scholarly journals Pulmonary vasculitis mimicking chronic thromboembolic disease

2019 ◽  
Vol 12 (4) ◽  
pp. e228409 ◽  
Author(s):  
Noor Ali ◽  
Lynsey Clarke ◽  
Robert Valentine MacKenzie Ross ◽  
Graham Robinson
Keyword(s):  
Pulmonary Artery ◽  
Final Diagnosis ◽  
Thromboembolic Disease ◽  
Imaging Features ◽  
Pulmonary Vasculitis ◽  
Pulmonary Angiogram ◽  
Positron Emission ◽  
Pet Ct ◽  
Ct Pulmonary Angiogram ◽  
Chronic Thromboembolic Disease

A 29-year-old female patient presented with chest pain, breathlessness and syncope on the background of constitutional symptoms, oral ulceration and a rash. Multiple investigations were performed, including a CT pulmonary angiogram (CTPA) that was initially felt to show imaging features consistent with a diagnosis of chronic thromboembolic disease (CTED). The patient was referred to a tertiary pulmonary hypertension centre and the possibility of pulmonary vasculitis was raised. Subsequent positron emission tomography (PET)-CT revealed imaging features supporting this diagnosis. The patient was treated with intravenous cyclophosphamide infusions, following which her symptoms improved. A repeat PET-CT 6 months after treatment showed resolution in pulmonary artery and mediastinal uptake, but persistence of pulmonary artery occlusions on a repeat CTPA. A final diagnosis of pulmonary vasculitis secondary to Behçet’s disease was made. This case report aims to raise awareness of the imaging features of CTED and its mimics.

Pulmonary artery sarcoma masquerading as a pulmonary embolism

2021 ◽  
Vol 14 (2) ◽  
pp. e232676
Author(s):  
Chevanthy Gnanalingam ◽  
Matthew Wright ◽  
Yasser Ahmed
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Pulmonary Vascular Disease ◽  
Pulmonary Artery Sarcoma ◽  
Early Referral ◽  
Pulmonary Angiogram ◽  
Pet Ct ◽  
Ct Pulmonary Angiogram ◽  
Pet Ct Scan ◽  
Subsequent Improvement

A 52-year-old woman was referred to the respiratory team with worsening shortness of breath for the last 3 months, which had deteriorated significantly over the last 2–3 weeks. She underwent a CT pulmonary angiogram, which was reported locally as showing a large pulmonary embolism. Given the chronic history and appearance of the thrombus, the patient was referred to a specialist pulmonary vascular disease multidisciplinary team and underwent a PET-CT scan with the diagnosis being felt to be more consistent with a pulmonary artery sarcoma. Within 4 weeks, she underwent a pulmonary endarterectomy which confirmed the presence of an extensive mass. She underwent bilateral endarterectomy and pulmonary artery valve replacement, with subsequent improvement of her breathlessness back to premorbid baseline. Postoperative histology has confirmed a pulmonary artery angiosarcoma. Alternate imaging modalities and early referral to a specialist unit allowed as early a diagnosis as possible with good symptomatic benefit.

scholarly journals Pulmonary Thromboembolism in a Child with Sickle Cell Hemoglobin D Disease in the Setting of Acute Chest Syndrome

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Hazel Villanueva ◽  
Sandeepkumar Kuril ◽  
Jennifer Krajewski ◽  
Aziza Sedrak
Keyword(s):  
Pulmonary Artery ◽  
Sickle Cell ◽  
Pulmonary Thromboembolism ◽  
Acute Chest Syndrome ◽  
Standard Management ◽  
Pulmonary Angiogram ◽  
Right Pulmonary Artery ◽  
Ct Pulmonary Angiogram ◽  
Complete Thrombosis ◽  
The Right

