Imaging Considerations for the Diagnosis and Management of Bronchioloalveolar Carcinoma. Sara Alcorn, HMS-4 Dr. Gillian Lieberman March 2010
|
|
- Judith Harvey
- 6 years ago
- Views:
Transcription
1 Imaging Considerations for the Diagnosis and Management of Bronchioloalveolar Carcinoma Sara Alcorn, HMS-4 Dr. Gillian Lieberman March 2010
2 Overview Presentation of index patient History of present illness Radiologic findings Review of differential diagnoses Discussion of bronchioloalveolar carcinoma General information Roles of radiology in diagnosis and management Follow-up of index patient Summary
3 Overview Presentation of index patient History of present illness Radiologic findings Review of differential diagnoses Discussion of bronchioloalveolar carcinoma General information Roles of radiology in diagnosis and management Follow-up of index patient Summary
4 Our Patient: History of Present Illness 81 year old female with a history of CAD, admitted to BIDMC 12/09/09 for anterior STEMI Underwent cardiac catheterization for 3-vessel disease Was found to be hypoxic following this procedure, prompting imaging
5 Our Patient: Review of Systems ROS positive for: 2 months of chronic cough productive of white sputum, refractory to treatment with courses of Ciprofloxacin and Azithromycin 20 pound unintentional weight loss over 3 months Otherwise negative, including no fevers, night sweats, hemoptysis, changes to bowel habits, sick contacts, or recent travel
6 Our Patient: Additional Background PMH: CAD s/p MI and CABG in 1978 Small CVA in 12/2008 Meds: clopidogrel, simvastatin Family history: Mother with h/o colorectal cancer and bone cancer Social history: Married, retired. Independent in ADLs Habits: ~60 pack-years of tobacco. Quit in 2008.
7 Our Patient: Physical Exam Vital signs: HR: 77, BP: 101/46, RR: 16, T: 98.8, O2 Sat: 91% on 4L at rest General: Looks younger than stated age. In NAD. Chest: Decreased breath sounds at right lung base, with crackles extending to mid-right lung field Cardiac, abdominal, extremities, and neurological exams within normal limits
8 Our Patient: Hypoxia Work Up Labs CBC and complete metabolic panel within normal limits ABG with respiratory acidosis and hypoxemia CXR ordered CXR from 1 year prior to presentation reviewed Performed in the setting of productive cough
9 Overview Presentation of index patient History of present illness Radiologic findings Review of differential diagnoses Discussion of bronchioloalveolar carcinoma General information Roles of radiology in diagnosis and management Follow-up of index patient Summary
10 Our Patient: Chest CXR from One Year Prior to Presentation Upright PA and lateral chest X-ray From PACS, BIDMC
11 Please evaluate our patient s CXR from one year prior to presentation for abnormalities.
12 Our Patient: CXR with RLL Opacity Upright PA and lateral chest X-ray read as RLL opacity consistent with pneumonia. From PACS, BIDMC
13 Our Patient: CXR at Presentation Supine AP chest X-ray From PACS, BIDMC
14 Please evaluate our patient s CXR at presentation for abnormalities.
15 Our Patient: CXR with Basilar Opacity Supine AP CXR read as: New right basilar opacity as compared with 1 year prior Consistent with PNA No other focal opacities suggestive of infection identified at the time From PACS, BIDMC
16 Given the findings of persistent RLL on CXR from (a) one year prior and (b) at the time of presentation, a chest CT was performed.
17 Our Patient: Anatomic Landmarks Right major fissure on Chest CT Left major fissure Axial C- Chest CT (lung window) From PACS, BIDMC
18 Our Patient: Multiple Nodules and Multiple nodules in LUL, LLL, RML, and RLL Ground Glass Opacities Varying sizes from 1-4 mm Associated ground glass opacities (GGO): Hazy increased lung opacity with preservation of underlying bronchial and vascular margins Axial C- Chest CT (lung window) From PACS, BIDMC
19 Our Patient: Multiple Nodules, GGO, and Consolidation Moving inferiorly on CT: Multiple nodules and GGO, especially in RML Consolidation in RLL Axial C- Chest CT (lung window) From PACS, BIDMC
20 Continuing to move inferiorly on CT: Our Patient: Dense RLL Consolidation Dense consolidation of RLL with absence of aerated lung Air bronchograms: Low attenuation, air-filled bronchi in the setting of a higher attenuation background Suggest evacuation or replacement of alveolar air Axial C- Chest CT (lung window) From PACS, BIDMC
21 Our Patient: Aerated Portion of RLL What is this aerated space on our patient s chest CT? Axial C- Chest CT, Lung Window From PACS, BIDMC
22 To clarify what comprises the aerated lung space on axial CT, let s compare this with the corresponding coronal CT view and with CXR
23 Our Patient: Comparing Aerated Lung Space on Axial and Coronal CT Axial C- Chest CT (lung window) Coronal C- Chest CT (lung window) From PACS, BIDMC
24 Our Patient: Comparing Aerated Lung Space on CT and CXR Coronal C- Chest CT (lung window) at presentation Supine AP CXR, 4 days after presentation From PACS, BIDMC
25 Unknown Aerated Space in RLL: Conclusions from CT and CXR Comparisons Sharp borders between the consolidated and aerated spaces suggest that the consolidation follows an anatomic border. To further understand the involved and uninvolved spaces of the RLL, let s review the segmental anatomy of the RLL
26 RLL Segmental Anatomy The 5 segments of the RLL follow branching of the RLL bronchus Superior (S) Anterior basal (AB) Lateral basal (LB) Posterior basal (PB) Medial basal (MB) Adapted from:
27 Our Patient: Aerated Space in RLL Identified RUL bronchus Bronchus intermedius RML Anterior basal segmental bronchus in the anterior basal lung segment Coronal C- Chest CT (lung window) From PACS, BIDMC MEDIAL BASAL LUNG SEGMENT
28 Overview Presentation of index patient History of present illness Radiologic findings Review of differential diagnoses Discussion of bronchioloalveolar carcinoma General information Roles of radiology in diagnosis and management Follow-up of index patient Summary
29 Differential Diagnostic Dilemma Are the radiologic findings of both consolidation and multiple nodules consistent with: One unifying diagnosis? Two or more concurrent processes leading to the mixed radiologic picture?
