Thoracic Imaging 2003 - Society of Thoracic Radiology

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REFERENCES: Becker M, Moulin G, Kurt AM, Dulgerov P, Vukanovic S, Zbaren P, Marchal F, Rufenacht DA, Terrier F. Non-squamous cell neoplasms of the larynx: radiologic-pathologic correlation. Radiographics. 18(5):1189-209,1998. Kushner DC, Harris GBC: Obstructing lesions of the larynx and trachea in infants and children. Radiol Clin North Am 16:181, 1978. Grillo HC. Tracheal tumors. In: Choi NC, Grillo HC, eds. Thoracic Oncology. New York: Raven Press, 1983. Hadu SI, Huvos AG, Goodner JT et al. Carcinoma of the trachea: Clinicopathologic study of 41 cases. Cancer 25:1448-1456, 1970. Heitmiller RF, Mathisen DJ, Ferry JA, Mark EJ, Grillo HC: Mucoepidermoid lung tumors, Ann Thorac Surg 47:3394-399, 1989. Mathisen DJ. Tracheal tumors. Chest Surg Clin N Am 6(4)853- 864, 1996. Mathisen DJ. Primary tracheal tumor management. Surg Oncologic Clin N Am 8(2):307, 1999. Meyers BF, Mathisen DJ. Management of Tracheal Neoplasms. Oncologist. 2(4):245-253, 1997. McCarthy MJ, Roasado-de-Christenson ML. Tumors of the trachea. J Thorac Imaging 10(3): 180-198, 1995. Weber AL, Grillo HC: Tracheal tumors: A radiological, clinical, and pathological evaluation of 84 cases. Radiol Clin North Am 16: 227, 1978. Weber AL, Shortsleeve M, Goodman M et al: Cartilaginous tumors of the larynx and trachea. Radiol Clin North Am 16: 261, 1978. Zwiebel BR, Austin JH, Grimes MM: Bronchial carcinoid tumors: Assessment with CT of location and intratumoral calcification in 31 patients, Radiology 179:48333-486, 1991. 261 THURSDAY
THURSDAY 262 Inflammatory Diseases of Central Airways Arfa Khan, M.D. COURSE OBJECTIVES 1. Become familiar with the rare inflammatory diseases of central airways. 2. Describe the radiographic findings and differential diagnosis of the inflammatory disease of central airways. INTRODUCTION 1. Inflammatory diseases of the central airway are uncommon. The following list contains the most common etiologies of the inflammatory diseases of central airways. Granulomatous Tracheobronchitis Infection - Scleroma, Fungal and T.B. Granulomatous - Wegener's and Sarcoid 2. Tracheopathia osteochonchoplastica 3. Relapsing Polychonditis 4. Amyloidosis 5. Ulcerative Colitis SCLEROMA Scleroma or rhinoscleroma is a chronic progressive granulomatous infection that affects the respiratory tract from the nose to bronchi. The etiologic agent is a gram-negative diplobacillus, klebsiella rhinoscleromatis. The disease primarily affects the nose, sinuses and pharynx. From 2 to 9 % of patients develop tracheal disease that most commonly affects the proximal trachea; however, it may involve the entire trachea and main bronchi. Scleroma is uncommon in the West, occurring mainly in the underdeveloped countries with low socioeconomic status. The disease manifests in four overlapping stages: the catarrhal stage, characterized by prolonged purulent rhinorrhea, the atrophic stage, with mucosal changes and crust formation; the granulomatous stage, characterized be granulomatous nodule in the nose with or without involvement of other respiratory tract and the sclerotic stage, with dense cicatricial fibrosis of involved tissues. The radiographic findings include thickening of tracheal wall, nodular deformity of the tracheal mucosa, subglottic stricture and concentric narrowing of the trachea and central bronchi. The disease can be arrested especially in the granulomatous pre fibrotic stage by appropriate antibiotics. Balloon dilation or mechanical dilation can sometimes be used to treat significant fibrotic stenosis of trachea and bronchus with the rigid bronchoscope. A tracheostomy is occasionally required for severe involvement of larynx or subglottic space. TUBERCULOSIS Although common in past, tracheobronchial tuberculosis is now rare. The reported incidence of bronchial tuberculous stenosis in patients with tuberculosis ranges from 40% in the preantibiotic era to 10% in more recent years. It is usually associated with cavitary lung disease and grossly infected sputum. There are three histopathalogical stages of tracheobronchial tuberculosis, which may exist alone or coexist. In the hyperplastic stage, there is formation of tubercles in the submucosal layer. Ulceration and necrosis of the bronchial wall is followed by a