Thoracic Manifestations Research Articles

Hallazgos radiológicos del compromiso torácico de las enfermedades dermatológicas: lo que los dermatólogos debemos saber

Existe una gran relación entre las enfermedades dermatológicas y sus manifestaciones torácicas. Su detección temprana no solo es importante para orientar el diagnóstico con su consecuente correlación con las manifestaciones cutáneas, también ayuda a dirigir el manejo clínico apropiado, principalmente el de la enfermedad pulmonar intersticial asociada a las patologías del tejido conectivo. Este artículo de revisión muestra la correlación clínica y radiológica de las principales entidades infecciosas, inflamatorias, del tejido conectivo, hereditarias y adquiridas de tipo dermatológico que presentan compromiso pulmonar asociado. Además, proporciona evidencia de la importancia en la realización de una tomografía computarizada multidetectora en la detección de la patología del parénquima pulmonar, que puede pasar desapercibida en la radiografía de tórax, y se proporciona una explicación de la terminología radiológica básica clave para el entendimiento por parte del dermatólogo.

Thoracic Manifestations of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is one of the most common chronic systemic inflammatory diseases and the most common chronic inflammatory arthritis. Classically a progressive symmetric polyarthritis, RA is characterized by inflammation, erosions, bone loss, and joint destruction. Up to half of patients with RA exhibit extra-articular manifestations (EAMs), which may precede articular disease and are more common in patients with seropositive RA (patients with detectable serum levels of rheumatoid factor and/or anticitrullinated peptide antibodies). Cardiovascular and pulmonary EAMs are the largest contributors to morbidity and mortality in RA and may be especially devastating. Imaging has a significant role in diagnosing these EAMs and assessing response to treatment. Although treatment with disease-modifying antirheumatic drugs has redefined the natural history of RA and helped many patients achieve low disease activity, patients are at risk for treatment-related complications, as well as infections. The clinical features of drug-induced lung disease and infection can overlap considerably with those of EAMs, presenting a diagnostic challenge. Radiologists, by recognizing the imaging characteristics and evolution of these various processes, are essential in diagnosing and distinguishing among EAMs, treatment-related complications, and unrelated processes and formulating an appropriate differential diagnosis. Moreover, recognizing these disease processes at imaging and contextualizing imaging findings with clinical information and laboratory and pathologic findings can facilitate definitive diagnosis and proper treatment. The authors review the articular and extra-articular thoracic imaging manifestations of RA, including cardiovascular, respiratory, and pleural diseases, as well as treatment-related complications and common infections. ©RSNA, 2021.

Рецидивирующий напряженный катамениальный пневмоторакс у пациентки с эндометриозом

Catamenial pneumothorax is a rare cause of spontaneous pneumothorax in women of reproductive age and one of the thoracic endometriosis manifestations. Researchers have shown an increased interest in catamenial pneumothorax but a clear treatment strategy for this pathology has not been developed yet. The thoracoscopic revision of the pleural cavity, as well as the identification and subsequent histological verification of ectopic endometriosis foci, play a crucial role in patient management. This case report describes the successful treat-ment of a patient with recurrent catamenial tension pneumothorax and following multidisciplinary analysis. Keywords: catamenial pneumothorax, thoracic endometriosis, histological examination

