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Purpose To investigate the relationship between carotid arterial calcium score (CarACS) and silent cerebrovascular lesions in patients with obstructive sleep apnea (OSA). Materials and Methods This study involved retrospective evaluation of 60 OSA patients who underwent both upper airway CT and brain MRI. Using polysomnography, several indicators, including apnea index (AI), were used to evaluate the relationship between OSA and silent cerebrovascular lesions. The CarACS was quantified on CT imaging using the modified Agatston method. Silent cerebrovascular lesions were evaluated on brain MRI by grading periventricular hyperintensity (PVH). Various clinical characteristics, including age, were analyzed in each patient. Results The number of patients per PVH grade 0, 1, 2, 3, and 4 was 26 (43.3%), 14 (23.3%), 14 (23.3%), 4 (6.7%), and 2 (3.3%), respectively. The mean age, hypertension, smoking status, AI, and CarACS were significantly different among PVH groups (Ps < 0.05). In univariate analysis, the presence of carotid arterial calcification (β = 0.483, p < 0.01), CarACS (β = 0.482, p < 0.01), and age (β = 0.360, p < 0.01) showed a significant association with PVH grade. The mean AI and lowest O2 saturation had statistically weak associations with PVH grade (β = 0.267, p < 0.01; β = -0.219, p < 0.14, respectively). In multivariate analysis, CarACS was the only factor affecting PVH grade (p < 0.04). Conclusion CarACS is associated with the severity of silent cerebrovascular lesions. Therefore, additional analysis of CarACS in OSA patients may provide more information on their cerebrovascular status.

Objective To evaluate the value of airway computed tomography (CT) in patients with obstructive sleep apnea (OSA) as a predictor of cerebrocardiovascular disease (CCVD) clinically, by quantitatively analyzing carotid arterial calcification (CarAC). Materials and methods This study included 287 patients aged 40-80 years, who had undergone both polysomnography (PSG) and airway CT between March 2011 and October 2015. The carotid arterial calcium score (CarACS) was quantified using the modified Agatston method on each upper airway CT. The OSA severity was categorized as normal, mild, moderate, and severe using the PSG results. Clinical characteristics, comorbid diseases, and lipid profiles of all patients were analyzed, and the prevalence of CCVDs was investigated during the follow up period (52.2 ± 16.0 months). Results CCVD occurred in 27 patients (9.3%) at the end of follow-up, and the CCVD-present groups showed a significantly older mean age (57.5 years vs. 54.2 years), higher prevalence of hypertension (59% vs. 34%) and CarAC (51.9% vs. 20.8%), whereas sex, other comorbid diseases, and severity of OSA were not significantly different from the CCVD-absent group. A univariate analysis showed that age, hypertension, incidence of CarAC, and CarACS were risk factors for the occurrence of CCVD events. In a multivariate analysis, the incidence of CarAC was the only independent risk factor for CCVD. Conclusion CarAC is an independent risk factor for CCVD, whereas the severity of OSA is not a contributory risk factor in patients with OSA. Therefore, additional analysis of CarACS based on airway CT scans may be useful for predicting CCVD.

For CT pulmonary angiograms, a scout view obtained in anterior–posterior projection is usually used for planning. For bolus tracking the radiographer manually locates a position in the CT scout view where the pulmonary trunk will be visible in an axial CT pre-scan. We automate the task of localizing the pulmonary trunk in CT scout views by deep learning methods. In 620 eligible CT scout views of 563 patients between March 2003 and February 2020 the region of the pulmonary trunk as well as an optimal slice (“reference standard”) for bolus tracking, in which the pulmonary trunk was clearly visible, was annotated and used to train a U-Net predicting the region of the pulmonary trunk in the CT scout view. The networks’ performance was subsequently evaluated on 239 CT scout views from 213 patients and was compared with the annotations of three radiographers. The network was able to localize the region of the pulmonary trunk with high accuracy, yielding an accuracy of 97.5% of localizing a slice in the region of the pulmonary trunk on the validation cohort. On average, the selected position had a distance of 5.3 mm from the reference standard. Compared to radiographers, using a non-inferiority test (one-sided, paired Wilcoxon rank-sum test) the network performed as well as each radiographer (P

PURPOSE: To develop and evaluate fully automatic scan range delimitation for chest CT by using deep learning. MATERIALS AND METHODS: For this retrospective study, scan ranges were annotated by two expert radiologists in consensus in 1149 (mean age, 65 years ± 16 [standard deviation]; 595 male patients) chest CT topograms acquired between March 2002 and February 2019 (350 with pleural effusion, 376 with atelectasis, 409 with neither, 14 with both). A conditional generative adversarial neural network was trained on 1000 randomly selected topograms to generate virtual scan range delimitations. On the remaining 149 topograms the software-based scan delimitations, scan lengths, and estimated radiation exposure were compared with those from clinical routine. For statistical analysis an equivalence test (two one-sided t tests) was used, with equivalence limits of 10 mm. RESULTS: The software-based scan ranges were similar to the radiologists’ annotations, with a mean Dice score coefficient of 0.99 ± 0.01 and an absolute difference of 1.8 mm ± 1.9 and 3.3 mm ± 5.6 at the upper and lower boundary, respectively. An equivalence test indicated that both scan range delimitations were similar (P < .001). The software-based scan delimitation led to shorter scan ranges compared with those used in clinical routine (298.2 mm ± 32.7 vs 327.0 mm ± 42.0; P < .001), resulting in a lower simulated total radiation exposure (3.9 mSv ± 3.0 vs 4.2 mSv ± 3.3; P < .001). CONCLUSION: A conditional generative adversarial neural network was capable of automating scan range delimitation with high accuracy, potentially leading to shorter scan times and reduced radiation exposure. Keywords: Adults and Pediatrics, CT, Computer Applications-Detection/Diagnosis, Convolutional Neural Network (CNN), Lung, Radiation Safety, Segmentation, Supervised learning, Thorax © RSNA, 2021 Supplemental material is available for this article.

Background and Aims An association between Crohn's disease (CD) and hepatic steatosis has been reported. However, the underlying mechanisms of steatosis progression in CD are not clear. Among the most effective CD treatments are agents that inhibit Tumor-Necrosis-Factor (TNF) activity, yet it is unclear why anti-TNF alpha agents would affect steatosis in CD. Recent studies suggest that microbiome can affect both, CD and steatosis pathogenesis. Therefore, we here analysed a potential relationship between anti-TNF treatment and hepatic steatosis in CD, focusing on the gut-liver axis. Methods This cross-sectional study evaluated patients with established CD, with and without anti-TNF alpha treatment, analysing serum markers of liver injury, measurement of transient elastography, controlled attenuation parameter (CAP) and MRI for fat detection. Changes in lipid and metabolic profiles were assessed by serum and stool lipidomics and metabolimics. Additionally, we analysed gut microbiota composition and mediators of bile acid (BA) signalling via stool and serum analysis. Results Patients on anti-TNF alpha treatment had less hepatic steatosis as assessed by CAP and MRI. Serum FGF19 levels were significantly higher in patients on anti-TNF alpha therapy and associate with reduced steatosis and increased bowel motility. Neutral lipids including triglycerides were reduced in the serum of patients on anti-TNF treatment. Bacteria involved in BA metabolism and FGF19 regulation, including Firmicutes, showed group-specific alterations with low levels in patients without anti-TNF alpha treatment. Low abundance of Firmicutes was associated with higher triglyceride levels. Conclusions Anti-TNF alpha treatment is associated with reduced steatosis, lower triglyceride levels, alterations in FXR-signalling (eg FGF19) and microbiota composition in CD. PM is supported by the German Research Foundation/Deutsche Foschungsgemeinschaft-(MA-6864/1-1) and the European Association for the Study of the Liver (EASL). SS received funding from the EASL and the German Liver Foundation (Deutsche Leberstiftung). AL is supported by the funds of the European Commission through the 'European funds for regional development' (EFRE) as well as by the regional Ministry of Economy, Science, and Digitalization as part of the Autonomie im Alter research group. FJC received funding from MINECO Retos (SAF2016-78711), EXOHEP-CM (S2017/BMD-3727), NanoLiver (CM Y2018/NMT-4949), ERAB (Ref. EA 18/14), AMMF (2018/117), UCM (25-2019), COST Action (CA17112), RYC (2014-15242) and Gilead Liver Research 2018. AC is supported by the Wilhelm-Laupitz-Foundation. LPB is supported by the German Research Foundation/Deutsche Foschungsgemeinschaft (BE-3967/3-1) and the Dr Werner Jackstaedt-Foundation.

