Malignant Mesothelioma Versus Metastatic Carcinoma of the Pleura: A CT Challenge.

BACKGROUND: Malignant pleural mesothelioma (MPM) is a rare malignant neoplasm of the pleura that typically affects individuals occupationally exposed to asbestos through a variety of industries. MPM presents with several CT features similar to more common pleural diseases such as metastatic pleural malignancy. OBJECTIVES: The aim of this study is to differentiate malignant pleural mesothelioma from metastatic carcinoma of the pleura by pathological and radiological assessment in order to investigate accuracy of CT scan in this regard and to compare CT features of these two malignancies. PATIENTS AND METHODS: Chest CT scans of 55 pleural malignancy patients including MPM and metastatic pleural malignancy were evaluated in this retrospective study. The pathologist made the definite diagnosis based on immunohistochemistry. A chest radiologist unaware of the pathology diagnosis observed all CT scans. Several parameters including pleural thickening, pleural effusion, thickening of inter lobar fissure, contralateral extension, contraction of involved hemithorax, parenchymal involvement (infiltration, nodules, fibrosis), pleural mediastinal involvement, lymphadenopathy, extrapleural invasion (hepatic, chest wall, diaphragm, intraperitoneal), and pericardial involvement were checked. Data analysis was carried out using SPSS version 16, and the ability of CT scan to differentiate malignant pleural mesothelioma and metastatic pleural diseases was investigated. RESULTS: Totally 29 males and 26 females were assessed in this study. Based on pathology, 17 MPM and 38 metastatic pleural malignancies were diagnosed. According to CT study, about 82% of the patients with MPM and about 79% of the patients with metastatic pleural diseases were correctly diagnosed by a radiologist. The most common findings suggestive of MPM were pleural thickening (88.2%), loculated effusion (58.8%), and thickening of the interlobar fissure (47.1%). Whereas free pleural effusion (71.7%), parenchymal infiltration (65.8%) and pleural thickening (63.2%) were most prevalent parameters among metastatic cases. CONCLUSION: CT scan is highly accurate in differentiating malignant pleural mesothelioma and metastatic pleural diseases. Pleural thickening and thickening of interlobar fissure lead us to the diagnosis of MPM and massive free pleural effusion is more commonly seen in metastatic pleural malignancy.

Extra-pulmonary Pneumocystis jiroveci infection: a case report.

In physical examination abdominal tenderness, gate disturbance and penile herpetic lesions were detected. Decreased disc height at T11-T12 level was detected in chest X-ray. Abdominal sonography and CT scan revealed hypo dense lesions in Lt left Lobe of liver and multiple hypo dense splenic and pancreatic lesions, ascitis, Lt left sided pleural effusion, thickening of jejuneal mucosa and edema of bowel wall. Vertebral body lesion and paravertebral abscess, bony calvarial involvement and adjacent extra axial brain lesion were observed in imaging were other findings. RNA analysis for HIV was positive. Vertebral lesion biopsy and aspiration of splenic lesion were performed and pathology revealed Pneumocystis jirovecii suggestive of extra pulmonary Pneumocystis carinii infection.

Thoracic Imaging Findings of Collagen Vascular Diseases: A CT Study.

BACKGROUND: Collagen vascular diseases (CVDs) are well known causes of pulmonary involvement, leading to significant morbidity. The purpose of this study was to identify several thoracic computed tomographic findings of CVDs. MATERIALS AND METHODS: The study included 56 patients (15 males and 41 females) with histopathologically and clinically proven CVDs who were identified retrospectively. The presence, extent and distribution of various CT findings were evaluated by a radiologist. RESULTS: Lung parenchyma (96.4%) was the most common area of involvement. The lower lobes (89.2%) were the most frequent sites of involvement. The predominant CT patterns were reticulation (55.3%), peripheral subpleural interlobular septal thickening (51.7%) and ground glass opacity (50%). The most common histopathological findings according to CT features were obliterative bronchiolitis (OB, 44.6%) and non-specific interstitial pneumonia (NSIP, 33.9%). Usual interstitial pneumonia was seen in 12.5% and organizing pneumonia in 26.7% of patients. CONCLUSION: A combination of reticular pattern, peripheral subpleural interlobular septal thickening and ground glass opacity is seen in the majority of patients with CVDs. The results indicate that OB is more prevalent than what has been reported in previous studies. The CT patterns of pulmonary fibrosis are similar to those in most other studies.

Huge hilar carcinoid tumor resected by transsternal pneumonectomy: a case presentation.

Carcinoid tumors comprise an uncommon group of pulmonary neoplasms with neuroendocrine origin. In comparison with typical carcinoid tumors, atypical tumors are less common and more aggressive. We present a 35-year old female with atypical carcinoid tumor. The mass was located centrally and transsternal pneumonectomy was performed to resect the tumor.

Multidrug resistant tuberculosis versus non-tuberculous mycobacterial infections: a CT-scan challenge.

