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Introduction Although bacterial co- and superinfections are rarely present in patients with COVID-19, overall antibiotic prescribing in admitted patients is high. In order to counter antibiotic overprescribing, antibiotic stewardship teams need reliable data concerning antibiotic prescribing in admitted patients with COVID-19. Methods In this prospective observational cohort study, we performed a quantitative and qualitative evaluation of antibiotic prescriptions in patients admitted to the COVID-19 ward of a 721-bed Belgian university hospital between 1 May and 2 November 2020. Data on demographics, clinical and microbiological parameters and antibiotic consumption were collected. Defined daily doses (DDD) were calculated for antibiotics prescribed in the context of a (presumed) bacterial respiratory tract infection and converted into two indicators: DDD/admission and DDD/100 hospital bed days. A team of infectious disease specialists performed an appropriateness evaluation for every prescription. A driver analysis was performed to identify factors increasing the odds of an antibiotic prescription in patients with a confirmed COVID-19 diagnosis. Results Of 403 eligible participants with a suspected COVID-19 infection, 281 were included. In 13.8% of the 203 admissions with a COVID-19 confirmed diagnosis, antibiotics were initiated for a (presumed) bacterial respiratory tract co-/superinfection (0.86 DDD/admission; 8.92 DDD/100 bed days; 39.4% were scored as ‘appropriate’). Five drivers of antibiotic prescribing were identified: history of cerebrovascular disease, high neutrophil/lymphocyte ratio in male patients, age, elevated ferritin levels and the collection of respiratory samples for bacteriological analysis. Conclusion In the studied population, the antibiotic consumption for a (presumed) bacterial respiratory tract co-/superinfection was low. In particular, the small total number of DDDs in patients with confirmed COVID-19 diagnosis suggests thoughtful antibiotic use. However, antibiotic stewardship programmes remain crucial to counter unnecessary and inappropriate antibiotic use in hospitalized patients with COVID-19. Trial Registration The study is registered at ClinicalTrials.gov (NCT04544072). Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00535-2.

Intra-abdominal fat is abundantly present in both the peritoneum and retroperitoneum. Fat necrosis or inflammation are common findings in abdominal imaging. The most common pathologies that we encounter are epiploic appendagitis, omental infarction, mesenteric panniculitis, and encapsulated fat necrosis. Less common entities that can occur are pancreatic saponification, heterotopic mesenteric ossification, and pseudolipoma of the capsule of Glisson. These entities can mimic more urgent pathologies such as appendicitis, diverticulitis, or malignancies.

BACKGROUND: The objective of this study was to evaluate if 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)-derived parameters are useful in predicting response and survival after programmed cell death protein 1 (PD-1) blocking immunotherapy in patients with advanced NSCLC characterized by a high programmed death-ligand 1 (PD-L1) expression (≥50%) on immunohistochemistry. PATIENTS AND METHODS: In 30 patients with advanced stage IV non-small-cell lung cancer (NSCLC) and high PD-L1 expression, 18F-FDG PET/CT parameters before start of treatment with PD-1 blocking immunotherapy were evaluated retrospectively. In 24 out of the 30 patients, 18F-FDG PET/CT was available 8 to 9 weeks after start of the treatment. Response Evaluation Criteria in Solid Tumors (RECIST 1.1) and metabolic responses assessed on 18F-FDG PET/CT were compared. RESULTS: Median follow-up was 20 months (range, 4.2-37.6). Median PD-L1 expression was 80%. The objective response rate with RECIST 1.1 was 53.3%. Median progression-free survival (PFS) was 12.4 months (95% confidence interval [CI], 1.0-37.8), and median overall survival (OS) was 14.9 months (95% CI, 2.4-38.2). Baseline 18F-FDG PET/CT parameters did not differ between responders and non-responders (all P > .05). The maximum standardized uptake value (SUVmax) was the only 18F-FDG PET/CT parameter associated with PFS (P = .04), with a trend for OS (P = .06). At first evaluation, response according to total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) were associated with PFS and OS (both P < .0001). This was not the case for RECIST 1.1 (P = .29 for PFS and P = .38 for OS). CONCLUSION: Clinical response and survival were independent from metabolic tumor volume at baseline. Reduction of metabolic tumor volume after 8 to 9 weeks of treatment was a better predictor for prolonged survival than RECIST 1.1.

