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Bankier AA, MacMahon H, Colby T, Gevenois PA, Goo JM, Leung AN, Lynch DA, Schaefer-Prokop CM, Tomiyama N, Travis WD, Verschakelen JA, White CS, Naidich DP. Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2024; 310:e232558. [PMID: 38411514 PMCID: PMC10902601 DOI: 10.1148/radiol.232558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 02/28/2024]
Abstract
Members of the Fleischner Society have compiled a glossary of terms for thoracic imaging that replaces previous glossaries published in 1984, 1996, and 2008, respectively. The impetus to update the previous version arose from multiple considerations. These include an awareness that new terms and concepts have emerged, others have become obsolete, and the usage of some terms has either changed or become inconsistent to a degree that warranted a new definition. This latest glossary is focused on terms of clinical importance and on those whose meaning may be perceived as vague or ambiguous. As with previous versions, the aim of the present glossary is to establish standardization of terminology for thoracic radiology and, thereby, to facilitate communications between radiologists and clinicians. Moreover, the present glossary aims to contribute to a more stringent use of terminology, increasingly required for structured reporting and accurate searches in large databases. Compared with the previous version, the number of images (chest radiography and CT) in the current version has substantially increased. The authors hope that this will enhance its educational and practical value. All definitions and images are hyperlinked throughout the text. Click on each figure callout to view corresponding image. © RSNA, 2024 Supplemental material is available for this article. See also the editorials by Bhalla and Powell in this issue.
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Affiliation(s)
- Alexander A. Bankier
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Heber MacMahon
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Thomas Colby
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Pierre Alain Gevenois
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Jin Mo Goo
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Ann N.C. Leung
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - David A. Lynch
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Cornelia M. Schaefer-Prokop
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Noriyuki Tomiyama
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - William D. Travis
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Johny A. Verschakelen
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Charles S. White
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - David P. Naidich
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
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Kusmirek JE, Meyer CA. High-Resolution Computed Tomography of Cystic Lung Disease. Semin Respir Crit Care Med 2022; 43:792-808. [PMID: 36252611 DOI: 10.1055/s-0042-1755565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The cystic lung diseases (CLD) are characterized by the presence of multiple, thin-walled, air-filled spaces in the pulmonary parenchyma. Cyst formation may occur with congenital, autoimmune, inflammatory, infectious, or neoplastic processes. Recognition of cyst mimics such as emphysema and bronchiectasis is important to prevent diagnostic confusion and unnecessary evaluation. Chest CT can be diagnostic or may guide the workup based on cyst number, distribution, morphology, and associated lung, and extrapulmonary findings. Diffuse CLD (DCLDs) are often considered those presenting with 10 or more cysts. The more commonly encountered DCLDs include lymphangioleiomyomatosis, pulmonary Langerhans' cell histiocytosis, lymphoid interstitial pneumonia, Birt-Hogg-Dubé syndrome, and amyloidosis/light chain deposition disease.
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Affiliation(s)
- Joanna E Kusmirek
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cristopher A Meyer
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Li M, Zhu WY, Wang J, Yang XD, Li WM, Wang G. Diagnostic performance of VEGF-D for lymphangioleiomyomatosis: a meta-analysis. J Bras Pneumol 2022; 48:e20210337. [PMID: 35293487 PMCID: PMC8964149 DOI: 10.36416/1806-3756/e20210337] [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: 08/19/2021] [Accepted: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: VEGF-D is a potential biomarker for lymphangioleiomyomatosis (LAM); however, its diagnostic performance has yet to be systematically studied. Methods: We searched PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library to identify primary studies on VEGF-D in relation to the diagnosis of LAM. The quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Summary estimates of diagnostic accuracy were pooled using a bivariate random effects model. Subgroup and sensitivity analyses were performed to explore possible heterogeneity. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was applied to rate the quality of evidence and indicate the strength of recommendations. Results: Ten studies involving 945 patients were of high risk in quality, as assessed using the QUADAS-2. The pooled diagnostic parameters were indicated as follows: sensitivity = 0.82 (95% CI, 0.71-0.90); specificity = 0.98 (95% CI, 0.94-0.99); and diagnostic OR = 197 (95% CI, 66-587). The AUC of summary ROC analysis was 0.98. The subgroup and sensitivity analyses revealed that the overall performance was not substantially affected by the composition of the control group, prespecified cutoff value, the country of origin, or different cutoff values (p > 0.05 for all). A strong recommendation for serum VEGF-D determination to aid in the diagnosis of LAM was made according to the GRADE. Conclusions: VEGF-D seems to have great potential implications for the diagnosis of LAM in clinical practice due to its excellent specificity and suboptimal sensitivity.
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Affiliation(s)
- Min Li
- . Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China.,. Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China.,. Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, China
| | - Wen-Ye Zhu
- . Department of Pharmacy, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ji Wang
- . Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China.,. Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, China.,. Pulmonology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Dong Yang
- . Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Wei-Min Li
- . Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China.,. Respiratory Microbiome Laboratory, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, China
| | - Gang Wang
- . Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China.,. Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, China
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Uncommon radiologic computed tomography appearances of the chest in patients with lymphangioleiomyomatosis. Sci Rep 2021; 11:7170. [PMID: 33785773 PMCID: PMC8010110 DOI: 10.1038/s41598-021-85999-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/09/2021] [Indexed: 01/16/2023] Open
Abstract
Lymphangioleiomyomatosis (LAM) is a rare destructive lung disease characterized by multiple thin-walled pulmonary cysts. The currently proposed diagnostic algorithm emphasizes the characteristic cystic appearance on high-resolution computed tomography (HRCT) so uncommon HRCT appearances present challenges to establishing the proper LAM diagnosis. The objective of this study is to accrue uncommon chest HRCT appearances, determine frequencies in both tuberous sclerosis complex (TSC)-associated LAM (TSC-LAM) and sporadic LAM (S-LAM) patients. 311 females referred to our hospital, including 272 S-LAM patients (mean age 39.2 years) and 39 TSC-LAM patients (mean age 38.3 years), were retrospectively evaluated. We found 2 types of radiologic findings likely to make HRCT cyst appearance atypical: characteristics of the cyst itself and uncommon findings in addition to cysts. We found that approximately 80% of LAM patients, whether TSC-associated or sporadic, showed typical HRCT appearance with mild to severe cystic destruction. The remaining 20% displayed unusual profiles in cyst appearance as well as additional findings aside from cyst: the former includes large cyst, thickened walls, and irregularly shaped whereas the latter includes ground glass attenuation and diffuse noncalcified nodules. It is important to be aware of various radiologic findings that make HRCT cystic appearance atypical of LAM.
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Arango-Díaz A, Martínez-de-Alegría-Alonso A, Baleato-González S, García-Figueiras R, Ecenarro-Montiel A, Trujillo-Ariza MV, Lama-López A. CT findings of pulmonary cysts. Clin Radiol 2021; 76:548.e1-548.e12. [PMID: 33741130 DOI: 10.1016/j.crad.2021.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 02/11/2021] [Indexed: 12/14/2022]
Abstract
Pulmonary cysts are thin-walled radiolucent lesions that may appear in a variety of uncommon disorders known as diffuse cystic lung diseases (DCLD) that essentially includes lymphangioleiomyomatosis (LAM), Langerhans cell histiocytosis (LCH), lymphocytic interstitial pneumonia (LIP), Pneumocystis jiroveci pneumonia (PJP), and Birt-Hogg-Dubé syndrome (BHDS). Moreover, they have been reported in several cases of coronavirus disease 2019 (COVID-19). The purpose of this review is to provide a practical approach for evaluating lung cysts when encountered on CT. We describe the imaging findings of DLCD emphasising their differences in terms of shape and distribution of the cysts, as well as their association with other findings such as nodules or ground-glass opacities, which may help in making a confident diagnosis. We also discuss the link between pulmonary cysts and COVID-19.
