To have an understanding of the different surgical techniques, including invasive and minimally invasive proceduresTo review the different types of lung resection To know the indications of thoracic surgeryTo recognize normal expected findings To identify potential complications in chest radiograhy and CT in order to optimize patient care in the postoperative period

Surgical techniques: minimally invasive techniques (video-assisted thoracoscopic surgery and robotic- assisted thoracic surgery) and open thoracotomies (Posterolateral, Shaw-Paulson, Anterolateral, axillary thoracotomy, thoracoabdominal incision, bilateral anterior transternal thoracotomy...)Types of lung resection and indications: sublobar resection (including wedge resection and segmentectomy), lobectomy, neumonectomy (intrapleural, extrapleural, intrapericardial)Normal findings for each type of resection in Radiographs and Computed TomographyComplications:• Airway and lung complications: Atelectasis, Pneumonia, Pulmonary edema, Acute respiratory distress syndrome, Air leak/bronchopleural fistula, Post pneumonectomy syndrome, lobar torsion, lung herniation.• Mediastinal and cardiovascular complications: Mediastinal hematoma, Acute mediastinitis/mediastinal abscess, Pneumopericardium, Cardiac herniation, Stump thrombus, Pulmonar Pseudoaneurysm. • Pleural and esophageal complications: Empyema, Hemothorax, Chylothorax, Esophageal anastomotic leak and esophagopleural fistula.

While it is not uncommon to see central mediastinal pathology on cross-sectional imaging, it is important to understand the pathway influencing the spread of disease at a radiological point of view. Mediastinal facial planes can be visualized in cross sectional imaging such as CT and MRI. However, MRI is more successful in identifying the mediastinal visceral fascia and the aorto-esophageal (AE) ligament; which courses from the anterior aspect of the aorta to the left lateral aspect of the esophagus. This recently discovered unknown anatomy aids us in understanding the possible pathway of spread of disease processes such as infection, air, fluid, and soft tissue (lipomas) in the mediastinum. CT and MRI could also be useful in determining the lymph node metastasis and tumor in growth in relation to the AE ligament. In addition, the aorto-esophageal ligament can be utilized in the preoperative planning of minimally invasive thoracic surgeries.

• Introduction to anatomy of Aorto-Esophageal Ligament• Classification of Mediastinal compartments on cross section imaging• Role of Imaging in identifying AE ligament - benefits and limitations• Application of AE ligament in imaging -Spread of disease (gas, fluid and soft tissue) in the mediastinum -Preoperative surgical planning-Oncology imaging, notably spread of lymph nodes• Case based learning • What Radiologists should know about AE ligament

1. Mycobacterium chimaera (MC) is an indolent infection that is often misdiagnosed or underrecognized. Having a high clinical suspicion and knowing its various imaging manifestations help avoid delay in diagnosis and allow for earlier treatment 2. Slowly developing or enlarging peri-sternotomy fluid collections, soft-tissue thickening or both, without other clinical findings to suggest acute infection may be seen with mycobacterium chimaera infection 3. PET/CT is a useful adjunct to suggest indolent infection in patients with unremarkable CT scans and in those with a high clinical suspicion of infection

1. Background/Epidemiology a. MC is a nontuberculous mycobacterium found in environment b. Disease manifestations include disseminated, pulmonary and surgical site c. Water used in Heater-Cooler Devices (HCD) became contaminated by MC which is then aerosolized by HCD fans during cardiothoracic surgery d. Surgical site or disseminated disease occurs after cardiothoracic surgery where patient, implanted material or both become infected with aerosolized MC 2. Clinical Course of MC Infection 3. CT PET/CT Findings a. Sternotomy site b. Blurred vascular wall c. Insidious development of fluid collections and soft tissue thickening/tracts d. Persistent fluid collections despite treatment enhancement characteristics e. Disseminated disease 4. Conclusion

Recognize the different radiologic patterns of fungal lung infections. Be familiar with the main fungal entities involved in certain radiologic patterns. Know the main differential diagnoses for the mentioned patterns. Differentiate between the entities involved in both immunocompetent and immunocompromised hosts.

1. Introduction. 2. Systematic approach - imaging patterns of thoracic fungal diseases: a. Ground glass opacities; b. Nodules; c. The halo and reversed halo signs; d. Miliary pattern; e. Mediastinal involvement; f. Airway disease; g. Cavitations. 3. Pattern-based differential diagnosis: Ground glass due to viral infection; Nodules related to lung metastasis; The halo and reversed halo sign related to organizing pneumonia; Miliary pattern related to neoplasia; Mediastinal involvement related to neoplasia; Airway disease related to viral respiratory tract infection; Cavitations related to vasculitis. 4. Major fungal pathogens according to imaging patterns and immunological status (immunocompetent vs. immunocompromised hosts).5. Summary

1. Prompt diagnosis of many emergent conditions with chest radiography requires appreciation of subtle or easily misinterpreted radiographic findings; a systematic search pattern is essential for prompt detection. 2. Awareness of direct and indirect findings of pleural and parenchymal emergencies such as pneumothorax, hemothorax, bronchopleural fistula, empyema, laceration, and abscess can prevent treatment delays. 3. Early detection of abnormal mediastinal lines, stripes, and interfaces can be clues to life-threatening pathology such as aortic dissection, mediastinitis, and mediastinal hemorrhage. 4. Diaphragmatic injuries, fractures, and sternal dehiscence are frequently missed emergent radiographic findings, requiring a high level of suspicion and knowledge of common patterns of injury. 5. Attention to the position and the courses of the lines and tubes in their entirety on the chest radiograph can help to detect extrathoracic device misplacement or related complications.

Pitfalls and pearls of chest imaging in the emergency and critical care unit with CXR/CT correlation.Pleura (PTx on supine CXR, bronchopleural fistula, empyema)Lung Parenchyma (Cardiogenic vs noncardiogenic pulmonary edema, lung abscess)Heart and vessels (Traumatic aortic injury, mediastinal hematoma, mediastinitis)Diaphragm and chest wall (Diaphragmatic rupture, sternal dehiscence, fracturesLines and tubes (Vascular, cardiac, pleural, airway devices) PDF Upload.

The finding of an incidental focal osseous lesion in an oncologic patient poses a unique diagnostic challenge due to the heightened concern for metastasis. While the majority of osseous lesions are benign, many may closely resemble metastasis on imaging, prompting the need for clear methods of differentiation. By following an algorithm for categorizing osseous lesions, radiologists may confidently recommend follow-up imaging studies while avoiding unnecessary referrals.After reviewing this exhibit, the learner will be able to:- Employ a systematic method to characterize osseous lesions according to their density, composition, and cortical features- Identify imaging features that characterize osseous lesions as malignant or benign (such as: wide zone of transition, discontinuous cortex, soft tissue component replacing the medullary cavity, or extension beyond the margin of the bone)- Identify several frequently encountered benign osseous lesions that resemble metastasis- Establish an appropriate imaging algorithm to further characterize osseous lesions in these patients

- Introduction: imaging features of osseous lesions with special emphasis on features suggestive of malignancy- Pictorial review of several commonly encountered benign osseous lesions that resemble metastasis in oncologic patients- Imaging algorithm to further characterize osseous lesions

1. Misconceptions in chest imaging may lead to excessive imaging, missed diagnoses, or inappropriate therapies, such as missed detection of malignancy manifesting as cyst associated lung cancer. Other misconceptions may lead to unnecessary follow up of nodules identified on incomplete thoracic exams.2. Knowledge of these misconceptions may lower costs, increase accuracy, and improve patient outcomes.

1. Background2. Malignancya. Lung cancer manifesting as cyst associated malignancy, persistent consolidation and subsolid noduleb. Incidental nodule on incomplete chest CTc. Intrapulmonary lymph node3. Diffuse Lung Diseasea. Reverse halo sign with pulmonary infarctb. DIPNECH as underdiagnosed diseasec. Patchy tree-in-bud opacities from infectious or aspiration bronchiolitis.d. Differentiating airspace enlargement with fibrosis from honeycombing.e. Dendriform pulmonary ossification due to pulmonary fibrosis or aspiration4. Mediastinuma. Pericardial recesses misinterpreted as lymphadenopathyb. Distinguishing normal thymus from mass5. Vasculara. Flow-related artifacts mimicking pulmonary embolism or dissectionb. Diffuse tree-in-bud opacities with excipient lung disease.c. Beaded vasculature with endovascular metastases6. Pleura/Chest Walla. Extrapleural fat deposition mimicking cardiomegaly or pleural effusionb. Elastofibroma mimicking chest wall mass7. Conclusion

This exhibition aims to review: • Anatomy of the lymphatic drainage of the lungs and mediastinal node stations. • Multimodality imaging staging of lung cancer, with focus on lymph node (LN) status and its importance to the appropriate lung cancer management. • Indications and impact of different types of lymphadenectomy: selective versus systematic node dissection. • A practical approach to lobe-specific nodal spread of lung cancer with imaging correlations.

1. BACKGROUND 1.1. Lung cancer overview 2. 8TH LUNG CANCER STAGE CLASSIFICATION 3. LYMPH NODE EVALUATION 3.1. Invasive and non-invasive approach to mediastinal nodal evaluation 3.2. Imaging characteristics of suspicious nodes 4. LYMPHATIC ANATOMY 4.1. Lungs and bronchial tree 4.2. Mediastinal Lymph nodes stations 5. LOBE-SPECIFIC PATTERNS OF LYMPHATIC SPREAD 5.1. Right upper lobe 5.2. Right middle lobe 5.3. Right Lower Lobe 5.4. Left Upper Lobe / Lingula 5.5. Left Lower Lobe 6. IS IT FEASIBLE TO ADOPT A SELECTIVE APPROACH? EVIDENCE SO FAR 7. NOVEL IMAGING TECHNIQUES AND FUTURE DIRECTIONS 8. TAKE-HOME MESSAGES

1. Lung cancer can manifest as lung cysts or enlarged airspaces. 2. This type of lung cancer represents significant number of missed diagnosis. 3. The main concerning features of lung cysts and enlarged cystic air-spaces include: wall thickening or nodules, adjacent ground glass changes, multilocular cysts, increase in size or change of internal structure overtime. 4. Knowledge of the various imaging presentations of lung cancer is essential for timely diagnosis and treatment thus preventing development of invasive disease.

I. Introduction: 1. Why do we have to raise awareness about lung cysts and enlarged cystic air-spaces? 2. What is the mechanism and pathogenesis of lung cysts and enlarged cystic air-spaces? II. Imaging findings 1. How lung cysts and enlarged cystic air-spaces should be described? 2. What are the concerning features of lung cysts and enlarged cystic air-spaces? 3. How malignant cysts and enlarged air-spaces can change overtime? III. Conclusion and take home message

-To describe the indications for interventional procedures in pulmonary pathology.-To review the interventional lung procedures that can be performed with ultrasound guidance.-To analyze the advantages and disadvantages of ultrasound guidance.-To describe how each procedure is carried out.

The different interventional lung procedures that can be performed with ultrasound guidance will be reviewed:-Lung biopsy-Pneumonia puncture.-Lung abscess drainage.-Intraoperative localization of lung nodules.The specific indications for each lung procedure as well as its advantages of using ultrasound guidance over other techniques such as CT will be covered.Moreover, the technique that should be used in each procedure and the pre and post procedure recommendations will also be addressed.

1. Review cancer drugs that are primarily responsible for causing pneumonitis as well as differentiating it from other treatment related findings 2. Discuss the CT imaging patterns of drug-induced pneumonitis 3. Discuss potential mimics of drug-induced pneumonitis patterns including cytokine release syndrome in CAR-T cell therapy4. Discuss the crucial role of the radiologist in monitoring/management of treatment-related pneumonitis with a focus on established guidelines5. Discuss use-cases of common anti-neoplastic agents causing pneumonitis - from Gemcitabine, through ICI to CAR-T cells

1. Discuss common anti-neoplastic agents that cause pneumonitis2. Enumerate prevalently reported imaging patterns of pneumonitis, along with their typical imaging findings3. Discuss other potential complications of anti-cancer therapy (Pleural effusions, Pneumonia, Worsening tumor burden, airway obstruction)4. Common mimics of drug-induced pneumonitis (atypical pneumonia, COVID-19, Cytokine release syndrome)5. Discuss presenting clinical symptoms and grading system for drug-induced pneumonitis (CTCAE and ASCO)6. Management guidelines for drug-induced pneumonitis with special focus on checkpoint inhibitors (ICI), targeted therapy, Antimetabolites (Gemcitabine) 7. How a Radiologist plays an important role in management8. Prognosis and clinical outcome of patients developing drug-induced pneumonitis9. Real-world cases showing management and clinical course of drug-induced pneumonitis in cancer therapies from Bleomycin, Gemcitabine to combination ICI and CAR-T cells

• Understand Dual-Energy Subtraction (DES) X-ray, the limitations of the old Dual-Exposure DES techniques, and how a Single Exposure portable detector can overcome these limitations. • Understand the clinical benefits enabled by portable Single Exposure Dual-Energy for small nodules identification, pneumonia, pneumothorax, and finding line and tube tips. • Learn about the added diagnostic value of dual-energy portable chest X-ray in a non-radiological reviewing environment for both regular and radiology trained clinicians.

This exhibit teaches the added diagnostic value of dual-energy X-rays (DEX) obtained using a novel portable multilayer detector in a reviewing environment simulating a non-radiological practice. A set of 28 AP images were obtained using a novel portable multi-layer DEX detector. A team of five (5) readers was recruited that included two fellowship-trained chest radiologists and the rest non-specialists. The team was provided with the conventional X-ray images first, and subsequently were unblinded to the corresponding DEX images. For both sets of images, the readers were asked to assess the presence of pulmonary nodules > 5 mm, pneumothorax, pneumonia (left and right lung), bone fractures, and tips of central and GI lines using a five point scale. Readers were also asked whether the additional DEX images (soft tissue, bone) impacted their confidence. Initial results show that DEX images, taken alongside CR, helped improve diagnostic confidence.

1) Bronchosopic lung volume reduction is a non-pharmacologic treatment for severe COPD, 2) Less invasive alternative to lung volume reduction surgery,3) Goal is complete collapse of the most emphysematous lobe, 4) Imaging is necessary for patient selection, and radiologists have an important role in multidisciplinary discussion, 5) The main role of pre-procedure CT is assessment of emphysema severity, emphysema distribution, and fissure integrity, 6) Sagittal and coronal reconstructions are helpful for fissure integrity, 7) Pneumothorax is the most common complication but does not typically affect clinical outcome

1) Description of procedure, 2) Patient selection, 3) Chest CT protocol,4) Pre-procedure imaging assessment,5) Expected post-procedure imaging findings,6) Complications,7) Other bronchoscopic lung volume reduction techniques in development

The purpose of the exhibit is: 1. To review surgical procedures and the postoperative changes for lung cancer. 2. To describe the imaging features of the complications after surgery. 3. To discuss how even rare complications can be radiologically significant.

1. The surgical procedures for lung cancer 2. The imaging findings of the normal postoperative changes: CXR and CT 3. The imaging features and the clinical manifestations of the complications after surgery: relatively common complications and rare complications 4. Summary

1. Review of options for acute mechanical right ventricular circulatory support including:The TandemHeart centrifugal flow pump (TandemLife, Pittsburgh, PA), the axial-flow Impella RP catheter (Abiomed Inc, Danvers, MA), the Protek Duo dual lumen cannula, and the veno-arterial extracorporeal membrane oxygenation (VA-ECMO).1a. Review of right ventricular bypass methods.1b. Review of methods of oxygenation.2. Review of options for durable mechanical right ventricular circulatory support including: The CentriMag pump (St. Jude, Minneapolis, MN) RA-to-PA cannulation as well as commercially available LVADs, including the Jarvik and HeartWare devices.3. Review of common complications of RVADs including access site complications, pulmonary and other complications such as cannula malposition, and abandoned cannula.

1. Background/Indications for RVADs/RV Bypass and Oxygenation Methods.2. Imaging for percutaneous acute and durable mechanical circulatory support systems: Direct and indirect RV bypass systems: Protek Duo, VA-ECMO, Impella RP.Durable mechanical circulatory support systems: Jarvik, Centrimag.3. Access site complications of RVADs: access site hematoma, access vessel thrombosis, access site infection.4. Pulmonary complications of RVADs: pulmonary edema, organizing pneumonia, ARDS, septic emboli.5. Other complications of RVADs such as a malpositioned cannula, abandoned cannula, distal hemorrhage.

