Pulmonary nodular lymphoid hyperplasia presenting as cavitating lung mass.

Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare non-neoplastic disorder, which can mimic malignancy due to its indolent yet progressive nature. Here, we report a case of surgically proven PNLH that progressed over many years from a ground glass opacity to a solid cavitating lesion mimicking a slow growing primary lung carcinoma.

The Use and Efficacy of FFR-CT: Real-World Multicenter Audit of Clinical Data With Cost Analysis.

BACKGROUND: Fractional flow reserve-computed tomography (FFR-CT) is endorsed by UK and U.S. chest pain guidelines, but its clinical effectiveness and cost benefit in real-world practice are unknown. OBJECTIVES: The purpose of this study was to audit the use of FFR-CT in clinical practice against England's National Institute for Health and Care Excellence guidance and assess its diagnostic accuracy and cost. METHODS: A multicenter audit was undertaken covering the 3 years when FFR-CT was centrally funded in England. For coronary computed tomographic angiograms (CCTAs) submitted for FFR-CT analysis, centers provided data on symptoms, CCTA and FFR-CT findings, and subsequent management. Audit standards included using FFR-CT only in patients with stable chest pain and equivocal stenosis (50%-69%). Diagnostic accuracy was evaluated against invasive FFR, when performed. Follow-up for nonfatal myocardial infarction and all-cause mortality was undertaken. The cost of an FFR-CT strategy was compared to alternative stress imaging pathways using cost analysis modeling. RESULTS: A total of 2,298 CCTAs from 12 centers underwent FFR-CT analysis. Stable chest pain was the main symptom in 77%, and 40% had equivocal stenosis. Positive and negative predictive values of FFR-CT were 49% and 76%, respectively. A total of 46 events (2%) occurred over a mean follow-up period of 17 months; FFR-CT (cutoff: 0.80) was not predictive. The FFR-CT strategy costs £2,102 per patient compared with an average of £1,411 for stress imaging. CONCLUSIONS: In clinical practice, the National Institute for Health and Care Excellence criteria for using FFR-CT were met in three-fourths of patients for symptoms and 40% for stenosis. FFR-CT had a low positive predictive value, making its use potentially more expensive than conventional stress imaging strategies.

Impaired Respiratory System Resistance and Reactance Are Associated With Bronchial Wall Thickening in Persistent Asthma.

BACKGROUND: A recent study demonstrated a significant correlation between bronchial biopsy airway remodeling and quantitative computed tomography looking at bronchial wall thickness. OBJECTIVE: To identify clinical associations with bronchial wall thickness in moderate to severe asthma. METHODS: Ninety-two respiratory physician-diagnosed Global Initiative for Asthma-defined patients with moderate to severe asthma were included in this retrospective cohort study. Blinded to all clinical data, 2 senior thoracic radiologists independently measured airway lumen and total airway area at 4 different bronchopulmonary segments using high-resolution computed tomography imaging. We calculated adjusted odds ratios with regard to the association of bronchial wall thickness with spirometry, oscillometry, exacerbations, and nasal polyps. RESULTS: The pooled analysis for all 4 bronchopulmonary segments showed that an area under reactance curve greater than or equal to 1.0 kPa/L, an R5-R20 ratio (resistance heterogeneity between 5 and 20 Hz divided by total resistance [R5]) of 25% or more, having 2 or more exacerbations per year, and presence of nasal polyposis exhibited adjusted odds ratios of 3.54 (95% CI, 1.22-10.32), 2.89 (95% CI, 1.03-8.05), 4.17 (95% CI, 1.25-13.90), and 9.85 (95% CI, 2.33-41.74), respectively, in their association with a wall area thickness of 50% or more. These translated into a respective 72%, 65%, 76%, and 90% increased likelihood for a wall area thickness of 50% or more. CONCLUSIONS: Bronchial wall thickness is associated with peripheral airways resistance and reactance, severe exacerbations, and nasal polyposis in persistent asthma.

