OBJECTIVE: Bronchogenic carcinoma can mimic or be masked by pulmonary tuberculosis (TB), and the aim of this study was to describe the radiologic findings and clinical significance of bronchogenic carcinoma and pulmonary TB which coexist in the same lobe. MATERIALS AND METHODS: The findings of 51 patients (48 males and three females, aged 48-79 years) in whom pulmonary TB and bronchogenic carcinoma coexisted in the same lobe were analyzed. The morphologic characteristics of a tumor, such as its diameter and margin, the presence of calcification or cavitation, and mediastinal lymphadenopathy, as seen at CT, were retrospectively assessed, and the clinical stage of the lung cancer was also determined. Using the serial chest radiographs available for 21 patients, the possible causes of delay in the diagnosis of lung cancer were analyzed. RESULTS: Lung cancers with coexisting pulmonary TB were located predominantly in the upper lobes (82.4%). The mean diameter of the mass was 5.3 cm, and most tumors (n=42, 82.4%) had a lobulated border. Calcification within the tumor was seen in 20 patients (39.2%), and cavitation in five (9.8%). Forty-two (82.4%) had mediastinal lymphadenopathy, and more than half the tumors (60.8%) were at an advanced stage [IIIB (n=11) or IV (n=20)]. The average delay in diagnosing lung cancer was 11.7 (range, 1-24) months, and the causes of this were failure to observe new nodules masked by coexisting stable TB lesions (n=8), misinterpretation of new lesions as aggravation of TB (n=5), misinterpretation of lung cancer as tuberculoma at initial radiography (n=4), masking of the nodule by an active TB lesion (n=3), and subtleness of the lesion (n=1). CONCLUSION: Most cancers concurrent with TB are large, lobulated masses with mediastinal lymphadenopathy, indicating that the morphologic characteristics of lung cancer with coexisting pulmonary TB are similar to those of lung cancer without TB. The diagnosis of lung cancer is delayed mainly because of masking by a tuberculous lesion, and this suggests that in patients in whom a predominant or growing nodule is present and who show little improvement of symptoms despite antituberculous or other medical therapy, coexisting cancer should be suspected.
Aged ; Carcinoma, Bronchogenic/*complications/radiography ; Female ; Human ; Lung Neoplasms/*complications/radiography ; Male ; Middle Age ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/*complications/radiography

Adult ; Aspergillosis ; etiology ; Humans ; Male ; Pulmonary Alveolar Proteinosis ; etiology ; Radiography, Thoracic ; Tomography, X-Ray Computed ; Tuberculosis ; complications

We report a case of central venous stenosis due to a structural deformity caused by a tuberculosis-destroyed lung in a 65-year-old woman. The patient presented with left facial edema. She had a history of pulmonary tuberculosis, and the chest X-ray revealed a collapsed left lung. Angiography showed leftward deviation of the innominate vein leading to kinking and stenosis of the internal jugular vein. Stent insertion improved her facial edema.
Aged ; Brachiocephalic Veins/*pathology/radiography ; *Central Venous Pressure ; Constriction, Pathologic/*etiology/pathology/therapy ; Edema/therapy ; Female ; Humans ; Jugular Veins/pathology/radiography ; Stents ; Tuberculosis, Pulmonary/*complications/pathology/radiography ; Vascular Diseases/*etiology/pathology/therapy

Cachexia ; etiology ; Cough ; Delayed Diagnosis ; Fever ; Humans ; Hypercalcemia ; etiology ; Male ; Middle Aged ; Radiography ; Renal Dialysis ; Renal Insufficiency ; etiology ; therapy ; Tuberculosis, Pulmonary ; complications ; diagnostic imaging

OBJECTIVETo evaluate the value of X-ray and spiral computed tomography (SCT) in the diagnosis of Swyer-James syndrome (SJS).

METHODSA total of 28 patients, 12 males and 16 females, were studied retrospectively. Ages ranged from 11 to 57 years, the mean age was 32 years. All patients underwent inspiratory chest X-ray films, 5 with expiratory chest films and 1 with bronchogram. Furthermore, inspiratory and expiratory SCT scans were performed. The SCT findings were analyzed and compared with X-ray films.

