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Nontuberculous Mycobacterial Pulmonary Infection in Immunocompetent Patients: Comparison of Thin-Section CT and Histopathologic Findings¹

¹ From the Department of Radiology and Center for Imaging Science (Y.J.J., K.S.L., T.S.K.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.J.K., O.J.K.), and Department of Pathology (J.H.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135–710, Korea. Received May 29, 2003; revision requested August 12; revision received September 17; accepted October 14. Supported by a grant from the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (00-PJ1-PG1-CY03–0001). Address correspondence to K.S.L. (e-mail: melon2@samsung.co.kr).

View larger version (165K): [in a new window]   Figure 1a. M avium-intracellulare complex infection in 52-year-old woman. Transverse thin-section (2.5-mm collimation) CT scans obtained at levels of (a) right lower lobar bronchus and (b) right inferior pulmonary vein show cavitary consolidation, small nodules (arrow), and branching centrilobular nodules (ie, tree-in-bud pattern) (arrowhead) in right lower lobe. (c) Right lower lobectomy specimen shows several granulomas with caseating material. One of the granulomas created a central necrotic cavity (arrow). Bronchial wall destruction (arrowhead) due to inflammation and granulomatous change also is apparent. (d) Low-magnification photomicrograph shows well-defined granuloma (arrow) around an inflamed bronchiole (B). Also note the Langhans-type giant cells (arrowheads). (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (164K): [in a new window]   Figure 1b. M avium-intracellulare complex infection in 52-year-old woman. Transverse thin-section (2.5-mm collimation) CT scans obtained at levels of (a) right lower lobar bronchus and (b) right inferior pulmonary vein show cavitary consolidation, small nodules (arrow), and branching centrilobular nodules (ie, tree-in-bud pattern) (arrowhead) in right lower lobe. (c) Right lower lobectomy specimen shows several granulomas with caseating material. One of the granulomas created a central necrotic cavity (arrow). Bronchial wall destruction (arrowhead) due to inflammation and granulomatous change also is apparent. (d) Low-magnification photomicrograph shows well-defined granuloma (arrow) around an inflamed bronchiole (B). Also note the Langhans-type giant cells (arrowheads). (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (124K): [in a new window]   Figure 1c. M avium-intracellulare complex infection in 52-year-old woman. Transverse thin-section (2.5-mm collimation) CT scans obtained at levels of (a) right lower lobar bronchus and (b) right inferior pulmonary vein show cavitary consolidation, small nodules (arrow), and branching centrilobular nodules (ie, tree-in-bud pattern) (arrowhead) in right lower lobe. (c) Right lower lobectomy specimen shows several granulomas with caseating material. One of the granulomas created a central necrotic cavity (arrow). Bronchial wall destruction (arrowhead) due to inflammation and granulomatous change also is apparent. (d) Low-magnification photomicrograph shows well-defined granuloma (arrow) around an inflamed bronchiole (B). Also note the Langhans-type giant cells (arrowheads). (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (159K): [in a new window]   Figure 1d. M avium-intracellulare complex infection in 52-year-old woman. Transverse thin-section (2.5-mm collimation) CT scans obtained at levels of (a) right lower lobar bronchus and (b) right inferior pulmonary vein show cavitary consolidation, small nodules (arrow), and branching centrilobular nodules (ie, tree-in-bud pattern) (arrowhead) in right lower lobe. (c) Right lower lobectomy specimen shows several granulomas with caseating material. One of the granulomas created a central necrotic cavity (arrow). Bronchial wall destruction (arrowhead) due to inflammation and granulomatous change also is apparent. (d) Low-magnification photomicrograph shows well-defined granuloma (arrow) around an inflamed bronchiole (B). Also note the Langhans-type giant cells (arrowheads). (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (164K): [in a new window]   Figure 2a. M avium-intracellulare complex infection in 58-year-old woman. (a) Transverse thin-section (2.5-mm collimation) CT scan obtained at level of suprahepatic inferior vena cava shows varicose bronchiectasis with volume loss, multiple small nodules, and branching centrilobular nodules (ie, tree-in-bud pattern) (arrows) in the right middle lung lobe. Similar findings were seen in the lingular segment of the left upper lobe and both lower lobes. (b) Photomicrograph of lung specimen obtained at transbronchial lung biopsy shows infiltration of lymphocytes with mural granulomas (arrows) at the bronchiolar wall. A small granuloma (arrowhead) in the peribronchiolar interstitium also is shown. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (213K): [in a new window]   Figure 2b. M avium-intracellulare complex infection in 58-year-old woman. (a) Transverse thin-section (2.5-mm collimation) CT scan obtained at level of suprahepatic inferior vena cava shows varicose bronchiectasis with volume loss, multiple small nodules, and branching centrilobular nodules (ie, tree-in-bud pattern) (arrows) in the right middle lung lobe. Similar findings were seen in the lingular segment of the left upper lobe and both lower lobes. (b) Photomicrograph of lung specimen obtained at transbronchial lung biopsy shows infiltration of lymphocytes with mural granulomas (arrows) at the bronchiolar wall. A small granuloma (arrowhead) in the peribronchiolar interstitium also is shown. (Hematoxylin-eosin stain; original magnification, x40.)