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Objective:To investigate characteristic CT manifestations of primary pulmonary diffuse large B-cell lymphoma (DLBCL).Methods:CT images of 14 patients [10 males and 4 females, age （54±2） years old, range 32 to 91] with pathologically-proved pulmonary DLBCL lymphoma were retrospectively analyzed．Plain CT and contrast enhanced CT imaging were performed in all 14 patients. Image characteristics including lesion size, locations and distribution, morphology and margin, density and enhancement degrees, bronchia and lesion surroundings, other thoracic extra-pulmonary manifestations, as well as distant metastasis were analyzed and recorded. The maximal diameter of mass and/or nodules, pre and post-contrast CT values were measured. Among all 14 cases, 8 cases were initially diagnosed as lung carcinoma, 5 cases as infection, one case as lymphoma.Results:Among all 14 primary lung DLBCL cases, there were 10 case with multiple lesions and 4 with single lesion. Masses and/or nodules were found in 12 cases, with the maximum diameter of the lesions as 0.8-8.2 cm, the median value as 5.3 (2.9, 7.8) cm. Two cases showed simple consolidation. The margins of the lesions were clear and smooth in 12 cases, and fuzzy in 2 cases. The density of the lesions on pre-contrast CT was relatively uniform, with mean CT value (35.1±1.0) HU. After contrast, 10 cases displayed mild to moderate homogeneous enhancement, 4 cases showed heterogenous enhancement. The mean CT value of post-contrast images was (61.8±1.5) HU. In arterial phase, the mean CT value was (50.9±1.3) HU. Angiographic sign was found in 9 cases in arterial phase. Of the 14 cases, bronchus was clear and smooth in 5 cases. In 4 cases, bronchus was found slight compressed or stenosis; and 5 cases showed intra-lesion bronchi invasion or occlusion. Interstitial tissue around the lesion was found slightly thickened in 8 cases. The pleura showed unevenly thickened and invaded in 8 cases. Mediastinal or hilar lymphadenopathy and fusion were found in 10 cases, with 3 cases involving mediastinal large blood vessels, and 7 cases displaying infiltrative growth pattern. There were 4 cases with pleural effusion. CT follow-up after treatment in 8 cases showed no distant metastasis (7 cases showed good prognosis, with lesions disappearing after radiotherapy, chemotherapy or surgical resection; 1 case showed progressed with lesion increased after chemotherapy). Six patients abandoned the treatment and discharged from the hospital.Conclusions:Primary DLBCL is a high invasive and malignant entity with certain CT characteristics. The confirmed diagnosis of pulmonary DLBCL depends on pathological results.
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Objective:To explore the value of bedside chest radiograph in the diagnosis and follow-up of severe and critical COVID-19.Methods:Twenty-nine patients with severe or critical COVID-19 were collected from January 23 to February 23, 2020，from four COVID-19 designated hospitals in Guangdong Province. Bedside radiography was taken in all the 29 patients, ranged from 1 to 16 times for each patient. Twenty-seven patients underwent follow-up, and the number of re-examination ranged 1 to 15 times, and the interval of review is 1 to 8 days.The imaging findings of bedside chest radiography and the imaging changes on follow-up chest radiography were analyzed retrospectively.Results:Twenty-nine patients were collected. The radiography showed the lesions involved all more than 3 lung fields. The films showed consolidation shadow in 19 cases, multiple patches of shadow in 23 cases, reticular pattern in 12 cases, strips shadow in 14 cases, interlobar fissure thickening in 18 cases, and "white lung" in 4 cases.The complications included pleural effusion in 4 cases, pneumothorax in 2 cases, mediastinal and subcutaneous emphysema in 1 case. The radiography showed the lesions progressed in 15 cases, with expanded involvement of the lung.The increase of lesion density was found in 6 cases, new lesions were noted in 5 cases, while both of them were found in 4 cases. Nine cases showed improvement, with reduced range and decreased density. Patchy or consolidation shadow turned to strips shadow or articular pattern shadow in 8 cases.There was no significant change in 3 cases with large consolidation shadow.Conclusions:Bedside chest radiography has a good value in the follow-up of severely and critically ill patients with COVID-19, and can provide great help for clinicians to evaluate their condition.
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Objective To investigate the difference in clinical features and chest HRCT findings between idiopathic nonspecific interstitial pneumonia(INSIP)and connective tissue disease-associated nonspecific interstitial pneumonia(CTD-NISP). Methods Totally 73 cases of NISP from 2011 to 2016 were retrospectively reviewed ,whose final diagnosis all were made after clinico-radiologic-pathologic discussion and 52 cases of them were diag-nosed as INSIP and 21 cases as CTD-NSIP. Clinical features ,lung function test results and chest HRCT findings of INSIP and CTD-NSIP were compared. Results Common underlying diseases of CTD-NSIP were poly-/dermato-myositis(PM/DM),rheumatoid arthritis(RA)and Sjogren syndrome(SS). The mean age of CTD-NSIP[(47.14 ± 9.24)y]was younger than that of INSIP[(59.09 ± 11.20)y](P<0.05). Compared to CTD-NSIP,expectoration was more common in patients with INSIP,while dry mouth/eyes,arthralgia and erythra were less common in INSIP (P < 0.05). Lung function test1 showed restrictive ventilatory dysfunction with dispersion function decline was found in both groups. There were no significant differences in lung function test results between INSIP and CTD-NSIP. In HRCT,the subpleural vertical line was more common in INSIP than that in CTD-NSIP,while patchy consolidation,subpleural curvilinear shadow,pleural effusion and esophageal dilation were less common in INSIP(P<0.05). Conclusions Specific difference of clinical and HRCT features between CTD-NSIP and INSIP are conducive to differentiating the two from each other.
