radiology journal reading

8/21/2019 Radiology Journal Reading

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Lung CT: Part 1, Mimickers of

LungCancer—Spectrum of CT FindingsWith Pathologic Correlation

!"#$L$%& '$()!L *!"#)%

Wil+ Pandu !riaanPulmonolog+ - espirator+

Medicine


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$.'*CT#/*

To describe CT fndings omiscellaneous pulmonary conditions

that mimic lung cancers, especiallyprimary cancers, to improvediagnosis o pulmonary lesions

Brie descriptions o patient clinicalinormation and pathologic fndingswill be included and correlated withimaging fndings in actual cases


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Computed Tomograph+ 0CTScan The origin o the word “tomography” is

rom the Greek word “tomos” means sliceor “section” and “graphe” meaning

“drawing”CT imaging system is an ! ray imagingproduces cross"sectional images or“slices” o anatomy #like the slices in a

loa or bread$ used or a variety odiagnostic and therapeutic pusposes

%& 'ood and (rug )dministration #*+-$ .hat is Computed Tomography/ 01nternet2)vailable at 3 http344

wwwdagov4radiation"emittingproducts4radiationemittingproductsandprocedures4medicalimaging4medical5"rays4ucm678htm

http://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115318.htmhttp://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115318.htmhttp://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115318.htmhttp://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115318.htmhttp://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115318.htmhttp://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115318.htmhttp://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115318.htm


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%reat impro2ement inCT Scan

Great improvement in CT, especiallyin high"resolution CT #:;CT$ and

ulmonary parenchymal disease3 evaluation with high"resolution CT Radiology 1989; 170:629–635

* ?wirewich C@, @edal &,


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CT 3ndings


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"iscussion

>ulmonary conditions that mimicprimary lung cancers

The clinical conditions and theirpathologic correlations o actual cases>ulmonary conditions grossly

classi3ed into 4 categories3

Ground"glass opacifcation #GGLEboth pure and mi5ed$

*&olid nodules and masses

7Consolidation on :;CT


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"iscussion

.e will ocus on %%$ and solidnodules and masses because

clinical diKculties in thediJerentiation o the benignity ormalignancy o a pulmonary lesionoccur much more reIuently in thesetwo types than with consolidativediseases


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%round5%lass $paci3cation 0%%$

GGL is defned as a haMy opacity that preservesunderlying bronchial and vascular margins on :;CT 06,2

on neoplastic GGL is caused by partial airspace flling,interstitial thickening with inNammation, edema,fbrosis, partial collapse o alveoli, or ocal hemorrhage0F, 82

6 )ustin 9:,


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%round5%lass $paci3cation0%%$

eoplastic GGL results mainly rom alveolarwall covering tumor growth or hemorrhagictumor 08, D2

GGL can be classifed into pure %%$ and halo

or mi6ed %%$ types according to the presenceor absence o solid components The halo signrepresents the ground"glass opacity surroundingthe circumerence o a nodule or mass 06, 2

6 )ustin 9:,


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%round5%lass $paci3cation0%%$

) mi5ed GGL is a nodule that hasboth GGL and solid components


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%%$

Pure GGOHalo or Mixed GGO


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Pure %%$


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!denocarcinoma in situ

F8"year"old woman with adenocarcinoma in situ!7 Pure ground5glass opaci3cation 0diameter, 18 mm preservinginvolved pulmonary vessel in right upper lobe is shown on high"resolution CT

image.7 9istolo icall tumor cells e6tend al2eolar all without destruction


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!denocarcinoma in situ

)denocarcinoma in situ #nonmucinoustype$ shows pure GGL on :;CT

(iJerential diagnosis o it includes

atypical adenomatous hyperplasia, ocalfbrosis, pulmonary hemorrhage, andacute inNammation 08, +H*2

8 >ark C


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Atypical adenomatous hyperplasia(AAH)

"year"old woman with atypical adenomatous hyperplasia!7 Pure ground5glass opaci3cation 0diameter, 1 mm in right upper

lobe is seen on high"resolution CT image.7 9istologicall+, at+pical cu;oidal pneumoc+tes e5tend along


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Atypical adenomatous hyperplasia #)):$ is aperipheral ocal lesion produced by prolierationo atypical cuboidal or columnar epithelial cellsalong the alveoli and respiratory bronchioles07, -2

