Pulmonary CT Findings Research Articles

Clinical and morphological features of lung injury long-term after SARS-CoV-2 recovery

To study the clinical and histological profile of lung tissue in patients with persistent pulmonary disease, respiratory symptoms and CT findings after SARS-CoV-2 infection. The study included 15 patients (7 females and 8 males) with a mean age of 57.7 years. All patients underwent laboratory tests, chest computed tomography, echocardiography, and pulmonary function tests. Pulmonary tissue and bronchoalveolar lavage samples were obtained by fibrobronchoscopy, transbronchial forceps (2 patients), and lung cryobiopsy (11 patients); open biopsy was performed in 2 patients. Cellular composition, herpesvirus DNA, SARS-CoV-2, Mycobacterium tuberculosis complex, galactomannan optical density index, and bacterial and fungal microflora growth were determined in bronchoalveolar lavage. SARS-CoV-2 was also identified in samples from the nasal mucosa, throat and feces using a polymerase chain reaction. The results showed no true pulmonary fibrosis in patients recovered from SARS-CoV-2 infection with persistent respiratory symptoms, functional impairment, and CT findings after SARS-CoV-2 infection. The observed changes comply with the current and/or resolving infection and inflammatory process. Thus, no true pulmonary fibrosis was found in patients after SARS-CoV-2 infection with persistent respiratory symptoms, functional impairment, and CT findings. The observed changes comply with the current and/or resolving infection and inflammatory process.

Unusual cause of chronic cough and bloody phlegm with Atypical pulmonary CT findings

Unusual cause of chronic cough and bloody phlegm with Atypical pulmonary CT findings

Clinical features and CT findings of fibrosing mediastinitis associated pulmonary hypertension

Objective: To investigate the clinical features and CT findings of pulmonary hypertension (PH) in patients with fibrosing mediastinitis (FM). Methods: Thirteen patients with FM diagnosed between September 2015 and June 2022 were studied retrospectively, including patients with PH (FM-PH group) and patients without PH (FM group) confirmed on right heart catheterization. The t test of two independent samples, Mann-Whitney U rank sum and Fisher's test were used to compare the general information, symptoms, laboratory examination, right ventricular and pulmonary artery measurement data and pulmonary artery CT findings between the two groups, respectively. Results: Compared with the 7 FM patients aged 28-79 (60.00±17.69) years, the 6 patients in the FM-PH group, aged from 60 to 82 (68.83±8.35) years, had more peripheral edema, lower percentage of PaO2, wider inner diameters of pulmonary artery and right ventricle, a higher ratio of right ventricle and left ventricular transverse diameter, faster tricuspid regurgitation velocity and higher estimated systolic pulmonary artery pressure (P<0.05). There were no differences in BNP levels and tricuspid annular plane systolic excursion between groups (P>0.05). Of the 6 patients with PH, 5 had precapillary PH and 1 had mixed PH. Except that the pulmonary vascular resistance in patients of the FM-PH group was significantly higher than that in the FM group (P<0.05), there were no significant differences in cardiac output, mixed venous oxygen saturation and pulmonary capillary wedge pressure between the two groups. CT pulmonary angiography (CTPA) showed pulmonary artery and vein stenosis. Patients in the FM-PH group had more severe stenosis and occlusion of pulmonary artery and pulmonary vein (P<0.05), and more involvement of multiple pulmonary veins (P<0.05). Conclusions: The clinical manifestation of FM complicated with PH is related to the degree of involvement of pulmonary artery, vein and airway. It is recommended that the disease be evaluated in combination with multiple parameters such as clinical manifestations, cardiac ultrasound, right cardiac catheter and CTPA.

