Combined computed tomography (CT)/scintigraphy strategy may help in diagnostic dilemmas in interstitial lung disease (ILD)

Logistic regression analysis and a risk prediction model of pneumothorax after CT-guided needle biopsy

Background

Pneumothorax is the most common complication of computed tomography (CT)-guided needle biopsy. The purpose of this study was to investigate independent risk factors of pneumothorax, other than emphysema, after CT-guided needle biopsy and to establish a risk prediction model.

Methods

A total of 864 cases of CT-guided needle biopsy with an 18-gauge cutting needle were enrolled in this study. The relevant risk factors associated with pneumothorax included age, sex, emphysema, short-axis size of the lesion, depth of the lesion, body position, and the number of pleural punctures. Several independent risk factors of pneumothorax were found, and a predictive model for pneumothorax was established using univariate and multivariate logistic regression analyses.

Results

Pneumothorax occurred in 31.4% (271/864) of cases. Univariate analysis showed that significant risk factors of pneumothorax included age, emphysema, small lesion size, no contact between the lesion and the pleura, prone or lateral body position, and multiple punctures. Independent risk factors of pneumothorax in the multivariate logistic regression analysis included emphysema (P=0.000), no contact between the lesion and the pleura (P=0.000), prone or lateral body position (P=0.002), and the number of pleural punctures (P=0.000). The sensitivity, specificity, and accuracy of the predictive model for pneumothorax were 56.8%, 79.6%, and 72.5%, respectively.

Conclusions

Pneumothorax is a common complication of CT-guided lung biopsy. Independent risk factors of pneumothorax include emphysema, no contact between the lesion and the pleura, and prone or lateral body position. The predictive model developed in this study was highly accurate in predicting the incidence of pneumothorax.

CT findings of pulmonary nocardiosis: a report of 9 cases

Background

Pulmonary nocardiosis often occurs among immunocompromised patients, especially in those with impaired cell immunity related to AIDS and transplant. As the number of patients receiving transplant, the occurrence of pulmonary nocardiosis may also increase. Radiologic characteristics of this entity have not been well documented. In present study, CT findings of clinical confirmed pulmonary nocardiosis were retrospectively reviewed in order to understand CT features of pulmonary nocardiosis.

Methods

Electronic databases of Shenzhen People's Hospital, Shenzhen, China, and the Third People's Hospital of Longgang District, Shenzhen, China were searched for patients with definitive diagnosis of pulmonary nocardiosis and available CT images. Nine patients were founded and they were included in this retrospective analysis. Clinical presentations at diagnosis and related medical history were recorded. CT images were retrospectively reviewed by two radiologists in consensus.

Results

The patients consisted of seven men and two women with a median age of 47 years (range, 20-73 years). There were three immunocompromised patients and six immunocompetent patients. The latter included two patients had history of bronchiectasis. The symptoms at the diagnosis were nonspecific of fever, cough, sputum, dyspnea, chest pain, and hemoptysis. CT findings included: lung consolidation (n=8) with cavitation in three cases and foci of decreased enhancement in one patient who had contrast-enhanced CT, nodules/masses (n=6) with cavitation in two patients, ground-glass opacity (n=4), centrilobular nodules (n=4), pleural effusion (n=4), bronchiectasis (n=4), interlobular septal thickening (n=3), interlobular reticular opacity (n=3), lymph node enlargement (n=2), halo sign (n=2) and mucoid impaction (n=1).

Conclusions

Lung consolidation and nodules/masses are the most common findings, but CT findings of pulmonary nocardiosis are diverse and nonspecific. In some clinical background, such as immunocompromised patients or with some underlying lung diseases, consolidation or nodules/masses with cavitation may suggest the possibility of pulmonary nocardiosis.