• Journal of Chest Surgery
• /
• v.36 no.12
• /
• pp.943-951
• /
• 2003

We are now detecting an increasing number of solitary pulmonary nodules (SPNs) that are difficult to diagnosis. The purpose of this study was to evaluate the useful radiologic findings for differentiating benign from malignant pulmonary nodules. Material and Method: The high-resolution CT (HRCT) findings of SPNs smaller than 3 cm in largest diameter were evaluated in 134 patients with malignant and benign nodules in regard to internal structures, margin characteristics, and surrounding parenchymal responses. Result: The nodules with the area of ground-glass attenuation (GGA) greater then 50% were noted in adenocarcinoma, inflammatory lesions and some of metastatic tumors, and the lesions greater than 90% were noted only in adenocarcinoma. The area of GGA in non-adenocarcinoma, benign tumors and tuberculomas were less than 50%, and mainly less than 10%. The findings of air bronchogram, spiculation, lobulation, vascular involvement, and pleural indentation were some noted at every types of malignant tumors, but especially high over than 30% in adenocarcinomas. Conclusion: Most peripheral lung adenocarcinomas form a characteristic radiologic findings especially in HRCT. Evaluation of these findings would be helpful in differentiating between lung cancer, especially adenocarcinoma, and other lesions.

• Journal of the Korean Society of Radiology
• /
• v.83 no.2
• /
• pp.387-393
• /
• 2022

Primary pulmonary malignant melanoma is an extremely rare type of melanoma. The radiologic features of primary pulmonary malignant melanoma are nonspecific; however, it almost always presents as a well-demarcated round or lobulated solitary solid nodule or mass. Herein, we report the case of a 78-year-old male with primary pulmonary malignant melanoma that was mistaken for primary pulmonary adenocarcinoma with lepidic growth and was seen as bilateral multiple subsolid nodules on CT.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.24
• /
• pp.10627-10630
• /
• 2015

Background: Epidermal growth factor receptor (EGFR) mutations play a vital role in the prognosis of patients with lung adenocarcinoma. Such somatic mutations are more common in women who are non-smokers with adenocarcinoma and are of Asian origin. However, to our knowledge, there are few studies that have focused on men. Materials and Methods: One hundred and eighty-four consecutive patients (90 men and 94 women) of resected lung adenocarcinoma were studied retrospectively. Results: EGFR mutations were positive in 48.9% and negative (wild type) in 51.1%. Overall mutation was significant in women (66.0% vs. 32.2%) compared with men (p<0.001). For overall patients, EGFR mutation status was associated with gender, pStage, pT status, lepidic dominant histologic subtype, pure or mixed ground-glass nodule type on computed tomography and smoking status. However, in men, EGFR mutation status was only associated with lepidic dominant histologic subtype and not the other variables. Interestingly, the Brinkman index of men with mutant EGFR also did not differ from that for the wild type ($680.0{\pm}619.3$ vs. $813.1{\pm}552.1$ p=0.1077). Conclusions: The clinical characteristics of men with lung adenocarcinoma related to EGFR mutation are not always similar to that of overall patients. Especially we failed to find the relationship between EGFR mutations and smoking status in men.

• Journal of the Korean Society of Radiology
• /
• v.84 no.6
• /
• pp.1391-1396
• /
• 2023

Malignant lymphoma has various pulmonary manifestations on chest CT, including nodules, masses, areas of consolidation, and ground-glass opacity. These presentations can pose a diagnostic challenge, as they mimic other disease patterns. Herein, we report a case of diffuse large B-cell lymphoma (DLBCL) manifesting as miliary nodules in a 67-year-old male initially presenting with dyspnea and fever. Radiologic findings included diffuse, bilateral, multiple tiny nodules consistent with metastasis, miliary tuberculosis, and fungal infection. However, further investigations, including laboratory tests, imaging, and biopsies, led to the diagnosis of DLBCL involving the lungs. Herein we reported a rare case of lymphoma involvement of the lung presenting as miliary nodules. Accurate diagnosis relies on a comprehensive evaluation of the clinical history, physical features, laboratory test results, and imaging findings.

