The Effect of Diabetes Control Status on CT Findings in Pulmonary Tuberculosis: Emphasis on Bronchial Erosive Changes.

PURPOSE: Studies on the effect of diabetes mellitus (DM) on the radiologic findings of pulmonary tuberculosis (PTB) have reported inconsistent results. These findings may have been influenced by the glycemic control status of the patients studied. To our knowledge, no recent data have described the effect of the DM control status on CT findings in PTB in terms of medium-sized airway involvement that is visualized as bronchial erosion on CT. The aim of this present study was to determine whether the DM control status influenced radiological manifestations in patients with PTB, with an emphasis on bronchial erosive changes. METHODS: We conducted a retrospective single-center study on patients who were newly diagnosed with PTB. A total of 426 consecutive patients with PTB who underwent CT scans at the time of diagnosis from 1 January 2017 to 31 March 2020 were included in this study. The included patients were categorized as having no DM (non-DM), controlled DM, or uncontrolled DM. The patient medical charts, microbiology study results, and pulmonary changes on the CT scans were analyzed. RESULTS: Among 426 patients with PTB who underwent CT scans at the time of diagnosis, 91 were excluded either due to undetermined hemoglobin A1C (HbA1C) levels (n = 25) or concomitant pulmonary diseases (n = 66) that would make the analysis of the pulmonary changes on CT scans difficult. Finally, 335 patients were included in this study (224 men and 111 women; mean age, 59 years; range, 16-95 years). Among the 335 patients, 82 (24.5%) had DM and 52 of those (63.4%) had an uncontrolled status. The frequency of cavitation (43% vs. 23% vs. 79%, p < 0.001) and bronchial erosion (44% vs. 30% vs. 73%, p < 0.001) was significantly different between the three groups. The uncontrolled DM group showed a high frequency of cavitation and bronchial erosion compared to the non-DM (cavitation, p < 0.001 and bronchial erosion, p < 0.001) and controlled DM groups (p < 0.001 and p < 0.001). However, the frequency of cavitation and bronchial erosion in the controlled DM group was not different compared to the non-DM group. CONCLUSION: The glycemic status (HbA1C ≥ 7.0), not the presence of DM, influenced the radiologic manifestations of PTB, especially in terms of medium-sized bronchial involvement, appearing as bronchial erosive changes and the feeding bronchus sign on chest CT scans. This difference in the uncontrolled DM group was likely to contribute to the higher frequency of cavitation.

CT Scan Differences of Pulmonary TB According to Presence of Pleural Effusion.

BACKGROUND: Subpleural micronodules and interlobular septal thickening are common CT scan findings in TB pleural effusion. These CT scan features could help us differentiate between TB pleural effusion and nonTB empyema. RESEARCH QUESTION: Does the frequency of subpleural micronodules and interlobular septal thickening correlate with the presence of pleural effusion in patients with pulmonary TB? STUDY DESIGN AND METHODS: CT scan findings of pulmonary TB, micronodules and their distribution (peribronchovascular, septal, subpleural, centrilobular, and random), large opacity (consolidation/macronodule), cavitation, tree-in-buds, bronchovascular bundle thickening, interlobular septal thickening, lymphadenopathy, and pleural effusion were retrospectively analyzed. Patients were divided into two groups according to the presence of pleural effusion. Clinicoradiologic findings of the two groups were then analyzed. We presented Benjamini-Hochberg critical value for multiple testing correction of CT scan findings, with a false discovery rate of 0.05. RESULTS: Of a total of 338 consecutive patients diagnosed with pulmonary TB who underwent CT scans, 60 were excluded because of coexisting pulmonary diseases. The frequency of subpleural nodules (47/68, 69% in pulmonary TB with pleural effusion vs 30/210, 14% in pulmonary TB without effusion, P < .001, Benjamini-Hochberg [B-H] critical value = 0.0036) and interlobular septal thickening (55/68, 81% vs 134/210, 64%, P = .009, B-H critical value = 0.0107) was significantly higher in the group of patients with pulmonary TB with pleural effusion than in the group without pleural effusion. In contrast, tree-in-buds (20/68, 29% vs 101/210, 48%, P = .007, B-H critical value = 0.0071) were less frequently seen in patients with pulmonary TB with pleural effusion. INTERPRETATION: Subpleural nodules and septal thickening were more common in pulmonary TB patients with pleural effusion than in those without pleural effusion. TB involvement of the lymphatics in the peripheral interstitium could be associated with the development of pleural effusion.

