Eun-Young Kang

Cytomegalovirus pneumonia in transplant patients: CT findings.

OBJECTIVEnOur goal was to assess the CT findings of cytomegalovirus (CMV) pneumonia in transplant patients.nnnMATERIALS AND METHODSnThe study included 10 transplant patients who had chest CT scan and pathologically proven isolated pulmonary CMV infection. Five patients had bone marrow transplant and five had solid organ transplant. The CT scans were retrospectively reviewed for pattern and distribution of disease and the CT findings compared with the findings on open lung biopsy (n = 9) and autopsy (n = 1).nnnRESULTSnNine of 10 patients had parenchymal abnormalities apparent at CT and 1 had normal CT scans. The findings in the nine patients included small nodules (n = 6), consolidation (n = 4), ground-glass attenuation (n = 4), and irregular lines (n = 1). The nodules had a bilateral and symmetric distribution and involved all lung zones. The consolidation was most marked in the lower lung zones.nnnCONCLUSIONnThe CT findings of CMV pneumonia in transplant patients are heterogeneous. The most common patterns include small nodules and areas of consolidation.

Interlobular septal thickening : patterns at high-resolution computed tomography

Thickening of the interlobular septa is a common and easily recognizable finding at high-resolution computed tomography (HRCT; 1–2 mm collimation high-spatial-frequency reconstruction algorithm). Interlobular septal thickening at HRCT can be smooth, nodular, or irregular in contour. It may be due to fluid, cellular infiltration, or fibrosis. Apparent thickening of septa at HRCT may also be due to abnormalities in the periphery of the secondary pulmonary lobule adjacent to but not involving the interlobular septa. This article illustrates the patterns of interlobular septal thickening at HRCT in various disease entities.

Large cell neuroendocrine carcinoma of the lung: radiologic and pathologic findings.

Purpose The purpose of this work was to determine the radiologic and pathologic findings of large cell neuroendocrine carcinoma (LCNEC). Method We retrospectively evaluated chest radiographs, CT scans, and pathologic findings of five patients with pathologically confirmed LCNEC. They were confirmed by percutaneous needle biopsy (n = 2) and by surgery (n = 3). The average age of patients was 60 (51–70) years, and all five were smokers (mean 30 pack-years) and men. Radiologic findings were reviewed for the pattern of lesion, location, and associated findings by two radiologists under consensus. Pathologic findings were reviewed by two pathologists. Results In all five patients, tumors were represented as a peripherally located nodule or mass without associated secondary pneumonitis or distal atelectasis radiographically. On CT scan, masses were oval or round and well demarcated with lobulated margin in all cases, their sizes ranged from 2 to 5 cm, and they did not show internal calcification and necrosis. On contrast-enhanced CT, three cases showed moderate enhancement more than the chest wall muscle. Lymphadenopathy was observed in ipsilateral hilar and mediastinal areas in three cases. Distant metastasis to liver was noted in one case. One case of LCNEC was Stage IV, two were Stage IIIa, and two were Stage Ia at the time of diagnosis. Conclusion Although the epidemiology of LCNEC is more similar to that of small cell carcinoma than atypical carcinoids, in its strong association with smoking, rapid progression, and poor prognosis, our five cases of LCNEC show peripherally located pulmonary nodule or mass with or without regional lymphadenopathy, which are findings similar to those of atypical carcinoids rather than small cell carcinoma.

CT in blunt chest trauma: Pulmonary, tracheobronchial, and diaphragmatic injuries

Routine use of CT in the initial evaluation of blunt chest trauma is controversial. CT however, has been shown to be useful in the diagnosis of unsuspected chest injuries and in directing therapeutic interventions. This review discusses the CT findings in patients with pulmonary, tracheobronchial, and diaphragmatic injuries after blunt chest trauma.

Nontraumatic pulmonary fat embolism syndrome: radiologic and pathologic correlations.

The authors report a case of pulmonary fat embolism syndrome without identifiable cause that was seen on chest radiographs and high-resolution computed tomography as diffuse ground-glass attenuation, particularly in nondependent portions of both lungs. The radiologic findings were shown on open-lung biopsy to represent diffuse pulmonary hemorrhage caused by fat embolism.

