Expiratory CT scan: When to do it and how to interpret it.

Expiratory CT scan is a complementary technique of inspiratory CT that provide valuable physiological information and may be more sensitive to detect air trapping than pul-monary function tests. It is useful in many obstructive airway diseases, including obliterative bronchiolitis, asthma, Swyer-James syndrome, tracheomalacia, hypersensitivity pneumonitis and sarcoidosis. In obliterative bronchiolitis, expiratory CT scan may be the only imaging technique that shows abnormalities in the early phase of disease. In order to obtain a good quality study, we should explain the procedure to the patient, use precise instructions and do some practice before image acquisition. Here we describe strategies to optimize the techni-que and propose an algorithm that help in interpretation of imaging findings in patients with obstructive airway disease.

CT findings of pulmonary cysts.

Pulmonary cysts are thin-walled radiolucent lesions that may appear in a variety of uncommon disorders known as diffuse cystic lung diseases (DCLD) that essentially includes lymphangioleiomyomatosis (LAM), Langerhans cell histiocytosis (LCH), lymphocytic interstitial pneumonia (LIP), Pneumocystis jiroveci pneumonia (PJP), and Birt-Hogg-Dubé syndrome (BHDS). Moreover, they have been reported in several cases of coronavirus disease 2019 (COVID-19). The purpose of this review is to provide a practical approach for evaluating lung cysts when encountered on CT. We describe the imaging findings of DLCD emphasising their differences in terms of shape and distribution of the cysts, as well as their association with other findings such as nodules or ground-glass opacities, which may help in making a confident diagnosis. We also discuss the link between pulmonary cysts and COVID-19.

Hipertensión arterial pulmonar secundaria a tromboembolismo crónico como causa de disnea: a propósito de un caso / Pulmonary arterial hypertension secondary to chronic thromboembolism as a cause of dyspnea: a case report

El tromboembolismo pulmonar es una patología relativamente frecuente y su diagnóstico sigue siendo hoy en día un grave problema en la práctica clínica diaria. Para realizarlo se combinan habitualmente la sospecha clínica con pruebas de imagen, como la gammagrafía de ventilación/perfusión, la tomografía computarizada y, en ocasiones, la angiografía. En el tromboembolismo agudo, la frecuencia de hipertensión pulmonar es elevada, mientras que un porcentaje mucho menor desarrolla hipertensión arterial pulmonar crónica. Presentamos el caso de una mujer de 81 años con antecedentes de hipertensión arterial y cardiopatía hipertensiva que tras un episodio de sensación de fatiga y disnea intensa y de la realización de las pruebas complementarias pertinentes fue diagnosticada de hipertensión arterial pulmonar crónica secundaria a tromboembolismo pulmonar. Estos enfermos habitualmente presentan un curso de deterioro progresivo y un pronóstico muy pobre a corto plazo (AU)

Pulmonary embolism is a relatively frequent disease and its diagnosis continues to be a serious problem in the daily clinical practice. For its diagnosis, clinical suspicion is usually combined with other imaging tests, such as ventilation/perfusion lung scan, computed tomography (CT) and sometimes angiography. In acute thromboembolism, frequency of pulmonary hypertension is elevated while a much lower percentage develops chronic pulmonary arterial hypertension. We present the case of an 81-year-old woman with a background of arterial hypertension and hypertensive heart disease, who, after an episode of intense fatigue and breathlessness, and carrying out the pertinent complementary tests, was diagnosed of pulmonary hypertension secondary to chronic pulmonary thromboembolism. These patients usually follow a course of progressive deterioration and have a poor short-term prognosis (AU)

Necrosis licuefactiva del anillo mitral / Liquefactive necrosis of the mitral ring

La necrosis licuefactiva del anillo valvular mitral se describe como una forma rara de calcificación perianular con un aspecto característico. Suele tratarse de un hallazgo ecográfico incidental que en la tomografía computarizada aparece típicamente como una masa semilunar hipodensa o hiperdensa con un margen de mayor densidad y situada en la zona posterior del anulus. El uso habitual de la TCMD hace que esta entidad se identifique cada vez con más frecuencia, y es importante familiarizarse con ella para evitar errores diagnósticos. Presentamos 3 casos de necrosis licuefactiva del anillo mitral, uno de ellos confirmado quirúrgicamente, y se discuten sus características de imagen y diagnóstico diferencial (AU)

Liquefactive necrosis of the mitral ring is a rare type of periannular calcification that has a characteristic appearance. It is usually discovered incidentally during echocardiography. On CT, it typically appears as a hypointense or hyperintense semilunar mass with margins of greater density that is situated in the area behind the annulus. The routine use of MDCT has led to increasing detection of this entity, and it is important for radiologists to be familiar with these findings to avoid diagnostic errors. We present three cases of liquefactive necrosis of the mitral ring, one of which was confirmed at surgery. We discuss the imaging characteristics and differential diagnosis of this entity (AU)

Hipertensión arterial pulmonar secundaria a tromboembolismo crónico como causa de disnea: a propósito de un caso / Pulmonary arterial hypertension secondary to chronic thromboembolism as a cause of dyspnea: A case report

El tromboembolismo pulmonar es una patología relativamente frecuente y su diagnóstico sigue siendo hoy en día un grave problema en la práctica clínica diaria. Para realizarlo se combinan habitualmente la sospecha clínica con pruebas de imagen, como la gammagrafía de ventilación/perfusión, la tomografía computarizada y, en ocasiones, la angiografía. En el tromboembolismo agudo, la frecuencia de hipertensión pulmonar es elevada, mientras que un porcentaje mucho menor desarrolla hipertensión arterial pulmonar crónica. Presentamos el caso de una mujer de 81 años con antecedentes de hipertensión arterial y cardiopatía hipertensiva que tras un episodio de sensación de fatiga y disnea intensa y de la realización de las pruebas complementarias pertinentes fue diagnosticada de hipertensión arterial pulmonar crónica secundaria a tromboembolismo pulmonar. Estos enfermos habitualmente presentan un curso de deterioro progresivo y un pronóstico muy pobre a corto plazo (AU)

Pulmonary embolism is a relatively frequent disease and its diagnosis continues to be a serious problem in the daily clinical practice. For its diagnosis, clinical suspicion is usually combined with other imaging tests, such as ventilation/perfusion lung scan, computed tomography (CT) and sometimes angiography. In acute thromboembolism, frequency of pulmonary hypertension is elevated while a much lower percentage develops chronic pulmonary arterial hypertension. We present the case of an 81-year-old woman with a background of arterial hypertension and hypertensive heart disease, who, after an episode of intense fatigue and breathlessness, and carrying out the pertinent complementary tests, was diagnosed of pulmonary hypertension secondary to chronic pulmonary thromboembolism. These patients usually follow a course of progressive deterioration and have a poor short-term prognosis (AU)

[Liquefactive necrosis of the mitral ring]. / Necrosis licuefactiva del anillo mitral.

Liquefactive necrosis of the mitral ring is a rare type of periannular calcification that has a characteristic appearance. It is usually discovered incidentally during echocardiography. On CT, it typically appears as a hypointense or hyperintense semilunar mass with margins of greater density that is situated in the area behind the annulus. The routine use of MDCT has led to increasing detection of this entity, and it is important for radiologists to be familiar with these findings to avoid diagnostic errors. We present three cases of liquefactive necrosis of the mitral ring, one of which was confirmed at surgery. We discuss the imaging characteristics and differential diagnosis of this entity.