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Objective:To investigate characteristic CT manifestations of primary pulmonary diffuse large B-cell lymphoma (DLBCL).Methods:CT images of 14 patients [10 males and 4 females, age （54±2） years old, range 32 to 91] with pathologically-proved pulmonary DLBCL lymphoma were retrospectively analyzed．Plain CT and contrast enhanced CT imaging were performed in all 14 patients. Image characteristics including lesion size, locations and distribution, morphology and margin, density and enhancement degrees, bronchia and lesion surroundings, other thoracic extra-pulmonary manifestations, as well as distant metastasis were analyzed and recorded. The maximal diameter of mass and/or nodules, pre and post-contrast CT values were measured. Among all 14 cases, 8 cases were initially diagnosed as lung carcinoma, 5 cases as infection, one case as lymphoma.Results:Among all 14 primary lung DLBCL cases, there were 10 case with multiple lesions and 4 with single lesion. Masses and/or nodules were found in 12 cases, with the maximum diameter of the lesions as 0.8-8.2 cm, the median value as 5.3 (2.9, 7.8) cm. Two cases showed simple consolidation. The margins of the lesions were clear and smooth in 12 cases, and fuzzy in 2 cases. The density of the lesions on pre-contrast CT was relatively uniform, with mean CT value (35.1±1.0) HU. After contrast, 10 cases displayed mild to moderate homogeneous enhancement, 4 cases showed heterogenous enhancement. The mean CT value of post-contrast images was (61.8±1.5) HU. In arterial phase, the mean CT value was (50.9±1.3) HU. Angiographic sign was found in 9 cases in arterial phase. Of the 14 cases, bronchus was clear and smooth in 5 cases. In 4 cases, bronchus was found slight compressed or stenosis; and 5 cases showed intra-lesion bronchi invasion or occlusion. Interstitial tissue around the lesion was found slightly thickened in 8 cases. The pleura showed unevenly thickened and invaded in 8 cases. Mediastinal or hilar lymphadenopathy and fusion were found in 10 cases, with 3 cases involving mediastinal large blood vessels, and 7 cases displaying infiltrative growth pattern. There were 4 cases with pleural effusion. CT follow-up after treatment in 8 cases showed no distant metastasis (7 cases showed good prognosis, with lesions disappearing after radiotherapy, chemotherapy or surgical resection; 1 case showed progressed with lesion increased after chemotherapy). Six patients abandoned the treatment and discharged from the hospital.Conclusions:Primary DLBCL is a high invasive and malignant entity with certain CT characteristics. The confirmed diagnosis of pulmonary DLBCL depends on pathological results.
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Objective: To explore CT and PET/CT features of primary mediastinal yolk sac tumor (PMYST). Methods: CT, PET/CT and clinical data of 14 patients with PMYST confirmed by percutaneous biopsy were retrospectively analyzed. All patients underwent plain scan and enhanced chest CT examination, while 7 patients underwent PET/CT examination. Results: CT showed round or lobulated masses in all 14 cases. The maximum diameter of masses was 4.10-13.50 cm, with an average of (10.65±2.27) cm. Lesions with the maximum diameter≥10.00 cm were in 13 cases (13/14, 92.86%).Plain CT showed non-uniform density or heterogeneous density, and the enhanced CT showed multiple strip, thin linear partition enhanced focus and flake non-enhanced area in 14 cases, among which moderate and mild enhancement were observed in 11 cases (11/14, 78.57%) and 3 cases (3/14, 21.43%), respectively. Cardiac envelope involvement was found in 5 cases (5/14, 35.71%), left cephalobrachial vein and/or superior vena cava involvement were detected in 3 cases (3/14, 21.43%), while the right upper and middle lobe involvement was noticed in 1 case (1/14, 7.14%).There were 3 patients (3/14, 21.43%) with right hilar and mediastinal lymph node metastasis, 1 (1/14, 7.14%) with right pleural metastasis and 1 (1/14, 7.14%) with right lower lung metastasis. Pericardial effusion (7/14, 50.00%) and pleural effusion (7/14, 50.00%) were found each in 7 cases, respectively. PET/CT showed markedly increased radioactivity uptake in all 7 cases. During following-up after treatment, stable or recovered well after operation were observed in 9 cases (9/14, 64.29%), whereas progressive or recurred after operation in 5 cases (5/14, 35.71%). Conclusion: The main imaging manifestations of PMYST include large round or lobulated non-uniform mass in the anterior mediastinum, often invading surrounding vessels, tissue and organs, mostly with lymph nodes and distant metastasis. The specific manifestations of PMYST are multiple strip-like, linear septate-like enhancement foci and patchy non-enhancement areas in enhanced CT. 18F-FDG uptake of the lesions are markedly hypermetabolic.
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Lizhong decoction was first recorded in the book "Treatise on Febrile Diseases" and was used to treat constant diarrhea of Taiyang disease and cold cholera. Lizhong decoction has the features of composing few medicines, enabling appropriate compatibility, and exerting obvious therapeutic effects. In this article, the compatibility and clinical application of this formula was briefly analyzed.