High-resolution Computed Tomography Findings Research Articles

Aspergillus precipitating antibody in patients with Mycobacterium avium complex lung disease: A cross-sectional study.

Little is known about the role of Aspergillus precipitating antibody (APAb) in patients with Mycobacterium avium complex lung disease (MAC-LD). We investigated the clinical characteristics of patients with MAC-LD positive for APAb. We conducted a cross-sectional study targeting patients with MAC-LD. APAb was checked in all participants. Clinical variables included laboratory data, pulmonary function, high-resolution computed tomography findings, and health-related quality of life. We analyzed 109 consecutive patients. Their median age was 68 years, and the median duration of MAC-LD was 4.8 years. Twenty (18.3%) patients tested positive for APAb. APAb-positive patients had significantly longer duration of MAC-LD (9.4 vs. 4.0 years, P = 0.017), more severe bronchiectasis evaluated by modified Reiff score (6.5 vs. 4, P = 0.0049), and lower forced expiratory volume in 1 s (%FEV1) (75.1% vs. 86.2%, P = 0.013) than APAb-negative patients. Analysis of covariance adjusted for background factors and underlying pulmonary disease revealed that %FEV1 was also significantly lower in patients with APAb (P = 0.045). Ten patients were newly diagnosed with chronic pulmonary aspergillosis (N = 5) or allergic bronchopulmonary aspergillosis (N = 5). APAb is associated with lower pulmonary function, and observed especially in patients with longer duration of MAC-LD and severe bronchiectasis, even in the absence of cavitary lesions.

Characteristics of COPD phenotypes classified according to the findings of HRCT and spirometric indices and its correlation to clinical characteristics.

In recent years, there has been increasing interest in diagnosing various components of chronic obstructive pulmonary disease (COPD) using high-resolution computed tomography (HRCT). The present study was undertaken to evaluate HRCT features in patients with COPD. Fifty patients of COPD (confirmed on Spirometry as per the GOLD guidelines 2014 guidelines) were enrolled, out of which 35 patients got a HRCT done. The Philips computer program for lung densitometry was used with these limits (-800/-1, 024 Hounsfield unit [HU]) to calculate densities, after validating densitometry values with phantoms. We established the area with a free hand drawing of the region of interest, then we established limits (in HUs) and the computer program calculated the attenuation as mean lung density (MLD) of the lower and upper lobes. There was a significant correlation between smoking index and anteroposterior tracheal diameter (P = 0.036). Tracheal index was found to be decreasing with increasing disease severity which was statistically significant (P = 0.037). A mild linear correlation of pre-forced expiratory volume in the first second (FEV1) was observed with lower lobe and total average MLD while a mild linear correlation of post-FEV1 was observed with both coronal (P = 0.042) and sagittal (P = 0.001) lower lobes MLD. In addition, there was a linear correlation between both pre (P = 0.050) and post (P = 0.024) FEV1/forced vital capacity with sagittal lower lobe MLD. HRCT may be an important additional tool in the holistic evaluation of COPD.

An evaluation of preoperative high resolution computed tomography of temporal bone in cholesteatoma

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Cholesteatoma is relatively common and potentially dangerous disease of the ear. It is characterised by local destruction and osseous erosion leading to complications. High resolution computed tomography (HRCT) is the imaging modality of choice for evaluation of middle ear structures and pathology. The aim of this study is to evaluate role of preoperative HRCT in the diagnosis of the disease, its extension and complications and plan for surgery.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This prospective study was conducted at a tertiary referral teaching hospital and 40 cases of cholesteatoma were selected and their pre-operative HRCT temporal bone findings and intraoperative findings were correlated. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">This study showed good correlation between preoperative HRCT findings of cholesteatoma, and intraoperative findings. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">We conclude therefore the preoperative HRCT temporal bone is useful guide for the surgeon for the diagnosis and management of cholesteatoma.</span></p>

Is HRCT Temporal Bone Necessary in All Cases of Active Squamous Chronic Otitis Media?

