OBJECTIVE: To evaluate how changes in lung volume affect volumetric measurements of lung nodules using a multi-detector row CT. MATERIALS AND METHODS: Ten subjects with asthma or chronic bronchitis who had one or more lung nodules were included. For each subject, two sets of CT images were obtained at inspiration and at expiration. A total of 33 nodules (23 nodules > or = 3 mm) were identified and their volume measured using a semiautomatic volume measurement program. Differences between nodule volume on inspiration and expiration were compared using the paired t-test. Percent differences, between on inspiration and expiration, in nodule attenuation, total lung volume, whole lung attenuation, and regional lung attenuation, were computed and compared with percent difference in nodule volume determined by linear correlation analysis. RESULTS: The difference in nodule volume observed between inspiration and expiration was significant (p < 0.01); the mean percent difference in lung nodule volume was 23.1% for all nodules and for nodules > or = 3 mm. The volume of nodules was measured to be larger on expiration CT than on inspiration CT (28 out of 33 nodules; 19 out of 23 nodules > or = 3 mm). A statistically significant correlation was found between the percent difference of lung nodule volume and lung volume or regional lung attenuation (p < 0.05) for nodules > or = 3 mm. CONCLUSION: Volumetric measurements of pulmonary nodules were significantly affected by changes in lung volume. The variability in this respiration-related measurement should be considered to determine whether growth has occurred in a lung nodule.
Tomography, X-Ray Computed/*methods ; Middle Aged ; Male ; Humans ; Female ; Coin Lesion, Pulmonary/pathology/*radiography ; Bronchitis/radiography ; Asthma/radiography ; Adult

The first case of allergic bronchopulmonary aspergillosis(ABPA) was reported by Hinson, et al. in 1952. This was followed by a number of significant description of the disorder. Although typical ABPA initially presents with asthma, fleeting pulmonary infiltrates, and marked eosinophilia, there are many other ways in which the disease may be first manifested. Common radiologic findings in ABPA include pulmonary infiltrates, atelectasis, emphysema, fibrosis, lobar shrinkage with hilar elevation, cavitation, pneumothorax, aspergilloma and central bronchiectasis. We experienced a case of allergic bronchopulmonary aspergillosis presenting rare radiologic finding of bilateral pulmonary masses in chest radiography. With oral corticosteroid treatment, the size of both pulmonary masses was decreased significantly and his asthmatic symptoms were improved.
Aspergillosis, Allergic Bronchopulmonary* ; Asthma ; Bronchiectasis ; Emphysema ; Eosinophilia ; Fibrosis ; Pneumothorax ; Pulmonary Atelectasis ; Radiography ; Thorax

Asthma is the most common disease of the lungs, and one that poses specific challenges for the physicians including radiologist. This article reviews for the clinical diagnosis, Radiologic features, and differential diagnosis of asthma, and outlines the radiologic features of the complications of asthma. Bronchial wall thickening and hyperinflation characterize the chest radiograph of the patients with asthma. On CT scan one may see airway wall thickening, thickened centrilobular structures, and focal or diffuse hyperlucency. Apparent bronchial dilatation may be seen, but the diagnosis of bronchiectasis should be made with caution. Quantification of changes in the airway wall and lung parenchyma may be valuable in understanding the mechanisms of asthma and in evaluating the effects of treatment. The challenge for the physician evaluating the images of a patient with asthma is to find complications.
Asthma* ; Bronchiectasis ; Diagnosis ; Diagnosis, Differential ; Dilatation ; Humans ; Lung ; Radiography, Thoracic ; Tomography, X-Ray Computed

Churg-Strauss syndrome (CSS) is a disorder characterized by pulmonary and systemic small- vessel vasculitis, extravascular eosinophilic infiltration and hypereosinophilia; it is rarely diagnosed in the pediatric age group. We experienced a case of CSS in a male infant who had repeated symptoms of asthma with hypereosinophilia and transitory non-fixed pulmonary infiltrates on chest radiographs. He also had rectal bleeding in early infancy and multiple erosions with extravascular eosinophilic infiltrations in the sigmoid colon. We report a rare case of CSS in a 14-month-old infant and review the medical literature.
Asthma ; Churg-Strauss Syndrome* ; Colon, Sigmoid ; Eosinophils ; Hemorrhage ; Humans ; Infant ; Male ; Radiography, Thoracic ; Vasculitis

