[Multidetector CT Findings of Solid Organ Injury Based on 2018 Updated American Association for the Surgery of Trauma Organ Injury Scaling System]. / 2018 ê°œì • ë¯¸êµ­ì™¸ìƒìˆ˜ìˆ í˜‘íšŒ ë³µë¶€ê³ í˜•ìž¥ê¸° 손상척도에 따른 다중검출 CT 소견.

The newly revised 2018 Organ Injury Scale (OIS) has a similar format to the previous American Association for Surgery and Trauma (AAST) Emergency General Surgery Grading System, dividing the criteria for grading solid organ damage into three groups; imaging, operation, and pathology. The most significant alteration in the OIS system 2018 revision is the incorporation of multidetector CT (MDCT) findings of vascular injury including pseudoaneurysm and arteriovenous fistula. Similar to the previous OIS, the highest of the three criteria is assigned the final grade. In addition, if multiple grade I or II injuries are present, one grade is advanced for multiple injuries up to grade III. This pictorial essay demonstrates the MDCT findings of solid organ injury grades based on the 2018 OIS system.

Computed tomographic thoracic morphologic indices in normal subjects and patients with chronic obstructive pulmonary disease: Comparison with spiral CT densitometry and pulmonary function tests.

OBJECTIVES: To determine what computed tomographic (CT) dimensions can predict obstructive lung disease on routine chest CT scans by comparing morphological and densitometric CT findings with pulmonary function test (PFT) in normal subjects and patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: Consecutive patients (n = 646; 260 females and 386 males; mean age 54.9 years, ranged 20-90 years) who received chest CT scans with densitometry during a 3-month period were retrospectively analyzed in single center. PFT was undertaken in 235 patients (152 males, 83 females) at same times of CT scanning. The patients were grouped by age (<30 years, 31-45 years, 46-60 years, and >61 years). CT parameters including tracheal, azygoesophageal, thoracic vertical, anterior-posterior (AP), transverse diameters, transverse cardiac diameter, diameters of main, right, and left pulmonary arteries, and CT densitometric values including lung volume and density (-900 to -1000 Hounsfield Units, HU), low attenuation value cluster (default threshold: -950 HU) were compared with PFT values. Spearman correlation coefficients was used to evaluate the relationship between the CT indices and PFT. RESULTS: Ninety of 235 patients with PFT were smokers (76 males, 14 females). Obstructive PFT was detected in 65 patients (27.7%: 46 males, 19 females). Male smokers with obstructive PFT displayed significantly larger thoracic anterior-posterior (mean: normal, 172.3 cm versus COPD, 185.9 cm, p = 0.0001) and smaller transverse diameters (mean: normal, 247.0 cm vs. COPD, 235.8 cm, p = 0.01), and increased right pulmonary artery diameter (mean: normal, 20.3 cm v s. COPD, 22.1 cm, p < 0.001), and increased left pulmonary artery diameter (mean: normal, 19.7 cm vs. COPD, 20.6 cm, p < 0.025). The lung parenchyma density (-1000 to -900 HU) and greater concentration of largest cluster on densitometry were significantly different between normal and obstructive PFT pattern in male smoker. Residual volume and total lung capacity are positively correlated with lung volume and lung density (-1000 to -800) of densitometry. CONCLUSIONS: CT findings of the overexpansion of the lungs, such as increases in the vertical diameter of the lung and decreases in the transverse diameter of the heart, can be significant as indirect findings of early chronic obstructive diseases. However, despite the significant CT findings in male smokers, particularly those in their 40s, most lung function parameters were not decidedly abnormal.

Successful thoracoscopic resection of a large mediastinal angiomyolipoma.

An angiomyolipoma (AML) is a benign mesenchymal tumor characterized by proliferation of mature vessels, smooth muscle, and adipose tissue. AMLs most commonly occur in the kidney but have been reported in a variety of extrarenal sites. Mediastinal AMLs are extremely rare. We herein present a case of a large AML of the mediastinum that was successfully treated by thoracoscopic resection.

