Drug-induced pneumonitis: thin-section CT findings in 60 patients

PURPOSE: To describe thin-section computed tomographic (CT) findings in patients with drug-induced pneumonitis, to compare these CT findings, and to correlate them with arterial oxygen tension level. MATERIALS AND METHODS: Thin-section CT scans obtained in 60 patients with drug-induced pneumonitis were evaluated retrospectively. The patients had 31 cases of antineoplastic agent-induced pneumonitis and 29 cases of nonneoplastic agent-induced pneumonitis (antibiotic agent, 20 cases; herbal medicine [sho-saiko-to], four cases; antirheumatic agent, three cases; phenytoin, one case; disodium cromoglycate, one case). CT scans were reviewed by two chest radiologists in consensus. Correlation between arterial oxygen tension level and the extent of disease at CT was available in 21 patients. These two factors were compared by using the Spearman rank correlation coefficient. RESULTS: The predominant findings in antineoplastic agent-induced pneumonitis were diffuse or multifocal ground-glass opacities with intralobular interstitial thickening. The predominant CT findings in antibiotic agent-induced pneumonitis were patchy ground-glass opacities with centrilobular opacities and interlobular septal lines. The predominant CT findings in herbal medicine-induced pneumonitis were diffuse ground-glass opacities with patchy consolidation. Interlobular septal lines and centrilobular opacities were observed more frequently in antibiotic agent-induced pneumonitis, and intralobular interstitial thickening was observed more frequently in antineoplastic agent-induced pneumonitis. A significant correlation was established between arterial oxygen tension level and extent of disease at CT (r = -0.84, P <.05). CONCLUSION: In addition to ground-glass opacities and interlobular septal lines, the most common thin-section CT findings were intralobular interstitial thickening, observed in antineoplastic agent-induced pneumonitis, and centrilobular opacities, observed in antibiotic-induced pneumonitis.     

Organizing pneumonia: perilobular pattern at thin-section CT

PURPOSE: To describe the appearance and frequency of a perilobular pattern at thin-section computed tomography (CT) in patients with organizing pneumonia. MATERIALS AND METHODS: Thin-section CT scans of 21 consecutive patients with cryptogenic organizing pneumonia were retrospectively reviewed. Two thoracic radiologists in consensus recorded the presence and distribution of the CT abnormalities (consolidation, ground-glass opacification, nodules, bandlike opacities, interlobular septal thickening, and findings of fibrosis), with a particular focus on the presence and predominant location of the perilobular pattern, that is, a poorly defined arcadelike or polygonal appearance. RESULTS: The perilobular pattern was present in 12 (57%) of 21 patients, 10 of whom had five or more perilobular opacities. Other CT features were consolidation (20 patients, 95%), which was predominantly a subpleural and/or peribronchial distribution in 17 patients, and ground-glass opacification (18 patients, 86%). Bandlike opacities and interlobular septal thickening were observed in four patients and one patient, respectively. The perilobular pattern abutted the pleural surface in 10 of 12 patients and was surrounded by aerated lung parenchyma in 11 of 12 patients. There was no obvious relationship between perilobular opacities and CT findings indicative of established fibrosis. CONCLUSION: A perilobular pattern was present in more than half of the patients, along with the expected thin-section CT features of organizing pneumonia.     

Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: evaluation with thin-section CT

