RESUMEN

The purpose of this study is to present the characteristic HRCT findings of the lung parenchyma in patients with proximal interruption of the right main pulmonary artery. HRCT findings of proximal interruption of the right pulmonary artery demonstrated reticular opacities, septal thickening, subpleural consolidation, cystic lung changes, and pleural thickening in all 5 patients; bronchial dilation and bronchial wall thickening in 4 patients; and subpleural ground glass opacity (GGO) in 3 patients. The changes may be caused by absent pulmonary artery perfusion and development of systemic vessel collateralization.

Asunto(s)

Pulmón/diagnóstico por imagen , Arteria Pulmonar/anomalías , Arteria Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Preescolar , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

PURPOSE: The purpose of our study was to evaluate CT findings during respiratory syncytial virus (RSV) infection in lung transplant recipients and to identify sequelae. METHOD: Thirty-nine CT scans prior to, during, and following acute infection in 10 lung transplant recipients were reviewed. Abnormalities that were new from baseline observations and occurred within 4 weeks of diagnosis were defined as acute. Chronic findings were defined as those present >4 weeks after diagnosis. RESULTS: Findings in nine patients were ground-glass (seven), air-space (five), and tree-in-bud (four) opacities and acute bronchial dilatation (four) and wall thickening (four). Patients lacked pleural effusions or lymph node enlargement. Five of seven patients with follow-up exams had new air trapping (three), persistent bronchial dilatation (three), and thickening (two). Three and 2 of the 10 patients developed bronchiolitis obliterans syndrome and obliterative bronchiolitis, respectively. CONCLUSION: During acute infection, patients commonly had ground-glass opacities but lacked pleural effusions and lymph node enlargement. There can be chronic sequelae after infection.

Asunto(s)

Bronquiolitis Obliterante/diagnóstico por imagen , Trasplante de Pulmón/diagnóstico por imagen , Infecciones Oportunistas/diagnóstico por imagen , Infecciones por Virus Sincitial Respiratorio/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Enfermedad Aguda , Administración por Inhalación , Adulto , Biopsia , Bronquiolitis Obliterante/etiología , Bronquiolitis Obliterante/patología , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Rechazo de Injerto/diagnóstico por imagen , Rechazo de Injerto/etiología , Humanos , Huésped Inmunocomprometido , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/virología , Trasplante de Pulmón/efectos adversos , Trasplante de Pulmón/patología , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/patología , Infecciones por Virus Sincitial Respiratorio/complicaciones , Infecciones por Virus Sincitial Respiratorio/tratamiento farmacológico , Estudios Retrospectivos , Ribavirina/administración & dosificación

RESUMEN

OBJECTIVE: We describe two new CT findings of congestive heart failure (CHF): enlarged mediastinal lymph nodes and hazy heterogeneous mediastinal fat. MATERIALS AND METHODS: Forty-six patients were retrospectively identified who had major and minor clinical signs of congestive heart failure and had undergone chest CT during their symptomatic period. Two radiologists reviewed the CT studies and by consensus documented the presence or absence of imaging findings of CHF, including interstitial abnormalities, vascular redistribution, axial thickening, pleural effusions, cardiac enlargement, and mediastinal abnormalities. RESULTS: Smooth septal thickening, bilateral pleural effusions, vascular redistribution, and cardiac enlargement were the most common CT findings in patients with CHF. Enlarged mediastinal lymph nodes and hazy mediastinal fat were seen in 55% and 33% of cases, respectively. In a cohort of 17 patients with elevated pressures in the pulmonary capillary wedge documented within 24 hr of CT, CT scans revealed lymphadenopathy in 14 patients (82%) and inhomogeneous fat in 10 patients (59%). CONCLUSION: Enlarged mediastinal lymph nodes and hazy mediastinal fat occur in patients with CHF and are revealed by CT. Lymphadenopathy in patients with CHF does not necessarily indicate malignancy or an infectious process.

