RESUMEN
AIM: To correlate CT morphological features and histopathological findings of adenosquamous carcinoma of the lung. MATERIALS AND METHODS: In all, 29 patients underwent contrast-enhanced CT of an adenosquamous carcinoma of the lung, followed by resection of the cancer. Correlations between CT morphological and histopathological features were evaluated, including location, characteristics of margins, attenuation and the presence of necrosis. RESULTS: The tumour was peripheral in 21 (72%) and central in 8 (28%) cases. The tumours varied in size from 1.1cm to 11.0cm (mean 3.8cm); 20 (69%) appeared as heterogeneous masses and 9 (31%) as homogeneous masses. The most common CT features were lobulation in 27 (93%), pleural tail in 22 (76%), spiculation in 17 (59%), necrosis in 15 (52%) and vessel convergence in 13 (45%). Among the 21 peripheral tumours, 14 (67%) showed intratumoural necrosis and 17 (81%) were heterogeneous. Among the 8 central tumours, only 1 (12.5%) showed intratumoural necrosis and 5 (62.5%) were homogeneous. These CT features corresponded mainly to solid tumour growth, which was composed of both squamous cell carcinomatous and adenocarcinomatous tissue. CONCLUSION: Adenosquamous carcinoma of the lung is shown to be characteristically a solid, lobulated nodule or mass, more commonly peripheral than central. After intravenous injection of positive contrast medium, CT shows that the peripheral lesions are usually of heterogeneous soft-tissue attenuation.
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Carcinoma Adenoescamoso/diagnóstico por imagen , Carcinoma Adenoescamoso/patología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Intensificación de Imagen Radiográfica , Interpretación de Imagen Radiográfica Asistida por Computador , Estudios Retrospectivos , Tomografía Computarizada por Rayos XAsunto(s)
Neoplasias Pulmonares/diagnóstico , Adenocarcinoma/diagnóstico , Adenocarcinoma/patología , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patología , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Tamizaje Masivo , Estadificación de Neoplasias , Tasa de SupervivenciaRESUMEN
OBJECTIVE: In patients undergoing a combined CT angiographic and CT venographic protocol, the accuracy of helical CT venography for the detection of deep venous thrombosis was compared with that of lower extremity sonography. MATERIALS AND METHODS: Patients who had undergone a combined CT angiographic and CT venographic protocol and sonography of the lower extremities within 1 week were identified. The final reports were evaluated for the presence or absence of deep venous thrombosis. Statistical measures for the identification of deep venous thrombosis with helical CT venography were calculated. In each true-positive case, the location of the thrombus identified with both techniques was compared. All false-positive and false-negative cases were reviewed to identify the reasons for the discrepancies. RESULTS: Seventy-four patients were included. There were eight patients (11%) with true-positive findings, 61 patients (82%) with true-negative findings, four patients (5%) with false-positive findings, and one patient (1%) with a false-negative finding. When comparing helical CT venography with sonography for the detection of lower extremity deep venous thrombosis, the sensitivity measured 89%; specificity, 94%; positive predictive value, 67%; negative predictive value, 98%; and accuracy, 93%. Of the eight true-positive cases, five had sites of thrombus that were in agreement on both CT venography and sonography. Of the five discordant cases, four were false-positives and one was a false-negative. Possible explanations for all discrepancies were identified. CONCLUSION: Compared with sonography, CT venography had a 93% accuracy in identifying deep venous thrombosis. However, the positive predictive value of only 67% for CT venography suggests that sonography should be used to confirm the presence of isolated deep venous thrombosis before anticoagulation is initiated. In addition, interpretation of CT venography should be performed with knowledge of certain pitfalls.