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Affiliation(s)
- A Arango-Díaz
- Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, Spain.
| | - A Martínez-de-Alegría-Alonso
- Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, Spain
| | - S Baleato-González
- Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, Spain
| | - R García-Figueiras
- Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, Spain
| | - A Ecenarro-Montiel
- Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, Spain
| | - M V Trujillo-Ariza
- Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, Spain
| | - A Lama-López
- Department of Pulmonology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, Spain
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Fleming H, Clifford SM, Haughey A, MacDermott R, McVeigh N, Healy GM, Lavelle L, Abbara S, Murphy DJ, Fabre A, McKone E, McCarthy C, Butler M, Doran P, Lynch DA, Keane MP, Dodd JD. Differentiating combined pulmonary fibrosis and emphysema from pure emphysema: utility of late gadolinium-enhanced MRI. Eur Radiol Exp 2020; 4:61. [PMID: 33141269 PMCID: PMC7641295 DOI: 10.1186/s41747-020-00187-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/01/2020] [Indexed: 11/16/2022] Open
Abstract
Background Differentiating combined pulmonary fibrosis with emphysema (CPFE) from pure emphysema can be challenging on high-resolution computed tomography (HRCT). This has antifibrotic therapy implications. Methods Twenty patients with suspected CPFE underwent late gadolinium-enhanced (LGE) thoracic magnetic resonance imaging (LGE-MRI) and HRCT. Data from twelve healthy control subjects from a previous study who underwent thoracic LGE-MRI were included for comparison. Quantitative LGE signal intensity (SI) was retrospectively compared in regions of fibrosis and emphysema in CPFE patients to similar lung regions in controls. Qualitative comparisons for the presence/extent of reticulation, honeycombing, and traction bronchiectasis between LGE-MRI and HRCT were assessed by two readers in consensus. Results There were significant quantitative differences in fibrosis SI compared to emphysema SI in CPFE patients (25.8, IQR 18.4–31.0 versus 5.3, IQR 5.0–8.1, p < 0.001). Significant differences were found between LGE-MRI and HRCT in the extent of reticulation (12.5, IQR 5.0–20.0 versus 25.0, IQR 15.0–26.3, p = 0.038) and honeycombing (5.0, IQR 0.0–10.0 versus 20.0, IQR 10.6–20.0, p = 0.001) but not traction bronchiectasis (10.0, IQR 5–15 versus 15.0, IQR 5–15, p = 0.878). Receiver operator curve analysis of fibrosis SI compared to similarly located regions in control subjects showed an area under the curve of 0.82 (p = 0.002). A SI cutoff of 19 yielded a sensitivity of 75% and specificity of 86% in differentiating fibrosis from similarly located regions in control subjects. Conclusion LGE-MRI can differentiate CPFE from pure emphysema and may be a useful adjunct test to HRCT in patients with suspected CPFE.
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Affiliation(s)
- Hannah Fleming
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Simon M Clifford
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Aoife Haughey
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Roisin MacDermott
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Niall McVeigh
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Gerard M Healy
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Lisa Lavelle
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Suhny Abbara
- Department of Radiology, UT Southwestern Hospital, Dallas, TX, USA
| | - David J Murphy
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Aurelie Fabre
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Pathology, St. Vincent's University Hospital, Dublin, Ireland
| | - Edward McKone
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Cormac McCarthy
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Marcus Butler
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Peter Doran
- UCD Clinical Research Center, University College Dublin, Dublin, Ireland
| | - David A Lynch
- Department of Radiology, National Jewish Medical and Research Center, Denver, CO, USA
| | - Michael P Keane
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Jonathan D Dodd
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. .,School of Medicine, University College Dublin, Dublin, Ireland.
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7
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Characteristics of primary Sjögren's syndrome related lymphocytic interstitial pneumonia. Clin Rheumatol 2020; 40:601-612. [PMID: 32613392 PMCID: PMC7327216 DOI: 10.1007/s10067-020-05236-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/29/2020] [Accepted: 06/10/2020] [Indexed: 12/03/2022]
Abstract
Objective This paper is aimed at investigating the clinical characteristics of primary Sjogren’s syndrome (pSS) with lymphocytic interstitial pneumonia (LIP). Methods The demographic data, clinical manifestations, laboratory and radiological findings, treatment, and prognosis from 15 cases of pSS-LIP patients were retrospectively analyzed. The data were compared with t test, χ2 test, and Pearson/Spearman correlation analysis. Results (1) Fifteen cases of patients with pSS-LIP are all females (100%). Compared with pSS with interstitial lung disease(pSS-ILD) patients, the incidence of dry cough, dental caries is higher in pSS-LIP patients. The incidence of shortness of breath, weight loss, and crackles is lower in pSS-LIP patients than that of pSS-ILD patients. (2) Compared with pSS-ILD patients, pSS-LIP patients had higher percentage of patients with ANA, anti-SSA52KD antibody, anti-SSA60KD antibody, and anti-SSB antibody, and the higher concentration of serum globulin. (3) Compared with pSS-ILD patients, the frequency of obstructive ventilation dysfunction is significantly higher and the frequency of diffusion dysfunction is significantly lower in pSS-LIP patients. (4) The most frequent HRCT findings in patients with pSS-LIP is cysts (100%), followed by ground-glass opacities (73.3%), nodular shadow (73.3%) among the pSS-LIP patients. Compared with PSS-ILD patients, the incidence of pulmonary nodule shadow is significantly higher in PSS-LIP patients, while that of grid shadow was significantly lower. (5) Compared with the baseline, the sum of the number, maximum diameter, and diameter of cysts in three levels of pSS-LIP patients showed an increasing trend after treatment. (6) Correlation analysis: The changes of ground-glass opacities were positively correlated with using GC or not, and those were negatively correlated with the dose of GC treatment. Besides, there is a positive correlation between the annual change rate of the maximum diameter of cysts (△Ømax1/t) and the use of CTX; there is a positive correlation between the annual change rate of the total diameter of cysts (△Øsum1/t) and the use of CTX. Conclusion To the patients of pSS-LIP, female were more common than male, and the onset of LIP was usually more insidious. Hyperglobulinemia and anti-SSA antibody were more prominent in patients with pSS-LIP. Pulmonary function showed the higher rate of obstructive ventilation dysfunction and the lower rate of diffusion dysfunction. The appearance of ground-glass opacities in pSS-LIP patients suggests that the infiltration of inflammatory cells increases, which may cause airway compression, the expansion of terminal bronchioles, and the formation of cysts. The more ground-glass opacities appear earlier, and the more appearance of new cysts later. Therapy with glucocorticoid may be effective on the ground-glass opacity during acute stage, and therapy with cyclophosphamide may be effective on the cysts during chronic stage. The heavier ground-glass opacity is at baseline, the more likely it will recur during maintenance treatment. So follow-up closely is needed.Key Points • It is the first clinical study with more cases of patients with pSS-LIP. • Female and hyperglobulinemia and anti-SSA antibody were more prominent in patients with pSS-LIP. • Pulmonary function showed the higher rate of obstructive ventilation dysfunction and the lower rate of diffusion dysfunction. • Therapy with glucocorticoid may be effective on the ground-glass opacity during acute stage, and therapy with cyclophosphamide may be effective on the cysts during chronic stage. |
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8
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Aquilina G, Caltabiano DC, Galioto F, Cancemi G, Pino F, Vancheri A, Vancheri C, Foti PV, Mauro LA, Basile A. Cystic Interstitial Lung Diseases: A Pictorial Review and a Practical Guide for the Radiologist. Diagnostics (Basel) 2020; 10:diagnostics10060346. [PMID: 32471113 PMCID: PMC7345690 DOI: 10.3390/diagnostics10060346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 01/30/2023] Open
Abstract
A cyst is a round circumscribed area of low attenuation, surrounded by epithelial or fibrous wall. Cysts can frequently occur on chest computed tomography (CT) and high-resolution computed tomography (HRCT); multiple parenchymal cysts of the lungs are the most typical feature of cystic lung interstitial diseases, characterizing a wide spectrum of diseases—ranging from isolated lung disorders up to diffuse pulmonary diseases. The aim of this review is to analyze scientific literature about cystic lung interstitial diseases and to provide a practical guide for radiologists, focusing on the main morphological features of pulmonary cysts: size, shape, borders, wall, location, and distribution. These features are shown on free-hand drawings and related to HRCT images, in order to help radiologists pursue the correct differential diagnosis between similar conditions.