1. Gas collections in the lung tend to be spherical, while gas collections in the pleura tend to be longer in one dimension.2. Pneumopericardium appears as “clean” gas that is bounded by the superior pericardial recess, while pneumomediastinum is “dirty” gas that can track superiorly into the neck.3. It is critically important to scan the upper abdomen for incidental abnormal gas, including pneumatosis and pneumoperitoneum.

1. Abnormal air in the lungsa. Bullab. Cavitary consolidation2. Abnormal air in the pleuraa. Pneumothorax, including deep sulcusb. Hydropneumothorax - distinguish from intraparenchymal gas3. Abnormal air in the mediastinuma. Pneumopericardiumb. Pneumomediastinumc. Signs: ring-around-the-artery, continuous diaphragmd. Herniae. Post-surgical4. Abnormal air in the abdomena. Pneumoperitoneumb. Pneumobiliac. Portal venous gas and pneumatosis

IgG4 is a systemic fibroinflammatory disease characterized by dense infiltration of IgG4 positive plasma cells in the affected tissues with or without elevated plasma levels of IgG4.The inflammatory infiltration can lead to the development of fibrotic tumefactive lesions that may affect any tissue often mimicking a neoplastic process.Thoracic involvement may affect the lung parenchyma, airways, the interstitium, pleura and the mediastinum.Most common manifestation include pulmonary nodules, interstitial lung disease, peribronchovascular infiltration, lymphadenopathy and fibrosing mediastinitis.

Definition, Pathophysiology, Histopathology, Associated or related conditions, Common clinical phenotypes, Pulmonary disease, Fibrosing mediastinitis, Cardiovascular involvement

- To know, identifiy and become familiar with the typical (and not so typical) radiological patterns of RA in lung involvement.- To suggest an early diagnosis in patients who have not shown any other RA manifestations and be able to offer a sooner treatment in these cases.

1. Introduction and generalities: rheumatoid arthritis is a multisystemic disease of uncertain etiology, with many factors involved (female sex, genetics, non genetic factors, biologic markers...).2. Extraarticular manifestations (EAM): although the typical manifestation is poliarthropaty, up to half of the patients who has RA, present extraarticular manifestations, more frequently in those who has positive analytic markers. Cardiovascular and respiratory EAM are the most important involvement in mobility and mortality terms.3. Pulmonary manifestations: An important group of the patients who undergoes this disease (60-80%) presents pulmonary involvement in the course of the disease, being interstitial involvement the second most important cause of mortality in these patients (after cardiovascular involvement). These manifestations can precede articular affectation up to 15% of the cases, and only in 10% of those, has significant clinical manifestations.4. Review of the typical patterns:- Usual Interstitial Pneumonia (UIP).- Non-Specific Interstitial Pneumonia (NSIP).- Organizing Pneumonia (OP).- Lymphocytic Interstitial Pneumonitis (LIP).5. Summary.

Pulmonary arteriovenous malformations (PAVMs) are abnormal direct vascular communications between pulmonary arteries and veins which create high-flow right-to-left shunts. Even when asymptomatic, presence of PAVMs increases patients’ risk of substantial morbidity and mortality mainly from the effects of paradoxical emboli. Potential complications include stroke, cerebral abscess, pulmonary hemorrhage and hypoxia. Transcatheter embolization eliminates the abnormal right-to-left-shunting. For more effective embolization, preventing recanalization after PAVMs embolization is the most important. Recently, the Japanese nationwide cohort study has revealed that embolization of the last normal branch was a key factor affected the prevention of recanalization. The last normal branch is generally identified on preoperative multi-detector CT, but the identification rate on the conventional angiography is low (39%). We performed dynamic imaging with Cone-beam CT utilizing two-step dilution and balloon catheter occlusion, which allows for precise assessment of vessel shape and number, the last normal branch and shunting points during the procedure. Its innovative four-dimensional angiography can detect the “hidden” normal last branch and smoothly execute the treatment straight away. This presentation reviews the updated imaging modalities regarding vascular structural understanding and planning the endovascular therapy of PAVMs.

i. Anatomical categories of PAVMs ii. What is the last normal branch of PAVM? Why is it important? iii. Imaging modalities for planning for embolization (4D angiography) iv. Ideal embolization based on anatomical structure

In UHRCT, the reliability of CT values of small structures is improved by reducing the partial volume effect due to the miniaturization of voxels. In particular, the contrast effect of small vessels with a diameter of 1 mm or less is enhanced. And the entire peripheral lung parenchyma can be displayed by deleting the cardiovascular image. This technique can display blood vessel distribution and contrast effect distribution (Moriya et al, Peripheral Pulmonary Artery Imaging Using Ultra-high Resolution CT - A New Method Of Evaluating Vascularity In The Lung Field CHEE-37 RSNA2021). On the other hand, the contrast effect and vascularity of the lung can be calculated using the radiologic lung density measurement, which is a method of converting the lung weight from the CT value. We present this technique and typical cases.

1. Method: UHRCT(SHR mode: 1024matrix 0.25mm), Workstation used: Ziostation2 (Segmentation of lung parenchyma, each lobe, lung + blood vessels of any thickness)2. Typical casesCase1(dynamic contrast CT before lung cancer surgery): Contrast-enhanced phase were well reflected in radiologic lung weight. Peripheral pulmonary vessel involvement was less than 10%. Case2(Pulmonary artery thromboembolism): Lung vascularity before and after treatment was calculated for each lobe. The therapeutic effect of the thrombus lesion was reflected in the radiologic lung weight.3. This method can be an easy pulmonary blood flow evaluation method.

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• Understand how pulmonary ablation works and it's role in thoracic malignancies treatment • Learn about the diferent techniques involved in pulmonary ablation • Recognize expected imaging features of the post ablation zone • Identify the main complications related to pulmonary ablation

• Introduction - General concepts about pulmonary ablation: o Current context o The procedure o Indications and contraindications o Imaging surveillance • Different techniques: o Radiofrequency ablation (RFA) o Microwaves ablation (MWA) o Cryoablation o Irreversible electroporation (IEP) • Post-ablation zone features: What to expect? • Case based review - Complications related to pulmonary ablation: o Asseptical Pleuritis o Pneumothorax o Lung Hemorrahge o Aspergilloma o Bronchopleural Fistula o Air embolism o Rib fracture o Other complications • Future perspectives • Conclusions and key takeaways

1. Vascular complications of infection can be divided into thromboembolic disorders and non-thromboembolic disorders.2. Thromboemboli from infections could be due to endothelial damage, hyperviscosity, embolization of vegetations containing infectious material or embolization of the culprit organism. Such conditions include COVID-19 infection, infectious endocarditis, Lemierre's syndrome and parasitic embolization into the pulmonary arteries (Echinococcus). 3. Vascular infections could also result from contiguous spread of infection from the adjacent organs causing inflammation of the vessels such as infectious aortitis associated with vertebral osteomyelitis, empyema or pneumonia. 4. Infections can damage the vessel wall and cause aneurysm such as Rasmussen's aneurysm or mycotic aneurysm.

• Introduction • Pulmonary embolism- COVID-19 infection• Septic infarcts- Infective endocarditis• Internal jugular vein thrombus- Lemierre’s syndrome • Infectious aortitis- Tuberculous aortitis, syphilitic aortitis, HIV aortitis, pyogenic aortitis• Mycotic aneurysm• Rasmussen’s aneurysm- Tuberculosis • Conclusion

Recognize the signs of chronic pulmonary emboli and pulmonary hypertension on CT, review the pathophysiology of pulmonary hypertension in CTEPH, and learn clues to identify common and uncommon mimickers of CTEPH on CT.

Chronic thromboembolic pulmonary hypertension (CTEPH) results from pulmonary artery obstruction due to non-resolving pulmonary embolism (PE). Among PE survivors, CTEPH is estimated to occur in 1% to 5% of cases. It is a potentially treatable cause of pulmonary arterial hypertension (PAH) and, if left untreated, may progress to right heart failure and death.CT signs of PE, PAH and CTEPH will be reviewed and clues to differential diagnosis will be provided.Some conditions may simulate CTEPH on imaging, encompassing intravascular, extravascular, and vascular (parietal) causes. Intravascular mimickers of CTEPH include pulmonary arterial malignancies (primary intimal sarcoma, metastatic tumoral thrombi) and in situ pulmonary thrombosis due to long-standing PAH (e.g., in cyanogenic congenital heart disease and schistosomiasis). Extravascular causes comprise IgG4-related and granulomatous fibrosing mediastinitis. Vascular abnormalities include congenital anomalies such as proximal interruption of the pulmonary artery and acquired physiological disturbances related to pulmonary hypoxic vasoconstriction.

1.Review the clinical, laboratory and diagnostic work up of patients suspected with acute pulmonary embolism (PE) 2. Discuss the typical and atypical CT appearance of acute PE and its mimics using an algorithmic approach 3. Discuss the important acute and emergent pathology beyond PE, that can mimic acute PE symptoms, visualized on a CT PE study 4. Briefly review additional incidental findings on a CT PE study 5.Illustrate newer advances in CT technology (Dual energy and multi-energy CT) and artificial intelligence methods for improved diagnostic assessment

1.When do you suspect an Acute PE - Risk factors, clinical history, symptoms, physical examination, laboratory findings 2.Clinical risk scores to determine whether imaging should be obtained in suspected Acute PE a. Wells score b. Pulmonary Embolism Rule-out criteria (PERC) c. Geneva score 3.Role of Bedside diagnostics in PE (Chest Radiograph, EKG, Ultrasound) and diagnostic signs.4.Discuss the algorithmic approach to obtain diagnostic imaging in PE 5.Imaging modalities including gold standard and alternatives to evaluate for PE 6. Imaging technique and challenges to obtain a diagnostic CT exam7. CT imaging in acute PE - primary and ancillary findings 8.Step wise approach to CT interpretation 9.Clinical examples showing conditions mimicking PE on CT imaging - Beyond filling defects a. Acute PE mimicking pathology (Acute aortic pathology, airway obstruction etc.) b. Other Urgent pathology (Pyelonephritis, abscess, arterial bleeds, DVT etc.) c. Incidental findings (Nodules, Nephrolithiasis, Cholelithiasis10.Newer imaging techniques for PE diagnosis 11. Future directions including role of Artificial Intelligence

1. The manifestations of pulmonary aspergillosis depend on the host immune state and underlying pulmonary disease.2. Non-invasive infections by aspergillus are airway-centered (e.g. APBA, mycetoma), while invasive infections often manifest by destruction of pulmonary vasculature (e.g. angioinvasive aspergillosis).

1. Allergic bronchopulmonary aspergillosisa. High attenuation mucus2. Mycetomaa. Monod sign3. Angioinvasive aspergillosisa. Halo signb. Air crescent signc. COVID-19 superinfection4. Tracheobronchial aspergillosis5. Airway-invasive aspergillosis6. Chronic necrotizing aspergillosis

• Describe high resolution CT (HRCT) patterns of various Connective Tissue Disorders associated Interstitial Lung Diseases (CTD-ILDs) with representative cases including usual interstitial pneumonia (UIP), non-specific interstitial pneumonia (NSIP), fibrosing organizing pneumonia (OP), lymphocytic interstitial pneumonia (LIP), follicular/obliterative bronchiolitis and other rare entities• Review common radiological signs used for diagnosis of CTD-ILDs including exuberant honeycombing, anterior upper lobe and straight edge sign• Brief overview of new concepts like Interstitial Pneumonia with Autoimmune Features (IPAF) and CTD associated Interstitial Lung abnormalities (CTD-ILAs), their radiological findings and management

1. Definition, epidemiology and clinical manifestations of CTD-ILDs 2. Radiological signs and patterns suggestive of CTD-ILDs on HRCT chest 3.Specific Imaging patterns seen in different CTD-ILDs (Rheumatoid arthritis, Systemic Sclerosis, Systemic Lupus Erythematosus, Polymyositis/Dermatomyositis, Sjogren syndrome) with representative cases 4. Overview of IPAF 5. Definition and management of CTD-ILAs 6. Conclusion-highlighting radiological pearls

Blastomas represent a group of primary malignancies with proliferation of immature element that look like fetal lung.They typically have a biphasic composition with malignant mesenchymal and epithelial immature component.Two types: Pleuropulmonary blastoma (PPB) seen in children and Pulmonary Blastoma (PB) seen in adults.PPPB is the most common primary lung malignancy in children, and most present in patients less than 6 years old.DICER1 mutation is seen in 66% of patients with PPB. Other DICER1 related tumors are seen in 40% of affected patients.Imaging presentation is misleading and often confused with other entities like CCAM, sequestration,congenital lobar emphysema etc.

Definition. DICER1 mutation. DICER1 associated tumors. 2015 WHO classification. Histopathology. Pathologic-radiologic correlation. Phenotypes and prognosis. Imaging manifestation. Differential diagnosis

Complications after coronary artery bypass grafting (CABG) are common and can range from simple atelectasis or pleural effusions to misplaced lines and other support apparatus issues, to more serious issues such as a pulmonary edema, mediastinal hematoma, or pneumothorax. Portable chest radiography is the mainstay of initial evaluation. It is fast with low radiation and gives the radiologist information that allows for quick action. Overlapping anatomic structures and support apparatus devices in combination with the limitations of portable radiography makes the diagnosis of CABG complications a radiologist’s dreaded dilemma. Being able to quickly identify the most common complications is essential to maintaining efficiency and accuracy and preventing morbidity and mortality in the postoperative state.

1. Introduction 2. Types of CABG (on-pump, off-pump, minimally invasive)3. Postoperative CABG complications -Immediate (< 24 hours) v. Subacute (1-7 days) v. Chronic (> 7 days)-Complication Categories:1. Lines and tubes2. Parenchymal 3. Mediastinal 4. Soft tissue/musculoskeletal4. Role of imaging: ICU plain chest radiography 5. How to report a postoperative CABG chest radiograph 6. Correlation with CT imaging for increased understanding 7. Algorithm for “next-step” recommendations for complications 8. Multidisciplinary approach and perspective of CT surgeons about the most clinically useful information from radiology

LEARNING OBJECTIVES 1. To give an overview of some uncommon pulmonary and pleural pathologies. 2. To review the spectrum of imaging manifestations of uncommon entities in lung and pleura. 3. To highlight the importance of clinical history, immunohistochemistry and histopathology in arriving at the correct diagnosis.BACKGROUND: Due to their overlapping imaging appearance, imaging-based diagnosis of many rare neoplastic and non-neoplastic conditions affecting the lung and pleura can be challenging. Being familiar with some of the rare and unusual entities, along with relevant clinical history, can aid a radiologist in narrowing down the differential diagnosis. Thinking outside the box and looking for certain potential distinguishing features may help in making an early and accurate diagnosis. Key imaging features on CT and MRI for uncommon pulmonary and pleural pathologies will be reviewed in this educational exhibit. These include spindle cell sarcoma of the lung, sclerosing pulmonary hemangioma, sclerosing pneumocytoma, pulmonary paraganglioma, pleural hemangioma, malignant peripheral nerve sheath tumor of the pleura and pleural epithelioid hemangioendothelioma. CONCLUSION: A wide range of pulmonary and pleural conditions exhibit imaging features that are similar to more common pathologies such as bronchogenic carcinoma and pleural metastasis. Awareness of additional less common conditions, as well as an understanding of their pathologic background, will aid in accurate diagnosis.

Pictorial depiction of rare cases

Primary benign lesions of the pleura are much less common than malignant diseases of the pleura. Distinguishing benign from malignant pleural diseases affects prognosis, treatment and outcomes. CT features suggesting malignancy are circumferential pleural thickening; nodular pleural thickening; parietal pleural thickening >1 cm; mediastinal pleural involvement. Malignant primary mesothelioma (MPM) is the most common primary malignancy of the pleura. However, pleural metastases are much more common than primary pleural tumors. The most common primaries metastasizing to pleura include lung, breast and GI carcinomas, particularly adenocarcinomas, and lymphoma. Some pleural tumors may manifest focally or be diffuse. Age, sex and clinical history play a part in both radiologic and pathologic diagnosis. We review helpful imaging findings in the differential diagnosis of pleural diseases and illustrate radiologic-pathologic correlation of benign and malignant pleural lesions.

