Roentgenographic Findings Research Articles

Bronchoscopy and Pathology Findings in an Unusual Case of Allergic Bronchopulmonary Mycosis

Abstract The diagnosis of allergic bronchopulmonary mycosis (ABPM) is usually made on clinical, serologic, and roentgenographic findings. However, the indicators in such diagnostic criteria still lack specificity, which results in a high rate of misdiagnosis. A 47-year-old woman was diagnosed with “tuberculosis” or “pneumonia” for 10 years and after thoracoscopic right upper lung resection the following chest CT showed right lung atelectasis. Brown sputum was seen in the right bronchus via bronchoscopy. Reviewing the surgical pathology specimen, the bronchi were found to be generally cystic dilated, and a large amount of mucus was retained and formed a mucus plug. The final diagnosis of the case was ABPM. The current diagnostic criteria of ABPM do not emphasize the role of bronchoscopy and pathological examination, but bronchoscopy and pathological examination still have important value for some atypical cases with suspected ABPM.

The lateral meniscal extrusion after repair with concomitant anterior cruciate ligament reconstruction at a mean follow-up of 3.5 years

BackgroundA meniscal repair is often performed on radial/flap or longitudinal tears of the lateral meniscus (LM) combined with anterior cruciate ligament reconstruction (ACLR). However, it is unknown if meniscal extrusion changes over time after repair. This study evaluated whether meniscal extrusion of the LM is maintained after repair or progresses with time using magnetic resonance imaging (MRI). MethodsAmong 574 patients who underwent primary anatomic ACLR, 123 patients followed up for more than 2 years were retrospectively analyzed. Forty patients with concomitant radial/flap tears of the LM (group R), 43 with longitudinal LM tears (group L), and 40 with intact LM (group C, matched-control group) were included. Clinical findings (pain, range of motion, swelling, and anterior laxity), lateral joint space on radiograph, and meniscal extrusion on MRI were assessed. Lateral/posterior meniscal extrusions were examined preoperatively, within 3 weeks after surgery, and at the final follow-up, and the absolute values and relative values (the preoperative values as baseline) were assessed respectively. ResultsThere were no significant differences in the clinical and roentgenographic findings among the groups. No difference was observed in the relative values within 3 weeks after surgery among three groups, although the absolute values were larger in the repaired groups than in group C. At the final follow-up, however, the lateral extrusion in group L had progressed significantly, compared with that in group C (P = 0.033), while no significant difference was detected in the lateral extrusion between groups R and C (P = 0.177). The posterior extrusion in groups R and L had progressed significantly compared with that in group C (P < 0.001). ConclusionsLM extrusion could not be improved even immediately after meniscal repair, and it progressed laterally and posteriorly for more than 2 years after surgery.

Clinical characteristics of dermatomyosits/polymyositis associated interstitial lung disease according to the autoantibody.

Dermatomyositis (DM) and polymyositis (PM) often have association with interstitial lung disease (ILD) which have disease specific autoantibody. We reviewed medical records of DM/PM associated ILD from January 2000 to December 2017 according to the autoantibody. We identified 52 patients, of whom 30 were antibody negative, 18 had anti aminoacyl-tRNA synthetases (ARS) antibodies and 4 had anti melanoma differentiation-associated gene (MDA)-5 antibody. In high resolution computed tomography (HRCT) of the chest, area of ground glass opacity (GGO), consolidation, and lung tip consolidation were more extensive in anti MDA-5 antibody positive patients (p=0.051, p=0.026, and p=0.027, respectively). Among laboratory findings, GOT had strong correlations with CPK (r=0.889, p < 0.001), and LDH (r=0.910, p < 0.001). Among roentgenographic findings, there were moderate correlations between GGO and consolidation (r=0.668, p < 0.001), and between reticular shadow and traction bronchiectasis (p=0.633, p < 0.001). ILD patients with anti MDA-5 antibodies had decreased survival (1.00 vs 84.3, 22.9 months, p < 0.001). ILD patients with anti ARS antibody had intense inflammation, but reversible fibrosis and good prognosis. On the other hand, anti MDA-5 antibody positive ILD patients had shorter survival. Extent of parenchymal shadow and serum GOT were useful indicator of disease activity of PM/DM associated ILD patients in our cohort. J. Med. Invest. 65:251-257, August, 2018.

