CT manifestations of late sequelae in patients with tuberculous pleuritis.
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Adult↗
Biomedical subjects
E Y Kang
Publications and source records attributed to E Y Kang.
CT bronchus sign in malignant solitary pulmonary lesions: value in the prediction of cell type.
The aim of this study was to evaluate differences in the prevalence of patterns of CT bronchus sign in malignant solitary pulmonary lesions (SPLs), according to their histologic cell types and with respect to size, location, and degree of cell differentiation. Computed tomography scans of 78 patients, in whom pathologically confirmed malignant SPLs with CT bronchus sign were present, were randomly selected and reviewed by two radiologists under consensus. All 78 were CT scans done using spiral technique with 10-mm collimation and 10-mm reconstruction intervals with enhancement, and 75 included additional high-resolution CT scans. Lesions were classified into four cell types as squamous cell carcinoma (n = 24), small cell carcinoma (n = 12), adenocarcinoma (n = 23), bronchioloalveolar carcinoma (BAC; n = 9), and others (n = 12), into three degrees of differentiation, into three size groups, and according to location (central or peripheral). Patterns of CT bronchus sign were classified into abruptly obstructing (I), patent (II), displacing (III), or tapered narrowing (IV) types. The relationships between the patterns of CT bronchus sign and cell type and degree of cell differentiation were evaluated. Eighty patterns of CT bronchus sign were observed in 78 patients. According to cell type, squamous cell carcinoma showed most often type-I pattern (45.8%) but no type-II pattern, which was the most common pattern observed in BAC (77.8%) and adenocarcinoma (34.8%; p<0.01). Small cell carcinoma showed a varied distribution among the four patterns of CT bronchus sign. According to location, in central squamous cell carcinomas, type-I pattern was more common(55%; p<0.01). Bronchioloalveolar carcinoma showed more peripheral lesions and in both central and peripheral lesions, type-II pattern was significantly more common (100 and 66.7%; p<0.01). In SPLs with CT bronchus sign of obstructing pattern, especially if central location, squamous cell carcinoma should be suspected, whereas in SPLs with patent CT bronchus sign, regardless of the location, the strong possibility of BAC should be considered.
Adult↗
Evaluating porcelain color match of different porcelain shade-matching systems.
PURPOSE: This in vitro study was designed to evaluate the new ShadeEye-EX Chroma Meter and a new visual porcelain shade-matching system (Vitapan 3-D Master, Omega 900) in comparison to the traditionally used visual porcelain shade-matching system (Vita Lumin Vacuum, VMK 68). MATERIALS AND METHODS: Shade matches and porcelain fabrications on individualized shade tabs were carried out. The fabricated porcelain tabs were evaluated against the respective natural tooth using the United States Public Health Service (USPHS) criteria to determine clinically acceptable match. The tabs also were ranked according to the final-color match to the corresponding natural tooth. RESULTS: The percentage of clinically acceptable color matches were as follows: Vita Lumin Vacuum (46.67%), ShadeEye-EX (40%), and Vitapan 3-D Master (56.67%). The generalized estimating equation (alpha = 0.5) showed no statistically significant difference between systems in obtaining a clinically acceptable match (p = .5729). The chi-squared test (alpha = 0.5) showed no statistically significant difference between systems in terms of rank order (p = .5017). The two new systems do not produce color match that is better than the conventional visual porcelain shade-matching system.
Chi-Square Distribution↗
Endobronchial actinomycosis simulating endobronchial tuberculosis: a case report.
We report a case of a 70-year-old woman who presented with mild exertional dyspnea and cough. Fiberoptic bronchoscopic findings revealed an endobronchial polypoid lesion with stenotic bronchus. The lesion was very similar to endobronchial tuberculosis. Histologic examination of the biopsy specimen demonstrated Actinomyces infection. There was a clinical response to intravenous penicillin therapy. Primary endobronchial actinomycosis must be considered in the differential diagnosis of an endobronchial lesion, especially endobronchial tuberculosis in Korea.
Actinomycosis↗
Nested polymerase chain reaction for detection of Mycobacterium tuberculosis in solitary pulmonary nodules.
