High-resolution CT findings of pulmonary atypical adenomatous hyperplasia of 5 mm or less in diameter

OBJECTIVE: To clarify the high-resolution CT(HRCT) findings of pulmonary atypical adenomatous hyperplasia (AAH) of 5 mm or less in diameter. MATERIALS AND METHODS: We evaluated the HRCT findings of 43 histopathologically confirmed AAH of 5 mm or less in diameter in 7 patients who underwent lobectomy for pulmonary adenocarcinoma. For comparison, we also examined the HRCT findings of 13 bronchioloalveolar carcinomas (BAC) of the same size from these patients. RESULTS: We identified 36 of 43 AAH and all 13 BAC on HRCT performed with multidetector-row CT. Thirty-five AAH and 11 BAC showed ground-glass opacity without any high-attenuation component. Margins of 20 AAH were well defined, and 16 were ill defined. In BAC, 11 lesions demonstrated well-defined margins, with only 2 showing ill-defined margins. CONCLUSION: Most AAH lesions of 5 mm or less in diameter are identified as ground-glass opacity on HRCT. Detection of minute ground-glass opacity is important in locating AAH on HRCT.     

Drowning—post-mortem imaging findings by computed tomography

The aim of this study was to identify the classic autopsy signs of drowning in post-mortem multislice computed tomography (MSCT). Therefore, the post-mortem pre-autopsy MSCT- findings of ten drowning cases were correlated with autopsy and statistically compared with the post-mortem MSCT of 20 non-drowning cases. Fluid in the airways was present in all drowning cases. Central aspiration in either the trachea or the main bronchi was usually observed. Consecutive bronchospasm caused emphysema aquosum. Sixty percent of drowning cases showed a mosaic pattern of the lung parenchyma due to regions of hypo- and hyperperfused lung areas of aspiration. The resorption of fresh water in the lung resulted in hypodensity of the blood representing haemodilution and possible heart failure. Swallowed water distended the stomach and duodenum; and inflow of water filled the paranasal sinuses (100%). All the typical findings of drowning, except Paltau’s spots, were detected using post-mortem MSCT, and a good correlation of MSCT and autopsy was found. The advantage of MSCT was the direct detection of bronchospasm, haemodilution and water in the paranasal sinus, which is rather complicated or impossible at the classical autopsy.     

Virtual autopsy: preliminary experience in high-velocity gunshot wound victims

PURPOSE: To retrospectively assess virtual autopsy performed with multidetector computed tomography (CT) for the forensic evaluation of gunshot wound victims. MATERIALS AND METHODS: The institutional review board approved this HIPAA-compliant study and did not require informed consent of the next of kin. Thirteen consecutive male gunshot wound victims (mean age, 27 years) were scanned with 16-section multidetector CT prior to routine autopsy. Retrospectively, the total-body nonenhanced scans were interpreted at a three-dimensional workstation by radiologists blinded to autopsy findings. Images were evaluated for lethal wound, number and location of wound tracks, injured structures, and metal fragment location. After image review, autopsy reports and photographs were compared with the images and interpretations to validate the multidetector CT determinations. RESULTS: Multidetector CT aided in correct identification of all lethal wounds, and metallic fragment location was always precise. In four cases, multidetector CT aided in accurate assessment of organ injuries and lethal wounds but led to underestimation of the number of wounds if comingling paths occurred. In two cases of a chest wound, multidetector CT aided in accurate assessment of the chest as having the lethal wound but failed to help identify specific sites of hemorrhage. In two cases of craniofacial injury, the path of the wound was not clear. Autopsy revealed a total of 78 wound tracks (mean, 6; range, 1-24). Ten (13%) wound tracks were not identified at multidetector CT (six upper extremity wounds and four thigh wounds). In two cases, findings missed at autopsy (fracture of the cervical spine, bullet fragments in the posterior area of the neck) were identified at multidetector CT. CONCLUSION: Multidetector CT can aid prediction of lethal wounds and location of metallic fragments.     

Quantification of ground-glass opacity on high-resolution CT of small peripheral adenocarcinoma of the lung: pathologic and prognostic implications.

