Imaging of unusual diffuse lung diseases

PURPOSE OF REVIEW: Computed tomography scans are commonly used in imaging lung diseases. As more information accumulates, patterns of rare or new diseases on CT scans are being increasingly reported. Several pulmonary diseases have distinguishing features, which are better delineated on high resolution CT scans than plain chest radiographs. The radiographic features of unusual diffuse lung diseases published in the past two years are described. RECENT FINDINGS: Severe acute respiratory syndrome generally manifests as focal or diffuse bilateral areas of consolidation on chest radiography and reticulation with ground-glass attenuation commonly seen on CT scans. A normal HRCT rules out the diagnosis of Pneumocystis carinii pneumonia while a normal chest radiograph does not. Immunocompromised patients without AIDS, who have CMV pneumonia, generally demonstrate a combination of ground-glass attenuation, air-space consolidation, and small nodules on HRCT. Nodules less than 10 mm in size in immunocompromised patients are highly suggestive of viral infections. Bronchial wall thickening on HRCT associated with cavitating nodules is suggestive of Wegner granulomatosis in the appropriate clinical setting. Small cysts may be seen in a minority of patients with subacute hypersensitivity pneumonitis and centrilobular emphysema in chronic farmer's lung. Reversed halo sign has a high specificity for cryptogenic organizing pneumonia. The triad of ground-glass opacities, ill-defined centrilobular nodules and cysts and focal areas of air trapping is highly suggestive of subacute hypersensitivity pneumonitis. SUMMARY: Familiarizing with radiographic and CT scan patterns may help the clinician to exclude certain diagnoses and narrow the differential diagnosis for others.     

Cocaine-induced pulmonary changes: HRCT findings

Objective:

To evaluate HRCT scans of the chest in 22 patients with cocaine-induced pulmonary disease.

Methods:

We included patients between 19 and 52 years of age. The HRCT scans were evaluated by two radiologists independently, discordant results being resolved by consensus. The inclusion criterion was an HRCT scan showing abnormalities that were temporally related to cocaine use, with no other apparent causal factors.

Results:

In 8 patients (36.4%), the clinical and tomographic findings were consistent with "crack lung", those cases being studied separately. The major HRCT findings in that subgroup of patients included ground-glass opacities, in 100% of the cases; consolidations, in 50%; and the halo sign, in 25%. In 12.5% of the cases, smooth septal thickening, paraseptal emphysema, centrilobular nodules, and the tree-in-bud pattern were identified. Among the remaining 14 patients (63.6%), barotrauma was identified in 3 cases, presenting as pneumomediastinum, pneumothorax, and hemopneumothorax, respectively. Talcosis, characterized as perihilar conglomerate masses, architectural distortion, and emphysema, was diagnosed in 3 patients. Other patterns were found less frequently: organizing pneumonia and bullous emphysema, in 2 patients each; and pulmonary infarction, septic embolism, eosinophilic pneumonia, and cardiogenic pulmonary edema, in 1 patient each.

Conclusions:

Pulmonary changes induced by cocaine use are varied and nonspecific. The diagnostic suspicion of cocaine-induced pulmonary disease depends, in most of the cases, on a careful drawing of correlations between clinical and radiological findings.     

Tree-in-bud sign as a manifestation of localized pulmonary lymphatic metastasis from a pancreas cancer

The tree-in-bud appearance usually reflects benign disorders of the bronchovascular bundle. Pulmonary metastasis reportedly also shows a tree-in-bud pattern in cases of dilated peripheral pulmonary artery filled with intravascular tumor emboli or fibrocellular intimal hyperplasia of the small pulmonary arteries induced by tumor microemboli, or endobronchial metastatic disease. On X-ray CT, pulmonary metastases may result in four main types of imaging manifestations: nodules, lymphatic spread, tumor emboli, and endobronchial tumor, and show diffuse interstitial thickening or multiple nodules in general. We report a rare case of localized pulmonary peribronchovascular lymphatic tumor spread without intravascular tumor emboli from a pancreas cancer, which mimicked the localized vascular tree-in-bud sign.     

