Lung involvement in systemic connective tissue diseases

BACGROUND/AIM: Systemic connective tissue diseases (SCTD) are chronic inflammatory autoimmune disorders of unknown cause that can involve different organs and systems.Their course and prognosis are different. All of them can, more or less, involve the respiratory sistem. The aim of this study was to find out the frequency of respiratory simptoms, lung function disorders, radiography and high-resolution computerized tomography (HRCT) abnormalities, and their correlation with the duration of the disease and the applied treatment. METHODS: In 47 non-randomised consecutive patients standard chest radiography, HRCT, and lung function tests were done. RESULTS: Hypoxemia was present in nine of the patients with respiratory simptoms (20%). In all of them chest radiography was normal. In five of these patients lung fibrosis was established using HRCT. Half of all the patients with SCTD had simptoms of lung involment. Lung function tests disorders of various degrees were found in 40% of the patients. The outcome and the degree of lung functin disorders were neither in correlation with the duration of SCTD nor with therapy used (p > 0.05 Spearmans Ro). CONCLUSION: Pulmonary fibrosis occures in about 10% of the patients with SCTD, and possibly not due to the applied treatment regimens. Hypoxemia could be a sing of existing pulmonary fibrosis in the absence of disorders on standard chest radiography.     

高分辨力CT在肾移植术后疑似肺炎患者中的应用价值

目的:评价高分辨率CT(HRCT)在诊断肾移植术后疑似肺炎中的应用价值。方法:33例肾移植术后疑似肺炎患者行胸片、胸部HRCT检查。所有患者均经影像学、实验室检查及临床随访而明确诊断。对33例患者的胸片和HRCT图像进行回顾性对比分析。结果:33例中10例(30.3%)胸片未见异常,其中9例HRCT提示肺炎并最终证实;23例胸片和HRCT均见异常,22例最终证实为肺炎,其中18例HRCT可提供更多更准确的信息,仅4例(12.1%)胸片与HRCT及最终诊断结果基本一致。结论:HRCT较胸片更敏感,有助于早期确诊肺炎,所有疑似肺炎的肾移植患者均应行HRCT检查,肾移植术后肺炎常见HRCT改变为磨玻璃样改变、小结节影和小片状实变。     

Pulmonary high-resolution computed tomography findings in nephropathia epidemica

Purpose

To evaluate lung high-resolution computed tomography (HRCT) findings in patients with Puumala hantavirus-induced nephropathia epidemica (NE), and to determine if these findings correspond to chest radiograph findings.

Materials and methods

HRCT findings and clinical course were studied in 13 hospital-treated NE patients. Chest radiograph findings were studied in 12 of them.

Results

Twelve patients (92%) showed lung parenchymal abnormalities in HRCT, while only 8 had changes in their chest radiography. Atelectasis, pleural effusion, intralobular and interlobular septal thickening were the most common HRCT findings. Ground-glass opacification (GGO) was seen in 4 and hilar and mediastinal lymphadenopathy in 3 patients. Atelectasis and pleural effusion were also mostly seen in chest radiographs, other findings only in HRCT.

Conclusion

Almost every NE patient showed lung parenchymal abnormalities in HRCT. The most common findings of lung involvement in NE can be defined as accumulation of pleural fluid and atelectasis and intralobular and interlobular septal thickening, most profusely in the lower parts of the lung. As a novel finding, lymphadenopathy was seen in a minority, probably related to capillary leakage and overall fluid overload. Pleural effusion is not the prominent feature in other viral pneumonias, whereas intralobular and interlobular septal thickening are characteristic of other viral pulmonary infections as well. Lung parenchymal findings in HRCT can thus be taken not to be disease-specific in NE and HRCT is useful only for scientific purposes.     

