PURPOSE: To compare the CT findings of tuberculous pneumonia (TBPN) with those of bacterial pneumonia (BAPN) in diabetic patients and to evaluate the usefulness of CT in the differential diagnosis of these two diseases. MATERIALS AND METHODS: The chest CT scans of 23 diabetic patients with TBPN (M:F=21:2; mean age, 59 yrs.) and of 37 diabetic patients with BAPN (M:F=21:16; mean age, 63 yrs.) were evaluated by two radiologists with regard to low attenuation areas in regions of consolidation, cavities, air bronchogram, volume changes, ground-glass attenuation, findings of bronchogenic spread, and other associated findings. The involvement of each segment was recorded in all patients. RESULTS:The frequencies of multiple small low-attenuation areas in regions of consolidation (52%, 0%), multiple cavities (35%, 3%), loss of volume (70%, 30%) and findings of bronchogenic spread (96%, 30%) were significantly higher in TBPN than in BAPN (p<.05). Low-attenuation masses and bizarre-shaped cavities were noted only in TBPN. Large areas of ground-glass attenuation (4%, 38%) and bilateral pleural effusions (0%, 19%) were more common in BAPN, while air-bronchogram was common in both groups (96%, 86%). The involvement of the superior segment was significantly more common in TBPN (p<.05). CONCLUSION: In the diabetic patients with pulmonary consolidation, CT findings of multiple small low-attenuation areas, multiple cavities, bizarre-shaped cavities, low attenuation masses in cavities, volume loss, and findings of bronchogenic spread are more suggestive of TBPN, while large areas of ground-glass attenuation and bilateral pleural effusions are more suggestive of BAPN. CT may be useful in the differential diagnosis between TBPN and BAPN.
Aminopropionitrile ; Diabetes Mellitus ; Diagnosis, Differential ; Humans ; Pleural Effusion ; Pneumonia* ; Pneumonia, Bacterial* ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary

Here, we describe a case of Turner syndrome first diagnosed at 61 years of age. The patient’s chief complaint was general edema. A cardiologist was consulted, who performed echocardiogram and coronary heart computed tomography. Chromosomal analysis yielded inconclusive results for Turner syndrome. The patient’s karyotype was 45,X[17]/46,X,psu idic(Y)(q11.23), and she was referred to a gynecologist a time span. The patient was nulliparous with no history of sexual contact. We performed a prophylactic gonadectomy, but no malignancy was detected pathologically.

BACKGROUND/AIMS: Amiodarone is one of the most widely used antiarrhythmic agents; however, amiodarone-induced pulmonary toxicity (APT) can be irreversible and sometimes fatal. The aim of this study was to evaluate the feasibility of chest computed tomography (CT) as a diagnostic tool for APT and to assess the utility of the CT APT score as an index for predicting the severity of APT. METHODS: Patients underwent amiodarone treatment for various reasons, most often atrial fibrillation, for more than 2 years, and those that received a cumulative dose > 100 g were enrolled. A total of 34 patients who underwent chest CT between December 2011 and June 2012 were enrolled, whether or not they had clinical symptoms. The APT CT score was defined as the number of involved regions in the lung, which was divided into 18 regions (right and left, upper, middle, and lower, and central, middle, and peripheral). The CT findings were evaluated according to the total dose and duration of amiodarone treatment and the results of a pulmonary function test. Clinical symptoms and outcomes were also evaluated according to APT CT scores. RESULTS: Seven patients had positive APT CT scores (interstitial fibrosis in five, organizing pneumonia in one, and mixed interstitial fibrosis and organizing pneumonia in one), and these patients exhibited significantly lower diffusion capacity for carbon monoxide in the lungs compared with patients without an increased APT CT score (70.2% +/- 6.9% vs. 89.7% +/- 19.4%; p = 0.011). Three of the seven patients experienced overt APT that required hospital admission. CONCLUSIONS: Chest CT is a useful diagnostic tool for APT, and the APT CT score might be a useful index for assessing the severity of APT.
Aged ; Amiodarone/*adverse effects ; Anti-Arrhythmia Agents/*adverse effects ; Atrial Fibrillation/diagnosis/*drug therapy ; Cross-Sectional Studies ; Cryptogenic Organizing Pneumonia/chemically induced/physiopathology/*radiography/therapy ; Feasibility Studies ; Female ; Forced Expiratory Volume ; Hospitalization ; Humans ; Lung/drug effects/physiopathology/*radiography ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Pulmonary Diffusing Capacity ; Pulmonary Fibrosis/chemically induced/physiopathology/*radiography/therapy ; Respiratory Function Tests ; Risk Factors ; Time Factors ; *Tomography, X-Ray Computed ; Vital Capacity

