Thickening Of Bronchovascular Bundles Research Articles

CT Scan Differences of Pulmonary TB According to Presence of Pleural Effusion

Subpleural micronodules and interlobular septal thickening are common computed tomography (CT) findings in tuberculous (TB) pleural effusion. These CT features could help us differentiate between TB pleural effusion and non-tuberculous empyema. Does the frequency of subpleural micronodules and interlobular septal thickening correlate with the presence of pleural effusion in patients with pulmonary TB? CT findings of pulmonary TB, micronodules and their distribution (peribronchovascular, septal, subpleural, centrilobular, and random), large opacity (consolidation/macronodule), cavitation, tree-in-buds, bronchovascular bundle thickening, interlobular septal thickening, lymphadenopathy, and pleural effusion were retrospectively analyzed. Patients were divided into two groups according to the presence of pleural effusion. Clinicoradiological findings of the two groups were then analyzed. We presented Benjamini-Hochberg critical value for multiple testing correction of CT findings with false discovery rate of 0.05. Of a total of 338 consecutive patients diagnosed with pulmonary TB who underwent CT scans, 60 were excluded due to co-existing pulmonary diseases. The frequency of subpleural nodules (47/68, 69% in pulmonary TB with pleural effusion vs. 30/210, 14% in pulmonary TB without effusion, p < 0.001, Benjamini-Hochberg (B-H) critical value = 0.0036) and interlobular septal thickening (55/68, 81% vs. 134/210, 64%, p = 0.009, B-H critical value = 0.0107) was significantly higher in the group of patients with pulmonary TB with pleural effusion than in the group without pleural effusion. In contrast, tree-in-buds (20/68, 29% vs. 101/210, 48%, p = 0.007, B-H critical value = 0.0071) were less frequently seen in patients with pulmonary TB with pleural effusion. Subpleural nodules and septal thickening were more common in pulmonary TB patients with pleural effusion than in those without pleural effusion. TB involvement of the lymphatics in the peripheral interstitium could be associated with the development of pleural effusion.

Predictability and Utility of Contrast-Enhanced CT on Occult Lymph Node Metastasis for Patients with Clinical Stage IA-IIA Lung Adenocarcinoma: A Double-Center Study

With the advantage of minimizing damage and preserving more functional lung tissue, limited surgery is considered depend on the lymph node (LN) involvement situation. However, occult lymph node metastasis (OLM) may be ignored by limited surgery and become a risk factor for local recurrence after surgical resection. The aim of this study was to assess the risk factors for OLM based on computed tomography enhanced image in patients with clinical lung adenocarcinoma (ADC). From January 2016 to July 2022, 707 patients with clinical stage IA-IIA ADC underwent lobectomy with systematic LN dissection and were divided into training and validation group based on different institution. Univariate analysis followed by multivariable logistic regression were performed to estimate different risk factors of OLM. A predictive model was established with visual nomogram and external validation, and evaluated in terms of accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Fifty-nine patients were diagnosed with OLM (11.9%), and four independent predictors of LN involvement were identified: larger consolidation diameter (odds ratio [OR], 2.35, 95% confidence interval [CI]: 1.06, 5.22, p=0.013), bronchovascular bundle thickening (OR, 1.99, 95% CI: 1.00, 3.95, p=0.049), lobulation (OR, 2.92, 95% CI: 1.22, 6.99, p=0.016) and obstructive change (OR, 1.69, 95% CI: 1.17, 6.16, p=0.020). The model showed good calibration (Hosmer-Lemeshow goodness-of-fit, p=0.816) with an AUC of 0.821 (95% CI: 0.775, 0.853). For the validation group, the AUC was 0.788 (95% CI: 0.732, 0.806). Our predictive model can non-invasively assess the risk of OLM in patients with clinical stage IA-IIA ADC, enable surgeons perform an individualized prediction preoperatively, and assist the clinical decision-making procedure.

