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Introduction The significance of mediastinal lymphadenopathy in bacterial pneumonia is unclear. Methods We performed a retrospective analysis of mediastinal lymph node size determined by chest CT in patients with bacteremic pneumococcal pneumonia. All patients who had positive blood cultures for streptococcus pneumonia over an 11-year period and had a chest CT scan (index CT) within 2 weeks of the positive blood culture were included in the study. Two thoracic radiologists and one pulmonologist independently examined the index CT plus any chest CT scans performed prior (pre-CT) or after (post-CT) the bacteremic episode. Results The study cohort of 49 patients was 57% male, 65% White, with mean age of 53 (SD = 20) years. Mediastinal lymphadenopathy was detected in 25/49 (51%) of the cases. The mean size of the largest mediastinal lymph node in short axis was 0.99 (SD = 0.71), ranging from 0.0 to 2.05 cm. There was no correlation noted between the number of lobes involved with pneumonia, and the size of the largest mediastinal lymph node (p = 0.33) or the number of pathologically enlarged mediastinal lymph nodes (p = 0.08). There was a statistically significant increase in the mean size of the largest lymph node between the pre-CT and index-CT group (p = 0.02), and decrease between the index-CT group and the post-CT (p = 0.03). Conclusion Pneumococcal pneumonia with bacteremia is associated with mild mediastinal lymph node enlargement. The presence of marked mediastinal lymphadenopathy (short axis LN size > 2 cm) should not be assumed from pneumococcal pneumonia., Author(s): Amit Chopra [sup.1] , Aakash Modi [sup.1] , Haroon Chaudhry [sup.1] , Recai Yucel [sup.2] , Neha Rane [sup.1] , John Fantauzzi [sup.3] , Frederic J. Hellwitz [sup.3] , [...]

Rationale: Prolonged air leak (PAL) after partial lung resection can occur owing to surgical complications or in the presence of residual thoracic space. The former type results in drainage-independent PAL (DIPAL), whereas the latter type results in drainage-dependent PAL (DDPAL). DDPAL is described after thoracentesis in patients with nonexpandable lung, where the thoracostomy tube can be discontinued safely despite an ongoing air leak. This distinction is clinically relevant, as in the presence of DDPAL, tube thoracostomy can be safely discontinued without the need for further interventions. Objectives: To determine the frequency and clinical relevance of DDAPL and DIPAL in patients with PAL after partial lung resection. Methods: We prospectively identified consecutive patients with PAL after partial lung resection. Pleural manometry was performed 3-5 days after surgery. Pleural pressure was measured for 20 minutes after clamping the thoracostomy tube. DDPAL was diagnosed if the end-expiratory pleural pressure remained stable after plateauing in the absence of respiratory symptoms. Results: Of 225 patients who underwent lung resection, we identified 22 (10%) who had PAL. Twenty patients had adequate pleural manometry readings. The majority, 16/20 (80%), had DDPAL and had lower median hospital length of stay than those with DIPAL (6.9 vs. 11 days; P = 0.02). All patients with DIPAL required reexploration surgery, whereas only one patient with DDPAL underwent reexploration surgery. Conclusions: Most PALs after partial lung resection are DDPAL. Patients with DDPAL have lower hospital length of stay and less need for reexploration surgery than those with DIPAL. [ABSTRACT FROM AUTHOR]

Case Presentation: A 19-year-old woman presented to pulmonary clinic with recurrent episodes of fevers and productive cough over the last 2 years. She was diagnosed with several episodes of respiratory infection that required antibiotic therapy. Her symptoms improved transiently after antibiotic therapy. However, symptoms continued to recur every 1 to 2 months. She denied any close TB contacts or travel outside the United States. She was a nonsmoker and had no history of immunodeficiency. There was no history of cystic fibrosis or any foreign body aspiration. [ABSTRACT FROM AUTHOR]

Case Presentation: A 67-year-old woman, who recently immigrated to the United States from Afghanistan, presented to the hospital after sustaining a mechanical fall. She had no significant medical history and was not on any medication routinely. She denied any fever, night sweats, weight loss, shortness of breath, or hemoptysis. The patient had no prior personal history or exposure to TB. Results of a previous purified protein derivative skin test upon immigration were negative. [ABSTRACT FROM AUTHOR]

We report a case of tonsillar histoplasmosis with hematogenous dissemination in a woman receiving infliximab for Crohn's disease. She also had a history of sarcoidosis. Due to the unusual location and confounding medical history, our case provided a diagnostic dilemma. Histoplasma infection was confirmed histologically, and the patient responded well to appropriate treatment. [ABSTRACT FROM AUTHOR]

Past medical history was significant for chronic hepatitis B infection diagnosed ten years prior as well as HCC diagnosed sixteen months ago. Prior to his presentation, the patient had a non-contrast chest CT, which revealed a mass in the anterior lower hemithorax on the right, representing a hepatic tumor invading through the diaphragm (Fig 3). [Extracted from the article]

Competing Interests: Competing interests: None declared.