A RARE PRESENTATION OF GRANULOMATOSIS WITH POLYANGITIS

SESSION TITLE: Fellows Pulmonary Manifestations of Systemic Disease Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Granulomatosis with polyangiitis (GPA) is a small to medium vessel vasculitis, usually ANCA positive. Clinically this disease is difficult to diagnose, as presentations vary. Patients can have ear, nose, and sinus disease as well as rapidly progressive glomerulonephritis.1 Renal complications occur in up to 75% of patients.1 Rare pulmonary complications include alveolar hemorrhage, nodules, and cavitary lesions. Seldom these patients have mediastinal lymphadenopathy and obstructive lung disease.2 Here we present a case of a woman who developed pulmonary nodules, lymphadenopathy, and obstructive lung disease due to GPA. CASE PRESENTATION: Our patient is a 75yo female nonsmoker with a history of polymyalgia rheumatica in remission that endorsed one year of dyspnea on exertion, hoarseness, and 20 lb weight loss. PFTs noted obstructive ventilatory defect meeting criteria for severe COPD. CT chest revealed multiple pulmonary nodules, mediastinal lymphadenopathy, and emphysematous change throughout of unknown duration as she did not have any previous imaging. CT-guided biopsy pathology showed chronic inflammatory changes, but no malignant cells. PET scan had hypermetabolic nodules bilaterally worrisome for metastasis. Bronchoscopy noted subglottic edema, but we were unable to pass ETT, so EBUS and ENB were aborted. She was noted to have mucosal inflammation throughout the tracheobronchial tree. Repeat CT-chest showed bilateral spiculated nodules increasing in size and number compared to prior scan. Second CT-guided biopsy pathology showed chronic inflammation and fibrosis with small noncaseating granulomas. Based on in-house and outside pathology consult, it was decided she likely had GPA. After evaluation by rheumatology she started rituximab infusions, but pulmonary nodules remained stable in size. P and c-ANCA were negative, along with negative c-ANCA by immunofluorescence. RF, CCP, ESR, CRP and renal function were within normal limits. CT maxillofacial was negative. DISCUSSION: When a vasculitis is suspected, a negative ANCA does not exclude the diagnosis of GPA, so further investigations, such as biopsy, should be considered. The lung is the most common site biopsied. Our case presented a diagnostic challenge given her presentation with a COPD-like syndrome and significant weight loss, as well as p-ANCA negativity. By some estimates <10% of cases of GPA present with isolated disease, such as in our patient.3 CONCLUSIONS: Prompt diagnosis for GPA is needed as the mortality is high without treatment. Treatment includes immunosuppression with glucocorticoids, methotrexate, azathioprine or cyclophosphamide.1 Our case highlights the importance of the pathologist in the diagnosis of small vessel vasculitis to lead the care team to the correct and rapid diagnosis. Reference #1: Seo P, Stone JH. The Antineutrophil Cytoplasmic Antibody-Associated Vasculitides. Am J Med. 2004; 117: 39-50. Reference #2: George TM, Cash JM, Farver C, et al. Mediastinal mass and hilar adenopathy: rare thoracic manifestations of Wegener's granulomatosis. Arthritis Rheum. 1997;40:1992–1997. Reference #3: Ananthakrishan L, Sharma N, Kanne JP. Wegner's Granulomatosis in the Chest: High-Resolution CT Findings. AJR 2009: 192; 676-682. DISCLOSURES: My spouse/partner as a Consultant relationship with Abbvie Please note: $1-$1000 Added 05/27/2020 by Ebtesam Islam, source=Web Response, value=Consulting fee No relevant relationships by Ximena Solis, source=Web Response