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Purpose To evaluate the application value of using a-cyanoacrylate rapid medical glue in preoperative localization of ground-glass nodules under CT guidance.Materials and Methods 48 cases were retrospectively analyzed,in which the pulmonary ground-glass nodules took preoperative localization under CT guidance.The rapid medical glue was injected in pulmonary ground-glass nodules,which was used for preoperative localization.Results After preoperative localization of rapid medical glue in 48 cases,pulmonary ground-glass nodules of all patients were resected successfully by video-assisted thoracoscope surgery (VATS).The complications of pneumothorax did not occur in all cases,with little pulmonary hemorrhagein in 10 cases.Conclusion When the fast medical glue has been used in the CT-guided preoperative localization of ground-glass nodules,there are advantages of high accuracy of localization and surgery.Moreover,this method is simple,safe and effective.
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Objective To better understanding the clinical presentations of phaeohyphomycosis,and improve the diagnosis and management of the disease.Methods We reported a case of pulmonary phaeohyphomycosis caused by Exophiala jeanselmei at the First Affiliated Hospital of Guangzhou Medical University in 2008,and reviewed the relevant literature.The clinical,radio-logical and etiological features were summarized based on this case and the other 23 phaeohyphomycosis patients reported in China from January 1995 to August 2013.Results 24 Chinese cases of phaeohyphomycosis have been reported to date,including 15 males and 9 females.The age of these patients ranged from 4 to 76 (mean 40.0±21 .8)years old.Seventeen patients were otherwise healthy.The other 7 patients had complications.Clinical presentations of phaeohyphomycosis vary widely,including cutaneous and subcutaneous infection in 18 cases,pulmonary and central nervous system involvement in two cases each,para-nasal sinus and palpebral conjunctiva infection one case each.The diagnosis of 18 cases were confirmed both microbiologically and histologically.One case was confirmed histologically alone.Five cases were identified microbiologically alone.The samples for culture were collected from skin abscess (1/5 ),pulmonary tissue (2/5 ),and cervical spinal fluid (2/5 ),respectively. Twenty-two strains of causative organisms were identified,7 of which were Exophiala jeanselmei .Twenty-three patients received treatment.They were cured by antifungal agents alone (18)or in conjunction with surgical resection (4 ),or assisted with XD-635AB-based photodynamic laser therapy (1).Specifically,10 pa-tients were cured by itraconazole alone.Conclusions In China, most patients of phaeohyphomycosis have concurrent conditions or have previously received immunosuppressive agents and cor-ticosteroids.Cutaneous and subcutaneous infection were most common,located mainly on limbs,face,chest and abdominal skin.The most frequently isolated pathogen is Exophiala jeanselmei ,followed by Phialophora verrucosa and Exophiala spinifera .Itraconazole therapy would be very effective.Susceptibility testing is very useful in case of refractory infection.
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ObjectiveTo evaluate the clinical feasibility of low dose MSCT for quantitative assessment of pulmonary function in smokers.MethodsOne hundred and forty-six patients with chronic objective pulmonary disease ( COPD ) including 109 smokers ( 74.6％ ) and 37 non-smokers ( 25.3％ )underwent pulmonary function test and low-dose MSCT scan.All data were analyzed using computer-aided lung anlysis software.Pulmonary function parameters from low-dose MSCT were compared between smokers and non-smokers and also compared with pulmonary function test in non-smokers ( Pearson test).Results In smokers,the average volume at full inspiratory phase (Vin) was (5125 ± 862 ) ml,mean lung attenuation was ( - 902 ± 26 ) HU,mean lung density was (0.0984 ± 0.0260 ) g/cm3,emphysema volume was (2890 ±1370) ml.The average volume at full expiratory phase (Vex) was (2756 ±1027) ml,mean lung attenuation was ( -811 ±62) HU,mean lung density was (0.1878 ±0.0631 ) g/cm3,emphysema volume was (685 ±104) ml.In non-smokers,the average Vin was (3734 ± 759) ml,mean lung attenuation was ( -876 ±40) HU,mean lung density was (0.1244 ±0.0401 )g/cm3,emphysema volume was ( 1503 ± 1217) ml.The average Vex was ( 1770 ± 679 ) ml,mean lung attenuation was ( - 765 ± 56 ) HU,mean lung density was (0.2360 ± 0.0563 ) g/cm3,emphysema volume was ( 156 ± 45 ) ml.There were significant differences between smokers and non-smokers (P ＜0.01 ).The Vex/Vin was correlated with residual volume/total lung capacity ( RV/TLC,r =0.60,P＜0.01 ),and Vin was correlated with TLC ( r =0.58,P ＜ 0.01 ),Vex with RV ( r =0.59,P＜0.01 ).Pixel index ( PI ) -950in was correlated with FEV 1％ pre and FEV1/FVC％ ( r =- 0.53,- 0.62,respective,P ＜ 0.01 ),Pl-950ex was correlated with FEV1 ％ pre and FEV1/FVC％ ( r =-0.71,-0.77,respective,P＜0.0l).ConclusionLow-dose MSCT can be a potential imaging tool for quantitative pulmonary function assessment in smokes.
