62才男性
脳梗塞フォロー中右下肺野に異常陰影指摘
Case 1
62-year-old man with abnormal shadow in right lower lung fieldduring follow up of brain infarction.
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今回は解答編 バージョン１です。症例の解説が主体です。
胸腺腫の総まとめビデオはこちら 10分余った時間で勉強してください。
Key words: Mediastinal tumor, Thymoma, thymoma, thymic tumor, 縦隔腫瘍、胸腺腫、胸腺腫瘍、WHO classification, WHO分類
Key images:
Case 1 62M Type A
Case 2 69M
胸腺腫： ADCとWHO分類との対比論文はこちら
１．
Abdel RazekAA, KhairyM Nada N.
2.
62-year-old man with abnormal shadow in right lower lung fieldduring follow up of brain infarction. 脳梗塞フォロー中右下肺野に異常陰影指摘
69-year-old man with fever and chest pain.69才男性、発熱・胸痛
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縦隔解剖を確認しないとだめですよね。
20140407 Multiple hepatic nodules : Answer
Key words: VMC, von Meyenburg’s complex, biliary hamartoma, 胆管過誤腫、胆管性過誤腫, comet-tail sign, DWI, diffusion weighted imaging, APKD
Key images:
80-year-old man with VMC or biliary hamartoma.
Reference
1) Luo TY, Itai Y, Eguchi N, et al.
Von Meyenburg complexes of the liver: imaging findings.
J Comput Assist Tomogr. 1998:22:372-378
2) Lung PF, Jaffer OS, Akbar N,et al.
Appearances of von meyenburg complex on cross sectional imaging.
J Clin imaging Sci. 2013 May 31;3:22. doi: 10.4103/2156-7514.112804. Print 2013.
3) Semelka RC, Hussain SM, Marcos HB, et al.
J MagnReson Imaging. 1999: 10: 196-201
4) MorteléB, Mortelé K, Seynaeve P, et al.
Hepatic bile duct hamartomas (von Meyenburg Complexes): MR and MR cholangiography findings.
J Comput Assist Tomogr. 2002 May-Jun;26(3):438-43.
5) Lev-ToaffAS, Bach AM, Wechsler RJ, et al.
The radiologic and pathologic spectrum of biliary hamartomas.
AJR Am J Roentgenol. 1995 Aug;165(2):309-13.
6) Maher MM, DervanP, Keogh B, et al.
Bile duct hamartomas (von Meyenburg complexes): value of MR imaging in diagnosis.
Abdom Imaging. 1999 Mar-Apr;24(2):171-3.
iphone ver
key word
Solitary fibrous tumor, SFT, pleura, clinical features
孤立性線維性腫瘍,間葉系細胞由来,臓側胸膜,胸膜,無症状,免疫染色,CD34,粘液変性
Differential diagnosis: pleural mesothelioma 胸膜中皮腫
Other sarcomatous lesions 他の肉腫系病変
すべての年齢,50-60代ピーク,75%が40歳以上
男女差無い,無症状
境界明瞭腫瘍,小さい場合均一,大きくなると不均一
良性はT2WI で低信号
T2WI で高信号の場合良性,悪性の判別難しい
良性でT2WI 高信号となるのは粘液変性,出血,壊死による
Reference 文献
Chu X, Zhang L, Xue Z, et al.
Solitary fibrous tumor of the pleura: An analysis of forty patients.
J Thorac Dis. 2012 Apr 1;4(2):146-54. doi: 10.3978/j.issn.2072-1439.2012.01.05.
Agarwal VK, Plotkin BE, Dumani D, et al.
Solitary fibrous tumor of pleura: a case report and review of clinical, radiographic and histologic findings.
J Radiol Case Rep. 2009;3(5):16-20. doi: 10.3941/jrcr.v3i5.200. Epub 2009 May 1.
Sekiya M, Yoshimi K, Muraki K, et al.
Solitary fibrous tumor of the pleura: ultrasonographic imaging findings of 3 cases.
Respir Investig. 2013 Sep;51(3):200-4. doi: 10.1016/j.resinv.2013.04.001. Epub 2013 Jun 13.