To assess the usefulness of high resolution computed tomography (HRCT) temporal bones in cases of active squamous chronic otitis media (COM). Comparison of HRCT findings with operative findings. A prospective study of 104 clinically diagnosed patients with COM were included. Each patient was subjected to full clinical evaluation and HRCT temporal bone was done. Preoperative HRCT finding were correlated with surgical findings. The sensitivity of HRCT temporal bone in detecting cholesteatoma was 91.81%. However it could not differentiate cholesteatoma from other soft tissue density like granulation or hypertrophic mucosa or discharge, but soft tissue attenuation content with bone erosion was considered as hallmark of cholesteatoma. The sensitivity and specificity of HRCT for detecting malleus, incus and stapes erosion was 71.5 and 88.5%, 86.3 and 95% and 53.1 and 64.7% respectively. The sensitivity and specificity for detecting erosion of lateral semicircular canal (LSCC) was 77.78 and 98.2%. The sensitivity and specificity for facial canal was 80 and 100%. HRCT gives excellent details about the extent of cholesteatoma with reasonable accuracy in expert hands. It helps to warn the surgeon about anatomical variations preoperatively and detects complications if any. It effectively depicts integrity or erosion of dural plate, sinus plate, LSCC, facial nerve. Malleus and incus are seen reasonably well but status of stapes are not recorded effectively.

Pulmonary sarcoidosis with and without extrapulmonary involvement: a cross-sectional and observational study in China

ObjectivesSarcoidosis is a multisystem disease characterised by the formation of granulomas within various organs, mainly the lungs. Several studies from different countries have been undertaken to investigate sarcoidosis with extrapulmonary...

High-resolution computerized tomography changes in diffuse parenchymal lung disease from chronic hypersensitivity pneumonitis related to bird antigen.

Background:Chronic hypersensitivity pneumonitis (HP) is the most common cause of diffuse parenchymal lung disease (DPLD) in India. There is no data regarding the avian antigen exposure-associated DPLD from the country.Methods:Chronic HP from exposure to avian antigen was diagnosed when the high resolution computerized tomography (HRCT) showed features for HP and was supported by the history of exposure to pigeons, the presence of precipitin antibodies (IgG) to avian antigen in high titre with negative rheumatoid factor, antinuclear antibody, and no clinical clue for a collagen vascular disease. The HRCT changes were noted on Likert scale (0–5) in terms of affection of peripheral and/or axial involvement, reticulation, honeycombing, haze, mosaic, traction bronchiectasis, pleural reactions, features of pulmonary hypertension, and air cysts. Cardiomegaly and independent cardiac chamber enlargement were also recorded.Results:The lower lobes were predominantly (65.6%) affected with similar frequency (78.1) of peripheral and axial parenchymal affection. The parenchymal changes in HRCT were haze or ground-glass opacity (100%), mosaic appearance (93.75%), reticulations (68.75%), traction bronchiectasis (34.3%), air cysts (21.8%), and honeycombing (9.37%). Pleural reactions, though not described so far, were found in 50% of cases. Features of pulmonary hypertension (87.5%), cardiomegaly (50%), left and right atrial enlargement (81.2% and 78.1%), and right ventricular enlargement (31.2%) were the common echocardiography findings.Conclusion:Chronic HP from avian exposure shows predominantly lower lobe involvement with haze, reticulation, features of pulmonary hypertension, and pleural reactions as common HRCT findings. The likelihood of pulmonary hypertension appears high and although honeycombing is often present, the classical UIP pattern has not been found.

