Search

Immune checkpoint inhibitors are a new and different treatment option in many of solid tumors, but with many recognized immune-related adverse side effects. In this interesting image, we are presenting a 56-year-old woman with primary malignant melanoma who underwent nivolumab therapy for 5 months, and a posttreatment whole-body FDG PET/CT scan for treatment response evaluation demonstrated increased metabolic activity in the entire major joints of the upper and lower extremities. This was a new finding compared with previous FDG PET/CT scan and was interpreted as an immune-related arthritis complication.

Background and Aim: Pulmonary tuberculosis (TB) infection is common in patients infected with the Human immunodeficiency virus (HIV). In this study, we evaluated thoracic CT scan findings of HIV/TB co-infection, before and after anti-TB treatment. Materials and Methods: In this retrospective cross-sectional study, pre-and post-treatment thoracic CT scans of patients diagnosed with HIV and definite pulmonary TB infection were evaluated. Results: A total of 101 patients (64 male, 37 female, mean age of 43±3.4) were included. The most common findings before treatment of TB were mediastinal or hilar lymphadenopathy with hypodense center (41.58%) and free pleural effusion (32.67%). The prevalence of these findings decreased to half after anti-TB treatment (P= 0.009 and P= 0.003 respectively). Loculated pleural effusion showed increased prevalence after treatment (P= 0.031) with no significant change in the prevalence of bronchiectasis, solitary pulmonary nodule, and lymphadenopathy without a hypodense center. Conclusion: The most prevalent thoracic CT scan findings in patients with HIV/TB co-infection before anti-TB treatment were lymphadenopathy with the hypodense center, pleural effusion, and ground-glass opacities. After treatment, numerous changes in imaging manifestations might be seen. The remaining residual CT scan findings (including bronchiectasis, lymphadenopathy with a hypodense center, and solitary pulmonary nodule) require more attention for accurate interpretation of thoracic CT scans in HIV patients.

Purpose Eosinophilic lung diseases are a group of pulmonary disorders associated with peripheral or tissue eosinophilia. They can be classified into primary (idiopathic) and secondary groups based on their aetiology. On the other hand, blood eosinophilia is a common clinical problem with various causes. In many cases the lung infiltrations in patients with peripheral eosinophilia are non-eosinophilic. Herein, we aim to assess the relationship between blood eosinophilia and abnormal high-resolution computed tomography (HRCT) features and their extent in idiopathic chronic eosinophilic pneumonia (ICEP) (the most common form of idiopathic eosinophilic lung disease). This can help in differentiating eosinophilic from non-eosinophilic lung infiltrations in patients with blood eosinophilia. Material and methods In this descriptive-correlational study, all patients with proven ICEP, who were referred to Masih Daneshvari Hospital, Tehran, Iran from 2012 to 2019, were included. The ICEP diagnosis was based on lung infiltrations on imaging, in addition to increased numbers of eosinophils in bronchoalveolar lavage fluid, blood or lung biopsy samples, and rapid response to corticosteroids. Patients with known aetiologies for eosinophilic lung diseases were excluded. The HRCT findings and their extent in each patient were compared with the blood eosinophil level. Results Positive correlation was found only between blood eosinophil level and frequency and extent of consolidation, and with frequency of lymphadenopathy. Conclusions HRCT can help to differentiate eosinophilic from non-eosinophilic lung infiltrations in patients with blood eosinophilia by comparing the extent of consolidation with the blood eosinophil level.

Background Allergic bronchopulmonary aspergillosis (ABPA) has been reported in various degrees among patients with persistent allergic asthma (PAA). Currently, there is no gold standard approach for diagnosis of ABPA. Objectives In the current study, we aimed the evaluation of three different mainly used algorithms as Rosenberg & Patterson (A), ISHAM Working Group (B) and Greenberger (C) for diagnosis of ABPA in 200 patients with underlying PAA. Methods All patients were evaluated using Aspergillus skin prick test (SPTAf), Aspergillus-specific IgE (sIgEAf) and IgG (sIgGAf), total IgE (tIgE), pulmonary function tests, radiological findings and peripheral blood eosinophil count. The prevalence rate of ABPA in PAA patients was estimated by three diagnostic criteria. We used Latent Class Analysis for the evaluation of different diagnostic parameters in different applied ABPA diagnostic algorithms. Results Aspergillus sensitisation was observed in 30 (15.0%) patients. According to algorithms A, B and C, nine (4.5%), six (3.0%) and 11 (5.5%) of patients were diagnosed with ABPA, respectively. The sensitivity and specificity of criteria B and C were (55.6% and 99.5%) and (100.0% and 98.9%) respectively. sIgEAf and sIgGAf showed the high significant sensitivity. The performance of algorithm A, in terms of sensitivity and specificity, was somewhat better than algorithm B. Conclusion Our study demonstrated that the sensitivity of different diagnostic algorithms could change the prevalence rate of ABPA. We also found that all of three criteria resulted an adequate specificity for ABPA diagnosis. A consensus patterns combining elements of all three criteria may warrant a better diagnostic algorithm.