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Affiliation(s)
- Giulia Aquilina
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—Radiology Unit I. University hospital “Policlinico-Vittorio Emanuele” Via Santa Sofia 78, 95123 Catania, Italy; (F.G.); (G.C.); (P.V.F.); (A.B.)
- Correspondence: (G.A.); (L.A.M.); Tel.: +39-34-2700-2249 (G.A.)
| | | | - Federica Galioto
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—Radiology Unit I. University hospital “Policlinico-Vittorio Emanuele” Via Santa Sofia 78, 95123 Catania, Italy; (F.G.); (G.C.); (P.V.F.); (A.B.)
| | - Giovanna Cancemi
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—Radiology Unit I. University hospital “Policlinico-Vittorio Emanuele” Via Santa Sofia 78, 95123 Catania, Italy; (F.G.); (G.C.); (P.V.F.); (A.B.)
| | - Fabio Pino
- Department of Clinical and Experimental Medicine, University of Catania, Regional Referral Centre for Rare Lung Disease, 95123 Catania, Italy; (F.P.); (A.V.); (C.V.)
| | - Ada Vancheri
- Department of Clinical and Experimental Medicine, University of Catania, Regional Referral Centre for Rare Lung Disease, 95123 Catania, Italy; (F.P.); (A.V.); (C.V.)
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, University of Catania, Regional Referral Centre for Rare Lung Disease, 95123 Catania, Italy; (F.P.); (A.V.); (C.V.)
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—Radiology Unit I. University hospital “Policlinico-Vittorio Emanuele” Via Santa Sofia 78, 95123 Catania, Italy; (F.G.); (G.C.); (P.V.F.); (A.B.)
| | - Letizia Antonella Mauro
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—Radiology Unit I. University hospital “Policlinico-Vittorio Emanuele” Via Santa Sofia 78, 95123 Catania, Italy; (F.G.); (G.C.); (P.V.F.); (A.B.)
- Correspondence: (G.A.); (L.A.M.); Tel.: +39-34-2700-2249 (G.A.)
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”—Radiology Unit I. University hospital “Policlinico-Vittorio Emanuele” Via Santa Sofia 78, 95123 Catania, Italy; (F.G.); (G.C.); (P.V.F.); (A.B.)
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9
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Chung JH. Is the Cyst-Airway Communicating Index a Possible Tool to Differentiate Cystic Lung Diseases? Radiol Cardiothorac Imaging 2020; 2:e200100. [PMID: 33779630 PMCID: PMC7977724 DOI: 10.1148/ryct.2020200100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Jonathan H. Chung
- From the Department of Radiology, The University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL 60637
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10
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Role of thoracic imaging in the management of lymphangioleiomyomatosis. Respir Med 2019; 157:14-20. [PMID: 31470185 DOI: 10.1016/j.rmed.2019.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 12/17/2022]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare diffuse lung cystic disease (DLCD) that occurs sporadically or in association with Tuberous Sclerosis Complex (TSC). The diagnostic pathway is tracked on the identification of the disease hallmarks on chest High-Resolution Computed Tomography (HRCT). Aim of this review is to discuss the thoracic HRCT pathognomonic features, essential to rule out other DLCD. It also examines the new evidences emerging from Computed Tomography (CT) quantitative studies that, by demonstrating a specific cysts distribution and a pathological aspect of the parenchyma near the cysts, could improve our understanding of this rare disorder and supply pulmonologists with a new tool for a more appropriate long-term management. Finally, the contribution of other image techniques as low dose chest CT, Magnetic Resonance Imaging (MRI) and Ultrasound (US) is discussed.
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11
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Chest Computed Tomographic Image Screening for Cystic Lung Diseases in Patients with Spontaneous Pneumothorax Is Cost Effective. Ann Am Thorac Soc 2017; 14:17-25. [PMID: 27737563 DOI: 10.1513/annalsats.201606-459oc] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Patients without a known history of lung disease presenting with a spontaneous pneumothorax are generally diagnosed as having primary spontaneous pneumothorax. However, occult diffuse cystic lung diseases such as Birt-Hogg-Dubé syndrome (BHD), lymphangioleiomyomatosis (LAM), and pulmonary Langerhans cell histiocytosis (PLCH) can also first present with a spontaneous pneumothorax, and their early identification by high-resolution computed tomographic (HRCT) chest imaging has implications for subsequent management. OBJECTIVES The objective of our study was to evaluate the cost-effectiveness of HRCT chest imaging to facilitate early diagnosis of LAM, BHD, and PLCH. METHODS We constructed a Markov state-transition model to assess the cost-effectiveness of screening HRCT to facilitate early diagnosis of diffuse cystic lung diseases in patients presenting with an apparent primary spontaneous pneumothorax. Baseline data for prevalence of BHD, LAM, and PLCH and rates of recurrent pneumothoraces in each of these diseases were derived from the literature. Costs were extracted from 2014 Medicare data. We compared a strategy of HRCT screening followed by pleurodesis in patients with LAM, BHD, or PLCH versus conventional management with no HRCT screening. MEASUREMENTS AND MAIN RESULTS In our base case analysis, screening for the presence of BHD, LAM, or PLCH in patients presenting with a spontaneous pneumothorax was cost effective, with a marginal cost-effectiveness ratio of $1,427 per quality-adjusted life-year gained. Sensitivity analysis showed that screening HRCT remained cost effective for diffuse cystic lung diseases prevalence as low as 0.01%. CONCLUSIONS HRCT image screening for BHD, LAM, and PLCH in patients with apparent primary spontaneous pneumothorax is cost effective. Clinicians should consider performing a screening HRCT in patients presenting with apparent primary spontaneous pneumothorax.
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12
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Gupta N, Finlay GA, Kotloff RM, Strange C, Wilson KC, Young LR, Taveira-DaSilva AM, Johnson SR, Cottin V, Sahn SA, Ryu JH, Seyama K, Inoue Y, Downey GP, Han MK, Colby TV, Wikenheiser-Brokamp KA, Meyer CA, Smith K, Moss J, McCormack FX. Lymphangioleiomyomatosis Diagnosis and Management: High-Resolution Chest Computed Tomography, Transbronchial Lung Biopsy, and Pleural Disease Management. An Official American Thoracic Society/Japanese Respiratory Society Clinical Practice Guideline. Am J Respir Crit Care Med 2017; 196:1337-1348. [PMID: 29140122 DOI: 10.1164/rccm.201709-1965st] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recommendations regarding key aspects related to the diagnosis and pharmacological treatment of lymphangioleiomyomatosis (LAM) were recently published. We now provide additional recommendations regarding four specific questions related to the diagnosis of LAM and management of pneumothoraces in patients with LAM. METHODS Systematic reviews were performed and then discussed by a multidisciplinary panel. For each intervention, the panel considered its confidence in the estimated effects, the balance of desirable (i.e., benefits) and undesirable (i.e., harms and burdens) consequences, patient values and preferences, cost, and feasibility. Evidence-based recommendations were then formulated, written, and graded using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. RESULTS For women who have cystic changes on high-resolution computed tomography of the chest characteristic of LAM, but who have no additional confirmatory features of LAM (i.e., clinical, radiologic, or serologic), the guideline panel made conditional recommendations against making a clinical diagnosis of LAM on the basis of the high-resolution computed tomography findings alone and for considering transbronchial lung biopsy as a diagnostic tool. The guideline panel also made conditional recommendations for offering pleurodesis after an initial pneumothorax rather than postponing the procedure until the first recurrence and against pleurodesis being used as a reason to exclude patients from lung transplantation. CONCLUSIONS Evidence-based recommendations for the diagnosis and treatment of patients with LAM are provided. Frequent reassessment and updating will be needed.
