Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: Wiener klinische Wochenschrift 9-10/2021

02.07.2020 | original article

Nodular distribution pattern on chest computed tomography (CT) in patients diagnosed with nontuberculous mycobacteria (NTM) infections

verfasst von: Ante Marušić, Ivana Kuhtić, Ivica Mažuranić, Mateja Janković, Goran Glodić, Ivan Sabol, Lucija Stanić

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 9-10/2021

Einloggen, um Zugang zu erhalten
share
TEILEN

Summary

Background

This study evaluated the prevalence of spreading pathways in nontuberculous mycobacteria (NTM) pulmonary infections according to nodular distribution patterns seen on chest computed tomography (CT).

Methods

This study included 63 patients diagnosed with NTM lung infections who underwent CT at our institution. A retrospective analysis of CT images focused on the presence and distribution of nodules, presence of intrathoracic lymphadenopathy and the predominant side of infection in the lungs. The findings were classified into five groups; centrilobular (bronchogenic spread), perilymphatic (lymphangitic spread), random (hematogenous spread), combined pattern and no nodules present. The groups were then compared according to other CT findings.

Results

Among 51 (81%) patients identified with a nodular pattern on chest CT, 25 (39.8%) presented with centrilobular, 7 (11.1%) with perilymphatic, 6 (9.5%) with random and 13 (20.6%) with combined nodular patterns but located in different areas of the lungs. The right side of the lungs was predominant in 38 cases (60.3%). Intrathoracic lymphadenopathy was evident in 20 patients (31.7%). Significant differences in distributions of nodular patterns were seen in patients infected with Mycoplasma avium complex (MAC) associated with centrilobular pattern (p = 0.0019) and M. fortuitum associated with random pattern (p = 0.0004). Some of the findings were related to perilymphatic nodules between other isolated species of NTM (p = 0.0379).