)): is a putative precursor o adenocarcinoma,including adenocarcinoma in situ 0-2

7 Travis ., Brambilla O,


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1t presents as a round or oval pure GGL nodulewithout pleural indentation or vascularconvergence

)): is usually smaller than 6 mm in diameter,though it may be as large as +HF mm, and isindistinguishable rom non mucinousadenocarcinoma in situ that maniests as pure

GGL on :;CT 0+H*, 62+ =im :P, &him Persistent pulmonary nodular

ground"glass opacity at thin"section CT3 histopathologic comparisonsRadiology 2007; 2#5:267–275

* akaQima ;, Pokose T, =akinuma ;, agai =, ishiwaki P, Lchiai ) ocaliMedpure ground"glass opacity on high"resolution CT3 histologic characteristics J

$o!p&t Assist To!ogr 2002; 26:323–3296 =awakami &, &one &, Takashima &, et al )typical adenomatous hyperplasia o


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Focal fbrosis

F-"year"old man with ocal fbrosis

!7 9igh5resolution CT image shos pure groundglass opaci3cation 0diameter, 1<

mm in let upper lobe preserving involved bronchiole and vascular structure.7 9istologicall+, focal 3;rosis ith atelectasis and infltration o inNammatory cells is


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Focal fbrosis

,ocal /rosis is a %"ig" "o" "%oplasticdisease oten maniesting as a GGL thatsometimes retains the same confguration

over a long period and oten produces thesame imaging fndings as neoplastic GGL 08,+, *, 2

8 >ark C


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Focal fbrosis

1t presents as GGL with a round,polygonal, spiculated, or ill"defnedmargin on :;CT 0F2

>athologically, it appears as a ocalinterstitial septal thickening withfbroblast prolieration and preservation

o alveolar airspaces and macrophage"flled alveoli 0*, F2* akaQima ;, Pokose T, =akinuma ;, agai =, ishiwaki P, Lchiai )ocaliMed pure ground"glass opacity on high"resolution CT3 histologiccharacteristics J $o!p&t Assist To!ogr 2002; 26:323–329

F >ark C


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Halo or MixedGGO


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Invasive asperillosis

*8"year"old woman with in2asi2e aspergillosis >atient had leukemia andwas treated with chemotherapy :igh"resolution CT image shows noduleith air ;ronchogram and halo sign 0diameter, 1= mm in let upperlobe


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Invasive asperillosis

1n non neoplastic lesions, thesepatterns are mainly seen in cases

with hemorrhagic nodules, such asinvasive aspergillosis and .egenergranulomatosis 0D2

D >rimack &, :artman TO, ee =&, ulmonary nodules and the

CT halo sign Radiology DD-E D+367H66


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Invasive asperillosis compares !ithminimally invasive adenocarcinoma

7"year"old woman with minimally invasiveadenocarcinoma!7 9igh5resolution CT image shos nodule0diameter, >8 mm ith air ;ronchiologramin right upper lo;e7 odular margin isaccompanied by Mone o ground"glass

attenuation #halo sign$.7 Pathologicall+, tumor cells e6tend idel+

*8"year"old womanwith in2asi2easpergillosis


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Invasive asperillosis and minimallyinvasive adenocarcinoma

The lesions are diKcult to distinguishrom a minimally invasive

adenocarcinoma, with a halo sign ormi5ed GGL on :;CT resulting rompredominant lepidic tumor growth

Careul attention to the patientsclinical inormation will help inmaking the correct diagnosis

" lid # d l d


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"olid #odules andMasses

HamartomaPneumocytoma ("clerosin Hemanioma)

In$ammatory Myofbroblastic %umorIntrapulmonary &ymph #odePulmonary %umorlets

%uberculoma and Histoplasmoma'ounded AtelectasisPulmonary Amyloidosis&un Abscess

Focal Oraniin Pneumonia


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Hamartoma

6"year"old woman with hamartoma!, Contrast5enhanced target CT image at mediastinal window showslobulated nodule #diameter, *8 mm$ with low"attenuation component in letupper lobe ow"attenuation area in nodule is not as low as that o at,resembling primary lung cancer with degeneration and necrosis

., 9istolog+ shos nodule composed of cartilage, fat, and othermesenchymal structures )rrow indicates slitlike clet lined by ciliated


