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Introduction and objectives: Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause for acute coronary syndrome. The optimal management and treatment of SCAD is still unknown. Methods: Data analysis of a prospective protocol including centralized care management of a consecutive series of patients with SCAD diagnosed between January 2010 and December 2018. Major adverse cardiovascular events included all-cause mortality, new myocardial infarction, coronary revascularization, ventricular arrhythmia, heart failure or stroke. Results: A total of 33 consecutive patients were included (41 lesions). Intravascular imaging modalities were used to confirm the diagnosis in 42% patients. None of the patient showed images of thrombus formation in the true lumen. Conservative treatment was the initial approach in most of the cases (82%). No deaths were reported during the index admission, but 15% experienced major adverse cardiovascular events. The coronary computed tomography angiography performed in 58% of patients during the admission identified SCADs in 79% of the patients. Most of the patients managed with conservative treatment received only 1 antiplatelet agent for a limited period of time (17 months [9-35]). During a median clinical follow-up of 33 months [13-49], 82% of patients did not have any adverse events. The angiographic surveillance obtained in 48% of patients at the 6-month follow-up confirmed the complete healing of the SCAD image in 86% of the patients. The screening for extracoronary vascular findings (97% of patients) resulted in a high prevalence of abnormalities (59%). Conclusions: The unrestricted use of intravascular imaging modalities showed no thrombus in the true lumen of patients with SCAD. In patients managed with conservative treatment, a limited course of antiplatelet monotherapy is safe and provides good clinical outcomes. Performing a coronary computed tomography angiography in the acute phase of SCAD is useful at the follow-up. The screening for extracoronary vascular findings confirmed a high prevalence of abnormalities.

There is a relationship between systemic sarcoidosis (SS) and malignancy. Sarcoidosis results from an exaggerated immune response in genetically susceptible individuals. In oncologic patients with sarcoidosis, tumoral antigens and antineoplastic treatment are considered potential triggering factors. The observation of a patient with granulomas in a parotid carcinoma who later developed SS led us to review the previous tumors of patients with SS. The aim of the study is to see whether granulomas were already present in the tumors that preceded sarcoidosis. We identified 196 sarcoidosis patients, 47 of whom had previously had a tumor. We were able to review 29 cases, 12 of which showed tumor-associated granulomas (TAGs) (41.4%). This ratio is much higher than that of the normal population (4.4–13.8). We analyzed five control patients without sarcoidosis for each tumor. In conclusion, we observed an increased number of TAGs in patients who later developed SS. This finding reinforces a pathogenic relationship between SS and neoplasia. The histology of tumors in patients with SS should be reviewed in an attempt to identify granulomas.

Coronavirus disease 2019 (COVID-19) was discovered after unusual cases of severe pneumonia emerged in December 2019 in Wuhan Province (China). Coronavirus is a family of single-stranded RNA viruses. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted from person to person. Although asymptomatic individuals can transmit the virus, symptomatic patients are more contagious. The incubation period ranges from 3-7 d and symptoms are mainly respiratory, including pneumonia or pulmonary embolism in severe cases. Elevated serum levels of interleukins (IL)-2, IL-6, IL-7 indicate the presence of cytokine release syndrome, which is associated with disease severity. The disease has three main phases: Viral infection, pulmonary involvement, and hyperinflammation. To date, no treatment has proved to be safe or effective. Chest X-ray and computed tomography (CT) are the primary imaging tests for diagnosis of SARS-CoV-2 pneumonia, follow-up, and detection of complications. The main radiological findings are ground-glass opacification and areas of consolidation. The long-term clinical course is unknown, although some patients may develop pulmonary fibrosis. Positron emission tomography-computed tomography (PET-CT) is useful to assess pulmonary involvement, to define the affected areas, and to assess treatment response. The pathophysiology and clinical course of COVID-19 infection remain poorly understood. However, patterns detected on CT and PET-CT may help to diagnose and guide treatment. In this mini review, we analyze the clinical manifestations and radiological findings of COVID-19 infection. Sin financiación No data 2020 UEM

El espectro de la proliferacion de celulas neuroendocrinas pulmonares va de la hiperplasia reactiva al carcinoma de celula pequena e incluye la hiperplasia difusa idiopatica. Se describe un caso de hiperplasia difusa idiopatica y se describen las caracteristicas de dicha entidad segun la evidencia publicada. Se trata de una entidad incluida por primera vez en la clasificacion de tumores de la OMS en 1999 y considerada precursora de tumores carcinoides. Cursa con mayor frecuencia con disnea y tos, en general lentamente progresivas, obstruccion al flujo aereo, nodulos pulmonares multiples y signos radiologicos de atrapamiento aereo, aunque se han descrito casos asintomaticos sin afectacion funcional. Histologicamente se caracteriza por la proliferacion de celulas neuroendocrinas en el epitelio de las vias respiratorias, en muchos casos mas alla de la membrana basal formando tumorlets y tumores carcinoides, con frecuencia multiples. Su pronostico es favorable en la mayoria de los casos.

OBJECTIVE: To analyze the prognostic value of pulmonary artery obstruction versus right-ventricle (RV) dysfunction radiologic indices in cancer-related pulmonary embolism (PE). METHODS: We enrolled 303 consecutive patients with paraneoplastic PE, evaluated by computed tomography pulmonary angiography (CTPA) between 2013 and 2014. The primary outcome measure was serious complications at 15days. Multivariate analyses were conducted by using binary logistic and robust regressions. Radiological features such as the Qanadli index (QI) and RV dysfunction signs were analyzed with Spearman's partial rank correlations. RESULTS: RV diameter was the only radiological variable associated with an adverse outcome. Subjects with enlarged RV (diameter>45mm) had more 15-day complications (58% versus 40%, p=0.001). The QI correlated with the RV diameter (r=0.28, p

Pulmonary hypertension is defined as an abnormal elevation of pressure in pulmonary circulation, with a mean pulmonary arterial pressure higher than 25 mmHg, regardless of the underlying mechanism. The clinical classification system for pulmonary hypertension was updated at the fourth World Symposium on Pulmonary Hypertension in Dana Point, California, in 2008. In patients with suspected pulmonary hypertension, the diagnostic approach includes four stages: suspicion, detection, classification, and functional evaluation. It is crucial to understand the advantages and disadvantages of the different imaging tools available for the diagnostic work-up and follow-up of patients with pulmonary hypertension. Many conditions that cause pulmonary hypertension have suggestive findings at multidetector computed tomography or magnetic resonance imaging; some causes may be surgically treatable, whereas others may demonstrate adverse reactions to vasodilator therapies used during the course of treatment. Therefore, the radiologist plays an important role in evaluating patients with this disease. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.321105232/-/DC1.

The spectrum of pulmonary neuroendocrine cell proliferation ranges from reactive hyperplasia to small cell carcinoma and includes diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. A case is reported and features of this disease are described according to the published evidence. The entity was first included in the WHO classification of tumors in 1999 and is considered a preneoplastic condition for carcinoid tumors. Patients generally report slowly progressive dyspnea and cough, and have airflow obstruction, multiple pulmonary nodules and/or radiological signs of air trapping, although asymptomatic cases with normal pulmonary function have been described. Histologically, it is characterized by neuroendocrine cell proliferation in the airway epithelium, in most cases beyond the basal membrane forming tumorlets and carcinoid tumors that are frequently multiple. The prognosis is favorable in most cases.