PULMONARY LEUKEMIC INFILTRATES CAUSING RESPIRATORY FAILURE IN ACUTE MYELOID LEUKEMIA

PULMONARY LEUKEMIC INFILTRATES CAUSING RESPIRATORY FAILURE IN ACUTE MYELOID LEUKEMIA

Differential diagnosis of infectious diseases, drug-induced lung injury, and pulmonary infiltration due to underlying malignancy in patients with hematological malignancy using HRCT

PurposeTo differentiate among infectious diseases, drug-induced lung injury (DILI) and pulmonary infiltration due to underlying malignancy (PIUM) based on high-resolution computed tomographic (HRCT) findings from patients with hematological malignancies who underwent chemotherapy or hematopoietic stem cell transplantation.Materials and methodsA total of 221 immunocompromised patients with hematological malignancies who had proven chest complications (141 patients with infectious diseases, 24 with DILI and 56 with PIUM) were included. Two chest radiologists evaluated the HRCT findings, including ground-glass opacity, consolidation, nodules, and thickening of bronchovascular bundles (BVBs) and interlobular septa (ILS). After comparing these CT findings among the three groups using the χ2test, multiple logistic regression analyses (infectious vs noninfectious diseases, DILI vs non-DILI, and PIUM vs non-PIUM) were performed to detect useful indicators for differentiation.ResultsSignificant differences were detected in many HRCT findings by the χ2 test. The results from the multiple logistic regression analyses identified several indicators: nodules without a perilymphatic distribution [p = 0.012, odds ratio (95% confidence interval): 4.464 (1.355–11.904)], nodules with a tree-in-bud pattern [p = 0.011, 8.364 (1.637–42.741)], and the absence of ILS thickening[p = 0.003, 3.621 (1.565–8.381)] for infectious diseases, the presence of ILS thickening [p = 0.001, 7.166 (2.343–21.915)] for DILI, and nodules with a perilymphatic distribution [p = 0.011, 4.256 (1.397–12.961)] and lymph node enlargement (p = 0.008, 3.420 (1.385–8.441)] for PIUM.ConclusionILS thickening, nodules with a perilymphatic distribution, tree-in-bud pattern, and lymph node enlargement could be useful indicators for differentiating among infectious diseases, DILI, and PIUM in patients with hematological malignancies.

Diagnostic index for acute eosinophilic pneumonia without bronchoscopy in military smokers.

Background/AimsAcute eosinophilic pneumonia (AEP) is common among military smokers; however, bronchoscopy is required for the diagnosis. We aimed to derive and validate a scoring system to diagnose AEP without bronchoscopy.MethodsWe conducted a retrospective study including patients diagnosed with AEP or any other pneumonia among military smokers hospitalized in the Armed Forces Capital Hospital from 15 November 2016 through 25 December 2019. The patients were divided into derivation and validation groups according to their admission day. Patient symptoms, laboratory findings, and computed tomography findings were candidate variables. Least absolute shrinkage and selection operator (LASSO) regression was used to calculate the scores for each variable.ResultsAmong 414 patients, AEP was confirmed in 54 of 279 patients (19.4%) in the derivation group and in 18 of 135 patients (13.3%) in the validation group. Ten variables were selected using LASSO regression: new-onset or a recently increased smoking (≤ 4 weeks) (8 points), interlobular septal thickening (5 points), absence of sputum (3 points), ground glass opacity (3 points), acute onset (≤ 3 days) (2 points), dyspnea (2 points), chest pain (2 points), leukocytosis (2 points), bronchovascular bundle thickening (2 points), and bilateral involvement (2 points). The area under the receiver-operating characteristic curve of the score to diagnose AEP was 0.997 (95% confidence interval, 0.992 to 1.000) in the derivation group and 0.985 (95% confidence interval, 0.965 to 1.000) in the validation group.ConclusionsWe introduce a scoring system that can distinguish AEP from other types of pneumonia in military smokers without the need for bronchoscopy.

Association of postoperative recurrence with radiological and clinicopathological features in patients with stage IA–IIA lung adenocarcinoma

ObjectivesTo retrospectively investigate whether radiological and clinicopathological characteristics were associated with the presence of stage IA–IIA lung adenocarcinoma in patients at high risk for a postoperative recurrence. Materials and MethodsThree hundred twelve patients with biopsy-proven node-negative early-stage (IA–IIA) lung adenocarcinoma met the inclusion criteria for this study. Demographics data and histopathological findings were collected from medical records. Computed tomography (CT) performed approximately 1 month before surgery was manually scored using 23 CT descriptors. Univariate analyses were applied to demonstrate an association between clinicopathological and radiological features and 2-/5-year recurrences. Multivariate logistic regression was performed to assess the ability of radiological and clinicopathological features to discriminate low and high-risk factors for recurrence. A ROC curve was used to evaluate prediction performance. ResultsUnivariate analysis revealed that the 2-year recurrence was associated with six radiological features and two clinicopathological features, while 5-year recurrence was associated with five radiological features and two clinicopathological features. A multivariate logistic regression model of combined clinicopathological and radiological features showed that stage IIA (OR = 2.87), solid texture (solid part > 50 %: OR = 4.81; solid part = 100 %: OR = 3.61), pleural attachment (OR = 3.97) and bronchovascular bundle thickening (OR = 2.16) were associated with the independent predictors of 2-year recurrence, and stage IIA (OR = 3.52), solid texture (solid part > 50 %: OR = 3.56; solid part = 100 %: OR = 2.44) and pleural attachment (OR = 4.57) were associated with 5-year recurrence. Combined radiological and clinicopathological features could be significant indicators of 2- and 5-year recurrences (AUC = 0.784 and AUC = 0.815, respectively). ConclusionsThe combination of radiological and clinicopathological features has the potential to help predict postoperative recurrence in patients with stage IA–IIA lung adenocarcinomas and guide oncologists and patients whether to undergo additional treatment after surgery.

