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We present a case of a 71-year-old woman with an unusual complication of aortic intramural hematoma and hepatic artery pseudoaneurysm following cardiopulmonary resuscitation and thrombolysis done for sudden cardiopulmonary arrest and pulmonary embolism. Patient was on Warfarin treatment for a prior history of pulmonary embolism and experienced recurrent cardiac arrests, which finally resolved after intravenous administration of thrombolytic agents. However, follow-up computed tomographic angiography revealed descending aortic intramural hematoma with intramural blood pool and concomitant liver laceration with hepatic artery pseudoaneurysm. The patient received transcatheter embolization for the hepatic injury with careful follow-up for the aortic injury and was later discharged in a stable condition. Follow-up with subsequent computed tomographic angiography at a regular interval over 1 month shows near complete resolution of the intramural hematoma. The purpose of this report is to describe the rare complication of cardiopulmonary resuscitation and thrombolysis in the form of concomitant injuries of the aorta and liver. Although the use of thrombolytic agents in patients with pulmonary embolism and cardiac arrest is still a matter of debate, this case report supports the concept that thrombolysis has a role in restoring cardiopulmonary circulation, especially in recurrent cardiac arrests resulting from pulmonary embolism. On the other hand, this case also highlights the increased association of the bleeding-related complication as a result of vigorous efforts of cardiopulmonary resuscitation. Aggressive management with interventional radiology for hepatic pseudoaneurysm and conservative management of the aortic intramural hematoma resulted in favorable outcome for our patient. [ABSTRACT FROM AUTHOR]

Coronary cameral fistula is a rare entity and is characterized by an abnormal communication between coronary artery and a cardiac chamber. It is usually congenital and asymptomatic in majority of patients. If symptomatic the patients usually present in childhood. We present a case of 45-year-old male who presented with anginal chest pain and dyspnea on exertion for last 1 year. His exercise treadmill test was positive for ischemic changes and ECG-gated contrast enhanced CT was done for further evaluation. CT showed a large right coronary artery to right atrium fistula. It also ruled out any coronary atherosclerosis as reason for chest pain and ischemic symptoms on exercise treadmill test. The fistula was successfully closed by surgery and there was resolution of chest pain and dyspnea. [ABSTRACT FROM AUTHOR]

The pentalogy of Cantrell, a rare syndrome, consists of the defects in the anterior diaphragm, diaphragmatic pericardium, lower sternum and supraumbilical abdominal wall, along with congenital cardiac abnormalities. Till date, only few patients with full spectrum of this syndrome have been reported with only 2 cases showing associated exencephaly and spinal dysraphism. We report extremely rare association of complete pentalogy of Cantrell syndrome with exencephaly and spinal dysraphism on antenatal sonogram and autopsy in a 18 weeks fetus of a 19 year-old primi gravida female. [ABSTRACT FROM AUTHOR]

Duplication of the gall bladder is a rare anomaly. Ectopic thyroid in a gall bladder is also exceedingly rare with only four cases of ectopic thyroid tissue in the gall bladder reported in English literature. We report the unique case of ectopic thyroid tissue in a duplicated gall bladder in a 51-year-old female with recurrent right upper quadrant pain. Abdominal sonography revealed a duplicated gall bladder with the cystic-solid mass in the septum separating the two gall bladders while subsequent histopathology from the cholecystectomy specimen confirmed ectopic thyroid tissue within the wall of double gall bladder. [ABSTRACT FROM AUTHOR]

Pulmonary arteriovenous malformations (PAVMs) occur in 30% to 50% of patients with hereditary hemorrhagic telangiectasia. Clinical presentations vary from asymptomatic disease to complications resulting from the right to left shunting of blood through the PAVM such as paradoxical stroke, brain abscesses, hypoxemia, and cardiac failure. Radiology plays an important role both in the diagnosis and treatment of PAVM. Based on different clinical scenarios, the appropriate imaging study has been reviewed and is presented in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