Viral pneumonia after hematopoietic stem cell transplantation: high-resolution CT findings

Hematopoietic stem cell transplantation (HSCT) is the treatment of choice for many hematologic malignancies and nonmalignant disorders of bone marrow function. Pulmonary infections from bacterial, fungal, and viral organisms are a major cause of morbidity and mortality in patients after HSCT. The radiographic and high-resolution computed tomography (HRCT) findings of the different lower respiratory tract viral infections are quite similar. Findings of viral pneumonia on HRCT include small poorly defined centrilobular nodules and patchy, often bilateral, areas of peribronchial ground-glass opacity and consolidation. Air trapping may be present because of associated bronchiolitis. Interlobular septal thickening, bronchial wall thickening, and tree-in-bud opacities may also be present. Advanced viral pneumonia with diffuse alveolar damage is characterized by patchy or confluent consolidation and ground-glass opacities. Although nonspecific, in the correct clinical setting, these HRCT findings can help suggest the diagnosis of viral pneumonia in recipients of HSCT.     

老年人肺结核的CT表现

目的　分析老年人肺结核的CT表现,评价CT检查对肺结核诊断的价值。方法 1993年8月至2000年3月间160例老年 (65～89岁,平均72.5岁)肺结核患者做CT检查,其中112例行病灶高分辨扫描 (HRCT)、84例做增强扫描。并进行综合回顾分析。结果 CT表现为：(1)结核病灶分布在一叶以上占78.6%;上、下叶均受累占56.4%,上叶受累占20.5%,下叶受累占23.0%。 (2)病变以纤维化为主占89.4%;伴有空洞者占48.5%;伴有钙化占40.8%;胸膜增厚占18.4%;结核瘤占6.8%。 (3)增强扫描显示病灶呈明显不均匀强化者占90.5%。 (4)具有结核活动征象者占76.8%,HRCT表现为2～4mm小叶中心结节和分支状结构,或5～8mm模糊结节、小叶间隔增厚及邻近支气管壁增厚。 (5)肺结核合并肺癌占9.4% (15160)。结论 老年肺结核的CT表现以纤维化为主,累及下肺叶比例较高,增强CT病灶呈明显强化,合并肺癌的发生率较高。HRCT可作为判断结核有无活动性的方法。     

Pulmonary involvement in sarcoidosis: CT findings at diagnosis and their changes at follow-up in cases without corticosteroid treatment]

To review the pulmonary CT findings in sarcoidosis at diagnosis, and to analyze the change in each finding at follow-up in cases without corticosteroid treatment. The study included 21 cases of pulmonary involvement of sarcoidosis. We analyzed the presence or absence and grade of each HRCT finding: bronchial wall thickening, enlargement of vascular shadows, pleural involvement, septal thickening, small nodules, ground-glass opacities, centrilobular opacities, consolidation, nodules, and volume loss. Afterwards, we compared the initial CT with the follow-up CT, and described the change of each finding as "improved" or "not improved". Furthermore, we decided if each case as a whole was improved or not after considering all of the pulmonary CT findings. Twelve of the 21 cases were improved. Small nodules, ground-glass opacities, centrilobular opacities, and nodules had improved in more than 50% of the cases since the initial CT. However, pleural involvement (10/11) and volume loss (6/9) were not improved. Pleural involvement and volume loss correlated the radiological irreversibility (p < 0.05). Of the several pulmonary CT findings in sarcoidosis, pleural involvement and volume loss show the highest rates of irreversible pulmonary changes.     

