Local Time : 04:07 CET

SF 13a - Cases I'll never forget in chest imaging

Saturday, March 4, 08:30 - 10:00 Room: C Session Type: Special Focus Session Topic: Chest Moderator: A. P. Parkar (Bergen/NO) Add session to my schedule In your schedule (remove)

A-581

Chairman's introduction

A. P. Parkar; Bergen/NO

Learning Objectives

1. To become familiar with the common mistakes in chest imaging.
2. To understand the value and limitation of pattern recognition.
3. To appreciate the value of combing pattern recognition and clinical information.

Abstract

Errors in radiology reporting occur regularly, and the underlying causes are well studied and documented. Most errors are recognized early and do not cause permanent harm, but sometimes the delays caused by errors lead to serious harm to patients. The errors can be divided into perceptual (observational) and cognitive (interpretative) errors, the prior being the most common, up to 80% of errors. The pathology is not seen or observed, often as it is hidden behind another structure or in an uncommon location. Sometimes the reason why it was missed initially cannot be found when reviewed retrospectively. In addition, an additional finding may be missed due to so-called “satisfaction of search”. Cognitive errors are when the pathology is seen but interpreted incorrectly. This may be because the reader is misled by irrelevant clinical information, or simply lacks the knowledge to understand the clinical relevance of the finding. In chest radiology, there are pitfalls in the plain radiographs related to certain anatomical areas, to the way the image has been performed (supine or with insufficient inspiration) or inherent limitations of the modality. Lung cancers are frequently missed, and up to 50% of nodules below 10mm are missed initially on radiography. A systematic approach to reading chest radiographs and CT images is necessary to avoid common reporting errors.

A-582

Nodules (0.4-2 cm)

A. R. Larici; Rome/IT

Learning Objectives

1. To understand the anatomical and pathological basis.
2. To learn about typical diagnoses and differentials.
3. To appreciate typical caveats and pitfalls.

Abstract

Errors in imaging interpretation are the principal causes that bring a radiologist to remember a certain case for the whole life, and this eventuality may occur both in chest radiographs and CT scans. Observer error is one of the most important mechanisms leading to a misdiagnosis of a pulmonary nodule and includes scanning error, recognition error, decision-making error and satisfaction of search. Technical considerations, such as image quality and patient positioning and movement, are also factors that can contribute to the likelihood of missing lung nodules, mainly on chest radiographs. Nodule characteristics also play a critical role and include size, conspicuity and location. Up to 96% of nodules are less than 10 mm, with a reported malignancy rate of 1-12%. These nodules may be easily missed on chest radiographs, particularly if they show ill-defined margins or ground-glass density, or if they are masked by superimposed chest structures or have endobronchial location. To learn about chest anatomical details and to become familiar with the possible appearance and differential diagnosis of pulmonary nodules is helpful in avoiding misinterpretation. This presentation will cover the learning objectives using side-by-side plain films and CT scans in most of the selected cases, to help understand how to systematically review chest x-ray and improve radiologist’s accuracy in interpreting this challenging topic.

A-583

Masses and consolidation (> 2 cm)

C. P. Heussel; Heidelberg/DE
Sorry
no recording
available

Learning Objectives

1. To understand the anatomical and pathological basis.
2. To learn about typical diagnoses and differentials.
3. To appreciate typical caveats and pitfalls.

Abstract

A mass is any pulmonary, pleural, or mediastinal lesion seen on chest radiographs as an solid or partly solid opacity greater than 3 cm in diameter (Fleischner Society: Glossary of Terms for Thoracic Imaging, Radiology 246). Radiologists are expected to identify masses sensitive and easy on chest x-ray; however, detectability might be difficult due to, e.g. superimposition. Consolidations, however, suffer mainly from correct differential diagnosis taking clinical information into account. Knowledge of anatomy, sensibility to the weaknesses of conventional radiology, and differential diagnoses are helpful for correct image reading and interpretation. Similar to masses, a consolidation appears as a homogeneous increase in pulmonary parenchymal attenuation that obscures the margins of vessels and airway walls usually giving an positive pneumobronchogram. Therefore, a series of abnormal chest x-ray is demonstrated with giving the audience the possibility for own image analysis like a quiz. Furthermore, characterization will be discussed in other lesions.

A-584

Ground glass opacity

M. Revel; Paris/FR

Learning Objectives

1. To understand the anatomical and pathological basis.
2. To learn about typical diagnoses and differentials.
3. To appreciate typical caveats and pitfalls.

Abstract

Ground glass opacity (GGO) is defined by a hazy increased opacity which does not obscure the underlying vascular markings of the lung parenchyma. It may result from a partial filling of the alveolar spaces, a thickening of the alveolar walls or septal interstitium, or from a combination of these changes. On CT, it is important to evaluate whether the GGO is focal or diffuse, and in diffuse forms to look for homogeneity, distribution and ancillary findings such as traction bronchiectasis, intralobular lines resulting in a crazy-paving pattern, the presence of cysts, of lobule sparing. The main differential diagnosis is mosaic perfusion, characterized by an asymmetry of vessels between the low and high attenuating areas. Diffuse GGO may also be overlooked, but can be suspected if the “dark bronchus sign” is present. To find out the cause, it is important to take into account the chronicity of symptoms, the patient's immune status, smoking history and preexisting medical condition.

