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Washington L, O'Sullivan-Murphy B, Christensen JD, McAdams HP. Radiographic Imaging of Community-Acquired Pneumonia: A Case-Based Review. Infect Dis Clin North Am 2024; 38:19-33. [PMID: 38280764 DOI: 10.1016/j.idc.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
The chest radiograph is the most common imaging examination performed in most radiology departments, and one of the more common indications for these studies is suspected infection. Radiologists must therefore be aware of less common radiographic patterns of pulmonary infection if they are to add value in the interpretation of chest radiographs for this indication. This review uses a case-based format to illustrate a range of imaging findings that can be associated with acute pulmonary infection and highlight findings that should prompt investigation for diseases other than community-acquired pneumonia to prevent misdiagnosis and delays in appropriate management.
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Affiliation(s)
- Lacey Washington
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, DUMC Box 3808, Durham, NC 27710, USA.
| | - Bryan O'Sullivan-Murphy
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, DUMC Box 3808, Durham, NC 27710, USA
| | - Jared D Christensen
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, DUMC Box 3808, Durham, NC 27710, USA
| | - H Page McAdams
- Department of Radiology, Duke University Medical Center, 2301 Erwin Road, DUMC Box 3808, Durham, NC 27710, USA
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Ma J, Zhang C, Dang K, Liao Y, Feng X, Zhou P. Spherical pneumonia caused by Ralstonia mannitolilytica: a case report and literature review. BMC Pulm Med 2023; 23:20. [PMID: 36647091 PMCID: PMC9841942 DOI: 10.1186/s12890-023-02316-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Spherical pneumonia is an extremely rare condition that is difficult to diagnose. It is a specific type of lung infection that often manifests as a round or round-like mass on chest imaging. Spherical pneumonia is easily misdiagnosed as a pulmonary tumor; therefore, awareness of this disease must be strengthened. CASE PRESENTATION The patient was a 29-year-old female who had persistent cough and sputum for approximately 1 month and fever for 5 days. Chest computed tomography (CT) at our hospital revealed a mass in the lower lobe of the right lung near the hilar region, with obstructive pulmonary atelectasis and obstructive pneumonia. Although lung cancer was suspected, Ralstonia mannitolilytica was detected by metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid, and no cancer cells or Mycobacterium tuberculosis were detected. Finally, the patient was diagnosed with spherical pneumonia caused by R. mannitolilytica. Anti-infective treatment, symptomatic treatment, and administration of a traditional Chinese medicine decoction were performed based on the syndrome differentiation. After 10 days of treatment, chest CT revealed few lesions in the lower lobe of the right lung, which were significantly reduced compared with those in the past. CONCLUSIONS Spherical pneumonia caused by R. mannitolilytica has not yet been reported and differential diagnosis is key in clinical diagnosis. When spherical pneumonia is difficult to diagnose, mNGS may be a better alternative.