BACKGROUND: Differential diagnosis of solitary pulmonary nodules (SPNs) can be difficult in areas, such as Korea, where tuberculosis is endemic. Nested polymerase chain reaction (PCR) is a widely used method to test a very small amount of pathogen and to detect Mycobacterium tuberculosis from fine needle aspirates. OBJECTIVES: The usefulness of nested PCR for the detection of M tuberculosis from tuberculous SPN and for the differential diagnosis of SPN was evaluated. METHODS: Thirty-three patients in whom a diagnosis of SPN was made based on a CT scan of the chest were enrolled in this study. Included were 17 malignant and 16 benign SPNs. Nested PCR was carried out for the detection of M tuberculosis by using TB-1, TB-2, TB-28, and TB-29C on fine needle aspirates from the nodule in all 33 cases. RESULTS: Aspirates from malignant neoplasms, pneumonia, and sequestration were all negative on nested PCR for tuberculosis. One of the three radiologically suspected tuberculous nodules without response to anti-tuberculosis drugs (uncertain) yielded positive results on nested PCR for the detection of M tuberculosis. In contrast, 7 out of 8 (87.5%) aspirates from proven tuberculous nodules showed positive results on nested PCR. Nested PCR could be used to detect M tuberculosis in fine needle aspirates from tuberculous SPNs with good sensitivity (87.5%) and specificity (96.0%). CONCLUSION: Nested PCR for the detection of M tuberculosis in fine needle aspirates may be useful in the differential diagnosis of SPNs.
Biopsy, Needle↗
CT in blunt chest trauma: pulmonary, tracheobronchial, and diaphragmatic injuries.
Routine use of CT in the initial evaluation of blunt chest trauma is controversial. CT however, has been shown to be useful in the diagnosis of unsuspected chest injuries and in directing therapeutic interventions. This review discusses the CT findings in patients with pulmonary, tracheobronchial, and diaphragmatic injuries after blunt chest trauma.
Adult↗
Miliary tuberculosis. Diagnostic accuracy of chest radiography.
STUDY OBJECTIVE: To assess the efficacy of the chest radiograph in identifying patients with miliary tuberculosis. DESIGN: Retrospective case-controlled review by three independent blinded chest radiologists. SETTING: Provincial tuberculosis control center. PATIENTS: Population-based sample, including all proved cases of miliary tuberculosis diagnosed in the Province of British Columbia, Canada, between November 1982 and November 1992. One hundred cases of miliary tuberculosis were identified, of which 71 had chest radiographs available for review. Forty-four normal chest radiographs and 20 chest radiographs of patients with localized pulmonary tuberculosis were also included as controls. MAIN OUTCOME MEASURES: The primary outcome of measurements was the sensitivity and interobserver variability of the chest radiograph in the diagnosis of miliary tuberculosis. The observers were also asked to describe the pattern and extent of pulmonary abnormalities based on the International Labor Organization (ILO) classification of pneumoconioses. RESULTS: The three independent observers identified 42, 44, and 49 of the 71 cases of miliary tuberculosis, respectively (sensitivity, 59 to 69%). The three observers incorrectly diagnosed miliary tuberculosis in 2, 0, and 2 of the 64 controls, respectively (specificity, 97 to 100%). There was good interobserver agreement (90%, kappa = 0.77). The nodules measured less than 3 mm in diameter in 90% of cases in which miliary tuberculosis was correctly identified. In 10% of cases, the nodules measured greater than 3 mm in diameter. The ILO profusion scores ranged from mild (profusion score 1) in 45% of cases, through moderate (profusion score 2) in 27%, and severe (profusion score 3) in 28%. CONCLUSIONS: The chest radiograph allowed identification of 59 to 69% of cases of miliary tuberculosis with a high specificity and good interobserver agreement.
Adolescent↗
Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia. Assessment with serial CT.
