Publications by authors named "Achala Donuru"

15 Publications

  • Page 1 of 1

Aortic Fistulas: Pathophysiologic Features, Imaging Findings, and Diagnostic Pitfalls.

Radiographics 2021 Sep-Oct;41(5):1335-1351. Epub 2021 Jul 30.

From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., A.D., M.P.); Department of Radiology, University of Kentucky Medical Center, Lexington, Ky (H.K.); and Division of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha University, Mumbai, India (K.G.).

Fistulas between the aorta and surrounding organs are extremely rare but can be fatal if they are not identified and treated promptly. Most of these fistulas are associated with a history of trauma or vascular intervention. However, spontaneous aortic fistulas (AoFs) can develop in patients with weakened vasculature, which can be due to advanced atherosclerotic disease, collagen-vascular disease, vasculitides, and/or hematogenous infections. The clinical features of AoFs are often nonspecific, with patients presenting with bleeding manifestations, back or abdominal pain, fever, and shock. Confirmation with invasive endoscopy is often impractical in the acute setting. Imaging plays an important role in the management of AoFs, and multiphasic multidetector CT angiography is the initial imaging examination of choice. Obvious signs of AoF include intravenous contrast material extravasation into the fistulizing hollow organ, tract visualization, and aortic graft migration into the adjacent structure. However, nonspecific indirect signs such as loss of fat planes and ectopic foci of gas are seen more commonly. These indirect signs can be confused with other entities such as infection and postoperative changes. Management may involve complex and staged surgical procedures, depending on the patient's clinical status, site of the fistula, presence of infection, and anticipated tissue friability. As endovascular interventions become more common, radiologists will need to have a high index of suspicion for this entity in patients who have a history of aneurysms, vascular repair, or trauma and present with bleeding. RSNA, 2021.
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http://dx.doi.org/10.1148/rg.2021210004DOI Listing
July 2021

Gunshot-Related Pediatric Left Ventricular Apical Aneurysm.

JACC Case Rep 2021 Jan 23;3(1):26-30. Epub 2020 Dec 23.

Department of Cardiology, A.I. DuPont Hospital for Children, Wilmington, Delaware, USA.

Penetrating injuries of the thorax and abdomen, such as gunshot and stabbing, are rare in children. We present the case of a pediatric patient with a history of remote gunshot injury presenting with a late aneurysm in the left ventricle. ().
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http://dx.doi.org/10.1016/j.jaccas.2020.10.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305065PMC
January 2021

Generalized Arterial Calcification of Infancy.

Radiol Cardiothorac Imaging 2020 Aug 13;2(4):e190226. Epub 2020 Aug 13.

Department of Radiology, Thomas Jefferson University Hospitals, 132 S 10th St, 1079 Main Building, Philadelphia, PA 19107 (A.D.); Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Del (V.K., D.S.); and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (E.O.).

Generalized arterial calcification of infancy (GACI) is a rare genetic disease that affects the circulatory system and the large- and medium-sized arteries throughout the body. GACI usually occurs during fetal development. Babies with GACI are diagnosed early, generally soon after birth and in some cases before birth by fetal ultrasound.
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http://dx.doi.org/10.1148/ryct.2020190226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977956PMC
August 2020

Performance of a Severity Score on Admission Chest Radiography in Predicting Clinical Outcomes in Hospitalized Patients With Coronavirus Disease (COVID-19).

AJR Am J Roentgenol 2021 09 28;217(3):623-632. Epub 2020 Oct 28.

Department of Sidney Kimmel Medical College, Thomas Jefferson University, 132 S 10th St, Ste 861, Main Bldg, Philadelphia, PA 19147.

Chest radiographs (CXRs) are typically obtained early in patients admitted with coronavirus disease (COVID-19) and may help guide prognosis and initial management decisions. The purpose of this study was to assess the performance of an admission CXR severity scoring system in predicting hospital outcomes in patients admitted with COVID-19. This retrospective study included 240 patients (142 men, 98 women; median age, 65 [range, 50-80] years) admitted to the hospital from March 16 to April 13, 2020, with COVID-19 confirmed by real-time reverse-transcriptase polymerase chain reaction who underwent chest radiography within 24 hours of admission. Three attending chest radiologists and three radiology residents independently scored patients' admission CXRs using a 0- to 24-point composite scale (sum of scores that range from 0 to 3 for extent and severity of disease in upper and lower zones of left and right lungs). Interrater reliability of the score was assessed using the Kendall coefficient. The mean score was obtained from the six readers' scores for further analyses. Demographic variables, clinical characteristics, and admission laboratory values were collected from electronic medical records. ROC analysis was performed to assess the association between CXR severity and mortality. Additional univariable and multivariable logistic regression models incorporating patient characteristics and laboratory values were tested for associations between CXR severity and clinical outcomes. Interrater reliability of CXR scores ranged from 0.687 to 0.737 for attending radiologists, from 0.653 to 0.762 for residents, and from 0.575 to 0.666 for all readers. A composite CXR score of 10 or higher on admission achieved 53.0% (35/66) sensitivity and 75.3% (131/174) specificity for predicting hospital mortality. Hospital mortality occurred in 44.9% (35/78) of patients with a high-risk admission CXR score (≥ 10) versus 19.1% (31/162) of patients with a low-risk CXR score (< 10) ( < .001). Admission composite CXR score was an independent predictor of death (odds ratio [OR], 1.17; 95% CI, 1.10-1.24; < .001). composite CXR score was a univariable predictor of intubation (OR, 1.23; 95% CI, 1.12-1.34; < .001) and continuous renal replacement therapy (CRRT) (OR, 1.15; 95% CI, 1.04-1.27; = .007) but was not associated with these in multivariable models ( > .05). For patients admitted with COVID-19, an admission CXR severity score may help predict hospital mortality, intubation, and CRRT. CXR may assist risk assessment and clinical decision-making early in the course of COVID-19.
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http://dx.doi.org/10.2214/AJR.20.24801DOI Listing
September 2021

