Journal of thoracic imaging
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The evaluation of patients presenting with chest pain to the emergency department remains a significant challenge. The primary goal is to distinguish clinically insignificant etiologies from life-threatening causes such as myocardial ischemia, aortic dissection, and pulmonary embolism. The conventional evaluation consisting of history, electrocardiography, and biochemical markers is often inconclusive and noninvasive imaging techniques may prove valuable. This article describes some of the available options and focuses on the potential role of CT angiography to assess indeterminate chest pain.
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The term tracheal bronchus encompasses a variety of bronchial anomalies originating from the trachea or main bronchus and directed to the upper lobe, and a true tracheal bronchus is any bronchus originating from the trachea. In most cases, it is found incidentally during bronchoscopy or tomography. It is often unilateral, and bilateral true tracheal bronchi are very rare. We report a case of a 54-year-old woman who had bilateral true tracheal bronchi associated with hemoptysis.
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Case Reports
An unusual case of thymic carcinoma with endobronchial metastases manifesting as centrilobular opacities.
We report a case of a 75-year-old man having unusual manifestation of thymic carcinoma associated with endobronchial metastases. To our knowledge, endobronchial metastases secondary to thymic carcinoma has not been reported in the literature. On high-resolution computed tomograms, the tree-in-bud centrilobular opacities caused by metastatic cells accumulating within the small bronchioles is indistinguishable from that caused by inflammatory process. Thus, in patients with thymic carcinoma and persistent tree-in-bud centrilobular opacities, endobronchial metastatic disease should be considered.
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We have analyzed the radiographic and computed tomographic (CT) appearance of thoracostomy (chest) tubes inadvertently placed into the lungs. We have studied the clinical sequela of such malpositioning and discussed treatment options. Cases were collected from chest CT log book reports between January 1998 and January 31, 2005 which indicated or suggested intrapulmonary thoracostomy tube placement. ⋯ Twelve patients (24%) required subsequent thoracic surgery. Intrapulmonary placement of thoracostomy tubes is probably more common than previously reported. This possibility should be considered when radiographs and CT scans are evaluated.
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Chronic contained rupture of aortic aneurysm is a rare but important subset of ruptured aneurysms, which has a presentation that is distinctly different from that of acute rupture. These aneurysms are usually small. Patients are hemodynamically stable, usually presenting with a long history of back or loin pain, with symptoms attributable to compressive or erosive effects. ⋯ Radiographs of the chest show large posterior mediastinal mass eroding the rib. Computed tomography scans demonstrate fusiform dilatation of the thoracoabdominal aorta with positive aortic drape sign, which is highly suggestive of a contained leak. The importance of early identification of this condition lies in the imminent danger of exsanguination, if undetected.