Reflections on recent ruptures of the diaphragm. Apropos of 45 cases

The aim of this study was to describe the high-resolution computed tomography (HRCT) appearances of pulmonary abnormalities in 34 cases of type I sarcoidosis according to radiographic classification--lymphadenopathy only). Abnormalities were seen in 56% cases in which the pulmonary parenchyma appeared on radiographs. Nodules (1-4 mm) were seen in 41%. Other lesions as linear network were--present in 11.8% and ground-glass opacities--in 8.8%. The opacities are clustered in the peribronchovascular spaces, with relative sparing of the lung periphery and predominate in upper and middle lung zones. This study demonstrated the usefulness of HRCT in the correct diagnosis of type I sarcoidosis.     

Pulmonary Wegener's granulomatosis: changes at follow-up CT

The objective of this study was to assess the reversibility of pulmonary lesions in Wegener's granulomatosis using serial CT. We reviewed the follow-up CT scans of ten treated patients with confirmed Wegener's granulomatosis. The delay between the first evaluation before treatment and the second, on patients in clinical and biological remission, ranged from 6 to 54 months (mean 20.5 months). Follow-up CT showed a decrease in the extent of disease in all cases. Lesions disappeared completely, without scarring, in 4 of 4 ground-glass opacities, 25 of 36 nodules, and 4 of 9 pulmonary consolidations; they disappeared with residual scarring in 8 of 8 masses, 3 of 9 pulmonary consolidations, and 2 of 36 nodules. The majority of lesions disappear without scarring. Residual fibrosis may follow the occurence of masses and pulmonary consolidation. Computed tomography permits assessment of cicatricial lesions.     

Adult-onset disseminated tracheobronchial papillomatosis: CT features

The high resolution CT (HRCT) findings in an adult with disseminated tracheobronchial papillomatosis are discussed. In addition to polypoid masses within the trachea and main bronchi, diffuse ill-defined parenchymal centrilobular opacities were present; these reflect lesions within the small airways. Some of the nodules showed central cavitation. In a patient with centrilobular opacities, some of which cavitate, on HRCT and concomitant endobronchial or endotracheal abnormality, disseminated papillomatosis should be considered in the differential diagnosis, particularly if there is a history of hoarseness or laryngeal disease.     

Findings at mammographic screening on only one standard projection: outcomes analysis

PURPOSE: To compare thallium-201 scintigraphy with gallium-67 scintigraphy in the detection of residual or recurrent mediastinal Hodgkin disease after treatment. MATERIALS AND METHODS: The authors performed planar Ga-67 and Tl-201 scintigraphy in 39 patients aged 7-18 years (27 with mediastinal primary disease) after primary treatment. These scans and those in a control group of 14 patients with newly diagnosed known mediastinal Hodgkin disease were evaluated independently by two radiologists for abnormal mediastinal activity. Results were compared with chest computed tomographic (CT) findings and with the clinical criteria of disease status. Interobserver agreement and consensus agreement on gallium and thallium scan findings were evaluated with the kappa statistic, and the specificity of the two imaging methods was analyzed. RESULTS: All study patients were judged to be free of mediastinal disease with CT and the clinical criteria. Interobserver agreement on findings in the treated and control patients was stronger with gallium scintigraphy (kappa +/- SD = 0.956 +/- 0.044) than with thallium scintigraphy (kappa = 0.638 +/- 0.110). Specificity of ratings based on thallium (85% +/- 6) and gallium (90% +/- 5) scintigraphic findings of mediastinal disease did not differ significantly (P = .48). Specificity improved when the results of the two examinations were combined (97% +/- 2). CONCLUSION: Thallium scintigraphy can help to predict the absence of mediastinal Hodgkin disease after treatment.     