Haemoptysis in patients with a normal chest radiograph: bronchoscopy-CT correlation

The exact role of fibre-optic bronchoscopy (FOB) and CT of the chest in the diagnosis of patients presenting with haemoptysis and a normal or non-localizing chest radiograph has not been clearly defined. A study was designed to evaluate 50 patients presenting with haemoptysis and a normal or non-localizing chest radiograph using FOB and high-resolution computed tomography (HRCT). A definitive diagnosis was established in 17 (34%) patients. The aetiologies included bronchiectasis (24%), bronchial adenoma (6%), tuberculosis (2%) and bronchitis (2%). The diagnosis was made by HRCT in 15 (30%) patients, while FOB was diagnostic in five (10%) patients. The diagnosis was made by HRCT and FOB in all patients with focal airway abnormalities. Therefore, HRCT effectively delineated abnormalities of both the central and peripheral airways. It is concluded that CT should be obtained prior to FOB in all patients presenting with haemoptysis and a normal or non-localizing chest radiograph.     

Primary ciliary dyskinesia in the paediatric population: range and severity of radiological findings in a cohort of patients receiving tertiary care

AIM: To investigate the clinical range and severity of radiological findings in a cohort of patients with primary ciliary dyskinesia (PCD) receiving tertiary care. MATERIALS AND METHODS: The case notes and clinical test results of 89 children attending the paediatric respiratory disease clinic at our institution were retrospectively analysed. Demographic details including age at diagnosis and common presenting signs and symptoms were studied. Results of chest radiographs, microscopy, and high-resolution computed tomography (HRCT) for quantification of lung damage were analysed. RESULTS: In a cohort of 89 children with PCD, a presentation chest radiograph was available in 62% of patients (n=55), with all but one demonstrating changes of bronchial wall thickening. HRCT of the lungs, available in 26 patients, were scored using the system described by Brody et al. analysing five specific features of lung disease, including bronchiectasis, mucus plugging, peribronchial thickening, parenchymal changes of consolidation, and ground-glass density, and focal air-trapping in each lobe. Peribronchial thickening was observed using HRCT in 25 patients, while 20 patients had bronchiectasis. Severity scores were highest for the middle and the lingular lobes. CONCLUSION: The radiographic findings of the largest reported cohort of patients with PCD are presented, with associated clinical findings. Dextrocardia remains the commonest finding on chest radiography. HRCT demonstrates peribronchial thickening and bronchiectasis, which is most marked in the lower zones. Radiological scoring techniques developed for assessment of cystic fibrosis can also be applied for the assessment of disease severity in this patient population.     

Acute and subacute non-infectious lung diseases: usefulness of HRCT for evaluation of activity especially in follow-up

PURPOSE: The purpose of this study was to survey the usefulness of high-resolution CT (HRCT) for the evaluation of activity in acute and subacute non-infectious diffuse infiltrative lung diseases before and after corticosteroid treatment. PATIENTS AND METHODS: Sequential HRCT images and chest radiographs obtained before and after treatment were retrospectively evaluated in 33 patients with acute or subacute noninfectious diffuse infiltrative lung diseases. All these patients were histologically confirmed to have pulmonary Inflammation and to have responded to treatment with corticosteroid. Radiographic and CT scores were correlated with the degree of dyspnea and the results of arterial blood gas analysis using Spearman's rank-correlation coefficient. RESULTS: On follow-up HRCT, the profusion score of areas with increased attenuation was significantly correlated with arterial oxygen tension (PaO2) (p=.003, r=-.53) and the alveolar-arterial oxygen tension difference (AaDO2) (p=.001, r=.57). No other correlation was found after treatment. Nodular and linear opacities were more commonly seen on follow-up chest radiographs and HRCT images than on initial ones. CONCLUSION: HRCT is useful for the evaluation of disease activity in acute and subacute noninfectious infiltrative lung diseases before and after treatment if paying special attention to the profusion of ground-glass attenuation. Even if pretreatment HRCT has not been performed, posttreatment HRCT should be examined.     

Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis

AIM:To investigate the chest radiographic and high resolution computed tomography(HRCT)chest manifestations in glucocorticoid-naive allergic bronchopulmonary aspergillosis(ABPA)patients.METHODS:This is a prospective observational study and includes 60 consecutive glucocorticoid-naive patients with ABPA who underwent chest radiography and HRCT of the chest(1.25 mm every 10 mm)in the routine diagnostic workup for ABPA.RESULTS:Chest radiographs were normal in 50%of cases.Of the remainder,most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis.Consolidation was detected in 17 cases but in the majority,the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities.Chest HRCT was normal in 22 patients,while central bronchiectasis(CB)was demonstrated in the remaining 38 patients.Bronchiectasis extended to the periphery in 33%-43%depending on the criteria used for defining CB.The other findings observed on HRCT were mucoid impaction,centrilobular nodules and high-attenuation mucus in decreasing order of frequency.CONCLUSION:Patients with ABPA can present with normal HRCT chest scans.Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed.Consolidation is an uncommon finding in ABPA.     

Interstitial lung disease in progressive systemic sclerosis: high-resolution CT versus radiography

High-resolution computed tomographic (HRCT) scans and chest radiographs were obtained in 23 patients with progressive systemic sclerosis (PSS) to assess the diagnostic merits of HRCT compared with chest radiography in detecting interstitial lung involvement in these patients. HRCT scans showed interstitial disease in 21 patients (91%). The most frequent finding was the so-called subpleural lines, which were demonstrated in 17 patients (74%). Honeycombing was seen in seven patients (30%), while parenchymal bands were seen in six patients (26%). Chest radiographs, on the other hand, showed definite interstitial opacification patterns in only nine patients (39%); six patients (26%) had equivocal reticular areas of attenuation, while eight patients (35%) had normal chest radiographs. Thus, HRCT is much more sensitive than chest radiography when assessing minimal interstitial lung involvement in patients with PSS.     

Comparison between conventional interrupted high-resolution CT and volume multidetector CT acquisition in the assessment of bronchiectasis

The aim of this study was to determine whether there is superior diagnostic accuracy for the detection and exclusion of bronchiectasis using 16-slice CT of the chest (1 mm) compared with conventional high-resolution CT (HRCT) of the chest (10 mm). A prospective study was carried out in patients who were referred for chest CT by a chest physician for the investigation of bronchiectasis over a 1-year period. All scans were performed using a 16-slice CT scanner. In addition to contiguous 1 mm slices, conventional HRCT images (1 mm slice every 10 mm) were prepared. Both datasets were dual read. There were 53 patients with a median age of 62 years (range, 51.5–71.5 years), comprising 14 males and 39 females. 10 of 53 scans had no bronchiectasis in either dataset. 36 patients had bronchiectasis diagnosed on both HRCT and 1 mm scans. Two patients had tubular bronchiectasis on the HRCT scans, which was not confirmed on the 1 mm scans. Five patients had confirmed tubular bronchiectasis on the 1 mm scans, which was not identified on HRCT scans. 40 extra lobes demonstrated bronchiectasis on the 1 mm vs the HRCT scans; of these, half were labelled as definite bronchiectasis on the 1 mm scan. There was a 32% increased confidence with the 1 mm scans compared with conventional HRCT of the chest in the diagnosis of bronchiectasis (p < 0.001). In conclusion, there is improved diagnostic accuracy and confidence for diagnosis and exclusion of bronchiectasis using 16-slice chest CT (1 mm cuts) compared with conventional HRCT of the chest.Bronchiectasis is a chronic disabling lung disease affecting between 1 in 1000 and 1 in 5000 of the general population. Pathologically, patients have irreversibly dilated and damaged bronchi. This leads to patients having a daily productive cough and recurrent chest infections.High-resolution computed tomography (HRCT) of the chest is the gold standard for the diagnosis of bronchiectasis. For diagnosis, patients should have bronchial dilatation at least greater than the associated arterial vessel [1–5]. There may be associated bronchial wall thickening and mucus plugging. The extent of bronchiectasis is determined by the number of lobes involved and the severity of bronchiectasis, varying from mild tubular bronchiectasis to severe cystic bronchiectasis. There has been shown to be good interobserver agreement for the detection and assessment of the severity of bronchiectasis using HRCT [6], with good pathological correlation [7].The aim of this study was to assess whether there is any difference in determining the extent and severity of bronchiectasis, and also if there is an improvement in the degree of confidence in diagnosis, using 16-slice CT of the chest using 1 mm contiguous slices compared with conventional HRCT using 1 mm slices every 10 mm.     

