Thoracic Imaging 2003 - Society of Thoracic Radiology

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6. Mylonakis E, Barlam TF, Flanigan T, Rich JD. Pulmonary aspergillosis and invasive disease in AIDS: review of 342 cases. Chest 1998;114:251-262 7. Nalaboff KM, Rozenshtein A, Kaplan MH. Imaging of Mycobacterium avium-intracellulare infection in AIDS patients on highly active antiretroviral therapy: reversal syndrome. AJR Am J Roentgenol 2000;175:387-390 8. Ognibene FP, Steis RG, Macher AM, et al. Kaposi's sarcoma causing pulmonary infiltrates and respiratory failure in the acquired immunodeficiency syndrome. Ann Intern Med 1985;102:471-475 9. Shah RM, Kaji AV, Ostrum BJ, Friedman AC. Interpretation of chest radiographs in AIDS patients: usefulness of CD4 lymphocyte counts. Radiographics 1997;17:47-58 10. Shelburne SA, III, Hamill RJ, Rodriguez-Barradas MC, et al. Immune reconstitution inflammatory syndrome: emergence of a unique syndrome during highly active antiretroviral therapy. Medicine (Baltimore) 2002;81:213-227 255 THURSDAY
THURSDAY 256 Viral Infection on HRCT Tomás Franquet, M.D. Chest Imaging Section. Department of Diagnostic Radiology, Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain Course Objectives 1. To summarize the high-resolution CT findings of some of the most common viral infectious processes seen in both the immunocompetent and the immunocompromised patient. 2. To understand the spectrum of radiological manifestations according to different immune status of the hosts Introduction Respiratory viral infections are the most common illnesses afflicting humans. In the United States more than 500 million acute respiratory illnesses are estimated to occur yearly. In healthy persons, respiratory viral infections associated with acute morbidity but low mortality. However, persons with underlying illness or immunosupression exhibit increased mortality. Diagnosis of respiratory viral infections relies on tissue culture techniques, special stains and serologic tests. Numerous viruses, including influenza virus, measles virus, Hantavirus, herpesviruses, varicella-zoster virus, cytomegalovirus, papilloma virus, and Epstein-Barr virus, can cause lower respiratory tract infection in adults. The radiologic manifestations of pulmonary viral infections are protean and include nodular opacities, tree-in-bud appearance, ground-glass opacities, air-space consolidation,bronchial wall thickening, and small pleural effusions. The differential diagnosis is based on the clinical history and the pattern and distribution of findings on high resolution CT High-resolution CT can be helpful in the detection, differential diagnosis, and management of immunocompromised patients with pulmonary complications. Although accurate clinical information is essential to narrow the differential diagnosis, it is often still imposible to determine the cause of parenchymal abnormalities in this group of patients. Combination of pattern recognition with knowledge of the clinical setting is the best approach to pulmonary infectious processes. A specific pattern of involvement can help suggest a likely diagnosis in many instances. The aim of this lecture is illustrate the radiographic and high-resolution CT findings of pulmonary viral infections in the normal and the immunocompromised host. Viral Infections in the Non-Immunocompromised Patient Epstein-Barr virus Pulmonary involvement associated with Epstein-Barr virus infection is a rare but potential complication of infectious mononucleosis.Pathologically, mononuclear inflammatory cells predominately in the interstitium along bronchovascular bundles, interlobular septa, and alveolar septa. The most common CT abnormalities consist of interstitial infiltrates and subsegmental areas of consolidation. Respiratory Syncytial virus The most common pneumonia in children under three years of age is caused by respiratory sincytial virus (RSV). Radiographic diagnosis is suggested by the presence of air trapping and patchy bilateral consolidation. Tracheobronchial Papillomatosis Squamous papillomatosis of the respiratory tract is an uncommon abnormality caused by human papillomavirus. It usually affects the larynx of children 18 months to 3 years of age. Bronchopulmonary disease may develop subsequently, typically 10 years or more later. CT may demonstrate small nodules projecting into the lumen of the airway. Involvement of distal airways and parenchyma can result in multiple, sharply circumscribed nodules that may also cavitate. Fluid levels sometimes can be identified. Long-standing tracheobronchial papillomatosis may be complicated by the development of squamous cell carcinoma. Hantaviruses Hantaviruses are lipid-enveloped RNA viruses. In the early 1990s, the Sin Nombre virus was identified as the agent responsible for a frequently more fulminant and clinically severe disease with prominent pulmonary involvement-the hantavirus pulmonary syndrome. This syndrome characteristically presents as noncardiogenic pulmonary edema. Radiographically, Hantavirus pulmonary syndrome manifests as interstitial edema with or without rapid progression to airspace disease. Viral Infections in Immunocompromised Patients Influenza virus Influenza virus is a common cause of lower respiratory tract infection in adults and children. It can occur in pandemics, epidemics, or sporadically. Pneumonia is uncommon and usually caused by type A organisms. The risk of developing pneumonia is increased in the elderly and in patients with underlying heart disease, chronic bronchitis, and cystic fibrosis. There have been isolated reports of influenza pneumonia in immunocompromised patients. In the immunocompromised patients, the predominant high resolution CT findings comsist of ground glass opacities, centrilobular nodules and branching linear opacities (tree-in-bud pattern). Cytomegalovirus Cytomegalovirus (CMV) pneumonia is a common lifethreatening complication seen in immunocompromised patients. It occurs most commonly following bone marrow and solid organ transplantation and in patients with the acquired immune deficiency syndrome (AIDS). The HRCT manifestations are variable and may consist of a reticular or reticulonodular pattern, ground glass opacities, airspace consolidation, nodular opacities or a combination of these patterns. There is no radiographic finding characteristic enough to allow differentiation of CMV pneumonia from other infections. Pathologic findings of CMV pneumonia include areas of acute interstitial pneumonia or diffuse alveolar damage, and focal inflammatory or hem-
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The Society of Thoracic Radiology T
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Dear Friends, Welcome to Miami Beac
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Continuing Medical Education Credit
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Warren B. Gefter, MD University of
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Ernest M. Scalzetti, MD SUNY Upstat
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Registration Hours Saturday, March
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Program Committee Ella A. Kazerooni
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Small Airway Disease Americana 3 Mo
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Benjamin Felson Memorial Lecture Am
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Session 2-B Concurrent Session Clin
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Workshops (choose 1) 1:00 - 1:45 D1
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Sunday
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March 2, 2003 General Session Sunda
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SUNDAY 46 One type of direct-readou
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CT-PET Imaging Suzanne Aquino, M.D.
