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Scano V, Fois AG, Manca A, Balata F, Zinellu A, Chessa C, Pirina P, Paliogiannis P. Role of EBUS-TBNA in Non-Neoplastic Mediastinal Lymphadenopathy: Review of Literature. Diagnostics (Basel) 2022; 12:diagnostics12020512. [PMID: 35204602 PMCID: PMC8871250 DOI: 10.3390/diagnostics12020512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 02/01/2023] Open
Abstract
Mediastinal lymphadenopathy is a condition in which one or more mediastinal lymph nodes are enlarged for malignant or benign causes, generally more than 10 mm. For a long time, the only way to approach the mediastinum was surgery, while in last decades endoscopic techniques gained their role in neoplastic diseases. At the present time, EBUS is the technique of choice for studying the mediastinum in the suspicion of cancer, while there are not strong indications in guidelines for the study of benign mediastinal lymphadenopathy. We reviewed the literature, looking for evidence of the role of EBUS in the diagnostics of non-neoplastic mediastinal lymphadenopathy, with special regard for granulomatous disease, both infectious and non-infectious. EBUS is a reliable alternative to surgery in non-neoplastic mediastinal lymphadenopathy, even if more evidence is needed for granulomatous diseases other than tuberculosis and sarcoidosis.
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Affiliation(s)
- Valentina Scano
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
- Correspondence: ; Tel.: +39-340-926-5637
| | - Alessandro Giuseppe Fois
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
- Unit of Respiratory Diseases, University Hospital Sassari (AOU), 07100 Sassari, Italy
| | - Andrea Manca
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
| | - Francesca Balata
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Carla Chessa
- Postgraduate School in Hospital Pharmacy, University of Sassari, 07100 Sassari, Italy;
| | - Pietro Pirina
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
- Unit of Respiratory Diseases, University Hospital Sassari (AOU), 07100 Sassari, Italy
| | - Panos Paliogiannis
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.G.F.); (A.M.); (F.B.); (P.P.); (P.P.)
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Renaud A, Pautre R, Morla O, Achille A, Durant C, Espitia O, Frampas E, Agard C. Thoracic lymphadenopathies in diffuse systemic sclerosis: an observational study on 48 patients using computed tomography. BMC Pulm Med 2022; 22:44. [PMID: 35078448 PMCID: PMC8788097 DOI: 10.1186/s12890-022-01837-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Thoracic multidetector computed tomography (MDCT) is essential for the detection of interstitial lung disease (ILD) in patients with systemic sclerosis (SSc). Thoracic MDCT assessment can reveal the presence of thoracic lymphadenopathies (LAP) whose signification remains uncertain. The purpose of the study was to describe the characteristics and to assess the significance of thoracic LAP in patients with diffuse SSc.
Methods
We conducted a monocentric observational study on adult patients with diffuse SSc, and collected general patient and first thoracic MDCT characteristics, PET-CT and outcome data. Comparisons were made between patients with and without thoracic LAP.
Results
Forty-eight patients were included. There were 30 patients (62.5%) with an ILD and 23 (48%) with at least one thoracic LAP on the first MDCT assessment. Median number per patient of thoracic LAP was 3 [1–8], with a mean size of 11.7 ± 1.7 mm, mainly located in right para-tracheal area (22.8% of the total number of LAP), right hilar area (20.3%), left hilar area (6.5%), and sub-carinal area (15.2%). PET-CT showed lymph node hypermetabolism in 11/15 patients (73.3%) with mean SUVmax at 4 ± 1.3. There were significantly more males (p = 0.002) and more patients exposed to silica (p = 0.001) in patients with thoracic LAP. ILD was significantly more extended according to Goh score (p = 0.03), and using semi-quantitative score for mixed ground-glass reticulation (p = 0.01) and global abnormalities (p = 0.03) in patients with thoracic LAP and ILD. Thirteen patients (27.1%) died during follow-up without significant difference according to the presence or not of thoracic LAP (p = 0.15). There was also no significant difference concerning immunosuppressive treatment initiation (p = 0.17).
