Ability of high-resolution computed tomography to distinguish Mycoplasma pneumoniae pneumonia from other bacterial pneumonia: Significance of lateral bronchial lesions, less air bronchogram, and no peripheral predominance.

BACKGROUND: No study has investigated the capability of high-resolution computed tomography (HRCT) to detect a lateral bronchus abnormality, degree of air bronchogram, and distribution of affected lesions in the diagnosis of Mycoplasma pneumoniae pneumonia (MPP). METHODS: We prospectively enrolled patients with serologically-confirmed MPP or culture-confirmed other bacterial pneumonia (OBP). The distribution of affected areas, abnormalities in lateral bronchial lesions, the degree of air bronchogram, and previously reported findings on HRCT were evaluated for MPP and OBP. Predictive HRCT findings for MPP were determined by logistic regression analysis. We provisionally designed our HRCT criteria (negative, probable, or highly suspected) for diagnosing MPP and investigated the diagnostic yield of the HRCT criteria. RESULTS: Sixty-three MPP and 126 OBP patients were included in this study. Logistic regression analysis showed that the absence of peripheral predominance, bronchial wall thickening, lateral bronchial wall thickening, intralobular or lobular ground-glass opacities, intralobular ground-glass opacities connected to a lateral bronchus, and less air bronchogram in infiltrates were significant predictors of MPP. Our HRCT criteria showed that the sensitivity and specificity in negative, probable, and highly suspected MPP were 0.0 and 0.33, 1.0 and 0.69, and 0.5 and 0.98, respectively. CONCLUSIONS: HRCT had considerable ability to detect a lateral bronchial abnormality and to diagnose or rule out MPP based on the distribution of affected areas, abnormalities in lateral bronchial lesions, and the degree of air bronchogram in the infiltrates.

[A Case of Acute Respiratory Distress Syndrome (ARDS) Accompanied with Influenza (H1N1) 2009 Successfully Treated with Polymyxin B-immobilized Fiber Column-direct Hemoperfusion (PMX-DHP)].

A 51-year-old man was admitted to our hospital because of fever and diarrhea. Chest X-ray revealed consolidation in the left lower lung field. Ceftriaxone and minocycline were given empirically, under the suspicion of bacterial or atypical pneumonia. In spite of treatment with antibiotics, the disease rapidly progressed to systemic inflammatory response syndrome. The diagnosis of acute respiratory distress syndrome (ARDS) accompanied with influenza (H1N1) 2009 was made because of positive findings of real-time polymerase chain reaction. While multidisciplinary treatment was performed, his condition was further deteriorated suggesting the excessive pro-inflammatory mediators. To remove them, we conducted polymyxin-B immobilized column-direct hemoperfusion (PMX-DHP), and his general condition recovered successfully. PMX-DHP may be a useful treatment choice for ARDS accompanied with influenza.

Neuroendocrine tumor (carcinoid) metastatic to orbital extraocular muscle: case report and literature review.

PURPOSE: To report a patient who showed neuroendocrine tumor (carcinoid) metastasis to the medial rectus muscle and to review patients' characteristics of carcinoid metastases to the extraocular muscles. CASE: A 72-year-old woman, who initially presented with spindle-shaped enlargement of the right medial rectus muscle, was followed for 3 years with a diagnosis of orbital myositis. Initial biopsy of the medial rectus muscle showed inflammation only. She showed remission and exacerbation of right proptosis and eyelid swelling, which responded to oral and intravenous steroids. On the occasion of abdominal computed tomography for ischemic colitis, a large retroperitoneal mass was detected and diagnosed as well-differentiated neuroendocrine tumor. The gradual increase of the medial rectus muscle with optic nerve compression, and hence, visual reduction, prompted a second excisional biopsy of the medial rectus mass, which proved to be neuroendocrine tumor metastasis. Whole body 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography fused with computed tomography revealed abnormal uptake only in the right orbit (maximum standardized uptake value: SUVmax = 3.83), and the patient underwent radiation to the right orbit with the subsidence of the residual mass. RESULTS: The literature review found 15 patients, including this patient, with neuroendocrine tumor metastases to the extraocular muscles. Frequent symptoms and signs were diplopia, proptosis, and ocular motility limitation. CONCLUSIONS: Neuroendocrine tumor appears to have propensity to extraocular muscle metastases and its slow growth might pose difficulty in differential diagnoses of orbital myositis.

Infectious mediastinitis after cardiovascular surgery: role of computed tomography.

