Small solitary pulmonary nodules: assessment of enhancement and enhancement patterns in benign and malignant tumours by high resolution computed tomography.
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Our aim was to determine the accuracy of quantitative and qualitative findings of contrast-enhanced computed tomography (CT) by means of differential analysis of small uncalcified solitary pulmonary nodules and to compare the CT diagnosis with the results of transthoracic needle biopsies (TTNB). We assessed a consecutive series of 109 patients with 66 malignant or 45 benign pulmonary nodules before TTNB and surgery with contrast and high resolution computed tomography (HRCT). Pulmonary nodules were classified as small when equal to or smaller than 15 mm and large when larger than 15 mm. Diagnostic accuracy of CT qualitative evaluation was 95% for large nodules and 92% for small nodules. Specificity was 92% for small nodules, 80% for large nodules. Enhancing regular septa were observed in 28 hamartomas (80%) while except for two cases (3%), inner septa were absent or irregular in malignant tumours. TTNB accuracy was 70% for small nodules and 94% for large ones. Low-enhancing hamartomas are more frequent in Italy than in the US where the prevalence of high-enhancing granulomas in benign nodules reduces the specificity of quantitative CT analysis. We propose that certain geographic areas would benefit from enhanced-CT in place of TTNB in managing lung nodules equal to or less than 1.5 cm.Keywords:
Contrast Enhancement
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Objective To study the imaging features of adrenal myelolipoma and differential diagnosis.Methods The imaging findings of 17 cases of adrenal myelolipoma proved by surgery and pathology were retrospectively analyzed.Results Of 17 cases on CT scan,there were 9 cases of low density mass,7 cases of confounding density mass,1 case of parenchyma mass,8 case of calcification,1 case of bleeding in the area of adrenal.There was no obviously increase in the density on contrast scan in 11 cases.Four cases examined with MRI showed high signal in T1WI and T2WI in the area of right adrenal.Conclusion CT and MRI scan are very useful in the diagnosis of the adrenal myelolipoma.
Myelolipoma
Hounsfield scale
Contrast Enhancement
Parenchyma
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Objective By analyzing and summarizing a variety of imaging findings of pulmonary cavitary lesions to provide a theoretical basis for clinical diagnosis and differential diagnosis of lung cavitary lesions.Methods Selected 186 cases of pulmonary cavitary lesions confirmed by imaging,sputum,puncture and pathological diagnosis in our hospital and evaluated the imaging features of various diseases caused by pulmonary cavitary lesions.Results After diagnosis,we found 63 cases of tuberculosis;46 cases of lung cancer;38 cases of abscess;39 cases of pulmonary aspergillosis,128 cases of single cavity(72 cases of upper lobe,56 cases of lung lower lobe) and 58 cases of both lungs coincided with cavity.Conclusion X-ray and CT have important clinical value in the diagnosis of pulmonary cavitary lesions.Clinicians should consider a comprehensive imaging data to grasp the different clinical imaging features of cavity lesions to improve diagnostic accuracy.
Lung abscess
Tuberculoma
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Objectives To describe the morphologic appearance over time of percutaneously radiofrequency-ablated pulmonary metastases from colorectal cancer and to focus on the occurrence of the most common complications. Methods Twenty patients have been treated with computed tomography (CT)–guided radiofrequency ablation (RFA) for 41 pulmonary metastases using the expandable 14-gauge StarBurst XL RF electrode along with the 1500 generator (RITA Medical Systems, Mountain View, CA). The average number of lesions per patient was 2.05, ranging from 1 to 4 lesions. Results The typical feature of the radiofrequency-ablated site immediately after the procedure was a light bulb–shaped opacification surrounding the probe. This became a more spherically shaped feature over time and steadily decreased in size. At 3 months after RFA, the lesion was approximately the same size as at baseline. The lesion subsequently shrank within the following 3 months, usually with a small scar remaining. Pneumothorax occurred in 50% of the patients, and a chest tube was required in 50% of the patients affected. Cavitation occurred in 24% of the lesions. Intraparenchymal hemorrhage was observed in 7.5% of the cases. Conclusions Image-guided pulmonary RFA is a safe minimally invasive therapy modality with acceptable morbidity. Ablated lesion size usually exceeds the dimensions of the initial tumor for the first 3 months after ablation and continuously shrinks thereafter.
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Hepatic echinococcosis generally gives rise to typical signs by ultrasound and computed tomography, even though a relatively large number of conditions has to be considered in the differential diagnosis. Comparing the two methods in 29 patients with manifestations of hepatic involvement by echinococcosis it was demonstrated that ultrasound is only slightly inferior, in cases of small-size involvement, which fails to be diagnosed as focal disease of the liver parenchyma. But ultrasound is the primary method of investigation, especially when the differential diagnosis is still open, and it is preferred for serial studies during and after treatment. Computed tomography is the method of choice particularly when it is necessary pre-operatively to document involvement beyond the liver itself.
Liver parenchyma
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Liver tumor
Metastatic carcinoma
Primary tumor
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Nodule (geology)
Lung biopsy
Aspiration biopsy
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This study aimed to evaluate the clinical benefits and risks of CT-guided percutaneous transthoracic needle lung biopsies (PTNBs) in patients with a suspected pulmonary infection.This study included 351 CT-guided PTNBs performed in 342 patients (mean age, 58.9 years [range, 17-91 years]) with suspected pulmonary infection from January 2010 to December 2016. The proportion of biopsies that revealed the causative organism for pulmonary infection and that influenced patient's treatment were measured. Multivariate analyses were performed to identify factors associated with PTNB that revealed the causative organism or affected the treatment. Finally, the complication rate was measured.CT-guided PTNB revealed the causative organism in 32.5% of biopsies (114/351). The presence of necrotic components in the lesion (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1-2.7; p = 0.028), suspected pulmonary tuberculosis (OR, 2.0; 95% CI, 1.2-3.5; p = 0.010), and fine needle aspiration (OR, 2.5; 95% CI, 1.1-5.8; p = 0.037) were factors associated with biopsies that revealed the causative organism. PTNB influenced patient's treatment in 40.7% (143/351) of biopsies. The absence of leukocytosis (OR, 1.9; 95% CI, 1.0-3.7; p = 0.049), presence of a necrotic component in the lesion (OR, 2.4; 95% CI, 1.5-3.8; p < 0.001), and suspected tuberculosis (OR, 1.7; 95% CI, 1.0-2.8; p = 0.040) were factors associated with biopsies that influenced the treatment. The overall complication rate of PTNB was 19% (65/351).In patients with suspected pulmonary infection, approximately 30-40% of CT-guided PTNBs revealed the causative organism or affected the treatment. The complication rate of PTNB for suspected pulmonary infection was relatively low.
Leukocytosis
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Radiologic findings are important in narrowing differential diagnosis. This becomes imperative in unusual presentation of diseases. An uncommon finding on lung imaging is Cheerios signs. It is described as lesions with hypodense center and noticeable rim. These lesions are associated with bronchioloalveolar carcinoma representing lepidic growth. We present a case of rapidly worsening shortness breath and cough. Initial computed tomography scan of the chest showed cystic lesions on ground glass background in both lungs. Extensive workup for inflammatory, infectious, or connective tissue disorders was unremarkable. The biopsy of lung lesions pointed at lung metastasis of cholangiocarcinoma. Our case focuses on the benefit of imaging findings, as metastatic lesions can mimic the presentation of that of other lung diseases.
Presentation (obstetrics)
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