[The manifestations and clinical significance of chest CT in paragonimiasis at different clinical phases].

OBJECTIVE: To investigate the chest CT manifestations of paragonimiasis at different clinical phases. METHODS: Forty-eight cases of paragonimiasis confirmed by laboratory studies were retrospectively analyzed. There were 30 males and e18 females ageing 9 - 66 years (average, 31.4 years). Conventional chest CT was performed in all cases and contrast enhanced CT in some cases. RESULTS: The chest CT findings of paragonimiasis included: (1) peribronchial inflammation (n = 9); (2) infiltration (n = 13), manifested as unilateral or bilateral patchy infiltrates with hazy borders. The location and shape were variable. The typical "canal gas-path" sign was seen in a few patients; (3) nodular and masses (n = 11); (4) cysts and cavity (n = 6); (5) pleural effusion (n = 9). The CT appearances of paragonimiasis were different at different clinical phases. Peribronchial inflammation, infiltration and pleural effusion were early presentations, not distinguishable from other common infections. The appearance of nodules, masses, cysts and cavities was more common in the clinical course. At the stabilization phase, nodular cavity or pleura thickening and calcification were revealed. CONCLUSION: There are various abnormalities on chest CT at different phases of paragonimiasis. Combination of clinical manifestations with chest CT characteristics is important in the diagnosis of paragonimiasis.

[Pulmonary sarcoidosis: CT features and the changes after glucocorticoid therapy].

OBJECTIVE: To investigate the CT features of pulmonary sarcoidosis and to follow the changes after glucocorticoid therapy. METHODS: CT scans and clinical data of 90 patients with histologically confirmed pulmonary sarcoidosis were retrospectively reviewed. CT follow-up was carried out 5-30 d following therapy in 43 cases. The follow-up lasted 3-48 months. RESULTS: The main CT finding of pulmonary sarcoidosis was nodules which were present in 69 cases (77%), mostly distributed around bronchovascular bundles (n = 37, 41%). Other abnormalities included consolidation (n = 31, 34%), ground-grass ( n = 39, 43%), thickening of bronchovascular bundles (n = 30, 33%) interlobular septal lines (n = 58, 64%), fibrosis (n = 17, 19%), air-trapping (n = 3, 3%) bronchial narrowing (n = 8, 9%), pleural thickening (n = 42, 47%), hilar and mediastinal adenopathy (n =76, 84%). Two or more radiological patterns were present in 83 cases. Twenty-five cases of nodules (25/30), 9 cases of consolidation (9/15), 11 cases of ground-grass (11/16), 10 cases of thickening of bronchovascular bundles (10/12) were improved after therapy. Ten cases of interlobular septa (10/22), 1 case of diffuse linear changes (1/3), but no bronchial distortion (0/4) and honeycombing (0/2), were improved. CONCLUSIONS: The CT manifestations of pulmonary sarcoidosis are varied, with some specific radiographic features. The radiological diagnosis and the effect of glucocorticoid therapy can be evaluated by repeated CT scanning. Nodules, consolidation, ground-grass, and thickening of bronchovascular bundles can be improved markedly after glucocorticoid therapy, but bronchial distortion, linear changes and honeycombing can not.

[Cryptogenic organizing pneumonia: CT features and the effect of glucocorticoids].

OBJECTIVE: To study the CT manifestations of cryptogenic organizing pneumonia (COP) after glucocorticoid treatment. METHODS: The diagnosis of COP was made based on clinical and radiological features and confirmed by lung biopsy and pathological examination in 21 cases from 2001 to 2005. CT follow-up was carried out 5 - 75 days following therapy. The follow-up lasted 3 - 43 months. All data were analyzed and relevant literatures were reviewed. RESULTS: There were 2 male an 19 female patients with ages of 39 - 74 years. CT scans revealed multiple patchy shadows or patchy air-space consolidations, often by a predominantly subpleural and/or basal distribution. Ground-glass opacities and bronchiectasis were common findings. Migratory lesions were found in some patients. Glucocorticoid treatment resulted in significant improvement in most cases. Cure was achieved in 4 cases, significant improvement in 16, and failure in 1 case. Recurrence was found in 2 cases. CONCLUSIONS: The diagnosis of COP requires combination of clinical, CT and pathological manifestations. The effect of glucocorticoid therapy can be evaluated by repeated CT scanning.

