The purpose of this study was to clarify the recognizable computed tomography (CT) features of small cell lung carcinoma (SCLC). Contrast enhanced CT scans were reviewed retrospectively for mass location, mediastinal extension, and other concomitant findings in 142 patients with pathologically proven SCLC. SCLC was classified into hilar mass only (type I), hilar mass with ipsilateral mediastinal extension (type II), hilar mass with bilateral mediastinal extension (type III), and peripheral mass (type IV). When mediastinal lymphadenopathy (m-LAP) was indistinguishable from a hilar mass, we defined it as a mediastinal conglomerate mass (m-CM). Type IIa or IIIa had ipsilateral or bilateral m-LAP and type IIb, IIIb or IIIc had ipsilateral or bilateral m-CM. Type I (n = 8, 5.6%), type II (n = 58, 40.8%), type III (n = 55, 38.8%), and type IV (n = 21, 14.8%) were manifested. The combination of a hilar mass and m-CM was found in 68 patients (47.9%). Type IV masses showed lobulation in 11, microlobulation in 4, both lobulated and irregular margins in 4, and spiculation in 2. A total of 120 patients (84.5%) had a bronchial stenosis/obstruction; single (n = 52) and 2 or more (n = 68). Ninety-five patients (67.0%) had vascular invasion including main/lobar pulmonary artery and superior vena cava, and 55 (38.7%) had pleural effusion and/or pleural nodules. Concomitant parenchymal findings (n = 92, 64.8%) were noted: contiguous consolidation/nodule (n = 45), hematogeneous spread (n = 32), lymphangitic spread (n = 21), obstructive pneumonia (n = 22), and obstructive atelectasis (n = 14). In conclusion, the recognizable CT features of SCLC were a hilar mass with m-CM. Most of the hilar masses showed 2 or more bronchial stenoses/obstructions. Most cases of peripheral SCLC manifested as a lobulated mass rather than a spiculated mass. Vascular invasion and concomitant parenchymal findings were observed commonly.

This review article provides an overview regarding the role of computed tomography (CT) in the evaluation of acute chest pain (ACP) in the emergency department (ED), focusing on characteristic CT findings.

Korean Circulation Journal 대한심장학회지 순환기 Lee D, et al. Korean Circ J. 2019 Aug;50:e24. https://doi.org/10.4070/kcj.2019.0289

This study investigated the potential role of paracardiac fat stranding (FS) interspersed with multiple fluid collections (FC) as a clue to differentiate between pleural tuberculosis (pleural TB) and malignant pleural effusion (MPE). The authors retrospectively analyzed chest computed tomography (CT) findings of 428 patients, 351 with pleural TB and 77 with MPE, focusing on the paracardiac fat, and level of pleural adenosine deaminase (ADA) and blood C-reactive protein (CRP). Two radiologists independently evaluated the chest CT findings regarding the paracardiac fat pad ipsilateral to the effusion, including FS, FC, phlegmonous appearance (a combination of the FS and multiple FC), and the presence of lymph node enlargement (>1 cm in short axis diameter). There were significant differences between patients with pleural TB and those with MPE with respect to the prevalence of phlegmonous appearance in the ipsilateral paracardiac fat (47.6% and 10.4%, p < 0.001, OR = 7.8; 95% CI 3.7–16.8) and paracardiac lymph node enlargement (1.4% and 19.5%, p < 0.001, OR = 0.06; 95% CI 0.02–0.2) on CT. In contrast, there was no difference in the prevalence of isolated FS or multiple FC within the ipsilateral paracardiac fat between the two groups. Median pleural ADA and serum CRP level were higher in patients with pleural TB accompanied by phlegmonous appearance in paracardiac fat compared to those without that appearance (ADA: median 104 IU/L versus 90 IU/L, p < 0.001; CRP: 6.5 mg/dL versus 4.2 mg/dL, p < 0.001). In conclusion, phlegmonous appearance in the ipsilateral paracardiac fat without paracardiac lymph node enlargement on chest CT favors a diagnosis of pleural TB over MPE.

Korean Circulation Journal 대한심장학회지 순환기 Lee D, et al. Korean Circ J. 2020 Oct;51:e35. https://doi.org/10.4070/kcj.2020.0469

The purpose of this study was to evaluate the diagnostic accuracy of patent with ductus arteriosus (PDA) based on the availability of pretest information on routine chest CT with 3 mm slice-thickness. We retrospectively evaluated CT of 64 patients with PDA. The enrolled patients were categorized as group 1 (presence of pretest information) and 2 (absence of pretest information, silent PDA). CTs were read by eleven board-certified radiologists, and subsequently by two blind readers. We investigated whether a PDA was mentioned on the initial CT reading. Correct diagnosis of PDA was made in all patients with group 1 (n = 42). In contrast, only 13.7% were correctly diagnosed in group 2. All cases of missed PDA in group 2 were also missed by two blind readers. It is important to realize that the diagnostic accuracy of silent PDA is poor on the chest CT with 3 mm slice-thickness. Thus, use of axial CT images with the thinnest slice-thickness and multi-planar reformatted images (i.e., sagittal and coronal images) may be one way to reduce the number of missed PDA.