BackgroundMultiple different types of mediastinal masses may be encountered on imaging techniques in symptomatic or asymptomatic patients. The location and composition of these lesions are critical to narrowing the differential diagnosis.MethodsRadiological compartmentalisation of the mediastinum helps in focusing the diagnosis of masses on the basis of their site. Some diseases, however, do not occur exclusively in any specific compartment and can spread from one compartment to another.ResultsTissular components of the mass, the degree of vascularisation and the relationships with mediastinal structures assessed by computed tomography (CT) or magnetic resonance imaging (MRI) are a leading edge of the radiological diagnosis. Special applications at MRI have been developed over the recent years in order to identify accurately tissular components of the mediastinal masses. The likelihood of malignancy of the mediastinal masses is influenced by the symptomatology and the age of the patient. This article reviews the most commonly encountered mediastinal masses considering clinical history and manifestations, anatomical position and certain details seen on different imaging modalities that allow correct diagnosis in many cases.ConclusionFamiliarity with the radiological features of mediastinal masses facilitates accurate diagnosis, differentiation from other mediastinic processes and, thus, optimal patient treatment.Teaching Points• CT and MRI are important for the diagnosis of mediastinal masses.• The location and tissue characteristics on imaging studies are critical to narrow down the differential diagnosis of mediastinal masses.• Symptomatology and patient age affect the likelihood of malignancy.
The number of women with breast implants is increasing. Radiologists must be familiar with the normal and abnormal findings of common implants. Implant rupture is a well-known complication after surgery and is the main cause of implant removal. Although mammography and ultrasonography are the standard first steps in the diagnostic workup, magnetic resonance imaging (MRI) is the most useful imaging modality for the characterisation of breast implants because of its high spatial resolution and contrast between implants and soft tissues and absence of ionising radiation. MRI has the highest sensitivity and specificity for implant rupture, thanks to its sequences that can suppress or emphasise the signal from silicone. Regardless of the technique used, the overall aim of imaging breast implants is to provide essential information about tissue and prosthesis integrity, detect implant abnormalities and detect breast diseases unrelated to implants, such as breast cancer.
A wide spectrum of abnormalities can affect the duodenum, ranging from congenital anomalies to traumatic and inflammatory entities. The location of the duodenum and its close relationship with other organs make it easy to miss or misinterpret duodenal abnormalities on cross-sectional imaging. Endoscopy has largely supplanted fluoroscopy for the assessment of the duodenal lumen. Cross-sectional imaging modalities, especially multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI), enable comprehensive assessment of the duodenum and surrounding viscera. Although overlapping imaging findings can make it difficult to differentiate between some lesions, characteristic features may suggest a specific diagnosis in some cases. Familiarity with pathologic conditions that can affect the duodenum and with the optimal MDCT and MRI techniques for studying them can help ensure diagnostic accuracy in duodenal diseases. The goal of this pictorial review is to illustrate the most common non-malignant duodenal processes. Special emphasis is placed on MDCT features and their endoscopic correlation as well as on avoiding the most common pitfalls in the evaluation of the duodenum.Teaching points • Cross-sectional imaging modalities enable comprehensive assessment of duodenum diseases. • Causes of duodenal obstruction include intraluminal masses, inflammation and hematomas. • Distinguishing between tumour and groove pancreatitis can be challenging by cross-sectional imaging. • Infectious diseases of the duodenum are difficult to diagnose, as the findings are not specific. • The most common cause of nonvariceal upper gastrointestinal bleeding is peptic ulcer disease.
A 66-year-old male patient, with chronic respiratory disease and right colon resection in March 2017 for colon low-grade adenocarcinoma was assessed for recurrence suggested by elevated levels of tumor marker and no evidence of oncological disease by CT scan. 18F-FDG PET/CT showed bilateral multiple peripheral FDG-avid foci that matched with a peripheral predominant ground-glass opacities (GGOs) observed in lower lobes and multiple FDG-positive enlarged lymph nodes were also identified in the mediastinum. Patient was hospitalized in March 14th 2020, one day after PET/CT scan, with cough, wheezing and fever, and was treated with anti-inflammatory drugs. A first SARS-CoV-2 RT-PCR in March 15th resulted as negative and patient was treated with antibiotic therapy lead to an improvement of respiratory symptoms. PET/CT scan was interpreted as a pneumonia foci. A deteriorating patient condition was observed, with respiratory symptomatology progression, fatigue and D-Dimer elevation and a new RT-PCR resulted positive. A week after PET/CT scan, hospitalization in intensive care unit was necessary for rapidly disease progression and severe respiratory distress syndrome and patient died four days later.
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