Purpose: To evaluate whether the rapid rollover technique reduces new or enlarging pneumothorax after anterior or lateral approach CT-guided lung biopsy. Materials and Methods: A prospective, single-institution, multisite, RCT was undertaken after institutional review board approval. Patients with target lesions most amenable to the anterior/lateral approach were considered. Patients with extrapulmonary nodules, intraprocedural chest tube, or conditions that preclude safe repositioning were excluded. The primary outcome was new/enlarging pneumothorax on postbiopsy radiographs. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed. Secondary outcomes, including chest tube insertion rate and patient discomfort, were also analyzed. Results A total of 59 patients were recruited, with 28 randomized to the intervention arm and 31 to the control arm, without significant differences in patient demographics and risk factors. There were 8 cases or 13.6% of new/enlarging pneumothorax, 7 from the control arm and 1 from the intervention. One patient who developed pneumothorax in the intervention arm did not complete the maneuver. The difference in rates of new/enlarging pneumothorax was significant by both ITT and PP analyses ( P =0.03 and 0.009). Only 2 patients required chest tube insertion, 1 in the control group and 1 who crossed over to the control group. Multivariate analysis was performed in the ITT analysis, with intervention as an independent significant factor ( P =0.0463). There were no significant differences in terms of postbiopsy discomfort. Conclusions: This randomized controlled trial showed that, without an increase in patient discomfort, the rapid rollover technique reduced the risk of new or enlarging pneumothorax after CT-guided lung biopsy via an anterior/lateral approach. Level of Evidence: Level I—randomized controlled trial.
PURPOSE:To evaluate whether the rapid rollover technique reduces new or enlarging pneumothorax after anterior or lateral approach CT-guided lung biopsy. MATERIALS AND METHODS:A prospective, single-institution, multisite, RCT was undertaken after institutional review board approval. Patients with target lesions most amenable to the anterior/lateral approach were considered. Patients with extrapulmonary nodules, intraprocedural chest tube, or conditions that preclude safe repositioning were excluded. The primary outcome was new/enlarging pneumothorax on postbiopsy radiographs. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed. Secondary outcomes, including chest tube insertion rate and patient discomfort, were also analyzed. RESULTS:A total of 59 patients were recruited, with 28 randomized to the intervention arm and 31 to the control arm, without significant differences in patient demographics and risk factors. There were 8 cases or 13.6% of new/enlarging pneumothorax, 7 from the control arm and 1 from the intervention. One patient who developed pneumothorax in the intervention arm did not complete the maneuver. The difference in rates of new/enlarging pneumothorax was significant by both ITT and PP analyses (P=0.03 and 0.009). Only 2 patients required chest tube insertion, 1 in the control group and 1 who crossed over to the control group. Multivariate analysis was performed in the ITT analysis, with intervention as an independent significant factor (P=0.0463). There were no significant differences in terms of postbiopsy discomfort. CONCLUSIONS:This randomized controlled trial showed that, without an increase in patient discomfort, the rapid rollover technique reduced the risk of new or enlarging pneumothorax after CT-guided lung biopsy via an anterior/lateral approach. LEVEL OF EVIDENCE:Level I-randomized controlled trial.
PURPOSE:This study evaluated epicardial adipose tissue (EAT) distribution in patients with different heart failure (HF) subtypes using contrast-enhanced cardiac computed tomography (CT), and explores its impact on clinical parameters and prognosis. MATERIALS AND METHODS:We retrospectively analyzed 67 heart failure patients treated at our institution from January 2021 to December 2022. Patients were divided into: group A, heart failure with preserved ejection fraction (HFpEF, n=35); and group B, heart failure with mid-range and reduced ejection fraction (HFmrEF and HFrEF, n=32). In addition, 34 non-heart failure patients were included as controls (group C). Epicardial adipose tissue volume (EATV) and fat attenuation index (FAI) were measured using contrast-enhanced cardiac CT. RESULTS:Group A showed the highest EATV, while group B had lower EATV than controls (65.37±19.51 vs. 48.88±15.38 vs. 60.10±10.19 cm3, P<0.001). EAT correlated negatively with NT-proBNP in HFrEF/HFmrEF patients, but positively in HFpEF patients. Both HF groups had significantly higher FAI than controls, and FAI correlated positively with C-reactive protein levels. CONCLUSION:EAT accumulation associates with elevated NT-proBNP in HFpEF, while lower EAT suggests higher NT-proBNP in HFmrEF/HFrEF. Increased FAI in heart failure patients correlates with higher C-reactive protein levels.
Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality worldwide, affecting individuals outside health care settings. Streptococcus pneumoniae is the predominant pathogen, although regional and socioeconomic factors significantly influence epidemiology, resistance patterns, and outcomes. Diagnosis relies on clinical evaluation supported by imaging, microbiology, and biomarkers, yet presentations are highly variable across age groups and comorbidities. Chest radiography remains the cornerstone for initial assessment, while high-resolution CT (HRCT) offers superior sensitivity for early detection and complications. Typical bacterial pathogens (eg, S. pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae) produce lobar or bronchopneumonic consolidations, whereas atypical organisms (Mycoplasma, Chlamydia, Legionella) and viruses often yield diffuse ground-glass or interstitial patterns. Fungal and mycobacterial infections must also be considered, particularly in endemic regions. Radiologic-pathologic correlation is essential to differentiate CAP etiologies, guide management, and identify complications such as cavitation, empyema, or necrosis. Understanding these imaging patterns within global and clinical contexts is critical for improving diagnostic accuracy and optimizing patient outcomes.
PURPOSE:The purpose of this study is to document the long-term natural history of granulomatous-lymphocytic interstitial lung disease (GLILD), including evolving chest CT features and prevalence of pulmonary fibrosis at follow-up of patients with longstanding disease. MATERIALS AND METHODS:This retrospective longitudinal study compares the CT features of GLILD in a cohort of patients with at least 2 chest CTs performed >24 months apart. A radiologic database identified 22 patients (median age 45.8 years, 13 females and 9 males) with common variable immunodeficiency (CVID) and a clinico-radio-pathologic or clinico-radiologic diagnosis of GLILD. Two chest radiologists jointly reviewed the chronologically first (CT1) and last (CT2) available chest CT examinations for each subject, scoring the severity of different pulmonary nodule types, features of pulmonary fibrosis, ground-glass opacity, and consolidation. Total severity score (TSS) for each category of CT features at CT1 and CT2 was compared using the Wilcoxon signed-rank test. RESULTS:On follow-up averaging 135 months (range 33-235 months) from CT1, CT2 studies demonstrated significantly decreased nodule TSS (P=0.01), significantly increased fibrosis TSS (P=0.0001), and relatively stable ground-glass opacity TSS (P=0.81) and consolidation TSS (P=0.72). Nodule TSS decreased in 73% of patients, in which peribronchial nodules < or ≥10 mm and perilymphatic nodules < or ≥5 mm improved. Fibrosis TSS increased in 82% of patients who developed new or worsening traction bronchiectasis, architectural distortion, and honeycombing. CONCLUSION:CT features of GLILD evolve over time, with new or worsening fibrosis recognized in 82% of patients at long-term follow-up.
PURPOSE:To measure the computed tomography (CT) attenuation of acute pulmonary embolism (PE) and establish an upper Hounsfield unit (HU) threshold above which it is unlikely to occur. MATERIALS AND METHODS:This retrospective study analyzed CT pulmonary angiography (CTPA) exams in patients with acute PE (2018-2023) who had a prior negative CTPA in the preceding 2 weeks. Clot and artifact attenuation were measured on the positive and prior negative CTPA respectively. Analysis of variance with post hoc tests and linear regression analysis were performed to determine the effects of technical and other parameters on clot and artifact attenuation. RESULTS:A total of 60 patients were included, each with 1 record or a pair of CTPA exams, yielding 105 clots and 41 artifacts. Mean attenuation for acute PE was 50±40 HU, and for artifact was 110±146 HU. A threshold of 125 HU achieved 97% (102/105) sensitivity for acute PE below it and the same specificity for artifact above it. Specificity for acute PE below this threshold was 37% (15/41). Subsegmental clots had a lower attenuation than all other clots as a group. Kilovoltage peak (kVp) and proximal vessel attenuation were poor predictors of clot attenuation. CONCLUSIONS:Most acute PE demonstrated a CT attenuation ≤125 HU on standard CTPA, an upper threshold higher than previously reported, while artifacts demonstrated both lower and higher attenuation. An attenuation >125 HU on standard CTPA, favoring artifact rather than acute PE, may be a useful adjunct to morphologic differentiation between these entities.