OBJECTIVE: To determine the outcome of areas of ground-glass attenuation and assess disease progression on serial high-resolution CT (HRCT) scans of patients with biopsy specimen-proved usual interstitial pneumonia (UIP) and desquamative interstitial pneumonia (DIP). MATERIALS AND METHODS: Twelve patients with biopsy specimen-proved UIP and 11 patients with biopsy specimen-proved DIP who had initial and follow-up HRCT scans (median interval, 10 months) were reviewed. Eleven patients with UIP and 11 with DIP received treatment between the initial and follow-up CT scans. The scans were evaluated for the presence and extent of ground-glass attenuation, irregular linear opacities and honeycombing, and overall extent of parenchymal involvement. RESULTS: On initial CT scans, all 12 patients with UIP had areas of ground-glass attenuation (mean +/- SD extent, 30 +/- 16%) and irregular lines (mean +/- SD extent, 17 +/- 7%) and 10 patients had honeycombing (mean +/- SD extent, 10 +/- 6%). All 11 patients with DIP had areas of ground-glass attenuation on initial HRCT scans (mean +/- SD extent, 51 +/- 26%), 5 patients had irregular linear opacities (mean +/- SD extent, 5 +/- 5%), and 1 patient had honeycombing. Nine of the 12 patients with UIP showed increase in the extent of ground-glass attenuation (n = 6) or progression to irregular lines (n = 2) or honeycombing (n = 4) on follow-up as compared with only 2 patients with DIP who showed progression to irregular lines (n = 1) or honeycombing (n = 1) (p < 0.01 chi 2 test). CONCLUSION: In patients with UIP, areas of ground-glass attenuation usually increase in extent or progress to fibrosis despite treatment. Areas of ground-glass attenuation in most patients with DIP remain stable or improve with treatment.
Adult↗
Detection and differential diagnosis of pulmonary infections and tumors in patients with AIDS: value of chest radiography versus CT.
OBJECTIVE: The purpose of this study was to compare the sensitivity and specificity of chest radiography with those of CT in the detection of pulmonary infections and tumors in patients with AIDS. MATERIALS AND METHODS: The study was retrospective and included the radiographs and CT scans of 139 patients. Eighty-nine had one proven thoracic complication, 17 had two proven thoracic complications, and 33 had no active intrathoracic disease at the time of the examinations. The radiographs and CT scans were interpreted blindly by two independent observers from different institutions. The observers assessed for the presence or absence of intrathoracic disease and recorded the most likely diagnosis and the degree of confidence in that diagnosis. RESULTS: The patients were more commonly correctly identified as having or not having intrathoracic disease on the basis of CT findings than on the basis of radiographic findings ( p < .01, chi-square test). Of the 106 patients with intrathoracic complications, 90% (191 of 212 interpretations) were correctly identified by the two observers on the radiograph and 96% (204 of 212 interpretations) at CT. Of 33 patients without intrathoracic disease, 73% (48 of 66 interpretations) were correctly identified at radiography and 86% (57 of 66 interpretations) at CT. Of 89 patients with one proved thoracic complication, the observers confident in their first-choice diagnosis in 34% of the cases (61 of 178 interpretations) at chest radiography and in 47% (83 of 178 interpretations) at CT. This diagnosis was correct in 67% (41 of 61) of confident radiographic interpretations as compared with 87% (72 of 83) of interpretations at CT (p < .01, chi-square test). CONCLUSION: CT is superior to chest radiography in allowing identification of patients with and without thoracic disease and in the differential diagnosis of pulmonary complications of patients with AIDS. However, the improvement in differential diagnosis is modest. Because in most cases the radiographs and CT scans were obtained as part of the clinical evaluation, the study is probably biased toward problematic clinical cases. In the majority of patients, the chest radiograph provides adequate information and CT is not warranted.
AIDS-Related Opportunistic Infections↗
Interlobular septal thickening: patterns at high-resolution computed tomography.
Thickening of the interlobular septa is a common and easily recognizable finding at high-resolution computed tomography (HRCT; 1-2 mm collimation high-spatial-frequency reconstruction algorithm). Interlobular septal thickening at HRCT can be smooth, nodular, or irregular in contour. It may be due to fluid, cellular infiltration, or fibrosis. Apparent thickening of septa at HRCT may also be due to abnormalities in the periphery of the secondary pulmonary lobule adjacent to but not involving the interlobular septa. This article illustrates the patterns of interlobular septal thickening at HRCT in various disease entities.
Adult↗
Acute lung disease in the immunocompromised host: differential diagnosis at high-resolution CT.