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Embolia Pulmonar/diagnóstico , Trombosis de la Vena/diagnóstico por imagen , Anciano , Distinciones y Premios , Femenino , Humanos , Pierna/irrigación sanguínea , Masculino , Flebografía/métodos , Valor Predictivo de las Pruebas , Radiología , Estudios Retrospectivos , Sensibilidad y Especificidad , Sociedades Médicas , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía , Estados UnidosRESUMEN
The authors assess clinical and radiographic findings of pulmonary nodules and masses after lung and heart-lung transplantation. One hundred and fifty nine patients who survived at least 3 months after lung and heart-lung transplantation were followed by serial chest radiographs for a median of 27 months. Single or multiple lung nodules or masses were noted at chest radiography in 15 (9.4%) of 159 patients. Imaging findings and causes of these nodules and masses were reviewed retrospectively. Infection was found in 10 (6%) of 159 patients. Specific pathogens (11 pathogens in 10 patients) were Aspergillus (n = 4), Mycobacteria (n = 4), and other bacteria (n = 3). Noninfectious causes were found in 5 (3%) of patients and included B-cell lymphoma (n = 2), bronchogenic carcinoma (n = 2), and pulmonary infarcts (n = 1). Nodules and masses appeared a median of 11 months after transplantation (range: 0.2 to 36 months). Five patients (33%) had single lesions; the other 10 (67%) patients had multiple lesions (range 2 to 50). Aspergillus lesions were most commonly located in the upper lobes, were cavitary in three of four patients, and all were fatal. Nodules and masses arose in the transplanted lung in 12 (80%) of the patients, and in the native lung in 3 (20%) of the patients (2 bronchogenic carcinoma, 1 M. tuberculosis simulating bronchogenic carcinoma). Nodules and masses detected by chest radiography are not uncommon (9.4%) after lung and heart-lung transplantation. Infections are more common than noninfectious causes of posttransplant nodules and masses. Specific clinical and imaging characteristics may provide clues to etiology.
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Trasplante de Corazón-Pulmón , Enfermedades Pulmonares/diagnóstico por imagen , Trasplante de Pulmón , Complicaciones Posoperatorias/diagnóstico por imagen , Adolescente , Adulto , Anciano , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía Torácica/métodos , Estudios Retrospectivos , Tuberculosis Pulmonar/diagnóstico por imagenRESUMEN
This study was undertaken to assess whether gastroparesis, as a chronic complication of lung transplantation, correlates with height of the gastric air bubble on chest radiographs of erect fasting subjects. Height of the gastric air bubble and presence or absence of a gastric air-fluid level were assessed on chest radiographic examinations (posteroanterior, lateral, upright position, during fasting, immediately after bronchoscopy, median 148 days after transplantation) obtained on 3 separate days for each of 19 recipients of lung transplantation. Seven of the subjects (five women, two men) had chronic upper gastrointestinal symptoms after transplantation and a confirmed diagnosis of gastroparesis. The gastroparesis was idiopathic in six of the subjects and associated with cytomegalovirus gastritis in one subject. The other 12 subjects, each without upper gastrointestinal symptoms, served as controls. Median height of the gastric air bubble was significantly less in the gastroparetic (2.8 cm; range, 1.0-4.6 cm) than in the control (4.7 cm; range, 1.0-12.4 cm) group (p<0.05). Height of the gastric air bubble was at most 4.6 cm among the seven gastroparetic subjects, whereas it exceeded 5.0 cm on at least one occasion in 8 (67%) of the 12 control subjects (p<0.005). The likelihood of a gastric air-fluid level was 86% for symptomatic subjects and 25% for the control group (p<0.01). When lung transplantation is complicated by chronic gastroparesis, postbronchoscopic chest radiographic examinations of fasting subjects are associated with a gastric air bubble limited to high in the fundus, usually including a fluid level.