SYMPTOMATIC PULMONARY AND INTRACRANIAL NODULES IN A PATIENT WITH LONGSTANDING, UNCONTROLLED RHEUMATOID ARTHRITIS

SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pulmonary manifestations of rheumatoid arthritis (RA) are found in 60-80% of all RA patients and are responsible for 10-20% of RA-related mortality. RA nodules are observed in approximately 20% of RA patients with 20- 32% prevalence pulmonary RA nodules. Rarer intracranial RA nodules have been described in two case studies.1 Here we present a patient who demonstrates significant symptomatic pulmonary nodulosis along with intracranial nodules leading to intractable seizures and ventilator support. CASE PRESENTATION: Our patient was a 67-year-old woman with a 9-year history of RA, recurrent bilateral knee septic arthritis, and three months of focal seizures who presented to the emergency department for breakthrough focal seizures. Prior magnetic resonance imaging (MRI) showed contrast enhancing right temporal and right thalamic nodules up to 4mm consistent with electroencephalogram (EEG) localization of the seizures. Rheumatologically, the patient had RA flares multiple times per month despite maximal doses of hydroxychloroquine, leflunomide, and methrotrexate (MTX). 6 months prior, an outpatient Chest CT ordered for evaluation of dyspnea showed multiple solid and cavitary pulmonary lesions. Endobronchial ultrasound with biopsy of nodules showed necrotizing granulomatous inflammation consistent with RA nodules. During hospitalization, the patient presented with mildly elevated CRP, RF, and anti-CCP, and mildly decreased complement C3 but otherwise normal exam and negative serologic and cerebrospinal fluid tuberculosis, fungal, bacterial, viral, cancer and autoimmune workup. Repeat imaging showed multiple new bilateral pulmonary nodules up to 2.3 cm with stable intracranial nodules despite empiric acyclovir. The patient continued to have seizures in the unit despite maximal doses of intravenous seizure medication, six days later developing, ultimately fatal severe metabolic acidosis, bradycardia, and hypotension. DISCUSSION: This unique case of symptomatic intracranial and pulmonary nodules in the setting of RA does not have much literature accompaniment, but we hope to add our experience to a potential disease etiology. Several case reports, however, do show reduction in pulmonary nodule size with oral steroid courses. There is currently no strong consensus on treatment of RA nodules. While RA nodules are often considered relatively benign, in this patient the EEG and imaging finding suggest that the nodules may have significantly contributed to this patient’s breakthrough seizures. Unfortunately due to this patient’s comorbidities and tenuous medical status, pathologic review of the brain lesions was not obtained. CONCLUSIONS: This report highlights the need to consider RA as a potentially reversible cause when considering unexplained systemic findings, as well as the need for more research into treatment of extraarticular manifestations of RA. Reference #1: Esposito AJ, Chu SG, Madan R, Doyle TJ, Dellaripa PF. Thoracic Manifestations of Rheumatoid Arthritis. Clin Chest Med 2019;40(3):545–560. DISCLOSURES: No relevant relationships by Oleh Hnatiuk, source=Web Response No relevant relationships by adarsh vangala, source=Web Response No relevant relationships by Nicholas Villalobos, source=Web Response

It's Not All in Your Head: Thoracic Manifestations of Neurologic Diseases and Disorders

Myriad conditions may affect both the neurologic system and the thorax, while other diseases primarily affecting the thorax may manifest with neurologic abnormalities. Correlation of signs, symptoms, and imaging findings in the neurological system with those in the thorax can help diagnose certain conditions and/or guide further diagnostic work-up and treatment. We will review and illustrate the imaging appearance of several systemic/neurological diseases with thoracic manifestations as well as discuss conditions in the thorax that can lead to neurologic symptoms.

Thoracic Manifestations of Primary Immunodeficiency Disorders.

Primary immunodeficiency disorders (PIDD) are a group of disorders presenting with recurrent infections. The authors retrospectively reviewed the imaging records of 24 proven cases of PIDD and correlated the imaging findings with the type of defect. Final diagnoses were categorized in four groups; Group I (humoral immunodeficiency), Group 2 (cell mediated immunodeficiency), Group 3 (phagocytic disorders) and Group 4 (others). Group 3 was the commonest, followed by 1 and 2. Three most common disorders encountered were chronic granulomatous disease (CGD) (7/24), hyper IgE syndrome (5/24) and common variable immunodeficiency (CVID) (4/24). Consolidation (12/24), nodules (10/24), bronchiectasis (9/24) and lymphadenopathy (8/24) were the commonest imaging findings. Although not statistically significant, some definite imaging trends could be established. Presence of consolidation and nodules; with absence of bronchiectasis was the striking finding in Group 3. Group 2 disorders predominantly showed bronchiectasis, whereas presence of consolidation, nodules, bronchiectasis all were very common in Group 1.

