Can clot size and stenotic degree predict perfusion defects on conventional computed tomographic pulmonary angiography in diagnoses of pulmonary embolism?

Purpose: To evaluate clot size and stenotic degree on conventional computed tomographic pulmonary angiography (CTPA) with perfusion defect. Material and Methods: Fifty-two pulmonary embolism (PE) patients with 144 PE locations underwent dual-energy CTPA with an iodine distribution map. Each PE location was rated as to whether there was a perfusion defect. Clot size, stenotic degree, and other associated PE findings were evaluated. These findings were then correlated with whether the perfusion defect was present. Results: There were no associations between demographics, clinical characteristics, anatomical data, and perfusion defect. The median iodine concentration ratio was 0.11. Imaging interpretation by 2 thoracic radiologists had excellent agreement. The clot size and stenotic degree in PE were significant predictors of perfusion defect on conventional CTPA. Lesions with higher degrees of stenosis had higher percentages of perfusion defect. The generalized estimating equation (GEE) logistic regression confirmed that clot size and stenotic degree could predict PE perfusion defects on conventional CTPA. Conclusions: The 2 significant predictors of perfusion defect were occluded vessels in both small and large branches together, or complete occlusion of the pulmonary artery

Endobronchial Mass: A Rare Manifestation of Multiple Solitary Plasmacytoma

Multiple solitary plasmacytoma is the rare presentation of plasma cell neoplasm that can mimic multiple metastases. Primary endobronchial plasmacytoma is an extremely rare condition of extramedullary plasmacytoma. Here, we describe a case of multiple solitary plasmacytoma that initially presented with an endobronchial mass. Teaching Point: The differential diagnosis of multiple lesions in the airway is mainly metastasis and multiple solitary plasmacytoma

Predictors of pleural decompression in blunt traumatic occult hemothorax: A retrospective study

Background: The increased use of computed tomography (CT) results in higher occult hemothorax detection in blunt chest trauma. The indication for pleural decompression is not well defined. This research aims to study the overall factors determining pleural decompression. Methods: All blunt chest injury patients were retrospectively reviewed from the institutional trauma registry. Patients who underwent chest or whole-abdomen CT within 24 h were reviewed by a radiologist to identify initial occult hemothorax defined as a negative chest X-ray with the presence of hemothorax in the CT. The data included demographic data, mechanism of injury, complications, treatments, and characteristics of the hemothorax from the CT. Results: Six hundred and eighty-six blunt chest injury patients were reviewed over a period of 30 months. Eighty-one (24.9) patients had occult hemothorax. The mean time from injury to CT was 5.7 h. Most patients (87.6) were male. Most patients (70.2) suffered from traffic collisions and 84.4 had rib fractures. Pleural decompression was performed in 25 patients who had significantly thicker hemothorax (1.1 cm vs. 0.8 cm,P P P 1.1 cm was associated with increased risk of pleural decompression (odds ratio OR: 5.51, 95% confidence interval CI: 1.42 /21.42) and occult pneumothorax (OR: 6.93, 95% CI: 1.56/30.77). Conclusions: Drainage of occult hemothorax after blunt chest trauma was significantly associated with concomitant occult pneumothorax, lung contusion, and hemothorax thicker than 1.1 cm

Feasibility and accuracy of CT-guided percutaneous needle biopsy of cavitary pulmonary lesions

PURPOSEWe aimed to evaluate the feasibility, accuracy, and complications of computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) of cavitary lesions.METHODSConsecutive PTNB procedures in an academic institution over a 4-year period were reviewed, 53 of which were performed on patients with cavitary lesions. The demographic data of patients, lesion characteristics, biopsy technique and complications, initial pathologic results, and final diagnosis were reviewed. A final diagnosis was established through surgical correlation, microbiology or clinico-radiologic follow-up for at least 18 months after biopsy.RESULTSThe overall accuracy of PTNB was 81%. In 33 patients (62%) the cavitary lesion was found to be malignant (23 lung cancers and 10 metastases). The sensitivity and specificity for malignancy was 91% and 100%, respectively. In 20 patients (38%) a benign etiology was established (16 infections and 4 noninfectious etiologies), with PTNB demonstrating a sensitivity of 81% and specificity of 100% for infection. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Minor complications occurred in 28% of cases: 13 pneumothoraces (5 requiring chest tube), 1 small hemothorax, and 1 mild hemoptysis. A nonsignificant higher chest tube insertion rate was seen in cavities with a thinner wall.CONCLUSIONPTNB of cavitary lesions provides high accuracy, sensitivity, and specificity for both malignancy and infection and has an acceptable complication rate. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Samples for microbiology should be obtained in all patients, especially in the absence of on-site cytology, due to the high prevalence of infection in cavitary lesions

Clinical role, safety and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation

Abstract Background To determine the clinical role, safety, and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation. Methods A retrospective review of all computed tomography (CT)-guided percutaneous transthoracic needle biopsies (PTNB) at a tertiary care hospital over a 4-year period was performed to identify all cases of PTNB performed for pulmonary consolidation. For each case, CT Chest images were reviewed by two thoracic radiologists. Histopathologic and microbiologic results were obtained and clinical follow-up was performed. Results Thirty of 1090 (M:F 17:30, mean age 67 years) patients underwent PTNB for pulmonary consolidation (2.8% of all biopsies). A final diagnosis was confirmed in 29 patients through surgical resection, microbiology, or clinicoradiologic follow-up for at least 18 months after biopsy. PTNB had an overall diagnostic accuracy of 83%. A final diagnosis of malignancy was made in 20/29 patients, of which 19 were correctly diagnosed by PTNB, resulting in a sensitivity of 95% and specificity of 100% for malignancy. In all cases of primary lung cancer, adequate tissue for molecular testing was obtained. A benign final diagnosis was made in 9 patients, infection in 5 cases and non-infectious benign etiology in 4 cases. PTNB correctly diagnosed all cases of infection. Minor complications occurred in 13% (4/30) of patients. Conclusions Pulmonary consolidation can be safely evaluated with CT-guided percutaneous needle biopsy. Diagnostic yield is high, especially for malignancy. PTNB of pulmonary consolidation should be considered following non-diagnostic bronchoscopy