Pub Date : 2019-07-01DOI: 10.1093/med/9780199858064.003.0075
J. Bueno
A micronodule is a rounded opacity that measures < 3 mm in diameter at CT. Nodules can be located within the lung interstitium, the airspace or both. The differential diagnosis of diseases manifesting with interstitial micronodules varies widely, and affected patients have variable clinical presentations. Familiarity with the anatomy of the pulmonary interstitium is fundamental when assessing micronodules as a concentration of micronodules within a particular compartment may be the imaging clue to the correct diagnosis. Thin-section CT and HRCT are optimal for detection and characterization of pulmonary micronodules; once micronodules are identified, their distribution within the pulmonary interstitium must be determined according to their location with respect to the secondary pulmonary lobule, and characterized as centrilobular, perilymphatic or random.
{"title":"Pulmonary Micronodules","authors":"J. Bueno","doi":"10.1093/med/9780199858064.003.0075","DOIUrl":"https://doi.org/10.1093/med/9780199858064.003.0075","url":null,"abstract":"A micronodule is a rounded opacity that measures < 3 mm in diameter at CT. Nodules can be located within the lung interstitium, the airspace or both. The differential diagnosis of diseases manifesting with interstitial micronodules varies widely, and affected patients have variable clinical presentations. Familiarity with the anatomy of the pulmonary interstitium is fundamental when assessing micronodules as a concentration of micronodules within a particular compartment may be the imaging clue to the correct diagnosis. Thin-section CT and HRCT are optimal for detection and characterization of pulmonary micronodules; once micronodules are identified, their distribution within the pulmonary interstitium must be determined according to their location with respect to the secondary pulmonary lobule, and characterized as centrilobular, perilymphatic or random.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124503848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780199858064.003.0077
S. Bhalla
The idiopathic interstitial pneumonias (IIPs) are a group of diffuse lung diseases that often manifest clinically with increasing dyspnea and hypoxemia. In the most recent revision of the American Thoracic Society/European Respiratory Society statement on IIPs, the major IIPs are divided into 3 groups: chronic fibrosing conditions (usual interstitial pneumonia and nonspecific interstitial pneumonia); smoking-related conditions (respiratory bronchiolitis and desquamative interstitial pneumonia) and acute/subacute IIPs (cryptogenic organizing pneumonia and acute interstitial pneumonia). Although some of these patterns may be seen with other conditions (e.g, NSIP with collagen vascular disease), the term IIP only refers to the idiopathic variants. Interestingly, the smoking-related conditions (RB-ILD and DIP) are included in this idiopathic grouping despite their association with cigarette use.
{"title":"Idiopathic Interstitial Pneumonias","authors":"S. Bhalla","doi":"10.1093/MED/9780199858064.003.0077","DOIUrl":"https://doi.org/10.1093/MED/9780199858064.003.0077","url":null,"abstract":"The idiopathic interstitial pneumonias (IIPs) are a group of diffuse lung diseases that often manifest clinically with increasing dyspnea and hypoxemia. In the most recent revision of the American Thoracic Society/European Respiratory Society statement on IIPs, the major IIPs are divided into 3 groups: chronic fibrosing conditions (usual interstitial pneumonia and nonspecific interstitial pneumonia); smoking-related conditions (respiratory bronchiolitis and desquamative interstitial pneumonia) and acute/subacute IIPs (cryptogenic organizing pneumonia and acute interstitial pneumonia). Although some of these patterns may be seen with other conditions (e.g, NSIP with collagen vascular disease), the term IIP only refers to the idiopathic variants. Interestingly, the smoking-related conditions (RB-ILD and DIP) are included in this idiopathic grouping despite their association with cigarette use.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131619725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780199858064.003.0058
S. Martinez-Jiménez
A variety of pathologic processes affect the connective tissues. The chapters that follow this one address some of these conditions with special emphasis on autoimmune disorders (e.g. rheumatoid arthritis, scleroderma, systemic lupus erythematosus, dermatomyositis/polymyositis, Sjögren syndrome, mixed connective tissue disease, and vasculitis), amyloidosis and eosinophilic lung disease. An autoimmune response is an immune response that targets an antigen within the host and attacks healthy body tissues. This often involves T and B lymphocytes in a response that is very similar to an allergic reaction. While the presence of an auto-antibody is often an essential component of the autoimmune response, its mere presence does not define the disease. In addition to the presence of auto-antibodies, the presence of soft tissue damage is required, thus auto-antibodies may be present in the absence of an inflammatory process. Amyloidosis is a pathologic entity with protean manifestations, often thought of as a single disease rather a group of diseases that share a similar pathophysiologic event: the deposition of proteins within the soft tissues. The term eosinophilic lung disease encompasses a wide variety of pathologic conditions that range from idiopathic diseases to systemic vasculitides and, in some cases, a response to parasitic infestation.
