Pulmonary lymphangiomyomatosis and tuberous sclerosis: comparison of radiographic and thin-section CT findings

Chest radiographs, thin-section computed tomographic (CT) scans, and results of pulmonary function tests in nine women with pulmonary lymphangiomyomatosis and two women with pulmonary tuberous sclerosis were retrospectively evaluated. In all patients, CT demonstrated thin-walled cysts less than 20 mm in diameter scattered at random in all parts of the lungs. In eight patients, cysts larger than 20 mm in diameter were also present. Lung tissue between cysts appeared normal in all 11 patients, except one with septal lines and dependent alveolar areas of attenuation. CT showed cysts in three patients whose radiographs were normal, and it demonstrated that many lesions that appeared reticular on plain radiographs were actually cysts. CT findings correlated better with the diffusion capacity of the lungs for carbon monoxide than did the plain radiographic findings. CT was more sensitive and more precise than radiography at showing the presence and morphology of lung abnormalities.     

Wegener's granulomatosis: findings from computed tomography of the chest in 10 patients.

Radiographs and computed tomography (CT) scans of the chest were reviewed for 10 patients with pathologically proven Wegener's granulomatosis. The CT scans revealed multiple pulmonary nodules in seven patients and a single nodule in one. The nodules ranged in diameter from 2 mm to 7 cm, and most had irregular margins. All of the nodules larger than 2 cm in diameter showed evidence of cavitation in the CT scans. Additional CT findings included associated areas of consolidation (in two patients), pleural thickening (in two) and pleural effusion (in two). Chest radiographs were available for eight patients, and the CT scans contributed information additional to that available from the radiographs for seven of these. In one patient lung nodules were visible in the CT scans but could not be distinguished from surrounding areas of consolidation in the chest radiographs. CT revealed additional nodules in five of the six patients in whom multiple nodules were seen in chest radiographs and in one of these also revealed cavitation tht was not visible in plain radiographs. CT excluded the possibility of a nodule that was suspected from the chest radiographs in a patient who had been treated previously for Wegener's granulomatosis. The authors conclude that Wegener's granulomatosis is characterized in CT scans by multiple nodules with irregular margins and by cavitation in nodules larger than 2 cm in diameter. CT may also demonstrate nodules and cavitation not apparent in radiographs.     

Spiral CT findings in septic pulmonary emboli

OBJECTIVES: The aim of the study was to determine the characteristics of septic pulmonary emboli and their prevalence on spiral computed tomographic (CT) scans. METHODS AND MATERIALS: We evaluated 65 lesions on spiral CT scans in ten patients with septic pulmonary emboli. Spiral CT scans (10-mm collimation) were obtained at 10-mm intervals from the lung apex to the diaphragm and were compared with posteroanterior chest radiographs obtained within 24 h after CT scanning. RESULTS: Only 21 (32%) of the 65 lesions detected on CT scans were also detected on chest radiographs. Peripheral nodules (39 lesions (60%)) were seen in all ten patients, wedge-shaped peripheral lesions (15 lesions (23%)) in nine patients, and infiltrates (11 lesions (17%)) in four patients. Subpleural lesions (45 lesions (69%)) and feeding vessels (35 (54%)) were found in all patients, and cavitary lesions (seven lesions (11%)) were seen in four patients. Subpleural peripheral nodules and wedge-shaped peripheral lesions were seen in nine patients. Thirty-two lesions (49%) ranged in diameter from 10 to 19 mm, and 59 lesions (91%) were less than 30 mm. CONCLUSIONS: Spiral CT is useful in detecting septic pulmonary emboli. On spiral CT subpleural peripheral nodules and wedge-shaped peripheral lesions less than 30 mm in diameter are often found in patients with septic pulmonary emboli.     

Pulmonary histiocytosis X: evaluation with high-resolution CT

Eighteen patients with pulmonary lesions of histiocytosis X were studied with high-resolution computed tomography (CT). Thin-walled cysts were found in all but one patient. The other abnormalities included nodules (n = 14), cavitated nodules (n = 3), thick-walled cysts (n = 7), reticulation (n = 4), ground-glass opacities (n = 4), and irregular interfaces (n = 4). The lesions were most often diffuse (n = 16), with a topographic predominance in the upper or middle lung zones in nine patients. Comparison of CT scans and chest radiographs shows that small and large cysts and micronodules are better detected with CT. Comparison of abnormalities found in patients in the early and late stages of the disease, as well as the evolution observed in one case, suggests that CT patterns progress from nodules to cavitated nodules and thick-walled cysts to cysts to confluent cysts.     

