Chest High-resolution Computed Tomography Findings in 601 Patients with Inflammatory Bowel Diseases.

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.

Multiple Tracheal Diverticula Detected by Multidetector-row Computed Tomography.

Multiple tracheal diverticula are rare. We report a case of a 62-year-old man who had multiple tracheal diverticula that were detected using multidetector-row computed tomography. Axial computed tomography images showed multiple air collections contiguous to the trachea. The multiple air collections were visible as outpouchings of the parts of the trachea between the cartilages, being located almost symmetrically on both lateral sides of the tracheal wall as seen on coronal multiplanar reconstruction images. Virtual bronchoscopy confirmed the presence of multiple openings in the tracheal wall of the diverticular necks. The alteration of the airway was better seen using volume-rendered reconstruction. Thin-slice multidetector-row computed tomography and advanced imaging techniques may increase the frequency of identification of multiple tracheal diverticula.

Computed tomography of the gastrointestinal manifestation of hereditary angioedema.

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.

Clinical/pathologic correlations in 553 patients with primary centrilobular findings on high-resolution CT scan of the thorax.

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.

Pulmonary computed tomography findings of visceral larva migrans caused by Ascaris suum.

OBJECTIVE: To retrospectively evaluate the computed tomography (CT) findings of pulmonary involvement in patients with visceral larva migrans caused by Ascaris suum. METHODS: Institutional review board approval was obtained, and informed consent was waived. Chest CT scans obtained between January 1994 and November 2005 in 32 patients infected with A. suum were retrospectively evaluated by 3 chest radiologists. In 4 patients who underwent surgical or transbronchial biopsy, comparisons of the CT images with the actual specimens were performed. RESULTS: On CT scans, abnormal findings were seen in 28 patients. The most common abnormality consisted of nodules (n = 19) in which the majority had a halo of ground-glass attenuation (n = 17), followed by ground-glass attenuation (n = 18), and interlobular septal thickening (n = 14). These abnormalities were predominantly seen in the peripheral lung (n = 25). Of the 7 patients who underwent follow-up CT scans, nodules (n = 6) and ground-glass attenuation (n = 5) had migrated in 4 patients. Pathologically, these findings corresponded to marked eosinophilic infiltration into the interstitium. CONCLUSIONS: These CT findings are considered to be suggestive of thoracic involvement in patients with visceral larva migrans caused by A. suum.

Bronchiolitis obliterans organizing pneumonia after bone marrow transplantation: association with human leukocyte antigens.

UNLABELLED: This is the first study reporting the relationship between the development of bronchiolitis obliterans organizing pneumonia (BOOP) and human leukocyte antigen (HLA) in patients with bone marrow transplantation (BMT). The HLA B35 was significantly higher in patients with BOOP than in patients without BOOP after BMT (P = 0.0069). The HLA B35 is important as a host factor for the generation of BOOP after BMT. OBJECTIVE: To assess the relationship between the development of BOOP after BMT and HLA. METHODS: We retrospectively reviewed clinical features and chest computed tomographic scans in 64 patients who underwent allogeneic BMT between March 1990 and September 2004, and evaluated the relationship between HLA and development of BOOP. RESULTS: Development of BOOP was between days 22 and 347 (mean, 114 days). The common computed tomographic findings consisted of patchy consolidation in subpleural and/or peribronchovascular distributions. Frequency of HLA B35 in patients with BOOP development after BMT was significantly higher than in patients without BOOP after BMT (P = 0.0069). There were no significant relationships between the others of this antigen and BOOP development. CONCLUSIONS: Our results suggested that HLA B35 is an important host factor for the generation of BOOP after BMT.

Pulmonary CT findings in 320 carriers of human T-lymphotropic virus type 1.

PURPOSE: To retrospectively evaluate pulmonary computed tomographic (CT) findings in human T-lymphotropic virus type 1 (HTLV-1) carriers, who were characterized by means of polyclonal integration of proviral DNA. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was waived. Chest CT scans obtained between January 1996 and October 2004 in 320 (154 men, 166 women; age range, 31-86 years; mean, 64 years) patients with HTLV-1 were retrospectively evaluated by three chest radiologists. Parenchymal abnormalities (ground-glass opacity, consolidation, centrilobular nodules, thickening of bronchovascular bundles, interlobular septal thickening, and bronchiectasis) were evaluated, along with enlarged lymph nodes and pleural effusion. In 58 patients who underwent surgical biopsy or transbronchial biopsy, comparison of CT images with the actual specimens was performed by a pathologist and three chest radiologists. RESULTS: On CT scans, abnormal findings were seen in 98 (30.1%) patients and consisted of centrilobular nodules (n = 95), thickening of bronchovascular bundles (n = 55), ground-glass opacity (n = 51), bronchiectasis (n = 50), interlobular septal thickening (n = 28), and consolidation (n = 5). These abnormalities were predominantly seen in the peripheral lung parenchyma (n = 70). Pathologically, these findings corresponded to lymphocytic infiltration along respiratory bronchioles and bronchovascular bundles. Pleural effusion and enlarged lymph nodes were found in two and five patients, respectively. CONCLUSION: CT findings in patients with HTLV-1 consisted mainly of centrilobular nodules, ground-glass opacity, and thickening of the bronchovascular bundles in the peripheral lung. These CT findings are considered suggestive of thoracic involvement in patients with HTLV-1.

