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Pulmonary artery sarcomas (PAS) are rare tumours causing an insidiously progressive obstruction of the pulmonary circulation. The clinical presentation is often indistinguishable from chronic thromboembolic pulmonary hypertension (CTEPH). However, the atypical appearance of a heterogeneous filling defect in CT pulmonary angiography (CTPA) should prompt further investigation.

Author(s): Farid Rashidi [sup.1] [sup.5] , Rezayat Parvizi [sup.2] , Eisa Bilejani [sup.2] , Babak Mahmoodian [sup.3] , Fatemeh Rahimi [sup.4] , Ata Koohi [sup.1] Author Affiliations: (1) grid.412888.f, 0000 [...], Purpose Chronic thromboembolic pulmonary hypertension (CTEPH) is an important complication after acute pulmonary embolism (PE) with considerable morbidity and mortality. The aim of this study was to estimate the CTEPH incidence in a cohort after the first occurrence of PE. Methods We conducted a 1-year follow-up cohort study between 2015 and 2018 to assess the incidence of CTEPH in 474 patients with their first acute episode of PE. For the diagnosis of CTEPH, patients with unexplained persistent dyspnea during follow-up underwent transthoracic echocardiography, right heart catheterization, ventilation-perfusion lung scanning, and CT pulmonary angiography. Results Overall, 317 patients were included in the study. The mean age of the patients was 56.5 ± 16 years. One hundred and three patients (32%) had exertional dyspnea at the 1-year follow-up. Patients with evidence of pulmonary hypertension (PH) on echocardiography underwent right heart catheterization. Eleven patients (18%) had no PH (mPAP 25 mmHg. Fifteen patients had PAWP > 15 mmHg, including those with underlying left heart problems or valvular diseases. There were 32 patients with PAH (mPAP > 25 mmHg and PVR > 3 WU) undergoing CTEPH studies; 22 patients (6.9%) had multiple segmental defects suggesting CTEPH on a perfusion scan. Conclusion The incidence of CTEPH observed in this study 1 year after the first episode of acute PE was approximately 6.9%. This incidence seems to be high in our population, and diagnostic and therapeutic strategies for the early identification of CTEPH are needed.

OBJECTIVE: A small percentage of acute pulmonary thromboembolisms (PTE) persist as chronic fibrin clots, potentially leading to chronic thromboembolic pulmonary hypertension (CTEPH). A scoring system for evaluating the burden of acute PTE based on computed tomography pulmonary angiogram (CTPA) findings was tested for its association with CTEPH within one year. MATERIAL AND METHODS: In this retrospective cohort of 475 patients with a definitive diagnosis of acute PTE, the Qanadli score (QS) was calculated on the initial CTPA. Through regular follow-up over 1 year, symptomatic patients underwent extensive evaluation. RESULTS: Of the 475 patients enrolled in the study [age 58.3 ± 16.6, 195 (41.1%) female, QS: 13.01 ± 7.37/40], 321 patients completed the study. A total of 22 (6.8%) patients were definitively diagnosed with CTEPH. In univariate analysis, the initial QS was significantly higher in patients with subsequent CTEPH than in patients without (17 ± 5.6 vs. 13 ± 7.6, P = .009). QS was directly associated with CTEPH (odds ratio: 1.08, 95% confidence interval: 1.0-1.16, P = .042). The evolution of CTEPH in men could be predicted with a sensitivity of 100% and a specificity of 54% when a cut-off point of 14.5 (43.5%) was set for QS. The area under the receiver operating characteristic curve in this setting was 0.74 with a P-value of .032. Qanadli score failed to predict CTEPH in women. CONCLUSION: Scoring the clot burden in the pulmonary arteries through the Qanadli method can predict the evolution of CTEPH only in men 1 year after acute PTE. Women comprise most of the CTEPH patients. Thus, strict follow-up adherence seems to be even more important in women. [ABSTRACT FROM AUTHOR]