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Affiliation(s)
- Jianli Ma
- grid.411304.30000 0001 0376 205XClinical Medical School, Chengdu University of Traditional Chinese Medicine, No 39 Shi-Er-Qiao Road, Jin Niu District, Chengdu, 610072 Sichuan Province People’s Republic of China
| | - Chuantao Zhang
- grid.415440.0Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province People’s Republic of China
| | - Kaijie Dang
- grid.411304.30000 0001 0376 205XClinical Medical School, Chengdu University of Traditional Chinese Medicine, No 39 Shi-Er-Qiao Road, Jin Niu District, Chengdu, 610072 Sichuan Province People’s Republic of China
| | - Yichao Liao
- grid.411304.30000 0001 0376 205XClinical Medical School, Chengdu University of Traditional Chinese Medicine, No 39 Shi-Er-Qiao Road, Jin Niu District, Chengdu, 610072 Sichuan Province People’s Republic of China
| | - Xue Feng
- grid.411304.30000 0001 0376 205XClinical Medical School, Chengdu University of Traditional Chinese Medicine, No 39 Shi-Er-Qiao Road, Jin Niu District, Chengdu, 610072 Sichuan Province People’s Republic of China
| | - Pengcheng Zhou
- grid.415440.0Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province People’s Republic of China
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Washington L, O'Sullivan-Murphy B, Christensen JD, McAdams HP. Radiographic Imaging of Community-Acquired Pneumonia. Radiol Clin North Am 2022; 60:371-381. [DOI: 10.1016/j.rcl.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jiménez-Castillo RA, Aguilar-Rivera LR, Carrizales-Sepúlveda EF, Gómez-Quiroz RA, Llantada-López AR, González-Aguirre JE, Náñez-Terreros H, Rendón-Ramírez EJ. A case of round pneumonia due to Enterobacter hormaechei: the need for a standardized diagnosis and treatment approach in adults. Rev Inst Med Trop Sao Paulo 2021; 63:e3. [PMID: 33503151 PMCID: PMC7816868 DOI: 10.1590/s1678-9946202163003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/23/2020] [Indexed: 01/13/2023] Open
Abstract
Round pneumonia is an unusual radiological manifestation of a bacterial lung infection. We present the case of an elderly male patient who arrived at the emergency room with a productive cough and exertional dyspnea. His chest x-ray and CT showed a round opacity and air bronchograms in the right upper lobe. Taken together, the patient's symptoms and images strongly suggest a pulmonary infection. Empirical antibiotic therapy with ceftriaxone and clarithromycin was started. The sputum culture was positive for Enterobacter hormaechei and the bacterium was sensitive to levofloxacin; therefore, the antibiotic therapy was changed. Despite the treatment, the patient progressed to respiratory failure and septic shock, dying six days after admission. Although round pneumonia is uncommon, it is a potentially curable disease and clinicians should always consider it in their differential diagnosis.
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Affiliation(s)
- Raúl Alberto Jiménez-Castillo
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Leonardo René Aguilar-Rivera
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Edgar Francisco Carrizales-Sepúlveda
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Cardiología, Monterrey, México
| | - Ricardo Andrés Gómez-Quiroz
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Anabella Rosalía Llantada-López
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Julio Edgardo González-Aguirre
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Homero Náñez-Terreros
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Erick Joel Rendón-Ramírez
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
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Violante-Cumpa JR, Violante-Cumpa KA, Carrizales-Sepúlveda EF. Unusual radiographic presentation of pneumonia in adults with chronic kidney disease. Intern Emerg Med 2019; 14:811-812. [PMID: 30603859 DOI: 10.1007/s11739-018-02022-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/27/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Jorge Rafael Violante-Cumpa
- Internal Medicine Department, Hospital Universitario, Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av, N/N Col. Mitras Centro, 64460, Monterrey, Nuevo León, Mexico.
| | | | - Edgar Francisco Carrizales-Sepúlveda
- Internal Medicine Department, Hospital Universitario, Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av, N/N Col. Mitras Centro, 64460, Monterrey, Nuevo León, Mexico
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Rodríguez E. [Pneumonia ward round: A case presentation]. Semergen 2018; 44:515-516. [PMID: 30206036 PMCID: PMC7110597 DOI: 10.1016/j.semerg.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 02/27/2018] [Accepted: 03/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- E Rodríguez
- Atención Primaria, Consultorio Auxiliar Cervera del Maestre, Consellería de Sanidad Universal de la Comunidad Valenciana, Cervera del Maestre, Castellón, España.
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An unusual case of lung abscess secondary to round pneumonia caused by recurrent Klebsiella pneumoniae strain and the role of occult metastases tumor. Respir Med Case Rep 2018; 23:107-109. [PMID: 29719793 PMCID: PMC5926507 DOI: 10.1016/j.rmcr.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 01/16/2018] [Accepted: 01/21/2018] [Indexed: 11/24/2022] Open
Abstract
Round pneumonia is an uncommon form of community-acquired pneumonia usually found in children. To this date, there has been no report on local pulmonary complications in this entity in adult patients. The present study reports a case of a 77-year-old male with lung abscess secondary to round pneumonia caused by recurrent Klebsiella pneumoniae infection accompanied by occult metastases tumor. Occult metastases may have played an important role in leading to cavity as in this present case. Further investigation regarding the relationship between recurrent infection and metastases is needed.