Conclusions
Thoracic LAP are common in diffuse SSc and are generally multiple, not bulky, moderately hypermetabolic, and located at the base of the mediastinum lymph node chains. Their presence correlates with the extent of ILD. In absence of ILD, thoracic LAP presence seems to be often explained by silica exposure.
Trial Registration: NA.
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Nguyen M, Gaujard G, Guinot PG, Bouhemad B. Using the lung ultrasound score to monitor disease progression for COVID-19-associated ARDS. Intensive Care Med 2021; 47:1329-1331. [PMID: 34595567 PMCID: PMC8483171 DOI: 10.1007/s00134-021-06515-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/24/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Maxime Nguyen
- Department of Anaesthesiology and Intensive Care, CHU Dijon, BP77908, 21709, Dijon Cedex, France
- Université Bourgogne Franche‑Comté, LNC UMR1231, 21000, Dijon, France
| | - Guillaume Gaujard
- Department of Anaesthesiology and Intensive Care, CHU Dijon, BP77908, 21709, Dijon Cedex, France
| | - Pierre-Grégoire Guinot
- Department of Anaesthesiology and Intensive Care, CHU Dijon, BP77908, 21709, Dijon Cedex, France
- Université Bourgogne Franche‑Comté, LNC UMR1231, 21000, Dijon, France
| | - Belaid Bouhemad
- Department of Anaesthesiology and Intensive Care, CHU Dijon, BP77908, 21709, Dijon Cedex, France.
- Université Bourgogne Franche‑Comté, LNC UMR1231, 21000, Dijon, France.
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Adegunsoye A, Oldham JM, Bonham C, Hrusch C, Nolan P, Klejch W, Bellam S, Mehta U, Thakrar K, Pugashetti JV, Husain AN, Montner SM, Straus CM, Vij R, Sperling AI, Noth I, Strek ME, Chung JH. Prognosticating Outcomes in Interstitial Lung Disease by Mediastinal Lymph Node Assessment. An Observational Cohort Study with Independent Validation. Am J Respir Crit Care Med 2020; 199:747-759. [PMID: 30216085 DOI: 10.1164/rccm.201804-0761oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
RATIONALE Mediastinal lymph node (MLN) enlargement on chest computed tomography (CT) is prevalent in patients with interstitial lung disease (ILD) and may reflect immunologic activation and subsequent cytokine-mediated immune cell trafficking. OBJECTIVES We aimed to determine whether MLN enlargement on chest CT predicts clinical outcomes and circulating cytokine levels in ILD. METHODS MLN measurements were obtained from chest CT scans of patients with ILD at baseline evaluation over a 10-year period. Patients with sarcoidosis and drug toxicity-related ILD were excluded. MLN diameter and location were assessed. Plasma cytokine levels were analyzed in a subset of patients. The primary outcome was transplant-free survival (TFS). Secondary outcomes included all-cause and respiratory hospitalizations, lung function, and plasma cytokine concentrations. Cox regression was used to assess mortality risk. Outcomes were assessed in three independent ILD cohorts. MEASUREMENTS AND MAIN RESULTS Chest CT scans were assessed in 1,094 patients (mean age, 64 yr; 52% male). MLN enlargement (≥10 mm) was present in 66% (n = 726) and strongly predicted TFS (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.12-2.10; P = 0.008) and risk of all-cause and respiratory hospitalizations (internal rate of return [IRR], 1.52; 95% CI, 1.17-1.98; P = 0.002; and IRR, 1.71; 95% CI, 1.15-2.53; P = 0.008, respectively) when compared with subjects with MLN <10 mm. Patients with MLN enlargement had lower lung function and decreased plasma concentrations of soluble CD40L (376 pg/ml vs. 505 pg/ml, P = 0.001) compared with those without MLN enlargement. Plasma IL-10 concentration >45 pg/ml predicted mortality (HR, 4.21; 95% CI, 1.21-14.68; P = 0.024). Independent analysis of external datasets confirmed these findings. CONCLUSIONS MLN enlargement predicts TFS and hospitalization risk in ILD and is associated with decreased levels of a key circulating cytokine, soluble CD40L. Incorporating MLN and cytokine findings into current prediction models might improve ILD prognostication.
