Papillary adenocarcinoma of the lung: radiologic and pathologic findings

We describe the radiologic and pathologic findings of papillary adenocarcinoma of the lung in three patients. The tumor appeared as a peripheral lung nodule (n = 1) or a mass (n = 2) on chest radiographs. On CT, the tumor appeared as a solitary pulmonary nodule, as a mass containing internal bubble lucencies with surrounding ground-glass opacity and satellite micronodules, and as a triangular mass with satellite micronodules. On pathology, all tumors showed distinct histologic features with papillary architecture, distortion and/or destruction of normal pulmonary architecture, and nuclear atypism.     

Squalene-induced extrinsic lipoid pneumonia: serial radiologic findings in nine patients.

PURPOSE: The purpose of this work was to demonstrate the initial and follow-up radiologic findings of squalene-induced extrinsic lipoid pneumonia. METHOD: Follow-up chest radiographs (n = 9) and high-resolution CT scans (n = 3) as well as initial radiographs (n = 9) and CT scans (n = 8) were obtained in nine patients with squalene-induced extrinsic lipoid pneumonia. The serial radiologic findings were analyzed retrospectively by three chest radiologists, focusing on the pattern and distribution of parenchymal abnormalities. RESULTS: The most frequent pattern of parenchymal abnormalities on chest radiograph was areas of ground-glass opacity (n = 9, bilateral 6), followed by consolidation (n = 7, bilateral 3) and poorly defined small nodules (n = 4, bilateral 2). The abnormalities were distributed in the right lower lung (n = 9), left lower lung (n = 6), and right middle lung (n = 6) zones. Initial CT scans (n = 8) demonstrated bilateral areas of ground-glass attenuation (n = 8), poorly defined centrilobular nodules (n = 8), crazy paving (n = 6), and consolidation (n = 3). The abnormalities were distributed in the right middle lobe (n = 8) and in both lower lobes (n = 5). Follow-up chest radiograph (n = 9) showed complete disappearance (n = 2) and decrease (n = 7) in the extent of the parenchymal abnormalities. Follow-up CT scans (n = 3) demonstrated decrease (n = 2) and no change (n = 1) in the extent of the abnormalities. CONCLUSION: Squalene-induced extrinsic lipoid pneumonia most commonly appears as areas of ground-glass attenuation mixed with poorly defined centrilobular nodules and crazy paving on CT, being distributed mainly in the right middle and both lower lobes. The lesions are indolent and remain after cessation of squalene ingestion.     

多层CT对肺孤立性病灶支气管改变的评价

目的:探讨肺孤立性病灶支气管改变的MSCT表现及其诊断价值.方法:回顾性分析27例经病理或随访证实的肺孤立性病灶支气管改变的CT表现.结果:CT显示支气管截断征14例(51.9%),其中周围型腺癌8例,鳞癌1例,腺鳞癌1例,恶性淋巴瘤1例,转移性恶性黑色素瘤1例,结核和炎性肉芽肿各1例;含气支气管征16例(59.3%),其中以腺癌最多见(10例);支气管在病灶边缘走行4例(14.8%),其中腺癌2例,肺泡癌1例,炎性肉芽肿1例;支气管受病灶牵拉移向病灶3例(11.1%),包括鳞癌1例,腺鳞癌1例,结核1例.结论:MSCT能够很好地评价肺孤立性病灶的支气管改变,对肺癌的诊断和鉴别诊断有重要的临床价值.     

Complications (excluding hyperinflation) involving the native lung after single-lung transplantation: incidence, radiologic features, and clinical importance