BACKGROUND: The diagnostic gold standard for Coronavirus-2019 disease (CoViD-19) is reverse transcriptase-polymerase chain reaction (RT-PCR). However, its sensitivity might be suboptimal. The current study aims to investigate predictive factors for false-negative nasopharyngeal RT-PCR in CoViD-19 patients. Additionally, the specificity and sensitivity of RT-PCR on the nasopharyngeal swab, serology and chest computerized-tomography (CCT) as a screening tool for the diagnosis of CoViD-19 were investigated. METHODS: Medical records of patients admitted at the university hospital UZ Brussel during the CoViD-19 epidemic were reviewed. A group of CoViD-19 patients with false-negative RT-PCR was identified through scrupulous examination of medical records. Serological testing was performed through chemiluminescent microparticle assay. RESULTS: Eighteen CoViD-19 patients with 'false negative' RT-PCR were identified and compared to 51 'true positives'. Logistic regression for prediction of 'false negative' RT-PCR found significantly higher serology results at hospitalization and more intensive care unit admission in the group with false-negative testing. In a cohort of 228 patients, the sensitivity of RT-PCR for the diagnosis of CoViD-19 was 85%. The sensitivity of serology was 86% and its specificity 92%. Chest computerized-tomography (CCT) showed a sensitivity of 93%, its specificity was 62%. By combining RT-PCR and serology results any 'false negative' could be excluded. CONCLUSIONS: In this cohort, the sensitivity and specificity of RT-PCR and serology for the diagnosis of CoViD-19 were high and comparable. CCT had the highest sensitivity and confirmed its efficacy as a screening tool. CoViD-19 patients, who have a more severe presentation, might have negative RT-PCR and positive serology results.

The objective of this study was to evaluate ifIn 30 patients with advanced stage IV non-small-cell lung cancer (NSCLC) and high PD-L1 expression,Median follow-up was 20 months (range, 4.2-37.6). Median PD-L1 expression was 80%. The objective response rate with RECIST 1.1 was 53.3%. Median progression-free survival (PFS) was 12.4 months (95% confidence interval [CI], 1.0-37.8), and median overall survival (OS) was 14.9 months (95% CI, 2.4-38.2). BaselineClinical response and survival were independent from metabolic tumor volume at baseline. Reduction of metabolic tumor volume after 8 to 9 weeks of treatment was a better predictor for prolonged survival than RECIST 1.1.

Introduction Since studies about clinical status after COVID-19 are scarce, we conducted a cross sectional study with assessment of residual symptoms, lung function and chest CT. Materials and Methods During an outpatient follow-up visit, chest CT, pulmonary function and COVID-19 related symptoms were assessed approximately 10 weeks after diagnosis. Demographics, baseline (time of diagnosis) CT score and blood results were collected from patient files. Association between lung function and clinical characteristics (baseline), blood markers (baseline), chest CT (baseline and follow-up) and symptom score (followup) was analysed. Mann-Whitney U tests and Chi squared tests were used for statistical comparison between subgroups with and without restriction. Results and discussion Two hundred-twenty subjects were evaluated at a median follow-up of 74±12 (SD) days. Median symptom and median CT score at follow-up were 1(IQR=0- 2) and 2(IQR=0-6) respectively. Forty-six percent of patients had normal lung function, while TLC and TLCO below the lower limit of normal were observed in 38% and 22% of subjects respectively. This restrictive pulmonary impairment was associated with length of hospital stay (8 vs 6 days; p=0.003), admission to the intensive care unit (27% vs 13%;p=0.009), and invasive mechanical ventilation (10% vs 0.7%;p=0.001), but not with symptom score or CT score at baseline and follow-up. Conclusions Fifty-four percent of COVID-19 survivors had abnormal lung function 10 weeks after diagnosis. Restriction was the most prevalent pulmonary function, with the more critically ill patients being more prone to this condition. Yet, restriction could not be linked with abnormal imaging results or residual symptoms., Highlights • 220 patients were assessed 10 weeks after severe COVID-19. • 54% of patients had abnormal lung function. • Restriction was the most frequently observed pattern of lung function impairment. • Restriction at follow-up was associated with more severe acute COVID-19. • No correlation was observed between restriction at follow up and chest CT.

