Unusual imaging characteristics of thoracic hydatid disease / Características incomuns de imagem da doença hidática torácica

Abstract Cystic echinococcosis (hydatid disease) is a zoonotic parasitic disease, caused by ingestion of Echinococcus granulosus eggs, that can result in cyst formation anywhere on the body. Hydatid disease is frequently seen in regions where there is human-animal contact and poor socioeconomic development. The prevalence of the disease ranges from 0 to 79 cases/100,000 population. Hydatid cysts are typically found in the liver and lungs, being less common in other parts of the body. Computed tomography or magnetic resonance imaging is often used in order to clarify the sites affected by a hydatid cyst, such as the cranial and thoracic regions, which also facilitates the surgical evaluation and minimizes complications. Although rare, hydatid cysts in atypical locations can provoke unusual complications, with unpredictable findings and symptoms. This essay discusses the radiological aspects of rare thoracic hydatid cysts.

Resumo A equinococose cística (doença hidática) é uma doença parasitária zoonótica causada pela ingestão de ovos de Echinococcus granulosus, que pode resultar na formação de cistos em qualquer parte do corpo. A doença hidática é frequentemente vista em regiões onde há contato humano-animal e baixo desenvolvimento socioeconômico. A prevalência da doença varia de 0 a 79 casos/100.000 habitantes. Os cistos hidáticos são normalmente encontrados no fígado e nos pulmões, sendo menos comuns em outras partes do corpo. A tomografia computadorizada ou a ressonância magnética são frequentemente utilizadas para indicar os locais afetados por um cisto hidático, como as regiões craniana e torácica, o que também facilita a avaliação cirúrgica e minimiza complicações. Embora raros, os cistos hidáticos em locais atípicos podem provocar complicações incomuns, com achados e sintomas imprevisíveis. Este ensaio discute os aspectos radiológicos dos raros cistos hidáticos no tórax.

Hemopneumotórax recorrente: descrição da síndrome da endometriose torácica / Recurrent hemopneumothorax: thoracic endometriosis syndrome description

A endometriose torácica é uma forma de endometriose extrapélvica encontrada em tecidos pulmonares ou na pleura. Caracteriza- se clinicamente pela presença de pneumotórax catamenial, hemotórax catamenial, hemoptise e nódulos pulmonares. O pneumotórax catamenial é a manifestação mais frequente, sendo caracterizado pelo acúmulo recorrente de ar na cavidade torácica durante o período menstrual. Ocorre, geralmente, no hemitórax direito e possui maior incidência na faixa etária dos 30 aos 40 anos de idade. Nosso objetivo é descrever um caso de derrame pleural hemorrágico recorrente e pneumotórax espontâneo correlacionados ao período menstrual em paciente de 34 anos. (AU)

Thoracic endometriosis is a form of extrapelvic endometriosis found in pulmonary tissue or the pleura. Clinically, it is characterized by the presence of catamenial pneumothorax, catamenial hemothorax, hemoptysis, and pulmonary nodules. The most frequent clinical presentation is catamenial pneumothorax, which is typified by a recurrent collection of air in the thoracic cavity occurring in conjunction with menstrual periods. It occurs more commonly on the right side and its highest incidence is between 30 and 40 years of age. Our objective is to describe a case of recurrent hemorrhagic pleural effusion and spontaneous pneumothorax correlated to the menstrual period in a 34-year-old patient. (AU)

Diagnostic value of CT at early infection stage of thoracic and pulmonary paragonimiasis / 中华地方病学杂志

