The objective was to analyse the potential of CT to distinguish pneumonic-type bronchioloalveolar cell carcinoma (BAC) from infectious pneumonia. The study consisted of 21 patients with pathologically proven BAC and 30 patients with infectious pneumonia. Both groups of patients had patchy or diffuse consolidation of more than half the area of a lobe or lobes on CT. CT findings in these two groups were compared with regard to morphological appearance, including CT angiogram, air bronchogram, mucous bronchogram, contrast enhancement pattern, pseudocavitation, cavity with air-fluid level, location, satellite lesion, ground-glass opacity and bulging of the interlobar fissure. Air-filled bronchi were morphologically analysed as dilatation, stretching, sweeping, widening of the branching angle, squeezing and crowding. Lymphadenopathy and pleural effusion were also analysed. CT findings favouring the diagnosis of BAC included an air-filled bronchus within the consolidation with stretching, squeezing, sweeping, widening of the branching angle and bulging of the interlobar fissure (p<0.05). It is concluded that CT may be helpful in differentiating pneumonic-type BAC from infectious pneumonia if the air-filled bronchus within the consolidation shows stretching, squeezing, widening of the branching angle or bulging of the interlobar fissure.

ABSTRACT. We report two cases of a very rare congenital anomaly, i.e. isolated unilateral pulmonary vein atresia. The patients were asymptomatic and the diagnosis was made using multidetector CT (MDCT), which also showed cyst formation in the right lung. Asymptomatic adult cases or association with cystic lung lesions have never been reported in this condition before. Unilateral pulmonary vein atresia without associated congenital heart disease is a rare condition [1]. Patients with congenital unilateral pulmonary vein atresia are usually symptomatic and present with recurrent episodes of pneumonia or haemoptysis in infancy or childhood [1]. Although a subclinical course of this anomaly has been recently reported in a 12-year-old boy, so far no asymptomatic adult cases have been described to our knowledge [1]. Also, the presence of pulmonary cysts has never been reported in this condition. We therefore report the CT findings of two asymptomatic adult patients with unilateral pulmonary vein atresia, with associated pulmonary cysts. Case report Case 1A previously healthy 23-year-old male visited the emergency room because of vomiting lasting 1 day. The chest radiograph obtained at the time showed diffuse interstitial infiltration in the right lung field. Multidetector CT (MDCT) showed a heterogeneous lung density, with areas of normal density, ground-glass opacity and small air-cysts (Figure 1a). The cysts were multiple, but predominantly distributed in the subpleural regions. Beaded thickening of the interlobular septum and nodularity along the fissures and costal pleura were noted in the right lower lung (Figure 1b). The volume of the right lung was not diminished. CT also showed a complete lack of the right pulmonary vein and enlargement of the left. The margin of the left atrium where the right pulmonary vein was expected to be was entirely smooth, with no vascular structures connected to it (Figure 1c). The right pulmonary artery was slightly small, with poor contrast enhancement compared with the left pulmonary artery. The mediastinal branches of the right bronchial artery were markedly dilated, suggesting the presence of systemic arterial flow into the hypoplastic pulmonary arteries (Figure 1d). Anomalous pulmonary venous return was excluded on the basis of the absence of pulmonary venous structures connected to systemic venous circulation on CT.Fibre-optic endoscopy revealed findings compatible with reflux oesophagitis and chronic superficial gastritis. The patient recalled being told that his chest radiography showed a ''small right pulmonary artery''. He did not complain of any respiratory, cardiac or other systemic symptoms, and refused further work-up. The patient was in good health 5 years after the initial emergency room visit. Case 2A 39-year-old female with rheumatoid arthritis recently underwent screening chest radiography in preparation for a clinical trial (Figure 2a). This showed a small right hemithorax with significant ipsilateral mediastinal shift, reduced vessel size in the hilar region and...

It is necessary to understand the characteristic imaging findings of enchondroma protuberans to avoid misdiagnosis. When radiography does not allow a clear diagnosis of enchondroma protuberans, MRI may be helpful for diagnosis.

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