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Hamartoma

:amartoma is a benign neoplasm composedo mesenchymal tissues such as cartilage, at,connective tissue, smooth muscle, and

calcifcation>athologically, it sometimes shows slitlike

clets lined by entrapped ciliated epithelium:amartoma accounts or H8U o solitary lung

tumors and FFU o all benign tumors 08, D2

8 Bateson O


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Hamartoma

Typical CT fndings consist o a well"defned,smooth, round, or lobulated nodule or mass0*+2

'at is recogniMed on the CT image in about+U o cases, and popcornlike calcifcation orcentral calcifcation n about *6U 0*+2

) hamartoma with little at and no calcifcationis diKcult to distinguish on CT rom primarylung cancer with a round or lobulated margin

*+ &iegelman &&, =houri ', &cott ..9, et al >ulmonary hamartoma3 CT

fndings Radiology D8E +377H7F


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Pneumocytoma ("clerosinHemanioma)

F*"year"old woman with pneumocytoma!, Contrast5enhanced target CT image at mediastinal window ineIuivalent phase shows homogeneously enhanced solid round nodule#diameter, *6 mm$ in right middle lobe >atient underwent surgery onsuspicion o primary lung cancer

., Specimen shos cu;oidal cells arranged in papillary or solid patternuclear atypia is not

P t


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Pneumocytoma("clerosin Hemanioma)

>neumocytoma is a rare benign tumorpredominantly ound in middle"aged women

The emale"to"male ratio is appro5imately -H

63 0*2:istologically, the essence is prolieration o

type * pneumocytes, and a pneumocytomaconsists o our maQor histologic components3

solid, papillary, sclerotic, and hemangiomatous072

7 Travis ., Brambilla O,


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Though low"attenuation areas,

calcifcation, and, rarely, airmeniscussign are sometimes present on CT, most

cases usually show a smoothlymarginated, homogeneously well"enhanced, round, or oval nodule or mass,

and diJerentiation rom solid lung cancerwith round or oval margins is diKcult onCT 0**, *72** 1m 9G, =im .:, :an


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:istologic conusion withadenocarcinoma with lepidic tumor

growth also occurs occasionally, withspecimens obtained rom not onlytransbronchial lung biopsy but also roMensections, especially when the specimencontains only papillary components 0*-2

*-


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In$ammatory Myofbroblastic%umor

-*"year"old woman with asymptomatic inNammatory myofbroblastic tumor!7 Contrast5enhanced CT image shos round nodule 0diameter, 1

mm in right middle lo;e7.7 Surgical specimen shos proliferation of spindle cells ith

marked in@ammator+ in3ltrate and 2ascular proliferation ith 9

and * stain7 #t as positi2e for 2imentin,$68) a"d a"aplastic ly!pho!a i"as% "ot sho4"* "a!!atory

I $


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In$ammatoryMyofbroblastic %umor

Because o its variable cellular components,inNammatory myofbroblastic tumor #1


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The spindle cell components e5press vimentin and W"smooth muscle actin on immunostaining

)lthough it has a wide spectrum o benign reactive"tomalignant characteristics and the true nature o these

lesions has not been ully elucidated, the e5pressiono anaplastic lymphoma inase in about 6U o casessuggests that they may be neoplastic 0*6, *2

1erkins &, Olenitoba"9ohnson =&, >erlman O, GriKn C) )= and

p8+ e5pression and chromosomal rearrangements involving *p*7 in inNammatorymyofbroblastic tumor -od 'athol 2001; 1#:569–576

* CoKn C


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Ondobronchial or endotracheal lesionsoccur occasionally, and it can occur in allother organs Though it occurs at all ages,

it reIuently is ound in children andadults younger than -+ years 072


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The tumor usually maniests as awell"defned lobulated or round

solitary peripheral pulmonary noduleor mass on CT 0*82 1t occasionally shows consolidation

or a nodule with an ill"defned marginor spiculations mimicking lungcancer 0*82*8 )grons G), ;osado"de"Christenson


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The internal structure is homogeneous orheterogeneous with hemorrhage,

necrosis, and calcifcation, and showsvarying degrees o contrastenhancement 0*D2

The varied CT maniestations make it

diKcult to make a correct imagingdiagnosis*D =im T&, :an 9, =im GP, ee =&, =im :, =im 9 >ulmonary inNammatorypseudotumor #inNammatory myofbroblastic tumor$3 CT eatures withpathologic correlation J $o!p&t Assist To!ogr *++6E *D377H7D

