PURPOSE: To compare the precise roles of high-resolution computed tomography (HRCT) and fiberoptic bronchoscopy (FOB) in the evaluation of patients presenting with hemoptysis and to determine the optimal timing for HRCT. MATERIALS AND METHODS: The results of HRCT and FOB were compared in 23 patients (15 men, 8 women) presenting with hemoptysis. Etiologies included bronchietasis (n=4), parenchymal pulmonary tuberculosis (n=4), lung cancer (n=4), endobronchial tuberculosis (n=2), and broncholithiasis (n=2). Hemoptysis was proved to be due to miscellaneous causes in an additional three cases and to be cryptogenic in four. The diagnostic results of FOB performed before and after HRCT were compared as were those of HRCT performed within and after the first 48 hours of active bleeding. RESULTS: FOB and HRCT offered a correct diagnosis in 39% and 65% of cases, respectively (p=0.005). HRCT demonstrated three cases of bronchiectasis and three of parenchymal pulmonary tuberculosis which were beyond the range of a bronchoscope. In two of five cases in which HRCT findings were nonspecific, chondromatous hamartoma and lung cancer were confirmed by FOB. In cases where HRCT was performed prior to FOB, the latter demonstrated the location and diagnosis in 82% and 47% of cases, respectively (p=0.303) ; when HRCT was performed after FOB, HRCT was correct in 67% and 17% of cases, respectively (p=0.178). In none of three cases (0%) in which HRCT was performed during the first 48 hours of active bleeding did the procedure allow a specific diagnosis. In 15 of 20 (75%) cases in which HRCT was performed after the first 48 hours, however, the diagnosis provided by CT was correct. CONCLUSION: The results of this study suggest that in patients presenting with hemoptysis, both HRCT and FOB should be used for evaluation, since they are diagnostically complementary. FOB is more useful for the diagnosis of endobronchial lesion, and HRCT for bronchiectasis and parenchymal pulmonary tuberculosis. If, in cases of hemoptysis, initial diagnosis is attempted within the first 48 hours of active bleeding, FOB should be the initial step, and HRCT images should not be obtained until active bleeding has been shown on plain chest radiograph to have abated. If this initial approach takes place after the first 48 hours of active bleeding, FOB and HRCT are equally suitable.
Bronchiectasis ; Bronchoscopes ; Bronchoscopy* ; Diagnosis ; Hamartoma ; Hemoptysis* ; Hemorrhage ; Humans ; Lung Neoplasms ; Male ; Radiography, Thoracic ; Tuberculosis ; Tuberculosis, Pulmonary

Though the incidence of paragonimiasis has been remarkably decreased since 1970, it is still not a rare disease in Korea. Major problems in the diagnosis of pulmonary paragonimiasis on chest radiography are its differentiation from pulmonary tuberculosis and lung cancer. Chest radiographic findings have been described in detail, but little have been reported on CT findings. We reviewed CT findings of 10 patients with pulmonary paragonimiasis. The characteristic CT findings were similar to those on chest radiography, such as air-space consolidation (70%), nodular mass (50%), pleural effusion (40%), cystic lesion (30%), small low density within the mass (30%), linear density (20%), pneumothorax(20%), and burrow track (20%). CT depicted the cystic lesions and the burrow tracks more clearly and showed the small worm-retaining cysts within the mass that were not detectable on chest radiography. In conclusion, all of these CT findings are useful in the diagnosis of pulmonary paragonimiasis especially when differentiation from tuberculosis or lung canceris difficult on chest radiography.
Diagnosis ; Humans ; Incidence ; Korea ; Lung ; Lung Neoplasms ; Paragonimiasis* ; Pleural Effusion ; Radiography ; Radiography, Thoracic ; Rare Diseases ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

