Connective tissue diseases (CTDs) are a heterogeneous group of idiopathic inflammatory diseases involving various organs. A thoracic involvement is frequent, and chest-CT represents the imaging technique of reference in...Connective tissue diseases (CTDs) are a heterogeneous group of idiopathic inflammatory diseases involving various organs. A thoracic involvement is frequent, and chest-CT represents the imaging technique of reference in its assessment. Pulmonary abnormalities related to CTDs are various; although several disease-specific aspects have been described, the two most clinically relevant complications are represented by interstitial lung disease and pulmonary arterial hypertension. The early identification of a thoracic involvement, with the adoption of specific therapies, can significantly change patient's prognosis. The aim of this article is to review the most common typical and atypical CT features of thoracic involvement occurring in CT, especially focusing on interstitial lung disease.
A 53-year-old male was referred to the department of maxillofacial surgery for the extraction of a destructed wisdom tooth. A preoperative orthopantomogram revealed a well delineated ovoid, radiolucent lesion at the left...A 53-year-old male was referred to the department of maxillofacial surgery for the extraction of a destructed wisdom tooth. A preoperative orthopantomogram revealed a well delineated ovoid, radiolucent lesion at the left angle of the mandible. For further lesion characterization, a dental CT scan and MRI were performed.
A 38-year-old male with no medical history complains about hemoptysis, chest pain, dyspnea on exertion and a cough. He has a history of occasional smoking, but had quitted smoking 1 year previously. There is a normal sat...A 38-year-old male with no medical history complains about hemoptysis, chest pain, dyspnea on exertion and a cough. He has a history of occasional smoking, but had quitted smoking 1 year previously. There is a normal saturation and normal spirometry. Clinical examination and auscultation are also normal. Because of these complaints CT scan of the thorax was performed. For further diagnostic workup bronchoscopy was performed afterwards.
A 49-year-old man presented at the emergency department with neck pain for one week but also with subfebrility, sore throat and difficulties for swallowing for 3 days. Physical examination showed limited neck movement an...A 49-year-old man presented at the emergency department with neck pain for one week but also with subfebrility, sore throat and difficulties for swallowing for 3 days. Physical examination showed limited neck movement and tenderness of the trapezius muscles. Blood test showed an elevated C-reactive protein level and a mild leukocytosis. Tracheolaryngoscopy was normal.
A 48-year-old male smoker with no significant previous medical history presented to the emergency department with acute respiratory distress, characterized by dyspnea and nonspecific chest pain. Laboratory findings and e...A 48-year-old male smoker with no significant previous medical history presented to the emergency department with acute respiratory distress, characterized by dyspnea and nonspecific chest pain. Laboratory findings and electrocardiography (ECG) were normal.
A 9-year-old boy was admitted to the emergency department because of repetitive vomiting and loss of appetite for 4 days. There was peristalsis present and laboratory tests were normal.A 9-year-old boy was admitted to the emergency department because of repetitive vomiting and loss of appetite for 4 days. There was peristalsis present and laboratory tests were normal.
A 61-year-old man was referred to our hospital after a high impact motor vehicle accident. A full body CT scan revealed a cranial subdural hematoma and multiple fractures of the axial and appendicular skeleton (not shown...A 61-year-old man was referred to our hospital after a high impact motor vehicle accident. A full body CT scan revealed a cranial subdural hematoma and multiple fractures of the axial and appendicular skeleton (not shown), as well as a retrosternal hematoma. Because of steadily decreasing hemoglobin and hematocrit levels on day 2, a repeat thoracoabdominal CT scan was performed, but active bleeding was not found. On day 7, sudden desaturation and increased drain output from the nasogastric tube prompted for a repeat thoraco-abdominal CT scan.