Does oxygen therapy increase the resolution rate of primary spontaneous pneumothorax?

BACKGROUND: Patients with small pneumothoraces are usually treated with oxygen therapy. However, evidence that oxygen therapy increases resolution rate is based on small populations with secondary spontaneous pneumothorax. Therefore, this study aimed to confirm whether oxygen therapy increases the resolution rate of primary spontaneous pneumothorax (PSP). METHODS: We retrospectively reviewed records of patients with PSP who had undergone outpatient observation (room air group) and those who were admitted for oxygen therapy (O2 group) between March 2005 and February 2016. The initial chest posteroanterior (PA) radiograph was compared with the last chest PA radiograph before the pneumothorax disappeared. The size of the pneumothorax was measured using the Collins' method. RESULTS: A total of 175 episodes were identified in 160 patients. Of these, 128 episodes (73.1%) occurred in patients in the O2 group. The mean age was 19.24±4.74 years. The mean initial size of the pneumothorax was smaller in the room air group (23.32%±7.00% vs. 20.26%±6.78%, P=0.011). The resolution rate was higher in the O2 group [(4.27%±1.97%) vs. (2.06%±0.97%)/day, P<0.001]. The initial size of the pneumothorax, time interval between radiographs, and use of oxygen therapy were significantly associated with the resolution rate in multivariate analysis. CONCLUSIONS: Oxygen therapy increases the resolution rate of PSP. However, routine use of oxygen therapy in patients with small pneumothoraces should be considered more carefully. Well-controlled prospective studies are required to confirm the indication of oxygen therapy.

Evaluation of temporal bone pneumatization with growth using 3D reconstructed image of computed tomography.

OBJECTIVE: To evaluate temporal bone pneumatization with growth using 3D reconstructed computed tomography (CT) images. PATIENTS AND METHODS: Eighty-four temporal bones of 42 patients under the age of 16 years who had undergone head and facial bone CT were included in this retrospective study. The bony growth of the temporal bone and the head size were evaluated with horizontal- and vertical-plane CT images. Pneumatization of the temporal bone was investigated with 3D reconstruction software using axial CT images, dividing them as follows: medially, anterosuperiorly, posterolaterally, and inferiorly. Pneumatization of each individual part was compared with that of other parts and was also evaluated according to the aging process. RESULTS: The mean pneumatization was measured as 1696.7mm3 in patients aged under 2 years, 3609.1mm3 in those aged 2-4 years, 5351.1mm3 in those aged 5-7 years, 7295.9mm3 in those aged 8-10 years, 7797.5mm3 in those aged 11-13 years, and 8526.6mm3 in those aged 14-16 years. The degree of temporal bone pneumatization of each part was correlated with that of other parts (p<0.05). The volume of pneumatization increased with growth of the temporal bone and with aging. The degree of pneumatization of specific parts might be related to developmental periods. CONCLUSION: The pneumatization of one part might affect the pneumatization of other nearby parts, or all parts might be affected by the same driving force of pneumatization.

The relation between CT findings and sputum microbiology studies in active pulmonary tuberculosis.

