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Caterson HJ, Kim S, Zaborowski M, Harden M, Hibbert M. An unusual case of persistent consolidation: Idiopathic lymphoid interstitial pneumonia. Respirol Case Rep 2024; 12:e01408. [PMID: 38860176 PMCID: PMC11164566 DOI: 10.1002/rcr2.1408] [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: 03/14/2024] [Accepted: 06/05/2024] [Indexed: 06/12/2024] Open
Abstract
Lymphocytic interstitial pneumonia (LIP) is a rare but largely benign interstitial lung disease, most frequently associated with HIV and autoimmune conditions. It is infrequently found to be an idiopathic condition. Diagnosis is complex and can require numerous invasive tests as evidenced in the case presented. The diagnosis is made from a combination of clinical, radiological, and histological features but the unusual radiological and clinical features meant diagnosis in our case required surgical biopsy. There is minimal evidence around best treatment although largely involves targeting the underlying cause. There is a small risk of transformation to lymphoma and fibrosis. Immunosuppression with steroids is the most common therapeutic strategy however in our case the radiographic changes spontaneously resolved. We present a case of an immunocompetent male presenting with significant radiological and histopathological findings of LIP, without significant symptomatology, that spontaneously resolved without intervention suggesting a monitoring approach may be a valid management strategy.
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Affiliation(s)
- Harriet J. Caterson
- Department of Respiratory MedicineRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Sewon Kim
- Department of Anatomical PathologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Matthew Zaborowski
- Department of Anatomical PathologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Michael Harden
- Department of CardiothoracicsRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Michael Hibbert
- Department of Respiratory MedicineRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
- Northern Clinical SchoolUniversity of SydneySt LeonardsNew South WalesAustralia
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Lassandro G, Picchi SG, Corvino A, Massimo C, Tamburrini S, Vanore L, Urraro G, Russo G, Lassandro F. Noninfectious Granulomatous Lung Disease: Radiological Findings and Differential Diagnosis. J Pers Med 2024; 14:134. [PMID: 38392568 PMCID: PMC10890318 DOI: 10.3390/jpm14020134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024] Open
Abstract
Granulomatous lung diseases (GLDs) are a heterogeneous group of pathological entities that can have different clinical presentations and outcomes. Granulomas are histologically defined as focal aggregations of activated macrophages, Langerhans cells, and lymphocytes, and may form in the lungs when the immune system cannot eliminate a foreign antigen and attempts to barricade it. The diagnosis includes clinical evaluation, laboratory testing, and radiological imaging, which especially consists of high-resolution computed tomography. bronchoalveolar lavage, transbronchial needle aspiration or cryobiopsy, positron emission tomography, while genetic evaluation can improve the diagnostic accuracy. Differential diagnosis is challenging due to the numerous different imaging appearances with which GLDs may manifest. Indeed, GLDs include both infectious and noninfectious, and necrotizing and non-necrotizing granulomatous diseases and the imaging appearance of some GLDs may mimic malignancy, leading to confirmatory biopsy. The purposes of our review are to report the different noninfectious granulomatous entities and to show their various imaging features to help radiologists recognize them properly and make an accurate differential diagnosis.
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Affiliation(s)
- Giulia Lassandro
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, I-80147 Naples, Italy
| | - Stefano Giusto Picchi
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, I-80147 Naples, Italy
| | - Antonio Corvino
- Medical, Movement and Wellbeing Sciences Department, University of Naples "Parthenope", Via Medina 40, I-80133 Naples, Italy
| | - Candida Massimo
- Department of Radiology, Monaldi Hospital, A.O. Ospedali dei Colli, Via Leonardo Bianchi, I-80131 Naples, Italy
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, I-80147 Naples, Italy
| | - Laura Vanore
- Department of Radiology, Ospedale S. Anna e SS. Madonna della Neve, ASL NA3 Sud, Via Lenze, Boscotrecase, I-80042 Naples, Italy
| | - Giovanna Urraro
- Department of Radiology, Ospedale S. Anna e SS. Madonna della Neve, ASL NA3 Sud, Via Lenze, Boscotrecase, I-80042 Naples, Italy
| | - Giuseppe Russo
- General Direction for Health Management, ASL Napoli 3 Sud, Via Marconi, Torre del Greco, I-80059 Naples, Italy
| | - Francesco Lassandro
- Department of Radiology, Ospedale S. Anna e SS. Madonna della Neve, ASL NA3 Sud, Via Lenze, Boscotrecase, I-80042 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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Antunes MDS, Hochhegger B, Alves GRT, Gazzoni FF, Forte GC, Andrade RGF, Felicetti JC. Postoperative computed tomography of insufflated lung specimens obtained by video-assisted thoracic surgery: detection and margin assessment of pulmonary nodules. Radiol Bras 2022; 55:151-155. [PMID: 35795601 PMCID: PMC9254709 DOI: 10.1590/0100-3984.2021.0046] [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: 03/10/2021] [Accepted: 07/18/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the utility of computed tomography (CT) scans to detect and
assess the margin status of pulmonary nodules that were insufflated after
being resected by video-assisted thoracic surgery. Materials and Methods This was a novel multicenter study conducted at two national referral centers
for thoracic diseases. Patients suspected of having lung cancer underwent
video-assisted thoracic surgery for the resection of pulmonary nodules,
which were submitted to postoperative CT. Measurements from the CT scans
were compared with the results of the histopathological analysis. Results A total of 37 pulmonary nodules from 37 patients were evaluated. The mean age
of the patients was 65 years (range, 36-84 years), and 27 (73%) were female.