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SUNDAY 58 an accompanying decreased
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SUNDAY 60 Radiofrequency Ablation i
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SUNDAY 62 17. Sewell PE, Vance RB.
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SUNDAY 64 cal ventilation will be r
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SUNDAY 66 radiologic, and histopath
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SUNDAY 68 application. The untreate
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SUNDAY 70 The Expanded Spectrum of
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SUNDAY 72 Hypersensitivity Pneumoni
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SUNDAY 74 Small Airway Diseases Mic
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SUNDAY 76 The “Head-cheese Sign
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SUNDAY 78 “Holes” in the Lung:
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SUNDAY 80 Pleural Effusions Gerald
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SUNDAY 82 Asbestos Related Pleural
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SUNDAY 84 Other Pleural Neoplasms S
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SUNDAY 86 Image-Guided Therapy of M
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Notes 88
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March 3, 2003 General Session 7:00
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Cardiac MRI: Established Indication
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Cardiac MRI: New Developments Gauth
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5. The volume of contrast medium re
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Acute Aortic Syndrome Ernest M. Sca
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as well as separation of the cusps
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Pulmonary Veins: Imaging for Radiof
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Imaging of Cardiopulmonary Support
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plied to the hollow fibers by an ex
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swelling of the entire leg, calf sw
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Multi-channel Pulmonary CTA: New Te
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terminate scintigrams, CT correctly
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CT Strucural and Functional Imaging
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curves (TDCs) are generated by manu
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7. Crawford T, Yoon C, Wolfson K, e
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80. Fleischmann D, Rubin GD, Bankie
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127 MONDAY
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129 MONDAY
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REFERENCES Bergin CJ, Rios G, King
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Notes 134
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March 4, 2003 General Session 7:00
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Adult Manifestations of Congenital
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will usually display the limbs of t
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Imaging of the Pericardium Paul L.
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Cardiomyopathy Martin J. Lipton, M.
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TUESDAY 150 Nuclear Cardiology Upda
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TUESDAY 152 ties. The predominant 1
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TUESDAY 154 Imaging protocols: Util
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Manpower Shortage in Radiology: Sol
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159 TUESDAY
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161 TUESDAY
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163 TUESDAY
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NIBIB Update for Thoracic Radiology
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vertically along the right atrium t
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Multidetector Pediatric Chest CT: P
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The Spectrum of Pulmonary Infection
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Immune deficiency occurs frequently
Page 137 and 138: TUESDAY 180 The Internet and the Pr
Page 139 and 140: TUESDAY 182 Workshop A1: Lymphoma:
Page 141 and 142: TUESDAY 184 Digital Images: Camera
Page 143 and 144: TUESDAY 186 Analysis of Mediastinal
Page 145 and 146: Unusual Manifestations of Lung Canc
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Page 149 and 150: March 5, 2003 General Session Wedne
Page 151 and 152: WEDNESDAY 208 principle is that “
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Page 155 and 156: WEDNESDAY 212 lesions generally mim
Page 157 and 158: WEDNESDAY 214 capable of studying t
Page 159 and 160: WEDNESDAY 216 Small T1 Lung Cancer:
Page 161 and 162: WEDNESDAY 218 REFERENCES Seely JM,
Page 163 and 164: WEDNESDAY 220 Therefore, radiologis
Page 165 and 166: WEDNESDAY 222 sectional area varies
Page 167 and 168: WEDNESDAY 224 Lung Cancer Staging A
Page 169 and 170: Metastatic Disease to Lung Gordon L
Page 171 and 172: Thoracic Metastates from Osteosarco
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Page 177 and 178: WEDNESDAY 236 Pulmonary Arterial Hy
Page 179 and 180: WEDNESDAY 238 pathological process,
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Page 183 and 184: THURSDAY 250 Pulmonary Tuberculosis
Page 185 and 186: THURSDAY 252 1. Clinical criteria:
Page 187: THURSDAY 254 AIDS patients are also
Page 191 and 192: THURSDAY 258 Imaging of Coccidioido
Page 193 and 194: THURSDAY 260 from the laryngeal sur
Page 195 and 196: THURSDAY 262 Inflammatory Diseases
Page 197 and 198: Virtual Endoscopy in the Thorax: Pr
Page 199 and 200: Notes 269 THURSDAY
Page 201: SECOND LEVEL THIRD LEVEL
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