Pulmonary metastatic nodules: CT-pathologic correlation.

To elucidate the characteristics of pulmonary metastatic nodules on high-resolution computed tomographic (HRCT) scans, a correlative computed tomographic (CT)-pathologic study was performed with five human lungs after autopsy. The relationship of metastatic nodules to pulmonary vessels was studied with HRCT scans, radiographs of the specimen, and stereomicroscopic study in 264 nodules 0.6-9.0 mm in diameter. On radiographs and stereomicroscopic images, 190 small nodules (less than 3 mm in diameter) were in contact with the pulmonary lobule on the central bronchovascular bundles (n = 33 [17.4%]), located between the central bronchovascular bundle and the perilobular structure (n = 127 [66.8%]), or attached to perilobular structures (n = 30 [15.8%]). On HRCT scans, 21 small nodules (11.1%) were located on the central bronchovascular bundle; 130 small nodules (68.4%), between the central bronchovascular bundle and the perilobular structure; and 39 small nodules (20.5%), on the perilobular structure. On radiographs and stereomicroscopic images, 43 of 74 large nodules (greater than 3 mm in diameter) (58%) compressed both bronchovascular bundles and perilobular structures. The central bronchovascular bundle was invaded in only 13 large nodules (18%).     

Amyloidosis and lymphoproliferative disease in Sjögren syndrome: thin-section computed tomography findings and histopathologic comparisons

OBJECTIVE: To describe the thin-section computed tomography (CT) findings of Sjogren syndrome accompanying pulmonary amyloidosis and lymphoproliferative disease and to compare these with histopathologic findings. SUBJECTS AND METHODS: The thin-section CT findings of 5 women (age range: 42-59 years, mean age=50 years) with primary Sjogren syndrome accompanying pulmonary amyloidosis and lymphoproliferative disease were reviewed retrospectively by 2 chest radiologists, and decisions on findings were reached by consensus. The pathologic specimens of parenchymal lesions (nodules, dense consolidation, and cystic lesion at CT) obtained using video-assisted thoracoscopic surgery were studied to compare with the thin-section CT findings. RESULTS: Nodules, observed in all 5 patients, were variable in size and ranged from 3 to 24 mm (mean=9.9 mm) in diameter, with lobulated or irregular margins. Nodular calcifications were present in 3 patients. Cysts, which also were observed in all patients, ranged from 4 to 45 mm (mean=18.6 mm) in diameter, with a thin (1-2 mm) or no visible wall. Multiple cysts were observed, especially in the distal portion of narrowed bronchioles. Nodules and cysts showed a random distribution. Mild bronchial wall thickening with bronchial dilatation was seen in all patients, ground-glass opacities were seen in 3, and consolidation was seen in 1. Nodules, consolidation, and bronchial wall thickening at CT were caused histopathologically by the interstitial and peribronchiolar deposition of mixed amyloid and lymphoproliferative cells. Cysts lined with respiratory epithelium contained amyloid deposition and lymphoproliferative cells in their walls. CONCLUSION: Sjogren syndrome accompanying pulmonary amyloidosis and lymphoproliferative disease manifests as multiple, large, thin-walled cysts; multiple nodules; parenchymal opacity; and bronchiectasis. These findings are caused by the interstitial or peribronchial infiltration of mixed amyloid and lymphoproliferative cells.     

Pulmonary nodule: evaluation with spiral volumetric CT

Spiral volumetric computed tomography (CT) was used prospectively in 20 patients with a suspected solitary pulmonary nodule less than 1 cm in diameter on plain chest radiographs. Four additional nodules were detected with spiral CT than were detected with conventional CT. This technique required a 12-second breath hold; patient cooperation was excellent.     

