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Ehsanipur F, Ebrahimi P, Tahernia L, Vafaee‐Shahi M. A fulminant presentation of post-COVID-19 necrotizing pneumonia and ischemic stroke in an 8-year-old girl: A case report and literature review. Clin Case Rep 2024; 12:e9222. [PMID: 39077727 PMCID: PMC11284262 DOI: 10.1002/ccr3.9222] [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: 03/07/2024] [Revised: 05/31/2024] [Accepted: 07/14/2024] [Indexed: 07/31/2024] Open
Abstract
Necrotizing pneumonia (NP) is the destruction of the interstitial part of the lung due to severe infection. One cause of this rare and fatal condition in pediatrics is Acinetobacter. Severe infections, especially pneumonia, can prone pediatric patients to ischemic stroke. This study reports an 8-year-old girl presented to the emergency department complaining of shortness of breath, fever, and fatigue. She was admitted to the intensive care unit due to respiratory distress and pericardial effusion. Swab and respiratory secretion tests for COVID-19 and Acinetobacter were positive. In her admission course, her condition deteriorated, and on the fifth day, she underwent a craniotomy due to the signs of increased intracranial pressure (ICP). The computed tomography (CT) scan showed an ischemic stroke. Despite all efforts and medical efforts, the patient's clinical condition got worse, and she died 10 days after the surgery. COVID-19 can lead to vulnerability to severe bacterial infections such as NP in pediatrics. Severe infections are a significant risk factor for ischemic stroke. The presentation might be different in intubated unconscious patients, such as detecting increased ICP signs. In severe and extensive cases of NP and ischemia, the destruction of the lungs and brain tissue might be irreversible and even lethal. Doctors and parents should consider neurologic complaints in children with infectious diseases as a serious issue since infections make children vulnerable to complications such as stroke.
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Affiliation(s)
- Fahimeh Ehsanipur
- Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Faculty of MedicineIran University of Medical SciencesTehranIran
| | - Pouya Ebrahimi
- Cardiovascular Disease Research Institute, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | | | - Mohammad Vafaee‐Shahi
- Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Faculty of MedicineIran University of Medical SciencesTehranIran
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2
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Ul Haq I, Ali Hameed M, Ahmed S, Ahmad M, Rasheed I. Unexpected origins: Bronchopulmonary dysplasia and the unusual spectrum of cystic lung disease. Qatar Med J 2024; 2024:27. [PMID: 38680405 PMCID: PMC11046138 DOI: 10.5339/qmj.2024.qitc.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Irfan Ul Haq
- Pulmonary Medicine Department, Hamad General Hospital, Doha, Qatar
| | | | - Shakeel Ahmed
- Pulmonary Medicine Department, Al Wakra Hospital, Al Wakra, Qatar
| | - Mushtaq Ahmad
- Pulmonary Medicine Department, Hamad General Hospital, Doha, Qatar
| | - Ibrahim Rasheed
- Pulmonary Medicine Department, Hamad General Hospital, Doha, Qatar
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3
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Alexopoulou E, Prountzos S, Raissaki M, Mazioti A, Caro-Dominguez P, Hirsch FW, Lovrenski J, Ciet P. Imaging of Acute Complications of Community-Acquired Pneumonia in the Paediatric Population-From Chest Radiography to MRI. CHILDREN (BASEL, SWITZERLAND) 2024; 11:122. [PMID: 38255434 PMCID: PMC10814200 DOI: 10.3390/children11010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
The most common acute infection and leading cause of death in children worldwide is pneumonia. Clinical and laboratory tests essentially diagnose community-acquired pneumonia (CAP). CAP can be caused by bacteria, viruses, or atypical microorganisms. Imaging is usually reserved for children who do not respond to treatment, need hospitalisation, or have hospital-acquired pneumonia. This review discusses the imaging findings for acute CAP complications and the diagnostic role of each imaging modality. Pleural effusion, empyema, necrotizing pneumonia, abscess, pneumatocele, pleural fistulas, and paediatric acute respiratory distress syndrome (PARDS) are acute CAP complications. When evaluating complicated CAP patients, chest radiography, lung ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) can be used, with each having their own pros and cons. Imaging is usually not needed for CAP diagnosis, but it is essential for complicated cases and follow-ups. Lung ultrasound can supplement chest radiography (CR), which starts the diagnostic algorithm. Contrast-enhanced computed tomography (CECT) is used for complex cases. Advances in MRI protocols make it a viable alternative for diagnosing CAP and its complications.
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Affiliation(s)
- Efthymia Alexopoulou
- 2nd Department of Radiology, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.A.); (A.M.)
| | - Spyridon Prountzos
- 2nd Department of Radiology, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.A.); (A.M.)
| | - Maria Raissaki
- University Hospital of Heraklion, Medical School, University of Crete, 70013 Heraklion, Greece;
| | - Argyro Mazioti
- 2nd Department of Radiology, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.A.); (A.M.)
| | - Pablo Caro-Dominguez
- Pediatric Radiology Unit, Radiology Department, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain;
| | - Franz Wolfgang Hirsch
- Department of Pediatric Radiology, University Hospital, Liebigstraße 20a, 04107 Leipzig, Germany;
| | - Jovan Lovrenski
- Radiology Department, Faculty of Medicine, Institute for Children and Adolescents Health Care of Vojvodina, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Pierluigi Ciet
- Department of Radiology and Nuclear Medicine, Erasmus MC—Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands;
- Department of Radiology, University of Cagliari, 09124 Cagliari, Italy
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4
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Hakimi T, Mangal M, Ibrahimi MA, Aslamzai M, Ekram K, Shiwa MH, Hakimi Z, Noory AT, Hamdard AG, Halimi SA, Jawed MA. A challenging high-risk surgery for necrotizing pneumonia in a right bilobed lung. BMC Pediatr 2023; 23:170. [PMID: 37046243 PMCID: PMC10099639 DOI: 10.1186/s12887-023-03999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/08/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Necrotizing pneumonia is rare in children and is one of the most serious complications of a lung infection caused by antibiotic failure. We present a 12-year-old leukopenic child with a long-lasting lung infection, presenting as having a lung hydatid cyst, but diagnosing with necrotizing pneumonia in the right bilobed lung. Failure to medical treatment and ongoing leukopenia justified surgical intervention with positive results. CASE PRESENTATION The patient was referred to our teaching hospital's pediatric surgery department. He had previously been diagnosed with intestinal tuberculosis (TB) and received anti-TB treatment. On referral to our hospital, the patient was suffering from restlessness, frequent coughing, fever, vomiting, and diarrhea. Following the completion of the clinical work-up, a blood test revealed leukopenia (white blood cell count of 2100/microliter), a normal platelet count, and a lesion in the right lung. Computerized tomography scanning (CT-Scan) image reported a lung hydatid cyst. In the pediatrics ward, a broad-spectrum antibiotics regimen with triple-antibiotic therapy (linezolid, vancomycin, and metronidazole) was instituted and continued for a week with no response, but worsening of the condition. In the pediatric surgery ward, our decision for surgical intervention was due to the failure of medical treatment because of a pulmonary lesion. Our team performed right lung upper lobe anterior segment wedge resection due to necrotizing pneumonia and followed the patient 45 days post-operation with a reasonable result. CONCLUSION Living in remote rural areas with low resources and inaccessibility to proper and specialized diagnostic and treatment centers will all contribute to an improper diagnosis and treatment of lung infection. In total, all of these will increase the morbidity and mortality due to lung necrosis in the pediatric population, regardless of their age. In low-resource facilities, high-risk patients can benefit from surgical intervention to control the ongoing infection process.
