Julie E. Takasugi

RADIOLOGY OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

This article reviews the radiologic manifestations and complications of chronic obstructive pulmonary disease, particularly those seen in association with emphysema. Current concepts on the pathogenesis of chronic obstructive pulmonary disease are discussed and related to findings on high-resolution CT scan and histologic examinations. Controversial issues concerning the detection and grading of emphysema using radiologic and physiologic tests are also addressed.

Intrathoracic granulocytic sarcomas

Recent trends in the treatment of intrathoracic granulocytic sarcoma (IGS) call for an overview of its radiographic manifestations. Nine patients from our institution and a review of 41 from the literature provide the basis of our conclusions on the typical and atypical appearance of IGS. Of the nine patients with IGS, all had chest radiographs, five had computed tomographic (CT) scans, and one had magnetic resonance (MR) scans. Radiographic studies and medical records were examined to establish the site and appearance of IGS. Three cases were histologically proved; in the others, the diagnosis was based on clinical presentation and response to chemotherapy. The mediastinum was the most common site of involvement (six of nine cases). A focal mass or mediastinal widening was visible on chest radiographs, and a focal mass or diffuse infiltration or replacement of fat was visible on chest CT. Less common sites of involvement were the lungs (two cases), the pleura (two), the pericardium (two), and the hilar (two). Mediastinal or hilar mass or mediastinal widening is the characteristic finding in IGS. Less common manifestations such as pleural and pericardial effusions and lung opacities should be confirmed histologically, since fluid or tissue is readily accessible.

Diffuse pulmonary ossification.

Diffuse pulmonary ossification (DPO) is an uncommon condition that is characterized by metaplastic bone formation in the lung parenchyma. It is usually not diagnosed clinically and may be apparent radiographically only when extensive. However, it is occasionally encountered at autopsy or on pathologic evaluation of surgical specimens. This article will review the clinical, histologic, and radiographic manifestations of DPO, focusing primarily on the chest radiograph and CT findings, both of which may be underappreciated, for even experienced radiologists may confuse DPO with other entities such as metastatic calcification as seen in chronic renal failure or chronic granulomatous disease.

Tumorlike Conditions of the Pleura

Tumorlike conditions of the pleura are rare, but diagnosis is facilitated by recognizing certain imaging patterns and interpreting them in the clinical context. A tumorlike condition of the pleura is any nonneoplastic lesion of the pleura itself, or within the pleural space, that resembles a tumor. An approach to diagnosis of the tumorlike conditions of the pleura is provided, and these conditions are grouped into focal or diffuse conditions, with an emphasis on specific imaging features. Focal tumorlike conditions of the pleura include pleural plaque, thoracic splenosis, thoracic endometriosis causing catamenial pneumothorax, and pseudotumor caused by pleural effusion. Thoracic splenosis should be considered in a patient who has a healed left lower rib fracture, an absent spleen, and left lower pleural nodules. Thoracic endometriosis with catamenial pneumothorax should be considered in a woman of childbearing age who presents with right scapular pain and recurrent pneumothorax occurring at or around the onset of menses. Extrapleural hematoma is a nonpleural mimic of pleural tumor and shares some imaging features with focal tumorlike conditions of the pleura, despite residing in the extrapleural space. Diffuse tumorlike conditions of the pleura include diffuse pleural thickening and rare conditions such as Erdheim-Chester disease and diffuse pulmonary lymphangiomatosis. Erdheim-Chester disease should be considered when diffuse pleural thickening occurs with a perirenal soft-tissue halo or distal femoral sclerosis. Diffuse pulmonary lymphangiomatosis should be considered when findings include diffuse pleural thickening, interlobular septal and peribronchovascular interstitial thickening, and mediastinal fat infiltration limited to the thorax and when these findings persist despite diuretic therapy.

Chronic Obstructive Pulmonary Disease: Radiology-Pathology Correlation

Chronic obstructive pulmonary disease is defined as a preventable and treatable disease state characterized by airflow limitation that is not fully reversible. This review will discuss the relevant anatomy of the secondary pulmonary lobule, the subtypes of emphysema, and their imaging appearances and corresponding pathologic findings.