Bronchoalveolar lavage (BAL) and thoracic radiography are routinely performed diagnostic procedures. We hypothesized that BAL increases the interstitial opacity of caudoventral and caudodorsal thoracic radiographs. Fifty-three horses, including 8 clinic owned and 45 from a referral hospital population, were classified as healthy controls (n = 12), severe equine asthma (recurrent airway obstruction, n = 12) or mild-to-moderate equine asthma (inflammatory airway disease, n = 21) based on the results of a clinical scoring system. Eight were excluded due to different diagnoses and poor image quality. Four randomized thoracic radiographs of each horse were scored by two blinded observers, who were also asked to identify the image as obtained before or after a BAL procedure. In severe equine asthma, the chance (adjusted odds) of misinterpretation of the correct imaging time was approximately 5 times higher than in controls (odds ratio [OR] = 5.373, p = 0.028). The chance of misinterpretation was approximately 4 times lower in caudodorsal images than in caudoventral projections (OR = 0.241, p = 0.004). Identification of the correct imaging time was highly correlated with an increase in interstitial opacity (OR = 9.976, p < 0.0001). In conclusion, we recommend performing BAL after thoracic radiography to avoid possible misinterpretation.
Airway Obstruction ; Asthma ; Bronchoalveolar Lavage ; Diagnosis ; Horses ; Lung ; Radiography, Thoracic ; Referral and Consultation ; Respiratory Tract Diseases

Timely diagnosis and subsequent appropriate intervention is important in respiratory diseases. Chest radiograph is the most commonly performed radiologic examination and is the imaging study that the majority of non-radiologist physicians are most likely to encounter in their clinical practice. Chest radiography, however, can be very complex and difficult to interpret accurately due to abnormalities that might be quite subtle. Failure to detect lung cancer on the chest radiograph, which has become one of the most frequent causes of missed diagnoses in radiology, is a major cause that brings up medicolegal suits. There are no reliable radiographic criteria to distinguish lung cancer from benign diseases. Being knowledgeable about thoracic imaging will help to minimize errors. The diagnosis of lung cancer is commonly delayed because of masking by a tuberculosis lesion. In diagnosing tuberculosis, clinicians should be aware of endobronchial tuberculosis, anthracofibrosis, multidrug resistant tuberculosis, and non-tuberculous mycobacterial diseases. If pneumonia was not resolved, endobronchial lesions such as a foreign body or cancer, bronchioloalveolar cell carcinoma, and atypical pathogens might be considered. In patients with chronic coughing, eosinophilic bronchitis also should be suspected in addition to postnasal drip syndrome, cough variant asthma, and gastroesophageal reflux disease. Most common pitfalls can be avoided by physicians who are familiar with diverse patterns of respiratory disease in diagnosis. Through an increased familiarity with variable manifestations of pulmonary diseases and a high index of suspicion, the diagnosis of respiratory diseases will be improved.
Asthma ; Bronchitis ; Cough ; Diagnosis* ; Eosinophils ; Foreign Bodies ; Gastroesophageal Reflux ; Humans ; Lung Diseases ; Lung Neoplasms ; Masks ; Pneumonia ; Radiography ; Radiography, Thoracic ; Recognition (Psychology) ; Thorax ; Tuberculosis

Tracheobronchopathia osteochondroplastica (TO) is a rare disorder of unknown cause characterized by the presence of multiple submucosal osseous and/or cartilaginous nodules that protrude into the lumen of the trachea and large bronchi. A simultaneous diagnosis of TO and amyloidosis is rarely reported. In this report, a case initially suspected to be asthma bronchiole that could not be treated, was radiologically diagnosed as TO, and also secondary amyloidosis is presented. A 53 years, man patient reported a 3 years history of dyspnea. Pulmonary function tests (PFTs) showed an obstructive pattern. Chest X-rays revealed right middle lobe atelectasis. FOB and CT detected nodular lesions in the trachea and in the anterior and lateral walls of the main bronchi. AA amyloidosis was confirmed by endobronchial biopsy. In the abdominal fat pad biopsy, amyloidosis was not detected. Asthma bronchiole was excluded by PFTs. This case illustrates that it is possible for TO and amyloidosis to masquerade as asthma. TO and amyloidosis should be suspected in patients of older ages with asthma and especially with poorly treated asthmatic patients. Although nodular lesions in the anterior and lateral tracheobronchial walls are typical for TO, a biopsy should be obtained to exclude amyloidosis.
Amyloidosis/complications/*diagnosis/pathology ; Asthma/diagnosis ; Bronchial Diseases/complications/*diagnosis/radiography ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Tracheal Diseases/complications/*diagnosis/radiography