{"title":"Introduction to Connective Tissue Disorders and Autoimmune Conditions","authors":"S. Martinez-Jiménez","doi":"10.1093/MED/9780199858064.003.0058","DOIUrl":"https://doi.org/10.1093/MED/9780199858064.003.0058","url":null,"abstract":"A variety of pathologic processes affect the connective tissues. The chapters that follow this one address some of these conditions with special emphasis on autoimmune disorders (e.g. rheumatoid arthritis, scleroderma, systemic lupus erythematosus, dermatomyositis/polymyositis, Sjögren syndrome, mixed connective tissue disease, and vasculitis), amyloidosis and eosinophilic lung disease. An autoimmune response is an immune response that targets an antigen within the host and attacks healthy body tissues. This often involves T and B lymphocytes in a response that is very similar to an allergic reaction. While the presence of an auto-antibody is often an essential component of the autoimmune response, its mere presence does not define the disease. In addition to the presence of auto-antibodies, the presence of soft tissue damage is required, thus auto-antibodies may be present in the absence of an inflammatory process. Amyloidosis is a pathologic entity with protean manifestations, often thought of as a single disease rather a group of diseases that share a similar pathophysiologic event: the deposition of proteins within the soft tissues. The term eosinophilic lung disease encompasses a wide variety of pathologic conditions that range from idiopathic diseases to systemic vasculitides and, in some cases, a response to parasitic infestation.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"431 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116724562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780199858064.003.0081
M. Rosado-de-Christenson
The mediastinum is the space between the pleura and lungs, extends from the thoracic inlet to the diaphragm, and contains various organs and structures that may be affected by a variety of disease processes including neoplasms, other acquired conditions and congenital anomalies. The abnormal mediastinum is typically initially identified on chest radiography because of a mediastinal contour abnormality or mass. The radiologist must assess the frontal chest radiograph to determine whether the lesion manifests as a focal, diffuse or multifocal mediastinal abnormality. The lesion must then be localized to a specific mediastinal compartment using the lateral chest radiograph. This allows the formulation of a focused differential diagnosis and recommendations for further evaluation and management that often involve contrast-enhanced chest CT and less frequently MRI. These studies allow further characterization of the lesion and identification of associated findings such as lymphadenopathy, skeletal involvement and locally invasive behavior. Cross-sectional imaging usually allows categorization of mediastinal abnormalities as vascular, surgical or non-surgical lesions. Benign pathognomonic conditions that do not require further treatment may also be confidently diagnosed.
