March 2015


Sunday, March 8 (ECR) – Cardiac and thoracic diseases are often intertwined and can be diagnosed during the same examination. Cardiovascular and chest radiologists are therefore trying to broaden their focus, and they have a lot to teach each other. Speakers from both sides will discuss the challenges ahead in today’s New Horizons session at the ECR.

Radiologists must adopt a comprehensive approach because of the relationship between diseases of the heart and chest, according to Prof. Christian Loewe, deputy head of the section of cardiovascular and interventional radiology at the Medical University of Vienna, Austria.

“There are a lot of situations and diseases where chest problems are caused by cardiac diseases and vice versa. There’s a huge interaction between heart and chest, and that’s why it’s interesting and important to look at this relationship in more detail today,” he said.

Some of the most severe causes of chest pain are due to cardiovascular diseases, such as myocardial infarction or acute aortic diseases. However, acute chest pain can also be caused by a number of pulmonary diseases, e.g. pulmonary embolism or pneumonia. Radiologists must learn the different life-threatening disorders that cause chest pain, whether they are respiratory or cardiovascular, and they must look at more than one organ during an examination, because technology enables them to, Loewe explained.

Prof. Martine Rémy-Jardin, professor of radiology and head of the department of cardiothoracic imaging at the University Centre of Lille in France, will speak about early detection of cardiothoracic disease in smokers. Lung cancer and coronary patients often have the same profile, as many are smokers, and they should be imaged for both pathologies whether they come in for a lung or coronary examination.

Despite the well-documented atherogenic effects of smoking, radiologists tend to remain focused on the depiction of emphysema and airways disease in smokers. However, recent guidelines for COPD patients have underlined the major impact of cardiovascular comorbidities, such as atherosclerotic coronary disease, ischaemic cardiopathy, atheromatous lesions of the aorta and supra-aortic vessels, recommending that they should be actively looked for and appropriately treated if present.

This recommendation could have a major impact on the way chest CT examinations of smokers are performed and reported, Rémy-Jardin pointed out. “The impact on the clinician’s understanding of symptoms is important because a given symptom can have a pulmonary or cardiovascular origin,” she said.

In the pretherapeutic assessment of bronchopulmonary carcinoma, chest radiologists should look for signs of COPD, smoking-related infiltrative lung disease and cardiovascular comorbidities, she recommended. Depending on the location and extent of lung carcinoma, the presence of signs suggesting cardiovascular invasion are also worth reporting. When examining coronary disease with CT, radiologists should also look for bronchopulmonary carcinoma and signs of COPD or smoking-related infiltrating disease in the explored volume, depending on the age of the patient and their degree of smoking.

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Christian Loewe, Vienna, Austria
Martine Rémy-Jardin, Lille, France

 

New Horizons Session

Sunday, March 8, 08:30–10:00, Room E2
NH 17 Comprehensive personalised imaging of cardiothoracic diseases

  • Chairman’s introduction: how to prepare for the future?
    T. Benedek; Targu Mures/RO
  • Patients with acute and chronic chest pain
    C. Loewe; Vienna/AT
  • Patients with acute shortness of breath
    J. Bremerich; Basle/CH
  • Patients with chronic shortness of breath
    E.J.R. van Beek; Edinburgh/UK
  • Early detection for cardiothoracic disease in smokers
    M. Rémy-Jardin; Lille/FR
  • Panel discussion: Comprehensive imaging and education in cardiothoracic diseases

Captions:
(right) Prof. Martine Rémy-Jardin is head of the department of cardiothoracic imaging at the University Centre of Lille in France.
(left) Dr. Christian Loewe is deputy head of the cardiovascular and interventional radiology section at the Medical University of Vienna, Austria.
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