Asunto(s)

Tejido Adiposo/diagnóstico por imagen , Insuficiencia Cardíaca/diagnóstico por imagen , Ganglios Linfáticos/diagnóstico por imagen , Mediastino/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos

RESUMEN

PURPOSE: To determine the sensitivity and specificity of helical computed tomography (CT) for the diagnosis of acute pulmonary embolism. MATERIALS AND METHODS: This prospective study included 47 patients who underwent pulmonary arteriography for evaluation for possible acute pulmonary embolism. Tailored helical CT and pulmonary arteriography were performed within 24 hours of each other. Each CT scan was interpreted by two chest radiologists, blinded to arteriographic results, at two institutions. CT scan interpretations were compared with findings on bilateral selective pulmonary arteriograms interpreted by two vascular radiologists at one institution. RESULTS: Fifteen (32%) of 47 patients had angiographically proved pulmonary embolism. For the readers at the first institution, helical CT had 60% sensitivity, 81% specificity, 60% positive predictive value, 81% negative predictive value, and 75% overall accuracy. For the readers at the second institution, helical CT had 53% sensitivity, 97% specificity, 89% positive predictive value, 82% negative predictive value, and 83% accuracy. CONCLUSION: Detection of pulmonary embolism with helical CT may be less accurate than previously reported. Given its high specificity but relatively low sensitivity, helical CT may not have the ideal attributes of a first-line imaging study for the diagnosis of pulmonary embolism.

Asunto(s)

Embolia Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Pronóstico , Estudios Prospectivos , Arteria Pulmonar/diagnóstico por imagen , Sensibilidad y Especificidad , Estadísticas no Paramétricas , Tomografía Computarizada por Rayos X/instrumentación , Tomografía Computarizada por Rayos X/estadística & datos numéricos

RESUMEN

OBJECTIVE: The purpose of this study was to prospectively assess the usefulness of the routine addition of an automated biopsy device (ABD) to fine-needle aspiration (FNA) of the lung and to examine the complication rate of this procedure. SUBJECTS AND METHODS: Fifty biopsies were performed under CT guidance using a coaxial technique with a 19-gauge introducer needle and a 22-gauge aspirating needle followed by a 20-gauge ABD. An average of 3.5 FNA specimens and 2.5 core specimens were obtained. Cytology and histology specimens were interpreted separately by two experienced pathologists who were unaware of the other's interpretation. Final diagnoses were based on surgery, microbiology, definitive biopsy diagnosis, and clinical follow-up. All complications were recorded. RESULTS: Of 34 malignant lesions, we achieved a diagnostic accuracy of 94% for FNA and 59% for core biopsy (p < .01). Combined accuracy was 94%. Of 16 benign lesions, an accurate definitive diagnosis was made in 31% of cases using FNA and in 69% of cases using core biopsy (p = .08). Combined accuracy was 69%. In the subset of benign lesions that were not acute infections (n = 8), an accurate definitive benign diagnosis was made in 12% of cases using FNA and in 75% of cases using core biopsy (p < .05). No false-positive diagnoses of malignancy occurred. Complications included pneumothorax, nine (18%) of 50 cases; chest tube, one (2%) of 50 cases minor pulmonary hemorrhage, seven (14%) of 50 cases; and minor hemoptysis, two (4%) of 50 cases. CONCLUSION: The complication rates of FNA with the addition of an ABD are similar to those reported in the literature for FNA alone. The addition of an ABD significantly increases the diagnostic accuracy only for the subset of benign lesions that are not acute infections.

Asunto(s)

Biopsia con Aguja/instrumentación , Pulmón/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja/efectos adversos , Biopsia con Aguja/métodos , Errores Diagnósticos , Femenino , Humanos , Pulmón/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía Intervencional , Tomografía Computarizada por Rayos X

RESUMEN

The diagnosis and treatment of pneumothorax in patients with complex cystic lung disease may be difficult when relying on plain chest radiography alone. We report four cases in which management was greatly facilitated by the use of CT scanning of the chest.

Asunto(s)

Fibrosis Quística/complicaciones , Enfermedades Pulmonares/complicaciones , Neumotórax/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Fibrosis Quística/diagnóstico por imagen , Femenino , Histiocitosis de Células de Langerhans/complicaciones , Histiocitosis de Células de Langerhans/diagnóstico por imagen , Humanos , Enfermedades Pulmonares/diagnóstico por imagen , Neumotórax/etiología , Neumotórax/terapia

RESUMEN

RATIONALE AND OBJECTIVES: The purpose of the study was to determine the relationship between pulmonary artery (PA) size at computed tomography (CT) and PA pressures, to develop a noninvasive CT method of PA pressure measurement, and to determine a PA diameter that can enable differentiation of normal subjects from those with pulmonary hypertension. METHODS: PA vessel diameters in 55 candidates for lung and heart-lung transplantation were measured at CT and correlated with PA pressures with both linear and stepwise multiple regression. The multiple regression equations were then tested prospectively in 35 pretransplantation patients. RESULTS: Combined main and left main PA cross-sectional area corrected for body surface area showed the best correlation with mean PA pressure (r = .87). The multiple regression equations helped predict mean PA pressure within 5 mm Hg in 50% of patients with chronic lung disease and in only 8% of patients with pulmonary vascular disease. CONCLUSION: There was a very good correlation between main and left main PA size and mean PA pressure. At present, however, CT has not demonstrated sufficient accuracy to be used clinically.