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Gastroparesia/diagnóstico por imagen , Gastroparesia/etiología , Trasplante de Pulmón/efectos adversos , Adulto , Aire , Ayuno , Femenino , Gastroscopía , Humanos , Masculino , Persona de Mediana Edad , Postura , Radiografía Torácica , Cintigrafía , Estudios Retrospectivos , Estadísticas no ParamétricasRESUMEN
RATIONALE AND OBJECTIVES: The purpose of this study was to identify practice patterns of extrathoracic imaging in patients newly diagnosed with non-small-cell lung, cancer. MATERIALS AND METHODS: The authors retrospectively reviewed the charts of 125 patients (71 men, 54 women; mean age, 67 years) from five hospitals (25 patients each) with newly diagnosed non-small-cell lung cancer. Charts were reviewed for cancer cell type, evidence of metastatic disease, and performance and results of extrathoracic imaging, including computed tomography (CT) and magnetic resonance (MR) imaging of the brain, bone scanning, and abdominal CT. RESULTS: Of 125 patients, 77 (62%) underwent extrathoracic imaging. These patients included 64 (64%) of 100 patients with clinical symptoms or laboratory signs of metastatic disease and 13 (52%) of 25 patients with no such indications. Extrathoracic imaging did not differ according to cancer cell type: It was performed for 30 (60%) of 50 patients with squamous cell carcinoma, 26 (60%) of 43 patients with adenocarcinoma, and 16 (73%) of 22 patients with non-small-cell lung cancer that was not further characterized. Brain CT or MR imaging bone scanning, or abdominal CT were performed in only 48%, 39%, and 30% of patients, respectively. Brain CT or MR images or bone scans revealed metastatic disease in seven of 20 and nine of 22 patients with clinical symptoms or laboratory signs of disease, respectively. These examinations revealed disease in four of 40 and two of 27 patients without such symptoms or signs, respectively (P < .05). No significant differences emerged among the practice patterns at the five participating hospitals. CONCLUSION: No consensus was found on performance of extrathoracic imaging in patients with newly diagnosed non-small-cell lung cancer.
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Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Abdomen/patología , Anciano , Huesos/diagnóstico por imagen , Huesos/patología , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/secundario , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Radiografía Abdominal , Cintigrafía , Estudios RetrospectivosRESUMEN
The volume and severity of pulmonary emphysema in individual lungs were measured by means of quantitative computed tomography (CT) studies in 28 patients (14 women, 14 men, median age 65 yr) who underwent either bilateral (n = 15) or unilateral (n = 13) lung volume reduction surgery (LVRS). Spirometric, total body plethysmographic, and CT data (at TLC and RV) were correlated before and after LVRS. Lung volumes determined by CT correlated well with volumes obtained by total body plethysmography (p < 0.0001). For individual lungs after LVRS, CT-derived mean lung capacity decreased 13% and residual volume 20% (p < 0.00001 for each), while mean total functional lung volume (TFLV, defined as the volume of lung with CT attenuation greater than -910 Hounsfield units) increased 9% (p < 0.01), and the mean ratio of the air space to tissue space volume (V(AS)/V(TS)) decreased more at RV (23%) than at TLC (14%) (p < 0.0005 for each). In contrast, unilateral LVRS did not affect exhalation from the unoperated lung (2% reduction in RV, p = NS). The magnitude of the postoperative response (CT-derived TLC, RV, TFLV, V(AS)/V(TS)) of each operated lung was comparable for unilateral and bilateral LVRS. Thus, a lung's response to LVRS was independent from that of the contralateral lung. Moreover, postoperative alterations in TFLV and FEV1 correlated significantly (r = 0.80, p < 0.0001), which suggests that the expansion of functioning tissue may contribute to the mechanism by which LVRS palliates airway obstruction.