Pulmonary manifestations of Hodgkin's disease: radiographic and CT findings

The aim of this study was to assess the radiological and CT findings in patients with pulmonary Hodgkin's disease and to analyse to what extent CT provides more diagnostic information. In 37 patients with 41 episodes of pulmonary manifestation of Hodgkin's disease (histological diagnosis: 11, clinical diagnosis: 30) 39 radiographs and 33 CT scans were analysed by two readers in consensus. Pulmonary nodules were recorded in 77% of radiographs (CXR) and 88% of CT scans. Nodules were multiple in 67% (CXR) and 86% (CT) and bilateral in 43% (CXR) and 66% (CT) of cases, respectively. Nodule size ranged from 2 to 100 mm. Of the nodules, 83% at radiography and CT, respectively, were < or =30 mm, and again 83% at radiography and CT, respectively, were irregularly marginated. Diffuse infiltration with and without nodules was less common. With pulmonary manifestations at initial diagnosis of Hodgkin's disease there was always hilar or mediastinal lymphadenopathy. Of 20 episodes, in which radiograph and CT had been obtained within 8 days, CT demonstrated pulmonary involvement when chest radiography was normal in 3 cases and demonstrated more lesions in 12 cases. The typical appearance of pulmonary HD consisted of multiple, irregularly marginated pulmonary nodules. Diffuse infiltration was less common. Computed tomography was superior to radiography not only in characterization of lesions but could also demonstrate pulmonary involvement when the radiograph was normal and should, therefore, be used liberally in addition to radiography.     

肺郎格汉斯细胞组织细胞增生症的CT表现

目的 分析肺郎格汉斯细胞组织细胞增生症(PLCH)的CT表现.方法 11例患者均行CT平扫,其中8例加HRCT扫描.11例均经病理确诊为PLCH.结果 11例PLCH的主要CT表现为囊腔和结节.2例仅表现为囊腔,1例仅表现为结节且多数结节伴空洞;余8例为囊腔与结节影合并存在,其中4例以囊腔为主要表现,无一例以结节影为主,2例出现间质性改变.病变的分布:1例仅有囊腔且位于左上肺;10例上、中、下肺均可见,其中2例以下肺及肋膈角区明显;3例以上叶和下叶背段明显,中叶及舌叶病变相对较轻;8例肋膈角区相对较轻.结论 PLCH的CT表现有一定的规律和特征,熟悉这些表现,有助于对该病的早期诊断.     

Pulmonary lymphangiomyomatosis

Two cases of pulmonary lymphangiomyomatosis are reported and findings of high resolution computed tomography (CT) are described. CT reveals that most lesions appearing reticular or emphysematous on radiographs are actually cysts, and accurately displays the extent and distribution of cystic change of the lung. On high resolution CT, individual cystic walls are much better displayed than on routine 10 mm section CT. Further, it is possible to detect even trivial pleural effusion and mediastinal lymph node swelling by CT.     

Pleuropulmonary paragonimiasis: radiologic findings in 71 patients.

Pleuropulmonary paragonimiasis is a disease caused by lung flukes characterized by migration of a juvenile worm in the early stage and by formation of cysts around the worm later on. The purpose of this study was to describe the radiologic manifestations of pleuropulmonary paragonimiasis, with special emphasis on the worm cyst and worm migration track. We retrospectively studied 71 patients who had evidence of pleuropulmonary paragonimiasis on chest radiographs (n = 71) and CT scans (n = 17). The diagnosis was based on the detection of eggs or on positive antibody tests. On chest radiographs, 59 patients (83%) had pulmonary lesions and 43 patients (61%) had pleural lesions. Pulmonary findings included patchy air-space consolidation (n = 37) with or without cystic changes; ring shadows (n = 16); and peripheral linear opacities (n = 29), which were more prominent in patients with pleural effusion. Twelve patients (17%) had bilateral pleural effusions or pneumothoraces. On CT scans, round low-attenuation cystic lesions (5-15 mm), filled either with fluid (n = 5) or gas (n = 5), were characteristically seen within the consolidation. Peripheral linear opacities seen on radiographs were suggestive of worm migration tracks on CT scans. CT may reveal an intracystic worm. Although the findings vary depending on the stage of the disease, findings on chest radiographs are usually typical of paragonimiasis. CT provides more specific information about the worm cyst and the worm migration track.     

Presence of local pleural adhesion in CT screening-detected small nodule in the lung periphery suggests noncancerous, inflammatory nature of the lesion

