Image Findings and Background Characteristics of Extrapleural Air Collection: A Pneumothorax Mimicker.

IF 1 4区 医学 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Hiroki Nishinaka, Mami Oi, Takashi Hiroi, Sho Ishikawa, Hitomi Kawamura, Koji Tokunaga, Shigeaki Umeoka
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引用次数: 0

Abstract

Objective: The extrapleural space (EPS) is a potential space external to the thoracic cavity. Extrapleural air collection (EAC) refers to the accumulation of air within the EPS. Differentiating EAC from pneumothorax using imaging is challenging but crucial for accurate diagnosis and effective management. This retrospective study aimed to identify imaging and clinical findings that aid in distinguishing EAC from pneumothorax.

Materials and methods: Two radiologists reviewed 2771 cases of pneumothorax identified in computed tomography reports, focusing on web-like linear septa within air collection around the lung (described as a web appearance). Twenty-two patients met the inclusion criteria. Additional imaging findings, including pneumomediastinum, dependent distribution (air localized dorsally relative to the ventral margin of the descending aorta), and perivascular distribution (air surrounding the internal thoracic artery), were evaluated. Patient background information was analyzed using medical records. We also investigated CT images of a control group to determine whether these imaging characteristics could be observed in age/sex-matched patients with typical pneumothorax.

Results: Pneumomediastinum was observed in all cases. Dependent distribution and perivascular distribution were present in 59% (13/22) and 50% (11/22) of cases, respectively.Concurrent interstitial lung disease and steroid use were identified in 77% (17/22) and 73% (16/22) of patients, respectively. In contrast, pneumomediastinum, dependent distribution and perivascular distribution were present in 4.5% (1/22), 55% (12/22), and 0% (0/22) of cases in the control group. In particular, pneumomediastinum ( P =3.71×10 -10 ) and perivascular distribution ( P =1.53×10 -4 ) were statistically more frequent in EAC patients than in the control group.

Conclusions: Pneumomediastinum is a critical diagnostic feature of EAC. Dependent distribution and perivascular distribution are valuable imaging findings for diagnosing EAC. Careful interpretation is warranted when pneumomediastinum is observed in patients with interstitial lung disease or those on steroid therapy.

胸膜外空气收集的图像表现和背景特征:一个气胸模拟者。
目的:胸膜外间隙是胸腔外的一个潜在空间。胸膜外空气收集(EAC)是指空气在EPS内的积聚。影像学鉴别EAC与气胸具有挑战性,但对准确诊断和有效治疗至关重要。这项回顾性研究的目的是确定影像学和临床表现,以帮助区分EAC和气胸。材料和方法:两位放射科医生回顾了2771例在计算机断层扫描报告中发现的气胸病例,重点关注肺周围空气集中的网状线状间隔(描述为网状外观)。22例患者符合纳入标准。其他影像学表现,包括纵隔气、依赖分布(相对于降主动脉腹侧缘的背侧空气定位)和血管周围分布(胸廓内动脉周围的空气)进行了评估。使用医疗记录分析患者背景信息。我们还研究了对照组的CT图像,以确定这些影像学特征是否可以在年龄/性别匹配的典型气胸患者中观察到。结果:所有病例均出现纵隔气肿。59%(13/22)的病例存在依赖分布,50%(11/22)的病例存在血管周围分布。同时存在间质性肺疾病和类固醇使用的患者分别为77%(17/22)和73%(16/22)。相比之下,对照组中有4.5%(1/22)、55%(12/22)和0%(0/22)的病例存在纵隔气、依赖分布和血管周围分布。特别是纵隔气肿(P=3.71×10-10)和血管周围分布(P=1.53×10-4)在EAC患者中比在对照组中更常见。结论:纵隔气肿是EAC的重要诊断特征。依赖分布和血管周围分布是诊断EAC的重要影像学表现。当观察到间质性肺疾病患者或接受类固醇治疗的患者纵膈气时,需要仔细解释。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.50
自引率
0.00%
发文量
230
审稿时长
4-8 weeks
期刊介绍: The mission of Journal of Computer Assisted Tomography is to showcase the latest clinical and research developments in CT, MR, and closely related diagnostic techniques. We encourage submission of both original research and review articles that have immediate or promissory clinical applications. Topics of special interest include: 1) functional MR and CT of the brain and body; 2) advanced/innovative MRI techniques (diffusion, perfusion, rapid scanning); and 3) advanced/innovative CT techniques (perfusion, multi-energy, dose-reduction, and processing).
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