Moureau-Zabotto L, Chetaille B, et al.
Solitary fibrous tumor of the prostate: case report and review of the literature.
Case Rep Oncol. 2012 Jan;5(1):22-9. doi: 10.1159/000335680. Epub 2012 Jan 10.
Li JP, Xie CM, Zhang R,et al.
[Imaging features and clinicopathological manifestations of solitary fibrous tumors].
Zhonghua Zhong Liu Za Zhi. 2010 May;32(5):363-7. Chinese.
Nomura T, Satoh R, Kashima K, et al.
A case of large solitary fibrous tumor in the retroperitoneum.
Clin Med Case Rep. 2009 Mar 23;2:21-5. eCollection 2009.
Rosado-de-Christenson ML, Abbott GF, McAdams HP, et al.
From the archives of the AFIP: Localized fibrous tumor of the pleura.
Radiographics. 2003 May-Jun;23(3):759-83.
Inaoka T, Takahashi K, Miyokawa N, et al.
Solitary fibrous tumor of the pleura: apparent diffusion coefficient (ADC) value and ADC map to predict malignant transformation.
J Magn Reson Imaging. 2007 Jul;26(1):155-8.
iphone ver
key image
iphone movie
<Key words>
肺胞上皮癌、bronchioloalveolarCarcinoma、bronchoalveolar cell carcinoma、BAC、粘液産生、
CT angiogram sign,大葉性肺炎、大葉性陰影、陰影消長、悪性リンパ腫、malignant lymphoma
<文献リスト>
Trigaux JP, Gevenois PA, Goncette L, et al.
Bronchioloalveolar carcinoma: computed tomography findings.
Eur Respir J. 1996 Jan;9(1):11-6.
http://erj.ersjournals.com/cgi/reprint/9/1/11
Lee KS, Kim Y, Han J, et al.
Bronchioloalveolar carcinoma: clinical, histopathologic, and radiologic findings.
Radiographics. 1997 Nov-Dec;17(6):1345-57.
http://radiographics.rsna.org/content/17/6/1345.long
Aquino SL, Chiles C, Halford P.
Distinction of consolidative bronchioloalveolar carcinoma from pneumonia: do CT criteria work?
AJR Am J Roentgenol. 1998 Aug;171(2):359-63.
http://www.ajronline.org/cgi/reprint/171/2/359
Akira M, Atagi S, Kawahara M, Iuchi K, Johkoh T.
High-resolution CT findings of diffuse bronchioloalveolar carcinoma in 38 patients.
AJR Am J Roentgenol. 1999 Dec;173(6):1623-9.
http://www.ajronline.org/cgi/reprint/173/6/1623
Kim TH, Kim SJ, Ryu YH, et al.
Differential CT features of infectious pneumonia versus bronchioloalveolar carcinoma (BAC) mimicking pneumonia.
Eur Radiol. 2006 Aug;16(8):1763-8. Epub 2006 Jan 18.
Patsios D, Roberts HC, Paul NS, et al.
Pictorial review of the many faces of bronchioloalveolar cell carcinoma.
Br J Radiol. 2007 Dec;80(960):1015-23. Epub 2007 Oct 16.
http://bjr.birjournals.org/cgi/reprint/80/960/1015
Sawada E, Nambu A, Motosugi U, et al.
Localized mucinous bronchioloalveolar carcinoma of the lung: thin-section computed tomography and fluorodeoxyglucose positron emission tomography findings.
Jpn J Radiol. 2010 May;28(4):251-8. Epub 2010 May 29.
CT angiogram sign 関連
Im JG, Han MC, Yu EJ, et al.
Lobar bronchioloalveolar carcinoma: “angiogram sign” on CT scans.
Radiology. 1990 Sep;176(3):749-53.
Vincent JM, Ng YY, Norton AJ, Armstrong P.
CT “angiogram sign” in primary pulmonary lymphoma.
J Comput Assist Tomogr. 1992 Sep-Oct;16(5):829-31.
Murayama S, Onitsuka H, Murakami J, et al.
“CT angiogram sign” in obstructive pneumonitis and pneumonia.