PURPOSE: Differential diagnosis of small nodules in the lung periphery detected by low-dose chest CT screening is important before surgery. The aim of the study was to discriminate between benign and malignant lesions, identified in our preoperative imaging work-up examinations and confirmed during surgery, for nodules detected on CT screening. MATERIALS AND METHODS: This study is based on 106 patients (46 men and 60 women, median age: 61.5 years) with 123 CT screening-detected and histologically confirmed nodules smaller than 30 mm in the lung periphery identified between 2002 and 2005 at Azumi General Hospital, Japan. Lesions were classified into three groups according to histological findings: adenocarcinoma, atypical adenomatous hyperplasia (AAH) and inflammatory focal lesions. We examined the visceral pleura during surgery at a location close to lung nodules. RESULTS: The median diameter of resected lung nodules on high-resolution CT (HRCT) was 9.0 mm. Nodules were nonsolid in 42, partly solid in 51 and solid in 30. Histopathological diagnosis was lung cancer in 69, AAH in 21, other noninflammatory tumours in 6 and inflammatory lesions in 27. Fifty-four lesions were located in the subpleural zone. Eight of 123 nodules showed local pleural adhesions (LPA), while 2 were buried in extensive pleural adhesion. LPA was noted more frequently in inflammatory nodules than in cancer nodules (P<.01). CONCLUSION: The presence of LPA in close proximity to a small nodule is indicative of noncancerous lesion. This feature allows the discrimination of pulmonary peripheral inflammatory lesion from peripheral small cancer on chest low-dose CT screening.     

Pulmonary nodules: detection using magnetic resonance and computed tomography

Detection of pulmonary nodules using spin-echo magnetic resonance (MR) imaging was compared with detection using computed tomography (CT). Of the 25 patients studied independently by two radiologists, no lung nodules were detected in 11 (CT or MR), ten had a single nodule, and four had multiple nodules. The lesions not seen using CT or MR were less than 1.3 cm in diameter. The greater spatial resolution of CT enabled better detection of nodules close to the diaphragm, the pleura, or to each other, whereas the better contrast resolution of MR enabled the detection of several nodules close to blood vessels. With MR, nodules were best seen on images with long repetition times (2.0 sec). Most pulmonary nodules are seen using both CT and MR. CT generally enables the detection of more small nodules than MR does, and some low-density nodules near blood vessels are better displayed using MR.     

Indeterminate small, low-attenuating hepatocellular nodules on helical CT in patients with chronic liver disease: 2-year follow-up

To evaluate the clinical significance of indeterminate, small, low-attenuating nodular lesions on helical dynamic computed tomography (CT) in chronic liver diseases, CT images were reviewed retrospectively in 281 patients. Indeterminate, low-attenuating nodular lesions less than 20 mm in diameter were followed for 24 to 35 months. Of 127 nodules in 73 patients, 21 nodules turned out to be hepatocellular carcinomas (16%), 25 nodules (20%) became larger, while the remaining 81 nodules (64%) remained unchanged or disappeared. Some low-attenuating nodules larger than 10 mm in diameter may develop into hepatocellular carcinoma.     

Standard PET/CT of the chest during shallow breathing is inadequate for comprehensive staging of lung cancer.

The incidence of malignancy associated with subcentimeter pulmonary nodules (micronodules) in patients with malignant disease has been reported to be as high as 58%. Thus, detection of small lung nodules is important for appropriate staging of lung cancer. Because of respiratory motion, small parenchymal lung lesions can be missed on CT acquired during shallow breathing. Micronodules are usually too small to be characterized reliably with 18F-FDG PET. We aimed to determine the incidence of missed pulmonary micronodules on PET/CT studies acquired during shallow breathing. METHODS: The study included 142 consecutive cancer patients (62 male and 80 female; mean age, 54 y) who underwent whole-body PET/CT during shallow breathing and breath-hold CT of the chest during maximal inspiration. CT findings were reviewed independently, and noncalcified nodules missed on the shallow-breathing scan were evaluated for size, location, and metabolic activity. RESULTS: Breath-hold chest CT detected an additional 125 parenchymal lung nodules (mean size, 3.4 +/- 1.6 mm; range, 1-9 mm) in 48 (34%) of the 142 patients. In these patients, 3 nodules, on average, were missed during shallow breathing. In 18 patients (13%), micronodules were identified exclusively on breath-hold images. None of the missed nodules demonstrated 18F-FDG uptake. CONCLUSION: Acquisition of standard PET/CT chest images during shallow breathing is inadequate for comprehensive cancer staging.     

Mediastinal tuberculous lymphadenitis: CT manifestations

An analysis was done of computed tomographic (CT) scans of 23 Korean patients who had presented with a mediastinal or hilar mass on plain chest radiographs and had subsequently been found to have tuberculous lymphadenitis. Most patients were young adults. Findings of pulmonary tuberculosis were seen on plain radiographs in 14 patients. On CT, findings were of an overwhelming preponderance of involvement of the right paratracheal and tracheobronchial nodes. After injection of contrast medium, nodes larger than 2 cm in diameter invariably showed central areas of relative low density and peripheral rim enhancement. Enhanced walls were usually irregular in thickness. Some smaller nodes did not show low-density areas, but instead showed varying degrees of homogeneous enhancement. Although metastatic nodes can be of low density, experience in this study suggests that mediastinal lymphadenopathy in a young adult with the CT findings described above is characteristic enough to support a diagnosis of tuberculosis.     