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne viral infection that can rapidly progress to multiple organ failure with a high mortality rate. Pulmonary involvement has been reported, but the radiologic-pathologic correlation remains poorly understood. We report an autopsy-proven fatal case of SFTS in a 79-year-old man with pre-existing collagen vascular disease-associated interstitial lung disease. Serial chest computed tomography (CT) initially demonstrated subtle peripheral ground-glass opacities that progressively expanded over time. On the final CT examination obtained shortly before death, extensive bilateral consolidation with high attenuation on mediastinal window images was observed, suggestive of pulmonary hemorrhage. The patient developed severe thrombocytopenia, disseminated intravascular coagulation, and respiratory failure and died despite intensive treatment. Autopsy revealed diffuse pulmonary hemorrhage, alveolar septal thickening, focal diffuse alveolar damage with hyaline membrane formation, and prominent hemophagocytosis. Immunohistochemical staining demonstrated numerous SFTS virus-infected cells within the lung tissue. This case highlights the CT findings of pulmonary involvement in fatal SFTS and demonstrates a direct radiologic-pathologic correlation. Our findings suggest that cytokine storm and hemophagocytic syndrome play critical roles in the development of pulmonary hemorrhage and lung injury in SFTS.
PURPOSE:To evaluate the accuracy, radiation dose, and clinical feasibility of a high-pitch low-dose chest CT (Sa36LDCT) scanning protocol with calcium-aware reconstruction for coronary artery calcium scoring (CAC). MATERIALS AND METHODS:In this prospective study, 90 patients underwent both standard CAC scanning (Qr36CACS, 120 kVp) and Sa36LDCT (70 to 120 kVp, high-pitch, ATVS). CAC scoring was quantified as Agatston score, calcium volume, and equivalent mass. Risk stratification was assessed using Agatston categories. Agreement between protocols was evaluated using intraclass correlation coefficients, Bland-Altman analysis, and weighted kappa. Subgroup analyses were performed according to heart rate (≤75 vs. >75 bpm). Radiation dose and subjective image quality were also compared. RESULTS:CAC metrics showed no significant difference between protocols, with excellent agreement (ICC = 0.983 to 0.996). Subgroup analysis revealed that heart rate did not significantly influence CAC quantification or risk classification, with Agatston score ICC values of 0.98 for ≤75 bpm and 0.99 for >75 bpm, demonstrating similar accuracy in both subgroups. Radiation dose reduction was consistently observed across both subgroups, with Sa36LDCT reducing effective radiation dose by 62% (0.74 vs. 0.28 mSv, P < 0.001), without compromising image quality. Risk stratification based on Agatston categories showed near-perfect consistency across heart rate subgroups (weighted k = 0.957). CONCLUSION:High-pitch Sa36LDCT provides accurate and reliable CAC scoring equivalent to standard CAC scoring, with substantial radiation dose reduction and preserved image quality. The protocol's robustness across heart rate subgroups demonstrates its potential as a safe and practical approach for combined pulmonary and cardiovascular screening, pending validation in larger, more diverse populations.
PURPOSE:To investigate the clinical outcomes of acute Stanford type B intramural hematoma (TBIMH) without ulcer-like lesions following medical management and to identify predictors of disease progression. MATERIALS AND METHODS:A retrospective analysis was performed on patients with acute TBIMH without ulcer-like lesions who received medical management. Patients were categorized into progression and nonprogression groups based on 1-year follow-up computed tomography angiography (CTA). Disease progression was defined as aortic rupture, aortic dissection, aortic enlargement (≥5 mm), or hematoma thickening (≥3 mm), while nonprogression was defined as complete/partial resolution or retention of the hematoma. A multivariate analysis identified the predictors of disease progression, and Kaplan-Meier curves were used to compare survival outcomes. RESULTS:A total of 110 patients (mean age 55.9±10.5 y, 25 females) were included, with 21 patients (19.1%) showing disease progression. Multivariate analysis revealed that the maximum aortic diameter (MAD) (OR=7.6, P=0.003) and maximum CT value of the hematoma (CTmax) (OR=1.04, P=0.025) were independently associated with disease progression. The optimal cutoff values for MAD and CTmax were 40.0 mm (AUC: 0.69, sensitivity: 38.1%, specificity: 92.1%) and 71.9 HU (AUC: 0.68, sensitivity: 76.2%, specificity: 66.3%), respectively. When MAD and CTmax were combined, the AUC increased to 0.75 (sensitivity: 81.0%, specificity: 66.3%). CONCLUSION:A model based on MAD and CTmax effectively stratifies progression risk in TBIMH without ulcer-like lesions, facilitating early intervention in high-risk patients.