The Atypical Manifestation of Pulmonary Tuberculosis in Patients with Bronchial Anthracofibrosis.

It has been stated that bronchial anthracofibrosis (BAF) has an important relationship with pulmonary tuberculosis (TB), and the coexistence of TB and BAF is high. The purpose of this study was to compare the differences in computed tomography (CT) characteristics of pulmonary TB according to the presence of underlying BAF. Total of 202 consecutive patients who were diagnosed with pulmonary TB and underwent bronchoscopy and CT in our institution were retrospectively reviewed. We classified the patients into two groups according to the presence of BAF and compared the clinicoradiological findings between the two groups (anthracofibrosis group vs. nonanthracofibrosis group). Elderly and female patients were significantly higher in anthracofibrosis group (mean age 79 ± 7 (64−94) vs. 56 ± 17 (16−95), p < 0.001; female 89% vs. 29%, p < 0.001). The frequency of internal low-density area or focal contour bulge within atelectasis (64% vs. 1%, p < 0.001), lower lobe predominance (43% vs. 9%, p < 0.001), endobronchial involvement (46% vs. 15%, p < 0.001), and lymphadenopathy (57% vs. 28%, p = 0.002) were significantly higher in anthracofibrosis group. In contrast, the anthracofibrosis group showed lower frequency of upper lobe predominance (32% vs. 81%, p < 0.001) and cavitation (14% vs. 51%, p = 0.001). In conclusion, being aware of these atypical manifestations of pulmonary TB in the presence of BAF will be of great help in early detection of TB.

Unusual presentation of granulomatosis with polyangiitis causing periaortitis and consequent subclavian steal syndrome: A case report.

BACKGROUND: Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease that involves small-to-medium-sized vessels and forms necrotizing vasculitis with granulomatous inflammation. The formation of a large vessel lesion in GPA patients has been scarcely reported, and it can cause confusion in the diagnosis. CASE SUMMARY: A 27-year-old man presented with mild left-sided pleuritic chest pain that started one year prior. An imaging study revealed up to 2.5 cm-sized two irregular nodular consolidation nodule in the left lower lobe. Both nodules showed central necrosis. Also, there was a periaortic mass occluding the branching porting of the subclavian artery. He had positive anti-neutrophil cytoplasmic antibodies (ANCAs), but myeloperoxidase-ANCAs and proteinase 3-ANCAs were negative. The patient also developed symptoms of subclavian vein syndrome during the follow-up. Wedge resection of the lung revealed necrotizing vasculitis, destructive parenchymal abscess and surrounding granuloma, and therefore diagnosed of GPA. The patient started on methotrexate and steroid therapy with a relief of symptomatic. CONCLUSION: Here, we present an unusual manifestation of GPA with periaortitis and consequent subclavian steal syndrome, which has never been previously described. This case alerts us that we should include GPA in the differential diagnosis of large vessel vasculitis as well as subclavian steal syndrome.

How to Review Postlobectomy Posteroanterior Chest Radiographs.

Lung cancer is currently the most common malignancy in the world. A lobectomy is the standard of care for most patients with operable lung cancer and accounts for 60% to 70% of lung resection. The chest radiograph may appear normal after a lobectomy, particularly in uncomplicated cases. However, lobectomy usually involves leaving surgical staples at the bronchial stump and causes various changes in the intra- and extrapulmonary thoracic structures on plain radiographs. These changes may differ according to the resected lobe. We retrospectively evaluated the plain radiographic appearances of the postlobectomy chest, free of postoperative complications or recurrent/metastatic lung cancer. On the basis of our observations, the changes that occur in pulmonary and extrapulmonary anatomy can differ according to the resected lobe. Recognition of these changes will make it easier to identify which lobe has been removed surgically.

