1 . Gaensler, E. A. and C. B. Carrington (1980). "Open biopsy for chronic diffuse infiltrative lung disease: clinical, roentgenographic, and physiological correlations in 502 patients." Ann Thorac Surg 30(5): 411-26.
Clinical, physiological, roentgenographic, and histological data concerning 502 patients who had open biopsy for chronic "interstitial" lung disease were reviewed. Mortality was 0.3%, the rate of complications was 2.5%, and the diagnostic yield was 92.2%. A modified Chamberlain approach in the second interspace is preferred for easy access to all lobes and mediastinum. Brief tube drainage is mandatory. Atelectasis and hemorrhage in the specimen are prevented by avoiding palpation and clamps, by delineating the wedge during full inflation, and by instant fixation. Customary biopsies of the tip of the lingula or middle lobe are avoided because these are common sites of inflammation, scarring, and passive congestion. Often, the most abnormal regions are biopsied apparently to aid the pathologist. Such selection has been the most important cause of meaningless histological findings and poor pathological, physiological, and roentgenographic correlations because these regions usually show end-stage disease of unrecognizable origin. Average lung is more likely to show an active and recognizable process.
2. Hillerdal G, Nou E, Osterman K, Schmekel B. Sarcoidosis: epidemiology and prognosis. A 15-year European study. Am Rev Respir Dis 1984; 130:29-32.
A 15-year study of patients with sarcoidosis is presented. In most patients, the disease was discovered at a general health screening examination. The mean total incidence among persons 15 yr of age or older was 19 per 100,000 per year (21.7 for women and 16.5 for men). There was a peak incidence in both sexes between the ages of 20 and 34, and in older women, there was a second but lower and broader peak. The frequency of symptoms was greater in older women than in other patients. The accumulated lifetime risk of sarcoidosis was 1.3% for women and almost 1% for men. Patients with Stage I sarcoidosis, i.e., with bilateral hilar adenopathy alone, had the best prognosis, with 50% of the patients showing a normal radiographic picture 15 months after the discovery of the disease. Among patients with Stage II sarcoidosis (both bilateral hilar adenopathy and pulmonary infiltration), it was 36 months before 50% returned to normal radiographically. Resolution of all radiographic evidence of the disease could still occur many years after the first pathologic findings were made on chest films.
3. Coultas DB, Zumwalt RE, Black WC, Sobonya RE. The epidemiology of interstitial lung diseases. Am J Respir Crit Care Med 1994; 150:967-72.
Little epidemiologic data are available on the occurrence of interstitial lung diseases (ILDs) in the general population. To describe the prevalence and incidence of ILDs a population-based registry of patients with ILDs was established in Bernalillo County, New Mexico in October 1988. All patients 18 yr of age and older who had a clinical diagnosis of an ILD were identified during the period 10/1/88 through 9/30/90 from physician referrals, hospital discharge diagnoses, histopathology reports, and death certificates. In addition, the prevalence of preclinical or undiagnosed cases was identified by screening lung specimens from 510 autopsy cases. A total of 2,936 referrals were screened; 8.8% were prevalent cases and 6.9% were incident cases. Overall, the prevalence of ILDs was 20% higher in males (80.9 per 100,000) than in females (67.2 per 100,000). Similarly the overall incidence of ILDs was slightly more common in males (31.5 per 100,000/year) than females (26.1 per 100,000/year). The estimated prevalence of preclinical or undiagnosed ILDs among all deaths was 1.8%. The most common incident diagnosed among both sexes were pulmonary fibrosis and idiopathic pulmonary fibrosis, together accounting for 46.2% of all ILD diagnoses in males and 44.2% in females. We conclude that the occurrence of ILDs in the general population may be more common than previous estimates based on selected populations, and these disorders may frequently be unrecognized.
4. Roelandt M, Demedts M, Callebaut W, et al. Epidemiology of interstitial lung disease (ILD) in flanders: registration by pneumologists in 1992-1994. Working group on ILD, VRGT. Vereniging voor Respiratoire Gezondheidszorg en Tuberculosebestrijding. Acta Clin Belg 1995;50(5):260-8.
Worldwide almost no epidemiologic data are available on the prevalence or incidence of interstitial lung diseases (ILD) in the general population. Therefore, a registration programme of ILD-prevalence was organised by the VRGT (Vereniging voor Respiratoire Gezondheidszorg en Tuberculosebestrijding), among about 100 Flemish pneumologists since 1990. Most categories of the classification by Crystal et al. (1) were included and the diagnostic criteria (histology, laboratory tests, clinic, radiology) were registered. The present paper presents the results of 1992-1994: twenty pneumologists had forwarded the summary files of 237 patients to the central office in 1992 (n = 68), 1993 (n = 90) and 1994 (n = 79). The diagnoses that were most frequently made were: sarcoidosis in 27%, idiopathic pulmonary fibrosis in 20%, hypersensitivity pneumonitis in 14% (of which 68% by birds) and collagen-vascular disease in 10% (of which 54% in rheumatoid arthritis). Less frequent causes were eosinophilic pneumonia (4%), inhalation of inorganic material (4%, anthracosilicosis being excluded), histiocytosis X (3%), drugs (3%), angiitis and granulomatosis (2%), pulmonary hemosiderosis (1%), lymphocytic infiltrative lung disease (1%) and lymphangioleiomyomatosis (1%). The order of relative frequencies of the different categories of diseases was the same in the 3 registration years. In 9% of the patients the diagnosis was confined to "undefined fibrosis". The diagnosis was confirmed by histology in 63% of the cases. The overall male-female ratio was nearly one, with, however, a male preponderance in hypersensitivity pneumonitis (22/12), UIP(8/3) and "undefined fibrosis" (14/7).(ABSTRACT TRUNCATED AT 250 WORDS)
5. Brauner MW, Grenier P, Mompoint D, Lenoir S, de Cremoux H. Pulmonary sarcoidosis: evaluation with high-resolution CT. Radiology 1989;172(2):467-71.
Forty-four patients with histologically confirmed sarcoidosis were prospectively studied with high-resolution computed tomography (CT). Nodules were seen in all cases. They were isolated in 19 cases and associated with other lesions in 25 cases. Other abnormalities were irregular interfaces (n = 18, 41%), linear network (n = 14, 32%), thickening of the pleural surface (n = 9, 20%), ground-glass opacities (n = 7, 16%), lung distortion (n = 11, 25%), traction bronchiectasis (n = 3, 7%), and network of air-filled cavities (n = 3, 7%). Predominant sites of lesions were the upper and middle zones (n = 30, 68%) and posterior zones (n = 13, 30%). Nodular abnormalities were noted at CT in six cases in which the pulmonary parenchyma appeared normal on radiographs. Lung distortion was noted at CT in eight cases without visible fibrosis on chest radiographs. The majority of patients with lung distortion (nine of 11, 82%) had disease of greater than a years duration. CT improved sensitivity for the detection of all types of lesions, mainly lung distortion. Low but significant correlations were found between visual score at CT and total lung capacity, vital capacity, forced expiratory volume in 1 second, and diffusing capacity
6. Moore AD, Godwin JD, Muller NL, et al. Pulmonary histiocytosis X: comparison of radiographic and CT findings. Radiology 1989;172(1):249-54.
The authors retrospectively evaluated radiographs, computed tomographic (CT) scans, and results of pulmonary function tests (when available) for 17 patients with biopsy-proved pulmonary histiocytosis X. In 11 patients, high-resolution CT was used. In 12 patients, CT demonstrated cystic air spaces, usually less than 10 mm in diameter. In three of these 12, cysts were the only abnormality, but in six others, nodules (usually less than 5 mm in diameter) were also present. Two patients had only nodules and one, only emphysema. CT showed that many lesions that appeared reticular on plain radiographs were actually cysts. CT showed no central or peripheral concentration of lesions, but it did reveal that many small nodules were distributed in the centers of secondary lobules around small airways. CT findings correlated better with the diffusing capacity (rho = -0.71) than did the plain radiographic findings (rho = -0.57). Thus, CT was better than radiography at showing the morphology and distribution of lung abnormalities.
7. David B, Coultas MB. Epidemiology of Idiopathic Pulmonary Fibrosis. Seminars in respiratory medicine 1993;14(3):181-96.
8. Hartman TE, Primack SL, Swensen SJ, Hansell D, McGuinness G, Muller NL. Desquamative interstitial pneumonia: thin-section CT findings in 22 patients. Radiology 1993;187(3):787-90.
To evaluate the findings on thin-section computed tomographic (CT) scans in desquamative interstitial pneumonia (DIP), the CT scans from 22 patients aged 22-71 years (mean age, 43 years) were reviewed. In all patients, DIP was proved with open-lung biopsy performed 1 day to 17 months before or after examination with CT (median interval, 1.5 months). The lungs were divided into three zones (upper, middle, and lower); each zone was evaluated separately. The predominant finding was the presence of areas of ground-glass attenuation that involved the middle and lower lung zones in all patients and the upper lung zones in 18 patients (82%). Such areas had a lower lung zone predominance in 16 patients (73%) and a predominantly peripheral distribution in 13 patients (59%). Irregular lines of attenuation suggestive of fibrosis were seen in 11 patients (50%) and cystic changes, in seven patients (32%). The distribution of abnormalities in DIP is similar to that seen in usual interstitial pneumonia (UIP), but the greater extent of ground- glass attenuation and the paucity of cystic changes in DIP should enable distinction from UIP in most patients.
9. Brauner MW, Grenier P, Tijani K, Battesti JP, Valeyre D. Pulmonary Langerhans cell histiocytosis: evolution of lesions on CT scans [see comments]. Radiology 1997;204(2):497-502.
PURPOSE: To document the evolution of pulmonary lesions of Langerhans cell histiocytosis (LCH) with sequential computed tomography (CT). MATERIALS AND METHODS: Initial and final CT scans of 21 patients with LCH and CT evidence of pulmonary disease were compared retrospectively. Histologic confirmation of pulmonary involvement was available in 11 patients. RESULTS: On initial CT images, a nodular pattern (n = 14) was seen more frequently than a cystic pattern (n = 7). On final CT images, a cystic pattern (n = 14) was seen more often than a nodular one (n = 6). There was complete resolution of parenchymal abnormality in one case. Nodular opacities, thick-walled cysts, and ground-glass opacities underwent regression. Thin-walled cysts, linear opacities, and emphysematous lesions remained unchanged or progressed. CONCLUSION: Pulmonary CT allows good assessment of the evolution of LCH lesions. Nodular lesions probably represent active disease and often undergo regression or transform into cysts.
10. Muller NL, Miller RR, Webb WR, Evans KG, Ostrow DN. Fibrosing alveolitis: CT-pathologic correlation. Radiology 1986;160(3):585-8.
