Thoracic Imaging 2003 - Society of Thoracic Radiology

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March 6, 2003 General Session 7:00 - 8:00 am Continental Breakfast Americana Foyer 8:00 - 11:00 am Guest Hospitality Suite Moon Room Thoracic Infection Americana 3 Moderator: Robert Tarver, MD 7:50 - 8:10 Pulmonary Tuberculosis Steven Primack, MD 8:10 - 8:30 Non-tuberculous Mycobacterial Infection David Schwartz, MD 8:30 - 8:50 HIV: Primary and Secondary Lung Infection Linda Haramati, MD 8:50 - 9:10 Viral Infection on HRCT Tomas Franquet, MD 9:10 - 9:30 Imaging of Coccidomycosis William Berger, MD 9:30 - 9:50 Session Discussion 9:50 - 10:10 am Coffee Break Americana Foyer The Airway Americana 3 Moderator: Georgeann McGuiness, MD 10:10 - 10:30 Tracheobronchial Malignancy Jo-Anne Shepard, MD 10:30 - 10:50 Inflammatory Disease of the Central Airways Arfa Khan, MD 11:10 - 11:30 Virtual Bronchoscopy R.C. Gilkeson, Jr., MD 11:30 - 11:50 Session Discussion 11:50 - 12:15 Scientific Presentation and Case of the Day Awards 12:15 pm Meeting Adjourns Thursday 249
THURSDAY 250 Pulmonary Tuberculosis Steven L. Primack, M.D. Although there had been an increase in the incidence of tuberculosis (Tb) in the late 1980’s, the incidence of tuberculosis has continued to decrease. In the United States, there were 53 cases per 100,000 in 1953. This incidence is now 6 per 100,000 in the year 2000. However, the most recent data from the World Health Organization found that the incidence of tuberculosis in Southeast Asia was 237 per 100,000 in 1995 and the incidence in Sub-Saharan Africa was 191 per 100,000. Risk factors for tuberculosis include lower socio-economic group, prisoners, nursing home residents, immigrants and refugees, health care workers, immunosuppressed patients, alcoholics and diabetics. Tuberculosis is initially acquired by inhalation of contaminated droplets, which are then ingested by macrophages when in the alveolus. Either a granuloma is formed or extensive tissue necrosis occurs with spread through lymphatics leading to primary tuberculosis. Postprimary tuberculosis occurs at a one percent rate per year in immunocompetent individuals but in a significantly higher rate in immunocompromised patients. The risk of development of active Tb include the contagiousness of the primarily infected individual, adequacy of antimicrobial defense of the exposed individual, the amount of contact and the environment where the contact occurred. Post primary Tb can occur either by reactivation of an endogenous focus of infection acquired early in life or, less commonly, exogenous reinfection. There tends to be an upper lung zone predilection probably related to higher oxygen tension and impaired lymphatic drainage. The clinical signs and symptoms of tuberculosis are somewhat nonspecific. Systemic symptoms include low grade fever, anorexia, fatigue, weight loss and night sweats. Pulmonary symptoms include cough, which is usually productive as well as hemoptysis on occasion. Severe shortness of breath is somewhat atypical. Patients are asymptomatic in approximately 5%. However, up to 60% of children are asymptomatic at the time of diagnosis. In the elderly, the diagnosis is frequently delayed. The radiologic manifestations of pulmonary Tb are dependent on host factors including prior exposure, age and immune status. Patients with tuberculosis are typically classified as either having primary or postprimary disease. However, from a clinical standpoint, the important distinction is between active and inactive Tb. When approached with a patient with possible tuberculosis, classification is based on clinical, bacteriologic and radiographic evaluation. Individuals are typically classified as having no disease, clinically active disease or are clinically inactive. A normal chest radiograph has a high negative predictive value but does have approximately a one percent false negative rate. Findings indicative of inactive disease on the chest radiograph include the Ghon focus, which is a calcified parenchymal granuloma and the Ranke complex, which is the Ghon focus with associated calcified lymph nodes. Findings sugges- tive of active disease include consolidation, poorly defined nodules, cavitation and enlarged lymph nodes. When interpreting chest radiographs for possible tuberculosis, it is essential to evaluate with prior radiographs available, particularly older chest