[Bronchiolo-alveolar carcinoma. The computed tomographic picture and histological correlations]. / Carcinoma bronchioloalveolare. Quadri con tomografia computerizzata e correlazioni istologiche.

Twenty-one CT examinations of 18 patients with a known bronchioloalveolar carcinoma in the lung were retrospectively reviewed to describe the CT features of bronchioloalveolar carcinomas. Surgical specimens were available in 13 cases in which CT-histologic correlation was also obtained. In 5 patients the diagnosis was made with cytology and confirmed with radiologic-clinical follow-up. Three patients were reexamined for relapses 6-20 months after the resection of a localized carcinoma. Carcinomas exhibited 3 radiologic patterns: a) solitary pulmonary nodule (11 cases), b) mass or pulmonary consolidation (3 cases) and c) multicentric or diffuse disease (7 cases). Solitary nodular bronchioloalveolar carcinomas were associated with irregular or spiculated margins in 9 of 11 patients. In some cases internal inhomogeneity due to bubble-like radiolucencies was demonstrated. At pathology, bubble-like radiolucencies correlated with air-containing cystic spaces lined by neoplastic epithelium or patent and dilated bronchi. Some nodules exhibited linear and serpentine internal radiolucencies. Pathology demonstrated them to be consistent with patent intratumoral bronchioles (air bronchiologram) and air-containing neoplastic glandular spaces, respectively. In two cases a perinodular ground-glass halo was demonstrated surrounding the nodule (CT halo sign), due to perinodular lepidic tumor growth. Massive or ground-glass opacity involving a pulmonary segment or a lobe was another CT pattern of bronchioloalveolar carcinoma. An air bronchogram was usually demonstrated within the lesion. In the mucinous type of bronchioloalveolar carcinoma, pulmonary consolidations had a low CT value because of the large amount of intratumoral mucus. The diffuse type of tumor presented as multiple pulmonary nodules or multiple pulmonary consolidations, or both. In two cases multiple nodules were associated with carcinomatous lymphangitis. In conclusion, bronchioloalveolar carcinoma should be considered in the differential diagnosis of solitary pulmonary nodules, multiple pulmonary nodules and chronic alveolar opacities. The diagnosis of a bronchioloalveolar carcinoma is of great value since surgery can help nearly 70% of the patients at this stage recover.

Carcinomatous solitary pulmonary nodules: evaluation of the tumor-bronchi relationship with thin-section CT.

To investigate the value of computed tomography (CT) for depicting the relationship between carcinomatous solitary pulmonary nodules and the bronchial tree and predicting the results of various bronchoscopic biopsy techniques, the authors retrospectively reviewed CT scans from 27 consecutive patients with solitary pulmonary nodules associated with a positive bronchus sign. All patients underwent bronchoscopy and transbronchial biopsy. Macroscopic demonstration of the tumor-bronchi relationship was obtained in 18 patients. Five basic types of tumor-bronchus relationships were identified with CT: (a) bronchus cut off by the tumor, (b) bronchus contained within the tumor, (c) bronchus compressed by the tumor, (d) thickening and smooth narrowing of the bronchus leading to the tumor, and (e) thickening and irregular narrowing of the bronchus leading to the tumor. The diagnostic yield of transbronchial forceps biopsy and bronchial brushing was significantly higher in nodules characterized by a cut-off or contained bronchus. Transbronchial needle aspiration was performed in six patients, and results were positive in five, all of whom had a compressed or thickened bronchus. These results confirm that yield of transbronchial biopsy is determined by the type of tumor-bronchus relationship and the biopsy technique performed.

[Contribution of computerized tomography to the diagnosis of patients with non-calcified solitary pulmonary nodule, without known neoplasm]. / Contributo della tomografia computerizzata alla diagnostica dei pazienti con nodulo solitario polmonare non calcifico, in assenza di neoplasia nota.

