Nodular Fasciitis of the Breast: A Case and Literature Review.

Nodular fasciitis is a benign fibroblastic proliferation in soft tissue that is most commonly found in the upper extremities, trunk, head, and neck region. Its occurrence in the breast has been rarely reported. The most characteristic features are the sudden appearance and rapid growth of a palpable lesion. Nodular fasciitis can clinically, radiologically, and histopathologically mimic a breast carcinoma. We present a case of nodular fasciitis of the breast and a review of the relevant literature.

Needlescopy-assisted resection of pulmonary nodule after dual localisation.

The aim of this study was to evaluate the feasibility of dual localisation with hookwire and lipiodol before needlescopy-assisted resection for pulmonary nodule. Computed tomography-guided dual marking was performed on 36 pulmonary nodules of 32 patients and needlescopy-assisted resection was performed monitored by C-arm fluoroscopy. The mean age of the patients was 58 ± 12 (range 12-77) yrs. The mean size of the nodules was 7.5 ± 3.7 (3-17) mm. Their mean distance from the pleural surface was 7.3 ± 7.5 (0-35) mm. There were nine pure ground-glass opacity lesions, five semi-solid lesions and 22 solid lesions. The time of the dual localisation procedure was 13.1 ± 4.8 (7-23) min. Complications of the marking were pneumothorax in nine patients, and intrapulmonary bleeding in three. One hookwire dislodged during the operation. All nodules were successfully resected under needlescopy without conversion to a conventional thoracoscopy (5 mm or 10 mm thoracoscopy) or a minithoracotomy. There was no complication related to needlescopy-assisted resection. Dual marking with hookwire and lipiodol is a safe and none time consuming procedure, and needlescopy-assisted lung resection for small nodules is technically feasible and useful for histological diagnosis and treatment.

Comparison of bioavailability of two ubidecarenone products in healthy Korean volunteers.

OBJECTIVE: This study aimed to evaluate the bioavailability of two pharmaceutical products of ubidecarenone (coenzyme Q10, CoQ10). MATERIALS: Two brands (brand A and brand B) of commercial CoQ10 hard capsules. METHODS: Two brands of CoQ10 capsules were administered at 100 mg dose to two groups of healthy volunteers, respectively, and blood samples were withdrawn at predetermined time intervals and assayed by a validated HPLC method with an electrochemical detector. RESULTS AND CONCLUSIONS: Intra- and inter-day precision and inter-day accuracy were acceptable for all quality control samples including the lower limit of quantitation of 50 ng/ml. Recovery of CoQ10 from human plasma was greater than 98.2%. CoQ10 was stable in human plasma under various storage conditions. This method was applied to a pharmacokinetic study after oral administration of CoQ10 hard capsules to healthy volunteers. The intrinsic CoQ10 concentrations were measured for three consecutive days before drug administration, which were ranged between 0.68 and 0.79 microg/ml, and there was no statistically significant difference between groups. In brand A, the plasma concentration after administration of CoQ10 was not higher than the intrinsic level, indicating that no significant drug absorption occurred, whereas considerably higher concentrations were obtained with brand B. The dissolution rates of brand A and B after 3 h were 0.35 +/- 0.09 and 1.27 +/- 0.16%, respectively. From the adjusted concentration-time curve, the AUC and t1/2 of brand B were calculated to be 11.51 +/- 5.76 microg x h/ml and 21.7 h, respectively. A mean Cmax of 0.32 +/- 0.1 microg/ml was obtained at 7.9 h. In conclusion, it was found that bioavailability of CoQ10 was significantly different depending on the formulations, and dissolution could be one of the important factors affecting CoQ10 absorption.

Miliary tuberculosis. Diagnostic accuracy of chest radiography.