A 26-year-old woman presented at the emergency department with a painful abdomen and fever up to 39°C, despite antibiotics. She had given prematurely birth by caesarian section to a twin 8 days earlier. On clinical exami...A 26-year-old woman presented at the emergency department with a painful abdomen and fever up to 39°C, despite antibiotics. She had given prematurely birth by caesarian section to a twin 8 days earlier. On clinical examination she had a diffuse painful and tender abdomen, especially on the right side and suprapubic region. Laboratory findings showed an increased c-reactive protein of 24 mg/dL (normal < 0,3) and increased white blood cell count of 13 Å~ 10E9/L (normal 4,3-10 Å~ 10E9/L). There was also a decreased hemoglobin level of 8,4 g/dL (normal 12-15 g/dL). An ultrasonography was performed by the gynecologist and revealed a large heterogeneous fluid collection anteriorly of the uterus.
An 80-year-old male (patient A) felt at home and consequently was admitted to the emergency unit. Following the head trauma, he was bleeding on the right frontoparietal area. The patient was found unconscious and the Gla...An 80-year-old male (patient A) felt at home and consequently was admitted to the emergency unit. Following the head trauma, he was bleeding on the right frontoparietal area. The patient was found unconscious and the Glasgow Coma Scale was 9/15. An unenhanced CT scan of the brain was performed. A second patient, an 86-year-old male (patient B) was admitted to the intensive care unit with a degrading Glasgow Coma scale from 14/15 to 8/15. A subdural hematoma was diagnosed on a first CT scan. An unenhanced CT scan of the brain was performed to control the hematoma.
A 65-year-old woman was admitted to the emergency department for sudden onset of neck pain and dysesthesia of both upper limbs. The pain occurred spontaneously, without any history of recent trauma. Rapidly after her adm...A 65-year-old woman was admitted to the emergency department for sudden onset of neck pain and dysesthesia of both upper limbs. The pain occurred spontaneously, without any history of recent trauma. Rapidly after her admission, she developed tetraparesia. The patient had a past medical history of long standing hypertension correctly controlled as confirmed at admission. Neurological examination confirmed the tetraparetic status with a sensory level at Th3. Moreover, a saddle anesthesia with impaired bladder control was observed. Cranial nerve examination and consciousness of the patient remained normal. Laboratory coagulation tests and platelets count were all within normal limits.
A 22-year-old woman was referred to our department with a painless, fast growing breast mass. She noticed this mass during lactation, after giving birth to her first child. Her gynecologist palpated a large mass in the l...A 22-year-old woman was referred to our department with a painless, fast growing breast mass. She noticed this mass during lactation, after giving birth to her first child. Her gynecologist palpated a large mass in the left breast, two smaller nodules in the left breast, and one small nodule in the right breast. Ultrasonography of the breasts, mammography and MRI were performed, and a tentative diagnosis of phyllodes tumor was proposed. She was subsequently referred to our centre.
A 32-year-old lady of Asian descent presented with pain and severe stiffness of the back and hips progressively worsening over several years. She was diabetic but had no past medical history of rickets or renal disease....A 32-year-old lady of Asian descent presented with pain and severe stiffness of the back and hips progressively worsening over several years. She was diabetic but had no past medical history of rickets or renal disease. On examination she was of short stature with marked thoracic kyphosis and flattening of the lumbar spine. Spinal movements were globally restricted and the hips demonstrated a fixed flexion deformity. Her initial diagnosis had been ankylosing spondylitis until she had a MRI scan. Plain radiographs and further MRI of the hips were also performed. Subsequent laboratory tests revealed she was vitamin D deficient, normocalcemic with raised parathyroid hormone (PTH) and alkaline phosphatase.
A 31-year-old woman presented at the department of neurology with a history of seizures since childhood. About five years ago her seize pattern changed from generalized atonic attacks with asphyxia to simple partial atta...A 31-year-old woman presented at the department of neurology with a history of seizures since childhood. About five years ago her seize pattern changed from generalized atonic attacks with asphyxia to simple partial attacks characterized by left hemiparesis and speech difficulties. These seizures occurred multiple times a day and typically lasted about a minute. The patient had a negative family history of epilepsy.
A 59-year-old man was referred for CT scan of the abdomen after repair of an eventrated appendectomy wound. The man had a known history of bipolar affective disorder, for which he had been on lithium therapy for many yea...A 59-year-old man was referred for CT scan of the abdomen after repair of an eventrated appendectomy wound. The man had a known history of bipolar affective disorder, for which he had been on lithium therapy for many years. As an incidental finding, CT scan showed numerous small hypodense renal lesions. Subsequently a MRI examination was performed to further characterize these renal abnormalities.