PURPOSE: To determine the incidence, importance, and radiologic features of native lung complications after single-lung transplantation. MATERIALS AND METHODS: Seventeen (15%) of 111 single-lung transplant recipients developed native lung complications (excluding hyperinflation) 0-58 months (mean, 17 months) after transplantation. Complaints at presentation, culture or histopathologic results, diagnostic or therapeutic procedures, and outcome were recorded. Chest radiographs (n = 17) and computed tomographic (CT) scans (n = 8) obtained at time of diagnosis were reviewed. Serial radiographs were assessed for disease progression or improvement. RESULTS: The most common complications were infection (n = 10), caused by bacteria (n = 4), fungi (n = 4), or mycobacteria (n = 2), typically manifested as lobar or segmental opacities on chest radiographs or CT scans. Lung cancer manifested as a solitary well-circumscribed nodule (n = 1), multiple nodules (n = 1), or a hilar mass (n = 1). Five (29%) of 17 patients died of native lung complications. Seven patients underwent mediastinoscopy (n = 3), lobectomy (n = 2), thoracoscopic wedge resection (n = 2), tube thoracostomy (n = 2), or pneumonectomy (n = 1) for diagnosis or treatment. CONCLUSION: Native lung complications occurred in 17 (15%) single-lung transplant recipients, were most commonly due to infection or lung cancer, and caused serious morbidity or mortality in 12 (71%) of 17 patients affected.     

Summer-type hypersensitivity pneumonitis: comparison of high-resolution CT and plain radiographic findings.

Summer-type hypersensitivity pneumonitis is an immunologic disease that occurs only in Japan. It is a form of hypersensitivity pneumonitis in which the clinical symptoms appear in the summer and subside spontaneously in mid autumn. The purpose of our study was to determine the CT findings in this condition, to compare the CT findings with those on chest radiographs, and to assess the variations in the CT findings over time. Accordingly, high-resolution CT scans and chest radiographs of 15 patients with summer-type hypersensitivity pneumonitis were retrospectively studied. Seven patients had sequential CT examinations 18-37 days apart. The CT scans and chest radiographs were reviewed by two observers independently. CT findings included diffuse micronodules (n = 15), slightly elevated lung density (n = 13), and patchy air-space consolidation (n = 13). In one patient, the findings on a chest radiograph were normal, while CT showed parenchymal abnormalities. In two cases, follow-up CT showed micronodular abnormalities after findings on the chest radiograph had returned to normal. Our results show that high-resolution CT findings of summer-type hypersensitivity pneumonitis include pulmonary micronodules, increased lung density, and air-space consolidation. High-resolution CT appears to be more useful than plain chest radiographs in the evaluation of pulmonary parenchymal abnormalities in this condition.     

Pulmonary cryptococcosis: CT and pathologic findings

PURPOSE: The purpose of this work was to describe the CT and pathologic findings of pulmonary cryptococcosis. METHOD: CT scans of 11 patients (7 immunocompromised, 4 immunocompetent) with proven pulmonary cryptococcosis were analyzed for number, morphologic characteristics, and distribution of parenchymal abnormalities as well for presence of lymphadenopathy and pleural effusion. Pathology of lung specimens obtained by open biopsy or resection (n = 5) and transbronchial biopsy (n = 1) was reviewed by one dedicated pulmonary pathologist. RESULTS: Pulmonary nodules, either solitary or multiple, were the most common CT finding, present in 10 of 11 patients (91%); associated findings included masses (n = 4), CT halo sign (n = 3), and consolidation (n = 2). On histologic examination, focal areas of ground-glass attenuation surrounding or adjacent to nodules were found to represent airspace collections of macrophages and proteinaceous fluid. CONCLUSION: Pulmonary cryptococcosis should be considered in the differential diagnosis of solitary or multiple pulmonary nodules (with or without associated CT halo sign), particularly in immunocompromised patients.     

乳腺非霍奇金淋巴瘤的影像表现

目的 复习10例乳腺非霍奇金淋巴瘤（NHL）的影像学表现,以期提高诊断准确率。材料与方法 回顾性分析10例经组织学及临床随诊证实的乳腺NHL影像表现。原发3例,继发7例,其中双侧受累3例。乳腺X线摄片10例,B超检查8例,CT检查2例。结果 乳腺X线摄片表现为孤立结节2例,乳腺大片密度增高及弥漫性皮肤增厚5例,双侧乳腺多发结节1例,双侧乳腺多发模糊小片影2例。无1例有成簇微小钙化、毛刺或肿物局部皮肤增厚、回缩。B超表现为轮廓规则或不规则的不均质低回声结节或肿块,后方透声增强2例,部分增强1例,无增强5例,皮肤增厚2例。CT扫描见多发结节及腋窝淋巴结肿大1例,乳腺弥漫性密度增高、皮肤增厚、乳头轻度回缩及纵隔、腋窝淋巴结肿大、胸大肌浸润、胸腔积液1例。结论 乳腺NHL无特异性的影像学表现,最常见的影像表现为乳腺弥漫性密度增高、皮肤增厚,其次为孤立或多发结节,少数亦可表现为乳腺内不规则的模糊小片状阴影。原发和继发病变的影像表现无明显区别。X线摄片结合B超及临床所见有助于提示NHL的诊断。     

