RESUMO
OBJECTIVES: Isavuconazole is a convenient triazole antifungal agent with a broad antifungal spectrum. A randomized, open-label study (ClinicalTrials.gov, NCT03471988) was conducted to evaluate the efficacy and safety of isavuconazole in Japanese patients with deep-seated mycoses. PATIENTS AND METHODS: In Cohort A, patients with aspergillosis (chronic pulmonary aspergillosis and invasive aspergillosis) were randomized in a 2:1 ratio to isavuconazole or voriconazole, and in Cohort B, patients with cryptococcosis and mucormycosis were assigned to isavuconazole for up to 84 days of treatment. The overall outcome was evaluated according to the clinical, radiological, and mycological responses at Days 42 and 84 and at the end of treatment (EOT). RESULTS: A total of 103 participants were enrolled and received the study drug. The overall response rate of patients with chronic pulmonary aspergillosis in the isavuconazole (52 patients) and voriconazole (27 patients) groups was 82.7% and 77.8% at EOT, respectively. The response rate in patients with cryptococcosis (10 patients, isavuconazole group only) was 90.0%. One of three participants with invasive aspergillosis and one of three participants with mucormycosis responded in the isavuconazole group. In the safety evaluation, the incidence of adverse events in participants with chronic pulmonary aspergillosis was similar in both groups. Adverse drug reactions were reported in 32 (61.5%) patients receiving isavuconazole and 23 (85.2%) patients receiving voriconazole. CONCLUSIONS: Isavuconazole showed efficacy and safety in Japanese patients with chronic pulmonary aspergillosis and cryptococcosis, for which the drug is not currently indicated.
Assuntos
Aspergilose , Criptococose , Infecções Fúngicas Invasivas , Mucormicose , Aspergilose Pulmonar , Humanos , Voriconazol/efeitos adversos , Mucormicose/tratamento farmacológico , Japão , Triazóis/efeitos adversos , Antifúngicos/efeitos adversos , Aspergilose/tratamento farmacológico , Infecções Fúngicas Invasivas/tratamento farmacológico , Aspergilose Pulmonar/tratamento farmacológico , Criptococose/tratamento farmacológicoRESUMO
OBJECTIVES: The aim of this study was to assess the CT findings that characterise haemoptysis in patients with chronic pulmonary aspergillosis (CPA). METHODS: We retrospectively identified 120 consecutive patients with CPA (84 men and 36 women, 17-89 years of age, mean age 68.4 years) who had undergone a total of 829 CT examinations between January 2007 and February 2017. In the 11 patients who underwent surgical resection, CT images were compared with the pathological results. RESULTS: The scab-like sign was seen on 142 of the 829 CT scans, specifically, in 87 of the 90 CT scans for haemoptysis and in 55 of the 739 CT scans obtained during therapy evaluation. In 48 of those 55 patients, haemoptysis occurred within 55 days (mean 12.0 days) after the CT scan. In the 687 CT scans with no scab-like sign, there were only three instances of subsequent haemoptysis in the respective patients over the following 6 months. Patients with and without scab-like sign differed significantly in the frequency of haemoptysis occurring after a CT scan (p<0.0001). Pathologically, the scab-like sign corresponded to a fibrinopurulent mass or blood crust. CONCLUSIONS: The scab-like sign should be considered as a CT finding indicative of haemoptysis. KEY POINTS: ⢠Haemoptysis is commonly found in patients with CPA. ⢠A CT finding indicative of haemoptysis in CPA patients is described. ⢠Scab-like sign may identify CPA patients at higher risk of haemoptysis.