Differentiation of pulmonary complications with extensive ground-glass attenuation on high-resolution CT in immunocompromised patients

PurposeThe purpose of this study was to compare the high-resolution CT (HRCT) findings of pulmonary infectious and noninfectious complications with extensive ground-glass attenuation (GGA) in immunocompromised patients.Materials and methodsOne hundred fifty-two immunocompromised patients with pulmonary complications that showed extensive GGA (> 50% of the whole lung on HRCT) were included in this study. The diagnoses of the 152 patients were as follows: pneumocystis pneumonia (PCP), n = 82; drug-induced pneumonia, n = 38; bacterial pneumonia, n = 9; cytomegalovirus pneumonia, n = 6; idiopathic pneumonia syndrome, n = 6; diffuse alveolar hemorrhage (DAH), n = 4; fungal infection, n = 3; tuberculosis, n = 2 and pulmonary edema, n = 2. Two chest radiologists retrospectively evaluated the CT criteria, which consisted of 12 findings.ResultsThe nodule (p = 0.015), the bronchovascular bundle (BVB) thickening (p = 0.001), and the interlobular septum (ILS) thickening (p = 0.002) were significantly infrequent in PCP. The ILS thickening was significantly frequent in drug-induced pneumonia (p < 0.001) though it was also frequent in other noninfectious and infectious diseases. The BVB thickening was significantly frequent in bacterial pneumonia (p = 0.005). The nodule was significantly frequent in DAH (p = 0.049).ConclusionNodules, BVB thickening, and ILS thickening could be useful HRCT findings for the differential diagnosis of pulmonary complications in immunocompromised patients with extensive GGA.

Intrathoracic manifestations of immunoglobulin G4-related disease: A pictorial review

Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized systemic fibro-inflammatory disease associated with elevated serum IgG4 levels. It affects virtually any organ system including the gastrointestinal system, salivary glands, periorbital tissues, kidneys, lungs, lymph nodes, central nervous system, large vessels, thyroid, and skin. Although the involved organ systems vary between studies and are influenced by the medical center and specialty, the most frequent manifestation of IgG4-RD is regarded to be type 1 autoimmune pancreatitis. The incidence of intrathoracic involvement is not known exactly, but it is thought to be relatively rare. Intrathoracic manifestations of IgG4-RD can be observed in airways (tracheobronchial stenosis, thickening of bronchovascular bundles), pulmonary parenchyma (nodules, masses, interstitial lung disease), pleura (pleural thickening, nodules, effusion), and mediastinum (lymphadenopathy, fibrosing mediastinitis). This review aimed to briefly describe the pathogenesis, histopathology, clinical features, diagnosis, and treatment of IgG4-RD; and make a pictorial review of its intrathoracic manifestations.

Bronchovascular bundle thickening on CT as a predictor of survival and brain metastasis in patients with stage IA peripheral small cell lung cancer

