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Kusmirek JE, Meyer CA. High-Resolution Computed Tomography of Cystic Lung Disease. Semin Respir Crit Care Med 2022; 43:792-808. [PMID: 36252611 DOI: 10.1055/s-0042-1755565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The cystic lung diseases (CLD) are characterized by the presence of multiple, thin-walled, air-filled spaces in the pulmonary parenchyma. Cyst formation may occur with congenital, autoimmune, inflammatory, infectious, or neoplastic processes. Recognition of cyst mimics such as emphysema and bronchiectasis is important to prevent diagnostic confusion and unnecessary evaluation. Chest CT can be diagnostic or may guide the workup based on cyst number, distribution, morphology, and associated lung, and extrapulmonary findings. Diffuse CLD (DCLDs) are often considered those presenting with 10 or more cysts. The more commonly encountered DCLDs include lymphangioleiomyomatosis, pulmonary Langerhans' cell histiocytosis, lymphoid interstitial pneumonia, Birt-Hogg-Dubé syndrome, and amyloidosis/light chain deposition disease.
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Affiliation(s)
- Joanna E Kusmirek
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cristopher A Meyer
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Mormile I, Mormile M, Rossi FW, Williams M, Valente T, Candia C, Granata F, Rega R, Orlandi M, Matucci-Cerinic M, Molino A, de Paulis A. Radiological patterns and pulmonary function values of lung involvement in primary Sjögren’s syndrome: A pilot analysis. Front Med (Lausanne) 2022; 9:998028. [PMID: 36388884 PMCID: PMC9649970 DOI: 10.3389/fmed.2022.998028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background Lung involvement in primary Sjögren’s syndrome (pSS) may vary from 9 to 90%. Interstitial lung disease and tracheobronchial alterations are the most typical findings. The evidence of primarily emphysematous changes at computed tomography of the chest of pSS patients has occasionally been described but poorly characterized. This study aims to assess pulmonary involvement and the impact on respiratory function in a cohort of pSS patients. Materials and methods A total of 22 consecutive patients diagnosed with pSS underwent pulmonary function tests to investigate the presence of ventilatory impairment and evaluate the exchanges of alveolar gases. All patients underwent a chest high-resolution computed tomography (HRTC). Results Dynamic volumes were within the normal range in 21 patients (95.4%). A reduction in the diffusing capacity of the lung for carbon monoxide (DLCO) was observed in 18 patients (81.8%). Ten (45.5%) patients showed a mild degree deficit, while 8 patients (36%) showed a moderate degree deficit. Analysis of DLCO revealed a significant difference between pSS patients and controls [t(30.98) = −10.77; p < 0.001], showing a higher DLCO value for the healthy controls (mean ± SE; 101.27 ± 6.08) compared to pSS patients (mean ± SE; 65.95 ± 12.78). Emphysema was found in 21 (94.5%) patients and was the most widespread pulmonary injury. Tracheal thickness was reduced in 15 (67%) patients. Micronodules were observed in 10 (45%) patients in all the pulmonary fields. Bronchial wall thickening and bronchiectasis were observed in 8 (36%) patients, mainly in the lower lobes. Ground glass was found in 5 (22.5%) patients in lower and higher lobes. Cysts were observed in two patients (9%). Conclusion The reduction of the DLCO could be related to early emphysematous alterations in the absence of spirometric alterations and relevant respiratory symptoms. In conclusion, emphysema might be seen as an early pulmonary involvement mark in patients suffering from pSS.