Assuntos
Hemoptise/diagnóstico por imagem , Aspergilose Pulmonar/patologia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Hemoptise/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVES: To assess chest high-resolution computed tomography (HRCT) findings in patients with acute transformation of adult T cell leukaemia/lymphoma (ATLL). METHODS: We retrospectively identified 72 consecutive patients at our institution with ATLL between October 2000 and March 2014. The cases included acute type (n = 20), lymphoma type (n = 21), smouldering type (n = 24) and chronic type (n = 7). Sixteen (7 men, 9 women; aged 36-85 years, mean 63.3 years) of 31 patients (24 with smouldering and seven with chronic type; 51.6 %) developed acute transformation of ATLL, and had undergone chest HRCT examinations. Parenchymal abnormalities, enlarged lymph nodes, pericardial effusion, pleural effusion and skin lesions were evaluated on HRCT. RESULTS: Chest HRCT of 15 of the 16 patients showed abnormal findings, including ground-glass opacity (GGO) (n = 8), consolidation (n = 5), interlobular septal thickening (n = 5) and nodules (n = 5). Pleural effusion was found in five patients, lymph node enlargement in 10 patients and multiple skin thickening in two patients. CONCLUSIONS: Almost all patients with acute transformation of ATLL had abnormal findings on chest HRCT, which consisted mainly of lymph node enlargement, GGO, interlobular septal thickening, nodules and bilateral pleural effusions. KEY POINTS: ⢠The recognition of CT findings of acute transformation is important ⢠Almost all patients with acute transformation have abnormal findings on HRCT ⢠Characteristic CT features are present in acute transformation of indolent ATLL.
Assuntos
Leucemia-Linfoma de Células T do Adulto/diagnóstico por imagem , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Leucemia-Linfoma de Células T do Adulto/complicações , Linfonodos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/complicações , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Derrame Pleural/complicações , Derrame Pleural/diagnóstico por imagem , Estudos Retrospectivos , Septo Interventricular/diagnóstico por imagemRESUMO
OBJECTIVE: To compare pulmonary high-resolution CT (HRCT) findings in patients with Pseudomonas aeruginosa pneumonia to HRCT findings in patients with Cytomegalovirus (CMV) pneumonia. METHODS: We studied 124 patients (77 men, 47 women; age range, 20-89 years; mean age, 65.4 years) with P. aeruginosa pneumonia and 44 patients (22 men, 22 women; age range, 36-86 years; mean age, 63.2 years) with CMV pneumonia. RESULTS: CT findings of consolidation (p < 0.005), bronchial wall thickening (p < 0.001), cavity (p < 0.05), and pleural effusion (p < 0.001) were significantly more frequent in patients with P. aeruginosa pneumonia than in those with CMV pneumonia. Centrilobular nodules, a crazy-paving appearance, and nodules were significantly more frequent in patients with CMV pneumonia than in those with P. aeruginosa pneumonia (all p < 0.001). CONCLUSION: Pulmonary HRCT findings, such as bronchial wall thickening, crazy-paving appearance, and nodules may be useful in distinguishing between P. aeruginosa pneumonia and CMV pneumonia. KEY POINTS: Distinguishing Pseudomonas aeruginosa pneumonia from Cytomegalovirus pneumonia is important. Characteristic features of underlying conditions are present in each pneumonia species. Bronchial wall thickening and cavities are more frequent in Pseudomonas aeruginosa pneumonia. Nodules and a crazy-paving appearance are more frequent in Cytomegalovirus pneumonia.
Assuntos
Infecções por Citomegalovirus/diagnóstico por imagem , Citomegalovirus/isolamento & purificação , Pneumonia Bacteriana/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Infecções por Pseudomonas/diagnóstico por imagem , Pseudomonas aeruginosa/isolamento & purificação , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Citomegalovirus/virologia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/microbiologia , Pneumonia Viral/virologia , Infecções por Pseudomonas/microbiologia , Estudos Retrospectivos , Adulto JovemRESUMO
PURPOSE: Several reporting systems have been proposed for providing standardized language and diagnostic categories aiming for expressing the likelihood that lung abnormalities on CT images represent COVID-19. We developed a machine learning (ML)-based CT texture analysis software for simple triage based on the RSNA Expert Consensus Statement system. The purpose of this study was to conduct a multi-center and multi-reader study to determine the capability of ML-based computer-aided simple triage (CAST) software based on RSNA expert consensus statements for diagnosis of COVID-19 pneumonia. METHODS: For this multi-center study, 174 cases who had undergone CT and polymerase chain reaction (PCR) tests for COVID-19 were retrospectively included. Their CT data were then assessed by CAST and consensus from three board-certified chest radiologists, after which all cases were classified as either positive or negative. Diagnostic performance was then compared by McNemar's test. To determine radiological finding evaluation capability of CAST, three other board-certified chest radiologists assessed CAST results for radiological findings into five criteria. Finally, accuracies of all radiological evaluations were compared by McNemar's test. RESULTS: A comparison of diagnosis for COVID-19 pneumonia based on RT-PCR results for cases with COVID-19 pneumonia findings on CT showed no significant difference of diagnostic performance between ML-based CAST software and consensus evaluation (p > 0.05). Comparison of agreement on accuracy for all radiological finding evaluations showed that emphysema evaluation accuracy for investigator A (AC = 91.7%) was significantly lower than that for investigators B (100%, p = 0.0009) and C (100%, p = 0.0009). CONCLUSION: This multi-center study shows COVID-19 pneumonia triage by CAST can be considered at least as valid as that by chest expert radiologists and may be capable for playing as useful a complementary role for management of suspected COVID-19 pneumonia patients as well as the RT-PCR test in routine clinical practice.