PURPOSE: To evaluate whether CT findings suggesting active pulmonary tuberculosis correlate with sputum microbiological studies, and to determine whether CT could predict infectivity. MATERIALS AND METHODS: Total 108 patients with active pulmonary tuberculosis were enrolled. We reviewed CT findings and sputum microbiological studies. Then, we analyzed the statistical difference in CT findings between the positive and negative groups of each sputum microbiological study (AFB smear, PCR, and culture). Also, we divided the patients into five groups according to sputum AFB smear grade and analyzed linear trends of CT findings between the five groups. RESULTS: Both frequencies and extents of centrilobular micronodules (63% vs 38%, p=0.011 for frequency; 1.6 ± 1.6 vs 0.6 ± 1.1, p=0.001 for extent), tree-in-bud opacities (63% vs 33%, p=0.002; 1.6 ± 1.6 vs 0.5 ± 0.9, p<0.001, respectively), consolidation (98% vs 81%, p=0.003; 2.7 ± 1.5 vs 1.3 ± 1.1, p<0.001, respectively), and cavitation (86% vs 33%, p<0.001; 1.5 ± 1.2 vs 0.4 ± 0.7, p<0.001, respectively), were significantly increased in the sputum AFB-positive group than in the negative group. These four CT findings were increase in frequency and extent in the sputum PCR-positive group with or without statistical significance. They did not show significant differences between the sputum culture-positive and negative groups. As the AFB smear grade increased, frequencies and extents of centrilobular micronodules, tree-in-bud, consolidation, and cavitation also increased. CONCLUSION: CT features representing active tuberculosis-centrilobular nodules, tree-in-bud, consolidation, and, cavitation-strongly correlate with the positivity and grading of AFB smear.

Clinical utility of three-dimensional facial computed tomography in the treatment of nasal bone fractures: a new modality involving an air-bone view with a volume rendering technique.

To evaluate the utility of three-dimensional (3D) reconstruction when planning the surgical treatment of nasal bone fractures. The axial scan of high-resolution facial bone CT was reconstructed in 3D using the program V-works 4.0 (CyberMed, Seoul, Korea) with a volume and surface rendering technique. For detailed stereoscopic examination of the nasal valve area, an air-bone view with the volume rendering technique was obtained using thresholds for air, cartilage, and bone. In most nasal bone fractures, 2D and 3D CT had similar detection rates. However, to determine the fracture angle and dimpled area, and identify multiple fractures, surgeons can get better information to help with the reduction of the fractured bone from 3D reconstruction images. Additionally, with a septal deformity, this view helps in deciding on the need for septal surgery during nasal reduction. The air view of the nasal passage provides clues to obstruction of the nasal cavity. We could identify the contour and location of the fracture site accurately from 3D CT images. The detection rate of fractures was similar to that of 2D CT. However, 3D CT enabled the accurate determination of the distance and direction of the fractured bony fragment from normal bone structure. Additionally, a stereoscopic image of the fracture site facilitated an understanding of the location and range of reduction. The air-bone view gave more information about the pathological obstruction of the nasal air passage.

Computed tomography and 18F-fluoro-2-deoxyglucose positron emission tomography findings of primary pulmonary follicular dendritic cell sarcoma: case report and a literature review.

We report herein computed tomography and F-fluoro-2-deoxyglucose positron emission tomography findings of primary pulmonary follicular dendritic cell sarcoma in a 51-year-old man, which is an extremely rare malignancy originating from follicular dendritic cells. Computed tomography scan revealed a 2.4-cm, well-defined solitary pulmonary nodule with delayed contrast enhancement but without regional lymphadenopathy, distant metastasis, or calcification within the nodule. On F-fluoro-2-deoxyglucose positron emission tomography scan, this nodule showed moderate hypermetabolic activity with a maximum standardized uptake value of 3.2.

Risk factors for progression of aortic arch calcification in patients on maintenance hemodialysis and peritoneal dialysis.

