Reversed halo sign in lymphomatoid granulomatosis.

Lymphomatoid granulomatosis is a rare lymphoproliferative disorder which affects extranodal sites, most commonly lung. Radiologically, it typically presents with multiple nodular opacities that may wax and wane. The reversed halo sign has previously been reported in cryptogenic organizing pneumonia and more recently in South American blastomycosis. We describe a case of histologically proven lymphomatoid granulomatosis in a patient who presented initially with the more typical nodular opacities, which subsequently progressed into the reversed halo sign. To the best of our knowledge, this association has not been previously described.

Mycobacterium avium complex lung disease in immunocompetent patients: radiography-CT correlation.

This study aimed to describe and correlate the chest radiography and CT findings of Mycobacterium avium complex (MAC) lung disease in immunocompetent patients. 26 patients fulfilled The American Thoracic Society criteria for MAC lung disease and underwent chest radiography and CT within 6 weeks of positive cultures. All abnormalities and predominant lobar involvement were recorded and abnormalities on chest radiography were correlated with those on CT. The images were evaluated by two chest radiologists and decisions were reached by consensus. 21 females and 5 males, with an overall mean age of 69 years, were included in the study. All chest radiographs and CT scans were abnormal. On chest radiography, overinflation was demonstrated in 18 patients. CT scan abnormalities included atelectasis (n=17), bronchiectasis (n=24), cavities (n=13), consolidation (n=3), emphysema (n=11), ground-glass opacity (n=8), linear opacities (n=26), mediastinal lymphadenopathy (n=3), nodules (n=25) and pleural disease (n=15). CT findings were at variance with chest radiography findings in 15 lobes. A new feature from this study is that the majority of patients with MAC lung disease demonstrate overinflation on chest radiography. 19% of cases had predominant upper lobe disease, indistinguishable from post-primary Mycobacterium tuberculosis infection. 77% of cases demonstrated the major imaging criteria of MAC lung disease. These are ill defined nodules, bronchiectasis, predominant middle lobe and/or lingular abnormalities, with or without overinflation. We believe that these characteristic radiological signs will assist the physician in the diagnostic work-up of patients with MAC lung disease.

Correlation of chest radiographic findings with biopsy-proven acute lung rejection.

The purpose of this study was to determine the chest radiographic findings of acute rejection and the accuracy of chest radiography in making this diagnosis in patients undergoing lung transplantation. For each of 100 transbronchial biopsies performed on 25 lung transplant recipients (single lung in three, double lung in 22), chest radiographs obtained within 24 hours before the biopsy were reviewed retrospectively without knowledge of clinical or biopsy information. Transbronchial biopsy revealed 42 instances of acute rejection in 17 patients and 58 instances of no acute rejection (normal, n = 43; other processes, n = 15). All pulmonary parenchymal radiographic abnormalities were assessed. Acute rejection was associated with the presence of middle or lower lung reticular interstitial or airspace disease in 21 lungs (sensitivity = 0.50 [21/42]). This pattern was seen in 18 lungs without acute rejection (specificity = 0.69 [40/58]). There was no difference in the appearance of the lungs between grades 1 and 2 acute rejection. Normal lungs were noted in 20 instances of acute rejection (48%). The authors conclude that chest radiograph findings are abnormal in about 50% of instances of biopsy-proven acute rejection. Because the appearance of acute rejection is similar to that of other conditions, the diagnosis cannot be made accurately by chest radiography.

Mycobacterium xenopi pulmonary infection: evaluation with CT.

PURPOSE: Our goal was to describe the CT appearances of Mycobacterium xenopi pulmonary infection. METHOD: A retrospective study period of 75 months was used. Eight immunocompetent patients fulfilled the American Thoracic Society criteria for M. xenopi infection and had CT scans of the thorax. CT scans were reviewed by two observers, and decisions were reached by consensus. RESULTS: Seven patients demonstrated upper lobe cavitary disease: one mass with cavity, one nodule with cavity, three consolidation with multiple cavities, and two cavities only. One patient demonstrated upper lobe consolidation only. All patients demonstrated adjacent lung architectural distortion indicating fibrosis and centrilobular nodules suggesting endobronchial spread of infection. Seven patients had a clinical history of preexisting chronic obstructive pulmonary disease that was confirmed by CT. Four patients demonstrated adjacent pleural disease. CONCLUSION: M. xenopi pulmonary infection usually affects patients with preexisting pulmonary emphysema. It predominantly affects the upper lobes, usually with cavitary opacities and evidence of fibrosis and endobronchial spread of infection.