High-resolution computed tomography findings are correlated with disease severity in asthma

BACKGROUND: The structural changes in the airways of asthmatics are also referred to as remodeling and can be identified using high-resolution computerized tomography (HRCT). OBJECTIVES: To find out whether there are any abnormal HRCT features which can be attributed to asthma and their clinical correlates, and any differences of abnormal HRCT features between asthmatics and patients with chronic obstructive pulmonary disease (COPD). METHODS: We performed (HRCT) scans to assess airway remodeling in 160 nonsmoker asthmatics compared with 27 patients with COPD. RESULTS: Bronchial wall thickening, hyperlucency, centrilobular prominence, bronchiectasis, thick linear opacities and mucoid impaction were all correlated with disease severity in asthma. FEV(1) values were inversely correlated with bronchial wall thickening, hyperlucency, mucoid impaction, linear shadows, centrilobular prominence and bronchiectasis. In addition, thick linear opacities, mucoid impaction and bronchiectasis were more prominent in those patients with a long duration of asthma. Bronchial wall thickening, thick linear opacities, mucoid impaction, bronchiectasis and emphysema were more prominent in COPD patients compared with asthmatics. There was no difference with regard to age, mean values of FEV(1) and the duration of asthma between allergic and nonallergic asthmatics as well as abnormal HRCT findings. CONCLUSIONS: COPD patients have more prominent HRCT findings as compared with asthmatics. In the asthmatics, abnormal HRCT findings are more prominent with increased severity, decreased FEV(1) values and the duration of asthma. The remodelling of airways in allergic asthmatics did not differ from that in their nonallergic counterparts as determined by HRCT.     

Lymphocytic interstitial pneumonia: follow-up CT findings in 14 patients

The aim of the present study was to assess the evolution of various computed tomographic (CT) findings of lymphocytic interstitial pneumonia (LIP) with determination of potentially reversible or irreversible features. The study included 14 patients with biopsy-proved LIP who had serial thin-section CT examination 4 to 82 months (median 13 months) apart. Initial and follow-up CT scans were evaluated independently and then directly compared with each other by two observers. The main parenchymal abnormalities on the initial CT scan consisted of ground-glass attenuation (n = 14), thickening of interlobular septa (n = 13), centrilobular nodules (n = 12), cystic airspaces (n = 10), and airspace consolidation (n = 4). On follow-up CT, nine patients improved, one showed no change, and four showed increased extent of disease. With the exception of cysts, the parenchymal opacities were reversible. On follow-up CT, new cysts were seen in three patients; these developed mainly in areas with centrilobular nodules on initial CT. Honeycombing was seen on follow-up CT in four patients; in three patients it developed in areas of airspace consolidation and in one patient it developed in an area with ground-glass attenuation on initial CT. The majority of patients with LIP improved on follow-up. However, airspace consolidation may progress to honeycombing and centrilobular nodules may precede cystic formation.     

Acute fibrinous and organizing pneumonia: initial presentation as a solitary nodule

A 55-year-old man complained of cough and dyspnea. His chest radiograph and CT scan revealed a solitary nodule with a diameter of 2 cm, which showed an air bronchogram and had a hazy contour. After 3 weeks, the radiologic findings changed to diffuse infiltration with small centrilobular nodules, alveolar consolidation, and bronchial wall thickening. The alveoli contained numerous fibrin balls and organizing tissue, which are typical pathologic features of acute fibrinous and organizing pneumonia (AFOP), on histologic examination. We report the initial radiologic features of AFOP and suggest that there are some radiologic similarities between this condition and cryptogenic organizing pneumonia.     

