Review of Thoracic Imaging Findings Unique to Women Alla Khashper, MD, James M. Gruber, MD, FRCP, Richard S. Fraser, MD, FRCP, Federico Discepola, MD, FRSCR, Alexandre Semionov, MD, PhD, FRCR  Canadian Association of Radiologists Journal  Volume 66, Issue 3, Pages 223-230 (August 2015) DOI: 10.1016/j.carj.2014.11.007 Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 1 Normal chest radiograph (A) of a 24-year-old woman clearly reflects gender-related features due to prominent breast shadows. Also, note characteristic central pattern of costal cartilage calcification (arrow) seen on coned down and zoomed-image (B). Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 2 Turner syndrome and a complex aortic malformation. Chest radiograph (A) shows right-sided aortic arch (asterisk in A; Rt arch in B) resulting in deviation of the trachea to the left. Aortic coarctation (AC) and aneurysmal right brachiocephalic artery (RtBCA) are demonstrated on computed tomography 3D volume rendering reconstruction (B). Note is made of normal size of the left common carotid artery (LtCCA). Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 3 Lymphangiomyomatosis. Coronal reconstruction of a computed tomography scan shows diffuse involvement of both lungs with innumerable thin-walled cysts, slightly more pronounced at the lung bases. Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 4 Catamenial pneumothorax in a 43-year-old woman who presented with 3 episodes of spontaneous pneumothorax, each associated with the onset of menses. Expiratory chest radiograph (A) shows a right-sided pneumothorax (arrows), as well as right apical scar from remote right apical bullectomy (arrowhead). Medium-power photomicrograph (original magnification, 20×; hematoxylin-eosin stain) (B) shows an endometriotic implant in the parietal pleura (arrows). This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 5 Metastatic choriocarcinoma. Coronal reconstruction of chest computed tomography reveals a few tiny nodules (arrows) scattered bilaterally, that resolved on follow up exam obtained after chemotherapy (not shown). Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 6 Metastatic ovarian cancer. Chest computed tomography demonstrates scattered bilateral pulmonary nodules, some of which underwent cavitation. Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 7 Small cell ovarian carcinoma in 28-year-old woman, who presented with chest pain and hyperkalemia. Chest radiograph reveals mediastinal and hilar lymphadenopathy. Positron emission tomography-computed tomography scan (not shown) demonstrates 17 cm left ovarian mass associated with infra- and supradiaphragmatic lymphadenopathy showing avid uptake of radiotracer. Percutaneous biopsy of supraclavicular lymph node proved the presence of small cell ovarian carcinoma. Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 8 Meigs syndrome. Sagittal reconstruction of contrast enhanced thoracoabdominal computed tomography reveals a large pelvic mass (arrows) associated with ascites and right pleural effusion. An ovarian fibroma was resected, followed by complete resolution of the effusion and ascites. Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 9 Metastatic uterine leiomyoma. Coronal reconstruction of a chest computed tomography reveals several cystic lesions (arrows) scattered in both lungs, as well as a small right pneumothorax. Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 10 Metastatic uterine leiomyosarcoma treated with hysterectomy 2 years prior. Chest computed tomography reveals solid (arrowhead) and cavitary (arrow) pulmonary nodules in the left lung. The spontaneous right pneumothorax was thought to be a result of an occult right lung metastasis. Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 11 A 67-year-old woman with metastatic breast cancer. Diffuse interlobular septal thickening (arrows) is consistent with lymphangitic carcinomatosis. Bilateral malignant pleural effusions and diffuse blastic bone metastases (arrowheads) confirm metastatic disease. Treatment-related findings include left mastectomy and axillary lymph node dissection, as well as architectural distortion, traction bronchiectasis, and fibrosis of the left lung secondary to prior radiotherapy. Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 12 A 67-year-old woman with history of thyroidectomy. Contrast-enhanced chest computed tomography (CT) demonstrates left chest wall mass (arrow) associated with borderline left axillary nodes. Positron emission tomography-CT revealed moderate fluorodeoxyglucose uptake, prompting CT-guided biopsy of the lesion. During the procedure the patient gave the history of previous breast implant removal due to local infection. Fibrosis and granulation tissue was demonstrated in a biopsy sample. Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 13 A 36-year-old woman with ovarian hyperstimulation syndrome. Abdominal computed tomography demonstrates bilateral pleural effusions (arrowheads) and passive atelectasis, ascites (asterisk), and bilateral ovarian cystic lesions (arrows). Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 14 Organizing pneumonia, following left partial mastectomy and adjuvant radiotherapy for breast cancer. The computed tomography images demonstrate reversed halo nodules (arrows) in the posterior segment of the right upper lobe and superior segment of the right lower lobe. Also note extensive post radiation changes in the anterior segment of the left upper lobe. Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 15 A 31-year-old woman presented with pleuritic chest pain. Her clinical history was positive for BRCA1 mutation, recent bilateral mastectomy and breast reconstruction surgery, complicated by right reconstructed breast infection. Computed tomography (CT) angiography of the chest ruled out pulmonary embolism, but revealed a new left pulmonary nodule which showed low density (–150 HU), and was visualized on wide window settings (W1500, L-600), but was not seen on narrower, “abdominal window.” Lack of fluorodeoxyglucose uptake on positron emission tomography-CT (not shown) confirmed nonmalignant etiology of the nodule that is compatible with direct injection of fat into lung parenchyma, a rare complication of fat grafting in postmastectomy breast reconstruction. Canadian Association of Radiologists Journal 2015 66, 223-230DOI: (10.1016/j.carj.2014.11.007) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions