Thorax MRI contribution to the differential diagnosis of pulmonary lesions

Abstract

1 Thorax Magnetic Resonance Imaging (MRI) is not routinely used in clinical practice for characterization of lung lesions, as presence of air in the lungs results in considerable reduction of the MRI diagnostic accuracy. We present a case of a 69-year-old patient, bedridden for the past year due to hemorrhagic stroke, who was transferred to the Emergency Department, due to breathlessness and productive cough. Microbiological exams revealed anemia (Hb: 9.9 g/dL), moderately elevated C-Reactive Protein (CRP) value (4.33 mg/dL, with normal values <0.5 mg/dL) and procalcitonin (PCT) value within normal range (0.03 ng/mL, with normal values <0.05 ng/mL). Blood and urine cultures were negative. The patient had a smoking history of 35 pack-years. CT imaging revealed a large lesion of the right upper lobe (Figure 1). The patient underwent CT guided FNA of the lesion twice, without findings suggestive of a definite diagnosis. A chest MRI was then conducted (Figure 2), revealing diffusion restriction in the diffusion-weighted imaging (DWI) of the upper right lobe lesion. Empiric treatment with amoxicillin-clavulanic acid 1 g × 3 was initiated, resulting in gradual increase of body weight and diminution of