Cavitary Pulmonary Nodules Research Articles

Multiple cavitary pulmonary nodules in association with pyoderma gangrenosum: case report

Pyoderma gangrenosum is a rare neutrophilic disease of unknown origin that is associated with systemic diseases in 50% of cases. It is characterized by erythematous-violaceous nodular lesions that quickly progress to painful ulcers, with undermined edges, necrotic-hemorrhagic, varying in size and depth, located mainly in the lower limbs. Extracutaneous locations of pyoderma gangrenosum are rare, usually involving the lungs; the main differential diagnosis in these cases is Wegener granulomatosis. We report a case of pyoderma gangrenosum, which showed multiple cavitary lung nodules, with good response to high doses of steroids. Once excluded the possibility of Wegener granulomatosis, the authors concluded that it was the manifestation of systemic pyoderma gangrenosum with pulmonary involvement.

Hodgkin Lymphoma Presenting as Multiple Cavitary Pulmonary Nodules With Associated Mediastinal Adenopathy and Neck Mass

Hodgkin lymphoma involving the lung may present in a variety of radiographic and clinical patterns including solid or necrotizing lesions, with or without associated mediastinal adenopathy. Cavitary pulmonary lesions are exceedingly rare, occurring in less than 1% of cases, and are typically solitary. We report a case of an 18-year-old male presenting with multiple cavitating pulmonary nodules and a palpable mass in the neck. Imaging revealed associated mediastinal and cervical adenopathy. Biopsy of the neck mass and lung nodule initially revealed necrosis and granulomata, suggesting infection. Treatment for a presumed infectious etiology was without resolution. Subsequent open lung biopsy revealed marked granulomatous inflammation with diagnostic Reed-Sternberg cells. Hodgkin lymphoma should always be considered in the differential diagnosis of cavitary pulmonary lesions, especially those refractory to treatment.

An Unusual Presentation of Spontaneous Pneumothorax Secondary to Talc-Induced Pulmonary Granulomatosis

Talc-induced pulmonary granulomatosis is an unusual condition resulting from the intravenous administration of medications intended for oral use. A patient with this condition who presented with a spontaneous tension pneumothorax is reported. Although the radiographic findings of a diffuse reticulonodular pattern are typical, this patient was found to have diffuse, small cavitary pulmonary nodules. Surgeons should be aware of this rare condition and should have a low threshold for performing a thoracoscopic lung biopsy.

Pyoderma Gangrenosum Presenting with Pulmonary Cavitary Lesions

Neutrophilic dermatoses like pyoderma gangrenosum (PG) are characterized by sterile, neutrophilic, cutaneous infiltrates. Extracutenous neutrophilic infiltrations may also be seen, but pulmonary involvement is very rare and usually characterized by patchy infiltrates or interstitial pneumonitis. In this case, a PG case who had cutenous lesions and large cavitary lung nodules, is reported. He was a 49 years old male patient whose thorax computed tomography revealed multiple pulmonary nodules with central necrosis. In his transbronchial and bronchial biopsies, nonspecific inflammatory aseptic nodules were detected corresponded to the pathologic findings of skin lesion biopsies. A dramatic response was occured after applying corticosteroid and immunesupressive treatment. In conclusion, cavitary pulmonary nodules of our case were thought to be due to pulmonary involvement of PG.

Accelerated Pulmonary Nodulosis and Sterile Pleural Effusion in a Patient With Psoriatic Arthropathy During Methotrexate Therapy

Pulmonary nodulosis and sterile pleural exudates are well-known extra-articular manifestations in rheumatoid arthritis patients with a positive rheumatoid factor. In some patients, treatment with methotrexate has been postulated as the trigger of these complications. We report a patient with psoriatic arthropathy, negative RF, negative anticyclic citrulinated peptide antibodies but positive antibodies to cardiolipin who developed massive sterile pleural empyema and multiple cavitary pulmonary nodules during methotrexate treatment. We suggest that awareness of methotrexate-induced lung and pleural complications should be extended to other than rheumatoid arthritis diseases, not necessarily accompanied by rheumatoid factor or anticyclic citrulinated peptide antibodies.

Massive cavitary pulmonary rheumatoid nodules in a patient with HIV

The case of a 52-yr-old female with rheumatoid arthritis and HIV who developed massive, progressive, cavitary pulmonary nodules is described. Multiple diagnostic bronchoscopies and lung biopsies failed to demonstrate the presence of any microorganisms. Pathological analysis showed palisading histiocytes with necrobiosis consistent with rheumatoid nodules. The effect of co-existing HIV infection on the course and prognosis of rheumatoid arthritis is discussed, and it is concluded that the complex relationship between these two disease processes warrants further investigation.

