International cooperation in radiology training: A multipronged approach.

INTRODUCTION: Medical imaging has undergone significant technical advancements in recent years, posing a considerable challenge for radiologists to stay up-to-date with emerging modalities and their applications in daily practice. This challenge is even more daunting in developing countries with limited resources compared to the US and other developed nations with greater economic assets. The collaboration between the United States and other advanced nations with radiological institutions in Latin America has been a significant achievement in the pursuit of new opportunities for continuous medical education. The aim of this study was to evaluate the effectiveness of international collaborations among Spanish-speaking Latin American institutions and radiologists through a survey. MATERIALS AND METHODS: A group of radiologists and institutions from various countries, including the USA, Spain, and Argentina, who have been working together for several years to improve Radiology education across Latin America, were selected. An online survey was conducted. The survey included questions about interest in the activities, participation, and impact of radiologic education during these educational efforts. RESULTS: The survey received responses from 166 participants, all of whom reported knowledge of at least one type of educational activity. The most well-known activity was ALAT Webinars. The primary motivators for participation were the quality of the content and the opportunity to learn new information. Additionally, improving local education in radiology and receiving expert advice on radiology issues were identified as priorities for participation in international collaborations. The Cronbach alpha coefficient was calculated for individual and global Likert questions, resulting in a global score of 0.96. CONCLUSION: The study confirms the significance of a multifaceted approach to address gaps in radiology education. While traditional models have relied on hosting international visitors or sending US teachers abroad, the results suggest that using a variety of methods will have a greater impact than relying on a single technique for those who benefit most from collaborative efforts.

Synchronous Mediastinal and Central Nervous System Involvement in Rosai-Dorfman Disease: A Case Report.

Rosai-Dorfman disease (RDD) is a rare disorder characterized by the proliferation and accumulation of histiocytes, primarily within lymph node sinuses. Uncommonly, other extranodal sites, such as the central nervous system, can also be affected. Here, we document the case of a 61-year-old woman presenting with dizziness, confusion, and headaches. Magnetic resonance imaging (MRI) showed an extra-axial avidly enhancing mass in the left parietal region presumed to be a meningioma based solely on its imaging appearance. The patient underwent surgical resection, and histopathological examination showed enlarged histiocytes positive for S100, CD68, and CD163 and negative for CD1a, consistent with RDD. She was followed up with a positron emission tomography/computed tomography (PET/CT) to evaluate other disease activity sites. A single mediastinal node was identified adjacent to the atriocaval junction intensely fluorodeoxyglucose avid. The patient underwent robotic node excision, with pathology analysis compatible with RDD. We emphasize the need to increase recognition of RDD on differential brain lesions, especially meningiomas, and suggest PET/CT as a valid tool to search for other disease activity lesions.

Williams-Campbell syndrome: an unusual presentation in an adult patient.

OBJECTIVE: Williams-Campbell syndrome (WCS) is a rare congenital disorder, which leads to bronchiectasis affecting fourth to sixth order of bronchial divisions. Symptoms include cough, sputum, wheeze and recurrent pulmonary infections, classically seen in the paediatric age group with selective bronchiectasis of the mid-order bronchioles. The literature describing diagnosis of Williams-Campbell syndrome in adult population is very sparse. METHODS: This report presents a 62-year-old female with cough, fever, dyspnea and generalized body ache. She has had multiple admissions to the hospital since her childhood due to recurrent lower respiratory tract infections. Imaging findings demonstrated multiple cystic thin walled airways, compatible with bronchiectatic changes in the upper, middle and lower lobes bilaterally, bronchial wall thickening with air-fluid levels prominent in the fifth and sixth generation bronchial divisions, with normal calibre trachea and central bronchi. These radiological findings are consistent with diagnosis of Williams-Campbell syndrome, which was diagnosed after ruling out the other common causes of bronchiectasis. CONCLUSION: Williams-Campbell syndrome is a rare congenital cystic lung disease, the diagnosis of which is made by exclusion of common causes of bronchiectasis such as cystic fibrosis, allergic bronchopulmonary aspergillosis, tuberculosis, dyskinetic cilia syndrome and alpha-1 antitrypsin deficiency. Whenever the clinical picture is consistent with bronchiectasis, especially involving the mid-order bronchioles and recurrent pulmonary infections, it is wise to include WCS in the list of differential diagnoses, even in the adult population.