• Journal of Chest Surgery
• /
• v.43 no.6
• /
• pp.681-686
• /
• 2010

Background: A chest computed-tomography has become more prevalent so that it is more common to detect small sized pulmonary nodules that have not been found in previous simple chest x-ray. If those detected nodules are undersized or located in pulmonary parenchyma, it is difficult to accomplish a biopsy since it is vulnerable to explore them either grossly or digitally. Thus, in our hospital, a thoracoscopic pulmonary wedge resection was performed after locating a lesion by means of hook wire with CT-guided. Material and Method: 31 patients (17 males and 14 female patients) from December in 2006 to June in 2010 became our subjects; their 34 pulmonary nodules were subjected to the thoracoscopic pulmonary wedge resection after locating a lesion by means of hook wire with CT-guided. Also we analyzed a possibility of hook wire dislocation, a frequency of conversion to open thoracotomy, time consumed to operation after location of a lesion, operation time, post operation complication, and histological diagnosis of the lesion. Result: 12 of 34 cases were ground glass lesion, whereas 22 cases of them were solitary pulmonary lesion. The median value of the lesion was 8mm in size (range: 3 to 23 mm), while the median value was 12.5 mm in depth (range: 1 to 34 mm). The median value of time consumed from location of the lesion to anesthetic induction was 86.5 minutes (41~473 minutes); furthermore the mean value of operation time was 103 minutes (25~345 minutes). Intrathoracic wire dislocation was found in one case, but a target lesion was successfully excised. Open thoracotomy was performed in four cases due to pleural adhesion. However, there was no case of conversion to open thoracotomy due to failure to detect a target lesion. In histological diagnosis, metastatic cancer were found in 15 cases, which were the most common, primary lung cancer were in 9 cases, non-specific inflammation were in 3 cases, tuberculosis inflammation were in 2 cases, lymph nodes were in 2 cases, active tuberculosis were in 1 case, atypical adenomatous hyperplasia was in 1 case and normal lung parenchymal finding was in 1 case, respectively. Conclusion: In our hospital, in order to accomplish a precise histological diagnosis of ground-glass lesion and pulmonary nodules in lung parenchyma, location of pulmonary nodules were exactly located with hook wire under chest computed-tomography, which was followed by lung biopsy. We concluded that this was an accurate, minimally invasive and valuable method to minimize the complications and increase of cost of medical service provided.

• Tuberculosis and Respiratory Diseases
• /
• v.62 no.5
• /
• pp.374-381
• /
• 2007

Background: This study evaluated which CT findings could be used to predict the negative results of a sputum smear in patients with active pulmonary tuberculosis and multiple cavities. Methods: Thirty-eight patients with active pulmonary tuberculosis and multiple cavities on CT were classified into 2 groups: smear-positive (n = 30) and -negative (n = 8). The CT findings were reviewed retrospectively. The maximum internal diameter of the largest cavity, the number of the cavities and lobes with cavities, and the characteristics of the associated findings such as consolidation, ground glass opacity, micronodules and nodule were accessed. The number of cavities above 20 mm in the maximum internal diameter and a necrotizing pneumonia-like pattern were also evaluated. Result: The maximum internal diameter and number of cavities was $32.23{\pm}17.66mm$ and $15.50{\pm}11.12mm$ (p = 0.0042), and $5.53{\pm}3.17$ and $2.43{\pm}1.13$ (p = 0.0002) in the smear-positive and -negative group, respectively. Three or more cavities were observed at 76.7% and 12.5% in the smear-positive and -negative group, respectively (p < 0.005). There were $2.00{\pm}1.34$ and $0.25{\pm}0.46$ (p = 0.001), and $1.5{\pm}1.50$ and $0.38{\pm}0.52$ (p =0.0016) lobes with consolidation and ground glass opacity in the smear-positive and -negative group, respectively. A necrotizing pneumonia-like pattern was observed in 43.3% of the smear-positive group only. The other findings were similar in both two groups. The sensitivity, specificity, positive and negative predictive value for the presence of at least a finding of consolidation, more than 3 cavities or the largest cavity > 20 mm in the maximum internal diameter were 100%, 62.5%, 90.9%, and 100%, respectively. Conclusion: Two cavities 20 mm or less in the maximum internal diameter without consolidation on CT might be associated with a negative result of the sputum smear in patients with active pulmonary tuberculosis and multiple cavities.

• Journal of Chest Surgery
• /
• v.42 no.5
• /
• pp.624-629
• /
• 2009

Background: Making the histologic diagnosis of small pulmonary nodules and ground glass opacity (GGO) lesions is difficult. CT-guided percutaneous needle biopsies often fail to provide enough specimen for making the diagnosis. Video-assisted thoracoscopic surgery (VATS) can be inefficient for treating non-palpable lesions. Preoperative localization of small intrapulmonary lesions provides a more obvious target to facilitate performing intraoperative. resection. We evaluated the efficacy of CT-guided localization with using a hook wire and this was followed by VATS for making the histologic diagnosis of small intrapulmonary nodules and GGO lesions. Material and Method: Eighteen patients (13 males) were included in this study from August 2005 to March 2008. 18 intrapulmonary lesions underwent preoperative localization by using a CT-guided a hook wire system prior to performing VATS resection for intrapulmonary lesions and GGO lesions. The clinical data such as the accuracy of localization, the rate of conversion-to-thoracotomy, the operation time, the postoperative complications and the histology of the pulmonary lesion were retrospectively collected. Result: Eighteen VATS resections were performed in 18 patients. Preoperative CT-guided localization with a hook-wire was successful in all the patients. Dislodgement of a hook wire was observed in one case. There was no conversion to thoracotomy, The median diameter of lesions was 8 mm (range: $3{\sim}15\;mm$). The median depth of the lesions from the pleural surfaces was 5.5 mm (range: $1{\sim}30\;mm$). The median interval between preoperative CT-guided with a hook-wire and VATS was 34.5 min (range: ($10{\sim}226$ min). The median operative time was 43.5.min (range: $26{\sim}83$ min). In two patients, clinically insignificant pneumothorax developed after CT-guided localization with a hook-wire and there were no other complications. Histological examinations confirmed 8 primary lung cancers, 3 cases of metastases, 3 cases of inflammation, 2 intrapulmonary lymph nodes and 2 other benign lesions. Conclusion: CT-guided localization with a hook-wire followed by VATS for treating small intrapulmonary nodules and GGO lesions provided a low conversion thoracotomy rate, a short operation time and few localization-related or postoperative complications. This procedure was efficient to confirm intrapulmonary lesions and GGO lesions.

