Longitudinal Follow up of Patients Undergoing Computed Tomography for Centrilobular Nodules at a Tertiary Care Centre

Abstract

Objective : The purpose of our study was to do longitudinal follow up of patients and study evolutive patterns , signs and clinical/pathologic correlations with CT scan findings of lung nodules ,predominant centrilobular opacities or preferential centrilobular . Another aim of this study was to establish whether there is any difference in the pattern and distribution of such calcifications in tuberculosis (TB) and sarcoidosis.Methods :We followed up over 3 months 150 patients with lung nodules. CT scans were performed before, during, and after 3 months of anti-tuberculosis ,sarcoidosis and other treatments. Both 10-mm-thick sections and 1.5-mm-thick HRCT scans were performed. Chest HRCT scans in 150 patients with predominant centrilobular opacities or preferential centrilobular disease were retrospectively evaluated. A tentative diagnosis was made by CT scan appearance ,supported by clinicopathological analysis and final diagnosis after 3 months was confirmed by response to treatment . Results: 104 EBB and 105 TBLB were performed. The mean age was 47 years and 55% patients were male. Most common symptom was cough (47%) and median duration of symptoms was 3 months. Most common diagnoses were sarcoidosis and TB. 150 had final diagnosis of TB or sarcoidosis. Conclusion: This HRCT may be helpful to demonstrate activity in patients suspected of having tuberculosis and to assess antituberculous treatment efficiency. Combined procedures had specificity of 96.8%, PPV of 99.4% and NPV of 40.7%.Knowledge of the two centrilobular patterns in CT scan and combined with pathological tests ,is of proven worth for generating differential diagnoses and is of particular value in suggesting a likely infectious etiology in cases with tree-in-bud appearance.