Intrathoracic Kaposi sarcoma in AIDS patients: radiographic-pathologic correlation

The chest radiographs and postmortem pathologic findings in 24 patients with acquired immunodeficiency syndrome (AIDS) and autopsy-proved intrathoracic Kaposi sarcoma were reviewed. Premortem radiographic visualization of pulmonary lesions of Kaposi sarcoma depended on the extent of involvement and the presence of concomitant disease. In three patients (13%) the radiographs showed nodular opacities that corresponded in size and configuration to nodules seen at autopsy. In 21 patients (87%) the lesions were not radiographically identifiable, in some cases because they were obscured by infection. The positive and negative predictive values of four radiographic findings for intrathoracic Kaposi sarcoma were evaluated, using a control group of 14 AIDS patients without intrathoracic Kaposi sarcoma at autopsy. Findings with a high positive predictive value were parenchymal nodular and reticular opacities (100%), pleural effusions (89%), and hilar and/or mediastinal lymphadenopathy (92%). None of these findings is specific, but the presence of any one in a patient with AIDS should increase the possibility of intrathoracic involvement by Kaposi sarcoma.     

Kaposi sarcoma involving bone: CT demonstration in a patient with AIDS

A case is presented of painful lytic bone lesions of the spine and pelvis as a manifestation of acquired immune deficiency syndrome (AIDS)-related Kaposi sarcoma (KS). Though KS is the most common AIDS-related neoplasm and may involve many organs, radiographic demonstration of bone involvement has not been previously reported. The value of CT in detecting these lesions, which were not evident on bone scan or plain films, is demonstrated.     

Diseases of the chest in AIDS: CT diagnosis

The advantages of computed tomography for the evaluation of various chest lesions commonly encountered in patients with AIDS are discussed. The significance of limited and extensive lymphadenopathy is considered and examples are presented. Also specifically illustrated are cases of opportunistic pneumocystis, cytomegalovirus, and nocardia pneumonitides and of candida esophagitis; septic emboli; empyema; premature bulla formation ranging from apical bullae to diffuse parenchymal destruction; Kaposi's sarcoma, and lymphoma. Examples of the value of CT in resolving obscure clinical chest problems in AIDS patients are also illustrated.     

Cystic fibrosis: scoring system with thin-section CT

The progression of lung disease in patients with cystic fibrosis (CF) was evaluated with chest radiography. The severity and extent of the various radiographic changes were scored with the Chrispin or the Birmingham method, which involves the use of imprecise and subjective terms, such as line shadows, large pulmonary shadows, and nodular cystic lesions. Although computed tomography (CT) has been shown to be helpful in the evaluation of lung disease in CF, no scoring system or other objective criteria have been developed for the evaluation of the wide range of pulmonary changes in these patients. A CT scoring system was devised that incorporates all of the changes seen in the lungs of patients with CF. Such a scoring system may facilitate objective evaluation of existing and newly developed therapeutic regimens and may be a valuable tool in the preoperative evaluation of patients being considered for lobectomy or bullectomy and in the selection of patients for lung transplantation.     

Kaposi's sarcoma in AIDS: the role of radiation therapy

Radiotherapy can provide good palliation for AIDS patients with symptomatic Kaposi's sarcoma. We have retrospectively reviewed the treatment of 13 lesions in 5 patients. All treated tumours demonstrated significant regression with moderate doses of radiation. Side effects were acceptable and treatment provided good pain relief, functional improvement, and restoration of cosmesis. Our experience confirms that radiotherapy has a meaningful role in the management of AIDS-related Kaposi's sarcoma.     

18F-FDG PET/CT findings of pharyngeal tuberculosis

A 58-year-old woman with dysphagia and hoarseness underwent 18F-FDG PET/CT to detect the original lesion and disease spread. Bilateral cervical lymphadenopathy and abnormal FDG uptakes in the right tonsil and pharyngeal wall were demonstrated. CT and MRI confirmed the bilateral cervical lymphadenopathy and mucosal thickening in the pharyngeal wall. On the basis of these findings, biopsy sites were selected. Pharyngeal tuberculosis was diagnosed based on culture of the biopsy specimens. 18F-FDG PET/CT contributed to clinical management in this case by detecting tuberculous lesions and showing the extent of these lesions in one examination.     