Smoking-induced ventilation heterogeneity measured at the mouth via established washout indices [lung clearance index (LCI) and alveolar mixing efficiency (AME)] potentially results from unequal expansion, which can be quantified by computer tomography (CT), and structural changes down to the lung periphery, characterized by CT parametric response mapping indices [percentage of lung affected by functional small airway disease (PRMfSAD) and emphysema (PRMEmph)]. By combining CT imaging and nitrogen (N2) washout tests in smokers, we specifically examined the roles of unequal lung expansion and peripheral structure. We first extracted three-dimensional maps of local lung expansion from registered inspiratory/expiratory CT images in 50 smokers (GOLD 0-IV) to compute for each smoker the theoretical N2 washout concentration curve solely attributable to unequal local expansion. By a head-on comparison with washout N2 concentrations measured at the mouth in the same smokers supine, we observed that 1) LCI increased from 4.8 ± 0.2 (SD) to 6.6 ± 0.8 (SD) due to unequal lung expansion alone and further increased to 9.0 ± 1.5 (SD) independent of local expansion and 2) AME decreased (from 100% by definition) to 95 ± 2 (SD)% due to unequal expansion alone and further decreased to 75 ± 7(SD)% independent of local expansion. In a multiple regression between the washout indices and CT-derived PRMfSAD and PRMEmph, LCI was related to PRMfSAD (r = +0.58; P < 0.001), whereas AME was related to both PRMfSAD (rpartial = -0.44; P = 0.002) and PRMEmph (rpartial = -0.31; P = 0.033), in line with AME being dominated by alterations in peripheral structure. We conclude that smokers showing an increased LCI without corresponding AME decrease are predominantly affected by unequal lung expansion, whereas an AME decrease with a commensurate LCI increase indicates a smoking-induced alteration of peripheral structure.NEW & NOTEWORTHY A head-on comparison between imaging and multiple breath washout in supine smokers shows that computer tomography-measured unequal local lung expansion accounts for 50% or less of smoking-induced increase in ventilation heterogeneity. The contributions from unequal lung expansion and peripheral structure to the two main washout indices also explain their respective association with parametric response mapping indices.

Smoking-induced ventilation heterogeneity is thought to occur in air spaces down to the lung periphery, and the multiple breath washout (MBW) test has been proposed to serve as a non-invasive diagnostic tool. We separately examined the roles of unequal lung expansion and of peripheral heterogeneity (independent of expansion) on MBW N2 curves. We first extracted 3D maps of local lung expansion from registered CT images in 50 smokers (GOLD 0-III) to predict for each subject, the N2 washout concentration curve solely attributable to local expansion. By a head-on comparison with MBW N2 concentrations measured at the mouth in the same subjects supine, we could observe that : (1) lung clearance index (LCI) increased from 4.82+0.16(SD) to 6.58+0.77(SD) due to unequal lung expansion alone, and further increased to 8.99+1.46(SD) independent of local expansion, (2) alveolar mixing efficiency (AME) derived from the beginning of the washout curve, decreased (from 100% by definition) to 95+2(SD)% due to unequal expansion alone, and further decreased to 75+7(SD)% independent of local expansion. In a multiple regression between ventilation heterogeneity and CT derived parametric response mapping indices (PRMfSAD and PRMemphys), LCI was related to PRMfSAD (r=+0.58;P

Many diseases affect the pleural space in both adults and children, including common diseases such as pneumonia, cancer and heart failure. Pleural effusion is the most common manifestation of pleural disease, and it is often a secondary effect of another disease process. Imaging plays a crucial role in the management of pleural disease. Chest radiography often remains the first examination in the assessment of these patients. Depending on the clinical context, the optimal imaging technique for further evaluation might be computed tomography (CT), ultrasound (US), or magnetic resonance (MR).