We define a solitary pulmonary noncalcified nodule (NPS) as a single focal rounded or ovoid lesion in the lung parenchyma, less than 4 cm in diameter, without associated adenopathy, atelectasis or pneumonia. An NPS, in the absence of a known primary malignancy, can be lung cancer (NPSM), a metastasis of unknown origin (NPSMT), or a benign lesion (NPSB). The best approach to the management of NPS and the value of CT are still controversial and uncertain. The finding on cross-section CT of a bronchus leading directly to, or contained within, the nodule is called "positive CT bronchus sign" (CT-BS). Our study was aimed at investigating the usefulness of CT bronchus sign, as studied on thin-slice (2 mm thick) CT sections, in order to establish the most appropriate diagnostic sequence in patients with solitary noncalcified pulmonary nodules (NPS). We evaluated 47 NPS (9 NPSB, 34 NPSM and 4 NPSMT) with thin-slice CT to detect the presence of CT bronchus sign. Seventeen cases had CT-BS (15 NPSM; 1 NPSB; 1 NPSMT); of them, 13 were diagnosed by means of transbronchial biopsy and brushing (TBB). Only one case (NPSM) of the 30 (19 NPSM; 3 NPSMT; 8 NPSB) without CT-BS, was diagnosed by TBB. TBB was negative in the 9 NPSB. The CT-BS is not pathognomonic of malignancy; in fact, the sign was observed in NPSB (one tuberculoma) too. Our results suggest that the CT bronchus sign is valuable in predicting the success of TBB in malignant solitary pulmonary nodules. On the other hand, it seems to be useless for NPSB. Therefore, to establish the most appropriate diagnostic sequence, thin-section CT should be performed in each patient with peripheral noncalcified lung lesions to plan whether TBB or transthoracic needle aspiration should come next. If biopsy results are poor, either surgery or the "wait and watch for growth" approaches can be suggested. The choice can be guided by the presence of predisposing factors for cancer or infection.

Bronchus sign on CT in peripheral carcinoma of the lung: value in predicting results of transbronchial biopsy.

The bronchus sign on CT represents the presence of a bronchus leading directly to a peripheral pulmonary lesion. We investigated the value of this sign in predicting the results of transbronchial biopsy and brushing in 33 consecutive cases of proved peripheral bronchogenic carcinoma studied with thin-slice CT (2-mm-thick sections). The bronchus sign was seen on CT in 22 patients and was absent in 11. Transbronchial biopsy and brushing showed peripheral carcinoma in 13 (59%) of 22 patients in whom the bronchus sign was seen on CT and in only two (18%) of 11 patients in whom it was not seen. The difference is statistically significant (Fisher's exact test, p = .029). When analyzed by the order of involved bronchus, a 90% success rate of transbronchial biopsy and brushing was found in patients in whom the bronchus sign was seen at a fourth-order bronchus (p = .01). This compared with a success of 33% when the bronchus sign was seen at fifth-, sixth-, or seventh-order branches. Our results suggest that the bronchus sign at a fourth-order bronchus is valuable in predicting the success of transbronchial biopsy and brushing. The presence of the sign on CT may be useful in determining if the workup should include transbronchial biopsy and brushing or transthoracic needle aspiration in patients with peripheral lung lesions.

[Extra-abdominal spread of pelvic neoplasms. CT evaluation and radiotherapeutic implications]. / Diffusione extra-addominale delle neoplasie pelviche. Valutazione TC ed implicazioni radioterapiche.

Meyers and other authors have described the extra-abdominal spread of inflammatory abdominal diseases. Conversely, little attention has been paid to the extra-abdominal spread of pelvic neoplasms. The authors have detected, by means of CT, 17 cases of extra-abdominal neoplastic spread in a series of 203 patients with pelvic neoplasms. Neoplastic spread involved the inguinal region in 1 case, the buttock in 6 cases, and the ischiorectal fossa and/or perineum in 12 cases, with more than one region involved in some patients. In such cases CT showed the extension of tumoral tissue beyond the muscular walls of the pelvis. Recurrent pelvic carcinomas are the most common neoplasms spreading outside the pelvis. Surgical obliteration of the pelvic fasciae can explain such a behavior. Differential diagnosis is to be made with inflammatory pelvic diseases with extrapelvic spread. When a pelvic tumor spreads outside the pelvis it can be seen as a primitive gluteal or inguinal or perineal mass. CT demonstration of such an insidious event is mandatory for both a correct diagnosis and radiation treatment planning.

Delayed enhancement of ascites following high-dose contrast CT for liver metastases.

Enhanced ascites has been described as a pathognomonic CT sign of urinary-peritoneal fistula. We have seen two cases of slowly enhancing ascites demonstrated with delayed contrast CT in the absence of urinary-peritoneal fistula. Knowledge of this phenomenon is important because hyperdense enhanced ascites can simulate urinary-peritoneal fistula or intraperitoneal hemorrhage.

[Importance of the flank line in the radiologic semiotics of abdominal pathology]. / Importanza della linea dei fianchi nella semeiotica radiologica della patologia addominale.

The authors have analysed the flank stripe in 70 normal subjects and in patients with abdominal disease. The flank stripe has a wide variability and is very useful to detect and locate abdominal pathologic conditions.