Lung Manifestation of Collagen Vascular Disease in HRCT

Background: The aim of this paper was to evaluate the thoracic manifestations associated with the Connective tissue disorders, with an emphasis on interstitial and airway disease pattern on the High Resolution computed tomography (HRCT) findings. Subjects and Methods: The present study was conducted for a period of one year. A total of 50 patients with various connective tissue disorders having respiratory complaints were evaluated. Results: During the study period 50 patients (80%females and 20%males) underwent evaluation. Cough and dyspnea were the most common presenting symptoms. Variety of thoracic abnormalities weredetected in 67 (95%) cases. Most common abnormality detected on HRCT was interstitial fibrosis/interstitial lung disease present in (60%) cases. Most common parenchymal abnormalities seen were reticulations (61.4%), ground glass opacification (40%), mosaic attenuation (32.8%) and honeycombing (24.3%). Airway abnormalities seen were bronchiectasis (48.5%), emphysema (12.8%), and ground glass nodules (2.8%). Conclusion: Interstitial lung disease is the most common pulmonary manifestation among patients with connective tissue disorders, and early detection and prompt treatment is expected to improve the outcome.

Uncommon thoracic manifestations from extrapulmonary tumors: Computed tomography evaluation - Pictorial review

Although metastasis can occur at a variety of sites, pulmonary involvement is common in patients with cancer. Depending on the source and type of tumor, pulmonary metastases present with a wide range of radiologic appearances. Hematogenous dissemination through the pulmonary arteries to the pulmonary capillary network is the most common form of spread in pulmonary metastases. However, they may also reach the lung via lymphatic dissemination, secondary airway involvement, vessel tumor embolism, and direct chest invasion. In the evaluation of patients with known extrathoracic tumors, CT is the state-of-the-art imaging modality for detecting and characterize pulmonary metastases as well as to predict resectability. Although CT limitations are well known, knowledge of growth rates of various tumors and understanding the pattern of spread may be helpful clues in suggesting and even establish the specific diagnosis. The purpose of this pictorial review is to discuss the imaging appearances of different patterns of intrathoracic tumoral dissemination.

Lung Transplantation after Allogeneic Stem Cell Transplantation: A Single-Centre Experience

Pulmonary chronic graft versus host disease (GVHD) is one of the thoracic manifestations that can complicate allogeneic hematopoietic stem cell transplantation (HSCT) causing respiratory failure and death. Lung transplantation (LTx) often remains the only therapeutic option for progressive forms although it has been reported in a small number of patients worldwide. This retrospective study focused on patients who underwent LTx for pulmonary GVHD in our Centre and consisted in a careful review of all crucial post-transplantation clinical (primary graft dysfunction, CLAD-free survival, overall survival) and pathological data [acute rejection and infection indices in all follow-up scheduled bronchoscopies (total number of biopsies: 35, total number of bronchoalveolar lavages: 33), signs of chronic rejection]. 467 patients underwent LTx in the 1995-2019 period: in 5 cases the referral diagnosis was pulmonary chronic GVHD (1%) [all males, mean age: 27±13 yrs, two patients aged ≤16, developed 23±14 months following HSCT for neoplastic conditions (mean±SD)]. At census date, 2 were alive (40%) with a median (Q1-Q3) follow-up of 59 (17-64) months. At 5 years post-LTx the overall survival was 60%. One patient died for multiorgan failure early after LTx. Two deaths occurred after 17 and 64 months due to infectious complications (cytomegalovirus, CMV) and, interestingly, only these cases developed CLAD with features of obliterans bronchiolitis during follow-up (at 8 and 13 months, respectively). At the last follow-up, no patients had a recurrence of haematological malignancy and the two patients who are still alive (at 80 and 59 months) have had viral infections but never CMV. Acute rejection index was 18% (12%-23%), if we consider only the first year post-LTx it was 10% (0%-32%) while in age-matched patients transplanted for cystic fibrosis (CF) at our centre it was 29% (12.5%-50%). Finally, the infection index was 50% (32%-66%). All indices are expressed as median (Q1-Q3). LTx is a feasible option for patients with severe GVHD. Survival is in line with data reported in the literature, as well as with the general LTx population; deaths were mainly related to CMV infections. Concerning acute rejection indexes, they were lower than those detected at our Centre when considering all LTx patients or only those with CF.

Thoracic tomographic manifestations in symptomatic respiratory patients with COVID-19.

