Radiology interesting cases for radiology resident core exam

16. 41 year old with fever and cough

17. Did you identify all the support devices correctly?

32. https://www.ncbi.nlm.nih.gov/pubm
ed/28185848

61. Poster Title
Author Names
Augusta University Pharmacy, Augusta, Georgia
METHODS
CONCLUSIONSINTRODUCTION
CLINICAL IMPLICATIONS
RESULTS
ACKNOWLEDGEMENTS
REFERENCES
Poster Title
Author Names
Augusta University Pharmacy, Augusta, Georgia
METHODS
CONCLUSIONSINTRODUCTION
CLINICAL IMPLICATIONS
RESULTS
ACKNOWLEDGEMENTS
REFERENCES
A Case of Histoplasmosis Mimicking Metastatic Esophageal Cancer
Thomas Fortson, Jayanth H. Keshavamurthy, Darko Pucar, Satyam Veean, Yuyang Zhang
Augusta University Medical Center, Augusta, Georgia
CASE DISCUSSION
DISCUSSIONINTRODUCTION
CLINICAL IMPLICATIONS
CLINICAL IMAGES
REFERENCES
50 yo female with 2x3 cm para-esophageal
mass found incidentally on CT during workup
of hematuria. The mass had central necrosis
concerning for metastatic paraesophageal
lymph node. A questionable nodule was also
noted in esophagus. A FDG PET shows intense
focal FDG uptake in this area corresponding to
the enlarged lymph node without abnormal
uptake of esophagus. Patent underwent EGD
x2 with nondiagnostic tissue. She then had
VATS showing necrotizing granuloma with
caseation suggestive of fungal infection
especially histoplasmosis. Itraconazole was
started after consult to infectious disease. On
follow-up PET-CT, feasible response is noted on
the mass reflected by significant decrease of
FDG avidity on FDG PET.
FDG (fluorodeoxyglucose) PET-CT is an
important modality for characterizing,
staging and restaging of esophageal
cancer[1]. FDG as an analog of glucose is a
nonspecific agent for tumor imaging. A focal
esophageal FDG uptake on PET should bring
up the differential diagnosis of esophageal
cancer, metastatic disease, infection and
inflammation[2]. The definite diagnosis
relies on tissue biopsy.
This case helps to illustrate that point.
Histoplasmosis, a condition caused by
histoplasma capsulatum, primarily affecting
the pulmonary system and causes cavitating
lesions. Histoplasmosis is likely to be a cause of
false positive result for FDG PET evaluation of
lung cancer[3]. Adrenal histoplasmosis is one
of the most common adrenal granulomatous
infections. Adrenal histoplasmosis should be
considered as one of the differential diagnosis
of focal adrenal uptake in area where
histoplasmosis is endemic.
Here we present a case of solitary lesion of
histoplasmosis mimicking esophageal cancer
without pulmonary or other evidence of
histoplasmosis. A focal FDG uptake of fungal
infection of esophagus could be so intense as
to mimic esophageal cancer therefore should
always be in the differential diagnosis until
tissue diagnosis can be achieved.
Reference #1 : Schmidt, T., et al., Value of functional imaging by PET in
esophageal cancer. J Natl Compr Canc Netw, 2015. 13(2): p. 239-47.
Reference #2: Sharma, P., et al., Potential role of 18F-FDG PET/CT in
patients with fungal infections. AJR Am J Roentgenol, 2014. 203(1): p.
180-9.
Reference #3: Croft, D.R., et al., FDG-PET imaging and the diagnosis of
non-small cell lung cancer in a region of high histoplasmosis
prevalence. Lung Cancer, 2002. 36(3): p. 297-301.
A B
C D A/B: CT images demonstrating
paraesophageal LN
C/D: PET CT images showing
isolated uptake in paraesophageal
LN
E: LN effaced by necrotizing
granulomatous inflammation
F: Yeast c/w Histoplasma capsulatum
E
F

73. 2008

74. 2012

75. 2014

84. Radiographic Signs of Acute PE Pathology/Description of Signs
Westermark Sign Regional Oligemia (Abbas)
Palla’s Sign Right Descending Pulmonary Artery
Enlargement (Abbas)
Hampton’s hump Wedge-Shaped Opacity of the
Peripheral Lung Field (Ladeiras-Lopes)
Fleischner Sign Proximal Pulmonary Arteries
Enlargement (Marshall)
Polomint Sign on axial CT Partial Filling defect surrounded by
contrast material (Wittram)
Railway Track Sign on Longitudinal
Imaging of Vessel
Partial Filling defect surrounded by
contrast material (Wittram)

85. Westermark Sign
Regional oligemia on chest radiograph. It has a high specificity and a low sensitivity
Differential Diagnosis
• Pulmonary Emphysema
• Unilateral Air Trapping
• Swyer-James Syndrome
• Tetralogy of Fallot
• Ebstein’s anomaly
• Tricuspid Atresia
• Eisenmenger Complex