Intrapulmonary &ymph


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Intrapulmonary &ymph#ode

D"year"old woman with intrapulmonary lymph node!7 CT image shos ell5demarcated o2al nodule #diameter, F mm$ inright lower lobe


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Intrapulmonary &ymph #ode

1ntrapulmonary lymph nodes are commonly ound in thepulmonary hilum, but they can also occur within the lungparenchyma, most commonly in the subpleural Mone o thelower lobes 07+, 72

They are oten ound in smokers)s CT has improved and more CT e5aminations have been

perormed, incidental intrapulmonary lymph nodes havebeen ound more oten

They are usually a single nodule smaller than + mm in

diameter, with +U o cases having two or more lesions 07+2

7+ BankoJ


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>athologically, they are normal lymphnodes with a capsule and lymphoid ollicles07+, 7*2

Though they commonly present as well"defned oval nodules #'ig D$, sometimesthey show spiculations, pleural indentation,uMMy margin, and vascular involvement,

mimicking primary lung cancer 07*27+ BankoJ


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Though they usually remain thesame siMe or many years, a ew

cases grow rapidly and are diKcultto diJerentiate rom cancer 0772

77 agahiro 1, )ndou ), )oe


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Pulmonary %umorlets

"year"old woman with pulmonary tumorlets! and ., Pol+gonal nodule 0diameter, >A mm 0arro! A) in riht lo!er lobeand multiple tiny nodules (diameter *+, mm) (arro!heads A and -) in rihtmiddle and lo!er lobe are shown on high"resolution CT images @ideo"assistedthoracic surgery was perormed or histologic e5aminationC, Pol+gonal nodule re2ealed nontu;erculous m+co;acteriosis granuloma0not shon7 Multiple tin+ nodules ere composed of pol+gonal or spindle

cells ith 3;rous stroma Tumor cells were positive or $56) chro!ogra"i") a"d%pith%lial !%!ra"% a"tig%" "ot sho4"* Gra"&l%s o( t&!or c%lls 4%r% positi% o"


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Pulmonary %umorlets

>ulmonary tumorlets reer to a minute nodularprolieration o airway neuroendocrine cells#=ulchitsky cells$ that e5tends beyond the epitheliuminto the adQacent wall or lung parenchyma 07, 7-2

:istologically, a tumorlet consists o nests o oval tospindle"shaped cells

euroendocrine granules are seen on electronmicroscopy, and polypeptides similar to those in

carcinoid are present in the tumorlet7 Travis ., Brambilla O, ( >ulmonary neoplasms 1n3 'raser;&, are >(, eds ,ras%r a"d 'ar%s diag"osis o(


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Pulmonary %umorlets

1t has a benign nonneoplastic nature 1t is oten associated with damaged and ectatic

small airways or carcinoid tumor itsel and ranges

in siMe rom microscopic to 6H8 mm in diameter) nodule bigger than this siMe should be

considered a carcinoidBecause o their minute siMe, they are not usually

apparent on CT but are ound incidentally athistopathologic e5amination, reIuently asmultiple tiny lesions


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Pulmonary %umorlets

1 visualiMed on :;CT, they showwell"defned tiny nodules and are

diKcult to diJerentiate rom cancer,especially rom metastatic cancer inthe case o multiple lesions 0762

76 Ginsberg


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%uberculoma andHistoplasmoma

F7"year"old man with asymptomatic tuberculoma!7 9igh5resolution CT image at pulmonar+ indo shos nodule 0diameter,

1B mm in left upper lo;e7 )odule has man+ 3ne spiculations mimickingprimar+ lung cancer7 &urrounding parenchyma is emphysematous

.7 Mediastinal indo image shos heterogeneous lo5attenuation areainside nodule in contrast ith enhanced margin7 Patient underent 2ideo5assisted thoracoscopic surgery on suspicion o primary lung cancer

C, Pathologic e6amination shos epithelioid granuloma ith caseousnecrosis7 "iagnosis as tu;erculoma