Role of HRCT in the identification of atypical pulmonary mycobacteriosis

AIM: 1) To identify the principal radiological signs of atypical pulmonary mycobacteriosis by means of X-rays and CT/HRCT; 2) to compare the two methods in order to evaluate their reliability with particular interest for the diagnostic role of HRCT in the identification of the disease; 3) to establish any significant differences in the pathology between AIDS and immunocompetent patients. MATERIAL AND METHODS: The chest X-rays and CT/HRCT of 28 atypical pulmonary mycobacteriosis patients (16 with AIDS and 12 immunocompetent) have been studied. The subjects were examined during the period of October 1993 to May 2000 and were found to be positive for atypical mycobacterium and consequently underwent a standard chest X-ray. Twenty cases were followed-up with a chest CT/HRCT; of these only 17 were performed within 30 days of the traditional chest X-ray which was considered to be the time limit in order to validate the comparison between the two methods. RESULTS: The significant semeiotical findings were the parenchymal consolidations observed in 25 patients (89%) by standard chest X-rays; the CT/HRCT confirmed the findings in 4 cases while in 13 it enhanced the evaluation of their extensions. In 9 cases the standard chest X-ray established the presence of cavitations which were confirmed by the CT/HRCT in only 7 cases. Lymphadenopathy was observed in 3/28 patients (10.7%) through standard X-rays and in 15/17 cases (82%) through CT/HRCT. The latter method revealed to be extremely useful in the identification of this pathology. Nodules and micronodules were seen in 5 patients with traditional X-rays and in 9 cases with CT/HRCT. Bronchogenic spread signs of disease became visible only with CT and in particular with HRCT (11/17 patients = 65%). Comparing the two groups (AIDS and immunocompetent) taken into consideration, the most frequent lesion present in both was parenchymal consolidation resulting more bilateral in the AIDS subjects. Cavitation and pleural edema were seen more often in the AIDS group while bronchiectasia, bronchogenic spread and signs of previous pleuro-parenchymal suffering were more frequent in the immunocompetent patients. Lymphadenopathy was frequently found in the total study population but appeared slightly prevalent for the group not afflicted with AIDS. CONCLUSION: Radiological study of the chest permitted the identification of signs useful in the diagnosis of mycobacteriosis in all the patients studied. The application of CT/HRCT added helpful elements in almost all of the cases examined demonstrating to be more effective than the standard chest X-ray not only in terms of improved evaluation of known lesions but also in the identification of lesions which are difficult to determine by means of traditional radiology.     

High-resolution CT in chronic pulmonary changes after mustard gas exposure

PURPOSE: To identify the findings of high-resolution CT (HRCT) of the lung in patients with previous sulfur mustard gas exposure, and to correlate these findings with clinical and chest X-ray (CXR) results. MATERIAL AND METHODS: 50 consecutive patients were studied prospectively. The clinical data were recorded. Standard p.a. CXR and HRCT of the lung and spirometry were performed. The findings of CXR, HRCT and clinical and spirometry results were scored between 0 and 3 according to the severity of the findings. RESULTS: HRCT abnormality was detected in all 50 patients (100%), while CXR was abnormal in 40 patients (80%). The most common HRCT findings was airway abnormalities (bronchial wall thickening in 100% of cases). Other important findings were suggestive of interstitial lung disease (ILD) (80%), bronchiectasis (26%), and emphysema (24%). A statistically significant correlation was found between the severity of clinical presentation and that of the HCTR scores in patients with bronchiectasis, bronchitis and ILD (p< 0.05), but not with severity scores of HRCT in patients with emphysema. No significant correlation was found between severity scores of CXR findings. HRCT evidence of bronchial wall thickening and with a lower frequency ILD were present despite normal CXR in 20% of the patients. CONCLUSION: The results of this study suggest that bronchial wall thickening, ILD and emphysema are common chronic pulmonary sequelae of sulfur mustard injury. HRCT of the chest should be considered as the imaging modality of choice in chemical war injury.     