Computed tomography (CT) was performed within 10 days of open lung biopsy in nine patients with fibrosing alveolitis. One-centimeter collimation contiguous scans through the chest were obtained in all patients. Additional 1.5-mm collimation scans were obtained in the area in which lung biopsy was later performed in six patients. In seven patients, CT demonstrated patchy involvement of the lung parenchyma, areas with a reticular pattern being intermingled with areas of normal lung. The reticular pattern was associated with cystic spaces 2-4 mm in diameter and was more severe in the lung periphery. Histologically, the reticular pattern corresponded to areas of irregular fibrosis. One patient had diffuse honeycombing (2-20-mm cysts), and one had honeycombing only in the lung periphery. In all patients, CT clearly defined the architectural changes seen on open lung biopsy. These changes were much better seen on the 1.5-mm than on the 10-mm collimation scans. CT may be helpful in determining the pattern and distribution of lung involvement in patients with fibrosing alveolitis and in guiding the surgeon to the most appropriate area(s) for biopsy.
11. Nishimura K, Kitaichi M, Izumi T, Nagai S, Kanaoka M, Itoh H. Usual interstitial pneumonia: histologic correlation with high- resolution CT. Radiology 1992;182(2):337-42.
The authors reviewed 46 cases of idiopathic pulmonary fibrosis with usual interstitial pneumonia (UIP), correlating findings on high- resolution computed tomographic (HRCT) scans with findings in specimens obtained at open lung biopsy and autopsy. The following HRCT findings were observed: (a) an accumulation of small cystic spaces with thick walls, (b) air bronchiolograms within areas of intense lung attenuation, (c) rugged pleural surfaces, (d) irregularly thickened pulmonary vessels, (e) bronchial wall thickening, and (f) slightly increased lung attenuation. Macroscopic honeycombing correlating with small cystic spaces was demonstrated at HRCT and pathologic examination. Air bronchiolograms in the areas of intense lung attenuation (ie, microscopic honeycombing) corresponded to dilated bronchioles (greater than 1 mm in diameter) with fibrosis. Irregularly thickened vessels and bronchial walls and irregular pleural surfaces were the result of fibrosis in the periphery of the secondary pulmonary lobules. Areas of slightly increased lung attenuation seen on the HRCT scans correlated with patchy alveolar septal fibrosis or inflammation. The authors conclude that microscopic honeycombing and a perilobular distribution in UIP may be clearly identified with HRCT.
12. Remy-Jardin M, Giraud F, Remy J, Copin MC, Gosselin B, Duhamel A. Importance of ground-glass attenuation in chronic diffuse infiltrative lung disease: pathologic-CT correlation. Radiology 1993;189(3):693-8.
PURPOSE: To correlate areas of ground-glass attenuation at computed tomography (CT) with findings at open lung biopsy in chronic diffuse lung disease. MATERIALS AND METHODS: The cases of 26 patients were included on the basis of (a) extensive areas of ground-glass attenuation as the predominant (n = 17) or exclusive (n = 9) abnormality at CT in the absence of honeycombing and (b) histologic evaluation at open lung biopsy. Severity of ground-glass attenuation was scored in the lobe sampled at biopsy, with separate analysis of associated lung changes. RESULTS: Correlation of CT with histologic findings at the 37 biopsy sites demonstrated that ground-glass attenuation corresponded to inflammation in 24 (65%) cases and to fibrosis in 13 (54%) cases. Eleven of the 13 patients (85%) with fibrosis had traction bronchiectasis or bronchiolectasis. These findings were not present in any of the patients with inflammation. CONCLUSION: In patients with chronic diffuse infiltrative lung disease, areas of ground-glass attenuation not associated with traction bronchiectasis or bronchiolectasis are a reliable indicator of inflammation.
13. Lenoir S, Grenier P, Brauner MW, et al. Pulmonary lymphangiomyomatosis and tuberous sclerosis: comparison of radiographic and thin-section CT findings. Radiology 1990;175(2):329-34.
Chest radiographs, thin-section computed tomographic (CT) scans, and results of pulmonary function tests in nine women with pulmonary lymphangiomyomatosis and two women with pulmonary tuberous sclerosis were retrospectively evaluated. In all patients, CT demonstrated thin- walled cysts less than 20 mm in diameter scattered at random in all parts of the lungs. In eight patients, cysts larger than 20 mm in diameter were also present. Lung tissue between cysts appeared normal in all 11 patients, except one with septal lines and dependent alveolar areas of attenuation. CT showed cysts in three patients whose radiographs were normal, and it demonstrated that many lesions that appeared reticular on plain radiographs were actually cysts. CT findings correlated better with the diffusion capacity of the lungs for carbon monoxide than did the plain radiographic findings. CT was more sensitive and more precise than radiography at showing the presence and morphology of lung abnormalities.
14. Muller NL, Chiles C, Kullnig P. Pulmonary lymphangiomyomatosis: correlation of CT with radiographic and functional findings. Radiology 1990;175(2):335-9.
In 14 patients with biopsy-proved lymphangiomyomatosis, disease extent at computed tomography (CT) was correlated with findings at chest radiography and pulmonary-function testing. The CT scans and chest radiographs were read independently by two chest radiologists. Disease extent was assessed on CT scans by using a visual score (0%-100% involvement of the lung parenchyma) and on radiographs by using an adaptation of the International Labour Office classification of the pneumoconioses. There was good concordance between the two observers for CT and radiographic scores (Kendall tau greater than or equal to .86, P less than .01). A significant but relatively low correlation was present between CT findings and radiographic severity of disease (r = .59, P less than .05). Impairment in gas exchange as assessed with the diffusing capacity correlated better with disease extent seen on CT scans (r = .69) than with chest radiographic findings (r = .59). Three patients had evidence of parenchymal disease on the CT scans but not on the radiographs. In one patient CT findings were negative despite a positive finding on chest radiographs. The authors conclude that CT is superior to chest radiography in the assessment of patients with lymphangiomyomatosis.
15. Fink JN. Epidemiologic aspects of hypersensitivity pneumonitis. Monogr Allergy 1987;21:59-69.
16. Yoshizawa Y, Ohtani Y, Hayakawa H, Sato A, Suga M, Ando M. Chronic hypersensitivity pneumonitis in Japan: a nationwide epidemiologic survey. J Allergy Clin Immunol 1999;103(2 Pt 1):315-20.
BACKGROUND: Pulmonary fibrosis inevitably develops in patients with chronic hypersensitivity pneumonitis (HP). OBJECTIVE: We conducted a nationwide epidemiologic study in Japan to evaluate the frequency and clinical characteristics of chronic HP. METHODS: This report is on 36 cases of chronic HP, including 10 patients with summer-type HP, 5 patients with home-related HP, 7 patients with bird fancier's lung, 5 patients with isocyanate-induced HP, 4 patients with farmer's lung, and 5 patients with other types of chronic HP. Chronic HP was further subgrouped into 2 types: one type of patients were first seen with chronic disease (9 patients), and the other type became chronic with fibrosis after repeated acute episodes (27 patients). RESULTS: The upper lung field was frequently involved in chronic HP (17%). Ground- glass opacities were observed in 57% and air space consolidation in 30% of the patients. Honeycombing was apparent in 37%. Twenty-six of 28 patients had antibodies to the presumptive antigens. Five of 8 patients with chronic HP were positive for antigen-induced lymphocyte proliferation. In 2 cases patients did not have detectable antibodies to causative antigens, although antigen-induced lymphocyte proliferation was detectable. The ratio of CD4 to CD8 in BAL lymphocytes was lowest in isocyanate-induced HP (mean 0.22) and tended to be high in farmer's lung and bird fancier's lung. Granulomas were observed in 39% and Masson bodies in 42% of specimens on histologic examination. Administration of prednisolone was effective in 58% of patients. CONCLUSIONS: The insidious form of chronic HP has probably been misdiagnosed as idiopathic pulmonary fibrosis when a good history was not taken and immunologic (especially antigen-induced lymphocyte proliferation) and BAL testing were not counted.
17. Hansell DM, Wells AU, Padley SP, Muller NL. Hypersensitivity pneumonitis: correlation of individual CT patterns with functional abnormalities. Radiology 1996;199(1):123-8.
PURPOSE: To correlate the pattern and extent of abnormalities on thin- section computed tomographic (CT) scans with pulmonary function test results in subacute and chronic hypersensitivity pneumonitis. MATERIALS AND METHODS: Thin-section scans (1-3 mm collimation) obtained in 22 patients were assessed for pattern of abnormality and extent of disease. CT scores were correlated with functional parameters by using Spearman rank correlation and forward stepwise regression analysis. RESULTS: The most common CT patterns were decreased attenuation and mosaic perfusion (n = 19), ground-glass opacification (n = 18), small nodules (n = 12), and a reticular pattern (n = 8). Areas of decreased attenuation correlated with severity of air trapping indicated by residual volume (r = .58, P .01), whereas ground-glass opacification and reticulation correlated independently with restrictive lung function. CONCLUSION: Areas of decreased attenuation and mosaic perfusion are an important ancillary CT finding in hypersensitivity pneumonitis, and obstructive functional abnormalities indicate that this phenomenon is caused by bronchiolitis.
18. Buschman DL, Gamsu G, Waldron JA, Jr., Klein JS, King TE, Jr.Chronic hypersensitivity pneumonitis: use of CT in diagnosis. AJR Am J Roentgenol 1992;159(5):957-60.
OBJECTIVE. In its subacute or chronic form, hypersensitivity pneumonitis is often difficult to distinguish clinically and physiologically from other idiopathic diffuse lung diseases. The aim of this study was to identify high-resolution CT features that allow distinction of chronic hypersensitivity pneumonitis from other chronic diffuse parenchymal lung diseases. MATERIALS AND METHODS. Six patients with chronic hypersensitivity pneumonitis were examined with pulmonary function testing, bronchoalveolar lavage, lung biopsy, chest radiography, and high-resolution CT. The chest radiographs and high- resolution CT scans were reviewed independently by three observers without knowledge of the patients' clinical status. Discrepancies between the observers were resolved by consensus. RESULTS. The chest radiographs revealed normal lung volumes with a combination of abnormalities: a mixed alveolar/interstitial pattern in five cases, peribronchiolar thickening in three, a diffuse granular pattern in one, and a linear fibrotic pattern in one. In general, the high-resolution CT scans showed more abnormalities than were apparent on the plain chest radiographs. High-resolution CT revealed centrilobular, peribronchiolar, indistinct nodular opacities, of various numbers, in all cases. Four cases had areas of ground-glass density, three cases had lobular areas of hyperlucency, and one case had areas of pulmonary fibrosis and honeycombing. CONCLUSION. We confirm that high-resolution CT can most clearly show the type and distribution of parenchymal abnormalities in patients with hypersensitivity pneumonitis. Importantly, although not pathognomonic, the high-resolution CT finding of centrilobular, peribronchiolar, indistinct nodules should suggest the diagnosis of chronic hypersensitivity pneumonitis.
