Chest radiography and tuberculosis case-finding in asymptomatic native and immigrant populations in Greece.

SETTING: A university hospital in southern Greece. OBJECTIVE: To determine the prevalence of tuberculosis (TB) and other clinically significant conditions in routine chest X-rays (CXRs) of asymptomatic Greeks and immigrants in Greece. DESIGN: Prospective study. METHODS: CXRs of 4338 asymptomatic persons (56.8% Greeks, 43.2% immigrants, 18-74 years of age) were examined by two experienced chest radiologists blinded to identifying data. Abnormalities were recorded and the final radiological diagnosis was established by consensus. Results were statistically analysed. RESULTS: The majority (94.7%) of the CXRs were reported as normal. Clinically significant findings were reported in four cases (0.08%). No case of active TB was depicted. The incidence of old TB was higher in the Greek-born group than among the immigrants, although the difference was not statistically significant. CONCLUSION: The low prevalence of TB in the Greek-born group implies that radiographic screening in that group presents an unnecessary risk and should possibly be abandoned. Our study does not confirm noticeably higher rates of TB in immigrants in comparison to the native Greek population. However, larger prospective studies are required to confirm this finding.

Late changes in barium sulfate aspiration: HRCT features.

Aspiration of barium sulfate occurs accidentally. Lung reaction is usually mild in the early phase due to inert character of the substance and long-term reactions or late toxicities are not expected. Little if any fibrotic response is speculated. We present a case with barium aspiration, studied by high-resolution computed tomography (HRCT) 1 year after the event, as late pulmonary sequelae studied by CT have not been described yet, to the best of our knowledge. The HRCT revealed thickened interlobular septa, subpleural lines, subpleural cysts, and centrilobular micronodules along with barium particles in a subpleural distribution. Those findings indicated that barium is capable of producing mild though silent clinically fibrosis.

Pulmonary sarcoidosis. Correlation of expiratory high-resolution CT findings with inspiratory patterns and pulmonary function tests.

PURPOSE: To assess the presence and extent of air trapping (AT) on chest high-resolution CT (HRCT) in sarcoidosis and to correlate such findings with patterns, lesion extent on inspiratory CT and pulmonary function tests (PFT). MATERIAL AND METHODS: Thirty patients with sarcoidosis underwent inspiratory and expiratory HRCT and PFT. HRCT images were evaluated for presence, distribution and AT extent as well as the predominant HRCT pattern and the extent of lesions at inspiration. Attenuation difference in the AT regions at expiration and at inspiration were calculated. The presence and extent of AT were correlated with PFT, extent of involvement and predominant inspiratory patterns. RESULTS: AT was present in 25/30 patients with no lung zone predilection. AT was the only CT indication of pulmonary sarcoidosis in 3/30 patients who also had normal PFT. Attenuation difference between inspiration and expiration ranged from -40 HU to 106 HU. In 2 patients, a paradoxical decrease of lung attenuation was observed at expiration. A significant correlation was found between AT extent at expiration, with residual volume-total lung capacity ratio and residual volume. CONCLUSION: AT is an additional HRCT finding in sarcoidosis. AT may involve any lung zone, including costophrenic angles and may be the only CT feature of pulmonary sarcoidosis. Strong correlation is only found with PFT values that are specific for incomplete lung emptying at expiration.

Patient dose reduction in CT examinations by optimising scanogram acquisition.

The objective was to determine the optimum settings of the scanogram performed in computed tomography (CT) examinations for scan localisation. Head, abdomen and thorax scanograms were performed on a Rando anthropomorphic phantom using various selectable combinations of tube voltage and tube current values. Thermoluminescence dosemeters were used to obtain entrance skin dose data. Effective dose was estimated using normalised organ dose data provided by the National Radiological Protection Board. One hundred and twelve head, 114 thoracic and 111 abdominal patient scanograms were obtained with lower settings than those recommended by the operator's manual. Scanogram sufficiency was assessed by four observers. Head and thoracic scanograms obtained with 80 kV/50 mA and abdominal scanograms obtained with 80 kV/75 mA were found to be acceptable, even though the operator's manual recommendation was 120 kV/100 mA. Thus, the scanogram effective dose was reduced by 72%, 84% and 88% for head, thorax and abdomen examination respectively. Effective dose from a complete CT examination may be reduced by up to 3.5% without any subsequent image quality degradation of the diagnostically important sectional images.

Infantile myofibromatosis with visceral involvement and complete spontaneous regression.