30 Differential Diagnosis: Multiple Pulmonary Nodules Neoplasm Primary lung Metastases (breast, colon) Disseminated mycoses Septic emboli Sarcoidosis Mycobacterial disease
31 Narrowed Ddx for Multiple Pulmonary Nodules In Our Patient Large number of nodules in close proximity, with sparing of intervening parenchyma Makes inflammatory etiologies (mycoses, sarcoid) that would cause destruction and/or infiltration of surrounding parenchyma less likely Makes neoplasm more likely Lack of systemic signs of infection Makes extensive septic embolic disease and infection less likely
32 Differential Diagnosis: Lobar Consolidation Infection Edema Pulmonary hemorrhage Atelectasis Tumor
33 Narrowed Ddx for Consolidations in Our Patient Probable long-standing consolidation Lipoid PNA Chronic aspiration Pseudolymphoma (lymphoid hyperplasia) Bronchioloalveolar carcinoma
34 Our Patient: Presumed Diagnosis Sputum cytology positive for adenocarcinoma Specific tumor markers initially pending Tissue sample not possible to obtain due to: Ongoing anticoagulation therapy Low respiratory performance status Pending specific identification of etiology, chemotherapy with premetrexed started Based on radiologic appearance of presumed cause: bronchioloalveolar carcinoma
35 Overview Presentation of index patient History of present illness Radiologic findings Review of differential diagnoses Discussion of bronchioloalveolar carcinoma General information Roles of radiology in diagnosis and management Follow-up of index patient Summary
36 Bronchioloalveolar Carcinoma (BAC): General Information Histology Subtype of adenocarcinoma Mucinous and non-mucinous histologies Spreads mainly though lepidic growth (using lung architecture as stroma) without destruction of underlying structure Epidemiology Up to 7% of all primary lung neoplasms 25-50% of patients with a history tobacco use Clinical features Often incidentally diagnosed and asymptomatic Symptoms: cough, sputum, SOB, weight loss, fever, bronchorrhea
37 Overview Presentation of index patient History of present illness Radiologic findings Review of differential diagnoses Discussion of bronchioloalveolar carcinoma General information Roles of radiology in diagnosis and management Follow-up of index patient Summary
38 Roles of Radiology in Diagnosis and Management of BAC To characterize the disease Unique radiologic findings of BAC Exclusion of other etiologies To identify patterns that correlate with specific BAC histologies (and thus prognosis) To further help establish prognosis and treatment by determining extent of disease To monitor treatment response
39 First, let s discuss the radiologic characteristics that help identify BAC
40 Radiologic Patterns of BAC Single nodule, part-nodule, mass, or ground glass opacity (GGO) 43% of cases Multifocal or diffuse 27% of cases Focal consolidation 30% of cases
41 Companion Patient 1: BAC as a Solitary Nodule or Mass Solid nodule or mass Usually peripheral May be lobulated or illmarginated Axial C+ Chest CT (lung window) From PACS, BIDMC May have heterogeneous CT attenuation, CT pseudocavitation, and/or air bronchograms
42 Companion Patient 2: BAC as Focal GGO Focal isolated GGO Especially with heterogeneous attenuation Axial C+ Chest CT (lung window) From PACS, BIDMC Can also be a partnodule: Partly solid opacity with an associated area of GGO
43 Pathophysiology of CT Features in Nodular BAC Heterogeneous attenuation of nodules, masses and GGO Due to non-destructive lepidic growth of tumors along alveolar walls without disruption of the underlying architecture Small patent airways or alveolar spaces left Pseudocavitations and bubble -like areas of low attenuation Favors BAC versus other causes of nodules and/or GGO Air bronchograms: Due to filling of alveoli adjacent to patent bronchi with tumor and mucin GGO: Due to lepidic growth pattern of malignant cells and/or mucin production
44 Our Patient: BAC as Multiple Multiple nodules of varying size Nodules Seen bilaterally With and without GGO Associated with lymphatic spread Axial C- Chest CT (lung window) From PACS, BIDMC
45 Our Patient: Consolidative (Pneumonic) BAC Filling of the airspace with mucus Low-attenuation consolidation on CT due to mucin content Air bronchograms CT angiogram sign on C+ images: Clearer visibility of vessels due to low attenuation of surrounding tumor Axial C+ Chest CT (bone window) From PACS, BIDMC Delayed diagnosis common due to radiologic similarity to pneumonia
46 Our Patient: Consolidative BAC CT changes of the airfilled bronchus in a consolidation that favor BAC to PNA: Stretching Squeezing Sweeping Widening of the branching angle versus PNA BAC is more chronic and with fewer systemic symptoms of infection Axial C- Chest CT (lung window) From PACS, BIDMC
47 Next, let s discuss how radiologic findings correlate with histology and prognosis in BAC
48 Radiologic Findings, Histology, and Prognosis in BAC Radiologic pattern Typical histology 5-year survival s/p resection <1 cm pure GGO or part nodule Non-mucinous 100% <1 cm solid nodule Non-mucinous 94% Multifocal Mucinous 40% Consolidative Mucinous 0%
49 Last, let s discuss radiologic considerations for staging BAC
50 TNM Staging in Lung Cancer: Imaging considerations Assessing tumor size (T) Look for involvement of the main bronchus, pleura, hilum, chest wall, diaphragm, pericardium vertebral bodies, mediastinum Assessing lymph nodes (N) Look for peribronchial, ipsilateral hilar, mediastinal, subarcinal nodes Consider ipsilateral versus contralateral involvement Assessing distant metastases (M) Consider whole body CT and/or PET
51 Overview Presentation of index patient History of present illness Radiologic findings Review of differential diagnoses Discussion of bronchioloalveolar carcinoma General information Roles of radiology in diagnosis and management Follow-up of index patient Summary
52 Our Patient: Diagnosis and Prognosis BAC confirmed with specific tumor markers General prognosis for BAC with multifocal and consolidative features: Almost 0% survival at 5 years However, she is responding well after 4 courses of chemotherapy.