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Affiliation(s)
- Turyalai Hakimi
- Department of Pediatric Surgery, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan.
| | - Mohmand Mangal
- Department of Pediatrics, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan
| | - Mohammad Akbar Ibrahimi
- Department of Pediatrics, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan
| | - Mansoor Aslamzai
- Department of Neonatology, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan
| | - Khesrow Ekram
- Department of Pediatrics, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan
| | - Mohammad Hussain Shiwa
- Department of General Surgery, Kabul University of medical science, Ali Abad teaching hospital, Kabul, Afghanistan
| | - Zamaryalai Hakimi
- Department of Infectious disease, Kabul University of medical science, Ali Abad teaching hospital, Kabul, Afghanistan
| | - Abdul Tawab Noory
- Department of Infectious disease, Kabul University of medical science, Ali Abad teaching hospital, Kabul, Afghanistan
| | - Abdul Ghafar Hamdard
- Department of Dermatology, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan
| | - Sultan Ahmad Halimi
- Department of Pathology, Kabul University of medical science, Kabul, Afghanistan
| | - Mohammad Anwar Jawed
- Department of Pediatric Surgery, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan
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5
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Chen Y, Li L, Wang C, Zhang Y, Zhou Y. Necrotizing Pneumonia in Children: Early Recognition and Management. J Clin Med 2023; 12:jcm12062256. [PMID: 36983257 PMCID: PMC10051935 DOI: 10.3390/jcm12062256] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023] Open
Abstract
Necrotizing pneumonia (NP) is an uncommon complicated pneumonia with an increasing incidence. Early recognition and timely management can bring excellent outcomes. The diagnosis of NP depends on chest computed tomography, which has radiation damage and may miss the optimal treatment time. The present review aimed to elaborate on the reported predictors for NP. The possible pathogenesis of Streptococcus pneumoniae, Staphylococcus aureus, Mycoplasma pneumoniae and coinfection, clinical manifestations and management were also discussed. Although there is still a long way for these predictors to be used in clinical, it is necessary to investigate early predictors for NP in children.
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Affiliation(s)
- Yuanyuan Chen
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Lanxin Li
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Chenlu Wang
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Yuanyuan Zhang
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
- Correspondence: (Y.Z.); (Y.Z.)
| | - Yunlian Zhou
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
- Correspondence: (Y.Z.); (Y.Z.)
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6
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Hoang VT, Hoang TH, Van HAT, Nguyen TTT, Chansomphou V. Traumatic rupture of congenital cystic adenomatoid malformation mimicking traumatic pulmonary pseudocyst: a case report. J Int Med Res 2023; 51:3000605231159327. [PMID: 36872862 PMCID: PMC9989401 DOI: 10.1177/03000605231159327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Thoracic trauma is commonly encountered in daily clinical practice; however, blunt thoracic trauma in patients with congenital cystic adenomatoid malformation (CCAM) is rare. CCAM rupture denotes a broad spectrum of manifestations on imaging and may be misdiagnosed as many other conditions. Consequently, this leads to inaccurate treatment and poor patient outcomes. We report the case of a girl with the initial diagnosis of a cavitary lung lesion that was likely a traumatic pulmonary pseudocyst or CCAM. The patient received medical therapy for 20 days; however, her condition did not improve. Subsequently, she underwent right lower lobectomy. Ruptured CCAM was confirmed during surgery and with histopathology. No complications occurred postoperatively, and the patient made a good recovery.
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Affiliation(s)
- Van Trung Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | - The Huan Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | - Hoang Anh Thi Van
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | | | - Vichit Chansomphou
- Department of Radiology, Savannakhet Medical-Diagnostic Center, Kaysone Phomvihane, Laos
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7
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Goyal VD, Pahade A, Misra G. Excision of a giant lung bulla in a child: Repair of bronchial leaks using redundant bullous wall/membrane. Asian Cardiovasc Thorac Ann 2022; 31:269-272. [PMID: 36544276 DOI: 10.1177/02184923221147094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Large lung bullae are rare in children. We report a rare case of a large bulla in the right lung causing compression of the underlying lung with a shift of the mediastinum to the contralateral side. Excision of the bulla was done and a novel technique was used in the repair of bronchial air leakage sites with part of the bullous wall/membrane. The patient recovered well with re-expansion of the underlying collapsed lung.
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Affiliation(s)
- Vikas Deep Goyal
- Department of Surgery, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, India
| | - Akhilesh Pahade
- Department of Anesthesia, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, India
| | - Gaurav Misra
- Department of Anesthesia, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, India
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8
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Hermelijn SM, Mackenbach MJ, van Horik C, Ciet P, Wolf JL, von der Thüsen JH, Wijnen RMH, Tiddens HAWM, Schnater JM. Quantitative CT imaging analysis to predict pathology features in patients with a congenital pulmonary airway malformation. J Pediatr Surg 2022; 57:1567-1572. [PMID: 34809963 DOI: 10.1016/j.jpedsurg.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/23/2021] [Accepted: 10/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Risk for infection and potential malignant degeneration are the most common arguments for resecting asymptomatic Congenital Pulmonary Airway Malformations (CPAM). We aimed to investigate if CT- imaging characteristics can be used to predict histopathological features, by using an objective quantitative CT scoring method. METHODS Archival CPAM tissue samples were histologically re-assessed and patients who had a pre-operative volumetric CT-scan were included. Lung disease was quantified using the newly-developed congenital lung abnormality quantification(CLAQ) scoring method and obtained percentages were used to predict histopathological signs of inflammation and presence of mucinous proliferation (MP). Because MP is presumed a precursor for mucinous adenocarcinoma in situ (AIS) this method was also used to compare CT-scans of patients with AIS to those with only CPAM. RESULTS Thirty-three CPAM patients were included of which 13(39%) had histological signs of inflammation and 8(24%) had a MP. Patients with inflammation had a significantly smaller lesion (14% vs 38%) while those with MP had more extensive disease (54%vs17%). Patients with AIS had a significantly smaller lesion compared to CPAM patients (5%vs29%). Significant predictors for inflammation were smaller lesion size and percentage hypodensity within lesions while a larger lesion size and percentage parenchymal hyperdensity (solid lung tissue components) were predictors for MP as well as AIS. CONCLUSIONS Smaller CPAM lesions may be more susceptible to inflammation while larger lesions may be associated with the presence of MP. Parenchymal hyperdensity is found as a predictor for MP as well as AIS and should therefore elicit more extensive gross sampling. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sergei M Hermelijn
- Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Molewaterplein 40. 3015 GD Rotterdam, Mailing address: Postbus 2060, Rotterdam 3000 CB, the Netherlands
| | - Maarten J Mackenbach
- Department of Pediatric Metabolic Diseases, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Cathy van Horik
- Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Molewaterplein 40. 3015 GD Rotterdam, Mailing address: Postbus 2060, Rotterdam 3000 CB, the Netherlands
| | - Pierluigi Ciet
- Department of Pediatric Pulmonology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Janina L Wolf
- Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan H von der Thüsen
- Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Molewaterplein 40. 3015 GD Rotterdam, Mailing address: Postbus 2060, Rotterdam 3000 CB, the Netherlands
| | - Harm A W M Tiddens
- Department of Pediatric Pulmonology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - J Marco Schnater
- Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Molewaterplein 40. 3015 GD Rotterdam, Mailing address: Postbus 2060, Rotterdam 3000 CB, the Netherlands.
