During plaque progression, calcified areas grow and generate calcified sheets, a marker of stable and
fibrocalcific lesions.
OCT was found to have sensitivity and specificity of 71% to 79% and 97% to 98% for fibrous plaques, 95% to 96% and 97% for
fibrocalcific plaques, and 90% to 94.5% and 90% to 92% for lipid-rich plaques, respectively.
The
fibrocalcific nodules found on the chest radiograph imply that either 1) the patient might have had histoplasmosis for years and it became disseminated because of immunosuppressive therapy for rheumatoid arthritis or 2) the patient was reinfected with the calcified lesions that resulted from prior histoplasmosis.
Conversely, the nonobstructive atheroma or Type N lesion, which has a nonfibrous, thin cap and does not cause lumenal obstruction, is often more susceptible to rupture compared with a more advanced, highly stenotic,
fibrocalcific lesion.
Mean Intima-Media Thickness was found to be 1.04 mm; 30 patients (42.25%) had plaque, out of which 18 (25.35%) had fibrofatty plaque and 12 (16.9%) had
fibrocalcific plaque; 4 patients (5.63%) had stenosis with haemodynamic compromise.
Second, they document greater numbers of periadventitial infiltrating macrophages in clinical specimens of coronary atherosclerosis with large lipid cores than in
fibrocalcific or nonatherosclerotic vessels.
The X-ray chest PA and Lateral views (Fig-1a, b) revealed fibrocalcific lesions with haziness in both mid and upper zones with multiple calcific lesions in both hilar and perihilar regions and blunting of both costophrenic angles suggestive of Pulmonary Koch's with calcified lymphadenopathy and associated pleural pathology.
Spiral CT chest (Fig-2a, b, c) was performed with findings of multiple paratracheal, tracheobronchial, hilar, carinal and peribronchial calcified lesions of variable sizes, situated closely to bronchial lumen, suggestive of calcified lymphadenopathy associated with fibrocalcific lesions and parenchymal infiltrations with bronchiectasis changes in both upper and middle lobes with minimal left pleural effusion--features suggestive of Chronic pulmonary tuberculosis.
In addition, macrophage density in the periadventitial fat of lipid-rich plaques is increased compared with
fibrocalcific plaques.
These could be in the form of volume loss, parenchymal scarring, fibronodular or
fibrocalcific densities and compensatory hyperinflation.