Objective To investigate the CT features of early infection stage of thoracic and pulmonary paragonimiasis. Methods Medical records of 56 patients with thoracic and pulmonary paragonimiasis from January 2010 to June 2017 were collected, and the patients were diagnosed and treated at Yongjia County People's Hospital, and the results of laboratory examination and CT imaging features were analyzed retrospectively. Results The absolute value of eosinophils in peripheral blood of 56 patients was (5.61 ± 3.18) × 109/L, and the percentage of eosinophils was (35.90 ± 19.16)％, all of which increased to varying degrees. Forty-two patients had different degrees of pleural effusion and 52 cases with lung lesions. Lung lesions demonstrated one or several kinds of foci at the same time, randomly distributed in the lung field, mostly located in the sub-pleural lung tissue. There were 12 cases with pulmonary ground glass shadow, 4 cases with peribronchitis, 31 cases with pulmonary invasive lesions and 28 cases with pulmonary nodular/strip shadow. The size of most nodules were 0.5 - 1.0 cm, accompanied with halo sign. Conclusions The CT features of early infection stage of thoracic and pulmonary paragonimiasis are diverse. The size of 0.5 - 1.0 cm lung nodules with halo sign has certain characteristics in the diagnosis of paragonimiasis. Peribronchitis, infiltrative lesions, pleural effusion and increased peripheral blood eosinophil percentage can suggest diagnosis.

Comparison of ultrasound-guided and CT-guided percutaneous biopsy in diagnosis of chest lesions not blocked by bone nor lung / 中国介入影像与治疗学

Objective To compare the value of ultrasound guided and CT-guided percutaneous biopsy in diagnosis of chest lesions not blocked by bone nor lung.Methods A total of 244 patients with chest lesions not blocked by bone nor lung were collected and divided into ultrasound-guided group (n=114) or CT-guided group (n=130).The puncture success rate,biopsy success rate and the complication rate were compared between the two groups.Results The puncture success rate (98.25％ [112/ 114]) and biopsy success rate (96.49％ [110/114]) in ultrasound-guided group were higher than those in CT-guided group (86.92％ [113/130],79.23％ [103/130]),and the complication rate (3.51％ [4/114]) in ultrasound-guided group was lower than that in CT-guided group (16.92％ [22/130],all P＜0.01).Conclusion For chest lesions not blocked by bone nor lung,ultrasound is more secure and effective than CT for guiding percutaneous biopsy.

High-resolution computed tomography findings of pulmonary tuberculosis in lung transplant recipients / Achados de tuberculose pulmonar na tomografia computadorizada de alta resolução em transplantados de pulmão

ABSTRACT Objective: Respiratory infections constitute a major cause of morbidity and mortality in solid organ transplant recipients. The incidence of pulmonary tuberculosis is high among such patients. On imaging, tuberculosis has various presentations. Greater understanding of those presentations could reduce the impact of the disease by facilitating early diagnosis. Therefore, we attempted to describe the HRCT patterns of pulmonary tuberculosis in lung transplant recipients. Methods: From two hospitals in southern Brazil, we collected the following data on lung transplant recipients who developed pulmonary tuberculosis: gender; age; symptoms; the lung disease that led to transplantation; HRCT pattern; distribution of findings; time from transplantation to pulmonary tuberculosis; and mortality rate. The HRCT findings were classified as miliary nodules; cavitation and centrilobular nodules with a tree-in-bud pattern; ground-glass attenuation with consolidation; mediastinal lymph node enlargement; or pleural effusion. Results: We evaluated 402 lung transplant recipients, 19 of whom developed pulmonary tuberculosis after transplantation. Among those 19 patients, the most common HRCT patterns were ground-glass attenuation with consolidation (in 42%); cavitation and centrilobular nodules with a tree-in-bud pattern (in 31.5%); and mediastinal lymph node enlargement (in 15.7%). Among the patients with cavitation and centrilobular nodules with a tree-in-bud pattern, the distribution was within the upper lobes in 66.6%. No pleural effusion was observed. Despite treatment, one-year mortality was 47.3%. Conclusions: The predominant HRCT pattern was ground-glass attenuation with consolidation, followed by cavitation and centrilobular nodules with a tree-in-bud pattern. These findings are similar to those reported for immunocompetent patients with pulmonary tuberculosis and considerably different from those reported for AIDS patients with the same disease.