OBJECTIVE: The purpose of our study was to correlate the high-resolution CT findings of small peripheral adenocarcinoma of the lung with underlying histopathology and to evaluate the prognostic implications of the CT findings. MATERIALS AND METHODS: The high-resolution CT findings of small peripheral adenocarcinoma of the lung in 224 patients were analyzed by two independent observers for location, size, marginal characteristics, and extent of ground-glass opacity and necrosis. The pathologic specimens were reviewed by an experienced lung pathologist. RESULTS: One hundred and thirty-two patients had bronchioloalveolar carcinoma and 92 had adenocarcinoma. The extent of ground-glass opacity was greater in bronchioloalveolar carcinomas (mean +/- SD, 29% +/- 31.6%) than in other adenocarcinomas (8% +/- 13.3%) (p < 0.001). The extent of ground-glass opacity was significantly greater in patients without recurrence (p = 0.020) and those without nodal (p = 0.017) or distant (p = 0.007) metastases than in patients with nodal or distant metastases or in whom the carcinoma had recurred. CONCLUSION: The extent of ground-glass opacity in a nodule is greater in bronchioloalveolar carcinomas than in other adenocarcinomas. Greater extent of ground-glass opacity also correlates with improved prognosis.     

Diffuse pulmonary neuroendocrine cell hyperplasia: radiologic and clinical features

PURPOSE: The purpose of this study was to define the radiologic features of pulmonary neuroendocrine cell hyperplasia and correlate them with clinical findings. METHOD: Five women, ranging in age from 45 to 63 years, were diagnosed with pulmonary neuroendocrine cell hyperplasia. Two radiologists assessed the presence and extent of airway wall thickening, mosaic pattern, air trapping, ground-glass opacity, nodular opacity, and centrilobular opacity on high resolution CT. The CT findings were compared with physiologic data and histologic features. RESULTS: On CT scans, mosaic pattern was the predominant finding in all patients. The extent of mosaic pattern was correlated with the forced expiratory volume in 1 s/forced vital capacity ratio (r = 0.8508, p = 0.0317). Nodular lesions were noted in three patients. Airway walls were thickened in four patients. In one patient, ground-glass opacity and centrilobular opacity were also noted on high resolution CT. CONCLUSION: Pulmonary neuroendocrine cell hyperplasia is characterized by mosaic perfusion due to air trapping, airway wall thickening, and occasional small nodules on high resolution CT scans. The extent of mosaic perfusion correlates with physiologic evidence of airway obstruction.     

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.     

Xanthogranulomatous cholecystitis: radiologic findings with histologic correlation that focuses on intramural nodules

OBJECTIVE: We assessed serial changes in high-resolution CT findings and pulmonary function in patients with nonspecific interstitial pneumonia with fibrosis. MATERIALS AND METHODS: Serial high-resolution CT findings in 13 patients with biopsy-proven nonspecific interstitial pneumonia with fibrosis (mean follow-up period, 11 months) and pulmonary function tests (mean follow-up period, 11 months) were retrospectively analyzed. On CT, the presence and extent of ground-glass opacity, irregular linear opacity, honeycombing, and consolidation were assessed. RESULTS: On initial CT, all patients had areas of ground-glass opacity (mean +/- SD, 21.6% +/-14.4) and irregular linear opacity (5.0% +/- 5.2). The areas of ground-glass opacity decreased significantly on follow-up CT (13.5% +/- 10.5, p = .003). The areas of irregular linear opacity decreased slightly (4.2% +/- 5.2, p > .05). Initial forced vital capacity (69.4% +/- 16.0) improved significantly on follow-up examination (83.9% +/- 16.5) (p = .003). The decrease in the extent of ground-glass opacity on CT correlated significantly with changes in forced vital capacity (r = -.702, p = .007) and diffusing capacity for carbon monoxide (r = - .597, p = .031). CONCLUSION: In patients with nonspecific interstitial pneumonia with fibrosis, areas of ground-glass opacity decrease on follow-up high-resolution CT, and the extent of decrease correlates significantly with that of functional improvement.     

Sinonasal computed tomography in patients with Wegener's granulomatosis

The goal of this study was to describe pathologies of sinonasal CT in patients with Wegener's granulomatosis. Between 1993 and 2004, sinonasal CT was performed in 28 patients (15 male, 13 female) with Wegener's granulomatosis. The following imaging findings were assessed on the CT scans: mucosal thickening, subtotal opacification, air-fluid level, bony destruction, sclerosing osteitis, bony thickening, orbital mass, and saddle nose deformity. Of the 28 patients, 61% showed mucosal thickening in the nasal cavity and 75% in the paranasal sinuses. A subtotal opacification of the paranasal sinuses was detected in 25%, and of the mastoid cells in 7% of patients. Fifty-seven percent of patients had bony destruction of the nasal cavity, and 54% of the paranasal sinuses. CT revealed sclerosing osteitis of the paranasal sinuses in 21%, and of the mastoid cells in 18% of patients. Bony thickening of the paranasal sinuses was detected in 18%, and of the mastoid cells in 14% of patients. With respect to all imaging findings, the maxillary sinuses were the most frequently affected paranasal sinuses. The authors conclude that the following sinonasal CT findings are observed in patients with Wegener's granulomatosis: (1) bony destruction, mainly of the nasal cavity, maxillary sinuses, and mastoid cells; (2) sclerosing osteitis, mainly of the maxillary sinuses and mastoid cells; (3) bony thickening, mainly of the maxillary sinuses and mastoid cells; and (4) mucosal thickening, mainly of the maxillary sinuses. These findings are, however, nonspecific and should be combined with other clinicopathologic and laboratory studies to confirm the diagnosis of Wegener's granulomatosis.     

