Castleman disease was originally described in 1954 as a form of localized mediastinal lymph-node hyperplasia. It has also been reported as a solitary mass in the hilar region or peripheral lymph nodes. The authors describe 4 cases, 3 in the chest and 1 in the neck. The intrathoracic lesions involved (a) the middle portion of the superior mediastinum with extension into the neck, (b) the posterior paravertebral mediastinum with extension into the posterior intercostal spaces, and (c) the extrapleural posterior chest wall, respectively: this last case is unusual in that the tumor recurred in the same site several years after removal. The clinical, radiological, and pathological features are presented.
The imaging studies obtained after single-lung transplantation in 14 patients were reviewed. The reimplantation response occurred in 13 patients and was an early, transient process, which varied in its manifestations from a subtle perihilar haze to dense consolidation with air bronchograms. Nine episodes of acute rejection, an imprecise clinical diagnosis, occurred in eight of the patients. The associated chest radiographic changes were variable and included basal or diffuse reticular interstitial disease in three cases and basal and/or perihilar consolidation in three cases; no change was detected in three cases. On four occasions, the radiographic changes resolved within 24 hours of intravenous corticosteroid administration. The radiographic findings associated with the reimplantation response and rejection were nonspecific and could have been mistaken for those of fluid overload, atelectasis, mucous plugging, and pneumonia. Bronchial dehiscence was well demonstrated by the finding at computed tomography of extraluminal air adjacent to the bronchial anastomosis. One patient developed multiple pulmonary nodules due to cyclosporine-induced lymphoma.
Two cases of nepheline rock dust pneumoconiosis are presented. Radiologically, this is seen as a diffuse increase in interstitial lung markings, lymphadenopathy, air-space disease, and atelectasis secondary to extrinsic compression by enlarged hilar lymph nodes. Major differential diagnoses include carcinoma of the lung, sarcoidosis, and interstitial lung disease caused by other inorganic dusts. Nepheline rock dust pneumoconiosis should be considered when the above radiological changes are observed and an occupational exposure to inorganic dust is documented.
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