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Background: Metastatic basal cell carcinoma is rare and the prognosis is poor, with a lack of established treatment options for patients progressing on or after treatment with inhibitors of the hedgehog signaling pathway., Case Report: A man with pulmonary metastases of a basal cell carcinoma progressing after treatment with sonidegib and vismodegib was started on treatment with the anti-PD-1 antibody pembrolizumab. Upon treatment, rapid clinical improvement occurred, and after 5 cycles, the computed tomography scan showed near-complete remission of all tumor lesions. The tumor cells showed the absence of PD-L1 expression., Discussion: We report the first case of a patient with metastatic basal cell carcinoma experiencing an exceptional response to treatment with pembrolizumab in the absence of PD-L1 expression on the tumor cells. Immune checkpoint inhibition seems a promising treatment strategy for metastatic basal cell carcinoma. Our case suggests that the lack of PD-L1 expression does not rule out potential benefit from checkpoint inhibitor treatment., (© 2018 S. Karger GmbH, Freiburg.)

Purpose: To prospectively evaluate the accuracy of ultralow radiation dose CT of the chest with tin filtration at 100 kV for pulmonary nodule detection., Materials and Methods: 202 consecutive patients undergoing clinically indicated chest CT (standard dose, 1.8 ± 0.7 mSv) were prospectively included and additionally scanned with an ultralow dose protocol (0.13 ± 0.01 mSv). Standard dose CT was read in consensus by two board-certified radiologists to determine the presence of lung nodules and served as standard of reference (SOR). Two radiologists assessed the presence of lung nodules and their locations on ultralow dose CT. Sensitivity and specificity of the ultralow dose protocol was compared against the SOR, including subgroup analyses of different nodule sizes and types. A mixed effects logistic regression was used to test for independent predictors for sensitivity of pulmonary nodule detection., Results: 425 nodules (mean diameter 3.7 ± 2.9 mm) were found on SOR. Overall sensitivity for nodule detection by ultralow dose CT was 91%. In multivariate analysis, nodule type, size and patients BMI were independent predictors for sensitivity (p < 0.001)., Conclusions: Ultralow dose chest CT at 100 kV with spectral shaping enables a high sensitivity for the detection of pulmonary nodules at exposure levels comparable to plain film chest X-ray., Keypoints: • 91% of all lung nodules were detected with ultralow dose CT • Sensitivity for subsolid nodule detection is lower in ultralow dose CT (77.5%) • The mean effective radiation dose in 202 patients was 0.13 mSv • Ultralow dose CT seems to be feasible for lung cancer screening.

Objectives: To determine the value of computer-aided detection (CAD) for solid pulmonary nodules in ultralow radiation dose single-energy computed tomography (CT) of the chest using third-generation dual-source CT at 100kV and fixed tube current at 70 mAs with tin filtration., Methods: 202 consecutive patients undergoing clinically indicated standard dose chest CT (1.8±0.7 mSv) were prospectively included and scanned with an additional ultralow dose CT (0.13±0.01 mSv) in the same session. Standard of reference (SOR) was established by consensus reading of standard dose CT by two radiologists. CAD was performed in standard dose and ultralow dose CT with two different reconstruction kernels. CAD detection rate of nodules was evaluated including subgroups of different nodule sizes (<5, 5-7, >7mm). Sensitivity was further analysed in multivariable mixed effects logistic regression., Results: The SOR included 279 solid nodules (mean diameter 4.3±3.4mm, range 1-24mm). There was no significant difference in per-nodule sensitivity of CAD in standard dose with 70% compared to 68% in ultralow dose CT both overall and in different size subgroups (all p>0.05). CAD led to a significant increase of sensitivity for both radiologists reading the ultralow dose CT scans (all p<0.001). In multivariable analysis, the use of CAD (p<0.001), and nodule size (p<0.0001) were independent predictors for nodule detection, but not BMI (p=0.933) and the use of contrast agents (p=0.176)., Conclusions: Computer-aided detection of solid pulmonary nodules using ultralow dose CT with chest X-ray equivalent radiation dose has similar sensitivities to those from standard dose CT. Adding CAD in ultralow dose CT significantly improves the sensitivity of radiologists., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Petroleum aspiration as a reason for lipid pneumonia is a rare complication. Mostly children are affected and mortality rates are low. In most case series, virtually every subject survived.We describe here the case of a patient who developed ARDS and pneumatoceles with a fatal outcome. Due to the undulant nature of the disease, multipe thoracic CT were performed, enabling us to describe the precise radiologic course of the disease., (© Georg Thieme Verlag KG Stuttgart · New York.)