53 Our Patient: CT after 4 Cycles of Chemotherapy Fewer nodules and GGO in RML Decreased extent of consolidation and more aerated space in RLL Axial C- Chest CT (lung window), at presentation From PACS, BIDMC Axial C+ Chest CT (lung window), after 4 cycles of chemotherapy
54 Overview Presentation of index patient History of present illness Radiologic findings Review of differential diagnoses Discussion of bronchioloalveolar carcinoma General information Roles of radiology in diagnosis and management Follow-up of index patient Summary
55 Summary Radiologic findings of BAC Patterns of growth Non-resolving singular nodule, mass or ground glass opacity Multiple nodules or masses Consolidations Heterogeneous attenuation on CT, with CT-angiogram sign, pseudocavitations, and air bronchograms Radiologic findings have implications for diagnosis, staging, prognosis, and treatment
56 Acknowledgements Dr. Paul Spirn Dr. Ammar Sarwar Dr. Prachi Dubey Dr. Gillian Lieberman Maria Levantakis
57 Select references Akira M, Atagi S, Kawahara M, et al High resolution CT findings of diffuse bronchioloalveolar carcinoma in 38 patients. Am J Roentgenol. 172 (6): Hansell DM, Bankier AA, MacMahon H, et al Fleischner Society: Glossary of terms for thoracic imaging. Radiology. 246: Jung, JI, Kim H, Park SH, et al CT differentiation of pneumonic-type bronchioloalveolar cell carcinoma and infectious pneumonia. Br J Radiol. 74: Lee KS, Kim Y, Ko EJ, et al Bronchioloalveolar carcinoma: clinical, histopathologic, and radiologic findings. RadioGraphics. 17: Lung Segments. Korea Critical Care. Accessed 3/15/10. Available online at: Maldonado RL The CT angiogram sign. Radiology. 210: Mirtcheva RM, Vazquez M, Yankelevitz, DF, Henschke CI Bronchioloalveolar carcinoma and adenocarcinoma with bronchioloalveolar features presenting as groundglass opacities on CT. Clin Imgaing. 26 (2) Patsios D, Roberts HC, Paul NS, et. al Pictorial review of the many faces of bronchioloalveolar cell carcinoma. Br J Radiol. 80 (960): Travis ED, Garg K, Franklin WA, et al Evolving concepts in the pathology and CT imaging of lung adenocarcinoma and bronchioloalveolar carcinoma. J of Clin Onc. 23 (14):
10/17/2016. Nuts and Bolts of Thoracic Radiology. Objectives. Techniques
Nuts and Bolts of Thoracic Radiology October 20, 2016 Carleen Risaliti Objectives Understand the basics of chest radiograph Develop a system for interpreting chest radiographs Correctly identify thoracic
More informationOBJECTIVES. Solitary Solid Spiculated Nodule. What would you do next? Case Based Discussion: State of the Art Management of Lung Nodules.
Organ Imaging : September 25 2015 OBJECTIVES Case Based Discussion: State of the Art Management of Lung Nodules Dr. Elsie T. Nguyen Dr. Kazuhiro Yasufuku 1. To review guidelines for follow up and management
More informationTB Radiology for Nurses Garold O. Minns, MD
TB Nurse Case Management Salina, Kansas March 31-April 1, 2010 TB Radiology for Nurses Garold O. Minns, MD April 1, 2010 TB Radiology for Nurses Highway Patrol Training Center Salina, KS April 1, 2010
More informationChest X-ray Interpretation
Chest X-ray Interpretation Introduction Routinely obtained Pulmonary specialist consultation Inherent physical exam limitations Chest x-ray limitations Physical exam and chest x-ray provide compliment
More informationUERMMMC Department of Radiology. Basic Chest Radiology
UERMMMC Department of Radiology Basic Chest Radiology PHYSICS DENSITIES BONE SOFT TISSUES WATER FAT AIR TELEROENTGENOGRAM Criteria for an Ideal Chest Radiograph 1. Upright 2. Posteroanterior View 3. Full
More informationThoracic CT pattern in lung cancer: correlation of CT and pathologic diagnosis
19 th Congress of APSR PG of Lung Cancer (ESAP): Update of Lung Cancer Thoracic CT pattern in lung cancer: correlation of CT and pathologic diagnosis Kazuma Kishi, M.D. Department of Respiratory Medicine,
More informationManagement of Multiple Pure Ground-Glass Opacity Lesions in Patients with Bronchioloalveolar Carcinoma
ORIGINAL ARTICLE Management of Multiple Pure Ground-Glass Opacity Lesions in Patients with Bronchioloalveolar Carcinoma Hong Kwan Kim, MD,* Yong Soo Choi, MD,* Jhingook Kim, MD, PhD,* Young Mog Shim, MD,
More informationThoracic Imaging: A Case of Metastatic Adenocarcinoma of Unknown Primary
January 28, 2009 Thoracic Imaging: A Case of Metastatic Adenocarcinoma of Unknown Primary Kristina Mirabeau-Beale, Harvard Medical School Year III Gillian Lieberman, MD Agenda Introduce Patient RS Discuss
More informationChest Radiology Interpretation: Findings of Tuberculosis
Chest Radiology Interpretation: Findings of Tuberculosis Get out your laptops, smart phones or other devices pollev.com/chestradiology Case #1 1 Plombage Pneumonia Cancer 2 Reading the TB CXR Be systematic!
