Synovial sarcoma of the esophagus: a case report and review of literature

Synovial sarcoma is an uncommon soft tissue tumor occurring mainly in the periarticular region of the extremities in young adults. It happens less frequently in the head and neck, mediastinum, lungs, heart, and digestive tract

A 28-year-old man two months after total esophagectomy with final diagnosis of esophageal synovial sarcoma was referred to our Positron Emission Tomography [PET-CT] department for the evaluation of treatment response and further treatment planning. To our knowledge this case is the 11[th] case of esophageal synovial sarcoma, being reported in the literature

We presented the 11[th] case of esophageal synovial sarcoma. Synovial sarcomas are very rare tumor entities, particularly in the gastrointestinal tract and are likely to be mistaken with other more common tumors such as gastrointestinal stromal tumors

Radiologic manifestations of pulmonary tuberculosis in patients of intensive care units

Tuberculosis [TB] is a serpent disease with various pulmonary manifestations, and timely diagnosis of the disease is paramount, since delayed treatment is associated with severe morbidity, particularly in intensive care units [ICU]. Therefore, it is imperative that intensivists understand the typical distribution, patterns, and imaging manifestations of TB. To describe different manifestations of pulmonary TB in patients in the ICU. In a retrospective study, all patients with a clinical and a laboratory-confirmed diagnosis of TB who were admitted to the ICU were entered in the study. All patients had a confirmatory laboratory diagnosis of TB including positive smears. The patterns of parenchymal lesions, involved segments and presence of cavity, bronchiectasis and bronchogenic spread of the lesions with computed tomography [CT] and chest/X-ray [CXR] were recorded and analyzed. Data of 146 patients with TB were entered in the study. The most common finding in CT was acute respiratory distress syndrome [ARDS]-like radiologic manifestations [17.1%], followed by parenchymal nodular infiltration [13.6%] and cavitation [10.9%], consolidation [10.2%], interstitial involvement [9.5%], calcified parenchymal mass [8.3%], ground-glass opacities [7.5%], and pleural effusion or thickening [6.9%]. Radiologic evidence of lymphadenopathy was seen in up to 43% of adults. Miliary TB was observed in 2.3% of patients, mostly in those older than 60 years of age. ARDS-like [64.5%] manifestations on CT and miliary TB [85.5%] had the highest mortality rates among other pulmonary manifestations. ARDS, interstitial involvement, and Parenchymal nodular infiltration are the most common manifestations of pulmonary TB. Various features of TB in ICU patients could be misleading for intensivists

[Designing a new CAD system for pulmonary nodule detection in High Resolution Computed Tomography [HRCT] images]

Lung diseases and lung cancer are among the most dangerous diseases with high mortality in both men and women. Lung nodules are abnormal pulmonary masses and are among major lung symptoms. A Computer Aided Diagnosis [CAD] system may play an important role in accurate and early detection of lung nodules. This article presents a new CAD system for lung nodule detection from chest computed tomography [CT] images. Twenty-five adult patients with lung nodules in their CT scan images presented to the National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Tehran, Iran in 2011-2012 were enrolled in the study. The patients were randomly assigned into two experimental [9 female, 6 male, mean age 43 +/- 5.63 yrs] and control [6 female, 4 male, mean age 39 +/- 4.91 yrs] groups. A fully-automatic method was developed for detecting lung nodules by employing medical image processing and analysis and statistical pattern recognition algorithms. Using segmentation methods, the lung parenchyma was extracted from 2-D CT images. Then, candidate regions were labeled in pseudo-color images. In the next step, some features of lung nodules were extracted. Finally, an artificial feed forward neural network was used for classification of nodules. Considering the complexity and different shapes of lung nodules and large number of CT images to evaluate, finding lung nodules are difficult and time consuming for physicians and include human error. Experimental results showed the accuracy of the proposed method to be appropriate [P<0.05] for lung nodule detection

Correlation between the pulmonary artery pressure measured in echocardiography and pulmonary artery diameter in the ct-scan of patients suffering from interstitial lung disease

