Radiographic patterns in patients diagnosed with acute pulmonary emobolism

Pulmonary embolism [PE] results in significant morbidity and mortality. Due to lack of awareness among physicians in this regard or non-availability of objective tests the diagnosis of PE is difficult. Clinical features are nonspecific and all diagnostic tests have certain limitations. The purpose of this study was to evaluate chest radiographic findings in diagnosed cases of acute pulmonary embolism. We conducted a retrospective, chart review study on chest radiographs of all patients admitted to Masih Daneshvari Hospital in Tehran, Iran with a diagnosis of acute PE from April 2005 to February 2006. Fifty-one consecutive patients were diagnosed with acute pulmonary embolism by single detection CT scan, perfusion scan and echocardiography. Three radiologists interpreted the chest radiographs. We found only 2 normal chest radiographs [4%] and the other 48 [96%] were abnormal. The most common abnormalities were pleural effusion [60%], pulmonary artery enlargement [56%], and parenchymal pulmonary infiltration [54%]. Although chest radiography cannot be used for diagnosing or excluding PE, it contributes to non-invasive diagnostic assessment of PE through the exclusion of diseases that may mimic PE

unusual presentation of hodgkin's lymphoma as a chest wall abscess in association with old tuberculosis

Chest wall abscess is a very rare presentation of extranodal Hodgkin's lymphoma. Only a few case reports have been found in this regard. Here, we describe a chest wall mass developed in association with tuberculosis in an 82-year-old woman. Radiologic examination revealed two masses outside of chest wall that lead to destructive changes in the manubrium of sternum. The diagnosis of Hodgkin lymphoma was made by open surgical excisional biopsy of the chest wall mass. This is a very unusual extranodal presentation of Hodgkin's lymphoma

Prevalence of tuberculosis in close contacts smear positive TB patients

Tuberculosis [TB] is considered as one of the main causes of mortality and morbidity in developing countries. At present, extensive contact investigation among households is not a routine part of TB control efforts in most countries. The investigation of contacts of TB cases is an essential part of TB control program. In this study, we have evaluated the active contact tracing among close contacts of smear positive TB patients. The main aim of this research was to demonstrate the prevalence of TB and to fully screen the close contacts of TB patients in order to detect active and infected TB cases. Close contacts of newly diagnosed smear positive pulmonary TB patients were identified. The information and data of the contacts including history, clinical examination, history of BCG vaccination, results of tuberculin skin test [TST], and bacteriological and radiological manifestations were collected on special questionnaires. Out of the total 147 close contacts of 34 index cases, 81 [55.1%] were female and 66 [44.9%] were male. Based on the nationality, there were 38 [25.9%] Afghan refugees and 109 [74.1%] Iranian cases. The duration of contact was as follows: in 30 cases the contact time period was less than 1 yr., in 75 individuals it was more than 1 yr., while 42 individuals had a persistent contact. In 61.8% of the cases the induration of TST was less than 15 mm, while in 38.2% it was more than 15 mm. Abnormal radiological manifestations were detected in 33.3% of close contacts including calcification [25.17%], parenchymal infiltration [4.08%], cavity [2.04%] and nodular lesions [2.04%]. According to the diagnostic findings, out of 147 contacts, 7 [4.8%] cases of pulmonary TB were detected. In our study no significant statistical difference was found regarding the prevalence of TB among the Iranian and Afghan close contacts. Also there was no significant statistical difference in the duration of contact time of the TB cases. Furthermore, positive radiological findings were detected in 33.3% of the close contacts. In 25.7% of the cases, the pattern was calcification indicating primary TB infection. According to the results of this research the rate of TB in contacts is 400 times higher than the society [4800/100,000 versus 12/100,000]. This study points out the importance of systematic investigation of contacts to discover new cases of TB. It also demonstrates the significant role of radiology as a major tool in diagnosing both TB infection and disease

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

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

SICAM-1 as a serum marker for follow-up of pulmonary tuberculosis therapy

Background: Tuberculosis [TB] is one of the commonest infectious diseases of our era; it is the second cause of death due to infectious diseases after AIDS. Studies have shown the significant effect of leukocyte integrins such as LFA-1and ICAM-1 on the function of macrophages against TB bacilli; increasing their activity during the process of TB infection. The objective of this research is to evaluate the changes observed in serum levels of SICAM-1 in pulmonary TB patients that had received treatment

Materials and Methods: All new pulmonary TB cases that had not received any treatment, did not suffer from any kind of co-existing or underlying disorders such as hepatitis, sarcoidosis, lung cancer, HBV, HCV and HIV infections, chronic renal failure, cirrhosis, malnutrition, collagen vascular disorders and had not consumed immunosuppressive agents, were enrolled in this study. The SICAM-1 levels of the cases were measured by ELISA method before and 2 months after treatment with standard anti-TB drugs [Isoniazid, Rifampin, Ethambutol and Pyrazinamide] at the same time. T - test was used to compare the two sets of values of SICAM-1 levels before and 2 months after therapy

