免疫健全和免疫抑制患者肺隐球菌病的CT表现

目的探讨不同免疫状态患者肺隐球菌病(pulmonary cryptococcosis,PC)的临床及CT表现,旨在提高对该病的认识和诊断水平。方法搜集经病理或细菌学证实的46例PC患者的临床及CT资料,分别对免疫健全和免疫抑制患者的CT征象进行分析。结果免疫健全患者临床症状较轻而CT表现较明显,CT像上以结节/肿块、实变影多见;免疫抑制患者临床症状与CT表现一致,CT像上以片状浸润/渗出影、空洞多见。结论 PC的CT表现多样化,病变多见于两下肺;其影像学表现与患者免疫状态有关,免疫健全患者以结节/肿块型为主。CT对PC的诊断有一定价值。     

Radiological Findings of Extensively Drug-Resistant Pulmonary Tuberculosis in Non-AIDS Adults: Comparisons with Findings of Multidrug-Resistant and Drug-Sensitive Tuberculosis

Objective

This study was designed to describe the radiological findings of extensively drug-resistant (XDR) pulmonary tuberculosis (TB) and to compare the observed findings with findings of drug-sensitive (DS) and non-XDR multidrug-resistant (MDR) TB in non-AIDS patients.

Materials and Methods

From September 1994 to December 2007, 53 MDR TB patients (M:F = 32:21; mean age, 38 years) and 15 XDR TB non-AIDS patients (M:F = 8:7; mean age, 36 years) were enrolled in the study. All of the MDR TB patients had received no treatment or less than one month of anti-TB treatment. In addition, all XDR TB patients received either no anti-TB treatment or only first-line anti-TB drugs. In addition, 141 consecutive DS TB patients (M:F = 79:62; mean age, 51 years) were also enrolled in the study for comparison. Chest radiograph, CT and demographic findings were reviewed and were compared among the three patient groups.

Results

For patients with XDR TB, the most frequent radiographic abnormalities were nodules (15 of 15 patients, 100%), reticulo-nodular densities (11 of 15, 73%), consolidation (9 of 15, 60%) and cavities (7 of 15, 47%) that were located mainly in the upper and middle lung zones. As seen on radiographs, significant differences were found for the frequency of nodules and ground-glass opacity lesions (all p < 0.001) (more frequent in DS TB patients than in MDR and XDR TB patients). For the use of CT, significant differences (more frequent in MDR and XDR TB patients) were found for the frequency of multiple cavities, nodules and bronchial dilatation (p = 0.001 or p < 0.001). Patients with MDR TB and XDR TB were younger as compared to patients with DS TB (p < 0.001). Imaging findings were not different between patients with MDR TB and XDR TB.

Conclusion

By observation of multiple cavities, nodules and bronchial dilatation as depicted on CT in young patients with acid-fast bacilli (AFB) positive sputum, the presence of MDR TB or XDR TB rather than DS TB can be suggested. There is no significant difference in imaging findings between patients with XDR TB and MDR TB.     

High-Resolution CT Findings of Re-Expansion Pulmonary Edema

Objective

To describe the high-resolution CT (HRCT) findings of re-expansion pulmonary edema (REPE) following a thoracentesis for a spontaneous pneumothorax.

Materials and Methods

HRCT scans from 43 patients who developed REPE immediately after a thoracentesis for treatment of pneumothorax were retrospectively analyzed. The study group consisted of 41 men and two women with a mean age of 34 years. The average time interval between insertion of the drainage tube and HRCT was 8.5 hours (range, 1-24 hours). The patterns and distribution of the lung lesions were analyzed and were assigned one of the following classifications: consolidation, ground-glass opacity (GGO), intralobular interstitial thickening, interlobular septal thickening, thickening of bronchovascular bundles, and nodules. The presence of pleural effusion and contralateral lung involvement was also assessed.

Results

Patchy areas of GGO were observed in all 43 patients examined. Consolidation was noted in 22 patients (51%). The geographic distribution of GGO and consolidation was noted in 25 patients (58%). Interlobular septal thickening and intralobular interstitial thickening was noted in 28 patients (65%), respectively. Bronchovascular bundle thickening was seen in 13 patients (30%), whereas ill-defined centrilobular GGO nodules were observed in five patients (12%). The lesions were predominantly peripheral in 38 patients (88%). Of these lesions, gravity-dependent distribution was noted in 23 cases (53%). Bilateral lung involvement was noted in four patients (9%), and a small amount of pleural effusion was seen in seven patients (16%).