Asunto(s)

Arteria Pulmonar/anatomía & histología , Arteria Pulmonar/fisiología , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Presión Sanguínea , Superficie Corporal , Cateterismo Cardíaco , Enfermedad Crónica , Femenino , Trasplante de Corazón , Trasplante de Corazón-Pulmón , Humanos , Hipertensión Pulmonar , Enfermedades Pulmonares/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Regresión , Reproducibilidad de los Resultados , Estudios Retrospectivos , Enfermedades Vasculares/fisiopatología

RESUMEN

Bilateral volume reduction surgery (VRS) improves lung function for selected patients with emphysema. However, predictors of outcome are not well defined. We reviewed the preoperative characteristics of the first 47 consecutive patients who underwent bilateral VRS at the Massachusetts General Hospital in order to define potential predictors of unacceptable outcome. Preoperative data included spirometry, plethysmography, diffusion of carbon monoxide (Dco), maximum inspiratory pressure (MIP), maximum expiratory pressure, resting arterial blood gases (ABG), cardiopulmonary exercise testing with ABG and lactate sampling, and radionuclide ventriculography. Prepulmonary and postpulmonary rehabilitation 6-min walk tets (6MWT), and preoperative chest CT scans were also obtained. Twenty-two subjects were male and 17 of the subjects were on the lung transplant list. Patient characteristics included age of 60.5 +/- 7.5 years, FEV1 of 0.67 +/- 0.20 L, total lung capacity of 7.56 +/- 1.7 L, Dco of 7.40 +/- 4.1 mL/min/mm Hg, and PaCO2 of 41.6 +/- 6.4 mm Hg (mean +/- SD). The FEV1, vital capacity, MIP, resting room air PaCO2, prepulmonary and postpulmonary rehabilitation 6MWT, and PaCO2 at maximum oxygen consumption correlated with length of hospitalization (p < 0.05). Based on analysis of 41 of 47 patients for whom there were complete data, the inability to walk more than 200 m on the 6MWT before or after preoperative pulmonary rehabilitation, and resting PaCO2 > or = 45 mm Hg were the best predictors of an unacceptable outcome. If either of these characteristics was present, six of 16 vs zero of 25 died (Fisher's Exact Test, p = 0.0025, one-tailed) and 11 of 16 vs four of 25 had hospital courses > 21 days (p < 0.002). Both the 6MWT < 200 m and resting PaCO2 > or = 45 mm Hg alone correlated with death (p = 0.004 and p = 0.012, respectively) and the resting PaCO2 > or = 45 mm Hg correlated with hospital days > 21 (p = 0.0002). In conclusion, the data suggest that the inability to walk at least 200 m in 6 min before or after pulmonary rehabilitation and a resting room air PaCO2 > or = 45 mm Hg are excellent preoperative predictors of unacceptable postoperative outcomes.

Asunto(s)

Enfermedades Pulmonares Obstructivas/cirugía , Pulmón/cirugía , Complicaciones Posoperatorias , Prueba de Esfuerzo , Femenino , Humanos , Tiempo de Internación , Enfermedades Pulmonares Obstructivas/mortalidad , Enfermedades Pulmonares Obstructivas/fisiopatología , Masculino , Persona de Mediana Edad , Pruebas de Función Respiratoria , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Resultado del Tratamiento

RESUMEN

OBJECTIVE: The purpose of this study was to compare the diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of pulmonary nodules less than or equal to 1.5 cm in diameter with those of nodules greater than 1.5 cm in diameter. MATERIALS AND METHODS: We retrospectively reviewed a consecutive series of 97 patients who underwent CT-guided percutaneous needle aspiration biopsy of a lung nodule and then surgical resection (n = 95) or autopsy (n = 2). By examining CT images, we classified 27 nodules as small ( < or = 1.5 cm) and 70 nodules as large ( > 1.5 cm). Diagnostic accuracy was calculated by comparing cytologic diagnoses based on biopsy with final diagnoses based on histologic findings from surgery or autopsy. Each case was reviewed for possible complications, including pneumothorax and chest tube placement. RESULTS: The diagnostic accuracy of CT-guided percutaneous needle aspiration biopsy of large nodules was 96%. The diagnostic accuracy for small nodules was 74%, a statistically significant difference (p < .05). The prevalences of pneumothorax in our population were nearly identical for small and large nodules (22 and 21%, respectively). The prevalence of chest tube placement in our population was approximately 2%. The prevalences of chest tube placement were 0% for small nodules and 3% for large nodules. CONCLUSION: CT-guided percutaneous needle aspiration biopsy is significantly less accurate for small pulmonary nodules than for large pulmonary nodules, but the complication rates for both are low.