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Mediciones del Volumen Pulmonar , Pulmón/diagnóstico por imagen , Pulmón/cirugía , Enfisema Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pletismografía Total , Enfisema Pulmonar/fisiopatología , Enfisema Pulmonar/cirugía , Volumen Residual , Espirometría , Capacidad Pulmonar TotalRESUMEN
PURPOSE: The authors present their experience with previously unsuspected carcinoma of the lung detected at preoperative computed tomography (CT) in patients with severe pulmonary emphysema who were scheduled to undergo lung volume reduction surgery. MATERIALS AND METHODS: Preoperative chest CT was performed in 148 patients (84 men, 64 women; mean age, 65 years +/- 8 [standard deviation]) with advanced pulmonary emphysema before lung volume reduction surgery. At surgery, an attempt was made to excise any pulmonary nodule considered suspicious for carcinoma at CT. RESULTS: Eighteen pulmonary nodules suspicious for lung cancer were found at CT in 17 (11%) of the 148 patients. Sixteen of these 148 nodules were resected at lung volume reduction surgery. Nine non-small cell carcinomas (adenocarcinoma, n = 4, including three with bronchioloalveolar differentiation; poorly differentiated, n = 3; squamous cell carcinoma, n = 2) were found in eight (5%) patients. Eight of the cancers were stage I, and one was unstaged surgically. Maximum diameters of the cancers ranged between 1.0 and 3.8 cm (median, 1.6 cm). The seven (5%) other resected nodules were all benign. CONCLUSION: A 5% rate of stage I primary lung cancer in patients selected for lung volume reduction surgery suggests that performance of chest CT in candidates for lung volume reduction surgery is appropriate not only to identify patterns of pulmonary parenchymal destruction but also to search for stage I lung cancer.
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Carcinoma/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Neumonectomía , Enfisema Pulmonar/cirugía , Tomografía Computarizada por Rayos X , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/cirugía , Adenocarcinoma Bronquioloalveolar/diagnóstico por imagen , Adenocarcinoma Bronquioloalveolar/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/cirugía , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/cirugía , Femenino , Granuloma/diagnóstico por imagen , Granuloma/cirugía , Hamartoma/diagnóstico por imagen , Hamartoma/cirugía , Humanos , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/cirugía , Neoplasias Pulmonares/cirugía , Escisión del Ganglio Linfático , Ganglios Linfáticos/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neumonía/diagnóstico por imagen , Neumonía/cirugía , Cuidados Preoperatorios , Enfisema Pulmonar/diagnóstico por imagen , Fibrosis Pulmonar/diagnóstico por imagen , Fibrosis Pulmonar/cirugía , Radiografía Torácica , Nódulo Pulmonar Solitario/diagnóstico por imagen , Nódulo Pulmonar Solitario/cirugíaRESUMEN
During a 5-year study period, we diagnosed pulmonary tuberculosis in two (2%) of 94 lung and heart-lung transplant recipients. Each infection occurred 3 months after bilateral lung transplantation in the presence of evidence implicating donor-to-recipient transmission of the pathogen. The radiographic patterns of pulmonary tuberculosis were subtle: narrowing of the middle lobe bronchus of the right lung caused by an endobronchial granulomatous mass (n = 1) and a focal cluster of small nodules in the upper lobe of the left lung and small bilateral pleural effusions (n = 1). Each patient achieved complete clinical and radiographic response after antituberculous therapy. We conclude that Mycobacterium tuberculosis may be transmitted directly by a donor lung and may involve bronchial mucosa, pulmonary parenchyma, and pleura.