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Affiliation(s)
- Ilaria Mormile
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Mauro Mormile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Francesca Wanda Rossi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
- *Correspondence: Francesca Wanda Rossi,
| | - Michela Williams
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Tullio Valente
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Claudio Candia
- Respiratory Division, Department of Respiratory Medicine, University of Naples Federico II, Naples, Italy
| | - Francescopaolo Granata
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Roberto Rega
- Department of Respiratory Medicine, AORN dei Colli, Naples, Italy
| | - Martina Orlandi
- Division of Rheumatology AOUC, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Division of Rheumatology AOUC, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Antonio Molino
- Respiratory Division, Department of Respiratory Medicine, University of Naples Federico II, Naples, Italy
| | - Amato de Paulis
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
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Imaging of Cystic Lung Disease. Radiol Clin North Am 2022; 60:951-962. [DOI: 10.1016/j.rcl.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Interstitial lung abnormalities and interstitial lung diseases associated with cigarette smoking in a rural cohort undergoing surgical resection. BMC Pulm Med 2022; 22:172. [PMID: 35488260 PMCID: PMC9055776 DOI: 10.1186/s12890-022-01961-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background Cigarette smoking is a risk factor for interstitial lung abnormalities (ILAs) and interstitial lung diseases (ILDs). Investigation defining the relationships between ILAs/ILDs and clinical, radiographic, and pathologic findings in smokers have been incomplete. Employing a cohort undergoing surgical resection for lung nodules/masses, we (1) define the prevalence of ILAs/ILDs, (2) delineate their clinical, radiographic and pathologic predictors, and (3) determine their associations with mortality. Methods Patients undergoing resection of lung nodules/masses between 2017 and 2020 at a rural Appalachian, tertiary medical center were retrospectively investigated. Predictors for ILAs/ILDs and mortality were assessed using multivariate logistic regression analysis. Results In the total study cohort of 352 patients, radiographic ILAs and ILDs were observed in 35.2% and 17.6%, respectively. Among ILA patterns, subpleural reticular changes (14.8%), non-emphysematous cysts, centrilobular (CL) ground glass opacities (GGOs) (8% each), and mixed CL-GGO and subpleural reticular changes (7.4%) were common. ILD patterns included combined pulmonary fibrosis emphysema (CPFE) (3.1%), respiratory bronchiolitis (RB)-ILD (3.1%), organizing pneumonitis (2.8%) and unclassifiable (4.8%). The group with radiographic ILAs/ILDs had a significantly higher proportion of ever smokers (49% vs. 39.9%), pack years of smoking (44.57 ± 36.21 vs. 34.96 ± 26.22), clinical comorbidities of COPD (35% vs. 26.5%) and mildly reduced diffusion capacity (% predicated 66.29 ± 20.55 vs. 71.84 ± 23). Radiographic centrilobular and paraseptal emphysema (40% vs. 22.2% and 17.6% vs. 9.6%, respectively) and isolated traction bronchiectasis (10.2% vs. 4.2%) were associated with ILAs/ILDs. Pathological variables of emphysema (34.9% vs. 18.5%), any fibrosis (15.9% vs. 4.6%), peribronchiolar metaplasia (PBM, 8% vs. 1.1%), RB (10.3% vs. 2.5%), and anthracosis (21.6% vs. 14.5%) were associated with ILAs/ILDs. Histologic emphysema showed positive correlations with any fibrosis, RB, anthracosis and ≥ 30 pack year of smoking. The group with ILAs/ILDs had significantly higher mortality (9.1% vs. 2.2%, OR 4.13, [95% CI of 1.84–9.25]). Conclusions In a rural cohort undergoing surgical resection, radiographic subclinical ILAs/ILDs patterns were highly prevalent and associated with ever smoking and intensity of smoking. The presence of radiographic ILA/ILD patterns and isolated honeycomb changes were associated with increased mortality. Subclinical ILAs/ILDs and histologic fibrosis correlated with clinical COPD as well as radiographic and pathologic emphysema emphasizing the co-existence of these pulmonary injuries in a heavily smoking population. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01961-9.
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Kourouni I, Abramovich CM, Tamarkin SW, Tomashefski JF, Sivak ED. A perplexing airspace: peace of mind now or later. Breathe (Sheff) 2021; 17:210017. [PMID: 34295413 PMCID: PMC8291947 DOI: 10.1183/20734735.0017-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
A 36-year-old, nonsmoking woman with a history of asthma presented for a second opinion about a “cavitating” right middle lobe (RML) lesion that was found incidentally 6 months prior, during preoperative evaluation for cholecystectomy. The lesion in question was pleural based, measuring 5.4×4×4.5 cm with thin and thick inner septations along with low-density right hilar and mediastinal adenopathy (figure 1a–c). A perplexing right middle lobe lesion in a young woman. Peace of mind now or later?https://bit.ly/3veB5wE
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Affiliation(s)
- Ismini Kourouni
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University (MetroHealth), Cleveland, OH, USA
| | - Caroline M Abramovich
- Dept of Pathology, Case Western Reserve University (MetroHealth), Cleveland, OH, USA
| | - Stephen W Tamarkin
- Dept of Radiology, Case Western Reserve University (MetroHealth), Cleveland, OH, USA
| | - Joseph F Tomashefski
- Dept of Pathology, Case Western Reserve University (MetroHealth), Cleveland, OH, USA
| | - Edward D Sivak
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University (MetroHealth), Cleveland, OH, USA
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Tjan A, Dwija Putra Ayusta IM, Mahiswara DG. Semilunar Sign of Trans-Mediastinal Herniation of Giant Bullae with Tension Hydropneumothrax. FOLIA MEDICA INDONESIANA 2021. [DOI: 10.20473/fmi.v56i4.24652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Herniation of bulla across mediastinum is rare, while transmediastinal giant bulla herniation accompanied with hydropneumothorax is even rarer. We report a case of an 18 years old male with dyspnea came to emergency department with trans-mediastinal giant bulla herniation, which appears as semilunar sign on chest x-ray, and righthydropneumothoraks. It appeared that the giant bulla also infected by the presence of air fluid level within. Semilunar sign was seen on the contralateral left mediastinum as the hallmark finding for trans-mediastinal herniation of bulla. Chest CT further confirms the diagnosis. Subsequently chest tube insertion and symptomatic relives were given, however the patient end up dead after 2 days of observation. Heart and lung compression by the lesions were the cause of this patient poor outcome. Bullous lung disease should be evaluated thoroughly and not underestimated since it could cause severe disease progression.
