RESUMEN
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.
Asunto(s)
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.
Asunto(s)
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
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.
Asunto(s)
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
An endobronchial lesion with lung abscess in a patient with AIDS was due to Rhodococcus equi. The patient responded to triple chemotherapy.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Infecciones por Actinomycetales/complicaciones , Enfermedades Bronquiales/microbiología , Absceso Pulmonar/microbiología , Infecciones Oportunistas/microbiología , Rhodococcus equi , Adulto , Humanos , MasculinoRESUMEN
Eighteen radiologists failed to detect 27 potentially resectable bronchogenic carcinomas revealed retrospectively on serial chest radiographs. Most of the cancers were in an upper lobe (n = 22 [81%]), especially the right upper lobe (n = 15 [56%]). More of the cancers were in women (n = 18 [67%]) than in men (n = 9 [33%]). The mean diameter of the missed lesions was 1.6 cm +/- 0.8 (range, 0.6-3.4 cm). Only two lesions (7%) were well defined around their entire extent. A lateral radiograph (available for 23 patients) revealed the missed lesion better than the posteroanterior radiograph in four patients (17%). Six consultant radiologists, who were biased by knowledge that the cases were of missed bronchogenic carcinoma, were individually shown the radiographs in 22 of the cases. Each consultant missed a mean of 26% (5.8 +/- 1.7) of the lesions. At least one of the six consultants missed the lesion in 16 (73%) of the cases. The predominant characteristics of radiographically missed and potentially resectable bronchogenic carcinomas were difficulty in radiographic detection, female gender, and location in an upper lobe, especially on the right side.
Asunto(s)
Carcinoma Broncogénico/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Carcinoma Broncogénico/epidemiología , Femenino , Humanos , Pulmón/diagnóstico por imagen , Neoplasias Pulmonares/epidemiología , Masculino , Mala Praxis/legislación & jurisprudencia , Persona de Mediana Edad , Variaciones Dependientes del Observador , Radiografía , Estudios Retrospectivos , Factores SexualesRESUMEN
The article describes a patient with a right paratracheal bronchogenic cyst in whom the preoperative diagnosis was unclear. The fluid component of the cyst was not readily apparent by CT or T1-weighted MR images. Very intense signal on T2-weighted MR images suggested a cystic lesion. Inhomogeneities evident on MR but not CT images provided further soft tissue characterization. These soft tissue elements correlated with a macroscopic ring of hyaline cartilage in the resected specimen. The usefulness of MRI for the differential diagnosis of mediastinal tumors is discussed.
Asunto(s)
Quiste Broncogénico/diagnóstico , Imagen por Resonancia Magnética , Enfermedades de la Tráquea/diagnóstico , Adulto , Quiste Broncogénico/patología , Cartílago/patología , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Enfermedades de la Tráquea/patologíaRESUMEN
Perfusion is usually diminished to areas of the lung that are poorly ventilated. A case is presented which demonstrates not only preservation of perfusion, but also an apparent increase in relative perfusion to an atelectatic lobe.
Asunto(s)
Atelectasia Pulmonar/fisiopatología , Circulación Pulmonar , Adulto , Humanos , Masculino , Compuestos Organometálicos , Ácido Pentético , Atelectasia Pulmonar/diagnóstico por imagen , Cintigrafía , Tecnecio , Agregado de Albúmina Marcado con Tecnecio Tc 99m , Pentetato de Tecnecio Tc 99m , Relación Ventilacion-PerfusiónRESUMEN
We determined a formula to establish objective guidelines for the administration of radionuclides to nursing mothers. The formula is based on the maximum permissible dose to the infant's critical organ, serial measurements of breast milk activity, milk volume, and dose to the critical organ per microcurie in milk. Using worst-case assumptions, we believe that cessation of nursing for 24 hours after administration of technetium labeled radiopharmaceuticals is sufficient for safety. Longer-lived agents require greater delays. Iodine-123 radiopharmaceuticals are preferable to iodine-131 agents and should always be used when studying the unblocked thyroid.