% b l d


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>ulmonary tuberculosis may present as anasymptomatic solitary pulmonary nodulecalled a tuberculoma, and histoplasmosis

may present as a histoplasmoma inimmunocompetent patients 072

They sometimes mimic lung cancer

) tuberculoma is a well"defned round oroval ocus o parenchymal tuberculosis 072

7 'raser ;&, are >( >ulmonary inection 1n3 'raser;&, are >(, eds ,ras%r a"d 'ar%s diag"osis o(

dis%as%s o( th% ch%st) #th %d* 'hilad%lphia) 'A: &aunders, DDD3D6H+

% berc loma and


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&ometimes calcifcation and cavitation in thenodule or satellite nodules can be seen andhelp in the imaging diagnosis 07, 7F2

>athologically, the central region o thetuberculoma consists o caseous necrosis anda marginal Mone o epithelioid granuloma,inNammatory cells, and collagen

7 'raser ;&, are >( >ulmonary inection 1n3 'raser;&, are >(, eds ,ras%r a"d 'ar%s diag"osis o(dis%as%s o( th% ch%st) #th %d* 'hilad%lphia) 'A: &aunders, DDD3D6H+

7F ee =&, 1m 9G CT in adults with tuberculosis o the chest3 characteristicfndings and role in management AJR 1995; 16#:1361–1367

%uberculoma and


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Tuberculomas show a variable contrast"enhancement pattern, depending on theinNammatory process on contrast"

enhanced CT, though most o them showa central low"attenuation areasurrounded by ring enhancement,

reNecting central necrosis andgranulomatous inNammatory tissue inthe outer Mone 078, 7D2

78


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This CT enhancement pattern is also ound in lungcancer with necrosis

Tuberculomas most commonly appear as smoothlymarginated round nodules on CT 07, 7F2

:owever, tuberculomas sometimes have spiculatedmargins, especially when the backgroundparenchyma is emphysematous or fbrotic, makingthem diKcult to distinguish rom cancer with fne

spiculations 0-, 72 #'ig $


7F ee =&, 1m 9G CT in adults with tuberculosis o the chest3 characteristicfndings and role in management AJR 1995; 16#:1361–1367

%uberculoma and


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9istoplasmoma is a chronic orm o pulmonaryhistoplasmosis caused by the ungus

istoplas!a caps&lat&! that !ay or !ay "ot beassociated with a history o symptomatic disease 072

1t usually is seen as a sharply defned nodule 1t may have a central Mone o calcifcation, may bediJusely calcifed, or may be accompanied by smallsatellite nodules that resemble a tuberculoma 07,-+2


-+ :ansell (


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The presence o central or diJuse calcifcation in anodule 7 cm or smaller in diameter is virtuallydiagnostic o a granuloma 072

1n an area where histoplasmosis is endemic, *

caps&lat&! is th% !ost li%ly ca&s%; ho4%%r) in theabsence o calcifcation, the diJerential diagnosis mustinclude all other causes o solitary or multiple nodules,including primary lung cancer 07, -+, -2

Lccasionally, a histoplasmoma shows shaggy or

irregular edge mimicking lung cancer 0-+2

7 'raser ;&, are >( >ulmonary inection 1n3 'raser ;&, are >(, eds ,ras%r a"d 'ar%s diag"osis o( dis%as%s o( th% ch%st) #th %d* 'hilad%lphia) 'A:&aunders, DDD3D6H+

-+ :ansell (


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'ounded Atelectasis

F-"year"old man with asymptomatic rounded atelectasis!7 CT image shos pleural5;ased solid mass ith spiculations

0diameter, 41 mm in left loer lo;e mimicking lung cancer7.7 Contiguous image shos pulmonar+ 2essels and ;ronchi cur2ing

into mass 0comet5tail sign that help to make correct diagnosis7C7 Contrast5enhanced CT image shos homogeneous enhancement7

Mass idel+ contacts ith thickened pleura ith calci3cation7


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'ounded Atelectasis

;ounded atelectasis is a ocal pleural based lesionthat is the result o pleural and subpleural scarringand atelectasis o the adQacent lung tissue 0-*2

1t occurs most oten in the dorsal subpleural regions

o the lower lobe in patients with a history oasbestos e5posure and in patients with tuberculosis0-*2