Computed tomography of cardiac and pericardial tumors

Computed tomography (CT) scans in 30 patients with neoplastic involvement of the heart and pericardium were retrospectively reviewed. Computed tomography was compared with echocardiography in three of four patients with large primary cardiac tumors and in three patients with metastatic pericardial disease. Computed tomography was superior to echocardiography in determining tumor extent and site of origin of a right atrial sarcoma, as well as in assessing tumor extent and presence of pulmonary arterial hypertension in a left atrial malignant fibrous histiocytoma and a left atrial myxoma. Pericardial effusions were detected by echocardiography in two out of three patients with metastatic pericardial disease, but the malignant nature of the effusion was not recognized; in all three cases CT showed nodular pericardial thickening. Of the 23 patients with evidence on CT of direct extension of anterior mediastinal masses, bronchogenic carcinoma or mesothelioma to the pericardium 21 had nodular pericardial thickening and 2 diffuse thickening; only 6 had pericardial effusion. We conclude that CT is useful in the characterization of large primary cardiac tumors that are incompletely visualized with echocardiography. Computed tomography is superior to echocardiography in assessing tumor involvement of the pericardium because pericardial effusions are often absent; CT is also superior in identifying nodular pericardial thickening.     

Pulmonary involvement with Erdheim-Chester disease: radiographic and CT findings

OBJECTIVE: We determined the chest radiographic and CT findings of Erdheim-Chester disease with pulmonary involvement. MATERIALS AND METHODS: We retrospectively reviewed the radiologic images of 15 patients with biopsy-proven Erdheim-Chester disease. Nine patients had chest radiographic images and CT scans that were available for review. Six men and three women were studied (age range, 25-70 years; mean age, 56 years). Two radiologists interpreted all images by consensus. Lung parenchyma was assessed for the type and distribution of disease. Bronchi, pleurae, hila, and mediastinal and extrathoracic structures were evaluated for abnormalities. Pathologic specimens from all patients were reviewed and correlated with radiologic findings. RESULTS: Eight of nine patients had thoracic images with abnormal findings. The most common radiographic pattern was reticular interstitial opacities with fissural and interlobular septal thickening. CT revealed regions of ground-glass attenuation and centrilobular nodular opacities. Typically, extrapulmonary findings included pleural effusions (6/8 patients), pericardial fluid or thickening (4/8), and extrathoracic infiltrative soft-tissue masses (4/8). CONCLUSION: The most common findings of Erdheim-Chester disease with pulmonary involvement include an interstitial process characterized by smooth interlobular septal thickening and centrilobular nodular opacities, fissural thickening, and pleural effusions. On CT, six of nine patients had pericardial fluid and thickening or extrathoracic soft-tissue masses. Such findings are characteristic of Erdheim-Chester disease with pulmonary involvement. Definitive diagnosis requires correlating skeletal findings and lung biopsy findings.     

Hepatic Kaposi sarcoma in AIDS: US and CT findings

Abdominal ultrasonography (US) and computed tomography (CT) were performed in two patients with acquired immunodeficiency syndrome (AIDS) and necropsy-proved hepatic Kaposi sarcoma. At US, small (5-12-mm) hyperechoic nodules and dense periportal bands were seen in the liver. These lesions appeared hypoattenuated on baseline and dynamic CT scans and enhanced on delayed scans after a bolus injection of contrast material. Although nonspecific, these features strongly suggest tumor involvement in the liver in patients with AIDS and Kaposi sarcoma.     

Diagnostic utility of FDG PET in multiple myeloma

OBJECTIVE: Very little information is available regarding the diagnostic utility of positron emission tomography with [(18)F]fluorodeoxyglucose (FDG PET) in multiple myeloma. Our objective was to further define the role of FDG PET in the clinical assessment of patients with multiple myeloma. DESIGN AND PATIENTS: Nine whole-body PET scans (45 min after intravenous administration of 370-555 MBq FDG) were performed in six patients (age 38-62 years, 5 males) with multiple myeloma for evaluation of the extent of disease at the time of initial diagnosis (n=3) and for assessment of therapy response (n=3). Three patients had PET scans both before and after therapy. Prior treatments included chemoradiation therapy (n=2) and chemotherapy with autologous bone marrow transplantation (n=1). Correlative imaging data were available in all patients and included skeletal radiographic survey (n=6), bone scan (n=3), and spinal CT or MRI (n=4), and were all obtained within 3 months of the PET study. Validation was by clinical or imaging follow-up. RESULTS: In three patients with both pre- and post-therapy PET scans, PET demonstrated a favorable treatment response, by showing a decline in lesion metabolic activity (n=1), or progression of disease, by showing development of new lesions or higher lesion glucose metabolism (n=2), concordant with the clinical evaluation, while the other imaging studies showed no discernible interval changes. PET detected multiple hypermetabolic lesions in one patient with a negative bone scan and concordant positive skeletal radiographic survey. Bone scans underestimated the extent of disease in two other patients in comparison with PET. PET also detected a few early marrow lesions with subtle radiographic changes while all radiographically aggressive lytic lesions corresponded to intense hypermetabolism on PET. CONCLUSION: PET can detect early marrow involvement of multiple myeloma and is useful in assessing the extent of active disease at the time of initial presentation and in evaluating treatment response.     