J Comput Assist Tomogr. 1993 Jul-Aug;17(4):609-12.
Shah RM, Friedman AC.
CT angiogram sign: incidence and significance in lobar consolidations evaluated by contrast-enhanced CT.
AJR Am J Roentgenol. 1998 Mar;170(3):719-21.
http://www.ajronline.org/cgi/reprint/170/3/719
Maldonado RL.
The CT angiogram sign.
Radiology. 1999 Feb;210(2):323-4.
リンパ腫
Ooi GC, Chim CS, Lie AK, Tsang KW
Computed tomography features of primary pulmonary non-Hodgkin’s lymphoma.
Clin Radiol. 1999 Jul;54(7):438-43.
King LJ, Padley SP, Wotherspoon AC, Nicholson AG.
Pulmonary MALT lymphoma: imaging findings in 24 cases.
Eur Radiol. 2000;10(12):1932-8.
Lee DK, Im JG, Lee KS, Lee JS, Seo JB, Goo JM, Kim TS, Lee JW.
B-cell lymphoma of bronchus-associated lymphoid tissue (BALT): CT features in 10 patients.
J Comput Assist Tomogr. 2000 Jan-Feb;24(1):30-4.
<キー画像＞
 1 年前正常時胸部単純写真 |
 10 ヶ月前肺炎発症時 |
 今回の胸部単純写真正面像 |
 今回の胸部単純写真側面像 |
 肺炎改善後 |
 造影 CT 縦隔条件 |
 造影 CT 肺野条件 |
iphone用動画
<key word>喫煙、尿崩症、両肺対称性網状陰影、上肺優位の縮み、多発空洞性陰影、多発結節影、骨病変、Langerhans cell histiocytosis, LCH, eosinophilic granuloma, 好酸球性肉芽腫
＜key画像＞
 下垂体 MRI |
骨病変 1 |
|
骨病変 2 |
縦隔条件 1 |
|
縦隔条件 2 |
縦隔条件 3 |
|
側頭骨 1 |
肺野条件 1 |
 肺野条件 2 |
肺野条件 3 |
＜文献＞
LCH肺
Abbott GF, Rosado-de-Christenson ML, et al.
From the archives of the AFIP: pulmonary Langerhans cell
histiocytosis.
Radiographics. 2004 May-Jun;24(3):821-41.
http://radiographics.rsna.org/content/24/3/821.full.pdf+html
Leatherwood DL, Heitkamp DE, Emerson RE.
Best cases from the AFIP: Pulmonary Langerhans cell
histiocytosis.
Radiographics. 2007 Jan-Feb;27(1):265-8.
http://radiographics.rsna.org/content/27/1/265.full.pdf+html
Sundar KM, Gosselin MV, Chung HL, Cahill BC.
Pulmonary Langerhans cell histiocytosis: emerging concepts
in pathobiology, radiology, and clinical evolution of
disease.
Chest. 2003 May;123(5):1673-83.
http://chestjournal.chestpubs.org/content/123/5/1673.full.pdf+html
Kulwiec EL, Lynch DA, Aguayo SM, Schwarz MI, King TE Jr.
Imaging of pulmonary histiocytosis X.
Radiographics. 1992 May;12(3):515-26.
http://radiographics.rsna.org/content/12/3/515.long
LCH縦隔
Donnelly LF, Frush DP.
Langerhans’ cell histiocytosis showing low-attenuation
mediastinal mass and cystic lung disease.
AJR Am J Roentgenol. 2000 Mar;174(3):877-8.
http://www.ajronline.org/cgi/content/full/174/3/877-a
LCH 全般
Meyer JS, Harty MP, Mahboubi S, Heyman S, Zimmerman RA,
Womer RB, Dormans JP, D’Angio GJ.
Langerhans cell histiocytosis: presentation and evolution
of radiologic findings with clinical correlation.
Radiographics. 1995 Sep;15(5):1135-46.
http://radiographics.rsna.org/content/15/5/1135.long
LCH 頭部
D’Ambrosio N, Soohoo S, Warshall C, Johnson A, Karimi S.
Craniofacial and intracranial manifestations of langerhans
cell histiocytosis: report of findings in 100 patients.