The diameter of callus in leg lengthening: 28 tibial lengthenings in 14 patients with achondroplasia

A 46-year-old man who had been pulled under water by a tidal wave when an earthquake occurred on July 12, 1993 was carried to our hospital the next day. He soon needed endotracheal intubation and mechanical ventilation because he expectorated sputa with sand and because arterial bloodgas analysis revealed severe hypoxemia. Chest X-ray on admission showed diffuse small nodules and areas of consolidation. Chest CT obtained on July 16 showed centrilobular small nodules bilaterally and alveolar opacities in the peribronchial region. After therapy with antibiotics and frequent bronchial lavages, sputum with sand disappeared on the 14 th hospital day and chest X-ray film and laboratory data showed marked improvement. He was discharged on October 1. A chest CT scan obtained on February 17, 1994 showed improvement of the small nodules. The areas of consolidation had also improved, but remained as linear and nodular opacities, which were considered to be organized lesions. There are few reports concerning radiographic findings particularly CT findings, after aspiration of sea water and sand during near drowning.     

High-resolution computed tomographic appearance of MALToma of the lung

MALToma of the lung is rare and advances in molecular techniques have only recently allowed accurate diagnostic classification of the previously termed "pseudolymphomas" by demonstrating that many are monoclonal B-cell proliferations of MALT tissue and therefore true low-grade lymphomas. No significant previous contribution was found in the literature regarding the high-resolution CT appearance (HRCT) of these tumours. We describe the high-resolution CT appearances in five cases presenting to our institution from 1994 to 1997. The HRCT scans (1-mm sections at 10- to 15-mm intervals) were performed as the opacities seen radiographically were thought to be part of a diffuse lung process. In one patient a spiral sequence was performed through the main airway. Multifocal, ill-defined nodules containing air bronchograms were seen in four cases and focal lobar consolidation in one case. Interlobular septal thickening, centrilobular micronodules and bronchial wall thickening were seen in two cases. Mediastinal lymphadenopathy and pleural reaction do not appear to be characteristic features. The appearance of multifocal consolidation is similar to that seen in bronchoalveolar cell carcinoma and cryptogenic organising pneumonia.     

Pulmonary Wegener''s granulomatosis: correlation between high-resolution CT findings and clinical scoring of disease activity

STUDY OBJECTIVE: To evaluate the usefulness of high-resolution CT (HRCT) for monitoring pulmonary disease activity in Wegener's granulomatosis (WG). DESIGN: Prospective study of CT and clinical data. SETTING: Main referral hospital for rheumatic diseases and department of diagnostic radiology of collaborating university hospital. PATIENTS: Seventy-three patients with WG underwent 98 staging examinations using HRCT. The status of pulmonary disease activity at the time of examination was scored according to clinical, bronchoscopic, BAL, and radiographic findings as follows: activity (n=25, group 1), past activity (n=45, group 2) and lack of any pulmonary disease (n=28, group 3). HRCT findings were correlated with the clinical scoring of pulmonary disease activity. RESULTS: Of 98 staging examinations 78 (79.6%) revealed abnormal CT scans showing the following main abnormalities: (a) nodules or masses (group 1: 16 [60.4%], group 2: 9 [20%]); (b) parenchymal bands (group 1: 12 [48%], group 2: 27 [60%], group 3: 6 [21.5%]); (c) septal thickening (group 1: 8 [32%], group 2: 6 [13.3%]); (d) parenchymal opacification (group 1: 7 [28%], group 2: 4 [8.9%]); and (e) pleural irregularity (group 1: 14 [56%], group 2: 22 [49%], group 3: 9 [32%]). Nodules/masses and areas of parenchymal opacification were significantly associated with florid disease activity of the lungs. Parenchymal bands and septal thickening were observed in both groups with pulmonary involvement, but statistical analysis revealed no significant difference. Pleural irregularities were nonspecific. CONCLUSION: HRCT may be a useful adjunct to clinical scoring of pulmonary disease activity in patients with WG and suspected lung involvement.     

Conjugation of the monoclonal antibody 17-1A with the nitroacridine compound C921 with the poly-L-lysine as an intermediate agent