19. Durieu J, Wallaert B, Tonnel AB. [Chronic eosinophilic pneumonia or Carrington's disease]. Rev Mal Respir 1993;10(6):499-507.
Chronic eosinophilic pneumonia (CEP) was described by Carrington in 1969. It is twice as common in women as it is in men and is probably most common at middle age. Symptoms usually associated fever, weight loss, fatigue and dyspnoea. Extra-respiratory manifestations are rare but may involve many organs. Classical radiological findings are diffuse alveolar infiltrates, with a peripheral predominance which explains the classic description of a "negative of pulmonary edema". Peripheral blood eosinophilia is present in 90%. The inflammatory syndrome with an eosinophilic alveolitis is constant. Pulmonary function tests show a restrictive pattern with depressed DLCO and hypoxemia. In atypical cases, proof of diagnosis is supported by lung biopsies that show intra alveolar and interstitial accumulation of eosinophils in peripheral air spaces. Areas of bronchiolitis obliterans are also frequently seen. In some atypical forms of chronic eosinophilic pneumonia, other disorders have to be discussed, like bronchiolitis obliterans with an organizing pneumonia or cryptogenetic organizing pneumonia and even tuberculosis. After corticosteroid therapy, the resolution occurs very rapidly but relapses are frequent. Steroid-dependence is seen in 20 to 30% of patients.
20. Ebara H, Ikezoe J, Johkoh T, et al. Chronic eosinophilic pneumonia: evolution of chest radiograms and CT features. J Comput Assist Tomogr 1994;18(5):737-44.
OBJECTIVE: Our object is to describe and compare the findings on plain chest radiographs and CT scans in patients with chronic eosinophilic pneumonia of varying duration, as judged by their clinical history. MATERIALS AND METHODS: We retrospectively reviewed the initial chest radiographs and initial CT scans that were obtained before treatment with corticosteroid in 17 patients with pathologically proven or clinically diagnosed chronic eosinophilic pneumonia. RESULTS: Eleven of the 17 patients showed predominantly peripheral patchy or confluent consolidation with or without ground-glass opacities on chest radiography. Sixteen patients, on the other hand, showed various types of abnormalities with peripheral predominance on CT. The seven patients in whom the initial CT was performed within 1 month after the onset of symptoms had dense confluent consolidation (7/7) with or without ground- glass opacities. When the initial CT was performed 1-2 months after onset of symptoms, inhomogeneous patchy consolidation or nodules (5/7) or ground-glass opacities (2/7) were observed. When the initial CT was performed > 2 months after the onset of symptoms, streaky or band-like opacities (1/3) or lobar atelectasis (1/3) was seen. CONCLUSION: Patients with chronic eosinophilic pneumonia show an evolution of CT features at varying time intervals after the onset of disease.
21. Munk PL, Muller NL, Miller RR, Ostrow DN. Pulmonary lymphangitic carcinomatosis: CT and pathologic findings. Radiology 1988;166(3):705-9.
The authors retrospectively reviewed the computed tomographic (CT) scans, biopsy specimens, autopsy results, and lobectomy specimens of 21 patients who had lymphangitic carcinomatosis. Ten-millimeter collimation CT scans were obtained from all patients, and selected 1.5- mm CT scans were obtained from ten patients. In five patients, the diagnosis was established with open lung biopsy, lobectomy, or autopsy; in nine, with bronchial biopsy or transbronchial biopsy; and in seven, with clinical and radiologic criteria. Certain characteristic findings on CT scans were evident: uneven thickening of bronchovascular bundles, thickening of isolated interstitial lines, and the presence of polygonal lines. These findings may be seen on CT scans even if the findings on chest radiographs are normal or nonspecific. The pathologic basis for these characteristic CT findings may relate to tumor thrombi in lymphatic vessels rather than edema and fibrosis, at least in the early stages of disease
22 . Bouchardy, L. M., J. E. Kuhlman, et al. (1993). “CT findings in bronchiolitis obliterans organizing pneumonia (BOOP) with radiographic, clinical, and histologic correlation.” J Comput Assist Tomogr 17(3): 352-7.
The CT features of 12 patients with bronchiolitis obliterans organizing pneumonia (BOOP) were reviewed and correlated with clinical history, histologic specimens, and chest radiography. From our series, a spectrum of CT findings of parenchymal lung involvement in BOOP emerged. Focal nodular or mass-like opacities were found in 42% (5 of 12). Areas of consolidation resembling pneumonia were seen in 33% (4 of 12). Peripheral subpleural reticular opacities were identified in 25% (3 of 12). Patchy ground glass infiltrates were seen in 8% (1 of 12). One patient demonstrated a mixed pattern consisting of nodular opacities and areas of pneumonic consolidation. In 4 of the 5 cases demonstrating the nodular form of BOOP either a feeding vessel or bronchus sign could be identified. This feature consisted of a pulmonary vessel leading to a nodular opacity or an air bronchogram entering into a nodular opacity. Correlation of the CT findings of BOOP with histologic specimens showed nodular opacities and areas of consolidation to be associated with classic pathologic features of BOOP including bronchiolar plugs of granulation tissue and surrounding organizing pneumonia. Cases demonstrating peripheral subpleural reticular opacities showed, in addition to pathologic evidence of BOOP, other features such as interstitial disease and fibrosis.
23 . Lee, K. S., P. Kullnig, et al. (1994). “Cryptogenic organizing pneumonia: CT findings in 43 patients.” AJR Am J Roentgenol 162(3): 543-6.
OBJECTIVE. Description of the CT findings of cryptogenic organizing pneumonia has been limited to a small number of cases. This study was performed to characterize the CT findings of this disease in a larger number of cases and to compare the findings in immunocompetent and immunocompromised patients. MATERIALS AND METHODS. The CT scans of 43 (32 immunocompetent and 11 immunocompromised) patients who had biopsy- proved cryptogenic organizing pneumonia were reviewed. The scans were obtained by using contiguous 8- or 10-mm collimation and selected thin (1.5 or 2.0 mm) section (n = 23), thin-section collimation at 10-mm intervals (n = 12), or 8- or 10-mm collimation only (n = 8). The scans were analyzed by three observers, and final decisions were reached by consensus. RESULTS. The most common pattern seen was consolidation, which was present alone or as part of a mixed pattern in 34 cases (79%). The consolidation had a predominantly subpleural and/or peribronchovascular distribution in 27 cases (63%). Ground-glass attenuation and nodules were seen in 26 patients (60%) and 13 patients (30%), respectively, and were usually random in distribution. Consolidation was present in 91% (29/32) of immunocompetent and 45% (5/11) of immunocompromised patients (p < .01). Ground-glass attenuation was present in 56% (18/32) of immunocompetent and 73% (8/11) of immunocompromised patients (p > .25). Nodules were present in seven (22%) of 32 immunocompetent patients and six (55%) of 11 immunocompromised patients (p < .025). CONCLUSION. We conclude that in immunocompetent patients the CT findings in cryptogenic organizing pneumonia most commonly consist of bilateral areas of consolidation involving mainly the subpleural and/or peribronchovascular regions. In the immunocompromised patient, the CT findings are variable.
24 . Akira, M., S. Yamamoto, et al. (1998). “Bronchiolitis
obliterans organizing pneumonia manifesting as multiple large nodules or masses.”
AJR Am J Roentgenol 170(2): 291-5.
OBJECTIVE: The purpose of this study was to describe the CT features and clinical features in bronchiolitis obliterans organizing pneumonia (BOOP) that manifest as multiple large nodules or masses. MATERIALS AND METHODS: We reviewed thin-section CT scans and clinical records of 12 patients with histologically proven BOOP manifesting as multiple large nodules or masses. For all patients follow-up CT scans were available, which we also reviewed. RESULTS: Of 60 lesions found in the 12 patients, 53 (88%) had an irregular margin, 27 (45%) had an air bronchogram, 23 (38%) had a pleural tag, and 21 (35%) had spicules. Ancillary findings included focal thickening of the interlobular septa in five (42%) of the 12 patients, pleural thickening in four (33%) patients, and parenchymal bands in three (25%) patients. Follow-up CT scans showed that the lesions with surrounding ground-glass attenuation evolved into lesions with pleural tags or parenchymal bands or both. CONCLUSION: BOOP should be considered when multiple large nodular lesions are seen on chest CT. In particular, BOOP should be considered when the lesions contain air bronchograms; have irregular margins, relatively broad pleural tags in contact with the pleura, parenchymal bands, or subpleural lines; or are associated with focal thickening of interlobular septa.
25 . Perez, T., M. Remy-Jardin, et al. (1998). "Airways involvement in rheumatoid arthritis: clinical, functional, and HRCT findings." Am J Respir Crit Care Med 157(5 Pt 1): 1658-65.
The aim of the present study was to assess the prevalence and characteristics of airways involvement in rheumatoid arthritis (RA) patients in the absence of interstitial lung disease. We prospectively evaluated, with high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs), 50 patients with RA (nine males and 41 females; mean age: 57.8 yr), including 39 nonsmokers and 11 smokers (mean cigarette consumption: 15.3 pack-yr) without radiographic evidence of RA-related lung changes. PFTs demonstrated airway obstruction (i.e., reduced FEV1/VC) in nine patients (18%) and small airways disease (SAD) (i.e., decreased FEF(25-75), defined as exceeding the predicted value by 1.64 residual SD [RSD] or more, and/or an increased phase III slope > 2 SD by single breath nitrogen washout) in four patients (8%). HRCT demonstrated bronchial and/or lung abnormalities in 35 cases (70%), consisting of air trapping (n = 16; 32%), cylindral bronchiectasis (n = 15; 30%), mild heterogeneity in lung attenuation (n = 10; 20%), and/or centrilobular areas of high attenuation (n = 3; 6%). Airway obstruction and SAD were correlated with the presence of bronchiectasis and bronchial-wall thickening (p = 0.003), and with bronchial infection (p = 0.01), but were unrelated to rheumatologic data. FEF(25-75) was reduced and the slope of phase III was increased in patients with airway changes on HRCT scans, whereas no PFT abnormalities were found in 13 of 15 patients with normal HRCT scans. HRCT depicted features of SAD in 20 of the 33 patients with normal PFTs. HRCT findings were unrelated to rheumatologic data. A high prevalence of airway abnormalities as assessed with HRCT and/or PFTs was observed in our RA population. HRCT appears to be more sensitive than PFTs for detecting small airways disease.
26 . Remy-Jardin, M., J. Remy, et al. (1994). "Lung changes in rheumatoid arthritis: CT findings." Radiology 193(2): 375-82.
