Pleural masses may be caused by various conditions, including benign and malignant neoplasms and non-neoplastic tumorlike conditions. Primary pleural neoplasms include solitary fibrous tumor, malignant mesothelioma, and primary pleural non-Hodgkin's lymphoma. Metastatic disease is the most common neoplasm of the pleura and may uncommonly occur in patients with hematologic malignancy, including lymphoma, leukemia, and multiple myeloma. Pleural effusion is usually associated with pleural malignancy. Rarely, pleural malignancy may arise from chronic empyema, and the most common cell type is non-Hodgkin's lymphoma (pyothorax-associated lymphoma). Non-neoplastic pleural masses may be observed in several benign conditions, including tuberculosis, pleural plaques caused by asbestos exposure, and pleural loose body. Herein, we present a review of benign and malignant pleural neoplasms and tumorlike conditions with illustrations of their computed tomographic images.

PURPOSE: To determine the clinical features, imaging findings and possible causes of pneumatosis intestinalis (PI) in thoracic disorder patients. MATERIALS AND METHODS: From 2005 to 2017, Among 62 PI patients, four of PI related with thoracic disease (6%) were identified. Medical records were reviewed to determine the clinical presentation, laboratory findings and treatment at the time of presentation of PI. Two experienced chest radiologists reviewed all imaging studies and recorded specific findings for each patient. RESULTS: The causative thoracic diseases for each four patient were severe asthma, emphysema and airway obstruction. The imaging appearance of PI, including the involved bowel segment and pattern of the air, were divided into two mesenteric vascular territories; three of our cases showed linear pattern of PI located in the ascending & proximal transverse colon and the fourth case (lung cancer) had bubbly and cystic PI in the distal transverse and descending colon. All of the remaining 3 patients, except one patient who had not been followed up, improved within 1 month by conservative treatment. CONCLUSION Thoracic disorder with obstructive lung disease may result in the development of benign PI. Such PI in thoracic disease patients has a similar linear and cystic appearance with ischemic bowel disease, but can nevertheless be managed by conservative treatment.

BACKGROUND: The incidence of tuberculosis (TB) in Korea is relatively high compared to the other Organisation for Economic Co-operation and Development (OECD) countries, with a prevalence of 71 per 100,000 in 2012, although the incidence is declining. Real-time polymerase chain reaction (PCR) has been introduced for the rapid diagnosis of TB. Recently, its advantage lies in higher sensitivity and specificity for the diagnosis of TB. This study evaluated the clinical accuracy of real-time PCR using respiratory specimens in a clinical setting. METHODS: Real-time PCR assays using sputum specimens and/or bronchoscopic aspirates from 2,877 subjects were reviewed retrospectively; 2,859 subjects were enrolled. The diagnosis of TB was determined by positive microbiology, pathological findings of TB in the lung and pleura, or clinical suspicion of active TB following anti-TB medication for more than 6 months with a favorable response. RESULTS: Sensitivity, specificity, and accuracy were 44%, 99%, and 86% from sputum, and 65%, 97%, and 87% from bronchoscopic aspirates, respectively. For overall respiratory specimens, sensitivity was 59%, specificity was 98%, and accuracy increased to 89%. CONCLUSION: Positivity in real-time PCR using any respiratory specimens suggests the possibility of active TB in clinically suspected cases, guiding to start anti-TB medication. Real-time PCR from selective bronchoscopic aspirates enhances the diagnostic yield much more when added to sputum examination.
Bronchoscopy ; Diagnosis* ; Incidence ; Korea ; Lung ; Pleura ; Prevalence ; Real-Time Polymerase Chain Reaction* ; Retrospective Studies ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary*

We present a rare case of a pleural loose body, thought to be a pedunculated pleural tumor, found incidentally in a 58-year-old female. Computed tomography showed a non-enhancing mass, which migrated along the mediastinum and paravertebral area. Thoracoscopic surgery revealed a 4 cm, soap-like mass that was found to be a fibrin body consisting of hyalinized collagen histopathologically. Mobility and the lack of contrast enhancement of a pleural mass are important clues to diagnosing this benign condition.
Diagnosis, Differential ; Female ; Fibrin/metabolism ; Humans ; Mediastinum ; Middle Aged ; Pleura/*pathology/surgery ; Pleural Neoplasms/diagnosis/pathology ; Tomography, X-Ray Computed