PURPOSE: To prospectively evaluate lung parenchyma on paired inspiration-expiration thin-section computed tomographic (CT) scans in patients recovering from severe acute respiratory syndrome (SARS). MATERIALS AND METHODS: After the institutional review board approved the study and written consent was obtained from patients, 40 patients (25 female, 15 male; mean age, 42.8 years +/- 12.3 [standard deviation]) underwent thin-section CT at 51.8 days +/- 20.2 after onset of SARS symptoms. Twenty of the 40 patients underwent follow-up thin-section CT at 140.7 days +/- 26.7 after symptom onset. Lung findings were scored according to extent and then grouped in three categories (ground-glass opacity, interstitial opacity, and air trapping) for analysis. Mean CT scores for each finding in the various patient subgroups were compared by using the Mann-Whitney test. Clinical parameters and scores were evaluated for correlation by using Spearman rank correlation analysis. Mean scores for each finding were compared between the two serial examinations by using the Wilcoxon matched-pairs signed rank test. RESULTS: Air trapping, ground-glass opacity, and reticulation were found in 37 (92%), 36 (90%), and 28 (70%) of 40 patients, respectively, at initial thin-section CT examination and in 16 (80%), 14 (70%), and 10 (50%) of 20 patients, respectively, at follow-up examination. Scans from patients with adult respiratory distress syndrome (ARDS) had a significantly higher score for ground-glass opacity than did those from patients without ARDS (P = .009). A comparison of scores for the serial thin-section CT examinations indicated a significant reduction in the extent of ground-glass opacity (P < .001) and interstitial opacity (P < .001) but not in that of air trapping (P = .38) at follow-up examination. At initial thin-section CT, scores for ground-glass opacity, interstitial opacity, and air trapping correlated with age; those for ground-glass opacity and air trapping, with peak C-reactive protein level. At the second examination, scores for ground-glass opacity and interstitial opacity correlated with peak lactate dehydrogenase level; that for air trapping, with age and peak C-reactive protein level. CONCLUSION: Thin-section CT scores correlated with clinical and laboratory parameters in patients after SARS. Although ground-glass opacity and interstitial opacity resolve over time, air trapping persists.     

Severe acute respiratory syndrome: temporal lung changes at thin-section CT in 30 patients

PURPOSE: To evaluate lung abnormalities on serial thin-section computed tomographic (CT) scans in patients with severe acute respiratory syndrome (SARS) during acute and convalescent periods. MATERIALS AND METHODS: Serial thin-section CT scans in 30 patients (17 men, aged 42.5 years +/- 12.2 [SD]) with SARS were reviewed by two radiologists together for predominant patterns of lung abnormalities: ground-glass opacities, ground-glass opacities with superimposed linear opacities, consolidation, reticular pattern, and mixed pattern (consolidation, ground-glass opacities, and reticular pattern). Scans were classified according to duration in weeks after symptom onset. Longitudinal changes of specific abnormalities were documented in 17 patients with serial scans obtained during 3 weeks. Each lung was divided into three zones; each zone was evaluated for percentage of lung involvement. Summation of scores from all six lung zones provided overall CT score (maximal CT score, 24). RESULTS: Median CT scores increased from 1 in the 1st week to 12.5 in the 2nd week. Ground-glass opacities with or without smooth interlobular septal thickening and consolidation were predominant patterns found during the 1st week. Ground-glass opacities with superimposed irregular reticular opacities, mixed pattern, and reticular opacities were noted from the 2nd week and peaked at or after the 4th week. After the 4th week, 12 (55%) of 22 patients had irregular linear opacities with or without associated ground-glass opacities and CT scores greater than 5; five of these patients had bronchial dilatation. When specific opacities were analyzed in 17 patients, consolidation generally resolved completely (n = 4) or to minimal residual opacities; six (55%) of 11 patients with ground-glass opacities had substantial residual disease (CT scores > 5) on final scans. CONCLUSION: There is a temporal pattern of lung abnormalities at thin-section CT in SARS. Predominant findings at presentation are ground-glass opacities and consolidation. Reticulation is evident after the 2nd week and persists in half of all patients evaluated after 4 weeks. Long-term follow-up is required to determine whether the reticulation represents irreversible fibrosis.     

Hermansky-Pudlak syndrome: radiography and CT of the chest compared with pulmonary function tests and genetic studies

OBJECTIVE: The objective of our study was to describe the chest radiographic and high-resolution CT findings in patients with Hermansky-Pudlak syndrome and to correlate the radiologic findings with age, causative gene, and pulmonary function. SUBJECTS AND METHODS: Sixty-seven patients with Hermansky-Pudlak syndrome underwent high-resolution CT of the chest. A scoring system based on the extent of pulmonary involvement and specific high-resolution CT findings was used, and the findings were compared with patient age and the results of pulmonary function and genetic studies. Fifty-eight (87%) of the 67 patients also underwent chest radiography. These radiographs were compared with the high-resolution CT scans. RESULTS: High-resolution CT was more sensitive than chest radiography in evaluating the extent of pulmonary disease in patients with Hermansky-Pudlak syndrome. All patients with mild findings on high-resolution CT scans had normal findings on chest radiographs. Common chest radiographic findings included reticulonodular interstitial pattern, perihilar fibrosis, and pleural thickening. High-resolution CT showed septal thickening, ground-glass opacities, and peribronchovascular thickening. For patients with Hermansky-Pudlak syndrome who were 30 years old or younger, high-resolution CT findings were usually minimal. Among patients who were older than 30 years, the 34 patients with HPS1 mutations had a score of 1.38+/-0.18 (mean+/-standard error of the mean) on high-resolution CT. This score is significantly greater than the score for the 11 patients without HPS1 mutations (0.36 +/- 0.15) (p < 0.001). The score based on high-resolution CT findings inversely correlated with percentage of forced vital capacity and was useful in defining the progression of interstitial disease. CONCLUSION: High-resolution CT provides a good radiologic monitor of disease status and progression in patients with Hermansky-Pudlak syndrome and correlates well with patient age, extent of pulmonary dysfunction, and genetic findings.     