Assuntos
COVID-19 , Humanos , SARS-CoV-2 , Estudos Retrospectivos , Triagem/métodos , Tomografia Computadorizada por Raios X/métodos , Sensibilidade e Especificidade , Aprendizado de Máquina , Radiologistas , ComputadoresRESUMO
BACKGROUND AND OBJECTIVE: Aspiration pneumonia is one of the common presentations of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP). However, its significance has not yet been fully evaluated due to the difficulties associated with the diagnosis of this condition. This study aimed to evaluate the impact of objectively defined aspiration pneumonia on patients' prognosis with CAP and HCAP. METHODS: This is a multicenter retrospective cohort study consisting of 417 CAP and 220 HCAP patients. We defined aspiration pneumonia as having both risk factors for aspiration (dysphagia due to a neurological disorder, or disturbance of consciousness) and evidence of gravity-dependent opacity on chest computed tomography (CT). The prognostic factors for 30-day mortality were analysed. RESULTS: One hundred sixteen (18%) patients met the definition of aspiration pneumonia, 72 (11%) patients had risks for aspiration alone, 129 (20%) patients had CT findings consistent with aspiration alone, and 320 (50%) patients had neither. Patients diagnosed with aspiration pneumonia had a significantly worse survival than those with risk factors alone (P = 0.001), CT findings of aspiration alone (P = 0.009) and neither (P < 0.001). A multivariate analysis indicated that aspiration pneumonia was independently associated with increased 30-day mortality (adjusted hazard ratio 5.690, P < 0.001) after adjusting for other variables, including the category of pneumonia, performance status, the severity score (CURB-65) and treatment failure due to resistant pathogens. CONCLUSION: Aspiration pneumonia may be a significant predictor of mortality among CAP and HCAP patients. Therefore, the concept of aspiration pneumonia should be considered in the guidelines for these types of pneumonia.
Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/epidemiologia , Pneumonia Aspirativa/epidemiologia , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/diagnóstico por imagem , Infecção Hospitalar/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Pneumonia Aspirativa/diagnóstico por imagem , Prognóstico , Radiografia Torácica , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Tomografia Computadorizada por Raios XRESUMO
Salivary duct carcinoma (SDC) of the extra-glandular segment of Stensen's duct is a very rare but aggressive neoplasm. Ultrasonography, computed tomography, and magnetic resonance imaging findings in a patient pathologically proven to have SDC of the extra-glandular segment of Stensen's duct are reported. When an early peak enhancement region in the mass with a well-enhanced dilated and thickened Stensen's duct wall is apparent on dynamic studies, a SDC of the extra-glandular segment of Stensen's duct should be strongly suspected.
Assuntos
Diagnóstico por Imagem/métodos , Ductos Salivares/diagnóstico por imagem , Ductos Salivares/patologia , Neoplasias das Glândulas Salivares/diagnóstico , Sialografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatística como Assunto , UltrassonografiaRESUMO
The aim of this study was to assess the clinical and pulmonary thin-section CT findings in patients with acute Klebsiella pneumoniae pneumonia. We retrospectively evaluated thin-section CT examinations performed between January 1991 and December 2007 from 962 patients with acute Klebsiella pneumoniae pneumonia. Seven hundred and sixty-four cases with concurrent infectious diseases were excluded. Thus, our study group comprised 198 patients (118 male, 80 female; age range 18-97 years, mean age 61.5). Underlying diseases and clinical findings were assessed. Parenchymal abnormalities were evaluated along with the presence of enlarged lymph nodes and pleural effusion. CT findings in patients with acute Klebsiella pneumoniae pneumonia consisted mainly of ground-glass attenuation (100%), consolidation (91.4%), and intralobular reticular opacity (85.9%), which were found in the periphery (96%) of both sides of the lungs (72.2%) and were often associated with pleural effusion (53%). The underlying conditions in patients with Klebsiella pneumoniae pneumonia were alcoholism or smoking habit.