Asunto(s)

Biopsia con Aguja , Pulmón/patología , Radiografía Intervencional , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja/efectos adversos , Biopsia con Aguja/métodos , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Humanos , Enfermedades Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad

RESUMEN

Comparison has been made between two different spin-echo sequence MR scans and CT scans of the lungs in 17 patients with cystic fibrosis. Scans were assessed for bronchial dilation, bronchial wall thickening and mucus plugging. The resolution of MR does not, at present, compare with CT. TE7 ms matched with CT for demonstrating the extent of bronchiectasis whereas TE30 ms scans were inferior to CT. Stronger background lung signal and less artefact was seen on TE7 ms scans compared with TE30 ms scans. MR is a developing technology that does not involve ionizing radiation which, with further refinement, may prove to be useful in imaging lung pathology in cystic fibrosis.

Asunto(s)

Fibrosis Quística/diagnóstico por imagen , Fibrosis Quística/patología , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Bronquios/patología , Bronquiectasia/patología , Broncografía , Niño , Dilatación Patológica/diagnóstico por imagen , Dilatación Patológica/patología , Femenino , Volumen Espiratorio Forzado , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Moco

RESUMEN

OBJECTIVE: To assess the value of a chest radiograph in the performance of diagnostic cardiac catheterisation in adults. PATIENTS AND METHODS: 340 consecutive diagnostic cardiac catheter procedures in adults at one institution. It is normal practice for primary operators to report the results of catheterisation using a graphical user interface database system. Data entry screens were modified to present a study questionnaire to assess the use made of the chest radiograph in the performance of the catheter procedure. SETTING: Tertiary referral cardiac centre. RESULTS: The chest radiograph was judged of value in only 12/340 procedures (4%). The radiograph influenced catheter selection in six procedures, the volume of injected radiographic contrast medium in five, and showed an abnormality important to the planning or conduct of the procedure in six procedures. A dual benefit was reported in five procedures. Utility of the radiograph was related to the pre-catheter diagnosis. It proved of value in only 2/283 (0.7%) procedures with a working diagnosis of ischaemic heart disease, influencing only catheter selection. Its utility was greater in congenital heart disease, contributing in 3/4 (75%) procedures, dilated cardiomyopathy in 2/6 (33%) procedures, and valvar heart disease in 4/35 (11.5%) procedures. CONCLUSIONS: In the performance of diagnostic cardiac catheterisation in adults access to a recent chest radiograph contributes little to the conduct of investigations performed for suspected ischaemic heart disease, but may be of greater value in congenital disease, valve abnormalities, and dilated cardiomyopathy.

Asunto(s)

Cateterismo Cardíaco , Cardiopatías/diagnóstico , Corazón/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Catéteres de Permanencia , Niño , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía

RESUMEN

Of 143 consecutive patients who survived at least 6 months after bone marrow transplantation (allogeneic [n = 131]; syngeneic [n = 5]; or autologous [n = 7]) and whose pulmonary function was evaluated before and on at least 2 occasions after BMT, 29 (20%) developed a chronic pulmonary syndrome without evidence for an infectious etiology. Twenty-eight (97%) presented with cough and 22 (76%) with dyspnea; abnormal chest signs were crackles in 23 (79%) and wheeze in 22 (76%). Chest roentgenogram showed pulmonary infiltrates in 15 (52%) cases but was normal in 14 (48%). All patients had major reductions in lung volumes (forced expiratory volume in 1 sec [FEV1]; relaxed vital capacity [VC]; and alveolar volume [VA]), and/or diffusing capacity (pulmonary diffusing capacity [TLCO] and single-breath carbon monoxide coefficient [KCO]). The obstructive component varied with only 18 (62%) patients developing overt airways obstruction (FEV1/VC < 75%), and in 6 of this group the fall in lung volumes preceded the onset of airways obstruction. Open lung biopsy (n = 4) showed both bronchiolitis obliterans and chronic patchy interstitial pneumonitis. The development of this syndrome was associated with acute (P < 0.001) and chronic (P < 0.0001) graft-versus-host disease of other organ systems. Twenty-four (83%) patients had a partial or complete response to immunosuppressive agents. Six (21%) have died, five (17%) of pulmonary complications. We suggest that this syndrome may be a manifestation of chronic GVHD involvement of the lung.