Benign vs Malignant: Benign includes solitary fibrous tumor, lipoma, schwannoma, endometriosis, pleuritis.Primary malignant includes MPM, solitary fibrous tumor, liposarcoma, PNET, synovial sarcoma, vascular sarcoma.Secondary malignant includes metastatic disease from lung cancer, lymphoma, plasmacytoma.Focal versus Diffuse: Typical focal includes metastatic disease, solitary fibrous tumor, schwannoma, thymoma, lipoma.Atypical focal includes PNET, synovial sarcoma, liposarcoma, meningioma, endometriosis.Typical diffuse includes metastatic disease, MPM, fibrothorax, thymoma.Atypical diffuse includes lymphoma, synovial sarcoma, epithelioid hemangioendothelioma.

During the pandemic caused by the SARS-CoV-2, lung ultrasound (US) has become a promising diagnostic method at the bedside mostly due to its fundamental role in patients who develop infection with severe acute respiratory syndrome. Since then, many studies have proven its value, especially in the pediatric age group. The high demand caused by the viral pneumonia pandemic intensified its use and consequently expanded its applicability in several situations, including pathologies accidentally detected, showing the high accuracy of the method. In addition, lung US provides dynamic data, feature that only ultrasound allows when compared to other imaging methods.For many reasons the pediatric population benefits a great deal from the use of US as a first line method, including the assessment of thoracic and pleural pathologies. US may also provide useful information that eliminates the need for more invasive or expensive studies, especially in cases with mild clinical changes.

The intention of this presentation is to demonstrate, through a series of cases, the extensive scope of ultrasound in the evaluation of the pediatric thorax. Demonstrate the main ultrasound findings in several parenchymal and pleural pathologies such as pneumonia, abscess, pleural effusion, empyema, among others, proving that the US can be used in the serial evaluation of these conditions. Discuss US radiological findings and their correlations with chest radiograph and chest tomography, and how sonographers can reproduce them adequately in many cases.

- To review uncommon non-thromboembolic entities that change the morphology or density of the pulmonary arteries on CT or PET/CT.- To describe imaging features of rare conditions that mimic pulmonary thromboembolism and/or bronchial pathology or cause pulmonary hypertension.

I. Background:Some uncommon conditions unrelated to thromboembolism can affect the pulmonary arteries, changing the imaging appearance of vessels in the proximal and/or distal pulmonary vasculature. These entities show key CT or PET-CT findings; their knowledge allows us to make the proper diagnosis.II. Content:We classify the entities into four categories:- Neoplastic (benign or malignant): pulmonary artery sarcoma, intravascular metastases, pulmonary tumor thrombotic microangiopathy, and intravascular leiomyomatosis.- Inflammatory: vasculitis (Takayasu arteritis and Behçet’s disease), thrombosis in situ.- Iatrogenic: embolization of non-biologic material or gas during invasive procedures such as vertebroplasty, embolization, or colonoscopy and 18 FDG embolism in a PET/CT.- Miscellaneous: excipient lung disease and pulmonary artery sheath hematoma, as a complication of acute aortic dissection.III. Conclusions:Detailed observation of the proximal and distal pulmonary arteries can provide diagnostic clues to unusual conditions causing pulmonary hypertension, simulating pulmonary thromboembolism or bronchial pathology.

To review pulmonary venous anatomy and the most common pattern of drainage. How a segmentectomy is performed, focusing on techniques to identify the intersegmental plane and the role of the pulmonary veins during the procedure. To explain anatomical variations of pulmonary veins, its significance in lung segmentectomies and how to identify them using computed tomography (CT). To present intraoperative complications related to pulmonary veins anomalies. Applications of CT with 3D reconstructions to reduce the risk of complications during the surgical procedure.

Introduction - General concepts of pulmonary venous anatomy Typical pattern of pulmonary venous drainage The use of CT to identify anatomical variations Lung segmentectomy’s technique: • A step-by-step explanation of how to perform a lung segmentectomy. • Pitfalls and some anatomical variations to know during the surgical procedure. • The use of technologies to avoid intraoperative complications Case-Based Review: Sample cases explaining and demonstrating anatomical variations of the pulmonary veins and how CT can be used to identify and prevent intraoperative complications. This section will present illustrative cases of each: Separate veins draining the middle lobe Middle lobe vein emptying into the left atrium Direct drainage from segment 6R Vein draining the right superior lobe running posteriorly to the intermediate bronchus Lingular drainage emptying into the left inferior pulmonary vein Long common trunk of left pulmonary veins Future Directions: the role of CT with 3D reconstructions and 3D printing in lung segmentectomy planning Conclusion and key takeaways.

The purpose of this exhibit is to: 1. Analyze the major complications of chronic interstitial lung disease, demonstrating both acute and chronic complications through didactic cases;2. Discuss how an imaging-based approach can be used to differentiate between acute and chronic complications.3. Distinguish between exacerbations and decompensations in chronic interstitial lung diseases, emphasizing the role of imaging in both characterization and etiologic investigation.

1.0. Chronic fibrosing interstitial pneumonia1.1. Basic evaluation algorithm (CDEF mnemonic)1.2. Imaging technical considerations2.0 Acute and chronic complications (the basics to memorize - with mnemonics)3.0 Acute complications3.1. Decompensation vs exacerbation3.2. Exacerbation3.2.1. idiopathic3.2.2. surgical procedures3.2.3. infectious trigger3.3. Acute decompensation3.3.1. pneumomediastinum3.3.2. pneumothorax3.3.3. Pulmonary thromboembolism3.3.4. infections3.3.5. Aspiration3.3.6. hydrostatic edema4.0 chronic complications4.1. aspergilloma4.2. tuberculosis4.3. Pulmonary hypertension4.4. pulmonary ossification4.5. neoplasms5.0. Summary6.0 References

This education exhibit will: 1) Review the types of fistulas that can occur within the chest, 2) Identify clinical and radiologic features of fistulas within the chest, and 3) Review complications and management of such fistulas.

1. Introduction2. Etiologies of various fistulas within the chest3. Clinical history and symptoms4. Imaging features ofa. Bronchopleural fistulasb. Esophageal-pleural fistulasc. Gastropleural fistulasd. Pancreaticopleural fistulase. Vascular fistulas5. Complications and management of fistulas6. Summary and conclusion

? To review the radiological anatomy and function of the diaphragm. ? To review the anatomic variations of the diaphragm. ? To review the multimodality imaging findings in primary or secondary pathologic conditions of the diaphragm

1. Anatomy and function of the diaphragm: The diaphragm is the most important respiratory muscle and is the muscle structure that separates the abdominal and thoracic cavities. 2. Anatomic Variations: Common anatomic variations of the diaphragm include diaphragmatic slip, bundles (nodular crura), the extension of diaphragmatic muscle fibres onto the m.quadratus lumborum, and prominent or hypertrophic median and lateral arcuate ligaments. 3. Pathologic conditions of the diaphragm: A) Primary pathological conditions of the diaphragm: That includes eventration, diaphragmatic herniation, diaphragmatic injuries, diaphragmatic tumors and tumor-like lesions. B) Secondary pathological conditions of the diaphragm: That includes diaphragmatic paralysis, diaphragmatic weakness due to neuromuscular disorders or prolonged mechanical ventilation, and tumors that invade the diaphragm.

The thymus is an organ that changes due to a variety of reasons, from aging to pathologic causes. Distinguish between benign and neoplastic changes can be challenging. Further, most thymic tumors are asymptomatic when detected, and histopathological diagnosis is not straightforward, so imaging plays an extremely important role in the evaluation of thymic lesions. In this presentation, we introduce the imaging spectrum of the thymus, from benign findings such as normal maturation and benign lesions to neoplasms.

Presentation goals:1. To demonstrate age-specific changes in normal thymus2. To demonstrate thymic hyperplasia depending on a variety of causes3. To demonstrate multimodality imaging findings of various mediastinal tumors based on WHO classificationIllustrative imaging/cases include:&1;Age-related changes in the thymus gland&1;Thymic hyperplasia of a variety of causes&1;Thymomas, including atypical variants&1;Thymic carcinoma&1;Thymic neuroendocrine tumor&1;Germ cell tumor of the mediastinum&1;Lymphoma of the mediastinum&1;Histiocytic and dendritic cell neoplasm of the mediastinum&1;Myeloid sarcoma and extramedullary acute myeloid leukemia&1;Soft tissue tumor of the mediastinum&1;Ectopic tumor of the thymus

Recently, a frequent occurrence of pulmonary vein (PV) stump thrombus following surgical treatment for lung cancer, especially left upper lobectomy, has been reported. The incidence of PV stump thrombus after left upper lobectomy ranged from 3.4% to 17.9%. Moreover, there is increasing evidence that PV stump thrombus is associated with postoperative cerebral infarction. It is important for radiologists to understand the occurrence mechanism, complications, and radiological features of PV stump thrombus after lobectomy to avoid misdiagnosis and improper patient management. The purposes of this exhibit are as follows: 1. To illustrate the etiology and epidemiology of PV stump thrombus after lobectomy. 2. To discuss the mechanism of PV stump thrombus formation after lobectomy based on radiological findings. 3. To review the complications and radiological imaging features of clinical cases of PV stump thrombus after lobectomy

1. Overview of the PV stump thrombus after lobectomy. 2. Clinicopathological and imaging features of PV stump thrombus after lobectomy and the complications. 3. Radiological approach to PV stump thrombus after lobectomy using 4D flow MRI, cine MRI, and 3D CT images

Primary mediastinal germ cell tumors (MGCT) are rare and generally affect young men. Imaging findings when used in conjunction with serological markers and patient demographics can often identify the specific type of MGCT and allows differentiation from other malignant and benign entities. Correlating surveillance imaging with serological markers allows for increased confidence in determining post-treatment response from tumor recurrence.

BackgroundDefinitions and classification of MGCTa. WHO classificationb. Cell-line based classificationImaging and histochemical features of MGCT sub-typesa. Classic imaging patterns at presentation including radiography, CT PET/CTb. Use of biomarkers in diagnosis and responseComparison to other mediastinal tumorsa. Lymphomab. Thymic epithelial neoplasmsc. Thymic Hyperplasia, Normal Thymic tissued. Metastatic Diseasee. Ectopic thyroidCommon pitfalls in diagnosis and determining recurrencea. Growing teratoma syndromeb. Misclassification of benign thymic tissuec. Identifying surgical scar tissue as residual tumor

Interlobular septal thickening is a frequent finding in patients with diffuse lung disease. While pulmonary edema and lymphangitic spread of tumor are the commonly encountered causes of interlobular septal thickening, there are several less common causes. It is important to differentiate the various diagnoses by the contour, distribution of interlobular septal thickening, other pulmonary and extrapulmonary findings. This presentation gives clues to the chest radiologists and pulmonologists to arrive at the final diagnosis.

Various causes of interlobular septal thickening will be discussed including infections (COVID-19 pneumonia, viral pneumonia, Pneumocystis carinii pneumonia), interstitial pneumonias (lymphocytic Interstitial pneumonia, non-specific interstitial pneumonia, eosinophilic pneumonia, and idiopathic pulmonary fibrosis), depositional/infiltrative conditions (pulmonary alveolar proteinosis, pulmonary amyloidosis, Erdheim Chester disease, Niemann- Picks disease), malignancies (lymphoma, leukemia, Kaposi’s sarcoma), congenital (congenital lymphangiectasia, diffuse pulmonary lymphangiomatosis, Yellow nail syndrome), iatrogenic (cytotoxic agents, radiation, lipoid pneumonia, silicone injection, EVALI/Vaping). Clues to differentiating the interlobular septal thickening based on type, distribution and other associated pulmonary and extrapulmonary findings will be reviewed.

1. EVLP is an advanced preservation tool for lung transplantation and has expanded the donor pool by perfusing the lungs ex vivo allowing for longer preservation time.2. Radiologists may participate in the EVLP team to evaluate lung radiographs during EVLP.3. Diagnostic tests and treatments can be performed on the lungs to optimize the quality of the transplant organ.4. Radiologists may have an increasingly important role in the future of EVLP as more transplant centers adopt this strategy of lung preservation and distribution.

1. Overview, Background, Terminology2. Donor lung evaluation prior to EVLP3. Radiologist’s role in EVLP with case examples a. Radiographic donor screening for masses, infection, contusion. b. Discuss potential radiographic exclusion criteria. c. Assessment of radiographic changes of the post perfusion lungs; correlating with other diagnostic tests d. Correctly identify complications (atelectasis vs pulmonary edema) e. Discuss how EVLP may impact radiologist training4. Conclusion

The aim of this exhibition is to review1. Multimodality anatomic imaging of diaphragm, focusing on ultrasonography (US)2. Technical and clinical aspects of diaphragmatic US, including a proposal for structured reporting3. Tips and tricks to evaluate diaphragm function (mobility) and trophism (diaphragm thickness and thickness fraction)4. Pathologic conditions detected through diaphragmatic US

1. INTRODUCTIONa. Anatomy of diaphragm with multimodality imagingb. Anatomic versus functional imaging2. DIAPHRAGM US: TECHNICAL ASPECTSa. Probes, positioning and acoustic windowsb. US modalities: B and M modesc. Step-by-step approach (videos and images)3. DIAPHRAGM US: CLINICAL ASPECTS a. Diaphragm paralysisb. Critically ill patients on mechanical ventilationc. Other respiratory diseases, including asthma, chronic obstructive pulmonary disease, cystic fibrosis, interstitial lung disease and COVID-19d. Neuromuscular disorderse. Pediatric patients4. DIAPHRAGM US: A PRATICAL APPROACH a. Tricks and tips b. Multimodality imaging correlations c. Structured reporting5. DIAPHRAGM US IN THE REAL WORLD a. Challenges and limitations of diaphragm US 6. FUTURE DIRECTIONS AND TAKE HOME MESSAGES

To analyze spectral CT feasibility in cardiac and thoracic pathologies. To underline its advantages and limitations compared to conventional CT. To define the clinical scenarios in which spectral CT findings are key in patient’s management.

We make a short introduction about spectral CT imaging techniques. We focus on Spectral GSI CT imaging that we used in the different cases of this exhibit. We describe Spectral CT findings in different cardiac and thoracic pathologies organized as: Vascular diseasesAcute Pulmonary embolismChronic Pulmonary embolismHemoptysisCongenital vascular diseases (Sequestration, MAV, others)Lung diseasesConsolidations (pneumonia, atelectasis, infarcts, organizing processes)Interstitial diseases (fibrosis, emphysema, post-covid, mosaic perfusion)Neoplasm (Lung neoplasm, mediastinal neoplasm and masses)Cardiac DiseasesAcute Myocardial Infarct, Myocarditis, Myocardial masses OUTLINE Spectral CT imaging is a relatively new technique which presents several advantages and may give functional data about different cardiac and thoracic diseases. Radiologists should be familiar with this technique that can play a pivotal role in patient management.

Teaching points:1. Identify zoonotic organisms and their animal vectors to which humans are susceptible.2. Understand the cardiothoracic symptoms and clinical findings of infection.3. Recognize the multimodality radiologic appearances of these diseases.4. Learn laboratory and other testing that confirms the diagnosis.

Content Organization:1- Introductiona Organisms and animal vectors2- Cardiothoracic findings of Zoonosesa. Tularemiab. Plaguec. Anthraxd. Leptospirosise. Monkeypoxf. Hantavirusg. Echinococcus3- Radiologic assessmenta. Identifying features, morphology, and distributionb. Multimodality radiologic appearances4- Pitfallsa. Potential mimics 5- Summary

1- Thymic hyperplasia, thymic cysts and thymoma may be difficult to distinguish by CT imaging alone. MRI of the mediastinum helps in the differential diagnosis. 2- Chemical shift sequences can differentiate thymic hyperplasia from thymoma. Correct use of the Chemical-Shift-Ratio identifies cases of hyperplasia when the characteristic signal drop is not identified. Small lesions may not be measurable due to inaccurate ROI placement and calculation. DWI in small lesions may be challenging as well. 3- Thymic cysts are typically hyperintense on T2-weighted images (T2WI). Pitfalls in identifying cyst on T2WI include intermediate T2WI signal of some cysts due to proteinaceous content and pseudo-nodules due to cardiac motion. Careful inspection of T1 weighted images with and without intravenous contrast may overcome these limitations. 4- Newer thymic MRI protocols including delayed phases are important to distinguish malignant from benign thymic lesions. Nevertheless, longer MRI studies may be prone to additional artifacts due to breathing. Breathing correction and subtraction imaging may help. 5- Thymoma pleural metastases can be missed leading to erroneous staging. Typical overlooked locations are adjacent to atelectatic lung or the crux of the diaphragm.

1- To describe thymic imaging techniques and radiologic appearance of thymic entities. 2- To discuss pitfalls in interpretation and possible imaging solutions. 3- To discuss blind-spots in thymoma pleural metastatic disease.