PURPOSE: To evaluate lung changes in rheumatoid arthritis (RA). MATERIALS AND METHODS: The authors reviewed the computed tomographic (CT) scans from 84 patients with RA with a mean articular disease duration (+/- standard deviation) of 12 years +/- 8 (range, 0.3-45 years). Fifteen patients underwent sequential CT evaluation during 5-65- month follow-up (mean, 18 months). RESULTS: Thirty-eight patients (49%) had abnormal CT scans showing the following abnormalities: (a) bronchiectasis and/or bronchiolectasis (n = 23, 30%), (b) pulmonary nodules (n = 17, 22%), (c) subpleural micronodules and/or pseudoplaques (n = 13, 17%), (d) nonseptal linear attenuation (n = 14, 18%), (e) areas of ground-glass attenuation (n = 11, 14%), and (f) honeycombing (n = 8, 10%). Abnormal CT examinations were recorded in 11 of 38 asymptomatic patients (29%) and 27 of 39 symptomatic patients (69%). The following CT abnormalities were found with a significantly higher frequency among patients with respiratory symptoms: (a) bronchiectasis and/or bronchiolectasis, (b) rounded areas of attenuation, (c) areas of ground-glass attenuation, and (d) honeycombing. CONCLUSION: CT may be a useful noninvasive tool for recognition of RA-associated lung disease with special emphasis on bronchial and bronchiolar changes.
27 . Steinberg, D. L. and W. R. Webb (1984). "CT appearances of rheumatoid lung disease." J Comput Assist Tomogr 8(5): 881-4.
The plain radiography and CT of four patients with rheumatoid lung disease are reviewed. One patient had histologically confirmed rheumatoid nodules. The subpleural location of the nodules and cavitation were more easily diagnosed using CT. Also on CT the nodules were commonly seen in clusters, a finding not previously reported and not visible on plain films. In three patients honeycombing was visible on both plain radiography and CT. However, the areas of cystic destruction visible on CT were larger than those appreciated on the plain films.
28 . Fujita J, Yoshinouchi T, Ohtsuki Y, et al. Non-specific interstitial pneumonia as pulmonary involvement of systemic sclerosis. Ann Rheum Dis 2001;60(3):281-3.
The pathological features of lung disease in nine patients with systemic sclerosis (SSc) were evaluated. The patients comprised one man and eight women, with a median age of 58 years. SSc was diagnosed according to the criteria of the American Rheumatism Association. In all patients, high resolution computed radiographic scanning of the lungs (HRCT) was performed, and apparent honeycomb formation was seen in four patients. Pathologically, four patients were diagnosed with usual interstitial pneumonia (UIP), three with non-specific interstitial pneumonia (NSIP) group II, one NSIP group II-III, and one NSIP group II with diffuse alveolar damage. HRCT showed no apparent honeycomb formations in patients diagnosed with NSIP. This is the first report describing NSIP as a pulmonary complication of SSc.
29 . Bhalla, M., R. M. Silver, et al. (1993). "Chest CT in patients with scleroderma: prevalence of asymptomatic esophageal dilatation and mediastinal lymphadenopathy." AJR Am J Roentgenol 161(2): 269-72.
OBJECTIVE. The high-resolution CT findings of chronic diffuse interstitial lung disease associated with scleroderma have been reported previously. This study determined the prevalence of esophageal dilatation and mediastinal adenopathy on high-resolution CT scans in patients with this disease. MATERIALS AND METHODS. We retrospectively reviewed the high-resolution CT scans of 25 patients with scleroderma who had diffuse interstitial lung disease. Esophageal dilatation was diagnosed if the esophagus below the aortic arch had a single, large, nonloculated collection of intraluminal air on four or more consecutive axial images and if the luminal diameter of such an air-filled esophagus exceeded 10 mm in the coronal plane. The presence of fluid or an air-fluid level was also considered abnormal. For mediastinal adenopathy, we used the American Thoracic Society lymph node mapping scheme and the size criteria described previously. RESULTS. Asymptomatic esophageal dilatation was detected in 20 patients (80%) and mediastinal adenopathy was present in 15 (60%). CONCLUSION. Our results suggest that CT is useful in the detection of mediastinal adenopathy and asymptomatic esophageal involvement in patients with scleroderma. These findings can be used to narrow the differential diagnosis in patients in whom CT shows diffuse interstitial lung disease. Furthermore, the early detection of esophageal involvement in these patients shows the need for treatment to forestall the complications of esophageal dysmotility and accompanying chronic gastroesophageal reflux.
30 . Schurawitzki, H., R. Stiglbauer, et al. (1990). "Interstitial lung disease in progressive systemic sclerosis: high- resolution CT versus radiography." Radiology 176(3): 755-9.
High-resolution computed tomographic (HRCT) scans and chest radiographs were obtained in 23 patients with progressive systemic sclerosis (PSS) to assess the diagnostic merits of HRCT compared with chest radiography in detecting interstitial lung involvement in these patients. HRCT scans showed interstitial disease in 21 patients (91%). The most frequent finding was the so-called subpleural lines, which were demonstrated in 17 patients (74%). Honeycombing was seen in seven patients (30%), while parenchymal bands were seen in six patients (26%). Chest radiographs, on the other hand, showed definite interstitial opacification patterns in only nine patients (39%); six patients (26%) had equivocal reticular areas of attenuation, while eight patients (35%) had normal chest radiographs. Thus, HRCT is much more sensitive than chest radiography when assessing minimal interstitial lung involvement in patients with PSS.
31 . Stupi, A. M., V. D. Steen, et al. (1986). "Pulmonary hypertension in the CREST syndrome variant of systemic sclerosis." Arthritis Rheum 29(4): 515-24.
Pulmonary hypertension (PHT) occurred in 59 (9%) of 673 systemic sclerosis patients seen between 1963 and 1983. In 30 patients, all with the CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias), the pulmonary hypertension was isolated, i.e., independent of other pulmonary or cardiac conditions. In 20 patients, isolated PHT was demonstrated by cardiac catheterization. All had normal or only mildly decreased lung volumes, and mild or no pulmonary interstitial fibrosis on chest roentgenogram. In comparison with 287 CREST syndrome patients without PHT, these 20 patients had markedly reduced diffusing capacity for carbon monoxide (DLCO) (mean 39% of predicted normal). In 6 patients, the low DLCO antedated clinical evidence of PHT by 1-6 years. At autopsy there was marked intimal fibrosis with hyalinization and smooth muscle hypertrophy in the small- and medium-sized arteries, without significant parenchymal fibrosis or inflammation. Patients with isolated PHT did not respond favorably to vasodilators and had a very poor prognosis, with a 2-year cumulative survival rate of 40%. A DLCO less than 45% of predicted in the absence of pulmonary interstitial fibrosis may be an important predictor of the subsequent development of isolated PHT.
32 . . Kim EA, Johkoh T, Lee KS, et al. Interstitial pneumonia in progressive systemic sclerosis: serial high-resolution CT findings with functional correlation. J Comput Assist Tomogr 2001;25(5):757-63.
PURPOSE: The aim of our study was to assess the serial high-resolution CT findings and their correlation with the results of pulmonary function tests in patients with progressive systemic sclerosis (PSS) and interstitial pneumonia. METHOD: The study included 40 patients with symptoms or signs of PSS and interstitial pneumonia, who underwent serial high-resolution CT scans (mean follow-up period 39 months). Seventeen patients simultaneously had serial pulmonary function tests (mean follow-up period 40 months). On high-resolution CT, the pattern and extent of parenchymal abnormalities were retrospectively analyzed. Serial changes on high-resolution CT were correlated with the changes of pulmonary function tests. RESULTS: On initial CT, areas of ground-glass opacity (mean +/- SD extent 17.7 +/- 12.3% in all patients), irregular linear opacity (4.4 +/- 4.4% in 36 patients), small nodules (3.9 +/- 12.5% in 28), consolidation (1.9 +/- 4.2% in 13), and honeycombing (1.9 +/- 3.8% in 12) were seen. The total disease extent (p = 0.042) and extents of ground-glass opacity (18.9 +/- 15.5%; p = 0.04) and honeycombing (5.0 +/- 7.2%; p = 0.002) increased significantly on follow-up CT. Both forced vital capacity (from 2.4 +/- 0.4 to 2.0 +/- 0.4 L; p = 0.002) and forced expiratory volume in 1 s (from 2.0 +/- 0.4 to 1.6 +/- 0.3 L; p = 0.013) decreased significantly on follow-up examination. The increase in the extent of honeycombing on CT correlated significantly with the decrease in diffusing capacity for carbon monoxide (r = -0.411, p = 0.049). CONCLUSION: In patients with PSS and interstitial pneumonia, the overall extent of disease and extents of honeycombing and ground-glass opacity increase significantly on follow-up CT. Increase of honeycombing correlates well with decrease of diffusing capacity for carbon monoxide.
33 . Andonopoulos AP, Yarmenitis S, Georgiou P, Bounas A, Vlahanastasi C. Bronchiectasis in systemic sclerosis. A study using high resolution computed tomography. Clin Exp Rheumatol 2001;19(2):187-90.
OBJECTIVE: To detect noninvasively the presence of bronchiectasis in patients with systemic sclerosis (SSc), through the use of high resolution chest computed tomography (HRCT). METHODS: Twenty two patients with SSc, of whom 13 with diffuse and 9 with limited disease, besides a complete history, physical and routine laboratory and immunologic profile, were evaluated by pulmonary function testing and HRCT. The chi square test with Yates' correction, the Fisher's exact test, the Fisher's test (F test) and the "t" test were used for statistical analysis of the results. RESULTS: Eleven patients (50.0%) had decreased carbon monoxide diffusing lung capacity (DLCO) and, out of these, four had restrictive lung disease, based on a combined decrease of forced vital capacity (FVC) and total lung capacity (TLC). Another two patients exhibited this pattern without DLCO impairment. HRCT revealed a ground glass picture in 15 patients (68.2%), fibrosis in 9 (40.9%) (of which 5 with ground glass as well), and cylindrical bronchiectasis in 13 (59.1%). Bronchiectasis was more common in diffuse than in limited SSc, and the difference approached but did not reach the level of statistical significance. On the other hand, it was not correlated with either decreased DLCO, presence of ground glass and fibrosis, or with patients' age and disease duration. CONCLUSION: Although the number of patients included in our study is relatively small, our data, for the first time in the literature, indicate a significant association between scleroderma and bronchiectasis. Bronchiectasis should be included in the list of pulmonary manifestations of SSc, and SSc in the list of conditions causing bronchiectasis.
34. Fenlon, H. M., M. Doran, et al. (1996). "High-resolution chest CT in systemic lupus erythematosus." AJR Am J Roentgenol 166(2): 301-7.
