Contrast enhanced CT manifestations of 141 pulmonary nodules having internal density less than 40 HU were evaluated to study the prevalence of causative disease and their differential points. Tuberculosis (n = 79) was most common, active in 96%. There were 22 cancers, 10 abscesses, 9 paragonimiases, 8 cysts, 7 metastases, 4 aspergillomas without air meniscus sign, and so on. 35% of the benign lesions were greater than 3 cm in diameter and 67% of benign lesions did not show a smooth outer margin. Lung cysts and aspergillomas showed relatively thin peripheral enhanced rim (PER), sharp transitional zone (TZ), a smooth inner border (IB), and homogeneous low densities (LD). Tuberculous nodules tended to be smaller in size with thin PER and most had smooth IB and homogeneous LD. Paragonimiasis, abscess, and cancer tended to present with thick PER and lobulated IB. Lung abscess and paragonimiasis both showed homogeneous LD and narrow TZ. However, in paragonimiasis, multiple locules were seen. Lung cancer showed wider TZ and heterogeneous LD. The size and outer margin of pulmonary nodules as a diagnostic criteria is less useful in LD pulmonary nodule. Therefore, CT can be more useful in differentiating the benign from the malignant lesions by observing a more specific and characteristic pattern of peripheral enhanced rim, transitional zone, inner border, and homogeneity of low density area.
Adolescent ; Adult ; Aged ; Analysis of Variance ; Chi-Square Distribution ; Contrast Media ; Diagnosis, Differential ; Female ; Human ; Lung Diseases/*radiography ; Lung Neoplasms/*radiography ; Male ; Middle Age ; Tomography, X-Ray Computed/*methods ; Tuberculosis, Pulmonary/radiography

OBJECTIVE: The incidence of ABPA was quite different according to the countries and the prevalence of ABPA has not been reported in Korea. In this study, we evaluated the prevalence of ABPA. In asthmatics with positive skin reactivity to Aspergillus fumigatus(Af). METHODS: Ninety asthmatics with positive skin reactivity to Af were enrolled. The ABPA were diagnosed by the Greenburg and Petterson's criteria or by the pathologic features of lung. RESULTS: Six cases out of 90 asthmatics (6.7%) were diagnosed as ABPA (ABPA group). Total IgE level were not significantly different between ABPA group and asthmatics with Af skin reactivity (BA group n=84). Five out of 6 ABPA had higher than 1000 ng/ml of total IgE and all six cases had more than 600/microliter of peripheral blood eosinophil counts. Only two cases had the positive immunoprecipitin band to Af antigen. Antibody index of Af specific IgE and IgG in ABPA group were 5.58+/-3.35, 2.75+/-1.29, respectively and coutruls were. Three cases of ABPA had central bronchiectasis, two case has only infiltrative lung lesions, one case with destructive lung lesions and another one cases have no pulmonary pathologic lesion at chest radiology but with the serologic evidence of ABPA. Although we could not find statistical significance, the FEV1(70.1+/-270% vs 87.8+/-23.2%) and PEFR (71.8+/-30.6% vs 95.0+/-26.5%) of ABPA group were lower than those of BA group. CONCLUSION: These results suggest that ABPA is not uncommon in Af sensitized asthmatics in Korea. We thought that initial examination of allergic skin test including Aspergillus should be emphasized for screening the ABPA in Korean asthmatics.
Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus fumigatus* ; Aspergillus* ; Bronchiectasis ; Eosinophils ; Immunoglobulin E ; Immunoglobulin G ; Incidence ; Korea ; Lung ; Mass Screening ; Peak Expiratory Flow Rate ; Prevalence* ; Skin Tests ; Skin* ; Thorax