Thin-section CT features of intrapulmonary lymph nodes

Purpose: The objective of this study was to evaluate CT findings of patholo gically proven intrapulmonary lymph nodes (IPLNs) and discuss the utility o f thin-section CT and contrast-enhanced CT. Method: CT findings of 18 nodules in 14 patients with pathologically proven IPLNs were reviewed. CT scanning of the whole lung was performed contiguou sly with slice thickness of 10 mm. In addition, a helical scan with slice t hickness of 2 mm was performed in nine patients, focusing on the nodule. Co ntrast-enhanced helical CT was performed in four patients, and the utility of thin section CT and contrast-enhanced CT was investigated. Results: One patient had three nodules, 2 patients had two nodules, and the remaining I I patients had a solitary nodule. All nodules were located bel ow the level of the carina and within 15 mm of the pleura. In one case, con ventional CT revealed the nodule 20 mm away from the pleura; however. the n odule attached to the major fissure was clearly revealed on thin-section CT . The size of the nodules was : 15 mm, and the shape was round (n = 8), ova l (n = 9), or lobulated (n = 1) with sharp border. One nodule demonstrated a spiculated border due to a surrounding pulmonary fibrosis on conventional CT; however, thin-section CT showed precisely a sharp border. The lobulate d shape of one case histopathologically reflected a hilus of lymph node. On contrast-enhanced helical CT, all four nodules were enhanced and the degre e enhancement was 36-85 HU (median 66.6 HU). Conclusion: In current times, IPLNs are not uncommon lesions. We should con sider IPLN in the differential diagnosis of solitary or multiple pulmonary nodules in the peripheral field and below the level of the carina. Thin-sec tion CT showed precisely the border or relation between IPLNs and the surro unding structure. It was difficult to distinguish between IPLNs and maligna nt nodules from the degree of enhancement on contrast-enhanced CT. On thin- section and contrast-enhanced CT, the findings of IPLNs are not necessarily specific. Therefore, strict observation on CT is necessary; in certain cas es that are increasing in size, video-assisted thoracic surgery should be c onsidered because of their location.