Thickening Of Bronchovascular Bundles Research Articles

Quantitative comparison of idiopathic interstitial pneumonias on high-resolution computed tomographic findings

To analyze the high-resolution computed tomographic (HRCT) findings of IPF (interstitial pulmonary fibrosis), NSIP (nonspecific interstitial pneumonia) and COP (cryptogenic organizing pneumonia) retrospectively through quantification methods and to explore their distinguishing features. Observers with no prior knowledge of the diagnosis evaluated the frequency, extent and distribution of various thin-section CT findings in 29 males and 17 females. The mean age was 50 ± 10 years old (range: 25 - 76). They had a histological diagnosis of IPF (n = 19), nonspecific interstitial pneumonia (NSIP) (n = 14) and cryptogenic organizing pneumonia (COP) (n = 13). Ground-glass opacity, thickening of bronchovascular bundles and interlobular septal thickening were frequent features of IPF and NSIP. The frequency and extent of honeycombing and bronchiolectasis were more found in IPF than in NSIP and COP (P < 0.05). The frequency and extent of air space consolidation were more found in COP than IPF (P < 0.05). There were more number of segments with traction bronchiectasis and less extent of air space consolidation in IPF than NSIP and COP. The number of segments with traction bronchiectasis was less in NSIP than that of IPF and COP. The various subtypes of idiopathic interstitial pneumonias often have the distinguishing characteristics easily identified on HRCT. Bronchiolectasis and honeycombing are valuable features for IPF; air space consolidation is a valuable feature for COP. The features of NSIP are also found in both IPF and COP so that additional features are required for both.

Microscopic polyangiitis with diffuse peribronchovascular nodular involvement: Case report

Microscopic polyangiitis (MPA) is a systemic necrotizing vasculitis that affects small vessels with no immune deposits. MPA is a rare disease. The incidence of MPA is approximately 1:100.000 per year. The etiology of this disease is unknown. Pulmonary involvement is mainly characterized with ground-glass attenuation, consolidation, thickening of bronchovascular bundles, and honeycombing on computerized tomography (CT). We report a patient with an atypical pattern of pulmonary involvement which is diffuse peribronchovascular nodular infiltration. A 59-year-old male patient presented with symptoms of shortness of breath, cough, purulent sputum, back pain and hemoptysis. Laboratory studies depicted increased serum creatinine levels, hematuria and proteinuria. His chest X-ray and CT of thorax showed bilateral diffuse peribronchovascular nodular infiltrations. Circulating myeloperoxidase (MPO) anti-neutrophil cytoplasmic antibody (p-ANCA) was positive. Renal biopsy was obtained because of hematuria, proteinuria and increased creatinine level and revealed crescentic glomerulonephritis associated with small vesel vasculitis which was consistent with MPA. He was treated with corticosteroid and cyclophosphamide. At the end of two months of treatment, renal function and other pulmonary symptoms improved.

High-Resolution CT Findings of Re-Expansion Pulmonary Edema

ObjectiveTo describe the high-resolution CT (HRCT) findings of re-expansion pulmonary edema (REPE) following a thoracentesis for a spontaneous pneumothorax.Materials and MethodsHRCT scans from 43 patients who developed REPE immediately after a thoracentesis for treatment of pneumothorax were retrospectively analyzed. The study group consisted of 41 men and two women with a mean age of 34 years. The average time interval between insertion of the drainage tube and HRCT was 8.5 hours (range, 1-24 hours). The patterns and distribution of the lung lesions were analyzed and were assigned one of the following classifications: consolidation, ground-glass opacity (GGO), intralobular interstitial thickening, interlobular septal thickening, thickening of bronchovascular bundles, and nodules. The presence of pleural effusion and contralateral lung involvement was also assessed.ResultsPatchy areas of GGO were observed in all 43 patients examined. Consolidation was noted in 22 patients (51%). The geographic distribution of GGO and consolidation was noted in 25 patients (58%). Interlobular septal thickening and intralobular interstitial thickening was noted in 28 patients (65%), respectively. Bronchovascular bundle thickening was seen in 13 patients (30%), whereas ill-defined centrilobular GGO nodules were observed in five patients (12%). The lesions were predominantly peripheral in 38 patients (88%). Of these lesions, gravity-dependent distribution was noted in 23 cases (53%). Bilateral lung involvement was noted in four patients (9%), and a small amount of pleural effusion was seen in seven patients (16%).ConclusionThe HRCT findings of REPE were peripheral patchy areas of GGO that were frequently combined with consolidation as well as interlobular septal and intralobular interstitial thickening.