Chest High-resolution Computed Tomography Findings in 601 Patients with Inflammatory Bowel Diseases

Pulmonary involvement in inflammatory bowel disease may reflect the common embryonic origin of the gastrointestinal tract and the bronchial tree. No studies have compared pulmonary high-resolution computed tomography (HRCT) findings between ulcerative colitis (UC) and Crohn disease (CD). This study aimed to assess the relationship between pulmonary HRCT findings and inflammatory bowel disease activity and to compare HRCT findings between UC and CD. We retrospectively identified 601 consecutive patients (350 with UC and 251 with CD) who had undergone chest HRCT examinations at our institutions between April 2004 and April 2016. Parenchymal abnormalities, enlarged lymph nodes, and pleural effusion were evaluated on HRCT. One hundred sixty-seven patients (94 men, 73 women; aged 12-86 years, mean: 47.2 years) with UC and 93 patients (61 men, 32 women; aged 12-71 years, mean: 37.9 years) with CD had abnormal findings on chest HRCT. The HRCT findings of UC and CD mainly consisted of centrilobular nodules (in 49.1% and 45.2% of cases, respectively) and bronchial wall thickening (in 31.7% and 54.8%, respectively). There was no relationship between HRCT findings and disease activity. Bronchial wall thickening was significantly more frequent in patients with CD than in those with UC (P < .001). The main chest HRCT findings in UC and CD are centrilobular nodules and bronchial wall thickening. There are differences in HRCT findings between UC and CD.

Several high-resolution computed tomography findings associate with survival and clinical features in rheumatoid arthritis-associated interstitial lung disease.

To compare the presence and extent of several high-resolution computed tomography (HRCT) observations in different subtypes of rheumatoid arthritis-related interstitial lung disease (RA-ILD) and to examine associations between radiological findings, hospitalization, age, RA duration, pulmonary function tests (PFT) and survival. HRCTs from 60 RA-ILD patients were independently evaluated and re-categorized into usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), organizing pneumonia (OP), diffuse alveolar damage (DAD) and unclassified subtypes by two radiologists. The presence and extent, which was reported using a semi-quantitative scoring system, of e.g. reticulation, ground-glass opacity, honeycombing, emphysema, traction bronchiectasis and architectural distortion were further evaluated and compared between the subtypes. Associations between radiological findings and survival were identified with the Kaplan-Meier method and Cox's univariate model. The correlations between radiological findings, hospitalization, age, pack years, RA duration and PFT were calculated using Spearman's correlation coefficient. The extents of reticulation (HR 1.144, p=0.041), traction bronchiectasis (HR 1.184, p=0.030), architectural distortion (HR 1.094, p=0.044) and the presence of pleural fluid (HR 14.969, p<0.001) were associated with decreased survival. A negative correlation was observed between ground-glass opacity (GGO) and the duration of RA (r=-0.308, p=0.023). The extents of honeycombing (r=0.266, p=0.046), traction bronchiectasis (r=0.333, p=0.012) and architectural distortion (r=0.353, p=0.007) correlated with hospitalizations due to respiratory reasons. Many radiological findings associate with the course of the disease of RA-ILD and could potentially be useful when planning the RA treatment or evaluating the risk of death in these patients.

Red blood cell distribution width as a related factor of pulmonary arterial hypertension in patients with systemic sclerosis.

The aim of this study was to investigate the utility of red blood cell distribution width (RDW) as a simple and readily available marker of occurrence of pulmonary arterial hypertension (PAH) in patients with systemic sclerosis (SSc). One hundred and forty-five consecutive patients with SSc were recruited to the single-center cross-sectional study. Demographic characteristics, hematological parameters, Modified Rodnan Skin Score, and World Health Organization functional classification were determined. Diagnosis of PAH was based on screening by echocardiography and was confirmed by right heart catheterization. Interstitial lung disease (ILD) was diagnosed based on chest high-resolution computed tomography findings. There were no significant differences in gender, age, or disease duration between limited and diffused SSc groups. PAH was detected in 28 of lcSSc (33.3%) and 14 of dcSSc (23.0%) subjects. Patients with higher RDW values were more likely to be men with high anti-u1RNP titers and PAH. A significant correlation was found between RDW and high-sensitivity C-reactive protein (p = 0.375, p < 0.01) and the diffusing capacity of the lungs for carbon monoxide (ρ = - 0.396, p < 0.01). The SSc-PAH group had significantly higher RDW values compared to the SSc group without pulmonary disease (15.7 ± 2.2 and 13.7 ± 1.0, p < 0.001). The mean RDW in the SSc-PAH-ILD group was significantly higher than that in the SSc-ILD group (16.3 ± 2.2% and 14.0 ± 1.5%, p < 0.001). Besides the recognized risk factors, high RDW was an independent predictor of PAH in patients with SSc (OR = 3.314 [95%CI 1.038-10.580], p < 0.05). RDW may be a related factor for identifying the pulmonary arterial hypertension in SSc patients.

