Immune reconstitution inflammatory syndrome, with pulmonary and neurological cryptococcosis, in an HIV-negative patient

High-resolution computed tomography findings in eight patients with hantavirus pulmonary syndrome

Objective:

The purpose of this study was to describe the high-resolution computed tomography (HRCT) findings in patients with hantavirus pulmonary syndrome (HPS).

Materials and Methods:

We retrospectively reviewed HRCT findings from eight cases of HPS. All patients were men, aged 19-70 (mean, 41.7) years. Diagnoses were established by serological test (enzyme-linked immunosorbent assay) in all patients. Two chest radiologists analyzed the images and reached decisions by consensus.

Results:

The predominant HRCT findings were ground-glass opacities (GGOs) and smooth inter- and intralobular septal thickening, found in all eight cases; however, the crazy-paving pattern was found in only three cases. Pleural effusion and peribronchovascular thickening were observed in five patients. The abnormalities were bilateral in all patients.

Conclusion:

The predominant HRCT findings in patients with HPS were GGOs and smooth inter- and intralobular septal thickening, which probably correlate with the histopathologic findings of pulmonary edema.

Radiologist agreement on the quantification of bronchiectasis by high-resolution computed tomography

Objective

To evaluate radiologist agreement on the quantification of bronchiectasis by high-resolution computed tomography (HRCT).

Materials and Methods

The HRCT scans of 43 patients with bronchiectasis were analyzed by two radiologists, who used a scoring system to grade the findings. Kappa (κ) values and overall agreement were calculated.

Results

For the measurement and appearance of bronchiectasis, the interobserver agreement was moderate (κ = 0.45 and κ = 0.43, respectively), as was the intraobserver agreement (κ = 0.54 and κ = 0.47, respectively). Agreement on the presence of mucous plugging was fair, for central distribution (overall interobserver agreement of 68.3% and κ = 0.39 for intraobserver agreement) and for peripheral distribution (κ = 0.34 and κ = 0.35 for interobserver and intraobserver agreement, respectively). The agreement was also fair for peribronchial thickening (κ = 0.21 and κ = 0.30 for interobserver and intraobserver agreement, respectively). There was fair interobserver and intraobserver agreement on the detection of opacities (κ = 0.39 and 71.9%, respectively), ground-glass attenuation (64.3% and κ = 0.24, respectively), and cysts/bullae (κ = 0.47 and κ = 0.44, respectively). Qualitative analysis of the HRCT findings of bronchiectasis and the resulting individual patient scores showed that there was an excellent correlation between the observers (intraclass correlation coefficient of 0.85 and 0.81 for interobserver and intraobserver agreement, respectively).

Conclusion

In the interpretation of HRCT findings of bronchiectasis, radiologist agreement appears to be fair. In our final analysis of the findings using the proposed score, we observed excellent interobserver and intraobserver agreement.