To determine if bronchovascular bundle (BVB) thickening on pretreatment computed tomography (CT) images helps predict survival in patients with peripheral small cell lung cancer (pSCLC) ≤3 cm. The pretreatment CT examinations of 79 histopathologically proven pSCLC ≤3 cm (TNM stage I, 21; II, 13; III, 22; IV, 23) were reviewed retrospectively. The CT characteristics of the nodule and associated findings, including BVB thickening, were evaluated. Progression-free survival (PFS), overall survival (OS), and brain metastasis-free survival were compared with the presence of BVB thickening using Kaplan-Meier and Cox regression analysis. Among the 79 patients, 34 (43%) had BVB thickening. BVB thickening was prevalent in patients with mediastinal lymph node metastasis (50.9% versus 22.7%; p=0.024) and distant metastasis (60.9% versus 35.7%; p=0.049). Out of the 21 patients with TNM stage IA disease, the 16 patients (76.2%) without BVB thickening showed better PFS, OS, and brain metastasis-free survival (mean, 1,762 versus 483 days; p=0.019: 2,243 versus 1,328 days; p=0.038: 2,274 versus 1,287 days; p=0.038, respectively). Multivariate Cox regression analysis showed that the absence of BVB thickening (hazard ratio [HR], 7.806; 95% CI, 1.241-49.091; p=0.029) and surgery (HR, 0.075; 95% CI, 0.008-0.746; p=0.027) were independent and useful prognostic factors for PFS. BVB thickening was found more frequently in patients with advanced-stage pSCLC ≤3 cm, and the PFS was more favourable in patients without BVB thickening, with a similar tendency to that of OS and brain metastasis-free survival, in stage IA pSCLC.

Features of IgG4-related lung disease on 18F-FDG PET/computed tomography imaging.

The aim of the study was to summarize the features of immunoglobulin G4-related lung disease (IgG4-RLD) on fluorine 18-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT). In this retrospective case series, 12 consecutive patients (9 men and 3 women, mean age 55.4 ± 13.7 years) with IgG4-RLD were included. The clinicopathological information and features of F-FDG PET/CT imaging were analyzed. Six (50%) patients had pulmonary involvement alone and six (50%) patients had extrapulmonary involvement with intense F-FDG uptake. Pulmonary manifestations included mass (25%, 3/12), solid nodule (solitary 25%, 3/12; multiple 50%, 6/12), multiple ground-glass opacities (GGOs) (50%, 6/12), thickening of alveolar interstitium (50%, 6/12), and thickening of bronchovascular bundle (33.3%, 4/12). The maximum standardized uptake value (SUVmax) of the solid nodules and masses, multiple GGOs, bronchovascular bundle and the thickening of septa was 4.0 ± 2.5, 2.3 ± 1.8, 1.4 ± 0.6, and 0.9 ± 0.5, respectively. The SUVmax statistically significant linear association with the diameter of masses or solid nodules (P value = 0.03), but no significant inverse linear association (P value = 0.06) with the concentration of serum IgG4 concentration. The image patterns of IgG4-RLD on F-FDG PET/CT are varying. Multiple pulmonary manifestations or multiple organ involvement, especially in combination with elevated levels of serum IgG and IgG4, may help to make the diagnosis. A potential major application of PET-CT would be evaluation of response to treatment, and the impact of PET/CT on IgG4-RLD management is worth investigating further in the future.

Pulmonary postmortem computed tomography of bacterial pneumonia and pulmonary edema in patients following non-traumatic in-hospital death.

In this study, we compared the postmortem computed tomography (PMCT) findings among nonpathological lungs, lungs with bacterial pneumonia, and lungs with pulmonary edema in patients following non-traumatic in-hospital death. We studied 104 consecutive adult patients (208 lungs) who died in our tertiary care hospital and underwent PMCT and pathological autopsy (both within 2.5days after death), and were pathologically diagnosed with nonpathological lungs, bacterial pneumonia, and pulmonary edema. Thirteen pulmonary features were assessed on the CT scans. We also examined the association between the time elapsed since death and the pulmonary findings. We observed increased lung opacities with horizontal plane formation, diffuse opacities, diffuse bronchovascular bundle thickening, symmetric opacities to the contralateral lung, and decreased segmental opacities with time elapsed since death (Cochran-Armitage test for trend). Multiple logistic regression revealed that the presence of opacities without horizontal plane formation or centrilobular opacities, and the absence of diffuse bronchovascular bundle thickening were associated with histopathological pneumonia, whereas the presence of opacities with horizontal plane formation, diffuse opacities, and interlobular septal thickening were associated with histopathological pulmonary edema. In conclusion, specific pulmonary PMCT findings increased with time elapsed since death, and some lung findings may facilitate the diagnosis of bacterial pneumonia and pulmonary edema.