{"title":"Introduction to Mediastinal Abnormalities","authors":"M. Rosado-de-Christenson","doi":"10.1093/MED/9780199858064.003.0081","DOIUrl":"https://doi.org/10.1093/MED/9780199858064.003.0081","url":null,"abstract":"The mediastinum is the space between the pleura and lungs, extends from the thoracic inlet to the diaphragm, and contains various organs and structures that may be affected by a variety of disease processes including neoplasms, other acquired conditions and congenital anomalies. The abnormal mediastinum is typically initially identified on chest radiography because of a mediastinal contour abnormality or mass. The radiologist must assess the frontal chest radiograph to determine whether the lesion manifests as a focal, diffuse or multifocal mediastinal abnormality. The lesion must then be localized to a specific mediastinal compartment using the lateral chest radiograph. This allows the formulation of a focused differential diagnosis and recommendations for further evaluation and management that often involve contrast-enhanced chest CT and less frequently MRI. These studies allow further characterization of the lesion and identification of associated findings such as lymphadenopathy, skeletal involvement and locally invasive behavior. Cross-sectional imaging usually allows categorization of mediastinal abnormalities as vascular, surgical or non-surgical lesions. Benign pathognomonic conditions that do not require further treatment may also be confidently diagnosed.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130660467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780199858064.003.0084
B. Carter
Mediastinal cysts are fluid-filled lesions surrounded by a thin wall with an epithelial lining. These cysts are typically congenital, account for approximately 15-20% of all mediastinal masses, and may be found in any mediastinal compartment. Although mediastinal cysts may be initially detected on chest radiography, these lesions are optimally evaluated with computed tomography (CT) or magnetic resonance imaging (MRI). Cysts typically manifest as well-circumscribed, spherical lesions of water attenuation or signal, buy may appear heterogeneous when complicated by hemorrhage or infection. A focused differential diagnosis may be generated based on lesion location. For instance, bronchogenic cysts are most common in the middle mediastinum and pericardial cysts are typically found in the right cardiophrenic angle. Other mediastinal cysts include esophageal duplication and neurenteric cyst. Although meningocele is not a true cyst, it exhibits a cystic appearance on imaging.
{"title":"Cysts of the Mediastinum","authors":"B. Carter","doi":"10.1093/MED/9780199858064.003.0084","DOIUrl":"https://doi.org/10.1093/MED/9780199858064.003.0084","url":null,"abstract":"Mediastinal cysts are fluid-filled lesions surrounded by a thin wall with an epithelial lining. These cysts are typically congenital, account for approximately 15-20% of all mediastinal masses, and may be found in any mediastinal compartment. Although mediastinal cysts may be initially detected on chest radiography, these lesions are optimally evaluated with computed tomography (CT) or magnetic resonance imaging (MRI). Cysts typically manifest as well-circumscribed, spherical lesions of water attenuation or signal, buy may appear heterogeneous when complicated by hemorrhage or infection. A focused differential diagnosis may be generated based on lesion location. For instance, bronchogenic cysts are most common in the middle mediastinum and pericardial cysts are typically found in the right cardiophrenic angle. Other mediastinal cysts include esophageal duplication and neurenteric cyst. Although meningocele is not a true cyst, it exhibits a cystic appearance on imaging.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"221 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122853299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/med/9780199858064.003.0097
N. Parkar, A. Bierhals
The diaphragm abnormalities chapter discusses a variety of acquired and congenital conditions of the diaphragm, the principal muscle of respiration. Most diaphragmatic abnormalities encountered on imaging relate to abnormal contour or abnormal function. The latter is usually due to phrenic nerve palsy or neoplastic involvement. Abnormal contour often results from congenital thinning (eventration). Herniation and rupture following trauma are associated with a high risk of gastric ischemia and require prompt diagnosis and treatment. Thus, radiologists must be familiar with CT findings of traumatic diaphragmatic injury. Nontraumatic hernias (namely, Bochdalek, foramen of Morgagni and hiatal hernias) have typical imaging appearances as well. Rarely, a subpulmonic pleural effusion may mimic an elevated hemidiaphragm on radiography. A pleural effusion may also invert the diaphragm and impair respiration.
