ObjectiveThis study was designed to evaluate the severity of subclinical atherosclerosis in patients with asymptomatic impaired fasting glucose (IFG) compared to those with diabetes mellitus (DM) and normal fasting glucose (NFG), as measured by coronary computed tomographic angiography (CCTA).DesignSubjects were divided into three groups: NFG (<100 mg/dL), IFG (100–125 mg/dL) and DM. Coronary artery calcium on non-contrast CT and plaque analysis on CCTA were performed.SettingUniversity hospital, single centre.Participants216 asymptomatic participants prospectively underwent CCTA for the evaluation of coronary artery disease (CAD).Primary and secondary outcome measuresAtherosclerotic plaque burden in IFG compared to NFG patients.Results2664 segments were analysed in 120 NFG, 44 IFG and 52 DM participants. The mean calcium scores were 178±395, 259±510 and 414±836 for NFG, IFG and DM, respectively (p=0·037). The mean plaque burdens in the NFG, IFG and DM groups were 0.31±0.45, 0.50±0.69 and 0.68±0.69, respectively (p=0·0007). A greater proportion of patients with DM (19/52, 36.5%) and IFG (13/44, 29.5%) had obstructive CAD compared to those with NFG (16/120, 13.3%) (p=0.0015). The number of segments with severe disease was significantly higher in the DM (60/637, 9.4%) and IFG (42/539, 7.8%) groups compared to that in the NFG group (34/1488, 2.3%) (p=0.0001).Conclusions(1) IFG and DM have significantly higher, but comparable, calcium scores, plaque burden and obstructive CAD compared to NFG in asymptomatic individuals. (2) Pending corroboration by other reports, more intensive efforts may be devoted to the evaluation and treatment of patients with IFG.

INTRODUCTION:Cannonball metastases refer to well-defined spherical nodules scattered over both lungs, being a classical presentation of hematogenous tumor spreading.1 This usually indicates an advanced stage of the disease with a poor prognosis. We present a rare case of Cannonball Lung metastases as the presenting form of Hodgkin Lymphoma (HL).CASE PRESENTATION: 22-year-old male patient with no significant personal or family history, was admitted to the hospital for hypoxia, tachycardia and profound dyspnea. He described progressive dyspnea, fatigue, and 30 lb weight loss over 4 months. Physical exam revealed left axillary and left supraclavicular lymphadenopathy and left breast palpable masses. To evaluate for hypoxia, a chest X-ray was obtained, revealing multiple pulmonary nodules (Fig 1). A CT chest was obtained, showing several well circumscribed nodules/masses (cannonball appearance) involving the lungs, concerning for metastatic disease. (Fig 2)An ultrasound-guided left axillary Node Biopsy confirmed the diagnosis of Classic Hodgkin Lymphoma, Lymphocyte-Rich Subtype. Further radiographic confirmation with Pet CT classified it as Ann Arbor stage IV disease. He was given combination chemotherapy of ABVD (doxorubicin, bleomycin, vinblastine dacarbazine (DTIC). After six cycles of chemotherapy, imaging displayed dramatic improvement in the Pulmonary nodules, with residual nodules not avid on PET-CT. (Fig.4)

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