In the era of coronavirus disease 2019 (COVID-19) pandemic, many cases may be misdiagnosed based on their semiology, laboratory tests or chest computed tomography (CT) images and further evaluation might be helpful in appropriately selected cases Methods:We are discussing usefulness of fluorodeoxyglucose (FDG) positron emission tomography PET/CT scan in appropriately selected suspicious cases of COVID-19 infection We are discussing two interesting cases on how18F-FDG PET/CT scan might be helpful to avoid COVID-19 infection diagnostic error Both cases had clinical symptoms suggestive for COVID-19 infection with nonspecific chest CT scan findings including lung nodules, ground glass opacities (GGOs), consolidations, and mosaic perfusion patterns This case series was approved by our institutional review board and informed consent obtained from both patients Results: In one case,18F-FDG PET/CT images demonstrated hypermetabolic mostly peripheral GGOs and nodules in both lungs with subsequent evaluation confirming COVID-19 infection The second case demonstrated right perihilar consolidation, not well appreciated on noncontrast chest CT images in addition to GGOs and further evaluation confirmed diagnosis of poorly differentiated squamous cell carcinoma of the lung Conclusion: During COVID-19 pandemic, many cases might be misdiagnosed by either clinicians or radiologists In appropriately selected cases, FDG PET/CT scan may be helpful during COVID-19 outbreak to avoid diagnostic errors © 2020 Biomedical and Biotechnology Research Journal (BBRJ) ;Published by Wolters Kluwer - Medknow

Gallium-68-labeled prostate-specific membrane antigen (68Ga-PSMA), as a relatively new positron emission tomography (PET) radiotracer, can be used to evaluate tumors other than prostate cancer, including renal cell carcinoma and probably non-small cell lung cancer, as discussed in our case. We present the case of a 65-year-old man with a history of lung adenocarcinoma diagnosed in 2015 and a subsequent diagnosis of renal cell carcinoma in 2018, treated with a right lower lobectomy and a left partial nephrectomy, respectively. Both conditions were evaluated using 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) scan before surgery. A rise in prostate-specific antigen (PSA) was detected in the follow-up in September 2020, and the patient was referred for a 68Ga-PSMA PET/CT scan following pelvic magnetic resonance imaging (MRI). The 68Ga-PSMA PET/CT scan demonstrated avid lesions in both lung and kidney surgical beds. The 68Ga-PSMA PET/CT scan can be potentially used in patients with recurrent renal cell carcinoma to detect metastasis. This modality may also detect non-small cell lung cancer lesions; however, further investigation is needed.

Most primary small cells carcinoma develop from the lung, and extra-pulmonary small cell carcinoma accounts for less than 5% of all small cell carcinoma cases. In the head and neck region, the most common sites are the larynx and salivary glands; however primary involvement of the palate is extremely rare. The extra-pulmonary small cell carcinoma is similar to its pulmonary counterpart regarding morphology, immunohistochemistry, and electron microscopy features and derives from pluripotential stem cells that develop neuroendocrine features. There is growing evidence regarding the ability of extra-pulmonary small cell carcinoma to arise from pluripotent basilar cells capable of divergent differentiation with the consequence of arising neuroendocrine phenotype as a trans-differentiation phenomenon in the progression of an organ-specific carcinoma. The differentiation between primary and metastatic extra-pulmonary small cell carcinoma is challenging. There is also no standard guideline for treatment as it is a rare occasion, and there is no consensus between radiation oncologists and cancer surgeons about the best treatment strategy. In this study, a very rare case of hard palate small cell carcinoma with neuroendocrine pathology features is presented. To our best of knowledge, this is the third case report of extra-pulmonary small cell carcinoma involving the palate in the literature review. Knowing the clinical presentation and pathology characteristics of such rare tumor in addition to follow-up outcome can be highly useful to establish a reliable guideline for hard palate small cell carcinoma management.

Introduction Cystic echinococcosis (CE) is a common zoonosis worldwide. The two most frequent location of CE are liver and lung. Confirmatory diagnosis of CE is routinely performed sung imaging methods such as computer aided tomography and nuclear magnetic resonance in humans. Aim to investigate CT scan imaging of patients with pulmonary CE in Masih Daneshvari Hospital from 2011 to 2017. Matarial and methods This descriptive-analytic study was carried out on patients with pulmonary CE referring to Masih Daneshvari Hospital. By using the convenience sampling, 195 cases were selected from eligible patients. The data collection tool was a researcher-made questionnaire that included demographic, clinical and laboratory information. Data were analyzed using SPSS software version 20. Results In this study, 84.1% and 15.9% of patients were diagnosed using surgical method and CT scan, respectively. Our findings indicated CE was most commonly located in liver (28.2%) and spleen was considered as the lowest location (3.1%). Furthermore, cough was the most common clinical symptom of patients. The lower right lobe opacity was found to be higher, while and Lingula was the least frequent. Conclusion According to the findings of this study, surgery is the most important diagnostic and cough method as the most common clinical symptom of the disease. Since the CE with atypical symptoms is relatively common, physicians should always consider the lung CE in differential diagnosis of localized radiological images.