- Understanding of thoracic anatomy is essential for accurate interpretation of thoracic imaging.- Some unfamiliar/less frequently encountered thoracic anatomic and variant structures can simulate pathology.- Prospectively differentiating these structures from true pathology will prevent overcalling pathologic processes and unnecessary downstream investigations.

- Review anatomic structures at CXR, CT, and MRI:a. Vasculature (inferior pulmonary vein confluence with left atrium; L SVC, cardiophrenic veins, azygos vein).b. Hilar anatomy (inferior pulmonary ligament vs sublobar septum).c. Pulmonary fissures (accessory or incomplete fissures, fissural lymph nodes).d. Pericardium (pericardial recesses simulating lymphadenopathy or mediastinal masses; mediastinal vs epicardial fat).e. Lymph nodes (unnamed stations, left supraclavicular lymph node vs vein confluence, extrapleural space nodes).f. Chest wall (axillary/breast variants, muscular arches).- Emphasize how radiologists can differentiate these entities from true pathology by imaging evaluation with case examples.

• Flow artifacts are commonly encountered in contrast-enhanced CT imaging studies and may be mistaken for important pathologic conditions, such as embolism or dissection.• Radiologists must be familiar with the appearance of flow artifacts and comfortable distinguishing these artifacts from true pathologic conditions.• By understanding the mechanics of flow artifacts, radiologists can better recognize the clinical settings that predispose to flow artifacts, such as pneumonia or altered cardiac output.• Radiologists must know how to troubleshoot a suspected flow artifact, including how to adjust imaging protocols, when to recommend additional imaging studies, and which additional imaging studies are most helpful.• Flow artifacts can be used as a tool when the radiologist encounters vascular pathology, such as when evaluating aortic dissection flaps.

• Discuss the physical mechanics of vascular blood flow and how these mechanics can give rise to flow artifacts.• Review how to distinguish flow artifact from true pathologic conditions, such as pulmonary embolism or aortic dissection.• Examine the causes of flow artifacts and how these artifacts may present in various clinical settings, such as pneumonia or altered cardiac output.• Discuss how to troubleshoot suspected flow artifact, including the utility of delayed image acquisition and MRI.• Evaluate how flow artifacts can be used as a diagnostic tool, such as when assessing aortic dissection flaps.

The purpose of this exhibition is: • Review common and uncommon cases related to the pericardial sinuses and recesses. • Correlate important findings with the anatomy of pericardial recesses. • Discuss imaging findings according to the classification of pericardial recesses to enhance radiologists’ skills. • Highlight their characteristics for radiologists with these conditions, avoiding unfavorable patient outcome. • Despite its characteristic density, describe the importance of distinguishing them from pathologic process, as mediastinal lymphadenopathy, and mediastinal cystic mass. • Correlate with the impact on the onco-image.

• Applied anatomy of the pericardial recesses: superior pericardial recess, right lung recess, left lung recess, postcaval recess, right pulmonary venous recess, superior pericardial recess, transverse sinus, left pulmonary venous recess and oblique sinus. • Evaluation of cases of prominent recesses with variable extensions, which may be possible confounding mechanisms. • Examples of pearl cases, diagnostic difficulties, and mimicry. • Summary and take-home messages.

Lung cancer is the leading cause of cancer death worldwide, and determination of the histological type is essential for management. Surgical resection is performed in the early stage, and the surgical specimen allows radiological-pathological investigation. In 2021, the WHO classification of thoracic tumors was updated. These revisions deal with lung cancer prognosis and recognize several new entities. Unfortunately, about 70% of lung cancers are unresectable when diagnosed. Histological diagnosis must therefore rely on molecular analysis of a small biopsy tissue. Accurate knowledge regarding the molecular biology and immunohistopathology of lung cancers has thus become crucial. Radiological imaging plays an important role in the management of both early and advanced stage lung cancers. Therefore, radiologists must be familiar with all updates made to the WHO classification and molecular biology. The aim of this presentation is 1) to understand the radiological-pathological correlations in surgical specimens according to the new WHO classification, 2) to update our knowledge of lung cancer molecular biology, and 3) to acknowledge the limitations of small biopsy samples.

1. Introduction: Revision of the WHO classification2. Radiological-Pathological correlations from surgical specimens: Adenocarcinomas, Squamous cell carcinomas, Sarcomatoid carcinomas, Neuroendocrine carcinomas, Salivary gland-type tumors, etc3. Molecular biology: EGFR, ALK, ROS1, HER2, RET, BRAF V600F, KRAS, NTRK, METamp, NRG1 fusion, PD-L1, etc4. Limitations of small biopsy samples5. Conclusion

1. To understand appropriate settings to recommend MRI for the evaluation of anterior mediastinal masses (AMM). 2. To understand the main roles of MRI in characterization of AMM. 3. To understand key features for the differential diagnoses of AMM.

1. Indication of MRI for AMM a. Incidentally found AMM on CT or chest radiograph b. Preoperative characterization and staging of AMM c. Screening for associated findings of AMM (lymph nodes or pleural lesions) d. MRI protocols for AMMe. Alternative imaging options to MRI. 2. Main roles of MRI in characterization of AMM a. Cystic vs solid b. Benign vs malignant (Normal/hyperplastic thymus vs neoplasm) c. Risk stratification or staging 3. Key MRI features for the differentiation of AMM a. T1 and T2 signal intensity b. Enhancement on post contrast images c. Demonstration of microscopic fat on out of phase T1-weighted images d. Diffusion weighted images/ADC map 4. Case review of AMM a. Normal/hyperplastic thymus (fat saturated or non-saturated thymic hyperplasia) b. Thymic cyst/bronchogenic cyst c. Ectopic thyroid tissue/retrosternal thyroid goiter d. Thymic epithelial tumors (thymoma, thymic carcinoma, neuroendocrine tumors) e. Primary mediastinal large B-cell lymphoma (PMBCL) f. Thymolipoma/lipoma g. Metastasis 5. Summary

The purpose of this exhibit is:- To play an adapted game show (“Who wants to be a millionaire”) related to normal variants in thoracic imaging.- To illustrate normal variants in thoracic imaging.- To differentiate between normal and pathological cases in CT and MRI imaging.- To demonstrate cases of physiological uptake on PET/CT.- To go through several typical and atypical findings in thoracic imaging to facilitate radiological understanding and diagnosis.

- Interactive game show.- Interactive cases related to normal variants in thoracic imaging.- Reporting language for imaging findings related to the variants in thoracic imaging.- Review of imaging findings according to illustrative cases of:1.Chest wall;2.Diaphragm;3.Pleura;4.Lungs;5.Mediastinum: heart, great vessels, airways, esophagus, thymus, neural and lymphatic structures;- Summary and gained knowledge.

Photon-counting computed tomography (PCCT) is a new technology in CT imaging. PCCT uses energy-resolving detectors, instead of integrating the entire x-ray signal (energy integrating detectors: EID), enabling spectral acquisitions without the need of specialized acquisition strategies (e.g., dual-source). PCCT records photons in different energy bins, starting at a minimum energy threshold, so electronic noise can be avoided altogether. PCCT detectors used a two-step conversion (x-rays to electrical signal), rather than the 3-step conversion EID (x-rays to light to electrical signal), and inherently have higher spatial resolution as no septa (dead space to separate voxels) are needed. This project is geared toward introducing the emerging technology of PCCT to the RSNA chest imaging community. The details of this technology will be explained using diagrams and examples of standard EID patient scans in comparison to PCCT scans to demonstrate the performance of the new scanner system. These examples will include tumor monitoring, lung cancer screening and contrasted chest CT.

1. PCCT - Detectors a. Comparison of energy-integrating vs photon-counting detectors b. How is higher spatial resolution of PCCT achieved? 2. PCCT - Photon Binning a. How does photon binning work? b. How are energy thresholds defined? c. How do thresholds help with electronic noise? 3. PCCT - Spectral Data a. How is it always available? b. What can it be used for?

1. Dynamic digital radiography (DDR) is a newer technology enabling rapid acquisition of multiple sequential radiographs with field of view and spatial resolution similar to that of conventional radiography.2. The simultaneous acquisition of detailed anatomical and functional imaging enables identification and evaluation of potential lung nodules, diaphragmatic motion, chest wall motion and restricted lung motion.3. As a digital acquisition DDR enables computerized mathematical evaluation of lung areas, lung volumes, graphing diaphragmatic motion and potential pulmonary function parameters.

After a brief introduction to this technology, the following potential applications will be discussed:1. Improved evaluation of potential lung nodules.2. Evaluation of diaphragm function.3. Follow up evaluation of post-surgical chest patients.4. Potential assessment of pulmonary ventilation and perfusion.5. Comprehensive pre-operative lung transplant evaluation.6. Correlation of measured lung areas and estimated volumes with pulmonary function testing.7. Evaluation of diffuse lung disease, e.g., post-COVID patients, and patients with interstitial lung disease, chronic obstructive pulmonary disease, cystic fibrosis, among others.

The purpose of this educational exhibit is:- To explain how to correctly perform a lung contrast-enhanced ultrasound (CEUS).- To describe the basics of pulmonary vascularization, which are fundamental to interpreting a lung CEUS.- To review the clinical situations in which lung CEUS may be useful in diagnosing and treating pulmonary pathology.

Pulmonary CEUS has experienced a constantly growing in the study of pulmonary pathology. In this educational exhibit we will focus on:- Explaining the exploration technique.- Reviewing the physiopathology of the pulmonary vasculature.- Reviewing the characteristic findings in CEUS in non-tumor entities such as:• Pulmonary atelectasis• Round atelectasis• Pulmonary infarction• Pneumonia• Lung abscess• Radiation pneumonitis- Describing the main findings that can help us differentiate between aggressive and non-aggressive pulmonary neoplasms (with examples).- Radiological findings in CEUS that can help us in the diagnosis of lymphoma or lung metastases.- The importance of CEUS in interventional procedures:• Evaluation of tumor necrosis.• Choice of puncture point.• Differentiate obstructive atelectasis from tumor lesion.• Avoid vascular structures.• Prevent the biopsy of benign lung lesions.

? Provide an overview of the normal costal arch cartilage anatomy, and how its used as autogenous graft material for cartilage reconstruction surgeries;? To explain how to evaluate the costal arch cartilages (degree of calcification, and calcification morphological patterns) on X-Ray, US and CT scan; ?Application of Artificial Intelligence assisting CT scan evaluation; ?To exemplify how to report the normal and abnormal crucial findings to the surgeon; ? To introduce the related surgical cartilage reconstructive techniques.

1) Costal arch cartilage overview. A) Anatomy of costal arch cartilage. B) Costal arch cartilage and its adjacent structures anatomical relations. C) Histology of costal arch cartilage. 2) Costal arch cartilage employment as an autologous donor site for cartilage reconstructions surgeries - pros and cons. 3) Costal arch cartilage calcifications as a complicating factor for surgical outcomes. 4) Imaging evaluation, epidemiology and examples of costal arch cartilage calcifications. A) X-Ray. B) US. C) CT scan. 5) How to report. 6) Rib (costal arch) cartilage harvesting surgical technique. 7) Examples of cartilage reconstructive surgical techniques in which costal arch cartilage is employed. A) Rhinoplasty. B) Microtia otoplasty. C) General face reconstructive surgeries. 8) Take-home messages.

To review the normal anatomy of the extrapleural space (EPS).To describe the extrapleural fat sign (internal displacement of the adipose tissue layer), a clue to locating different conditions in the EPS.To show the many entities that can involve the EPS, emphasizing the role of CT.

Background:The EPS lies between the parietal pleura, the chest wall and diaphragm. It is a poorly understood anatomical compartment which can lead to diagnostic errors.Anatomical scheme.Extrapleural fat can be displaced, enlarged, or affected by:- Blood (extrapleural hematoma): from trauma, iatrogenic lesion of a thoracic vessel, aortic dissection or aneurysm rupture, spontaneous bleeding.- Air (extrapleural emphysema): barotrauma.- Fat: non-pathologic (obesity or estrogens), lipoma, chronic pleural conditions.- Edema/Infection: acute pleural exudates, empyema necessitatis.- Soft tissue: extramedullary hematopoiesis, neurogenic lesions, primary or metastatic pleural tumors, infiltration of lung tumor, chest-wall malignancies.- Calcium: chronic hematoma/empyema, asbestos related pleural disease.Conclusions:The extrapleural fat sign helps differentiate between pleural and extrapleural lesions. Conditions involving the EPS may require different treatment approaches than pleural or lung diseases.

Leukemia presents with multitude of disease related and various infective and noninfective presentations.Presentations include ground glass opacities, centrilobular nodules, interstitial septal thickening in various patterns. Mediastinal, pleural, nodal and bony involvement also need to be carefully looked for.Disease related manifestations include nodal, parenchymal, mediastinal and bony involvement, biopsy is necessitated in conditions when inflammatory and infective pathology is ruled out. Drugs and infection related injuries require both clinical and radiological approach based addressal with knowledge of specific pattern of presentations. For instance apical predominance with cystic changes are seen in PCP pneumonia, unsharp hazy ground glass changes with confluent centrilobular nodules seen in CMV pneumonia, tree-in-bud pattern in mycobacterial diseases. Non-contrast CT and HRCT thorax are a valuable tool in diagnosis, follow-up, serial correlation of presentations. They also aid in guiding image guided interventions when necessary. This educational exhibit aims to familiarize with various paradigms of presentations, pattern based understanding and clincobiochemical correlation, henceforth providing apt differentials. Clinical radiology plays a key role in reducing morbidity and mortality in hematolymphoid malignancies when timely approach and diagnosis helps early treatment.

1. Flow chart of pulmonary manifestations in leukemia 2. Disease related manifestations 3. Non infectious pulmonary complications 4. Infections and their patterns of involvement.

The purpose of this exhibit is: To review the components of the most common breast implants and prostheses, as well the main pathological conditions involving them. To emphasize that chest computed tomography (CT), which is widely available and allows rapid image acquisition, can detect incidental findings involving breast implants. To discuss the pathophysiology of breast implants conditions and their imaging findings, especially on CT, correlating them with more specific studies for breast implant evaluation. To offer a didactic case-based review on the theme, proving teaching points and references, in order to allow radiologists to detect abnormalities involving breast implants in CT scans performed for different reasons.

Breast implants and their normal appearance in CT. Intracapsular breast implant rupture: Imaging findings, including signs such as the “keyhole”, “subcapsular", “linguine” and “droplet”, discontinuity of the elastomer, among others. Degrees of implant collapse: uncollapsed, minimal, partial and full collapse. Extracapsular breast implant rupture: Imaging findings, including extra capsular silicone and siliconomas. Diagnostic difficulties and mimics. Capsular contracture: Image findings. Breast implant rotation: Image findings. Other breast implants complications related to the theme. Summary and take-home messages.

1. For adults two major ECMO types function to bypass the lungs [veno-venous (VV)] or the heart and lungs [veno-arterial (VA)] with variable catheter types and positions for both. 2. ECMO catheters are imaged with radiographs, echocardiography and CT both incidentally and intentionally. 3. Radiologists should recognize appropriate configuration/positioning of the various types and be aware of potential complications for each. 4. Radiologists need to know the indications for contrast and the indications and contraindications for stopping ECMO or clamping the ECMO catheters to optimize image quality.

• Introduction o Overview of ECMO o Importance to the average radiologist • Normal catheter placement for ECMO o Venovenous ECMO § Single lumen vs. dual lumen catheters o Venoarterial ECMO § Peripheral vs. central catheterization § Comparing points of entry o Effect of cannula sizing on correct placement (especially emergency settings) • Comparing imaging modalities used to verify correct catheter placement o Echocardiography o Chest Radiograph [CXR] o Computed Tomography [CT] • Visualizing complications during/post catheter placement o Contrast CT or Non-contrast CT: Indications o Safety and technical issues in giving contrast to a patient on ECMO • Special cases to consider o ECMO during COVID-19 • Conclusion o Radiologists have an important role in diagnosis and patient safety with the growing use of ECMO technology

1. Approach the differential diagnosis of fat-containing lesions in the chest. 2. Recognize the fat-containing lesions, using radiologic features as Hounsfield Units (HU) measurement at computed tomography (CT), or the signal intensity characteristics of fat at magnetic resonance imaging (MR). 3. Correlate lesion location with the fat imaging characteristics to narrow the differential diagnosis.