Assuntos
Infecções por Klebsiella/diagnóstico , Klebsiella pneumoniae/metabolismo , Pneumonia/diagnóstico , Pneumonia/microbiologia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Alcoolismo , Diagnóstico por Imagem/métodos , Feminino , Humanos , Infecções por Klebsiella/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico por imagem , Estudos Retrospectivos , FumarRESUMO
We report a case of gastrointestinal manifestation of hereditary angioedema. Computed tomography (CT) revealed wall thickening of the gastric antrum, duodenum, and jejunum. Dilatation of the third part of the duodenum, thickening of the small bowel mesentery and omentum, and retroperitoneal edema were present. The importance of considering this condition in patients presenting such CT findings correlated with the appropriate history is discussed.
Assuntos
Angioedemas Hereditários/diagnóstico por imagem , Trato Gastrointestinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Dor Abdominal/etiologia , Angioedemas Hereditários/complicações , Angioedemas Hereditários/tratamento farmacológico , Proteína Inibidora do Complemento C1/administração & dosagem , Inativadores do Complemento/administração & dosagem , Diagnóstico Diferencial , Edema/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Náusea/etiologiaRESUMO
PURPOSE: To directly compare the effect of a reconstruction algorithm on nodule detection capability of the computer-aided detection (CADe) system using standard-dose, reduced-dose and ultra-low dose chest CTs with and without adaptive iterative dose reduction 3D (AIDR 3D). MATERIALS AND METHODS: Our institutional review board approved this study, and written informed consent was obtained from each patient. Standard-, reduced- and ultra-low-dose chest CTs (250â¯mA, 50â¯mA and 10â¯mA) were used to examine 40 patients, 21 males (mean age⯱â¯standard deviation: 63.1⯱â¯11.0â¯years) and 19 females (mean age, 65.1⯱â¯12.7â¯years), and reconstructed as 1 mm-thick sections. Detection of nodule equal to more than 4â¯mm in dimeter was automatically performed by our proprietary CADe software. The utility of iterative reconstruction method for improving nodule detection capability, sensitivity and false positive rate (/case) of the CADe system using all protocols were compared by means of McNemar's test or signed rank test. RESULTS: Sensitivity (SE: 0.43) and false-positive rate (FPR: 7.88) of ultra-low-dose CT without AIDR 3D was significantly inferior to those of standard-dose CTs (with AIDR 3D: SE, 0.78, pâ¯<â¯.0001, FPR, 3.05, pâ¯<â¯.0001; and without AIDR 3D: SE, 0.80, pâ¯<â¯.0001, FPR: 2.63, pâ¯<â¯.0001), reduced-dose CTs (with AIDR 3D: SE, 0.81, pâ¯<â¯.0001, FPR, 3.05, pâ¯<â¯.0001; and without AIDR 3D: SE, 0.62, pâ¯<â¯.0001, FPR: 2.95, pâ¯<â¯.0001) and ultra-low-dose CT with AIDR 3D (SE, 0.79, pâ¯<â¯.0001, FPR, 4.88, pâ¯=â¯.0001). CONCLUSION: The AIDR 3D has a significant positive effect on nodule detection capability of the CADe system even when radiation dose is reduced.
Assuntos
Imageamento Tridimensional/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Algoritmos , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
RATIONALE AND OBJECTIVES: Pulmonary involvement in inflammatory bowel disease may reflect the common embryonic origin of the gastrointestinal tract and the bronchial tree. No studies have compared pulmonary high-resolution computed tomography (HRCT) findings between ulcerative colitis (UC) and Crohn disease (CD). This study aimed to assess the relationship between pulmonary HRCT findings and inflammatory bowel disease activity and to compare HRCT findings between UC and CD. MATERIALS AND METHODS: We retrospectively identified 601 consecutive patients (350 with UC and 251 with CD) who had undergone chest HRCT examinations at our institutions between April 2004 and April 2016. Parenchymal abnormalities, enlarged lymph nodes, and pleural effusion were evaluated on HRCT. RESULTS: One hundred sixty-seven patients (94 men, 73 women; aged 12-86 years, mean: 47.2 years) with UC and 93 patients (61 men, 32 women; aged 12-71 years, mean: 37.9 years) with CD had abnormal findings on chest HRCT. The HRCT findings of UC and CD mainly consisted of centrilobular nodules (in 49.1% and 45.2% of cases, respectively) and bronchial wall thickening (in 31.7% and 54.8%, respectively). There was no relationship between HRCT findings and disease activity. Bronchial wall thickening was significantly more frequent in patients with CD than in those with UC (P < .001). CONCLUSION: The main chest HRCT findings in UC and CD are centrilobular nodules and bronchial wall thickening. There are differences in HRCT findings between UC and CD.