Pulmonary inflammatory pseudotumor (inflammatory myofibroblastic tumor): CT features with pathologic correlation

The objective of this study was to assess the CT features of pulmonary inflammatory myofibroblastic tumors with pathologic correlation. The authors retrospectively reviewed CT and pathologic findings of 10 patients with surgically resected inflammatory myofibroblastic tumor of the lung. On CT, five patients showed a polypoid endotracheal (n = 3) or endobronchial nodule in the left main bronchus (n = 2). Two patients showed a central parenchymal mass, and the remaining three patients showed a peripheral pulmonary nodule. All tumors had well defined margins and were round to ovoid; they ranged in diameter from 13 to 52 mm and showed varying degrees of contrast enhancement (range 13-89 H). On histopathologic examination, the two central parenchymal masses involving segmental bronchi were also mainly endobronchial in location. The three peripheral pulmonary nodules also showed a peribronchiolar location, with a bronchial mucosal lining spared in part. The authors conclude that pulmonary inflammatory myofibroblastic tumors are closely related to the airway.     

Bronchogenic carcinoma after lung transplantation: frequency,clinical characteristics,and imaging findings

PURPOSE: To determine the frequency, clinical characteristics, and radiologic findings of bronchogenic carcinoma in patients surviving more than 1 month after lung transplantation. MATERIALS AND METHODS: The study population was composed of 2,168 consecutive patients at seven lung transplantation centers who survived longer than 1 month after lung transplantation. Medical records, chest radiographs, and computed tomographic (CT) scans obtained at the time of diagnosis and prior images when available were reviewed for various items of information and imaging features. RESULTS: Twenty-four (1%) of the 2,168 patients, all with single-lung transplants, developed cancer in the native lung. Eighteen patients had emphysema, and six had pulmonary fibrosis. The frequencies of cancer in patients with emphysema and fibrosis were 2% (18 of 859 patients) and 4% (six of 147 patients), respectively. Twelve (50%) of their 24 cancers were detected at chest radiography. Fourteen (58%) patients had clinical symptoms. Twenty-one (88%) of the 24 patients had one (n = 11) or more (n = 10) nodules, and nine (38%) had one (n = 8) or more (n = 1) masses visible on CT scans. Nodules and masses were visible on 12 (50%) and seven (29%) of 24 chest radiographs, respectively. Eleven (48%) of 23 cancers for which prior chest radiographs were available were seen retrospectively on prior chest radiographs. CONCLUSION: Bronchogenic carcinoma develops in the native lung of transplant recipients with emphysema and pulmonary fibrosis with frequencies of 2% and 4%, respectively. The carcinomas most commonly manifest as a pulmonary nodule or mass on chest radiographs, with more nodules seen on CT scans.     

艾滋病相关肺孢子菌肺炎影像学诊断

目的:分析艾滋病患者的肺孢子菌肺炎影像学特点。材料和方法:收集58例AIDS患者经临床诊断发生肺孢子菌肺炎的胸片(40例)和CT(20例),并分析其影像表现。结果:肺孢子菌肺炎的典型表现是两侧肺门周围对称性磨玻璃影、网状或网状结节影,呈斑片或地图状分布,由肺门向外周肺野发展并融合趋势;不典型表现为肺内多发结节、肺囊肿、胸腔积液、气胸、肺门及纵隔淋巴结肿大等。HRCT显示以上征象明显高于胸片。临床主要表现为低热、干咳、进行性呼吸困难及低氧血症。结论:艾滋病患者发生肺孢子菌肺炎时有一定的影像特点,影像检查有助于该病的诊断和鉴别。     

Large cell neuroendocrine carcinoma of the lung: radiologic and pathologic findings