Sarcoidosis: correlation of extent of disease at CT with clinical, functional, and radiographic findings

Computed tomography (CT) was compared with chest radiography in the assessment of disease severity in 27 patients with sarcoidosis. The CT scans and radiographs were each read twice by two independent observers. Disease extent was assessed on CT scans by visual scoring (0%-100% involvement of the lung parenchyma) and on radiographs by using an adaptation of the International Labour Office classification. The severity of parenchymal changes on the CT scan and on the radiograph was significantly correlated with the severity of dyspnea (r = .61 and .58, respectively; P less than .001), diffusing capacity (r = -.62 and -.52, P less than .01), and vital capacity (r = -.49 and -.51, P less than .01). Patients with predominantly irregular opacities had more severe dyspnea and lower lung volumes than patients with predominantly nodular opacities (P less than .05). The authors conclude that in patients with sarcoidosis, the radiographic and CT assessments of disease severity show similar correlation with clinical and functional impairment.     

Necrotizing sarcoid-like granulomatosis: radiologic-pathologic correlation

Necrotizing sarcoid-like granulomatosis is one of five forms of pulmonary disease characterized histologically by angiitis and granulomata formation. Although there have been several reports of the clinical and pathological characteristics of the disease, there has been little reported radiographic correlation. We present two patients with necrotizing sarcoid-like granulomatosis with radiographic and pathologic correlation. The radiographic finding of diffuse lesions, either bilateral nodules or nodular densities with or without cavitation, should prompt definitive diagnostic evaluation. Tissue diagnosis is imperative as necrotizing sarcoid-like granulomatosis has a relatively good prognosis when compared with other similar granulomatous diseases.     

艾滋病患者肺部疾病的影像学诊断

目的分析艾滋病患者肺部疾病的影像学特征,并评价其在鉴别诊断中的意义。方法 12例经临床证实的艾滋病患者肺部疾病,包括卡氏肺囊虫感染7例,卡波氏肉瘤2例,肺结核2例,以及真菌感染1例,均经胸部X线检查,8例又经胸部CT扫描,对所有患者的影像表现进行了回顾性分析。结果 7例卡氏肺囊虫感染表现为双肺弥漫性病变,呈网状合并斑片状、结节状及磨玻璃样影,2例卡波氏肉瘤表现为直径小于等于1cm的结节影,沿支气管血管分布,伴小叶间隔增厚或淋巴结肿大,2例肺结核表现为血行播散型和浸润型各1例,1例真菌感染表现为肺内结节伴空洞形成及空洞内结节与气体半月征。结论胸部X线与CT检查在艾滋病患者各种肺部疾病的鉴别诊断中起重要作用。     

Pulmonary lymphangiomyomatosis: correlation of CT with radiographic and functional findings

In 14 patients with biopsy-proved lymphangiomyomatosis, disease extent at computed tomography (CT) was correlated with findings at chest radiography and pulmonary-function testing. The CT scans and chest radiographs were read independently by two chest radiologists. Disease extent was assessed on CT scans by using a visual score (0%-100% involvement of the lung parenchyma) and on radiographs by using an adaptation of the International Labour Office classification of the pneumoconioses. There was good concordance between the two observers for CT and radiographic scores (Kendall tau greater than or equal to .86, P less than .01). A significant but relatively low correlation was present between CT findings and radiographic severity of disease (r = .59, P less than .05). Impairment in gas exchange as assessed with the diffusing capacity correlated better with disease extent seen on CT scans (r = .69) than with chest radiographic findings (r = .59). Three patients had evidence of parenchymal disease on the CT scans but not on the radiographs. In one patient CT findings were negative despite a positive finding on chest radiographs. The authors conclude that CT is superior to chest radiography in the assessment of patients with lymphangiomyomatosis.     

Update on esophageal radiology

This article reviews the current status of double-contrast radiography in diagnosing pharyngeal tumors and opportunistic esophagitis and the radiologic evaluation of esophageal motility disorders in patients with chest pain. Double-contrast pharyngography is a valuable technique for detecting pharyngeal tumors. These lesions may be manifested by an intraluminal mass, mucosal irregularity, or asymmetric distensibility. Furthermore, barium studies may demonstrate lesions involving the valleculae, tongue base, lower hypopharynx, and pharyngoesophageal segment that are difficult to visualize at endoscopy. Double-contrast radiography is also a valuable technique for detecting opportunistic esophagitis and for differentiating the underlying causes. Mucosal plaques should suggest Candida esophagitis, whereas discrete ulcers should suggest herpes esophagitis, and one or more large, relatively flat ulcers should suggest cytomegalovirus esophagitis. Finally, in evaluating patients with chest pain, in only a small percentage are esophageal motility disorders found to be a possible cause of their pain. Instead, the majority are found to have cardiac disease, structural esophageal lesions, or gastroesophageal reflux, so that barium studies are more useful in documenting normal motility or structural abnormalities in these patients.     