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Yoshimura Y, Sakamoto Y, Kwangyeol L, Amano Y, Tachikawa N. Round Pneumonia With Murine Typhus After Travel to Indonesia. J Travel Med 2015; 22:353-4. [PMID: 26171885 DOI: 10.1111/jtm.12226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 05/26/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Yukihiro Yoshimura
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama City, Japan
| | - Yohei Sakamoto
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama City, Japan
| | - Lee Kwangyeol
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama City, Japan
| | - Yuichiro Amano
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama City, Japan
| | - Natsuo Tachikawa
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama City, Japan
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Çimen D, Bulcun E, Ekici A, Güngör Ö, Ekici M. Case of round pneumonia: pulmonary infarct and a rare situation that is similar with the lung cancer. CLINICAL RESPIRATORY JOURNAL 2014; 9:512-5. [PMID: 24725533 DOI: 10.1111/crj.12137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 03/05/2014] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Round pneumonia (RP) is a rare radiological presentation of a subtype of lobar pneumonia that arises because of a developmental defect in connective tissues (pores of Köhn and channels of Lambert). The round appearance on chest X-ray (CXR) is thought to occur from an infectious process that spreads from small peripheral alveoli centrifugally through interalveolar channels via the pores of Kohn and the canals of Lambert. This explains the nonsegmental distribution and shape of RP. The pathogenesis of RP is unknown. An alternative theory holds that RP in children occurs because of underdeveloped pores of Kohn and the absence of canals of Lambert, limiting the spread of the organism and resulting in a focal, round mass seen on radiographs. As a result of this developmental defect, dissemination of infection remains in a limited area. While this is a well-known entity in childhood, it has been described infrequently in adults. Lesions of RP are not necessarily round; oval lesions can also be seen. It is a radiological subtype of the pneumonia subtype and presents as a solitary nodule or a mass lesion in CXR. METHODS We presented two cases of RP. One mimicked and was mistaken for pulmonary infarction because of triangular pleural-based density and the other mimicked pulmonary malignancy because of a homogeneous triangular opacity based on the pleura on the posteroanterior radiography and computed tomography. CONCLUSION These cases were presented because of RP's importance, and RP should be considered a part of differential diagnosis of pulmonary infarct and lung tumor.
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Affiliation(s)
- Dilay Çimen
- Faculty of Medicine, Department of Pulmonary Medicine, University of Kirikkale, Kirikkale, Turkey
| | - Emel Bulcun
- Faculty of Medicine, Department of Pulmonary Medicine, University of Kirikkale, Kirikkale, Turkey
| | - Aydanur Ekici
- Faculty of Medicine, Department of Pulmonary Medicine, University of Kirikkale, Kirikkale, Turkey
| | - Ömür Güngör
- Faculty of Medicine, Department of Pulmonary Medicine, University of Kirikkale, Kirikkale, Turkey
| | - Mehmet Ekici
- Faculty of Medicine, Department of Pulmonary Medicine, University of Kirikkale, Kirikkale, Turkey
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Velasco-Tirado V, Hernández-Cabrera M, Pisos-Álamo E, Pérez-Arellano JL. Rickettsia typhi. A new causative agent of round pneumonia in adults. Enferm Infecc Microbiol Clin 2012; 30:427-8. [PMID: 22503113 DOI: 10.1016/j.eimc.2012.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/16/2012] [Accepted: 02/18/2012] [Indexed: 12/01/2022]
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Anton E, Larrañaga O. An Unusual Presentation of Adult Pneumonia to the Emergency Department. J Emerg Med 2011; 40:214-5. [DOI: 10.1016/j.jemermed.2009.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 01/06/2009] [Indexed: 11/29/2022]
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Focal mass-like opacity on chest radiography: round pneumonia. J Emerg Med 2008; 39:e89-90. [PMID: 18650049 PMCID: PMC7126507 DOI: 10.1016/j.jemermed.2007.11.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 01/12/2007] [Accepted: 11/15/2007] [Indexed: 11/23/2022]