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9
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Desale AN, Badhe PV, Nair MG, Rane CD. Traumatic pseudocyst of the lung following blunt trauma to the chest. BMJ Case Rep 2022; 15:e248492. [PMID: 35793852 PMCID: PMC9260763 DOI: 10.1136/bcr-2021-248492] [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] [Accepted: 06/20/2022] [Indexed: 11/04/2022] Open
Abstract
Traumatic pseudocysts of the lung are a rare complication following blunt trauma to the chest. Differentiating them from other cystic lesions of the lung is important. Traumatic pseudocysts usually occur in children and young adults who present with haemoptysis and persistent pain. History of trauma and radiological evaluation with a chest radiograph and a CT scan help in making the diagnosis. Follow-up chest radiographs showing resolution of the pseudocyst can confirm thediagnostic confirmation. This is a report of one such patient, a young man who improved after conservative treatment, with spontaneous radiological resolution of the pseudocyst.
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Affiliation(s)
| | | | - Megha Gireesan Nair
- Radiology, KEM Hospital and Seth GS Medical College, Mumbai, Maharashtra, India
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10
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Bakhle A, Sreekumar K, Baracho B, Sardessai S, Silveira MP. Cavitary lung lesions in a neonate: Potential manifestation of COVID-19 related multisystem inflammatory syndrome. Pediatr Pulmonol 2022; 57:311-314. [PMID: 34714960 PMCID: PMC8661966 DOI: 10.1002/ppul.25732] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The hyperinflammatory state of multisystem inflammatory syndrome in children (MIS-C) predisposes to thromboembolic complications. We report a neonate with multiple cavitary lesions in lung, which we suspect could be a manifestation of multisystem inflammatory syndrome in neonate (MIS-N) following maternal COVID-19 infection during pregnancy. CASE REPORT Eight-day-old neonate was referred with fever and fast breathing. Mother was positive for COVID-19 in 29th week. COVID-19 reverse-transcription polymerase chain reaction was negative, however, antibodies were positive. He had increased leucocyte count, and elevated levels of C-reactive protein (CRP), procalcitonin, ferritin, lactate dehydrogenase, and d-dimer along with bilateral reticulonodular opacities on chest radiograph and multiple nodules with evidence of cavitation in both lungs on chest tomography. All cultures were negative. A possible diagnosis of MIS was made. Infant was treated with intravenous immunoglobulin (IVIG) which he responded to with resolution of symptoms. CONCLUSION Neonates exposed to COVID-19 should be evaluated for thromboembolic complications and IVIG can be one of the treatment modalities.
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Affiliation(s)
- Anish Bakhle
- Department of PediatricsGoa Medical CollegeBambolimGoaIndia
| | | | - Bonny Baracho
- Department of PediatricsGoa Medical CollegeBambolimGoaIndia
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11
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Imaging of congenital lung diseases presenting in the adulthood: a pictorial review. Insights Imaging 2021; 12:153. [PMID: 34716817 PMCID: PMC8557233 DOI: 10.1186/s13244-021-01095-2] [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: 07/22/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022] Open
Abstract
Congenital lung diseases in adults are rare diseases that can present with symptoms or be detected incidentally. Familiarity with the imaging features of different types of congenital lung diseases helps both in correct diagnosis and management of these diseases. Congenital lung diseases in adults are classified into three main categories as bronchopulmonary anomalies, vascular anomalies, and combined bronchopulmonary and vascular anomalies. Contrast-enhanced computed tomography, especially 3D reconstructions, CT, or MR angiography, can show vascular anomalies in detail. The tracheobronchial tree, parenchymal changes, and possible complications can also be defined on chest CT, and new applications such as quantitative 3D reconstruction CT images, dual-energy CT (DECT) can be helpful in imaging parenchymal changes. In addition to the morphological assessment of the lungs, novel MRI techniques such as ultra-short echo time (UTE), arterial spin labeling (ASL), and phase-resolved functional lung (PREFUL) can provide functional information. This pictorial review aims to comprehensively define the radiological characteristics of each congenital lung disease in adults and to highlight differential diagnoses and possible complications of these diseases.
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12
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Kan J, Bauquier J, Tyrrell D, O'Byrne K, Stent AW, Brosnan B. Radiographic and CT appearance of cavitary pulmonary lesions in a lamb. Aust Vet J 2021; 99:529-534. [PMID: 34528254 DOI: 10.1111/avj.13115] [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: 03/07/2021] [Revised: 06/26/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pulmonary abscesses may be cavitary lesions on thoracic radiographs and computed tomography (CT). CASE REPORT A 26-day-old, cross-breed lamb presented for respiratory distress despite procaine penicillin treatment. Thoracic radiographs revealed several pulmonary ovoid thin-walled gas and soft tissue opacity structures. CT showed that these gas-filled structures enclosed mildly contrast enhancing soft tissue attenuating material and surrounded the lobar bronchus to the right middle and caudal lung lobes. Imaging revealed pulmonary cavitary lesions, and chronic pulmonary abscesses was confirmed with histopathology on samples obtained from a right caudal lung lobectomy. CONCLUSION To the authors' knowledge, this is the first radiographic and CT report of cavitary pulmonary lesions in a lamb. The pulmonary abscesses in this case were suspected to be due aspiration pneumonia occurring during bottle feeding, along with the high possibility of failure of passive transfer from its orphan history.