Follicular bronchiolitis: thin-section CT and histologic findings.

PURPOSE: To evaluate the thin-section computed tomographic (CT) findings of follicular bronchiolitis and compare them with the histologic findings. MATERIALS AND METHODS: Thin-section CT scans obtained in 12 patients (age range, 24-77 years; mean age, 47 years) with follicular bronchiolitis proved at open lung biopsy were reviewed by two observers. Underlying conditions included rheumatoid arthritis (n = 8), mixed collagen vascular disorders (n = 2), autoimmune disorder (n = 1), and acquired immunodeficiency syndrome (n = 1). All patients had thin-section CT scans (1.0-1.5-mm collimation, 11 patients; 3.0-mm collimation, one patient; high-spatial-frequency reconstruction algorithm) obtained at 10-mm intervals through the chest. RESULTS: The main CT findings included bilateral centrilobular (n = 12) and peribronchial (n = 5) nodules. All 12 patients had nodules smaller than 3 mm in diameter; six patients also had nodules 3-12 mm in diameter. Areas of ground-glass opacity were present in nine (75%) patients. Histologically, all patients had lymphoid hyperplasia along the bronchioles; eight had peribronchiolar lymphocytic infiltration. CONCLUSION: The cardinal CT feature of follicular bronchiolitis consists of small centrilobular nodules variably associated with peribronchial nodules and areas of ground-glass opacity.     

Focal area of ground-glass opacity and ground-glass opacity predominance on thin-section CT: discrimination between neoplastic and non-neoplastic lesions

AIM: To reveal differences in thin-section computed tomography (CT) findings between lung neoplastic lesions and non-neoplastic lesions, which showed a focal area of ground-glass opacity or ground-glass opacity predominance. MATERIALS AND METHODS: A total of 82 focal areas of ground-glass opacity and ground-glass opacity predominance, consisting of 38 neoplastic and 44 non-neoplastic lesions, were assessed retrospectively regarding their thin-section CT findings. RESULTS: The frequency of wholly well-defined margin (p=0.001), spiculation (p=0.019), pleural indentation (p=0.016), air bronchograms (p=0.027), air-containing space (p=0.004) was significantly higher in neoplastic lesions than in non-neoplastic lesions. Thirty-four of 38 (89%) neoplastic lesions were well-defined in more than 50% of the circumference, of which nine had an air-containing space other than air bronchogram, whereas only one non-neoplastic lesion had these features. CONCLUSION: A focal area of ground-glass opacity or ground-glass opacity predominance with a well-defined margin and air-containing space is more likely to be a neoplasm.     

Transient radiographic progression during initial treatment of pulmonary tuberculosis: CT findings

PURPOSE: A study was undertaken to describe the thin-section CT features of transient radiographic progression during initial treatment of active pulmonary tuberculosis. METHOD: The CT scans of 13 patients who developed transient radiographic progression during initial treatment of pulmonary tuberculosis were evaluated and compared with those of 10 patients with true progression of pulmonary tuberculosis. Two patients underwent transbronchial lung biopsy for pathologic evaluation of new lesion. RESULTS: Eight patients had increased opacity at the site of their original lesion, whereas five had new opacities elsewhere: ipsilateral (n = 3) or contralateral (n = 1) to the original lesion or both (n = 1). Relatively extensive areas of ground-glass attenuation were concomitantly depicted in three of the eight patients with progression in the area of the original lesion. In those with progression ipsilateral or contralateral to the lesion, the character of the new lesions was ground-glass opacity and/or consolidation mainly in the subpleural region. Transbronchial lung biopsy specimens obtained from two patients showed intraluminal organizing exudates and thickened alveolar septa with lymphocyte infiltration, whereas the dominant CT findings of true progression of pulmonary tuberculosis were nodules (n = 8) or centrilobular nodules (n = 7). CONCLUSION: Thin-section CT may be useful to differentiate transient radiographic progression from true progression of pulmonary tuberculosis.     

