Jeung Sook Kim

Thoracic involvement of systemic lupus erythematosus: clinical, pathologic, and radiologic findings.

Thoracic involvement occurs more frequently in systemic lupus erythematosus than in any other connective tissue diseases, and more than half of patients with the disease suffer from the involvement. Primary intrathoracic manifestations include pleural disease (effusions and/or thickening), acute lupus pneumonitis, subacute interstitial lung disease including bronchiolitis obliterans organizing pneumonia and non-specific interstitial pneumonia with fibrosis, chronic interstitial lung disease of usual interstitial pneumonia, pulmonary hemorrhage, pulmonary vascular disease, small airway disease of bronchiolitis obliterans, and pulmonary arterial hypertension. Secondary intrathoracic manifestations include atelectasis due to diaphragmatic dysfunction, opportunistic pneumonia, drug and oxygen toxicity, aspiration, and pleuropulmonary consequences of cardiac and renal failure.

Lung diseases in patients with common variable immunodeficiency : Chest radiographic and computed tomographic findings

Objective: To evaluate chest radiographic and computed tomographic (CT) findings of lung disease related to common variable immunodeficiency. Methods: Thirty-five chest radiographs and 30 CT scans of 46 patients were assessed. Lung parenchymal abnormalities that were evaluated included airspace consolidation, ground-glass attenuation, nodules, bronchiectasis, and air trapping. Results: On CT, ground-glass attenuation and nodules were the most frequent findings, observed in 60% (n = 18/30) and 83% (n = 25/30), respectively. Three major CT patterns were identified: airway disease (n = 13), nodules (n = 8), and parenchymal opacification (n = 6). All 13 patients with airway disease showed centrilobular opacities. One patient with peribronchial nodules showed lymphoid interstitial pneumonia, and 1 with randomly distributed nodules showed noncaseating granulomas. Patients with a CT pattern of parenchymal opacification showed lower lung predominance; surgical biopsies showed organizing pneumonia in 1 patient and lymphoid interstitial pneumonia with nonnecrotizing granulomas in another. Conclusions: Common variable immunodeficiency is associated with 3 major CT patterns: airway disease, nodules, and parenchymal opacification.

Pulmonary involvement of idiopathic hypereosinophilic syndrome: CT findings in five patients

PURPOSE The aim of this study was to assess the CT findings of pulmonary involvement in patients with idiopathic hypereosinophilic syndrome (HES). METHOD The study included five patients with idiopathic HES who had pulmonary involvement proven by bronchoalveolar lavage (n = 3) or based on clinical and radiologic findings (n = 2). Four patients had high resolution CT and one had conventional CT. The CT scans were retrospectively reviewed by two chest radiologists for pattern and distribution of disease. RESULTS All five patients had several small nodules in both lungs at CT scan. Four patients had nodules with a halo of ground-glass attenuation. Three patients had focal areas of ground-glass attenuation in both lungs. These lesions were present in all lung zones and involved mainly the peripheral lung. There was neither lobar predilection nor peribronchovascular distribution. Other organs involved included bone marrow (n = 3), liver (n = 3), stomach (n = 1), and peritoneum (n = 1). CONCLUSION The CT findings of pulmonary involvement in patients with idiopathic HES included small nodules with or without a halo of ground-glass attenuation and focal areas of ground-glass attenuation mainly in the lung periphery.

Nontuberculous Mycobacterial Infection

STUDY OBJECTIVE The purpose of this study was to compare the imaging findings of nontuberculous mycobacterial (NTM) infection in patients with normal and abnormal cystic fibrosis (CF) genotypes, and normal and abnormal alpha1-antitrypsin (AAT) phenotypes. DESIGN A retrospective review of medical records and chest CT scans from 85 patients with microbiologically proven NTM infection was performed. All patients had undergone genotype analysis for CF mutations, and phenotypic evaluation for AAT status. Patients with homozygous CF or AAT were not included. Two independent observers assessed the patterns and distribution of disease, according to a standardized score sheet. In 52 patients, follow-up CT scans were obtained 1 to 46 months (mean duration, 8 months) following the initial CT scan. The CT scan findings on the follow-up scan were visually compared with those on the initial CT scan for progression or regression of abnormalities. Statistical analysis was performed to evaluate the relationship between the dominant CT scan pattern and CF/AAT status, and between CT scan pattern and radiologic change on follow-up. RESULTS Fifteen patients (18%) were found to carry a single CF mutation, and an abnormal AAT phenotype was seen in 13 patients (15%). Three patients (3%) were found to have both a heterozygous CF mutation and a heterozygous AAT phenotype. On the initial CT scans, bronchiectasis and nodules were the most frequent findings of NTM infection in all three groups (p > 0.05). The prevalence of nodules was slightly lower in the CF group, and the prevalence of linear scarring was greater in the AAT group than in the normal group (p < 0.05). Among the 52 patients who had a follow-up CT scan, 8 (15%) had a CF mutation and 6 (12%) had an abnormal AAT phenotype. The extent and pattern of abnormality seen on the initial CT scan did not predict change on follow-up evaluation. After treatment, 40 patients (56%) with a normal CF genotype had decrease in disease extent, compared with 4 patients (25%) with a CF mutation (p < 0.05). Bronchiectasis was improved in approximately 35% of those with normal genotype, but in none of those with a CF mutation. CONCLUSION In patients with NTM infection, the CT scan findings show only minor differences according to phenotype and genotype. Initial CT scan findings do not predict change on follow-up CT scan evaluation. However, on follow-up CT scan, patients with CF mutations are less likely to improve, while those with AAT phenotype appear to have a radiographic outcome similar to those with normal phenotype.