Tumors and Tumorlike Conditions of the Large Airways

OBJECTIVE Large-airway tumors and tumorlike conditions are uncommon, but a systematic approach aids in narrowing the differential diagnosis. In this article, we describe an approach to dealing with large-airway lesions and discuss their imaging characteristics and clinical presentations. CONCLUSION We have found it useful to separate these entities into groups on the basis of the distribution pattern (focal vs diffuse) and location (trachea vs bronchi).

Congenital thoracic cardiovascular anomalies presenting in adulthood: A pictorial review

Advances in surgical and medical therapy for congenital heart disease have led to increased long-term survival in patients whose conditions were diagnosed in childhood. However, a subset of patients with congenital cardiovascular anomalies may first be detected in adulthood. This pictorial review summarizes the CT findings of untreated congenital cardiovascular anomalies that can present in adulthood.

Sarcoid-like reaction-computed tomography features in 12 patients.

Purpose The aim of the study was to analyze the computed tomography (CT) findings of sarcoid-like reaction caused by underlying malignancy or immune modulation. Methods Twelve patients with pathologically proven sarcoidosis from underlying causes (malignancies, hepatitis C infection, and immune-modulatory treatment) in 2001 to 2011 were identified. All patients had chest CT scans, which were reviewed by 3 experienced thoracic radiologists. Medical records were also reviewed. Follow-up imaging, available in 11 patients, was assessed for response. Results All patients were white, 8 women and 4 men, with ages ranging from 26 to 72 years. Seven had underlying malignancy, 2 had inflammatory bowel disease, and 3 had liver disease caused by chronic hepatitis C viral infection. On CT, 92% (11/12) of patients had lymphadenopathy, 75% (9/12) had pulmonary nodules less than 5 mm, and 50% (6/12) had ground-glass opacity (GGO). In 42% (5/12) of patients, the dominant finding was discrete nodules (1–5 mm). In 33% (4/12) of patients, the dominant finding was ultrafine nodules with confluence, mimicking GGO. The most common distribution of lung nodules was perilymphatic, found in 78% (7 of the 9 patients with lung nodules). Follow-up was available in 10 patients, limited follow-up in 1, and no follow-up in 1. Six of the 11 patients who had follow-up had complete resolution of CT findings, 3 had partial resolution, and 2 had no resolution. Conclusions Imaging features of patients with sarcoid-like reaction include lymphadenopathy, small nodules, and ultrafine nodules with confluence, mimicking GGO. Ultrafine nodules with confluence mimicking GGO were unexpectedly common in this series.

CT in congenitally-corrected transposition of the great vessels

Congenitally-corrected transposition of the great vessels (CTGV) may be detected de novo in adulthood and the plain radiographic findings may be ambiguous or they may be mimicked by a mediastinal mass. CT readily shows the malposition of the aorta and pulmonary artery, and may also show associated congenital heart lesions. The following cases demonstrate the CT findings in CTGV and the distinction of CTGV from conditions resembling it on radiographs.

Septic pulmonary emboli from an unusual source

Septic pulmonary embolism, though an uncommon diagnosis, is an important consideration in the differential diagnosis of multiple pulmonary nodules. Septic emboli are now more commonly observed in association with central venous catheters and prosthetic intravascular materials than with intravenous drug use, although the latter continues to be a significant risk factor for septic pulmonary embolism. Chest radiograph findings include multiple, ill-defined, peripheral pulmonary nodules with or without cavitation. Computed tomography is more sensitive and perhaps more specific than radiography. Imaging demonstrates multiple peripheral nodules or consolidation, often in varying stages of cavitation and frequently associated pleural effusion or empyema. Complications may include empyema, pyopneumothorax, and bronchopleural fistula. With early antimicrobial treatment, complete recovery without long-term sequelae is likely for most patients. We present the clinical and imaging findings of a 59-year-old man with septic pulmonary embolism and review the characteristic imaging findings.