Background: An initial evaluation of non-small cell lung cancer (NSCLC) patients with 18F- fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan can modify treatment planning. We investigated the clinical significance of FDG PET/CT quantitative parameters (QPs) in NSCLC patients. Materials and Methods: We included 125 NSCLC patients for initial staging FDG PET/CT scan. The primary tumor (T), regional lymph node metastases (N), and distant metastases (M) were evaluated on FDG PET/CT images. QPs, including standard uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated separately for each T, N, and M lesion and also for the whole body. Statistical analysis through SPSS version 22 was used to evaluate the clinical significance of PET/CT QPs concerning primary tumor pathology characteristics, initial tumor stage, and patient’s prognosis. Results: We followed the patients for 19.28 (±11.42) months. Considering primary tumor pathology, there was a significant difference in FDG PET/CT QPs, including primary tumor SUVmax (p=0.00), metastases SUVmax (p=0.014), whole-body MTV (p=0.045), and whole-body TLG (p=0.002). There was also a significant difference in QPs, including primary tumor SUVmax (p=0.00) and regional lymph node metastases SUVmax (p=0.048) when accounting for tumor initial stage. There was a significant prognostic value for the whole-body TLG (p=0.01) and a cut-off point of 568 was reached to differentiate better versus worse survival outcome. Conclusion: We demonstrated a statistically significant difference in FDG PET/CT QPs when accounting for primary NSCLC pathology characteristics and initial stage, as well as patient’s prognosis, and recommend incorporating QP values into clinical PET/CT reports.

Highlight • Anti-viral therapy significantly. • A) Reduced CT scan scores and the elevated serum levels of CRP and LDH, serum levels of IL-6, CXCL8 and IFNγ were elevated at baseline in COVID-19 subjects compared to healthy subjects. • IL-1β (p=0.002) and TNFα (p=0.023) levels were also enhanced after treatment but baseline levels were similar to those of healthy controls. • B) These changes occurred irrespective of whether patients were admitted to the intensive care unit. • C) Antiviral treatments did not suppress the inflammatory phase of COVID-19 after 7 days treatment although CT, CRP and LDH suggest a decline in lung inflammation. There was limited evidence for a viral-mediated cytokine storm in these COVID-19 subjects., Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has infected 86,4M patients and resulted in 1,86M deaths worldwide. Severe COVID-19 patients have elevated blood levels of interleukin-6 (IL-6), IL-1β, tumor necrosis factor (TNF)α, CXCL8 and interferon (IFN)γ. Objective To investigate the effect of antiviral treatment serum cytokines in severe COVID-19 patients. Methods Blood was obtained from 29 patients (aged 32-79yr) with laboratory-confirmed COVID-19 upon admission and 7 days after antiviral (Favipiravir or Lopinavir/Ritonavir) treatment. Patients also received standard supportive treatment in this retrospective observational study. Chest computed tomography (CT) scans were evaluated to investigate lung manifestations of COVID-19. Serum was also obtained and cytokines levels were evaluated. 19 age- and gender-matched healthy controls were studied. Results Anti-viral therapy significantly reduced CT scan scores and the elevated serum levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH). In contrast, sserum levels of IL-6, CXCL8 and IFNγ were elevated at baseline in COVID-19 subjects compared to healthy subjects with IL-6 (p=0.002) and CXCL8 (p=0.023) levels being further elevated after antiviral therapy. IL-1β (p=0.002) and TNFα (p=0.023) levels were also enhanced after treatment but baseline levels were similar to those of healthy controls. These changes occurred irrespective of whether patients were admitted to the intensive care unit. Conclusion Antiviral treatments did not suppress the inflammatory phase of COVID-19 after 7 days treatment although CT, CRP and LDH suggest a decline in lung inflammation. There was limited evidence for a viral-mediated cytokine storm in these COVID-19 subjects.

Hypersensitivity pneumonitis (HP) is an immune-mediated diffuse parenchymal lung disease induced by inhaled antigens. High-resolution computed tomography (HRCT) is widely used in the diagnosis and follow-up of patients and determining the progression and prognosis of the disease. In this retrospective study, 45 consecutive patients with the final diagnosis of HP, seen at a large tertiary care center during a period of 4 years, were included and their HRCT findings were evaluated. The most common HRCT findings were ground glass opacity and reticulation. Some HRCT patterns were detected more severely in bird fanciers in comparison with other etiologies. There is no “gold standard” for the diagnosis of HP. HRCT findings play an important role in hypersensitivity pneumonitis diagnosis and CT scan also help to define the severity of hypersensitivity pneumonitis injuries. In our study, reticulation and ground glass opacity were the most common findings in HRCT of patients with HP. We also find that patients with avian contacts had a significantly higher rate of fibrosis.

Background: Two major complications of Aspergillus sensitization in patients with asthma, including severe asthma with fungal sensitization (SAFS) and asthma associated with fungal sensitization (AAFS), have been recently described. Objectives: In the present study, we aimed to evaluate the prevalence of SAFS and AAFS in Iranian patients with asthma. Methods: Two hundred consecutive outpatients aged ≥ 18 years with moderate to severe allergic asthma, referred to a pulmonary subspecialty hospital (Tehran, Iran) for 25 months, were included in the study. Skin prick test (SPT), total IgE (tIgE), and specific IgE (sIgEAf) and IgG against Aspergillus fumigatus (sIgGAf) were determined for all subjects. Comprehensive criteria were applied for the diagnosis of SAFS and AAFS. Results: Of 200 included patients, 103 (51.5%) and 97 (48.5%) were with moderate and severe asthma, respectively. Of these patients, 111 (55.5%) were female. The mean (range) of age was 45.8 (18 - 78) years. Of 200 patients, 27 (13.5%), 22 (11.0%), 114 (57.0%), and 131 (65.5%) were positive for Aspergillus SPT, sIgEAf, sIgGAf, and tIgE, respectively. The overall prevalence of SAFS in patients with severe asthma and AASF in patients with moderate asthma were 7.2% (7/97) and 3.9% (4/103), respectively. Conclusions: According to the findings, the prevalence of SAFS and AAFS in Iranian patients with severe and moderate allergic asthma was lower than the previously published global data. This low-prevalence reported rate may be due to the fact that we applied strict criteria in the present study.

