The radiologic differential diagnosis of diffuse lung diseases characterized by multiple cysts or cavities

A variety of pulmonary diseases have diffuse cystic abnormalities within the lungs, including emphysema, cystic bronchiectasis, desquamative interstitial pneumonia, lymphocytic interstitial pneumonia, usual interstitial pneumonia, lymphangioleiomyomatosis, Langerhans histiocytosis, cystic metastasis, Wegener granulomatosis, Pneumocystis carinii pneumonia, pulmonary paragonimiasis, and septic pulmonary emboli. CT can easily detect cystic abnormalities as common features in many diseases. However, some characteristic pattern of them can facilitate specific diagnoses.

[Bilateral excavated nodular pneumopathy: amebiasis? Report of a case]

Pleuropulmonary amibiasis is generally secondary to hepatic amibiasis with migration into the thorax. Direct pulmonary involvement is exceptional. We report a case of pulmonary ambiasis without associated liver involvement causing multiple bilateral pulmonary lesions.

Case report: Paragonimiasis westermani with seroconversion from immunoglobulin (Ig) m to IgG antibody with the clinical course

A 66-year-old man visited our hospital with primary complaint of cough. Chest roentgenogram showed slight pleural effusion and pneumothorax in the left lung. Eosinophilia (22.8%) was also found in his peripheral blood. Multiple-dot enzyme-linked immunosorbent assay (dot-ELISA) for the detection of parasite-specific immunoglobulin (Ig) G antibody was used to screen his serum against various parasitic diseases, but no significant binding was observed with any of the 12 parasite antigens examined, including those of Paragonimus westermani and P. miyazakii. Although he seemed to have been spontaneously cured without treatment, a nodular shadow appeared in the right upper medial lung field on the chest roentgenogram 6 months later. This time, his serum was positive for anti-P. westermani IgG antibody by the same method. A reexamination of the first and second admission serum samples for parasite-specific IgM and IgG antibodies revealed significant level of IgM antibody in the serum of the first admission, which had decreased at the time of the second admission. Conversely, the level of IgG antibody, which was low at the first admission, became dominant in the second admission serum 6 months later. These results clearly show that although the dot-ELISA to detect IgG antibody is generally useful for screening and detecting paragonimiasis, detection of IgM antibody seems to be a useful aid and should also be included in immunoserological diagnosis, especially if the patient is considered to be in the early stage of infection.

Radiology of pneumonia

Infection of the lower respiratory tract, acquired by way of the airways and confined to the lung parenchyma and airways, typically presents radiologically as one of three patterns: (1) focal nonsegmental or lobar pneumonia, (2) multifocal bronchopneumonia or lobular pneumonia, and (3) focal or diffuse "interstitial" pneumonia. These patterns can be useful in identifying the etiological organism in the appropriate clinical setting. To serve the purpose of this article, these patterns are used as the primary method of classification of pulmonary infections caused by different organisms. Mycobacterial and fungal pulmonary infections are reviewed separately because of their wide range of radiographic appearance that depend on the stage of the disease at presentation. This article discusses the clinical and radiographic features of the most common causes of pneumonia, primarily in the adult population of the United States.

Subacute pulmonary granulomatous schistosomiasis: high resolution CT appearances--another cause of the halo sign

A case of probable acute granulomatous pulmonary schistosomiasis is described with multiple focal opacities on chest radiography and widespread, but predominantly peribronchovascular, nodules with ground-glass halos on high resolution CT (HRCT). The HRCT appearances in early schistosomiasis have not been described previously. Although the features are not diagnostic and may be seen in other conditions, in the appropriate clinical context they may suggest pulmonary involvement in schistosomiasis. The features of pulmonary schistosomiasis in the different stages of infection are discussed. Pulmonary involvement should be suspected in patients with even minor respiratory symptoms when there is a history of exposure to fresh water in endemic areas.

A nodular pulmonary lesion due to Linguatula serrata in an HIV-positive man

A coin-shaped pulmonary lesion was accidentally detected in a 42-year-old, HIV-seropositive man residing in Bari (Apulia, Southern Italy) during a routine X-ray examination. A lung cancer was suspected, obliging physicians to investigate surgically. After thoracotomy a lung nodule, 1.8 cm in diameter, was excised and submitted for histological examination. Histological analysis revealed a nodular infarctual lesion containing a larva of Pentastomida. Despite the poor state of preservation of the parasite it was possible to recognise some morphological characteristics which enabled the parasite to be identified as Linguatula serrata (Pentastomida, Porocephalida). This is the first case reported in Europe in the lung in a living man due to this parasite, the few others occurring in autopsy reports. No evident correlations were found in the present case between HIV-seropositivity and the development of the parasitosis. The importance of lung nodules caused by metazoan invertebrates is emphasised: even though they are rare in man, they are regularly mistaken for cancer at X-ray examination.