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Lim S, Leem JH, Hong YS, Kim J, Park S, Joh JS, Kwon WJ, Kim Y. Comparison of Long Term Follow-up Chest CT Imaging in Adult and Pediatric Patients with Humidifier Disinfectant-related Lung Injury. J Korean Med Sci 2020; 35:e377. [PMID: 33230985 PMCID: PMC7683241 DOI: 10.3346/jkms.2020.35.e377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/08/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To compare the chest computed tomography (CT) images of children and adults in families with clusters of humidifier disinfectant-related lung injury (HDLI) after cessation of exposure to humidifier disinfectant (HD). METHODS We reviewed medical records of 19 families with 43 patients (21 adults, 22 children) among families, which had at least one adult and one child with HDLI. Each family was exposed to the same HD exposure environment. RESULTS In adults, centrilobular nodules were predominant (95.2%) in chronic HDLI findings after cessation of exposure to HD, however, in children, normal pattern was most prevalent on chest CT (45.5%), followed by centrilobular nodule (36.4%), bizarre lung cysts (36.4%), and reticulation (13.6%). CONCLUSION Unlike the known chronic HDLI finding of adults, centrilobular nodules were only present in 36.4% of children. The frequency of bizarre lung cysts were significantly greater in children than that in adults after cessation of similar exposure to HD. Thus, bizarre lung cysts may be useful as another novel finding of chronic HDLI in children who have no history of pulmonary infection or other perinatal disorder such as hyaline membrane disease or other interstitial lung disease.
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Affiliation(s)
- Soyeoun Lim
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jong Han Leem
- Department of Occupational and Environmental Medicine, Inha University College of Medicine, Incheon, Korea
| | - Young Seoub Hong
- Department of Preventive Medicine, Dong-A University Collage of Medicine, Busan, Korea
| | - Jungwon Kim
- Department of Occupational and Environmental Medicine, Kosin University College of Medicine, Busan, Korea
| | - Soyoung Park
- Total Health Care Center, Kangbuk Samsung Hospital, School of Medicine, Sungkyungkwan University, Seoul, Korea
| | - Joon Sung Joh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Woon Jung Kwon
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yangho Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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Aspergilloma Superimposed Infection on Lymphoid Interstitial Pneumonia. Case Rep Emerg Med 2020; 2020:3151036. [PMID: 32082646 PMCID: PMC6995327 DOI: 10.1155/2020/3151036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/08/2019] [Accepted: 12/03/2019] [Indexed: 11/17/2022] Open
Abstract
We describe a case of a 27-year-old female without any prior underlying immunodeficiency syndromes who presented with hemoptysis secondary to subacute invasive pulmonary aspergillosis and subsequently diagnosed with lymphoid interstitial pneumonia (LIP). CT chest demonstrated bilateral interstitial disease with patchy opacities and multiple large cysts and bullae. Diagnosis was confirmed histologically after surgical lung resection of the mycetoma containing cavitation. Therefore, LIP should be suspected in patients presenting with opportunistic infections in the setting of cystic lung disease.