Background: A few studies have evaluated the predictive value of fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) in patients with head-and-neck squamous cell carcinoma (HNSCC). Methods: We performed a retrospective study on 32 HNSCC patients, undergoing PET/CT after completion of planned treatment. The PET/CT volumetric parameters measured separately for primary tumor site and nodal or distant metastases. The primary outcome measure of the study was overall survival. Results: There was significant difference between alive and dead patients regarding some of volumetric parameters. Univariate and multivariate Cox regression analyses demonstrated association between metabolic tumor burdens with survival outcome. There was also significant difference in time to survival between patients with metastatic metabolic tumor burden and metastatic total lesion glycolysis (TLG) above and below 50th percentile. Conclusion: PET/CT volumetric parameters including metabolic tumor burden and TLG are significant prognostic markers for overall survival of patients with primary HNSCC after treatment.

Introduction. Incidental hypermetabolic thyroid lesions on Positron Emission Tomography have significant clinical value and may harbor malignancy. In this study we evaluated laboratory, radiologic, and pathologic characteristics of incidental hypermetabolic thyroid lesions. Materials and Methods. We evaluated 18 patients prospectively with various malignancies and hypermetabolic thyroid incidentaloma. The thyroid function tests, ultrasound assessment, and guided FNA biopsy were performed on all cases. Results. We included 9 male and 9 female patients with mean age of 51 years. Most common malignancy was colon cancer. Metabolic activity quantification using maximum standard uptake value demonstrated range between 1.4 and 65.4 with mean value of 9.4. We found highest metabolic activity in patients with lung adenocarcinoma, B-cell lymphoma, and colon adenocarcinoma. On ultrasound exam most thyroid lesions were of solid, hypoechoic, noncalcified nature with either normal or peripheral increased vascularity. FNA biopsy report was benign in 15 cases and malignant or highly suggestive for malignancy in 3 other cases. Two of the three malignant cases demonstrated metabolic activity higher than average SUV max. Conclusion. Most thyroid hypermetabolic incidentalomas are benign lesions, while higher values of SUV max are in favor of malignancy. This mandates further evaluation of incidentally found thyroid hypermetabolic lesions on routine PET/CT scans.

Primary Ewing sarcoma (ES) or primitive neuroectodermal tumour (PNET) is a rare tumour in adults and primary renal involvement is extremely rare. Patients with renal ES or PNET respond to and would benefit from conventional ES treatment according to ES study protocols. Here, we report a case of a young woman, presenting with right flank pain and haematuria. After ultrasound and CT evaluation, a right middle pole renal mass was detected. The patient underwent radical right nephrectomy, and a grade 4 ES with peritoneal involvement was documented. Subsequently, the patient underwent adjuvant chemotherapy for 5 months. Follow-up 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scan demonstrated bilateral cervical, hilar, mediastinal and retroperitoneal FDG-avid adenopathies associated with mild right-sided pleural effusion with no metabolic activity, signifying the role of PET/CT scan in tumour restaging.

In this chapter, chest X-ray and computed tomography findings are used to differentiate between nontuberculous mycobacteria (NTM) and tuberculosis infection. Common and recognized patterns of NTM infection include cavitary diseases, bronchiectasis, and pulmonary infections in AIDS patients. Less commonly, the nodular pattern, a mass mimicking malignancy and of hypersensitivity pneumonitis can be seen. Any diagnosis requires a combination of laboratory, clinical and radiological findings.

Background: The use of imaging techniques is important for prompt diagnosis and treatment of atypical mycobacterial infections; it also reduces the burden of these infections. The purpose of the present study was to determine the association between computed tomography (CT) scan findings of pulmonary infection caused by atypical mycobacteria and bacillus count in sputum samples. Methods: This cross-sectional, observational, comparative study included 50 consecutive patients with pulmonary infection caused by atypical mycobacteria, who were hospitalized in Masih-Daneshvari Hospital of Tehran, Iran during 2012–2017. The association between CT scan findings of pulmonary infection caused by atypical mycobacteria and bacillus count in sputum samples was determined in these patients. Results: The results demonstrated that the presence of nodules smaller than 5 mm in diameter, consolidation, bronchiectasis, and pleural thickening were related to bacillus count in sputum samples (P < 0.05). Conclusion: Some CT scan findings, such as nodule diameter smaller than 5 mm, consolidation, bronchiectasis, and pleural thickening, may be indicators of atypical mycobacterial infection. Increased number of involved lobes with bronchiectasis can promote early diagnosis in patients with higher smear and culture grading.