This document discusses preprocedural planning for transcatheter aortic valve replacement, evaluating the imaging modalities used in initial imaging for preprocedure planning under two variants 1) Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root; and 2) Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. US echocardiography transesophageal, MRI heart function and morphology without and with IV contrast, MRI heart function and morphology without IV contrast and CT heart function and morphology with IV contrast are usually appropriate for assessment of aortic root. CTA chest with IV contrast, CTA abdomen and pelvis with IV contrast, CTA chest abdomen pelvis with IV contrast are usually appropriate for assessment of supravalvular aorta and vascular access. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation., (Copyright © 2023 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Background and Objective: Several incidental cardiovascular findings are present in a routine chest computed tomography (CT) scan, many of which do not make it to the final radiology report. However, these findings have important clinical implications, particularly providing prognosis and risk-stratification for future cardiovascular events. The purpose of this article is to review the literature on these incidental cardiovascular findings in a routine chest CT and inform the radiologist on their clinical relevance., Methods: A time unlimited review of PubMed and Web of Science was performed by using relevant keywords. Articles in English that involved adults were included., Key Content and Findings: Coronary artery calcification (CAC) is the most common incidental cardiac finding detected in a routine chest CT and is a significant predictor of cardiovascular events. Noncoronary vascular calcifications in chest CT include aortic valve, mitral annulus, and thoracic aortic calcifications (TAC). Among these, aortic valve calcification (AVC) has the strongest association with coronary artery disease and cardiovascular events. Additional cardiac findings such as myocardial scar and left ventricular size and noncardiac findings such as thoracic fat, bone density, hepatic steatosis, and breast artery calcifications can also help in risk stratification and patient management., Conclusions: The radiologist interpreting a routine chest CT should be cognizant of the incidental cardiovascular findings, which helps in the diagnosis and risk-stratification of cardiovascular disease. This will guide appropriate referral and management., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cdt.amegroups.com/article/view/10.21037/cdt-23-79/coif). AC and PSR report that they received royalties from Elsevier, unrelated to the content of this manuscript. PSR serves as an unpaid editorial board member of Cardiovascular Diagnosis and Therapy from September 2021 to August 2023. The other authors have no conflicts of interest to declare., (2023 Cardiovascular Diagnosis and Therapy. All rights reserved.)

Aggressive, albeit false marketing of electronic nicotine delivery systems (ENDS) or vaping devices as safer alternatives to cigarette smoking, combined with lack of regulations, has led to its mass adoption, especially among youth. A sudden increase in acute lung injuries was noted in 2019 which was linked to ENDS. It was termed by the Centers for Disease Control and Prevention (CDC) as electronic cigarette or vaping product use-associated lung injury (EVALI). Analysis of bronchoalveolar lavage fluid samples linked EVALI to vitamin E acetate (VEA), which is used as a diluting agent for marijuana oils. Patients with EVALI present with a combination of non-specific respiratory, gastrointestinal, and systemic symptoms. Laboratory results may show elevated inflammatory biomarkers. EVALI is a diagnosis of exclusion and must meet the following criteria: i) history of vaping within last 90 days, ii) abnormal chest imaging, iii) negative evaluation for infection, and iv) no other plausible diagnosis. A spectrum of computed tomography (CT) chest findings has been reported in EVALI, ranging from diffuse alveolar damage to organizing pneumonia, characterized by bilateral ground-glass opacities, consolidation, and septal thickening. A similar spectrum is seen on histopathology, characterized by lipid-laden alveolar macrophages, with varying degrees of infiltrative inflammatory cells and fibrin deposition. Early and accurate identification of the EVALI pattern can help optimize patient care. For example, in diffuse alveolar damage (DAD), a lower threshold for ventilation support and corticosteroid may improve outcomes. Here, we review the etiopathogenesis, clinical management, histopathology, and imaging features of EVALI., Competing Interests: Conflict of Interest Eric Hoffman, PhD is a founder and shareholder of VIDA Diagnostics, a company commercializing lung image analysis software, developed in part at the University of Iowa. The other authors confirm that this article content has no conflict of interest., (Copyright © 2022 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)