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Spontaneous pneumothorax and air travel in Pulmonary Langerhans cell histiocytosis: A patient survey. Respir Investig 2019; 57:582-589. [PMID: 31563637 DOI: 10.1016/j.resinv.2019.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/18/2019] [Accepted: 07/26/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The optimal approach for management of spontaneous pneumothoraces (SPs) and the safety of air travel in patients with pulmonary Langerhans cell histiocytosis (PLCH) are not well established. METHODS Patients with PLCH were recruited from the Rare Lung Diseases Clinic Network and the Histiocytosis Association, and surveyed about disease manifestations and safety of air travel. RESULTS A total of 94 patients completed the survey. Median age at diagnosis of PLCH was 40 years (range: 15-67 years). Average interval between symptom onset and diagnosis was 2.9 years (range: -4 to 31 years). Twenty-two patients (23%) had at least one SP, of which 14 (64%) had at least one additional SP that showed either an ipsilateral recurrence (10 patients; 45%) or a contralateral recurrence (8 patients; 36%). Mean age at the time of first SP was 29 years. SP was the presenting manifestation that led to the diagnosis of PLCH in 19% of patients, typically after the second episode. Surgical pleurodesis reduced the recurrence rate of SP by half in comparison with conservative management (29% vs. 65%, p = 0.025). Two patients experienced an episode of SP during air travel, consistent with an air travel-related pneumothorax rate of 2.4% per patient and 0.27% per flight. CONCLUSIONS SP is a common manifestation of PLCH, can be seen in approximately one-fourth of the patients, and has a high recurrence risk. Surgical pleurodesis leads to a substantial reduction in the SP recurrence risk. The risk of an air travel-related SP in patients with PLCH is about 2-3 per thousand flights. TRIAL REGISTRY CLINICALTRIALS.GOV: NCT03052101.
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Role of thoracic imaging in the management of lymphangioleiomyomatosis. Respir Med 2019; 157:14-20. [PMID: 31470185 DOI: 10.1016/j.rmed.2019.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 12/17/2022]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare diffuse lung cystic disease (DLCD) that occurs sporadically or in association with Tuberous Sclerosis Complex (TSC). The diagnostic pathway is tracked on the identification of the disease hallmarks on chest High-Resolution Computed Tomography (HRCT). Aim of this review is to discuss the thoracic HRCT pathognomonic features, essential to rule out other DLCD. It also examines the new evidences emerging from Computed Tomography (CT) quantitative studies that, by demonstrating a specific cysts distribution and a pathological aspect of the parenchyma near the cysts, could improve our understanding of this rare disorder and supply pulmonologists with a new tool for a more appropriate long-term management. Finally, the contribution of other image techniques as low dose chest CT, Magnetic Resonance Imaging (MRI) and Ultrasound (US) is discussed.
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Tan Y, Gao J, Wu C, Zhao S, Yu J, Zhu R, Zhang Q, Wu G, Xue X, Wu J. CT Characteristics and Pathologic Basis of Solitary Cystic Lung Cancer. Radiology 2019; 291:495-501. [PMID: 30860446 DOI: 10.1148/radiol.2019181598] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There are increasing reports of a type of lung cancer that manifests as solitary cystic airspaces. The purpose of this case series was to
identify the CT features and possible mechanisms of solitary cystic lung cancer, on the basis of CT observations and pathologic characteristics.
The clinical, imaging, and pathologic data of 106 patients with solitary cystic lung cancer were collected and analyzed between
January 2011 and December 2017. CT images were reviewed independently by three radiologists who were blinded to pathologic findings.
Demographic data and clinical and smoking status were extracted from the medical records. The mean age was 58.8 years 6 10.6
(standard deviation) (range, 30–82 years). CT features in the 106 patients included nonuniform cystic walls in 96 (90.6%) patients, cyst
septations in 62 (58.5%) patients, nodular walls in 58 (54.7%) patients, ground-glass opacity around the cyst in 53 patients (50.0%), and
irregular margins in 42 (39.6%) patients. At histologic examination, the majority of cases (81 [87.1%] of 93) were adenocarcinoma.
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Affiliation(s)
- Yang Tan
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Jie Gao
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Chongchong Wu
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Shaohong Zhao
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Jing Yu
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Ruiping Zhu
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Qing Zhang
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Guangyao Wu
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Xinying Xue
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
| | - Jianlin Wu
- From the Departments of Radiology (Y.T., J.Y., Q.Z., G.W., J.W.) and Pathology (R.Z.), the Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Respiratory and Critical Care Medicine, the Affiliated Beijing Shijitan Hospital of Capital Medical University, Beijing, China (X.X.); and Departments of Pathology (J.G.), Radiology (C.W., S.Z.), and Respiratory and Critical Care Medicine (X.X.), the Chinese PLA General Hospital, Beijing, China
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