Chest radiograph abnormalities in patients hospitalized with leptospirosis in the city of Salvador, Bahia, Brazil

This study was designed to estimate the prevalence of pulmonary radiograph abnormalities and describe the distribution of the patterns of radiographic alterations among patients hospitalized with leptospirosis. Chest radiographs of 139 patients hospitalized with leptospirosis in Couto Maia Hospital, in Salvador, Bahia, Brazil, between July, 1997, and July, 1999, were analyzed. The radiographs were requested soon after hospital admission, independent of the clinical manifestations of the patients. Only the first radiograph was considered. Pulmonary radiograph alterations were recorded in 35/139 patients (25.2%); 95% mid-point confidence interval = 18.5% to 32.9%. Among the patients with radiograph alterations, alveolar infiltrate was seen in 26/35 (74.3%). The lesions were bilateral in 54.3% and located in the inferior lobes in 45.5%. Pleural effusion, represented by blunting of the costo-phrenic angle, was detected in 8.6% of the patients. The pattern of the pulmonary alterations, predominantly bilateral alveolar infiltrates, is consistent with the evidence that the basic pulmonary alteration in leptospirosis is a generalized capillaritis.

Pulmonary manifestations of early schistosome infection among nonimmune travelers

PURPOSE

The clinical aspects of acute pulmonary schistosomiasis among nonimmune patients have not been well characterized.

METHODS

We evaluated 8 patients who presented with pulmonary symptoms and abnormal chest radiographs after recent travel to Africa. Diagnosis was based on the detection of schistosomal eggs or positive serology.

RESULTS

Of 60 patients evaluated in our center for schistosomiasis during a 3-year period, 8 (6 with Schistosoma hematobium, 2 with S. mansoni) had pulmonary symptoms. These symptoms appeared 3 to 6 weeks after exposure and consisted of dry cough and shortness of breath without concurrent fever. The mean (+/- SD) eosinophil count was 4020 +/- 1400 per micromL. Chest radiography revealed multiple small nodules in 7 patients; in 1 patient, a diffuse interstitial infiltrate was also seen. Computerized tomographic scans of the chest were obtained in 4 patients; the scans confirmed the nodular pattern and detected a greater number of nodules. A transbronchial biopsy in 1 patient revealed eosinophilic pneumonia without detection of larva or eggs.

CONCLUSION

Pulmonary manifestations during the early stage of schistosomal infection may occur with either S. hematobium or S. mansoni infection. These manifestations may represent an immunologic process, as is thought to be responsible for the febrile systemic response (Katayama fever) to acute infection.

Solitary pulmonary nodule due to dirofilariasis

Pulmonary dirofilariasis can produce a noncalcified solitary nodule and therefore be mistaken for a lung cancer. Careful analysis of the imaging findings in this disease can suggest the proper evaluation and management in affected patients.

[Porocephalosis: still a rare diagnosis]

We report a case of porocephalosis in a 35-year-old Congolese adult who habitually ate large amounts of snake. The principal nonspecific clinical sign was abdominal pain. Diagnosis was based on X-ray examination of the abdomen without preparation and abdominal ultrasound scan.

[Paragonimiasis Miyazakii with variable X-ray shadows]

A 77-year-old woman was admitted to our hospital with hemoptysis and weight loss. She had eaten 15 raw freshwater crabs about 5 months before the onset of her clinical symptoms. Chest X-ray films obtained on the first admission showed left pleural effusion. After 1 week of chemotherapy with SBTPC, the pleural effusion disappeared. Two months later, the patient was re-admitted with recurrent hemoptysis. Chest X-ray films showed a solitary nodular lesion in the right lung. Eosinophilia and increased serum IgE levels were detected. The solitary nodular lesion moved from the middle to upper field of the right lung during the patient's 3-week stay in the hospital. Serologic tests yielded a conclusive diagnosis of Paragonimiasis miyazakii infection. Praziquantel administration relieved the patient's symptoms.

Halo sign on high resolution CT: findings in spectrum of pulmonary diseases with pathologic correlation

The halo sign in a pulmonary nodule refers to the condition in which soft tissue attenuation of a pulmonary nodule is surrounded by peripheral ground glass attenuation on high resolution CT. The halo sign can be caused by several pathologic processes: hemorrhagic pulmonary nodules, tumor cell infiltration, and nonhemorrhagic inflammatory lesions. Hemorrhagic pulmonary nodules may occur in infectious diseases including invasive pulmonary aspergillosis, mucormycosis, and candidiasis and noninfectious diseases including Wegener granulomatosis and primary and metastatic hemorrhagic tumors. Tumor cell infiltration in bronchioloalveolar carcinoma, pulmonary lymphoma, and pulmonary metastatic neoplasm may appear with the halo sign. Eosinophilic lung disease and organizing pneumonia are representative of inflammatory lesions showing the sign.

A lung nematode in Canadian Arctic muskoxen. Standard radiographic and computed tomographic imaging

Medical imaging was used before death to follow the development of U. pallikuukensis infection in muskoxen and postmortem to investigate the distribution and characteristics of parasite-associated pulmonary cysts. In two experimentally infected animals, lesions were not visible radiographically until days 178 and 191 PI, 3 months after the parasites became patent. Serial radiographs taken throughout the period of patency of one animal showed an initial increase in lesion size by day 415 PI, but by day 789 PI, lesions had stabilized or decreased in size. Although all lesions detected postmortem were not visible radiographically during life, the radiographs did provide an indication of the relative severity of infection. In contrast to other parasitic pneumonias, there was no evidence of pulmonary disease outside of the discrete parasitic cysts. Radiographs of lungs postmortem proved to be an effective tool for locating parasitic cysts in a lightly infected muskox and demonstrated a bronchovascular cyst distribution. Postmortem CT provided a more rapid and detailed assessment of the number, size, and distribution of cysts in the lungs of one muskox.