Conclusion

The results of this study showed a high proportion of perilymphatic nodules and right-sided predominance in the upper lobe, which, combined with intrathoracic lymphadenopathy is highly suggestive of the lymphangitic spread of lung NTM infections.
Literatur
1.
Zurück zum Zitat Verschakelen JA, De Wever W. Computed tomography of the lung. Berlin, Heidelberg, New York: Springer; 2018. CrossRef Verschakelen JA, De Wever W. Computed tomography of the lung. Berlin, Heidelberg, New York: Springer; 2018. CrossRef
2.
Zurück zum Zitat Remy-Jardin M, Beuscart R, Sault M, Marquette C, Remy J. Subpleural micronodules in diffuse infiltrative lung diseases: evaluation with thin section CT scans. Radiology. 1990;177:133–9. CrossRef Remy-Jardin M, Beuscart R, Sault M, Marquette C, Remy J. Subpleural micronodules in diffuse infiltrative lung diseases: evaluation with thin section CT scans. Radiology. 1990;177:133–9. CrossRef
3.
Zurück zum Zitat Raoof S, Amchentsev A, Vlahos I, Goud A, Naidich DP. Pictorial essay: multinodular disease—a high-resolution CT scan diagnostic algorithm. Chest. 2006;129:805–15. CrossRef Raoof S, Amchentsev A, Vlahos I, Goud A, Naidich DP. Pictorial essay: multinodular disease—a high-resolution CT scan diagnostic algorithm. Chest. 2006;129:805–15. CrossRef
4.
Zurück zum Zitat Collins J, Blankenbaker D, Stern EJ. CT patterns of bronchiolar disease: what is tree-in-bud? AJR Am J Roentgenol. 1998;171:365–70. CrossRef Collins J, Blankenbaker D, Stern EJ. CT patterns of bronchiolar disease: what is tree-in-bud? AJR Am J Roentgenol. 1998;171:365–70. CrossRef
5.
Zurück zum Zitat Gallardo X, Castaner E, Mata J, et al. Nodular pattern at lung computed tomography in fat embolism syndrome. A helpful finding. J Comput Assist Tomogr. 2006;30:254–7. CrossRef Gallardo X, Castaner E, Mata J, et al. Nodular pattern at lung computed tomography in fat embolism syndrome. A helpful finding. J Comput Assist Tomogr. 2006;30:254–7. CrossRef
6.
Zurück zum Zitat Colby TV, Swensen SJ. Anatomic distribution and histopathologic patterns in diffuse lung disease: correlation with HRCT. J Thorac Imaging. 1996;11:1–26. CrossRef Colby TV, Swensen SJ. Anatomic distribution and histopathologic patterns in diffuse lung disease: correlation with HRCT. J Thorac Imaging. 1996;11:1–26. CrossRef
7.
Zurück zum Zitat Voloudaki AE, Tritou IN, Magkanas EG, et al. HRCT in miliary lung disease. Acta Radiol. 1999;40:451–6. CrossRef Voloudaki AE, Tritou IN, Magkanas EG, et al. HRCT in miliary lung disease. Acta Radiol. 1999;40:451–6. CrossRef
8.
Zurück zum Zitat Kim TS, Koh WJ, Han J, Chung MJ, Lee JH, Lee KS, et al. Hypothesis on the evolution of cavitary lesions in nontuberculous mycobacterial pulmonary infection: thin-section CT and histopathologic correlation. AJR Am J Roentgenol. 2005;184(4):1247–52. CrossRef Kim TS, Koh WJ, Han J, Chung MJ, Lee JH, Lee KS, et al. Hypothesis on the evolution of cavitary lesions in nontuberculous mycobacterial pulmonary infection: thin-section CT and histopathologic correlation. AJR Am J Roentgenol. 2005;184(4):1247–52. CrossRef
9.
Zurück zum Zitat McEvoy S, Lavelle L, Kilcoyne A, McCarthy C, deJong PA, Loeve M, et al. High-resolution CT of nontuberculous mycobacterium infection in adult CF patients: diagnostic accuracy. Eur Radiol. 2012;22(12):2736–42. CrossRef McEvoy S, Lavelle L, Kilcoyne A, McCarthy C, deJong PA, Loeve M, et al. High-resolution CT of nontuberculous mycobacterium infection in adult CF patients: diagnostic accuracy. Eur Radiol. 2012;22(12):2736–42. CrossRef
10.
Zurück zum Zitat Polverosi R, Guarise A, Balestro E, Carloni A, Dalpiaz G, Feragalli B. High-resolution CT of nontuberculous mycobacteria pulmonary infection in immunocompetent, non-HIV-positive patients. Radiol Med. 2010;115(2):191–204. CrossRef Polverosi R, Guarise A, Balestro E, Carloni A, Dalpiaz G, Feragalli B. High-resolution CT of nontuberculous mycobacteria pulmonary infection in immunocompetent, non-HIV-positive patients. Radiol Med. 2010;115(2):191–204. CrossRef
11.
