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Güttlein M, Wucherpfennig L, Kauczor HU, Eichinger M, Heußel CP, Wielpütz MO. [Differential diagnosis of cystic and nodular lung diseases]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:617-627. [PMID: 38937303 DOI: 10.1007/s00117-024-01341-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Cystic and nodular lung diseases encompass a broad spectrum of diseases with different etiologies and clinicoradiological presentations. Their differentiation is crucial for patient management but can be complex due to diseases with features of both categories and overlapping radiological patterns. OBJECTIVE This study aims to describe the imaging features of cystic and nodular lung diseases in high-resolution computed tomography (CT) in detail-primarily based on their etiology-in order to allow a more accurate differential diagnosis of these diseases. MATERIALS AND METHODS A narrative review based on current literature on the topic was conducted from a clinicoradiological perspective. RESULTS This paper systematically categorizes the differential diagnosis of cystic and nodular lung disease and provides insights into their radiological patterns and etiologies. It highlights the role of CT in the diagnosis of these diseases and emphasizes the importance of multidisciplinary panels combining expertise from radiology, pulmonology, rheumatology, and pathology. CONCLUSION Reliable differential diagnosis of cystic and nodular lung diseases, particularly based on their radiological features alone, remains difficult due to their overlapping and dynamic nature. Multidisciplinary boards should be the clinical standard for accurate work-up of these diseases, as they combine the medical history, symptoms, radiological findings, and, if necessary, histopathological examinations, thus providing a more robust framework for diagnosis and management.
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Affiliation(s)
- Maximilian Güttlein
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
- Translational Lung Research Center Heidelberg (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
- Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland
| | - Lena Wucherpfennig
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
- Translational Lung Research Center Heidelberg (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
- Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland
| | - Hans-Ulrich Kauczor
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
- Translational Lung Research Center Heidelberg (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
- Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland
| | - Monika Eichinger
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
- Translational Lung Research Center Heidelberg (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
- Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland
| | - Claus Peter Heußel
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
- Translational Lung Research Center Heidelberg (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
- Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland
| | - Mark O Wielpütz
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
- Translational Lung Research Center Heidelberg (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland.
- Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland.
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Abstract
Birt-Hogg-Dubé syndrome is an uncommon autosomal dominant systemic disorder with cutaneous findings notable for fibrofolliculomas or trichodiscomas on the scalp, face, neck, and trunk. These cutaneous signs are associated with bilateral renal cell carcinoma, benign renal cysts, pulmonary cysts, and spontaneous pneumothorax. Given its autosomal dominant inheritance pattern, the successful diagnosis of Birt-Hogg-Dubé syndrome (BHDS) may elucidate a diagnosis in family members. BHDS results from a mutation in the FLCN gene encoding the folliculin protein, a transcriptional regulator of the mammalian target of rapamycin signaling pathway. Like tuberous sclerosis, BHDS's clinical features may subside with the use of oral rapamycin for mammalian target of rapamycin inhibition, a theoretical concept meriting exploration. Although its prevalence in the general population has been estimated at 2 cases per million, BHDS has been detected in a few patients from the nearby Portuguese-lineage quarter of the city of Newark, a disproportionate prevalence possibly explained by the founder effect.
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Affiliation(s)
- Rohan R Shah
- Departments of Pathology and Dermatology, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - William Clark Lambert
- Departments of Pathology and Dermatology, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
| | - Robert A Schwartz
- Departments of Pathology and Dermatology, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
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Hoppe BP, Stoel BC, Postmus PE. Natural Course of Cysts in Birt-Hogg-Dubé Syndrome. Am J Respir Crit Care Med 2022; 205:1474-1475. [PMID: 35452378 DOI: 10.1164/rccm.202106-1382im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Bart P Hoppe
- Leiden University Medical Center, 4501, Respiratory Medicine, Leiden, Netherlands;
| | - Berend C Stoel
- Leiden University Medical Center, Radiology, div. of Image Processing, Leiden, Netherlands
| | - Pieter E Postmus
- Leiden University Medical Center, 4501, Respiratory Medicine, Leiden, Netherlands
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