Chlamydia pneumoniae pneumonia and Mycoplasma pneumoniae pneumonia: comparison of clinical findings and CT findings.

The objective of this study was to identify the clinical and pulmonary CT findings associated with Chlamydia pneumoniae pneumonia and to compare them with those of Mycoplasma pneumoniae pneumonia. The clinical features and CT scans of 40 patients with C. pneumoniae pneumonia and 42 patients with M. pneumoniae pneumonia were retrospectively reviewed. There were no significant differences between the two etiologic agents with regard to clinical signs. Chest CT findings in patients with C. pneumoniae pneumonia consisted mainly of ground-glass attenuation (n = 38) and acinar patterns (n = 28). Acinar patterns and pleural effusions (n = 12) were observed significantly more frequently than in patients with M. pneumoniae pneumonia (P < 0.0001, P < 0.039, respectively). CT findings of centrilobular nodules and bronchial wall thickening were significantly less common than in the M. pneumoniae pneumonia patients (P < 0.0001, P < 0.0001, respectively). The CT finding of acinar patterns, although nonspecific, can be considered suggestive of C. pneumoniae pneumonia.

Radiotherapy combined with transarterial infusion chemotherapy and concurrent infusion of a vasoconstrictor agent for nonresectable advanced hepatic hilar duct carcinoma.

BACKGROUND: The treatment of patients with advanced hepatic hilar duct carcinoma is a challenging problem. The current study was performed to evaluate the outcome of patients with advanced hepatic hilar duct carcinoma who received external beam radiotherapy (EBRT) combined with transarterial chemotherapy and infusion of a vasoconstrictor. METHODS: Between April 1993 and December 2002, 23 patients with histopathologically confirmed hilar duct carcinoma entered the study. The median total dose of EBRT was 41.4 grays (Gy). Transarterial chemotherapy was performed twice during EBRT. It was comprised of an infusion of a cocktail of 20 mg of epirubicin, 10 mg of mitomycin C, and 500 mg of 5-fluorouracil and was administered 1 minute after injection of epinephrine via a catheter introduced in the hepatic arteries. After the combined treatment, the patients underwent biliary endoprosthesis after evaluation of the initial response to treatment by percutaneous transhepatic cholangiography (PTC). The initial responses based on PTC were classified into four categories: CR, no stenosis; PR, relief of stenosis/obstruction; NC, no change; and PD, progressive stenosis/obstruction. The outcome parameters were survival rates and time, as well as frequency and type of complications. RESULTS: Excluding 1 patient who discontinued the treatment, the initial responses of 22 patients were 1 CR (5%), 8 PR (36%), 11 NC (50%), and 2 PD (9%). The response rate was 41%. The overall survival rates at 1 year, 2 years, and 3 years after treatment were 59%, 36%, and 18%, respectively. CONCLUSIONS: The combination of radiotherapy, transarterial infusion chemotherapy, and concurrent infusion of a vasoconstrictor can be delivered safely with good efficacy for patients with advanced hilar duct carcinoma.

A case of subglottic carcinoma effectively treated with intraluminal irradiation using low dose rate iridium-192 thin wires combined with external beam irradiation.

Subglottic carcinoma is rare and has a poor prognosis. It is usually treated with surgical resection, external beam irradiation (EBR) and/or a combination of both. Intraluminal irradiation (IR) as a curative treatment for subglottic carcinoma has never been reported. We report a case of subglottic carcinoma in a 66-year-old man, who was effectively treated with IR combined with EBR. IR was conducted using low dose rate iridium-192 thin wires at a subglottic mucosal dose of 5.1-6.0 Gy per fraction, with a total dose of 43.8 Gy in eight fractions. EBR was administered, using cobalt-60 and 6 MV X-rays delivered at 2 Gy per fraction, with a total dose of 66 Gy in 33 fractions. Complete response was obtained without serious complications and no recurrence occurred in the 79-month follow-up period. IR combined with EBR is useful as a potential curative treatment. It should be considered as one of the treatment options for subglottic carcinoma.