Congenital defects of the pericardium, which are generally asymptomatic, are rare disorders characterized by complete or partial absence of the pericardium. Here, we report a rare case of a 19-year-old male who was incidentally diagnosed with congenital absence of the left pericardium during examination for symptoms of pneumothorax. Chest radiography and CT revealed a collapsed left lung without any evidence of trauma, no unusual findings of free air spaces along the right side of the ascending aorta, heart shifted toward the left side of the thorax, and a shallow chest. Subsequent thoracoscopy confirmed the absence of the left pericardium and displacement of the heart toward the left thoracic cavity. We further discuss the correlation between radiologic images and surgical findings of a congenital pericardial defect associated with spontaneous pneumothorax.

Objective To evaluate the relationship between obstructive sleep apnea (OSA) severity and carotid arterial calcification by quantitative analysis using airway computed tomography (CT). Methods This study included a total of 180 consecutive OSA patients aged 45–80 years underwent polysomnography and airway CT between March 2014 and October 2016. The subjects were divided into three groups based on the results of the respiratory disturbance index (RDI): mild (RDI 5–14, n = 29), moderate (RDI 15–29, n = 50), and severe (RDI ≥ 30, n = 101). The extent of carotid arterial calcification on each airway CT scan was quantified according to the modified Agatston scoring method. Differences among the three groups in clinical characteristics including age, gender, body mass index (BMI), comorbid disease, blood pressure, total cholesterol, and carotid arterial calcification score (CarACS) were analyzed. Results The severe OSA group showed significantly stronger predominance for male and smoker, higher prevalence of diabetes, and larger BMI than those of mild and moderate OSA groups. The mean CarACS was significantly different among the three groups (mild RDI: 4.3 ± 13.4, moderate RDI: 7.4 ± 28.8, severe RDI: 48.6 ± 121.6, P = 0.011). Univariate linear regression showed that RDI, age, hypertension, male sex and diabetes significantly influenced on the CarACS. In a multivariate linear regression model, the CarACS was related to age, male sex, and diabetes. Conclusions The patients with severe OSA showed larger CarACS and a higher prevalence of atherosclerotic risk factors. The CarACS was correlated with severity of OSA, which might be more dependent on the conventional risk factors of atherosclerosis.

It has become the information medium that mediate between individuals of marketing with the new information media that use of the Internet in accordance with the progress of the IT industry- real estate marketing, real estate leasing, real estate auctions, etc. The real estate registration services should be disclosed to outside that include a schedule details the public book-register and problems caused by it should be reasonably resolved by handling a large amount of real estate registration work quickly, accurately handling to utilize Information Technology(IT) through the information system construction as the feature to process the information of register entries. Computerization of real estate registration will raise the efficiency of the registration as well as people can see the information related to real estate on the basis of published content without limitation the time and place and will pursue the ideal and reliability of the registration -web accessibility improving of the Internet Registry and permanent storage of preserving documents by electronic means. It is very large that impact on the real estate transaction if the accuracy of legal registration choosing formalism in the processing of real estate registration business through the Internet than written application is highly probable to occur incorrect registration. Also, It is necessary to manage it effectively -if you do not quickly and exactly respond to it, there is problems such as delays or poor registration service because real estate business activated and real estate registration services also increased sharply. In this paper, we will identify the problems of the real estate registration work and suggest improvements about it.

Demands of thermal recording paper have been increased significantly by increase in us-age of invoice, fax, and label. Thermal recording paper was mainly made based on virgin fiber. It is necessary to find a suitable alternative to virgin fiber in terms of environment protectional resources conservation. In this paper, deinking properties of different recov-ered papers were analyzed in order to use the recovered paper as raw material of thermal recording paper. Recovered paper were ONP, OMG and white ledger. Flotation reject of OMG was high because inorganic pigments in coating layer could be removed by upstream of froth. Brightnessof white ledger and OMG were much higher than that of ONP. Therefore, properties of pulp made from the recovered paper could be enhanced with increase in blending ratio of white ledger and OMG. However, blending ratio of OMG caused the increase of flotation reject. Consequently, the optimum blending ratio of ONP, OMG, and white ledger was 3:3:3 for eco-friendly thermal recording paper. Under the condition, brightness was about 70% and ERIC was below 300 ppm. Keywords: Deinking, thermal recording paper, flotation, old newspaper, white ledger, old magazine

