to iron deposition in the chronic stage. These lesions were stable over seven years of follow-up (arrows). b and c 57-year-old male patient with primary myelofibrosis. b Axial plane T2W-fat-suppressed shows hyperintense lesions within the spleen (arrowheads). c T1W postcontrast axial plane MR image demonstrated contrast enhancement within these nodules (arrowheads). There was also a large right perirenal mass almost completely encircling the right kidney (asterisks). Percutaneous biopsy of the right perirenal lesion was consistent with extramedullary hematopoiesis. Based on this histopathologic finding, the splenic lesions were also considered to represent EMH foci. The lesions are stable over two years of imaging follow-upFig.\xa035Splenic Gaucheroma. 51-year-old male patient with known long-standing Gaucher disease presented with abdominal pain. Coronal plane T2W-fat-suppressed abdominal MR image showed multiple splenic masses (arrows) with hypointense siderotic walls (white asterisks) and hyperintense cystic centers (black asterisks). Note was also made of massive splenomegaly. US-guided percutaneous biopsy of these masses confirmed Gaucheromas'], '261_2021_3130_Fig36_HTML': ['Recently, splenic infarcts have been reported in multisystem inflammatory syndrome in children (MIS-C). This disease should be considered in the differential diagnosis of children with splenic infarcts of unknown etiology in these times of the COVID-19 pandemia (Fig.\xa0<xref rid="261_2021_3130_Fig36_HTML" ref-type="fig">36</xref>) [) [94].Fig.\xa036MIS-C: 12-year-old boy with a recent history of COVID-19 infection presented to the ER with complaints of fever, malaise, rash, abdominal pain, and vomiting. Physical examination was unremarkable except for mildly enlarged cervical lymph nodes. Thoracoabdominal CT was ordered in order to rule out possible infectious foci. Axial plane postcontrast abdominal CT showed small-sized parenchymal infarcts within the spleen (arrows). The patient was hospitalized immediately after this CT study. Thorough clinical and laboratory evaluation led to the diagnosis of MIS-C'], '261_2021_3130_Fig37_HTML': ['Scattered splenic parenchymal calcifications are mostly expected to develop in the chronic stage of granulomatous diseases. These lesions may be seen in brucellosis, mycobacterial and fungal infections (Fig.\xa0<xref rid="261_2021_3130_Fig37_HTML" ref-type="fig">37</xref>). The presence of widespread parenchymal calcification in a shrunken spleen is a well-known imaging finding in patients with sickle cell anemia before autosplenectomy (Fig.\xa0). The presence of widespread parenchymal calcification in a shrunken spleen is a well-known imaging finding in patients with sickle cell anemia before autosplenectomy (Fig.\xa0<xref rid="261_2021_3130_Fig38_HTML" ref-type="fig">38</xref>). Diffuse splenic calcifications may also be observed in patients with amyloidosis, systemic lupus erythematosus (SLE), and treated Hodgkin lymphoma [). Diffuse splenic calcifications may also be observed in patients with amyloidosis, systemic lupus erythematosus (SLE), and treated Hodgkin lymphoma [95].Fig.\xa037Calcified splenic granulomas: 41-year-old female patient with a known remote history of pulmonary tuberculosis. Axial plane postcontrast abdominal CT showed multiple calcified nodular lesions in the spleen (arrows), which were thought to represent calcified splenic granulomas. Also, note was made of a calcified lymph node at the liver hilum (arrowhead)Fig.\xa038Sickle cell anemia: 19-year-old male patient with known sickle cell anemia. Axial plane non-enhanced abdominal CT showed diffuse punctate calcifications within the parenchyma of the partially shrunken spleen (arrowheads)']} | Cross-sectional imaging findings of splenic infections: is differential diagnosis possible? | [
"Spleen",
"İnfection",
"İmaging",
"Differential diagnosis",
"Cross-sectional"
] | Abdom Radiol (NY) | 1622185200 | The COVID-19 pandemic has brought into sharp focus the need to build back dental services in a more equitable way that targets oral health inequalities and addresses persistently poor oral health in socially excluded groups.The aim of this article is to introduce the concept of social enterprise in dentistry, to discuss the role of social enterprise in the wider NHS and its place in the NHS Long Term Plan, and to highlight some of the benefits for patients, communities and the system that social enterprises can offer. | [
"COVID-19",
"Dentistry",
"Humans",
"Pandemics",
"SARS-CoV-2"
] | other | PMC8160561 | null | 12 | [
"{'Citation': \"Hurley S. Why re-invent the wheel if you've run out of road? Br Dent J 2020; 228: 755-756.\", 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7243239'}, {'@IdType': 'pubmed', '#text': '32444743'}]}}",
"{'Citation': 'Office of the Chief Dental Officer England. Standard Operating Procedure: Transition to Recovery. Version 4 London: NHS England, 2020.'}",
"{'Citation': 'The Nuffield Trust. Root causes: quality and inequality in dental health. 2017. Available online at https://www.nuffieldtrust.org.uk/news-item/new-report-reveals-stark-difference-in-dental-health-between-north-and-south-of-england (accessed December 2020).'}",
"{'Citation': 'NHS. NHS Long Term Plan. Available online at https://www.longtermplan.nhs.uk/ (accessed December 2020).'}",
"{'Citation': 'Social Enterprise UK. Start your social enterprise. Available online at https://www.socialenterprise.org.uk/looking-to-start-a-social-enterprise/start-your-social-enterprise/ (accessed April 2021).'}",
"{'Citation': 'Department for Digital, Culture, Media & Sport and Department for Business, Energy & Industrial Strategy. Social Enterprise: Market Trends 2017. 2017. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/644266/MarketTrends2017report_final_sept2017.pdf (accessed April 2021).'}",
"{'Citation': 'Social Enterprise UK. The Hidden Revolution. Available online at https://www.socialenterprise.org.uk/policy-and-research-reports/the-hidden-revolution/ (accessed April 2021).'}",
"{'Citation': 'Office of the Regulator of Community Interest Companies. Companies House. Available online at https://www.gov.uk/government/organisations/office-of-the-regulator-of-community-interest-companies (accessed December 2020).'}",
"{'Citation': 'NHS Confederation. Social Enterprises: Part of the NHS Family. 2019. Available at https://www.nhsconfed.org/resources/2019/07/social-enterprises--part-of-the-nhs-family-an-explanatory-guide-for-the-wider-nhs (accessed April 2021).'}",
"{'Citation': 'UK Government. The Public Services (Social Value) Act 2012. Available at https://www.gov.uk/government/publications/social-value-act-information-and-resources/social-value-act-information-and-resources (accessed April 2021).'}",
"{'Citation': 'Paisi M, Baines R, Worle C, Withers L, Witton R. Evaluation of a community dental clinic providing care to people experiencing homelessness: A mixed methods approach. Health Expect 2020; 23: 1289-1299.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7696139'}, {'@IdType': 'pubmed', '#text': '32761764'}]}}",
"{'Citation': 'Batchelor P. A case of somnambulism? Br Dent J 2020; 228: 565.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '32332931'}}}"
] | Abdom Radiol (NY). 2021 May 28; 46(10):4828-4852 | NO-CC CODE |
|
Abdominal CT scanner one day after the first intervention; Embolic agents filled in the aneurysm and the fistula (arrow) (A); In another hand, there might be some compartments in the aneurysm which had not been filled by embolic agent, resulting in existing leakage (B) | OAMJMS-7-1512-g003 | 7 | 97e2a4ddca0859791ff00db96498afb65bd6be90151fa8061959fc3ad02130b0 | OAMJMS-7-1512-g003.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
556,
198
] | [{'image_id': 'OAMJMS-7-1512-g005', 'image_file_name': 'OAMJMS-7-1512-g005.jpg', 'image_path': '../data/media_files/PMC6542381/OAMJMS-7-1512-g005.jpg', 'caption': 'CT scanner of the patient before (A) and after treatment (B) showed a significant decrease of abdominal fluid; Some lymphatic aneurysms (arrow) before and after the intervention still endure, but there is no complication recognised, no further interventions have been indicated', 'hash': 'ef8b1ce00964bfbf4d067b7b9b979195268394adbba6b8f48e5b9991c368ee2d'}, {'image_id': 'OAMJMS-7-1512-g002', 'image_file_name': 'OAMJMS-7-1512-g002.jpg', 'image_path': '../data/media_files/PMC6542381/OAMJMS-7-1512-g002.jpg', 'caption': 'Lymphatic aneurysm and lymphatic extravasation; A lymphatic vessel is enlarged to the size of multi fusiform aneurysm (long arrow) and the presence of extravasation contrast in the peritoneal cavity (arrowhead) (A); Normal pattern of lymphatic channels at the left area (B); A 22-gauge-needle was punctured under guidance of DSA to perform embolization (arrow) (C)', 'hash': '13baca94ced794cd9b4e86b34f4edacd2abce3859851e7ac906ce4d4160ba38f'}, {'image_id': 'OAMJMS-7-1512-g003', 'image_file_name': 'OAMJMS-7-1512-g003.jpg', 'image_path': '../data/media_files/PMC6542381/OAMJMS-7-1512-g003.jpg', 'caption': 'Abdominal CT scanner one day after the first intervention; Embolic agents filled in the aneurysm and the fistula (arrow) (A); In another hand, there might be some compartments in the aneurysm which had not been filled by embolic agent, resulting in existing leakage (B)', 'hash': '97e2a4ddca0859791ff00db96498afb65bd6be90151fa8061959fc3ad02130b0'}, {'image_id': 'OAMJMS-7-1512-g004', 'image_file_name': 'OAMJMS-7-1512-g004.jpg', 'image_path': '../data/media_files/PMC6542381/OAMJMS-7-1512-g004.jpg', 'caption': 'The amount of fluid drainage decreased after the first and second intervention', 'hash': '70b81a564175822bdb752041332e302c90b580a5c10c0051b253eda48a3a93c9'}, {'image_id': 'OAMJMS-7-1512-g001', 'image_file_name': 'OAMJMS-7-1512-g001.jpg', 'image_path': '../data/media_files/PMC6542381/OAMJMS-7-1512-g001.jpg', 'caption': 'Abdominal CT scanner and fluid before treatment; Abdominal CT scanner revealed a large amount of fluid intraperitoneal and right pleural cavities (not shown) (A); Fluid obtained by paracentesis from ascites in milky white (B)', 'hash': '319030628dc13d3c452d1252a3b29c6fb729c6a6234c7a25c5ef7f7fe9c012c8'}, {'image_id': 'OAMJMS-7-1512-g006', 'image_file_name': 'OAMJMS-7-1512-g006.jpg', 'image_path': '../data/media_files/PMC6542381/OAMJMS-7-1512-g006.jpg', 'caption': 'Lymph nodes closet to the lesion (white arrow) with pseudo aneurysm (black arrow); The needle is punctured into a lymph node at the pelvic area (A) [12]; 21G Needle is punctured into lymphatic channels just under the pseudoaneurysm (B)', 'hash': 'd3f174ee5a58a580b6523f1175c969a7337328a695754dce04c7419052dc7f6a'}] | {'OAMJMS-7-1512-g001': ['The patient came to our hospital with abdominal distention and physical exhaustion. Ultrasonography and computed tomography revealed a large amount of free abdominal fluid and right pleural cavity (<xref ref-type="fig" rid="OAMJMS-7-1512-g001">Figure 1A</xref>). About 5 litres of ascites (Pigtail 6Fr- Biotech) drained out as milky white fluid (). About 5 litres of ascites (Pigtail 6Fr- Biotech) drained out as milky white fluid (<xref ref-type="fig" rid="OAMJMS-7-1512-g001">Figure 1B</xref>). Biochemical tests of the drainage fluid showed a very high concentration of triglyceride (7.1 mmol/l).). Biochemical tests of the drainage fluid showed a very high concentration of triglyceride (7.1 mmol/l).'], 'OAMJMS-7-1512-g002': ['Lymphangiography was performed using an intranodal technique using system DSA with contrast injection to lymph nodes at both inguinal regions. The lymph node at both groins was punctured under sonography guidance with the 25-gauge needle. Contrast material (lipiodol) which was heated (up to 37°C) to reduce viscosity was injected with a recommended volume of 0.2- 0.4 ml per minute. When lymphatic vessels were opacified, we found lymphatic lesion at the right iliac fossa: a lymphatic vessel at the right iliac fossa enlarged like multi fusiform lymphatic aneurysms. From the biggest aneurysm, there was an extravasation of lymph directly into the peritoneal cavity (<xref ref-type="fig" rid="OAMJMS-7-1512-g002">Figure 2</xref>). Our diagnosis was that the patient had multi fusiform lymphatic aneurysms and there was a rupture of the biggest aneurysm into the abdomen cavity. The lymphatic aneurysms may result from the reflux of lymph within the vessel valves’ pathology.). Our diagnosis was that the patient had multi fusiform lymphatic aneurysms and there was a rupture of the biggest aneurysm into the abdomen cavity. The lymphatic aneurysms may result from the reflux of lymph within the vessel valves’ pathology.', 'A lymphatic aneurysm is defined as a focal dilatation of lymphatic vessels with inflow and outflow to the normal lymphatic vessels (<xref ref-type="fig" rid="OAMJMS-7-1512-g002">Figure 2A</xref>). It can appear during a long time of reflux of the lymph into the peripheral lymphatic vessels. Percutaneous injection of the ruptured aneurysm was performed with a 22-gauge Chiba needle. The needle was punctured into the aneurysm revealed by lymphatic fluid coming out of the needle. The mixture ratio of NBCA and lipiodol was about 1:1 or 1:2 that was injected in the aneurysm. The injection time was about 10-30 seconds before the removal of the entire system. In our patients, we noticed that the leakage was high flow when injecting the contrast, so we decide to put coil before NBCA to prevent the unexpected migration of glue.). It can appear during a long time of reflux of the lymph into the peripheral lymphatic vessels. Percutaneous injection of the ruptured aneurysm was performed with a 22-gauge Chiba needle. The needle was punctured into the aneurysm revealed by lymphatic fluid coming out of the needle. The mixture ratio of NBCA and lipiodol was about 1:1 or 1:2 that was injected in the aneurysm. The injection time was about 10-30 seconds before the removal of the entire system. In our patients, we noticed that the leakage was high flow when injecting the contrast, so we decide to put coil before NBCA to prevent the unexpected migration of glue.'], 'OAMJMS-7-1512-g003': ['To occlude the ruptured aneurysm, a needle (Chiba 22 G, Cook) was percutaneously punctured under the guidance of fluoroscopy into the lymphatic aneurysm. We then injected 5 ml contrast (Xenetic 350) through the needle to affirm that the tip of the needle was placed in the aneurysm. A guide wire 0.014” (transcend 14, Boston Scientific) was inserted into the lymphatic aneurysm through the needle. Through the guide wire, the 4-French-sheath was cannulated. One coil (5/20 mm, Axium 3D, EV3) was pushed into the aneurysm through the sheath. After that, we injected 10 ml mixture of n-butyl cyanoacrylate (NBCA) which was diluted with lipiodol at the ratio 1:2. After the procedure, the drainage still came out about 1 litre per 24 hours during 2 days. Abdominal CT scanner showed that the lymphatic aneurysm was partially filled with an embolic agent; where remained some compartments that were not filled with embolic agents (<xref ref-type="fig" rid="OAMJMS-7-1512-g003">Figure 3</xref>). For those reasons, we decided to do the second intervention.). For those reasons, we decided to do the second intervention.'], 'OAMJMS-7-1512-g004': ['The second procedure was performed after 2 days. Because the aneurysm was still opacified, we punctured it with a 22-G needle under fluoroscopy. When the needle tip was in the aneurysm, we injected the sclerosis agent with the expectation that the inflammation reaction within the aneurysm can collapse all the compartments and heal the fistular. The sclerosant used was lauromacrogol 400 (Aetoxisclerol 2%-KreusslerPharma, France) (10ml mixture of foam solution containing 2ml of laucromacrogol and 8 ml of air). Finally, we embolized the lymph node by a technique that was described as “closet upstream lymph node embolisation” in the literature [2]; 1 ml of NBCA (history/lipiodol 1:6 ratio) was injected into the lymph node at the right groin. After the second intervention, the amount of fluid leakage decreased significantly (<xref ref-type="fig" rid="OAMJMS-7-1512-g004">Figure 4</xref>).).'], 'OAMJMS-7-1512-g005': ['The patient was discharged one week later when the drain was empty. After six months, computed tomography revealed no more abdominal fluid, but there were still some retroperitoneal lymphatic aneurysms along the right iliac vessels that were not indicated for interventions, the patient was still under supervision (<xref ref-type="fig" rid="OAMJMS-7-1512-g005">Figure 5</xref>).).'], 'OAMJMS-7-1512-g006': ['The closest lymph node is the lymph node from which efferent extravasated vessels on lymphangiography (<xref ref-type="fig" rid="OAMJMS-7-1512-g006">Figure 6A</xref>). A 26-gauge needle was punctured into the lymph node under ultrasound guidance to inject the embolic liquid NBCA. Depending on the flow velocity in the ). A 26-gauge needle was punctured into the lymph node under ultrasound guidance to inject the embolic liquid NBCA. Depending on the flow velocity in the lymphatic vessels, the NBCA to lipiodol ratio was adjusted appropriately, usually from 1:3 to 1:9, according to the experiences of operator. The injection lasted for 10 - 30 seconds so that the mixture filled the lymph node and entered lymphatic vessels [6], [9]. In our patient, when injecting contrast media into the lymph node, we noticed the flow of lymph was slow. Therefore, we chose the ratio NBCA/lipodol at 1:2.', 'The upstream lymphatic vessel is the vessel that goes directly into the lymphatic lesion on lymphangiography. It can be directly punctured with a 21-gauge needle [5]. Embolisation of this vessel can be done through the needle or a catheter by using glue NBCA. The ratio of historic/lipiodol was about 1:1.5 [2] (<xref ref-type="fig" rid="OAMJMS-7-1512-g006">Figure 6B</xref>). Percutaneous intervention may have potential risks including infection and bleeding. However, no damage has been recorded even with the usage of the largest needle like the 21 gauge [). Percutaneous intervention may have potential risks including infection and bleeding. However, no damage has been recorded even with the usage of the largest needle like the 21 gauge [10], [11]. The most severe complication that may occur in lymphangiography is pulmonary artery occlusion due to embolic lipiodol flowing to the thoracic duct and then to the right ventricular. To prevent the risk, lipiodol volume should be limited under 10 ml [2], [5], [6]. Contraindications of the lymphangiography include the patients with respiratory insufficiency and left-to-right cardiac shunt.']} | Interventional Treatment of Lymphatic Leakage Post Appendectomy: Case Report | [
"Lymphatic leakage",
"Lymphatic ascite post operation",
"Lymphangiography",
"Intranidal lymphangiography"
] | Open Access Maced J Med Sci | 1557817200 | [{'@Label': 'BACKGROUND', '@NlmCategory': 'BACKGROUND', '#text': 'Postoperative lymphatic complications are not common, and lymphatic leakage complication post appendectomy (LLCPC) is even rarer. However, the number of this operation is high so LLCPC can occur.'}, {'@Label': 'CASE REPORT', '@NlmCategory': 'METHODS', '#text': 'Here, we report a female patient post appendectomy with severe chylous ascites. This patient underwent six operations. A leakage point at the right iliac-fossa, which was embolized successfully after two sessions, was spotted during intranodal lymphangiography. After 6 months, the ascites were significantly reduced while some lymphatic aneurysms still existed in the lumbar-retroperitoneal region.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'Basing the knowledge of this clinical case and literature, we have concluded that lymphatic leakage can be diagnosed and embolized by percutaneous intervention.'}] | [] | other | PMC6542381 | null | 12 | [
"{'Citation': 'Shulan LV, et al. Review postoperative lymphatic leak. Oncotarget. 2017;8(40):69062–69075. https://doi.org/10.18632/oncotarget.17297.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC5620321'}, {'@IdType': 'pubmed', '#text': '28978181'}]}}",
"{'Citation': 'Hur S, Shin JH, Lee IJ, Min SK, Min SI, Ahn S, Kim J, Kim SY, Kim M, Lee M, Kim HC. Early experience in the management of postoperative lymphatic leakage using lipiodol lymphangiography and adjunctive glue embolisation. Journal of Vascular and Interventional Radiology. 2016;27(8):1177–86. https://doi.org/10.1016/j.jvir.2016.05.011 PMid:27373491.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '27373491'}}}",
"{'Citation': 'Yoshimatsu R, Yamagami T, Miura H, Matsumoto T. Prediction of therapeutic effectiveness according to CT findings after therapeutic lymphangiography for lymphatic leakage. Japanese journal of radiology. 2013;31(12):797–802. https://doi.org/10.1007/s11604-013-0252-2 PMid:24158649.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '24158649'}}}",
"{'Citation': 'Lv S, Wang Q, Zhao W, Han L, Wang Q, Batchu N, Ulain Q, Zou J, Sun C, Du J, Song Q. A review of the postoperative lymphatic leakage. Oncotarget. 2017;8(40):69062–69075. https://doi.org/10.18632/oncotarget.17297 PMid:28978181 PMCid:PMC5620321.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC5620321'}, {'@IdType': 'pubmed', '#text': '28978181'}]}}",
"{'Citation': 'Baek Y, Won JH, Chang SJ, Ryu HS, Song SY, Yim B, Kim J. Lymphatic embolization for the treatment of pelvic lymphoceles:preliminary experience in five patients. Journal of Vascular and Interventional Radiology. 2016;27(8):1170–6. https://doi.org/10.1016/j.jvir.2016.04.011 PMid:27241389.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '27241389'}}}",
"{'Citation': 'Lee EW, Shin JH, Ko HK, Park J, Kim SH, Sung KB. Lymphangiography to treat postoperative lymphatic leakage:a technical review. Korean journal of radiology. 2014;15(6):724–32. https://doi.org/10.3348/kjr.2014.15.6.724 PMid:25469083 PMCid:PMC4248627.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC4248627'}, {'@IdType': 'pubmed', '#text': '25469083'}]}}",
"{'Citation': 'Mahrer A, Ramchandani P, Trerotola SO, Shlansky-Goldberg RD, Itkin M. Sclerotherapy in the management of postoperative lymphocele. Journal of Vascular and Interventional Radiology. 2010;21(7):1050–3. https://doi.org/10.1016/j.jvir.2010.03.014 PMid:20537556.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '20537556'}}}",
"{'Citation': 'Kim EA, Park H, Jeong SG, Lee C, Lee JM, Park CT. Octreotide therapy for the management of refractory chylous ascites after a staging operation for endometrial adenocarcinoma. Journal of Obstetrics and Gynaecology Research. 2014;40(2):622–6. https://doi.org/10.1111/jog.12183 PMid:24118223.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '24118223'}}}",
"{'Citation': 'Inoue M, Nakatsuka S, Yashiro H, Tamura M, Suyama Y, Tsukada J, Ito N, Oguro S, Jinzaki M. Lymphatic intervention for various types of lymphorrhea:access and treatment. Radiographics. 2016;36(7):2199–211. https://doi.org/10.1148/rg.2016160053 PMid:27831840.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '27831840'}}}",
"{'Citation': 'Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR. Nonoperative thoracic duct embolization for traumatic thoracic duct leak:experience in 109 patients. The Journal of thoracic and cardiovascular surgery. 2010;139(3):584–90. https://doi.org/10.1016/j.jtcvs.2009.11.025 PMid:20042200.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '20042200'}}}",
"{'Citation': 'Nadolski GJ, Itkin M. Thoracic duct embolization for nontraumatic chylous effusion:experience in 34 patients. Chest. 2013;143(1):158–63. https://doi.org/10.1378/chest.12-0526 PMid:22797603.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '22797603'}}}",
"{'Citation': 'Gemmete JJ, Srinivasa RN, Chick JF. Treatment of Chylous Ascites in a Child after Wilms Tumor Resection with Intranodal Injection of N-Butyl Cyanoacrylate Glue. Journal of vascular and interventional radiology:JVIR. 2017;28(7):1067–1069. https://doi.org/10.1016/j.jvir.2017.02.024 PMid:28645505.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '28645505'}}}"
] | Open Access Maced J Med Sci. 2019 May 14; 7(9):1512-1515 | NO-CC CODE |
|
Glomus jugulare tumour. Coronal (A), sagittal (B) and axial (C) images from a contrast-enhanced CT scan demonstrate a bilobed, expansile, hypervascular mass (white arrows) within the right base of the skull extending through the jugular foramen into the right cerebellopontine angle. On the axial image (C), there is clear evidence of involvement of the adjacent bones. (D) Axial T2-weighted image from an MRI scan in the same patient showing heterogeneous signal within the lesion (white arrow) with high signal interspersed with signal void, the so-called salt and pepper appearance that is typical of a paraganglioma (glomus jugulare). | ci13003407 | 7 | be714401ba5aac638e7a549f056ee0deb8a18997d428e53f8f8026fcebca8613 | ci13003407.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
762,
745
] | [{'image_id': 'ci13003408', 'image_file_name': 'ci13003408.jpg', 'image_path': '../data/media_files/PMC3830426/ci13003408.jpg', 'caption': 'Olfactory neuroblastoma (ethesioneuroblastoma). Axial (A), sagittal (B) and coronal (C) images from a contrast-enhanced CT examination demonstrate an enhancing mass lesion centred on the right cribriform plate extending intracranially (white arrows) into the anterior cranial fossa and the right nasal cavity. (D) Sagittal T1-weighted image from an MRI scan in the same patient showing the right nasal cavity mass extending into the anterior cranial fossa. Biopsy confirmed an olfactory neuroblastoma.', 'hash': 'ad5e0ed4e61401d61b68a154cb7ab2b4e15501953ace844d5c65939333c00892'}, {'image_id': 'ci13003406', 'image_file_name': 'ci13003406.jpg', 'image_path': '../data/media_files/PMC3830426/ci13003406.jpg', 'caption': 'Carotid body tumour. (A) Axial maximum intensity projection image from a contrast-enhanced CT of the neck showing a heterogeneous, hypervascular mass in the left carotid space (white arrow). (B) Sagittal reformat of the same study shows that the lesion is positioned between the bifurcation of the common carotid artery (white arrow); this is the typical appearance of a carotid body tumour (paraganglioma).', 'hash': 'a15e57cc6c1606f859b693ef4d9d7ca330f159b1ec0080d4aef8d38b740e5eca'}, {'image_id': 'ci13003401', 'image_file_name': 'ci13003401.jpg', 'image_path': '../data/media_files/PMC3830426/ci13003401.jpg', 'caption': 'Supraglottic neuroendocrine carcinoma. Axial contrast-enhanced CT demonstrates asymmetrical thickening and enhancement of the right supraglottic soft tissues (white arrow). Oedema within the prelaryngeal subcutaneous tissues is secondary to recent radiotherapy.', 'hash': '1167f68f84b7ea4d41daf66992de6f65f227c1505f05818c3adb248cd1430ec1'}, {'image_id': 'ci13003407', 'image_file_name': 'ci13003407.jpg', 'image_path': '../data/media_files/PMC3830426/ci13003407.jpg', 'caption': 'Glomus jugulare tumour. Coronal (A), sagittal (B) and axial (C) images from a contrast-enhanced CT scan demonstrate a bilobed, expansile, hypervascular mass (white arrows) within the right base of the skull extending through the jugular foramen into the right cerebellopontine angle. On the axial image (C), there is clear evidence of involvement of the adjacent bones. (D) Axial T2-weighted image from an MRI scan in the same patient showing heterogeneous signal within the lesion (white arrow) with high signal interspersed with signal void, the so-called salt and pepper appearance that is typical of a paraganglioma (glomus jugulare).', 'hash': 'be714401ba5aac638e7a549f056ee0deb8a18997d428e53f8f8026fcebca8613'}, {'image_id': 'ci13003409', 'image_file_name': 'ci13003409.jpg', 'image_path': '../data/media_files/PMC3830426/ci13003409.jpg', 'caption': 'Merkel cell carcinoma. Axial fat-suppressed T1-weighted image after Ga (A), axial (B) and coronal (C) fat-suppressed T2-weighted images and coronal fat-suppressed T1-weighted image after Ga (D) demonstrate a high-signal/enhancing lesion within the right parotid gland, which has a non-specific appearance. This was histologically confirmed to be a nodal deposit from a Merkel cell carcinoma. The primary tumour was subcentimetre in size and located within the skin of the right neck (not seen on imaging).', 'hash': '8b73d98e9839d87706d0e86a7b6aec881cc3427dda21650bd969b26f49adb427'}, {'image_id': 'ci13003404', 'image_file_name': 'ci13003404.jpg', 'image_path': '../data/media_files/PMC3830426/ci13003404.jpg', 'caption': 'Glomus vagale in a patient with SDHD genetic mutation. (A) Maximum intensity projection PET image from a half-body FDG-PET/CT scan demonstrates avid FDG uptake within the right parapharyngeal region (black arrow). (B) Axial images from the same study: CT (top), PET (middle) and fused PET/CT (bottom) showing an FDG-avid paraganglioma within the right posterior parapharyngeal space (white arrow). (C) Coronal T1 (top) and short tau inversion recovery (bottom) images from an MRI examination in the same patient demonstrates a 2.5-cm mass situated immediately posterior to the carotid vessels in the right parapharyngeal space consistent with a glomus vagale tumour (paraganglioma). The bottom image shows a heterogeneous signal within the lesion with high signal interspersed with signal void, the so-called salt and pepper appearance.', 'hash': 'aad8cae74dfc065141c6b039c792293660a87a7907fbfc29f4b8cdc2925d8158'}, {'image_id': 'ci13003403', 'image_file_name': 'ci13003403.jpg', 'image_path': '../data/media_files/PMC3830426/ci13003403.jpg', 'caption': 'Sphenoid sinus neuroendocrine carcinoma. (A) Axial CT (bone windows) demonstrates an expansile soft tissue mass within the right side of the sphenoid sinus causing erosion of the right lateral wall of the sphenoid sinus (white arrow) extending into the petrous temporal bone. (B) Anterior view from a whole-body planar [111In]DTPA-octeotride scintigram showing low-grade tracer uptake in the region of the right sphenoid sinus (black arrow). (C) Axial, coronal and sagittal fused SPECT/CT images from the same study confirm that there is abnormal octreotide uptake within the sphenoid sinus NED (red cross-hairs).', 'hash': '89aea66d28b7050ece4397caf65f59e3c046a2d65bedef69169c871130bb4cc7'}, {'image_id': 'ci13003402', 'image_file_name': 'ci13003402.jpg', 'image_path': '../data/media_files/PMC3830426/ci13003402.jpg', 'caption': 'Right ethmoid sinus neuroendocrine carcinoma with nodal spread. (A) Axial contrast-enhanced CT and (C) coronal short tau inversion recovery MRI demonstrates the NET (white arrows) centred in the right ethmoidal complex without tumour extension outside the ethmoidal air cells; there is associated expansion of the sinus and bony erosion best appreciated on CT. (B) Axial contrast-enhanced CT and (D) axial fat-suppressed T1-weighted image on Ga MRI showing a right retropharyngeal lymph node (white arrows), which is much more conspicuous on MRI.', 'hash': '67616cad3411bdb1553288c3a940c8a3281f0f4e30a179b1820e136a84afe75c'}, {'image_id': 'ci13003405', 'image_file_name': 'ci13003405.jpg', 'image_path': '../data/media_files/PMC3830426/ci13003405.jpg', 'caption': 'Metastatic head and neck paraganglioma in SDHB genetic mutation. (A) Maximum intensity projection PET image from a half-body FDG-PET/CT scan demonstrates a plaque-like area of extremely intense FDG uptake in the right neck around the carotid sheath (top black arrow). There are multiple foci of abnormal uptake elsewhere including the lungs (lower black arrow) and axial skeleton, including the right scapula, ribs, sternum and numerous vertebrae. (B) Axial images from the same study: CT (top), PET (middle) and fused PET/CT (bottom) showing a large FDG-avid bone metastasis within the left side of the sacrum; there is little evidence of structural abnormality on the CT component (white arrow, top).', 'hash': 'fe3d43a557f5871200c0d68dc85335c2ec1d9c13fa4be0a5e7573078f0293735'}] | {'ci13003401': ['Anatomical imaging of laryngeal NETs typically demonstrates an enhancing mass arising from the vocal cords (<xref ref-type="fig" rid="ci13003401">Fig. 1</xref>). CT and MRI are useful to demonstrate local extension of the disease. The findings are non-specific and cannot lead to a definitive diagnosis. Small primary NETs may only be localized by endoscopic assessment and not by conventional anatomical imaging.\n). CT and MRI are useful to demonstrate local extension of the disease. The findings are non-specific and cannot lead to a definitive diagnosis. Small primary NETs may only be localized by endoscopic assessment and not by conventional anatomical imaging.\nFigure 1Supraglottic neuroendocrine carcinoma. Axial contrast-enhanced CT demonstrates asymmetrical thickening and enhancement of the right supraglottic soft tissues (white arrow). Oedema within the prelaryngeal subcutaneous tissues is secondary to recent radiotherapy.'], 'ci13003402': ['Anatomical imaging typically demonstrates a heterogeneously enhancing mass within one of the paranasal sinuses with underlying bony destruction and extension into the adjacent anatomical spaces (<xref ref-type="fig" rid="ci13003402">Fig. 2</xref>). Appearances are often non-specific but the presence of expansion as well as erosion of sinus walls is more suggestive of a NET than the altogether more common squamous cell carcinoma). Appearances are often non-specific but the presence of expansion as well as erosion of sinus walls is more suggestive of a NET than the altogether more common squamous cell carcinoma[27]. Somatostatin receptor scintigraphy (SRS) improves specificity and positive cases are usually well-differentiated/moderately differentiated tumours and have better clinical outcome with treatment (<xref ref-type="fig" rid="ci13003403">Fig. 3</xref>). Conversely, lack of uptake on octreotide scintigraphy does not exclude the diagnosis. There are no data in the literature on the use of other functional imaging techniques in this rare subtype of head and neck NETs.\n). Conversely, lack of uptake on octreotide scintigraphy does not exclude the diagnosis. There are no data in the literature on the use of other functional imaging techniques in this rare subtype of head and neck NETs.\nFigure 2Right ethmoid sinus neuroendocrine carcinoma with nodal spread. (A) Axial contrast-enhanced CT and (C) coronal short tau inversion recovery MRI demonstrates the NET (white arrows) centred in the right ethmoidal complex without tumour extension outside the ethmoidal air cells; there is associated expansion of the sinus and bony erosion best appreciated on CT. (B) Axial contrast-enhanced CT and (D) axial fat-suppressed T1-weighted image on Ga MRI showing a right retropharyngeal lymph node (white arrows), which is much more conspicuous on MRI.\nFigure 3Sphenoid sinus neuroendocrine carcinoma. (A) Axial CT (bone windows) demonstrates an expansile soft tissue mass within the right side of the sphenoid sinus causing erosion of the right lateral wall of the sphenoid sinus (white arrow) extending into the petrous temporal bone. (B) Anterior view from a whole-body planar [111In]DTPA-octeotride scintigram showing low-grade tracer uptake in the region of the right sphenoid sinus (black arrow). (C) Axial, coronal and sagittal fused SPECT/CT images from the same study confirm that there is abnormal octreotide uptake within the sphenoid sinus NED (red cross-hairs).'], 'ci13003404': ['Paragangliomas demonstrate early neural or blood vessel involvement and a propensity for skull base invasion and intracranial involvement. CT is the study of choice to investigate bone involvement, whereas MRI defines soft tissue detail, intracranial, neural and dural involvement. On MRI, all paragangliomas exhibit a high signal on T2-weighted imaging and a low signal on T1-weighted imaging (<xref ref-type="fig" rid="ci13003404">Fig. 4</xref>). As with CT, they demonstrate avid contrast enhancement. The classic salt and pepper appearance seen on MRI relates to the presence of hyperintense foci (salt) interspersed with multiple areas of signal void (pepper) due to high flow in vascular channels (). As with CT, they demonstrate avid contrast enhancement. The classic salt and pepper appearance seen on MRI relates to the presence of hyperintense foci (salt) interspersed with multiple areas of signal void (pepper) due to high flow in vascular channels (<xref ref-type="fig" rid="ci13003404">Fig. 4</xref>))[35]. This feature is only reliably seen in tumours over 1\u2009cm in size[36].\nFigure 4Glomus vagale in a patient with SDHD genetic mutation. (A) Maximum intensity projection PET image from a half-body FDG-PET/CT scan demonstrates avid FDG uptake within the right parapharyngeal region (black arrow). (B) Axial images from the same study: CT (top), PET (middle) and fused PET/CT (bottom) showing an FDG-avid paraganglioma within the right posterior parapharyngeal space (white arrow). (C) Coronal T1 (top) and short tau inversion recovery (bottom) images from an MRI examination in the same patient demonstrates a 2.5-cm mass situated immediately posterior to the carotid vessels in the right parapharyngeal space consistent with a glomus vagale tumour (paraganglioma). The bottom image shows a heterogeneous signal within the lesion with high signal interspersed with signal void, the so-called salt and pepper appearance.', 'Vagal paragangliomas typically occur within or below the inferior ganglion (nodose ganglion) or within the superior ganglion (jugular ganglion)[54]. These are the third most common type of paragangliomas in the head and neck. Typically, patients present with a painless insidious lateral neck mass behind the angle of the mandible. Lower cranial nerve palsies occur late in the disease process[55]. On CT, vagal paragangliomas appear similar to carotid body tumours but displace both internal and external carotid arteries anteromedially (<xref ref-type="fig" rid="ci13003404">Fig. 4</xref>). In addition, extension into the suprahyoid carotid space is seen in approximately two-thirds of vagal paragangliomas.). In addition, extension into the suprahyoid carotid space is seen in approximately two-thirds of vagal paragangliomas.'], 'ci13003405': ['Familial paraganglioma is associated with mutations in the succinate dehydrogenase (SDH) gene-mitochondrial complex involved in electron transfer and the Krebs cycle[44]. There are four subunits (A to D) that form the enzyme complex, and these are associated with different geno-phenotypic expressions of disease. Patients with SDHB mutations are prone to malignant head and neck paragangliomas with a high propensity for metastasis, whereas SDHD mutations typically manifest with multiple, benign head and neck paragangliomas with very rare occurrence of metastatic disease[45]. Up to 10% of head and neck paragangliomas are reported to be related to these hereditary mutations[46]. Limited data exist concerning the clinical and imaging features that distinguish sporadic from familial paragangliomas. A recent study reported that young age, large tumour volume, greater rate of metastatic and multifocal paragangliomas, higher intralesional metabolic activity on FDG-PET, and increased CT enhancement were observed in SDHB-related head and neck paragangliomas[47]. The authors suggested that these findings may warrant genetic screening for SDH mutations and because SDHB-positive patients demonstrate more supradiaphragmatic lesions, whole-body functional imaging may be of particular value in these patients. In another study that evaluated 30 patients with SDHB germline mutation-related metastatic neural crest tumours, FDG-PET had a sensitivity of 100%, which exceeded that of FDOPA (88%), MIBG (80%), and SRS sensitivity (81%). A large proportion (90%) of the lesions negative on FDOPA and MIBG were localized with FDG-PET suggesting it to be the imaging study of choice in patients with SDHB germline mutations[43]. Others have reported that FDA-PET had the highest sensitivity (90%) for detection of bone metastases in patients with metastatic phaeochromocytomas and paragangliomas, followed by bone scintigraphy (82%), CT or MRI (78%), FDG-PET (76%) and MIBG (71%). However, in the subgroup with SDHB mutation, the optimal imaging approaches for bone metastases were CT and MRI (96%), bone scintigraphy (95%), and FDG-PET (92%)[48]. It is not possible to predict the best combination of anatomical and functional imaging in individual patients with head and neck paragangliomas but, in general, FDG;PET/CT should be considered in the diagnostic work-up of SDHB mutation carriers to provide the most accurate staging (<xref ref-type="fig" rid="ci13003405">Fig. 5</xref>). FDOPA- or FDA-PET may provide the highest accuracy in non-SDHB patients although there are no cost-effectiveness data available and these tracers are limited to highly specialized centres at present.\n). FDOPA- or FDA-PET may provide the highest accuracy in non-SDHB patients although there are no cost-effectiveness data available and these tracers are limited to highly specialized centres at present.\nFigure 5Metastatic head and neck paraganglioma in SDHB genetic mutation. (A) Maximum intensity projection PET image from a half-body FDG-PET/CT scan demonstrates a plaque-like area of extremely intense FDG uptake in the right neck around the carotid sheath (top black arrow). There are multiple foci of abnormal uptake elsewhere including the lungs (lower black arrow) and axial skeleton, including the right scapula, ribs, sternum and numerous vertebrae. (B) Axial images from the same study: CT (top), PET (middle) and fused PET/CT (bottom) showing a large FDG-avid bone metastasis within the left side of the sacrum; there is little evidence of structural abnormality on the CT component (white arrow, top).'], 'ci13003406': ['The most common type arises from the carotid body and accounts for over 60% of head and neck paragangliomas[49]. The epicentre of this tumour is typically the posteromedial wall of the carotid bifurcation but growth along the wall of the external or internal carotid arteries has also been reported[49]. They typically splay the internal and external carotid arteries. On further disease extension, these tumours encase the carotid arteries and extension into the skull base/intracranial cavity is recognized[30]. The most common clinical presentation of a carotid body paraganglioma is an insidiously enlarging lateral neck mass often associated with bruit. Other symptoms include hoarseness, stridor, tongue paresis, vertigo, and mild dysphagia[30]. The typical CT appearance of a carotid body tumour is an avidly enhancing soft tissue mass located in the infrahyoid neck splaying the internal and external carotid arteries (<xref ref-type="fig" rid="ci13003406">Fig. 6</xref>).\n).\nFigure 6Carotid body tumour. (A) Axial maximum intensity projection image from a contrast-enhanced CT of the neck showing a heterogeneous, hypervascular mass in the left carotid space (white arrow). (B) Sagittal reformat of the same study shows that the lesion is positioned between the bifurcation of the common carotid artery (white arrow); this is the typical appearance of a carotid body tumour (paraganglioma).'], 'ci13003407': ['Glomus jugulare paragangliomas arise from the jugular bulb, the tympanic branch of the glossopharyngeal nerve (Jacobson nerve), or the auricular branch of the vagal nerve (Arnold nerve). The tumour spreads along the path of least resistance including mastoid air cells[50], vascular channels[50,51], Eustachian tube[52], and neural foramina. The prevalence of these tumours is uncertain; some authors believe they are more common than carotid body paragangliomas, whereas others believe carotid body tumours are more common. Nonetheless, about 80% of all paragangliomas are either carotid body tumours or glomus jugulare tumours[53]. Typically, patients present with pulsatile tinnitus. Less common manifestations include conduction deafness, vertigo, hoarseness, and aural pain or discharge. Cranial nerve palsies occur late in the disease progression. High-resolution CT early on in the disease process typically shows an irregular/enlarged jugular foramen. Progressive growth of the tumour causes a moth-eaten pattern of erosion of the jugular foramen and mastoid (<xref ref-type="fig" rid="ci13003407">Fig. 7</xref>). Ossicular chain destruction is common.\n). Ossicular chain destruction is common.\nFigure 7Glomus jugulare tumour. Coronal (A), sagittal (B) and axial (C) images from a contrast-enhanced CT scan demonstrate a bilobed, expansile, hypervascular mass (white arrows) within the right base of the skull extending through the jugular foramen into the right cerebellopontine angle. On the axial image (C), there is clear evidence of involvement of the adjacent bones. (D) Axial T2-weighted image from an MRI scan in the same patient showing heterogeneous signal within the lesion (white arrow) with high signal interspersed with signal void, the so-called salt and pepper appearance that is typical of a paraganglioma (glomus jugulare).'], 'ci13003408': ['Cross-sectional imaging with CT to assess the extent of bone destruction and MRI are recommended to define the local extent of disease[69]. Anatomical imaging classically reveals a dumbbell-shaped mass centred at the cribriform plate containing intracranial and nasal cavity components (<xref ref-type="fig" rid="ci13003408">Fig. 8</xref>). Speckled calcification and bone erosion are often seen on CT; the tumour exhibits intense contrast enhancement. MRI demonstrates the local extent of the soft tissue component. These tumours are hypointense on T1 and hyperintense on T2 with marked homogeneous contrast enhancement. Both obstructed secretions in the adjacent sinuses and areas of cystic degeneration appear hyperintense). Speckled calcification and bone erosion are often seen on CT; the tumour exhibits intense contrast enhancement. MRI demonstrates the local extent of the soft tissue component. These tumours are hypointense on T1 and hyperintense on T2 with marked homogeneous contrast enhancement. Both obstructed secretions in the adjacent sinuses and areas of cystic degeneration appear hyperintense[70]. Anatomical imaging cannot reliably differentiate these tumours from other more common sinonasal tumours, including sinonasal undifferentiated carcinoma and squamous cell carcinoma[65].\nFigure 8Olfactory neuroblastoma (ethesioneuroblastoma). Axial (A), sagittal (B) and coronal (C) images from a contrast-enhanced CT examination demonstrate an enhancing mass lesion centred on the right cribriform plate extending intracranially (white arrows) into the anterior cranial fossa and the right nasal cavity. (D) Sagittal T1-weighted image from an MRI scan in the same patient showing the right nasal cavity mass extending into the anterior cranial fossa. Biopsy confirmed an olfactory neuroblastoma.'], 'ci13003409': ['The use of imaging to exclude distant metastases is essential before aggressive locoregional treatment with curative intent. When pathology demonstrates a cutaneous small cell carcinoma, all patients should undergo chest imaging to determine whether this is a manifestation of a metastatic small cell carcinoma of the lung or to identify lung metastases. About one-third of patients present with distant metastases[86]. The metastases can be evaluated with cross-sectional imaging, which may show hypervascular lesions with avid contrast enhancement but the findings are non-specific (<xref ref-type="fig" rid="ci13003409">Fig. 9</xref>). SRS can be used with greater reported sensitivity compared with anatomical imaging). SRS can be used with greater reported sensitivity compared with anatomical imaging[96] but may be limited in assessing metastases in organs with physiological uptake of octreotide such as the liver, kidneys and spleen.\nFigure 9Merkel cell carcinoma. Axial fat-suppressed T1-weighted image after Ga (A), axial (B) and coronal (C) fat-suppressed T2-weighted images and coronal fat-suppressed T1-weighted image after Ga (D) demonstrate a high-signal/enhancing lesion within the right parotid gland, which has a non-specific appearance. This was histologically confirmed to be a nodal deposit from a Merkel cell carcinoma. The primary tumour was subcentimetre in size and located within the skin of the right neck (not seen on imaging).']} | Neuroendocrine tumours of the head and neck: anatomical, functional and molecular imaging and contemporary management | [
"Neuroendocrine carcinoma",
"head and neck malignancy",
"magnetic resonance imaging",
"positron emission tomography/computed tomography",
"somatostatin receptor scintigraphy",
"{'sup': '123', '#text': '[I]meta-iodobenzylguanidine scintigraphy'}"
] | Cancer Imaging | 1380870000 | [{'@Label': 'BACKGROUND', '@NlmCategory': 'BACKGROUND', '#text': 'Preclinical drug screens identified disulfiram as a potent in vitro inhibitor of prostate cancer (PCa) cell growth. Although many mechanisms for its anticancer activity have been proposed, tumor suppressor gene re-expression through promoter demethylation emerged as one of the more plausible.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': "We conducted an open-label, dose escalation trial of disulfiram in men with non-metastatic recurrent PCa after local therapy. Dose escalation occurred if a demethylating 'response' (that is, \ue2f610% decrease in peripheral blood mononuclear cell (PBMC) global 5-methyl cytosine (5(me)C) content) was observed in <3 patients in cohort 1. Cohorts 1 and 2 received disulfiram 250\u2009mg and 500\u2009mg daily, respectively. The primary end point was the proportion of subjects with a demethylation response. Secondary end points included the rate of PSA progression at 6 months, changes in PSA doubling time and safety/tolerability."}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'Changes in global 5(me)C content were observed in two of nine patients (22.2%) in cohort 1 and 3 of 10 (30.0%) in cohort 2. Only five subjects were on trial for \ue2f66 months, all were in cohort 1 and all had PSA progression by 6 months. No changes in PSA kinetics were observed in either cohort. Disulfiram was poorly tolerated with six patients experiencing grade 3 adverse events (three per cohort). Three of the responders displayed pretreatment instability in their 5(me)C content.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'A minority of patients had transient global PBMC demethylation changes. Instability in 5(me)C may limit the reproducibility of these findings, limiting our ability to confirm our hypothesis. Given the toxicities and no clinical benefits, further development of disulfiram should not be pursued in this population.'}] | [
"Aged",
"Antineoplastic Agents",
"Ceruloplasmin",
"DNA Methylation",
"Disulfiram",
"Epigenesis, Genetic",
"Humans",
"Male",
"Middle Aged",
"Neoplasm Recurrence, Local",
"Prostate-Specific Antigen",
"Prostatic Neoplasms"
] | other | PMC3830426 | null | 29 | [
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"{'Citation': 'Lin J, Haffner MC, Zhang Y, Lee BH, Brennen WN, Britton J, et al. Disulfiram is a DNA demethylating agent and inhibits prostate cancer cell growth. Prostate. 2011;71:333–343.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3043358'}, {'@IdType': 'pubmed', '#text': '20809552'}]}}",
"{'Citation': 'Iljin K, Ketola K, Vainio P, Halonen P, Kohonen P, Fey V, et al. High-throughput cell-based screening of 4910 known drugs and drug-like small molecules identifies disulfiram as an inhibitor of prostate cancer cell growth. Clin Cancer Res. 2009;15:6070–6078.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19789329'}}}",
"{'Citation': 'Jeltsch A. Beyond Watson and Crick: DNA methylation and molecular enzymology of DNA methyltransferases. Chembiochem. 2002;3:274–293.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11933228'}}}",
"{'Citation': 'Marikovsky M, Nevo N, Vadai E, Harris-Cerruti C. Cu/Zn superoxide dismutase plays a role in angiogenesis. Int J Cancer. 2002;97:34–41.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11774241'}}}",
"{'Citation': 'Shian SG, Kao YR, Wu FY, Wu CW. Inhibition of invasion and angiogenesis by zinc-chelating agent disulfiram. Mol Pharmacol. 2003;64:1076–1084.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14573756'}}}",
"{'Citation': 'Yakisich JS, Siden A, Eneroth P, Cruz M. Disulfiram is a potent in vitro inhibitor of DNA topoisomerases. Biochem Biophys Res Commun. 2001;289:586–590.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11716515'}}}",
"{'Citation': 'Wang W, McLeod HL, Cassidy J. Disulfiram-mediated inhibition of NF-kappaB activity enhances cytotoxicity of 5-fluorouracil in human colorectal cancer cell lines. Int J Cancer. 2003;104:504–511.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12584750'}}}",
"{'Citation': 'Liu GY, Frank N, Bartsch H, Lin JK. Induction of apoptosis by thiuramdisulfides, the reactive metabolites of dithiocarbamates, through coordinative modulation of NFkappaB, c-fos/c-jun, and p53 proteins. Mol Carcinog. 1998;22:235–246.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9726816'}}}",
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"{'Citation': 'Cho HJ, Lee TS, Park JB, Park KK, Choe JY, Sin DI, et al. Disulfiram suppresses invasive ability of osteosarcoma cells via the inhibition of MMP-2 and MMP-9 expression. J Biochem Mol Biol. 2007;40:1069–1076.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18047805'}}}",
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"{'Citation': 'Lovborg H, Oberg F, Rickardson L, Gullbo J, Nygren P, Larsson R. Inhibition of proteasome activity, nuclear factor-KappaB translocation and cell survival by the antialcoholism drug disulfiram. Int J Cancer. 2006;118:1577–1580.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16206267'}}}",
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] | Cancer Imaging. 2013 Oct 4; 13(3):407-422 | NO-CC CODE |
|
Chest CECT (coronal view) showing the hydatid cyst with “air bubble” sign. | amjcaserep-16-20-g004 | 7 | 03980a6371f183c1673bc2def65bb49d07eaa370fb2485a81f7d1739036c28d6 | amjcaserep-16-20-g004.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
600,
697
] | [{'image_id': 'amjcaserep-16-20-g007', 'image_file_name': 'amjcaserep-16-20-g007.jpg', 'image_path': '../data/media_files/PMC4307737/amjcaserep-16-20-g007.jpg', 'caption': 'Chest CECT showing an “empty cyst” sign.', 'hash': '8fdcbf05e60710ea4d73f9bf9e2592b04735b37e0bebadaebc5379bab7fcf39d'}, {'image_id': 'amjcaserep-16-20-g006', 'image_file_name': 'amjcaserep-16-20-g006.jpg', 'image_path': '../data/media_files/PMC4307737/amjcaserep-16-20-g006.jpg', 'caption': 'Chest X-ray shows a ruptured hydatid cyst masked by surrounding pneumonitis and an air-fluid level mimicking lung abscess.', 'hash': 'f074eebef2cffc0442ee122cf47e0e24984f47d08292dd150a80b0efaa232bbd'}, {'image_id': 'amjcaserep-16-20-g001', 'image_file_name': 'amjcaserep-16-20-g001.jpg', 'image_path': '../data/media_files/PMC4307737/amjcaserep-16-20-g001.jpg', 'caption': 'Chest X-ray PA view showing a homogeneous opacity in the right upper zone.', 'hash': '519cf66b1666f23fd4a458582110e283470358692b2fa5ddc0456860d1c80168'}, {'image_id': 'amjcaserep-16-20-g002', 'image_file_name': 'amjcaserep-16-20-g002.jpg', 'image_path': '../data/media_files/PMC4307737/amjcaserep-16-20-g002.jpg', 'caption': 'Chest X-ray PA view showing a homogeneous opacity in the right upper zone.', 'hash': '7105734ae1856e6f2f15ef367f7dd8f2b77a0204dd67e1efe3547bb149322290'}, {'image_id': 'amjcaserep-16-20-g005', 'image_file_name': 'amjcaserep-16-20-g005.jpg', 'image_path': '../data/media_files/PMC4307737/amjcaserep-16-20-g005.jpg', 'caption': 'Coughed-up pieces of the whitish-yellowish membrane of the hydatid cyst.', 'hash': 'b51cd56e7a7a59431160b18ad8d2c138e88f056f2b4b77cb6de9af1c8b58576c'}, {'image_id': 'amjcaserep-16-20-g004', 'image_file_name': 'amjcaserep-16-20-g004.jpg', 'image_path': '../data/media_files/PMC4307737/amjcaserep-16-20-g004.jpg', 'caption': 'Chest CECT (coronal view) showing the hydatid cyst with “air bubble” sign.', 'hash': '03980a6371f183c1673bc2def65bb49d07eaa370fb2485a81f7d1739036c28d6'}, {'image_id': 'amjcaserep-16-20-g003', 'image_file_name': 'amjcaserep-16-20-g003.jpg', 'image_path': '../data/media_files/PMC4307737/amjcaserep-16-20-g003.jpg', 'caption': 'Chest CECT mediastinal window showing the hydatid cyst with “air bubble” sign. The surrounding parenchyma also shows secondary infection.', 'hash': '6fda5bb1c47006f6b10232fb481bad9233cd8ca2e663d9dd14c913ecba8c4db9'}] | {'amjcaserep-16-20-g001': ['A 32-year-old woman presented to our department with complaints of fever and cough with expectoration for the past 4 months. The fever was low-grade and intermittent, and the cough was accompanied with expectoration, was moderate in quantity and mucopurulent in character. Three months earlier, she had been put on anti-tubercular treatment on the basis of her lesions on X-ray (<xref ref-type="fig" rid="amjcaserep-16-20-g001">Figure 1</xref>), despite her sputum for AFB (Acid fast bacilli) being negative, in the form of category 1 DOTS (directly observed therapy short course) under RNTCP (Revised National Tuberculosis Control Programme) without any improvement. General physical examination showed a moderately built and nourished anemic female. She was febrile, alert, with a pulse rate of 92/min, respiratory rate of 22/min, and blood pressure of 110/76 mm Hg. Examination of all other organs were essentially normal. Examination of the respiratory system revealed impaired percussion note, decreased vesicular breath sounds, and vocal resonance over the right clavicular and supra scapular region. Her latest x-ray chest (), despite her sputum for AFB (Acid fast bacilli) being negative, in the form of category 1 DOTS (directly observed therapy short course) under RNTCP (Revised National Tuberculosis Control Programme) without any improvement. General physical examination showed a moderately built and nourished anemic female. She was febrile, alert, with a pulse rate of 92/min, respiratory rate of 22/min, and blood pressure of 110/76 mm Hg. Examination of all other organs were essentially normal. Examination of the respiratory system revealed impaired percussion note, decreased vesicular breath sounds, and vocal resonance over the right clavicular and supra scapular region. Her latest x-ray chest (<xref ref-type="fig" rid="amjcaserep-16-20-g002">Figure 2</xref>) showed no change in the opacity in the right upper zone as compared to her earlier x-ray. Other than a hemoglobin of 9.5% gm, her hematological and biochemical tests were non-revealing. Her sputum for AFB (acid-fast bacilli) and gram stain were negative. Her sputum, sent for culture for pyogenic organisms and BACTEC for AFB, showed no growth.) showed no change in the opacity in the right upper zone as compared to her earlier x-ray. Other than a hemoglobin of 9.5% gm, her hematological and biochemical tests were non-revealing. Her sputum for AFB (acid-fast bacilli) and gram stain were negative. Her sputum, sent for culture for pyogenic organisms and BACTEC for AFB, showed no growth.'], 'amjcaserep-16-20-g003': ['Her contrast-enhanced computed tomography (CECT) chest showed a mass-like lesion (attenuation value 24 HU) with air bubbles and secondary infection in the surrounding parenchyma (<xref ref-type="fig" rid="amjcaserep-16-20-g003">Figures 3</xref> and and <xref ref-type="fig" rid="amjcaserep-16-20-g004">4</xref>). A CT-guided trans-thoracic FNAC (fine-needle aspiration cytology) was attempted and 10 ml of pus was aspirated. Various tests, gram stain, AFB stain, and fungal stains were negative. The culture for pyogenic organisms and BACTEC for AFB showed no growth. The patient was put on broad-spectrum antibiotics and treated for non-resolving pneumonia. After 14 days, although the patient showed symptomatic improvement, she did not show radiological improvement; thus, we planned to do bronchoscopy. On the night prior to the bronchoscopy, she had an episode of vigorous coughing with expectoration of whitish yellowish membranous material (). A CT-guided trans-thoracic FNAC (fine-needle aspiration cytology) was attempted and 10 ml of pus was aspirated. Various tests, gram stain, AFB stain, and fungal stains were negative. The culture for pyogenic organisms and BACTEC for AFB showed no growth. The patient was put on broad-spectrum antibiotics and treated for non-resolving pneumonia. After 14 days, although the patient showed symptomatic improvement, she did not show radiological improvement; thus, we planned to do bronchoscopy. On the night prior to the bronchoscopy, she had an episode of vigorous coughing with expectoration of whitish yellowish membranous material (<xref ref-type="fig" rid="amjcaserep-16-20-g005">Figure 5</xref>), suggesting a ruptured hydatid cyst in the lung. The patient continued to expectorate pieces of similar membranous material for the next 3 days. Histopathology of this membranous tissue confirmed it to be the outer layers of a hydatid cyst. Her latest x-ray showed a ruptured cyst in the form of a lung abscess obscured by the surrounding pneumonitis (), suggesting a ruptured hydatid cyst in the lung. The patient continued to expectorate pieces of similar membranous material for the next 3 days. Histopathology of this membranous tissue confirmed it to be the outer layers of a hydatid cyst. Her latest x-ray showed a ruptured cyst in the form of a lung abscess obscured by the surrounding pneumonitis (<xref ref-type="fig" rid="amjcaserep-16-20-g006">Figure 6</xref>). ELISA for Echinococcus, which was advised after the patient expectorated membranous material, turned out to be highly positive – 45.47 U/ml (N <8 U/ml). Searching through the literature, we came across the “air bubble” sign and its importance in the diagnosis of complicated hydatid cyst, and indeed we were able to appreciate this sign on the patient’s CECT (). ELISA for Echinococcus, which was advised after the patient expectorated membranous material, turned out to be highly positive – 45.47 U/ml (N <8 U/ml). Searching through the literature, we came across the “air bubble” sign and its importance in the diagnosis of complicated hydatid cyst, and indeed we were able to appreciate this sign on the patient’s CECT (<xref ref-type="fig" rid="amjcaserep-16-20-g003">Figure 3</xref>). Ultrasonography of the abdomen revealed no abnormality of any organ. Further, there was no history of any pet dog. On the basis of clinical, radiological, and serological findings, she was diagnosed as having a complicated hydatid cyst. The patient refused surgery and received medical treatment consisting of albendazole 400 mg twice daily for 3 weeks, to be repeated after a gap of 15 days for at least 3–4 cycles. The patient then showed marked symptomatic and radiological improvement. After 1 month, a repeat CECT chest was done, which showed an empty cyst/cavity, also known as the “empty cyst” sign (). Ultrasonography of the abdomen revealed no abnormality of any organ. Further, there was no history of any pet dog. On the basis of clinical, radiological, and serological findings, she was diagnosed as having a complicated hydatid cyst. The patient refused surgery and received medical treatment consisting of albendazole 400 mg twice daily for 3 weeks, to be repeated after a gap of 15 days for at least 3–4 cycles. The patient then showed marked symptomatic and radiological improvement. After 1 month, a repeat CECT chest was done, which showed an empty cyst/cavity, also known as the “empty cyst” sign (<xref ref-type="fig" rid="amjcaserep-16-20-g007">Figure 7</xref>). She is on regular follow-up and continuing medical treatment.). She is on regular follow-up and continuing medical treatment.']} | Complicated Hydatid Cyst and “Air Bubble” Sign: A Stepping-Stone to Correct Diagnosis | [
"Echinococcosis, Pulmonary",
"Helminthiasis",
"Lung Diseases"
] | Am J Case Rep | 1421568000 | [{'@Label': 'MOTIVATION', '@NlmCategory': 'BACKGROUND', '#text': 'Abstract shape analysis, first proposed in 2004, allows one to extract several relevant structures from the folding space of an RNA sequence, preferable to focusing in a single structure of minimal free energy. We report recent extensions to this approach.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'We have rebuilt the original RNAshapes as a repository of components that allows us to integrate several established tools for RNA structure analysis: RNAshapes, RNAalishapes and pknotsRG, including its recent extension pKiss. As a spin-off, we obtain heretofore unavailable functionality: e. g. with pKiss, we can now perform abstract shape analysis for structures holding pseudoknots up to the complexity of kissing hairpin motifs. The new tool pAliKiss can predict kissing hairpin motifs from aligned sequences. Along with the integration, the functionality of the tools was also extended in manifold ways.'}, {'@Label': 'AVAILABILITY AND IMPLEMENTATION', '@NlmCategory': 'METHODS', '#text': 'As before, the tool is available on the Bielefeld Bioinformatics server at http://bibiserv.cebitec.uni-bielefeld.de/rnashapesstudio.'}, {'@Label': 'CONTACT', '@NlmCategory': 'BACKGROUND', '#text': '[email protected].'}] | [
"Computational Biology",
"Coronavirus",
"Nucleic Acid Conformation",
"RNA",
"Sequence Analysis, RNA"
] | other | PMC4307737 | null | 19 | [
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] | Am J Case Rep. 2015 Jan 18; 16:20-24 | NO-CC CODE |
|
Right kidney stone on CT. | fig-2 | 7 | 881d262fc892d4c0bd99dddd60f939ca7d706d2e4c210cdd6772023dc80bc769 | fig-2.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
750,
256
] | [{'image_id': 'fig-1', 'image_file_name': 'fig-1.jpg', 'image_path': '../data/media_files/PMC5788244/fig-1.jpg', 'caption': 'Chest CT showing severe pulmonary fibrosis.', 'hash': '13f6c17a8615b17f8ab23a254d2500053dfaf854c72617618c3a4f8050cfc31b'}, {'image_id': 'fig-2', 'image_file_name': 'fig-2.jpg', 'image_path': '../data/media_files/PMC5788244/fig-2.jpg', 'caption': 'Right kidney stone on CT.', 'hash': '881d262fc892d4c0bd99dddd60f939ca7d706d2e4c210cdd6772023dc80bc769'}, {'image_id': 'fig-4', 'image_file_name': 'fig-4.jpg', 'image_path': '../data/media_files/PMC5788244/fig-4.jpg', 'caption': 'Operating room set-up for simultaneous bilateral PCNL. PCNL, percutaneous nephrolithotomy.', 'hash': 'ddc0ec57b30a8d56c82d0b14634311e5a61603746648b1d87c7e31390e7dff9d'}, {'image_id': 'fig-3', 'image_file_name': 'fig-3.jpg', 'image_path': '../data/media_files/PMC5788244/fig-3.jpg', 'caption': 'Left kidney stone on CT.', 'hash': 'd04073881325a08a2abcf9f41d6669b7a306de46ae7eb83d44edf35b437647fe'}] | {'fig-1': ['We present a case of a 60-year-old Middle-Eastern female with end-stage lung disease because of history of interstitial lung disease (<xref ref-type="fig" rid="fig-1">Fig. 1</xref>), undergoing evaluation for lung transplant; she had a severe restrictive pattern (FEV), undergoing evaluation for lung transplant; she had a severe restrictive pattern (FEV1\u2009=\u200925%, FVC\u2009=\u200924%), and was on steroids and continuous oxygen therapy (2\u2009L/min at rest). She also had right ventricle severe pulmonary hypertension (RVSP\u2009=\u200984\u2009mm Hg) with right ventricle (RV) dilation, gastroesophageal reflux disease, chronic anemia, and asthma. She had normal BMI (23.4). She reported a history of nephrolithiasis for 10 years, previously passing stones without urologic intervention. She had two urinary tract infections in the past but was asymptomatic at the time of our evaluation. During work-up for lung transplant, she was found to have bilateral staghorn calculi. This was considered an infectious risk that would preclude her from proceeding with lung transplantation, particularly considering the need for post-transplant immunosuppression, and she was referred to urology for stone management before transplant.'], 'fig-2': ['In the urology clinic, she was found to have significant pyuria and bacteriuria on urinalysis. CT imaging confirmed bilateral staghorn renal calculi (right: 4\u2009cm; left: 3\u2009cm) (<xref ref-type="fig" rid="fig-2">Figs. 2</xref> and and <xref ref-type="fig" rid="fig-3">3</xref>). There was also a 2.2\u2009cm cystic lesion on the right kidney; subsequent ultrasonography confirmed a hyperdense cyst. At this time, the patient was considered for bilateral PCNL but surgery was deferred as the patient was not cleared for GA. She was treated with ciprofloxacin for extended spectrum beta-lactamases (ESBL) ). There was also a 2.2\u2009cm cystic lesion on the right kidney; subsequent ultrasonography confirmed a hyperdense cyst. At this time, the patient was considered for bilateral PCNL but surgery was deferred as the patient was not cleared for GA. She was treated with ciprofloxacin for extended spectrum beta-lactamases (ESBL) Klebsiella pneumoniae, but infection persisted.'], 'fig-4': ['Two weeks after stent insertion, she underwent bilateral PCNL under thoracic (T8-9) epidural anesthesia with 45\u2009mg of lidocaine as a test dose, followed by loading dose of bupivacaine 15\u2009mg and subsequently started on bupivacaine 12.5\u2009mg/h infusion and tapered to 5\u2009mg/h during the surgery. Two teams operated simultaneously on the two kidneys, minimizing surgical time to 195 minutes (<xref ref-type="fig" rid="fig-4">Fig. 4</xref>). Lower pole access was chosen to avoid lung complications. The access tract was dilated with ). Lower pole access was chosen to avoid lung complications. The access tract was dilated with NephroMax™ balloon with Encore™ 26 inflator (Boston Scientific, Boston, MA) up to 30F. Stone fragmentation was performed with Olympus ShockPulse-SE ultrasonic lithotripsy through a rigid nephroscope. Intraoperatively, she experienced hypotension requiring vasopressors, and was given 1\u2009U of blood intraoperatively. Oxygen saturation was stable >96% with O2 at 3\u2009L/min. Bilateral 7.1F ureteral stents and 22F Councill-tip nephrostomy tubes were left for access. Postoperatively, the epidural was removed and the patient did well with mild pain managed with IV hydromorphone. Stone analysis revealed stone composition as 80% uric acid and 20% calcium oxalate monohydrate. CT on postoperative day 1 showed residual stone fragments bilaterally with a maximum of 10\u2009mm on the right and 8\u2009mm on the left. There were also fragments in the proximal right ureter and a 4\u2009mm calculus at the right ureterovesical junction.']} | Bilateral Prone Percutaneous Nephrolithotomy Under Epidural in Candidate for Lung Transplant: Case Report and Review of Literature | [
"percutaneous nephrolithotomy",
"kidney stones",
"epidural",
"pulmonary fibrosis"
] | J Endourol Case Rep | 1514793600 | Compartmentalization of proteases enables spatially and temporally controlled protein degradation in cells. Here we show that an engineered lumazine synthase protein cage, which possesses a negatively supercharged lumen, can exploit electrostatic effects to sort substrates for an encapsulated protease. This proteasome-like nanoreactor preferentially cleaves positively charged polypeptides over both anionic and zwitterionic substrates, inverting the inherent substrate specificity of the guest enzyme approximately 480 fold. Our results suggest that supercharged nanochambers could provide a simple and potentially general means of conferring substrate specificity to diverse encapsulated catalysts. | [] | other | PMC5788244 | null | 33 | [
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] | J Endourol Case Rep. 2018 Jan 1; 4(1):5-8 | NO-CC CODE |
|
T2 weighted magnetic resonance imaging showed low intensities with unevenness in the mass and destructions of the posterior bone wall (arrow). | cp-2012-1-e16-g003 | 7 | dce539db062734f7e4b4bedc3d62c84e9c5dc4b67d46845f2397f028aae546e6 | cp-2012-1-e16-g003.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
500,
551
] | [{'image_id': 'cp-2012-1-e16-g001', 'image_file_name': 'cp-2012-1-e16-g001.jpg', 'image_path': '../data/media_files/PMC3981353/cp-2012-1-e16-g001.jpg', 'caption': 'In the preoperative computed tomography, a mass occupied the left maxillary sinus, showing irregular densities with destructions of the posterior bone wall (arrow).', 'hash': '4eb161d85e03286ffa94d5812abf5abbbb7274b0526b7f61345a9b73858a79a8'}, {'image_id': 'cp-2012-1-e16-g002', 'image_file_name': 'cp-2012-1-e16-g002.jpg', 'image_path': '../data/media_files/PMC3981353/cp-2012-1-e16-g002.jpg', 'caption': 'In the preoperative computed tomography, a mass occupied the left maxillary sinus, invading the orbita (arrow).', 'hash': '330c1c68b09ce4abdea8a25400da17a462f292e63b1dcc48bd4dbdafb3b164cf'}, {'image_id': 'cp-2012-1-e16-g003', 'image_file_name': 'cp-2012-1-e16-g003.jpg', 'image_path': '../data/media_files/PMC3981353/cp-2012-1-e16-g003.jpg', 'caption': 'T2 weighted magnetic resonance imaging showed low intensities with unevenness in the mass and destructions of the posterior bone wall (arrow).', 'hash': 'dce539db062734f7e4b4bedc3d62c84e9c5dc4b67d46845f2397f028aae546e6'}, {'image_id': 'cp-2012-1-e16-g004', 'image_file_name': 'cp-2012-1-e16-g004.jpg', 'image_path': '../data/media_files/PMC3981353/cp-2012-1-e16-g004.jpg', 'caption': 'Histopathological examination (H&E staining, ×200) revealed nesting patterns with necrosis and the proliferation of cell round nuclei.', 'hash': 'bf7ed96e8aace764945e0691f3a4260616c811a08dd69f743df4ef445fcfecae'}] | {'cp-2012-1-e16-g001': ['A 65-year-old Japanese woman consulted our hospital with a 1-week history of left exophthalmos with cheek swelling and eye movement disorders. Forty years prior, she had undergone an operation on the bilateral maxillary sinus by Caldwell-Luc\'s method. In a pre-operative computed tomography (CT) scan, a mass occupied the left maxillary sinus showing irregular densities with destruction of the posterior bone wall and invasion into the left orbital (<xref ref-type="fig" rid="cp-2012-1-e16-g001">Figures 1</xref> and and <xref ref-type="fig" rid="cp-2012-1-e16-g002">2</xref>). Both TI and T2 weighted magnetic resonance imaging (MRI) showed low intensities and unevenness in the mass (). Both TI and T2 weighted magnetic resonance imaging (MRI) showed low intensities and unevenness in the mass (<xref ref-type="fig" rid="cp-2012-1-e16-g003">Figure 3</xref>). Thus, CT and MRI suggested a solid mass in the maxillary. At the first medical examination, we suspected carcinoma arising in the postoperative maxillary sinus in addition to postoperative maxillary cyst. We performed biopsy of the maxillary tumor according to Caldwell-Luc\'s method. On the histological examination, the carcinoma tissues showed nesting patterns with necrosis, proliferation of cells with round nuclei and numerous abnormal mitotic features (). Thus, CT and MRI suggested a solid mass in the maxillary. At the first medical examination, we suspected carcinoma arising in the postoperative maxillary sinus in addition to postoperative maxillary cyst. We performed biopsy of the maxillary tumor according to Caldwell-Luc\'s method. On the histological examination, the carcinoma tissues showed nesting patterns with necrosis, proliferation of cells with round nuclei and numerous abnormal mitotic features (<xref ref-type="fig" rid="cp-2012-1-e16-g004">Figure 4</xref>). Immunohistochemical studies showed positive staining for keratin, CAM5.2, and CD56, but not LCA (leukocyte common antigen). From the above results, we diagnosed neuroendocrine carcinoma. After biopsy, radiation therapy (total 66Gy) resulted in partial remission (PR) for this tumor. We consulted her concerning radio-chemotherapy or chemotherapy after radiation therapy for the remains of the tumors, but she refused the above combined chemotherapy. Regression of the tumor after therapy has been continued 24 months.). Immunohistochemical studies showed positive staining for keratin, CAM5.2, and CD56, but not LCA (leukocyte common antigen). From the above results, we diagnosed neuroendocrine carcinoma. After biopsy, radiation therapy (total 66Gy) resulted in partial remission (PR) for this tumor. We consulted her concerning radio-chemotherapy or chemotherapy after radiation therapy for the remains of the tumors, but she refused the above combined chemotherapy. Regression of the tumor after therapy has been continued 24 months.']} | Neuroendocrine carcinoma arising in a wound of the postoperative maxillary sinus | [
"neuroendocrine carcinoma",
"maxillary carcinoma",
"postoperative maxillary sinus",
"Radiation therapy",
"MRI."
] | Clin Pract | 1327392000 | We report a case of a neuroendocrine carcinoma arising in a wound of the postoperative maxillary sinus that was difficult to distinguish from a postoperative maxillary cyst. The patient was a 65-year-old Japanese woman who complained of left exophthalmos with cheek swelling and eye movement disorders. In past history, she had, 40 years previously undergone operation on the bilateral maxillary sinus by Caldwell-Luc's method. In a preoperative computed tomography, a mass occupied the left maxillary sinus showing irregular densities with destruction of the posterior bone walls and invasion into the left orbital. Both TI and T2 weighted magnetic resonance imaging showed low intensities and unevenness in the mass. We performed a biopsy of the maxillary tumor according to Caldwell-Luc's method. Histological examination diagnosed neuroendocrine carcinoma. Radiation therapy (total 66Gy) resulted in partial response for this tumor. However, sinonasal neuroendocrine carcinoma has been identified as highly aggressive, with a high probability of recurrence and metastasis. | [] | other | PMC3981353 | null | 17 | [
"{'Citation': 'Perez-Ordonez B, Caruana SM, Huvos AG, Shah JP. Small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses. Hum Pathol. 1998;29:826–32.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9712424'}}}",
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"{'Citation': 'Tojima I, Suzuki M, Hanamitsu M, et al. Two cases of small cell neuroendocrine carcinoma in head and neck. Pract Otol (Kyoto) 2005;98:897–902.'}",
"{'Citation': 'Som PM, Shapiro MD, Biller HF, et al. Sinonasal tumors and inflammatory tissues; differentiation with MR imaging. Radiology. 1888;167:803–8.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '3363145'}}}",
"{'Citation': 'Manome Y, Yamaoka R, Yuhki K, et al. [Intracranial invasion of neroendocine carcinoma: a case report] No Shinkei Geka. 1990;18:483–7. [Article in Japanese]', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2385325'}}}",
"{'Citation': 'Yanagi K, Kodama M, Hono H. Olfactory neuroblastoma and neuroendocrine carcinoma. ORL Tokyo. 1991;34:449–56.'}",
"{'Citation': 'Contrucci RB, Holmes WF, Heffron T. Neuroendocrine tumors of the nose and upper airway. Ear Nose Throat J. 1985;64:235–8.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '3996274'}}}",
"{'Citation': 'Kodama A, Okabe H, Kitajima K, et al. Neuroendocrine carcinoma of the nasal cavity: a case report. Pract Otol (Kyoto) 1994;87:645–50.'}",
"{'Citation': 'Gao W, Raeside DE. Orthovoltage radiation therapy treatment planning using Monte Carlo simulation: treatment of neuroendocrine carcinoma of the maxillary sinus. Phys Med Biol. 1997;42:2421–33.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9434298'}}}",
"{'Citation': 'Morikawa T, Yoshihara T, Goto S, et al. Four cases of carcinoma in the nasal cavity which contained neurosecretory granules. Otologia Fukuoka. 2003;49:111–7.'}",
"{'Citation': 'Takahashi N, Tsukuda M, Mochimatsu I, et al. [Neuroendocrine carcionoma of the head and neck] Nihon Jibiinkoka Gakkai Kaiho. 1996;99:567–75. [Article in Japanese]', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8683367'}}}",
"{'Citation': 'Georgiou AF, Walker DM, Collins AP, et al. Primary small cell undifferentiated (neuroendocine) carcinoma of the maxillary sinus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98:572–8.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15529129'}}}",
"{'Citation': 'Bailey BJ, Barton G. Olfactory neuroblastoma. Management and prognosis. Arch Otolaryngol. 1975;101:1–5.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '804302'}}}",
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] | Clin Pract. 2012 Jan 24; 2(1):e16 | NO-CC CODE |
|
Contrast enhanced CT (transverse section) showing intraparietal mass in left lumbar region with no intraperitoneal extension. | cp-2011-4-e135-g002 | 7 | 18148c63d378c331e06726ae4da31eb87dbea91c6f1de2180bc481d41fb1a87f | cp-2011-4-e135-g002.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
649,
482
] | [{'image_id': 'cp-2011-4-e135-g002', 'image_file_name': 'cp-2011-4-e135-g002.jpg', 'image_path': '../data/media_files/PMC3981408/cp-2011-4-e135-g002.jpg', 'caption': 'Contrast enhanced CT (transverse section) showing intraparietal mass in left lumbar region with no intraperitoneal extension.', 'hash': '18148c63d378c331e06726ae4da31eb87dbea91c6f1de2180bc481d41fb1a87f'}, {'image_id': 'cp-2011-4-e135-g005', 'image_file_name': 'cp-2011-4-e135-g005.jpg', 'image_path': '../data/media_files/PMC3981408/cp-2011-4-e135-g005.jpg', 'caption': 'Histopathology showing small round cells with vesicular nuclei, small inconspicuous nucleoli. Cells showing mild pleomorphism with pseudorossette formation.', 'hash': '0a07aa67e7e132c6ef807906213bd35e448bca2161dd2a3d5103c8aa469b2ee7'}, {'image_id': 'cp-2011-4-e135-g004', 'image_file_name': 'cp-2011-4-e135-g004.jpg', 'image_path': '../data/media_files/PMC3981408/cp-2011-4-e135-g004.jpg', 'caption': 'Reconstruction of abdominal wall using polypropylene mesh.', 'hash': '5ca97764ebe73d953e5c57f9f1215fa92743ab91238a09542334e2bbdd39c37f'}, {'image_id': 'cp-2011-4-e135-g003', 'image_file_name': 'cp-2011-4-e135-g003.jpg', 'image_path': '../data/media_files/PMC3981408/cp-2011-4-e135-g003.jpg', 'caption': 'Contrast enhanced CT (longitudinal section) showing same mass with normal liver and lung fields.', 'hash': '3f4cecc2fdf5df8841dc0810fca554a7abeb2a3054b355f3fc81533537e973e4'}, {'image_id': 'cp-2011-4-e135-g001', 'image_file_name': 'cp-2011-4-e135-g001.jpg', 'image_path': '../data/media_files/PMC3981408/cp-2011-4-e135-g001.jpg', 'caption': 'Lump in the left lumbar region.', 'hash': '5dcd4b7dfc6ea8ca761b42b3cd02e260e233fc857220417588a398435f0ea94e'}] | {'cp-2011-4-e135-g001': ['A 23-year female presented to surgical out-patients department with a painless lump in the left flank, which had been progressively increasing in size for seven months (<xref ref-type="fig" rid="cp-2011-4-e135-g001">Figure 1</xref>). There was no history of fever, cough, chest pain, burning micturition, hematuria, alteration of bowel habits, bleeding per rectum or malena. On examination, there was an approximatley 15×15 cm round variegated firm-hard intraparietal lump over the left lumbar and left iliac fossa with a 5×5 cm overlying non-healing ulcer. Clinically a diagnosis of soft tissue sarcoma was made. All routine blood investigations and chest X-ray were normal. Contrast enhanced CT scan of chest and abdomen revealed a 14×10×7 cm well defined lobulated, heterogenous, enhancing, hypodense lesion in the left lateral abdominal wall with ill-defined margins with underlying abdominal wall muscle with no evidence of intraperitoneal extension (). There was no history of fever, cough, chest pain, burning micturition, hematuria, alteration of bowel habits, bleeding per rectum or malena. On examination, there was an approximatley 15×15 cm round variegated firm-hard intraparietal lump over the left lumbar and left iliac fossa with a 5×5 cm overlying non-healing ulcer. Clinically a diagnosis of soft tissue sarcoma was made. All routine blood investigations and chest X-ray were normal. Contrast enhanced CT scan of chest and abdomen revealed a 14×10×7 cm well defined lobulated, heterogenous, enhancing, hypodense lesion in the left lateral abdominal wall with ill-defined margins with underlying abdominal wall muscle with no evidence of intraperitoneal extension (<xref ref-type="fig" rid="cp-2011-4-e135-g002">Figures 2</xref> and and <xref ref-type="fig" rid="cp-2011-4-e135-g003">3</xref>). There was no free fluid and no evidence of metastasis in chest or abdomen. Core biopsy suggested small round cell tumor. Wide excision of the tumor was planned under general anesthesia. Intraoperatively, the mass was found to be originating from the external oblique aponeurosis and involving few fibers of the internal oblique muscle; transversus abdominis muscle and tissues below were free. Reconstruction of the abdominal wall was performed using polypropylene mesh (15×15 cm) (). There was no free fluid and no evidence of metastasis in chest or abdomen. Core biopsy suggested small round cell tumor. Wide excision of the tumor was planned under general anesthesia. Intraoperatively, the mass was found to be originating from the external oblique aponeurosis and involving few fibers of the internal oblique muscle; transversus abdominis muscle and tissues below were free. Reconstruction of the abdominal wall was performed using polypropylene mesh (15×15 cm) (<xref ref-type="fig" rid="cp-2011-4-e135-g004">Figure 4</xref>). The postoperative period was uneventful. Histopathology of the resected specimen showed small round cells with vesicular nuclei, small inconspicuous nulceoli with mild pleomorphism with pseudorossette formation (). The postoperative period was uneventful. Histopathology of the resected specimen showed small round cells with vesicular nuclei, small inconspicuous nulceoli with mild pleomorphism with pseudorossette formation (<xref ref-type="fig" rid="cp-2011-4-e135-g005">Figure 5</xref>). All the margins were free of tumor. Immunohistochemistry revealed CD99 and PAS positivity whereas it was negative for desmin, chromogranin, LCA and cytokeratin. Thus a diagnosis of EES was established. The patient received post-operative radiotherapy (Total 54Gy with 1.8Gy per fraction) and chemotherapy VAC with IE regime (vincristine, adriamycin, cyclophospamide, ifosfamide, etoposide). The patient is doing well after eight months of follow up.). All the margins were free of tumor. Immunohistochemistry revealed CD99 and PAS positivity whereas it was negative for desmin, chromogranin, LCA and cytokeratin. Thus a diagnosis of EES was established. The patient received post-operative radiotherapy (Total 54Gy with 1.8Gy per fraction) and chemotherapy VAC with IE regime (vincristine, adriamycin, cyclophospamide, ifosfamide, etoposide). The patient is doing well after eight months of follow up.']} | Extraosseous Ewing's tumor of lateral abdominal wall | [
"Ewings",
"extraosseous",
"chemoradiation."
] | Clin Pract | 1322640000 | Extraosseous Ewings tumor (EES) is a rare entity. Few cases have been reported in literature. There are no specific guidelines for management of this disease. We are reporting a case of EES arising from left lateral abdominal wall. We did wide excision of tumor followed by chemoradiation. Patient is asymptomatic after 8 months of follow up. | [] | other | PMC3981408 | null | 13 | [
"{'Citation': \"Lee WS, Kim YH, Chee HK, et al. Multimodal Treatment of Primary Extraskeletal Ewing's Sarcoma of the Chest Wall: Report of 2 Cases. Cancer Res Treat. 2009;41:108–12.\", 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2731215'}, {'@IdType': 'pubmed', '#text': '19707510'}]}}",
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] | Clin Pract. 2011 Nov 30; 1(4):e135 | NO-CC CODE |
|
Computed tomography image showing sinus over manubrium sterni reaching up to periosteum. | cp-2011-4-e90-g003 | 7 | c1cf2a77c9d721599a7c00ce0d5acaafb10520e22b113873a81a6a9f2ff7968a | cp-2011-4-e90-g003.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
645,
858
] | [{'image_id': 'cp-2011-4-e90-g002', 'image_file_name': 'cp-2011-4-e90-g002.jpg', 'image_path': '../data/media_files/PMC3981432/cp-2011-4-e90-g002.jpg', 'caption': 'Sinus tract with acute on chronic inflammatory granulation tissue and caseating epithelioid cell granulomas (Haematoxylin & Eosin × 250).', 'hash': '7a299518ca4882e2c7030bbd7a3a97f67f6129629231e951211a7ad6da40b0f5'}, {'image_id': 'cp-2011-4-e90-g003', 'image_file_name': 'cp-2011-4-e90-g003.jpg', 'image_path': '../data/media_files/PMC3981432/cp-2011-4-e90-g003.jpg', 'caption': 'Computed tomography image showing sinus over manubrium sterni reaching up to periosteum.', 'hash': 'c1cf2a77c9d721599a7c00ce0d5acaafb10520e22b113873a81a6a9f2ff7968a'}, {'image_id': 'cp-2011-4-e90-g001', 'image_file_name': 'cp-2011-4-e90-g001.jpg', 'image_path': '../data/media_files/PMC3981432/cp-2011-4-e90-g001.jpg', 'caption': 'Sinus opening over manubrium.', 'hash': 'ff1eb64d0d0b67012f775d6256705462e5ae16a9580cb1338e17411eb76bd541'}] | {'cp-2011-4-e90-g001': ['A 32-year-old female came to our surgical out patient department with a pus discharging sinus over manubrium sterni for 2 months (<xref ref-type="fig" rid="cp-2011-4-e90-g001">Figure 1</xref>). There was no history of cough, fever, weight loss or anorexia. There was no history of trauma or any surgery over sternum. On examination, she was afebrile, weighed 54 kg. There was no significant lymphadenopathy and systemic examination revealed no abnormalities. There was a pus-discharging sinus over the manubrium sterni and the surrounding skin was erythematous and indurated. Laboratory investigations revealed haemoglobin 12 g/dL, total leukocytes count 7800 mm). There was no history of cough, fever, weight loss or anorexia. There was no history of trauma or any surgery over sternum. On examination, she was afebrile, weighed 54 kg. There was no significant lymphadenopathy and systemic examination revealed no abnormalities. There was a pus-discharging sinus over the manubrium sterni and the surrounding skin was erythematous and indurated. Laboratory investigations revealed haemoglobin 12 g/dL, total leukocytes count 7800 mm3, differential leukocyte count- Polymorphs 74, lymphocytes 26, and erythrocyte sedimentation rate 30. Tuberculin skin test was positive with a 22-mm induration. Human immunodeficiency virus test was negative. Chest X-ray was normal. Gram and Ziel Neilson staining of pus didn\'t reveal any organism. Computed Tomography of chest showed a sinus tract in subcutaneous tissue over manubrium sterni reaching up to the periosteum (<xref ref-type="fig" rid="cp-2011-4-e90-g002">Figure 2</xref>). Surgical excision of sinus tract was planned. Intraoperatively, it was found that tract was going upwards up to the manubrium sterni and there was erosion of the underlying periosteum. Tract was excised completely and bone was curetted thoroughly. Histopathological examination of the sinus tract showed caseating granulomas with acid fast bacilli (). Surgical excision of sinus tract was planned. Intraoperatively, it was found that tract was going upwards up to the manubrium sterni and there was erosion of the underlying periosteum. Tract was excised completely and bone was curetted thoroughly. Histopathological examination of the sinus tract showed caseating granulomas with acid fast bacilli (<xref ref-type="fig" rid="cp-2011-4-e90-g003">Figure 3</xref>). Culture revealed Mycobacterium Tuberculosis sensitive to standard anti- tubercular drugs. Patient received antitubercular therapy for 9 months. Patient is doing fine after 12 months of follow-up.). Culture revealed Mycobacterium Tuberculosis sensitive to standard anti- tubercular drugs. Patient received antitubercular therapy for 9 months. Patient is doing fine after 12 months of follow-up.']} | Tubercular sinus over manubrium sterni: a rare presentation | [
"tuberculosis",
"sternum",
"sinus."