Value of computed tomography in radiotherapy of lung cancer.

The effectiveness of CT scanning in radiotherapeutic treatment planning was evaluated in 32 patients with bronchogenic carcinoma. CT of the chest in pretreatment evaluation of these patients supplemented conventional clinical and radiographic patients supplemented conventional clinical and radiographic studies, resulting in (1) more clear delineation of tumor extent in 24 patients (75%); (2) change in assessment of the size of lesions in 14 patients (43%); (3) change of disease stage in 13 (40%); (4) demonstration of inadequacy of treatment plan in nine (28%); and (5) changes in the volume of normal tissue irradiated in 14 (40%). CT scan data was judged essential for treatment planning in 17 patients studied (53%). Unsuspected areas of tumor involvement were seen in 21 patients (65%). Use of the CT scan as a patient contour for radiotherapy treatment planning of lung cancer and alternative techniques are discussed.     

Acquired immunodeficiency syndrome and pulmonary Mycobacterium xenopi infection. Role of computerized tomography

INTRODUCTION: Mycobacterium xenopi is one of the most common agents responsible for nontubercular mycobacterial pulmonary disease on AIDS patients. These lesions have been studied with conventional radiography, while CT has been used in patients with aspecific mycobacterioses or non-AIDS pulmonary conditions from Mycobacterium xenopi. PURPOSE: We investigated the yield of CT in the study of lung lesions from Mycobacterium xenopi in AIDS patients. MATERIAL AND METHODS: We examined 12 AIDS patients with pulmonary lesions from Mycobacterium xenopi, patients age ranged 30 to 46 years. All patients had CD4 blood levels lower than 250 cells/mL and Mycobacterium xenopi in the sputum. All patients underwent a standard chest radiograph and a CT examination. CT images were evaluated by three radiologists independently and the definitive diagnosis was made in the presence of a fourth radiologist. RESULTS: Chest CT showed parenchymal consolidation in 66% of cases, associated with bilateral basal bands in 16% of cases. Consolidation was unilateral in 41% of cases and most frequently involved the right lower lobe. Bilateral reticular interstitial involvement was seen in the patients (41%). Micronodules in 1 patient (8%) and mediastinal adenopathy in 33% of cases. Two patients had pre-xisting emphysema and 1 had bronchiectasis. DISCUSSION AND CONCLUSIONS: The frequency of lung disease from Mycobacoerium xenopi has increased because of the spreading of the HIV infection. Such lung lesions in AIDS patients are aspecific in appearance and localization, which the clinical radiologist needs to consider to address treatment planning. The frequent finding of parenchymal consolidation and the absence of cavitary lesions may be referred to the poor capability of AIDS to produce an adequate inflammatory response. The lung lesions tend to distribute in the lower lobes unilaterally. Adenopathy was also a frequent finding. CT plays a fundamental role in studying the chest of these patients because it permits to locate lung lesions with higher accuracy than conventional radiography and to detect adenopathies, micronodules reticular interstitial involvement and bronchiectases.     

Abdominal CT findings of disseminated Mycobacterium avium-intracellulare in AIDS

Disseminated infection from Mycobacterium avium-intracellulare (MAI) has recently been recognized as a common and serious complication of the acquired immunodeficiency syndrome (AIDS). The authors report the computed tomographic (CT) findings of 17 patients with AIDS and disseminated MAI referred for abdominal CT examination. Multiple large retroperitoneal and mesenteric lymph nodes were demonstrated in 14 patients (82%). MAI involvement was confirmed within abdominal lymph nodes in six patients by fine-needle percutaneous aspiration (five patients) or postmortem examination (one patient) and within enlarged peripheral lymph nodes in two other patients. The authors concluded that large, bulky, intraabdominal adenopathy in AIDS patients should suggest the diagnosis of MAI infection as well as other known causes of adenopathy, including lymphoma and metastatic Kaposi sarcoma. The authors recommend percutaneous aspiration of enlarged intraabdominal lymph nodes to establish the correct diagnosis.     

艾滋病合并念珠菌性食管炎的X线表现

目的探讨AIDS患者合并念珠菌食管炎的影像学表现。方法10例临床证实的AIDS患者均经食管钡餐与食管镜检查。结果10例食管钡餐检查阳性患者表现的黏膜粗糙，呈结节样网格状与食道镜检查吻合。结论比较食管钡餐造影及食管镜检查，均可较好显示AIDS食管念珠菌感染，同时，结合实验室检查可定性诊断。