RESUMO Objetivo: As infecções respiratórias constituem a principal causa de morbidade e mortalidade em transplantados de órgãos sólidos. A incidência de tuberculose pulmonar é alta entre esses pacientes. Em exames de imagem, a tuberculose tem diferentes apresentações. Uma maior compreensão dessas apresentações poderia reduzir o impacto da doença ao facilitar o diagnóstico precoce. Portanto, buscamos descrever os padrões de tuberculose pulmonar na TCAR em transplantados de pulmão. Métodos: De dois hospitais no sul do Brasil, foram coletados os seguintes dados sobre transplantados de pulmão que desenvolveram tuberculose pulmonar: sexo; idade; sintomas; doença pulmonar que levou ao transplante; padrão na TCAR; distribuição dos achados; tempo entre transplante e tuberculose pulmonar; e taxa de mortalidade. Os achados na TCAR foram classificados como nódulos miliares; cavitação e nódulos centrolobulares com padrão de árvore em brotamento; atenuação em vidro fosco com consolidação; linfonodomegalia mediastinal; ou derrame pleural. Resultados: Foram avaliados 402 transplantados de pulmão, dos quais 19 desenvolveram tuberculose pulmonar após o transplante. Entre esses 19 pacientes, os padrões mais comuns na TCAR foram atenuação em vidro fosco com consolidação (em 42%); cavitação e nódulos centrolobulares com padrão de árvore em brotamento (em 31,5%); e linfonodomegalia mediastinal (em 15,7%). Entre os pacientes com cavitação e nódulos centrolobulares com padrão de árvore em brotamento, esses achados se distribuíam nos lobos superiores em 66,6%. Não se observou derrame pleural. Apesar do tratamento, a mortalidade em um ano foi de 47,3%. Conclusões: O padrão predominante na TCAR foi atenuação em vidro fosco com consolidação, seguido por cavitação e nódulos centrolobulares com padrão de árvore em brotamento. Esses achados são semelhantes aos relatados para pacientes imunocompetentes com tuberculose pulmonar e consideravelmente diferentes dos relatados para portadores de AIDS com a mesma doença.

Análisis bibliométrico de las revistas de enfermedades respiratorias de América Latina / A bibliometric analysis of Latin American journals on respiratory diseases

In 2007, the editorial situation of seven Latin American journals on respiratory diseases was analyzed in a meeting sponsored by ALAT (Latin American Association of Thoracic Diseases). Among the major problems reported were the lack of a regular and adequate periodicity in issue’s circulation, high turnover of editors and lack of original papers submitted, that lead to a low percentage of submitted papers rejection. The present situation of Latin American journals on respiratory diseases is currently compared with the Iberian Peninsula journals Archivos de Bronconeumología and Revista Portuguesa de Pneumologia, through the international data base LILACS (Literatura Latinoamericana en Ciencias de la Salud), SciELO (Scientific Electronic Library on Line), SCImago Journal & Country Rank, MEDLINE (National Library of Medicine, USA) and JCR (Journal Citation Report). The Jornal Brasileiro de Pneumologia is the Latin American journal with the best bibliometric indices; nevertheless, it is ranked behind Spain’s Archivos de Bronconeumología (ABN). Interestingly 11% of the 238 citable articles published in ABN from 2013 to 2015 had authors from Latin America. Conclusions: Although Latin American journals on respiratory diseases disseminate valuable information in their national environment accomplishing an educational role, their global impact and bibliometric indices are exiguous.