More informationUse of Integrated PET CT in the Clinical Staging of Non Small Cell Lung Cancer
November 2010 Use of Integrated PET CT in the Clinical Staging of Non Small Cell Lung Cancer Laura Myers, Harvard Medical School, Year III Clinical Presentation 79yo woman with cough productive of green
More informationSystemic lupus erythematosus (SLE): Pleuropulmonary Manifestations
08/30/10 09/26/10 Systemic lupus erythematosus (SLE): Pleuropulmonary Manifestations Camila Downey S. Universidad de Chile, School of Medicine, Year VII Harvard University, School of Medicine Sept 17,
More informationCT findings in multifocal or diffuse non-mucinous bronchioloalveolar carcinoma (BAC)
CT findings in multifocal or diffuse non-mucinous bronchioloalveolar carcinoma (BAC) Poster No.: C-2192 Congress: ECR 2014 Type: Educational Exhibit Authors: I. Sandu, A. R. Popita, I.-A. Brumboiu; Cluj-Napoca/RO
More informationCT findings in multifocal or diffuse non-mucinous bronchioloalveolar carcinoma (BAC)
CT findings in multifocal or diffuse non-mucinous bronchioloalveolar carcinoma (BAC) Poster No.: C-2192 Congress: ECR 2014 Type: Educational Exhibit Authors: I. Sandu, A. R. Popita, I.-A. Brumboiu; Cluj-Napoca/RO
More informationSigns in Chest Radiology
Signs in Chest Radiology Jonathan H. Chung, MD Disclosures No pertinent disclosures Jonathan H. Chung, MD Assistant Professor Institute t of fadvanced d Biomedical Imaging National Jewish Health Denver,
More informationHRCT in Diffuse Interstitial Lung Disease Steps in High Resolution CT Diagnosis. Where are the lymphatics? Anatomic distribution
Steps in High Resolution CT Diagnosis Pattern of abnormality Distribution of disease Associated findings Clinical history Tomás Franquet MD What is the diagnosis? Hospital de Sant Pau. Barcelona Secondary
More informationDo you want to be an excellent Radiologist? - Focus on the thoracic aorta on lateral chest image!!!
The lateral chest radiograph: Challenging area around the thoracic aorta!!! Do you want to be an excellent Radiologist? - Focus on the thoracic aorta on lateral chest image!!! Dong Yoon Han 1, So Youn
More informationInteresting Cases. Pulmonary
Interesting Cases Pulmonary 54M with prior history of COPD, hep B/C, and possible history of TB presented with acute on chronic dyspnea, and productive cough Hazy opacity overlying the left hemithorax
More informationBronchioloalveolar Carcinoma Mimicking DILD:
Bronchioloalveolar Carcinoma Mimicking DILD: A Case Report 1 Ju Young Lee, M.D., In Jae Lee, M.D., Dong Gyu Kim, M.D. 2, Soo Kee Min, M.D. 3, Min-Jeong Kim, M.D., Sung Il Hwang, M.D., Yul Lee, M.D., Sang
More informationLow-dose CT Lung Cancer Screening Guidelines for Pulmonary Nodules Management Version 2
Low-dose CT Lung Cancer Screening Guidelines for Pulmonary Nodules Management Version 2 The Committee for Management of CT-screening-detected Pulmonary Nodules 2009-2011 The Japanese Society of CT Screening
More informationChief Complain. For chemotherapy
Chief Complain For chemotherapy Present Illness 93.12 Progressive weakness of R t arm for 1 year X-ray: peneative lesion over right proximal humorous Bone scan: multiple increased intake Biopsy of distal
More informationPictorial essay of unusual radiologic manifestations of pulmonary and airway metastasis at initial presentation of lung cancer
Pictorial essay of unusual radiologic manifestations of pulmonary and airway metastasis at initial presentation of lung cancer Poster No.: C-2297 Congress: ECR 2012 Type: Educational Exhibit Authors: Y.
More informationPulmonary Nodules & Masses
Pulmonary Nodules & Masses A Diagnostic Approach Heber MacMahon The University of Chicago Department of Radiology Disclosure Information Consultant for Riverain Technology Minor equity in Hologic Royalties
More informationAn Introduction to Radiology for TB Nurses
An Introduction to Radiology for TB Nurses Garold O. Minns, MD September 14, 2017 TB Nurse Case Management September 12 14, 2017 EXCELLENCE EXPERTISE INNOVATION Garold O. Minns, MD has the following disclosures
More informationLUNG NODULES: MODERN MANAGEMENT STRATEGIES
Department of Radiology LUNG NODULES: MODERN MANAGEMENT STRATEGIES Christian J. Herold M.D. Department of Biomedical Imaging and Image-guided Therapy Medical University of Vienna Vienna, Austria Pulmonary
More informationMonitor Images for Respiratory System Dissection
Monitor Images for Respiratory System Dissection **This document includes extra images of the radiology of the bronchopulmonary segments. These imaged are an excellent way to review the three-dimensional
More informationObjectives. What is a Chest X Ray? CXR Workshop. Definition (diagnostic tool/internal PE) Types. Cost
Objectives CAPA 2011 Christy Wilson, PA C Georgia Lung Associates Identify the radiographic landmarks on a chest radiograph Recognize identifiers of poor quality on the chest radiograph Outline an approach
More informationUniportal video-assisted thoracoscopic surgery segmentectomy
Case Report on Thoracic Surgery Page 1 of 5 Uniportal video-assisted thoracoscopic surgery segmentectomy John K. C. Tam 1,2 1 Division of Thoracic Surgery, National University Heart Centre, Singapore;
More informationA Case of Pediatric Plasma Cell Granuloma
August 2001 A Case of Pediatric Plasma Cell Granuloma Nii Tetteh, Harvard Medical School Year IV Our Patient 8 year old male with history of recurrent left lower lobe and lingular pneumonias since 1994.