>athologic e5aminations show pleural fbrosis

overlying the abnormal parenchyma, as well asinvaginations o fbrotic pleura into the collapsedparenchyma

-* :illerdal G ;ounded atelectasis3 clinical e5perience with F- patients

$h%st 1989; 95:836–8#1


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'ounded Atelectasis

Characteristic CT fndings consist o a roundmass at the lung base adQacent to the pleuralthickening and a comet"tail signXthat is,vessels and bronchi converge on and swirlaround the mass

1t may appear as an air bronchogram 0-72 1t sometimes shows a mass with a wedge"

shaped or irregular margin on CT that isconused with a malignant tumor-7 &chneider :9, 'elson B, GonMaleM ;ounded atelectasis AJR 1980;13#:225–232


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'ounded Atelectasis

Correct diagnosis is very important, especially inpatients e5posed to asbestos owing to theincreased incidence o malignant mesotheliomaand lung cancer

Good homogeneous enhancement on contrast"enhanced CT is a clue or diJerentiating it rommalignancy 0--2

'luorine"8"'(G >OT can also help in correctdiagnosis because the atelectasis ound is mostcommonly metabolically inactive 0-62

-- :akomYki 9, =eski"isula , >aakkala T Contrast enhancement o round atelectases Acta Radiol *++*E -737FH7FD

-6 , Orasums 99, >atM O', Goodman >C, Coleman ;O Ovaluation o patientswith round atelectasis using *"08'2"Nuoro"*"deo5y"("glucose >OT J $o!p&t Assist


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Pulmonary Amyloidosis

D"year"old man with asymptomatic pulmonary amyloidosis!7 Thin5section CT image at pulmonar+ indo shos nodule ith

serrated margin 0diameter, >4 mm in right middle lo;e mimickingprimar+ lung cancer7

.7 )odule shos relati2el+ poor enhancement on contrast5enhanced

CT image7


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)myloidosis is the accumulation ovarious abnormal insoluble fbrillarproteins #amyloid$ in the e5tracellular

space The most reIuent amyloid ound in the

lung is amyloid light chain 0-2

)myloidosis can aJect the lung as eithera primary or secondary type, and as asystemic type or as a disease limited tothe lung

- Chen =T )myloidosis presenting in the respiratory tract 'athol A""&1989; 2#:253–273


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)myloidosis that maniests primarily in the lowerrespiratory tract can be di2ided into three t+pes3tracheo;ronchial, nodular parench+mal, anddiuse parench+mal #also termed al%olar s%ptal$

amyloidosisodular parenchymal amyloidosis presents as a single

or multiple peripheral pulmonary nodules in a widevariety o siMes with a round, lobulated, serrated, orspiculated margin 0-F2

Cavitation is seen in up to *+U o cases andcalcifcation is seen in *+H6+U on CT scans 0-F2

-F >ickord :), &wensen &9, %tM 9> Thoracic crosssectional imaging oamyloidosis AJR 1997; 8376H766


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1t may grow very slowly over years>oor enhancement on contrast"enhanced CT is

reported in cases o pulmonary amyloidosis 0-82%sually,patients with nodular amyloidosis are

asymptomatic(iJerentiation rom lung cancer on CT is diKcult,

especially in cases with an uncalcifed solitarynodule with an irregular margin 0-F, -82 #'ig 7$

-F >ickord :), &wensen &9, %tM 9> Thoracic crosssectional imaging oamyloidosis AJR 1997; 8376H766

-8


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ow signal intensity on T*"weighted


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&un Abscess

+"year"old man with lung abscess due to aspiration o oreign body!7 9igh5resolution CT image shos nodule 0diameter, >= mm ith

3ne spiculations and pleural indentation in peripher+ of rightloer lo;e7

.7 Mediastinal indo image shos small ca2it+ in center of nodule7C7 Specimen image shos parench+mal defect surrounded ;+

marked in3ltration of chronic in@ammator+ cells7 !rro indicates


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&un Abscess

ung abscess is oten associated with bacterialpneumonia or is preceded by aspiration

The organisms are oten anaerobic bacteria, including( >ulmonary inection 1n3 'raser ;&, are >(, eds ,ras%r a"d 'ar%s diag"osis o( dis%as%s o( th% ch%st) #th %d* 'hilad%lphia) 'A:

&aunders, DDD3D6H+-D (ail (: Bronchial and transbronchial diseases 1n3 (ail (:, :ammar &>, eds '&l!o"ary


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&un Abscess

They may be isolated or occur within areas oconsolidation 07, -+2

1n most cases, the walls o the cavities are smooth andless than 6 mm thick 07, 6+2

)n irregular and thick wall #Z 6 mm$ is occasionallyseen and, in such cases, it resembles cavitated lungcancer 06+2

ung abscess may also maniest as a nonspecifcconsolidation or nodular opacity, and diJerentiation

rom cancer is challenging in the latter case 0-2 #'ig-$

7 'raser ;&, are >( >ulmonary inection 1n3 'raser ;&, are >(, eds ,ras%r a"d 'ar%s diag"osis o( dis%as%s o( th% ch%st) #th %d* 'hilad%lphia) 'A:&aunders, DDD3D6H+

-+ :ansell (


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Focal OraniinPneumonia

+"year"old man with asymptomatic ocal organiMing pneumonia!7 9igh5resolution CT image shos solid nodule #diameter, *6 mm$ with serratedmargin and rough spiculations in periphery o right lower lobe Convergence operipheral vessels and pleural indentation are also shown :e underwent videoassistedthoracoscopic surgery on suspicion o primary lung cancer

.7 9istolog+ image re2eals 3;rotic foci ith 3;ro;last prolieration, chronicinNammatory infltrate, and dilated regenerative alveolar spaces containing fbrinous

Focal Oraniin


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'ocal organiMing pneumonia is reerred to asunresolving pneumonia or pneumonia with a delayedresolution, but there is no clear clinical defnition 062

1t consists histologically o polypoid granulation tissue

in the alveolar spaces and peripheral bronchial lumenassociated with chronic inNammatory infltrate 062 1t shows a wide variety o CT fndings%sually, it shows consolidation Ln the other hand, ocal

organiMing pneumonia may present as a nodule with anoval or spindle"shaped margin and satellite lesions

6 Cordier 9' Lrganising pneumonia Thora 2000; 66378H7*8

Focal Oraniin


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&ometimes the CT images o ocal organiMingpneumonia show a nodule with a spiculated margin, airbronchogram, bubblelike lucency, halo sign, mi5edGGL, and pleural indentation resembling primary lung

cancer 06*, 672(iJerentiation rom lung cancer is diKcult, and manypatients undergo surgery in such cases 06*, 672

ot only in ocal organiMing pneumonia but also inother inNammatory nodules as well, the margins are

sometimes concave with a ew rough spiculations 0-2

6* Pang >&, ee =&, :an 9, =im O), =im T&, Choo 1. 'ocal organiMingpneumonia3 CT and pathologic fndings J


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Lne report postulated that retraction o theaJected lobule, in contrast to intact adQacentlobules, causes a concave margin in thehealing process o the inNammation 06-2

1t sometimes mimics primary lung cancer withspiculated margin 0-2

The diJerentiation between such inNammatorynodules and lung cancer is diKcult 0-, 6*, 672

- 'uruya =,


72/75

&ymphoma

F7"year"old woman with secondary lymphoma who had been treated or non":odgkin ollicular lymphoma!7 CT image shos solid mass 0diameter, 4> mm ith lobulatedmargin and ground"glass opacifcation component along bronchovascularbundle that resembles primary lung cancer

.7 Specimen image o;tained ;+ trans;ronchial lung biopsy shows

& h


73/75

&ymphoma

>rimary lymphoma o the lung is rareress, *++-3DH*-

66 .isleM


74/75

&ymphoma

&econdary pulmonary lymphoma occurs morereIuently than primary lymphoma

) wide variety o CT fndings are ound in primaryand secondary lymphoma3 single or multiple

pulmonary nodules and masses, consolidation,GGL, air bronchogram, cavities, andperibronchovascular thickening 066, 62

&ometimes lymphoma maniests as a nodule or

mass resembling a primary or metastatic lungcancer in the CT images 066H6F2

66 .isleM


75/75

C$)CL(S#$)

) wide variety o pulmonary conditionspresent imaging eatures that mimicthose o primary lung cancers and arediKcult to diJerentiate rom cancer

)wareness o these conditions with anunderstanding o their pathologic

background and careul attention tothe clinical inormation will helpachieve correct diagnoses

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