Introduction: Tuberculosis (TB) and diabetes mellitus (DM) are significant causes of morbidity and mortality in developing countries. This study aimed to explore the relationship between diabetes and TB. Methods: This was a prospective cohort study in which all newly diagnosed inpatients with TB above the age of 18 years during the study period (September 2018 to August 2020) were included. Fasting sugars and glycosylated hemoglobin (HbA1c) levels were recorded at the baseline, 3rd month, and 6th month in the diabetic patients on antitubercular therapy (ATT). Treatment outcomes were measured in both the diabetic and the nondiabetic groups. Results: The prevalence of diabetes in patients with TB admitted at our tertiary care hospital was found to be 38.5%. A favorable treatment outcome was seen in 96.3% of the patients with DM when compared to 95.6% in those without diabetes. A decreasing trend of HbA1c and fasting sugars was noticed in patients with DM during ATT. Conclusion: The screening of DM in patients with TB can help in early diagnosis and better glycemic control which may improve the possibility of favorable outcomes.

Summary Objective.There are different diagnostic criteria for the diagnosis of Allergic bronchopulmonary aspergillosis (ABPA) in CF patients. In this present study we evaluated the prevalence of ABPA in Iranian CF patients by two more usual diagnostic criteria as ISHAM working criteria (A) and CF Foundation Consensus Conference criteria (B). Methods.Eighty-six CF patients were included in the study. All CF patients underwent for Aspergillus skin prick test (AST), Aspergillus-specific IgE (sIgEAf) and Aspergillus-specific IgG (sIgGAf), total IgE. The ABPA prevalence was estimated by two diagnostic criteria, (A) and (B) and compared. Results. The frequency of positive AST, total IgE, sIgEAf and sIgGAf were 47 (54.6%), 9 (10.5%), 42 (48.8%) and 67 (77.9%), respectively. The obtained rate of ABPA prevalence (10.5%) was identical in two diagnostic criteria A and B (kappa value of 1.000). Conclusions.The applied diagnostic criteria had no significant effect on the reported rate of ABPA prevalence.

The aim of this study was to evaluate the relationship between maximum standardized uptake value (SUVmax) with tumor size and tumor pathological characteristics as well as suggesting equations between SUVmax and tumor size in patients with nonsmall cell lung cancer (NSCLC) to help differentiate between pathology types. We retrospectively analyzed the fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) findings of 98 patients with NSCLC. Statistical differences were considered significant when P

Inflammatory myofibroblastic tumour (IMT) is a rare neoplasm, occurring most often in children and young adults. IMTs have intermediate biological behaviour with the chance of local invasion, recurrence and even distant metastasis. Wide range of clinical presentations makes the precise diagnosis of IMT more challenging. The best method for definitive diagnosis is tissue biopsy and newer imaging modalities including fleurodeoxyglucose (FDG) positron emission tomography (PET)/CT are useful tools in detection of disease recurrence or distant metastasis. Complete surgical resection is the best-known treatment for this tumour. Here we are presenting an IMT case in a 12-year-old girl in which her recurrent pulmonary IMT was diagnosed based on FDG PET/CT findings and referred for further salvage treatment. Overall imaging modalities are not specific, but PET/CT scan can be useful tool for evaluation of IMT regarding initial staging and restaging to assess treatment response and recurrence.

We present a middle-aged woman complaining of weakness, lethargy and weight loss for 6 months. Positron emission tomography (PET)/CT scan revealed huge bilateral adrenal masses with intense 18F-fluorodeoxyglucose avidity. Biopsy and immunohistochemical staining were compatible with mantle cell lymphoma (MCL). The patient received six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) followed by four cycles of intrathechal methotrexate chemotherapy. Bone marrow aspiration biopsy was performed for initial staging and also before bone marrow transplantation. Follow-up PET/CT scan after completion of chemotherapy and before bone marrow transplantation demonstrated complete metabolic response with no evidence of abnormal metabolic activity in either adrenal gland or bone marrow. MCL has an aggressive nature and is usually considered incurable; however, there have been a few reports indicating favourable treatment response when MCL is rarely arising from the adrenal glands. Dramatic response of a primary adrenal MCL to R-CHOP is documented in this case.

Background: Intrathoracic Lymphadenopathy (ITLN) in Human Immunodeficiency Virus (HIV) infected patients may have various etiologies and prognoses. Etiologies of ITLN can be distinguished based on the distribution of enlarged lymph nodes. Sometimes tuberculosis (TB) is the first sign of underlying HIV infection. Objective: We sought to determine ITLN distribution and associated pulmonary findings in TB/HIV co-infection using Computed Tomography (CT) scan. Methods: In this retrospective, observational, cross-sectional study, chest CT scans of 52 patients with TB/HIV co-infection were assessed for enlarged intrathoracic lymph nodes (>10 mm in short axis diameter), lymphadenopathy (LAP) distribution, calcification, conglomeration, the presence of hypodense center and associated pulmonary abnormalities. LAP distribution was compared in TB/HIV co-infection with isolated TB infection. Results: Mediastinal and/or hilar LAP were seen in 53.8% of TB/HIV co-infection patients. In all cases, LAP was multinational. The most frequent stations were right lower paratracheal and subcarinal stations. Lymph node conglomeration, hypodense center and calcification were noted in 25%, 21.4% and 3.5% of patients, respectively. LAP distribution was the same as that in patients with isolated TB infection except for the right hilar, right upper paratracheal and prevascular stations. All patients with mediastinal and/or hilar adenopathy had associated pulmonary abnormalities. Conclusion: All patients with TB/HIV co-infection and mediastinal and/or hilar adenopathy had associated pulmonary abnormalities. Superior mediastinal lymph nodes were less commonly affected in TB/HIV co-infection than isolated TB.