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13
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Abstract
INTRODUCTION Lymphangioleiomyomatosis (LAM) is a destructive lung disease affecting primarily women. LAM is caused by inactivating mutations in the tuberous sclerosis complex (TSC) genes, resulting in hyperactivation of mechanistic/mammalian target of rapamycin complex 1 (mTORC1). Over the past five years, there have been remarkable advances in the diagnosis and therapy of LAM, including the identification of vascular endothelial growth factor D (VEGF-D) as a diagnostic biomarker and the US Food and Drug Administration approval of sirolimus as therapy for LAM. In appropriate clinical situations VEGF-D testing can make lung biopsy unnecessary to diagnose LAM. However, there remains an urgent unmet need for additional biomarkers of disease activity and/or response to therapy. Areas covered: This work reviews VEGF-D, an established LAM biomarker, and discusses emerging biomarkers, including circulating LAM cells, imaging, lipid, and metabolite biomarkers, focusing on those with the highest potential impact for LAM patients. Expert commentary: Ongoing research priorities include the development of validated biomarkers to 1) noninvasively diagnose LAM in women whose VEGF-D levels are not diagnostic, 2) accurately predict the likelihood of disease progression and 3) quantitatively measure disease activity and LAM cell burden. These biomarkers would enable personalized, precision clinical care and fast-track clinical trial implementation, with high clinical impact.
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Affiliation(s)
- Julie Nijmeh
- a Pulmonary and Critical Care Medicine, Department of Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston , MA , USA
| | - Souheil El-Chemaly
- a Pulmonary and Critical Care Medicine, Department of Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston , MA , USA
| | - Elizabeth P Henske
- a Pulmonary and Critical Care Medicine, Department of Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston , MA , USA
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14
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Mittal S, Jain A, Arava S, Hadda V, Mohan A, Guleria R, Madan K. A 26-year-old man with dyspnea and chest pain. Lung India 2017; 34:562-566. [PMID: 29099006 PMCID: PMC5684818 DOI: 10.4103/lungindia.lungindia_111_17] [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] [Indexed: 11/08/2022] Open
Abstract
A 26-year-old smoker male presented with a history of sudden onset dyspnea and right-sided chest pain. Chest radiograph revealed large right-sided pneumothorax which was managed with tube thoracostomy. High-resolution computed tomography thorax revealed multiple lung cysts, and for a definite diagnosis, a video-assisted thoracoscopic surgery-guided lung biopsy was performed followed by pleurodesis. This clinicopathologic conference discusses the clinical and radiological differential diagnoses, utility of lung biopsy, and management options for patients with such a clinical presentation.
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Affiliation(s)
- Saurabh Mittal
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Akanksha Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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15
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Pathologic and Radiologic Correlation of Adult Cystic Lung Disease: A Comprehensive Review. PATHOLOGY RESEARCH INTERNATIONAL 2017; 2017:3502438. [PMID: 28270943 PMCID: PMC5320373 DOI: 10.1155/2017/3502438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/11/2016] [Accepted: 12/18/2016] [Indexed: 12/17/2022]
Abstract
The presence of pulmonary parenchymal cysts on computed tomography (CT) imaging presents a significant diagnostic challenge. The diverse range of possible etiologies can usually be differentiated based on the clinical setting and radiologic features. In fact, the advent of high-resolution CT has facilitated making a diagnosis solely on analysis of CT image patterns, thus averting the need for a biopsy. While it is possible to make a fairly specific diagnosis during early stages of disease evolution by its characteristic radiological presentation, distinct features may progress to temporally converge into relatively nonspecific radiologic presentations sometimes necessitating histological examination to make a diagnosis. The aim of this review study is to provide both the pathologist and the radiologist with an overview of the diseases most commonly associated with cystic lung lesions primarily in adults by illustration and description of pathologic and radiologic features of each entity. Brief descriptions and characteristic radiologic features of the various disease entities are included and illustrative examples are provided for the common majority of them. In this article, we also classify pulmonary cystic disease with an emphasis on the pathophysiology behind cyst formation in an attempt to elucidate the characteristics of similar cystic appearances seen in various disease entities.
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16
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Sabri YY, Fouad MA, Assal HAH, Abdullah HE. Cystic lesions in multislice computed tomography of the chest: A diagnostic approach. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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17
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Sabri YY, Ibrahim IMH, Ahmed HM, Assal HH. Role of high resolution computed tomography (HRCT) of the chest in the diagnosis of lymphangioleiomyomatosis (LAM) – A serial study of 15 patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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18
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Raoof S, Bondalapati P, Vydyula R, Ryu JH, Gupta N, Raoof S, Galvin J, Rosen MJ, Lynch D, Travis W, Mehta S, Lazzaro R, Naidich D. Cystic Lung Diseases: Algorithmic Approach. Chest 2016; 150:945-965. [PMID: 27180915 DOI: 10.1016/j.chest.2016.04.026] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 02/16/2016] [Accepted: 04/06/2016] [Indexed: 12/14/2022] Open
Abstract
Cysts are commonly seen on CT scans of the lungs, and diagnosis can be challenging. Clinical and radiographic features combined with a multidisciplinary approach may help differentiate among various disease entities, allowing correct diagnosis. It is important to distinguish cysts from cavities because they each have distinct etiologies and associated clinical disorders. Conditions such as emphysema, and cystic bronchiectasis may also mimic cystic disease. A simplified classification of cysts is proposed. Cysts can occur in greater profusion in the subpleural areas, when they typically represent paraseptal emphysema, bullae, or honeycombing. Cysts that are present in the lung parenchyma but away from subpleural areas may be present without any other abnormalities on high-resolution CT scans. These are further categorized into solitary or multifocal/diffuse cysts. Solitary cysts may be incidentally discovered and may be an age related phenomenon or may be a remnant of prior trauma or infection. Multifocal/diffuse cysts can occur with lymphoid interstitial pneumonia, Birt-Hogg-Dubé syndrome, tracheobronchial papillomatosis, or primary and metastatic cancers. Multifocal/diffuse cysts may be associated with nodules (lymphoid interstitial pneumonia, light-chain deposition disease, amyloidosis, and Langerhans cell histiocytosis) or with ground-glass opacities (Pneumocystis jirovecii pneumonia and desquamative interstitial pneumonia). Using the results of the high-resolution CT scans as a starting point, and incorporating the patient's clinical history, physical examination, and laboratory findings, is likely to narrow the differential diagnosis of cystic lesions considerably.
