Simultaneous Presentation of Swimming-Induced Pulmonary Edema in a Set of Monozygotic Twin Elite Maritime Warfare Candidates: A Novel Case Report.

Swimming-induced pulmonary edema (SIPE) is an incompletely understood condition that is often seen in U.S. special operations candidates participating in maritime qualification training courses.

Incidence of Respiratory Pathogens in Naval Special Warfare Sea, Air, and Land Team Candidates With Swimming-Induced Pulmonary Edema.

Background: Swimming-induced pulmonary edema (SIPE) is a respiratory condition frequently seen among Naval Special Warfare (NSW) trainees. The incidence of positive respiratory panel (RP) findings in trainees with a diagnosis of SIPE currently is unknown.

Research Question: Does a significant difference exist in the incidence of respiratory pathogens in nasopharyngeal samples of NSW candidates with SIPE and a control group?

Study Design And Methods: Retrospective analysis of clinical information from NSW Sea, Air, and Land (SEAL) team candidates with a diagnosis of SIPE over a 12-month period.

Dual-Energy, Dual-Exposure PA and Lateral Chest Radiograph: Not Your Father's Chest X-Ray.

In the last two decades, our military and federal health care facilities have transitioned from traditional X-rays exposing film screen systems, developed much like photographic film, to an entirely digital detection system that affords computer processing of images and digital image and report distribution. While health care providers are well aware of the practicality of these advancements, they may not be aware of the improved diagnostic capabilities afforded by these new methods. In this report, we outline how application of physical principles of X-rays, with digital detectors and computer data manipulation, can present images demonstrating chest and heart diseases that were previously not readily visible by traditional film screen systems.

Pulmonary Barotrauma in a BUD/S Candidate Following Shallow Dives Using the MK 25 Rebreather.

Pulmonary barotrauma of ascent is a well-recognized risk of compressed air diving in the civilian and military diving communities. Chest imaging is a beneficial adjunct to clinical evaluation in screening select individuals for fitness to dive, evaluating dive-related injuries, and safely returning individuals to diving duty. We present a case of a 26-year-old male U.

Opportunistic Detection of Coronary Calcium on Dual-Energy Lateral Chest Radiograph.

Heart disease remains the leading cause of death among men and women in the world. The majority of cardiac morbidity worldwide is secondary to atherosclerotic coronary disease. In this article, we discuss our experience using dual exposure, dual-energy lateral chest x-ray (CXR) technique to detect coronary calcium.

Multimodality Imaging Assessment of Anomalous Aortic Origin of the Left Main Coronary Artery Presenting With Syncope and Non-ST Elevation Myocardial Infarction.

Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital abnormality associated with myocardial ischemia and sudden cardiac death. We present a case of a 20 year old previously healthy male presenting with exertional syncope and non-ST elevation myocardial infarction. Coronary computed tomography angiography showed an anomalous left main coronary artery arising from the right coronary cusp with a slit-like appearance, acute angle origin, intramural course, and a subsequent inter-arterial course between the main pulmonary artery and the proximal aorta.

Incidence and Impact of Swimming-Induced Pulmonary Edema on Navy SEAL Candidates.

Background: Respiratory complications such as swimming-induced pulmonary edema (SIPE) are a common feature of United States Navy Special Warfare (NSW) training.

Research Question: This study was designed to evaluate the incidence and clinical features of SIPE seen in this population.

Study Design And Methods: A prospective, observational review of all NSW candidates over a 15-month period was designed.

Parathyroid Computed Tomography Angiography: Early Experience with a Novel Imaging Technique in Primary Hyperparathyroidism.

Objectives: To describe parathyroid computed tomography angiography (PCTA), determine its accuracy, and, as a secondary objective, calculate its mean radiation dosimetry.

Study Design: Retrospective chart review of patients who underwent parathyroidectomy for primary hyperparathyroidism from 2007 to 2015.

Setting: Single-center tertiary care academic military hospital.

Development and Early Experience of the First Joint Military Health System-Veterans Affairs Transcatheter Aortic Valve Replacement Program.

Background: Transcatheter aortic valve replacement (TAVR) is a minimally invasive cardiac surgical procedure that has revolutionized the treatment of aortic stenosis. This is the most common valvular heart condition in developed countries, affecting 3.4% of those ages 75 and above.

CT dose reduction using prospectively triggered or fast-pitch spiral technique employed in cardiothoracic imaging (the CT dose study).

Objectives: To establish current radiation dose levels with contemporary scanners capable of prospectively triggered or high-pitch spiral scan modes to previous generation scanners among patients evaluated for coronary artery disease, pulmonary embolism, aortic disease, and "triple rule out" in a large population of patients at multiple centers.