Thin-section CT findings in flock worker's lung,a work-related interstitial lung disease

PURPOSE: To characterize the thin-section computed tomographic (CT) features of flock worker's lung (FWL) and to determine whether these features may be used to distinguish workers with FWL from flock workers who do not fulfill diagnostic criteria for FWL. MATERIALS AND METHODS: Thin-section CT images obtained in 43 flock workers (including 11 with FWL) were reviewed independently by radiologists blinded to occupational and clinical details. CT features recorded included ground-glass opacities, consolidation, micronodules, reticular abnormality, and septal thickening. Thirty-five of the CT scans (including nine obtained in patients with FWL) were also studied by using quantitative image analysis. The Student t test was used to compare mean lung attenuation between the workers with FWL and those without it. RESULTS: Every patient with FWL and 19 (59%) of the 32 exposed flock workers who did not meet criteria for the disease had an abnormal thin-section CT scan. The most common findings in FWL were ground-glass opacities and micronodules. Quantitative analysis showed a mean lung attenuation of -736.4 HU in patients with FWL, compared with -775.0 HU in workers without the disease (P <.05). CONCLUSION: While ground-glass opacities, micronodules, or both were found in all cases of FWL, these abnormalities were also present in a substantial proportion of symptomatic flock workers who did not satisfy current criteria for FWL. Although nonspecific, these findings should suggest the diagnosis of FWL in exposed individuals.     

Pulmonary candidiasis after hematopoietic stem cell transplantation: thin-section CT findings

PURPOSE: To retrospectively evaluate thin-section computed tomographic (CT) findings in hematopoietic stem cell transplant (ie, bone marrow transplant) patients with histopathologically proved pulmonary candidiasis. MATERIALS AND METHODS: Ethical approval was obtained from the institutional review board of each of the three institutions; informed consent was not required. The study included 17 hematopoietic stem cell transplant recipients with proved pulmonary candidiasis. Histopathologic specimens were acquired at transbronchial biopsy (n = 8), open lung biopsy (n = 6), and autopsy (n = 3). The patients included seven men and 10 women (age range, 20-62 years; mean age, 37 years). The thin-section CT scans were retrospectively reviewed by two thoracic radiologists for the presence, appearance, and distribution of parenchymal abnormalities. RESULTS: Multiple nodules were present in 15 (88%) patients, including centrilobular nodules and tree-in-bud pattern in seven (41%) patients. Nodules were bilateral in 12 patients and unilateral in three. An associated halo of ground-glass opacity was identified in five (33%) patients. Nodules were the only CT finding in five patients (29%). Areas of air-space consolidation were identified in 11 (65%) patients. Areas of ground-glass opacity were seen in six (35%) of 17 patients and were always associated with other abnormalities. Other less common CT findings included pleural effusion (n = 3), thickening of the bronchial walls (n = 2), and cavitation (n = 1). CONCLUSION: The most common thin-section CT findings of pulmonary candidiasis in hematopoietic stem cell transplant patients are multiple bilateral nodular opacities often associated with areas of consolidation.     

CT findings and progression of small peripheral lung neoplasms having a replacement growth pattern

OBJECTIVE: We investigated the imaging findings and progression of replacement lung neoplasms that were revealed on thin-section CT and serial CT. MATERIALS AND METHODS: We evaluated the age of patients and thin-section CT findings (lesion size; percentage of ground-glass opacity areas; and presence or absence of solid portions, lobulation, coarse spiculation, air bronchogram, cavity, multiplicity, and pleural tags) in 73 lesions (11 atypical adenomatous hyperplasias, 17 type A [Noguchi's classification], 18 type B, and 27 type C small peripheral adenocarcinomas). We compared the serial findings of 48 of 73 lesions on low-dose screening CT (n = 21) or thin-section CT (n = 27) obtained at a mean interval of 450 days (range, 85-951 days). Progression from atypical adenomatous hyperplasia through type A to type B and then to type C tumor was studied using trend tests. RESULTS: A significant linear trend was seen for lesion size (r = 0.55; p < 0.001), percentages of ground-glass opacity areas (r = 0.75; p < 0.001), and the prevalence of lobulation (p < 0.001), spiculation (p = 0.001), air bronchogram (p = 0.023), cavity (p = 0.046), pleural tag (p < 0.001), and solid portions (p < 0.001). In general from serial CT assessment, lesions were recognized first as a ground-glass opacity nodule (56% of 48 lesions) with subsequent increase in size (75%), then solid portions appeared in the nodule (17%), and finally solid portions increased (23%) with occasional augmentation of tissue contraction (6%). CONCLUSIONS: CT analysis revealed stepwise progression of replacement-type lung neoplasms.     