Results of repeated video-assisted thoracic surgery for recurrent pneumothorax after primary spontaneous pneumothorax.

This study aimed to identify the causes of recurrent pneumothorax and to evaluate the results of repeated video-assisted thoracic surgery (VATS) for recurrent pneumothorax after VATS wedge resection for primary spontaneous pneumothorax (PSP). A retrospective review was conducted on 188 patients with recurrent PSP, of a population of 1414 patients who underwent VATS wedge resection for PSP. Reoperations were performed when an air leak persisted longer than 3 days after closed thoracostomy, when a visible bulla of greater than 1 cm on high-resolution computed tomography (HRCT) was observed and when rerecurrence took place after other treatments. The HRCT findings before and after recurrence were compared to evaluate the type of the new bulla. Patients were divided into 2 groups according to the additional procedure performed during the first operation; in Group I, a coverage procedure was performed, and in Group II, mechanical pleurodesis was performed after VATS wedge resection. During a median follow-up period of 27.7 months, 76 patients underwent repeated VATS for ipsilateral recurrent PSP after VATS. The indications for repeated VATS were the presence of a bulla on HRCT in 41 patients and a persistent air leak in 35 patients. Group I comprised 36 patients and Group II comprised 40 patients. The HRCT findings showed no bulla in 3 (4%) patients, were suspicious for a bulla in 11 (15%) patients, showed a bulla at the staple line in 26 (34%) patients and showed a new bulla in a location other than on the staple line in 36 (47%) patients. The frequency of new bullae was not different between the 2 groups, but Group I showed a lesser tendency for bullae to occur at the staple line than Group II. Dense fibrosis around the staple line was also found intraoperatively. Repeated VATS was a feasible method to treat recurrent PSP after VATS for PSP.

Lymphangioleiomyomatosis Diagnosis and Management: High-Resolution Chest Computed Tomography, Transbronchial Lung Biopsy, and Pleural Disease Management. An Official American Thoracic Society/Japanese Respiratory Society Clinical Practice Guideline.

Recommendations regarding key aspects related to the diagnosis and pharmacological treatment of lymphangioleiomyomatosis (LAM) were recently published. We now provide additional recommendations regarding four specific questions related to the diagnosis of LAM and management of pneumothoraces in patients with LAM. Systematic reviews were performed and then discussed by a multidisciplinary panel. For each intervention, the panel considered its confidence in the estimated effects, the balance of desirable (i.e., benefits) and undesirable (i.e., harms and burdens) consequences, patient values and preferences, cost, and feasibility. Evidence-based recommendations were then formulated, written, and graded using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. For women who have cystic changes on high-resolution computed tomography of the chest characteristic of LAM, but who have no additional confirmatory features of LAM (i.e., clinical, radiologic, or serologic), the guideline panel made conditional recommendations against making a clinical diagnosis of LAM on the basis of the high-resolution computed tomography findings alone and for considering transbronchial lung biopsy as a diagnostic tool. The guideline panel also made conditional recommendations for offering pleurodesis after an initial pneumothorax rather than postponing the procedure until the first recurrence and against pleurodesis being used as a reason to exclude patients from lung transplantation. Evidence-based recommendations for the diagnosis and treatment of patients with LAM are provided. Frequent reassessment and updating will be needed.