The aim of this manuscript is to review the CT findings of pulmonary complications seen in acquired immunodeficiency syndrome (AIDS) and in non-AIDS immunocompromised patients. The most common pulmonary complications in patients with AIDS include infection, Kaposi's sarcoma, and AIDS-related lymphoma. The most common complications seen in non-AIDS immunocompromised patients include infection, drug-induced lung disease, diffuse pulmonary hemorrhage, and pulmonary edema.
Acquired Immunodeficiency Syndrome↗
Diaphragmatic rupture: CT findings in 11 patients.
PURPOSE: To determine the signs of diaphragmatic rupture at computed tomography (CT) and the frequency of preoperative diagnosis with CT. MATERIALS AND METHODS: CT scans in 11 consecutive patients with surgically proved tears of the diaphragm due to blunt trauma were reviewed by two chest radiologists. The observers assessed the presence of discontinuity of the diaphragm, herniation of abdominal viscera or omentum, and waistlike constriction of the herniated stomach or bowel (collar sign). Hospital records were reviewed to confirm surgical findings and ascertain whether the diagnosis has been suggested at CT. RESULTS: In eight of 11 patients, rupture of the diaphragm was on the left, and in three it was on the right. In nine patients, diagnostic findings were identified retrospectively on CT scans; these included discontinuity of the diaphragm (n = 9), herniation of the abdominal organs or bowel (n = 7), and constriction of the stomach (n = 3). CONCLUSION: CT enables detection of most diaphragmatic tears due to blunt trauma.
Adult↗
Bronchiectasis: comparison of preoperative thin-section CT and pathologic findings in resected specimens.
PURPOSE: To compare thin-section computed tomographic (CT) and pathologic findings in patients who have undergone resection for bronchiectasis. MATERIALS AND METHODS: Twenty-two consecutive patients underwent thin-section CT (1.0-1.5-mm collimation) and resection for bronchiectasis. CT scans were reviewed by two observers without knowledge of the pathologic findings. The presence and extent of bronchiectasis and associated findings were assessed. All pathologic specimens were reviewed by a pathologist. RESULTS: Forty-seven lobes had pathologically proved bronchiectasis. CT allowed detection of bronchiectasis in 41 lobes (87%). CT findings included lack of tapering of bronchial lumina (n = 37), internal diameter of bronchi greater than that of the adjacent pulmonary artery (n = 28), visualized bronchi within 1 cm of pleura (n = 21), and mucus-filled dilated bronchi (n = 3). Forty lobes had bronchiolitis. CT scans depicted bronchiolitis in 30 lobes (75%). CT findings of bronchiolitis included mosaic perfusion (n = 21), bronchiolectasis (n = 17), and centrilobular nodules or branching areas of soft-tissue attenuation (n = 10). CONCLUSION: Thin-section CT depicted bronchiectasis in most of the resected bronchiectatic lobes.
Adolescent↗
Invasive pulmonary aspergillosis in AIDS: radiographic, CT, and pathologic findings.
PURPOSE: To review the radiographic and computed tomographic (CT) manifestations of invasive pulmonary aspergillosis and to correlate the imaging and pathologic findings in patients with acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: Chest radiographs, CT scans, and pathologic specimens were reviewed retrospectively in 10 AIDS patients with proved invasive pulmonary aspergillosis. RESULTS: The most common radiographic finding was the presence of thick-walled cavitary lesions. Less common findings included nodules, consolidation, and pleural effusion. CT depicted more nodules and cavities than did radiography. The predominant pathologic abnormalities consisted of tissue invasion and abscess formation and angioinvasion with or without infarction. All patients had infection with Aspergillus fumigatus as well as other pathogens, the most common being cytomegalovirus and Pseudomonas aeruginosa. CONCLUSION: Thick-walled cavitary lesions are the most common radiologic manifestation of invasive pulmonary aspergillosis in AIDS. The findings are more numerous and better defined on CT scans. The radiologic findings reflect a spectrum of pathologic abnormalities.
AIDS-Related Opportunistic Infections↗
Analysis of the carbohydrate composition of glycoproteins by high-performance liquid chromatography.
A procedure for rapid and sensitive analysis of carbohydrate in glycoproteins is described. After methanolysis and benzoylation of the monosaccharides and carbohydrates of a glycoprotein, the derivatized sugars were analyzed by reverse-phase high-performance chromatography using a Vydac C18 stationary phase and a mobile phase composed of a water/acetonitrile gradient. The advantages of this procedure over previously described methods are (1) the simple binary solvent system which is used requires no buffering salts and (2) separate sets of peaks from individual sugars obviate the usual need to reacetylate sugar amino groups.