A modified Matti-Russe technique of grafting scaphoid non-unions.

In treatment of scaphoid non-union bone healing requires beside vital tissue and stability, enduring compression and a good interface between the graft and scaphoid fragments. While fixation techniques show a good primary stability, they reduce sintering and thus compression of fragments in the long term. Therefore, a modified technique optimising the cancellous interface between graft and scaphoid but still providing enough stability without fixating implants should be evaluated. A corticocancellous bone graft from iliac crest was shaped ellipsoid and was implanted in a modified Matti-Russe press fit-technique. Thereby the cancellous side contacts the scaphoid fragments. In a retrospective design, we reviewed 52 patients with documented non-unions of the scaphoid. The average length of follow-up was 8.6 months. Range-of-motion, pain and grip-strength was measured and compared with contralateral wrist. Radiological assessment included beside X-rays CT scans. Results were further measured by DASH score and Mayo wrist score. The average postoperative pain was 0.9 based on NRS-Score. The mean range-of-motion was satisfactory with a dorsal-palmar arch of 115.3°, radial-ulnar: 48.2° and pro-supination: 171.3°. Mayo Wrist Score showed with 91.2 out of 100 an excellent result. The analysis of DASH score revealed a mild subjective constriction (9.2/100). Regarding roentgenographic findings complete union was confirmed in 44 of the 52 patients (84.6%). Patients with non-union were significantly older than patients with union (p < 0.05). Grip-strength on average was equal to that of the uninjured hand although in failure cases a slightly reduced grip-strength was seen. The modified technique of Matti-Russe provided a good contact of the cancellous part of the bone graft to the scaphoid in grafting a scaphoid pseudarthrosis with a high healing rate. However, since age, previous failed surgery and a proximal fracture line are the most important handicaps for bone healing in this study, for patients at risk gadolinium-enhanced MRI scan could be helpful to estimate vascularisation preoperatively. In cases of poor vitality, vascularised bone grafting should be considered.

Functional results of surgical treatment of deltoid ligament rupture as components of fracture of the lateral malleolus

Injury of the deltoid ligament as a component of the lateral malleolus fractures is caused by the fact rotational forces during the support. The aim of this research is to examine the functional results of the patient who had undergone suture of the deltoid ligament and osteosynthesis of fracture of the lateral malleolus. In a retrospective study the analysis included a series of 45 patients. The diagnosis of rupture of the deltoid ligament is made based on physical findings islands and tenderness in the region of the deltoid ligament and roentgenographic confirmation width of the medial joint space > 4 mm. There is a high degree of correlation with the 25 (55.55%) patients between excellent functional outcomes of treatment calculated by Gregory[11] score and great roentgenographic findings by Konrath score[12]. The total clinical scores of subjective and objective clinical assessment by Gregory of a sample of patients, characterized by an excellent, even with the 40 (88.89%) patients. In the literature there is no agreement on the method of treatment of the deltoid ligament rupture associated with fractures of the lateral malleolus. Based on theoretical considerations, a number of authors advocate surgical treatment discontinued deltoid ligament. In our series, using suture of the deltoid ligament and osteosynthesis of the lateral malleolus, the best results are obtained with the PAB fracture, lower percentages of excellent results is with the SER fractures. The worst result was obtained with the PER type fracture. Anatomical and functional integrity of all parts of the talocrural joint that allows harmony of movement and stability is achieved with osteosynthesis of lateral malleolus and suture of the deltoid ligament.

