Purpose
To describe the perfusion patterns of peripheral pulmonary granulomatous lesions (PPGLs) by contrast‐enhanced ultrasound (CEUS) and their correlation with vascularization patterns (VPs) represented by immunohistochemical (CD34) endothelial staining.
Patients and methods
From January 2007 until September 2020, 10 consecutive patients with histologically confirmed PPGLs were investigated by CEUS. The time to enhancement, classified as early pulmonary‐arterial (PA) pattern of enhancement versus delayed bronchial‐arterial (BA) pattern of enhancement, the extent of enhancement, classified as marked or reduced, the homogeneity of enhancement, classified as homogeneous or inhomogeneous, and the decrease of enhancement, classified as rapid washout (<120 seconds) or a late washout (≥120 seconds), were analyzed retrospectively. Furthermore, the tissue samples from the study patients and as a control group, 10 samples of normal lung tissue obtained by autopsy, and 10 samples of lung tissue with acute pneumonia obtained by autopsy were immunohistochemically stained with CD34 antibody. The presence of avascular areas (AAs) and the VPs were evaluated in all tissue samples.
Results
On CEUS, all PPGLs showed a reduced inhomogeneous BA pattern of enhancement and a rapid washout (<120 seconds). On CD34 staining, all PPGLs showed central AAs in granulomas and a chaotic VP similar to angiogenesis in lung tumors. The lung tissue in control groups revealed on CD34 staining a regular alveolar VP.
Conclusion
The PPGLs on CEUS show an identical perfusion pattern similar to those of malignant lesions. Furthermore, for the first time, neoangiogenesis was demonstrated as a histopathological correlate to BA pattern of enhancement on CEUS.
B‐mode ultrasound (B‐US) is the standard imaging modality to evaluate pleural effusion. The value of B‐US for assessing the malignancy of a pleural effusion (PE) is limited. For this purpose, computed tomography (CT) and thoracoscopy are the methods of choice to evaluate an effusion. The aim of this Pictorial Essay is to demonstrate contrast‐enhanced ultrasound (CEUS) as a method in addition to B‐US and CT for the evaluation of PE taking into account the clinical background. The characteristic patterns of pleural pathologies, effusion morphology, and associated lung parenchymal consolidations are presented.
Purpose
This retrospective study aimed to describe the B‐mode lung ultrasound (B‐LUS) and contrast‐enhanced ultrasound (CEUS) follow‐up patterns of peripheral pulmonary lesions (PPLs) in patients with confirmed pulmonary embolism (PE).
Patients and Methods
Data from 27 patients with a confirmed diagnosis of PE and PPLs over 5 mm from October 2009 to November 2018 were included retrospectively in the study. The inclusion criteria were performance of a baseline CEUS examination, a short‐term B‐LUS and CEUS follow‐up, and a long‐term B‐LUS follow‐up of PPLs. The homogeneity of enhancement of PPLs (homogeneous/inhomogeneous/absent) on CEUS and the presence and size of PPLs on B‐LUS were evaluated.
Results
A total of n = 25/27 (92.6%) lesions showed absent or inhomogeneous enhancement during baseline examination or short‐term follow‐up, indicating impaired perfusion. On short‐term CEUS follow‐up, 9/27 cases (33.3%) showed a pattern shift. On B‐LUS long‐term follow‐up, 26/27 lesions (96.3%) were detectable for an average of 10 weeks (range 3–32 weeks). The size of reference lesions was significantly reduced at the time of the final follow‐up examination (P < .05).
Conclusion
B‐LUS follow‐up showed that, in patients with confirmed PE, PPLs had a delayed regression. On CEUS follow‐up examination, various perfusion patterns of PPLs were observed, indicating the different ages and the variable reparative processes of pulmonary infarction. In PPLs independent of the underlying signs and symptoms, follow‐up B‐LUS and CEUS examinations may be helpful for a possible retrospective diagnosis of peripheral pulmonary infarction suggestive of PE.
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