Small nodular lesions in the lung periphery: new approach to diagnosis with CT

To evaluate relationships between lesions in the lung periphery and surrounding structures, particularly vessels and bronchi, axial multiplanar reconstruction (AMPR) computed tomography (CT) was used to study 26 patients who underwent surgical resection of pulmonary nodules less than 3 cm in diameter. Findings at AMPR CT, conventional CT, and digital radiographic tomography were compared with findings obtained at evaluation of the resected specimen with regard to the ability to display the relationships between vessels, bronchi, and lesions. AMPR CT was significantly superior to conventional CT and digital radiographic tomography in detecting involvement of pulmonary vessels (P less than .001). Involvement of pulmonary veins was seen in all lung cancers, whereas such involvement was seen in only one of eight nonneoplastic lesions. Thus, involvement of pulmonary veins is strongly suggestive of malignancy. AMPR CT permits three-dimensional visualization and morphologic assessment of pulmonary nodules.     

Pulmonary lymphangioleiomyomatosis: high-resolution CT findings

Lymphangioleiomyomatosis (LAM) of the lung is a very rare disease. There are obvious discrepancies in the literature concerning the appearance of LAM on CT scans of the lung. This study adds the imaging findings of 11 patients and demonstrates how the imaging findings changed over time in four patients. Twenty-two CT examinations, and radiographs that had been obtained close to the CT examinations, of 11 patients with LAM confirmed by open lung biopsy were retrospectively evaluated with particular attention to the size of cystic lesions and wall thickness. Furthermore the CT scans were analysed for the type of pulmonary infiltration process and its distribution, presence or absence of pleural effusion, pneumothorax and lymph node enlargement. Clinical and CT follow-up studies were available in four patients. The CT scans revealed an increase in the interstitial pattern in all patients. Architectural distortion was seen in two patients and cystic lesions were present in all. The size of the cysts varied from small lesions to bullous emphysema. The cystic lesions revealed a wall thickness up to 2 mm but a wall was not perceptible in all. Pneumothorax was seen in only two patients; pleural effusion was seen in two patients. CT examination of patients with LAM reveals neither a uniform nor a pathognomonic appearance. In the early stages of LAM or in cases with interstitial changes the differential diagnosis of centrilobular emphysema or idiopathic pulmonary fibrosis seems to be more difficult than most authors believe. Received: 28 July 1997; Revision received: 20 October 1997; Accepted: 25 March 1998     

Cystic fibrosis: a comparison of computed tomography and plain chest radiographs

In patients with cystic fibrosis, plain chest radiographs may suggest the presence of bronchiectasis, bronchoceles, hilar adenopathy, or pulmonary arterial hypertension. We compared computed tomography (CT) with conventional chest radiography in 12 patients. CT clearly reveals the cause of increased linear markings, nodular lesions, and enlarged hila as seen on plain chest radiographs. It showed that nine patients had hilar adenopathy, five had enlarged pulmonary arteries, and 11 had bronchiectasis. Bronchoceles, a finding that may influence therapy, were seen on seven CT scans but on only four of the plain films.     

CT扫描对肺隔离症的诊断价值

目的 :探讨CT扫描对肺隔离症的诊断价值。方法 :搜集经手术病理、主动脉造影证实的 2 1例肺隔离症。所有病例均行CT平扫及增强扫描 ,其中 5例行螺旋CT动态增强扫描。结果 :16例CT表现为含气体或液体的囊肿和 /或软组织肿块 ,5例肿块周围可见肺气肿。 16例非含气囊肿平扫密度均匀 ,增强扫描 7例无明显强化、5例为薄壁环形强化、4例为厚壁周围性强化。无强化区的病理成分为粘液、脓液或胶样液体。CT显示出 14支异常供血血管 ( 14 / 2 1) ,螺旋CT显示率 ( 4 / 5 )高于普通CT( 10 / 16)。结论 :肺隔离症的主要CT表现是囊肿、结节或肿块 ,增强CT扫描、螺旋CT动态增强扫描能发现平扫所不易显示的结节和肿块内部的囊性成分 ,有助于隔离肺异常供血血管的显示 ,后者对发现细小的异常供血血管有较大价值