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Affiliation(s)
- J Kan
- Diagnostic Imaging Service, U-Vet Werribee Animal Hospital, Werribee, Victoria, Australia
| | - J Bauquier
- Department of Veterinary Biosciences, The University of Melbourne, Werribee, Victoria, Australia
| | - D Tyrrell
- Diagnostic Imaging Service, U-Vet Werribee Animal Hospital, Werribee, Victoria, Australia
| | - K O'Byrne
- Surgery Service, U-Vet Werribee Animal Hospital, Werribee, Victoria, Australia
| | - A W Stent
- Gribbles Veterinary Pathology, Clayton, Victoria
| | - B Brosnan
- Golden Plains Animal Hospital, Bannockburn, Victoria, Australia
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13
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Kilgore J, Pelletier J, Becken B, Kenny S, Das S, Parnell L. Miliary tuberculosis in a paediatric patient with psoriasis. BMJ Case Rep 2021; 14:14/3/e237580. [PMID: 33687934 PMCID: PMC7944982 DOI: 10.1136/bcr-2020-237580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We present a 16-year-old girl with a history of well-controlled psoriasis, on immunosuppression, who sought evaluation in the emergency department for 4 months of fever, cough and unintentional weight loss. The patient had seen multiple providers who had diagnosed her with community-acquired pneumonia, but she was unimproved after oral antibiotic therapy. On presentation, she was noted to be febrile, tachycardic and chronically ill-appearing. Her chest X-ray showed diffuse opacities and a right upper lobe cavitary lesion concerning for tuberculosis. A subsequent chest CT revealed miliary pulmonary nodules in addition to the cavitary lesion. The patient underwent subsequent brain MRI, which revealed multifocal ring-enhancing nodules consistent with parenchymal involvement. The patient was diagnosed with miliary tuberculosis and improved on quadruple therapy. Though rates of tuberculosis are increasing, rates remain low in children, though special consideration should be given to children who are immunosuppressed.
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Affiliation(s)
- Jacob Kilgore
- Division of Pediatric Infectious Diseases, Duke University Hospital, Durham, North Carolina, USA
| | - Jonathon Pelletier
- Division of Pediatric of Critical Care Medicine, UPMC, Pittsburgh, Pennsylvania, USA
| | - Bradford Becken
- Division of Pediatric Infectious Diseases, Duke University Hospital, Durham, North Carolina, USA
| | - Stephen Kenny
- Department of Pediatrics, King Edward VII Memorial Hospital, Paget, Bermuda
| | - Samrat Das
- Department of Pediatrics, Duke University Hopistal, Durham, North Carolina, USA
| | - Lisa Parnell
- Department of Pediatrics, Duke University Hopistal, Durham, North Carolina, USA
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14
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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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15
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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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16
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Canan A, Batra K, Saboo SS, Landay M, Kandathil A. Radiological approach to cavitary lung lesions. Postgrad Med J 2020; 97:521-531. [PMID: 32934178 DOI: 10.1136/postgradmedj-2020-138694] [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: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 11/03/2022]
Abstract
Cavitary lesions in the lung are not an uncommon imaging encounter and carry a broad differential diagnosis that includes a wide range of pathological conditions from cancers, infections/inflammatory processes to traumatic and congenital lung abnormalities. In this review article, we describe a comprehensive approach for evaluation of cavitary lung lesions and discuss the differential diagnosis in the light of radiological findings.
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Affiliation(s)
| | - Kiran Batra
- Department of Radiology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 75390, USA
| | - Sachin S Saboo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, 78229, USA
| | - Michael Landay
- Department of Radiology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 75390, USA
| | - Asha Kandathil
- Department of Radiology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 75390, USA
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17
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de Benedictis FM, Kerem E, Chang AB, Colin AA, Zar HJ, Bush A. Complicated pneumonia in children. Lancet 2020; 396:786-798. [PMID: 32919518 DOI: 10.1016/s0140-6736(20)31550-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/20/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
Complicated community-acquired pneumonia in a previously well child is a severe illness characterised by combinations of local complications (eg, parapneumonic effusion, empyema, necrotising pneumonia, and lung abscess) and systemic complications (eg, bacteraemia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation, and, rarely, death). Complicated community-acquired pneumonia should be suspected in any child with pneumonia not responding to appropriate antibiotic treatment within 48-72 h. Common causative organisms are Streptococcus pneumoniae and Staphylococcus aureus. Patients have initial imaging with chest radiography and ultrasound, which can also be used to assess the lung parenchyma, to identify pleural fluid; CT scanning is not usually indicated. Complicated pneumonia is treated with a prolonged course of intravenous antibiotics, and then oral antibiotics. The initial choice of antibiotic is guided by local microbiological knowledge and by subsequent positive cultures and molecular testing, including on pleural fluid if a drainage procedure is done. Information from pleural space imaging and drainage should guide the decision on whether to administer intrapleural fibrinolytics. Most patients are treated by drainage and more extensive surgery is rarely needed; in any event, in low-income and middle-income countries, resources for extensive surgeries are scarce. The clinical course of complicated community-acquired pneumonia can be prolonged, especially when patients have necrotising pneumonia, but complete recovery is the usual outcome.
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Affiliation(s)
| | - Eitan Kerem
- Department of Pediatrics, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Andrew A Colin
- Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa; MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial School of Medicine, Imperial College London, London, UK.
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18
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Giant pulmonary bullae in children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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19
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Brand EM, Lim CK, Biswell E, Jones-Hall Y, Heng HG. Concurrent bullous emphysema, bronchointerstitial pneumonia with necrosis, and tension pneumothorax in an 8-week-old puppy. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2020; 61:951-955. [PMID: 32879519 PMCID: PMC7424943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
An 8-week-old, male, mixed breed puppy was presented because of progressive respiratory distress. Thoracic radiographs revealed innumerable coalescing pulmonary bullae throughout the lungs with increased soft tissue opacity of the remaining pulmonary parenchyma and tension pneumothorax. Necropsy and histopathological findings were compatible with bullous emphysema and marked neutrophilic to histiocytic bronchointerstitial pneumonia with necrosis, bronchiectasis, fibrosis, dystrophic mineralization, and vasculitis with thrombosis. Tests for agents of infectious disease did not reveal an underlying etiological agent. This case highlights the radiographic, gross necropsy, and histopathologic features of a puppy with bullous emphysema and severe bronchointerstitial pneumonia with necrosis.