Imaging Features of Pulmonary Leukemic Infiltration With Comparison of Lymphoid and Myeloid Leukemias

PurposeTo describe the imaging findings of lung infiltration by leukemia and differential findings of lymphoid and myeloid leukemias. Materials and MethodsThrough a search of electronic medical records from 2005 to 2017, we identified 21 patients with pathologically proven lung involvement by leukemia. Concurrent CT findings were analyzed by 2 chest radiologists in consensus for ground glass or consolidative opacities, septal thickening, bronchovascular bundle thickening, pulmonary nodules, pulmonary masses, and hilar and mediastinal lymphadenopathy. ResultsThere were 13 cases of lymphoid leukemias and 8 of myeloid leukemias. Nodules and masses were the most common imaging feature (n = 13, 62%). Bronchovascular bundle thickening and hilar lymphadenopathy were exclusively seen in lymphoid leukemias (P = 0.01 and P = 0.006). Centrilobular nodules were also exclusively seen in 3 patients with chronic lymphocytic leukemia. ConclusionLung infiltration by leukemia presents most commonly with nodules or masses, but interstitial abnormalities such as bronchovascular bundle thickening were seen as well. Radiologists should consider leukemic infiltration in the differential diagnosis for nodules, including centrilobular nodules, in these patients.

A retrospective analysis of distinguishing features of chest HRCT and clinical manifestation in primary Sjögren's syndrome-related interstitial lung disease in a Chinese population.

To characterize the distinctive chest high-resolution computerized tomography (HRCT) features and clinical manifestations of primary Sjögren syndrome (pSS)-related interstitial lung disease (ILD). The demographic data, clinical manifestations, and laboratory and radiological findings of 527 pSS patients were retrospectively analyzed. ILD was defined based on the presences of pulmonary signs in HRCT. Two hundred six of 527 patients were diagnosed as pSS-ILD, and the prevalence was 39.1%. The three most frequent abnormalities in HRCT were reticular pattern (92.7%), ground-glass attenuation (87.4%), and bronchovascular bundle thickening (82%). One hundred twenty-four cases (60.2%) of the pSS-ILD patients had only a single HRCT pattern, which involved 86 non-specific interstitial pneumonitis (NSIP) cases (41.7%), 22 usual interstitial pneumonia (UIP) cases (10.68%), 8 organizing pneumonia (OP) cases (3.9%), and 8 lymphocytic interstitial pneumonia (LIP) cases (3.9%), respectively. Besides, the more important observation was that 82 cases had no less than two HRCT patterns, and NSIP admixed with OP (43.9%), NSIP admixed with UIP (35.4%), and NSIP admixed with LIP (19.5%) were the most frequent. HRCT of pSS-ILD patients demonstrated bilateral infiltrates (99%), with abnormalities predominantly in the lower lobes (89.3%) and subpleural areas (81.1%), and a few lesions were characterized by hilum distributed (8.7%). Pulmonary function tests (PFTs) revealed impaired diffusion capacity for carbon monoxide and total lung capacity, and the rate of small airway lesions in the pSS-ILD patients was 3.5 times higher in patients of pSS. Logistic regression analysis showed that dry cough (OR 59.05), clubbing (OR 6.26), elevated lactate dehydrogenase (OR 21.38) and positive anti-Ro (OR 7.86) were relevant factors of pSS-ILD. ILD is the common pulmonary involvement of pSS and the prevalence of pSS-ILD is 39.1%. The single pattern of NSIP and UIP in HRCT are the commonest, and about 40% of the pSS-ILD patients possess multiple patterns in HRCT. The classification of idiopathic pulmonary fibrosis cannot completely include the pulmonary imaging features of pSS-ILD.

Subjective and objective comparisons of image quality between ultra-high-resolution CT and conventional area detector CT in phantoms and cadaveric human lungs

