About

Achala Donuru, MBBS, MRCPCH, DCH, FRCR, is an Associate Professor of Clinical Radiology at the University of Pennsylvania. She is an active member of the medical staff at Pennsylvania Hospital, Penn Presbyterian Medical Center, and The Chester County Hospital, and serves as an attending at the Hospital of the University of Pennsylvania. Her professional roles include Network Practice Optimization Team Leader in Cardiothoracic Imaging and Wellness Program Director within the same division at the Hospital of the University of Pennsylvania. Her educational background includes an M.D. from Gandhi Medical College, Andhra Pradesh University of Health Sciences, India, obtained in 1998, a Diploma in Child Health from the Royal College of Pediatrics and Child Health in the United Kingdom in 2002, and fellowships including MRCPCH and FRCR. Her research contributions involve multimodality imaging approaches to thoracic wall reconstruction, differentiation of inflammatory tumors, and imaging of thoracic pseudoaneurysms, among others. She has presented her work at various professional meetings and has been recognized with awards such as the Certificate of Merit at the RSNA Annual Meeting.

Research topics

• Medicine
• Radiology
• Pathology

Selected publications

• Evolving Landscape of Chest Wall Reconstruction

  Journal of Thoracic Imaging · 2026-01-21

  articleSenior authorCorresponding

  Chest wall reconstruction (CWR) is a complex and evolving field that clinically benefits from the use of multimodal radiologic imaging. This review summarizes the essential role of multimodal imaging, such as ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), in preoperative and postoperative CWR evaluation. Preoperative CWR planning involves characterization of defects, assessment of surrounding structures, and guidance for surgical approach and implant selection. Postoperative CWR evaluation focuses on monitoring graft/flap viability, assessing structural integrity, and identifying complications such as infection or hardware failure. This article guided radiologists in approaching CWR cases and creating effective reports to guide patient management.

  PublisherDOI

• Spontaneous Pneumothorax: A Review of Underlying Etiologies and Diagnostic Imaging Modalities

  Tomography · 2025-11-07 · 3 citations

  reviewOpen accessSenior authorCorresponding

  This review focuses on the diverse etiologies of secondary spontaneous pneumothorax (SSP) and the crucial role of imaging in their diagnosis. Unlike primary spontaneous pneumothorax (PSP), which is typically due to ruptured blebs, SSP results from a wide array of underlying pulmonary conditions that can pose significant diagnostic challenges. These include infections like tuberculosis, airway diseases such as chronic obstructive pulmonary disease, malignancies (primary and metastatic), interstitial lung diseases like sarcoidosis, cystic lung diseases such as lymphangioleiomyomatosis, and connective tissue disorders. In women, catamenial pneumothorax secondary to endometriosis should be considered. The role of radiologists is crucial in uncovering these underlying conditions. While chest radiography is the initial imaging modality, computed tomography (CT) provides superior sensitivity for detecting subtle parenchymal abnormalities. Advanced techniques like photon-counting detector CT offer further benefits, including enhanced spatial resolution, reduced noise, and lower radiation dose, potentially revealing underlying causes that might be missed with conventional CT. This enhanced visualization of subtle parenchymal changes, small airways, and vascular structures can be the key to diagnosing the underlying cause of pneumothorax. Recognizing the diverse etiologies of SSP and utilizing advanced imaging techniques is paramount for accurate diagnosis, appropriate management, and improved patient outcomes.