En una reunión patrocinada por la ALAT (Asociación Latinoamericana de Tórax) realizada en 2007, se analizó la situación editorial de siete revistas latinoamericanas de enfermedades respiratorias. Entre los principales problemas se señalaron la carencia de una periodicidad regular y adecuada en la publicación de los fascículos, el elevado recambio de editores y la escasez de manuscritos originales enviados para su eventual publicación, de lo cual resulta un bajo porcentaje de rechazo en los manuscritos sometidos a revisión. La actual situación de las revistas latinoamericanas de enfermedades respiratorias es comparada en este artículo con las revistas de la península ibérica Archivos de Bronconeumología y Revista Portuguesa de Pneumologia, mediante las bases de datos internacionales LILACS (Literatura Latinoamericana en Ciencias de la Salud), SciELO (Scientific Electronic Library on line), SCImago Journal & Country Rank, MEDLINE (National Library of Medicine, USA) y JCR (Journal Citation Report). El Jornal Brasileiro de Pneumologia es la revista latinoamericana que tiene los mejores índices bibliométricos, sin embargo, está clasificada por debajo de Archivos de Bronconeumología (ABN). Es interesante destacar que 11% de los 238 artículos citables publicados en ABN entre 2013 y 2015 fueron generados por autores de América Latina. Conclusiones: Si bien las revistas latinoamericanas de enfermedades respiratorias difunden una valiosa información en sus ambientes nacionales cumpliendo una función educacional, tanto su impacto global como sus índices bibliométricos son exiguos.

Impact of reconstruction techniques on low dose chest CT image quality：comparison of FBP,iDose4 and IMR / 实用放射学杂志

Objective To investigate the impact of different reconstruction algorithms ,including filtered back projection (FBP) , hybrid iterative reconstruction technique (iDose4 ,Philips Healthcare) and iterative model reconstruction (IMR ,Philips Healthcare) on image quality of the low dose chest CT .Methods 30 consecutive patients underwent chest CT on a 256‐slice CT (80 kVp ,80 mAs) were enrolled .Raw data were reconstructed with FBP ,iDose4 ,IMR_soft (L1_Body_Soft_Tissue) and IMR_routine(L1_Body_Routine) algorithms respectively ,and reconstructed thickness was 1 mm ,increment 0 .5 mm .SD ,SNR and CNR were measured and recor‐ded .Image quality was assessed using 4‐point scale (poor to excellent) with lung and mediastinum window ,respectively .We com‐pared quantitative and qualitative parameters among three reconstructions .Results SD of four groups were 55 .7 ± 20 .7 ,37 .0 ± 13 .0 , 13 .4 ± 4 .9 and 19 .5 ± 7 .0 ,repectively .Compared with FBP group ,SD reduced by 33 .5% ,75 .9% ,65% (all ,P0 .05) .The image quality score of lung window in IMR_routine group was the highest in groups ,but was no significantly different with IMR_soft group ,and was significantly different with FBP group and iDose4 group ,respectively .The image quality score of mediastinum window in IMR_soft group was the highest in groups , but was no significantly different with IMR_routine group and was significantly different with FBP group and iDose4 group ,respec‐tively .Conclusion Compared with FBP technique ,iDose4 and IMR techniques can distinctly reduce image noise and improve image quality on low dose CT ,especially IMR algorithm .

A Study into the Potential for Safe Application of Single-Incision Thoracoscopic Surgery in Various Thoracic Diseases

OBJECTIVE: Single-incision thoracoscopic surgery (SITS) is being applied to various thoracic diseases because it produces a smaller surgical scar, and is associated with less pain and loss of sensation compared to the traditional 3-port video-assisted thoracoscopic surgery (VATS). In our previous study, we showed that SITS can be used as a first-line surgical method to treat primary spontaneous pneumothorax. Therefore in this study, we looked into whether SITS can be safely and conveniently applied to other various thoracic diseases. METHODS: The subjects for this study those patients who underwent SITS at this hospital for thoracic diseases, who were admitted to this hospital between December 2013 and February 2015. RESULTS: In this study, SITS was attempted in 50 patients with various thoracic diseases. In 46 cases, SITS was successfully performed. However, in the remaining 4 cases were converted to 2-port or 3-port VATS (8%, 4/50). The reasons for conversion to VATS was due to difficulty in approaching the lesion (n=3) and severe pleural adhesion (n=1). CONCLUSION: We found that SITS is a relatively easy and safe procedure that can be applied to various thoracic diseases. However, the operation may be difficult to perform depending on the location of the lesions or the extent of pleural adhesions. Therefore we recommend SITS in conditions where the lesion is mainly in the upper lobe, such as spontaneous pneumothorax, and in patients with minimal level of pleural adhesions.