Sarcoidosis-related pulmonary veno-occlusive disease presenting with recurrent haemoptysis

To the Editors: A 52-yr-old female nonsmoker presented with haemoptysis consisting of streaks of bright red blood daily for 3 weeks. She gave a 3-yr history of dry cough, episodic wheeze and mild exertional dyspnoea. The symptoms had not improved with inhaled corticosteroids (fluticasone 250 μg b.i.d ). The patient denied fever, sweats or weight loss and had no significant past medical history. Physical examination was unremarkable. Chest radiograph showed no focal pulmonary abnormality or obvious lymphadenopathy, and electrocardiogram was normal. Pulmonary function tests recorded a forced expiratory volume in 1 s (FEV1) of 2.22 L (86% predicted), a forced vital capacity (FVC) of 2.93 L (96% pred) and a diffusing capacity of the lung for carbon monoxide ( D L,CO) of 7.23 mmol·m−1·kPa−1 (88% pred). Laboratory investigations showed a haemoglobin level of 12.9 g·dL−1, and a normal coagulation screen, metabolic screen and erythrocyte sedimentation rate (21 mm·h−1). Serum auto-antibodies were negative and the angiotensin converting enzyme (ACE) level was 53 IU·L−1 (normal range 0–52 IU·L−1). High-resolution computed tomography (HRCT) of the chest showed thickening of central bronchovascular bundles and scattered, nodular, ground-glass and airspace opacities (fig. 1a⇓). Fibreoptic bronchoscopy was requested. At 1 h prior to the procedure, the patient had a large haemoptysis of 200 mL bright red blood. Bronchoscopy showed diffuse fresh blood and grossly hyperaemic bronchial mucosa with generalised oozing from major and lobar bronchi (fig. 1b⇓). Fig. 1— a) Axial high-resolution computed tomography (HRCT) image showing nodular thickening extending along central bronchovascular bundles in the apical segment of the left lower lobe. Elsewhere, there were scattered nodular, ground-glass and airspace opacities consistent with pulmonary sarcoidosis. b) Bronchoscopic view of the right main and right upper lobe bronchus (arrow) showing diffuse mucosal erythema. c) HRCT thorax image taken 15 months after initial presentation showing thickened interlobular septa and patchy ground-glass attenuation. The subsegmental …

Immunoglobulin G4–related Lung Disease: CT Findings with Pathologic Correlations

To retrospectively analyze radiologic findings of immunoglobulin G4 (IgG4)-related lung disease as correlated with pathologic specimens. This study was approved by the institutional review board, and all patients had consented to the use of their medical records for the purpose of research. This study included 13 patients with IgG4-related lung disease (nine men and four women; age range, 43-76 years). Computed tomographic (CT) findings were retrospectively analyzed with regard to the characteristics, shape, and distribution of the radiologic findings and were correlated with surgically resected or biopsy lung specimens in seven patients. Statistical analysis was not used in this study. On the basis of the predominant radiologic abnormality, IgG4-related lung disease could be categorized into four major subtypes: solid nodular type having a solitary nodular lesion that included a mass (four patients); round-shaped ground-glass opacity (GGO) type characterized by multiple round-shaped GGOs (two patients); alveolar interstitial type showing honeycombing, bronchiectasis, and diffuse GGO (two patients); and bronchovascular type showing thickening of bronchovascular bundles and interlobular septa (five patients). Pathologically, solitary nodular lesions consisted of diffuse lymphoplasmacytic infiltration with fibrosis. Thickened bronchovascular bundles or interlobular septa and GGO on CT images pathologically corresponded to lymphoplasmacytic infiltration and fibrosis in peribronchiolar or interlobular interstitium and alveolar interstitium, respectively. The radiologic findings of honeycombing corresponded to disrupted alveolar structures and dilated peripleural air spaces. IgG4-related lung disease manifested as four major categories of CT features. Pathologically, these features corresponded to IgG4-related sclerosing inflammation along the intrapulmonary connective tissue.