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Trasplante de Pulmón , Tuberculosis Pulmonar/transmisión , Adulto , Antituberculosos/uso terapéutico , Bronquios/microbiología , Enfermedades Bronquiales/diagnóstico por imagen , Broncografía , Transmisión de Enfermedad Infecciosa , Trasplante de Corazón/efectos adversos , Humanos , Pulmón/microbiología , Trasplante de Pulmón/efectos adversos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis , Pleura/microbiología , Derrame Pleural/microbiología , Donantes de Tejidos , Tuberculoma/diagnóstico por imagen , Tuberculosis Pulmonar/diagnóstico por imagenRESUMEN
We have recently noted an unexpected high incidence of lung cancer in our population of cardiac allograft recipients. We conducted a retrospective review of cardiac transplantation at our institution to investigate the incidence, clinical course, and outcome of patients who developed lung cancer following heart transplantation. Nine patients--each with a history of smoking at 30 pack-years--developed lung cancer following heart transplantation, for an incidence of 1.56% of patients at risk. Eight of the patients were male > or = 50 years of age, representing 3.3% of the male transplant recipients in this age group. The interval from transplantation to diagnosis clustered around 3-5 years after transplantation, but in two instances (22%), a neoplasm was discovered within 6 months of transplantation. Almost half of the cancers were discovered incidentally, despite routine radiographic surveillance. Seven of 9 (78%) patients had stage IV disease at presentation. Median survival after diagnosis was 3 months, and five of the seven patients who died survived less than 4 months after diagnosis. We conclude that cardiac transplant recipients are at increased risk for development of lung cancer. Patients with a moderate to heavy smoking history might well be advised to undergo chest CT scanning in an aggressive search for occult lung cancer before cardiac transplantation is considered further. Finally, despite frequent radiologic examinations, these lung cancers are often diagnosed incidentally, are far advanced at the time of diagnosis, are not surgically resectable, and are poorly responsive to adjuvant therapy.
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Carcinoma/epidemiología , Trasplante de Corazón , Terapia de Inmunosupresión/efectos adversos , Neoplasias Pulmonares/epidemiología , Complicaciones Posoperatorias/epidemiología , Fumar/efectos adversos , Adolescente , Adulto , Anciano , Carcinoma/diagnóstico por imagen , Carcinoma/etiología , Carcinoma/patología , Niño , Preescolar , Errores Diagnósticos , Femenino , Humanos , Lactante , Recién Nacido , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/etiología , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/cirugía , New York/epidemiología , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/patología , Pronóstico , Radiografía , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
PURPOSE: To assess clinical and radiographic findings in opportunistic bronchopulmonary infections after lung transplantation. MATERIALS AND METHODS: Forty-five episodes of opportunistic bronchopulmonary infection occurred in 27 (35%) of 77 lung transplant recipients during a 4-year period. Causative organisms, radiographic patterns, and mortality were reviewed. RESULTS: Cytomegalovirus (CMV) was the most common pathogen (25 episodes), followed by Aspergillus species (seven episodes), Pneumocystis carinii (six episodes), herpes simplex virus (four episodes), Mycobacterium avium complex (two episodes), and M tuberculosis (one episode). Eighteen of the 25 episodes (72%) of CMV pneumonitis occurred in the first 4 months after transplantation; 24 (96%) occurred within the 1st year. Radiographic patterns of symptomatic CMV pneumonitis were diffuse haziness (60%), focal haziness (33%), and focal consolidation (7%). Aspergillus species locally invaded a necrotic bronchial anastomosis in three patients, each within 4 months of transplantation. P carinii was seen as focal haziness and caused no symptoms. Radiographic findings, when present, were seen almost exclusively in the transplanted lung. Despite three deaths attributable to opportunistic bronchopulmonary infection, the difference between the survival rates of patients with and those of patients without bronchopulmonary infection was not statistically significant (82% and 81%, respectively, 1 year after transplantation). CONCLUSION: Opportunistic bronchopulmonary infections are common after lung transplantation. The most common pathogen is CMV, which causes diverse chest radiographic patterns. Opportunistic bronchopulmonary infections do not adversely affect overall mortality.