Comparative accuracy of high resolution computed tomography and chest radiography in the diagnosis of chronic diffuse infiltrative lung disease

One hundred individuals who had undergone both high resolution computed tomography (HRCT) and chest radiography were studied to determine the accuracy of each technique in establishing the diagnosis of diffuse lung disease. The group consisted of 86 patients with a diagnosis of a chronic diffuse infiltrative lung disease and 14 normal subjects. Two independent observers assessed the HRCT examinations and chest radiographs and recorded the three most likely diagnoses. Overall a confident diagnosis was reached more often with HRCT (49%) than with chest radiography (41%). The diagnoses were correct in 82% of HRCT examinations and 69% of chest radiographs. Diagnoses made on HRCT, irrespective of the degree of certainty, were accurate more often than diagnoses made on chest radiography (56% and 47% respectively). Of the patients thought to have a normal chest radiograph, 42% had diffuse infiltrative lung disease (DILD). Of the patients thought to be normal on HRCT, 18% had DILD. Conversely, normal subjects were correctly identified as such in 82% of chest radiographs and in 96% of HRCT examinations. This study emphasizes the important role of CT in helping to confirm or refute the presence of abnormality when the chest radiograph is normal or questionably abnormal, and underlines the superior diagnostic accuracy of HRCT compared with conventional chest radiography in DILD.     

Lung findings on high resolution CT in early ankylosing spondylitis

OBJECTIVE: Ankylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the axial skeleton and pulmonary involvement is a well known feature of the disease. The aim of this study was to investigate the pulmonary high resolution computed tomography (HRCT) findings of patients with early AS. The relationship between pulmonary function tests (PFT) and HRCT findings was also determined. SUBJECTS AND METHODS: Twenty-eight patients with AS (mean age 30.8+/-7.4 and disease duration 7.0+/-2.6) were included in the study. Patients with a disease duration of >10 years or had other pulmonary diseases were excluded. All patients underwent plain chest radiography (posteroanterior and lateral views), thoracic HRCT and PFT. RESULTS: All chest radiographs were normal and HRCT revealed abnormalities in 18 patients. The most common abnormalities seen on HRCT were mosaic pattern (ten of 28), subpleural nodule (seven of 28) and parenchymal bands (five of 28). Seven of ten patients with mosaic pattern revealed air trapping areas on end expiratory scans. Twelve patients had abnormal PFT and all had restrictive type of involvement. Ten of these 12 patients had abnormal HRCT and the remaining two patients had normal HRCT. On the other hand, eight patients with normal PFT had abnormalities on HRCT. CONCLUSION: Patients with early AS frequently have abnormalities on HRCT, even though they have normal PFT and chest X-ray. Small airway involvement was found as frequent as interstitial lung disease in early AS.     

HRCT对类风湿性关节炎早期肺损害的诊断价值

目的 :研究胸片正常的类风湿关节炎患者早期肺损害在HRCT上的影像学表现 ,探讨HRCT对类风湿关节炎早期肺损害的诊断价值 ,及其与临床肺功能检查的相关性。方法 :对 2 4例临床诊断为类风湿关节炎且无吸烟史的患者 ,进行临床体检、普通X线胸片、HRCT扫描及临床肺功能检查 ,剔除 4例胸片有明显征象与类风湿无关的患者。结果 :2 0名患者CT扫描发现 1 4例 (70 %)肺部有间质性病变 ,其中为小叶间隔增厚 1 1例 (5 7%) ,气管壁增厚及其牵拉性支气管扩张 6例(43%) ,胸膜肥厚 5例 (36 %) ,壁胸膜肥厚粘连 4例 (2 9%) ,长瘢痕线 1例 (7%) ,胸部小结节影 2例 (1 4 %) ,磨玻璃样改变 2例 (1 4 %) ,蜂窝样改变 1例 (7%)。 6例 (30 %)患者无肺间质改变。 1 4例患者HRCT异常的患者中有 7例 (5 0 %)有临床肺功能损害 ,6名HRCT显示正常的患者中有 2名 (33%)有肺功能损害。结论 :类风湿性关节炎患者早期病变细微而胸片正常 ,HRCT检查常有异常 ,但与临床肺功能检查结果相关性较差 ,小叶间隔增厚与气管壁增厚牵拉性支气管扩张及胸膜肥厚是类风湿性关节炎累及肺最常见的表现 ,HRCT对类风湿早期肺损害的诊断意义是有限的。     