Pulmonary infections after kidney transplantation:analysis of CT findings

Objective To review the CT findings in patients with pulmonary infection after kidney transplantation and to determine the characteristic features in different infections.Methods The medical records were reviewed in 446 patients with pulmonary infection after kidney transplantation and 121 patients who had pulmonary thin-section CT were included in this study.The pattern and distribution of the pulmonary abnormalities were interpreted independently by two thoracic radiologists.Statistical analysis was performed using the X2 test and the Fisher's exact teat.Results (1)Time course:65(14.6/) patients initially had pulmonary infection in the first 30 days,147(32.9/)between 1 and 3 months,91(20.4/)between 3 and 6 months,23(5.2/)between 6 and 12 months,120(26.9/)afler 12 months of transplantation.In the first month after procedure,bacterial infection(4/5,80.0/)was the most common infection,bacterial(34/41,82.9/)、mixed(19/41,46.3/)and virus infections(11/41.26.8/)were seen commonly 1 to 6 months following transplant,the incidence of fungal(14/38,36.8/)and myeobaeterial(5/38,1 3.2/)infections was increased after 1 2 months of transplantation.(2)Pathogens:Baeterial(34,28/)and mixed infections(34,28/)were the most common,followed by fungus infeetion(9.7/),TB(7,6/)and eytomegalovirus(5,4/).(3)CT findings:Ground-galss attenuations(69,57.0/)was the most common findings of pneumonia,followed by reticular or linear opacities(68,56.2/),nodules (66,54.5/),pleural thickening(41,33.9/),consolidations(31,25.6/),tree-in-bud patterns(24,19.8/),pleural effusion(22,18.2/),and bronchovascular bundle thickening(16,13.2/).Ground-glass attenuation was commonly seen in cytomegalovirus pneumonia (4,80.0/),and nodule was commonly observed in bacterial infection(23.67.6/),tree-in-bud pattern was the most common finding in pulmonary tuberculosis (4.P=0.049).There were no statistically significant difierences in the prevalence of other CT paRerns (P＞0.05).Conclusions The peak incidence of pulmonary infection is in the 3 month after renal transplantation and bacterial infection is the most common.The CT diagnosis of infeetion can be made by combining the time course of infection,clinical laboratory data and lesion distribution. Key words: Kidney transplantation; Pulmollia; Tomography,X-ray computed

Pulmonary lymphangitic sarcomatosis and a review of the literature

Intrapulmonary spread of a sarcoma via lymphatics is a rare cause of death in a young adult. A 31-year old man was admitted to our hospital complaining of dyspnea and malaise of 2 months' duration. A chest radiography revealed bilateral hilar enlargement, and reticulonodular infiltrations. Thoracic CT-scans demonstrated mediastinal lymphadenopathy, thickening of interlobular septa, polygonal lines, and thickening of bronchovascular bundles. The diagnosis was made by open-lung biopsy. The patient died within 3 months after diagnosis. Pulmonary lymphangitic sarcomatosis is a rare but important manifestation of an angiosarcoma. Optimal treatment of these patients is not well defined, but a trial of chemotherapy may be warranted.

Disseminated cryptococcal infection with eosinophilia in a healthy person

A 23-year-old man with no recent medical history was hospitalized complaining of high fever and cough. In addition to very marked eosinophilia, chest X-ray revealed extensive bronchovascular bundle thickening. Transbronchial lung biopsy (TBLB) showed moderate eosinophil infiltration. Cryptococcus neoformans infection was diagnosed, based on blood culture, cerebrospinal fluid culture, urine culture, and lung biopsy specimens. The eosinophilia was successfully alleviated by treatment for cryptococcal meningitis. Furthermore, cryptococcal sepsis resolved with amphotericin B and 5-flucytosine treatment. Eosinophilia commonly occurs following chronic Aspergillus infection, but the present case suggests the involvement of Cryptococcus in another mechanism for eosinophilia.

A Long-Term (5-Year) Sustained Efficacy of Tocilizumab for Multicentric Castleman's Disease and the Effect on Pulmonary Complications.