More informationAccomplishes fundamental surgical tenets of R0 resection with systematic nodal staging for NSCLC Equivalent survival for Stage 1A disease
Segmentectomy Made Simple Matthew J. Schuchert and Rodney J. Landreneau Department of Cardiothoracic Surgery University of Pittsburgh Medical Center Financial Disclosures none Why Consider Anatomic Segmentectomy?
More informationResident Case Review CHEST. Daria Manos CAR 2016
Resident Case Review CHEST CAR 2016 Daria Manos Disclosure Speakers bureau, Roche CAR 2016 Daria Manos 1. Recognize common and critical chest radiograph and computed tomography signs and use these clues
More informationThe Spectrum of Management of Pulmonary Ground Glass Nodules
The Spectrum of Management of Pulmonary Ground Glass Nodules Stanley S Siegelman CT Society 10/26/2011 No financial disclosures. Noguchi M et al. Cancer 75: 2844-2852, 1995. 236 surgically resected peripheral
More informationJoseph Garland, HMS IV Gillian Lieberman, MD. Round Pneumonia. Joseph Garland, HMS IV Gillian Lieberman, MD
Round Pneumonia Joseph Garland, HMS IV Case 1: Mr. H Mr. H is a 45-year-old man who presents with a 4 day history of full-body myalgias, headaches and fever to 103 F. He also complains of sharp leftsided
More informationAmerican College of Radiology ACR Appropriateness Criteria
American College of Radiology ACR Criteria Radiologic Management of Thoracic Nodules and Masses Variant 1: Middle-aged patient (35 60 years old) with an incidental 1.5-cm lung nodule. The lesion was smooth.
More informationobjectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University
objectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University To determine the regions of physiologic activity To understand
More informationIntroduction to Radiology for TB Nurses
Introduction to Radiology for TB Nurses Juzar Ali, MD; FRCP(C); FCCP May 4, 2018 Essential Skills for the TB Nurse Case Manager Little Rock, AR May 3 4, 2017 Juzar Ali, MD; FRCP(C); FCCP has the following
More informationLung Cancer Imaging. Terence Z. Wong, MD,PhD. Department of Radiology Duke University Medical Center Durham, NC 9/9/09
Lung Cancer Imaging Terence Z. Wong, MD,PhD Department of Radiology Duke University Medical Center Durham, NC 9/9/09 Acknowledgements Edward F. Patz, Jr., MD Jenny Hoang, MD Ellen L. Jones, MD, PhD Lung
More informationAn Image Repository for Chest CT
An Image Repository for Chest CT Francesco Frajoli for the Chest CT in Antibody Deficiency Group An Image Repository for Chest CT he Chest CT in Antibody Deficiency Group is an international and interdisciplinary
More informationFDG PET/CT in Lung Cancer Read with the experts. Homer A. Macapinlac, M.D.
FDG PET/CT in Lung Cancer Read with the experts Homer A. Macapinlac, M.D. Patient with suspected lung cancer presents with left sided chest pain T3 What is the T stage of this patient? A) T2a B) T2b C)
More informationUndergraduate Teaching
Prof. James F Meaney Undergraduate Teaching Chest X-Ray Understanding the normal anatomical by reference to cross sectional imaging Radiology? It s FUN! Cryptic puzzle Sudoku (Minecraft?) It s completely
More informationCollaborative Stage. Site-Specific Instructions - LUNG
Slide 1 Collaborative Stage Site-Specific Instructions - LUNG In this presentation, we are going to review the AJCC Cancer Staging criteria for the lung primary site. Slide 2 Reading Assignments As each
More informationRadiology Pathology Conference
Radiology Pathology Conference Sharlin Johnykutty,, MD, Cytopathology Fellow Sara Majewski, MD, Radiology Resident Friday, August 28, 2009 Presentation material is for education purposes only. All rights
More informationWith recent advances in diagnostic imaging technologies,
ORIGINAL ARTICLE Management of Ground-Glass Opacity Lesions Detected in Patients with Otherwise Operable Non-small Cell Lung Cancer Hong Kwan Kim, MD,* Yong Soo Choi, MD,* Kwhanmien Kim, MD,* Young Mog
More informationRadiological Aspects of Pulmonary Tuberculosis in Immunocompetent Hosts
Nov 2003 Radiological Aspects of Pulmonary Tuberculosis in Immunocompetent Hosts Josh Rempell, Harvard Medical School Year III Tuberculosis: the captain of all (wo)men of death Overall, one third of the
More informationCase Study #2. Case Study #1 cont 9/28/2011. CAPA 2011 Christy Wilson PA C. LH is 78 yowf with PMHx of metz breast CA presents
Case Study #1 CAPA 2011 Christy Wilson PA C 46 yo female presents with community acquired PNA (CAP). Her condition worsened and she was transferred to the ICU and placed on mechanical ventilation. Describe
More informationAJCC-NCRA Education Needs Assessment Results
AJCC-NCRA Education Needs Assessment Results Donna M. Gress, RHIT, CTR Survey Tool 1 Survey Development, Delivery, Analysis THANKS to NCRA for the following work Developed survey with input from partners