鸟-胞内分枝杆菌复合群肺病和脓肿分枝杆菌肺病的CT影像学比较

目的 探讨鸟胞内分枝杆菌复合群（MAC）肺病和脓肿分枝杆菌肺病的CT影像学特点.方法 回顾性分析2011年1月至2013年10月间在首都医科大学附属北京胸科医院住院并经临床及实验室证实的16例MAC肺病患者和15例脓肿分枝杆菌肺病患者的CT及高分辨率CT（HRCT）的表现.统计学分析采用SPSS13.0软件进行,计数资料采用x2检验,计量资料采用t检验.两组的CT表现、常见病变的分布特点进行四格表x2检验.由于患者总例数＜40例,用确切概率法计算统计结果,以P＜0.05为差异有统计学意义.结果 两组患者中肺实变影（28/31）、支气管扩张（28/31）、小叶中心性结节影及树芽征（28/31）的影像学表现多见.MAC肺病患者上叶发病优势（10/16）高于脓肿分枝杆菌肺病患者（2/15）（确切概率法,P＜0.01）.MAC肺病患者以空洞型为主（11/16）,而脓肿分枝杆菌肺病患者以结节支气管扩张型为主（11/15）（确切概率法,P＜0.05）.MAC肺病患者肺实变、空洞病变、小叶中心性结节影及树芽征累及肺区范围（分别为55/96,33/96,68/96）多于脓肿分枝杆菌肺病患者（分别为26/90,18/90,48/90）（确切概率法,P值分别为＜0.01、＜0.01、＜0.05）.MAC肺病患者于右肺中叶（11/16）及左肺舌叶（12/16）出现肺实变者多于脓肿分枝杆菌肺病（右肺中叶及左肺舌叶均为4/15）（确切概率法,P＜0.05）.结论 鸟-胞内分枝杆菌复合群（MAC）和脓肿分枝杆菌肺病的CT表现有一定相似性,但亦有各自一定的特点,为临床早期诊断及早期治疗可提供一定的帮助.     

Thoracic manifestation of Churg-Strauss syndrome: radiologic and clinical findings

STUDY OBJECTIVES: To describe the radiologic and clinical findings of Churg-Strauss syndrome (CSS) and its thoracic manifestations. DESIGN: We used retrospective analysis to review and characterize the radiographic, thin-section CT, and clinical findings of CSS. PATIENTS: The study involved nine patients with CSS. The patients included four men and five women, whose ages ranged from 18 to 60 years (median, 35 years). Thin-section CT scans and chest radiographs were retrospectively analyzed by three radiologists in consensus. Clinical data were obtained by chart review. Histologic samples were available in eight patients. RESULTS: All patients had a history of asthma averaging 28 months (range, 4 to 72 months) prior to the initial symptom of vasculitis and marked peripheral blood eosinophilia (mean peak count, 8,726/microL; range, 3,000 to 32,000/microL; mean differential count, 41%; range, 19 to 67%). All patients had systemic vasculitis involving the lung and two to four extrapulmonary organs, most commonly the nervous system (n = 8) and skin (n = 7). Chest radiographs showed bilateral nonsegmental consolidation (n = 5), reticulonodular opacities (n = 3), bronchial wall thickening (n = 3), and multiple nodules (n = 1). The most common thin-section CT findings included bilateral ground-glass opacity (n = 9); airspace consolidation (n = 5), predominantly subpleural and surrounded by the ground-glass opacity; centrilobular nodules mostly within the ground-glass opacity (n = 8); bronchial wall thickening (n = 7); and increased vessel caliber (n = 5). Other findings were hyperinflation (n = 4), larger nodules (n = 4), interlobular septal thickening (n = 2), hilar or mediastinal lymph node enlargement (n = 4), pleural effusion (n = 2), and pericardial effusion (n = 2). CONCLUSIONS: In CSS, thoracic organs are invariably involved with additional diverse manifestations. The possibility of CSS should be raised in patients with a history of asthma and hypereosinophilia who present with thin-section CT findings of bilateral subpleural consolidation with lobular distribution, centrilobular nodules (especially within the ground-glass opacity) or multiple nodules, especially in association with bronchial wall thickening.     