The clinical analysis of video-assisted-thoracoscopic in the treatment of 282 patients with thoracic disease / 中国基层医药

Objective To summarize the clinical experience about video-assisted-thoracoscopic in the treatment of thoracic surgical disease.Methods Through the video-assisted-thoracoscopic technique in the treatment of 282 cases with thoracic surgical diseases,which included the pulmonary bulla resection in 162 cases,the organizing blood thoracic dissection by trauma in 23 cases,the excision of lung-cyst in 17 cases,the empyema clearance and fibreboard stripping in 30 cases,the pulmonary nodular lesion resection in 17 cases,the peripheral lung wedge resection in 13 cases,the spontaneous pneumothorax pulmonary bulla resection and hemostasis hysterectomy in 9 cases,the pleural tumors in 6 cases,the esophageal leiomyoma in 2 cases,the removal foreign body of lung in 3 cases.Results The operative time was 30 ～ 180minutes,the volume of bleed was 20 ～650ml,the postoperative thoracic drainage was 3 ～ 16 days,the postoperative complications occurred in 11 patients,the incidence of complications was 3.9％,there was no death.Conclusion The thoracoscopic minimally invasive surgery is trauma,less bleeding,rapid recovery,and had the broader indications for thoracic surgery.

Clinical experience of single port VATS procedure in treatment of thoracic disease / 中华胸心血管外科杂志

Objective Summarize the experience of single port video-assisted thoracoscopic surgery (SPVATS).Evaluate the value of SPVATS for thoracic diseases.Methods 32 patients underwent SPVATS from March 2011 to May 2011,including 28 males and4 females,with an average age of (26.5 ±9.2) years (ranged 18-72 years).There were twenty-seven cases of spontaneous pneumothorax ( including 2 cases of single stage bilateral surgery),three cases of unknown pleural effusion,one case of bilateral pulmonary nodules,and one case of pulmonary metastasis tumor.Results All procedures were successfully accomplished without conversion to conventional multi-port VATS or open approach.There was no major complication or operative death.All procedures were using self-developed specialized surgical instruments and two-incision joint protection.The procedures inluded resection of lung bullae in 27 cases,purulent drainage fiber stripping pleural lavage in 3,parietal pleural biopsy in 1,and pulmonary wedge resection in 1.The operating time ranged from (22.0 ± 9.5 ) min.The average intraoperative blood loss was ( 14.5 ± 8.8 )ml.The mean chest tube duration was (3.1 ± 0.6 ) days.The average postoperative hospital stay was (6.8 ± 1.6 ) days.Conclusion SPVATS is a new approach for treatment of thoracic diseases.This technique is preferred as a minimally invasive and cosmetic procedure with decreased operative time,quickened postoperative recovery,few complications,and satisfactory short-term outcome.

Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of thoracic diseases / 中华胸心血管外科杂志

