Nodular Fasciitis of the Breast: A Case and Literature Review.

Nodular fasciitis is a benign fibroblastic proliferation in soft tissue that is most commonly found in the upper extremities, trunk, head, and neck region. Its occurrence in the breast has been rarely reported. The most characteristic features are the sudden appearance and rapid growth of a palpable lesion. Nodular fasciitis can clinically, radiologically, and histopathologically mimic a breast carcinoma. We present a case of nodular fasciitis of the breast and a review of the relevant literature.

Accuracy of lung nodule volumetry in low-dose CT with iterative reconstruction: an anthropomorphic thoracic phantom study.

OBJECTIVE: The purpose of this study was to assess accuracy of lung nodule volumetry in low-dose CT with application of iterative reconstruction (IR) according to nodule size, nodule density and CT tube currents, using artificial lung nodules within an anthropomorphic thoracic phantom. METHODS: Eight artificial nodules (four diameters: 5, 8, 10 and 12 mm; two CT densities: -630 HU that represents ground-glass nodule and +100 HU that represents solid nodule) were randomly placed inside a thoracic phantom. Scans were performed with tube current-time product to 10, 20, 30 and 50 mAs. Images were reconstructed with IR and filtered back projection (FBP). We compared volume estimates to a reference standard and calculated the absolute percentage error (APE). RESULTS: The APE of all nodules was significantly lower when IR was used than with FBP (7.5 ± 4.7% compared with 9.0 ±6.9%; p < 0.001). The effect of IR was more pronounced for smaller nodules (p < 0.001). IR showed a significantly lower APE than FBP in ground-glass nodules (p < 0.0001), and the difference was more pronounced at the lowest tube current (11.8 ± 5.9% compared with 21.3 ± 6.1%; p < 0.0001). The effect of IR was most pronounced for ground-glass nodules in the lowest CT tube current. CONCLUSION: Lung nodule volumetry in low-dose CT by application of IR showed reliable accuracy in a phantom study. Lung nodule volumetry can be reliably applicable to all lung nodules including small, ground-glass nodules even in ultra-low-dose CT with application of IR. ADVANCES IN KNOWLEDGE: IR significantly improved the accuracy of lung nodule volumetry compared with FBP particularly for ground-glass (-630 HU) nodules. Volumetry in low-dose CT can be utilized in patient with lung nodule work-up, and IR has benefit for small, ground-glass lung nodules in low-dose CT.

Paratracheal air cysts on thoracic multidetector CT: incidence, morphological characteristics and relevance to pulmonary emphysema.

OBJECTIVE: To determine the incidence, morphological characteristics and relevance of paratracheal air cysts (PTACs) with pulmonary emphysema, as seen on thoracic multidetector CT (MDCT). METHODS: The CT images of 854 consecutive patients who underwent thoracic MDCT during a period of 2 months at our institution were reviewed. 538 of the patients were male and 316 were female. The incidence, size and shape of the PTACs and their relation to pulmonary emphysema were retrospectively analysed. RESULTS: Among the 854 patients, 69 (8.1%) had PTACs. 37 (6.9%) of the 538 male patients and 32 (10.1%) of the 316 female patients had PTACs. The highest prevalence of PTACs (25 patients, 11.2%) was found in those who were in the sixth decade of life. 48 (69.6%) PTACs measured 3-10 mm at the longest diameter and 33 (47.8%) were elongated on the coronal section images. 12 (17.4%) patients with PTACs had underlying gross morphological emphysema. The relationship between the presence of PTACs and the presence of emphysema and the relationship between the presence of PTACs and the severity of emphysema were not statistically significant. The size of PTACs showed an inverse relation to the severity of emphysema. CONCLUSION: The incidence of PTACs was estimated to be much higher than that of previous studies. There was a slight female predilection for PTACs, most commonly found in the sixth decade of life; PTACs mostly measured 3-10 mm and were elongated in shape. The relation of PTACs to gross morphological emphysema was low. ADVANCES IN KNOWLEDGE: PTACs are not correlated with the presence of emphysema on MDCT.

Reversed halo sign on thin-section CT in a patient with non-specific interstitial pneumonia.