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Affiliation(s)
| | - Justin M Oldham
- 2 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California at Davis, Davis, California
| | - Catherine Bonham
- 1 Section of Pulmonary and Critical Care, Department of Medicine
| | - Cara Hrusch
- 1 Section of Pulmonary and Critical Care, Department of Medicine
| | | | | | - Shashi Bellam
- 4 Division of Pulmonary and Critical Care, Department of Medicine and
| | - Uday Mehta
- 5 Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois; and
| | - Kiran Thakrar
- 5 Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois; and
| | - Janelle Vu Pugashetti
- 2 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California at Davis, Davis, California
| | | | | | | | - Rekha Vij
- 1 Section of Pulmonary and Critical Care, Department of Medicine
| | - Anne I Sperling
- 1 Section of Pulmonary and Critical Care, Department of Medicine.,7 Committee on Immunology, Biological Sciences Division, University of Chicago, Chicago, Illinois
| | - Imre Noth
- 8 Division of Pulmonary and Critical Care and Sleep Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Mary E Strek
- 1 Section of Pulmonary and Critical Care, Department of Medicine
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Forbearance With Bronchoscopy. Chest 2019; 155:834-847. [DOI: 10.1016/j.chest.2018.08.1035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 02/06/2023] Open
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Hochhegger B, Marchiori E, Zanon M, Rubin AS, Fragomeni R, Altmayer S, Carvalho CRR, Baldi BG. Imaging in idiopathic pulmonary fibrosis: diagnosis and mimics. Clinics (Sao Paulo) 2019; 74:e225. [PMID: 30726312 PMCID: PMC6384526 DOI: 10.6061/clinics/2019/e225] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/13/2018] [Indexed: 12/27/2022] Open
Abstract
Idiopathic pulmonary fibrosis is a chronic disease of unknown etiology that usually has a progressive course and is commonly associated with a poor prognosis. The main symptoms of idiopathic pulmonary fibrosis, including progressive dyspnea and dry cough, are often nonspecific. Chest high-resolution computed tomography is the primary modality used in the initial assessment of patients with suspected idiopathic pulmonary fibrosis and may have considerable influence on subsequent management decisions. The main role of computed tomography is to distinguish chronic fibrosing lung diseases with a usual interstitial pneumonia pattern from those presenting with a non-usual interstitial pneumonia pattern, suggesting an alternative diagnosis when possible. A usual interstitial pneumonia pattern on chest tomography is characterized by the presence subpleural and basal predominance, reticular abnormality honeycombing with or without traction bronchiectasis, and the absence of features suggestive of an alternative diagnosis. Idiopathic pulmonary fibrosis can be diagnosed according to clinical and radiological criteria in approximately 66.6% of cases. Confirmation of an idiopathic pulmonary fibrosis diagnosis is challenging, requiring the exclusion of pulmonary fibroses with known causes, such as asbestosis, connective tissue diseases, drug exposure, chronic hypersensitivity pneumonitis, and other forms of idiopathic interstitial pneumonitis. The histopathological hallmark of usual interstitial pneumonia is a heterogeneous appearance, characterized by areas of fibrosis with scarring and honeycombing alternating with areas of less affected or normal parenchyma. The aim of this article was to review the clinical, radiological, and pathological features of idiopathic pulmonary fibrosis and of diseases that might mimic idiopathic pulmonary fibrosis presentation.