Asunto(s)

Trasplante de Médula Ósea/efectos adversos , Enfermedad Injerto contra Huésped/complicaciones , Enfermedad Injerto contra Huésped/etiología , Enfermedades Pulmonares/complicaciones , Adolescente , Adulto , Obstrucción de las Vías Aéreas/complicaciones , Obstrucción de las Vías Aéreas/diagnóstico por imagen , Obstrucción de las Vías Aéreas/microbiología , Biopsia , Niño , Enfermedad Crónica , Femenino , Humanos , Pulmón/patología , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/fisiopatología , Masculino , Persona de Mediana Edad , Fibrosis Pulmonar/complicaciones , Fibrosis Pulmonar/diagnóstico por imagen , Fibrosis Pulmonar/microbiología , Radiografía , Pruebas de Función Respiratoria , Factores de Riesgo , Síndrome , Trasplante Homólogo

RESUMEN

An increased frequency of bacterial pneumonia occurs in HIV-infected individuals: however the development of bronchiectasis is not well recognized. We describe seven patients with HIV infection who developed chronic symptomatic lung disease, six with troublesome recurrent infective exacerbations. Bronchiectasis was demonstrated by computed tomography in five patients, and bronchial wall thickening was shown in a further two patients. The characteristics of the patients are described, and possible aetiological factors are discussed. As measures become available which prolong the later stages of HIV disease, bronchiectasis may become an increasing problem in this patient population. Early recognition and appropriate management may significantly alter morbidity in advanced HIV disease.

Asunto(s)

Bronquiectasia/complicaciones , Infecciones por VIH/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Adolescente , Adulto , Bronquiectasia/diagnóstico por imagen , Bronquiectasia/etiología , Enfermedad Crónica , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/complicaciones , Tomografía Computarizada por Rayos X

RESUMEN

Pulmonary function and disease activity were assessed in a large series of patients with acromegaly (19 men and 16 women). Large lungs, defined as a vital capacity greater than 120 per cent of predicted normal occurred in six of 19 males and six of 16 females. Ten of the 12 patients with elevated vital capacity had active disease (growth hormone greater than 5 mU/l during a glucose tolerance test). There was no association with duration of disease. Diffusing capacity was normal overall but DLCO greater than 120 per cent occurred in six of 14 females and one of 18 males. Significant intrathoracic airflow obstruction occurred in eight of 35 patients, six of whom were nonsmokers. Upper (extrathoracic) airflow obstruction was the most common pulmonary function abnormality. A maximal expiratory/inspiratory flow ratio greater than 1.0 at 50 per cent vital capacity occurred in 13 of 18 males and four of 16 female patients, and there was an association with disease activity (17 of 25 subjects with active disease had upper airflow obstruction compared to one of nine in remission; p = 0.01). Nocturnal hypoxaemia occurred in three of 13 patients studied: six of this group had upper airways obstruction. They were all male with elevated growth hormone levels and upper airflow obstruction. In summary, in 35 acromegalics (26 with active disease), large lungs occurred in 12 patients (34 per cent) and upper airflow obstruction in 17 patients (50 per cent). The latter may develop nocturnal hypoxaemia--this was seen in three of six patients with upper airflow obstruction. Upper airways obstruction was more common in males (13 of 18 compared to four of 16 females; p = 0.04) and its presence in males should arouse suspicion of nocturnal hypoxaemia.

Asunto(s)

Acromegalia/fisiopatología , Obstrucción de las Vías Aéreas/etiología , Pulmón/fisiopatología , Acromegalia/sangre , Acromegalia/complicaciones , Adulto , Anciano , Femenino , Hormona del Crecimiento/sangre , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Pruebas de Función Respiratoria , Síndromes de la Apnea del Sueño/etiología , Capacidad Vital/fisiología

RESUMEN

A 35 year old markedly underweight woman presented with uncontrolled diabetes. Following insulin therapy she developed gross fluid retention with extensive peripheral oedema, bilateral pleural effusions and weight gain of 18.8 kg in 22 days, accompanied by a fall in plasma albumin. She responded well to treatment with diuretics and salt-poor albumin, losing 10.3 kg in 6 days without recurrence of oedema. Severe insulin oedema is an uncommon complication of insulin therapy and may be due to effects of insulin on both vascular permeability and the renal tubule.

Asunto(s)

Edema/inducido químicamente , Insulina/efectos adversos , Adulto , Femenino , Humanos