We present a case of non-specific interstitial pneumonia (NSIP) with reversed halo sign on thin-section CT. A 52-year-old female presented with a cough and New York Heart Association (NYHA) class 2 dyspnoea of 4 months duration. A chest radiograph showed poorly defined, patchy ground-glass opacities in both lungs. Thin-section CT demonstrated the reversed halo sign, which is a central ground-glass opacity surrounded by crescent or ring-shaped areas of consolidation in multifocal areas. Multifocal patchy ground-glass opacity and consolidation and enlarged paratracheal, hilar and subcarinal lymph nodes were also shown. Video-assisted thoracic surgical (VATS) lung biopsy was performed, and histopathology revealed cellular NSIP.

Needlescopy-assisted resection of pulmonary nodule after dual localisation.

The aim of this study was to evaluate the feasibility of dual localisation with hookwire and lipiodol before needlescopy-assisted resection for pulmonary nodule. Computed tomography-guided dual marking was performed on 36 pulmonary nodules of 32 patients and needlescopy-assisted resection was performed monitored by C-arm fluoroscopy. The mean age of the patients was 58 ± 12 (range 12-77) yrs. The mean size of the nodules was 7.5 ± 3.7 (3-17) mm. Their mean distance from the pleural surface was 7.3 ± 7.5 (0-35) mm. There were nine pure ground-glass opacity lesions, five semi-solid lesions and 22 solid lesions. The time of the dual localisation procedure was 13.1 ± 4.8 (7-23) min. Complications of the marking were pneumothorax in nine patients, and intrapulmonary bleeding in three. One hookwire dislodged during the operation. All nodules were successfully resected under needlescopy without conversion to a conventional thoracoscopy (5 mm or 10 mm thoracoscopy) or a minithoracotomy. There was no complication related to needlescopy-assisted resection. Dual marking with hookwire and lipiodol is a safe and none time consuming procedure, and needlescopy-assisted lung resection for small nodules is technically feasible and useful for histological diagnosis and treatment.

Comparison of bioavailability of two ubidecarenone products in healthy Korean volunteers.

OBJECTIVE: This study aimed to evaluate the bioavailability of two pharmaceutical products of ubidecarenone (coenzyme Q10, CoQ10). MATERIALS: Two brands (brand A and brand B) of commercial CoQ10 hard capsules. METHODS: Two brands of CoQ10 capsules were administered at 100 mg dose to two groups of healthy volunteers, respectively, and blood samples were withdrawn at predetermined time intervals and assayed by a validated HPLC method with an electrochemical detector. RESULTS AND CONCLUSIONS: Intra- and inter-day precision and inter-day accuracy were acceptable for all quality control samples including the lower limit of quantitation of 50 ng/ml. Recovery of CoQ10 from human plasma was greater than 98.2%. CoQ10 was stable in human plasma under various storage conditions. This method was applied to a pharmacokinetic study after oral administration of CoQ10 hard capsules to healthy volunteers. The intrinsic CoQ10 concentrations were measured for three consecutive days before drug administration, which were ranged between 0.68 and 0.79 microg/ml, and there was no statistically significant difference between groups. In brand A, the plasma concentration after administration of CoQ10 was not higher than the intrinsic level, indicating that no significant drug absorption occurred, whereas considerably higher concentrations were obtained with brand B. The dissolution rates of brand A and B after 3 h were 0.35 +/- 0.09 and 1.27 +/- 0.16%, respectively. From the adjusted concentration-time curve, the AUC and t1/2 of brand B were calculated to be 11.51 +/- 5.76 microg x h/ml and 21.7 h, respectively. A mean Cmax of 0.32 +/- 0.1 microg/ml was obtained at 7.9 h. In conclusion, it was found that bioavailability of CoQ10 was significantly different depending on the formulations, and dissolution could be one of the important factors affecting CoQ10 absorption.

Wide spectrum of thoracic neurogenic tumours: a pictorial review of CT and pathological findings.

The purpose of this pictorial essay is to illustrate the radiological and pathological findings of a wide spectrum of neurogenic tumours of the thorax according to their anatomical location and histological subtype. Knowledge of these findings will narrow the differential diagnosis and provide guidance for patient management.