STUDY OBJECTIVE: To assess the efficacy of the chest radiograph in identifying patients with miliary tuberculosis. DESIGN: Retrospective case-controlled review by three independent blinded chest radiologists. SETTING: Provincial tuberculosis control center. PATIENTS: Population-based sample, including all proved cases of miliary tuberculosis diagnosed in the Province of British Columbia, Canada, between November 1982 and November 1992. One hundred cases of miliary tuberculosis were identified, of which 71 had chest radiographs available for review. Forty-four normal chest radiographs and 20 chest radiographs of patients with localized pulmonary tuberculosis were also included as controls. MAIN OUTCOME MEASURES: The primary outcome of measurements was the sensitivity and interobserver variability of the chest radiograph in the diagnosis of miliary tuberculosis. The observers were also asked to describe the pattern and extent of pulmonary abnormalities based on the International Labor Organization (ILO) classification of pneumoconioses. RESULTS: The three independent observers identified 42, 44, and 49 of the 71 cases of miliary tuberculosis, respectively (sensitivity, 59 to 69%). The three observers incorrectly diagnosed miliary tuberculosis in 2, 0, and 2 of the 64 controls, respectively (specificity, 97 to 100%). There was good interobserver agreement (90%, kappa = 0.77). The nodules measured less than 3 mm in diameter in 90% of cases in which miliary tuberculosis was correctly identified. In 10% of cases, the nodules measured greater than 3 mm in diameter. The ILO profusion scores ranged from mild (profusion score 1) in 45% of cases, through moderate (profusion score 2) in 27%, and severe (profusion score 3) in 28%. CONCLUSIONS: The chest radiograph allowed identification of 59 to 69% of cases of miliary tuberculosis with a high specificity and good interobserver agreement.

Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia. Assessment with serial CT.

OBJECTIVE: To determine the outcome of areas of ground-glass attenuation and assess disease progression on serial high-resolution CT (HRCT) scans of patients with biopsy specimen-proved usual interstitial pneumonia (UIP) and desquamative interstitial pneumonia (DIP). MATERIALS AND METHODS: Twelve patients with biopsy specimen-proved UIP and 11 patients with biopsy specimen-proved DIP who had initial and follow-up HRCT scans (median interval, 10 months) were reviewed. Eleven patients with UIP and 11 with DIP received treatment between the initial and follow-up CT scans. The scans were evaluated for the presence and extent of ground-glass attenuation, irregular linear opacities and honeycombing, and overall extent of parenchymal involvement. RESULTS: On initial CT scans, all 12 patients with UIP had areas of ground-glass attenuation (mean +/- SD extent, 30 +/- 16%) and irregular lines (mean +/- SD extent, 17 +/- 7%) and 10 patients had honeycombing (mean +/- SD extent, 10 +/- 6%). All 11 patients with DIP had areas of ground-glass attenuation on initial HRCT scans (mean +/- SD extent, 51 +/- 26%), 5 patients had irregular linear opacities (mean +/- SD extent, 5 +/- 5%), and 1 patient had honeycombing. Nine of the 12 patients with UIP showed increase in the extent of ground-glass attenuation (n = 6) or progression to irregular lines (n = 2) or honeycombing (n = 4) on follow-up as compared with only 2 patients with DIP who showed progression to irregular lines (n = 1) or honeycombing (n = 1) (p < 0.01 chi 2 test). CONCLUSION: In patients with UIP, areas of ground-glass attenuation usually increase in extent or progress to fibrosis despite treatment. Areas of ground-glass attenuation in most patients with DIP remain stable or improve with treatment.

Nested polymerase chain reaction for detection of Mycobacterium tuberculosis in solitary pulmonary nodules.

BACKGROUND: Differential diagnosis of solitary pulmonary nodules (SPNs) can be difficult in areas, such as Korea, where tuberculosis is endemic. Nested polymerase chain reaction (PCR) is a widely used method to test a very small amount of pathogen and to detect Mycobacterium tuberculosis from fine needle aspirates. OBJECTIVES: The usefulness of nested PCR for the detection of M tuberculosis from tuberculous SPN and for the differential diagnosis of SPN was evaluated. METHODS: Thirty-three patients in whom a diagnosis of SPN was made based on a CT scan of the chest were enrolled in this study. Included were 17 malignant and 16 benign SPNs. Nested PCR was carried out for the detection of M tuberculosis by using TB-1, TB-2, TB-28, and TB-29C on fine needle aspirates from the nodule in all 33 cases. RESULTS: Aspirates from malignant neoplasms, pneumonia, and sequestration were all negative on nested PCR for tuberculosis. One of the three radiologically suspected tuberculous nodules without response to anti-tuberculosis drugs (uncertain) yielded positive results on nested PCR for the detection of M tuberculosis. In contrast, 7 out of 8 (87.5%) aspirates from proven tuberculous nodules showed positive results on nested PCR. Nested PCR could be used to detect M tuberculosis in fine needle aspirates from tuberculous SPNs with good sensitivity (87.5%) and specificity (96.0%). CONCLUSION: Nested PCR for the detection of M tuberculosis in fine needle aspirates may be useful in the differential diagnosis of SPNs.