Infantile myofibromatosis is an unusual mesenchymal disorder characterized by the proliferation of tumors in the skin, muscle, bone, and viscera. Two types can be distinguished; the solitary type, defined by the presence of one nodule in the skin, muscle, bone or subcutaneous tissue; and the multicentric type which can be divided into two sub-types. In the first sub-type the lesions are multicentric but without visceral involvement, while in the second, visceral involvement is present. The prognosis of the disease depends on whether visceral involvement is present. Solitary and multicentric nodules without visceral involvement usually have excellent prognosis with spontaneous regression of lesions within 1 to 2 years of diagnosis. On the other hand, visceral lesions are associated with a significant morbidity and mortality, resulting from vital organ obstruction, failure to thrive, or infection. Death in these cases often occurs at birth, or soon after, and is usually due to cardio-pulmonary or gastrointestinal complications. The case being reported here, is that of a female newborn who had multiple skin, subcutaneous tissue, skeletal muscle, bone, and lung lesions immediately after bith. At the age of three years, the child is in good health, her psychomotor development is in accordance with her age group, and the lesions have completely regressed. This is a case of the multicentic type of infantile myofibromatosis with visceral involvement, where all lesions have spontaneously regressed. This is a rarity since the prognosis in the majority of such cases is poor.

Estimation of fetal radiation dose from computed tomography scanning in late pregnancy: depth-dose data from routine examinations.

RATIONALE AND OBJECTIVES: To provide depth-dose data for estimating fetal radiation dose from routine computed tomography (CT) examinations of the trunk. METHODS: Doses were measured during CT examinations of the thorax, upper abdomen, abdomen, and pelvis in two anthropomorphic phantoms simulating pregnant women in the second and third trimesters. Thermoluminescent dose meters were used for dose measurements. RESULTS: In CT examinations of the abdomen, doses of 30.0 to 43.6 mGy and of 29.1 to 42.0 mGy were measured at the measuring points in the phantom simulating pregnancy in the second and third trimesters, respectively. In CT examinations of the upper abdomen, pelvis, and thorax, both phantoms received lower doses of radiation. Knowledge of the normalized weighted dose index of the CT scanner and of the kVp and mAs settings of the protocol used for examination of the pregnant woman is needed to adjust the dose data found in the present study to modified protocols and different CT equipment. CONCLUSIONS: These dosimetric data may be used to guide the management of pregnant patients undergoing CT examinations of the trunk.

Q fever pneumonia: CT findings.

PURPOSE: To evaluate the computed tomographic (CT) features of Q fever pneumonia. MATERIALS AND METHODS: The authors retrospectively reviewed the chest radiographs and CT scans obtained in 12 patients, who were selected on the basis of chest CT availability from a group of patients with a definite diagnosis of acute Q fever infection during an 8.5-year period. RESULTS: In all cases, CT depicted lesions indicative of airspace involvement, which was expressed as lobar (n = 3), segmental (n = 3), patchy (n = 3), or a combination of these patterns (n = 3). Involvement of more than one lobe was observed in seven (58%) patients. In one patient with multiple patchy areas of consolidation, nodular lesions with a vascular connection and a halo of ground-glass opacity, which were suggestive of an angioinvasive process, were demonstrated. In addition, CT performed in a patient with acute Coxiella burnetii infection who abused alcohol revealed necrotizing pneumonia. Pleural effusions were seen at both CT and radiography in three patients, and mild lymph node enlargement in isolated regions was seen at CT in four patients. Chest radiography was less accurate than CT in the detection of segmental and patchy areas of consolidation. CONCLUSION: The typical CT findings of Q fever pneumonia consisted mainly of multilobar airspace consolidation. A nodular pattern accompanied by a halo of ground-glass opacification and vessel connection, and necrotizing pneumonia in the setting of impaired immunity were less frequent.

Successful conservative treatment of neutropenic enterocolitis complicating taxane-based chemotherapy: a report of five cases.

Five cases of acute neutropenic enterocolitis complicating taxane-based chemotherapy are described. During a 34-month period, our department administered 4,600 courses of taxane-based (paclitaxel and docetaxel) chemotherapy to 800 cancer patients. Seven to 10 days postchemotherapy in five patients (0.1% of the given courses), neutropenic fever, abdominal pain, rebound tenderness, and grade II-IV diarrhea (bloody in two cases) developed. Two patients had oral candidiasis, and in two others septic shock developed. Computed tomography scans of the abdomen revealed in all patients thickening of the colon wall and pericolic edema, and a pericolic abscess was revealed in three of them. Both clinical and radiologic findings supported the diagnosis of acute neutropenic enterocolitis. All patients were successfully treated with broad-spectrum antibiotics and recombinant human granulocyte colony-stimulating factor. In conclusion, acute neutropenic enterocolitis is a severe complication of taxane-based chemotherapy. Early diagnosis and appropriate conservative treatment leads to complete recovery. Although rare, this infection is less often associated with other chemotherapeutic regimens.