PURPOSE:To characterize longitudinal trends in clinical indications, technical quality, diagnostic outcomes, and demographic patterns of chest magnetic resonance imaging (MRI) at a US quaternary care center over 25 years. MATERIALS AND METHODS:This institutional review board-approved retrospective cohort study analyzed 3730 consecutive chest MRI examinations performed between August 2001 and April 2026 at a US quaternary care academic medical center. Clinical indications and technical quality assessment were extracted from radiology report narratives, normalized, and classified into 7 major categories. Differences in indication and diagnosis distributions between cohorts were evaluated using the χ2 test; age was compared using the independent-samples t test. RESULTS:A total of 3730 examinations were included (mean patient age 34.0 ± 23.4 y; 55.1% females). Annual volume peaked at 270 in 2012 with a resurgence to 172 in 2025. The share of vascular indications declined from 70.9% of early-era examinations (2001-2005) to 23.5% in the recent era (2020-2025), while oncologic indications increased from 10.9% to 36.8% (both P < 0.001). Confirmed aortic/vascular pathology fell from 17.3% to 2.1%; malignant diagnoses increased from 3.2% to 10.2% (P < 0.001). Documented motion artifact decreased from the early to recent era (5.3% vs. 3.3%; P = 0.046). CONCLUSIONS:Chest MRI utilization has shifted significantly over 25 years from predominantly vascular to oncology-driven indications, with stable diagnostic yield. Technical examination quality limitations were significantly more frequent during off-hours.
PURPOSE:To conduct a meta-analysis assessing the effectiveness of cine MRI in evaluating tumor invasion of the chest wall, using surgical and histopathologic analysis as the reference standard. MATERIALS AND METHODS:This systematic review and meta-analysis was conducted following the recommendations of the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Diagnostic Test Accuracy (PRISMA-DTA) guidelines. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD420250654330. RESULTS:Five prospective studies comprising 190 patients with suspected chest wall invasion were included. The pooled sensitivity of cine MRI for detecting chest wall invasion was 99% (95% CI: 34%-100%), with a specificity of 74% (95% CI: 64%-82%), a negative predictive value of 100% (95% CI: 52%-100%), and a positive predictive value of 50% (95% CI: 39%-61%). No substantial heterogeneity was observed across studies. CONCLUSIONS:Cine MRI showed high sensitivity and excellent negative predictive value for ruling out chest wall invasion in lung cancer. These findings suggest cine MRI may be a useful noninvasive tool for preoperative assessment, particularly in cases with inconclusive CT or static MRI; however, CIs were wide due to the limited evidence base. Conversely, when cine MRI suggests invasion, the modest specificity and positive predictive value highlight the importance of invasive confirmation before definitive therapeutic decisions. Further prospective, multicenter studies using standardized protocols are warranted to validate and expand its clinical application.
Purpose: To conduct a meta-analysis assessing the effectiveness of cine MRI in evaluating tumor invasion of the chest wall, using surgical and histopathologic analysis as the reference standard. Materials and Methods: This systematic review and meta-analysis was conducted following the recommendations of the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Diagnostic Test Accuracy (PRISMA-DTA) guidelines. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD420250654330. Results: Five prospective studies comprising 190 patients with suspected chest wall invasion were included. The pooled sensitivity of cine MRI for detecting chest wall invasion was 99% (95% CI: 34%-100%), with a specificity of 74% (95% CI: 64%-82%), a negative predictive value of 100% (95% CI: 52%-100%), and a positive predictive value of 50% (95% CI: 39%-61%). No substantial heterogeneity was observed across studies. Conclusions: Cine MRI showed high sensitivity and excellent negative predictive value for ruling out chest wall invasion in lung cancer. These findings suggest cine MRI may be a useful noninvasive tool for preoperative assessment, particularly in cases with inconclusive CT or static MRI; however, CIs were wide due to the limited evidence base. Conversely, when cine MRI suggests invasion, the modest specificity and positive predictive value highlight the importance of invasive confirmation before definitive therapeutic decisions. Further prospective, multicenter studies using standardized protocols are warranted to validate and expand its clinical application.