Objective To review the experience d EBUS-TBNA for staging of lung cancer and the value in diagnosing thoracic diseases in our single center.Methods The data of 343 patients who underwent EBUS-TBNA from September 2009 to August 2011 in our institution were retrospectively reviewed.There were 219 males and 124 females with an average age of (59.4 ± 13.6 ) years.Based on their primary indication,patyients were divided into three categories:group A:with known or strongly suspected lung cancer and enlarged mediastinal lymph nodes on chest radiographic examination ( short axis ≥ 1.0cm) ; group B:with enlarged mediastinal lymph nodes or mediastinal masses of unknown origin; and group C:with pulmonary parenchymal mass located close to the central airways.Results The average short axis diameter of the thoracic lesions was ( 1.94 ± 1.01 ) cm ( range from 0.5 to 8.0cm),and 2.66 punctures were performed per lesion.In group A ( n =208 ),151 patients were confirmed to have mediestinal lymph nodes metastasis while 51 showed negative results.Four patients were diagnosed as tuberculosis and two were confirmed to be stage Ⅱ sarcoidosis.37 in the 51 patients with negative EBUS-TBNA underwent thoracoscopic or thoracotomy for pulmonary resection and mediastinal lymph node dissection.Postoperative pathology confirmed that 32 patients did not have lymph nodes metastases.The diagnostic sensitivity,specificity,accuracy,positive predictive and negative predictive of EBUS-TBNA for the mediastiral staging of lung cancer were 96.8％ (151/156),100.0％ (32/32),97.3％ ( 183/188 ),100％ ( 151/151 ) and 86.5％ (32/37),respectively.In group B ( n =94),22 patients had malignancy and 72 had benign diseases.Thirteen patients received operative validation in the 23 cases which were diagnosed as proliferative lymph nodes by EBUS-TBNA,and by further operation two and three patients were confirmed as malignancy and other benign diseases respectively.The sensitivity,negative predictive value ( NPV ) and accuracy of EBUS-TBNA in distinguishing malignant mediastinal diseases was 88.0％ (22/25)、100％ (73/73) 、95.9％ (70/73)and 97.9％ (92/94),respectively.In group C( n =41 ),malignant diagnosis was achieved in 33 patients,while 4 patients confirmed as malignancy by further operations in the other 8 negative cases.The diagnostic sensitivity and accuracy of EBUS-TBNA for the diagnosis of unknown pulmonary parenchymal mass were 89.2％ (33/37) and 90.2％ (37/41),respectively.All the procedures were uneventful and no complication occurred.Conclusion EBUS-TBNA is a highly effective and safe procedure in the diagnosis of thoracic diseases and staging.of lung cancer.

The chest features of patients with the novel influenza type A H1N1 on high resolution CT / 中华放射学杂志

Objective To explore the chest features of patients with the novel influenza type A H1N1 on HRCT. Methods One hundred and seventy-two chest HRCT examinations on 163 cases with Influenza type A H1N1 (9 cases were reexamed) were retrospectively analyzed using standard pulmonary window and mediastinal window, respectively. HRCT imaging appearances were summarized. Results Ninety-seven cases showed normal on chest HRCT, while the others showed abnormalities of parenchymal and interstitial. Among them, HRCT identified ground-glass opacity in 35 cases (53.0%), centrilobular nodules in 30 cases (45.5%), thickening of intralobular septa in 31 cases (47.0%), intralobular thin reticulation and micro-nodule in 8 cases (12.1%), single-lobular inflammation in 19 cases (28.8%), consolidation of lung(the large consolidation and multiple small consolidations)in 15 cases (22.7%), pulmonary atelectasis in 3 cases (4.5%), and irregular lines in 2 cases (3.0%). Pleurisy was also revealed including 8 cases with right pleurisy, 5 cases with left pleurisy, and 19 cases with bilateral pleurisy. Mediastinal and axillary lymphadenopathy were found in 7 cases, who were spared of pleural effusion. All above abnormalities resolved quickly after anti- virus treatment. Conclusion Parenchymal and interstitial abnormalities, mediastinum and axillary fossa lymphadenopathy, and pleural effusion were the common findings on HRCT in patients with Influenza type A H1N1, which were similar to those of other viral pneumonia.