PURPOSE: The purpose of this work was to determine the radiologic and pathologic findings of large cell neuroendocrine carcinoma (LCNEC). METHOD: We retrospectively evaluated chest radiographs, CT scans, and pathologic findings of five patients with pathologically confirmed LCNEC. They were confirmed by percutaneous needle biopsy (n = 2) and by surgery (n = 3). The average age of patients was 60 (51-70) years, and all five were smokers (mean 30 pack-years) and men. Radiologic findings were reviewed for the pattern of lesion, location, and associated findings by two radiologists under consensus. Pathologic findings were reviewed by two pathologists. RESULTS: In all five patients, tumors were represented as a peripherally located nodule or mass without associated secondary pneumonitis or distal atelectasis radiographically. On CT scan, masses were oval or round and well demarcated with lobulated margin in all cases, their sizes ranged from 2 to 5 cm, and they did not show internal calcification and necrosis. On contrast-enhanced CT, three cases showed moderate enhancement more than the chest wall muscle. Lymphadenopathy was observed in ipsilateral hilar and mediastinal areas in three cases. Distant metastasis to liver was noted in one case. One case of LCNEC was Stage IV, two were Stage IIIa, and two were Stage Ia at the time of diagnosis. CONCLUSION: Although the epidemiology of LCNEC is more similar to that of small cell carcinoma than atypical carcinoids, in its strong association with smoking, rapid progression, and poor prognosis, our five cases of LCNEC show peripherally located pulmonary nodule or mass with or without regional lymphadenopathy, which are findings similar to those of atypical carcinoids rather than small cell carcinoma.     

Computed tomography in the evaluation of benign asbestos-related disorders.

High-resolution CT is more sensitive than chest radiography and conventional CT in the detection and assessment of benign asbestos-related pleural and parenchymal diseases. The HRCT features of asbestosis correlate with clinical and functional restriction. The specificity of HRCT findings of asbestosis needs further evaluation. Given its low cost and availability, chest radiography remains the mainstay of imaging in benign asbestos-related diseases. CT (conventional or high-resolution) is not recommended as a universal screening test in asbestos-exposed workers. It has a useful role in identifying and quantitating pulmonary fibrosis distinct from emphysema and pleural disease, in distinguishing pleural disease from normal extrapleural soft tissues, and in clarifying the confusing chest radiograph or conflicting pulmonary function data. CT is useful in excluding a mass that may be obscured by extensive pleural and parenchymal fibrosis and is helpful in the follow-up of benign fibrotic masses or in the direction of their biopsy.     

Recrudescence of pulmonary tuberculosis: radiological and CT features in an asymptomatic Southern Italian young population

AIM: The authors report the results observed in apparently healthy young adults undergoing chest radiography for pre-employment screening. MATERIALS AND METHODS: Between July 1996 and December 1997, 2292 young adults underwent conventional chest radiography for pre-employment screening purposes. Of these, 378 subjects (16.4%) in whom the chest X-ray showed alterations indicative for pulmonary parenchymal lesions were selected for the study. The lesions were divided into four groups: 1) single nodular opacity (n=98/378=25.9%); 2) multiple nodular opacities (n=25/378=6.6%); 3) single or multiple parenchymal consolidation(s) (n=203/378= 53.7%); 4) interstitial disease ( %). All subjects received a tuberculin skin test. The subjects in groups 1, 2 and 3 underwent the diagnostic protocol, which consisted of tuberculin skin test (TST) and CT scan for groups 1 and 2, and a repeat chest radiograph at 30 days for group 3. The subjects in group 4 were studied by high-resolution CT (HRCT). RESULTS: In group 1, CT showed nodular opacities with psammomatous calcifications in 13 cases, vascular dilatations in 3, calcified nodule in 7 subjects with positive TST, and uncalcified nodular lesions in 75 subjects (53/75 with positive TST). In group 2, FNAB confirmed the preliminary diagnosis of metastases in 2 cases; CT demonstrated the pleural origin of opacities in 1 patient, and multiple nodular lesions in 12 subjects; it invalidated the radiographic findings in 3 subjects, and demonstrated multiple nodules associated to increased interstitial thickening in 3 subjects. In group 3, the lung alterations had completely disappeared in 106 subjects, whereas in 97 subjects there was reduced extension of the previously observed lesions, but appearance of new sites of parenchymal consolidation. In group 4 CT confirmed the radiographic suspicion in 14 cases. CONCLUSIONS: Tubercular infection is currently increasing in industrialised countries. In our study it showed a relatively high prevalence of about 4.5% in a young asymptomatic population.     

