Recognition of abnormalities on computed scout images in CT examinations of the head and spine

Summary We investigated the information which can be obtained from the computer-generated digital radiographs (scout images) performed for CT examinations. One hundred CT examinations of the head and one hundred of the spine were randomly selected and retrospectively reviewed: the head scout images were acquired in the lateral projection, and those of the spine in the lateral and/or anteroposterior projections. In 122 patients with demonstrable pathology on the CT sections or the scout image, a total of 154 abnormalities was found, of which 31 (20%) were identified only on the scout images. Eight (25.8% of this number) required additional clinico-radiologic study and were therefore designated as clinically pertinent positives. This study demonstrates that the CT scout image may contain considerable, clinically relevant information which is not available on, or is complementary to, the CT sections.     

Virtual bronchoscopy in the child using multi-slice CT: initial clinical experiences

PURPOSE: Virtual bronchoscopy of the pediatric patient has been reported to be more difficult because of artifacts due to breathing or motion. We demonstrate the benefit of the accelerated examination based on multislice spiral CT (MSCT) in the pediatric patient which has not been reported so far. MATERIAL AND METHODS: MSCT (tube voltage 120 kV, tube current 110 mA, 4 x 1 mm Slice thickness, 500 ms rotation time, Pitch 6) was performed on a CT scanner of the latest generation (Volume Zoom, Siemens Corp. Forchheim, Germany). In totally we examined 11 patients (median age 48 months, range 2-122 months) suspected of having tracheoesophageal fistula (n = 2), tracheobronchial narrowing (n = 8) due to intrinsic or extrinsic factors or injury of the bronchial system (n = 1). RESULTS: In all patients we obtained sufficient data for 3D reconstruction avoiding general anesthesia. 6/11 examinations were described to be without pathological finding. A definite diagnosis was obtained in 10 patients. Virtual bronchoscopy could avoid other invasive diagnostic examination in 8/11 patients (73%). CONCLUSION: Helical CT provides 3D-reconstruction and virtual bronchoscopy in the newborn as well as the infant. It avoids additional diagnostic bronchoscopy in a high percentage of all cases.     

新生儿气胸的X线诊断

目的 分析新生儿气胸的X线表现特点，以提高其诊断能力。资料与方法 39例新生儿气胸均摄有仰卧前后位胸片，30例同时摄有仰卧水平侧位片，19例有1次或多次随访X线片，3例作胸部螺旋CT扫描。结果 39例新生儿气胸表现为内侧气胸16例，前部气胸22例，外侧气胸1例，其中伴有纵隔积气9例。结论 由于新生儿多采用卧位摄片，因此其气胸与年长儿、成人的X线表现不同，气体多聚集在胸腔前部和内侧，并常伴有纵隔积气。CT能提供更多的病变信息。     

Tendon involvement in pedal infection: MR analysis of frequency,distribution, and spread of infection

OBJECTIVE: The objective of our study was to evaluate the frequency, distribution, and extent of tendon involvement in patients with pedal infections. MATERIALS AND METHODS: Contrast-enhanced MR imaging examinations of 159 infected feet performed at 1.5 T were reviewed by two musculoskeletal radiologists for the presence and location of tendon infection (peritendinous enhancement contiguous to an adjacent ulcer or cellulitis) and for the spread of infection along tendons, which was defined as peritendinous contrast enhancement extending more than 2 cm beyond surrounding cellulitis. The study group was composed of 156 consecutive patients, 82.7% of whom had diabetes; all patients underwent subsequent surgical treatment. Results of MR evaluations were compared with the patients' charts and surgical reports. RESULTS: Of the 129 MR examinations showing an infection in the forefoot, MR evidence of tendon involvement in the infection was observed in 56 MR examinations (43%). The sum of involved tendons per ray was as follows: first ray (flexor tendon, n = 19; extensor tendon, n = 13), second (flexor tendon, n = 12; extensor tendon, n = 7), third (flexor tendon, n = 5; extensor tendon, n = 4), fourth (flexor tendon, n = 5; extensor tendon, n = 1), and fifth (flexor tendon, n = 11; extensor tendon, n = 6). Of the 32 MR examinations showing infection in the hindfoot, 14 examinations (44%) showed evidence of tendon involvement, most frequently of the distal Achilles tendon (n = 7). MR evidence of the spread of infection along a tendon was seen in 12 examinations, always with proximal spread of infection; and infection led to the development of an abscess in the central plantar compartment in three patients. Intraoperative evidence of a tendon infection was documented in 11 patients. The surgical procedure was altered because of the tendon infection in six patients. CONCLUSION: MR evidence of tendon infection is present in approximately half the patients who require surgery for pedal infection. Evidence of spread of the infection along tendons is seen infrequently on MR imaging. Detection of a tendon infection could influence surgical therapy.     