Comparison between coronal reformatted images and direct coronal CT images of the swine lung specimen: assessment of image quality with 64-detector row CT.

The aims of this study were to compare the image quality of coronal multiplanar reconstruction (MPR) images from axial spiral images with that of direct coronal spiral and sequential images, and to estimate and analyse the effect of an incremental change on the image quality using 64-detector row CT. 12 swine lungs were used. Five kinds of images from each lung specimen were obtained using 64-detector row CT. All images were analysed by categories and grades, and the direct coronal sequential images were used as the reference standard for the image quality. Statistical analysis was performed for the following categories: (i) inter-observer reliability, (ii) interaction between the observers and images, (iii) image analysis, (iv) anatomical structural analysis of each observer, (v) stair-step artefact and (vi) background noise. The overall image quality and the image quality of all anatomical structures of coronal MPR images with 0.67 mm slice increments were inferior to the image quality of the other images; this difference was statistically significant (p<0.05). Stair-step artefact was detected on coronal MPR images, and was more prominent on coronal MPR images with 0.67 mm slice increments than on coronal MPR images with 0.34 mm slice increments. The most severe background noise was detected on the direct coronal sequential images, but there was no significant difference between the direct coronal sequential images and the direct coronal spiral images. Background noise was least prominent on coronal MPR images with 0.67 mm slice increments. The increment process is important for improving the image quality of MPR images even when using 64-detector row CT. Coronal MPR images with 0.34 mm slice increments using 64-detector row CT showed a similar image quality to that obtained from the direct coronal images, and can be used instead. This means that the coronal MPR images obtained with 64-detector row CT could be as useful for evaluating the lung parenchyma as the axial high-resolution CT images.

Primary localized amyloidosis manifested as supraclavicular and mediastinal lymphadenopathy.

Thoracic involvement of amyloidosis is relatively rare, but mediastinal lymphadenopathy in the absence of pulmonary parenchymal involvement is extremely rare. The case presented here is of a previously healthy elderly woman who developed a palpable mass in the right supraclavicular area. The chest CT scan showed extensive, contiguous and homogeneous low attenuated lymphadenopathy with stippled calcification in the right supraclavicular area and mediastinum. Amyloidosis was confirmed histopathologically on a biopsy specimen from a right supraclavicular lymph node. Because there were no other sites found to be affected by amyloidosis and there was no underlying chronic disease, we made a final diagnosis of primary localized amyloidosis involving only the supraclavicular and mediastinal lymph nodes.

A giant malignant peripheral nerve sheath tumour of the breast: CT and pathological findings.

Malignant peripheral nerve sheath tumour (MPNST) is a rare soft tissue sarcoma. In particular, primary MPNST of the breast is extremely rare. We report a case of a giant malignant peripheral nerve sheath tumour involving the entire right breast, which was not associated with neurofibromatosis type 1 (NF-1) or previous radiation therapy. A CT scan showed a huge heterogeneous soft tissue mass with well-enhanced nodules at its periphery and low-density internal necrosis, which was confirmed by modified radical mastectomy.

Thoracic manifestations associated with advanced liver disease.

Advanced liver disease and portal hypertension may produce various intrathoracic complications that involve the pleural space, lung parenchyma, and pulmonary circulation. Dyspnea and arterial hypoxemia are the common clinical symptoms and signs in patients with such complications. In these patients, intrathoracic complications most often develop during the course of hepatic disease, but a few patients may be seen first with respiratory symptoms or radiographic abnormalities. Therefore, radiologists should be made aware of these disorders that occur in patients with chronic liver disease. In this article, the authors describe and illustrate the clinical and imaging spectrum of thoracic abnormalities associated with advanced liver disease and portal hypertension.

Large cell neuroendocrine carcinoma of the lung: radiologic and pathologic findings.