CT evaluation of mesenteric panniculitis: prevalence and associated diseases.

OBJECTIVE: This study was undertaken to assess the prevalence of mesenteric panniculitis on CT and to describe its appearance and associated diseases. SUBJECTS AND METHODS: A total of 7620 consecutive abdominal CT examinations were prospectively evaluated for features common to mesenteric panniculitis such as a well-delineated inhomogeneous hyperattenuated fatty mass at the mesenteric root, envelopment of mesenteric vessels, and no evidence of invasion of the adjacent small-bowel loops that may be displaced. RESULTS: CT findings of mesenteric panniculitis were seen in 49 patients (0.6%). We found a female predominance. Mesenteric panniculitis coexisted with malignancy in 34 patients and with benign disorders in 11 patients. In the remaining four patients, mesenteric panniculitis, verified on histology, was considered to be responsible for the patients' clinical manifestations; no other abnormality was identified. Soft-tissue nodules (n = 39) and a fatty halo surrounding vessels and nodules (n = 42) were observed in most patients. Follow-up abdominal CT examinations in 29 of the 49 patients showed changes in only one patient. CONCLUSION: CT findings of mesenteric panniculitis may be seen in patients undergoing abdominal CT for various symptoms.

Pneumoconiosis among Cretan dental technicians.

Pneumoconiosis among dental technicians has recently emerged as an area of research in interstitial lung disease. This study was carried out to estimate the prevalence of pneumoconiosis in Greek dental technicians on the island of Crete. Fifty-one of the 58 dental technicians of the Heraklion Dental Technicians' Association completed an exposure history questionnaire and underwent a clinical examination, including chest radiographs, and spirometric assessment of lung volume and diffusing capacity. Values were compared with 51 control subjects. Five dental technicians showed radiological evidence of pneumoconiosis. Mean lung function values of the dental technicians, even in those with pneumoconiosis, were not significantly different from controls. No significant changes in lung function parameters were associated with smoking, exposure to metals and other contaminants. Dental technicians, however, reported more respiratory symptoms than controls (p = 0.008). Symptoms were associated to the absence of a ventilation system. We concluded that occupational exposure in dental technicians in Crete did not affect lung function. The prevalence of pneumoconiosis in this study was 9. 8%.

Gastric ulcer bleeding: diagnosis by computed tomography.

A case of CT demonstration of a bleeding gastric ulcer is presented, in a patient with confusing clinical manifestations. Abdominal CT was performed without oral contrast medium administration, and showed extravasation of intravenous contrast into a gastric lumen distended with material of mixed attenuation. It is postulated that if radiopaque oral contrast had been given, peptic ulcer bleeding would probably have been masked. CT demonstration of gastric ulcer bleeding, may be of value in cases of differential diagnostic dilemmas.

HRCT in miliary lung disease.

PURPOSE: To analyze high resolution CT (HRCT) features of a miliary pattern in different diseases. MATERIAL AND METHODS: Eight HRCT studies with a miliary lung pattern were retrospectively reviewed with the diagnoses tuberculosis (n=3), Candida albicans (n=1), sarcoidosis (n=3), and metastatic adenocarcinoma (n=1). RESULTS: In all cases, HRCT showed diffusely disseminated nodules up to 3 mm. In 2 cases of tuberculosis and 1 of sarcoidosis, the lesions predominated in the upper/middle lung zones. In the case of metastatic adenocarcinoma the nodules were more sparse in the lung periphery while in 1 case of sarcoidosis, HRCT revealed a predominance of the lesions in the outer third of the lungs. Cyst-like lesions of 12 mm were observed in 2/3 cases of tuberculosis and in metastatic adenocarcinoma. Notably thickened interlobular septa and interlobar fissures were each seen in 2/3 cases of sarcoidosis. In general, a random relationship of miliary nodules to secondary lobular structures and bronchovascular bundles was observed, despite the co-existence of centrilobular, subpleural and paraseptal nodules. CONCLUSION: HRCT features that potentially contribute in making a differential diagnosis are: a) A peripheral distribution of nodules, an increased number of thickened interlobular septae, and a notable thickening of interlobar fissures, all of which are indicative of sarcoidosis; and b) Multiple cyst-like lesions which should direct attention to tuberculous or metastatic origin. The predominance of miliary nodules in relation to cephalocaudal axis, their margin and size are not helpful features to the differential diagnosis of diseases presenting a miliary pattern.