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Affiliation(s)
| | | | | | | | - Nishant Gupta
- Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati
| | | | - Jeff Galvin
- Department of Radiology, University of Maryland
| | - Mark J Rosen
- Pulmonary, Critical Care and Sleep Medicine, North Shore University Hospital
| | - David Lynch
- Department of Radiology, National Jewish Health
| | - William Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | | | - Richard Lazzaro
- Department of Thoracic Surgery, Lenox Hill Hospital, Northwell Health
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19
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Ahuja J, Kanne JP, Meyer CA, Pipavath SNJ, Schmidt RA, Swanson JO, Godwin JD. Histiocytic disorders of the chest: imaging findings. Radiographics 2016; 35:357-70. [PMID: 25763722 DOI: 10.1148/rg.352140197] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Histiocytic disorders of the chest comprise a broad spectrum of diseases. The lungs may be involved in isolation or as part of systemic disease. Some of these disorders are primary and have unknown etiology, and others result from a histiocytic response to a known cause. Among primary histiocytic disorders, pulmonary Langerhans cell histiocytosis (PLCH) is the most common; others include Erdheim-Chester disease and Rosai-Dorfman disease. Adult PLCH occurs almost exclusively in adults aged 20-40 years who smoke. Pediatric PLCH is extremely rare and typically occurs as part of multisystemic disease. Erdheim-Chester disease affects middle-aged and older adults; thoracic involvement usually occurs as part of systemic disease. Rosai-Dorfman disease affects children and young adults and manifests as painless cervical lymphadenopathy. Examples of secondary histiocytic disorders are storage diseases such as Gaucher disease, Niemann-Pick disease, and Fabry disease; pneumoconiosis such as silicosis and coal workers' pneumoconiosis; and infections such as Whipple disease and malakoplakia. These disorders are characterized at histopathologic examination on the basis of infiltration of alveoli or the pulmonary interstitium by histiocytes, which are a group of cells that includes macrophages and dendritic cells. Dendritic cells are a heterogeneous group of nonphagocytic antigen-presenting immune cells. Immunohistochemical markers help to distinguish among various primary histiocytic disorders. Characteristic radiologic findings in the appropriate clinical context may obviate biopsy to establish a correct diagnosis. However, in the absence of these findings, integration of clinical, pathologic, and radiologic features is required to establish a diagnosis.
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Affiliation(s)
- Jitesh Ahuja
- From the Departments of Radiology (J.A., S.N.J.P., J.O.S., J.D.G.) and Pathology (R.A.S.), University of Washington, 1959 NE Pacific St, UW Mailbox 357115, Seattle, WA 98195; and Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, Wis (J.P.K., C.A.M.)
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20
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Ferreira Francisco FA, Soares Souza A, Zanetti G, Marchiori E. Multiple cystic lung disease. Eur Respir Rev 2015; 24:552-64. [DOI: 10.1183/16000617.0046-2015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Multiple cystic lung disease represents a diverse group of uncommon disorders that can present a diagnostic challenge due to the increasing number of diseases associated with this presentation. High-resolution computed tomography of the chest helps to define the morphological aspects and distribution of lung cysts, as well as associated findings. The combination of appearance upon imaging and clinical features, together with extrapulmonary manifestations, when present, permits confident and accurate diagnosis of the majority of these diseases without recourse to open-lung biopsy. The main diseases in this group that are discussed in this review are lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis and folliculin gene-associated syndrome (Birt–Hogg–Dubé); other rare causes of cystic lung disease, including cystic metastasis of sarcoma, are also discussed. Disease progression is unpredictable, and understanding of the complications of cystic lung disease and their appearance during evolution of the disease are essential for management. Correlation of disease evolution and clinical context with chest imaging findings provides important clues for defining the underlying nature of cystic lung disease, and guides diagnostic evaluation and management.
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21
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High-Resolution Computed Tomography in the Diagnosis of Diffuse Parenchymal Lung Diseases: Is it Possible to Improve Radiologist's Performance? J Comput Assist Tomogr 2015; 40:248-55. [PMID: 26571061 DOI: 10.1097/rct.0000000000000344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to assess the concordance between high-resolution computed tomography (HRCT) diagnostic hypotheses (DH) and final diagnosis in patients with diffuse lung disease and to evaluate whether clinical data or the radiologist's degree of certainty influence concordance. METHODS Concordances between first and any one of radiologists' DH and final diagnosis were assessed before and after access to clinical data, with study of importance of degree of certainty in the DH formulated. RESULTS Concordances of HRCT DH and final diagnosis were 48% and 76%, respectively, considering first or any of the DH without access to clinical data. Accessing clinical data improved concordance especially for hypersensitivity pneumonitis. Diagnostic hypotheses formulated with high degree of confidence were correct in 69% of cases. CONCLUSIONS First HRCT DH was concordant with final diagnosis in approximately half of cases, increasing to approximately 75% when considering any 1 of the 3 DH. Radiologists' knowledge of clinical data or increased degree of certainty improved concordance of HRCT DH and the final diagnosis.
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22
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Sverzellati N, Lynch DA, Hansell DM, Johkoh T, King TE, Travis WD. American Thoracic Society-European Respiratory Society Classification of the Idiopathic Interstitial Pneumonias: Advances in Knowledge since 2002. Radiographics 2015; 35:1849-71. [PMID: 26452110 DOI: 10.1148/rg.2015140334] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In the updated American Thoracic Society-European Respiratory Society classification of the idiopathic interstitial pneumonias (IIPs), the major entities have been preserved and grouped into (a) "chronic fibrosing IIPs" (idiopathic pulmonary fibrosis and idiopathic nonspecific interstitial pneumonia), (b) "smoking-related IIPs" (respiratory bronchiolitis-associated interstitial lung disease and desquamative interstitial pneumonia), (c) "acute or subacute IIPs" (cryptogenic organizing pneumonia and acute interstitial pneumonia), and (d) "rare IIPs" (lymphoid interstitial pneumonia and idiopathic pleuroparenchymal fibroelastosis). Furthermore, it has been acknowledged that a final diagnosis is not always achievable, and the category "unclassifiable IIP" has been proposed. The diagnostic interpretation of the IIPs is often challenging because other diseases with a known etiology (most notably, connective tissue disease and hypersensitivity pneumonitis) may show similar morphologic patterns. Indeed, more emphasis has been given to the integration of clinical, computed tomographic (CT), and pathologic findings for multidisciplinary diagnosis. Typical CT-based morphologic patterns are associated with the IIPs, and radiologists play an important role in diagnosis and characterization. Optimal CT quality and a systematic approach are both pivotal for evaluation of IIP. Interobserver variation for the various patterns encountered in the IIPs is an issue. It is important for radiologists to understand the longitudinal behavior of IIPs at serial CT examinations, especially for providing a framework for cases that are unclassifiable or in which a histologic diagnosis cannot be obtained.
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Affiliation(s)
- Nicola Sverzellati
- From the Section of Diagnostic Imaging, Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43100 Parma, Italy (N.S.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Royal Brompton Hospital, London, England (D.M.H.); Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan (T.J.); Department of Medicine, University of California-San Francisco, San Francisco, Calif (T.E.K.); and Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.)
| | - David A Lynch
- From the Section of Diagnostic Imaging, Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43100 Parma, Italy (N.S.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Royal Brompton Hospital, London, England (D.M.H.); Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan (T.J.); Department of Medicine, University of California-San Francisco, San Francisco, Calif (T.E.K.); and Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.)
| | - David M Hansell
- From the Section of Diagnostic Imaging, Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43100 Parma, Italy (N.S.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Royal Brompton Hospital, London, England (D.M.H.); Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan (T.J.); Department of Medicine, University of California-San Francisco, San Francisco, Calif (T.E.K.); and Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.)
| | - Takeshi Johkoh
- From the Section of Diagnostic Imaging, Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43100 Parma, Italy (N.S.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Royal Brompton Hospital, London, England (D.M.H.); Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan (T.J.); Department of Medicine, University of California-San Francisco, San Francisco, Calif (T.E.K.); and Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.)
| | - Talmadge E King
- From the Section of Diagnostic Imaging, Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43100 Parma, Italy (N.S.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Royal Brompton Hospital, London, England (D.M.H.); Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan (T.J.); Department of Medicine, University of California-San Francisco, San Francisco, Calif (T.E.K.); and Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.)
| | - William D Travis
- From the Section of Diagnostic Imaging, Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43100 Parma, Italy (N.S.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Royal Brompton Hospital, London, England (D.M.H.); Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan (T.J.); Department of Medicine, University of California-San Francisco, San Francisco, Calif (T.E.K.); and Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.)