Multicentric Castleman's disease (MCD) is an atypical lymphoproliferative disease, which is closely associated with dysregulated overproduction of interleukin-6 (IL-6). These patients have numerous complications including secondary amyloidosis, paraneoplastic mucocutaneous disease, renal failure, and pulmonary manifestations such as diffuse lymphoid hyperplasia. We previously reported on a 60 weeks study of the humanized anti-human IL-6 receptor monoclonal antibody tocilizumab (TCZ) in patients with MCD and showed that TCZ provides rapid clinical improvement in constitutional symptoms as well as biochemical markers such as c-reactive protein, erythrocyte sedimentation rate, serum amyloid A, hemoglobin, and albumin levels. In this long-term follow-up over 5 years, we investigated the efficacy and safety of TCZ. Patients received TCZ monotherapy at 8 mg/kg intravenously every 2 weeks for 5 years. The dose and dosing interval were allowed to be adjusted according to disease activity. Pulmonary diffuse lymphoid hyperplasia was examined by high resolution computed tomography (HRCT) and evaluated and scored by 2 independent radiologists who were blinded to the time sequence of the images and clinical response of each patient. This study complied with all provisions of the Declaration of Helsinki and was conducted in accordance with Good Clinical Practice guidelines. Thirty-five patients were enrolled in this clinical trial and 30 patients (86%) continued TCZ treatment over the period of 5 years. The reduction in size of enlarged lymph nodes as reported previously was sustained. Clinical improvement in constitutional symptoms as well as the improvement of laboratory markers was maintained. Twenty-two patients had received corticosteroids at baseline (mean corticosteroid dose was 16.5 mg/day prednisolone equivalent), and 11 patients (50%) were able to discontinue corticosteroid therapy without flare. Pulmonary diffuse lymphoid hyperplasia was identified in 31 patients at baseline. Significant improvement was observed in the scores of centrilobular nodules, interlobular septal thickening, bronchovascular bundle thickening and ground glass attenuation with 50 to 60% reductions evaluated by HRCT over the 5 year period. No statistically significant change was observed in scores of cyst and airspace consolidation. TCZ was generally well tolerated during this 5 years treatment. The majority of adverse events (AEs) were mild to moderate in severity. Most frequently reported AEs were mild to moderate infections such as common cold and urinary tract infections (2.3 AEs / patient year). In conclusion, in this 5 years extension study tocilizumab demonstrated an excellent long term efficacy on inflammatory manifestations and pulmonary diffuse lymphoid hyperplasia. Tocilizumab treatment also showed a very good safety profile.

Acute eosinophilic pneumonia: Thin-section CT findings in 29 patients

Purpose To determine thin-section computed tomography (CT) characteristics of acute eosinophilic pneumonia (AEP). Materials and methods Thin-section CT scans of 29 patients (14 males, 15 females; mean age, 26 ± 15 years; age range, 15–72 years) with AEP were included this retrospective study. The clinical diagnosis of AEP was established by Allen's criteria. Each thin-section CT was reviewed by two observers. Results Bilateral areas with ground-glass attenuation were observed on thin-section CT in all patients. Areas of air-space consolidation were present in 16 (55%) of 29 patients. Poorly defined centrilobular nodules were present in 9 patients (31%). Interlobular septal thickening was present in 26 patients (90%). Thickening of bronchovascular bundles was present in 19 patients (66%). Pleural effusions were present in 23 patients (79%) (bilateral = 22, right side = 1, left side = 0). The predominant overall anatomic distribution was central in only 2 (7%) of 29 patients, peripheral in 9 patients (31%), and random in 18 patients (62%). The overall zonal predominance was upper in 4 patients (14%), lower in 8 patients (28%), and random in 17 patients (58%). Conclusion CT findings in AEP patients consisted mainly of bilateral areas of ground-glass attenuation, interlobular septal thickening, thickening of bronchovascular bundles, and the presence of a pleural effusion without cardiomegaly. The most common overall anatomic distribution and zonal predominance of the abnormal CT findings were random.

Idiopathic airway-centered interstitial fibrosis: report of two cases

Idiopathic airway-centered interstitial fibrosis: report of two cases

Comparison between PET and CT Findings for 7 Patients with a Pulmonary Lymphangitic Metastasis

Purpose: This study was conducted to compare the PET and CT findings for patients with a pulmonary lymphangitic metastasis. Materials and Methods: We retrospectively reviewed the PET and CT findings of seven patients diagnosed with a pulmonary lymphangitic metastasis between May 2005 and May 2007. Results: All patients had interstitial thickening, as seen on a CT scan, while the PET scans showed abnormal findings in only three patients. In these three patients, one patient had interlobular septal thickening of more than 10, another patient had interlobular septal thickening of more than 5 but less than 10, and another patient had interlobular septal thickening of less than 5. All of the patients had bronchovascular bundle thickening. However, among the four patients that had normal FDG uptake, no patient had interlobular septal thickening of more than 10, two of the patients had interlobular septal thickening of more than 5 but less than 10, and the remaining patients had interlobular septal thickening of less than 5. Only two of the patients had bronchovascular bundle thickening. Conclusion: All patients with pulmonary lymphangitic metastasis have typical CT findings, but some of the patients had FDG uptake, as seen in the PET scans. Thus, CT is a more useful modality for diagnosis for pulmonary lymphangitic metastases.

