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This article discusses a case study of a 25-year-old Spanish male who traveled to Senegal and developed symptoms of acute pulmonary schistosomiasis. The patient presented with fever, myalgia, and dry cough, and his blood tests showed eosinophilia. After treatment with praziquantel and prednisone, the patient's symptoms worsened, but eventually resolved. The article highlights the challenges in diagnosing and treating acute schistosomiasis and emphasizes the importance of timely diagnosis and the use of steroids in severe cases. The article also discusses the radiological manifestations of acute pulmonary schistosomiasis. [Extracted from the article]

Objectives To assess the impact of shifting from a standard double reading plus arbitration protocol to a single reading by experienced radiologists assisted by computer-aided detection (CAD) in a breast cancer screening program. Methods This was a prospective study approved by the ethics committee. Data from 21,321 consecutive screening mammograms in incident rounds (2010–2012) were read following a single reading plus CAD protocol and compared with data from 47,462 consecutive screening mammograms in incident rounds (2004–2010) that were interpreted following a double reading plus arbitration protocol. For the single reading, radiologists were selected on the basis of the appraisement of their previous performance. Results Period 2010–2012 vs. period 2004–2010: Cancer detection rate (CDR): 6.1‰ (95% confidence interval: 5.1–7.2) vs. 5.25‰; Recall rate (RR): 7.02% (95% confidence interval: 6.7–7.4) vs. 7.24% (selected readers before arbitration) and vs. 3.94 (all readers after arbitration); Predictive positive value of recall: 8.69% vs. 13.32%. Average size of invasive cancers: 14.6 ± 9.5 mm vs. 14.3 ± 9.5 mm. Stage: 0 (22.3/26.1%); I (59.2/50.8%); II (19.2/17.1%); III (3.1/3.3%); IV (0/1.9%). Specialized breast radiologists performed better than general radiologists. Conclusions The cancer detection rate of the screening program improved using a single reading protocol by experienced radiologists assisted by CAD, at the cost of a moderate increase of the recall rate mainly related to the lack of arbitration. [ABSTRACT FROM AUTHOR]

Aim: To describe mammographic features in screening detected invasive breast cancer less than or equal to 10mm using Breast Imaging Reporting and Data System lexicon in full-field digital mammography. Patients and Methods: A retrospective analysis of 123 pT1 (a-b) invasive breast cancers in women aged 50-69 years from our screening program. Radiologic patterns were: masses, calcifications, distortions, asymmetries and mixed. Masses: shape, margins and density, and calcifications: morphology, number of flecks and size of the cluster were taken into account, following Breast Imaging Reporting and Data System terminology. Results: We found 61 masses (49.6%), 8 masses with calcifications (6.5%), 30 groups of calcifications (24.4%), 19 architectural distortions (15.4%), 1 architectural distortion with calcifications (0.8%), 4 asymmetries (3.2%). Sixty out of 69 masses were irregular in shape, 6 lobular, 2 ovals and 1 round. Thirty-four showed ill-defined margins, 29 spiculated and 6 microlobulated. Most of them showed a density similar to surrounding fibroglandular tissue. Calcifications were pleomorphic or fine linear in 24 of 30 (80%). Most of cases showed more than 10 flecks and a size greater than 1cm. Conclusion: The predominant radiologic finding is an irregular, isodense mass those margins tend to share different descriptors, being ill-defined margins the most constant finding. Calcifications representing invasive cancer are predominantly pleomorphic with more than 10 flecks per cm. Architectural distortion and invasive tubular carcinoma are more common than reported in general series. [ABSTRACT FROM AUTHOR]