Pulmonary lesions associated with Sjögren's syndrome: radiographic and CT findings

The aim of this study was to analyse and compare the chest radiographic and CT findings in patients with primary and secondary Sj?gren's syndrome. We retrospectively evaluated the frequency of abnormality and findings of both the chest radiography (n=107) and CT (n=59) in patients with Sj?gren's syndrome. Abnormal cases were classified into five patterns based on predominant CT findings. Chest radiographic and CT abnormalities were seen in 24 (22%) and in 34 (58%) patients, respectively. Most frequently observed abnormal findings were linear and reticular opacities on chest radiograph, and ground-glass opacity, interlobular septal thickening and intralobular interstitial thickening on CT in both primary and secondary Sj?gren's syndrome. Centrilobular abnormalities were significantly more common in patients with primary Sj?gren's syndrome (p=0.018). According to our CT classification, interstitial pneumonia (IP) pattern was the most common in patients with both primary and secondary Sj?gren's syndrome. Bronchiolitis pattern was more common in patients with primary Sj?gren's syndrome and lymphoproliferative disorder (LPD) pattern was only observed in primary Sj?gren's syndrome. In conclusion, although the most frequently observed pattern in our CT classification was IP pattern in both primary and secondary Sj?gren's syndrome, centrilobular abnormalities and LPD pattern were relatively characteristic in patients with primary Sj?gren's syndrome.     

Persistent pulmonary nodular ground-glass opacity at thin-section CT: histopathologic comparisons

PURPOSE: To retrospectively compare pure pulmonary ground-glass opacity (GGO) nodules observed on thin-section computed tomography (CT) images with histopathologic findings. MATERIALS AND METHODS: The institutional review board approved this study and waived informed consent. Histopathologic specimens were obtained from 53 GGO nodules in 49 patients. CT scans were assessed in terms of nodule size, shape, contour, internal characteristics, and the presence of a pleural tag. The findings obtained were compared with histopathologic results. Differences in thin-section CT findings according to histopathologic diagnoses were analyzed by using the Kruskal-Wallis test or Fisher exact test. RESULTS: Of 53 nodules in 49 patients (20 men, 29 women; mean age, 54 years; range, 29-78 years), 40 (75%) proved to be broncholoalveolar cell carcinoma (BAC) (n=36) or adenocarcinoma with predominant BAC component (n=4), three (6%) atypical adenomatous hyperplasia, and 10 (19%) nonspecific fibrosis or organizing pneumonia. No significant differences in morphologic findings on thin-section CT scans were found among the three diseases (all P>0.05). A polygonal shape (25%, 10 of 40 nodules) and a lobulated or spiculated margin (45%, 18 of 40) in BAC or adenocarcinoma with predominant BAC component were caused by interstitial fibrosis or infiltrative tumor growth. A polygonal shape and a lobulated or spiculated margin were observed in two (20%) and three (30%) of 10 nodules, respectively, in organizing pneumonia/fibrosis were caused by granulation tissue aligned in a linear manner in perilobular regions with or without interlobular septal thickening. CONCLUSION: About 75% of persistent pulmonary GGO nodules are attributed to BAC or adenocarcinoma with predominant BAC component, and at thin-section CT, these nodules do not manifest morphologic features that distinguish them from other GGO nodules with different histopathologic diagnoses.     