OBJECTIVE: The purpose of our study was to identify high-resolution CT (HRCT) findings in patients with systemic lupus erythematosus (SLE) and to determine their significance by correlation with clinical findings, plain chest radiography, and pulmonary function testing. SUBJECTS AND METHODS: Thirty-four patients with documented SLE were prospectively studied. All patients had plain chest radiography (posteroanterior and lateral) thoracic spiral CT, HRCT, and pulmonary function testing performed. RESULTS: HRCT abnormalities were identified in 24 patients (70%), pulmonary function abnormalities were present in only 14 patients (41%), and the plain chest radiograph was abnormal in only 8 patients (24%). The most common CT findings were: interstitial lung disease (n = 11), bronchiectasis (n = 7), mediastinal or axillary lymphadenopathy (n =6), and pleuropericardial abnormalities (n =5). No correlation was found between disease activity, duration of disease, chest symptoms, drug therapy, smoking history, and the presence of abnormal HRCT findings. More importantly, no correlation was found between pulmonary function abnormalities and the presence or grade of interstitial lung disease or bronchiectasis as determined by HRCT. CONCLUSION: The results of this study, the first to describe the HRCT findings in SLE, suggest that airways disease, lymphadenopathy, and interstitial lung disease are common thoracic manifestations of SLE, whereas pleural abnormalities are less common than previously suggested. HRCT evidence of airways disease and interstitial lung disease was frequently present despite an absence of symptoms, a normal chest radiograph, and normal pulmonary function testing. HRCT provides a sensitive and noninvasive technique for detecting pulmonary involvement in SLE, with the added advantage that it can be performed in all patients, including those too compromised to undergo a surgical procedure. In patients with advanced disease, HRCT permits procedures such as bronchoalveolar lavage and lung biopsy to be directed toward areas of particular interest.
35 . Kim, J. S., K. S. Lee, et al. (2000). "Thoracic involvement of systemic lupus erythematosus: clinical, pathologic, and radiologic findings." J Comput Assist Tomogr 24(1): 9-18.
Thoracic involvement occurs more frequently in systemic lupus erythematosus than in any other connective tissue diseases, and more than half of patients with the disease suffer from the involvement. Primary intrathoracic manifestations include pleural disease (effusions and/or thickening), acute lupus pneumonitis, subacute interstitial lung disease including bronchiolitis obliterans organizing pneumonia and non- specific interstitial pneumonia with fibrosis, chronic interstitial lung disease of usual interstitial pneumonia, pulmonary hemorrhage, pulmonary vascular disease, small airway disease of bronchiolitis obliterans, and pulmonary arterial hypertension. Secondary intrathoracic manifestations include atelectasis due to diaphragmatic dysfunction, opportunistic pneumonia, drug and oxygen toxicity, aspiration, and pleuropulmonary consequences of cardiac and renal failure.
36 . Franquet, T., C. Diaz, et al. (1999). "Air trapping in primary Sjogren syndrome: correlation of expiratory CT with pulmonary function tests." J Comput Assist Tomogr 23(2): 169-73.
PURPOSE: The purpose of our study was to correlate the extent of air trapping on expiratory CT scans with results of pulmonary function tests (PFTs) in a large group of patients with primary Sjogren syndrome and to determine whether these techniques may be complementary in assessing small airways obstruction. METHOD: Thirty-four nonsmoking patients with proven primary Sjogren syndrome and 10 healthy nonsmokers underwent paired inspiratory-expiratory thin section CT and PFTs. Expiratory scans were scored for the presence and extent of areas of air trapping. Extent of air trapping was assessed visually and given a score. The functional significance of the extent of air trapping was evaluated in both groups and then correlated with the results of PFTs. RESULTS: Bronchiolar abnormalities were seen in 11 (32%) of 34 patients with primary Sjogren syndrome. On the expiratory CT scans, a mosaic pattern of lung attenuation was identified in 17 patients. Air trapping was found in 44 of 204 lobar observations on the expiratory scans. The median point scale score at end-expiration was 3.6 (20%, Grade 1), ranging from 1 (5.5%, Grade 1) to 9 (50%, Grade 2). The mean total score of air trapping was more prevalent in lower (46/68) lobes (22.4%) than in upper (22/136) lobes (5.3%) (p < 0.001). PFTs were normal in the primary Sjogren syndrome patients as well as the healthy subjects. Air trapping was found more frequently in patients with primary Sjogren syndrome than in the healthy group. Only during exhalation was there evidence of minimal lobular-sized areas or air trapping (Grade 1) in three of the healthy subjects. We did not find any correlation between air trapping and PFTs including the forced expiratory flow rate between 25 and 75% of the forced vital capacity (FEF25-75). CONCLUSION: Expiratory high resolution CT revealed the extent of bronchiolar disease in patients with primary Sjogren syndrome. We also found that the extent of air trapping did not correlate with PFTs, which suggests the existence of a subclinical bronchiolar inflammatory process that may precede detectable abnormalities in lung function tests.
37 . Franquet, T., A. Gimenez, et al. (1997). "Primary Sjogren's syndrome and associated lung disease: CT findings in 50 patients [see comments]." AJR Am J Roentgenol 169(3): 655-8.
OBJECTIVE: We prospectively evaluated the high-resolution CT findings in 50 nonsmoking patients with proven primary Sjogren's syndrome. CONCLUSION: High-resolution CT is a sensitive technique in assessing pulmonary involvement in patients with primary Sjogren's syndrome. Interstitial lung disease and bronchiolar inflammatory changes are common abnormal findings seen on CT scans in primary Sjogren's syndrome.
38 . Akira, M., H. Hara, et al. (1999). "Interstitial lung disease in association with polymyositis- dermatomyositis: long-term follow-up CT evaluation in seven patients." Radiology 210(2): 333-8.
PURPOSE: To determine the long-term follow-up computed tomographic (CT) findings of interstitial lung disease associated with polymyositis- dermatomyositis. MATERIALS AND METHODS: CT scans in seven patients with interstitial lung disease and associated polymyositis-dermatomyositis were evaluated retrospectively. Six patients underwent sequential CT (follow-up range, 2-8 years; mean, 4.3 years). Histologic confirmation of pulmonary involvement was available in five patients. RESULTS: The predominant finding on the initial CT scans in four patients was subpleural consolidation, which corresponded to bronchiolitis obliterans organizing pneumonia with or without coexistent chronic eosinophilic pneumonia. In most cases, consolidation improved with use of corticosteroid and/or immunosuppressive therapy; in two patients, however, consolidation evolved into honeycombing. In one patient, diffuse areas of ground-glass opacity and consolidation appeared rapidly during illness; this patient died of sudden, rapid deterioration. In one patient with subpleural linear opacities, parenchymal abnormalities slowly progressed, and linear opacities had evolved into honeycombing at 8-year follow-up. In one patient with histologically proved organizing diffuse alveolar damage, bilateral patchy areas of ground-glass opacity and consolidation were seen. In one patient, subpleural bands changed to subpleural lines on sequential CT scans. CONCLUSION: CT provides an excellent demonstration of the lung changes in patients with interstitial lung disease and associated polymyositis-dermatomyositis.
39 . Ikezoe, J., T. Johkoh, et al. (1996). "High-resolution CT findings of lung disease in patients with polymyositis and dermatomyositis." J Thorac Imaging 11(4): 250-9.
The purpose of this study was to determine the type and distribution of interstitial lung disease seen in patients with polymyositis and dermatomyositis, using high-resolution computed tomography (HRCT). The presence and distribution of high-resolution CT findings were retrospectively evaluated in 25 patients with polymyositis/dermatiomyositis. In 14 patients, a pathological diagnosis of pulmonary disease was obtained. Three lung specimens were also studied. Results showed that 23 patients had abnormal HRCT showing the following abnormalities: ground glass opacities (92%), linear opacities (92%), irregular interfaces (88%), airspace consolidation (52%), parenchymal micronodules (28%), and honeycombing (16%). A relatively high prevalence of airspace consolidation (52%) and a low prevalence of honeycombing (16%) were observed. Two patients with extensive consolidation proved to have diffuse alveolar damage; eight patients with either subpleural band-like opacities (n = 5) and/or airspace consolidation (n = 7) had bronchiolitis obliterans organizing pneumonia; four patients with honeycombing had usual interstitial pneumonitis. We conclude that HRCT findings in patients with polymyositis/dermatomyositis are nonspecific. However, a high prevalence of airspace consolidation and a low prevalence of honeycombing were observed. Predominant HRCT patterns are suggestive of the pathologic processes occurring in polymyositis/dermatomyositis.
40 . Fenlon, H. M., I. Casserly, et al. (1997). "Plain radiographs and thoracic high-resolution CT in patients with ankylosing spondylitis." AJR Am J Roentgenol 168(4): 1067-72.
OBJECTIVE: The aims of this study were to identify the spectrum of abnormalities seen on high-resolution CT in patients with ankylosing spondylitis and to compare our findings with reports of plain film pulmonary manifestations of the disease. SUBJECTS AND METHODS: We prospectively studied 26 patients with documented ankylosing spondylitis. All patients underwent plain chest radiography (posteroanterior and lateral views), thoracic helical CT, high- resolution CT, and pulmonary function tests. RESULTS: High-resolution CT revealed abnormalities in 18 patients (69%), whereas plain chest radiography revealed abnormalities in four patients (15%). The most common abnormalities seen on CT were interstitial lung disease (ILD) (n = 4), bronchial wall thickening and bronchiectasis (n = 6), paraseptal emphysema (n = 3), mediastinal lymphadenopathy (n = 3), tracheal dilatation (n = 2), and apical fibrosis (n = 2). CONCLUSION: This study, which describes high-resolution CT findings in patients with ankylosing spondylitis, reveals a spectrum of abnormalities unlike those described in previous reports in which researchers used plain chest radiographs as the sole imaging technique. In addition to apical fibrosis, high-resolution CT revealed nonapical ILD, bronchiectasis, paraseptal emphysema, and tracheobronchomegaly. Of these new findings, we believe that identification of ILD is the most important. We suggest that nonapical ILD should be actively sought as an explanation for pulmonary symptoms developing in patients with ankylosing spondylitis. High-resolution CT should form an integral part of such workup.
41 . Kuhlman, J. E., R. H. Hruban, et al. (1991). "Wegener granulomatosis: CT features of parenchymal lung disease." J Comput Assist Tomogr 15(6): 948-52.
