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Biomedical subjects

D M Hansell

Publications and source records attributed to D M Hansell.

At least 109 records · Page 6Linked to original sources
PubMed1996

Surgical treatment of parapneumonic empyema.

The management of parapneumonic empyema remains controversial. We present the management of 20 children with empyema who were referred to The Royal Brompton Hospital, over a 5-year period from January 1990 to December 1994. Prior to referral, only 12 of the 20 patients had undergone thoracocentesis, all confirming the diagnosis of empyema. Six of these 12 patients then underwent closed chest tube drainage. There was a 2 to 32 day (median, 8 days) delay from initial hospital presentation to referral. Following referral 13 of the 20 patients were assessed as having persistence of clinical symptoms and radiological appearances making recovery with continued conservative management unlikely. These patients had a thoracotomy with decortication within 2 days. The remaining 7 were initially treated with closed chest tube drainage, but 5 subsequently required decortication. All patients made an uneventful postoperative recovery and were discharged within 3-11 days (mean. 6.8 days) Four patients were subsequently found to have a significant underlying immunological defect We conclude that there is a lack of agreement regarding the initial management of parapneumonic empyema. In our experience, decortication gives excellent results in those children not responding to medical treatment within 7-0 days. In experienced hands this technique is safe with rapid resolution. All patients who present with empyema should be screened for immunological abnormalities.

Chest Tubes↗
PubMed1996

Changes in cross-sectional area of the lungs on end expiratory computed tomography in normal individuals.

With the increasing use of expiratory computed tomography (CT) for the detection of air-trapping, and specifically the diagnosis of small airways disease, information about the range of excursion of the chest wall in normal individuals is needed. CT was performed, in full inspiration and end expiration, in 78 individuals (age range 17-70 years) with no demonstrable lung disease. The area of the lungs was measured at the level of the carina, in inspiration and end expiration, and the percentage change in area was calculated. In normal subjects there is, on average, a 55% (SD 8.7%) change in cross-sectional area of the lungs at the level of the carina. Awareness of the normal change in area is of value in assessing the severity of air-trapping in patients undergoing CT for suspected obstructive lung disease.

Adolescent↗
PubMed1996

Pulmonary sarcoidosis mimicking cryptogenic fibrosing alveolitis on CT.

AIM: The high resolution CT (HRCT) characteristics of fibrosing alveolitis and sarcoidosis are well established, and HRCT has been shown to have a high diagnostic accuracy in these two conditions. We report two cases of sarcoidosis with features in common with the usual appearances of cryptogenic fibrosing alveolitis (CFA). PATIENTS AND METHODS: Two adult male patients with sarcoidosis established by transbronchial biopsy or open lung biopsy who had undergone HRCT scanning were reviewed. At presentation both cases had an atypical pattern of radiological abnormality more in keeping with the features of CFA. Two observers independently assessed the CT scans for accepted features of CFA and sarcoidosis. RESULTS: In both cases CFA was the most likely radiological diagnosis based on the accepted HRCT criteria for this condition. In neither patient were the appearances suggestive of sarcoidosis. In both cases the predominant distribution of abnormality was peripheral, subpleural and in the lower lung zones rather than peribronchial, central and in the mid and upper lung zones. Nodular opacities were not present in either case. CONCLUSION: HRCT is an accurate and reliable method of suggesting or confirming the diagnosis of CFA and sarcoidosis. In a very small number of cases, sarcoidosis may produce HRCT appearances almost identical to CFA.

Aged↗
PubMed1996

The pattern and distribution of calcified mediastinal lymph nodes in sarcoidosis and tuberculosis: a CT study.

UNLABELLED: Following granulomatous involvement, calcification of hilar and mediastinal lymph nodes is common and calcified nodes are frequently identified on computed tomography (CT). The aim of this study was to establish whether there is any difference in the pattern and distribution of such calcifications in tuberculosis (TB) and sarcoidosis. METHODS: The thoracic CT scans of 77 patients with proven TB (n=28) or sarcoidosis (n=49) were studied retrospectively. Lymph nodes were categorized by size and pattern of calcification: diffuse/homogeneous, focal deposits, eggshell, and complete nodal replacement by calcification. The position of hilar or mediastinal calcified nodes was recorded. RESULTS: Nodal calcification was present in 26 fo 49 (53%) sarcoidosis patients and 13 of 28 (46%) TB patients. The mean short axis diameter of calcified nodes was significantly larger in sarcoidosis patients (sarcoidosis 12 mm, TB 7 mm, P < 0.003). A focal pattern of calcification was commoner in sarcoidosis (58% sarcoidosis nodes, 23% TB nodes) and complete calcification in TB (62% TB nodes, 27% sarcoidosis nodes). When hilar node calcification was present it was more likely to be bilateral in sarcoidosis than in TB (65% and 8%, respectively, P < 0.001). CONCLUSION: CT of the mediastinum shows significant differences in distribution and pattern of calcification in lymph nodes in TB and sarcoidosis. Possible explanations for these differences include the route of lymphatic drainage of pulmonary TB and the caseating nature of tuberculous granulomas.