Irreversiblity of Remodeled Features on High-Resolution Computerized Tomography Scans of Asthmatic Patients on Conventional Therapy: A 6-Year Longitudinal Study

Airway remodeling can be assessed using high-resolution computerized tomography (HRCT) scanning of both parenchymal-and airway abnormalities in patients with asthma. The aim of this study was to examine structural changes in large and small airways of asthmatic patients using HRCT to determine if remodeling changes had occurred after prolonged use of conventional anti-asthma therapy. HRCT scans were evaluated prospectively for evidence of the following abnormalities: bronchial wall thickening (BWT), bronchiectasis, mucoid impactions, small centrilobular opacities, thick linear opacities, focal hyperlucency, and emphysema. Fifty mild and moderate asthmatics were enrolled in the study group. These abnormalities were re-evaluated in the patients after the passage of 6 years of regular anti-asthma medication. Forty-six of the patients completed the study. The probability of finding at least one abnormality by HRCT investigation was statistically higher in the second scan than in the first (26 patients [56.5%] versus 18 patients [39.1%], p = 0.02]. Irreversibility ratios of abnormalities were 80%, 100%, 75%, 87.7%, 77.8%, and 100% for BWT, bronchiectasis, small centrilobular opacities, focal hyperlucency, thick linear opacity, and emphysema, respectively. The ratios for newly detected structural abnormalities were 25%, 2.5%, 0%, 7.9%, 8.1%, and 0% for BWT, bronchiectasis, small centrilobular opacities, focal hyperlucency, thick linear opacity, and emphysema, respectively. New occurrences and progression in BWT are associated with the duration of asthma affliction (p = 0.03). The results of our study indicate that HRCT remodeling features, once occurring, are irreversible in most of the patients, and new remodeling features also occur despite administering the standard asthma treatment.     

HRCT findings for four cases of measles pneumonia]

Although, in Western countries, adult-onset pneumonia that is associated with measles is not rare, reports of its incidence in Japan have been sparse. Among eight adolescent and adult (16-34-year-old) measles patients hospitalized in National Sanatorium Tsuruga Hospital, we found four in whom chest radiography and CT revealed pneumonia. The high-resolution lung CTs of these patients revealed features differing from those characteristic of bacterial pneumonia: bronchial wall thickness, centrilobular nodules in ground glass opacity, interstitial lesions (interlobular septal thickening, fissure thickening, pleural effusion) and lymphadenopathy. Of these findings, the centrilobular nodules in ground glass opacity were marked in these cases, and so this may be the most prominent finding in measles pneumonia; and furthermore, since interlobular septal thickening has not been reported in mycoplasma pneumonia or other atypical pneumonias, it may indicate a measles-specific, virus-induced pneumonia.     

Pulmonary involvement in mixed connective tissue disease: high-resolution CT findings in 41 patients

The objective of this study was to describe the pulmonary abnormalities on high-resolution computed tomography (CT) in patients with mixed connective tissue disease (MCTD). The study included 41 patients who met the diagnostic criteria for MCTD and showed abnormal findings on high-resolution CT. The presence, extent, and distribution of various high-resolution CT findings were evaluated. The predominant abnormalities included areas of ground-glass attenuation (n = 41), subpleural micronodules (n = 40), and nonseptal linear opacities (n = 32). Other common findings included peripheral predominance (n = 40), lower lobe predominance (n = 39), intralobular reticular opacities (n = 25), architectural distortion (n = 20), and traction bronchiectasis (n = 18). Less common findings included honeycombing, ill-defined centrilobular nodules, airspace consolidation, interlobular septal thickening, thickening of bronchovascular bundles, bronchial wall thickening, bronchiectasis, and emphysema. Pulmonary involvement of MCTD is characterized by the presence of ground-glass attenuation, nonseptal linear opacities, and peripheral and lower lobe predominance. Ill-defined centrilobular opacities were uncommonly seen.     

Lung manifestation in asymptomatic patients with primary Sj?gren syndrome: assessment with high resolution CT and pulmonary function tests.