Results: A total of 28 patients; 23 [82.1%] male and 5[17.9%] female cases were enlisted .Meanwhile, 50% of the patients were Iranian and the remaining had Afghan nationality. All of them were sputum smear and culture positive for Mycobacterium tuberculosis. Regarding the extent of pulmonary involvement as shown on lung CT-Scan, 68% demonstrated diffuse pulmonary involvement. The mean SICAM-1 level before the initiation of treatment was 554.17 +/- 202.85 ng/ml. Considering age, sex ratio, ESR level, PPD test and severity of lung involvement, the SICAM-1 levels did not show any significant differences in different groups of patients. Among the patients enrolled in the study we were able to follow the seventeen patients [61%] who completed 2 months of treatment. The mean level of SICAM-1 before and after treatment in these patients were 573.9 +/- 204.4 and 481.2 +/- 103.2 ng/ml, respectively [P <0.05]

Conclusion: SICAM-1 is considered as one of the inflammatory mediators that undergoes fluctuations during TB disease; its level is very much related to the extent of lung involvement. Since the level of this marker declines after therapy, it could be used as a "Serum marker "in evaluating the therapeutic response observed during the follow- up. Abbreviations: SICAM: Soluble Intercellular Adhesion Molecule, ICAM: Intercellular Adhesion Molecule, LFA: Leukocyte Function Antigen

case of angiomyolipoma of the posterior upper mediastinum

Angiomyolipoma [AML] is uncommon outside the kidney, and it rarely occurs in mediastinum. This article presents a case of posterior upper mediastinal AML with a review of the literature on angiomyolipoma. A 56-year-old woman was referred to our hospital with 8-month history of cough and chest pain. Radiology showed a mass in the posterior upper mediastinum. Left thoracotomy was done for surgical removal of the tumor. Pathologic findings revealed an AML tumor in the left paravertebral and posterior upper mediastinal regions with massive infiltration of the intercostal nerves and subtle invasion of the adjacent thoracic spinal canal. This case is the third reported AML of posterior upper mediastinum. To prevent misdiagnosis, it is suggested that AML could be considered for the differential diagnosis of mediastinal tumors

Tuberculosis of the spine in children

Tuberculous spondylitis or Pott's disease results in characteristic deformity. In developed counties, Pott's disease occurs primarily in older adult rather than children. In developing countries where the infection rate is high, it occurs mainly among children. We have reviewed the hospital records of pediatrics ward with diagnosis of tuberculosis between 1995 and 2001. There were seven children with the diagnosis of Pott's disease. The age of the patients ranged from 7 to 14 years with mean of 11.14 years. All of them were Afghans. In four cases, spine was the main affected site, in two patients disseminated tuberculosis was seen; and in 1 case, spinal involvement was associated with pulmonary tuberculosis. Of them, five patients had paraspinal abscess. Fistula was formed in the lumbar region of 2 patients. Abscess discharge was AFB smear positive only in one case. The most common involved vertebral bodies were T12 and L1; however, thoracic and lumbar vertebrae from T12 to L4 were affected. In 4 cases, spondylitis resulted in kyphosis and in two patients; spinal cord compression was detected by imaging techniques. Pott's paraplegia was seen in one patient. All patients were treated according to DOTS strategy, and one underwent surgical drainage of abscess. After termination of initial phase and relative improvement of signs and symptoms, 5 cases were referred for surgical management and subsequently maintenance treatment was continued for 10 months. We suggest that in the endemic countries for tuberculosis, Pott's disease in children must be taken into consideration. Imaging techniques are also valuable means for confirmation of diagnosis

Thoracic CT-guided needle biopsy: a report of 150 cases

The purpose of this study is how to use CT-guided needle biopsy for the diagnosis of pulmonary, pleural, and mediastinal mass lesions. Meanwhile, the complications of the procedure were evaluated. The pathology results of 150 biopsy specimens, which were obtained from 145 patients aged from 9 to 87 years old [55.3 +/- 17.6] referred during a one-year period were reviewed, and the frequency of pneumothorax and hemoptysis were analyzed. Lesion size ranged 1-18 cm [mean [ +/- SD] 6.5 +/- 3.4 cm. 95 lesions were contacted to the chest wall. Pathological studies showed that 22 specimens were benign, 61 malignant, 28 nonspecifics, 17 suspicious for malignancy, and 22 insufficient for diagnosis. Risk for pneumothorax and hemoptysis was 6 and 2 percent respectively, which were much better results than previous reports. Although our low complication rate may be attributed to the large size of the lesions and their small distance from the chest wall, we still recommend CT-guided needle biopsy as a useful diagnostic method for thoracic mass lesions