Joanne R. Cleverley

Invasive and noninvasive thymoma: distinctive CT features.

Purpose The purpose of this work was to evaluate the CT features of thymoma and to determine the most helpful findings in differentiating invasive from noninvasive thymoma. Method The CT scans from 27 patients with invasive thymoma and 23 with noninvasive thymoma were independently assessed by two observers without knowledge of their invasiveness. The presence and distribution of various CT findings were independently analyzed. Results Invasive thymomas were more likely to have lobulated (16/27, 59%) or irregular (6/27, 22%) contours than noninvasive thymomas (8/23, 35% and 1.5/23, 6%, respectively) (p < 0.05). Invasive thymomas had a higher prevalence of low attenuation areas within the tumor (16/27, 60%) than noninvasive thymomas (5/23, 22%) (p < 0.001) as well as foci of calcification (14.5/27, 54% vs. 6/23, 26%; p < 0.01). Conclusion The presence of lobulated or irregular contour, areas of low attenuation, and multifocal calcification is suggestive of invasive thymoma.

British Society for Medical Mycology best practice recommendations for the diagnosis of serious fungal diseases

Invasive fungal diseases are an important cause of morbidity and mortality in a wide range of patients, and early diagnosis and management are a challenge. We therefore did a review of the scientific literature to generate a series of key recommendations for the appropriate use of microbiological, histological, and radiological diagnostic methods for diagnosis of invasive fungal diseases. The recommendations emphasise the role of microscopy in rapid diagnosis and identification of clinically significant isolates to species level, and the need for susceptibility testing of all Aspergillus spp, if treatment is to be given. In this Review, we provide information to improve understanding of the importance of antigen detection for cryptococcal disease and invasive aspergillosis, the use of molecular (PCR) diagnostics for aspergillosis, and the crucial role of antibody detection for chronic and allergic aspergillosis. Furthermore, we consider the importance of histopathology reporting with a panel of special stains, and emphasise the need for urgent (<48 hours) and optimised imaging for patients with suspected invasive fungal infection. All 43 recommendations are auditable and should be used to ensure best diagnostic practice and improved outcomes for patients.

Acute respiratory distress syndrome and acute interstitial pneumonia : Comparison of thin-section CT findings

Purpose The purpose of this work was to compare the thin-section CT findings of acute respiratory distress syndrome (ARDS) with those of acute interstitial pneumonia (AIP). Method The thin-section CT scans from 25 patients with ARDS and 25 with AIP were independently assessed by two observers without knowledge of clinical and pathologic data. The presence, extent, and distribution of various CT findings were independently analyzed. Results Honeycombing was seen more frequently in lobes of patients with AIP (26%) than in lobes with ARDS (8%) (p < 0.001). Compared with patients with ARDS, a greater number of patients with AIP had a predominantly lower lung zone distribution (p < 0.05) and a symmetric distribution (p < 0.05) of the parenchymal abnormalities. Conclusion Patients with AIP have a greater prevalence of honeycombing and are more likely to have a symmetric bilateral distribution and a lower lung zone predominance than patients with ARDS. However, significant overlap exists among the CT findings.

Advances in Radiologic Assessment of Chronic Obstructive Pulmonary Disease

Chest radiography allows detection of moderate and severe emphysema but does not allow quantitation of severity of disease or detection of mild emphysema. Chest radiography is helpful in assessing complications of emphysema such as pneumothorax or secondary infection of a bulla. HRCT provides a detailed image of emphysematous lung disease comparable to that of macroscopic pathologic appearance. The main role of HRCT in patients with COPD is in the preoperative assessment of patients being considered for bullectomy or LVRS.

Wegener's granulomatosis with multiple pulmonary nodules – diagnostic difficulties

We describe the case of a 65-year-old woman with multiple pulmonary nodules on a chest radiograph where subsequent investigations led to diagnostic difficulties.

Successful treatment of HIV-associated multicentric Castleman's disease and multiple organ failure with rituximab and supportive care: a case report

IntroductionMulticentric Castlemans Disease (MCD), a lymphoproliferative disorder associated with Human Herpes Virus-8 (HHV-8) infection, is increasing in incidence amongst HIV patients. This condition is associated with lymphadenopathy, polyclonal gammopathy, hepato-splenomegaly and systemic symptoms. A number of small studies have demonstrated the efficacy of the anti-CD20 monoclonal antibody, rituximab, in treating this condition.Case presentationWe report the case of a 46 year old Zambian woman who presented with pyrexia, diarrhoea and vomiting, confusion, lymphadenopathy, and renal failure. She rapidly developed multiple organ failure following the initiation of treatment of MCD with rituximab. Following admission to intensive care (ICU), she received prompt multi-organ support. After 21 days on the ICU she returned to the haematology medical ward, and was discharged in remission from her disease after 149 days in hospital.ConclusionRituximab, the efficacy of which has thus far been examined predominantly in patients outside the ICU, in conjunction with extensive organ support was effective treatment for MCD with associated multiple organ failure. There is, to our knowledge, only one other published report of its successful use in an ICU setting, where it was combined with cyclophosphamide, adriamycin and prednisolone. Reports such as ours support the notion that critically unwell patients with HIV and haematological disease can benefit from intensive care.

Carcinoid tumour presenting as recurrent pneumonia

A 39-year-old woman non-smoker gave a history of three separate episodes of pneumonia over 2 years. Each involved the right lower lobe (figure 1), and clinical plus chest radiographic resolution was achieved following antibiotics. CT of the chest revealed a partially calcified lesion lying externally adjacent to the right lower lobe bronchus causing partial compression …

Imaging in Acute and Chronic Pulmonary Thromboembolic Disease

Acute pulmonary embolism (PE) is the third commonest acute cardiovascular disease. Prompt and accurate diagnosis is important. Significant morbidity and mortality are associated with both false-positive and -negative diagnosis. Although chronic thromboembolic disease (CTED) is an uncommon sequelae of acute PE, it is a potentially curable cause of pulmonary arterial hypertension (PAH) by means of pulmonary endarterectomy. Imaging plays an important role in the surgical work-up of patients with CTED. This chapter reviews the latest recommended algorithms in the diagnosis of acute PE and the role of leg sonography, ventilation-perfusion isotope imaging, computed tomography pulmonary angiography, conventional angiography, magnetic resonance angiography, and high-resolution computed tomography in the diagnosis of both acute and chronic pulmonary thromboembolism.