Diagnostic radiology and radiation medicine

Lung infections and vascular pathology

The section on chest imaging covers a wide range of disorders. Special attention is paid to viral pathologies such as Middle East respiratory syndrome (MERS-CoV), pandemic influenza H1N1, and various viral pneumonias. The radiological picture is critical in assessing the course of infection in patients who have undergone allogeneic hematopoietic stem cell transplantation. In community-acquired pneumonia (Community-acquired pneumonia), radiological methods help identify specific pathogen patterns and perform differential diagnosis with non-infectious diseases.

Among comorbid conditions, the development of bronchopleural fistulas and pulmonary involvement in schistosomiasis (Schistosomiasis), causing vascular dilation and aneurysm formation, are notable. In immunocompromised individuals (e.g., at the initiation of antiretroviral therapy), it is important to consider immune reconstitution inflammatory syndrome (IRIS).

International guidelines are used to assess pulmonary embolism (PE). The gold standard for diagnosing acute PE is CT angiography. The acute form is characterized by a fresh filling defect within the vessel lumen. In chronic thromboembolic pulmonary hypertension, mural organized changes and tortuous pulmonary vessels are visualized. Alternatives may include MR angiography and ventilation-perfusion scintigraphy.

Soft tissue mass imaging

Diagnosis of musculoskeletal disorders is based on a multimodal approach:

• Ultrasound (US): used for triage of suspicious masses. The use of power Doppler and spectral waveform analysis allows for predicting tumor malignancy.
• X-ray imaging: useful for the initial characterization of pathology.
• Magnetic resonance imaging (MRI): essential for assessing mass size, depth, and surgical planning for sarcomas.

Differential diagnosis is based on the WHO classification (2013) and epidemiological data. Physicians differentiate benign lipomas from well-differentiated liposarcomas, and evaluate vascular anomalies and knee joint pathologies (e.g., tumors of Hoffa's fat pad). Imaging methods reveal elastofibroma dorsi (Elastofibroma dorsi), synovial sarcoma, and fibromatoses, where radiologic-pathologic correlation is crucial. Accessory muscles and pigmented villonodular synovitis are also visualized.

Pediatric skeletal radiology: tuberculous discitis

In pediatric radiology, non-traumatic lesions such as tuberculous discitis (spondylodiscitis) are studied in detail. When the L1-L2 segment is affected, the imaging picture demonstrates specific features. MRI reveals an area of edema in the epiphyseal growth plate region and an intraosseous abscess within the vertebral body structure. Computed tomography allows visualization of the formation of a large paravertebral cold abscess — the psoas abscess of the iliopsoas muscle.

Differential diagnosis is performed with bacterial spinal osteomyelitis. Since the pattern of contrast enhancement is not always specific, a CT-guided biopsy followed by microbiological examination is strictly required for definitive confirmation. In adjacent areas, dual-energy X-ray absorptiometry (DXA) is used to assess fractures, and MRI/CT is used to detect temporomandibular joint lesions in juvenile idiopathic arthritis.

Class and exam questions

What else to study on this topic

• MRI semiotics of tumor-like lesions of the infrapatellar Hoffa's fat pad.
• Differential diagnosis of benign lipoma and well-differentiated liposarcoma.
• Features of the radiological picture of influenza in patients after allogeneic hematopoietic stem cell transplantation.
• Radiologic-pathologic correlation in synovial sarcoma and fibromatoses.
• Immune reconstitution inflammatory syndrome (IRIS): imaging patterns.

Other topics in the "Additional Topics" section

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