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23
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Kligerman SJ, Henry T, Lin CT, Franks TJ, Galvin JR. Mosaic Attenuation: Etiology, Methods of Differentiation, and Pitfalls. Radiographics 2015; 35:1360-80. [PMID: 26274445 DOI: 10.1148/rg.2015140308] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mosaic attenuation is a commonly encountered pattern on computed tomography that is defined as heterogeneous areas of differing lung attenuation. This heterogeneous pattern of attenuation is the result of diverse causes that include diseases of the small airways, pulmonary vasculature, alveoli, and interstitium, alone or in combination. Small airways disease can be a primary disorder, such as respiratory bronchiolitis or constrictive bronchiolitis, or be part of parenchymal lung disease, such as hypersensitivity pneumonitis, or large airways disease, such as bronchiectasis and asthma. Vascular causes resulting in mosaic attenuation are typically chronic thromboembolic pulmonary hypertension, which is characterized by organizing thrombi in the elastic pulmonary arteries, or pulmonary arterial hypertension, a heterogeneous group of diseases affecting the distal pulmonary arterioles. Diffuse ground-glass opacity can result in a mosaic pattern related to a number of processes in acute (eg, infection, pulmonary edema), subacute (eg, organizing pneumonia), or chronic (eg, fibrotic diseases) settings. Imaging clues that can assist the radiologist in pinpointing a diagnosis include evidence of large airway involvement, cardiovascular abnormalities, septal thickening, signs of fibrosis, and demonstration of airtrapping at expiratory imaging.
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Affiliation(s)
- Seth J Kligerman
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
| | - Travis Henry
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
| | - Cheng T Lin
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
| | - Teri J Franks
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
| | - Jeffrey R Galvin
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
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24
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Gupta N, Meraj R, Tanase D, James LE, Seyama K, Lynch DA, Akira M, Meyer CA, Ruoss SJ, Burger CD, Young LR, Almoosa KF, Veeraraghavan S, Barker AF, Lee AS, Dilling DF, Inoue Y, Cudzilo CJ, Zafar MA, McCormack FX. Accuracy of chest high-resolution computed tomography in diagnosing diffuse cystic lung diseases. Eur Respir J 2015; 46:1196-9. [PMID: 26160866 DOI: 10.1183/13993003.00570-2015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/06/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Nishant Gupta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Riffat Meraj
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Daniel Tanase
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Laura E James
- Research Dept, Shriners Hospital for Children - Cincinnati, Cincinnati, OH, USA
| | - Kuniaki Seyama
- Dept of Respiratory Medicine, Juntendo University, Tokyo, Japan
| | - David A Lynch
- Dept of Radiology, National Jewish Health, Denver, CO, USA
| | - Masanori Akira
- Dept of Radiology, National Kinki-Chuo Chest Medical Center, Osaka, Japan
| | | | - Stephen J Ruoss
- Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Charles D Burger
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Lisa R Young
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Khalid F Almoosa
- Division of Critical Care Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Srihari Veeraraghavan
- Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, Atlanta, GA, USA
| | - Alan F Barker
- Division of Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR, USA
| | - Augustine S Lee
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Yoshikazu Inoue
- Dept of Diffuse Lung Diseases and Respiratory Failure, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Corey J Cudzilo
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Muhammad A Zafar
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Francis X McCormack
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
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25
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Koelsch TL, Chung JH, Lynch DA. Radiologic Evaluation of Idiopathic Interstitial Pneumonias. Clin Chest Med 2015; 36:269-82, ix. [DOI: 10.1016/j.ccm.2015.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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WU KAI, LU HUIYU. Sporadic lymphangioleiomyomatosis with bloody sputum as an initial symptom: A case report and review of the literature. Exp Ther Med 2015; 9:2159-2164. [DOI: 10.3892/etm.2015.2397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 03/20/2015] [Indexed: 11/06/2022] Open
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27
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Kilincer A, Ariyurek OM, Karabulut N. Cystic lung disease in birt-hogg-dubé syndrome: a case series of three patients. Eurasian J Med 2015; 46:138-41. [PMID: 25610314 DOI: 10.5152/eajm.2014.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/18/2013] [Indexed: 11/22/2022] Open
Abstract
Birt-Hogg-Dubé syndrome is characterized by clinical manifestations such as hamartomas of the skin, renal tumors and lung cysts with spontaneous pneumothoraces. Patients with Birt-Hogg-Dubé syndrome may present with only multiple lung cysts. We report the chest computerized tomography (CT) features of three patients with Birt-Hogg-Dubé syndrome. Each patient had multiple lung cysts of various sizes according to chest CT evaluation, most of which were located in lower lobes and related to pleura. The identification of unique characteristics in the chest CT of patients with Birt-Hogg-Dubé syndrome may provide an efficient mechanism for diagnosis.
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Affiliation(s)
- Abidin Kilincer
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Orhan Macit Ariyurek
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nevzat Karabulut
- Department of Radiology, Pamukkale University Hospital, Denizli, Turkey
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28
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Kadoch MA, Cham MD, Beasley MB, Ward TJ, Jacobi AH, Eber CD, Padilla ML. Idiopathic interstitial pneumonias: a radiology-pathology correlation based on the revised 2013 American Thoracic Society-European Respiratory Society classification system. Curr Probl Diagn Radiol 2014; 44:15-25. [PMID: 25512168 DOI: 10.1067/j.cpradiol.2014.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/05/2014] [Accepted: 07/22/2014] [Indexed: 01/15/2023]
Abstract
The idiopathic interstitial pneumonias (IIPs) are a group of diffuse lung diseases that share many similar radiologic and pathologic features. According to the revised 2013 American Thoracic Society-European Respiratory Society classification system, these entities are now divided into major IIPs (idiopathic pulmonary fibrosis, idiopathic nonspecific interstitial pneumonia, respiratory bronchiolitis-associated interstitial lung disease, desquamative interstitial pneumonia, cryptogenic organizing pneumonia, and acute interstitial pneumonia), rare IIPs (idiopathic lymphoid interstitial pneumonia, idiopathic pleuroparenchymal fibroelastosis), and unclassifiable idiopathic interstitial pneumonias. Some of the encountered radiologic and histologic patterns can also be seen in the setting of other disorders, which makes them a diagnostic challenge. As such, the accurate classification of IIPs remains complex and is best approached through a collaboration among clinicians, radiologists, and pathologists, as the treatment and prognosis of these conditions vary greatly.
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Affiliation(s)
- Michael A Kadoch
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Matthew D Cham
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mary B Beasley
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Thomas J Ward
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adam H Jacobi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Corey D Eber
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maria L Padilla
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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29
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Abbey P, Narula MK, Anand R, Chandra J. Persistent pulmonary interstitial emphysema in a case of Langerhans cell histiocytosis. Indian J Radiol Imaging 2014; 24:121-4. [PMID: 25024518 PMCID: PMC4094960 DOI: 10.4103/0971-3026.134386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 10-month-old boy with multisystem Langerhans cell histiocytosis showing thin-walled lung cysts along with computed tomography (CT) evidence of persistent pulmonary interstitial emphysema (PPIE), in the absence of pneumothorax or pneumomediastinum. Follow-up CT performed after 6 months demonstrated complete resolution of interstitial emphysema.