More information4/16/2017. Learning Objectives. Interpretation of the Chest Radiograph. Components. Production of the Radiograph. Density & Appearance
Interpretation of the Arthur Jones, EdD, RRT Learning Objectives Identify technical defects in chest radiographs Identify common radiographic abnormalities This Presentation is Approved for 1 CRCE Credit
More informationBronchogenic Carcinoma
A 55-year-old construction worker has smoked 2 packs of ciggarettes daily for the past 25 years. He notes swelling in his upper extremity & face, along with dilated veins in this region. What is the most
More informationHow to Analyse Difficult Chest CT
How to Analyse Difficult Chest CT Complex diseases are:- - Large lesion - Unusual or atypical pattern - Multiple discordant findings Diffuse diseases are:- - Numerous findings in both sides 3 basic steps
More informationCongenital Lung Malformations: Radiologic-Pathologic Correlation
Acta Radiológica Portuguesa, Vol.XVIII, nº 70, pág. 51-60, Abr.-Jun., 2006 Congenital Lung Malformations: Radiologic-Pathologic Correlation Marilyn J. Siegel Mallinckrodt Institute of Radiology, Washington
More informationThe revised lung adenocarcinoma classification an imaging guide
Review Article The revised lung adenocarcinoma classification an imaging guide Natasha Gardiner 1, Sanjay Jogai 2, Adam Wallis 3 1 Specialty Registrar in Clinical Radiology, Wessex Deanery, UK; 2 Consultant
More informationBronchial carcinosarcoma
Bronchial carcinosarcoma Carolina Carcano 1*, Edward Savage 2, Maria Julia Diacovo 3, Jacobo Kirsch 1 1. Division of Radiology, Cleveland Clinic Florida, Weston, Fl, USA 2. Department of Thoracic and Cardiovascular
More informationCT Signs of Solitary Pulmonary Lesions: Revisited
CT Signs of Solitary Pulmonary Lesions: Revisited Poster No.: C-1764 Congress: ECR 2015 Type: Educational Exhibit Authors: H. Hayashi, K. Ashizawa, Y. Ogihara, A. Nishida, T. Tanaka, 1 1 2 1 1 1 1 1 2
More informationBronchial syndrome. Atelectasis Draining bronchus Bronchiectasis
Bronchial syndrome Atelectasis Draining bronchus Bronchiectasis Etienne Leroy Terquem Pierre L Her SPI / ISP Soutien Pneumologique International / International Support for Pulmonology Atelectasis Consequence
More informationX-Rays. Kunal D Patel Research Fellow IMM
X-Rays Kunal D Patel Research Fellow IMM The 12-Steps } 1: Name 2: Date 3: Old films 4: What type of view(s) 5: Penetration } Pre-read 6: Inspiration 7: Rotation Quality Control 8: Angulation 9: Soft tissues
More informationGround Glass Opacities
Ground Glass Opacities A pathologist s perspective Marie-Christine Aubry, M.D. Professor of Pathology Mayo Clinic Objectives Discuss the proposed new pathologic classification of adenocarcinoma with historical
More informationChest X-ray (CXR) Interpretation Brent Burbridge, MD, FRCPC
Chest X-ray (CXR) Interpretation Brent Burbridge, MD, FRCPC An approach to reviewing a chest x-ray will create a foundation that will facilitate the detection of abnormalities. You should create your own
More informationCharles Mulligan, MD, FACS, FCCP 26 March 2015
Charles Mulligan, MD, FACS, FCCP 26 March 2015 Review lung cancer statistics Review the risk factors Discuss presentation and staging Discuss treatment options and outcomes Discuss the status of screening
More informationAcute and Chronic Lung Disease
KATHOLIEKE UNIVERSITEIT LEUVEN Faculty of Medicine Acute and Chronic Lung Disease W De Wever, JA Verschakelen Department of Radiology, University Hospitals Leuven, Belgium Clinical utility of HRCT To detect
More informationThe small subsolid pulmonary nodules. What radiologists need to know.
The small subsolid pulmonary nodules. What radiologists need to know. Poster No.: C-1250 Congress: ECR 2016 Type: Educational Exhibit Authors: L. Fernandez Rodriguez, A. Martín Díaz, A. Linares Beltrán,
More informationACUTE PULMNARY INFECTIONS: UNDERSTANDING THE CHEST RADIOGRAPH. Leonard E. Swischuk, M.D. University of Texas Medical Branch
ACUTE PULMNARY INFECTIONS: UNDERSTANDING THE CHEST RADIOGRAPH Leonard E. Swischuk, M.D. University of Texas Medical Branch AUTHOR HAS NOTHING TO DECLARE LEARNING OBJETIVES Understand the pathophysiology
More informationCT Screening for Lung Cancer for High Risk Patients
CT Screening for Lung Cancer for High Risk Patients The recently published National Lung Cancer Screening Trial (NLST) showed that low-dose CT screening for lung cancer reduces mortality in high-risk patients
More informationCase 1 : Question. 1.1 What is the intralobular distribution? 1. Centrilobular 2. Perilymphatic 3. Random
Interesting case Case 1 Case 1 : Question 1.1 What is the intralobular distribution? 1. Centrilobular 2. Perilymphatic 3. Random Case 1: Answer 1.1 What is the intralobular distribution? 1. Centrilobular
More informationInterpretation of Chest Radiographs Paul Christensen, MD 10/21/09. Diagnostic Evaluation. Medical Evaluation & CXR Interpretation.