Pulmonary CT findings in Patients Recovered from COVID-19 Pneumonia

Background: The COVID-19 infection is a more recent pandemic disease all over the world and studying the pulmonary findings on survivors of this disease has lately commenced. Objective: We aimed to estimate the cumulative percentage of whole radiological resolution after 3 months from recovery and to define the residual chest CT findings and exploring the relevant affecting factors. Subjects and Methods: Patients who had been previously diagnosed with COVID-19 pneumonia confirmed by RT-PCR test and had radiological evidence of pulmonary involvement by Chest CT during the acute illness were included in the present study. The radiological data of chest CT scan of all patients were collected and analyzed after recovery (confirmed by negative RT- PCR) three months after their initial diagnosis of having COVID 19 pneumonia. Results: A total of 40 patients who had a second CT scans were assessed; there were 27 (67.5%) male and 13 (32.5%) female, with a mean age of 40.3 years old. The collective percentage of whole radiological resolution was 65% (26 patients). Patients &gt;40 years old showed a significantly lower cumulative percentage of complete radiological resolution than patients ≤40 years old at the 3 months follow-up. The predominant patterns of abnormalities observed at discharge were ground-glass opacity (GGO), fibrous stripe and reticular opacities. Conclusion: Lung findings in COVID-19 pneumonia patients can be resolved completely during medium-term follow up with no sequelae. The older age and co-morbidities are the main significant risk factors for residual radiological findings of COVID-19 disease.

An investigation into the Effects of Intravenous Vitamin C on Pulmonary CT Findings and Clinical Outcomes of Patients with COVID 19 Pneumonia A Randomized Clinical Trial.

In late December 2019, a series of unexplained cases of pneumonia were reported in Wuhan, China. On January 12, 2020, the World Health Organization temporarily named the virus responsible for the emerging cases of pneumonia as the 2019 coronavirus. Acute respiratory distress syndrome (ARDS) due to Covid-19 has rapidly spread around the world, and while no specific treatment or vaccine has been reported, mortality rates remain high. One of the suggested treatments for cellular damage in the pathogenesis of ARDS caused by the coronavirus is the administration of high doses of intravenous vitamin C. Considering the paucity of literature on the therapeutic effects of high doses of intravenous vitamin C in patients with ARDS resulting from the coronavirus, this study was conducted to assess this therapeutic supplement in these patients. This study was performed as a single-center clinical trial in patients with a documented diagnosis of COVID-19 pneumonia. 54 eligible patients with moderate to severe COVID-19 symptoms, based on specific inclusion and exclusion criteria, were included in the investigation and randomly divided into two groups. The control group consisted of 26 patients who received standard treatment, whereas the treatment group was comprised of 18 patients administered intravenous vitamin C at a dose of 2 g every 6 hours for 5 days in addition to standard treatment. Demographic characteristics, underlying diseases, length of hospital stay, and mortality rates were reviewed and collected. Oxygen saturation, respiratory rates, serum C Reactive Protein (CRP) levels, lymphopenia and lung parenchymal involvement on CT were investigated at the time of admission and on the sixth day after hospitalization. Finally, all variables were analyzed with IBM SPSS Statistics 23 software and a significant statistical difference was defined for all variables, P <0.05. Of these variables, the amount of oxygen saturation in the vitamin C group increased significantly from 86±5% on the first day of hospitalization to 90±3% on the sixth day of hospitalization (P value=0.02). Also, the respiratory rate in the vitamin C group decreased significantly from 27±3 on the first day of hospitalization to 24±3 on the sixth day of hospitalization (P value=0.03). Lung CT scans of patients in the two groups reported by two radiologists were also compared. Based on the report of the radiologists, the rate of lung involvement in the vitamin C group was significantly lower than in the control group at the end of treatment (P value=0.02). Due to the effectiveness of high doses of intravenous vitamin C on reducing lung involvement and improving clinical symptoms, further studies with a larger sample size are recommended to demonstrate the effects of this drug supplement.

An Analysis on the Clinical Features of Maintenance Hemodialysis Patients with Coronavirus Disease 2019: A Single Center Study

Background and Objectives:Patients on maintenance hemodialysis (MHD) are at high risk for coronavirus disease 2019 (COVID-19). However, patients undergoing MHD who are infected with COVID-19 are not fully studied. The objective of this study is to describe the characteristics of patients with COVID-19 undergoing MHD and provide a basis for the recognition and prevention of COVID-19 infection.Materials and Methods:Patients undergoing MHD were assigned into the normal group (537 cases), diagnosed group (66 cases), and suspected group (24 cases). General data, clinical symptoms, hemodialysis indicators, and laboratory indicators were collected and compared.Results:A total of 627 patients undergoing MHD were evaluated. The prevalence of COVID-19 was 10.53% (66/627), mortality was 18.18% (12/66), and death rate was 1.91% (12/627). In addition, 26% of patients were asymptomatic. Cough was the most common symptom (36%), followed by fatigue (16%), dyspnea (16%), and fever (13%). Ultrafiltration volume, ultrafiltration rate, and the duration of weekly dialysis in the diagnosed group were significantly lower than those in the other two groups. Moreover, neutrophil ratio and neutrophil, monocyte, and total carbon dioxide levels in the diagnosed group were significantly higher than those in the normal group, and the lymphocyte ratio was considerably lower than in the normal group. Sixty-five of the suspected and diagnosed patients had positive pulmonary CT findings.Conclusion:Compared with the general population, patients on hemodialysis have a significantly higher risk of contracting COVID-19 and postinfection mortality. Moreover, most patients undergoing hemodialysis have no obvious clinical symptoms after infection with COVID-19 but only have pulmonary changes which make it particularly important to screen and manage patients undergoing hemodialysis on outpatient basis.