  PublisherOA PDFDOI

• Rare perifissural air in barotrauma-induced pneumomediastinum

  Lung India · 2025-12-31

  articleOpen accessSenior author

  Dear Editor, We present a compelling case of a 35-year-old man with a complex medical background—including a seizure disorder, tracheostomy for subglottic stenosis, and ongoing chemotherapy for lymphoma—who developed acute hypoxic respiratory failure necessitating mechanical ventilation. Subsequent imaging revealed a rare and educationally significant constellation of findings: barotrauma-induced pneumomediastinum, extensive pulmonary interstitial emphysema (PIE), and incidental perifissural air (PFA). The patient’s clinical course was marked by the rapid onset of respiratory distress, leading to intubation and ventilation. A computed tomography (CT) scan of the chest was performed to evaluate the cause of his deterioration. The CT findings were striking: extensive pneumomediastinum was evident (visualized as air outlining mediastinal structures, indicated by a star in the provided images), alongside diffuse PIE characterized by linear and cystic air lucencies tracking along bronchovascular bundles within the lung parenchyma. Concurrently, areas of pneumonia were noted. Critically, incidental PFA was identified (Figure 1, open white arrow open arrow), distinguished from a loculated pneumothorax by the presence of delicate linear structures (Figure 2, dashed white arrow) traversing the air collection near the minor fissure, representing subpleural interstitial connective tissues separated by interstitial air. Sputum cultures subsequently grew Stenotrophomonas, prompting targeted antibiotic therapy in conjunction with continued supportive respiratory management, which ultimately led to clinical improvement.Figure 1: Sagittal image demonstrates perifissural air (open white arrow)Figure 2: Axial image demonstrates linear structures traversing the perifissural air (dashed white arrow) and extensive pneumomediastinum (star)Pneumomediastinum in ventilated patients is a recognized complication of barotrauma, often attributed to the Macklin effect, where alveolar rupture leads to air dissecting along bronchovascular sheaths towards the mediastinum. PIE in adults, while less common than in neonates, can also result from barotrauma, as well as underlying obstructive lung diseases or severe infections. Its radiological appearance as linear or cystic collections of air, often in a peribronchovascular distribution, can sometimes be extensive and challenging to manage. Perifissural air, however, is more commonly described in the context of spontaneous pneumomediastinum, particularly in younger, otherwise healthy individuals, where it is thought to arise from alveolar rupture adjacent to interlobar fissures. Its presence in our patient—an adult with multiple comorbidities, experiencing iatrogenic barotrauma and diffuse PIE—is unusual. The key diagnostic feature differentiating PFA from a small or loculated pneumothorax is the visualization of intact, though separated, visceral pleural layers of the fissure, with air contained within the septal interstitium abutting the fissure. Misinterpreting PFA as pneumothorax could potentially lead to unnecessary interventions, such as chest drain insertion. The concurrent presentation of extensive barotrauma- induced pneumomediastinum, diffuse PIE, and PFA in an adult patient with such a complex clinical picture is, to our knowledge, a rare occurrence and highlights the multifaceted ways air can dissect within the thorax following positive pressure ventilation. This case underscores the importance of meticulous CT image interpretation to accurately identify and differentiate these entities. Recognizing PFA, particularly in the setting of widespread interstitial air, is crucial for appropriate clinical decision-making and avoiding iatrogenic complications. We believe this case offers significant educational value for radiologists and pulmonologists by illustrating this uncommon but important radiological finding and its clinical context. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

  PublisherDOI

• A Rare Encounter: Incidental Ectopic Origin of the Right Pulmonary Artery in an Adult

  Aorta · 2024-12-01

  articleOpen accessSenior author

  Ectopic origin of the right pulmonary artery (RPA) from the aorta is a rare congenital anomaly typically found in infants. We report an adult female presenting with shortness of breath diagnosed incidentally with ectopic RPA via computed tomography angiography. This case underscores the need to consider rare congenital anomalies in adults presenting with unexplained pulmonary symptoms.

  PublisherOA PDFDOI

• Grayscale Inversion to aid Diagnosis of Acute Occlusive and Chronic Pulmonary Embolism on CT

  International Journal of Angiology · 2024-06-01

  articleOpen access1st authorCorresponding

  Pulmonary embolism (PE) is a potentially life-threatening disease requiring accurate diagnosis and treatment. CT pulmonary angiography (CTPA) has high accuracy for detecting PE.[1] CT is therefore the first-line diagnostic imaging modality in patients suspected of having acute PE. There are several tools described in the literature to improve our accuracy and confidence in diagnosing PE. For example, it is important to select an optimal display window width (W) and level (L) for evaluating the pulmonary arteries.[2] A filling defect representing PE can be masked in standard soft tissue window display setting around W:400, L:40; therefore, radiologists prefer to manually adjust it to a PE-specific window that is unique to each exam. This is done by widening the width and increasing the level, arriving close to the double-half setting (W: 2×, L: 0.5×) where × is the mean attenuation in Hounsfield units within the main pulmonary artery.[3]