Recent advances in dual-energy imaging techniques, dual-energy subtraction radiography (DESR) and dual-energy CT (DECT), offer new and useful additional information to conventional imaging, thus improving assessment of cardiothoracic abnormalities. DESR facilitates detection and characterization of pulmonary nodules. Other advantages of DESR include better depiction of pleural, lung parenchymal, airway and chest wall abnormalities, detection of foreign bodies and indwelling devices, improved visualization of cardiac and coronary artery calcifications helping in risk stratification of coronary artery disease, and diagnosing conditions like constrictive pericarditis and valvular stenosis. Commercially available DECT approaches are classified into emission based (dual rotation/spin, dual source, rapid kilovoltage switching and split beam) and detector-based (dual layer) systems. DECT provide several specialized image reconstructions. Virtual non-contrast images (VNC) allow for radiation dose reduction by obviating need for true non contrast images, low energy virtual mono-energetic images (VMI) boost contrast enhancement and help in salvaging otherwise non-diagnostic vascular studies, high energy VMI reduce beam hardening artifacts from metallic hardware or dense contrast material, and iodine density images allow quantitative and qualitative assessment of enhancement/iodine distribution. The large amount of data generated by DECT can affect interpreting physician efficiency but also limit clinical adoption of the technology. Optimization of the existing workflow and streamlining the integration between post-processing software and picture archiving and communication system (PACS) is therefore warranted., Competing Interests: The author(s) or author(s) institutions have no conflicts of interest pertaining to this project., (© 2021 The Authors.)

The Tumor, Node, Metastasis (TNM) staging system, adopted by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC), has been recently revised, with the new 8 th edition of the staging manual being published in January 2017. This edition has few but important evidence-based changes to the TNM staging system used for lung cancer. Radiologists should be aware of the updated classification system to accurately provide staging information to oncologists and oncosurgeons. In this article, we discuss the rationale, illustrate the changes with relevance to Radiology, and review the clinical implications of the 8 th edition of the UICC/AJCC TNM staging system with regards to lung cancer., Competing Interests: Conflict-of-interest statement: All authors do not have any conflict of interest or financial disclosure relevant to this article.

Acute traumatic aortic injury (ATAI) is a life-threatening injury. CT is the imaging tool of choice, and the knowledge of direct and indirect signs of injury, grading system, and current management protocol helps the emergency radiologist to better identify and classify the injury and provide additional details that can impact management options. Newer dual-source CT technology with ultrafast acquisition speed has also influenced the appropriate protocol for imaging in patients with suspected ATAI. This review highlights the imaging protocol in patients with blunt trauma, CT appearance and grading systems of ATAI, management options, and the role of the multidisciplinary team in the management of these patients. We also briefly review the current literature on the definition, treatment, and follow-up protocol in patients with minimal aortic injury.