A 77-year-old patient with a history of coronary artery bypass grafting and end-stage renal disease was admitted to our hospital with recurrent fever. Within the past 6 months, the patient had three reoccurrences of oxacilline-sensitive Staphylococcus aureus (MSSA) sepsis of unknown origin. At admission, laboratory findings revealed a C-reactive …

In adult patients with cystic fibrosis (CF), the lung clearance index (LCI) derived from the multiple breath washout relates to both acinar and conductive ventilation heterogeneity. The latter component predicts an association between LCI and the number of bronchial segments affected by bronchiectasis. Here, we experimentally demonstrated this association in patients with CF, and also examined an ancillary group of patients with non-CF bronchiectasis. We conclude that lung disease severity in terms of number of bronchial segments results in an associated LCI increase, likely constituting a portion of LCI that cannot be reversed by treatment in patients with CF lung disease.

Background: While it is generally accepted that inertial impaction will lead to particle loss as aerosol is being carried into the pulmonary airways, most predictive aerosol deposition models adopt the hypothesis that the inhaled particles that remain airborne will distribute according to the gas flow distribution between airways downstream. Methods: Using a 3D printed cast of human airways, we quantified particle deposition and distribution and visualized their inhaled trajectory in the human lung. The human airway cast was exposed to 6 μm monodisperse, radiolabeled aerosol particles at distinct inhaled flow rates and imaged by scintigraphy in two perpendicular planes. In addition, we also imaged the distribution of aerosol beyond the airways into the five lung lobes. The experimental aerosol deposition patterns could be mimicked by computational fluid dynamic (CFD) simulation in the same 3D airway geometry. Results: It was shown that for particles with a diameter of 6 μm inhaled at flows up to 60 L/min, the aerosol distribution over both lungs and the individual five lung lobes roughly followed the corresponding distributions of gas flow. While aerosol deposition was greater in the main bronchi of the left versus right lung, distribution of deposited and suspended particles toward the right lung exceeded that of the left lung. The CFD simulations also predict that for both 3 and 6 μm particles, aerosol distribution between lung units subtending from airways in generation 5 did not match gas distribution between these units and that this effect was driven by inertial impaction. Conclusions: We showed combined imaging experiments and CFD simulations to systematically study aerosol deposition patterns in human airways down to generation 5, where particle deposition could be spatially linked to the airway geometry. As particles are negotiating an increasing number of airways in subsequent branching generations, CFD predicts marked deviations of aerosol distribution with respect to ventilation distribution, even in the normal human lung.

In this article an overview is given of the present knowledge of whole body MRI, MRI of the retroperitoneum, intestines and pelvis. Recommendations are based on current literature and clinical applications in daily routine focusing on efficacy rather than cost considerations. The contribution and complementary role of MRI relative to those of its competing modalities was the most important endpoint assessed. Perfusion and functional information, as well as specific contrast agents in the area of the pelvis are still considered research indications.

We report the CT findings in a case of partial anomalous pulmonary venous return (PAPVR) from the left upper lobe in an adult. PAPVR is an anatomic variant in which one to three pulmonary veins drain into the right atrium or its tributaries, rather than into the left atrium. This results in a left-to-right shunt with varying clinical presentation. These can range from asymptomatic patients to advanced cardiac failure.

PURPOSE: To investigate a computed tomographic (CT) protocol with iterative reconstruction at conventional radiography dose levels for the assessment of structural lung abnormalities in patients with cystic fibrosis ( CF cystic fibrosis ). MATERIALS AND METHODS: In this institutional review board-approved study, 38 patients with CF cystic fibrosis (age range, 6-58 years; 21 patients 18 years) underwent investigative CT (at minimal exposure settings combined with iterative reconstruction) as a replacement of yearly follow-up posteroanterior chest radiography. Verbal informed consent was obtained from all patients or their parents. CT images were randomized and rated independently by two radiologists with use of the Bhalla scoring system. In addition, mosaic perfusion was evaluated. As reference, the previous available conventional chest CT scan was used. Differences in Bhalla scores were assessed with the χ(2) test and intraclass correlation coefficients ( ICC intraclass correlationcoefficient s). Radiation doses for CT and radiography were assessed for adults (>18 years) and children (

