ABSTRACT
The management of infections in haematology is dictated by the patient's type of acquired or induced immune deficiency (neutropenia, deficiency in cell-mediated or antibody-mediated immunity), and findings from clinical examination, laboratory studies, or morphologic investigations. The CT scan dominates in the initial management and follow-up of these patients, since clinical features very often appear to be non-specific. The radiologist's role is to guide the clinician towards a specific diagnosis such as aspergillosis or pneumocystosis, or to point them towards a non-infectious cause: tumour localisation, hypervolaemia, bronchiolitis obliterans suggestive of GVH disease, drug toxicity, or embolism.
Subject(s)
Hematologic Neoplasms/complications , Infections/diagnostic imaging , Thorax , Tomography, X-Ray Computed , Adult , Aged , Algorithms , Aspergillosis/diagnosis , Aspergillosis/diagnostic imaging , Bronchiolitis Obliterans/diagnosis , Embolism/diagnosis , Female , France , Hematologic Neoplasms/diagnosis , Hematologic Neoplasms/pathology , Humans , Immunologic Deficiency Syndromes/diagnosis , Immunologic Deficiency Syndromes/immunology , Immunologic Deficiency Syndromes/therapy , Lung Diseases/chemically induced , Lung Diseases/diagnosis , Lung Diseases/etiology , Male , Middle Aged , Neoplasms/diagnosis , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/diagnostic imaging , Thorax/microbiology , Thorax/pathologyABSTRACT
Follow-up after thoracic aortic repair relies on CT and MR imaging in order to detect complications from the treatment or underlying pathology. Following prosthetic repair of the ascending aorta, peri-prosthetic hematoma and anastomotic complications (leak, false aneurysm, peri-prosthetic circulation) should be excluded. Following treatment with a covered stent, the location of the prosthesis and its skeleton should be evaluated and endo-leaks and wall defects should be excluded. Following treatment of a dissection, there often is persistent flow in the false lumen. The entry points into the false lumen should be identified. The caliber of the aorta at different levels should be assessed. Signs of ischemia (static and dynamic) and acute complications should be excluded in patients with acute chest pain. Atherosclerosis and dysplastic conditions may affect other segments of the aorta (aneurysm, dissection, hematoma). Follow-up is performed with CT, if possible, when high-resolution evaluation is required, of with MRI in other cases. Follow-up is obtained on a yearly basis or twice a year when an evolutive process is identified. It is performed every two to five years when the risk is low. Follow-up should be suggested by the radiologist.