Association between roentgenographic findings of the cervical spine and neck symptoms in a Japanese community population

BackgroundRadiographic findings may provide clues to the underlying cause of neck symptoms. However, these associations remain controversial. This study investigates the association between roentgenographic findings of the cervical spine and neck symptoms in a Japanese community population. MethodsA total of 762 volunteers participated in this study. Sagittal radiographs of the cervical spine were taken and a questionnaire about the presence of and visual analog scale (VAS) for neck pain or stiff shoulder was completed. The sagittal alignment of the cervical spine (C2-C7) and the degenerative index were measured from lateral aspect radiographs. Three groups based on the sagittal alignment of C2-C7 were defined: straight-spine, lordotic-spine, and kyphotic-spine. The roentgenographic findings were examined in relation to symptoms. ResultsThe prevalence rate of stiff shoulder on the day of examination was significantly higher in females than males. Although the VAS for neck pain and stiff shoulder on the examination day and for stiff shoulder in the preceding 12 months were not significantly different between females and males, that for neck pain in the preceding 12 months was significantly higher in females than males. Although there was no association between the sagittal alignment of C2-C7 and neck symptoms in males or females, a significant correlation between the degenerative index and VAS for neck pain on the examination day and in the preceding 12 months was seen in females after adjusting for age. The prevalence of and VAS for neck pain and stiff shoulder were not significantly different among the three C2-C7 sagittal alignment groups. ConclusionAlthough the sagittal alignment of the cervical spine was not associated with neck symptoms, degenerative changes were associated with the severity of neck pain in females.

Patellar dislocation due to iatrogenic quadriceps fibrosis: results of operative treatment in 54 cases.

ObjectiveTo evaluate the clinical and functional results of a surgical treatment of patellar dislocation whose etiology was iatrogenic quadriceps fibrosis in children.Materials and methodsA prospective study was undertaken from February 2004 to December 2009. The study included 54 pediatric patients (56 knees) that had developed dislocation of the patella after repeated intramuscular injections of antibiotic(s) into the quadriceps muscle. There were 11 males (20.4 %) and 43 females (79.6 %). The patients’ mean age at surgery was 7 years, 9 months (range 6 years, 4 months to 12 years, 6 months). A complete history of each patient was recorded. The affected knees were evaluated preoperatively and postoperatively on the basis of the symptoms, signs, and roentgenographic findings. Patellar dislocation was classified according Bensahel’s criteria. All patients had a three-part surgical procedure that combined capsulorrhaphy, quadricepsplasty, and transfer of the vastus medialis oblique to the superior border of the patella.ResultsThere has been no poor postsurgical result or recurrence so far; we have noted an ugly scar in nine knees (16.1 %), limitation of the knee flexion in five knees (8.9 %), and loss of extension of 5 °–20 ° in four knees (7.1 %). Overall, we attained excellent results in 39 knees (69.7 %), good results in 13 knees (23.2 %), and fair results in four knees (7.1 %).ConclusionIn our cases of pediatric dislocation of the patella caused by iatrogenic quadriceps fibrosis, the introduced three-part surgical procedure has shown great success in restoring the realignment mechanism of the patella. The technique is simple, safe, and effective in skeletally immature children.

Chondroblastoma of rib in situs inversus

Chondroblastoma is a rare benign cartilaginous tumour accounting for approximately 1% of all bone tumours. It commonly arises from epiphysis of a long bone, particularly the humerus, tibia and femur. Rib is an extremely rare site for this tumour with a few cases reported in the literature. It is commonly seen in children and adults between the ages of 10 - 20 years. Although roentgenographic findings are quite common characteristic of this tumour, it can sometimes be misdiagnosed as giant cell tumour, osteogenic sarcoma and myeloma on histopathology. We report a 26-year-old male patient with situs inversus and chondroblastoma of rib. To the best of our knowledge, this is the first case of chondroblastoma of the rib in a patient of situs inversus. Segmental resection is the treatment of choice. It usually behaves in a benign fashion, but few cases have shown local recurrences and distant metastasis; hence, follow-up of the patient is essential.

