CT manifestations of tracheobronchial involvement in relapsing polychondritis

Two patients with relapsing polychondritis presented with tracheobronchial stenosis without clinical manifestation of nasal septum or ear lobe cartilage involvement. The CT findings included diffuse, smooth tracheobronchial wall thickening with narrowing and deformity of the lumen. Areas of dense calcium deposition within the thickened tracheal cartilage were seen. On follow-up after steroid medication, tracheobronchial wall thickening was decreased and the configuration of the tracheal lumen returned to normal.     

F-18 FDG PET/CT in relapsing polychondritis

We report a case of relapsing polychondritis for which fluorodeoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) showed increased FDG accumulation in all rib cartilages, as well as in the larynx, trachea, and major bronchi. Contrast-enhanced CT during PET/CT showed smooth tracheal and bronchial wall thickening with calcification and airway narrowing. After steroid therapy, clinical symptoms and laboratory data were improved and cartilaginous FDG accumulation had completely disappeared. FDG PET/CT is considered to be a powerful radiological tool to assess the disease activity of relapsing polychondritis.     

复发性多软骨炎1例

患者 男,56岁,反复咳嗽2年余,活动后喘憋,无痰中带血,无畏寒、发热.查体:外鼻塌陷、畸形,咽充血,双肺呼吸音粗,可闻及散在哮鸣音、痰鸣音,未闻及干湿啰音.行右中叶肺切除术,术后患者反复咳嗽并出现右肋弓下缘肿痛,双手及足关节肿痛,临床考虑反应性关节炎.     

Narrowing of the airway in relapsing polychondritis

Relapsing polychondritis, once thought to be a very rare disease, is being recognized with increasing frequency. It is characterized by inflammation of cartilaginous structures throughout the body. In some cases, the eye and ear are involved; aortic aneurysms develop in a minority of patients. The cartilages of the airway are affected in more than 50% of all cases, and the resulting stenotic lesions can be life-threatening. Radiographic study of the airway is of great value in detection and evaluation of upper respiratory involvement.     

The radiological manifestations of relapsing polychondritis

Four patients with relapsing polychondritis are described. The radiological appearances of the arthropathy and the tracheobronchial involvement are illustrated, and the value of these findings in early diagnosis and management are emphasised.     

Intracranial aneurysm associated with relapsing polychondritis

We describe a 50-year-old man with relapsing polychondritis (RP) involving auricular cartilage, uveitis and hearing loss, who had an aneurysm of the anterior cerebral artery. Intracranial aneurysm is a rare manifestation of RP. Received: 13 October 2000 Accepted: 19 December 2000     

复发性多软骨炎气道病变的MSCT诊断

目的 探讨MSCT及其后处理技术在复发性多软骨炎气道病变中的诊断价值.方法 对7例确诊为复发性多软骨炎患者气道进行MSCT容积扫描及后处理成像,并对气道病变CT表现进行回顾性分析.结果 复发性多软骨炎患者气道病变特征性CT表现是不同程度气道管壁增厚、钙化及管腔狭窄,其后处理图像能清楚、全面地显示全气道病变形态特点、狭窄范围及程度.结论 复发性多软骨炎气道病变的MSCT表现有一定特征性,其后处理技术对病变的诊断及显示可提供很大的帮助.     

18F-FDG PET/CT is a valuable tool for relapsing polychondritis diagnose and therapeutic response monitoring

Objectives

To retrospectively investigate the role of ¹⁸ F–fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) for the diagnosis and therapeutic response in relapsing polychondritis (RP) patients.

Methods

¹⁸F-FDG PET/CT findings were reviewed in six RP patients. The initial scans were performed for all patients, follow-up scans were performed during steroid therapy for five patients. Changes in the abnormal lesions and the maximal standard uptake value (SUV_max) were analyzed.

Results

The initial PET/CT scans revealed intense FDG uptake in the cartilages for all six patients. The lesions of abnormal FDG uptake were tracheal/bronchial cartilage (n = 4), costicartilage (n = 4), nasal cartilage (n = 3), cricoid cartilage (n = 3), auricular cartilage (n = 3), arytenoid cartilage (n = 3), thyroid cartilage (n = 2), hyoid cartilage (n = 1) and mediastinum lymph node (n = 1). The mean visual score and the mean SUV_max were 2.96 ± 0.20 and 4.10 ± 0.6. The intense uptake reduced or disappeared during steroid therapy for five patients, the mean visual score and the mean SUV_max were 1.58 ± 1.4 and 1.51 ± 1.4.

Conclusions

¹⁸F-FDG PET/CT enables the acquisition of both morphologic and glucose metabolic of the related cartilage structures. It plays a valuable role in assessing almost all cartilage and detecting RP, which is a better selection of a biopsy site as well as therapeutic response monitoring.     

CT诊断复发性多软骨炎累及气道2例

患者1 男性,61岁.农民,因"反复咳嗽咳痰伴发热2月,加重20天"于2010年4月2日入院.患者入院前2月受凉后出现咳嗽咳痰,痰量少色白呈泡沫样,体温午后升高,最高达38.8℃,咳嗽剧时伴胸部闷塞感、胸骨前区疼痛.在当地医院抗感染治疗无效.20天前咳嗽加剧,以夜间平卧时明显,仍有发热.当地医院诊断为"慢性阻塞性肺疾病、支气管哮喘",予"信必可、思力华"等抗炎平喘治疗无好转,咳嗽进一步加剧,伴气急,喉间似有异物阻塞感,曾行喉镜检查未见异常,有吸烟史.入院查体:体温38.4℃,心率102次/min,呼吸频率22次/min,血压BP 112/66mmHg (1mmHg＝0.133kPa).     

Increased cartilagenous uptake on bone scintigraphy in a patient with relapsing polychondritis

A patient with relapsing polychondritis and increased uptake on bone scintigraphy (using ^99mTc-MDP) in the cartilagenous parts of the ribs, the sternum and in the larynx region is described. A biopsy of a costochondral junction (where uptake on the bone scan was increased) was compatible with relapsing polychondritis. After treatment with prednisolone and azathioprine the patient improved and a repeated bone scan (after six years) showed less intensive uptake.     

Increased cartilagenous uptake on bone scintigraphy in a patient with relapsing polychondritis

A patient with relapsing polychondritis and increased uptake on bone scintigraphy (using 99mTc-MDP) in the cartilagenous parts of the ribs, the sternum and in the larynx region is described. A biopsy of a costochondral junction (where uptake on the bone scan was increased) was compatible with relapsing polychondritis. After treatment with prednisolone and azathioprine the patient improved and a repeated bone scan (after six years) showed less intensive uptake.