Alterações difusas da traquéia: aspectos na tomografia computadorizada / Diffuse abnormalities of the trachea: computed tomography findings

O objetivo deste ensaio pictórico foi apresentar as principais alterações tomográficas observadas em doenças que acometem a traquéia de forma difusa. As doenças estudadas foram amiloidose, traqueobroncopatia osteocondroplástica, traqueobroncomegalia, papilomatose laringo-traqueo-brônquica, linfoma, neurofibromatose, policondrite recidivante, granulomatose de Wegener, tuberculose, paracoccidioidomicose e traqueobroncomalácia. O principal aspecto observado na tomografia computadorizada foi o espessamento das paredes traqueais, com ou sem nodulações, calcificações parietais ou comprometimento da parede posterior. Embora a tomografia computadorizada permita a detecção e a caracterização das doenças das vias aéreas centrais, e a correlação com os dados clínicos reduza as possibilidades diagnósticas, a broncoscopia com biópsia continua sendo o procedimento mais importante no diagnóstico das lesões difusas da traquéia.

The aim of this pictorial essay was to present the main computed tomography findings seen in diffuse diseases of the trachea. The diseases studied included amyloidosis, tracheobronchopathia osteochondroplastica, tracheobronchomegaly, laryngotracheobronchial papillomatosis, lymphoma, neurofibromatosis, relapsing polychondritis, Wegener's granulomatosis, tuberculosis, paracoccidioidomycosis, and tracheobronchomalacia. The most common computed tomography finding was thickening of the walls of the trachea, with or without nodules, parietal calcifications, or involvement of the posterior wall. Although computed tomography allows the detection and characterization of diseases of the central airways, and the correlation with clinical data reduces the diagnostic possibilities, bronchoscopy with biopsy remains the most useful procedure for the diagnosis of diffuse lesions of the trachea.

Pulmonary Actinomycosis: CT Studies of Diagnostic and Post-treatment Findings

PURPOSE: To investigate the value of the computed tomography (CT) in the study of diagnostic and post-treatment findings of pulmonary actinomycosis. MATERIALS AND METHODS: Clinical data and CT findings were retrospectively analyzed in 10 patients with histopathologically confirmed pulmonary actinomycosis. We analyzed the initial CT findings in search of patterns and distributions which suggest possible lung abnormalities and found the pleura, chest wall, and lymphadenopathy to be involved as part of the indicators of lung abnormalities. We analyzed follow-up CT findings for changes in the lungs after antibiotic therapy and recurrence after surgery. RESULTS: Of the 10 patients analyzed by CT for lung lesions, seven had been diagnosed with alcoholism and nine were male. The initial CTs (n=10) indicated that all the pulmonary lesions were solitary without chest wall involvement. However, a transfissural extension was observed in 20% of the study population (n=2). Furthermore, peripheral lung distribution and adjacent pleural thickening was observed in 70% of the study population (n=7). Within the consolidation (n=6) or mass (n=4), a central low density with peripheral enhancement was seen in 70% of the study population (n=7). A follow-up CT of the seven cases following antiobiotic therapy revealed that four cases showed minimal improvement or aggravation of their lung lesions, whereas three cases showed resolution or improvement. The improvement of the central low density was related to the improvement of consolidation or mass. Furthermore the presence of fibrosis was observed after the resolution of pulmonary lesions (n=2). No relationship was found between the duration and response of antibiotic therapy. A follow-up CT (n=4) subsequent to a lung resection revealed the onset of chest wall actinomycosis and a thickened pleura in one case. CONCLUSION: The results of this study highlight the value of the CT in pulmonary actinomycosis in order to diagnose and evaluate antibiotic responses, complications, or post-surgical recurrences of lung lesions.