[The clinical value and characteristics of subclavian artery angiography for hemoptysis due to pulmonary tuberculosis].

OBJECTIVE: To study the signs of subclavian artery angiography for hemoptysis due to pulmonary tuberculosis and to evaluate its clinical use in artery embolization. METHODS: Thirty-nine patients with hemoptysis due to pulmonary tuberculosis underwent subclavian artery angiography after artery embolization performed in the hemorrhagic branches of descending aorta. Of the 39 cases, 25 had severe pulmonary fibrosis or were complicated with cavity formation, aspergilloma, pleural thickening and postoperative thorax. The signs of subclavian artery angiography were divided into three categories: (-), normal; (+), the branches of subclavian artery and axillary artery chaotic and hyperplasia; (+ +), the branches of subclavian artery and axillary artery appeared tortuosity, dilatation, aneurysm and shunt with pulmonary circulation. Signs of bleeding was designated (+) and (+ +), with (+ +) indicating strongly positive. The signs of subclavian artery angiography were studied and statistically analyzed. Artery embolization was performed in some of the patients, among whom 15 were analyzed for long-term clinical curative effect. RESULTS: Signs of positive bleeding was found in 32/39 of the cases, and strongly positive bleeding in 17/39 of the cases. Positive bleeding arteries accounted for 39/58 of the branches, including 24/58 (+ +) and 15/58 (+). Angiography demonstrated that the internal mammary artery, lateral thoracic artery and subscapular artery were the main hemorrhagic arteries. Patients with severe pulmonary fibrosis or complicated with cavity, aspergilloma, pleural thickening and postoperative thorax showed higher rate of positive and strongly positive bleeding. Artery embolization was performed in 15 cases: cure was achieved in 6, effective in 7 and failure in 2 cases. Of the 15 cases, 8 had been ineffective after embolization of the hemorrhagic branches of descending aorta alone. CONCLUSIONS: Our results suggest that corresponding subclavian artery angiography should be performed after the hemorrhagic branches of descending aorta artery have been embolized for hemoptysis due to pulmonary tuberculosis, especially in cases with failed embolization, or complicated with severe pulmonary fibrosis, cavity formation, aspergilloma, pleural thickening, or postoperative thorax. The hemorrhagic arteries shown by subclavian artery angiography must be embolized.

[Primary pulmonary schwannoma: clinical analysis of 7 cases and review of the literature].

OBJECTIVE: To analyze the clinical and radiological manifestations of primary pulmonary schwannoma in order to improve the diagnosis of this rare disease. METHODS: Seven cases of primary pulmonary schwannoma which was confirmed by pathology of surgical specimens were retrospectively analyzed. RESULTS: Three cases were benign (1 of pulmonary parenchymal origin and 2 of bronchial origin) and 4 were malignant (3 of pulmonary parenchymal origin and 1 of bronchial origin). There were four male and three female patients, age ranging from 31 to 74 years. All the 7 cases had chest X-ray films and 6 cases had chest CT examinations. The major complains included slight hemoptysis, cough, fever, chest pain and shortness of breath. Bronchoscopy showed bronchial tumors in 3 cases and partial stenosis of bronchus in 2 cases. Radiology showed nodules in the left main bronchus in 2 cases. Solitary mass was found in 4 cases and multiple masses (2 lesions) were found in one patient. The margin of the lesions was smooth in 3 cases (one malignant and two benign) and irregular in another three cases (all malignant). Chest CT showed reticular enhancement in one case (benign), heterogeneous enhancement in 4 cases (3 malignant and 1 benign), and peripheral enhancement with a large central hypodense area in one case (malignant). Compression of the trachea and ribs was prominent in 2 patients. Pleural effusion and blood vessel infiltration were evident in 3 patients with malignant schwannoma. CONCLUSION: Primary pulmonary schwannoma is rare. The symptoms and CT manifestations are nonspecific. The size and the density of the tumor are not helpful in differentiating malignant schwannoma from the benign one. Marginal irregularity and invasion of adjacent structures are suggestive of malignancy.