A Rare Case of Non-Small Cell Lung Cancer Presenting as Exudative Retinal Detachment.

Teaching Point: Retinal detachment is a rare initial clinical manifestation of lung cancer with intraorbital metastases, early diagnosis on magnetic resonance imaging is important for therapeutic implications.

Inferior Alveolar Intraneural Cyst Arising from Temporomandibular Joint.

Teaching Point: Cystic nerve enlargement near a joint should evoke an intraneural synovial cyst and lead to the tracking of the articular connection for confirmation, where ever the location within the body is.

Lung Adenocarcinoma Mimicking a Bilateral Cavitary Pneumonia.

Teaching Point: Failure to recognize unusual radiological presentations of some lung adenocarcinomas can lead to misdiagnosis and/or delay appropriate treatment.

Unusually Large Extent of Pagetic Vertebral Ankylosis in a Patient with Ankylosing Spondylitis.

Teaching point: When the joints between bones are ankylosed, such as in ankylosing spondylitis, Paget's disease can involve multiple contiguous bones leading to pagetic vertebral ankylosis.

Perigastric and Portal Venous Gas Induced by Vomiting.

Teaching point: Portal venous gas is often associated with severe abdominal pathologies, but may be also encountered in less dramatic conditions such as vomiting.

Protein-Losing Enteropathy in Primary Lymphangiectasia.

Teaching Point: Intestinal lymphangectasia should be evoked in the rare context of protein-losing enteropathy with low-attenuation thickening of the bowel wall.

Pulmonary hypertension detection by computed tomography pulmonary transit time in heart failure with reduced ejection fraction.

AIMS: To evaluate the relationships between pulmonary transit time (PTT), cardiac function, and pulmonary haemodynamics in patients with heart failure with reduced ejection fraction (HFrEF) and to explore how PTT performs in detecting pulmonary hypertension (PH). METHODS AND RESULTS: In this prospective study, 57 patients with advanced HFrEF [49 men, 51 years ± 8, mean left ventricular (LV) ejection fraction 26% ± 8] underwent echocardiography, right heart catheterization, and cardiac computed tomography (CT). PTT was measured as the time interval between peaks of attenuation in right ventricle (RV) and LV and was compared between patients with or without PH and 15 controls. PTT was significantly longer in HFrEF patients with PH (21 s) than in those without PH (11 s) and controls (8 s) (P < 0.001) but not between patients without PH and controls (P = 0.109). PTT was positively correlated with pulmonary artery wedge pressure (PAWP) (r = 0.74), mean pulmonary artery pressure (r = 0.68), N-terminal pro-B-type natriuretic peptide (r = 0.60), mitral (r = 0.54), and tricuspid (r = 0.37) regurgitation grades, as well as with LV, RV, and left atrial volumes (r from 0.39 to 0.64) (P < 0.01). PTT was negatively correlated with cardiac index (r = -0.63) as well as with LV (r = -0.66) and RV (r = -0.74) ejection fractions. PAWP, cardiac index, mitral regurgitation grade, and RV end-diastolic volume were all independent predictors of PTT. PTT value ≥14 s best-detected PH with 91% sensitivity and 88% specificity (area under the receiver operating characteristic curve: 0.95). CONCLUSION: In patients with HFrEF, PTT correlates with cardiac function and pulmonary haemodynamics, is determined by four independent parameters, and performs well in detecting PH.