PURPOSE: To evaluate the utility of high-resolution computed tomography(HRCT), as used to determine the activity of tuberculosis, and to analyze the HRCT findings in active and in inactive tuberculosis. MATERIALS AND METHODS: We analyzed the HRCT findings of 100 patients (54 men, 46 women; average age, 54 years) who according to the results of chest radiography had pulmonary tuberculosis of undetermined activity. We assessed HRCT findings such as the presence of a entrilobular, macro-, or micronodule; consolidation, ground-glass opacity, cavity, interlobular septal thickening, irregular linear opacities, bronchial wall thickening, bronchovascular bundle distortion, bronchiectasis, atelectasis, and pericicatrical emphysema. We compared the ratio of the area of nodule and consolidation to that of whole lung, and compared the findings between active and inactive tuberculosis. RESULTS: Eleven of 100 patients were excluded because the final diagnosis was other than tuberculosis. In 59 patients, the presence of active pulmonary tuberculosis was proven by positive sputum smear and/or culture for Mycobacterium tuberculosis. On the basis of the negative results of these tests, pulmonary tuberculosis was found to be inactive in 30 patients; serial chest radiographs indicated that their condition remained stable over a 6-month period. For HRCT, sensitivity was 96.6%, specificity 56.7%, positive predictive value 81.4%, negative predictive value 89.5%, and accuracy 83.1%. For active tuberculosis, the presence of centrilobular nodules, tree-in-bud, macronodules, cavity within the nodule, and consolidations was statistically significant, while for inactive tuberculosis, that of irregular linear opacities, micronodules, bronchiectasis, and cicatrization atelectasis was similarly significant. The CT score for the area of nodules and consolidations was higher in active than in inactive tuberculosis, but only the nodule score showed statistical significance. CONCLUSION: HRCT can be a useful diagnostic tool for evaluating the activity of pulmonary tuberculosis
Bronchiectasis ; Cicatrix ; Diagnosis ; Emphysema ; Female ; Humans ; Lung ; Male ; Mycobacterium tuberculosis ; Pulmonary Atelectasis ; Radiography ; Radiography, Thoracic ; Sensitivity and Specificity ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*

Mycobacterium lentiflavum has recently been described as an emerging human pathogen without regard to the immune status of the host. We herein report on M. lentiflavum isolated from a respiratory specimen of a patient. Although the organism described in this case seems to be a colonizer of a lung destroyed by tuberculosis, the current methods for species identification of nontuberculous mycobacteria have to be re-evaluated so as not to underestimate these organisms.
Aged ; Humans ; Male ; Mycobacterium/genetics/*isolation & purification ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/diagnosis/*microbiology/radiography

We found calcified pulmonary nodules in a middle-aged female mummy discovered from 350-yr-old Joseon tomb of Korea. In the CT scan, we found six radiopaque nodules in right lung, through the levels of thoracic vertebrae 1 to 6. We also found presumptive pleural adhesions in right thoracic cavity of CT images. We re-confirmed radiological findings by our post-factum dissection on the same mummy. By the differential diagnosis, we speculate that the radiopaque calcification nodules and associated pleural adhesion could have been caused by tuberculosis. This is the first-ever report on the pulmonary tuberculosis identified in archaeologically obtained, pre-modern Korean samples.
Adult ; Female ; Humans ; Mummies/*radiography ; Republic of Korea ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/*diagnosis

PURPOSE: This study was performed to identify the characteristic findings of miliary pulmonary tuberculosis on HRCT and to evaluate the usefulness of HRCT by compareson with chest radiographs. MATERIAL AND METHODS: High resolution CT, chest radiographs and medical records were retrospectively reviewed in 10 patients with miliary pulmonary tuberculosis. We analysed the size, distribution and margin of nodules, reticular or ground-glass density, parenchymal lesion, mediastinal lymphadenopathy and pleural effusion on HRCT which were compared with chest radiographic findings. RESULTS: On HRCT, characteristic 1--2mm sized sharp or ill-defined nodular densities were randomly distributed throughout both lungs in all cases. In seven cases, the nodules were evenly scattered, but slightly more in upper lung zone in two cases, and in lower in one case. Only three cases revealed somewhat large and abundant nodules in posterior lung zone. There were findings of ill-defined margin of nodules in three cases, reticular densities in three cases and ground-glass opacity in two cases, all of which were observed within 4 weeks after onset of symptom. In one case, HRCT scan revealed a micronodular pattern in the lung parenchyma, even though chest radiographs of 2 days before were not obviously abnormal. HRCT was better to evaluate the margin of nodule and distribution than chest radiographs in four cases. Focal parenchymal lesion (n=5), pleural effusion(n=4), mediastinal lymphadenopathy(n=6) and ARDS(n=I) were also associated. CONCLUSION: HRCT could suggest a more specific diagnosis of miliary pulmonary tuberculosis with the above characteristic findings in appropriate clinical setting and normal or interstitial pattern of chest radiographs.
Diagnosis ; Humans ; Lung ; Lymphatic Diseases ; Medical Records ; Pleural Effusion ; Radiography, Thoracic ; Retrospective Studies ; Tuberculosis, Pulmonary*

