Multidetector CT of thoracic aortic aneurysms.

Thoracic aortic aneurysms (TAAs) can be broadly divided into true aneurysms and false aneurysms (pseudoaneurysms). True aneurysms contain all three layers of the aortic wall (intima, media, and adventitia), whereas false aneurysms have fewer than three layers and are contained by the adventitia or periadventitial tissues. Multidetector computed tomographic (CT) angiography allows the comprehensive evaluation of TAAs in terms of morphologic features and extent, presence of thrombus, relationship to adjacent structures and branches, and signs of impending or acute rupture, and is routinely used in this setting. Knowledge of the causes, significance, imaging appearances, and potential complications of both common and uncommon aortic aneurysms, as well as of the normal postoperative appearance of the thoracic aorta, is essential for prompt and accurate diagnosis. Supplemental material available at http://radiographics.rsnajnls.org/cgi/content/full/29/2/537/DC1.

Necrotizing granuloma of the lung: imaging characteristics and imaging-guided diagnosis.

OBJECTIVE: The purpose of this study was to assess CT findings and the sensitivities of imaging-guided fine-needle aspiration (FNA) biopsy and core needle biopsy in the diagnosis of necrotizing granuloma of the lung. CONCLUSIONS: The CT characteristics of necrotizing granuloma are indistinguishable from those of malignant tumors; tissue diagnosis therefore is necessary. Core needle biopsy is a sensitive method for diagnosing necrotizing granuloma of the lung, but FNA biopsy is insufficient for diagnosis.

Wandering pleuropericardial cyst.

Change in position of a chest mass is considered virtually pathognomonic of a solitary fibrous tumor of the pleura. Rarely, however, a pleuropericardial cyst may manifest as a mobile chest lesion. The computed tomography appearance and imaging characteristics of a "wandering" pleuropericardial cyst are discussed.

Ultrathin needle (25 G) aspiration lung biopsy: diagnostic accuracy and complication rates.

The aim of this study was to evaluate the diagnostic accuracy and complication rate of 25-G fine-needle aspiration biopsy (FNAB) of the lung in patients with suspected malignant focal lesions and abnormal lung function. The 25-G FNAB was performed in 123 patients who underwent prebiopsy CT and pulmonary function tests. Retrospective evaluation included pulmonary function, cytology, size of the lesion, depth of location, presence of emphysema on CT, needle passes, pneumothorax and drainage. The final diagnosis (gold standard) was based on histopathology after surgical resection or follow-up and response to treatment. Sixty-one patients had normal lung function or mild impairment (group 1) and 62 had moderate or severe impairment (group 2). Pneumothorax occurred in 26 of 126 procedures (20.6%) with drainage needed in 11 (8.7%). In group 2 pneumothorax occurred in 19 of 63 procedures (30.15%) with drainage needed in 11 (17.5%). The sensitivity, specificity and diagnostic accuracy of cytology results were 93.6, 100 and 94.4%, respectively. FEV1 ( p=0.014), FEV1/FVC ( p=0.005), FEF25-75 ( p=0.001), DLCO ( p=0.013) and presence of emphysema on CT ( p<0.001) correlated with pneumothorax (Student's t test). The 25-G lung FNAB is accurate and safe in diagnosing malignancy in patients with severe lung functional abnormality. Patients with moderate to severe airway obstruction have a higher prevalence of pneumothorax than patients with mild or no functional impairment.

Surgical staple metalloptysis after apical bullectomy: a reaction to bovine pericardium?

Palliation of symptomatic emphysema may include bullous resection to improve function of the remaining lung. Buttressing staple lines with bovine pericardium partially alleviates postoperative air leak, but can promote inflammation and infection. We report a patient expectorating staples and pericardium 5 years after bilateral apical bullectomy. Previous reporting of this complication in lung volume reduction operation also involved both pericardium and staples, and we propose that an ongoing local inflammatory reaction to these materials may facilitate delayed erosion into airways.