Pulmonary hypertension [PH] is a significant cause of morbidity and mortality in patients suffering from pulmonary parenchymal diseases. Diagnosis of PH has always been a major clinical dilemma due to its non-specific clinical manifestations. However, diagnosing PH and determining its severity are essential for the prognosis and treatment planning in PH patients. This study aimed at evaluating the correlation between the pulmonary artery diameter [PAD] in the CT-scan and pulmonary artery pressure [PAP] in echocardiography of patients. PAD was evaluated in the CT-scan of 117 patients suffering from interstitial lung disease [ILD] and the correlation between PAD and PAP was studied. A receiver operating characteristic curve [ROC curve] which is indicative of the precision of the diagnostic test was drawn to find the cut off point for the MPAD representing PH. The area under the curve was also calculated in order to define the discriminative power of the test. PAP higher than 25 mmHg was considered as PH. PAD over 29 mm reported in the CT-scan for the diagnosis of PH in ILD patients had sensitivity of 63% and specificity of 41.5%. No significant linear correlation was found between PAD and PAP [P-value=0.17, r=0.15]. The area under the ROC curve was calculated to be 0.49 in the cutoff point of 29 mm for determining PH [CI 95%=0.38-0.60, P=0.89]. ROC curve showed a weak discriminative power. PAD had low sensitivity and specificity in the CT-scan for the diagnosis of PH. Therefore, we conclude that CT-scan alone is not helpful in finding PH cases and further examinations are required

Is mining the main cause of silicosis? case series

Silicosis is an irreversible progressive lung disease which leads to ultimate death. This study aimed to describe characteristics of individuals affected by silicosis, evaluate the prevalence of silicosis in miners and also introduce preventive policies. Cases with pathologic diagnosis of silicosis were retrieved from archive of pathology department of national research institute of tuberculosis and lung disease [NRITLD] during 2000-2009. All hematoxylin and eosin stained slides were reviewed by two pathologists independent of clinical and imaging findings. Occupational history, clinical information, imaging findings, history of associated disease, method of biopsy and pathologic diagnosis were reviewed. During 2000 and 2009, 29 cases had pathologic diagnosis of silicosis, 4 of them were excluded due to unavailable occupational history. The disease presented among patients in the age range of 22-80 years. The most common occupation was sandblasting while mining was in the second position. The male patients who were miners were old except for one who was a 28-year old car painter whose previous job was mining. Most sandblasters were young except one who was 55. The most prevalent radiologic finding was pulmonary nodules. Restrictive pattern was the most common finding in pulmonary function test [PFT]. Of patients, 28% had current tuberculosis. Transbronchial lung biopsy was the method of choice in 14 cases. The most prevalent pathologic finding was early silicotic nodules. Our study demonstrated that mining was not the main occupational history in our understudy cases. We also observed the change in the age range of patients suffering from silicosis which may be due to the prevalence of sandblasting and job demands in young patients. It is recommended that protective measures be applied not only in mining industries, but also in small workshops and studios. It is also necessary that working conditions in these workplaces be evaluated regularly by the occupational safety and health administration

Comparison between CT-scan and trans-abdominal sonography in celiac and splanchnic plexus blocks in patients with advanced pancreatic head cancer

Malignant diseases are usually associated with severe pain during their course especially at the end stages. Pancreatic head cancer is one of these diseases which can be associated with severe intolerable pains in the end stages. Sometimes, these pains are extremely severe and interfere with patient's normal life. There are various techniques to control the pain out of which, celiac and splanchnic plexus blocks [temporary and permanent] are widely accepted procedures especially in severe cases and can control the pain efficiently. There are different approaches for performing this block which are all acceptable technically but are different in case of efficacy, accuracy and potential complications. Two groups were studied prospectively in 3 academic centers to evaluate different techniques of celiac plexus block in terms of feasibility and complications. For this purpose, 61 patients with a confirmed pancreatic head cancer who experienced severe pains were divided into two groups. CT- and sonographically-guided celiac and splanchnic plexus blocks were evaluated in group 1 [n=32] and group 2 [n=29], respectively. This study showed that the pain control and patients' satisfaction were greater in the CT-scan group [group A, p=0.18]. The success rate of performing a ganglion block was higher in the ultrasound group [group B, p=0.000]. The need for a re-block was also higher in the latter group. But, the quality of life improved more in the first group [CT-scan group]. However, no statistically significant difference was found between the two groups regarding these two variables. Pain relief started earlier and lasted longer in the CT-scan group. No complication was detected except for one case of abdominal infection in the sonography group and in some cases a mild pain [score<3] was reported which was not significant. Considering the limited number of cases, it seems that although there was no significant difference in the outcome of plexus block or related complications between the two above-mentioned procedures, the suggested imaging technique for celiac plexus block is CT-scan because of its feasibility, accuracy and lower number of trials to achieve a favorable result. More complementary assessments are recommended to obtain more precise results

