Chest
Volume 105, Issue 1, January 1994, Pages 49-52
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Clinical Investigations: Infections
Computed Tomographic Diagnosis of Mycobacterium avium-intracellulare Complex in Patients With Bronchiectasis

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We tested the hypothesis that bronchiectasis and multiple small lung nodules seen on chest computed tomography (CT) are indicative of Mycobacterium avium-intracellulare complex (MAC) infection or colonization by reviewing CT scans and histories of 100 outpatients with CT diagnosis of bronchiectasis. Of the 24 patients with multiple pulmonary nodules, 19 had lung nodules and bronchiectasis in the same lobe. Mycobacterial cultures 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 cultures positive for MAC, as did 2 of the 48 (4 percent) patients with no CT evidence of lung nodules. The number of cultures positive for fungi was approximately the same in both groups. In our outpatient population, CT prediction of cultures positive for MAC in bronchiectatic patients with multiple small lung nodules has a sensitivity of 80 percent, a specificity of 87 percent, and an accuracy of 86 per

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Material and Methods

The chest 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 coded by radiologic diagnosis. From a list of all patients with a CT diagnosis of bronchiectasis, we selected the last 100 patients on the list. The primary clinical indications for the CT scans indicated on the referral forms included the following: evaluation of

Results

Of the 100 patients with CT evidence of bronchiectasis, 24 had multiple pulmonary nodules (Table 1), and 21 of these patients had nodules that were predominantly <5 mm in diameter. Three patients had nodules that were predominantly ≥5 mm in diameter. No nodules were >15 mm in diameter. In 19 of the 24 patients, the lung nodules were in the same lobe as the bronchiectasis (Fig 1), and in the 5 other patients, the bronchiectasis and lung nodules were in different lobes. Of 14 patients with

Discussion

Pulmonary infection with MAC has become a more frequently reported cause of infection in both normal and immunocompromised patients.3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 We tested the following hypothesis: bronchiectasis and multiple small lung nodules are indicative of MAC infection or colonization.

We found that the concomitant presence of multiple small well-circumscribed lung nodules and bronchiectasis on CT (Fig 1) is an indication that the patient is likely to have sputum or bronchial

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