Assuntos
Brônquios/diagnóstico por imagem , Colite Ulcerativa/complicações , Doença de Crohn/complicações , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brônquios/patologia , Criança , Feminino , Humanos , Linfadenopatia/complicações , Linfadenopatia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Derrame Pleural/complicações , Derrame Pleural/diagnóstico por imagem , Estudos Retrospectivos , Nódulo Pulmonar Solitário/complicações , Adulto JovemRESUMO
BACKGROUND: Clinical/pathologic correlations in patients with high-resolution CT (HRCT) scan findings presenting with two patterns of centrilobular opacity remain unclear. METHODS: Chest HRCT scans in 553 patients with predominant centrilobular opacities or preferential centrilobular disease were retrospectively evaluated. In 141 patients who underwent biopsy, CT scan images were compared with actual specimens. RESULTS: Centrilobular nodules with a tree-in-bud appearance and bronchial wall thickening were observed in most patients who were carriers of human T-lymphotropic virus type 1 (88 patients and 57 of 99 patients, respectively), Mycoplasma pneumoniae pneumonia (44 patients and 45 of 52 patients, respectively), Mycobacterium tuberculosis (38 patients and 37 of 52 patients, respectively), Mycobacterium avium-intracellulare complex (22 patients and 27 of 37 patients, respectively), Mycobacterium kansasii (27 patients and 19 of 33 patients, respectively), allergic bronchopulmonary aspergillosis (6 patients and 7 of 9 patients, respectively), diffuse panbronchiolitis (12 patients and 10 of 12 patients, respectively), and diffuse aspiration bronchiolitis (12 patients and 12 of 13 patients, respectively). On the other hand, ill-defined centrilobular nodules of ground-glass attenuation were frequently seen in patients with subacute hypersensitivity pneumonitis (all 15 patients), metastatic calcification (all 4 patients), Churg-Strauss syndrome (4 of 12 patients), microscopic polyangiitis (27 of 48 patients), systemic lupus erythematosus (7 of 8 patients), and respiratory bronchiolitis-associated interstitial lung disease (all 8 patients). Pathologically, the tree-in-bud appearance correlated well with the plugging of small airways with mucous, pus, or fluid; dilated bronchioles; and bronchiolar wall thickening. Ill-defined centrilobular nodules represented peribronchiolar inflammation or the deposition of hemorrhagic materials. CONCLUSIONS: Knowledge of the two centrilobular patterns is of proven worth for generating differential diagnoses and is of particular value in suggesting a likely infectious etiology in cases with tree-in-bud appearance.
Assuntos
Pneumopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Pneumopatias/microbiologia , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Estudos RetrospectivosRESUMO
OBJECTIVE: This study aimed to compare CT findings in patients with Epstein-Barr virus positive (EBV+) diffuse large B-cell lymphoma (DLBCL) of the elderly with CT findings in patients with Epstein-Barr virus negative (EBV-) DLBCL. METHODS: We retrospectively identified 9 consecutive patients with EBV+ DLBCL (6 males and 3 females; aged 72-83 years, mean: 76.2 years) and 39 consecutive patients with EBV- DLBCL (19 males and 20 females; aged 53-91 years, mean: 71.3 years) who had undergone CT examinations between September 2007 and August 2016. In each type of disease, clinical and CT findings were evaluated. RESULTS: No significant differences in B symptom incidence or serum lactate dehydrogenase levels were found between the two diseases. However, the prognosis of patients with EBV+ DLBCL was significantly poorer than that of those with EBV- DLBCL (p < 0.05). Nodal and extranodal necrosis was found in 6 (66.7%) of 9 patients with EBV+ DLBCL and in 6 (15.4%) of 39 patients with EBV- DLBCL (p < 0.005). CONCLUSION: The CT finding of nodal and extranodal necrosis was significantly more frequent in patients with EBV+ DLBCL than in patients with EBV- DLBCL. Advances in knowledge: This is the first report on the CT findings in patients with EBV+ DLBCL of the elderly. Different CT findings are present in EBV+ DLBCL and EBV- DLBCL.