Clinical pattern of idiopathic pulmonary fibrosis: a retrospective study

IPF is the most common form of interstitial lung disease. IPF is a clinico-pathological syndrome characterized by cough, exertional dyspnea, basilar crackles, a restrictive pattern on pulmonary function test [PFT] and honey comb pattern on HRCT. Since there are no exact data on IPF in Iranian patients and also the controversy that exist in this regard we decided to study the IPF cases in regard to epidemiologic, clinical features, radiologic manifestations and diagnosis in Masih Daneshvari Hospital during 1998-2001. This study was a descriptive retrospective study on files of IPF patients in Masih Daneshvari Hospital during 1998-2001. Although the total number of patients was 98, only 50 cases that had clinical and pathological findings compatible with IPF were included in the study. Twenty-seven [54%] were males and 23 [46%] were females. Mean age was 56.25 +/- 15.86 yrs. The most common clinical signs and symptoms were dyspnea [100%], cough [90%] and crackle [90%]. HRCT findings were abnormal in all patients. Eighteen percent were smokers and the most common occupational exposure was through agriculture. 82.2% of patients had restrictive pattern on PFT. Seventy percent of patients had transbronchial lung biopsy [TBLB], 26% had open lung biopsy [OLB] and 4% had video-assisted thoracoscopy [VATS]. Age of patients with IPF in our study is one decade lower than in Western countries. HRCT and TBLB assist significantly in the diagnosis of IPF and limiting the surgical procedures to only a limited number of cases

CT-guided percutaneous fine-needle aspiration biopsy of pulmonary lesions

Transthoracic CT-guided percutaneous fine-needle aspiration biopsy [FNAB] has become a well- established diagnostic technique and been useful in differentiating malignant and benign pulmonary lesions. 505 patients [311 men and 194 women] aged 7-90 years old [mean age 56.2 years] with pulmonary lesions underwent CT-guided transthoracic fine-needle aspiration biopsy. Cytopathologic evaluation of FNAB samples was performed in all patients. In addition, each case was reviewed for complications, including pneumothorax and hemoptysis. Data were analysed using SPSS software for windows ver. 11.5. FNAB samples were adequate for diagnosis in 410 [81.2%] of 505 patients. Two hundred and forty-nine lesions [60.7%0] were malignant, and 161 [39.3%] were benign or atypical. Thirty-four [6.7%] patients had pneumothorax out of which none of them required thoracostomy tube placement. Additionally, hemoptysis was noted in 9 [1.8%] patients and follow-up was carried out. No further complications were reported. CT-guided FNAB of pulmonary lesions can yield well-established diagnoses and it can be useful in the management of patients with suspected lung cancer

Pulmonary function and lung radiography of rockwool exposed workers

Synthetic fibers of rockwool are deciphered from Basalt stone. Chemical, physical and biological similarities with asbestos detain scientists to consider effects and complications caused by rockwool in lung. This historical cohort research was designed to state impact of rockwool on radiographic findings of lung and its spirometric changes. Encountered group, "Iran Rockwool Factory" was selected by simple random sampling technique and matched with comparison group, "Minoo Confectionery Factory", regarding age and cigarette smoking. Medical and occupational histories, clinical examinations and all spirometries were carried out in health centers of the two factories. Chest x-ray was taken for all subjects of the two groups. All data were gathered and registered in designed questionnaires. Although a significant discrepancy existed in dyspnea, non cardiac chest pain and wheeze, there was not any statistically significant difference in radiographic findings and spirometric parameters between the two groups. We do not have enough evidence to support the adverse effects of rockwool on respiratory function and significant observable radiographic changes in chest x-ray