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Affiliation(s)
- Pooja Abbey
- Department of Radio-Diagnosis, Medical College and Associated Hospitals, New Delhi, India
| | - Mahender K Narula
- Department of Radio-Diagnosis, Medical College and Associated Hospitals, New Delhi, India
| | - Rama Anand
- Department of Radio-Diagnosis, Medical College and Associated Hospitals, New Delhi, India
| | - Jagdish Chandra
- Department of Pediatrics, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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30
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Castoldi MC, Verrioli A, De Juli E, Vanzulli A. Pulmonary Langerhans cell histiocytosis: the many faces of presentation at initial CT scan. Insights Imaging 2014; 5:483-92. [PMID: 24996395 PMCID: PMC4141336 DOI: 10.1007/s13244-014-0338-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 12/22/2022] Open
Abstract
Objectives Pulmonary Langerhans cell histiocytosis (PLCH) is a rare interstitial granulomatous disease that usually affects young adults who are smokers. Chest computed tomography (CT) allows a confident diagnosis of PLCH only in typical presentation, when nodules, cavitated nodules and cysts coexist and predominate in the upper and middle lungs. Methods This article includes a pictorial essay of typical and atypical presentations of PLCH at initial chest CT. Various appearances of PLCH are illustrated and possible differential diagnosis is discussed. Results PLCH can present with some aspecific features that may cause diagnosis of the initial disease to be overlooked or other pulmonary diseases to be suspected. In cases of nodule presentation alone, the main differential diagnosis should include lung metastasis, tuberculosis and other infections, sarcoidosis, silicosis and Wegener’s disease. In cases of cysts alone, the most common diseases to be differentiated are centrilobular emphysema and lymphangiomyomatosis. Clinical symptoms are usually non-specific, although a history of cigarette smoking, coupled with the presence of typical or suggestive findings at imaging, is key to suspecting the disease. Atypical presentations require surgical biopsy for diagnosis. Conclusions The radiologist should be familiar with PLCH imaging features to correctly diagnose the disease or need for further investigation. Teaching Points • PLCH is a rare interstitial smoking-related disease that usually affects young adults. • The typical first CT shows a mix of nodules, cavitary nodules and cysts in the upper-middle lungs. • Atypical appearance, either cysts or nodules alone, mandates that other diagnoses be considered. • Lung cystic involvement correlates with lung function abnormalities and predicts functional decline. • Integration of the clinical history and imaging results is key to diagnosis.
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Affiliation(s)
- M C Castoldi
- Department of Radiology, Ospedale CTO, via Bignami 1, 20162, Milan, Italy,
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31
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Smoking Related Interstitial Lung Disease - High Resolution Computed Tomography (HRCT) findings in 40 smokers. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2013.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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32
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Jawad H, Walker CM, Wu CC, Chung JH. Cystic Interstitial Lung Diseases: Recognizing the Common and Uncommon Entities. Curr Probl Diagn Radiol 2014; 43:115-27. [DOI: 10.1067/j.cpradiol.2014.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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33
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Affiliation(s)
- Matthew Gillott
- Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC
| | - Brian Flemming
- Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC
| | - James G Ravenel
- Department of Radiology and Radiologic Sciences, Medical University of South Carolina, Charleston, SC.
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Abstract
Idiopathic interstitial pneumonias (IIPs) are a group of disorders with distinct histologic and radiologic appearances and no identifiable cause. The IIPs comprise 8 currently recognized entities. Each of these entities demonstrates a prototypical imaging and histologic pattern, although in practice the imaging patterns may overlap, and some interstitial pneumonias are not classifiable. To be considered an IIP, the disease must be idiopathic; however, each pattern may be secondary to a recognizable cause, most notably collagen vascular disease, hypersensitivity pneumonitis, or drug reactions. The diagnosis of IIP requires the correlation of clinical, imaging, and pathologic features.
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35
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Bano S, Chaudhary V, Narula MK, Anand R, Venkatesan B, Mandal S, Majumdar K. Pulmonary Langerhans cell histiocytosis in children: A spectrum of radiologic findings. Eur J Radiol 2014; 83:47-56. [DOI: 10.1016/j.ejrad.2013.04.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 03/19/2013] [Accepted: 04/11/2013] [Indexed: 01/29/2023]
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36
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Ryu JH, Tian X, Baqir M, Xu K. Diffuse cystic lung diseases. Front Med 2013; 7:316-27. [PMID: 23666611 DOI: 10.1007/s11684-013-0269-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 03/28/2013] [Indexed: 12/16/2022]
Abstract
Diffuse cystic lung diseases are uncommon but can present a diagnostic challenge because increasing number of diseases have been associated with this presentation. Cyst in the lung is defined as a round parenchymal lucency with a well-defined thin wall (< 2 mm thickness). Focal or multifocal cystic lesions include blebs, bullae, pneumatoceles, congenital cystic lesions, traumatic lesions, and several infectious processes such as coccidioidomycosis, Pneumocystis jiroveci pneumonia, and hydatid disease. "Diffuse" distribution in the lung implies involvement of all lobes. Diffuse lung involvement with cystic lesions can be seen in pulmonary lymphangioleiomyomatosis, pulmonary Langerhans' cell histiocytosis, lymphoid interstitial pneumonia, Birt-Hogg-Dubé syndrome, amyloidosis, light chain deposition disease, honeycomb lung associated with advanced fibrosis, and several other rare causes including metastatic disease. High-resolution computed tomography of the chest helps define morphologic features of the lung lesions as well as their distribution and associated features such as intrathoracic lymphadenopathy. Correlating the tempo of the disease process and clinical context with chest imaging findings serve as important clues to defining the underlying nature of the cystic lung disease and guide diagnostic evaluation as well as management.
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Affiliation(s)
- Jay H Ryu
- Mayo Clinic, Division of Pulmonary and Critical Care Medicine, Rochester, MN 55905, USA.
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Tobino K, Hirai T, Johkoh T, Kurihara M, Fujimoto K, Tomiyama N, Mishima M, Takahashi K, Seyama K. Differentiation between Birt–Hogg–Dubé syndrome and lymphangioleiomyomatosis: Quantitative analysis of pulmonary cysts on computed tomography of the chest in 66 females. Eur J Radiol 2012; 81:1340-6. [DOI: 10.1016/j.ejrad.2011.03.039] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 03/04/2011] [Accepted: 03/11/2011] [Indexed: 10/18/2022]
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38
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Jawad H, Chung JH, Lynch DA, Newell JD. Radiological approach to interstitial lung disease: a guide for the nonradiologist. Clin Chest Med 2012; 33:11-26. [PMID: 22365242 DOI: 10.1016/j.ccm.2012.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Articles in the past have described the radiological appearances of different interstitial lung diseases (ILDs) in varying levels of detail. However, these articles have generally been written for radiologists with a background in basic chest computed tomography (CT) interpretation. This article summarizes a basic approach for diagnosing ILDs on high-resolution CT (HRCT) for the nonradiologist clinician and discusses the most common HRCT features of common ILDs.
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Affiliation(s)
- Hamza Jawad
- Division of Radiology, National Jewish Health, Denver, CO 80206, USA
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Kanne JP. Idiopathic Interstitial Pneumonias. CLINICALLY ORIENTED PULMONARY IMAGING 2012. [PMCID: PMC7120217 DOI: 10.1007/978-1-61779-542-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The idiopathic interstitial pneumonias are a distinct group of clinicopathologic entities. High-resolution computed tomography (HRCT) plays a critical role in the evaluation and management of patients. In the appropriate clinical setting, characteristic HRCT findings may be diagnostic, obviating the need for open lung biopsy. In more challenging or complicated cases, consensus among the clinician, radiologist, and pathologist may be required. This chapter describes and depicts the characteristic HRCT features of usual interstitial pneumonia, nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, respiratory bronchiolitis, respiratory bronchiolitis associated interstitial lung disease, desquamative interstitial pneumonia, and lymphoid interstitial pneumonia.
