艾滋病合并马红球菌肺炎的胸部影像表现

目的 探讨艾滋病合并马红球菌肺炎的胸部影像表现.方法 回顾性分析3例艾滋病合并马红球菌肺炎的胸部影像表现.结果 3例X线胸片均可见斑片状渗出实变和小结节,见大面积实变及空洞2例.CT显示大面积(叶、段分布)实变及多发空洞、斑片状渗出实变、小叶中心结节和树芽征各2例,支气管扩张1例.结论 肺浸润实变伴空洞及散发结节是艾滋病合并马红球菌肺炎的常见胸部影像表现.

Abstract：

Objective To study the imaging appearances of Rhodococcus equi pneumonia in three patients with acquired immunodeficiency syndrome ( AIDS). Methods Thoracic imaging appearances of Rhodococcus equi pneumonia in three patients with AIDS were retrospectively analyzed. Results The chest radiograph showed patchy consolidations and small nodules ( n = 3 ), large consolidations with multiple cavitations ( n = 2). CT showed large lobar or segmental consolidations with multiple cavitations (n=2),patchy consolidations (n=2), bronchiectasis (n=1), multiple small centrilobular nodules ( n = 2) and tree-in-bud patterns (n = 2). Conclusion The most common radiological findings in AIDS patients with Rhodococcus equi pulmonary infection are large consolidations with multiple cavitations and multiple centrilobular nodules.     

Laryngeal papillomatosis

Four cases of laryngeal papillomatosis are presented to illustrate the clinical and radiological features associated with this condition. In children the papillomas are usually multiple and benign but they frequently recur after surgical treatment. In adults they are generally solitary and have a very low recurrence rate. Xeroradiography of the neck is useful in assessing the extent of papilloma spread.     

HRCT in detection of pulmonary infections from nontuberculous mycobacteria: personal experience

Purpose

The authors sought to assess the role of highresolution computed tomography (HRCT) in the detection and follow-up of nontuberculous mycobacteria (NTM) pulmonary infection in immunocompetent patients and to identify the most common radiological patterns for diagnosis.

Materials and methods

Plain chest radiographs and HRCT scans of 42 consecutive patients with NTM pulmonary infection (M/F 26/16; mean age 57, range 41–83) were retrospectively reviewed. Ten of these patients were followed up for 18 months after diagnosis. Small nodules (<10 mm), nodules 10- to 30-mm in diameter, lobar/segmental consolidation, cavitations, bronchiectasis and tree-in-bud pattern were analysed.

Results

Small nodules were more frequent than nodules 10- to 30-mm in diameter, and segmental consolidation was more frequent than lobar. Cavitations, tree-in-bud and bronchiectasis were more frequently located in the upper lobes. Four of the followed-up patients had cavitation of preexisting nodules, and five had progression of bronchiectasis.

Conclusions

HRCT allows accurate detection and followup of the most frequent presentation patterns: diffuse small nodules, bronchiectasis, upper lobe segmental consolidation and cavitations. The appearance of new bronchiectasis and progression of old disease are due to pulmonary infection.     

Broncho-alveolar spread in a case of juvenile laryngeal papillomatosis (author's transl)

The authors report the case of a 30-year-old man suffering from juvenile laryngeal papillomatosis, recurrent since the age of 4. 23 years later, multiple round opacities were found in the lungs, progressing slowly to excavation. Bronchoscopy with broncho-aspiration provided histological confirmation of the diagnosis of broncho-alveolar spread of the papillomatosis, made on the basis of plain films and tomography.     

Renal metastases from a squamous cell carcinoma of the larynx

Laryngeal squamous cell carcinoma (SCC) tends to exhibit local spread with a low incidence of distal metastases. The majority of distal metastases are to the lungs and renal involvement is extremely rare. We present a case of laryngeal SCC with metastatic spread to the left kidney presenting as a large, mainly cystic mass. The radiological differentiation of renal metastases from primary renal tumours is discussed.     

Atypical radiological manifestations of pulmonary Langerhans cell histiocytosis in a 12-year-old girl

Pulmonary Langerhans cell histiocytosis is a rare pulmonary disease that typically affects cigarette smokers from 30-40 years of age onwards. It is very rare in children, especially for those under 15 years of age. We report an atypical radiological manifestation of isolated pulmonary Langerhans cell histiocytosis in a 12-year-old girl that showed multifocal consolidation and multiple small nodules on an initial chest radiograph, and gradual fibrotic change with multiple cysts on follow-up chest radiographs and CT scans.     