A 55-year-old male was admitted for evaluation of severe dyspnoea and hypoxaemia. Physical examination upon admission showed elevated jugular venous pressure and an accentuated second heart sound. Chest radiograph showed cardiomegaly with increased bibasilar markings. Arterial blood gas analysis while breathing room air showed marked hypoxaemia. High resolution computed tomography angiography of the chest showed modestly enlarged mediastinal lymph nodes with discrete diffuse ground-glass attenuation especially at the lower lung zones. Positron emission tomography using 18F labelled 2-deoxy-D-glucose (FDG) demonstrated the mediastinal lymph nodes were FDG-avid. Transthoracic echocardiography showed dilated hypokinetic right heart chambers with bulging of the interventricular septum to the left, compatible with acute cor-pulmonale. From the tricuspid regurgitation jet measurement a systolic pulmonary artery pressure (PAP) of 48 mmHg was estimated. Patent foramen ovale was suspected on bubble test. Right heart catheterisation confirmed pulmonary arterial hypertension: mPAP 47 mmHg, pulmonary artery occlusion pressure 5 mmHg, cardiac index 1.1 L/min/m2, pulmonary vascular resistance (PVR) 959 dyne.sec.cm(-5). Pulmonary function tests showed a marked diffusing capacity for carbon monoxide (DLCO) decrease of 32% predicted but no obstructive lung deficit. Before an open lung biopsy could be scheduled the patient developed acute cardiogenic shock. At autopsy pulmonary veno-occlusive disease with marked pulmonary hypertension was diagnosed.

Leiomyomatosis peritonealis disseminata (LPD) – or diffuse abdominal leiomyomatosis – is a very rare benign abdominal entity. Only a little more than 100 cases have been reported in the English literature since its first description in 1965. Middle aged female are typically affected and the clinical presentation is rather aspecific. The differential diagnosis between benign LPD and diffuse peritoneal carcinomatosis or abdominal disseminated malignancy represents the crucial diagnostic challenge that can only definitively be made through biopsy and histologic analysis. Multimodal imaging features (ultrasound, CT, MR and PET) of a case of LPD diagnosed in a 50-year old female are presented with review the literature.

A 39-year old man, a smoker without significant medical history, presented with vague chest pain, cough, and hemoptysis. His symptoms had started 2 weeks earlier. Radiography showed an area of decreased lucency (ground glass appearance) in the right lower lobe. CT scan confirms the presence of a triangular area of inhomogeneous parenchymatous increased attenuation mainly of ground glass with inlying bronchocoeles and tree-in-bud appearance compatible with an intrapulmonary sequestration. The arterial supply is derived from the lower thoracic aorta. The venous drainage is to the left atrium. The hemoptysis is a result of a supratherapeutic International Normalized Ratio (INR) on Sintrom intake for atrial fibrillation (AF). Treatment of sequestration consisted of a thoracoscopic lobectomy.

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Erdheim-Chester disease (ECD) is a rare non-Langerhans’ cell histiocytosis. Mild but permanent juxta-articular bone pain in mainly knees and ankles is the most frequent associated symptom. Despite the pathognomonic radiographic findings, most cases are still diagnosed by the pathologist. The lesions consist of lipid-storing CD 68 +/ CD 1a – non- Langerhans’ cell histiocytes, most frequently localized in bone but also involving multiple organ systems in the body. We present a case report in which the diagnosis of ECD was established with 99mTc MDP bone SPECT/CT.

In order to exclude acute pulmonary embolism, a lung perfusion scintigraphy was performed in a 53-year-old male, with a history of Fallot’s tetralogy. He had been immobilized because of a tibial fracture and complained of worsening chest pain and dyspnea.

We report on a healthy 39-year-old man who developed spontaneous pneumomediastinum during a soccer game without a traumatic impact. Chest radiography and CT demonstrated the extensive pneumomediastinum and subcutaneous emphysema. Treatment of this rare condition is conservative and prognosis is excellent.

A routine follow-up FDG-PET/CT was performed in a 67-year-old female with a history of head and neck carcinoma. In 2006, a T1 N0 M0 squamous cell carcinoma of the mouth floor had been resected. Subsequent clinical and radiological follow-up on regular base showed no evidence of locoregional recurrence or metastatic disease. There was no actual symptomatic disease.