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Affiliation(s)
- Emily M Brand
- Department of Veterinary Clinical Sciences (Brand, Lim, Heng) and Department of Comparative Pathobiology (Biswell, Jones-Hall), College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Chee Kin Lim
- Department of Veterinary Clinical Sciences (Brand, Lim, Heng) and Department of Comparative Pathobiology (Biswell, Jones-Hall), College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Ethan Biswell
- Department of Veterinary Clinical Sciences (Brand, Lim, Heng) and Department of Comparative Pathobiology (Biswell, Jones-Hall), College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Yava Jones-Hall
- Department of Veterinary Clinical Sciences (Brand, Lim, Heng) and Department of Comparative Pathobiology (Biswell, Jones-Hall), College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Hock Gan Heng
- Department of Veterinary Clinical Sciences (Brand, Lim, Heng) and Department of Comparative Pathobiology (Biswell, Jones-Hall), College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
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20
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Lee KC, Kang EY, Yong HS, Kim C, Lee KY, Hwang SH, Oh YW. A Stepwise Diagnostic Approach to Cystic Lung Diseases for Radiologists. Korean J Radiol 2020; 20:1368-1380. [PMID: 31464115 PMCID: PMC6715565 DOI: 10.3348/kjr.2019.0057] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
Lung cysts are commonly seen on computed tomography (CT), and cystic lung diseases show a wide disease spectrum. Thus, correct diagnosis of cystic lung diseases is a challenge for radiologists. As the first diagnostic step, cysts should be distinguished from cavities, bullae, pneumatocele, emphysema, honeycombing, and cystic bronchiectasis. Second, cysts can be categorized as single/localized versus multiple/diffuse. Solitary/localized cysts include incidental cysts and congenital cystic diseases. Multiple/diffuse cysts can be further categorized according to the presence or absence of associated radiologic findings. Multiple/diffuse cysts without associated findings include lymphangioleiomyomatosis and Birt-Hogg-Dubé syndrome. Multiple/diffuse cysts may be associated with ground-glass opacity or small nodules. Multiple/diffuse cysts with nodules include Langerhans cell histiocytosis, cystic metastasis, and amyloidosis. Multiple/diffuse cysts with ground-glass opacity include pneumocystis pneumonia, desquamative interstitial pneumonia, and lymphocytic interstitial pneumonia. This stepwise radiologic diagnostic approach can be helpful in reaching a correct diagnosis for various cystic lung diseases.
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Affiliation(s)
- Kyu Chong Lee
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Eun Young Kang
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea.
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Cherry Kim
- Department of Radiology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Korea
| | - Ki Yeol Lee
- Department of Radiology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Yu Whan Oh
- Department of Radiology, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
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21
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Bouyssou S, Sanz I, Marchesi F, Eivers C. Radiographic, computed tomographic and histopathological characteristics of multilobar congenital pulmonary emphysema in a puppy. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sarah Bouyssou
- Diagnostic ImagingUniversity of Glasgow School of Veterinary MedicineGlasgowUK
| | - Inigo Sanz
- CardiologyUniversity of Glasgow School of Veterinary MedicineGlasgowUK
| | - Francesco Marchesi
- Anatomic pathologyUniversity of Glasgow School of Veterinary MedicineGlasgowUK
| | - Caroline Eivers
- Diagnostic ImagingUniversity of Glasgow School of Veterinary MedicineGlasgowUK
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22
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Yoo YJ, Sun JS, Lee JH, Jung HJ, Koh YH, Jung J, Kim HG. Atypical Presentation of Chronic Granulomatous Disease in a Neonate with a Pulmonary Granuloma Mimicking a Tumor: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:990-995. [PMID: 36238165 PMCID: PMC9432210 DOI: 10.3348/jksr.2020.81.4.990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/15/2019] [Accepted: 10/30/2019] [Indexed: 11/15/2022]
Abstract
Chronic granulomatous disease (CGD) is an uncommon primary immune deficiency caused by phagocytes defective in oxygen metabolite production. It results in recurrent bacterial or fungal infections. Herein, we present a case of CGD with a large pulmonary granuloma in a neonate and review the imaging findings. The patient was a 24-day-old neonate admitted to the hospital with fever. A round opacified lesion was identified on the chest radiograph. Subsequent CT and MRI revealed a round mass with heterogeneous enhancement in the right lower lobe. There were foci of diffusion restriction in the mass. Surgical biopsy of the mass revealed chronic granuloma. Finally, the neonate was diagnosed with CGD caused by mutation of the gp91phox gene. Herein, we present the clinical and imaging findings of this unusual case of CGD.
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Affiliation(s)
- Young Jin Yoo
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Joo Sung Sun
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Hyun Joo Jung
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Yeong Hwa Koh
- Department of Pathology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Joonho Jung
- Department of Cardiac Surgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Hyun Gi Kim
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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23
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Cho SY, Rowe SP, Jain SK, Schon LC, Yung RC, Nayfeh TA, Bingham CO, Foss CA, Nimmagadda S, Pomper MG. Evaluation of Musculoskeletal and Pulmonary Bacterial Infections With [ 124I]FIAU PET/CT. Mol Imaging 2020; 19:1536012120936876. [PMID: 32598214 PMCID: PMC7325456 DOI: 10.1177/1536012120936876] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Imaging is limited in the evaluation of bacterial infection. Direct imaging of in situ bacteria holds promise for noninvasive diagnosis. We investigated the ability of a bacterial thymidine kinase inhibitor ([124I]FIAU) to image pulmonary and musculoskeletal infections. METHODS Thirty-three patients were prospectively accrued: 16 with suspected musculoskeletal infection, 14 with suspected pulmonary infection, and 3 with known rheumatoid arthritis without infection. Thirty-one patients were imaged with [124I]FIAU PET/CT and 28 with [18F]FDG PET/CT. Patient histories were reviewed by an experienced clinician with subspecialty training in infectious diseases and were determined to be positive, equivocal, or negative for infection. RESULTS Sensitivity, specificity, positive-predictive value, negative-predictive value, and accuracy of [124I]FIAU PET/CT for diagnosing infection were estimated as 7.7% to 25.0%, 0.0%, 50%, 0.0%, and 20.0% to 71.4% for musculoskeletal infections and incalculable-100.0%, 51.7% to 72.7%, 0.0% to 50.0%, 100.0%, and 57.1% to 78.6% for pulmonary infections, respectively. The parameters for [18F]FDG PET/CT were 75.0% to 92.3%, 0.0%, 23.1% to 92.3%, 0.0%, and 21.4% to 85.7%, respectively, for musculoskeletal infections and incalculable to 100.0%, 0.0%, 0.0% to 18.2%, incalculable, and 0.0% to 18.2% for pulmonary infections, respectively. CONCLUSIONS The high number of patients with equivocal clinical findings prevented definitive conclusions from being made regarding the diagnostic efficacy of [124I]FIAU. Future studies using microbiology to rigorously define infection in patients and PET radiotracers optimized for image quality are needed.