1. Imaging characteristics of fat-containing lesions in the thorax employing ultrasound, computed tomography (CT) and magnetic resonance imaging (MR). 2. Schematic approach of various fat-containing lesions and their location in the chest. 3. Sample cases from our institution with their radiographic and epidemiological features.

Pulmonary complications are a common cause of morbidity and mortality in burn patients. It is important that radiologists are familiar with these complications so that early and specific diagnosis is made on chest imaging. While admission radiographs are often normal or underestimates findings, within just a few days pulmonary complications can be severe. While CT is a useful tool, many burn patients do not undergo CT imaging of the chest. Thus it is important for radiologist to be familiar with the radiographic features of these complications and utilize timing after injury as a diagnostic tool.

• Pathophysiology of burns and radiographic correlation (what happens on alveolar level) • Timeline of pulmonary complications• Role of radiologist in utilizing this timeline when interpreting chest radiographs• Algorithm demonstrating management of inhalational injury• Findings suggestive of acute inhalational injury• With what frequency should chest radiographs be obtained?• Chest radiograph and CT correlation of varied imaging findings• ARDS as a complication of direct alveolar injury or secondary complications • Phases of ARDS• Delayed pulmonary complications• Long term complications: subglottic stenosis, bronchiectasis, bronchiolitis• Multidisciplinary approach • Role of imaging in follow up• Role of other imaging modalities not previously discussed• Bonus: Vaping associated lung injury chest radiograph and CT correlates

• Two distinct pathologies although similar in appearance on chest radiographs have nuanced differences (fraternal twins). Differentiating these may be challenging for residents.• Accurate differentiation is important as this impacts management strategies.• Case based review of radiographic “fraternal twins” with tips on differentiating two is presented.• Example: Large apical bulla is differentiated from pneumothorax by the convex margin of the bulla as compared to the parallel margin to chest wall in pneumothorax.• Length of air fluid levels is equal on frontal and lateral view in lung abscess and is unequal in empyema.• Diaphragmatic eventration has preserved sharp posterior costophrenic angle on lateral radiograph whereas flattened in paralysis, etc.

Case examples of fraternal twins with tips on differentiation1. Pneumothorax / large bulla2. Pneumothorax / pneumomediastinum3. Pneumomediastinum / pneumopericardium4. Lung abscess / empyema5. Diaphragmatic eventration / paralysis6. Hilar mass / enlarged pulmonary artery (Hilum convergence sign)7. Hilar mass / anterior/ posterior mediastinal mass (Hilum overlay sign)8. Anterior / posterior mediastinal mass (Cervicothoracic and thoracoabdominal signs)9. Lung mass / pleural/extra pleural mass10. Opaque hemithorax: atelectasis/ consolidation / pleural effusion11. Cardiomegaly / pericardial effusion12. Portal venous air / pneumobilia13. Basilar atelectasis / subpulmonic effusion

1. To review the anomalies of the thoracic systemic veins and the pulmonary veins. 2. To describe characteristic imaging features on multiple modalities, including chest radiograph, CT, and MRI. 3. To discuss the importance of clinical implications and the pitfall.

1. Normal anatomy 2. Embryology 3. The anomalies of the thoracic systemic veins: persistent left superior vena cava (PLSVC), postaortic left innominate vein (PALIV), azygous/hemiazygous continuation of inferior vena cava, azygous lobe, and others 4. The anomalies of the pulmonary veins: left common pulmonary vein, separate middle lobe vein, aberrant vein (right top pulmonary vein), partial anomalous pulmonary venous return, scimitar syndrome, meandering pulmonary vein and others

1.Congenital thoracic vascular anomalies can present in adulthood.2.Assessment of thoracic vasculature in compartments can simplify complex vascular anatomy aiding understanding and communication of results.3.CT is well placed to assess all vascular compartments within the thorax and provide datasets for 3D reconstructions to further communicate findings and plan surgical intervention.

Systemic venous pathology (including left SVC, anomalous drainage to left atrium and azygous continuation of the IVC). Pulmonary arteries (absence or disconnection of branch pulmonary artery, pulmonary stenosis e.g. in Edwards syndrome, patent ductus arteriosus, aortopulmonary window and arteriovenous malformations). Pulmonary veins (partial and total anomalous return, sinus venosus ASD and scimitar syndrome). Aortic (truncus arteriosus and hemitruncus, congenitally corrected transposition of the great arteries, right arch with anomalous left subclavian artery, left arch with anomalous right subclavian artery, double arch, coarctation, interruption of the arch, pulmonary sequestration).

1. Introduction to the vascular structures of the thorax.2. Enlisting various vascular conditions of the thorax associated with genetic conditions and discussing commonly associated imaging findings affecting the various vessels of the thorax.3. Detailed case-based description of thoracic imaging findings associated with inherited vascular conditions, along with common differential diagnoses.4. Developing a Checklist and Understanding the salient features to be reported when encountering these inherited vascular conditions of the thorax.

1. Description of various vascular conditions with genetic predisposition and their associated common thoracic imaging findings.2. Brief discussion on Ehlers Danlos, Marfan’s, Turners syndromes and associated constellation of imaging findings with a focus on related vascular thoracic imaging findings, case examples and common differential diagnoses.3. Brief discussion on BMPR2 and Factor V Leiden Mutations, associated constellation of imaging findings with a focus on related vascular thoracic imaging findings, case examples and common differential diagnoses.4. Brief discussion on Cystic Fibrosis, Hereditary hemorrhagic Telangiectasia's and associated constellation of imaging findings with a focus on related vascular thoracic imaging findings, case examples and common differential diagnoses.5. Enlisting salient imaging features to be added in the report based on what the clinician needs to know for each of the above listed conditions.

1. Review the definition and variations of scimitar syndrome with a focus on imaging findings.2. Familiarize the reader with common and uncommon congenital anomalies associated with scimitar syndrome to improve radiology exam interpretation.3. Discuss clinical presentation and complications of scimitar syndrome.

1. Background2. Definition a. Scimitar syndrome (hypogenic lung or congenital venolobar syndrome) refers to partial anomalous venous drainage of the right lung to the IVC with hypoplasia of the ipsilateral lung, systemic artery supply, and dextroposition of the heart b. Scimitar sign refers to the curved, tubular opacity adjacent to the right heart border on chest radiograph representing the anomalous vein and is considered pathognomonic for scimitar syndrome. Scimitar refers to a Turkish sword with a curved blade3. Types a. Infantile type presents in infancy and associated with congenital heart disease b. Childhood/adult type, which can be asymptomatic or result in recurrent infection.4. Imaging Findings a. Chest radiograph as a screening tool b. Contrast enhanced CT to define anatomy and identify other anomalies c. Phase contrast MRI to quantify shunt d. Pertinent radiology report findings for surgical planning5. Associated congenital anomalies a. Lungs and airways b. Vascular c. Cardiac6. Clinical considerations and complications a. Discuss range of clinical manifestations and presentation including congestive heart failure in infants and recurrent infection in adults b. Cardiovascular complications c. Pulmonary complications d. Post surgical imaging7. Conclusion

1. Define chronic thromboembolic pulmonary hypertension (CTEPH) and describe its development 2. Review the imaging findings in CTEPH 3. Discuss surgical management of CTEPH 4. Review the role of the radiologist in the diagnosis, evaluation, and management of CTEPH

1. Definition of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) 2. Pathophysiology of CTEPH 3. Multimodality Diagnosis of CTEPH (CT, Echo, V/Q scan, CMR, Angiography) 4. Surgical Management of CTEPH 5. What does the referring team need to know? a. Is the case operable b. What is the likelihood of RV recovery c. Are there accessible targets for endarterectomy?

- To review the major direct and indirect findings of both acute and chronic pulmonary embolism on CT angiography.- To discuss the role of iodine map in chronic pulmonary embolism.- To highlight other important differential diagnosis of chronic PE as well as potential pitfalls.

Introduction: basic concepts on chronic pulmonary embolism (epidemiology, pathophysiology, clinical findings and treatment goals)CTA protocol for pulmonary embolismAcute x chronic pulmonary embolism: a CTA-centered approachCurrent state of the iodine map in chronic pulmonary embolismOther differential diagnosis to keep in mindIdiopathic pulmonary hypertension and in situ thrombosisPulmonary artery sarcomaVasculitisCongenital anomaliesPotential pitfalls and artifacts in chronic pulmonary embolism

To learn the causes of thoracic flow artifacts and provide clues to distinguish them from true filling defects.To be aware of persistent and anomalous cardiac communications that are relevant in clinical practice and its typical imaging findings.

I. Background Thoracic flow artifacts as well vascular and cardiac shunts can be challenging for radiologists to diagnose. We propose a practical approach to recognize the main causes and CT features in both situations.II. ContentA) Thoracic flow artifacts ("smoke"): non-opacified blood in a contrast-filled chamber, indicative of incomplete opacification.1. Pulmonary artery (mimicking pulmonary embolism): bilateral smoke (heart failure, early/fast scanning, transient interruption of contrast) or unilateral smoke (focal lung abnormality, collateral vessel inflow).2. Aortic pseudo-dissection.3. Left atrial appendage pseudo-thrombus.B) Congenital or acquired shunt (aberrant pathway): Abnormal passage of contrast between cardiac chambers or between vascular structures and cardiac chambers, indicative of an abnormal communication.1. Congenital atrial septal defect, patent foramen ovale, ventricular septal defect.2. Acquired: collateral venous pathway from stenosis or occlusion of the superior vena cava. III. Conclusions Recognizing smoke can help prevent misdiagnosis of important diseases like pulmonary embolism or aortic dissection, and detection of contrast aberrant-paths provide a diagnosis clue to the presence of shunts or vascular stenosis.

Vasculitides are multi-systemic diseases that can lead to severe consequences if left untreated.There are several ways these disease processes can present on imaging. Thoracic imaging, for instance, has a lot to add when characterizing them, given the considerable importance of the great vessels of the mediastinum and the lung involvement commonly shown.Knowledge of typical findings that suggest a diagnosis of vasculitis is therefore a valuable asset for the radiologist and yields better outcomes.

Inflammatory diseases of the vessel walls can affect small, medium and large vessels in all segments of the body. These are often treatable diseases, bringing alleviation of the inflammatory activity and better overall outcomes. These diseases can be quite a challenge to diagnose, as they can present similarly to one another and have a nonspecific clinical course and laboratory features. The intention of this presentation is to demonstrate, through a series of cases, different vasculitides and diagnostic tips that helped suggesting these diagnoses through imaging, such as the vessels involved by parietal thickening and aneurysms, lung opacities and their temporal evolution, as well as some associations with patient characteristics and clinical features. Chest multidetector computerized tomography is the main method to be explored, an imaging modality that has a lot to offer in this task since the great mediastinal vessels and lungs are often involved.

Highlight the role of imaging tests in chronic thromboembolic pulmonary hypertension (CTEPH) focused on the detection and characterization of those pathologies that can mimic this disease, because both therapeutic management and prognosis are substantially different.

CTEPH represents a special form of PH potentially curable by surgical treatment (thromboendarterectomy). Imaging tests play a fundamental role in this disease: they confirm the diagnosis, establish the location and extension of the lesions in order to plan the most appropriate treatment (surgery vs. angioplasty vs. medical treatment) and they detect other associated injuries that may condition the patient management. They also allow diagnosis of other pathologies that may have been erroneously labeled as CTEPH. For this reason, it is essential to know what the mimicking pathologies are and the radiological signs that allow them to be detected. The main pathologies that can mimic CTEPH are sarcomas of the pulmonary arteries, large vessel vasculitis (Takayasu's arteritis), fibrosing mediastinitis, in stu thrombosis, pulmonary intravascular hydatid disease, and congenital interruption of the pulmonary artery. These pathologies and the keys to their diagnosis are reviewed.

1. Review relevant anatomy, embryogenesis, and pathophysiology of congenital thoracic vascular anomalies. 2. Correlate clinical findings and complaints in childhood and adult life with imaging findings of vascular anomalies, according to subgroups and classifications. 3. Summarize imaging protocols and post-processing techniques. 4. Highlight the role of invasive and non-invasive imaging techniques for anomalies of the great thoracic vessels. 5. Discuss the relevance of multidisciplinary team meetings and the role of radiologists in patient care with case reviews.

1. Applied anatomy and embryogenesis of pulmonary arteries, pulmonary veins, aortic arch, and superior vena cava. 2. Congenital variants and anomalies: 2.1. Pulmonary arteries. 2.2. Pulmonary veins (total and partial anomalous pulmonary venous return). 2.3. Aortic arch. 2.4. Superior vena cava.3. Sample cases and outcome review: 3.1. State-of-the-art imaging protocols and post-processing techniques. 3.2. Current and potential diagnostic methods, including invasive and non-invasive studies. 3.3. Follow-up, treatment, and prognosis. 4. Congenital vascular anomalies: practical approach and structure reporting. 5. Summary and take-home messages.

1.To understand normal vascular anatomy of the thorax, common and uncommon anatomic vascular variants. 2. To classify venous variant anatomy in the thorax based on draining veins. 3.To identify salient imaging features of described anatomic variants in a case based method, common differential diagnoses, and important points to be reported based on their clinical presentations.

1. Description of normal vascular anatomic structures within the thorax, common and uncommon anatomic variants. 2. Classification of venous anatomic variant anatomy in the thorax based on draining veins as follows:• Azygous Vein- Absent Azygous, Azygous Continuation of Inferior Vena Cava, Azygous Fissure variant in right upper lobe • Hemiazygos Vein- Left Superior Intercostal Vein, Hemiazygos continuation of the IVC, Accessory Hemiazygos Veins. • Superior Vena Cava- Persistent left SVC, Retroaortic Left Brachiocephalic Vein. • Pulmonary Vein- Partial and Total Anomalous Pulmonary Venous Return, Scimitar Syndrome, Accessory and Meandering Pulmonary veins 3. Brief description, salient imaging features, differential diagnoses and examples of anatomic variants draining into the azygous vein. 4. Important points to be included in reporting above listed anatomic variants from a clinical and interventional standpoint.

• Updated USPSTF recommendations lung cancer screening (LCS). • LDCT Lung-RADS classification, reporting, and management recommendations with emphasis on challenging imaging findings and atypical patterns. • The spectrum of potential pitfalls in pulmonary nodule detection and characterization, including equivocal or atypical presentations, is important for avoiding misinterpretation that can alter patient management.

• Brief review of LCS history and impact, highlighting recently updated guidelines. • Interactive imaging-based approach with teaching points for diagnosis and/or work-up of equivocal cases with challenging imaging findings and atypical presentations on LDCT screening, chest CT and PET/CT imaging. • Discussion and Illustration of main LDCT screening pitfalls and causes of false positive and false negative screening results including, for example, artifacts related to CT technique, inflammatory and post-treatment changes mimicking neoplasm, cystic and cavitary lesions, pleural attached nodules, endobronchial lesions, temporary regression of malignant nodules. • Discussion and Illustration of main PET/CT pitfalls and false positive and false negative findings in the investigation of screen-detected nodules. • Limitations and new directions. • Take-home messages.

The purpose of this exhibit is:- Briefly review the epidemiology of COVID-19 infection and of post COVID-19 CT lungs abnormalities.- Describe and illustrate lung complications related to COVID-19 infection.- Describe post COVID-19 chest CT imaging protocols and technics.- Review the radiological management and follow-up protocols of post COVID-19 pneumonia.- Describe and illustrate the post COVID-19 CT lungs abnormalities, evolution patterns and complications.

1. Introduction: COVID-19 epidemiology review. Post COVID-19 CT lungs abnormalities epidemiology and predictors.2. Lung complications related to COVID-19 infection: Pneumothorax / Pneumodiastinum / Bronchopleural fistula. Co-infecction / superinfection. Vascular complications.3. Post COVID-19 Chest CT protocols.4. Post COVID-19 imaging follow-up: Review of societies recommendations and propositions.5. Key Imaging Findings: Main post COVID-19 CT findings. Imaging evolution patterns. Review of fibrotic-like changes. Post-treatment related complications.6. Take home messages.

The purposes of this exhibit are:1. Make a multimodality-based didactic review of the various chest malformations. 2. Propose a didactic categorization of these conditions in: -Bronchopulmonary malformations. -Malformations of the pulmonary vessels. -Malformations of the thoracic wall and diaphragm 3. Illustrate those conditions based on cases from our chest radiology group.

