Azygoesophageal recess

Knowledge of the normal radiologic appearance and manifestations of disease in the azygoesophageal recess can facilitate the detection and diagnosis of intrathoracic disease. The azygoesophageal recess is located lateral or posterior to the esophagus and anterior to the spine. It extends from the anterior turn of the azygous vein to the aortic hiatus. The configuration of the azygoesophageal recess is normally a smooth arc convex to the left. Because the right lung extends into the recess, pathology in this region can often be detected radiographically and typically manifests as increased opacity and/or as a contour abnormality. In adults, convexity directed to the right and immediately below the level of the azygous vein on a frontal radiograph is abnormal and requires further evaluation.     

Combined acute traumatic aortic injury and left main bronchus transection in a 5-year-old child

Blunt traumatic aortic and tracheobronchial injuries are extremely rare in children. We report a case of a 5 year old male who suffered both of these rare injuries (traumatic aortic rupture and left mainstem bronchus transaction). To our knowledge this combination of injuries has not been previously described in a child. CT with multiplanar images was critical for the detection of both injuries.     

Progression of idiopathic pulmonary fibrosis in native lungs after single lung transplantation

This retrospective, single-center study was conducted to assess the response of native idiopathic pulmonary fibrosis (IPF) lungs to a potent cyclosporine-based immunosuppressive regimen in single-lung transplantation recipients. The study included IPF patients who had undergone single-lung transplantation and had chest CT scans before and after transplantation. Five patients underwent single-lung transplantation for IPF between April 1992 and January 2001, and met entry criteria. All patients were placed on an immunosuppressive regimen consisting of prednisone, azathioprine, and cyclosporine. In two of the five patients, ground glass attenuation in the native IPF lung improved post-transplantation. However, fibrotic changes progressed in all five patients. In patients with advanced IPF, a potent cyclosporine-based immunosuppressive regimen is not likely to have an effect on the progression of the disease.     

Multiplanar and three-dimensional imaging of the thorax

Although axial images are sufficient for diagnosis in most instances, knowledge of multiplanar imaging techniques is essential to apply them in appropriate circumstances. In particular, appropriately applied multiplanar imaging adds confidence to interpretations and assists surgeons and bronchoscopists in planning procedures. The need for multiplanar imaging must be assessed before performing any study so that the image acquisition parameters allow for suitable reformations.