Background: Primary right-sided colon cancer (RCC) is associated with a higher mortality than left-sided colon cancer (LCC), but the etiology of this phenomenon remains unclear. We sought to study whether cancer laterality is associated with the prevalence of clinical coronary artery disease, calcific atherosclerosis as measured by computed tomography (CT), and cardiovascular risk factors., Methods: We conducted a single center retrospective study of 546 participants who had previously been diagnosed with colon cancer between January 2005 and December 2014. The presence of coronary and aortic calcifications was assessed by CT in 486 of these patients. We examined the prevalence of clinical cardiovascular disease (CAD) (prior myocardial infarction or revascularization), comorbidities, coronary and aortic calcification in patients with RCC (n=261) and LCC (n=285). Logistic regression analysis was performed to assess the likelihood of clinical CAD and calcific atherosclerosis by cancer laterality., Results: Compared to patients with LCC, patients with RCC were more likely to have hypertension, hyperlipidemia, hypothyroidism and clinical CAD. In the patients with available CT scans, RCC was associated with higher prevalence of coronary, thoracic, and abdominal calcifications than LCC. On univariate and multivariate analyses, RCC was associated with higher likelihood of clinical CAD (adjusted risk ratio 2.15, 95% CI, 1.37-3.38, P=0.001) as well as radiological evidence of calcific atherosclerosis compared to LCC., Conclusions: we found that both clinical CAD and vascular calcifications are prevalent in patients with colon cancer, and are independently increased in patients with RCC compared to LCC., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Objective: The purpose of this study was to assess the impact of an automated program on improvement in lung nodule matching efficiency., Materials and Methods: Four thoracic radiologists independently reviewed two serial chest CT examinations from each of 57 patients. Each radiologist performed timed manual lung nodule matching. After 6 weeks, all radiologists independently repeated the timed matching portion using an automated nodule matching program. The time required for manual and automated matching was compared. The impact of nodule size and number on matching efficiency was determined., Results: An average of 325 (range, 244-413) noncalcified solid pulmonary nodules was identified. Nodule matching was significantly faster with the automated program irrespective of the interpreting radiologist (p < 0.0001 for each). The maximal time saved with automated matching was 11.4 minutes (mean, 2.3 ± 2.0 minutes). Matching was faster in 56 of 57 cases (98.2%) for three readers and in 46 of 57 cases (80.7%) for one reader. There were no differences among readers with respect to the mean time saved per matched nodule (p > 0.5). The automated program achieved 90%, 90%, 79%, and 92% accuracy for the four readers. The improvement in efficiency for a given patient using the automated technique was proportional to the number of matched nodules (p < 0.0001) and inversely proportional to nodule size (p < 0.05)., Conclusion: Use of the automated lung nodule matching program significantly improves diagnostic efficiency. The time saved is proportionate to the number of nodules identified and inversely proportional to nodule size. Adoption of such a program should expedite CT examination interpretation and improve report turnaround time.

Objective: The objective of our study was to identify the significance of lung nodules reported on abdominal CT., Materials and Methods: Abdominal CT reports from a 1-year period were reviewed for the terms "nodule," "nodular," or "mass" in reference to the lung bases. Patients with prior chest or abdominal CT examinations were excluded; the study population included patients with an initial abdominal CT study and at least one follow-up chest or abdominal CT examination. Two thoracic radiologists characterized nodules in consensus. Radiology and clinical records were reviewed for nodule growth and clinical diagnoses., Results: The term "nodule," "nodular," or "mass" in reference to the lung bases was reported in 364 of 12,287 abdominal CT studies (3%). Of 125 patients with no prior CT examination, 42 had undergone follow-up chest CT, abdominal CT, or both. Common imaging indications included abdominal pain (13/42, 31%) and preexisting malignancy (n = 7, 16.7%). Regardless of the indication for imaging, 16 (38.1%) had malignancy that was known (n = 13) or newly diagnosed (n = 3) on the initial abdominal CT. Three of 42 patients (7.1%) had malignant nodules representing metastatic disease: Nodule growth was seen in one patient with preexisting colon cancer, one patient with newly diagnosed metastatic pancreatic cancer, and a third with known bladder cancer. The latter patient had suspected lung metastases that were confirmed on chest CT 1 day later. Three of the 16 patients (18.8%) with preexisting or newly diagnosed cancer had malignant nodules. No malignant nodules were identified without such history. Six patients (14.3%) had an infection., Conclusion: Lung nodules incidentally detected on abdominal CT were rarely malignant and were seen only in the setting of an underlying abdominal malignancy. Knowledge of such history is of critical importance to both the clinician and the radiologist. Dedicated chest CT is most useful when assessing pulmonary nodules in patients with localized malignancy.

Rationale and Objectives: The purpose of the study was to quantitatively assess the percentage of total lung parenchyma visualized on cardiac computed tomographic angiography (CTA) using standard and tight-coned fields of view (FOVs)., Materials and Methods: The authors evaluated lung volumes in 43 electrocardiogram-gated cardiac CTAs performed as part of triple rule-out/chest pain protocol CTAs over a 9-month period. Using a commercially available software package, a quantitative tissue differentiation analysis was performed using a threshold of -750 Hounsfield units to segment air in the lungs. Using each triple rule-out data set as a starting point, measurements of lung volume were performed with 2 cardiac CTA FOV scenarios, obtained by excluding the periphery of the triple rule-out volume: (1) standard cardiac CTA FOV typically used and recommended by the manufacturer and (2) tight cardiac CTA FOV maximally coned to the heart. For each scenario, the volume of the lung within the restricted FOV was compared with the overall volume of the lungs derived from the triple rule-out study, expressed as a percentage., Results: On the standard cardiac CTA FOV typically used at our institution, a mean of 58% of the lung parenchyma is included with wide variability (range, 26%-86%). On the severely limited FOV, a mean of 14% (range, 7.5%-22%) of the lung parenchyma is included., Conclusions: The percentage of lung parenchyma included in a standard FOV is considerable, although this can be mitigated by using a tight FOV, with potential exclusion of part of the cardiac anatomy. Interpreters of cardiac CTA images should have adequate training and skill in evaluating structures outside the heart.