Vascular calcification is accelerated during dialysis and is known to be an important risk factor for cardiovascular disease. Progression of aortic arch calcification (AoAC) can be simply estimated with an AoAC score (AoACS) using plain chest radiography. The objective of this study was to evaluate risk factors for AoAC progression. The enrolled subjects were 125 newly treated hemodialysis patients and 59 peritoneal dialysis patients. In the patients who had undergone chest radiography before initial dialysis therapy and every year, we estimated AoACS and then divided the patients into two groups based on the presence or absence of AoAC progression. We also compared the baseline clinical and biochemical profiles in the two groups. Eighty-five (46.2%) were men (mean age, 58.6 ± 12.7 years). Seventy-six patients (41.3%) had AoAC before initial dialysis, with a mean AoACS of 13.0 ± 20.4%. The mean duration of follow-up was 2.7 ± 1.0 years. Half of the patients (50%) had progressive AoAC. Age >65 years (p = 0.003), dialysis duration (p = 0.004), diabetes (p = 0.015), and the presence of AoAC at baseline (p = 0.001) were related to AoAC progression. No significant association was found between AoAC progression and the baseline clinical parameters, including gender, obesity, hypertension, and dialysis modality. In a multivariate analysis, dialysis duration (p = 0.003) and the presence of AoAC at baseline (p < 0.001) were independent risk factors for AoAC progression in patients undergoing dialysis. The duration of dialysis and the presence of AoAC before initial dialysis were significantly related to the progression of AoAC in these patients. The results suggest that patients should be carefully managed from the predialysis stage to prevent AoAC progression and to reduce cardiovascular morbidity.

Cystic hypersecretory ductal carcinoma of the breast: a rare cause of cystic breast mass.

We present the case of a surgically confirmed, invasive, cystic hypersecretory ductal carcinoma (CHDC) of the breast in a 43-year-old woman. The initial sonography showed a complex cyst, which required a core biopsy; however, the diagnosis was delayed as the patient refused to undergo the biopsy and the cyst decreased in size, as seen on follow-up sonography. Excision biopsy was performed, and invasive CHDC was diagnosed after regrowth of the cystic lesion. Meticulous sonographic evaluation of a cystic breast mass is always important, and pathology confirmation must be considered if the lesion shows features suspicious for malignancy, as a CHDC could be the cause of a cystic breast mass.

CT evaluation of vocal cord paralysis due to thoracic diseases: a 10-year retrospective study.

PURPOSE: To discuss computed tomography (CT) evaluation of the etiology of vocal cord paralysis (VCP) due to thoracic diseases. MATERIALS AND METHODS: From records from the past 10 years at our hospital, we retrospectively reviewed 115 cases of VCP that were evaluated with CT. Of these 115 cases, 36 patients (23 M, 13 F) had VCP due to a condition within the thoracic cavity. From these cases, we collected the following information: sex, age distribution, side of paralysis, symptom onset date, date of diagnosis, imaging, and primary disease. The etiology of VCP was determined using both historical information and diagnostic imaging. Imaging procedures included chest radiograph, CT of neck or chest, and esophagography or esophagoscopy. RESULTS: Thirty-three of the 36 patients with thoracic disease had unilateral VCP (21 left, 12 right). Of the primary thoracic diseases, malignancy was the most common (19, 52.8%), with 18 of the 19 malignancies presenting with unilateral VCP. The detected malignant tumors in the chest consisted of thirteen lung cancers, three esophageal cancers, two metastatic tumors, and one mediastinal tumor. We also found other underlying etiologies of VCP, including one aortic arch aneurysm, five iatrogenic, six tuberculosis, one neurofibromatosis, three benign nodes, and one lung collapse. A chest radiograph failed to detect eight of the 19 primary malignancies detected on the CT. Nine patients with lung cancer developed VCP between follow-ups and four of them were diagnosed with a progression of malignancy upon CT evaluation of VCP. CONCLUSION: CT is helpful for the early detection of primary malignancy or progression of malignancy between follow-ups. Moreover, it can reveal various non-malignant causes of VCP.

Malignant solitary fibrous tumor of the pleura: computed tomography-pathological correlation and comparison with computed tomography of benign solitary fibrous tumor of the pleura.