Prognostic value of radiological findings indeterminate for UIP pattern and anterior upper lobe honeycomb-like lesion in chronic fibrosing interstitial lung disease associated with MPO-ANCA

BackgroundMyeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) is often positive in patients with interstitial lung disease (ILD), which is also often present in patients with microscopic polyangiitis (MPA). A possible association between MPO-ANCA, MPA, and idiopathic ILD remains unclear. The objective of this study was to determine whether high-resolution computed tomography (HRCT) classification based on recent idiopathic pulmonary fibrosis guideline and specific CT findings can obtain new knowledge of prognostic factors in all MPO-ANCA-positive patients with ILD including both idiopathic ILD and MPA-ILD.MethodsWe analyzed 101 consecutive MPO-ANCA-positive patients with respiratory disease. We assessed the diagnostic accuracy of CT findings, HRCT pattern, and specific radiological signs. Prognostic predictors were determined using Cox regression models.ResultsSubjects with chronic ILD included 22 patients with MPA-ILD and 39 patients with ILD but without MPA. A quarter of the patients were radiological indeterminate for usual interstitial pneumonia (UIP) pattern, which resulted in a better prognosis than that for UIP pattern. “Increased attenuation around honeycomb and traction bronchiectasis” and “anterior upper lobe honeycomb-like lesion” were found to be highly frequent radiological findings (39% and 30%, respectively). In addition, the latter finding was a significant negative prognostic factor.ConclusionsRadiological indeterminate for UIP was a useful HRCT classification in MPO-ANCA-positive patients with ILD. In addition, anterior upper lobe honeycomb-like lesion was found to be specific radiological finding that was a significant prognostic factor. The present results might aid in the assessment of appropriate strategies of diagnosis in these patients.

Clinical features and CT findings of Takayasu's arteritis associated pulmonary hypertension

Objective: Takayasu's arteritis involving the pulmonary artery (PTA) is uncommon, and those with pulmonary hypertension (PH) are even rarer. This study investigated the clinical features and CT findings in PTA patients with PH. Methods: A total of 40 PTA patients were retrospective selected in the First Hospital of Air Force Medical University from January 2008 to January 2018. There were 14 PTA patients with PH, including 3 male and 11 female cases, aged from 18 to 53 (29.7±9.4) years, as the study group (PTA+PH group). There were 26 PTA patients without PH, including 4 males and 22 females, aged 15-52 (28.9±8.5) years, as the control group (PTA group). The Chi-square or Fisher's test, T test of two independent samples and Mann-Whitney U rank sum test were used to compare the general information, symptoms, signs, laboratory examination data, right ventricular and pulmonary artery measurement data, and pulmonary artery CT findings between the two groups. Results: Compared with the PTA group, the patients in the PTA+PH group had longer disease duration, fewer active cases, more shortness of breath, chest distress and lower limb edema, lower blood oxygen partial pressure (PaO2) and lower ESR (all P<0.05). The width of right atrium and right ventricle in PTA+PH group was greater than that in PTA group (all P<0.05). The main CT findings of the involved pulmonary artery included lumen stenosis (39 cases, 97.5%), lumen occlusion (16 cases, 40%), wall thickening (9 cases, 22.5%), and lumen dilation (2 cases, 5.0%). Patients in the PTA+PH group had less wall thickening and mild lumen stenosis (<50%), more severe lumen stenosis (≥50%) and occlusion than those in the PTA group (all P<0.05). Conclusions: PTA patients with PH showed certain characteristics in clinical, laboratory and CT findings, which may be correlated to the stage of the disease duration, the severity, and the prognosis.

Pulmonary findings on high-resolution computed tomography in Takayasu arteritis.