Decompression sickness is a self contained underwater breath apparatus (SCUBA)-related injury with various symptoms and is considered an extreme emergency condition. This is a case of pulmonary involvement in decompression sickness in a 26-year-old SCUBA diver. Although pulmonary involvement in decompression sickness is a potentially severe condition that requires immediate treatment, this condition can be under- or misdiagnosed, and evaluation of this disease by imaging findings is not clearly understood. We experienced a case of pulmonary involvement in decompression sickness and herein present the chest computed tomography and simple radiograph findings associated with this condition.
Decompression ; Decompression Sickness ; Dyspnea ; Emergencies ; Thorax

BACKGROUND: More than half of cases for advanced non-small-cell lung cancer (NSCLC) occur in elderly patients with a median age at diagnosis of 70 years. The aim of our study was to examine the clinical features and prognostic factors contributing to mortality in elderly patients with advanced NSCLC. METHODS: Following a retrospective review of clinical data, 122 patients aged 70 years and over with a histopathological diagnosis of locally advanced (stage IIIB, n=32) and metastatic (stage IV, n=90) NSCLC between 2005 and 2011 were enrolled. RESULTS: The median age was 76 years (interquartile range, [IQR], 72-80 years), and 85 (70%) patients were male. Fifty-seven (46%) patients had never smoked, and 17 (19%) were in a malnourished state with a body mass index (BMI) of <18.5 kg/m2. The initial treatments included chemotherapy (40%) and radiotherapy (7%), but 57% of the patients received supportive care only. The 1-year survival rate was 32%, and the 3-year survival rate was 4%, with a median survival duration of 6.2 months (IQR, 2.5-15.3 months). Male gender (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.3-3.9; p=0.005), low BMI (HR, 2.3; 95% CI, 1.3-3.9; p=0.004), and supportive care only (HR, 1.9; 95% CI, 1.2-2.9; p=0.007) were independent predictors of shorter survival based on a Cox proportional hazards model. CONCLUSION: Elderly patients with advanced NSCLC had a poor prognosis, particularly male patients, those with a low BMI, and those who received supportive care only.
Aged ; Body Mass Index ; Carcinoma, Non-Small-Cell Lung ; Humans ; Lung ; Lung Neoplasms ; Male ; Prognosis ; Retrospective Studies ; Smoking ; Survival Rate ; Tertiary Care Centers

OBJECTIVE: To evaluate the reliability of virtual non-contrast (VNC) images reconstructed from contrast-enhanced, dual-energy scans compared with true non-contrast (TNC) images in the assessment of high CT attenuation or calcification of mediastinal lymph nodes. MATERIALS AND METHODS: A total of 112 mediastinal nodes from 45 patients who underwent non-contrast and dual-energy contrast-enhanced scans were analyzed. Node attenuation in TNC and VNC images was compared both objectively, using computed tomography (CT) attenuation, and subjectively, via visual scoring (0, attenuation < or = the aorta; 1, > the aorta; 2, calcification). The relationship among attenuation difference between TNC and VNC images, CT attenuation in TNC images, and net contrast enhancement (NCE) was analyzed. RESULTS: CT attenuation in TNC and VNC images showed moderate agreement (intraclass correlation coefficient, 0.612). The mean absolute difference was 7.8 +/- 7.6 Hounsfield unit (HU) (range, 0-36 HU), and the absolute difference was equal to or less than 10 HU in 65.2% of cases (73/112). Visual scores in TNC and VNC images showed fair agreement (kappa value, 0.335). Five of 16 nodes (31.3%) which showed score 1 (n = 15) or 2 (n = 1) in TNC images demonstrated score 1 in VNC images. The TNC-VNC attenuation difference showed a moderate positive correlation with CT attenuation in TNC images (partial correlation coefficient [PCC] adjusted by NCE: 0.455) and a weak negative correlation with NCE (PCC adjusted by CT attenuation in TNC: -0.245). CONCLUSION: VNC images may be useful in the evaluation of mediastinal lymph nodes by providing additional information of high CT attenuation of nodes, although it is underestimated compared with TNC images.
Adult ; Aged ; Aged, 80 and over ; Calcinosis/*radiography ; Contrast Media/diagnostic use ; Female ; Humans ; Image Processing, Computer-Assisted ; Lymph Nodes/*radiography ; Male ; Mediastinum/*radiography ; Middle Aged ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods

OBJECTIVE: The aim of this study was to evaluate the usefulness of combined fluoroscopy- and CT-guided transthoracic needle biopsy (FC-TNB) using a cone beam CT system in comparison to fluoroscopy-guided TNB (F-TNB). MATERIALS AND METHODS: We retrospectively evaluated 74 FC-TNB cases (group A) and 97 F-TNB cases (group B) to compare their respective diagnostic accuracies according to the size and depth of the lesion, as well as complications, procedure time, and radiation dose. RESULTS: The sensitivity for malignancy and diagnostic accuracy for small (< 30 mm in size) and deep (> or = 50 mm in depth) lesions were higher in group A (91% and 94%, 92% and 94%) than in group B (73% and 81%, 84% and 88%), however not statistically significant (p > 0.05). Concerning lesions > or = 30 mm in size and < 50 mm in depth, both groups displayed similar results (group A, 91% and 92%, 80% and 87%; group B, 90% and 92%, 86% and 90%). Pneumothorax occurred 26% of the time in group A and 14% for group B. The mean procedure time and patient skin dose were significantly higher in group A (13.6 +/- 4.0 minutes, 157.1 +/- 76.5 mGy) than in group B (9.0 +/- 3.5 minutes, 21.9 +/- 15.2 mGy) (p < 0.05). CONCLUSION: Combined fluoroscopy- and CT-guided TNB allows the biopsy of small (< 30 mm) and deep lesions (> or = 50 mm) with high diagnostic accuracy and short procedure times, whereas F-TNB is still a useful method for large and superficial lesions with a low radiation dose.
Adult ; Aged ; Aged, 80 and over ; *Biopsy, Fine-Needle ; *Cone-Beam Computed Tomography ; Female ; *Fluoroscopy ; Humans ; Lung/*pathology ; Lung Neoplasms/pathology ; Male ; Middle Aged ; *Radiography, Interventional ; Sensitivity and Specificity

OBJECTIVES: These days, the main injection laryngoplasty technique is cricothyroid (CT) approach. However, patients who have previously undergone other neck treatments, such as thyroidectomy or neck dissection have distorted anatomical landmark makes this approach more difficult. The aim of this study is to determined the efficiency of transcartilaginous (TC) approah as compared with CT approach for unilateral vocal fold paralysis patients, especially for previously neck treated patients. METHODS: From March 2005 to February 2008, 137 consecutive injection laryngoplasties were performed in patients with unilateral glottic insufficiency. Percutaneous injection was performed under local anesthesia into the vocalis muscle, using disposable 25 G 4 cm long needles through the cricothyroid membrane or directly through the thyroid cartilage. Of the 137 patients, 124 completed acoustic, perceptual, stroboscopic, and subjective evaluations prior to the injection and at 3 months after the injection. RESULTS: In the 124 patients, the CT and TC approaches were used in 94 and 30 patients, respectively. Acoustic and perceptual parameters (GRBAS, MPT, jitter, shimmer), voice handicap index, and grades of mucosal waves and glottic closure were significantly improved after the injection in both the CT and TC groups (P<0.05). Only two patients (6.6%) had penetration difficulties, because of ossification of the thyroid cartilage. The overall success rates of the CT and TC approaches were 86.2%, 93.3%, respectively. However, the success rate of the TC approach in patients who had previously undergone neck treatments was significantly higher than that of the CT approach (100% vs. 65% P<0.05). CONCLUSION: Based on the preliminary results of this trial, injection laryngoplasty using a TC approach was an effective alternative to the CT approach, especially in patients who had previously undergone neck surgeries.
Acoustics ; Anesthesia, Local ; Humans ; Laryngeal Muscles ; Laryngoplasty ; Membranes ; Neck ; Neck Dissection ; Needles ; Paralysis ; Thyroid Cartilage ; Thyroidectomy ; Vocal Cord Paralysis ; Vocal Cords ; Voice