Bronchial foreign body misdiagnosed as pulmonary tuberculosis

Retained and neglected foreign bodies in the respiratory tract in children are a common occurrence. Undiagnosed foreign bodies can cause mechanical effects or chemical reactions and may present as chronic pulmonary infection, bronchiectasis, asthma, and lung collapse or lung abscess. Delay in diagnosis, appears to result from a failure to give serious consideration to the diagnosis, normal chest roentgenographic findings, and negative bronchoscopic findings. A case of left bronchial foreign body aspiration is herein reported to illustrate the causes and complications of the delayed diagnosis. It is hoped that this will help sensitize the medical practitioner of the need for a high index of suspicion in children presenting with symptoms suggestive of foreign body aspiration. This study will also serve as advocacy for the provision of adequate bronchoscopic equipments for paediatric practice in our health facilities.

Primary Hydatid Cyst of the Chest Wall

A 69-year-old female was examined in the emergency room for abdominal pain that had recurred during the preceding 4 years. During the physical evaluation no pathology was determined, except for sensitivity to deep palpations in the upper right quadrant of the abdomen. On the chest roentgenogram, a nonhomogeneous dense area with calcific foci was observed adjacent to the right costophrenic sinus (Fig. 1). The thorax tomography revealed a mass lesion of 5 9 6 cm with calcification, which was located in the chest wall of the lower outer region of the right hemithorax (Fig. 2). Abdominal ultrasonography showed a mass that was pressuring the right lobe of the liver from the outside. The acid-fast bacillus test was negative and other laboratory tests were within normal limits. The results of the transthoracic fine-needle aspiration biopsy indicated the presence of necrotic tissue material containing calcifications. The patient was admitted for surgery with the prediagnosis of chest wall tumor. The mass was completely removed by excisional biopsy (Fig. 3). A 7 9 7 cm defect caused by the en bloc chest wall resection was reconstructed using the M. serratus anterior muscle flap. During the histopathological examination, germinative and cuticular membranes showed dystrophic calcification and chronic inflammation, and a hydatid cyst was diagnosed (Fig. 4a, b). The patient was discharged without any complications. Albendazol 15 mg/kg/day was prescribed for 3 months. Upon completion of the 1 year of follow-up, the patient was still asymptomatic and no recurrence was observed, either clinically or radiologically. A hydatid cyst is a parasitic disease caused by Echinococcus granulosus. It is endemic in countries where sheep and cattle farming is prevalent, such as the Middle East, New Zealand, South Africa, and South America. Although hydatid cyst is frequently seen in the liver and lungs, it can lead to disease in any part of the body [1]. Hydatid cysts can be located in the chest wall through to the sternum, ribs, and regional soft tissues. Yilmaz Avci et al. [2] reported that hydatid cysts in the chest wall might form due to either the rupturing of lung hydatid cysts into the pleural space or inoculation. Currently, the primary treatment for hydatid cyst disease is surgery in which all of the parasitic material is removed. Even though the roentgenographic findings are frequently diagnostic for hydatid cyst, in cases where a definite preoperative diagnosis of lesions cannot be reached, a final diagnosis can be made histopathologically through surgical intervention. Thus, the surgical treatment of these patients S. Karapolat Department of Thoracic Surgery, Duzce University School of Medicine, Duzce, Turkey

50 Years Ago in T he J ournal of P ediatrics: A Correlation of Clinical, Electroencephalographic, and Roentgenographic Findings in Children with Epilepsy

50 Years Ago in T he J ournal of P ediatrics: A Correlation of Clinical, Electroencephalographic, and Roentgenographic Findings in Children with Epilepsy

Negative pressure pulmonary edema with laryngeal mask airway use: Recognition, pathophysiology and treatment modalities

Negative pressure pulmonary edema (NPPE) following the use of the laryngeal mask airway (LMA) is an uncommon and under-reported event. We present a case of a 58-year-old male, who developed NPPE following LMA use. After biting vigorously on his LMA, the patient developed stridor upon emergence, with concurrent appearance of blood-tinged, frothy sputum and pulmonary edema. He subsequently required three days of mechanical ventilation. After discontinuation of mechanical ventilation the patient continued to require additional pulmonary support using continuous positive airway pressure, with a full facemask, to correct the persistent hypoxemia. His roentgenographic findings demonstrated an accelerated improvement with judicious administration of intravenous furosemide.