radiographs. Prior radiographs other than the most recent should be used since changes can occur slowly. If there is extensive lung disease that is unchanged, the phrase “radiographically stable” is more appropriate than “inactive”. If there is indeterminate disease activity, it is appropriate to dictate that it is indeterminate but one should attempt to favor either active or inactive disease. The radiograph is a data point in the evaluation of a patient with suspected tuberculosis. The radiographic findings of primary Tb include lymphadenopathy, which is present in 95% of pediatric cases. CT scan often demonstrates rim enhancing necrotic lymph nodes. Consolidation is the most common parenchymal finding and is often multifocal with no zonal predominance. Nodules and masses often are also identified. Pleural effusion is present in 5 - 30% of cases, however, this is less common in pediatric patients. The radiographic findings of postprimary Tb often demonstrate heterogeneous opacities with linear, nodular and consolidative opacities present. Consolidation is the most common radiographic manifestation occurring in 50 – 70% of patients. Cavitation is identified in 20 – 45% of patients. Cavities can have either thin or thick nodular walls and have air fluid levels in up to 20% of cases. Endobronchial spread is often present and is characterized by poorly defined 5 – 10mm nodules in an airway distribution. Well defined nodules or masses with or without satellite nodules can be identified as well. Postprimary Tb has a characteristic radiographic distribution predominantly involving the apical or posterior segments of the upper lobes and the superior segments of the lower lobe. Other segments are often involved but generally occur in association with the characteristic sites. Multiple segments are involved in 70 – 90% of patients. Complications of pulmonary Tb include pneumothorax, bronchiectasis, residual cavities, aspergilloma and broncholithiasis. Another pattern of tuberculosis is miliary disease, which is more common in immunocompromised patients. This indicates the presence of hematogenous dissemination and is apparent radiographically by the presence of innumerable 1 – 3mm noncalcified nodules throughout both lungs. There is a mild basilar predominance. Interlobular septal thickening is often present which is better identified on CT scanning. CT scanning can be useful in the evaluation of Tb, particularly for identification of bronchogenic spread with identification of centrilobular nodules (“tree-in-bud”). Satellite nodules associated with masses or nodules are also better identified on CT. Cavitation is also better evaluated. Although CT scanning is helpful to distinguish between active and inactive Tb, it may not be definitive. Consolidation, centrilobular nodules, cavitation suggest active disease.
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The Society of Thoracic Radiology T
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Dear Friends, Welcome to Miami Beac
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Continuing Medical Education Credit
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Warren B. Gefter, MD University of
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Ernest M. Scalzetti, MD SUNY Upstat
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Registration Hours Saturday, March
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Program Committee Ella A. Kazerooni
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Small Airway Disease Americana 3 Mo
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Benjamin Felson Memorial Lecture Am
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Session 2-B Concurrent Session Clin
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Workshops (choose 1) 1:00 - 1:45 D1
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Sunday
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March 2, 2003 General Session Sunda
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SUNDAY 46 One type of direct-readou
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CT-PET Imaging Suzanne Aquino, M.D.
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SUNDAY 58 an accompanying decreased
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SUNDAY 60 Radiofrequency Ablation i
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SUNDAY 62 17. Sewell PE, Vance RB.