This study aimed to describe pulmonary high-resolution CT (HRCT) findings in Takayasu arteritis (TA) and to determine possible causes. A total of 243 TA patients were enrolled from a prospective cohort after excluding patients with other pulmonary disorders or incomplete data. Patients were divided into two groups: those with normal lung HRCT and those with abnormal lung HRCT. Clinical characteristics were compared between groups and binary logistic regression analysis was applied to identify possible causes of the lung lesions. Follow-up HRCT (obtained in 64 patients) was analysed to study changes in pulmonary lesions after treatment. Of the 243 patients, 107 (44.0%) had normal lung HRCT while 136 (56.0%) had abnormal lung HRCT, including stripe opacity (60.3%), nodules (44.9%), patchy opacity (25.0%), pleural thickening (15.4%), pleural effusion (10.3%), ground-glass opacity (8.1%), pulmonary infarction (6.6%), mosaic attenuation (4.4%), bronchiectasis (3.7%) and pulmonary oedema (2.2%). Patients with abnormal HRCT were significantly more likely to have type II arterial involvement (25% vs 12.2%, P = 0.04), pulmonary arterial involvement (PAI; 21.3% vs 5.6%, P < 0.001), pulmonary hypertension (20.6% vs 8.4%, P = 0.01) and abnormal heart function (27.9% vs 7.6%, P < 0.001). Logistic regression analysis demonstrated that PAI, worsened heart function and age were associated with presence of pulmonary lesions. Pulmonary infarction, pleural effusion and patchy opacities improved partially after treatment. Pulmonary lesions are not rare in patients with TA. Age, PAI and worsened heart function are potential risk factors for presence of pulmonary lesions in TA.

The relationship between pulmonary arterial enlargement and pulmonary function in COPD patients

Objective To investigate the relationship between pulmonary arterial(PA) enlargement and pulmonary function in patients with chronic obstructive pulmonary disease (COPD). Methods From December 2012 to June 2016, 78 patients with acute exacerbation of COPD in the Eighth People's Hospital of Qingdao were selected.According to pulmonary CT findings, they were divided into two groups: PA enlargement group(38 cases) was PA>3.0cm, normal PA group(40 cases) was PA≤3.0cm.FEV1 and FVC of stable phase were compared. Results The FEV1 of men in the A enlargement group was (1.08±0.44)L, that in the normal PA group was (1.44±0.66)L, the difference was statistically significant (t=2.27, P=0.028). The FEV1 of women in the PA enlargement group was (0.90±0.41)L, which in the normal PA group was (1.35±0.58)L, the difference was statistically significant (t=2.28, P=0.026). Correlation analysis showed that the diameter of PA was negatively related with FEV1/FVC(r=-0.509, P=0.001), PA enlargement was related with lung function decline. Conclusion COPD patients with PA enlargement are more associated with accelerated loss of lung function and should be treated early. Key words: Pulmonary disease, chronic obstructive; Respiratory function tests; Pulmonary artery; Vital capacity; Forced expiratory volume

Medical image of the week: typical pulmonary CT findings following radiotherapy

Medical image of the week: typical pulmonary CT findings following radiotherapy

JAK2/STAT3 Pathway Was Associated with the Protective Effects of IL-22 On Aortic Dissection with Acute Lung Injury.

Patients with aortic dissection (AD) may present acute lung injury (ALI) that may affect the prognosis. In this study, we aim to investigate the roles and mechanism of IL-22 in the pathogenesis of AD complicated with ALI. Six hundred and twenty-one AD patients were included, and the incidence of ALI and pulmonary CT findings were analyzed. Mouse ALI model was established through AngII, and then IL-22 injection and AG490 were given. The pathological changes, infiltration of inflammatory cells, and expression of STAT3 were determined. For the in vitro experiment, cultivated pulmonary microvascular endothelial cells (PMVECs) were treated by angiotensin II (AngII), followed by treating with IL-22 and/or AG490. The expression and migration of STAT3 was determined. Flow cytometry was carried out to evaluate the apoptosis. IL-22 contributed to the expression of STAT3 in lung tissues and attenuation of ALI. IL-22 obviously inhibited the apoptosis of PMVECs mediated by AngII and downregulated the expression and intranuclear transmission of STAT3. Such phenomenon was completely inhibited upon administration of AG490, an inhibitor of JAK2. Our data showed IL-22 contributed to the inhibition of PMVEC apoptosis mediated by AngII through activating the JAK2/STAT3 signaling pathway, which may attenuate the ALI induced by AngII.