] | Clin Pract | 1320217200 | Isolated sternal involvement in tuberculosis is rare. Very few case reports are available in literature even from the countries where tuberculosis is endemic. We are reporting a case of 32-year-old female who presented to us with a pus discharging sinus over manubrium sterni with no other systemic features of tuberculosis. Sinus tract was excised and biopsy confirmed tuberculosis. Patient received antitubercular therapy for 9 months. | [] | other | PMC3981432 | null | 11 | [
"{'Citation': 'Bohl JM, Janner D. Mycobacterium tuberculosis sternal osteomyelitis presenting as anterior chest wall mass. Pediatr Infect Dis J. 1999;18:1028–9.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10571449'}}}",
"{'Citation': 'Jhamb DK, Bhatnagar MK, Verma S, et al. Tubercular cold abscess over the manubrium sterni. J Assoc Physicians India. 1989;36:292–3.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2613657'}}}",
"{'Citation': 'Ray M, Kataria S, Singhi P. Unusual presentation of disseminated tuberculosis. Indian Pediatrics. 2002;39:88–91.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11805360'}}}",
"{'Citation': 'Sharma S, Juneja M, Garg A. Primary tubercular osteomyelitis of the sternum. Indian J Pediatr. 2005;72:709–10.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16131781'}}}",
"{'Citation': 'Saifudheen K, Anoop TM, Mini PN, et al. Primary tubercular osteomyelitis of the sternum. Int J Infect Dis. 2010;14:e164–6.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19524467'}}}",
"{'Citation': 'Davies PDO, Humphries MJ, Byfield SP, et al. Bone and joint tuberculosis. A survey of notifications in England and Wales. J Bone Joint Surg Br. 1984;66:326–30.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '6427232'}}}",
"{'Citation': 'Tuli SM, Sinha GP. Skeletal tuberculosis unusual lesions. Indian J Orthop. 1969;3:5–18.'}",
"{'Citation': 'McLellan DG, Philips KB, Corbett CE, Bronze MS. Sternal osteomyelitis caused by mycobacterium tuberculosis: case report and review of the literature. Am J Med Sci. 2000;319:250–54.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10768611'}}}",
"{'Citation': 'Sarlak AY, Gundes H, Alp M. Primary sternal tuberculosis: a rare unhealed case treated by resection and local rotational flap. Thorac Cardiovasc Surg. 2001;49:58–9.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '11243527'}}}",
"{'Citation': 'Hajjar W, Logan AM, Belcher PR. Primary sternal tuberculosis treated by resection and reconstruction. Thorac Cardiovasc Surg. 1996;44:317–8.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9021912'}}}",
"{'Citation': 'Ford SJ, Rathinam S, King JE, Vaughan R. Tuberculous osteomyelitis of the sternum: successful management with debridement and vacuum assisted closure. Eur J Cardiothorac Surg. 2005;28:645–7.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16179195'}}}"
] | Clin Pract. 2011 Nov 2; 1(4):e90 | NO-CC CODE |
|
CT scan Spigelian Hernia. | jsls-6-3-217-g02 | 7 | dbe629d8cb707515bc4e5b35d77d98f44e1ba3fad14fa7b924710805e6fef0b3 | jsls-6-3-217-g02.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
513,
522
] | [{'image_id': 'jsls-6-3-217-g02', 'image_file_name': 'jsls-6-3-217-g02.jpg', 'image_path': '../data/media_files/PMC3043429/jsls-6-3-217-g02.jpg', 'caption': 'CT scan Spigelian Hernia.', 'hash': 'dbe629d8cb707515bc4e5b35d77d98f44e1ba3fad14fa7b924710805e6fef0b3'}, {'image_id': 'jsls-6-3-217-g01', 'image_file_name': 'jsls-6-3-217-g01.jpg', 'image_path': '../data/media_files/PMC3043429/jsls-6-3-217-g01.jpg', 'caption': 'Trocar and hand-assist port placement.', 'hash': '3f726f2b257030d10194196566fa694d865216b602f3e3f6522527cc817f2130'}] | {} | Incarcerated Spigelian Hernia Following Laparoscopic Living-Donor Nephrectomy | [
"Laparoscopic nephrectomy",
"Kidney transplant",
"Spigelian hernia"
] | JSLS | 1025506800 | [{'@Label': 'OBJECTIVE', '@NlmCategory': 'OBJECTIVE', '#text': 'Image-guided core needle biopsy (IGCNB) is an accepted technique for sampling nonpalpable mammographically detected suspicious breast lesions. However, the concern for needle-track seeding in malignant lesions remains. An alternative to IGCNB is needle-localization breast biopsy (NLBB). No study has been done to compare the local recurrence rate of breast cancer after IGCNB versus NLBB.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'We have retrospectively reviewed the local recurrence of breast cancer in patients diagnosed by either IGCNB or NLBB who underwent breast-preserving treatment for their cancer between May 1990 and June 1995. The length of follow-up averaged 29.7 months.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'Three hundred ninety-eight patients were diagnosed with breast cancer by IGCNB (297 patients) or NLBB (101 patients). All patients underwent breast-conserving surgery. Fifteen (3.77%) patients had a local recurrence: 11(3.70%) in the IGCNB group and 4 (3.96%) in the NLBB group. These recurrence rates are not statistically different.'}, {'@Label': 'CONCLUSION', '@NlmCategory': 'CONCLUSIONS', '#text': 'Concerns for seeding of the needle track with cancer cells have made some surgeons wary of IGCNB. However, we did not find an increased rate of recurrence due to needle-track seeding, and IGCNB remains our procedure of choice for diagnosing mammographically detected suspicious breast lesions.'}] | [
"Biopsy, Needle",
"Breast Neoplasms",
"Humans",
"Neoplasm Recurrence, Local",
"Neoplasm Seeding",
"Retrospective Studies"
] | other | PMC3043429 | null | 7 | [
"{'Citation': 'Parker SH, Burbank F, Jackman RJ, et al. Percutaneous large-core breast biopsy: a multi-institutional study. Radiology. 1994;193:359–364', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '7972743'}}}",
"{'Citation': 'Devia A, Murray KA, Nelson EW. Stereotactic core needle biopsy and the workup of mammographic breast lesions. Arch Surg. 1997:132:512–516', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9161394'}}}",
"{'Citation': 'Harter LP, Curtis JS, Ponto G, Craig PH. Malignant seeding of the needle track during stereotaxic core needle breast biopsy. Radiology. 1992;185:713–714', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1343569'}}}",
"{'Citation': 'Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995;333:1456–1461', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '7477145'}}}",
"{'Citation': \"Early Breast Cancer Trialists' Collaborative Group Effects of radiotherapy and surgery in early breast cancer: an overview of the randomized trials. N Engl J Med. 1995;333:1444–1455\", 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '7477144'}}}",
"{'Citation': 'Vicini FA, Recht A, Abner A, et al. Recurrence in the breast following conservative surgery and radiation therapy for early-stage breast cancer. J Natl Cancer Inst Monogr. 1992;11:33–39', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1627429'}}}",
"{'Citation': 'Youngson BJ, Cranor M, Rosen PP. Epithelial displacement in surgical breast specimens following needling procedures. Am J Surg Pathol. 1994;18:896–903', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8067510'}}}"
] | JSLS. 2002 Jul; 6(3):217-219 | NO-CC CODE |
|
Computed tomography of a 14-year-old boy. Mucus plugging and bronchiectasia can be seen in the right lung. | IJMS-36-18-g003 | 7 | 8bc48294808fbd8833d13fa4d790f54afdc6ef262f86bf754bf200a540b0fa05 | IJMS-36-18-g003.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
771,
672
] | [{'image_id': 'IJMS-36-18-g002', 'image_file_name': 'IJMS-36-18-g002.jpg', 'image_path': '../data/media_files/PMC3559112/IJMS-36-18-g002.jpg', 'caption': 'Computed tomography of a 9-year-old boy. Bronchiectasia is seen in right and left lungs.', 'hash': 'c63364189ec6a8551cd07bd596b451f8cb5854565e69ccf04a0fdb9a4a451d22'}, {'image_id': 'IJMS-36-18-g003', 'image_file_name': 'IJMS-36-18-g003.jpg', 'image_path': '../data/media_files/PMC3559112/IJMS-36-18-g003.jpg', 'caption': 'Computed tomography of a 14-year-old boy. Mucus plugging and bronchiectasia can be seen in the right lung.', 'hash': '8bc48294808fbd8833d13fa4d790f54afdc6ef262f86bf754bf200a540b0fa05'}, {'image_id': 'IJMS-36-18-g001', 'image_file_name': 'IJMS-36-18-g001.jpg', 'image_path': '../data/media_files/PMC3559112/IJMS-36-18-g001.jpg', 'caption': 'Computed tomography from a 13-year-old girl. Bronchiectasia, peribronchial wall thickening, mucus plugging can be seen in both lungs.', 'hash': '24702f16b09eec0c9e927ebb898c7bbf9bdbb4d21dc7a64dbd7e190de5dcad34'}] | {'IJMS-36-18-g001': ['Twenty three (nine females and 14 males) patients with CF entered this prospective study. The range of the patients\' age was 5-23 years (mean: 13.42 years). The overall CT score for all patients was 57.6±24.2. The most common findings in patients’ HRCT were bronchiectasia (100%), peribronchial thickening (100%), mucus plugging (95%) and air trapping (90%). A prototype of bronchiechtasia, peribronchial wall thickening and mucus plugging in patients\' HRCT are shown in <xref ref-type="fig" rid="IJMS-36-18-g001">figures 1</xref>--<xref ref-type="fig" rid="IJMS-36-18-g003">3</xref>..']} | The Correlation of Brody High Resolution Computed Tomography Scoring System with Clinical Status and Pulmonary Function Test in Patients with Cystic Fibrosis | [
"Clinical status",
"pulmonary function test",
"cystic fibrosis"
] | Iran J Med Sci | 1298966400 | [{'@Label': 'BACKGROUND', '@NlmCategory': 'BACKGROUND', '#text': 'To reduce the mortality and morbidity rates of cystic fibrosis (CF) patients, and to have an effective clinical management, it is important to monitor the progression of the disease. The aim of this study was to evaluate the progression of lung disease in CF patients by means of assessing the correlation of the CT scoring system with clinical status and pulmonary function test at the Pediatric Pulmonary Ward of Masih Daneshvari Hospital in 2008.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': "Pulmonary high resolution computed tomography (HRCT) was performed in 23 CF patients using the Brody's scoring system. Morphologic signs as well as the extent and severity of each sign were scored, and the total score was calculated. The correlation of HRCT scores (total score as well as the score for each parameter) with Shwachman Kuczycki scoring system and pulmonary function test were examined."}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': "The study included 9 female and 14 male patients with an age range of 5-23 years (mean: 13.42 years). Bronchiectasis (100%) and peribronchial wall thickening (100%) were the most frequent CT abnormalities. Mucus plugging, air trapping and parenchymal involvements were respectively seen in 95.7%, 91.3% and 47.8% of patients. The overall CT score for all patients was 57.6±24.2 (means±SD). The results of pulmonary function test showed a restrictive pattern; however, in 5.3% of the patients PFT was normal. The overall Shwachman-Kulczycki score was 53.48±13.8. There was a significantly (P=0.015) negative correlation between the total CT score and Shwachman-Kulczycki score; however, there was no significant correlation between total CT score and the results of PFT (P=0.481)CONCLUSION: The Brody's scoring system for high resolution computed tomography seems to be a sensitive and efficient method to evaluate the progression of CF, and can be more reliable when we combine the CT scores with clinical parameters."}] | [] | other | PMC3559112 | null | 26 | [
"{'Citation': 'Cystic Fibrosis Foundation. Cystic Fibrosis Foundation Patient Registry: 2005 Annual data report to the center directors. Bethesda, MD: Cystic Fibrosis Foundation; 2006.'}",
"{'Citation': 'Accurso FJ. Update in Cystic fibrosis 2007. Am J Respir Crit Care Med. 2008;177:1058–61.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2720148'}, {'@IdType': 'pubmed', '#text': '18460460'}]}}",
"{'Citation': \"Flume PA, O'Sullivan BP, Robinson KA, et al. Cystic Fibrosis Pulmonary Guidelines,Chronic Medications for Maintenance of Lung Health. Am J Respir Crit Care Med. 2007;176:957–69.\", 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17761616'}}}",
"{'Citation': 'Gibson RL, Burns JL, Ramsey BW. Ransey. Pathophysiology and management of pulmonmary infection in Cystic fibrosis. Am J Respir Crit Care Med. 2003;168:918–51.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14555458'}}}",
"{'Citation': 'Cleveland RH, Neish AS, Zurakowaski D, et al. Cystic fibrosis: a system for assessing and predicting progression. AJR. 1998;170:1067–72.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9530060'}}}",
"{'Citation': 'Rosenberg SM, Howatt WF, Grum CM. Spirometry and chest roentgenographic appearance in adult with cystic fibrosis. Chest. 1992;101:961–4.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1555469'}}}",
"{'Citation': \"Taussig LM, Kattwinkel J, Friedewald WT, Di Sant'AgnesePA. A new prognostic score and clinical evaluation system for CF. J Pediatr. 1973;82:380–90.\", 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '4698929'}}}",
"{'Citation': 'Shah RM, Sexauer W, Ostrum BJ, et al. High resolution CT in the acute exacerbation of cystic fibrosis: Evaluation of acute findings, reversibility of those findings and clinical correlation. AJR Am J Roentgenol. 1997;169:375–80.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9242738'}}}",
"{'Citation': 'Maffessanti M, Candusso M, Brizzi F, Piovesana F. Cystic fibrosis in children: HRCT findings and distribution of disease. J Thorac Imaging. 1996;11:27–38.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8770824'}}}",
"{'Citation': 'Nathanson I, Conboy K, Murphy S, et al. Ultrafast computerized tomography of the chest in cystic fibrosis: a new scoring system. Pediatr Pulmonol. 1991;11:81–6.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1923671'}}}",
"{'Citation': 'Robinson TE. Computed Tomography Scanning Techniques for the Evaluation of Cystic Fibrosis Lung Disease. Proc Am ThoracSoc. 2007;4:310–5.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17652492'}}}",
"{'Citation': 'Bhalla M, Turcios N, Aponte V, et al. Cystic fibrosis: scoring system with thin section CT. Radiology. 1991;179:783–8.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2027992'}}}",
"{'Citation': 'Helbich TH, Heinz-peer G, Fleischmann D, et al. Evolution of CT findings in patient with cystic fibrosis. AJR Am J Roentgenol. 173:81–88.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10397104'}}}",
"{'Citation': 'Helbich TH, Heinz-Peer G, Eichler I, et al. Cystic fibrosis CT: assessment of lung involvement in children and adult. Radiology. 1999;213:537–44.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10551238'}}}",
"{'Citation': 'Santamaria F, Grillo G, Guidi G, et al. Cystic fibrosis: when should high resolution computed tomography of the chest be obtained? Pediatrics. 1998;101:908–13.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '9565424'}}}",
"{'Citation': 'Brody AS, Kosorok MR, Li Z, et al. Reproducibility of scoring system for computed tomography scanning in cystic fibrosis. J Thorac Imaging. 2006;21:14–21.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16538150'}}}",
"{'Citation': 'de JongPA, Nakano Y, Lequin MH, et al. Progressive damage on high resolution computed tomography despite stable lung function in cystic fibrosis. Eur Respir J. 2004;23:93–7.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14738238'}}}",
"{'Citation': 'Brody AS, Suchare H, Campbeu JD, et al. Computed tomograghy correlates with pulmonary exacerbation s in children with Cystic Fibrosis. AMJ Respire Crit Care Med. 2005;172:1128–32.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16100015'}}}",
"{'Citation': 'de JongPA, Lindblad A, Rubin L, et al. Progression of lung disease on computed tomography and pulmonary function tests in children and adults with cystic fibrosis. Thorax. 2006;61:80–5.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2080716'}, {'@IdType': 'pubmed', '#text': '16244089'}]}}",
"{'Citation': \"Klieman , Behrman , Jenson , Stanton . In: Nelson's Textbook of Pediatrics. 18 th ed. Kliegman, R.M, editor. Vol 2. 2007. pp. 1806–8.\"}",
"{'Citation': 'Shwachman H, Kulczycki LL. Long term study of 105 patients with cystic fibrosis. Am J Dis Child. 1958;96:6–10.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '13544726'}}}",
"{'Citation': 'Davis SD, Fordham LA, Brody AS, et al. Computed tomography reflects lower airway inflammation and tracks changes in early cystic fibrosis. Am J Respir Crit Care Med. 2007;175:943–50.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17303797'}}}",
"{'Citation': 'Klein JS, Quan J, Beanj A. High-resolution computed tomography in young patients with cystic fibrosis: distribution of abnormalities and correlation with pulmonary function test. J Pediatr. 2004;145:32–8.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15238903'}}}",
"{'Citation': 'Taccone A, Romano L, Marzoli A, Giroso D, Dell’Acqua A. High-resolution computed tomography in cystic fibrosis. Eur J Radiol. 1992;15:125–9.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1425747'}}}",
"{'Citation': 'Alan SBrody. Scoring system for CT in cystic fibrosis: who cares. Radiology. 2004;231:296–8.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15128979'}}}",
"{'Citation': 'Judge EP, Dodd JD, Masterson JB, Gallaghe CG. Pulmonary abnormalities on high resolution CT demonstrate more rapid decline than FEV1 in adult with cystic fibrosis. Chest. 2006;130:1424–32.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17099020'}}}"
] | Iran J Med Sci. 2011 Mar; 36(1):18-23 | NO-CC CODE |
|
Sagittal views of a magnetic resonance imaging showing recurrent spinal stenosis (arrows) after the fracture. | ebsj02019-4 | 7 | e8ef1f7c4c5cb07a6e6d9f9c7a045c8bd28d4ecfd80e63d5034bd5adc546efa6 | ebsj02019-4.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
675,
351
] | [{'image_id': 'ebsj02019-4', 'image_file_name': 'ebsj02019-4.jpg', 'image_path': '../data/media_files/PMC3621856/ebsj02019-4.jpg', 'caption': 'Sagittal views of a magnetic resonance imaging showing recurrent spinal stenosis (arrows) after the fracture.', 'hash': 'e8ef1f7c4c5cb07a6e6d9f9c7a045c8bd28d4ecfd80e63d5034bd5adc546efa6'}, {'image_id': 'ebsj02019-3', 'image_file_name': 'ebsj02019-3.jpg', 'image_path': '../data/media_files/PMC3621856/ebsj02019-3.jpg', 'caption': 'A sagittal postoperative computed tomographic scan of the same patient indicating a fracture of the L4 spinous process between two DIAMs that were placed in the L3/4 and L4/5. Arrow indicates the fracture (the patient underwent decompression of these heights as well). b–c Axial view of the fracture height.', 'hash': '15afdf516ca43e9abcb48a30a54da07a420fa0ed7d64192c337e775ee4acf497'}, {'image_id': 'ebsj02019-2', 'image_file_name': 'ebsj02019-2.jpg', 'image_path': '../data/media_files/PMC3621856/ebsj02019-2.jpg', 'caption': 'X-rays of AP lumbar spine of a 78-year-old man before surgery. Severe degenerative changes are seen and instability at the L3/L4 intervertebral disc (2b).', 'hash': '185fd6d0e8845a040ef6e183a729adc4fcc68c5dff074d702058e90ef43bba6f'}, {'image_id': 'ebsj02019-5', 'image_file_name': 'ebsj02019-5.jpg', 'image_path': '../data/media_files/PMC3621856/ebsj02019-5.jpg', 'caption': 'X-ray of AP lumbar spine of the patient after a revision surgery; he had the DIAMs removed and underwent formal transforaminal lumbar interbody fusion L3–L5. His symptoms subsided. b Lateral view of the lumbar spine of the same patient after transforaminal lumbar interbody fusion L3–L5.', 'hash': '3084cdff4ec6b1666bfc22543d947a1fedba299ebb9069a40eb9d019caeea0d2'}, {'image_id': 'ebsj02019-1', 'image_file_name': 'ebsj02019-1.jpg', 'image_path': '../data/media_files/PMC3621856/ebsj02019-1.jpg', 'caption': 'Patient sampling and selection. ISD indicates interspinous device; DIAM implant from Medtronic Sofamor Danek, Switzerland.', 'hash': '19a8c80e9c7474b87c04c4e4ec3be68a0af40b12ff633d99c0f7a854f82d75e9'}] | {'ebsj02019-1': ['Exclusion criteria: Patients with insertion of other ISDs (<xref rid="ebsj02019-1" ref-type="fig">Fig. 1</xref>). Other ISDs were excluded as a mean to reduce variability, as the insertion process is different for each ISD and the methods of fixation are also different.). Other ISDs were excluded as a mean to reduce variability, as the insertion process is different for each ISD and the methods of fixation are also different.', 'Patient population (<xref rid="ebsj02019-1" ref-type="fig">Fig. 1</xref>)):'], 'ebsj02019-2': ['Of 68 patients implanted with interspinous devices, 21 (32%) had complications (<xref rid="ebsj02019-2" ref-type="fig">Fig. 2</xref>,,<xref rid="ebsj02019-3" ref-type="fig">Fig. 3</xref>,,<xref rid="ebsj02019-4" ref-type="fig">Fig. 4</xref>).).'], 'ebsj02019-5': ['Seven patients (10.1%) underwent revision surgery (<xref rid="ebsj02019-5" ref-type="fig">Fig. 5</xref>).).']} | Interspinous devices: are they as attractive as they seem? An intermediate-term follow-up | null | Evid Based Spine Care J | 1304233200 | [{'@Label': 'STUDY DESIGN', '@NlmCategory': 'METHODS', '#text': 'A retrospective cohort of 68 patients who underwent insertion of the DIAM (Medtronic Sofamor Danek, Switzerland) interspinous device (ISD) during 2006-2008 at one medical center.'}, {'@Label': 'OBJECTIVES', '@NlmCategory': 'OBJECTIVE', '#text': 'To assess the short- and intermediate-term outcomes and complications associated with ISD.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'Evaluation of files and all patients who underwent insertion of a DIAM ISD was performed. Patients walking distances and pain (visual analog scale score) were compared with data gathered before surgery. Outcome and all complications related to ISD have been identified and analyzed.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': "All 68 patients were available for follow-up. Mean follow-up was 34 months (23-52 months). The average age was 57 (±13) years. Walking distance increased by 890% and patient's pain score improved by 3.27 points on visual analog scale. Twenty-one (32%) of the 68 patients had perioperative or late complications. Nine complications (75%) were unrelated to ISD and included 5 dura tears, 3 wound-related complications, and 1 transient ischemic attack. Spinous process fractures occurred in 5 cases, leading to revision in 2 cases. In total, 7 of the patients required revision surgery. These patients were older, with an average age of 69 years."}, {'@Label': 'CONCLUSION', '@NlmCategory': 'CONCLUSIONS', '#text': 'The outcome of patients who had an implantation of the DIAM ISD is good. In this cohort, 6% developed recurrent claudication symptoms in the second postoperative year. In an older population, the combination of softer bone and rigid stenosis increase the risk of spinous process fracture, resulting in failure and leading to revision surgery. Other solutions should be sought for these patients. [Table: see text] The definiton of the different classes of evidence is available on page 55.'}] | [] | other | PMC3621856 | null | 9 | [
"{'Citation': 'Barbagallo G M, Olindo G, Corbino L. et al.Analysis of complications in patients treated with the X-Stop Interspinous Process Decompression System: proposal for a novel anatomic scoring system for patient selection and review of the literature. Neurosurgery. 2009;2:111–119.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19574832'}}}",
"{'Citation': 'Bowers C, Amini A, Dailey A T. et al.Dynamic interspinous process stabilization: review of complications associated with the X-Stop device. Neurosurg Focus. 2010;2:E8.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '20568923'}}}",
"{'Citation': 'Lindsey D P, Swanson K E, Fuchs P. et al.The effects of an interspinous implant on the kinematics of the instrumented and adjacent levels in the lumbar spine. Spine (Phila Pa 1976) 2003;2:219–217.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14520030'}}}",
"{'Citation': 'Mariottini A, Pieri S, Giachi S. et al.Preliminary results of a soft novel lumbar intervertebral prothesis (DIAM) in the degenerative spinal pathology. Acta Neurochir Suppl. 2005;2:129–131.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15830984'}}}",
"{'Citation': 'Zucherman J F, Hsu K Y, Hartjen C A. et al.A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results. Spine (Phila Pa 1976) 2005;2:1351–1358.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15959362'}}}",
"{'Citation': 'Taylor J, Pupin P, Delajoux S. et al.Device for intervertebral assisted motion: technique and initial results. Neurosurg Focus. 2007;2:E6.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17608340'}}}",
"{'Citation': 'Hägg O, Fritzell P, Nordwall A. The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J. 2003;2:12–20.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '12592542'}}}",
"{'Citation': 'Kondrashov D G, Hannibal M, Hsu K Y. et al.Interspinous process decompression with the X-STOP device for lumbar spinal stenosis: a 4-year follow-up study. J Spinal Disord Tech. 2006;2:323–327.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '16826002'}}}",
"{'Citation': 'Li G, Patil C G, Lad S P. et al.Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients. Spine (Phila Pa 1976) 2008;2:1250–1255.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18469700'}}}"
] | Evid Based Spine Care J. 2011 May; 2(2):19-24 | NO-CC CODE |
|
Preoperative coronal T2 MRI sequences demonstrating increased signal intensity on the occiput-C1 and C1-2 joints. | ebsj01069-3 | 7 | dad5be62c1a73e5897b81d79ef005b06abb9d9d936bafc4a2150a9c487b2fb39 | ebsj01069-3.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
633,
384
] | [{'image_id': 'ebsj01069-3', 'image_file_name': 'ebsj01069-3.jpg', 'image_path': '../data/media_files/PMC3623094/ebsj01069-3.jpg', 'caption': 'Preoperative coronal T2 MRI sequences demonstrating increased signal intensity on the occiput-C1 and C1-2 joints.', 'hash': 'dad5be62c1a73e5897b81d79ef005b06abb9d9d936bafc4a2150a9c487b2fb39'}, {'image_id': 'ebsj01069-4', 'image_file_name': 'ebsj01069-4.jpg', 'image_path': '../data/media_files/PMC3623094/ebsj01069-4.jpg', 'caption': 'Postoperative lateral C-spine x-ray showing rigid posterior instrumented fusion from occiput to C2.', 'hash': '92471b25718178bf05657e43df12b34f403e3e8094cbe9a0bc55577298ec06b1'}, {'image_id': 'ebsj01069-5', 'image_file_name': 'ebsj01069-5.jpg', 'image_path': '../data/media_files/PMC3623094/ebsj01069-5.jpg', 'caption': 'Postoperative sagittal C-spine x-ray showing rigid posterior instrumented fusion from occiput to C2.', 'hash': 'fd1fe4377290216b0e87ed56b4766bec1201c822283f7f45ed9e7a6600e5d5de'}, {'image_id': 'ebsj01069-2', 'image_file_name': 'ebsj01069-2.jpg', 'image_path': '../data/media_files/PMC3623094/ebsj01069-2.jpg', 'caption': 'Sagittal C-spine CT scan obtained as part of the initial ATLS survey demonstrating an occiput C2 distractive injury.', 'hash': '72a958c6e6b8456ee6f220f4bb59b0c2b6d5b700831b6f49ca761b3556bc6a92'}, {'image_id': 'ebsj01069-1', 'image_file_name': 'ebsj01069-1.jpg', 'image_path': '../data/media_files/PMC3623094/ebsj01069-1.jpg', 'caption': 'Initial lateral C-spine radiograph obtained as part of the initial ATLS survey demonstrating an occiput C1 distractive injury.', 'hash': '18e4461dff5195ec3f411a573bc2e9e41d0b2eb3d4bb2293bebc1c553b723fbb'}] | {'ebsj01069-1': ['Methods:\u2003Following institutional review board approval, a search of the Harborview Medical Center (HMC) trauma registry was conducted for all surgically treated CCD patients between 1996 and 2008. Forty-eight consecutive cases were identified. A retrospective review of the radiological and clinical results with emphasis on timing of diagnosis, modality used for diagnosis (<xref rid="ebsj01069-1" ref-type="fig">Figures 1</xref> and and <xref rid="ebsj01069-2" ref-type="fig">2</xref>), clinical effect of delayed diagnosis, potential clinical or imaging warning signs, and response to treatment was performed. Thirty-one patients treated from 2003 to 2008 were compared to 17 patients that were treated from 1996 to 2002 and reported previously.), clinical effect of delayed diagnosis, potential clinical or imaging warning signs, and response to treatment was performed. Thirty-one patients treated from 2003 to 2008 were compared to 17 patients that were treated from 1996 to 2002 and reported previously.1'], 'ebsj01069-3': [' All patients sustained high-energy injuries and were evaluated according to standard Advanced Trauma Life Support (ATLS) protocols. Once CCD was identified or suspected, provisional stabilization was applied and MRI evaluation performed (<xref rid="ebsj01069-3" ref-type="fig">Figure 3</xref>). Definitive surgical management with rigid posterior instrumentation and fusion was performed as soon as physiologically possible (). Definitive surgical management with rigid posterior instrumentation and fusion was performed as soon as physiologically possible (<xref rid="ebsj01069-4" ref-type="fig">Figures 4</xref> and and <xref rid="ebsj01069-5" ref-type="fig">5</xref>).).']} | Diagnosis and treatment of craniocervical dissociation in 48 consecutive survivors | null | Evid Based Spine Care J | 1280646000 | [{'@Label': 'STUDY TYPE', '@NlmCategory': 'METHODS', '#text': 'Case series Introduction: \u2003Craniocervical dissociation (CCD) is an uncommon and frequently fatal injury with few reports in the literature of survivors. Advances in automobile safety and improved emergency medical services have resulted in increased survival. Timely diagnosis and treatment are imperative for optimal outcome. Regrettably, the presence of multiple life threatening injuries, low clinical suspicion, and lack of familiarity with the upper cervical radiographic anatomy frequently lead to missed or delayed diagnosis.'}, {'@Label': 'OBJECTIVE', '@NlmCategory': 'OBJECTIVE', '#text': 'This paper represents the largest series of surgically treated CCD survivors. The goal of this study is to determine if any improvements have been made in the timely diagnosis of CCD while performing a complete patient evaluation.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'Following institutional review board approval, a search of the Harborview Medical Center (HMC) trauma registry was conducted for all surgically treated CCD patients between 1996 and 2008. Forty-eight consecutive cases were identified. A retrospective review of the radiological and clinical results with emphasis on timing of diagnosis, modality used for diagnosis (Figures 1 and 2), clinical effect of delayed diagnosis, potential clinical or imaging warning signs, and response to treatment was performed. Thirty-one patients treated from 2003 to 2008 were compared to 17 patients that were treated from 1996 to 2002 and reported previously.1 Figure 1 Initial lateral C-spine radiograph obtained as part of the initial ATLS survey demonstrating an occiput C1 distractive injury.Figure 2 Sagittal C-spine CT scan obtained as part of the initial ATLS survey demonstrating an occiput C2 distractive injury. All patients sustained high-energy injuries and were evaluated according to standard Advanced Trauma Life Support (ATLS) protocols. Once CCD was identified or suspected, provisional stabilization was applied and MRI evaluation performed (Figure 3). Definitive surgical management with rigid posterior instrumentation and fusion was performed as soon as physiologically possible (Figures 4 and 5). Figure 3a-b Preoperative coronal T2 MRI sequences demonstrating increased signal intensity on the occiput-C1 and C1-2 joints.Figure 4 Postoperative lateral C-spine x-ray showing rigid posterior instrumented fusion from occiput to C2.Figure 5 Postoperative sagittal C-spine x-ray showing rigid posterior instrumented fusion from occiput to C2.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'Craniocervical dissociation was identified on initial cervical spine imaging in 26 patients (84%). The remaining five patients (16%) were diagnosed by cervical spine MRI. Twenty-three patients (74.2%) were diagnosed within 24 hours of presentation, four (22.6%) were diagnosed between 24 and 48 hours, and one (3.2%) experienced a delay of greater than 48 hours (Table 1). In comparison, four (24%) of the previously treated 17 patients were diagnosed on initial cervical spine imaging. Four patients (24%) were diagnosed within 24 hours of presentation, nine (52%) were diagnosed between 24 and 48 hours, and four (24%) experienced a delay of greater than 48 hours. There were no cases of craniocervical pseudarthrosis or hardware failure during a mean nine-month follow-up period. Four patients expired during their hospital course. The mean American Spinal Injury Association (ASIA) motor score of 47 improved to 60, and the number of patients with useful motor function (ASIA Grade D or E) increased from eight (26%) preoperatively to 17 (55%) postoperatively.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'Improvements have been made in time to diagnosis of CCD in recent years. Increased awareness and the routine use of CT scan as part of the initial ATLS evaluation account for this progress. Expedited diagnosis has decreased preoperative neurological deterioration. However, differences in length of follow-up between the two groups preclude conclusions about its effect on long-term neurological outcome. [Table: see text].'}] | [] | other | PMC3623094 | null | 2 | [
"Citation",
"ArticleIdList"
] | Evid Based Spine Care J. 2010 Aug; 1(2):69-70 | NO-CC CODE |
|
Maximal canal compromise (MCC), and maximal spinal cord compression (MSCC). MCC(%) = 1−[Dx/(Da+Db)/2] × 100%; MSCC(%) = 1−[dx/(da+db)/2] × 100% | ebsj01056-3 | 7 | 89941871cedb025f16c9309bf7b95f8856c4ae6cb4229759bd76cc7547684268 | ebsj01056-3.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
602,
489
] | [{'image_id': 'ebsj01056-1', 'image_file_name': 'ebsj01056-1.jpg', 'image_path': '../data/media_files/PMC3623104/ebsj01056-1.jpg', 'caption': 'Transverse area (TA)', 'hash': '4b86bd317359bdbc00a1042d8e96578dc828cae2300818ee9212afbcd639fcff'}, {'image_id': 'ebsj01056-2', 'image_file_name': 'ebsj01056-2.jpg', 'image_path': '../data/media_files/PMC3623104/ebsj01056-2.jpg', 'caption': 'Compression ratio (CR\u2009=\u2009AP/W)', 'hash': 'f678d31d460a044c8e52d751bc11c19fe708352acf30eae0efec88e4b5db3a66'}, {'image_id': 'ebsj01056-3', 'image_file_name': 'ebsj01056-3.jpg', 'image_path': '../data/media_files/PMC3623104/ebsj01056-3.jpg', 'caption': 'Maximal canal compromise (MCC), and maximal spinal cord compression (MSCC). MCC(%)\u2009=\u20091−[Dx/(Da+Db)/2] × 100%; MSCC(%)\u2009=\u20091−[dx/(da+db)/2] × 100%', 'hash': '89941871cedb025f16c9309bf7b95f8856c4ae6cb4229759bd76cc7547684268'}, {'image_id': 'ebsj01056-4', 'image_file_name': 'ebsj01056-4.jpg', 'image_path': '../data/media_files/PMC3623104/ebsj01056-4.jpg', 'caption': 'Intraclass correlation coefficients (ICC)', 'hash': '944d562a28075831c6fcd5b81badf40189c3fa248b0398de24546093558949fe'}] | {'ebsj01056-1': ['Methods:\u2003Seventeen CSM patients (13 male) of mean age 54.5 years old were selected from the AOSpine North America database. The patients had different combinations of stenotic levels (1–4 levels) and the clinical severity (range mJOA baseline: 8–18). Asymptomatic or previous surgically treated CSM, active infection, neoplastic disease, rheumatoid arthritis, ankylosing spondylitis, trauma, or concomitant lumbar stenosis were excluded. The patients underwent preoperative MRI using 1.5T (15 patients) and 3T (two patients) scanner, including mid-sagittal T1-weighted, axial and mid-sagittal T2-weighted series. MRI data were analyzed (Mango 2.0 software; Multi-Image Analysis GUI) by four blind raters in three different sessions. Four measurements were analysed: transverse area (TA) (<xref rid="ebsj01056-1" ref-type="fig">Figure 1</xref>), compression ratio (CR) (), compression ratio (CR) (<xref rid="ebsj01056-2" ref-type="fig">Figure 2</xref>), maximal canal compromise (MCC), and maximal spinal cord compression (MSCC) (), maximal canal compromise (MCC), and maximal spinal cord compression (MSCC) (<xref rid="ebsj01056-3" ref-type="fig">Figure 3</xref>). The differences for each measurement were evaluated using mixed-effect ANOVA models (ratter, session, ratter x session). The intra- and inter-rater reliability was evaluated with intraclass correlation coefficients (ICC) (). The differences for each measurement were evaluated using mixed-effect ANOVA models (ratter, session, ratter x session). The intra- and inter-rater reliability was evaluated with intraclass correlation coefficients (ICC) (<xref rid="ebsj01056-4" ref-type="fig">Figure 4</xref>).).']} | Accuracy and reliability of MRI quantitative measurements to assess spinal cord compression in cervical spondylotic myelopathy: a prospective study | null | Evid Based Spine Care J | 1280646000 | [{'@Label': 'STUDY TYPE', '@NlmCategory': 'METHODS', '#text': 'Reliability study Introduction: \u2003Cervical spondylotic myelopathy (CSM) is the most common spinal cord disorder in persons more than 55 years old. Despite multiple neuroimaging approaches proposed to quantify the spinal cord compromise in CSM patients, magnetic resonance imaging (MRI) remains the procedure of choice by providing helpful information for clinical decision making, determining optimal subpopulations for treatment, and selecting the optimal treatment strategies. However, the validity, reliability, and accuracy of the MRI quantitative measurements have not yet been addressed.'}, {'@Label': 'OBJECTIVE', '@NlmCategory': 'OBJECTIVE', '#text': 'To assess the intra- and inter-observer reliability of MRI quantitative measurements of the spinal cord compromise in CSM patients.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'Seventeen CSM patients (13 male) of mean age 54.5 years old were selected from the AOSpine North America database. The patients had different combinations of stenotic levels (1-4 levels) and the clinical severity (range mJOA baseline: 8-18). Asymptomatic or previous surgically treated CSM, active infection, neoplastic disease, rheumatoid arthritis, ankylosing spondylitis, trauma, or concomitant lumbar stenosis were excluded. The patients underwent preoperative MRI using 1.5T (15 patients) and 3T (two patients) scanner, including mid-sagittal T1-weighted, axial and mid-sagittal T2-weighted series. MRI data were analyzed (Mango 2.0 software; Multi-Image Analysis GUI) by four blind raters in three different sessions. Four measurements were analysed: transverse area (TA) (Figure 1), compression ratio (CR) (Figure 2), maximal canal compromise (MCC), and maximal spinal cord compression (MSCC) (Figure 3). The differences for each measurement were evaluated using mixed-effect ANOVA models (ratter, session, ratter x session). The intra- and inter-rater reliability was evaluated with intraclass correlation coefficients (ICC) (Figure 4). Figure 1 Transverse area (TA)Figure 2 Compression ratio (CR\u2009=\u2009AP/W)Figure 3 Maximal canal compromise (MCC), and maximal spinal cord compression (MSCC). MCC(%)\u2009=\u20091-[Dx/(Da+Db)/2] × 100%; MSCC(%)\u2009=\u20091-[dx/(da+db)/2] × 100%Figure 4 Intraclass correlation coefficients (ICC) Results: \u2003The principal findings were: (i) for TA (71.48 ± 12.99mm2), the intra-rater agreement was 0.97 (95% CI, range 0.94-0.99) and the inter-rater agreement was 0.76 (95% CI, range 0.49-0.90); (ii) for CR (0.35 ± 0.04%), 0.94 (95% CI, range 0.88-0.98), and 0.79 (95% CI, range 0.57-0.91) respectively; (iii) for MCC (83.21 ± 2.08%), 0.95 (95% CI, range 0.89-0.98), and 0.64 (95% CI, range 0.28-0.85) respectively; and (iv) for MSCC (82.87 ± 1.52%), 0.93 (95% CI, range 0.86-0.97), and 0.84 (95% CI, range 0.65-0.93) respectively.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'Our data suggest that three out of four measurements (TA, CR and MSCC) have acceptable intra- and interreliability coefficients (ICC > 0.75). However, for the maximal canal compromise measure, although the intrareliability was acceptable, the inter-rater reliability was not acceptable (0.64). Based on this study, we recommend that three MRI measures: transverse area, compression ratio and maximal spinal cord compression should be used in the imaging assessment of the spinal cord in CSM patients.'}] | [] | other | PMC3623104 | null | 3 | [
"{'Citation': 'Okada Y, Ikata T, Yamada H. et al.Magnetic resonance imaging study on the results of surgery for cervical compression myelopathy. Spine. 1993;15;18(14):2024–2029.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '8272953'}}}",
"{'Citation': 'Bednarik J, Kadanka Z, Dusek L. et al.Presymptomatic spondylotic cervical myelopathy: an updated predictive model. Eur Spine J. 2008;17(3):421–431.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC2270386'}, {'@IdType': 'pubmed', '#text': '18193301'}]}}",
"{'Citation': 'Fehlings M G, Rao S C, Tator C H. et al.The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury. Part II: Results of a multicenter study. Spine. 1999;15;24(6):605–613.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10101829'}}}"
] | Evid Based Spine Care J. 2010 Aug; 1(2):56-57 | NO-CC CODE |
|
Postoperative T2-weighted MRI scan a mid-sagittal view demonstrates interval decompression of the spinal cord at the T4–5 level. The persistent syrinx has decreased substantially in size b axial view at the level of T3 showing interval decrease in syrinx size c axial view at the T4 level showing re-expansion of the thoracic cord following laminectomy and resection of calcified arachnoid | ebsj01046-4 | 7 | 04881ef1b7e63a69f5a8bd1425f3b4f07dcf299b0d09ce722d60137d9f8becaf | ebsj01046-4.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
707,
511
] | [{'image_id': 'ebsj01046-2', 'image_file_name': 'ebsj01046-2.jpg', 'image_path': '../data/media_files/PMC3623106/ebsj01046-2.jpg', 'caption': 'Intraoperative ultrasonography demonstrating the syrinx as well as the hyerechoic calcified arachnoid', 'hash': 'd5db9240b3b0195d69014d07369f59dfa6e44aa3b44ce64abb8e3dd2b14d1a36'}, {'image_id': 'ebsj01046-3', 'image_file_name': 'ebsj01046-3.jpg', 'image_path': '../data/media_files/PMC3623106/ebsj01046-3.jpg', 'caption': 'a Intraoperative image showing dissection and elevation of the calcified arachnoid plaque from the spinal cord. The calcified arachnoid is firmly adhered to the dorsal surface of the spinal cord b pathological specimen of calcified arachnoid plaque measuring 38 × 18 mm', 'hash': 'fa388fa62af8a3e9ea220da2bbc900b7421502e13b3e9132b104b97f33e85518'}, {'image_id': 'ebsj01046-4', 'image_file_name': 'ebsj01046-4.jpg', 'image_path': '../data/media_files/PMC3623106/ebsj01046-4.jpg', 'caption': 'Postoperative T2-weighted MRI scan a mid-sagittal view demonstrates interval decompression of the spinal cord at the T4–5 level. The persistent syrinx has decreased substantially in size b axial view at the level of T3 showing interval decrease in syrinx size c axial view at the T4 level showing re-expansion of the thoracic cord following laminectomy and resection of calcified arachnoid', 'hash': '04881ef1b7e63a69f5a8bd1425f3b4f07dcf299b0d09ce722d60137d9f8becaf'}, {'image_id': 'ebsj01046-1', 'image_file_name': 'ebsj01046-1.jpg', 'image_path': '../data/media_files/PMC3623106/ebsj01046-1.jpg', 'caption': 'Preoperative T2-weighted MRI scan a mid-sagittal view demonstrating a thoracic syrinx at the T3 level as well as an intradural extramedullary lesion displacing the spinal cord at the T4–5 levels b axial view at the level of T3 showing the large syrinx c axial view at the level of T4 demonstrating cord compression by the intradural extramedullary lesion. Abnormal cord signal is evident', 'hash': '901d79bf80624dad9e2e8030831e5513b7fe90415c346d9318361192bb1fc056'}] | {'ebsj01046-1': ['A plain film of the thoracic spine revealed no abnormalities. An MRI scan revealed a thoracic syrinx at the T3 level measuring 2 cm × 5 mm. There was no evidence of enhancing tumor associated with the syrinx. An intradural extramedullary mass along the left posterolateral aspect of the thecal sac was noted at T4–5. This lesion displaced the spinal cord anteriorly and was associated with abnormal signal within the spinal cord suggestive of myelomalacia or edema. Hypointense nodularity with the appearance of intradural calcification was seen posteriorly from T5–10 (<xref rid="ebsj01046-1" ref-type="fig">Figure 1</xref>). Our initial differential diagnoses for this intradural extramedullary lesion included: meningioma, schwannoma, a drop metastasis from the previous cerebellar gangioglioma or a primary exophytic tumor. At this point, we proceeded with a T4–7 laminectomy for spinal cord decompression.). Our initial differential diagnoses for this intradural extramedullary lesion included: meningioma, schwannoma, a drop metastasis from the previous cerebellar gangioglioma or a primary exophytic tumor. At this point, we proceeded with a T4–7 laminectomy for spinal cord decompression.'], 'ebsj01046-2': ['With monitoring of motor and somatosensory evoked potentials, a laminectomy was undertaken from T4–T7 and the thecal sac was exposed. Intraoperative ultrasound was used to identify and characterize the extent of the syrinx and calcified lesion (<xref rid="ebsj01046-2" ref-type="fig">Figure 2</xref>). As the durotomy was performed, it was apparent that there was marked arachnoiditis with arachnoid calcification extending as low as T8–9. The lesion was visualized to be a large calcified segment of arachnoid densely adherent to the dorsal surface of the cord. Meticulous and careful dissection allowed the lesion to be elevated away from the cord surface. The lesion itself was approximately 38 × 18 mm (). As the durotomy was performed, it was apparent that there was marked arachnoiditis with arachnoid calcification extending as low as T8–9. The lesion was visualized to be a large calcified segment of arachnoid densely adherent to the dorsal surface of the cord. Meticulous and careful dissection allowed the lesion to be elevated away from the cord surface. The lesion itself was approximately 38 × 18 mm (<xref rid="ebsj01046-3" ref-type="fig">Figure 3</xref>). The cord was noted to be pulsatile following the decompression. A duroplasty was fashioned to reconstruct the subarachnoid space. Evoked potentials were unchanged throughout the procedure.). The cord was noted to be pulsatile following the decompression. A duroplasty was fashioned to reconstruct the subarachnoid space. Evoked potentials were unchanged throughout the procedure.'], 'ebsj01046-4': ['Repeat MRI revealed a significant decrease in the size of the lesion (<xref rid="ebsj01046-4" ref-type="fig">Figure 4</xref>). The syrinx at T3 was significantly smaller compared to preoperatively and there was near complete resolution of the edema within the spinal cord. There was also a marked reduction in mass effect and compression of the spinal cord at the decompressed levels. Persistent adhesions of the arachnoid at other levels were noted.). The syrinx at T3 was significantly smaller compared to preoperatively and there was near complete resolution of the edema within the spinal cord. There was also a marked reduction in mass effect and compression of the spinal cord at the decompressed levels. Persistent adhesions of the arachnoid at other levels were noted.']} | Arachnoiditis ossificans associated with syringomyelia: An unusual cause of myelopathy | null | Evid Based Spine Care J | 1280646000 | [{'@Label': 'OBJECTIVE', '@NlmCategory': 'OBJECTIVE', '#text': 'The pathophysiology of arachnoiditis ossificans (AO) and its association with syringomyelia remains a rare and poorly understood phenomenon. Here, we present a case of AO associated with syringomyelia, a review of literature, and a discussion of current understanding of disease pathophysiology.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'A literature review was performed using MEDLINE (January 1900-May 2010) and Embase (January 1900-May 2010) to identify all English-language studies that described AO with syringomyelia. The current report was added to published cases.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'Over 50 cases of AO are reported in literature, of which only eight are associated with syringomyelia. The various presumptive etiologies of syrinx formation include abnormalities in blood circulation, ischemia, hydrodynamic alternations in cerebrospinal fluid (CSF) flow, tissue damage, or incidental coexistence. Changing CSF dynamics related to decreased compliance of the subarachnoid space and subsequent paracentral dissection of the spinal cord may be implicated in the disease process. magnetic resonance imaging (MRI) scanning may identify the syrinx but fail to diagnose the calcified arachnoid. Five patients, including the current case, improved clinically following laminectomy and decompression.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'Syringomyelia in association in AO is a rare phenomenon. A high index of suspicion is required and both MRI and computed tomography (CT) are recommended for diagnosis. The pathophysiology of syringomyelia in AO remains an area of ongoing research.'}] | [] | other | PMC3623106 | null | 13 | [
"{'Citation': 'Kaufman A B, Dunsmore R H. Clinicopathological considerations in spinal meningeal calcification and ossification. Neurology. 1971;21(12):1243–1248.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '5002424'}}}",
"{'Citation': 'Papavlasopoulos F, Stranjalis G, Kouyialis A T. et al.Arachnoiditis ossificans with progressive syringomyelia and spinal arachnoid cyst. J Clin Neurosci. 2007;14(6):572–576.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17368029'}}}",
"{'Citation': 'Nelson J. Intramedullary cavitation resulting from adhesive spinal arachnoiditis. Arch Neurol Psychiatry. 1943;50(1):1–7.'}",
"{'Citation': 'Van Paesschen W, Van den Kerchove M, Appel B. et al.Arachnoiditis ossificans with arachnoid cyst after cranial tuberculous meningitis. Neurology. 1990;40(4):714–716.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2320252'}}}",
"{'Citation': 'Kahler R J, Knuckey N W, Davis S. Arachnoiditis ossificans and syringomyelia: a unique case report. J Clin Neurosci. 2000;7(1):66–68.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10847657'}}}",
"{'Citation': 'Nagpal R D, Gokhale S D, Parikh V R. Ossification of spinal arachnoid with unrelated syringomyelia. Case report. J Neurosurg. 1975;42(2):222–225.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '803555'}}}",
"{'Citation': 'Domenicucci M, Ramieri A, Passacantilli E. et al.Spinal arachnoiditis ossificans: report of three cases. Neurosurgery. 2004;55(4):985.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15934184'}}}",
"{'Citation': 'Slavin K V, Nixon R R, Nesbit G M. et al.Extensive arachnoid ossification with associated syringomyelia presenting as thoracic myelopathy. Case report and review of the literature. J Neurosurg. 1999;91(S2):223–229.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10505510'}}}",
"{'Citation': 'Revilla T Y, Ramos A, Gonzalez P. et al.Arachnoiditis ossificans. Diagnosis with helical computed tomography. Clin Imaging. 1999;23(1):1–4.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10332589'}}}",
"{'Citation': 'Schwarz E. Präparate von einem Falle syphilitischer Meningomyelitis mit Höhlenbildung im Rükenmarke und besonderen degenerativen Veränderungen der Neuroglia. Wien. klin. Wchnschr. 1897;110:17.'}",
"{'Citation': 'Milhorat T H, Capocelli A L, Anzil A P. et al.Pathological basis of spinal cord cavitation in syringomyelia: analysis of 105 autopsy cases. J Neurosurg. 1995;82(5):802–812.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '7714606'}}}",
"{'Citation': 'Heiss J D, Patronas N, Devroom H L. et al.Elucidating the pathophysiology of syringomyelia. J Neurosurg. 1999;91(4):553–562.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10507374'}}}",
"{'Citation': 'Abou-Hamden A, Jones N R, Stoodley A. et al.Investigations of cerebrospinal fluid dynamics in a sheep model of traumatic syringomyelia. The proceedings of the spine society meeting of Australasia, April 2003 (Abstract) 2003;9'}"
] | Evid Based Spine Care J. 2010 Aug; 1(2):46-51 | NO-CC CODE |
|
Preoperative T2-weighted MRI scan a mid-sagittal view demonstrating a thoracic syrinx at the T3 level as well as an intradural extramedullary lesion displacing the spinal cord at the T4–5 levels b axial view at the level of T3 showing the large syrinx c axial view at the level of T4 demonstrating cord compression by the intradural extramedullary lesion. Abnormal cord signal is evident | ebsj01046-1 | 7 | 901d79bf80624dad9e2e8030831e5513b7fe90415c346d9318361192bb1fc056 | ebsj01046-1.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
705,
510
] | [{'image_id': 'ebsj01046-2', 'image_file_name': 'ebsj01046-2.jpg', 'image_path': '../data/media_files/PMC3623106/ebsj01046-2.jpg', 'caption': 'Intraoperative ultrasonography demonstrating the syrinx as well as the hyerechoic calcified arachnoid', 'hash': 'd5db9240b3b0195d69014d07369f59dfa6e44aa3b44ce64abb8e3dd2b14d1a36'}, {'image_id': 'ebsj01046-3', 'image_file_name': 'ebsj01046-3.jpg', 'image_path': '../data/media_files/PMC3623106/ebsj01046-3.jpg', 'caption': 'a Intraoperative image showing dissection and elevation of the calcified arachnoid plaque from the spinal cord. The calcified arachnoid is firmly adhered to the dorsal surface of the spinal cord b pathological specimen of calcified arachnoid plaque measuring 38 × 18 mm', 'hash': 'fa388fa62af8a3e9ea220da2bbc900b7421502e13b3e9132b104b97f33e85518'}, {'image_id': 'ebsj01046-4', 'image_file_name': 'ebsj01046-4.jpg', 'image_path': '../data/media_files/PMC3623106/ebsj01046-4.jpg', 'caption': 'Postoperative T2-weighted MRI scan a mid-sagittal view demonstrates interval decompression of the spinal cord at the T4–5 level. The persistent syrinx has decreased substantially in size b axial view at the level of T3 showing interval decrease in syrinx size c axial view at the T4 level showing re-expansion of the thoracic cord following laminectomy and resection of calcified arachnoid', 'hash': '04881ef1b7e63a69f5a8bd1425f3b4f07dcf299b0d09ce722d60137d9f8becaf'}, {'image_id': 'ebsj01046-1', 'image_file_name': 'ebsj01046-1.jpg', 'image_path': '../data/media_files/PMC3623106/ebsj01046-1.jpg', 'caption': 'Preoperative T2-weighted MRI scan a mid-sagittal view demonstrating a thoracic syrinx at the T3 level as well as an intradural extramedullary lesion displacing the spinal cord at the T4–5 levels b axial view at the level of T3 showing the large syrinx c axial view at the level of T4 demonstrating cord compression by the intradural extramedullary lesion. Abnormal cord signal is evident', 'hash': '901d79bf80624dad9e2e8030831e5513b7fe90415c346d9318361192bb1fc056'}] | {'ebsj01046-1': ['A plain film of the thoracic spine revealed no abnormalities. An MRI scan revealed a thoracic syrinx at the T3 level measuring 2 cm × 5 mm. There was no evidence of enhancing tumor associated with the syrinx. An intradural extramedullary mass along the left posterolateral aspect of the thecal sac was noted at T4–5. This lesion displaced the spinal cord anteriorly and was associated with abnormal signal within the spinal cord suggestive of myelomalacia or edema. Hypointense nodularity with the appearance of intradural calcification was seen posteriorly from T5–10 (<xref rid="ebsj01046-1" ref-type="fig">Figure 1</xref>). Our initial differential diagnoses for this intradural extramedullary lesion included: meningioma, schwannoma, a drop metastasis from the previous cerebellar gangioglioma or a primary exophytic tumor. At this point, we proceeded with a T4–7 laminectomy for spinal cord decompression.). Our initial differential diagnoses for this intradural extramedullary lesion included: meningioma, schwannoma, a drop metastasis from the previous cerebellar gangioglioma or a primary exophytic tumor. At this point, we proceeded with a T4–7 laminectomy for spinal cord decompression.'], 'ebsj01046-2': ['With monitoring of motor and somatosensory evoked potentials, a laminectomy was undertaken from T4–T7 and the thecal sac was exposed. Intraoperative ultrasound was used to identify and characterize the extent of the syrinx and calcified lesion (<xref rid="ebsj01046-2" ref-type="fig">Figure 2</xref>). As the durotomy was performed, it was apparent that there was marked arachnoiditis with arachnoid calcification extending as low as T8–9. The lesion was visualized to be a large calcified segment of arachnoid densely adherent to the dorsal surface of the cord. Meticulous and careful dissection allowed the lesion to be elevated away from the cord surface. The lesion itself was approximately 38 × 18 mm (). As the durotomy was performed, it was apparent that there was marked arachnoiditis with arachnoid calcification extending as low as T8–9. The lesion was visualized to be a large calcified segment of arachnoid densely adherent to the dorsal surface of the cord. Meticulous and careful dissection allowed the lesion to be elevated away from the cord surface. The lesion itself was approximately 38 × 18 mm (<xref rid="ebsj01046-3" ref-type="fig">Figure 3</xref>). The cord was noted to be pulsatile following the decompression. A duroplasty was fashioned to reconstruct the subarachnoid space. Evoked potentials were unchanged throughout the procedure.). The cord was noted to be pulsatile following the decompression. A duroplasty was fashioned to reconstruct the subarachnoid space. Evoked potentials were unchanged throughout the procedure.'], 'ebsj01046-4': ['Repeat MRI revealed a significant decrease in the size of the lesion (<xref rid="ebsj01046-4" ref-type="fig">Figure 4</xref>). The syrinx at T3 was significantly smaller compared to preoperatively and there was near complete resolution of the edema within the spinal cord. There was also a marked reduction in mass effect and compression of the spinal cord at the decompressed levels. Persistent adhesions of the arachnoid at other levels were noted.). The syrinx at T3 was significantly smaller compared to preoperatively and there was near complete resolution of the edema within the spinal cord. There was also a marked reduction in mass effect and compression of the spinal cord at the decompressed levels. Persistent adhesions of the arachnoid at other levels were noted.']} | Arachnoiditis ossificans associated with syringomyelia: An unusual cause of myelopathy | null | Evid Based Spine Care J | 1280646000 | [{'@Label': 'OBJECTIVE', '@NlmCategory': 'OBJECTIVE', '#text': 'The pathophysiology of arachnoiditis ossificans (AO) and its association with syringomyelia remains a rare and poorly understood phenomenon. Here, we present a case of AO associated with syringomyelia, a review of literature, and a discussion of current understanding of disease pathophysiology.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'A literature review was performed using MEDLINE (January 1900-May 2010) and Embase (January 1900-May 2010) to identify all English-language studies that described AO with syringomyelia. The current report was added to published cases.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'Over 50 cases of AO are reported in literature, of which only eight are associated with syringomyelia. The various presumptive etiologies of syrinx formation include abnormalities in blood circulation, ischemia, hydrodynamic alternations in cerebrospinal fluid (CSF) flow, tissue damage, or incidental coexistence. Changing CSF dynamics related to decreased compliance of the subarachnoid space and subsequent paracentral dissection of the spinal cord may be implicated in the disease process. magnetic resonance imaging (MRI) scanning may identify the syrinx but fail to diagnose the calcified arachnoid. Five patients, including the current case, improved clinically following laminectomy and decompression.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'Syringomyelia in association in AO is a rare phenomenon. A high index of suspicion is required and both MRI and computed tomography (CT) are recommended for diagnosis. The pathophysiology of syringomyelia in AO remains an area of ongoing research.'}] | [] | other | PMC3623106 | null | 13 | [
"{'Citation': 'Kaufman A B, Dunsmore R H. Clinicopathological considerations in spinal meningeal calcification and ossification. Neurology. 1971;21(12):1243–1248.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '5002424'}}}",
"{'Citation': 'Papavlasopoulos F, Stranjalis G, Kouyialis A T. et al.Arachnoiditis ossificans with progressive syringomyelia and spinal arachnoid cyst. J Clin Neurosci. 2007;14(6):572–576.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '17368029'}}}",
"{'Citation': 'Nelson J. Intramedullary cavitation resulting from adhesive spinal arachnoiditis. Arch Neurol Psychiatry. 1943;50(1):1–7.'}",
"{'Citation': 'Van Paesschen W, Van den Kerchove M, Appel B. et al.Arachnoiditis ossificans with arachnoid cyst after cranial tuberculous meningitis. Neurology. 1990;40(4):714–716.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2320252'}}}",
"{'Citation': 'Kahler R J, Knuckey N W, Davis S. Arachnoiditis ossificans and syringomyelia: a unique case report. J Clin Neurosci. 2000;7(1):66–68.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10847657'}}}",
"{'Citation': 'Nagpal R D, Gokhale S D, Parikh V R. Ossification of spinal arachnoid with unrelated syringomyelia. Case report. J Neurosurg. 1975;42(2):222–225.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '803555'}}}",
"{'Citation': 'Domenicucci M, Ramieri A, Passacantilli E. et al.Spinal arachnoiditis ossificans: report of three cases. Neurosurgery. 2004;55(4):985.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '15934184'}}}",
"{'Citation': 'Slavin K V, Nixon R R, Nesbit G M. et al.Extensive arachnoid ossification with associated syringomyelia presenting as thoracic myelopathy. Case report and review of the literature. J Neurosurg. 1999;91(S2):223–229.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10505510'}}}",
"{'Citation': 'Revilla T Y, Ramos A, Gonzalez P. et al.Arachnoiditis ossificans. Diagnosis with helical computed tomography. Clin Imaging. 1999;23(1):1–4.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10332589'}}}",
"{'Citation': 'Schwarz E. Präparate von einem Falle syphilitischer Meningomyelitis mit Höhlenbildung im Rükenmarke und besonderen degenerativen Veränderungen der Neuroglia. Wien. klin. Wchnschr. 1897;110:17.'}",
"{'Citation': 'Milhorat T H, Capocelli A L, Anzil A P. et al.Pathological basis of spinal cord cavitation in syringomyelia: analysis of 105 autopsy cases. J Neurosurg. 1995;82(5):802–812.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '7714606'}}}",
"{'Citation': 'Heiss J D, Patronas N, Devroom H L. et al.Elucidating the pathophysiology of syringomyelia. J Neurosurg. 1999;91(4):553–562.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '10507374'}}}",
"{'Citation': 'Abou-Hamden A, Jones N R, Stoodley A. et al.Investigations of cerebrospinal fluid dynamics in a sheep model of traumatic syringomyelia. The proceedings of the spine society meeting of Australasia, April 2003 (Abstract) 2003;9'}"
] | Evid Based Spine Care J. 2010 Aug; 1(2):46-51 | NO-CC CODE |
|
Coronal Short TI Inversion Recovery
(STIR) MRI image of a typical example of predominantly solid pseudotumour
with low signal intensity (arrows). | 2000019-galleyfig1 | 7 | 0b48d717ec63f1afa6bad1e8694554de0977be02e873f72aa209fb0d778beef1 | 2000019-galleyfig1.jpg | multiple | multiple panels: images | [
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In hip A\n(in blue), the force path does not enter the outer most radial zone\n(zone 1), thus no edge-loading is observed. In hip B (in red), during\nwalking, the force path enters the outer most radial zone (zone 1),\nindicating edge-loading. The black circles (●) indicate force path\nat heelstrike and the black triangles (▲) indicate force path locus\nat toe-off.', 'hash': '631935840fc5c8d9e8d455cf38b1b1d85e3a6af603c27cf9b85540b56d735a95'}, {'image_id': '2000019-galleyfig3b', 'image_file_name': '2000019-galleyfig3b.jpg', 'image_path': '../data/media_files/PMC3626206/2000019-galleyfig3b.jpg', 'caption': 'Graphs showing the distribution\nof ‘zone duration’ (the percentage of total stance time spent by\nthe force path in each zone) during a) walking, b) stair climbing\nand c) rising from a chair. Zone 1 is defined as the edge-loading\nzone. The error bars represent standard errors of mean. An asterisk\n(*) indicates significant difference between the two MoMHRA patient\ngroups.', 'hash': '991dbb16ed0834e38f9bedb11b5b1355d07e8859415215983f811a40b60ad0cf'}, {'image_id': '2000019-galleyfig6b', 'image_file_name': '2000019-galleyfig6b.jpg', 'image_path': '../data/media_files/PMC3626206/2000019-galleyfig6b.jpg', 'caption': 'Boxplots showing the median serum\ncobalt (Co) (a) and chromium (Cr) (b)\xa0level measurements in the\nsix patients with psuedotumour and the 13\xa0patients without. The\nboxes represent the median and interquartile range, and the whiskers\ndenote the range of data excluding outliers (°, between 1.5\xa0and\n3×IQR) and extremes (*, > 3×IQR).', 'hash': '6a4d5ea3800434151bf78b3bfc819f971188a250c7ffe12ca0a6f134b450f19b'}, {'image_id': '2000019-galleyfig4a', 'image_file_name': '2000019-galleyfig4a.jpg', 'image_path': '../data/media_files/PMC3626206/2000019-galleyfig4a.jpg', 'caption': 'Graphs showing the distribution\nof normalised hip joint ‘force impulse’ (the cumulative magnitude\nof the segment force throughout activity over time estimated by\ncalculating the area under the force/time curve normalised to patient body\nweight) in each zone during a) walking, b) stair climbing and c)\nrising from a chair. Zone 1 is defined as the edge-loading zone.\nThe error bars represent standard errors of mean. An asterisk (*)\nindicates significant difference between the two MoMHRA patient groups.', 'hash': '91327d28614748d34e0ae0783696cfc747bfbcf2cfe63fcb62e87766214f4ef4'}, {'image_id': '2000019-galleyfig3c', 'image_file_name': '2000019-galleyfig3c.jpg', 'image_path': '../data/media_files/PMC3626206/2000019-galleyfig3c.jpg', 'caption': 'Graphs showing the distribution\nof ‘zone duration’ (the percentage of total stance time spent by\nthe force path in each zone) during a) walking, b) stair climbing\nand c) rising from a chair. Zone 1 is defined as the edge-loading\nzone. The error bars represent standard errors of mean. An asterisk\n(*) indicates significant difference between the two MoMHRA patient\ngroups.', 'hash': '3b110719b4db3e4db64844a9b628e8cec168d2bec67e15f052dd15650d8a5490'}, {'image_id': '2000019-galleyfig4b', 'image_file_name': '2000019-galleyfig4b.jpg', 'image_path': '../data/media_files/PMC3626206/2000019-galleyfig4b.jpg', 'caption': 'Graphs showing the distribution\nof normalised hip joint ‘force impulse’ (the cumulative magnitude\nof the segment force throughout activity over time estimated by\ncalculating the area under the force/time curve normalised to patient body\nweight) in each zone during a) walking, b) stair climbing and c)\nrising from a chair. Zone 1 is defined as the edge-loading zone.\nThe error bars represent standard errors of mean. An asterisk (*)\nindicates significant difference between the two MoMHRA patient groups.', 'hash': 'b53da66d5c4c21c45724444b19bb8d6658cd28b59f84241b4fbf64645bb273aa'}, {'image_id': '2000019-galleyfig6a', 'image_file_name': '2000019-galleyfig6a.jpg', 'image_path': '../data/media_files/PMC3626206/2000019-galleyfig6a.jpg', 'caption': 'Boxplots showing the median serum\ncobalt (Co) (a) and chromium (Cr) (b)\xa0level measurements in the\nsix patients with psuedotumour and the 13\xa0patients without. The\nboxes represent the median and interquartile range, and the whiskers\ndenote the range of data excluding outliers (°, between 1.5\xa0and\n3×IQR) and extremes (*, > 3×IQR).', 'hash': 'f3fa53e4088780c153cc5034c0b23954b5986a120facb18e6fd282606aadcaf1'}, {'image_id': '2000019-galleyfig3a', 'image_file_name': '2000019-galleyfig3a.jpg', 'image_path': '../data/media_files/PMC3626206/2000019-galleyfig3a.jpg', 'caption': 'Graphs showing the distribution\nof ‘zone duration’ (the percentage of total stance time spent by\nthe force path in each zone) during a) walking, b) stair climbing\nand c) rising from a chair. Zone 1 is defined as the edge-loading\nzone. The error bars represent standard errors of mean. An asterisk\n(*) indicates significant difference between the two MoMHRA patient\ngroups.', 'hash': '88b38164a48f47a5bc3e9df1d04e7accfbd385bd03d17d7f0ff6da2dd9ae2710'}, {'image_id': '2000019-galleyfig4c', 'image_file_name': '2000019-galleyfig4c.jpg', 'image_path': '../data/media_files/PMC3626206/2000019-galleyfig4c.jpg', 'caption': 'Graphs showing the distribution\nof normalised hip joint ‘force impulse’ (the cumulative magnitude\nof the segment force throughout activity over time estimated by\ncalculating the area under the force/time curve normalised to patient body\nweight) in each zone during a) walking, b) stair climbing and c)\nrising from a chair. Zone 1 is defined as the edge-loading zone.\nThe error bars represent standard errors of mean. An asterisk (*)\nindicates significant difference between the two MoMHRA patient groups.', 'hash': 'd23404b78e9b4efa4e4cdeec648956ad0d1da08e00b4b31b2d01297ab490d99f'}, {'image_id': '2000019-galleyfig1', 'image_file_name': '2000019-galleyfig1.jpg', 'image_path': '../data/media_files/PMC3626206/2000019-galleyfig1.jpg', 'caption': 'Coronal Short TI Inversion Recovery\n(STIR) MRI image of a typical example of predominantly solid pseudotumour\nwith low signal intensity (arrows).', 'hash': '0b48d717ec63f1afa6bad1e8694554de0977be02e873f72aa209fb0d778beef1'}] | {} | In vivo evaluation
of edge-loading in metal-on-metal hip resurfacing patients with
pseudotumours | [
"Pseudotumours",
"Edge-loading",
"In vivo evaluation",
"Metal-on-metal",
"Hip resurfacing",
"Metal ions"
] | Bone Joint Res | 1333263600 | [{'@Label': 'INTRODUCTION', '@NlmCategory': 'BACKGROUND', '#text': 'The objective of this study was to determine if a synthetic bone substitute would provide results similar to bone from osteoporotic femoral heads during in vitro testing with orthopaedic implants. If the synthetic material could produce results similar to those of the osteoporotic bone, it could reduce or eliminate the need for testing of implants on bone.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'Pushout studies were performed with the dynamic hip screw (DHS) and the DHS Blade in both cadaveric femoral heads and artificial bone substitutes in the form of polyurethane foam blocks of different density. The pushout studies were performed as a means of comparing the force displacement curves produced by each implant within each material.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'The results demonstrated that test material with a density of 0.16 g/cm(3) (block A) produced qualitatively similar force displacement curves for the DHS and qualitatively and quantitatively similar force displacement curves for the DHS Blade, whereas the test material with a density of 0.08 g/cm(3) (block B) did not produce results that were predictive of those recorded within the osteoporotic cadaveric femoral heads.'}, {'@Label': 'CONCLUSION', '@NlmCategory': 'CONCLUSIONS', '#text': 'This study demonstrates that synthetic material with a density of 0.16 g/cm(3) can provide a good substitute for cadaveric osteoporotic femoral heads in the testing of implants. However we do recognise that no synthetic material can be considered as a definitive substitute for bone, therefore studies performed with artificial bone substrates may need to be validated by further testing with a small bone sample in order to produce conclusive results.'}] | [] | other | PMC3626206 | null | 20 | [
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] | Bone Joint Res. 2012 Apr 1; 1(4):42-49 | NO-CC CODE |
|
Chest computed tomography (CT) scans for three patients.A: Patient 1: CT scan detected bilateral subpleural reticular shadows and emphysema.B: Patient 2: CT scan showed bilateral diffuse ground glass lesions with bronchiectasis.C: Patient 3: CT scan revealed bilateral multiple patchy ground glass opacities with bronchiectasis. | gr1_lrg | 7 | d0b504d9ce582860d029dc67a6deefb9daee9e0311d19d33730364e912b6a4e7 | gr1_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
793,
227
] | [{'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7441042/gr1_lrg.jpg', 'caption': 'Chest computed tomography (CT) scans for three patients.A: Patient 1: CT scan detected bilateral subpleural reticular shadows and emphysema.B: Patient 2: CT scan showed bilateral diffuse ground glass lesions with bronchiectasis.C: Patient 3: CT scan revealed bilateral multiple patchy ground glass opacities with bronchiectasis.', 'hash': 'd0b504d9ce582860d029dc67a6deefb9daee9e0311d19d33730364e912b6a4e7'}] | {'gr1_lrg': ['A 64-year-old man with a smoking history of 42-pack years and a mild fever and fatigue since late March 2020 (day 1: the first day symptoms begin) was brought to our hospital in early April (day 10) because of worsening dyspnea. He had no significant travel history or contact with COVID-19 patients. Physical examination revealed a fever of 37.8℃ with an oxygen saturation of 93% under an 8\u2009L/min reservoir mask. Computed tomography (CT) detected emphysema and showed bilateral diffuse multiple ground glass opacities (<xref rid="gr1_lrg" ref-type="fig">Figure 1</xref>\na).\na).Figure 1Chest computed tomography (CT) scans for three patients.A: Patient 1: CT scan detected bilateral subpleural reticular shadows and emphysema.B: Patient 2: CT scan showed bilateral diffuse ground glass lesions with bronchiectasis.C: Patient 3: CT scan revealed bilateral multiple patchy ground glass opacities with bronchiectasis.Figure 1', 'CT showed bilateral diffuse ground glass opacities with bronchiectasis, suggesting ARDS (<xref rid="gr1_lrg" ref-type="fig">Figure 1</xref>b). Although he promptly began favipiravir, his respiratory condition worsened, and he needed a maximum oxygen intake of 8\u2009L/min via reservoir mask for over 36\u2009hours. However, within 5 days, his symptoms were alleviated, his respiratory condition improved, and oxygen administration was tapered (b). Although he promptly began favipiravir, his respiratory condition worsened, and he needed a maximum oxygen intake of 8\u2009L/min via reservoir mask for over 36\u2009hours. However, within 5 days, his symptoms were alleviated, his respiratory condition improved, and oxygen administration was tapered (Table 1). A chest radiograph showed consolidation with a reticular shadow that had progressed for a week and then started to regress.', 'On admission, physical examination revealed fever of 37.2℃ with an oxygen saturation of 97% under a 6\u2009L/min reservoir mask. CT showed bilateral multiple patchy ground glass opacities with bronchiectasis, suggesting ARDS (<xref rid="gr1_lrg" ref-type="fig">Figure 1</xref>c).c).']} | Case studies of SARS-CoV-2 treated with favipiravir among patients in critical or severe condition | [
"COVID-19",
"SARS-CoV-2",
"viral pneumonia",
"favipiravir",
"acute respiratory distress syndrome"
] | Int J Infect Dis | 1605945600 | The COVID-19 pandemic has caused a complementary infodemic, whereby various outlets and digital media portals shared false information and unsourced recommendations on health. In addition, journals and authors published a mass of academic articles at a speed that suggests a non-existent or a non-rigorous peer review process. Such lapses can promote false information and adoption of health policies based on misleading data. Reliable information is vital for designing and implementing preventive measures and promoting health awareness in the fight against COVID-19. In the age of social media, information travels wide and fast, emphasizing a need for accurate data to be corroborated swiftly and for preventing misleading information from wide dissemination. Here, we discuss the implications of the COVID-19 infodemic and explore practical ways to leverage health communication strategies to overcome it. We propose the "Infodemic Response Checklist" as a comprehensive tool to overcome the challenges posed by the current and any future infodemics. | [
"Adaptation, Psychological",
"COVID-19",
"Empathy",
"Health Communication",
"Humans",
"Internet",
"Mass Media",
"Pandemics",
"SARS-CoV-2",
"Social Media",
"Stress, Psychological",
"Time Factors"
] | other | PMC7441042 | null | 44 | [
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"{'Citation': 'Centers for Disease Control and Prevention. World Map: Global Map.\\xa02020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/world-map.html.'}",
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"{'Citation': 'Zarocostas J. How to fight an infodemic. Lancet. 2020;395:676. doi: 10.1016/S0140-6736(20)30461-X.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S0140-6736(20)30461-X'}, {'@IdType': 'pmc', '#text': 'PMC7133615'}, {'@IdType': 'pubmed', '#text': '32113495'}]}}",
"{'Citation': 'Collins B. False coronavirus rumors surge in ‘hidden viral’ text messages. NBC News. 2020. https://www.nbcnews.com/tech/tech-news/false-coronavirus-rumors-surge-hidden-viral-text-messages-n1160936.'}",
"{'Citation': 'Brewster T. Coronavirus ‘Cure’ Claims Get FTC Warning, So Maybe Don’t Drink Silver. Forbes. 2020. https://www.forbes.com/sites/thomasbrewster/2020/03/09/teas-essential-oils-and-drinking-silver-ftc-warns-about-dubious-coronavirus-cures/#3da43f2e1cba.'}",
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"{'Citation': 'World Health Organization. Munich Security Conference. 2020. https://www.who.int/dg/speeches/detail/munich-security-conference.'}",
"{'Citation': 'Pichai S. COVID-19: How we’re continuing to help. Google’s response to COVID-19. 2020. https://blog.google/inside-google/company-announcements/covid-19-how-were-continuing-to-help/.'}",
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"{'Citation': 'Oransky I, Marcus A. Quick retraction of a faulty coronavirus paper was a good moment for science. 2020. https://www.statnews.com/2020/02/03/retraction-faulty-coronavirus-paper-good-moment-for-science/.'}",
"{'Citation': 'Marcus A, Oransky I. The Science of This Pandemic Is Moving at Dangerous Speeds. 2020. https://www.wired.com/story/the-science-of-this-pandemic-is-moving-at-dangerous-speeds/.'}",
"{'Citation': 'Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN. Retraction: cardiovascular disease, drug therapy, and mortality in Covid-19. N Engl J Med. 2020;382:2582. doi: 10.1056/NEJMoa2007621.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1056/NEJMoa2007621'}, {'@IdType': 'pmc', '#text': 'PMC7206931'}, {'@IdType': 'pubmed', '#text': '32356626'}]}}",
"{'Citation': 'Mehra MR, Desaii SS, Ruschitzka F, Patel AN. RETRACTED: hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet. 2020 doi: 10.1016/S0140-6736(20)31180-6.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S0140-6736(20)31180-6'}, {'@IdType': 'pmc', '#text': 'PMC7255293'}, {'@IdType': 'pubmed', '#text': '32450107'}]}}",
"{'Citation': 'United Nations. UN tackles ‘infodemic’ of misinformation and cybercrime in COVID-19 crisis. 2020. https://www.un.org/en/un-coronavirus-communications-team/un-tackling-%E2%80%98infodemic%E2%80%99-misinformation-and-cybercrime-covid-19.'}",
"{'Citation': 'World Health Organization. Coronavirus disease (COVID-19) advice for the public: Myth busters. 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters..'}",
"{'Citation': 'Centers for Disease Control and Prevention. Stop the Spread of Rumors. 2020. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/share-facts.html.'}",
"{'Citation': 'International Monetary Fund. Policy Tracker. 2020. https://www.imf.org/en/Topics/imf-and-covid19/Policy-Responses-to-COVID-19.'}",
"{'Citation': 'Rufai SR, Bunce C. World leaders’ usage of Twitter in response to the COVID-19 pandemic: a content analysis. J Public Health (Oxf). 2020. In press.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7188178'}, {'@IdType': 'pubmed', '#text': '32309854'}]}}",
"{'Citation': 'Scott M. Facebook’s private groups are abuzz with coronavirus fake news. Politico. 2020. https://www.politico.eu/article/facebook-misinformation-fake-news-coronavirus-covid19/.'}",
"{'Citation': 'Valinsky J. Amazon deleted 1 million items for price gouging or false advertising about coronavirus. CNN Business. 2020. https://www.cnn.com/2020/03/02/tech/amazon-coronavirus-products/index.html..'}",
"{'Citation': 'Porter T. Twitter deleted a tweet by Rudy Giuliani for spreading coronavirus misinformation. Business Insider. 2020. https://www.businessinsider.com/coronavirus-twitter-deletes-giuliani-tweet-for-spreading-misinformation-2020-3.'}",
"{'Citation': 'Warzel C. What we pretend to know about the coronavirus could kill us. The New York Times. 2020. https://www.nytimes.com/2020/04/03/opinion/sunday/coronavirus-fake-news.html.'}",
"{'Citation': 'Sholts S. Accurate science communication is key in the fight against COVID-19. 2020. https://www.weforum.org/agenda/2020/03/science-communication-covid-coronavirus.'}",
"{'Citation': 'Hernández-García I, Giménez-Júlvez T. Assessment of Health Information About COVID-19 prevention on the internet: infodemiological study. JMIR Public Health Surveill. 2020;6:e18717. doi: 10.2196/18717.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.2196/18717'}, {'@IdType': 'pmc', '#text': 'PMC7117090'}, {'@IdType': 'pubmed', '#text': '32217507'}]}}",
"{'Citation': 'Avery EJ. Public information officers’ social media monitoring during the Zika virus crisis, a global health threat surrounded by public uncertainty. Public Relat Rev. 2017;43(3):468–476. doi: 10.1016/j.pubrev.2017.02.018.', 'ArticleIdList': {'ArticleId': {'@IdType': 'doi', '#text': '10.1016/j.pubrev.2017.02.018'}}}",
"{'Citation': 'Centers for Disease Control and Prevention. Manage anxiety & stress. 2020. https://www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html.'}",
"{'Citation': 'Mansour A, Atoui R, Kanso K, et al. First Case of an Infant with COVID-19 in the Middle East. Cureus. 2020;12:e7520.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7198082'}, {'@IdType': 'pubmed', '#text': '32377468'}]}}",
"{'Citation': 'Liao Q, Yuan J, Dong M, Yang L, Richard F, Lam WT. Learning public engagement and government responsiveness in the communications about COVID-19 during the early epidemic stage in China: an analysis of social media data. J Med Internet Res. 2020. In press.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7284407'}, {'@IdType': 'pubmed', '#text': '32412414'}]}}",
"{'Citation': 'Corcoran B, Clarke A, Barrett T. Rapid response to HPV vaccination crisis in Ireland. Lancet. 2018;391(10135):2103. doi: 10.1016/S0140-6736(18)30854-7.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1016/S0140-6736(18)30854-7'}, {'@IdType': 'pubmed', '#text': '29856339'}]}}",
"{'Citation': 'Aleem Z. New CDC data shows Covid-19 is affecting African Americans at exceptionally high rates. Vox. 2020. https://www.vox.com/coronavirus-covid19/2020/4/18/21226225/coronavirus-black-cdc-infection.'}",
"{'Citation': 'Yancy CW. COVID-19 and African Americans. JAMA. 2020. In press. 10.1001/jama.2020.6548.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '32293639'}}}",
"{'Citation': 'Mheidly N, Fares J. Health communication in low-income countries: a 60-year bibliometric and thematic analysis. J Educ Health Promot. 2020;9:163. doi: 10.4103/jehp.jehp_384_20.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.4103/jehp.jehp_384_20'}, {'@IdType': 'pmc', '#text': 'PMC7482704'}, {'@IdType': 'pubmed', '#text': '32953895'}]}}"
] | Int J Infect Dis. 2020 Nov 21; 100:283-285 | NO-CC CODE |
|
a NCCT of the head in a COVID-19 patient shows hemorrhage in the anterior right temporal lobe. b Axial FLAIR image from brain MRI in the same patient shows hemorrhage and edema, most consistent with hemorrhagic venous infarct. c Intracranial MR venography in the same patient demonstrates absence of flow-related enhancement in the right transverse and sigmoid sinuses, consistent with dural venous sinus thromboses. Reference: Hemasian H, Ansari B. First case of Covid-19 presented with cerebral venous thrombosis: A rare and dreaded case. Revue Neurologique. 2020. doi:10.1016/j.neurol.2020.04.013. (Permission granted) | 10140_2020_1840_Fig2_HTML | 7 | 5ab5accf9e3527785710dff938dd069ea5164e4ee169d7e7e397ce2d2580335f | 10140_2020_1840_Fig2_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
708,
307
] | [{'image_id': '10140_2020_1840_Fig4_HTML', 'image_file_name': '10140_2020_1840_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7441306/10140_2020_1840_Fig4_HTML.jpg', 'caption': 'a. NCCT of the head in a COVID-19 patient demonstrates numerous punctate foci of hyperdensity (arrowheads), consistent with petechial hemorrhage. b Axial susceptibility-weighted image (SWI) from a brain MRI of the same patient demonstrates extensive foci of hypointensity, consistent with susceptibility artifact from hemorrhage. Findings were consistent with thrombotic microangiopathy. Reference: Nicholson P, Alshafai L, Krings T. Neuroimaging Findings in Patients with COVID-19. American Journal of Neuroradiology. 2020;41(8). doi:10.3174/ajnr.a6630. (Permission granted)', 'hash': 'f1eb6f42b76530424474a4ca9498a01252d0e6921c849b76b74f2589f6ea0399'}, {'image_id': '10140_2020_1840_Fig3_HTML', 'image_file_name': '10140_2020_1840_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC7441306/10140_2020_1840_Fig3_HTML.jpg', 'caption': 'Sagittal reconstruction of an intracranial CT venogram in a patient with COVID-19 shows filling defects in the vein of Galen (short arrow) and internal cerebral veins (long arrow), consistent with thromboses of the deep cerebral venous system. Reference: Cavalcanti DD, Raz E, Shapiro M, et al. Cerebral Venous Thrombosis associated with COVID-19. American Journal of Neuroradiology. 2020;41(8). doi:10.3174/ajnr.a6644. (Permission granted)', 'hash': '934c0424343a476611f84cba9d40a5860a0858db277ba9f2ff2fe021290bc21b'}, {'image_id': '10140_2020_1840_Fig5_HTML', 'image_file_name': '10140_2020_1840_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC7441306/10140_2020_1840_Fig5_HTML.jpg', 'caption': 'a NCCT of the head in a COVID-19 patient shows symmetric edema within the bilateral thalami (arrows). b Axial FLAIR image from brain MRI in the same patient shows edema and mass effect in the bilateral thalami (arrows). c Axial SWI from a brain MRI of the same patient demonstrates susceptibility artifact, confirming the presence of hemorrhage (arrows). The bilateral medial temporal lobes also demonstrated edema and hemorrhage (not shown), and findings were consistent with acute hemorrhagic necrotizing encephalopathy. Reference: Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B. COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features. Radiology. 2020:201187. doi:10.1148/radiol.2020201187. (Permission granted)', 'hash': 'd97a473c5bd8445b62da8ac6bbb62cf915901320a7f720fd7319492c399bdc38'}, {'image_id': '10140_2020_1840_Fig2_HTML', 'image_file_name': '10140_2020_1840_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC7441306/10140_2020_1840_Fig2_HTML.jpg', 'caption': 'a NCCT of the head in a COVID-19 patient shows hemorrhage in the anterior right temporal lobe. b Axial FLAIR image from brain MRI in the same patient shows hemorrhage and edema, most consistent with hemorrhagic venous infarct. c Intracranial MR venography in the same patient demonstrates absence of flow-related enhancement in the right transverse and sigmoid sinuses, consistent with dural venous sinus thromboses. Reference: Hemasian H, Ansari B. First case of Covid-19 presented with cerebral venous thrombosis: A rare and dreaded case. Revue Neurologique. 2020. doi:10.1016/j.neurol.2020.04.013. (Permission granted)', 'hash': '5ab5accf9e3527785710dff938dd069ea5164e4ee169d7e7e397ce2d2580335f'}, {'image_id': '10140_2020_1840_Fig1_HTML', 'image_file_name': '10140_2020_1840_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7441306/10140_2020_1840_Fig1_HTML.jpg', 'caption': 'a NCCT of the head in a COVID-19 patient demonstrates findings of AIS, including hypoattenuation of the brain parenchyma, loss of gray-white differentiation, and sulcal effacement. b Axial CTA of the head in the same patient demonstrates reduced vascular filling in branches of the right middle cerebral artery (arrowheads) and bilateral anterior cerebral arteries (arrows). Reference: Goldberg MF, Goldberg MF, Cerejo R, Tayal A. Cerebrovascular Disease in COVID-19. American Journal of Neuroradiology. 2020. doi:10.3174/ajnr.a6588. (Permission granted)', 'hash': '5c80872a949d5bf0add60dd4f1508c2b68e4669dcde5a205b9930f70be40fdac'}, {'image_id': '10140_2020_1840_Fig6_HTML', 'image_file_name': '10140_2020_1840_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC7441306/10140_2020_1840_Fig6_HTML.jpg', 'caption': 'NCCT of the head in a COVID-19 patient demonstrates edema in the bilateral occipital lobes, consistent with PRES. Within the edema of the right occipital lobe, there is a small, superimposed parenchymal hemorrhage (arrow). Reference: Franceschi A, Ahmed O, Giliberto L, Castillo M. Hemorrhagic Posterior Reversible Encephalopathy Syndrome as a Manifestation of COVID-19 Infection. American Journal of Neuroradiology. 2020. doi:10.3174/ajnr.a6595. (Permission granted)', 'hash': 'bc812ee1eabc6bc793e16bcec992b2f0854af889aa6afa16ccd8a2170528d5b8'}] | {'10140_2020_1840_Fig1_HTML': ['Typical imaging findings of AIS on non-contrast CT of the head (NCCT) have been reported in the setting of COVID-19 [12]. These findings are similar to those in non-COVID-19 patients, including abnormal hypoattenuation of the brain parenchyma, loss of gray-white differentiation, and sulcal effacement (Fig.\xa0<xref rid="10140_2020_1840_Fig1_HTML" ref-type="fig">1</xref>). Intracranial angiographic imaging in some of these patients has revealed extensive vascular occlusive disease, including large vessel occlusions (LVO) [). Intracranial angiographic imaging in some of these patients has revealed extensive vascular occlusive disease, including large vessel occlusions (LVO) [11, 12]. Markedly reduced flow has been demonstrated on CT angiography, even in the absence of LVO (Fig.\xa0<xref rid="10140_2020_1840_Fig1_HTML" ref-type="fig">1</xref>) [) [12]. Based on limited case reports, there is a suggestion that thrombosis of the extracranial carotid arteries may play a causative role for stroke in some COVID-19 patients [12, 14, 15].Fig.\xa01a NCCT of the head in a COVID-19 patient demonstrates findings of AIS, including hypoattenuation of the brain parenchyma, loss of gray-white differentiation, and sulcal effacement. b Axial CTA of the head in the same patient demonstrates reduced vascular filling in branches of the right middle cerebral artery (arrowheads) and bilateral anterior cerebral arteries (arrows). Reference: Goldberg MF, Goldberg MF, Cerejo R, Tayal A. Cerebrovascular Disease in COVID-19. American Journal of Neuroradiology. 2020. doi:10.3174/ajnr.a6588. (Permission granted)'], '10140_2020_1840_Fig2_HTML': ['Another cerebrovascular manifestation of COVID-19 may be the development of cerebral venous thrombosis (CVT), which has been widely reported as a complication of COVID-19-associated coagulopathy, resulting in multisystem organ failure [19, 22, 27]. Specifically, several researchers have raised the possibility of an association between cerebral venous thrombosis and COVID-19 [28–32]. Once again, this potential association is based on a small number of patients, so a definitive, causal relationship has yet to be established, although it is suspected. Based on a case series of three patients, another case series of two patients, and three individual case reports, several apparently common features of CVT in COVID-19 have been observed [28–32]. All eight patients in these studies presented with neurologic complaints, ranging from mild to severe, including headache, confusion, aphasia, altered mental status, seizure, and hemiparesis. In all cases, respiratory symptoms were initially mild or non-existent, despite abnormal findings on chest imaging in seven out of eight patients that were consistent with COVID-19. In all eight patients, NCCT revealed edema and hemorrhage, consistent with cerebral hemorrhagic venous infarction; in two of those cases, hyperdensity was identified within intracranial veins, representing intravascular thrombosis (Fig.\xa0<xref rid="10140_2020_1840_Fig2_HTML" ref-type="fig">2</xref>).).Fig.\xa02a NCCT of the head in a COVID-19 patient shows hemorrhage in the anterior right temporal lobe. b Axial FLAIR image from brain MRI in the same patient shows hemorrhage and edema, most consistent with hemorrhagic venous infarct. c Intracranial MR venography in the same patient demonstrates absence of flow-related enhancement in the right transverse and sigmoid sinuses, consistent with dural venous sinus thromboses. Reference: Hemasian H, Ansari B. First case of Covid-19 presented with cerebral venous thrombosis: A rare and dreaded case. Revue Neurologique. 2020. doi:10.1016/j.neurol.2020.04.013. (Permission granted)'], '10140_2020_1840_Fig3_HTML': ['On venography, thromboses were seen in the dural venous sinuses, deep cerebral veins, and cortical veins. Notably, the internal cerebral veins are thrombosed in four out of eight cases (Fig.\xa0<xref rid="10140_2020_1840_Fig3_HTML" ref-type="fig">3</xref>). In one case, the researchers speculated that the source of hemorrhagic venous infarct was thrombotic microangiopathy due to compromised flow in deep medullary veins [). In one case, the researchers speculated that the source of hemorrhagic venous infarct was thrombotic microangiopathy due to compromised flow in deep medullary veins [28]. In the 6 cases in which mortality was reported, the death rate was 67%. This high mortality rate is in contradistinction to a reported CVT mortality rate of 4–8% in non-COVID-19 cases. The higher mortality rate seen in these COVID-19 patients may be related to the involvement of the deep venous system and/or non-neurologic complications of COVID-19 [33, 34]. The predilection for thrombosis of the deep venous system is also striking―in a large, international, prospective multicenter study of CVT in non-COVID-19 patients, thrombosis of the deep venous system occurred in only 10.9% of cases [34].Fig.\xa03Sagittal reconstruction of an intracranial CT venogram in a patient with COVID-19 shows filling defects in the vein of Galen (short arrow) and internal cerebral veins (long arrow), consistent with thromboses of the deep cerebral venous system. Reference: Cavalcanti DD, Raz E, Shapiro M, et al. Cerebral Venous Thrombosis associated with COVID-19. American Journal of Neuroradiology. 2020;41(8). doi:10.3174/ajnr.a6644. (Permission granted)'], '10140_2020_1840_Fig4_HTML': ['Nicholson et al. published a case series of four critically ill COVID-19 patients, three of whom were on extracorporeal membrane oxygenation (ECMO) [36]. These four patients underwent neuroimaging due to changes in neurologic status. In these patients, brain imaging demonstrates several different types of hemorrhages, including parenchymal hemorrhage, diffuse petechial hemorrhage, and subarachnoid hemorrhage (Fig.\xa0<xref rid="10140_2020_1840_Fig4_HTML" ref-type="fig">4</xref>). Although the authors acknowledge the inherent limitations of a small case series in drawing causal relationships, they refer to the extensive, early literature of hypercoagulability and endothelial dysfunction associated with COVID-19. Therefore, they hypothesize that the intracranial hemorrhage seen in their case series could be due to a diffuse thrombotic microangiopathy with both arterial and venous involvement. Although other studies have demonstrated definitive, pathologic evidence of microthrombi and endothelial dysfunction in other organ systems, this study did not include any pathologic/autopsy analyses [). Although the authors acknowledge the inherent limitations of a small case series in drawing causal relationships, they refer to the extensive, early literature of hypercoagulability and endothelial dysfunction associated with COVID-19. Therefore, they hypothesize that the intracranial hemorrhage seen in their case series could be due to a diffuse thrombotic microangiopathy with both arterial and venous involvement. Although other studies have demonstrated definitive, pathologic evidence of microthrombi and endothelial dysfunction in other organ systems, this study did not include any pathologic/autopsy analyses [22, 37]. Lastly, the authors note that ECMO alone (in the absence of SARS-CoV-2 infection) is a risk factor for intracranial hemorrhage, further limiting the generalizability of this small case series. Notably, however, in a case series of nine patients with COVID-19 (none of whom were on ECMO), Fitsiori et al. described cerebral microbleeds in unusual distributions, including involvement of the internal capsule, corpus callosum, and middle cerebellar peduncles [38].Fig.\xa04a. NCCT of the head in a COVID-19 patient demonstrates numerous punctate foci of hyperdensity (arrowheads), consistent with petechial hemorrhage. b Axial susceptibility-weighted image (SWI) from a brain MRI of the same patient demonstrates extensive foci of hypointensity, consistent with susceptibility artifact from hemorrhage. Findings were consistent with thrombotic microangiopathy. Reference: Nicholson P, Alshafai L, Krings T. Neuroimaging Findings in Patients with COVID-19. American Journal of Neuroradiology. 2020;41(8). doi:10.3174/ajnr.a6630. (Permission granted)'], '10140_2020_1840_Fig5_HTML': ['Poyiadji et al. published a case report of a COVID-19 patient presenting with cough, fever, and altered mental status [52]. NCCT revealed hypoattenuation in the bilateral thalami. Brain MRI showed enhancing hemorrhagic lesions bilaterally within the medial temporal lobes, subinsular regions, and thalami (Fig.\xa0<xref rid="10140_2020_1840_Fig5_HTML" ref-type="fig">5</xref>). Based on these findings, the diagnosis was COVID-19-related acute hemorrhagic encephalopathy. The authors based their diagnosis on not only the above-described imaging features but also on the known association between acute necrotizing encephalopathy (ANE) and other viral infections, including influenza [). Based on these findings, the diagnosis was COVID-19-related acute hemorrhagic encephalopathy. The authors based their diagnosis on not only the above-described imaging features but also on the known association between acute necrotizing encephalopathy (ANE) and other viral infections, including influenza [52]. As mentioned above, cytokine storm syndrome has been strongly associated with COVID-19 and other severe infections, and this may be the likely underlying etiology for ANE, with resultant breakdown in the BBB [41].Fig.\xa05a NCCT of the head in a COVID-19 patient shows symmetric edema within the bilateral thalami (arrows). b Axial FLAIR image from brain MRI in the same patient shows edema and mass effect in the bilateral thalami (arrows). c Axial SWI from a brain MRI of the same patient demonstrates susceptibility artifact, confirming the presence of hemorrhage (arrows). The bilateral medial temporal lobes also demonstrated edema and hemorrhage (not shown), and findings were consistent with acute hemorrhagic necrotizing encephalopathy. Reference: Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B. COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features. Radiology. 2020:201187. doi:10.1148/radiol.2020201187. (Permission granted)'], '10140_2020_1840_Fig6_HTML': ['Hemorrhagic posterior reversible encephalopathy syndrome (PRES) has recently been described in the setting of COVID-19 [42]. In a small case series, Franceschi et al. detailed similar imaging findings in two patients with COVID-19 who underwent neuroimaging after the development of altered mental status. In a 48-year-old male, a NCCT demonstrates subcortical edema in the bilateral parieto-occipital regions with a small component of hemorrhage (Fig.\xa0<xref rid="10140_2020_1840_Fig6_HTML" ref-type="fig">6</xref>). The NCCT on the second patient, a 67-year-old female, also demonstrated edema in the bilateral parieto-occipital regions. A follow-up brain MRI showed more extensive edema, including not only the bilateral parieto-occipital regions but also the right frontal lobe, basal ganglia, and cerebellar hemispheres. Hemorrhage was also seen in the right parieto-occipital region. No evidence of arterial or venous thromboses was identified in either patient. Imaging findings were considered to be consistent with PRES complicated by hemorrhage [). The NCCT on the second patient, a 67-year-old female, also demonstrated edema in the bilateral parieto-occipital regions. A follow-up brain MRI showed more extensive edema, including not only the bilateral parieto-occipital regions but also the right frontal lobe, basal ganglia, and cerebellar hemispheres. Hemorrhage was also seen in the right parieto-occipital region. No evidence of arterial or venous thromboses was identified in either patient. Imaging findings were considered to be consistent with PRES complicated by hemorrhage [53].Fig.\xa06NCCT of the head in a COVID-19 patient demonstrates edema in the bilateral occipital lobes, consistent with PRES. Within the edema of the right occipital lobe, there is a small, superimposed parenchymal hemorrhage (arrow). Reference: Franceschi A, Ahmed O, Giliberto L, Castillo M. Hemorrhagic Posterior Reversible Encephalopathy Syndrome as a Manifestation of COVID-19 Infection. American Journal of Neuroradiology. 2020. doi:10.3174/ajnr.a6595. (Permission granted)']} | Neuroradiologic manifestations of COVID-19: what the emergency radiologist needs to know | [
"COVID-19",
"Encephalopathy",
"PRES",
"SARS-CoV-2",
"Stroke"
] | Emerg Radiol | 1597993200 | The organization of genomic DNA into nucleosomes profoundly affects all DNA-related processes in eukaryotes. The histone chaperone known as 'facilitates chromatin transcription' (FACT) (consisting of subunits SPT16 and SSRP1) promotes both disassembly and reassembly of nucleosomes during gene transcription, DNA replication and DNA repair. However, the mechanism by which FACT causes these opposing outcomes is unknown. Here we report two cryo-electron-microscopic structures of human FACT in complex with partially assembled subnucleosomes, with supporting biochemical and hydrogen-deuterium exchange data. We find that FACT is engaged in extensive interactions with nucleosomal DNA and all histone variants. The large DNA-binding surface on FACT appears to be protected by the carboxy-terminal domains of both of its subunits, and this inhibition is released by interaction with H2A-H2B, allowing FACT-H2A-H2B to dock onto a complex containing DNA and histones H3 and H4 (ref. ). SPT16 binds nucleosomal DNA and tethers H2A-H2B through its carboxy-terminal domain by acting as a placeholder for DNA. SSRP1 also contributes to DNA binding, and can assume two conformations, depending on whether a second H2A-H2B dimer is present. Our data suggest a compelling mechanism for how FACT maintains chromatin integrity during polymerase passage, by facilitating removal of the H2A-H2B dimer, stabilizing intermediate subnucleosomal states and promoting nucleosome reassembly. Our findings reconcile discrepancies regarding the many roles of FACT and underscore the dynamic interactions between histone chaperones and nucleosomes. | [
"Cell Cycle Proteins",
"Cryoelectron Microscopy",
"DNA",
"DNA-Binding Proteins",
"High Mobility Group Proteins",
"Histones",
"Humans",
"Models, Molecular",
"Nucleosomes",
"Protein Structure, Quaternary",
"Protein Structure, Tertiary",
"Transcription Factors",
"Transcriptional Elongation Factors"
] | other | PMC7441306 | null | 50 | [
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"{'Citation': 'Masson GR et al. Recommendations for performing, interpreting and reporting hydrogen deuterium exchange mass spectrometry (HDX-MS) experiments. Nat Methods 16, 595–602, doi:10.1038/s41592-019-0459-y (2019).', 'ArticleIdList': {'ArticleId': [{'@IdType': 'doi', '#text': '10.1038/s41592-019-0459-y'}, {'@IdType': 'pmc', '#text': 'PMC6614034'}, {'@IdType': 'pubmed', '#text': '31249422'}]}}"
] | Emerg Radiol. 2020 Aug 21; 27(6):737-745 | NO-CC CODE |
|
Dissection of the thalamus (mediodorsal nucleus). | cln63_2p0255f2 | 7 | 2d07eb54d37a10ce80f90a5b4c0b7a7e827065534907caa0b36f875e7406355b | cln63_2p0255f2.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
413,
275
] | [{'image_id': 'cln63_2p0255f2', 'image_file_name': 'cln63_2p0255f2.jpg', 'image_path': '../data/media_files/PMC2664212/cln63_2p0255f2.jpg', 'caption': 'Dissection of the thalamus (mediodorsal nucleus).', 'hash': '2d07eb54d37a10ce80f90a5b4c0b7a7e827065534907caa0b36f875e7406355b'}, {'image_id': 'cln63_2p0255f1', 'image_file_name': 'cln63_2p0255f1.jpg', 'image_path': '../data/media_files/PMC2664212/cln63_2p0255f1.jpg', 'caption': 'Dissection of the prefrontal cortex (BA46).', 'hash': '791ec97d7e9fa0a8dd2c28dacf2e908eae923c971cf2d0ef96c1a7df7e00c8c5'}] | {} | Is Brain Banking of Psychiatric Cases Valuable for Neurobiological Research? | [
"Brain Banking",
"Post Mortem",
"Schizophrenia",
"Bipolar Disorder",
"Neurobiology"
] | Clinics | 1207033200 | [{'@Label': 'OBJECTIVE', '@NlmCategory': 'OBJECTIVE', '#text': 'To describe the degree of difficulty that HIV-infected patients have with therapy treatment.'}, {'@Label': 'INTRODUCTION', '@NlmCategory': 'BACKGROUND', '#text': 'Patients perceptions about their treatment are a determinant factor for improved adherence and a better quality of life.'}, {'@Label': 'METHODS', '@NlmCategory': 'METHODS', '#text': 'Two cross-sectional analyses were conducted in public AIDS referral centers in Brazil among patients initiating treatment. Patients interviewed at baseline, after one month, and after seven months following the beginning of treatment were asked to classify and justify the degree of difficulty with treatment. Logistic regression was used for analysis.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'Among 406 patients initiating treatment, 350 (86.2%) and 209 (51.5%) returned for their first and third visits, respectively. Treatment perceptions ranged from medium to very difficult for 51.4% and 37.3% on the first and third visits, respectively. The main difficulties reported were adverse reactions to the medication and scheduling. A separate logistic regression indicated that the HIV-seropositive status disclosure, symptoms of anxiety, absence of psychotherapy, higher CD4+ cell count (> 200/mm3) and high (> 4) adverse reaction count reported were independently associated with the degree of difficulty in the first visit, while CDC clinical category A, pill burden (> 7 pills), use of other medications, high (> 4) adverse reaction count reported and low understanding of medical orientation showed independent association for the third visit.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'A significant level of difficulty was observed with treatment. Our analyses suggest the need for early assessment of difficulties with treatment, highlighting the importance of modifiable factors that may contribute to better adherence to the treatment protocol.'}] | [
"Adolescent",
"Adult",
"Anti-HIV Agents",
"Antiretroviral Therapy, Highly Active",
"Brazil",
"Cross-Sectional Studies",
"Female",
"HIV Infections",
"Health Services Accessibility",
"Humans",
"Logistic Models",
"Male",
"Patient Compliance",
"Prospective Studies",
"Quality of Life",
"Risk Factors",
"Socioeconomic Factors",
"Treatment Outcome",
"Young Adult"
] | other | PMC2664212 | null | 31 | [
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] | Clinics. 2008 Apr; 63(2):255-266 | NO-CC CODE |
|
(1a) Maximum intensity projection reconstruction of chest computed tomography (CT) showed pulmonary artery embolism. (1b) Brain magnetic resonance venography (MRV) revealed cerebral sinus venous thrombosis. (1c) Abdominal computed tomography (CT) showed the thrombosis with occlusion in her right hepatic vein. | gr1_lrg | 7 | dd8eade248f76d4e96d549895cce656679580ffa2bd6c4ba00f34a632abd9d1a | gr1_lrg.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
708,
236
] | [{'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC8839803/gr2_lrg.jpg', 'caption': 'The functional result of platelet activation was positive in our patient: the positive functional result of platelet activation was presented in serum without heparin, the percentage of platelets activated for both anti-CD61 and anti-CD62p conjugated antibodies was 19.19% to indicate that platelet activation was triggered (data were shown in the upper right quadrant of each plot). In the presence of patient serum plus heparin (0.1\xa0IU/mL, 0.3\xa0IU/mL, and 100\xa0IU/mL), donor platelets show the reduced reactivity with 12.8%, 12.3% and 15.8% of activated platelets. The definition of positive flow cytometric assay was with percentage of activated platelets more than 11%. Abbreviation: CD61 (glycoprotein IIIa): a marker of platelet identification; CD62p (p-selectin): a marker of platelet activation; Adenosine diphosphate (ADP): a positive control of normal platelet activation.', 'hash': '832d0b2a9bfa9972fc8859ecdaab95004b89f82bb44eb2bf58c3ff21a0991601'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC8839803/gr1_lrg.jpg', 'caption': '(1a) Maximum intensity projection reconstruction of chest computed tomography (CT) showed pulmonary artery embolism. (1b) Brain magnetic resonance venography (MRV) revealed cerebral sinus venous thrombosis. (1c) Abdominal computed tomography (CT) showed the thrombosis with occlusion in her right hepatic vein.', 'hash': 'dd8eade248f76d4e96d549895cce656679580ffa2bd6c4ba00f34a632abd9d1a'}] | {'gr1_lrg': ['A 40-year-old woman presented to the emergency department with a 1-day history of chest pain, headache, and abdominal pain. She was healthy in the past and just received the first vaccination with AstraZeneca 6-day prior. The family history was unremarkable. Her temperature was 37.2\xa0°C, blood pressure was in the normal range, and no heart murmur was found. On initial assessment, skin petechiae over bilateral upper and lower extremities were found. Pregnancy test result was negative and urinalysis result was normal. Polymerase chain reaction (PCR) test for SARS-CoV-2 was negative. Blood tests indicated decreased platelet count (31\xa0×\xa0109/L; normal\xa0≥\xa0150\xa0×\xa0109/L) and high D-dimer level (>10,000\xa0ng/mL; normal\xa0≤\xa0250\xa0ng/mL, latex enhanced immunoturbidimetric immunoassay). The results of screening tests for autoimmune antibodies were negative and no schistocytes were found in peripheral blood smears. Coagulation tests results including plasma fibrinogen, prothrombin time, activated partial thromboplastin time, antithrombin, protein S and protein C were all in normal range. Chest computed tomography (CT) showed pulmonary embolism (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>\na) and brain magnetic resonance venography (MRV) revealed cerebral sinus venous thrombosis (\na) and brain magnetic resonance venography (MRV) revealed cerebral sinus venous thrombosis (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>b). In addition, abdominal CT demonstrated the thrombosis with obstruction in her right hepatic vein (b). In addition, abdominal CT demonstrated the thrombosis with obstruction in her right hepatic vein (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>c). The level of blood platelet factor 4 (PF4) antibodies using enzyme-linked immunosorbent assay (ELISA) of Lifecodes PF4 IgG assay (Immucor) was high (110.76\xa0ng/ml; normal\xa0≤\xa040\xa0ng/ml) and result of platelet activation test (c). The level of blood platelet factor 4 (PF4) antibodies using enzyme-linked immunosorbent assay (ELISA) of Lifecodes PF4 IgG assay (Immucor) was high (110.76\xa0ng/ml; normal\xa0≤\xa040\xa0ng/ml) and result of platelet activation test (<xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>\n) was positive, confirming the diagnosis of VITT. Medical treatments including intravenous immunoglobulin (1\xa0g/kg daily for 2\xa0days), methylprednisolone (40\xa0mg/day for 4\xa0days) and anticoagulation with the direct oral anticoagulant dabigatran were administered. After a 3-month follow-up, the platelet count (263\xa0×\xa010\n) was positive, confirming the diagnosis of VITT. Medical treatments including intravenous immunoglobulin (1\xa0g/kg daily for 2\xa0days), methylprednisolone (40\xa0mg/day for 4\xa0days) and anticoagulation with the direct oral anticoagulant dabigatran were administered. After a 3-month follow-up, the platelet count (263\xa0×\xa0109/L; normal\xa0≥\xa0150\xa0×\xa0109/L) and D-dimer level (234.51\xa0ng/mL; normal\xa0≤\xa0250\xa0ng/mL) were in normal range. In addition, the titer of PF4 antibodies (optical density: 0.425; normal\xa0≤\xa00.4, ELISA) fell compared with initial presentation. Her general condition completely recovered after a 6-month follow-up.Fig. 1(1a) Maximum intensity projection reconstruction of chest computed tomography (CT) showed pulmonary artery embolism. (1b) Brain magnetic resonance venography (MRV) revealed cerebral sinus venous thrombosis. (1c) Abdominal computed tomography (CT) showed the thrombosis with occlusion in her right hepatic vein.Fig. 2The functional result of platelet activation was positive in our patient: the positive functional result of platelet activation was presented in serum without heparin, the percentage of platelets activated for both anti-CD61 and anti-CD62p conjugated antibodies was 19.19% to indicate that platelet activation was triggered (data were shown in the upper right quadrant of each plot). In the presence of patient serum plus heparin (0.1\xa0IU/mL, 0.3\xa0IU/mL, and 100\xa0IU/mL), donor platelets show the reduced reactivity with 12.8%, 12.3% and 15.8% of activated platelets. The definition of positive flow cytometric assay was with percentage of activated platelets more than 11%. Abbreviation: CD61 (glycoprotein IIIa): a marker of platelet identification; CD62p (p-selectin): a marker of platelet activation; Adenosine diphosphate (ADP): a positive control of normal platelet activation.'], 'gr2_lrg': ['The flow cytometry (FC) method of HIPA in our patient was performed in-house method with some modifications as the follows: (a) use of normal donor platelets regardless of blood group type; (b) use of CD61 (glycoprotein IIIa) and CD62p (p-selectin) as indicators of the identification and activation of platelet, individually; (c) use of adenosine diphosphate to check the standard platelet activation; (d) all processes were performed at the temperature (20–25\xa0°C); (e) use of phosphate-buffered saline as the buffer solution for the entire procedure; and (f) analysis of 10,000 platelets per sample [20], [21]. This patient\'s plasma was incubated without unfractionated heparin (UFH) and with 0.1\xa0IU/ml, 0.3\xa0IU/ml and 100\xa0IU/ml UFH (<xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>). The positive result of platelet activation tests was presented in serum without UFH, the percentage of activated platelets was 19.2% to indicate that platelet activation was triggered. In the presence of this patient’s serum plus UFH, donor platelets showed the reduced reactivity with of platelet activation. VITT had unique pattern of platelet reactivity in vitro, which presented activated platelets without UFH and did not exhibit any dependence on UFH for platelet activation ). The positive result of platelet activation tests was presented in serum without UFH, the percentage of activated platelets was 19.2% to indicate that platelet activation was triggered. In the presence of this patient’s serum plus UFH, donor platelets showed the reduced reactivity with of platelet activation. VITT had unique pattern of platelet reactivity in vitro, which presented activated platelets without UFH and did not exhibit any dependence on UFH for platelet activation [6], [21], [22].']} | The role of anti-platelet factor 4 antibodies and platelet activation tests in patients with vaccine-induced immune thrombotic thrombocytopenia: Brief report on a comparison of the laboratory diagnosis and literature review | [
"COVID-19 vaccine",
"ChAdOx1 COVID-19 (AstraZeneca) vaccine",
"Anti-platelet factor 4 antibodies",
"Platelet activation test",
"Vaccine-induced immune thrombotic thrombocytopenia",
"Thrombosis with thrombocytopenia syndrome"
] | Clin Chim Acta | 1648796400 | [{'@Label': 'IMPORTANCE', '#text': 'The Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study showed that the addition of postnatal weight gain to birth weight and gestational age detects similar numbers of infants with ROP, but requires examination of fewer infants.'}, {'@Label': 'OBJECTIVE', '#text': 'To determine the incremental cost-effectiveness of screening with G-ROP compared with conventional screening.'}, {'@Label': 'DESIGN, SETTING AND PARTICIPANTS', '#text': 'We built a microsimulation model of a 1-year US birth cohort <32 weeks gestation, using data from the G-ROP study. We obtained resource utilization estimates from the G-ROP dataset and from secondary sources, and test characteristics from the G-ROP cohort.'}, {'@Label': 'RESULTS', '#text': 'Among 78,281 infants nationally, screening with G-ROP detected ~25 additional infants with Type 1 ROP. This was accomplished with 36,233 fewer examinations, in 14,073 fewer infants, with annual cost savings of approximately US$2,931,980 through hospital discharge.'}, {'@Label': 'CONCLUSIONS', '#text': 'Screening with G-ROP reduced costs while increasing the detection of ROP compared with current screening guidelines.'}] | [
"Birth Weight",
"Gestational Age",
"Humans",
"Infant",
"Infant, Newborn",
"Neonatal Screening",
"Retinopathy of Prematurity",
"Retrospective Studies",
"Risk Factors"
] | other | PMC8839803 | null | 29 | [
"{'Citation': 'Early Treatment For Retinopathy of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: Results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol. 2003;121(12):1684–94.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '14662586'}}}",
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"{'Citation': 'Fierson WM, American Academy of Pediatrics Section on Ophthalmology, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Association of Certified Orthoptists. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2018;142(6): e20183061', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '30478242'}}}",
"{'Citation': 'Binenbaum G, Ying GS, Quinn GE, Huang J, Dreiseitl S, Antigua J, et al. The CHOP postnatal weight gain, birth weight, and gestational age retinopathy of prematurity risk model. Arch Ophthalmol. 2012;130(12):1560–5.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '23229697'}}}",
"{'Citation': 'Binenbaum G, Ying GS, Tomlinson LA, Postnatal Growth and Retinopathy of Prematurity Study Group. Validation of the Children’s Hospital of Philadelphia Retinopathy of Prematurity (CHOP ROP) model. JAMA Ophthalmol. 2017;135(8):871–7.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC5710287'}, {'@IdType': 'pubmed', '#text': '28715553'}]}}",
"{'Citation': 'Cao JH, Wagner BD, Cerda A, McCourt EA, Palestine A, Enzenauer RW, et al. Colorado retinopathy of prematurity model: a multi-institutional validation study. Journal of American Association for Pediatric Ophthalmology and Strabismus Journal of American Association for Pediatric Ophthalmology and Strabismus. 2016;20(3):220–5.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '27166790'}}}",
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"{'Citation': 'Lofqvist C, Hansen-Pupp I, Andersson E, Holm K, Smith LE, Ley D, et al. Validation of a new retinopathy of prematurity screening method monitoring longitudinal postnatal weight and insulinlike growth factor I. Arch Ophthalmol. 2009;127(5):622–7.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '19433710'}}}",
"{'Citation': 'Wu C, Lofqvist C, Smith LE, VanderVeen DK, Hellstrom A, Consortium W. Importance of early postnatal weight gain for normal retinal angiogenesis in very preterm infants: a multicenter study analyzing weight velocity deviations for the prediction of retinopathy of prematurity. Arch Ophthalmol. 2012;130(8):992–9.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC4059056'}, {'@IdType': 'pubmed', '#text': '22491391'}]}}",
"{'Citation': 'Binenbaum G, Bell EF, Donohue P, Quinn G, Shaffer J, Tomlinson LA, et al. Development of modified screening criteria for retinopathy of prematurity: Primary results from the Postnatal Growth and Retinopathy of Prematurity Study. JAMA Ophthalmol. 2018;136(9):1034–40.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC6142979'}, {'@IdType': 'pubmed', '#text': '30003216'}]}}",
"{'Citation': 'Quinn GE, Ying GS, Bell EF, Donohue PK, Morrison D, Tomlinson LA, et al. Incidence and early course of retinopathy of prematurity: Secondary analysis of the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study. JAMA Ophthalmol. 2018;136(12):1383–9.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC6583045'}, {'@IdType': 'pubmed', '#text': '30326046'}]}}",
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"{'Citation': 'Multicenter trial of cryotherapy for retinopathy of prematurity. One-year outcome--structure and function. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Archives of Ophthalmology. 1990;108:1408–16.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '2222274'}}}",
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] | Clin Chim Acta. 2022 Apr 1; 529:42-45 | NO-CC CODE |
|
Tuberculosis primaria. La TC con contraste a un nivel 2 cm por encima del cayado aórtico muestra aumento del tamaño de los ganglios linfáticos paratraqueales derechos (flechas curvas), con baja atenuación central y refuerzo periférico. | gr24 | 7 | bf46a3f80b5ddba94c40635af3a3b60ea9eefe7458acf1d015d2bae791ea5987 | gr24.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
349,
335
