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Inflammatory, Hypersensitivity and Immune Lung Diseases, including Parasitic Diseases.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Pneumonic consolidation is usually massive and rapidly spreading; the affected lobe often being 'swollen' (i.e. larger than normal due to outward bowing of the adjacent fissures, as is also seen with Klebsiella, etc. pneumonia - see ps. 2.1, 2.3 & 4.19 - 20). Massive enlargement of the hilar and mediastinal lymph nodes often occurs.
The cases
Published in Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young, Paediatric Radiology for MRCPCH and FRCR, 2020
Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young
The right hilum is enlarged due to adenopathy and perihilar consolidation. There is a right paratracheal soft tissue mass displacing the trachea to the left. The CT scan confirms large-volume right paratracheal lymphadenopathy.
Lung and pleural metastases
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Tumour spread through the lymphatics and surrounding interstitium may initially originate either from pulmonary arterial metastases or by direct extension from hilar lymphadenopathy along the axial interstitium. The former route is most commonly seen in malignancies from the breast, gastrointestinal tract, and melanoma. Direct extension from the hilum is more likely to be seen in primary lung cancer with hilar disease, lymphoma (especially Hodgkin lymphoma), and, on rare occasions, leukaemia (28).
Unilateral Retinal Arteritis and Macroaneurysm in Sarcoidosis
Published in Ocular Immunology and Inflammation, 2022
Raziyeh Mahmoudzadeh, Anand Gopal, Rebecca Soares, James P. Dunn
Ophthalmic manifestations of sarcoidosis are estimated to occur in 30–60% of patients, either in the presence or absence of systemic disease.6 Bilateral granulomatous uveitis is the most frequent ocular manifestation, occurring in 12% of biopsy-proven sarcoid cases.7 In the absence of specific laboratory testing and given the risks associated with biopsy of ocular tissue, diagnosis of ocular sarcoidosis is established based on integration of compatible ocular findings, corroboratory radiographic studies, non-ocular histopathology, and systemic investigations. According to the 2019 revised International Workshop on Ocular Sarcoidosis (IWOS) diagnostic criteria, diagnosis of ocular sarcoidosis is definite when a compatible uveitis is supported by histopathology from one or more sites demonstrating non-caseating granulomas; presumed when two or more ocular findings occur in concert with chest imaging findings of bilateral hilar lymphadenopathy; and probable when three or more ocular findings are found in patients with at least two supportive systemic studies, including elevated serum angiotensin-converting enzyme (ACE) or lysozyme levels, abnormal PET imaging, elevated bronchoalveolar lavage (BAL) fluid CD4/CD8 ratio, and exclusion of other causes of granulomatous uveitis, most notably ocular tuberculosis.8 Our patient’s diagnosis was definite, based on biopsy-confirmation of hilar lymph node tissue and further corroborated by clinical findings, radiographic studies, and laboratory investigations.
Primary Pleuropulmonary Synovial Sarcoma: Report of Two Cases and a Comprehensive Review of the Literature
Published in Cancer Investigation, 2022
Neda Khalili, Elham Askari, Nastaran Khalili, Aboulghasem Daneshvar-Kakhki, Makan Sadr, Sara Haseli, Mihan Pourabdollah Toutkaboni
Since primary pleuropulmonary SSs are typically large tumors, mediastinal shift may occur. According to reports from previous studies, mediastinal shift was detected in 7% of patients (Table 4). Overall, ipsilateral pleural effusion is a frequent observation and might be attributed to acute or recurrent hemothorax (15,16,57). The results of our literature review also showed that pleural effusion was existent in 21% and 32% of cases on CXR and CT, respectively. On the other hand, the presence of pneumothorax was a rare finding that was observed in the chest CT of only 2% of cases. Calcification and mediastinal lymphadenopathy were also infrequent CT features of primary PPSS and were reported in less than 10% and 11% of cases, respectively (Table 4). Hilar or mediastinal lymphadenopathy shifts the diagnosis toward other malignancies of the lung, such as bronchogenic carcinoma (15,16). Also, the presence of multiple foci of calcification can complicate the diagnosis of SS and raise the suspicion for other tumors such as carcinoid tumor and metastatic SS (31). In such instances, PET/CT imaging might be able to narrow the diagnosis (16). Table 4 shows in detail the frequency of reported imaging features of primary pleuropulmonary SS on CXR and CT.
Mediastinal lymphadenopathy: a practical approach
Published in Expert Review of Respiratory Medicine, 2021
Hariharan Iyer, Abhishek Anand, PB Sryma, Kartik Gupta, Priyanka Naranje, Nishikant Damle, Saurabh Mittal, Neha Kawatra Madan, Anant Mohan, Vijay Hadda, Pawan Tiwari, Randeep Guleria, Karan Madan
Sarcoidosis is a multisystem granulomatous disease that primarily affects the lung and mediastinal lymph nodes. Diagnosis is often incidental. Clinically, dry cough, dyspnea, fatigue, and fever are the common clinical features of pulmonary sarcoidosis. Of the described radiological stages, mediastinal lymphadenopathy is seen in stages 1 and 2. Most commonly, bilateral hilar and right paratracheal lymph nodes are enlarged. This pattern of involvement (was referred to Garland’s triad), may also be seen in other diseases. Multiple symmetrically enlarged, non-necrotic mediastinal lymph nodes in a middle-aged patient should lead to the consideration of sarcoidosis. CT scan features may include peribronchial thickening, subpleural and peribronchovascular nodularity, traction bronchiectasis, and upper lobe predominant disease (Figure 5) [8–11].