Background: The purpose is to develop a comprehensive risk-scoring system based on CT findings for predicting 30-day mortality after acute pulmonary embolism (PE), and to compare it with PE Severity Index (PESI)., Materials and Methods: The study included consecutive 1698 CT pulmonary angiograms (CTPA) positive for acute PE performed at a single institution (2003-2010). Two radiologists independently assessed each study regarding clinically relevant findings and then performed adjudication. These variables plus patient clinical information were included to build a LASSO logistic regression model to predict 30-day mortality. A point score for each significant variable was generated based on the final model. PESI score was calculated in 568 patients who visited the hospital after 2007., Results: Inter-reader agreements of interpretations were >95% except for septal bowing (92%). The final prediction model showed superior ability over PESI (AUC = 0.822 vs 0.745) for predicting all-cause 30-day mortality (12.4%). The scoring system based on the significant variables (age (years), pleural effusion (+20), pericardial effusion (+20), lung/liver/bone lesions suggesting malignancy (+60), chronic interstitial lung disease (+20), enlarged lymph node in thorax (+20), and ascites (+40)) stratified patients into 4 severity categories, with mortality rates of 0.008% in class-I (≤50 pt), 3.8% in class-II (51-100 pt), 17.6% in class-III (101-150 pt), and 40.9% in class-IV (>150 pt). The mortality rate in the CTPA-high risk category (class-IV) was higher than those in the PESI's high risk (27.4%) and very high risk (25.2%) categories., Conclusion: The CTPA-based model was superior to PESI in predicting 30-day mortality. Incorporating the CTPA-based scoring system into image interpretation workflows may help physicians to select the most appropriate management approach for individual patients., (Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Objective: The objective was to study the imaging features of primary and metastatic intrathoracic synovial sarcoma (ISS)., Materials and Methods: We reviewed the imaging of 42 patients with ISS (31 pleural, 7 intrapulmonary, 4 mediastinal), with baseline imaging of 19 patients and follow-up imaging in all., Results: Primary tumors (n=19) were well circumscribed (15/19), homogeneous or heterogeneously enhancing, with mean size 9.1 cm (range: 1.8-25 cm). Recurrent/metastatic disease developed in 28/42 patients (67%). Lung was the most common site of metastases (21/28), with most of them predominantly pleural (11/21). On pathology, 30 patients had monophasic tumors, and 6 each had biphasic tumors and poorly differentiated tumors., Conclusion: Intrathoracic SS most commonly presents as a large heterogeneous pleural mass without associated adenopathy. Lung metastases are often pleural based and ipsilateral., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to evaluate the prevalence, MDCT angiography (MDCTA) appearance, associated congenital cardiovascular abnormalities, and prognosis of anomalous origin of one pulmonary artery from the aorta (AOPA) on the basis of MDCTA., Materials and Methods: We conducted a retrospective search of patients with AOPA from our database in a single center, consisting of 5729 patients referred for MDCTA with known or suspected congenital heart diseases from transthoracic echocardiography. The clinical information, subtypes of AOPA, associated cardiovascular anomalies, and surgical and clinical outcomes were retrospectively collected and analyzed. The MDCTA images were retrospectively processed for analysis, and the MDCTA and echocardiography images were interpreted by radiologist and cardiologist without knowledge of the actual diagnosis or surgical outcome., Results: AOPA was seen in 19 patients (14 males and five females; median age, 3 months; range, 4 days-21 years) showing a prevalence of 0.33%. Anomalous origin of the right pulmonary artery (AORPA, 89%), proximal origin subtype of the AOPA (89%), and ipsilateral aortic wall origin of AOPA (58%) were more commonly seen. In addition to the benefit of preoperative planning, MDCTA also supplemented echocardiography by providing accurate diagnosis of AOPA and other associated cardiovascular anomalies compared with transthoracic echocardiography (TTE). We found a total of four patients (21%) with misdiagnosis by TTE, including three patients with underdiagnosis of AOPA and one patient with misdiagnosis as transposition of the great arteries. In addition, two other patients had AOPA diagnosed, but the associated patent ductus arteriosus (PDA) was not detected. MDCTA revealed 95% association with other congenital cardiovascular anomalies, including PDA (71% of AORPA), and aortic arch anomalies (100% of anomalous origin of the left pulmonary artery, AOLPA). The types of surgery depended on the MDCTA findings, including the sub-type, origin sites of AOPA, and associated cardiovascular anomalies. Analysis of the pulmonary arterial sizes showed the McGoon ratios in these patients with a median value of 2.4 (range, 1.5-2.9). Surgical treatment performed before the age of 1 year enabled normalization of pulmonary artery pressure in 92% of patients., Conclusion: AOPA had a prevalence of 0.33% among patients with congenital heart disease in our series. MDCTA was an important supplement for the diagnosis, delineating the different subtypes and origin sites of AOPA and permitting preoperative planning of AOPA in patients suspected on the basis of echocardiography of having AOPA because accurate diagnosis and early surgical treatment remain the mainstays in improving patient outcome.

Pseudoaneurysm is defined as contained blood pooling due to rupture of vascular wall. They have higher risk of rupture and hence are usually managed aggressively. Trauma, infection and prior surgery are the most common etiologies for pseudoaneurysm of most sites. Traumatic cardiac pseudoaneurysm are rare and poses a diagnostic challenge to the treating physician since there is no specific symptoms associated with pseudoaneurysm and electrocardiogram; cardiac enzymes and echocardiogram may be unrevealing or inconclusive in many cases. Cross-sectional imaging [computed tomography (CT) and magnetic resonance imaging (MRI)] is done in cases with high index of suspicion and is the standard modality for diagnosis for cardiac pseudoaneurysm. We present a case of conservatively managed post-traumatic right atrial pseudoaneurysm with aim to highlight the role of electrocardiography (ECG)-gated multidetector computed tomography (MDCT) in diagnosis and follow-up of this rare entity that ultimately underwent rapid partial thrombosis.