This report is a clinical analysis and comparative study with previous report of bronchial asthma at National Medical Center on bronchial asthma in children who were admitted to the MP dept. of national Medical Center from January 1987 to December 1990. The results of the study were as follows: 1) The out-break ratio of bronchial asthma is 3.7% of hospitalized children which is no change that about 4% since 1980. 2) The children under 6 years of ge was 62.7% which among under 3 years was 33.1%. The rate of under 3 year children is increased as previous study. 3) The out-break of bronchial asthma was most common in September and October and so peak incidence was noted in fall and duration of hospitalization was most 2 week. 4) Familial allergic history was positive in 54.6% and bronchial asthma was most common. The presence of allergic past history was 52.2%) and atopic dermatitis was most common 5) Eosinophilia was found in 80.8% and elevated IgE was also in 61.6% of bronchial asthma. 6) We could get positive results of IgE RAST and skin test: D. pteronyssinus, D. farinae, Houst dust. 7) The most frequent findigs of the chest radiograph were within normal limits. 8) The clinical improvement rate of bronchial asthma is 52.5%.
Asthma* ; Child* ; Child, Hospitalized ; Dermatitis, Atopic ; Dust ; Eosinophilia ; Hospitalization ; Humans ; Immunoglobulin E ; Incidence ; Radiography, Thoracic ; Skin Tests

BACKGROUND: Despite the clinical clues of bronchial asthma, some chronic coughers fail to be diagnosed due to negative test results. This study was aimed at evaluating the diagnostic performance of routine objective tests and identifying a cost-effective approach for asthmatics with a chronic cough. METHODS: Patients with a chronic cough of more than 3 weeks duration, and showing normal chest radiograph and spirometry were enrolled. On the first visit, objective tests, composed of serum total IgE, peripheral blood eosinophil count, spontaneous sputum eosinophil count, methacholine bronchial provocation test (MBPT) and paranasal sinus radiograph, were performed, with the simultaneous administration of oral prednisolone (0.5mg/kg) for one week. The final diagnoses were made on the basis of the test results, and the patients grouped according to their steroid responsiveness. The role of the etiologic diagnosis tests was evaluated, and the medical costs of the final management plan simulated with respect to three assumed models. RESULTS: Sixty chronic coughers were finally analyzed. The final diagnoses were as follows: bronchial asthma 21.7%, eosinophilic bronchitis 6.7%, paranasal sinusitis 18.3%, presumptive allergy 8.3% and non-diagnostic case 45.0%. Ninety percent were steroid responder. With the bronchial asthma cases, the positive rate of MBPT was 38.5%, with sputum eosinophil count in 84.6%, serum total IgE in 38.5%, and a peripheral blood eosinophil count rate of 30.8%. When the test results and steroid responsiveness data were applied to the 3 models, the chest radiograph, spirometry, sputum eosinophil count and paranasal sinus radiograph test results, and simultaneous short term steroid treatment seemed to have acceptable diagnostic performances, which could be used as a further guide to cost-effective planning. Conclusion:Objective tests, composed of chest radiograph, spirometry, paranasal sinus radiograph and sputum eosinophil count, with simultaneous short term steroid treatment, are suggested as cost-effective approaches for asthmatics with a chronic cough.
Asthma ; Bronchial Provocation Tests ; Bronchitis ; Cough* ; Diagnosis ; Eosinophils ; Humans ; Hypersensitivity ; Immunoglobulin E ; Methacholine Chloride ; Prednisolone ; Radiography, Thoracic ; Sinusitis ; Spirometry ; Sputum

PURPOSE: We aimed to evaluate the abnormalities of chest radiographs including atelectasis in children who were admitted with bronchial asthma. METHODS: We retrospectively analyzed the 357 chest radiographs and the clinical and laboratory features of the 144 children with asthma, who were admitted at Daejoen St. Mary's Hospital from April 1994 to May 1998. RESULTS: Clinical and laboratory characteristics were as follows: male to female ratio, 2.1 : 1; mean age, 4.8 years of age; mean numbers of admission, 2.5; mean hospitalization, 5.0 days; mean IgE, 387 IU/mL; mean eosinophil count, 362/mm3. In the abnormal findings of the 357 radiographs, there were 314 cases(88.0%) of hyperinflation, pulmonary infiltration 35.0%, atelectasis 5.3% and pneumomediastinum 0.3%. All(19) cases of atelectasis were observed in the right lung field with mostly segmental and lobular distribution, except one with lobar involvement. Atelectasis was predominant in males and those under 2 years of age. There was a tendency that the right upper lung was more involved under two years while the right lower lung was more involved over seven years of age. CONCLUSION: Radiographs of children admitted to hospital with bronchial asthma showed abnormal findings including pneumonia or atelectasis(5.3%). These abnormal findings can help to determine other therapeutic modalities in addition to asthma treatment.
Asthma* ; Child* ; Eosinophils ; Female ; Hospitalization ; Humans ; Immunoglobulin E ; Lung ; Male ; Mediastinal Emphysema ; Pneumonia ; Pulmonary Atelectasis* ; Radiography, Thoracic ; Retrospective Studies