{"title":"Diaphragmatic Abnormalities","authors":"N. Parkar, A. Bierhals","doi":"10.1093/med/9780199858064.003.0097","DOIUrl":"https://doi.org/10.1093/med/9780199858064.003.0097","url":null,"abstract":"The diaphragm abnormalities chapter discusses a variety of acquired and congenital conditions of the diaphragm, the principal muscle of respiration. Most diaphragmatic abnormalities encountered on imaging relate to abnormal contour or abnormal function. The latter is usually due to phrenic nerve palsy or neoplastic involvement. Abnormal contour often results from congenital thinning (eventration). Herniation and rupture following trauma are associated with a high risk of gastric ischemia and require prompt diagnosis and treatment. Thus, radiologists must be familiar with CT findings of traumatic diaphragmatic injury. Nontraumatic hernias (namely, Bochdalek, foramen of Morgagni and hiatal hernias) have typical imaging appearances as well. Rarely, a subpulmonic pleural effusion may mimic an elevated hemidiaphragm on radiography. A pleural effusion may also invert the diaphragm and impair respiration.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128855955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780199858064.003.0005
G. Abbott
The basic “signs” in chest radiology are each formed by a combination of imaging findings that are known to be characteristic for a specific observation, often leading the radiologist to a more precise conclusion. Many of these signs were developed in the earliest decades of chest radiographic interpretation; others have been recognized in more recent years in the era of chest CT. Radiologists who are familiar with imaging signs facilitate the rapid recognition of complex imaging patterns, enabling the suggestion of a specific diagnosis, or a narrowed differential of diagnostic possibilities to be considered.
{"title":"Basic Signs in Chest Radiology: Silhouette, Hilar Overlay, and Hilar Convergence Signs","authors":"G. Abbott","doi":"10.1093/MED/9780199858064.003.0005","DOIUrl":"https://doi.org/10.1093/MED/9780199858064.003.0005","url":null,"abstract":"The basic “signs” in chest radiology are each formed by a combination of imaging findings that are known to be characteristic for a specific observation, often leading the radiologist to a more precise conclusion. Many of these signs were developed in the earliest decades of chest radiographic interpretation; others have been recognized in more recent years in the era of chest CT. Radiologists who are familiar with imaging signs facilitate the rapid recognition of complex imaging patterns, enabling the suggestion of a specific diagnosis, or a narrowed differential of diagnostic possibilities to be considered.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"136 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126296000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/med/9780199858064.003.0080
Cylen Javidan-Nejad
Organizing pneumonia (OP) is a nonfibrotic form of interstitial pneumonia that represents a manifestation of lung injury. It may be secondary to another process (such as vasculitis, collagen vascular disease, or drug therapy). When no inciting cause is found, the OP is believed to cryptogenic and the term Cryptogenic Organizing Pneumonia (COP) may be used clinically. Various patterns of OP may be encountered on imaging including classic (peripheral or bronchiolocentric consolidation), focal, crescentic, multinodular and fibrotic. The classic pattern is the most common, but the crescentic form (often known as the atoll or reverse halo sign) can be the most striking. The latter two patterns are more typical of OP associated with collagen vascular disease, most notably dermatomyositis and polymyositis.
{"title":"Organizing Pneumonia","authors":"Cylen Javidan-Nejad","doi":"10.1093/med/9780199858064.003.0080","DOIUrl":"https://doi.org/10.1093/med/9780199858064.003.0080","url":null,"abstract":"Organizing pneumonia (OP) is a nonfibrotic form of interstitial pneumonia that represents a manifestation of lung injury. It may be secondary to another process (such as vasculitis, collagen vascular disease, or drug therapy). When no inciting cause is found, the OP is believed to cryptogenic and the term Cryptogenic Organizing Pneumonia (COP) may be used clinically. Various patterns of OP may be encountered on imaging including classic (peripheral or bronchiolocentric consolidation), focal, crescentic, multinodular and fibrotic. The classic pattern is the most common, but the crescentic form (often known as the atoll or reverse halo sign) can be the most striking. The latter two patterns are more typical of OP associated with collagen vascular disease, most notably dermatomyositis and polymyositis.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124170572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780199858064.003.0073
J. Bueno
Ground-glass opacity (GGO) is defined at thin-section CT as abnormally increased lung density in which vascular and bronchial margins remain visible. This contrasts with consolidation in which those margins are obscured. In the setting of diffuse lung disease, GGO may be related to airspace filling, interstitial thickening or both. Pathologic processes manifesting as diffuse GGO have widely varied symptoms according to the etiology. The assessment of diffuse GGO is primarily achieved with HRCT. Helpful features in establishing a differential diagnosis include: chronicity, distribution of opacities and ancillary findings. Differential diagnosis of acute GGO includes infection, alveolar hemorrhage and pulmonary edema. Chronic GGO may be seen in hypersensitivity pneumonitis, organizing pneumonia, acute or chronic eosinophilic pneumonia, pulmonary alveolar proteinosis and desquamative interstitial pneumonia (DIP). GGO is a nonspecific HRCT pattern that should always be interpreted in light of acuity of symptoms, specific clinical presentation and laboratory results.