CT features of pulmonary alveolar proteinosis

OBJECTIVE: This investigation describes the CT features of pulmonary alveolar proteinosis in a large group of patients. MATERIALS AND METHODS: A retrospective review of 139 chest CT scans (79 thick-section scans and 60 thin-section scans) from 27 patients with pathologically proven pulmonary alveolar proteinosis was performed. Two independent observers assessed the intraslice patterns and zonal distribution of disease on three CT images of each lung. The observers also graded the percentage of ground-glass opacities, air-space opacities, fibrosis, interlobular opacities, intralobular opacities, and emphysema in each slice. CT scans obtained before and after lavage related to 12 whole-lung lavage treatments on nine patients were evaluated. RESULTS: The dominant intraslice pattern was geographic, but a diffuse pattern was sometimes seen. The most common zonal pattern was uniform; a lower zone predominance was next most frequent. Ground-glass, air-space, and fibrotic opacities had a generally homogeneous craniocaudal distribution, but there was a trend toward more interlobular opacities at the lung bases (p < 0.002). Ground-glass opacities were seen on at least one scan in 100% of the patients. Interlobular opacities (85%), air-space opacities (78%), substantial fibrosis (7%), and intralobular opacities (7%) occurred less frequently. Compared with thick-section images, thin-section images showed more interlobular opacities, but no difference in ground-glass, air-space, or fibrotic disease. The proportion of lung affected by ground-glass and interlobular opacities decreased significantly (p < 0.05) after lavage. CONCLUSION: Pulmonary alveolar proteinosis does not present only with alveolar disease. The CT appearance typically combines different types of opacities with a geographic pattern and a uniform zonal distribution with variation over time.     

Near drowning: thin-section CT findings in six patients

PURPOSE: The purpose of this study was to assess the thin-section CT findings of near drowning in six patients. METHOD: Thin-section (1 mm collimation) CT scans of six patients who experienced near drowning were retrospectively analyzed. The CT scans were performed 0-5 days (median 1 day) after near drowning. RESULTS: Thin-section CT findings included bilateral patchy or diffuse areas of ground-glass attenuation (n = 6) with geographic pattern (n = 3) and fine intralobular reticular opacities ("crazy-paving" appearance) (n = 3), ill-defined centrilobular nodules (n = 4), and air-space consolidation (n = 1). Distribution of ground-glass attenuation was predominantly central (n = 4) or diffuse (n = 2). Interstitial pulmonary emphysema and pneumomediastinum were present in two patients. CONCLUSION: The thin-section CT findings of near drowning consist of ground-glass opacities with or without associated reticular opacities and centrilobular nodules.     

脓肿型分枝杆菌肺部感染胸片和CT表现

目的：探讨脓肿型分支杆菌病的胸部X线和CT影像学表现。方法：回顾性分析18例经临床确诊为脓肿型分枝杆菌感染患者的X线、CT表现。结果：胸片异常征象：斑点状、细网状阴影16例（89%,16/18）,空洞8例（44%,8/18）,肺叶体积缩小8例（44%,8/18）,实变4例（22%,4/18）,支气管扩张8例（44%,8/18）。CT异常征象：支气管扩张12例（66.7%,12/18）,其中表现为柱状支气管扩张9例（50%,9/18）,囊状支气管扩张5例（27.8%,5/18）,静脉曲张型支气管扩张3例（16.7%,3/18）;直径小于10mm结节17例（94.4%,17/18）,树丫征15例（83.3%,15/18）;直径大于10mm结节13例（72.2%,13/18）,肺叶实变6例（33.3%,6/18）,段或亚段实变9例（50%,9/18）,空洞9例（50%,9/18）,肺体积缩小7例（38.9%,7/18）。结论：脓肿型分枝杆菌感染的胸片和CT表现主要为小结节样斑片状、细网状影、支气管扩张和空洞形成。     

HRCT findings in the lungs of primary care patients with lower respiratory tract infection

Purpose: To survey the prevalence and type of lung patterns detectable at high-resolution CT (HRCT) in a primary care population seeking help for cough and fever.Material and Methods: The HRCT patterns of 103 patients obtained at the primary visit to a municipal health centre for cough and fever were evaluated. Forced expiratory examinations were obtained in 93 patients.Results: Lower respiratory tract infection (LRTI)-related findings (present at inclusion, healed at follow-up, not explained by any other factor) were seen in 19 patients (18.7%), of whom 11 also showed opacities, even though of lesser extent, at conventional chest radiography. The following patterns were found: ground-glass opacity (58%), discrete consolidations (52%), confluent consolidations (16%; 1 case with an air bronchogram), air space nodules (10%), peribronchovascular thickening (37%), tree-in-bud pattern (26%), free pleural fluid (5%), and septal thickening (5%). An expiratory mosaic pattern was seen in 19 (20%) out of 93 patients. In addition, lymph node enlargement (>1 cm) was recorded in 7 patients out of 103.Conclusion: HRCT is more sensitive than chest radiography in detecting LRTI-related lung lesions in a primary care population. The pattern typically comprises subtle scattered polymorphous opacities with varying attenuation affecting several lung segments. LRTI-related HRCT pattern deserves consideration as a differential diagnostic alternative in patients examined due to any lower respiratory tract symptoms.     

