M. Attia

Interstitial lung diseases: Imaging contribution to diagnosis and elementary radiological lesions

Interstitial pneumonias comprise a heterogeneous group of disorders in which a multidisciplinary approach is important for accuracy in diagnosis; indeed, one might say, even mandatory. The team of collaborators should include radiologists, because high resolution computed tomography (HRCT) of the thorax is the first, and most of times, the only imaging examination to be prescribed after chest X-ray. Elementary lesions of the interstitium can be accurately described with HRCT, inasmuch as lung windowing with sharp filtering in this technique reproduces the microscopic features of the lung. Guidance of bronchoalveolar lavage and biopsy procedures is also possible with HRCT.

Angiofibrolipoma of posterior mediastinum with transforaminal extension

Angiofibrolipoma is a histological variant of lipoma, which commonly occurs in subcutaneous tissues. In the present report we illustrate the case of an angiofibrolipoma of the posterior upper mediastinum in a 75-year-old man presented with progressive chest pain. Xray chest showed a homogeneous opacity vertically oriented along the right lateral aspect of thoracic vertebrae with an obtuse angle to the mediastinum. The upper extremity of the mass extended above the superior clavicle, suggestive of a posterior mediastinal lesion. Thoracic magnetic resonance imaging revealed a posterior mediastinal mass, in keeping with a nonaggressive lesion, with particular endocanalar extension and heterogeneous signal and enhancement patterns that was highly suggestive of a mixed mesenchymal tumor. The tumor was incompletely removed by right postero-lateral thoracotomy with final diagnosis of angiofibrolipoma. To the author’s knowledge, such a case of angiofibrolipoma located in the posterior mediastinum has not been previously reported in the literature.

Atypical Pleuropulmonary Tuberculosis Mimicking a Malignant Disease

Figure 1. Plain chest radiograph showing multiple bilateral nodules (arrows) and right hilar lymphadenopathies (dashed arrow). To the Editor: Pseudotumoral tuberculosis is considered to be among the most important differential diagnoses of lung and pleural malignancies. This form of tuberculosis is rare and occurs in 3.5% to 4.5% of immunocompetent patients. It is more frequent in those with immunocompromised status and is diagnosed with a delay of 30 to 70 days. We report the case of a 47-year-old women with a history of diabetes who consulted for cough with purulent sputum, weakness, and fever. A plain chest radiograph showed multiple bilateral nodules and right hilar lymphadenopathies (Fig 1). An atypical pneumonia was suspected. Antibiotics were administered. However, the patient clinically worsened. Enhanced computed tomography was performed. It showed subcarinal as well as right hilar and bilateral bronchial lymph node enlargement. There were bilateral lung nodules—especially in the lower lobes. The pleura exhibited bilateral nodular enhanced thickening that was more obvious in the lower regions. Pleural effusion was absent (Fig. 2). Metastatic involvement of the lungs and pleura was suggested. Transbronchial biopsy and cytologic examination of the bronchial fluid showed inflammation with no signs of malignancy. Bronchoalveolar lavage fluid analysis showed no malignant cells. The results of screening for Mycobacterium tuberculosis in the sputum and bronchial fluid were negative. The patient underwent a surgical pleural and parenchymal biopsy. Anatomopathological examination resulted in a diagnosis of caseofollicular tuberculosis. The patient received combined antibacillary medication. One month later, a second chest computed tomography scan showed improvement of the pulmonary and pleural lesions (Fig. 3). This case illustrates how confusing pseudotumoral tuberculosis can be. Generally, typical features of postprimary pulmonary tuberculosis include centrilobular branching 2to 4-mm nodules with a tree-in-bud