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.

Tracheal diverticula in cystic fibrosis—A potentially important underreported finding on chest CT

BackgroundWe aim to assess the prevalence and describe characteristics of tracheal diverticula (TD) in patients with cystic fibrosis (CF). MethodsThis retrospective study included 92 patients with known CF treated in our medical center who had available chest CT, performed between 2001 and 2013. Presence, number, size, and location of TD were recorded on the most recent chest CT. The severity of CF-related pulmonary CT findings and pulmonary function tests were recorded and correlated with the presence of the diverticula. ResultsTwenty-six (28%) of the 92 patients (17 males, 9 females, age range 5–59years) had one or more TD. The size of TD ranged from 2mm to 32mm. TDs were on the right posterolateral aspect of the upper tracheain nearly all patients. Small TDs appeared as a focal paratracheal lucency and larger ones as a soft tissue mass with central air bubbles. There was no significant difference in the Bhalla score between patients with and without TD. There was no correlation between the Bhalla score and patients' age, size, or number of diverticula. Pulmonary function tests were worse and declined faster in patients with TD compared to those without. ConclusionsTDs are quite common on chest CT of CF patients. Those with diverticula have significantly worse pulmonary function tests than those without.

Cardiovascular disease prediction: do pulmonary disease-related chest CT features have added value?

ObjectiveCertain pulmonary diseases are associated with cardiovascular disease (CVD). Therefore we investigated the incremental predictive value of pulmonary, mediastinal and pleural features over cardiovascular imaging findings.MethodsA total of 10,410 patients underwent diagnostic chest CT for non-cardiovascular indications. Using a case-cohort approach, we visually graded CTs from the cases and from an approximately 10 % random sample of the baseline cohort (n = 1,203) for cardiovascular, pulmonary, mediastinal and pleural findings. The incremental value of pulmonary disease-related CT findings above cardiovascular imaging findings in cardiovascular event risk prediction was quantified by comparing discrimination and reclassification.ResultsDuring a mean follow-up of 3.7 years (max. 7.0 years), 1,148 CVD events (cases) were identified. Addition of pulmonary, mediastinal and pleural features to a cardiovascular imaging findings-based prediction model led to marginal improvement of discrimination (increase in c-index from 0.72 (95 % CI 0.71–0.74) to 0.74 (95 % CI 0.72–0.75)) and reclassification measures (net reclassification index 6.5 % (p < 0.01)).ConclusionPulmonary, mediastinal and pleural features have limited predictive value in the identification of subjects at high risk of CVD events beyond cardiovascular findings on diagnostic chest CT scans.Key Points • Incidental cardiovascular findings on routine chest CT can predict cardiovascular disease • Non-cardiovascular chest CT abnormalities are associated with cardiovascular disease • Non-cardiovascular chest CT features have limited predictive value beyond cardiovascular features Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-014-3495-0) contains supplementary material, which is available to authorized users.

Forensic pathological evaluation of postmortem pulmonary CT high-density areas in serial autopsy cases of sudden cardiac death

Previous studies suggested substantial postmortem interference with pulmonary CT findings. The present study evaluated postmortem CT (PM-CT) morphology of the lung, compared with histology, in autopsy cases of sudden cardiac death without recovery from cardiac arrest (SCD, n=22) with regard to the posture at the time of death and postmortem interference from a forensic pathological viewpoint. In witnessed cases (n=5), a case of SCD in a prone position had anterior consolidation with weak hypostatic opacification in the posterior about 18h later. Among unwitnessed deaths (n=17), 8 cases of death lying prone, sitting facedown and lying laterally had possible gravity-dependent opacity about 15–38h postmortem. Hypostatic opacification with ‘niveau’ formation was not evident in more than half of the cases (n=15). Histological findings for ground glass opacification and consolidation on PM-CT varied by case, involving intraalveolar edema and hemorrhages, accompanied by marked congestion; however, possible postmortem hypostatic opacification mostly represented intraalveolar edema. CT morphology of acute pulmonary congestion in SCD may often remain without serious postmortem interference in cases without clinical intervention involving massive fluid infusion, suggesting plain PM-CT findings of the lung to be useful for investigating the death process when combined with histology; however, the possible influence of the hydration status of the lungs at the time of death should be assessed by evaluation of CT and autopsy findings.