China was the epicenter for the novel coronavirus disease (COVID-19), which quickly spread to other Asian countries and later to Western countries; subsequently, COVID-19 was categorized as a pandemic by the World Health Organization. Diagnosis primarily depends on viral detection in respiratory samples; however, available kits are limited, lack high sensitivity, and have a long turnaround time for providing results. In this scenario, computed tomography has emerged as an efficient and available high-sensitivity method, allowing radiologists to readily recognize findings related to COVID-19. The objective of this article is to demonstrate the main tomographic findings in symptomatic respiratory patients with COVID-19 to assist medical professionals during this critical moment.

Diagnosis issues in sarcoidosis

Multiple problems may be encountered during the diagnosis of sarcoidosis: at first diagnose sarcoidosis in an appropriate clinical setting, secondly, identify any manifestation to be linked to sarcoidosis at diagnosis work-up and during evolution; thirdly, recognize “danger” in sarcoidosis and parasarcoidosis syndromes, and finally, diagnose sarcoidosis recovery. Diagnosis is often delayed as presentation may be diverse, non-specific, or atypical. Diagnosis of sarcoidosis is based on three criteria: a compatible presentation; evidence of non-caseating granulomas and exclusion of any alternative diagnosis. However, even when all criteria are fulfilled, the probability of sarcoidosis diagnosis varies from definite to only possible depending upon the presence of more or less characteristic radio-clinical and histopathological findings and on the epidemiological context. Bilateral hilar lymphadenopathy and/or diffuse lung micronodules mainly along lymphatics are the most frequent highly suggestive findings. Evidence of granulomas relies on superficial biopsies of clinically suspected lesion when present or most often by bronchial endoscopy. The diagnosis of sarcoidosis may be difficult in absence of thoracic or skin manifestations and may require the benefit of hindsight before being definitive. Differential diagnoses, mainly tuberculosis, must be considered. The diagnosis of events during evolution relies on serial clinical, pulmonary function, radiographic evaluation and on extrapulmonary manifestations work-up, including electrocardiogram and blood biology. Affected organs need to be related to sarcoidosis using an appropriate diagnostic assessment instrument. To declare the recovery of sarcoidosis, all manifestations must have disappeared spontaneously or after 3–5 years post-treatment without relapse.

The thoracic air-leak syndrome (TALS): the frequency of occurrence and radiological signs in the structure of late non-infectious lung lesions in children after the allogeneic HSСT

The thoracic air-leak syndrome (TALS) can be a presentation of late-onset noninfectious pulmonary complications in children with a chronic pulmonary graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation. We determined the frequency of occurrence of TALS in patients of the Center after HSСT in the period from January 2012 to December 2017. We have described the main X-ray signs of the Thoracic air-leak syndrome and manifestations of late onset noninfectious pulmonary complications in children. The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology. Parents patients agreed to use personal data in research and publications.

Thoracic Manifestations of Genitourinary Neoplasms and Treatment-related Complications.

Genitourinary (GU) malignancies are a diverse group of common and uncommon neoplasms that may be associated with significant mortality. Metastases from GU neoplasms are frequently encountered in the chest, and virtually all thoracic structures can be involved. Although the most common imaging manifestations include hematogenous dissemination manifesting with peripheral predominant bilateral pulmonary nodules and lymphatic metastases manifesting with mediastinal and hilar lymphadenopathy, some GU malignancies exhibit unique features. We review the general patterns, pathways, and thoracic imaging features of renal, adrenal, urothelial, prostatic, and testicular metastatic neoplasms, as well as provide a discussion of treatment-related complications that might manifest in the chest. Detailed reporting of these patterns will allow the imager to assist the referring clinicians and surgeons in accurate determination of the stage, prognosis, and treatment options available for the patient. Awareness of specific treatment-related complications further allows the imager to enhance patient safety through accurate and timely reporting of potentially life-threatening consequences of therapies.

