Clinico Radiological Series IMAGING OF CHEST TUMORS
Clinico Radiological Series IMAGING OF CHEST TUMORS
Editors Ashu Seith Bhalla MD MAMS FICR
Professor Department of Radiodiagnosis All India Institute of Medical Sciences New Delhi, India
Manisha Jana MD DNB FRCR
Additional Professor Department of Radiodiagnosis All India Institute of Medical Sciences New Delhi, India
Co-Editor Priyanka Naranje MD DNB MNAMS
Associate Professor Department of Radiodiagnosis All India Institute of Medical Sciences New Delhi, India
Clinical Contents Edited by Randeep Guleria MD DM
Director, AIIMS, New Delhi Professor and Former Head Department of Pulmonary, Critical Care and Sleep Medicine All India Institute of Medical Sciences New Delhi, India
Anant Mohan MD DM
Professor Department of Pulmonary, Critical Care and Sleep Medicine All India Institute of Medical Sciences New Delhi, India
Jaypee Brothers Medical Publishers (P) Ltd
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Overseas Offices
J.P. Medical Ltd
83 Victoria Street, London
SW1H 0HW (UK)
Phone: +44 20 3170 8910
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2020, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Clinico Radiological Series: Imaging of Chest Tumors
First Edition: 2020
9789389587173
Printed at
Our families for bearing with us through these all-consuming ventures.
- Abanti Das
- MD DNB Fellow in Thoracic Radiology
- Assistant Professor
- Department of Radiology
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Abhishek Mahajan
- MD Fellowship in Cancer Imaging
- MRes (KCL, London)
- Associate Professor
- Department of Radiodiagnosis and Imaging
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- Amit Kumar Janu DMRD DNB
- Associate Professor
- Department of Radiodiagnosis
- ACTREC, Tata Memorial Center, Mumbai
- Homi Bhabha National Institute Mumbai, Maharashtra, India
- Ankur Goyal MD DNB MNAMS
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Anant Mohan MD DM
- Professor
- Department of Pulmonary, Critical Care and Sleep Medicine
- All India Institute of Medical Sciences
- New Delhi, India
- Anuradha Dawani MD DNB FRCR
- Fellow in Pediatric Radiology
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Anuradha Singh
- MD DNB Fellow in Thoracic Radiology
- Assistant Professor
- Department of Radiology
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Aparna Irodi MD FRCR
- Professor
- Department of Radiology
- Christian Medical College
- Vellore, Tamil Nadu, India
- Ashu Seith Bhalla MD MAMS FICR
- Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Deepali Jain MD DNB FIAC
- Additional Professor
- Department of Pathology
- All India Institute of Medical Sciences
- New Delhi, India
- Devasenathipathy Kandasamy
- MD DNB FRCR
- Additional Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Dodul Mondal MD DNB
- Assistant Professor
- Department of Radiation Oncology
- National Cancer Institute, All India Institute of Medical Sciences
- New Delhi, India
- Gh Mohammad Wani DNB
- Fellow in Thoracic Radiology
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Imtiyaz Ahmad Khan MD
- Fellow in Thoracic Radiology
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Karan Madan MD DM
- Associate Professor
- Department of Pulmonary, Critical Care and Sleep Medicine
- All India Institute of Medical Sciences
- New Delhi, India
- Madhuri Kumari MD
- Fellow in Pediatric Radiology
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Manisha Jana MD DNB FRCR
- Additional Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Manjunath Bale MBBS MS MCh
- Senior Resident, Minimal Access Surgery
- Department of Surgical Disciplines
- All India Institute of Medical Sciences
- New Delhi, India
- Mukesh Yadav MD
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Pawan Tiwari MD DM
- Assistant Professor
- Department of Pulmonary, Critical Care and Sleep Medicine
- All India Institute of Medical Sciences
- New Delhi, India
- Pooja Pande MBBS
- Junior Resident
- Department of Radiodiagnosis and Imaging
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- Prabhat S Malik MD DM
- Assistant Professor
- Department of Medical Oncology
- Dr BR Ambedkar Institute Rotary Cancer Hospital
- All India Institute of Medical Sciences
- New Delhi, India
- Priyanka Naranje MD DNB MNAMS
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Rajinder Parshad MS DNB FACS
- Professor
- Department of Surgical Disciplines
- All India Institute of Medical Sciences
- New Delhi, India
- Raju Sharma MD MAMS FICR
- Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Rakesh Kumar DRM DNB PhD
- Professor
- Department of Nuclear Medicine