] | [{'image_id': 'gr45', 'image_file_name': 'gr45.jpg', 'image_path': '../data/media_files/PMC7271218/gr45.jpg', 'caption': 'Neumonía por Pneumocystis. La radiografía posteroanterior de tórax (A) muestra un aumento borroso y difuso de la densidad pulmonar (opacidad en vidrio esmerilado) en ambos pulmones, más intenso en los lóbulos inferiores. Varios días más tarde (B) la enfermedad ha progresado hasta la consolidación.', 'hash': '1f5a2797ecd4f8202a8277041b3261d8e751536f1b58db5c6888055ff9f2a11d'}, {'image_id': 'gr39', 'image_file_name': 'gr39.jpg', 'image_path': '../data/media_files/PMC7271218/gr39.jpg', 'caption': 'Coccidioidomicosis primaria. Las imágenes del pulmón izquierdo en las radiografías posteroanterior (A) y lateral (B) muestran una consolidación homogénea de gran parte del segmento lingular del lóbulo superior izquierdo. En las radiografías originales se podía identificar un broncograma aéreo débil, que no se aprecia en la figura. El borde superior de la consolidación está bien circunscrito y recuerda a una masa.', 'hash': '29bceb621d66f99d00f9e11828b2ce1e195da0f0bf045b93da96b29fdf7c7874'}, {'image_id': 'gr42', 'image_file_name': 'gr42.jpg', 'image_path': '../data/media_files/PMC7271218/gr42.jpg', 'caption': 'Blastomicosis sudamericana. Varón de 52 años con fiebre y cefalea intensa pero sin síntomas respiratorios. La TC demostró granulomas intracerebrales. Al ingreso la radiografía posteroanterior de tórax (A) mostraba numerosos nódulos bilaterales de 0,5 a 2 cm de diámetro, así como adenopatías hiliares derechas y paratraqueales. La TC (B) revela que algunos nódulos están cavitados. La biopsia por aspiración con aguja fina de uno de los nódulos demostró Paracoccidioides brasiliensis.', 'hash': 'f64961518725756a49c773b967bf01e1a1cc1c24d42b9277834cf66b534095a1'}, {'image_id': 'gr30', 'image_file_name': 'gr30.jpg', 'image_path': '../data/media_files/PMC7271218/gr30.jpg', 'caption': 'Tuberculosis: diseminación endobronquial.. La radiografía posteroanterior de tórax (A) muestra opacidades nodulares mal definidas en ambos pulmones. La TCAR (B) muestra una cavidad en el segmento superior del lóbulo inferior izquierdo y opacidades nodulares de 2 a 8 mm de diámetro y distribución centrolobulillar (flechas rectas). Unas pocas opacidades lineales ramificadas, junto con los nódulos centrolobulillares, proporcionan un aspecto que ha sido comparado con el de un árbol en brote (flecha curva).', 'hash': 'f611f9066ecd09ac4289bf1a7c03ba19b401bc320e2aefe96a3e121733e1f3fd'}, {'image_id': 'gr4', 'image_file_name': 'gr4.jpg', 'image_path': '../data/media_files/PMC7271218/gr4.jpg', 'caption': 'Bronconeumonía aguda. El corte histológico (A) muestra enfermedad precoz formada por un exudado inflamatorio agudo dentro de la luz de un bronquiolo terminal y en el parénquima pulmonar inmediatamente próximo; los espacios aéreos vecinos no están afectados. B. Se muestra la enfermedad más avanzada; aunque existe confluencia de la inflamación que se origina en varios bronquiolos, todavía se identifica la naturaleza focal del proceso. El cultivo pulmonar post mortem fue positivo para Pseudomonas aeruginosa.', 'hash': '7c270a5e4da861e0ec098e11cc224cb5c6cbc3d4d1646254957a19b7e704c274'}, {'image_id': 'gr3', 'image_file_name': 'gr3.jpg', 'image_path': '../data/media_files/PMC7271218/gr3.jpg', 'caption': 'Neumonía aguda por Klebsiella: abombamiento de la cisura. Imagen del pulmón derecho en una radiografía posteroanterior de tórax, que revela una consolidación masiva del espacio aéreo con afectación de la mayor parte del lóbulo superior. El desplazamiento hacia abajo de la cisura menor (flechas) indica expansión lobar; las zonas centrales de radiotransparencia (entre las puntas de flecha) indican necrosis parenquimatosas.', 'hash': '88a2bc41903d64bd2671921636b147c745b5256d2e6701c1734170e20661cb81'}, {'image_id': 'gr37', 'image_file_name': 'gr37.jpg', 'image_path': '../data/media_files/PMC7271218/gr37.jpg', 'caption': 'Histoplasmosis: broncolitiasis. En esta mujer de 45 años con antecedentes de hemoptisis y episodios repetidos de tos con expectoración de pequeñas concreciones, la radiografía posteroanterior de tórax (A) muestra ganglios linfáticos calcificados hiliares (flecha) y paratraqueales derechos. Los dos cortes de TC con colimación de 6 mm (B y C) muestran un ganglio hiliar derecho calcificado (flecha recta) y un broncolito (flecha curva), dentro del bronquio segmentario anterior del lóbulo superior derecho.', 'hash': 'f6c316dc045f7e6836692e6e33ce91ec8fed1295f30eed97d1087b8102c075a4'}, {'image_id': 'gr70', 'image_file_name': 'gr70.jpg', 'image_path': '../data/media_files/PMC7271218/gr70.jpg', 'caption': 'Neumonía por Mycoplasma pneumoniae. La TCAR correspondiente al lóbulo inferior derecho revela nódulos pequeños (flechas) con una distribución predominantemente centrolobulillar y zonas de atenuación en vidrio esmerilado. La demarcación nítida entre los lóbulos pulmonares normales y anormales es compatible con una neumonía lobulillar.', 'hash': 'b8b939bafc3e1ec945cea95e6fc07bbb5f824c201635cc77777462045b3a3ed6'}, {'image_id': 'gr61', 'image_file_name': 'gr61.jpg', 'image_path': '../data/media_files/PMC7271218/gr61.jpg', 'caption': 'Neumonía por hantavirus. La radiografía de tórax muestra cardiomegalia leve con prominencia de las marcas vasculares pulmonares y pequeños derrames pleurales bilaterales. Esas alteraciones se resolvieron con rapidez después de la diálisis renal.', 'hash': 'c3da85d920d908e43db3d16ff072dc721a59c890628ed0f9bc52a85f3804acca'}, {'image_id': 'gr66', 'image_file_name': 'gr66.jpg', 'image_path': '../data/media_files/PMC7271218/gr66.jpg', 'caption': 'Neumonía por citomegalovirus. La TCAR muestra opacidades nodulares bilaterales de bordes irregulares y zonas de atenuación en vidrio esmerilado. Hay opacidades lineales irregulares en el lóbulo inferior. El paciente era un varón de 38 años sometido a un trasplante pulmonar bilateral.', 'hash': 'fc4876c1224cbeb6d4b8b5616fe8c44d93650a76e9848f44a438ece4f3eda71f'}, {'image_id': 'gr14', 'image_file_name': 'gr14.jpg', 'image_path': '../data/media_files/PMC7271218/gr14.jpg', 'caption': 'Embolia séptica. La radiografía de tórax (A) muestra múltiples nódulos cavitados bilaterales. La TC (B) demuestra que varios nódulos tienen una localización subpleural; algunos tienen vasos que penetran en su interior (signo del vaso nutricio) (flechas rectas). También se aprecia un foco de consolidación subpleural con forma de cuña (flecha curva). Los hemocultivos fueron positivos para Nocardia. El paciente era VIH positivo.', 'hash': 'ef29e51abbf2534924e23cee4bc0b3e04ba60c524a37e426e77774330810e212'}, {'image_id': 'gr68', 'image_file_name': 'gr68.jpg', 'image_path': '../data/media_files/PMC7271218/gr68.jpg', 'caption': 'Mycoplasma pneumoniae: bronquiolitis y neumonitis. El corte de una muestra de biopsia pulmonar abierta de un varón de 23 años con insuficiencia respiratoria rápidamente progresiva (A) muestra neumonitis intersticial focal entre leve y moderada e inflamación intensa centrada alrededor de un bronquiolo membranoso y un bronquiolo respiratorio (b). También se aprecia un grado ligero de inflamación intersticial alveolar. Otro campo de la misma biopsia (B) muestra la misma reacción en un bronquiolo respiratorio terminal.', 'hash': '9e57c1d020d20fda61a77b9c96c5f3a6d2675b8ee9de5269051cad2b50497f88'}, {'image_id': 'gr13', 'image_file_name': 'gr13.jpg', 'image_path': '../data/media_files/PMC7271218/gr13.jpg', 'caption': 'Tuberculosis miliar. La imagen del pulmón izquierdo en una radiografía anteroposterior de tórax muestra numerosos nódulos bien definidos de 1 a 3 mm de diámetro, más abundantes en la base.', 'hash': 'f8620d7d2fd4399b7f85cbb8407d74deba71efb452f2bc077cbd7a87386f6b20'}, {'image_id': 'gr26', 'image_file_name': 'gr26.jpg', 'image_path': '../data/media_files/PMC7271218/gr26.jpg', 'caption': 'Tuberculosis posprimaria. La imagen de la porción superior del hemitórax izquierdo en una radiografía posteroanterior muestra zonas focales mal definidas de consolidación y pequeños focos satélites en el lóbulo izquierdo superior.', 'hash': '455c507787de329281929e7610da1fef2f0594cc0c34c80b5fe52050bb6c4661'}, {'image_id': 'gr21', 'image_file_name': 'gr21.jpg', 'image_path': '../data/media_files/PMC7271218/gr21.jpg', 'caption': 'Neumonía por anaerobios: neumonía del espacio aéreo con formación de un absceso. La primera radiografía (A) de esta mujer alcohólica de 45 años de edad reveló una consolidación homogénea masiva del lóbulo inferior derecho y una consolidación focal del pulmón izquierdo. Veinticuatro horas más tarde (B) la neumonía se había extendido a la mayor parte del pulmón derecho y a una zona grande del izquierdo. Durante las dos semanas siguientes, en las que recibió tratamiento antibiótico, desapareció la mayor parte de la neumonía del pulmón izquierdo (C); sin embargo, apareció una cavidad de paredes gruesas en el pulmón derecho.', 'hash': '07e25009ec80f3d9cc28058f1b36e10e17a665f88e9be131f21e6bd4965facbc'}, {'image_id': 'gr53', 'image_file_name': 'gr53.jpg', 'image_path': '../data/media_files/PMC7271218/gr53.jpg', 'caption': 'Aspergilosis angioinvasora: progresión de las alteraciones radiográficas. Paciente de 23 años con leucemia aguda que presentó fiebre y tos. La radiografía anteroposterior (AP) de tórax (A) muestra una zona redondeada de consolidación en el lóbulo superior derecho que mostró una progresión considerable al cabo de una semana (B). Al día siguiente la biopsia pulmonar abierta demostró hemorragia pulmonar, pero no identificó ningún microorganismo. Una radiografía de tórax anteroposterior dos semanas más tarde de la biopsia (C) y la TCAR (D) demuestran una cavidad de bordes lisos en el lóbulo superior derecho que contiene una masa de tejidos blandos. La biopsia que se repitió bajo guía de TC confirmó el diagnóstico de aspergilosis invasora, y la masa de tejidos blandos de la cavidad correspondía a pulmón necrótico (secuestro).', 'hash': '07794e8d609a66b13e2b47d2870852206336b58341f8bcc794e2f1ec4afe6e35'}, {'image_id': 'gr54', 'image_file_name': 'gr54.jpg', 'image_path': '../data/media_files/PMC7271218/gr54.jpg', 'caption': 'Aspergilosis angioinvasora: signo del halo en la TC. La TCAR del lóbulo superior izquierdo demuestra un nódulo rodeado por un halo con atenuación en vidrio esmerilado (flecha) (signo del halo). La paciente era una mujer de 72 años con leucemia aguda.', 'hash': 'a8364c7888d743e2764d8dac68e2c4744e6ed5c1c6cfca3ab1b964aab8eeda97'}, {'image_id': 'gr28', 'image_file_name': 'gr28.jpg', 'image_path': '../data/media_files/PMC7271218/gr28.jpg', 'caption': 'Tuberculoma. La imagen del lóbulo superior derecho de un fumador de 59 años muestra un nódulo de 1,5 cm de diámetro de bordes espiculados y una cola pleural (flecha). También se ve enfisema. Se encontró que el nódulo resecado era un granuloma, y los cultivos fueron positivos para Mycobacterium tuberculosis.', 'hash': '02cddd5f28192cbdd9252787ec7b5148fb60b700e88378706fa61467a6ccdfab'}, {'image_id': 'gr71', 'image_file_name': 'gr71.jpg', 'image_path': '../data/media_files/PMC7271218/gr71.jpg', 'caption': 'Amebiasis. La radiografía posteroanterior de tórax (A) muestra elevación del hemidiafragma derecho. La TC después de la administración de contraste intravenoso (B) presenta un derrame pleural derecho pequeño y zonas de atelectasia en el lóbulo inferior derecho. El corte a través del hígado (C) muestra una lesión quística grande en el lóbulo derecho hepático. El examen ecográfico (D) demuestra material ecógeno dentro de la lesión compatible con un absceso. El diagnóstico de amebiasis se demostró mediante aspiración con aguja fina bajo guía ecográfica. El paciente era un varón de 42 años de Corea del Sur con historia de fiebre y escalofríos desde una semana antes.', 'hash': 'c9effa75f2be53be562fd1f41bb4ebc11775cb0bad6db24f59b033e19ed585f2'}, {'image_id': 'gr76', 'image_file_name': 'gr76.jpg', 'image_path': '../data/media_files/PMC7271218/gr76.jpg', 'caption': 'Paragonimiasis: opacidades múltiples. La radiografía de tórax (A) muestra opacidades mal definidas en la zona media del pulmón derecho (flecha). La TCAR (B y C) presenta opacidades nodulares subpleurales de bordes mal definidos, así como una zona de consolidación subsegmentaria. El paciente era un varón surcoreano de 38 años al que se evaluó por dolor torácico inespecífico y tos.', 'hash': 'aee0a447cef14a0b32b1f36d245b7bbdd90d3f2f27d8bfb5b8edbd10e6491b75'}, {'image_id': 'gr2', 'image_file_name': 'gr2.jpg', 'image_path': '../data/media_files/PMC7271218/gr2.jpg', 'caption': 'Neumonía aguda del espacio aéreo. Las radiografías de tórax posteroanterior (A) y lateral (B) de un varón de 79 años muestran consolidación difusa del lóbulo superior derecho. Hay pequeños focos de consolidación en el lóbulo inferior derecho y en el pulmón izquierdo. Los cultivos de esputo fueron positivos para Streptococcus pneumoniae.', 'hash': '36bb21a9841efdbdd1ab993df615bd7ee17659cb2b8717b9f2bf87787adf1659'}, {'image_id': 'gr36', 'image_file_name': 'gr36.jpg', 'image_path': '../data/media_files/PMC7271218/gr36.jpg', 'caption': 'Histoplasmoma calcificado. La radiografía posteroanterior de tórax (A) muestra un nódulo de 1,5 cm de diámetro en el lóbulo inferior derecho (flecha); no se aprecia calcificación. Las imágenes de TCAR (B y C) muestran calcificación del nódulo, así como adenopatías hiliares derechas y subcarínicas calcificadas.', 'hash': 'e58f7de72742d412ce4b0f2f8358d6baa4de21db50426214b6bca5e06c983dab'}, {'image_id': 'gr31', 'image_file_name': 'gr31.jpg', 'image_path': '../data/media_files/PMC7271218/gr31.jpg', 'caption': 'Tuberculosis miliar. Una imagen del pulmón izquierdo en la radiografía anteroposterior de tórax (A) muestra numerosos nódulos bien definidos de 1 a 3 mm de diámetro. La TCAR de otro paciente (B) muestra múltiples nódulos de aproximadamente 2 mm de diámetro y distribución aleatoria por el pulmón.', 'hash': 'a415d5c7289ffcbfbe5671a6754284fd57d29def9b1ed861db4f3317ecc83561'}, {'image_id': 'gr5', 'image_file_name': 'gr5.jpg', 'image_path': '../data/media_files/PMC7271218/gr5.jpg', 'caption': 'Neumonía por Haemophilus influenzae. La radiografía de tórax anteroposterior (A) muestra opacidades nodulares mal definidas y zonas focales de consolidación. La TCAR (B) demuestra que los nódulos pequeños tienen una distribución centrolobulillar compatible con bronquiolitis. También hay una zona de consolidación lobulillar (flechas), característica de bronconeumonía precoz. Los cultivos de esputo y de sangre fueron positivos para H. influenzae.', 'hash': 'bc3ca4ce32d739ce07730efea85003d465086bf1b8dedaae6a4c158db3ca6894'}, {'image_id': 'gr43', 'image_file_name': 'gr43.jpg', 'image_path': '../data/media_files/PMC7271218/gr43.jpg', 'caption': 'Neumonía criptocócica aguda. Las radiografías posteroanterior (A) y lateral (B) muestran una consolidación homogénea no segmentaria de ambos lóbulos inferiores y del lóbulo medio derecho.', 'hash': '8ec70e8e43134ccb68bda92a3b137d6329a49df9e6bf4b33aa01c3e48c8e2358'}, {'image_id': 'gr44', 'image_file_name': 'gr44.jpg', 'image_path': '../data/media_files/PMC7271218/gr44.jpg', 'caption': 'Pneumocystis jiroveci (carinii): ciclo reproductivo propuesto. La representación esquemática de un alvéolo ilustra los posibles mecanismos del desarrollo de los quistes y la reproducción del microorganismo.', 'hash': '760ac10409173b5f9227a9a59bff6c6f62cfd4ac1e41371e53d6c80371beed1b'}, {'image_id': 'gr38', 'image_file_name': 'gr38.jpg', 'image_path': '../data/media_files/PMC7271218/gr38.jpg', 'caption': 'Histoplasmosis progresiva crónica. La imagen de la mitad superior del pulmón izquierdo (A) muestra una opacidad heterogénea mal definida (flechas) que contiene una zona radiotransparente central correspondiente a una cavidad. El pulmón derecho no tenía lesiones en aquella época. Aproximadamente un año después (B) la lesión apical izquierda ha desaparecido casi por completo, pero ahora se aprecia una enfermedad extensa en todo el lóbulo superior derecho, junto con una pérdida de volumen considerable (obsérvese la desviación de la tráquea hacia la derecha). El aspecto es similar al de la tuberculosis crónica.', 'hash': 'a26f0ff42db2188debddfec74729a35dd508348e6366e6f72db28dcb64b0dbb6'}, {'image_id': 'gr55', 'image_file_name': 'gr55.jpg', 'image_path': '../data/media_files/PMC7271218/gr55.jpg', 'caption': 'Mucormicosis. La radiografía posteroanterior de tórax (A) muestra una zona redondeada de consolidación en el segmento superior del lóbulo inferior derecho. La radiografía de seguimiento que se obtuvo al día siguiente (B) muestra un aumento considerable del tamaño de la consolidación. El paciente era un varón de 15 años con neutropenia intensa secundaria a quimioterapia por leucemia aguda.', 'hash': 'dcfb9cd3f479feb1676747a1a6cff8b6a622ce9a8f7d0235908953c163ba6079'}, {'image_id': 'gr29', 'image_file_name': 'gr29.jpg', 'image_path': '../data/media_files/PMC7271218/gr29.jpg', 'caption': 'Tuberculosis: opacidades nodulares pequeñas. La imagen de la porción superior del tórax en una radiografía posteroanterior muestra pequeñas opacidades nodulares mal definidas que afectan al segmento apicoposterior del lóbulo superior izquierdo.', 'hash': '3b6b083c4289f0a3692fd47369e0e4166b7be37a6ad290beefc05b55bcb66e21'}, {'image_id': 'gr52', 'image_file_name': 'gr52.jpg', 'image_path': '../data/media_files/PMC7271218/gr52.jpg', 'caption': 'Bronconeumonía por Aspergillus. En un varón de 36 años con fiebre y tos después de un trasplante de médula ósea alógena la radiografía de tórax anteroposterior (A) muestra opacidades nodulares mal definidas en ambos pulmones. La TCAR (B) revela zonas focales de consolidación con una distribución predominantemente peribronquial (flechas).', 'hash': '4124e799a9afb122b3725bceebe1ed65e863c7c8f6f4890c9c8b7027a13e14de'}, {'image_id': 'gr20', 'image_file_name': 'gr20.jpg', 'image_path': '../data/media_files/PMC7271218/gr20.jpg', 'caption': 'Formación de un absceso: Legionella pneumophila. La radiografía posteroanterior de tórax de una paciente de 25 años con trasplante renal muestra una cavidad de 3 cm de diámetro en el vértice pulmonar derecho.', 'hash': '79386e2ed72c4558c045b65bdef6ea65bbcfcf4aeacb559787d9d390cd893b94'}, {'image_id': 'gr27', 'image_file_name': 'gr27.jpg', 'image_path': '../data/media_files/PMC7271218/gr27.jpg', 'caption': 'Tuberculosis cavitaria. Las radiografías posteroanterior (A) y lateral (B) muestran una cavidad mal definida y de paredes finas en el segmento superior del lóbulo inferior derecho (flechas en B). Ambos pulmones son por lo demás normales.', 'hash': '93baa4e497eafff587dc7d27364d9b19ea46f3b0e25364caef554724114df1c2'}, {'image_id': 'gr12', 'image_file_name': 'gr12.jpg', 'image_path': '../data/media_files/PMC7271218/gr12.jpg', 'caption': 'Tuberculosis miliar. Imagen ampliada del lóbulo inferior que muestra numerosos nódulos de distribución aleatoria y de aproximadamente 1 a 3 mm de diámetro por diseminación hematógena de los bacilos tuberculosos (barra = 1 cm).', 'hash': '0bc2427c55ce234f27a59e8360ac69fe9c6baccdb1803ecc1d314b432c9b8f3b'}, {'image_id': 'gr15', 'image_file_name': 'gr15.jpg', 'image_path': '../data/media_files/PMC7271218/gr15.jpg', 'caption': 'Neumonía aguda del espacio aéreo: Streptococcus pneumoniae. Las radiografías posteroanterior (A) y lateral (B) revelan una consolidación extensa del lóbulo inferior derecho, y una parte del segmento anterior es el único tejido pulmonar no afecto. Se ve broncograma aéreo en la proyección lateral. Hay poca pérdida de volumen.', 'hash': 'eb6e0be7ebcf9b96a61ec13b361555efad86334ea51423def344b02f557291e7'}, {'image_id': 'gr69', 'image_file_name': 'gr69.jpg', 'image_path': '../data/media_files/PMC7271218/gr69.jpg', 'caption': 'Neumonía aguda por Mycoplasma pneumoniae. Las imágenes de las radiografías posteroanterior (A) y lateral (B) del pulmón izquierdo muestran una consolidación focal del espacio aéreo en la distribución de los segmentos lingular y posterior del lóbulo superior izquierdo.', 'hash': 'dc46b2073924076a9fc03023666a2f873aeffe772c4cd8ec297b587b36b73442'}, {'image_id': 'gr67', 'image_file_name': 'gr67.jpg', 'image_path': '../data/media_files/PMC7271218/gr67.jpg', 'caption': 'Mononucleosis infecciosa. Paciente de 17 años con anamnesis y datos de laboratorio compatibles con mononucleosis infecciosa. Las imágenes de las radiografías posteroanterior (A) y lateral (B) demuestran un aumento marcado del tamaño de ambos hilios con un contorno lobulado típico de adenopatías. No existen datos de adenopatías mediastínicas ni de enfermedad pulmonar o pleural. Un mes más tarde la radiografía de tórax era normal.', 'hash': '57a60e7d03abd99c9ef7f7816292a8dc83f8d54a1e6b90c50f6fbd8fbc84466d'}, {'image_id': 'gr60', 'image_file_name': 'gr60.jpg', 'image_path': '../data/media_files/PMC7271218/gr60.jpg', 'caption': 'Neumonía sarampionosa (de células gigantes). La imagen a bajo aumento (A) muestra consolidación extensa del espacio aéreo por líquido proteináceo, macrófagos y eritrocitos. Se ven con claridad células gigantes de forma irregular. La imagen ampliada (B) de una célula gigante muestra numerosos núcleos, algunos de los cuales contienen inclusiones víricas con tinción ligera pero bien definida (flecha).', 'hash': 'f166303fcb64c7154b04d4c08414092bd4187d4b0265a4a003dfb7883b6d9123'}, {'image_id': 'gr51', 'image_file_name': 'gr51.jpg', 'image_path': '../data/media_files/PMC7271218/gr51.jpg', 'caption': 'Aspergilosis broncopulmonar alérgica. La radiografía posteroanterior (A) revela opacidades nodulares focales en el segmento superior del lóbulo inferior izquierdo. Una TCAR (B) demuestra impactación mucoide en ese segmento (flechas), así como bronquiectasias extensas.', 'hash': '3bb3850b8a5b2fd013d2fa6be86626c7ed68924bf6d1494e5ccbf6cc31eb833f'}, {'image_id': 'gr56', 'image_file_name': 'gr56.jpg', 'image_path': '../data/media_files/PMC7271218/gr56.jpg', 'caption': 'Actinomicosis. Un corte de parénquima pulmonar (A) muestra fibrosis intersticial alveolar ligera y ocupación extensa del espacio aéreo por macrófagos alveolares. También se aprecia un exudado neutrófilo, probablemente en un bronquiolo respiratorio; contiene dos colonias actinomicóticas pequeñas (una de las cuales se muestra ampliada en B).', 'hash': '9e59708f2011df4f6d708525efbcd05b59bb26d91ea4c56e08e482649ef72fae'}, {'image_id': 'gr58', 'image_file_name': 'gr58.jpg', 'image_path': '../data/media_files/PMC7271218/gr58.jpg', 'caption': 'Nocardiosis pleuropulmonar. Varón de 36 años, previamente sano, al que se evaluó por dolor pleurítico intenso. La radiografía posteroanterior de tórax (A) demuestra zonas de consolidación en los lóbulos superiores y el lóbulo medio derecho y derrame pleural derecho. La TC (B) revela una consolidación extensa en los lóbulos superiores. La TC con ventana para tejidos blandos (C) demuestra un gran derrame pleural derecho con signos de loculación anterolateral y posteromedial (flechas). También se aprecia una consolidación en el lóbulo medio derecho. Se aisló Nocardia asteroides en el líquido tanto del LBA como pleural.', 'hash': '4c4febfe3bdaf55ea2c3cd00a6c721360f44214235454769b66f2929e042da1f'}, {'image_id': 'gr24', 'image_file_name': 'gr24.jpg', 'image_path': '../data/media_files/PMC7271218/gr24.jpg', 'caption': 'Tuberculosis primaria. La TC con contraste a un nivel 2 cm por encima del cayado aórtico muestra aumento del tamaño de los ganglios linfáticos paratraqueales derechos (flechas curvas), con baja atenuación central y refuerzo periférico.', 'hash': 'bf46a3f80b5ddba94c40635af3a3b60ea9eefe7458acf1d015d2bae791ea5987'}, {'image_id': 'gr23', 'image_file_name': 'gr23.jpg', 'image_path': '../data/media_files/PMC7271218/gr23.jpg', 'caption': 'Tuberculosis primaria. La radiografía posteroanterior de tórax (A) y la TC (B) muestran aumento del tamaño de los ganglios linfáticos hiliares izquierdos (G). La TC a un nivel ligeramente inferior (C) muestra el foco primario en el segmento superior del lóbulo inferior (flecha), detrás de la arteria pulmonar izquierda (API). El paciente era un varón de 25 años.', 'hash': '8305c765a812f0d40affe333e8e3e1d4459531173095ea2bd9c2f8f9cd1cc9d0'}, {'image_id': 'gr16', 'image_file_name': 'gr16.jpg', 'image_path': '../data/media_files/PMC7271218/gr16.jpg', 'caption': 'Absceso agudo de pulmón: Staphylococcus aureus. Las radiografías posteroanterior (A) y lateral (B) revelan consolidación masiva de todo el lóbulo superior derecho con una gran cavidad irregular en el centro. Hay aumento del volumen del lóbulo, a juzgar por el abombamiento hacia atrás de la cisura mayor.', 'hash': 'df10eac53976824114fe2f1be9c1a6db0696115df09f48e55561d901f0240a18'}, {'image_id': 'gr11', 'image_file_name': 'gr11.jpg', 'image_path': '../data/media_files/PMC7271218/gr11.jpg', 'caption': 'Neumonía por Pneumocystis. La radiografía posteroanterior de tórax (A) muestra opacidades bilaterales en vidrio esmerilado y un patrón reticulonodular mal definido. La TCAR de otro paciente (B) muestra zonas bilaterales con atenuación en vidrio esmerilado y zonas de pulmón de aspecto normal, lo que origina un patrón geográfico. Ambos pacientes tenían sida.', 'hash': 'bac3847e32ad1deeb92072c512831440fd0a6794664cbeb79c006afe464ab318'}, {'image_id': 'gr63', 'image_file_name': 'gr63.jpg', 'image_path': '../data/media_files/PMC7271218/gr63.jpg', 'caption': 'Neumonía aguda por varicela-zóster. Las radiografías posteroanterior (A) y lateral (B) revelan una enfermedad pulmonar generalizada con un patrón característico de consolidación del espacio aéreo. También se ven múltiples opacidades nodulares mal definidas. La paciente era una mujer de 42 años con un linfoma no hodgkiniano.', 'hash': 'b3fda54c903dd9d14a1172a9b498ca44b02739794a7f11cb0c0eaa9d3aeb1f76'}, {'image_id': 'gr18', 'image_file_name': 'gr18.jpg', 'image_path': '../data/media_files/PMC7271218/gr18.jpg', 'caption': 'Bronconeumonía aguda: Pseudomonas aeruginosa. Mujer de 38 años ingresada en coma profundo por una sobredosis de barbitúricos. Varios días después del ingreso una radiografía anteroposterior mostró consolidación masiva de todos los lóbulos de ambos pulmones, y la porción superior del lóbulo superior izquierdo era la menos afecta. También se observaba broncograma aéreo en todas las zonas.', 'hash': '1fed399d8e6affd0dfd1a7f85737cab7077ef70b3ffe3a21e7d8042bdb094ec2'}, {'image_id': 'gr64', 'image_file_name': 'gr64.jpg', 'image_path': '../data/media_files/PMC7271218/gr64.jpg', 'caption': 'Citomegalovirus. Una célula epitelial pulmonar infectada muestra una inclusión nuclear redonda intensamente basófila rodeada por un halo claro (la membrana nuclear está indicada por una flecha). También existen varias inclusiones intracitoplásmicas.', 'hash': '2d3f386e2a5e9076dc6dca9925c8a8357f324837f1c18f060f6af66916abb63b'}, {'image_id': 'gr75', 'image_file_name': 'gr75.jpg', 'image_path': '../data/media_files/PMC7271218/gr75.jpg', 'caption': 'Quiste hidatídico roto. La masa homogénea bien circunscrita (A) de la porción media del pulmón izquierdo tiene un contorno liso pero algo lobulado. Cuatro años más tarde (B) el quiste contiene aire; la masa irregular presente en el fondo del quiste (flechas) corresponde a membranas colapsadas. El broncograma (C) muestra material de contraste dentro del quiste, que delinea las membranas.', 'hash': 'f4ca5bd39e00b4f02e0eb1444029c431f9d7188b5ee755cd6c7713620997987b'}, {'image_id': 'gr72', 'image_file_name': 'gr72.jpg', 'image_path': '../data/media_files/PMC7271218/gr72.jpg', 'caption': 'Toxoplasmosis. Varón de 45 años sin trastornos inmunitarios conocidos que había presentado picos febriles desde hacía un mes. La radiografía de tórax (A) muestra una zona mal definida de aumento de la opacidad en el lóbulo inferior izquierdo. La TCAR (B) revela zonas de atenuación en vidrio esmerilado en ambos lóbulos inferiores y una zona focal de consolidación en el lóbulo inferior izquierdo. El estudio anatomopatológico de un ganglio linfático extirpado indicó el diagnóstico, que se confirmó por la serología positiva.', 'hash': '350eb7911f0f006ddf2befd0d23d9b97cf00df96a97d7648d36ccd162e02a360'}, {'image_id': 'gr32', 'image_file_name': 'gr32.jpg', 'image_path': '../data/media_files/PMC7271218/gr32.jpg', 'caption': 'Espondilitis tuberculosa. La radiografía posteroanterior de tórax (A) muestra nódulos miliares en el pulmón y desplazamiento de las interfases paraespinales (flechas). La radiografía lateral (B) muestra destrucción del cuerpo vertebral D10 (V), que provoca cifosis localizada. La TC con contraste (C y D) muestra destrucción del cuerpo vertebral D10, formación de un absceso paraespinal con centro de atenuación baja y refuerzo periférico (flechas rectas) y erosión cortical del cuerpo vertebral D9 adyacente (flecha curva).', 'hash': 'f61fd3933b2dc4babd514c3a45079eb3e8f74597fa643513170f071659b45fa7'}, {'image_id': 'gr6', 'image_file_name': 'gr6.jpg', 'image_path': '../data/media_files/PMC7271218/gr6.jpg', 'caption': 'Absceso pulmonar. Las imágenes del pulmón derecho en las radiografías de tórax posteroanterior (A) y lateral (B) muestran un absceso grande con nivel aire-líquido en el segmento anterior del lóbulo superior derecho. El borde interno del absceso es irregular y hay una consolidación adyacente mínima. El paciente era un varón alcohólico de 38 años que solía dormir en decúbito prono. La tinción de Gram del esputo reveló bacterias grampositivas y gramnegativas.', 'hash': '6820a060d852f4ce1c0e49f3b29925707d37d59e71267f3b5f84344f8806ec91'}, {'image_id': 'gr1', 'image_file_name': 'gr1.jpg', 'image_path': '../data/media_files/PMC7271218/gr1.jpg', 'caption': 'Bronquiolitis aguda: Mycoplasma pneumoniae. La TCAR muestra opacidades nodulares pequeñas (flechas) de distribución centrolobulillar que afectan principalmente a los lóbulos inferiores. La paciente era una mujer de 40 años.', 'hash': 'c692f8da84bda62dcfbb3c808c42a5741c4cfc444421fd304072614bf3533a13'}, {'image_id': 'gr49', 'image_file_name': 'gr49.jpg', 'image_path': '../data/media_files/PMC7271218/gr49.jpg', 'caption': 'Aspergiloma con el signo del menisco aéreo y cambio de posición. Varón de 65 años con tuberculosis previa que consulta por hemoptisis. La radiografía posteroanterior de tórax (A) muestra cicatrización extensa en los lóbulos superiores. Un gran aspergiloma en el lóbulo superior derecho presenta un menisco aéreo característico que lo separa de la pared de la cavidad (flecha). La cavidad está rodeada por un engrosamiento pleural marcado. Las imágenes de TCAR con el paciente en decúbito supino (B) y prono (C) muestran cambio de la posición del aspergiloma (flechas) a pesar de su gran tamaño. Se observan también bronquiectasias y engrosamiento pleural marcado. Se recuperó Aspergillus fumigatus en las muestras que se obtuvieron mediante broncoscopia.', 'hash': '7784b27c6ed197144f1442f5ad2dea786de5c7cda758afc34f6200e98ec7bb8c'}, {'image_id': 'gr35', 'image_file_name': 'gr35.jpg', 'image_path': '../data/media_files/PMC7271218/gr35.jpg', 'caption': 'Histoplasmosis aguda. Varón de 48 horas con historia de tres semanas de dolor pleurítico en el lado derecho del tórax. La radiografía posteroanterior de tórax muestra una consolidación extensa del lóbulo superior derecho y pequeñas zonas de consolidación en el vértice pulmonar izquierdo. Los cultivos de esputo fueron positivos para Histoplasma capsulatum.', 'hash': 'eb5d4b5335265e77602188d7df066f42a6c89a46fb7426142e0ebdd2aa54a694'}, {'image_id': 'gr47', 'image_file_name': 'gr47.jpg', 'image_path': '../data/media_files/PMC7271218/gr47.jpg', 'caption': 'Neumonía por Candida. La radiografía posteroanterior de tórax (A) muestra zonas mal definidas de consolidación y algunas opacidades nodulares en los lóbulos superiores. La TCAR (B) revela nódulos de varios tamaños y zonas focales de consolidación y atenuación en vidrio esmerilado. La paciente era una mujer de 27 años sometida a un trasplante de médula ósea.', 'hash': '4b199648c75b5522f1665239a9e08f9b22672591b54e518e6b27caa23505d191'}, {'image_id': 'gr8', 'image_file_name': 'gr8.jpg', 'image_path': '../data/media_files/PMC7271218/gr8.jpg', 'caption': 'Neumatocele pulmonar. La radiografía de tórax (A) de un hombre de 28 años muestra una opacidad mal definida en el parénquima periférico del lóbulo superior izquierdo (flecha). Doce días más tarde (B) la opacidad ha sido sustituida por una cavidad de pared fina de aproximadamente 4 cm de diámetro. Al día siguiente (C) la lesión medía 5,5 cm a pesar del colapso parcial del pulmón izquierdo como consecuencia de un neumotórax (flechas).', 'hash': '5f09fc47f9c4a4bf9550a41ade81345a1601cd5c94360303ac4074ca34242785'}, {'image_id': 'gr40', 'image_file_name': 'gr40.jpg', 'image_path': '../data/media_files/PMC7271218/gr40.jpg', 'caption': 'Coccidioidomicosis cavitaria. La radiografía posteroanterior de tórax (A) muestra un nódulo cavitado bien circunscrito en el lóbulo superior derecho. La TCAR (B) presenta una pared de grosor no uniforme y bordes externos lisos.', 'hash': '709b3ffb1fb72ddf51cade7a366c31fd0d0b52ecc2a0598ab499509d04f8c751'}, {'image_id': 'gr19', 'image_file_name': 'gr19.jpg', 'image_path': '../data/media_files/PMC7271218/gr19.jpg', 'caption': 'Neumonía aguda de los legionarios. La radiografía posteroanterior (A) muestra una consolidación homogénea de la porción axilar del lóbulo superior derecho; se aprecia broncograma aéreo. Dos días más tarde las radiografías (B) muestran empeoramiento marcado. Se aisló Legionella pneumophila en el esputo.', 'hash': '384eb6adbf9206a81a836d570734945c229a8eb7891b28c9a07b3f3051c8ee35'}, {'image_id': 'gr65', 'image_file_name': 'gr65.jpg', 'image_path': '../data/media_files/PMC7271218/gr65.jpg', 'caption': 'Neumonía aguda por citomegalovirus. La radiografía posteroanterior de tórax muestra una consolidación generalizada parcheada del espacio aéreo, más marcada en los lóbulos inferiores. Existe aumento ligero del tamaño del ventrículo izquierdo. El paciente había sido sometido a trasplante renal.', 'hash': '4b5bfb0733fa365c74ef20a5bf7b0d15369097f49d910d7961856454105fc0f6'}, {'image_id': 'gr62', 'image_file_name': 'gr62.jpg', 'image_path': '../data/media_files/PMC7271218/gr62.jpg', 'caption': 'Traqueítis por herpes simple. La tráquea de este paciente quemado de 40 años de edad se ha abierto en la porción posterior y revela múltiples focos de ulceración, algunos de ellos cubiertos por una membrana piógena (flecha).', 'hash': 'b7f0fd0aed66b48a8150e6cb27a85228386c58cd61502eeb561f04e88ba6e672'}, {'image_id': 'gr10', 'image_file_name': 'gr10.jpg', 'image_path': '../data/media_files/PMC7271218/gr10.jpg', 'caption': 'Neumonía intersticial aguda: Mycoplasma pneumoniae. La radiografía posteroanterior de tórax muestra engrosamiento de los fascículos broncovasculares y opacidad en vidrio esmerilado en ambos pulmones. También se aprecia una consolidación focal en el lóbulo superior izquierdo y adenopatías hiliares bilaterales. La paciente era una joven de 17 años previamente sana.', 'hash': '8e994dc03304fd7af70c20361710238124bc39ef5b122a3b2ccd01993f81da67'}, {'image_id': 'gr17', 'image_file_name': 'gr17.jpg', 'image_path': '../data/media_files/PMC7271218/gr17.jpg', 'caption': 'Absceso agudo de pulmón: Klebsiella pneumoniae. La imagen del pulmón izquierdo en la radiografía posteroanterior de tórax (A) muestra una zona mal definida de consolidación del espacio aéreo en el lóbulo inferior. Tres días más tarde (B) la consolidación es más extensa y han aparecido varias zonas radiotransparentes indicadoras de necrosis y comunicación bronquial. Cinco días después (C) las cavidades han confluido para formar un absceso multiloculado de contornos lisos (puntas de flecha). El paciente era un varón alcohólico de 45 años.', 'hash': '020620dfde7adc9da805299e4e6e194f0959d0b7e71bb44e1046a2d6b916a952'}, {'image_id': 'gr22', 'image_file_name': 'gr22.jpg', 'image_path': '../data/media_files/PMC7271218/gr22.jpg', 'caption': 'Tuberculosis: formación de granulomas. El corte de un caso de enfermedad relativamente precoz (A) muestra varios focos bien definidos de inflamación granulomatosa rodeados por un infiltrado inflamatorio mononuclear. Se aprecia necrosis en el centro de un granuloma. La enfermedad avanzada (B) muestra focos confluentes de necrosis delimitados por una zona de tejido inflamatorio granulomatoso (ampliado en C). F, fibrosis; M, células mononucleares; N, necrosis; X, histiocitos epitelioides.', 'hash': '8a196961eb21255dd7625ccbade63615ca6765861701e12ac7d24b59bf61320e'}, {'image_id': 'gr59', 'image_file_name': 'gr59.jpg', 'image_path': '../data/media_files/PMC7271218/gr59.jpg', 'caption': 'Neumonía aguda por el virus influenza. Varón de 32 años ingresado en el hospital por historia de tres días de tos con expectoración amarilla blanquecina, dolor pleurítico en el lado derecho del tórax y fiebre. La radiografía posteroanterior de tórax que se realizó el día del ingreso (A) muestra una consolidación extensa y homogénea del espacio aéreo del lóbulo superior derecho con opacidades focales de consolidación del espacio aéreo del lóbulo inferior derecho; el pulmón izquierdo no tiene alteraciones. Dos días más tarde (B) la consolidación del lóbulo inferior derecho se ha hecho casi homogénea y la enfermedad del espacio aéreo se ha extendido por todo el pulmón izquierdo. Veinticuatro horas más tarde ambos pulmones están consolidados casi por completo y el único aire visible se localiza dentro del árbol bronquial (broncograma aéreo difuso).', 'hash': 'd86359932d64e0dc6d6ed1dbb0c3da332115713bea0ac9ac0419031992a7d3b1'}, {'image_id': 'gr25', 'image_file_name': 'gr25.jpg', 'image_path': '../data/media_files/PMC7271218/gr25.jpg', 'caption': 'Foco de Ghon y ganglios linfáticos calcificados (complejo de Ranke). La radiografía posteroanterior de tórax muestra un nódulo calcificado en el lóbulo superior derecho (flecha recta) y ganglios linfáticos paratraqueales derechos también calcificados (flechas curvas).', 'hash': '8c664dafbac1fadd9d039ba2fc9acd43b2d24b97ad71e5af7a8b57c657b0d3d1'}, {'image_id': 'gr57', 'image_file_name': 'gr57.jpg', 'image_path': '../data/media_files/PMC7271218/gr57.jpg', 'caption': 'Actinomicosis pleuropulmonar. La radiografía posteroanterior de tórax (A) y la TC con colimación de 10 mm (B) revelan zonas focales de consolidación en los lóbulos superior e inferior derechos, con engrosamiento pleural derecho asociado. La TCAR (C) que se realizó tras la administración de contraste intravenoso muestra zonas de baja atenuación dentro de la consolidación, compatibles con formación de abscesos. El paciente era un varón alcohólico de 59 años.', 'hash': 'c813fb48b43e2f882bac933c4e594abe022e84474f73d009271e6acc84d65242'}, {'image_id': 'gr50', 'image_file_name': 'gr50.jpg', 'image_path': '../data/media_files/PMC7271218/gr50.jpg', 'caption': 'Aspergilosis broncopulmonar alérgica. La radiografía posteroanterior (A) muestra opacidades ramificadas en forma de banda en el lóbulo inferior derecho (flecha oblicua) y en el lóbulo superior derecho (flecha vertical); se observa una opacidad vista de frente (punta de flecha) en la parte superior del hilio. La TC (B) demuestra que una de las opacidades está calcificada (punta de flecha).', 'hash': 'd99fde0062be96d8dcfdda81e7ec46d6f6f3f7e27f8149e3474198f18dc3d7c4'}, {'image_id': 'gr9', 'image_file_name': 'gr9.jpg', 'image_path': '../data/media_files/PMC7271218/gr9.jpg', 'caption': 'Neumonía intersticial. La biopsia pulmonar abierta de un varón de 68 años con aplasia eritrocítica (A) muestra engrosamiento intersticial más o menos difuso por un infiltrado celular (que a mayor aumento en B se ve que es predominantemente linfocítico); los espacios aéreos no están afectados. Se identificaron citomegalovirus en la histología (flecha en B) y mediante inmunohistoquímica. Otro corte perteneciente a un niño de 8 años con leucemia (C) muestra engrosamiento intersticial leve, hiperplasia de las células tipo II, material proteico dentro de los espacios aéreos alveolares y varias membranas hialinas (flechas). El patrón es de lesión alveolar difusa. Se identificaron virus del herpes zóster en las células epiteliales alveolares.', 'hash': '3183df5ce3679b92ff53d242fe16e90214edd69e67f599ced34afd38abcf46ef'}, {'image_id': 'gr41', 'image_file_name': 'gr41.jpg', 'image_path': '../data/media_files/PMC7271218/gr41.jpg', 'caption': 'Blastomicosis norteamericana. Las radiografías de tórax posteroanterior (A) y lateral (B) muestran una gran opacidad mal definida de densidad homogénea en la língula; la consolidación no es segmentaria y no muestra signos de broncograma aéreo. La radiografía posteroanterior revela también destrucción de la porción anterior de la quinta costilla derecha (flecha). Se cultivó Blastomyces dermatitidis en una muestra de esputo de 24 horas y en el líquido que se aspiró de la tumefacción que recubría la quinta costilla derecha.', 'hash': '1aed4de267d5afc6f525d5641625e6113dd3109a43a653cd4b232b69e439b980'}, {'image_id': 'gr46', 'image_file_name': 'gr46.jpg', 'image_path': '../data/media_files/PMC7271218/gr46.jpg', 'caption': 'Neumonía por Pneumocystis. La TCAR muestra zonas bilaterales de atenuación en vidrio esmerilado entremezcladas con zonas de pulmón aparentemente normal, lo que origina un patrón en mosaico. El paciente era un varón de 46 años con sida.', 'hash': 'fb61ff69f8e9765269390185902acde25a03fb94baf241498759c804d5188d2f'}, {'image_id': 'gr48', 'image_file_name': 'gr48.jpg', 'image_path': '../data/media_files/PMC7271218/gr48.jpg', 'caption': 'Género Aspergillus. Se muestra una masa en abanico de hifas tabicadas que se ramifican en un ángulo de aproximadamente 45̊ (flecha). Obsérvese que los hongos atraviesan la pared de la arteria pulmonar con una reacción inflamatoria y necrosis mínimas.', 'hash': 'b418367061da60cf978b4059da820e78c14a05f543d6ff4077fdcd5f0f0f3196'}, {'image_id': 'gr34', 'image_file_name': 'gr34.jpg', 'image_path': '../data/media_files/PMC7271218/gr34.jpg', 'caption': 'Infección pulmonar por el complejo Mycobacterium avium. La radiografía posteroanterior de tórax (A) de una mujer de 52 años muestra opacidades nodulares pequeñas mal definidas y signos de bronquiectasias en las zonas pulmonares superiores. La TCAR (B) muestra bronquiectasias (flechas abiertas) y varios nódulos centrolobulillares y subpleurales (flecha cerrada).', 'hash': '2557e55ba5c8cf56e6e294f41410b5df63e6a5d168304482581f61fc27fc04bb'}, {'image_id': 'gr33', 'image_file_name': 'gr33.jpg', 'image_path': '../data/media_files/PMC7271218/gr33.jpg', 'caption': 'Infección pulmonar por el complejo Mycobacterium avium. La radiografía posteroanterior de tórax (A) de una mujer de 28 años muestra opacidades nodulares pequeñas mal definidas en el lóbulo inferior derecho. La TCAR (B) revela una cavidad (c) en el lóbulo inferior derecho con colas pleurales (flechas abiertas) y varias opacidades nodulares centrolobulillares (flecha cerrada). El cultivo de esputo fue positivo para el complejo M. avium.', 'hash': '92db108db9a2cd5c0bbc2ea7100ec80b4996a0b14e94c73f9f643e0f52cf849f'}, {'image_id': 'gr7', 'image_file_name': 'gr7.jpg', 'image_path': '../data/media_files/PMC7271218/gr7.jpg', 'caption': 'Secuestro pulmonar. Un corte del pulmón izquierdo muestra un fragmento grande de pulmón necrótico dentro de una cavidad en el lóbulo superior derecho. Se aisló Klebsiella pneumoniae en el esputo pre mortem del paciente.', 'hash': 'a2b09a223b3d75c5cecde17ce7a7fb731b35b1791244c117a75519902bd93c28'}, {'image_id': 'gr73', 'image_file_name': 'gr73.jpg', 'image_path': '../data/media_files/PMC7271218/gr73.jpg', 'caption': 'Toxoplasmosis. Varón de 45 años sin trastornos inmunitarios conocidos que había presentado picos febriles desde hacía un mes. La radiografía de tórax (A) muestra una zona mal definida de aumento de la opacidad en el lóbulo inferior izquierdo. La TCAR (B) revela zonas de atenuación en vidrio esmerilado en ambos lóbulos inferiores y una zona focal de consolidación en el lóbulo inferior izquierdo. El estudio anatomopatológico de un ganglio linfático extirpado indicó el diagnóstico, que se confirmó por la serología positiva.', 'hash': '698bf7f5f0aed715edc1680726cdb65c09d96a828861a62a9bd9c7905b036c41'}, {'image_id': 'gr74', 'image_file_name': 'gr74.jpg', 'image_path': '../data/media_files/PMC7271218/gr74.jpg', 'caption': 'Quiste hidatídico. La radiografía posteroanterior de tórax (A) muestra una masa de 6 cm de bordes lisos en el pulmón izquierdo. La TC (B) revela una lesión quística que contiene líquido y que tiene valores de atenuación similares a los del agua (0 UH). El paciente era un varón asintomático de 51 años que se había dedicado a la caza durante varios años en el norte de Canadá.', 'hash': 'b9d33231cae54861bd76151e07d324ccfdfd056ee62bf52521fb19bcb1b71499'}] | {'gr1': ['La bronquitis aguda se suele asociar a radiografía normal, o sólo a signos inespecíficos; en ocasiones se encuentra engrosamiento de la pared bronquial y/o dilatación de los bronquios53. La bronquiolitis puede cursar también con radiografía normal, o manifestarse en forma de acentuación de las marcas pulmonares o un patrón reticulonodular. En la TCAR la inflamación de la pared bronquiolar y la ocupación de la luz de los bronquiolos por exudado dan lugar a la presencia de nódulos centrolobulillares pequeños y líneas ramificadas (patrón de «árbol en brote»; <xref rid="gr1" ref-type="fig">figura 6-1</xref>\n)\n)54.FIGURA 6-1Bronquiolitis aguda: Mycoplasma pneumoniae. La TCAR muestra opacidades nodulares pequeñas (flechas) de distribución centrolobulillar que afectan principalmente a los lóbulos inferiores. La paciente era una mujer de 40 años.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr2': ['Desde el punto de vista radiográfico, la neumonía no segmentaria del espacio aéreo aparece como una consolidación homogénea, relativamente bien delimitada respecto al parénquima vecino no afecto (<xref rid="gr2" ref-type="fig">figura 6-2</xref>\n). Como implica el nombre de la enfermedad, la consolidación sobrepasa típicamente los límites segmentarios, un dato muy importante para distinguir entre esta forma y la bronconeumonía. Por lo general el proceso llega hasta una cisura interlobar, pero rara vez puede afectar a todo el lóbulo (lo que justifica la preferencia del término neumonía aguda del espacio aéreo en vez de neumonía lobar). Los bronquios mayores suelen permanecer permeables y con aire en su interior, lo que da lugar a la formación de un broncograma aéreo. La cantidad de exudado inflamatorio puede ser tan grande como para originar expansión de un lóbulo y dar lugar al signo de la cisura abombada (\n). Como implica el nombre de la enfermedad, la consolidación sobrepasa típicamente los límites segmentarios, un dato muy importante para distinguir entre esta forma y la bronconeumonía. Por lo general el proceso llega hasta una cisura interlobar, pero rara vez puede afectar a todo el lóbulo (lo que justifica la preferencia del término neumonía aguda del espacio aéreo en vez de neumonía lobar). Los bronquios mayores suelen permanecer permeables y con aire en su interior, lo que da lugar a la formación de un broncograma aéreo. La cantidad de exudado inflamatorio puede ser tan grande como para originar expansión de un lóbulo y dar lugar al signo de la cisura abombada (<xref rid="gr3" ref-type="fig">figura 6-3</xref>\n)\n)56.\nFIGURA 6-2Neumonía aguda del espacio aéreo. Las radiografías de tórax posteroanterior (A) y lateral (B) de un varón de 79 años muestran consolidación difusa del lóbulo superior derecho. Hay pequeños focos de consolidación en el lóbulo inferior derecho y en el pulmón izquierdo. Los cultivos de esputo fueron positivos para Streptococcus pneumoniae.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.FIGURA 6-3Neumonía aguda por Klebsiella: abombamiento de la cisura. Imagen del pulmón derecho en una radiografía posteroanterior de tórax, que revela una consolidación masiva del espacio aéreo con afectación de la mayor parte del lóbulo superior. El desplazamiento hacia abajo de la cisura menor (flechas) indica expansión lobar; las zonas centrales de radiotransparencia (entre las puntas de flecha) indican necrosis parenquimatosas.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr4': ['\nBronconeumonía. Son ejemplos de bronconeumonía la infección por S. aureus, la mayoría de las bacterias gramnegativas y algunos hongos. Desde el punto de vista patogénico, difiere de la neumonía no segmentaria del espacio aéreo por la producción de una cantidad relativamente pequeña de líquido y exudación rápida de numerosos leucocitos polimorfonucleares, típicamente alrededor de los bronquiolos membranosos y respiratorios pequeños (<xref rid="gr4" ref-type="fig">figura 6-4</xref>\n). Los neutrófilos parecen limitar la diseminación de los microorganismos, al menos inicialmente, y por tanto la enfermedad tiene un aspecto focal (véase figura en color 6-2); la extensión de la infección dentro de los lobulillos secundarios produce neumonía confluente, un proceso que se asocia muchas veces a necrosis y hemorragia.\n). Los neutrófilos parecen limitar la diseminación de los microorganismos, al menos inicialmente, y por tanto la enfermedad tiene un aspecto focal (véase figura en color 6-2); la extensión de la infección dentro de los lobulillos secundarios produce neumonía confluente, un proceso que se asocia muchas veces a necrosis y hemorragia.FIGURA 6-4Bronconeumonía aguda. El corte histológico (A) muestra enfermedad precoz formada por un exudado inflamatorio agudo dentro de la luz de un bronquiolo terminal y en el parénquima pulmonar inmediatamente próximo; los espacios aéreos vecinos no están afectados. B. Se muestra la enfermedad más avanzada; aunque existe confluencia de la inflamación que se origina en varios bronquiolos, todavía se identifica la naturaleza focal del proceso. El cultivo pulmonar post mortem fue positivo para Pseudomonas aeruginosa.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr5': ['Las manifestaciones radiológicas de la bronconeumonía pueden oscilar desde zonas focales peribronquiales y peribronquiolares de consolidación, con afectación de uno o varios segmentos de un solo lóbulo, hasta la consolidación multilobar bilateral (<xref rid="gr5" ref-type="fig">figura 6-5</xref>\n)\n)57. La inflamación de los bronquiolos pequeños y los alvéolos adyacentes produce opacidades nodulares centrolobulillares mal definidas, de 4 a 10 mm de diámetro (nódulos del espacio aéreo), o se puede extender para afectar a todo el lobulillo secundario (consolidación lobulillar)43\n,\n58. La confluencia de la neumonía hacia los lobulillos adyacentes puede producir un patrón que simula la neumonía no segmentaria del espacio aéreo; la distinción con esta última se puede establecer en la mayoría de los casos por la presencia de una distribución segmentaria o lobulillar de las alteraciones en otras zonas. Debido a que el proceso afecta a las vías aéreas, la bronconeumonía produce con frecuencia pérdida de volumen de los segmentos o lóbulos enfermos.FIGURA 6-5Neumonía por Haemophilus influenzae. La radiografía de tórax anteroposterior (A) muestra opacidades nodulares mal definidas y zonas focales de consolidación. La TCAR (B) demuestra que los nódulos pequeños tienen una distribución centrolobulillar compatible con bronquiolitis. También hay una zona de consolidación lobulillar (flechas), característica de bronconeumonía precoz. Los cultivos de esputo y de sangre fueron positivos para H. influenzae.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr6': ['Las manifestaciones radiológicas incluyen masas únicas o múltiples, frecuentemente cavitadas (<xref rid="gr6" ref-type="fig">figura 6-6</xref>\n). Pueden aparecer aisladas o dentro de zonas de consolidación. En una revisión de los signos radiográficos de 50 pacientes, los bordes internos de los abscesos eran lisos en casi el 90% de los casos y deshilachados en el resto\n). Pueden aparecer aisladas o dentro de zonas de consolidación. En una revisión de los signos radiográficos de 50 pacientes, los bordes internos de los abscesos eran lisos en casi el 90% de los casos y deshilachados en el resto60. Había niveles aire-líquido en casi el 70% y consolidación del parénquima adyacente en el 50%. El grosor parietal máximo era de 4 mm o menos en aproximadamente el 5% de los casos, entre 5 y 15 mm en aproximadamente el 80% y mayor de 15 mm en aproximadamente el 15%.FIGURA 6-6Absceso pulmonar. Las imágenes del pulmón derecho en las radiografías de tórax posteroanterior (A) y lateral (B) muestran un absceso grande con nivel aire-líquido en el segmento anterior del lóbulo superior derecho. El borde interno del absceso es irregular y hay una consolidación adyacente mínima. El paciente era un varón alcohólico de 38 años que solía dormir en decúbito prono. La tinción de Gram del esputo reveló bacterias grampositivas y gramnegativas.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr7': ['\nGangrena pulmonar. Una complicación relativamente infrecuente de la neumonía es la formación de fragmentos de pulmón necrótico en la cavidad de un absceso (secuestro o gangrena pulmonar) (<xref rid="gr7" ref-type="fig">figura 6-7</xref>\n). La patogenia de la necrosis pulmonar en estos casos puede guardar relación con la acción directa de las toxinas bacterianas, la isquemia secundaria a trombosis de los vasos pulmonares adyacentes al foco de neumonía o la combinación de ambos factores\n). La patogenia de la necrosis pulmonar en estos casos puede guardar relación con la acción directa de las toxinas bacterianas, la isquemia secundaria a trombosis de los vasos pulmonares adyacentes al foco de neumonía o la combinación de ambos factores63. Cualquiera que sea el mecanismo, se considera probable que la separación entre tejido necrótico y pulmón viable adyacente esté mediada, al menos en parte, por enzimas leucocíticas. Las manifestaciones radiológicas son inicialmente transparencias pequeñas dentro de una zona de consolidación\npulmonar, de modo habitual en un lóbulo agrandado que muestra abombamiento de la cisura hacia fuera64. Las transparencias confluyen con rapidez para formar una cavidad grande que contiene líquido y pulmón necrótico. La proyección en decúbito lateral demuestra que los fragmentos de pulmón necrótico se mueven libremente dentro de la cavidad.FIGURA 6-7Secuestro pulmonar. Un corte del pulmón izquierdo muestra un fragmento grande de pulmón necrótico dentro de una cavidad en el lóbulo superior derecho. Se aisló Klebsiella pneumoniae en el esputo pre mortem del paciente.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr8': ['\nNeumatocele. El neumatocele es un espacio lleno de gas con paredes finas que habitualmente guarda relación con una infección; de forma característica el neumatocele aumenta de tamaño a lo largo de días o semanas y casi siempre acaba por desaparecer (<xref rid="gr8" ref-type="fig">figura 6-8</xref>\n). Entre los varios mecanismos que se han propuesto para explicar su formación el más probable es el drenaje de un foco de parénquima pulmonar necrótico, seguido por obstrucción con mecanismo valvular de la vía aérea que ventila la zona. La «válvula», que puede ser un exudado inflamatorio y/o pared necrótica de la vía aérea, permite la entrada de aire al espacio parenquimatoso durante la inspiración, pero impide que el aire salga durante la espiración\n). Entre los varios mecanismos que se han propuesto para explicar su formación el más probable es el drenaje de un foco de parénquima pulmonar necrótico, seguido por obstrucción con mecanismo valvular de la vía aérea que ventila la zona. La «válvula», que puede ser un exudado inflamatorio y/o pared necrótica de la vía aérea, permite la entrada de aire al espacio parenquimatoso durante la inspiración, pero impide que el aire salga durante la espiración65. La complicación está causada la mayoría de las veces por S. aureus en lactantes y niños y por P. jiroveci en los pacientes con sida66.FIGURA 6-8Neumatocele pulmonar. La radiografía de tórax (A) de un hombre de 28 años muestra una opacidad mal definida en el parénquima periférico del lóbulo superior izquierdo (flecha). Doce días más tarde (B) la opacidad ha sido sustituida por una cavidad de pared fina de aproximadamente 4 cm de diámetro. Al día siguiente (C) la lesión medía 5,5 cm a pesar del colapso parcial del pulmón izquierdo como consecuencia de un neumotórax (flechas).Tomado de Quigley MF, Fraser RS: Pulmonary pneumatocele: Pathology and pathogenesis. AJR Am J Roentgenol 150:1275, 1988.'], 'gr9': ['\nNeumonía intersticial. La neumonía intersticial se asocia típicamente a infección por virus, M. pneumoniae o P. jiroveci. Se encuentran dos patrones anatomopatológicos, dependiendo en parte de la virulencia del germen y de la rapidez con que se produzca la infección: 1) infección relativamente prolongada o insidiosa que se manifiesta de forma predominante por infiltración linfocítica de los tabiques alveolares sin alteraciones significativas del espacio aéreo (<xref rid="gr9" ref-type="fig">figura 6-9A</xref>\n) y 2) enfermedad con progresión más rápida o más virulenta, caracterizada por lesión alveolar difusa (\n) y 2) enfermedad con progresión más rápida o más virulenta, caracterizada por lesión alveolar difusa (<xref rid="gr9" ref-type="fig">figura 6-9B</xref>). El mecanismo patogénico subyacente en la segunda forma de la enfermedad guarda relación con la lesión de la membrana alveolocapilar. Las manifestaciones histológicas incluyen engrosamiento intersticial por el líquido de edema, congestión capilar y un infiltrado celular inflamatorio; hiperplasia de las células tipo II, y exudado proteináceo dentro de los espacios aéreos. En los conductos alveolares y los bronquiolos respiratorios el exudado típicamente está concentrado y aplanado (membranas hialinas).). El mecanismo patogénico subyacente en la segunda forma de la enfermedad guarda relación con la lesión de la membrana alveolocapilar. Las manifestaciones histológicas incluyen engrosamiento intersticial por el líquido de edema, congestión capilar y un infiltrado celular inflamatorio; hiperplasia de las células tipo II, y exudado proteináceo dentro de los espacios aéreos. En los conductos alveolares y los bronquiolos respiratorios el exudado típicamente está concentrado y aplanado (membranas hialinas).FIGURA 6-9Neumonía intersticial. La biopsia pulmonar abierta de un varón de 68 años con aplasia eritrocítica (A) muestra engrosamiento intersticial más o menos difuso por un infiltrado celular (que a mayor aumento en B se ve que es predominantemente linfocítico); los espacios aéreos no están afectados. Se identificaron citomegalovirus en la histología (flecha en B) y mediante inmunohistoquímica. Otro corte perteneciente a un niño de 8 años con leucemia (C) muestra engrosamiento intersticial leve, hiperplasia de las células tipo II, material proteico dentro de los espacios aéreos alveolares y varias membranas hialinas (flechas). El patrón es de lesión alveolar difusa. Se identificaron virus del herpes zóster en las células epiteliales alveolares.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr10': ['Las manifestaciones radiológicas de la neumonía intersticial causada por infección vírica o por micoplasmas son un patrón reticular o reticulonodular (<xref rid="gr10" ref-type="fig">figura 6-10</xref>\n)\n)67. La bronquiolitis asociada puede producir opacidades centrolobulillares, lineales y nodulares54; la bronquitis se puede manifestar por engrosamiento peribronquial y acentuación de las marcas pulmonares. Típicamente la neumonía por P. jiroveci se manifiesta en las radiografías por un patrón granular fino o reticulonodular mal definido bilateral y simétrico (<xref rid="gr11" ref-type="fig">figura 6-11A</xref>\n)\n)68. En caso de infección más grave los sig\nnos progresan hacia una opacificación parenquimatosa más homogénea que varía desde el aspecto de vidrio esmerilado hasta la consolidación; muchas veces se aprecia un patrón reticulonodular heterogéneo en la periferia de la opacidad homogénea69. La alteración predominante en la TCAR son en zonas bilaterales extensas de atenuación en vidrio esmerilado (<xref rid="gr11" ref-type="fig">figura 6-11B</xref>); entre el 20% y el 40% de los pacientes tiene nódulos pequeños, opacidades reticulares y engrosamiento de los tabiques interlobulillares); entre el 20% y el 40% de los pacientes tiene nódulos pequeños, opacidades reticulares y engrosamiento de los tabiques interlobulillares70.FIGURA 6-10Neumonía intersticial aguda: Mycoplasma pneumoniae. La radiografía posteroanterior de tórax muestra engrosamiento de los fascículos broncovasculares y opacidad en vidrio esmerilado en ambos pulmones. También se aprecia una consolidación focal en el lóbulo superior izquierdo y adenopatías hiliares bilaterales. La paciente era una joven de 17 años previamente sana.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.FIGURA 6-11Neumonía por Pneumocystis. La radiografía posteroanterior de tórax (A) muestra opacidades bilaterales en vidrio esmerilado y un patrón reticulonodular mal definido. La TCAR de otro paciente (B) muestra zonas bilaterales con atenuación en vidrio esmerilado y zonas de pulmón de aspecto normal, lo que origina un patrón geográfico. Ambos pacientes tenían sida.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr12': ['La infección a través de los vasos pulmonares suele aparecer en pacientes que tienen un foco de infección extrapulmonar. Muchas veces el origen de esta infección es evidente por los signos clínicos. Sin embargo, en ocasiones, como en la endocarditis o en el caso de focos diminutos localizados en la piel o en un órgano interno, el foco primario no es evidente. Los microorganismos responsables de la infección pueden circular libremente en la sangre (sepsis) o pueden estar unidos a material trombótico (émbolos sépticos). Es típico el aspecto nodular de los focos individuales. Cuando la enfermedad pulmonar se debe a sepsis típicamente adopta la forma de innumerables nódulos de 1 a 5 mm de diámetro (infección miliar) (<xref rid="gr12" ref-type="fig">figura 6-12</xref>\n); puesto que los microorganismos se diseminan probablemente desde los capilares alveolares, las arteriolas y las vénulas, la enfermedad tiende a distribuirse de modo más o menos aleatorio dentro del lobulillo. Este patrón se encuentra con más frecuencia en la tuberculosis, pero también se ve a veces en la infección micótica (sobre todo en pacientes inmunodeprimidos). La enfermedad pulmonar causada por émbolos sépticos se manifiesta también por nódulos múltiples, aunque habitualmente menos numerosos; además, la oclusión de arterias pulmonares por trombos puede originar hemorragia o infarto (o ambos) y focos peor definidos o con forma de cuña.\n); puesto que los microorganismos se diseminan probablemente desde los capilares alveolares, las arteriolas y las vénulas, la enfermedad tiende a distribuirse de modo más o menos aleatorio dentro del lobulillo. Este patrón se encuentra con más frecuencia en la tuberculosis, pero también se ve a veces en la infección micótica (sobre todo en pacientes inmunodeprimidos). La enfermedad pulmonar causada por émbolos sépticos se manifiesta también por nódulos múltiples, aunque habitualmente menos numerosos; además, la oclusión de arterias pulmonares por trombos puede originar hemorragia o infarto (o ambos) y focos peor definidos o con forma de cuña.FIGURA 6-12Tuberculosis miliar. Imagen ampliada del lóbulo inferior que muestra numerosos nódulos de distribución aleatoria y de aproximadamente 1 a 3 mm de diámetro por diseminación hematógena de los bacilos tuberculosos (barra = 1 cm).Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr13': ['El aspecto radiológico de la infección miliar se caracteriza por opacidades puntiformes bien definidas, de modo habitual con una distribución uniforme por ambos pulmones71; a veces existe un ligero predominio basal que refleja el aumento del flujo sanguíneo inducido por la gravedad (<xref rid="gr13" ref-type="fig">figura 6-13</xref>\n). Cuando comienzan a verse, los nódulos miden de 1 a 2 mm de diámetro (el término «miliar» se refiere a un tamaño similar al de los granos de mijo); en ausencia de tratamiento adecuado el diámetro puede aumentar hasta 3 mm-5 mm\n). Cuando comienzan a verse, los nódulos miden de 1 a 2 mm de diámetro (el término «miliar» se refiere a un tamaño similar al de los granos de mijo); en ausencia de tratamiento adecuado el diámetro puede aumentar hasta 3 mm-5 mm71. Los émbolos sépticos se caracterizan por la presencia de nódulos que de modo habitual miden de 1 a 3 cm de diámetro y que muchas veces están cavitados (<xref rid="gr14" ref-type="fig">figura 6-14</xref>\n). Como ya se ha dicho, la TC también muestra con frecuencia zonas de consolidación subpleural con forma de cuña, muchas veces con zonas centrales de necrosis o cavitación franca (véase \n). Como ya se ha dicho, la TC también muestra con frecuencia zonas de consolidación subpleural con forma de cuña, muchas veces con zonas centrales de necrosis o cavitación franca (véase <xref rid="gr14" ref-type="fig">figura 6-14</xref>))72.FIGURA 6-13Tuberculosis miliar. La imagen del pulmón izquierdo en una radiografía anteroposterior de tórax muestra numerosos nódulos bien definidos de 1 a 3 mm de diámetro, más abundantes en la base.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.FIGURA 6-14Embolia séptica. La radiografía de tórax (A) muestra múltiples nódulos cavitados bilaterales. La TC (B) demuestra que varios nódulos tienen una localización subpleural; algunos tienen vasos que penetran en su interior (signo del vaso nutricio) (flechas rectas). También se aprecia un foco de consolidación subpleural con forma de cuña (flecha curva). Los hemocultivos fueron positivos para Nocardia. El paciente era VIH positivo.Por cortesía del Dr. Tomàs Franquet, Departamento de Radiología, Hospital de Sant Pau, Barcelona, España.'], 'gr15': ['\nManifestaciones radiológicas. El patrón radiográfico característico es una consolidación no segmentaria homogénea que afecta a un lóbulo (<xref rid="gr15" ref-type="fig">figura 6-15</xref>\n). Puesto que la consolidación comienza en los espacios aéreos periféricos, casi siempre está en contacto con una superficie de la pleura visceral, interlobar o de la convexidad del pulmón. La infección se manifiesta como un foco redondo (esférico) de consolidación que simula una masa\n). Puesto que la consolidación comienza en los espacios aéreos periféricos, casi siempre está en contacto con una superficie de la pleura visceral, interlobar o de la convexidad del pulmón. La infección se manifiesta como un foco redondo (esférico) de consolidación que simula una masa172, zonas focales de consolidación u opacidades mixtas del espacio aéreo y del intersticio43. Las complicaciones como cavitación, gangrena pulmonar y formación de neumatoceles son raras; se considera probable que muchas de esas complicaciones guarden relación con infecciones mixtas171.FIGURA 6-15Neumonía aguda del espacio aéreo: Streptococcus pneumoniae. Las radiografías posteroanterior (A) y lateral (B) revelan una consolidación extensa del lóbulo inferior derecho, y una parte del segmento anterior es el único tejido pulmonar no afecto. Se ve broncograma aéreo en la proyección lateral. Hay poca pérdida de volumen.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr16': ['Se producen abscesos en el 15% al 30% de los pacientes (<xref rid="gr16" ref-type="fig">figura 6-16</xref>\n)\n)57\n,\n197. La formación de neumatoceles también es frecuente, y se observa en aproximadamente el 50% de los niños y el 15% de los adultos57\n,\n198. Los neumatoceles suelen aparecer durante la primera semana de la neumonía y desaparecen espontáneamente al cabo de semanas o meses. Se producen derrames pleurales en el 30% al 50% de los pacientes; aproximadamente la mitad de los derrames son empiemas57\n,\n197. A veces se encuentra neumotórax espontáneo.FIGURA 6-16Absceso agudo de pulmón: Staphylococcus aureus. Las radiografías posteroanterior (A) y lateral (B) revelan consolidación masiva de todo el lóbulo superior derecho con una gran cavidad irregular en el centro. Hay aumento del volumen del lóbulo, a juzgar por el abombamiento hacia atrás de la cisura mayor.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr3': ['La neumonía por Klebsiella se manifiesta de modo característico en las radiografías como una consolidación parenquimatosa homogénea que contiene un broncograma aéreo. En comparación con la neumonía neumocócica, muestra una mayor tendencia a la formación de exudado inflamatorio voluminoso que produce expansión lobar con el consiguiente abombamiento de las cisuras interlobares (véase <xref rid="gr3" ref-type="fig">figura 6-3</xref>, página 227), página 227)56, mayor tendencia a la formación de abscesos y cavidades (<xref rid="gr17" ref-type="fig">figura 6-17</xref>\n)\n)239 y una mayor frecuencia de derrame pleural y empiema240. En ocasiones la neumonía experimenta sólo resolución parcial y pasa a una forma crónica con cavitación y positividad persistente de los cultivos; en estos casos el cuadro radiográfico simula al de la tuberculosis.FIGURA 6-17Absceso agudo de pulmón: Klebsiella pneumoniae. La imagen del pulmón izquierdo en la radiografía posteroanterior de tórax (A) muestra una zona mal definida de consolidación del espacio aéreo en el lóbulo inferior. Tres días más tarde (B) la consolidación es más extensa y han aparecido varias zonas radiotransparentes indicadoras de necrosis y comunicación bronquial. Cinco días después (C) las cavidades han confluido para formar un absceso multiloculado de contornos lisos (puntas de flecha). El paciente era un varón alcohólico de 45 años.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr18': ['Las manifestaciones radiológicas suelen corresponder a una bronconeumonía y son múltiples zonas bilaterales de consolidación285. Esas zonas pueden tener una distribución lobulillar, subsegmentaria o segmentaria y ser focales o confluentes (<xref rid="gr18" ref-type="fig">figura 6-18</xref>\n)\n)285. Es frecuente que la consolidación afecte a todos los lóbulos285, aunque tiende a predominar en los inferiores.FIGURA 6-18Bronconeumonía aguda: Pseudomonas aeruginosa. Mujer de 38 años ingresada en coma profundo por una sobredosis de barbitúricos. Varios días después del ingreso una radiografía anteroposterior mostró consolidación masiva de todos los lóbulos de ambos pulmones, y la porción superior del lóbulo superior izquierdo era la menos afecta. También se observaba broncograma aéreo en todas las zonas.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr19': ['\nManifestaciones radiológicas. El patrón radiográfico característico es una consolidación del espacio aéreo inicialmente periférica y sublobar similar a la que se observa en la neumonía aguda por S. pneumoniae (<xref rid="gr19" ref-type="fig">figura 6-19</xref>\n). En muchos casos la zona de consolidación aumenta posteriormente hasta ocupar todo un lóbulo o gran parte del mismo o afectar lóbulos contiguos del mismo lado\n). En muchos casos la zona de consolidación aumenta posteriormente hasta ocupar todo un lóbulo o gran parte del mismo o afectar lóbulos contiguos del mismo lado336\n,\n337. La progresión de la neumonía suele ser rápida y afecta a la mayor parte de un lóbulo en tres o cuatro días, muchas veces a pesar de readministrar un tratamiento antibiótico adecuado; este comportamiento se ve rara vez en la neumonía aguda del espacio aéreo por S. pneumoniae\n336\n,\n338. Existe tendencia a la afectación bilateral conforme progresa la enfermedad.FIGURA 6-19Neumonía aguda de los legionarios. La radiografía posteroanterior (A) muestra una consolidación homogénea de la porción axilar del lóbulo superior derecho; se aprecia broncograma aéreo. Dos días más tarde las radiografías (B) muestran empeoramiento marcado. Se aisló Legionella pneumophila en el esputo.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr20': ['En los pacientes inmunocompetentes se observa formación de abscesos con posterior cavitación en aproximadamente el 5% de los casos339. En contraste, la cavitación es muy frecuente en los pacientes inmunodeprimidos (<xref rid="gr20" ref-type="fig">figura 6-20</xref>\n)\n)340\n,\n341. Se puede producir derrame pleural, habitualmente en el acmé de la enfermedad. El aumento de los ganglios linfáticos hiliares es muy infrecuente. El patrón radiográfico que se asocia a la infección por otras especies del género Legionella es similar al descrito para L. pneumophila\n342\n,\n343.FIGURA 6-20Formación de un absceso: Legionella pneumophila. La radiografía posteroanterior de tórax de una paciente de 25 años con trasplante renal muestra una cavidad de 3 cm de diámetro en el vértice pulmonar derecho.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr21': ['El patrón radiográfico típico es una bronconeumonía que varía entre zonas segmentarias localizadas de consolidación, una consolidación focal bilateral y una consolidación multilobar confluente extensa (<xref rid="gr21" ref-type="fig">figura 6-21</xref>\n). La distribución refleja el flujo sanguíneo por el efecto de la gravedad; los segmentos posteriores de los lóbulos superiores y los segmentos superiores de los lóbulos inferiores se suelen afectar cuando la aspiración se produce en decúbito, mientras que la afectación es más frecuente en los segmentos basales de los lóbulos inferiores cuando la aspiración se produce en postura erguida\n). La distribución refleja el flujo sanguíneo por el efecto de la gravedad; los segmentos posteriores de los lóbulos superiores y los segmentos superiores de los lóbulos inferiores se suelen afectar cuando la aspiración se produce en decúbito, mientras que la afectación es más frecuente en los segmentos basales de los lóbulos inferiores cuando la aspiración se produce en postura erguida372. Es relativamente frecuente la formación de abscesos y la cavitación373\n,\n374. Puede aparecer empiema con o sin anomalías parenquimatosas visibles373. En ocasiones el aumento del tamaño de los ganglios linfáticos hiliares o mediastínicos se asocia a un absceso, una combinación que recuerda a la que se observa en pacientes que tienen cáncer de pulmón375.FIGURA 6-21Neumonía por anaerobios: neumonía del espacio aéreo con formación de un absceso. La primera radiografía (A) de esta mujer alcohólica de 45 años de edad reveló una consolidación homogénea masiva del lóbulo inferior derecho y una consolidación focal del pulmón izquierdo. Veinticuatro horas más tarde (B) la neumonía se había extendido a la mayor parte del pulmón derecho y a una zona grande del izquierdo. Durante las dos semanas siguientes, en las que recibió tratamiento antibiótico, desapareció la mayor parte de la neumonía del pulmón izquierdo (C); sin embargo, apareció una cavidad de paredes gruesas en el pulmón derecho.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr22': ['Al cabo de varias semanas (coincidiendo con la aparición de hipersensibilidad), los granulomas están bien formados y su porción central experimenta necrosis (<xref rid="gr22" ref-type="fig">figura 6-22</xref>\n)\n)459. Conforme progresa la enfermedad los focos necróticos individuales tienden a aumentar de tamaño y confluir, lo que origina focos relativamente grandes de restos necróticos rodeados por una capa de histiocitos epitelioides y células gigantes multinucleadas. A su vez, estas células están rodeadas por capas de células mononucleares –linfocitos y monocitos procedentes de la sangre– y fibroblastos. Estas tres zonas –células epitelioides, células mononucleares y fibroblastos– aíslan los bacilos tuberculosos dentro de una región relativamente definida de parénquima pulmonar y en la mayoría de los casos evitan que la enfermedad se extienda más. Al llegar a este punto el foco inflamatorio puede ser visible a simple vista y el material necrótico central aparece blanco y friable (similar al queso de cabra); este aspecto se conoce como necrosis caseosa y es característico, aunque no diagnóstico, de la necrosis tuberculosa. Aunque las consecuencias de estas reacciones son claramente beneficiosas para el huésped porque localizan y destruyen un número sustancial de bacterias, también conllevan el inconveniente fundamental de provocar destrucción tisular.FIGURA 6-22Tuberculosis: formación de granulomas. El corte de un caso de enfermedad relativamente precoz (A) muestra varios focos bien definidos de inflamación granulomatosa rodeados por un infiltrado inflamatorio mononuclear. Se aprecia necrosis en el centro de un granuloma. La enfermedad avanzada (B) muestra focos confluentes de necrosis delimitados por una zona de tejido inflamatorio granulomatoso (ampliado en C). F, fibrosis; M, células mononucleares; N, necrosis; X, histiocitos epitelioides.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr23': ['El mayor estudio sobre las manifestaciones radiológicas de la tuberculosis primaria en niños se basa en la revisión de 252 casos consecutivos, de los que se dispuso de radiografías de tórax en 191461. Se identificó consolidación del espacio aéreo en aproximadamente el 70% de esos casos; el pulmón derecho se afectó con más frecuencia que el izquierdo, la afectación fue bilateral en el 15% de los casos y no se encontró predilección significativa por ninguna región particular del pulmón. La consolidación del espacio aéreo también representa la manifestación más frecuente de la enfermedad en los adultos462. Suele ser homogénea, densa y anatómicamente limitada a un segmento (<xref rid="gr23" ref-type="fig">figura 6-23</xref>\n) o, con más frecuencia, a un lóbulo\n) o, con más frecuencia, a un lóbulo463. La enfermedad es multifocal en aproximadamente el 25% de los casos y bilateral en el 10%461\n,\n462. Se produce enfermedad miliar y/o cavitación en aproximadamente el 2% al 5% de los casos461\n,\n462.FIGURA 6-23Tuberculosis primaria. La radiografía posteroanterior de tórax (A) y la TC (B) muestran aumento del tamaño de los ganglios linfáticos hiliares izquierdos (G). La TC a un nivel ligeramente inferior (C) muestra el foco primario en el segmento superior del lóbulo inferior (flecha), detrás de la arteria pulmonar izquierda (API). El paciente era un varón de 25 años.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.', 'La radiografía de tórax identifica aumento del tamaño de los ganglios linfáticos en aproximadamente el 90% al 95% de los niños con enfermedad primaria461\n,\n464. La mayor parte presenta afectación hiliar, con más frecuencia en el lado derecho; aproximadamente el 50% exhibe lesiones hiliares y mediastínicas (habitualmente en la región paratraqueal derecha)461. El aumento del tamaño de los ganglios linfáticos es menos frecuente en los adultos y se ha encontrado en aproximadamente el 10% al 30% de los pacientes462\n,\n465. Al igual que en los niños, las adenopatías suelen ser unilaterales e hiliares o paratraqueales (véase <xref rid="gr23" ref-type="fig">figura 6-23</xref>). Pueden ser la única alteración; de hecho, este aspecto debe indicar la enfermedad.Aunque el aumento bilateral del tamaño de los ganglios linfáticos o la presencia de adenopatías sin consolidación parenquimatosa no excluye el diagnóstico, este cuadro es infrecuente en los adultos (excepto en los pacientes con sida)). Pueden ser la única alteración; de hecho, este aspecto debe indicar la enfermedad.Aunque el aumento bilateral del tamaño de los ganglios linfáticos o la presencia de adenopatías sin consolidación parenquimatosa no excluye el diagnóstico, este cuadro es infrecuente en los adultos (excepto en los pacientes con sida)462.'], 'gr24': ['En la TC aproximadamente el 50% de los ganglios afectos presenta atenuación baja (<30 unidades Hounsfield [UH]) y el 50% tiene atenuación de tejidos blandos (>35 UH)466. Tras la administración intravenosa de contraste aproximadamente el 60% de los ganglios linfáticos afectos muestra una atenuación relativamente baja en la región central y refuerzo periférico (rodete) (<xref rid="gr24" ref-type="fig">figura 6-24</xref>\n), el 20% presenta refuerzo heterogéneo y el 20% muestra refuerzo homogéneo o ausencia de refuerzo\n), el 20% presenta refuerzo heterogéneo y el 20% muestra refuerzo homogéneo o ausencia de refuerzo466.FIGURA 6-24Tuberculosis primaria. La TC con contraste a un nivel 2 cm por encima del cayado aórtico muestra aumento del tamaño de los ganglios linfáticos paratraqueales derechos (flechas curvas), con baja atenuación central y refuerzo periférico.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr25': ['Las radiografías de tórax de los niños que han tenido tuberculosis primaria muestran datos de calcificación de la lesión pulmonar en aproximadamente el 10% al 15% de los casos, y de los ganglios linfáticos en aproximadamente del 5% al 35%461\n,\n464. Aunque un complejo de Ranke calcificado es una prueba razonable de tuberculosis primaria (<xref rid="gr25" ref-type="fig">figura 6-25</xref>\n), se pueden encontrar los mismos signos radiográficos como secuela de una infección micótica. Se ha descrito atelectasia, habitualmente lobar y del lado derecho, en el 10% al 30% de los niños que tienen tuberculosis\n), se pueden encontrar los mismos signos radiográficos como secuela de una infección micótica. Se ha descrito atelectasia, habitualmente lobar y del lado derecho, en el 10% al 30% de los niños que tienen tuberculosis461\n,\n464. Esta lesión suele deberse a la compresión bronquial por adenopatías; la enfermedad endobronquial es responsable con menos frecuencia464. Esta complicación resulta menos frecuente en los adultos; tiende a afectar al segmento anterior de un lóbulo superior y puede simular un cáncer de pulmón467.FIGURA 6-25Foco de Ghon y ganglios linfáticos calcificados (complejo de Ranke). La radiografía posteroanterior de tórax muestra un nódulo calcificado en el lóbulo superior derecho (flecha recta) y ganglios linfáticos paratraqueales derechos también calcificados (flechas curvas).Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr26': ['En las radiografías la zonas de consolidación tienen bordes mal definidos y muestran tendencia a confluir, muchas veces con focos satélites pequeños en el pulmón adyacente (<xref rid="gr26" ref-type="fig">figura 6-26</xref>\n). Es frecuente la acentuación de las marcas broncovasculares que se dirigen hacia el hilio ipsolateral. Se identifica aumento asociado del tamaño de los ganglios hiliares o mediastínicos en las radiografías de aproximadamente el 5% al 10% de los pacientes\n). Es frecuente la acentuación de las marcas broncovasculares que se dirigen hacia el hilio ipsolateral. Se identifica aumento asociado del tamaño de los ganglios hiliares o mediastínicos en las radiografías de aproximadamente el 5% al 10% de los pacientes465\n,\n475. Las adenopatías mediastínicas (definidas como un ganglio linfático >10 mm de diámetro en el eje menor) se ven con más frecuencia en la TCAR476\n,\n479; como en la enfermedad primaria, estos ganglios suelen mostrar refuerzo heterogéneo o un centro de atenuación baja con refuerzo periférico después de la administración intravenosa de contraste480.FIGURA 6-26Tuberculosis posprimaria. La imagen de la porción superior del hemitórax izquierdo en una radiografía posteroanterior muestra zonas focales mal definidas de consolidación y pequeños focos satélites en el lóbulo izquierdo superior.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr27': ['Se identifica cavitación en las radiografías de tórax del 20% al 45% de los pacientes (<xref rid="gr27" ref-type="fig">figura 6-27</xref>\n)\n)475\n,\n481 y con algo más de frecuencia en la TCAR481\n,\n482. La mayoría de las cavidades se localiza en los segmentos apicales o posteriores de los lóbulos superiores o en los segmentos superiores de los lóbulos inferiores477. Pueden ser únicas o múltiples y tener paredes finas o gruesas. Aproximadamente el 20% presenta un nivel aire-líquido. Después del tratamiento adecuado una cavidad puede desaparecer o permanecer como un espacio quístico lleno de aire de paredes finas.FIGURA 6-27Tuberculosis cavitaria. Las radiografías posteroanterior (A) y lateral (B) muestran una cavidad mal definida y de paredes finas en el segmento superior del lóbulo inferior derecho (flechas en B). Ambos pulmones son por lo demás normales.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr28': ['Se ha descrito que la presencia de un solo nódulo mayor de 1 cm de diámetro (tuberculoma), con o sin nódulos menores adyacentes, es la alteración principal o única en las radiografías de tórax de aproximadamente el 5% de los pacientes465\n,\n475. La lesión aparece como una opacidad redonda u oval situada la mayoría de las veces en un lóbulo superior483. Suele medir de 1 a 4 cm de diámetro y típicamente es lisa y bien definida; en ocasiones presenta un margen mal definido, lobulado o espiculado (<xref rid="gr28" ref-type="fig">figura 6-28</xref>\n)\n)484. En la mayoría de los casos se pueden identificar pequeños nódulos discretos en la vecindad inmediata de la lesión principal (lesiones satélites)483. De modo similar a los granulomas causados por otros gérmenes infecciosos, los tuberculomas muestran con frecuencia refuerzo escaso o nulo en la TC después de la administración de contraste intravenoso485. La mayor parte de estas lesiones permanece estable durante mucho tiempo y muchas de ellas se calcifican. La calcificación suele ser difusa, pero también puede ser central o punteada463\n,\n486.FIGURA 6-28Tuberculoma. La imagen del lóbulo superior derecho de un fumador de 59 años muestra un nódulo de 1,5 cm de diámetro de bordes espiculados y una cola pleural (flecha). También se ve enfisema. Se encontró que el nódulo resecado era un granuloma, y los cultivos fueron positivos para Mycobacterium tuberculosis.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr29': ['Se han descrito opacidades nodulares de 2 a 10 mm de diámetro y localizadas en una o dos regiones del pulmón, habitualmente en los segmentos apicales de los lóbulos superiores o los segmentos superiores de los lóbulos inferiores, como manifestación radiológica principal o única en aproximadamente el 20% al 25% de los pacientes (<xref rid="gr29" ref-type="fig">figura 6-29</xref>\n)\n)465\n,\n475. Con más frecuencia estas opacidades se asocian a zonas focales de consolidación465\n,\n476. En la TCAR presentan una distribución centrolobulillar y muchas veces se asocian a opacidades lineales ramificadas (<xref rid="gr30" ref-type="fig">figura 6-30</xref>\n), un aspecto que ha sido comparado con el de un árbol en brote\n), un aspecto que ha sido comparado con el de un árbol en brote479. Se ha demostrado que estas alteraciones reflejan la presencia de material necrótico dentro de las luces de bronquiolos terminales y respiratorios y de un exudado inflamatorio en sus paredes y en el parénquima adyacente479\n,\n481. Se puede sospechar una diseminación endobronquial más extensa cuando se ven múltiples nódulos de 2 a 10 mm de diámetro en dos o más lóbulos o en un lóbulo distinto del que contiene la cavidad o la zona de consolidación. Esta diseminación se observa en el 10% al 20% de los pacientes en la radiografía de tórax y en casi todos en la TCAR465\n,\n475\n,\n487. Por orden descendente de frecuencia se pueden encontrar también nódulos de 4 a 8 mm de diámetro de bordes mal definidos (localizados habitualmente también con una distribución centrolobulillar), zonas de consolidación lobulillar y engrosamiento de los tabiques interlobulillares477\n,\n479.FIGURA 6-29Tuberculosis: opacidades nodulares pequeñas. La imagen de la porción superior del tórax en una radiografía posteroanterior muestra pequeñas opacidades nodulares mal definidas que afectan al segmento apicoposterior del lóbulo superior izquierdo.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.FIGURA 6-30Tuberculosis: diseminación endobronquial.. La radiografía posteroanterior de tórax (A) muestra opacidades nodulares mal definidas en ambos pulmones. La TCAR (B) muestra una cavidad en el segmento superior del lóbulo inferior izquierdo y opacidades nodulares de 2 a 8 mm de diámetro y distribución centrolobulillar (flechas rectas). Unas pocas opacidades lineales ramificadas, junto con los nódulos centrolobulillares, proporcionan un aspecto que ha sido comparado con el de un árbol en brote (flecha curva).Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr31': ['Cuando se ve por primera vez, la tuberculosis miliar aparece en las radiografías como un incontable número de nódulos de 1 a 2 mm de diámetro (<xref rid="gr31" ref-type="fig">figura 6-31A</xref>\n); sin un tratamiento adecuado esos nódulos pueden crecer hasta los 2 mm-3mm de diámetro\n); sin un tratamiento adecuado esos nódulos pueden crecer hasta los 2 mm-3mm de diámetro71. En la TCAR los nódulos suelen estar bien definidos y medir de 1 a 4 mm de diámetro (<xref rid="gr31" ref-type="fig">figura 6-31B</xref>))488\n,\n489. Aunque algunos de ellos pueden estar relacionados con los vasos, los tabiques interlobulillares o las superficies pleurales, y la mayoría tiene una distribución aleatoria en relación con las estructuras del lobulillo pulmonar secundario197. Entre las demás alteraciones que pueden verse se incluyen engrosamiento nodular de los tabiques interlobulillares y de las cisuras interlobares, irregularidad nodular de los vasos y zonas de atenuación en vidrio esmerilado42\n,\n488., 489., 490..FIGURA 6-31Tuberculosis miliar. Una imagen del pulmón izquierdo en la radiografía anteroposterior de tórax (A) muestra numerosos nódulos bien definidos de 1 a 3 mm de diámetro. La TCAR de otro paciente (B) muestra múltiples nódulos de aproximadamente 2 mm de diámetro y distribución aleatoria por el pulmón.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr32': ['Se produce afectación de los huesos y de las articulaciones en aproximadamente el 10% de los casos de tuberculosis extrapulmonar en pacientes sin sida, con más frecuencia en pacientes ancianos497. La tuberculosis de la columna (enfermedad de Pott) es la forma más frecuente de enfermedad esquelética y afecta a las vértebras dorsales inferiores o lumbares superiores504. Las manifestaciones radiográficas tempranas son irregularidad de las placas terminales vertebrales, disminución de la altura del espacio discal intervertebral y esclerosis del hueso adyacente. Al progresar la enfermedad se aprecia tendencia a la deformidad anterior del cuerpo vertebral y aparición posterior de cifosis y abscesos paravertebrales (estos últimos asociados a desplazamiento de la interfase paraespinal)505 (<xref rid="gr32" ref-type="fig">figura 6-32</xref>\n). La TC es superior a la radiografía para evaluar la presencia de abscesos paraespinales y la afectación del conducto raquídeo\n). La TC es superior a la radiografía para evaluar la presencia de abscesos paraespinales y la afectación del conducto raquídeo506\n,\n507.FIGURA 6-32Espondilitis tuberculosa. La radiografía posteroanterior de tórax (A) muestra nódulos miliares en el pulmón y desplazamiento de las interfases paraespinales (flechas). La radiografía lateral (B) muestra destrucción del cuerpo vertebral D10 (V), que provoca cifosis localizada. La TC con contraste (C y D) muestra destrucción del cuerpo vertebral D10, formación de un absceso paraespinal con centro de atenuación baja y refuerzo periférico (flechas rectas) y erosión cortical del cuerpo vertebral D9 adyacente (flecha curva).Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr33': ['La superposición considerable entre los patrones radiológicos de la enfermedad pulmonar causada por MNT y por M. tuberculosis impide una distinción fiable entre las dos entidades en un caso particular (<xref rid="gr33" ref-type="fig">figura 6-33</xref>\n)\n)482\n,\n613. De hecho, uno de los patrones más frecuentes son cavidades únicas o múltiples, muchas veces asociadas a signos radiográficos de diseminación endobronquial482\n,\n613. A pesar de todo, ciertos patrones se ven con más frecuencia en la infección por MNT y pueden ser útiles para indicar el diagnóstico en el contexto clínico apropiado614\n,\n615.FIGURA 6-33Infección pulmonar por el complejo Mycobacterium avium. La radiografía posteroanterior de tórax (A) de una mujer de 28 años muestra opacidades nodulares pequeñas mal definidas en el lóbulo inferior derecho. La TCAR (B) revela una cavidad (c) en el lóbulo inferior derecho con colas pleurales (flechas abiertas) y varias opacidades nodulares centrolobulillares (flecha cerrada). El cultivo de esputo fue positivo para el complejo M. avium.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr34': ['Un segundo patrón algo más distintivo que se observa sobre todo en mujeres no inmunodeprimidas que están infectadas por el complejo M. avium son nódulos pequeños bilaterales habitualmente bien delimitados que miden menos de 1 cm de diámetro y tienen una distribución centrolobulillar616\n,\n617. Los nódulos están distribuidos muchas veces de modo focal en todos los lóbulos482, aunque en ocasiones predominan en los lóbulos superiores o en el lóbulo medio y la língula616\n,\n618. En la TCAR la mayoría de los pacientes presenta bronquiectasias, habitualmente con afectación de varios lóbulos y en ocasiones con afectación de sólo el lóbulo medio y la língula (<xref rid="gr34" ref-type="fig">figura 6-34</xref>\n\n<xref rid="gr34" ref-type="fig">Figure 34</xref>))619. La extensión de las bronquiectasias y el número de nódulos tienden a ser mayores en los pacientes que tienen infección por M. avium-intracellulare que en los que tienen otras MNT o tuberculosis482\n,\n615.FIGURA 6-34Infección pulmonar por el complejo Mycobacterium avium. La radiografía posteroanterior de tórax (A) de una mujer de 52 años muestra opacidades nodulares pequeñas mal definidas y signos de bronquiectasias en las zonas pulmonares superiores. La TCAR (B) muestra bronquiectasias (flechas abiertas) y varios nódulos centrolobulillares y subpleurales (flecha cerrada).Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr35': ['La radiografía de tórax es normal en la mayoría de los pacientes651. Los signos radiográficos más frecuentes son zonas únicas o múltiples mal definidas de consolidación del espacio aéreo652. La enfermedad grave se caracteriza por consolidación homogénea no segmentaria del parénquima que simula una neumonía bacteriana aguda del espacio aéreo (<xref rid="gr35" ref-type="fig">figura 6-35</xref>\n). En contraste con esta última, la enfermedad tiende a desaparecer en una zona y aparecer en otra. Es frecuente el aumento del tamaño de los ganglios linfáticos hiliares, mientras que el derrame pleural es poco frecuente\n). En contraste con esta última, la enfermedad tiende a desaparecer en una zona y aparecer en otra. Es frecuente el aumento del tamaño de los ganglios linfáticos hiliares, mientras que el derrame pleural es poco frecuente651\n,\n652. En caso de exposición intensa la radiografía puede mostrar opacidades nodulares bastante bien definidas y ampliamente diseminadas, y las lesiones individuales miden 3-4 mm de diámetro653. Estas alteraciones pueden no aparecer hasta una semana o más después del comienzo de los síntomas. En la mayoría de los casos hay adenopatías hiliares652.FIGURA 6-35Histoplasmosis aguda. Varón de 48 horas con historia de tres semanas de dolor pleurítico en el lado derecho del tórax. La radiografía posteroanterior de tórax muestra una consolidación extensa del lóbulo superior derecho y pequeñas zonas de consolidación en el vértice pulmonar izquierdo. Los cultivos de esputo fueron positivos para Histoplasma capsulatum.Por cortesía del Dr. Thomas Hartman, Mayo Clinic, Rochester, MN.'], 'gr36': ['\nHistoplasmoma. Esta forma relativamente frecuente de histoplasmosis pulmonar se puede asociar o no a antecedentes de enfermedad sintomática previa654. La alteración aparece típicamente en la radiografía como un nódulo bien definido de 0,5 a 3 cm de diámetro, la mayoría de las veces en un lóbulo inferior655.Aunque la lesión puede ser solitaria,muchas veces se ven lesiones satélites menores649. Los nódulos pueden tener un foco central de calcificación con formación de una imagen en «diana» característica o con calcificación difusa (<xref rid="gr36" ref-type="fig">figura 6-36</xref>\n); esta calcificación se identifica con frecuencia en la TC incluso cuando no es aparente en las radiografías\n); esta calcificación se identifica con frecuencia en la TC incluso cuando no es aparente en las radiografías656. Las radiografías seriadas a lo largo de meses o años pueden revelar un crecimiento moderado, incluso hasta el punto de indicar el diagnóstico de neoplasia657. La presencia de calcificación no significa necesariamente que un histoplasma esté «curado»: estas lesiones también pueden aumentar de tamaño, y el examen histológico ha demostrado fibrosis aparentemente activa transcurridos 10 años o más desde su identificación inicial. Aunque no está clara la patogenia de este fenómeno, se ha propuesto que representa una reacción similar a la que se observa en la mediastinitis fibrosante (véase página 850).FIGURA 6-36Histoplasmoma calcificado. La radiografía posteroanterior de tórax (A) muestra un nódulo de 1,5 cm de diámetro en el lóbulo inferior derecho (flecha); no se aprecia calcificación. Las imágenes de TCAR (B y C) muestran calcificación del nódulo, así como adenopatías hiliares derechas y subcarínicas calcificadas.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr37': ['La calcificación de los ganglios linfáticos también es frecuente en la infección cicatrizada y se puede ver aislada o asociada a un histoplasmoma. La broncolitiasis representa una complicación ocasional (<xref rid="gr37" ref-type="fig">figura 6-37</xref>\n)\n)651; en muchos casos la TC revela calcificación parabronquial y aclara la naturaleza de la alteración658.FIGURA 6-37Histoplasmosis: broncolitiasis. En esta mujer de 45 años con antecedentes de hemoptisis y episodios repetidos de tos con expectoración de pequeñas concreciones, la radiografía posteroanterior de tórax (A) muestra ganglios linfáticos calcificados hiliares (flecha) y paratraqueales derechos. Los dos cortes de TC con colimación de 6 mm (B y C) muestran un ganglio hiliar derecho calcificado (flecha recta) y un broncolito (flecha curva), dentro del bronquio segmentario anterior del lóbulo superior derecho.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr38': ['El aspecto radiográfico (<xref rid="gr38" ref-type="fig">figura 6-38</xref>\n) simula a la tuberculosis posprimaria\n) simula a la tuberculosis posprimaria651, y las manifestaciones más tempranas son zonas segmentarias o subsegmentarias de consolidación en los vértices de los pulmones, que muchas veces dibujan zonas de enfisema cen\ntrolobulillar. Las ampollas de paredes gruesas contienen en ocasiones niveles líquidos; con el paso del tiempo las ampollas pueden desaparecer por completo o aumentar gradualmente de tamaño. Las radiografías de tórax seriadas tienden a mostrar pérdida de volumen progresiva con aumento de la prominencia de las opacidades lineales.FIGURA 6-38Histoplasmosis progresiva crónica. La imagen de la mitad superior del pulmón izquierdo (A) muestra una opacidad heterogénea mal definida (flechas) que contiene una zona radiotransparente central correspondiente a una cavidad. El pulmón derecho no tenía lesiones en aquella época. Aproximadamente un año después (B) la lesión apical izquierda ha desaparecido casi por completo, pero ahora se aprecia una enfermedad extensa en todo el lóbulo superior derecho, junto con una pérdida de volumen considerable (obsérvese la desviación de la tráquea hacia la derecha). El aspecto es similar al de la tuberculosis crónica.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr39': ['La manifestación radiológica más frecuente son focos únicos o múltiples de consolidación del espacio aéreo (<xref rid="gr39" ref-type="fig">figura 6-39</xref>\n)\n)677. En ocasiones los focos evolucionan hacia la formación de cavidades de paredes finas que pueden persistir o desaparecer espontáneamente678. Se producen derrames pleurales pequeños en aproximadamente el 20% de los casos679; los derrames grandes son raros. Se encuentra aumento del tamaño de los ganglios linfáticos en aproximadamente el 20% de los casos, rara vez sin afectación parenquimatosa.FIGURA 6-39Coccidioidomicosis primaria. Las imágenes del pulmón izquierdo en las radiografías posteroanterior (A) y lateral (B) muestran una consolidación homogénea de gran parte del segmento lingular del lóbulo superior izquierdo. En las radiografías originales se podía identificar un broncograma aéreo débil, que no se aprecia en la figura. El borde superior de la consolidación está bien circunscrito y recuerda a una masa.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr40': ['Desde el punto de vista radiográfico, el nódulo típico evoluciona a lo largo de aproximadamente 5 o 6 semanas como un foco de consolidación que se hace más pequeño, más denso y mejor definido679. En ocasiones la ocupación de la cavidad da lugar a opacidades nodulares677. Los nódulos son en general solitarios, de 0,5 a 5 cm de diámetro y localizados en la periferia del pulmón677. En la mayoría de los pacientes muestran atenuación homogénea en la TC; sin embargo, en algunos casos se observan zonas centrales de baja atenuación como consecuencia de la necrosis, y en algunos casos se ven focos de calcificación681. Se ha descrito cavitación en aproximadamente el 10% al 15% de los casos681\n,\n682. Las cavidades suelen ser únicas y se localizan en los lóbulos superiores, y pueden tener paredes finas o gruesas (<xref rid="gr40" ref-type="fig">figura 6-40</xref>\n)\n)683; las de paredes finas muestran tendencia a cambiar de tamaño, quizás como consecuencia de la aparición de una comunicación bronquiolar con un mecanismo valvular.FIGURA 6-40Coccidioidomicosis cavitaria. La radiografía posteroanterior de tórax (A) muestra un nódulo cavitado bien circunscrito en el lóbulo superior derecho. La TCAR (B) presenta una pared de grosor no uniforme y bordes externos lisos.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr41': ['El signo radiografico mas frecuente es la consolidacion aguda del espacio aereo701\n,\n702. La consolidacion puede ser focal o confluente y subsegmentaria, segmentaria o no segmentaria (<xref rid="gr41" ref-type="fig">figura 6-41</xref>\n). La siguiente alteracion mas frecuente es la presencia de masas unicas o multiples\n). La siguiente alteracion mas frecuente es la presencia de masas unicas o multiples703. Se produce cavitacion en el 15% al 20% de los casos701. El aumento del tamano de los ganglios hiliares y mediastinicos es poco frecuente, incluso en la TC704. Se han identificado derrames pleurales en las radiografias de torax del 10% al 15% de los casos, y practicamente siempre se asocian a enfermedad parenquimatosa. La infeccion hiperaguda se suele acompanar de un patron radiografico de diseminacion miliar705.\nFIGURA 6-41Blastomicosis norteamericana. Las radiografías de tórax posteroanterior (A) y lateral (B) muestran una gran opacidad mal definida de densidad homogénea en la língula; la consolidación no es segmentaria y no muestra signos de broncograma aéreo. La radiografía posteroanterior revela también destrucción de la porción anterior de la quinta costilla derecha (flecha). Se cultivó Blastomyces dermatitidis en una muestra de esputo de 24 horas y en el líquido que se aspiró de la tumefacción que recubría la quinta costilla derecha.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr42': ['En la forma primaria de la enfermedad se puede observar una opacidad transitoria del espacio aéreo en las zonas medias del pulmón. Los paracoccidioidomas (únicos o múltiples, sólidos o cavitados) son la manifestación principal en otros casos717. La enfermedad pulmonar progresiva puede recordar a la tuberculosis; sin embargo, los lóbulos inferiores se afectan con más frecuencia que los superiores y las radiografías muestran cavitación en una proporción menor de casos (<xref rid="gr42" ref-type="fig">figura 6-42</xref>\n)\n)718. Es posible el aumento del tamaño de los ganglios linfáticos hiliares, solo o asociado a cualquier forma de enfermedad pulmonar. Las manifestaciones de la enfermedad crónica en la TCAR incluyen engrosamiento de los tabiques interlobulillares, bronquiectasias por tracción, múltiples nódulos de tamaño variable (entre 1 y 25 mm) que a veces están cavitados, engrosamiento intersticial peribroncovascular, opacidades centrolobulillares y líneas intralobulillares (véase <xref rid="gr42" ref-type="fig">figura 6-42</xref>))719. Estas alteraciones suelen ser bilaterales y simétricas, y afectan a todas las zonas pulmonares.FIGURA 6-42Blastomicosis sudamericana. Varón de 52 años con fiebre y cefalea intensa pero sin síntomas respiratorios. La TC demostró granulomas intracerebrales. Al ingreso la radiografía posteroanterior de tórax (A) mostraba numerosos nódulos bilaterales de 0,5 a 2 cm de diámetro, así como adenopatías hiliares derechas y paratraqueales. La TC (B) revela que algunos nódulos están cavitados. La biopsia por aspiración con aguja fina de uno de los nódulos demostró Paracoccidioides brasiliensis.Por cortesía del Dr. Arthur Soores Souza Jr, Instituto de Radiodiagnostico Rio Preto, São Paulo, Brazil.'], 'gr43': ['Las manifestaciones radiológicas más frecuentes de la infección pulmonar son nódulos únicos o múltiples y zonas de consolidación724\n,\n725. Los nódulos suelen tener una localización subpleural y miden entre 0,5 y 4 cm de diámetro726\n,\n727. Las zonas de consolidación pueden ser segmentarias, no segmentarias, parcheadas o con aspecto de masa (<xref rid="gr43" ref-type="fig">figura 6-43</xref>\n). La cavitación es infrecuente en pacientes por lo demás sanos, pero se encuentra con frecuencia en pacientes inmunodeprimidos, sobre todo en los que tienen sida\n). La cavitación es infrecuente en pacientes por lo demás sanos, pero se encuentra con frecuencia en pacientes inmunodeprimidos, sobre todo en los que tienen sida727. Estos últimos pacientes tienen también una mayor incidencia de enfermedad diseminada. Esta enfermedad se puede manifestar con un patrón miliar o difuso de opacidades mal definidas726\n,\n728. Se ha descrito aumento del tamaño de los ganglios linfáticos hiliares y mediastínicos en aproximadamente el 40% de los pacientes con sida y del 10% al 25% de los que no tienen sida725\n,\n729. El derrame pleural es infrecuente y no suele indicar diseminación del microorganismo729.\nFIGURA 6-43Neumonía criptocócica aguda. Las radiografías posteroanterior (A) y lateral (B) muestran una consolidación homogénea no segmentaria de ambos lóbulos inferiores y del lóbulo medio derecho.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr44': ['\nP. jiroveci (P. carinii) es un microorganismo ubicuo que inicialmente se consideraba un protozoo, pero que ahora se clasifica entre los hongos734. In vivo el microorganismo puede adoptar dos formas735\n,\n736: 1) quistes de paredes gruesas con forma redonda o semilunar que miden de 3 a 6 μm de diámetro y 2) «trofozoítos» extraquísticos que miden entre 1 y 5 μm, son pleomorfos y muchas veces muestran proyecciones superficiales similares a seudópodos. Se ha propuesto que el ciclo vital del microorganismo en el pulmón comienza con los trofozoítos; los trofozoítos crecen fuera de las células, maduran y se enquistan (<xref rid="gr44" ref-type="fig">figura 6-44</xref>\n). Los quistes individuales experimentan después maduración mediante el desarrollo de esporozoítos intraquísticos que se liberan al romperse el quiste y se transforman en trofozoítos. También se ha indicado la posibilidad de que los trofozoítos se puedan reproducir mediante fisión binaria\n). Los quistes individuales experimentan después maduración mediante el desarrollo de esporozoítos intraquísticos que se liberan al romperse el quiste y se transforman en trofozoítos. También se ha indicado la posibilidad de que los trofozoítos se puedan reproducir mediante fisión binaria735.FIGURA 6-44Pneumocystis jiroveci (carinii): ciclo reproductivo propuesto. La representación esquemática de un alvéolo ilustra los posibles mecanismos del desarrollo de los quistes y la reproducción del microorganismo.Tomado de Gutierrez Y: The biology of Pneumocystis carinii. Semin Diagn Pathol 6:203, 1989.'], 'gr45': ['En la fase precoz de la NPC se aprecia una opacidad granular o borrosa (aspecto en vidrio esmerilado), sobre todo en las zonas perihiliares (<xref rid="gr45" ref-type="fig">figura 6-45</xref>\n)\n)769. En la enfermedad más avanzada el patrón suele ser una consolidación del espacio aéreo (aunque todavía se puede apreciar un patrón granular o reticulogranular en la periferia de la zona consolidada)68\n. En las fases terminales los pulmones pueden experimentar consolidación masiva hasta el punto de casi no contener aire; de hecho, en algunos pacientes el comienzo agudo y la afectación difusa son característicos del SDRA770. La neumonía es en general bilateral y más prominente en los lóbulos inferiores; con menos frecuencia afecta de forma predominante o exclusiva a los lóbulos superiores771.FIGURA 6-45Neumonía por Pneumocystis. La radiografía posteroanterior de tórax (A) muestra un aumento borroso y difuso de la densidad pulmonar (opacidad en vidrio esmerilado) en ambos pulmones, más intenso en los lóbulos inferiores. Varios días más tarde (B) la enfermedad ha progresado hasta la consolidación.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr46': ['La manifestación predominante de la NPC en la TC son zonas bilaterales de atenuación similar al vidrio esmerilado, que pueden ser difusas o mostrar un patrón en mosaico peculiar que se caracteriza por zonas de pulmón normal entremezcladas entre los focos con atenuación en vidrio esmerilado (<xref rid="gr46" ref-type="fig">figura 6-46</xref>\n)\n)70. El engrosamiento asociado de los tabiques interlobulillares y la consolidación parenquimatosa se ven en aproximadamente el 20% al 50% de los casos778. Con el paso del tiempo las zonas de atenuación en vidrio esmerilado progresan hasta la consolidación; finalmente se pueden ver alteraciones intersticiales, como engrosamiento de los tabiques interlobulillares y líneas irregulares de atenuación, que pueden ser predominantes68. A veces hay un patrón de fibrosis difusa o de bronquiectasias o bronquiolectasias periféricas68\n,\n779.FIGURA 6-46Neumonía por Pneumocystis. La TCAR muestra zonas bilaterales de atenuación en vidrio esmerilado entremezcladas con zonas de pulmón aparentemente normal, lo que origina un patrón en mosaico. El paciente era un varón de 46 años con sida.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr47': ['Las manifestaciones radiográficas más frecuentes son zonas unilaterales o bilaterales de consolidación segmentaria o no segmentaria (<xref rid="gr47" ref-type="fig">figura 6-47</xref>\n)\n)802. Con menos frecuencia se ve un patrón difuso, nodular o miliar803. El tamaño de los nódulos puede oscilar entre pocos milímetros y hasta 3 cm de diámetro. Se producen derrames pleurales en aproximadamente el 20% de los pacientes. Los signos en la TCAR incluyen un patrón bilateral predominantemente nodular y zonas bilaterales de atenuación en vidrio esmerilado y consolidación (véase <xref rid="gr47" ref-type="fig">figura 6-47</xref>))46.FIGURA 6-47Neumonía por Candida. La radiografía posteroanterior de tórax (A) muestra zonas mal definidas de consolidación y algunas opacidades nodulares en los lóbulos superiores. La TCAR (B) revela nódulos de varios tamaños y zonas focales de consolidación y atenuación en vidrio esmerilado. La paciente era una mujer de 27 años sometida a un trasplante de médula ósea.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.'], 'gr48': ['La aspergilosis es una enfermedad de distribución mundial que está causada por hongos dimórficos del género Aspergillus. Aunque se han descrito más de 300 especies, sólo unas cuantas se relacionan con la enfermedad humana, y la más importante es Aspergillus fumigatus. Otras especies de Aspergillus que pueden ser patógenas para los seres humanos son A. niger, A. flavus y A. glaucus. En la fase micelial los microorganismos aparecen como hifas tabicadas bastante uniformes que se ramifican por dicotomía en un ángulo de 45° (<xref rid="gr48" ref-type="fig">figura 6-48</xref>\n). Suelen ser visibles en las muestras tisulares teñidas con hematoxilina y eosina, pero se ven especialmente bien con las tinciones de ácido peryódico de Schiff (PAS) y de metenamina de Grocott. Sin embargo, la identificación definida de un hongo particular como \n). Suelen ser visibles en las muestras tisulares teñidas con hematoxilina y eosina, pero se ven especialmente bien con las tinciones de ácido peryódico de Schiff (PAS) y de metenamina de Grocott. Sin embargo, la identificación definida de un hongo particular como Aspergillus suele precisar el cultivo y la confirmación inmunohistoquímica o molecular, en particular si sólo se dispone de una pequeña cantidad de tejido o de líquido para el examen.FIGURA 6-48Género Aspergillus. Se muestra una masa en abanico de hifas tabicadas que se ramifican en un ángulo de aproximadamente 45̊ (flecha). Obsérvese que los hongos atraviesan la pared de la arteria pulmonar con una reacción inflamatoria y necrosis mínimas.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr49': ['Desde el punto de vista radiográfico, el aspergiloma está formado por una masa sólida más o menos redonda y de densidad de tejidos blandos que está dentro de una cavidad esférica u oval, habitualmente en un lóbulo superior831. Típicamente, la masa está separada de la pared de la cavidad por un espacio aéreo de tamaño y forma variables, el peculiar signo del menisco aéreo (<xref rid="gr49" ref-type="fig">figura 6-49</xref>\n). Rada vez se observa un nivel líquido\n). Rada vez se observa un nivel líquido832. La mayoría de las cavidades tiene paredes finas y está en contacto con una superficie pleural, que puede aparecer engrosada833. De hecho, se ha descrito que el engrosamiento de la pared de una caverna tuberculosa o de la pleura adyacente es un signo radiográfico precoz de colonización que precede a la formación del aspergiloma visible.FIGURA 6-49Aspergiloma con el signo del menisco aéreo y cambio de posición. Varón de 65 años con tuberculosis previa que consulta por hemoptisis. La radiografía posteroanterior de tórax (A) muestra cicatrización extensa en los lóbulos superiores. Un gran aspergiloma en el lóbulo superior derecho presenta un menisco aéreo característico que lo separa de la pared de la cavidad (flecha). La cavidad está rodeada por un engrosamiento pleural marcado. Las imágenes de TCAR con el paciente en decúbito supino (B) y prono (C) muestran cambio de la posición del aspergiloma (flechas) a pesar de su gran tamaño. Se observan también bronquiectasias y engrosamiento pleural marcado. Se recuperó Aspergillus fumigatus en las muestras que se obtuvieron mediante broncoscopia.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.', 'El aspergiloma se suele mover cuando el paciente cambia de posición834; sin embargo, algunas de estas lesiones tienen forma irregular y se adaptan, por ejemplo, a una cavidad bronquiectásica alargada, en cuyo caso el cambio de postura del paciente puede no inducir ningún desplazamiento del aspergiloma. De modo similar a la radiografía, el signo más característico del aspergiloma en la TC es una masa intracavitaria oval o redonda de tejido blando que se mueve cuando el paciente pasa del decúbito supino al prono (véase <xref rid="gr49" ref-type="fig">figura 6-49</xref>))835. Son relativamente frecuentes las zonas de aumento de la atenuación, que quizás representen depósitos de calcio836. La TC puede mostrar frondas micóticas sobre la pared de la cavidad, que se cruzan entre sí y forman una red similar a una esponja, antes de aparecer el aspergiloma maduro836.'], 'gr50': ['El patrón radiográfico típico son opacidades digitiformes homogéneas, de la misma densidad, que tienen una distribución exactamente peribronquial y que habitualmente afectan a los lóbulos superiores y casi siempre son más intensas en los bronquios segmentarios centrales que en las ramas periféricas (<xref rid="gr50" ref-type="fig">figura 6-50</xref>\n). Se ha descrito que opacidades bifurcadas tienen aspecto de \n). Se ha descrito que opacidades bifurcadas tienen aspecto de dedo enguantado, de Y o V invertidas o de racimos de uvas. Las opacidades tienden a ser transitorias, pero pueden persistir sin variación durante semanas o incluso meses, y también pueden aumentar de tamaño. Quizás se aprecien bronquiectasias después de la expectoración de un tapón de moco; cuando están muy dilatados, los bronquios afectos pueden contener un nivel de líquido o un aspergiloma852. Como en las radiografías, los signos de ABPA en la TC son principalmente impactación mucoide y bronquiectasias que afectan de modo predominante a las vías aéreas segmentarias y subsegmentarias (<xref rid="gr51" ref-type="fig">figura 6-51</xref>\n)\n)853. Las bronquiectasias tienden a ser varicosas y a afectar a más de dos lóbulos (de modo predominante, los lóbulos superiores). La TCAR puede mostrar atenuación alta en los tapones de moco, quizás relacionada con la presencia de calcio854. Las alteraciones menos frecuentes incluyen atelectasias y zonas de consolidación.FIGURA 6-50Aspergilosis broncopulmonar alérgica. La radiografía posteroanterior (A) muestra opacidades ramificadas en forma de banda en el lóbulo inferior derecho (flecha oblicua) y en el lóbulo superior derecho (flecha vertical); se observa una opacidad vista de frente (punta de flecha) en la parte superior del hilio. La TC (B) demuestra que una de las opacidades está calcificada (punta de flecha).Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.FIGURA 6-51Aspergilosis broncopulmonar alérgica. La radiografía posteroanterior (A) revela opacidades nodulares focales en el segmento superior del lóbulo inferior izquierdo. Una TCAR (B) demuestra impactación mucoide en ese segmento (flechas), así como bronquiectasias extensas.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr52': ['El patrón radiográfico se caracteriza por consolidación focal u homogénea del espacio aéreo sin características específicas875\n,\n876. Los signos en la TC incluyen focos de consolidación bilaterales, predominantemente peribronquiales (<xref rid="gr52" ref-type="fig">figura 6-52</xref>\n), u opacidades nodulares centrolobulillares mal definidas de 2 a 5 mm de diámetro\n), u opacidades nodulares centrolobulillares mal definidas de 2 a 5 mm de diámetro877. Desde el punto de vista clínico, el paciente típico tiene fiebre continua que responde poco al tratamiento antibiótico. Los pacientes que tienen una enfermedad más extensa tienen disnea y taquipnea.FIGURA 6-52Bronconeumonía por Aspergillus. En un varón de 36 años con fiebre y tos después de un trasplante de médula ósea alógena la radiografía de tórax anteroposterior (A) muestra opacidades nodulares mal definidas en ambos pulmones. La TCAR (B) revela zonas focales de consolidación con una distribución predominantemente peribronquial (flechas).Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr53': ['El patrón radiográfico son nódulos o zonas únicas o múltiples de consolidación homogénea (<xref rid="gr53" ref-type="fig">figura 6-53</xref>\n)\n)803\n,\n874. La cavitación es frecuente y a veces se manifiesta por una semiluna aérea (menisco aéreo) que rodea parcial o completamente una masa homogénea central (véase <xref rid="gr53" ref-type="fig">figura 6-53</xref>))880. Este signo del menisco aéreo puede aparecer entre 1 día y 3 semanas después de detectar la alteración radiográfica inicial881. En ocasiones la consolidación característica se extiende hasta afectar a todo el lóbulo, y desde el punto de vista radiográfico simula una neumonía bacteriana aguda873. La afectación pleural es poco frecuente, pero puede producir derrame o neumotórax debido a una fístula broncopleural882.FIGURA 6-53Aspergilosis angioinvasora: progresión de las alteraciones radiográficas. Paciente de 23 años con leucemia aguda que presentó fiebre y tos. La radiografía anteroposterior (AP) de tórax (A) muestra una zona redondeada de consolidación en el lóbulo superior derecho que mostró una progresión considerable al cabo de una semana (B). Al día siguiente la biopsia pulmonar abierta demostró hemorragia pulmonar, pero no identificó ningún microorganismo. Una radiografía de tórax anteroposterior dos semanas más tarde de la biopsia (C) y la TCAR (D) demuestran una cavidad de bordes lisos en el lóbulo superior derecho que contiene una masa de tejidos blandos. La biopsia que se repitió bajo guía de TC confirmó el diagnóstico de aspergilosis invasora, y la masa de tejidos blandos de la cavidad correspondía a pulmón necrótico (secuestro).Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr54': ['La TC puede mostrar un reborde de atenuación en vidrio esmerilado alrededor de un nódulo de tejido blando (<xref rid="gr54" ref-type="fig">figura 6-54</xref>\n, «signo del halo»)\n, «signo del halo»)876\n,\n883 como consecuencia de la hemorragia en el espacio aéreo que rodea el nódulo de tejido pulmonar necrótico884\n,\n885. Con el paso del tiempo esas lesiones pueden presentar meniscos aéreos o progresar hacia la cavitación franca883. La obstrucción vascular puede producir una consolidación homogénea subsegmentaria, segmentaria o lobar como consecuencia de infarto o hemorragia886.FIGURA 6-54Aspergilosis angioinvasora: signo del halo en la TC. La TCAR del lóbulo superior izquierdo demuestra un nódulo rodeado por un halo con atenuación en vidrio esmerilado (flecha) (signo del halo). La paciente era una mujer de 72 años con leucemia aguda.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr55': ['Los signos radiográficos más frecuentes son consolidación del espacio aéreo, focal o multifocal y unilateral o bilateral910. La consolidación es con frecuencia segmentaria y homogénea por la obstrucción vascular911\n,\n912. La consolidación puede ser de forma redonda y progresar con rapidez913 (<xref rid="gr55" ref-type="fig">figura 6-55</xref>\n); en ocasiones se observa expansión lobar\n); en ocasiones se observa expansión lobar910. Otras alteraciones frecuentes son nódulos solitarios o múltiples y pequeños o grandes910. Se observa cavitación de las zonas de consolidación o de los nódulos en aproximadamente el 40% de los pacientes. Como en la aspergilosis angioinvasora, la TC puede mostrar un halo de atenuación en vidrio esmerilado alrededor del nódulo (signo del halo)911. Se encuentran adenopatías hiliares o mediastínicas asociadas en aproximadamente el 10% de los pacientes, y derrame pleural unilateral o bilateral en el 20%910.FIGURA 6-55Mucormicosis. La radiografía posteroanterior de tórax (A) muestra una zona redondeada de consolidación en el segmento superior del lóbulo inferior derecho. La radiografía de seguimiento que se obtuvo al día siguiente (B) muestra un aumento considerable del tamaño de la consolidación. El paciente era un varón de 15 años con neutropenia intensa secundaria a quimioterapia por leucemia aguda.Por cortesía del Dr. James Barrie, University of Alberta Hospital, Edmonton, Canada.'], 'gr56': ['Antes de la introducción de los antibióticos la actinomicosis era la enfermedad «micótica» pulmonar que se diagnosticaba con más frecuencia; producía un cuadro clínico muy típico con empiema y tractos sinusales en la pared torácica.Hoy día se ve con más frecuencia en la región cervicofacial después de extracciones dentales, habitualmente en forma de osteomielitis del maxilar inferior o como un absceso de tejidos blandos que drena muchas veces espontáneamente a través de la piel. La enfermedad pulmonar, con o sin afectación de la pared torácica, es poco frecuente. En el examen macroscópico los pulmones contienen típicamente uno o más abscesos que cuando son múltiples suelen estar conectados por tractos sinusales944. Se pueden ver gránulos de azufre dentro de los agregados de neutrófilos en el examen histológico (<xref rid="gr56" ref-type="fig">figura 6-56</xref>\n). Los microorganismos se suelen identificar con facilidad mediante la tinción de Gram y con plata. Se pueden ver los gránulos característicos en los esputos y en muestras obtenidas mediante punción transtorácica con aguja\n). Los microorganismos se suelen identificar con facilidad mediante la tinción de Gram y con plata. Se pueden ver los gránulos característicos en los esputos y en muestras obtenidas mediante punción transtorácica con aguja947\n,\n948.FIGURA 6-56Actinomicosis. Un corte de parénquima pulmonar (A) muestra fibrosis intersticial alveolar ligera y ocupación extensa del espacio aéreo por macrófagos alveolares. También se aprecia un exudado neutrófilo, probablemente en un bronquiolo respiratorio; contiene dos colonias actinomicóticas pequeñas (una de las cuales se muestra ampliada en B).Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr57': ['La manifestación radiológica más frecuente es una consolidación del espacio aéreo unilateral, focal o confluente949\n,\n450. En ocasiones el paciente presenta un nódulo o una masa, a veces cavitado. Las zonas de consolidación suelen medir entre 2 y 12 cm de diámetro y afectan con más frecuencia a los lóbulos inferiores de modo predominante o exclusivo (<xref rid="gr57" ref-type="fig">figura 6-57</xref>\n). Se observa engrosamiento pleural adyacente a la consolidación en las radiografías de aproximadamente el 50% de los pacientes y en la TC del 75% al 100%\n). Se observa engrosamiento pleural adyacente a la consolidación en las radiografías de aproximadamente el 50% de los pacientes y en la TC del 75% al 100%949\n,\n950. La TC muestra con frecuencia zonas centrales de baja atenuación dentro de la consolidación con refuerzo periférico después de la administración de contraste intravenoso (véase <xref rid="gr57" ref-type="fig">figura 6-57</xref>). En la mayoría de los casos la TC revela adenopatías hiliares o mediastínicas). En la mayoría de los casos la TC revela adenopatías hiliares o mediastínicas950. Es infrecuente la invasión de la pared torácica.FIGURA 6-57Actinomicosis pleuropulmonar. La radiografía posteroanterior de tórax (A) y la TC con colimación de 10 mm (B) revelan zonas focales de consolidación en los lóbulos superior e inferior derechos, con engrosamiento pleural derecho asociado. La TCAR (C) que se realizó tras la administración de contraste intravenoso muestra zonas de baja atenuación dentro de la consolidación, compatibles con formación de abscesos. El paciente era un varón alcohólico de 59 años.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr58': ['La alteración radiográfica más frecuente es la consolidación del espacio aéreo, en general homogénea y no segmentaria, pero a veces focal y heterogénea (<xref rid="gr58" ref-type="fig">figura 6-58</xref>\n)\n)960\n,\n961. La consolidación suele ser multilobar962. Otra alteración frecuente es la presencia de nódulos o masas963. La TC demuestra con frecuencia zonas localizadas de baja atenuación con refuerzo periférico indicativas de formación de abscesos dentro de las zonas de consolidación y de los nódulos963\n,\n964. Se observa cavitación en las TC de aproximadamente el 80% de los pacientes con sida y en el 20% de los que no tienen sida963. La infección se puede extender al espacio pleural para causar derrame o empiema y, con menos frecuencia, a la pared torácica964.\nFIGURA 6-58Nocardiosis pleuropulmonar. Varón de 36 años, previamente sano, al que se evaluó por dolor pleurítico intenso. La radiografía posteroanterior de tórax (A) demuestra zonas de consolidación en los lóbulos superiores y el lóbulo medio derecho y derrame pleural derecho. La TC (B) revela una consolidación extensa en los lóbulos superiores. La TC con ventana para tejidos blandos (C) demuestra un gran derrame pleural derecho con signos de loculación anterolateral y posteromedial (flechas). También se aprecia una consolidación en el lóbulo medio derecho. Se aisló Nocardia asteroides en el líquido tanto del LBA como pleural.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr59': ['La afectación puede ser local o general. La primera suele adoptar la forma de consolidación segmentaria de los lóbulos inferiores, homogénea o focal y unilateral o bilateral995. Las radiografías seriadas pueden mostrar zonas parcheadas mal definidas de consolidación de 1 a 2 cm de diámetro que hacen confluentes con rapidez (<xref rid="gr59" ref-type="fig">figura 6-59</xref>\n). El derrame pleural es comparativamente raro. Como media, la resolución tarda aproximadamente tres semanas.\n). El derrame pleural es comparativamente raro. Como media, la resolución tarda aproximadamente tres semanas.FIGURA 6-59Neumonía aguda por el virus influenza. Varón de 32 años ingresado en el hospital por historia de tres días de tos con expectoración amarilla blanquecina, dolor pleurítico en el lado derecho del tórax y fiebre. La radiografía posteroanterior de tórax que se realizó el día del ingreso (A) muestra una consolidación extensa y homogénea del espacio aéreo del lóbulo superior derecho con opacidades focales de consolidación del espacio aéreo del lóbulo inferior derecho; el pulmón izquierdo no tiene alteraciones. Dos días más tarde (B) la consolidación del lóbulo inferior derecho se ha hecho casi homogénea y la enfermedad del espacio aéreo se ha extendido por todo el pulmón izquierdo. Veinticuatro horas más tarde ambos pulmones están consolidados casi por completo y el único aire visible se localiza dentro del árbol bronquial (broncograma aéreo difuso).Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr60': ['Los signos anatomopatológicos de la neumonía sarampionosa mortal sin sobreinfección bacteriana son los de lesión alveolar difusa1044. De forma característica, esa lesión se asocia a numerosas células gigantes multinucleadas que contienen inclusiones víricas eosinófilas, nucleares y citoplásmicas (lo que justifica el nombre de neumonía de células gigantes; <xref rid="gr60" ref-type="fig">figura 6-60</xref>\n). Las células gigantes se pueden ver en el esputo expectorado o las muestras de LBA mediante examen citológico, antes y durante el exantema\n). Las células gigantes se pueden ver en el esputo expectorado o las muestras de LBA mediante examen citológico, antes y durante el exantema1045.FIGURA 6-60Neumonía sarampionosa (de células gigantes). La imagen a bajo aumento (A) muestra consolidación extensa del espacio aéreo por líquido proteináceo, macrófagos y eritrocitos. Se ven con claridad células gigantes de forma irregular. La imagen ampliada (B) de una célula gigante muestra numerosos núcleos, algunos de los cuales contienen inclusiones víricas con tinción ligera pero bien definida (flecha).Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr61': ['La radiografía de tórax inicial revela con frecuencia cambios indicadores de edema pulmonar intersticial, como líneas septales (líneas B de Kerley), borrosidad hiliar y formación de manguitos peribronquiales (<xref rid="gr61" ref-type="fig">figura 6-61</xref>\n)\n)1072. También se puede apreciar consolidación del espacio aéreo, que a veces se hace extensa rápidamente. Los derrames pleurales son frecuentes y pueden ser grandes.FIGURA 6-61Neumonía por hantavirus. La radiografía de tórax muestra cardiomegalia leve con prominencia de las marcas vasculares pulmonares y pequeños derrames pleurales bilaterales. Esas alteraciones se resolvieron con rapidez después de la diálisis renal.Por cortesía del Dr. Eun-Young Kang, Department of Radiology, Korea University Medical Center, Guro Hospital, Seoul, South Korea.'], 'gr62': ['La enfermedad traqueobronquial se manifiesta en el estudio anatomopatológico por úlceras epiteliales focales o difusas (<xref rid="gr62" ref-type="fig">figura 6-62</xref>\n)\n)1090\n,\n1091. Las células infectadas de los bordes de la úlcera contienen inclusiones intranucleares eosinófilas características o aparecen como células únicas o multinucleadas con núcleos con aspecto de vidrio esmerilado. Estas células se pueden detectar en el esputo expectorado o en los lavados o cepillados bronquiales y son un dato convincente de infección del tracto respiratorio inferior por el VHS cuando no hay enfermedad herpética orofaríngea (que puede causar contaminación de la muestra)1092. La neumonía se suele caracterizar por necrosis alveolar y un exudado proteico con respuesta inflamatoria polimorfonuclear variable.\nFIGURA 6-62Traqueítis por herpes simple. La tráquea de este paciente quemado de 40 años de edad se ha abierto en la porción posterior y revela múltiples focos de ulceración, algunos de ellos cubiertos por una membrana piógena (flecha).Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr63': ['El patrón radiográfico característico de la neumonía aguda está formado por múltiples opacidades nodulares de 5 a 10 mm de diámetro (<xref rid="gr63" ref-type="fig">figura 6-63</xref>\n). También se pueden ver opacidades nodulares más pequeñas y nódulos de aspecto miliar, aunque son infrecuentes\n). También se pueden ver opacidades nodulares más pequeñas y nódulos de aspecto miliar, aunque son infrecuentes1111. Las opacidades suelen estar bien definidas en la periferia pulmonar, mientras que tienden a confluir cerca de los hilios y en las bases de los pulmones1112. Es frecuente la progresión rápida hacia la consolidación extensa del espacio aéreo. Se produce aumento del tamaño de los ganglios linfáticos hiliares, aunque quizás sea difícil apreciarlo a causa de la proximidad de la consolidación en el parénquima pulmonar vecino1109\n,\n1111., 1112., 1113.. El derrame pleural es infrecuente y prácticamente nunca es grande1114.FIGURA 6-63Neumonía aguda por varicela-zóster. Las radiografías posteroanterior (A) y lateral (B) revelan una enfermedad pulmonar generalizada con un patrón característico de consolidación del espacio aéreo. También se ven múltiples opacidades nodulares mal definidas. La paciente era una mujer de 42 años con un linfoma no hodgkiniano.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr64': ['La patogenia de la enfermedad pulmonar inducida por CMV es compleja y no se conoce totalmente. A juzgar por observaciones experimentales y anatomopatológicas parece claro que el virus produce una tisular directa en muchos casos1124. Los estudios clínicos y en animales de experimentación han aportado datos de que un mecanismo inmunitario puede participar también en la patogenia de algunos casos de enfermedad1124. La neumonía se puede manifestar desde el punto de vista anatomopatológico por múltiples nódulos hemorrágicos relativamente bien definidos de 0,1 a 1,5 cm de diámetro, diseminados aleatoriamente por el parénquima, o como enfermedad más difusa (lesión alveolar difusa o neumonitis intersticial)1125. Las células infectadas están muy aumentadas de tamaño y contienen inclusiones basófilas homogéneas, redondas u ovales, que ocupan la mayor parte del núcleo y están separadas de la membrana nuclear por un halo bien definido (núcleo en ojo de lechuza) (<xref rid="gr64" ref-type="fig">figura 6-64</xref>\n). También se pueden ver inclusiones intracitoplásmicas, que aparecen cuando ya están bien desarrolladas las inclusiones nucleares.\n). También se pueden ver inclusiones intracitoplásmicas, que aparecen cuando ya están bien desarrolladas las inclusiones nucleares.FIGURA 6-64Citomegalovirus. Una célula epitelial pulmonar infectada muestra una inclusión nuclear redonda intensamente basófila rodeada por un halo claro (la membrana nuclear está indicada por una flecha). También existen varias inclusiones intracitoplásmicas.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr65': ['Los signos radiográficos más frecuentes son las opacidades lineales bilaterales (patrón reticular), las opacidades en vidrio esmerilado y la consolidación parenquimatosa (<xref rid="gr65" ref-type="fig">figura 6-65</xref>\n)\n)1126. Las manifestaciones menos frecuentes incluyen opacidades nodulares pequeñas, un patrón reticulonodular y consolidación lobar46\n,\n1127 Los hallazgos de la TCAR habitualmente son una combinación de zonas de atenuación en vidrio esmerilado, consolidación parenquimatosa y opacidades nodulares o reticulonodulares (<xref rid="gr66" ref-type="fig">figura 6-66</xref>\n)\n)1128\n,\n1129. Las alteraciones son bilaterales y simétricas y tienden a afectar a todas las zonas pulmonares. Se observa derrame pleural en aproximadamente el 50% de los casos.FIGURA 6-65Neumonía aguda por citomegalovirus. La radiografía posteroanterior de tórax muestra una consolidación generalizada parcheada del espacio aéreo, más marcada en los lóbulos inferiores. Existe aumento ligero del tamaño del ventrículo izquierdo. El paciente había sido sometido a trasplante renal.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.FIGURA 6-66Neumonía por citomegalovirus. La TCAR muestra opacidades nodulares bilaterales de bordes irregulares y zonas de atenuación en vidrio esmerilado. Hay opacidades lineales irregulares en el lóbulo inferior. El paciente era un varón de 38 años sometido a un trasplante pulmonar bilateral.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr67': ['El VEB quizás sea más conocido como causa de la mononucleosis infecciosa, un síndrome que afecta de modo predominante a los adultos jóvenes y se caracteriza por faringitis, fiebre, adenopatías más o menos generalizadas, esplenomegalia y aumento de la cifra de linfocitos, muchos de ellos citológicamente atípicos, en sangre periférica. La enfermedad intratorácica es infrecuente, y se manifiesta con más frecuencia por aumento del tamaño de los ganglios linfáticos (<xref rid="gr67" ref-type="fig">figura 6-67</xref>\n) y/o neumonitis intersticial\n) y/o neumonitis intersticial1135. Típicamente el paciente refiere un cuadro que comienza de forma insidiosa con debilidad, malestar general, fiebre y molestias faríngeas. La tos espasmódica que produce pequeñas cantidades de esputo y la disnea son manifestaciones de la afectación del tracto respiratorio inferior.FIGURA 6-67Mononucleosis infecciosa. Paciente de 17 años con anamnesis y datos de laboratorio compatibles con mononucleosis infecciosa. Las imágenes de las radiografías posteroanterior (A) y lateral (B) demuestran un aumento marcado del tamaño de ambos hilios con un contorno lobulado típico de adenopatías. No existen datos de adenopatías mediastínicas ni de enfermedad pulmonar o pleural. Un mes más tarde la radiografía de tórax era normal.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr68': ['Los signos anatomopatológicos son sobre todo un infiltrado inflamatorio mononuclear, peribronquial y peribronquiolar (<xref rid="gr68" ref-type="fig">figura 6-68</xref>\n); en los casos más graves se observa ulceración epitelial y un infiltrado neutrófilo\n); en los casos más graves se observa ulceración epitelial y un infiltrado neutrófilo1148. Se produce un grado variable de inflamación e hiperplasia de las células de tipo II en el parénquima adyacente. Otros patrones histológicos que se han descrito ocasionalmente incluyen lesión alveolar difusa, neumonía organizada, hemorragia alveolar y un cuadro similar a la proteinosis alveolar1148\n,\n1149. No está claro hasta qué punto esos signos representan un efecto directo de los micoplasmas o son secundarios a otros mecanismos. Es posible la aparición de fibrosis intersticial como complicación a largo plazo1150.FIGURA 6-68Mycoplasma pneumoniae: bronquiolitis y neumonitis. El corte de una muestra de biopsia pulmonar abierta de un varón de 23 años con insuficiencia respiratoria rápidamente progresiva (A) muestra neumonitis intersticial focal entre leve y moderada e inflamación intensa centrada alrededor de un bronquiolo membranoso y un bronquiolo respiratorio (b). También se aprecia un grado ligero de inflamación intersticial alveolar. Otro campo de la misma biopsia (B) muestra la misma reacción en un bronquiolo respiratorio terminal.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr69': ['El patrón radiográfico típico es indistinguible del de muchas neumonías víricas y son opacidades intersticiales y/o del espacio aéreo (<xref rid="gr69" ref-type="fig">figura 6-69</xref>\n)\n)1151. En las fases tempranas la inflamación intersticial causa un patrón reticular fino1152, seguido por signos de consolidación del espacio aéreo que tiende a ser segmentaria, en contraste con la distribución no segmentaria de la neumonía bacteriana aguda del espacio aéreo (p. ej., la causada por S. pneumoniae)1153. La enfermedad se manifiesta de forma predominante en los lóbulos inferiores1154. El aumento del tamaño de los ganglios linfáticos hiliares es poco frecuente en adultos1155, pero ocurre en aproximadamente el 30% de los niños1156. Los derrames pleurales suelen ser pequeños y unilaterales1157.FIGURA 6-69Neumonía aguda por Mycoplasma pneumoniae. Las imágenes de las radiografías posteroanterior (A) y lateral (B) del pulmón izquierdo muestran una consolidación focal del espacio aéreo en la distribución de los segmentos lingular y posterior del lóbulo superior izquierdo.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr70': ['Los principales signos en la TCAR son opacidades nodulares centrolobulillares y lineales ramificadas con una distribución focal, engrosamiento de los fascículos broncovasculares y zonas de atenuación en vidrio esmerilado y consolidación lobulillar o segmentaria (<xref rid="gr70" ref-type="fig">figura 6-70</xref>\n)\n)1158. En muchos pacientes las zonas de consolidación tienen una distribución lobulillar.FIGURA 6-70Neumonía por Mycoplasma pneumoniae. La TCAR correspondiente al lóbulo inferior derecho revela nódulos pequeños (flechas) con una distribución predominantemente centrolobulillar y zonas de atenuación en vidrio esmerilado. La demarcación nítida entre los lóbulos pulmonares normales y anormales es compatible con una neumonía lobulillar.Tomado de Reittner P, Müller NL, Heyneman L et al: Mycoplasma pneumoniae pneumonia: Radiographic and high-resolution CT features in 28 patients. AJR Am J Roentgenol 174:37-41, 2000.'], 'gr71': ['Las manifestaciones radiográficas más frecuentes en el tórax son elevación del hemidiafragma derecho, derrame pleural y atelectasia o consolidación del lóbulo inferior derecho (<xref rid="gr71" ref-type="fig">figura 6-71</xref>\n)\n)1206a. La consolidación puede progresar hasta la formación de abscesos. La presencia de un absceso hepático y su extensión a través del hemidiafragma se pueden evaluar mediante TC o ecografía1209.FIGURA 6-71Amebiasis. La radiografía posteroanterior de tórax (A) muestra elevación del hemidiafragma derecho. La TC después de la administración de contraste intravenoso (B) presenta un derrame pleural derecho pequeño y zonas de atelectasia en el lóbulo inferior derecho. El corte a través del hígado (C) muestra una lesión quística grande en el lóbulo derecho hepático. El examen ecográfico (D) demuestra material ecógeno dentro de la lesión compatible con un absceso. El diagnóstico de amebiasis se demostró mediante aspiración con aguja fina bajo guía ecográfica. El paciente era un varón de 42 años de Corea del Sur con historia de fiebre y escalofríos desde una semana antes.Por cortesía del Dr. Soon Ju Cha, Inje University Hospital, Seoul, South Korea.'], 'gr72': ['En los pacientes inmunocompetentes la toxoplasmosis pulmonar suele originar un patrón reticular focal que recuerda a la neumonía vírica aguda; en algunos casos se produce consolidación del espacio aéreo. En ocasiones se pueden ver zonas mal definidas de opacidad en vidrio esmerilado, más fáciles de apreciar en la TCAR que en las radiografías (<xref rid="gr72" ref-type="fig">figura 6-72</xref>\n). Es frecuente el aumento del tamaño de los ganglios linfáticos hiliares\n). Es frecuente el aumento del tamaño de los ganglios linfáticos hiliares1213. En los pacientes que tienen sida las manifestaciones radiográficas son un patrón nodular bilateral, predominantemente grueso, o con menos frecuencia un patrón reticulonodular fino difuso indistinguible del que se observa en la NPC1214\nFIGURA 6-72Toxoplasmosis. Varón de 45 años sin trastornos inmunitarios conocidos que había presentado picos febriles desde hacía un mes. La radiografía de tórax (A) muestra una zona mal definida de aumento de la opacidad en el lóbulo inferior izquierdo. La TCAR (B) revela zonas de atenuación en vidrio esmerilado en ambos lóbulos inferiores y una zona focal de consolidación en el lóbulo inferior izquierdo. El estudio anatomopatológico de un ganglio linfático extirpado indicó el diagnóstico, que se confirmó por la serología positiva.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr73': ['Desde el punto de vista radiográfico, la afectación pulmonar es difusa y simétrica y se caracteriza por un patrón reticulonodular, acompañado a veces de nódulos de 2 a 5 mm de diámetro (<xref rid="gr73" ref-type="fig">figura 6-73</xref>\n); se afectan predominantemente las zonas pulmonares media e inferior. En algunos casos se produce aumento del tamaño de los ganglios linfáticos hiliares, y el derrame pleural es poco frecuente\n); se afectan predominantemente las zonas pulmonares media e inferior. En algunos casos se produce aumento del tamaño de los ganglios linfáticos hiliares, y el derrame pleural es poco frecuente1235\n,\n1236\nFIGURA 6-73Toxoplasmosis. Varón de 45 años sin trastornos inmunitarios conocidos que había presentado picos febriles desde hacía un mes. La radiografía de tórax (A) muestra una zona mal definida de aumento de la opacidad en el lóbulo inferior izquierdo. La TCAR (B) revela zonas de atenuación en vidrio esmerilado en ambos lóbulos inferiores y una zona focal de consolidación en el lóbulo inferior izquierdo. El estudio anatomopatológico de un ganglio linfático extirpado indicó el diagnóstico, que se confirmó por la serología positiva.Tomado de Fraser RS, Müller NL, Colman NC, Paré PD: Fraser and Paré\'s Diagnosis of Diseases of the Chest, 4th ed. Philadelphia, WB Saunders, 1999.'], 'gr74': ['Los quistes se ven característicamente en las radiografías como masas solitarias bien delimitadas, esféricas u ovales, rodeadas por pulmón normal (<xref rid="gr74" ref-type="fig">figura 6-74</xref>\n)\n)1252. Son múltiples en el 20%-30% de los pacientes. Su tamaño varía entre 1 y más de 20 cm de diámetro1253; los quistes más grandes se suelen ver en la enfermedad de tipo pastoral, mientras que los de la variedad selvática superan rara vez los 10 cm1249. La mayor parte de los quistes se localiza en los lóbulos inferiores, con más frecuencia en la región posterior que en la anterior y con algo más de frecuencia en el lado derecho que en el izquierdo1254. Aunque muchas veces son esféricos u ovales, también pueden tener una forma irregular, que algunos autores atribuyen al hecho de que cuando contactan con estructuras relativamente rígidas, como los fascículos broncovasculares, al crecer presentan melladuras y lobulaciones1252.FIGURA 6-74Quiste hidatídico. La radiografía posteroanterior de tórax (A) muestra una masa de 6 cm de bordes lisos en el pulmón izquierdo. La TC (B) revela una lesión quística que contiene líquido y que tiene valores de atenuación similares a los del agua (0 UH). El paciente era un varón asintomático de 51 años que se había dedicado a la caza durante varios años en el norte de Canadá.Tomado de Müller NL, Fraser RS, Colman NC, Paré PD: Radiologic Diagnosis of Diseases of the Chest. Philadelphia, WB Saunders, 2001.', 'La TC puede ser útil para identificar las membranas endoquísticas desprendidas o colapsadas, las membranas colapsadas de los quistes hijos y los quistes hijos intactos1257. El líquido del quiste tiene un valor de atenuación próximo a 0 UH (véase <xref rid="gr74" ref-type="fig">figura 6-74</xref>))1258. La RM también permite la diferenciación fiable entre quistes llenos de líquido y tumores sólidos1259\n,\n1260, ya que los quistes tienen una intensidad de señal baja en las imágenes potenciadas en T1 y una intensidad de señal alta y homogénea en las imágenes potenciadas en T2.'], 'gr75': ['Cuando se establece una comunicación entre el quiste y el árbol bronquial puede entrar aire en el espacio que hay entre el periquiste y el exoquiste y producir una semiluna fina alrededor de la periferia del quiste, el llamado signo del menisco o de la\nsemiluna\n1255. Una vez que el quiste se ha roto en la vía aérea, su membrana puede quedar flotando en el líquido residual dentro de la cavidad quística y dar lugar al clásico signo del nenúfar o del camalote (<xref rid="gr75" ref-type="fig">figura 6-75</xref>\n)\n)1256. Este aspecto se encuentra rara vez en la forma selvática de la enfermedad1250.FIGURA 6-75Quiste hidatídico roto. La masa homogénea bien circunscrita (A) de la porción media del pulmón izquierdo tiene un contorno liso pero algo lobulado. Cuatro años más tarde (B) el quiste contiene aire; la masa irregular presente en el fondo del quiste (flechas) corresponde a membranas colapsadas. El broncograma (C) muestra material de contraste dentro del quiste, que delinea las membranas.Por cortesía de Alfred Hospital, Melbourne, Australia.'], 'gr76': ['La radiografía de tórax es normal en aproximadamente el 20% de los pacientes en los que se identifican huevos de Paragonimus en el esputo1266. Las alteraciones más frecuentes son opacidades parenquimatosas y lesiones quísticas, que se ven en aproximadamente el 50% de los pacientes1267. Las opacidades parenquimatosas pueden estar mal definidas o pueden ser homogéneas, únicas o múltiples, y nodulares, subsegmentarias o segmentarias (<xref rid="gr76" ref-type="fig">figura 6-76</xref>\n). Las lesiones quísticas pueden medir entre 0,5 y 5 cm de diámetro y tienen paredes finas. Se pueden observar en zonas de consolidación o como sombras anulares aisladas. Las lesiones tienen con frecuencias una opacidad en semiluna u oval a lo largo de una cara del revestimiento interno; esa opacidad presenta atenuación de tejidos blandos en la TC y probablemente representa el parásito\n). Las lesiones quísticas pueden medir entre 0,5 y 5 cm de diámetro y tienen paredes finas. Se pueden observar en zonas de consolidación o como sombras anulares aisladas. Las lesiones tienen con frecuencias una opacidad en semiluna u oval a lo largo de una cara del revestimiento interno; esa opacidad presenta atenuación de tejidos blandos en la TC y probablemente representa el parásito1267. La comunicación entre los quistes y un bronquio se puede demostrar en la TC, y puede imitar una bronquiectasia1267. Se han identificado tractos o surcos irregulares que miden hasta 5 mm de diámetro y conectan quistes adyacentes tanto en las radiografías como en la TC de un pequeño número de pacientes. Los estudios en inmigrantes de EE.UU. que han residido en zonas endémicas muestran un patrón algo distinto en la radiografía de tórax, en el que las opacidades imitan a la tuberculosis posprimaria1265. Las alteraciones pleurales incluyen derrame unilateral o bilateral, hidroneumotórax y engrosamiento pleural1267.FIGURA 6-76Paragonimiasis: opacidades múltiples. La radiografía de tórax (A) muestra opacidades mal definidas en la zona media del pulmón derecho (flecha). La TCAR (B y C) presenta opacidades nodulares subpleurales de bordes mal definidos, así como una zona de consolidación subsegmentaria. El paciente era un varón surcoreano de 38 años al que se evaluó por dolor torácico inespecífico y tos.Por cortesía del Dr. Kyung Soo Lee, Samsung Medical Center, Seoul, South Korea.']} | Enfermedades infecciosas de los pulmones | null | None | 1136966400 | None | null | other | PMC7271218 | null | null | [
""
] | Fundamentos de las enfermedades del tórax. 2006 Jan 11;:222-336 | NO-CC CODE |
|
A-C, Thoracic imaging at day 6. A, Six days, later high-resolution CT imaging showed persistent multiple bilateral consolidations with predominant right-side distribution and increasing of bilateral pleural effusion (red arrows). B, Contrast-enhanced CT scan confirmed a large amount of right-sided pleural effusion with a slight enhancement on parietal pleura (yellow arrows). C, Thoracic ultrasound in the right mid-axillary line revealed moderate pleural effusion with atelectasis of the lower lobe. | gr2_lrg | 7 | 64ff959c239cb8f4f91ffc405f8504610f39734104575188d29d0547c5d16181 | gr2_lrg.jpg | multiple | multiple panels: images | [
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782,
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] | [{'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7287448/gr2_lrg.jpg', 'caption': 'A-C, Thoracic imaging at day 6. A, Six days, later high-resolution CT imaging showed persistent multiple bilateral consolidations with predominant right-side distribution and increasing of bilateral pleural effusion (red arrows). B, Contrast-enhanced CT scan confirmed a large amount of right-sided pleural effusion with a slight enhancement on parietal pleura (yellow arrows). C, Thoracic ultrasound in the right mid-axillary line revealed moderate pleural effusion with atelectasis of the lower lobe.', 'hash': '64ff959c239cb8f4f91ffc405f8504610f39734104575188d29d0547c5d16181'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7287448/gr1_lrg.jpg', 'caption': 'A-C, Thoracic imaging at baseline. A, High-resolution CT imaging showed multiple bilateral consolidations with inner air bronchogram sign (red arrows) with predominant right-side distribution. B, Contrast-enhanced CT scan ruled out pulmonary embolism, revealing small bilateral pleural effusion (yellow arrows). C, Thoracic ultrasound by convex probe array in right mid-axillary line confirmed demarcated consolidation (green circle) with inner air bronchogram sign (arrowhead).', 'hash': '59237e3276909c372f6c00dc3eca15b12e55ad0842d20d31dd34961f0b732858'}] | {'gr1_lrg': ['Chest radiography showed bilateral infiltrates, with prevalent distribution on the right side, and a CT scan confirmed bilateral, multilobar ground-glass opacities with multifocal consolidations, predominantly in the lower lobes and small bilateral pleural effusion; contrast-enhanced CT imaging was negative for pulmonary embolism (<xref rid="gr1_lrg" ref-type="fig">Figs 1</xref>A, A, <xref rid="gr1_lrg" ref-type="fig">1</xref>B). TUS examination by convex probe in the right mid-axillary line revealed demarcated consolidation with an inner air bronchogram sign (B). TUS examination by convex probe in the right mid-axillary line revealed demarcated consolidation with an inner air bronchogram sign (<xref rid="gr1_lrg" ref-type="fig">Fig 1</xref>C). Laboratory results documented lymphopenia (415/mmc), elevated levels of lactate dehydrogenase (270 U/L), D-dimer (706\xa0ng/mL), IL-6 (84 pg/mL), and C-reactive protein (30.4\xa0mg/dL) (C). Laboratory results documented lymphopenia (415/mmc), elevated levels of lactate dehydrogenase (270 U/L), D-dimer (706\xa0ng/mL), IL-6 (84 pg/mL), and C-reactive protein (30.4\xa0mg/dL) (Table\xa01\n). Results of urinary antigen tests for Legionella pneumophila and Streptococcus pneumoniae were negative.Figure\xa01A-C, Thoracic imaging at baseline. A, High-resolution CT imaging showed multiple bilateral consolidations with inner air bronchogram sign (red arrows) with predominant right-side distribution. B, Contrast-enhanced CT scan ruled out pulmonary embolism, revealing small bilateral pleural effusion (yellow arrows). C, Thoracic ultrasound by convex probe array in right mid-axillary line confirmed demarcated consolidation (green circle) with inner air bronchogram sign (arrowhead).Table\xa01Laboratory and Clinical Features at Baseline and at Day 6ParameterReference RangeDay 1Day 6WBC count (per mmc)4-10,0006,2002,870Platelet count (per mmc)150-4,000,000153,000217,000Hemoglobin, g/dL12.5-1714.214.1Absolute lymphocyte count (per mmc)1,000-4,000415761Lactate dehydrogenase, U/L≤ 240270257C-reactive protein, mg/dL≤ 0.630.41.9Procalcitonin, ng/mL≤ 0.050.440.03IL-6, pg/mL<584186Total protein, g/dL6-84.95.2Albumin, g/dL4-4.761.862.49Alanine aminotransferase, U/L≤ 404629Aspartate aminotransferase, U/L≤ 402726Creatinine, mg/dL0.6-1.400.850.71D-dimer, ng/mL0-3557061684Brain natriuretic peptide, ng/mL≤ 150…28Ratio partial pressure of oxygen/Fio2na175142'], 'gr2_lrg': ['Due to worsening of respiratory symptoms and gas exchanges, the patient’s CT scan and TUS evaluations were repeated after 6\xa0days, and both showed persistence of lung consolidations, mainly in the right lower lobes, and significant right pleural effusion (<xref rid="gr2_lrg" ref-type="fig">Fig 2</xref>\n). TUS-guided thoracentesis was therefore performed, removing 600\xa0mL of clear yellow pleural fluid; this sample was sent for differential cell counts, chemical analysis, cultures, cytologic examination, and SARS-CoV-2 RT-PCR. Cell count examination revealed predominant mononucleated cells (92%); chemical parameters showed an exudate according to the criteria of Light et\xa0al,\n). TUS-guided thoracentesis was therefore performed, removing 600\xa0mL of clear yellow pleural fluid; this sample was sent for differential cell counts, chemical analysis, cultures, cytologic examination, and SARS-CoV-2 RT-PCR. Cell count examination revealed predominant mononucleated cells (92%); chemical parameters showed an exudate according to the criteria of Light et\xa0al,9 pH was 7.35, and results of microbiologic tests for detection of both anaerobic and aerobic bacteria, mycobacteria, and fungi were negative. Cytologic analysis documented reactive mesothelial cells and lymphocytes. The SARS-CoV-2 RT-PCR assay revealed the presence of virus at a moderate viral load (6,776/mL) (Table\xa02\n).Figure\xa02A-C, Thoracic imaging at day 6. A, Six days, later high-resolution CT imaging showed persistent multiple bilateral consolidations with predominant right-side distribution and increasing of bilateral pleural effusion (red arrows). B, Contrast-enhanced CT scan confirmed a large amount of right-sided pleural effusion with a slight enhancement on parietal pleura (yellow arrows). C, Thoracic ultrasound in the right mid-axillary line revealed moderate pleural effusion with atelectasis of the lower lobe.Table\xa02Pleural Fluid CharacteristicsParameterResultsAppearanceClearColorYellowTotal protein, g/dL2.3 g/dLCholesterol, mg/dL50\xa0mg/dLLactate dehydrogenase, U/L168 U/LGlucose, mg/dL115\xa0mg/dLWBC count120/mcl (92%\xa0of mononucleated cells)CytologyReactive mesothelial cells and lymphocytesMicrobiologyNegativeSARS-CoV-2 (RT-PCR)\xa0Qualitatative (positive/negative)Positive\xa0Quantitative (copies/mL)6,776RT-PCR\xa0= reverse transcription real-time polymerase chain reaction; SARS-CoV-2\xa0= severe acute respiratory syndrome coronavirus\xa02.']} | First Detection of SARS-CoV-2 by Real-Time Reverse Transcriptase-Polymerase Chain Reaction Assay in Pleural Fluid | null | Chest | 1602399600 | [
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"{'Citation': 'Guidance for Corona Virus Disease 2019: Prevention, Control, Diagnosis and Management National Health Commission (NHC) of the PRC, General Office; National Administration of Traditional Chinese Medicine of the PRC, General Office. Available at: http://www.pmph.com/.'}",
"{'Citation': 'Adler Y., Charron P., Imazio M. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS) Eur Heart J. 2015;36:2921.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7539677'}, {'@IdType': 'pubmed', '#text': '26320112'}]}}",
"{'Citation': 'Ai T., Yang Z., Hou H. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020;2019:200642.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7233399'}, {'@IdType': 'pubmed', '#text': '32101510'}]}}",
"{'Citation': 'Guan W., Ni Z., Hu Y., Liang W., Ou C., He J. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Feb 28 NEJMoa2002032.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC7092819'}, {'@IdType': 'pubmed', '#text': '32109013'}]}}",
"{'Citation': 'Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med. 2017;69:e27–e54.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '28442101'}}}"
] | Chest. 2020 Oct 11; 158(4):e143-e146 | NO-CC CODE |
||
Neural activity varies as a function of tau-dot. Activity in (A) primary visual cortex (V1) and (B) Supplementary Motor Area (SMA) increased as tau-dot value decreased, indicating a parametric response to the increasing certitude of a collision (see Figure 2 for the behavioural corollary of this response). V1 activity was modulated during both allocentric (yellow) and egocentric (red) viewpoints, whereas SMA activity was modulated during egocentric viewpoints only. Activations are displayed on transverse (z = 9 mm) and coronal (y = 0 mm) slices of the averaged structural MRI of all 12 subjects. | fnhum-02-010-g004 | 7 | 6ff5f2682ed151d1a74ff2b86d5db9f39751790559086fdc9f112f6713773227 | fnhum-02-010-g004.jpg | multiple | multiple panels: images | [
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513,
250
] | [{'image_id': 'fnhum-02-010-g002', 'image_file_name': 'fnhum-02-010-g002.jpg', 'image_path': '../data/media_files/PMC2572212/fnhum-02-010-g002.jpg', 'caption': "Predictive value of tau-dot for making “contact” decisions. Mean performance (averaged across subjects) on TTC and colour tasks is plotted for each value of tau-dot for (A) allocentric and (B) egocentric viewpoints. Performance is measured as the proportion of trials in which the subject made a YES response (i.e. when the subject decided that a TTC trial would result in contact, or that a colour trial contained a colour-match). As expected, and for both alloentric and egocentric viewpoints, there was a significant relationship between tau-dot and percentage of trials judged to result in contact (♦), but no significant relationship between tau-dot and the percentage of trials judged to result in a colour-match (). Specifically, the lower the tau-dot value the more likely the subject was to make a “contact” decision. Fitted curves represent the result of the logistic regression analysis. Each value of tau-dot was calculated using distances between the car and wall and the car's motion parameters (Supplementary Material 2). A tau-dot value of −0.5 represents the objective cut-off between a contact and no-contact trial.", 'hash': '8e5479671df48fd5473dc4c55543f5e3d1641b7eebd9a0cb17502e21e20667f3'}, {'image_id': 'fnhum-02-010-g003', 'image_file_name': 'fnhum-02-010-g003.jpg', 'image_path': '../data/media_files/PMC2572212/fnhum-02-010-g003.jpg', 'caption': 'Task-specific networks. (A) Colour tasks preferentially activated visual area V4 (x, y, z\u2009=\u2009−18, −75, −12; 36, −60, −21) and intraparietal sulcus (IPS) (x, y, z\u2009=\u2009−30, −69, 39; 30, −66, 42) bilaterally during both allocentric and egocentric viewpoints. Activations are rendered onto a standard template brain, and superimposed onto coronal (y\u2009=\u2009−69\u2009mm) and transverse (z\u2009=\u2009−18\u2009mm) slices of the averaged structural MRI. (B) TTC tasks preferentially activated left pars opercularis of the inferior frontal lobe (part of ventral premotor cortex (vPMC)) (x, y, z\u2009=\u2009−51, 6, 3) and the supramarginal gyrus of left inferior parietal lobule (IPL) (x, y, z\u2009=\u2009−63, −45, 39) during both allocentric and egocentric viewpoints. Activations are rendered onto a standard template brain, and superimposed onto saggital (x\u2009=\u2009−51 and −60\u2009mm for vPMC and IPL activations respectively) and transverse (z\u2009=\u20093 and 39\u2009mm for vPMC and IPL activations respectively) slices of the averaged structural MRI. Areas of activity common to allocentric and egocentric viewpoints were derived from a logical AND inclusive-masking procedure.', 'hash': 'b2ec84199db407a57b73128960e06582988d9b3d173ae90499c7c29dd343490d'}, {'image_id': 'fnhum-02-010-g004', 'image_file_name': 'fnhum-02-010-g004.jpg', 'image_path': '../data/media_files/PMC2572212/fnhum-02-010-g004.jpg', 'caption': 'Neural activity varies as a function of tau-dot. Activity in (A)\u2009primary visual cortex (V1) and (B) Supplementary Motor Area (SMA) increased as tau-dot value decreased, indicating a parametric response to the increasing certitude of a collision (see Figure 2 for the behavioural corollary of this response). V1 activity was modulated during both allocentric (yellow) and egocentric (red) viewpoints, whereas SMA activity was modulated during egocentric viewpoints only. Activations are displayed on transverse (z\u2009=\u20099\u2009mm) and coronal (y\u2009=\u20090\u2009mm) slices of the averaged structural MRI of all 12 subjects.', 'hash': '6ff5f2682ed151d1a74ff2b86d5db9f39751790559086fdc9f112f6713773227'}, {'image_id': 'fnhum-02-010-g001', 'image_file_name': 'fnhum-02-010-g001.jpg', 'image_path': '../data/media_files/PMC2572212/fnhum-02-010-g001.jpg', 'caption': "Task structure and timing. (A) contact egocentric trial (B) colour allocentric trial. A briefly-presented cue (“contact” or “colour”) instructed subjects to make time-to-contact (TTC) or colour judgements for a forthcoming animation. During the animation subjects saw a car (the dark green foreground object in panel (A); the blue lower field object in panel (B)) approaching a wall (the light green object in panels (A) and (B)) either from the driver's point of view (egocentric condition (A)) or from a bird's eye view (allocentric condition (B)). The TTC task was to estimate potential contact between the car and wall while the colour task was to detect a possible colour-match between the car and wall. Subjects responded to “yes” or “no” response options presented on the screen, whose positions varied from trial to trial. Subjects made an index- or middle-finger right-handed button-press corresponding to whether their contact or colour-match judgement (yes/no) appeared on the left or right of the screen, respectively. The colour of the car changed gradually throughout its trajectory, while the colour of the wall remained constant (top panel). Exactly the same animations were used for the TTC and colour tasks. ISI\u2009=\u2009inter-stimulus interval; ITI\u2009=\u2009inter-trial interval.", 'hash': '614af9415d0820a3751b9ca7f1f7193352a30b5189e582a9d072960bff76af56'}] | {'fnhum-02-010-g001': ['One of our aims was to use an ecologically-valid stimulus display. To this end, subjects viewed a short (2–3.5\u2009s) animated simulation (Supplementary Material 1) of a car driving towards a wall (Figure <xref ref-type="fig" rid="fnhum-02-010-g001">1</xref>). Virtual reality software was used to create animated simulations of the car\'s trajectory, in a 3-dimensional space, using the distance and movement parameters defined in ). Virtual reality software was used to create animated simulations of the car\'s trajectory, in a 3-dimensional space, using the distance and movement parameters defined in Supplementary Material 2. Throughout the animation, the car decelerated at a constant rate but the animation ended before the car came to a complete stop. The colour of the car changed gradually throughout its trajectory, while the colour of the wall remained constant. The animation was shown either from the driver\'s point of view (egocentric, Figure <xref ref-type="fig" rid="fnhum-02-010-g001">1</xref>A) or from a bird\'s eye view (allocentric, Figure A) or from a bird\'s eye view (allocentric, Figure <xref ref-type="fig" rid="fnhum-02-010-g001">1</xref>B) and the same animations were used for both experimental (TTC) and control (COL) tasks. This resulted in a 2\u2009×\u20092 factorial design yielding four conditions: TTCego, TTCallo, COLego, COLallo.B) and the same animations were used for both experimental (TTC) and control (COL) tasks. This resulted in a 2\u2009×\u20092 factorial design yielding four conditions: TTCego, TTCallo, COLego, COLallo.', 'An experimental trial started with the presentation (500\u2009ms) of an informative cue, either the word “contact” or “colour”, which instructed subjects to make either contact or colour judgements on the forthcoming animated simulation. This was immediately followed by the 2–3.5\u2009s animation described above. Finally, following a pseudo-random delay (1–2\u2009s), a response-signal was presented for 1500\u2009ms. During this response period, subjects pressed one of two response buttons corresponding to their contact or colour judgement (“yes” for a contact/colour-match decision or “no” for a no-contact/no-colour-match decision). Due to the neuroanatomical overlap in areas related to motor preparation with those of timing [e.g. SMA (Coull et al., 2004; Lee et al., 1999)] and temporal expectation [e.g. left parietal cortex (Coull and Nobre, 1998; Rushworth et al., 2003)], we aimed to minimise motor preparation confounds as far as possible. Therefore, the manual response (index/middle finger) associated with each kind of judgement (yes/no) could change on a trial-by-trial basis. Specifically, the words “yes” or “no” could appear on either the left or right side of the screen (see Figure <xref ref-type="fig" rid="fnhum-02-010-g001">1</xref>). If the word corresponding to the subject\'s judgement appeared on the left, the subject responded with the index finger of their right hand, and if it appeared on the right they responded with their middle finger. In this way, even if subjects made their decision (on a cognitive level) during presentation of the animation, they could not begin to prepare the appropriate response (at the motor level) until presentation of the response signal, thus dissociating processes of temporal expectation and motor preparation. Index-/middle-finger responses were counter-balanced for yes/no judgements across all trials. Inter-trial intervals varied pseudo-randomly from 1–2\u2009s. All subjects performed a training session consisting of 16 trials per condition, prior to fMRI scanning.). If the word corresponding to the subject\'s judgement appeared on the left, the subject responded with the index finger of their right hand, and if it appeared on the right they responded with their middle finger. In this way, even if subjects made their decision (on a cognitive level) during presentation of the animation, they could not begin to prepare the appropriate response (at the motor level) until presentation of the response signal, thus dissociating processes of temporal expectation and motor preparation. Index-/middle-finger responses were counter-balanced for yes/no judgements across all trials. Inter-trial intervals varied pseudo-randomly from 1–2\u2009s. All subjects performed a training session consisting of 16 trials per condition, prior to fMRI scanning.', 'We then examined performance as a function of the tau-dot value for each trial (Figure <xref ref-type="fig" rid="fnhum-02-010-g001">2</xref>). Logistic regression analysis revealed a significant correlation between tau-dot value and the percentage of trials judged to result in contact (a “yes” decision) for both the TTCego [). Logistic regression analysis revealed a significant correlation between tau-dot value and the percentage of trials judged to result in contact (a “yes” decision) for both the TTCego [R2(13)\u2009=\u20090.60, p\u2009<\u20090.001] and TTCallo [R2(13)\u2009=\u20090.79, p\u2009<\u20090.001] conditions. This indicates that the tau-dot value significantly predicted whether subjects would judge a particular scenario to result in contact or not. The lower the tau-dot value, the more likely subjects were to make a contact rather than no-contact decision. Conversely, there was no significant correlation between tau-dot value and the percentage of trials judged to result in a colour-match (a “yes” decision) for either the COLego [R2(13)\u2009=\u20090.03, ns] or COLallo [R2(13)\u2009=\u20090.002, ns] conditions. As expected, this suggests that tau-dot value had no predictive value for making colour judgements. Finally, in order to ensure that dynamic variables other than tau-dot could not also significantly predict TTC performance, we performed two additional logistic regression analyses between performance and (1) the car\'s final velocity and (2) the duration for which the animation was presented. Neither velocity nor duration significantly correlated with TTC performance in either the allocentric [R2(13)\u2009=\u20090.29 and 0.16, ns, for velocity and duration respectively] or egocentric [R2(13)\u2009=\u20090.13 and 0.05, ns, for velocity and duration respectively] condition.', 'Neural activity varies as a function of tau-dot. Activity in (A)\u2009primary visual cortex (V1) and (B) Supplementary Motor Area (SMA) increased as tau-dot value decreased, indicating a parametric response to the increasing certitude of a collision (see Figure <xref ref-type="fig" rid="fnhum-02-010-g001">2</xref> for the behavioural corollary of this response). V1 activity was modulated during both allocentric (yellow) and egocentric (red) viewpoints, whereas SMA activity was modulated during egocentric viewpoints only. Activations are displayed on transverse ( for the behavioural corollary of this response). V1 activity was modulated during both allocentric (yellow) and egocentric (red) viewpoints, whereas SMA activity was modulated during egocentric viewpoints only. Activations are displayed on transverse (z\u2009=\u20099\u2009mm) and coronal (y\u2009=\u20090\u2009mm) slices of the averaged structural MRI of all 12 subjects.', 'Behavioural data were extremely similar to previous psychophysical examinations of allocentric and egocentric TTC tasks (Bootsma and Craig, 2003), both in terms of performance accuracy and the predictive value of tau-dot. The objective value of tau-dot on any given trial was a good predictor of subjective perception, such that lower tau-dot values corresponded to an increased likelihood of making a contact judgement (sure-hits), while higher tau-dot values corresponded to increased likelihood of making a no-contact judgement (sure-misses). Signal Detection analysis revealed that egocentric tasks elicited a significantly higher incidence of false alarms than allocentric ones, such that subjects were more likely to make “contact” decisions, even for non-contact trials (Figure <xref ref-type="fig" rid="fnhum-02-010-g001">2</xref>). This relatively liberal response bias for egocentric versus allocentric trials, also observed by Bootsma and Craig (). This relatively liberal response bias for egocentric versus allocentric trials, also observed by Bootsma and Craig (2003), may indicate increased caution for head-on approaches that would allow situations potentially harmful to the observer to be avoided. Increased caution may be implemented either by simply categorising all ambiguous trials as collision trials in a “better safe than sorry” approach and/or by subjectively shifting the point of potential contact forward to a location somewhat in front of the actual point of contact (i.e. to a point somewhere in front of the car\'s bonnet) so as to provide a larger safety margin.'], 'fnhum-02-010-g003': ['Egocentric representations of colour-processing activated visual area V1, visual area V4 bilaterally, intraparietal sulcus bilaterally and left middle frontal gyrus. Allocentric representations of colour-processing activated a more dorsal region of visual area V1, visual area V4 bilaterally, intraparietal sulcus bilaterally, left middle frontal gyrus and retrosplenial cortex (Table 2). Inclusive masking revealed that areas common to both egocentric and allocentric viewpoints were V4 bilaterally and intraparietal sulcus bilaterally (Figure <xref ref-type="fig" rid="fnhum-02-010-g003">3</xref>A).A).', 'Egocentric representations of TTC activated left ventral premotor cortex/frontal operculum, left inferior parietal cortex, and primary visual area V1. Allocentric representations of TTC activated a more distributed and bilateral network, including ventral premotor cortex/frontal operculum, medial rostral prefrontal cortex, inferior parietal cortex, dorsolateral posterior visual cortex, posterior cingulate and precuneus, as well as left-lateralised visual area V5 (also known as hMT+) (Table 3). Inclusive masking revealed that the only areas common to both egocentric and allocentric viewpoints were left pars opercularis of the inferior frontal lobe (BA44 and part of ventral premotor cortex) and the supramarginal gyrus of left inferior parietal cortex (BA40) (Figure <xref ref-type="fig" rid="fnhum-02-010-g003">3</xref>B). Interaction analyses revealed that the only region selectively activated by egocentric, rather than allocentric, representations of TTC was primary visual area V1 (B). Interaction analyses revealed that the only region selectively activated by egocentric, rather than allocentric, representations of TTC was primary visual area V1 (x, y, z co-ordinates\u2009=\u2009−6, −105, 6\u2009mm) while the only region selectively activated by allocentric, rather than egocentric, representations of TTC was left-lateralised visual area V5 (x, y, z co-ordinates\u2009=\u2009−54, −69, 3\u2009mm).', 'Estimating the time-to-contact (TTC) of approaching objects is critical for formulating future action plans. We used an ecologically valid driving simulation, in which a braking car approached a distant wall, to index the use of TTC information in assessing the potential for collision. This task did not require an explicit temporal estimate of TTC but, rather, a prediction of what would happen at a specific moment in time. Event-related fMRI data showed selective activation of left pars opercularis of the inferior frontal lobe (part of ventral premotor cortex, and also known as frontal operculum) and the supramarginal gyrus of left inferior parietal cortex during TTC tasks (Figure <xref ref-type="fig" rid="fnhum-02-010-g003">3</xref>B). We confirmed the B). We confirmed the functional specificity of these findings by comparing TTC tasks to colour controls that were matched for both visuo-motor task demands and task difficulty. We also confirmed the visuo-spatial generality of the TTC-induced activity by demonstrating activation of this network whether the subject was viewing the approach from an egocentric (driver\'s viewpoint) or allocentric (bird\'s-eye view) viewpoint. However, we also found differences between these two conditions such that allocentric judgements selectively activated visual area V5 (hMT+), while egocentric TTC judgements selectively activated primary visual cortex, area V1. V1 activity also varied as a function of the increasing certainty of potential collision. Finally, there was notable overlap between the left-sided premotor-parietal regions activated by the TTC task and those previously implicated in a temporal attentional orienting task (Coull and Nobre, 1998). Despite widely-differing visual and task demands, both paradigms encourage subjects to use predictive information (stimulus motion or attentional cues) to project forwards to a precise moment in time. Based on the anatomical and functional correspondence between these two paradigms, we therefore suggest that left ventral premotor and parietal cortices are critically involved in temporal prediction.'], 'fnhum-02-010-g004': ['Linear modulations indexed the likelihood of making a contact versus no-contact judgement. The lower the tau-dot value (i.e. the more likely to be associated with a contact judgement) the more activity increased in visual area V1/2 for both egocentric and allocentric viewpoints (Figure <xref ref-type="fig" rid="fnhum-02-010-g004">4</xref>A), and additionally in SMA for egocentric viewpoints only (Figure A), and additionally in SMA for egocentric viewpoints only (Figure <xref ref-type="fig" rid="fnhum-02-010-g004">4</xref>B). The higher the tau-dot value (i.e. the more likely to be associated with a no-contact judgement), the more activity increased in anterior cingulate for both egocentric and allocentric viewpoints, and additionally in left IPS, bilateral inferior frontal cortex and left ventromedial visual cortex for egocentric viewpoints only (Table B). The higher the tau-dot value (i.e. the more likely to be associated with a no-contact judgement), the more activity increased in anterior cingulate for both egocentric and allocentric viewpoints, and additionally in left IPS, bilateral inferior frontal cortex and left ventromedial visual cortex for egocentric viewpoints only (Table 4).']} | Using Time-to-Contact Information to Assess Potential Collision Modulates Both Visual and Temporal Prediction Networks | [
"collision",
"timing",
"prediction",
"attention",
"fMRI",
"visual",
"parietal",
"premotor"
] | Front Hum Neurosci | 1221289200 | Rtt109, also known as KAT11, is a recently characterized fungal-specific histone acetyltransferase (HAT) that modifies histone H3 lysine 56 (H3K56) to promote genome stability. Rtt109 does not show sequence conservation with other known HATs and depends on association with either of two histone chaperones, Asf1 or Vps75, for HAT activity. Here we report the X-ray crystal structure of an Rtt109-acetyl coenzyme A complex and carry out structure-based mutagenesis, combined with in vitro biochemical studies of the Rtt109-Vps75 complex and studies of Rtt109 function in vivo. The Rtt109 structure reveals noteworthy homology to the metazoan p300/CBP HAT domain but exhibits functional divergence, including atypical catalytic properties and mode of cofactor regulation. The structure reveals a buried autoacetylated lysine residue that we show is also acetylated in the Rtt109 protein purified from yeast cells. Implications for understanding histone substrate and chaperone binding by Rtt109 are discussed. | [
"Acetyl Coenzyme A",
"Acetylation",
"Animals",
"Binding Sites",
"Crystallography, X-Ray",
"Histone Acetyltransferases",
"Histones",
"Lysine",
"Models, Molecular",
"Mutagenesis",
"Mutagens",
"Mutant Proteins",
"Protein Structure, Secondary",
"Saccharomyces cerevisiae",
"Saccharomyces cerevisiae Proteins",
"Structural Homology, Protein",
"Structure-Activity Relationship",
"p300-CBP Transcription Factors"
] | other | PMC2572212 | null | 33 | [
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] | Front Hum Neurosci. 2008 Sep 13; 2:10 | NO-CC CODE |
|
Head computed tomography for the first time came to the emergency room (A) and at the next two weeks after the incident (B) | OAMJMS-6-1446-g002 | 7 | 08911994237f8e1ecfc57049b8247a637f24b5cc1b9f92007a66221ec59e0443 | OAMJMS-6-1446-g002.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
549,
339
] | [{'image_id': 'OAMJMS-6-1446-g001', 'image_file_name': 'OAMJMS-6-1446-g001.jpg', 'image_path': '../data/media_files/PMC6108786/OAMJMS-6-1446-g001.jpg', 'caption': 'Skull radiograph lateral view; marker (arrow) and the pellet (opaque round shape material)', 'hash': 'b4b6ebd9167bdf1b6f23252bef019759d123e981b2644a6c9259cc3bc2418847'}, {'image_id': 'OAMJMS-6-1446-g002', 'image_file_name': 'OAMJMS-6-1446-g002.jpg', 'image_path': '../data/media_files/PMC6108786/OAMJMS-6-1446-g002.jpg', 'caption': 'Head computed tomography for the first time came to the emergency room (A) and at the next two weeks after the incident (B)', 'hash': '08911994237f8e1ecfc57049b8247a637f24b5cc1b9f92007a66221ec59e0443'}, {'image_id': 'OAMJMS-6-1446-g004', 'image_file_name': 'OAMJMS-6-1446-g004.jpg', 'image_path': '../data/media_files/PMC6108786/OAMJMS-6-1446-g004.jpg', 'caption': 'The pellet', 'hash': '25c5c377f8e14db0d1e30a49689c8fc97bc57b461908563f0fe1d2f324343d0f'}, {'image_id': 'OAMJMS-6-1446-g003', 'image_file_name': 'OAMJMS-6-1446-g003.jpg', 'image_path': '../data/media_files/PMC6108786/OAMJMS-6-1446-g003.jpg', 'caption': 'The C-arm to detect the position of the pellet (A) and draw site marking on the right occipital region (B)', 'hash': '8dc4a6b2a99f3837fbfe5b1c8c740849922fe5201f5ddfc38c2351d1452c54ca'}] | {} | An Intracerebral Penetration of Air Shotgun Pellet in Toddler: A Case without Neurological Sequelae | [
"Air shotgun pellet",
"Intracerebral",
"Toddler"
] | Open Access Maced J Med Sci | 1534489200 | [{'@Label': 'BACKGROUND', '@NlmCategory': 'BACKGROUND', '#text': 'Knee osteoarthritis is a chronic degenerative disease, known as the most common cause of difficulty walking in older adults and subsequently is associated with slow walking. Functional decline, increased risk of falls and the presence of pain are, in many studies, related to the muscle weakness caused by osteoarthritis especially weakness of the quadriceps muscles. Many studies have shown that the strength of the quadriceps femoris muscle can affect gait, by improving or weakening it. Kinesio Tape is a physiotherapeutic technique, which reduces pain and increases muscular strength by irritating the skin receptors.'}, {'@Label': 'AIM', '@NlmCategory': 'OBJECTIVE', '#text': 'This study aimed to verify if the application of Kinesio Tape on quadriceps femoris muscle increases gait speed while decreasing the time needed to accomplish the 10-meter walk test in patients with knee osteoarthritis and also in subjects without knee osteoarthritis.'}, {'@Label': 'METHOD', '@NlmCategory': 'METHODS', '#text': 'In this study, we observed the change of gait speed with the help of the 10-meter walk test before, one day and three days after the application of Kinesio Tape in quadriceps femoris muscle. We compared the results of the time needed to perform the 10-meter walk in two groups. In the first group, the Patients group, participated 102 out-patients with a clinical diagnosis of primary knee osteoarthritis, while in the second group, the Control group, participated 73 subjects with a main excluding criterion a clinical diagnosis of primary knee osteoarthritis.'}, {'@Label': 'RESULTS', '@NlmCategory': 'RESULTS', '#text': 'Our results indicated that there was a significant decrease of time needed to perform the 10-meter walk test in both groups three days after application of Kinesio Tape on quadriceps femoris muscle. However, there was not a significant change one day after the application of Kinesio Tape compared before its application in both groups.'}, {'@Label': 'CONCLUSIONS', '@NlmCategory': 'CONCLUSIONS', '#text': 'Our results indicated that there was a significant decrease in time needed to accomplish the 10-meter walk test. Kinesio Tape is a technique that can be used especially when changing walking stereotypes is a long-term goal of the treatment.'}] | [] | other | PMC6108786 | null | 41 | [
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"{'Citation': 'http://www.rehabmeasures.org/PDF%20Library/10%20Meter%20Walk%20Test%20Instructions.pdf .'}",
"{'Citation': 'Choi YK, Nam CW, Lee JH, et al. The effects of taping prior to PNF treatment on lower extremity proprioception of hemiplegic patients. J Phys Ther Sci. 2013;25:1119–1122. https://doi.org/10.1589/jpts.25.1119 PMid:24259927 PMCid: PMC3818771.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3818771'}, {'@IdType': 'pubmed', '#text': '24259927'}]}}",
"{'Citation': 'Kase K, Wallis J, Kase T. Clinical therapeutic application of the kinesio taping method. Tokyo (Japan): Ken Ikai Co Ltd; 2003.'}",
"{'Citation': 'Huang CY, Hsieh TH, Lu SC, Su FC. Effect of the Kinesiotape to muscle activity and vertical jump performance in healthy inactive people. Biomed Eng Online. 2011;10(1):70. https://doi.org/10.1186/1475-925X-10-70 PMid:21831321 PMCid: PMC3174125.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3174125'}, {'@IdType': 'pubmed', '#text': '21831321'}]}}",
"{'Citation': 'Karlsson J, Andreasson GO. The effect of external ankle support in chronic lateral ankle joint instability. An electromyographic study. The American Journal of Sports Medicine. 1992;20(3):257–261. https://doi.org/10.1177/036354659202000304 PMid:1636854.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '1636854'}}}",
"{'Citation': 'Kase K, Wallis J, Kase T. Clinical therapeutic applications of the kinesio taping method. Tokyo: Ken Ikai Co. Ldt; 2003. p. 348.'}",
"{'Citation': 'Thelen MD, Dauber JA, Stoneman PD. (2008). The Clinical Efficacy of Kinesio Tape for Shoulder Pain. Journal of Orthopaedic and Sports Phycical Therapy. 2008;38:389–395. https://doi.org/10.2519/jospt.2008.2791 PMid:18591761.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18591761'}}}",
"{'Citation': 'Kim H, Lee B. The effects of kinesio tape on isokinetic muscular function of horse racing jockeys. J Phys Ther Sci. 2013;25(10):1273–7. https://doi.org/10.1589/jpts.25.1273 PMid:24259774 PMCid: PMC3820175.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3820175'}, {'@IdType': 'pubmed', '#text': '24259774'}]}}",
"{'Citation': 'Vercelli S, Sartorio F, Foti C, Colletto L, Virton D, Ronconi G, et al. Immediate effects of kinesiotaping on quadriceps muscle strength: a single-blind, placebo-controlled crossover trial. Clin J Sport Med. 2012;22(4):319–26. https://doi.org/10.1097/JSM.0b013e31824c835d PMid:22450591.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '22450591'}}}",
"{'Citation': 'Chang HY, Chou KY, Lin JJ, Lin CF, Wang CH. Immediate effect of forearm Kinesio taping on maximal grip strength and force sense in healthy collegiate athletes. Phys Ther Sport. 2010;11(4):122–7. https://doi.org/10.1016/j.ptsp.2010.06.007 PMid:21055705.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '21055705'}}}",
"{'Citation': 'Słupik A, Dwornik M, Białoszewski D, Zych E. Effect of Kinesio Taping on bioelectrical activity of vastus medialis muscle. Preliminary report. Ortop Traumatol Rehabil. 2007;9(6):644–51. PMid:18227756.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '18227756'}}}",
"{'Citation': 'Lins CA, Neto FL, Amorim AB, Macedo LB, Brasileir JS. Kinesio Taping does not alter neuromuscular performance of femoral quadriceps or lower limb function in healthy subjects: randomized, blind, controlled, clinical trial. Man Ther. 2013;18(1):41–5. https://doi.org/10.1016/j.math.2012.06.009 PMid:22796389.', 'ArticleIdList': {'ArticleId': {'@IdType': 'pubmed', '#text': '22796389'}}}",
"{'Citation': 'Stedge HL, Kroskie RM, Docherty CL. Kinesio Taping and the circulation and endurance ratio of the gastrocnemius muscle. Journal of Athletic Training. 2012;47(6):635–642. https://doi.org/10.4085/1062-6050-47.5.15 PMid:23182011 PMCid: PMC3499887.', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC3499887'}, {'@IdType': 'pubmed', '#text': '23182011'}]}}",
"{'Citation': 'Ward E. Sports performance, placebo effects and kinesio-tape. 2013. https://sportandperformancepsych.wordpress.com/2013/08/29/sports-performance-and-placebo-effects/'}"
] | Open Access Maced J Med Sci. 2018 Aug 17; 6(8):1446-1449 | NO-CC CODE |
|
Ghon lesion and Rhanke complex. Coronal reformation chest CT image (bone windows) of a patient previously exposed to Mycobacterium tuberculosis shows a calcified right lower lobe nodule (arrow), together with a calcified right hilar node (i.e., Rhanke complex) (arrow). | gr23 | 7 | ede94113c59a632d1f7a948d0f7d29808a67fb5ab734165253c14324b1055c71 | gr23.jpg | multiple | multiple panels: images | [
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"computerized tomography"
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320,
318
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There is a mass in a large, right upper lobe cavity, with air dissecting into the cavity producing air crescents (arrows).', 'hash': 'eae09f5cf662d2b2aeeb8f612d9378e9fe14b9999eafe06f8132346e505d8e53'}, {'image_id': 'gr47', 'image_file_name': 'gr47.jpg', 'image_path': '../data/media_files/PMC7310947/gr47.jpg', 'caption': 'No caption found', 'hash': '1a34938df383c18a8cfb4befe2967e27afecf577ed558335eb187fa949166c23'}, {'image_id': 'gr35', 'image_file_name': 'gr35.jpg', 'image_path': '../data/media_files/PMC7310947/gr35.jpg', 'caption': 'Healed histoplasmosis is characterized by multiple, small, calcified nodules in both lungs and by densely calcified hilar and mediastinal nodes.', 'hash': 'bc266a8a8d7729e755665859b8c0068886f84572bef1d869608137ed3b2c784e'}, {'image_id': 'gr49', 'image_file_name': 'gr49.jpg', 'image_path': '../data/media_files/PMC7310947/gr49.jpg', 'caption': 'No caption found', 'hash': '54d9dc7416ca1ae175d8fcb0d0593965478496634504b0000edccddb51bd473c'}, {'image_id': 'gr32', 'image_file_name': 'gr32.jpg', 'image_path': '../data/media_files/PMC7310947/gr32.jpg', 'caption': 'Atypical mycobacterial infection. Chest CT of a patient with emphysema shows the appearance of classic atypical mycobacterial infection. Biapical fibronodular opacities (arrows) are accompanied by architectural distortion resembling the appearance of reactivation tuberculosis.', 'hash': 'd6ae9fe50960bd36399053ff6cb94660297b9bea07543e5f0592d8432b3bc1e5'}, {'image_id': 'gr2', 'image_file_name': 'gr2.jpg', 'image_path': '../data/media_files/PMC7310947/gr2.jpg', 'caption': 'Anteroposterior view of a patient with Klebsiella pneumonia shows homogeneous opacity of the right upper lobe with slight bulging of the minor fissure (arrow).', 'hash': '282bc9f377f5a9afee1ffe30ac9085049ac1c802599b5d3dae5125348f42acb8'}, {'image_id': 'gr5', 'image_file_name': 'gr5.jpg', 'image_path': '../data/media_files/PMC7310947/gr5.jpg', 'caption': 'Acute interstitial pneumonia due to varicella (chickenpox). Coned-down view of the right lung demonstrates a fine reticulonodular pattern, which is more prominent centrally.', 'hash': '79acd03697e41babd430c9eb97de19b02fcf6300dd13c65f50ffcfcb05be9e67'}, {'image_id': 'gr27a', 'image_file_name': 'gr27a.jpg', 'image_path': '../data/media_files/PMC7310947/gr27a.jpg', 'caption': 'Bronchogenic spread of tuberculosis. A, CT shows a cavitary nodule communicating with the right upper lobe posterior segment bronchus (single arrow), with associated centrilobular nodular opacities in the superior segment of the right lower lobe (three arrows). B, CT of another patient shows a typical tree-in-bud pattern. Centrilobular nodules and branching opacities can be identified close to the pleural surface (arrows).', 'hash': '11e31e2a360ab74c2e22da43bda1471c74788363d34a553408859bac0d271976'}, {'image_id': 'gr18', 'image_file_name': 'gr18.jpg', 'image_path': '../data/media_files/PMC7310947/gr18.jpg', 'caption': 'Tree-in-bud appearance. Peripheral branching opacities (single arrow) and centrilobular nodules 2 to 3\xa0mm deep to the pleura (double arrows) can be identified. The appearance results from small airways filled with secretions and inflammatory debris.', 'hash': '68e5acde0ffba6a97ccfd39681fb275fbcae4185cb76040ce57187df207f6efc'}, {'image_id': 'gr16', 'image_file_name': 'gr16.jpg', 'image_path': '../data/media_files/PMC7310947/gr16.jpg', 'caption': 'Legionnaires’ disease. A, The posteroanterior chest radiograph shows consolidation involving the right middle lobe and left middle lung zones. B, Twenty-four hours later, the consolidation has become more extensive bilaterally.', 'hash': '8b7e55d3b1e7d006ddc5ddbd662e9a778df188deee5ec5417f9145d125eff61d'}, {'image_id': 'gr23', 'image_file_name': 'gr23.jpg', 'image_path': '../data/media_files/PMC7310947/gr23.jpg', 'caption': 'Ghon lesion and Rhanke complex. Coronal reformation chest CT image (bone windows) of a patient previously exposed to Mycobacterium tuberculosis shows a calcified right lower lobe nodule (arrow), together with a calcified right hilar node (i.e., Rhanke complex) (arrow).', 'hash': 'ede94113c59a632d1f7a948d0f7d29808a67fb5ab734165253c14324b1055c71'}, {'image_id': 'gr24', 'image_file_name': 'gr24.jpg', 'image_path': '../data/media_files/PMC7310947/gr24.jpg', 'caption': 'Reactivation tuberculosis. Patchy areas of consolidation involve the left upper lobe and superior segment of the left lower lobe. There is also evidence of some volume loss with a shift of the trachea to the left, a common finding with Mycobacterium tuberculosis infection, even in the early stages of disease. Nodular lesions can be identified in the right upper lobe.', 'hash': '38f96660a57945411bc95a6abc484cda94feb89a94ab71699622e277574edf81'}, {'image_id': 'gr4', 'image_file_name': 'gr4.jpg', 'image_path': '../data/media_files/PMC7310947/gr4.jpg', 'caption': 'Bronchopneumonia. The posteroanterior view demonstrates bilateral, patchy, and inhomogeneous opacities, which have become confluent in some areas. The patient was diagnosed with viral influenza pneumonia.', 'hash': '81b97525ffeab0bbb71cb18506916f1feaa54bda85f466b7ed97cfaa7ead0cf2'}, {'image_id': 'gr11b', 'image_file_name': 'gr11b.jpg', 'image_path': '../data/media_files/PMC7310947/gr11b.jpg', 'caption': 'Parapneumonic effusion (pneumococcal pneumonia). A, The posteroanterior view shows a right upper lobe consolidation. B, An oblique view 2 days later demonstrates a right effusion.', 'hash': '2d4a95fcb07048abaf2335f00f3c656a467fe9249c9d6302a9e4f12a119be8b4'}, {'image_id': 'gr3', 'image_file_name': 'gr3.jpg', 'image_path': '../data/media_files/PMC7310947/gr3.jpg', 'caption': 'CT of a pneumococcal left upper lobar consolidation shows clearly defined air bronchograms and evidence of cavitation.', 'hash': '1f9adef46f727850d904191a3864eb7e89d34e47fa8dbcef84571a511bc7f6e5'}, {'image_id': 'gr33', 'image_file_name': 'gr33.jpg', 'image_path': '../data/media_files/PMC7310947/gr33.jpg', 'caption': 'Mycobacterial avium complex infection. Three selected images from a chest CT study of an elderly woman show scattered nodules and peripheral areas of bronchiectasis with mucous plugging (arrows).', 'hash': 'dcac9cef81e195ae9d5b0dad475f07ee84038d45586d8f22d32b3597a19ee2f4'}, {'image_id': 'gr34', 'image_file_name': 'gr34.jpg', 'image_path': '../data/media_files/PMC7310947/gr34.jpg', 'caption': 'CT shows acute histoplasmosis. A, The lung windows demonstrate multiple, bilateral pulmonary nodules. B, On the mediastinal windows, there is adenopathy in the aorticopulmonary window (arrow).', 'hash': 'f36b5916ecc109f43414061f3f58a636d43fd4639d6cc20eea8c4faeca50e986'}, {'image_id': 'gr48', 'image_file_name': 'gr48.jpg', 'image_path': '../data/media_files/PMC7310947/gr48.jpg', 'caption': 'No caption found', 'hash': '8b4c1f210282514d0551a5aeaa5ee09b98e862bf6b0d9729d861d4b2d748197b'}, {'image_id': 'gr46', 'image_file_name': 'gr46.jpg', 'image_path': '../data/media_files/PMC7310947/gr46.jpg', 'caption': 'Inhalational anthrax. Contrast-enhanced CT scan of the chest shows diffuse widening of mediastinal and hilar regions due to a combination of widespread edema and enlarged lymph nodes. High-attenuation foci in the right paratracheal soft tissue (arrows) likely are caused by hemorrhagic foci in the lymph nodes. Notice the bilateral pleural effusions.', 'hash': '4c0cba7c28ff624c29de6a5a3154e7c8aebca6c846bd9f10eb9e2f2885933b2e'}, {'image_id': 'gr41', 'image_file_name': 'gr41.jpg', 'image_path': '../data/media_files/PMC7310947/gr41.jpg', 'caption': 'Echinococcal cysts. Both lungs contain multiple nodules, some of which are cavitated. A meniscus or crescent can be identified (white arrows) in the large cyst in the left lung, which also displays an air-fluid level and water lily sign (black arrow).', 'hash': '5bfe25e1cb8f7e5608ad37ad71ec30e32c8b752708d3b7430a8f1a10cf4b2dfe'}, {'image_id': 'gr25', 'image_file_name': 'gr25.jpg', 'image_path': '../data/media_files/PMC7310947/gr25.jpg', 'caption': 'Cavitary tuberculosis. The posteroanterior chest radiograph shows multiple cavities in the left upper lobe. A thick-walled cavity can be seen lateral to the left hilum. There is pronounced volume loss in the left upper lobe and apical pleural thickening.', 'hash': 'c50b207e8216d7b10f33cc4b0fecac2a585fde27fada7e3d773d73700fef0693'}, {'image_id': 'gr22', 'image_file_name': 'gr22.jpg', 'image_path': '../data/media_files/PMC7310947/gr22.jpg', 'caption': 'Mediastinal adenopathy in primary tuberculosis. A young, black woman presented with cervical adenopathy. The posteroanterior chest radiograph shows enlargement of the right paratracheal and left aorticopulmonary window nodes (arrows).', 'hash': 'de85f18013d5165caa5e8043aed1d9ee7a63af66ae627365b9e1e471e877fe75'}, {'image_id': 'gr17', 'image_file_name': 'gr17.jpg', 'image_path': '../data/media_files/PMC7310947/gr17.jpg', 'caption': 'Chlamydia pneumonia. CT scan demonstrates bilateral, patchy areas of consolidation.', 'hash': '258046a6003a46f1a375afd4a800b7469d34cb5cba51585ec6c1be0f1fd273f4'}, {'image_id': 'gr10', 'image_file_name': 'gr10.jpg', 'image_path': '../data/media_files/PMC7310947/gr10.jpg', 'caption': 'Pneumatocele. Coned-down (anteroposterior) view of the chest in a patient with fulminant staphylococcal pneumonia shows a rounded lucency in left lower lobe caused by a pneumatocele (arrow).', 'hash': '79e4f15416b67fbc7559f96c069d262310ce36d668d93afcf3c38937dfaa61fb'}, {'image_id': 'gr19', 'image_file_name': 'gr19.jpg', 'image_path': '../data/media_files/PMC7310947/gr19.jpg', 'caption': 'Varicella (chickenpox) pneumonia. Coned-down view of the upper lobes shows multiple, ill-defined nodules in both upper lobes.', 'hash': '1652825cc9d17d3b36c24b4ab46890d7d769f006be03d83dbbd514449464a3bc'}, {'image_id': 'gr28', 'image_file_name': 'gr28.jpg', 'image_path': '../data/media_files/PMC7310947/gr28.jpg', 'caption': 'Fibrocalcific tuberculosis. The posteroanterior chest radiograph demonstrates the features of chronic, healed tuberculosis. Apical pleural thickening and multiple, calcified nodular and irregular opacities can be seen in the left upper lobe (arrows). Volume loss is not a prominent feature in this case. Although such an appearance suggests inactive disease, serial radiographs are necessary to determine stability. Viable organisms may be present, and the development of clinically active disease may rarely occur.', 'hash': '3f59f7ffcf3a5fe96cf481dddd32b2c32809c5b53b946c0e4dbd09078ffbf329'}, {'image_id': 'gr21', 'image_file_name': 'gr21.jpg', 'image_path': '../data/media_files/PMC7310947/gr21.jpg', 'caption': 'Posteroanterior (A) and lateral (B) views show primary tuberculous pneumonia. A patchy consolidation can be seen in the left lower lobe.', 'hash': 'e5cad5f7bf50422728c23e47dfe465790f7b7b47be4ee2ae632ca6fd0e57d8ec'}, {'image_id': 'gr26', 'image_file_name': 'gr26.jpg', 'image_path': '../data/media_files/PMC7310947/gr26.jpg', 'caption': 'Cavitary tuberculosis. Minimal intensity projection CT image of a patient with reactivation tuberculosis shows a thick-walled cavity (arrow) in the posterior segment of the right upper lobe.', 'hash': '1fdf0c311b0d65bd8b59758f3569b10df5c60db85677746d5ed9d602dca42cc1'}, {'image_id': 'gr13', 'image_file_name': 'gr13.jpg', 'image_path': '../data/media_files/PMC7310947/gr13.jpg', 'caption': 'Staphylococcus aureus abscess. In the composite of four CT images of a patient with a left lower lobe staphylococcal abscess, notice the thick walls of the cavity (closed arrows) and the retained thick exudate in the center. Pockets of air in the peripheral regions of the cavity probably represent small pneumatoceles (open arrows).', 'hash': '7ff502cb35d0db98b6f5f23c186f0b6ab12b336a36068a810ba18bca25a4e1ec'}, {'image_id': 'gr14', 'image_file_name': 'gr14.jpg', 'image_path': '../data/media_files/PMC7310947/gr14.jpg', 'caption': 'Aspiration pneumonia in a patient with a history of seizures. The posteroanterior (A) and lateral (B) chest radiographs demonstrate consolidation in the superior segment of the right lower lobe.', 'hash': '4fcab04d2342ca0d2f9670b397d9e486d4ba0efc1db736867e68752b7cfb6bf9'}, {'image_id': 'gr9', 'image_file_name': 'gr9.jpg', 'image_path': '../data/media_files/PMC7310947/gr9.jpg', 'caption': 'Microabscesses caused by Pseudomonas pneumonia in the right upper lobe. Multiple, thin-walled, multiloculated cavities can be seen with little surrounding parenchymal opacity.', 'hash': 'ef7b04f8b6cc607dd0e3a647311955a7dcb4a01ad57ec46628002deb0ba976a5'}, {'image_id': 'gr11a', 'image_file_name': 'gr11a.jpg', 'image_path': '../data/media_files/PMC7310947/gr11a.jpg', 'caption': 'Parapneumonic effusion (pneumococcal pneumonia). A, The posteroanterior view shows a right upper lobe consolidation. B, An oblique view 2 days later demonstrates a right effusion.', 'hash': 'be5d5b4e68b57c313a453f5905e2a8f62f55e5014f8962167ebb225f17427cf7'}, {'image_id': 'gr7', 'image_file_name': 'gr7.jpg', 'image_path': '../data/media_files/PMC7310947/gr7.jpg', 'caption': 'Cavitary pneumonia due to gram-negative organisms. CT shows two areas of cavitation with an air-fluid level in the more posterior area, indicating bronchial communication.', 'hash': '018b6e665e67163d7b3af8a822b0e1b4b4129997a20c9b57b5e0164af6ba6725'}, {'image_id': 'gr37', 'image_file_name': 'gr37.jpg', 'image_path': '../data/media_files/PMC7310947/gr37.jpg', 'caption': 'Coccidioidomycosis. CT demonstrates a relatively thin-walled cavity in the right lower lobe. The classic lesion of coccidioidomycosis has a paper-thin wall.', 'hash': 'a851991ec5cdefdad21ab8fd8bedcdd58a4f0f2a4208fcab09820dad4bc23550'}, {'image_id': 'gr30', 'image_file_name': 'gr30.jpg', 'image_path': '../data/media_files/PMC7310947/gr30.jpg', 'caption': 'CT findings for miliary tuberculosis. In contrast to bronchogenic spread, the nodules are diffuse and uniformly distributed (arrows).', 'hash': '27f07a81c64fbc7b8f0e6f7249dc6d9e37e5697a6b4e464f7ff975cd63655921'}, {'image_id': 'gr42', 'image_file_name': 'gr42.jpg', 'image_path': '../data/media_files/PMC7310947/gr42.jpg', 'caption': 'Pulmonary arterial hypertension in pulmonary schistosomiasis is characterized by dilation of the central pulmonary arteries. The patient was a 48-year-old Puerto Rican woman with proven schistosomiasis, cirrhosis, and portal hypertension.', 'hash': '6a92cee617652cfc7481c2ff2688e1adfee2f4060bc179e73814f5f9d75e5664'}, {'image_id': 'gr39', 'image_file_name': 'gr39.jpg', 'image_path': '../data/media_files/PMC7310947/gr39.jpg', 'caption': 'CT shows actinomycosis in a patient who developed a right upper lobe, posterior segment necrotic consolidation after dental extraction. Notice the erosion of the cortex of the overlying rib (arrows).', 'hash': 'c6ba1e3b5e87d21baf206f9bbc90324bb1065ce37715eba329587243cce2bfd0'}, {'image_id': 'gr45', 'image_file_name': 'gr45.jpg', 'image_path': '../data/media_files/PMC7310947/gr45.jpg', 'caption': 'Hantavirus pulmonary syndrome. A, Portable chest radiograph shows bilateral central airspace opacities and diffuse Kerley lines due to combined alveolar and interstitial edema. B, Portable chest radiograph of same patient 1 day later shows progressive alveolar pulmonary edema and interval intubation.', 'hash': 'ea1d27ee2e6843bc7435f35f98a055db9f58b28162ea80507032aad1e907afb7'}, {'image_id': 'gr15', 'image_file_name': 'gr15.jpg', 'image_path': '../data/media_files/PMC7310947/gr15.jpg', 'caption': 'Mycoplasma pneumonia. A and B, Patchy, bilateral areas of inhomogeneous consolidation involve multiple lobes.', 'hash': '821f11eae1eb0c7ff8e88609416428d0414bb88a7a9e0e8106e12be4d234a40c'}, {'image_id': 'gr12', 'image_file_name': 'gr12.jpg', 'image_path': '../data/media_files/PMC7310947/gr12.jpg', 'caption': 'Rounded pneumonia. The lateral (A) and posteroanterior (B) chest radiographs and CT (C) of an adult patient shows an ill-defined, rounded opacity in the left upper lobe due to rounded pneumonia caused by pneumococcus. The opacity simulated a lung neoplasm radiographically, but it completely resolved after antibiotic therapy.', 'hash': 'fe375596e499d69b3bb72bad44b3b925559c478597d8580bb19c5efe79c7f4fb'}, {'image_id': 'gr20', 'image_file_name': 'gr20.jpg', 'image_path': '../data/media_files/PMC7310947/gr20.jpg', 'caption': 'Healed varicella pneumonia. Multiple 1- to 3-mm calcified nodules can be seen in both lungs.', 'hash': 'cd1ee4ba5503b5388a262fdfeaa6134a8d1b87ed8ed79bf3fe19c621a97ee1d1'}, {'image_id': 'gr29', 'image_file_name': 'gr29.jpg', 'image_path': '../data/media_files/PMC7310947/gr29.jpg', 'caption': 'Miliary tuberculosis. The posteroanterior chest radiograph demonstrates innumerable tiny, 1- to 2-mm nodules in both lungs.', 'hash': '3a00d776c6ef379817edd2ed741a9b61099f4ddbd1c0e4d93c83c67ae291dec4'}, {'image_id': 'gr38', 'image_file_name': 'gr38.jpg', 'image_path': '../data/media_files/PMC7310947/gr38.jpg', 'caption': 'Cryptococcus infection in a patient with lymphoma. CT demonstrates an irregular nodule with a tag extending to the pleura.', 'hash': '2f44ae2c1f5d82a2dd8614f19f0f5d0451dc5d26cda3f9810c2adf549cf233a7'}, {'image_id': 'gr44', 'image_file_name': 'gr44.jpg', 'image_path': '../data/media_files/PMC7310947/gr44.jpg', 'caption': 'Severe acute respiratory syndrome (SARS). CT shows multifocal, peripheral foci of ground-glass attenuation with superimposed reticular opacities.', 'hash': '22ea3ab326d4cc29ad8b789c5706864fba750eaa9790f0cf053d9b5dc31e1515'}, {'image_id': 'gr43', 'image_file_name': 'gr43.jpg', 'image_path': '../data/media_files/PMC7310947/gr43.jpg', 'caption': 'H5N1 avian influenza. The chest radiograph demonstrates bilateral, multifocal airspace consolidation.', 'hash': '17f98d59af516d98cf805f40ee995168ed3b81ce4c2bc3d6d46de0728662a09a'}, {'image_id': 'gr31', 'image_file_name': 'gr31.jpg', 'image_path': '../data/media_files/PMC7310947/gr31.jpg', 'caption': 'Tuberculoma. CT shows a somewhat lobulated nodule in the left lower lobe. There was no evidence of calcification or other manifestations of tuberculosis in the lungs.', 'hash': 'c0a48e0e3a4fa065f28a576db5936f4d2929eb1df198995a87845f2c3cd2880e'}, {'image_id': 'gr36', 'image_file_name': 'gr36.jpg', 'image_path': '../data/media_files/PMC7310947/gr36.jpg', 'caption': 'Broncholith. CT (bone window setting) demonstrates a small, rounded calcification (arrow) eroding into the superior segment right lower lobe bronchus and shows distal atelectasis. Notice the small, calcified granuloma in left lower lobe.', 'hash': 'c753a3d5733a82a843a7e095a56d2041895ee00825616d50c63d72c514a6fafa'}, {'image_id': 'gr6', 'image_file_name': 'gr6.jpg', 'image_path': '../data/media_files/PMC7310947/gr6.jpg', 'caption': 'Septic infarcts in an intravenous drug abuser. A, The posteroanterior chest radiograph shows multiple, bilateral cavitary nodules. B and C, CT examination demonstrates that most of the infarcts are peripheral in location; some abut the pleura and occasionally are wedge shaped. True and pseudocavities (curved arrow) are present.', 'hash': '528eb069a637e3e630b8d02da95b16346ac356b01bc6ac43034e2a4dc3cf672d'}, {'image_id': 'gr1', 'image_file_name': 'gr1.jpg', 'image_path': '../data/media_files/PMC7310947/gr1.jpg', 'caption': 'Posteroanterior (A) and lateral (B) views of lobar consolidation involving the middle lobe supported the diagnosis of Streptococcus pneumoniae (pneumococcus) infection.', 'hash': '404d3299138abf9c7cacbf2cb8c5bd86cce3f91d7e2df407ff57a82a651a60be'}, {'image_id': 'gr27b', 'image_file_name': 'gr27b.jpg', 'image_path': '../data/media_files/PMC7310947/gr27b.jpg', 'caption': 'Bronchogenic spread of tuberculosis. A, CT shows a cavitary nodule communicating with the right upper lobe posterior segment bronchus (single arrow), with associated centrilobular nodular opacities in the superior segment of the right lower lobe (three arrows). B, CT of another patient shows a typical tree-in-bud pattern. Centrilobular nodules and branching opacities can be identified close to the pleural surface (arrows).', 'hash': '421d52c280777295fd11d4126941f660d2ecf3683a5f96bea6010e0482ecee49'}, {'image_id': 'gr8', 'image_file_name': 'gr8.jpg', 'image_path': '../data/media_files/PMC7310947/gr8.jpg', 'caption': 'Primary lung abscess due to aspiration. The posteroanterior (A) and lateral (B) views show a well-defined, masslike opacity in the superior segment of the right lower lobe. There is cavitation with an air-fluid level and a thick wall.', 'hash': '33ff807af6ea5489e06aa5e98a17e779c59c6d960c1b86c9e07a91645401696c'}] | {'gr1': ['This type of pneumonia produces a pattern of confluent opacification, often with air bronchograms (<xref rid="gr1" ref-type="fig">Fig. 3-1</xref>\n). The entire lobe may be involved, but more frequently because of early use of antibiotics, the pneumonia involves only one or more segments within a lobe (i.e., sublobar form). A lobar pneumonia may result in expansion of the lobe due to voluminous edema, which is usually caused by infection with \n). The entire lobe may be involved, but more frequently because of early use of antibiotics, the pneumonia involves only one or more segments within a lobe (i.e., sublobar form). A lobar pneumonia may result in expansion of the lobe due to voluminous edema, which is usually caused by infection with K. pneumoniae (<xref rid="gr2" ref-type="fig">Fig. 3-2</xref>\n). The enlargement of the lobe can be recognized radiographically by bulging of the interlobar fissures. Necrosis, cavitation, and development of a unique complication, pulmonary gangrene, may ensue.\n). The enlargement of the lobe can be recognized radiographically by bulging of the interlobar fissures. Necrosis, cavitation, and development of a unique complication, pulmonary gangrene, may ensue.Figure 3-1Posteroanterior (A) and lateral (B) views of lobar consolidation involving the middle lobe supported the diagnosis of Streptococcus pneumoniae (pneumococcus) infection.Figure 3-2Anteroposterior view of a patient with Klebsiella pneumonia shows homogeneous opacity of the right upper lobe with slight bulging of the minor fissure (arrow).', 'The radiographic features include consolidation that is usually unilateral, although it may be bilateral, and it typically affects the lower lobes (see <xref rid="gr1" ref-type="fig">Fig. 3-1</xref>). Although it is a lobar pneumonia, it is uncommon for the lobe to be completely consolidated. Cavitation is rare, and large pleural effusions are uncommon. When present, they suggest the development of empyema. Sometimes, especially in children, the pneumonia may have a rounded, masslike appearance (). Although it is a lobar pneumonia, it is uncommon for the lobe to be completely consolidated. Cavitation is rare, and large pleural effusions are uncommon. When present, they suggest the development of empyema. Sometimes, especially in children, the pneumonia may have a rounded, masslike appearance (<xref rid="gr12" ref-type="fig">Fig. 3-12</xref>\n). This is called a \n). This is called a round pneumonia; it results from centrifugal spread of the rapidly replicating bacteria by way of the pores of Kohn and canals of Lambert from a single primary focus in the lung.Figure 3-12Rounded pneumonia. The lateral (A) and posteroanterior (B) chest radiographs and CT (C) of an adult patient shows an ill-defined, rounded opacity in the left upper lobe due to rounded pneumonia caused by pneumococcus. The opacity simulated a lung neoplasm radiographically, but it completely resolved after antibiotic therapy.'], 'gr3': ['The computed tomography (CT) features of lobar pneumonia are similar to those seen on standard radiography (<xref rid="gr3" ref-type="fig">Fig. 3-3</xref>\n). There is usually evidence of confluent opacification with air bronchograms. The air bronchograms are often more easily visualized with CT examination. \n). There is usually evidence of confluent opacification with air bronchograms. The air bronchograms are often more easily visualized with CT examination. Table 3-2\nsummarizes the radiographic clues to the cause of pneumonia.Figure 3-3CT of a pneumococcal left upper lobar consolidation shows clearly defined air bronchograms and evidence of cavitation.Table 3-2Radiographic Clues to the Cause of PneumoniaRadiographic FindingLikely Causative OrganismsRound pneumoniaSuspect Streptococcus pneumoniae (pneumococcus)Complete lobar consolidationS. pneumoniae, Klebsiella pneumoniae, and other gram-negative bacilli; Legionella pneumophila and occasionally Mycoplasma pneumoniaeLobar enlargementK. pneumoniae, pneumococcus, Staphylococcus aureus, Haemophilus influenzaeBilateral pneumonia (bronchopneumonia)S. pneumoniae still common, but suspect others, including S. aureus, streptococci, gram-negative bacilli, anaerobes, L. pneumophila, virus, and aspiration syndromesInterstitial pneumoniaVirus, M. pneumoniae, and occasionally H. influenzae, S. pneumoniae, and other bacteriaSeptic emboliUsually S. aureus; occasionally gram-negative bacilli, anaerobes, and streptococciEmpyema or bronchopleural fistulaS. aureus, gram-negative bacilli, anaerobes, and occasionally, pneumococcus; mixed bacterial infections commonContiguous spread to chest wallActinomycosis; occasionally other bacteria or fungiCavitationS. aureus, gram-negative bacilli, anaerobic bacteria, and streptococci; cavitation uncommon with S. pneumoniae or L. pneumophilaPulmonary gangreneK. pneumoniae, Escherichia coli, H. influenzae, Mycobacterium tuberculosis, S. pneumoniae, anaerobes, or fungiPneumatocelesS. aureus, gram-negative bacilli, H. influenzae, M. tuberculosis, and measles; S. pneumoniae rareLymphadenopathyM. tuberculosis, fungi, virus, M. pneumoniae, common bacterial lung abscess, and rarely plague, tularemia, and anthraxFulminant course with acute respiratory distress syndrome (ARDS)Virus, S. aureus, streptococci, M. tuberculosis, and L. pneumophilaFrom Woodring JH: Pulmonary bacterial and viral infections. In Freundlich IM, Bragg DG (eds): A Radiologic Approach to Diseases of the Chest. Baltimore, Williams & Wilkins, 1992.'], 'gr4': ['The radiographic appearance of bronchopneumonia pneumonia is most frequently that of multiple, ill-defined nodular opacities that are patchy but that may eventually become confluent and produce consolidation with airspace opacification (<xref rid="gr4" ref-type="fig">Fig. 3-4</xref>\n). The opacification may be multifocal and involve several lobes, or it may be diffuse. As the disease progresses, segmental and lobar opacification develops, similar to the pattern of a lobar pneumonia. Early necrosis and cavitation can occur. The nodular opacities of bronchopneumonia can be identified with facility on CT scans. The small nodules, usually less than 1\xa0cm in diameter, represent peribronchiolar areas of consolidation or ground-glass opacity. They are called \n). The opacification may be multifocal and involve several lobes, or it may be diffuse. As the disease progresses, segmental and lobar opacification develops, similar to the pattern of a lobar pneumonia. Early necrosis and cavitation can occur. The nodular opacities of bronchopneumonia can be identified with facility on CT scans. The small nodules, usually less than 1\xa0cm in diameter, represent peribronchiolar areas of consolidation or ground-glass opacity. They are called acinar or airspace nodules, but these nodules histologically are found in a peribronchiolar location. They are ill-defined and may be of homogenous soft tissue opacity and obscuring vessels, or they may be hazy and less dense so that adjacent vessels are clearly seen (i.e., ground-glass opacity). These nodules usually have a centrilobular location because of their proximity to small bronchioles.Figure 3-4Bronchopneumonia. The posteroanterior view demonstrates bilateral, patchy, and inhomogeneous opacities, which have become confluent in some areas. The patient was diagnosed with viral influenza pneumonia.', 'When the infection spreads to the alveoli, the disease is usually limited to the parenchyma around the terminal airways. The radiographic features in children and adults usually consist of a diffuse reticulonodular pattern, often with focal and patchy areas of consolidation (see <xref rid="gr4" ref-type="fig">Fig. 3-4</xref>). Multiple lobes are usually involved. CT may reveal the anatomic localization of the disease. The bronchiolitis and surrounding inflammation produces nodular opacities, which are located in the center of the lobules. Branching centrilobular opacities represent impaction of small airways, and their appearance has been referred to as the ). Multiple lobes are usually involved. CT may reveal the anatomic localization of the disease. The bronchiolitis and surrounding inflammation produces nodular opacities, which are located in the center of the lobules. Branching centrilobular opacities represent impaction of small airways, and their appearance has been referred to as the tree-in-bud pattern (<xref rid="gr18" ref-type="fig">Fig. 3-18</xref>\n). Other common CT findings of viral pneumonia include ground-glass attenuation with a lobular distribution and foci of segmental and subsegmental consolidation.\n). Other common CT findings of viral pneumonia include ground-glass attenuation with a lobular distribution and foci of segmental and subsegmental consolidation.Figure 3-18Tree-in-bud appearance. Peripheral branching opacities (single arrow) and centrilobular nodules 2 to 3\xa0mm deep to the pleura (double arrows) can be identified. The appearance results from small airways filled with secretions and inflammatory debris.'], 'gr5': ['Bronchopneumonia or an acute interstitial pneumonia may be seen with viral infections (<xref rid="gr5" ref-type="fig">Fig. 3-5</xref>\n). The early radiographic appearance is that of thickening of end-on bronchi and tram lines. However, this often evolves into a reticular pattern that may be seen extending outward from the hila.\n). The early radiographic appearance is that of thickening of end-on bronchi and tram lines. However, this often evolves into a reticular pattern that may be seen extending outward from the hila.Figure 3-5Acute interstitial pneumonia due to varicella (chickenpox). Coned-down view of the right lung demonstrates a fine reticulonodular pattern, which is more prominent centrally.'], 'gr6': ['Septic infarcts tend to be multiple and peripheral and to abut the pleural surface. They occur more frequently in the lower lobes. These nodules or wedge-shaped opacities may show evidence of cavitation (<xref rid="gr6" ref-type="fig">Fig. 3-6</xref>\n). CT often demonstrates a vessel connected to the area of infarction. On CT, the septic infarcts appear as wedge-shaped, peripheral opacities abutting the pleura. They may contain air bronchograms or rounded lucencies of air, sometimes referred to as \n). CT often demonstrates a vessel connected to the area of infarction. On CT, the septic infarcts appear as wedge-shaped, peripheral opacities abutting the pleura. They may contain air bronchograms or rounded lucencies of air, sometimes referred to as pseudocavitation. True cavitation is common. Occasionally, septic bacterial infection may result in diffuse massive seeding of the lungs with a miliary pattern (i.e., very small nodular pattern), although this is much more common with hematogenous dissemination of granulomatous infections.Figure 3-6Septic infarcts in an intravenous drug abuser. A, The posteroanterior chest radiograph shows multiple, bilateral cavitary nodules. B and C, CT examination demonstrates that most of the infarcts are peripheral in location; some abut the pleura and occasionally are wedge shaped. True and pseudocavities (curved arrow) are present.'], 'gr7': ['Necrosis of lung parenchyma with cavitation (<xref rid="gr7" ref-type="fig">Fig. 3-7</xref>\n) may occur in pneumonia, particularly that produced by virulent bacteria, including \n) may occur in pneumonia, particularly that produced by virulent bacteria, including S. aureus, streptococci, gram-negative bacilli, and anaerobic bacteria. If the inflammatory process is localized, a lung abscess will form. It is usually rounded and focal, and it appears to be a mass (<xref rid="gr8" ref-type="fig">Fig. 3-8</xref>\n). With liquefaction of the central inflammatory process, a communication may develop with the bronchus; air enters the abscess, forming a cavity, which often contains an air-fluid level. The walls of the cavity may be smooth, but more often, they are thick and irregular.\n). With liquefaction of the central inflammatory process, a communication may develop with the bronchus; air enters the abscess, forming a cavity, which often contains an air-fluid level. The walls of the cavity may be smooth, but more often, they are thick and irregular.Figure 3-7Cavitary pneumonia due to gram-negative organisms. CT shows two areas of cavitation with an air-fluid level in the more posterior area, indicating bronchial communication.Figure 3-8Primary lung abscess due to aspiration. The posteroanterior (A) and lateral (B) views show a well-defined, masslike opacity in the superior segment of the right lower lobe. There is cavitation with an air-fluid level and a thick wall.'], 'gr9': ['Multiple, small cavities or microabscesses may develop in necrotizing pneumonia (<xref rid="gr9" ref-type="fig">Fig. 3-9</xref>\n). They are recognized as multiple areas of lucency within a consolidated lobe or segment. A similar appearance may be produced by consolidation superimposed on areas of preexisting emphysema. If the necrosis is extensive, arteritis and vascular thrombosis may occur in an area of intense inflammation, causing ischemic necrosis and death of a portion of lung. This is a particular complication of \n). They are recognized as multiple areas of lucency within a consolidated lobe or segment. A similar appearance may be produced by consolidation superimposed on areas of preexisting emphysema. If the necrosis is extensive, arteritis and vascular thrombosis may occur in an area of intense inflammation, causing ischemic necrosis and death of a portion of lung. This is a particular complication of Klebsiella pneumonia and other pneumonias producing lobar enlargement. The radiographic features include multiple areas of cavitation, often with air-fluid levels. Portions of dead lung may slough and form intracavitary masses.Figure 3-9Microabscesses caused by Pseudomonas pneumonia in the right upper lobe. Multiple, thin-walled, multiloculated cavities can be seen with little surrounding parenchymal opacity.', '\nP. aeruginosa pneumonia (Box 3-7\n) usually occurs in hospitalized patients, particularly those with debilitating disease (see <xref rid="gr9" ref-type="fig">Fig. 3-9</xref>). Organisms that affect the lungs often result from contamination of suction and tracheostomy devices. Radiographic features include a lower lobe predilection. However, the consolidation may spread rapidly to affect both lungs. Pleural effusions are uncommon. Multiple, irregular nodules may develop and are usually associated with bacteremia. These nodules may cavitate.). Organisms that affect the lungs often result from contamination of suction and tracheostomy devices. Radiographic features include a lower lobe predilection. However, the consolidation may spread rapidly to affect both lungs. Pleural effusions are uncommon. Multiple, irregular nodules may develop and are usually associated with bacteremia. These nodules may cavitate.Box 3-7Pseudomonas aeruginosaCHARACTERISTICS\nHospitalized, debilitated patientsTracheostomy tubes and suction devices\nRADIOGRAPHIC FEATURES\nLower lobes, consolidationRapid spread to both lungsMultiple, irregular nodulesCavitationPleural effusions uncommon\n'], 'gr10': ['Pneumatoceles are usually associated with pneumonia caused by virulent organisms; the classic offender is S. aureus (<xref rid="gr10" ref-type="fig">Fig. 3-10</xref>\n). They usually form subpleural collections of air, which result from alveolar rupture. Radiographically, they appear as single or multiple, cystic lesions with thin and smooth walls. They may show rapid change in size and location on serial radiographs.\n). They usually form subpleural collections of air, which result from alveolar rupture. Radiographically, they appear as single or multiple, cystic lesions with thin and smooth walls. They may show rapid change in size and location on serial radiographs.Figure 3-10Pneumatocele. Coned-down (anteroposterior) view of the chest in a patient with fulminant staphylococcal pneumonia shows a rounded lucency in left lower lobe caused by a pneumatocele (arrow).'], 'gr11a': ['Pleural effusion is a common complication of pneumonia, occurring in about 40% of cases (<xref rid="gr11a" ref-type="fig">Fig. 3-11</xref>\n). Most effusions are parapneumonic, but infection of the pleural space with empyema requiring drainage is an important but uncommon complication of some pneumonias. Empyemas can be recognized by the presence of gross pus within the pleural space, by a white blood cell count in the pleural fluid of greater than 15,000 cells/mm\n). Most effusions are parapneumonic, but infection of the pleural space with empyema requiring drainage is an important but uncommon complication of some pneumonias. Empyemas can be recognized by the presence of gross pus within the pleural space, by a white blood cell count in the pleural fluid of greater than 15,000 cells/mm3, by the presence of bacteria within the pleural fluid, or by a pH less than 7.2. Chapter 18 provides more detail on the pleural complications of pneumonia.Figure 3-11Parapneumonic effusion (pneumococcal pneumonia). A, The posteroanterior view shows a right upper lobe consolidation. B, An oblique view 2 days later demonstrates a right effusion.'], 'gr13': ['\nS. aureus (Box 3-3\n) is a gram-positive coccus, and the spherical organisms occur in pairs and clusters. This pneumonia rarely develops in healthy adults, but it is sometimes a complication of viral infections and is much more common in infants and children. In infants, unilateral or bilateral consolidation involving the lower lungs is the most frequent radiographic presentation. Pneumatoceles, thin-walled cysts filled with air or partially filled with fluid, may develop and occasionally rupture into the pleural space, resulting in pneumothorax. In adults, the disease is usually bilateral and is preceded by an atypical pneumonia such as influenza. Cavitation is a common feature, and the cavities may be multiple, thick walled, and irregular (<xref rid="gr13" ref-type="fig">Fig. 3-13</xref>\n). There is a high incidence of large pleural effusions, and empyema resulting from bronchopleural fistula is a common complication. Methicillin resistant staphylococcus aureus (MRSA) pneumonia usually occurs as a nosocomial infection in health care centers particularly in older, immunocompromised or intensive care unit patients.\n). There is a high incidence of large pleural effusions, and empyema resulting from bronchopleural fistula is a common complication. Methicillin resistant staphylococcus aureus (MRSA) pneumonia usually occurs as a nosocomial infection in health care centers particularly in older, immunocompromised or intensive care unit patients.Box 3-3Staphylococcus aureusCHARACTERISTICS\nGram-positive coccusInfants and children (more common)Occurs after viral infectionSeptic emboliIntravenous drug abusersIndwelling catheters\n\nRADIOGRAPHIC FEATURES\nChildrenConsolidationLower lungsPneumatoceles\nAdultsBilateralCavitationEmpyema\nSeptic emboli (infarcts)MultipleNodules or wedge-shaped opacitiesPeripheral, abut pleuraCavitationSeen on computed tomographyPseudocavitation or true cavitationFeeding vessel\n\nFigure 3-13Staphylococcus aureus abscess. In the composite of four CT images of a patient with a left lower lobe staphylococcal abscess, notice the thick walls of the cavity (closed arrows) and the retained thick exudate in the center. Pockets of air in the peripheral regions of the cavity probably represent small pneumatoceles (open arrows).(Courtesy of Dorothy L. McCauley, MD. New York University Medical Center, New York, NY.)'], 'gr2': ['\nKlebsiella pneumonia (Box 3-5\n) usually occurs in middle-aged or elderly patients, in those with underlying chronic lung disease, and in alcoholic individuals. Radiographic features consist of an upper lobe consolidation. Cavitation is common, and the lobar consolidation may lead to an expanded lobe with bulging interlobar fissures (see <xref rid="gr2" ref-type="fig">Fig. 3-2</xref>). If necrosis is extensive, pulmonary gangrene may develop.). If necrosis is extensive, pulmonary gangrene may develop.Box 3-5Klebsiella pneumoniaeCHARACTERISTICS\nMiddle-aged or elderly patientsChronic lung disease and alcoholic patients\nRADIOGRAPHIC FEATURES\nLobar consolidationBulging fissuresCavitationPulmonary gangrene\n'], 'gr14': ['Ninety percent of aspiration pneumonias and lung abscesses are caused by anaerobic organisms. The pathogens include Prevotella, Bacteroides, Fusobacterium, and Peptostreptococcus. Because of the presence of oxygen in the lung, the progression of anaerobic infection is slow, beginning in the dependent lung zones. If the patient is in a supine position when the aspiration occurs, the superior segments of the lower lobes are most commonly affected, with the right side affected more frequently than the left (<xref rid="gr14" ref-type="fig">Fig. 3-14</xref>\n). Aspiration can also affect the posterior segments of both upper lobes. Chronic or recurrent aspiration, particularly in patients who are in the upright position, usually results in consolidation involving the basilar segments of the lower lobes. The middle lobe and lingula are uncommon sites for aspiration pneumonia. Aspiration is the most common cause of a primary lung abscess (see \n). Aspiration can also affect the posterior segments of both upper lobes. Chronic or recurrent aspiration, particularly in patients who are in the upright position, usually results in consolidation involving the basilar segments of the lower lobes. The middle lobe and lingula are uncommon sites for aspiration pneumonia. Aspiration is the most common cause of a primary lung abscess (see <xref rid="gr8" ref-type="fig">Fig. 3-8</xref>).).Figure 3-14Aspiration pneumonia in a patient with a history of seizures. The posteroanterior (A) and lateral (B) chest radiographs demonstrate consolidation in the superior segment of the right lower lobe.'], 'gr15': ['The radiographic features are usually those of a fairly diffuse, interstitial, fine reticulonodular pattern. This may evolve to patchy airspace consolidation, particularly in the lower lobes (<xref rid="gr15" ref-type="fig">Fig. 3-15</xref>\n). Hilar adenopathy is seen in approximately 20% to 40% of patients. The radiographic appearance is very similar to that of many viral infections. The diagnosis is made by serologic evaluation.\n). Hilar adenopathy is seen in approximately 20% to 40% of patients. The radiographic appearance is very similar to that of many viral infections. The diagnosis is made by serologic evaluation.Figure 3-15Mycoplasma pneumonia. A and B, Patchy, bilateral areas of inhomogeneous consolidation involve multiple lobes.'], 'gr16': ['The radiographic features of Legionnaires’ disease often consist of segmental opacification and consolidation, particularly of an upper lobe. Rapid development of coalescence with complete consolidation of an involved lobe and rapid extension to adjacent lobes are common features (<xref rid="gr16" ref-type="fig">Fig. 3-16</xref>\n). Parenchymal changes are extensive, but pleural effusions are uncommon. The diagnosis of Legionnaires’ disease is usually made by serology using indirect fluorescent antibody. Direct identification of the organism may be confirmed by direct fluorescent antibody (DFA) techniques using properly collected specimens.\n). Parenchymal changes are extensive, but pleural effusions are uncommon. The diagnosis of Legionnaires’ disease is usually made by serology using indirect fluorescent antibody. Direct identification of the organism may be confirmed by direct fluorescent antibody (DFA) techniques using properly collected specimens.Figure 3-16Legionnaires’ disease. A, The posteroanterior chest radiograph shows consolidation involving the right middle lobe and left middle lung zones. B, Twenty-four hours later, the consolidation has become more extensive bilaterally.'], 'gr17': ['Radiographic features may be similar to those of Mycoplasma pneumonia. However, more commonly there is a localized area of consolidation in the middle or lower lobes, which may be patchy or homogeneous (<xref rid="gr17" ref-type="fig">Fig. 3-17</xref>\n).\n).Figure 3-17Chlamydia pneumonia. CT scan demonstrates bilateral, patchy areas of consolidation.'], 'gr19': ['Varicella-herpes zoster (i.e., chickenpox) infection may be responsible for severe pneumonia in adults. The radiographic features are fairly characteristic. They consist of nodules ranging from 4 to 6\xa0mm in diameter, with ill-defined margins diffusely distributed throughout both lungs (<xref rid="gr19" ref-type="fig">Fig. 3-19</xref>\n). Radiographic resolution usually occurs over many weeks. One of the interesting sequelae of chickenpox pneumonia is the development of diffuse, discrete pulmonary calcifications that can be identified on routine radiographs obtained after the infection (\n). Radiographic resolution usually occurs over many weeks. One of the interesting sequelae of chickenpox pneumonia is the development of diffuse, discrete pulmonary calcifications that can be identified on routine radiographs obtained after the infection (<xref rid="gr20" ref-type="fig">Fig. 3-20</xref>\n). Histoplasmosis should be considered in the differential diagnosis of this radiologic appearance.\n). Histoplasmosis should be considered in the differential diagnosis of this radiologic appearance.Figure 3-19Varicella (chickenpox) pneumonia. Coned-down view of the upper lobes shows multiple, ill-defined nodules in both upper lobes.Figure 3-20Healed varicella pneumonia. Multiple 1- to 3-mm calcified nodules can be seen in both lungs.'], 'gr21': ['The radiographic features of primary tuberculosis are summarized in Box 3-16\n. Primary tuberculous pneumonia can occur in any lobe of the lung but is more common at the lung bases (<xref rid="gr21" ref-type="fig">Fig. 3-21</xref>\n). In more than one half of cases, the disease occurs in the lower lobes. Any chronic consolidation, particularly in the bases of the lungs, may suggest tuberculosis. Cavitation, although rare in primary tuberculosis, is more frequently reported in adults than in children with the primary form of disease.\n). In more than one half of cases, the disease occurs in the lower lobes. Any chronic consolidation, particularly in the bases of the lungs, may suggest tuberculosis. Cavitation, although rare in primary tuberculosis, is more frequently reported in adults than in children with the primary form of disease.Box 3-16Tuberculosis: Radiographic FeaturesPRIMARY TUBERCULOSIS\nTuberculous pneumoniaBasilar consolidationCavitation rare\nMediastinal and hilar adenopathyChildrenRight sideCT shows rim enhancement\nPleuritisGhon lesion and Rhanke complexCalcificationHealed lesions\nREACTIVATION TUBERCULOSIS\nApical and posterior segments, upper lobes, and superior segments, lower lobesPatchy areas of consolidationCavitationBronchogenic spread, tree in bud opacities on CTChronic patternFibronodularFibrocalcificVolume lossBronchiectasis\n\nFigure 3-21Posteroanterior (A) and lateral (B) views show primary tuberculous pneumonia. A patchy consolidation can be seen in the left lower lobe.'], 'gr22': ['\nMediastinal and hilar adenopathy is another feature of primary tuberculosis (<xref rid="gr22" ref-type="fig">Fig. 3-22</xref>\n). It may occur alone or in association with consolidation in the lung. It tends to be particularly predominant in children. CT may be helpful in identifying and localizing adenopathy. On CT scans, tuberculous adenopathy has a predilection for the right paratracheal, right tracheobronchial, and subcarinal regions. Occasionally, atelectasis may result from extrinsic obstruction of a bronchus by enlarged lymph nodes. On CT scans obtained with intravenously administered contrast material, these nodes often demonstrate low-attenuation necrotic centers.\n). It may occur alone or in association with consolidation in the lung. It tends to be particularly predominant in children. CT may be helpful in identifying and localizing adenopathy. On CT scans, tuberculous adenopathy has a predilection for the right paratracheal, right tracheobronchial, and subcarinal regions. Occasionally, atelectasis may result from extrinsic obstruction of a bronchus by enlarged lymph nodes. On CT scans obtained with intravenously administered contrast material, these nodes often demonstrate low-attenuation necrotic centers.Figure 3-22Mediastinal adenopathy in primary tuberculosis. A young, black woman presented with cervical adenopathy. The posteroanterior chest radiograph shows enlargement of the right paratracheal and left aorticopulmonary window nodes (arrows).'], 'gr23': ['The Ghon lesion (<xref rid="gr23" ref-type="fig">Fig. 3-23</xref>\n) is a manifestation of primary tuberculosis, which usually occurs in childhood and is self-limited. The host defense mechanisms handle the initial infection, and the area of consolidation in the lung slowly regresses to a well-circumscribed nodule. This nodule then shrinks and may disappear completely or remain as a solitary, calcified granuloma. The adenopathy regresses and may also exhibit calcification (i.e., Rhanke complex).\n) is a manifestation of primary tuberculosis, which usually occurs in childhood and is self-limited. The host defense mechanisms handle the initial infection, and the area of consolidation in the lung slowly regresses to a well-circumscribed nodule. This nodule then shrinks and may disappear completely or remain as a solitary, calcified granuloma. The adenopathy regresses and may also exhibit calcification (i.e., Rhanke complex).Figure 3-23Ghon lesion and Rhanke complex. Coronal reformation chest CT image (bone windows) of a patient previously exposed to Mycobacterium tuberculosis shows a calcified right lower lobe nodule (arrow), together with a calcified right hilar node (i.e., Rhanke complex) (arrow).'], 'gr24': ['Reactivation tuberculosis usually occurs in the apical and posterior segments of the upper lobes and in the superior segment of the lower lobes. It is characterized by chronic, patchy areas of consolidation (<xref rid="gr24" ref-type="fig">Fig. 3-24</xref>\n). Cavitation is a hallmark of reactivation tuberculosis (\n). Cavitation is a hallmark of reactivation tuberculosis (<xref rid="gr25" ref-type="fig">Fig. 3-25</xref>\n). Cavities result when areas of caseation necrosis erode into the bronchial tree, expelling liquefied debris. CT is more sensitive than plain radiography in the detection of small cavities (\n). Cavities result when areas of caseation necrosis erode into the bronchial tree, expelling liquefied debris. CT is more sensitive than plain radiography in the detection of small cavities (<xref rid="gr26" ref-type="fig">Fig. 3-26</xref>\n). They may have thick or thin walls, which can be smooth or irregular. Bronchogenic spread of tuberculosis occurs when a cavity erodes into an adjacent airway and organisms spread endobronchially to other parts of the lung.\n). They may have thick or thin walls, which can be smooth or irregular. Bronchogenic spread of tuberculosis occurs when a cavity erodes into an adjacent airway and organisms spread endobronchially to other parts of the lung.Figure 3-24Reactivation tuberculosis. Patchy areas of consolidation involve the left upper lobe and superior segment of the left lower lobe. There is also evidence of some volume loss with a shift of the trachea to the left, a common finding with Mycobacterium tuberculosis infection, even in the early stages of disease. Nodular lesions can be identified in the right upper lobe.Figure 3-25Cavitary tuberculosis. The posteroanterior chest radiograph shows multiple cavities in the left upper lobe. A thick-walled cavity can be seen lateral to the left hilum. There is pronounced volume loss in the left upper lobe and apical pleural thickening.Figure 3-26Cavitary tuberculosis. Minimal intensity projection CT image of a patient with reactivation tuberculosis shows a thick-walled cavity (arrow) in the posterior segment of the right upper lobe.'], 'gr27a': ['The typical radiographic features (<xref rid="gr27a" ref-type="fig">Fig. 3-27</xref>\n) consist of ill-defined nodules that usually are 5 to 6\xa0mm in diameter. They are numerous and often bilateral. On CT, the pattern of bronchogenic spread can easily be recognized by a tree-in-bud pattern. This consists of centrilobular, branching, linear opacities with or without the presence of centrilobular nodules within 3 to 5\xa0mm of the pleural surface or interlobular septa. This pattern is best appreciated on high-resolution CT (HRCT). It is not specific for bronchogenic spread of tuberculosis and may occur in other inflammatory diseases involving the peripheral airways.\n) consist of ill-defined nodules that usually are 5 to 6\xa0mm in diameter. They are numerous and often bilateral. On CT, the pattern of bronchogenic spread can easily be recognized by a tree-in-bud pattern. This consists of centrilobular, branching, linear opacities with or without the presence of centrilobular nodules within 3 to 5\xa0mm of the pleural surface or interlobular septa. This pattern is best appreciated on high-resolution CT (HRCT). It is not specific for bronchogenic spread of tuberculosis and may occur in other inflammatory diseases involving the peripheral airways.Figure 3-27Bronchogenic spread of tuberculosis. A, CT shows a cavitary nodule communicating with the right upper lobe posterior segment bronchus (single arrow), with associated centrilobular nodular opacities in the superior segment of the right lower lobe (three arrows). B, CT of another patient shows a typical tree-in-bud pattern. Centrilobular nodules and branching opacities can be identified close to the pleural surface (arrows).'], 'gr28': ['The chronic lesion of reactivation tuberculosis usually consists of fibronodular opacities in the upper lobes, often with the presence of calcification (<xref rid="gr28" ref-type="fig">Fig. 3-28</xref>\n). It is usually associated with volume loss and retraction of the hila. Another feature of chronic reactivation tuberculosis is bronchiectasis. Tuberculosis should be considered in the differential diagnosis of upper lobe bronchiectasis. The activity of tuberculous disease cannot be determined by radiographs; it is confirmed only by positive cultures. However, tuberculosis is considered radiographically stable if there has been no change over 6 months.