ObjectivesTo compare the image quality of the lungs between ultra-high-resolution CT (U-HRCT) and conventional area detector CT (AD-CT) images.MethodsImage data of slit phantoms (0.35, 0.30, and 0.15 mm) and 11 cadaveric human lungs were acquired by both U-HRCT and AD-CT devices. U-HRCT images were obtained with three acquisition modes: normal mode (U-HRCTN: 896 channels, 0.5 mm × 80 rows; 512 matrix), super-high-resolution mode (U-HRCTSHR: 1792 channels, 0.25 mm × 160 rows; 1024 matrix), and volume mode (U-HRCTSHR-VOL: non-helical acquisition with U-HRCTSHR). AD-CT images were obtained with the same conditions as U-HRCTN. Three independent observers scored normal anatomical structures (vessels and bronchi), abnormal CT findings (faint nodules, solid nodules, ground-glass opacity, consolidation, emphysema, interlobular septal thickening, intralobular reticular opacities, bronchovascular bundle thickening, bronchiectasis, and honeycombing), noise, artifacts, and overall image quality on a 3-point scale (1 = worst, 2 = equal, 3 = best) compared with U-HRCTN. Noise values were calculated quantitatively.ResultsU-HRCT could depict a 0.15-mm slit. Both U-HRCTSHR and U-HRCTSHR-VOL significantly improved visualization of normal anatomical structures and abnormal CT findings, except for intralobular reticular opacities and reduced artifacts, compared with AD-CT (p < 0.014). Visually, U-HRCTSHR-VOL has less noise than U-HRCTSHR and AD-CT (p < 0.00001). Quantitative noise values were significantly higher in the following order: U-HRCTSHR (mean, 30.41), U-HRCTSHR-VOL (26.84), AD-CT (16.03), and U-HRCTN (15.14) (p < 0.0001). U-HRCTSHR and U-HRCTSHR-VOL resulted in significantly higher overall image quality than AD-CT and were almost equal to U-HRCTN (p < 0.0001).ConclusionsBoth U-HRCTSHR and U-HRCTSHR-VOL can provide higher image quality than AD-CT, while U-HRCTSHR-VOL was less noisy than U-HRCTSHR.Key Points• Ultra-high-resolution CT (U-HRCT) can improve spatial resolution.• U-HRCT can reduce streak and dark band artifacts.• U-HRCT can provide higher image quality than conventional area detector CT.• In U-HRCT, the volume mode is less noisy than the super-high-resolution mode.• U-HRCT may provide more detailed information about the lung anatomy and pathology.

Immunoglobulin G4-related acquired hemophilia: A case report.

Acquired hemophilia A (AHA) is a relatively rare and life-threatening bleeding disorder whose pathogenesis is not completely understood. The present study reports a rare case of immunogubulin (IgG)4-related AHA with multisystemic involvement. A 55-year old male patient presented with symptoms of bronchial asthma and multiple subdermal hematomas. Chest computed tomography showed multiple diffuse nodular lesions with thickening of bronchovascular bundles, and scattered high-density spots in both lung lobes. Laboratory investigations showed increased activated partial prothrombin time (120.0 sec), a markedly decreased factor VIII (FVIII) activity (0.5%), a high-titer of FVIII inhibitor (27.2 Bethesda units/ml) and a marked increase in serum IgG4 (>4.03 g/l) level. Left inguinal lymph node biopsy revealed capsular thickening with marked lymphoplasmacytic infiltration, occlusive phlebitis and irregular fibrosis. Immunostaining revealed numerous IgG4-positive plasma cells (>100 cells/human plasma fibronectin) in the nodular lesions, with an IgG4/IgG ratio of >40%. The symptoms were markedly alleviated following corticosteroid therapy. The current study presents the first reported case of a rare IgG4-related AHA that presented with unusual clinical features and multisystemic involvement. The patient responded well to corticosteroid therapy. Documentation of such rare cases will help in characterizing the pathogenesis, and prompt recognition and timely treatment of this rare disorder.

Antisynthetase syndrome: Pulmonary computed tomography findings of adult patients with antibodies to aminoacyl-tRNA synthetases

ObjectivesTo describe the pulmonary CT findings in patients with anti-ARS-antibody-positive interstitial lung disease (anti-ARS-ILD) MethodsThe CT findings of 64 patients with anti-ARS-ILD were retrospectively reviewed. The images were retrospectively reviewed independently by 2 chest radiologists, and the final decision on the CT findings was made by a third chest radiologist. ResultsThere were 16 male and 48 female patients, aged 54.2±13.4 years. Sixteen patients had anti Jo-1, 24 had anti-EJ, 9 had anti-PL-7, 7 had anti-PL-12, 5 had anti-KS, and 3 had anti-OJ antibodies. Overall, 63 patients (98.4%) had CT findings predominantly in the lower lobe; 61 patients (95.3%) showed peripheral opacities, and 47 patients (73.4%) showed peribronchovascular opacities. Ground-glass attenuation, consolidation, and reticulation showed similar distribution patterns. Regarding detailed CT findings, 89.1% of patients had lower volume loss, 76.6% had interlobular septal thickening, and 67.2% had thickening of bronchovascular bundles. The final radiologic diagnoses were as follows: inconsistent with usual interstitial pneumonia (UIP) in 63 patients (98.4%), which included nonspecific interstitial pneumonia (NSIP) in 35 patients (55.6%), organizing pneumonia (OP) in 4 patients (6.3%), and OP with fibrosis in 22 patients (34.9%). ConclusionsThe characteristic CT findings of patients with anti-ARS-ILD were areas of ground-glass attenuation and reticulation, predominantly distributed as lower and peribronchovascular lesions, which is compatible with NSIP. One-third of patients showed OP with fibrosis.