The authors studied 37 consecutive patients with primary Sj?gren syndrome and normal chest radiographs. Thin-section CT images were analyzed using a semiquantitative grading system. The presence, distribution, and severity of 9 morphologic parameters were assessed. In 34 patients, CT findings were correlated to pulmonary function tests (PFTs). Abnormal high resolution CT (HRCT) findings were seen in 24 of 37 patients (65%): interlobular septal thickening, n = 9; micronodules, n = 9; ground glass attenuation n = 4; parenchymal cysts, n = 5. Intralobular opacities, honey combing, bronchial wall thickening, bronchiectasis, and pleural irregularities were less frequent. Both HRCT and PFTs were normal in 10 patients. Computed tomography was normal in four patients with PFTs that indicated the presence of small airway disease. High resolution CT abnormalities were found in seven patients with normal PFT. The overall correlation between HRCT and PFTs was poor. High resolution CT and PFTs appear to be sensitive for both the early detection of parenchymal abnormalities and a decreases in lung function in asymptomatic patients with primary Sj?gren syndrome. However, abnormal HRCT findings do not necessarily indicate a substantial alteration in PFTs.     

Disorders of the small airways: high-resolution computed tomographic features

Several infectious and noninfectious processes may affect predominantly or exclusively the small airways and result in reversible or irreversible abnormalities. Small-airway diseases can be considered as synonymous with bronchiolitis and can be classified into three main categories: (a) obliterative (constrictive) bronchiolitis, (b) cellular bronchiolitis, and (c) respiratory bronchiolitis. The introduction of high-resolution computed tomography (HRCT) has led to a considerable improvement in our ability to diagnose small-airway diseases. The characteristic HRCT findings of obliterative bronchiolitis consist of areas of decreased attenuation and vascularity with blood flow redistribution resulting in areas of increased lung attenuation and vascularity ("mosaic perfusion" pattern). In cellular bronchiolitis, the characteristic HRCT findings consist of centrilobular nodules and branching opacities ("tree-in-bud" pattern). Finally, bilateral areas of ground-glass attenuation and/or poorly defined centrilobular nodules are characteristic of respiratory bronchiolitis and respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). This article reviews the clinical, pathological, and HRCT features of some of the most common small-airway diseases.     

Zinc chloride (smoke bomb) inhalation lung injury: clinical presentations, high-resolution CT findings, and pulmonary function test results

STUDY OBJECTIVES: Zinc chloride smoke inhalation injury (ZCSII) is uncommon and has been rarely described in previous studies. We hypothesized that structural changes of the lung might correlate with pulmonary function. To answer this question, we correlated findings from high-resolution CT (HRCT) scan and the results of pulmonary function tests (PFTs) in patients with ZCSII. DESIGN: Retrospective cohort study. SETTING: University hospital. PATIENTS: Twenty patients who had been hospitalized with ZCSII-related conditions. MEASUREMENTS: The study included HRCT scan scores (0 to 100), static and dynamic lung volumes, and diffusing capacity of the lung for carbon monoxide (D(LCO)). RESULTS: HRCT scans and PFTs were performed initially after injury (range, 3 to 21 days) in all patients and during the follow-up period (range, 27 to 66 days) in 10 patients. The predominant CT scan findings were patchy or diffuse ground-glass opacities with or without consolidation. The majority of patients showed a significant reduction of FVC, FEV1, total lung capacity, and D(LCO), but normal FEV1/FVC ratio values. Changes of functional parameters correlated well with HRCT scan scores. Substantial improvements in CT scan abnormalities and pulmonary function were observed at follow-up. CONCLUSIONS: The majority of our patients with ZCSII presented with a predominant parenchymal injury of the lung that was consistent with a restrictive type of functional impairment and a reduction in Dlco rather than with obstructive disease. Our results suggest that HRCT scanning and pulmonary function testing may reliably predict the severity of ZCSII.     