Assuntos
Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Infecções por Vírus Epstein-Barr/patologia , Feminino , Avaliação Geriátrica , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfoma Difuso de Grandes Células B/patologia , Masculino , Estudos RetrospectivosRESUMO
RATIONALE AND OBJECTIVES: Nocardiosis is difficult to diagnose, and the diagnosis is thus frequently delayed. High-resolution computed tomography (HRCT) findings of patients with pulmonary nocardiosis have been documented in few reports. Our study objective was to assess HRCT findings of patients with pulmonary nocardiosis. MATERIALS AND METHODS: This was a retrospective study of 20 consecutive patients with pulmonary Nocardia infections who underwent HRCT of the chest at our institutions from January 2011 to August 2014. After the exclusion of two patients with concurrent infections, the study group comprised 18 patients (11 men, 7 women; age range, 39-83 years; mean, 67.9 years) with pulmonary Nocardia infections. Parenchymal abnormalities, enlarged lymph nodes, and pleural effusion were evaluated on HRCT. RESULTS: Underlying conditions included respiratory disease (n = 6, 33.3%), collagen diseases (n = 5, 27.8%), and diabetes mellitus (n = 4, 22.2%). All patients showed abnormal HRCT findings, including the presence of a nodule/mass (n = 17, 94.4%), ground-glass opacity (n = 14, 77.8%), interlobular septal thickening (n = 14, 77.8%), and cavitation (n = 12, 66.7%). Pleural effusion was seen in two patients. There were no cases of lymph node enlargement. CONCLUSIONS: Among the HRCT findings in patients with pneumonia, a nodule/mass with interlobular septal thickening and/or cavitation are suggestive of pulmonary nocardiosis.
Assuntos
Tomografia Computadorizada Multidetectores/métodos , Nocardiose/diagnóstico por imagem , Pneumonia Bacteriana/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Colágeno/complicações , Complicações do Diabetes/diagnóstico , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Pulmão/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Doenças Respiratórias/complicações , Estudos Retrospectivos , Nódulo Pulmonar Solitário/diagnóstico por imagemRESUMO
Fluorodeoxyglucose (FDG)-positron emission tomography with computed tomography (FDG-PET/CT) is useful in disease monitoring of malignancies after therapy, while an FDG uptake may also be present in benign diseases. We herein demonstrate a case of disseminated Mycobacterium tuberculosis mimicking systemic metastasis of prostate cancer. This case highlights that clinicians should consider Mycobacterium tuberculosis in patients with prostate cancer who demonstrate multifocal FDG uptakes masquerading as metastasis, even when the chest photographs reveal a normal appearance and a sputum examination demonstrates negative results. An invasive surgical biopsy may be required and a pathological analysis would be critical in the diagnosis of Mycobacterium tuberculosis.
Assuntos
Radioterapia com Íons Pesados , Mycobacterium tuberculosis , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Tuberculose Miliar/diagnóstico , Idoso , Diagnóstico Diferencial , Fluordesoxiglucose F18 , Humanos , Masculino , Neoplasias da Próstata/secundário , Compostos RadiofarmacêuticosRESUMO
Ninety-nine patients (29 males and 70 females; mean age, 57.1 years; range, 22-81 years) were included in this study to evaluate the factors affecting smaller lung volume changes in expiratory high-resolution computed tomography performed to depict air trapping. All patients underwent inspiratory and expiratory chest thin-section CT examinations and pulmonary function tests. Air trapping on CT images was graded subjectively. All variables (age, sex, diagnosis, pulmonary function index, and air trapping score) were compared with the degree of change in lung volume between the inspiratory and expiratory CT examinations. The variables affecting a lower degree of volume change were vital capacity, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1.0), and the FEV1.0/FVC ratio. Bronchiolitis obliterans was the dominant diagnosis in patients with insufficient degrees of breath holding and in patients with negative air trapping scores despite an abnormal air trapping index. An insufficient degree of lung changes between inspiration and expiration on CT examinations represented bronchiolitis obliterans, which resulted in low FEV1.0 and FEV1.0/FVC values. Changes in the time gap from the announcement of exhalation and breath holding to the start of scanning most effectively indicated air trapping in patients with bronchiolar disorders.