Chest CT from eight patients with pulmonary Wegener granulomatosis were reviewed. The CT features of parenchymal lung involvement included multiple nodules or masses (seven of eight; 88%), ranging in size from 0.3 to 5.0 cm. Lung nodules demonstrated distinct feeding vessels in seven of eight patients (88%); and lesions similar to pulmonary infarcts, i.e., peripheral wedge-shaped lesions abutting the pleura, were identified in seven cases (88%). Scarring, spiculation, and pleural tags emanating from pulmonary nodules were prominent features (seven of eight; 88%). Other findings included cavitation (four of eight; 50%), air bronchograms through nodules (two of eight; 25%), and pleural effusions (two of eight; 25%). One patient on immunosuppressant therapy also demonstrated scattered ground glass infiltrates due to complicating pneumocystis pneumonia. In comparison to corresponding conventional chest radiography, CT examinations revealed more parenchymal lesions in five of eight cases (63%) and bilateral disease instead of unilateral disease in one of eight cases (13%). Feeding vessels were only identified on CT. Wegener granulomatosis is a primary necrotizing granulomatous vasculitis, and when it affects the lung it demonstrates CT features that are similar to other vessel-related disorders of the lung such as septic emboli, pulmonary infarcts, and tumor emboli of hematogenous metastases. We believe that these CT features--nodules with feeding vessels and wedge-shaped lesions abutting the pleura--are related to the necrotizing angiitis that affects pulmonary arteries and veins in this disease.
42 .Maskell, G. F., C. M. Lockwood, et al. (1993). "Computed tomography of the lung in Wegener's granulomatosis." Clin Radiol 48(6): 377-80.
Computed tomography of the thorax was performed in 30 patients with Wegener's granulomatosis to define the anatomical basis of pulmonary involvement. A wide variety of parenchymal and bronchial abnormalities was demonstrated in addition to the cavitary nodules commonly described. The high incidence (40%) of bronchial abnormalities in these patients may suggest that bronchocentric injury is more important in the pathogenesis of lung involvement in this disease than has previously been considered. Serial scans in individual patients showed broad correlation between the extent of the pulmonary abnormalities and the clinical and immunological markers of disease activity.
43 . Worthy, S. A., N. L. Muller, et al. (1998). "Churg-Strauss syndrome: the spectrum of pulmonary CT findings in 17 patients." AJR Am J Roentgenol 170(2): 297-300.
OBJECTIVE: The aim of this study was to evaluate the pulmonary CT findings in patients with Churg-Strauss syndrome to determine the frequency and nature of parenchymal abnormalities. MATERIALS AND METHODS: CT examinations performed at the time of diagnosis in 17 patients with Churg-Strauss syndrome were retrospectively evaluated by two observers who reached a decision by consensus about the presence and nature of parenchymal abnormalities. High-resolution CT (1- to 3-mm collimation) was performed in 14 patients and conventional CT (6- to 10- mm collimation) was performed in three cases. RESULTS: Predominant CT findings consisted of parenchymal opacification (consolidation or ground-glass attenuation) (n = 10), pulmonary nodules (n = 2), bronchial wall thickening or dilatation (n = 2), interlobular septal thickening (n = 1), and normal anatomy (n = 2). Parenchymal opacification was predominantly peripheral (n = 6) or random in distribution (n = 4). CONCLUSION: The most common CT finding in patients with Churg-Strauss syndrome consists of areas of parenchymal opacification that may be random or peripheral in distribution. These findings are nonspecific.
44 . Primack, S. L. and N. L. Muller (1998). "Radiologic manifestations of the systemic autoimmune diseases." Clin Chest Med 19(4): 573-86, vii.
Advances in thoracic imaging during the past two decades, such as CT scans and MR imaging, have enhanced our understanding of the pleuropulmonary abnormalities that develop in the systemic autoimmune diseases. In this article, the thoracic radiologic manifestations of several connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis, Sjogren's syndrome, polymyositis/dermatomyositis, progressive systemic sclerosis, and anklyosing spondylitis), two granulomatous vasculitides, (Wegener's Granulomatosis and Churg-Strauss syndrome), and antiglomerular basement membrane disease are reviewed.
45 . Johkoh, T., N. L. Muller, et al. (1999). "Lymphocytic interstitial pneumonia: thin-section CT findings in 22 patients." Radiology 212(2): 567-72
. PURPOSE: To assess the thin-section computed tomographic (CT) findings of lymphocytic interstitial pneumonia. MATERIALS AND METHODS: The study included 22 patients (five men, 17 women; age range, 24-83 years; mean age, 50 years) with biopsy-proved lymphocytic interstitial pneumonia. The CT scans were obtained by using 1-3-mm collimation and reconstructed by using a high-spatial-frequency algorithm. RESULTS: The predominant abnormalities consisted of areas of ground-glass attenuation and poorly defined centrilobular nodules present in all 22 patients and subpleural small nodules seen in 19 patients. Other common findings included thickening of bronchovascular bundles (n - 19), interlobular septal thickening (n = 18), cystic airspaces (n = 15), and lymph node enlargement (n = 15). Less common findings included large nodules, emphysema, airspace consolidation, bronchiectasis, architectural distortion, honeycombing, and pleural thickening. CONCLUSION: Lymphocytic interstitial pneumonia is characterized by the presence of ground-glass attenuation, poorly defined centrilobular nodules, and thickening of the interstitium along the lymphatic vessels. Lymph node enlargement is more common than previously recognized; it was seen in 68% of patients.
46 . Bergin, C. J., N. L. Muller, et al. (1986). "CT in silicosis: correlation with plain films and pulmonary function tests." AJR Am J Roentgenol 146(3): 477-83.
To investigate the usefulness of computed tomography (CT) in the qualitative and quantitative assessment of silicosis, CT scans, chest radiographs, and pulmonary function tests were obtained in 17 patients with silicosis and six controls. CT scans were graded for extent of silicosis visually and using mean attenuation values. The extent of associated emphysema was also determined. Extent of silicosis as assessed by CT was compared with extent estimated from the chest radiographs using the ILO 1980 classification and pulmonary function tests. Significant correlation was found between both the mean attenuation values (r greater than 0.62, p less than 0.001) and the visual CT scores (r greater than 0.84, p less than 0.001) compared with the ILO category of profusion. There was good inter- and intraobserver correlation for the visual CT grades of silicosis (r greater than 0.93, p less than 0.001). There was poor correlation between the pulmonary function tests and the nodular profusion on the chest radiograph and CT (r less than 0.50). Correlation was significant, however, between the CT emphysema score and both the FEV1% predicted (r greater than 0.66, p less than 0.001) and the diffusing capacity (r greater than 0.71, p less than 0.001). Using chest film assessment of the extent of silicosis, visual CT quantitation of silicosis is accurate and reproducible. Attenuation values were less reliable and their use is not recommended as an independent assessment of disease severity. The reduced levels of lung function in these patients correlated with superimposed emphysema rather than the nodular profusion. Emphysema associated with silicosis was easily detected on CT but not on the radiograph.
47 . Remy-Jardin, M., J. Remy, et al. (1992). "Computed tomographic evaluation of silicosis and coal workers' pneumoconiosis." Radiol Clin North Am 30(6): 1155-76.
The introduction of computed tomography (CT) has modified the radiologic approach to silicosis and coal worker's pneumoconiosis considerably, allowing earlier recognition and more precise characterization of pulmonary abnormalities than chest radiography. An optimal approach to CT recognition requires an understanding of the main physiologic and pathologic features that are known to occur in both pneumoconioses. This report focuses on the most common CT features of simple and complicated forms of silicosis and coal worker's pneumoconiosis as well as on the optimal scanning protocol. The respective roles of chest radiographs and CT scans in the recognition of pneumoconiosis and follow-up of exposed workers are discussed.
48 . Wagner, G. R. (1997). "Asbestosis and silicosis." Lancet 349(9061): 1311-5.
Interstitial fibrosis resulting from workplace exposure to asbestos and crystalline silica persists throughout the world despite knowledge of the causes and effective means for prevention. Asbestosis and silicosis occurrence is predictable among people overexposed to dusts in various industries and occupations such as mining, construction, manufacturing, and building maintenance. Asbestosis and silicosis are incurable and may be progressive even after dust exposure has ceased, therefore early recognition and supportive interventions are important. Although current disease is a result of past exposures, effective control of current workplace exposures is the only way to prevent continued occurrence of these potentially debilitating diseases. Physicians can contribute to this effort through accurate diagnosis and disease reporting.
49 . Akira, M., S. Yamamoto, et al. (1990). "Asbestosis: high-resolution CT-pathologic correlation." Radiology 176(2): 389-94.
High-resolution computed tomography (HRCT) was performed in seven inflated and fixed postmortem lungs from seven asbestos-exposed patients with pathologically proved asbestosis. The parenchymal abnormalities seen at in vitro HRCT included thickened intralobular lines (n = 7), thickened interlobular lines (n = 7), pleural-based opacities (n = 7), parenchymal fibrous bands (n = 5), subpleural curvilinear shadows (n = 4), ground-glass appearance (n = 4), traction bronchiectasis (n = 4), and honeycombing (n = 2). The thickened intralobular lines were shown histologically to be due to peribronchiolar fibrosis. Thickened interlobular lines were due mainly to interlobular fibrotic thickening in four lungs and edema in three. The peribronchiolar fibrosis was most severe in the subpleural lung regions, creating curvilinear line shadows and pleural-based areas of opacity. Some subpleural fibrosis extended proximally along the bronchovascular sheath to create bandlike lesions. Areas of ground- glass appearance on HRCT scans were shown to be the result of mild alveolar wall and interlobular septal thickening due to fibrosis or edema. Postmortem HRCT findings were similar to premortem HRCT findings and correlated well with the pathologic findings of asbestosis.
50 . Akira, M., K. Yokoyama, et al. (1991). "Early asbestosis: evaluation with high-resolution CT." Radiology 178(2): 409-16.
To determine the earliest stage at which lesions in asbestosis can be diagnosed and to assess their progression, 23 asbestos-exposed patients with minimal or no abnormalities at plain radiography were examined with high-resolution computed tomography (HRCT) twice, with an interval of 12-37 months between examinations. In 21 of the patients, parenchymal abnormalities were found. Major parenchymal features seen at CT included thickened intralobular and interlobular lines, subpleural curvilinear lines, pleural-based nodular irregularities, hazy patches of increased attenuation, small cystic spaces, and small areas of low attenuation. At paired serial CT, subpleural isolated dots or branching structures connected with the most peripheral branch of the pulmonary artery started to appear in lower subpleural zones and then became confluent to create pleural-based nodular irregularities. CT-pathologic correlation led to the conclusion that the confluence of subpleural peribronchiolar fibrosis creates subpleural fibrosis.
51 . Harris, K. M., K. McConnochie, et al. (1993). "The computed tomographic appearances in chronic berylliosis."
Clin Radiol 47(1): 26-31. Computed tomography (CT) of the thorax was performed in eight patients with chronic berylliosis. The pulmonary CT features were variable and included pulmonary nodularity, and patterns consistent with upper lobe fibrosis or diffuse interstitial fibrosis. Mediastinal or hilar lymphadenopathy was shown in three cases. CT clearly demonstrates the pattern and distribution of pulmonary and mediastinal involvement in chronic pulmonary berylliosis but the appearances are non-specific.