The first radiography was obtained more than 100 years ago. Despite Computed Tomography (CT) revolutionizing diagnostic imaging 30 years ago, chest radiography still remains one of the most performed imaging modality in radiology worldwide, due to low costs, low radiation and wide availability. Chest radiographs are obtained for detection, diagnosis and follow-up of many forms of thoracic diseases, evaluation of chest trauma, and many other conditions including screening purposes. Its interpretation is notoriously difficult and needs to receive a careful attention for teaching and learning. With the advent of multi-slice CT scanners (MDCT) enabling isotropic reconstructions and high-quality reformats, new tools are available for both radiologists and clinicians for re-interpreting chest radiographs in light of orthogonal views or additional planes. The concept of this book was imagined in 2008, just after a successful symposium dedicated to a "side-by-side comparison with MDCT" that we held in Brussels. The idea was to provide a comprehensive approach of chest diseases using a direct comparison between the old two-dimensional technology and the up-to date three-dimensional technology of MDCT. In collaboration with Belgian and international experts in chest radiologists, we have elaborated the content of this book on three different parts. The first part summarizes clinical indications and technical aspects of chest radiography and CT with emphasis on reconstruction and tools for image comparison. The second part is related to the semeiology of normal variants and diseased chest using an anatomical approach. The third part deals with some diseases presenting a peculiar aspect on chest radiography. This book is designed for radiologists, internists, pneumologists, surgeons and acute unit physicians involved in the care of patients with chest diseases, and students who want to improve their understanding in chest radiology. At the end of this book, a link to a website containing additional clinical cases is available for the most curious readers.

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The first radiography was obtained more than 100 years ago. Despite Computed Tomography (CT) revolutionizing diagnostic imaging 30 years ago, chest radiography still remains one of the most performed imaging modality in radiology worldwide, due to low costs, low radiation and wide availability. Chest radiographs are obtained for detection, diagnosis and follow-up of many forms of thoracic diseases, evaluation of chest trauma, and many other conditions including screening purposes. Its interpretation is notoriously difficult and needs to receive a careful attention for teaching and learning. With the advent of multi-slice CT scanners (MDCT) enabling isotropic reconstructions and high-quality reformats, new tools are available for both radiologists and clinicians for re-interpreting chest radiographs in light of orthogonal views or additional planes. The concept of this book was imagined in 2008, just after a successful symposium dedicated to a "side-by-side comparison with MDCT" that we held in Brussels. The idea was to provide a comprehensive approach of chest diseases using a direct comparison between the old two-dimensional technology and the up-to date three-dimensional technology of MDCT. In collaboration with Belgian and international experts in chest radiologists, we have elaborated the content of this book on three different parts. The first part summarizes clinical indications and technical aspects of chest radiography and CT with emphasis on reconstruction and tools for image comparison. The second part is related to the semeiology of normal variants and diseased chest using an anatomical approach. The third part deals with some diseases presenting a peculiar aspect on chest radiography. This book is designed for radiologists, internists, pneumologists, surgeons and acute unit physicians involved in the care of patients with chest diseases, and students who want to improve their understanding in chest radiology. At the end of this book, a link to a website containing additional clinical cases is available for the most curious readers.

Reading chest X-rays is a difficult and challenging task, and is still important despite the development of powerful imaging techniques such as computed tomography, high-resolution computed tomography, and magnetic resonance. For a correct reading and interpretation of chest X-rays, it is necessary to understand the techniques, their limitations, basic anatomy and physiology, and to have a systematic system of scrutiny. However, we have to keep in mind that interpretation is submitted to perceptual and cognitive limitations and errors. In this chapter, chest X-ray will be discussed from prescription to report in all its facets.

In the past, the mediastinum has been considered as the so-called “black-box” of thoracic radiology. Nowadays, CT and MRI nicely depict and explain “the who’s and the why’s” of the mediastinal lines in physiological as well in pathological conditions. The aim of this chapter is to emphasize on the important role of basic radiological findings in standard diagnostic chest XR interpretation and to correlate the radiological anatomy with cross-sectional imaging. The mediastinal lines can be defined as linear structures (reflections) visible on the conventional X-ray, formed by points of contact of the mediastinal soft tissues and the adjacent aerated lung or contact of pulmonary tissue by intervening soft tissue. Normal anatomic structures of the mediastinum may be altered by mediastinal disease. This alteration of normal anatomy and the accompanying displacement of the mediastinal lines and spaces may alert the radiologist to the presence of a mediastinal mass. Thus, familiarity with the appearance of normal mediastinal structures on chest radiography is the first crucial part in locating and identifying an abnormality. These elements will further on permit to narrow the differential diagnosis and possibly influence the choice of modality for further diagnostic imaging.