fibrostenotic stage, in which a residual stenosis is formed. Tracheobronchial stenosis can develop acutely at the time of the pulmonary tuberculosis or can become manifest as many as 30 years later. However, active parenchymal tuberculosis is not a prerequisite to the development of tracheobronchial stenosis. The radiographic findings of central airway tuberculosis differ according to the stage of the disease. Central airways narrowing are seen in both active and fibrotic stages. However, in patients with active disease, CT shows irregular and thick walled airways, a pattern that usually reverses after appropriate antitubercular therapy, whereas patients with fibrotic disease generally have smooth narrowing of the airways and minimal wall thickening, a pattern that is irreversible. WEGENER'S GRANULOMTOSIS Wegener's granulomatosis is a granulomatous vasculitis of the upper and lower respiratory tract that is usually accompanied by renal and other organ involvement. It is a disease of unknown pathogenesis and is more prevalent in men and typically affects middle-aged persons. The classic manifestations include glomerulonephritis in addition to systemic vasculitis. Laryngeal and endobronchial involvement is rare and usually seen late in the disease process. The radiographic features of airway involvement may be focal or diffuse. The diseased portions of trachea typically have circumferential mucosal thickening; irregularity, and ulceration that are best shown with CT. Involvement of the cartilaginous rings is less common but may result in deformity and narrowing of the trachea. Bronchial wall involvement may lead to airway obstruction and atelectasis. Other radiographic findings include parenchymal nodular opacities, which may cavitate; ill-defined areas of increased opacity; and pleural effusions. SARCOIDOSIS Sarcoidosis typically affects the hilar and mediastinal nodes and the lung parenchyma. However, 1-3% of patients will have tracheal involvement, primarily in the upper part of trachea. The distal parts of the trachea and primary bronchi are affected infrequently. Narrowing of the airway may be secondary to extrinsic compression from enlarged lymph nodes or may be the result of granuloma formation within the airway mucosa and submucosa. The radiographic appearance is similar to that of other stenosis. Bronchial wall thickening reflects the presence of granuloma in the bronchial mucosa. Other findings, such as lymph node enlargement, may also be present. TRACHEOPATHIA OSTEOCHONDROPLASTICA Tracheopathia osteochondroplastica (TO) is a rare, benign disorder involving the trachea and main bronchi characterized by multiple submucosal osteocartilagenous nodules .TO was originally described by Wilks in 1857. The etiology is not known, although different theories like congenital, familial, chronic infectious-inflammatory, degenerative, metabolic etc have been posulated. The nodules classically affect the lower two-thirds of the trachea and proximal portions of the primary
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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
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TUESDAY 180 The Internet and the Pr
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TUESDAY 182 Workshop A1: Lymphoma:
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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 151 and 152: WEDNESDAY 208 principle is that “
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Page 155 and 156: WEDNESDAY 212 lesions generally mim
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Page 159 and 160: WEDNESDAY 216 Small T1 Lung Cancer:
Page 161 and 162: WEDNESDAY 218 REFERENCES Seely JM,
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Page 167 and 168: WEDNESDAY 224 Lung Cancer Staging A
Page 169 and 170: Metastatic Disease to Lung Gordon L
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Page 177 and 178: WEDNESDAY 236 Pulmonary Arterial Hy
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Page 183 and 184: THURSDAY 250 Pulmonary Tuberculosis
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Page 191 and 192: THURSDAY 258 Imaging of Coccidioido
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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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