Adult↗
PubMed1996

Density gradient of the lung parenchyma at computed tomographic scanning in patients with pulmonary hypertension and systemic sclerosis.

RATIONALE AND OBJECTIVES: Pulmonary hypertension may complicate systemic sclerosis in the absence of fibrosing alveolitis. Abnormal pulmonary perfusion is known to result in regional differences in lung density at computed tomographic (CT) scanning. We assessed possible disturbances in the normal CT density gradient in patients with systemic sclerosis and reduced gas transfer but no clinical or radiologic evidence of fibrosing alveolitis. METHODS: We analyzed the CT scans of 15 patients with systemic sclerosis. Regions of interest were drawn in the most dependent and nondependent zones in the upper and lower lobes of each lung. Average densities for the most dependent and nondependent zones were calculated for the upper and lower lobes, and a global lung density measurement was derived. Zonal and global density gradients were derived from mean density measures (mean density of dependent areas minus mean densities of nondependent areas). RESULTS: Five of the 15 patients had pulmonary hypertension, defined as an estimated systolic pressure in the pulmonary artery of greater than 30 mm Hg shown by Doppler echocardiography. Patients with pulmonary hypertension were characterized by higher global lung density for nondependent zones (median, -821 H versus -853 H; p = .07) but not for dependent zones (-800 H versus -815 H, p = .71). The lung density gradient was reduced globally and in the lower zones in patients with pulmonary hypertension (p = .05). CONCLUSION: In cases of systemic sclerosis without fibrosing alveolitis, we found a significantly smaller density gradient between dependent and nondependent lung regions in patients with pulmonary hypertension compared with patients without pulmonary hypertension. This finding suggests that the normal CT density gradient depends in part on normal compliance of the pulmonary vasculature.

Absorptiometry, Photon↗
PubMed1996

CT evaluation of fibrosing alveolitis--applications and insights.

The clinical management of patients with fibrosing alveolitis has traditionally been empirical; without lung biopsy, a definitive diagnosis may be impossible and decisions about treatment are often arbitrary. With the advent of high-resolution computed tomography (CT), the proportion of patients needing lung biopsy for confirmation of the diagnosis of fibrosing alveolitis has declined. There is now much evidence that CT provides an accurate guide to disease activity, and more recent work has shown the important role of CT in providing new insights into the biologic behaviour and pathogenesis of fibrosing alveolitis.

Biopsy↗
PubMed1996

Partial resolution of acute interstitial pneumonia in native lung after single lung transplantation.

The case of a 49 year old man presenting with rapidly progressive interstitial lung disease is described. Radiological findings and the lung biopsy specimen were compatible with an acute interstitial pneumonia, as was the relentless clinical course culminating in hypoxic respiratory failure. After right single lung transplantation there was considerable improvement in lung function and radiographic clearing of disease in the native left lung.

Acute Disease↗
PubMed1996

Hypersensitivity pneumonitis: correlation of individual CT patterns with functional abnormalities.

PURPOSE: To correlate the pattern and extent of abnormalities on thin-section computed tomographic (CT) scans with pulmonary function test results in subacute and chronic hypersensitivity pneumonitis. MATERIALS AND METHODS: Thin-section scans (1-3 mm collimation) obtained in 22 patients were assessed for pattern of abnormality and extent of disease. CT scores were correlated with functional parameters by using Spearman rank correlation and forward stepwise regression analysis. RESULTS: The most common CT patterns were decreased attenuation and mosaic perfusion (n = 19), ground-glass opacification (n = 18), small nodules (n = 12), and a reticular pattern (n = 8). Areas of decreased attenuation correlated with severity of air trapping indicated by residual volume (r = .58, P < .01), whereas ground-glass opacification and reticulation correlated independently with restrictive lung function. CONCLUSION: Areas of decreased attenuation and mosaic perfusion are an important ancillary CT finding in hypersensitivity pneumonitis, and obstructive functional abnormalities indicate that this phenomenon is caused by bronchiolitis.

Alveolitis, Extrinsic Allergic↗
PubMed1996

Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia. Assessment with serial CT.