Interstitial lung disease (ILD), also known as diffuse parenchymal lung disease, is a broad category of lung diseases that are grouped together because of their similar clinical, radiographic, physiologic, or pathologic manifestations. It includes more than 130 disorders characterized by scarring (i.e., “fibrosis”) and/or inflammation of the lungs. The traditional approach to radiographic assessement of ILD consists primarily of determining whether the pulmonary parenchymal process is located within the interstitium. This is often difficult, although radiographic criteria have been established over the past years. Therefore, radiologists use a more descriptive approach to analyze the predominant pulmonary pattern, lung volumes, lesion distribution, and the presence of associated findings. High-resolution computed tomography (HRCT) has been widely accepted as the imaging gold standard for ILD. This chapter reviews the different interstitial patterns seen on chest radiograph classified and based on their appearance patterns on HRCT.

An 88-year-old woman was seen at the emergency department with sudden onset of abdominal pain and nausea. She had been constipated for a week. Medical history was positive for arterial hypertension, diabetes mellutis type II, and heart failure. Laboratory findings showed an elevation of cholestatic liver enzymes. CRP was within normal limits. An upright radiograph of the abdomen showed multiple air fluid levels (F) in the small bowel consistent with obstruction. Pneumobilia (short arrow) was also seen as well as an obstructing gallstone (long arrow). A CT of the abdomen was performed. This showed pneumobilia (long arrow), a small bowell faeces sign (white asterisk) in the jejenum consistent with obstruction, and a non radioopaque gallstone in the ileum (dark asterisk). A CT scan from a few years earlier shows signs of cholecystitis and the non radioopaque gall stone (dark asterisk).The patient was treated with laparoscopic enterotomy with removal of the gallstone and cholecystectomy. The cholecystoduodenal fistula was demonstrated.

Radiofrequency ablation is a minimally invasive cancer treatment used as an alternative for unresectable hepaticmalignancies. Tumor ablation implies direct application of thermal or chemical therapies on a specific focal tumor.The aim of radiofrequency ablation is a total eradication of the tumor or at least a substantial tumor destruction.Thethermal energy can be heat (radiofrequency, laser, microwave,...) or cold (cryoablation).Key-word: Radiofrequency (RF) ablation.From: 1. Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, 2. Depart-ment of Radiology, Universitair Ziekenhuis Antwerpen, Antwerp, Belgium.Address for correspondence: Dr F. Vandenbroucke, Department of Radiology, AZ VUB,Laarbeeklaan101, 1090 Brussel, Belgium.Fig. 1.— A. Hypovascular metastasisof a colon carcinoma on a T1-weightedimage after intravenous Gadoliniuminjection in segment IV of the liver.B. Placement of the triple RFA electrodebased on the metallic coil, placed priorlyto the procedure. C. Contrast enhancedCT-scan after 3 months. The ablated zoneis uniform and smooth. There is noevidence of residual tumor.ABC Radiofrequency ablation of the liver: how do we do it (PDF Download Available). Available from: https://www.researchgate.net/publication/5475417_Radiofrequency_ablation_of_the_liver_how_do_we_do_it [accessed May 20, 2016].

In order to exclude acute pulmonary embolism, a lung perfusion scintigraphy was performed in a 53-year-old male, with a history of Fallot’s tetralogy. He had been immobilized because of a tibial fracture and complained of worsening chest pain and dyspnea.

During virtual colonoscopy, performed for severe constipation in a 77-year-old male, a mass (22 x 51 mm) was detected in the tail of the pancreas. The CT features of the lesion were compatible with a mucous cystadenoma / cystadenocarcinoma: low density (HU: 40), smooth margins and presence of micro-calcifications (Fig. A).

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In this article an overview is given of the present knowledge of whole body MRI, MRI of the retroperitoneum, intestines and pelvis. Recommendations are based on current literature and clinical applications in daily routine focusing on efficacy rather than cost considerations. The contribution and complementary role of MRI relative to those of its competing modalities was the most important endpoint assessed. Perfusion and functional information, as well as specific contrast agents in the area of the pelvis are still considered research indications.