• Tuberculosis and Respiratory Diseases
• /
• v.62 no.6
• /
• pp.479-485
• /
• 2007

Background: The purpose of this study was to evaluate the differences in CT findings according to sputum smear-positive or -negative results in patients with active pulmonary tuberculosis having a single cavity. Methods: A total of 32 patients with active pulmonary tuberculosis having a single cavity on CT were classified into two groups: smear-positive (n=19) and smear-negative (n=13). The CT findings were reviewed retrospectively. The presence of consolidation, the number of lobes showing consolidation, ground-glass opacity, micronodules and nodule, the maximum diameter of the cavity, and the shape and maximum thickness of the cavity wall were assessed. Result: The maximum diameter of the cavity was $33.84{\pm}13.65mm$ and $27.08{\pm}9.04mm $ in the smear-positive and -negative groups, respectively (p>0.05). The amount of consolidation and the number of lobes with consolidation were found to be 89.5% and 30.8% (p=0.01) and $1.37{\pm}0.90$ and $0.31{\pm}0.48$ (p=0.0002) in the smear-positive and -negative groups, respectively. Consolidations in two or more lobes were only noted in 31.6% of in the sputum smear- positive group (p< 0.05). There were no other significant differences between the two groups. The sensitivity, specificity, positive and negative predictive values for the presence of consolidation were 89.5%, 69.2%, 73.9%, and 81.8%, respectively. Conclusion: While the absence of consolidation on CT may be associated with sputum smear-negative results in patients with active pulmonary tuberculosis having a single cavity, the presence of consolidation in two or more lobes on CT may be associated with spear-positive results in these patients.

• Tuberculosis and Respiratory Diseases
• /
• v.45 no.6
• /
• pp.1199-1213
• /
• 1998

Background : The number of immunocompromised hosts has been increasing steadily and a new pulmonary infiltrate in these patients is a potentially lethal condition which needs rapid diagnosis and treatment. In this study we sought to examine the clinical manifestations, radiologic findings, and therapeutic outcomes of pulmonary mycoses presenting as a new pulmonary infiltrate in immunocompromised hosts. Method : All cases presenting as a new pulmonary infiltrate in immunocompromised hosts and confirmed to be pulmonary mycoses by pathologic examination or by positive culture from a sterile site between October of 1996 and April of 1998 were included in the study and their chart and radiologic findings were retrospectively reviewed. Results : In all, 14 cases of pulmonary mycoses from 13 patients(male : female ratio = 8 : 5, median age 47 yr) were found. Twelve cases were diagnosed as aspergillosis while two were diagnosed as mucormycosis. Major risk factors for fungal infections were chemotherapy for hematologic malignancy(10 cases) and organ transplant recipients(4 cases). Three cases were receiving empirical amphotericin B at the time of appearance of new lung infiltrates. Cases in the hematologic malignancy group had more prominent symptoms : fever(9/10), cough(6/10), sputum(5/10), dyspnea(4/10), chest pain(5/10). Patients in the organ transplant group had minimal symptoms(p<0.05). On simple chest films, all of the cases presented as single or multiple nodules(6/14) or consolidations(8/14). High resolution computed tomograph showed peri-lesional ground glass opacities(14/14), pleural effusions(5/14), and cavitary changes(7/14). Definitive diagnostic methods were as follows : 10 cases underwent minithoracotomy, 2 underwent video-assisted thoracoscopic surgery, 1 underwent percutaneous needle aspiration and 1 case was diagnosed by culture of abscess fluid. All cases received treatment with amphotericin B with 1 case each being treated with liposomal amphotericin B and itraconazole due to renal toxicity. Lung lesion improved in 12 of 14 patient but 4 patients died before completing therapy. Conclusion : When a new lung infiltrate develops presenting either as a nodule or consolidation in a neutropenic patient with hematologic malignancy or in a transplant recipient, you should always consider pulmonary mycoses as one of the differential diagnosis. By performing aggressive work up and early treatment, we may improve prognosis of these patients.