Tracheal Deviation in Thy roid Lesions: Correlation with Chest Radiograph

Purpose: To evaluate the prevalence and degree of tracheal deviation seen on chest PA radiographs of thyroid lesions and to correlate these findings with their size, volume, pattern (localized or diffuse), location, and constitution . Materials and Methods: Between May 1995 and July 1998, tracheal deviation seen on chest PA radiographs was retrospectively reviewed in 179 consecutive cases in which a thyroid lesion was seen on ultrasonography and/or CT of the thyroid. The criterion of tracheal deviation was more than 3mm. Thyroid lesions were classified as diffuse or localized according to their pattern; as central, marginal or borderline on the basis of their location, and as cystic, solid or mixed, depending on their constitution. Results: Tracheal deviation was seen in 53 cases (29.6%, n=179); mean deviation was 5.6mm (3 -27 mm). Its incidence increased with lesion size (p2.8 cm in the tracheal deviation group and 1.6 1 .2 cm in the non-tracheal deviation group. Tracheal deviation was seen in 46 localized-type cases (86.8 %) and 7 diffuse-type cases (13.2 %) (p>0.05). The volume of the former type was measured and the incidence and degree of tracheal deviation was found to increase with lesion volume (p0.05). The most common location was borderline (n=30, 65.2 %), followed by central (n=12, 26.1%), and marginal (n=4, 8.7%). The most common type by constitution was solid (n=32, 69.6 %), followed by cystic (n=10, 21.7 %), and mixed type (n=4, 8.7 %) (p>0.05). Conclusion: Chest PA radiography revealed tracheal deviation of thyroid lesion in 53 cases (29.6 %). The incidence and degree of deviation increased with increasing size and volume of the lesion, but deviation did not correlate with the pattern (localized or diffuse), location or constitution of the lesion.

CT Evaluation of Solitary Pulmonary Nodule: Value of Additional HRCT Scan

Purpose : The aim of our study was to evaluate the usefulness of high-resolution CT scans in addition to helical CT for characterizing a solitary pulmonary nodule. Materials and Methods : Our study included 49 patients with a solitary pulmonary nodule ; in each patient this was evaluated by both additional high-resolution CT and helical scanning. Images were evaluated by three independent observers, each of whom read them twice : initially with helical CT images only and then with helical images plus high-resolution CT images. After analysis, the observers recorded the following : histologic diagnosis, benignancy or malignancy of a nodule, and confidence in their diagnosis (three scales). Results : In differentiating benign and malignant nodules, the accuracy of helical scans only was 75% (110/147 readings) whereas that of helical plus high-resolution CT scans was 82% (121/147readings) (p=0.001). Correct histologic diagnosis was made in 47% of cases (69/147 readings) when helical scans only had been evaluated and in 48% of cases (71/147 readings) for which both helical and high-resolotion CT scans were available (p=0.815). Diagnosis was more often highly confident on the basis of additional high-resolution CT scans (25%) than helical scans only (5%) (p= 0.001). Conclusion : By enhancing differential diagnostic accuracy between benign and malignant nodules and by increasing confidence in the histologic diagnosis of apulmonary nodule, additional high-resolution CT scans are valuable for the evaluation of a solitary pulmonary nodule.

Bronchogenic Cysts in Adults: CT, MR, and Pathologic Findings

Bronchogenic cysts can arise either in the mediastinum or in the lung parenchyma. On both CT and T1 -weighted MR images, the cyst contents can show a variable signal characteristics . However, on T2 -weighted MR images, the cyst show high signal intensity. Although unusual , the cyst may communicate with the tracheobronchial tree and demonstrate partial or complete air content . With hemorrhage, fluid-fluid levels can also be seen within the cyst. Pathologically, the diagnosis of bronchogenic cyst rests on demonstration of tissues normally fou nd in the tracheobronchial tree within the cyst wal l.