[Thoracic roentgen findings in acquired antibody deficiency syndrome with chronic granulomatous inflammation]

Ten cases of acquired antibody deficiency syndrome with chronic granulomatous infection were diagnosed in our hospital during the past 10 years. We were able to perform a retrospective analysis of the initial and follow-up chest radiographs in 8 of these patients. The following pathological findings could be demonstrated: 1. increased bronchovascular markings in the basal lung fields, 2. reticular densities in the middle and basal lung fields, 3. confluent nodular densities of varying size in the periphery of the basal and middle fields, 4. pulmonary infiltrates in the middle and lower lobes, 5. hilar node enlargement of moderate extent. Findings 2, 3 and 5 completely disappeared under steroid therapy whereas 1 showed only partial recovery. If both the radiologic and serological findings are considered, it is possible to differentiate this disease from sarcoidosis.

[X-ray diagnosis of immunologically induced lung diseases in children and adolescents]

After coverage of pathophysiological mechanisms, radiological symptoms and differential diagnosis of bacterial and opportunistic infections of the bronchopulmonary system are discussed as they occur in humoral, cellular and combined congenital and acquired immune deficiencies. The discussion is based on case reports. Humoral deficiencies cause recurrent and chronic bacterial infections of the bronchopulmonary system, frequently with bronchiectasis. In the case of cellular and combined immune deficiencies, not only bacterial infections but also the very serious opportunistic infections occur. Opportunistic infections of the lung are predominantly caused by Pneumocystis carinii, by the cytomegaly virus, and by fungi such as Candida, Aspergillus and Mucor. Pneumocystis is also the most frequent cause of opportunistic infections of the lungs in children with AIDS. In contrast to the situation in adults, in children a relatively low-grade lymphocytic interstitial pneumonitis occasionally precedes the typical opportunistic infections. Lymphocytic interstitial pneumonitis and Pneumocystis pneumonia can be differentiated from each other easily in children because of their relatively characteristic appearances. Fungal infections, on the other hand, sometimes pose severe diagnostic problems. Radiological chest findings in autoimmune diseases are discussed.

CT of the gut in the immunocompromised host

The spread of the acquired immunodeficiency syndrome, the increasing popularity of bone marrow, renal, and other organ transplants, and the development of potent immunosuppressive drugs have produced a large population of immunocompromised hosts. These patients are at great risk for developing both opportunistic infections and neoplasms such as Kaposi's sarcoma and lymphoma. The gastrointestinal complications and computed tomographic manifestations of these previously rare disorders are discussed.

Visualization of the spleen with radiophosphate in severe combined immunodeficiency disease

This is a case report of a 12-month-old male suffering from severe combined immunodeficiency disease who demonstrated an intense concentration of MDP in the spleen. The precise mechanism for this accretion is not known and remains speculative.

Radiology of immunologic diseases of the lung

In the last two decades research in immunology has greatly expanded our knowledge of this important medical specialty. Many diseases of previously unknown etiology are now much better understood. This review emphasizes the basics of immunology in order to assist the reader in understanding the mechanisms that cause immunologic lung disease. The radiologic appearance of these diseases is discussed.

Ossification centre of the hyoid bone in DiGeorge syndrome and tetralogy of Fallot

The incidence of radiographic visibility of the ossification centre of the body of the hyoid bone in radiographs taken during the first month of life was analysed for 34 autopsied infants: 16 with DiGeorge syndrome (DGS), 14 with tetralogy of Fallot (TOF), four with interrupted aortic arch (IAA) and a further 13, surviving infants with non-DGS TOF or non-DGS IAA. The incidence of visible hyoid ossification centre (HOC) was 75.7% in a control series of infants with neither congenital heart disease (CHD) nor DGS. Autopsied patients with DGS, TOF without DGS, and IAA without DGS showed a significantly low incidence of visible HOC. Infants with TOF (and possibly those with IAA) who did not have DGS and who did not die during infancy showed a normal incidence of visible HOC in radiographs taken during the first post-natal month. Radiological visibility of the HOC in the first post-natal month appears useful in the diagnosis of DGS and forms of CHD often seen in association with DGS and in assessing prognosis of neonates with certain types of CHD.