Comparison of consumer perception and liking of bulgogi marinade sauces between Korea and Japan using flash profiling.

This study compared the perception of and preference for seven bulgogi marinade sauces between Korean and Japanese consumers. Flash profiling (10 panelists each) and consumer test (97 Japanese and 102 Koreans) were conducted. Results showed that both Korean and Japanese panelists perceived the samples similarly but described using different terms. There were significant crosscultural differences in most liking and just-about-right attributes, except texture liking and sweetness. Both consumer panelists preferred sweeter samples, but Japanese consumers rated liking for less sweet samples higher than Korean consumers. Japanese consumers considered strong saltiness, umami, and soy sauce flavor as "just-about-right," whereas Korean consumers considered the same levels as "much too strong". Familiarity showed a significantly positive correlation with both Korean and Japanese consumers' liking, but authenticity was only significantly correlated with Korean consumers' liking. This indicates that perception of authenticity might not have a strong impact on Japanese consumers' liking.

Depth of Pleural Effusion in Thoracentesis: Comparison of Lateral, Posterolateral and Posterior Approaches in the Supine Position.

BACKGROUND: In patients who have difficulty sitting, thoracentesis is attempted in a supine position via lateral approach. Recently, a new table has been designed for supine thoracentesis. This table has gaps that allow access to the posterolateral and posterior hemithorax. OBJECTIVES: To compare important safety-related parameters between lateral, posterolateral, and posterior approaches in supine thoracentesis. MATERIALS AND METHODS: First, two cadavers were placed supine on a table featuring gaps allowing access to the posterolateral and posterior hemithorax. Water was administered with sonographic measurement of the depth of pleural effusion (DPE) at the mid-axillary and posterior axillary line. Second, CT images were analyzed in 25 consecutive patients (32 free-shifting, moderate-to-large effusions; mean, 668 (146 - 2020 mL). DPE, craniocaudal distance that effusion can be visualized (CCD), and presence of passive atelectasis at each of the lateral, posterolateral, and posterior routes was assessed. RESULTS: In each cadaver, DPE in the posterolateral route was greater than that in the lateral route (P = 0.002, P < 0.001). The amount of pleural fluid enough to spread DPE to higher than 1 cm at the posterior axillary line was less than half the amount at the mid-axillary line (500 mL vs. 1,100 mL; 800 mL vs. 1700 mL). CT showed that the DPEs and CCDs of posterolateral and posterior routes were greater than those of the lateral route (P < 0.001). In thirteen effusions (40.6%), DPE was greater than 1 cm in both posterolateral and posterior routes but less than 1 cm in the lateral route. Frequencies of passive atelectasis in posterolateral and posterior routes (81.3% and 90.6%) were higher (P < 0.001) than that in the lateral route (28.1%). CONCLUSION: Safety-related parameters of posterolateral and posterior approaches in supine thoracentesis are far better than that of the conventional lateral approach.

Pitfalls in Radiographic Interpretation of Emphysema Patients.

Emphysema commonly accompanies various complications such as pneumonia. Sometimes, these comorbidities look so strange on images, because destroyed airspaces could change the usual disease progression. So, we demonstrated various cases of common comorbidities with unusual radiographic findings in emphysema patients. Awareness of various findings of emphysema with commonly coexistent diseases may aid in the proper diagnosis and management of emphysema patients.

The relation between CT findings and sputum microbiology studies in active pulmonary tuberculosis.

