Correlation between clinical features, high-resolution computed tomography findings, and a visual scoring system in patients with pneumonia due to Mycoplasma pneumoniae.

BACKGROUND: Mycoplasma pneumoniae (MP) is the primary cause of community-acquired pneumonia. We aimed to evaluate the correlation between clinical features, with special reference to hypoxemia and the total affected area obtained using high-resolution computed tomography (HRCT). METHODS: Medical records of MP pneumonia patients > 15 years of age at Kyorin University Hospital between January 2006 and November 2013 were reviewed retrospectively and compared to patients with Streptococcus pneumoniae pneumonia, diagnosed between January 2013 and September 2014. RESULTS: We identified 65 and 32 patients with MP- and S. pneumoniae pneumonia, respectively. HRCT data were available for 42 and 32 patients with MP- and S. pneumoniae pneumonia, respectively. Data were available for all hypoxemic patients. Hypoxemia was significantly higher in patients with S. pneumoniae (14/32, p = 0.008) than those with MP (5/39). Total visual score on HRCT correlated significantly with hypoxemia in both groups, but showed significantly higher scores with MP- than with S pneumoniae pneumonia in hypoxemic patients. MP pneumonia showed significant positive correlation between the total visual score and serum inflammatory markers (C-reaction protein [r = 0.43, p = 0.025] and lactate dehydrogenase [r = 0.466, p = 0.016]). In both groups, individual scores in the middle and lower lung fields were significantly higher than in the upper field, suggesting zonal predominance. CONCLUSIONS: This study provides the first evidence that the total affected area on lung HRCT was more with MP compared to S. pneumoniae pneumonia in hypoxemic patients and positively correlated with hypoxemia and serum inflammatory markers.

The Correlation between Chest X-ray Scores and the Clinical Findings in Children and Adults with Mycoplasma pneumoniae Pneumonia.

Objective To compare the radiological and laboratory data of children and adults with Mycoplasma pneumoniae pneumonia (MPP) and to evaluate the correlation between the total affected lung area and the clinical findings. Methods We retrospectively examined the data from MPP patients who visited our hospital during the period from April 2006 to July 2014. All data were retrieved at the time of the diagnosis of MPP and were analyzed to investigate the correlation between the clinical findings and the total affected lung area using a chest X-ray scoring system. Results We identified 71 children and 54 adults with MPP. The incidence of consolidation, which was the most common chest X-ray finding in both groups, was similar (children: n = 62, 87.3%; adults: n = 45, 83.3%). In contrast, air bronchogram, bronchial thickening, and atelectasis were observed significantly more frequently among children than among adults. In both groups, a chest X-ray scoring system revealed a zonal predominance of the affected area (middle-to-lower lung fields). The body temperature and serum data such as the C-reactive protein level, white blood cell count, and lactate dehydrogenase level were significantly higher in the child group than in the adult group. The total score did not significantly correlate with the above-mentioned inflammatory markers or the presence of hypoxemia in either group. Conclusion This study showed the first evidence of a correlation between the extent of lung abnormalities on chest X-ray (calculated as a total score) and the clinical findings, including the presence of hypoxemia, in children and adults with MPP.

Clinical significance of the "galaxy sign" in patients with pulmonary sarcoidosis in a Japanese single-center cohort.

BACKGROUND: The galaxy sign is an irregularly marginated pulmonary nodule formed by a confluence of multiple small nodules, and it is a diagnostic radiological finding for pulmonary sarcoidosis. However, the clinical significance of the galaxy sign for sarcoidosis has been poorly investigated. OBJECTIVE: This study aimed to investigate the clinical significance and detailed radiological features of the galaxy sign in patients with pulmonary sarcoidosis. METHODS: We retrospectively reviewed 87 patients with biopsy-proven sarcoidosis and 108 patients with pulmonary tuberculosis. Galaxy sign incidence was assessed on thoracic high-resolution computed tomography (HRCT) images from each group. Correlations of galaxy sign with clinical characteristics and disease outcomes were evaluated for patients with sarcoidosis. RESULTS: HRCT findings were available for 65 of 87 patients with pulmonary sarcoidosis and all 108 patients with pulmonary tuberculosis. Galaxy sign incidence was significantly higher in patients with pulmonary sarcoidosis (n=15, 23.1%) than in those with pulmonary tuberculosis (n=2, 1.9%, p<0.001). Among the 65 patients with pulmonary sarcoidosis, those with galaxy signs (n=15) were significantly younger (median: 32 years, interquartile range [IQR] 28-38 years) than those without (n=50) (median: 62 years, IQR 37.7-73 years). The CD4/CD8 ratio in bronchoalveolar lavage fluid (BALF) was also significantly lower in the former group (median: 2.6, IQR 2.0-3.9 vs. median 5.8, IQR 3.7-8.6, p<0.001). CONCLUSION: Galaxy signs are associated with younger age and low BALF CD4/CD8 ratio but not disease severity.