Transferrin and transferrin receptors play an important role in the transport of iron into the brain. To determine whether gallium enters the brain by the same mechanism, uptakes of 67Ga and 59Fe have been compared under controlled conditions. Rates of gallium penetration into brain (K(in)) were four times slower than those for 59Fe. K(in) for 67Ga when infused with citrate were 0.88 +/- 0.24 and 0.94 +/- 0.39 x 10(-3) ml g-1h-1 for cerebral hemisphere and cerebellum, respectively. When infused as the transferrin complex, 67Ga uptake into the brain was not different from that when infused with citrate. The presence of the anti-transferrin receptor antibody OX-26 significantly reduced uptake of 59Fe by 60% and 64% into cerebral hemisphere and cerebellum, respectively. By contrast, pretreatment of rats with OX-26 enhanced the uptake of 67Ga into brain, particularly when infused with citrate; mean increases in uptake of 67Ga were 120% and 144% for cerebral hemisphere and cerebellum, respectively. Purified 67Ga-transferrin was also taken up into both brain regions examined in the presence of OX-26. These results indicate that the transport of non-transferrin bound gallium is an important mechanism for gallium uptake into brain.     

13C-urea breath test in Helicobacter pylori diagnosis and eradication. Correlation to histology, origin of ''false'' results, and influence of food intake

Obliterative or constrictive bronchiolitis is characterized by narrowing of the small airways, due to submucosal and peribronchiolar fibrosis, with chronic obstruction. The vast majority of cases of bronchiolitis obliterans are associated with other diseases and only few cases are idiopathic. We report on the main computed tomography (CT) methods used study obliterative bronchiolitis, the CT findings and the differential diagnosis with other diseases. The dynamic study of alveolar ventilation with CT uses inspiratory and expiratory CT or high-resolution CT (HRCT), spiral dynamic CT or HRCT with advanced image display, ultrafast CT. In abnormal cases HRCT shows direct and indirect signs of small airways disease. The most common (> 80%) sign of obliterative bronchiolitis is the so-called mosaic oligohemia, with low attenuating lobules, caused by air trapping and best seen on expiratory CT, associated with blood flow redistribution to more normal lobules; this finding simulates the ground-glass pattern from infiltrative lung disease. Differential diagnosis is more difficult in the presence of true ground-glass patterns associated with diffuse bronchiolar obstruction and also with mosaic oligohemia due to pulmonary vascular disease and pulmonary emphysema. HRCT can distinguish these diseases and dynamic CT is more sensitive than functional tests in detecting regional abnormalities and air trapping. The combination of HRCT, rapid volumetric scanning and advanced image display is a powerful tool study the normal and abnormal features of bronchiolar function and alveolar ventilation.     

High-resolution computer tomography of diffuse infiltrative lung diseases

During a period of 17 months, a total of 101 patients were examined by high resolution computed tomography (HRCT) whose minor focal changes revealed by chest X-ray raised the suspicion of diffuse infiltrative pulmonary disease. The disease of the interstitium was primarily caused by idiopathic pulmonary fibrosis (19%), autoimmune disease (18%), Boeck sarcoidosis (18%) as well as by specific (16%) and aspecific inflammation (12%). HRCT disclosed reticular (61%), nodular (55%), ground-glass opacity-like (48%), emphysematous (33%) and ring-like changes (17%). Also transbronchial excision was performed in 51 patients the results of which were compared to the changes observed during HRCT. Concerning fibrosis and inflammation, HRCT and histological analysis showed identical results in 70%. According to the authors observations, this technique is suitable for detection of fairly fine fibrotic, empysematous and inflammatory signs and for defining the activity of the individual disease as also for the selection of the optimal site of transbronchial excision. HRCT is a useful investigative method both for diagnosing diffuse infiltrative pulmonary disease as well as in following up the effectiveness of treatment.     

Transfectable and transplantable postmitotic human neurons: a potential "platform" for gene therapy of nervous system diseases