Clinical Associations of Mucus Plugging in Moderate to Severe Asthma.

BACKGROUND: Mucus plugging is recognized as a contributory factor to airway obstruction and symptoms in persistent asthma. OBJECTIVE: We aimed to determine phenotypic associations of mucus plugging in patients with moderate to severe asthma in a real-life clinic setting. METHODS: Mucus plugs (MPs) were identified by a thoracic radiologist upon high-resolution computed tomography imaging. A MP score was subsequently calculated and analyzed along with type 2 biomarkers, spirometry, severe exacerbations, and asthma control for 126 patients with moderate to severe asthma before biologic therapy. RESULTS: Asthma patients with MP had significantly worse FEV1%, forced expiratory flow at 25% to 75% of FVC percent, and FEV1/FVC as well as higher levels of peripheral blood eosinophils, FeNO, total IgE, and Aspergillus fumigatus IgE titers, and had previously experienced more frequent severe exacerbations. FEV1/FVC, more than two exacerbations per year, blood eosinophils, total IgE, and A fumigatus IgE titers were associated with MPs after adjusting for confounders. CONCLUSIONS: Poorly controlled asthma patients with MPs exhibited significantly worse airflow obstruction and greater type 2 inflammation associated with more frequent severe exacerbations. Impaired spirometry, more frequent exacerbations, raised blood eosinophils, total IgE, and A fumigatus IgE increased the likelihood of MPs.

An unusual presentation of neuroglial heterotopia: case report.

We report a rare case of nasopharyngeal neuroglial heterotopia in a 16-year-old girl who presented with sore throat and feeling of a lump in her throat. Neuroglial heterotopia is a mass composed of misplaced neural tissue during embryonic development which has lost its intracranial connection. A careful review of literature in PUBMED shows most of the previously reported cases of nasopharyngeal glial heterotopia presented during neonatal or infancy period with symptoms of respiratory distress or airway obstruction. Our case caused a diagnostic dilemma due to late presentation and atypical radiological findings. Imaging, especially MRI, is vital for evaluating such nasopharyngeal masses in children for pre-surgical planning and more importantly to rule out any intracranial communication. Treatment is surgical resection by endoscopic or external approach, with a rare possibility of recurrence.

Natural course of incidentally detected isolated Celiac Artery Dissection with hepatic artery occlusion.

Isolated celiac artery dissection (ICAD) is a rare entity with over 160 cases described in literature. We report a case of incidentally detected isolated celiac artery dissection during computed tomography evaluation for occult gastrointestinal bleeding. Though most cases of isolated celiac artery dissection are initially managed conservatively with antiplatelet and anticoagulants, some patients may require endovascular or occasionally surgical treatment. In our case, the celiac artery dissection had already progressed to cause hepatic artery occlusion and secondary collateral formation in the porta hepatis region. We retrospectively analyze the natural course of celiac artery dissection with hepatic artery occlusion in an asymptomatic patient for over 3 years.

MDCT evaluation of sternal variations: Pictorial essay.

Sternal variations and anomalies have been identified in the past during autopsy or cadaveric studies. Recently, an increasing number of minor sternal variations have been reported with the advent of multidetector computed tomography (CT). Although there are many sternal variations that occur with varying appearance and prevalence, most of them are not recognized or are underreported during routine imaging of thorax. Identification of sternal variations is important to differentiate from pathological conditions and to prevent fatal complications prior to sternal interventions like marrow aspiration or acupuncture. This article aims to describe the minor and asymptomatic sternal variations by multidetector CT and their clinical significance.

Case report: Intra-atrial course of right coronary artery: Evaluation by dual-source CT.

We report a case of an anomalous course of the right coronary artery (RCA) through the right atrium, which was evaluated using dual-source CT angiography. There have been a few cases described previously in literature, but most of them were found either during surgery or at autopsy. Although this variant is clinically benign, it has significant consequences during interventional procedures or bypass surgery.