OBJECTIVES To assess the false-negative (FN) rate of positron emission tomography (PET)-chest computed tomography (CT) scan in clinical non-central cIA and cIB non-small-cell lung cancer (NSCLC) for mediastinal staging. METHODS Between January 2007 and December 2010, 402 patients with potentially operable NSCLC were assessed by thoracic CT scan and 18-fluoro-2-deoxy-d-glucose PET-CT for mediastinal staging and to detect extrathoracic metastases, of which 153 surgically treated patients (79 cIA and 74 cIB cases) were prospectively included in the study. Central tumours were excluded on the basis of CT scan criteria, defined as contact with the intrapulmonary main bronchi, pulmonary artery, pulmonary veins or the origin of the first segmental branches. CT scan was considered negative if lymph nodes were <1 cm at the smaller diameter. 18FDG PET-CT was considered negative when the high maximum standard uptake value (SUVmax) was <2.5. Non-invasive surgical staging was carried out in this group, and curative resection plus systematic mediastinal dissection was performed except in the event of unexpected oncological contraindication. RESULTS Composite non-invasive staging (CT scan, PET-CT) showed a negative predictive value (NPV) of 92% (CI 83.6–96.8) in the cIA group and 85% (CI 74–92) in the cIB group. There were 6 of 79 (7.6%) false-negatives (FNs) in cIA and 11 of 74 (14.8%) in cIB. Multilevel pN2 were detected in four cases, all of them in the cIB group. The most frequently involved N2 was subcarinal (two cases) in cIA and right lower paratracheal (R4) and seven (five cases) in cIB. Occult (pN2) lymph nodes were more frequent in tumour sizes ≥5 cm (pT2b, nine cases, four FNs, P = 0.03), pN1, adenocarcinoma [excluding minimally invasive adenocarcinoma (MIA) and lepidic predominant growth (LPA)] (P = 0.029) and female patients, but no other risk factors for mediastinal metastases were identified (age, clinical stage, tumour location, central or peripheral, P > 0.05). Multilevel pN2 was significantly more frequent in the cIB group (P < 0.03). In pT ≤ 1 cm (T1a), NPV was significantly better (NPV = 100%, P < 0.05) than the other subgroups studied (IA > 1 cm and IB). CONCLUSIONS Composite results for non-invasive mediastinal staging (CT scan, PET-CT) showed 11% of FNs in cI stage (7.6% in non-central cIA and 14.8% in cIB). In tumours ≤1 cm, NPV makes surgical staging unnecessary. In women with adenocarcinoma and non-central cIB, however, the high FN rate makes invasive staging necessary, particularly in pT2b to decrease the incidence of unexpected pN2 in thoracotomy. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: To study the outcomes of broncho±angioplastic sleeve lobectomy (SL) versus pneumonectomy (PN), and the PN:SL ratio after an aggressive policy of parenchyma-sparing surgery to improve postoperative complications rate and long-term quality of life (QoL). Methods: A prospective study was conducted in 490 patients with non-small cell lung cancer between 2005 and 2009. All patients not suitable for standard lobectomy were scheduled for SL, if possible, or for PN; eight patients with functional impairment were directly scheduled for SL. Results: Of 76 procedures, 21 (4%) were PN and 55 (11%) SL (29 bronchoplastic, seven bronchovascular, seven angioplastic; 11 extended to more than one lobe). There were no surgical, oncological or physiological preoperative differences between the groups. The 5-year PN:SL ratio was 1:2.6 (2005: 1:2.1; 2006: 1:2.6; 2007: 1:3.6; 2008: 1:3; 2009: 1:3.5). SL and PN mortality were 2 (3.6%) and 1 (5%), respectively. Postoperative complications occurred in 18 (32%) SL and 7 (33%) PN patients. pN1 (p =0.04), vascular reconstruction and upper-left SL were risk factors for postoperative complications of SL (p =0.03) but were not detected as a mortality risk. Overall 5-year survival was 61% for SL and 31% for PN. Survival at 5 years was significantly higher for SL (p =0.03, Kaplan–Meier). Age <70 years and SL were positive factors for long-term survival. In multivariate modelling, both remained positive factors. Surviving PN patients experienced significantly greater loss of respiratory function and lower QoL than those who avoided this surgery (preoperative score, PN vs SL: 52 vs 51; 3 months, 41 vs 43; and 6 months, 42 vs 51, p =0.04). The adjuvant treatment complement was higher in SL at 34 (62%) than at PN 10 (47%). The side effects of this treatment were more frequent in patients with more extirpated parenchyma (p =0.04). Conclusions: Parenchyma-sparing procedures can reduce the PN rate to less than 10%. A PN:SL index lower than 1:1.5 as a quality standard in a specialised thoracic unit should encourage the use of broncho-angioplastic procedures and improve patient outcomes. Long-term survival, QoL, postoperative lung function test and tolerance of adjuvant therapies are significantly better after SL than PN intervention. [Copyright &y& Elsevier]