PURPOSE: To evaluate whether CT findings suggesting active pulmonary tuberculosis correlate with sputum microbiological studies, and to determine whether CT could predict infectivity. MATERIALS AND METHODS: Total 108 patients with active pulmonary tuberculosis were enrolled. We reviewed CT findings and sputum microbiological studies. Then, we analyzed the statistical difference in CT findings between the positive and negative groups of each sputum microbiological study (AFB smear, PCR, and culture). Also, we divided the patients into five groups according to sputum AFB smear grade and analyzed linear trends of CT findings between the five groups. RESULTS: Both frequencies and extents of centrilobular micronodules (63% vs 38%, p=0.011 for frequency; 1.6 ± 1.6 vs 0.6 ± 1.1, p=0.001 for extent), tree-in-bud opacities (63% vs 33%, p=0.002; 1.6 ± 1.6 vs 0.5 ± 0.9, p<0.001, respectively), consolidation (98% vs 81%, p=0.003; 2.7 ± 1.5 vs 1.3 ± 1.1, p<0.001, respectively), and cavitation (86% vs 33%, p<0.001; 1.5 ± 1.2 vs 0.4 ± 0.7, p<0.001, respectively), were significantly increased in the sputum AFB-positive group than in the negative group. These four CT findings were increase in frequency and extent in the sputum PCR-positive group with or without statistical significance. They did not show significant differences between the sputum culture-positive and negative groups. As the AFB smear grade increased, frequencies and extents of centrilobular micronodules, tree-in-bud, consolidation, and cavitation also increased. CONCLUSION: CT features representing active tuberculosis-centrilobular nodules, tree-in-bud, consolidation, and, cavitation-strongly correlate with the positivity and grading of AFB smear.

Evaluation of Lip Cant Change by 2-Jaw Surgery in Class III Asymmetry Cases Using Three-Dimensional Facial Scan in Conjunction With Computed Tomographic Images.

The aim of our study was to evaluate the effect of cant correction in the anterior (AMXTOP) and posterior maxillary transverse occlusal planes (PMXTOP) on the change in lip cant (LC) using three-dimensional facial scan (FS) in conjunction with computed tomographic (CT) images. Thirty-five class III asymmetry patients treated with 2-jaw surgery were selected. Three-dimensional CT and three-dimensional FS images were taken before (T1) and after orthognathic surgery (T2). After obtaining the same head orientation between 2 images, bracket slot midpoints of the maxillary right and left canines as well as the first molars, point A, point B, and menton on three-dimensional CT images and the right and left lip commissures on three-dimensional FS images were located. Linear and angular variables of AMXTOP, PMXTOP, and LC were measured and statistically analyzed. At the T1 stage, linear and angular LC showed significant correlations with linear and angular cant of AMXTOP and PMXTOP, as well as menton deviation (all P < 0.001). During T1 to T2, significant linear and angular cant corrections were observed: ΔAMXTOP (1.3 mm, 1.9 degrees), ΔPMXTOP (1.9 mm, 1.7 degrees), and ΔLC (1.5 mm, 1.8 degrees) (all P < 0.001). Although angular change ratios of ΔLC/ΔAMXTOP and ΔLC/ΔPMXTOP did not exhibit a significant difference (1.0 vs 0.7), linear change ratio of ΔLC/ΔAMXTOP was higher than that of ΔLC/ΔPMXTOP (3.0 vs 0.5, P < 0.05). The vertical change in commissures was related to that in the maxillary right and left canines or maxillary right and left first molars and the extent of mandibular setback (all P < 0.01). To conclude, the use of three-dimensional FS images in conjunction with three-dimensional CT can provide more accurate information for changes in AMXTOP, PMXTOP, and LC.

Clinicoradiologic evidence of pulmonary lymphatic spread in adult patients with tuberculosis.

OBJECTIVE: The purpose of this study is to evaluate the prevalence and clinicoradiologic characteristics of pulmonary tuberculosis with lymphatic involvement. MATERIALS AND METHODS: A total of 126 adults with active tuberculosis who underwent CT were enrolled. A retrospective investigation of CT images focused on the presence of perilymphatic micronodules, as well as other CT features of active tuberculosis. We selected two groups of patients with micronodules according to distribution (perilymphatic vs centrilobular). We compared clinical and CT findings between the two groups. RESULTS: Fifteen patients were excluded because of coexisting pulmonary disease. Among 111 patients, the prevalence of perilymphatic micronodules, galaxy or cluster signs, and interlobular septal thickening was 64 (58%), 18 (16%), and 30 (27%), respectively. Of 106 patients with micronodules, 37 and 40 were classified into the perilymphatic and centrilobular groups, respectively. Compared with the centrilobular group, the perilymphatic group had statistically significantly lower frequencies of positive acid-fast bacilli smears (32% vs 70%), consolidation (70% vs 98%), and cavitation (30% vs 60%). However, frequencies of interlobular septal thickening (41% vs 18%), galaxy or cluster signs (30% vs 0%), and pleural effusion (43% vs 20%) were statistically significantly higher in the perilymphatic group. CONCLUSION: CT findings representing pulmonary perilymphatic involvement are relatively common in adults with tuberculosis. These findings may represent lymphatic spread of tuberculosis and provide an explanation for the unusual CT features of pulmonary tuberculosis mimicking sarcoidosis and the low detection of Mycobacterium tuberculosis in patients with micronodules.