\n). It is usually associated with volume loss and retraction of the hila. Another feature of chronic reactivation tuberculosis is bronchiectasis. Tuberculosis should be considered in the differential diagnosis of upper lobe bronchiectasis. The activity of tuberculous disease cannot be determined by radiographs; it is confirmed only by positive cultures. However, tuberculosis is considered radiographically stable if there has been no change over 6 months.Figure 3-28Fibrocalcific tuberculosis. The posteroanterior chest radiograph demonstrates the features of chronic, healed tuberculosis. Apical pleural thickening and multiple, calcified nodular and irregular opacities can be seen in the left upper lobe (arrows). Volume loss is not a prominent feature in this case. Although such an appearance suggests inactive disease, serial radiographs are necessary to determine stability. Viable organisms may be present, and the development of clinically active disease may rarely occur.'], 'gr29': ['Unusual patterns of tuberculosis (Box 3-17\n) may occur in the patient who has altered host resistance to the primary infection. Miliary tuberculosis is a term used to describe diffuse hematogenous dissemination of tuberculosis that has progressed when the host defense system is overwhelmed by massive hematogenous dissemination of organisms. It may occur at any time after the primary infection. The radiographic appearance (<xref rid="gr29" ref-type="fig">Fig. 3-29</xref>\n) is that of multiple, tiny nodules in the interstitium of the lung that are approximately 1 to 2\xa0mm in diameter. CT may allow earlier detection than standard radiography (\n) is that of multiple, tiny nodules in the interstitium of the lung that are approximately 1 to 2\xa0mm in diameter. CT may allow earlier detection than standard radiography (<xref rid="gr30" ref-type="fig">Fig. 3-30</xref>\n). Miliary disease takes up to 6 weeks to become apparent on plain radiographs.\n). Miliary disease takes up to 6 weeks to become apparent on plain radiographs.Box 3-17Tuberculosis: Other Radiographic Features\nMiliary tuberculosisHematogenous disseminationDiffuse, 1- to 2-mm nodules\nPneumothoraxEndobronchial tuberculosisLobar or segmental atelectasis\nTuberculomaSingle or multipleNodules larger than 1\xa0cm\nTuberculous empyemaBronchopleural fistula\nFigure 3-29Miliary tuberculosis. The posteroanterior chest radiograph demonstrates innumerable tiny, 1- to 2-mm nodules in both lungs.Figure 3-30CT findings for miliary tuberculosis. In contrast to bronchogenic spread, the nodules are diffuse and uniformly distributed (arrows).'], 'gr31': ['Pneumothorax occasionally results from tuberculosis. Tuberculosis may also cause ulceration of the bronchi, and advanced endobronchial tuberculosis may produce lobar atelectasis and strongly simulate a primary carcinoma of the lung. A localized nodular focus of tuberculosis, referred to as a tuberculoma (<xref rid="gr31" ref-type="fig">Fig. 3-31</xref>\n), occurs in any portion of the lung and may result from primary or reactivation tuberculosis. It is usually solitary, spherical, and smooth. It may contain a central calcification, but tuberculomas occasionally may be multiple and simulate metastatic disease.\n), occurs in any portion of the lung and may result from primary or reactivation tuberculosis. It is usually solitary, spherical, and smooth. It may contain a central calcification, but tuberculomas occasionally may be multiple and simulate metastatic disease.Figure 3-31Tuberculoma. CT shows a somewhat lobulated nodule in the left lower lobe. There was no evidence of calcification or other manifestations of tuberculosis in the lungs.'], 'gr32': ['The classic form of atypical mycobacterial infection produces features almost identical to those of reactivation tuberculosis (<xref rid="gr32" ref-type="fig">Fig. 3-32</xref>\n). Involvement occurs in the apical and posterior segments of the upper lobes and superior segment of the lower lobes. Cavitation is common, and multiple cavities may be observed. The disease tends to be slowly progressive.\n). Involvement occurs in the apical and posterior segments of the upper lobes and superior segment of the lower lobes. Cavitation is common, and multiple cavities may be observed. The disease tends to be slowly progressive.Figure 3-32Atypical mycobacterial infection. Chest CT of a patient with emphysema shows the appearance of classic atypical mycobacterial infection. Biapical fibronodular opacities (arrows) are accompanied by architectural distortion resembling the appearance of reactivation tuberculosis.'], 'gr33': ['MAC lung disease occurring in older women who are usually nonsmokers without evidence of COPD is noncavitary and is associated with bronchiectasis. The classic radiographic features are best appreciated on CT (<xref rid="gr33" ref-type="fig">Fig. 3-33</xref>\n). The findings are those of cylindrical bronchiectasis associated with multiple, small, focal lung nodules that are approximately 5\xa0mm in diameter. Any lobe may be involved, but disease in the lingula and middle lobe has the highest prevalence. Occasionally, airspace disease may be delineated. Evidence indicates that patients with these findings are truly infected and not colonized with MAC and that the MAC infection causes the bronchiectasis rather than colonizing preexisting disease.\n). The findings are those of cylindrical bronchiectasis associated with multiple, small, focal lung nodules that are approximately 5\xa0mm in diameter. Any lobe may be involved, but disease in the lingula and middle lobe has the highest prevalence. Occasionally, airspace disease may be delineated. Evidence indicates that patients with these findings are truly infected and not colonized with MAC and that the MAC infection causes the bronchiectasis rather than colonizing preexisting disease.Figure 3-33Mycobacterial avium complex infection. Three selected images from a chest CT study of an elderly woman show scattered nodules and peripheral areas of bronchiectasis with mucous plugging (arrows).'], 'gr34': ['The radiographic manifestations of histoplasmosis vary. The acute phase of the disease is characterized by single or multiple areas of consolidation, which are usually segmental or sublobar in distribution. These areas may be accompanied by ipsilateral hilar or mediastinal adenopathy, and occasionally, adenopathy alone may be the only finding. In the epidemic form of the disease, multiple, discrete nodules may be seen throughout both lungs; nodules may occur alone or be associated with hilar adenopathy (<xref rid="gr34" ref-type="fig">Fig. 3-34</xref>\n). They are usually 1 to 5\xa0mm in diameter, discrete, and poorly marginated. With healing, the nodules may remain visible as multiple, discrete, calcified lesions less than 1\xa0cm in diameter with or without calcified hilar lymph nodes (\n). They are usually 1 to 5\xa0mm in diameter, discrete, and poorly marginated. With healing, the nodules may remain visible as multiple, discrete, calcified lesions less than 1\xa0cm in diameter with or without calcified hilar lymph nodes (<xref rid="gr35" ref-type="fig">Fig. 3-35</xref>\n). A third radiographic pattern consists of a solitary granuloma or histoplasmoma, which is usually well defined and can range in size from several millimeters to 4\xa0cm. It typically contains a central or target type of calcification. These lesions usually occur in the lower lobes, and they may have associated smaller, calcified satellite nodules.\n). A third radiographic pattern consists of a solitary granuloma or histoplasmoma, which is usually well defined and can range in size from several millimeters to 4\xa0cm. It typically contains a central or target type of calcification. These lesions usually occur in the lower lobes, and they may have associated smaller, calcified satellite nodules.Figure 3-34CT shows acute histoplasmosis. A, The lung windows demonstrate multiple, bilateral pulmonary nodules. B, On the mediastinal windows, there is adenopathy in the aorticopulmonary window (arrow).Figure 3-35Healed histoplasmosis is characterized by multiple, small, calcified nodules in both lungs and by densely calcified hilar and mediastinal nodes.'], 'gr36': ['Additional radiographic features may be identified in patients with Histoplasma infection. They include calcifications in the spleen, which often are best detected on CT. Mediastinal lymphadenopathy is common as a sole manifestation of histoplasmosis or accompanying pulmonary consolidation or nodules. Nodes frequently calcify as healing occurs. Calcified lymph nodes may lead to two complications: broncholiths and fibrosing mediastinitis. Calcified lymph nodes may over time erode into a bronchus, producing broncholithiasis and its resulting symptom complex. Patients may have unexplained chronic cough and hemoptysis. CT can best identify the intrabronchial calcification that may be associated with distal atelectasis of a segment or lobe (<xref rid="gr36" ref-type="fig">Fig. 3-36</xref>\n). The other complication, fibrosing mediastinitis, is discussed in Chapter 17. This condition is caused by the effect of large, calcified lymph nodes constricting and encasing important mediastinal structures, particularly the superior vena cava, with resultant superior vena caval syndrome; the trachea; right main bronchus; and central pulmonary arteries. Compression of pulmonary veins may lead to venous infarcts in the lungs.\n). The other complication, fibrosing mediastinitis, is discussed in Chapter 17. This condition is caused by the effect of large, calcified lymph nodes constricting and encasing important mediastinal structures, particularly the superior vena cava, with resultant superior vena caval syndrome; the trachea; right main bronchus; and central pulmonary arteries. Compression of pulmonary veins may lead to venous infarcts in the lungs.Figure 3-36Broncholith. CT (bone window setting) demonstrates a small, rounded calcification (arrow) eroding into the superior segment right lower lobe bronchus and shows distal atelectasis. Notice the small, calcified granuloma in left lower lobe.'], 'gr37': ['The radiographic features of chronic coccidioidomycosis include solitary or multiple nodules. These tend to cavitate rapidly, and the cavities typically have very thin walls (<xref rid="gr37" ref-type="fig">Fig. 3-37</xref>\n). The thin-walled cavity is the classic lesion of coccidioidomycosis, but it occurs in only 10% to 15% of cases. Disseminated coccidioidomycosis is rare and is characterized radiographically by nodules ranging from 5\xa0mm to 1\xa0cm in diameter. A classic miliary pattern can also be observed.\n). The thin-walled cavity is the classic lesion of coccidioidomycosis, but it occurs in only 10% to 15% of cases. Disseminated coccidioidomycosis is rare and is characterized radiographically by nodules ranging from 5\xa0mm to 1\xa0cm in diameter. A classic miliary pattern can also be observed.Figure 3-37Coccidioidomycosis. CT demonstrates a relatively thin-walled cavity in the right lower lobe. The classic lesion of coccidioidomycosis has a paper-thin wall.'], 'gr38': ['In the normal host, the most common finding is that of single or multiple pulmonary nodules that are approximately 1 to 5\xa0cm in diameter and that usually occur in the lower lobes (<xref rid="gr38" ref-type="fig">Fig. 3-38</xref>\n). Cavitation, lymph node enlargement, and pleural effusion are uncommon. Adenopathy is rarely identified. Characteristically, the single or multiple nodules tend to abut the pleura.\n). Cavitation, lymph node enlargement, and pleural effusion are uncommon. Adenopathy is rarely identified. Characteristically, the single or multiple nodules tend to abut the pleura.Figure 3-38Cryptococcus infection in a patient with lymphoma. CT demonstrates an irregular nodule with a tag extending to the pleura.'], 'gr39': ['The radiographic features initially consist of an area of consolidation in the lung. This area may become rounded and suggest an abscess. Classic signs include extension of the disease process into the chest wall with bone destruction and osteomyelitis (<xref rid="gr39" ref-type="fig">Fig. 3-39</xref>\n). Chest wall invasion is best appreciated on CT. Pleural effusions are moderately common. Invasion of the ribs or vertebral bodies characteristically causes bone destruction and fairly extensive reactive periostitis.\n). Chest wall invasion is best appreciated on CT. Pleural effusions are moderately common. Invasion of the ribs or vertebral bodies characteristically causes bone destruction and fairly extensive reactive periostitis.Figure 3-39CT shows actinomycosis in a patient who developed a right upper lobe, posterior segment necrotic consolidation after dental extraction. Notice the erosion of the cortex of the overlying rib (arrows).'], 'gr40': ['The radiographic appearance of a fungus ball or mycetoma can be quite characteristic (<xref rid="gr40" ref-type="fig">Fig. 3-40</xref>\n). Typically, there is a solid, round opacity within a cavity or thin-walled cyst. Air may dissect into the solid mass, creating the appearance of an air crescent. In most cases, the fungus ball is mobile, and changes in position occur with changes in body posture. Extensive pleural thickening at the apex of the thorax frequently accompanies the development of a mycetoma. In making the differential diagnosis, necrotizing squamous cell carcinoma and an intrapulmonary abscess should be considered.\n). Typically, there is a solid, round opacity within a cavity or thin-walled cyst. Air may dissect into the solid mass, creating the appearance of an air crescent. In most cases, the fungus ball is mobile, and changes in position occur with changes in body posture. Extensive pleural thickening at the apex of the thorax frequently accompanies the development of a mycetoma. In making the differential diagnosis, necrotizing squamous cell carcinoma and an intrapulmonary abscess should be considered.Figure 3-40Fungus ball or mycetoma due to Aspergillus. Coned-down posteroanterior view shows the chest of a patient with biapical, fibrocavitary tuberculosis accompanied by volume loss. There is a mass in a large, right upper lobe cavity, with air dissecting into the cavity producing air crescents (arrows).'], 'gr41': ['Echinococcal cysts are usually well-circumscribed, spherical or oval masses that may be single or multiple (<xref rid="gr41" ref-type="fig">Fig. 3-41</xref>\n). They are usually located in the lower lobes. If communication develops between the cysts and the bronchial tree, air may enter between the pericyst and exocyst, producing the appearance of a thin crescent of air around the periphery of the cyst, sometimes called the \n). They are usually located in the lower lobes. If communication develops between the cysts and the bronchial tree, air may enter between the pericyst and exocyst, producing the appearance of a thin crescent of air around the periphery of the cyst, sometimes called the meniscus or crescent sign. Bronchial communication occurs directly into the endocyst. Occasionally, an air crescent sign and air-fluid level can be identified. The membrane of the cyst, which has ruptured into the bronchial tree, may float on the fluid within the cyst, giving rise to the classic water lily sign. CT can differentiate cystic from solid lesions and may identify the pathognomonic features in ruptured or complicated hydatid cysts, such as the presence of daughter cysts and endocyst membranes. Calcification of a pulmonary hydatid cyst is rare.Figure 3-41Echinococcal cysts. Both lungs contain multiple nodules, some of which are cavitated. A meniscus or crescent can be identified (white arrows) in the large cyst in the left lung, which also displays an air-fluid level and water lily sign (black arrow).'], 'gr42': ['Pulmonary arterial hypertension is the most common finding in patients with pulmonary schistosomiasis (<xref rid="gr42" ref-type="fig">Fig. 3-42</xref>\n). The appearance consists of dilation of the central pulmonary arteries with rapid tapering. The passage of larva through the pulmonary capillaries can cause a transitory eosinophilic pneumonia, simulating Loeffler\'s syndrome. This is characterized by the presence of peripheral areas of consolidation.\n). The appearance consists of dilation of the central pulmonary arteries with rapid tapering. The passage of larva through the pulmonary capillaries can cause a transitory eosinophilic pneumonia, simulating Loeffler\'s syndrome. This is characterized by the presence of peripheral areas of consolidation.Figure 3-42Pulmonary arterial hypertension in pulmonary schistosomiasis is characterized by dilation of the central pulmonary arteries. The patient was a 48-year-old Puerto Rican woman with proven schistosomiasis, cirrhosis, and portal hypertension.'], 'gr43': ['Chest radiographs usually show abnormalities at the time of presentation. The most common finding is multifocal consolidation (<xref rid="gr43" ref-type="fig">Fig 3-43</xref>\n), which is bilateral in 80% of cases. Consolidation may infrequently be complicated by areas of cavitation. Bilateral pleural effusions occur in about one third of cases.\n), which is bilateral in 80% of cases. Consolidation may infrequently be complicated by areas of cavitation. Bilateral pleural effusions occur in about one third of cases.Figure 3-43H5N1 avian influenza. The chest radiograph demonstrates bilateral, multifocal airspace consolidation.(From Ketai L, Paul NS, Wong KT: Radiology of severe acute respiratory syndrome [SARS]: the emerging pathologic-radiologic correlates of an emerging disease. J Thorac Imaging 21:276–283, 2006).'], 'gr44': ['Chest radiographs show abnormalities at the time of clinical presentation in about 80% of cases. The most common radiographic finding is poorly defined airspace consolidation. Although about one half of cases appear to have a focal distribution at the time of presentation, progression to multifocal involvement is common. Areas of consolidation have a predilection for the lower lobes and lung periphery. CT shows abnormalities at the time of clinical presentation, even when chest radiographs do not. The most common CT finding is ground-glass opacification (<xref rid="gr44" ref-type="fig">Fig 3-44</xref>\n), which is often accompanied by small foci of consolidation and interlobular and intralobular thickening. Severe SARS may progress to diffuse alveolar damage.\n), which is often accompanied by small foci of consolidation and interlobular and intralobular thickening. Severe SARS may progress to diffuse alveolar damage.Figure 3-44Severe acute respiratory syndrome (SARS). CT shows multifocal, peripheral foci of ground-glass attenuation with superimposed reticular opacities.(From Ketai L, Paul NS, Wong KT: Radiology of severe acute respiratory syndrome [SARS]: the emerging pathologic-radiologic correlates of an emerging disease. J Thorac Imaging 21:276–283, 2006).'], 'gr45': ['HPS is caused by endothelial damage to the lung. The initial interstitial edema manifests radiographically as Kerley lines, bronchial wall thickening, and subpleural edema. Although some patients recover fully from the initial stage of infection, many progress to diffuse alveolar edema, which is manifested by symmetric perihilar and basilar airspace consolidation (<xref rid="gr45" ref-type="fig">Fig 3-45</xref>\n). This phase of illness requires mechanical ventilation and is associated with a high mortality rate. As the disease progresses, it may be accompanied by myocardial depression, which worsens tissue hypoxia and contributes to the high mortality rate associated with this syndrome.\n). This phase of illness requires mechanical ventilation and is associated with a high mortality rate. As the disease progresses, it may be accompanied by myocardial depression, which worsens tissue hypoxia and contributes to the high mortality rate associated with this syndrome.Figure 3-45Hantavirus pulmonary syndrome. A, Portable chest radiograph shows bilateral central airspace opacities and diffuse Kerley lines due to combined alveolar and interstitial edema. B, Portable chest radiograph of same patient 1 day later shows progressive alveolar pulmonary edema and interval intubation.(Courtesy of Loren Ketai, MD, University of New Mexico, Albuquerque, NM.)'], 'gr46': ['CT may provide convincing evidence of inhalational anthrax before confirmatory laboratory tests have returned (<xref rid="gr46" ref-type="fig">Fig 3-46</xref>\n). Unenhanced CT may show high-attenuation (46 to 62 Hounsfield units) mediastinal and hilar lymph nodes, which may rapidly enlarge over a period of days. These findings reflect the presence of hemorrhage and edema within lymph nodes. Because of this characteristic appearance, unenhanced CT is considered the imaging modality of choice for the diagnosis of inhalational anthrax.\n). Unenhanced CT may show high-attenuation (46 to 62 Hounsfield units) mediastinal and hilar lymph nodes, which may rapidly enlarge over a period of days. These findings reflect the presence of hemorrhage and edema within lymph nodes. Because of this characteristic appearance, unenhanced CT is considered the imaging modality of choice for the diagnosis of inhalational anthrax.Figure 3-46Inhalational anthrax. Contrast-enhanced CT scan of the chest shows diffuse widening of mediastinal and hilar regions due to a combination of widespread edema and enlarged lymph nodes. High-attenuation foci in the right paratracheal soft tissue (arrows) likely are caused by hemorrhagic foci in the lymph nodes. Notice the bilateral pleural effusions.(From Ketai L, Alrahji AA, Hart B, et al: Radiologic manifestations of potential bioterrorist agents of infection. AJR Am J Roentgenol 180:565–575, 2003.)']} | Pulmonary Infections in the Normal Host | null | Thoracic Radiology | 1277190000 | None | null | other | PMC7310947 | null | null | [
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] | Thoracic Radiology. 2010 Jun 22;:80-120 | NO-CC CODE |
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3 mm coronal MPR (a) and 10 mm minimum intensity projection (MinIP, b) demonstrating the better visualization of lobular air trapping | 72913_2_En_7_Fig9_HTML | 7 | 4ac2f7c17670e1c4a3169e6836b06370c257b8c5be02d2e149393c89fea47a3d | 72913_2_En_7_Fig9_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
672,
333
] | [{'image_id': '72913_2_En_7_Fig13_HTML', 'image_file_name': '72913_2_En_7_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig13_HTML.jpg', 'caption': '1 mm axial slices in two patients with increased density in a geographic distribution: (a) shows no signs of distortion (desquamative interstitial pneumonia\u2009=\u2009DIP), (b) shows bronchiectasis and reticulation as signs of fibrosis; additionally, there are areas of air trapping (chronic exogenic allergic alveolitis)', 'hash': 'adaa2325e7297bd95eabfc053eb7cce22db34125dd2f0431cbb14e9836638558'}, {'image_id': '72913_2_En_7_Fig1_HTML', 'image_file_name': '72913_2_En_7_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig1_HTML.jpg', 'caption': 'Coronal reconstructions 1 mm versus 3 mm slice thickness demonstrating the impact of SL on detail resolution', 'hash': '5a30d7685a8476ba6953e3b62468cbbecd910ebc8630b1718940ee15a09d0224'}, {'image_id': '72913_2_En_7_Fig14_HTML', 'image_file_name': '72913_2_En_7_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig14_HTML.jpg', 'caption': 'Definite usual interstitial pneumonia (UIP) with honeycombing in a subpleural and mostly basal distribution. There is traction bronchiectasis and very little ground glass', 'hash': '015be74a4aa2b64096ea069c027c7deccdd9dec094ee86d0a30a2f3c23e89536'}, {'image_id': '72913_2_En_7_Fig9_HTML', 'image_file_name': '72913_2_En_7_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig9_HTML.jpg', 'caption': '3 mm coronal MPR (a) and 10 mm minimum intensity projection (MinIP, b) demonstrating the better visualization of lobular air trapping', 'hash': '4ac2f7c17670e1c4a3169e6836b06370c257b8c5be02d2e149393c89fea47a3d'}, {'image_id': '72913_2_En_7_Fig6_HTML', 'image_file_name': '72913_2_En_7_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig6_HTML.jpg', 'caption': 'Impact of window width on visualization of structures and bronchial wall thickness: (a) narrow window; (b) normal window settings', 'hash': 'f64609a63656231fca74221be1c000e6f70e553c18b9eb9355411ff7d9d72589'}, {'image_id': '72913_2_En_7_Fig12_HTML', 'image_file_name': '72913_2_En_7_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig12_HTML.jpg', 'caption': '1 mm coronal MPR in two patients with a nodular pattern: (a) shows the diffuse distribution in a patient with bronchiolitis, (b) shows the upper lobe predominance in a patient with sarcoidosis', 'hash': 'bd6b7a9f8ae350253de6c8822f464bcea865266d0259a7fc335179026f90798b'}, {'image_id': '72913_2_En_7_Fig7_HTML', 'image_file_name': '72913_2_En_7_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig7_HTML.jpg', 'caption': '1 mm axial slice (a) and 10 mm maximum intensity projection (MIP, b) demonstrating the better visualization of the distribution of a diffuse nodular pattern in MIPs in a patient with diffuse tree-in-bud due to infectious bronchiolitis nodular densities (here small granulomas) in MIPS', 'hash': '1cab70b5c7cdfcf3109a4053cb5542323e299c2dafb43c3ce390f2efe4b3cc57'}, {'image_id': '72913_2_En_7_Fig8_HTML', 'image_file_name': '72913_2_En_7_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig8_HTML.jpg', 'caption': '1 mm axial slice (a) and 7 mm maximum intensity projection (MIP, b) demonstrating the better visualization of nodular densities (here small granulomas) in MIPs', 'hash': 'a979e8b142d72016ad84da2d38d035fc9f64ae0d07439aba605389dde607ff99'}, {'image_id': '72913_2_En_7_Fig15_HTML', 'image_file_name': '72913_2_En_7_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig15_HTML.jpg', 'caption': 'Patient with fibrosis inconsistent with UIP through the predominant basal distribution: there is no honeycombing, but areas of ground glass and consolidations; reticulation is not predominant over ground glass', 'hash': 'b29724631256a2c2bbbd7e292434fb487015edbe4796aa67fc6b5eb9cc052aef'}, {'image_id': '72913_2_En_7_Fig4_HTML', 'image_file_name': '72913_2_En_7_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig4_HTML.jpg', 'caption': 'Impact of iterative noise reconstruction (IR) on image noise but also on visualization of attenuation differences and detail resolution: (a) IR factor 1, (b) IR factor 3, and (c) IR factor 5', 'hash': '0cb986dc4d738ff12f839b7d61b2a1f9b1d1186dfd81ba6303e04b871076d21f'}, {'image_id': '72913_2_En_7_Fig16_HTML', 'image_file_name': '72913_2_En_7_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig16_HTML.jpg', 'caption': 'The “many faces” of nonspecific interstitial pneumonia (NSIP): (a) subpleural bands of reticulation and ground glass (systemic sclerosis), (b) diffuse fine reticulation and traction bronchiectasis (systemic sclerosis), (c) patchy areas of ground glass and traction bronchiectasis (CREST)', 'hash': '2feeb5fa5b90c6a8c459d2de143e2eb39e3af5d91d7527ed28fabefac55cb323'}, {'image_id': '72913_2_En_7_Fig3_HTML', 'image_file_name': '72913_2_En_7_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig3_HTML.jpg', 'caption': 'Impact of dose: the right-sided image (b) was obtained with double acquisition dose compared to the left-sided image (a) (4.5 mGy versus 6.8 mGy, no iterative noise reconstruction has been applied)', 'hash': '7980ac66ca07d86f59e39a95b2968e96dcbbef65c9b3a2a8831819151873632c'}, {'image_id': '72913_2_En_7_Fig11_HTML', 'image_file_name': '72913_2_En_7_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig11_HTML.jpg', 'caption': 'Examples of a centrilobular (a), perilymphatic (b), and random (c) nodular distribution. (a) bronchiolitis, (b) sarcoidosis, and (c) miliary tuberculosis', 'hash': '69fac53bc353011d7e082d54d48db3bb5f4f100235d13d11933c29ac2b7cb0af'}, {'image_id': '72913_2_En_7_Fig17_HTML', 'image_file_name': '72913_2_En_7_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig17_HTML.jpg', 'caption': 'Patterns with increased density: (a) organizing pneumonia with sharply demarcated areas of consolidations and ground glass, (b) crazy pacing in alveolar proteinosis, (c) ground glass with air trapping in subacute exogenic allergic alveolitis', 'hash': 'b98fff45d2a1207b71f1be007df2193ed79589365b29770325fbd26bb3677cb9'}, {'image_id': '72913_2_En_7_Fig18_HTML', 'image_file_name': '72913_2_En_7_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig18_HTML.jpg', 'caption': 'Patterns with cystic parenchymal disease density: (a) Lymphangiomyomatosis with uniform cysts and enlarged pleural space after recurrent pneumothoraces, (b) diffuse ground glass and subpleural cysts in lymphocytic interstitial pneumonia (LIP), (c) bizarre-shaped cysts predominantly located in the upper lobes in Langerhans cell histiocytosis (LCH)', 'hash': '3e5165ced22fc3495b3729a4d28006b4047173d7b7faf7fa8b4d1a6f35bb5696'}, {'image_id': '72913_2_En_7_Fig5_HTML', 'image_file_name': '72913_2_En_7_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig5_HTML.jpg', 'caption': 'Images in full inspiration and after full expiration: lobular areas of lower attenuation (black) demonstrate air trapping. Air trapping is more easily and sometimes exclusively seen in expiration', 'hash': 'f1efb5ed66abe101713d1b926a27401262024b73e496b78713a857bbb711ea1f'}, {'image_id': '72913_2_En_7_Fig10_HTML', 'image_file_name': '72913_2_En_7_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig10_HTML.jpg', 'caption': '1 mm coronal MPR (a) and 10 mm minimum intensity projection (MinIP, b, c) demonstrating the better visualization of bronchiectasis; increased peribronchial parenchymal density increases the visualization of ectatic peripheral bronchi', 'hash': '84f899415be31177eafc973f9faa65e19a31dc34093d280ffb29dedbb763a781'}, {'image_id': '72913_2_En_7_Fig2_HTML', 'image_file_name': '72913_2_En_7_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC7120362/72913_2_En_7_Fig2_HTML.jpg', 'caption': 'Isotropic resolution in all three dimensions allows for axial, coronal, and sagittal reconstructions with equally high detail resolution. While pattern analysis is done on axial slices, the multiplanar reconstructions (MPR) nicely demonstrate the subpleural and craniocaudal distribution of disease in this patient with systemic sclerosis', 'hash': '161ad10294e0ca9890890faf7fb1edb0c5500f3efeb6803656b659288d8f072a'}] | {'72913_2_En_7_Fig1_HTML': ['There are two essential factors that constitute a “high-resolution” CT study: firstly, thin axial slices using narrow detector width (0.5–1.25 mm) and reconstruction of 1–1.5 mm thick slices (Fig. <xref rid="72913_2_En_7_Fig1_HTML" ref-type="fig">1</xref>) and, secondly, reconstruction of the scan data with a high-spatial-frequency (sharp or high-resolution) algorithm (Muller ) and, secondly, reconstruction of the scan data with a high-spatial-frequency (sharp or high-resolution) algorithm (Muller 1991).Fig. 1Coronal reconstructions 1 mm versus 3 mm slice thickness demonstrating the impact of SL on detail resolution\n'], '72913_2_En_7_Fig2_HTML': ['The ability of HRCT to provide high morphological detail of normal and abnormal lung parenchyma is based on high-quality examinations. With optimal scan technique, the spatial resolution is as low as 0.5 mm. Due to the high contrast within the lung parenchyma, even structures as small as 0.2 mm can be visualized (Murata et al. 1989). Thus, pulmonary artery branches down to the 16th and bronchi down to the 8th generation can be depicted. Since partial volume averaging effects on the margins of such small structures are minimized, HRCT provides a very accurate image of their true size. This represents the base for CT-based quantification, e.g., of bronchial wall thickness and airway lumen in COPD patients. Since this high resolution is available isotropically, meaning in all three directions, diameters of vessels, lung nodules, or obliquely oriented bronchi are accurately reflected, irrespective of their location in or near the scan plane or even perpendicular to the scan plane (Fig. <xref rid="72913_2_En_7_Fig2_HTML" ref-type="fig">2</xref>).).Fig. 2Isotropic resolution in all three dimensions allows for axial, coronal, and sagittal reconstructions with equally high detail resolution. While pattern analysis is done on axial slices, the multiplanar reconstructions (MPR) nicely demonstrate the subpleural and craniocaudal distribution of disease in this patient with systemic sclerosis\n', 'Multidetector-HRCT produces an isotropic dataset that allows for contiguous visualization of the lung parenchyma in three dimensions and to create multiplanar two-dimensional (2D) reconstructions in any arbitrary plane. Mostly planar coronal and sagittal reconstructions are routinely performed and considered standard for reconstructed series of any HRCT dataset (Prosch et al. 2013; Beigelman-Aubry et al. 2005; Walsh et al. 2013) (Fig. <xref rid="72913_2_En_7_Fig2_HTML" ref-type="fig">2</xref>).).'], '72913_2_En_7_Fig3_HTML': ['3D dose modulation – automatically adapting the delivered dose in the transverse plane (xy-axis) and along patient length (z-axis) – is an effective means to reduce dose by about 30\u2009% and is strongly recommended (Kubo et al. 2014) (Table 1). The abovementioned survey in 2013 confirmed that 90\u2009% of the respondents indeed apply it. Additional options are to adapt the protocol to patient weight, patient age, or scan indication. Principally a tube voltage of 120 kV is recommended, but in young patients or patients of lower body weight, a tube voltage of 100 kV can be applied, further contributing to dose saving. The tube current is mostly set around 100 mAs. Ultimately a dose between 1.5 and 4 mSv should be aimed for (Fig. <xref rid="72913_2_En_7_Fig3_HTML" ref-type="fig">3</xref>).).Table 1Dose ranges of HRCT techniques demonstrating the potential of modern dose-reduction techniquesEffective radiation dose (mSv)Yearly background radiation2.5PA chest radiograph0.05Discontinuous HRCT (10 mm gap)0.7Volumetric HRCT4–7Volumetric HRCT with xyz-modulation3–5Volumetric HRCT with iterative noise reconstruction1.5–3\nFig. 3Impact of dose: the right-sided image (b) was obtained with double acquisition dose compared to the left-sided image (a) (4.5 mGy versus 6.8 mGy, no iterative noise reconstruction has been applied)\n'], '72913_2_En_7_Fig4_HTML': ['New iterative reconstruction algorithms (IR) allow for greater noise reduction than standard filtered back projection (FBP) and subsequently more effective dose reduction. While increased spatial resolution is directly correlated with increase of image noise in standard filtered back projection, iterative reconstruction allows for decoupling of spatial resolution and image noise to a certain extent. Once an image has been reconstructed from measured projections, this image itself is used as “scan object” in a simulated CT measurement of the same projection, resulting in an image of calculated projections. The differences between the measured and calculated projections result in correction projections which are subsequently used to update the originally measured projections. This process is repeated until the difference between the calculated projections and measured projections is smaller than a predefined limit. With each update to the original image, image-processing algorithms enhance spatial resolution in higher contrast areas of the image and reduce noise in low contrast areas. While the first generations of IR produced images of lower noise, they were criticized for modifying the visual appearance of images, either being smoothed or pixelated especially with increased weighting of iterative noise reconstruction (Pontana et al. 2011; Prakash et al. 2010) (Fig. <xref rid="72913_2_En_7_Fig4_HTML" ref-type="fig">4</xref>). The second generation of so-called model-based IR – active in the raw data space – aims for reducing noise and maintaining image sharpness, thus having less impact on the visual image impression.). The second generation of so-called model-based IR – active in the raw data space – aims for reducing noise and maintaining image sharpness, thus having less impact on the visual image impression.Fig. 4Impact of iterative noise reconstruction (IR) on image noise but also on visualization of attenuation differences and detail resolution: (a) IR factor 1, (b) IR factor 3, and (c) IR factor 5\n'], '72913_2_En_7_Fig5_HTML': ['Scans after full expiration are obtained to display lobular areas of air trapping (Fig. <xref rid="72913_2_En_7_Fig5_HTML" ref-type="fig">5</xref>). Air trapping refers to lobular demarcated areas of hypertransparency caused by air trapped in expiration by a check valve mechanism of small airways. Consequently the involved secondary lobule will not decrease in volume and increase in attenuation during expiration compared to the surrounding uninvolved lung parenchyma. Areas of air trapping are more easily visible in expiration than in inspiration. In some patients air trapping may be seen exclusively in expiration. The finding of air trapping as indirect sign of small airway disease is an important diagnostic finding in all diseases with an obstructive or combined obstructive/restrictive lung function impairment. Diseases in which the finding of air trapping and thus expiratory CT scans represent an important part of the diagnostic workup are exogenous allergic alveolitis, collagen vascular diseases such as Sjögren’s disease and rheumatoid arthritis, but also sarcoidosis and diseases with predominant airway pathology such as asthma and cystic fibrosis.). Air trapping refers to lobular demarcated areas of hypertransparency caused by air trapped in expiration by a check valve mechanism of small airways. Consequently the involved secondary lobule will not decrease in volume and increase in attenuation during expiration compared to the surrounding uninvolved lung parenchyma. Areas of air trapping are more easily visible in expiration than in inspiration. In some patients air trapping may be seen exclusively in expiration. The finding of air trapping as indirect sign of small airway disease is an important diagnostic finding in all diseases with an obstructive or combined obstructive/restrictive lung function impairment. Diseases in which the finding of air trapping and thus expiratory CT scans represent an important part of the diagnostic workup are exogenous allergic alveolitis, collagen vascular diseases such as Sjögren’s disease and rheumatoid arthritis, but also sarcoidosis and diseases with predominant airway pathology such as asthma and cystic fibrosis.Fig. 5Images in full inspiration and after full expiration: lobular areas of lower attenuation (black) demonstrate air trapping. Air trapping is more easily and sometimes exclusively seen in expiration\n'], '72913_2_En_7_Fig6_HTML': ['The window setting has a substantial effect on the accuracy of size measurements. This is particularly important for the assessment of bronchial lumen diameter and bronchial wall thickness. It has been demonstrated that an intermediate window width between 1000 and 1400 HU together with a window level between −250 and −700 HU reflects best the true size of the bronchi and especially the thickness of the bronchial wall (Bankier et al. 1996) (Fig. <xref rid="72913_2_En_7_Fig6_HTML" ref-type="fig">6</xref>).).Fig. 6Impact of window width on visualization of structures and bronchial wall thickness: (a) narrow window; (b) normal window settings\n'], '72913_2_En_7_Fig7_HTML': ['Maximum intensity projection (MIP) is a 3D display technique, displaying the voxel of maximum intensity along the path of X-rays. To retain spatial information, MIPs are usually reconstructed with a thickness between 5 and 10 mm, dependent on the indication. Since they largely facilitate the differentiation between tubular (vascular structures) and nodular densities, their major advantage lies in demonstrating the distribution of nodules (Remy-Jardin et al. 1996; Beigelman-Aubry et al. 2005). The analysis of nodule distribution pattern in relation to the secondary lobule (e.g., perilymphatic, centrilobular, or random) is one of the key elements for the differential diagnosis; however, especially in cases with subtle findings and low numbers of nodules or on the contrary in cases with a very high number of nodules, it can be difficult to assess their distribution on axial thin slices alone, since vascular structures and nodules have the same appearance (Fig. <xref rid="72913_2_En_7_Fig7_HTML" ref-type="fig">7</xref>).).Fig. 71 mm axial slice (a) and 10 mm maximum intensity projection (MIP, b) demonstrating the better visualization of the distribution of a diffuse nodular pattern in MIPs in a patient with diffuse tree-in-bud due to infectious bronchiolitis nodular densities (here small granulomas) in MIPS\n'], '72913_2_En_7_Fig8_HTML': ['Similarly, MIPs are very useful for the detection of (solitary) nodular densities, e.g., metastases. MIPs were found to show a large advantage especially in the central parts of the lungs; it proved to be significantly superior to regular MPR with over 25\u2009% additional findings and increased diagnostic confidence (Peloschek et al. 2007) (Fig. <xref rid="72913_2_En_7_Fig8_HTML" ref-type="fig">8</xref>).).Fig. 81 mm axial slice (a) and 7 mm maximum intensity projection (MIP, b) demonstrating the better visualization of nodular densities (here small granulomas) in MIPs\n'], '72913_2_En_7_Fig9_HTML': ['Minimum intensity projections (MinIPs) are less commonly used, but have been shown to facilitate the assessment of lung disease associated with decreased attenuation. MinIPs are created by projecting the voxel with the lowest attenuation value for every view throughout the volume onto a 2D image. It was demonstrated that MinIP enhances the visualization of air trapping as a result of small airway disease, yielding not only increased observer confidence but also increased interreader agreement as compared to HRCT alone (Fig. <xref rid="72913_2_En_7_Fig9_HTML" ref-type="fig">9</xref>). MinIPs revealed additional findings in 8\u2009% of patients with emphysema and in 25\u2009% of cases with ground-glass opacities (Gavelli et al. ). MinIPs revealed additional findings in 8\u2009% of patients with emphysema and in 25\u2009% of cases with ground-glass opacities (Gavelli et al. 1998). These results have been confirmed by another study where MinIP improved the detection of pulmonary cysts and their differentiation from honeycombing (Vernhet et al. 1999).Fig. 93 mm coronal MPR (a) and 10 mm minimum intensity projection (MinIP, b) demonstrating the better visualization of lobular air trapping\n'], '72913_2_En_7_Fig10_HTML': ['There is a subtle difference in density between the endobronchial (pure) air and the lung parenchyma (HU difference 50–150). This allows visualization of the bronchi below the subsegmental level (Beigelman-Aubry et al. 2005) (Fig. <xref rid="72913_2_En_7_Fig10_HTML" ref-type="fig">10</xref>). Recently, more attention has been paid to the options of MinIPs in facilitating the differentiation of bronchiectasis from honeycombing. The presence of honeycombing represents a key finding for the diagnosis of UIP/IPF (Raghu et al. ). Recently, more attention has been paid to the options of MinIPs in facilitating the differentiation of bronchiectasis from honeycombing. The presence of honeycombing represents a key finding for the diagnosis of UIP/IPF (Raghu et al. 2011), but a relatively large interreader disagreement, even between experienced radiologists, has been described (Watadani et al. 2013).Fig. 101 mm coronal MPR (a) and 10 mm minimum intensity projection (MinIP, b, c) demonstrating the better visualization of bronchiectasis; increased peribronchial parenchymal density increases the visualization of ectatic peripheral bronchi\n'], '72913_2_En_7_Fig11_HTML': ['In general, the location or anatomic distribution of nodules is of great importance for the differential diagnosis. According to localization with regard to the anatomy of the secondary lobule, three main distribution categories of nodules are differentiated: perilymphatic, random, and centrilobular (Fig. <xref rid="72913_2_En_7_Fig11_HTML" ref-type="fig">11</xref>). Once the predominant distribution pattern has been determined, the overall distribution within the complete lung is considered in the differential diagnosis (Fig. ). Once the predominant distribution pattern has been determined, the overall distribution within the complete lung is considered in the differential diagnosis (Fig. <xref rid="72913_2_En_7_Fig12_HTML" ref-type="fig">12</xref>).).Fig. 11Examples of a centrilobular (a), perilymphatic (b), and random (c) nodular distribution. (a) bronchiolitis, (b) sarcoidosis, and (c) miliary tuberculosis\nFig. 121 mm coronal MPR in two patients with a nodular pattern: (a) shows the diffuse distribution in a patient with bronchiolitis, (b) shows the upper lobe predominance in a patient with sarcoidosis\n'], '72913_2_En_7_Fig13_HTML': ['The normal interlobular septa contain venous and lymphatic structures. They measure approximately 0.1 mm in thickness and are only occasionally or partially seen on HRCT under normal conditions. Thickening of interlobular septa results in outlining the margins of the secondary lobules in part or completely; a regular network becomes apparent, and the centrilobular arteries are easily identified as small dots in the center of the secondary lobules. For differential diagnosis it is most important whether increased reticular margins are associated with signs of parenchymal distortion (e.g., traction bronchiectasis) suggesting the diagnosis of fibrosis, or whether there are no signs of distortion as, e.g., seen in crazy paving (Fig. <xref rid="72913_2_En_7_Fig13_HTML" ref-type="fig">13</xref>).).Fig. 131 mm axial slices in two patients with increased density in a geographic distribution: (a) shows no signs of distortion (desquamative interstitial pneumonia\u2009=\u2009DIP), (b) shows bronchiectasis and reticulation as signs of fibrosis; additionally, there are areas of air trapping (chronic exogenic allergic alveolitis)\n'], '72913_2_En_7_Fig14_HTML': ['\nUsual interstitial pneumonia (UIP) carries a particularly poor prognosis: its 5-year survival is approximately 15–30\u2009%. Because of prognostic and lately also therapeutic differences, UIP/IPF is separated from the remaining ILDs. The definition of IPF is a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause that occurs primarily in older adults and is limited to the lungs and associated with the histopathologic and/or radiologic pattern of UIP. Other forms of interstitial pneumonia, including other idiopathic interstitial pneumonias and ILD associated with environmental exposure, medication, or systemic disease, must be excluded. UIP is characterized by the presence of reticular opacities associated with traction bronchiectasis. Honeycombing is critical for making a definite diagnosis following the criteria by Raghu et al. (Raghu et al. 2011) (Fig. <xref rid="72913_2_En_7_Fig14_HTML" ref-type="fig">14</xref>). For the HRCT-based diagnosis of UIP, ground glass can be present, but is less extensive than reticulation. The distribution of UIP is characteristically predominantly basal and subpleural. Coexistent pleural abnormalities (e.g., pleural plaques, calcifications, pleural effusion) suggest an alternative etiology for the UIP pattern. Also, findings such as micronodules, air trapping, cysts, extensive ground-glass opacities, consolidation, or a peribronchovascular-predominant distribution represent findings ). For the HRCT-based diagnosis of UIP, ground glass can be present, but is less extensive than reticulation. The distribution of UIP is characteristically predominantly basal and subpleural. Coexistent pleural abnormalities (e.g., pleural plaques, calcifications, pleural effusion) suggest an alternative etiology for the UIP pattern. Also, findings such as micronodules, air trapping, cysts, extensive ground-glass opacities, consolidation, or a peribronchovascular-predominant distribution represent findings inconsistent with UIP and suggest an alternative diagnosis (Fig. <xref rid="72913_2_En_7_Fig15_HTML" ref-type="fig">15</xref>).).Fig. 14Definite usual interstitial pneumonia (UIP) with honeycombing in a subpleural and mostly basal distribution. There is traction bronchiectasis and very little ground glass\nFig. 15Patient with fibrosis inconsistent with UIP through the predominant basal distribution: there is no honeycombing, but areas of ground glass and consolidations; reticulation is not predominant over ground glass\n'], '72913_2_En_7_Fig16_HTML': ['\nNonspecific interstitial pneumonia (NSIP) forms the second group of lung fibrosis, having a very variable clinical, radiological, and histological presentation. It may be idiopathic but is more commonly associated with collagen vascular diseases, hypersensitivity pneumonitis, drug-induced lung disease, or slowly healing DAD. The typical HRCT features are ground-glass opacities, irregular linear (reticular) opacities, and traction bronchiectasis. It has a peripheral and basal predominance, with typically (but not always present) relative sparing of the immediate subpleural space in the dorsal regions of the lower lobes. A more acute inflammatory (cellular) type of NSIP representing with predominant ground glass is differentiated from the more fibrotic type representing with reticulation and traction bronchiectasis (Fig. <xref rid="72913_2_En_7_Fig16_HTML" ref-type="fig">16</xref>). Opposite to UIP, NSIP can also demonstrate a very patchy distribution. NSIP is typically characterized by a more uniform pattern, indicating the same stage of evolution of disease, distinct from the multi-temporal and morphological heterogeneity of UIP.). Opposite to UIP, NSIP can also demonstrate a very patchy distribution. NSIP is typically characterized by a more uniform pattern, indicating the same stage of evolution of disease, distinct from the multi-temporal and morphological heterogeneity of UIP.Fig. 16The “many faces” of nonspecific interstitial pneumonia (NSIP): (a) subpleural bands of reticulation and ground glass (systemic sclerosis), (b) diffuse fine reticulation and traction bronchiectasis (systemic sclerosis), (c) patchy areas of ground glass and traction bronchiectasis (CREST)\n'], '72913_2_En_7_Fig17_HTML': ['\nOrganizing pneumonia (OP) is a common reaction pattern secondary to pulmonary infection, connective tissue diseases, inflammatory bowel disease, inhalation injury, hypersensitivity pneumonitis, drug toxicity, malignancy, radiation therapy, or aspiration but can also be idiopathic. Organizing pneumonia can present with a wide variety of HRCT findings with increased density, ranging from a more nodular pattern to geographically demarcated ground-glass or focal consolidations. Suggestive for organizing pneumonia (as opposed to an infectious pneumonia) are sharply demarcated consolidations in a peripheral subpleural distribution or following the bronchovascular bundle (Fig. <xref rid="72913_2_En_7_Fig17_HTML" ref-type="fig">17</xref>). Mostly the areas with increased density show dilated air-filled bronchi without signs of underlying distortion. A patchy distribution is described as atoll sign, demonstrating islands with a peripheral rim-like consolidation around central areas of ground glass (reversed halo). Densities along the periphery of the secondary lobules are described as perilobular pattern.). Mostly the areas with increased density show dilated air-filled bronchi without signs of underlying distortion. A patchy distribution is described as atoll sign, demonstrating islands with a peripheral rim-like consolidation around central areas of ground glass (reversed halo). Densities along the periphery of the secondary lobules are described as perilobular pattern.Fig. 17Patterns with increased density: (a) organizing pneumonia with sharply demarcated areas of consolidations and ground glass, (b) crazy pacing in alveolar proteinosis, (c) ground glass with air trapping in subacute exogenic allergic alveolitis\n'], '72913_2_En_7_Fig18_HTML': ['Cysts are the leading pattern of specific lung diseases, such as Langerhans cell histiocytosis or lymphangioleiomyomatosis (LAM). Other more rare diseases with cysts are LIP and Birt-Hogg-Dube (Fig. <xref rid="72913_2_En_7_Fig18_HTML" ref-type="fig">18</xref>).).Fig. 18Patterns with cystic parenchymal disease density: (a) Lymphangiomyomatosis with uniform cysts and enlarged pleural space after recurrent pneumothoraces, (b) diffuse ground glass and subpleural cysts in lymphocytic interstitial pneumonia (LIP), (c) bizarre-shaped cysts predominantly located in the upper lobes in Langerhans cell histiocytosis (LCH)\n']} | CT Imaging of Interstitial Lung Diseases | [
"Idiopathic Pulmonary Fibrosis",
"Interstitial Lung Disease",
"Interstitial Pneumonia",
"Maximum Intensity Projection",
"Usual Interstitial Pneumonia"
] | Multidetector-Row CT of the Thorax | 1456560000 | None | null | other | PMC7120362 | null | null | [
""
] | Multidetector-Row CT of the Thorax. 2016 Feb 27;:105-130 | NO-CC CODE |
|
A 50-year-old man developing a varicella without respiratory symptoms. Axial (a) and coronal (b) 10 mm-thick MIP images of a CT performed due to suspicion of pulmonary nodules on the chest X-ray show micronodules with random distribution that almost completely disappeared at the follow-up 3 months later (c, d) | 72913_2_En_8_Fig34_HTML | 7 | 578c3e20c6b39bf61a39f7f130288a1a7acdef7e2e3c94d0212a31e159872115 | 72913_2_En_8_Fig34_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
672,
547
] | [{'image_id': '72913_2_En_8_Fig25_HTML', 'image_file_name': '72913_2_En_8_Fig25_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig25_HTML.jpg', 'caption': 'P. jirovecii pneumonia in an AIDS patient appearing as ground-glass opacity sparing the pulmonary cortex and typically predominantly located at the upper region of the lungs', 'hash': '0b3109b50da7baf1b27933f8af6e656f0c228c0ca03f9cc7b2796900285bf5ca'}, {'image_id': '72913_2_En_8_Fig5_HTML', 'image_file_name': '72913_2_En_8_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig5_HTML.jpg', 'caption': 'A 60-year-old man suffering from bronchiectasis of unknown cause presented with fever and new respiratory symptoms related to an abscess due to a usually nosocomial germ, Serratia marcescens and Cronobacter, a gram-negative bacteria of the Enterobacteriaceae family. Chest X-ray (a) and axial CT section with IV contrast in mediastinal (b) and lung (c) windows show the abscess of the LUL with thick walls, a necrotic component and an air-fluid level. The coronal 1.5 mm (d), 30 mm (e), and 150 mm (f) thick AIP reformatted images allow for a better understanding of the opacities related to a bronchocele at the level of the RUL and the abscess situated close to a bronchiectatic area of the LUL', 'hash': 'f2db0b936dd2364f1dd0a634c0ea599c3d0b0d86365720c2574d1a2a79a143ab'}, {'image_id': '72913_2_En_8_Fig35_HTML', 'image_file_name': '72913_2_En_8_Fig35_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig35_HTML.jpg', 'caption': 'Pulmonary and hepatosplenic candidiasis in a 62-year-old patient with an acute myeloid leukemia treated by chemotherapy. Axial CT image of 1 mm (a) and 15 mm-thick MIP (b) shows multiple nodules of various sizes with random distribution. The added value of MIP in the assessment of the detection and evaluation of profusion of nodules is undeniable', 'hash': '36dc2d8169da876182bd6d2b0321e912211fecece9f6ee356862c5013006e719'}, {'image_id': '72913_2_En_8_Fig15_HTML', 'image_file_name': '72913_2_En_8_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig15_HTML.jpg', 'caption': 'Lobar pneumonia of the RUL related to Streptococcus pneumococcus in a 25-year-old smoker. Scout view (a) and axial CT image (b) show an alveolar consolidation with an air bronchogram. The 10 mm-thick mIP (c) permits to display the entire length of the bronchi from their origin within the alveolar consolidation. Although CT does not replace fiber-optic bronchoscopy, no obstructive lesion was detected by using CT', 'hash': 'd9a65d73cc20b40666b91931a98d2de22d9b2b7c33632a4acf7e20f7589daa99'}, {'image_id': '72913_2_En_8_Fig42_HTML', 'image_file_name': '72913_2_En_8_Fig42_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig42_HTML.jpg', 'caption': 'Invasive aspergillosis in a 27-year-old woman with acute myeloid leukemia. Baseline CT (a) performed in a context of febrile agranulocytosis (a) with 5 mm-thick axial sections shows alveolar consolidation of the posterior segment of the upper part of the LUL with peripheral ground-glass opacity. Bronchiolo-alveolar nodules with ill borders are also seen in the RUL. On CT performed 3 weeks after (b), during bone marrow recovery, multiple nodules with air-crescent sign were seen, this finding suggesting a rather late stage of angioinvasive aspergillosis. Note the somewhat atypical presence of peripheral ground glass at this late stage of the disease', 'hash': '39868c2e9a9033422e83930de3b7db54ea4c8b53a2b0f49b1fbcb9a9cabdae4d'}, {'image_id': '72913_2_En_8_Fig32_HTML', 'image_file_name': '72913_2_En_8_Fig32_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig32_HTML.jpg', 'caption': 'Postprimary (reactivation) tuberculosis in a 37-year-old man, native of Cameroun, complaining about cough, weight loss, and night sweats for 3 months. Axial CT image at the level of the RUL (a) shows the typical hallmarks of reactivation TB including cavities, surrounded by thick and irregular borders, and dense centrilobular nodules with sharp margins predominantly located at the level of the apical and posterior segments of the upper lobes and the apical segment of the lower lobes. A 4 mm-thick MIP axial reformat at the level of the apical bronchus of the RLL (b) demonstrates typical centrilobular nodules with sparing of the subpleural space (3 mm) and lobular consolidation of the anterior segment of the RUL (arrows). Two consecutive coronal reformats 20 mm-thick AIP (c, e) and thin coronal slice at the level of the drainage bronchus of the largest cavity of the RUL (d) allow for a complete understanding of the appearance seen on chest X-ray (f)', 'hash': '6ae671f6fe2764d601a538d3253cab9707766560cb09c3b21a8ef4951c2080c2'}, {'image_id': '72913_2_En_8_Fig2_HTML', 'image_file_name': '72913_2_En_8_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig2_HTML.jpg', 'caption': 'Low-dose CT was performed for the follow-up of an angioinvasive aspergillosis in a 38-year-old woman with acute myeloid leukemia. The baseline CT (a) was performed with a CTDI of 5 and a DLP at 147 mGy.cm and the follow-up CT (b) with a CTDI of 2 and a DLP of 72 mGy.cm by using filter back projection reconstruction (FBP) with a soft kernel, without iterative reconstruction (IR) algorithm. Although a relative lesser image quality than the reference image, the disease’s evolution may be perfectly assessed at less than half of the initial dose', 'hash': '088a9850a1afe871f54c427b086d72228f405f6ff8a9243679d12213dc4bcb11'}, {'image_id': '72913_2_En_8_Fig22_HTML', 'image_file_name': '72913_2_En_8_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig22_HTML.jpg', 'caption': 'CMV infection in a patient with renal graft appears as a bronchopneumonia pattern on two successive axial sections (a, b). The bronchial thickening in (a) is associated with bilateral segmental alveolar consolidations at the lung bases in (b)', 'hash': '3f73a0df56c7526537a586083ac2985722b869d6e4d50b6aa89ed2c0a9ac2d4c'}, {'image_id': '72913_2_En_8_Fig12_HTML', 'image_file_name': '72913_2_En_8_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig12_HTML.jpg', 'caption': 'Rasmussen aneurysm in a 35-year-old patient presenting hemoptysis 9 days after the initial diagnosis of TB. Axial CT without (a) and with IV contrast media injection (b) focused at the level of the RUL shows a vascular enhancement within the tuberculoma that was clearly differentiated from the calcification depicted without contrast. The selective angiogram of the right bronchial artery (c) shows the aneurysm that was immediately successfully embolized', 'hash': '7ac36fd4ac97649070420bbc260e35c4502d8758cb11f5b96c1882131b57ee96'}, {'image_id': '72913_2_En_8_Fig45_HTML', 'image_file_name': '72913_2_En_8_Fig45_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig45_HTML.jpg', 'caption': 'Tuberculosis in a patient with a history of ulcerous colitis under anti-TNF treatment and lung graft for panlobular emphysema related to α1-antitrypsin deficiency. Axial sections in mediastinal (a) and lung (b) windows show an enlarged right paratracheal lymph node associated with a homolateral alveolar consolidation of the RLL, hallmarks of primary TB. Note the peripheral centrilobular nodules (arrows)', 'hash': '8d5d68a466f22fe112cfb57dcaa68d5dab14856dddd81aeefd549b5eff609a54'}, {'image_id': '72913_2_En_8_Fig14_HTML', 'image_file_name': '72913_2_En_8_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig14_HTML.jpg', 'caption': 'Segmental pneumonia of the lingula in an 82-year-old woman. Axial CT scan focused at the level of the lower part of the LUL (a) and sagittal reformat (b) show an alveolar consolidation with a well-defined air bronchogram anterior to the great fissure', 'hash': 'ab37422e5c9721f5e9a37e47da5f68b33dd3a7b2799b871564f413d8cdba6524'}, {'image_id': '72913_2_En_8_Fig43_HTML', 'image_file_name': '72913_2_En_8_Fig43_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig43_HTML.jpg', 'caption': 'Necrotizing pneumonia in a context of mucormycosis (same patient as in Fig. 13) presenting with hemoptysis 2 weeks after initial diagnosis despite adequate treatment. The retraction of the central necrotic mass of the LLL creates an air-crescent sign visible on mediastinal (a) and lung (b) windows. It had occurred at the same time as the pulmonary artery involvement', 'hash': 'ab3d625900654b0aa8144b5dceb681ac453f770e9a3b12cec451b07ef6fbf520'}, {'image_id': '72913_2_En_8_Fig24_HTML', 'image_file_name': '72913_2_En_8_Fig24_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig24_HTML.jpg', 'caption': 'Diffuse alveolar consolidation with air bronchogram and ground-glass opacity in a patient with autoimmune hepatitis treated with long-term steroids presenting with dyspnea and severe hypoxemia. This was related to a Pneumocystis jirovecii pneumonia. Note the pneumomediastinum in this mechanically ventilated patient staying in the intensive care unit who died from this severe infection with rapid deterioration', 'hash': '31a98b6bc04605adfb27bc70f8498f238350eed9b0bda037c9966913a8ac17c4'}, {'image_id': '72913_2_En_8_Fig34_HTML', 'image_file_name': '72913_2_En_8_Fig34_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig34_HTML.jpg', 'caption': 'A 50-year-old man developing a varicella without respiratory symptoms. Axial (a) and coronal (b) 10 mm-thick MIP images of a CT performed due to suspicion of pulmonary nodules on the chest X-ray show micronodules with random distribution that almost completely disappeared at the follow-up 3 months later (c, d)', 'hash': '578c3e20c6b39bf61a39f7f130288a1a7acdef7e2e3c94d0212a31e159872115'}, {'image_id': '72913_2_En_8_Fig4_HTML', 'image_file_name': '72913_2_En_8_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig4_HTML.jpg', 'caption': 'Coronal reformatted images with progressive thickening of the slabs from 1 (a) to 30 (b) to 150 mm (c) thick slabs by using the average intensity projection (AIP) post-processing tool in a patient known for a voluminous bullae of the right apex of the lung with superimposed infectious alveolar consolidation. Note that the bullae is not easily seen on the chest X-ray rendering in (c), as it was the case with the conventional chest X-ray (not shown). The same limitation also occurs in case of cavitation that may be missed on conventional chest X-ray', 'hash': '9afefd867fe7bd5207197d82a8d2468d0a0f51c1ad01ec4fb67fe2210662b644'}, {'image_id': '72913_2_En_8_Fig13_HTML', 'image_file_name': '72913_2_En_8_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig13_HTML.jpg', 'caption': 'Hemoptysis in the context of a mucormycosis in a 26-year-old woman suffering from acute lymphoblastic leukemia under antifungal prophylaxis. CT angiography in axial (a) and coronal oblique reformat (b) shows the vessel involvement originating from the necrotic parenchymal mass of the left lower lobe. This was confirmed after LLL lobectomy', 'hash': '3f74442af72ebd9de2bd27be821e58decefbf980ffcb11b56f89bc685b42ea69'}, {'image_id': '72913_2_En_8_Fig44_HTML', 'image_file_name': '72913_2_En_8_Fig44_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig44_HTML.jpg', 'caption': 'Air-crescent sign caused by an invasive epidermoid carcinoma stage IIIb treated by radiochemotherapy that progressively cavitated. Axial image at baseline CT (a), 3 weeks (b) and two consecutive axial CT images performed 3 months (c, d) after beginning of the treatment. The necrotic tumor appears progressively as a pseudo-aspergilloma with an air-crescent sign', 'hash': '657e9dd7d5b27d9a80fe7ec366eb37b783707829b26abe28723e84bd0ac72052'}, {'image_id': '72913_2_En_8_Fig3_HTML', 'image_file_name': '72913_2_En_8_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig3_HTML.jpg', 'caption': 'Ultralow dose CT performed at 100 kV and 10 mAs corresponding to a CTDIvol of 0.4 mGy reconstructed with FBP and a lung kernel. Native thin axial section (a) and 10 mm-thick maximum intensity projection reformat (b) exhibit noise well seen outside of the chest wall. Such noise projected on the lung mimics micronodulation with random distribution that may simulate a miliary disease in a context of a febrile immunocompromised patient. Although IR is the method of reconstruction of choice with low-dose CT and available in most institutions today, such potential pitfalls with FBP and lung kernel must be known when IR is not available. This precludes the use of such doses in this setting', 'hash': '7c356f929909fcd9d00438ebef244d9903df5a5074e65b5edfdeea5ffdb552af'}, {'image_id': '72913_2_En_8_Fig33_HTML', 'image_file_name': '72913_2_En_8_Fig33_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig33_HTML.jpg', 'caption': 'Miliary tuberculosis with multisystemic involvement in an HIV-positive CDC stage three patient highly immunosuppressed with CD4 level at 64 c/mm3. Axial CT scan shows diffuse tiny micronodules with ground-glass opacity leading to alveolar consolidation at the level of the apical segment of the RLL. Such an involvement may result in a respiratory distress syndrome (ARDS)', 'hash': '8d405301fee045d6d57112608dd21af7b690767000013e481c5f8af4f8e0a9d6'}, {'image_id': '72913_2_En_8_Fig23_HTML', 'image_file_name': '72913_2_En_8_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig23_HTML.jpg', 'caption': 'Invasive airway aspergillosis. Three axial CT images show peribronchial ground-glass attenuation at the level of the RUL (blue arrows) with slight bronchial wall thickening and ill-defined nodules (a) and alveolar consolidation (orange arrows) in a peribronchial location at the level of the posterobasal bronchus of the RLL (b) and a segmental distribution in the LLL (c). This presentation of aspergillosis mainly concerns non-acute leukemia patients with a leukocyte count >100/mm3', 'hash': 'cca09ceda7822e841855ea80772e8403e942a15241d3f5c51e1d9197a68bfe6e'}, {'image_id': '72913_2_En_8_Fig30_HTML', 'image_file_name': '72913_2_En_8_Fig30_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig30_HTML.jpg', 'caption': 'Pulmonary hemorrhage in a 65-year-old woman known for an acute myeloid leukemia with thrombocytopenia appears as a perihilar ground-glass opacity predominantly located at the level of the lower lobes', 'hash': 'b56c70ff042200b039fc92e7f418db7525a5714a2b3b26d0a404040ba1d1999d'}, {'image_id': '72913_2_En_8_Fig20_HTML', 'image_file_name': '72913_2_En_8_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig20_HTML.jpg', 'caption': 'Two consecutive coronal reformats in a 67-year-old man suffering from a bronchopneumonia show airspace nodules smaller than 1 cm with perinodular ground-glass opacity and patchy alveolar consolidation (arrows) (a) as well as peribronchiolar consolidation (b)', 'hash': '94ba4754a061d6a78691c520c760ea675037ad42aa89ece89dda6f19cbd0d497'}, {'image_id': '72913_2_En_8_Fig47_HTML', 'image_file_name': '72913_2_En_8_Fig47_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig47_HTML.jpg', 'caption': 'Airway aspergillosis in a 74-year-old woman with lymphoma of the marginal zone complaining of cough and fever. A circumferential peribronchial thickening around the mainstem left bronchus is seen on the axial CT image with mediastinal window (a). Two weeks later, a worsening of the stenosis with a wall fistula is observed on the axial image with the lung window (b). Note the presence of a bilateral pleural effusion', 'hash': 'f84293e17050c668dcc823b4f291ab239ac2b7542e2d18512d28bcdf4d49c496'}, {'image_id': '72913_2_En_8_Fig48_HTML', 'image_file_name': '72913_2_En_8_Fig48_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig48_HTML.jpg', 'caption': 'Sequelae of TB in a 35-year-old woman originating from Cameroun. Axial section in parenchymal (a) and mediastinal windows (b) at the level of the upper lobes showing cicatricial collapsus of the upper part of LUL well delineated by a small accessory fissure (arrows) with bronchovascular distortion, bronchiectasis, thin-walled cavities, and calcified nodules. The 3 mm-thick mIP oblique reformat (c) allows for an overall assessment of the bronchiectasis. The coronal 150 mm-thick AIP reformat (d) shows the upper retraction of the left hilum', 'hash': '66a4c29ee0ced7df9ce765387d1aea23cbc22870c58d434444703ce4f66efcd0'}, {'image_id': '72913_2_En_8_Fig10_HTML', 'image_file_name': '72913_2_En_8_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig10_HTML.jpg', 'caption': 'Empyema with right pulmonary abscesses in a context of bronchoaspiration pneumonia due to Streptococcus milleri and Fusobacterium necrophorum in a 47-year-old patient known for previous drug abuse that was found unconscious at home. In addition to antibiotherapy, a thoracoscopy was performed with drainage of the empyema. The reference chest X-ray (a) shows a pleural effusion. The axial CT with IV contrast media administration in mediastinal (b) and lung (c) window at the level of the apical segment of the RUL performed at the same day confirms the pleural effusion with thin enhancement of the parietal pleura suggesting empyema with associated alveolar consolidation. An axial section in lung window at the level of the right upper lobe bronchus (d) of the reference CT and also a follow-up CT performed 3 days later (e) demonstrate the cavitation of a pulmonary abscess of the anterior segment of the RUL that appears solid in (d). An axial image at the level of the middle lobe (f) shows additional cavities and another solid nodule related to multiple abscesses', 'hash': '150eae54ee195bd36ae884ea555cb661b558015cbd01da0a4fb426c0dbfff452'}, {'image_id': '72913_2_En_8_Fig28_HTML', 'image_file_name': '72913_2_En_8_Fig28_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig28_HTML.jpg', 'caption': 'Bilateral ground-glass opacity at the level of the upper lobes are related to a Coronavirus infection in a 72-year-old man known for a small cell carcinoma treated by radiochemotherapy', 'hash': '437bef7b61d1670875e8f7514c6ef998e173320d36a60029e94f68f6208744ed'}, {'image_id': '72913_2_En_8_Fig27_HTML', 'image_file_name': '72913_2_En_8_Fig27_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig27_HTML.jpg', 'caption': 'PCP pneumonia in an HIV-negative patient with a history of cerebral glioblastoma treated by surgery and radiochemotherapy. Axial CT shows ground-glass opacity predominating on the left side without sparing of the pulmonary cortex. The rounded hypoattenuated areas mostly correspond to centrilobular emphysema and not cysts that are rare in this condition', 'hash': 'ef9be4f902feb9b3fbc987f189d7acf71fd7906e671187715b77b7b9570dd39c'}, {'image_id': '72913_2_En_8_Fig37_HTML', 'image_file_name': '72913_2_En_8_Fig37_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig37_HTML.jpg', 'caption': 'Angioinvasive aspergillosis in a 27-year-old woman appears as nodules with peripheral ground-glass opacity at the apex of the LUL', 'hash': '602623cd88c664cdc6868ec07afd68d8f44a31d29a9303d988a7badf842bc6a8'}, {'image_id': '72913_2_En_8_Fig7_HTML', 'image_file_name': '72913_2_En_8_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig7_HTML.jpg', 'caption': 'Chest CT of a 36-year-old patient with ankylosing spondylarthritis treated by using anti-TNF alpha. Although numerous micronodules are visible on the thin axial section (a), their profusion and centrilobular distribution with tree in bud appearance related to Mycoplasma pneumoniae is more obvious when using 10 mm-thick MIP reformat (b). Note the sparing of the subpleural area typical of centrilobular distribution', 'hash': '20ba3a02aeca192364345c8eadb52ad54545e6052d3bca9a64ed6ffb1b533fbd'}, {'image_id': '72913_2_En_8_Fig38_HTML', 'image_file_name': '72913_2_En_8_Fig38_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig38_HTML.jpg', 'caption': 'Septic emboli in a 31-year-old female; HIV-negative drug abuser, known for chronic HCV and IV cocaine injections, presents with fever, shivering, and episodes of hemoptysis. Blood cultures were positive for Staphylococcus aureus with a 2 cm vegetation at the level of the tricuspid valve causing marked tricuspid insufficiency. Axial CT sections at baseline (a) and 8 days later (b), respectively, show multiple nodules with peripheral ground-glass opacity (a) that secondary cavitated. The latter is a usual finding with Staphylococcus aureus infection', 'hash': 'da3c597ff0a67c216a555c2b5fd1a573298d2131f0210af7ac23325a94be4437'}, {'image_id': '72913_2_En_8_Fig8_HTML', 'image_file_name': '72913_2_En_8_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig8_HTML.jpg', 'caption': 'Chest CT of a patient suffering from a Good’s syndrome (thymoma with immunodeficiency) and miliary tuberculosis (TB). The thin coronal reformatted image (a) shows an apparent limited number of nodules, unlike the 10 mm-thick MIP reformat (b) that shows obvious micronodules with random distribution that were related to a hematogenous spread of TB', 'hash': 'de2c671b80c4adc0029aa8f8efea0eeb9ad02ef18056050f5a4b0b844b856f42'}, {'image_id': '72913_2_En_8_Fig50_HTML', 'image_file_name': '72913_2_En_8_Fig50_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig50_HTML.jpg', 'caption': 'A 77-year-old man with a calcified fibrothorax as a sequelae of a previous TB. Axial section in mediastinal (a) and lung (b) windows show a pleural calcification with parenchymatous bands converging toward the latter and related to fibrosis of the visceral pleura. A 70 mm-thick MIP coronal reformat in bone window (c) shows the upper predominance of this fibrothorax. A 180 mm-thick AIP reformat (d) reproducing the chest X-ray appearance shows the retraction of the left hemithorax and the blunting of the costophrenic angle, a classical finding in this setting', 'hash': '5cf71514c78e1db685d8972f4187284eed26bb2879f03945955a1b5e021729a3'}, {'image_id': '72913_2_En_8_Fig40_HTML', 'image_file_name': '72913_2_En_8_Fig40_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig40_HTML.jpg', 'caption': 'Mycobacterium xenopi infection in a COPD patient. Chest X-ray (a), coronal reformat (b), and axial CT at the level of upper lobes (c) show an alveolar consolidation with cavities of various sizes that almost totally resolved on the follow-up CT performed 1 year later (d)', 'hash': '989887803884f51ae2dadb9f1c44998ee7c9d8c4ee0d964a028d70014436085d'}, {'image_id': '72913_2_En_8_Fig18_HTML', 'image_file_name': '72913_2_En_8_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig18_HTML.jpg', 'caption': 'Alveolar consolidation of the middle lobe related to an adenocarcinoma. The stretched appearance of the bronchi may suggest the diagnosis (Courtesy Pr Brillet, Bobigny, France)', 'hash': '36746ba212aa5e2fead48480244f222054bb08c4d0b815c6c7ba45a89a03ef55'}, {'image_id': '72913_2_En_8_Fig17_HTML', 'image_file_name': '72913_2_En_8_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig17_HTML.jpg', 'caption': 'Acute fibrinous organizing pneumonia (AFOP) in a 52-year-old patient suffering from plasmacytoid dendritic cells acute leukemia with febrile agranulocytosis. The noninfectious nature of the alveolar consolidation with peripheral ground-glass attenuation of the LUL was proven by a transbronchial biopsy performed under endobronchial ultrasonography (EBUS)', 'hash': 'cf8edab1c1830d5cc88ea7bfad80442e411766a90fe1d064799ac795ec3a4e73'}, {'image_id': '72913_2_En_8_Fig49_HTML', 'image_file_name': '72913_2_En_8_Fig49_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig49_HTML.jpg', 'caption': 'Ranke complex related to scars from a previous primary TB. Axial section with the bone window at the level of the right hilum (a) and of the RLL (b) show a calcified hilar node and a calcified parenchymal nodule, respectively', 'hash': '52d7344a3a661eedf69a795199ea976f0567491ee0680124dcc7958b14989ff2'}, {'image_id': '72913_2_En_8_Fig46_HTML', 'image_file_name': '72913_2_En_8_Fig46_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig46_HTML.jpg', 'caption': 'Right paratracheal lymph node metastasis with necrosis and parietal enhancement in a patient treated by chemotherapy and immunotherapy in a context of a poorly differentiated carcinoma with hepatic and bone metastases', 'hash': '7ab0f04dfa8b50a4e09b3fffc3948af8875b725d58e09beddb00517f3c9ae5c7'}, {'image_id': '72913_2_En_8_Fig11_HTML', 'image_file_name': '72913_2_En_8_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig11_HTML.jpg', 'caption': 'A 46-year-old male drug abuser known for COPD presents with fever after bullectomy and pleurodesis performed for a spontaneous pneumothorax. Chest X-ray (a) and axial chest CT after IV contrast media injection in mediastinal (b) and lung (c) windows with sagittal reformat (d) allow for an easy differentiation between the parenchymal involvement with necrosis on an underlying bullous emphysema from empyema. The thickening of the pleura that is suggestive of empyema (orange and blue arrows) appears laterally as a continuous line internal to the ribs (orange arrows)', 'hash': '7bfe95cb3c9c08769e278a3774eed56b47c67002e3458bd57ef5bca1df24838f'}, {'image_id': '72913_2_En_8_Fig31_HTML', 'image_file_name': '72913_2_En_8_Fig31_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig31_HTML.jpg', 'caption': 'Pulmonary infarct appears as a reverse halo sign in a 93-year-old patient with bilateral pulmonary emboli as nicely seen on axial CT section in lung (a) and mediastinal (b) windows', 'hash': 'd1a56b3a6bdec3fdc455f7460b5dedccbcf3ea7fb071d12c18b6f5ae65176a3d'}, {'image_id': '72913_2_En_8_Fig1_HTML', 'image_file_name': '72913_2_En_8_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig1_HTML.jpg', 'caption': 'Ultralow dose CT was performed because of the appearance of a cavity with an air-fluid level in the left axillary area on chest X-ray (a) in a 20-year-old female patient with cystic fibrosis and persistent symptoms due to Staphylococcus aureus and Cepacia infection despite antibiotic treatment. Axial sections reconstructed by using iterative reconstruction (IR) algorithm (b) and FBP with soft kernel and a slice thickness of 4 mm (c). Coronal reformatted image reconstructed by using IR (d, f) and filtered back projection (FBP) with soft kernel (e.g). The drainage bronchus of the abscess cavity (d, e) is clearly differentiated from the varicose bronchiectasis that are well assessed with a 3 mm-thick minimum intensity projection (mIP) reformat (f, g). Despite a slight distortion of the details seen on the axial image when using IR (b) compared with FBP (c), a substantial reduction of the noise is observed with IR (d, f)', 'hash': 'b4bdbc8ab2770db4b79de28ccd91a1504ce4bdc47225254448d7443390f6f03a'}, {'image_id': '72913_2_En_8_Fig21_HTML', 'image_file_name': '72913_2_En_8_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig21_HTML.jpg', 'caption': 'Bronchopneumonia pattern appears on this axial section at the level of the upper lobes as bronchial wall thickening, centrilobular nodules with tree-in-bud sign (blue arrow), lobular (orange arrow), and segmental alveolar consolidation with multifocal and patchy involvement', 'hash': 'da2fdf5cc57671c5129b281fc62ec21162a30f6a7ee6f1db60de4431ee68bd25'}, {'image_id': '72913_2_En_8_Fig41_HTML', 'image_file_name': '72913_2_En_8_Fig41_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig41_HTML.jpg', 'caption': 'Aspergilloma developing in a cavity in a 69-year-old man with a history of stage IV sarcoidosis who complained of hemoptysis. The treatment consisted of antifungal therapy and bronchial embolization followed by a left upper lobectomy. Axial CT section in lung window (a) at the level of the LUL shows the air-crescent sign. Axial CT section on bone window (b) at the same level demonstrates the calcified lymph nodes related to sarcoidosis and the slight calcifications within the aspergilloma. The coronal reformat (c) shows the typical dependent location of the aspergilloma within the cavity', 'hash': '39ebb704d6bd378dffca45e8c73b2cecb927298726194e66f7e7768936098464'}, {'image_id': '72913_2_En_8_Fig16_HTML', 'image_file_name': '72913_2_En_8_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig16_HTML.jpg', 'caption': 'Round pneumonia occurs in a 44-year-old man suddenly presenting with fever and chest pain and addressed to the emergency department. The chest X-ray (a) shows a right parahilar pseudo-tumoral opacity. Due to this atypical aspect, chest CT was performed on the same day. Axial CT image (b) and sagittal reformat (c) demonstrate a rounded alveolar consolidation of the posterior segment of the RUL and the apical segment of the RLL. Note the ground-glass opacity located around the alveolar consolidation reflecting the partial filling of the alveoli', 'hash': '601a8e6c25f1db9cdf4c98ff011d7b43229ba6b002fb7ed5d90d46c746b90272'}, {'image_id': '72913_2_En_8_Fig19_HTML', 'image_file_name': '72913_2_En_8_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig19_HTML.jpg', 'caption': 'Infectious bronchiolitis appears as thickening of the bronchial walls and centrilobular nodules with tree-in-bud sign', 'hash': '2100d648fe7b0c6e07a80e8839dd22da8865329f4b2a92c6c02bb8a41857dc91'}, {'image_id': '72913_2_En_8_Fig26_HTML', 'image_file_name': '72913_2_En_8_Fig26_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig26_HTML.jpg', 'caption': 'PCP pneumonia in an AIDS patient presenting with cough and fever. The crazy-paving appearance associated with cysts strongly suggests the diagnosis', 'hash': '9c6dd34089f804076cfd51ec25ec34a4713a30396184e1a010d90adc52bed674'}, {'image_id': '72913_2_En_8_Fig29_HTML', 'image_file_name': '72913_2_En_8_Fig29_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig29_HTML.jpg', 'caption': 'Axial CT image shows a reverse halo sign in a 26-year-old woman known for an acute lymphoblastic leukemia that developed fever and cough with hemodynamic compromise despite antifungal prophylaxis. This was related to a mucormycosis (Lichtheimia spp) proven by transbronchial biopsy and panfungal PCR in the BAL', 'hash': '68c79124aba53664f4cb5969dfc748f034196145c765da7125790ec953ae7a24'}, {'image_id': '72913_2_En_8_Fig9_HTML', 'image_file_name': '72913_2_En_8_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig9_HTML.jpg', 'caption': 'Pulmonary abscess related to multisensible Escherichia coli in a 52-year-old male alcoholic and heavy smoker suffering from fever with respiratory symptoms resisting to first line of antibiotics. After an initial chest X-ray (a), a chest CT with intravenous (IV) contrast media injection was performed due to worsening of the status. It allowed for the exclusion of pulmonary embolism and demonstrated the necrotic component of a pulmonary abscess of the LUL on axial sections with mediastinal (b) and lung (c) windows. A coronal reformatted image (d) showed cavitation within the upper part of the lesion that was better assessed when applying 7 mm-thick mIP post-processing (e). The latter also allowed for demonstration of the drainage bronchus that helped the clinician to guide the BAL. A follow-up CT in axial sections (f) demonstrated the resolution of this lesion with a sequelae appearing as a cavity with lobulated margins with thin wall', 'hash': 'e22fdbe3587fbc4660babb70b0a5fc9d7c5caa4968c2fc19450e685d322f7b7e'}, {'image_id': '72913_2_En_8_Fig39_HTML', 'image_file_name': '72913_2_En_8_Fig39_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig39_HTML.jpg', 'caption': 'Lemierre syndrome in a 21-year-old man suffering from a sore throat with jugular vein thrombosis well depicted by CT with contrast media injection (a) and septic embolism appearing as peripheral nodules of various sizes with wedge-shaped consolidation (arrows) and slight peripheral ground-glass opacity on axial CT image (b). The 8 mm-thick MIP image (c) shows the lateralized trajectory of the artery around the nodule', 'hash': 'f83ca2e5c8e0733f063a8c7e1d8500f23a4f14af390a10a3bd5830e606f915d7'}, {'image_id': '72913_2_En_8_Fig6_HTML', 'image_file_name': '72913_2_En_8_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig6_HTML.jpg', 'caption': '16\u2009mm-thick axial MIP image in a 58-year-old patient with Crohn disease under infliximab treatment. Although invisible on 1.25 mm-thick axial image (a), the MIP reformatted image (b) permits to detect micronodules with random distribution that were related to a miliary tuberculosis', 'hash': '52fcc308463b1224e1c9af1f22de0f0dfdc6adf7e9000ba739627a773550bbcf'}, {'image_id': '72913_2_En_8_Fig36_HTML', 'image_file_name': '72913_2_En_8_Fig36_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig36_HTML.jpg', 'caption': 'A 24-year-old woman is known for a recurrence of Hodgkin’s lymphoma appearing on the PET-CT (a, b) as multiple pulmonary nodules. A necrotic bronchopneumonia occurring 2 months later presents as bilateral alveolar consolidation superimposed on the preexisting nodules (c, d) that lead to a septic shock with death of the patient. This case reinforces the usefulness of evaluation of previous imaging features', 'hash': 'd22641e5d59abadbd0d74d3372f6930e575078e169ad3312ea5a1aa9dc0b694c'}] | {'72913_2_En_8_Fig1_HTML': ['Today, CT has to be performed on a multidetector row CT scanner acquiring around 1 mm-thick sections and using an exposure dose which needs to be carefully chosen. Low-dose (LD) CT may be used without impairing the diagnostic information of specific CT patterns, in particular in case of pulmonary fungal infections (Christe et al. 2012), and even ultralow dose (ULD) CT may be possible, according to the clinical context. Overall, the dose may be decreased depending on the size of anomalies to be detected. If they are greater than 1 cm, which is often the case for patients with cystic fibrosis and suspected of acute pulmonary infections, ULD-CT at a dose that nearly reaches that of a chest X-ray may demonstrate the abnormalities, provided that the series are reconstructed with the correct technical parameters (Fig. <xref rid="72913_2_En_8_Fig1_HTML" ref-type="fig">1</xref>). These doses also apply to the follow-up of this young population that is exposed to frequent ionizing radiation procedures during the whole life. In other cases, LD-CTs with a CTDI of 2–3 mGy.cm in non-obese patients (Bankier and Tack ). These doses also apply to the follow-up of this young population that is exposed to frequent ionizing radiation procedures during the whole life. In other cases, LD-CTs with a CTDI of 2–3 mGy.cm in non-obese patients (Bankier and Tack 2010) are perfectly suited for the follow-up of infectious lung diseases (Fig. <xref rid="72913_2_En_8_Fig2_HTML" ref-type="fig">2</xref>). A comparison with previous baseline examinations is always required to accurately assess the disease’s evolution. Of importance, although ULD-CT with a mean radiation expose dose of 0.60\u2009±\u20090.15 mSv has been proven to provide acceptable image quality in case of pulmonary infections in febrile neutropenic patients with hematologic malignancy (Kim et al. ). A comparison with previous baseline examinations is always required to accurately assess the disease’s evolution. Of importance, although ULD-CT with a mean radiation expose dose of 0.60\u2009±\u20090.15 mSv has been proven to provide acceptable image quality in case of pulmonary infections in febrile neutropenic patients with hematologic malignancy (Kim et al. 2014), caution must be taken due to potential pitfalls with LD-CT (Fig. <xref rid="72913_2_En_8_Fig3_HTML" ref-type="fig">3</xref>). Multiplanar reformats with average intensity projection (AIP) post-processing of variable thickness may give rise to tomographic or chest X-ray appearance (Figs. ). Multiplanar reformats with average intensity projection (AIP) post-processing of variable thickness may give rise to tomographic or chest X-ray appearance (Figs. <xref rid="72913_2_En_8_Fig4_HTML" ref-type="fig">4</xref> and and <xref rid="72913_2_En_8_Fig5_HTML" ref-type="fig">5</xref>) that may be compared with previous or following conventional chest X-rays. The use of maximum intensity projection (MIP) may optimize the detection of micronodules, which sometimes cannot be assessed by using thin slices alone (Fig. ) that may be compared with previous or following conventional chest X-rays. The use of maximum intensity projection (MIP) may optimize the detection of micronodules, which sometimes cannot be assessed by using thin slices alone (Fig. <xref rid="72913_2_En_8_Fig6_HTML" ref-type="fig">6</xref>). It is also helpful to characterize micronodules as centrilobular ones with tree in bud appearance (Fig. ). It is also helpful to characterize micronodules as centrilobular ones with tree in bud appearance (Fig. <xref rid="72913_2_En_8_Fig7_HTML" ref-type="fig">7</xref>), corresponding to a bronchocentric distribution, or as ones with a random distribution as seen in miliary disease (Fig. ), corresponding to a bronchocentric distribution, or as ones with a random distribution as seen in miliary disease (Fig. <xref rid="72913_2_En_8_Fig8_HTML" ref-type="fig">8</xref>) (Beigelman-Aubry et al. ) (Beigelman-Aubry et al. 2005). The use of minimum intensity projection (mIP) allows to accurately locate an abnormal area in order to guide a bronchoalveolar lavage (BAL) (Fig. <xref rid="72913_2_En_8_Fig9_HTML" ref-type="fig">9</xref>), to differentiate bronchiectasis from a cavitary lesion (Fig. ), to differentiate bronchiectasis from a cavitary lesion (Fig. <xref rid="72913_2_En_8_Fig1_HTML" ref-type="fig">1</xref>), to visualize the drainage bronchus in the latter situation, as well as to help to recognize a bronchopleural fistula.), to visualize the drainage bronchus in the latter situation, as well as to help to recognize a bronchopleural fistula.Fig. 1Ultralow dose CT was performed because of the appearance of a cavity with an air-fluid level in the left axillary area on chest X-ray (a) in a 20-year-old female patient with cystic fibrosis and persistent symptoms due to Staphylococcus aureus and Cepacia infection despite antibiotic treatment. Axial sections reconstructed by using iterative reconstruction (IR) algorithm (b) and FBP with soft kernel and a slice thickness of 4 mm (c). Coronal reformatted image reconstructed by using IR (d, f) and filtered back projection (FBP) with soft kernel (e.g). The drainage bronchus of the abscess cavity (d, e) is clearly differentiated from the varicose bronchiectasis that are well assessed with a 3 mm-thick minimum intensity projection (mIP) reformat (f, g). Despite a slight distortion of the details seen on the axial image when using IR (b) compared with FBP (c), a substantial reduction of the noise is observed with IR (d, f)\nFig. 2Low-dose CT was performed for the follow-up of an angioinvasive aspergillosis in a 38-year-old woman with acute myeloid leukemia. The baseline CT (a) was performed with a CTDI of 5 and a DLP at 147 mGy.cm and the follow-up CT (b) with a CTDI of 2 and a DLP of 72 mGy.cm by using filter back projection reconstruction (FBP) with a soft kernel, without iterative reconstruction (IR) algorithm. Although a relative lesser image quality than the reference image, the disease’s evolution may be perfectly assessed at less than half of the initial dose\nFig. 3Ultralow dose CT performed at 100 kV and 10 mAs corresponding to a CTDIvol of 0.4 mGy reconstructed with FBP and a lung kernel. Native thin axial section (a) and 10 mm-thick maximum intensity projection reformat (b) exhibit noise well seen outside of the chest wall. Such noise projected on the lung mimics micronodulation with random distribution that may simulate a miliary disease in a context of a febrile immunocompromised patient. Although IR is the method of reconstruction of choice with low-dose CT and available in most institutions today, such potential pitfalls with FBP and lung kernel must be known when IR is not available. This precludes the use of such doses in this setting\nFig. 4Coronal reformatted images with progressive thickening of the slabs from 1 (a) to 30 (b) to 150 mm (c) thick slabs by using the average intensity projection (AIP) post-processing tool in a patient known for a voluminous bullae of the right apex of the lung with superimposed infectious alveolar consolidation. Note that the bullae is not easily seen on the chest X-ray rendering in (c), as it was the case with the conventional chest X-ray (not shown). The same limitation also occurs in case of cavitation that may be missed on conventional chest X-ray\nFig. 5A 60-year-old man suffering from bronchiectasis of unknown cause presented with fever and new respiratory symptoms related to an abscess due to a usually nosocomial germ, Serratia marcescens and Cronobacter, a gram-negative bacteria of the Enterobacteriaceae family. Chest X-ray (a) and axial CT section with IV contrast in mediastinal (b) and lung (c) windows show the abscess of the LUL with thick walls, a necrotic component and an air-fluid level. The coronal 1.5 mm (d), 30 mm (e), and 150 mm (f) thick AIP reformatted images allow for a better understanding of the opacities related to a bronchocele at the level of the RUL and the abscess situated close to a bronchiectatic area of the LUL\nFig. 616\u2009mm-thick axial MIP image in a 58-year-old patient with Crohn disease under infliximab treatment. Although invisible on 1.25 mm-thick axial image (a), the MIP reformatted image (b) permits to detect micronodules with random distribution that were related to a miliary tuberculosis\nFig. 7Chest CT of a 36-year-old patient with ankylosing spondylarthritis treated by using anti-TNF alpha. Although numerous micronodules are visible on the thin axial section (a), their profusion and centrilobular distribution with tree in bud appearance related to Mycoplasma pneumoniae is more obvious when using 10 mm-thick MIP reformat (b). Note the sparing of the subpleural area typical of centrilobular distribution\nFig. 8Chest CT of a patient suffering from a Good’s syndrome (thymoma with immunodeficiency) and miliary tuberculosis (TB). The thin coronal reformatted image (a) shows an apparent limited number of nodules, unlike the 10 mm-thick MIP reformat (b) that shows obvious micronodules with random distribution that were related to a hematogenous spread of TB\nFig. 9Pulmonary abscess related to multisensible Escherichia coli in a 52-year-old male alcoholic and heavy smoker suffering from fever with respiratory symptoms resisting to first line of antibiotics. After an initial chest X-ray (a), a chest CT with intravenous (IV) contrast media injection was performed due to worsening of the status. It allowed for the exclusion of pulmonary embolism and demonstrated the necrotic component of a pulmonary abscess of the LUL on axial sections with mediastinal (b) and lung (c) windows. A coronal reformatted image (d) showed cavitation within the upper part of the lesion that was better assessed when applying 7 mm-thick mIP post-processing (e). The latter also allowed for demonstration of the drainage bronchus that helped the clinician to guide the BAL. A follow-up CT in axial sections (f) demonstrated the resolution of this lesion with a sequelae appearing as a cavity with lobulated margins with thin wall\n'], '72913_2_En_8_Fig9_HTML': ['CT may be performed without or with intravenous (IV) contrast, the latter especially to evaluate the necrotic component of a pneumoniae or abscesses (Fig. <xref rid="72913_2_En_8_Fig9_HTML" ref-type="fig">9</xref>) and to optimize the differentiation from an empyema (Figs. ) and to optimize the differentiation from an empyema (Figs. <xref rid="72913_2_En_8_Fig10_HTML" ref-type="fig">10</xref> and and <xref rid="72913_2_En_8_Fig11_HTML" ref-type="fig">11</xref>). It has also been described as helpful for differentiation between a pulmonary angioinvasive mycosis and a bacterial pneumonia in high-risk hematologic patients by using volume perfusion CT (Schulze et al. ). It has also been described as helpful for differentiation between a pulmonary angioinvasive mycosis and a bacterial pneumonia in high-risk hematologic patients by using volume perfusion CT (Schulze et al. 2012). IV contrast-enhanced CT is also required in case of hemoptysis, being able to demonstrate enlarged bronchial and non-bronchial systemic arteries due to former tuberculosis or, less frequently, Rasmussen aneurysms (Fig. <xref rid="72913_2_En_8_Fig12_HTML" ref-type="fig">12</xref> ) occurring in the same situation as well as vessel involvement in case of fungal disease (Fig. ) occurring in the same situation as well as vessel involvement in case of fungal disease (Fig. <xref rid="72913_2_En_8_Fig13_HTML" ref-type="fig">13</xref>). It may also highlight a concomitant thromboembolic disease.). It may also highlight a concomitant thromboembolic disease.Fig. 10Empyema with right pulmonary abscesses in a context of bronchoaspiration pneumonia due to Streptococcus milleri and Fusobacterium necrophorum in a 47-year-old patient known for previous drug abuse that was found unconscious at home. In addition to antibiotherapy, a thoracoscopy was performed with drainage of the empyema. The reference chest X-ray (a) shows a pleural effusion. The axial CT with IV contrast media administration in mediastinal (b) and lung (c) window at the level of the apical segment of the RUL performed at the same day confirms the pleural effusion with thin enhancement of the parietal pleura suggesting empyema with associated alveolar consolidation. An axial section in lung window at the level of the right upper lobe bronchus (d) of the reference CT and also a follow-up CT performed 3 days later (e) demonstrate the cavitation of a pulmonary abscess of the anterior segment of the RUL that appears solid in (d). An axial image at the level of the middle lobe (f) shows additional cavities and another solid nodule related to multiple abscesses\nFig. 11A 46-year-old male drug abuser known for COPD presents with fever after bullectomy and pleurodesis performed for a spontaneous pneumothorax. Chest X-ray (a) and axial chest CT after IV contrast media injection in mediastinal (b) and lung (c) windows with sagittal reformat (d) allow for an easy differentiation between the parenchymal involvement with necrosis on an underlying bullous emphysema from empyema. The thickening of the pleura that is suggestive of empyema (orange and blue arrows) appears laterally as a continuous line internal to the ribs (orange arrows)\nFig. 12Rasmussen aneurysm in a 35-year-old patient presenting hemoptysis 9 days after the initial diagnosis of TB. Axial CT without (a) and with IV contrast media injection (b) focused at the level of the RUL shows a vascular enhancement within the tuberculoma that was clearly differentiated from the calcification depicted without contrast. The selective angiogram of the right bronchial artery (c) shows the aneurysm that was immediately successfully embolized\nFig. 13Hemoptysis in the context of a mucormycosis in a 26-year-old woman suffering from acute lymphoblastic leukemia under antifungal prophylaxis. CT angiography in axial (a) and coronal oblique reformat (b) shows the vessel involvement originating from the necrotic parenchymal mass of the left lower lobe. This was confirmed after LLL lobectomy\n', 'A pulmonary abscess may be single or multiple, with a characteristic spherical shape. It measures between 2 and 6 cm in diameter, demonstrates a central hypoattenuation (Fig. <xref rid="72913_2_En_8_Fig9_HTML" ref-type="fig">9</xref>) or cavitation representing localized necrotic cavity, contains pus, and demonstrates peripheral enhancement after intravenous contrast medium injection, without or with an air-fluid level (Fig. ) or cavitation representing localized necrotic cavity, contains pus, and demonstrates peripheral enhancement after intravenous contrast medium injection, without or with an air-fluid level (Fig. <xref rid="72913_2_En_8_Fig5_HTML" ref-type="fig">5</xref>). It usually displays an acute angle when it intersects with an adjacent pleural surface. Consolidation in the adjacent parenchyma occurs in half of all cases (Muller ). It usually displays an acute angle when it intersects with an adjacent pleural surface. Consolidation in the adjacent parenchyma occurs in half of all cases (Muller 2003). Bronchopulmonary fistula may be observed. As the most frequent cause of lung abscess is aspiration, the most common localizations are the posterior segment of an upper lobe or the superior segment of a lower lobe (Muller 2003). Bilateral involvement that predominantly affects the lung bases with abscess formation suggests a P. aeruginosa infection. Infections caused by anaerobic bacteria are commonly encountered, abscesses caused by S. aureus, K. pneumoniae, and P. aeruginosa being associated with higher mortality (Francis et al. 2005).'], '72913_2_En_8_Fig14_HTML': ['Lobar pneumonia, characterized by an inflammatory exudate filling distal airspaces, typically begins in the lung area adjacent to the visceral pleura and spreads through the interalveolar pores of Kohn and the small airways from one segment to another (Muller 2003) respecting a centripetal pattern. Appearing as a single subpleural area of alveolar consolidation with blurred margins restricted to the area next to the fissures, it then progresses to a sublobar or lobar alveolar consolidation sharply demarcated by the interlobar fissure (Fig. <xref rid="72913_2_En_8_Fig14_HTML" ref-type="fig">14</xref>) (Franquet ) (Franquet 2008). An air bronchogram sign is strongly suggestive (Fig. <xref rid="72913_2_En_8_Fig15_HTML" ref-type="fig">15</xref>) (Syrjälä et al. ) (Syrjälä et al. 1998). Ground-glass opacities adjacent to the alveolar consolidation corresponding to a partial filling of the alveoli may be observed (Fig. <xref rid="72913_2_En_8_Fig16_HTML" ref-type="fig">16</xref>) (Tanaka et al. ) (Tanaka et al. 1996). This aspect is the classical presentation of acute bacterial community-acquired pneumonia (CAP), mainly caused by S. pneumoniae (Bhalla and McLoud 1998), other agents responsible of complete lobar consolidation including Klebsiella pneumoniae, and other gram-negative bacilli, L. pneumophila, H. influenzae, and occasionally M. pneumoniae (Franquet 2008). A P. jirovecii infection, a fungal infection, or a mycobacteriosis has also to be considered in case of immunocompromised patients. An enlarged lobe with bulging fissures due to edematous engorgement may be observed, in particular with K. pneumoniae infection, with a current lower occurrence likely due to early treatment in case of suspected pneumonia (Walker et al. 2014).Fig. 14Segmental pneumonia of the lingula in an 82-year-old woman. Axial CT scan focused at the level of the lower part of the LUL (a) and sagittal reformat (b) show an alveolar consolidation with a well-defined air bronchogram anterior to the great fissure\nFig. 15Lobar pneumonia of the RUL related to Streptococcus pneumococcus in a 25-year-old smoker. Scout view (a) and axial CT image (b) show an alveolar consolidation with an air bronchogram. The 10 mm-thick mIP (c) permits to display the entire length of the bronchi from their origin within the alveolar consolidation. Although CT does not replace fiber-optic bronchoscopy, no obstructive lesion was detected by using CT\nFig. 16Round pneumonia occurs in a 44-year-old man suddenly presenting with fever and chest pain and addressed to the emergency department. The chest X-ray (a) shows a right parahilar pseudo-tumoral opacity. Due to this atypical aspect, chest CT was performed on the same day. Axial CT image (b) and sagittal reformat (c) demonstrate a rounded alveolar consolidation of the posterior segment of the RUL and the apical segment of the RLL. Note the ground-glass opacity located around the alveolar consolidation reflecting the partial filling of the alveoli\n'], '72913_2_En_8_Fig17_HTML': ['The differential diagnosis includes aspiration pneumonia when the lower lung is affected, especially on the right side. Lobar or segmental consolidation may also be related to bronchial obstruction, pulmonary hemorrhage, organizing pneumonia, acute fibrinous organizing pneumonia (Fig. <xref rid="72913_2_En_8_Fig17_HTML" ref-type="fig">17</xref>), radiation pneumonitis, adenocarcinoma (Fig. ), radiation pneumonitis, adenocarcinoma (Fig. <xref rid="72913_2_En_8_Fig18_HTML" ref-type="fig">18</xref>), or lymphoma.), or lymphoma.Fig. 17Acute fibrinous organizing pneumonia (AFOP) in a 52-year-old patient suffering from plasmacytoid dendritic cells acute leukemia with febrile agranulocytosis. The noninfectious nature of the alveolar consolidation with peripheral ground-glass attenuation of the LUL was proven by a transbronchial biopsy performed under endobronchial ultrasonography (EBUS)\nFig. 18Alveolar consolidation of the middle lobe related to an adenocarcinoma. The stretched appearance of the bronchi may suggest the diagnosis (Courtesy Pr Brillet, Bobigny, France)\n'], '72913_2_En_8_Fig19_HTML': ['Histologically, bronchopneumonia is characterized by a predominantly bronchiolar and peribronchiolar inflammation with a patchy distribution. Firstly, the adjacent alveoli are involved, followed by the lobules, segments, and/or lobes. An air bronchogram is usually absent. CT features include those of infectious bronchiolitis consisting of thickening of the bronchial walls, centrilobular nodules and tree-in-bud sign (Fig. <xref rid="72913_2_En_8_Fig19_HTML" ref-type="fig">19</xref>) (see below), airspace nodules generally smaller than 1 cm in size related to the inflammatory spreading to the peribronchiolar alveoli with areas of ground-glass opacity or peribronchiolar consolidation (Fig. ) (see below), airspace nodules generally smaller than 1 cm in size related to the inflammatory spreading to the peribronchiolar alveoli with areas of ground-glass opacity or peribronchiolar consolidation (Fig. <xref rid="72913_2_En_8_Fig20_HTML" ref-type="fig">20</xref>), and multifocal lobular, segmental, or lobar consolidation (Figs. ), and multifocal lobular, segmental, or lobar consolidation (Figs. <xref rid="72913_2_En_8_Fig21_HTML" ref-type="fig">21</xref> and and <xref rid="72913_2_En_8_Fig22_HTML" ref-type="fig">22</xref>). Bronchopneumonias are most commonly encountered in nosocomial infections and usually caused by gram-negative bacteria (GNB), especially ). Bronchopneumonias are most commonly encountered in nosocomial infections and usually caused by gram-negative bacteria (GNB), especially P. aeruginosa or E. coli. Other commonly involved bacteria are S. aureus (Morikawa et al. 2012), Haemophilus influenzae, anaerobes, and some species of fungus, especially Aspergillus (Fig. <xref rid="72913_2_En_8_Fig23_HTML" ref-type="fig">23</xref>). The latter as well as viruses (Franquet ). The latter as well as viruses (Franquet 2011) or atypical mycobacteriosis has to be considered when suggested by the individual clinical setting. Bronchiectasis predominantly located at the level of the middle lobe and the lingula may be associated in case of mycobacterium avium complex (MAC) infection (Lady Windermere syndrome).Fig. 19Infectious bronchiolitis appears as thickening of the bronchial walls and centrilobular nodules with tree-in-bud sign\nFig. 20Two consecutive coronal reformats in a 67-year-old man suffering from a bronchopneumonia show airspace nodules smaller than 1 cm with perinodular ground-glass opacity and patchy alveolar consolidation (arrows) (a) as well as peribronchiolar consolidation (b)\nFig. 21Bronchopneumonia pattern appears on this axial section at the level of the upper lobes as bronchial wall thickening, centrilobular nodules with tree-in-bud sign (blue arrow), lobular (orange arrow), and segmental alveolar consolidation with multifocal and patchy involvement\nFig. 22CMV infection in a patient with renal graft appears as a bronchopneumonia pattern on two successive axial sections (a, b). The bronchial thickening in (a) is associated with bilateral segmental alveolar consolidations at the lung bases in (b)\nFig. 23Invasive airway aspergillosis. Three axial CT images show peribronchial ground-glass attenuation at the level of the RUL (blue arrows) with slight bronchial wall thickening and ill-defined nodules (a) and alveolar consolidation (orange arrows) in a peribronchial location at the level of the posterobasal bronchus of the RLL (b) and a segmental distribution in the LLL (c). This presentation of aspergillosis mainly concerns non-acute leukemia patients with a leukocyte count >100/mm3\n\n'], '72913_2_En_8_Fig24_HTML': ['Diffuse alveolar consolidation suggests diffuse alveolar damage (DAD), typically encountered in case of adult respiratory distress syndrome (ARDS). An air bronchogram sign is usually observed as well as small pleural effusions. P. jirovecii pneumonia (Festic et al. 2005) (Fig. <xref rid="72913_2_En_8_Fig24_HTML" ref-type="fig">24</xref>) as well as uncommon, unusual, or exotic organisms can be involved. Nondependent anomalies are more related to pneumonia rather than lesions in the dependent lung (Beigelman-Aubry et al. ) as well as uncommon, unusual, or exotic organisms can be involved. Nondependent anomalies are more related to pneumonia rather than lesions in the dependent lung (Beigelman-Aubry et al. 2012).Fig. 24Diffuse alveolar consolidation with air bronchogram and ground-glass opacity in a patient with autoimmune hepatitis treated with long-term steroids presenting with dyspnea and severe hypoxemia. This was related to a Pneumocystis jirovecii pneumonia. Note the pneumomediastinum in this mechanically ventilated patient staying in the intensive care unit who died from this severe infection with rapid deterioration\n'], '72913_2_En_8_Fig25_HTML': ['The most common causes are viruses, Mycoplasma pneumoniae, Chlamydia, and P. jirovecii. In viral infections and in those caused by M. pneumoniae, ground-glass attenuation is associated with signs of cellular bronchiolitis and focal consolidation fitting with bronchopneumonia. When a predominant ground-glass opacity occurs in an immunocompetent patient, respiratory syncytial virus or varicella infection should be first considered. In immunocompromised patients, P. jirovecii (Thomas and Limper 2004) CMV (McGuinness et al. 1994) or Mycoplasma infection must be suggested. P. jiroveci infections typically present as ground-glass opacity sparing the pulmonary cortex that predominantly affects the upper region, especially in AIDS patients (Fig. <xref rid="72913_2_En_8_Fig25_HTML" ref-type="fig">25</xref>). A crazy-paving sign, defined as a combination of ground-glass opacity and smooth interlobular septal thickening that resembles a masonry pattern used in walkways (Hansell et al. ). A crazy-paving sign, defined as a combination of ground-glass opacity and smooth interlobular septal thickening that resembles a masonry pattern used in walkways (Hansell et al. 2008), may be observed in infections, in particular with Pneumocystis jirovecii pneumonia and influenza (Walker et al. 2014). Pulmonary cysts or pneumatoceles within the same areas should suggest PCP (Fig. <xref rid="72913_2_En_8_Fig26_HTML" ref-type="fig">26</xref>). In immunocompromised non-HIV-positive patients, features are less suggestive of the diagnosis, with rapid progression, this being the result of severe or dysregulated inflammatory responses that are evoked by a relatively small number of ). In immunocompromised non-HIV-positive patients, features are less suggestive of the diagnosis, with rapid progression, this being the result of severe or dysregulated inflammatory responses that are evoked by a relatively small number of Pneumocystis organisms (Chang et al. 2013; Tasaka and Tokuda 2012) (Fig. <xref rid="72913_2_En_8_Fig27_HTML" ref-type="fig">27</xref>). In the latter category of patients, ground-glass opacities can also be caused by viral (Fig. ). In the latter category of patients, ground-glass opacities can also be caused by viral (Fig. <xref rid="72913_2_En_8_Fig28_HTML" ref-type="fig">28</xref>) or pyogenic infection (Kang et al. ) or pyogenic infection (Kang et al. 1996).Fig. 25\nP. jirovecii pneumonia in an AIDS patient appearing as ground-glass opacity sparing the pulmonary cortex and typically predominantly located at the upper region of the lungs\nFig. 26PCP pneumonia in an AIDS patient presenting with cough and fever. The crazy-paving appearance associated with cysts strongly suggests the diagnosis\nFig. 27PCP pneumonia in an HIV-negative patient with a history of cerebral glioblastoma treated by surgery and radiochemotherapy. Axial CT shows ground-glass opacity predominating on the left side without sparing of the pulmonary cortex. The rounded hypoattenuated areas mostly correspond to centrilobular emphysema and not cysts that are rare in this condition\nFig. 28Bilateral ground-glass opacity at the level of the upper lobes are related to a Coronavirus infection in a 72-year-old man known for a small cell carcinoma treated by radiochemotherapy\n'], '72913_2_En_8_Fig29_HTML': ['Peculiar aspects of GGO are seen with the halo sign (see below) and the reversed halo sign (RHS), defined as focal rounded area of ground-glass opacity surrounded by a crescent or complete ring of consolidation (Fig. <xref rid="72913_2_En_8_Fig29_HTML" ref-type="fig">29</xref>) (Georgiadou et al. ) (Georgiadou et al. 2011). Histopathologically, the RHS has been associated to infarcted lung tissue, with a greater amount of hemorrhage at the periphery than at the center, with a frequent subsequent cavitation after neutropenia recovery (Wahba et al. 2008). Halo sign (HS) and RHS are highly suggestive of early infection by an angioinvasive fungus in severely immunocompromised patients. The former is most commonly associated with invasive pulmonary aspergillosis and the latter with pulmonary mucormycosis. An RHS may also be related to other infectious diseases, in particular invasive aspergillosis, tuberculosis, or paracoccidioidomycosis (Georgiadou et al. 2011).Fig. 29Axial CT image shows a reverse halo sign in a 26-year-old woman known for an acute lymphoblastic leukemia that developed fever and cough with hemodynamic compromise despite antifungal prophylaxis. This was related to a mucormycosis (Lichtheimia spp) proven by transbronchial biopsy and panfungal PCR in the BAL\n'], '72913_2_En_8_Fig30_HTML': ['The differential diagnosis of ground-glass attenuation is wide, especially in immunocompromised patients. It can be related to drug-induced toxicity (Fig. <xref rid="72913_2_En_8_Fig30_HTML" ref-type="fig">30</xref>), alveolar hemorrhage, post-radic changes, pulmonary edema, organizing pneumonia, or hypersensitivity pneumonitis. An RHS may also be observed in numerous conditions including granulomatosis with polyangiitis, organizing pneumonia (Georgiadou et al. ), alveolar hemorrhage, post-radic changes, pulmonary edema, organizing pneumonia, or hypersensitivity pneumonitis. An RHS may also be observed in numerous conditions including granulomatosis with polyangiitis, organizing pneumonia (Georgiadou et al. 2011), or pulmonary infarct (Fig. <xref rid="72913_2_En_8_Fig31_HTML" ref-type="fig">31</xref>).).Fig. 30Pulmonary hemorrhage in a 65-year-old woman known for an acute myeloid leukemia with thrombocytopenia appears as a perihilar ground-glass opacity predominantly located at the level of the lower lobes\nFig. 31Pulmonary infarct appears as a reverse halo sign in a 93-year-old patient with bilateral pulmonary emboli as nicely seen on axial CT section in lung (a) and mediastinal (b) windows\n'], '72913_2_En_8_Fig7_HTML': ['Bronchogenic distribution presents as nonhomogeneous centrilobular micronodules that spare the subpleural space with a location at least 3 mm from the pleura and that are associated with a tree-in-bud pattern, defined as centrilobular branching structures that resemble a budding tree (Hansell et al. 2008). This presentation may be seen in bacterial, fungal, viral, mycobacterial, or mycoplasma (Fig. <xref rid="72913_2_En_8_Fig7_HTML" ref-type="fig">7</xref>) infections. In postprimary (reactivation) tuberculosis, centrilobular micronodules and linear branching opacities have a dense attenuation and distinct margins. These features are readily associated with cavitation, predominantly localized in the apical and posterior segments of the superior lobes and the superior segment of the lower lobes in this setting (Fig. ) infections. In postprimary (reactivation) tuberculosis, centrilobular micronodules and linear branching opacities have a dense attenuation and distinct margins. These features are readily associated with cavitation, predominantly localized in the apical and posterior segments of the superior lobes and the superior segment of the lower lobes in this setting (Fig. <xref rid="72913_2_En_8_Fig32_HTML" ref-type="fig">32</xref>). ). Aspergillus bronchiolitis and/or bronchopneumonia must be considered in immunocompromised patients (Logan et al. 1994).Fig. 32Postprimary (reactivation) tuberculosis in a 37-year-old man, native of Cameroun, complaining about cough, weight loss, and night sweats for 3 months. Axial CT image at the level of the RUL (a) shows the typical hallmarks of reactivation TB including cavities, surrounded by thick and irregular borders, and dense centrilobular nodules with sharp margins predominantly located at the level of the apical and posterior segments of the upper lobes and the apical segment of the lower lobes. A 4 mm-thick MIP axial reformat at the level of the apical bronchus of the RLL (b) demonstrates typical centrilobular nodules with sparing of the subpleural space (3 mm) and lobular consolidation of the anterior segment of the RUL (arrows). Two consecutive coronal reformats 20 mm-thick AIP (c, e) and thin coronal slice at the level of the drainage bronchus of the largest cavity of the RUL (d) allow for a complete understanding of the appearance seen on chest X-ray (f)\n'], '72913_2_En_8_Fig8_HTML': ['A hematogenous miliary pattern in case of random distribution may suggest tuberculosis (Figs. <xref rid="72913_2_En_8_Fig8_HTML" ref-type="fig">8</xref> and and <xref rid="72913_2_En_8_Fig33_HTML" ref-type="fig">33</xref>), histoplasmosis, candidiasis, blastomycosis, or a viral cause (), histoplasmosis, candidiasis, blastomycosis, or a viral cause (CMV, herpes, varicella) (Fig. <xref rid="72913_2_En_8_Fig34_HTML" ref-type="fig">34</xref>), especially in immunocompromised patients.), especially in immunocompromised patients.Fig. 33Miliary tuberculosis with multisystemic involvement in an HIV-positive CDC stage three patient highly immunosuppressed with CD4 level at 64 c/mm3. Axial CT scan shows diffuse tiny micronodules with ground-glass opacity leading to alveolar consolidation at the level of the apical segment of the RLL. Such an involvement may result in a respiratory distress syndrome (ARDS)\nFig. 34A 50-year-old man developing a varicella without respiratory symptoms. Axial (a) and coronal (b) 10 mm-thick MIP images of a CT performed due to suspicion of pulmonary nodules on the chest X-ray show micronodules with random distribution that almost completely disappeared at the follow-up 3 months later (c, d)\n'], '72913_2_En_8_Fig35_HTML': ['Pulmonary nodules of infectious nature, sometimes cavitated, are most commonly seen in nosocomial pneumonia and in immunocompromised patients. They may be due to nocardiosis, tuberculosis, and angioinvasive aspergillosis (Althoff Souza et al. 2006) in neutropenic patients, Cryptococcus neoformans, Coccidioides immitis, Blastomyces sp., or atypical mycobacteriosis (Oh et al. 2000; Franquet et al. 2003). Less often, infections such as candidiasis (Fig. <xref rid="72913_2_En_8_Fig35_HTML" ref-type="fig">35</xref>), legionella, or Q fever may be considered if suggested by the individual setting. They must be differentiated from noninfectious causes including malignancy (Fig. ), legionella, or Q fever may be considered if suggested by the individual setting. They must be differentiated from noninfectious causes including malignancy (Fig. <xref rid="72913_2_En_8_Fig36_HTML" ref-type="fig">36</xref>).).Fig. 35Pulmonary and hepatosplenic candidiasis in a 62-year-old patient with an acute myeloid leukemia treated by chemotherapy. Axial CT image of 1 mm (a) and 15 mm-thick MIP (b) shows multiple nodules of various sizes with random distribution. The added value of MIP in the assessment of the detection and evaluation of profusion of nodules is undeniable\nFig. 36A 24-year-old woman is known for a recurrence of Hodgkin’s lymphoma appearing on the PET-CT (a, b) as multiple pulmonary nodules. A necrotic bronchopneumonia occurring 2 months later presents as bilateral alveolar consolidation superimposed on the preexisting nodules (c, d) that lead to a septic shock with death of the patient. This case reinforces the usefulness of evaluation of previous imaging features\n'], '72913_2_En_8_Fig37_HTML': ['Nodules with a peripheral ground-glass halo refer to the halo sign (HS), which is a CT finding of ground-glass opacity surrounding a nodule or a mass (Hansell et al. 2008). Although inconstant, with a reported incidence of ranging from 25 to 95\u2009% among neutropenic patients with hematological malignancies (Georgiadou et al. 2011), the HS strongly suggests an early invasive aspergillosis in patients with severe neutropenia (Fig. <xref rid="72913_2_En_8_Fig37_HTML" ref-type="fig">37</xref>), in association with wedge-shaped areas of subpleural consolidation. Furthermore, initiation of antifungal treatment on the basis of the identification of an HS by chest CT appears associated with a significantly better response to treatment and improved survival (Greene et al. ), in association with wedge-shaped areas of subpleural consolidation. Furthermore, initiation of antifungal treatment on the basis of the identification of an HS by chest CT appears associated with a significantly better response to treatment and improved survival (Greene et al. 2007). In invasive aspergillosis, these nodules typically become larger during neutrophil engraftment (Barnes and Marr 2007) and/or during the first 10 days of therapy (Caillot et al. 2001). Histopathologically, the HS represents a focus of pulmonary infarction surrounded by alveolar hemorrhage, secondary to invasion by Aspergillus of small and medium-sized pulmonary vessels causing thrombosis and subsequent ischemic necrosis of the lung parenchyma (Georgiadou et al. 2011). The same appearances have been reported in numerous infectious pulmonary diseases such as observed with Mucorales, Candida, herpes simplex virus, cytomegalovirus, varicella-zoster virus, mycobacterial infections, bacterial pneumonia, or septic emboli (Fig. <xref rid="72913_2_En_8_Fig38_HTML" ref-type="fig">38</xref>). The differential diagnoses of noninfectious nodules with an HS include granulomatosis with polyangiitis, cryptogenic organizing pneumonia, adenocarcinoma, angiosarcoma, Kaposi’s sarcoma in association with spiculated nodules, and hemorrhagic metastases (Georgiadou et al. ). The differential diagnoses of noninfectious nodules with an HS include granulomatosis with polyangiitis, cryptogenic organizing pneumonia, adenocarcinoma, angiosarcoma, Kaposi’s sarcoma in association with spiculated nodules, and hemorrhagic metastases (Georgiadou et al. 2011).Fig. 37Angioinvasive aspergillosis in a 27-year-old woman appears as nodules with peripheral ground-glass opacity at the apex of the LUL\nFig. 38Septic emboli in a 31-year-old female; HIV-negative drug abuser, known for chronic HCV and IV cocaine injections, presents with fever, shivering, and episodes of hemoptysis. Blood cultures were positive for Staphylococcus aureus with a 2 cm vegetation at the level of the tricuspid valve causing marked tricuspid insufficiency. Axial CT sections at baseline (a) and 8 days later (b), respectively, show multiple nodules with peripheral ground-glass opacity (a) that secondary cavitated. The latter is a usual finding with Staphylococcus aureus infection\n'], '72913_2_En_8_Fig38_HTML': ['\nCavitated nodules can be related to septic embolism. The primary source of infection is tricuspid endocarditis, especially in intravenous illicit drug use, peripheral thrombophlebitis, venous catheter, and pacemaker wires. The mechanism includes endothelial damage combined with the formation of crumbling thrombi containing infective agents. Turbulences caused by the circulating blood detach fragments of thrombus which then migrate to the peripheral pulmonary arteries with consecutive obstruction. Ischemia then results in infarction and/or hemorrhage and the organisms release toxins causing parenchymal necrosis (Muller 2003). Nodules related to septic emboli are mainly peripheral and basal with blurred margins. A simultaneous appearance of solid nodules and nodules with variable size cavitations (Fig. <xref rid="72913_2_En_8_Fig38_HTML" ref-type="fig">38</xref>) as well as subpleural wedge-shaped consolidation may be seen (Franquet ) as well as subpleural wedge-shaped consolidation may be seen (Franquet 2008). The nodules often appear to have a vessel leading into them on axial views – the so-called “feeding vessel” sign – corresponding to the pulmonary vein, whereas most arteries have a lateralized trajectory around the nodule (Dodd et al. 2006) (Fig. <xref rid="72913_2_En_8_Fig39_HTML" ref-type="fig">39</xref>).).Fig. 39Lemierre syndrome in a 21-year-old man suffering from a sore throat with jugular vein thrombosis well depicted by CT with contrast media injection (a) and septic embolism appearing as peripheral nodules of various sizes with wedge-shaped consolidation (arrows) and slight peripheral ground-glass opacity on axial CT image (b). The 8 mm-thick MIP image (c) shows the lateralized trajectory of the artery around the nodule\n'], '72913_2_En_8_Fig32_HTML': ['Necrotizing pneumonia or pulmonary gangrene presenting with hypoenhancing geographic areas of low lung attenuation and cavitation is frequently seen before frank abscess formation (Walker et al. 2014). They can be encountered in various situations such as acute CAP, pulmonary tuberculosis (Fig. <xref rid="72913_2_En_8_Fig32_HTML" ref-type="fig">32</xref>), atypical mycobacteria (Fig. ), atypical mycobacteria (Fig. <xref rid="72913_2_En_8_Fig40_HTML" ref-type="fig">40</xref>), anaerobic bacteria, and angioinvasive or chronic fungal infections. Unilateral or bilateral areas of consolidation, multiple expanding usually thick-walled cavities containing or not aspergillomas and concomitant pleural thickening, suggest chronic cavitary pulmonary aspergillosis. In young patients with no medical history, an infection caused by ), anaerobic bacteria, and angioinvasive or chronic fungal infections. Unilateral or bilateral areas of consolidation, multiple expanding usually thick-walled cavities containing or not aspergillomas and concomitant pleural thickening, suggest chronic cavitary pulmonary aspergillosis. In young patients with no medical history, an infection caused by S. aureus, Panton-Valentine leukodicin secretor, that can be severe and rapid in onset with a poor prognosis should routinely be investigated. Bilateral consolidations of the superior lobes followed by the development of coalescent lucencies are commonly seen. An air-crescent sign may also be present (see below).Fig. 40\nMycobacterium xenopi infection in a COPD patient. Chest X-ray (a), coronal reformat (b), and axial CT at the level of upper lobes (c) show an alveolar consolidation with cavities of various sizes that almost totally resolved on the follow-up CT performed 1 year later (d)\n'], '72913_2_En_8_Fig41_HTML': ['The air-crescent sign, defined as a collection of air in a crescentic shape that separates the wall of a cavity from an inner mass, firstly suggests an Aspergillus colonization of preexisting cavities, i.e., an aspergilloma (Fig. <xref rid="72913_2_En_8_Fig41_HTML" ref-type="fig">41</xref>). An aspergilloma may also be manifested as an irregular spongeworks or fungal strands forming a coarse and irregular network within a cavity. An air-crescent sign also suggests the retraction of a central necrotic mass after recovery of the bone marrow in a rather late stage of angioinvasive aspergillosis (De Marie ). An aspergilloma may also be manifested as an irregular spongeworks or fungal strands forming a coarse and irregular network within a cavity. An air-crescent sign also suggests the retraction of a central necrotic mass after recovery of the bone marrow in a rather late stage of angioinvasive aspergillosis (De Marie 2000) (Fig. <xref rid="72913_2_En_8_Fig42_HTML" ref-type="fig">42</xref>). It may also occur in mucormycosis (Fig. ). It may also occur in mucormycosis (Fig. <xref rid="72913_2_En_8_Fig43_HTML" ref-type="fig">43</xref>), tuberculosis, granulomatosis with polyangiitis, intracavitary hemorrhage, and cavitary lung cancer (Fig. ), tuberculosis, granulomatosis with polyangiitis, intracavitary hemorrhage, and cavitary lung cancer (Fig. <xref rid="72913_2_En_8_Fig44_HTML" ref-type="fig">44</xref>) (Hansell et al. ) (Hansell et al. 2008).Fig. 41Aspergilloma developing in a cavity in a 69-year-old man with a history of stage IV sarcoidosis who complained of hemoptysis. The treatment consisted of antifungal therapy and bronchial embolization followed by a left upper lobectomy. Axial CT section in lung window (a) at the level of the LUL shows the air-crescent sign. Axial CT section on bone window (b) at the same level demonstrates the calcified lymph nodes related to sarcoidosis and the slight calcifications within the aspergilloma. The coronal reformat (c) shows the typical dependent location of the aspergilloma within the cavity\nFig. 42Invasive aspergillosis in a 27-year-old woman with acute myeloid leukemia. Baseline CT (a) performed in a context of febrile agranulocytosis (a) with 5 mm-thick axial sections shows alveolar consolidation of the posterior segment of the upper part of the LUL with peripheral ground-glass opacity. Bronchiolo-alveolar nodules with ill borders are also seen in the RUL. On CT performed 3 weeks after (b), during bone marrow recovery, multiple nodules with air-crescent sign were seen, this finding suggesting a rather late stage of angioinvasive aspergillosis. Note the somewhat atypical presence of peripheral ground glass at this late stage of the disease\nFig. 43Necrotizing pneumonia in a context of mucormycosis (same patient as in Fig. <xref rid="72913_2_En_8_Fig13_HTML" ref-type="fig">13</xref>) presenting with hemoptysis 2 weeks after initial diagnosis despite adequate treatment. The retraction of the central necrotic mass of the LLL creates an air-crescent sign visible on mediastinal () presenting with hemoptysis 2 weeks after initial diagnosis despite adequate treatment. The retraction of the central necrotic mass of the LLL creates an air-crescent sign visible on mediastinal (a) and lung (b) windows. It had occurred at the same time as the pulmonary artery involvement\nFig. 44Air-crescent sign caused by an invasive epidermoid carcinoma stage IIIb treated by radiochemotherapy that progressively cavitated. Axial image at baseline CT (a), 3 weeks (b) and two consecutive axial CT images performed 3 months (c, d) after beginning of the treatment. The necrotic tumor appears progressively as a pseudo-aspergilloma with an air-crescent sign\n'], '72913_2_En_8_Fig10_HTML': ['Pneumatoceles manifest as single or multiple approximately round thin-walled and gas-filled spaces in the lung (Hansell et al. 2008) (Fig. <xref rid="72913_2_En_8_Fig10_HTML" ref-type="fig">10</xref>). These lucencies are associated with a recent infection and usually transient, progressively increasing in size over the following days and weeks and then resolving after weeks or months. They are most likely due to bronchial drainage of necrotic parenchymal tissue, followed by a check-valve airway obstruction. They usually occur in ). These lucencies are associated with a recent infection and usually transient, progressively increasing in size over the following days and weeks and then resolving after weeks or months. They are most likely due to bronchial drainage of necrotic parenchymal tissue, followed by a check-valve airway obstruction. They usually occur in P. jirovecii infections occurring in patients with acquired immune deficiency syndrome (AIDS) (Fig. <xref rid="72913_2_En_8_Fig26_HTML" ref-type="fig">26</xref>) or in case of previous ) or in case of previous S. aureus pneumonia, but they can also be seen with other infections including E. coli and S. pneumoniae (Beigelman-Aubry et al. 2012).', '\nEmpyema, which occurs in less than 5\u2009% of pulmonary infections, typically displays obtuse angles along its interface with adjacent pleura. It appears as a smooth and thin enhancement of the visceral and parietal pleura that surrounds the fluid collection and that is referred as the split pleura sign (Walker et al. 2014) (Figs. <xref rid="72913_2_En_8_Fig10_HTML" ref-type="fig">10</xref> and and <xref rid="72913_2_En_8_Fig11_HTML" ref-type="fig">11</xref>). It is commonly associated with a hyperattenuation of the extra-pleural fat. The pathogens traditionally involved in empyema are ). It is commonly associated with a hyperattenuation of the extra-pleural fat. The pathogens traditionally involved in empyema are S. pneumoniae, Streptococcus pyogenes, and S. aureus. The same findings may be seen in case of TB.'], '72913_2_En_8_Fig45_HTML': ['The most common mediastinal and hilar abnormality is lymphadenopathy (Fig. <xref rid="72913_2_En_8_Fig45_HTML" ref-type="fig">45</xref>). Right paratracheal, hilar, and subcarinal regions and/or hilar lymph node enlargement with associated homolateral small focal infiltrate or parenchymal consolidation, which is commonly sublobar and subpleural in location in the middle lobe, basal segments of lower lobes, and anterior segments of upper lobes, is the usual hallmark of primary TB (Beigelman et al. ). Right paratracheal, hilar, and subcarinal regions and/or hilar lymph node enlargement with associated homolateral small focal infiltrate or parenchymal consolidation, which is commonly sublobar and subpleural in location in the middle lobe, basal segments of lower lobes, and anterior segments of upper lobes, is the usual hallmark of primary TB (Beigelman et al. 2000). Necrotic components with peripheral rim enhancement (rim sign) mainly suggest tuberculosis, but they can also correspond to fungal infection, atypical mycobacteria, histoplasmosis, metastases (Fig. <xref rid="72913_2_En_8_Fig46_HTML" ref-type="fig">46</xref>) from head/neck and testicular malignancy, and lymphoma (Bhalla et al. ) from head/neck and testicular malignancy, and lymphoma (Bhalla et al. 2015). Bronchonodal fistula can be observed as a complication of active pulmonary TB with TB lymphadenitis especially in the elderly. The fistulas usually involve the right lobar bronchus and the main bronchus on the left side (Park et al. 2015).Fig. 45Tuberculosis in a patient with a history of ulcerous colitis under anti-TNF treatment and lung graft for panlobular emphysema related to α1-antitrypsin deficiency. Axial sections in mediastinal (a) and lung (b) windows show an enlarged right paratracheal lymph node associated with a homolateral alveolar consolidation of the RLL, hallmarks of primary TB. Note the peripheral centrilobular nodules (arrows)\nFig. 46Right paratracheal lymph node metastasis with necrosis and parietal enhancement in a patient treated by chemotherapy and immunotherapy in a context of a poorly differentiated carcinoma with hepatic and bone metastases\n'], '72913_2_En_8_Fig47_HTML': ['In case of a circumferential thickening of the trachea or main bronchi occurring in the same context, the possibility of invasive aspergillosis of the respiratory tract should always be considered (Fig. <xref rid="72913_2_En_8_Fig47_HTML" ref-type="fig">47</xref>) with the specific risk of tracheal rupture. Acute tuberculous tracheobronchial involvement may also be seen with circumferential narrowing associated with smooth or irregular wall thickening (Bhalla et al. ) with the specific risk of tracheal rupture. Acute tuberculous tracheobronchial involvement may also be seen with circumferential narrowing associated with smooth or irregular wall thickening (Bhalla et al. 2015). Sequelar fibrotic bronchostenosis predominating on the left main bronchus and post-obstructive bronchiectasis may occur in this setting (Bhalla et al. 2015).Fig. 47Airway aspergillosis in a 74-year-old woman with lymphoma of the marginal zone complaining of cough and fever. A circumferential peribronchial thickening around the mainstem left bronchus is seen on the axial CT image with mediastinal window (a). Two weeks later, a worsening of the stenosis with a wall fistula is observed on the axial image with the lung window (b). Note the presence of a bilateral pleural effusion\n'], '72913_2_En_8_Fig12_HTML': ['\nMycotic aneurysms of pulmonary vessels may be observed in case of hemoptysis and a context of invasive fungal infections (Georgiadou et al. 2011) or tuberculosis (Fig. <xref rid="72913_2_En_8_Fig12_HTML" ref-type="fig">12</xref>).).'], '72913_2_En_8_Fig48_HTML': ['Fibro-parenchymal lesions with bronchovascular distortion and bronchiectasis, thin-walled cavities, emphysema, and fibro-atelectatic bands firstly suggest prior tuberculosis with scarring (Fig. <xref rid="72913_2_En_8_Fig48_HTML" ref-type="fig">48</xref>). Calcified mediastinal/hilar lymph nodes (Fig. ). Calcified mediastinal/hilar lymph nodes (Fig. <xref rid="72913_2_En_8_Fig49_HTML" ref-type="fig">49</xref>), well-defined nodules, and pleural thickening with or without calcification (Fig. ), well-defined nodules, and pleural thickening with or without calcification (Fig. <xref rid="72913_2_En_8_Fig50_HTML" ref-type="fig">50</xref>) are also common imaging features of healed TB. Tuberculomas and small calcified lung nodules suggest likewise prior TB infection (Bhalla et al. ) are also common imaging features of healed TB. Tuberculomas and small calcified lung nodules suggest likewise prior TB infection (Bhalla et al. 2015). Calcified nodules may also be seen as sequelae of histoplasmosis or varicella infection (Chou et al. 2015) but also in other conditions like amyloidosis or metastasis, in particular from osteogenic sarcoma or medullary carcinoma of the thyroid.Fig. 48Sequelae of TB in a 35-year-old woman originating from Cameroun. Axial section in parenchymal (a) and mediastinal windows (b) at the level of the upper lobes showing cicatricial collapsus of the upper part of LUL well delineated by a small accessory fissure (arrows) with bronchovascular distortion, bronchiectasis, thin-walled cavities, and calcified nodules. The 3 mm-thick mIP oblique reformat (c) allows for an overall assessment of the bronchiectasis. The coronal 150 mm-thick AIP reformat (d) shows the upper retraction of the left hilum\nFig. 49Ranke complex related to scars from a previous primary TB. Axial section with the bone window at the level of the right hilum (a) and of the RLL (b) show a calcified hilar node and a calcified parenchymal nodule, respectively\nFig. 50A 77-year-old man with a calcified fibrothorax as a sequelae of a previous TB. Axial section in mediastinal (a) and lung (b) windows show a pleural calcification with parenchymatous bands converging toward the latter and related to fibrosis of the visceral pleura. A 70 mm-thick MIP coronal reformat in bone window (c) shows the upper predominance of this fibrothorax. A 180 mm-thick AIP reformat (d) reproducing the chest X-ray appearance shows the retraction of the left hemithorax and the blunting of the costophrenic angle, a classical finding in this setting\n']} | Pulmonary Infections: Imaging with CT | [