Conclusion

The HRCT findings of REPE were peripheral patchy areas of GGO that were frequently combined with consolidation as well as interlobular septal and intralobular interstitial thickening.     

Pulmonary Metastases of Alveolar Soft-Part Sarcoma: CT Findings in Three Patients

Alveolar soft-part sarcoma is a rare soft tissue sarcoma of young adults with unknown histogenesis, and the organ most frequently involved in metastasis is the lung. We report the CT findings of three patients of pulmonary metastases of alveolar soft-part sarcoma, which manifested as clearly enhanced pulmonary nodules or masses. On enhanced scans, some of the masses were seen to contain dilated and tortuous intratumoral vessels.     

Usual Interstitial Pneumonia and Non-Specific Interstitial Pneumonia: Serial Thin-Section CT Findings Correlated with Pulmonary Function

Objective

We wanted to demonstrate and compare the serial high-resolution CTs (HRCT) and the pulmonary function test (PFT) findings of the usual interstitial pneumonia (UIP) and the non-specific interstitial pneumonia (NSIP).

Materials and Methods

The serial HRCT scans and the PFT results were retrospectively analysed and compared for 35 patients having UIP without significant honeycombing (UIP-w/o hc, < 5% of honeycombing at CT), 35 patients having UIP with honeycombing (UIP-w/i hc, ≥ 5% of honeycombing), and 25 patients with NSIP. The mortality rates were also compared. Follow-up CT scans were available in 75 patients (29 UIP-w/o hc patients, 22 UIP-w/i hc patients and 24 NSIP patients) and the follow-up periods ranged from 150 to 2,370 days. The initial and follow-up PFT data were available for 71 patients.

Results

On the initial CT, significant differences were present between the UIP-w/i hc patients and both the UIP-w/o hc patients and the NSIP patients in the overall extent, ground-glass opacity (GGO) away from the reticulation, reticulation and honeycombing (all p < 0.05). Improvement was noticed in five (17%) of 29 UIP-w/o hc patients, none of 22 UIP-w/i hc patients, and 9 (37%) of 24 NSIP patients; deterioration was noted in six (21%) UIP-w/o hc patients, two (9%) UIP-w/i hc patients and three (13%) NSIP patients (p = 0.044 between UIP-w/o and UIP-w/i hc; p = 0.637 between UIP-w/o hc and NSIP; p = 0.007 between UIP-w/i hc and NSIP). The serial changes of the pulmonary function in the NSIP patients were different from those noted for the UIP-w/i hc and UIP-w/o hc patients (p = 0.440 between UIP-w/o and UIP-w/i hc; p = 0.022 between UIP-w/o hc and NSIP; p = 0.003 between UIP-w/i hc and NSIP). Five (14%) of the 35 patients with UIP-w/o hc, 16 (46%) of the 35 patients with UIP-w/i hc and three (12%) of the 25 patients with NSIP died (p = 0.002, comparison for the three groups).

Conclusion

On CT, NSIP and UIP-w/o hc patients have similar patterns of parenchymal abnormalities and a similar likelihood of change in the extent of disease on follow-up. Patients with UIP-w/i hc have distinctive features and a worst prognosis.     

Esophageal Leiomyoma: Radiologic Findings in 12 Patients

Objective

The aim of our study was to describe and compare the radiologic findings of esophageal leiomyomas.

Materials and Methods

The chest radiographic (n = 12), esophagographic (n = 12), CT (n = 12), and MR (n = 1) findings of surgically proven esophageal leiomyomas in 12 consecutive patients [ten men and two women aged 34 - 47 (mean, 39) years] were retrospectively reviewed.

Results

The tumors, surgical specimens of which ranged from 9 to 90 mm in diameter, were located in the upper (n = 1), middle (n = 5), or lower esophagus (n = 6). In ten of the 12 patients, chest radiography revealed the tumors as mediastinal masses. Esophagography showed them as eccentric, smoothly elevated filling defects in 11 patients and a multilobulated encircling filling defect in one. In 11 of the 12 patients, enhanced CT scans revealed a smooth (n = 9) or lobulated (n = 2) tumor margin, and attenuation was homogeneously low (n = 7) or iso (n = 4). In one patient, the tumor signal seen on T2-weighted MR images was slightly high.