Diagnostic Evaluation Medical Evaluation & CXR Interpretation University of Michigan TB Consultant Washtenaw County Medical history Physical examination Testing for TB exposure (previously covered) Radiologic
More informationGUIDELINES FOR CANCER IMAGING Lung Cancer
GUIDELINES FOR CANCER IMAGING Lung Cancer Greater Manchester and Cheshire Cancer Network Cancer Imaging Cross-Cutting Group April 2010 1 INTRODUCTION This document is intended as a ready reference for
More informationMolly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010
LSU HEALTH SCIENCES CENTER NSCLC Guidelines Feist-Weiller Cancer Center Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010 Initial Evaluation/Intervention: 1. Pathology Review 2. History and Physical
More informationRole of CT imaging to evaluate solitary pulmonary nodule with extrapulmonary neoplasms
Original Research Article Role of CT imaging to evaluate solitary pulmonary nodule with extrapulmonary neoplasms Anand Vachhani 1, Shashvat Modia 1*, Varun Garasia 1, Deepak Bhimani 1, C. Raychaudhuri
More informationApproach to Pulmonary Nodules
Approach to Pulmonary Nodules Edwin Jackson, Jr., DO Assistant Professor-Clinical Director, James Early Detection Clinic Department of Internal Medicine Division of Pulmonary, Allergy, Critical Care and
More informationSlide 1. Slide 2. Slide 3. Investigation and management of lung cancer Robert Rintoul. Epidemiology. Risk factors/aetiology
Slide 1 Investigation and management of lung cancer Robert Rintoul Department of Thoracic Oncology Papworth Hospital Slide 2 Epidemiology Second most common cancer in the UK (after breast). 38 000 new
More informationImaging of Lung Cancer: A Review of the 8 th TNM Staging System
Imaging of Lung Cancer: A Review of the 8 th TNM Staging System Travis S Henry, MD Associate Professor of Clinical Radiology Cardiac and Pulmonary Imaging Section University of California, San Francisco
More informationClinical Radiological Pathological Conference
Clinical Radiological Pathological Conference CASE 1: A 59-year-old female Housekeeper Live in Phuket, Thailand Progressive dyspnea for 1 year Present illness 1 year PTA : She developed dyspnea on exertion
More information8/14/2017. Objective: correlate radiographic findings of common lung diseases to actual lung pathologic features
What is that lung disease? Pulmonary Patterns & Correlated Pathology Dr. Russell Tucker, DACVR Objective: correlate radiographic findings of common lung diseases to actual lung pathologic features Improved
More informationLung cancer in patients with chronic empyema
Lung cancer in patients with chronic empyema Poster No.: P-0025 Congress: ESTI 2015 Type: Scientific Poster Authors: Y. Lee, C.-K. Park; Guri/KR Keywords: Neoplasia, Biopsy, PET-CT, CT, Thorax, Lung DOI:
More informationPULMONARY NODULES AND MASSES : DIAGNOSTIC APPROACH AND NEW MANAGEMENT GUIDELINES. https://tinyurl.com/hmpn2018
PULMONARY NODULES AND MASSES : DIAGNOSTIC APPROACH AND NEW MANAGEMENT GUIDELINES Heber MacMahon MB, BCh Department of Radiology The University of Chicago https://tinyurl.com/hmpn2018 Disclosures Consultant
More informationSeptember 2014 Imaging Case of the Month. Michael B. Gotway, MD. Department of Radiology Mayo Clinic Arizona Scottsdale, AZ
September 2014 Imaging Case of the Month Michael B. Gotway, MD Department of Radiology Mayo Clinic Arizona Scottsdale, AZ Clinical History: A 57-year-old non-smoking woman presented to her physician as
More informationChest XRay interpretation INTERPRETATIONS Identifications: Name & Date Technical evaluation Basic Interpretations
Chest XRay interpretation INTERPRETATIONS Identifications: Name & Date Technical evaluation Basic Interpretations TECHNICAL EVALUATION 1. Projection: AP/PA view To differentiate between AP & PA films,
More informationGuidelines for the Management of Pulmonary Nodules Detected by Low-dose CT Lung Cancer Screening
Guidelines for the Management of Pulmonary Nodules Detected by Low-dose CT Lung Cancer Screening 1. Introduction In January 2005, the Committee for Preparation of Clinical Practice Guidelines for the Management
More informationDiagnosis and Staging of Non-Small Cell Lung Cancer Carlos Eduardo Oliveira Baleeiro, MD. November 18, 2017
Diagnosis and Staging of Non-Small Cell Lung Cancer Carlos Eduardo Oliveira Baleeiro, MD November 18, 2017 Disclosures I do not have a financial interest/arrangement or affiliation with one or more organizations
More informationBoy 8 months TPRC. 21 Sep 06 CXR. Flat and. CLE findings. BPD findings a. Left opacity
CLE in BPD lung Boy 8 months 17 Sep 06 21 Sep 06 CXR Flat and low position of the diaphragm ICD insertion, right; ET tube slightly shift to the left RUL atelectasis RML hyperinflation, herniating across
More informationCT Screening for Lung Cancer: Frequency and Significance of Part-Solid and Nonsolid Nodules
Claudia I. Henschke 1 David F. Yankelevitz 1 Rosna Mirtcheva 1 Georgeann McGuinness 2 Dorothy McCauley 1 0lli S. Miettinen 3 for the ELCAP Group Received June 19, 2001; accepted after revision November
More informationSESSION IV: MECHANISMS OF HUMAN DISEASE: LABORATORY SESSIONS PULMONARY PATHOLOGY I. December 5, 2012
SESSION IV: MECHANISMS OF HUMAN DISEASE: LABORATORY SESSIONS PULMONARY PATHOLOGY I December 5, 2012 FACULTY COPY GOAL: Describe the basic morphologic and pathophysiologic changes in various conditions
More informationRadiology of the respiratory disease
Radiology of the respiratory disease [ Color index: Important Notes Extra ] [ Editing file Feedback Share your notes Shared notes ] Resources: - 435 Slides - 434 Team - 435 Notes Done by: - Mai Alageel
More informationAdam J. Hansen, MD UHC Thoracic Surgery
Adam J. Hansen, MD UHC Thoracic Surgery Sometimes seen on Chest X-ray (CXR) Common incidental findings on computed tomography (CT) chest and abdomen done for other reasons Most lung cancers discovered
More informationCase 1. A 35-year-old male presented with fever, cough, and purulent sputum for one week. This was his CXR (Fig. 1.1). What is the diagnosis?
