Computed Tomography Findings of Bronchiectasis in Different Respiratory Phases Correlate with Pulmonary Function Test Data in Adults.

OBJECTIVE: To investigate bronchiectasis variations in different computed tomography (CT) respiratory phases, and their correlation with pulmonary function test (PFT) data, in adults. METHODS: Retrospective data analysis from 63 patients with bronchiectasis according to CT criteria selected from the institution database and for whom PFT data were also available. Bronchiectasis diameter was measured on inspiratory and expiratory phases. Its area and matched airway-vessel ratios in both phases were also calculated. Finally, PFT results were compared with radiological measurements. RESULTS: Bronchiectatic airways were larger on inspiration than on expiration (mean cross-sectional area, 69.44 vs. 40.84 mm2; p < 0.05) as were airway-vessel ratios (2.1 vs. 1.4; p < 0.05). Cystic bronchiectasis cases showed the least variation in cross-sectional area (48%). Mean predicted values of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were 81.5 and 77.2%, respectively, in the group in which bronchiectasis could not be identified on expiratory images, and 58.3 and 56.0%, respectively, in the other group (p < 0.05). Variation in bronchiectasis area was associated with poorer lung function (r = 0.32). CONCLUSION: Bronchiectasis detection, diameter, and area varied significantly according to CT respiratory phase, with non-reducible bronchiectasis showing greater lung function impairment.

Ectopic Intrathoracic Kidney Presenting as Recurrent Pneumonias in a 1-year-old Infant: A Case Report.

Ectopic intrathoracic kidney is a rare congenital anomaly, representing less than 5% of all renal ectopias. Most cases are discovered in asymptomatic adult patients undergoing imaging exams for unrelated reasons. Less than twenty cases of thoracic kidneys in the infant group have been reported in the literature, mostly comprising asymptomatic patients. Herein, we report a case of an 18-month-old boy with recurrent pneumonia episodes who was found to have a right-sided intrathoracic ectopic kidney. A brief literature review addressing the pathogenesis, prognosis, and treatment of this condition is also presented.

Normal variance in emphysema index measurements in 64 multidetector-row computed tomography.

The purpose of this study was to identify the normal variance of emphysema index (EI) measured in examinations acquired with 64 multidetector-row computed tomography (64-MDCT). A longitudinal, noninterventional study was performed retrieving all patients in our institution who are currently registered in our lung nodule protocol. All patients with clinical, functional, or significant radiological changes were excluded. We assumed that EI should remain unchanged within a short period of time. We reviewed 475 MDCTs in order to select 50 clinically stable patients who had two sequential chest MDCTs performed within a time interval of less than three months, and who presented at least one lung free of abnormalities but emphysema. CT densitovolumetry was used to calculate EI with thresholds set at -950 Hounsfield units (HUs) (EI-950) and -970 HUs (EI-970); on both studies from each patient. We observed the variation of total lung volume (TLV), mean lung density (MDL), and EI for measurements at the baseline and at follow-up scans. Differences observed between baseline and follow-up measurements were: TLV µ= 149 ml; IC = µ +1.96 (133); EI-950 µ = 0.02%; p 95 = 0.89%; EI-970 µ = 0.04%; p 95 = 0.23% and MLD µ = 15 HU; IC = µ +1.96 (18). The correlations obtained were the following: TLV r = 0.96, EI-950 r = 0.79, EI-970 r = 0.85. Accepting that emphysema would remain unchanged within three months on stable patients, differences of less than 0.89% for EI-950 and of less than 0.23% for EI-970 are within the variance of the method.

Multidetector Computed Tomography Findings in Pulmonary Hamartomas: A New Fat Detection Threshold.

PURPOSE: The aim of the study was to determine the accuracy of multidetector computed tomography in the evaluation of histologically confirmed pulmonary hamartomas (PHs), with a special focus on fat detection. MATERIALS AND METHODS: Data from 55 patients who had received a histologically confirmed diagnosis of PH and had undergone 64-slice thoracic MDCT were retrospectively evaluated. RESULTS: PHs manifested predominantly as peripheral pulmonary nodules with lobulated margins. The average lesion diameter was 1.51 cm (SD 0.6 cm). Histologic analyses identified fat content in 43/55 (78.2%) surgical specimens. The accuracy, sensitivity, and specificity of fat detection at a density threshold of -40 HU were 83.7%, 100%, and 87.2%, respectively. A threshold of -33 HU yielded better results (95.3%, 100%, and 96.3%, respectively). Popcorn-like calcifications were found in only 12/55 (21.8%) PHs and were the only imaging feature suggestive of PH in 7.2% of cases. Most (66%) lesions with popcorn-like calcifications also contained fat. CONCLUSIONS: The adoption of a new threshold for fat content (<-33 HU) can lead to further improvements in the overall ability to detect PHs by CT.

Computed tomographic pulmonary changes in patients with chronic rhinosinusitis.

OBJECTIVE: To investigate whether patients with a diagnosis of chronic rhinosinusitis (CRS) show characteristic pulmonary changes on chest CT compared with a control group without sinusopathy. METHODS: This retrospective, observational study included patients with and without a diagnosis of CRS who underwent CT examination of the lungs between 2012 and 2014. Two radiologists, who were blinded for the presence of CRS, reviewed the scans for the presence of any abnormalities consensually. The χ(2) test was used for correlative analysis, with a significance level of 0.05. RESULTS: A total of 123 CT series (51.2% from male patients, mean age 41 ± 16 years) were reviewed, including those from 59 (48%) patients with a diagnosis of CRS. Patients with CRS were more likely than the control group to exhibit atelectasis, bronchiolectasis, centrilobular nodules and ground-glass opacities (all p < 0.05), with a significant predilection for middle lobe and lingular involvement observed (p < 0.001). Other abnormalities, such as bronchial wall thickening and air trapping, did not differ between groups. CONCLUSION: Atelectatic changes, ground-glass opacities, bronchiolectasis and centrilobular nodules are the most frequent abnormalities associated with CRS, with peculiar middle lobe and lingular involvement observed on chest CT examinations. ADVANCES IN KNOWLEDGE: CRS is a frequent disorder that displays typical pulmonary changes at CT. The recognition of such findings can prevent patients with this condition from undergoing unnecessary investigations that might be based on the presence of the aforementioned radiological features.

Interobserver agreement between radiologists and radiology residents and emergency physicians in the detection of PE using CTPA.

OBJECTIVE: To assess interobserver agreement between thoracic radiologists, radiology residents, and emergency physicians in diagnosing pulmonary embolism (PE). MATERIALS AND METHODS: Emergency physicians, radiology residents, and thoracic radiologists evaluated 123 computed tomography pulmonary angiography images. Interobserver agreement was analysed using kappa statistics. RESULTS: Very good agreements were observed between thoracic radiologists and radiology residents (0.81 and 0.82). Fair and moderate agreements (0.39 and 0.42) were demonstrated between emergency physicians and thoracic radiologists. CONCLUSIONS: Important differences in interobserver agreement were found, with emergency physicians tending to overdiagnose PE.