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Affiliation(s)
- Bruno Hochhegger
- Departamento de Radiologia, Laboratorio de Pesquisas em Imagens Medicas (LABIMED), Irmandade Santa Casa de Misericordia de Porto Alegre, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, BR
| | - Edson Marchiori
- Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - Matheus Zanon
- Departamento de Radiologia, Laboratorio de Pesquisas em Imagens Medicas (LABIMED), Irmandade Santa Casa de Misericordia de Porto Alegre, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, BR
- *Corresponding author. E-mail:
| | - Adalberto Sperb Rubin
- Departamento de Pneumologia, Irmandade Santa Casa de Misericordia de Porto Alegre, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, BR
| | - Renata Fragomeni
- Departamento de Patologia, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, BR
| | - Stephan Altmayer
- Departamento de Radiologia, Laboratorio de Pesquisas em Imagens Medicas (LABIMED), Irmandade Santa Casa de Misericordia de Porto Alegre, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, BR
| | - Carlos Roberto Ribeiro Carvalho
- Divisao Pulmonar, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Bruno Guedes Baldi
- Divisao Pulmonar, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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7
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Chung JH, Kanne JP. Imaging of Idiopathic Pulmonary Fibrosis. Respir Med 2019. [DOI: 10.1007/978-3-319-99975-3_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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Lee SH, Kim YO, Lee E, Jeong IS, Choi YD, Cho HJ. Mediastinal lymphadenopathy reflecting disease activity in an infant with chronic pneumonitis of infancy associated with surfactant protein C mutation: a case report and literature review. J Thorac Dis 2018; 10:E730-E735. [PMID: 30505512 DOI: 10.21037/jtd.2018.09.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sang Hoon Lee
- Department of Pediatrics, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Young Ok Kim
- Department of Pediatrics, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical school and Hospital, Gwangju, Korea
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University Medical school and Hospital, Gwangju, Korea
| | - Hwa Jin Cho
- Department of Pediatrics, Chonnam National University Medical School and Hospital, Gwangju, Korea
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9
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Impact of mediastinal lymph node enlargement on the prognosis of idiopathic pulmonary fibrosis. PLoS One 2018; 13:e0201154. [PMID: 30044866 PMCID: PMC6059471 DOI: 10.1371/journal.pone.0201154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/10/2018] [Indexed: 01/08/2023] Open
Abstract
Background Mediastinal lymph node enlargement (LNE) is common in idiopathic pulmonary fibrosis (IPF) and is known to be associated with the severity of lung fibrosis. However, the relationship between mediastinal LNE and the prognosis of IPF has not been determined to date. Methods This study included patients with IPF from the interstitial lung disease registry at Seoul National University Bundang Hospital, from January 2012 to March 2016. Two thoracic radiologists independently reviewed mediastinal LNE and lung parenchymal fibrosis and ground glass opacities in chest computed tomography scans of each patient, which were obtained upon diagnosis. Mortality and admission rates were analyzed. Results In total, 132 patients (104 [78.8%] male; median age, 72 years; range, 51–84 years) were enrolled and 73 (55.3%) patients had mediastinal LNE (short axis ≥ 10 mm in diameter). Mortality was significantly higher among patients with LNE than among those without LNE (hazard ratio 2.26 [95% confidence interval 1.20–4.23], p = 0.011). Of the patients with LNE, 24.7% experienced acute exacerbation and 43.8% experienced hospital admission for respiratory causes, in comparison with 16.9% and 40.0% of patients without LNE respectively. Although patients with LNE had a tendency to have increased rate of acute exacerbation, it was not statistically significant. Conclusion Mediastinal LNE in IPF is associated with increased mortality and its occurrence may be considered a poor prognostic factor in patients with IPF.
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Abstract
Idiopathic interstitial pneumonias are a heterogeneous group of diffuse lung diseases characterized by distinct clinicopathologic entities with the usual interstitial pneumonia (UIP) being the most common. The pattern of UIP can be seen in idiopathic pulmonary fibrosis (IPF) as well as in secondary causes, most commonly in connective tissue diseases. IPF is usually progressive and associated with a very poor prognosis, and newer therapies pose a risk of serious complications; therefore, diagnostic certainty is crucial. This article reviews the radiologic findings in UIP with clinical correlation and histopathologic features along with its significance for prognosis and patients monitoring.