"Pulmonary Infections-CT"
] | Multidetector-Row CT of the Thorax | 1456560000 | None | null | other | PMC7120395 | null | null | [
""
] | Multidetector-Row CT of the Thorax. 2016 Feb 27;:131-161 | NO-CC CODE |
|
Chest CT of a 36-year-old patient with ankylosing spondylarthritis treated by using anti-TNF alpha. Although numerous micronodules are visible on the thin axial section (a), their profusion and centrilobular distribution with tree in bud appearance related to Mycoplasma pneumoniae is more obvious when using 10 mm-thick MIP reformat (b). Note the sparing of the subpleural area typical of centrilobular distribution | 72913_2_En_8_Fig7_HTML | 7 | 20ba3a02aeca192364345c8eadb52ad54545e6052d3bca9a64ed6ffb1b533fbd | 72913_2_En_8_Fig7_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
437,
285
] | [{'image_id': '72913_2_En_8_Fig25_HTML', 'image_file_name': '72913_2_En_8_Fig25_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig25_HTML.jpg', 'caption': 'P. jirovecii pneumonia in an AIDS patient appearing as ground-glass opacity sparing the pulmonary cortex and typically predominantly located at the upper region of the lungs', 'hash': '0b3109b50da7baf1b27933f8af6e656f0c228c0ca03f9cc7b2796900285bf5ca'}, {'image_id': '72913_2_En_8_Fig5_HTML', 'image_file_name': '72913_2_En_8_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig5_HTML.jpg', 'caption': 'A 60-year-old man suffering from bronchiectasis of unknown cause presented with fever and new respiratory symptoms related to an abscess due to a usually nosocomial germ, Serratia marcescens and Cronobacter, a gram-negative bacteria of the Enterobacteriaceae family. Chest X-ray (a) and axial CT section with IV contrast in mediastinal (b) and lung (c) windows show the abscess of the LUL with thick walls, a necrotic component and an air-fluid level. The coronal 1.5 mm (d), 30 mm (e), and 150 mm (f) thick AIP reformatted images allow for a better understanding of the opacities related to a bronchocele at the level of the RUL and the abscess situated close to a bronchiectatic area of the LUL', 'hash': 'f2db0b936dd2364f1dd0a634c0ea599c3d0b0d86365720c2574d1a2a79a143ab'}, {'image_id': '72913_2_En_8_Fig35_HTML', 'image_file_name': '72913_2_En_8_Fig35_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig35_HTML.jpg', 'caption': 'Pulmonary and hepatosplenic candidiasis in a 62-year-old patient with an acute myeloid leukemia treated by chemotherapy. Axial CT image of 1 mm (a) and 15 mm-thick MIP (b) shows multiple nodules of various sizes with random distribution. The added value of MIP in the assessment of the detection and evaluation of profusion of nodules is undeniable', 'hash': '36dc2d8169da876182bd6d2b0321e912211fecece9f6ee356862c5013006e719'}, {'image_id': '72913_2_En_8_Fig15_HTML', 'image_file_name': '72913_2_En_8_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig15_HTML.jpg', 'caption': 'Lobar pneumonia of the RUL related to Streptococcus pneumococcus in a 25-year-old smoker. Scout view (a) and axial CT image (b) show an alveolar consolidation with an air bronchogram. The 10 mm-thick mIP (c) permits to display the entire length of the bronchi from their origin within the alveolar consolidation. Although CT does not replace fiber-optic bronchoscopy, no obstructive lesion was detected by using CT', 'hash': 'd9a65d73cc20b40666b91931a98d2de22d9b2b7c33632a4acf7e20f7589daa99'}, {'image_id': '72913_2_En_8_Fig42_HTML', 'image_file_name': '72913_2_En_8_Fig42_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig42_HTML.jpg', 'caption': 'Invasive aspergillosis in a 27-year-old woman with acute myeloid leukemia. Baseline CT (a) performed in a context of febrile agranulocytosis (a) with 5 mm-thick axial sections shows alveolar consolidation of the posterior segment of the upper part of the LUL with peripheral ground-glass opacity. Bronchiolo-alveolar nodules with ill borders are also seen in the RUL. On CT performed 3 weeks after (b), during bone marrow recovery, multiple nodules with air-crescent sign were seen, this finding suggesting a rather late stage of angioinvasive aspergillosis. Note the somewhat atypical presence of peripheral ground glass at this late stage of the disease', 'hash': '39868c2e9a9033422e83930de3b7db54ea4c8b53a2b0f49b1fbcb9a9cabdae4d'}, {'image_id': '72913_2_En_8_Fig32_HTML', 'image_file_name': '72913_2_En_8_Fig32_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig32_HTML.jpg', 'caption': 'Postprimary (reactivation) tuberculosis in a 37-year-old man, native of Cameroun, complaining about cough, weight loss, and night sweats for 3 months. Axial CT image at the level of the RUL (a) shows the typical hallmarks of reactivation TB including cavities, surrounded by thick and irregular borders, and dense centrilobular nodules with sharp margins predominantly located at the level of the apical and posterior segments of the upper lobes and the apical segment of the lower lobes. A 4 mm-thick MIP axial reformat at the level of the apical bronchus of the RLL (b) demonstrates typical centrilobular nodules with sparing of the subpleural space (3 mm) and lobular consolidation of the anterior segment of the RUL (arrows). Two consecutive coronal reformats 20 mm-thick AIP (c, e) and thin coronal slice at the level of the drainage bronchus of the largest cavity of the RUL (d) allow for a complete understanding of the appearance seen on chest X-ray (f)', 'hash': '6ae671f6fe2764d601a538d3253cab9707766560cb09c3b21a8ef4951c2080c2'}, {'image_id': '72913_2_En_8_Fig2_HTML', 'image_file_name': '72913_2_En_8_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig2_HTML.jpg', 'caption': 'Low-dose CT was performed for the follow-up of an angioinvasive aspergillosis in a 38-year-old woman with acute myeloid leukemia. The baseline CT (a) was performed with a CTDI of 5 and a DLP at 147 mGy.cm and the follow-up CT (b) with a CTDI of 2 and a DLP of 72 mGy.cm by using filter back projection reconstruction (FBP) with a soft kernel, without iterative reconstruction (IR) algorithm. Although a relative lesser image quality than the reference image, the disease’s evolution may be perfectly assessed at less than half of the initial dose', 'hash': '088a9850a1afe871f54c427b086d72228f405f6ff8a9243679d12213dc4bcb11'}, {'image_id': '72913_2_En_8_Fig22_HTML', 'image_file_name': '72913_2_En_8_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig22_HTML.jpg', 'caption': 'CMV infection in a patient with renal graft appears as a bronchopneumonia pattern on two successive axial sections (a, b). The bronchial thickening in (a) is associated with bilateral segmental alveolar consolidations at the lung bases in (b)', 'hash': '3f73a0df56c7526537a586083ac2985722b869d6e4d50b6aa89ed2c0a9ac2d4c'}, {'image_id': '72913_2_En_8_Fig12_HTML', 'image_file_name': '72913_2_En_8_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig12_HTML.jpg', 'caption': 'Rasmussen aneurysm in a 35-year-old patient presenting hemoptysis 9 days after the initial diagnosis of TB. Axial CT without (a) and with IV contrast media injection (b) focused at the level of the RUL shows a vascular enhancement within the tuberculoma that was clearly differentiated from the calcification depicted without contrast. The selective angiogram of the right bronchial artery (c) shows the aneurysm that was immediately successfully embolized', 'hash': '7ac36fd4ac97649070420bbc260e35c4502d8758cb11f5b96c1882131b57ee96'}, {'image_id': '72913_2_En_8_Fig45_HTML', 'image_file_name': '72913_2_En_8_Fig45_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig45_HTML.jpg', 'caption': 'Tuberculosis in a patient with a history of ulcerous colitis under anti-TNF treatment and lung graft for panlobular emphysema related to α1-antitrypsin deficiency. Axial sections in mediastinal (a) and lung (b) windows show an enlarged right paratracheal lymph node associated with a homolateral alveolar consolidation of the RLL, hallmarks of primary TB. Note the peripheral centrilobular nodules (arrows)', 'hash': '8d5d68a466f22fe112cfb57dcaa68d5dab14856dddd81aeefd549b5eff609a54'}, {'image_id': '72913_2_En_8_Fig14_HTML', 'image_file_name': '72913_2_En_8_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig14_HTML.jpg', 'caption': 'Segmental pneumonia of the lingula in an 82-year-old woman. Axial CT scan focused at the level of the lower part of the LUL (a) and sagittal reformat (b) show an alveolar consolidation with a well-defined air bronchogram anterior to the great fissure', 'hash': 'ab37422e5c9721f5e9a37e47da5f68b33dd3a7b2799b871564f413d8cdba6524'}, {'image_id': '72913_2_En_8_Fig43_HTML', 'image_file_name': '72913_2_En_8_Fig43_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig43_HTML.jpg', 'caption': 'Necrotizing pneumonia in a context of mucormycosis (same patient as in Fig. 13) presenting with hemoptysis 2 weeks after initial diagnosis despite adequate treatment. The retraction of the central necrotic mass of the LLL creates an air-crescent sign visible on mediastinal (a) and lung (b) windows. It had occurred at the same time as the pulmonary artery involvement', 'hash': 'ab3d625900654b0aa8144b5dceb681ac453f770e9a3b12cec451b07ef6fbf520'}, {'image_id': '72913_2_En_8_Fig24_HTML', 'image_file_name': '72913_2_En_8_Fig24_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig24_HTML.jpg', 'caption': 'Diffuse alveolar consolidation with air bronchogram and ground-glass opacity in a patient with autoimmune hepatitis treated with long-term steroids presenting with dyspnea and severe hypoxemia. This was related to a Pneumocystis jirovecii pneumonia. Note the pneumomediastinum in this mechanically ventilated patient staying in the intensive care unit who died from this severe infection with rapid deterioration', 'hash': '31a98b6bc04605adfb27bc70f8498f238350eed9b0bda037c9966913a8ac17c4'}, {'image_id': '72913_2_En_8_Fig34_HTML', 'image_file_name': '72913_2_En_8_Fig34_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig34_HTML.jpg', 'caption': 'A 50-year-old man developing a varicella without respiratory symptoms. Axial (a) and coronal (b) 10 mm-thick MIP images of a CT performed due to suspicion of pulmonary nodules on the chest X-ray show micronodules with random distribution that almost completely disappeared at the follow-up 3 months later (c, d)', 'hash': '578c3e20c6b39bf61a39f7f130288a1a7acdef7e2e3c94d0212a31e159872115'}, {'image_id': '72913_2_En_8_Fig4_HTML', 'image_file_name': '72913_2_En_8_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig4_HTML.jpg', 'caption': 'Coronal reformatted images with progressive thickening of the slabs from 1 (a) to 30 (b) to 150 mm (c) thick slabs by using the average intensity projection (AIP) post-processing tool in a patient known for a voluminous bullae of the right apex of the lung with superimposed infectious alveolar consolidation. Note that the bullae is not easily seen on the chest X-ray rendering in (c), as it was the case with the conventional chest X-ray (not shown). The same limitation also occurs in case of cavitation that may be missed on conventional chest X-ray', 'hash': '9afefd867fe7bd5207197d82a8d2468d0a0f51c1ad01ec4fb67fe2210662b644'}, {'image_id': '72913_2_En_8_Fig13_HTML', 'image_file_name': '72913_2_En_8_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig13_HTML.jpg', 'caption': 'Hemoptysis in the context of a mucormycosis in a 26-year-old woman suffering from acute lymphoblastic leukemia under antifungal prophylaxis. CT angiography in axial (a) and coronal oblique reformat (b) shows the vessel involvement originating from the necrotic parenchymal mass of the left lower lobe. This was confirmed after LLL lobectomy', 'hash': '3f74442af72ebd9de2bd27be821e58decefbf980ffcb11b56f89bc685b42ea69'}, {'image_id': '72913_2_En_8_Fig44_HTML', 'image_file_name': '72913_2_En_8_Fig44_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig44_HTML.jpg', 'caption': 'Air-crescent sign caused by an invasive epidermoid carcinoma stage IIIb treated by radiochemotherapy that progressively cavitated. Axial image at baseline CT (a), 3 weeks (b) and two consecutive axial CT images performed 3 months (c, d) after beginning of the treatment. The necrotic tumor appears progressively as a pseudo-aspergilloma with an air-crescent sign', 'hash': '657e9dd7d5b27d9a80fe7ec366eb37b783707829b26abe28723e84bd0ac72052'}, {'image_id': '72913_2_En_8_Fig3_HTML', 'image_file_name': '72913_2_En_8_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig3_HTML.jpg', 'caption': 'Ultralow dose CT performed at 100 kV and 10 mAs corresponding to a CTDIvol of 0.4 mGy reconstructed with FBP and a lung kernel. Native thin axial section (a) and 10 mm-thick maximum intensity projection reformat (b) exhibit noise well seen outside of the chest wall. Such noise projected on the lung mimics micronodulation with random distribution that may simulate a miliary disease in a context of a febrile immunocompromised patient. Although IR is the method of reconstruction of choice with low-dose CT and available in most institutions today, such potential pitfalls with FBP and lung kernel must be known when IR is not available. This precludes the use of such doses in this setting', 'hash': '7c356f929909fcd9d00438ebef244d9903df5a5074e65b5edfdeea5ffdb552af'}, {'image_id': '72913_2_En_8_Fig33_HTML', 'image_file_name': '72913_2_En_8_Fig33_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig33_HTML.jpg', 'caption': 'Miliary tuberculosis with multisystemic involvement in an HIV-positive CDC stage three patient highly immunosuppressed with CD4 level at 64 c/mm3. Axial CT scan shows diffuse tiny micronodules with ground-glass opacity leading to alveolar consolidation at the level of the apical segment of the RLL. Such an involvement may result in a respiratory distress syndrome (ARDS)', 'hash': '8d405301fee045d6d57112608dd21af7b690767000013e481c5f8af4f8e0a9d6'}, {'image_id': '72913_2_En_8_Fig23_HTML', 'image_file_name': '72913_2_En_8_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig23_HTML.jpg', 'caption': 'Invasive airway aspergillosis. Three axial CT images show peribronchial ground-glass attenuation at the level of the RUL (blue arrows) with slight bronchial wall thickening and ill-defined nodules (a) and alveolar consolidation (orange arrows) in a peribronchial location at the level of the posterobasal bronchus of the RLL (b) and a segmental distribution in the LLL (c). This presentation of aspergillosis mainly concerns non-acute leukemia patients with a leukocyte count >100/mm3', 'hash': 'cca09ceda7822e841855ea80772e8403e942a15241d3f5c51e1d9197a68bfe6e'}, {'image_id': '72913_2_En_8_Fig30_HTML', 'image_file_name': '72913_2_En_8_Fig30_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig30_HTML.jpg', 'caption': 'Pulmonary hemorrhage in a 65-year-old woman known for an acute myeloid leukemia with thrombocytopenia appears as a perihilar ground-glass opacity predominantly located at the level of the lower lobes', 'hash': 'b56c70ff042200b039fc92e7f418db7525a5714a2b3b26d0a404040ba1d1999d'}, {'image_id': '72913_2_En_8_Fig20_HTML', 'image_file_name': '72913_2_En_8_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig20_HTML.jpg', 'caption': 'Two consecutive coronal reformats in a 67-year-old man suffering from a bronchopneumonia show airspace nodules smaller than 1 cm with perinodular ground-glass opacity and patchy alveolar consolidation (arrows) (a) as well as peribronchiolar consolidation (b)', 'hash': '94ba4754a061d6a78691c520c760ea675037ad42aa89ece89dda6f19cbd0d497'}, {'image_id': '72913_2_En_8_Fig47_HTML', 'image_file_name': '72913_2_En_8_Fig47_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig47_HTML.jpg', 'caption': 'Airway aspergillosis in a 74-year-old woman with lymphoma of the marginal zone complaining of cough and fever. A circumferential peribronchial thickening around the mainstem left bronchus is seen on the axial CT image with mediastinal window (a). Two weeks later, a worsening of the stenosis with a wall fistula is observed on the axial image with the lung window (b). Note the presence of a bilateral pleural effusion', 'hash': 'f84293e17050c668dcc823b4f291ab239ac2b7542e2d18512d28bcdf4d49c496'}, {'image_id': '72913_2_En_8_Fig48_HTML', 'image_file_name': '72913_2_En_8_Fig48_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig48_HTML.jpg', 'caption': 'Sequelae of TB in a 35-year-old woman originating from Cameroun. Axial section in parenchymal (a) and mediastinal windows (b) at the level of the upper lobes showing cicatricial collapsus of the upper part of LUL well delineated by a small accessory fissure (arrows) with bronchovascular distortion, bronchiectasis, thin-walled cavities, and calcified nodules. The 3 mm-thick mIP oblique reformat (c) allows for an overall assessment of the bronchiectasis. The coronal 150 mm-thick AIP reformat (d) shows the upper retraction of the left hilum', 'hash': '66a4c29ee0ced7df9ce765387d1aea23cbc22870c58d434444703ce4f66efcd0'}, {'image_id': '72913_2_En_8_Fig10_HTML', 'image_file_name': '72913_2_En_8_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig10_HTML.jpg', 'caption': 'Empyema with right pulmonary abscesses in a context of bronchoaspiration pneumonia due to Streptococcus milleri and Fusobacterium necrophorum in a 47-year-old patient known for previous drug abuse that was found unconscious at home. In addition to antibiotherapy, a thoracoscopy was performed with drainage of the empyema. The reference chest X-ray (a) shows a pleural effusion. The axial CT with IV contrast media administration in mediastinal (b) and lung (c) window at the level of the apical segment of the RUL performed at the same day confirms the pleural effusion with thin enhancement of the parietal pleura suggesting empyema with associated alveolar consolidation. An axial section in lung window at the level of the right upper lobe bronchus (d) of the reference CT and also a follow-up CT performed 3 days later (e) demonstrate the cavitation of a pulmonary abscess of the anterior segment of the RUL that appears solid in (d). An axial image at the level of the middle lobe (f) shows additional cavities and another solid nodule related to multiple abscesses', 'hash': '150eae54ee195bd36ae884ea555cb661b558015cbd01da0a4fb426c0dbfff452'}, {'image_id': '72913_2_En_8_Fig28_HTML', 'image_file_name': '72913_2_En_8_Fig28_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig28_HTML.jpg', 'caption': 'Bilateral ground-glass opacity at the level of the upper lobes are related to a Coronavirus infection in a 72-year-old man known for a small cell carcinoma treated by radiochemotherapy', 'hash': '437bef7b61d1670875e8f7514c6ef998e173320d36a60029e94f68f6208744ed'}, {'image_id': '72913_2_En_8_Fig27_HTML', 'image_file_name': '72913_2_En_8_Fig27_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig27_HTML.jpg', 'caption': 'PCP pneumonia in an HIV-negative patient with a history of cerebral glioblastoma treated by surgery and radiochemotherapy. Axial CT shows ground-glass opacity predominating on the left side without sparing of the pulmonary cortex. The rounded hypoattenuated areas mostly correspond to centrilobular emphysema and not cysts that are rare in this condition', 'hash': 'ef9be4f902feb9b3fbc987f189d7acf71fd7906e671187715b77b7b9570dd39c'}, {'image_id': '72913_2_En_8_Fig37_HTML', 'image_file_name': '72913_2_En_8_Fig37_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig37_HTML.jpg', 'caption': 'Angioinvasive aspergillosis in a 27-year-old woman appears as nodules with peripheral ground-glass opacity at the apex of the LUL', 'hash': '602623cd88c664cdc6868ec07afd68d8f44a31d29a9303d988a7badf842bc6a8'}, {'image_id': '72913_2_En_8_Fig7_HTML', 'image_file_name': '72913_2_En_8_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig7_HTML.jpg', 'caption': 'Chest CT of a 36-year-old patient with ankylosing spondylarthritis treated by using anti-TNF alpha. Although numerous micronodules are visible on the thin axial section (a), their profusion and centrilobular distribution with tree in bud appearance related to Mycoplasma pneumoniae is more obvious when using 10 mm-thick MIP reformat (b). Note the sparing of the subpleural area typical of centrilobular distribution', 'hash': '20ba3a02aeca192364345c8eadb52ad54545e6052d3bca9a64ed6ffb1b533fbd'}, {'image_id': '72913_2_En_8_Fig38_HTML', 'image_file_name': '72913_2_En_8_Fig38_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig38_HTML.jpg', 'caption': 'Septic emboli in a 31-year-old female; HIV-negative drug abuser, known for chronic HCV and IV cocaine injections, presents with fever, shivering, and episodes of hemoptysis. Blood cultures were positive for Staphylococcus aureus with a 2 cm vegetation at the level of the tricuspid valve causing marked tricuspid insufficiency. Axial CT sections at baseline (a) and 8 days later (b), respectively, show multiple nodules with peripheral ground-glass opacity (a) that secondary cavitated. The latter is a usual finding with Staphylococcus aureus infection', 'hash': 'da3c597ff0a67c216a555c2b5fd1a573298d2131f0210af7ac23325a94be4437'}, {'image_id': '72913_2_En_8_Fig8_HTML', 'image_file_name': '72913_2_En_8_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig8_HTML.jpg', 'caption': 'Chest CT of a patient suffering from a Good’s syndrome (thymoma with immunodeficiency) and miliary tuberculosis (TB). The thin coronal reformatted image (a) shows an apparent limited number of nodules, unlike the 10 mm-thick MIP reformat (b) that shows obvious micronodules with random distribution that were related to a hematogenous spread of TB', 'hash': 'de2c671b80c4adc0029aa8f8efea0eeb9ad02ef18056050f5a4b0b844b856f42'}, {'image_id': '72913_2_En_8_Fig50_HTML', 'image_file_name': '72913_2_En_8_Fig50_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig50_HTML.jpg', 'caption': 'A 77-year-old man with a calcified fibrothorax as a sequelae of a previous TB. Axial section in mediastinal (a) and lung (b) windows show a pleural calcification with parenchymatous bands converging toward the latter and related to fibrosis of the visceral pleura. A 70 mm-thick MIP coronal reformat in bone window (c) shows the upper predominance of this fibrothorax. A 180 mm-thick AIP reformat (d) reproducing the chest X-ray appearance shows the retraction of the left hemithorax and the blunting of the costophrenic angle, a classical finding in this setting', 'hash': '5cf71514c78e1db685d8972f4187284eed26bb2879f03945955a1b5e021729a3'}, {'image_id': '72913_2_En_8_Fig40_HTML', 'image_file_name': '72913_2_En_8_Fig40_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig40_HTML.jpg', 'caption': 'Mycobacterium xenopi infection in a COPD patient. Chest X-ray (a), coronal reformat (b), and axial CT at the level of upper lobes (c) show an alveolar consolidation with cavities of various sizes that almost totally resolved on the follow-up CT performed 1 year later (d)', 'hash': '989887803884f51ae2dadb9f1c44998ee7c9d8c4ee0d964a028d70014436085d'}, {'image_id': '72913_2_En_8_Fig18_HTML', 'image_file_name': '72913_2_En_8_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig18_HTML.jpg', 'caption': 'Alveolar consolidation of the middle lobe related to an adenocarcinoma. The stretched appearance of the bronchi may suggest the diagnosis (Courtesy Pr Brillet, Bobigny, France)', 'hash': '36746ba212aa5e2fead48480244f222054bb08c4d0b815c6c7ba45a89a03ef55'}, {'image_id': '72913_2_En_8_Fig17_HTML', 'image_file_name': '72913_2_En_8_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig17_HTML.jpg', 'caption': 'Acute fibrinous organizing pneumonia (AFOP) in a 52-year-old patient suffering from plasmacytoid dendritic cells acute leukemia with febrile agranulocytosis. The noninfectious nature of the alveolar consolidation with peripheral ground-glass attenuation of the LUL was proven by a transbronchial biopsy performed under endobronchial ultrasonography (EBUS)', 'hash': 'cf8edab1c1830d5cc88ea7bfad80442e411766a90fe1d064799ac795ec3a4e73'}, {'image_id': '72913_2_En_8_Fig49_HTML', 'image_file_name': '72913_2_En_8_Fig49_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig49_HTML.jpg', 'caption': 'Ranke complex related to scars from a previous primary TB. Axial section with the bone window at the level of the right hilum (a) and of the RLL (b) show a calcified hilar node and a calcified parenchymal nodule, respectively', 'hash': '52d7344a3a661eedf69a795199ea976f0567491ee0680124dcc7958b14989ff2'}, {'image_id': '72913_2_En_8_Fig46_HTML', 'image_file_name': '72913_2_En_8_Fig46_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig46_HTML.jpg', 'caption': 'Right paratracheal lymph node metastasis with necrosis and parietal enhancement in a patient treated by chemotherapy and immunotherapy in a context of a poorly differentiated carcinoma with hepatic and bone metastases', 'hash': '7ab0f04dfa8b50a4e09b3fffc3948af8875b725d58e09beddb00517f3c9ae5c7'}, {'image_id': '72913_2_En_8_Fig11_HTML', 'image_file_name': '72913_2_En_8_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig11_HTML.jpg', 'caption': 'A 46-year-old male drug abuser known for COPD presents with fever after bullectomy and pleurodesis performed for a spontaneous pneumothorax. Chest X-ray (a) and axial chest CT after IV contrast media injection in mediastinal (b) and lung (c) windows with sagittal reformat (d) allow for an easy differentiation between the parenchymal involvement with necrosis on an underlying bullous emphysema from empyema. The thickening of the pleura that is suggestive of empyema (orange and blue arrows) appears laterally as a continuous line internal to the ribs (orange arrows)', 'hash': '7bfe95cb3c9c08769e278a3774eed56b47c67002e3458bd57ef5bca1df24838f'}, {'image_id': '72913_2_En_8_Fig31_HTML', 'image_file_name': '72913_2_En_8_Fig31_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig31_HTML.jpg', 'caption': 'Pulmonary infarct appears as a reverse halo sign in a 93-year-old patient with bilateral pulmonary emboli as nicely seen on axial CT section in lung (a) and mediastinal (b) windows', 'hash': 'd1a56b3a6bdec3fdc455f7460b5dedccbcf3ea7fb071d12c18b6f5ae65176a3d'}, {'image_id': '72913_2_En_8_Fig1_HTML', 'image_file_name': '72913_2_En_8_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig1_HTML.jpg', 'caption': 'Ultralow dose CT was performed because of the appearance of a cavity with an air-fluid level in the left axillary area on chest X-ray (a) in a 20-year-old female patient with cystic fibrosis and persistent symptoms due to Staphylococcus aureus and Cepacia infection despite antibiotic treatment. Axial sections reconstructed by using iterative reconstruction (IR) algorithm (b) and FBP with soft kernel and a slice thickness of 4 mm (c). Coronal reformatted image reconstructed by using IR (d, f) and filtered back projection (FBP) with soft kernel (e.g). The drainage bronchus of the abscess cavity (d, e) is clearly differentiated from the varicose bronchiectasis that are well assessed with a 3 mm-thick minimum intensity projection (mIP) reformat (f, g). Despite a slight distortion of the details seen on the axial image when using IR (b) compared with FBP (c), a substantial reduction of the noise is observed with IR (d, f)', 'hash': 'b4bdbc8ab2770db4b79de28ccd91a1504ce4bdc47225254448d7443390f6f03a'}, {'image_id': '72913_2_En_8_Fig21_HTML', 'image_file_name': '72913_2_En_8_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig21_HTML.jpg', 'caption': 'Bronchopneumonia pattern appears on this axial section at the level of the upper lobes as bronchial wall thickening, centrilobular nodules with tree-in-bud sign (blue arrow), lobular (orange arrow), and segmental alveolar consolidation with multifocal and patchy involvement', 'hash': 'da2fdf5cc57671c5129b281fc62ec21162a30f6a7ee6f1db60de4431ee68bd25'}, {'image_id': '72913_2_En_8_Fig41_HTML', 'image_file_name': '72913_2_En_8_Fig41_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig41_HTML.jpg', 'caption': 'Aspergilloma developing in a cavity in a 69-year-old man with a history of stage IV sarcoidosis who complained of hemoptysis. The treatment consisted of antifungal therapy and bronchial embolization followed by a left upper lobectomy. Axial CT section in lung window (a) at the level of the LUL shows the air-crescent sign. Axial CT section on bone window (b) at the same level demonstrates the calcified lymph nodes related to sarcoidosis and the slight calcifications within the aspergilloma. The coronal reformat (c) shows the typical dependent location of the aspergilloma within the cavity', 'hash': '39ebb704d6bd378dffca45e8c73b2cecb927298726194e66f7e7768936098464'}, {'image_id': '72913_2_En_8_Fig16_HTML', 'image_file_name': '72913_2_En_8_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig16_HTML.jpg', 'caption': 'Round pneumonia occurs in a 44-year-old man suddenly presenting with fever and chest pain and addressed to the emergency department. The chest X-ray (a) shows a right parahilar pseudo-tumoral opacity. Due to this atypical aspect, chest CT was performed on the same day. Axial CT image (b) and sagittal reformat (c) demonstrate a rounded alveolar consolidation of the posterior segment of the RUL and the apical segment of the RLL. Note the ground-glass opacity located around the alveolar consolidation reflecting the partial filling of the alveoli', 'hash': '601a8e6c25f1db9cdf4c98ff011d7b43229ba6b002fb7ed5d90d46c746b90272'}, {'image_id': '72913_2_En_8_Fig19_HTML', 'image_file_name': '72913_2_En_8_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig19_HTML.jpg', 'caption': 'Infectious bronchiolitis appears as thickening of the bronchial walls and centrilobular nodules with tree-in-bud sign', 'hash': '2100d648fe7b0c6e07a80e8839dd22da8865329f4b2a92c6c02bb8a41857dc91'}, {'image_id': '72913_2_En_8_Fig26_HTML', 'image_file_name': '72913_2_En_8_Fig26_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig26_HTML.jpg', 'caption': 'PCP pneumonia in an AIDS patient presenting with cough and fever. The crazy-paving appearance associated with cysts strongly suggests the diagnosis', 'hash': '9c6dd34089f804076cfd51ec25ec34a4713a30396184e1a010d90adc52bed674'}, {'image_id': '72913_2_En_8_Fig29_HTML', 'image_file_name': '72913_2_En_8_Fig29_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig29_HTML.jpg', 'caption': 'Axial CT image shows a reverse halo sign in a 26-year-old woman known for an acute lymphoblastic leukemia that developed fever and cough with hemodynamic compromise despite antifungal prophylaxis. This was related to a mucormycosis (Lichtheimia spp) proven by transbronchial biopsy and panfungal PCR in the BAL', 'hash': '68c79124aba53664f4cb5969dfc748f034196145c765da7125790ec953ae7a24'}, {'image_id': '72913_2_En_8_Fig9_HTML', 'image_file_name': '72913_2_En_8_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig9_HTML.jpg', 'caption': 'Pulmonary abscess related to multisensible Escherichia coli in a 52-year-old male alcoholic and heavy smoker suffering from fever with respiratory symptoms resisting to first line of antibiotics. After an initial chest X-ray (a), a chest CT with intravenous (IV) contrast media injection was performed due to worsening of the status. It allowed for the exclusion of pulmonary embolism and demonstrated the necrotic component of a pulmonary abscess of the LUL on axial sections with mediastinal (b) and lung (c) windows. A coronal reformatted image (d) showed cavitation within the upper part of the lesion that was better assessed when applying 7 mm-thick mIP post-processing (e). The latter also allowed for demonstration of the drainage bronchus that helped the clinician to guide the BAL. A follow-up CT in axial sections (f) demonstrated the resolution of this lesion with a sequelae appearing as a cavity with lobulated margins with thin wall', 'hash': 'e22fdbe3587fbc4660babb70b0a5fc9d7c5caa4968c2fc19450e685d322f7b7e'}, {'image_id': '72913_2_En_8_Fig39_HTML', 'image_file_name': '72913_2_En_8_Fig39_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig39_HTML.jpg', 'caption': 'Lemierre syndrome in a 21-year-old man suffering from a sore throat with jugular vein thrombosis well depicted by CT with contrast media injection (a) and septic embolism appearing as peripheral nodules of various sizes with wedge-shaped consolidation (arrows) and slight peripheral ground-glass opacity on axial CT image (b). The 8 mm-thick MIP image (c) shows the lateralized trajectory of the artery around the nodule', 'hash': 'f83ca2e5c8e0733f063a8c7e1d8500f23a4f14af390a10a3bd5830e606f915d7'}, {'image_id': '72913_2_En_8_Fig6_HTML', 'image_file_name': '72913_2_En_8_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig6_HTML.jpg', 'caption': '16\u2009mm-thick axial MIP image in a 58-year-old patient with Crohn disease under infliximab treatment. Although invisible on 1.25 mm-thick axial image (a), the MIP reformatted image (b) permits to detect micronodules with random distribution that were related to a miliary tuberculosis', 'hash': '52fcc308463b1224e1c9af1f22de0f0dfdc6adf7e9000ba739627a773550bbcf'}, {'image_id': '72913_2_En_8_Fig36_HTML', 'image_file_name': '72913_2_En_8_Fig36_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig36_HTML.jpg', 'caption': 'A 24-year-old woman is known for a recurrence of Hodgkin’s lymphoma appearing on the PET-CT (a, b) as multiple pulmonary nodules. A necrotic bronchopneumonia occurring 2 months later presents as bilateral alveolar consolidation superimposed on the preexisting nodules (c, d) that lead to a septic shock with death of the patient. This case reinforces the usefulness of evaluation of previous imaging features', 'hash': 'd22641e5d59abadbd0d74d3372f6930e575078e169ad3312ea5a1aa9dc0b694c'}] | {'72913_2_En_8_Fig1_HTML': ['Today, CT has to be performed on a multidetector row CT scanner acquiring around 1 mm-thick sections and using an exposure dose which needs to be carefully chosen. Low-dose (LD) CT may be used without impairing the diagnostic information of specific CT patterns, in particular in case of pulmonary fungal infections (Christe et al. 2012), and even ultralow dose (ULD) CT may be possible, according to the clinical context. Overall, the dose may be decreased depending on the size of anomalies to be detected. If they are greater than 1 cm, which is often the case for patients with cystic fibrosis and suspected of acute pulmonary infections, ULD-CT at a dose that nearly reaches that of a chest X-ray may demonstrate the abnormalities, provided that the series are reconstructed with the correct technical parameters (Fig. <xref rid="72913_2_En_8_Fig1_HTML" ref-type="fig">1</xref>). These doses also apply to the follow-up of this young population that is exposed to frequent ionizing radiation procedures during the whole life. In other cases, LD-CTs with a CTDI of 2–3 mGy.cm in non-obese patients (Bankier and Tack ). These doses also apply to the follow-up of this young population that is exposed to frequent ionizing radiation procedures during the whole life. In other cases, LD-CTs with a CTDI of 2–3 mGy.cm in non-obese patients (Bankier and Tack 2010) are perfectly suited for the follow-up of infectious lung diseases (Fig. <xref rid="72913_2_En_8_Fig2_HTML" ref-type="fig">2</xref>). A comparison with previous baseline examinations is always required to accurately assess the disease’s evolution. Of importance, although ULD-CT with a mean radiation expose dose of 0.60\u2009±\u20090.15 mSv has been proven to provide acceptable image quality in case of pulmonary infections in febrile neutropenic patients with hematologic malignancy (Kim et al. ). A comparison with previous baseline examinations is always required to accurately assess the disease’s evolution. Of importance, although ULD-CT with a mean radiation expose dose of 0.60\u2009±\u20090.15 mSv has been proven to provide acceptable image quality in case of pulmonary infections in febrile neutropenic patients with hematologic malignancy (Kim et al. 2014), caution must be taken due to potential pitfalls with LD-CT (Fig. <xref rid="72913_2_En_8_Fig3_HTML" ref-type="fig">3</xref>). Multiplanar reformats with average intensity projection (AIP) post-processing of variable thickness may give rise to tomographic or chest X-ray appearance (Figs. ). Multiplanar reformats with average intensity projection (AIP) post-processing of variable thickness may give rise to tomographic or chest X-ray appearance (Figs. <xref rid="72913_2_En_8_Fig4_HTML" ref-type="fig">4</xref> and and <xref rid="72913_2_En_8_Fig5_HTML" ref-type="fig">5</xref>) that may be compared with previous or following conventional chest X-rays. The use of maximum intensity projection (MIP) may optimize the detection of micronodules, which sometimes cannot be assessed by using thin slices alone (Fig. ) that may be compared with previous or following conventional chest X-rays. The use of maximum intensity projection (MIP) may optimize the detection of micronodules, which sometimes cannot be assessed by using thin slices alone (Fig. <xref rid="72913_2_En_8_Fig6_HTML" ref-type="fig">6</xref>). It is also helpful to characterize micronodules as centrilobular ones with tree in bud appearance (Fig. ). It is also helpful to characterize micronodules as centrilobular ones with tree in bud appearance (Fig. <xref rid="72913_2_En_8_Fig7_HTML" ref-type="fig">7</xref>), corresponding to a bronchocentric distribution, or as ones with a random distribution as seen in miliary disease (Fig. ), corresponding to a bronchocentric distribution, or as ones with a random distribution as seen in miliary disease (Fig. <xref rid="72913_2_En_8_Fig8_HTML" ref-type="fig">8</xref>) (Beigelman-Aubry et al. ) (Beigelman-Aubry et al. 2005). The use of minimum intensity projection (mIP) allows to accurately locate an abnormal area in order to guide a bronchoalveolar lavage (BAL) (Fig. <xref rid="72913_2_En_8_Fig9_HTML" ref-type="fig">9</xref>), to differentiate bronchiectasis from a cavitary lesion (Fig. ), to differentiate bronchiectasis from a cavitary lesion (Fig. <xref rid="72913_2_En_8_Fig1_HTML" ref-type="fig">1</xref>), to visualize the drainage bronchus in the latter situation, as well as to help to recognize a bronchopleural fistula.), to visualize the drainage bronchus in the latter situation, as well as to help to recognize a bronchopleural fistula.Fig. 1Ultralow dose CT was performed because of the appearance of a cavity with an air-fluid level in the left axillary area on chest X-ray (a) in a 20-year-old female patient with cystic fibrosis and persistent symptoms due to Staphylococcus aureus and Cepacia infection despite antibiotic treatment. Axial sections reconstructed by using iterative reconstruction (IR) algorithm (b) and FBP with soft kernel and a slice thickness of 4 mm (c). Coronal reformatted image reconstructed by using IR (d, f) and filtered back projection (FBP) with soft kernel (e.g). The drainage bronchus of the abscess cavity (d, e) is clearly differentiated from the varicose bronchiectasis that are well assessed with a 3 mm-thick minimum intensity projection (mIP) reformat (f, g). Despite a slight distortion of the details seen on the axial image when using IR (b) compared with FBP (c), a substantial reduction of the noise is observed with IR (d, f)\nFig. 2Low-dose CT was performed for the follow-up of an angioinvasive aspergillosis in a 38-year-old woman with acute myeloid leukemia. The baseline CT (a) was performed with a CTDI of 5 and a DLP at 147 mGy.cm and the follow-up CT (b) with a CTDI of 2 and a DLP of 72 mGy.cm by using filter back projection reconstruction (FBP) with a soft kernel, without iterative reconstruction (IR) algorithm. Although a relative lesser image quality than the reference image, the disease’s evolution may be perfectly assessed at less than half of the initial dose\nFig. 3Ultralow dose CT performed at 100 kV and 10 mAs corresponding to a CTDIvol of 0.4 mGy reconstructed with FBP and a lung kernel. Native thin axial section (a) and 10 mm-thick maximum intensity projection reformat (b) exhibit noise well seen outside of the chest wall. Such noise projected on the lung mimics micronodulation with random distribution that may simulate a miliary disease in a context of a febrile immunocompromised patient. Although IR is the method of reconstruction of choice with low-dose CT and available in most institutions today, such potential pitfalls with FBP and lung kernel must be known when IR is not available. This precludes the use of such doses in this setting\nFig. 4Coronal reformatted images with progressive thickening of the slabs from 1 (a) to 30 (b) to 150 mm (c) thick slabs by using the average intensity projection (AIP) post-processing tool in a patient known for a voluminous bullae of the right apex of the lung with superimposed infectious alveolar consolidation. Note that the bullae is not easily seen on the chest X-ray rendering in (c), as it was the case with the conventional chest X-ray (not shown). The same limitation also occurs in case of cavitation that may be missed on conventional chest X-ray\nFig. 5A 60-year-old man suffering from bronchiectasis of unknown cause presented with fever and new respiratory symptoms related to an abscess due to a usually nosocomial germ, Serratia marcescens and Cronobacter, a gram-negative bacteria of the Enterobacteriaceae family. Chest X-ray (a) and axial CT section with IV contrast in mediastinal (b) and lung (c) windows show the abscess of the LUL with thick walls, a necrotic component and an air-fluid level. The coronal 1.5 mm (d), 30 mm (e), and 150 mm (f) thick AIP reformatted images allow for a better understanding of the opacities related to a bronchocele at the level of the RUL and the abscess situated close to a bronchiectatic area of the LUL\nFig. 616\u2009mm-thick axial MIP image in a 58-year-old patient with Crohn disease under infliximab treatment. Although invisible on 1.25 mm-thick axial image (a), the MIP reformatted image (b) permits to detect micronodules with random distribution that were related to a miliary tuberculosis\nFig. 7Chest CT of a 36-year-old patient with ankylosing spondylarthritis treated by using anti-TNF alpha. Although numerous micronodules are visible on the thin axial section (a), their profusion and centrilobular distribution with tree in bud appearance related to Mycoplasma pneumoniae is more obvious when using 10 mm-thick MIP reformat (b). Note the sparing of the subpleural area typical of centrilobular distribution\nFig. 8Chest CT of a patient suffering from a Good’s syndrome (thymoma with immunodeficiency) and miliary tuberculosis (TB). The thin coronal reformatted image (a) shows an apparent limited number of nodules, unlike the 10 mm-thick MIP reformat (b) that shows obvious micronodules with random distribution that were related to a hematogenous spread of TB\nFig. 9Pulmonary abscess related to multisensible Escherichia coli in a 52-year-old male alcoholic and heavy smoker suffering from fever with respiratory symptoms resisting to first line of antibiotics. After an initial chest X-ray (a), a chest CT with intravenous (IV) contrast media injection was performed due to worsening of the status. It allowed for the exclusion of pulmonary embolism and demonstrated the necrotic component of a pulmonary abscess of the LUL on axial sections with mediastinal (b) and lung (c) windows. A coronal reformatted image (d) showed cavitation within the upper part of the lesion that was better assessed when applying 7 mm-thick mIP post-processing (e). The latter also allowed for demonstration of the drainage bronchus that helped the clinician to guide the BAL. A follow-up CT in axial sections (f) demonstrated the resolution of this lesion with a sequelae appearing as a cavity with lobulated margins with thin wall\n'], '72913_2_En_8_Fig9_HTML': ['CT may be performed without or with intravenous (IV) contrast, the latter especially to evaluate the necrotic component of a pneumoniae or abscesses (Fig. <xref rid="72913_2_En_8_Fig9_HTML" ref-type="fig">9</xref>) and to optimize the differentiation from an empyema (Figs. ) and to optimize the differentiation from an empyema (Figs. <xref rid="72913_2_En_8_Fig10_HTML" ref-type="fig">10</xref> and and <xref rid="72913_2_En_8_Fig11_HTML" ref-type="fig">11</xref>). It has also been described as helpful for differentiation between a pulmonary angioinvasive mycosis and a bacterial pneumonia in high-risk hematologic patients by using volume perfusion CT (Schulze et al. ). It has also been described as helpful for differentiation between a pulmonary angioinvasive mycosis and a bacterial pneumonia in high-risk hematologic patients by using volume perfusion CT (Schulze et al. 2012). IV contrast-enhanced CT is also required in case of hemoptysis, being able to demonstrate enlarged bronchial and non-bronchial systemic arteries due to former tuberculosis or, less frequently, Rasmussen aneurysms (Fig. <xref rid="72913_2_En_8_Fig12_HTML" ref-type="fig">12</xref> ) occurring in the same situation as well as vessel involvement in case of fungal disease (Fig. ) occurring in the same situation as well as vessel involvement in case of fungal disease (Fig. <xref rid="72913_2_En_8_Fig13_HTML" ref-type="fig">13</xref>). It may also highlight a concomitant thromboembolic disease.). It may also highlight a concomitant thromboembolic disease.Fig. 10Empyema with right pulmonary abscesses in a context of bronchoaspiration pneumonia due to Streptococcus milleri and Fusobacterium necrophorum in a 47-year-old patient known for previous drug abuse that was found unconscious at home. In addition to antibiotherapy, a thoracoscopy was performed with drainage of the empyema. The reference chest X-ray (a) shows a pleural effusion. The axial CT with IV contrast media administration in mediastinal (b) and lung (c) window at the level of the apical segment of the RUL performed at the same day confirms the pleural effusion with thin enhancement of the parietal pleura suggesting empyema with associated alveolar consolidation. An axial section in lung window at the level of the right upper lobe bronchus (d) of the reference CT and also a follow-up CT performed 3 days later (e) demonstrate the cavitation of a pulmonary abscess of the anterior segment of the RUL that appears solid in (d). An axial image at the level of the middle lobe (f) shows additional cavities and another solid nodule related to multiple abscesses\nFig. 11A 46-year-old male drug abuser known for COPD presents with fever after bullectomy and pleurodesis performed for a spontaneous pneumothorax. Chest X-ray (a) and axial chest CT after IV contrast media injection in mediastinal (b) and lung (c) windows with sagittal reformat (d) allow for an easy differentiation between the parenchymal involvement with necrosis on an underlying bullous emphysema from empyema. The thickening of the pleura that is suggestive of empyema (orange and blue arrows) appears laterally as a continuous line internal to the ribs (orange arrows)\nFig. 12Rasmussen aneurysm in a 35-year-old patient presenting hemoptysis 9 days after the initial diagnosis of TB. Axial CT without (a) and with IV contrast media injection (b) focused at the level of the RUL shows a vascular enhancement within the tuberculoma that was clearly differentiated from the calcification depicted without contrast. The selective angiogram of the right bronchial artery (c) shows the aneurysm that was immediately successfully embolized\nFig. 13Hemoptysis in the context of a mucormycosis in a 26-year-old woman suffering from acute lymphoblastic leukemia under antifungal prophylaxis. CT angiography in axial (a) and coronal oblique reformat (b) shows the vessel involvement originating from the necrotic parenchymal mass of the left lower lobe. This was confirmed after LLL lobectomy\n', 'A pulmonary abscess may be single or multiple, with a characteristic spherical shape. It measures between 2 and 6 cm in diameter, demonstrates a central hypoattenuation (Fig. <xref rid="72913_2_En_8_Fig9_HTML" ref-type="fig">9</xref>) or cavitation representing localized necrotic cavity, contains pus, and demonstrates peripheral enhancement after intravenous contrast medium injection, without or with an air-fluid level (Fig. ) or cavitation representing localized necrotic cavity, contains pus, and demonstrates peripheral enhancement after intravenous contrast medium injection, without or with an air-fluid level (Fig. <xref rid="72913_2_En_8_Fig5_HTML" ref-type="fig">5</xref>). It usually displays an acute angle when it intersects with an adjacent pleural surface. Consolidation in the adjacent parenchyma occurs in half of all cases (Muller ). It usually displays an acute angle when it intersects with an adjacent pleural surface. Consolidation in the adjacent parenchyma occurs in half of all cases (Muller 2003). Bronchopulmonary fistula may be observed. As the most frequent cause of lung abscess is aspiration, the most common localizations are the posterior segment of an upper lobe or the superior segment of a lower lobe (Muller 2003). Bilateral involvement that predominantly affects the lung bases with abscess formation suggests a P. aeruginosa infection. Infections caused by anaerobic bacteria are commonly encountered, abscesses caused by S. aureus, K. pneumoniae, and P. aeruginosa being associated with higher mortality (Francis et al. 2005).'], '72913_2_En_8_Fig14_HTML': ['Lobar pneumonia, characterized by an inflammatory exudate filling distal airspaces, typically begins in the lung area adjacent to the visceral pleura and spreads through the interalveolar pores of Kohn and the small airways from one segment to another (Muller 2003) respecting a centripetal pattern. Appearing as a single subpleural area of alveolar consolidation with blurred margins restricted to the area next to the fissures, it then progresses to a sublobar or lobar alveolar consolidation sharply demarcated by the interlobar fissure (Fig. <xref rid="72913_2_En_8_Fig14_HTML" ref-type="fig">14</xref>) (Franquet ) (Franquet 2008). An air bronchogram sign is strongly suggestive (Fig. <xref rid="72913_2_En_8_Fig15_HTML" ref-type="fig">15</xref>) (Syrjälä et al. ) (Syrjälä et al. 1998). Ground-glass opacities adjacent to the alveolar consolidation corresponding to a partial filling of the alveoli may be observed (Fig. <xref rid="72913_2_En_8_Fig16_HTML" ref-type="fig">16</xref>) (Tanaka et al. ) (Tanaka et al. 1996). This aspect is the classical presentation of acute bacterial community-acquired pneumonia (CAP), mainly caused by S. pneumoniae (Bhalla and McLoud 1998), other agents responsible of complete lobar consolidation including Klebsiella pneumoniae, and other gram-negative bacilli, L. pneumophila, H. influenzae, and occasionally M. pneumoniae (Franquet 2008). A P. jirovecii infection, a fungal infection, or a mycobacteriosis has also to be considered in case of immunocompromised patients. An enlarged lobe with bulging fissures due to edematous engorgement may be observed, in particular with K. pneumoniae infection, with a current lower occurrence likely due to early treatment in case of suspected pneumonia (Walker et al. 2014).Fig. 14Segmental pneumonia of the lingula in an 82-year-old woman. Axial CT scan focused at the level of the lower part of the LUL (a) and sagittal reformat (b) show an alveolar consolidation with a well-defined air bronchogram anterior to the great fissure\nFig. 15Lobar pneumonia of the RUL related to Streptococcus pneumococcus in a 25-year-old smoker. Scout view (a) and axial CT image (b) show an alveolar consolidation with an air bronchogram. The 10 mm-thick mIP (c) permits to display the entire length of the bronchi from their origin within the alveolar consolidation. Although CT does not replace fiber-optic bronchoscopy, no obstructive lesion was detected by using CT\nFig. 16Round pneumonia occurs in a 44-year-old man suddenly presenting with fever and chest pain and addressed to the emergency department. The chest X-ray (a) shows a right parahilar pseudo-tumoral opacity. Due to this atypical aspect, chest CT was performed on the same day. Axial CT image (b) and sagittal reformat (c) demonstrate a rounded alveolar consolidation of the posterior segment of the RUL and the apical segment of the RLL. Note the ground-glass opacity located around the alveolar consolidation reflecting the partial filling of the alveoli\n'], '72913_2_En_8_Fig17_HTML': ['The differential diagnosis includes aspiration pneumonia when the lower lung is affected, especially on the right side. Lobar or segmental consolidation may also be related to bronchial obstruction, pulmonary hemorrhage, organizing pneumonia, acute fibrinous organizing pneumonia (Fig. <xref rid="72913_2_En_8_Fig17_HTML" ref-type="fig">17</xref>), radiation pneumonitis, adenocarcinoma (Fig. ), radiation pneumonitis, adenocarcinoma (Fig. <xref rid="72913_2_En_8_Fig18_HTML" ref-type="fig">18</xref>), or lymphoma.), or lymphoma.Fig. 17Acute fibrinous organizing pneumonia (AFOP) in a 52-year-old patient suffering from plasmacytoid dendritic cells acute leukemia with febrile agranulocytosis. The noninfectious nature of the alveolar consolidation with peripheral ground-glass attenuation of the LUL was proven by a transbronchial biopsy performed under endobronchial ultrasonography (EBUS)\nFig. 18Alveolar consolidation of the middle lobe related to an adenocarcinoma. The stretched appearance of the bronchi may suggest the diagnosis (Courtesy Pr Brillet, Bobigny, France)\n'], '72913_2_En_8_Fig19_HTML': ['Histologically, bronchopneumonia is characterized by a predominantly bronchiolar and peribronchiolar inflammation with a patchy distribution. Firstly, the adjacent alveoli are involved, followed by the lobules, segments, and/or lobes. An air bronchogram is usually absent. CT features include those of infectious bronchiolitis consisting of thickening of the bronchial walls, centrilobular nodules and tree-in-bud sign (Fig. <xref rid="72913_2_En_8_Fig19_HTML" ref-type="fig">19</xref>) (see below), airspace nodules generally smaller than 1 cm in size related to the inflammatory spreading to the peribronchiolar alveoli with areas of ground-glass opacity or peribronchiolar consolidation (Fig. ) (see below), airspace nodules generally smaller than 1 cm in size related to the inflammatory spreading to the peribronchiolar alveoli with areas of ground-glass opacity or peribronchiolar consolidation (Fig. <xref rid="72913_2_En_8_Fig20_HTML" ref-type="fig">20</xref>), and multifocal lobular, segmental, or lobar consolidation (Figs. ), and multifocal lobular, segmental, or lobar consolidation (Figs. <xref rid="72913_2_En_8_Fig21_HTML" ref-type="fig">21</xref> and and <xref rid="72913_2_En_8_Fig22_HTML" ref-type="fig">22</xref>). Bronchopneumonias are most commonly encountered in nosocomial infections and usually caused by gram-negative bacteria (GNB), especially ). Bronchopneumonias are most commonly encountered in nosocomial infections and usually caused by gram-negative bacteria (GNB), especially P. aeruginosa or E. coli. Other commonly involved bacteria are S. aureus (Morikawa et al. 2012), Haemophilus influenzae, anaerobes, and some species of fungus, especially Aspergillus (Fig. <xref rid="72913_2_En_8_Fig23_HTML" ref-type="fig">23</xref>). The latter as well as viruses (Franquet ). The latter as well as viruses (Franquet 2011) or atypical mycobacteriosis has to be considered when suggested by the individual clinical setting. Bronchiectasis predominantly located at the level of the middle lobe and the lingula may be associated in case of mycobacterium avium complex (MAC) infection (Lady Windermere syndrome).Fig. 19Infectious bronchiolitis appears as thickening of the bronchial walls and centrilobular nodules with tree-in-bud sign\nFig. 20Two consecutive coronal reformats in a 67-year-old man suffering from a bronchopneumonia show airspace nodules smaller than 1 cm with perinodular ground-glass opacity and patchy alveolar consolidation (arrows) (a) as well as peribronchiolar consolidation (b)\nFig. 21Bronchopneumonia pattern appears on this axial section at the level of the upper lobes as bronchial wall thickening, centrilobular nodules with tree-in-bud sign (blue arrow), lobular (orange arrow), and segmental alveolar consolidation with multifocal and patchy involvement\nFig. 22CMV infection in a patient with renal graft appears as a bronchopneumonia pattern on two successive axial sections (a, b). The bronchial thickening in (a) is associated with bilateral segmental alveolar consolidations at the lung bases in (b)\nFig. 23Invasive airway aspergillosis. Three axial CT images show peribronchial ground-glass attenuation at the level of the RUL (blue arrows) with slight bronchial wall thickening and ill-defined nodules (a) and alveolar consolidation (orange arrows) in a peribronchial location at the level of the posterobasal bronchus of the RLL (b) and a segmental distribution in the LLL (c). This presentation of aspergillosis mainly concerns non-acute leukemia patients with a leukocyte count >100/mm3\n\n'], '72913_2_En_8_Fig24_HTML': ['Diffuse alveolar consolidation suggests diffuse alveolar damage (DAD), typically encountered in case of adult respiratory distress syndrome (ARDS). An air bronchogram sign is usually observed as well as small pleural effusions. P. jirovecii pneumonia (Festic et al. 2005) (Fig. <xref rid="72913_2_En_8_Fig24_HTML" ref-type="fig">24</xref>) as well as uncommon, unusual, or exotic organisms can be involved. Nondependent anomalies are more related to pneumonia rather than lesions in the dependent lung (Beigelman-Aubry et al. ) as well as uncommon, unusual, or exotic organisms can be involved. Nondependent anomalies are more related to pneumonia rather than lesions in the dependent lung (Beigelman-Aubry et al. 2012).Fig. 24Diffuse alveolar consolidation with air bronchogram and ground-glass opacity in a patient with autoimmune hepatitis treated with long-term steroids presenting with dyspnea and severe hypoxemia. This was related to a Pneumocystis jirovecii pneumonia. Note the pneumomediastinum in this mechanically ventilated patient staying in the intensive care unit who died from this severe infection with rapid deterioration\n'], '72913_2_En_8_Fig25_HTML': ['The most common causes are viruses, Mycoplasma pneumoniae, Chlamydia, and P. jirovecii. In viral infections and in those caused by M. pneumoniae, ground-glass attenuation is associated with signs of cellular bronchiolitis and focal consolidation fitting with bronchopneumonia. When a predominant ground-glass opacity occurs in an immunocompetent patient, respiratory syncytial virus or varicella infection should be first considered. In immunocompromised patients, P. jirovecii (Thomas and Limper 2004) CMV (McGuinness et al. 1994) or Mycoplasma infection must be suggested. P. jiroveci infections typically present as ground-glass opacity sparing the pulmonary cortex that predominantly affects the upper region, especially in AIDS patients (Fig. <xref rid="72913_2_En_8_Fig25_HTML" ref-type="fig">25</xref>). A crazy-paving sign, defined as a combination of ground-glass opacity and smooth interlobular septal thickening that resembles a masonry pattern used in walkways (Hansell et al. ). A crazy-paving sign, defined as a combination of ground-glass opacity and smooth interlobular septal thickening that resembles a masonry pattern used in walkways (Hansell et al. 2008), may be observed in infections, in particular with Pneumocystis jirovecii pneumonia and influenza (Walker et al. 2014). Pulmonary cysts or pneumatoceles within the same areas should suggest PCP (Fig. <xref rid="72913_2_En_8_Fig26_HTML" ref-type="fig">26</xref>). In immunocompromised non-HIV-positive patients, features are less suggestive of the diagnosis, with rapid progression, this being the result of severe or dysregulated inflammatory responses that are evoked by a relatively small number of ). In immunocompromised non-HIV-positive patients, features are less suggestive of the diagnosis, with rapid progression, this being the result of severe or dysregulated inflammatory responses that are evoked by a relatively small number of Pneumocystis organisms (Chang et al. 2013; Tasaka and Tokuda 2012) (Fig. <xref rid="72913_2_En_8_Fig27_HTML" ref-type="fig">27</xref>). In the latter category of patients, ground-glass opacities can also be caused by viral (Fig. ). In the latter category of patients, ground-glass opacities can also be caused by viral (Fig. <xref rid="72913_2_En_8_Fig28_HTML" ref-type="fig">28</xref>) or pyogenic infection (Kang et al. ) or pyogenic infection (Kang et al. 1996).Fig. 25\nP. jirovecii pneumonia in an AIDS patient appearing as ground-glass opacity sparing the pulmonary cortex and typically predominantly located at the upper region of the lungs\nFig. 26PCP pneumonia in an AIDS patient presenting with cough and fever. The crazy-paving appearance associated with cysts strongly suggests the diagnosis\nFig. 27PCP pneumonia in an HIV-negative patient with a history of cerebral glioblastoma treated by surgery and radiochemotherapy. Axial CT shows ground-glass opacity predominating on the left side without sparing of the pulmonary cortex. The rounded hypoattenuated areas mostly correspond to centrilobular emphysema and not cysts that are rare in this condition\nFig. 28Bilateral ground-glass opacity at the level of the upper lobes are related to a Coronavirus infection in a 72-year-old man known for a small cell carcinoma treated by radiochemotherapy\n'], '72913_2_En_8_Fig29_HTML': ['Peculiar aspects of GGO are seen with the halo sign (see below) and the reversed halo sign (RHS), defined as focal rounded area of ground-glass opacity surrounded by a crescent or complete ring of consolidation (Fig. <xref rid="72913_2_En_8_Fig29_HTML" ref-type="fig">29</xref>) (Georgiadou et al. ) (Georgiadou et al. 2011). Histopathologically, the RHS has been associated to infarcted lung tissue, with a greater amount of hemorrhage at the periphery than at the center, with a frequent subsequent cavitation after neutropenia recovery (Wahba et al. 2008). Halo sign (HS) and RHS are highly suggestive of early infection by an angioinvasive fungus in severely immunocompromised patients. The former is most commonly associated with invasive pulmonary aspergillosis and the latter with pulmonary mucormycosis. An RHS may also be related to other infectious diseases, in particular invasive aspergillosis, tuberculosis, or paracoccidioidomycosis (Georgiadou et al. 2011).Fig. 29Axial CT image shows a reverse halo sign in a 26-year-old woman known for an acute lymphoblastic leukemia that developed fever and cough with hemodynamic compromise despite antifungal prophylaxis. This was related to a mucormycosis (Lichtheimia spp) proven by transbronchial biopsy and panfungal PCR in the BAL\n'], '72913_2_En_8_Fig30_HTML': ['The differential diagnosis of ground-glass attenuation is wide, especially in immunocompromised patients. It can be related to drug-induced toxicity (Fig. <xref rid="72913_2_En_8_Fig30_HTML" ref-type="fig">30</xref>), alveolar hemorrhage, post-radic changes, pulmonary edema, organizing pneumonia, or hypersensitivity pneumonitis. An RHS may also be observed in numerous conditions including granulomatosis with polyangiitis, organizing pneumonia (Georgiadou et al. ), alveolar hemorrhage, post-radic changes, pulmonary edema, organizing pneumonia, or hypersensitivity pneumonitis. An RHS may also be observed in numerous conditions including granulomatosis with polyangiitis, organizing pneumonia (Georgiadou et al. 2011), or pulmonary infarct (Fig. <xref rid="72913_2_En_8_Fig31_HTML" ref-type="fig">31</xref>).).Fig. 30Pulmonary hemorrhage in a 65-year-old woman known for an acute myeloid leukemia with thrombocytopenia appears as a perihilar ground-glass opacity predominantly located at the level of the lower lobes\nFig. 31Pulmonary infarct appears as a reverse halo sign in a 93-year-old patient with bilateral pulmonary emboli as nicely seen on axial CT section in lung (a) and mediastinal (b) windows\n'], '72913_2_En_8_Fig7_HTML': ['Bronchogenic distribution presents as nonhomogeneous centrilobular micronodules that spare the subpleural space with a location at least 3 mm from the pleura and that are associated with a tree-in-bud pattern, defined as centrilobular branching structures that resemble a budding tree (Hansell et al. 2008). This presentation may be seen in bacterial, fungal, viral, mycobacterial, or mycoplasma (Fig. <xref rid="72913_2_En_8_Fig7_HTML" ref-type="fig">7</xref>) infections. In postprimary (reactivation) tuberculosis, centrilobular micronodules and linear branching opacities have a dense attenuation and distinct margins. These features are readily associated with cavitation, predominantly localized in the apical and posterior segments of the superior lobes and the superior segment of the lower lobes in this setting (Fig. ) infections. In postprimary (reactivation) tuberculosis, centrilobular micronodules and linear branching opacities have a dense attenuation and distinct margins. These features are readily associated with cavitation, predominantly localized in the apical and posterior segments of the superior lobes and the superior segment of the lower lobes in this setting (Fig. <xref rid="72913_2_En_8_Fig32_HTML" ref-type="fig">32</xref>). ). Aspergillus bronchiolitis and/or bronchopneumonia must be considered in immunocompromised patients (Logan et al. 1994).Fig. 32Postprimary (reactivation) tuberculosis in a 37-year-old man, native of Cameroun, complaining about cough, weight loss, and night sweats for 3 months. Axial CT image at the level of the RUL (a) shows the typical hallmarks of reactivation TB including cavities, surrounded by thick and irregular borders, and dense centrilobular nodules with sharp margins predominantly located at the level of the apical and posterior segments of the upper lobes and the apical segment of the lower lobes. A 4 mm-thick MIP axial reformat at the level of the apical bronchus of the RLL (b) demonstrates typical centrilobular nodules with sparing of the subpleural space (3 mm) and lobular consolidation of the anterior segment of the RUL (arrows). Two consecutive coronal reformats 20 mm-thick AIP (c, e) and thin coronal slice at the level of the drainage bronchus of the largest cavity of the RUL (d) allow for a complete understanding of the appearance seen on chest X-ray (f)\n'], '72913_2_En_8_Fig8_HTML': ['A hematogenous miliary pattern in case of random distribution may suggest tuberculosis (Figs. <xref rid="72913_2_En_8_Fig8_HTML" ref-type="fig">8</xref> and and <xref rid="72913_2_En_8_Fig33_HTML" ref-type="fig">33</xref>), histoplasmosis, candidiasis, blastomycosis, or a viral cause (), histoplasmosis, candidiasis, blastomycosis, or a viral cause (CMV, herpes, varicella) (Fig. <xref rid="72913_2_En_8_Fig34_HTML" ref-type="fig">34</xref>), especially in immunocompromised patients.), especially in immunocompromised patients.Fig. 33Miliary tuberculosis with multisystemic involvement in an HIV-positive CDC stage three patient highly immunosuppressed with CD4 level at 64 c/mm3. Axial CT scan shows diffuse tiny micronodules with ground-glass opacity leading to alveolar consolidation at the level of the apical segment of the RLL. Such an involvement may result in a respiratory distress syndrome (ARDS)\nFig. 34A 50-year-old man developing a varicella without respiratory symptoms. Axial (a) and coronal (b) 10 mm-thick MIP images of a CT performed due to suspicion of pulmonary nodules on the chest X-ray show micronodules with random distribution that almost completely disappeared at the follow-up 3 months later (c, d)\n'], '72913_2_En_8_Fig35_HTML': ['Pulmonary nodules of infectious nature, sometimes cavitated, are most commonly seen in nosocomial pneumonia and in immunocompromised patients. They may be due to nocardiosis, tuberculosis, and angioinvasive aspergillosis (Althoff Souza et al. 2006) in neutropenic patients, Cryptococcus neoformans, Coccidioides immitis, Blastomyces sp., or atypical mycobacteriosis (Oh et al. 2000; Franquet et al. 2003). Less often, infections such as candidiasis (Fig. <xref rid="72913_2_En_8_Fig35_HTML" ref-type="fig">35</xref>), legionella, or Q fever may be considered if suggested by the individual setting. They must be differentiated from noninfectious causes including malignancy (Fig. ), legionella, or Q fever may be considered if suggested by the individual setting. They must be differentiated from noninfectious causes including malignancy (Fig. <xref rid="72913_2_En_8_Fig36_HTML" ref-type="fig">36</xref>).).Fig. 35Pulmonary and hepatosplenic candidiasis in a 62-year-old patient with an acute myeloid leukemia treated by chemotherapy. Axial CT image of 1 mm (a) and 15 mm-thick MIP (b) shows multiple nodules of various sizes with random distribution. The added value of MIP in the assessment of the detection and evaluation of profusion of nodules is undeniable\nFig. 36A 24-year-old woman is known for a recurrence of Hodgkin’s lymphoma appearing on the PET-CT (a, b) as multiple pulmonary nodules. A necrotic bronchopneumonia occurring 2 months later presents as bilateral alveolar consolidation superimposed on the preexisting nodules (c, d) that lead to a septic shock with death of the patient. This case reinforces the usefulness of evaluation of previous imaging features\n'], '72913_2_En_8_Fig37_HTML': ['Nodules with a peripheral ground-glass halo refer to the halo sign (HS), which is a CT finding of ground-glass opacity surrounding a nodule or a mass (Hansell et al. 2008). Although inconstant, with a reported incidence of ranging from 25 to 95\u2009% among neutropenic patients with hematological malignancies (Georgiadou et al. 2011), the HS strongly suggests an early invasive aspergillosis in patients with severe neutropenia (Fig. <xref rid="72913_2_En_8_Fig37_HTML" ref-type="fig">37</xref>), in association with wedge-shaped areas of subpleural consolidation. Furthermore, initiation of antifungal treatment on the basis of the identification of an HS by chest CT appears associated with a significantly better response to treatment and improved survival (Greene et al. ), in association with wedge-shaped areas of subpleural consolidation. Furthermore, initiation of antifungal treatment on the basis of the identification of an HS by chest CT appears associated with a significantly better response to treatment and improved survival (Greene et al. 2007). In invasive aspergillosis, these nodules typically become larger during neutrophil engraftment (Barnes and Marr 2007) and/or during the first 10 days of therapy (Caillot et al. 2001). Histopathologically, the HS represents a focus of pulmonary infarction surrounded by alveolar hemorrhage, secondary to invasion by Aspergillus of small and medium-sized pulmonary vessels causing thrombosis and subsequent ischemic necrosis of the lung parenchyma (Georgiadou et al. 2011). The same appearances have been reported in numerous infectious pulmonary diseases such as observed with Mucorales, Candida, herpes simplex virus, cytomegalovirus, varicella-zoster virus, mycobacterial infections, bacterial pneumonia, or septic emboli (Fig. <xref rid="72913_2_En_8_Fig38_HTML" ref-type="fig">38</xref>). The differential diagnoses of noninfectious nodules with an HS include granulomatosis with polyangiitis, cryptogenic organizing pneumonia, adenocarcinoma, angiosarcoma, Kaposi’s sarcoma in association with spiculated nodules, and hemorrhagic metastases (Georgiadou et al. ). The differential diagnoses of noninfectious nodules with an HS include granulomatosis with polyangiitis, cryptogenic organizing pneumonia, adenocarcinoma, angiosarcoma, Kaposi’s sarcoma in association with spiculated nodules, and hemorrhagic metastases (Georgiadou et al. 2011).Fig. 37Angioinvasive aspergillosis in a 27-year-old woman appears as nodules with peripheral ground-glass opacity at the apex of the LUL\nFig. 38Septic emboli in a 31-year-old female; HIV-negative drug abuser, known for chronic HCV and IV cocaine injections, presents with fever, shivering, and episodes of hemoptysis. Blood cultures were positive for Staphylococcus aureus with a 2 cm vegetation at the level of the tricuspid valve causing marked tricuspid insufficiency. Axial CT sections at baseline (a) and 8 days later (b), respectively, show multiple nodules with peripheral ground-glass opacity (a) that secondary cavitated. The latter is a usual finding with Staphylococcus aureus infection\n'], '72913_2_En_8_Fig38_HTML': ['\nCavitated nodules can be related to septic embolism. The primary source of infection is tricuspid endocarditis, especially in intravenous illicit drug use, peripheral thrombophlebitis, venous catheter, and pacemaker wires. The mechanism includes endothelial damage combined with the formation of crumbling thrombi containing infective agents. Turbulences caused by the circulating blood detach fragments of thrombus which then migrate to the peripheral pulmonary arteries with consecutive obstruction. Ischemia then results in infarction and/or hemorrhage and the organisms release toxins causing parenchymal necrosis (Muller 2003). Nodules related to septic emboli are mainly peripheral and basal with blurred margins. A simultaneous appearance of solid nodules and nodules with variable size cavitations (Fig. <xref rid="72913_2_En_8_Fig38_HTML" ref-type="fig">38</xref>) as well as subpleural wedge-shaped consolidation may be seen (Franquet ) as well as subpleural wedge-shaped consolidation may be seen (Franquet 2008). The nodules often appear to have a vessel leading into them on axial views – the so-called “feeding vessel” sign – corresponding to the pulmonary vein, whereas most arteries have a lateralized trajectory around the nodule (Dodd et al. 2006) (Fig. <xref rid="72913_2_En_8_Fig39_HTML" ref-type="fig">39</xref>).).Fig. 39Lemierre syndrome in a 21-year-old man suffering from a sore throat with jugular vein thrombosis well depicted by CT with contrast media injection (a) and septic embolism appearing as peripheral nodules of various sizes with wedge-shaped consolidation (arrows) and slight peripheral ground-glass opacity on axial CT image (b). The 8 mm-thick MIP image (c) shows the lateralized trajectory of the artery around the nodule\n'], '72913_2_En_8_Fig32_HTML': ['Necrotizing pneumonia or pulmonary gangrene presenting with hypoenhancing geographic areas of low lung attenuation and cavitation is frequently seen before frank abscess formation (Walker et al. 2014). They can be encountered in various situations such as acute CAP, pulmonary tuberculosis (Fig. <xref rid="72913_2_En_8_Fig32_HTML" ref-type="fig">32</xref>), atypical mycobacteria (Fig. ), atypical mycobacteria (Fig. <xref rid="72913_2_En_8_Fig40_HTML" ref-type="fig">40</xref>), anaerobic bacteria, and angioinvasive or chronic fungal infections. Unilateral or bilateral areas of consolidation, multiple expanding usually thick-walled cavities containing or not aspergillomas and concomitant pleural thickening, suggest chronic cavitary pulmonary aspergillosis. In young patients with no medical history, an infection caused by ), anaerobic bacteria, and angioinvasive or chronic fungal infections. Unilateral or bilateral areas of consolidation, multiple expanding usually thick-walled cavities containing or not aspergillomas and concomitant pleural thickening, suggest chronic cavitary pulmonary aspergillosis. In young patients with no medical history, an infection caused by S. aureus, Panton-Valentine leukodicin secretor, that can be severe and rapid in onset with a poor prognosis should routinely be investigated. Bilateral consolidations of the superior lobes followed by the development of coalescent lucencies are commonly seen. An air-crescent sign may also be present (see below).Fig. 40\nMycobacterium xenopi infection in a COPD patient. Chest X-ray (a), coronal reformat (b), and axial CT at the level of upper lobes (c) show an alveolar consolidation with cavities of various sizes that almost totally resolved on the follow-up CT performed 1 year later (d)\n'], '72913_2_En_8_Fig41_HTML': ['The air-crescent sign, defined as a collection of air in a crescentic shape that separates the wall of a cavity from an inner mass, firstly suggests an Aspergillus colonization of preexisting cavities, i.e., an aspergilloma (Fig. <xref rid="72913_2_En_8_Fig41_HTML" ref-type="fig">41</xref>). An aspergilloma may also be manifested as an irregular spongeworks or fungal strands forming a coarse and irregular network within a cavity. An air-crescent sign also suggests the retraction of a central necrotic mass after recovery of the bone marrow in a rather late stage of angioinvasive aspergillosis (De Marie ). An aspergilloma may also be manifested as an irregular spongeworks or fungal strands forming a coarse and irregular network within a cavity. An air-crescent sign also suggests the retraction of a central necrotic mass after recovery of the bone marrow in a rather late stage of angioinvasive aspergillosis (De Marie 2000) (Fig. <xref rid="72913_2_En_8_Fig42_HTML" ref-type="fig">42</xref>). It may also occur in mucormycosis (Fig. ). It may also occur in mucormycosis (Fig. <xref rid="72913_2_En_8_Fig43_HTML" ref-type="fig">43</xref>), tuberculosis, granulomatosis with polyangiitis, intracavitary hemorrhage, and cavitary lung cancer (Fig. ), tuberculosis, granulomatosis with polyangiitis, intracavitary hemorrhage, and cavitary lung cancer (Fig. <xref rid="72913_2_En_8_Fig44_HTML" ref-type="fig">44</xref>) (Hansell et al. ) (Hansell et al. 2008).Fig. 41Aspergilloma developing in a cavity in a 69-year-old man with a history of stage IV sarcoidosis who complained of hemoptysis. The treatment consisted of antifungal therapy and bronchial embolization followed by a left upper lobectomy. Axial CT section in lung window (a) at the level of the LUL shows the air-crescent sign. Axial CT section on bone window (b) at the same level demonstrates the calcified lymph nodes related to sarcoidosis and the slight calcifications within the aspergilloma. The coronal reformat (c) shows the typical dependent location of the aspergilloma within the cavity\nFig. 42Invasive aspergillosis in a 27-year-old woman with acute myeloid leukemia. Baseline CT (a) performed in a context of febrile agranulocytosis (a) with 5 mm-thick axial sections shows alveolar consolidation of the posterior segment of the upper part of the LUL with peripheral ground-glass opacity. Bronchiolo-alveolar nodules with ill borders are also seen in the RUL. On CT performed 3 weeks after (b), during bone marrow recovery, multiple nodules with air-crescent sign were seen, this finding suggesting a rather late stage of angioinvasive aspergillosis. Note the somewhat atypical presence of peripheral ground glass at this late stage of the disease\nFig. 43Necrotizing pneumonia in a context of mucormycosis (same patient as in Fig. <xref rid="72913_2_En_8_Fig13_HTML" ref-type="fig">13</xref>) presenting with hemoptysis 2 weeks after initial diagnosis despite adequate treatment. The retraction of the central necrotic mass of the LLL creates an air-crescent sign visible on mediastinal () presenting with hemoptysis 2 weeks after initial diagnosis despite adequate treatment. The retraction of the central necrotic mass of the LLL creates an air-crescent sign visible on mediastinal (a) and lung (b) windows. It had occurred at the same time as the pulmonary artery involvement\nFig. 44Air-crescent sign caused by an invasive epidermoid carcinoma stage IIIb treated by radiochemotherapy that progressively cavitated. Axial image at baseline CT (a), 3 weeks (b) and two consecutive axial CT images performed 3 months (c, d) after beginning of the treatment. The necrotic tumor appears progressively as a pseudo-aspergilloma with an air-crescent sign\n'], '72913_2_En_8_Fig10_HTML': ['Pneumatoceles manifest as single or multiple approximately round thin-walled and gas-filled spaces in the lung (Hansell et al. 2008) (Fig. <xref rid="72913_2_En_8_Fig10_HTML" ref-type="fig">10</xref>). These lucencies are associated with a recent infection and usually transient, progressively increasing in size over the following days and weeks and then resolving after weeks or months. They are most likely due to bronchial drainage of necrotic parenchymal tissue, followed by a check-valve airway obstruction. They usually occur in ). These lucencies are associated with a recent infection and usually transient, progressively increasing in size over the following days and weeks and then resolving after weeks or months. They are most likely due to bronchial drainage of necrotic parenchymal tissue, followed by a check-valve airway obstruction. They usually occur in P. jirovecii infections occurring in patients with acquired immune deficiency syndrome (AIDS) (Fig. <xref rid="72913_2_En_8_Fig26_HTML" ref-type="fig">26</xref>) or in case of previous ) or in case of previous S. aureus pneumonia, but they can also be seen with other infections including E. coli and S. pneumoniae (Beigelman-Aubry et al. 2012).', '\nEmpyema, which occurs in less than 5\u2009% of pulmonary infections, typically displays obtuse angles along its interface with adjacent pleura. It appears as a smooth and thin enhancement of the visceral and parietal pleura that surrounds the fluid collection and that is referred as the split pleura sign (Walker et al. 2014) (Figs. <xref rid="72913_2_En_8_Fig10_HTML" ref-type="fig">10</xref> and and <xref rid="72913_2_En_8_Fig11_HTML" ref-type="fig">11</xref>). It is commonly associated with a hyperattenuation of the extra-pleural fat. The pathogens traditionally involved in empyema are ). It is commonly associated with a hyperattenuation of the extra-pleural fat. The pathogens traditionally involved in empyema are S. pneumoniae, Streptococcus pyogenes, and S. aureus. The same findings may be seen in case of TB.'], '72913_2_En_8_Fig45_HTML': ['The most common mediastinal and hilar abnormality is lymphadenopathy (Fig. <xref rid="72913_2_En_8_Fig45_HTML" ref-type="fig">45</xref>). Right paratracheal, hilar, and subcarinal regions and/or hilar lymph node enlargement with associated homolateral small focal infiltrate or parenchymal consolidation, which is commonly sublobar and subpleural in location in the middle lobe, basal segments of lower lobes, and anterior segments of upper lobes, is the usual hallmark of primary TB (Beigelman et al. ). Right paratracheal, hilar, and subcarinal regions and/or hilar lymph node enlargement with associated homolateral small focal infiltrate or parenchymal consolidation, which is commonly sublobar and subpleural in location in the middle lobe, basal segments of lower lobes, and anterior segments of upper lobes, is the usual hallmark of primary TB (Beigelman et al. 2000). Necrotic components with peripheral rim enhancement (rim sign) mainly suggest tuberculosis, but they can also correspond to fungal infection, atypical mycobacteria, histoplasmosis, metastases (Fig. <xref rid="72913_2_En_8_Fig46_HTML" ref-type="fig">46</xref>) from head/neck and testicular malignancy, and lymphoma (Bhalla et al. ) from head/neck and testicular malignancy, and lymphoma (Bhalla et al. 2015). Bronchonodal fistula can be observed as a complication of active pulmonary TB with TB lymphadenitis especially in the elderly. The fistulas usually involve the right lobar bronchus and the main bronchus on the left side (Park et al. 2015).Fig. 45Tuberculosis in a patient with a history of ulcerous colitis under anti-TNF treatment and lung graft for panlobular emphysema related to α1-antitrypsin deficiency. Axial sections in mediastinal (a) and lung (b) windows show an enlarged right paratracheal lymph node associated with a homolateral alveolar consolidation of the RLL, hallmarks of primary TB. Note the peripheral centrilobular nodules (arrows)\nFig. 46Right paratracheal lymph node metastasis with necrosis and parietal enhancement in a patient treated by chemotherapy and immunotherapy in a context of a poorly differentiated carcinoma with hepatic and bone metastases\n'], '72913_2_En_8_Fig47_HTML': ['In case of a circumferential thickening of the trachea or main bronchi occurring in the same context, the possibility of invasive aspergillosis of the respiratory tract should always be considered (Fig. <xref rid="72913_2_En_8_Fig47_HTML" ref-type="fig">47</xref>) with the specific risk of tracheal rupture. Acute tuberculous tracheobronchial involvement may also be seen with circumferential narrowing associated with smooth or irregular wall thickening (Bhalla et al. ) with the specific risk of tracheal rupture. Acute tuberculous tracheobronchial involvement may also be seen with circumferential narrowing associated with smooth or irregular wall thickening (Bhalla et al. 2015). Sequelar fibrotic bronchostenosis predominating on the left main bronchus and post-obstructive bronchiectasis may occur in this setting (Bhalla et al. 2015).Fig. 47Airway aspergillosis in a 74-year-old woman with lymphoma of the marginal zone complaining of cough and fever. A circumferential peribronchial thickening around the mainstem left bronchus is seen on the axial CT image with mediastinal window (a). Two weeks later, a worsening of the stenosis with a wall fistula is observed on the axial image with the lung window (b). Note the presence of a bilateral pleural effusion\n'], '72913_2_En_8_Fig12_HTML': ['\nMycotic aneurysms of pulmonary vessels may be observed in case of hemoptysis and a context of invasive fungal infections (Georgiadou et al. 2011) or tuberculosis (Fig. <xref rid="72913_2_En_8_Fig12_HTML" ref-type="fig">12</xref>).).'], '72913_2_En_8_Fig48_HTML': ['Fibro-parenchymal lesions with bronchovascular distortion and bronchiectasis, thin-walled cavities, emphysema, and fibro-atelectatic bands firstly suggest prior tuberculosis with scarring (Fig. <xref rid="72913_2_En_8_Fig48_HTML" ref-type="fig">48</xref>). Calcified mediastinal/hilar lymph nodes (Fig. ). Calcified mediastinal/hilar lymph nodes (Fig. <xref rid="72913_2_En_8_Fig49_HTML" ref-type="fig">49</xref>), well-defined nodules, and pleural thickening with or without calcification (Fig. ), well-defined nodules, and pleural thickening with or without calcification (Fig. <xref rid="72913_2_En_8_Fig50_HTML" ref-type="fig">50</xref>) are also common imaging features of healed TB. Tuberculomas and small calcified lung nodules suggest likewise prior TB infection (Bhalla et al. ) are also common imaging features of healed TB. Tuberculomas and small calcified lung nodules suggest likewise prior TB infection (Bhalla et al. 2015). Calcified nodules may also be seen as sequelae of histoplasmosis or varicella infection (Chou et al. 2015) but also in other conditions like amyloidosis or metastasis, in particular from osteogenic sarcoma or medullary carcinoma of the thyroid.Fig. 48Sequelae of TB in a 35-year-old woman originating from Cameroun. Axial section in parenchymal (a) and mediastinal windows (b) at the level of the upper lobes showing cicatricial collapsus of the upper part of LUL well delineated by a small accessory fissure (arrows) with bronchovascular distortion, bronchiectasis, thin-walled cavities, and calcified nodules. The 3 mm-thick mIP oblique reformat (c) allows for an overall assessment of the bronchiectasis. The coronal 150 mm-thick AIP reformat (d) shows the upper retraction of the left hilum\nFig. 49Ranke complex related to scars from a previous primary TB. Axial section with the bone window at the level of the right hilum (a) and of the RLL (b) show a calcified hilar node and a calcified parenchymal nodule, respectively\nFig. 50A 77-year-old man with a calcified fibrothorax as a sequelae of a previous TB. Axial section in mediastinal (a) and lung (b) windows show a pleural calcification with parenchymatous bands converging toward the latter and related to fibrosis of the visceral pleura. A 70 mm-thick MIP coronal reformat in bone window (c) shows the upper predominance of this fibrothorax. A 180 mm-thick AIP reformat (d) reproducing the chest X-ray appearance shows the retraction of the left hemithorax and the blunting of the costophrenic angle, a classical finding in this setting\n']} | Pulmonary Infections: Imaging with CT | [
"Pulmonary Infections-CT"
] | Multidetector-Row CT of the Thorax | 1456560000 | None | null | other | PMC7120395 | null | null | [
""
] | Multidetector-Row CT of the Thorax. 2016 Feb 27;:131-161 | NO-CC CODE |
|
16 mm-thick axial MIP image in a 58-year-old patient with Crohn disease under infliximab treatment. Although invisible on 1.25 mm-thick axial image (a), the MIP reformatted image (b) permits to detect micronodules with random distribution that were related to a miliary tuberculosis | 72913_2_En_8_Fig6_HTML | 7 | 52fcc308463b1224e1c9af1f22de0f0dfdc6adf7e9000ba739627a773550bbcf | 72913_2_En_8_Fig6_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
502,
165