Interlobular septal thickening: patterns at high-resolution computed tomography.

Thickening of the interlobular septa is a common and easily recognizable finding at high-resolution computed tomography (HRCT; 1-2 mm collimation high-spatial-frequency reconstruction algorithm). Interlobular septal thickening at HRCT can be smooth, nodular, or irregular in contour. It may be due to fluid, cellular infiltration, or fibrosis. Apparent thickening of septa at HRCT may also be due to abnormalities in the periphery of the secondary pulmonary lobule adjacent to but not involving the interlobular septa. This article illustrates the patterns of interlobular septal thickening at HRCT in various disease entities.

CT in blunt chest trauma: pulmonary, tracheobronchial, and diaphragmatic injuries.

Routine use of CT in the initial evaluation of blunt chest trauma is controversial. CT however, has been shown to be useful in the diagnosis of unsuspected chest injuries and in directing therapeutic interventions. This review discusses the CT findings in patients with pulmonary, tracheobronchial, and diaphragmatic injuries after blunt chest trauma.

Acute lung disease in the immunocompromised host: differential diagnosis at high-resolution CT.

The aim of this manuscript is to review the CT findings of pulmonary complications seen in acquired immunodeficiency syndrome (AIDS) and in non-AIDS immunocompromised patients. The most common pulmonary complications in patients with AIDS include infection, Kaposi's sarcoma, and AIDS-related lymphoma. The most common complications seen in non-AIDS immunocompromised patients include infection, drug-induced lung disease, diffuse pulmonary hemorrhage, and pulmonary edema.

Accuracy of lung nodule volumetry in low-dose CT with iterative reconstruction: an anthropomorphic thoracic phantom study.

OBJECTIVE: The purpose of this study was to assess accuracy of lung nodule volumetry in low-dose CT with application of iterative reconstruction (IR) according to nodule size, nodule density and CT tube currents, using artificial lung nodules within an anthropomorphic thoracic phantom. METHODS: Eight artificial nodules (four diameters: 5, 8, 10 and 12 mm; two CT densities: -630 HU that represents ground-glass nodule and +100 HU that represents solid nodule) were randomly placed inside a thoracic phantom. Scans were performed with tube current-time product to 10, 20, 30 and 50 mAs. Images were reconstructed with IR and filtered back projection (FBP). We compared volume estimates to a reference standard and calculated the absolute percentage error (APE). RESULTS: The APE of all nodules was significantly lower when IR was used than with FBP (7.5 ± 4.7% compared with 9.0 ±6.9%; p < 0.001). The effect of IR was more pronounced for smaller nodules (p < 0.001). IR showed a significantly lower APE than FBP in ground-glass nodules (p < 0.0001), and the difference was more pronounced at the lowest tube current (11.8 ± 5.9% compared with 21.3 ± 6.1%; p < 0.0001). The effect of IR was most pronounced for ground-glass nodules in the lowest CT tube current. CONCLUSION: Lung nodule volumetry in low-dose CT by application of IR showed reliable accuracy in a phantom study. Lung nodule volumetry can be reliably applicable to all lung nodules including small, ground-glass nodules even in ultra-low-dose CT with application of IR. ADVANCES IN KNOWLEDGE: IR significantly improved the accuracy of lung nodule volumetry compared with FBP particularly for ground-glass (-630 HU) nodules. Volumetry in low-dose CT can be utilized in patient with lung nodule work-up, and IR has benefit for small, ground-glass lung nodules in low-dose CT.

Paratracheal air cysts on thoracic multidetector CT: incidence, morphological characteristics and relevance to pulmonary emphysema.