Abstract: Objective: This study sought to assess the real incidence of pN2 among patients with non-small-cell lung cancer (NSCLC) (cN0) with negative mediastinal uptake of 2-deoxy-2-(18F)-fluoro-o-glucose (FDG). Methods: During 30 consecutive months (January 2007–May 2009), all patients with NSCLC scheduled for surgery in our unit had a preoperative FDG-positron emission tomography (PET)/computed tomography (CT) in our institution, after a dedicated chest CT (n =259). Only patients with both FDG-PET/CT and negative dedicated chest CT scan (N1 and N2 nodes <1cm) were prospectively included (n =125). Patients with cN1/cN2/cN3 and patients who had undergone preoperative chemo-radiotherapy were excluded. No invasive surgical staging was carried out in this group and curative resection plus systematic mediastinal dissection was performed except in the event of unexpected oncological contraindication. All variables were collected prospectively and, when pathological information was obtained, all the cases were carefully reviewed. Results: Mediastinal assessment by FDG-PET/CT, negative predictive value (NPV) was 85.6%, confidence interval (CI): [77–91]; false negatives (FNs) for mediastinal lymph nodes involvement was 14.4% (18 cases). The pN2 stations most frequently involved were: 4R (six cases), seven (six cases) and five (five cases). Multiple-level pN2 occurred in six (4.8%) cases. Occult (pN2) lymph nodes were more frequent in women (p <0.01), adenocarcinoma (p <0.05) and pN1 (p <0.05). Pathological N2 prevalence for pN1 was 34 (27.7%). Considering pathological staging as the gold standard, the agreement was 70% and 47.5% for stage IA and IB (Kappa''s index: 0.72 and 0.76) and, in all patients, 47% (Kappa''s index: 0.27). In general, down-staging is more frequent than up-staging. Conclusions: Mediastinal staging of NSCLC by FDG-PET/CT showed a considerable incidence of FNs. NPV is lower than previously reported and the preoperative mediastinal staging by 18FDG-PET/CT may jeopardise the accurate treatment for early stage NSCLC patients. [Copyright &y& Elsevier]

