Organizing pneumonia: what is it? A conceptual approach and pictorial review.

Organizing pneumonia (formerly named bronchiolitis obliterans with organizing pneumonia or BOOP) is a clinical, radiological and histological entity that is classified as an Interstitial Lung Disease. The understanding of this family of diseases has seen great progress over the past twenty years. CT presentation of organizing pneumonia is polymorphous but a few patterns have been recently recognized as being more specific to this diagnosis. The aim of this work is to summarize new understandings of the clinical and histological presentation of the disease and to review the most relevant CT features.

Multiple lung parenchymal abnormalities: Don't panic, let's be pragmatic! The 6 question rule - a checklist strategy.

Analysis of multiple lung parenchymal abnormalities on HRCT is a real diagnostic challenge. These abnormalities may be due to a disease of the pulmonary interstitial tissue, the bronchial tree, the cardiovascular system or to abnormal alveolar filling with fluid, blood, cells or tumor, several of these etiologies possibly being concomitant. Systematic pathophysiological reasoning, in the form of a logical checklist, guides reflection and covers many of the most frequent diagnoses and potentially treatable emergencies that can be identified by the non-specialist radiologist. This approach also provides a basis for deepening knowledge of each area. The use of the mnemonic FIBROVAKIM (fibrosis-bronchi-vascular-cancer-infection-medication) is easy to apply and summarizes this strategy.

Lateral cavity wall thickening as an early radiographic sign of mycetoma formation.

The sensitivity of chest radiography for the early detection of mycetoma formation within fibrotic cavities is poor. The purpose of this study was to determine the predictive value of the secondary sign of lateral cavity wall thickening for the detection of a radiographically occult mycetoma. The chest radiographs and CT scans of 70 patients who had a total of 109 fibrotic cavities on CT were reviewed by two observers. Dimensions of the cavity, mycetoma, and cavity wall thickness on chest radiography and CT scans were recorded. Mycetomas were visible in 41 of 99 cavities on chest radiographs and in 61 of 109 cavities on CT. Using CT as the gold standard for detecting the presence of mycetomas, the sensitivity of chest radiography for the presence of a mycetoma was 62 % and the specificity 94 %, and the positive and negative predictive values were 93 and 66 %, respectively. On logistic regression analysis, lateral wall thickness on chest radiography was predictive of the presence of a mycetoma (p < 0.0005) independent of other radiographic features. In patients with chronic fibrocavitary disease on chest radiography, the presence of lateral wall thickening is highly suggestive of an underlying mycetoma.

Pericardial thickening or effusion in patients with pulmonary artery hypertension: a CT study.

OBJECTIVE: The aim of the study was to determine the prevalence of pericardial thickening or effusion revealed by CT in patients with pulmonary artery hypertension. MATERIALS AND METHODS: Forty-five patients underwent pulmonary artery catheterization and CT of the thorax. On CT, we measured the maximum pericardial thickness, total pericardial score (the sum of four measures of pericardial thickness), and thickness of the anterior pericardial recess. Patients were grouped according to mean pulmonary artery pressure: group 1, less than 21 mm Hg (n = 15); group 2, 21-35 mm Hg (n = 15); and group 3, greater than 35 mm Hg (n = 15). RESULTS: The prevalence of an increased pericardial score and increased maximum pericardial thickening was higher in group 3 than in group 1 or group 2 (p = .02 and < .001, respectively). Anterior pericardial recess thickening was markedly increased in group 3 (p < .0001). For all patients, significant correlations (Spearman's rank correlation coefficient = .44-.56, p < .005-.0001) were found between mean pulmonary artery pressure and all pericardial measures. CONCLUSION: On CT, pericardial thickening or effusion is a frequent finding in patients with severe pulmonary hypertension.