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Affiliation(s)
- Joanna E Kusmirek
- Department of Radiology, Virginia Commonwealth University, 1250 East Marshall Street, Richmond, VA 23298, USA.
| | - Maria Daniela Martin
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792-3252, USA
| | - Jeffrey P Kanne
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792-3252, USA
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11
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Rodrigues JCL, Lyen SM, Loughborough W, Amadu AM, Baritussio A, Dastidar AG, Manghat NE, Bucciarelli-Ducci C. Extra-cardiac findings in cardiovascular magnetic resonance: what the imaging cardiologist needs to know. J Cardiovasc Magn Reson 2016; 18:26. [PMID: 27156861 PMCID: PMC4860770 DOI: 10.1186/s12968-016-0246-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/21/2016] [Indexed: 12/21/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is an established non-invasive technique to comprehensively assess cardiovascular structure and function in a variety of acquired and inherited cardiac conditions. A significant amount of the neck, thorax and upper abdomen are imaged at the time of routine clinical CMR, particularly in the initial multi-slice axial and coronal images. The discovery of unsuspected disease at the time of imaging has ethical, financial and medico-legal implications. Extra-cardiac findings at the time of CMR are common, can be important and can change clinical management. Certain patient groups undergoing CMR are at particular risk of important extra-cardiac findings as several of the cardiovascular risk factors for atherosclerosis are also risk factors for malignancy. Furthermore, the presence of certain extra-cardiac findings may contribute to the interpretation of the primary cardiac pathology as some cardiac conditions have multi-systemic extra-cardiac involvement. The aim of this review is to give an overview of the type of extra-cardiac findings that may become apparent on CMR, subdivided by anatomical location. We focus on normal variant anatomy that may mimic disease, common incidental extra-cardiac findings and important imaging signs that help distinguish sinister pathology from benign disease. We also aim to provide a framework to the approach and potential further diagnostic work-up of incidental extra-cardiac findings discovered at the time of CMR. However, it is beyond the scope of this review to discuss and determine the clinical significance of extracardiac findings at CMR.
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Affiliation(s)
- Jonathan C L Rodrigues
- Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
- Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
- School of Physiology, Pharmacology and Neurosciences, Faculty of Biomedical Sciences, University of Bristol, Medical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - Stephen M Lyen
- Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - William Loughborough
- Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Antonio Matteo Amadu
- Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
- Department of Surgical, Microsurgical and Medical Sciences, Institute of Radiological Sciences, University of Sassari, Sassari, Italy
| | - Anna Baritussio
- Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
- Department of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Amardeep Ghosh Dastidar
- Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
- Department of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Nathan E Manghat
- Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Chiara Bucciarelli-Ducci
- Cardiovascular Magnetic Resonance Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK.
- Department of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.
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13
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Nin CS, de Souza VVS, do Amaral RH, Schuhmacher Neto R, Alves GRT, Marchiori E, Irion KL, Balbinot F, Meirelles GDSP, Santana P, Gomes ACP, Hochhegger B. Thoracic lymphadenopathy in benign diseases: A state of the art review. Respir Med 2016; 112:10-7. [PMID: 26860219 DOI: 10.1016/j.rmed.2016.01.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/14/2015] [Accepted: 01/28/2016] [Indexed: 12/27/2022]
Abstract
Lymphadenopathy is a common radiological finding in many thoracic diseases and may be caused by a variety of infectious, inflammatory, and neoplastic conditions. This review aims to describe the patterns of mediastinal and hilar lymphadenopathy found in benign diseases in immunocompetent patients. Computed tomography is the method of choice for the evaluation of lymphadenopathy, as it is able to demonstrate increased size of individual nodes, abnormalities of the interface between the mediastinum and lung, invasion of surrounding fat, coalescence of adjacent nodes, obliteration of the mediastinal fat, and hypo- and hyperdensity in lymph nodes. Intravenous contrast enhancement may be needed to help distinguish nodes from vessels. The most frequent infections resulting in this finding are tuberculosis and fungal disease (particularly histoplasmosis and coccidioidomycosis). Sarcoidosis is a relatively frequent cause of lymphadenopathy in young adults, and can be distinguished from other diseases - especially when enlarged lymph nodes are found to be multiple and symmetrical. Other conditions discussed in this review are silicosis, drug reactions, amyloidosis, heart failure, Castleman's disease, viral infections, and chronic obstructive pulmonary disease.