OBJECTIVE: To determine the incidence, morphological characteristics and relevance of paratracheal air cysts (PTACs) with pulmonary emphysema, as seen on thoracic multidetector CT (MDCT). METHODS: The CT images of 854 consecutive patients who underwent thoracic MDCT during a period of 2 months at our institution were reviewed. 538 of the patients were male and 316 were female. The incidence, size and shape of the PTACs and their relation to pulmonary emphysema were retrospectively analysed. RESULTS: Among the 854 patients, 69 (8.1%) had PTACs. 37 (6.9%) of the 538 male patients and 32 (10.1%) of the 316 female patients had PTACs. The highest prevalence of PTACs (25 patients, 11.2%) was found in those who were in the sixth decade of life. 48 (69.6%) PTACs measured 3-10 mm at the longest diameter and 33 (47.8%) were elongated on the coronal section images. 12 (17.4%) patients with PTACs had underlying gross morphological emphysema. The relationship between the presence of PTACs and the presence of emphysema and the relationship between the presence of PTACs and the severity of emphysema were not statistically significant. The size of PTACs showed an inverse relation to the severity of emphysema. CONCLUSION: The incidence of PTACs was estimated to be much higher than that of previous studies. There was a slight female predilection for PTACs, most commonly found in the sixth decade of life; PTACs mostly measured 3-10 mm and were elongated in shape. The relation of PTACs to gross morphological emphysema was low. ADVANCES IN KNOWLEDGE: PTACs are not correlated with the presence of emphysema on MDCT.

Reversed halo sign on thin-section CT in a patient with non-specific interstitial pneumonia.

We present a case of non-specific interstitial pneumonia (NSIP) with reversed halo sign on thin-section CT. A 52-year-old female presented with a cough and New York Heart Association (NYHA) class 2 dyspnoea of 4 months duration. A chest radiograph showed poorly defined, patchy ground-glass opacities in both lungs. Thin-section CT demonstrated the reversed halo sign, which is a central ground-glass opacity surrounded by crescent or ring-shaped areas of consolidation in multifocal areas. Multifocal patchy ground-glass opacity and consolidation and enlarged paratracheal, hilar and subcarinal lymph nodes were also shown. Video-assisted thoracic surgical (VATS) lung biopsy was performed, and histopathology revealed cellular NSIP.

Wide spectrum of thoracic neurogenic tumours: a pictorial review of CT and pathological findings.

The purpose of this pictorial essay is to illustrate the radiological and pathological findings of a wide spectrum of neurogenic tumours of the thorax according to their anatomical location and histological subtype. Knowledge of these findings will narrow the differential diagnosis and provide guidance for patient management.

Comparison between coronal reformatted images and direct coronal CT images of the swine lung specimen: assessment of image quality with 64-detector row CT.

The aims of this study were to compare the image quality of coronal multiplanar reconstruction (MPR) images from axial spiral images with that of direct coronal spiral and sequential images, and to estimate and analyse the effect of an incremental change on the image quality using 64-detector row CT. 12 swine lungs were used. Five kinds of images from each lung specimen were obtained using 64-detector row CT. All images were analysed by categories and grades, and the direct coronal sequential images were used as the reference standard for the image quality. Statistical analysis was performed for the following categories: (i) inter-observer reliability, (ii) interaction between the observers and images, (iii) image analysis, (iv) anatomical structural analysis of each observer, (v) stair-step artefact and (vi) background noise. The overall image quality and the image quality of all anatomical structures of coronal MPR images with 0.67 mm slice increments were inferior to the image quality of the other images; this difference was statistically significant (p<0.05). Stair-step artefact was detected on coronal MPR images, and was more prominent on coronal MPR images with 0.67 mm slice increments than on coronal MPR images with 0.34 mm slice increments. The most severe background noise was detected on the direct coronal sequential images, but there was no significant difference between the direct coronal sequential images and the direct coronal spiral images. Background noise was least prominent on coronal MPR images with 0.67 mm slice increments. The increment process is important for improving the image quality of MPR images even when using 64-detector row CT. Coronal MPR images with 0.34 mm slice increments using 64-detector row CT showed a similar image quality to that obtained from the direct coronal images, and can be used instead. This means that the coronal MPR images obtained with 64-detector row CT could be as useful for evaluating the lung parenchyma as the axial high-resolution CT images.

A giant malignant peripheral nerve sheath tumour of the breast: CT and pathological findings.

Malignant peripheral nerve sheath tumour (MPNST) is a rare soft tissue sarcoma. In particular, primary MPNST of the breast is extremely rare. We report a case of a giant malignant peripheral nerve sheath tumour involving the entire right breast, which was not associated with neurofibromatosis type 1 (NF-1) or previous radiation therapy. A CT scan showed a huge heterogeneous soft tissue mass with well-enhanced nodules at its periphery and low-density internal necrosis, which was confirmed by modified radical mastectomy.