Difficult thoracic lesions: CT-guided biopsy experience in 150 cases

Computed tomography (CT) was used to guide percutaneous fine-needle biopsy in 150 cases of difficult thoracic lesions; in 76 cases, nondiagnostic bronchoscopy (n = 62) and fluoroscopic biopsy (n = 14) had previously been performed. CT was indicated for guidance when the pulmonary or pleural lesions were small (0.3-2.5 cm); in a juxta-vascular location, either hilar or mediastinal; not seen or poorly visualized on conventional radiographs; or considered inaccessible. A diagnosis was made in 124 of 150 cases (82.7%) (107 of 124 malignant and 17 of 26 benign lesions), including 86 of 107 lung nodules (80.4%), 28 of 31 mediastinal lesions (90.3%), and ten of 12 pleural masses (83.3%). Complications included pneumothorax (n = 64), hemoptysis (n = 5), hemothorax (n = 2), and pericarditis (n = 1). The high rate of pneumothorax, its treatment, and advantages of its immediate radiologic management are discussed. Use of CT guidance considerably expands the scope of thoracic lesions amenable to percutaneous biopsy.     

Gas in the sternoclavicular joints of patients with blunt chest trauma: significance and frequency of CT findings.

OBJECTIVE: In trauma patients, gas (vacuum phenomenon) in the sternoclavicular joints could represent sequelae of significant distraction forces and thus serve as a potential marker for severe intrathoracic injury. We evaluated the significance and frequency of the finding of gas in the sternoclavicular joints on chest CT of patients with blunt trauma. SUBJECTS AND METHODS: We prospectively studied all chest CT examinations performed at our institution over a 14-week period for the finding of gas in the sternoclavicular joints. Chest CT examinations (n = 267) were performed in 234 patients. We excluded data from follow-up CT examinations (n = 33), limiting our evaluation to the initial CT examination for each patient. Of the study population, 103 patients (83 men and 20 women) who ranged in age from 14 to 79 years (mean, 40 years) had sustained blunt chest trauma. For all trauma patients, we recorded the mechanism of injury and the associated thoracic injuries. RESULTS: CT revealed gas in the sternoclavicular joints in 47 patients (21%). Gas was unilateral in 27 patients and bilateral in 20 patients. Sternoclavicular joint gas was seen in 39 (38%) of the 103 trauma patients but was found in only eight (6%) of the 131 nontrauma patients (p < .0001). In the 39 trauma patients with sternoclavicular joint gas, associated thoracic injuries were seen in 17 patients (44%); either a sternal fracture or a retrosternal hematoma was seen in three patients. Radiographically evident thoracic injury was revealed in 20 (31%) of the 64 trauma patients who had no gas in the sternoclavicular joint; however, 10 of these 20 patients had either a sternal fracture or a mediastinal hematoma. CONCLUSION: Although gas in the sternoclavicular joints is more frequently seen in patients with blunt chest trauma than in patients undergoing chest CT for other indications, this finding does not indicate a greater risk of significant mediastinal or thoracic injury.     

Image-guided pleural biopsies: indications, technique, and results in 23 patients

Twenty-six pleural biopsies were performed on 23 patients over a 3-year period. Twenty-three biopsies were performed guided with ultrasound; one, with computed tomography; and two, with fluoroscopy. Indications for an image-guided pleural biopsy were (a) pleural masses or thickening that were either not seen on chest radiographs or seen only on one view and (b) small or loculated pleural effusions of unknown cause with no mass seen. If only pleural fluid was present, reverse bevel needles were used for biopsy (n = 15). If a discrete pleural mass or thickening was seen with cross-sectional imaging, standard (16-20 gauge) biopsy needles were used (n = 11). In the 23 patients, biopsy results were true positive in ten (nine with malignancy, one with tuberculous pleurisy), true negative in ten (confirmed either at subsequent thoracotomy or clinical follow-up), and false negative in three. Complications were few, with a significant pneumothorax occurring in two patients (8.7%). Image-guided biopsy of small pleural lesions and small pleural effusions can be performed by the radiologist who understands the special needles and techniques involved.     