A CT analysis of insufflated specimens identified all 37 nodules, and 33 of
those nodules were found to have tumor-free margins. The histopathological
analysis revealed lung cancer in 30 of the nodules, all with tumor-free
margins, and benign lesions in the seven remaining nodules. Conclusion Postoperative CT of insufflated suspicious lung lesions provides real-time
detection of pulmonary nodules and satisfactory assessment of tumor margins.
This initial study shows that CT of insufflated lung lesions can be a
valuable tool at centers where intraoperative histopathological analysis is
unavailable.
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Affiliation(s)
| | - Bruno Hochhegger
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
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Warszawiak D. Usual interstitial pneumonia. Are we "speaking the same language" and "seeing the same things" when analyzing computed tomography scans? Radiol Bras 2022; 55:V-VI. [PMID: 35795598 PMCID: PMC9254704 DOI: 10.1590/0100-3984.2022.55.3e1-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Danny Warszawiak
- Radiologist at DAPI - Diagnóstico Avançado por Imagem/Liga das Senhoras Católicas de Curitiba and at Hospital Erasto Gaertner/Liga Paranaense de Combate ao Câncer, Curitiba, PR, Brazil
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Warszawiak D. Pneumonia intersticial usual. Estamos “falando a mesma língua” e “vendo as mesmas coisas” ao analisar a tomografia computadorizada? Radiol Bras 2022. [DOI: 10.1590/0100-3984.2022.55.3e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Mançano AD. Neurofibromatosis type 1. Radiol Bras 2022; 55:VII-VIII. [PMID: 35210668 PMCID: PMC8864685 DOI: 10.1590/0100-3984.2022.55.1e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Alves Júnior SF, Irion KL, de Melo ASA, Meirelles GDSP, Rodrigues RS, Souza AS, Hochhegger B, Zanetti G, Marchiori E. Neurofibromatosis type 1: evaluation by chest computed tomography. Radiol Bras 2021; 54:375-380. [PMID: 34866697 PMCID: PMC8630947 DOI: 10.1590/0100-3984.2020.0150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to evaluate chest computed tomography (CT) findings
in patients diagnosed with neurofibromatosis type 1 (NF1). Material and Methods This was a retrospective study in which we reviewed the chest CT scans of 14
patients diagnosed with NF1 and neurofibromatosis-associated diffuse lung
disease (NF-DLD). The sample comprised eight women and six men. The median
age was 55 years (range, 11-75 years). The diagnosis of NF1 was made on the
basis of the diagnostic criteria established by the U.S. National Institutes
of Health. The images were analyzed by two chest radiologists, who reached
decisions by consensus. Results The predominant CT finding of NF-DLD was multiple cysts, which were observed
in 13 patients (92.9%), followed by emphysema, in eight (57.1%) and
subpleural bullae, in six (42.9%). Other findings included subcutaneous
neurofibromas, in 12 patients (85.7%), ground-glass opacities, in one
(7.1%), and tracheobronchial neurofibromas, in one (7.1%). The pulmonary
abnormalities were bilateral in 12 cases (85.7%). The abnormalities were
predominantly in the upper lung fields in eight cases (57.1%), and their
distribution was random in 11 (78.6%). Conclusion Pulmonary cysts, emphysema, and subpleural bullae appear to be the chest CT
findings that are most characteristic of NF-DLD.
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Affiliation(s)
| | - Klaus Loureiro Irion
- Manchester University, NIHR Biomedical Research Centre, Manchester, United Kingdom
| | | | | | | | - Arthur Soares Souza
- Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Bruno Hochhegger
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Santos FDS, Verma N, Watte G, Marchiori E, Mohammed TLH, Medeiros TM, Hochhegger B. Diffusion-weighted magnetic resonance imaging for differentiating between benign and malignant thoracic lymph nodes: a meta-analysis. Radiol Bras 2021; 54:225-231. [PMID: 34393288 PMCID: PMC8354191 DOI: 10.1590/0100-3984.2020.0084] [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: 06/16/2020] [Accepted: 07/29/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To establish the diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) in discriminating malignant from non-malignant thoracic lymph nodes. MATERIALS AND METHODS This was a meta-analysis involving systematic searches of the MEDLINE, EMBASE, and Web of Science databases up through April 2020. Studies reporting thoracic DWI and lymph node evaluation were included. The pooled sensitivity, specificity, diagnostic odds ratio, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated. RESULTS We evaluated six studies, involving a collective total of 356 mediastinal lymph nodes in 214 patients. Thoracic DWI had a pooled sensitivity and specificity of 92% (95% confidence interval [95% CI]: 71-98%) and 93% (95% CI: 79-98%), respectively. The positive and negative likelihood ratios were 13.2 (95% CI: 4.0-43.8) and 0.09 (95% CI: 0.02-0.36), respectively. The diagnostic odds ratio was 149 (95% CI: 18-1,243), and the AUC was 0.97 (95% CI: 0.95-0.98). CONCLUSION DWI is a reproducible technique and has demonstrated high accuracy for differentiating between malignant and benign states in thoracic lymph nodes.
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Affiliation(s)
- Francisco de Souza Santos
- Graduate Program in Internal Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Nupur Verma
- Department of Radiology, University of Florida (UF), Gainesville, FL, USA
| | - Guilherme Watte
- Graduate Program in Internal Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Edson Marchiori
- Department of Radiology, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Tássia Machado Medeiros
- Graduate Program in Internal Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Bruno Hochhegger
- Graduate Program in Internal Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
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Barreto MM, Rodrigues RS. Chest computed tomography to evaluate lymphocytic interstitial pneumonia. Radiol Bras 2020; 53:V-VI. [PMID: 33071382 PMCID: PMC7545734 DOI: 10.1590/0100-3984.2020.53.5e1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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