PURPOSE: The aim of this study was to determine the computed tomography (CT)-pathological correlation of malignant solitary fibrous tumors of the pleura (MSFP) and to compare these findings with CT findings of benign solitary fibrous tumors of the pleura (BSFTP). MATERIALS AND METHODS: We retrospectively identified the clinical, CT, and pathological findings in seven cases of MSFP. There was a CT-pathological correlation for the MSFPs. Additionally, 12 cases of BSFTP from case files were compared with the clinical and CT features of the MSFPs. RESULTS: On CT, the MSFP appeared as a heterogeneously enhancing mass >10 cm (100%). Pleural metastasis (57.1%) and lung metastasis (14.3%) were associated. In the CT-pathological correlation, the enhancing area was mixed cellular and collagenous tissue with hypercellularity, mitosis, and pleomorphism. Hemorrhage, necrosis, cystic, or myxoid degeneration produced areas of intratumoral low attenuation. MSFPs showed a higher incidence of intratumoral low-attenuation areas (P = 0.034) and pleural metastasis (P = 0.009); and on CT, MSFPs tended to be larger than BSFTPs (P = 0.076). CONCLUSION: MSFPs showed a >10 cm pleural mass with low-attenuation regions on CT, which corresponded to hemorrhage, necrosis, cystic, or myxoid degeneration. MSFPs had a higher incidence of intratumoral low-attenuation areas and pleural metastasis, and on CT they tended to be larger than BSFTPs.

A comparative analysis of intranasal volume and olfactory function using a three-dimensional reconstruction of paranasal sinus computed tomography, with a focus on the airway around the turbinates.

The aim of this study was to investigate the relationship between the intranasal airway around the turbinates and olfactory function. In total, 32 nostrils of 16 patients who were awaiting septal surgery were involved in this study. For measurements of the volume of the nasal cavity, paranasal sinus computed tomography scans were performed and reconstructed into three-dimensional images. The Butanol Threshold Test and Cross-Cultural Smell Identification Test were used to evaluate olfactory function. The results were analyzed with Pearson's test. The volume around the turbinates was significantly correlated with the olfactory threshold. However, olfactory identification had no significant correlation with each volume. The airway around the turbinates is very important for nasal airflow and its volume influences olfactory function. Understanding such relationships may help in preserving or improving olfactory function in septal, turbinate or sinus surgery. Further studies are needed regarding the relationships between not only the volume of the nasal cavity and nasal airflow, but also between nasal volume changes and olfactory function.

Comparative study of the pneumatization of the mastoid air cells and paranasal sinuses using three-dimensional reconstruction of computed tomography scans.

PURPOSE: The purpose of this study was to investigate the relationship between the pneumatization of mastoid air cells and PNS using three-dimensional (3D) reconstruction of computed tomography (CT) scans of the PNS. METHODS: A retrospective review of PNS CT scans from 60 cases was performed. Patients with evidence of sinusitis or mastoiditis, or a history of head trauma, were excluded from the study. Volumes were measured using 3D reconstruction based on axial images of 1 mm thickness. Volumes of the mastoid air cells (right and left), frontal sinus, sphenoid sinus, and maxillary sinuses (right and left) were obtained and compared using statistical analysis. RESULTS: The volume of mastoid air cells and sinuses did change with age, but the volumes of male subjects were larger than those of females. There was a positive correlation between the pneumatization of mastoid air cells and that of the sphenoid sinus; however, no relationship was observed between the volume of mastoid air cells and that of the maxillary sinuses. CONCLUSIONS: This study examined whether a similarity in pneumatization exists between the mastoid air cells and PNS of individuals; these results may be useful in understanding the normal and pathological conditions of both structures.

Typical and atypical manifestations of intrathoracic sarcoidosis.

Sarcoidosis is a systemic disorder of unknown cause that is characterized by the presence of noncaseating granulomas. The radiological findings associated with sarcoidosis have been well described. The findings include symmetric, bilateral hilar and paratracheal lymphadenopathy, with or without concomitant parenchymal abnormalities (multiple small nodules in a peribronchovascular distribution along with irregular thickening of the interstitium). However, in 25% to 30% of cases, the radiological findings are atypical and unfamiliar to most radiologists, which cause difficulty for making a correct diagnosis. Many atypical forms of intrathoracic sarcoidosis have been described sporadically. We have collected cases with unusual radiological findings associated with pulmonary sarcoidosis (unilateral or asymmetric lymphadenopathy, necrosis or cavitation, large opacity, ground glass opacity, an airway abnormality and pleural involvement) and describe the typical forms of the disorder as well. The understanding of a wide range of the radiological manifestations of sarcoidosis will be very helpful for making a proper diagnosis.