High-resolution computed tomography findings in chronic eosinophilic vs. cryptogenic organising pneumonia.

The similar clinical and computed tomography (CT) characteristics of cryptogenic organising pneumonia (COP) and chronic eosinophilic pneumonia (CEP) make precise diagnosis challenging. To help differentiate between COP and CEP using high-resolution CT (HRCT). Clinical data and HRCT images of COP and CEP patients referred to Masih Daneshvari Hospital, Tehran, Iran, from 2007 to 2015 were reviewed. Diagnosis of COP or CEP was confirmed using open lung biopsy or a combination of transbronchial biopsy, bronchoalveolar lavage fluid (BALF) analysis, peripheral eosinophilia and a favourable response to corticosteroids. Ground-glass opacity, a dominant ground-glass pattern, upper-lobe pneumonia, increased thickness of bronchial walls and a mosaic pattern in the lungs were more frequent in CEP. Lower-lobe pneumonia, subpleural reticulation, a dominant consolidation pattern, nodules and masses, non-septal linear opacities, bronchial dilation and a reverse halo sign were more frequent in COP. History of asthma, wheezing and peripheral eosinophilia was significantly more common in CEP than in COP. Distinguishing between CEP and COP based on HRCT alone is not always possible. However, in many cases, especially if the correct diagnosis cannot be established by other means, certain HRCT features can be very helpful.

Chest HRCT findings in patients with primary Sjögren's syndrome.

Pulmonary manifestations (PMs) in primary Sjögren's syndrome (pSS) are among the most frequent extraglandular complications, with reported prevalence varying widely (9-75%), depending on the methods of detection. The aim of this study was to assess the incidence of PMs in pSS and to determine the factors predisposing to the occurrence of this complication. The study group consisted of 68 patients with pSS. Among the patients who were possibly affected by PMs, chest High Resolution Computed Tomography (HRCT) was performed. In the group of all patients afflicted with pSS, 30 people indicated the need to expand medical imaging via chest HRCT scan. (The most frequent reason, in 80%, was persistent, dry cough periodically waking up patients at night). The chest HRCT scan revealed lung tissue changes in the course of 29% of all examined patients (of 68). No correlation was found between the occurrence of HRCT changes and the age of patients (p = 0.8), increased CRP > 5 mg/1 (p = 0.1) or ESR > 20 mm/h (p = 0.9), focus score (p = 0.8), leucopenia (p = 0.5), RF value (p = 0.3), gamma globulin value (p = 0.5), intensity of eye and oral cavity dryness (p = 0.6; 0.3) and smoking cigarettes. Additionally, no correlation was found between more frequent occurrences of antibodies anti-SSA, anti-SSB or anti-Ro52 and HRCT changes (p = 0.3; 0.07; 0.4). Pertaining to the clinical signs, HRCT changes occurred more often only in patients suffering from peripheral arthritis (p < 0.01). PM is a frequent symptom of pSS. A factor predisposing to the development of changes in the respiratory system was not found. Changes in HRCT occur more frequently in patients with peripheral arthritis.

