The apical cap

McLoud, TC; Isler, RJ; Novelline, R A; Putman, Charles E.; Simeone, Joseph F.; Stark, Paul

doi:10.2214/ajr.137.2.299

Cited by 44 publications

(16 citation statements)

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“…Pulmonary apical cap is not a rare radiologic finding and the prevalence in the general population was reported as around 10%, more predominantly in older individuals [1]. However, its prevalence in patients with CTD, regardless of an associated ILD, is unknown.…”

Section: Discussionmentioning

confidence: 99%

“…This radiologic term represents an irregular density on the apex of lung that is generally less than 5 mm. The typical pathologic feature is a subpleural fibroelastic scar and is commonly accompanied by thickening of the visceral pleura [1,2]. Changes secondary to other conditions, including infection/post-infectious scarring (e.g., tuberculosis-related changes), post-radiation fibrosis, and lung or pleural neoplasms, can mimic an apical cap.…”

Section: Introductionmentioning

confidence: 99%

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Radiologic pleuroparenchymal fibroelastosis-like lesion in connective tissue disease-related interstitial lung disease

et al. 2017

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BackgroundRadiologic pleuroparenchymal fibroelastosis (PPFE)-like lesion including pulmonary apical cap can be occasionally observed in clinical settings. However, the significance of radiologic PPFE-like lesion is unclear in connective tissue disease (CTD)-related interstitial lung disease (ILD).Materials and methodsA total of 113 patients with CTD-related ILD were enrolled and assessed for radiologic PPFE-like lesion, which was defined as bilateral, upper lobe, and subpleural dense consolidations with or without pleural thickening on chest high-resolution computed tomography. The clinical, radiologic, and pathologic characteristics were evaluated.ResultsRadiologic PPFE-like lesion was found in 21 patients (19%) and were relatively frequent in those with systemic sclerosis (6/14: 43%) and primary Sjögren's syndrome (4/14: 29%). Patients with PPFE-like lesion were significantly older, had lower body mass index, higher ratio of residual volume to total lung capacity, and higher complication rate of pneumothorax and/or pneumomediastinum than those without. Twelve of the 21 patients were diagnosed radiologically as usual interstitial pneumonia (UIP) or possible UIP pattern. Two of three patients who underwent surgical lung biopsy of the upper lobes showed UIP on histopathology. Another patient was confirmed to have upper lobe PPFE on autopsy. During the clinical course, progression of the radiologic PPFE-like lesions was observed in 13 of 21 patients. Six patients died (mortality rate: 29%) and their PPFE-like lesions were commonly progressive. In the total cohort, our multivariate analysis identified the presence of PPFE-like lesion as a significant risk factor for respiratory death (hazard ratio: 4.10, 95% confidence interval: 1.33–12.65, p = 0.01).ConclusionIn patients with CTD-related ILD, radiologic PPFE-like lesion, which may present as not only PPFE but also apical cap and upper lobe subpleural fibrosis commonly due to UIP, was not uncommon and was associated with poor prognosis. Clinicians should be cautious with this radiologic finding, particularly when it is progressive.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiologic pleuroparenchymal fibroelastosis-like lesion in connective tissue disease-related interstitial lung disease

et al. 2017

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“…Changes in the shape of the extrapleural fat and anterior mediastinum can be seen in localized inflammatory diseases such as tuberculosis and empyema, and this can also occur as a consequence of chronic fibrotic diseases of the lung and pleura (2-4). Radiation fibrosis or lobectomy can also cause focal or diffuse thickening of the mediastinum (4, 5).…”

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confidence: 99%

CT Analysis of the Anterior Mediastinum in Idiopathic Pulmonary Fibrosis and Nonspecific Interstitial Pneumonia

Lee

Son

et al. 2006

Korean J Radiol

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ObjectiveWe wanted to determine whether the amount and shape of the anterior mediastinal fat in the patients suffering with usual interstitial pneumonia (UIP) or nonspecific interstitial pneumonia (NSIP) was different from those of the normal control group.Materials and MethodsWe selected patients who suffered with UIP (n = 26) and NSIP (n = 26) who had undergone CT scans. Twenty-six controls were selected from individuals with normal CT findings and normal pulmonary function tests. All three groups (n = 78) were individually matched for age and gender. The amounts of anterior mediastinal fat, and the retrosternal anteroposterior (AP) and transverse dimensions of the anterior mediastinal fat were compared by one-way analysis of variance and Bonferroni's test. The shapes of the anterior mediastinum were compared using the Chi-square test. Exact logistic regression analysis and polychotomous logistic regression analysis were employed to assess whether the patients with NSIP or UIP had a tendency to show a convex shape of their anterior mediastinal fat.ResultsThe amount of anterior mediastinal fat was not different among the three groups (p = 0.175). For the UIP patients, the retrosternal AP dimension of the anterior mediastinal fat was shorter (p = 0.037) and the transverse dimension of the anterior mediastinal fat was longer (p = 0.001) than those of the normal control group. For the NSIP patients, only the transverse dimension was significantly longer than those of the normal control group (p < 0.001). The convex shape of the anterior mediastinum was predictive of NSIP (OR = 19.7, CI 3.32 -∞, p < 0.001) and UIP (OR = 24.42, CI 4.06 -∞, p < 0.001).ConclusionFor UIP patients, the retrosternal AP and transverse dimensions are different from those of normal individuals, whereas the amounts of anterior mediastinal fat are similar. UIP and NSIP patients have a tendency to have a convex shape of their anterior mediastinal fat.

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“…Many reports have since addressed the anatomy of the lung apex and radiological signs of Pancoast tumors [3,9,[11][12][13][14][15] that could improve their detection. Nevertheless, in our study, over half of the radiological workups were misdiagnosed, and these errors were identified in more than half of the patients, occurring more frequently than in other reports [3,13].…”

Section: Discussionmentioning

confidence: 99%