Background: The mediastinum is composed primarily of fatty tissue that is surrounded by the lungs bilaterally. There is a lack in the published literature in studying changes in mediastinal fat in idiopathic pulmonary fibrosis (IPF). The purpose of this study was to determine whether the shape and dimensions of the anterior mediastinal fat in patients with IPF are different from that of a normal control group and to correlate the changes with disease severity. Design and Setting: This prospective case control study was done at the chest department of Assiut University Hospital on IPF patients from May 2010-September 2012. A questionnaire containing questions such as age, sex, clinical findings, high resolution computerized tomography (HRCT) score and pulmonary function tests (PFTs) was filled for patients and normal controls. Results: The IPF retrosternal AP dimension was significantly shorter (p = 0.03) and the transverse dimension was longer (p = 0.001) than that in the normal control group. The convex shape of the anterior mediastinum was predictive of IPF (p = 0.001), whereas concave shape was predictive of normal controls (p = 0.001). The change in anteroposterior diameter (AP) and transverse diameters showed significant correlation with the changes in FVC, DLCO and HRCT score. Conclusions: IPF patients had reduced retrosternal AP and increased transverse dimensions than those of the controls with convex shape of their anterior mediastinal fat. Changes in anterior mediastinal fat dimensions are correlated with lower FVC, DLCO and higher HRCT score. A larger sample size, better multicenteric study is needed to confirm the results of this study.

Background and Objectives: In clinical practice, spirometry plays a key role in the diagnosis of chronic obstructive pulmonary disease (COPD), however, it provides no information about structural pulmonary abnormality. The aim of this study was to evaluate whether there is a relation between the clinical criteria and chest radiography or CT studies in differentiating chronic bronchitis from emphysema in COPD. Patients and methods: In a prospective study, data analysis on 165 COPD subjects who were enrolled between September, 2011 and December 2012 was completed. Data were collected including clinical characteristics of stable COPD, pulmonary function tests, chest X-ray and multidetector computerized tomography (MDCT) findings. Results: Emphysema was diagnosed in 90 (55%) of 165 CT scans. The median emphysema score was 58 (range 48-72) and significantly correlated with lower FEV1 values (r = 0.542, p = 0.003). In chronic bronchitis, bronchial wall thickening was diagnosed approximately as often in chest radiography (56%) as in CT (64%) as a major finding. Body mass index (BMI), forced expiratory volume in the first second (FEV1), and diffusion capacity of the lung for carbon monoxide (DL,CO) were significantly lower, whereas total lung capacity (TLC) was higher in patients with emphysema. Cardiovascular diseases and obstructive sleep apnea syndrome (OSAS) were more common in chronic bronchitis group. Conclusions: Chest radiography is a valuable, inexpensive means of diagnosing emphysema or bronchial wall thickening in chronic bronchitis. Emphysematous patients show a worse pulmonary function and a greater dyspnea. Greater comorbidity in chronic bronchitis may require specific treatment strategies in this subgroup.