Using edge enhancement to identify subtle findings on soft-copy neonatal chest radiographs.

OBJECTIVE: The purpose of this study was to evaluate whether edge enhancement could improve the visibility of subtle findings on soft copies of neonatal chest radiographs. MATERIALS AND METHODS: Two radiologists reviewed 82 soft-copy neonatal chest radiographs before and after the application of edge enhancement on our picture archiving and communication system (PACS). The visibility of a pneumothorax (n = 22), central venous catheter (n = 32), umbilical arterial catheter (n = 36), endotracheal tube (n = 40), and normal anatomic structures (the minor fissure, anterior segmental bronchus of the right upper lobe, and aortic arch, n = 57) was evaluated. Six of 22 soft-copy images depicting a pneumothorax were excluded from the evaluation of image quality either because of the large size of the pneumothorax itself (n = 7) or because of the lack of confirmatory evidence that would have been provided by an additional lateral decubitus (n = 6) or cross-table lateral radiograph (n = 3). Image quality was evaluated by visual grading analysis. RESULTS: The visibility of a pneumothorax (p < 0.01), vascular catheters (p < 0.001), the minor fissure (p < 0.001), and the anterior segmental bronchus of the right upper lobe (p < 0.001) improved significantly after applying edge enhancement to soft copies of neonatal chest radiographs, whereas the visibility of the aortic arch did not improve. Evaluations of the improvements in the visibility of the endotracheal tube were inconsistent. CONCLUSION: Application of edge enhancement to soft copies of neonatal chest radiographs helps radiologists to identify small pneumothoraces, vascular catheters, and delicate normal structures, thereby improving the detection of subtle chest findings in the neonatal intensive care unit.     

Cause of increased focal uptake in the cervical vertebrae in skeletal scintigraphic routine studies

Focal uptake was seen in the cervical vertebral column of 61 patients in the course of routine bone scintigraphy. These focal increases were subjected to close analysis. In 60 of these patients (98.4%) degenerative lesions became manifest as the cause of the scintigraphic finding already by the bone scintigraphy pattern (paravertebral localisation in the posterior projection and dorsal localisation in the lateral. Two typical examples of metastatic changes are presented to facilitate differentiation. The bone scintigraphic pattern in arthrosis of the intervertebral joint is so typical that x-ray control examinations to confirm the diagnosis can be omitted in many cases.     

静脉畸形骨肥大综合征的影像诊断

目的 探讨静脉畸莆骨肥大综合征影诊断的征象,材料与方法 ２５例静脉畸形骨肥大综合征行下肢静脉顺行造影,７例行下肢动脉数字减影血管造影,４例行磁共振检查,８例行彩色多普勒超声波检查。结果２５例静脉畸形骨肥大综合征下肢静脉顺行造影均有浅静脉曲线,其外侧静脉畸形占９２％明深脉病变占３６％;７例下肢动脉数字减影血管造影有动脉小分支异常,其中２例有低分流量动静脉瘘;４例磁共振检查有骨及血管畸开有骨及血管畸形     

CT Fluoroscopy–Guided Percutaneous Fiducial Marker Placement for CyberKnife Stereotactic Radiosurgery: Technical Results and Complications in 222 Consecutive Procedures

PurposeTo evaluate technical outcome and safety of computed tomographic (CT) fluoroscopy–guided percutaneous fiducial marker placement before CyberKnife stereotactic radiosurgery.Materials and MethodsRetrospective analysis was performed of 196 patients (106 men) undergoing CT fluoroscopy–guided fiducial marker placement in 222 consecutive procedures under local anesthesia from March 2006 to February 2012. Technical success was defined as fiducial marker location in the tumor or vicinity suitable for CyberKnife radiosurgery evaluated on postinterventional planning CT. Complications were classified per Society of Interventional Radiology (SIR).ResultsOne hundred ninety-six patients (age, 61.5 y ± 13.1) underwent percutaneous placement of 321 fiducial markers (mean per tumor, 1.2 ± 0.5; range, 1–4) in 37 primary tumors and 227 metastases in the thorax (n = 121), abdomen (n = 122), and bone (n = 21). Fiducial marker placement was technically successful in all procedures: intratumoral localization in 193 (60.1%), at tumor margin in 50 (15.6%), and outside of tumor in 78 cases (24.3%; mean distance to marker, 0.4 cm ± 0.6; range, 0–2.9 cm). Complications were observed in 63 placement procedures (28.4%), including minor self-limiting pneumothorax (n = 21; SIR class B) and self-limiting pulmonary hemorrhage (n = 35; SIR class A), and major pneumothorax requiring thoracostomy/drainage insertion (n = 14; SIR class D) and systemic toxicity of local anesthetic drug (n = 1; SIR class D).ConclusionsCT fluoroscopy–guided percutaneous fiducial marker placement can be performed with high technical success under local anesthesia in various anatomic regions. Although self-limiting in most cases, pneumothorax and pulmonary hemorrhage are frequently observed during fiducial marker implantation into lung tumors.     