RESULTSSCT demonstrated 56 lobes with hyperlucency and diminished vascularity. The size of 51 lobes were smaller and 5 were normal. X-ray films showed that hyperlucency was only in 29 lobes, in which 19 lobes were small-sized and the other 10 lobes normal. There were 56 lobes with air-trapping on expiratory SCT scans, but only 5 lobes with air-trapping on expiratory X-ray films. Bronchogram in 1 case demonstrated bronchiectasis and bronchiolitis obliterans. SCT showed 24 patients with bronchiectasis, 9 patients with tuberculosis, 10 patients with bronchiolitis, and 2 with segmental collapse.

CONCLUSIONSCT scan is superior to chest radiography in the diagnosis and differential diagnosis of SJS.

Adolescent ; Adult ; Bronchiectasis ; complications ; diagnostic imaging ; Bronchiolitis ; complications ; diagnostic imaging ; Child ; Diagnosis, Differential ; Female ; Humans ; Lung, Hyperlucent ; complications ; diagnostic imaging ; Male ; Middle Aged ; Radiography, Thoracic ; Retrospective Studies ; Tomography, Spiral Computed ; methods ; Tuberculosis, Pulmonary ; complications ; diagnostic imaging

PURPOSE: To discuss computed tomography (CT) evaluation of the etiology of vocal cord paralysis (VCP) due to thoracic diseases. MATERIALS AND METHODS: From records from the past 10 years at our hospital, we retrospectively reviewed 115 cases of VCP that were evaluated with CT. Of these 115 cases, 36 patients (23 M, 13 F) had VCP due to a condition within the thoracic cavity. From these cases, we collected the following information: sex, age distribution, side of paralysis, symptom onset date, date of diagnosis, imaging, and primary disease. The etiology of VCP was determined using both historical information and diagnostic imaging. Imaging procedures included chest radiograph, CT of neck or chest, and esophagography or esophagoscopy. RESULTS: Thirty-three of the 36 patients with thoracic disease had unilateral VCP (21 left, 12 right). Of the primary thoracic diseases, malignancy was the most common (19, 52.8%), with 18 of the 19 malignancies presenting with unilateral VCP. The detected malignant tumors in the chest consisted of thirteen lung cancers, three esophageal cancers, two metastatic tumors, and one mediastinal tumor. We also found other underlying etiologies of VCP, including one aortic arch aneurysm, five iatrogenic, six tuberculosis, one neurofibromatosis, three benign nodes, and one lung collapse. A chest radiograph failed to detect eight of the 19 primary malignancies detected on the CT. Nine patients with lung cancer developed VCP between follow-ups and four of them were diagnosed with a progression of malignancy upon CT evaluation of VCP. CONCLUSION: CT is helpful for the early detection of primary malignancy or progression of malignancy between follow-ups. Moreover, it can reveal various non-malignant causes of VCP.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lung Neoplasms/complications/pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; Recurrent Laryngeal Nerve/pathology ; Retrospective Studies ; Thoracic Diseases/*complications ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/complications ; Vocal Cord Paralysis/*etiology/*radiography

Pulmonary tuberculosis (PTB) is a common infectious disease worldwide. However, mediastinal tuberculous lymphadenitis complicated by oesophageal involvement and oesophago-respiratory fistula is now uncommon due to improved anti-tuberculous regimes and better general awareness. The overall incidence of acquired oesophago-respiratory fistula due to infection is low, and therefore, the lesion is not often a frontrunner in differential diagnosis. Still, tuberculous oesophago-respiratory fistulae can potentially occur in patients with retroviral disease, as they tend to have atypical and more virulent manifestations. In this study, we report the case of multiple oesophago-respiratory fistulae in a patient with PTB and retroviral disease, and highlight the computed tomography features of these lesions as an atypical presentation of PTB in retroviral disease. Clinicians should suspect oesophago-respiratory fistulae if patients present with Ono’s sign, and remain particularly vigilant for patients with underlying PTB and retroviral disease, as early diagnosis and treatment could help to reduce mortality.
Adult ; Diagnosis, Differential ; Esophagus ; physiopathology ; Fistula ; diagnosis ; Humans ; Lung ; pathology ; Male ; Radiography, Thoracic ; Retroviridae ; metabolism ; Tomography, X-Ray Computed ; Trachea ; physiopathology ; Treatment Outcome ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary ; complications ; diagnosis