Importance: Thrombotic events are commonly reported in critically ill patients with COVID-19. Limited data exist to guide the intensity of antithrombotic prophylaxis.Objective: To evaluate the effects of intermediate-dose vs standard-dose prophylactic anticoagulation among patients with COVID-19 admitted to the intensive care unit (ICU).Design, Setting, and Participants: Multicenter randomized trial with a 2 × 2 factorial design performed in 10 academic centers in Iran comparing intermediate-dose vs standard-dose prophylactic anticoagulation (first hypothesis) and statin therapy vs matching placebo (second hypothesis; not reported in this article) among adult patients admitted to the ICU with COVID-19. Patients were recruited between July 29, 2020, and November 19, 2020. The final follow-up date for the 30-day primary outcome was December 19, 2020.Interventions: Intermediate-dose (enoxaparin, 1 mg/kg daily) (n = 276) vs standard prophylactic anticoagulation (enoxaparin, 40 mg daily) (n = 286), with modification according to body weight and creatinine clearance. The assigned treatments were planned to be continued until completion of 30-day follow-up.Main Outcomes and Measures: The primary efficacy outcome was a composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days, assessed in randomized patients who met the eligibility criteria and received at least 1 dose of the assigned treatment. Prespecified safety outcomes included major bleeding according to the Bleeding Academic Research Consortium (type 3 or 5 definition), powered for noninferiority (a noninferiority margin of 1.8 based on odds ratio), and severe thrombocytopenia (platelet count <20 ×103/µL). All outcomes were blindly adjudicated.Results: Among 600 randomized patients, 562 (93.7%) were included in the primary analysis (median [interquartile range] age, 62 [50-71] years; 237 [42.2%] women). The primary efficacy outcome occurred in 126 patients (45.7%) in the intermediate-dose group and 126 patients (44.1%) in the standard-dose prophylaxis group (absolute risk difference, 1.5% [95% CI, -6.6% to 9.8%]; odds ratio, 1.06 [95% CI, 0.76-1.48]; P = .70). Major bleeding occurred in 7 patients (2.5%) in the intermediate-dose group and 4 patients (1.4%) in the standard-dose prophylaxis group (risk difference, 1.1% [1-sided 97.5% CI, -∞ to 3.4%]; odds ratio, 1.83 [1-sided 97.5% CI, 0.00-5.93]), not meeting the noninferiority criteria (P for noninferiority >.99). Severe thrombocytopenia occurred only in patients assigned to the intermediate-dose group (6 vs 0 patients; risk difference, 2.2% [95% CI, 0.4%-3.8%]; P = .01).Conclusions and Relevance: Among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days. These results do not support the routine empirical use of intermediate-dose prophylactic anticoagulation in unselected patients admitted to the ICU with COVID-19.Trial Registration: ClinicalTrials.gov Identifier: NCT04486508. [ABSTRACT FROM AUTHOR]

Purpose: To correlate metabolic response to neoadjuvant chemoradiotherapy (NACR) on FDG-PET/CT using PERCIST-based criteria to pathologic and clinical response, and survival in patients with locally advanced esophageal cancer (LAEC). Materials and methods: Forty-five patients with LAEC underwent PET/CT at baseline and after NACR. Tumors were evaluated using PERCIST (PET response criteria in solid tumors)-based criteria including SUL, SUL tumor/liver ratio, % change in SUL. These parameters were compared to pathology regression grade (PRG), clinical response (including residual or new disease beyond the surgical specimen), and overall survival. Results: On surgical pathology, there was complete or near-complete regression of tumor in 51.1 %, partial response in 42.2 %, and lack regression in 4.4 %. One patient (2.2 %) had progression of disease on imaging and did not undergo surgical resection. None of the baseline PET parameters had significant correlation to pathology regression grade or clinical response. On follow-up, a positive correlation was found between post-therapy SUL ratio, %∆ SUL and %∆ SUL ratio and clinical response ( p = 0.025, 0.035, 0.030, respectively). A weak correlation was found between post-therapy SUL ratio to PRG ( p = 0.049). A strong correlation was found between the metabolic response score and PRG ( p = 0.002) as well as between metabolic response and clinical response ( p < 0.001). Conclusion: PERCIST-based metabolic response assessment to NACR in LAEC may correlate with clinical outcome and survival. [ABSTRACT FROM AUTHOR]

Purpose: Determine the educational background, research publications/presentations experience, and rates of research publication and presentation inaccuracies in applications to a Canadian diagnostic imaging residency program. Method: The education and publication/presentation sections of the Canadian Resident Matching Service form for all applicants to the University of Saskatchewan diagnostic imaging residency program from 2019–20 and 2020–21 were reviewed. Number of advanced degrees (Master's/PhDs), publications, and presentations were recorded. Accuracy of publications listed was confirmed via PubMed-MEDLINE, journal's website, or internet searching. Accuracy of presentations was confirmed via society and residency program websites. Inaccuracies of non-authorship, incorrect authorship order/status (self-promotion or demotion), and nonexistence of article/presentation from a verifiable source were recorded. Result: There were a total of 106 applicants. Thirty (28%) had advanced degrees. There were 230 publications from 61 applicants with inaccuracies in only 5 (2%) of the publications (2 self-promotion, 3 self-demotion). For the 77 publications listed as pending, 25 (31%) were published within 6 months of applications deadlines with 1 non-authorship, 1 self-promotion, and 1 self-demotion. For scientific presentations, there were 467 listed presentations by 91 applicants. Two hundred and twenty-one presentations were from verifiable sources with inaccuracies in 28 (13%) of presentations (9 self-promotion, 9 self-demotion, 1 non-authorship, and 9 non-existence). Conclusion: Despite some uncertainty with scientific articles reported as pending and scientific presentations, radiology residency applicants are accurately representing their published articles with a negligible number of misrepresentations. Canadian radiology residency programs should regard the publication profiles of the applicants with a high level of confidence. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a multisystem disorder with unknown etiology and is characterized by noncaseating granuloma in involved organs. Sarcoidosis frequency involves the lungs. Common presenting symptoms include cough, dyspnea and chest pain. Massive hemoptysis is a rare presentation in sarcoidosis. There are a few reports on massive hemoptysis in sarcoidosis. We are reporting the case of a 24 year old man who presented with massive hemoptysis and normal lung parenchyma. The diagnosis was made with mediastinal lymph node biopsy. [ABSTRACT FROM AUTHOR]