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Affiliation(s)
- Jeffrey P. Kanne
- , Cardiothoracic Radiology, University of Wisconsin Hospital and Cli, 600 Highland Ave., Madison, 53792 USA
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[CT imaging of chronic interstitial lung diseases: from diagnosis to automated quantification]. Rev Mal Respir 2011; 28:1207-15. [PMID: 22152930 DOI: 10.1016/j.rmr.2011.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 04/02/2011] [Indexed: 12/31/2022]
Abstract
Computed tomography is important for the diagnosis and follow-up of chronic diffuse interstitial lung diseases. Image quality has improved from each generation of scanner to the next and this continues to allow a better characterization of extent of pathology, or even the nature of the pathological process (potentially reversible inflammatory lesions compared to fibrotic lesions). The diagnostic imaging approach has evolved at the same time as technological developments. We initially thought in terms of the predominant lesions (nodular, alveolar consolidation, ground-glass opacity), and then moved to reasoning based on patterns, which are a combination of several elementary lesions (typically for the diagnosis of idiopathic pulmonary fibrosis). Nowadays, studies are focused on building models characterizing a specific disease and which combine several distinct patterns (typically for ground-glass opacity analysis). CT also allows a quantification of the extent of lung disease, which is linked to the prognosis of the disease and helps to monitor its progression. This quantification is usually based on visual criteria, the principles of which are summarized here. The development of automated quantification software could in the near future, be a support for the radiologist.
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Abstract
In the last decade, significant progress has been made toward a better understanding of interstitial lung disease (ILD). A valuable tool for the clinician is high-resolution computed tomography, which aids in narrowing the differential diagnosis in patients with ILD and obviates the need for surgical lung biopsy when a usual interstitial pneumonia pattern is present. Clinicians evaluating and caring for patients with ILD need to recognize associated comorbidities. Substantial evidence shows that implementation of a multidisciplinary approach provides a high standard of care for patients, leading to improvements in the accuracy of clinical diagnosis that can significantly affect patient outcome.
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Affiliation(s)
- Esam H Alhamad
- Division of Pulmonary Medicine, College of Medicine, King Saud University, Riyadh 11461, KS, USA.
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Utility of spiral CAT scan in the follow-up of patients with pulmonary Langerhans cell histiocytosis. Eur J Radiol 2011; 81:1907-12. [PMID: 21549535 DOI: 10.1016/j.ejrad.2011.04.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 04/06/2011] [Indexed: 11/23/2022]
Abstract
Pulmonary Langerhans cell histiocytosis (PLCH) is a rare disease that occurs almost exclusively in smokers, generally young adults between 20 and 40 years old. Prognostic biomarkers of the disease are lacking. This study describes the clinical-radiological features of a group of PLCH patients and applies a semi-quantitative CT score of the chest to verify the prognostic value of radiological findings in this disease. Clinical-radiological and immunological data from 12 Caucasian patients (6M, 7 smokers and 5 ex-smokers, mean age 36±8 years) were recorded at onset and after a follow-up period of 4 years. Application of the semi-quantitative CT score revealed a prevalently cystic pattern at onset and follow-up in the majority of the patients. Patients with a prevalently nodular pattern developed cystic lesions during follow-up. Interestingly, significant correlations were found between the extent of cystic lesions and DLCO values at onset (time 0: p<0.05) and at the end of follow-up (time 1, p<0.05) and with FEV1 values at time 0 (p<0.05) and time 1 (p<0.05). Patients with progressive functional decline were those with CT evidence of severe cystic alterations. The results suggest that high resolution CT scan of the chest is mandatory for characterizing PLCH patients at diagnosis and during follow-up. The proposed CT score of the chest showed potential prognostic value.
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Harari S, Torre O, Moss J. Lymphangioleiomyomatosis: what do we know and what are we looking for? Eur Respir Rev 2011; 20:34-44. [PMID: 21357890 PMCID: PMC3386525 DOI: 10.1183/09059180.00011010] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Lymphangioleiomyomatosis (LAM) is a rare disease characterised by proliferation of abnormal smooth muscle-like cells (LAM cells) leading to progressive cystic destruction of the lung, lymphatic abnormalities and abdominal tumours. It affects predominantly females and can occur sporadically or in patients with tuberous sclerosis complex. This review describes the recent progress in our understanding of the molecular pathogenesis of the disease and LAM cell biology. It also summarises current therapeutic approaches and the most promising areas of research for future therapeutic strategies.
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Affiliation(s)
- S. Harari
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria – Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare Ospedale San Giuseppe, Milan, Italy. Translational Medicine Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.,S. Harari, Unità di Pneumologia e Terapia Semi-Intensiva Respiratoria, Ospedale San Giuseppe, via San Vittore 12, 20123 Milan, Italy. E-mail:
| | - O. Torre
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria – Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare Ospedale San Giuseppe, Milan, Italy. Translational Medicine Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - J. Moss
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria – Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare Ospedale San Giuseppe, Milan, Italy. Translational Medicine Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Ansótegui Barrera E, Mancheño Franch N, Vera-Sempere F, Padilla Alarcón J. Lymphangioleiomyomatosis. Arch Bronconeumol 2011; 47:85-93. [PMID: 21255897 DOI: 10.1016/j.arbres.2010.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 08/02/2010] [Accepted: 08/07/2010] [Indexed: 12/28/2022]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare disease that mainly affects women, particularly at fertile age. It is sporadic or associated with tuberous sclerosis complex. It is characterised by an abnormal proliferation of immature smooth muscle cells (SMC), which grow aberrantly in the airway, parenchyma, lymphatics and pulmonary blood vessels and which can gradually lead to respiratory failure. It affects several systems, affecting the lymphatic ganglia and causing abdominal tumours. Given its very low prevalence, a difficult to establish early diagnosis, absence of curative treatment and the difficulty in obtaining information, places LAM under the heading of the so-called Rare Diseases. There is a growing interest in the study of this disease which has led to the setting up of patient registers and an exponential growth in LAM research, both at a clinical level and cellular level.
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Maffessanti M, Dalpiaz G. Computed Tomography of Diffuse Lung Diseases and Solitary Pulmonary Nodules. PRACTICAL PULMONARY PATHOLOGY: A DIAGNOSTIC APPROACH 2011:27-89. [DOI: 10.1016/b978-1-4160-5770-3.00003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Beddy P, Babar J, Devaraj A. A practical approach to cystic lung disease on HRCT. Insights Imaging 2010; 2:1-7. [PMID: 22347931 PMCID: PMC3259352 DOI: 10.1007/s13244-010-0050-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 10/18/2010] [Accepted: 10/21/2010] [Indexed: 12/19/2022] Open
Abstract
A lung cyst is defined as a round parenchymal lucency or area of low attenuation with a thin wall. They are not uncommon findings on high-resolution (HR) thoracic computed tomography (CT) and when identified, they require explanation. The differential diagnosis for diseases characterised by lung cysts is broad ranging from isolated chest disorders to rare multisystem diseases. This article provides a practical approach for evaluating lung cysts on HRCT, highlighting disorders in which the HRCT findings can be diagnostic as well as conditions where correlation with clinical history or biopsy is required.
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The idiopathic interstitial pneumonias: understanding key radiological features. Clin Radiol 2010; 65:823-31. [DOI: 10.1016/j.crad.2010.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 03/18/2010] [Accepted: 03/22/2010] [Indexed: 12/21/2022]
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