  PublisherOA PDFDOI

• Uncommon Causes of Interlobular Septal Thickening on CT Images and Their Distinguishing Features

  Tomography · 2024-04-17 · 6 citations

  articleOpen access1st authorCorresponding

  Interlobular septa thickening (ILST) is a common and easily recognized feature on computed tomography (CT) images in many lung disorders. ILST thickening can be smooth (most common), nodular, or irregular. Smooth ILST can be seen in pulmonary edema, pulmonary alveolar proteinosis, and lymphangitic spread of tumors. Nodular ILST can be seen in the lymphangitic spread of tumors, sarcoidosis, and silicosis. Irregular ILST is a finding suggestive of interstitial fibrosis, which is a common finding in fibrotic lung diseases, including sarcoidosis and usual interstitial pneumonia. Pulmonary edema and lymphangitic spread of tumors are the commonly encountered causes of ILST. It is important to narrow down the differential diagnosis as much as possible by assessing the appearance and distribution of ILST, as well as other pulmonary and extrapulmonary findings. This review will focus on the CT characterization of the secondary pulmonary lobule and ILST. Various uncommon causes of ILST will be discussed, including infections, interstitial pneumonia, depositional/infiltrative conditions, inhalational disorders, malignancies, congenital/inherited conditions, and iatrogenic causes. Awareness of the imaging appearance and various causes of ILST allows for a systematic approach, which is important for a timely diagnosis. This study highlights the importance of a structured approach to CT scan analysis that considers ILST characteristics, associated findings, and differential diagnostic considerations to facilitate accurate diagnoses.

  PublisherOA PDFDOI

• Thoracic Trauma

  2023-01-01

  book-chapterSenior authorCorresponding
  PublisherDOI

• Photon-counting detector CT allows significant reduction in radiation dose while maintaining image quality and noise on non-contrast chest CT

  European Journal of Radiology Open · 2023-11-10 · 21 citations

  articleOpen access1st authorCorresponding

  Purpose: To investigate if clinical non-contrast chest CT studies obtained with PCD CT using much lower radiation exposure can achieve the same image quality as with the currently established EID protocol. Materials/methods: A total of seventy-one patients were identified who had a non-contrast chest computed tomography (CT) done on PCD CT and EID CT scanners within a 4-month interval. Five fellowship trained chest radiologists, blinded to the scanner details were asked to review the cases side-by-side and record their preference for images from either the photon-counting-detector (PCD) CT or the energy-integrating detector (EID) CT scanner. Results: The median CTDIvol for PCD-CT system was 4.710 mGy and EID system was 7.80 mGy (p < 0.001). The median DLP with the PCD-CT was 182.0 mGy.cm and EID system was 262.60 mGy.cm (p < 0.001). The contrast to noise ratio (CNR) was superior on the PCD-CT system 59.2 compared to the EID-CT 53.3; (p < 0.001). Kappa-statistic showed that there was poor agreement between the readers over the image quality from the PCD and EID scanners (κ = 0.19; 95 % CI: 0.12 - 0.27; p < 0.001). Chi-square analysis revealed that 3 out of 5 readers showed a significant preference for images from the PCDCT (p ≤ 0.012). There was no significant difference in the preferences of two readers between EID-CT and PCD-CT images. Conclusion: The first clinical PCD-CT system allows a significant reduction in radiation exposure while maintaining image quality and image noise using a standardized non-contrast chest CT protocol.