10. A case of right middle lobe pulmonary arteriovenous malformation presenting as non-resolving pneumonia

Background Pulmonary arteriovenous malformations (PAVMs) are direct communications between the smaller pulmonary arteries and veins. These lesions allows blood to bypass the capillary system, flowing from arteries directly into veins. Case history The patient was a 51-year-old male, non-hypertensive, non-diabetic, asthmatic who came in due to recurrent episodes of haemoptysis. Initially this was treated as a case of pneumonia and/or pulmonary tuberculosis (PTB). A CT scan with contrast and CT angiogram were done and revealed AV malformation. He was referred to surgical service for elective thoracotomy and right middle lobe lobectomy. Histopathological findings showed lung tissue exhibiting areas of variably sized thin and partially thick vascular channels. The area was in close proximity to a bronchus and accompanying medium-sized arteries, predominantly extended to the pleural lining. Discussion The diagnosis of PAVM should be suspected in patients with any of the following presentations: (1) one or more pulmonary nodules associated with typical roentgenographic findings, (2) mucocutaneous telangiectases, and (3) unexplained findings such as dyspnoea, haemoptysis, hypoxaemia, polycythaemia, clubbing, cyanosis, cerebral embolism, or brain abscess. A practical approach would be to screen patients initially with chest radiograph, followed by shunt measurement by 100% oxygen. Our case was confirmed with PAVM by CT scan and CT angiogram and underwent right middle lobectomy. Other treatment options are embolisation and lungtransplantation. Conclusion The rarity of PAVMs and the variability of presentation posed a great challenge. Our case, in particular presenting as a non-resolving pneumonia with an unusual location, is a significant contribution to our registry. Its rarity should alert clinicians to include PAVMs in the differential diagnosis of patients with pneumonia and haemoptysis.

Osteoid Osteoma of the Proximal Fibula: An Uncommon Location with the Indication for Open Surgery

Purpose. This is a case report of a patient with an osteoid osteoma of the proximal fibula. The objective is to illustrate a rare tumor location that requires open surgery due to closeness of neurological structures. Methods. Clinical and roentgenographic findings, treatment, and histological appearance are presented. Results. Local pain and swelling of the proximal fibula with improvement under salicylates led to the diagnosis of an osteoid osteoma, what was confirmed with an MRI scan. Due to proximity to the common peroneal nerve, we decided for open surgery. During the operation, the nerve was seen to cross the tumor site making it necessary to retract it to expose the entire tumor. Histologically, typical features of osteoid osteoma with a rather well-defined nidus surrounded by sclerotic bone were seen. A complete removal was performed. Conclusion. Osteoid osteomas of the proximal fibula are rare. When planning surgery, the common peroneal nerve must be identified, and its further distal course should be taken into account to avoid iatrogenic damage to the nerve.

