Theodore J. Lee

Carotid Intima-Media Thickness Among Human Immunodeficiency Virus–Infected Patients Without Coronary Calcium

Subjects infected with human immunodeficiency virus (HIV) have increased risk for atherosclerosis. Carotid artery intima-media thickness (IMT) assessed using ultrasound and coronary artery calcium (CAC) detected using computed tomography predict cardiovascular risk in the general population; however, their usefulness and comparability in patients with HIV are less well defined. The purpose of this study was to compare IMT and CAC in the detection of atherosclerosis in subjects with HIV. CAC and IMT were measured in 253 HIV-infected and 58 uninfected adults. Associations among HIV-related factors, traditional risk factors, and CAC and IMT were evaluated. The distribution of IMT among subjects with and without CAC was compared. Among the patients with HIV, 37% had detectable CAC compared to 28% of controls (p = 0.19); 16% of the patients with HIV had CAC >100 compared to 5% of controls (p = 0.03). With either detectable or undetectable CAC, HIV-infected subjects had higher IMT compared to controls (1.02 ± 0.34 vs 0.78 ± 0.12 mm, p <0.0001), even after adjustment for traditional risk factors. Among those with undetectable CAC, 34% of patients with HIV had markedly increased IMT (≥1 mm) compared to no controls (p <0.0001). HIV-related factors were associated with IMT but not with CAC. In conclusion, patients with HIV and controls had similar rates of detectable CAC, while absolute CAC scores were modestly higher in the HIV group. Conversely, carotid IMT detected advanced subclinical atherosclerosis in patients with HIV even in the absence of CAC. Thus, with HIV, IMT is associated with disease-related factors and may be a more sensitive indicator of subclinical atherosclerosis than CAC.

Detailed Analysis of the Radiographic Presentation of Mycobacterium kansasii Lung Disease in Patients With HIV Infection

BACKGROUND Published criteria for the diagnosis of Mycobacterium kansasii lung disease require the presence of clinical symptoms, positive microbiologic results, and radiographic abnormalities. In patients with HIV infection, the radiographic findings of M kansasii lung disease are not well described. METHODS Medical records and chest radiographs of all patients with HIV infection and at least one respiratory specimen culture positive for M kansasii at San Francisco General Hospital between December 1989 and July 2002 were reviewed. RESULTS Chest radiographic results were abnormal in 75 of 83 patients (90%) included in the study. Radiographic abnormalities were diverse, with consolidation (66%) and nodules (42%) as the most frequent findings. The mid or lower lung zones were involved in 89% of patients. The pattern of radiographic abnormalities did not differ based on acid-fast bacilli smear status, the presence or absence of coexisting pulmonary infections, or CD4+ T-lymphocyte count. In multivariate Cox regression analysis, cavitation was the only radiographic abnormality independently associated with mortality (hazard ratio, 4.8; 95% confidence interval, 1.2 to 19.6). CONCLUSION Patients with HIV infection and M kansasii lung disease present with diverse radiographic patterns, most commonly consolidation and nodules predominantly located in the mid and lower lung zones. This finding is in contrast to the upper-lobe cavitary presentation described in patients without HIV infection. Although rare, the presence of cavitary disease in patients with HIV infection and M kansasii independently predicts worse outcome. The diversity in the radiographic presentation of M kansasii lung disease implies that clinicians should obtain sputum mycobacterial culture samples from any patient with HIV infection and an abnormal chest radiograph finding.

MR imaging evaluation of disorders of the chest wall.

Chest wall lesions constitute a diverse group of thoracic diseases, including those of soft tissue and osseous origin. MR imaging, with its superior tissue-resolving capability and multiplanar image acquisition, is an important tool for assessing chest wall lesions. In this article, the authors review common and uncommon diseases of the chest wall, with an emphasis on the MR imaging characteristics of these diseases. Among the diseases they discuss are diseases of the soft tissue including lipoma, hibernoma, liposarcoma, hemangioma, and lymphoma. They also examine diseases of the osseous thorax, including benign osseous tumors, fibrous dysplasia, and aneurysmal bone cyst. In addition, they discuss such malignant osseous tumors as osteosarcoma and Ewings sarcoma.