Respiratory bronchiolitis-associated interstitial lung disease: radiologic features with clinical and pathologic correlation.

PURPOSE: The purpose of this work was to describe the radiographic and CT findings in patients with respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) and to correlate them with clinical, physiologic, and pathologic features. METHOD: RB-ILD was proved pathologically in all 21 patients. Sixteen (76%) patients were current smokers, and five (24%) patients were ex-smokers. The mean cigarette consumption was 38.7 pack-years. Chest radiographs and CT scans were semiquantitatively analyzed and correlated with clinical findings, physiologic measures, and a pathologic score of disease extent. RESULTS: The major radiographic findings were bronchial wall thickening in 16 patients (76%) and ground-glass opacity in 12 patients (57%). The predominant initial CT findings were central bronchial wall thickening (proximal to subsegmental bronchi) in 19 patients (90%), peripheral bronchial wall thickening (distal to subsegmental bronchi) in 18 patients (86%), centrilobular nodules in 15 patients (71%), and ground-glass opacity in 14 patients (67%), None of these CT findings had a significant zonal predominance. Other findings were upper lung predominant centrilobular emphysema (57%) and patchy areas of hypoattenuation (38%) with a lower lung predominance. Radiologic findings were similar in both current and ex-smokers. The amount of ground-glass opacity correlated inversely with arterial oxygen saturation ( r = -0.67, p = 0.04), and the areas of hypoattenuation correlated with alveolar-arterial oxygen gradient ( r = 0.56, p = 0.04). The extent of centrilobular nodules correlated with the extent of macrophages in respiratory bronchioles ( r = 0.53, p = 0.03) and with chronic inflammation of respiratory bronchioles ( r = 0.57, p = 0.02). The extent of ground-glass opacity correlated with the amount of macrophage accumulation in the alveoli and alveolar ducts ( r = 0.56, p < 0.01 and r = 0.54, p = 0.04, respectively). At follow-up CT after steroid treatment and smoking cessation, in nine patients, the extent of bronchial wall thickening, centrilobular nodules, and ground-glass opacity had decreased, but the areas of hypoattenuation had increased (p < 0.05). CONCLUSION: The CT findings of RB-ILD are centrilobular nodules, ground-glass opacity, and air trapping. These radiologic features, in patients with a history of heavy cigarette smoking, may differentiate RB-ILD from other interstitial lung diseases.     

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.     

Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients

Our objective was to describe the CT findings of thoracic Wegener's granulomatosis. At presentation, both conventional and thin-section CT scans were available in 30 patients with Wegener's granulomatosis. Serial CT scans (range of intervals: 1–25 months, mean 4.5 months) were available in 20 patients. The initial and follow-up CT scans were analyzed retrospectively by two observers in terms of pattern and extent of parenchymal and airway lesions. Positive CT findings were seen in 29 of 30 (97%) patients at initial presentation. The most common pattern was nodules or masses seen in 27 of 30 (90%) patients. They were multiple in 23 of 27 (85%) patients, bilateral in 18 (67%), subpleural in 24 (89%), and peribronchovascular in 11 (41%) in distribution. Bronchial wall thickening in the segmental or subsegmental bronchi was seen in 22 (73%) patients. Large airways were also abnormal in 9 (30%) patients. Patchy areas of consolidation and ground-glass opacity were seen in 7 (23%) patients, respectively. In 17 of 20 (85%) patients in whom follow-up CT scans were available, the parenchymal or airway lesion showed complete or partial improvement with treatment. The CT findings of Wegener's granulomatosis, although multiple and variable, consist mainly of bilateral subpleural or peribronchovascular nodules or masses and bronchial wall thickening in the segmental or subsegmental bronchi. Parenchymal and airway lesions improve with treatment in most patients. Electronic Publication     