Clinical and Radiographic Indices Associated With Airflow Limitation in Patients With Sarcoidosis

Airflow limitation is found in some patients with sarcoidosis, and it is associated with a poor prognosis. The aim of this study was to investigate clinical and radiographic indices associated with airflow limitation in patients with sarcoidosis. A prospective, observational study was performed on 228 consecutive sarcoidosis patients followed up at our patient clinic at the Central Clinic of Kyoto. Patients underwent pulmonary function tests, and high-resolution CT (HRCT) of the lung was evaluated for the presence of lymph node enlargement, lung opacity, reticular shadow, and thickening of bronchovascular bundles (BVB). Airflow limitation was defined as FEV(1)/FVC < 70%. Airway reversibility was tested in subjects with airflow limitation. The frequency of airflow limitation was evaluated, and clinical and radiographic parameters were compared between patients with and without airflow limitation. Among all 228 subjects, 20 subjects (8.8%) had airflow limitation, and none showed airway reversibility. Patients with airflow limitation were predominantly male, smokers, and had advanced chest radiographic stage, increased frequency of lung opacities, reticular shadows, and thickened BVB on HRCT. Stepwise regression analysis showed that chest radiographic stage IV, higher age, smoking, and thickened BVB were independently associated with lower FEV(1)/FVC. The frequency of airflow limitation was 8.8% in Japanese sarcoidosis patients. Chest radiographic stage IV, higher age, smoking, and thickened BVB were associated with airflow limitation in patients with sarcoidosis.

Pulmonary Lymphangitic Carcinomatosis (PLC): Spectrum of FDG-PET Findings

The lungs are among the most common sites for metastases from a multitude of cancers. The majority of pulmonary metastases appear nodular on radiologic images. Interstitial spread of tumor through pulmonary lymphatics, also known as pulmonary lymphangitic carcinomatosis (PLC), is not uncommon and constitutes approximately 7% of pulmonary metastases. PLC is most often seen with adenocarcinoma of a variety of histologies such as thyroid carcinoma, and melanoma. It is usually noted in late stages of malignancy and therefore is indicative of a poor prognosis. Diagnosis of PLC is usually based on a combination of clinical and radiologic findings. However, the diagnosis is difficult when patients have limited clinical findings or have a history of or the possibility of other interstitial lung diseases. High-resolution computed tomography (HRCT) has been the modality of choice in the radiologic diagnosis of PLC. Imaging features of PLC on HRCT include thickening of interlobular septa, fissures, and bronchovascular bundles. Distribution of PLC may be focal or diffuse, unilateral or bilateral, and symmetric or asymmetric. Although FDG-PET has been extensively used in primary or secondary lung malignancies, its role and appearance in PLC have not been well determined in the literature. In this communication, we describe a spectrum of FDG-PET and CT findings in 5 cases with PLC. Similar to CT, the distribution of PLC can be extensive or limited on the FDG-PET. Diffuse, lobar, or segmental FDG uptake in the lungs is seen in extensive PLC. In limited PLC, a linear or a hazy area of FDG uptake extending from the tumor can be seen. Recognition of various patterns related to PLC on FDG-PET may allow accurate diagnosis of disease and could potentially influence the management of these patients.

Incidence of Pulmonary Hypertension and Its Clinical Relevance in Patients With Sarcoidosis