Background:: Imaging is the mainstay of diagnostic criteria in tuberculosis (TB) diagnosis, especially in children; however, the exact role of chest X-ray (CXR) and thoracic CT scan (TCT) still remains controversial. The aim of this study is to compare digital chest X-ray and thoracic CT scan in childhood tuberculosis. Materials and Methods:: In this retrospective comparative study, 38 children under 15 years old with proved diagnosis of TB who were admitted to Massih Daneshvari hospital during 2010 to 2012. Digital chest X-ray and spiral thoracic CT was performed before starting medication. Results:: Direct smear for acid-fast bacillus was positive only in 38%. Positive tuberculin skin test was seen in 51% of the cases. Chest X-ray was normal in 36.8% of children, while CT scan was negative only in 21%. Overall sensitivity of thoracic CT scan and chest X-ray were 78.9% and 63.2%, respectively which show no significant difference. CT scan detected lymphadenopathy, nodule/nodular infiltration, collapse and pleural effusion/ thickening significantly better than chest X-ray; however, there was no significant difference between CXR and TCT in detection rate of consolidation/ground glass opacity, bronchiectasis, cicatricial volume loss and cavity/abscess. Conclusions:: This study proposed that investigation of children suspicious of tuberculosis by digital chest X-ray is still of great value. It seems that thoracic CT scan in children suspected of tuberculosis infection can be limited only to investigation of complications in selected patients.

Background The similar clinical and computed tomography (CT) characteristics of cryptogenic organising pneumonia (COP) and chronic eosinophilic pneumonia (CEP) make precise diagnosis challenging. Objectives To help differentiate between COP and CEP using high-resolution CT (HRCT). Design Clinical data and HRCT images of COP and CEP patients referred to Masih Daneshvari Hospital, Tehran, Iran, from 2007 to 2015 were reviewed. Diagnosis of COP or CEP was confirmed using open lung biopsy or a combination of transbronchial biopsy, bronchoalveolar lavage fluid (BALF) analysis, peripheral eosinophilia and a favourable response to corticosteroids. Results Ground-glass opacity, a dominant ground-glass pattern, upper-lobe pneumonia, increased thickness of bronchial walls and a mosaic pattern in the lungs were more frequent in CEP. Lower-lobe pneumonia, subpleural reticulation, a dominant consolidation pattern, nodules and masses, non-septal linear opacities, bronchial dilation and a reverse halo sign were more frequent in COP. History of asthma, wheezing and peripheral eosinophilia was significantly more common in CEP than in COP. Conclusion Distinguishing between CEP and COP based on HRCT alone is not always possible. However, in many cases, especially if the correct diagnosis cannot be established by other means, certain HRCT features can be very helpful.

PET/CT scan has an emerging role in head and neck oncology with a few well-established indications, including: detection of unknown primary tumor site, tumor staging, radiotherapy planning, treatment response assessment and detection of recurrent disease. The purpose of this study is reporting PET/CT findings in head and neck cancer patients to emphasize its role in head and neck oncology.In a retrospective study, we reviewed our PET/CT database and found 94 patients with primary head and neck cancer. This is a descriptive report of PET/CT scan findings in head and neck cancer patients referred to Masih Daneshvari hospital, Tehran, Iran between 2013 and 2016.The most common primary tumor sites were oral cavity (27%) and nasopharynx (22%). The most common indication for referral was tumor restaging (76%) including treatment response evaluation and differentiation between recurrence and post-treatment fibrosis. In 60% of patients with negative primary tumor site, PET/CT was able to detect evidence of regional or distant metastasis. PET/CT was able to localize the primary tumor site in 66% of patients with unknown primary tumor site. We also had 19 patients with primary head and neck cancer referred for initial staging, demonstrating evidence of metastasis in 66% of all cases.Most patients are referred for restaging and demonstrate evidence of regional or distant metastasis with significant value for further treatment planning. Providing insurance coverage and familiarizing referring physicians about correct indications of this relatively new diagnostic modality will be to the best interest of head and neck cancer patients in the long run.

Background: PET/CT scan has emerging role in head and neck oncology with a few well-established indications, including: detection of unknown primary tumor site, tumor staging, radiotherapy planning, treatment response assessment and detection of recurrent disease. The purpose of this study is reporting PET/CT findings in head and neck cancer patients to emphasize on its role in head and neck oncology. Methods: We reviewed our PET/CT date-base retrospectively and found 94 patients, referred with primary head and neck cancer. This is a descriptive report of PET/CT scan findings in head and neck cancer patients referred to MasihDaneshvari hospital since 2013 to 2016. Results: The most common primary tumor sites were oral cavity (27%) and nasopharynx (22%). The most common indication for referral was tumor restaging (76%) including treatment response evaluation and differentiation between recurrence and post-treatment fibrosis. In 60% of patients with negative primary tumor site, PET/CT was able to detect evidence of regional or distant metastasis. PET/CT was able to localize the primary tumor site in 66% of patients with unknown primary tumor site. We had also 19 patients with primary head and neck cancer referred for initial staging, demonstrating evidence of metastasis in 66.2% of all cases. Conclusions: Most patients are referred for restaging and demonstrate evidence of regional or distant metastasis with significant value for further treatment planning. Providing insurance coverage and familiarizing referring physicians about appropriate indications of this relatively new diagnostic modality will be to the best interest of head and neck cancer patients in long term.