- All India Institute of Medical Sciences
- New Delhi, India
- Randeep Guleria MD DM
- Director, AIIMS, New Delhi
- Professor and Former Head
- Department of Pulmonary, Critical Care and Sleep Medicine
- All India Institute of Medical Sciences
- New Delhi, India
- Ravikant Gupta MBBS MD
- Senior Resident
- Department of Nuclear Medicine
- All India Institute of Medical Sciences
- New Delhi, India
- Richa Yadav DMRD DNB
- Fellow in Pediatric Radiology
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Saurabh Mittal MD DM MRCP
- Assistant Professor
- Department of Pulmonary, Critical Care and Sleep Medicine
- All India Institute of Medical Sciences
- New Delhi, India
- Shashikiran NJ MBBS MS MCh
- Senior Resident, Minimal Access Surgery
- Department of Surgical Disciplines
- All India Institute of Medical Sciences
- New Delhi, India
- Smita Manchanda MD DNB MNAMS
- Associate Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Sudhakar Pipavath MD
- Professor
- Department of Radiology
- University of Washington Medical Center
- Seattle, WA, USA
- Sudheer K Arava MD
- Additional Professor
- Department of Pathology
- All India Institute of Medical Sciences
- New Delhi, India
- Surabhi Vyas MD
- Additional Professor
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Tahleel Altaf Shera MD DNB
- Fellow in Thoracic Radiology
- Department of Radiodiagnosis
- All India Institute of Medical Sciences
- New Delhi, India
- Vijay Hadda MD DM
- Associate Professor
- Department of Pulmonary, Critical Care and Sleep Medicine
- All India Institute of Medical Sciences
- New Delhi, India
From the infancy of one's clinical practice, and throughout our careers, it is a norm to encounter multiple chest masses that are often mystifying in both their origin and behavior. The myriad of organs in this region afford a variety of primaries, both benign and malignant as well as metastasis. Since the inception of radiology, there have been efforts to classify these based on appearances on modalities right from radiographs to the various cross-sectional anatomical and functional techniques.
This book presents a unique perspective to these tumors, classifying them each by compartments, pathological subtypes and biological behavior to provide a comprehensive understanding of not just the radiology, but also the histopathology and treatment options for each of these conditions. In the era of Tumor Boards and Disease Management Groups, the book has brought together contributions from experts in All India Institute of Medical Sciences, New Delhi, India; Tata Memorial Hospital, Mumbai, Maharashtra; and Christian Medical College, Vellore, Tamil, Nadu.
While tumors of the mediastinum and lung form a major component of chest imaging, equally important are lesions of the pleura, chest wall and various other tumor mimics. Typical patterns must be identified while atypical patterns assessed with a pattern approach to provide a close list of differentials to aid both the pathologist and treating physician as well as for patient education.
An exhaustive variety of illustrative cases as well as imaging pointers have been included as well as a Reporting/Examination Section for residents preparing for MD/DNB examinations as well as senior residency, fellowship and international examinations to strategize learning and decode these ‘exam essentials’.
In addition, this book will prove of aid to practicing radiologists, physicians and surgeons alike as it covers not just latest staging and classification systems, but also planned therapies, post-treatment imaging appearances as well as complications—including drug-specific outcomes that influence management decisions.
We welcome any feedback or suggestions on enhancing the content of the book, which can be incorporated in the subsequent editions.
Ashu Seith Bhalla
Manisha Jana
Acknowledgments
We wish to thank all our contributors, for their efforts in compiling the text. We sincerely thank Professor Randeep Guleria for guiding us in this new endeavor. We are especially thankful to our radiology colleagues without the help of whom this effort would not have been easy. We are also grateful to our colleagues from the Department of Pulmonary Medicine and Sleep Disorders, Pathology, Surgery, Medical Oncology, Radiation Oncology and Nuclear Medicine and for their contributions.
We would also like to thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Ms Chetna Malhotra Vohra (Associate Director–Content Strategy), Ms Nedup Denka Bhutia (Development Editor), and the staff of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their support and timely publication of the book.