Ultrasonographic measurement of intima-media thickness of radial artery in pre-dialysis uraemic patients: comparison with histological examination.

BACKGROUND: Increased intima-media thickness (IMT) of the radial artery is associated with early failure of radiocephalic arteriovenous fistula (AVF) in haemodialysis patients. Therefore, non-invasive measurements of radial artery IMT before AVF operations are very important in predicting AVF patency. This study was designed to evaluate the accuracy of high-resolution ultrasonography in measuring radial artery IMT in pre-dialysis uraemic patients. METHODS: This study enrolled 43 pre-dialysis uraemic patients awaiting radiocephalic AVF operations for the first time. In this study, 17 age- and sex-matched uncomplicated hypertensive patients and 15 healthy subjects were included as a control. We measured the internal diameter (ID) and IMT of the radial artery using high-resolution ultrasonography on the wrists of uraemic patients as well as the control group before the AVF operation. We obtained specimens of the radial artery during the AVF operation and directly measured the IMT by histological examination. RESULTS: The radial artery IMT of the uraemic patients (0.41 +/- 0.09 mm) was significantly thicker, compared to both those of the hypertensive (0.33 +/- 0.05 mm, P < 0.001) and the healthy patients (0.25 +/- 0.04 mm, P = 0.002). In contrast, the radial artery ID in the uraemic patients (1.85 +/- 0.48 mm) was smaller than both that of the hypertensive patients (2.08 +/- 0.31 mm, P = 0.023) and the healthy persons (2.34 +/- 0.37 mm, P = 0.001). Radial artery IMT had a negative correlation with radial artery ID in a total of 73 subjects (r = -0.290, P = 0.012). The value of the radial arterial IMT measured by sonographic examination correlated significantly with that by histological examination in 43 uraemic patients (r = 0.786, P < 0.001) and it correlated significantly with early AVF failure (r = 0.358, P = 0.027). CONCLUSION: Our data suggest that high-resolution ultrasonography is an effective tool in measuring radial artery IMT in uraemic patients before AVF operation.

Three-dimensional reconstruction based on images from spiral high-resolution computed tomography of the temporal bone: anatomy and clinical application.

The aim of this study was to investigate the usefulness of a three-dimensional (3D) reconstruction of computed tomography (CT) images in determining the anatomy and topographic relationship between various important structures. Using 40 ears from 20 patients with various otological diseases, a 3D reconstruction based on the image data from spiral high-resolution CT was performed by segmentation, volume-rendering and surface-rendering algorithms on a personal computer. The 3D display of the middle and inner ear structures was demonstrated in detail. Computer-assisted measurements, many of which could not be easily measured in vivo, of the reconstructed structures provided accurate anatomic details that improved the surgeon's understanding of spatial relationships. A 3D reconstruction of temporal bone CT might be useful for education and increasing understanding of the anatomical structures of the temporal bone. However, it will be necessary to confirm the correlation between the 3D reconstructed images and histological sections through a validation study.

The analysis of maxillary sinus aeration according to aging process; volume assessment by 3-dimensional reconstruction by high-resolutional CT scanning.

