Inflammatory Pseudotumor of the Lung: CT Findings and Pathologic Correlation

PURPOSE: To define the CT findings of inflammatory pseudotumor of the lung, and determine pathologiccorrelation. MATERIALS AND METHODS: We retrospectively analyzed the CT scans of seven patients withpathologically-proven (surgery:n=6; automated gun biopsy:n=1) inflammatory pseudotumor of the lung. Postcontrastscans were obtained in six cases, while one underwent only precontrast scanning. In all cases, these resultscorrelated with pathologic findings. RESULTS: In five cases, CT showed that irregular, spiculated nodules ormasses contacted with the pleura; in one, a well-defined nodule contacted with the fissure; and in one, there wasconsolidation. On postcontrast CT images, all six cases showed enhancement, with a central, low-density component. In four cases, ground-glass opacity surrounding the lesion was identified, and in three focal pleural thickeningadjacent to the lesion was noted. The predominant pathologic composition of the enhanced portions of the lesion,as seen on CT, was chronic inflammatory or spindle cells, and the angiogenesis of small vessels was also noted.Non-enhanced, central, low-density areas were accounted for by hemorrhaging, necrosis and the focal aggregation ofacute and chronic inflammatory cells. Surrounding gound-glass opacity corresponded pathologically to organizingpneumonia, cellular infiltration along the alveolar wall, and alveolar collapse. CONCLUSION: The CT features ofinlammatory pseudotumor of the lung were mainly peripheral irregular, spiculated nodule or mass, withcontrast-enhancement and a central low-density component, combined with surrounding ground-glass opacity. Allthese findings correlated well with pathologic findings.

Correction of Malfunctioning peritoneal Dialysis Catheter with Guidewire and Stiffener Under fluoroscopic Guidance

PURPOSE: To determine the efficacy of correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance. MATERIALS AND METHODS: Between November 1994 and March 1997, we performed 15 manipulations in 12 patients in whom a dual-cuff, straight Tenckhoff peritoneal dialysis catheter had been implanted due to chronic renal failure. The causes of catheter malfunctioning were inadequate drainage of the dialysate (n=14) and painful dialysis (n=1). Under fluoroscopic guidance, adhesiolysis and repositioning of the malfunctioning catheter were performed with an Amplatz Super Stiff guidewire and the stiffener from a biliary drainage catheter. The results of procedures were categorized as either immediate or durable success, this latter being defined as adequate catheter function for at least one month after the procedure. RESULTS: Immediate success was achieved in 14 of 15 procedures (93%), and durable success in 7 of 15 (47%). The mean duration of catheter function was 157 (range, 30 to 578) days. After manipulation, abdominal pain developed in eight patients and peritonitis in two, but with conservative treatment, these symptoms improved. CONCLUSION: The correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance is an effective means of restoring catheter function and may be an effective alternative to surgical reimplantation of the catheter, or hemodialysis.