Radiology Education and Clinical Service during the COVID-19 Pandemic - the Puerto Rico Medical Center Experience.

Residency training programs have faced the dual challenge of providing continuous and effective clinical services and graduate medical education during the Coronavirus Disease 2019 (COVID-19) pandemic. This article outlines the changes incorporated by the University of Puerto Rico School of Medicine Diagnostic Radiology Program during the COVID-19 pandemic, including incorporating a virtual approach for read-out sessions, didactic conferences and additional learning experiences for the radiology residents. By means of collaboration and unity in the noble goal of public service, the faculty and residents of the Diagnostic Radiology Program at UPR-SOM have shown resilience throughout the many challenges faced during the current COVID-19 pandemic.

Marked 18-Fuorine-Fluorodeoxyglucose (FDG) Avidity of an Intrapulmonary Typical Carcinoid Tumor Manifesting as a Bronchocele in an Asymptomatic Middle-Aged Woman.

BACKGROUND Intrapulmonary carcinoid tumors (ICTs) are malignant, slow-growing tumors classified as either: i) typical, less aggressive, well-differentiated tumors or ii) atypical, more aggressive, poorly-differentiated tumors. Most typical carcinoid tumors originate in the central airway and present with symptoms related to bronchial obstruction. In contrast, atypical carcinoids tend to occur more peripherally and are generally detected incidentally as a solitary pulmonary nodule (SPN). Typical carcinoid tumors usually do not exhibit increased metabolic activity on positron emission tomography with 18-fuorine-fluorodeoxyglucose (FDG PET) as would be expected for malignant tumors. In this case report, we present an unusual case of a typical, well-differentiated, peripheral carcinoid tumor showing marked FDG avidity manifesting as a bronchocele. We discuss the differential diagnoses and describe the diagnostic approach undertaken in this exemplary case of a common clinical problem. CASE REPORT A left upper-lobe, peripheral, 2-cm pulmonary nodule was incidentally identified on chest radiography of an asymptomatic 67-year-old female patient. Chest CT scan with intravenous (IV) contrast showed a noncalcified nodule with a branching pattern. Further evaluation with FDG PET/CT scan demonstrated marked FDG avidity. Post-surgical biopsy revealed a typical, well-differentiated, intrapulmonary carcinoid tumor. CONCLUSIONS Carcinoid tumors of the lung remain a diagnostic challenge for primary care physicians and radiologists due to their diverse clinical and radiological presentations. Peripheral carcinoid tumors usually present as an asymptomatic peripheral, solitary, pulmonary nodule, but isolated peripheral bronchocele has been described, as in our case. In addition, caution must be taken when utilizing FDG PET/CT scan for the evaluation of a possible lung carcinoid tumor, as an accurate value range of FDG uptake for diagnosis of these tumors has not been defined.

Diagnostic Yield of Pulmonary CT Angiography in the Evaluation of Pulmonary Embolisms Treated at the Puerto Rico Medical Center from 2008 to 2012.

OBJECTIVE: The objective of this study was to determine the diagnostic yield of pulmonary CT angiography (PCTA) in the evaluation of pulmonary embolisms treated at the Puerto Rico Medical Center from 2008 to 2012. METHODS: A total of 1,004 CT angiograms were reviewed in the evaluation of pulmonary embolisms. Patient records covering from 2008 to 2012 were obtained from the picture archiving and communication system (PACS) of the Puerto Rico Medical Center. Follow-up studies and those of pediatric patients were excluded from the study. The results were recorded as either positive or negative for pulmonary embolism, according to the final report rendered by board-certified radiologists. RESULTS: Of the 1,004 patient records reviewed, 964 were included in the study. Forty-six out of the total studies reviewed were positive, while a total of 918 studies were negative. A mean diagnostic yield of 4.8% (SD = 0.63) was obtained. CONCLUSION: At the Puerto Rico Medical Center, the mean diagnostic yield in the evaluation of pulmonary embolism using PCTA was 4.8%, which is in concordance with those of several previous studies, all of which had similar low yields. New diagnostic algorithms for efficiently employing PCTA for the evaluation of pulmonary embolisms are discussed herein.