Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society.
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Humans↗
Biomedical subjects
J H Austin
Publications and source records attributed to J H Austin.
Opportunistic bronchopulmonary infections after lung transplantation: clinical and radiographic findings.
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.
Adult↗
Pulmonary sarcoidosis: could mycoplasma-like organisms be a cause?
The etiology of sarcoidosis is unknown but an unusual bacterial agent is possible. Mycoplasma-Like Organisms [MLO] are obligate intracellular cell wall deficient bacteria with a distinctive ultrastructural appearance. MLO are a common cause of various transmissible plant diseases. Despite over 25 years of effort MLO remain uncultivated. Molecular biologic studies indicate MLO are only distantly related to extracellular cultivable mycoplasma. Diagnosis of MLO diseases is based chiefly on detection of the organisms in infected cells by electron microscopy. Recently MLO have been detected by electron microscopy within leucocytes in sterile inflamed aqueous and vitreous humor from patients with idiopathic chronic uveitis including sarcoidosis uveitis. Preliminary molecular biologic studies suggest that human MLO are quite closely related phylogenetically to plant MLO. Inoculation of human uveitis MLO into mouse eyelids produced chronic uveitis and lethal systemic granulomatous disease with MLO within leucocytes and endothelial cells in the disease sites. The MLO induced animal pulmonary disease resembled sarcoidosis. This report describes abnormal intracellular bodies consistent with MLO within leucocytes and endothelial cells adjacent to the granulomas in transbronchial biopsies from 9 corticosteroid untreated sarcoidosis patients versus none in 4 control lungs.
Adult↗
Images in clinical medicine. Acupuncture-needle fragments.
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Acupuncture Points↗
Paratracheal radiolucency as a sign of tracheal disruption after heart-lung transplantation.
Focal mediastinal radiolucency to the immediate left of the distal part of the trachea was evident on a frontal chest radiograph 12 days after heart-lung transplantation in a 31-year-old woman. Bronchoscopy revealed ulcerating necrosis immediately distal to the tracheal anastomosis. We conclude that chest radiography may show focal mediastinal air as the first sign of anastomotic necrosis of a major airway after lung transplantation.
Adult↗
Accessory fissures of the upper lobe of the left lung: CT and plain film appearance.
OBJECTIVE: The purpose of this study was to assess CT and chest radiographic features of accessory fissures of the upper lobe of the left lung. MATERIALS AND METHODS: Eighteen accessory fissures of the upper lobe of the left lung were identified on CT scans of 17 adult patients. The collimation was 10 mm in 12 patients and 8 mm in five patients. Additional, thinner sections (1.5-5.0 mm) were available for 12 patients. The segments separated by each fissure were identified by means of the individual segmental bronchi and vessels. Available chest radiographs were correlated with CT studies in 12 patients. RESULTS: The fissures separated the anterior segment of the left upper lobe from the superior segment of the lingula (left minor fissure) in 13 cases (72%), the superior from the inferior segment of the lingula in three cases (17%), and the apico-posterior from the anterior segment in two cases (11%). Ten (56%) of the 18 fissures could be seen only on thin sections. Eleven (61%) of the accessory fissures were incomplete. The fissures were classified into four types: convex laterally (n = 8), convex medially (n = 2), anteromedial (n = 5), and transverse (n = 3). On posteroanterior chest radiographs, the accessory fissure was evident in 10 (83%) of 12 patients. CT studies showed that nine of the 10 fissures seen on radiographs represented a left minor fissure, and the remaining fissure separated the two segments of the lingula. CONCLUSION: Accessory fissures of the upper lobe of the left lung, as shown by CT, can separate any two contiguous segments, are frequently incomplete, and occur in four different configurations. The left minor fissure is the most common of these fissures and the most frequently seen on chest radiographs. The ability to recognize accessory fissures of the left upper lobe should help in the segmental and topographic localization of pulmonary lesions.
Female↗
Long term survival in non-encapsulated primary liposarcoma of the mediastinum.
An elderly woman presented with dyspnoea secondary to extensive mediastinal invasion by a primary well differentiated liposarcoma of the mediastinum. Five years after partial resection and postoperative radiotherapy (45 Gy) she is alive and well. To our knowledge, long term survival has not previously been reported for a non-encapsulated mediastinal liposarcoma treated by incomplete resection and subsequent radiation therapy.
Aged↗
Lung nodules and masses after cardiac transplantation.