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Affiliation(s)
- Steve Y. Cho
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Steven P. Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sanjay K. Jain
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lew C. Schon
- Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rex C. Yung
- Division of Pulmonary Medicine and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Clifton O. Bingham
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine A. Foss
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sridhar Nimmagadda
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin G. Pomper
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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24
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Kini H, Sreeram S, Shukla S, Rao S, Sahu K, Adiga D, Suresh P. Congenital Pulmonary Airway Malformation - 19-Year Experience from a Tertiary Care Center in India. Fetal Pediatr Pathol 2019; 38:449-459. [PMID: 31084392 DOI: 10.1080/15513815.2019.1613703] [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] [Indexed: 01/30/2023]
Abstract
Background: Congenital pulmonary airway malformation (CPAM) is a collection of non-hereditary, developmental anomalies. Our aim was to analyze the histological profiles and prevalence of CPAMs diagnosed in our center. Methods: A retrospective study of all CPAMs diagnosed from January 1999 to May 2018 from a general hospital pathology service was performed. Results: There were 79 cystic lesions encountered in fetuses, neonates, and children, 15 of which were CPAMs {5/2372 (0.21%) autopsies and 10/216026 (0.0046%) surgical resections}. The male:female ratio was 1:1.14. Gestational age of antenatal cases ranged from 22 to 32 weeks, postnatal ages ranged from 7 days to 15 years (mean 2.9 years). The cases were right-sided (8/15;53.3%), left-sided (4/15;26.7%) and bilateral (3/15,20%). Seven (46.7%), 4 (26.7%),3 (20%) and 1 (6.7%) were types 1, 2, 3 and 4, respectively. None of the surgical cases had postoperative mortality or morbidity. Conclusions: Prompt recognition and surgical resectability resulted in normal growth and symptom free survival in our postnatally diagnosed patients. Mortality in antenatally diagnosed fetuses remains high (5/11;45%).
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Affiliation(s)
- Hema Kini
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Saraswathy Sreeram
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Saumya Shukla
- Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, Lucknow, India
| | - Sadashiva Rao
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kausalya Sahu
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Deepa Adiga
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pooja Suresh
- Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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25
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Cheng J, Li C, Corsini EM, Antonoff MB, Hekmat K, Liu L. Left destroyed lung caused by a pen cap in the left lower lobe bronchus "swallowed" 25 years ago. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:711. [PMID: 31930110 DOI: 10.21037/atm.2019.11.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A delayed diagnosis of tracheobronchial foreign body aspiration (FBA) may result in severe respiratory complications such as pneumonia, bronchiectasis, and atelectasis. Here, we present a rare case of a left lung destruction caused by a pen cap that remained in the left lower lobe bronchus for 25 years and was previously misdiagnosed as cavitary tuberculosis. The foreign body was not detected in bronchoscopic examination prior to surgery due to severe stenosis of the left main bronchus. The foreign body was found incidentally while the patient was undergoing left pneumonectomy. To the best of our knowledge, this the second longest delay to diagnosis of FBA reported. This case also exemplifies the grave consequences of misdiagnosis of FBA.
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Affiliation(s)
- Jiahan Cheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China.,Department of Pathology, School of Medicine, Stanford University, Palo Alto, CA,94304, USA
| | - Chuan Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Erin M Corsini
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Khosro Hekmat
- Department of Cardiothoracic Surgery, University of Cologne, 50937 Cologne, Germany
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
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26
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Rawat S, Kumar R, Raja J, Singh RS, Thingnam SKS. Pulmonary hydatid cyst: Review of literature. J Family Med Prim Care 2019; 8:2774-2778. [PMID: 31681642 PMCID: PMC6820383 DOI: 10.4103/jfmpc.jfmpc_624_19] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/21/2019] [Accepted: 09/03/2019] [Indexed: 11/29/2022] Open
Abstract
Echinococcosis is a rare infectious disease in human being that occurs by the larval stages of taeniid cestodes of the genus Echinococcus. Human cystic echinococcosis is the most common presentation. The liver is the most common site of echinococcal cyst, followed by the lungs. The symptoms of lung infestation lead to sudden onset of chest pain, cough, fever, and hemoptysis after a cyst rupture. The diagnosis is confirmed by radiology supplemented with serology. Chest X-ray and computer tomography of chest is the principal investigation for pulmonary hydatid cyst (PHC). The treatment of PHCs is either pharmacotherapy and/or surgery. Surgical intervention is the most preferred treatment of choice; pharmacotherapy is useful in selected patients. Pharmacotherapy includes oral administration of benzimidazoles group of drugs like mebendazole or albendazole.
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Affiliation(s)
- Sanjib Rawat
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Kumar
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Javid Raja
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rana Sandip Singh
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyam Kumar Singh Thingnam
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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27
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Arkoudis NA, Pastroma A, Velonakis G, Tsochatzis A, Mazioti A, Vakaki M, Alexopoulou E. Solitary round pulmonary lesions in the pediatric population: a pictorial review. Acta Radiol Open 2019; 8:2058460119851998. [PMID: 31210963 PMCID: PMC6545655 DOI: 10.1177/2058460119851998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/30/2019] [Indexed: 11/16/2022] Open
Abstract
The purpose of this current pictorial review is to define the solitary round pulmonary lesion (SRPL), to familiarize with its prevalence in the pediatric population, and, moreover, to educate radiologists on its vast differential diagnosis and imaging manifestations. Furthermore, by highlighting valuable clues, it intends to assist radiologists efficiently partake in its diagnosis, work-up, and follow-up in order to narrow down the differential diagnosis by working alongside the clinician and combining clinical information, lab results, and radiological findings.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- Second Department of Radiology, University General Hospital of Athens "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angeliki Pastroma
- Second Department of Radiology, University General Hospital of Athens "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- Radiology and Medical Imaging Research Unit, Second Department of Radiology, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Tsochatzis
- Second Department of Radiology, University General Hospital of Athens "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyro Mazioti
- Second Department of Radiology, University General Hospital of Athens "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina Vakaki
- Department of Radiology, P & A Kyriakou Children's Hospital, Athens, Greece
| | - Efthymia Alexopoulou
- Second Department of Radiology, University General Hospital of Athens "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
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28
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Singh A, Srivastva NK, Tewari P, Majumdar G. Unrecognized hyperlucent lesion on lateral film of chest X-Ray. Ann Card Anaesth 2018; 21:440-441. [PMID: 30333344 PMCID: PMC6206806 DOI: 10.4103/aca.aca_84_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report an interesting case of bulla right lung, incidently found during CABG surgery.