F-18 FDG PET/CT in Bilateral Diffuse Pulmonary Lymphangitic Carcinomatosis.

A 51-year-old female patient, who had undergone left-sided modified radical mastectomy for left breast carcinoma 4 years ago, presented with dyspnea of 4 months duration. F-18 FDG PET/CT of this patient showed diffusely increased FDG uptake in the bilateral lung fields along the thickened bronchovascular bundles (Fig. 1a–c). SUVmax of lymphangitic lung was 5.2. The standardized uptake ratio (SUR) of mediastinal blood pool to lymphangitic lung was 0.44. High resolution computed tomography (HRCT) of the same patient showed thickening of interlobular septa and bronchovascular bundles, with preservation of normal parenchymal architecture. Multiple intrapulmonary nodules and bilateral hilar lymphadenopathy were also seen (Fig. 1d, e). These findings are consistent with pulmonary lymphangitic carcinomatosis (PLC). Fig. 1 F-18 FDG PET/CT images (A, B, C) showing diffusely increased FDG uptake in the bilateral lung fields along the thickened bronchovascular bundles. High resolution computed tomography (D, E) of the same patient showed thickening of interlobular septa and ... The lungs are the second most common sites for metastases after lymph nodes [1]. These metastases are usually nodular on radiologic images. PLC with interstitial involvement constitutes only 7% of pulmonary metastases [2]. The most common primary sites, in order of frequency, are adenocarcinoma of the lung, breast, stomach, colon, and prostrate [2]. HRCT has been the modality of choice in the radiologic diagnosis of PLC. Only a few studies have described the F-18 FDG PET/CT findings in pulmonary lymphangitic carcinomatosis [3–5]. These studies have shown diffusely increased FDG uptake corresponding to the typical changes in the CT as the most common finding. One study has reported that F-18 FDG PET/CT is 100% specific and 86% sensitive in diagnosing PLC by subjective analysis. The mean SUV in the region of pulmonary lymphangitic carcinomatosis was 1.37 ± 0.64 vs. 0.51 ± 0.29 in normal lung. The SUR of mediastinal blood pool to lymphangitic lung was 1.26 ± 0.45, and that of blood pool to normal lung was 3.78 ± 1.37 [5].

Cystic Lung Changes in a Thin Section CT in an Asymptomatic Young Adult with Unilateral Pulmonary Vein Atresia: A Case Report

Unilateral pulmonary vein atresia is a very rare congenital anomaly usually associated with high morbidity and mortality (1-4). Most of the patients reported were in infancy or early childhood with recurrent episodes of hemoptysis or pneumonia. Based on the gravity of symptoms, coil embolization and pneumonectomy are the usual forms of treatment (5, 6). There have been few radiologic reports about the findings of systemic collaterals to the pulmonary vessels such as interlobular septal thickening, ground-glass opacity and subpleural nodules (1, 2, 4, 7). We present the case of a 20-year-old male, who had been an asymptomatic pulmonary vein atresia and systemic-to-pulmonary collaterals patient. We observed cystic changes on right upper lobe of the lung, a rarely reported condition, and the septal thickenings, bronchovascular bundle thickening, and groundglass opacity which represent peripheral collaterals on thin section computed tomography (CT).

Smoking Inhibits the Frequency of Bronchovascular Bundle Thickening in Sarcoidosis