A 26-year-old male presented with pain in his left tibia. Ultrasonography revealed no abnormalities. Tc-99m-bonescan was requested to rule out stress fracture. The scan confirmed the presence of a left tibial stress frac...A 26-year-old male presented with pain in his left tibia. Ultrasonography revealed no abnormalities. Tc-99m-bonescan was requested to rule out stress fracture. The scan confirmed the presence of a left tibial stress fracture, as well as an enhancing lesion in the left parietal bone. The patient had no neurological symptoms.
A 19-year-old woman, Academy of Sport student, noticed a progressive bluish discoloration, swelling and pain of the right hand and axilla during abduction. The symptoms had been progressive for 6 months. During physical...A 19-year-old woman, Academy of Sport student, noticed a progressive bluish discoloration, swelling and pain of the right hand and axilla during abduction. The symptoms had been progressive for 6 months. During physical examination there was a normal sensibility and motor function, and normal pulsations of the radial and ulnar artery. There was no significant medical history. A thorax aperture radiograph was performed, followed by venography of the right arm in neutral position and with abduction.
A 48-year-old woman suffering from headaches for a longer period of time underwent a MRI scan. Based on the MRI findings, she was referred to our hospital for further analysis of a suprasellar lesion. In addition, we per...A 48-year-old woman suffering from headaches for a longer period of time underwent a MRI scan. Based on the MRI findings, she was referred to our hospital for further analysis of a suprasellar lesion. In addition, we performed a non-contrast and a contrast-enhanced CT scan.
A 57-year-old patient was admitted for high-grade fever, asthenia, sweating, dry cough and diffuse arthro-myalgias. Two years earlier, elevated titers of anticytoplasmic antibodies (ANCA) of anti-proteinase 3 specificity...A 57-year-old patient was admitted for high-grade fever, asthenia, sweating, dry cough and diffuse arthro-myalgias. Two years earlier, elevated titers of anticytoplasmic antibodies (ANCA) of anti-proteinase 3 specificity and renal biopsy led to a diagnosis of granulomatosis with polyangiitis (GPA) with lung and renal involvement. GPA was treated by steroids, cyclophosphamide and rituximab with subsequent clinical and biological remission. The current chest CT scan was performed for a lung opacity that eventually was proved to be an organising pneumonia. CT also showed an unsuspected pattern of the spleen that was compared with a previous chest CT.
A 34-year-old male teacher was referred to the hospital with a persisting dry cough and dyspnea on exercise since eight weeks. He had no fever, neither complaints of ear, nose or throat. There were no complaints during t...A 34-year-old male teacher was referred to the hospital with a persisting dry cough and dyspnea on exercise since eight weeks. He had no fever, neither complaints of ear, nose or throat. There were no complaints during the night. He had been a smoker until four months before presentation (12 pack years). At work a student was diagnosed with pulmonary tuberculosis, but the Mantoux and Quantiferon tests were negative. Physical examination was normal, without fever, lymphadenopathy or auscultation abnormalities. Laboratory investigation revealed a C-reactive protein of 2 mg/L. Pulmonary function testing showed a slight restriction. Immunological bronchial alveolar lavage (BAL) was rich of cells, especially T-lymphocytes of the CD4 type. CD4+/CD8+ ratio of the BAL was raised to 4.2, compared to a ratio of 2.4 in blood. There were no eosinophils found in the BAL. Conventional chest radiographs were performed, and showed multiple areas of consolidation in the bilateral lung fields, predominantly on the right side.
A 1-year-old girl was referred to the neurosurgery department. The patient presented with a swelling on the vertex of the head which was present at birth but increased gradually over time. There were no perinatal problem...A 1-year-old girl was referred to the neurosurgery department. The patient presented with a swelling on the vertex of the head which was present at birth but increased gradually over time. There were no perinatal problems and the child developed normally. The swelling produced no discomfort nor pain, and measured 2 cm Å~ 3 cm. The child was followed during 6 months because there was a chance of involution. The patient was reevaluated 6 months later.