52 . Newman, L. S., D. L. Buschman, et al. (1994). "Beryllium disease: assessment with CT ."
Radiology 190(3): 835-40. PURPOSE: To describe the thin-section computed tomographic (CT) features of beryllium disease and compare the sensitivities of thin- section CT and chest radiography. MATERIALS AND METHODS: In 28 patients with biopsy-proved beryllium disease and 12 healthy control subjects, radiographs were scored with an international classification system. Thin-section CT scans were scored for 11 parenchymal, airway, pleural, and mediastinal findings. RESULTS: Thin-section CT revealed at least one abnormality in 25 patients (89%); chest radiography, in 15 patients (54%). After the finding of bronchial wall thickening attributable to tobacco smoking was excluded, CT scans in 21 (75%) of 28 patients were abnormal because of beryllium disease. The most common CT abnormalities were parenchymal nodules (n = 16) and septal lines (n = 14). With use of CT, abnormalities were detected in 10 (77%) of 13 patients with normal radiographs. CONCLUSION: Thin-section CT was more sensitive than chest radiography in detection of beryllium disease, but the diagnosis was missed in up to 25% of cases with histologic proof.
53 . Akira, M., S. Atagi, et al. (1999). "High-resolution CT findings of diffuse bronchioloalveolar carcinoma in 38 patients." AJR Am J Roentgenol 173(6): 1623-9.
OBJECTIVE: The purpose of this study was to analyze the high-resolution CT features of diffuse bronchioloalveolar carcinoma and determine the useful findings in differential diagnosis. MATERIALS AND METHODS: High- resolution CT scans of 38 patients with pathologically proven diffuse bronchioloalveolar carcinoma were reviewed. Sequential CT scans were obtained in 15 patients. The high-resolution CT findings were compared with those of eosinophilic pneumonia (n = 22), multiple pulmonary metastases (n = 12), and tuberculosis (bronchogenic: n = 22; miliary: n = 12). RESULTS: High-resolution CT findings of diffuse bronchioloalveolar carcinoma included ground-glass opacity (n = 29), consolidation (n = 29), nodules (n = 28), centrilobular nodules (n = 26), peripheral distribution (n = 19), and air bronchogram (n = 18). According to the major features, high-resolution CT findings of diffuse bronchioloalveolar carcinoma could be classified into three patterns: predominantly ground-glass (n = 4), consolidative (n = 22), and multinodular (n = 12). Most patients with diffuse bronchioloalveolar carcinoma had a mixture of these findings. The frequency of findings of diffuse bronchioloalveolar carcinoma on high-resolution CT was not different from that of tuberculosis, but the predominant distribution of the nodules and areas of ground-glass attenuation differed between the two. Difference in distribution between bronchioloalveolar carcinoma and bronchogenic tuberculosis included ground-glass opacity remote from the consolidation and a lower lung predominance. CONCLUSION: Although these high-resolution CT findings are not specific, the combination of consolidation and nodules and the coexistence of centrilobular nodules and remote areas of ground-glass attenuation are characteristic of diffuse bronchioloalveolar carcinoma.
54 . Lee, K. S., Y. Kim, et al. (1997). "Bronchioloalveolar carcinoma: clinical, histopathologic, and radiologic findings." Radiographics 17(6): 1345-57.
Bronchioloalveolar carcinoma is characterized pathologically by a pulmonary neoplasm showing lepidic growth. More than half of all patients with bronchioloalveolar carcinoma are asymptomatic. The most frequent symptoms and signs are cough, sputum, shortness of breath, weight loss, hemoptysis, and fever. Bronchorrhea is unusual and a late manifestation. Nonmucinous bronchioloalveolar carcinoma tends to be more localized and has a lower frequency of bronchogenic spread than mucinous bronchioloalveolar carcinoma. Bronchioloalveolar carcinoma appears radiographically as a single nodule, segmental or lobar consolidation, or diffuse nodules. At computed tomography (CT), the single nodular form appears as a peripheral nodule or localized ground- glass attenuation with or without consolidation, frequently associated with bubblelike areas of low attenuation and open bronchus signs. The lobar consolidative form may demonstrate the CT angiogram and open bronchus signs. The diffuse nodular form appears as multiple nodules or areas of ground-glass attenuation or consolidation. The single nodular form has a better prognosis than the others but may show false-negative results for malignancy at 2-(fluorine-18) fluoro-2-deoxy-D-glucose positron emission tomography.
55 . Khalil, A. M., M. F. Carette, et al. (1995). "Intrathoracic Kaposi's sarcoma. CT findings." Chest 108(6): 1622-6.
AIM: To describe the thin CT scans findings in AIDS patients with intrathoracic Kaposi's sarcoma (KS). MATERIAL AND METHODS: Fifty-three CT scans of patients with KS were retrospectively reviewed. The diagnosis of intrathoracic KS was established histologically (n = 17) or on the association of skin KS and the visualization of characteristic endobronchial lesions (n = 36). CT scans were performed with thin slices (2 mm) obtained at 10-mm intervals, and a 512 x 512 reconstruction matrix. No patients had Pneumocystis carinii pneumonia within the 3 months preceding the CT scan examination. RESULTS: Numerous nodules (n = 42), tumoral masses (n = 28), bronchovascular pathways thickening (n = 35), and pleural effusions (n = 28) were the most frequent patterns. Septal lines (n = 15), ground-glass opacities (n = 3), and mediastinal adenopathies (n = 8) were not frequent. CONCLUSION: Numerous nodules, tumoral masses, bronchovascular pathways thickening, and bilateral pleural effusions were the main signs of intrathoracic KS; their association (66%) is very characteristic. An opportunistic infection or mycobacteriosis must be sought if the thin CT scans reveal ground-glass opacities and/or mediastinal adenopathies.
56 . Edinburgh, K. J., R. M. Jasmer, et al. (2000). "Multiple pulmonary nodules in AIDS: usefulness of CT in distinguishing among potential causes." Radiology 214(2): 427-32.
PURPOSE: To determine whether the computed tomographic (CT) appearances of multiple pulmonary nodules in patients with acquired immunodeficiency syndrome (AIDS) can help differentiate the potential infectious and neoplastic causes. MATERIALS AND METHODS: The thoracic CT scans obtained in 60 patients with AIDS and multiple pulmonary nodules were reviewed retrospectively by two thoracic radiologists who were blinded to clinical and pathologic data. The scans were evaluated for nodule size, distribution, and morphologic characteristics. CT findings were correlated with final diagnoses. RESULTS: Thirty-six (84%) of 43 patients with opportunistic infection had a predominance of nodules smaller than 1 cm in diameter, whereas 14 (82%) of 17 patients with a neoplasm had a predominance of nodules larger than 1 cm (P <.001). Of the 43 patients with opportunistic infection, 28 (65%) had a centrilobular distribution of nodules; only one (6%) of 17 patients with a neoplasm had this distribution (P <.001). Seven (88%) of eight patients with a peribronchovascular distribution had Kaposi sarcoma (P <.001). CONCLUSION: In patients with AIDS who have multiple pulmonary nodules at CT, nodule size and distribution are useful in the differentiation of potential causes. Nodules smaller than 1 cm, especially those with a centrilobular distribution, are typically infectious. Nodules larger than 1 cm are often neoplastic. A peribronchovascular distribution is suggestive of Kaposi sarcoma.
57 . Lewis, E. R., C. I. Caskey, et al. (1991). "Lymphoma of the lung: CT findings in 31 patients." AJR Am J Roentgenol 156(4): 711-4.
Lymphomatous involvement of the lungs is often a difficult clinical and radiologic diagnosis to make, yet is often critical in determining treatment. To better define the CT appearance of pulmonary lymphoma, we undertook a retrospective review of 31 patients with recurrent or secondary non-Hodgkin lymphoma or Hodgkin disease and lung parenchymal involvement on CT scans. Diagnoses were confirmed either by lung biopsy or by disease regression or progression with appropriate therapy. The CT scans were evaluated for the following findings: (1) nodules less than 1 cm, (2) a mass or masslike consolidation greater than 1 cm with or without cavitations or bronchograms, (3) alveolar or interstitial infiltrates, (4) masses of pleural origin, (5) peribronchial or perivascular thickening with or without atelectasis, (6) pleural effusions, and (7) hilar or mediastinal lymphadenopathy. The most common CT finding was a mass or masslike consolidation larger than 1 cm, seen in 21 (68%) of the 31 patients. The second most common finding was nodules less than 1 cm (19 patients). Sixty-eight percent of patients had three or more of the CT abnormalities. Lymphoma involving the lung parenchyma causes a variety of CT findings, the most common being a mass or masslike consolidation. Two-thirds of patients have more than one type of CT finding simultaneously.
58 . Ikezoe, J., S. Takashima, et al. (1988). "CT appearance of acute radiation-induced injury in the lung." AJR Am J Roentgenol 150(4): 765-70.
To determine how soon radiation-induced lung injury is detectable, to compare the CT findings with those on chest radiographs, and to observe the appearance of the abnormality during the acute phase, we performed 83 CT studies in 17 radiotherapy patients at relatively short intervals. All 17 patients received fractionated radiotherapy to the thorax with a large irradiated lung volume. The CT findings were variable; pulmonary infiltrates were homogeneous, patchy, or discrete. CT abnormalities were evident in 15 of 17 cases within 16 weeks after radiotherapy; in 13 of these it was detected within 4 weeks. In three of these 15 cases, no abnormality was detected on chest radiographs, and in three other cases, the change was observed much later on chest radiographs than on CT scans. In the other nine cases, abnormalities were detected simultaneously on CT scans and chest radiographs. In four cases, extensive radiation pneumonitis was observed on CT, but in two of these, the change was misdiagnosed on the chest radiograph. We conclude that CT is useful in the detection of acute radiation-induced pulmonary disease.
59 . Libshitz, H. I. and L. S. Shuman (1984). "Radiation-induced pulmonary change: CT findings." J Comput Assist Tomogr 8(1): 15-9.
Four patterns of radiation change in the lung were identified in 53 computed tomographic studies of 41 patients at various times following completion of radiotherapy. (a) The homogeneous pattern shows slight increase in density uniformly involving irradiated portions of lung and is believed to represent a diffuse, minimal radiation pneumonitis. (b) Patchy consolidation is contained within irradiated lung but does not conform to the shape of the radiation field. It is analogous to radiation pneumonitis seen on chest radiographs. (c) Discrete consolidation that conforms to the radiation portal but does not uniformly involve it has several possible analogues. (d) Solid consolidation totally involves the irradiated lung and contains ectatic bronchi within it. This finding is analogous to radiation fibrosis. The temporal sequence and dose relationships of these appearances are discussed and related to those seen with conventional studies.