Smoking has been associated with decreased incidence and prevalence of sarcoidosis, but few studies have evaluated effects of smoking on clinical parameters of the disease. The objectives were to determine the association of smoking with radiographic patterns and to evaluate the associations of these smoking-related radiographic patterns on airflow obstruction in sarcoidosis. Clinical data and computed tomography (CT) scans of 124 patients with sarcoidosis were reviewed. CT scans were assessed for lymph nodes, nodules, bronchiectasis, bronchovascular bundle thickening, displaced hilum, fibrosis, ground glass, emphysema, pleural changes, and alveolar opacities. CT patterns were compared between patients with and without a history of smoking. The effect of smoking on the associations between radiographic patterns and airflow obstruction was assessed with multivariable analysis. Smokers had less frequency of bronchovascular bundle thickening than nonsmokers (11/38 subjects [29%] vs 50/86 subjects [58%], P = .003) and more emphysema (7/38 subjects [18%] vs 1/86 subjects [1%], P = .001). Patients who had bronchovascular bundle thickening were less likely to have ever smoked (11/61 subjects [18%] vs 27/63 subjects [43%], P = .003) or be current smokers (4/61 subjects [7%] vs 15/63 subjects [24%], P = .008). Age (P = .003) and bronchovascular bundle thickening (P = .02) were independent predictors of airflow obstruction. There were no differences in smoking history between patients with airflow obstruction versus those without (10/37 subjects [27%] vs 28/87 subjects [32%], P = .63). In patients with sarcoidosis, smoking is associated with decreased frequency of bronchovascular bundle thickening, an important clinical manifestation of the lung disease. Further, bronchovascular bundle thickening and age are the only independent predictors of airflow obstruction, and smoking does not confound these associations.

Diagnostic Difficulties in Differentiating Sarcoidosis from Tuberculosis

Distinguishing sarcoidosis from pulmonary tuberculosis can sometimes be a great challenge to physicians, especially in developing countries where there is high prevalence of tuberculosis. Both tuberculosis and sarcoidosis are granulomatous diseases, however, tuberculosis has a caseating granuloma as opposed to sarcoidosis, which present with non-caseating epithelioid cell granuloma. Due to the marked clinico-radiological similarity of these entities and high prevalence of tuberculosis, these patients receive repeated courses of anti-tubercular therapy (ATT) while lung damage continues to progress. Recently, a 51 year old man presented to the out-patient department at Firoz Specialist Hospital, with one year history of non-productive cough, on and off low grade fever, and 9 kg weight loss. He was on ATT for the past one month. He had a past history of pulmonary tuberculosis 15 years before, for which he had a complete course of ATT. Respiratory system examination revealed inspiratory crept throughout in the right lung. Laboratory investigations showed normocytic normochromic anemia, white blood count 7530/mm3, erythrocyte sedimentation rate 45 mm at the end of one hour. Sputum for acid fast bacilli was negative. Chest radiography showed inhomogeneous opacity with reticulations in the right upper-mid zone (perihilar region), as shown in Fig. 1. High resolution Computed Tomography (HRCT) of the thorax revealed a cavitatory lesion in the posterior segment of the right upper lobe with multiple nodules in the anterior segment of the upper lobe and the middle lobe (Fig. 2). It was also associated with thickening of the interlobular septa and peri-bronchovascular bundle. Radiological differential diagnosis would be tuberculosis, sarcoidosis and lymphangitis carcinomatosis. However, secondary reactivation of tuberculosis was strongly suspected considering both clinical and radiological (mainly the cavitatory lesion) findings. Computed tomography guided lung biopsy revealed the presence of non-caseating granulomas suggestive of sarcoidosis. The patient was treated with prednisolone 60 mg/day. Within 3 weeks, marked clinical improvement was seen. Steroid was gradually tapered over the period of 4 weeks. The patient remained asymptomatic during the next six months. Figure 1 Chest X-ray (PA)-shows reticulonodular opacity in right perihilar region. Figure 2 HRCT thorax- shows a thick walled cavitatory lesion with multiple nodules in right middle lobe along with thickening of interlobular septa and bronchovascular bundle. Also patch of consolidation seen in lingular lobe. Sarcoidosis is a multisystem disorder of unknown etiology, characterized by the presence of non-caseating granuloma.1 Non-specific constitutional symptoms such as fever, fatigue, malaise and weight loss are present in approximately one-third of patients. The chest radiograph usually shows hilar and mediastinal lymphadenopathy. Other characteristic findings include interstitial lung disease, or occasional calcification of affected lymph nodes. Most commonly, high resolution CT of the thorax shows thickening of bronchovascular bundles and perilymphatic distribution of nodules which represent the sarcoid granuloma. Clinical and radiological features of tuberculosis and sarcoidosis are quite overlapping and therefore, a diagnostic dilemma often persists. Exclusion of tuberculosis is important, particularly because corticosteroids form the mainstay of treatment for sarcoidosis. Cavity formation is common in tuberculosis and uncommon in sarcoidosis. Greiner et al. reported only 3% of cases with cavity formation.2 The diagnosis is established most securely when clinico-radiologic findings are supported by histologic evidence of widespread non-caseating granulomas.1 Recently, adding to the diagnostic difficulty, there are also several reports of coexistence of sarcoidosis and tuberculosis in the same patients.3