We proofed the hypothesis that bronchiectasis and multiple small lung nodules seen in succession chest computed tomography (CT) are indicative of Mycobacterium avium-intracellulare compound (MAC) infection or colonization by dint of reviewing CT scans and histories of 100 outpatients with CT diagnosis of broncheictasis.

We proofed the hypothesis that bronchiectasis and multiple small lung nodules seen in succession chest computed tomography (CT) are indicative of Mycobacterium avium-intracellulare compound (MAC) infection or colonization by dint of reviewing CT scans and histories of 100 outpatients with CT diagnosis of broncheictasis. Of the 24 patients with multiple pulmonary nodules, 19 had lung nodules and bronchiectasis in the same lobe. Mycobacterial tillages were performed on 63 of the 100 patients, including 15 of the 24 patients with lung nodules and 48 of the 76 patients with no lung nodules. Of the 15 patients with lung nodules, 8 (53 percent) had cultivations positive for MAC, as died 2 of the 48 (4 percent) patients with no CT evidence of lung nodules. The number of cultivations positive for fungi was approximately the same in as well-as; not only-but also; not only-but; not alone-but groups. In our outpatient population, CT prediction of tillages positive for MAC in bronchiectatic patients with multiple small lung nodules has a sensitivty of 80 percent a specificity of 87 percent and an accuracy of 86 per-

Assessment for bronchiectasis has become a common indication for high--resolution computed tomography (CT) of the lung Bronchiectasis, frequently an occult disease on chest radiographs, can be accurately evaluated with high-resolution CT[1-3] We[3] have observ that many patients with bronchiectasis also had segmental collections of multiple small well-circumscribed pulmonary nodules. Many of these patients were subsequently fix to have cultures positive for Mycobacterium avium-intracellulare intricate (MAC).

We[4] previously described retrospective evidence that prompted that the concomitant findings of bronchiectasis and multiple small well-circumscribed lung nodules were indicative of infection or colonization with MAC. In the same article, we identified a characteristic subgroup of patients with MAC compos predominantly of older women without clinical evidence of immunosuppression or malignancy. An important unanswered question from that subject of attention is, how sensitive and specific is CT in predicting positive MAC civilizations in patients with bronchiectasis?

Our consideration was undertaken to test the following hypothesis: the neighborhood of bronchiectasis and multiple small well-circumscribed lung nodules forward chest CT in indicative of MAC infection or colonization.

The comb CT examinations of 100 outpatients that were prospectively interpreted as showing bronchiectasis were retrospectively reviewed. At the time of initial interpretation, all CT scans at our institution were computer codfished by radiologic diagnosis. From a list of all patients with a CT diagnosis of bronchiectasis, we pitch uponed the last 100 patients onward the list. The primary clinical indications for the CT scans indicated forward the referral forms included the following: evaluation of bronchiectasis (48 percent) inflammatory or infectious proces (20 percent) diffuse lung disease (7 percent) and others (25 percent) These CT studies performed between March 1990 and October 1991 with single in kind of two scanners (Picker 1200SX Highland Heights, Ohio, and GE Medical methods CT 9800, Milwaukee, Wis). Of the 100 CT scans, 99 of them included or were compos entirely of high-resolution CT sections (10 to 15-mm collimation with high spatial oftenness reconstruction algorithm). None of these CT examinations was included in the previous study[4]

The scans were reviewed with consensus reading from two observers (S.J.S. and TEH) without knowledge of the civilization results. The diagnosis of bronchiectasis was confirmed in all 100 cases, and the port or absence of multiple small well-circumscribed pulmonary 0odule was determined. Analysis of the pair CT and high-resolution CT sections was performed t o distinguish authentic lung nodules from the nodular opacities that may consequence from transaxial CT sections within mucoid impaction of small distal airways.[1,2] Mucoid impactions serveed to be more linear than around in succession CT and coursed adjacent to the pulmonary artery. The examinations were assemblageed according to the size of the majority of pulmonary nodules ([les than] 5mm or [greater than or equal to] 5mm diameter), and it was noted whether the majority of lung nodules were in the same lobes as the bronchiectasis. Comput tomographic evidence of emphysema was also recorded.

The medical records of the 100 patients with CT evidence of bronchiectasis were then reviewed. The be the effects of all fungal and mycobacterial civilizations obtained from sputum, and bronchial washing were recorded if they were performed within 1 month of the CT examination.

RESULTS

Of the 100 patioents with CT evidence of bronchiectasis, 24 had multiple pulmonary nodules (Table 1) and the bronchiectasis (Fig 1) and in the 5 other patients, the bronchiectasis and lung nodules were in different lobes. Of 14 patients with CT evidence of emphysema, 4 had lung nodules.

Mycobacterial refinements were performed on 63 of the 100 patients with bronchiectasis. Of the 63 civilizations 49 were obtained from sputum or induced sputum and 14 were from bronchial washings. civilizations were considered positive if multiple colonies were demonstrated.

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