Carbohydrates↗
Cytomegalovirus pneumonia in transplant patients: CT findings.
OBJECTIVE: Our goal was to assess the CT findings of cytomegalovirus (CMV) pneumonia in transplant patients. MATERIALS AND METHODS: The study included 10 transplant patients who had chest CT scan and pathologically proven isolated pulmonary CMV infection. Five patients had bone marrow transplant and five had solid organ transplant. The CT scans were retrospectively reviewed for pattern and distribution of disease and the CT findings compared with the findings on open lung biopsy (n = 9) and autopsy (n = 1). RESULTS: Nine of 10 patients had parenchymal abnormalities apparent at CT and 1 had normal CT scans. The findings in the nine patients included small nodules (n = 6), consolidation (n = 4), ground-glass attenuation (n = 4), and irregular lines (n = 1). The nodules had a bilateral and symmetric distribution and involved all lung zones. The consolidation was most marked in the lower lung zones. CONCLUSION: The CT findings of CMV pneumonia in transplant patients are heterogeneous. The most common patterns include small nodules and areas of consolidation.
Adolescent↗
CT of chronic infiltrative lung disease: prevalence of mediastinal lymphadenopathy.
OBJECTIVE: Our goal was to determine the prevalence of mediastinal lymph node enlargement at CT in patients with diffuse infiltrative lung disease. MATERIALS AND METHODS: The study was retrospective and included 175 consecutive patients with diffuse infiltrative lung diseases. Diagnoses included idiopathic pulmonary fibrosis (IPF) (n = 61), usual interstitial pneumonia associated with collagen vascular disease (CVD) (n = 20), idiopathic bronchiolitis obliterans organizing pneumonia (BOOP) (n = 22), extrinsic allergic alveolitis (EAA) (n = 17), and sarcoidosis (n = 55). Fifty-eight age-matched patients with CT of the chest performed for unrelated conditions served as controls. The presence, number, and sites of enlarged nodes (short axis > or = 10 mm in diameter) were recorded. RESULTS: Enlarged mediastinal nodes were present in 118 of 175 patients (67%) with infiltrative lung disease and 3 of 58 controls (5%) (p <0.001). The prevalence of enlarged nodes was 84% (46 of 55) in sarcoidosis, 67% (41 of 61) in IPF, 70% (14 of 20) in CVD, 53% (9 of 17) in EAA, and 36% (8 of 22) in BOOP. The mean number of enlarged nodes was higher in sarcoidosis (mean 3.2) than in the other infiltrative diseases (mean 1.2) (p <0.001). Enlarged nodes were most commonly present in station 10R, followed by 7, 4R, and 5. CONCLUSION: Patients with infiltrative lung disease frequently have enlarged mediastinal lymph nodes. However, in diseases other than sarcoid, usually only one or two nodes are enlarged and their maximal short axis diameter is <15 mm.
Adult↗
Pulmonary involvement of idiopathic hypereosinophilic syndrome: CT findings in five patients.
PURPOSE: The aim of this study was to assess the CT findings of pulmonary involvement in patients with idiopathic hypereosinophilic syndrome (HES). METHOD: The study included five patients with idiopathic HES who had pulmonary involvement proven by bronchoalveolar lavage (n = 3) or based on clinical and radiologic findings (n = 2). Four patients had high resolution CT and one had conventional CT. The CT scans were retrospectively reviewed by two chest radiologists for pattern and distribution of disease. RESULTS: All five patients had several small nodules in both lungs at CT scan. Four patients had nodules with a halo of ground-glass attenuation. Three patients had focal areas of ground-glass attenuation in both lungs. These lesions were present in all lung zones and involved mainly the peripheral lung. There was neither lobar predilection nor peribronchovascular distribution. Other organs involved included bone marrow (n = 3), liver (n = 3), stomach (n = 1), and peritoneum (n = 1). CONCLUSION: The CT findings of pulmonary involvement in patients with idiopathic HES included small nodules with or without a halo of ground-glass attenuation and focal areas of ground-glass attenuation mainly in the lung periphery.
Adult↗