A Blast From the Past: A Novel Complication of Bronchopulmonary Dysplasia

SESSION TITLE: Imaging SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Bronchopulmonary dysplasia (BPD) is a pulmonary complication of pre-mature birth. BPD occurs in pre-mature infants experiencing respiratory distress syndrome (RDS) treated with mechanical ventilation (MV), resulting in an inflammatory condition characterized by diverse radiographic findings and histologically by fibrosis and smooth muscle hypertrophy in the pulmonary tissues. In this case, we describe unique radiographic sequelae of BPD manifesting in adulthood. CASE PRESENTATION: A 43-year-old Caucasian female with history of premature birth, supported with MV, presented to her primary care physician for a retirement physical. She endorsed mild dyspnea on exertion, but denied chest pain, cough, or shortness of breath at rest. On physical exam, lungs were clear bilaterally with good air movement in all fields. Chest radiograph was normal except a 6mm nodular density noted in the right lower lobe. A non-contrast computed tomography scan of the chest was performed revealing a 2mm calcified granuloma. In addition, there were global, mild, and uniform paraseptal emphysematous changes throughout the pleural surfaces of the lungs and the fissures. Pulmonary work up including spirometry, carbon monoxide diffusing capacity, and testing for alpha-1 antitrypsin deficiency was normal. DISCUSSION: The long term sequelae of BPD is heterogeneous and depends on the initial degree of insult. MV of the premature infant in the setting of RDS is the predominant risk factor. Mild-moderate BPD may have no long-term effects with normal to only mildly obstructed spirometry; these patients typically go on to have normal chest radiographs by adolescence. More severe cases may demonstrate bronchial wall thickening, air trapping, lung cysts, linear interstitial opacities and emphysema. Case series suggest infants with BPD have more frequent airway hyperreactivity in adulthood and may have increased susceptibility to respiratory infections. Our patient presented with minimal symptoms, a history of MV during premature infancy and a novel, bilateral paraseptal emphysematous pattern without other underlying etiology suggesting BPD as the cause. Prevention in premature infants is key to management of this disease and centers on minimizing airway pressures during MV, antenatal glucocorticoids and exogenous surfactant therapy. CONCLUSIONS: The sequela of BPD infrequently persists into adulthood. We postulate that the diffuse and symmetric paraseptal emphysema in this adult patient with no other pulmonary risk factors is a previously undescribed manifestation of bronchopulmonary dysplasia as a premature infant. Reference #1: Howling SJ, Northway WH Jr, Hansell DM, Moss RB, Ward S, Müller NL. Pulmonary sequelae of bronchopulmonary dysplasia survivors: high-resolution CT findings. AJR Am J Roentgenol. 2000 May;174(5):1323-6. DISCLOSURE: The following authors have nothing to disclose: Tyler Church, Kyle Keinath, Whittney Warren, John Sherner No Product/Research Disclosure Information

Clinical and follow-up study of bronchiolitis obliterans in pediatric patients in China

Bronchiolitis obliterans (BO) is in general a rare and life-threatening form of non-reversible obstructive lung disease in which the bronchioles are compressed and narrowed by fibrosis and/or inflammation. The purpose of this study was to evaluate the clinical features of BO in pediatric patients and explore its risk factors. The medical records of 35 pediatric patients with BO at Guangzhou Women and Children’s Medical Center were evaluated. The age at onset of symptoms was 2–42 months (mean 13.3 ± 8.9 months), with age at diagnosis of 5 months–4 years (mean 17.8 ± 9.0 months). High-resolution computed tomography findings included mosaic pattern (100%), atelectasis (37.1%), air trapping (31.4%), and bronchiectasis (20.0%). Three patients received lung biopsies and mainly exhibited an inflammatory process surrounding the lumen of bronchioles. BO predominantly resulted from post-infectious causes (91.4%) which were primarily caused by adenovirus (50%), followed by Mycoplasma pneumoniae (46.7%) and influenza (20%). Pulmonary function tests (PFTs) showed severe and fixed airflow obstruction, decreased compliance, and increased resistance. No significant difference was found between before and after steroid treatment ( P &gt; 0.05). Two patients died owing to severe pulmonary complications, one of whom had inherent immunodeficiency. Our study suggests that the occurrence of BO, especially post-infectious BO, in China is relatively high and might result from primary immunodeficiency diseases in severe cases. Recurrent aspiration pneumonia caused by congenital dysplasia of the larynx and vaccination not on schedule might be potential risk factors for persistent and recurrent BO.

Lung Ultrasonography in Patients With Idiopathic Pulmonary Fibrosis: Evaluation of a Simplified Protocol With High-Resolution Computed Tomographic Correlation.