Noncaseating granulomatous diseases in germ cell cancer patients–A single-center experience

ObjectivesIn patients with testicular Germ Cell Tumors (GCT) noncaseating granulomatous diseases such as Sarcoid Like Lesions (SLL) or Sarcoidosis can mimic metastasis due to hilar or mediastinal lymphadenopathy. Due to the clinical and prognostic impact, exclusion of malignant diseases is mandatory. Material and methodsRetrospectively, data from 636 GCT patients, who were seen in the course of tumor surveillance/follow-up were collected. Focus was put on the detection of tumor relapse vs. noncaseating granulomatous reactions. For the differential diagnosis of thoracic lymphadenopathy or pulmonary infiltrates either bronchoscopy (e.g., endobronchial ultrasound-guided transbronchial needle aspiration, endobronchial ultrasound-guided transbronchial needle aspiration) or thoracic surgery was performed. Both GCT patients with either tumor relapse or coexisting SLL were compared to GCT patients without SLL and tumor relapse. ResultsTwenty-nine patients suffered from suspected tumor relapse. Whereas thoracic relapses were suspected in 15 patients on chest computed tomography, thoracic relapse was confirmed in 5 cases by open surgery. In 2 cases open surgery yielded reactive lymphadenitis, and in 8 cases SLL was diagnosed either via EBUS-TBNA (n = 7) or thoracoscopic wedge resection plus lymphadenectomy (n = 1). With focus on overall survival, no relevant difference was found between all tested subgroups (P = 0.265; logrank test). ConclusionsIn GCT patients, the coexistence of noncaseating granulomatous disease is common. Minimal invasive bronchoscopic techniques can serve for the cytopathologic exclusion of malignant thoracic manifestations. In our monocenter patient group the coexistence of SLL did not have any prognostic impact on overall survival.

Aneurysmal Bone Cyst of the Rib: An Unusual Tumour at an Unusual Location. A Case Report and Review of Literature

Aneurysmal bone cysts are uncommon bony abnormalities that most often affect those in the third decade of life, but are rarely seen in the thoracic cage. This study reported the case of a recurrent lesion in a 37-year-old gentleman who had undergone initial curettage of the aneurysmal bone cyst 14 years earlier. The lesion involved the anterior right chest wall, in particular arising from the third rib, and presented with intermittent chest pain over a 12-month period. Computed tomography scan demonstrated a large mass deep to the pectoral muscles, which expanded both inward into the pleural space as well as externally. Histopathology confirmed the diagnosis, with a similar appearance to the original tumour. This case highlighted the importance of complete resection whenever possible, rather than curettage. The literature relating to the thoracic manifestations of these tumours was reviewed with a focus on typical clinical manifestations, radiological and histological identifiers, and the key elements of management to avoid problems of recurrence and malignant transformation.

Thoracic manifestations of Gynecological tumors: Airway and lung parenchymal involvement commoner in endometrial and ovarian cancers while pleural and interstitial involvement is predominant in cervix malignancies