To investigate the frequency of pulmonary hypertension (PH) and clinical parameters associated with PH in sarcoidosis patients. A prospective, observational study was performed on 246 consecutive Japanese sarcoidosis patients followed up at the outpatient sarcoidosis clinic in the Central Clinic of Kyoto. The patients were evaluated for PH by Doppler echocardiography. Among these patients, 192 underwent pulmonary function tests. In addition, high-resolution CT of the lung was evaluated for the presence of lymph node enlargement, lung opacity, and thickening of bronchovascular bundles in 122 patients. PH was defined as estimated systolic pulmonary artery pressure (sPAP) > or = 40 mm Hg. The frequency of PH was evaluated, and clinical parameters were compared between patients with PH and those without PH. Among 212 patients who were successfully evaluated for sPAP, 12 patients (5.7%) had PH. Patients with PH had the following clinical characteristics: advanced chest radiographic stage, decreased oxygen saturation, predominantly male gender, and decreased percentage of predicted vital capacity, percentage of predicted FVC, percentage of predicted FEV1, percentage of predicted functional residual capacity, and percentage of predicted total lung capacity (%TLC). Multivariate logistic regression analysis showed that decreased %TLC was independently associated with PH. There was a weak negative correlation between sPAP and %TLC (p < 0.05). The frequency of PH in Japanese sarcoidosis patients was 5.7% evaluated with Doppler echocardiography. Decreased lung volume increases the risk of PH developing in patients with sarcoidosis.

Do Hemodynamic Studies of Stage T1 Lung Cancer Enable the Prediction of Hilar or Mediastinal Nodal Metastasis?

We aimed to identify CT enhancement characteristics that predict hilar or mediastinal nodal metastasis in patients with stage T1 lung cancer. Eighty-four patients (50 men and 34 women; age range, 39-80 years; mean age, 61 years) with stage T1 lung cancer underwent a hemodynamic and a conventional morphologic CT study before curative surgical resection. Peak enhancement (maximum attenuation over the entire time course), net enhancement (peak enhancement minus preenhancement attenuation), maximum enhancement ratio (MER), time to peak enhancement, slope of enhancement on dynamic studies, nodule size, presence of tumor necrosis or thickening of bronchovascular bundles, and marginal characteristics on morphologic studies were analyzed and correlated with the presence of histologically determined mediastinal or hilar nodal metastasis. Mediastinal or hilar nodal metastases were found at surgery in 26 (31%) of 84 patients: mediastinal nodes in 13 (15%) and hilar nodes in 19 (23%). Six (7%) had both mediastinal and hilar nodal metastasis. Peak enhancement, net enhancement, and MER were significantly associated (p = 0.001, 0.002, and 0.008, respectively) with the presence of mediastinal or hilar nodal metastasis. A peak attenuation of 110 H or greater and a net enhancement of 60 H or greater predicted nodal metastasis with accuracies of 73% (61/84 nodules) and 73% (61/84 nodules) and odd ratios of 4.98 and 5.94, respectively. Stage T1 lung cancers showing peak enhancement of 110 H or greater or net enhancement of 60 H or greater on dynamic CT indicate a high likelihood of hilar or mediastinal nodal metastasis.

Chlamydia Pneumoniae: Comparison with Findings ofMycoplasmaPneumoniaeandStreptococcusPneumoniaeat Thin-Section CT

To retrospectively compare thin-section computed tomographic (CT) findings of Chlamydia pneumoniae pneumonia with those of Streptococcus pneumoniae pneumonia and Mycoplasma pneumoniae pneumonia. Institutional review board and patient informed consent were not required. Twenty-four patients with C pneumoniae pneumonia (17 men, seven women; age range, 19-89 years) underwent thin-section CT; 41 patients with S pneumoniae pneumonia (28 men, 13 women; age range, 19-91 years) and 30 patients with M pneumoniae pneumonia (20 men, 10 women; age range, 16-67 years) were also enrolled. Thin-section CT scans of each patient were retrospectively and independently assessed by two chest radiologists for consolidation, ground-glass opacity (GGO), bronchovascular bundle thickening, nodules, pleural effusion, lymphadenopathy, reticular or linear opacity, airway dilatation, pulmonary emphysema, and bilateral lung involvement. Consensus was reached for disagreements. The frequency of each finding was compared among the three types of pneumonia by using the chi2 test. For C pneumoniae pneumonia, CT demonstrated consolidation in 20 patients, GGO in 13, bronchovascular bundle thickening in 17, nodules in 18, pleural effusion in six, lymphadenopathy in eight, reticular or linear opacity in 15, airway dilatation in nine, pulmonary emphysema in 11, and bilateral lung involvement in 12. Bronchovascular bundle thickening (P = .022) and airway dilatation (P = .034) were significantly more frequent in patients with C pneumoniae pneumonia than in those with S pneumoniae pneumonia. Reticular or linear opacity (P = .017), airway dilatation (P = .016), and associated pulmonary emphysema (P = .003) were significantly more frequent in patients with C pneumoniae pneumonia than in those with M pneumoniae pneumonia. C pneumoniae pneumonia demonstrates a wide spectrum of thin-section CT findings that are similar to those of S pneumoniae pneumonia and M pneumoniae pneumonia; airway dilatation and bronchovascular thickening were significantly more frequent in patients with C pneumoniae pneumonia.