Notes from the 2002 annual meeting of the Korean Society of Thoracic Radiology.

The Korean Society of Thoracic Radiology holds a clinicoradiologicopathologic meeting annually, which comprises one of the monthly meetings of the thoracic radiologists in Korea. The 2002 meeting was held on November 21, 2002 in Seoul, Korea. All active members of the Korean Society of Thoracic Radiology, chest physicians, and lung pathologists in Korea participated in this year’s meeting. Interesting, informative, and inconclusive cases encountered during clinical practice in the past year were discussed, with an exchange of the experts’ knowledge and ideas regarding the cases. This year the participants discussed five cases in detail. A summary of the four outstanding cases is presented. Case 1: Hypersensitivity Pneumonitis in a Welder Yu-Whan Oh, M.D.*, Kyu Ran Cho, M.D.*, and Han Kyeom Kim, M.D.† From the Departments of *Radiology and †Pathology, Korea University Hospital, Korea University Medical School, Seoul, Korea A 63-year-old man presented to our hospital with a dry cough and exertional dyspnea of 3 months’ duration. He had worked as a welder at various construction sites for 25 years. The welding operations involved an electric-arc or oxyacetylene flame with the use of a variety of metals and alloys. He had a 20-pack-year history of cigarette smoking. Routine laboratory data were within normal range. Serum precipitants to many microbial agents and animal proteins were negative. Lung function tests were as follows: forced vital capacity, 3.40 L (101% of predicted value); forced expiratory volume in 1 second, 2.46 L (101% of predicted value); forced expiratory volume in 1 second/forced vital capacity, 0.72 (99% of predicted value); total lung capacity (TLC), 5.74 L (122% of predicted value); and diffusing capacity of the lung for carbon monoxide (DLCO), 12.4 mL/min per mmHg (74% of predicted value). A chest radiograph obtained on admission demonstrated bilateral reticular opacities in the middle and lower lung zones. High-resolution computed tomography showed centrilobular emphysema, intralobular reticular opacities, and patchy areas of ground-glass attenuation in both the mid and lower lung zones (Figs. 1A, B). The patient underwent open lung biopsy. Pathologic examination showed ill-defined small granulomas, interstitial pneumonitis, and occasional tufts of organizing young connective tissue with alveolar ducts. The findings were consistent with hypersensitivity pneumonitis (Figs. 1C, D). Hypersensitivity pneumonitis, typically a granulomatous interstitial lung disease (ILD), results from repeated inhalation and sensitization to a wide variety of organic aerosols and chemical antigens. The chemical-induced forms of hypersensitivity pneumonitis are probably less common than microbial and animal protein-induced cases. Welding operations with a variety of metals and alloys result in the production of a respirable fume containing various chemicals that may cause inflammation or fibrosis in airways and alveolar septa. Some of these metals such as Ni, Cr, Cu, and Co can serve as incomplete antigens (haptens) with high immunogenic potential that induce hypersensitivity reactions in allergic individuals. There is strong evidence for a cellular immune response involving metal-specific T cells in the pathogenesis of metal hypersensitivity. A hypersensitivity pneumonitis-like reaction has been reported among workers in certain industrial operations. In this case, we could not find an association of microbial agents or animal proteins with hypersensitivity pneumonitis, despite extensive diagnostic studies. We speculate that this case of hypersensitivity pneumonitis may be associated with a hypersensitivity reaction caused by inhalation of various chemical compounds generated during welding procedures. Further studies are needed to evaluate the association of hypersensitivity pneumonitis with chemical From the *Department of Diagnostic Radiology, Korea University Guro Hospital, Seoul, Korea; the †Department of Radiology, Dankook University Hospital, Cheonan, Korea; the ‡Department of Radiology, Seoul National University Hospital, Seoul, Korea; and the §Department of Radiology, Hanyang University Kuri Hospital, Kuri Korea. Address correspondence and reprint requests to Dr. Eun-Young Kang, Department of Diagnostic Radiology, Korea University Guro Hospital 80 Guro-dong, Guro-ku, 152-050, Seoul, Korea. E-mail: keyrad@korea.ac.kr Journal of Thoracic Imaging 18:116–121