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ObjectiveTo estimate the value of CT virtual colonoscopy (CTVC) and its image postprocessing techniques in the diagnosis of colorectal diseases.MethodsCTVC images of 84 patients with suspected colorectal diseases were retrospectively analyzed combined with multiple planar reconstruction (MPR),shaded surface display(SSD) and transparent image reconstruction.The location,size,shape and type of the lesions were analyzed and the images were compared with electronic colonoscopy and pathologic specimen finding.ResulltsFify-nine of 84 patients were diagnosed as coloretal cancer (23 cases with cancer in sigmoid colon,22 cases in rectum,11 cases in ascending colon and 3 cases in appendix),8 cases were porctopolypus,3 cases were multiple colonic diverticula,1 case was hemorrhoids,13 cases were normal.All the diagnosis was confirmed correct by operation pathology or clinic.ConclusionCTVC can show the shape and other features of colorectal diseases,and has important significance for clinical staging and surgical planning of colorectal cancer.
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ObjectiveTo evaluate CT and MRI findings of the intrathoracic ganglioneuroma and to improve its diagnosis and differential diagnosis ability.MethodsClinical,CT( n = 14),MRI (n = 6) and pathology manifestations of 20 patients with the intrathoracic ganglioneuroma were retrospectively analyzed.All 20 cases had chest CT and MRI plain scanning and multiphase enhance scanning before operation.ResultsSeventeen of 20 lesions were located in posterior mediastinum,2 in pleura side and 1 in right thorax cavity.The CT value of the plain scans ranged from 20 to 40 HU ( mean 30.5 HU),Tubercle calcification were detected in four masses,one case with fat density was showed on CT scanning.After injecting contrast media,CT value ranged from 0 to 12 HU (mean 6.2 HU) in artery phase,ranging from 10 to 20 HU ( mean 14.3 HU) in delay phase.Five of 6 cases of MRI signals were homogeneously low intensity on T1 WI,1 case with fat signal was imhomogeneously low intensity on T1WI.Six cases were imhomogeneously high intensity on T2WI.A whorled appearance was visualized in one tumor on T2WI.The post-contrast enhancement MR images was slight enhancement imhomogeneously in artery phase and gradual increasing enhancement in delay phase.ConclusionOn CT and MR imaging,no enhancement or slight enhancement in artery phase and gradual increasing enhancement in delay phase are characteristic manifestations of ganglioneuroma in the thorax.
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Objective To evaluate the relevance of MSCT pulmonary function parameters and pulmonary function test (PFT) parameters, and to define the reference value of MSCT pulmonary function parameters. Methods Thirty male volunteers received clinical PFT and MSCT scan. MSCT scan was perfomed at the end of the maximum inspiratory and maximum expiratory. All data were analyzed with the lung analysis software of computer-aided inspection system correlatedly with pulmonary function parameters. Results The lung volume at full inspiratory volume (Vin) and full expiratory volume (Vex) in MSCT scan had good correlation with total lung capacity (TLC) and residual volume (RV) (r=0.90, P<0.01; r=0.74, P<0.01). Vex/Vin was correlated with RV/TLC (r=0.74, P<0.01), and Vin-Vex was correlated with MVC (r=0.85, P<0.01). In inspiration, the average lung density was (-879.51±32.82) HU, the density per unit volume was (0.12±0.03) g/cm3, while in expiratory they were (-688.14±62.38) HU and (0.31±0.06) g/cm3. Conclusion MSCT pulmonary function tests with the analysis software of computer-aided inspection system have good correlation with PFT.
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r diagnosing the disease to combine pathology, immunohistochemistry and SYT-SSX gene detection.
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Objective To study the CT features and enhance the knowledge of tracheobronchopathia osteochondroplastica (TO). Methods The CT appearances in 6 patients with pathologically proved TO were analyzed retrospectively. Results CT of the chest revealed scattered and multiple mural nodules protruding into the tracheobronchial lumen. Punctate calcification occurred within these nodules. The nodular lesions usually involved the anterior and lateral walls of the trachea and major bronchi. These nodules generally ranged from 2 to 4 mm in diameter. The nodular lesions were seen on lobar bronchi in two cases. Diffuse irregular mural thickening of the trachea and deformed tracheal cartilage rings were observed in two cases. Conclusion CT demonstration of multiple mural nodules with calcification in the tracheobronchial tree is a characteristic finding for TO.