The effectiveness of percutaneous embolotherapy in cases of hemoptysis due to pulmonary tuberculosis from increasing severity of lung parenchymal injury was compared. The pattern of pleural involvement, as seen on chest radiography and angiography, were comparatively analyzed in 230 patients who were available for follow-ups from March 1992 to December 2003. Chest radiography findings were classified into 4 types based on levels of complicated lesions and pleural involvement. Angiography findings were divided into 4 groups based on the level of blood supply to lesions. Early hemostasis with respect to radiographic group were as follows: Type I-92% (73/79), Type II-80% (52/65), Type III-70% (42/60), and Type IV-56% (52/92); there was an average success rate of 73% (219/296), and continued hemostasis was found in 80% of Type I patients (62/77), 77% of Type II patients (41/53), 62% of Type III patients (25/40), and 45% of Type IV patients (27/60), with an average long-term hemostatic rate of 67% (155/230). Increasing severity of pleural involvement and associated complications correlated with increasing development of systemic collateral arteries other than the bronchial artery. The severely increased circulation in systemic collateral arteries makes it difficult to predict good hemostatic results following embolization. Therefore, we recommend aggressive treatment, such as surgical intervention, after embolization in such instances.
Tuberculosis, Pulmonary/*complications/radiography ; Treatment Outcome ; Severity of Illness Index ; Middle Aged ; Male ; Humans ; Hemoptysis/*microbiology/radiography/*therapy ; Follow-Up Studies ; Female ; *Embolization, Therapeutic ; Angiography ; Aged, 80 and over ; Aged ; Adult ; Adolescent

The effectiveness of percutaneous embolotherapy in cases of hemoptysis due to pulmonary tuberculosis from increasing severity of lung parenchymal injury was compared. The pattern of pleural involvement, as seen on chest radiography and angiography, were comparatively analyzed in 230 patients who were available for follow-ups from March 1992 to December 2003. Chest radiography findings were classified into 4 types based on levels of complicated lesions and pleural involvement. Angiography findings were divided into 4 groups based on the level of blood supply to lesions. Early hemostasis with respect to radiographic group were as follows: Type I-92% (73/79), Type II-80% (52/65), Type III-70% (42/60), and Type IV-56% (52/92); there was an average success rate of 73% (219/296), and continued hemostasis was found in 80% of Type I patients (62/77), 77% of Type II patients (41/53), 62% of Type III patients (25/40), and 45% of Type IV patients (27/60), with an average long-term hemostatic rate of 67% (155/230). Increasing severity of pleural involvement and associated complications correlated with increasing development of systemic collateral arteries other than the bronchial artery. The severely increased circulation in systemic collateral arteries makes it difficult to predict good hemostatic results following embolization. Therefore, we recommend aggressive treatment, such as surgical intervention, after embolization in such instances.
Tuberculosis, Pulmonary/*complications/radiography ; Treatment Outcome ; Severity of Illness Index ; Middle Aged ; Male ; Humans ; Hemoptysis/*microbiology/radiography/*therapy ; Follow-Up Studies ; Female ; *Embolization, Therapeutic ; Angiography ; Aged, 80 and over ; Aged ; Adult ; Adolescent

We evaluated the effects of previous pulmonary tuberculosis (TB) on the risk of obstructive lung disease. We analyzed population-based, the Second Korea National Health and Nutrition Examination Survey 2001. Participants underwent chest X-rays (CXR) and spirometry, and qualified radiologists interpreted the presence of TB lesion independently. A total of 3,687 underwent acceptable spirometry and CXR. Two hundreds and ninty four subjects had evidence of previous TB on CXR with no subjects having evidence of active disease. Evidence of previous TB on CXR were independently associated with airflow obstruction (adjusted odds ratios [OR] = 2.56 [95% CI 1.84-3.56]) after adjustment for sex, age and smoking history. Previous TB was still a risk factor (adjusted OR = 3.13 [95% CI 1.86-5.29]) with exclusion of ever smokers or subjects with advanced lesion on CXR. Among never-smokers, the proportion of subjects with previous TB on CXR increased as obstructive lung disease became more severe. Previous TB is an independent risk factor for obstructive lung disease, even if the lesion is minimal and TB can be an important cause of obstructive lung disease in never-smokers. Effort on prevention and control of TB is crucial in reduction of obstructive lung disease, especially in countries with more than intermediate burden of TB.
Adolescent ; Adult ; Aged ; Female ; Humans ; Lung Diseases, Obstructive/*etiology ; Male ; Middle Aged ; Odds Ratio ; Questionnaires ; Radiography, Thoracic ; Republic of Korea/epidemiology ; Respiratory Function Tests ; Risk Factors ; Spirometry ; Tuberculosis, Pulmonary/*complications/*epidemiology/pathology ; Young Adult