Diagnostic value of lung CT-scan in childhood tuberculosis

Many different methods and approaches have been applied for confirmation of tuberculosis in children. The diagnostic criteria being currently used for detection of childhood TB consist of clinical symptoms, history of close contact, radiological findings, PPD test and positive bacteriologic or pathologic findings. Since each of these methods may have false positive or negative results, it is necessary to find a better method for prompt diagnosis. This study was performed to determine the value of CT-scan as a sensitive method in detecting hilar, parenchymal and mediastinal involvements in early diagnsis of childhood TB and compare it with other diagnostic criteria. This cross-sectional comparative study was carried out on 100 children, suspicious of having primary pulmonary TB between September 1999 and September 2000 in Masih Daneshvari Hospital. All patients had prior history of close contact with smear-positive patients having active pulmonary TB. Epidemiological factors as well as radiological and microbiological findings were evaluated. Of total 100 patients, 43 were female and 57 were male. The mean age was 7.5 +/- 3.6 yrs ranging from 4 months to 14 years. Forty two were Iranian and 58 were Afghan. Thirty nine children had a positive PPD test. Bacteriological and simple chest x ray findings compatible with TB were positive in 11 and 36 patients, respectively. Pulmonary CT-scan without contrast revealed lung lesions in 55 patients while 25 of them [45.4%] had normal chest x rays. In 12 patients positive CTscan was the only positive diagnostic finding. Our results show the value of pulmonary CT-scan as a diagnostic criterion in pediatiric tuberculosis and we recommend it for early diagnosis in suspicious cases with no other positive findings

Radiographic manifestations in TB/ HIV patients

Background: HIV is the most common risk factor for reactivation of latent TB and is associated with increased rate of progression of infection to disease. Radiological presentation of TB is variable in both HIV [-] and HIV [+] patients but is more in the latter. In this study we describe and analyze radiological presentation of TB/HIV patients in Massih Daneshvari hospital in IRAN

Materials and Methods: We registered the demographic, clinical and laboratory information of TB/HIV patients in Massih Daneshvari hospital between 2002-2003. Inclusion criteria were standard serologic test for HIV [Two positive Elisa test and one positive westernblot test] and proof of TB with clinical and mycobacteriologic or pathologic criteria. Chest x-ray was reported by pulmonary imaging specialist and was divided to two category: Typical [fibrocavitary infiltration in posteroapical segment of upper lobes] and atypical [opacity in middle and lower lobe, hilar and mediastinal adenopathy, pleural effusion, diffuse nodular opacity and normal X-ray]. Findings were analyzed using SPSS version 10.5

Results: 15 patients, 13 men [86.7%] and 2 women were included. Mean [ +/- SD] of CD4 count was 229.15 +/- 199.45. 53.3% of patients had adenopathy, 26.7% had pleural effusion. Only one patient had cavitary disease. Radiographic pattern was typical in one [6.7%] and atypical in 93.3% of patients. In regard to severity of radiological presentation, mild; moderate and severe pattern was seen in 40%, 26.7% and 33.3% respectively. There was no correlation between severity of radiological presentation and death [p=0.8] and severity of radiological presentation and CD4 count [p=0.53]

Conclusion: In this study, it was shown that in spite of some other studies, radiological presentation had not direct correlation with CD4 count; thus, in HIV+ patient, we must consider TB in all atypical radiological presentation regardless of CD4 count

Clinical and radiological presentation of adult tuberculous spondylitis

Tuberculous spondylitis is an uncommon form of extra-pulmonary TB. Delay in establishing diagnosis and management causes spinal cord compression and spinal deformity. We studied to determine clinical and radiological presentations of this dangerous form of TB diseases. During 2002-3 years, all patients over 14 years old who hospitalized with a probable diagnosis of TB spondylitis were evaluated. Everybody with mycobacteriologic or pathologic confirmation was enrolled in study. fourteen patients met our inclusion criteria. The mean age [SD] was 39[16] year. 57% were male. Treatment delay was 8.3 months. Fever reported in 7[50%] patients. Local tenderness was reported in 92.6% of cases. PPD was positive in half of the patients. The most regions involved were T8-T12 [43%] and L1-L3 [36%] respectively. Sputum smear was surprisingly positive in 50% of cases. Most of the patients had received anti-TB drugs for 9-12 months. CT guided aspiration and biopsy of spine lead to correct diagnosis in 93% of patients. Simultaneous pulmonary involvement is evident in half of them