Objective To evaluate the effects of vasodilators on contrast enhancement and transluminal attenuation gradient (TAG) of coronary arteries at coronary computed tomography angiography (CCTA). Materials and Methods We retrospectively reviewed CCTA scans of patients who underwent double-acquisition CCTA; CCTA without a vasodilator, and CCTA during a intravenous (IV) infusion of nitrate. Among them, we enrolled 19 patients who had no significant atherosclerotic lesions or coronary spasms. In the control group, 28 patients were enrolled who showed normal coronary arteries on CCTA, which was acquired by a conventional method (sublingual vasodilator). We measured the TAG and Hounsfield units for each of the three major epicardial coronary arteries (reported as ‘ProxHU’) and then compared the results between the nitrate administration methods (CT without vasodilator [CTpre], CT with IV vasodilator [CTiv], and CT with sublingual vasodilator [CTsub]). Results The mean TAG showed a significant difference between the coronary arteries (right coronary artery [RCA] > left anterior descending artery [LAD] > left circumflex artery [LCX], p < 0.05), while there was no difference in ProxHU of each coronary artery in all three types of nitrate administration methods (p > 0.05). The TAG of CTpre group showed steeper slope than those of vasodilator groups (CTiv and CTsub) on LAD and LCX ([LAD: CTpre = −22.1 ± 6.66, CTiv = −16.76 ± 5.78, and CTsub = −16.47 ± 5.78, p = 0.005], [LCX: CTpre = −31.26 ± 17.43, CTiv = −23.74 ± 14.06, and CTsub = −20.94 ± 12.15, p = 0.051]), while that of RCA showed no significant differences (p = 0.600). When comparing proxHU, CTiv showed higher proxHU than that of CTpre or CTsub, especially on LCX (CTpre = 426.7 ± 68.3, CTiv = 467.9 ± 84.9, and CTsub = 404.9 ± 63.3, p = 0.013). ProxHU showed a negative correlation with TAG on all three of methods (r = −0.280, p < 0.001). Conclusion TAG in CCTA was significantly affected by vasodilator administration. Both TAG and ProxHU of coronary arteries tend to increase with vasodilator administration on CCTA.

Rationale Gastric hyperplastic polyps are frequently found on upper gastrointestinal endoscopy and usually asymptomatic. Patients concerns A 65-year-old man visited the emergency department due to melena. Emergency upper endoscopy revealed a semi-pedunculated polyp measuring 1.2 cm in diameter with blood oozing. We resected the polyp using snare polypectomy. Ulceration was noted on the polypectomy specimen and was thought to be a bleeding focus. Diagnoses Histopathologic findings revealed hyperplastic polyp with focal well-differentiated adenocarcinoma in the ulcerated area and involvement of the lateral resection margin by carcinoma. Intervention We performed additional endoscopic resection using endoscopic submucosal dissection at the previous polypectomy site. Outcome At 1 year follow up, no recurrence or other distant metastasis was detected. Lessons This is a rare case of upper gastrointestinal bleeding from a small gastric hyperplastic polyp, which was found to be adenocarcinoma. When bleeding small gastric polyps are encountered during endoscopy, the possibility of malignancy and wider resection should be considered.

Bronchogenic cysts are congenital lesions usually observed in the mediastinum, near the tracheal carina and middle mediastinum. Herein, we present an exceedingly rare case of intradiaphragmatic bronchogenic cyst with an infectious complication in a 52-year-old man. Chest CT and three-dimensional volume rendered reconstructed images revealed an oval, cystic mass with multiple nodular calcifications, centered in the left diaphragm crus. CT facilitated documentation of the healing process of this rare entity, revealing decrease in size and increase in internal density.