Coronary artery aneurysm in Kawasaki disease.

Ann Pediatr Cardiol 2020 Jul-Sep;13(3):267-268. Epub 2020 Jun 11.

Department of Medical Imaging, Wilmington, DE 19803, USA.

A 3-year-old male presents to the emergency department with chief complaints of fever and vomiting. He had a positive rapid streptococcus throat test with cervical lymphadenopathy. The patient was started on antibiotics. On examination, there was diffuse erythematous macular rash on the chest. Laboratory tests revealed elevated white cell count and C-reactive protein. Electrocardiogram was notable for prolonged PR interval indicating 1 degree atrioventricular block. Echocardiogram revealed ectasia of the right coronary artery (RCA). A presumptive diagnosis of Kawasaki disease was made and the patient was started on high-dose aspirin and intravenous immunoglobulins. Cardiac computed tomography angiography (CTA) showed an aneurysm of the proximal RCA measuring up to 7.4 mm. The RCA immediately proximal to the aneurysm measured 3 mm in diameter. The Z score was 13.4. Oblique coronal image from cardiac CTA and volume rendered images demonstrated an aneurysm of the proximal RCA. The patient improved with treatment.
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http://dx.doi.org/10.4103/apc.APC_6_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437614PMC
June 2020

Paraspinal soft tissue masses in a patient with a metabolic bone disease.

Skeletal Radiol 2021 Jan;50(1):263-264

Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

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http://dx.doi.org/10.1007/s00256-020-03537-2DOI Listing
January 2021

Paraspinal soft tissue masses in a patient with a metabolic bone disease.

Skeletal Radiol 2021 Jan;50(1):241-242

Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

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http://dx.doi.org/10.1007/s00256-020-03536-3DOI Listing
January 2021

Review of the Chest CT Differential Diagnosis of Ground-Glass Opacities in the COVID Era.

Radiology 2020 12 7;297(3):E289-E302. Epub 2020 Jul 7.

From the Department of Radiology, Thomas Jefferson University Hospitals, 132 S 10th St, 1079 Main Building, Philadelphia, PA 19107 (M.P., A.D., R.B.); and Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio (S.K.).

Coronavirus disease 2019 (COVID-19), a recently emerged lower respiratory tract illness, has quickly become a pandemic. The purpose of this review is to discuss and differentiate typical imaging findings of COVID-19 from those of other diseases, which can appear similar in the first instance. The typical CT findings of COVID-19 are bilateral and peripheral predominant ground-glass opacities. As per the Fleischner Society consensus statement, CT is appropriate in certain scenarios, including for patients who are at risk for and/or develop clinical worsening. The probability that CT findings represent COVID-19, however, depends largely on the pretest probability of infection, which is in turn defined by community prevalence of infection. When the community prevalence of COVID-19 is low, a large gap exists between positive predictive values of chest CT versus those of reverse transcriptase polymerase chain reaction. This implies that with use of chest CT there are a large number of false-positive results. Imaging differentiation is important for management and isolation purposes and for appropriate disposition of patients with false-positive CT findings. Herein the authors discuss differential pathology with close imaging resemblance to typical CT imaging features of COVID-19 and highlight CT features that may help differentiate COVID-19 from other conditions.
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http://dx.doi.org/10.1148/radiol.2020202504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350036PMC
December 2020

The Spectrum of Rib Neoplasms in Adults: A Practical Approach and Multimodal Imaging Review.

AJR Am J Roentgenol 2020 07 6;215(1):165-177. Epub 2020 May 6.

Department of Radiology, Division of Cardiothoracic Imaging, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140.

Adult neoplasms of the ribs are a heterogeneous group consisting of both benign and aggressive entities. Rib neoplasms have a variety of overlapping imaging features, with much of the imaging data disjointed across the musculoskeletal, thoracic, and oncologic imaging literature. Arrival at accurate diagnosis can therefore be quite challenging. This article consolidates this information and introduces the reader to an algorithmic approach to rib lesion evaluation based on imaging. Rib neoplasms are a diverse group of benign and malignant entities, which often makes determining an accurate diagnosis challenging. Evaluation requires a multipronged approach that incorporates radiographic imaging features, nonradiographic imaging findings, lesion location, and clinical data.
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http://dx.doi.org/10.2214/AJR.19.21554DOI Listing
July 2020

Development of a risk assessment model to differentiate malignant and benign musculoskeletal soft-tissue masses on magnetic resonance imaging.