Neumonía por COVID19: Valoración por imagen, lo básico / COVID­19 pneumonia: Imaging evaluation, the basics

La pandemia de COVID­19 ha resultado en una emergencia de salud global. Los estu­dios de imagen utilizados en esta enfermedad son la radiografía de tórax (RX) y la to­mografía computarizada (TC). Ambas modalidades tienen sus hallazgos descritos, pero no son específicos dado que muchas enfermedades pueden producir patrones simila­res, particularmente las neumonías virales. Los RX de tórax muestra hallazgos consis­tentes en opacidades alveolares las cuales son múltiples, periféricas, bilaterales y basales, mientras que la tomografía de tórax sus hallazgos más frecuentes son presen­cia de patrón en vidrio deslustrado, consolidaciones, engrosamiento septal, patrón en empedrado, dilatación bronquial y engrosamiento peri bronquial, broncograma, patrón de halo invertido y patrón de neumonía organizada. Los hallazgos por imagen depen­den del tiempo de evolución de la enfermedad ya que en etapas tempranas puede ser normal tanto en la RX como la TC. El riesgo de trombo embolismo pulmonar es alto y más frecuente que en pacientes con COVID­19 negativo

The COVID­19 pandemic has resulted in a global health emergency. The imaging stu­dies used in this disease are chest radiography (CXR) and computed tomography (CT). Both imaging modalities findings have had their findings. These findings described are not specific since many diseases can produce similar patterns. CXR shows somewhat consistent findings consisting of alveolar opacities which are multiple, peripheral, bilate­ral and basal, while CT the most frequent findings are the presence of grounded glass pattern, consolidations, septal thickening, crazy paving pattern, bronchial dilation and peribronchial thickening, air bronchograms, inverted halo sign and organized pneumo­nia. Imaging findings depends on the evolution time of the disease since in the early sta­ges both chest radiography and tomography may be normal. The risk for pulmonary embolism is high and more frequent than in patients with negative COVID­19

Metachronous mediastinal and lung metastases from head and neck cancer: A case series, literature review and considerations for treatment.

Metachronous mediastinal and lung metastases (MMLM), important sources of morbidity and mortality, in people with head and neck cancer (HNC) have received little attention. Between 1980 and 2004, 37 patients with treated HNC and MMLM diagnosed on follow-up imaging (with histological confirmation in 14 cases) were identified. The median interval from diagnosis of HNC to the appearance of MMLM was 14.5 months. The overall median survival was 4 months, and the 1-year crude survival rate (CSR) was 16%. A meaningful difference in the 1-year CSRs between the palliative radiation treated and untreated subjects (39% and 4%, respectively, p < 0.01) was observed. Because associated costs of health care utilization are considerable, and yet survival is limited, optimum management of MMLM-HNC with improvement of prognosis remains a challenge.

CT imaging spectrum of infiltrative renal diseases.

Most renal lesions replace the renal parenchyma as a focal space-occupying mass with borders distinguishing the mass from normal parenchyma. However, some renal lesions exhibit interstitial infiltration-a process that permeates the renal parenchyma by using the normal renal architecture for growth. These infiltrative lesions frequently show nonspecific patterns that lead to little or no contour deformity and have ill-defined borders on CT, making detection and diagnosis challenging. The purpose of this pictorial essay is to describe the CT imaging findings of various conditions that may manifest as infiltrative renal lesions.

The Non-Innoculous Hilar Calcification: Recurrent Pneumonia Secondary to Broncholith-Associated Actinomyces.

Dystrophic calcification of hilar lymph nodes is a common response to chronic inflammation related to several etiologies and rarely is associated with any clinical findings. A clinical scenario related to these calcified lymph nodes can thus be delayed by the low clinical suspicion associated with such a presumably innocuous finding. Normal respiratory movements however, can cause erosion into adjacent bronchi leading to a broncholith, complications of which can result in morbidity. We illustrate one of these complications, a partial obstruction with subsequent recurrent infection due to normal oral flora - actinomyces.

Cachexia Index in Advanced Non-Small-Cell Lung Cancer Patients.

INTRODUCTION: Cancer cachexia affects many advanced non-small-cell lung cancer (NSCLC) patients. Cachexia index (CXI) was developed to assess the degree of cachexia in these patients. METHODS: Patients with metastatic NSCLC diagnosed between January 1, 2000, and June 30, 2011, at our institution were retrospectively studied. Abdominal computed tomography scans done within 1 month of diagnosis were reviewed to estimate skeletal muscle area (SMA) and skeletal muscle index (SMI) at the L3 level. CXI was developed as follows: [Formula: see text] where SMI is the skeletal muscle index, Alb is the serum albumin, and NLR is the neutrophil-to-lymphocyte ratio. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Survival among various factors was calculated using the log-rank test. Multivariate Cox regression was used to perform survival analysis in order to estimate the effects of various factors. RESULTS: Patients were divided into two groups around the median into stage I cachexia (CXI ≥35, n = 56) and stage II cachexia (CXI <35, n = 56). Groups did not differ in age, gender, ethnicity, or histology of cancer. Patients with stage II cachexia had significantly worse PFS (2.45 vs 5.43 months, P < 0.0001) and OS (3.45 vs 8.8 months, P = 0.0001) than those with stage I cachexia. On multivariate analysis adjusting for gender, race, and histology, patients with stage II cachexia were found to have worse PFS (hazard ratio [HR] 1.94, 95% confidence interval [CI] 1.27-2.95) and OS (HR 1.53, 95% CI 1.0009-2.34). CONCLUSION: The CXI is a novel index for estimating cachexia that also correlates with prognosis in both men and women with advanced NSCLC.