OBJECTIVE: To evaluate F-18 fluorodeoxyglucose positron emission tomography (PET) in terms of its sensitivity and specificity in diagnosing malignant pulmonary nodules and staging bronchogenic carcinoma. METHODS: A retrospective review of any patient that presented to the VA Palo Alto Health Care System with a pulmonary nodule between 9/94 and 3/96 revealed 49 patients (four female, 45 male) age 37-85 (mean 63) with 54 pulmonary nodules who had: chest CT scan, PET scan; and tissue characterization of the nodule. Characterization of each nodule was achieved by histopathologic (N = 44) or cytopathologic (N = 10) analysis. Of the 49 patients, 18 had bronchogenic carcinoma which was adequately staged. Mediastinal PET and CT findings in these 18 patients were compared with the surgical pathology results. N2 disease was defined as mediastinal lymph node involvement by the American Thoracic Society's classification system. Mediastinal lymph nodes were interpreted as positive by CT if they were larger that 1.0 cm in the short-axis diameter. RESULTS: Sensitivity and specificity for the diagnosis of malignant pulmonary nodules using PET was 93 and 70%, respectively. All nodules (N = 3) that were falsely positive by PET scan were infectious in origin. All nodules (N = 4) that were falsely negative by PET were technically limited studies (outdated scanner, no attenuation correction, hyperglycemia) except for one case of metastatic adenocarcinoma. The sensitivity and specificity of PET in diagnosing N2 disease was 67 and 100%, compared with 56% and 100% for CT scan (not statistically significant). However, one more patient with N2 disease was correctly diagnosed by PET than by CT scan. CONCLUSION: PET is a valuable tool in the diagnosis and management of pulmonary nodules and may more accurately stage patients with bronchogenic carcinoma than CT scanning alone.     

Respiratory bronchiolitis: radiographic and CT findings in a pathologically proven case

A small number of cases of cigarette-smoking-associated respiratory bronchiolitis (RB) with positive findings on the chest radiograph have been reported in the literature. High-resolution computed tomography (HRCT) findings are available in even fewer cases. We describe the case of an asymptomatic female smoker presenting with a reticulomicronodular infiltrate on a routine chest radiograph. High-resolution CT was characterized by ground-glass opacities and centrilobular micronodules with an upper lobe predominance. Surgical biopsy revealed peribronchiolar lesions, with accumulation of brown pigmented macrophages in the lumen of alveolar and bronchiolar lumen, consistent with the pathologic diagnosis of RB.     

Intravenous pulse cyclophosphamide in the treatment of interstitial lung disease due to collagen vascular diseases

OBJECTIVE: Substantial toxicity limits the use of daily oral cyclophosphamide (CYC) for the treatment of interstitial lung disease (ILD) due to collagen vascular diseases. We examined whether intravenous (i.v.) pulse CYC can be substituted for daily oral therapy. METHODS: Six patients with rapidly progressive ILD due to polymyositis, systemic sclerosis, systemic lupus erythematosus, or primary Sj?gren's syndrome received 6-9 cycles of i.v. pulse CYC (0.5 gm/m2 of body surface area), together with an initial course of 50 mg of prednisolone, which was tapered to a maintenance dosage of 5-7.5 mg/day, and their response was measured clinically, by high-resolution computed tomography (HRCT) and by assessment of the bronchoalveolar lavage (BAL) cell profile. RESULTS: All patients showed significant improvement in exercise tolerance and lung function. Elevated BAL neutrophils dropped substantially, whereas the response of BAL lymphocytes was inconsistent. Low-attenuation opacities in the HRCT regressed in 4 patients and remained unchanged in 2, but reticular infiltrates remained largely unaffected. Remission was maintained with hydroxychloroquine, azathioprine, or cyclosporin A. CONCLUSION: I.v. pulse CYC proved to be an effective and well-tolerated treatment in these patients. Since it appears to target mainly the inflammatory component of the disease, it should be reserved for progressive ILD featuring indices of high inflammatory activity.     

Pathological and High Resolution CT Findings in Churg-Strauss Syndrome

Objective To investigate the Churg-Strauss syndrome (CSS) associated lung involvement,concentrating on clinical characteristics,pathological findings of lung involvements,response to treatment,and prognosis.Methods We retrospectively analyzed the characters of the clinical manifestations,thin-section CT and pathological findings of CSS.The study involved 16 patients.Clinical data were obtained by chart review.All patients underwent transbronchial lung biopsy (TBLB).Six of them underwent surgical lung biopsy as well.Results The patients included 7 men and 9 women,aged from 14 to 61 years (median,47.5 years).Extrathoracic organs involved included nervous system (7/16) and skin (5/16).Respiratory symptoms included cough (12/16),exertional dyspnea (11/16),hemoptysis (4/16),and chest pain (3/16).CT findings included bilateral ground-glass opacities (12/16),bilateral patchy opacities (12/16),and centrilobular nodules (6/16).The pathological findings of TBLB demonstrated increased eosinophils (3/16),vasculitis (3/16),and interstitial pneumonia (16/16).The pathological findings of surgical lung biopsy of 6 cases showed ne-crotizing vasculitis in 4 cases,capillaries in S,eosinophilic pneumonia in 3,granulomas in 2,and airway abnormalities in 3.All patients improved in symptoms after therapy during the study period (range,3 to 51 months; median,15 months).Conclusions Asthma may be present in CSS patient when there is bronchial involvement.Ground-glass opacities and consolidation seen on high-resolution CT reflect the presence of eosinophilic pneumonia,vasculitis,and pulmonary alveolar hemorrhage.TBLB has significant limitations for the diagnosis of CSS.Early diagnosis and therapy can result in satisfactory prognosis.     