Cystic change (pseudocavitation) associated with bronchioloalveolar carcinoma: a report of four patients.

Cavitation in bronchioloalveolar carcinoma is uncommon, but apparent radiologic cavitation may be produced by other causes of abnormal air collections in and around the tumor. We report four patients whose plain films and computed tomography scans were interpreted as showing cavitary masses. Paracicatricial emphysema, fibrosis with honeycombing, and localized bronchiectasis were present pathologically to explain the abnormal air collections.

Congenital bronchopulmonary diseases in adults: CT findings.

Congenital lung disease is divided into two types: lesions that arise from the primitive foregut (i.e., bronchopulmonary malformations) and lesions that originate in the pulmonary vasculature. The latter often are detected early in life because of signs and symptoms or other serious associated anomalies. Conversely, many of the bronchopulmonary anomalies are asymptomatic and therefore are not discerned until adulthood. This essay illustrates the spectrum of CT findings of many congenital bronchopulmonary malformations that are seen in adults, including pulmonary agenesis, anomalous bronchial branching, bronchial atresia, foregut cysts, bronchopulmonary sequestration, and pulmonary arteriovenous malformations.

Pulmonary manifestations of coccidioidomycosis.

Pulmonary coccidioidomycosis is a fungal disease seen primarily in the southwestern United States and Mexico. However, with the advent of mass travel it is being seen increasingly in countries outside the zone where it is endemic. Pulmonary coccidioidomycosis, which has a high infectivity, is acquired by inhalation of fungal arthrospores. Its infectivity is increased in immunosuppressed patients, particularly those with the acquired immunodeficiency syndrome. Because of these factors, it is important for radiologists (particularly those practising outside the area of endemicity) to recognize the various manifestations of this disease. The authors review the major clinical syndromes and their radiologic manifestations.

Mediastinal invasion by bronchogenic carcinoma: CT signs.

PURPOSE: To determine the accuracy of computed tomographic (CT) signs in assessment of direct mediastinal invasion by primary bronchogenic carcinoma. MATERIALS AND METHODS: In 90 patients with primary bronchogenic carcinoma who underwent CT with thoracic surgical staging and thoracotomy, the pathologic and CT findings in 14 mediastinal structures were compared retrospectively. The degree of contact of the primary tumor with each structure and whether the structure was distorted or contained intraluminal tumor were recorded. A total of 785 mediastinal structures (25 with tumor invasion) were analyzed. RESULTS: When greater than 90 degrees of contact was considered a positive CT finding, the sensitivity of CT was 40% (10 of 25 structures); specificity, 99% (752 of 760 structures); and positive and negative predictive values, 56% and 98%. All structures with > 180 degrees of contact had pathologic involvement, but only 11 of 17 distorted structures (65%) and five of seven structures with intraluminal tumor (71%) were involved. CONCLUSION: CT is insensitive in detection of mediastinal invasion by primary bronchogenic carcinoma. The positive predictive value may be higher, depending on the criteria used.

Bronchioloalveolar carcinoma and the air bronchogram sign: a new pathologic explanation.

Bronchioloalveolar carcinoma (BAC) is one of the few lung tumors known to demonstrate the air bronchogram sign. Production of this valuable radiologic sign by this tumor has been ascribed to an "alveolar" filling process in which tumor grows along alveolar walls with preservation of the architecture and secretes copious amounts of mucus. Thus, aerated bronchi are surrounded by alveoli that are filled with mucus and tumor. We present a case in which the air bronchogram sign and pulmonary consolidation are associated with a nonsecretory BAC. Alternative mechanisms that may produce the air bronchogram sign in BAC are offered.

Transthoracic needle biopsy.

Percutaneous fine-needle aspiration biopsy is a relatively simple invasive procedure with good patient acceptance, low morbidity, and almost negligible mortality. It provides a diagnosis of pulmonary, hilar, and mediastinal masses quickly and accurately, thus eliminating many laboratory tests, saving hospital days, and thereby saving time and money. Percutaneous fine-needle aspiration biopsy should be performed early in the investigation of many types of intrathoracic lesions.