Specific diagnosis by CT and HRCT in six chronic lung diseases.

CT and high-resolution CT (HRCT) are both important modalities for imaging lung chronic disease, and certain features (distribution of disease in the axial plane, unilateral or bilateral disease, bronchovascular bundle thickening, septal thickening, central dot thickening, polygons, distortion of parenchyma, air-space disease, nodules) are well known to suggest specific diagnoses. In a series of 54 consecutive patients with six specific diseases (scleroderma or UIP, sarcoidosis, lymphangitic carcinomatosis, drug toxicity, lymphomas, eosinophilic granuloma), these diagnostic CT features were always present. In 50/54 cases, a histologic proof was obtained. In 36 patients with histologic confirmation of four different diseases and in six normal controls, we compared sensibility, specificity, and accuracy of chest radiography, chest CT, and HRCT and found the highest diagnostic accuracy by HRCT together with standard CT.     

High-resolution CT in renal transplant patients with suspected pulmonary infections

Objective: This prospective study was carried out to assess the usefulness of high-resolution CT (HRCT) of the chest in immunocompromised renal transplant patients with suspected pulmonary infections.Material and Methods: Twenty-one consecutive renal transplant patients with clinically suspected pulmonary infections underwent chest radiography, HRCT and other tests including bronchoalveolar lavage (BAL). HRCT was performed using a high spatial frequency algorithm with 2-mm-thick sections at 10-mm intervals from apices to domes of the diaphragm. The findings on chest radiography and HRCT were interpreted by two thoracic radiologists and the usefulness of HRCT was evaluated. The images were interpreted independently by two radiologists, who were blinded to the findings of other imaging modalities and the final diagnosis. Any differences regarding the imaging findings were resolved through consensus.Results: Final diagnosis was obtained in 17 patients, and no cause for symptomatology was established in 4 patients. The spectrum of infections included pulmonary tuberculosis (TB) in 11 patients, cytomegalovirus pneumonia (CMV) in 2 patients, cryptococcal and streptococcal pneumonia, pulmonary aspergillosis and esophageal candidiasis in 1 patient each. Compared to chest radiography, HRCT revealed additional findings in 11 patients. HRCT findings were suggestive of underlying infection in 11 patients. The final diagnosis coincided with HRCT diagnosis in all but 1 patient. HRCT findings were non-specific in 3 patients and normal in 7. The findings were concordant in 19 cases. The results were not in agreement in only 2 cases.Conclusion: HRCT can provide useful information and suggest the diagnosis in a significant proportion of renal transplant patients with pulmonary infection.     

HRCT findings of chest complications in patients with leukemia

High-resolution CT (HRCT) findings of several chest complications occurring in leukemic patients were reviewed. Although most entities show non-specific HRCT findings including ground-glass opacity and air-space consolidation, characteristic findings are observed in several pulmonary complications including Pneumocystis carinii pneumonia, fungal infections, miliary tuberculosis, leukemic infiltration, pulmonary edema, bronchiolitis obliterans, and bronchiolitis obliterans organizing pneumonia. A combination of these characteristic HRCT findings and the information obtained from the clinical setting may help in achieving a correct diagnosis of chest complications occurring in leukemic patients.     