] | [{'image_id': '72913_2_En_8_Fig25_HTML', 'image_file_name': '72913_2_En_8_Fig25_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig25_HTML.jpg', 'caption': 'P. jirovecii pneumonia in an AIDS patient appearing as ground-glass opacity sparing the pulmonary cortex and typically predominantly located at the upper region of the lungs', 'hash': '0b3109b50da7baf1b27933f8af6e656f0c228c0ca03f9cc7b2796900285bf5ca'}, {'image_id': '72913_2_En_8_Fig5_HTML', 'image_file_name': '72913_2_En_8_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig5_HTML.jpg', 'caption': 'A 60-year-old man suffering from bronchiectasis of unknown cause presented with fever and new respiratory symptoms related to an abscess due to a usually nosocomial germ, Serratia marcescens and Cronobacter, a gram-negative bacteria of the Enterobacteriaceae family. Chest X-ray (a) and axial CT section with IV contrast in mediastinal (b) and lung (c) windows show the abscess of the LUL with thick walls, a necrotic component and an air-fluid level. The coronal 1.5 mm (d), 30 mm (e), and 150 mm (f) thick AIP reformatted images allow for a better understanding of the opacities related to a bronchocele at the level of the RUL and the abscess situated close to a bronchiectatic area of the LUL', 'hash': 'f2db0b936dd2364f1dd0a634c0ea599c3d0b0d86365720c2574d1a2a79a143ab'}, {'image_id': '72913_2_En_8_Fig35_HTML', 'image_file_name': '72913_2_En_8_Fig35_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig35_HTML.jpg', 'caption': 'Pulmonary and hepatosplenic candidiasis in a 62-year-old patient with an acute myeloid leukemia treated by chemotherapy. Axial CT image of 1 mm (a) and 15 mm-thick MIP (b) shows multiple nodules of various sizes with random distribution. The added value of MIP in the assessment of the detection and evaluation of profusion of nodules is undeniable', 'hash': '36dc2d8169da876182bd6d2b0321e912211fecece9f6ee356862c5013006e719'}, {'image_id': '72913_2_En_8_Fig15_HTML', 'image_file_name': '72913_2_En_8_Fig15_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig15_HTML.jpg', 'caption': 'Lobar pneumonia of the RUL related to Streptococcus pneumococcus in a 25-year-old smoker. Scout view (a) and axial CT image (b) show an alveolar consolidation with an air bronchogram. The 10 mm-thick mIP (c) permits to display the entire length of the bronchi from their origin within the alveolar consolidation. Although CT does not replace fiber-optic bronchoscopy, no obstructive lesion was detected by using CT', 'hash': 'd9a65d73cc20b40666b91931a98d2de22d9b2b7c33632a4acf7e20f7589daa99'}, {'image_id': '72913_2_En_8_Fig42_HTML', 'image_file_name': '72913_2_En_8_Fig42_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig42_HTML.jpg', 'caption': 'Invasive aspergillosis in a 27-year-old woman with acute myeloid leukemia. Baseline CT (a) performed in a context of febrile agranulocytosis (a) with 5 mm-thick axial sections shows alveolar consolidation of the posterior segment of the upper part of the LUL with peripheral ground-glass opacity. Bronchiolo-alveolar nodules with ill borders are also seen in the RUL. On CT performed 3 weeks after (b), during bone marrow recovery, multiple nodules with air-crescent sign were seen, this finding suggesting a rather late stage of angioinvasive aspergillosis. Note the somewhat atypical presence of peripheral ground glass at this late stage of the disease', 'hash': '39868c2e9a9033422e83930de3b7db54ea4c8b53a2b0f49b1fbcb9a9cabdae4d'}, {'image_id': '72913_2_En_8_Fig32_HTML', 'image_file_name': '72913_2_En_8_Fig32_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig32_HTML.jpg', 'caption': 'Postprimary (reactivation) tuberculosis in a 37-year-old man, native of Cameroun, complaining about cough, weight loss, and night sweats for 3 months. Axial CT image at the level of the RUL (a) shows the typical hallmarks of reactivation TB including cavities, surrounded by thick and irregular borders, and dense centrilobular nodules with sharp margins predominantly located at the level of the apical and posterior segments of the upper lobes and the apical segment of the lower lobes. A 4 mm-thick MIP axial reformat at the level of the apical bronchus of the RLL (b) demonstrates typical centrilobular nodules with sparing of the subpleural space (3 mm) and lobular consolidation of the anterior segment of the RUL (arrows). Two consecutive coronal reformats 20 mm-thick AIP (c, e) and thin coronal slice at the level of the drainage bronchus of the largest cavity of the RUL (d) allow for a complete understanding of the appearance seen on chest X-ray (f)', 'hash': '6ae671f6fe2764d601a538d3253cab9707766560cb09c3b21a8ef4951c2080c2'}, {'image_id': '72913_2_En_8_Fig2_HTML', 'image_file_name': '72913_2_En_8_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig2_HTML.jpg', 'caption': 'Low-dose CT was performed for the follow-up of an angioinvasive aspergillosis in a 38-year-old woman with acute myeloid leukemia. The baseline CT (a) was performed with a CTDI of 5 and a DLP at 147 mGy.cm and the follow-up CT (b) with a CTDI of 2 and a DLP of 72 mGy.cm by using filter back projection reconstruction (FBP) with a soft kernel, without iterative reconstruction (IR) algorithm. Although a relative lesser image quality than the reference image, the disease’s evolution may be perfectly assessed at less than half of the initial dose', 'hash': '088a9850a1afe871f54c427b086d72228f405f6ff8a9243679d12213dc4bcb11'}, {'image_id': '72913_2_En_8_Fig22_HTML', 'image_file_name': '72913_2_En_8_Fig22_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig22_HTML.jpg', 'caption': 'CMV infection in a patient with renal graft appears as a bronchopneumonia pattern on two successive axial sections (a, b). The bronchial thickening in (a) is associated with bilateral segmental alveolar consolidations at the lung bases in (b)', 'hash': '3f73a0df56c7526537a586083ac2985722b869d6e4d50b6aa89ed2c0a9ac2d4c'}, {'image_id': '72913_2_En_8_Fig12_HTML', 'image_file_name': '72913_2_En_8_Fig12_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig12_HTML.jpg', 'caption': 'Rasmussen aneurysm in a 35-year-old patient presenting hemoptysis 9 days after the initial diagnosis of TB. Axial CT without (a) and with IV contrast media injection (b) focused at the level of the RUL shows a vascular enhancement within the tuberculoma that was clearly differentiated from the calcification depicted without contrast. The selective angiogram of the right bronchial artery (c) shows the aneurysm that was immediately successfully embolized', 'hash': '7ac36fd4ac97649070420bbc260e35c4502d8758cb11f5b96c1882131b57ee96'}, {'image_id': '72913_2_En_8_Fig45_HTML', 'image_file_name': '72913_2_En_8_Fig45_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig45_HTML.jpg', 'caption': 'Tuberculosis in a patient with a history of ulcerous colitis under anti-TNF treatment and lung graft for panlobular emphysema related to α1-antitrypsin deficiency. Axial sections in mediastinal (a) and lung (b) windows show an enlarged right paratracheal lymph node associated with a homolateral alveolar consolidation of the RLL, hallmarks of primary TB. Note the peripheral centrilobular nodules (arrows)', 'hash': '8d5d68a466f22fe112cfb57dcaa68d5dab14856dddd81aeefd549b5eff609a54'}, {'image_id': '72913_2_En_8_Fig14_HTML', 'image_file_name': '72913_2_En_8_Fig14_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig14_HTML.jpg', 'caption': 'Segmental pneumonia of the lingula in an 82-year-old woman. Axial CT scan focused at the level of the lower part of the LUL (a) and sagittal reformat (b) show an alveolar consolidation with a well-defined air bronchogram anterior to the great fissure', 'hash': 'ab37422e5c9721f5e9a37e47da5f68b33dd3a7b2799b871564f413d8cdba6524'}, {'image_id': '72913_2_En_8_Fig43_HTML', 'image_file_name': '72913_2_En_8_Fig43_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig43_HTML.jpg', 'caption': 'Necrotizing pneumonia in a context of mucormycosis (same patient as in Fig. 13) presenting with hemoptysis 2 weeks after initial diagnosis despite adequate treatment. The retraction of the central necrotic mass of the LLL creates an air-crescent sign visible on mediastinal (a) and lung (b) windows. It had occurred at the same time as the pulmonary artery involvement', 'hash': 'ab3d625900654b0aa8144b5dceb681ac453f770e9a3b12cec451b07ef6fbf520'}, {'image_id': '72913_2_En_8_Fig24_HTML', 'image_file_name': '72913_2_En_8_Fig24_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig24_HTML.jpg', 'caption': 'Diffuse alveolar consolidation with air bronchogram and ground-glass opacity in a patient with autoimmune hepatitis treated with long-term steroids presenting with dyspnea and severe hypoxemia. This was related to a Pneumocystis jirovecii pneumonia. Note the pneumomediastinum in this mechanically ventilated patient staying in the intensive care unit who died from this severe infection with rapid deterioration', 'hash': '31a98b6bc04605adfb27bc70f8498f238350eed9b0bda037c9966913a8ac17c4'}, {'image_id': '72913_2_En_8_Fig34_HTML', 'image_file_name': '72913_2_En_8_Fig34_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig34_HTML.jpg', 'caption': 'A 50-year-old man developing a varicella without respiratory symptoms. Axial (a) and coronal (b) 10 mm-thick MIP images of a CT performed due to suspicion of pulmonary nodules on the chest X-ray show micronodules with random distribution that almost completely disappeared at the follow-up 3 months later (c, d)', 'hash': '578c3e20c6b39bf61a39f7f130288a1a7acdef7e2e3c94d0212a31e159872115'}, {'image_id': '72913_2_En_8_Fig4_HTML', 'image_file_name': '72913_2_En_8_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig4_HTML.jpg', 'caption': 'Coronal reformatted images with progressive thickening of the slabs from 1 (a) to 30 (b) to 150 mm (c) thick slabs by using the average intensity projection (AIP) post-processing tool in a patient known for a voluminous bullae of the right apex of the lung with superimposed infectious alveolar consolidation. Note that the bullae is not easily seen on the chest X-ray rendering in (c), as it was the case with the conventional chest X-ray (not shown). The same limitation also occurs in case of cavitation that may be missed on conventional chest X-ray', 'hash': '9afefd867fe7bd5207197d82a8d2468d0a0f51c1ad01ec4fb67fe2210662b644'}, {'image_id': '72913_2_En_8_Fig13_HTML', 'image_file_name': '72913_2_En_8_Fig13_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig13_HTML.jpg', 'caption': 'Hemoptysis in the context of a mucormycosis in a 26-year-old woman suffering from acute lymphoblastic leukemia under antifungal prophylaxis. CT angiography in axial (a) and coronal oblique reformat (b) shows the vessel involvement originating from the necrotic parenchymal mass of the left lower lobe. This was confirmed after LLL lobectomy', 'hash': '3f74442af72ebd9de2bd27be821e58decefbf980ffcb11b56f89bc685b42ea69'}, {'image_id': '72913_2_En_8_Fig44_HTML', 'image_file_name': '72913_2_En_8_Fig44_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig44_HTML.jpg', 'caption': 'Air-crescent sign caused by an invasive epidermoid carcinoma stage IIIb treated by radiochemotherapy that progressively cavitated. Axial image at baseline CT (a), 3 weeks (b) and two consecutive axial CT images performed 3 months (c, d) after beginning of the treatment. The necrotic tumor appears progressively as a pseudo-aspergilloma with an air-crescent sign', 'hash': '657e9dd7d5b27d9a80fe7ec366eb37b783707829b26abe28723e84bd0ac72052'}, {'image_id': '72913_2_En_8_Fig3_HTML', 'image_file_name': '72913_2_En_8_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig3_HTML.jpg', 'caption': 'Ultralow dose CT performed at 100 kV and 10 mAs corresponding to a CTDIvol of 0.4 mGy reconstructed with FBP and a lung kernel. Native thin axial section (a) and 10 mm-thick maximum intensity projection reformat (b) exhibit noise well seen outside of the chest wall. Such noise projected on the lung mimics micronodulation with random distribution that may simulate a miliary disease in a context of a febrile immunocompromised patient. Although IR is the method of reconstruction of choice with low-dose CT and available in most institutions today, such potential pitfalls with FBP and lung kernel must be known when IR is not available. This precludes the use of such doses in this setting', 'hash': '7c356f929909fcd9d00438ebef244d9903df5a5074e65b5edfdeea5ffdb552af'}, {'image_id': '72913_2_En_8_Fig33_HTML', 'image_file_name': '72913_2_En_8_Fig33_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig33_HTML.jpg', 'caption': 'Miliary tuberculosis with multisystemic involvement in an HIV-positive CDC stage three patient highly immunosuppressed with CD4 level at 64 c/mm3. Axial CT scan shows diffuse tiny micronodules with ground-glass opacity leading to alveolar consolidation at the level of the apical segment of the RLL. Such an involvement may result in a respiratory distress syndrome (ARDS)', 'hash': '8d405301fee045d6d57112608dd21af7b690767000013e481c5f8af4f8e0a9d6'}, {'image_id': '72913_2_En_8_Fig23_HTML', 'image_file_name': '72913_2_En_8_Fig23_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig23_HTML.jpg', 'caption': 'Invasive airway aspergillosis. Three axial CT images show peribronchial ground-glass attenuation at the level of the RUL (blue arrows) with slight bronchial wall thickening and ill-defined nodules (a) and alveolar consolidation (orange arrows) in a peribronchial location at the level of the posterobasal bronchus of the RLL (b) and a segmental distribution in the LLL (c). This presentation of aspergillosis mainly concerns non-acute leukemia patients with a leukocyte count >100/mm3', 'hash': 'cca09ceda7822e841855ea80772e8403e942a15241d3f5c51e1d9197a68bfe6e'}, {'image_id': '72913_2_En_8_Fig30_HTML', 'image_file_name': '72913_2_En_8_Fig30_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig30_HTML.jpg', 'caption': 'Pulmonary hemorrhage in a 65-year-old woman known for an acute myeloid leukemia with thrombocytopenia appears as a perihilar ground-glass opacity predominantly located at the level of the lower lobes', 'hash': 'b56c70ff042200b039fc92e7f418db7525a5714a2b3b26d0a404040ba1d1999d'}, {'image_id': '72913_2_En_8_Fig20_HTML', 'image_file_name': '72913_2_En_8_Fig20_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig20_HTML.jpg', 'caption': 'Two consecutive coronal reformats in a 67-year-old man suffering from a bronchopneumonia show airspace nodules smaller than 1 cm with perinodular ground-glass opacity and patchy alveolar consolidation (arrows) (a) as well as peribronchiolar consolidation (b)', 'hash': '94ba4754a061d6a78691c520c760ea675037ad42aa89ece89dda6f19cbd0d497'}, {'image_id': '72913_2_En_8_Fig47_HTML', 'image_file_name': '72913_2_En_8_Fig47_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig47_HTML.jpg', 'caption': 'Airway aspergillosis in a 74-year-old woman with lymphoma of the marginal zone complaining of cough and fever. A circumferential peribronchial thickening around the mainstem left bronchus is seen on the axial CT image with mediastinal window (a). Two weeks later, a worsening of the stenosis with a wall fistula is observed on the axial image with the lung window (b). Note the presence of a bilateral pleural effusion', 'hash': 'f84293e17050c668dcc823b4f291ab239ac2b7542e2d18512d28bcdf4d49c496'}, {'image_id': '72913_2_En_8_Fig48_HTML', 'image_file_name': '72913_2_En_8_Fig48_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig48_HTML.jpg', 'caption': 'Sequelae of TB in a 35-year-old woman originating from Cameroun. Axial section in parenchymal (a) and mediastinal windows (b) at the level of the upper lobes showing cicatricial collapsus of the upper part of LUL well delineated by a small accessory fissure (arrows) with bronchovascular distortion, bronchiectasis, thin-walled cavities, and calcified nodules. The 3 mm-thick mIP oblique reformat (c) allows for an overall assessment of the bronchiectasis. The coronal 150 mm-thick AIP reformat (d) shows the upper retraction of the left hilum', 'hash': '66a4c29ee0ced7df9ce765387d1aea23cbc22870c58d434444703ce4f66efcd0'}, {'image_id': '72913_2_En_8_Fig10_HTML', 'image_file_name': '72913_2_En_8_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig10_HTML.jpg', 'caption': 'Empyema with right pulmonary abscesses in a context of bronchoaspiration pneumonia due to Streptococcus milleri and Fusobacterium necrophorum in a 47-year-old patient known for previous drug abuse that was found unconscious at home. In addition to antibiotherapy, a thoracoscopy was performed with drainage of the empyema. The reference chest X-ray (a) shows a pleural effusion. The axial CT with IV contrast media administration in mediastinal (b) and lung (c) window at the level of the apical segment of the RUL performed at the same day confirms the pleural effusion with thin enhancement of the parietal pleura suggesting empyema with associated alveolar consolidation. An axial section in lung window at the level of the right upper lobe bronchus (d) of the reference CT and also a follow-up CT performed 3 days later (e) demonstrate the cavitation of a pulmonary abscess of the anterior segment of the RUL that appears solid in (d). An axial image at the level of the middle lobe (f) shows additional cavities and another solid nodule related to multiple abscesses', 'hash': '150eae54ee195bd36ae884ea555cb661b558015cbd01da0a4fb426c0dbfff452'}, {'image_id': '72913_2_En_8_Fig28_HTML', 'image_file_name': '72913_2_En_8_Fig28_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig28_HTML.jpg', 'caption': 'Bilateral ground-glass opacity at the level of the upper lobes are related to a Coronavirus infection in a 72-year-old man known for a small cell carcinoma treated by radiochemotherapy', 'hash': '437bef7b61d1670875e8f7514c6ef998e173320d36a60029e94f68f6208744ed'}, {'image_id': '72913_2_En_8_Fig27_HTML', 'image_file_name': '72913_2_En_8_Fig27_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig27_HTML.jpg', 'caption': 'PCP pneumonia in an HIV-negative patient with a history of cerebral glioblastoma treated by surgery and radiochemotherapy. Axial CT shows ground-glass opacity predominating on the left side without sparing of the pulmonary cortex. The rounded hypoattenuated areas mostly correspond to centrilobular emphysema and not cysts that are rare in this condition', 'hash': 'ef9be4f902feb9b3fbc987f189d7acf71fd7906e671187715b77b7b9570dd39c'}, {'image_id': '72913_2_En_8_Fig37_HTML', 'image_file_name': '72913_2_En_8_Fig37_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig37_HTML.jpg', 'caption': 'Angioinvasive aspergillosis in a 27-year-old woman appears as nodules with peripheral ground-glass opacity at the apex of the LUL', 'hash': '602623cd88c664cdc6868ec07afd68d8f44a31d29a9303d988a7badf842bc6a8'}, {'image_id': '72913_2_En_8_Fig7_HTML', 'image_file_name': '72913_2_En_8_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig7_HTML.jpg', 'caption': 'Chest CT of a 36-year-old patient with ankylosing spondylarthritis treated by using anti-TNF alpha. Although numerous micronodules are visible on the thin axial section (a), their profusion and centrilobular distribution with tree in bud appearance related to Mycoplasma pneumoniae is more obvious when using 10 mm-thick MIP reformat (b). Note the sparing of the subpleural area typical of centrilobular distribution', 'hash': '20ba3a02aeca192364345c8eadb52ad54545e6052d3bca9a64ed6ffb1b533fbd'}, {'image_id': '72913_2_En_8_Fig38_HTML', 'image_file_name': '72913_2_En_8_Fig38_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig38_HTML.jpg', 'caption': 'Septic emboli in a 31-year-old female; HIV-negative drug abuser, known for chronic HCV and IV cocaine injections, presents with fever, shivering, and episodes of hemoptysis. Blood cultures were positive for Staphylococcus aureus with a 2 cm vegetation at the level of the tricuspid valve causing marked tricuspid insufficiency. Axial CT sections at baseline (a) and 8 days later (b), respectively, show multiple nodules with peripheral ground-glass opacity (a) that secondary cavitated. The latter is a usual finding with Staphylococcus aureus infection', 'hash': 'da3c597ff0a67c216a555c2b5fd1a573298d2131f0210af7ac23325a94be4437'}, {'image_id': '72913_2_En_8_Fig8_HTML', 'image_file_name': '72913_2_En_8_Fig8_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig8_HTML.jpg', 'caption': 'Chest CT of a patient suffering from a Good’s syndrome (thymoma with immunodeficiency) and miliary tuberculosis (TB). The thin coronal reformatted image (a) shows an apparent limited number of nodules, unlike the 10 mm-thick MIP reformat (b) that shows obvious micronodules with random distribution that were related to a hematogenous spread of TB', 'hash': 'de2c671b80c4adc0029aa8f8efea0eeb9ad02ef18056050f5a4b0b844b856f42'}, {'image_id': '72913_2_En_8_Fig50_HTML', 'image_file_name': '72913_2_En_8_Fig50_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig50_HTML.jpg', 'caption': 'A 77-year-old man with a calcified fibrothorax as a sequelae of a previous TB. Axial section in mediastinal (a) and lung (b) windows show a pleural calcification with parenchymatous bands converging toward the latter and related to fibrosis of the visceral pleura. A 70 mm-thick MIP coronal reformat in bone window (c) shows the upper predominance of this fibrothorax. A 180 mm-thick AIP reformat (d) reproducing the chest X-ray appearance shows the retraction of the left hemithorax and the blunting of the costophrenic angle, a classical finding in this setting', 'hash': '5cf71514c78e1db685d8972f4187284eed26bb2879f03945955a1b5e021729a3'}, {'image_id': '72913_2_En_8_Fig40_HTML', 'image_file_name': '72913_2_En_8_Fig40_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig40_HTML.jpg', 'caption': 'Mycobacterium xenopi infection in a COPD patient. Chest X-ray (a), coronal reformat (b), and axial CT at the level of upper lobes (c) show an alveolar consolidation with cavities of various sizes that almost totally resolved on the follow-up CT performed 1 year later (d)', 'hash': '989887803884f51ae2dadb9f1c44998ee7c9d8c4ee0d964a028d70014436085d'}, {'image_id': '72913_2_En_8_Fig18_HTML', 'image_file_name': '72913_2_En_8_Fig18_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig18_HTML.jpg', 'caption': 'Alveolar consolidation of the middle lobe related to an adenocarcinoma. The stretched appearance of the bronchi may suggest the diagnosis (Courtesy Pr Brillet, Bobigny, France)', 'hash': '36746ba212aa5e2fead48480244f222054bb08c4d0b815c6c7ba45a89a03ef55'}, {'image_id': '72913_2_En_8_Fig17_HTML', 'image_file_name': '72913_2_En_8_Fig17_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig17_HTML.jpg', 'caption': 'Acute fibrinous organizing pneumonia (AFOP) in a 52-year-old patient suffering from plasmacytoid dendritic cells acute leukemia with febrile agranulocytosis. The noninfectious nature of the alveolar consolidation with peripheral ground-glass attenuation of the LUL was proven by a transbronchial biopsy performed under endobronchial ultrasonography (EBUS)', 'hash': 'cf8edab1c1830d5cc88ea7bfad80442e411766a90fe1d064799ac795ec3a4e73'}, {'image_id': '72913_2_En_8_Fig49_HTML', 'image_file_name': '72913_2_En_8_Fig49_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig49_HTML.jpg', 'caption': 'Ranke complex related to scars from a previous primary TB. Axial section with the bone window at the level of the right hilum (a) and of the RLL (b) show a calcified hilar node and a calcified parenchymal nodule, respectively', 'hash': '52d7344a3a661eedf69a795199ea976f0567491ee0680124dcc7958b14989ff2'}, {'image_id': '72913_2_En_8_Fig46_HTML', 'image_file_name': '72913_2_En_8_Fig46_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig46_HTML.jpg', 'caption': 'Right paratracheal lymph node metastasis with necrosis and parietal enhancement in a patient treated by chemotherapy and immunotherapy in a context of a poorly differentiated carcinoma with hepatic and bone metastases', 'hash': '7ab0f04dfa8b50a4e09b3fffc3948af8875b725d58e09beddb00517f3c9ae5c7'}, {'image_id': '72913_2_En_8_Fig11_HTML', 'image_file_name': '72913_2_En_8_Fig11_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig11_HTML.jpg', 'caption': 'A 46-year-old male drug abuser known for COPD presents with fever after bullectomy and pleurodesis performed for a spontaneous pneumothorax. Chest X-ray (a) and axial chest CT after IV contrast media injection in mediastinal (b) and lung (c) windows with sagittal reformat (d) allow for an easy differentiation between the parenchymal involvement with necrosis on an underlying bullous emphysema from empyema. The thickening of the pleura that is suggestive of empyema (orange and blue arrows) appears laterally as a continuous line internal to the ribs (orange arrows)', 'hash': '7bfe95cb3c9c08769e278a3774eed56b47c67002e3458bd57ef5bca1df24838f'}, {'image_id': '72913_2_En_8_Fig31_HTML', 'image_file_name': '72913_2_En_8_Fig31_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig31_HTML.jpg', 'caption': 'Pulmonary infarct appears as a reverse halo sign in a 93-year-old patient with bilateral pulmonary emboli as nicely seen on axial CT section in lung (a) and mediastinal (b) windows', 'hash': 'd1a56b3a6bdec3fdc455f7460b5dedccbcf3ea7fb071d12c18b6f5ae65176a3d'}, {'image_id': '72913_2_En_8_Fig1_HTML', 'image_file_name': '72913_2_En_8_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig1_HTML.jpg', 'caption': 'Ultralow dose CT was performed because of the appearance of a cavity with an air-fluid level in the left axillary area on chest X-ray (a) in a 20-year-old female patient with cystic fibrosis and persistent symptoms due to Staphylococcus aureus and Cepacia infection despite antibiotic treatment. Axial sections reconstructed by using iterative reconstruction (IR) algorithm (b) and FBP with soft kernel and a slice thickness of 4 mm (c). Coronal reformatted image reconstructed by using IR (d, f) and filtered back projection (FBP) with soft kernel (e.g). The drainage bronchus of the abscess cavity (d, e) is clearly differentiated from the varicose bronchiectasis that are well assessed with a 3 mm-thick minimum intensity projection (mIP) reformat (f, g). Despite a slight distortion of the details seen on the axial image when using IR (b) compared with FBP (c), a substantial reduction of the noise is observed with IR (d, f)', 'hash': 'b4bdbc8ab2770db4b79de28ccd91a1504ce4bdc47225254448d7443390f6f03a'}, {'image_id': '72913_2_En_8_Fig21_HTML', 'image_file_name': '72913_2_En_8_Fig21_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig21_HTML.jpg', 'caption': 'Bronchopneumonia pattern appears on this axial section at the level of the upper lobes as bronchial wall thickening, centrilobular nodules with tree-in-bud sign (blue arrow), lobular (orange arrow), and segmental alveolar consolidation with multifocal and patchy involvement', 'hash': 'da2fdf5cc57671c5129b281fc62ec21162a30f6a7ee6f1db60de4431ee68bd25'}, {'image_id': '72913_2_En_8_Fig41_HTML', 'image_file_name': '72913_2_En_8_Fig41_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig41_HTML.jpg', 'caption': 'Aspergilloma developing in a cavity in a 69-year-old man with a history of stage IV sarcoidosis who complained of hemoptysis. The treatment consisted of antifungal therapy and bronchial embolization followed by a left upper lobectomy. Axial CT section in lung window (a) at the level of the LUL shows the air-crescent sign. Axial CT section on bone window (b) at the same level demonstrates the calcified lymph nodes related to sarcoidosis and the slight calcifications within the aspergilloma. The coronal reformat (c) shows the typical dependent location of the aspergilloma within the cavity', 'hash': '39ebb704d6bd378dffca45e8c73b2cecb927298726194e66f7e7768936098464'}, {'image_id': '72913_2_En_8_Fig16_HTML', 'image_file_name': '72913_2_En_8_Fig16_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig16_HTML.jpg', 'caption': 'Round pneumonia occurs in a 44-year-old man suddenly presenting with fever and chest pain and addressed to the emergency department. The chest X-ray (a) shows a right parahilar pseudo-tumoral opacity. Due to this atypical aspect, chest CT was performed on the same day. Axial CT image (b) and sagittal reformat (c) demonstrate a rounded alveolar consolidation of the posterior segment of the RUL and the apical segment of the RLL. Note the ground-glass opacity located around the alveolar consolidation reflecting the partial filling of the alveoli', 'hash': '601a8e6c25f1db9cdf4c98ff011d7b43229ba6b002fb7ed5d90d46c746b90272'}, {'image_id': '72913_2_En_8_Fig19_HTML', 'image_file_name': '72913_2_En_8_Fig19_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig19_HTML.jpg', 'caption': 'Infectious bronchiolitis appears as thickening of the bronchial walls and centrilobular nodules with tree-in-bud sign', 'hash': '2100d648fe7b0c6e07a80e8839dd22da8865329f4b2a92c6c02bb8a41857dc91'}, {'image_id': '72913_2_En_8_Fig26_HTML', 'image_file_name': '72913_2_En_8_Fig26_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig26_HTML.jpg', 'caption': 'PCP pneumonia in an AIDS patient presenting with cough and fever. The crazy-paving appearance associated with cysts strongly suggests the diagnosis', 'hash': '9c6dd34089f804076cfd51ec25ec34a4713a30396184e1a010d90adc52bed674'}, {'image_id': '72913_2_En_8_Fig29_HTML', 'image_file_name': '72913_2_En_8_Fig29_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig29_HTML.jpg', 'caption': 'Axial CT image shows a reverse halo sign in a 26-year-old woman known for an acute lymphoblastic leukemia that developed fever and cough with hemodynamic compromise despite antifungal prophylaxis. This was related to a mucormycosis (Lichtheimia spp) proven by transbronchial biopsy and panfungal PCR in the BAL', 'hash': '68c79124aba53664f4cb5969dfc748f034196145c765da7125790ec953ae7a24'}, {'image_id': '72913_2_En_8_Fig9_HTML', 'image_file_name': '72913_2_En_8_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig9_HTML.jpg', 'caption': 'Pulmonary abscess related to multisensible Escherichia coli in a 52-year-old male alcoholic and heavy smoker suffering from fever with respiratory symptoms resisting to first line of antibiotics. After an initial chest X-ray (a), a chest CT with intravenous (IV) contrast media injection was performed due to worsening of the status. It allowed for the exclusion of pulmonary embolism and demonstrated the necrotic component of a pulmonary abscess of the LUL on axial sections with mediastinal (b) and lung (c) windows. A coronal reformatted image (d) showed cavitation within the upper part of the lesion that was better assessed when applying 7 mm-thick mIP post-processing (e). The latter also allowed for demonstration of the drainage bronchus that helped the clinician to guide the BAL. A follow-up CT in axial sections (f) demonstrated the resolution of this lesion with a sequelae appearing as a cavity with lobulated margins with thin wall', 'hash': 'e22fdbe3587fbc4660babb70b0a5fc9d7c5caa4968c2fc19450e685d322f7b7e'}, {'image_id': '72913_2_En_8_Fig39_HTML', 'image_file_name': '72913_2_En_8_Fig39_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig39_HTML.jpg', 'caption': 'Lemierre syndrome in a 21-year-old man suffering from a sore throat with jugular vein thrombosis well depicted by CT with contrast media injection (a) and septic embolism appearing as peripheral nodules of various sizes with wedge-shaped consolidation (arrows) and slight peripheral ground-glass opacity on axial CT image (b). The 8 mm-thick MIP image (c) shows the lateralized trajectory of the artery around the nodule', 'hash': 'f83ca2e5c8e0733f063a8c7e1d8500f23a4f14af390a10a3bd5830e606f915d7'}, {'image_id': '72913_2_En_8_Fig6_HTML', 'image_file_name': '72913_2_En_8_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig6_HTML.jpg', 'caption': '16\u2009mm-thick axial MIP image in a 58-year-old patient with Crohn disease under infliximab treatment. Although invisible on 1.25 mm-thick axial image (a), the MIP reformatted image (b) permits to detect micronodules with random distribution that were related to a miliary tuberculosis', 'hash': '52fcc308463b1224e1c9af1f22de0f0dfdc6adf7e9000ba739627a773550bbcf'}, {'image_id': '72913_2_En_8_Fig36_HTML', 'image_file_name': '72913_2_En_8_Fig36_HTML.jpg', 'image_path': '../data/media_files/PMC7120395/72913_2_En_8_Fig36_HTML.jpg', 'caption': 'A 24-year-old woman is known for a recurrence of Hodgkin’s lymphoma appearing on the PET-CT (a, b) as multiple pulmonary nodules. A necrotic bronchopneumonia occurring 2 months later presents as bilateral alveolar consolidation superimposed on the preexisting nodules (c, d) that lead to a septic shock with death of the patient. This case reinforces the usefulness of evaluation of previous imaging features', 'hash': 'd22641e5d59abadbd0d74d3372f6930e575078e169ad3312ea5a1aa9dc0b694c'}] | {'72913_2_En_8_Fig1_HTML': ['Today, CT has to be performed on a multidetector row CT scanner acquiring around 1 mm-thick sections and using an exposure dose which needs to be carefully chosen. Low-dose (LD) CT may be used without impairing the diagnostic information of specific CT patterns, in particular in case of pulmonary fungal infections (Christe et al. 2012), and even ultralow dose (ULD) CT may be possible, according to the clinical context. Overall, the dose may be decreased depending on the size of anomalies to be detected. If they are greater than 1 cm, which is often the case for patients with cystic fibrosis and suspected of acute pulmonary infections, ULD-CT at a dose that nearly reaches that of a chest X-ray may demonstrate the abnormalities, provided that the series are reconstructed with the correct technical parameters (Fig. <xref rid="72913_2_En_8_Fig1_HTML" ref-type="fig">1</xref>). These doses also apply to the follow-up of this young population that is exposed to frequent ionizing radiation procedures during the whole life. In other cases, LD-CTs with a CTDI of 2–3 mGy.cm in non-obese patients (Bankier and Tack ). These doses also apply to the follow-up of this young population that is exposed to frequent ionizing radiation procedures during the whole life. In other cases, LD-CTs with a CTDI of 2–3 mGy.cm in non-obese patients (Bankier and Tack 2010) are perfectly suited for the follow-up of infectious lung diseases (Fig. <xref rid="72913_2_En_8_Fig2_HTML" ref-type="fig">2</xref>). A comparison with previous baseline examinations is always required to accurately assess the disease’s evolution. Of importance, although ULD-CT with a mean radiation expose dose of 0.60\u2009±\u20090.15 mSv has been proven to provide acceptable image quality in case of pulmonary infections in febrile neutropenic patients with hematologic malignancy (Kim et al. ). A comparison with previous baseline examinations is always required to accurately assess the disease’s evolution. Of importance, although ULD-CT with a mean radiation expose dose of 0.60\u2009±\u20090.15 mSv has been proven to provide acceptable image quality in case of pulmonary infections in febrile neutropenic patients with hematologic malignancy (Kim et al. 2014), caution must be taken due to potential pitfalls with LD-CT (Fig. <xref rid="72913_2_En_8_Fig3_HTML" ref-type="fig">3</xref>). Multiplanar reformats with average intensity projection (AIP) post-processing of variable thickness may give rise to tomographic or chest X-ray appearance (Figs. ). Multiplanar reformats with average intensity projection (AIP) post-processing of variable thickness may give rise to tomographic or chest X-ray appearance (Figs. <xref rid="72913_2_En_8_Fig4_HTML" ref-type="fig">4</xref> and and <xref rid="72913_2_En_8_Fig5_HTML" ref-type="fig">5</xref>) that may be compared with previous or following conventional chest X-rays. The use of maximum intensity projection (MIP) may optimize the detection of micronodules, which sometimes cannot be assessed by using thin slices alone (Fig. ) that may be compared with previous or following conventional chest X-rays. The use of maximum intensity projection (MIP) may optimize the detection of micronodules, which sometimes cannot be assessed by using thin slices alone (Fig. <xref rid="72913_2_En_8_Fig6_HTML" ref-type="fig">6</xref>). It is also helpful to characterize micronodules as centrilobular ones with tree in bud appearance (Fig. ). It is also helpful to characterize micronodules as centrilobular ones with tree in bud appearance (Fig. <xref rid="72913_2_En_8_Fig7_HTML" ref-type="fig">7</xref>), corresponding to a bronchocentric distribution, or as ones with a random distribution as seen in miliary disease (Fig. ), corresponding to a bronchocentric distribution, or as ones with a random distribution as seen in miliary disease (Fig. <xref rid="72913_2_En_8_Fig8_HTML" ref-type="fig">8</xref>) (Beigelman-Aubry et al. ) (Beigelman-Aubry et al. 2005). The use of minimum intensity projection (mIP) allows to accurately locate an abnormal area in order to guide a bronchoalveolar lavage (BAL) (Fig. <xref rid="72913_2_En_8_Fig9_HTML" ref-type="fig">9</xref>), to differentiate bronchiectasis from a cavitary lesion (Fig. ), to differentiate bronchiectasis from a cavitary lesion (Fig. <xref rid="72913_2_En_8_Fig1_HTML" ref-type="fig">1</xref>), to visualize the drainage bronchus in the latter situation, as well as to help to recognize a bronchopleural fistula.), to visualize the drainage bronchus in the latter situation, as well as to help to recognize a bronchopleural fistula.Fig. 1Ultralow dose CT was performed because of the appearance of a cavity with an air-fluid level in the left axillary area on chest X-ray (a) in a 20-year-old female patient with cystic fibrosis and persistent symptoms due to Staphylococcus aureus and Cepacia infection despite antibiotic treatment. Axial sections reconstructed by using iterative reconstruction (IR) algorithm (b) and FBP with soft kernel and a slice thickness of 4 mm (c). Coronal reformatted image reconstructed by using IR (d, f) and filtered back projection (FBP) with soft kernel (e.g). The drainage bronchus of the abscess cavity (d, e) is clearly differentiated from the varicose bronchiectasis that are well assessed with a 3 mm-thick minimum intensity projection (mIP) reformat (f, g). Despite a slight distortion of the details seen on the axial image when using IR (b) compared with FBP (c), a substantial reduction of the noise is observed with IR (d, f)\nFig. 2Low-dose CT was performed for the follow-up of an angioinvasive aspergillosis in a 38-year-old woman with acute myeloid leukemia. The baseline CT (a) was performed with a CTDI of 5 and a DLP at 147 mGy.cm and the follow-up CT (b) with a CTDI of 2 and a DLP of 72 mGy.cm by using filter back projection reconstruction (FBP) with a soft kernel, without iterative reconstruction (IR) algorithm. Although a relative lesser image quality than the reference image, the disease’s evolution may be perfectly assessed at less than half of the initial dose\nFig. 3Ultralow dose CT performed at 100 kV and 10 mAs corresponding to a CTDIvol of 0.4 mGy reconstructed with FBP and a lung kernel. Native thin axial section (a) and 10 mm-thick maximum intensity projection reformat (b) exhibit noise well seen outside of the chest wall. Such noise projected on the lung mimics micronodulation with random distribution that may simulate a miliary disease in a context of a febrile immunocompromised patient. Although IR is the method of reconstruction of choice with low-dose CT and available in most institutions today, such potential pitfalls with FBP and lung kernel must be known when IR is not available. This precludes the use of such doses in this setting\nFig. 4Coronal reformatted images with progressive thickening of the slabs from 1 (a) to 30 (b) to 150 mm (c) thick slabs by using the average intensity projection (AIP) post-processing tool in a patient known for a voluminous bullae of the right apex of the lung with superimposed infectious alveolar consolidation. Note that the bullae is not easily seen on the chest X-ray rendering in (c), as it was the case with the conventional chest X-ray (not shown). The same limitation also occurs in case of cavitation that may be missed on conventional chest X-ray\nFig. 5A 60-year-old man suffering from bronchiectasis of unknown cause presented with fever and new respiratory symptoms related to an abscess due to a usually nosocomial germ, Serratia marcescens and Cronobacter, a gram-negative bacteria of the Enterobacteriaceae family. Chest X-ray (a) and axial CT section with IV contrast in mediastinal (b) and lung (c) windows show the abscess of the LUL with thick walls, a necrotic component and an air-fluid level. The coronal 1.5 mm (d), 30 mm (e), and 150 mm (f) thick AIP reformatted images allow for a better understanding of the opacities related to a bronchocele at the level of the RUL and the abscess situated close to a bronchiectatic area of the LUL\nFig. 616\u2009mm-thick axial MIP image in a 58-year-old patient with Crohn disease under infliximab treatment. Although invisible on 1.25 mm-thick axial image (a), the MIP reformatted image (b) permits to detect micronodules with random distribution that were related to a miliary tuberculosis\nFig. 7Chest CT of a 36-year-old patient with ankylosing spondylarthritis treated by using anti-TNF alpha. Although numerous micronodules are visible on the thin axial section (a), their profusion and centrilobular distribution with tree in bud appearance related to Mycoplasma pneumoniae is more obvious when using 10 mm-thick MIP reformat (b). Note the sparing of the subpleural area typical of centrilobular distribution\nFig. 8Chest CT of a patient suffering from a Good’s syndrome (thymoma with immunodeficiency) and miliary tuberculosis (TB). The thin coronal reformatted image (a) shows an apparent limited number of nodules, unlike the 10 mm-thick MIP reformat (b) that shows obvious micronodules with random distribution that were related to a hematogenous spread of TB\nFig. 9Pulmonary abscess related to multisensible Escherichia coli in a 52-year-old male alcoholic and heavy smoker suffering from fever with respiratory symptoms resisting to first line of antibiotics. After an initial chest X-ray (a), a chest CT with intravenous (IV) contrast media injection was performed due to worsening of the status. It allowed for the exclusion of pulmonary embolism and demonstrated the necrotic component of a pulmonary abscess of the LUL on axial sections with mediastinal (b) and lung (c) windows. A coronal reformatted image (d) showed cavitation within the upper part of the lesion that was better assessed when applying 7 mm-thick mIP post-processing (e). The latter also allowed for demonstration of the drainage bronchus that helped the clinician to guide the BAL. A follow-up CT in axial sections (f) demonstrated the resolution of this lesion with a sequelae appearing as a cavity with lobulated margins with thin wall\n'], '72913_2_En_8_Fig9_HTML': ['CT may be performed without or with intravenous (IV) contrast, the latter especially to evaluate the necrotic component of a pneumoniae or abscesses (Fig. <xref rid="72913_2_En_8_Fig9_HTML" ref-type="fig">9</xref>) and to optimize the differentiation from an empyema (Figs. ) and to optimize the differentiation from an empyema (Figs. <xref rid="72913_2_En_8_Fig10_HTML" ref-type="fig">10</xref> and and <xref rid="72913_2_En_8_Fig11_HTML" ref-type="fig">11</xref>). It has also been described as helpful for differentiation between a pulmonary angioinvasive mycosis and a bacterial pneumonia in high-risk hematologic patients by using volume perfusion CT (Schulze et al. ). It has also been described as helpful for differentiation between a pulmonary angioinvasive mycosis and a bacterial pneumonia in high-risk hematologic patients by using volume perfusion CT (Schulze et al. 2012). IV contrast-enhanced CT is also required in case of hemoptysis, being able to demonstrate enlarged bronchial and non-bronchial systemic arteries due to former tuberculosis or, less frequently, Rasmussen aneurysms (Fig. <xref rid="72913_2_En_8_Fig12_HTML" ref-type="fig">12</xref> ) occurring in the same situation as well as vessel involvement in case of fungal disease (Fig. ) occurring in the same situation as well as vessel involvement in case of fungal disease (Fig. <xref rid="72913_2_En_8_Fig13_HTML" ref-type="fig">13</xref>). It may also highlight a concomitant thromboembolic disease.). It may also highlight a concomitant thromboembolic disease.Fig. 10Empyema with right pulmonary abscesses in a context of bronchoaspiration pneumonia due to Streptococcus milleri and Fusobacterium necrophorum in a 47-year-old patient known for previous drug abuse that was found unconscious at home. In addition to antibiotherapy, a thoracoscopy was performed with drainage of the empyema. The reference chest X-ray (a) shows a pleural effusion. The axial CT with IV contrast media administration in mediastinal (b) and lung (c) window at the level of the apical segment of the RUL performed at the same day confirms the pleural effusion with thin enhancement of the parietal pleura suggesting empyema with associated alveolar consolidation. An axial section in lung window at the level of the right upper lobe bronchus (d) of the reference CT and also a follow-up CT performed 3 days later (e) demonstrate the cavitation of a pulmonary abscess of the anterior segment of the RUL that appears solid in (d). An axial image at the level of the middle lobe (f) shows additional cavities and another solid nodule related to multiple abscesses\nFig. 11A 46-year-old male drug abuser known for COPD presents with fever after bullectomy and pleurodesis performed for a spontaneous pneumothorax. Chest X-ray (a) and axial chest CT after IV contrast media injection in mediastinal (b) and lung (c) windows with sagittal reformat (d) allow for an easy differentiation between the parenchymal involvement with necrosis on an underlying bullous emphysema from empyema. The thickening of the pleura that is suggestive of empyema (orange and blue arrows) appears laterally as a continuous line internal to the ribs (orange arrows)\nFig. 12Rasmussen aneurysm in a 35-year-old patient presenting hemoptysis 9 days after the initial diagnosis of TB. Axial CT without (a) and with IV contrast media injection (b) focused at the level of the RUL shows a vascular enhancement within the tuberculoma that was clearly differentiated from the calcification depicted without contrast. The selective angiogram of the right bronchial artery (c) shows the aneurysm that was immediately successfully embolized\nFig. 13Hemoptysis in the context of a mucormycosis in a 26-year-old woman suffering from acute lymphoblastic leukemia under antifungal prophylaxis. CT angiography in axial (a) and coronal oblique reformat (b) shows the vessel involvement originating from the necrotic parenchymal mass of the left lower lobe. This was confirmed after LLL lobectomy\n', 'A pulmonary abscess may be single or multiple, with a characteristic spherical shape. It measures between 2 and 6 cm in diameter, demonstrates a central hypoattenuation (Fig. <xref rid="72913_2_En_8_Fig9_HTML" ref-type="fig">9</xref>) or cavitation representing localized necrotic cavity, contains pus, and demonstrates peripheral enhancement after intravenous contrast medium injection, without or with an air-fluid level (Fig. ) or cavitation representing localized necrotic cavity, contains pus, and demonstrates peripheral enhancement after intravenous contrast medium injection, without or with an air-fluid level (Fig. <xref rid="72913_2_En_8_Fig5_HTML" ref-type="fig">5</xref>). It usually displays an acute angle when it intersects with an adjacent pleural surface. Consolidation in the adjacent parenchyma occurs in half of all cases (Muller ). It usually displays an acute angle when it intersects with an adjacent pleural surface. Consolidation in the adjacent parenchyma occurs in half of all cases (Muller 2003). Bronchopulmonary fistula may be observed. As the most frequent cause of lung abscess is aspiration, the most common localizations are the posterior segment of an upper lobe or the superior segment of a lower lobe (Muller 2003). Bilateral involvement that predominantly affects the lung bases with abscess formation suggests a P. aeruginosa infection. Infections caused by anaerobic bacteria are commonly encountered, abscesses caused by S. aureus, K. pneumoniae, and P. aeruginosa being associated with higher mortality (Francis et al. 2005).'], '72913_2_En_8_Fig14_HTML': ['Lobar pneumonia, characterized by an inflammatory exudate filling distal airspaces, typically begins in the lung area adjacent to the visceral pleura and spreads through the interalveolar pores of Kohn and the small airways from one segment to another (Muller 2003) respecting a centripetal pattern. Appearing as a single subpleural area of alveolar consolidation with blurred margins restricted to the area next to the fissures, it then progresses to a sublobar or lobar alveolar consolidation sharply demarcated by the interlobar fissure (Fig. <xref rid="72913_2_En_8_Fig14_HTML" ref-type="fig">14</xref>) (Franquet ) (Franquet 2008). An air bronchogram sign is strongly suggestive (Fig. <xref rid="72913_2_En_8_Fig15_HTML" ref-type="fig">15</xref>) (Syrjälä et al. ) (Syrjälä et al. 1998). Ground-glass opacities adjacent to the alveolar consolidation corresponding to a partial filling of the alveoli may be observed (Fig. <xref rid="72913_2_En_8_Fig16_HTML" ref-type="fig">16</xref>) (Tanaka et al. ) (Tanaka et al. 1996). This aspect is the classical presentation of acute bacterial community-acquired pneumonia (CAP), mainly caused by S. pneumoniae (Bhalla and McLoud 1998), other agents responsible of complete lobar consolidation including Klebsiella pneumoniae, and other gram-negative bacilli, L. pneumophila, H. influenzae, and occasionally M. pneumoniae (Franquet 2008). A P. jirovecii infection, a fungal infection, or a mycobacteriosis has also to be considered in case of immunocompromised patients. An enlarged lobe with bulging fissures due to edematous engorgement may be observed, in particular with K. pneumoniae infection, with a current lower occurrence likely due to early treatment in case of suspected pneumonia (Walker et al. 2014).Fig. 14Segmental pneumonia of the lingula in an 82-year-old woman. Axial CT scan focused at the level of the lower part of the LUL (a) and sagittal reformat (b) show an alveolar consolidation with a well-defined air bronchogram anterior to the great fissure\nFig. 15Lobar pneumonia of the RUL related to Streptococcus pneumococcus in a 25-year-old smoker. Scout view (a) and axial CT image (b) show an alveolar consolidation with an air bronchogram. The 10 mm-thick mIP (c) permits to display the entire length of the bronchi from their origin within the alveolar consolidation. Although CT does not replace fiber-optic bronchoscopy, no obstructive lesion was detected by using CT\nFig. 16Round pneumonia occurs in a 44-year-old man suddenly presenting with fever and chest pain and addressed to the emergency department. The chest X-ray (a) shows a right parahilar pseudo-tumoral opacity. Due to this atypical aspect, chest CT was performed on the same day. Axial CT image (b) and sagittal reformat (c) demonstrate a rounded alveolar consolidation of the posterior segment of the RUL and the apical segment of the RLL. Note the ground-glass opacity located around the alveolar consolidation reflecting the partial filling of the alveoli\n'], '72913_2_En_8_Fig17_HTML': ['The differential diagnosis includes aspiration pneumonia when the lower lung is affected, especially on the right side. Lobar or segmental consolidation may also be related to bronchial obstruction, pulmonary hemorrhage, organizing pneumonia, acute fibrinous organizing pneumonia (Fig. <xref rid="72913_2_En_8_Fig17_HTML" ref-type="fig">17</xref>), radiation pneumonitis, adenocarcinoma (Fig. ), radiation pneumonitis, adenocarcinoma (Fig. <xref rid="72913_2_En_8_Fig18_HTML" ref-type="fig">18</xref>), or lymphoma.), or lymphoma.Fig. 17Acute fibrinous organizing pneumonia (AFOP) in a 52-year-old patient suffering from plasmacytoid dendritic cells acute leukemia with febrile agranulocytosis. The noninfectious nature of the alveolar consolidation with peripheral ground-glass attenuation of the LUL was proven by a transbronchial biopsy performed under endobronchial ultrasonography (EBUS)\nFig. 18Alveolar consolidation of the middle lobe related to an adenocarcinoma. The stretched appearance of the bronchi may suggest the diagnosis (Courtesy Pr Brillet, Bobigny, France)\n'], '72913_2_En_8_Fig19_HTML': ['Histologically, bronchopneumonia is characterized by a predominantly bronchiolar and peribronchiolar inflammation with a patchy distribution. Firstly, the adjacent alveoli are involved, followed by the lobules, segments, and/or lobes. An air bronchogram is usually absent. CT features include those of infectious bronchiolitis consisting of thickening of the bronchial walls, centrilobular nodules and tree-in-bud sign (Fig. <xref rid="72913_2_En_8_Fig19_HTML" ref-type="fig">19</xref>) (see below), airspace nodules generally smaller than 1 cm in size related to the inflammatory spreading to the peribronchiolar alveoli with areas of ground-glass opacity or peribronchiolar consolidation (Fig. ) (see below), airspace nodules generally smaller than 1 cm in size related to the inflammatory spreading to the peribronchiolar alveoli with areas of ground-glass opacity or peribronchiolar consolidation (Fig. <xref rid="72913_2_En_8_Fig20_HTML" ref-type="fig">20</xref>), and multifocal lobular, segmental, or lobar consolidation (Figs. ), and multifocal lobular, segmental, or lobar consolidation (Figs. <xref rid="72913_2_En_8_Fig21_HTML" ref-type="fig">21</xref> and and <xref rid="72913_2_En_8_Fig22_HTML" ref-type="fig">22</xref>). Bronchopneumonias are most commonly encountered in nosocomial infections and usually caused by gram-negative bacteria (GNB), especially ). Bronchopneumonias are most commonly encountered in nosocomial infections and usually caused by gram-negative bacteria (GNB), especially P. aeruginosa or E. coli. Other commonly involved bacteria are S. aureus (Morikawa et al. 2012), Haemophilus influenzae, anaerobes, and some species of fungus, especially Aspergillus (Fig. <xref rid="72913_2_En_8_Fig23_HTML" ref-type="fig">23</xref>). The latter as well as viruses (Franquet ). The latter as well as viruses (Franquet 2011) or atypical mycobacteriosis has to be considered when suggested by the individual clinical setting. Bronchiectasis predominantly located at the level of the middle lobe and the lingula may be associated in case of mycobacterium avium complex (MAC) infection (Lady Windermere syndrome).Fig. 19Infectious bronchiolitis appears as thickening of the bronchial walls and centrilobular nodules with tree-in-bud sign\nFig. 20Two consecutive coronal reformats in a 67-year-old man suffering from a bronchopneumonia show airspace nodules smaller than 1 cm with perinodular ground-glass opacity and patchy alveolar consolidation (arrows) (a) as well as peribronchiolar consolidation (b)\nFig. 21Bronchopneumonia pattern appears on this axial section at the level of the upper lobes as bronchial wall thickening, centrilobular nodules with tree-in-bud sign (blue arrow), lobular (orange arrow), and segmental alveolar consolidation with multifocal and patchy involvement\nFig. 22CMV infection in a patient with renal graft appears as a bronchopneumonia pattern on two successive axial sections (a, b). The bronchial thickening in (a) is associated with bilateral segmental alveolar consolidations at the lung bases in (b)\nFig. 23Invasive airway aspergillosis. Three axial CT images show peribronchial ground-glass attenuation at the level of the RUL (blue arrows) with slight bronchial wall thickening and ill-defined nodules (a) and alveolar consolidation (orange arrows) in a peribronchial location at the level of the posterobasal bronchus of the RLL (b) and a segmental distribution in the LLL (c). This presentation of aspergillosis mainly concerns non-acute leukemia patients with a leukocyte count >100/mm3\n\n'], '72913_2_En_8_Fig24_HTML': ['Diffuse alveolar consolidation suggests diffuse alveolar damage (DAD), typically encountered in case of adult respiratory distress syndrome (ARDS). An air bronchogram sign is usually observed as well as small pleural effusions. P. jirovecii pneumonia (Festic et al. 2005) (Fig. <xref rid="72913_2_En_8_Fig24_HTML" ref-type="fig">24</xref>) as well as uncommon, unusual, or exotic organisms can be involved. Nondependent anomalies are more related to pneumonia rather than lesions in the dependent lung (Beigelman-Aubry et al. ) as well as uncommon, unusual, or exotic organisms can be involved. Nondependent anomalies are more related to pneumonia rather than lesions in the dependent lung (Beigelman-Aubry et al. 2012).Fig. 24Diffuse alveolar consolidation with air bronchogram and ground-glass opacity in a patient with autoimmune hepatitis treated with long-term steroids presenting with dyspnea and severe hypoxemia. This was related to a Pneumocystis jirovecii pneumonia. Note the pneumomediastinum in this mechanically ventilated patient staying in the intensive care unit who died from this severe infection with rapid deterioration\n'], '72913_2_En_8_Fig25_HTML': ['The most common causes are viruses, Mycoplasma pneumoniae, Chlamydia, and P. jirovecii. In viral infections and in those caused by M. pneumoniae, ground-glass attenuation is associated with signs of cellular bronchiolitis and focal consolidation fitting with bronchopneumonia. When a predominant ground-glass opacity occurs in an immunocompetent patient, respiratory syncytial virus or varicella infection should be first considered. In immunocompromised patients, P. jirovecii (Thomas and Limper 2004) CMV (McGuinness et al. 1994) or Mycoplasma infection must be suggested. P. jiroveci infections typically present as ground-glass opacity sparing the pulmonary cortex that predominantly affects the upper region, especially in AIDS patients (Fig. <xref rid="72913_2_En_8_Fig25_HTML" ref-type="fig">25</xref>). A crazy-paving sign, defined as a combination of ground-glass opacity and smooth interlobular septal thickening that resembles a masonry pattern used in walkways (Hansell et al. ). A crazy-paving sign, defined as a combination of ground-glass opacity and smooth interlobular septal thickening that resembles a masonry pattern used in walkways (Hansell et al. 2008), may be observed in infections, in particular with Pneumocystis jirovecii pneumonia and influenza (Walker et al. 2014). Pulmonary cysts or pneumatoceles within the same areas should suggest PCP (Fig. <xref rid="72913_2_En_8_Fig26_HTML" ref-type="fig">26</xref>). In immunocompromised non-HIV-positive patients, features are less suggestive of the diagnosis, with rapid progression, this being the result of severe or dysregulated inflammatory responses that are evoked by a relatively small number of ). In immunocompromised non-HIV-positive patients, features are less suggestive of the diagnosis, with rapid progression, this being the result of severe or dysregulated inflammatory responses that are evoked by a relatively small number of Pneumocystis organisms (Chang et al. 2013; Tasaka and Tokuda 2012) (Fig. <xref rid="72913_2_En_8_Fig27_HTML" ref-type="fig">27</xref>). In the latter category of patients, ground-glass opacities can also be caused by viral (Fig. ). In the latter category of patients, ground-glass opacities can also be caused by viral (Fig. <xref rid="72913_2_En_8_Fig28_HTML" ref-type="fig">28</xref>) or pyogenic infection (Kang et al. ) or pyogenic infection (Kang et al. 1996).Fig. 25\nP. jirovecii pneumonia in an AIDS patient appearing as ground-glass opacity sparing the pulmonary cortex and typically predominantly located at the upper region of the lungs\nFig. 26PCP pneumonia in an AIDS patient presenting with cough and fever. The crazy-paving appearance associated with cysts strongly suggests the diagnosis\nFig. 27PCP pneumonia in an HIV-negative patient with a history of cerebral glioblastoma treated by surgery and radiochemotherapy. Axial CT shows ground-glass opacity predominating on the left side without sparing of the pulmonary cortex. The rounded hypoattenuated areas mostly correspond to centrilobular emphysema and not cysts that are rare in this condition\nFig. 28Bilateral ground-glass opacity at the level of the upper lobes are related to a Coronavirus infection in a 72-year-old man known for a small cell carcinoma treated by radiochemotherapy\n'], '72913_2_En_8_Fig29_HTML': ['Peculiar aspects of GGO are seen with the halo sign (see below) and the reversed halo sign (RHS), defined as focal rounded area of ground-glass opacity surrounded by a crescent or complete ring of consolidation (Fig. <xref rid="72913_2_En_8_Fig29_HTML" ref-type="fig">29</xref>) (Georgiadou et al. ) (Georgiadou et al. 2011). Histopathologically, the RHS has been associated to infarcted lung tissue, with a greater amount of hemorrhage at the periphery than at the center, with a frequent subsequent cavitation after neutropenia recovery (Wahba et al. 2008). Halo sign (HS) and RHS are highly suggestive of early infection by an angioinvasive fungus in severely immunocompromised patients. The former is most commonly associated with invasive pulmonary aspergillosis and the latter with pulmonary mucormycosis. An RHS may also be related to other infectious diseases, in particular invasive aspergillosis, tuberculosis, or paracoccidioidomycosis (Georgiadou et al. 2011).Fig. 29Axial CT image shows a reverse halo sign in a 26-year-old woman known for an acute lymphoblastic leukemia that developed fever and cough with hemodynamic compromise despite antifungal prophylaxis. This was related to a mucormycosis (Lichtheimia spp) proven by transbronchial biopsy and panfungal PCR in the BAL\n'], '72913_2_En_8_Fig30_HTML': ['The differential diagnosis of ground-glass attenuation is wide, especially in immunocompromised patients. It can be related to drug-induced toxicity (Fig. <xref rid="72913_2_En_8_Fig30_HTML" ref-type="fig">30</xref>), alveolar hemorrhage, post-radic changes, pulmonary edema, organizing pneumonia, or hypersensitivity pneumonitis. An RHS may also be observed in numerous conditions including granulomatosis with polyangiitis, organizing pneumonia (Georgiadou et al. ), alveolar hemorrhage, post-radic changes, pulmonary edema, organizing pneumonia, or hypersensitivity pneumonitis. An RHS may also be observed in numerous conditions including granulomatosis with polyangiitis, organizing pneumonia (Georgiadou et al. 2011), or pulmonary infarct (Fig. <xref rid="72913_2_En_8_Fig31_HTML" ref-type="fig">31</xref>).).Fig. 30Pulmonary hemorrhage in a 65-year-old woman known for an acute myeloid leukemia with thrombocytopenia appears as a perihilar ground-glass opacity predominantly located at the level of the lower lobes\nFig. 31Pulmonary infarct appears as a reverse halo sign in a 93-year-old patient with bilateral pulmonary emboli as nicely seen on axial CT section in lung (a) and mediastinal (b) windows\n'], '72913_2_En_8_Fig7_HTML': ['Bronchogenic distribution presents as nonhomogeneous centrilobular micronodules that spare the subpleural space with a location at least 3 mm from the pleura and that are associated with a tree-in-bud pattern, defined as centrilobular branching structures that resemble a budding tree (Hansell et al. 2008). This presentation may be seen in bacterial, fungal, viral, mycobacterial, or mycoplasma (Fig. <xref rid="72913_2_En_8_Fig7_HTML" ref-type="fig">7</xref>) infections. In postprimary (reactivation) tuberculosis, centrilobular micronodules and linear branching opacities have a dense attenuation and distinct margins. These features are readily associated with cavitation, predominantly localized in the apical and posterior segments of the superior lobes and the superior segment of the lower lobes in this setting (Fig. ) infections. In postprimary (reactivation) tuberculosis, centrilobular micronodules and linear branching opacities have a dense attenuation and distinct margins. These features are readily associated with cavitation, predominantly localized in the apical and posterior segments of the superior lobes and the superior segment of the lower lobes in this setting (Fig. <xref rid="72913_2_En_8_Fig32_HTML" ref-type="fig">32</xref>). ). Aspergillus bronchiolitis and/or bronchopneumonia must be considered in immunocompromised patients (Logan et al. 1994).Fig. 32Postprimary (reactivation) tuberculosis in a 37-year-old man, native of Cameroun, complaining about cough, weight loss, and night sweats for 3 months. Axial CT image at the level of the RUL (a) shows the typical hallmarks of reactivation TB including cavities, surrounded by thick and irregular borders, and dense centrilobular nodules with sharp margins predominantly located at the level of the apical and posterior segments of the upper lobes and the apical segment of the lower lobes. A 4 mm-thick MIP axial reformat at the level of the apical bronchus of the RLL (b) demonstrates typical centrilobular nodules with sparing of the subpleural space (3 mm) and lobular consolidation of the anterior segment of the RUL (arrows). Two consecutive coronal reformats 20 mm-thick AIP (c, e) and thin coronal slice at the level of the drainage bronchus of the largest cavity of the RUL (d) allow for a complete understanding of the appearance seen on chest X-ray (f)\n'], '72913_2_En_8_Fig8_HTML': ['A hematogenous miliary pattern in case of random distribution may suggest tuberculosis (Figs. <xref rid="72913_2_En_8_Fig8_HTML" ref-type="fig">8</xref> and and <xref rid="72913_2_En_8_Fig33_HTML" ref-type="fig">33</xref>), histoplasmosis, candidiasis, blastomycosis, or a viral cause (), histoplasmosis, candidiasis, blastomycosis, or a viral cause (CMV, herpes, varicella) (Fig. <xref rid="72913_2_En_8_Fig34_HTML" ref-type="fig">34</xref>), especially in immunocompromised patients.), especially in immunocompromised patients.Fig. 33Miliary tuberculosis with multisystemic involvement in an HIV-positive CDC stage three patient highly immunosuppressed with CD4 level at 64 c/mm3. Axial CT scan shows diffuse tiny micronodules with ground-glass opacity leading to alveolar consolidation at the level of the apical segment of the RLL. Such an involvement may result in a respiratory distress syndrome (ARDS)\nFig. 34A 50-year-old man developing a varicella without respiratory symptoms. Axial (a) and coronal (b) 10 mm-thick MIP images of a CT performed due to suspicion of pulmonary nodules on the chest X-ray show micronodules with random distribution that almost completely disappeared at the follow-up 3 months later (c, d)\n'], '72913_2_En_8_Fig35_HTML': ['Pulmonary nodules of infectious nature, sometimes cavitated, are most commonly seen in nosocomial pneumonia and in immunocompromised patients. They may be due to nocardiosis, tuberculosis, and angioinvasive aspergillosis (Althoff Souza et al. 2006) in neutropenic patients, Cryptococcus neoformans, Coccidioides immitis, Blastomyces sp., or atypical mycobacteriosis (Oh et al. 2000; Franquet et al. 2003). Less often, infections such as candidiasis (Fig. <xref rid="72913_2_En_8_Fig35_HTML" ref-type="fig">35</xref>), legionella, or Q fever may be considered if suggested by the individual setting. They must be differentiated from noninfectious causes including malignancy (Fig. ), legionella, or Q fever may be considered if suggested by the individual setting. They must be differentiated from noninfectious causes including malignancy (Fig. <xref rid="72913_2_En_8_Fig36_HTML" ref-type="fig">36</xref>).).Fig. 35Pulmonary and hepatosplenic candidiasis in a 62-year-old patient with an acute myeloid leukemia treated by chemotherapy. Axial CT image of 1 mm (a) and 15 mm-thick MIP (b) shows multiple nodules of various sizes with random distribution. The added value of MIP in the assessment of the detection and evaluation of profusion of nodules is undeniable\nFig. 36A 24-year-old woman is known for a recurrence of Hodgkin’s lymphoma appearing on the PET-CT (a, b) as multiple pulmonary nodules. A necrotic bronchopneumonia occurring 2 months later presents as bilateral alveolar consolidation superimposed on the preexisting nodules (c, d) that lead to a septic shock with death of the patient. This case reinforces the usefulness of evaluation of previous imaging features\n'], '72913_2_En_8_Fig37_HTML': ['Nodules with a peripheral ground-glass halo refer to the halo sign (HS), which is a CT finding of ground-glass opacity surrounding a nodule or a mass (Hansell et al. 2008). Although inconstant, with a reported incidence of ranging from 25 to 95\u2009% among neutropenic patients with hematological malignancies (Georgiadou et al. 2011), the HS strongly suggests an early invasive aspergillosis in patients with severe neutropenia (Fig. <xref rid="72913_2_En_8_Fig37_HTML" ref-type="fig">37</xref>), in association with wedge-shaped areas of subpleural consolidation. Furthermore, initiation of antifungal treatment on the basis of the identification of an HS by chest CT appears associated with a significantly better response to treatment and improved survival (Greene et al. ), in association with wedge-shaped areas of subpleural consolidation. Furthermore, initiation of antifungal treatment on the basis of the identification of an HS by chest CT appears associated with a significantly better response to treatment and improved survival (Greene et al. 2007). In invasive aspergillosis, these nodules typically become larger during neutrophil engraftment (Barnes and Marr 2007) and/or during the first 10 days of therapy (Caillot et al. 2001). Histopathologically, the HS represents a focus of pulmonary infarction surrounded by alveolar hemorrhage, secondary to invasion by Aspergillus of small and medium-sized pulmonary vessels causing thrombosis and subsequent ischemic necrosis of the lung parenchyma (Georgiadou et al. 2011). The same appearances have been reported in numerous infectious pulmonary diseases such as observed with Mucorales, Candida, herpes simplex virus, cytomegalovirus, varicella-zoster virus, mycobacterial infections, bacterial pneumonia, or septic emboli (Fig. <xref rid="72913_2_En_8_Fig38_HTML" ref-type="fig">38</xref>). The differential diagnoses of noninfectious nodules with an HS include granulomatosis with polyangiitis, cryptogenic organizing pneumonia, adenocarcinoma, angiosarcoma, Kaposi’s sarcoma in association with spiculated nodules, and hemorrhagic metastases (Georgiadou et al. ). The differential diagnoses of noninfectious nodules with an HS include granulomatosis with polyangiitis, cryptogenic organizing pneumonia, adenocarcinoma, angiosarcoma, Kaposi’s sarcoma in association with spiculated nodules, and hemorrhagic metastases (Georgiadou et al. 2011).Fig. 37Angioinvasive aspergillosis in a 27-year-old woman appears as nodules with peripheral ground-glass opacity at the apex of the LUL\nFig. 38Septic emboli in a 31-year-old female; HIV-negative drug abuser, known for chronic HCV and IV cocaine injections, presents with fever, shivering, and episodes of hemoptysis. Blood cultures were positive for Staphylococcus aureus with a 2 cm vegetation at the level of the tricuspid valve causing marked tricuspid insufficiency. Axial CT sections at baseline (a) and 8 days later (b), respectively, show multiple nodules with peripheral ground-glass opacity (a) that secondary cavitated. The latter is a usual finding with Staphylococcus aureus infection\n'], '72913_2_En_8_Fig38_HTML': ['\nCavitated nodules can be related to septic embolism. The primary source of infection is tricuspid endocarditis, especially in intravenous illicit drug use, peripheral thrombophlebitis, venous catheter, and pacemaker wires. The mechanism includes endothelial damage combined with the formation of crumbling thrombi containing infective agents. Turbulences caused by the circulating blood detach fragments of thrombus which then migrate to the peripheral pulmonary arteries with consecutive obstruction. Ischemia then results in infarction and/or hemorrhage and the organisms release toxins causing parenchymal necrosis (Muller 2003). Nodules related to septic emboli are mainly peripheral and basal with blurred margins. A simultaneous appearance of solid nodules and nodules with variable size cavitations (Fig. <xref rid="72913_2_En_8_Fig38_HTML" ref-type="fig">38</xref>) as well as subpleural wedge-shaped consolidation may be seen (Franquet ) as well as subpleural wedge-shaped consolidation may be seen (Franquet 2008). The nodules often appear to have a vessel leading into them on axial views – the so-called “feeding vessel” sign – corresponding to the pulmonary vein, whereas most arteries have a lateralized trajectory around the nodule (Dodd et al. 2006) (Fig. <xref rid="72913_2_En_8_Fig39_HTML" ref-type="fig">39</xref>).).Fig. 39Lemierre syndrome in a 21-year-old man suffering from a sore throat with jugular vein thrombosis well depicted by CT with contrast media injection (a) and septic embolism appearing as peripheral nodules of various sizes with wedge-shaped consolidation (arrows) and slight peripheral ground-glass opacity on axial CT image (b). The 8 mm-thick MIP image (c) shows the lateralized trajectory of the artery around the nodule\n'], '72913_2_En_8_Fig32_HTML': ['Necrotizing pneumonia or pulmonary gangrene presenting with hypoenhancing geographic areas of low lung attenuation and cavitation is frequently seen before frank abscess formation (Walker et al. 2014). They can be encountered in various situations such as acute CAP, pulmonary tuberculosis (Fig. <xref rid="72913_2_En_8_Fig32_HTML" ref-type="fig">32</xref>), atypical mycobacteria (Fig. ), atypical mycobacteria (Fig. <xref rid="72913_2_En_8_Fig40_HTML" ref-type="fig">40</xref>), anaerobic bacteria, and angioinvasive or chronic fungal infections. Unilateral or bilateral areas of consolidation, multiple expanding usually thick-walled cavities containing or not aspergillomas and concomitant pleural thickening, suggest chronic cavitary pulmonary aspergillosis. In young patients with no medical history, an infection caused by ), anaerobic bacteria, and angioinvasive or chronic fungal infections. Unilateral or bilateral areas of consolidation, multiple expanding usually thick-walled cavities containing or not aspergillomas and concomitant pleural thickening, suggest chronic cavitary pulmonary aspergillosis. In young patients with no medical history, an infection caused by S. aureus, Panton-Valentine leukodicin secretor, that can be severe and rapid in onset with a poor prognosis should routinely be investigated. Bilateral consolidations of the superior lobes followed by the development of coalescent lucencies are commonly seen. An air-crescent sign may also be present (see below).Fig. 40\nMycobacterium xenopi infection in a COPD patient. Chest X-ray (a), coronal reformat (b), and axial CT at the level of upper lobes (c) show an alveolar consolidation with cavities of various sizes that almost totally resolved on the follow-up CT performed 1 year later (d)\n'], '72913_2_En_8_Fig41_HTML': ['The air-crescent sign, defined as a collection of air in a crescentic shape that separates the wall of a cavity from an inner mass, firstly suggests an Aspergillus colonization of preexisting cavities, i.e., an aspergilloma (Fig. <xref rid="72913_2_En_8_Fig41_HTML" ref-type="fig">41</xref>). An aspergilloma may also be manifested as an irregular spongeworks or fungal strands forming a coarse and irregular network within a cavity. An air-crescent sign also suggests the retraction of a central necrotic mass after recovery of the bone marrow in a rather late stage of angioinvasive aspergillosis (De Marie ). An aspergilloma may also be manifested as an irregular spongeworks or fungal strands forming a coarse and irregular network within a cavity. An air-crescent sign also suggests the retraction of a central necrotic mass after recovery of the bone marrow in a rather late stage of angioinvasive aspergillosis (De Marie 2000) (Fig. <xref rid="72913_2_En_8_Fig42_HTML" ref-type="fig">42</xref>). It may also occur in mucormycosis (Fig. ). It may also occur in mucormycosis (Fig. <xref rid="72913_2_En_8_Fig43_HTML" ref-type="fig">43</xref>), tuberculosis, granulomatosis with polyangiitis, intracavitary hemorrhage, and cavitary lung cancer (Fig. ), tuberculosis, granulomatosis with polyangiitis, intracavitary hemorrhage, and cavitary lung cancer (Fig. <xref rid="72913_2_En_8_Fig44_HTML" ref-type="fig">44</xref>) (Hansell et al. ) (Hansell et al. 2008).Fig. 41Aspergilloma developing in a cavity in a 69-year-old man with a history of stage IV sarcoidosis who complained of hemoptysis. The treatment consisted of antifungal therapy and bronchial embolization followed by a left upper lobectomy. Axial CT section in lung window (a) at the level of the LUL shows the air-crescent sign. Axial CT section on bone window (b) at the same level demonstrates the calcified lymph nodes related to sarcoidosis and the slight calcifications within the aspergilloma. The coronal reformat (c) shows the typical dependent location of the aspergilloma within the cavity\nFig. 42Invasive aspergillosis in a 27-year-old woman with acute myeloid leukemia. Baseline CT (a) performed in a context of febrile agranulocytosis (a) with 5 mm-thick axial sections shows alveolar consolidation of the posterior segment of the upper part of the LUL with peripheral ground-glass opacity. Bronchiolo-alveolar nodules with ill borders are also seen in the RUL. On CT performed 3 weeks after (b), during bone marrow recovery, multiple nodules with air-crescent sign were seen, this finding suggesting a rather late stage of angioinvasive aspergillosis. Note the somewhat atypical presence of peripheral ground glass at this late stage of the disease\nFig. 43Necrotizing pneumonia in a context of mucormycosis (same patient as in Fig. <xref rid="72913_2_En_8_Fig13_HTML" ref-type="fig">13</xref>) presenting with hemoptysis 2 weeks after initial diagnosis despite adequate treatment. The retraction of the central necrotic mass of the LLL creates an air-crescent sign visible on mediastinal () presenting with hemoptysis 2 weeks after initial diagnosis despite adequate treatment. The retraction of the central necrotic mass of the LLL creates an air-crescent sign visible on mediastinal (a) and lung (b) windows. It had occurred at the same time as the pulmonary artery involvement\nFig. 44Air-crescent sign caused by an invasive epidermoid carcinoma stage IIIb treated by radiochemotherapy that progressively cavitated. Axial image at baseline CT (a), 3 weeks (b) and two consecutive axial CT images performed 3 months (c, d) after beginning of the treatment. The necrotic tumor appears progressively as a pseudo-aspergilloma with an air-crescent sign\n'], '72913_2_En_8_Fig10_HTML': ['Pneumatoceles manifest as single or multiple approximately round thin-walled and gas-filled spaces in the lung (Hansell et al. 2008) (Fig. <xref rid="72913_2_En_8_Fig10_HTML" ref-type="fig">10</xref>). These lucencies are associated with a recent infection and usually transient, progressively increasing in size over the following days and weeks and then resolving after weeks or months. They are most likely due to bronchial drainage of necrotic parenchymal tissue, followed by a check-valve airway obstruction. They usually occur in ). These lucencies are associated with a recent infection and usually transient, progressively increasing in size over the following days and weeks and then resolving after weeks or months. They are most likely due to bronchial drainage of necrotic parenchymal tissue, followed by a check-valve airway obstruction. They usually occur in P. jirovecii infections occurring in patients with acquired immune deficiency syndrome (AIDS) (Fig. <xref rid="72913_2_En_8_Fig26_HTML" ref-type="fig">26</xref>) or in case of previous ) or in case of previous S. aureus pneumonia, but they can also be seen with other infections including E. coli and S. pneumoniae (Beigelman-Aubry et al. 2012).', '\nEmpyema, which occurs in less than 5\u2009% of pulmonary infections, typically displays obtuse angles along its interface with adjacent pleura. It appears as a smooth and thin enhancement of the visceral and parietal pleura that surrounds the fluid collection and that is referred as the split pleura sign (Walker et al. 2014) (Figs. <xref rid="72913_2_En_8_Fig10_HTML" ref-type="fig">10</xref> and and <xref rid="72913_2_En_8_Fig11_HTML" ref-type="fig">11</xref>). It is commonly associated with a hyperattenuation of the extra-pleural fat. The pathogens traditionally involved in empyema are ). It is commonly associated with a hyperattenuation of the extra-pleural fat. The pathogens traditionally involved in empyema are S. pneumoniae, Streptococcus pyogenes, and S. aureus. The same findings may be seen in case of TB.'], '72913_2_En_8_Fig45_HTML': ['The most common mediastinal and hilar abnormality is lymphadenopathy (Fig. <xref rid="72913_2_En_8_Fig45_HTML" ref-type="fig">45</xref>). Right paratracheal, hilar, and subcarinal regions and/or hilar lymph node enlargement with associated homolateral small focal infiltrate or parenchymal consolidation, which is commonly sublobar and subpleural in location in the middle lobe, basal segments of lower lobes, and anterior segments of upper lobes, is the usual hallmark of primary TB (Beigelman et al. ). Right paratracheal, hilar, and subcarinal regions and/or hilar lymph node enlargement with associated homolateral small focal infiltrate or parenchymal consolidation, which is commonly sublobar and subpleural in location in the middle lobe, basal segments of lower lobes, and anterior segments of upper lobes, is the usual hallmark of primary TB (Beigelman et al. 2000). Necrotic components with peripheral rim enhancement (rim sign) mainly suggest tuberculosis, but they can also correspond to fungal infection, atypical mycobacteria, histoplasmosis, metastases (Fig. <xref rid="72913_2_En_8_Fig46_HTML" ref-type="fig">46</xref>) from head/neck and testicular malignancy, and lymphoma (Bhalla et al. ) from head/neck and testicular malignancy, and lymphoma (Bhalla et al. 2015). Bronchonodal fistula can be observed as a complication of active pulmonary TB with TB lymphadenitis especially in the elderly. The fistulas usually involve the right lobar bronchus and the main bronchus on the left side (Park et al. 2015).Fig. 45Tuberculosis in a patient with a history of ulcerous colitis under anti-TNF treatment and lung graft for panlobular emphysema related to α1-antitrypsin deficiency. Axial sections in mediastinal (a) and lung (b) windows show an enlarged right paratracheal lymph node associated with a homolateral alveolar consolidation of the RLL, hallmarks of primary TB. Note the peripheral centrilobular nodules (arrows)\nFig. 46Right paratracheal lymph node metastasis with necrosis and parietal enhancement in a patient treated by chemotherapy and immunotherapy in a context of a poorly differentiated carcinoma with hepatic and bone metastases\n'], '72913_2_En_8_Fig47_HTML': ['In case of a circumferential thickening of the trachea or main bronchi occurring in the same context, the possibility of invasive aspergillosis of the respiratory tract should always be considered (Fig. <xref rid="72913_2_En_8_Fig47_HTML" ref-type="fig">47</xref>) with the specific risk of tracheal rupture. Acute tuberculous tracheobronchial involvement may also be seen with circumferential narrowing associated with smooth or irregular wall thickening (Bhalla et al. ) with the specific risk of tracheal rupture. Acute tuberculous tracheobronchial involvement may also be seen with circumferential narrowing associated with smooth or irregular wall thickening (Bhalla et al. 2015). Sequelar fibrotic bronchostenosis predominating on the left main bronchus and post-obstructive bronchiectasis may occur in this setting (Bhalla et al. 2015).Fig. 47Airway aspergillosis in a 74-year-old woman with lymphoma of the marginal zone complaining of cough and fever. A circumferential peribronchial thickening around the mainstem left bronchus is seen on the axial CT image with mediastinal window (a). Two weeks later, a worsening of the stenosis with a wall fistula is observed on the axial image with the lung window (b). Note the presence of a bilateral pleural effusion\n'], '72913_2_En_8_Fig12_HTML': ['\nMycotic aneurysms of pulmonary vessels may be observed in case of hemoptysis and a context of invasive fungal infections (Georgiadou et al. 2011) or tuberculosis (Fig. <xref rid="72913_2_En_8_Fig12_HTML" ref-type="fig">12</xref>).).'], '72913_2_En_8_Fig48_HTML': ['Fibro-parenchymal lesions with bronchovascular distortion and bronchiectasis, thin-walled cavities, emphysema, and fibro-atelectatic bands firstly suggest prior tuberculosis with scarring (Fig. <xref rid="72913_2_En_8_Fig48_HTML" ref-type="fig">48</xref>). Calcified mediastinal/hilar lymph nodes (Fig. ). Calcified mediastinal/hilar lymph nodes (Fig. <xref rid="72913_2_En_8_Fig49_HTML" ref-type="fig">49</xref>), well-defined nodules, and pleural thickening with or without calcification (Fig. ), well-defined nodules, and pleural thickening with or without calcification (Fig. <xref rid="72913_2_En_8_Fig50_HTML" ref-type="fig">50</xref>) are also common imaging features of healed TB. Tuberculomas and small calcified lung nodules suggest likewise prior TB infection (Bhalla et al. ) are also common imaging features of healed TB. Tuberculomas and small calcified lung nodules suggest likewise prior TB infection (Bhalla et al. 2015). Calcified nodules may also be seen as sequelae of histoplasmosis or varicella infection (Chou et al. 2015) but also in other conditions like amyloidosis or metastasis, in particular from osteogenic sarcoma or medullary carcinoma of the thyroid.Fig. 48Sequelae of TB in a 35-year-old woman originating from Cameroun. Axial section in parenchymal (a) and mediastinal windows (b) at the level of the upper lobes showing cicatricial collapsus of the upper part of LUL well delineated by a small accessory fissure (arrows) with bronchovascular distortion, bronchiectasis, thin-walled cavities, and calcified nodules. The 3 mm-thick mIP oblique reformat (c) allows for an overall assessment of the bronchiectasis. The coronal 150 mm-thick AIP reformat (d) shows the upper retraction of the left hilum\nFig. 49Ranke complex related to scars from a previous primary TB. Axial section with the bone window at the level of the right hilum (a) and of the RLL (b) show a calcified hilar node and a calcified parenchymal nodule, respectively\nFig. 50A 77-year-old man with a calcified fibrothorax as a sequelae of a previous TB. Axial section in mediastinal (a) and lung (b) windows show a pleural calcification with parenchymatous bands converging toward the latter and related to fibrosis of the visceral pleura. A 70 mm-thick MIP coronal reformat in bone window (c) shows the upper predominance of this fibrothorax. A 180 mm-thick AIP reformat (d) reproducing the chest X-ray appearance shows the retraction of the left hemithorax and the blunting of the costophrenic angle, a classical finding in this setting\n']} | Pulmonary Infections: Imaging with CT | [
"Pulmonary Infections-CT"
] | Multidetector-Row CT of the Thorax | 1456560000 | None | null | other | PMC7120395 | null | null | [
""
] | Multidetector-Row CT of the Thorax. 2016 Feb 27;:131-161 | NO-CC CODE |
|
Pneumonia complicating human infection of avian influenza (H5N1). (a–h) At day 7 after the onset, CT scanning demonstrates light small flakes of shadows at the posterior segment of the right upper lung lobe and medial segment of the right middle lung lobe. The apical posterior and anterior segments of the left upper lung lobe are demonstrated with irregular small flakes of consolidation shadows. The lingual segment of the upper lung lobe and most segments of the lower lung lobe are demonstrated with large flakes of dense consolidation shadow, with inner air bronchus sign. The left pleural cavity is demonstrated with rare liquid density shadow. (i) The liver and spleen are subject to obvious enlargement and diffuse lesion. (j–o) At day 172 after the onset, CT scanning demonstrates that the lesions at both lungs are fibrous cord-like and grid-like shadows, rigidity of some vascular markings, and no obvious absorption of the lesions. (p–s) At day 286 after the onset, CT scanning demonstrates that the lesions at both lungs are still mainly changes of pulmonary interstitial tissues, such as fibrous cord-like and grid-like shadows, with slow absorption of the lesions. (t–y) At day 730 after the onset, reexamination by CT scanning demonstrates that the lesions at both lungs are still mainly changes of pulmonary interstitial tissues, such as fibrous cord-like and grid-like shadows with rare ground-glass opacity. Compare to previous chest CT findings; the lesions at both lungs are slightly absorbed | 324949_1_En_18_Fig5d_HTML | 7 | 4f0b51c322696e2e8ccab4285e0a81b03de09cb2ce406064164ea872bfd416b8 | 324949_1_En_18_Fig5d_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
400,
245
] | [{'image_id': '324949_1_En_18_Fig3_HTML', 'image_file_name': '324949_1_En_18_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig3_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza H5N1. At day 4 after the onset, X-ray demonstrates diffuse consolidation at both lungs with inner air bronchus sign', 'hash': '8ae9d507afbb9a4a66f26a4a1364c57b6ad12b575ad3ed54f9b4e94ed2f215d7'}, {'image_id': '324949_1_En_18_Fig8a_HTML', 'image_file_name': '324949_1_En_18_Fig8a_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig8a_HTML.jpg', 'caption': 'Pneumonia and pleural effusion complicating human infection of avian influenza H7N9. (a–d) On March 27, 2013, CT scanning demonstrates large flake of consolidation at the right lung with air bronchus sign as well as ground-glass opacity and patches of shadows at both lungs. (e) On March 31, 2013, X-ray demonstrates consolidation shadows at both lungs that are more obvious at the right upper lung and enlarged heart shadow. (f) On April 10, 2013, consolidation shadow at the right upper lung is demonstrated to be absorbed slightly and bilateral costophrenic angles are demonstrated to be blunt (Note: The case and the figures were provided by Tang YH from Ruijin Hospital, Shanghai, China)', 'hash': 'eaf1bd6e120a84c225c1e8e14a9455f227ed8d94ab2d82afd6c308b7476cde0f'}, {'image_id': '324949_1_En_18_Fig4g_HTML', 'image_file_name': '324949_1_En_18_Fig4g_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig4g_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H5N1). (a) At day 6 after the onset, the left middle and lower lung fields are demonstrated with large flakes of shadows with increased density and poorly defined boundary. Some lesions are demonstrated as ground-glass opacity and the left hilum is poorly defined. (b) At day 8 after the onset, the conditions progress rapidly with large flakes of increased density shadow at the left lung in white lung sign. Flakes of increased density shadow are demonstrated at the right hilar area, right middle lung, as well as middle and medial parts of the right lower lung field. (c) At day 9 after the onset, the left lung field is demonstrated with large flakes of shadow and the right lung is demonstrated with slightly larger range with lesions. (d) At day 10 after the onset, the left lower lung field is demonstrated with slightly light shadow indicating partially absorption of some lesions. The right lung is demonstrated with obviously larger range with lesions. (e) At day 11 after the onset, the left upper and middle lung fields are demonstrated with slightly light shadows. The right lung is demonstrated with continued expansion of the range with lesions of increased density, especially at the right middle and lower lung fields. (f) At day 14 after the onset, the shadows at the left middle and lower lung fields as well as at the middle and lateral parts of right middle and lower lung fields are demonstrated to be lightened, indicating absorption of some lesions. (g) At day 20 after the onset, both lungs are demonstrated with patches of shadows. The middle and lateral parts of both middle lung fields are demonstrated with small flakes of light blurry shadows. The left lower lung field is demonstrated with slight decreased transparency. The left costophrenic angle is demonstrated to be poorly defined. (h) At day 22 after the onset, the right lung field is demonstrated with patches and large flakes of consolidation shadows. The left lung field is demonstrated with diffuse increased density shadows. The left diaphragmatic surface and left costophrenic angle are poorly defined. The conditions progressed. (i) At day 28 after the onset, the left lung is demonstrated with diffuse increased density consolidation. The right lung is demonstrated with large flakes and patches of shadows. Some lung fields are demonstrated with increased transparency. The mediastinum is demonstrated with slight shift leftwards. (j) At day 30 after the onset, the left lung is demonstrated with systemic increased density consolidation shadow. The right lung is demonstrated with large flakes and patches of shadows, with slightly more lesions. (k) At day 32 after the onset, the right middle and lower lung is demonstrated with large flakes and cord-like shadows. The left middle and lower lung is demonstrated with systemic increased density consolidation shadow. The lesions at the right lung and the left upper lung are absorbed, with improved transparency. (l) At day 34 after the onset, the right lung is demonstrated with patches and cord-like increased density shadows. The left lung is demonstrated with systemic light increased density shadows. The lesions at both lungs are obviously absorbed. (m) At day 47 after the onset, the medial part the right lower lung is demonstrated with dense strips of shadows, with poorly defined right heart margin. The left lung is demonstrated with dense cord-like shadows, with well-defined boundary, patches, and spots of shadows as well as less cord-like shadows. (n) At day 53 after the onset, both middle and lower lung fields are demonstrated with less patches of high-density shadows, with scattering cord-like shadows and well-defined boundary. The lesion at the right cardiophrenic angle is demonstrated with cystic dilation of bronchus. Most fields of both lungs are demonstrated with no abnormality. (o) At day 79 after the onset, both lungs are demonstrated with scattering patches and cord-like high-density shadows that are well defined. The lesions are characterized by fibrosis. (p) At day 172 after the onset, both lungs are demonstrated with scattering spots and cord-like high-density shadows with well-defined boundary', 'hash': 'cf9549ded8e4cd07741bd930ac1e535ef376a44178f206f1ad82b4cadef46ed2'}, {'image_id': '324949_1_En_18_Fig1a_HTML', 'image_file_name': '324949_1_En_18_Fig1a_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig1a_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H5N1). (a) At day 5 after the onset, X-ray demonstrates small flakes of light blurry shadow at the left upper lung. (b) At day 9 after the onset, the lesions at the left upper lung rapidly spread to the upper and middle lung fields with accompanying pulmonary tissue atrophy and collapse and inner air bronchus sign. The right lung is demonstrated with patches of blurry shadow at the medial part. (c) At day 13 after the onset, the lesions at the left lung spread to the whole lung with white lung sign. The pulmonary atrophy and collapse are aggravated. And the right lung is demonstrated with more lesions. (d) At day 15 after the onset, CT scanning demonstrates collapse of the left thorax, large quantities of flakes, and cord-like shadow at the left lung and the upper right lung lobe with inner air bronchus sign. Some pulmonary tissues herniate into the anterior-posterior mediastinum with leftward shift of the mediastinum. (e) At day 22 after the onset, HRCT demonstrates that all lesions at both lungs are absorbed but aggravated atrophy and collapse of the left lung tissue as well as aggravated mediastinal herniation. (f) At day 31 after the onset, the lesions at both lungs are obviously absorbed. The absorption at the left anterolateral lung is more obvious than that at the posteromedial lung. (g) At day 53 after the onset, HRCT demonstrates more cord-like shadow at the left upper lung with grid-like change. The right upper lung lobe is demonstrated with small quantities of cord-like shadow and ground-glass opacity, with leftward shift of the mediastinum. (h) By reexamination after 11 months, CT scanning still demonstrates cord-like shadow and slight leftward shift of the mediastinum', 'hash': 'a41700c01f49f9388c230330cc2e989285e82dd07d813cfb3719535f663e2afa'}, {'image_id': '324949_1_En_18_Fig4f_HTML', 'image_file_name': '324949_1_En_18_Fig4f_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig4f_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H5N1). (a) At day 6 after the onset, the left middle and lower lung fields are demonstrated with large flakes of shadows with increased density and poorly defined boundary. Some lesions are demonstrated as ground-glass opacity and the left hilum is poorly defined. (b) At day 8 after the onset, the conditions progress rapidly with large flakes of increased density shadow at the left lung in white lung sign. Flakes of increased density shadow are demonstrated at the right hilar area, right middle lung, as well as middle and medial parts of the right lower lung field. (c) At day 9 after the onset, the left lung field is demonstrated with large flakes of shadow and the right lung is demonstrated with slightly larger range with lesions. (d) At day 10 after the onset, the left lower lung field is demonstrated with slightly light shadow indicating partially absorption of some lesions. The right lung is demonstrated with obviously larger range with lesions. (e) At day 11 after the onset, the left upper and middle lung fields are demonstrated with slightly light shadows. The right lung is demonstrated with continued expansion of the range with lesions of increased density, especially at the right middle and lower lung fields. (f) At day 14 after the onset, the shadows at the left middle and lower lung fields as well as at the middle and lateral parts of right middle and lower lung fields are demonstrated to be lightened, indicating absorption of some lesions. (g) At day 20 after the onset, both lungs are demonstrated with patches of shadows. The middle and lateral parts of both middle lung fields are demonstrated with small flakes of light blurry shadows. The left lower lung field is demonstrated with slight decreased transparency. The left costophrenic angle is demonstrated to be poorly defined. (h) At day 22 after the onset, the right lung field is demonstrated with patches and large flakes of consolidation shadows. The left lung field is demonstrated with diffuse increased density shadows. The left diaphragmatic surface and left costophrenic angle are poorly defined. The conditions progressed. (i) At day 28 after the onset, the left lung is demonstrated with diffuse increased density consolidation. The right lung is demonstrated with large flakes and patches of shadows. Some lung fields are demonstrated with increased transparency. The mediastinum is demonstrated with slight shift leftwards. (j) At day 30 after the onset, the left lung is demonstrated with systemic increased density consolidation shadow. The right lung is demonstrated with large flakes and patches of shadows, with slightly more lesions. (k) At day 32 after the onset, the right middle and lower lung is demonstrated with large flakes and cord-like shadows. The left middle and lower lung is demonstrated with systemic increased density consolidation shadow. The lesions at the right lung and the left upper lung are absorbed, with improved transparency. (l) At day 34 after the onset, the right lung is demonstrated with patches and cord-like increased density shadows. The left lung is demonstrated with systemic light increased density shadows. The lesions at both lungs are obviously absorbed. (m) At day 47 after the onset, the medial part the right lower lung is demonstrated with dense strips of shadows, with poorly defined right heart margin. The left lung is demonstrated with dense cord-like shadows, with well-defined boundary, patches, and spots of shadows as well as less cord-like shadows. (n) At day 53 after the onset, both middle and lower lung fields are demonstrated with less patches of high-density shadows, with scattering cord-like shadows and well-defined boundary. The lesion at the right cardiophrenic angle is demonstrated with cystic dilation of bronchus. Most fields of both lungs are demonstrated with no abnormality. (o) At day 79 after the onset, both lungs are demonstrated with scattering patches and cord-like high-density shadows that are well defined. The lesions are characterized by fibrosis. (p) At day 172 after the onset, both lungs are demonstrated with scattering spots and cord-like high-density shadows with well-defined boundary', 'hash': 'a97bd603c3ea37bc23cd7fcdb0a8668b8a76f8fb6ef4b4509c72561f9e187de2'}, {'image_id': '324949_1_En_18_Fig2_HTML', 'image_file_name': '324949_1_En_18_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig2_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H5N1). (a) At day 6 after the onset, X-ray demonstrates large flakes of high-density shadow at the left upper lung, patches of blurry shadow at the right upper lung, and slightly narrowed left intercostal space. (b) At day 7 after the onset, the lesions at both lung increase obviously. (c) By reexamination after 8 months, CT scanning demonstrates that some ground-glass opacity and inferior line of the pleura at the left upper lung', 'hash': '20f864c2ca4b71f82903af5261bcb45a56aae2dc5c6da3b1bb366c86626cf202'}, {'image_id': '324949_1_En_18_Fig4a_HTML', 'image_file_name': '324949_1_En_18_Fig4a_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig4a_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H5N1). (a) At day 6 after the onset, the left middle and lower lung fields are demonstrated with large flakes of shadows with increased density and poorly defined boundary. Some lesions are demonstrated as ground-glass opacity and the left hilum is poorly defined. (b) At day 8 after the onset, the conditions progress rapidly with large flakes of increased density shadow at the left lung in white lung sign. Flakes of increased density shadow are demonstrated at the right hilar area, right middle lung, as well as middle and medial parts of the right lower lung field. (c) At day 9 after the onset, the left lung field is demonstrated with large flakes of shadow and the right lung is demonstrated with slightly larger range with lesions. (d) At day 10 after the onset, the left lower lung field is demonstrated with slightly light shadow indicating partially absorption of some lesions. The right lung is demonstrated with obviously larger range with lesions. (e) At day 11 after the onset, the left upper and middle lung fields are demonstrated with slightly light shadows. The right lung is demonstrated with continued expansion of the range with lesions of increased density, especially at the right middle and lower lung fields. (f) At day 14 after the onset, the shadows at the left middle and lower lung fields as well as at the middle and lateral parts of right middle and lower lung fields are demonstrated to be lightened, indicating absorption of some lesions. (g) At day 20 after the onset, both lungs are demonstrated with patches of shadows. The middle and lateral parts of both middle lung fields are demonstrated with small flakes of light blurry shadows. The left lower lung field is demonstrated with slight decreased transparency. The left costophrenic angle is demonstrated to be poorly defined. (h) At day 22 after the onset, the right lung field is demonstrated with patches and large flakes of consolidation shadows. The left lung field is demonstrated with diffuse increased density shadows. The left diaphragmatic surface and left costophrenic angle are poorly defined. The conditions progressed. (i) At day 28 after the onset, the left lung is demonstrated with diffuse increased density consolidation. The right lung is demonstrated with large flakes and patches of shadows. Some lung fields are demonstrated with increased transparency. The mediastinum is demonstrated with slight shift leftwards. (j) At day 30 after the onset, the left lung is demonstrated with systemic increased density consolidation shadow. The right lung is demonstrated with large flakes and patches of shadows, with slightly more lesions. (k) At day 32 after the onset, the right middle and lower lung is demonstrated with large flakes and cord-like shadows. The left middle and lower lung is demonstrated with systemic increased density consolidation shadow. The lesions at the right lung and the left upper lung are absorbed, with improved transparency. (l) At day 34 after the onset, the right lung is demonstrated with patches and cord-like increased density shadows. The left lung is demonstrated with systemic light increased density shadows. The lesions at both lungs are obviously absorbed. (m) At day 47 after the onset, the medial part the right lower lung is demonstrated with dense strips of shadows, with poorly defined right heart margin. The left lung is demonstrated with dense cord-like shadows, with well-defined boundary, patches, and spots of shadows as well as less cord-like shadows. (n) At day 53 after the onset, both middle and lower lung fields are demonstrated with less patches of high-density shadows, with scattering cord-like shadows and well-defined boundary. The lesion at the right cardiophrenic angle is demonstrated with cystic dilation of bronchus. Most fields of both lungs are demonstrated with no abnormality. (o) At day 79 after the onset, both lungs are demonstrated with scattering patches and cord-like high-density shadows that are well defined. The lesions are characterized by fibrosis. (p) At day 172 after the onset, both lungs are demonstrated with scattering spots and cord-like high-density shadows with well-defined boundary', 'hash': '84189c33b9656eb1124c5a1759322a1bd37a8e47d9ae57f7f929300ffbffe12b'}, {'image_id': '324949_1_En_18_Fig5a_HTML', 'image_file_name': '324949_1_En_18_Fig5a_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig5a_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H5N1). (a–h) At day 7 after the onset, CT scanning demonstrates light small flakes of shadows at the posterior segment of the right upper lung lobe and medial segment of the right middle lung lobe. The apical posterior and anterior segments of the left upper lung lobe are demonstrated with irregular small flakes of consolidation shadows. The lingual segment of the upper lung lobe and most segments of the lower lung lobe are demonstrated with large flakes of dense consolidation shadow, with inner air bronchus sign. The left pleural cavity is demonstrated with rare liquid density shadow. (i) The liver and spleen are subject to obvious enlargement and diffuse lesion. (j–o) At day 172 after the onset, CT scanning demonstrates that the lesions at both lungs are fibrous cord-like and grid-like shadows, rigidity of some vascular markings, and no obvious absorption of the lesions. (p–s) At day 286 after the onset, CT scanning demonstrates that the lesions at both lungs are still mainly changes of pulmonary interstitial tissues, such as fibrous cord-like and grid-like shadows, with slow absorption of the lesions. (t–y) At day 730 after the onset, reexamination by CT scanning demonstrates that the lesions at both lungs are still mainly changes of pulmonary interstitial tissues, such as fibrous cord-like and grid-like shadows with rare ground-glass opacity. Compare to previous chest CT findings; the lesions at both lungs are slightly absorbed', 'hash': '50d2c3010aacfe478b7512f741278a7d27cb0eed5e3cd13284cd68c9ab7be5a7'}, {'image_id': '324949_1_En_18_Fig6a_HTML', 'image_file_name': '324949_1_En_18_Fig6a_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig6a_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H7N9). (a) At day 4 after the onset, X-ray demonstrates small flakes of dense shadow at the left lower lung field and small flakes of light blurry shadows at the right lower lung field. The left costophrenic angle is poorly defined and the pulmonary markings at the right lung are also enhanced. (b) At day 5 after the onset, X-ray demonstrates large flakes of dense shadow at the left middle and lower lung fields as well as scattering patches of shadows at the right lung. The conditions progress. (c) At day 6 after the onset, the range with lesions at the right lung is enlarged. (d) At day 7 after the onset, X-ray demonstrates strips of dense shadow at the right middle lung field with inner cavity-like lesion. The conditions progress. (e) At day 8 after the onset, the lesions show no obvious change. (f) At day 12 after the onset, the lesions are obviously absorbed, but dense shadows are demonstrated at the lateral part of the left lower lung field. (g) At day 14 after the onset, the lesions at the left lower lung field are absorbed obviously. (h) At day 18 after the onset, the lesions at both lungs are completely absorbed, with clearly defined lung markings and no enlarged hilar shadow (Note: The case and the figures were provided by Zhao QX and Yang YJ from Infectious Diseases Hospital, Zhengzhou, Henan, China)', 'hash': 'db190eb8fe57af6559149cb7ad137b721410a17b1ab02db5274a318c29ec7a81'}, {'image_id': '324949_1_En_18_Fig7a_HTML', 'image_file_name': '324949_1_En_18_Fig7a_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig7a_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H7N9). (a) At day 4 after the onset, X-ray demonstrates large flakes of high-density shadows at the left lower lung field and overlapping of some lesions with the heart shadow. (b) At day 5 after the onset, X-ray demonstrates large flakes of ground-glass opacity and consolidation shadows at the left lung. The left costophrenic angle and diaphragmatic surface are poorly defined. The right upper lung field is demonstrated with large flakes of increased density shadows with thickened horizontal fissure. Compared to the previous X-ray finding, the range with lesions at both lungs is obviously enlarged. (c–f) At day 6 after the onset, CT scanning demonstrates flakes of ground-glass opacity at the right upper lung and left lower lung, with consolidation shadow at the left lower lung and a little pleural effusion at the right side. (g–i) At day 12 after the onset, reexamination by CT scanning demonstrates that the lesions at the right lung are basically absorbed while most of the lesions at the left lower lung are absorbed, but still with patches of shadows. The clinical symptoms are obviously alleviated. (j, k) At day 18 after the onset, CT scanning demonstrates slight absorption of the lesions at the left lung and left pleural effusion. (l, m) At day 25 after the onset, chest CT scanning demonstrates the lesions at the left lung continue to be absorbed and left pleural effusion is absorbed apparently', 'hash': '0641628e488e6cba6c5a8c0ee7e0a4c639c31a685e1e112c7da39de6b03e2702'}, {'image_id': '324949_1_En_18_Fig6b_HTML', 'image_file_name': '324949_1_En_18_Fig6b_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig6b_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H7N9). (a) At day 4 after the onset, X-ray demonstrates small flakes of dense shadow at the left lower lung field and small flakes of light blurry shadows at the right lower lung field. The left costophrenic angle is poorly defined and the pulmonary markings at the right lung are also enhanced. (b) At day 5 after the onset, X-ray demonstrates large flakes of dense shadow at the left middle and lower lung fields as well as scattering patches of shadows at the right lung. The conditions progress. (c) At day 6 after the onset, the range with lesions at the right lung is enlarged. (d) At day 7 after the onset, X-ray demonstrates strips of dense shadow at the right middle lung field with inner cavity-like lesion. The conditions progress. (e) At day 8 after the onset, the lesions show no obvious change. (f) At day 12 after the onset, the lesions are obviously absorbed, but dense shadows are demonstrated at the lateral part of the left lower lung field. (g) At day 14 after the onset, the lesions at the left lower lung field are absorbed obviously. (h) At day 18 after the onset, the lesions at both lungs are completely absorbed, with clearly defined lung markings and no enlarged hilar shadow (Note: The case and the figures were provided by Zhao QX and Yang YJ from Infectious Diseases Hospital, Zhengzhou, Henan, China)', 'hash': '67fdc0286b4289087028ec85ff03d64fc352b5facc47bfe9dad133294e68b374'}, {'image_id': '324949_1_En_18_Fig7b_HTML', 'image_file_name': '324949_1_En_18_Fig7b_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig7b_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H7N9). (a) At day 4 after the onset, X-ray demonstrates large flakes of high-density shadows at the left lower lung field and overlapping of some lesions with the heart shadow. (b) At day 5 after the onset, X-ray demonstrates large flakes of ground-glass opacity and consolidation shadows at the left lung. The left costophrenic angle and diaphragmatic surface are poorly defined. The right upper lung field is demonstrated with large flakes of increased density shadows with thickened horizontal fissure. Compared to the previous X-ray finding, the range with lesions at both lungs is obviously enlarged. (c–f) At day 6 after the onset, CT scanning demonstrates flakes of ground-glass opacity at the right upper lung and left lower lung, with consolidation shadow at the left lower lung and a little pleural effusion at the right side. (g–i) At day 12 after the onset, reexamination by CT scanning demonstrates that the lesions at the right lung are basically absorbed while most of the lesions at the left lower lung are absorbed, but still with patches of shadows. The clinical symptoms are obviously alleviated. (j, k) At day 18 after the onset, CT scanning demonstrates slight absorption of the lesions at the left lung and left pleural effusion. (l, m) At day 25 after the onset, chest CT scanning demonstrates the lesions at the left lung continue to be absorbed and left pleural effusion is absorbed apparently', 'hash': 'b4e72fe6fc412f5f1bada1f0ab5618fd55125f48673e9680a6544273c9d8578a'}, {'image_id': '324949_1_En_18_Fig9_HTML', 'image_file_name': '324949_1_En_18_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig9_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H7N9). (a) X-ray demonstrates large flakes of high-density shadow at both lungs. (b, c) CT scanning demonstrates consolidation at both lungs (Note: The case and the figures were provided by Cheng JL from the First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China)', 'hash': '518dade2c52e97584045399ac201ef9265723b4d7149b4ff4bbe2fc34ac5717b'}, {'image_id': '324949_1_En_18_Fig4b_HTML', 'image_file_name': '324949_1_En_18_Fig4b_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig4b_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H5N1). (a) At day 6 after the onset, the left middle and lower lung fields are demonstrated with large flakes of shadows with increased density and poorly defined boundary. Some lesions are demonstrated as ground-glass opacity and the left hilum is poorly defined. (b) At day 8 after the onset, the conditions progress rapidly with large flakes of increased density shadow at the left lung in white lung sign. Flakes of increased density shadow are demonstrated at the right hilar area, right middle lung, as well as middle and medial parts of the right lower lung field. (c) At day 9 after the onset, the left lung field is demonstrated with large flakes of shadow and the right lung is demonstrated with slightly larger range with lesions. (d) At day 10 after the onset, the left lower lung field is demonstrated with slightly light shadow indicating partially absorption of some lesions. The right lung is demonstrated with obviously larger range with lesions. (e) At day 11 after the onset, the left upper and middle lung fields are demonstrated with slightly light shadows. The right lung is demonstrated with continued expansion of the range with lesions of increased density, especially at the right middle and lower lung fields. (f) At day 14 after the onset, the shadows at the left middle and lower lung fields as well as at the middle and lateral parts of right middle and lower lung fields are demonstrated to be lightened, indicating absorption of some lesions. (g) At day 20 after the onset, both lungs are demonstrated with patches of shadows. The middle and lateral parts of both middle lung fields are demonstrated with small flakes of light blurry shadows. The left lower lung field is demonstrated with slight decreased transparency. The left costophrenic angle is demonstrated to be poorly defined. (h) At day 22 after the onset, the right lung field is demonstrated with patches and large flakes of consolidation shadows. The left lung field is demonstrated with diffuse increased density shadows. The left diaphragmatic surface and left costophrenic angle are poorly defined. The conditions progressed. (i) At day 28 after the onset, the left lung is demonstrated with diffuse increased density consolidation. The right lung is demonstrated with large flakes and patches of shadows. Some lung fields are demonstrated with increased transparency. The mediastinum is demonstrated with slight shift leftwards. (j) At day 30 after the onset, the left lung is demonstrated with systemic increased density consolidation shadow. The right lung is demonstrated with large flakes and patches of shadows, with slightly more lesions. (k) At day 32 after the onset, the right middle and lower lung is demonstrated with large flakes and cord-like shadows. The left middle and lower lung is demonstrated with systemic increased density consolidation shadow. The lesions at the right lung and the left upper lung are absorbed, with improved transparency. (l) At day 34 after the onset, the right lung is demonstrated with patches and cord-like increased density shadows. The left lung is demonstrated with systemic light increased density shadows. The lesions at both lungs are obviously absorbed. (m) At day 47 after the onset, the medial part the right lower lung is demonstrated with dense strips of shadows, with poorly defined right heart margin. The left lung is demonstrated with dense cord-like shadows, with well-defined boundary, patches, and spots of shadows as well as less cord-like shadows. (n) At day 53 after the onset, both middle and lower lung fields are demonstrated with less patches of high-density shadows, with scattering cord-like shadows and well-defined boundary. The lesion at the right cardiophrenic angle is demonstrated with cystic dilation of bronchus. Most fields of both lungs are demonstrated with no abnormality. (o) At day 79 after the onset, both lungs are demonstrated with scattering patches and cord-like high-density shadows that are well defined. The lesions are characterized by fibrosis. (p) At day 172 after the onset, both lungs are demonstrated with scattering spots and cord-like high-density shadows with well-defined boundary', 'hash': 'e50cebaaad0fc8c7a281973a5a86a8c88308ef849f018aa6da2714b9c983c459'}, {'image_id': '324949_1_En_18_Fig5b_HTML', 'image_file_name': '324949_1_En_18_Fig5b_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig5b_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H5N1). (a–h) At day 7 after the onset, CT scanning demonstrates light small flakes of shadows at the posterior segment of the right upper lung lobe and medial segment of the right middle lung lobe. The apical posterior and anterior segments of the left upper lung lobe are demonstrated with irregular small flakes of consolidation shadows. The lingual segment of the upper lung lobe and most segments of the lower lung lobe are demonstrated with large flakes of dense consolidation shadow, with inner air bronchus sign. The left pleural cavity is demonstrated with rare liquid density shadow. (i) The liver and spleen are subject to obvious enlargement and diffuse lesion. (j–o) At day 172 after the onset, CT scanning demonstrates that the lesions at both lungs are fibrous cord-like and grid-like shadows, rigidity of some vascular markings, and no obvious absorption of the lesions. (p–s) At day 286 after the onset, CT scanning demonstrates that the lesions at both lungs are still mainly changes of pulmonary interstitial tissues, such as fibrous cord-like and grid-like shadows, with slow absorption of the lesions. (t–y) At day 730 after the onset, reexamination by CT scanning demonstrates that the lesions at both lungs are still mainly changes of pulmonary interstitial tissues, such as fibrous cord-like and grid-like shadows with rare ground-glass opacity. Compare to previous chest CT findings; the lesions at both lungs are slightly absorbed', 'hash': '6eae50d467e76616e7ab3f687d860e39d4f32409bd62303114076b733b5cf5a1'}, {'image_id': '324949_1_En_18_Fig4e_HTML', 'image_file_name': '324949_1_En_18_Fig4e_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig4e_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H5N1). (a) At day 6 after the onset, the left middle and lower lung fields are demonstrated with large flakes of shadows with increased density and poorly defined boundary. Some lesions are demonstrated as ground-glass opacity and the left hilum is poorly defined. (b) At day 8 after the onset, the conditions progress rapidly with large flakes of increased density shadow at the left lung in white lung sign. Flakes of increased density shadow are demonstrated at the right hilar area, right middle lung, as well as middle and medial parts of the right lower lung field. (c) At day 9 after the onset, the left lung field is demonstrated with large flakes of shadow and the right lung is demonstrated with slightly larger range with lesions. (d) At day 10 after the onset, the left lower lung field is demonstrated with slightly light shadow indicating partially absorption of some lesions. The right lung is demonstrated with obviously larger range with lesions. (e) At day 11 after the onset, the left upper and middle lung fields are demonstrated with slightly light shadows. The right lung is demonstrated with continued expansion of the range with lesions of increased density, especially at the right middle and lower lung fields. (f) At day 14 after the onset, the shadows at the left middle and lower lung fields as well as at the middle and lateral parts of right middle and lower lung fields are demonstrated to be lightened, indicating absorption of some lesions. (g) At day 20 after the onset, both lungs are demonstrated with patches of shadows. The middle and lateral parts of both middle lung fields are demonstrated with small flakes of light blurry shadows. The left lower lung field is demonstrated with slight decreased transparency. The left costophrenic angle is demonstrated to be poorly defined. (h) At day 22 after the onset, the right lung field is demonstrated with patches and large flakes of consolidation shadows. The left lung field is demonstrated with diffuse increased density shadows. The left diaphragmatic surface and left costophrenic angle are poorly defined. The conditions progressed. (i) At day 28 after the onset, the left lung is demonstrated with diffuse increased density consolidation. The right lung is demonstrated with large flakes and patches of shadows. Some lung fields are demonstrated with increased transparency. The mediastinum is demonstrated with slight shift leftwards. (j) At day 30 after the onset, the left lung is demonstrated with systemic increased density consolidation shadow. The right lung is demonstrated with large flakes and patches of shadows, with slightly more lesions. (k) At day 32 after the onset, the right middle and lower lung is demonstrated with large flakes and cord-like shadows. The left middle and lower lung is demonstrated with systemic increased density consolidation shadow. The lesions at the right lung and the left upper lung are absorbed, with improved transparency. (l) At day 34 after the onset, the right lung is demonstrated with patches and cord-like increased density shadows. The left lung is demonstrated with systemic light increased density shadows. The lesions at both lungs are obviously absorbed. (m) At day 47 after the onset, the medial part the right lower lung is demonstrated with dense strips of shadows, with poorly defined right heart margin. The left lung is demonstrated with dense cord-like shadows, with well-defined boundary, patches, and spots of shadows as well as less cord-like shadows. (n) At day 53 after the onset, both middle and lower lung fields are demonstrated with less patches of high-density shadows, with scattering cord-like shadows and well-defined boundary. The lesion at the right cardiophrenic angle is demonstrated with cystic dilation of bronchus. Most fields of both lungs are demonstrated with no abnormality. (o) At day 79 after the onset, both lungs are demonstrated with scattering patches and cord-like high-density shadows that are well defined. The lesions are characterized by fibrosis. (p) At day 172 after the onset, both lungs are demonstrated with scattering spots and cord-like high-density shadows with well-defined boundary', 'hash': '261740d909045e1a1e2ef923d92d7057a5b55d404e0beb935da90edbcde85116'}, {'image_id': '324949_1_En_18_Fig1b_HTML', 'image_file_name': '324949_1_En_18_Fig1b_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig1b_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H5N1). (a) At day 5 after the onset, X-ray demonstrates small flakes of light blurry shadow at the left upper lung. (b) At day 9 after the onset, the lesions at the left upper lung rapidly spread to the upper and middle lung fields with accompanying pulmonary tissue atrophy and collapse and inner air bronchus sign. The right lung is demonstrated with patches of blurry shadow at the medial part. (c) At day 13 after the onset, the lesions at the left lung spread to the whole lung with white lung sign. The pulmonary atrophy and collapse are aggravated. And the right lung is demonstrated with more lesions. (d) At day 15 after the onset, CT scanning demonstrates collapse of the left thorax, large quantities of flakes, and cord-like shadow at the left lung and the upper right lung lobe with inner air bronchus sign. Some pulmonary tissues herniate into the anterior-posterior mediastinum with leftward shift of the mediastinum. (e) At day 22 after the onset, HRCT demonstrates that all lesions at both lungs are absorbed but aggravated atrophy and collapse of the left lung tissue as well as aggravated mediastinal herniation. (f) At day 31 after the onset, the lesions at both lungs are obviously absorbed. The absorption at the left anterolateral lung is more obvious than that at the posteromedial lung. (g) At day 53 after the onset, HRCT demonstrates more cord-like shadow at the left upper lung with grid-like change. The right upper lung lobe is demonstrated with small quantities of cord-like shadow and ground-glass opacity, with leftward shift of the mediastinum. (h) By reexamination after 11 months, CT scanning still demonstrates cord-like shadow and slight leftward shift of the mediastinum', 'hash': '93a443f1ee9124b4f5146135c4fe68fa796a21b0a53212e1b0c86f06c6a96f66'}, {'image_id': '324949_1_En_18_Fig4c_HTML', 'image_file_name': '324949_1_En_18_Fig4c_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig4c_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H5N1). (a) At day 6 after the onset, the left middle and lower lung fields are demonstrated with large flakes of shadows with increased density and poorly defined boundary. Some lesions are demonstrated as ground-glass opacity and the left hilum is poorly defined. (b) At day 8 after the onset, the conditions progress rapidly with large flakes of increased density shadow at the left lung in white lung sign. Flakes of increased density shadow are demonstrated at the right hilar area, right middle lung, as well as middle and medial parts of the right lower lung field. (c) At day 9 after the onset, the left lung field is demonstrated with large flakes of shadow and the right lung is demonstrated with slightly larger range with lesions. (d) At day 10 after the onset, the left lower lung field is demonstrated with slightly light shadow indicating partially absorption of some lesions. The right lung is demonstrated with obviously larger range with lesions. (e) At day 11 after the onset, the left upper and middle lung fields are demonstrated with slightly light shadows. The right lung is demonstrated with continued expansion of the range with lesions of increased density, especially at the right middle and lower lung fields. (f) At day 14 after the onset, the shadows at the left middle and lower lung fields as well as at the middle and lateral parts of right middle and lower lung fields are demonstrated to be lightened, indicating absorption of some lesions. (g) At day 20 after the onset, both lungs are demonstrated with patches of shadows. The middle and lateral parts of both middle lung fields are demonstrated with small flakes of light blurry shadows. The left lower lung field is demonstrated with slight decreased transparency. The left costophrenic angle is demonstrated to be poorly defined. (h) At day 22 after the onset, the right lung field is demonstrated with patches and large flakes of consolidation shadows. The left lung field is demonstrated with diffuse increased density shadows. The left diaphragmatic surface and left costophrenic angle are poorly defined. The conditions progressed. (i) At day 28 after the onset, the left lung is demonstrated with diffuse increased density consolidation. The right lung is demonstrated with large flakes and patches of shadows. Some lung fields are demonstrated with increased transparency. The mediastinum is demonstrated with slight shift leftwards. (j) At day 30 after the onset, the left lung is demonstrated with systemic increased density consolidation shadow. The right lung is demonstrated with large flakes and patches of shadows, with slightly more lesions. (k) At day 32 after the onset, the right middle and lower lung is demonstrated with large flakes and cord-like shadows. The left middle and lower lung is demonstrated with systemic increased density consolidation shadow. The lesions at the right lung and the left upper lung are absorbed, with improved transparency. (l) At day 34 after the onset, the right lung is demonstrated with patches and cord-like increased density shadows. The left lung is demonstrated with systemic light increased density shadows. The lesions at both lungs are obviously absorbed. (m) At day 47 after the onset, the medial part the right lower lung is demonstrated with dense strips of shadows, with poorly defined right heart margin. The left lung is demonstrated with dense cord-like shadows, with well-defined boundary, patches, and spots of shadows as well as less cord-like shadows. (n) At day 53 after the onset, both middle and lower lung fields are demonstrated with less patches of high-density shadows, with scattering cord-like shadows and well-defined boundary. The lesion at the right cardiophrenic angle is demonstrated with cystic dilation of bronchus. Most fields of both lungs are demonstrated with no abnormality. (o) At day 79 after the onset, both lungs are demonstrated with scattering patches and cord-like high-density shadows that are well defined. The lesions are characterized by fibrosis. (p) At day 172 after the onset, both lungs are demonstrated with scattering spots and cord-like high-density shadows with well-defined boundary', 'hash': '8421db66f0c3300b4b71a57512e8e5dc3ab01b775354942e81b437c95b3d541a'}, {'image_id': '324949_1_En_18_Fig5c_HTML', 'image_file_name': '324949_1_En_18_Fig5c_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig5c_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H5N1). (a–h) At day 7 after the onset, CT scanning demonstrates light small flakes of shadows at the posterior segment of the right upper lung lobe and medial segment of the right middle lung lobe. The apical posterior and anterior segments of the left upper lung lobe are demonstrated with irregular small flakes of consolidation shadows. The lingual segment of the upper lung lobe and most segments of the lower lung lobe are demonstrated with large flakes of dense consolidation shadow, with inner air bronchus sign. The left pleural cavity is demonstrated with rare liquid density shadow. (i) The liver and spleen are subject to obvious enlargement and diffuse lesion. (j–o) At day 172 after the onset, CT scanning demonstrates that the lesions at both lungs are fibrous cord-like and grid-like shadows, rigidity of some vascular markings, and no obvious absorption of the lesions. (p–s) At day 286 after the onset, CT scanning demonstrates that the lesions at both lungs are still mainly changes of pulmonary interstitial tissues, such as fibrous cord-like and grid-like shadows, with slow absorption of the lesions. (t–y) At day 730 after the onset, reexamination by CT scanning demonstrates that the lesions at both lungs are still mainly changes of pulmonary interstitial tissues, such as fibrous cord-like and grid-like shadows with rare ground-glass opacity. Compare to previous chest CT findings; the lesions at both lungs are slightly absorbed', 'hash': 'cffa98aa85b6746fcb248a38baf19cee875375f37ba8880696a28cd039d244ac'}, {'image_id': '324949_1_En_18_Fig7c_HTML', 'image_file_name': '324949_1_En_18_Fig7c_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig7c_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H7N9). (a) At day 4 after the onset, X-ray demonstrates large flakes of high-density shadows at the left lower lung field and overlapping of some lesions with the heart shadow. (b) At day 5 after the onset, X-ray demonstrates large flakes of ground-glass opacity and consolidation shadows at the left lung. The left costophrenic angle and diaphragmatic surface are poorly defined. The right upper lung field is demonstrated with large flakes of increased density shadows with thickened horizontal fissure. Compared to the previous X-ray finding, the range with lesions at both lungs is obviously enlarged. (c–f) At day 6 after the onset, CT scanning demonstrates flakes of ground-glass opacity at the right upper lung and left lower lung, with consolidation shadow at the left lower lung and a little pleural effusion at the right side. (g–i) At day 12 after the onset, reexamination by CT scanning demonstrates that the lesions at the right lung are basically absorbed while most of the lesions at the left lower lung are absorbed, but still with patches of shadows. The clinical symptoms are obviously alleviated. (j, k) At day 18 after the onset, CT scanning demonstrates slight absorption of the lesions at the left lung and left pleural effusion. (l, m) At day 25 after the onset, chest CT scanning demonstrates the lesions at the left lung continue to be absorbed and left pleural effusion is absorbed apparently', 'hash': 'b628d8adbbe1793d836b5bbfb6281e5019009b36d5e8c6459a52b187612f1e0b'}, {'image_id': '324949_1_En_18_Fig5d_HTML', 'image_file_name': '324949_1_En_18_Fig5d_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig5d_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H5N1). (a–h) At day 7 after the onset, CT scanning demonstrates light small flakes of shadows at the posterior segment of the right upper lung lobe and medial segment of the right middle lung lobe. The apical posterior and anterior segments of the left upper lung lobe are demonstrated with irregular small flakes of consolidation shadows. The lingual segment of the upper lung lobe and most segments of the lower lung lobe are demonstrated with large flakes of dense consolidation shadow, with inner air bronchus sign. The left pleural cavity is demonstrated with rare liquid density shadow. (i) The liver and spleen are subject to obvious enlargement and diffuse lesion. (j–o) At day 172 after the onset, CT scanning demonstrates that the lesions at both lungs are fibrous cord-like and grid-like shadows, rigidity of some vascular markings, and no obvious absorption of the lesions. (p–s) At day 286 after the onset, CT scanning demonstrates that the lesions at both lungs are still mainly changes of pulmonary interstitial tissues, such as fibrous cord-like and grid-like shadows, with slow absorption of the lesions. (t–y) At day 730 after the onset, reexamination by CT scanning demonstrates that the lesions at both lungs are still mainly changes of pulmonary interstitial tissues, such as fibrous cord-like and grid-like shadows with rare ground-glass opacity. Compare to previous chest CT findings; the lesions at both lungs are slightly absorbed', 'hash': '4f0b51c322696e2e8ccab4285e0a81b03de09cb2ce406064164ea872bfd416b8'}, {'image_id': '324949_1_En_18_Fig4d_HTML', 'image_file_name': '324949_1_En_18_Fig4d_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig4d_HTML.jpg', 'caption': 'Pneumonia complicating human infection of avian influenza (H5N1). (a) At day 6 after the onset, the left middle and lower lung fields are demonstrated with large flakes of shadows with increased density and poorly defined boundary. Some lesions are demonstrated as ground-glass opacity and the left hilum is poorly defined. (b) At day 8 after the onset, the conditions progress rapidly with large flakes of increased density shadow at the left lung in white lung sign. Flakes of increased density shadow are demonstrated at the right hilar area, right middle lung, as well as middle and medial parts of the right lower lung field. (c) At day 9 after the onset, the left lung field is demonstrated with large