Guinea worm cause of adult onset asthmatic attack, a radiological diagnosis

A case report of a fifty years old Hausa male from Sokoto town, Nigeria an endemic region of guinea worm infestation, who presented with sudden adult onset of asthmatic attack and was evaluated radiologically and the diagnosis of acute obstructive airway disease was confirmed. It was noted, that there were associated calcified chain of guinea worms in the lung parenchyma. A rare association of acute asthmatic attack. Patient responded there-after to an anti-asthmatic regime of management.

Paragonimiasis westermani presenting as an asymptomatic nodular lesion in the lung: report of a case

A 57-year-old man with a history of having consumed fresh-water crab 8 months previously presented with a solitary mass lesion in the left lung without any symptoms. Since neoplastic disease could not be ruled out, an open biopsy was performed, and histological examination confirmed a definite diagnosis of paragonimiasis. A high level of the anti-Paragonimus westermani antibody was detected in the sera of the patient, but this level decreased substantially 3 months after chemotherapy with bithionol.

The spectrum of eosinophilic lung disease: radiologic findings

PURPOSE

Eosinophilic lung disease includes various disease entities. Each disease manifests different radiologic findings. The purpose of this review is to present the radiologic findings of the spectrum of eosinophilic lung disease.

METHOD

We reviewed the radiologic, histologic, and clinical findings of the spectrum of eosinophilic lung disease from the previous reports and our experiences.

RESULTS

Simple pulmonary eosinophilia is characterized by transient and migrating opacities on chest radiography. Acute eosinophilic pneumonia is characterized by acute clinical symptoms and signs and rapid changes of radiographic diffuse reticular lesions. Chronic eosinophilic pneumonia, with more prolonged symptom duration, history of asthma, occurrence of relapse, and radiologic features of subpleural consolidation, can be differentiated from acute eosinophilic pneumonia. Allergic bronchopulmonary aspergillosis presents with bilateral central bronchiectasis with or without mucoid impaction. Although these diseases show specific radiographic findings, some show overlapping radiographic features. High-resolution CT enables characterization of parenchymal lesions further by showing internal and marginal features and the exact extent of the lesions. Extrapulmonary organs are involved in Churg-Strauss syndrome and idiopathic hypereosinophilic syndrome. Asthma is associated with Churg-Strauss syndrome, allergic bronchopulmonary aspergillosis, chronic eosinophilic pneumonia, and bronchocentric granulomatosis.

CONCLUSION

Integration of clinical, laboratory, and radiologic findings enables initial and differential diagnoses of various eosinophilic lung diseases.

Human pulmonary dirofilariasis: analysis of 24 cases from São Paulo, Brazil

STUDY OBJECTIVE

To present the clinical, radiologic, and pathologic aspects of 24 cases of human pulmonary dirofilariasis (HPD) from São Paulo, Brazil.

DESIGN

Retrospective study of 24 patients with a confirmed diagnosis of HPD over a 14-year period (from February 1982 to June 1996).

SETTING

Thoracic Surgery and Pulmonary Division, University of São Paulo and Hospital Albert Einstein, São Paulo, Brazil.

RESULTS

Seventeen patients were male (70.1%) and seven were female (29.9%). Their mean age was 51.4 years. Fifty-four percent of the patients were asymptomatic and 75% had a well-circumscribed noncalcified peripheral subpleural pulmonary nodule on the chest radiograph and thoracic CT scan, located preferentially in the lower lobes. The diagnosis was made after thoracotomy and wedge resections in 16 patients, by videothoracoscopy in six, after a pleural biopsy in one, and after necropsy in one. The pathologic examination of all the nodules revealed a central zone of necrosis, surrounded by a narrow granulomatous zone and peripherally by fibrous tissue. Pulmonary vessels exhibit varying degrees of endarteritis. In all cases, a dead worm, usually necrotic and fragmented, was found.

CONCLUSIONS

A subpleural, noncalcified pulmonary nodule in the appropriate clinical and epidemiologic setting should alert the clinician, radiologist, or pathologist to the possibility of Dirofilaria. HPD should be considered in the differential diagnosis of pulmonary nodules.

[Pulmonary dirofilariasis with cavity formation and spontaneous regression]

A 70-year-old woman was admitted to our hospital for evaluation of a nodular shadow and an apparent cavity in the right middle lung field. Transbronchial biopsy and percutaneous needle biopsy had failed to result in a diagnosis. Serial chest X-ray films revealed slight regression of the nodule without therapy. Pulmonary dirofilariasis was diagnosed after open-lung biopsy and Ouchterlony's double diffusion test. Cavity formation and spontaneous regression are rare in pulmonary dirofilariasis.