Zurück zum Zitat Kwak N, Lee CH, Lee HJ, Kang YA, Lee JH, Han SK, et al. Non-tuberculous mycobacterial lung disease: diagnosis based on computed tomography of the chest. Eur Radiol. 2016;26(12):4449–56. CrossRef Kwak N, Lee CH, Lee HJ, Kang YA, Lee JH, Han SK, et al. Non-tuberculous mycobacterial lung disease: diagnosis based on computed tomography of the chest. Eur Radiol. 2016;26(12):4449–56. CrossRef
12.
Zurück zum Zitat Jeong YJ, Lee KS, Koh WJ, Han J, Kim TS, Kwon OJ. Nontuberculous mycobacterial pulmonary infection in immunocompetent patients: comparison of thin-section CT and histopathologic findings. Radiology. 2004;231(3):880–6. CrossRef Jeong YJ, Lee KS, Koh WJ, Han J, Kim TS, Kwon OJ. Nontuberculous mycobacterial pulmonary infection in immunocompetent patients: comparison of thin-section CT and histopathologic findings. Radiology. 2004;231(3):880–6. CrossRef
13.
Zurück zum Zitat Lee KS, Kim TS, Han J, Hwang JH, Yoon JH, Kim Y, et al. Diffuse micronodular lung disease: HRCT and pathologic findings. J Comput Assist Tomogr. 1999;23(1):99–106. CrossRef Lee KS, Kim TS, Han J, Hwang JH, Yoon JH, Kim Y, et al. Diffuse micronodular lung disease: HRCT and pathologic findings. J Comput Assist Tomogr. 1999;23(1):99–106. CrossRef
14.
Zurück zum Zitat Ko JM, Park HJ, Cho DG, Kim CH. CT differentiation of tuberculous and non-tuberculous pleural infection, with emphasis on pulmonary changes. Int J Tuberc Lung Dis. 2015;19(11):1361–8. CrossRef Ko JM, Park HJ, Cho DG, Kim CH. CT differentiation of tuberculous and non-tuberculous pleural infection, with emphasis on pulmonary changes. Int J Tuberc Lung Dis. 2015;19(11):1361–8. CrossRef
15.
Zurück zum Zitat Klein E. Contributions to the normal and pathological anatomy of the lymphatic system of the lungs. Proc R Soc Lond. 1874;22:133–45. Klein E. Contributions to the normal and pathological anatomy of the lymphatic system of the lungs. Proc R Soc Lond. 1874;22:133–45.
16.
Zurück zum Zitat Basaraba RJ, Smith EE, Shanley CA, Orme IM. Pulmonary lymphatics are primary sites of Mycobacterium tuberculosis infection in guinea pigs infected by aerosol. Infect Immun. 2006;74(9):5397–401. CrossRef Basaraba RJ, Smith EE, Shanley CA, Orme IM. Pulmonary lymphatics are primary sites of Mycobacterium tuberculosis infection in guinea pigs infected by aerosol. Infect Immun. 2006;74(9):5397–401. CrossRef
17.
Zurück zum Zitat Behr MA, Waters WR. Is tuberculosis a lymphatic disease with a pulmonary portal? Lancet Infect Dis. 2014;14(3):250–5. CrossRef Behr MA, Waters WR. Is tuberculosis a lymphatic disease with a pulmonary portal? Lancet Infect Dis. 2014;14(3):250–5. CrossRef
18.
Zurück zum Zitat Pereira M, Gazzoni FF, Marchiori E, Irion K, Moreira J, Giacomelli IL, et al. High-resolution CT findings of pulmonary Mycobacterium tuberculosis infection in renal transplant recipients. Br J Radiol. 2016;89(1058):20150686. CrossRef Pereira M, Gazzoni FF, Marchiori E, Irion K, Moreira J, Giacomelli IL, et al. High-resolution CT findings of pulmonary Mycobacterium tuberculosis infection in renal transplant recipients. Br J Radiol. 2016;89(1058):20150686. CrossRef
19.
Zurück zum Zitat He W, Chen BD, Lv Y, Zhou Z, Xu JP, Lv PX, et al. Use of low-dose computed tomography to assess pulmonary tuberculosis among healthcare workers in a tuberculosis hospital. Infect Dis Poverty. 2017;6(1):68. CrossRef He W, Chen BD, Lv Y, Zhou Z, Xu JP, Lv PX, et al. Use of low-dose computed tomography to assess pulmonary tuberculosis among healthcare workers in a tuberculosis hospital. Infect Dis Poverty. 2017;6(1):68. CrossRef
20.
Zurück zum Zitat Kienzl-Palma D, Prosch H. Thoracic manifestation of tuberculosis. Radiologe. 2016;56(10):866–73. CrossRef Kienzl-Palma D, Prosch H. Thoracic manifestation of tuberculosis. Radiologe. 2016;56(10):866–73. CrossRef
21.
Zurück zum Zitat McGuinness G, Naidich DP, Jagirdar J, Leitman B, McCauley DI. High resolution CT findings in miliary lung disease. J Comput Assist Tomogr. 1992;16:384–90. CrossRef McGuinness G, Naidich DP, Jagirdar J, Leitman B, McCauley DI. High resolution CT findings in miliary lung disease. J Comput Assist Tomogr. 1992;16:384–90. CrossRef
22.