A-585

Reticular pattern

J. Coolen; Leuven/BE

Learning Objectives

1. To understand the anatomical and pathological basis.
2. To learn about typical diagnoses and differentials.
3. To appreciate typical caveats and pitfalls.

Abstract

When a collection of innumerable small linear opacities on CXR or HRCT merges into an network we speak about reticulation. On HRCT it is one of the imaging findings that may suggest the presence of a diffuse interstitial lung disease (ILD). The Fleischner Society propose this ‘reticular pattern’ in the glossary of terms, because this pattern approach is not purely descriptive but already contains some interpretation of what is seen and hence narrows the differential diagnosis. The key points are to identify the dominant types of linear opacities (interlobular/perilobular/intralobular), to establish what portion of the lung is predominantly involved (central/peripheral and upper/mid/lower zone) and to describe the appearance of reticulation (smooth/nodular/irregular). When all the radiological patterns (ground glass/nodular/honeycombing/mosaic attenuation) or other radiological signs are correctly interpreted, the radiologist must be aware whether these findings fit with acute disease or are more likely to be associated with chronic inflammatory or even fibrotic change of lung tissue. This format provides mostly a pattern-based specific diagnosis or a shortened list of differential diagnoses. However, in ILD establishing the correct diagnosis, mostly an integrated pathologic-radiologic-clinical correlation is mandatory.

A-586

Cystic pattern

S. R. Desai; London/UK

Learning Objectives

1. To understand the anatomical and pathological basis.
2. To learn about typical diagnoses and differentials.
3. To appreciate typical caveats and pitfalls.

Abstract

"no abstract submitted"

A-587

Airway abnormalities

E. Castañer; Sabadell/ES

Learning Objectives

1. To understand the anatomical and pathological basis.
2. To learn about typical diagnoses and differentials.
3. To appreciate typical caveats and pitfalls.

Abstract

Radiologists are crucial in the diagnosis of airway abnormalities. Conventional radiography is the first step but often lesions are identified only when large. MDCT plays an important role in the characterization of lesions and improved planning for interventional procedures. The radiologist is often the first to suggest the diagnosis of a diffuse tracheal disease. A systematic approach to a large-airway lesion considers the focality or diffuseness of the lesion, the airway that is involved, and whether the posterior airway membrane is involved. By noting the wall portion affected and its abnormal characteristics sometimes a diagnosis can be suggested. Some entities cause circumferential wall thickening (Wegener´s granulomatosis, amyloidosis, intestinal inflammatory disease), whereas others affect mainly the tracheal cartilage (relapsing polychondritis, tracheobronchopathia osteochondroplastica). We will review the anatomy and histology of the airways, and present some demonstrative cases. Most errors in diagnosing central airway disease are caused by our failure to look at these structures. If we remember to look at the airways, we usually have no difficulties in recognizing disease.

A-588

Vascular abnormalities

M. Das; Maastricht/NL

Learning Objectives

1. To understand the anatomical and pathological basis.
2. To learn about typical diagnoses and differentials.
3. To appreciate typical caveats and pitfalls.

Abstract

"no abstract submitted"

A-589

Pleural disease

C. Beigelman; Lausanne/CH

Learning Objectives

1. To understand the anatomical and pathological basis.
2. To learn about typical diagnoses and differentials.
3. To appreciate typical caveats and pitfalls.

Abstract

Common reporting errors regarding pleural disorders may be related to the difficult recognition of findings with chest x-ray such as those related to a pneumothorax in supine position or intrafissural in location. The projection of a device or the presence of an underlying lung disease such as bullae of emphysema may also be responsible of an underestimation (satisfaction of search) of a pneumothorax. All these mistakes are usually solved using CT. Errors in interpretation may also delay the accurate diagnosis. This is especially the case for focal pleural thickening (PT) that may be related to typical pleural plaques, but may also correspond to normal structures, previous tuberculosis, pleural metastasis, silicosis, or other rarer conditions. Furthermore, postero-basal PT in supine examination may be reversible on prone position. In all cases, a careful analysis of other CT findings, of previous imaging studies and the clinical history (previous malignancy, talc pleurodesis) are determinant for the final diagnosis. Features suggestive of malignancy include circumferential pleural thickening, nodular pleural thickening, parietal pleural thickening greater than 1 cm and mediastinal pleural involvement. However, atypical aspects such as pleural effusion even without plaque and pleural irregularity may be observed in mesothelioma and slight changes in the mediastinal or interlobar pleura should be considered suspicious of this diagnosis. The correct recognition of such potential pitfalls will ensure the best diagnostic quality for the patients.

Panel discussion: How to avoid common mistakes in the interpretation of chest imaging?

Sorry
no recording
available

(no abstract)

This website uses cookies. Learn more