Evaluation of pneumoconiosis by high-resolution CT]

Forty-eight patients with pneumoconiosis (47 males and 1 female) were evaluated by high-resolution computed tomography (HRCT), which was compared with chest radiography and pulmonary function studies. 1) HRCT was superior to chest radiography in detecting small nodular shadows. There was a good correlation between HRCT and chest radiography in evaluating nodule quantity and size. 2) HRCT was superior to chest radiography in detecting emphysematous changes, and the difference was significant. HRCT and chest radiography were closely correlated in their evaluation of the grade of emphysema. 3) The grade of emphysema on HRCT was negatively correlated with the number of nodules. Subpleural curvilinear shadow (SCLS) on HRCT was correlated with the grade of emphysema, but not with the number of nodules. 4) The comparison with pulmonary function studies showed that emphysematous change on HRCT alone was correlated with %DLCO, while SCLS was correlated with FEV1.0%, RV/TLC and %DLCO. HRCT of the lung is useful for complementing chest radiography and pulmonary function studies in the evaluation of pneumoconiosis.     

Clinical and high-resolution computed tomographic findings in five patients with pulmonary tuberculosis who developed respiratory failure following chemotherapy.

AIM: The purpose of this study was to describe the clinical and high-resolution computed tomographic (HRCT) findings in patients with pulmonary tuberculosis who developed respiratory failure after starting chemotherapy. MATERIALS AND METHODS: The clinical records, chest radiographs, and HRCT findings in five patients with non-miliary pulmonary tuberculosis who developed respiratory failure after starting chemotherapy were reviewed. RESULTS: Chest radiographs taken early in the course of acute respiratory failure showed progression of the original lesions with (n = 4) or without (n = 1) new areas of opacity away from the site of the original lesions. HRCT demonstrated widespread ground-glass attenuation with a reticular pattern as well as segmental or lobar consolidation with cavitation and nodules, consistent with active tuberculous foci in all five cases. Prominent interlobular septal thickening was seen in two cases. Four of the five patients had received corticosteroids. Of these five, two died and three recovered with continued corticosteroid therapy. Transbronchial biopsy in three cases showed evidence of acute alveolar damage. CONCLUSION: In selected patients with tuberculosis who develop respiratory failure following the initiation of antituberculous therapy, HRCT may be a helpful adjunct to clinical evaluation in differentiating hypersensitivity reactions (presumed to be due to the release of mycobacterial antigens) from other pulmonary complications.     

Comparison of plain chest radiography and high-resolution CT in human immunodeficiency virus infected patients with community-acquired pneumonia: a sub-Saharan Africa study

The objective of the study was to determine the proportion of patients with missed lesions on plain chest radiographs compared with high-resolution computed tomography (HRCT) in 49 human immunodeficiency virus (HIV) infected patients with community-acquired pneumonia (CAP). Patients underwent plain chest radiography and HRCT scans of the chest at admission. Microbiological investigations for CAP were performed. An experienced radiologist, without knowledge of clinical or pathological data, reported the chest radiographs and HRCT scans. The study group included 26 females and 23 males, aged 18-53 years (mean age 36 years). Organisms were isolated from 26 patients (53%). In 40 patients (82%), the HRCT scans demonstrated lesions not visualized on the plain chest radiographs. There was 100% correlation between plain radiographic and HRCT scan findings in nine cases (18%). Lesions that were not visualized on the plain radiographs but elucidated on HRCT included: pleural effusion (n = 14), ground-glass opacification (n = 20), pericardial effusion (n = 8), cavitation (n = 4), cysts (n = 4), bullae (n = 4), abscess (n = 1) and pneumothorax (n = 1). In 20 of 23 cases, hilar lymphadenopathy, identified on HRCT, was not recognized on plain chest radiographs. In patients in whom an organism was isolated, a correct HRCT diagnosis of pulmonary tuberculosis, bacterial pneumonia and Pneumocystis carinii pneumonia (PCP) was made in 80%, 84% and 100% of cases, respectively. The proportion of patients with missed lesions on plain chest radiographs in HIV infected patients with CAP was high. This has important implications for management and prognosis. HRCT scans correlate well with the microbiological diagnosis when reported by an experienced radiologist.