Imaging
Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology.
The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend. Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology. The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend.
Medical Image of the Week: VA Shunt Remnant Fibrosing into Right Atrium
Figure 1. Transthoracic echocardiography demonstrating tubular echo density in the right atrium (arrow).
Figure 2: Transesophageal echocardiography demonstrating the VA shunt remnant fibrosed (vs. calcified) in SVC (arrow) extending into right atrium (RA).
A 71-year-old man with a history of ventriculo-atrial (VA) shunt, removed in 2004 due to infection, was admitted to the hospital complaining of syncopal symptoms for one day’s duration. On presentation he denied any symptoms of syncope or focal weakness. The patient was placed on telemetry monitoring, and overnight observation demonstrated multiple sinus pauses with frequent episodes of premature atrial contractions. Stat transthoracic echocardiography (TTE) on the night of admission demonstrated a right tubular echodensity in the right atrium crossing the tricuspid valve (Figure 1). Follow up transesophageal echocardiography (TEE) redemonstrated evidence of a tubular structure in the SVC extending into the right atrium with evidence of fibrosis (?calcification)(Figure 2). These studies demonstrate the importance of echocardiographical work up in any patient with risk of retained foreign body even after reported removal (1).
Richard Young, MD; Joshua Sifuentes, MD; Joao Paulo Ferreira, MD
Department of Internal Medicine
Banner University Medical Center
University of Arizona
Tucson, Arizona USA
Reference
- Choi CH, Elahi MM, Konda S. Iatrogenic retained foreign body in the right atrium. Lessons to Learn. Int J Surg Case Rep. 2013;4(11):985-7. [CrossRef] [PubMed]
Cite as: Young R, Sifuentes J, Ferreira JP. Medical image of the week: VA shunt remnant fibrosing into right atrium. Southwest J Pulm Crit Care. 2017;14(3): 117-8. doi: https://doi.org/10.13175/swjpcc023-17 PDF
Medical Image of the Week: 'CSFoma'
Figure 1. Chest X-ray showing the ‘CSFoma’ in the right pleural space. The shunt can be traced to the lesion. Also seen is a right-sided peripherally inserted central catheter (PICC) line.
A 34 year old woman with a history of CNS coccidiodomycosis leading to hydrocephalus treated with a ventriculo-peritoneal (V-P) shunt along with antifungal treatment was admitted for a post abdominal surgery wound infection. The V-P shunt was revised due to concerns of infection to a ventriculo-pleural shunt. This lead to a collection of cerebrospinal fluid (CSF) in the pleural cavity in a loculated fashion appearing as a pleural ‘CSFoma’.
V-P shunts are placed to drain excessive CSF which otherwise can lead to hydrocephalus and increased intracrnaial pressures. ‘CSFoma’ is a pseudocyst usually seen in the abdomen since most ventricular drains are placed in the peritoneal cavity. Adhesions, blockages or inadequate absorption can lead to collection of the CSF at the distal end of the catheter. These usually self resolve by reabsorption or can be treated by repositioning the catheter or draining the fluid percutaneuosly.
Our patient had a self resolution once the VP drain was repositioned to the peritoneal cavity after the infection was treated.
Sohail Habibi MD1, Craig Jenkins DO1 and Bhupinder Natt MD2
1Department of Internal Medicine
2Division of Pulmonary, Critical Care, Allergy and Sleep Medicine
Banner-University Medical Center
Tucson, AZ
Cite as: Habibi S, Jenkins C, Natt B. Medical image of the week: 'CSFoma'. Southwest J Pulm Crit Care. 2015;11(4):192. doi: http://dx.doi.org/10.13175/swjpcc101-15 PDF