Purpose: Pulmonary vascular remodeling is a key factor in chronic obstructive pulmonary disease (COPD) progression, but noninvasive prognostic markers are limited. This study assessed whether the computed tomography (CT)-derived Nakata index, a measure of body surface area–adjusted pulmonary arterial cross-sectional area, predicts functional impairment in COPD patients. Materials and Methods: This retrospective cohort study included 82 COPD patients who underwent thoracic CT and six-minute walk testing (6MWT) from 2023 to 2025. Patients were divided into severely impaired (<334 m, n=18) and less impaired (≥334 m, n=64) groups based on 6MWT distance. Nakata index, pulmonary artery diameters, McGoon ratio, and echocardiographic parameters were evaluated. Multivariate logistic regression identified predictors of severe functional impairment, and receiver operating characteristic (ROC) analysis determined optimal thresholds. Results: Severely impaired patients had a higher Nakata index (395 vs. 330 mm 2 /m 2 , P <0.001) and larger left (21.5 vs. 19 mm, P =0.002) and right (22.2 vs. 20 mm, P =0.004) pulmonary artery diameters. Multivariate analysis identified elevated Nakata index (odds ratio: 1.0110, P =0.036), increased left pulmonary artery diameter (odds ratio: 1.3683, P =0.038), and enlarged left atrial diameter (odds ratio: 1.1075, P =0.015) as independent predictors of severe impairment. A Nakata index >373 mm 2 /m 2 showed optimal discriminatory performance (area under the curve: 0.791, sensitivity: 75%, and specificity: 72%). Conclusions: CT-derived Nakata index is independently associated with severe functional impairment in chronic obstructive pulmonary disease, offering superior discriminatory value over simple diameter measurements. This marker may enhance risk stratification and guide treatment strategies.
Purpose: Machine learning-based coronary computed tomography fractional flow reserve (CT-FFR) holds great potential for assessing coronary ischemic status. The current literature lacks a comprehensive description of the routine implementation of CT-FFR in real world. To investigate the clinical characteristics and acceptance of CT-FFR in clinical decision-making among Chinese patients and subsequently assess the diagnostic accuracy of invasive coronary angiography as the reference. Materials and Methods: In this retrospective single-center study, 4564 patients were included. In the first part, we conducted a baseline analysis of patients and their epicardial coronary arteries. Then, we analyzed hospitalization and revascularization in the context of application of CT-FFR, using logistic regression and Sankey diagrams. Finally, we performed a diagnostic analysis of 2718 vessels in 906 patients. Results: The baseline analysis included a total of 4564 patients. A statistically significant distinction was observed in the traditional risk factors for coronary heart disease between 2 groups with CT-FFR 0.8 cutoff values. Logistic regression analysis and Sankey plots revealed a association between CT-FFR ≤0.8 and subsequent hospitalization. Finally, a diagnostic analysis was performed on 2718 vessels, and the optimal diagnostic model efficacy was achieved by using a CT-FFR cutoff value of 0.8 in conjunction with stenosis ≥70% for CCTA. Conclusions: Our study provides evidence that machine learning-based CT-FFR values exhibit a probably positive correlation with individuals presenting high-risk factors for coronary artery disease. Furthermore, we observed a influence of CT-FFR on the clinical decisions made by physicians. The integration of CT-FFR and CCTA has the potential to enhance diagnostic efficacy.