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Affiliation(s)
- Ankita Singh
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Prabhat Tewari
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Gauranga Majumdar
- Department of Cardiothoracic Vascular Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
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Traumatic Pulmonary Pseudocyst Mimicking a Congenital Cystic Lung Disease. Case Rep Pulmonol 2018; 2018:7269694. [PMID: 30112242 PMCID: PMC6077363 DOI: 10.1155/2018/7269694] [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: 05/20/2018] [Accepted: 07/04/2018] [Indexed: 11/25/2022] Open
Abstract
Traumatic pulmonary pseudocyst (TPP) is a rare entity that occurs following a trauma to the chest. It usually presents as multiple cystic lesions on thoracic imaging. It is treated conservatively and tends to completely resolve after few months. In the absence of striking signs of trauma such as rib fractures, TPP can be mistaken for other cystic lung diseases. We present a case of TPP in a 17-year-old male who was seen for mild hemoptysis after falling off a cliff. The extent of his right lower lobe cystic lesions along with the lack of major signs of trauma led to an incorrect diagnosis of congenital pulmonary airway malformation. The patient was considered for lobectomy, which he refused. Imaging of the chest repeated one and three years later showed complete resolution of the lesions.
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30
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Kudo F, Ohta H, Nagai Y, Minegishi K, Koyama S. A young immunocompetent patient with spontaneous Aspergillus empyema who developed severe eosinophilia. Respir Med Case Rep 2017; 22:220-223. [PMID: 28913161 PMCID: PMC5587871 DOI: 10.1016/j.rmcr.2017.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 08/25/2017] [Accepted: 08/27/2017] [Indexed: 12/03/2022] Open
Abstract
Aspergillus empyema is usually reported as a complication of surgical procedures, and spontaneous cases are quite rare. Here, we describe the case of a 16-year-old man who suddenly developed dyspnea despite previously being healthy. Chest computed tomography showed multiple mass-containing cavity lesions, pneumothorax, and pleural effusion in the left thorax. Within 2 weeks, Aspergillus fumigatus grew from his pleural effusion, thus he was diagnosed with Aspergillus empyema. He also developed severe eosinophilia after admission, and was treated with anti-fungal drugs. Although there are many factors that can cause eosinophilia, we suspect that infection with Aspergillus fumigatus was the major cause of the eosinophilia in this patient. The lack of bronchial symptoms and lesions were not consistent with a diagnosis of allergic bronchopulmonary aspergillosis. As far as we know, this is the first case of spontaneous Aspergillus empyema resulting in severe eosinophilia.
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Affiliation(s)
- Fumiaki Kudo
- Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hiromitsu Ohta
- Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshiaki Nagai
- Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kentaro Minegishi
- Department of General Thoracic Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shinichiro Koyama
- Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
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31
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Masters IB, Isles AF, Grimwood K. Necrotizing pneumonia: an emerging problem in children? Pneumonia (Nathan) 2017; 9:11. [PMID: 28770121 PMCID: PMC5525269 DOI: 10.1186/s41479-017-0035-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/22/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In children, necrotizing pneumonia (NP) is an uncommon, severe complication of pneumonia. It is characterized by destruction of the underlying lung parenchyma resulting in multiple small, thin-walled cavities and is often accompanied by empyema and bronchopleural fistulae. REVIEW NP in children was first reported in children in 1994, and since then there has been a gradual increase in cases, which is partially explained by greater physician awareness and use of contrast computed tomography (CT) scans, and by temporal changes in circulating respiratory pathogens and antibiotic prescribing. The most common pathogens detected in children with NP are pneumococci and Staphylococcus aureus. The underlying disease mechanisms are poorly understood, but likely relate to multiple host susceptibility and bacterial virulence factors, with viral-bacterial interactions also possibly having a role. Most cases are in previously healthy young children who, despite adequate antibiotic therapy for bacterial pneumonia, remain febrile and unwell. Many also have evidence of pleural effusion, empyema, or pyopneumothorax, which has undergone drainage or surgical intervention without clinical improvement. The diagnosis is generally made by chest imaging, with CT scans being the most sensitive, showing loss of normal pulmonary architecture, decreased parenchymal enhancement and multiple thin-walled cavities. Blood culture and culture and molecular testing of pleural fluid provide a microbiologic diagnosis in as many as 50% of cases. Prolonged antibiotics, draining pleural fluid and gas that causes mass effects, and maintaining ventilation, circulation, nutrition, fluid, and electrolyte balance are critical components of therapy. Despite its serious nature, death is uncommon, with good clinical, radiographic and functional recovery achieved in the 5-6 months following diagnosis. Increased knowledge of NP's pathogenesis will assist more rapid diagnosis and improve treatment and, ultimately, prevention. CONCLUSION It is important to consider that our understanding of NP is limited to individual case reports or small case series, and treatment data from randomized-controlled trials are lacking. Furthermore, case series are retrospective and usually confined to single centers. Consequently, these studies may not be representative of patients in other locations, especially when allowing for temporal changes in pathogen behaviour and differences in immunization schedules and antibiotic prescribing practices.
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Affiliation(s)
- I. Brent Masters
- Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, QLD Australia
| | - Alan F. Isles
- Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, QLD Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Gold Coast campus, Griffith University, Building G40, Southport Gold Coast, QLD Australia
- Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Southport Gold Coast, QLD Australia
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32
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Roemers R, Patberg K, van de Wauwer C, Nguyen T, Shahin G. Robot-assisted thoracoscopic lobectomy as treatment of a giant bulla. J Cardiothorac Surg 2017; 12:31. [PMID: 28521787 PMCID: PMC5437605 DOI: 10.1186/s13019-017-0595-3] [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: 11/03/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A bulla is a marked enlarged space within the parenchyma of the lung. Bullae may cause dyspnea by compressing healthy lung parenchyma and can cause a pneumothorax. Also, bullae are associated with malignancy, therefore surgical bullectomy is indicated on preventive basis. This case is unique and therefore valuable because of the remarkable presentation, innovative treatment and the spectacular improvement of lung function and socio-economic performance of the patient. CASE PRESENTATION In this case report we describe the presentation, minimally invasive surgical treatment by means of a robot-assisted lobectomy and postoperative outcome of a young patient with a giant congenital bulla of the left upper lobe. CONCLUSIONS In this case robot-assisted lobectomy has shown spectacular improvement of lung function and fast-track recovery with beneficial socio-economic performance in a young patient with a giant congenital bulla.
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Affiliation(s)
- Rosa Roemers
- Department of Cardio-thoracic Surgery, Universitair Medisch Centrum Groningen (UMCG), Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Kornelis Patberg
- Department of Pulmonology, Isala Clinics Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Caroline van de Wauwer
- Department of Cardio-thoracic Surgery, Universitair Medisch Centrum Groningen (UMCG), Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Tam Nguyen
- Department of Pulmonology, Isala Clinics Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Ghada Shahin
- Department of Cardio-thoracic Surgery, Isala Clinics Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
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33
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Abstract
OBJECTIVE Radiographic imaging of the pediatric chest presents several unique challenges and nuances, stemming from congenital variants and pathologic processes specific to this population. Errors in interpretation may lead to inappropriate further imaging, incurring additional radiation exposure and cost, as well as psychologic effects on the patients and their families. CONCLUSION Here, we aim to highlight some common and less common pitfalls in pediatric chest radiography, as well as some tools for avoiding potential mistakes.
