Santiago Martinez

Imaging Appearances of the Sternum and Sternoclavicular Joints

The sternum and sternoclavicular joints--critical structures of the anterior chest wall--may be affected by various anatomic anomalies and pathologic processes, some of which require treatment. Pectus excavatum and pectus carinatum are common congenital anomalies that are usually benign but may warrant surgical treatment if they cause compression of vital internal structures. By contrast, developmental variants such as the sternal foramen are asymptomatic and do not require further evaluation or treatment. Arthritides of the sternoclavicular joint (osteoarthritis, septic arthritis, and seronegative arthropathies) are common and must be differentiated before an appropriate management method can be selected. The recognition of complications of sternotomy (eg, sternal dehiscence, secondary osteomyelitis) is critical to avoid life-threatening sequelae such as acute mediastinitis. Likewise, the detection of sternal fractures and sternoclavicular dislocations is important, especially where they impinge on vital structures. In addition, sternal malignancies (most commonly, metastases and chondrosarcoma) must be distinguished from benign neoplasms. To achieve accurate and timely diagnoses that facilitate appropriate treatment, radiologists must be familiar with the appearances of these normal anatomic variants and diseases of the sternum.

The Many Faces of Pulmonary Nontuberculous Mycobacterial Infection

OBJECTIVE The purpose of this article is to review clinical and radiologic manifestations of pulmonary nontuberculous mycobacterial infection. CONCLUSION Common and well-recognized patterns of infection include cavitary and bronchiectatic disease and infection in AIDS patients. Less common or well-recognized manifestations include nodules or masses mimicking malignancy, hypersensitivity pneumonitis, and others. Definitive diagnosis can be difficult and patterns may overlap. Timely diagnosis requires a high index of suspicion and knowledge of the spectrum of clinical and radiologic features.

Mucoid Impactions: Finger-in-Glove Sign and Other CT and Radiographic Features

Mucoid impaction is a relatively common finding at chest radiography and computed tomography (CT). Both congenital and acquired abnormalities may cause mucoid impaction of the large airways that often manifests as tubular opacities known as the finger-in-glove sign. The congenital conditions in which this sign most often appears are segmental bronchial atresia and cystic fibrosis. The sign also may be observed in many acquired conditions, include inflammatory and infectious diseases (allergic bronchopulmonary aspergillosis, broncholithiasis, and foreign body aspiration), benign neoplastic processes (bronchial hamartoma, lipoma, and papillomatosis), and malignancies (bronchogenic carcinoma, carcinoid tumor, and metastases). To point to the correct diagnosis, the radiologist must be familiar with the key radiographic and CT features that enable differentiation among the various likely causes. CT is more useful than chest radiography for differentiating between mucoid impaction and other disease processes, such as arteriovenous malformation, and for directing further diagnostic evaluation. In addition, knowledge of the patients medical history, clinical symptoms and signs, and predisposing factors is important.

The Diaphragmatic Crura and Retrocrural Space: Normal Imaging Appearance, Variants, and Pathologic Conditions

The retrocrural space (RCS) is a small triangular region within the most inferior posterior mediastinum bordered by the two diaphragmatic crura. Multiplanar imaging modalities such as computed tomography and magnetic resonance imaging allow evaluation of the RCS as part of routine examinations of the chest, abdomen, and spine. Normal structures within the retrocrural region include the aorta, nerves, the azygos and hemiazygos veins, the cisterna chyli with the thoracic duct, fat, and lymph nodes. There is a wide range of normal variants of the diaphragmatic crura and of structures within the RCS. Diverse pathologic processes can occur within this region, including benign tumors (lipoma, neurofibroma, lymphangioma), malignant tumors (sarcoma, neuroblastoma, metastases), vascular abnormalities (aortic aneurysm, hematoma, azygos and hemiazygos continuation of the inferior vena cava), and abscesses. An understanding of the anatomy, normal variants, and pathologic conditions of the diaphragmatic crura and retrocrural structures facilitates diagnosis of disease processes within this often overlooked anatomic compartment.

MDCT Angiography of Thoracic Aorta Endovascular Stent-Grafts: Pearls and Pitfalls

OBJECTIVE The objective of our study was to review expected findings and complications after thoracic endovascular aortic repair on CT angiography (CTA). CONCLUSION Luminal and extraluminal changes to the thoracic aorta occur after endovascular stent-grafting. The radiologist can facilitate appropriate management by detecting and differentiating expected CTA findings from complications.

MDCT Angiography After Open Thoracic Aortic Surgery: Pearls and Pitfalls

OBJECTIVE The purpose of this article is to review open thoracic aortic surgical techniques and to describe the range of postoperative findings on CT angiography (CTA). CONCLUSION An understanding of surgical thoracic aortic procedures will allow appropriate differentiation of normal from abnormal CTA findings on postoperative imaging.

Cardiovascular complications of cocaine: Imaging findings

Cocaine is the second most commonly abused illicit drug in the US and the most common one involved in emergency department visits, the majority of which are related to the cardiovascular system. Cardiovascular complications related with cocaine abuse include myocardial ischemia and infarction, myocarditis, hypertrophic cardiomyopathy, dilated cardiomyopathy, aortic dissection, thrombosis, stroke and cerebral hemorrhage, and different forms of visceral ischemia, among others. In an era where cocaine use has reached epidemic proportions, it is necessary for the radiologist to understand the pathophysiology, clinical presentation, and imaging characteristics of its cardiovascular complications.

Kaposi sarcoma after bilateral lung transplantation.

We describe radiologic findings in 2 patients and 18-fluoro-deoxy-glucose positron emission tomography/computed tomography findings in 1 patient who developed Kaposi sarcoma of the lung after bilateral lung transplantation. These findings included lung nodules, mediastinal or hilar lymphadenopathy, and pleural fluid.

Thoracic Manifestations of Inflammatory Bowel Disease

OBJECTIVE The purpose of this article is to present the spectrum of inflammatory bowel disease manifestations in the chest, including the airways, lung parenchyma, pulmonary vasculature, and serosal surfaces. CONCLUSION The spectrum of inflammatory bowel disease manifestations in the chest is broad, and the manifestations may mimic other diseases. Knowledge of these manifestations in conjunction with pertinent clinical data is essential for establishing the correct diagnosis and treatment.

Imaging of the Postoperative Thoracic Aorta: The Spectrum of Normal and Abnormal Findings

F a a a c ( g t c pen surgical and endovascular repair techniques can be used to manage thoracic aortic diseases such as dissecion, intramural hematoma, aneurysm, pseudoaneurysm, nd penetrating ulcer. Following thoracic aortic repair, imging has an important role in routine follow-up and in inestigation of suspected complications. The thoracic aorta as a spectrum of expected postoperative findings on comuted tomography angiography (CTA), magnetic resonance ngiography (MRA), conventional angiography, and chest adiographs. These expected findings must be differentiated rom complications in which intervention is required. In this rticle, we describe the normal and abnormal radiographic ppearances of the postoperative thoracic aorta following pen surgical and endovascular repair.