Background: Due to the impact of threats on the clinical outcome and survival of the lung-heart transplant recipients, such as invasive pulmonary Aspergillosis, we aimed to compare the high resolution computed tomography (HRCT) scan findings with the serum BAL galactomannan and fungal culture in these patients. Methods: We reviewed the data of lung-heart transplant recipients within a 5 year period at our center. The inclusion criterion was confirmed invasive pulmonary Aspergillosis. Demographic, clinical, radiologic and laboratory characteristics of the patients were retrieved from their files and reported. Results: We reviewed the data of 30 patients (mean age = 36.1 13.3; Male gender = 22 (73.3%). Seventeen patients (56.7%) patients had double lung transplant, 10 933.3% had single lung transplant and 3 (10%) had heart-lung transplant. Consolidation was the most observed finding in the HRCT (n = 25) ([83.3%]) and it was more present in the left lower lobe of the lung. Ground glass opacity was observed in 19 (63.3%) of the patients and mostly in the left lower lobe. Pleural thickening and pleural effusion were present in 7 (23.3) and 19 (63.3%) of the patients, respectively. Small-size nodular infiltration ( 5 mm) was observed in only 5 (16.7%) patients. Twenty-seven (90%) patients had positive culture results, while serum and bronchoalveolar lavage galactomannan was positive in 5 (16.7) and 9 (30%) patients, respectively. Four (13.3%) patients died during the study period. However, there was no association between the HRCT and laboratory characteristics of the study population. Conclusions: HRCT is helpful in the diagnosis of invasive pulmonary aspergillosis in patients with lung-heart transplant.

Background: Lung cancer has wide variety of clinical presentations and different imaging features relating its subtypes. This study is focused on the role of CT scan in differentiating primary lung cancer subtypes including adenocarcinoma, squamous cell carcinoma and small cell carcinoma. Materials and Methods: This retrospective study is conducted on 55 pathologically diagnosed primary lung cancer patients. Several CT features including lung mass and pleural effusion and parenchymal nodule characteristics, mediastinal and hilar involvement, pericardial effusion and thickening, chest wall invasion, reticulation, superior vena cava (SVC) syndrome and encasement of main bronchus were checked. Results: We enrolled 55 primary lung cancer patients including 29 adenocarcinomas, 19 squamous cell carcinomas and 7 small cell carcinomas, 36 males and 19 females with mean age of 60.3 years. Most common CT features of primary lung cancer were lung mass (94.5%) particularly located in hilum (51.9%) and irregular bordered (55.8%). Other prevalent findings included parenchymal nodules (60%), pleural effusion (41.8%), mediastinal adenopathy (47.3%), hilar adenopathy (42.9%), mediastinal invasion (43.6%) and reticulation (56.4%). Hilar adenopathy (47.4%), reticulation (48.3%) and parenchymal nodule (62.1%) in adenocarcinoma; hilar mass (57.9%) and parenchymal nodule (68.4%) in squamouos cell carcinoma; hilar and mediastinal involvement in small cell carcinoma were the most frequent findings. Conclusion: Comparing three subtypes, we found squamous cell and adenocarcinoma more similar regarding CT images parenchymal nodules, mass calcification and cavitation were more frequently seen in them compared to small cell lung cancer whereas hilar involvement, mediastinal involvement, irregular bordered mass and encasement of main bronchus were more prevalent in small cell carcinoma.

Background: In many cases of ILD (interstitial lung disease), overlap diagnosis is considered. Here, a few cases with diagnosis of a variety of ILDs, where eventual open lung biopsy has been performed are selected. Reference will be made to reliable sources to show that NSIP can still be a variant of UIP (Usual interstitial pneumonia) with better treatment response and prognosis. Case Presentation: In case 1, there is a difference between the HRCT(High Resolution Computed Tomography) result (NSIP pattern without fibrosis) and pathologic result (which includes fibrosing NSIP more closely related to UIP).Case 2 shows obvious discord between HRCT result (UIP pattern) and pathologic result (NSIP pattern). In case 3, there is again a discrepancy between HRCT report (very mild architectural distortion suggestive for ILD like NSIP) and pathology report (destructed lung tissue with interstitial fibrosis suggestive of HP (Hypersesitivity Pneumonitis) and not NSIP. Conclusion: In this paper, we demonstrate that although NSIP can be a distinct diagnosis in most cases, but in rare cases the distinction between the other kinds of ILD especially UIP and NSIP in spite of full workup including tissue assessment can be very difficult.