PURPOSE: To analyse the radiographic and HRCT findings of pulmonary sarcoidosis and to evaluate thediagnostic usefulness of HRCT MATERIALS AND METHODS: Initial chest radiographs (n=14) and HRCT scans (n=14), anda followup HRCT scan (n=1) from 14 patients (5 men and 9 women;median age, 38 Years) with biopsy proven pulmonarysarcoidosis were analyzed. RESULT: On initial chest radiographs, they showed pulmonary lesions were seenpredominantly in the middle, upper and lower lung zones in four, two and one patient, respectively. Patterns oflesions were reticulonodular opacities (n=4), air-space (n=2), honeycombing(n=1), macronodule(n=1), and cavitarynodule (n=1). In all patients, HRCT scans demonstrated both pulmonary lesions and intrathoracic lymphadenopathy.Pulmonary lesions were seen predominantly in the middle, lower and upper lung zones in nine, three and twopatients, and in the posterior and anterior lung zones in eight and four patients repectively. Lesions werepredominantly micronodules, with perilymphatic distribution (n=12), macronodules with air-bronchogram (n=1),cavitary macronodules (n=1), ground-glass opacity (n=5), consolidation (n=2), and irregular lines (n=8). CONCLUSION: Reticulonodular lesions in the middle lung zone were seen on radiograph, while the most common HRCTfinding was micronodular lesions with perilymhpatic distribution. HRCT is much more sensitive than chestradiograph for the detection of both pulmonary lesions and lymphadenopathy; this modality revealed micronoduleswhich were invisible on chest radiographs.
Biopsy ; Follow-Up Studies ; Humans ; Lung ; Lymphatic Diseases ; Male ; Radiography, Thoracic ; Sarcoidosis ; Sarcoidosis, Pulmonary*

PURPOSE: The aim of our study was to evaluate the usefulness of high-resolution CT scans in addition tohelical CT for characterizing a solitary pulmonary nodule. MATERIALS AND METHODS: Our study included 49 patientswith a solitary pulmonary nodule ; in each patient this was evaluated by both additional high-resolution CT andhelical scanning. Images were evaluated by three independent observers, each of whom read them twice : initiallywith helical CT images only and then with helical images plus high-resolution CT images. After analysis, theobservers recorded the following : histologic diagnosis, benignancy or malignancy of a nodule, and confidence intheir diagnosis (three scales). RESULTS: In differentiating benign and malignant nodules, the accuracy of helicalscans only was 75% (110/147 readings) whereas that of helical plus high-resolution CT scans was 82% (121/147readings) (p=0.001). Correct histologic diagnosis was made in 47% of cases (69/147 readings) when helical scansonly had been evaluated and in 48% of cases (71/147 readings) for which both helical and high-resolotion CT scanswere available (p=0.815). Diagnosis was more often highly confident on the basis of additional high-resolution CTscans (25%) than helical scans only (5%) (p=0.001) . CONCLUSION: By enhancing differential diagnosticaccuracy between benign and malignant nodules and by increasing confidence in the histologic diagnosis of apulmonary nodule, additional high-resolution CT scans are valuable for the evaluation of a solitary pulmonarynodule.
Diagnosis ; Humans ; Solitary Pulmonary Nodule* ; Tomography, Spiral Computed ; Tomography, X-Ray Computed

Acute respiratory failure from mycoplasma pneumonia is uncommon, because community-acquired pneumonia from mycoplasma pneumonia is typically not severe in patients without underlying disease. In addition, alveolar hemorrhage is a rare manifestation in these cases. We describe a case of acute respiratory failure that required mechanical ventilation due to diffuse alveolar hemorrhage in an immunocompetent patient with mycoplasma pneumonia.
Hemorrhage ; Humans ; Mycoplasma ; Pneumonia ; Pneumonia, Mycoplasma ; Respiration, Artificial ; Respiratory Insufficiency