Conclusion

Esophageal leiomyomas, located mainly in the middle or distal esophagus, are consistently shown by esophagography to be mainly eccentrically elevated filling defects and at CT, lesions showing homogeneous low or isoattenuation are demonstrated.     

Drug-sensitive tuberculosis, multidrug-resistant tuberculosis, and nontuberculous mycobacterial pulmonary disease in nonAIDS adults: comparisons of thin-section CT findings

The aim of this work was to compare thin-section CT (TSCT) findings of drug-sensitive (DS) tuberculosis (TB), multidrug-resistant (MDR) TB, and nontuberculous mycobacterial (NTM) pulmonary disease in nonAIDS adults. During 2003, 216 (113 DS TB, 35 MDR TB, and 68 NTM) patients with smear-positive sputum for acid-fast bacilli (AFB), and who were subsequently confirmed to have mycobacterial pulmonary disease, underwent thoracic TSCT. The frequency of lung lesion patterns on TSCT and patients' demographic data were compared. The commonest TSCT findings were tree-in-bud opacities and nodules. On a per-person basis, significant differences were found in the frequency of multiple cavities and bronchiectasis (P < 0.001, chi-square test and multiple logistic regression analysis). Multiple cavities were more frequent in MDR TB than in the other two groups and extensive bronchiectasis in NTM disease (multiple logistic regression analysis). Patients with MDR TB were younger than those with DS TB or NTM disease (P < 0.001, multiple logistic regression analysis). Previous tuberculosis treatment history was significantly more frequent in patients with MDR TB or NTM disease (P < 0.001, chi-square test and multiple logistic regression analysis). In patients with positive sputum AFB, multiple cavities, young age, and previous tuberculosis treatment history imply MDR TB, whereas extensive bronchiectasis, old age, and previous tuberculosis treatment history NTM disease.     

免疫力低下肺部侵袭性曲霉菌感染的早期及进展期CT征象回归分析

目的探讨免疫力低下患者肺部侵袭性曲霉菌感染的早期及进展期的CT征象。资料与方法分析符合免疫力低下继发肺部感染的72例患者的CT资料,其中32例为肺部侵袭性曲霉菌感染,40例为肺部常规细菌感染。将曲霉菌感染者作为研究组,常规细菌感染者作为对照组,对相应CT征象分析采用二分类Logistic回归分析,逐步筛选出对诊断免疫力低下肺部侵袭性霉菌感染的早期及进展期有统计学意义的CT征象。结果肺部侵袭性曲霉菌感染的早期及进展期表现一般出现两种或两种以上的CT征象。最多见者为晕征+枝果征,占73.4%,其次为肺段性楔形实变+晕征+枝果征,占64.6%,再次为毛玻璃征+晕征+枝果征,占58.3%。对诊断早期及进展期肺部侵袭性曲霉菌感染有显著性影响的CT表现依次为晕征、枝果征、病灶数目多发及空气新月征。结论免疫力低下肺部侵袭性曲霉菌感染早期及进展期的CT表现具有一定的特异性,对临床治疗及预后具有重要指导意义。     

白塞氏病的胸部CT表现

目的；探讨白塞氏病胸部ＣＴ表现。材料与方法；回顾性分析了１５例白塞氏病患者的胸部ＣＴ表现。结果：１５例中１１例胸部ＣＴ可见不同程度的异常改变，其中２例肺部肿块ＣＴ增强扫描为肺动脉瘤；１例上腔静脉狭窄血栓形成致胸壁侧支循环形成；１例肺动脉高压及肺间质病变；其他异常包括胸腔积液、胸膜增厚、肺灌注不良、肺间质病变及纵隔淋巴结肿大。结论：ＣＴ对白塞氏病患者胸部病变尤其是肺动脉脉瘤的诊断具有重要的价值。     

Hypereosinophilic Syndrome: CT Findings in Patients with Hepatic Lobar or Segmental Involvement

Objective

The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved.

Materials and Methods

Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation.