OBJECTIVE: To evaluate change of the maxillary sinus volume according to patient age and gender by using a 3-dimensional (3-D) reconstruction of computed tomography images. STUDY DESIGN AND SETTING: One hundred seventy-three people (totaling 238 maxillary sinuses) who had undergone paranasal sinus CT scan between December 2000 and November 2003 and had no evidence of inflammation or hypoplasia in the CT finding and had no specific history of paranasal sinus surgery or maxillofacial trauma were retrospectively analyzed. The 3-D reconstruction images were obtained by using a surface-rendering technique (Vworks; CybeMed, Seoul, Korea) on a personal computer. The mean volume of maxillary sinus was evaluated according to patient chronologic age and gender. The ratio of the maximum horizontal and half-horizontal extension for the estimation of the morphological change of maxillary sinus and the degree of descent of the sinus below the nasal floor were evaluated in the 3-D image. RESULTS: The development of the maxillary sinus continued until the 3rd decade in males and until the 2nd decade in females. The mean maxillary sinus volume in early adults was 24,043 mm 3 (males) and 15,859.5 mm 3 (females). There was a significance difference in the sinus volume ( P < 0.05) according to gender, and there was a significant difference in the maxillary sinus volume according to age before it reached maximum. After its maximum growth period, however, there was no significant difference in the volume change of maxillary sinus and the descent below the nasal floor between two adjacent groups. CONCLUSIONS: The growth of the maxillary sinus continues until the 3rd decade in males and the 2nd decade in females. Therefore, a maxillary sinus operation affecting the bony structures before these ages might affect the development of the sinus and needs to be performed carefully.

Clinical role of interstitial pneumonia in patients with scrub typhus: a possible marker of disease severity.

Interstitial pneumonia (IP) frequently occurs in patients with scrub typhus, but its clinical significance is not well known. This study was designed to evaluate interstitial pneumonia as a marker of severity of the disease for patients with scrub typhus. We investigated clinical parameters representing the severity of the disease, and the chest radiographic findings for 101 patients with scrub typhus. We then compared these clinical factors between patients with and without IP. We also studied the relationship between IP and other chest radiographic findings. The chest radiography showed IP (51.4%), pleural effusion (42.6%), cardiomegaly (14.9%), pulmonary alveolar edema (20.8%), hilar lymphadenopathy (13.8%) and focal atelectasis (11.8%), respectively. The patients with IP (n=52) had higher incidences in episode of hypoxia (p=0.030), hypotension (p=0.024), severe thrombocytopenia (p=0.036) and hypoalbuminemia (p=0.013) than the patients without IP (n=49). The patients with IP also had higher incidences of pleural effusion (p<0.001), focal atelectasis (p=0.019), cardiomegaly (p<0.001), pulmonary alveolar edema (p=0.011) and hilar lymphadenopathy (p<0.001) than the patients without IP. Our data suggest that IP frequently occurs for patients with scrub typhus and its presence is closely associated with the disease severity of scrub typhus.

Thoracic manifestations of breast cancer and its therapy.

Breast cancer is the second most common cause of cancer-related death in women. In most patients, imaging demonstrates thoracic changes resulting from either treatment, complications of treatment, or tumor recurrence or metastasis. The postsurgical imaging appearance of the chest wall depends on the surgical method used (radical mastectomy, modified radical mastectomy, breast-conserving surgery, breast reconstruction). The most common surgery-related complication is seroma. Radiation therapy frequently causes radiation pneumonitis, which occurs approximately 4-12 weeks after the completion of therapy and is characteristically limited to the field of irradiation. Chemotherapy-related complications include cardiotoxicity, pneumonitis, and infection. Ultrasonography and computed tomography are more sensitive than physical examination for detecting local and regional recurrence. The thorax is a common site of metastasis, which may affect the lymph nodes, bone, lung, pleura, or heart and pericardium. Bone metastasis is usually evaluated with bone scintigraphy and may cause spinal cord compression, a serious complication that requires early diagnosis. Intrapulmonary metastasis may manifest as single or multiple pulmonary nodules, airspace pattern metastasis, lymphangitic metastasis, or endobronchial metastasis. Pleural metastasis usually manifests as pleural effusion, with or without a pleural mass. Familiarity with the spectrum of radiologic findings in breast cancer patients allows accurate image interpretation and correct diagnosis.