Clinical Manifestations of 6 Cases of Septic Pulmonary Embolism at Increased Risk Recently

Objectives The aim of this study was to investigate the clinico-radiologic features and microbiologic data of patients with SPE in a tertiary care hospital in Busan. Methods We retrospectively analyzed clinical and radiologic features of 6 cases with septic pulmonary embolism that occurred from March 2009 to March 2011 in Dong-A university medical center. Results The mean age of the study population was 58 years, and two men and four women were included. Clinical symptoms included general weakness (5 patients), febrile sensation (4 patients) and pleuritic chest pain (2 patients). Underlying conditions were chemoport infection (4 patients), dental abscess (1 patients), and cellulitis of hip (1 patient). Chest computed tomography revealed bilateral multiple nodular opacities in most patients, and cavitation, central necrosis, feeding vessels were identified. All patients received parenteral antimicrobial therapy with or without central catheter removal, drainage of the extrapulmonary infection. Causative organisms were Pseudomonas aeruginosa (2 patients), Candida albicans (1 patient), Bacillus species (1 patient), and Klebsiella pneumonia (1 patient). Conclusions Clinical and radiologic features of septic pulmonary embolism were various and nonspecific. The diagnosis was usually suggested by the presence of a predisposing factor of septic pulmonary embolism and CT findings of bilateral multiple nodular opacities in patients with infectious signs and symptoms. Most important underlying condition was intravascular device infection.

The Utility of Pulmonary PET Activity and CT Findings in Sarcoidosis

The Utility of Pulmonary PET Activity and CT Findings in Sarcoidosis

Thin-section CT findings of patients with acute Streptococcus pneumoniae pneumonia with and without concurrent infection

The aim of this study was to compare the pulmonary thin-section CT findings of patients with acute Streptococcus pneumoniae pneumonia with and without concurrent infection. The study group comprised 86 patients with acute S. pneumoniae pneumonia, 36 patients with S. pneumoniae pneumonia combined with Haemophilus influenzae infection, 26 patients with S. pneumoniae pneumonia combined with Pseudomonas aeruginosa infection and 22 patients with S. pneumoniae pneumonia combined with methicillin-susceptible Staphylococcus aureus (MSSA) infection. We compared the thin-section CT findings among the groups. Centrilobular nodules and bronchial wall thickening were significantly more frequent in patients with pneumonia caused by concurrent infection (H. influenzae: p<0.001 and p<0.001, P. aeruginosa: p<0.001 and p<0.001, MSSA: p<0.001 and p<0.001, respectively) than in those infected with S. pneumoniae alone. Cavity and bilateral pleural effusions were significantly more frequent in cases of S. pneumoniae pneumonia with concurrent P. aeruginosa infection than in cases of S. pneumoniae pneumonia alone (p<0.001 and p<0.001, respectively) or with concurrent H. influenzae (p<0.05 and p<0.001, respectively) or MSSA infection (p<0.05 and p<0.05, respectively). When a patient with S. pneumoniae pneumonia has centrilobular nodules, bronchial wall thickening, cavity or bilateral pleural effusions on CT images, concurrent infection should be considered.

Thin-section CT findings inPseudomonas aeruginosapulmonary infection

The aim of this study was to assess clinical and pulmonary thin-section CT findings in patients with acute Pseudomonas aeruginosa (PA) pulmonary infection. We retrospectively identified 44 patients with acute PA pneumonia who had undergone chest thin-section CT examinations between January 2004 and December 2010. We excluded nine patients with concurrent infections. The final study group comprised 35 patients (21 males, 14 females; age range 30-89 years, mean age 66.9 years) with PA pneumonia. The patients' clinical findings were assessed. Parenchymal abnormalities, enlarged lymph nodes and pleural effusion were evaluated on thin-section CT. Underlying diseases included malignancy (n=13), a smoking habit (n=11) and cardiac disease (n=8). CT scans of all patients revealed abnormal findings, including ground-glass opacity (n=34), bronchial wall thickening (n=31), consolidation (n=23) and cavities (n=5). Pleural effusion was found in 15 patients. PA pulmonary infection was observed in patients with underlying diseases such as malignancy or a smoking habit. The CT findings in patients with PA consisted mainly of ground-glass attenuation and bronchial wall thickening. The CT findings consisted mainly of ground-glass attenuation, bronchial wall thickening and cavities. These findings in patients with an underlying disease such as malignancy or a smoking habit may be suggestive of pneumonia caused by PA infection.