We will discuss the following congenital chest malformations and focus on their imaging features using a multimodality approach in this exhibit.1. Bronchopulmonary malformations: -Bronchial atresia. -Accessory bronchus. -Bronchogenic cyst. -Congenital lobar overinflation. -Congenital pulmonary airways malformation (CPAM). -Pulmonary sequestration. -Pulmonary aplasia, hypoplasia, and agenesis. 2. Malformations of the pulmonary vessels: -Unilateral absence of the pulmonary artery. -Pulmonary artery sling. -Congenital pulmonary venolobar syndrome.3. Thoracic wall and diaphragm malformations: -Bochdalek hernia. -Morgagni hernia.

The purposes of this exhibit are:To emphasize the importance of basic breast image knowledge for the general and thoracic specialized radiologist when reporting chest CTs;To review mammary anatomy;To illustrate several breast pathologies and its findings in chest CTs from our department in didactic sections to improve understanding.

To review the mammary anatomy:Thoracic wall (ribs and muscles);Mammary lobules and ducts;Areola and nipple;Neoplasms and other tumors:Fibroadenoma;Ductal invasive carcinoma;Metastases to breasts;Breast cancer in male patient;Evaluating local extension and lymphatic spreading;Male breasts;Infections and organized collections:Mammary abscess;Organizing hematomas;Post mammoplasty intramammary hematoma;Industrial silicone injection;Implant-related changes:Intrathoracic migration of breast implant after thoracoscopic surgery;Flipped implant;Postoperative abscess;Intracapsular implant rupture;Implant contraction;Implant-related lymphoma.

In the era of personalized medicine, imaging diagnosis plays an important part as biomarkers of the following items: prediction for pathological diagnosis, prediction for prognosis, prediction for driver oncogenes, evaluation of treatment response, and evaluation of side effects, etc. Imaging is not always perfect, but it can capture the whole image of lung cancer. This education exhibit focuses on CT imaging in lung cancer with driver oncogene mutation / gene translocation positive and quantitative analysis for predicting gene. It is much appreciated if our information would be useful in your clinical and research setting.

1. CT imaging in lung cancer with driver oncogene mutation/gene translocation positive: EGFR (epidermal growth factor receptor) mutation, ALK (anaplastic lymphoma kinase) rearrangement, ROS1 (c-ros oncogene) rearrangement, BRAF (v-raf murine viral oncogene homolog B1) mutation, MET exon 14 skipping-mutation, NTRK fusion, and Others [rearranged during transfection proto-oncogene (RET) fusion, KRAS mutation, and human epidermal growth factor receptor 2 (HER-2) mutation]. 2. CT imaging for an immune checkpoint inhibitor in lung cancer with programmed death ligand 1 (PD-L1). 3. Quantitative analysis for predicting gene: Radiomics approach. 4. Tailor-made medicine: Molecular-targeted therapies for driver oncogene mutations / gene translocations.

1. Although myocardium is typically evaluated with cardiac CT there is an opportunity to identify abnormalities on routine CTs done for other reasons. 2. Attention to myocardial contour, attenuation and enhancement patterns on a routine chest CT can enable detection of previously unsuspected disease.3. Recognition of myocardial abnormalities on routine chest CT will help in early detection of cardiac abnormalities and appropriate management.

Given the widespread use of chest CT, cardiac abnormalities are increasingly being identified on chest CTs often done for other reasons. While several reports have shown the value of incidentally discovered abnormalities (such as coronary anomalies) there is scant literature on myocardial abnormalities. These are challenging to detect, however, attention to this can enable diagnosis of unsuspected disease.The following myocardial abnormalities will be discussed:Attenuation: Differential attenuation between blood pool and myocardium (anemia); Fat deposition (tuberous sclerosis, prior infarct, arrhythmogenic cardiomyopathy, benign); Focal low attenuation (acute myocardial infarction (MI), acute myocarditis); Calcification (old MI, calcified tumor, renal failure) Morphology and enhancement: Thickened with diffuse heterogenous enhancement (infiltrative processes, Loeffler); Focal thickening with abnormal enhancement (acute MI, myocarditis); Normal thickness with focal heterogeneous enhancement (tumor, acute MI); Thinning (chronic MI, aneurysm/pseudoaneurysm) Future directions: Strain, role of artificial intelligence. Pitfalls: Artifacts can simulate myocardial pathology

1) Various diseases of the bronchi can cause acute symptoms and physiologic abnormalities.2) We will apply a systematic approach to analyzing and characterizing bronchial disorders in the emergent setting. These disorders can be grouped into the following categories: endobronchial lesions, bronchiectasis, bronchial wall thickening, and bronchomalacia.3) Post-processing reconstructions should be utilized to better visualize and highlight characteristic imaging features.

Endobronchial lesions-Benign: Aspiration pneumonia, foreign body aspiration, broncholith, pulmonary hamartoma-Malignant: Carcinoid, adenoid cystic carcinoma, mucoepidermoid carcinoma, metastasisBronchiectasis - Cystic fibrosis- Graft versus host disease- Primary ciliary dyskinesia- Infection (e.g., nontuberculous mycobacterium, Pseudomonas aeruginosa)- Allergic bronchopulmonary aspergillosis- Tracheobronchomegaly- Williams-Campbell syndrome- Bronchial atresiaBronchial wall thickening- Bronchial asthma- Relapsing polychondritis- Tracheobronchial amyloidosis- Sarcoidosis- Granulomatous with polyangiitis- Infection (e.g. tuberculosis, Klebsiella)Bronchomalacia Bronchial trauma- Bronchopleural fistula- Bronchomediastinal fistula- Bronchial disruption/rupture

Air trapping is a manifestation of many diverse entities such as infections, aspiration or inhalation of foreign substances, immunologic and connective tissue disorders, and miscellaneous causes. The presence of air trapping is an excellent clue to the diagnosis of small airways disease. Air trapping consists of focal zones of decreased attenuation commonly seen at expiratory thin-section CT scans of the lungs obtained during suspended expiration following a forced exhalation.The goals of this exhibit are to help the learner:1) To review a variety of diffuse lung diseases commonly associated with air trapping2) To emphasize the diagnostic value of volumetric expiratory CT 3) Present radiology-pathology correlation4) Provide and algorithmic approach to a differential diagnosis

1. Introduction. Review Diffuse lung diseases associated with air trapping2. Review the diagnostic value of volumetric expiratory HRCT scans in providing additional significant information in the evaluation of a variety of diffuse lung diseases with suspected airway abnormalities.3. Recognize pathologic mechanisms for air trapping in diffuse lung diseases land their impact on radiologic appearance4. Etiologies of air trapping related to diffuse lung diseases: Infectious Causes, Immunologically mediated, Drug-induced, Toxic/chemical fume inhalation, and miscellaneous causes/associations5. Algorithm to approach air trapping in diffuse lung diseases.6. Conclusion

Mycobacterium tuberculosis infects one third of the world’s population and tuberculosis continues to be a major global public health problem. Imaging diagnosis of tuberculosis is sometimes challenging and complex. The purpose of the exhibit is: 1. To review the etiology of tuberculosis. 2. To describe the imaging features of tuberculosis, including the thoracic region other than the lungs. 3. To discuss the complications and sequelae.

1. The etiology of tuberculosis 2. The imaging findings of pulmonary tuberculosis: primary tuberculosis, postprimary tuberculosis including typical and atypical pattern, bronchial tuberculosis, tuberculoma, and miliary tuberculosis 3. The imaging features and the clinical manifestations of complications and sequelae: lung parenchyma, airways, blood vessels, mediastinum, pleura, chest wall 4. The differential diagnosis 5. Summary

To review the pathophysiology, histopathology, and imaging manifestations of thoracic and abdominal tropical diseases.To mention the imaging patterns of parasitic tropical diseases with their histological correlation.To conceptualize the role of imaging in the diagnosis of tropical diseases.

1. Introduction2. Tropical diseases classification and physiopathology.3. Epidemiology and Imaging findings of tropical diseases in computed tomography and its pathological correlation of:a. Parasites:I. Helminth Infections:1. Ascariasis2. Echinococcosis3. Paragonimiasis4. Strongylodiasisii. Protozoal Infections:1. Amebiasis2. Leishmaniasis3. Chagas disease4. Malariab. Bacterial:i. Salmonellosisii. Tuberculosisc. Fungal:i. Paracoccidiomycosisd.Viral:i. Dengue fever4. Conclusions.

- To review the main causes of calcified mediastinal lymph nodes- To review conditions other than calcified lymph nodes that can cause high attenuation lesions in the mediastinum compartments

All radiologists are used to describing calcified mediastinal lymph nodes. We will discuss several other conditions that may present with a high-attenuation pattern in the mediastinum: - Calcified lymph nodes: a)Healed granulomatous infection b)Sarcoidosis c)Chronic silicosis - Calcified masses a)Thyroid pathologies b)Germ cell neoplasm c)Calcified mediastinal cysts d)Healed lymphoma - Calcified tissue involving mediastinal structures: a)Inflammatory pseudotumor b)Fibrosing mediastinitis c)Tracheobronchial amyloidosis - Other conditions: a)Pitfalls: azygos vein contrast, contrast inside lymphatic ducts b)Foreign body: device embolism, aspiration

To provide a brief overview of the fundamental classic radiologic and histologic findings of sarcoidosis. To demonstrate and discuss the others presentations of thoracic sarcoidosis that are outside the usual. To illustrate the correlation between radiological and histological findings, focusing on atypical cases.

Besides thoracic sarcoidosis's common findings (bilateral hilar lymph node enlargement, micronodules with a perilymphatic distribution, fibrotic changes, and bilateral perihilar opacities), one must remember its atypical manifestations and the possibility of concomitance with lung abnormalities of another nature. We will review the most common thoracic sarcoidosis presentations in this educational exhibit, as well as illustrate and describe atypical manifestations and complications. When pertinent, we will also include radiology-pathology correlation for the cases.

1) To explain the basic principles of lung perfusion assessment using dynamic chest radiography (DCR) 2) To discuss the advantages of DCR compared to other imaging modalities 3) To review multiple, specific clinical applications of DCR for pulmonary vascular diseases and compare them with other imaging modalities

1) Basic principles of DCR •System composition •Acquisition techniques 2) Different acquisitions of DCR imaging •Lung perfusion images •Lung ventilation images 3) Different methods of DCR lung perfusion imaging •Cross-correlation method •Reference frame-subtraction method 4) Advantages compared to other imaging modalities •Readily available •No need for contrast media or radionuclides •Non-invasive •Low radiation exposure •Cost-effective 5) Clinical applications and correlation with other imaging modalities •Pulmonary arterial diseases - Acute pulmonary thromboembolism - Chronic thromboembolic pulmonary hypertension - Pulmonary arteriovenous malformation - Pulmonary arterial stenosis/occlusion •Pulmonary venous diseases - Partial anomalous pulmonary venous return - Pulmonary venous stenosis/occlusion 6) Limitations

Dynamic low dose evaluation of the airway with Digital Tomosynthesis (DTS) and Dual Source Computed Tomography can be used to monitor complex airway pathologies and airway devices. Having an institution-speci&7;c DTS may reduce use of CT imaging, loweringcost and radiation exposure. Dynamic DSCT imaging decreases radiation dose to conventional CT acquisition

1. An introduction to Digital Tomosynthesis and dynamic DSCT: Acquisition and Current Uses2. Case 1: 37-year-old male with post-intubation stricture—we discuss how the stenotic airway is poorly visualized by conventional radiograph, yet can be readily visualized using DTS.3. Case 2: 28-year old female with post-intubation stricture. We demonstrate how can provide a functional assessment of the airways by imaging the trachea in both the inspiratory and expiratory phase post-dilation4. Case 3: 67-year-old male with NSCLC complicated by malignant tracheal stenosis. We will see that DTS allows for visualization of an intraluminal mass.5. Case 4: 57 year old female with malignant stricture s/p stent placement with recurrent airway obstruction. DTS enabled low dose evaluation and monitoring of therapeutic interventions.6. Case 5: 72-year-old male with left lung transplant for usual interstitial pneumonia status post endobronchial stent placement. We show how DTS enables visualization of the endobronchial stent in both inspiration and expiration, again enabling one to monitor stability of airways and associated devices while avoiding the cost and radiation of CT imaging.7. Discussion

Purpose Identification of anatomic structures in the chest on 2D conventional chest radiography may be challenging for new trainees. Due to the subtlety of pleural lining on CT, the concepts of expanded, effaced, or obliterated pleural borders on interaction with the mediastinum may be difficult to understand with radiographic and cross-sectional imaging correlation. 3D cinematic rendering, which can accentuate the draping effects of pleural borders, may provide a novel way to understand classic chest radiography. Teaching Points• Identify the anatomic structures in the chest that create the classic “lines and stripes” on chest radiography though the assist of 3D cinematic rendering (CR) depictions.• Recognize the abnormal appearances of the borders on CXR, and the corresponding appropriate pathologies in the differential diagnosis through a case-based teaching series.

Outline1. Normal pleural anatomy and mediastinal borders. 2. Anterior Junction Line. a. Anterior mediastinal mass differential. 3. Posterior Junction Line. a. Posterior mediastinal mass differential. 4. Aorto-pulmonic relationships. a. AP stripe AP window differential. 5. Paraspinal Lines. a. Right left paraspinal line differentials. 6. Posterior tracheal stripe differentials. 7. Azygosesophageal recess differentials

To guide clinical application of US-guided percutaneous needle biopsy (PCNB) for thoracic lesions.

1. Introduction of US-guided percutaneous needle biopsy (PCNB) - Indications - Advantages and limitations 2. US images of thoracic lesions - Subpleural lung lesions - Pleural lesions- Bony thorax lesions- Anterior mediastinal lesions- Soft tissue lesions 3. Procedure of US-guided PCNB - Localization of the lesion - Risk evaluation- Determination of the target - Acquisition of the tissue- Evaluation of immediate post-procedural complication4. Diagnostic performance and complication rate of US-guided PCNB - Diagnostic yield - Complication rate - CT guided vs. US guided PCNBPlease visit the Learning Center to also view this presentation in hardcopy format.

1) To define the characteristics of lung nodules amenable to image-guided localization before video-assisted thoracoscopic surgery (VATS) resection.2) To explain the advantages, disadvantages, and techniques of the different modalities available in the localization of lung nodules prior to VATS resection.3) To review the results of the different modalities available for the localization of lung nodules before VATS resection. Particular focus on new techniques: Radioactive tracer injection (ROLL) and radioactive seed placement.

1. Introduction.2. Lung nodules amenable for image-guided localization before VATS resection.3. Currently available modalities for lung nodule localization.3.1. Preoperative.3.1.1. Hookwire placement. 3.1.2. Microcoil placement. 3.1.3. Dye injection. 3.2. Intraoperative.3.2.1. Ultrasound. 3.3. Mixed.3.3.1. Radioactive seed placement. 3.3.2. Radioactive tracer injection (ROLL). 4. Comparative results.4.1. Detection rate.4.2. Conversion to thoracotomy rate.4.3. Complications.5. Summarize.6. Conclusion.

1. Paragangliomas (PGL) within the thorax: where do they occur and in whom? Experience from a specialist centre2. Multimodality imaging features of thoracic PGLs: strengths and challenges of imaging modalities; lessons from missed lesions3. Considerations for management and recommendations for screening and surveillance

1. Thoracic PGLs - what the general radiologist needs to knowa. Overview of pathophysiologyb. Succinate Dehydrogenase deficiency disordersc. Summary of literature - anatomical location and clinical presentation2. Our cohort of 17 thoracic PGL cases - two decades’ experience in a specialist centrea. How the PGLs are identified: screening vs. surveillance vs symptomatic b. Locations of PGLs within the mediastinum: i. Superior ii. Anterior iii. Middle 1. Cardiac iv. Posterior v. Correlation symptoms and biochemistry c. Discussion of management: i. Surgical considerations ii. Medical including radionuclide therapy3. Radiological lessons:a. Common imaging findings i. CT - including cardiac CT ii. MRI - whole body, cardiac MRI iii. Functional imaging - Gallium Dotatate PET, FDG PET, MIBG SPECT, Octreotide iv. Plain radiographb. Key differential diagnosisc. Learning from errors: which imaging modalities are PGLs most frequently missed on? What do we learn when we look back in retrospect?4. Recommendations for imaging screening and surveillance

Numerous medical conditions have multiorgan imaging findings. Here, we review specifically the ocular and cardiothoracic findings of selected infectious, inflammatory, autoimmune, neoplastic, and hereditary disorders. These correlations are meant to remind the astute clinician that certain ophthalmologic signs should trigger a careful radiologic evaluation that includes imaging of the head and chest.