Thin-section CT features of intrapulmonary lymph nodes

PURPOSE: The objective of this study was to evaluate CT findings of pathologically proven intrapulmonary lymph nodes (IPLNs) and discuss the utility of thin-section CT and contrast-enhanced CT. METHOD: CT findings of 18 nodules in 14 patients with pathologically proven IPLNs were reviewed. CT scanning of the whole lung was performed contiguously with slice thickness of 10 mm. In addition, a helical scan with slice thickness of 2 mm was performed in nine patients, focusing on the nodule. Contrast-enhanced helical CT was performed in four patients, and the utility of thin section CT and contrast-enhanced CT was investigated. RESULTS: One patient had three nodules, 2 patients had two nodules, and the remaining 11 patients had a solitary nodule. All nodules were located below the level of the carina and within 15 mm of the pleura. In one case, conventional CT revealed the nodule 20 mm away from the pleura; however, the nodule attached to the major fissure was clearly revealed on thin-section CT. The size of the nodules was < or =15 mm, and the shape was round (n = 8), oval (n = 9), or lobulated (n = 1) with sharp border. One nodule demonstrated a spiculated border due to a surrounding pulmonary fibrosis on conventional CT; however, thin-section CT showed precisely a sharp border. The lobulated shape of one case histopathologically reflected a hilus of lymph node. On contrast-enhanced helical CT, all four nodules were enhanced and the degree enhancement was 36-85 HU (median 66.6 HU). CONCLUSION: In current times, IPLNs are not uncommon lesions. We should consider IPLN in the differential diagnosis of solitary or multiple pulmonary nodules in the peripheral field and below the level of the carina. Thin-section CT showed precisely the border or relation between IPLNs and the surrounding structure. It was difficult to distinguish between IPLNs and malignant nodules from the degree of enhancement on contrast-enhanced CT. On thin-section and contrast-enhanced CT, the findings of IPLNs are not necessarily specific. Therefore, strict observation on CT is necessary; in certain cases that are increasing in size, video-assisted thoracic surgery should be considered because of their location.     

Sarcomas: rare primary malignant tumors of the thorax

In this article, it is aimed to review the radiological signs of unusual primary malignant tumors of the thorax. Radiological studies of 11 patients with histologic diagnosis of thoracic sarcomas were interpreted retrospectively. Tumors originated from the chest wall (n=3), mediastinum (n=4), and pulmonary parenchyma (n=4). Histopathologic diagnoses were fibrosarcoma (n=1), alveolar rhabdomyosarcoma (n=1), malignant hemangiopericytoma (n=1), malignant fibrous histiocytoma (n=2), pulmonary vein leiomyosarcoma (n=1), pulmonary artery sarcoma (n=2), pleuropulmonary blastoma (n=1), and chondrosarcoma (n=2). In order to evaluate thoracic sarcomas, cross-sectional methods such as CT and MRI can be useful in demonstrating the origin of the mass, relationship with and involvement of adjacent structures. They present as masses and, unfortunately, radiological findings are not sufficient for specific diagnosis.     

Pulmonary involvement of malignant melanoma: thin-section CT findings with pathologic correlation

OBJECTIVES: The purpose of this study was to characterize the thin-section computed tomography (CT) findings of primary and secondary pulmonary malignant melanoma and to correlate them with the histopathologic features. MATERIALS AND METHODS: Patients were identified from a pathologic registration system database through a query for patients with diagnosed primary or secondary pulmonary melanoma who had undergone surgical resection. A total of 19 pulmonary malignant melanomas, including one primary and 18 secondary involvements, from 10 patients were enrolled into this study. The patients consisted of 3 men and 6 women, with a mean age of 55 years (range, 28 to 71 years). Thin-section CT findings evaluated by consensus between two radiologists were compared with the histopathologic specimens. RESULTS: Tumor size ranged from 4 to 62 mm (mean, 19 mm) on thin-section CT images. Four characteristic patterns including solitary or multiple solid nodule, endobronchial lesion, cavitary nodule, and nodule with ground-glass attenuation were disclosed by correlation between thin-section CT and pathologic findings. The most common thin-section CT finding was a solid nodule with a well-defined, smooth margin (n=14). Endobronchial lesions were seen in one primary and one secondary involvement (n=2). Less common CT findings were cavitary nodule (n=1) and nodule with ground-glass attenuation (n=1). CONCLUSION: Primary and secondary pulmonary malignant melanomas show various patterns of involvement on thin-section CT.     