Dual radiopharmaceutical imaging in congenital asplenia syndrome

Asplenia was suspected in one patient with combined immunodeficiency syndrome and 5 with congenital cardiac anomalies who had Howell-Jolly bodies on peripheral blood smears. 99mTc-sulfur colloid scans were equivocal for absence of the spleen. When they were compared with the 99mTc-PIPIDA hepatobiliary images, a discrepancy in organ morphology between the two scans indicated that the spleen was present, whereas similarity of the two images suggested asplenia. This procedure was useful in establishing asplenia in 4 patients and confirming the presence of a rudimentary or ectopic spleen in 2 others. Unequivocal demonstration of the spleen on the sulfur colloid scans makes the hepatobiliary study unnecessary, while unequivocal demonstration of a normal-appearing liver without splenic activity may warrant a tagged red-cell study for a more complete evaluation.

Lymphoreticular disorders of the gastrointestinal tract: roentgenographic features

Recent advances have permitted close correlation of characteristic roentgen signs with the pathophysiologic alterations in lymphoreticular disorders of the gastrointestinal tract. The background of primary and secondary immunoglobin disorders with gastrointestinal manifestations is reviewed. The roentgenographic alterations in the small bowel of the enteropathic immunoglobulin deficiency syndromes and in lymphoma of the small bowel, stomach, and colon are discussed and illustrated in detail.

Immunoglobulin deficiency diseases of the intestine

Marshak has emphasized the role of the gastrointestinal tract as a major immunologic organ and described the radiologic findings of immunoglobulin deficiency diseases of the small intestine. According to his classification the radiologic findings include multiple nodular defects, edema and increased secretions associated with Giardiasis, a sprue-like pattern, and thickened folds. In this report, the role of the intestine in the immune response is briefly reviewed and several of the radiologic features of immune deficiency diseases and those of benign nodular lymphoid hyperplasia are illustrated.

Ataxia-telangiectasia

The clinical and radiographic features of twenty-two cases of ataxia-telangiectasia are reviewed. Severity of pulmonary manifestations tended to correlate closely with severity of immunodeficiency. Observations are made upon the problem of intercurrent malignancy in ataxia-telangiectasia. The radiographic studies of patients seen at the National Institutes of Health with A-T were reviewed retrospectively and correlated with degrees of immunodeficiency determined clinically. Three fairly distinct groups with high, intermediate and low incidence of sinopulmonary disease were found. Comment is made on the problem of increased malignancy in A-T and possible clues in the detection by the radiologist.

The radiology corner: the small bowel in immunoglobulin deficiency syndromes

Recent advances in immunology have permitted recognition of a group of patients who have gastrointestinal manifestations as part of an immunoglobulin deficency syndrome. Such immunoglobulin deficiency may be primary or may be secondary to a variety of diseases. We have classified and described the small bowel roentgen features associated with the various immunoglobulin deficiency syndromes as follows: 1. the sprue pattern, as seen in hypogammaglobulinemic sprue and in Ig-A deficient sprue; 2. multiple nodular defects; 3. inflammatory changes secondary to giardiasis, associated with immune deficiency diseases; 4. thickening of the small intestinal folds, as seen in the plasma cell dyscrasias, lymphoma, intestinal lymphangiectasia and amyloidosis.

Primary immunodeficiency diseases and malignancy

The incidence of malignant tumors in the primary immunodeficiency diseases is dramatically increased. Four patients with primary immunodeficiencies who developed fatal malignancies are reported. Lymphoreticular tumors and leukemia predominate in most conditions, but epithelial neoplasms are the most common tumors in selective Iga deficiency, and they comprise over one-fourth of malignancies in common variable immunodeficiency. With the exception of common variable immunodeficiency and the Wiskott-Aldrich syndrome, hyperplasia of lymphoid tissue usually does not occur. Lymph node enlargement in any of the other immunodeficiencies is therefore most likely secondary to malignancy. Benign gastrointestinal nodular lymphoid hyperplasia occurs frequently in common variable immunodeficiency and in some instances may be impossible to differentiate roentgenologically from lymphoma.

Diagnosis of immunologic deficiency in childhood

A defective host response may be responsible for recurring infections in certain children. Recognition of these defects may be important both therapeutically for the patient and for genetic counseling for the family. Family history, age of onset of illness and type of infecting agents may all point to one or another defect in host resistance. An initial evaluation for suspected immunologic disease may be rapidly accomplished and should include absolute neutrophil and lymphocyte counts, chest X-ray for a thymic shadow, Schick test for functional IgG antibodies and isohemagglutinin titers for functional IgM antibodies. Although serum protein electrophoresis is unreliable for diagnosis of most disorders of circulating antibodies, quantitation of the IgG, IgA and IgM antibody classes is generally available. More extensive studies may be carried out to further define defects in the cell-mediated immune system, in the various complement components, or in the ingestion and killing of bacteria by neutrophils.