Gastric fluid detected by sonography in fasting patients: relation to duodenal ulcer disease and gastric-outlet obstruction

We correlated the amount of gastric fluid identified by sonography in 143 fasting patients with the presence of duodenal ulcer disease and gastric-outlet obstruction as seen on barium studies. Unselected consecutive patients who were referred for a barium study of the upper gastrointestinal tract were included in a double-blinded prospective study. Sonograms were obtained in the right lateral decubitus position to allow gastric fluid to accumulate in the antrum, where it was quantified by measuring the maximal cross-sectional area of antral fluid in square centimeters. Sonograms revealed no fluid or a small amount (less than 5 cm2) in 87 (61%) of the patients and a large amount of fluid (greater than or equal to 5 cm2) in 56 patients (39%). Barium examinations showed a duodenal ulcer in 26 (46%) of the 56 patients with sonographic evidence of a large amount of gastric fluid compared with 10 patients (11%) in the group with little or no fluid on sonography (p = .001). Sonographic evidence of a large amount of fluid was found in all five patients who had gastric-outlet obstruction on barium examination (p = .02). The detection of a large amount of fluid in the stomach on sonography appears to be a feature of duodenal ulcer disease and gastric-outlet obstruction.     

Axillary projection in radiography of the nontraumatized shoulder

A series of 239 consecutive radiographic examinations of the shoulder performed on patients without acute trauma was analyzed prospectively. Each examination included anteroposterior projections with external and internal rotation of the humerous and an axillary projection. The abnormalities that could be identified on each view were listed separately. There were 109 normal examinations and 130 abnormal examinations. The anteroposterior view with external rotation identified 14 abnormalities not seen on the other views. The axillary projection identified 15 abnormalities not seen on other views. If only these two views had been obtained, 99.3% of the abnormalities would have been identified. The implications for altering routine film series are discussed.     

CT evaluation of mesenteric panniculitis: prevalence and associated diseases

OBJECTIVE: This study was undertaken to assess the prevalence of mesenteric panniculitis on CT and to describe its appearance and associated diseases. SUBJECTS AND METHODS: A total of 7620 consecutive abdominal CT examinations were prospectively evaluated for features common to mesenteric panniculitis such as a well-delineated inhomogeneous hyperattenuated fatty mass at the mesenteric root, envelopment of mesenteric vessels, and no evidence of invasion of the adjacent small-bowel loops that may be displaced. RESULTS: CT findings of mesenteric panniculitis were seen in 49 patients (0.6%). We found a female predominance. Mesenteric panniculitis coexisted with malignancy in 34 patients and with benign disorders in 11 patients. In the remaining four patients, mesenteric panniculitis, verified on histology, was considered to be responsible for the patients' clinical manifestations; no other abnormality was identified. Soft-tissue nodules (n = 39) and a fatty halo surrounding vessels and nodules (n = 42) were observed in most patients. Follow-up abdominal CT examinations in 29 of the 49 patients showed changes in only one patient. CONCLUSION: CT findings of mesenteric panniculitis may be seen in patients undergoing abdominal CT for various symptoms.     