Pulmonary involvement in microscopic polyangiitis

Microscopic polyangiitis is a systemic necrotizing vasculitis that affects small vessels, resulting in a wide spectrum of organ involvement including the kidneys and the lungs. This paper reviews recent insights and observations into the pathogenesis, clinical manifestations, and treatment of pulmonary involvement in microscopic polyangiitis. The spectrum of clinical presentations ranges from antecedent interstitial fibrosis to frank hemoptysis secondary to capillaritis. Computerized tomography imaging reveals a variety of pulmonary findings, including ground-glass attenuation, consolidation, thickening of bronchovascular bundles, and honeycombing. Antineutrophil cytoplasmic antibodies are important in diagnosis as well as in the pathogenesis and prognosis of microscopic polyangiitis. There is more evidence to support the various therapeutic modalities currently used in pulmonary manifestations of microscopic polyangiitis, including induction therapy with cyclophosphamide, the use of other novel pharmacologic agents such as the tumor necrosis factor-alpha blockers and rituximab, and nonpharmacologic modalities such as plasmapheresis and ventilatory management. The pulmonary manifestations of microscopic polyangiitis are diverse and often difficult to manage; however, as our understanding and experience grows so does our ability to successfully diagnose and treat these patients.

Pulmonary Alveolar Microlithiasis: CT and pathologic findings in 10 patients

To evaluate CT findings of pulmonary alveolar microlithiasis and correlate the CT with the pathologic findings. The study included 10 patients with pathologically proven microlithiasis. Two independent observers evaluated the presence, extent and distribution of the CT findings. CT findings were compared with those at autopsy in two patients and with transbronchial biopsy in eight patients. All patients had a myriad of calcified nodules measuring approximately 1 mm in diameter. Close apposition of the nodules resulted in areas of ground-glass attenuation and consolidation, which were the predominant abnormality on CT in all 10 patients, involving 41% +/- 16.3 (mean +/- SD) and 30% +/- 4.8 of the lung parenchyma, respectively. Calcifications were also seen along interlobular septa, bronchovascular bundles and pleura. Other findings included interlobular septal thickening, thickening of bronchovascular bundles, nodules, and subpleural cysts. There was a solid agreement between the observers for the presence (kappa value; 0.77) and extent (Spearman rank correlation; r = 0.81 to 1.0 p < 0.01) of abnormalities. Autopsy specimens demonstrated microliths in alveolar airspaces and along interlobular septa, bronchovascular bundles and pleura. Subpleural small cysts were shown to represent dilated alveolar ducts. Pulmonary microlithiasis is characterised by the presence of numerous small, calcified nodules, calcifications along interlobular septa, bronchovascular bundles and pleura, ground-glass opacities, consolidation, and subpleural cysts. The cysts represent dilated alveolar ducts.

A study on the pericancerous tissue and vascular changes in non-small cell lung cancer with high-resolution CT

To investigate the CT changes of pericancerous tissues with high-resolution CT (HRCT) and to explore the specific signs of CT in non-small cell lung cancer. Thirty-one patients with non-small cell lung cancer and 12 patients with benign pulmonary nodules were analysed. An attention was paid on bronchovascular bundles, vessels and interlobular septa. HRCT films were read independently by two radiologists and results were statistically Chi-square tested. In the cancer group, 20 cases (64.5%) had thickening of bronchovascular bundles, 15 cases (48.4%) angiectasis of superior lobular arteries, 13 cases (41.9%) angiectasis of superior lobular veins, 16 cases (51.6%) thickening of interlobular septa, and 5 cases (16.1%) ground-glass opacity. In benign pulmonary lesion group, the values were 2 (16.7%) , 1 (8.3%), 2 (16.7%), 6 (50.0%) and 5 (41.7%) cases respectively. Significant differences were found between the two groups in the thickening of bronchovascular bundles and the angiectasis of superior lobular arteries. Thickening of bronchovascular bundles and angiectasis of superior lobular arteries are the specific signs of non-small cell lung cancer.