{"title":"Ground-Glass Opacities","authors":"J. Bueno","doi":"10.1093/MED/9780199858064.003.0073","DOIUrl":"https://doi.org/10.1093/MED/9780199858064.003.0073","url":null,"abstract":"Ground-glass opacity (GGO) is defined at thin-section CT as abnormally increased lung density in which vascular and bronchial margins remain visible. This contrasts with consolidation in which those margins are obscured. In the setting of diffuse lung disease, GGO may be related to airspace filling, interstitial thickening or both. Pathologic processes manifesting as diffuse GGO have widely varied symptoms according to the etiology. The assessment of diffuse GGO is primarily achieved with HRCT. Helpful features in establishing a differential diagnosis include: chronicity, distribution of opacities and ancillary findings. Differential diagnosis of acute GGO includes infection, alveolar hemorrhage and pulmonary edema. Chronic GGO may be seen in hypersensitivity pneumonitis, organizing pneumonia, acute or chronic eosinophilic pneumonia, pulmonary alveolar proteinosis and desquamative interstitial pneumonia (DIP). GGO is a nonspecific HRCT pattern that should always be interpreted in light of acuity of symptoms, specific clinical presentation and laboratory results.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126724358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780199858064.003.0048
R. Benson
Lymphadenopathy and extrapulmonary involvement may be presenting manifestations of advanced lung cancer. Central tumors such as squamous cell carcinomas and small cell carcinomas often exhibit ipsilateral hilar and mediastinal lymphadenopathy. Metastatic lymphadenopathy may exhibit subtle findings on radiography but is readily identified on CT, MRI and PET-CT. Lymphadenopathy in the setting of lung cancer portends a poorer prognosis compared with lung cancer without lymph node involvement. The differential diagnosis includes reactive lymphadenopathy from infection, granulomatous lymphadenopathy from sarcoidosis and malignant lymphadenopathy from metastatic disease and lymphoma. Advanced lung cancer may exhibit extrapulmonary involvement as the first manifestation of disease. Central lung cancers may directly invade the mediastinum and its organs and vessels. Peripheral lung cancers may invade the adjacent chest wall structures. Pleural and pericardial involvement may also occur and often manifests with effusion. Metastases to upper abdominal organs may be identified on chest CT. PET-CT allows identification of distant metastases.
{"title":"Lung Cancer: Lymphadenopathy and Extrapulmonary Involvement","authors":"R. Benson","doi":"10.1093/MED/9780199858064.003.0048","DOIUrl":"https://doi.org/10.1093/MED/9780199858064.003.0048","url":null,"abstract":"Lymphadenopathy and extrapulmonary involvement may be presenting manifestations of advanced lung cancer. Central tumors such as squamous cell carcinomas and small cell carcinomas often exhibit ipsilateral hilar and mediastinal lymphadenopathy. Metastatic lymphadenopathy may exhibit subtle findings on radiography but is readily identified on CT, MRI and PET-CT. Lymphadenopathy in the setting of lung cancer portends a poorer prognosis compared with lung cancer without lymph node involvement. The differential diagnosis includes reactive lymphadenopathy from infection, granulomatous lymphadenopathy from sarcoidosis and malignant lymphadenopathy from metastatic disease and lymphoma. Advanced lung cancer may exhibit extrapulmonary involvement as the first manifestation of disease. Central lung cancers may directly invade the mediastinum and its organs and vessels. Peripheral lung cancers may invade the adjacent chest wall structures. Pleural and pericardial involvement may also occur and often manifests with effusion. Metastases to upper abdominal organs may be identified on chest CT. PET-CT allows identification of distant metastases.","PeriodicalId":415668,"journal":{"name":"Chest Imaging","volume":"210 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115763860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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