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Gupta N, Vassallo R, Wikenheiser-Brokamp KA, McCormack FX. Diffuse Cystic Lung Disease. Part II. Am J Respir Crit Care Med 2015; 192:17-29. [PMID: 25906201 DOI: 10.1164/rccm.201411-2096ci] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The diffuse cystic lung diseases have a broad differential diagnosis. A wide variety of pathophysiological processes spanning the spectrum from airway obstruction to lung remodeling can lead to multifocal cyst development in the lung. Although lymphangioleiomyomatosis and pulmonary Langerhans cell histiocytosis are perhaps more frequently seen in the clinic, disorders such as Birt-Hogg-Dubé syndrome, lymphocytic interstitial pneumonia, follicular bronchiolitis, and light-chain deposition disease are increasingly being recognized. Obtaining an accurate diagnosis can be challenging, and management approaches are highly disease dependent. Unique imaging features, genetic tests, serum studies, and clinical features provide invaluable clues that help clinicians distinguish among the various etiologies, but biopsy is often required for definitive diagnosis. In part II of this review, we present an overview of the diffuse cystic lung diseases caused by lymphoproliferative disorders, genetic mutations, or aberrant lung development and provide an approach to aid in their diagnosis and management.
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Affiliation(s)
- Nishant Gupta
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine and.,2 Veterans Affairs Medical Center, Department of Veterans Affairs, Cincinnati, Ohio
| | - Robert Vassallo
- 3 Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota; and
| | - Kathryn A Wikenheiser-Brokamp
- 4 Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, Ohio.,5 Division of Pathology and Laboratory Medicine and.,6 Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Francis X McCormack
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine and.,2 Veterans Affairs Medical Center, Department of Veterans Affairs, Cincinnati, Ohio
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35
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Gupta N, Vassallo R, Wikenheiser-Brokamp KA, McCormack FX. Diffuse Cystic Lung Disease. Part I. Am J Respir Crit Care Med 2015; 191:1354-66. [PMID: 25906089 DOI: 10.1164/rccm.201411-2094ci] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The diffuse cystic lung diseases (DCLDs) are a group of pathophysiologically heterogenous processes that are characterized by the presence of multiple spherical or irregularly shaped, thin-walled, air-filled spaces within the pulmonary parenchyma. Although the mechanisms of cyst formation remain incompletely defined for all DCLDs, in most cases lung remodeling associated with inflammatory or infiltrative processes results in displacement, destruction, or replacement of alveolar septa, distal airways, and small vessels within the secondary lobules of the lung. The DCLDs can be broadly classified according to underlying etiology as those caused by low-grade or high-grade metastasizing neoplasms, polyclonal or monoclonal lymphoproliferative disorders, infections, interstitial lung diseases, smoking, and congenital or developmental defects. In the first of a two-part series, we present an overview of the cystic lung diseases caused by neoplasms, infections, smoking-related diseases, and interstitial lung diseases, with a focus on lymphangioleiomyomatosis and pulmonary Langerhans cell histiocytosis.
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Affiliation(s)
- Nishant Gupta
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine and.,2 Veterans Affairs Medical Center, Department of Veterans Affairs, Cincinnati, Ohio
| | - Robert Vassallo
- 3 Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota; and
| | - Kathryn A Wikenheiser-Brokamp
- 4 Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, Ohio.,5 Division of Pathology and Laboratory Medicine and.,6 Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Francis X McCormack
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine and.,2 Veterans Affairs Medical Center, Department of Veterans Affairs, Cincinnati, Ohio
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36
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Zucker EJ, Epelman M, Newman B. Perinatal Thoracic Mass Lesions: Pre- and Postnatal Imaging. Semin Ultrasound CT MR 2015; 36:501-21. [PMID: 26614133 DOI: 10.1053/j.sult.2015.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Chest masses present a common problem in the perinatal period. Advances in prenatal ultrasound, supplemented by fetal magnetic resonance imaging, now allow early detection and detailed characterization of many thoracic lesions in utero. As such, in asymptomatic infants, assessment with postnatal computed tomography or magnetic resonance imaging can often be delayed for several months until the time at which surgery is being contemplated. Bronchopulmonary malformations comprise most of the thoracic masses encountered in clinical practice. However, a variety of other pathologies can mimic their appearances or produce similar effects such as hypoplasia of a lung or both lungs. Understanding of the key differentiating clinical and imaging features can assist in optimizing prognostication and timely management.
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Affiliation(s)
- Evan J Zucker
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA.
| | - Monica Epelman
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL
| | - Beverley Newman
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA
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37
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Singh U, Kumar S, Gour H, Singh N, Ramaraj M, Mittal V, Jhim D. Complicated hydatid cyst and "air bubble" sign: a stepping-stone to correct diagnosis. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:20-4. [PMID: 25612057 PMCID: PMC4307737 DOI: 10.12659/ajcr.892621] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hydatid cyst, or Echinococcosis, is an important helminthic zoonotic disease in humans that commonly affects the liver and lungs. Uncomplicated hydatid cysts, seen as round opaque lesions on chest radiography, are easily diagnosed, whereas complicated cysts (infected and or perforated) may change the radiographic appearance of the hydatid cyst, causing an incorrect diagnosis and delayed treatment. Although in radiology many signs have been described, the "air bubble" sign, seen in the mediastinal window of CECT as a single or multiple small rounded radiolucent areas with sharp margins within the periphery of a solid mass lesion, is being recognized as a sign with high sensitivity and specificity in the diagnosis of complicated hydatid cysts. CASE REPORT A 32-year-old female on anti-tubercular treatment for the past 3 months without any improvement was admitted to our hospital. CECT of the chest revealed a mass-like lesion with the "air bubble" sign. After 15 days the patient had a vigorous bout of coughing, leading to expectoration of pieces of whitish yellowish gelatinous membrane for the next 3 days. The ELISA result for Echinococcus was highly positive. On the basis of the "air bubble" sign, positive serology, and expectorated pieces of the membrane, the patient was diagnosed as having a complicated hydatid cyst. CONCLUSIONS Due to the varied presentations of complicated hydatid cyst, the knowledge and awareness of various signs in radiology associated with the hydatid cyst, in particular the "air bubble" sign, is imperative in making a prompt and accurate diagnosis of a complicated hydatid cyst.
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Affiliation(s)
- Urvinderpal Singh
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
| | - Sunil Kumar
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
| | - Hitesh Gour
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
| | - Navdeep Singh
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
| | - Murlidharan Ramaraj
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
| | - Vidhu Mittal
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
| | - Daksh Jhim
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
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