Introduction. Sickle cell hemoglobin D disease (HbSD) is a rare variant of sickle cell disease (SCD). Incidence of pulmonary thromboembolism (PE) and deep venous thrombosis (DVT) in children with HbSD is unknown. PE and DVT are known complications of SCD in adults but have not been reported in the literature in children with HbSD.Case Report. We are reporting a case of a 12-year-old boy with HbSD with acute chest syndrome (ACS) complicated by complete thrombosis of the branch of the right pulmonary artery and multiple small pulmonary artery emboli seen on computed tomography (CT) pulmonary angiogram and thrombosis of the right brachial vein seen on Doppler ultrasound. Our patient responded to treatment with anticoagulant therapy.Conclusion. There are no cases reported in children with HbSD disease presenting as ACS with pulmonary thromboembolism. We suggest that PE should be suspected in patients presenting with ACS who do not show improvement with standard management. CT pulmonary angiogram should be utilized for early diagnosis and appropriate management as there is no current protocol for management of PE/DVT in pediatric patients with SCD.

scholarly journals Diffuse Infiltrative Non-mass-like Brain Parenchymal Lesions on MRI: Differentiating Lymphomatosis Cerebri from its Mimics

2021 ◽  
Vol 11 ◽  
pp. 41
Author(s):  
Anurima Patra ◽  
Anitha Jasper ◽  
Harshad Vanjare ◽  
Geetha Chacko ◽  
Sherin Susheel ◽  
...  
Keyword(s):  
Whole Body ◽  
Rapid Progression ◽  
Imaging Features ◽  
Clinical Factor ◽  
Lymphomatosis Cerebri ◽  
Mri Brain ◽  
Inflammatory Conditions ◽  
Positron Emission ◽  
Pet Ct ◽  
Brain Parenchymal

Objectives: Diffuse infiltrative “non-mass-like” parenchymal lesions on MRI brain are a known presentation of an aggressive condition called lymphomatosis cerebri (LC) but are often misdiagnosed due to its non-specific clinical and imaging findings. We aim to identify clues to differentiate lymphomatosis from its less aggressive mimics based on imaging features. Material and Methods: MRI brain studies showing diffuse infiltrative “non-mass-like” parenchymal lesions between January 2013 and March 2020 were retrospectively identified and read for lesion location, signal characteristics, and enhancement pattern by two radiologists. Additional findings on MRI spine and whole-body fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) were recorded wherever available. The clinical diagnosis, patient demographics, symptoms, laboratory and histopathology results, treatment details, and follow-up details were also noted. Results: Of the 67 patients, 28 (41.7%) were diagnosed with lymphomatosis. The remaining 39 (13.4%) patients were classified as non-lymphomas (infective, vasculitis, and inflammatory conditions). Diffusion restriction on MRI (20/67, P = 0.007) and increased regional activity on FDG PET-CT (12/31, P = 0.017) were the two imaging parameters found to significantly favor lymphomatosis over other conditions, whereas the presence of microhemorrhages on susceptibility-weighted imaging was significantly associated with vasculitis (P = 0.002). Rapid clinical or imaging deterioration on a short trial of steroids (P = 0.00) was the only relevant clinical factor to raise an early alarm of lymphomatosis. Positive serological markers and non-central nervous system systemic diseases were associated with non-lymphomatous diseases. Conclusion: LC and its less aggressive mimics can be differentiated on diffusion-weighted imaging-MRI and PET-CT when read in conjunction with rapid progression of clinical features, serological workup, and systemic evaluation.

18F-FDG PET/CT findings in patients with Kikuchi disease

2013 ◽  
Vol 52 (03) ◽  
pp. 101-106 ◽  
Author(s):  
K. Chun ◽  
Y. Hong ◽  
J. Hah ◽  
I. Cho ◽  
E. Kong
Keyword(s):  
Fdg Pet ◽  
Cervical Lymphadenopathy ◽  
Standard Uptake Value ◽  
Solid Organ ◽  
Imaging Features ◽  
Neck Masses ◽  
Ct Findings ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct

Summary Purpose: Kikuchi disease (KD) is a benign and self-limited syndrome characterized by cervical lymphadenopathy. This study evaluated 18F-fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/ CT) findings in patients with KD and analyzed their imaging features. Patients, material, methods: We evaluated the FDG PET/CT findings of 22 patients (14 men, 8 women) with KD, ranging in age from 9 to 73 years. All patients had been diagnosed based on the pathological findings of biopsy. We examined the locations, metabolic activity and size of hypermetabolic lymph nodes (LNs) on FDG PET/CT imaging with medical history including laboratory results. Results: Among the 22 patients, we identified 619 hypermetabolic LNs which had maximum standard uptake value (SUVmax) above 3.0. The 16 patients were studied with FDG PET/CT to identify the cause of fever, another 5 patients for their neck masses, and the remaining patient for his left inguinal mass. Hypermetabolic LNs were noted in neck (18 bilaterally, 2 right, 1 left) of 21 patients, axilla of 10, mediastinum of 9, abdomen of 17, pelvis of 6, and inguinal area of 3. The SUVmax of FDG uptake in affected LNs by patient base analysis were 6.2–29.4. Of the 619 hypermetabolic LNs identified, 440 LNs (71.1%) were less than 10 mm in their short axis determined by CT, and were occasionally aggregated. No patient showed solid organ hypermetabolic lesion in FDG PET/CT. Conclusion: Kikuchi disease could present multiple hypermetabolic LNs in body on FDG PET/CT. Based on the physical findings, consideration of the generalized distribution of the relatively small-sized hypermetabolic LNs, FDG PET/CT may be useful as a diagnostic tool in cases of Kikuchi disease.

FDG-PET/CT in the diagnosis of recurrent breast cancer

2012 ◽  
Vol 53 (1) ◽  
pp. 12-16 ◽  
Author(s):  
Ryusuke Murakami ◽  
Shin-ichiro Kumita ◽  
Tamiko Yoshida ◽  
Keiichi Ishihara ◽  
Tomonari Kiriyama ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Predictive Value ◽  
Cancer Recurrence ◽  
Final Diagnosis ◽  
Recurrent Breast Cancer ◽  
Whole Body ◽  
Positron Emission ◽  
Pet Ct ◽  
The Difference ◽  
Recurrent Breast

Background An advantage of PET/CT has been demonstrated for diagnosis of several tumor entities. In patients with breast cancer, early diagnosis and accurate restaging of recurrence after surgery is important for selection of the most appropriate therapeutic strategy. Purpose To evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) using 18F-fluorodeoxyglucose (FDG), for follow-up of patients with suspected recurrent breast cancer. Material and Methods Forty-seven patients with suspected recurrent breast cancer underwent PET/CT. The PET and PET/CT images were interpreted without knowledge of the results of other diagnostic modalities, and compared with each other with reference to the final diagnosis. Results Twenty-five (53%) patients suffered tumor recurrence. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT were 96%, 91%, 92%, 95%, and 94%, respectively. In comparison with PET, PET/CT had a higher sensitivity and accuracy (96% vs. 80% and 94% vs. 81%, respectively). The difference in diagnostic accuracy between PET/CT and PET was significant ( P < 0.05). Conclusion The present findings indicate that PET/CT is an accurate, sensitive and reliable modality for screening and detection of breast cancer recurrence. PET/CT appears to be an effective surveillance tool, as it is able to cover the whole body in a single procedure and shows good performance.

scholarly journals Mass in Right Pulmonary Artery—Case Report

2017 ◽  
Vol 02 (04) ◽  
pp. 091-093
Author(s):  
Ravi Muddada
Keyword(s):  
Pulmonary Artery ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Final Diagnosis ◽  
Artery Thrombosis ◽  
Pulmonary Angiogram ◽  
Right Pulmonary Artery ◽  
Thromboembolic Pulmonary Hypertension ◽  
Dimensional Echocardiography ◽  
The Right ◽  
Two Dimensional Echocardiography

AbstractThe authors present a case of mass in the right pulmoary artery in a 60-year-old female patient who had dyspnea on exertion for 1 month before admission. Two-dimensional echocardiography and computed tomography pulmonary angiogram revealed mass in the right pulmonary artery. There was no evidence of deep venous thrombosis. Though the final diagnosis was not made, the authors present this case mainly for identifying and differentiating pulmonary artery thrombosis from chronic thromboembolic pulmonary hypertension and tumor.