Iodinated contrast delivery is a key component of coronary CT angiography. However, the purpose of contrast delivery has been limited to morphology alone. Specifically, iodine opacification of the coronary lumen has been used to separate it from the coronary artery wall and lesions within the coronary arteries. Because contrast is delivered to the coronary arteries according to the coronary blood flow, there is flow information encoded within the contrast opacification which, depending on CT hardware and acquisition protocol, can be recognized in coronary CT angiography. In addition, metrics related to flow have been identified and studied. They include coronary contrast opacification differences and contrast opacification gradients.

Objective: The purpose of this article is to describe the evaluation of congenital coronary artery fistulas (CAFs) with MDCT angiography with ECG gating (MDCTA), including the clinical manifestations, scanning techniques, differential diagnosis, and other imaging methods that may be used., Conclusion: Congenital CAFs are rare coronary artery anomalies of termination. MDCTA is a first-line modality for pretreatment planning, and imaging findings should be recognized because CAFs may be detected incidentally.

Objective: The purpose of this article is to enlighten radiologists with the clinical presentation, multimodality imaging features, local recurrence, distant spread, differential diagnosis, and prognosis of skin and subcutaneous malignancies., Conclusion: Cutaneous and subcutaneous malignancies represent the most common type of cancer and frequently present with overlapping imaging appearances. CT, MRI, and (18)F-FDG PET/CT are commonly used for staging, preoperative planning, and posttreatment assessment. Knowledge of the multimodality imaging features can narrow down the differential diagnosis and elucidate their metastatic pattern.

Background: Pneumosinus dilatans (PD) is a pathologic condition involving the hyperaeration of one or several of the paranasal sinuses that can lead to significant deformation of the overlying bone. Although the presenting complaint of patients with PD is most commonly aesthetic in nature, the condition has also been associated with intracranial tumors and several other serious conditions., Materials and Methods: A meta-analysis of all available clinical publications on the subject of PD was conducted. Patients were categorized on the basis of their sinus involvement. Associated conditions were also identified and categorized. The resulting data were used to further characterize the condition and describe previously unreported associations between PD and other conditions., Results: To date, a total of 123 cases of PD have been reported. The frontal sinus was the most commonly involved (63%), followed by the sphenoid sinus (24%), maxillary sinus (20%), and ethmoid sinus (19%). Of patients with symptomatic PD of the frontal sinus, 25% had intracranial pathology (meningioma or arachnoid cyst or orbital tumor). Patients with sphenoid PD had an 83% chance of having associated diagnosis of visual loss, meningioma, or arachnoid cyst, whereas patients with ethmoid PD had 83% chance of having associated diagnosis of exophthalmos, vision loss, or arachnoid cyst., Conclusions: Although the presenting complaint of patients with PD is most commonly aesthetic in nature, a significant percentage may have an associated diagnosis. Health care providers must be able to recognize the condition and carry out the appropriate clinical evaluation to avoid missing an associated diagnosis.

Objective: Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine tumor. The purpose of this review is to provide a comprehensive description of the staging, workup, treatment, and follow-up of MCC., Conclusion: Sentinel lymph node mapping and PET/CT are the cornerstones of staging of MCC. MCC is a radiosensitive tumor, and hence radiotherapy plays a major role in its management. Close follow-up with PET/CT helps in detecting recurrences of MCC.

Objective: Rhabdomyosarcomas are rare and aggressive soft-tissue sarcomas in adults. The purpose of this article is to describe the imaging features of primary and secondary adult rhabdomyosarcomas utilizing MRI, CT, and (18)F-FDG PET/CT., Conclusion: MRI is the imaging technique of choice for the evaluation of primary rhabdomyosarcoma involving most body sites (extremity, pelvis, head, and neck), with the added advantages of diffusion-weighted imaging and whole-body MRI for staging. CT and FDG PET/CT play major roles in the evaluation of metastatic disease. Because the imaging features of adult rhabdomyosarcoma are nonspecific, other parameters, such as clinical findings, age, site, lymphadenopathy, and metastatic disease, should be combined to narrow the differential diagnosis.