Masaki Wakisaka

Chlamydia pneumoniae pneumonia and Mycoplasma pneumoniae pneumonia: comparison of clinical findings and CT findings.

The objective of this study was to identify the clinical and pulmonary CT findings associated with Chlamydia pneumoniae pneumonia and to compare them with those of Mycoplasma pneumoniae pneumonia. The clinical features and CT scans of 40 patients with C. pneumoniae pneumonia and 42 patients with M. pneumoniae pneumonia were retrospectively reviewed. There were no significant differences between the two etiologic agents with regard to clinical signs. Chest CT findings in patients with C. pneumoniae pneumonia consisted mainly of ground-glass attenuation (n = 38) and acinar patterns (n = 28). Acinar patterns and pleural effusions (n = 12) were observed significantly more frequently than in patients with M. pneumoniae pneumonia (P < 0.0001, P < 0.039, respectively). CT findings of centrilobular nodules and bronchial wall thickening were significantly less common than in the M. pneumoniae pneumonia patients (P < 0.0001, P < 0.0001, respectively). The CT finding of acinar patterns, although nonspecific, can be considered suggestive of C. pneumoniae pneumonia.

Computed tomography of the gastrointestinal manifestation of hereditary angioedema

We report a case of gastrointestinal manifestation of hereditary angioedema. Computed tomography (CT) revealed wall thickening of the gastric antrum, duodenum, and jejunum. Dilatation of the third part of the duodenum, thickening of the small bowel mesentery and omentum, and retroperitoneal edema were present. The importance of considering this condition in patients presenting such CT findings correlated with the appropriate history is discussed.

Pulmonary computed tomography findings of visceral larva migrans caused by Ascaris suum.

Objective: To retrospectively evaluate the computed tomography (CT) findings of pulmonary involvement in patients with visceral larva migrans caused by Ascaris suum. Methods: Institutional review board approval was obtained, and informed consent was waived. Chest CT scans obtained between January 1994 and November 2005 in 32 patients infected with A. suum were retrospectively evaluated by 3 chest radiologists. In 4 patients who underwent surgical or transbronchial biopsy, comparisons of the CT images with the actual specimens were performed. Results: On CT scans, abnormal findings were seen in 28 patients. The most common abnormality consisted of nodules (n = 19) in which the majority had a halo of ground-glass attenuation (n = 17), followed by ground-glass attenuation (n = 18), and interlobular septal thickening (n = 14). These abnormalities were predominantly seen in the peripheral lung (n = 25). Of the 7 patients who underwent follow-up CT scans, nodules (n = 6) and ground-glass attenuation (n = 5) had migrated in 4 patients. Pathologically, these findings corresponded to marked eosinophilic infiltration into the interstitium. Conclusions: These CT findings are considered to be suggestive of thoracic involvement in patients with visceral larva migrans caused by A. suum.

Radiotherapy combined with transarterial infusion chemotherapy and concurrent infusion of a vasoconstrictor agent for nonresectable advanced hepatic hilar duct carcinoma

The treatment of patients with advanced hepatic hilar duct carcinoma is a challenging problem. The current study was performed to evaluate the outcome of patients with advanced hepatic hilar duct carcinoma who received external beam radiotherapy (EBRT) combined with transarterial chemotherapy and infusion of a vasoconstrictor.

Bronchiolitis obliterans organizing pneumonia after bone marrow transplantation: association with human leukocyte antigens.

This is the first study reporting the relationship between the development of bronchiolitis obliterans organizing pneumonia (BOOP) and human leukocyte antigen (HLA) in patients with bone marrow transplantation (BMT). The HLA B35 was significantly higher in patients with BOOP than in patients without BOOP after BMT (P = 0.0069). The HLA B35 is important as a host factor for the generation of BOOP after BMT. Objective: To assess the relationship between the development of BOOP after BMT and HLA. Methods: We retrospectively reviewed clinical features and chest computed tomographic scans in 64 patients who underwent allogeneic BMT between March 1990 and September 2004, and evaluated the relationship between HLA and development of BOOP. Results: Development of BOOP was between days 22 and 347 (mean, 114 days). The common computed tomographic findings consisted of patchy consolidation in subpleural and/or peribronchovascular distributions. Frequency of HLA B35 in patients with BOOP development after BMT was significantly higher than in patients without BOOP after BMT (P = 0.0069). There were no significant relationships between the others of this antigen and BOOP development. Conclusions: Our results suggested that HLA B35 is an important host factor for the generation of BOOP after BMT.