Endothelial cell compatibility of glycopeptide antibiotics for intravenous use

OBJECTIVE: The aim of this study was to evaluate the pulmonary CT findings in patients with Churg-Strauss syndrome to determine the frequency and nature of parenchymal abnormalities. MATERIALS AND METHODS: CT examinations performed at the time of diagnosis in 17 patients with Churg-Strauss syndrome were retrospectively evaluated by two observers who reached a decision by consensus about the presence and nature of parenchymal abnormalities. High-resolution CT (1- to 3-mm collimation) was performed in 14 patients and conventional CT (6- to 10-mm collimation) was performed in three cases. RESULTS: Predominant CT findings consisted of parenchymal opacification (consolidation or ground-glass attenuation) (n = 10), pulmonary nodules (n = 2), bronchial wall thickening or dilatation (n = 2), interlobular septal thickening (n = 1), and normal anatomy (n = 2). Parenchymal opacification was predominantly peripheral (n = 6) or random in distribution (n = 4). CONCLUSION: The most common CT finding in patients with Churg-Strauss syndrome consists of areas of parenchymal opacification that may be random or peripheral in distribution. These findings are nonspecific.     

Cigarette smoking: CT and pathologic findings of associated pulmonary diseases

The health risks associated with cigarette smoking are well known. Cigarette smoking is the most important causative factor in the development of bronchogenic carcinoma. Pulmonary diseases such as chronic bronchitis, centrilobular and panacinar emphysema, respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), and pulmonary Langerhans cell histiocytosis are also related to cigarette smoking. In adenocarcinoma and squamous cell carcinoma, the most common manifestation at computed tomography (CT) is a solitary pulmonary nodule; in small cell carcinoma, hilar and mediastinal adenopathy secondary to metastases; and in large cell carcinoma, a mass with central necrosis or cavitation in the lung periphery. For chronic bronchitis, the most common CT finding is bronchial wall thickening, but this finding is nonspecific. Emphysema, both centrilobular and panacinar associated with alpha-1-antitrypsin deficiency, usually manifests as areas of decreased attenuation and may involve bullous changes. However, centrilobular emphysema more commonly involves the upper lungs, whereas panacinar emphysema more commonly involves the lower lungs. Most patients with RB-ILD have normal high-resolution CT scans; however, abnormalities may be present, the most common of which are areas of ground-glass attenuation. CT appearance of pulmonary Langerhans cell histiocytosis varies depending on the disease stage: In the early stage, typical CT findings include multiple nodules, usually accompanied by cystic spaces with thin, well-defined walls. As the disease progresses, the cystic spaces become more numerous and the number of nodules decreases.     

Aspiration after administration of oral contrast material in children undergoing abdominal CT for trauma