To the Editor, Patients with chronic lymphocytic leukemia (CLL) have an increased incidence of secondary malignancies, such as solid tumors and lymphoid malignancies, during their clinical course. Here, we report a case of synchronous detection of colon cancer during initial staging with whole-body positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (18F-FDG) in a 53-year-old male patient with newly diagnosed CLL. Extranodal involvement and high-intensity FDG uptake in CLL are rare; thus, increased uptake in localized extranodal sites is highly suspicious of transformation to other hematological malignancies or the development of secondary solid tumors. Our findings suggest that patients with CLL should be carefully evaluated for secondary cancers in the initial staging and during the follow-up period. 18FDG-PET/computed tomography (CT) may be useful for detecting secondary malignancies; however, further studies are needed to investigate the cost-effectiveness of this imaging procedure compared to conventional CT in the follow-up setting. A 53-year-old male presented with chronic fatigue, night sweats, constipation, and a weight loss of 4 kg experienced over a 3-month period. He was otherwise relatively well and asymptomatic and had no history of previous exposure to ionizing radiation, cytotoxic agents, or a family history of leukemia. Physical examination revealed no lymphadenopathy, but the spleen tip was palpable 8 cm below the left lower costal margin. The peripheral blood (PB) white cell count was 34.3 × 109/L, with 70% lymphocytes. The complete blood count revealed a hemoglobin level of 11.0 g/dL and platelet count of 149 × 109/L of blood. Bone marrow (BM) aspirate was hypercellular; 70% of cells were mature B-lymphocytes. Immunophenotyping of PB and BM revealed a monoclonal B-lymphocyte population expressing surface immunoglobulin (slg) kappa (κ), CD19, CD20, CD5, and CD23 antigens. However, cytogenetic analysis using fluorescence in situ hybridization showed no specific chromosomal abnormalities. The diagnosis of B-cell stage II (intermediate-risk) was established according to the Rai staging system. Conventional abdomen/pelvic CT showed a focal soft tissue mass of ~6 cm with irregular borders involving the hepatic flexure of the right colon without pericolic infiltration or regional lymphadenopathy and marked splenomegaly. Because the incidence of extranodal involvement in CLL is low, 18FDG-PET/CT was performed to evaluate secondary malignancies such as Richter's transformation to diffuse large B-cell lymphoma, which is more aggressive than the underlying CLL or colon cancer. The staging 18FDG-PET/CT revealed intense FDG uptake in the ascending colon and mild focal metabolic activity in the left internal jugular region. The scan revealed diffuse increased FDG activity related to splenic lesions associated with splenomegaly (Fig. 1). Colonoscopy and biopsy identified a massive ulcerofungating tumor measuring ~6.0 × 5.5 cm on the hepatic flexure. A right hemicolectomy was performed (Fig. 2A). Pathology revealed a well-differentiated adenocarcinoma invading the submucosa with no metastatic lymph nodes (0/48) that was classified as pT1N0M0 according to the Union Internationale Contre le Cancer staging system (Fig. 2B). The patient then received intravenous fludarabine 25 mg/m2/day (42.5 mg total daily dose) and cyclophosphamide 250 mg/m2/day (450 mg total daily dose) for 3 consecutive days every 4 weeks; a total of three cycles of chemotherapy. No delays in administration or dose reductions were required, and no complications developed during chemotherapy. Treatment response was assessed by physical examination and evaluation of the blood and BM 2 months after chemotherapy. The patient's constitutional symptoms and splenomegaly resolved, and his clinical laboratory tests and BM findings returned to normal. On follow-up CT, no hepatosplenomegaly or lymphadenopathy or recurrence of colon cancer was found. The surveillance PET/CT scan and colonoscopy were unremarkable. At the time of writing, the patient had received a total of five cycles of fludarabine plus cyclophosphamide (FC) chemotherapy and is in complete remission without recurrence of colon cancer following the surgery. Figure 1 Whole-body positron emission tomography with fluorine-18 fluorodeoxyglucose (FDG). Intense FDG uptake in the ascending colon and mild focal metabolic activity in the left internal jugular region and diffuse increased FDG activity related to splenic lesions ... Figure 2 Gross specimen and histological findings following right hemicolectomy. (A) Colonoscopy revealed a massive ulcerofungating tumor of ~6.0 × 5.5 cm on the hepatic flexure. (B) Pathological analysis of the biopsy specimen revealed a well-differentiated ... CLL and other malignant neoplasms occasionally occur concomitantly, and patients with CLL are at significantly increased risk of developing solid tumors such as lung cancer, gastrointestinal carcinoma, and melanoma (Supplementary Table 1 online). In a large study involving 4,869 patients with CLL diagnosed between 1935 and 1971, subsequent neoplasms were observed in 4.8% of cases, and the relative risk (RR) was estimated to be 1.1, with a 