AJR Am J Roentgenol. 2008 Aug;191(2):589-97.
http://www.ajronline.org/cgi/reprint/191/2/589
Grois N, Prayer D, Prosch H, Lassmann H; CNS LCH
Co-operative Group.
Neuropathology of CNS disease in Langerhans cell
histiocytosis.
Brain. 2005 Apr;128(Pt 4):829-38. Epub 2005 Feb 10.
http://brain.oxfordjournals.org/cgi/reprint/128/4/829
Prayer D, Grois N, Prosch H, Gadner H, Barkovich AJ.
MR imaging presentation of intracranial disease associated
with Langerhans cell histiocytosis.
AJNR Am J Neuroradiol. 2004 May;25(5):880-91.
http://www.ajnr.org/cgi/reprint/25/5/880
LCH骨
Stull MA, Kransdorf MJ, Devaney KO.
Langerhans cell histiocytosis of bone.
Radiographics. 1992 Jul;12(4):801-23.
http://radiographics.rsna.org/content/12/4/801.long
Sartoris DJ, Parker BR.
Histiocytosis X: rate and pattern of resolution of osseous
lesions.
Radiology. 1984 Sep;152(3):679-84.
http://radiology.rsna.org/content/152/3/679.long
LCH甲状腺
Uchiyama M, Watanabe R, Ito I, Ikeda T.
Thyroid involvement in pulmonary langerhans cell
histiocytosis.
Intern Med. 2009;48(23):2047-8. Epub 2009 Dec 1.
http://www.jstage.jst.go.jp/article/internalmedicine/48/23/2047/_pdf
LCH肝
Radin DR.
Langerhans cell histiocytosis of the liver: imaging
findings.
AJR Am J Roentgenol. 1992 Jul;159(1):63-4.
＜キーワード＞
びまん性肺疾患、HRCT、volume loss, 容量減少、左右対称性陰影、bronchovascular bandle、気管支血管束、薬剤性肺障害、好酸球性肺炎、薬剤性好酸球性肺炎,traction bronchiectasis, 牽引性気管支拡張
＜key画像＞
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2005 年 3 月正常時の単純写真 |
呼吸困難時、 2005 年末の胸部単純写真 |
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呼吸困難時の胸部 CT1 |
呼吸困難時の胸部 CT2 |
| ＜参考文献＞Souza CA, et al. Drug-induced eosinophilic pneumonia: high-resolution CT findings in 14 patients.AJR. 2006 ;186:368-73. http://www.ajronline.org/cgi/reprint/186/2/368Akira M, et al. Drug-induced pneumonitis: thin-section CT finding in 60 patients. Radiology. 2002;224 :852-860 http://radiology.rsna.org/content/224/3/852.full.pdf+htmlEllis, SJ, et al. Drug-induced lung disease: high-resolution CT findings. AJR. 2000;175 :1019-1024 http://www.ajronline.org/cgi/reprint/175/4/1019Cleverley JR, et al. Drug-induced lung disease: high-resolution CT and histological findings.Clin Radiol. 2002;57:292-9. Johkoh T, et al. Eosinophilic lung diseases: diagnostic accuracy of thin-section CT in 111 patients.Radiology. 2000;216 :773-80. http://radiology.rsna.org/content/216/3/773.full.pdf+html*パナルジンが原因の間質性肺炎の症例報告論文 Oon PC, et al. Diffuse alveolar damage associated with ticlopidine use: a case report.J Formos Med Assoc. 2003;102 :262-5.Nakamura R, et al. Interstitial pneumonia induced by ticlopidine.Circ J. 2002;66 :773-776. http://www.jstage.jst.go.jp/article/circj/66/8/773/_pdfWatanebe M, et al. Multiple pulmonary nodules due to ticlopidine-induced pneumonitis Nihon Kokyuki Gakkai Zasshi. 1999;37 :841-5Alonso-Martinez JL, et al. Bronchiolitis obliterans-organizing pneumonia caused by ticlopidine.Ann Intern Med. 1998;129 :71-2 http://www.annals.org/content/129/1/71.3.full.pdf+html |