PURPOSE: The aim of this study was to evaluate the effectiveness of computed tomography (CT) findings in the diagnosis of mediastinitis after cardiovascular surgery with median sternotomy. MATERIAL AND METHODS: A total of 122 patients were divided into two groups: the early group (21 days after surgery). Among them, six patients were ultimately diagnosed with infectious mediastinitis. CT findings in each patient were evaluated. Mediastinal fluid collections or free gas bubbles were regarded as the primary findings of mediastinitis. RESULTS: In the early group, sensitivity and specificity of the primary CT findings were 100% and 39%, respectively. In the late group, the sensitivity was 100% and the specificity 85%. Mediastinal fluid collections were observed in all six patients with mediastinitis. CONCLUSION: Mediastinal fluid collections or free gas bubbles are not specific during the early postoperative period. However, after 2 21 days, these observations could be indicative of mediastinitis.

Testicular seminoma presenting with mediastinal lymphadenopathy and gynecomastia.

Chest computed tomography (CT) of a 22-year-old man with a history of long-term low fever and nonproductive cough demonstrated lymphadenopathy in the superior, middle, and posterior mediastinum. Slight bilateral gynecomastia was also observed on the CT scan. Subsequent physical examination and ultrasonography revealed a left testicular mass, and abdominal CT showed retroperitoneal lymphadenopathy. Left orchiectomy was performed, with the histological examination confirming the diagnosis of seminoma.

Percutaneous ipsilateral portal vein embolization using a modified four-lumen balloon catheter with fibrin glue: initial clinical experience.

PURPOSE: The purpose of the present study was to show the feasibility and safety of ipsilateral portal vein embolization (PVE) using an improved four-lumen balloon catheter with fibrin glue. MATERIALS AND METHODS: To improve the ipsilateral PVE with fibrin glue, we modified a commercially available four-lumen balloon catheter to create a catheter comprising one lumen with a catheter tip for a guidewire, one lumen for an occlusion balloon, and two lumens, each with a side-hole just proximal to the balloon. Eight patients had hepatobiliary disease (three with bile duct carcinoma, two with gallbladder carcinoma, one with hepatocellular carcinoma, one with Caroli disease, and one with metastatic carcinoma). RESULTS: All embolization procedures were technically successful. After embolization, the volume of the future remnant liver increased a mean of 131%. There was no inadvertent embolization of portal vein branches and no major procedure-related complications. CONCLUSION: Our method is potentially easier and safer than the traditional ipsilateral method with fibrin glue using a three-lumen balloon catheter because the fourth lumen makes possible the use of a guidewire to access the targeted portal vein and measurement of any portal vein pressure elevation following PVE via the fourth lumen.

[A case of pulmonary parenchymal endometriosis].

In 1982, a 45-year-old woman was hospitalized because of an abnormal lung shadow. The chest film provided evidence of pulmonary nodules. She was asymptomatic and had no labolatory abnormalities. Exploratory excision was performed to further assess the pulmonary nodules. The initial diagnosis was a suspected "hemangiopericytoma". She received combination chemotherapy but it was not effective. The nodules increased and decreased in size and number over the next decade from 1982, reaching a maximum by 1990 and a minimum by the end of 1992. However, her clinical condition remained stable during this period. Retrospective immunohistochemical analysis of CD10 and progesterone receptors confirmed a diagnosis of pulmonary parenchymal endometriosis. This was an unusual case of pulmonary parenchymal endometriosis that demonstrated various changes in the size and number of nodules without symptoms. There are few previous reports that demonstrated such nodular variation without symptoms over the course of disease.

[A case of multicentric Castleman's disease with multiple pulmonary nodules].

A 55-year-old woman visited our hospital for further examination of abnormal shadows on chest radiographs. Her routine chest radiograph showed two nodular shadows in the right lower lung field. A chest CT scan revealed other nodules, small patchy shadows in both lung fields, and enlargement of the mediastinal lymphnodes (#2, 3). Laboratory data showed polyclonal hyperimmunoglobulinemia. This case was initially considered on the basis of a transbronchial lung biopsy to be a plasma cell granuloma. However, serum gammaglobulin levels gradually increased, and video-assisted thoracoscopic surgery was performed to aid in making a definite diagnosis. Biopsy specimens revealed lymphoid follicles with plasma cells which were stained with both anti-kappa chain and anti-lambda chain antibodies. The patient was treated with prednisolone (50 mg/day), and the serum gammaglobulin level and the shadows on the chest CT were temporarily slightly improved. During the clinical course, her laboratory data and histological specimens were re-examined, and the final diagnosis was multicentric Castleman's disease.