Recurrent angiosarcoma effectively treated with superselective continuous intra-arterial injection of recombinant interleukin-2 combined with radiotherapy

We report a case of recurrent angiosarcoma (AS) in a 63-year-old man, effectively treated with a superselective continuous intra-arterial injection of recombinant interleukin-2 (rIL-2) combined with electron beam radiotherapy. The patient, who had undergone surgical resection for AS on his face near the nasal bridge, was admitted to our hospital because of recurrent AS on his bilateral cheeks. We placed 4-French catheters in the right external carotid artery (ECA) and superselectively in the left facial artery. A continuous intra-arterial injection of rIL-2 was administered in combination with radiotherapy using a 6 MeV electron beam. The lesion rapidly decreased in size. The total dose of rIL-2 was 3.72 × 107 IU (International Unit) in the right ECA and 2.96 × 107 IU in the left facial artery, while the total radiation dose was 50 Gy, in 25 fractions, for the tumor on the right cheek and 46 Gy, in 23 fractions, for the erythematous plaque on the left cheek. The patient was discharged with almost no cutaneous lesion on his cheeks. Unfortunately, there was another recurrence of AS and the patient died of respiratory failure due to lung metastases. However, as the lesion could be completely controlled even for a while, we believe this treatment method will contribute to the future management of AS.

Multiple Tracheal Diverticula Detected by Multidetector-row Computed Tomography.

Multiple tracheal diverticula are rare. We report a case of a 62-year-old man who had multiple tracheal diverticula that were detected using multidetector-row computed tomography. Axial computed tomography images showed multiple air collections contiguous to the trachea. The multiple air collections were visible as outpouchings of the parts of the trachea between the cartilages, being located almost symmetrically on both lateral sides of the tracheal wall as seen on coronal multiplanar reconstruction images. Virtual bronchoscopy confirmed the presence of multiple openings in the tracheal wall of the diverticular necks. The alteration of the airway was better seen using volume-rendered reconstruction. Thin-slice multidetector-row computed tomography and advanced imaging techniques may increase the frequency of identification of multiple tracheal diverticula.

Correlation of Pathological Finding with Dose Distribution in a Case of Intraocular Choroidal Melanoma Treated by Stereotactic Radiosurgery