Clinical and radiological features of biliary papillomatosis

Biliary papillomatosis is a rare disease with strong potential for malignant degeneration. Diagnosis is often not easy and most are made intraoperatively. In the present study, five patients with biliary papillomatosis admitted between 1990 and 1997 were reviewed. Their clinical presentation, radiological and biochemical findings were analysed. The aim of the study was to discern a set of characteristic features that would enable an early diagnosis. All of the five patients presented with recurrent episodes of acute cholangitis and epigastric pain with raised serum alkaline phosphatase. Imaging modalities including ultrasound, CT, endoscopic retrograde cholangio-pancreatogram, MRI and magnetic resonance cholangio-pancreatogram were reviewed. Salient imaging features included a dilated biliary tree with multiple ill-defined and fuzzy filling defects or endoluminal frond-like mass lesions. In conclusion, biliary papillomatosis is a rare but important cause of biliary obstruction with relapsing cholangitis and obstructive jaundice. With a healthy index of suspicion, the diagnosis can be reached when the above features are available.     

Primary solitary amyloidoma of the lung: findings on CT and MRI

Pulmonary amyloidoma is a rare disease which is usually found incidentally on chest radiographs in asymptomatic, elderly people. Amyloid nodules may be solitary or much more commonly multiple. There have been many reports of radiological findings of pulmonary amyloidosis; however, those have not been characteristic. We report the findings on CT and MRI of a proven primary pulmonary amyloidoma in an asymptomatic 76-year-old woman. The low intensity of the lesion on T2-weighted images may be useful in the differential diagnosis from bronchogenic carcinoma. Received 3 May 1996; Revision received 13 August 1996; Accepted 4 September 1996     

螺旋CT及三维重组技术在肺结核中的诊断价值

目的探讨螺旋CT及各种三维重组技术在肺结核诊断中的价值。方法回顾性分析经病理和临床证实的肺结核病例145例,全部病例行螺旋CT扫描,针对不同病例行CTVE、MPR及CPR等不同类型三维重组。结果螺旋CT(尤其是HRCT)能够显示小叶中心结节、树芽征、结核空洞、干酪肺炎、粟粒结节、支气管播散、支气管结核、淋巴结肿大和钙化等肺结核的不同表现。螺旋CT诊断正确率为96.6%,结合各种三维重组方式后,诊断正确率99.31%。结论螺旋CT结合各种三维重组法能够对肺结核做出准确诊断。     

The small nodular pattern of primary and secondary lung neoplasia (author's transl)]

The radiographic pattern of multiple disseminated pulmonary nodules is especially difficult to interpret. There are some special forms of primary and secondary lung neoplasia which present as small nodular lesions of various distribution. Alveolar cell carcinoma and bronchogenic carcinoma with intracanalicular spread or small nodular or even miliary type lesions serve as well known examples. The radiographic morphology of small disseminated nodular foci of pulmonary metastases of primary lung tumors as well as of tumors outside the lung is being discussed. Even very subtle film analysis, observation of all radiological signs, as well as the clinical picture and the laboratory data, provides only limited help for the differential diagnosis.     

脓毒性肺栓塞的多层螺旋CT诊断

目的 探讨脓毒性肺栓塞的多层螺旋CT(MSCT)表现,以提高对该病的认识.方法 回顾性分析12例脓毒性肺栓塞MSCT表现,并与X线胸片比较.结果 所有12例患者,X线胸片和CT表现比较,分别见结节(8、12例),滋养血管征(0、9例),空洞(6、10例),楔形阴影(4、7例),局灶浸润影(2、4例),气囊(2、5例)及胸腔积液、脓胸(3、6例),肺门或纵隔淋巴结肿大(0、3例).发现病灶分布在外周或胸膜下分别为8和12例,CT较X线胸片可更清晰地显示病灶.多平面重组(MPR)、最大密度投影(MIP)显示大多数滋养血管环绕结节周围,MPR显示结节边缘规整.结论 脓毒性肺栓塞的CT表现多样,但MIP、MPR能更好显示滋养血管征及结节的特征.     

Ability of radiological technologists in charge of CT in a general hospital to detect pulmonary nodules with low-dose CT

PURPOSE: To examine the ability of radiological technologists (RT) to detect pulmonary nodules with low-dose CT (LCT). MATERIALS AND METHODS: LCT (20 mAs) and normal-dose CT (NCT; 160 mAs) were performed in 60 patients. We used an RT to detect pulmonary nodules with LCT. The results were compared with those of a radiologist who detected nodules with NCT. The diameter and density of the nodules in NCT were compared between the group of nodules detected (DN) by the RT and the group of nodules not detected (NN). RESULTS: 60 nodules were detected with LCT out of 74 nodules detected with NCT (81.1%). Eleven patients had NN as well as DN. The mean diameter of NN was smaller than that of DN, and the density of NN was lower than that of DN. CONCLUSION: The detection of pulmonary nodules with LCT by radiological technologists was acceptable.     

Bilateral multiple pulmonary tuberculous nodules mimicking metastatic disease

We present CT findings of a young woman who has bilateral pulmonary nodules mimicking metastases. Clinical presentation with active multiple pulmonary macronodules without cavitation responsive to treatment is an atypical manifestation of pulmonary tuberculosis. We reviewed the causes of multiple pulmonary nodules, role of radiological findings in differential diagnosis and parenchymal manifestations of pulmonary tuberculosis in this report.     