INTRODUCTION: Clinical, laboratory and imaging findings in patients with multidrug resistant-tuberculosis (MDR-TB) and non-tuberculosis mycobacterium (NTM) are similar, and the majority of these patients present with positive smear for Acid Fast Bacilli (ADB) and no response to first line anti-TB treatment, so sputum culture and PCR are necessary, especially in NTM. OBJECTIVE: In this study we evaluate more details of imaging findings to help earlier diagnosis of pathogens. MATERIALS AND METHODS: 66 patients with positive smear for AFB and no response to first line anti-TB drugs were divided into two groups by PCR and culture: MDR-TB (43 patients) and NTM (23 patients). Age, sex, history of anti-TB treatment, smoking and CT-scan findings (parenchymal, pleural and mediastinal variables) by details and lobar distribution were analyzed. RESULTS: Mean age of NTM patients was slightly higher (52 versus 45) and there is no significant difference in sex and smoking. In MDR-TB group, history of anti-TB treatment and evidence of chronic pulmonary disease such as calcified and fibrodestructed parenchyma, volume loss and pleural thickening were higher significantly. Cavities in MDR-TB were thick-wall in the background of consolidation, while NTM cavities were more thin-walled with adjacent satellite nodules in same segment or lobe. Prevalence of bronchiectasis was similar in both groups, while bronchiectasis in MDR-TB group was in fibrobronchiectatic background in upper lobes, and in NTM group the distribution was more uniform with slightly middle lobes predominance. Prevalence and distribution of nodular infiltrations were similar more in Tree in Buds and scattered pattern. Calcified or non-calcified lymph nodes and also pleural changes were more frequent in MDR-TB but prevalence of lymphadenopathy was mildly higher in NTM. CONCLUSION: A check-list with multiple variables is helpful for differentiation between the two groups.

Chest CT Manifestations in Children with CVID: A 10-Year Report.

BACKGROUND: This study aimed at evaluating HRCT pulmonary manifestations in children with Common Variable Immunodeficiency (CVID) hospitalized in the Pediatric Ward of Masih Daneshvari Hospital during a 10-year period. MATERIALS AND METHODS: This retrospective study evaluated 25 children hospitalized with the diagnosis of CVID in the Pediatric Ward of Masih Daneshvari Hospital from 2001 to 2011 and their pulmonary HRCT scans were evaluated. RESULTS: The most common pulmonary HRCT findings were lymphadenopathy (66.7%), bronchiectasis (50%), air trapping (33.3%) and peribronchial wall thickening (33.3%). The highest percentage of CT-scan findings was detected in patients aged 13-17 yrs. CONCLUSION: Most of the pulmonary changes due to CVID are preventable or treatable. Also, it is possible to prevent irreversible complications of disease if it is diagnosed early. Therefore, HRCT is strongly recommended as an accurate and effective method for monitoring and fast recognition of pulmonary manifestations of the disease especially bronchiectasis which is a very common finding indicative of poor prognosis.

Extra-pulmonary Pneumocystis jiroveci infection: a case report

In physical examination abdominal tenderness, gate disturbance and penile herpetic lesions were detected. Decreased disc height at T11-T12 level was detected in chest X-ray. Abdominal sonography and CT scan revealed hypo dense lesions in Lt left Lobe of liver and multiple hypo dense splenic and pancreatic lesions, ascitis, Lt left sided pleural effusion, thickening of jejuneal mucosa and edema of bowel wall. Vertebral body lesion and paravertebral abscess, bony calvarial involvement and adjacent extra axial brain lesion were observed in imaging were other findings. RNA analysis for HIV was positive. Vertebral lesion biopsy and aspiration of splenic lesion were performed and pathology revealed Pneumocystis jirovecii suggestive of extra pulmonary Pneumocystis carinii infection.

Multidrug resistant tuberculosis versus non-tuberculous mycobacterial infections: a CT-scan challenge

INTRODUCTION: Clinical, laboratory and imaging findings in patients with multidrug resistanttuberculosis (MDR-TB) and non-tuberculosis mycobacterium (NTM) are similar, and the majority of these patients present with positive smear for Acid Fast Bacilli (ADB) and no response to first line anti-TB treatment, so sputum culture and PCR are necessary, especially in NTM. OBJECTIVE: In this study we evaluate more details of imaging findings to help earlier diagnosis of pathogens. MATERIALS AND METHODS: 66 patients with positive smear for AFB and no response to first line anti-TB drugs were divided into two groups by PCR and culture: MDR-TB (43 patients) and NTM (23 patients). Age, sex, history of anti-TB treatment, smoking and CT-scan findings (parenchymal, pleural and mediastinal variables) by details and lobar distribution were analyzed. RESULTS: Mean age of NTM patients was slightly higher (52 versus 45) and there is no significant difference in sex and smoking. In MDR-TB group, history of anti-TB treatment and evidence of chronic pulmonary disease such as calcified and fibrodestructed parenchyma, volume loss and pleural thickening were higher significantly. Cavities in MDR-TB were thickwall in the background of consolidation, while NTM cavities were more thin-walled with adjacent satellite nodules in same segment or lobe. Prevalence of bronchiectasis was similar in both groups, while bronchiectasis in MDR-TB group was in fibrobronchiectatic background in upper lobes, and in NTM group the distribution was more uniform with slightly middle lobes predominance. Prevalence and distribution of nodular infiltrations were similar more in Tree in Buds and scattered pattern. Calcified or non-calcified lymph nodes and also pleural changes were more frequent in MDR-TB but prevalence of lymphadenopathy was mildly higher in NTM. CONCLUSION: A check-list with multiple variables is helpful for differentiation between the two groups.