Results

CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis.

Conclusion

Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis.     

Pulmonary Complication of Novel Influenza A (H1N1) Infection: Imaging Features in Two Patients

Novel influenza A (H1N1) virus is the pathogen of recent global outbreaks of febrile respiratory infection. We herein report the imaging findings of pulmonary complication in two patients with novel influenza A (H1N1) infection. The first patient without secondary infection showed the ill-defined ground-glass opacity nodules and patch areas of ground-glass opacities. The second patient with secondary pneumococcal pneumonia showed areas of lobar consolidation in the right middle lobe and left lower lobe and ground-glass opacities.     

Congenital anomalies of tracheobronchial branching patterns: spiral CT aspects in adults

Congenital abnormalities of the bronchi have been classically described with chest X-rays, conventional tomography, bronchography, CT and MR imaging. Recently, the capacity of spiral CT to explore a complete volume with no gap and excellent multiplanar reformations has been emphasized. The contribution of this technique to the analysis of congenital anomalies of tracheobronchial branching patterns encountered in adult patients is illustrated. Agenesis, aplasia, and hypoplasia are discussed, followed by bronchial atresia and abnormalities of bronchial divisions. In most cases spiral CT permits a full and correct evaluation of the malformation as well as its associated anomalies. It appears therefore to be the preferable technique for studying such anomalies of the tracheobronchial tree. Moreover, knowledge of CT aspects of the main congenital bronchial abnormalities along with complete visualization of the tracheobronchial tree will probably lead to detection of more incidental anomalies. Received 10 February 1997; Revision received 18 April 1997; Accepted 21 April 1997     

Spiral CT findings in a postoperative intrathoracic gastric herniation: a case report

A case is reported in which spiral CT was most the contributive imaging technique in the diagnosis of a postoperative intrathoracic gastric herniation. The coronal reformatted spiral CT images demonstrated very well the intrathoracic stomach located above a normally positioned left hemi-diaphragm. Compared with conventional CT, the multiplanar reconstruction capability provided by spiral CT allowed a much better delineation of the diaphragm in this case. Correspondence to: J. Bogaert     

Migrating Lobar Atelectasis of the Right Lung: Radiologic Findings in Six Patients

Objective

To describe the radiologic findings of migrating lobar atelectasis of the right lung.

Materials and Methods

Chest radiographs (n = 6) and CT scans (n = 5) of six patients with migrating lobar atelectasis of the right lung were analyzed retrospectively. The underlying diseases associated with lobar atelectasis were bronchogenic carcinoma (n = 4), bronchial tuberculosis (n = 1), and tracheobronchial amyloidosis (n = 1).

Results

Atelectasis involved the right upper lobe (RUL) (n = 3) and both the RUL and right middle lobe (RML) (n = 3). On supine anteroposterior radiographs (n = 5) and on an erect posteroanterior radiograph (n = 1), the atelectatic lobe(s) occupied the right upper lung zone, with a wedge shape abutting onto the right mediastinal border. On erect posteroanterior radiographs (n = 6), the heavy atelectatic lobe(s) migrated downward, forming a peri- or infrahilar area of increased opacity and obscuring the right cardiac margin. Erect lateral radiographs (n = 4) showed inferior shift of the anterosuperiorly located atelectatic lobe(s) to the anteroinferior portion of the hemithorax.

Conclusion

Atelectatic lobe(s) can move within the hemithorax according to changes in a patient''s position. This process involves the RUL or both the RUL and RML.     

肺腺鳞癌的螺旋CT表现与病理对照研究

目的　探讨肺腺鳞癌的螺旋CT表现与组织病理所见的相关性。资料与方法　搜集经手术病理证实的肺腺鳞癌 15例 ,男 10例 ,女 5例 ,年龄 42～ 73岁 ,平均 6 0 .8岁。均采用螺旋CT扫描。结合组织病理所见 ,观察和评价肿瘤内部结构、密度分布、边缘特征及周围肺组织改变等CT表现。结果　 15例肺腺鳞癌中 ,周围型 12例 ,中央型 3例 ;肿块直径为 3.8± 1.1cm ;均匀密度肿块 2例 (13%) ,不均匀密度肿块 13例 (87%) ;常见CT征象包括分叶征 14例 (93%) ,胸膜凹陷征 12例 (80 %) ,肿块内坏死 11例 (73%) ,血管集束征 10例 (6 7%)和毛刺征 8例 (5 3%)。不常见征象包括空洞和支气管气相各 1例。病理上肿瘤呈灰白色 ,边界清楚 ,分叶 ,肿瘤呈实体性生长 ,腺癌与鳞癌成分并存。结论　肺腺鳞癌以周围型多见 ,螺旋CT像上呈软组织肿块 ,常伴有坏死 ,这与肿瘤呈实体性生长的组织病理学特征有关。     