Roentgenographic findings in bronchiolitis

Background. Acute bronchiolitis is a very frequent respiratory infection in infancy characterized by obstructive respiratory distress with crepitations and wheezing. The diagnosis of bronchiolitis is complex because characteristic radiological patterns are combined with each other. The aim of this study is to reveal radiologic changes in patients with acute bronchiolitis. Methods. One hundred and seventy-five children with bronchiolitis in their first wheezing episode were included in this study, who were admitted to the pediatric intensive care unit between 2000 and 2008. All patients underwent X-rays of the lungs in addition to other clinical and laboratory examinations. Results. Our results show that radiological changes were present in all cases: hyperinflation of the lungs in 175 children (100%), perihilar linear density and peribronchal thickening in 121 children (69.14%), bilateral bronchopneumonia in 44 children (25.14%), lobar pneumonia in 26 children (14.85%) and atelectasis in 28 children (16%). Usually radiological changes appear in combined forms: pulmonary hyperinflation and pulmonary trauma signs in 121 children (69.14%), pulmonary hyperinflation with bronchopneumonia and atelectasis in 31 children (17.71%), pulmonary hyperinflation with lobar pneumonia and atelectasis in 23 children (13.14%). Conclusions. We conclude that pulmonary hyperinflation and perihilar linear density are more evident when the auscultatory findings are poor. This fact has a practical value and is the main cause for the disappearance of alveolar consolidation. The differentiation between viral and bacterial bronchopneumonia as well as pneumonia and atelectasis is specially important. The radiological aspect gives us guidance for therapeutic follow up and treatment.

Cervical Myelopathy from Spinal Sarcoidosis as the Unexpected Initial Presentation for Systemic Sarcoidosis

This is a case which highlights unique diagnostic challenges in the evaluation of a previously healthy patient presenting with a myelopathy initially most concerning for malignancy. However, timely recognition and nonoperative therapy of unexpected spinal sarcoidosis with corticosteroidal therapy was crucial in averting the sequelae of undiagnosed or misdiagnosed neurosarcoidosis, which can be devastating and life-threatening. Diagnosis is challenging due to significant similarities in clinical and roentgenographic findings of spinal sarcoidosis with infection, inflammation, and malignancy. Our case demonstrates that diagnosis of spinal sarcoidosis is especially elusive when it is the initial manifestation of sarcoidosis.

67Ga accumulation in pulmonary lesions associated with bleomycin toxicity

The radionuclide, gallium-67, accumulates in a wide variety of neoplastic and inflammatory lesions. Diffuse bilateral lung localization of67Ga occurred in two cases of interstitial pneumonitis associated with bleomycin therapy. Clinical symptoms and laboratory evaluation of pulmonary status correlated with scintigraphic studies in these two patients, while discrepancies between scinti-graphic and roentgenographic findings were observed.Cancer 36:1966–1972,1975.

Injury to Endoscopic Personnel from Tripping over Exposed Cords, Wires, and Tubing in the Endoscopy Suite: A Preventable Cause of Potentially Severe Workplace Injury

BACKGROUND The endoscopy unit before remediation may be a high-risk area for slip and fall injuries due to a large number of exposed above-the-floor wires in the endoscopy rooms, dimmed lighting during endoscopic procedures, and staff inattention to obstacles due to preoccupation with the endoscopic patient. AIM To describe a novel, previously unappreciated workplace hazard to endoscopic personnel: Exposed wires in the endoscopy unit.METHODS This study is a retrospective review of 110,000 endoscopic procedures performed during the last 5 years at an academic, teaching hospital with a high-volume endoscopy unit. All significant orthopedic injuries to endoscopic personnel from slips, twists, and falls from tripping over exposed cords in the endoscopy unit were reviewed. The severity of injury was documented based on roentgenographic findings, number of days of missed work, number of days with a modified work schedule, and requirement for orthopedic surgery. The number of potentially exposed cords per endoscopy room was determined. RESULTS During the 5-year study period, three endoscopic personnel suffered significant orthopedic injuries from slips, twists, and falls from tripping over cords, wires, or tubing lying exposed over the floor in the endoscopy suite: The resulting injuries consisted of fourth and fifth metacarpal hand fractures due to a fall after tripping on oxygen tubing; a rib fracture due to tripping on electrical wires trailing from an endoscopy cart; and a grade II ankle sprain due to the foot becoming entangled in oxygen tubing. All injuries resulted in lost days of work [mean 9.3 +/- 11.0 (SD) days] and in additional days of restricted work (mean 41.7 +/- 31.8 days). One injury required orthopedic surgery. Hospital review revealed a mean of 35.3 +/- 7.5 cords, wires, or tubing per endoscopy procedure room, the majority of which were exposed above the floor before remediation (n = 10 rooms). Remediation of exposed wires included: bundling related wires together in a cable to reduce the number of independent wires, covering exposed wires on the floor with a nonslip heavy mat, and running wires from ceiling outlets to equipment high above ground (e.g. mounted endoscopy video monitors). CONCLUSIONS Tripping, slipping, and falling over exposed wires can cause significant injury to endoscopic personnel. This previously undescribed hazard should be preventable by simple remediation, and all endoscopic personnel, hospital architects, hospital administrators, and governmental regulators should be alerted to this potential hazard

