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Respiratory Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Ian Pavord, Nayia Petousi, Nick Talbot
Computerized tomography (CT) is more sensitive than chest radiography and is a very common imaging modality in respiratory medicine. Common types of CT include: CT thorax with contrast: most approriate for identification and/or staging of malignancy or pleural disease; may be combined with positron emission tomography (PET) scanningHigh resolution CT thorax (HRCT): non-contrast scan providing higher resolution images but with gaps between imaged slices; useful for diffuse lung disease but may miss discrete lesionsCT pulmonary angiogram (CTPA): image acquisition is timed to ensure maximum contrast in the pulmonary circulation; useful for excluding pulmonary emboli, but high contrast load makes it less suitable for investigating diffuse lung disease
Paper 1
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 22 year old male medical student reports to his GP with recurrent spontaneous epistaxis as well as fatigue and increasing dyspnoea. The patient is found to be tachycardic and tachypnoeic. The GP is concerned and in view of the patient’s significant family history refers him to be seen by the on-call medical team at hospital. The medical team organise an urgent chest radiograph and perform an arterial blood gas which demonstrates hypoxia. They refer the patient to you for a CT pulmonary angiogram to exclude a pulmonary embolus. On review of the plain film, you confirm the presence of multiple pulmonary nodules and the heart appears large. There is no other significant abnormality.
Haematological disorders
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
A CT pulmonary angiogram (CTPA) can be used, in which the chest is assessed using CT following the injection of a dye into the bloodstream; however, the RCOG Guidelines (2007) suggest there is a high radiation dose to the breasts.
Osteosarcoma emboli presenting as chronic thromboembolic pulmonary hypertension in a child
Published in Pediatric Hematology and Oncology, 2023
Laura L. Donahoe, Serina Patel, Soumitra Tole, Alexandra P. Zorzi, Lennox Huang, Osami Honjo, Marc de Perrot
Differentiating bland PE from pulmonary tumor emboli can be very difficult, and often not done until the time of surgery, as with our patient. She had risk factors for bland PE, including active malignancy, immobilization after major surgery and DVT on pre-operative ultrasound. The pre-operative work-up includes a ventilation/perfusion scan and CT-pulmonary angiogram (CT-PA) to establish the persistence and location of disease, and an echocardiogram to diagnose pulmonary hypertension. Stable patients undergo right heart catheterization and 6-minute walk test to confirm the presence of pulmonary hypertension and establish the severity of the disease. In our case, the patient rapidly progressed to right heart failure and required emergent surgery before these investigations could be completed. The situation became a medical emergency, as her previously normal RV did not tolerate the acute and fixed afterload caused by the PE.7
An unusual localisation of dissection: left lower lobe pulmonary artery dissection
Published in Acta Cardiologica, 2021
A 78-year-old male patient with known chronic obstructive pulmonary disease (COPD) admitted to the emergency department with progressive dyspnoea and atypical chest pain. The patient did not receive any treatment except inhaler treatment for COPD. The haemodynamic status was stable and electrocardiogram showed no pathological findings. Echocardiography demonstrated normal left ventricular systolic function, mild dilatation of right heart chambers and moderate pulmonary hypertension (systolic pulmonary artery pressure (SPAP) was 56 mmHg). CT pulmonary angiogram (CTPA) performed and excluded the signs of acute or chronic pulmonary embolism, however, CTPA revealed dissection flap in the left lower lobe of the pulmonary artery (Figure 1(A–C), with arrows). The patient refused surgery and was treated conservatively. The patient followed-up for 2 weeks without any complication and was discharged uneventfully. The patient’s follow-up has been continuing without any complications for 5 months.
Unilateral pleural effusion: a rare presentation in pregnancy
Published in Journal of Obstetrics and Gynaecology, 2020
Nurul Iftida Basri, Nurul Huda Mohd Nor
A 23-year-old, gravida 2 para 1 at 32 weeks of gestation presented with right-sided discomfort, fever, palpitation and breathlessness. She happened to have a history of contact with a tuberculosis (TB) patient. The examinations made found that she had a pulse rate of 120 bpm, a blood pressure of 128/74 mmHg, a respiratory rate of 24 bpm and an oxygen saturation of 95% under room air. A respiratory examination showed dullness on percussion with a reduced air entry over the right lower zone. The abdomen was soft with uterus size corresponding to dates. An electrocardiogram (ECG) showed S1Q3T3 changes with a heart rate of 126 bpm. Arterial blood gases showed that there was a type 1 respiratory failure. A CT pulmonary angiogram (CTPA) conducted excludes pulmonary embolism. There was a right pleural effusion with an adjacent lung consolidation on a chest X-ray (Figure 1) and CTPA. A foetal assessment showed a small for gestational age foetus.