The lung is an organ that is particularly susceptible to infection in the immunocompromised host. Patterns of involvement produced on the chest radiograph include (1) lobar or segmental consolidation; (2) nodules with rapid growth and/or cavitation; and (3) diffuse lung disease. There is a general correlation between the type of radiographic pattern and the microorganism producing the pneumonia. Invasive diagnostic procedures include needle aspiration, transbronchial, and open lung biopsy.

OBJECTIVE:The objective of our study was to review the classic direct and indirect angiographic signs of acute and chronic pulmonary embolism (PE) and correlate these findings with MDCT.CONCLUSION:CT and angiography have complementary roles in the accurate diagnosis of acute and chronic thromboembolic disease. Conventional angiography should be used as a problem-solving technique after CT angiography has been performed because CT angiography is less invasive.

Computed tomographic (CT) pulmonary angiography is becoming the standard of care at many institutions for the evaluation of patients with suspected pulmonary embolism. This pathologic condition, whether acute or chronic, causes both partial and complete intraluminal filling defects, which should have a sharp interface with intravascular contrast material. In acute pulmonary embolism that manifests as complete arterial occlusion, the affected artery may be enlarged. Partial filling defects due to acute pulmonary embolism are often centrally located, but when eccentrically located they form acute angles with the vessel wall. Chronic pulmonary embolism can manifest as complete occlusive disease in vessels that are smaller than adjacent patent vessels. Other CT pulmonary angiographic findings in chronic pulmonary embolism include evidence of recanalization, webs or flaps, and partial filling defects that form obtuse angles with the vessel wall. Factors that cause misdiagnosis of pulmonary embolism may be patient related, technical, anatomic, or pathologic. The radiologist needs to determine the quality of a CT pulmonary angiographic study and whether pulmonary embolism is present. If the quality of the study is poor, the radiologist should identify which pulmonary arteries have been rendered indeterminate and whether additional imaging is necessary.

The American Thoracic Society and the European Respiratory Society 2002 classification defines the histologic patterns that provide the basis for a clinico-radiologic-pathologic diagnosis of an idiopathic interstitial pneumonia. Idiopathic pulmonary fibrosis is the clinical term for usual interstitial pneumonia, the characteristic histologic pattern is interstitial fibrosis with temporal heterogeneity, and the radiologic pattern is basal and subpleural areas of ground-glass and reticular attenuation and honeycomb pattern. Nonspecific interstitial pneumonia has cellular or fibrosing patterns of chronic inflammation with temporal homogeneity; the radiologic pattern is subpleural and basal areas of ground-glass and reticular attenuation. Lymphoid interstitial pneumonia results from lymphocyte interstitial infiltration; CT demonstrates ground-glass attenuation and nodular interlobular septal thickening. Respiratory bronchiolitis-associated interstitial lung disease is characterized by bronchiolocentric alveolar macrophage accumulation; CT shows centrilobular ground-glass attenuation. Desquamative interstitial pneumonia is characterized by alveolar macrophage accumulation with predominantly lower zone ground-glass attenuation seen on CT scans. Cryptogenic organizing pneumonia is characterized radiologically by peribronchial ground-glass attenuation and subpleural consolidation. Acute interstitial pneumonia is the clinical term for idiopathic diffuse alveolar damage; the exudative phase is characterized radiologically by diffuse ground-glass attenuation and dependent consolidation, with the additional feature of lung architectural distortion in the organizing phase. Ideally, diagnosis of an idiopathic interstitial pneumonia should be rendered only after all clinico-radiologic-pathologic data have been reviewed.

provide information concerning the physiology of lung cancer imaging with fluorodeoxyglucose (FDG) positron emission tomography (PET)

PURPOSETo study factors that may influence pneumothorax and chest tube placement rate, especially needle dwell time and pleural puncture angle.MATERIALS AND METHODSIn 159 patients, 160 coaxial computed tomography (CT)-guided lung biopsies were performed. Dwell time, the time between pleural puncture and needle removal, was calculated. The smallest angle of the needle with the pleura ("needle-pleural angle") was measured. These and other variables were correlated with pneumothorax and chest tube rates.RESULTSOne hundred fifty biopsies were included. There were 58 (39%) pneumothoraces (14 noted only at CT), with eight (5%) biopsies resulting in chest tube placement. Longer dwell times (mean, 29 minutes; range, 12-66 minutes) did not correlate with pneumothoraces (P =.81). Smaller needle-pleural angles (< 80 degrees) [corrected], decreased forced expiratory volume in 1 second to vital capacity ratio (<50%), lateral pleural puncture, and lesions along fissures were associated with higher [corrected] pneumothorax rates (P <.05). Emphysema along the needle path, pulmonary function tests showing ventilatory obstruction, and lesions along fissures predisposed patients to chest tube placement (P <.05). Pleural thickening and prior surgery were associated with lower pneumothorax rates (P <.05).CONCLUSIONLonger dwell times do not correlate with pneumothorax and should not influence the decision to obtain more biopsy samples. A shallow pleural puncture angle may increase the pneumothorax rate.