Purpose: Although 16-cm wide-detector CT scanners with prospective ECG-gating enable coronary artery imaging within a single cardiac cycle at a low radiation dose, many institutions still rely on scanners with detector widths <16 cm. These scanners typically use retrospective scanning, resulting in higher radiation exposure. This study tests the feasibility of lowering the radiation dose of ECG-gated retrospective CCTA on 8-cm detector scanners to the level of prospective acquisition on 16-cm ones, using deep learning reconstruction (DLR). Materials and Methods: This study involved 83 low-dose (group A) and 62 routine-dose (group B) retrospective CCTA cases on an 8-cm detector scanner, with the low-dose protocol targeting a radiation level comparable to prospective acquisitions on 16-cm scanners. Groups Ref1 and Ref2 were used as the dose and image quality benchmarks. They consisted of prospective CCTA cases acquired on 16-cm scanners from a shared vendor, and were extracted from published studies. Specific subsets (A1/B1 and A2/B2) were selected from group A/B based on weight (55 to 75 kg) and HR (<75 bpm) to match Ref1 and Ref2. DLR was used for group A. Image quality was evaluated using signal-to-noise ratio (SNR) and subjective scoring. Results: No significant differences in demographics were noted among Ref1/A1/B1 or Ref2/A2/B2 (all P >0.05). CTDIvol for A1 was comparable to Ref1 (median: 13.6 mGy vs. 13.2 mGy, P >0.999), whereas A2 had lower CTDIvol than Ref2 (median: 13.3 mGy vs. 16.1 mGy, P =0.018). DLR improved SNRs in group A, with higher values than Ref and B (all P <0.05). With DLR, image quality scores were comparable between groups A and B (all P >0.05). Conclusion: DLR can lower the radiation dose in retrospective CCTA on 8-cm detector scanners to that of prospective CCTA on 16-cm ones, with non-inferior image quality.
IgG4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition characterized by IgG4-positive plasma cells, storiform fibrosis, obliterative phlebitis, and elevated serum IgG4 levels. Thoracic involvement commonly presents with mediastinal lymphadenopathy and peribronchovascular thickening, along with pulmonary abnormalities (nodules or masses, ground-glass opacities, fibrosis, consolidation, or cavities or cysts), pleural effusion or thickening, mediastinal or chest wall masses, and thoracic arteritis. Given the imaging overlap with other entities, a pattern-based approach is essential to narrow the differential diagnosis. Comprehensive radiologic evaluation across thoracic organs plays a pivotal role in early detection, timely treatment, and prevention of irreversible fibrosis.
Purpose: Benign metastasizing leiomyomatosis (BML) is a rare complication of uterine leiomyoma and most often develops following uterine surgery. Pulmonary BML usually follows a benign clinical course and is often encountered incidentally, but may manifest clinical symptoms or even hypoxic respiratory failure in patients with large tumor burdens. In this paper, we present the “air-cleft sign,” a potentially useful and previously unreported CT finding in pulmonary BML patients with larger pulmonary nodules. Materials and Methods: We queried the electronic medical record and picture archiving and communication system at our institution and identified a total of 7 cases of biopsy-confirmed pulmonary BML over the last 25 years. A team of 4 chest radiologists and a surgical pathologist reviewed these cases for key imaging and pathology findings. Results: All 7 patients in our cohort had a history of uterine surgery or intervention before developing lung nodules. Most of the patients had nodules that demonstrated either very slow growth or long-term stability. Six of these 7 patients had nodules containing crescentic or oblong-shaped air-density clefts, and we observed these air clefts mostly in the larger nodules (average diameter 63 mm). At pathology, the air clefts corresponded to normal entrapped respiratory epithelium and are thus distinct from true cavitation. Conclusions: Establishing a diagnosis of pulmonary BML is difficult, given the rarity of the disease. In this small cohort of patients with pulmonary BML, we report a previously undescribed finding, the air-cleft sign, which can potentially help radiologists recognize pulmonary BML in women with multiple pulmonary nodules.
Parasitic infections affect approximately two billion people globally, most commonly in developing countries in the tropics and subtropical regions. However, they are being seen in developed countries with increasing frequency due to immigration and travel. Many parasitic infections present with nonspecific and overlapping clinical findings, and many present with chest involvement. Thoracic manifestations of parasitic infection can be subdivided into 2 major categories: those that result in nondestructive-type physiological response with patchy, migratory, and transient pulmonary opacities, and those that undergo a locally destructive-type manifestation with lung cysts or linear tracts, smooth muscle denervation, chronic and recurrent inflammation, or even osseous destruction. Considering a third nontraditional category of parasitic infections that rarely result in thoracic pathology can be a useful diagnostic tool to broaden the differential diagnosis and assist the radiologist in considering additional pathogen disease patterns. Recognizing the temporal, zonal, and other classic thoracic manifestations in conjunction with the common systemic imaging findings can assist in accurate and timely diagnosis.