Background: Previous small-scale studies with carefully controlled scan protocols report that CT scanners that facilitate prospectively triggered scanning and provide high-pitch spiral CT scan modes drastically lower radiation doses. However, diagnostic reference levels should be selected by medical bodies on the basis of large surveys of representative sites and reviewed at appropriate time intervals.

Diagnosis of right ventricular cardiac sarcoidosis with cardiac magnetic resonance in a patient presenting with ventricular tachycardia.

Sarcoidosis patients often have myocardial involvement, however, very few have clinically significant cardiac disease and ventricular tachycardia as the initial presentation is exceedingly rare. We report the case of a middle-aged male with symptomatic but clinically stable ventricular tachycardia. Chest radiograph, computed tomography, and positron emission tomography demonstrated pulmonary and mediastinal abnormalities but no definitive etiology for his arrhythmia.

Bronchial carcinoid imaged with cardiac gated, 128-slice, dual-source, flash CT scanner to direct operative management.

Carcinoid is a rare lung cancer that typically presents with a relatively indolent clinical behavior. We present the case of a 32-year-old male with progressive respiratory symptoms, which resulted in the diagnosis of typical bronchial carcinoid. This case shows a novel imaging technique for staging a bronchial carcinoid for determination of optimal management.

Cardiac gated computed tomography used to confirm iatrogenic aortic valve leaflet perforation after mitral valve replacement.

Aortic insufficiency from iatrogenic valve perforation from nonaortic valve operations is rarely reported despite the prevalence of these procedures. Rapid diagnosis of these defects is essential to prevent deterioration of cardiac function. In this paper, we describe a young man who reported to our institution after two open cardiac surgeries with new aortic regurgitation found to be due to an iatrogenic perforation of his noncoronary aortic valve cusp.

Anterior mediastinal mass biopsy and resection: anesthetic techniques and perioperative concerns.

The perioperative management of the patient with an anterior mediastinal mass (AMM) is viewed as one of the more challenging anesthetic endeavors. Diligent preoperative planning is essential and often involves imaging studies using multiple modalities, pulmonary function assessment, and minimally invasive biopsy for tissue diagnosis prior to arriving in the operating room. Anesthetic induction, often without major risks in most patients, can be catastrophic in AMM patients, with possible complications that include complete airway obstruction and cardiovascular collapse.

The association of epicardial adipose tissue with coronary artery calcification among HIV-infected men.

Little data exist regarding the association of epicardial adipose tissue (EAT) and cardiovascular disease among HIV-infected persons. Among 213 HIV-infected men, there was a significant association between protease inhibitor use and increasing EAT volume. EAT was significantly associated with coronary artery calcium greater than 100.

Reversal of flow in the pulmonary artery: high-pitch spiral as a new method for dose reduction in functional imaging.

Advancements in CT technology lave led to substantial dose reductions for anatomic imaging of the heart. Here we illustrate an example where rapid repeat imaging with a high pitch spiral technique can image physiologic function. By optimal timing, and repeat sub second scanning, we illustrate an unusual case where direction of blood flow in the right pulmonary artery is reversed.

Gerbode defect with Staphylococcus lugdunensis native tricuspid valve infective endocarditis.

Coagulase-negative staphylococci are generally not considered to be very virulent; they are an uncommon cause of native valve endocarditis. Staphylococcus lugdunensis is an important exception and causes more severe infections, clinically mimicking S. aureus.

Right ventricular outflow tract pseudoaneurysm: two cases.

Right ventricular pseudoaneurysm is a rare complication following repair of Tetralogy of Fallot. Presented are two patients, both with history of Tetralogy of Fallot, successful repair and pseudoaneurysms discovered on symptomatic follow up. Because surgical intervention is often required, the location and characteristics of the pseudoaneurysm are critical determinants of successful outcomes.

Clinically significant incidental findings among human immunodeficiency virus-infected men during computed tomography for determination of coronary artery calcium.

Those infected with the human immunodeficiency virus (HIV) have a greater risk of cardiovascular disease and might undergo computed tomographic (CT) scans for early detection. Incidental findings on cardiac CT imaging are important components of the benefits and costs of testing. We determined the prevalence and factors associated with incidental findings on CT scans performed to screen for coronary artery calcium (CAC) among HIV-infected men.

Recurrent Takotsubo cardiomyopathy.

We present the case of a 71-year-old woman with Takotsubo Cardiomyopathy as imaged with a dual source multidetector CT, MRI, and follow-up echocardiography. This demonstrates normal coronary arteries by use of CT angiography, and a 3D perspective of abnormal mid left ventricular hypokinesis and apical left ventricular akinesis.