Perineural spread of melanoma demonstrated by F-18 FDG PET With MRI and pathologic correlation.

Abstract:F-18 FDG-PET is generally considered insensitive for the detection of perineural tumor spread. A case is presented of abnormal linear tracer uptake corresponding to the body of the right mandible on a PET scan in a patient with a history of lip melanoma. MRI correlation showed abnormal enla

Mediastinal glomangioma: CT and octreotide scintigraphy appearance, and review of the literature.

The glomus body is a neuromyovascular, arteriovenous structure primarily found in the skin and, less commonly, other organs, and is involved with thermoregulation. Neoplasms of the glomus organ are most commonly encountered in the skin and soft tissues of the extremities, particularly the subungual region. Glomus tumors are rare vascular neoplasms originating from the glomus body resulting from proliferation of modified muscle cells within this organ. Glomus tumors are commonly subdivided, based on the prominence of glomocytes, vascular structures, and smooth muscle cells, into solid glomus tumors (the most common variant), glomangioma, and glomangiomyoma. Previous reports of intrathoracic glomus tumors have shown that these tumors are most commonly encountered within the tracheobronchial tree or pulmonary parenchyma; mediastinal lesions are exceptionally rare. On the basis of imaging appearance of the glomangioma reported in this case as well as prior reports of tracheobronchial and pulmonary glomus tumors, mediastinal glomus tumors manifest as intensely enhancing masses with circumscribed or poorly defined margins, closely resembling thymic carcinoid tumor, pheochromocytoma, or hypervascular lymphadenopathy. Secretion of catecholamines and tracer uptake on Indium-111 octreotide scintigraphy, as seen in the present case, is probably exceptional. Because glomus tumors may be difficult to diagnose on routine histopathologic specimens, radiologists should be aware of this rare lesion and consider the diagnosis of glomus tumor when an intensely enhancing mediastinal mass is encountered.

Persistent lobar consolidation: Diagnostic considerations

The radiographic appearance of pulmonary opacities reflects the underlying anatomic structure and anatomic considerations influencing disease spread. Recognition of these considerations allows one pattern of pulmonary opacity often encountered at chest radiography, consolidation, to be grouped into air space and bronchopneumonia patterns. Pulmonary infection is the primary diagnostic consideration when consolidation is encountered, although noninfectious etiologies require consideration in certain situations. The primary noninfectious consideration for an air space pattern on chest radiography is bronchioloalveolar carcinoma, although this bronchogenic neoplasm may present in a number of different ways on thoracic imaging. The most common presentation of bronchioloalveolar carcinoma is the solitary pulmonary nodule with less common manifestations, including multifocal nodular or segmental/lobar ground-glass opacity or consolidation. The latter presentation frequently resembles pneumonia. Recognition of these presentations is important, especially in patients with radiographic abnormalities that suggest pneumonia but fail to resolve with appropriate treatment.

Recurrent pneumonia in a young adult

Pulmonary sequestrations are rare lesions divided into intralobar and extralobar varieties. Intralobar and extralobar sequestrations are distinguished by the lack of an investing pleural envelope surrounding the former. Furthermore, the typical ages of presentation and clinical manifestations of the 2 lesions differ: intralobar sequestrations present as recurrent pulmonary infection in young adults, whereas extralobar sequestrations are usually incidentally detected during the neonatal period and are often associated with other congenital anomalies. Additionally, intralobar sequestrations are usually drained by the pulmonary venous system, whereas extralobar sequestrations are usually drained by the systemic venous system. Intralobar sequestrations usually present as a lower lobe mass, but areas of cavitation, cystic change, or air trapping are commonly encountered as well. The aberrant systemic arterial supply of intralobar sequestrations from the descending thoracic or upper abdominal aorta is usually readily demonstrable with helical computed tomography angiography. Pulmonary venous drainage is also usually readily visible. Extralobar sequestrations usually present as lower lobe masses without air. The aberrant arterial supply to the lesion is readily visible and allows extralobar sequestration to be distinguished from other causes of thoracic masses in the neonate. Intralobar sequestrations are usually treated surgically. Although extralobar sequestrations may not require surgery, they are often resected during the course of treatment of other congenital anomalies.