To compare a simplified ultrasonographic (US) protocol in 2 patient positions with the same-positioned comprehensive US assessments and high-resolution computed tomographic (CT) findings in patients with idiopathic pulmonary fibrosis. Twenty-five consecutive patients with idiopathic pulmonary fibrosis were prospectively enrolled and examined in 2 sessions. During session 1, patients were examined with a US protocol including 56 lung intercostal spaces in supine/sitting (supine/sitting comprehensive protocol) and lateral decubitus (decubitus comprehensive protocol) positions. During session 2, patients were evaluated with a 16-intercostal space US protocol in sitting (sitting simplified protocol) and left/right decubitus (decubitus simplified protocol) positions. The 16 intercostal spaces were chosen according to the prevalence of idiopathic pulmonary fibrosis-related changes on high-resolution CT. The sum of B-lines counted in each intercostal space formed the US scores for all 4 US protocols: supine/sitting and decubitus comprehensive US scores and sitting and decubitus simplified US scores. High-resolution CT-related Warrick scores (J Rheumatol 1991; 18:1520-1528) were compared to US scores. The duration of each protocol was recorded. A significant correlation was found between all US scores and Warrick scores and between simplified and corresponding comprehensive scores (P < .0001). Decubitus simplified US scores showed a slightly higher correlation with Warrick scores compared to sitting simplified US scores. Mean durations of decubitus and sitting simplified protocols were 4.76 and 6.20 minutes, respectively (P < .005). Simplified 16-intercostal space protocols correlated with comprehensive protocols and high-resolution CT findings in patients with idiopathic pulmonary fibrosis. The 16-intercostal space simplified protocol in the lateral decubitus position correlated better with high-resolution CT findings and was less time-consuming compared to the sitting position.

Human Immunodeficiency Virus-Associated Chronic Lung Disease in Children and Adolescents in Zimbabwe: Chest Radiographic and High-Resolution Computed Tomographic Findings.

Chronic respiratory symptoms are common among children living with human immunodeficiency virus (HIV). We investigated the radiological features of chronic lung disease in children aged 6-16 years receiving antiretroviral therapy for ≥6 months in Harare, Zimbabwe. Consecutive participants from a HIV clinic underwent clinical assessment and chest radiography. Participants with an abnormal chest radiograph (assessed by a clinician) and/or those meeting a clinical case definition for chronic lung disease underwent high-resolution computed tomography (HRCT). Radiological studies were scored independently and blindly by 2 thoracic radiologists. Relationships between radiological abnormalities and lung function were examined. Among 193 participants (46% female; median age, 11.2 years; interquartile range, 9.0-12.8 years), the median CD4 cell count was 720/µL (473-947/µL), and 79% had a human immunodeficiency virus (HIV) load of <400 copies/mL. The most common chest radiographic finding was ring/tramline opacities (55 of 193 participants; 29%). HRCT scans were evaluated in 84 participants (69%); decreased attenuation (present in 43%) was the dominant abnormality seen. The extent of decreased attenuation was strongly correlated with both the severity and extent of bronchiectasis (rs = 0.68 and P < .001 for both). The extent of decreased attenuation was also negatively correlated with forced expiratory volume in first second of expiration (rs = -0.52), forced vital capacity (rs = -0.42), and forced expiratory flow, midexpiratory phase (rs = -0.42) (P < .001 for all). The HRCT findings strongly suggest that obliterative bronchiolitis may be the major cause of chronic lung disease in our cohort. Further studies to understand the pathogenesis and natural history are urgently needed.

HRCT findings of childhood follicular bronchiolitis.