Abbreviations
ACC
adenoid cystic carcinoma
ACCP
American College of Chest Physicians
ACTH
adrenocorticotropic hormone
ADC
apparent diffusion coefficient
AFP
alpha-fetoprotein
AIDS
acquired immunodeficiency syndrome
AIS
adenocarcinoma in situ
ALL
acute lymphoblastic leukemia
AML
acute myeloid leukemia
AP window
aortopulmonary window
ARDS
acute respiratory distress syndrome
AV
atrioventricular
BNP
B-type natriuretic peptide
BOOP
bronchiolitis obliterans organizing pneumonia
CC
craniocaudal length
CECT
contrast-enhanced computed tomography
CNS
central nervous system
COPD
chronic obstructive pulmonary disease
CP
costophrenic
CPMT
congenital peribronchial myofibroblastic tumor
CT
computed tomography
CTPA
CT pulmonary angiography
CXCR4
C-X-C chemokine receptor type 4
CXR
chest radiograph
DAD
diffuse alveolar damage
DIPNECH
diffuse intrapulmonary neuroendocrine cell hyperplasia
DLBCL-NHL
diffuse large B-cell non-Hodgkin lymphoma
DLBCL
diffuse large B-cell lymphoma
DVT
deep vein thrombosis
DWI
diffusion-weighted imaging
EGFR
epidermal growth factor receptor
EMH
extramedullary hematopoiesis
ES-SCLC
extensive stage-small cell lung carcinoma
FDG
F-labeled fluoro-2-deoxyglucose
FDG
fluorodeoxyglucose
FDG PET-CT
fluorodeoxyglucose positron emission tomography-computed tomography
FLAIR
fluid-attenuated inversion recovery
FSH
follicle-stimulating hormone
GCT
germ cell tumor
GG
ground glass
GGN
ground-glass nodule
GGO
ground-glass opacity
GNB
ganglioneuroblastoma
hCG
human chorionic gonadotropin
HHV-8
human herpesvirus-8
HL
Hodgkin's lymphoma
IASLC
International Association for the Study of Lung Cancer
IL
Interleukin
ILD
interstitial lung disease
IMT
inflammatory myofibroblastic tumor
KSHV
Kaposi sarcoma-associated herpesvirus
LAM
lymphangioleiomyomatosis
LB-NHL
lymphoblastic non-Hodgkin lymphoma
LCH
Langerhans cell histiocytosis
LDCT
low-dose computed tomography
LDH
lactate dehydrogenase
LH
luteinizing hormone
LN
lymph node
LPA
lepidic predominant adenocarcinoma
LS-SCLC
limited stage-small cell lung carcinoma
LV
left ventricle
M
major axis measurement
MEC
mucoepidermoid carcinoma
MIA
minimally invasive adenocarcinoma
MK
Masaoka-Koga staging system
MLC-NHL
mediastinal large cell non-Hodgkin lymphoma
MMPH
multifocal micronodular pneumocyte hyperplasia
MPNST
malignant peripheral nerve sheath tumor
mRECIST
modified RECIST
MRI
magnetic resonance imaging
NCCT
noncontrast computed tomography
NET
neuroendocrine tumor
NETs
neuroendocrine epithelial tumors
NHL
non-Hodgkin lymphoma
NSCLC
nonsmall cell lung cancer
NSCLC
nonsmall cell lung carcinoma
NSGCT
nonseminomatous germ cell tumor
NSIP
nonspecific interstitial pneumonia
PA
pulmonary arteries
PAIS
pulmonary artery intimal sarcoma
PDL1
program death ligand 1
PERCIST
Positron Emission Tomography Response Criteria in Solid Tumors
PET
positron emission tomography
PET-CT
positron emission tomography-computed tomography
PMF
progressive massive fibrosis
PNET
primitive neuroendocrine tumor
PORT
postoperative radiotherapy
PPB
pleuropulmonary blastoma
PS
part solid
PTE
pulmonary thromboembolism
PTLD
post-transplant lymphoproliferative disorders
PUO
pyrexia of unknown origin
RA
right atrium
RCA
right coronary artery
RECIST
Response Evaluation Criteria in Solid Tumors
RET
rearranged during transfection
RFA
radiofrequency ablation
RML
right middle lobe
RRP
recurrent respiratory papillomatosis
RUL
right upper lobe
SABR
stereotactic ablative body radiotherapy
SAD
short-axis diameter
SBRT
stereotactic ablative body radiotherapy
SCC
squamous cell carcinoma
SCLC
small cell lung cancer
SCLC
small cell lung carcinoma
SDF
stromal cell-divided factor
SFT
solitary fibrous tumor
SI
signal intensity
SIADH
syndrome of inappropriate secretion of antidiuretic hormone
SLD
summation of longest diameter
SLE
systemic lupus erythematosus
SPD
sum of product of diameter
SSFP
steady-state free precession
STIR
short-TI inversion recovery
SUL
lean body mass-normalized standardized uptake value
SUV
standardized uptake value
SVC
superior vena cava
T2WI
T2-weighted image
TGF
transforming growth factor
TKI
tyrosine kinase inhibitors
TKIs
tyrosine kinase inhibitors
TLC
total leukocyte count
TNF
tumor necrosis factor
TSC
tuberous sclerosis
TSC
tuberous sclerosis complex
UIP
usual interstitial pneumonia
USG
ultrasonography
VALSG
Veterans Administration Study Group System
VEGF
vascular endothelial growth factor
WHO
World Health Organization
WI
weighted image