PURPOSE: To describe the CT and clinical features of tuberculosis involving the right middle lobe of the lung. MATERIALS AND METHODS: Among patients diagnosed with pulmonary tuberculosis at our hospital during the past three years, 16 cases (mean age of patients: 72 years) were reviewed for radiological and clinical presentation of patients that underwent CT and chest radiography and showed mainly right middle lobe involvement. RESULTS: Middle lobe collapse or consolidation (n=16) and bronchial stenosis or obstruction without the presence of soft tissue masses (n=15) were the main findings. Enlarged mediastinal or hilar lymph nodes (n=15), cavities within consolidated tissue (n=2), ill-defined centrilobular nodules (n=12), a tree-in-bud appearance (n=10), focal consolidations (n=7) and small nodules (n=4) were found. All patients were older than 64 years and most complained of non-specific symptoms. A sputum smear for AFB was positive in four cases. CONCLUSION: A diagnosis of tuberculosis in the right middle lobe is suggested in older patients with following CT findings: 1) middle lobe collapse or consolidation; 2) middle lobe bronchus stenosis or obstruction without the presence of soft tissue masses; 3) mediastinal or hilar lymphadenopathy; 4) cavities within consolidation, and centrilobular nodules with branching linear structure in the adjacent lungs. Further evaluation such as bronchoscopy is recommended for confirmation even when the sputum smear for AFB is negative.
Bronchi ; Bronchoscopy ; Constriction, Pathologic ; Diagnosis ; Humans ; Lung* ; Lymph Nodes ; Lymphatic Diseases ; Radiography ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*

BACKGROUND: Since the advent of AIDS, tuberculosis has become a major public health problem in the western society. Therefore, it is essential that pulmonary tuberculosis be rapidly diagnosed. Light microscopic detection of acid-fast organisms in sputum has traditionally been used for rapidly diagnosing tuberculosis. However positive smears are only observed in about one-half to three-quarters of cases. Studies using PCR for diagnosing pulmonary tuberculosis disclosed several shortcomings suggesting an inability to distinguish between active and treated or in active tuberculosis. In this study, the clinkcal significance of a PCR-bases rapid technique for detecting Mycobacterium tuberculosis DNA in peripheral blood investigated. MATERIALS AND METHODS: From July 1, 1998 through to August 30, 1999, 59 patients with presumed tuberculosis, who had no previous history of anti-tuberculosis medication use whithin one year prior to this study were recruite and followed up for more than 3 months. AFB stain and culture in the sputum and/or pleural fluids and biopsies when needed were performed. Blood samples from each of the 59 patients were obtained in order to identify Mycobacterium Tuberculosis DNA by a PCR test. RESULTS: 1) Forty five out of 59 patients had a final diagnosis of tugerculosis; Twenty eight were confirmed as having active pulmonary tuberculosis by culture or biopsy. Four were clinkcally diagnosed with pulmonary tuberculosis. The othe 13 patients were diagnosed as having tuberculous pleurisy (9) and extrapulmonary tuberculosis (4). 2) Fourteen patients showed a positive blood PCR test. The PCR assay correctly identified active tuberculosis in 13 out of 14 patients. The overall sensitivity and specificity of this blood PCR assay for diagnosing tuberculosis were 29% and 93%, respectively. The positive predictive value was 93%, the negative predictive value was 29% and diagnostic accuracy was 44%. 3) Six out of 14(43%) patients with blood PCR positive tuberculosis were immunologically compromised hosts. 4) A simple chest radiograph in blood PCR positive tuberculosis patients showed variable and inconsistent findings. CONCLUSION: A peripheral blood PCR assay for Mycobacterium tuberculosis is not recommended as screening method for diagnosing active tuberculosis. However, it was suggested that the blood PCR assay could contribute to an early diagnostic rate due to its high positive predictive value.
Biopsy ; Diagnosis ; DNA* ; Humans ; Mass Screening ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymerase Chain Reaction ; Public Health ; Radiography, Thoracic ; Sensitivity and Specificity ; Sputum ; Tuberculosis ; Tuberculosis, Pleural ; Tuberculosis, Pulmonary