Q fever pneumonia: appearance on chest radiographs.

PURPOSE: To determine the radiographic features of Q fever pneumonia. MATERIALS AND METHODS: Chest radiographs in 85 patients admitted to the hospital during a 7-year period with Q fever pneumonia were retrospectively reviewed by two observers. RESULTS: The most commonly recorded abnormalities were segmental (n = 53 [62%]) and lobar (n = 15 [18%]) areas of opacity. Segmental pneumonia was observed as a unilateral single area of opacity in 38 (72%) patients. It was more frequently located in the upper lobes. The left upper lobe was involved in 31% of patients, the right upper lobe, in 23%; and the right lower lobe, in 27%. Lobar pneumonia was less frequently observed as a single lesion in eight (53%) of 15 patients; It was located in the left upper lobe in 31% and in the right middle lobe in 27% of patients. There was no correlation between the extent of pulmonary involvement and the course of the disease; the outcome was favorable in all patients. Complete resolution of the radiographic findings occurred in a mean of 39 days. CONCLUSION: The radiographic differentiation of Q fever pneumonia from the other community-acquired pneumonias is not possible. Clinical, serologic, and epidemiologic data provide the best basis for diagnosis.

Sacroiliac joints: anatomical variants on CT.

The purpose of this work was to examine the type and prevalence of anatomical variants of the sacroiliac joints (SJs) in patients without SJ disease on CT examinations. The study comprised 534 consecutive patients undergoing pelvic CT with various indications not related to diseases that could involve the SJ. Images printed on bone window settings were evaluated with reference to any deviation from the usual appearance of the SJ. Physical data and history of low back pain were recorded in each patient. Six types of anatomical variants were observed: accessory joints in 102 patients (19.1%), "iliosacral complex" in 31 (5.8%), bipartite iliac bony plate in 22 (4.1%), crescent-like iliac bony plate in 20 (3.7%), semicircular defects at the sacral or iliac side in 16 (3%), and ossification centers in 3 patients (0.6%). Accessory joints were more common in obese than in normal-weight individuals (p < 0.05) and in older than younger (<60 years) patients (p < 0.001) and presented degenerative alterations especially in patients with episodes of low back pain. Three of these variants (iliosacral complex, bipartite iliac bony plate, and crescent-like iliac bony plate) had higher incidence in women than in men (p < 0.05) and were not associated with degenerative changes. Knowledge of the normal variations in the SJ appearance broadens the understanding of SJ anatomy, facilitating image interpretation.

Pneumothorax as a first manifestation of sarcoidosis.

Pneumothorax is a rare manifestation of sarcoidosis, occurring usually late in the course of the disease. We report five cases of pneumothorax as a presenting manifestation of sarcoidosis. In two patients, thoracotomy showed extensive pleural infiltration by noncaseating granulomas. High-resolution CT scans showed cavitated subpleural nodules and subpleural bullae in one case. These findings support that necrosis of subpleural granulomas or rupture of a subpleural bullae, or both, are the mechanisms of pneumothorax in sarcoidosis. Three patients with a lung function impairment were treated with oral corticosteroids. One nontreated patient died due to progression of the disease.

Crescentic and ring-shaped opacities. CT features in two cases of bronchiolitis obliterans organizing pneumonia (BOOP).

Two cases of idiopathic bronchiolitis obliterans organizing pneumonia (BOOP) with unusual CT findings are presented. On CT both cases exhibited crescentic and ring-shaped opacities, surrounding areas of groundglass attenuation, and associated with a nodular pattern in one patient and airspace consolidations in the second patient. CT-pathologic correlation disclosed that the central areas of groundglass attenuation corresponded to alveolar septal inflammation, in contrast to the denser periphery where granulomatous tissue in peripheral airspaces predominated. In the broad spectrum of CT findings, BOOP can exhibit specific CT features with regard to the crescentic or ring-shaped opacities with a central groundglass attenuation area. Since these features have not been described in any other disease, they might be characteristic features for the diagnosis of BOOP.

Emphysematous cystitis after orchiectomy.

A 59-year-old man developed emphysematous cystitis 3 weeks after undergoing left orchiectomy because of suppurative epididymitis. The case is presented because of its unusual cause and to emphasize the high degree of suspicion required for the diagnosis.