flakes of shadow and the right lung is demonstrated with slightly larger range with lesions. (d) At day 10 after the onset, the left lower lung field is demonstrated with slightly light shadow indicating partially absorption of some lesions. The right lung is demonstrated with obviously larger range with lesions. (e) At day 11 after the onset, the left upper and middle lung fields are demonstrated with slightly light shadows. The right lung is demonstrated with continued expansion of the range with lesions of increased density, especially at the right middle and lower lung fields. (f) At day 14 after the onset, the shadows at the left middle and lower lung fields as well as at the middle and lateral parts of right middle and lower lung fields are demonstrated to be lightened, indicating absorption of some lesions. (g) At day 20 after the onset, both lungs are demonstrated with patches of shadows. The middle and lateral parts of both middle lung fields are demonstrated with small flakes of light blurry shadows. The left lower lung field is demonstrated with slight decreased transparency. The left costophrenic angle is demonstrated to be poorly defined. (h) At day 22 after the onset, the right lung field is demonstrated with patches and large flakes of consolidation shadows. The left lung field is demonstrated with diffuse increased density shadows. The left diaphragmatic surface and left costophrenic angle are poorly defined. The conditions progressed. (i) At day 28 after the onset, the left lung is demonstrated with diffuse increased density consolidation. The right lung is demonstrated with large flakes and patches of shadows. Some lung fields are demonstrated with increased transparency. The mediastinum is demonstrated with slight shift leftwards. (j) At day 30 after the onset, the left lung is demonstrated with systemic increased density consolidation shadow. The right lung is demonstrated with large flakes and patches of shadows, with slightly more lesions. (k) At day 32 after the onset, the right middle and lower lung is demonstrated with large flakes and cord-like shadows. The left middle and lower lung is demonstrated with systemic increased density consolidation shadow. The lesions at the right lung and the left upper lung are absorbed, with improved transparency. (l) At day 34 after the onset, the right lung is demonstrated with patches and cord-like increased density shadows. The left lung is demonstrated with systemic light increased density shadows. The lesions at both lungs are obviously absorbed. (m) At day 47 after the onset, the medial part the right lower lung is demonstrated with dense strips of shadows, with poorly defined right heart margin. The left lung is demonstrated with dense cord-like shadows, with well-defined boundary, patches, and spots of shadows as well as less cord-like shadows. (n) At day 53 after the onset, both middle and lower lung fields are demonstrated with less patches of high-density shadows, with scattering cord-like shadows and well-defined boundary. The lesion at the right cardiophrenic angle is demonstrated with cystic dilation of bronchus. Most fields of both lungs are demonstrated with no abnormality. (o) At day 79 after the onset, both lungs are demonstrated with scattering patches and cord-like high-density shadows that are well defined. The lesions are characterized by fibrosis. (p) At day 172 after the onset, both lungs are demonstrated with scattering spots and cord-like high-density shadows with well-defined boundary', 'hash': '2f2ff3134b147183ff3fe4c54bb886812eae6c4af0e347a69ac0b3f7b7b35172'}, {'image_id': '324949_1_En_18_Fig8b_HTML', 'image_file_name': '324949_1_En_18_Fig8b_HTML.jpg', 'image_path': '../data/media_files/PMC7120431/324949_1_En_18_Fig8b_HTML.jpg', 'caption': 'Pneumonia and pleural effusion complicating human infection of avian influenza H7N9. (a–d) On March 27, 2013, CT scanning demonstrates large flake of consolidation at the right lung with air bronchus sign as well as ground-glass opacity and patches of shadows at both lungs. (e) On March 31, 2013, X-ray demonstrates consolidation shadows at both lungs that are more obvious at the right upper lung and enlarged heart shadow. (f) On April 10, 2013, consolidation shadow at the right upper lung is demonstrated to be absorbed slightly and bilateral costophrenic angles are demonstrated to be blunt (Note: The case and the figures were provided by Tang YH from Ruijin Hospital, Shanghai, China)', 'hash': '7f7c0a86fb44c8c4d11193febe57d71ee751be375981fdb0e2da6f82ed3664b5'}] | {'324949_1_En_18_Fig1a_HTML': ['The lesions of pneumonia in the cases of human infected avian influenza are gradually absorbed within 15–30 days, and the lesions of most patients can be completely absorbed. However, in rare cases, the lesions are partially absorbed with development of fibrosis or proliferation of pulmonary interstitial tissues. Obvious proliferation of pulmonary interstitial tissues may occur 30–40 days after the onset, firstly occurring as thickening of interlobular septum and intralobular interstitium as well as subpleural arc shape linear shadow. The flakes of shadow at the lungs shrink with increased density, with following occurrence of high-density cord-like or honeycomb-like shadow. In some serious cases, pulmonary interstitial proliferation causes shrinkage of lung volume and shift of mediastinum towards the affected lung. Pulmonary interstitial proliferation may extensively exist at the lungs, characterized by thickening of interlobular septum, intralobular septum, and interstitium as well as subpleural arch shape linear shadow. Pulmonary interstitial fibrosis is characterized by honeycomb-like shadow and referred bronchiectasis. After the conditions remain stable, the lesions begin to be absorbed, with decreased range and decreased density. In some cases, despite no abnormal findings by X-ray, CT scanning still demonstrates light ground-glass opacity, which may remain for a long period of time. Therefore, regular CT scanning is recommended to demonstrate lesions that fail to be demonstrated by X-ray. The reexaminations by CT scanning should be regularly performed till complete absorption of the lesions. During absorption of the lesions, pulmonary interstitial proliferations may be observed (Figs. <xref rid="324949_1_En_18_Fig1a_HTML" ref-type="fig">18.1</xref>, , <xref rid="324949_1_En_18_Fig2_HTML" ref-type="fig">18.2</xref>, , <xref rid="324949_1_En_18_Fig3_HTML" ref-type="fig">18.3</xref>, , <xref rid="324949_1_En_18_Fig4a_HTML" ref-type="fig">18.4</xref>, and , and <xref rid="324949_1_En_18_Fig5a_HTML" ref-type="fig">18.5</xref>).).Fig. 18.1Pneumonia complicating human infection of avian influenza (H5N1). (a) At day 5 after the onset, X-ray demonstrates small flakes of light blurry shadow at the left upper lung. (b) At day 9 after the onset, the lesions at the left upper lung rapidly spread to the upper and middle lung fields with accompanying pulmonary tissue atrophy and collapse and inner air bronchus sign. The right lung is demonstrated with patches of blurry shadow at the medial part. (c) At day 13 after the onset, the lesions at the left lung spread to the whole lung with white lung sign. The pulmonary atrophy and collapse are aggravated. And the right lung is demonstrated with more lesions. (d) At day 15 after the onset, CT scanning demonstrates collapse of the left thorax, large quantities of flakes, and cord-like shadow at the left lung and the upper right lung lobe with inner air bronchus sign. Some pulmonary tissues herniate into the anterior-posterior mediastinum with leftward shift of the mediastinum. (e) At day 22 after the onset, HRCT demonstrates that all lesions at both lungs are absorbed but aggravated atrophy and collapse of the left lung tissue as well as aggravated mediastinal herniation. (f) At day 31 after the onset, the lesions at both lungs are obviously absorbed. The absorption at the left anterolateral lung is more obvious than that at the posteromedial lung. (g) At day 53 after the onset, HRCT demonstrates more cord-like shadow at the left upper lung with grid-like change. The right upper lung lobe is demonstrated with small quantities of cord-like shadow and ground-glass opacity, with leftward shift of the mediastinum. (h) By reexamination after 11 months, CT scanning still demonstrates cord-like shadow and slight leftward shift of the mediastinum\nFig. 18.2Pneumonia complicating human infection of avian influenza (H5N1). (a) At day 6 after the onset, X-ray demonstrates large flakes of high-density shadow at the left upper lung, patches of blurry shadow at the right upper lung, and slightly narrowed left intercostal space. (b) At day 7 after the onset, the lesions at both lung increase obviously. (c) By reexamination after 8 months, CT scanning demonstrates that some ground-glass opacity and inferior line of the pleura at the left upper lung\nFig. 18.3Pneumonia complicating human infection of avian influenza H5N1. At day 4 after the onset, X-ray demonstrates diffuse consolidation at both lungs with inner air bronchus sign\nFig. 18.4Pneumonia complicating human infection of avian influenza (H5N1). (a) At day 6 after the onset, the left middle and lower lung fields are demonstrated with large flakes of shadows with increased density and poorly defined boundary. Some lesions are demonstrated as ground-glass opacity and the left hilum is poorly defined. (b) At day 8 after the onset, the conditions progress rapidly with large flakes of increased density shadow at the left lung in white lung sign. Flakes of increased density shadow are demonstrated at the right hilar area, right middle lung, as well as middle and medial parts of the right lower lung field. (c) At day 9 after the onset, the left lung field is demonstrated with large flakes of shadow and the right lung is demonstrated with slightly larger range with lesions. (d) At day 10 after the onset, the left lower lung field is demonstrated with slightly light shadow indicating partially absorption of some lesions. The right lung is demonstrated with obviously larger range with lesions. (e) At day 11 after the onset, the left upper and middle lung fields are demonstrated with slightly light shadows. The right lung is demonstrated with continued expansion of the range with lesions of increased density, especially at the right middle and lower lung fields. (f) At day 14 after the onset, the shadows at the left middle and lower lung fields as well as at the middle and lateral parts of right middle and lower lung fields are demonstrated to be lightened, indicating absorption of some lesions. (g) At day 20 after the onset, both lungs are demonstrated with patches of shadows. The middle and lateral parts of both middle lung fields are demonstrated with small flakes of light blurry shadows. The left lower lung field is demonstrated with slight decreased transparency. The left costophrenic angle is demonstrated to be poorly defined. (h) At day 22 after the onset, the right lung field is demonstrated with patches and large flakes of consolidation shadows. The left lung field is demonstrated with diffuse increased density shadows. The left diaphragmatic surface and left costophrenic angle are poorly defined. The conditions progressed. (i) At day 28 after the onset, the left lung is demonstrated with diffuse increased density consolidation. The right lung is demonstrated with large flakes and patches of shadows. Some lung fields are demonstrated with increased transparency. The mediastinum is demonstrated with slight shift leftwards. (j) At day 30 after the onset, the left lung is demonstrated with systemic increased density consolidation shadow. The right lung is demonstrated with large flakes and patches of shadows, with slightly more lesions. (k) At day 32 after the onset, the right middle and lower lung is demonstrated with large flakes and cord-like shadows. The left middle and lower lung is demonstrated with systemic increased density consolidation shadow. The lesions at the right lung and the left upper lung are absorbed, with improved transparency. (l) At day 34 after the onset, the right lung is demonstrated with patches and cord-like increased density shadows. The left lung is demonstrated with systemic light increased density shadows. The lesions at both lungs are obviously absorbed. (m) At day 47 after the onset, the medial part the right lower lung is demonstrated with dense strips of shadows, with poorly defined right heart margin. The left lung is demonstrated with dense cord-like shadows, with well-defined boundary, patches, and spots of shadows as well as less cord-like shadows. (n) At day 53 after the onset, both middle and lower lung fields are demonstrated with less patches of high-density shadows, with scattering cord-like shadows and well-defined boundary. The lesion at the right cardiophrenic angle is demonstrated with cystic dilation of bronchus. Most fields of both lungs are demonstrated with no abnormality. (o) At day 79 after the onset, both lungs are demonstrated with scattering patches and cord-like high-density shadows that are well defined. The lesions are characterized by fibrosis. (p) At day 172 after the onset, both lungs are demonstrated with scattering spots and cord-like high-density shadows with well-defined boundary\nFig. 18.5Pneumonia complicating human infection of avian influenza (H5N1). (a–h) At day 7 after the onset, CT scanning demonstrates light small flakes of shadows at the posterior segment of the right upper lung lobe and medial segment of the right middle lung lobe. The apical posterior and anterior segments of the left upper lung lobe are demonstrated with irregular small flakes of consolidation shadows. The lingual segment of the upper lung lobe and most segments of the lower lung lobe are demonstrated with large flakes of dense consolidation shadow, with inner air bronchus sign. The left pleural cavity is demonstrated with rare liquid density shadow. (i) The liver and spleen are subject to obvious enlargement and diffuse lesion. (j–o) At day 172 after the onset, CT scanning demonstrates that the lesions at both lungs are fibrous cord-like and grid-like shadows, rigidity of some vascular markings, and no obvious absorption of the lesions. (p–s) At day 286 after the onset, CT scanning demonstrates that the lesions at both lungs are still mainly changes of pulmonary interstitial tissues, such as fibrous cord-like and grid-like shadows, with slow absorption of the lesions. (t–y) At day 730 after the onset, reexamination by CT scanning demonstrates that the lesions at both lungs are still mainly changes of pulmonary interstitial tissues, such as fibrous cord-like and grid-like shadows with rare ground-glass opacity. Compare to previous chest CT findings; the lesions at both lungs are slightly absorbed\n'], '324949_1_En_18_Fig6a_HTML': ['The cases complicated by pneumonia are radiologically demonstrated with flakes of shadow at the lungs. In severe cases, the conditions progress rapidly, with ground-glass opacity, pulmonary consolidation shadow, and accompanying small quantity of pleural effusion (Figs. <xref rid="324949_1_En_18_Fig6a_HTML" ref-type="fig">18.6</xref>, , <xref rid="324949_1_En_18_Fig7a_HTML" ref-type="fig">18.7</xref>, , <xref rid="324949_1_En_18_Fig8a_HTML" ref-type="fig">18.8</xref>, and , and <xref rid="324949_1_En_18_Fig9_HTML" ref-type="fig">18.9</xref>). In the cases with ARDS, the lesions are extensively distributed.). In the cases with ARDS, the lesions are extensively distributed.Fig. 18.6Pneumonia complicating human infection of avian influenza (H7N9). (a) At day 4 after the onset, X-ray demonstrates small flakes of dense shadow at the left lower lung field and small flakes of light blurry shadows at the right lower lung field. The left costophrenic angle is poorly defined and the pulmonary markings at the right lung are also enhanced. (b) At day 5 after the onset, X-ray demonstrates large flakes of dense shadow at the left middle and lower lung fields as well as scattering patches of shadows at the right lung. The conditions progress. (c) At day 6 after the onset, the range with lesions at the right lung is enlarged. (d) At day 7 after the onset, X-ray demonstrates strips of dense shadow at the right middle lung field with inner cavity-like lesion. The conditions progress. (e) At day 8 after the onset, the lesions show no obvious change. (f) At day 12 after the onset, the lesions are obviously absorbed, but dense shadows are demonstrated at the lateral part of the left lower lung field. (g) At day 14 after the onset, the lesions at the left lower lung field are absorbed obviously. (h) At day 18 after the onset, the lesions at both lungs are completely absorbed, with clearly defined lung markings and no enlarged hilar shadow (Note: The case and the figures were provided by Zhao QX and Yang YJ from Infectious Diseases Hospital, Zhengzhou, Henan, China)\nFig. 18.7Pneumonia complicating human infection of avian influenza (H7N9). (a) At day 4 after the onset, X-ray demonstrates large flakes of high-density shadows at the left lower lung field and overlapping of some lesions with the heart shadow. (b) At day 5 after the onset, X-ray demonstrates large flakes of ground-glass opacity and consolidation shadows at the left lung. The left costophrenic angle and diaphragmatic surface are poorly defined. The right upper lung field is demonstrated with large flakes of increased density shadows with thickened horizontal fissure. Compared to the previous X-ray finding, the range with lesions at both lungs is obviously enlarged. (c–f) At day 6 after the onset, CT scanning demonstrates flakes of ground-glass opacity at the right upper lung and left lower lung, with consolidation shadow at the left lower lung and a little pleural effusion at the right side. (g–i) At day 12 after the onset, reexamination by CT scanning demonstrates that the lesions at the right lung are basically absorbed while most of the lesions at the left lower lung are absorbed, but still with patches of shadows. The clinical symptoms are obviously alleviated. (j, k) At day 18 after the onset, CT scanning demonstrates slight absorption of the lesions at the left lung and left pleural effusion. (l, m) At day 25 after the onset, chest CT scanning demonstrates the lesions at the left lung continue to be absorbed and left pleural effusion is absorbed apparently\nFig. 18.8Pneumonia and pleural effusion complicating human infection of avian influenza H7N9. (a–d) On March 27, 2013, CT scanning demonstrates large flake of consolidation at the right lung with air bronchus sign as well as ground-glass opacity and patches of shadows at both lungs. (e) On March 31, 2013, X-ray demonstrates consolidation shadows at both lungs that are more obvious at the right upper lung and enlarged heart shadow. (f) On April 10, 2013, consolidation shadow at the right upper lung is demonstrated to be absorbed slightly and bilateral costophrenic angles are demonstrated to be blunt (Note: The case and the figures were provided by Tang YH from Ruijin Hospital, Shanghai, China)\nFig. 18.9Pneumonia complicating human infection of avian influenza (H7N9). (a) X-ray demonstrates large flakes of high-density shadow at both lungs. (b, c) CT scanning demonstrates consolidation at both lungs (Note: The case and the figures were provided by Cheng JL from the First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China)\n']} | Highly Pathogenic Avian Influenza | [
"Influenza Virus",
"Acute Lung Injury",
"Acute Respiratory Distress Syndrome",
"Avian Influenza",
"Severe Acute Respiratory Syndrome"
] | None | 1430377200 | None | null | other | PMC7120431 | null | null | [
""
] | Radiology of Infectious Diseases: Volume 1. 2015 Apr 30;:157-189 | NO-CC CODE |
|
Clinical features of RAS and BOS. (a) Pulmonary function of a patient diagnosed with BOS. The upper graph shows a decline in FVC, the lower graph a decline in FEV1. (b) HRCT of a patient diagnosed with BOS (c) Pulmonary function of a patient diagnosed with RAS. The upper graph shows a decline in FVC, the middle graph a decline in FEV1 and the lower graph a decline in TLC. (d) HRCT of a patient diagnosed with RAS. BOS bronchiolitis obliterans syndrome, FVC forced vital capacity, FEV1 forced expiratory volume in 1 second, HRCT high resolution computed tomography, RAS restrictive allograft syndrome, TLC total lung capacity | 459911_1_En_22_Fig8d_HTML | 7 | fc98e7e0fd6fa30fae7d00069ff22fb70e4f54018b7de5ed773acb20605841ce | 459911_1_En_22_Fig8d_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
627,
269
] | [{'image_id': '459911_1_En_22_Fig5_HTML', 'image_file_name': '459911_1_En_22_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig5_HTML.jpg', 'caption': 'Rehospitalisation post lung transplant. This figure shows the hospitalizations reported on the 1-year, 3-year, and 5-year follow-up. All follow-ups between January 2009 and June 2017 were included. (Based on data from the International Society of Heart and Lung Transplantation)', 'hash': '06ef94feddaed9f2ff6948e88741bd971ee7604c3c89011521940e3e7370d5af'}, {'image_id': '459911_1_En_22_Fig8c_HTML', 'image_file_name': '459911_1_En_22_Fig8c_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig8c_HTML.jpg', 'caption': 'Clinical features of RAS and BOS. (a) Pulmonary function of a patient diagnosed with BOS. The upper graph shows a decline in FVC, the lower graph a decline in FEV1. (b) HRCT of a patient diagnosed with BOS (c) Pulmonary function of a patient diagnosed with RAS. The upper graph shows a decline in FVC, the middle graph a decline in FEV1 and the lower graph a decline in TLC. (d) HRCT of a patient diagnosed with RAS. BOS bronchiolitis obliterans syndrome, FVC forced vital capacity, FEV1 forced expiratory volume in 1\xa0second, HRCT high resolution computed tomography, RAS restrictive allograft syndrome, TLC total lung capacity', 'hash': '78450c6322c66e9ffe9ef89606004b25a2ec15df054e575f503d6c3ba232bb05'}, {'image_id': '459911_1_En_22_Fig10_HTML', 'image_file_name': '459911_1_En_22_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig10_HTML.jpg', 'caption': 'Kaplan Meier Survival curve after lung transplantation. Lung transplantations performed in UZ Leuven, Belgium from July 1991 till December 2018 in the KU Leuven Lung Transplant Unit were included', 'hash': 'f5617c4a00f0a68c528a15e72f241aef6c4feea4cf65142895041e2db947f8c2'}, {'image_id': '459911_1_En_22_Fig2_HTML', 'image_file_name': '459911_1_En_22_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig2_HTML.jpg', 'caption': 'Evolution in numbers and percentage of extended-criteria lung donors [16]. SCD standard-criteria donor, ECD extended-criteria lung donor', 'hash': 'efbf82b3380b288529f1289f66333325713b7950decd891c37715110f28a6ff3'}, {'image_id': '459911_1_En_22_Fig8d_HTML', 'image_file_name': '459911_1_En_22_Fig8d_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig8d_HTML.jpg', 'caption': 'Clinical features of RAS and BOS. (a) Pulmonary function of a patient diagnosed with BOS. The upper graph shows a decline in FVC, the lower graph a decline in FEV1. (b) HRCT of a patient diagnosed with BOS (c) Pulmonary function of a patient diagnosed with RAS. The upper graph shows a decline in FVC, the middle graph a decline in FEV1 and the lower graph a decline in TLC. (d) HRCT of a patient diagnosed with RAS. BOS bronchiolitis obliterans syndrome, FVC forced vital capacity, FEV1 forced expiratory volume in 1\xa0second, HRCT high resolution computed tomography, RAS restrictive allograft syndrome, TLC total lung capacity', 'hash': 'fc98e7e0fd6fa30fae7d00069ff22fb70e4f54018b7de5ed773acb20605841ce'}, {'image_id': '459911_1_En_22_Fig8b_HTML', 'image_file_name': '459911_1_En_22_Fig8b_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig8b_HTML.jpg', 'caption': 'Clinical features of RAS and BOS. (a) Pulmonary function of a patient diagnosed with BOS. The upper graph shows a decline in FVC, the lower graph a decline in FEV1. (b) HRCT of a patient diagnosed with BOS (c) Pulmonary function of a patient diagnosed with RAS. The upper graph shows a decline in FVC, the middle graph a decline in FEV1 and the lower graph a decline in TLC. (d) HRCT of a patient diagnosed with RAS. BOS bronchiolitis obliterans syndrome, FVC forced vital capacity, FEV1 forced expiratory volume in 1\xa0second, HRCT high resolution computed tomography, RAS restrictive allograft syndrome, TLC total lung capacity', 'hash': '1e6633edf1d0b4c57f006f9cbf4ebec038ee7ae53398568dbd6746c0ccf10038'}, {'image_id': '459911_1_En_22_Fig4_HTML', 'image_file_name': '459911_1_En_22_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig4_HTML.jpg', 'caption': 'Histopathological findings in patients with acute lung allograft rejection [55]. (a) Minimal acute cellular rejection (grade A1, ×40). The hallmark feature of acute cellular rejection is the presence of truly circumferential perivascular cellular infiltrates around blood vessels in the alveolar parenchyma, particularly small veins. These perivascular cuffs consist of mononuclear cells, two to three cells in thickness. Eosinophililic infiltration, endothelialitis or expansion of the cellular infiltrate into the alveolar septa is absent in minimal acute rejection. (b) High-grade lymphocytic bronchiolitis (grade B2R). The lamina propria contains a prominent infiltrate of activated lymphocytes; admixed with some plasmacytoid cells, neutrophils, and eosinophils. This mononuclear infiltrate extends into the epithelium, with the presence of prominent intra-epithelial lymphocytes. The overlying epithelium further shows signs of epithelial damage, evidenced by necrosis and apoptosis. (Representative pictures from selected cases from the KULeuven Lung Transplant Unit)', 'hash': 'ff88802c4581737c0533c2ce9f78f9bcbadb2534d85b699692de91bc12d4b060'}, {'image_id': '459911_1_En_22_Fig3_HTML', 'image_file_name': '459911_1_En_22_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig3_HTML.jpg', 'caption': 'CT at 72\xa0hours posttransplantation of a patient diagnosed with PGD. PGD scores were 1, 3, and 2 at 24, 48, and 72\xa0hours of posttransplantation, respectively, according to the ISHLT grading system of PGD [37]. CT computed tomography, PGD primary graft dysfunction, ISHLT International Society for Heart and Lung Transplantation', 'hash': '86dfcd1279135a80e7c484157af3f3895aff02c447c67c892b3d14e5d49ea7e1'}, {'image_id': '459911_1_En_22_Fig7_HTML', 'image_file_name': '459911_1_En_22_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig7_HTML.jpg', 'caption': 'Kaplan Meier CLAD curve after lung transplantation. Lung transplantations performed from January 2004 till December 2015 in UZ Leuven, Belgium were included. CLAD chronic lung allograft dysfunction, LTx lung transplantation', 'hash': 'c0edcc39d0896c0e8e49d671a4ae96cf9e6d848561d6d408472b2f0b77a0d9b7'}, {'image_id': '459911_1_En_22_Fig8a_HTML', 'image_file_name': '459911_1_En_22_Fig8a_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig8a_HTML.jpg', 'caption': 'Clinical features of RAS and BOS. (a) Pulmonary function of a patient diagnosed with BOS. The upper graph shows a decline in FVC, the lower graph a decline in FEV1. (b) HRCT of a patient diagnosed with BOS (c) Pulmonary function of a patient diagnosed with RAS. The upper graph shows a decline in FVC, the middle graph a decline in FEV1 and the lower graph a decline in TLC. (d) HRCT of a patient diagnosed with RAS. BOS bronchiolitis obliterans syndrome, FVC forced vital capacity, FEV1 forced expiratory volume in 1\xa0second, HRCT high resolution computed tomography, RAS restrictive allograft syndrome, TLC total lung capacity', 'hash': '3cdad38cdc4bda21730c543b1b7e157cc12d5043477bdd2f35288b8f0458b886'}, {'image_id': '459911_1_En_22_Fig1_HTML', 'image_file_name': '459911_1_En_22_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig1_HTML.jpg', 'caption': 'Average center volume for lung transplantation (not including heart-lung transplants)', 'hash': '3d52031f1278505907d0846d95d977ede23124ff66413a958b9c2852992a644e'}, {'image_id': '459911_1_En_22_Fig9_HTML', 'image_file_name': '459911_1_En_22_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig9_HTML.jpg', 'caption': 'Prevalence of causes of chronic pulmonary function decline [66]. CLAD chronic lung allograft dysfunction, RAS restrictive allograft syndrome, BOS bronchiolitis obliterans syndrome', 'hash': '61f48192e986da5dcb861ccf5d05520418554a146afaaf2cee73588fd2cae4fa'}, {'image_id': '459911_1_En_22_Fig6_HTML', 'image_file_name': '459911_1_En_22_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig6_HTML.jpg', 'caption': 'Diagnosis of chronic lung allograft dysfunction [32]. In the case of suspected CLAD, all other causes of a decrease in FEV1 should be excluded. If no cause is found, a trial therapy with azithromycin should be started. If a patient is responsive (defined as an improvement in FEV1 with ≥10% after 3–6\xa0months azithromycin), this phenotype is referred to as ARAD. If a patient is nonresponsive, further investigations should differentiate between BOS and RAS. LAD lung allograft dysfunction, FEV1 forced expiratory volume in 1\xa0second, FVC forced vital capacity, TLC total lung capacity, ALAD acute lung allograft dysfunction, CLAD chronic lung allograft dysfunction, P-CLAD potential chronic lung allograft dysfunction, ACR acute cellular rejection, LB lymphocytic bronchiolitis, AMR antibody-mediated rejection, ARAD azithromycin responsive allograft dysfunction, RAS restrictive allograft syndrome, BOS bronchiolitis obliterans syndrome', 'hash': 'ec8d5b975f7d5824f3d09f206efda8cd6bfa64d3b0dd07f2ca186ee455bf59bb'}] | {'459911_1_En_22_Fig1_HTML': ['The history of lung transplantation starts in the 1940s: researchers tried to perform lung transplantation, initially in laboratory animals followed by human to human. Many of these early attempts were unsuccessful, and even after successful lung transplantation, most lungs were ultimately rejected despite the use of various immunosuppressants available at that time. The first human single lung transplantation was performed in 1963 by James Hardy in Mississippi, using the left lung of a circulatory death donor. The patient survived for 18\xa0days before dying of renal failure. Over the next decade, many more lung transplantations were performed, with limited success: few patients survived over 2 weeks. At that time, the leading causes of death were peri-operative problems. Subsequent improvements in surgical techniques and especially the introduction of immunosuppressive drugs such as cyclosporin and tacrolimus resulted in rapid progress in the 1980s, with the first successful heart-lung transplantation in 1981 in Stanford by Bruce Reitz and the first single lung transplantation in Toronto in 1983 by Joel Cooper [1]. The second successful lung transplantation from a circulatory death donor was reported by Steen [2]. These advances led to higher success rates and transplant centers all over the world started developing their programs. Today over 100 transplant centers in Europe and North America are active, although the majority of lung transplantations is still performed in a small number of highly specialized centers (see Fig. <xref rid="459911_1_En_22_Fig1_HTML" ref-type="fig">22.1</xref>). As short-term survival improved substantially, more patients developed long-term complications [). As short-term survival improved substantially, more patients developed long-term complications [3]. These long-term complications compromised the initially increased quality of life (QoL) due to restored normal pulmonary function [4].Fig. 22.1Average center volume for lung transplantation (not including heart-lung transplants)\n'], '459911_1_En_22_Fig2_HTML': ['Not all organ donors are suitable to be lung donors. Strict criteria of the “standard-criteria lung donor” (SCD) have previously been defined; donors meeting these criteria are considered “ideal” (Table 22.2) [6]. Only 15–25% of all multi-organ donors are suitable for lung transplantation, due to injury from cardio-pulmonary resuscitation, lung contusion, airway aspiration, and pulmonary infection at the time of brain insult, as well as underlying lung disease [15]. This scarcity of suitable donor organs leads to persistent mortality of patients on the waiting list; and thus these criteria have been liberalized to “extended-criteria lung donors” (ECD) in order to increase the number of transplantable donor organs [7, 8]. ECD are lung donors not matching the strict criteria of an SCD, for example, because of pre-existing conditions, a smoking history of more than 20 pack-years or hepatitis, among others. There is no consensus about ECD, and multiple centers report different criteria [16–20]. This increase of transplantable lungs is associated with a negative impact on early outcome: prevalence of severe PGD, length of stay in intensive care unit (ICU) and duration of mechanical ventilation [16, 18]. There is still debate about whether the use of ECD lungs compromises long-term clinical outcomes [17–20]. Figure <xref rid="459911_1_En_22_Fig2_HTML" ref-type="fig">22.2</xref> shows the increased use of ECD lungs in lung transplantation [ shows the increased use of ECD lungs in lung transplantation [16].Table 22.2Standard-criteria lung donor [6]Age\xa0<\xa055\xa0yearsABO compatibilityClear serial chest X-rayNormal gas exchange (PaO2\xa0>\xa0300 mm Hg on FiO2 1.0, PEEP 5 cm H2O)≤20-pack-year smoking historyAbsence of chest traumaNo previous surgery on side(s) of harvestNo evidence of aspiration or sepsisAbsence of purulent secretions at bronchoscopyAbsence of organisms on sputum gram stainAppropriate size match with prospective recipientPaO\n2 arterial partial pressure of oxygen, FiO\n2 fractional inspired oxygen, PEEP positive end-expiratory pressure\nFig. 22.2Evolution in numbers and percentage of extended-criteria lung donors [16]. SCD standard-criteria donor, ECD extended-criteria lung donor\n'], '459911_1_En_22_Fig3_HTML': ['First, primary graft dysfunction (PGD) is a common complication that occurs immediately after lung transplantation, resulting in acute failure of the graft. In the past, it was also referred to as ischemia-reperfusion injury, early graft dysfunction, primary graft failure or re-implantation edema. PGD occurs within the first 72\xa0hours after lung transplantation and is characterized by severe hypoxemia, lung edema with diffuse alveolar damage and radiographic evidence of diffuse pulmonary infiltration without other identifiable cause (Fig. <xref rid="459911_1_En_22_Fig3_HTML" ref-type="fig">22.3</xref>). The radiographic and histological findings resemble acute respiratory distress syndrome (ARDS) [). The radiographic and histological findings resemble acute respiratory distress syndrome (ARDS) [33–37]. Several harmful events may contribute to the development of PGD, such as prolonged mechanical ventilation, prolonged warm ischemia, cold ischemia during storage in cold preservation\nsolution, reperfusion, and peri-operative insults. Several risk factors exist and are summarized up in Table 22.3 [38–40]. This complication leads to prolonged length of mechanical ventilation, prolonged ICU stays, prolonged hospital stay and even increased short-term mortality, but may also have an impact on long-term survival, as it might impact the later development of BOS, a phenotype of CLAD [41–45]. This long-term impact may, however, be modified by accurate treatment. Only supportive treatment is available for PGD, including lung-protective ventilation, restrictive fluid balance, inhaled nitric oxide (iNO), and finally extracorporeal membrane oxygenation (ECMO) [38, 46–48]. No preventive treatment options have proven to be effective, and retransplantation can be considered, but predicted survival in this setting is poor, and therefore retransplantation for severe PGD is not recommended [49].Fig. 22.3CT at 72\xa0hours posttransplantation of a patient diagnosed with PGD. PGD scores were 1, 3, and 2 at 24, 48, and 72\xa0hours of posttransplantation, respectively, according to the ISHLT grading system of PGD [37]. CT computed tomography, PGD primary graft dysfunction, ISHLT International Society for Heart and Lung Transplantation\nTable 22.3Risk factors for development of primary graft dysfunction [38–40]Donor-related factors\n\u2003Donor smoking (especially >20 pack years)Operative-related factors\n\u2003Single-lung transplant\u2003Prolonged cold ischemic time\u2003High fractional inspired oxygen upon reperfusion\u2003Poly-transfusion\u2003Intracellular type preservation solutions\u2003Use of cardiopulmonary bypassRecipient-related factors\n\u2003BMI\xa0≥\xa025\u2003Sarcoidosis\u2003IPF\u2003Primary PAH\u2003Increased pulmonary arterial pressuresBMI body mass index, IPF idiopathic pulmonary fibrosis, PAH pulmonary arterial hypertension\n'], '459911_1_En_22_Fig4_HTML': ['Another frequent complication\nis acute lung allograft rejection, especially during the first year after lung transplantation, which does not cause mortality per se is frequently treatable with a short pulse of IV steroids. However, mortality should not be neglected as 3.6% of deaths among adult lung transplant recipients within the first 30\xa0days, respectively, and 1.8% up to 1-year posttransplant are attributable to acute rejection. Twenty-nine percent of adult patients experience at least one episode of treated acute rejection between discharge from the hospital and 1-year follow-up after transplant [51, 53]. This complication should not be underestimated as patients who suffer one or more episodes of acute rejection already have a higher risk for later CLAD [51]. Symptoms are nonspecific and may include cough, dyspnea, fever, leukocytosis, and an increased alveolar-arterial oxygen gradient. High resolution computed\ntomography (HRCT) of the chest may show ground-glass opacities and septal thickening, which are nonspecific features [54]. Risk factors for acute rejection are genetic predisposition, human leukocyte antigen (HLA) mismatch and the type of immunosuppressive treatment [54]. Transbronchial biopsies remain the gold standard for diagnosis of acute allograft rejection and to discriminate it from aspiration, infection, drug toxicity, or recurrent disease [51]. There are different types of acute lung allograft rejection, first the classic and most frequent form of acute lung allograft rejection: acute cellular rejection, which is divided into A-grade rejection and B-grade rejection: lymphocytic bronchiolitis (LB). A-grade rejection is characterized by perivascular rejection and is mediated by T lymphocytes that recognize foreign HLAs or other antigens. Transbronchial biopsy displays perivascular and interstitial mononuclear cell infiltrates (Fig. <xref rid="459911_1_En_22_Fig4_HTML" ref-type="fig">22.4a</xref>), whereas BAL presents elevated lymphocyte and neutrophil counts [), whereas BAL presents elevated lymphocyte and neutrophil counts [54]. LB is considered an acute rejection of the small airways mediated by T-lymphocytes, peribronchial mononuclear cell infiltration and sometimes epithelial damage of the airways can be observed on concurrent transbronchial biopsies (Fig. <xref rid="459911_1_En_22_Fig4_HTML" ref-type="fig">22.4b</xref>) [) [55]. Second, antibody-mediated rejection (AMR), which is a rejection of the allograft by the production of antibodies directed to donor HLA molecules [56]. These antibodies may be formed prior to transplantation or de novo. Findings on transbronchial biopsies are mostly non-specific: capillary inflammation and acute lung injury, with or without diffuse alveolar damage (DAD) and endothelialitis, sometimes with evidence of endothelial capillary complement 4d staining. In addition to clinical findings and transbronchial biopsies, diagnosis of AMR can be suspected when donor-specific antibodies (DSA) are found in the blood [51, 57]. Also, there is a form of AMR known as hyperacute rejection, which occurs minutes to hours after transplantation and is mediated by preformed antibodies directed toward donor HLA and ABO molecules [58].Fig. 22.4Histopathological findings in patients with acute lung allograft rejection [55]. (a) Minimal acute cellular rejection (grade A1, ×40). The hallmark feature of acute cellular rejection is the presence of truly circumferential perivascular cellular infiltrates around blood vessels in the alveolar parenchyma, particularly small veins. These perivascular cuffs consist of mononuclear cells, two to three cells in thickness. Eosinophililic infiltration, endothelialitis or expansion of the cellular infiltrate into the alveolar septa is absent in minimal acute rejection. (b) High-grade lymphocytic bronchiolitis (grade B2R). The lamina propria contains a prominent infiltrate of activated lymphocytes; admixed with some plasmacytoid cells, neutrophils, and eosinophils. This mononuclear infiltrate extends into the epithelium, with the presence of prominent intra-epithelial lymphocytes. The overlying epithelium further shows signs of epithelial damage, evidenced by necrosis and apoptosis. (Representative pictures from selected cases from the KULeuven Lung Transplant Unit)\n'], '459911_1_En_22_Fig5_HTML': ['Other causes of ALAD can be capillary leak syndrome, anastomotic problems (e.g., dehiscence of bronchial anastomoses) and pulmonary embolism, among others. Infection and allograft rejection remain, however, the leading cause of rehospitalization\nafter lung transplant (Fig. <xref rid="459911_1_En_22_Fig5_HTML" ref-type="fig">22.5</xref>).).Fig. 22.5\nRehospitalisation post lung transplant. This figure shows the hospitalizations reported on the 1-year, 3-year, and 5-year follow-up. All follow-ups between January 2009 and June 2017 were included. (Based on data from the International Society of Heart and Lung Transplantation)\n'], '459911_1_En_22_Fig6_HTML': ['CLAD is a term that encompasses chronic lung dysfunction after transplantation that is not explained by other conditions. CLAD is defined as a persistent (at least 3\xa0weeks), often progressive, decline in pulmonary function (FEV1 with/without FVC)\xa0≥\xa020% from baseline (baseline defined as the average of the two best posttransplant values for FEV1 and FVC obtained at least 3\xa0weeks apart) [32, 63]. Potential CLAD is defined as a persistent (at least 3\xa0weeks), otherwise unexplained decline in pulmonary function ≥10% from baseline. Potential CLAD\nshould always trigger an in-depth investigation of possible causes of pulmonary function decline, including blood sampling (HLA-antibodies, infection parameters), full pulmonary function testing (measurement of total lung capacity (TLC) and residual volume (RV), in addition to spirometry), transbronchial biopsy specimen analysis, BAL with total and differential cell count, and chest HRCT with inspiratory and expiratory imaging. If no cause is found, trial therapy with azithromycin should be started to differentiate between CLAD and ARAD (see Fig. <xref rid="459911_1_En_22_Fig6_HTML" ref-type="fig">22.6</xref>) [) [32, 63]. Definite CLAD is a term used when all other causes are treated or excluded, azithromycin trial therapy was not or only partially successful, and lung allograft dysfunction continues for at least 3 months [63]. CLAD is a common long-term complication, its prevalence increasing over post lung transplantation time (Fig. <xref rid="459911_1_En_22_Fig7_HTML" ref-type="fig">22.7</xref>) [) [11].Fig. 22.6Diagnosis of chronic lung allograft dysfunction [32]. In the case of suspected CLAD, all other causes of a decrease in FEV1 should be excluded. If no cause is found, a trial therapy with azithromycin should be started. If a patient is responsive (defined as an improvement in FEV1 with ≥10% after 3–6\xa0months azithromycin), this phenotype is referred to as ARAD. If a patient is nonresponsive, further investigations should differentiate between BOS and RAS. LAD lung allograft dysfunction, FEV1 forced expiratory volume in 1\xa0second, FVC forced vital capacity, TLC total lung capacity, ALAD acute lung allograft dysfunction, CLAD chronic lung allograft dysfunction, P-CLAD potential chronic lung allograft dysfunction, ACR acute cellular rejection, LB lymphocytic bronchiolitis, AMR antibody-mediated rejection, ARAD azithromycin responsive allograft dysfunction, RAS restrictive allograft syndrome, BOS bronchiolitis obliterans syndrome\nFig. 22.7Kaplan Meier CLAD curve after lung transplantation. Lung transplantations performed from January 2004 till December 2015 in UZ Leuven, Belgium were included. CLAD chronic lung allograft dysfunction, LTx lung transplantation\n'], '459911_1_En_22_Fig8a_HTML': ['When no specific\ncause is found, and the FEV1 decline is not only persistent but also purely obstructive (FEV1/FVC\xa0<\xa00.70, with no drop in TLC) the term BOS should be used to describe this clinical phenotype (Fig. <xref rid="459911_1_En_22_Fig8a_HTML" ref-type="fig">22.8a</xref>). BOS accounts for approximately 70% of CLAD patients [). BOS accounts for approximately 70% of CLAD patients [65, 67]. Histopathological reports from transbronchial biopsies and autopsy specimens show fibrotic lesions of the bronchioles, known as OB lesions, with surrounding normal parenchyma, as well as collapse lesions [68, 69]. HRCT changes, like air trapping with or without bronchiectasis, can be observed (Fig. <xref rid="459911_1_En_22_Fig8a_HTML" ref-type="fig">22.8b</xref>). There should be no persistent infiltrates on HRCT. In contrast to ARAD, BOS is not fully responsive to azithromycin therapy [). There should be no persistent infiltrates on HRCT. In contrast to ARAD, BOS is not fully responsive to azithromycin therapy [32].Fig. 22.8Clinical features of RAS and BOS. (a) Pulmonary function of a patient diagnosed with BOS. The upper graph shows a decline in FVC, the lower graph a decline in FEV1. (b) HRCT of a patient diagnosed with BOS (c) Pulmonary function of a patient diagnosed with RAS. The upper graph shows a decline in FVC, the middle graph a decline in FEV1 and the lower graph a decline in TLC. (d) HRCT of a patient diagnosed with RAS. BOS bronchiolitis obliterans syndrome, FVC forced vital capacity, FEV1 forced expiratory volume in 1\xa0second, HRCT high resolution computed tomography, RAS restrictive allograft syndrome, TLC total lung capacity\n', 'A persistent FEV1 decline with no specific cause, accompanied by a persistent decline in TLC (>10% compared to baseline) is defined as restrictive allograft syndrome (RAS) (Fig. <xref rid="459911_1_En_22_Fig8a_HTML" ref-type="fig">22.8c</xref>), also referred to as restrictive CLAD (r-CLAD). RAS accounts for approximately 30% of CLAD [), also referred to as restrictive CLAD (r-CLAD). RAS accounts for approximately 30% of CLAD [65, 67]. When TLC is not available, FEV1/FVC can be used as a surrogate marker (FEV1/FVC\xa0>\xa00.70). RAS has a lower survival rate compared to BOS, and the cause of this poor prognosis is unclear [32, 70]. Histopathology obtained from explanted lungs shows pleural and septal thickening and parenchymal fibrosis in the lung periphery [65]. HRCT demonstrates changes such as interstitial opacities, ground-glass opacities, upper lobe dominant fibrosis, and honeycombing (Fig. <xref rid="459911_1_En_22_Fig8a_HTML" ref-type="fig">22.8d</xref>) [) [32]. The RAS phenotype is still a very heterogeneous entity, and there are no clear-cut guidelines for diagnosis. As a result, there is some overlap with other (histological) phenotypes, such as acute fibrinous and organizing pneumonia (AFOP), pleuroparenchymal fibroelastosis (PPFE) and diffuse alveolar damage (DAD). There is still debate whether these phenotypes are pathological subtypes of RAS or represent separate clinical entities [71].'], '459911_1_En_22_Fig9_HTML': ['These CLAD\nsubtypes are not permanent, and there may be some overlap: some patients initially display a typical FEV1 decline compatible with BOS, but may subsequently develop the RAS phenotype. The frequency of each subtype can be found in Fig. <xref rid="459911_1_En_22_Fig9_HTML" ref-type="fig">22.9</xref>. Development of persistent parenchymal infiltrates on HRCT seems predictive of the conversion from BOS to RAS, even when initially the pulmonary function status is not consistent with a restrictive pattern. Likewise, some patients may first develop RAS, but end up with the classical BOS phenotype after the resolution of their infiltrates. Table . Development of persistent parenchymal infiltrates on HRCT seems predictive of the conversion from BOS to RAS, even when initially the pulmonary function status is not consistent with a restrictive pattern. Likewise, some patients may first develop RAS, but end up with the classical BOS phenotype after the resolution of their infiltrates. Table 22.5 shows an overview of the key features of the phenotypes of CLAD [32]. Many factors may contribute to the development of CLAD. Reported risk factors for RAS and BOS seem fairly similar and are summed up in Table 22.6 [72–74].Fig. 22.9Prevalence of causes of chronic pulmonary function decline [66]. CLAD chronic lung allograft dysfunction, RAS restrictive allograft syndrome, BOS bronchiolitis obliterans syndrome\nTable 22.5Key features of the main phenotypes of chronic lung allograft dysfunction [32]EntityClassic BOSRASPulmonary functionObstructive (FEV1/FVC\xa0<\xa00.70)Restrictive (TLC\xa0≤\xa090% of stable baseline value) and/or FEV1/FVC\xa0>\xa00.70FEV1\xa0≤\xa080% of stable baseline valueFEV1 decline ≤80% of stable baseline valueHRCT thoracic imagingNo/minimal infiltratesInfiltrates usually presentAir trapping usually presentWith/without air trappingWith/without bronchiectasisWith/without bronchiectasisHistopathologyOB (difficult to diagnose by transbronchial biopsy specimen)Parenchymal/pleural fibrosis with/without OBClinical courseTypically progressive but may stabilizeTends to be relentlessly progressiveMay evolve to RASMay start as or coincide with BOSRecipients may have coexistent chronic bacterial infectionOtherUsually responds poorly to pharmacologic therapiesCorrelates with the presence of early diffuse alveolar damage posttransplantBOS bronchiolitis obliterans syndrome, RAS restrictive allograft syndrome, FEV\n1 forced expiratory volume in 1\xa0second, FVC forced vital capacity, TLC total lung capacity, OB obliterative bronchiolitis\nTable 22.6Risk factors for RAS and BOS [72–74]Allo-immune dependent risk factors\nAcute allograft rejection\u2003Acute cellular rejection –A-grade\u2003Acute antibody mediated rejection\u2003Lymphocytic bronchiolitis\u2003Azithromycin responsive allograft dysfunctionHLA mismatchAllo-immune independent risk factors\nPrimary graft dysfunctionGastroesophageal reflux and microaspirationInfection and colonization\u2003Viral\u2003Bacterial\u2003FungalPersistent neutrophil influx and sequestration (elevated BAL neutrophilia)Airway eosinophilia (elevated BAL eosinophilia)Recipient ageDonor ageAutoimmunity (e.g., collagen V sensitization)Ischemic timeAir pollutionGenetic factorsBOS bronchiolitis obliterans syndrome, RAS restrictive allograft syndrome, BAL bronchoalveolar lavage\n'], '459911_1_En_22_Fig10_HTML': ['Lung transplantation is a life-saving intervention in patients with advanced lung disease. Although the technical aspects of the procedure have evolved significantly since the earlier days of the technique, the main challenge to precision and long-term survival after lung transplantation is the recognition and management of CLAD. Prevention of CLAD is an important approach as therapeutic strategies have been largely unsuccessful. CLAD, however, covers different phenotypes, with different pathophysiological mechanisms and different clinical characteristics. Specifically tailored therapeutic regimes have yet to be developed. Nevertheless, lung transplantation is moving forward: with more and more experience in all centers, survival is improving (Fig. <xref rid="459911_1_En_22_Fig10_HTML" ref-type="fig">22.10</xref>) and will hopefully soon reach the level of other solid organ transplantations.) and will hopefully soon reach the level of other solid organ transplantations.Fig. 22.10Kaplan Meier Survival curve after lung transplantation. Lung transplantations performed in UZ Leuven, Belgium from July 1991 till December 2018 in the KU Leuven Lung Transplant Unit were included\n']} | Lung Transplantation and Precision Medicine | [
"Lung transplantation",
"Donor selection",
"Primary graft dysfunction",
"Allograft rejection",
"Acute cellular rejection",
"Lymphocytic bronchiolitis",
"Antibody mediated rejection",
"Ex-vivo lung perfusion",
"Chronic lung allograft dysfunction",
"Restrictive allograft dysfunction",
"Bronchiolitis obliterans syndrome",
"Risk factors",
"Diagnosis",
"Therapy"
] | Precision in Pulmonary, Critical Care, and Sleep Medicine | 1569654000 | None | null | other | PMC7120453 | null | null | [
""
] | Precision in Pulmonary, Critical Care, and Sleep Medicine. 2019 Sep 28;:335-353 | NO-CC CODE |
|
Clinical features of RAS and BOS. (a) Pulmonary function of a patient diagnosed with BOS. The upper graph shows a decline in FVC, the lower graph a decline in FEV1. (b) HRCT of a patient diagnosed with BOS (c) Pulmonary function of a patient diagnosed with RAS. The upper graph shows a decline in FVC, the middle graph a decline in FEV1 and the lower graph a decline in TLC. (d) HRCT of a patient diagnosed with RAS. BOS bronchiolitis obliterans syndrome, FVC forced vital capacity, FEV1 forced expiratory volume in 1 second, HRCT high resolution computed tomography, RAS restrictive allograft syndrome, TLC total lung capacity | 459911_1_En_22_Fig8b_HTML | 7 | 1e6633edf1d0b4c57f006f9cbf4ebec038ee7ae53398568dbd6746c0ccf10038 | 459911_1_En_22_Fig8b_HTML.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
625,
209
] | [{'image_id': '459911_1_En_22_Fig5_HTML', 'image_file_name': '459911_1_En_22_Fig5_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig5_HTML.jpg', 'caption': 'Rehospitalisation post lung transplant. This figure shows the hospitalizations reported on the 1-year, 3-year, and 5-year follow-up. All follow-ups between January 2009 and June 2017 were included. (Based on data from the International Society of Heart and Lung Transplantation)', 'hash': '06ef94feddaed9f2ff6948e88741bd971ee7604c3c89011521940e3e7370d5af'}, {'image_id': '459911_1_En_22_Fig8c_HTML', 'image_file_name': '459911_1_En_22_Fig8c_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig8c_HTML.jpg', 'caption': 'Clinical features of RAS and BOS. (a) Pulmonary function of a patient diagnosed with BOS. The upper graph shows a decline in FVC, the lower graph a decline in FEV1. (b) HRCT of a patient diagnosed with BOS (c) Pulmonary function of a patient diagnosed with RAS. The upper graph shows a decline in FVC, the middle graph a decline in FEV1 and the lower graph a decline in TLC. (d) HRCT of a patient diagnosed with RAS. BOS bronchiolitis obliterans syndrome, FVC forced vital capacity, FEV1 forced expiratory volume in 1\xa0second, HRCT high resolution computed tomography, RAS restrictive allograft syndrome, TLC total lung capacity', 'hash': '78450c6322c66e9ffe9ef89606004b25a2ec15df054e575f503d6c3ba232bb05'}, {'image_id': '459911_1_En_22_Fig10_HTML', 'image_file_name': '459911_1_En_22_Fig10_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig10_HTML.jpg', 'caption': 'Kaplan Meier Survival curve after lung transplantation. Lung transplantations performed in UZ Leuven, Belgium from July 1991 till December 2018 in the KU Leuven Lung Transplant Unit were included', 'hash': 'f5617c4a00f0a68c528a15e72f241aef6c4feea4cf65142895041e2db947f8c2'}, {'image_id': '459911_1_En_22_Fig2_HTML', 'image_file_name': '459911_1_En_22_Fig2_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig2_HTML.jpg', 'caption': 'Evolution in numbers and percentage of extended-criteria lung donors [16]. SCD standard-criteria donor, ECD extended-criteria lung donor', 'hash': 'efbf82b3380b288529f1289f66333325713b7950decd891c37715110f28a6ff3'}, {'image_id': '459911_1_En_22_Fig8d_HTML', 'image_file_name': '459911_1_En_22_Fig8d_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig8d_HTML.jpg', 'caption': 'Clinical features of RAS and BOS. (a) Pulmonary function of a patient diagnosed with BOS. The upper graph shows a decline in FVC, the lower graph a decline in FEV1. (b) HRCT of a patient diagnosed with BOS (c) Pulmonary function of a patient diagnosed with RAS. The upper graph shows a decline in FVC, the middle graph a decline in FEV1 and the lower graph a decline in TLC. (d) HRCT of a patient diagnosed with RAS. BOS bronchiolitis obliterans syndrome, FVC forced vital capacity, FEV1 forced expiratory volume in 1\xa0second, HRCT high resolution computed tomography, RAS restrictive allograft syndrome, TLC total lung capacity', 'hash': 'fc98e7e0fd6fa30fae7d00069ff22fb70e4f54018b7de5ed773acb20605841ce'}, {'image_id': '459911_1_En_22_Fig8b_HTML', 'image_file_name': '459911_1_En_22_Fig8b_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig8b_HTML.jpg', 'caption': 'Clinical features of RAS and BOS. (a) Pulmonary function of a patient diagnosed with BOS. The upper graph shows a decline in FVC, the lower graph a decline in FEV1. (b) HRCT of a patient diagnosed with BOS (c) Pulmonary function of a patient diagnosed with RAS. The upper graph shows a decline in FVC, the middle graph a decline in FEV1 and the lower graph a decline in TLC. (d) HRCT of a patient diagnosed with RAS. BOS bronchiolitis obliterans syndrome, FVC forced vital capacity, FEV1 forced expiratory volume in 1\xa0second, HRCT high resolution computed tomography, RAS restrictive allograft syndrome, TLC total lung capacity', 'hash': '1e6633edf1d0b4c57f006f9cbf4ebec038ee7ae53398568dbd6746c0ccf10038'}, {'image_id': '459911_1_En_22_Fig4_HTML', 'image_file_name': '459911_1_En_22_Fig4_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig4_HTML.jpg', 'caption': 'Histopathological findings in patients with acute lung allograft rejection [55]. (a) Minimal acute cellular rejection (grade A1, ×40). The hallmark feature of acute cellular rejection is the presence of truly circumferential perivascular cellular infiltrates around blood vessels in the alveolar parenchyma, particularly small veins. These perivascular cuffs consist of mononuclear cells, two to three cells in thickness. Eosinophililic infiltration, endothelialitis or expansion of the cellular infiltrate into the alveolar septa is absent in minimal acute rejection. (b) High-grade lymphocytic bronchiolitis (grade B2R). The lamina propria contains a prominent infiltrate of activated lymphocytes; admixed with some plasmacytoid cells, neutrophils, and eosinophils. This mononuclear infiltrate extends into the epithelium, with the presence of prominent intra-epithelial lymphocytes. The overlying epithelium further shows signs of epithelial damage, evidenced by necrosis and apoptosis. (Representative pictures from selected cases from the KULeuven Lung Transplant Unit)', 'hash': 'ff88802c4581737c0533c2ce9f78f9bcbadb2534d85b699692de91bc12d4b060'}, {'image_id': '459911_1_En_22_Fig3_HTML', 'image_file_name': '459911_1_En_22_Fig3_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig3_HTML.jpg', 'caption': 'CT at 72\xa0hours posttransplantation of a patient diagnosed with PGD. PGD scores were 1, 3, and 2 at 24, 48, and 72\xa0hours of posttransplantation, respectively, according to the ISHLT grading system of PGD [37]. CT computed tomography, PGD primary graft dysfunction, ISHLT International Society for Heart and Lung Transplantation', 'hash': '86dfcd1279135a80e7c484157af3f3895aff02c447c67c892b3d14e5d49ea7e1'}, {'image_id': '459911_1_En_22_Fig7_HTML', 'image_file_name': '459911_1_En_22_Fig7_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig7_HTML.jpg', 'caption': 'Kaplan Meier CLAD curve after lung transplantation. Lung transplantations performed from January 2004 till December 2015 in UZ Leuven, Belgium were included. CLAD chronic lung allograft dysfunction, LTx lung transplantation', 'hash': 'c0edcc39d0896c0e8e49d671a4ae96cf9e6d848561d6d408472b2f0b77a0d9b7'}, {'image_id': '459911_1_En_22_Fig8a_HTML', 'image_file_name': '459911_1_En_22_Fig8a_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig8a_HTML.jpg', 'caption': 'Clinical features of RAS and BOS. (a) Pulmonary function of a patient diagnosed with BOS. The upper graph shows a decline in FVC, the lower graph a decline in FEV1. (b) HRCT of a patient diagnosed with BOS (c) Pulmonary function of a patient diagnosed with RAS. The upper graph shows a decline in FVC, the middle graph a decline in FEV1 and the lower graph a decline in TLC. (d) HRCT of a patient diagnosed with RAS. BOS bronchiolitis obliterans syndrome, FVC forced vital capacity, FEV1 forced expiratory volume in 1\xa0second, HRCT high resolution computed tomography, RAS restrictive allograft syndrome, TLC total lung capacity', 'hash': '3cdad38cdc4bda21730c543b1b7e157cc12d5043477bdd2f35288b8f0458b886'}, {'image_id': '459911_1_En_22_Fig1_HTML', 'image_file_name': '459911_1_En_22_Fig1_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig1_HTML.jpg', 'caption': 'Average center volume for lung transplantation (not including heart-lung transplants)', 'hash': '3d52031f1278505907d0846d95d977ede23124ff66413a958b9c2852992a644e'}, {'image_id': '459911_1_En_22_Fig9_HTML', 'image_file_name': '459911_1_En_22_Fig9_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig9_HTML.jpg', 'caption': 'Prevalence of causes of chronic pulmonary function decline [66]. CLAD chronic lung allograft dysfunction, RAS restrictive allograft syndrome, BOS bronchiolitis obliterans syndrome', 'hash': '61f48192e986da5dcb861ccf5d05520418554a146afaaf2cee73588fd2cae4fa'}, {'image_id': '459911_1_En_22_Fig6_HTML', 'image_file_name': '459911_1_En_22_Fig6_HTML.jpg', 'image_path': '../data/media_files/PMC7120453/459911_1_En_22_Fig6_HTML.jpg', 'caption': 'Diagnosis of chronic lung allograft dysfunction [32]. In the case of suspected CLAD, all other causes of a decrease in FEV1 should be excluded. If no cause is found, a trial therapy with azithromycin should be started. If a patient is responsive (defined as an improvement in FEV1 with ≥10% after 3–6\xa0months azithromycin), this phenotype is referred to as ARAD. If a patient is nonresponsive, further investigations should differentiate between BOS and RAS. LAD lung allograft dysfunction, FEV1 forced expiratory volume in 1\xa0second, FVC forced vital capacity, TLC total lung capacity, ALAD acute lung allograft dysfunction, CLAD chronic lung allograft dysfunction, P-CLAD potential chronic lung allograft dysfunction, ACR acute cellular rejection, LB lymphocytic bronchiolitis, AMR antibody-mediated rejection, ARAD azithromycin responsive allograft dysfunction, RAS restrictive allograft syndrome, BOS bronchiolitis obliterans syndrome', 'hash': 'ec8d5b975f7d5824f3d09f206efda8cd6bfa64d3b0dd07f2ca186ee455bf59bb'}] | {'459911_1_En_22_Fig1_HTML': ['The history of lung transplantation starts in the 1940s: researchers tried to perform lung transplantation, initially in laboratory animals followed by human to human. Many of these early attempts were unsuccessful, and even after successful lung transplantation, most lungs were ultimately rejected despite the use of various immunosuppressants available at that time. The first human single lung transplantation was performed in 1963 by James Hardy in Mississippi, using the left lung of a circulatory death donor. The patient survived for 18\xa0days before dying of renal failure. Over the next decade, many more lung transplantations were performed, with limited success: few patients survived over 2 weeks. At that time, the leading causes of death were peri-operative problems. Subsequent improvements in surgical techniques and especially the introduction of immunosuppressive drugs such as cyclosporin and tacrolimus resulted in rapid progress in the 1980s, with the first successful heart-lung transplantation in 1981 in Stanford by Bruce Reitz and the first single lung transplantation in Toronto in 1983 by Joel Cooper [1]. The second successful lung transplantation from a circulatory death donor was reported by Steen [2]. These advances led to higher success rates and transplant centers all over the world started developing their programs. Today over 100 transplant centers in Europe and North America are active, although the majority of lung transplantations is still performed in a small number of highly specialized centers (see Fig. <xref rid="459911_1_En_22_Fig1_HTML" ref-type="fig">22.1</xref>). As short-term survival improved substantially, more patients developed long-term complications [). As short-term survival improved substantially, more patients developed long-term complications [3]. These long-term complications compromised the initially increased quality of life (QoL) due to restored normal pulmonary function [4].Fig. 22.1Average center volume for lung transplantation (not including heart-lung transplants)\n'], '459911_1_En_22_Fig2_HTML': ['Not all organ donors are suitable to be lung donors. Strict criteria of the “standard-criteria lung donor” (SCD) have previously been defined; donors meeting these criteria are considered “ideal” (Table 22.2) [6]. Only 15–25% of all multi-organ donors are suitable for lung transplantation, due to injury from cardio-pulmonary resuscitation, lung contusion, airway aspiration, and pulmonary infection at the time of brain insult, as well as underlying lung disease [15]. This scarcity of suitable donor organs leads to persistent mortality of patients on the waiting list; and thus these criteria have been liberalized to “extended-criteria lung donors” (ECD) in order to increase the number of transplantable donor organs [7, 8]. ECD are lung donors not matching the strict criteria of an SCD, for example, because of pre-existing conditions, a smoking history of more than 20 pack-years or hepatitis, among others. There is no consensus about ECD, and multiple centers report different criteria [16–20]. This increase of transplantable lungs is associated with a negative impact on early outcome: prevalence of severe PGD, length of stay in intensive care unit (ICU) and duration of mechanical ventilation [16, 18]. There is still debate about whether the use of ECD lungs compromises long-term clinical outcomes [17–20]. Figure <xref rid="459911_1_En_22_Fig2_HTML" ref-type="fig">22.2</xref> shows the increased use of ECD lungs in lung transplantation [ shows the increased use of ECD lungs in lung transplantation [16].Table 22.2Standard-criteria lung donor [6]Age\xa0<\xa055\xa0yearsABO compatibilityClear serial chest X-rayNormal gas exchange (PaO2\xa0>\xa0300 mm Hg on FiO2 1.0, PEEP 5 cm H2O)≤20-pack-year smoking historyAbsence of chest traumaNo previous surgery on side(s) of harvestNo evidence of aspiration or sepsisAbsence of purulent secretions at bronchoscopyAbsence of organisms on sputum gram stainAppropriate size match with prospective recipientPaO\n2 arterial partial pressure of oxygen, FiO\n2 fractional inspired oxygen, PEEP positive end-expiratory pressure\nFig. 22.2Evolution in numbers and percentage of extended-criteria lung donors [16]. SCD standard-criteria donor, ECD extended-criteria lung donor\n'], '459911_1_En_22_Fig3_HTML': ['First, primary graft dysfunction (PGD) is a common complication that occurs immediately after lung transplantation, resulting in acute failure of the graft. In the past, it was also referred to as ischemia-reperfusion injury, early graft dysfunction, primary graft failure or re-implantation edema. PGD occurs within the first 72\xa0hours after lung transplantation and is characterized by severe hypoxemia, lung edema with diffuse alveolar damage and radiographic evidence of diffuse pulmonary infiltration without other identifiable cause (Fig. <xref rid="459911_1_En_22_Fig3_HTML" ref-type="fig">22.3</xref>). The radiographic and histological findings resemble acute respiratory distress syndrome (ARDS) [). The radiographic and histological findings resemble acute respiratory distress syndrome (ARDS) [33–37]. Several harmful events may contribute to the development of PGD, such as prolonged mechanical ventilation, prolonged warm ischemia, cold ischemia during storage in cold preservation\nsolution, reperfusion, and peri-operative insults. Several risk factors exist and are summarized up in Table 22.3 [38–40]. This complication leads to prolonged length of mechanical ventilation, prolonged ICU stays, prolonged hospital stay and even increased short-term mortality, but may also have an impact on long-term survival, as it might impact the later development of BOS, a phenotype of CLAD [41–45]. This long-term impact may, however, be modified by accurate treatment. Only supportive treatment is available for PGD, including lung-protective ventilation, restrictive fluid balance, inhaled nitric oxide (iNO), and finally extracorporeal membrane oxygenation (ECMO) [38, 46–48]. No preventive treatment options have proven to be effective, and retransplantation can be considered, but predicted survival in this setting is poor, and therefore retransplantation for severe PGD is not recommended [49].Fig. 22.3CT at 72\xa0hours posttransplantation of a patient diagnosed with PGD. PGD scores were 1, 3, and 2 at 24, 48, and 72\xa0hours of posttransplantation, respectively, according to the ISHLT grading system of PGD [37]. CT computed tomography, PGD primary graft dysfunction, ISHLT International Society for Heart and Lung Transplantation\nTable 22.3Risk factors for development of primary graft dysfunction [38–40]Donor-related factors\n\u2003Donor smoking (especially >20 pack years)Operative-related factors\n\u2003Single-lung transplant\u2003Prolonged cold ischemic time\u2003High fractional inspired oxygen upon reperfusion\u2003Poly-transfusion\u2003Intracellular type preservation solutions\u2003Use of cardiopulmonary bypassRecipient-related factors\n\u2003BMI\xa0≥\xa025\u2003Sarcoidosis\u2003IPF\u2003Primary PAH\u2003Increased pulmonary arterial pressuresBMI body mass index, IPF idiopathic pulmonary fibrosis, PAH pulmonary arterial hypertension\n'], '459911_1_En_22_Fig4_HTML': ['Another frequent complication\nis acute lung allograft rejection, especially during the first year after lung transplantation, which does not cause mortality per se is frequently treatable with a short pulse of IV steroids. However, mortality should not be neglected as 3.6% of deaths among adult lung transplant recipients within the first 30\xa0days, respectively, and 1.8% up to 1-year posttransplant are attributable to acute rejection. Twenty-nine percent of adult patients experience at least one episode of treated acute rejection between discharge from the hospital and 1-year follow-up after transplant [51, 53]. This complication should not be underestimated as patients who suffer one or more episodes of acute rejection already have a higher risk for later CLAD [51]. Symptoms are nonspecific and may include cough, dyspnea, fever, leukocytosis, and an increased alveolar-arterial oxygen gradient. High resolution computed\ntomography (HRCT) of the chest may show ground-glass opacities and septal thickening, which are nonspecific features [54]. Risk factors for acute rejection are genetic predisposition, human leukocyte antigen (HLA) mismatch and the type of immunosuppressive treatment [54]. Transbronchial biopsies remain the gold standard for diagnosis of acute allograft rejection and to discriminate it from aspiration, infection, drug toxicity, or recurrent disease [51]. There are different types of acute lung allograft rejection, first the classic and most frequent form of acute lung allograft rejection: acute cellular rejection, which is divided into A-grade rejection and B-grade rejection: lymphocytic bronchiolitis (LB). A-grade rejection is characterized by perivascular rejection and is mediated by T lymphocytes that recognize foreign HLAs or other antigens. Transbronchial biopsy displays perivascular and interstitial mononuclear cell infiltrates (Fig. <xref rid="459911_1_En_22_Fig4_HTML" ref-type="fig">22.4a</xref>), whereas BAL presents elevated lymphocyte and neutrophil counts [), whereas BAL presents elevated lymphocyte and neutrophil counts [54]. LB is considered an acute rejection of the small airways mediated by T-lymphocytes, peribronchial mononuclear cell infiltration and sometimes epithelial damage of the airways can be observed on concurrent transbronchial biopsies (Fig. <xref rid="459911_1_En_22_Fig4_HTML" ref-type="fig">22.4b</xref>) [) [55]. Second, antibody-mediated rejection (AMR), which is a rejection of the allograft by the production of antibodies directed to donor HLA molecules [56]. These antibodies may be formed prior to transplantation or de novo. Findings on transbronchial biopsies are mostly non-specific: capillary inflammation and acute lung injury, with or without diffuse alveolar damage (DAD) and endothelialitis, sometimes with evidence of endothelial capillary complement 4d staining. In addition to clinical findings and transbronchial biopsies, diagnosis of AMR can be suspected when donor-specific antibodies (DSA) are found in the blood [51, 57]. Also, there is a form of AMR known as hyperacute rejection, which occurs minutes to hours after transplantation and is mediated by preformed antibodies directed toward donor HLA and ABO molecules [58].Fig. 22.4Histopathological findings in patients with acute lung allograft rejection [55]. (a) Minimal acute cellular rejection (grade A1, ×40). The hallmark feature of acute cellular rejection is the presence of truly circumferential perivascular cellular infiltrates around blood vessels in the alveolar parenchyma, particularly small veins. These perivascular cuffs consist of mononuclear cells, two to three cells in thickness. Eosinophililic infiltration, endothelialitis or expansion of the cellular infiltrate into the alveolar septa is absent in minimal acute rejection. (b) High-grade lymphocytic bronchiolitis (grade B2R). The lamina propria contains a prominent infiltrate of activated lymphocytes; admixed with some plasmacytoid cells, neutrophils, and eosinophils. This mononuclear infiltrate extends into the epithelium, with the presence of prominent intra-epithelial lymphocytes. The overlying epithelium further shows signs of epithelial damage, evidenced by necrosis and apoptosis. (Representative pictures from selected cases from the KULeuven Lung Transplant Unit)\n'], '459911_1_En_22_Fig5_HTML': ['Other causes of ALAD can be capillary leak syndrome, anastomotic problems (e.g., dehiscence of bronchial anastomoses) and pulmonary embolism, among others. Infection and allograft rejection remain, however, the leading cause of rehospitalization\nafter lung transplant (Fig. <xref rid="459911_1_En_22_Fig5_HTML" ref-type="fig">22.5</xref>).).Fig. 22.5\nRehospitalisation post lung transplant. This figure shows the hospitalizations reported on the 1-year, 3-year, and 5-year follow-up. All follow-ups between January 2009 and June 2017 were included. (Based on data from the International Society of Heart and Lung Transplantation)\n'], '459911_1_En_22_Fig6_HTML': ['CLAD is a term that encompasses chronic lung dysfunction after transplantation that is not explained by other conditions. CLAD is defined as a persistent (at least 3\xa0weeks), often progressive, decline in pulmonary function (FEV1 with/without FVC)\xa0≥\xa020% from baseline (baseline defined as the average of the two best posttransplant values for FEV1 and FVC obtained at least 3\xa0weeks apart) [32, 63]. Potential CLAD is defined as a persistent (at least 3\xa0weeks), otherwise unexplained decline in pulmonary function ≥10% from baseline. Potential CLAD\nshould always trigger an in-depth investigation of possible causes of pulmonary function decline, including blood sampling (HLA-antibodies, infection parameters), full pulmonary function testing (measurement of total lung capacity (TLC) and residual volume (RV), in addition to spirometry), transbronchial biopsy specimen analysis, BAL with total and differential cell count, and chest HRCT with inspiratory and expiratory imaging. If no cause is found, trial therapy with azithromycin should be started to differentiate between CLAD and ARAD (see Fig. <xref rid="459911_1_En_22_Fig6_HTML" ref-type="fig">22.6</xref>) [) [32, 63]. Definite CLAD is a term used when all other causes are treated or excluded, azithromycin trial therapy was not or only partially successful, and lung allograft dysfunction continues for at least 3 months [63]. CLAD is a common long-term complication, its prevalence increasing over post lung transplantation time (Fig. <xref rid="459911_1_En_22_Fig7_HTML" ref-type="fig">22.7</xref>) [) [11].Fig. 22.6Diagnosis of chronic lung allograft dysfunction [32]. In the case of suspected CLAD, all other causes of a decrease in FEV1 should be excluded. If no cause is found, a trial therapy with azithromycin should be started. If a patient is responsive (defined as an improvement in FEV1 with ≥10% after 3–6\xa0months azithromycin), this phenotype is referred to as ARAD. If a patient is nonresponsive, further investigations should differentiate between BOS and RAS. LAD lung allograft dysfunction, FEV1 forced expiratory volume in 1\xa0second, FVC forced vital capacity, TLC total lung capacity, ALAD acute lung allograft dysfunction, CLAD chronic lung allograft dysfunction, P-CLAD potential chronic lung allograft dysfunction, ACR acute cellular rejection, LB lymphocytic bronchiolitis, AMR antibody-mediated rejection, ARAD azithromycin responsive allograft dysfunction, RAS restrictive allograft syndrome, BOS bronchiolitis obliterans syndrome\nFig. 22.7Kaplan Meier CLAD curve after lung transplantation. Lung transplantations performed from January 2004 till December 2015 in UZ Leuven, Belgium were included. CLAD chronic lung allograft dysfunction, LTx lung transplantation\n'], '459911_1_En_22_Fig8a_HTML': ['When no specific\ncause is found, and the FEV1 decline is not only persistent but also purely obstructive (FEV1/FVC\xa0<\xa00.70, with no drop in TLC) the term BOS should be used to describe this clinical phenotype (Fig. <xref rid="459911_1_En_22_Fig8a_HTML" ref-type="fig">22.8a</xref>). BOS accounts for approximately 70% of CLAD patients [). BOS accounts for approximately 70% of CLAD patients [65, 67]. Histopathological reports from transbronchial biopsies and autopsy specimens show fibrotic lesions of the bronchioles, known as OB lesions, with surrounding normal parenchyma, as well as collapse lesions [68, 69]. HRCT changes, like air trapping with or without bronchiectasis, can be observed (Fig. <xref rid="459911_1_En_22_Fig8a_HTML" ref-type="fig">22.8b</xref>). There should be no persistent infiltrates on HRCT. In contrast to ARAD, BOS is not fully responsive to azithromycin therapy [). There should be no persistent infiltrates on HRCT. In contrast to ARAD, BOS is not fully responsive to azithromycin therapy [32].Fig. 22.8Clinical features of RAS and BOS. (a) Pulmonary function of a patient diagnosed with BOS. The upper graph shows a decline in FVC, the lower graph a decline in FEV1. (b) HRCT of a patient diagnosed with BOS (c) Pulmonary function of a patient diagnosed with RAS. The upper graph shows a decline in FVC, the middle graph a decline in FEV1 and the lower graph a decline in TLC. (d) HRCT of a patient diagnosed with RAS. BOS bronchiolitis obliterans syndrome, FVC forced vital capacity, FEV1 forced expiratory volume in 1\xa0second, HRCT high resolution computed tomography, RAS restrictive allograft syndrome, TLC total lung capacity\n', 'A persistent FEV1 decline with no specific cause, accompanied by a persistent decline in TLC (>10% compared to baseline) is defined as restrictive allograft syndrome (RAS) (Fig. <xref rid="459911_1_En_22_Fig8a_HTML" ref-type="fig">22.8c</xref>), also referred to as restrictive CLAD (r-CLAD). RAS accounts for approximately 30% of CLAD [), also referred to as restrictive CLAD (r-CLAD). RAS accounts for approximately 30% of CLAD [65, 67]. When TLC is not available, FEV1/FVC can be used as a surrogate marker (FEV1/FVC\xa0>\xa00.70). RAS has a lower survival rate compared to BOS, and the cause of this poor prognosis is unclear [32, 70]. Histopathology obtained from explanted lungs shows pleural and septal thickening and parenchymal fibrosis in the lung periphery [65]. HRCT demonstrates changes such as interstitial opacities, ground-glass opacities, upper lobe dominant fibrosis, and honeycombing (Fig. <xref rid="459911_1_En_22_Fig8a_HTML" ref-type="fig">22.8d</xref>) [) [32]. The RAS phenotype is still a very heterogeneous entity, and there are no clear-cut guidelines for diagnosis. As a result, there is some overlap with other (histological) phenotypes, such as acute fibrinous and organizing pneumonia (AFOP), pleuroparenchymal fibroelastosis (PPFE) and diffuse alveolar damage (DAD). There is still debate whether these phenotypes are pathological subtypes of RAS or represent separate clinical entities [71].'], '459911_1_En_22_Fig9_HTML': ['These CLAD\nsubtypes are not permanent, and there may be some overlap: some patients initially display a typical FEV1 decline compatible with BOS, but may subsequently develop the RAS phenotype. The frequency of each subtype can be found in Fig. <xref rid="459911_1_En_22_Fig9_HTML" ref-type="fig">22.9</xref>. Development of persistent parenchymal infiltrates on HRCT seems predictive of the conversion from BOS to RAS, even when initially the pulmonary function status is not consistent with a restrictive pattern. Likewise, some patients may first develop RAS, but end up with the classical BOS phenotype after the resolution of their infiltrates. Table . Development of persistent parenchymal infiltrates on HRCT seems predictive of the conversion from BOS to RAS, even when initially the pulmonary function status is not consistent with a restrictive pattern. Likewise, some patients may first develop RAS, but end up with the classical BOS phenotype after the resolution of their infiltrates. Table 22.5 shows an overview of the key features of the phenotypes of CLAD [32]. Many factors may contribute to the development of CLAD. Reported risk factors for RAS and BOS seem fairly similar and are summed up in Table 22.6 [72–74].Fig. 22.9Prevalence of causes of chronic pulmonary function decline [66]. CLAD chronic lung allograft dysfunction, RAS restrictive allograft syndrome, BOS bronchiolitis obliterans syndrome\nTable 22.5Key features of the main phenotypes of chronic lung allograft dysfunction [32]EntityClassic BOSRASPulmonary functionObstructive (FEV1/FVC\xa0<\xa00.70)Restrictive (TLC\xa0≤\xa090% of stable baseline value) and/or FEV1/FVC\xa0>\xa00.70FEV1\xa0≤\xa080% of stable baseline valueFEV1 decline ≤80% of stable baseline valueHRCT thoracic imagingNo/minimal infiltratesInfiltrates usually presentAir trapping usually presentWith/without air trappingWith/without bronchiectasisWith/without bronchiectasisHistopathologyOB (difficult to diagnose by transbronchial biopsy specimen)Parenchymal/pleural fibrosis with/without OBClinical courseTypically progressive but may stabilizeTends to be relentlessly progressiveMay evolve to RASMay start as or coincide with BOSRecipients may have coexistent chronic bacterial infectionOtherUsually responds poorly to pharmacologic therapiesCorrelates with the presence of early diffuse alveolar damage posttransplantBOS bronchiolitis obliterans syndrome, RAS restrictive allograft syndrome, FEV\n1 forced expiratory volume in 1\xa0second, FVC forced vital capacity, TLC total lung capacity, OB obliterative bronchiolitis\nTable 22.6Risk factors for RAS and BOS [72–74]Allo-immune dependent risk factors\nAcute allograft rejection\u2003Acute cellular rejection –A-grade\u2003Acute antibody mediated rejection\u2003Lymphocytic bronchiolitis\u2003Azithromycin responsive allograft dysfunctionHLA mismatchAllo-immune independent risk factors\nPrimary graft dysfunctionGastroesophageal reflux and microaspirationInfection and colonization\u2003Viral\u2003Bacterial\u2003FungalPersistent neutrophil influx and sequestration (elevated BAL neutrophilia)Airway eosinophilia (elevated BAL eosinophilia)Recipient ageDonor ageAutoimmunity (e.g., collagen V sensitization)Ischemic timeAir pollutionGenetic factorsBOS bronchiolitis obliterans syndrome, RAS restrictive allograft syndrome, BAL bronchoalveolar lavage\n'], '459911_1_En_22_Fig10_HTML': ['Lung transplantation is a life-saving intervention in patients with advanced lung disease. Although the technical aspects of the procedure have evolved significantly since the earlier days of the technique, the main challenge to precision and long-term survival after lung transplantation is the recognition and management of CLAD. Prevention of CLAD is an important approach as therapeutic strategies have been largely unsuccessful. CLAD, however, covers different phenotypes, with different pathophysiological mechanisms and different clinical characteristics. Specifically tailored therapeutic regimes have yet to be developed. Nevertheless, lung transplantation is moving forward: with more and more experience in all centers, survival is improving (Fig. <xref rid="459911_1_En_22_Fig10_HTML" ref-type="fig">22.10</xref>) and will hopefully soon reach the level of other solid organ transplantations.) and will hopefully soon reach the level of other solid organ transplantations.Fig. 22.10Kaplan Meier Survival curve after lung transplantation. Lung transplantations performed in UZ Leuven, Belgium from July 1991 till December 2018 in the KU Leuven Lung Transplant Unit were included\n']} | Lung Transplantation and Precision Medicine | [
"Lung transplantation",
"Donor selection",
"Primary graft dysfunction",
"Allograft rejection",
"Acute cellular rejection",
"Lymphocytic bronchiolitis",
"Antibody mediated rejection",
"Ex-vivo lung perfusion",
"Chronic lung allograft dysfunction",
"Restrictive allograft dysfunction",
"Bronchiolitis obliterans syndrome",
"Risk factors",
"Diagnosis",
"Therapy"
] | Precision in Pulmonary, Critical Care, and Sleep Medicine | 1569654000 | None | null | other | PMC7120453 | null | null | [
""
] | Precision in Pulmonary, Critical Care, and Sleep Medicine. 2019 Sep 28;:335-353 | NO-CC CODE |
|
CT (coronal plane). Left renal stone. | fig-1 | 7 | 0ca2cf15651422ea855a4f4d29fbecbfc8710ab653014e87283e28d38aa8965b | fig-1.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
660,
685
] | [{'image_id': 'fig-2', 'image_file_name': 'fig-2.jpg', 'image_path': '../data/media_files/PMC5628562/fig-2.jpg', 'caption': 'X-ray film of impacted flexible ureteroscope in the distal ureter and possible mechanism of impaction.', 'hash': 'b53c856be9366a386a9dea202911834f28c998f3f84ca0a32f0ca0a2d009a353'}, {'image_id': 'fig-3', 'image_file_name': 'fig-3.jpg', 'image_path': '../data/media_files/PMC5628562/fig-3.jpg', 'caption': 'Mechanism of instrument retrieval.', 'hash': '09d608686929720729f275cc108191f7d54439f2340e187c5d843b830baad39f'}, {'image_id': 'fig-4', 'image_file_name': 'fig-4.jpg', 'image_path': '../data/media_files/PMC5628562/fig-4.jpg', 'caption': 'Outer coating of a distal end of the flexible ureteroscope.', 'hash': 'd9040b58fc5acd25661576b75af78bbc2eb1ecb70813c41de975acfe527abf8f'}, {'image_id': 'fig-1', 'image_file_name': 'fig-1.jpg', 'image_path': '../data/media_files/PMC5628562/fig-1.jpg', 'caption': 'CT (coronal plane). Left renal stone.', 'hash': '0ca2cf15651422ea855a4f4d29fbecbfc8710ab653014e87283e28d38aa8965b'}] | {'fig-1': ['The patient is a 53-year-old male with a dense (1370 HU) 7\u2009mm calculus in the upper calyx of the left kidney treated with fURS (<xref ref-type="fig" rid="fig-1">Fig. 1</xref>). The patient was not prestented, nor alpha blockers given before the procedure. Under general anesthesia, rigid inspection of the ureter was first performed, and the decision was made to proceed without placement of a ureteral access sheath (UAS) after obtaining access to the left kidney. A flexible 7.5F ureteroscope (Storz Flex-X). The patient was not prestented, nor alpha blockers given before the procedure. Under general anesthesia, rigid inspection of the ureter was first performed, and the decision was made to proceed without placement of a ureteral access sheath (UAS) after obtaining access to the left kidney. A flexible 7.5F ureteroscope (Storz Flex-X2, Storz, Inc., Germany) was introduced into the kidney over a guidewire without any difficulty. Lithotripsy using a 275-μm Holmium laser fiber (0.5\u2009J and 20\u2009Hz) was performed to reduce the stone to small fragments for subsequent extraction. Residual stone fragments were captured with a 1.9F Tipless Nitinol Basket. Unfortunately, the residual stone did not pass through the ureteral orifice and was released from the basket. Due to reduced visibility, the ureteroscope was advanced to the proximal ureter, and the laser fiber was used to further reduce the size of the stone. During this step, the ureteroscope could not be retracted due to stone fragments impacted between the ureteroscope and the distal ureter. We were able to advance the ureteroscope toward the proximal ureter; however, the endoscope could not be withdrawn past the distal ureter. The laser fiber was subsequently removed and multiple unsuccessful attempts were made to retrieve the ureteroscope. Therefore, we proposed the following mechanism: stone fragments were abutting the coating at the distal end of the ureteroscope and the ureteral wall as shown in <xref ref-type="fig" rid="fig-2">Figure 2</xref>. At that point, we placed a guidewire through the working channel of the ureteroscope and a Foley catheter was placed for proper drainage of the bladder. Although there was no evidence of significant bleeding, endoscopic visualization was significantly obscured and the stone was not identified in the collecting system. The patient was stable with no vital sign changes and retrograde contrast pyelography under fluoroscopy imaging showed no evidence of perforation of the collecting system.. At that point, we placed a guidewire through the working channel of the ureteroscope and a Foley catheter was placed for proper drainage of the bladder. Although there was no evidence of significant bleeding, endoscopic visualization was significantly obscured and the stone was not identified in the collecting system. The patient was stable with no vital sign changes and retrograde contrast pyelography under fluoroscopy imaging showed no evidence of perforation of the collecting system.'], 'fig-3': ['At this point, different intervention options, including percutaneous approach to unlock the tip of the scope in case there was a locked mechanism, were considered. Open procedure was also an option in case there was evidence of perforation and significant bleeding. After lengthy discussions, we decided to proceed with the endoscopic route. Under general anesthesia, with addition of muscle relaxant, and after a period of 10 minutes to give the ureteral wall time to accommodate the instrument, attempts to remove the scope were continued in a gentle manner to avoid any damage to the ureter. Gentle rotational, back and forth maneuvers under direct visual control were attempted with moderate application of traction (<xref ref-type="fig" rid="fig-3">Fig. 3</xref>). After a few attempts, the instrument was freed from the ureter. After the removal of the scope, which showed no evidence of malfunction, retrograde pyelography was performed with no evidence of pelvic or ureteral perforation or bleeding. Careful reinsertion of the ureteroscope into the ureter revealed that the stone fragment had got retained right behind the ureteral orifice. It was fragmented and removed with a basket. A ureteral stent and a Foley catheter were placed. No visible defects were identified on the ureteroscope. Slight attenuation of the deflecting mechanism was the only consequence of the instrument impaction. The Foley catheter was removed the same day and the ureteral stent in 14 days. During the follow-up visit after a month, neither pain nor hydronephrosis confirmed by ultrasound was present at the ipsilateral site.). After a few attempts, the instrument was freed from the ureter. After the removal of the scope, which showed no evidence of malfunction, retrograde pyelography was performed with no evidence of pelvic or ureteral perforation or bleeding. Careful reinsertion of the ureteroscope into the ureter revealed that the stone fragment had got retained right behind the ureteral orifice. It was fragmented and removed with a basket. A ureteral stent and a Foley catheter were placed. No visible defects were identified on the ureteroscope. Slight attenuation of the deflecting mechanism was the only consequence of the instrument impaction. The Foley catheter was removed the same day and the ureteral stent in 14 days. During the follow-up visit after a month, neither pain nor hydronephrosis confirmed by ultrasound was present at the ipsilateral site.'], 'fig-4': ['The most difficult complications are those requiring additional manipulations such as for locked deflection of a flexible ureteroscope in the kidney related to improper surgical technique and ureteral avulsion due to removing excessively large stone fragments down a relatively narrow ureter. Open incision to remove a flexible ureteroscope or ureteral reconstruction will then be needed. To our knowledge, our type of complication has never been presented before. The mechanism used was as follows: the stone fragment was abutting the outer coating of the distal end of the ureteroscope, which is fluted (<xref ref-type="fig" rid="fig-4">Fig. 4</xref>) from one side of the ureteral wall to the other. Slow rotational movements under visual control resulted in instrument withdrawal. Also, we believe that the muscle relaxants injected during the procedure facilitated ureteral muscle relaxation and significantly helped to remove the scope.) from one side of the ureteral wall to the other. Slow rotational movements under visual control resulted in instrument withdrawal. Also, we believe that the muscle relaxants injected during the procedure facilitated ureteral muscle relaxation and significantly helped to remove the scope.']} | “Valve”-Type Retainment of Flexible Ureteroscope in the Distal Ureter | [
"retained ureteroscope",
"ureteroscopy",
"kidney stones",
"urolithiasis",
"stones",
"ureters",
"complications"
] | J Endourol Case Rep | 1501570800 | Because delta-9-tetrahydrocannabinol (THC), the primary psychoactive ingredient in cannabis, binds to cannabinoid 1 (CB1) receptors, levels of CB1 protein could serve as a potential biomarker for response to THC. To date, available techniques to characterize CB1 expression and function are limited. In this study, we developed an assay to quantify CB1 in lymphocytes to determine how it relates to cannabis use in 58 daily cannabis users compared with 47 nonusers. Furthermore, we tested whether CB1 levels are associated with mutations in a single nucleotide polymorphism known to regulate CB1 functioning (i.e., rs2023239). Total protein concentration was analyzed through the Pierce BCA Protein assay kit. CB1 protein was quantified through enzyme-linked immunosorbent assay (ELISA) kit from MyBioSource. CB1 concentration and total protein concentration were quantified and used to calculate a ratio of CB1 to total protein. Inherent levels of peripheral lymphocyte CB1 were sufficient for quantification through ELISA without protein amplification. We found a group×genotype interaction such that users with the G allele had greater CB1 concentration than users with the A/A genotype, and a trend-level difference between genotypes in nonusers. This study demonstrates a minimally invasive technique of CB1 quantification that holds promise for the use of CB1 protein concentration, along with rs2023239 genotype, as a potential biomarker for susceptibility to cannabis use. These results suggest a gene (rs2023239 G)×environment (cannabis use) effect on CB1 density. | [] | other | PMC5628562 | null | 46 | [
"{'Citation': 'Elphick MR, Egertová M. The neurobiology and evolution of cannabinoid signalling. Philos Trans R Soc Lond Ser B. 2001;356:381–408', 'ArticleIdList': {'ArticleId': [{'@IdType': 'pmc', '#text': 'PMC1088434'}, {'@IdType': 'pubmed', '#text': '11316486'}]}}",
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] | J Endourol Case Rep. 2017 Aug 1; 3(1):108-110 | NO-CC CODE |
|
Images from noncontrast CT kidney, ureter, and bladder. Arrow points to (a) dilated right ureter. Contrast given at the time of the CTPA (done previously) is seen to pool in the dilated ureter; (b) dilated right renal pelvis; (c) dilated right ureter; (d) stricture in distal right ureter. | fig-1 | 7 | 25faf9a88a80270b0426cc0a439071623956087e474eae6f67264c3bcc936d0f | fig-1.jpg | multiple | multiple panels: images | [
"Clinical Imaging"
] | [
"computerized tomography"
] | [
750,
465
] | [{'image_id': 'fig-1', 'image_file_name': 'fig-1.jpg', 'image_path': '../data/media_files/PMC5628567/fig-1.jpg', 'caption': 'Images from noncontrast CT kidney, ureter, and bladder. Arrow points to (a) dilated right ureter. Contrast given at the time of the CTPA (done previously) is seen to pool in the dilated ureter; (b) dilated right renal pelvis; (c) dilated right ureter; (d) stricture in distal right ureter.', 'hash': '25faf9a88a80270b0426cc0a439071623956087e474eae6f67264c3bcc936d0f'}, {'image_id': 'fig-2', 'image_file_name': 'fig-2.jpg', 'image_path': '../data/media_files/PMC5628567/fig-2.jpg', 'caption': 'Fluoroscopy images from initial attempt at ureteroscopy and retrograde Double-J stent insertion. Arrows point to (a) extravasation of contrast during retrograde study, probably caused by a ureteral perforation from the guidewire, (b) sensor guidewire kinking at level of distal ureteral stricture, (c) guidewire manipulated into appropriate position within the ureter, (d) Double-J ureteral stent placed effectively with coil in upper pole, and (e) coil in bladder.', 'hash': '3a16752ddf8a469b75ce1fc551f7b447811639e4036d9ad8a3eac17ff2afab57'}, {'image_id': 'fig-4', 'image_file_name': 'fig-4.jpg', 'image_path': '../data/media_files/PMC5628567/fig-4.jpg', 'caption': 'Sequential MAG-3 renograms. (a) soon after third look ureteroscopy with no stent in place—equivocal drainage from right kidney, (b) 3 weeks later with no stent—obstructed right kidney, (c) after stent was reinserted—unobstructed, and (d) after Boari flap ureteral reimplant with no stent—unobstructed.', 'hash': 'a4c6641dc55179dfbb1558226ea9996039ee9e6c72566bef5500f7f12f1e70a1'}, {'image_id': 'fig-3', 'image_file_name': 'fig-3.jpg', 'image_path': '../data/media_files/PMC5628567/fig-3.jpg', 'caption': 'Ureteral biopsy. Arrows point to (a) egg of Schistosoma, (b) giant cell, and (c) eosinophil.', 'hash': 'f77cee47e5bc4c378fa6b40bd134dc7ce2b9ee9465ec631c10cf1454c41e3083'}] | {'fig-1': ['A CT pulmonary angiogram was carried out which excluded a pulmonary embolus, but it demonstrated the right kidney to be hydronephrotic. A subsequent noncontrast CT of the kidneys, ureter, and bladder revealed a dilated and hydronephrotic right pelvicaliceal system with a dilated right ureter traceable to the distal ureter. Contrast administered at the time of the prior CTPA could still be seen in the dilated right ureter (<xref ref-type="fig" rid="fig-1">Fig. 1</xref>).).'], 'fig-2': ['Cystoscopy revealed a tight bladder neck and red patches throughout the bladder. Retrograde pyelogram revealed a dilated right pelvicaliceal system and ureter to the distal ureter, consistent with the CT images. Ureteroscopy was challenging. The initial hydrophilic tipped (Sensor™) guidewire was positioned well in the kidney; the distal ureter was extremely tight and inserting the ureteroscope was difficult. Insertion of a second Sensor guidewire to help facilitate ureteroscopy, as is standard practice, also proved to be challenging. Retrograde studies at this point showed extravasation indicating ureteral perforation (<xref ref-type="fig" rid="fig-2">Fig. 2</xref>). A Double-J ureteral stent was placed in the appropriate position, and a biopsy of the bladder was taken which showed an accumulation of inflammatory cells, but no diagnostic pathology.). A Double-J ureteral stent was placed in the appropriate position, and a biopsy of the bladder was taken which showed an accumulation of inflammatory cells, but no diagnostic pathology.'], 'fig-3': ['Histologic analysis of the ureteral tissue showed both calcified and noncalcified eggs, multinucleated giant cells, and eosinophils (<xref ref-type="fig" rid="fig-3">Fig. 3</xref>) pathognomonic of ) pathognomonic of S. haematobium infection.'], 'fig-4': ['MAG-3 renogram carried out 4 weeks after stent removal showed a curve with equivocal drainage; repeat MAG-3 renogram a further 3 weeks later showed an obstructed curve with deteriorating renal function. This indicated that the stricture was recurring and that the kidney was not draining adequately. The ureteral stent was replaced and the patient underwent reconstructive surgery with Boari flap ureteral reimplant. Due to local surgical expertise this was done open. Follow-up MAG-3 showed normal unobstructed drainage (<xref ref-type="fig" rid="fig-4">Fig. 4</xref>). He will continue to have routine annual cystoscopies for surveillance of his bladder mucosa given the increased risk of bladder squamous cell carcinoma in these patients.). He will continue to have routine annual cystoscopies for surveillance of his bladder mucosa given the increased risk of bladder squamous cell carcinoma in these patients.']} | Schistosomiasis—A Disobedient Ureter, a Disobedient Diagnosis | [
"schistosomiasis",
"ureteral strictures",
"bilharzia",
"urogenital schistosomiasis",
"HIV"
] | J Endourol Case Rep | 1501570800 | Major gaps exist in the measurement of cannabis exposure. The accuracy of self-reported cannabis and tobacco dose per joint is poorly characterized and has never been investigated following acute cannabis/tobacco exposure. Using an innovative "Roll a Joint" paradigm, this study aims to (1) compare estimated and actual dose of cannabis and tobacco per joint at baseline and (2) examine the acute effects of cannabis and/or tobacco on estimated and actual dose. We investigated this by using a randomized, double-blind, placebo-controlled crossover 2 (active cannabis, placebo cannabis)×2 (active tobacco, placebo tobacco) design in a laboratory setting. Participants were 24 recreational cousers of cannabis and tobacco. At baseline, they were asked to measure out the amount of cannabis and tobacco they would put in an average joint for themselves (dose per joint). Then, on each of four drug administration sessions, participants were again asked to do this for a joint they would want to smoke "right now." Self-reported and actual amount was recorded (g). At baseline, the amount of cannabis per joint (0.28±0.23 g) was double the (0.14±0.12 g) (=0.003, =0.723). No difference emerged between estimated (0.43±0.25 g) and actual (0.35±0.15 g) (=0.125) amount of tobacco per joint. Compared to placebo, active cannabis reduced the dose of both cannabis (=0.035) and tobacco (<0.001) they put in a joint. Participants accurately estimated this reduction for tobacco (=0.014), but not for cannabis (=0.680). Self-reported dose per joint is accurate for tobacco but dramatically overestimates cannabis exposure and therefore should be viewed with caution. Cannabis administration reduced the amount of cannabis and tobacco added to joints, suggesting a reduction in dose during a smoking session. The "Roll A Joint" paradigm should be implemented for better accuracy in assessing dose per joint. | [] | other | PMC5628567 | null | 32 | [
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] | J Endourol Case Rep. 2017 Aug 1; 3(1):114-118 | NO-CC CODE |
|
Early changes: A 7-year-old female COVID-19 patient who had experienced a fever and fatigue for 5 days; she had a history of contact with relatives who returned from Wuhan. A) A plain axial CT image showed cord-like consolidation in the left lower lung lobe with even density and blurred boundaries, and an air bronchogram was observed(arrow), as is seen in lobar pneumonia; B) A plain axial CT image taken 6 days later showed that the consolidation had been partially absorbed compared with the previous image and the lesion boundaries were slightly blurred; C) A plain axial CT image taken after 16 days showed that left lower lung lobe lesions had been virtually absorbed; a SARS-CoV-2 nucleic acid test taken at this time was negative. | gr2_lrg | 7 | a38dc577a2265adffdf561d1921d74725bd9342dd0fc42e87b5b653a4dd97a28 | gr2_lrg.jpg | multiple | multiple panels: images | [
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] | [{'image_id': 'gr2_lrg', 'image_file_name': 'gr2_lrg.jpg', 'image_path': '../data/media_files/PMC7214302/gr2_lrg.jpg', 'caption': 'Early changes: A 7-year-old female COVID-19 patient who had experienced a fever and fatigue for 5\xa0days; she had a history of contact with relatives who returned from Wuhan. A) A plain axial CT image showed cord-like consolidation in the left lower lung lobe with even density and blurred boundaries, and an air bronchogram was observed(arrow), as is seen in lobar pneumonia; B) A plain axial CT image taken 6\xa0days later showed that the consolidation had been partially absorbed compared with the previous image and the lesion boundaries were slightly blurred; C) A plain axial CT image taken after 16\xa0days showed that left lower lung lobe lesions had been virtually absorbed; a SARS-CoV-2 nucleic acid test taken at this time was negative.', 'hash': 'a38dc577a2265adffdf561d1921d74725bd9342dd0fc42e87b5b653a4dd97a28'}, {'image_id': 'gr6_lrg', 'image_file_name': 'gr6_lrg.jpg', 'image_path': '../data/media_files/PMC7214302/gr6_lrg.jpg', 'caption': 'Mild or moderate changes: A 28-year-old male COVID-19 patient who had experienced fever for 1\xa0day, but reported no history of contact with people from the epidemic region or confirmed COVID-19 patients. Clinical type: mild or moderate. A,B) Initial plain axial chest CT images did not show any apparent abnormalities; C,D) Plain axial CT images taken after 3\xa0days showed patchy ground-glass opacities and cord-like shadows bilaterally in the subpleural regions(arrow); these are more significant in the left lung; E, F) Plain axial CT images taken after 6\xa0days showed increased areas of subpleural ground-glass opacity bilaterally accompanied by consolidation and cord-like shadows, as well as interlobular septal thickening; G, H) Plain axial CT images taken after10 days showed that the lesions were mostly absorbed and there were fibrous cord-like shadows with clear boundaries in the subpleural area; a SARS-CoV-2 nucleic acid test taken at this time was negative.', 'hash': '68b7b3fc55eac74a121059c214cf9d39c2901593130035bdaba580e3b3ff41f5'}, {'image_id': 'gr3_lrg', 'image_file_name': 'gr3_lrg.jpg', 'image_path': '../data/media_files/PMC7214302/gr3_lrg.jpg', 'caption': 'Progressive changes: A 45-year-old female COVID-19 patient who had experienced a fever for 7\xa0days and had a sore throat, dyspnoea, and a history of a short residence in Wuhan. A, B) Plain axial CT images showed multiple bilateral subpleural ground-glass opacities(arrow); the long axis of the lesions was vertical to the thoracic wall; C, D) Plain axial CT images taken 7\xa0days later showed diffuse bilateral subpleural and central patchy ground-glass opacities involving multiple lung lobes.', 'hash': '9b52c8526490851d2f604beea783135ea8b983477d5d88eeaa08b35c52c7e82c'}, {'image_id': 'gr7_lrg', 'image_file_name': 'gr7_lrg.jpg', 'image_path': '../data/media_files/PMC7214302/gr7_lrg.jpg', 'caption': 'Severe changes: A 78-year-old female COVID-19 patient who reported an intermittent fever and cough for 1\xa0week, and had a history of contact with family members from the epidemic region. Clinical type: severe. A,B) Plain axial chest CT images; C, D) Plain coronal chest CT images. All images showed extensive ground-glass opacities and areas of consolidation bilaterally in the lung periphery and subpleural areas (arrow); these are more significant in the lower lungs. Air bronchograms and vascular thickening shadows were also observed.', 'hash': '78e6e513d2f602a4a73f084e6fef39fb5bd5b11686232678505115c3ba465e36'}, {'image_id': 'gr1_lrg', 'image_file_name': 'gr1_lrg.jpg', 'image_path': '../data/media_files/PMC7214302/gr1_lrg.jpg', 'caption': 'Early changes: A 41-year-old male COVID-19 patient with a history of occupational exposure to the disease who had experienced fever for 2\xa0days. A) An initial plain axial chest CT image showed small patchy ground-glass opacities (arrow) located along vascular bundles in the subpleural region of the left upper lobe lingular segment; B) A plain axial CT image taken 2\xa0days later showed that the ground-glass opacities had increased in area and density; C) A plain axial CT image taken after 9\xa0days showed that the lesion area had significantly increased with an uneven increase in density, and an air bronchogram and vascular shadows were observed; D) A plain axial CT image taken after 15\xa0days showed that the density of ground-glass opacities was decreased and partial absorption was observed; E) A plain axial CT image taken after 20\xa0days showed that the lesions in the left upper lobe lingular segment were practically absorbed; a SARS-CoV-2 nucleic acid test taken at this time was negative.', 'hash': '743803768c965d1a1f895379aa20a618272eaefc2d8664ac9240cd4931e45ce4'}, {'image_id': 'gr5_lrg', 'image_file_name': 'gr5_lrg.jpg', 'image_path': '../data/media_files/PMC7214302/gr5_lrg.jpg', 'caption': 'Early to Severe changes: A 67-year-old male COVID-19 patient with a history of residence in Wuhan who reported fever, fatigue, and poor appetite for 6\xa0days. A–D) Initial plain axial chest CT images showed bilateral bronchial wall thickening and mild dilation, bilateral centrilobular emphysema, and bilateral lower lung interstitial thickening; E–H) Plain axial CT images taken 4\xa0days later showed diffuse patchy ground-glass opacities in both lungs (arrow); in the left lung the lesions have a fan-like distribution and grid-like shadows, and vascular thickening is also seen; I–L) Plain axial CT images taken after 7\xa0days showed a significant expansion of the lesion area with multiple patchy and grid-like shadows and areas of consolidation in both lungs; M–P) Plain axial CT images taken after 10\xa0days showed diffuse bilateral lung lesions, with a “white lung” presentation.', 'hash': '4b18ab81030fdac352a6c34c7b75747da39ea87231102a4c4044346993bb57a5'}, {'image_id': 'gr4_lrg', 'image_file_name': 'gr4_lrg.jpg', 'image_path': '../data/media_files/PMC7214302/gr4_lrg.jpg', 'caption': 'Progressive changes: A 69-year-old female COVID-19 patient with a history of residence in Wuhan who reported a productive cough accompanied by systemic muscle soreness for 14\xa0days. A–D) Plain axial CT images showed patchy ground-glass opacities and grid-like changes bilaterally in the subpleural areas of the lung periphery, with a “crazy-paving sign”(arrow); E–H) Plain axial CT images taken 3\xa0days later showed an increased lesion area and an uneven increase in ground-glass opacities bilaterally in the lung periphery accompanied by consolidation. Ground-glass opacities and grid-like shadows were also present inside the lungs, accompanied by interlobular septal thickening.', 'hash': 'b19aa7e326d4c29d6fb946477b6fdb818a7dccca76608ebb74a75dae78459d6e'}] | {'gr1_lrg': ['Ninety-five patients with suspected COVID-19 underwent two to three SARS-CoV-2 nucleic acid tests for definitive diagnosis. All patients showed signs of COVID-19 pneumonia on chest imaging during diagnosis. Fifty-three (55.8%) patients were classified as early stage (<xref rid="gr1_lrg" ref-type="fig">Fig. 1</xref>, , <xref rid="gr2_lrg" ref-type="fig">Fig. 2</xref>\n). These cases frequently showed peripheral subpleural ground-glass opacities, which were observed as local patches in 22/53 patients (41.5%). Ground-glass opacities were seen with interlobular septal thickening in 4/53 patients (7.5%). Thirty-four (35.8%) patients were classified into the progression stage (\n). These cases frequently showed peripheral subpleural ground-glass opacities, which were observed as local patches in 22/53 patients (41.5%). Ground-glass opacities were seen with interlobular septal thickening in 4/53 patients (7.5%). Thirty-four (35.8%) patients were classified into the progression stage (<xref rid="gr3_lrg" ref-type="fig">Fig. 3</xref>, , <xref rid="gr4_lrg" ref-type="fig">Fig. 4</xref>\n); these patients commonly exhibited lesions in multiple lung segments and lobes (21/34, 61.8%), with an uneven increase in ground-glass opacity density accompanied by consolidation and grid-like or cord-like shadows (30%).There were two (2.1%) patients in the severe stage group (\n); these patients commonly exhibited lesions in multiple lung segments and lobes (21/34, 61.8%), with an uneven increase in ground-glass opacity density accompanied by consolidation and grid-like or cord-like shadows (30%).There were two (2.1%) patients in the severe stage group (<xref rid="gr5_lrg" ref-type="fig">Fig. 5</xref>\n), these presented with diffuse bilateral lung lesions, mixed ground-glass opacities and consolidation with cord-like interstitial thickening or air bronchograms, entire lung involvement with a “white lung” presentation, and a slight pleural effusion. Six patients in remission (6.3%) (\n), these presented with diffuse bilateral lung lesions, mixed ground-glass opacities and consolidation with cord-like interstitial thickening or air bronchograms, entire lung involvement with a “white lung” presentation, and a slight pleural effusion. Six patients in remission (6.3%) (Table 1\n). The distribution and severity of lesions on imaging progressed during the course of the disease, and one or multiple imaging presentations could be identified at each stage (Table 2\n). Seventy-one (74.7%), 22 (23.2%), and two (2.1%) patients had mild or moderate (<xref rid="gr6_lrg" ref-type="fig">Fig. 6</xref>\n), severe (\n), severe (<xref rid="gr7_lrg" ref-type="fig">Fig. 7</xref>\n), and critical clinical disease, respectively (\n), and critical clinical disease, respectively (Table 3\n).Fig. 1Early changes: A 41-year-old male COVID-19 patient with a history of occupational exposure to the disease who had experienced fever for 2\xa0days. A) An initial plain axial chest CT image showed small patchy ground-glass opacities (arrow) located along vascular bundles in the subpleural region of the left upper lobe lingular segment; B) A plain axial CT image taken 2\xa0days later showed that the ground-glass opacities had increased in area and density; C) A plain axial CT image taken after 9\xa0days showed that the lesion area had significantly increased with an uneven increase in density, and an air bronchogram and vascular shadows were observed; D) A plain axial CT image taken after 15\xa0days showed that the density of ground-glass opacities was decreased and partial absorption was observed; E) A plain axial CT image taken after 20\xa0days showed that the lesions in the left upper lobe lingular segment were practically absorbed; a SARS-CoV-2 nucleic acid test taken at this time was negative.Fig. 1Fig. 2Early changes: A 7-year-old female COVID-19 patient who had experienced a fever and fatigue for 5\xa0days; she had a history of contact with relatives who returned from Wuhan. A) A plain axial CT image showed cord-like consolidation in the left lower lung lobe with even density and blurred boundaries, and an air bronchogram was observed(arrow), as is seen in lobar pneumonia; B) A plain axial CT image taken 6\xa0days later showed that the consolidation had been partially absorbed compared with the previous image and the lesion boundaries were slightly blurred; C) A plain axial CT image taken after 16\xa0days showed that left lower lung lobe lesions had been virtually absorbed; a SARS-CoV-2 nucleic acid test taken at this time was negative.Fig. 2Fig. 3Progressive changes: A 45-year-old female COVID-19 patient who had experienced a fever for 7\xa0days and had a sore throat, dyspnoea, and a history of a short residence in Wuhan. A, B) Plain axial CT images showed multiple bilateral subpleural ground-glass opacities(arrow); the long axis of the lesions was vertical to the thoracic wall; C, D) Plain axial CT images taken 7\xa0days later showed diffuse bilateral subpleural and central patchy ground-glass opacities involving multiple lung lobes.Fig. 3Fig. 4Progressive changes: A 69-year-old female COVID-19 patient with a history of residence in Wuhan who reported a productive cough accompanied by systemic muscle soreness for 14\xa0days. A–D) Plain axial CT images showed patchy ground-glass opacities and grid-like changes bilaterally in the subpleural areas of the lung periphery, with a “crazy-paving sign”(arrow); E–H) Plain axial CT images taken 3\xa0days later showed an increased lesion area and an uneven increase in ground-glass opacities bilaterally in the lung periphery accompanied by consolidation. Ground-glass opacities and grid-like shadows were also present inside the lungs, accompanied by interlobular septal thickening.Fig. 4Fig. 5Early to Severe changes: A 67-year-old male COVID-19 patient with a history of residence in Wuhan who reported fever, fatigue, and poor appetite for 6\xa0days. A–D) Initial plain axial chest CT images showed bilateral bronchial wall thickening and mild dilation, bilateral centrilobular emphysema, and bilateral lower lung interstitial thickening; E–H) Plain axial CT images taken 4\xa0days later showed diffuse patchy ground-glass opacities in both lungs (arrow); in the left lung the lesions have a fan-like distribution and grid-like shadows, and vascular thickening is also seen; I–L) Plain axial CT images taken after 7\xa0days showed a significant expansion of the lesion area with multiple patchy and grid-like shadows and areas of consolidation in both lungs; M–P) Plain axial CT images taken after 10\xa0days showed diffuse bilateral lung lesions, with a “white lung” presentation.Fig. 5Table 1Staging of coronavirus disease 2019 based on CT imagingTable 1Imaging presentationImaging stageEarly stageProgression stageSevere stageRemission stageProportion (%)Lesion distributionSubpleural subsegmental or segmental distribution1935.8%Involves >3 lung segments or 2 lung lobes2161.8%Diffuse bilateral lung distribution accompanied by air bronchogram150%\u2028\u2028Lesion characteristicNormal or few abnormal dense shadows59.4%Absence of specific ground-glass opacities or unilateral lung segment patchy shadows35.7%Local patchy ground-glass opacity2241.5%Ground-glass opacity or interlobular septal thickening47.5%Ground-glass opacity, non-uniform consolidation, and grid-like or cord-like shadows617.6%Mixed consolidation shadow and cord-like interstitial thickening150%Ground-glass opacity and diffuse fibrous cord-like shadow466.7%\u2028\u2028Lesion progressionLesion expansion by >50%720.6%\u2028\u2028Lesion outcomeAbsorption of exudative lesions233.3%Total (n)533426100%Table 2CT imaging presentation of coronavirus disease 2019Table 2Imaging characteristicNumber of patients (n\xa0=\xa095)Proportion (%)Lesion distributionUnilateral lung lobe3941.2Bilateral lung lobes5658.9\u2028\u2028Lesion siteLung periphery, subpleural distribution4547.4Central distribution1313.7Simultaneous peripheral and central distribution3738.9Number of lesionsn\xa0=\xa07983.2%\xa0Single2223.2\xa0Multiple5760Ground-glass opacityn\xa0=\xa07983.2%\xa0Ground-glass opacity4143.2\xa0Ground-glass opacity with consolidation and grid-like or cord-like shadows2930.5\xa0Mixed type99.5Other imaging signsn\xa0=\xa02122.1%\xa0Fibrous cord-like shadow1313.7\xa0Pleural hypertrophy55.3\xa0Pleural effusion22.1\xa0Mediastinal lymph node enlargement11.1Fig. 6Mild or moderate changes: A 28-year-old male COVID-19 patient who had experienced fever for 1\xa0day, but reported no history of contact with people from the epidemic region or confirmed COVID-19 patients. Clinical type: mild or moderate. A,B) Initial plain axial chest CT images did not show any apparent abnormalities; C,D) Plain axial CT images taken after 3\xa0days showed patchy ground-glass opacities and cord-like shadows bilaterally in the subpleural regions(arrow); these are more significant in the left lung; E, F) Plain axial CT images taken after 6\xa0days showed increased areas of subpleural ground-glass opacity bilaterally accompanied by consolidation and cord-like shadows, as well as interlobular septal thickening; G, H) Plain axial CT images taken after10 days showed that the lesions were mostly absorbed and there were fibrous cord-like shadows with clear boundaries in the subpleural area; a SARS-CoV-2 nucleic acid test taken at this time was negative.Fig. 6Fig. 7Severe changes: A 78-year-old female COVID-19 patient who reported an intermittent fever and cough for 1\xa0week, and had a history of contact with family members from the epidemic region. Clinical type: severe. A,B) Plain axial chest CT images; C, D) Plain coronal chest CT images. All images showed extensive ground-glass opacities and areas of consolidation bilaterally in the lung periphery and subpleural areas (arrow); these are more significant in the lower lungs. Air bronchograms and vascular thickening shadows were also observed.Fig. 7Table 3Clinical typing of coronavirus disease 2019 in relation to CT imaging presentationTable 3Imaging presentationClinical type (n (%))Mild or moderateSevereCriticalLesion distributionSubsegmental or segmental distribution15 (21.1%)Unilateral or bilateral lung periphery, subpleural distribution56 (78.9%)5 (22.7%)Involves 2 or more lung lobes9 (40.9%)Diffuse bilateral lung distribution8 (36.4%)2 (100%)\u2028\u2028Ground-glass opacity characteristicsSingle20 (28.2%)2 (9.1%)Multiple45 (63.4%)12 (63.4%)Vascular thickening and air bronchogram27 (38%)13 (59.1%)1 (50%)Consolidation and grid-like or cord-like shadows23 (32.4%)5 (22.7%)1 (50%)Mixed type1 (1.4%)8 (36.4%)\u2028\u2028Other imaging signsInterlobar or bilateral pleural thickening1 (1.4%)4 (18.2%)Free or local encapsulated effusion1 (4.5%)1 (50%)Total (n)71 (5\xa0+\xa066)222']} | Preliminary CT findings of coronavirus disease 2019 (COVID-19) | null | Clin Imaging | 1599894000 | [] | other | PMC7214302 | null | 0 | [] | Clin Imaging. 2020 Sep 12; 65:124-132 | NO-CC CODE |
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