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Camargo JJDP, Camargo SM, Machuca TN, Perin FA. Round pneumonia: a rare condition mimicking bronchogenic carcinoma. Case report and review of the literature. SAO PAULO MED J 2008; 126:236-8. [PMID: 18853036 PMCID: PMC11025979 DOI: 10.1590/s1516-31802008000400010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 05/16/2007] [Accepted: 06/17/2008] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Round pneumonia is a condition usually described in children, with few reports addressing adult patients. It is an oval-shaped consolidation that, due to its radiological appearance, simulates bronchogenic carcinoma. Its evolution tends to be benign, although diagnostic dilemmas have sometimes required exploratory thoracotomy. Deaths caused by this condition have even been reported. To the best of our knowledge, there have been 31 previous cases of round pneumonia in adults reported in the English and Portuguese-language literature, of which only one was completely asymptomatic. CASE REPORT The case of a 54-year-old female patient presenting a lung mass found on routine imaging evaluation is reported. Respiratory symptoms and signs were absent, but the patient had a significant history of smoking. Her physical examination gave normal results. On chest radiographs, a mass located in the middle third of the right lung was observed. Three weeks after the initial evaluation, the patient was admitted for a complete evaluation and for staging of a pulmonary malignancy, but repeated chest radiographs showed complete resolution.
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Celebi S, Hacimustafaoglu M. Round pneumonia in children. Indian J Pediatr 2008; 75:523-5. [PMID: 18537020 DOI: 10.1007/s12098-008-0085-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 01/17/2008] [Indexed: 11/30/2022]
Abstract
We evaluated four children with rounded densities on their chest radiographs in whom the final diagnosis was presumed to be lower respiratory tract infection. The differential diagnose between round pneumonia and a neoplastic process is difficult to make. In this report, all of cases of round pneumonia have resolved clinically and radiographically with antibiotic therapy.
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Affiliation(s)
- Solmaz Celebi
- Uludag University Medical Faculty, Department of Pediatrics, Division of Pediatric Infectious Diseases, Gorukle, Bursa, Turkey.
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Round pneumonia: imaging findings in a large series of children. Pediatr Radiol 2007; 37:1235-40. [PMID: 17952428 DOI: 10.1007/s00247-007-0654-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 08/23/2007] [Accepted: 09/07/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although round pneumonia is a well-known clinical entity, there have been no large case reviews, with most knowledge based on case reports and small series from the 1960s and 1970s. OBJECTIVE To review the imaging findings of a large series of children with round pneumonia. MATERIALS AND METHODS A retrospective review of radiographic and CT findings in all children reported to have round pneumonia at a large children's hospital from 2000 to 2006 was performed. Children with underlying medical conditions were excluded. Epidemiologic characteristics, radiographic and CT findings, and follow-up imaging were reviewed. RESULTS The review identified 109 children (mean age 5 years, range 4 months to 19 years). Round pneumonias tended to be solitary 98% (107/109), have well-defined borders 70% (77/109), and be posteriorly located 83% (91/109), with the following lobar distribution: left lower lobe (36), right lower lobe (33), right upper lobe (28), left upper lobe (7), right middle lobe (4), and lingula (2). Round pneumonia tended to resolve on follow-up imaging (95%, 41/43) as compared to progression to lobar pneumonia (4.6%, 2/43). Three patients (2.6%, 3/112) originally suspected to have round pneumonia were later shown to have other diagnoses: cavitary necrosis in pneumonia (two) or pleural pseudocyst (one). CONCLUSION Round pneumonia occurs in young children (mean age 5 years), tends to be a solitary lesion, and is most commonly posteriorly located. Misdiagnosis of other pathology as round pneumonia is uncommon.
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Shie P, Farukhi I, Hughes RS, Oz OK. Round Pneumonia Mimicking Pulmonary Malignancy on F-18 FDG PET/CT. Clin Nucl Med 2007; 32:55-6. [PMID: 17179809 DOI: 10.1097/01.rlu.0000249628.58514.fd] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Philip Shie
- Division of Nuclear Medicine, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9153, USA
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