Background: Exposure to cigarette smoke has been shown to lead to vascular remodelling. Computed tomography (CT) imaging measures of vascular pruning have been associated with pulmonary vascular disease, an important morbidity associated with smoking. In this study we compare CT-based measures of distal vessel loss to histological vascular and parenchymal changes., Methods: A retrospective review of 80 patients who had undergone lung resection identified patients with imaging appropriate for three-dimensional (3D) vascular reconstruction (n=18) and a second group for two-dimensional (2D) analysis (n=19). Measurements of the volume of the small vessels (3D) and the cross-sectional area of the small vessels (<5 mm 2 cross-section) were computed. Histological measures of cross-sectional area of the vasculature and loss of alveoli septa were obtained for all subjects., Results: The 2D cross-sectional area of the vasculature on CT imaging was associated with the histological vascular cross-sectional area (r=0.69; p=0.001). The arterial small vessel volume assessed by CT correlated with the histological vascular cross-sectional area (r=0.50; p=0.04), a relationship that persisted even when adjusted for CT-derived measures of emphysema in a regression model., Conclusions: Loss of small vessel volume in CT imaging of smokers is associated with histological loss of vascular cross-sectional area. Imaging-based quantification of pulmonary vasculature provides a noninvasive method to study the multiscale effects of smoking on the pulmonary circulation., Competing Interests: Conflict of interest: F.N. Rahaghi has nothing to disclose. Conflict of interest: G. Argemi has nothing to disclose. Conflict of interest: P. Nardelli has nothing to disclose. Conflict of interest: D. Dominguez-Fandos has nothing to disclose. Conflict of interest: P. Arguis has nothing to disclose. Conflict of interest: V.I. Peinado has nothing to disclose. Conflict of interest: J.C. Ross reports grants from NIH, during the conduct of the study. Conflict of interest: S.Y. Ash has nothing to disclose. Conflict of interest: I. de La Bruere has nothing to disclose. Conflict of interest: C.E. Come reports grants from NIH/NHLBI (K23HL114735), during the conduct of the study. Conflict of interest: A.A. Diaz has nothing to disclose. Conflict of interest: M. Sanchez has nothing to disclose. Conflict of interest: G.R. Washko reports grants from NIH and BTG Interventional Medicine, grants from and has provided consultancy and participated on advisory boards for Boehringer Ingelheim, has provided consultancy for Genentech, Regeneron and GlaxoSmithKline, has provided consultancy and participated on data and safety monitoring boards for PulmonX, participated on advisory boards for ModoSpira and Toshiba, grants from and has provided consultancy for Janssen Pharmaceuticals, outside the submitted work; and is a founder and co-owner of Quantitative Imaging Solutions, which is a company that provides image-based consulting and develops software to enable data sharing; in addition, G.R. Washko's spouse works for Biogen, which is focused on developing therapies for fibrotic lung disease. Conflict of interest: J.A. Barberà has nothing to disclose. Conflict of interest: R. San Jose Estepar reports grants from NHLBI, personal fees from Toshiba and Boehringer Ingelheim, outside the submitted work; and is also a founder and co-owner of Quantitative Imaging Solutions, which is a company that provides image-based consulting and develops software to enable data sharing., (Copyright ©ERS 2019.)

A 70-year-old man with operated colorectal cancer relapsed with a solitary lung metastasis. Dual time-point PET/CT performed at 60' (standard images) and after 2 hours (delayed images) showed focal uptake in the lung nodule. A second uptake in the liver dome was also visualized only in the delayed images. Radiofrequency of the lung metastasis was performed by CT-fluoroscopy guide. A PET/CT 1 month after radiofrequency showed significant reduction of activity in the delayed images, and the uptake at 3 months was virtually normal. A fine-needle biopsy of the liver lesion confirmed the final diagnosis of metastasis from adenocarcinoma.

Sarcoidosis is a multisystem disorder that is characterized by noncaseous epithelioid cell granulomas, which may affect almost any organ. Thoracic involvement is common and accounts for most of the morbidity and mortality associated with the disease. Thoracic radiologic abnormalities are seen at some stage in approximately 90% of patients with sarcoidosis, and an estimated 20% develop chronic lung disease leading to pulmonary fibrosis. Although chest radiography is often the first diagnostic imaging study in patients with pulmonary involvement, computed tomography (CT) is more sensitive for the detection of adenopathy and subtle parenchymal disease. Pulmonary sarcoidosis may manifest with various radiologic patterns: Bilateral hilar lymph node enlargement is the most common finding, followed by interstitial lung disease. At high-resolution CT, the most typical findings of pulmonary involvement are micronodules with a perilymphatic distribution, fibrotic changes, and bilateral perihilar opacities. Atypical manifestations, such as masslike or alveolar opacities, honeycomb-like cysts, miliary opacities, mosaic attenuation, tracheobronchial involvement, and pleural disease, and complications such as aspergillomas, also may be seen. To achieve a timely diagnosis and help reduce associated morbidity and mortality, it is essential to recognize both the typical and the atypical radiologic manifestations of the disease, take note of features that may be suggestive of diseases other than sarcoidosis, and correlate imaging features with pathologic findings to help narrow the differential diagnosis., (© RSNA, 2010.)