OBJECTIVE: The practice of routinely administering oral contrast material to children undergoing abdominal CT for blunt trauma is controversial, primarily because of the increased risk of aspiration. The purpose of this study was to determine how often aspiration occurs in this population of children. MATERIALS AND METHODS: We retrospectively studied 50 children who underwent abdominal CT scans after blunt trauma. All children received diluted 3% water-soluble oral contrast material. The medical record of each child was reviewed for evidence of aspiration pneumonia as many as 48 hr after the CT. In each patient, sections of the CT scan through the lung bases were examined for opacities. When lung opacities were identified, they were classified as atelectasis, confusion, laceration, or nonspecific. We made attenuation measurements of lung opacities larger than 1 cm, and each measurement was compared with the attenuation measurement of contrast material in that patient's stomach. Student's two-tailed t test was used to compare the two measurements. RESULTS: Four patients were febrile after the CT scan, but in none was aspiration pneumonia suspected to be the cause. The remaining 46 patients did not have any clinical evidence of aspiration. Twelve of the 50 patients had pulmonary opacities revealed by CT that were sufficiently large that attenuation measurements could be obtained. The opacity in one of these patients was classified as nonspecific, and the attenuation was as high as that of contrast material in the stomach. CONCLUSION: No clinically symptomatic episodes of aspiration pneumonia were found in 50 pediatric patients with blunt trauma who were given oral contrast material for abdominal CT. Although one of the children had CT findings that suggested clinically silent aspiration of oral contrast material, no evidence was found that administration of oral contrast material was harmful.     

Spirometrically controlled quantitative CT for assessing diffuse parenchymal lung disease

OBJECTIVE: Assessment of lung attenuation by CT reflects changes in the air-to-tissue ratio of the lung. We have analyzed the interdependence of intrathoracic gas volume, lung morphology, and functional disorder by high resolution CT (HRCT) to assess quantitative disease threshold in obstructive and restrictive diffuse lung disease. MATERIALS AND METHODS: Pulmonary HRCT was performed on 24 healthy volunteers, 11 patients with chronic obstructive pulmonary disease (COPD), and 16 patients with idiopathic lung fibrosis (IPF). HRCT measurement was standardized by taking three scans at the carina +/- 5 cm and by defining inspiration levels by percent vital capacity (VC) via spirometrically gating to the scanner. RESULTS: The mean lung density at 50% VC (DL50) for healthy subjects was -819 +/- 3.8 (mean +/- SEM) HU. In contrast, COPD DL50 was lower, averaging -861 +/- 6.4 HU, and the IPF DL50 was considerably higher (-731 +/- 17.7 HU), both significantly different (p < 0.001) compared with the control group. The accuracy of quantitative HRCT at different inspiration levels was evaluated by scanning the basal layer at 20, 50, and 80% VC. The control values were -747 +/- 5.6, -816 +/- 3.6, and -855 +/- 3.0 HU, respectively, which were significantly higher (p < 0.001) than those seen in COPD patients at 20 and 50% VC. Again, the IPF patients exhibited increased lung density (p < 0.001) at all inspiratory levels. Discrimination power was best among all cohorts at 20 and 50% VC. Position-dependent artifacts on lung density were quantified by the anteroposterior density gradient (APG). Irrespective of the underlying disease, APG at 50 and 80% VC was similar, but was up to twofold higher at 20% VC, indicating that quantitative estimates near RV may misrepresent mean lung density. CONCLUSION: Our data indicate that quantitative HRCT measurements should be performed not near full inspiration or expiration, but at an intermediate degree of lung inflation, e.g., 50% VC, for reasons of accuracy, intra- and intersubjective comparability, and feasibility. We conclude quantitative HRCT to be a sensitive tool for the evaluation of diffuse parenchymal lung disease.     

A case of sarcoidosis associated with chronic eosinophilic pneumonia

A 38-year-old man was hospitalized in our university hospital because of pulmonary opacities with bilateral hilar and mediastinal lymphadenopathy seen on chest radiograph. Eosinophilia was observed in the circulation and bronchoalveolar lavage (BAL) fluid. Histological examination revealed noncaseating epithelioid granulomas and eosinophilic infiltration in the lung. Based on these findings, a diagnosis of sarcoidosis combined with chronic eosinophilic pneumonia was made. The infiltrates on chest radiograph and BAL eosinophilia were promptly reduced with corticosteroid therapy, but only mild reduction was observed in diffuse nodular shadows and hilar and mediastinal lymphadenopathy, and high amounts of lymphocytes in BAL fluid remained. Increased IFN-gamma, IL-4 and IL-5 were detected in the BAL fluid, and corticosteroid therapy reduced IL-4 and IL-5 (Th-2 cytokines) but not IFN-gamma (Th-1 cytokine). These cytokine levels in BAL fluid were intimately correlated with the clinical course of sarcoidosis and chronic eosinophilic pneumonia.