1 Interpreting Chest X-Rays CASE 1 Fig. 1.1 Case 1. A 35-year-old male presented with fever, cough, and purulent sputum for one week. This was his CXR (Fig. 1.1). What is the diagnosis? CASE 1 Interpreting
More informationPET/CT in lung cancer
PET/CT in lung cancer Andrei Šamarin North Estonia Medical Centre 3 rd Baltic Congress of Radiology 08.10.2010 Imaging in lung cancer Why do we need PET/CT? CT is routine imaging modality for staging of
More informationPULMONARY INFARCTS ASSOCIATED WITH BRONCHOGENIC CARCINOMA
Thor-ax (1954), 9, 304. PULMONARY INFARCTS ASSOCIATED WITH BRONCHOGENIC CARCINOMA W. J. HANBURY, R. J. R. CURETON, AND G. SIMON From St. Bartholomew's Hospital, London BY (RECEIVED FOR PUBLICATION JUNE
More informationXiaohuan Pan 1,2 *, Xinguan Yang 1,2 *, Jingxu Li 1,2, Xiao Dong 1,2, Jianxing He 2,3, Yubao Guan 1,2. Original Article
Original Article Is a 5-mm diameter an appropriate cut-off value for the diagnosis of atypical adenomatous hyperplasia and adenocarcinoma in situ on chest computed tomography and pathological examination?
More informationThe Upper Airway. Trachea. The Human Airway. Nasopharynx Oropharynx Larynx
The Human Airway (with thanks to David N. Hager, MD, PhD Johns Hopkins University) The Upper Airway Nasopharynx Oropharynx Larynx voice airflow Gray, Anatomy of the Human Body Trachea Length: 9-15 cm Internal
More informationUpdate on 2015 WHO Classification of Lung Adenocarcinoma 1/3/ Mayo Foundation for Medical Education and Research. All rights reserved.
1 Our speaker for this program is Dr. Anja Roden, an associate professor of Laboratory Medicine and Pathology at Mayo Clinic as well as consultant in the Anatomic Pathology Laboratory and co-director of
More informationCommunity-Acquired Acinetobacter baumannii Pneumonia: Initial Chest Radiographic Findings and Follow-up CT Findings in Helping Predict Patient Outcome
Community-Acquired Acinetobacter baumannii Pneumonia: Initial Chest Radiographic Findings and Follow-up CT Findings in Helping Predict Patient Outcome Jeong Joo Woo, Dong Hyun Lee, Jin Kyung An Department
More informationLung Cancer Diagnosis for Primary Care
Lung Cancer Diagnosis for Primary Care Daniel Nader, DO, FCCP Cancer Treatment Center of America Case 1 In which of the following situations would the U.S. Preventive Services Task Force (USPSTF) recommend
More informationNew lung lesion in a 55 year-old male treated with chemoradiation for non-small cell lung carcinoma
July 2016 New lung lesion in a 55 year-old male treated with chemoradiation for non-small cell lung carcinoma Contributed by: Laurel Rose, MD, Resident Physician, Indiana University School of Medicine,
More informationLung Cancer Screening: To Screen or Not to Screen?
Lung Cancer Screening: To Screen or Not to Screen? Lorriana Leard, MD Co-Director of UCSF Lung Cancer Screening Program Vice Chief of Clinical Activities UCSF Pulmonary, Critical Care, Allergy & Sleep
More informationPositron Emission Tomography in Lung Cancer
May 19, 2003 Positron Emission Tomography in Lung Cancer Andrew Wang, HMS III Patient DD 53 y/o gentleman presented with worsening dyspnea on exertion for the past two months 30 pack-year smoking Hx and
More informationPulmonary changes induced by radiotherapy. HRCT findings
Pulmonary changes induced by radiotherapy. HRCT findings Poster No.: C-2299 Congress: ECR 2015 Type: Educational Exhibit Authors: R. E. Correa Soto, M. Albert Antequera, K. Müller Campos, D. 1 2 4 3 1
More informationPathology and Prognosis of Persistent Stable Pure Ground-Glass Opacity Nodules After Surgical Resection
GENERAL THORACIC Pathology and Prognosis of Persistent Stable Pure Ground-Glass Opacity Nodules After Surgical Resection Sukki Cho, MD, HeeChul Yang, MD, Kwhanmien Kim, MD, and Sanghoon Jheon, MD Department
More informationInterpreting thoracic x-ray of the supine immobile patient: Syllabus
Interpreting thoracic x-ray of the supine immobile patient: Syllabus Johannes Godt Dep. of Radiology and Nuclear Medicine Oslo University Hospital Ullevål NORDTER 2017, Helsinki Content - Why bedside chest
More informationWeb Chapter 3. Image Gallery: Lesion detection on low dose chest CT
Web Chapter 3 Image Gallery: Lesion detection on low dose chest CT Sarabjeet Singh, MD Mannudeep K. Kalra, MD *Eugene J. Mark, MD *James Stone, MD James H. Thrall, MD Department of Radiology and *Department
More informationCase of the Day Chest
Case of the Day Chest Darin White MDCM FRCPC Department of Radiology, Mayo Clinic 76 th Annual Scientific Meeting Canadian Association of Radiologists Montreal, QC April 26, 2013 2013 MFMER slide-1 Disclosures
More informationLung Cancers Manifesting as Part-Solid Nodules in the National Lung Screening Trial
Cardiopulmonary Imaging Original Research Yip et al. Lung Cancers Manifesting as Part-Solid Nodules Cardiopulmonary Imaging Original Research Rowena Yip 1 Claudia I. Henschke 1 Dong Ming Xu 1 Kunwei Li
More information