Lemierre Syndrome: An All-But-Forgotten Disease

DOI:10.2214/AJR.06.0096 WEB—This is a Web exclusive article. Lemierre Syndrome: An All-But-Forgotten Disease An otherwise healthy 21-year-old man presented to the emergency department with a 1week history of progressively worsening fever, chills, sore throat, nausea, vomiting, and cough. He was toxic-appearing, tachycardic, tachypneic, and hypotensive on arrival. Physical examination findings were significant for erythematous, swollen tonsils without exudate and diffuse bilateral crackles on lung auscultation. Laboratory values revealed an elevated WBC with a left shift and findings compatible with acute kidney failure. A portable chest radiograph showed diffuse parenchymal opacities and bilateral pleural effusions. The patient was admitted to the ICU with the diagnosis of sepsis and was given broad-spectrum antibiotics pending culture results. Despite intensive monitoring and broadspectrum antibiotic therapy, the patient continued to decompensate, requiring endotracheal intubation. Contrast-enhanced CT of the neck and chest was performed, revealing right internal jugular vein thrombosis (Fig. 3A), multiple cavitary pulmonary nodules, and bilateral pleural effusions (Fig. 3B). Thoracentesis confirmed the suspicion of bilateral exudative effusions. On the basis of the clinical history of a recent oropharyngeal infection and the presence of internal jugular vein thrombosis with multiple pulmonary septic emboli, the diagnosis of Lemierre syndrome was suspected and later confirmed with blood cultures positive for Fusobacterium necrophorum. After prolonged treatment with tailored antibiotic therapy and percutaneous drainage of the bilateral exudative effusions, the patient achieved a remarkably full recovery with restoration of baseline renal and pulmonary functions. Lemierre syndrome is a rare clinical entity, with fewer than 160 cases reported since it was first described in the early 1900s [1]. This syndrome consists of internal jugular vein thrombosis after a primary oropharyngeal infection with the development of distant septic emboli [2]. The lungs are most often affected; however, almost any organ may be involved. Classically, Lemierre syndrome occurs in otherwise healthy adolescents and young adults. Appropriate diagnosis is often delayed because of the initial indolent course of the infection and the relative obscurity of the disease. The diagnosis is made with positive blood cultures, usually F. necrophorum, and appropriate imaging findings. Often, imaging findings precede blood culture results; therefore, radiologists play a crucial role in the early recognition of this syndrome [3]. Prompt diagnosis and treatment are necessary to prevent sepsis and subsequent death. O’Brien WT Sr, Kattin GE Jr, Thompson AK William T. O’Brien, Sr. Grant E. Lattin, Jr. Adrianne K. Thompson David Grant U.S. Air Force Medical Center Travis AFB, CA 94535 Note—The views expressed in this material are those of the authors and do not reflect the official policy or position of the U.S. government, the Department of Defense, or the Department of the Air Force.

Pneumocystis carinii pneumonia in an aids patient unusual manifestation as multiple cavitary and noncavitary peripheral pulmonary nodules and spontaneous pneumothorax

Pneumocystis carinii pneumonia in a 52-year-old homosexual AIDS patient is described because of its unusual manifestations of multiple cavitary and noncavitary peripheral pulmonary nodules and spontaneous pneumothorax. Such manifestations might become more common in the future because of the improvement of diagnostic techniques and therapeutic measures.

Cavitary Pulmonary Nodules in Atypical Collagen Disease and Lupoid Drug Reaction

The case histories of two patients with cavitary pulmonary nodules and the findings at chest radiography are reviewed. The first patient had a connective tissue disease with features common to systematic lupus erythematosus and Wegener's granulomatosis. In the second patient the lung changes developed as part of a drug reaction to carbamezapine and/or phenytoin. The common denominator of the cavitating nodules is probably the presence of granulomas, developing as a sequela of pulmonary vasculitis.

Cavitary Pulmonary Nodules in Atypical Collagen Disease and Lupoid Drug Reaction

Cavitary Pulmonary Nodules in Atypical Collagen Disease and Lupoid Drug Reaction

Cavitary pulmonary nodules with systemic lupus erythematosus: differential diagnosis.

Cavitary pulmonary nodules rarely occur in patients with systemic lupus erythematosus and the lupuslike syndrome associated with mixed connective tissue disease. Although it has been suggested that such cavitary nodules represent areas of vasculitis and ischemic necrosis, five of seven occurrences of cavitary nodules in a series of six patients with systemic lupus erythematosus or mixed connective tissue disease proved to be the result of infection or pulmonary embolism. The causes in the other two cases are unknown, but no attempt was made to obtain a biopsy in either instance. It was concluded that vasculitis with ischemic necrosis is not a common cause of cavitary pulmonary nodules in patients with lupus.