Pulmonary tuberculosis presenting as acute respiratory failure: radiologic findings

PURPOSE: The purpose of this work was to describe the radiologic findings of pulmonary tuberculosis in patients who presented with acute respiratory failure. METHODS: We included patients who had newly diagnosed active pulmonary tuberculosis and who presented with acute respiratory failure. Initial chest radiographic (n = 17) and high-resolution CT (n = 11) findings of each patient were analyzed retrospectively. RESULTS: Of 1,010 patients with active pulmonary tuberculosis, 17 patients (1.7%) presented with acute respiratory failure. Nine (53%) of the 17 patients died. The most common initial chest radiographic findings were small nodular lesions (16/17; 94%), consolidation (13/17; 76%), and ground-glass opacity (12/17; 70%). Eleven (69%) of 16 nodular lesions, 9 of 13 (69%) consolidations, and 10 of 12 (83%) ground-glass opacities were bilateral. On HRCT (n = 11), miliary micronodular lesions were seen in 6 patients (55%), whereas bronchogenic spread of tuberculosis with disseminated centrilobular nodules and tree-in-bud appearance was seen in 5 patients (45%). Diffuse areas of ground-glass attenuation were seen in all six patients with miliary nodules and four of five patients with bronchogenic spread of tuberculosis. CONCLUSION: Patients with pulmonary tuberculosis occasionally present with acute respiratory failure. In this condition, chest radiograph most commonly shows bilateral small nodular lesions mixed with consolidation or ground-glass opacity, whereas HRCT demonstrates findings of miliary or bronchogenic disseminated tuberculosis with diffuse areas of ground-glass attenuation.     

成人麻疹病毒肺炎的影像表现

目的 探讨成人麻疹肺炎的胸部影像表现.方法 对163例成人麻疹患者行胸部X线平片检查,其中3例行MSCT扫描,共确诊10例成人麻疹肺炎患者.结果 10例肺炎患者中8例X线胸片异常,特征性表现为磨玻璃密度影(6例)和支气管增粗(2例);2例X线胸片正常者行MSCT检查.MSCT表现为双肺磨玻璃密度灶1例,右上叶呈肺小叶分布的磨玻璃密度灶2例.结论 了解麻疹肺炎的X线胸片和MSCT表现可以缩小鉴别诊断范围,首次X线胸片正常患者不能除外肺部受累.

Abstract：

Objective To illustrate the chest radiography and MSCT findings of measles pneumonia in adults. Methods One hundred and sixty three measles patients underwent chest radiography, MSCT was performed in 3 of them. Measles pneumonia was confirmed in 10 patients (6.13%). Results Eight of 10 patients had abnormal appearances in initial chest radiography. The characteristic chest radiographic findings were ground-glass opacities (n=6) and bronchial wall thickening (n=2). MSCT showed bilateral multiple ground-glass opacities in 1 patient,unilateral patchy ground-glass opacities with lobular distribution in the right upper lung in 2 patients. Conclusions Familiarizing with radiographic and MSCT appearances of measles pneumonia in adults is very important for the differential diagnosis and appropriate management of measles pneumonia. Normal initial chest radiography cannot exclude the involvement of the lungs.     

Radiographic and high-resolution CT findings of influenza virus pneumonia in patients with hematologic malignancies

OBJECTIVE: We sought to describe the radiographic and high-resolution CT findings of influenza virus pneumonia in patients with hematologic malignancies. CONCLUSION: Radiologic findings of influenza virus pneumonia in immunocompromised patients consist of patchy or confluent consolidation and nodular opacities on chest radiography and ground-glass attenuation, consolidation, centrilobular nodules, and branching linear opacities on high-resolution CT.