Role of high resolution computed tomography (HRCT) of the chest in the diagnosis of lymphangioleiomyomatosis (LAM) – A serial study of 15 patients

AbstractAim of workTo highlight the characteristic high resolution computed tomography (HRCT) findings in 15 patients diagnosed with lymphangioleiomyomatosis (LAM), narrowing the wide range of ILD and allowing accurate diagnosis preventing unnecessary interventional procedures.Patients and methods15 female patients ranged in age from 17 to 55years (mean age=40.33years). ILD was suspected based on clinical examination and chest radiographs. They were referred to do HRCT chest for further assessment. A 64 MSCT scanner was used.ResultsAll patients showed bilateral multiple cysts showing upper lobar predominance in 13.3% of cases and lower lobar one in 6.7%. The size of the cysts ranged from few mms to 3cm with variable wall thickness. Pneumothorax was reported in three patients and pulmonary hypertension in 15 cases.ConclusionHRCT is a valued diagnostic tool for diagnosis of LAM showing characteristic features for the disease

The role of HRCT in evaluation of thoracic manifestations of rheumatoid arthritis

Background: Pulmonary involvement is frequent and among the most severe extra-articular manifestations of rheumatoid arthritis (RA) ranking as the second cause of mortality in this patient population. RA can affect lung parenchyma, airways and pleura. HRCT is currently the imaging modality of choice in diagnosis of thoracic manifestations of RA being superior to chest radiography in demonstrating the presence and extent of lung abnormalities. Aim of work: Evaluate the HRCT findings in patients with pulmonary complications of RA. Patients and methods: This study involved 20 patients; 14 females and 6 males, age range 16–64 years (average 48 years). All patients were known cases of RA presenting with dyspnea and cough. Pulmonary complications associated with RA have been evaluated through: clinical examination; laboratory tests mostly CBC and other tests were considered according to case e.g., sputum analysis etc.; and radiological (chest radiograph and HRCT) and functional (Spirometry) assessment. Results: HRCT findings showed signs of interstitial disease in 9 cases (45%), air-way disease in 9 cases (45%) and findings of both entities in 2 cases (10%). 11 cases showed HRCT signs of ILD as follows: 10 (91%) cases showed bilateral subpleural predominantly basal GGO, 8 (73%) cases showed bilateral subpleural predominantly basal reticulation with traction bronchiolectasis, 1 (9%) case showed diffuse GGO, and 2 (18%) cases showed cysts. Out of 11 cases, 9 (89%) cases were consistent with NSIP and 2 (11%) cases were consistent with LIP. 11 cases showed HRCT signs of airway disease, 10 (91%) cases showed bronchial wall thickening, 9 (82%) cases showed hyperinflation, 6 (55%) cases showed bronchiectasis, 5 (45%) cases showed mosaic perfusion, 3 (27%) cases showed beading of the bronchial wall, and 1 (9%) case showed air trapping. PFT showed restrictive changes in 6 out of the 9 patients with HRCT findings of ILD, obstructive changes with signs of small airway disease in 8 out of the 9 patients with HRCT findings suggestive of airway disease, and mixed restrictive and obstructive findings in the 2 patients with both entities by HRCT. Conclusion: Role of HRCT imaging in the evaluation and diagnosis of patients with intra-thoracic manifestations of RA is central, being accurate and non-invasive

Multi-detector CT (MDCT) evaluation in interstitial lung disease (ILD): Comparison of MinIP and volumetric high resolution CT (HRCT) images

The aim of the study: Is to compare the role of minimum intensity projection (MinIP) images with that of volumetric high resolution computed tomography (HRCT) images in the diagnosis of interstitial lung diseases (ILD). Patients and methods: 180 patients (149 females and 31 males) were included in this prospective study that took place over a duration of two and half years. All patients underwent HRCT and MinIP images. The positive findings were compared recording which technique was better and if MinIP adds a value in reaching an accurate diagnosis. Results: MinIP images showed better visualization of traction bronchiectasis, ground glass opacities and mosaic attenuation pattern, as well as, the cystic lung changes seen in LAM. While MinIP did not add a significant value in thick-walled cystic changes e.g.: honeycombing. Conclusion: MinIP is one of the multiplanar techniques of HRCT that proved throughout our study to be an informative complementary tool increasing the observer confidence and agreement regarding some findings as compared with HRCT alone