BACKGROUND: Airway obstruction and the extent of emphysema are reported to be responsible for reduced bone mineral density (BMD). Corresponding to different phenotypes of a pulmonary disease, different severity in extra pulmonary features may exist. We compared BMDs of subjects with or without airway obstruction and/or emphysema and investigated the relationships among BMD, the severity of airway obstruction, and the extent of emphysema. METHODS: Using a university hospital database, we reviewed patients over 40 years old who performed spirometry, computed tomography of chest, and measurement of BMD of the lumbar (L) spine. According to the presence or absence of airway obstruction and/or emphysema, four groups were classified. RESULTS: Among a total of 59 subjects, 33 (56%) had osteoporosis. The prevalence of osteoporosis in subjects with no airway obstruction and no emphysema, those with only emphysema, those with only airway obstruction, and those with both airway obstruction and emphysema were 42%, 57%, 64%, and 73%, respectively (p=0.047 by linear-by-linear association). The mean T-scores of BMD of L1 (p=0.032) and L1-4 spines were different among the four groups (p=0.034). Although the T-score of L1 BMD negatively correlated with the extent of emphysema (r=-0.275, p=0.035) and positively with each of body mass index (BMI) (r=0.520, p<0.001), forced expiratory volume in one second (FEV1) (r=0.330, p=0.011), FEV1/forced vital capacity (r=0.409, p=0.001), and forced expiratory flow at 25~75% of FVC (FEF(25-75%)) (r=0.438, p=0.0001), respectively, multiple linear regression analysis indicated that BMI (p<0.001) and FEF(25-75%) were predictive of BMD (p=0.012). CONCLUSION: Low BMI and airway obstruction were strongly associated with reduced bone density rather than the extent of emphysema.
Airway Obstruction ; Body Mass Index ; Bone Density ; Emphysema ; Forced Expiratory Volume ; Humans ; Linear Models ; Lung Diseases ; Osteoporosis ; Phenotype ; Prevalence ; Pulmonary Emphysema ; Spine ; Spirometry ; Thorax ; Vital Capacity

Ankylosing spondylitis is a chronic inflammatory multisystem disease that primarily affects the axial joints. Pleuropulmonary involvement is an uncommon extra-articular manifestation of ankylosing spondylitis. There is a wide spectrum of pulmonary parenchymal changes in ankylosing spondylitis, beginning in the early stages of the disease and increasing over time. The lesions are usually asymptomatic, and not visible on chest radiographs in early stages. We reported a case of advanced ankylosing spondylitis in a 56-year-old man with progressive pulmonary bullous fibrocystic changes on both upper lobes that were misdiagnosed as tuberculosis in the early stages of the disease.
Humans ; Joints ; Lung* ; Middle Aged ; Radiography, Thoracic ; Spondylitis, Ankylosing* ; Tuberculosis

PURPOSE: The purpose of this study is to describe the characteristic high-resolution(HR) Ct findings ofsolitary nodular bronchioloalveolar carcinoma(BAC) of the lung which are valuable for specific diagnosis of thedisease. MATERIALS AND METHODS: HRCT scans of 46 patients (31 with malignant and 15 with benign lesion) with asolitary pulmonary nodule seen on chest radiograph were distributed in random order and analyzed retrospectively.Two blinded observers jointly analyzed the marginal and internal characteristics of nodules as seen on HRCT, anddecisions on the findings were reached by consensus. Stepwise discriminant analysis for characteristic findings ofBAC was performed. RESULTS: The most frequent CT findings of BAC (n=15) were internal bubble lucency (14/15,93%)(p=0.001), area of ground-glass opacity (12/15, 80%;average 58% of tumor volume)(p=0.0001), pleural tag(12/15,80%;p=0/097), and lobulated and spiculated margin(8/15, 53%;p=0.459). Findings of ground-glass opacity(p=0.0001)and bubble lucency(p=0.0187) appeared to be discriminantin the diagnosis of BAC. CONCLUSION: Peripheral pulmonarynodules containing an area of ground-glass opacity associated with internal bubble-lucency are characteristic ofBAC. Specific histologic diagnosis of solitary nodular BAC can be suggested by careful analysis of HRCT findings.
Adenocarcinoma, Bronchiolo-Alveolar* ; Consensus ; Diagnosis ; Humans ; Lung* ; Radiography, Thoracic

BACKGROUND: This study analyzed the negative prognostic factors in patients who received second-line chemotherapy for advanced inoperable non-small cell lung cancer (NSCLC). METHODS: We retrospectively reviewed the records of 137 patients with inoperable stage III-IV NSCLC who received second-line chemotherapy. The effects of clinical parameters on survival were analyzed and the hazard ratios (HR) for mortality were identified by a Cox regression analysis. RESULTS: Sex, age older than 65 years, smoking history, cell type, T-stage, best response to first-line chemotherapy and first-line chemotherapy regimen were significant negative predictors in univariate analysis. The multivariate analysis showed that patients older than 65 years (HR, 1.530; 95% confidence interval [CI], 1.020-2.297), advanced T stage (T4 vs. T1; HR, 2.273; 95% CI, 1.010-5.114) and non-responders who showed progression with first-line chemotherapy (HR, 1.530; 95% CI, 1.063-2.203) had higher HR for death. CONCLUSION: The age factor, T stage and responsiveness to first-line chemotherapy were important factors in predicting the outcome of patients with advanced NSCLC who received second-line chemotherapy. The results may help to predict outcomes for these patients in the future.
Age Factors ; Carcinoma, Non-Small-Cell Lung* ; Drug Therapy* ; Humans ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Smoke ; Smoking