Main pulmonary artery dilatation in patients with anthracofibrosis.

This study assessed main pulmonary artery diameter of patients with anthracofibrosis. Patients with anthracofibrosis and CT scans were evaluated after exclusion of patients with co-existing disease. We measured the diameter of the main pulmonary artery (PAD) and ascending aorta (AD) and calculated the pulmonary artery to aorta ratio (APR). The upper reference limit for comparison of PAD was 29 mm. Cut-off values for PAD and APR indicating pulmonary hypertension were 33 mm and 1. We correlated the CT parameters with echocardiographic results. Total 51 patients were included in the analysis. The mean PAD, AD, and APR were 33 mm, 38 mm, and 0.87 respectively. The PAD was larger than the upper reference limit, 29 mm (P<0.001). The PAD was >33 mm in 30 (65%) and the APR was >1 in 9 patients (18%). Of 21 patients with echocardiography, 11 (52%) were found to have pulmonary hypertension. There was no statistical difference in the diagnosis of pulmonary hypertension between echocardiography and CT (P=1.000). In conclusion, main pulmonary artery is dilated in patients with anthracofibrosis more than in the healthy population.

Pulmonary changes of pleural TB: up-to-date CT imaging.

BACKGROUND: The objective of this study was to evaluate pulmonary abnormalities of pleural TB by CT scanning and to determine CT scan findings for the development of the paradoxical response (PR). METHODS: CT scans were performed for 349 patients with pleural TB (between 2008 and 2013). We excluded 34 patients with coexisting pulmonary disease (n 5 13) or a totally collapsed lung (n 5 21). We analyzed CT scans focusing on pulmonary abnormalities such as the presence of consolidation, cavitation, interlobular septal thickening, and micronodules and their distribution. In addition, we recorded the development of PR during follow-up and statistically analyzed differences in clinical and CT scan findings between patients with and without PR. RESULTS: A total of 270 of 315 patients (86%) had pulmonary abnormalities. Common CT scan findings were micronodules (n 5 209 [77%]), interlobular septal thickening (n 5 202 [75%]),and consolidation (n 5 120 [44%]). Cavitation was seen in 49 patients (18%). Among 209 with micronodules, the nodules were in the subpleural region (n 5 146 [70%]), peribronchovascular interstitium (n 5 113 [54%]), and centrilobular region (n 5 64 [31%]). PR occurred in 81 patients(26%), and patients with PR tended to be young, male, and without underlying disease ( P , .05 by t test, Pearson x 2 test). Subpleural micronodules were more common in patients with PR than in those without PR (Pearson x 2 , P 5 .025). CONCLUSIONS: Pulmonary abnormalities are very common in pleural TB. Th e most common CT scan findings were micronodules in the subpleural and peribronchovascular interstitium and interlobular septal thickening, suggesting the lymphatic spread of TB. In addition, PR is not rare in patients with pleural TB, especially in young, previously healthy, male patients who show subpleural nodules on initial CT scans.

Image quality and radiation exposure of coronary CT angiography in patients after coronary artery bypass graft surgery: influence of imaging direction with 64-slice dual-source CT.