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.     

Lung diseases in patients with common variable immunodeficiency: chest radiographic, and computed tomographic findings

OBJECTIVE: To evaluate chest radiographic and computed tomographic (CT) findings of lung disease related to common variable immunodeficiency. METHODS: Thirty-five chest radiographs and 30 CT scans of 46 patients were assessed. Lung parenchymal abnormalities that were evaluated included airspace consolidation, ground-glass attenuation, nodules, bronchiectasis, and air trapping. RESULTS: On CT, ground-glass attenuation and nodules were the most frequent findings, observed in 60% (n = 18/30) and 83% (n = 25/30), respectively. Three major CT patterns were identified: airway disease (n = 13), nodules (n = 8), and parenchymal opacification (n = 6). All 13 patients with airway disease showed centrilobular opacities. One patient with peribronchial nodules showed lymphoid interstitial pneumonia, and 1 with randomly distributed nodules showed noncaseating granulomas. Patients with a CT pattern of parenchymal opacification showed lower lung predominance; surgical biopsies showed organizing pneumonia in 1 patient and lymphoid interstitial pneumonia with nonnecrotizing granulomas in another. CONCLUSIONS: Common variable immunodeficiency is associated with 3 major CT patterns: airway disease, nodules, and parenchymal opacification.     

Mucoepidermoid carcinoma of the tracheobronchial tree: radiographic and CT findings in 12 patients.

PURPOSE: To determine the radiographic and computed tomographic (CT) findings and clinical features of mucoepidermoid carcinoma of the tracheobronchial tree. MATERIALS AND METHODS: Chest radiographic and CT findings and clinical features of 12 histopathologically proved mucoepidermoid carcinomas in 12 consecutive patients (five male, seven female; age range, 9-72 years; mean age, 36 years) were reviewed retrospectively. RESULTS: The tumors were located at the distal trachea (n = 1) or at a main (n = 2), lobar (n = 1), or segmental (n = 8) bronchus. On chest radiographs, the tumors appeared as central masses with post-obstructive pneumonia or peripheral atelectasis in four patients and as solitary pulmonary or endotracheobronchial nodules in eight. At CT, the tumors were all smoothly oval (n = 6) or lobulated (n = 6) in shape (ranging 9-40 mm in diameter), adapting to the branching features of the airways. Punctate calcification within the tumor was seen in six patients. Neither metastasis nor recurrence was seen after the surgical resection (follow-up of 8-103 months; mean, 30 months). CONCLUSION: Mucoepidermoid carcinoma of the tracheobronchial tree, usually located in a segmental bronchus, appears at CT as a smoothly oval or lobulated airway mass. It adapts to the branching features of the airways.     

Pulmonary artery false aneurysms secondary to Swan-Ganz pulmonary artery catheters

Several complications from the use of balloon-tipped flow-directed (Swan-Ganz) pulmonary artery catheters are recognized. One infrequent but life-threatening complication is false aneurysm formation associated with rupture or dissection of the pulmonary artery. We report 10 cases of catheter-induced pulmonary artery false aneurysms identified during a 9-year period. Initial presentation was radiologic in six patients and clinical (hemoptysis) in four. Later chest radiographic findings consisted of a well-defined, persistent pulmonary nodule or mass (three patients) or focal, dense parenchymal consolidation (six patients) that either persisted (two patients) or evolved into a nodule or mass (four patients) adjacent to the catheter tip. Cavitation of a pulmonary mass developed in one case. Two of eight deaths were caused by pulmonary artery false aneurysm formation and rupture with subsequent fatal hemorrhage. In one patient who survived, the false aneurysm was shown by pulmonary angiography and embolized with coils and Gelfoam. We conclude that pulmonary artery false aneurysms are life-threatening complications of pulmonary artery catheters and have characteristic chest radiographic findings.