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 radiographic findings and mortality in hospitalized patients with lower respiratory tract infections

Lower respiratory tract infections (LRTIs) remain a widespread problem and have a significant impact on primary healthcare resources. Previous studies have reported conflicting results on whether pulmonary radiographic findings at presentation predict lethality for patients with LRTIs.The aim of this study was to determine if the pulmonary radiographic findings at the third day of hospitalisation were independently associated with lethality in patients with LRTIs.A total of 616 patients with LRTIs, admitted to our hospital, were evaluated with regard to radiographic data. The prognostic analysis included an univariate approach of the following radiographic findings: focal alveolar infiltrates in one or more segments, focal alveolar infiltrates in one or more lobes, cavitations, diffuse infiltrates, solitary or multiple nodules, pleural effusion and fibrosis. Of the 616 patients, 560 patients (90.0%) had at least one pulmonary radiographic finding confirmed by a panel of radiologists. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) for Windows. Eleven independent radiographic variables were examined for association with lethality.Overall lethality was 10.2% (553 survivors, 63 non-survivors). The only parameter found to be significantly different between survivors and non-survivors was cavitations on chest radiograph (p-value: 0.047).In conclusion, the presence of cavitations on chest radiograph at third day of hospitalisation can help physicians' assessment of prognosis in patients with LRTIs, as it is an independent predictor of lethality.     

Vocal cord paralysis secondary to a benign parathyroid cyst: a case report with clinical,imaging and pathological findings (2008:6b)

Parathyroid cysts are uncommon entities. Symptomatic parathyroid cysts are extremely rare with approximately only 200 cases reported in the literature. Only ten cases have been reported with recurrent laryngeal nerve paralysis and none in the radiological literature. We present a case of parathyroid cyst and recurrent laryngeal nerve paralysis with illustrations of the clinical, radiological and pathological appearances as well as discussion on the management of this condition.     

HIV阴性肺隐球菌病CT表现

目的 分析HIV阴性肺隐球菌病的CT表现,提高对本病的认识及诊断水平.资料与方法 回顾性分析2000-04～2011-10经病理或临床证实的20例HIV阴性肺隐球菌患者(包括7例免疫功能抑制者)的CT图像及临床资料.结果 ①肿块或结节型8例,其中孤立病灶3例,多发病灶5例,下肺、外周分布为主.②实变型7例,其中局限病灶3例,密度较高,边界较清;多发病灶4例,双肺散在分布.③混合型5例,表现为结节、团块、实变及磨玻璃影混合存在.20例患者中,晕征6例(30％),空洞11例(55％),支气管气相为10例(50％).结论 肺隐球菌病CT表现多样,病灶以下肺及外周分布为主,晕征、空洞及支气管气相有一定提示意义,有助于作出早期诊断,减少误诊.     

Congestive heart failure presenting as diffuse pulmonary nodules on CT

Congestive heart failure (CHF) patients have typical radiological features that assist in diagnosis. This is a case that demonstrates an atypical radiologic presentation for CHF which showed diffuse pulmonary nodules on CT. Diffuse nodules can be present in several disease processes and clinical correlation is a necessity for diagnosis. It is important for radiologists and clinicians to be aware of uncommon radiological features of CHF to avoid unnecessary procedures or treatments.     

Radiological findings in nine AIDS patients with Rhodococcus equi pneumonia

Rhodococcus equi (R. equi) infections have been incidentally reported as a cause of pulmonary infection in severely immunocompromised hosts, including AIDS patients. Our purpose is to describe the radiological findings in nine AIDS patients with R. equi pneumonia assessed by bronchoalveolar lavage (BAL), biopsies, cultures of sputum, and hemocultures. All patients were examined by chest radiographs and contrast-medium-enhanced chest CT. Dense pulmonary consolidations with or without cavitations accounted for the most striking radiological patterns. Chest CT also revealed six mediastinal involvements, strongly mimicking a lymphoma. Two of them had multiple bilateral pulmonary nodular opacities. Pleural effusion was not identified. Although intensive therapies were administered, seven among nine patients died within few months. In an AIDS patient living in a rural area or exposed to horses and presenting these radiological patterns, the possibility of R. equi pneumonia should be considered in the differential diagnosis along with other infectious diseases or lymphomas.Correspondence to: P. Schnyder     

Charakterisierung und Management inzidentell diagnostizierter solitärer Lungenrundherde

How to deal with solitary pulmonary nodules (SPN) which are incidentally detected by computed tomography (CT) is an increasingly important task in the era of modern multislice CT. This paper reviews the morphological and functional characteristics and their value for discrimination between benign and malignant SPNs. In particular, the importance of nodule size, growth rate, margin morphology, density, calcifications or fatty components within the nodules, the significance of cavitations or aerobronchograms, enhancement patterns at dynamic contrast-enhanced CT and findings on positron emission tomography (PET) are discussed. The Bayesian analysis to calculate the probability of malignancy is presented. Finally, flow charts demonstrate the national and international recommendations for nodule management.