Evolution of peripheral lung adenocarcinomas: CT findings correlated with histology and tumor doubling time

OBJECTIVE: This study was performed to evaluate the evolution of peripheral lung adenocarcinomas using CT findings and histologic classification related to tumor doubling time. MATERIALS AND METHODS: The subjects were 34 patients, each with an adenocarcinoma smaller than 3 cm. All patients underwent chest radiography and 10 of them had previously undergone CT more than 6 months before surgery. Tumor doubling time was estimated by examining sequential radiographs using the method originally described by Schwartz. Tumor growth was also observed by studying the changes on CT in the 10 patients who had previously undergone CT. The histologic classification (types A-F) was evaluated according to the criteria of Noguchi et al. RESULTS: Five (83%) of the six adenocarcinomas with tumor types A or B showed localized ground-glass opacity on high-resolution CT. All six tumors had a tumor doubling time of more than 1 year. Fifteen (71%) of the 21 tumors with type C showed partial ground-glass opacity mixed with localized solid attenuation on high-resolution CT. Ten (48%) of these 21 type C tumors had a tumor doubling time of more than 1 year. In types B and C, the solid component or the development of pleural indentation and vascular convergence increased during observation before surgery. All seven tumors with types D, E, and F showed mostly solid attenuation, and the tumor doubling time was less than 1 year in six (87%) of the seven tumors. CONCLUSION: Two main types of peripheral lung adenocarcinoma exist. The first type appears on CT as a localized ground-glass opacity with slow growth, and the other appears as a solid attenuation with rapid growth.     

Postmortem lung features in drowning cases on computed tomography

Purpose

We sought to compare postmortem chest computed tomography (CT) features of drowning cases with autopsy findings, and to classify these features.

Materials and method

We performed a retrospective analysis of high-resolution and multi-planar reconstruction chest CT images of drowning in 92 adults (54 men, 38 women; mean age 65.4 years) scanned before forensic autopsy. The average lung CT number was calculated from whole-lung images reconstructed on a 3D workstation. The statistically significant differences of CT numbers were assessed with an alpha level of 0.05.

Results

Postmortem chest CT image patterns were classified into six types: the two main types were ground-glass opacities with thickened pulmonary interstitium (n = 31), and a centrilobular distribution of ill-defined nodules along the airways (n = 38). Some cases were mixed type (n = 10). There were significant differences in CT numbers between each type. The remaining three types were consolidation (n = 5), emphysema and/or fibrosis (n = 4), and unclassifiable (n = 4).

Conclusion

Postmortem CT images of drowning cases can be classified into three major types with a few exceptions.     

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.     

Pulmonary involvement in Churg-Strauss syndrome: an analysis of CT,clinical, and pathologic findings

We tried to assess retrospectively thin-section CT findings of Churg-Strauss syndrome (CSS) in 25 patients and to compare these findings with clinical and histopathologic findings. Of 25 patients, 19 (76%) had parenchymal abnormalities at CT; small nodules (n = 12; 63%), ground-glass opacity (n = 10; 53%), bronchial wall thickening (n = 10; 53%), and consolidation (n = 8; 42%). Parenchymal abnormalities (n = 19) were categorizable as an airway pattern in 11 and an airspace pattern in eight. Patients with an airway pattern (n = 5) had obstructive (n = 3) or combined (n = 2) PFT results, whereas those with an airspace pattern (n = 4) had restrictive (n = 3) or obstructive (n = 1) results. Parenchymal opacities at CT corresponded histologically to areas of eosinophilic pneumonia, necrotizing granulomas, and granulomatous vasculitis; small nodules to eosinophilic bronchiolitis and peribronchiolar vasculitis; and bronchial wall thickening to airway wall eosinophil and lymphocyte infiltration. Patients with airspace pattern responded more readily to treatment than those with airway pattern. CT shows lung parenchymal abnormalities in about three-quarters of CSS patients and these abnormalities can be categorized as airspace or airway patterns. This classification helps predict PFT data, underlying histopathology, and treatment response.     