Celiacomesenteric trunk: a rare anatomical variation with potential clinical and surgical implications.

The arterial supply of the abdominal viscera is derived via three single arteries: the celiac axis, the superior mesenteric artery, and the inferior mesenteric artery. These arteries usually originate separately from the ventral aspect of the abdominal aorta. In some cases, two or more of these arteries may originate from a common trunk. The celiacomesenteric trunk is a rare condition that can generate clinical and surgical complications. Preoperative knowledge of vascular anomalies is critical when planning a surgical approach. We report a patient who underwent Multi-detector Computed Tomography (MDCT) before a vascular procedure, and a common trunk for celiac axis and superior mesenteric artery (celiac mesenteric trunk) was incidentally found.

Radiological evolution of relapsing polychondritis.

Relapsing Polychondritis (RP) is a systemic condition characterized by chronic, episodic inflammation, especially of cartilaginous and proteoglycan-rich structures. The etiology of this rare autoimmune disease is unknown, and so far, there is very little data available for non-Caucasians. RP presents with a constellation of non-specific inflammation, which sometimes appear in characteristic locations. Radiology is important in supporting the diagnosis, and this paper presents a case of a non-Caucasian patient monitored radiologically from early onset to the terminal stages.

Histoplasmosis brain abscesses in an immunocompetent adult. A case report and literature review.

We describe the case of a 62-year-old man, who presented with a new onset of focal seizures of his right leg. There were no other clinical symptoms, and laboratory results were normal. Brain magnetic resonance imaging revealed multiple lesions, two supratentorial lesions were ring-enhancing. The brain biopsy tissue showed Histoplasma capsulatum abscesses. He improved on treatment with Amphotericin B. This case is reported since cerebral ring-enhancing lesions are rarely associated with histoplasmosis, which is also rare in an immunocompetent individual. We review the literature and discuss the radiologic and pathologic findings of this case compared with previous reports.

Anemia de células falciformes: hallazgos radiológicos de las complicaciones en el tórax / Sickle Cell Anemia: Imaging Findings of Thoracic Complications

La anemia de células falciformes es una enfermedad autosómica recesiva que se caracteriza por hematíes rígidos que no pueden atravesar normalmente los capilares de los tejidos, y son destruidos y eliminados de la circulación. La escasa deformidad que tienen los glóbulos rojos falciformes facilita la formación de trombos y ocasiona oclusión vascular. Las complicaciones secundarias a la trombosis vascular son las que causan mayor impacto clínico. En este artículo revisamos las manifestaciones radiológicas de las complicaciones en el tórax de esta enfermedad.

Sickle cell anemia is an autosomal recessive disease characterized by rigid Red Blood cells (RBCs) that cannot pass through the capillaries of the tissue, and are destroyed and removed from circulation. The low deformity of the RBCs eases thrombus formation and vascular occlusion. Complications secondary to vascular thrombosis have the greatest clinical impact. In this paper, we review the radiologic manifestations of chest complications which result from this disease.

MDCT Imaging Findings of Liver Cirrhosis: Spectrum of Hepatic and Extrahepatic Abdominal Complications.

Hepatic cirrhosis is the clinical and pathologic result of a multifactorial chronic liver injury. It is well known that cirrhosis is the origin of multiple extrahepatic abdominal complications and a markedly increased risk of hepatocellular carcinoma (HCC). This tumor is the sixth most common malignancy worldwide and the third most common cause of cancer related death. With the rising incidence of HCC worldwide, awareness of the evolution of cirrhotic nodules into malignancy is critical for an early detection and treatment. Adequate imaging protocol selection with dynamic multiphase Multidetector Computed Tomography (MDCT) and reformatted images is crucial to differentiate and categorize the hepatic nodular dysplasia. Knowledge of the typical and less common extrahepatic abdominal manifestations is essential for accurately assessing patients with known or suspected hepatic disease. The objective of this paper is to illustrate the imaging spectrum of intra- and extrahepatic abdominal manifestations of hepatic cirrhosis seen on MDCT.