BACKGROUND: The evaluation of native coronary arteries (NCAs) as well as coronary artery bypass graft (CABG) patency after surgery is essential. However, NCAs are often blurred in the craniocaudal scan direction because of long scan time with 64-slice CT. OBJECTIVE: The purpose of the study was to determine the effect of scan direction on image quality and radiation exposure in assessment of NCAs and CABGs. METHODS: Retrospective analysis of 191 consecutive individuals undergoing coronary CT angiography to evaluate CABG patency using 64-slice dual source CT. A retrospectively ECG gated spiral acquisition protocol with ECG based tube current modulation and automatic adjustment of tube current to a reference of 320 mAs ("CareDose 4D") was used. Tube current was 120 kVp. Scan direction was either cranio-caudal (CRC, n = 98) or caudo-cranial (CRC, n = 93) and the scan volume covered the entire course of all bypass grafts. Independent investigators determined quantitative image quality of the coronary arteries by evaluating contrast-to-noise ratio (CNR), radiation exposure by comparing the effective dose, and qualitative image quality through a 5 point rating scale. RESULTS: Quantitative image quality was not significantly different for the two groups except for the CNR of the right coronary artery which was significantly higher in patients with caudio-cranial scan direction (P = .0007). The qualitative image quality of the CaC group also was better for both NCAs and CABGs (P = .002 for NCAs and <.001 for CABGs), mostly because of the lower frequency of respiration artifacts on coronary arteries of the CaC group (P = .005). As an effect of automatic tube current adjustment, radiation dose was lower in patients with caudo-cranial scan direction (6.8 mSv vs. 9.6 mSv, p < 0.0001). CONCLUSION: In patients with coronary bypass grafts imaged by 64-slice dual source CT with spiral acquisition and automated tube current adjustment, a caudo-cranial scan direction results in improved image quality and reduced radiation exposure.

A patient with protrusion and multiple missing teeth treated with autotransplantation and space closure.

OBJECTIVE: To present a patient treated with submerging autotransplantation (SA) of an immature premolar and subsequent orthodontic space closure (OSC) and to report a 10-year follow-up result. CASE AND METHOD: A 10-year-old boy had multiple missing premolars with an asymmetric pattern (maxillary right first and second premolars, teeth 14 and 15; maxillary left second premolar, tooth 25; and mandibular right second premolar, tooth 45). After considering several treatment options, tooth 35 with immature root development underwent SA into the missing site of tooth 15 at a depth 5 mm below the occlusal plane and was stabilized with sutures to create a symmetric missing condition of the premolars in the four quadrants. RESULTS: Three months after autotransplantation, spontaneous eruption of the transplanted tooth was observed. Nine months after autotransplantation, presence of the lamina dura of the transplanted tooth was confirmed with a periapical radiograph. Active orthodontic treatment was initiated to reduce lip protrusion by closing the missing spaces of teeth 14, 25, 35, and 45 and to correct dental midline deviation. After 33 months of active orthodontic treatment, Class I canine and molar relationships were obtained. During the 10-year follow-up, the pulp vitality of the transplanted tooth was maintained without any pathologic findings, including root resorption or pulp canal obliteration. CONCLUSIONS: In a patient with lip protrusion and multiple congenitally missing premolars with an asymmetric pattern, SA of one premolar from the normal quadrant into the quadrant missing two premolars with subsequent OSC of the missing sites of the other premolars can be an effective treatment modality.

Novel supine thoracentesis bed enabling thoracentesis via the posterior axillary line.

PURPOSE: This study describes on supine thoracentesis bed (STB), which helps thoracentesis of supine patient by enabling unlimited access to the posterolateral surface of a hemithorax. MATERIALS AND METHODS: Records of 15 patients who had received US-guided supine thoracentesis on STB were reviewed. We investigated the lateral or posterolateral approaches selected by the operators. We reviewed pre-procedural CT scans (obtained within 1 day) to examine if the approach of the operators could be justified in terms of depth of effusion and overlying chest wall thickness. RESULTS: The most common rationale for the use of the supine position was back or leg pain in 6 patients and hemi-or quadriplegia in 4. The operators chose the posterolateral approach in all 15 patients. On 6 concurrent CT scans, the mean depth of effusion was significantly (p < 0.004) greater in the posterolateral approach (3.0 ± 2.2 vs. 1.5 ± 1.9 cm). There was no significant difference in the thickness of the chest wall between the two approaches (1.6 ± 0.3 vs. 1.8 ± 1.0 cm, p = 0.61). CONCLUSIONS: By using STB, supine thoracentesis can be done via the posterolateral approach, which was associated with greater depth of effusion in our study, and may be superior to the conventional lateral approach.