1. Introduction. 2. Examples of cases: a. Infectious conditions: aspergillosis, nocardiosis, COVID-19. b. Inflammatory conditions: sarcoidosis, IgG-4 sclerosing disease. c. Autoimmune conditions: Graves’ disease, scleroderma, Sjogren’s syndrome. d. Neoplastic conditions: uveal melanoma, lymphoma, lung cancer. e. Hereditary conditions: Marfan syndrome, Ehlers Danlos syndrome, tuberous sclerosis, neurofibromatosis type 1. 3. Conclusion.

1. To review the anatomy and embryology of the systemic thoracic veins. 2. To describe imaging findings in congenital anomalies of the systemic thoracic veins (CASTV). 3. To emphasize the physiologic consequences of these anomalies, and their impact in associated congenital heart diseases surgery.

Congenital anomalies of the systemic thoracic veins are commonly underdiagnosed, in part because they are often asymptomatic or have little or no clinical consequences. They are frequently discovered as an incidental finding in a radiological examination for unrelated reasons, but sometimes are diagnosed because an anomalous course of a central venous line or during a systematic study for congenital heart disease. In certain cardiac or thoracic surgical procedures it is of prime importance to diagnose these anomalies to prevent surgical failure or complications. Pulmonary venous anomalous connections to the systemic thoracic veins and Raghib syndrome can be symptomatic and diagnosed at early age or be discovered in adulthood in patients with right heart dilatation or cardiac symptoms. Besides azygos lobe, a well-known normal variant, the most common CASTV include: 1. Persistent left superior vena cava (SVC) (with or without absent right SVC). 2. Left superior intercostal vein variants. 3. SVC aneurysm. 4. Pulmonary venous anomalous connections to the SVC. 5. Absent inferior vena cava with an enlarged azygous vein. 6. Persistence of the levoatriocardinal vein. 7. Persistent left SVC with absence of the coronary sinus (Raghib syndrome). 8. Subaortic innominate vein. We describe the embryology, anatomy, physiology, imaging findings, and potential complications of these anomalies.

1. Cinematic Rendering provides unique 3D capabilities allowing for detailed analysis of complex soft tissue and vascular anatomy allowing for improved analysis of chest and mediastinal pathology2. Cinematic rendering is especially valuable for evaluation of complex vascular pathology ranging from aortic dissection to aneurysm as well as coarctation of the aorta and coronary artery anomalies3. 3D mapping is an important tool for transmitting critical information to the referring physician and the patient care team4. complex anatomy defined with cinematic rendering is helpful in pre-operative planning and in analyzing complex structures for robotic surgery5. Cinematic Rendering is a helpful tool for teaching residents and fellows in complex cases of vascular anatomy and anomalies

1.CT protocols for optimizing data acquisition for 3D mapping2. protocols and techniques used for Cinematic Rendering including the use of presets to optimize workflow and throughput3. representative case studies are presented using axial, multiplanar, MIP and Cinematic Rendering to show how we use the technique in clinical practice. The advantages of Cinematic Rendering in select clinical applications will be discussed4. case studies will be divided into section incuding;a. vascular anatomy and anomaliesb. aortic aneurysm including dissection, intramural hematoma, ulcerations and active bleedingc. congenital anomalies including coarctation of the aorta and arch anomaliesd. cardiac pathology including cardiac tumors including atrial myxoma and angiosarcoma, and coronary artery fistulae e. mediastinal masses that involve or are in close proximity to key vascular structures

Review of the pathophysiology and categorization of pulmonary vascular diseases. Describe imaging patterns on CT and traditional angiography. Analyze common and uncommon etiologies with a case-based review.

This presentation aims to discuss imaging findings in the diagnosis and categorization of pulmonary vascular diseases including acute pulmonary embolism, chronic thromboembolic pulmonary hypertension, pulmonary arteriovenous malformation, venous anomalies and mimics, hereditary hemorrhagic telangiectasia, granulomatous with polyangiitis, and microscopic polyangiitis. We will explore the spectrum of chest CT findings within the pulmonary vasculature, parenchyma, airways, mediastinum, and heart that help the radiologist narrow down the differential diagnosis. We will provide a review of the diagnostic criteria and key imaging findings, correlated with physiopathology and current categorization. We will also include a discussion of pros and cons of the currently available diagnostic tools and an update of the most recent imaging technical advancements. Additionally, a case-based review exemplifies common and uncommon pulmonary vascular pathologies.

? To review the spectrum of pulmonary vascular diseases and imaging features ? To review the clinical presentation associated with each pulmonary vascular disease

Pulmonary embolism, chronic thromboembolic pulmonary hypertension (CTEPH), pulmonary arterial hypertension (PAH), pulmonary arteriovenous malformations (PAVM), Portopulmonary hypertension, cavopulmonary pulmonary artery aneurysm/pseudoaneurysm, bronchial artery aneurysm/pseudoaneurysm, tumor thrombotic microangiopathy, in situ pulmonary artery thrombosis after receiving radiation therapy, pulmonary artery angiosarcoma, tumoral invasion of pulmonary artery or vein, pulmonary vein thrombosis, cement embolism, pulmonary vein varix, pulmonary veno-occlusive disease, pulmonary capillary hemangiomatosis, pulmonary sequestration, abnormal pulmonary venous return, pulmonary vasculitides.

To describe imaging findings in Pulmonary Embolism (PE) at different imaging modalities. To underline advantages and limitations of these techniques and to define the clinical scenarios in which they are key in patient management.

After a short introduction about PE etiology and incidence, we review PE imaging findings at different non-invasive techniques.We organize PE typical imaging findings as: Chest Radiography, Chest Ultrasound, CT Angiography, Spectral CT, Cardiac MR, V/Q (ventilation/perfusion) scan.We discuss advantages and limitations of these imaging modalities as the potential differential diagnosis. We analyze the differences between acute and chronic PE, focusing especially on Spectral CT findings. We evaluate the impact of these imaging techniques on patient prognosis, especially focusing on CT and cardiac MR. ConclusionsOUTLINE PE represents a lifetreathing condition with a challenging diagnosis. Radiologists should be familiar with PE findings at all imaging modalities that may be key in patient management and treatment.

To explain the basics and technique of dual-energy CT (DE-CT) and cone-beam CT (CB-CT), specifically during the management of patients with chronic thromboembolic pulmonary hypertension (CTEPH). To describe the imaging findings observed in the newly available imaging modalities: DE-CT and CB-CT in patients with CTEPH, with correlation with digital subtraction angiography (DSA).To explain the current role of DE-CTA and CB-CTA in the diagnosis, treatment and follow-up of patients with CTEPH.

1.- Introduction. 2.- Basic concepts of DE-CT and CB-CT. 2.1.- DE-CT basics and technique in the study of CTEPH. 2.2.- CB-CT basics and technique in the study of CTEPH. 3.- DE-CT and CB-CT in the diagnosis of suspected CTEPH. 3.1.- Added value compared to conventional CT and DSA. 3.2.- DE-CT imaging findings. 3.3.- CB-CT imaging findings. 3.4.- Correlation with DSA. 4.- DE-CT and CB-CT in the planning of invasive treatment for CTEPH. 4.1.- DE-CT and CB-CT in the planning of pulmonary endarterectomy. 4.2.- DE-CT and CB-CT in the planning of balloon pulmonary angioplasty. 4.3.- Added value of both techniques compared to conventional CT and DSA. 5.- Postprocedural CB-Ct ad DE-CT imaging findings. 5.1.- Normal spectrum of post-BPA and post-PEA imaging findings. 5.2.- Complications of BPA and PEA. 5.3.- Post-procedural imaging follow-up. 6.- Role of DE-CT and CB-CT in the long-term follow-up of patients with CTPEH. 7.- Current scientific evidence and status of both techniques in established diagnostic algorithms. 8.- Summarize. 9.- Conclusion.

A wide spectrum of pathologies in the paediatric population can present as cystic lesions in the thorax. Imaging findings on chest radiography and computed tomography (CT) can provide diagnostic clues to the aetiology. Evolution of imaging findings on serial imaging can provide crucial diagnostic clues.

? Introduction ? Overview and classification of the cystic lesions in the paediatric chestClassification based on aetiology: Congenital cystic lesions - Congenital pulmonary airway malformation/ Hybrid lesion, Bronchogenic cyst, Cystic lung disease in neuro-cutaneous syndromes [Tuberous Sclerosis, Neurofibromatosis-1 (NF-1)], Syndromic cystic lung disease (Down’s syndrome, Birt-Hogg-Dube syndrome)Acquired cystic lesions - Post infective- tuberculosis, pneumatocele, Diffuse lung disease-Lymphangioleiomyomatosis and Langerhans cell histiocytosis, Broncho-pulmonary dysplasia (BPD), End-stage Interstitial lung disease (ILD)/Diffuse lung disease (DLD), Post traumatic pneumatoceleMimics - Bronchiectasis, Pulmonary interstitial emphysema, Emphysema (alpha 1 antitrypsin deficiency)Classification based on pattern:Single simple cyst - Bronchogenic cyst, Post traumatic pneumatoceleSingle complex/ conglomerated cysts - Congenital pulmonary airway malformation/ Hybrid lesionMultiple bilateral cysts - Post infective- tuberculosis, pneumatocele, Diffuse lung disease-Lymphangioleiomyomatosis and Langerhans cell histiocytosis, BPD, End-stage ILD/DLD, Cystic lung disease in neuro-cutaneous syndromes (Tuberous Sclerosis, NF-1), Syndromic cystic lung disease (Down’s syndrome, Birt-Hogg-Dube syndrome)

Tracheal neoplasms are rare, with less than 10% of these lesions considered benign. The radiologist is in a unique position of often being the first health team member to encounter these lesions.The objectives of this exhibit are:1. Discuss epidemiology of tracheal neoplasms2. Review the clinical and imaging presentation of some of the most common benign and malignant tracheal neoplasms. 3. Familiarize the radiologist with entities that act as mimics or pitfalls in the evaluation of the trachea

1. Benign Tracheal Neoplasms a. Tracheal Papilloma b. Hemangioma c. Paraganglioma d. Chondroma e. Hamartoma f. Neurogenic tumors 2. Malignant Tracheal Neoplasms a. Metastases b. Direct Invasion c. Squamous Cell Carcinoma d. Adenoid Cystic Carcinoma e. Mucoepidermoid Carcinoma f. Carcinoid Tumor g. Chondrosarcoma

Briefly review the main connective tissue disorders (CTD) typical clinical presentations and laboratory findings, and the expected pattern of interstitial lung disease (ILD) for each CTD;Introduce the readers to interstitial pneumonia with autoimmune features (IPAF);Recognize the most typical imaging features of ILDs and other thoracic manifestations of CTDs;Highlight the role of the radiologist in differential diagnosis and detecting complications.

INTRODUCTION: Connective tissue disorders (CTD) and their relation with interstitial lung diseases (ILD); CTD key points to diagnosis; Interstitial pneumonia with autoimmune features - when ILD takes the spotlight.IMAGING FINDINGS: Step by step approach and algorithm to evaluate connective tissue disease associated with interstitial lung disease (CTD-ILD); CTD-ILD: major patterns of involvement and suggestive signs at Chest CT; Other thoracic manifestations of connective tissue diseases.DIFFERENTIAL DIAGNOSIS AND COMPLICATIONS;TAKE-HOME MESSAGES

Tracheobronchial neoplasms are much less common than lung parenchymal neoplasms but can be associated with significant morbidity and mortality. They include a broad differential of both benign and malignant entities, extending far beyond more commonly known pathologies such as squamous cell carcinoma and carcinoid. Airway lesions may be incidental findings on imaging or present with symptoms related to airway narrowing or mucosal irritation, invasion of adjacent structures, or distant metastatic disease. While there is considerable overlap in clinical presentation, imaging, and bronchoscopic appearances, an awareness of potential distinguishing factors may help narrow the differential diagnosis. The authors review the epidemiology, imaging characteristics, typical anatomic distributions, bronchoscopic appearances, and histopathology of a wide range of neoplastic entities involving the tracheobronchial tree. Special attention is paid to any distinguishing features.

1. Primary malignant tumors: squamous cell carcinoma, malignant salivary gland tumors (adenoid cystic carcinoma and mucoepidermoid carcinoma), carcinoid, sarcomas, primary tracheobronchial lymphoma, and inflammatory myofibroblastic tumor. 2. Secondary malignant tumors (direct invasion or hematogenous spread). 3. Benign neoplasms: hamartoma, chondroma, lipoma, papilloma, amyloid, leiomyoma, neurogenic lesions, and benign salivary gland tumors (pleomorophic adenoma and mucous gland adenoma).

1. Usual Interstitial Pneumonia (UIP) is the most common histologic pattern of fibrosis and has typical imaging findings on HRCT. 2. UIP is an imaging/histologic diagnosis while Idiopathic Pulmonary Fibrosis (IPF) is a multidisciplinary diagnosis. 3. While most patients with UIP pattern of fibrosis are diagnosed with IPF, this imaging pattern can be seen in other settings such as connective tissue related disease, hypersensitivity pneumonitis, asbestosis, vasculitis, familial pulmonary fibrosis, and drug reaction

1. Distinguish UIP from IPF 2. Review histologic and imaging patterns of UIP; review updated 2022 ATS criteria diagnosis for IPF. 3. Explore the differential diagnosis for UIP and associated imaging findings including IPF, connective tissue disease, hypersensitivity pneumonitis, asbestosis, vasculitis, familial pulmonary fibrosis, and drug reaction. 4. Present multidisciplinary approach to UIP including the clinical presentations and serologic markers that can aid the radiologist.

1. Provide a foundation for the clinical diagnosis of CTDs that may present with ILD including symptomatology and serologic markers. 2. Describe the radiologic and pathologic patterns of CTD-ILD 3. Review helpful imaging signs in the diagnosis of CTD-ILD. 4. Discuss idiopathic pneumonia with autoimmune features (IPAF). 5. Review the specific prognosis and management of CTD-ILDs, with comparison to ILDs secondary to other causes.

CTD-ILD represents an underdiagnosed subset of ILDs. The imaging appearance of CTD-ILDs can often precede the rheumatic signs with interpretation of these cases difficult for even experienced radiologists. The literature on CTD-ILD has progressed over recent years, underscored by the emergence of new diagnostic criteria and characteristic imaging patterns. This presentation will provide the radiologist with a comprehensive framework to best facilitate diagnosis and guide management of these diseases.This exhibit is designed for residents, fellows, as well as general and thoracic radiologists. The primary goal is to achieve better understanding of clinical and imaging features of various CTD-ILDs, drawing from our large multicenter patient database. 1. Clinical features of CTDs manifesting with ILD. 2. Pathophysiology of CTD-ILDs. 3. CT imaging characteristics of CTD-ILDs, including imaging signs. 4. Prognosis and management of CTD-ILDs.

Introduction Pulmonary abnormalities on computed tomography (CT) in women with breast cancer may be secondary to pulmonary metastases, radiotherapy or systemic treatment of the primary tumor or metastases, increased prevalence of other cancers, or be due to an unrelated cause. In this exhibit we review the range of pulmonary abnormalities seen on CT and present representative cases illustrating the value of multidisciplinary discussion based on weekly oncology tumor board meetings at out institution and systematic follow-up of all patients.1) To review the typical and atypical manifestations of pulmonary metastases at presentation and with progression or improvement. 2) To illustrate the CT findings of pulmonary complications related to treatment including radiation, chemotherapy, hormone therapy, targeted therapy and immunotherapy. 3) To discuss the differential diagnosis of unrelated pulmonary abnormalities that may affect management. 4) To highlight the importance of multidisciplinary discussion in reaching a timely diagnosis.

1) Introduction; 2) Spectrum of manifestations and types of response of pulmonary metastases; 3) Pulmonary complications of radiotherapy; 4) Pulmonary complications of systemic therapy; 5) Unrelated pulmonary conditions; 6) Conclusions.

Review the appropriate technique and parameters to perform chest ultrasonography. Describe the normal anatomy of the chest wall, pleura, and lung parenchyma in ultrasound imaging, its pearls, and pitfalls. Illustrate the most common imaging findings in ultrasound of the pathologies involving the chest wall, diaphragm, pleura, and lung parenchyma.