Tracheobronchial Amyloidosis in a Patient with Sjögren's Syndrome.

A 65-year-old woman was referred to our respiratory department because of incidentally detected endobronchial deposits. She had been diagnosed with Sjögren's syndrome 12 years earlier. Bronchoscopy showed protrusion of the reddened, shiny or edematous mucosa at the orifice of the lower lobe bronchus, suggesting a submucosal tumor. Based on the pathological findings of the transbronchial biopsied specimens, the patient was diagnosed with non-classified type tracheobronchial amyloidosis associated with Sjögren's syndrome, which was negative for both λ and κ chains, transthyretin and amyloid A. She has remained in good health without a relapse of the tumor.

A Simple Method for Differentiating Complicated Parapneumonic Effusion/Empyema from Parapneumonic Effusion Using the Split Pleura Sign and the Amount of Pleural Effusion on Thoracic CT.

BACKGROUND: Pleural separation, the "split pleura" sign, has been reported in patients with empyema. However, the diagnostic yield of the split pleura sign for complicated parapneumonic effusion (CPPE)/empyema and its utility for differentiating CPPE/empyema from parapneumonic effusion (PPE) remains unclear. This differentiation is important because CPPE/empyema patients need thoracic drainage. In this regard, the aim of this study was to develop a simple method to distinguish CPPE/empyema from PPE using computed tomography (CT) focusing on the split pleura sign, fluid attenuation values (HU: Hounsfield units), and amount of fluid collection measured on thoracic CT prior to diagnostic thoracentesis. METHODS: A total of 83 consecutive patients who underwent chest CT and were diagnosed with CPPE (n=18)/empyema (n=18) or PPE (n=47) based on the diagnostic thoracentesis were retrospectively analyzed. RESULTS: On univariate analysis, the split pleura sign (odds ratio (OR), 12.1; p<0.001), total amount of pleural effusion (≥30 mm) (OR, 6.13; p<0.001), HU value≥10 (OR, 5.94; p=0.001), and the presence of septum (OR, 6.43; p=0.018), atelectasis (OR, 6.83; p=0.002), or air (OR, 9.90; p=0.002) in pleural fluid were significantly higher in the CPPE/empyema group than in the PPE group. On multivariate analysis, only the split pleura sign (hazard ratio (HR), 6.70; 95% confidence interval (CI), 1.91-23.5; p=0.003) and total amount of pleural effusion (≥30 mm) on thoracic CT (HR, 7.48; 95%CI, 1.76-31.8; p=0.006) were risk factors for empyema. Sensitivity, specificity, positive predictive value, and negative predictive value of the presence of both split pleura sign and total amount of pleural effusion (≥30 mm) on thoracic CT for CPPE/empyema were 79.4%, 80.9%, 75%, and 84.4%, respectively, with an area under the curve of 0.801 on receiver operating characteristic curve analysis. CONCLUSION: This study showed a high diagnostic yield of the split pleura sign and total amount of pleural fluid (≥30 mm) on thoracic CT that is useful and simple for discriminating between CPPE/empyema and PPE prior to diagnostic thoracentesis.

Evidence of unilateral metastatic pulmonary calcification with a prolonged Fever and arthralgia caused by acute lymphoblastic leukemia in a chronic dialysis patient.

A 55-year-old man was transferred to our hospital with unilateral lung lesions, a persistent fever and vague chest pain with arthralgia lasting for three months. He had been treated for end-stage renal disease with hemodialysis for 15 years and had a medical history of recurrent subcutaneous calciphylaxis due to secondary hyperparathyroidism. Transbronchial biopsied specimens demonstrated metastatic pulmonary calcification, and a bone marrow biopsy showed Philadelphia chromosome-positive acute lymphoblastic leukemia. Although metastatic calcification often lacks specific symptoms, the lungs is a primary site for deposition. This is the first report of unilateral metastatic pulmonary calcification associated with secondary hyperparathyroidism.