scholarly journals 18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-PET/CT) for the diagnosis of native valve infective endocarditis (NVIE): a prospective study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Philip ◽  
S Delcourt ◽  
S Cammilleri ◽  
F Gourriet ◽  
L Tessonnier ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Fdg Pet ◽  
Final Diagnosis ◽  
Native Valve ◽  
Positron Emission ◽  
Pet Ct ◽  
Splenic Uptake ◽  
Major Criterion ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract Background and objectives 18F-FDG PET/CT has recently been added as a major criterion in the ESC 2015 infective endocarditis (IE) guidelines. We and others have demonstrated that18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) / computed tomography (CT) was useful in patients with suspected prosthetic valve and cardiac device IE. However, the sensitivity and specificity of ESC classification is unknown in patients with native valve endocarditis (NVE) as well as the clinical impact of PET findings. Purposes 1. Primary objective: To assess the value of the new ESC criteria including 18F-FDG PET/CT in native valve infective endocarditis (NVIE). 2. Secondary objectives: – to determine the usefulness of PET/CT concerning embolic or neoplastic detection. – to describe a new PET/CT feature, i.e. the diffuse splenic uptake. Methods Between 2012 and 2017, 75 patients with suspected NVIE were prospectively included, after exclusion of patients with uninterpretable or not feasible PET/CT. Using the expert consensus of the Endocarditis Team after a 3-month follow-up as gold standard, 63 IE were confirmed and 12 were rejected. Patients follow-up was scheduled at one and three months after hospitalization. Results Significant cardiac uptake by PET/CT (major criterion) was observed in 11 among 63 patients with definite NVIE and no patients with rejected IE (sensitivity 18%, specificity 100%). Among the 63 patients with a final diagnosis of NVE, a peripheral embolism or mycotic aneurysm was observed in 20 cases (32%). Considering this, the ESC 2015 classification increased the sensitivity of Duke criteria from 64 to 70% (p&lt;0.001) without no change on specificity (p&lt;0.001). Twenty-four patients (38%) were diagnosed with secondary infectious sites or infectious portal of entry. A diffuse splenic uptake was observed in 39 (52%) patients, including 37 (59%) of patients with a final diagnosis of NVE (specificity 83%). Conclusion 1. The value of 18F-FDG PET/CT in NVE diagnosis is poor (18% sensitivity) 2. Usefulness of PET/CT remains high when concerning embolic or neoplastic detection. 3. Our study describes for the first time in NVE a new potential endocarditis criterion, i.e. the presence of a diffuse splenic uptake on 18F-FDG PET/CT Diffuse splenic uptake Funding Acknowledgement Type of funding source: None

Pulmonary mucormycosis causing a mycotic pulmonary artery aneurysm

2021 ◽  
pp. 021849232199849
Author(s):  
Richard Saldanha ◽  
Ravi Ghatanatti ◽  
Mohan D Gan ◽  
Kiran Kurkure ◽  
Gautam Suresh ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Artery Aneurysm ◽  
High Morbidity ◽  
Pulmonary Artery Aneurysm ◽  
Pulmonary Mucormycosis ◽  
Pulmonary Angiogram ◽  
Ct Pulmonary Angiogram ◽  
Pulmonary Artery Aneurysms ◽  
The Right ◽  
Very High

Mycotic pulmonary artery aneurysms requiring pneumonectomy are extremely rare. We present a severely breathless immunocompromised diabetic middle-aged female patient. CT pulmonary angiogram revealed a giant pulmonary artery aneurysm with impending rupture in the right lung. We did an emergency right pneumonectomy under cardiopulmonary bypass support. Histopathology report of the lung specimen confirmed mucormycosis. She received amphotericin B after the procedure. The patient had a prolonged postoperative hospital stay and succumbed to sepsis. Mycotic pulmonary artery aneurysm portends very high morbidity and mortality in immunocompromised patients.

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