  PublisherOA PDFDOI

• AB006. Atypical morphologies of thymic hyperplasia on CT and MRI

  Mediastinum · 2023-12-01

  articleOpen access

  Background: Thymic hyperplasia (TH) appears as predominantly soft-tissue attenuating thymus with triangular/quadrilateral shape. There are sporadic case reports of TH with multinodular or cystic changes possibly related to Sjogren’s syndrome (SjS) and human immunodeficiency virus (HIV). No large systematic study was performed. Therefore, the purpose of this study is: (I) to investigate atypical morphologies of TH, which could be helpful in the appropriate diagnosis of TH; (II) to investigate demographical and clinical conditions relevant to the atypical morphologies. Methods: Radiological reports of CT and MRI from January 2021 to March 2023 in our medical health network were searched by the term “thymic hyperplasia” (Montage). Two-board certified radiologists reviewed identified cases. First radiologist reviewed all CTs to confirm the presence of TH (>50% of soft-tissue attenuation) and for atypical morphologies. Second radiologist reviewed cases with atypical features to confirm, and discrepancies were resolved in consensus. Atypical features include: (I) multinodular, (II) cystic, (III) lobulated contour, (IV) calcification. MR images were also reviewed if available. Electronic medical records (EMRs) were reviewed for demographics and clinical information relevant to TH. Results: The search yielded 1,415 reports, belonging to 954 patients. After review by radiologists, 35 cases were found with atypical morphologies. A multinodular morphology was most common (N=19), followed by cystic (N=12), lobulated (N=7), and calcification (N=5). Of those, eight cases demonstrated overlap features (multinodular/cystic, N=5; multinodular/calcification, N=1; multicystic/calcification, N=1; cystic/calcification, N=1). A total of 51% were male (18/35). Mean age was 52 years. And, 43% (N=11) were former/current smokers (mean 13.4 pack-year); 43% (N=15) of the patients had clinical conditions relevant to TH; most common autoimmune disease was rheumatoid arthritis (N=3), SjS (N=3, including one case with SSA positive), sarcoidosis (N=3), followed by systemic lupus erythematosus (SLE) (N=2), ulcerative colitis (N=1), graves disease (N=1), and steroid therapy (N=3). All three patients with SjS showed overlapping atypical morphologies of multinodular and cystic features. The 29% (10/35) had a history of malignancy, most commonly breast cancer (N=3). One patient with HIV infection demonstrated multinodular feature. However, 34% (12/35) had no clinical conditions relevant to TH. One patient with lobulated TH underwent thymectomy and was pathologically diagnosed with langerhans cell histiocytosis (LCH) involving thymic gland. Conclusions: Atypical morphologies of TH were investigated. Multinodular and cystic features were relatively common and seen in patients with autoimmune diseases such as RA and SjS, however, also seen in patients with no relevant clinical conditions.

  PublisherDOI

• Large aortic pseudoaneurysm after Bentall procedure in a patient with Marfan's syndrome

  Annals of Pediatric Cardiology · 2022-05-01 · 7 citations

  articleOpen accessCorresponding

  An 11-year-old male with Marfan's syndrome and aortic root dilatation underwent an uneventful Bentall procedure to replace his aortic root and valve. Five months later, surveillance echocardiogram revealed a slowly enlarging pseudoaneurysm arising from the ascending aorta. This finding was subsequently confirmed by computed tomographic angiogram. The patient had successful open surgical repair and paraaortic hematoma evacuation.

  PublisherDOI

Frequent coauthors

• Maansi Parekh

  Thomas Jefferson University Hospital

  66 shared

• Vinay Kandula

  Nemours Children's Health System

  49 shared

• Aishwarya Gulati

  Mallinckrodt (United States)

  37 shared

• Harit Kapoor

  Albert B. Chandler Hospital

  33 shared

• David Saul

  Brigham and Women's Hospital

  32 shared

• Kunal Gala

  18 shared

• Edward R. Oliver

  Children's Hospital of Philadelphia

  16 shared

• Vaibhav Gulati

  Mallinckrodt (United States)

  16 shared

Labs

• Achala Donuru LabPI

Education

• M.D.

  Gandhi Medical College, Andhra Pradesh University of Health Sciences, India

  1998

• Other

  Royal College of Pediatrics and Child Health, United Kingdom

  2002

• Other

  Royal College of Pediatrics and Child Health, United Kingdom

  2002

• Other

  Royal College of Radiologists, United Kingdom

  2007

Awards & honors

• Certificate of Merit award (2025)