Primary localized amyloidosis manifested as supraclavicular and mediastinal lymphadenopathy.

Thoracic involvement of amyloidosis is relatively rare, but mediastinal lymphadenopathy in the absence of pulmonary parenchymal involvement is extremely rare. The case presented here is of a previously healthy elderly woman who developed a palpable mass in the right supraclavicular area. The chest CT scan showed extensive, contiguous and homogeneous low attenuated lymphadenopathy with stippled calcification in the right supraclavicular area and mediastinum. Amyloidosis was confirmed histopathologically on a biopsy specimen from a right supraclavicular lymph node. Because there were no other sites found to be affected by amyloidosis and there was no underlying chronic disease, we made a final diagnosis of primary localized amyloidosis involving only the supraclavicular and mediastinal lymph nodes.

Bronchiectasis: comparison of preoperative thin-section CT and pathologic findings in resected specimens.

PURPOSE: To compare thin-section computed tomographic (CT) and pathologic findings in patients who have undergone resection for bronchiectasis. MATERIALS AND METHODS: Twenty-two consecutive patients underwent thin-section CT (1.0-1.5-mm collimation) and resection for bronchiectasis. CT scans were reviewed by two observers without knowledge of the pathologic findings. The presence and extent of bronchiectasis and associated findings were assessed. All pathologic specimens were reviewed by a pathologist. RESULTS: Forty-seven lobes had pathologically proved bronchiectasis. CT allowed detection of bronchiectasis in 41 lobes (87%). CT findings included lack of tapering of bronchial lumina (n = 37), internal diameter of bronchi greater than that of the adjacent pulmonary artery (n = 28), visualized bronchi within 1 cm of pleura (n = 21), and mucus-filled dilated bronchi (n = 3). Forty lobes had bronchiolitis. CT scans depicted bronchiolitis in 30 lobes (75%). CT findings of bronchiolitis included mosaic perfusion (n = 21), bronchiolectasis (n = 17), and centrilobular nodules or branching areas of soft-tissue attenuation (n = 10). CONCLUSION: Thin-section CT depicted bronchiectasis in most of the resected bronchiectatic lobes.

Cytomegalovirus pneumonia in transplant patients: CT findings.

OBJECTIVE: Our goal was to assess the CT findings of cytomegalovirus (CMV) pneumonia in transplant patients. MATERIALS AND METHODS: The study included 10 transplant patients who had chest CT scan and pathologically proven isolated pulmonary CMV infection. Five patients had bone marrow transplant and five had solid organ transplant. The CT scans were retrospectively reviewed for pattern and distribution of disease and the CT findings compared with the findings on open lung biopsy (n = 9) and autopsy (n = 1). RESULTS: Nine of 10 patients had parenchymal abnormalities apparent at CT and 1 had normal CT scans. The findings in the nine patients included small nodules (n = 6), consolidation (n = 4), ground-glass attenuation (n = 4), and irregular lines (n = 1). The nodules had a bilateral and symmetric distribution and involved all lung zones. The consolidation was most marked in the lower lung zones. CONCLUSION: The CT findings of CMV pneumonia in transplant patients are heterogeneous. The most common patterns include small nodules and areas of consolidation.

Evaluating porcelain color match of different porcelain shade-matching systems.

PURPOSE: This in vitro study was designed to evaluate the new ShadeEye-EX Chroma Meter and a new visual porcelain shade-matching system (Vitapan 3-D Master, Omega 900) in comparison to the traditionally used visual porcelain shade-matching system (Vita Lumin Vacuum, VMK 68). MATERIALS AND METHODS: Shade matches and porcelain fabrications on individualized shade tabs were carried out. The fabricated porcelain tabs were evaluated against the respective natural tooth using the United States Public Health Service (USPHS) criteria to determine clinically acceptable match. The tabs also were ranked according to the final-color match to the corresponding natural tooth. RESULTS: The percentage of clinically acceptable color matches were as follows: Vita Lumin Vacuum (46.67%), ShadeEye-EX (40%), and Vitapan 3-D Master (56.67%). The generalized estimating equation (alpha = 0.5) showed no statistically significant difference between systems in obtaining a clinically acceptable match (p = .5729). The chi-squared test (alpha = 0.5) showed no statistically significant difference between systems in terms of rank order (p = .5017). The two new systems do not produce color match that is better than the conventional visual porcelain shade-matching system.