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Trasplante de Pulmón , Infecciones Oportunistas/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Adulto , Aspergilosis/diagnóstico por imagen , Aspergilosis/epidemiología , Broncoscopía , Infecciones por Citomegalovirus/diagnóstico por imagen , Infecciones por Citomegalovirus/epidemiología , Femenino , Trasplante de Corazón-Pulmón , Herpes Simple/diagnóstico por imagen , Herpes Simple/epidemiología , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Enfermedades Pulmonares Fúngicas/epidemiología , Masculino , Infecciones Oportunistas/epidemiología , Neumonía por Pneumocystis/diagnóstico por imagen , Neumonía por Pneumocystis/epidemiología , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/epidemiología , Complicaciones Posoperatorias/epidemiología , Radiografía , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
AIM: To determine the aetiology of isolated intrathoracic lymphadenopathy on chest radiographs of HIV-infected patients. PATIENTS AND METHODS: Over a 40 month span in 1990-1993, 18 HIV-infected patients (13 men, 5 women) from our New York City adult HIV outpatient clinic development isolated intrathoracic lymphadenopathy (defined as intrathoracic nodal enlargement without other persistent abnormalities on chest radiographs). Serial chest radiographs (n = 18), CT scans when available (n = 7), and clinical charts (n = 18) were reviewed retrospectively. RESULTS: Median patient age was 34 (range 25-49) years. The diagnoses associated with adenopathy were Mycobacterium tuberculosis (Mtb) in eight (44%), Mycobacterium avium intracellulare complex (MAC) in four (22%), and Mtb and MAC co-infection in three (17%). Cryptococcal infection, thymic hyperplasia, and spontaneous resolution without diagnosis or treatment occurred in one patient each. In 16 (89%) of the 18 patients, lymphadenopathy was present in more than one nodal station. Enlarged nodes were found in the following sites: paratracheal/tracheobronchial (n = 14), aortopulmonary window (n = 9), hilar (n = 7), anterior mediastinum (n = 3), subcarinal (n = 2), and left paraesophageal (n = 2). CONCLUSION: Mycobacterial infection was the aetiology of isolated intrathoracic lymphadenopathy in 15 of 18 (83%) HIV-infected patients. When an inner city HIV-infected patient presents with isolated intrathoracic lymphadenopathy, we recommend an aggressive work-up for mycobacterial disease.
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Complejo Relacionado con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Enfermedades Pulmonares/complicaciones , Enfermedades Linfáticas/etiología , Infecciones por Mycobacterium/complicaciones , Complejo Relacionado con el SIDA/diagnóstico por imagen , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico por imagen , Adulto , Femenino , Humanos , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Linfáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium/diagnóstico por imagen , Complejo Mycobacterium avium , Infección por Mycobacterium avium-intracellulare/complicaciones , Infección por Mycobacterium avium-intracellulare/diagnóstico por imagen , Mycobacterium tuberculosis , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Tuberculosis Ganglionar/complicaciones , Tuberculosis Ganglionar/diagnóstico por imagen , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico por imagenRESUMEN
PURPOSE: To describe the appearances of overlooked lung cancer at computed tomographic (CT) examination and to analyze the reasons for failure to diagnose these lesions. MATERIALS AND METHODS: Fourteen patients with 15 overlooked lung cancers were identified by radiologists at three institutions. Location, shape, and cell type of each cancer were reviewed, and other relevant findings of CT examinations were assessed. RESULTS: The missed tumors manifested as endobronchial lesion (n = 10), solitary parenchymal nodule (n = 2), area of focal peripheral air-space disease (n = 2), or pleural-based thickening (n = 1). Eleven (73%) of the 15 lesions were located in a lower lobe. In six (43%) of 14 patients, major distracting findings were present elsewhere in the thorax. CONCLUSION: Endobronchial location and lower lobe predominance were the most common characteristics of overlooked lung cancer at CT. The presence of unrelated major abnormalities at CT may also have contributed to failure to diagnose the tumor.
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Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Errores Diagnósticos , Reacciones Falso Negativas , Femenino , Humanos , Neoplasias Pulmonares/epidemiología , Masculino , Mala Praxis , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Nódulo Pulmonar Solitario/diagnóstico por imagen , Nódulo Pulmonar Solitario/epidemiología , Tomografía Computarizada por Rayos X/métodosRESUMEN
The main and right pulmonary arteries may be compressed by the false lumen of a type I aortic dissection. We report a 73-year-old women with a dissection of the aorta in whom echocardiographic examination revealed acute pulmonary arterial compression causing right ventricular failure and hemodynamic collapse.