J Med Imaging Radiat Oncol 2020 Feb 2;64(1):9-17. Epub 2019 Dec 2.

Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Introduction: This study aimed to develop a risk stratification model to differentiate benign and malignant MRI-imaged musculoskeletal soft-tissue tumours, informing decisions surrounding biopsy and follow-up imaging.

Methods: Imaging of patients who underwent MRI and subsequent biopsy to evaluate a soft-tissue mass was retrospectively reviewed. Features analysed included patient age; tumour size; shape; margins; enhancement pattern; signal intensity pattern; deep fascia, neurovascular bundle, bone and joint involvement; and the presence of necrosis, haemorrhage, oedema and intralesional fat. Univariate comparisons, by final histopathological status, employed t-tests and chi-square tests, followed by simple and multiple logistic regressions. Variables included in the final multiple regression model were used to define a three-level risk stratification strategy.

Results: One-hundred and ten patients were included in the analysis. Univariate relationships were identified between malignancy and age, tumour size, deep fascia involvement, neurovascular involvement, necrosis, haemorrhage, oedema and heterogeneous enhancement (all P < 0.01). Final multiple regression modelling included size, enhancement and oedema. Thirty of 40 (75%) tumours >5 cm with surrounding oedema ('high risk') were malignant, 13 of 47 (28%) tumours with one or more of tumour size >5 cm, surrounding oedema or heterogeneous enhancement ('moderate risk') were malignant, and none of the 16 tumours ≤5 cm with the absence of surrounding oedema and heterogeneous enhancement ('low risk') were malignant.

Conclusions: A model including tumour size, enhancement and oedema has potential to stratify soft-tissue tumours into high-, intermediate- and low-risk categories; this may inform decisions surrounding biopsy and follow-up imaging.
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http://dx.doi.org/10.1111/1754-9485.12981DOI Listing
February 2020

Review of Thoracic Causes of Systemic Arterial Air Embolism on Computed Tomography.

J Thorac Imaging 2020 May;35(3):W68-W74

Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA.

Systemic arterial air embolism (SAAE) is a rare but potentially life-threatening condition that may occur when air enters into pulmonary veins or directly into the systemic circulation after pulmonary procedures (biopsy or resection) or penetrating trauma to the lung. While venous air embolism is commonly reported, arterial air embolism is rare. Even a minor injury to the chest along with positive-pressure ventilation can cause SAAE. Small amounts of air may cause neurological or cardiac symptoms depending on the affected arteries, while massive embolism can result in fatal cardiovascular collapse. We discuss the various causes of SAAE, including trauma, computed tomography-guided lung biopsy, and various intervention procedures such as mechanical circulatory support device implantation, coronary catheterization, and atrial fibrillation repair. SAAE diagnosis can be overlooked because its symptoms are not specific, and confirmation of the presence of air in the arterial system is difficult. Although computed tomography is the optimal imaging tool for diagnosis, patient instability and resuscitation often precludes its use. When imaging is performed, awareness of the causes of SAAE allows the radiologist to promptly diagnose the condition and relay findings to the clinicians so that treatment, namely hyperbaric oxygen therapy, may be started promptly.
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http://dx.doi.org/10.1097/RTI.0000000000000454DOI Listing
May 2020

Left Upper Lobe Pulmonary Vein Traversing The Left Oblique Fissure-A Rare, Unseen Anatomic Variant.

J Ayub Med Coll Abbottabad 2018 Oct-Dec;30(4):625-626

Department of Radiology, Thomas Jefferson University, US.

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January 2019

Poststernotomy Complications: A Multimodal Review of Normal and Abnormal Postoperative Imaging Findings.

AJR Am J Roentgenol 2018 12 9;211(6):1194-1205. Epub 2018 Oct 9.

1 Department of Radiology, Division of Cardiothoracic Imaging, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140.

Objective: The purpose of this article is to review the normal postoperative appearance of various sternotomy configurations as well as the pathophysiologic and imaging characteristics of sternotomy complications on radiographs, MDCT, MRI, and scintigraphy.

Conclusion: Clinical signs of sternotomy complications are nonspecific and often overlap with normal postoperative changes. Knowledge of normal and abnormal imaging findings is essential to guide management and treatment.
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http://dx.doi.org/10.2214/AJR.18.19782DOI Listing
December 2018

Nondecussating retinal-fugal fiber syndrome (achiasmatic syndrome).

Neurology 2018 05;90(21):979-980

From the Department of Medical Imaging (R.N., V.K.), Nemours A.I. DuPont Hospital for Children, Wilmington, DE; and Department of Radiology (A.D.), Thomas Jefferson University Hospitals, Philadelphia, PA.

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http://dx.doi.org/10.1212/WNL.0000000000005563DOI Listing
May 2018
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