Effect of needle tract bleeding on occurrence of pneumothorax after transthoracic needle biopsy

PURPOSE: Occasionally bleeding along the needle trajectory is observed at post-biopsy computed tomographic sections. This study was designed to evaluate the possible effect of needle tract bleeding on the occurrence of pneumothorax and on requirement of chest tube insertion. MATERIALS AND METHODS: Two hundred eighty-four needle biopsies performed in 275 patients in whom the needle traversed the aerated lung parenchyma were retrospectively reviewed. Bleeding along the needle tract, occurrence of pneumothorax and need for chest tube insertion, type and size of the needle, size of the lesion, length of the lung traversed by the needle, presence or absence of emphysema were noted. Effect of these factors on the rate of pneumothorax and needle-tract bleeding was evaluated. The data were analyzed by chi2 test. RESULTS: Pneumothorax developed in 100 (35%) out of 284 procedures requiring chest tube placement in 16 (16%). Variables that were significantly associated with an increased risk of pneumothorax were depth of the lesion (P < 0.001) and severity of emphysema (P < 0.05). There was bleeding along the needle tract in 18.6% (n = 53) of the procedures. Pneumothorax occurred in 18 (33.9%) out of 53 procedures in which tract-bleeding was observed and in 82 (35.4%) out of 231 procedures in which tract-bleeding was not seen. The difference between the two groups was not significant (P > 0.05). However, analysis of the relation between length of lung traversed by the needle, tract-bleeding and pneumothorax rate indicated that tract-bleeding had a preventive effect on development of pneumothorax (P < 0.001). Occurrence of tract bleeding also had preventive effect on pneumothorax in the presence of emphysema (P < 0.05). The only variable which had effect on occurrence of tract-bleeding was the length of the lung traversed by needle (p < 0.001). Requirement for chest tube insertion was smaller in the tract-bleeding group than non-tract bleeding group, 11% (2/18) to 17% (14/82), respectively. But this difference was not significant statistically (P > 0.05). CONCLUSION: Bleeding in the needle tract has a preventive effect on the occurrence of the pneumothorax in deep-seated lesions and in the presence of emphysema, although it does not affect the overall rate of pneumothorax.     

Tödliche stumpfe Schädel-Hirn-Traumen

The results of forensic neuropathologic (macroscopic) examinations of formalin-fixed brains in 676 cases of fatal blunt head injuries concerning involvement of the centro-axial/periventricular internal structures were analyzed. The causes of injuries were predominantly falls at ground level (n=195), traffic accidents (n=86), falling down stairs (n=61) and from a height (n=47), complex traffic accidents (n=65) and passengers (59). The most frequent main intracranial injuries were contrecoup lesions without (n=157) and with significant subdural hemorrhaging (n=122), followed by pure subdural hematomas (n=91) and diffuse injuries (n=66). Lesions characterized as inner cerebral trauma were present in 91 victims (13.5%), seldom in ground level falls (<10%) and frequent (23–30%) in traffic accidents. In frontal/frontolateral impacts the rate (20.4%) was twice as high as in occipital trauma. Massive ventricular bleeding was related to such injuries in only 5 cases in which other life-threatening intracranial injuries were also present. Summarizing the experiences, inner cerebral trauma was relatively frequent as a component of fatal head injuries, not as the decisive lesion but as a secondary finding. Only 3 cases of pure inner cerebral trauma (2 by bodily harm and 1 traffic accident) were observed in which a difficult differentiation from a spontaneous event was necessary.     

Usefulness of the blood patch technique after transthoracic needle aspiration biopsy

The authors investigated the effectiveness of the blood patch technique in reducing the pneumothorax and chest tube insertion rates after transthoracic needle lung biopsy. Biopsy of 100 pulmonary nodules was performed with a coaxial system. In this prospective, randomized study, patients either received a blood patch (group A, n = 46) or did not (group B, n = 47). Seven procedures were excluded: five for technical reasons and two because of lack of follow-up information. Comparison of the two groups by means of X2 analysis and the Student t test revealed no difference in the mean age, gender, smoking history, proportion of heavy smokers, nodule size, presence of cavitation, or number of needle passes. The pneumothorax rate was 24% (11 of 46 patients) in group A and 30% (14 of 47 patients) in group B. The chest tube insertion rate was 2.2% (one patient) in group A and 2.1% (one patient) in group B. The difference between the groups in either rate was not significant (P greater than .5). The blood patch technique did not lower the rate of pneumothorax or chest tube insertion.     