CT-guided core biopsy of malignant lung lesions: how many needle passes are needed?

AIM: The study aims to determine the number of needle pass in the CT-guided core needle biopsy (CNB) in making a diagnosis of pulmonary malignancy. MATERIALS AND METHODS: A total of 434 CNB records were retrospectively reviewed. The specimen obtained from each needle pass was put in a formalin container and then labelled for separate histopathological reporting. The patients were divided into five groups according to the total number of needle passes (n = 1, n = 2, n = 3, n = 4 and n ≥ 5). In each of the groups 2-4, it was analysed how many needle passes are required before a plateau in diagnostic yield is achieved. RESULTS: CNB produced 283 true-positive and 23 false-negative diagnosis of malignancy. Cumulative sensitivity significantly (P < 0.05) increased between the first and second as well as the second and the third (if done) needle passes, but not between the third and fourth ones. CONCLUSION: Three coaxial needle passes might be optimal in the diagnosis of lung malignancy.

Complications of pneumoconiosis: radiologic overview.

A wide spectrum of pulmonary complications occurs in patients with pneumoconiosis. Those complications include chronic obstructive pulmonary disease, hemoptysis, pneumothorax, pleural disease, tuberculosis, autoimmune disease, anthracofibrosis, chronic interstitial pneumonia, and malignancy. Generally, imaging workup starts with plain chest radiography. However, sometimes, plain radiography has limited role in the diagnosis of pulmonary complications of pneumoconiosis because of overlapping pneumoconiotic infiltration. Computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI) are potentially helpful for the detection of pulmonary complications in patients with pneumoconiosis. CT, with its excellent contrast resolution, is more sensitive and specific method than plain radiograph in the evaluation of pulmonary abnormalities. CT is useful in detecting lung parenchymal abnormalities caused by infection, anthracofibrosis, and chronic interstitial pneumonia. Also, CT is valuable in distinguishing localized pneumothorax from bullae and aiding the identification of multiloculated effusions. US can be used in detection of complicated pleural effusions and guidance of the thoracentesis procedure. MRI is useful for differentiating between progressive massive fibrosis and lung cancer. Radiologists need to be familiar with the radiologic and clinical manifestations of, as well as diagnostic approaches to, complications associated with pneumoconiosis. Knowledge of the various imaging features of pulmonary complications of pneumoconiosis can enhance early diagnosis and improve the chance to cure.

Segregation analysis of mandibular prognathism in Korean orthognathic surgery patients and their families.

OBJECTIVE: To investigate the existence of genetic influences on the incidence of mandibular prognathism (MP) in Korean Class III patients. MATERIALS AND METHODS: The probands consisted of 100 Class III patients with MP (51 men and 49 women; mean age, 22.1 ± 5.2 years; SNA, 81.2° ± 3.2°; SNB, 84.1° ± 3.9°) who underwent orthognathic surgery. Using three-generation pedigree charts, questionnaires, and clinical examinations, general information and information regarding MP for a total of 3777 relatives of the probands (1911 men and 1866 women) was ascertained. Familial correlations of MP between possible pairs in the pedigree were estimated. Heritability (h(2)) of MP under various models was estimated. Segregation analysis was conducted under the assumption of the nonpolygenic multivariate logistic model and finite polygenic mixed model. One-, two-, and three-susceptibility-type models were evaluated. RESULTS: Among 3777 relatives, 199 (97 men and 102 women) were affected with MP (5.3%). Correlation coefficients of MP incidence in full siblings and in parent-offspring were .2003 and .2036, respectively (all P < .001). The h(2) of MP was estimated as 21.5% after adjusting for sex and founder effects. Two- and three-susceptibility-type models showed that the general model fit better than the other models. MP incidence did not have a major gene transmission model and was influenced by numerous minor effect genes and their additive effects. CONCLUSION: These results suggest that the inherited susceptibility to MP in Korean Class III patients might be due to the summation of minor effects from a variety of different genes and/or influence of environmental factors, rather than Mendelian transmission of major genes.