Imaging Features of the Total Anomalous Pulmonary Venous Connection to the Portal Vein Shown by Multidetector Computed Tomography Angiography

A 2-month-old girl with ventriculoseptal defect and pulmonary hypertension (PHT) presented with respiratory distress and coughing. Peroral cyanosis, tachypnea, dyspnea, growth retardation, systolic murmur, crepitant rales in both lungs, and hepatomegaly were discovered at the physical examination. A chest roentgenogram showed a normal-sized heart and mild venous congestion. Echocardiography exhibited a small perimembranous ventriculoseptal defect. The pulmonary veins were draining into the portal vein through a vertical vein. Angiography showed drainage of the pulmonary veins into a portal vein via a vertical vein. The superior vena cava and right atrium were filling via an innominate vein. Multidetector computed tomography (MDCT) angiography showed that the right and the left pulmonary veins were joined at the anterior side of the proximal descending aorta, forming the vertical vein. The latter connected to the portal confluens, with the splenic vein and superior mesenteric vein below the diaphragm (Figs. 1 and 2). There also was hepatomegaly, but no congenital anomaly of the pulmonary arteries and lungs was observed. Despite conservative therapy, the girl died in 2 weeks because of congestive heart failure and pneumonia. The infradiaphragmatic total anomalous pulmonary venous connection (TAPVC) is almost always obstructed or narrowed when it passes through the diaphragm. However, no obstruction was observed in the reported case. Because no congenital anomaly was found in the lungs or pulmonary arteries and because the pulmonary venous return was not partial, ‘‘scimitar syndrome’’ was easily excluded. The snowman figure seen on the chest radiographs is due to enlargement of the left vertical vein and superior vena cava and characteristic of type 1 TAPVC. In contrast, other types of TAPVC show nonspecific roentgenographic findings. Nonobstructive types include cardiomegaly with right atrial and right ventricular enlargement, an enlarged pulmonary vein, and increased pulmonary flow. Obstructive types demonstrate

Clinical Features of Pulmonary Langerhans Cell Histiocytosis in Korea

Methods: The patients with PLCH confirmed by biopsy at any body site were included and the patients should have lung lesions present. A questionnaire that had items on the symptoms, lung function tests, the roentgenographic findings and the treatment was collected retrospectively at a Korean ILD Research Meeting. Results: A total of 56 cases were collected. The number of males and females was 48 and 8, respectively, and their median age was 43 years (range: 18∼67 years). The patients were current or ex-smokers in 79% of the cases. The most frequent symptom was coughing (39%), followed in decreasing order by dyspnea (38%), sputum (20%) and chest pain (20%). Pneumothorax was observed in 16 (29%) patients. Lung function tests showed a normal, restrictive, mixed or obstructive pattern in 26 (61%), 7 (16%), 7 (16%) and 3 patients (7%), respectively. Nodular-cystic lesion was most frequently observed in 59% of the patients on HRCT. The lung lesions were located in the middle and upper lobes in almost the cases. The median follow-up period was 90 months (range: 1 ∼180 months) and only two patients died during this period. Conclusion: This study provides a national survey of the patients with PLCH during a long follow-up period.