误诊为间质性肺疾病的肺结核12例临床分析

目的 对误诊为间质性肺疾病(ILD)的肺结核患者临床、影像学及病理学特征进行探讨,以减少误诊.方法 对2003年10月至2007年10月在北京协和医院住院的230例胸部CT表现为ILD样改变,并经病理活检确诊的患者进行回顾性分析.活动性肺结核的诊断标准为肺组织标本显示上皮样肉芽肿或抗酸染色阳性,经抗结核治疗后肺内病变吸收.结果 230例中12例为肺结核,男5例,女7例;年龄17～68岁,平均(38±11)岁;病程0.5～18个月,中位病程2个月.肺结核患者中发热11例,咳嗽9例,呼吸困难7例,浅表淋巴结肿大4例,肝脾肿大2例;胸部CT示磨玻璃影4例,多发性斑片影5例,树芽征1例,小叶中心性结节2例.12例肺结核患者经抗结核治疗后随访3～12个月(中位随访时间9个月),11例肺部病变吸收,1例死于糖尿病酮症酸中毒.结论 对病程短、发热及肝脾和淋巴结肿大、CT表现为ILD的患者应排除肺结核.     

Lung structure abnormalities, but normal lung function in pediatric bronchiectasis

BACKGROUND: Bronchiectasis is not considered to be uncommon in children anymore. The relationship between pulmonary function and severity of bronchiectasis is still controversial. STUDY OBJECTIVES: To assess the extent and severity of bronchiectasis through high-resolution CT (HRCT) scan score, and to correlate it with clinical, microbiological, and functional data. PATIENTS AND METHODS: Forty-three white children with HRCT-diagnosed bronchiectasis were studied. Bronchiectasis extent, bronchial wall thickening severity, and bronchial wall dilatation severity were evaluated using the Reiff score. Clinical, microbiological, and spirometry results were related to total HRCT scan score and to subscores as well. RESULTS: The percentages of affected lobes were as follows: right lower lobe, 65%; middle lobe, 56%; left lower lobe, 51%; right upper lobe, 37%; lingula, 30%; and left upper lobe, 30% (chi(2) = 18.4; p = 0.002). The mean (+/- SEM) HRCT score was 20 +/- 2.6. Total score or subscores of bronchiectasis extent, bronchial wall thickening severity, and bronchial wall dilatation severity were not significantly related to FEV(1) and FVC. Seventy-four percent of patients had asthma. The age at the onset of cough correlated with age at the time of the HRCT scan (p = 0.004) and with the presence of asthma (p = 0.01). Positive findings of deep throat or sputum cultures were found more frequently in atopic patients (p = 0.02) and asthmatic (p < 0.01) patients, and in children who were < 2 years of age at the onset of cough (p < 0.01). CONCLUSIONS: Normal lung function may coexist with HRCT scan abnormalities and does not exclude damage to the bronchial structure. Pulmonary function is not an accurate method for assessing the severity of lung disease in children with bronchiectasis.     

Analysis of chest CT in patients with Mycobacterium avium complex pulmonary disease

BACKGROUND: The radiographic changes of Mycobacterium avium complex (MAC) pulmonary disease during therapy have not been studied well. OBJECTIVE: To assess the efficacy of antituberculous drug therapy against MAC pulmonary disease using computed tomography (CT). METHOD: We analyzed chest CT scans before and after antituberculous therapy in 30 patients (21 women, 9 men) with MAC pulmonary disease. To evaluate radiographic changes during therapy, we defined a 'degree of improvement' (DI) that is calculated according to the CT appearance. RESULTS: DI was better (1.35 +/- 0.21) in patients who had converted sputum culture than in those who had not (0.44 +/- 0.25) (p < 0.05). In patients who were diagnosed by bronchial washing, DI was better (1.60 +/- 0.22) than in patients who were diagnosed by sputum (0.67 +/- 0.20) (p < 0.01). We categorized the CT appearance into 6 types: small nodules, cavities, bronchial wall thickening, infiltration, pleural thickening and atelectasis. Patients who showed pleural thickening had a significantly worse DI (0.12 +/- 0.40) than those who did not (1.23 +/- 0.18) (p < 0.01). Most of the lesions that disappeared after therapy were small nodules. CONCLUSION: These results indicate that chest CT might be a useful tool for the prediction or assessment of drug therapy for MAC pulmonary disease.