Follicular bronchiolitis is a lymphoproliferative form of interstitial lung disease (ILD) defined by the presence of peribronchial lymphoid follicles. Follicular bronchiolitis has been associated with viral infection, autoimmune disease and immunodeficiency. The most common clinical manifestation is respiratory distress in infancy followed by a prolonged course with gradual improvement. We found no reports of systematic review of high-resolution computed tomography (HRCT) findings in pediatric follicular bronchiolitis. The purpose of this study was to describe the HRCT findings of follicular bronchiolitis in children and correlate these imaging findings with histopathology. A 5-year retrospective review of all pathology-proven cases of follicular bronchiolitis was performed. Inclusion criteria were age <18years and an HRCT within 6months of lung biopsy. HRCTs were reviewed by three observers and scored using the system previously described by Brody et al. Six patients met the inclusion criteria with age range at HRCT of 7-82months (median: 39.5months). Pulmonary nodules (n=6) were the most common HRCT finding followed by focal consolidation (n=5), bronchiectasis (n=4) and lymphadenopathy (n=3). Tree and bud opacities and nodules on CT correlated with interstitial lymphocytic infiltrates and discrete lymphoid follicles on pathology. The salient HRCT findings of childhood follicular bronchiolitis are bilateral, lower lung zone predominant pulmonary nodules and bronchiectasis with infantile onset of symptoms. These characteristic HRCT findings help differentiate follicular bronchiolitis from other forms of infantile onset ILD.

Analysis of clinical characteristic of the middle ear malformation with cholesteatoma

Objective To discuss the clinical characteristic of middle ear malformation with cholesteatoma. Methods From September, 2011 to November, 2016, 23 cases of middle ear malformation with cholesteatoma were collected. Their symptoms, ENT examination, temporal bone high resolution computed tomography (HRCT) and intra-operative findings were analyzed. Results All 23 patients had hearing loss. 90.0% patients had ear discharge and tin-nitus. 86.96% patients had perforation in pars flaccida of tympanic membrane. 95.7% patients had poor mastoid gasification. 73.9% patients had undeveloped or dysplastic tympanic antrum. 100% patients had destruction of the ossicular chain. 56.5% patients had malformation of the ossicular chain. 52.2% patients had exposed facial nerve. 30.4% patients had hyperplasia of the attic bone. Conclusion The symptoms and physical examinations of middle ear malformation with cholesteatoma are the same as middle ear cholesteatoma. Poor mastoid gasification can usually be detected on temporal bone HRCT. The most common malformation is dysplastic tympanic antrum, followed by malformation of the ossicular chain, exposed facial nerve and hyperplasia of the attic bone. Temporal bone HRCT can indicate the mal-formation and destruction quite well. Key words: Middle ear malformation; Cholesteatoma; Temporal bone; High resolution computed tomography (HRCT)

Mycoplasma pneumoniae\u2013Associated Bronchiolitis Obliterans Following Acute Bronchiolitis

The characteristics of Mycoplasma pneumonia (M. pneumoniae)-associated bronchiolitis obliterans (BO) are not well known. We retrospectively reviewed 17 patients with M. pneumoniae–associated BO. All patients had M. pneumoniae–associated acute bronchiolitis prior to the development of BO. In the acute bronchiolitis stage, all patients had fever and cough; six patients also had wheezing and dyspnoea. BO was diagnosed approximately 1.5–8 months later based on clinical manifestations and chest high-resolution computed tomography (HRCT) findings. All patients presented with wheezing and/or dyspnoea at the time of diagnosis of BO. HRCT findings included mosaic attenuation, pronounced air trapping, central bronchiectasis and emphysema, according to disease severity. Lung function tests revealed mild to severe airway obstruction. Fourteen of 17 patients had a greater than 12% increase in forced expiratory volume in 1 second values after taking salbutamol. All patients had positive allergy test results and family or personal history of atopic disease. Four patients had a history of asthma before M. pneumonia bronchiolitis. Asthma was diagnosed before, at the time of or after the diagnosis of BO in 11 cases. M. pneumoniae–associated BO may therefore develop following M. pneumonia bronchiolitis and overlap with asthma.