IntroductionChest ultrasound techniqueAnatomy of the chest wall, pleura, and lung parenchyma in ultrasound.Common imaging findings in the pathology of:Chest Wall and diaphragm Diaphragm paralysisNeoplasic involvementPleuraPleural effusionPneumothoraxPleural thickeningLung ParenchymaAtelectasisConsolidationPulmonary edemaPulmonary nodulesConclusion

The audience will learn about the applied art and science in suboptimal chest radiographs (CXRs): 1. Various causes of suboptimal CXRs with case-based illustration 2. Impact of suboptimal CXRs: The missed and misinterpreted findings 3. How parallel suboptimality affects the representation of art: Connecting CXR illusions with artistic allusions 4. Where and how artificial intelligence (AI) helps in mitigating suboptimal CXRs

The four-part exhibit will begin with case-based illustrations of what makes CXRs suboptimal and/or rejected for repeat acquisition. The second part will illustrate the impact of suboptimality on CXR findings including the missed and misinterpreted ones. In the third part, the presenting authors will use their own self-drawn, painted artwork to highlight how suboptimality affects the representation of art and interpretation of suboptimal CXRs. The final part informs about the role of AI in mitigating suboptimal CXRs. The free-to-share and display exhibit will help raise awareness about suboptimal CXRs and inspire a positive downward trend in suboptimal CXR frequency which according to some exist in as much as 90% of all CXRs.Please visit the Learning Center to also view this presentation in hardcopy format.

-Studies have shown some areas of radiology have miss rates and (false negative) and false-positive rates as high as 30% of daily reads. -Errors have a significant impact on patient care and increase healthcare costs and burdens. -Perceptual errors can be due to errors in scanning, recognition, or decision. -Identifying and understanding the causes of perceptual errors, increasing awareness amongst trainees, and improving educational models can improve detection and localization accuracy. -Perceptual training algorithms geared toward the reduction of perceptual errors may be a useful adjunct to conventional radiology training.

-Different types of diagnostic errors in radiology and their frequency -What radiologists need to know about perceptual errors in the setting of cardiothoracic imaging. -Table demonstrating different types of perceptual errors in radiology, definitions, and potential means to overcome them.

Fistulous tracts in the thorax can involve a number of different spaces and have multiple causes.These unusual communications are hard to depict well, and when only standard imaging protocols are used they are often overlooked or misinterpreted.Imaging acquisition techniques and tips can be used to alter the common protocols and demonstrate these tracts more conspicuously.

Acquired and congenital fistulous tracts of the thoracic region often pose significant diagnostic difficulties to the radiologist. Multiple spaces can be involved, such as the tracheobonchial tree, pleural space, the digestive tract (such as the esophagus and stomach), the lymphatic and the circulatory systems; and many etiologies can be the culprit, such as infectious or inflammatory diseases, neoplasms, surgical and medical procedures, and so on. This presentation is a series of cases, by no means exhaustive, of the many fistulous tracts within the thoracic region, some of which with an unusual presentation. Tips and techniques of imaging acquisition are presented, in order to help better depicting these conditions.

Advances in CT technology and computer processing technology have made it easier to perform precise morphological disassembly and automatic extraction and volume measurement of anatomical structures. In the diagnosis after lobectomy, morphological changes such as thoracic deformity, pleural thickening, organizing pleural effusion, lung parenchyma, bronchi, and pulmonary arteries and veins can be analyzed. In particular, ultra-high-resolution CT (UHRCT) with improved spatial resolution can perform morphological measurement more precisely than conventional CT, so in addition to changes in the anatomical position of each lobe and the volume of the remaining lobe before and after excision.

Equipment and method: UHRCT (Aquilion Precision, SHR mode), inspiratory / expiratory imaging. Workstation (Ziostation 1K).Results: It was possible to calculate the spatial position of the residual lobe and the ventilation volume for each lobe. By automatic extraction of the bronchial tree, it was possible to depict 3-dimensional expansion and flexion.Bronchial flexion case: Right upper lobectomy. There is an air trapping in the middle lobe. Decreased ventilation of the middle lobe located at the apex of the lung, and flexion and stenosis of the bronchus at the expiratory phase were confirmed.Adhesion case: Partial resection of the right upper lobe. Extensive adhesions due to pleural dissemination. Ventilation of the middle lobe is restricted. The bronchus was confirmed to be patency.Summary: UHRCT is excellent for bronchial morphological analysis. Inspiratory and expiratory CT can be used to analyze changes in bronchial morphology, movement and rotation of the lobes.

The purposes of this exhibit are: Examine the most common cardiovascular devices seen on chest radiographs. Describe each cardiovascular device, including its proper location, components, types, and major complications. Illustrate those cardiovascular devices, using both usual and unusual cases from our chest radiology group.

This exhibit will go over various cardiovascular devices that can be seen on a chest x-ray. The anticipated correct position, as well as the major complications associated with those devices, will be detailed and illustrated. Cardiac devices: - Pacemaker.- Ventricular assist device.-Occlusion devices.- Mitraclip.- Valve prosthesis.- Loop event recorder.Vascular devices: - Central venous catheter. - Port-a-cath. - Swan-Ganz catheter. - Intra-aortic balloon pump. - Extracorporeal membrane oxygenation (ECMO). - Exogenous material embolized.

- Thoracic lesions can have a wide variety of differential diagnoses. - Chest magnetic resonance imaging (MRI) can be helpful for narrowing down the different etiologies when lesions detected in other imaging methods demonstrate nonspecific features. - Chest MRI is an increasingly available method that uses no ionizing radiation and has sufficient spatial resolution for a number of usages.

Chest MRI is a widely underappreciated imaging modality, despite its large applicability in the evaluation of abnormalities of cardiovascular origin, of the mediastinum, the pleural space, the brachial plexus, the chest wall and even the lung parenchyma. It is thought that a broader usage of chest MRI is discouraged by the motion artifacts generated by cardiac and respiratory motions and the low signal-to-noise ratio yielded by the large amount of air in the lungs. However, there is great value in utilizing the multiple resources offered by MRI, such as T1, T2, diffusion, in-phase and out-of-phase sequences in order to narrow down the differential diagnoses of lesions found through other imaging methods such as computerized tomography (CT). MRI quality and availability is continuously increasing over the years, so radiologists are facing these diagnostic dilemmas more and more frequently, and knowledge of the behavior of thoracic lesions on MRI is also increasingly important. In this work, we intend to demonstrate how the resources offered by chest MRI can be used to narrow down the differential diagnoses of different thoracic lesions.

1) To review the spectrum of clinico-radiological features of pleural diseases2) To discuss the clinico-radiological key findings in the differential diagnosis

1) Clinical findings of pleural diseases2) Illustrated findings of the following pleural anatomy and diseasesl Normal variants (incomplete fissure, accessory fissure)l Asbestos pleural diseases (pleural plaque, pleural mesothelioma)l Inflammatory and infectious diseases (fibrinous pleuritis, TB/actinomycotic empyema)l Pleural tumors (solitary fibrous tumors, neurogenic tumors, desmoid-type fibromatosis)l Lymphoproliferative diseases (pyothorax associated lymphoma, methotrexate-associated lymphoproliferative disorders)l Miscellaneous (thoracic endometriosis, talc pleurodesis)3) Clinico-radiological key findings in the differential diagnosis

Discuss the physiopathology, epidemiology, and clinical manifestations of pulmonary tuberculosis (PTB). Learn to recognize the atypical distribution of small nodules and uncommon patterns of PTB. Review and illustrate imaging findings. Discuss the main differential diagnosis.

Comprehensive review of pulmonary tuberculosis: pathogenesis; epidemiology; clinical manifestations. Atypical distribution of small nodules and uncommon patterns clusters of non-coalescent small nodules; coalescent small nodules - Galaxy sign; nodular reversed halo sign; subpleural nodules and fissural nodularity; halo sign; mass-like consolidation; pulmonary artery pseudoaneurysm - Rasmussen’s aneurysm; tracheobronchial abnormalities; endogenous reactivation. Main differential diagnosis.

A variety of systemic diseases may affect both the nervous system and the thorax, while other diseases primarily affecting the thorax may manifest with neurological abnormalities. Correlations of signs, symptoms, and imaging findings in the neurological system with those in the thorax can help guide further diagnostic work-up and treatment. We will illustrate the imaging appearance of several systemic/neurological diseases with thoracic manifestations as well as discuss conditions in the thorax that can lead to neurologic symptoms.

Inflammatory: Sarcoidosis Dermatomyositis/polymyositis IgG4 disease Infectious: COVID-19 Tuberculosis Invasive fungal infection Syphilis Malignancy: Myasthenia gravis and thymic abnormalities Meningioma with intrathoracic metastases Paraganglioma Vascular: Vasculitis (Giant Cell Arteritis and Takayasu Arteritis) Congenital: Tuberous sclerosis Hereditary hemorrhagic telangiectasia Neurofibromatosis type 1

1-Discuss the role of radiology in postoperative thoracic evaluation. 2-Review normal postoperative findings of most common thoracic surgeries, such as lung ressections: segmentectomy, lobectomy, and pneumonectomy. 3-Recognize the imaging findings related to postoperative complications and what is important to report. 4-Highlight the radiologist role in decision-making within a multidisciplinary team when assessing thoracic surgery early and late outcomes.

1-Introduction: basic concepts on thoracic surgery (most common techniques and clinical scenarios, purpose / goals, highlights of operative technique). 2-CT protocols available and importance of x-ray analysis.3 - Normal postoperative findings (acute and chronic): Surgical threads; Band atelectasis and fibrotic streaks; Mediastinal and diaphragm shift; Compensatory remanescent lung hyperinflation; Pneumothorax (small); Pleural effusion (small or non-loculated).4-Postoperative complications and its findings: Empyema; Bronchopleural fistula; Re-expansion pulmonary edema; Airway and / or vascular stenosis or compressions; Kinking of bronchial branch; Post bronchoplasty bronchial stenosis (telescoping); Pulmonary torsion; Postpneumonectomy syndrome; Inadvertent pulmonary vein clamping; Hilar hematoma; Pulmonary hernia.

1. To understand appropriate image modalities for anterior mediastinal masses (AMM). 2. To understand common differential diagnosis of AMM. 3. To understand key image finding in differential diagnoses of AMM.

1. Appropriate selection of image modalities for AMM a. Role of chest radiograph, CT, and MRI b. Additional imaging options (Dual-energy CT, PET/CT, SPECT) 2. Anatomy of mediastinum a. Mediastinal compartment suggested by Felson b. Cross sectional mediastinal compartment suggested by ITMIG c. Common lesions in each compartment 3. Review of 5Ts a. Thymic epithelial tumors: Top of differential of AMM? b. Thyroid tumor: Is MRI helpful? c. Teratoma: Macroscopic fat, when it’s malignant? d. Terrible lymphoma: Why terrible? e. Thoracic aorta: not neoplastic, though f. Are 5Ts common as AMM? 4. Beyond 5Ts: More practical DD of AMM than 5Ts a. Lymph nodes b. Benign mediastinal lesions (Thymic cyst/pericardial cyst) • Unilocular vs multilocular thymic cyst • Morgagni hernia c. Normal/hyperplastic thymus • Normal morphology of thymus • What is “normal” thymus for age and sex • True vs lymphoid hyperplasia d. Ectopic thyroid lesion 5. Key image features useful in differential a. CT density and MRI signal density on T1 and T2WI b. Solid vs cystic c. Microscopic and macroscopic fat d. Detection of calcification e. Diffusion weighted images/ADC map f. FDG uptake on PET/CT g. Iodine and fat quantification on DE-CT 6. Summary

1. Pulmonary barotrauma is typically diagnosed on imaging and can be associated with increased mortality therefore it is important to recognize and promptly manage barotrauma. Critical to diagnosis is a high suspicion especially in those at high risk.2. In addition to common imaging findings (pneumomediastinum, pneumothorax, pneumoperitoneum, and subcutaneous emphysema), few uncommon findings (pneumopericardium, broncho-pleural fistula, tension lung cyst, subpleural air cyst and air embolism) may be present.

1. Discuss definition, possible mechanisms and etiologies associated with pulmonary barotrauma.2. Epidemiology of barotrauma in different clinical scenarios.3. Illustrative cases showing common and uncommon manifestations of barotrauma.4. Briefly discuss clinical features, the prevention, diagnostic evaluation, and management of barotrauma.

CT is the best non-invasive imaging modality to evaluate the trachea and its potential diseases. Most tracheal diseases cause stenosis and have different causes and treatments. The knowledge of their specific features in CT helps to approach the diagnosis.

Objectives To review tracheal diseases and their characteristic features on CT. To describe normal variants of the tracheobronchial tree.Findings: A CT image-based quiz will lead the review of:Normal Variants: The knowledge of the non-pathological variants of the tracheobronchial tree will avoid mistakes. The most frequent anatomical variants are tracheal bronchus and accessory cardiac bronchus.Tracheal pathology: Tracheal diseases are congenital or acquired and can be diffuse or focal. Most of them cause tracheal stenosis in asymptomatic patients. These pathologies can have iatrogenic, neoplastic, congenital origins or be related to systemic diseases. Neoplastic causes can be benign or malignant and include hamartomas, papillomas, lipomas, leiomyomas, epidermoid carcinomas, adenoid cystic carcinomas or metastases. Other origins are sabre-sheath trachea, tracheobronchomalacia, tracheobronchial amyloidosis, sarcoidosis, Wegener granulomatosis, relapsing polychondritis, tracheobronchopathia osteochondroplastica and inflammatory bowel disease with tracheobronchial involvement. The Mounier-Kuhn syndrome is a rare entity that causes tracheobronchomegalia.ConclusionSeveral tracheal diseases show slight symptoms and subtle CT findings. The knowledge of these entities enables radiologists to reduce the differential diagnosis and give information to plan future bronchoscopies and treatments.

1. The lungs’ response to acute injury follows a predictable course even across disparate etiologies. Radiologists should recognize the typical imaging manifestations of RP-ILD along with their associated disorders.2. Acute complications of RP-ILD include pneumomediastinum and pneumothorax.3. RP-ILD may resolve or evolve into other chronic ILD patterns.

I. Overview of acute lung injury and healing process a. Acute/subacute i. Histology of diffuse alveolar damage (DAD) and organizing pneumonia (OP) ii. HRCT appearance of DAD and OP b. Chronic i. Resolution or fibrosisII. Defining RP-ILD a. Timeline b. Severity c. Alternative names in the literatureIII. Etiologies of RP-ILD, with example cases a. Connective tissue disease i. Various types: myositis, rheumatoid arthritis, scleroderma, lupus ii. Anti-melanoma differentiation-associated gene 5 dermatomyositis (high association with RP-ILD) b. Viral infection i. COVID-19/SARS/MERS ii. Influenza c. Acute Interstitial Pneumonia d. Acute Exacerbation of ILD e. Treatment-related pneumonitis i. Medications ii. Chemotherapy/immunotherapy iii. RadiationIV. Clinical significance of RP-ILD a. Treatment b. Prognosis: acute and chronic phases c. Follow-up

Pulmonary actinomycosis is a chronic suppurative infection caused by Actinomyces species and the infection occurs typically due to aspiration of endogenous organisms. There are a variety of CT findings of pulmonary actinomycosis, however, there are some key points for differential diagnosis. The purpose of this exhibit is: 1. To explain the clinical characteristics and the common CT findings of pulmonary actinomycosis. 2. To review the CT images of pulmonary actinomycosis with uncommon findings such as bronchiectatic form and endobronchial calcified nodule. 3. To discuss the differential diagnosis of pulmonary actinomycosis, including pulmonary tuberculosis, fungal infection, lung cancer and granulomatosis with polyangiitis.

(1) Clinical characteristics of pulmonary actinomycosis (2) CT findings of pulmonary actinomycosis (3) Sample cases (4) Differential diagnosis

Parasitic diseases effect immunocompetent and immunocompromised patients worldwide. To create an accurate differential diagnosis for thoracic infections, radiologists must utilize both patient travel history and characteristic imaging findings. Understanding both imaging patterns and the geographic distribution of these diseases will help to narrow the differential and can impact clinical testing and management. Although some parasitic infections result in nonspecific imaging findings, familiarity with their imaging features as well as their epidemiological, clinical, and pathologic features may be helpful in to ensure the appropriate diagnosis and treatment.

1. Review endemic thoracic parasitic diseases A. Helminths i. Cestodes (tapeworm), e.g Echinococcus ii. Nematodes (roundworm), e.g Strongyloidiasis Ascariasis iii. Trematode (fluke), e.g. Schistosomiasis B. Protozoa i. Amebiasis ii. Trypanosomiasis (Chagas Disease)2. Epidemiology 3. Modes of transmission/ lifecycle 4. Geographic distribution 5. Clinical presentation 6. Imaging/ pathology findings