Zurück zum Zitat Chu H, Li B, Zhao L, Huang D, Xu J, Zhang J, et al. Tree-in bud pattern of chest CT images for diagnosis of Mycobacterium abscesses. Int J Clin Exp Med. 2015;8(10):18705–12. PubMedPubMedCentral Chu H, Li B, Zhao L, Huang D, Xu J, Zhang J, et al. Tree-in bud pattern of chest CT images for diagnosis of Mycobacterium abscesses. Int J Clin Exp Med. 2015;8(10):18705–12. PubMedPubMedCentral
23.
Zurück zum Zitat Schiff HF, Jones S, Achaiah A, Pereira A, Stait G, Green B. Clinical relevance of non-tuberculous mycobacteria isolated from respiratory specimens: seven year experience in a UK hospital. Sci Rep. 2019;9(1):1730. CrossRef Schiff HF, Jones S, Achaiah A, Pereira A, Stait G, Green B. Clinical relevance of non-tuberculous mycobacteria isolated from respiratory specimens: seven year experience in a UK hospital. Sci Rep. 2019;9(1):1730. CrossRef
24.
Zurück zum Zitat Yasin H, Mangano WE, Malhotra P, Farooq A, Mohamed H. Hot tub lung: a diagnostic challenge. Cureus. 2017;9(8):e1617. PubMedPubMedCentral Yasin H, Mangano WE, Malhotra P, Farooq A, Mohamed H. Hot tub lung: a diagnostic challenge. Cureus. 2017;9(8):e1617. PubMedPubMedCentral
25.
Zurück zum Zitat Kim C, Park SH, Oh SY, Kim SS, Jo KW, Shim TS, et al. Comparison of chest CT findings in nontuberculous mycobacterial diseases vs. Mycobacterium tuberculosis lung disease in HIV-negative patients with cavities. PLoS One. 2017;12(3):e174240. CrossRef Kim C, Park SH, Oh SY, Kim SS, Jo KW, Shim TS, et al. Comparison of chest CT findings in nontuberculous mycobacterial diseases vs. Mycobacterium tuberculosis lung disease in HIV-negative patients with cavities. PLoS One. 2017;12(3):e174240. CrossRef
26.
Zurück zum Zitat Yuan MK, Chang CY, Tsai PH, Lee YM, Huang JW, Chang SC. Comparative chest computed tomography findings of non-tuberculous mycobacterial lung diseases and pulmonary tuberculosis in patients with acid fast bacilli smear-positive sputum. BMC Pulm Med. 2014;14:65. CrossRef Yuan MK, Chang CY, Tsai PH, Lee YM, Huang JW, Chang SC. Comparative chest computed tomography findings of non-tuberculous mycobacterial lung diseases and pulmonary tuberculosis in patients with acid fast bacilli smear-positive sputum. BMC Pulm Med. 2014;14:65. CrossRef
27.
Zurück zum Zitat Kuhlman JE, Deutsch JH, Fishman EK, Siegelman SS. CT features of thoracic mycobacterial disease. Radiographics. 1990;10:413–31. CrossRef Kuhlman JE, Deutsch JH, Fishman EK, Siegelman SS. CT features of thoracic mycobacterial disease. Radiographics. 1990;10:413–31. CrossRef
29.
Zurück zum Zitat Ko JM, Park HJ, Kim CH. Clinicoradiologic evidence of pulmonary lymphatic spread in adult patients with tuberculosis. AJR Am J Roentgenol. 2015;204(1):38–43. CrossRef Ko JM, Park HJ, Kim CH. Clinicoradiologic evidence of pulmonary lymphatic spread in adult patients with tuberculosis. AJR Am J Roentgenol. 2015;204(1):38–43. CrossRef
30.
Zurück zum Zitat Mehta AR, Mehta PR, Mehta RL. A cough conundrum in a patient with a previous history of BCG immunotherapy for bladder cancer. BMJ Case Rep. 2012;24:2012. Mehta AR, Mehta PR, Mehta RL. A cough conundrum in a patient with a previous history of BCG immunotherapy for bladder cancer. BMJ Case Rep. 2012;24:2012.
31.
Zurück zum Zitat Marusić A, Katalinić-Janković V, Popović-Grle S, Janković M, Mazuranić I, Puljić I, et al. Mycobacterium xenopi pulmonary disease—epidemiology and clinical features in non-immunocompromised patients. J Infect. 2009;58(2):108–12. CrossRef Marusić A, Katalinić-Janković V, Popović-Grle S, Janković M, Mazuranić I, Puljić I, et al. Mycobacterium xenopi pulmonary disease—epidemiology and clinical features in non-immunocompromised patients. J Infect. 2009;58(2):108–12. CrossRef
Metadaten
Titel
Nodular distribution pattern on chest computed tomography (CT) in patients diagnosed with nontuberculous mycobacteria (NTM) infections
verfasst von
Ante Marušić
Ivana Kuhtić
Ivica Mažuranić
Mateja Janković
Goran Glodić
Ivan Sabol
Lucija Stanić
Publikationsdatum
02.07.2020
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 9-10/2021
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-020-01701-1