PURPOSE: The purpose of this work was to determine the radiologic and pathologic findings of large cell neuroendocrine carcinoma (LCNEC). METHOD: We retrospectively evaluated chest radiographs, CT scans, and pathologic findings of five patients with pathologically confirmed LCNEC. They were confirmed by percutaneous needle biopsy (n = 2) and by surgery (n = 3). The average age of patients was 60 (51-70) years, and all five were smokers (mean 30 pack-years) and men. Radiologic findings were reviewed for the pattern of lesion, location, and associated findings by two radiologists under consensus. Pathologic findings were reviewed by two pathologists. RESULTS: In all five patients, tumors were represented as a peripherally located nodule or mass without associated secondary pneumonitis or distal atelectasis radiographically. On CT scan, masses were oval or round and well demarcated with lobulated margin in all cases, their sizes ranged from 2 to 5 cm, and they did not show internal calcification and necrosis. On contrast-enhanced CT, three cases showed moderate enhancement more than the chest wall muscle. Lymphadenopathy was observed in ipsilateral hilar and mediastinal areas in three cases. Distant metastasis to liver was noted in one case. One case of LCNEC was Stage IV, two were Stage IIIa, and two were Stage Ia at the time of diagnosis. CONCLUSION: Although the epidemiology of LCNEC is more similar to that of small cell carcinoma than atypical carcinoids, in its strong association with smoking, rapid progression, and poor prognosis, our five cases of LCNEC show peripherally located pulmonary nodule or mass with or without regional lymphadenopathy, which are findings similar to those of atypical carcinoids rather than small cell carcinoma.

CT bronchus sign in malignant solitary pulmonary lesions: value in the prediction of cell type.

The aim of this study was to evaluate differences in the prevalence of patterns of CT bronchus sign in malignant solitary pulmonary lesions (SPLs), according to their histologic cell types and with respect to size, location, and degree of cell differentiation. Computed tomography scans of 78 patients, in whom pathologically confirmed malignant SPLs with CT bronchus sign were present, were randomly selected and reviewed by two radiologists under consensus. All 78 were CT scans done using spiral technique with 10-mm collimation and 10-mm reconstruction intervals with enhancement, and 75 included additional high-resolution CT scans. Lesions were classified into four cell types as squamous cell carcinoma (n = 24), small cell carcinoma (n = 12), adenocarcinoma (n = 23), bronchioloalveolar carcinoma (BAC; n = 9), and others (n = 12), into three degrees of differentiation, into three size groups, and according to location (central or peripheral). Patterns of CT bronchus sign were classified into abruptly obstructing (I), patent (II), displacing (III), or tapered narrowing (IV) types. The relationships between the patterns of CT bronchus sign and cell type and degree of cell differentiation were evaluated. Eighty patterns of CT bronchus sign were observed in 78 patients. According to cell type, squamous cell carcinoma showed most often type-I pattern (45.8%) but no type-II pattern, which was the most common pattern observed in BAC (77.8%) and adenocarcinoma (34.8%; p<0.01). Small cell carcinoma showed a varied distribution among the four patterns of CT bronchus sign. According to location, in central squamous cell carcinomas, type-I pattern was more common(55%; p<0.01). Bronchioloalveolar carcinoma showed more peripheral lesions and in both central and peripheral lesions, type-II pattern was significantly more common (100 and 66.7%; p<0.01). In SPLs with CT bronchus sign of obstructing pattern, especially if central location, squamous cell carcinoma should be suspected, whereas in SPLs with patent CT bronchus sign, regardless of the location, the strong possibility of BAC should be considered.

Evaluating porcelain color match of different porcelain shade-matching systems.

PURPOSE: This in vitro study was designed to evaluate the new ShadeEye-EX Chroma Meter and a new visual porcelain shade-matching system (Vitapan 3-D Master, Omega 900) in comparison to the traditionally used visual porcelain shade-matching system (Vita Lumin Vacuum, VMK 68). MATERIALS AND METHODS: Shade matches and porcelain fabrications on individualized shade tabs were carried out. The fabricated porcelain tabs were evaluated against the respective natural tooth using the United States Public Health Service (USPHS) criteria to determine clinically acceptable match. The tabs also were ranked according to the final-color match to the corresponding natural tooth. RESULTS: The percentage of clinically acceptable color matches were as follows: Vita Lumin Vacuum (46.67%), ShadeEye-EX (40%), and Vitapan 3-D Master (56.67%). The generalized estimating equation (alpha = 0.5) showed no statistically significant difference between systems in obtaining a clinically acceptable match (p = .5729). The chi-squared test (alpha = 0.5) showed no statistically significant difference between systems in terms of rank order (p = .5017). The two new systems do not produce color match that is better than the conventional visual porcelain shade-matching system.