Rectal carcinoma with metastasis to skeletal muscle is a rare finding. According to literature review, 17 cases of skeletal muscle metastasis from colorectal carcinoma have been documented where only six cases were rectal carcinomas.We discuss a case of a middle-aged man with a known history of high-grade mucinous adenocarcinoma of the rectum, status post abdominoperineal resection followed by adjuvant radiotherapy and chemotherapy. During the planned chemotherapy course, a right proximal thigh subcutaneous mass was incidentally found which on subsequent biopsy proved to be metastatic from rectal primary site. On subsequent 18F-FDG (Fluorodeoxyglucose) positron emission tomography (PET)/CT scan after completion of chemotherapy for the purpose of treatment response evaluation, only FDG-avid lesion was residual right proximal thigh metastatic mass without involvement of other common sites, such as liver and lung. In this case, the 18F-FDG-PET/CT scan was able to exclude additional metastatic sites and also evaluate the patient’s treatment response.

literature. Objectives: This study defines the clinical and radiological features of tuberculosis in infants less than one year of age. Materials and Methods: The medical records were reviewed for all infants aging 12 months or less with diagnosis of tuberculosis at TB wards of National Research Institute of Tuberculosis and Lung Disease (N.R.I.T.L.D.) in Tehran, Iran between 2006 - 2012 retrospectively. Results: Nine infants with a median age of eight months were identified, all of whom had endothoracic Tuberculosis. The cause of medical evaluation was the unset of symptom in five infants and close contact with infected patients in four. Common symptoms and signs included cough in four, Night sweat in three and Crackles in two patients. Chest X-ray showed consolidation in three, nodular lesions in three, consolidation and ground glass in one, mediastinal bulging in one. Chest CT scan revealed consolidation in three, disseminated pulmonary nodules in one, tiny nodules in two, ground glass lesion in two, right Para-tracheal and subcarinal lymphadenopathies in two, pre-bronchial thickening in one and bronchiectasis in one. Culture was obtained from all of the patients and was positive in one. All infants promptly responded to the treatment. No complications and deaths occurred. Conclusions: Pulmonary tuberculosis predominates in infants. Prompt diagnosis and treatment seem to reduce morbidity and mortality in this age group. Chest CT may be supportive in the diagnosis of infants with characteristic lymphadenopathy.

Amac: Bu calismada yaygin degisken immun yetmezlikte (CVID) pulmoner ve sinus goruntulemenin rolu incelendi. Hastalar ve yontemler: Nisan 2001 Mart 2011 tarihleri arasinda Tahran Masih Daneshvari Hastanesi’nde CVID nedeni ile pulmoner veya sinus bilgisayarli tomografisi (BT) ve gogus rontgeni cekilen 48 hasta (30 erkek, 18 kadin; ort. yas 19 yil; dagilim 9 ay-58 yil) retrospektif olarak incelendi. Hastalarin yasi ve cinsiyeti ve isleme bagli gorulen komplikasyonlar kaydedildi. Bulgular: Bilgisayarli tomografi taramasi yapilan 38 hastada en sik gorulen komplikasyonlar sag alt lobda en yuksek insidans ile bronsektazi (%52.6), hiler adenopati (%39.5) ve mediastinal adenopati (%39.5) idi. Gogus rontgeni cekilen 29 hastada ana bulgu, erkeklere kiyasla kadinlarda daha yuksek oranda gorulmek ile birlikte, parenkimal infiltrasyon idi (%35’e kiyasla %50). Toplam 30 hasta sinus BT veya gogus rontgeni ile degerlendirildi. Bu goruntuleme yontemlerinde yuksek tutulum maksiller sinuste olmak uzere, hastalarin %76.7’sinde sinuzit izlendi. Sonuc: Akciger ve sinus komplikasyonlari, BT basta olmak uzere, goruntuleme yontemleri ile kolaylik ile degerlendirilebilen CVID’nin sik rastlanan bulgularidir. Gogus muayenesinin yani sira, CVID olan hatalarin sinuzit acisindan degerlendirilmesini onermekteyiz. Anahtar sozcukler: Gogus rontgeni; yaygin degisken immun yetmezlik; bilgisayarli tomografi; akciger komplikasyonlari; sinuzit. Objectives: This study aims to evaluate the role of pulmonary and sinus imaging in common variable immunodeficiency (CVID). Patients and methods: Between April 2001 and March 2011, 48 patients (30 males, 18 females; mean age 19 years; range 9 months to 58 years) who underwent pulmonary or sinus computed tomography (CT) and chest X-ray due to CVID in Masih Daneshvari Hospital, Tehran were retrospectively analyzed. Age and sex of the patients and procedure-related complications were recorded. Results: The most common complications were bronchiectasis (52.6%) with the highest incidence in right lower lobe (39.5%), hilar adenopathy (39.5%) and mediastinal adenopathy (39.5%) in 38 patients who underwent CT scan. The main finding was parenchymal infiltration in 29 patients who underwent chest X-ray, indicating a higher trend in females than males (50% vs. 35%). A total of 30 patients were assessed by sinus CT and/or chest X-ray. These imaging modalities revealed sinusitis in 76.7% patients with a higher involvement of maxillary sinus. Conclusion: Pulmonary and sinus complications are common manifestations of CVID which can be easily assessed by imaging modalities, such as CT, particularly. We recommend evaluating CVID patients for sinusitis in addition to pulmonary examination.