Robert Loneragan

Guidelines for the diagnosis and treatment of malignant pleural mesothelioma

Malignant Pleural Mesothelioma (MPM), the asbestos-induced neoplasm originating in the mesothelial lining of the lung cavities represents significant diagnostic and therapeutic challenges for clinicians in Australia. Very seldom diagnosed prior to the advent of widespread asbestos mining in the early to midtwentieth century, it has sharply risen in incidence over the last five decades. According to the most recent Australian Institute of Health and Welfare data, there were 666 cases of malignant mesothelioma diagnosed in Australia in 2009 and around 90% of them originated in the pleura.

Long-term outcome of radiological-guided insertion of implanted central venous access port devices (CVAPD) for the delivery of chemotherapy in cancer patients: institutional experience and review of the literature

Central venous access port devices (CVAPD) are necessary for delivery of prolonged infusional chemotherapy or in patients with poor peripheral venous access. Previous studies of Hickman catheters report complication rates in about 45% of patients. Our aim was to assess the early and late complication rate, and duration that the CVAPD remained functional, following insertion by interventional radiologists in patients with solid tumours. A prospective study was undertaken in 110 consecutive patients who had insertion of 111 subclavian CVAPD. The median age of patients was 57 years (range 17–83), 64 were females; 68 patients (61%) had gastrointestinal tumours and 25 (23%) had breast cancer. CVAPD were successfully implanted in all but one patient. There were four (4%) immediate major complications: thrombosis 2 and pneumothorax 2. Nine patients (8%) had bruising or pain. Four devices (4%) became infected. In total, 100 CVAPD (90%) were either removed as planned at the end of treatment (n=23) after a median 203 days, or remained in situ for a median of 237 days (7–1133). Premature removal occurred in eight patients due to infection (n=4), thrombosis (n=3) or faulty device (n=1). Four patients were lost to follow-up. Radiological insertion of CVAPD is safe and convenient with low rates of complications.

Cetuximab-Associated Pulmonary Toxicity

There is increasing evidence for the use of epidermal growth factor receptor (EGFR) inhibitors in head and neck, non-small-cell lung, and colorectal cancers. We report the case of a 78-year-old man with metastatic colorectal cancer (CRC) involving liver and lung who received cetuximab plus irinotecan as third-line treatment. Two months later, he presented with signs and symptoms consistent with bronchiolotis obliterans organizing pneumonia secondary to cetuximab. Reports of cetuximab-associated pulmonary toxicity are rare, although there have been extensive reports of interstitial fibrosis with the use of other EGFR inhibitors such as gefitinib and erlotinib. There are many causes of pulmonary infiltrates in patients treated for advanced CRC, and this case highlights the importance of considering drug toxicity.

Bone scintigraphy in acetabular labral tears.

Background: Acetabular labral tears are an increasingly recognized cause of hip pain in young adults with hip dysplasia and older patients with degenerative disease of the hips. Methods: The authors analyzed retrospectively bone scintigraphy in 27 patients with acetabular labral tears diagnosed by MRI/arthroscopy. Analysis was also made of scintigraphy in 30 patients without labral tears being investigated for other causes of hip pain for comparison. Results: Patients with labral tears had hyperemia of the superior or superomedial aspect of the acetabulum and increased delayed uptake in either a focal superior pattern or in an “eyebrow” pattern of a superomedial tear. This pattern was not seen in any other sources of hip pathology. Conclusion: Uptake in the superior or superomedial aspect of the acetabular rim is characteristic of a labral tear. Absence of this pattern carries a high negative predictive value for the diagnosis.

Artefact on CT brain images caused by the presence of air bubbles in the cooling oil of the X‐ray tube

We report a series of patients who had computed tomography (CT) of their brains which showed an uncommon artefact caused by excess air bubbles in the cooling oil around the X‐ray tube.

Radiological Imaging in Trauma and Sports Injuries: Current Status and Limitations

Most acute traumatic and sporting injuries are clinically obvious or only require plain film imaging. In a minority of cases, more sophisticated imaging is required in the acute setting. MRI has revolutionised the imaging of both acute and chronic trauma of soft tissues and bone. It has provided an avenue for surgical planning and the exclusion of occult injuries. However, a well-planned approach is necessary to get the best out of MRI, with important decisions regarding arthrography and type of sequences that is optimal. Ultrasound is a good alternative in many instances but is limited by local expertise and experience and is operator dependant. CT has well-defined uses but is limited by the radiation doses, especially in the paediatric setting. There are a number of instances in which special care is required in imaging of trauma, especially with reference to child abuse. A team approach to imaging of athletic injuries is mandatory, especially in imaging of elite athletes.

Radiological Imaging in Arthritis: Current Status and Limitations

Knowledge of the rheumatic disease has grown immeasurably since the early twentieth century, changing the criteria and classification of the diseases. The rheumatic diseases have broadly been classified according to positivity for rheumatoid factor. The immunological and genetic basis of these diseases has been refined, and the pathophysiology elucidated to a large extent. These changes have been reflected in the advances in imaging of the rheumatic diseases, particularly with the increasing adoption of MRI. MRI criteria have become accepted as part of the early disease classification, allowing the commencement of therapy before the radiological or clinical evidence of disease manifests, thus allowing treatment at a potentially reversible stage. The evidence for these changes in the paradigm of imaging the rheumatic disease will be presented and assessed together with potential shortcomings.