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Affiliation(s)
- Carlos Schüler Nin
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
| | | | | | | | | | - Edson Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Fernanda Balbinot
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
| | | | - Pablo Santana
- Hospital São Joaquim Beneficência Portuguesa, São Paulo-SP, Brazil
| | | | - Bruno Hochhegger
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
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Strollo DC, Franks TJ, Galvin JR. The idiopathic interstitial pneumonias: histology and imaging. Semin Roentgenol 2014; 50:8-15. [PMID: 25498398 DOI: 10.1053/j.ro.2014.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Diane C Strollo
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Teri J Franks
- Pulmonary & Mediastinal Pathology, The Joint Pathology Center, Silver Spring, MD
| | - Jeffrey R Galvin
- Department of Diagnostic Radiology, Chest Imaging, University of Maryland School of Medicine, MD; Department of Internal Medicine, Pulmonary/Critical Care Medicine, University of Maryland School of Medicine, MD; Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, MD
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15
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Attili AK, Kazerooni EA, Gross BH, Flaherty KR, Martinez FJ. Thoracic Lymph Node Enlargement in Usual Interstitial Pneumonitis and Nonspecific-interstitial Pneumonitis. J Thorac Imaging 2006; 21:288-92. [PMID: 17110853 DOI: 10.1097/01.rti.0000213562.55914.9a] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the prevalence of thoracic lymph node enlargement (LNE) in usual (UIP) and nonspecific (NSIP) interstitial pneumonitis, change in LNE over time, and if LNE is related to disease activity. METHODS AND MATERIALS High-resolution CT scans (HRCT) in 20 patients each with UIP and NSIP were retrospectively reviewed. Two HRCT scans were reviewed for each patient, at diagnosis and a mean of 1 +/- 0.7 years later. Two thoracic radiologists independently recorded the location and size of thoracic lymph nodes (LNs) > 10-mm in short-axis diameter, using the American Thoracic Society lymph node mapping scheme. HRCT disease severity was scored for ground glass opacity and fibrosis. The number and size of enlarged LN stations were compared with HRCT scores. RESULTS LNE was found on 44 HRCT examinations (21 baseline prevalence 52.5%, 23 follow-up, prevalence 57.5%), most common in the low right paratracheal (38%) and subcarinal (36%) regions. There was no significant difference in LN size or number of enlarged LN stations between baseline and follow-up CT. LNE prevalence was not different on baseline CT (P = 0.34) follow-up CT (P = 0.11) between UIP and NSIP patients. The mean size of the largest enlarged LN was 1.36 cm (1 to 2.1 cm) at baseline and 1.43 cm (1 to 1.9 cm) on follow-up CT. Mean CT ground glass and fibrosis scores were 1.98 and 1.6 when LNE was present, and 1.34 and 1.03 when absent (P = 0.008 and 0.003, respectively). The number and maximum size of enlarged LNs did not correlate with CT ground glass or fibrosis scores. Five patients who developed LNE between baseline and follow-up CT examinations had a greater increase in CT fibrosis scores than patients whose LNE status did not change (P = 0.004); CT ground glass scores were not significantly different. There was a trend for UIP patients to progress from absence of LNE to presence of LNE (4/20 patients or 20%). CONCLUSIONS Intrathoracic LNE is common in both UIP and NSIP, and becomes increasingly prevalent in UIP patients over time. LNE is more prevalent with more severe lung disease. An increase in LNE over time is associated with the progression of fibrosis, and should not raise concern for co-existing infection or malignancy, in the absence of other clinical findings that would suggest this.
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Affiliation(s)
- Anil K Attili
- Division of Thoracic Radiology, Department of Radiology, University of Michigan Medical School, Ann Arbor, MI 48109-0326, USA
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Idiopathic Pulmonary Fibrosis. Proceedings of the 1st Annual Pittsburgh International Lung Conference. October 2002. Am J Respir Cell Mol Biol 2003; 29:S1-105. [PMID: 12936907 DOI: 10.1165/rcmb.2003-0159su] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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