Experimental drowning lung images on postmortem CT – Difference between sea water and fresh water

PurposeExperimental drowning models were prepared to investigate the time-related course of lung changes using postmortem CT. This study was approved by our institutional animal ethics committee.Materials and methodsFifteen NZW rabbits (female fifteen, 2.6–4.3 (mean 3.3) kg) were divided into 3 groups: fresh water drowning (FRESH), sea water drowning (SEA), and sea water drowning with anterior chest compression (ACC). All individuals were examined by CT (Aquilion CX, Toshiba, Japan) on postmortem time course. The rabbit’s head was submerged in a water bath for a total of 10 min. In ACC, cardiopulmonary resuscitation was performed for 2 min, additionally. The percentage of aerated lung volumes (%ALV = 100 (aerated lung volume/total lung volume)) were statistically evaluated and the lung CT image patterns and pleural fluid appearance time were investigated.ResultsAll lungs had decreased their %ALV within 24 h, and there were no statistical differences in and among the 3 groups. After 36 h, %ALV tended to increase in all groups, and only ACC presented a statistical difference between 1 h and 36 h (p < 0.005).On postmortem lung CT, all lungs presented ground-glass opacity with interstitial thickening spread pattern (100%) and no pattern change during the follow-up period. After presenting pleural space fluid collection, the %ALV tended to increase.ConclusionThere were no differences among FRESH, SEA, and ACC in %ALV within 24 h. Only ground-glass opacity could be detected on postmortem lung CT, experimentally.     

MSCT三维重组对肺内局限性磨玻璃影的诊断价值

目的探讨多层螺旋CT(MSCT)三维重组对肿瘤性和非肿瘤性肺内局限性磨玻璃影(fGGO)的鉴别诊断价值。资料与方法回顾性分析经病理或临床证实的48例fGGO(36例肿瘤性病变,12例非肿瘤性病变)的MSCT三维重组资料,对病灶的大小、三维比率、形状(圆形/类圆形、多边形/不规则形)、边缘(毛刺、分叶、棘状突起)、轮廓(清楚、模糊)、内部结构(实性成分、空泡征、支气管充气征、其他含气腔隙)及邻近结构改变(胸膜凹陷征、血管纠集征)进行评估,并与病理结果相对照,用χ2检验、Fisher确切概率法检验、非参数Mann-Whitney U检验进行统计学分析肿瘤性与非肿瘤性fGGO之间是否存在差异,Р<0.05为差异具有统计学意义。结果 48例fG-GO中,纯磨玻璃影(pGGO)15例,混合性磨玻璃影(mGGO)33例。对于临床资料、病灶大小、病灶边缘(毛刺、棘状突起)、内部结构(其他含气腔隙)、邻近结构改变(胸膜凹陷征)在肿瘤性fGGO和非肿瘤性fGGO之间差异均无统计学意义(Р>0.05)。病灶三维比率、病灶形状(圆形/类圆形、多边形/不规则形)、病灶边缘(分叶)、病灶轮廓(清楚、模糊)、内部结构(实性成分、空泡征、...     

Radium-induced malignant tumors of the mastoid and paranasal sinuses.

In the records of 5,058 persons with therapeutic or occupational exposure to radium, 21 patients with carcinoma of the mastoid and 11 with malignant tumors of the paranasal sinuses were identified. Tumor induction times were 21-50 years for mastoid tumors (median, 33) and 19-52 years for paranasal sinus tumors (median, 34). Dosimetric data are given for the patients whose body burdens of radium have been measured. We found a high proportion of mucoepidermoid carcinoma, comprising 38% of the mastoid and 36% of the paranasal sinus tumors. Three patients had antecedent bone sarcoma at 20, 11, and 5 years, respectively, and a bone sarcoma was discovered at autopsy in a fourth patient. Radiographic changes in the mastoid and paranasal sinuses were similar to those seen in nonradium malignant tumors. More than 800 known persons exposed to radium before 1930 and another group of unknown size who received radium water or injections of radium from physicians are still alive and at risk of developing malignant tumors of the mastoid and paranasal sinuses.     

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.     

Assessment of the relationship between drowning and fluid accumulation in the paranasal sinuses on post-mortem computed tomography

Recent reports have detailed common computed tomography (CT) findings in drowning victims, most notably fluid accumulation in the maxillary and sphenoidal sinuses. This CT finding could help forensic doctors to diagnose drowning. This study retrospectively investigated 151 subjects: 39 drowning and 112 non-drowning cases. Pearson's chi-square tests demonstrated that fluid accumulation in the maxillary or sphenoidal sinuses was associated significantly with drowning (p = 0.0001). The sensitivity of the drowning diagnosis was 97%, specificity was 35%, accuracy was 51%, positive predictive value was 34% and negative predictive value was 98%. Drowning was significantly associated with fluid accumulation in the maxillary and sphenoidal sinuses, but the specificity and positive predictive value of the drowning diagnosis were poor. Although the presence of fluid in the maxillary and sphenoidal sinuses cannot be used to diagnose drowning, the absence of the fluid can be used to virtually exclude drowning.