95% confidence interval (CI) of 1.0 to 1.3. The National Cancer Institute's Surveillance, Epidemiology, and End Results Cancer Statistics Review 1973 to 1996 reported subsequent neoplasms in 11.1% of CLL cases (RR, 1.20; 95% CI, 1.15 to 1.26). Both reports found significant excess risks of Kaposi's sarcoma (RR, 5.3 and 5.09, respectively) and malignant melanoma (RR, 6.7 and 3.18, respectively). However, the neoplasms most commonly identified as having an elevated RR were cancers of the lung (RR, 1.5 and 1.66, respectively) and colon (RR, 1.0 and 1.13, respectively). Prolonged immunosuppression caused by asymptomatic B-cell CLL and chemotherapy, including the use of alkylating agents, may explain the association between CLL and secondary malignancies. That is, patients with CLL have an increased risk of developing additional malignancies during their clinical course, particularly when they have been treated with alkylating agents for long periods. Thus, clinicians should be aware of the potential for of a secondary malignancies occurring in patients with CLL [1]. Secondary malignancies may be detected incidentally regardless of treatment regime, but they may be more frequent in patients with CLL exposed to nucleoside analog therapy [2]. The present case is notable because the synchronous colon cancer was detected during initial staging with whole body PET with 18F-FDG in a patient with newly diagnosed CLL. PET imaging is useful for diagnosing hematological malignancies, particularly Hodgkin's lymphoma and aggressive non-Hodgkin's lymphoma, and is recommended for staging, prediction of prognosis, treatment planning, and response evaluation of lymphomas [3]. Furthermore, 18F-FDG PET/CT is of high diagnostic value in the staging and restaging of various malignant diseases, such as colorectal cancer, lung cancer, breast cancer, head and neck cancer, and malignant lymphomas. In a retrospective study of 37 patients with CLL undergoing 18F-FDG PET/CT between March 2003 and July 2005, Richter's transformation of CLL to diffuse large B-cell lymphoma and a new malignancy showing abnormally increased 18F-FDG uptake were detected with high sensitivity (94%), specificity (90%), and negative predictive values (97%) [4]. However, 18F-FDG PET/CT has not provided useful information for the management of CLL with the exception of detecting Richter's transformation; thus, further studies should investigate the cost-effectiveness and benefit of PET/CT compared to conventional CT in the follow-up period [3,4]. The prognosis for CLL with secondary malignancies is generally poor. Here we present a case of synchronously diagnosed B-cell CLL and adenocarcinoma of the colon. Although previous studies have reported a nonsignificant increase in colon cancer subsequent to the diagnosis of CLL, we noted an epidemiological association in our case suggesting the neoplasm was not a simple coincidence. This synchronous relationship may be explained in terms of prolonged immunosuppression as a result of asymptomatic B-cell CLL or shared cancer genes. A common alteration on chromosome 7, which has been demonstrated in 10% to 15% of B-cell CLL and 75% of colorectal cancer patients, may be the genetic basis of an association between hematological malignancy and hereditary nonpolyposis colon cancer with abnormalities in p53 gene expression. Chemotherapy administered in early stage B-cell CLL does not provide a survival advantage over conservative treatment and does not reduce the incidence of second neoplasms. Furthermore, the risk of recurrent solid tumors with a diagnosis of B-cell CLL has not been investigated. Here, we report an incidentally identified colon cancer in a 53-year-old male with newly diagnosed CLL during initial staging with whole body PET scanning with 18F-FDG. Our patient achieved complete remission 2 months after three cycles of FC chemotherapy with no evidence of recurrent colon cancer or other malignancies following surgery. Patients with CLL have an increased risk of subsequent cancers, such as other hematological malignancies or secondary solid tumors. Although the role of shared etiological factors remains unclear, patients with CLL should be carefully evaluated in initial staging and during the follow-up period for subsequent cancers, which can be detected using 18FDG-PET/CT.

Asymptomatic right ventricular outflow tract (RVOT) myxoma is quite rare. We report an unusual case of asymptomatic myxoma arising from the RVOT which was successfully surgically removed.

Incidence of nontuberculous mycobacterium (NTM) pulmonary disease is increasing with the wider recognition and development of diagnostic technology. Mycobacterium kansasii is the second most common pathogen of NTM pulmonary disease in human immunodeficiency virus (HIV)-infected patients. However in Korea, the incidence of M. kansasii pulmonary disease is relatively low, and there has been no report of M. kansasii pulmonary disease with bronchial involvement in HIV patients, to the best of our knowledge. We report a case of M. kansasii pulmonary disease presenting with endobronchial lesions in an HIV-infected patient complaining of chronic cough with bilateral enlargements of hilar lymph nodes on chest X-ray.