Lung metastases manifesting as pulmonary infarction by mucin and tumor embolization: radiographic, high-resolution CT, and pathologic findings.

We present a case of lung metastasis manifesting as lung infarction by mucin and tumor embolization. The radiograph and high-resolution CT showed multiple focal consolidations with ground glass attenuation in subpleural areas of both lungs. Diagnosis was made by open lung biopsy, which revealed pulmonary infarction caused by intravascular adenocarcinoma with numerous mucus emboli in pulmonary arteries. Subpleurally located consolidations on high-resolution CT correlated well with the histologic findings of lung infarction by mucin and tumor emboli.

Endobronchial actinomycosis simulating endobronchial tuberculosis: a case report.

We report a case of a 70-year-old woman who presented with mild exertional dyspnea and cough. Fiberoptic bronchoscopic findings revealed an endobronchial polypoid lesion with stenotic bronchus. The lesion was very similar to endobronchial tuberculosis. Histologic examination of the biopsy specimen demonstrated Actinomyces infection. There was a clinical response to intravenous penicillin therapy. Primary endobronchial actinomycosis must be considered in the differential diagnosis of an endobronchial lesion, especially endobronchial tuberculosis in Korea.

Nested polymerase chain reaction for detection of Mycobacterium tuberculosis in solitary pulmonary nodules.

BACKGROUND: Differential diagnosis of solitary pulmonary nodules (SPNs) can be difficult in areas, such as Korea, where tuberculosis is endemic. Nested polymerase chain reaction (PCR) is a widely used method to test a very small amount of pathogen and to detect Mycobacterium tuberculosis from fine needle aspirates. OBJECTIVES: The usefulness of nested PCR for the detection of M tuberculosis from tuberculous SPN and for the differential diagnosis of SPN was evaluated. METHODS: Thirty-three patients in whom a diagnosis of SPN was made based on a CT scan of the chest were enrolled in this study. Included were 17 malignant and 16 benign SPNs. Nested PCR was carried out for the detection of M tuberculosis by using TB-1, TB-2, TB-28, and TB-29C on fine needle aspirates from the nodule in all 33 cases. RESULTS: Aspirates from malignant neoplasms, pneumonia, and sequestration were all negative on nested PCR for tuberculosis. One of the three radiologically suspected tuberculous nodules without response to anti-tuberculosis drugs (uncertain) yielded positive results on nested PCR for the detection of M tuberculosis. In contrast, 7 out of 8 (87.5%) aspirates from proven tuberculous nodules showed positive results on nested PCR. Nested PCR could be used to detect M tuberculosis in fine needle aspirates from tuberculous SPNs with good sensitivity (87.5%) and specificity (96.0%). CONCLUSION: Nested PCR for the detection of M tuberculosis in fine needle aspirates may be useful in the differential diagnosis of SPNs.

Pulmonary involvement of idiopathic hypereosinophilic syndrome: CT findings in five patients.

PURPOSE: The aim of this study was to assess the CT findings of pulmonary involvement in patients with idiopathic hypereosinophilic syndrome (HES). METHOD: The study included five patients with idiopathic HES who had pulmonary involvement proven by bronchoalveolar lavage (n = 3) or based on clinical and radiologic findings (n = 2). Four patients had high resolution CT and one had conventional CT. The CT scans were retrospectively reviewed by two chest radiologists for pattern and distribution of disease. RESULTS: All five patients had several small nodules in both lungs at CT scan. Four patients had nodules with a halo of ground-glass attenuation. Three patients had focal areas of ground-glass attenuation in both lungs. These lesions were present in all lung zones and involved mainly the peripheral lung. There was neither lobar predilection nor peribronchovascular distribution. Other organs involved included bone marrow (n = 3), liver (n = 3), stomach (n = 1), and peritoneum (n = 1). CONCLUSION: The CT findings of pulmonary involvement in patients with idiopathic HES included small nodules with or without a halo of ground-glass attenuation and focal areas of ground-glass attenuation mainly in the lung periphery.