Introduction:The thorax is a frequent site of metastasis from numerous non-pulmonary cancers. Intrathoracic metastatic disease may manifest in a variety of forms, including solitary or multiple pulmonary nodules, endobronchial tumor, lymphangitic carcinomatosis, or a pleural effusion.Material and Methods:This is muticentric, observational study conducted in Pulmonary Medicine, MIMSR medical college & Venkatesh chest hospital and critical care center, Latur during June 2012 to November 2016 to observe various thoracic manifestations of gynecological malignancies. Total 2300 cases of various gynecological malignancies were screened and finally 330 cases showing various thoracic manifestations were enrolled after subjecting those cases to inclusion and exclusion criteria. All study cases were subjected to chest radiological investigations and histopathological investigations whenever necessary to diagnose metastatic disease. Hospital’s ethical committee & IRB approval has been taken and written informed consent of patient was taken before enrollment.Results:Screened total 2000 cases of gynecological malignancies (ovary, endometrium, cervix & benign ovarian tumors) and selected 330 cases with various metastatic thoracic manifestations. Malignant gynecological tumors including endometrial, cervical & ovarian cancers predominantly observed in above 50 years of age while benign ovarian and uterine tumors in below 50 years of age (p<0.00001). In study of 100 cases of ovarian cancer with thoracic manifestation, documented lung mass lesion as predominant involvement in 38% cases, pleural effusion in 19% cases & lymphangitic carcinomatosis in 11 % cases. In study of 100 cases of endometrial cancer with thoracic manifestation, documented lung mass lesion as predominant in 58% cases, endobronchial metastasis in 16% cases & lymphangitic carcinomatosis in 6 % cases. In study of 100 cases of cervical cancer with thoracic manifestation, documented lymphangitic carcinomatosis as predominant in 36 % cases, pleural effusion in 26% cases & endobronchial metastasis in 5 % cases. Lung metastasis and endobronchial involvement documented predominantly in ovarian and endometrial malignancies while pleural effusion and lymphangitic carcinomatosis documented predominantly in cervical malignancies (p<0.00001). Involvement of airway (endobronchial metastasis) and lung parenchymal mass lesion predominantly documented in endometrial malignancies; lung parenchymal (mass lesion) with lymphangitic carcinomatosis in ovarian malignancies and predominantly pleural involvement with lymphangitic carcinomatosis documented in cervical malignancies (p<0.003).Conclusions:Thoracic metastatic manifestations of gynecological tumors are underdiagnosed & less reported in clinical practice because of lack of suspicion & use of modern radiological techniques to diagnose these lesions. Cases with gynecological tumors with respiratory symptoms should be evaluated with all possible conventional & advanced diagnostic methods to document metastatic manifestations of these tumors to have successful treatment outcome and longevity in survival.

Thoracic involvement in IgG4-related disease in a UK-based patient cohort.

IgG4-related disease (IgG4-RD) is a multi-system fibro-inflammatory disorder with classical histopathological findings, often in the context of elevated serum IgG4 levels. The thoracic manifestations of IgG4-RD are numerous and can mimic several common and better known conditions. The objective of this study was to outline the frequency and nature of thoracic involvement in a prospective cohort of IgG4-RD patients who met defined diagnostic criteria. Over 40% of IgG4-RD patients had clinicoradiological and/or histological evidence of thoracic involvement, predominantly mediastinal lymphadenopathy, the majority associated with multi-system disease outside the chest. Thoracic involvement was associated with a higher serum IgG4 level, potentially representing greater disease activity or spread. Our data highlight the diverse nature of thoracic IgG4-RD, and the importance of knowledge and recognition of the condition among respiratory physicians who are likely to encounter this disease entity on an increasing basis.

Pulmonary and Thoracic Vascular Involvement in Behcet's Disease on CT

Behcet’s disease (BD) is characterized by recurrent oral and genital ulcerations, ocular and additional clinical manifestations. The exact cause of the disease is unknown. Thoracic manifestations of BD show a wide spectrum including vascular, mediastinal, pleural and parenchymal involvement. CT is the imaging modality that provides the assessment of the thoracic presentations of BD. The typical presentations of BD are aneurysms of the pulmonary arteries and venous occlusion. Aneurysms of the aorta, occlusion of vena cava superior, venous aneurysms, mediastinal lymphadenopathy, mediastinal fibrosis, pneumonia, pulmonary hemorrhage, infarction, pleural and pericardial effusions, and pleural nodules are other thoracic manifestations of BD. Assessment of these thoracic involvements can be used in the diagnosis of BD.

Imaging of Systemic Sclerosis (Scleroderma)

Systemic sclerosis (scleroderma) is a chronic autoimmune connective tissue disease involving excess collagen production and deposition, resulting in fibrosis of the skin, vasculature, lungs, and visceral organs including the heart. Its pathogenesis remains unknown. It affects middle-aged women more commonly than men. The majority of patients with systemic sclerosis have clinical symptoms such as dry cough and exertional dyspnea. This article presents and discusses various radiologic manifestations of systemic sclerosis, with particular focus on the thoracic and cardiac manifestations, and musculoskeletal and gastrointestinal involvement.