Stereotactic biopsy of the breast using an upright unit, a vacuum-suction needle, and a lateral arm-support system

OBJECTIVE: This study evaluated the vacuum-suction needle (8- to 11-gauge) on an upright stereotactic machine with a lateral arm-support system. SUBJECTS AND METHODS: From July 1999 to August 2000, 185 core biopsies of the breast in 179 consecutive patients were planned in four institutions using 8- 11-gauge vacuum-suction probes on an upright stereotactic unit. Needles were stabilized and attached to the x, y, and z coordinates of the machines via a lateral arm-support system. Needle entry was made in the x-axis. RESULTS: Five patients were canceled, and 180 biopsies were performed in 174 patients while the patients were in seated (n = 171) and lateral decubitus (n = 9) positions. An average of 9.5 cores were taken (range, 5-26 cores). Targeting was successful in 176 (98%) of 180 cores. Lesions were missed because of movement associated with Parkinson's disease (n = 1), or because the mass was obscured (n = 1) or calcifications were not in the core specimen (n = 2). Findings in 152 (84%) of the biopsies were benign and 28 (16%) were malignant. Forty-one lesions underwent surgical excision and 106 underwent mammographic follow-up. Discordance was 4% (6/147). Complications included vasovagal reactions (n = 10, 5.6%), bleeding (n = 5, 3%), hematomas (n = 3, 1.7%), vomiting (n = 1, 0.6%), and technical failure (n = 1, 0.6%). CONCLUSION: Vacuum-suction needle core biopsies can be successfully performed on an upright stereotactic machine with a lateral arm attachment. Thinly compressed breasts and lesions located near the chest wall are well sampled. The vasovagal rate is higher than that on a prone table but is acceptable.     

Accessory fissures of the lung: evaluation by high-resolution computed tomography

This study was performed to classify and assess the frequency of accessory fissures of the lung by high-resolution CT (HRCT) scans. The HRCT scans of 443 patients were retrospectively reviewed. After exclusion of patients with pulmonary parenchymal distortion, pleural disease or those who had had lobectomy, 186 patients were included in the study. The HRCT scans consisted of 1.5-mm sections obtained at 10-mm intervals and reconstructed with a high-spatial-resolution algorithm. In 59 of 186 patients (32%), a total of 69 accessory fissures were detected. The most common fissure was the inferior accessory fissure ( n=40; 21%, 38 on the right, 2 on the left) followed by the left minor fissure ( n=17; 9%). Other accessory fissures observed were the right superior accessory fissure ( n=2; 1%), the azygos fissure ( n=1; 0.5%) and intersegmental fissures between the medial and lateral segments of the right middle lobe ( n=3; 2%), the superior and inferior segments of the lingula ( n=2; 1%), the anterobasal and laterobasal segments of both the right ( n=1; 0.5%) and the left ( n=3; 2%) lower lobe. In conclusion, the inferior accessory fissure and the left minor fissure were the most common accessory fissures seen on HRCT examinations.     

Thin-section CT findings in 32 immunocompromised patients with cytomegalovirus pneumonia who do not have AIDS

OBJECTIVE: The aim of this study was to review the thin-section CT findings in 32 immunocompromised patients without AIDS who had proven Cytomegalovirus pneumonia. MATERIALS AND METHODS: The causes of immunocompromise included bone marrow (n = 25) or solid organ transplantation (n = 5) and corticosteroid therapy (n = 2). The patients included 16 men and 16 women ranging in age from 22 to 70 years (mean age, 43 years). The CT scans were retrospectively reviewed by two thoracic radiologists for the presence, appearance, and distribution of parenchymal abnormalities. RESULTS: Bilateral abnormalities were seen in all patients. Areas of ground-glass opacification were seen in 21 (66%) of 32 patients. Ground-glass opacification was the predominant CT feature in nine cases (28%). In 19 of 32 patients, ground-glass attenuation was associated with other abnormalities. Multiple nodules were identified in 19 patients (59%). Nodules were bilateral in 15 patients and unilateral in four patients. Nodules were the only CT finding in three patients (9%). Areas of air-space consolidation were identified in 19 patients (59%). Air-space consolidation was the only CT finding in one patient (3%). Other less common CT findings included thickening of the bronchovascular bundles (n = 7) and the tree-in-bud appearance (n = 4). Pleural effusions were seen in seven patients. CONCLUSION: The thin-section CT manifestations of Cytomegalovirus pulmonary infection usually consist of a mixture of patterns, most commonly ground-glass attenuation, areas of consolidation, and small nodules.