Archaeological, radiological, and biological evidence offer insight into Inca child sacrifice.

Examination of three frozen bodies, a 13-y-old girl and a girl and boy aged 4 to 5 y, separately entombed near the Andean summit of Volcán Llullaillaco, Argentina, sheds new light on human sacrifice as a central part of the Imperial Inca capacocha rite, described by chroniclers writing after the Spanish conquest. The high-resolution diachronic data presented here, obtained directly from scalp hair, implies escalating coca and alcohol ingestion in the lead-up to death. These data, combined with archaeological and radiological evidence, deepen our understanding of the circumstances and context of final placement on the mountain top. We argue that the individuals were treated differently according to their age, status, and ritual role. Finally, we relate our findings to questions of consent, coercion, and/or compliance, and the controversial issues of ideological justification and strategies of social control and political legitimation pursued by the expansionist Inca state before European contact.

Primary retroperitoneal paraganglioma simulating a pancreatic mass: a case report and review of the literature.

Paragangliomas are extra-adrenal tumors of the autonomic nervous system and may be found within the skull base, neck, chest, and abdomen. When presenting within the abdominal cavity, they may arise as a primary retroperitoneal neoplasm and can mimic vascular malformations or other conditions related to specific retroperitoneal organs such as the pancreas, kidneys, or adrenals. Retroperitoneal paragangliomas are mostly benign with good prognosis; however, they can present with abdominal pain, palpable mass, or hypertensive episodes. Patients should be initially evaluated with catecholamine levels, followed by computed tomography or magnetic resonance imaging to locate the primary lesion. Surgical excision remains the mainstay of treatment, although advanced disease and proximity to vital organs can make excision difficult or impossible. This case report describes a patient who initially underwent work up for a suspected pancreatic head mass which was discovered to be a retroperitoneal paraganglioma by frozen section.

Parosteal lipoma of the rib: a benign condition that mimics malignancy.

Parosteal lipomas (PL) account for 0.3% of all lipomas. They are composed of adipose tissue adjacent to the bone cortex and elicit bony reactive changes. Location of this typically slow-growing indolent lesion in the ribs is unusual. Albeit a benign condition, PL imaging findings may be misinterpreted as a malignant lesion. We present a patient with a PL in which a surgical biopsy was performed. Distinctive features of PL in the computed tomographic (CT) scan and magnetic resonance image (MRI) are described. Familiarity with the characteristic radiographic PL signs assist in avoiding invasive diagnostic studies. Lipomas are benign tumors consisting of mature fat cells. They are the most common mesenchymal neoplasias and account for 50% of all soft tissue tumors. Their location varies from superficial to deep seated lesions. Musculoskeletal lipomatous lesions may be located in bones, soft tissues, and may also affect joint and tendon sheaths. PL is a rare benign deep fatty-tissue tumor that arises contiguous to the periosteum without originating from it. In 1836, Seering was the first in describing this lesion and named it "periosteal lipoma." Upon realization that there are no adipocytes in the periosteum, the term was changed to the more descriptive "parosteal lipoma" by Power in 1888. This is a case report of a patient with a chest wall mass that on CT scan and MRI had the typical PL appearance. This pattern allows one to identify the lesion and thus, to differentiate it from malignant conditions.

Radiologic evaluation of the Llullaillaco mummies.

OBJECTIVE: Our purpose was to determine the imaging findings in three 500-year-old frozen mummies of sacrificial Inca children. MATERIALS AND METHODS: CT, conventional radiography, and dental radiography of Inca mummies were reviewed. Different techniques, which were adjusted to the anatomic position of the bodies, were used for radiologic analyses. Working sessions were limited to 20 min because of the fragility of these mummies and to prevent thawing of the specimens. RESULTS: Internal organs in good condition with a natural shrinkage caused by dehydration were shown on CT scans. Both white and gray matter were clearly observed in the brain and cerebellum. The white matter and the fatty tissue of the bodies were visibly white. This condition was possibly caused by the transformation of the fatty tissue into a waxlike substance and the deposition of calcium salts. The lungs were expanded in all three mummies. The ages of the three children at the time of their deaths were estimated by means of radiographs of the teeth and long bones. Bone mineralization, the muscular volume, and the thickness of the adipose panniculus indicated the good nutritional state of the three Inca children. The spleen was not visualized in any case. CONCLUSION: Radiology helped us determine the state of the internal organs, the nutritional conditions, and the physical abnormalities of the naturally mummified children. These mummies can be considered among the best preserved mummies currently known.