Early Recurring Hepatocellular Carcinoma after Partial Hepatic Resection: Preoperative CT Findings

Objective

The purpose of this study was to determine the utility of preoperative CT in predicting early recurrence of hepatocellular carcinoma after partial hepatic resection.

Materials and Methods

Preoperative three-phase helical CT scans in 53 patients with hepatocellular carcinoma were retrospectively reviewed by two radiologists. In 27 patients (group I), HCC had recurred within six months, while 26 (group II) had remained disease free for at least two years. In each group, preoperative CT findings were evaluated in each group for the tumor size and number, the presence or absence of capsule, distinctness of tumor margin, perinodular extension, and the presence or absence of portal vein thrombosis.

Results

In group I, a tumor capsule of tumor was seen in five of 27 patients (19%), and in group II, in 16 of 26 (62%) (p = .001). The tumor margin was distinct in eight patients (30%) in group I and in 20 (77%) in group II (p = .001). Multiple tumors, perinodular extension, and portal vein thrombosis were more frequently seen in group I but the differences were not statistically significant (p > .05). Tumor size was similar in each group (p > .05).

Conclusion

Preoperative CT findings that may help predict the early recurrence of hepatocellular carcinoma after surgical resection are an absence of capsule of tumors and an indistinct margin. Reference to these findings during preoperative CT can guide clinicians in their choice of treatment.     

Pulmonary Mucinous Cystadenocarcinoma: Report a Case and Review of CT Findings

A pulmonary mucinous cystadenocarcinoma is an extremely rare tumor that is considered to be a cystic variant of mucin-producing lung adenocarcinoma. We present a case of pulmonary mucinous cystadenocarcinoma in a 54-year-old woman. Chest CT scans showed a 4.3-cm-sized, lobulated, well-defined, and homogeneous mass in the right middle lobe with peripheral stippled calcifications that demonstrated low-attenuation with no enhancement after contrast administration; ¹⁸F-fluorodeoxyglucose (FDG) PET/CT demonstrated mild heterogeneous FDG uptake. The mass was diagnosed as adenocarcinoma with mucin production by transbronchial lung biopsy. Right middle lobectomy was performed, and the pathologic examination disclosed a pulmonary mucinous cystadenocarcinoma.     

Dependent Lung Opacity at Thin-Section CT: Evaluation by Spirometrically-Gated CT of the Influence of Lung Volume

Objective

To evaluate the influence of lung volume on dependent lung opacity seen at thin-section CT.

Materials and Methods

In thirteen healthy volunteers, thin-section CT scans were performed at three levels (upper, mid, and lower portion of the lung) and at different lung volumes (10, 30, 50, and 100% vital capacity), using spirometric gated CT. Using a three-point scale, two radiologists determined whether dependent opacity was present, and estimated its degree. Regional lung attenuation at a level 2 cm above the diaphragm was determined using semiautomatic segmentation, and the diameter of a branch of the right lower posterior basal segmental artery was measured at each different vital capacity.

Results

At all three anatomic levels, dependent opacity occurred significantly more often at lower vital capacities (10, 30%) than at 100% vital capacity (p = 0.001). Visually estimated dependent opacity was significantly related to regional lung attenuation (p < 0.0001), which in dependent areas progressively increased as vital capacity decreased (p < 0.0001). The presence of dependent opacity and regional lung attenuation of a dependent area correlated significantly with increased diameter of a segmental arterial branch (r = 0.493 and p = 0.0002; r = 0.486 and p = 0.0003, respectively).

Conclusion

Visual estimation and CT measurements of dependent opacity obtained by semiautomatic segmentation are significantly influenced by lung volume and are related to vascular diameter.