60 . Pagani, J. J. and H. I. Libshitz (1982). "CT manifestations of radiation-induced change in chest tissue." J Comput Assist Tomogr 6(2): 243-8.
The computed tomographic appearance of acute and chronic radiation change in the thorax is described. Acute radiation pneumonitis demonstrates patchy, confluent regions of increased pulmonary attenuation. Chronic changes include soft tissue density fibrotic changes that blend smoothly with the pleural surfaces and adjacent mediastinal structures. Also seen are bronchiectatic changes and distortion of normal intrathoracic anatomic relationships. Both the acute and chronic changes usually make linear lateral margins with adjacent aerated lung. Development of a discrete mass or focal cavitation after the radiation changes have become stable is suspect for recurrent tumor or infection.
61 . Park, K. J., J. Y. Chung, et al. (2000). "Radiation-induced lung disease and the impact of radiation methods on imaging features."
Radiographics 20(1): 83-98. Although radiologic findings in radiation-induced lung disease are well described in the literature, the influence exerted on these findings by different radiation methods is not well understood. Radiation treatment of non-small cell lung cancer varies depending on the location and extent of disease. Irradiation with oblique beam angles results in unusual distribution of radiation-induced lung disease. Small cell lung cancer is treated with irradiation concurrent with or following chemotherapy, and portal arrangements are controversial. In breast cancer, use of tangential beam portals may induce radiation pneumonitis or fibrosis at the peripheral lung anterolaterally. Use of supraclavicular portals may produce lesions in the lung apex that appear similar to pulmonary tuberculosis. In esophageal cancer, radiation portals with a 5-6-cm margin above and below the tumor are generally recommended, and computed tomography (CT) frequently demonstrates radiation-related lung damage adjacent to the mediastinum. In mediastinal tumors, the mantle field includes all the major lymph node regions above the diaphragm. Radiation pneumonitis varies from minimal to extremely marked change in the paramediastinal areas and in both apices. CT is more sensitive to radiation-induced lung disease than chest radiography and demonstrates related changes earlier. Furthermore, it more clearly depicts the precise distribution and pattern of disease. Familiarity with the imaging findings in radiation- induced lung disease produced by different radiation methods will help radiologists interpret abnormalities seen at chest radiography and CT in affected patients.
62 . Kuhlman, J. E. (1991). "The role of chest computed tomography in the diagnosis of drug-related reactions." J Thorac Imaging 6(1): 52-61.
Computed tomography (CT) of the chest provides important information toward the diagnosis of drug-induced lung disease. CT's ability to demonstrate subtle parenchymal and pleural changes, small nodules, and adenopathy is valuable in the early detection of drug-related reactions. CT is also of value in monitoring the appearance, progression, and resolution of pulmonary damage in patients receiving potentially toxic drugs. The CT appearances of specific drug reactions are reviewed, including the spectrum of CT findings in bleomycin toxicity and amiodarone-induced lung disease.
63 . Padley, S. P., B. Adler, et al. (1992). "High-resolution computed tomography of drug-induced lung disease." Clin Radiol 46(4): 232-6.
In order to determine the potential clinical utility of high-resolution CT (HRCT) in the assessment of drug-induced lung disease, we reviewed the chest radiographs and HRCT scans of 23 patients and five normal controls. The radiographs and HRCT scans were reviewed separately in random order by two independent observers who were not aware of the relative numbers of patients and controls. Abnormal findings were detected in the affected patients in 17/23 radiographs compared to 23/23 HRCT scans. The patients included five cases of bleomycin toxicity, five cases of nitrofurantoin toxicity, two cases each of penicillamine, busulphan, BCNU and amiodarone toxicity, and one case each of cyclophosphamide, procainamide, mitomycin and methotrexate toxicity. The HRCT appearances could be grouped into four categories according to their dominant pattern and distribution of disease. These include fibrosis with or without consolidation (n = 12), ground-glass opacities (n = 7), widespread bilateral consolidation (n = 2), and bronchial wall thickening with areas of decreased attenuation (n = 2). The results of this study indicate that HRCT is more sensitive than the radiograph in the detection of drug-induced lung disease. The appearances demonstrated by HRCT reflect the pathological mechanisms of drug-induced lung disease.
64 . Pietra, G. G. (1991). "Pathologic mechanisms of drug-induced lung disorders." J Thorac Imaging 6(1): 1-7.
The pathology of drug-induced lung disease is approached on the basis of patterns of tissue reaction in this review. The entities described include various pathologic lesions, from diffuse alveolar damage to interstitial pneumonias and angiopathies. Because the histopathologic manifestations of drug injury are variable and nonspecific, pathogenetic mechanisms are emphasized. Drugs may cause injury by direct toxicity or by triggering immunologic responses, but often this neat distinction is blurred by the combined effects of preexisting lung injury and the concurrent administration of several drugs. Thus the identification of drug-induced lung disease requires thorough knowledge of the clinical history and rigorous analysis of histopathologic features.
65 . Nishiyama, O., Y. Kondoh, et al. (2000). "Serial high resolution CT findings in nonspecific interstitial pneumonia/fibrosis." J Comput Assist Tomogr 24(1): 41-6.
PURPOSE: The purpose of this work was to evaluate the radiographic and serial high resolution CT (HRCT) findings in patients with nonspecific interstitial pneumonia/ fibrosis (NSIP). METHOD: We identified 15 patients with biopsy-proven NSIP. Radiography and initial and follow-up CT findings were reviewed. RESULTS: Predominant radiographic findings were bilateral infiltrates distributing in the middle and lower lung zones and decreased lung volumes. At initial CT, predominant patterns were peribronchovascular interstitial thickening (n = 6), parenchymal bands (n = 8), intralobular interstitial thickening (n = 12), and traction bronchiectasis (n = 14). Mixed pattern of ground-glass opacity and consolidation (n = 11) were predominant findings of increased lung opacity. At follow-up CT in 14 cases, the abnormalities had disappeared completely in 3, improved in 9, persisted in 1, and worsened in 1. CONCLUSION: The pulmonary abnormalities observed in NSIP on HRCT can disappear or be diminished in most cases after corticosteroid therapy. Intralobular interstitial thickening and traction bronchiectasis, which have been considered to be indicators of irreversible fibrosis, also show favorable responses.
66.Grenier P.(2000)." Scanographie haute-résolution: le verre dépoli". 11é journées d'imagerie thoracique de la Pitié-Salpétriere 2000, Hopital de la Pitié-Salpetriere (Paris): 43-7.
67.Lee KS, Kim TS, Han J, et al. Diffuse micronodular lung disease: HRCT and pathologic findings. J Comput Assist Tomogr 1999;23(1):99-106.
PURPOSE: The purpose of our study was to compare the findings seen on HRCT with those from pathologic examination in patients with diffuse micronodular lung disease (DMLD). METHOD: Forty consecutive patients with biopsy-proven DMLD (each nodule being 5 mm in diameter and occupying more than two-thirds of lung volume on chest radiograph) were included. High resolution CT (HRCT) scans were analyzed with particular attention to the location of nodules in and around the secondary pulmonary lobule (centrilobular, perilymphatic, and random) and the zonal distribution. The findings were compared to pathology. RESULTS: CT scans showed centrilobular nodules in the patients with diffuse panbronchiolitis (n = 4), infectious bronchiolitis [n = 4; Hemophilus influenzae (n = 3) and Mycoplasma pneumoniae (n = 1)], hypersensitivity pneumonia (n = 3), bronchogenic disseminated tuberculosis (n = 3), pneumoconiosis (n = 1), primary lymphoma of the lung (n = 1), and foreign body-induced necrotizing vasculitis (n = 1). They demonstrated perilymphatic nodules in the patients with pneumoconiosis (n = 5), sarcoidosis (n = 2), and amyloidosis (n = 2). They demonstrated micronodules of random distribution in the patients with miliary tuberculosis (n = 9) and pulmonary metastasis (n = 5). Upper and middle zonal predominance was seen in two of two patients with sarcoidosis and in two of six patients with pneumoconiosis. The CT location of nodules in the secondary pulmonary lobule represented the location and nature of the lesion on pathologic examination. CONCLUSION: By showing the distribution of micronodules in and around the secondary pulmonary lobule, HRCT enables the narrowing of the differential diagnosis of DMLD. CT findings reflect gross morphologic features of pathologic examination.
68.Grenier P.(2000)." Scanographie haute-résolution: le syndrome nodulaire". 11é journées d'imagerie thoracique de la Pitié-Salpétriere 2000, Hopital de la Pitié-Salpetriere (Paris): 59-70.
69. MacDonald SL, Rubens MB, Hansell DM, et al. Nonspecific Interstitial Pneumonia and Usual Interstitial Pneumonia: Comparative Appearances at and Diagnostic Accuracy of Thin-Section CT. Radiology 2001;221(3):600-5.
PURPOSE: To compare the morphologic abnormalities on thin-section computed tomographic (CT) images in a group of patients with histopathologically confirmed nonspecific interstitial pneumonia (NSIP) or usual interstitial pneumonia (UIP) and a clinical presentation of idiopathic pulmonary fibrosis. MATERIALS AND METHODS: Thin-section CT imaging patterns and distribution of disease in 53 patients with histologic diagnoses of NSIP (n = 21) or UIP (n = 32) were quantified retrospectively and independently by four observers. The appearances of NSIP and UIP at CT were compared with univariate and multivariate techniques. RESULTS: The use of thin-section CT proved to have moderate sensitivity (70%), specificity (63%), and accuracy (66%) in the diagnosis of NSIP. An increased proportion of ground-glass attenuation was the cardinal feature of NSIP at CT (odds ratio: 1.04 for each 1% increase in the proportion of ground-glass attenuation). A histologic diagnosis of NSIP was most frequent (in 24 of 35 observations [69%]) when ground-glass attenuation predominated, and was more frequent with mixed (35 of 79 observations [44%]) than with predominantly reticular disease (25 of 98 [26%] observations, P <.005). Logistic regression analysis of the data indicated that misdiagnosis of UIP in patients with NSIP was associated with less ground-glass attenuation (P <.005) at CT and a subpleural disease distribution (P =.02), with the converse being true for UIP cases misdiagnosed as NSIP. CONCLUSION: In patients with a clinical presentation of idiopathic pulmonary fibrosis, the accuracy of thin-section CT in identifying NSIP is considerably higher than previously reported. At CT, NSIP is characterized by more ground-glass attenuation and a finer reticular pattern than is UIP. Nevertheless, considerable overlap in thin-section CT patterns exists between NSIP and UIP.
70. Ferretti G. Imagerie des pneumopathies infiltrantes diffuses liées à la polymyosite-dermatomyosite. imageriedes connectivites et des vascularites, société d'imagerie thoracique, journée de printemps du 11/05/2001 2001, Hopital Tenon, Paris.