The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of endovascular lesions has rarely been described. We report a case of EBUS-TBNA of a solid mass in the left pulmonary artery in a patient with synovial sarcoma of the kidney, which was performed without complications and led to the diagnosis of metastatic disease. EBUS-TBNA seems to be a rapid, minimally invasive, safe and effective diagnostic procedure in selected cases of endovascular lesions., (Copyright © 2013 S. Karger AG, Basel.)

Background: Bleomycin is an antineoplastic agent that is mainly used in combination regimens. Dose-limiting toxicity is the bleomycin-induced pneumonitis (BIP) that can be diagnosed by clinical and radiological findings. The early diagnosis of BIP is often challenging., Case Report: We report the occurrence of a diffuse pulmonary increase of FDG uptake in the FDG-PET scan in association with suspected BIP in a patient treated for relapsed seminoma. A retroperitoneal relapse was treated with a combination chemotherapy containing cisplatin, etoposide, and bleomycin. After 3 cycles of this regimen the patient developed mild clinical signs of early BIP. A following FDG-PET in order to evaluate treatment response showed a diffuse increased FDG uptake of the right lung. The subsequent HRCT revealed pathological findings consistent with BIP. After cessation of bleomycin and a systemic steroid trial a prompt normalization of the abnormal radiological and clinical findings occurred together with a disappearance of the increased pulmonary FDG uptake., Conclusion: FDG-PET can be used for evaluation of residual disease in patients treated for advanced seminoma. In cases of otherwise unexplained increased pulmonary FDG uptake in patients under treatment with bleomycin an evaluation for early BIP as a possible cause of this finding is warranted.

Objective: We evaluated the prevalence and significance of hepatic capsular retraction in hepatic metastases from breast cancer and correlated these with metastatic number, size, change in size over time, breast tumor histopathology, chemotherapeutic regimen, and tumor-receptor status., Materials and Methods: Abdominal CT scans of 200 consecutive women with breast carcinoma (mean age, 57 years; range, 33-81 years), obtained over a 7-month period, were retrospectively reviewed. Fifty-eight women had hepatic metastases. Two hundred seventy-two CT scans, including present and prior examinations (mean [+/- SD], 4.6 +/- 2 per patient), were evaluated. The number and diameter of liver metastases at all examinations, chemotherapeutic agents used, histopathologic diagnosis of breast tumor, and tumor-receptor status were compared in patients with and without capsular retraction. Descriptive analyses of the variables and comparisons of means and proportions as well as correlations were conducted., Results: Hepatic capsular retraction was observed in 29 patients with hepatic metastases (50%). Retraction ranged from 1 to 10 mm in depth. Patients with capsular retraction had significantly larger metastases than those without retraction (p < 0.05). The associations between retraction and increase in size of the subjacent metastasis and between retraction and decrease in size were statistically significant (p < 0.05). Capsular retraction was independent of the number of hepatic metastases, histopathologic diagnosis, tumor-receptor status, and chemotherapeutic regimen., Conclusion: Hepatic capsular retraction is common in patients with hepatic metastases from breast cancer and is associated with larger metastases and both increase and decrease in subjacent lesion size. It is unrelated to lesion number, histopathology, receptor status, or chemotherapeutic regimen.