HomeRadiologyVol. 220, No. 2 PreviousNext Letters to the EditorPneumothorax Rate during CT-guided Lung BiopsiesUzma Alam, Rachna Punjabi, Mark S. RzeszotarskiUzma Alam, Rachna Punjabi, Mark S. RzeszotarskiAuthor AffiliationsDepartment of Radiology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109-1998, e-mail: [email protected]Uzma AlamRachna PunjabiMark S. RzeszotarskiPublished Online:Aug 1 2001https://doi.org/10.1148/radiology.220.2.r01au48554MoreSectionsFull textPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In References 1 Ko JP, Shepard JO, Drucker EA, et al. Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors?. Radiology 2001; 218:491-496. Link, Google ScholarArticle HistoryPublished in print: Aug 2001 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 220, No. 2 Metrics Altmetric Score PDF download

The Challenges Facing Radiology EducationMark GoldsheinAudio Available | Share

Lung cancer is the leading cause of cancer mortality in the United States. Imaging is helpful in the diagnosis of peripheral lung cancers and in the staging of lung neoplasms. CT may establish the benign nature of a solitary pulmonary nodule by detecting either benign types of calcification or fat. Contrast enhancement is a new and innovative method that can be used to distinguish benign from malignant peripheral lung lesions. Both CT and MR play important roles in the preoperative staging of lung carcinoma. Both have significant limitations, however, and surgical staging is often required.

HomeRadiologyVol. 211, No. 2 PreviousNext Letters to the EditorPercutaneous Needle-Aspiration Lung Biopsy: Is It Really Necessary in All Patients with a Focal Lung Opacity?Sameh K. Morcos, Paul B. AndersonSameh K. Morcos, Paul B. AndersonAuthor AffiliationsDepartments of Diagnostic ImagingThoracic Medicine, Northern General Hospital NHS Trust, Herries Road, Sheffield S5 7AU, United KingdomSameh K. MorcosPaul B. AndersonPublished Online:May 1 1999https://doi.org/10.1148/radiology.211.2.r99ma10590MoreSectionsFull textPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In References 1 Lucidarme O, Howarth N, Finet JF, Grenier PA. Intrapulmonary lesions: percutaneous automated biopsy with a detachable, 18-gauge, coaxial cutting needle. Radiology 1998; 207: 759-765. Link, Google Scholar2 McLoud TC. Should cutting needles replace needle aspiration of lung lesions? (editorial). Radiology 1998; 207: 569-570. Link, Google Scholar3 Moore EH. Technical aspects of needle aspiration lung biopsy: a personal perspective. Radiology 1998; 208: 303-318. Link, Google Scholar4 Flower CD, Verney GI. Percutaneous needle biopsy of thoracic lesions: an evaluation of 300 biopsies. Clin Radiol 1979; 30: 215-218. Crossref, Medline, Google Scholar5 Macfarlane J. Lung biopsy (editorial). BMJ 1986; 290: 97-98. Google Scholar6 Godwin JD. The solitary pulmonary nodule. Radiol Clin North Am 1983; 21: 709-721. Medline, Google Scholar7 Payne CR, Hadfield JW, Stovin PG, Barker V, Heard BE, Stark JE. Diagnostic accuracy of cytology and biopsy in primary bronchial carcinoma. J Clin Pathol 1981; 34: 773-778. Crossref, Medline, Google Scholar8 Charig MJ, Stutley JE, Padley SP, Hansell DM. The value of negative needle biopsy in suspected operable lung cancer. Clin Radiol 1991; 44: 147-149. Crossref, Medline, Google ScholarArticle HistoryPublished in print: May 1999 FiguresReferencesRelatedDetailsCited BySimultaneous laparoscopic colorectal resection and pulmonary resection by minithoracotomy: Report of four casesTetsuoTsukahara, SeiichiroYamamoto, TaiheiOshiro, ShinFujita, HiroyukiSakurai, Shun‐ichiWatanabe2014 | Asian Journal of Endoscopic Surgery, Vol. 7, No. 2Necrotizing Granuloma of the Lung: Imaging Characteristics and Imaging-Guided DiagnosisRennaeThiessen, Jean M.Seely, Frederick R. K.Matzinger, PrachiAgarwal, Karen L.Burns, Carole J.Dennie, RebeccaPeterson2007 | American Journal of Roentgenology, Vol. 189, No. 6CT-GUIDED PERCUTANEOUS CORE BIOPSIES OF PULMONARY LESIONS. Diagnostic accuracy, complications and therapeutic impactE.Lopez Hanninen, T. J.Vogl, J.Ricke, R.Felix2001 | Acta Radiologica, Vol. 42, No. 2Solitary pulmonary nodule: time to think smallDavid E.Midthun2000 | Current Opinion in Pulmonary Medicine, Vol. 6, No. 4Cutting needle biopsy in the diagnosis of clinically suspected non-carcinomatous disease of the lung.S KMorcos2000 | The British Journal of Radiology, Vol. 73, No. 875Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 211, No. 2 Metrics Altmetric Score PDF download