OBJECTIVE: To determine the outcome of areas of ground-glass attenuation and assess disease progression on serial high-resolution CT (HRCT) scans of patients with biopsy specimen-proved usual interstitial pneumonia (UIP) and desquamative interstitial pneumonia (DIP). MATERIALS AND METHODS: Twelve patients with biopsy specimen-proved UIP and 11 patients with biopsy specimen-proved DIP who had initial and follow-up HRCT scans (median interval, 10 months) were reviewed. Eleven patients with UIP and 11 with DIP received treatment between the initial and follow-up CT scans. The scans were evaluated for the presence and extent of ground-glass attenuation, irregular linear opacities and honeycombing, and overall extent of parenchymal involvement. RESULTS: On initial CT scans, all 12 patients with UIP had areas of ground-glass attenuation (mean +/- SD extent, 30 +/- 16%) and irregular lines (mean +/- SD extent, 17 +/- 7%) and 10 patients had honeycombing (mean +/- SD extent, 10 +/- 6%). All 11 patients with DIP had areas of ground-glass attenuation on initial HRCT scans (mean +/- SD extent, 51 +/- 26%), 5 patients had irregular linear opacities (mean +/- SD extent, 5 +/- 5%), and 1 patient had honeycombing. Nine of the 12 patients with UIP showed increase in the extent of ground-glass attenuation (n = 6) or progression to irregular lines (n = 2) or honeycombing (n = 4) on follow-up as compared with only 2 patients with DIP who showed progression to irregular lines (n = 1) or honeycombing (n = 1) (p < 0.01 chi 2 test). CONCLUSION: In patients with UIP, areas of ground-glass attenuation usually increase in extent or progress to fibrosis despite treatment. Areas of ground-glass attenuation in most patients with DIP remain stable or improve with treatment.

Adult↗
PubMed1995

Is lung cancer associated with asbestos exposure when there are no small opacities on the chest radiograph?

This study was designed to test the hypothesis that the risk of lung cancer from asbestos exposure is confined to persons with radiographic evidence of pulmonary fibrosis. Occupational and smoking histories were obtained from 271 patients with a confirmed diagnosis of primary lung cancer and 678 referents (279 with other respiratory disease and 399 with cardiac disease). Histories were reviewed blind to assess the timing, duration, and probability of exposure to asbestos. To allow for a lag between asbestos exposure and the development of lung cancer, subjects were classified by the time they had spent in an occupation entailing definite or probable exposure more than 15 years before diagnosis. The presence and extent of fibrosis was assessed blindly from chest radiographs by three readers and scored for small opacities with the ILO 1989 International Classification of Radiographs of the Pneumoconioses. 93 (34.3%) cases had worked in an occupation with definite or probable asbestos exposure compared with 176 (25.8%) referents (crude odds ratio for lung cancer 1.49, 95% CI 1.09-2.04). After adjustment for age, sex, smoking history, and area of referral, the odds ratio (95% CI) was 2.03 (1.00-4.13) in the subgroup of 211 with a median ILO score for small parenchymal opacities of 1/0 or more, and 1.56 (1.02-2.39) in the 738 with a score of 0/1 or less (ie, those without radiological evidence of pulmonary fibrosis). These results suggest that asbestos is associated with lung cancer even in the absence of radiologically apparent pulmonary fibrosis.

Aged↗
PubMed1995

Accuracy of CT in predicting the cause of bronchiectasis.

There are many reports that state that the distribution and pattern of bronchiectasis may be sufficiently characteristic for a specific cause to be suggested. The aim of this study was to determine whether experienced chest radiologists could confidently and accurately diagnose various aetiologies of bronchiectasis from the computed tomography (CT) pattern of disease alone. CT scans of 108 patients with bronchiectasis of various causes (67 with idiopathic bronchiectasis, 10 with allergic bronchopulmonary aspergillosis, 12 with syndromes of impaired mucociliary clearance, 12 with hypogammaglobulinaemia and seven with adult cystic fibrosis) were assessed by three chest radiologists without knowledge of clinical data. Each observer listed the three most likely diagnoses in order of probability. In addition, a level of confidence on a 3-point scale was assigned to the first choice diagnosis. A correct first-choice diagnosis was made in 45% of readings. A high confidence level was given in only 9% of the first choice readings. Of these, a correct diagnosis was reached in 35%. There was poor interobserver agreement (mean kappa = 0.20). In conclusion, we found that the causes of bronchiectasis cannot be reliably diagnosed on the basis of CT appearances alone.

Adult↗
PubMed1995

Reactive pulmonary lymphoid disorders.

The two main reactive pulmonary lymphoid disorders are lymphoid interstitial pneumonia and follicular bronchitis/bronchiolitis, both pathological entities with a variety of aetiologies. We reviewed the morphological and immunohistochemical features of 26 cases with one or other of these two diagnoses, to explore the possibility that they represented overlapping patterns of hyperplasia of the bronchopulmonary immune system. The polymerase chain reaction was used to determine the clonality of the infiltrates. Histologically, there was a spectrum of changes with two main components. An interstitial infiltrate of mainly T lymphocytes, plasma cells and histiocytes predominated in lymphoid interstitial pneumonia, whilst lymphoid follicles predominated around airways in follicular bronchitis/bronchiolitis. Classification of the disorder rested on which component the pathologists believed to be dominant. In two cases, histology and immunohistochemistry suggested lymphoma, and in one of these cases this diagnosis was confirmed by the polymerase chain reaction. One case of lymphoid interstitial pneumonia produced three bands. The remainder produced polyclonal patterns when samples were adequate. Clinically, there was no clear difference between patients with the two disorders, or patients with pathological features of both.

Adolescent↗