BACKGROUND: To compare the diagnostic accuracies of High-resolution CT(HRCT) and chest radiography in the diagnosis of diffuse infiltrative lung disease(DILD). METHODS: This study included ninety-nine patients with a diagnosis of acute or chronic DILD, representing 20 different diseases. Twelve normal subjects were included as control. The disease state was confirmed either pathologically or clinically. Radiographs and CT scans were evaluated separately by three independent observers without knowledge of clinical and pathologic results. The observers listed three most likely diagnoses and recorded degree of confidence. RESULTS: The sensitivity of HRCT in the detection of DILD was 98.9% compared to 97.9% of chest radiography. Overall, a correct first-choice diagnosis was made in 48% using chest radiographs and in 60% using HRCT images. The correct diagnosis was among the top-three choices in 64% when chest radiographs were used, and in 75% when HRCT images were reviewed. Overally a confident diagnosis was reached more often with HRCT(55%) than with chest radiography(26%). The correct first-choice diagnosis increased remarkably when the HRCT was used in usual interstitial pneumonia, miliary tuberculosis, diffuse panbronchiolitis and lymphangitic carcinomatosis. CONCLUSION: HRCT is confirmed to be superior to conventional radiography in the detection and accurate diagnosis of DILD. HRCT is especially valuable in the diagnosis of usual interstitial pneumonia, miliary tuberculosis, diffuse panbronchiolitis, and lymphangitic carcinomatosis.
Carcinoma ; Diagnosis ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung Diseases* ; Lung* ; Radiography* ; Radiography, Thoracic ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis, Miliary

PURPOSE: To determine whether tuberculous pneumonia can be distinguished from community-acquired pneumonia on the basis of chest radiographic findings only and the diagnostic utility of differences in serum CA-125 levels. MATERIALS AND METHODS: Forty-five patients with a high fever (>38 'C) in whom chest radiography revealed lobar consolidation were retrospectively studied. In 27 cases, the presence of acid-fast bacilli in sputum (n=21), the isolation of Mycobacterium tuberculosis from bronchoscopic biopsy tissue and sputum cultures (n=16), and improvement in the findings of serial radiography and in clinical symptoms during antituberculous therapy (n=1) let to a diagnosis of tuberculous pneumonia. A diagnosis of community-acquired pneumonia (n=18) was based on improvement in the serial radiographic findings obtained during antibacterial therapy (n=16), and the isolation of bacteria from sputum and pleural fluid culture (n=2). On the basis of independently analysed findings, radiologist determined the presence or absence of nodular density, cavitary lesions and loss of lung volume, while two radiologists differentiated between tuberculous pneumonia and community-acquired pneumonia. RESULT: Initial chest radiographs of tuberculous pneumonia revealed nodular density in 89% of cases, cavitary lesions in 29%, and loss of lung volume nodular density was in 26%, while those of community-acquired pneumonia demonstrated nodular density in only 22%, cavitary lesions in 6%, and loss of lung volume in none was a significant statistical difference in nodular density, cavitary lesions and loss of lung voume (p<0.005). The average serum CA-125 level in tuberculous pneumonia was 306.5 (range, 21.3 -1078) U/ml, whereas the average level in community-acquired pneumonia was 38.0 (range, 11.3 -114.8) U/ml (p<0.005). CONCLUSION: Initial chest radiography can differentiate between tuberculous and community-acquired pneumonia on the basis of nodular density, cavitary lesions and loss of lung volume and differences in CA-125 levels also provide a useful means of differentiating between these pneumonias.
Bacteria ; Biopsy ; Diagnosis ; Fever ; Humans ; Linear Energy Transfer ; Lung ; Mycobacterium tuberculosis ; Pneumonia* ; Radiography* ; Radiography, Thoracic ; Retrospective Studies ; Sputum ; Thorax* ; Tuberculosis, Pulmonary