[Evaluation of mediastinal lymph nodes in the course of lung diseases in dynamic contrast-enhanced magnetic resonance imaging]. / Ocena wezlów chlonnych sródpiersia w przebiegu chorób pluc z zastosowaniem dynamicznych badan metoda rezonansu magnetycznego po podaniu preparatów kontrastowych.

The purpose of this study was to evaluate the ability of dynamic contrast-enhanced magnetic resonance to provide differentiation between malignant and benign mediastinal or hilar lymph nodes. The group of 109 patients were examined, with lung carcinoma (63 patients) and sarcoidosis (46 patients). Relative signal intensity increase after administration of Gd-DTPA in standard dose (0.1 mmol/kg) was measured four times (20 s-3 min after injection). There was no significant difference between all groups. In conclusion, differentiation between types of enlarged lymph nodes could not be achieved using the described protocol.

[Diffuse large B-cell lymphoma mimicking Wegener's granulomatosis]. / Rozlany chloniak z duzych komórek B imitujacy ziarniniakowatosc Wegenera.

We report 39 years old man with the history of chronic sinusitis and rhinitis. After tooth extraction he gradually developed unilateral proptosis with ophtalmoplegia and visual loss caused by retroorbital mass which was related to destruction of the adjacent orbital walls, sinuses and base of the skull. During the following month the progressing lung nodules with mediastinal and hilar lymphadenopathy, macular skin lesions, renal insufficiency with proteinuria and anaemia appeared. The diagnosis of Wegener's Granulomatosis (WG) was formed on the base of clinical features and result of pathologic examination of surgical specimen from the paranasal sinuses. The progressive course under the standard immunosuppressive therapy required reevaluation of histologic slides, which resulted with the diagnosis of diffuse large B-cell lymphoma confirmed by the immunohistochemical staining. Administration of CHOP regimen resulted in spectacular regression of all of lesions.

[Wegener's granulomatosis overlapped with Takayasu arteritis complicated by thrombosis of the internal jugular vein]. / Ziarniniakowatosc Wegenera z nakladajaca sie choroba Takayasu i zakrzepica zyly szyjnej wewnetrznej.

A 30 year-old woman with Wegener's granulomatosis with typical lesions of nose, mouth, skin, lung and positive c-ANCA titre was admitted to our hospital because of ineffective treatment with corticosteroids and cyclophosphamide. Infiltration of the left side of chest wall and collateral circulation were seen during physical examination. Ultrasound examination revealed thrombus in the left internal jugular vein and in the left subclavicular vein. Angio CT revealed parenchymal infiltration in the lower right lobe, thrombi in segmental arteries in this area and enlarged mediastinum. MRI examination revealed thickened aorta wall to 25 mm with its contrast enhancement. It suggested inflammatory infiltration of aorta arcus and its branches. This picture was similar to early stages of Takayasu arteritis but our patient had no typical clinical symptoms related to narrowing or obliteration of large arteries. We recognised Wegener's granulomatosis with overlapped Takayasu arteritis with thrombosis of jugular vein and pulmonary thrombosis. In differential diagnosis: Wegener's granulomatosis with large arteries involvement is taken into account. Treatment with cyclophosphamide and prednisolone was effective.