False Positive and False Negative FDG-PET Scans in Various Thoracic Diseases

Fluorodeoxyglucose (FDG)-positron emission tomography (PET) is being used more and more to differentiate benign from malignant focal lesions and it has been shown to be more efficacious than conventional chest computed tomography (CT). However, FDG is not a cancer-specific agent, and false positive findings in benign diseases have been reported. Infectious diseases (mycobacterial, fungal, bacterial infection), sarcoidosis, radiation pneumonitis and post-operative surgical conditions have shown intense uptake on PET scan. On the other hand, tumors with low glycolytic activity such as adenomas, bronchioloalveolar carcinomas, carcinoid tumors, low grade lymphomas and small sized tumors have revealed false negative findings on PET scan. Furthermore, in diseases located near the physiologic uptake sites (heart, bladder, kidney, and liver), FDG-PET should be complemented with other imaging modalities to confirm results and to minimize false negative findings. Familiarity with these false positive and negative findings will help radiologists interpret PET scans more accurately and also will help to determine the significance of the findings. In this review, we illustrate false positive and negative findings of PET scan in a variety of diseases.

Magnetic Resonance Imaging in Thorax / 결핵

Magnetic Resonance Imaging (MRI) is one of the most advanced imaging techniques in clinical and research medicine. However, clinical application of MRI to the lung or thorax has been limited due to various drawbacks. Low signal intensity of the lung and cardiac and respiratory movements are the most serious problems with MRI in thorax. Nevertheless, MRI is superior to CT in some selected patients with thoracic diseases. The role of clinical MRI in thoracic disease has been widened with improvement of MR equipments and development of new pulse sequences. Otherwise, functional assessment of lung by MRI has been studied for the last decade. These include perfusion MRI with or without contrast enhancement and ventilation MRI with oxygen-enhancement or hyperpolarized noble gas, (3)He and (129)Xe.

EXPERIENCE IN VIDEO-ASSISTED THORACOSCOPIC SURGERY (REPORT OF 616 CASES) / 解放军医学杂志

To evaluate and summary clinical experience in video assisted thoracoscopic surgery (VATS)for some thoracic diseases, clinical data of 616 patients (644 times) subjected to thoracoscopic surgery in our hospital from December 1993 to December 2001 were retrospectively analyzed. Among them, spontaneous pneumothorax occurred in 276 patients, emphysema in 44, mediastinal tumor or cyst in 55, esophageal diseases in 78, pulmonary malignant or benign diseases in 75, and other diseases in 65. Double lumen tracheal tubes were placed in 576 patients, single one was placed to ensure one lung ventilation in 6 patients and two lung ventilation in 34 patients. surgical procedures were completed by VATS in 593 cases, and 23 cases were converted into thoracotomy because of pleural adhesion or tumor invasion. Postoperative complications occurred in 24 cases with a morbidity rate of 4 0%. Persistent air leak (over 7 days) were noted in 15 cases and postoperative bleeding in 3. One case with spontaneous pneumothorax and type Ⅱ respiratory failure died of repiratory failure on the fifth day postoperatively. Six of 276 patients with spontaneous pneumothorax relapsed. VATS has more advantages than tranditional thoracotomy for some selected chest diseases,so thoracic surgeons shoulds convert tranditional thoracotomy method to perfom VATS step by step.

Cervical Mediastinoscopy for Diagnosis of Thoracic Diseases in 281 Patients / 中国微创外科杂志

Objective To investigate the value of cervical mediastinoscopy(CM) in the diagnosis of thoracic diseases.Methods From January 1990 to September 2008,281 patients with diseases in the chest were examined by cervical mediastinoscopy under local infiltration anesthesia or general anesthesia.Through the pretracheal space,exploration and biopsy of the neoplasms and lymph nodes around the trachea were carried out.Results Among the cases,pathological diagnosis were made in 268 patients(95.4%),including the 23 patients who were not clearly diagnosed before the operation.The accuracy of the preoperative diagnosis was 56.9%(41/72) for malignant tumors,and 87.4%(104/119) for benign lesions.Conclusions Cervical mediastinoscopy is an effective method to detect mediastinum diseases with or without other thoracic diseases,especially for simply enlarged lymph nodes in the mediastinum.For the patients with lung cancer complicated with enlarged lymph nodes in the mediastinum or those with tumors in the mediastinum,the method is also feasible.