Malignant melanoma is a radioresistant tumor and surgical resection has been established as a treatment of choice for large tumors. Recently, the effectiveness of stereotactic radiosurgery (SRS) for intraocular choroidal melanoma has been reported, but the proper radiation dose has not yet been established. We report a case of intraocular choroidal melanoma treated by SRS using a conventional linear accelerator as preoperative radiation therapy (RT) to prevent operation-induced metastases, and correlate the pathological finding in the resected specimen with the dose distribution obtained by SRS to establish the pathologically effective radiation dose. Case report. A 65-year-old woman who complained of decreasing vision of the left eye was admitted to our hospital. An orbital postcontrast computed tomography (CT) done on admission demonstrated a slightly enhancing tumor, 16×16 mm in size, attached to the posterior wall of the left eyeball. Ophthalmoscopy revealed a brown tumor at the posterior part of the left eyeball. T1and T2-weighted magnetic resonance (MR) images (Fig. 1) revealed a tumor of high and low signal intensities, respectively. Clinically, a malignant melanoma was highly suspected. Scintigraphy with gallium-67 revealed a high accumulation corresponding to the left intraocular lesion but did not demonstrate any other abnormal uptake suggesting distant metastases. The clinical stage was T3NOMO (Stage III; 1987, UICC). SRS was chosen as a method of preoperative RT to prevent operation-induced metastases. At first, a head ring (BRW; Radionics, Inc., Burlington, MA, USA) was attached to the outer table of the cranium of the patient using a four-point fixation under local anesthesia. After achieving satisfactory akinesia of the left eyeball by injection of local anesthetic to the retrobulbar space, CT with contrast enhancement was performed with continuous 3-mm thick slices through the affected eye to the top of the skull to define the target for SRS planning. The tumor and the adjacent critical organs, such as the optic nerves, the optic chiasma, the brain stem and the major vessels, were marked according to the CT data and three-dimensional radiation planning was performed by a treatment planning workstation (X-Knife III software system; Radionics, Inc.). The entire tumor was within the 80% isodose contour border. A marginal dose of 20 Gy with a central dose of 25 Gy with five arcs using a narrow beam collimator with a 3-cm diameter was planned (Fig. 2 and Fig. 3). This dose was decided on from doses previously reported as preoperative RT for intraocular choroidal melanoma. The average irradiation doses to the adjacent critical organs were as follows: the left optic nerve, 6.17 Gy; the right optic nerve, 0.12 Gy; the optic chiasma 0.096 Gy; and the brain stem, 0.051 Gy. All of these doses seemed to be tolerable. The dose volume histogram (DVH) of the left intraocular lesion is shown in Fig. 4. After completion of the 3D radiation planning, the patient was placed on the treatment couch to align the center of the tumor with the isocenter of the linear accelerator (Mevatron 77DX 67; Siemens, Germany), and a retrobulbar injection of local anesthetic was administered again for immobilization of the left eyeball during irradiation. Stercotactic irradiation was performed with combined rotations of the gantry and the treatment couch. Two weeks after SRS, the left eyeball was surgically enucleated. The pathological examination (Fig. 5) revealed spindle B cell type tumors in the Callender classification (1) containing a high amount of melanin at the periphery of the tumor. Necrotic areas were observed mainly around the center of the tumor, and cystic changes were also observed. These pathologic changes were similar to those of tumors treated with iodine-125 brachytherapy (2). The distribution of necrotic areas in the tumor corresponded to the areas irradiated by more than 24.9 Gy in dose distributions obtained by SRS. Three years after the treatment, there was no local recurrence, nor was any distant metastases noted. Discussion. Uveal melanoma is a relatively rare disease in Asian countries, but is the most common primary ocular malignancy in adults in Western countries. It occurs in approximately six to seven cases per million people per year according to US figures (3). Enucleation has been the standard treatment for

Chest High-resolution Computed Tomography Findings in 601 Patients with Inflammatory Bowel Diseases

RATIONALE AND OBJECTIVES Pulmonary involvement in inflammatory bowel disease may reflect the common embryonic origin of the gastrointestinal tract and the bronchial tree. No studies have compared pulmonary high-resolution computed tomography (HRCT) findings between ulcerative colitis (UC) and Crohn disease (CD). This study aimed to assess the relationship between pulmonary HRCT findings and inflammatory bowel disease activity and to compare HRCT findings between UC and CD. MATERIALS AND METHODS We retrospectively identified 601 consecutive patients (350 with UC and 251 with CD) who had undergone chest HRCT examinations at our institutions between April 2004 and April 2016. Parenchymal abnormalities, enlarged lymph nodes, and pleural effusion were evaluated on HRCT. RESULTS One hundred sixty-seven patients (94 men, 73 women; aged 12-86 years, mean: 47.2 years) with UC and 93 patients (61 men, 32 women; aged 12-71 years, mean: 37.9 years) with CD had abnormal findings on chest HRCT. The HRCT findings of UC and CD mainly consisted of centrilobular nodules (in 49.1% and 45.2% of cases, respectively) and bronchial wall thickening (in 31.7% and 54.8%, respectively). There was no relationship between HRCT findings and disease activity. Bronchial wall thickening was significantly more frequent in patients with CD than in those with UC (P < .001). CONCLUSION The main chest HRCT findings in UC and CD are centrilobular nodules and bronchial wall thickening. There are differences in HRCT findings between UC and CD.

Idiopathic aneurysm of the azygos arch exhibiting fluid-fluid layering on contrast-enhanced computed tomography.

To the Editor Aneurysm of the azygos arch is a rarely described abnormality. This condition is often incidentally detected on routine chest radiographs or computed tomography (CT) obtained for another purpose. Intravenous dynamic contrast-enhanced CT (CE-CT) plays an important role in the diagnosis of this phenomenon. CT findings have already been reported in the English-language literature. We report herein the first case of an azygos arch aneurysm in which fluid–fluid layers formed by blood and injected contrast material were observed using CE-CT, together with a review of the literature.