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SUNDAY 64 cal ventilation will be r
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SUNDAY 66 radiologic, and histopath
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SUNDAY 68 application. The untreate
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SUNDAY 70 The Expanded Spectrum of
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SUNDAY 72 Hypersensitivity Pneumoni
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SUNDAY 74 Small Airway Diseases Mic
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SUNDAY 76 The “Head-cheese Sign
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SUNDAY 78 “Holes” in the Lung:
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SUNDAY 80 Pleural Effusions Gerald
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SUNDAY 82 Asbestos Related Pleural
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SUNDAY 84 Other Pleural Neoplasms S
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SUNDAY 86 Image-Guided Therapy of M
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Notes 88
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March 3, 2003 General Session 7:00
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Cardiac MRI: Established Indication
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Cardiac MRI: New Developments Gauth
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5. The volume of contrast medium re
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Acute Aortic Syndrome Ernest M. Sca
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as well as separation of the cusps
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Pulmonary Veins: Imaging for Radiof
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Imaging of Cardiopulmonary Support
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plied to the hollow fibers by an ex
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swelling of the entire leg, calf sw
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Multi-channel Pulmonary CTA: New Te
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terminate scintigrams, CT correctly
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CT Strucural and Functional Imaging
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curves (TDCs) are generated by manu
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7. Crawford T, Yoon C, Wolfson K, e
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80. Fleischmann D, Rubin GD, Bankie
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127 MONDAY
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129 MONDAY
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REFERENCES Bergin CJ, Rios G, King
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Notes 134
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March 4, 2003 General Session 7:00
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Adult Manifestations of Congenital
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will usually display the limbs of t
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Imaging of the Pericardium Paul L.
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Cardiomyopathy Martin J. Lipton, M.
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TUESDAY 150 Nuclear Cardiology Upda
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TUESDAY 152 ties. The predominant 1
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TUESDAY 154 Imaging protocols: Util
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Manpower Shortage in Radiology: Sol
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159 TUESDAY
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161 TUESDAY
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163 TUESDAY
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NIBIB Update for Thoracic Radiology
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vertically along the right atrium t
Page 131 and 132: Multidetector Pediatric Chest CT: P
Page 133 and 134: The Spectrum of Pulmonary Infection
Page 135 and 136: Immune deficiency occurs frequently
Page 137 and 138: TUESDAY 180 The Internet and the Pr
Page 139 and 140: TUESDAY 182 Workshop A1: Lymphoma:
Page 141 and 142: TUESDAY 184 Digital Images: Camera
Page 143 and 144: TUESDAY 186 Analysis of Mediastinal
Page 145 and 146: Unusual Manifestations of Lung Canc
Page 147 and 148: Wednesday
Page 149 and 150: March 5, 2003 General Session Wedne
Page 151 and 152: WEDNESDAY 208 principle is that “
Page 153 and 154: WEDNESDAY 210 years and a current o
Page 155 and 156: WEDNESDAY 212 lesions generally mim
Page 157 and 158: WEDNESDAY 214 capable of studying t
Page 159 and 160: WEDNESDAY 216 Small T1 Lung Cancer:
Page 161 and 162: WEDNESDAY 218 REFERENCES Seely JM,
Page 163 and 164: WEDNESDAY 220 Therefore, radiologis
Page 165 and 166: WEDNESDAY 222 sectional area varies
Page 167 and 168: WEDNESDAY 224 Lung Cancer Staging A
Page 169 and 170: Metastatic Disease to Lung Gordon L
Page 171 and 172: Thoracic Metastates from Osteosarco
Page 173 and 174: STR tutorial: Use of MD CT reconstr
Page 175 and 176: ogenic edema, fat embolism, heroin
Page 177 and 178: WEDNESDAY 236 Pulmonary Arterial Hy
Page 179 and 180: WEDNESDAY 238 pathological process,
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Page 185 and 186: THURSDAY 252 1. Clinical criteria:
Page 187 and 188: THURSDAY 254 AIDS patients are also
Page 189 and 190: THURSDAY 256 Viral Infection on HRC
Page 191 and 192: THURSDAY 258 Imaging of Coccidioido
Page 193 and 194: THURSDAY 260 from the laryngeal sur
Page 195 and 196: THURSDAY 262 Inflammatory Diseases
Page 197 and 198: Virtual Endoscopy in the Thorax: Pr
Page 199 and 200: Notes 269 THURSDAY
Page 201: SECOND LEVEL THIRD LEVEL
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