Single or multiple lung nodules or masses were noted at chest radiography in 25 (9.7%) of 257 patients after cardiac transplantation. Two episodes occurred in each of three patients, for a total of 28 (10.9%) episodes in the 257 patients within the first 18 months after transplantation (transplantation performed between July 1987 and December 1990). Bronchoscopy, percutaneous needle biopsy, and open lung biopsy were performed as clinically warranted to establish a diagnosis. Infection was found in 21 instances (8.2%) in 18 patients. The most frequent pathogens were Aspergillus (n = 9 [3.5%]) and Nocardia (n = 7 [2.7%]). Aspergillus was hospital acquired in eight (89%) of nine patients and had a right-sided predominance (20 [74%] of 27 lesions). The nodules or masses appeared a median of 2 months after transplantation for Aspergillus (range, 0.5-12 months) and 5 months for Nocardia (range, 1-10 months). B cell lymphoma manifested as numerous nodules in two patients (0.8%). Although a variety of causes were found for post-cardiac transplantation nodules or masses, the majority (75%) were infectious.
Adolescent↗
Value of having a cytopathologist present during percutaneous fine-needle aspiration biopsy of lung: report of 55 cancer patients and metaanalysis of the literature.
OBJECTIVE: Percutaneous fine-needle aspiration biopsy is an accepted procedure for diagnosing intrathoracic malignant disease. The value of having a cytopathologist present during the procedure was studied with respect to the number of needle passes, the accuracy of the procedure, and complications. A metaanalysis was performed on the combined results of the present and previous series. SUBJECTS AND METHODS: We analyzed data from 55 adult patients who underwent percutaneous CT-guided fine-needle (22-gauge) aspiration biopsy of the lung for a lesion that either the biopsy or another subsequent invasive procedure showed to be nonlymphomatous and malignant. A cytopathologist was present for the first 25 procedures and not present for the next 30 procedures. When present, the cytopathologist stained the aspirated material with toluidine blue and gave an immediate opinion on the diagnostic adequacy of the specimen based on microscopic evaluation. If appropriate, the radiologist obtained additional biopsy specimens. When a cytopathologist was not present, the radiologist assessed the adequacy of the specimen by gross examination. A metaanalysis was performed of 211 cases from the present study and two previous series with respect to the effect of the presence of a cytopathologist on the diagnostic accuracy of the procedure. RESULTS: Biopsy specimens showed cancer in 25 (100%) of 25 patients when obtained while the cytopathologist was present, and in 24 (80%) of 30 patients when obtained while the cytopathologist was absent (p < .05, Fisher exact test). No significant differences in the number of needle passes performed or in the frequency of pneumothorax when aerated lung was traversed were noted between the two groups. Although two previous studies showed nonsignificant trends toward increased accuracy of thoracic fine-needle aspiration when a cytopathologist participated in the procedure, metaanalysis revealed significantly increased accuracy when a cytopathologist was present (p < .02, Mantel-Haenszel chi 2-test). CONCLUSION: An accurate diagnosis from fine-needle aspiration biopsy of intrathoracic cancer was more likely when a cytopathologist was present than when not present during the procedure.
Adult↗
Missed bronchogenic carcinoma: radiographic findings in 27 patients with a potentially resectable lesion evident in retrospect.
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.
Carcinoma, Bronchogenic↗
Reversible pulmonary artery obstruction in a patient with bronchogenic carcinoma. Diagnosis by two-dimensional and Doppler echocardiography.
Neoplastic invasion of the pulmonary arteries, although common, rarely results in obstruction to right ventricular outflow. We report an unusual case of severe pulmonary hypertension, right ventricular dilatation, and righ ventricular dysfunction resulting from pulmonary arterial compression by bronchogenic carcinoma. The diagnosis was made by two-dimensional and Doppler echocardiography and supported by computed tomographic findings. Echocardiography was used to follow the patient's response to therapy and documented the subsequent resolution of pulmonary arterial obstruction.
Carcinoma, Bronchogenic↗
Enhanced respiratory muscular function in normal adults after lessons in proprioceptive musculoskeletal education without exercises.
A subjective sense of enhanced ease of breathing has been described after instruction in the Alexander technique of proprioceptive musculoskeletal education (awareness and voluntary inhibition of personal habitual patterns of rigid musculoskeletal constriction). We investigated the effects of AT instruction on respiratory function in healthy adult volunteers (group 1, ten subjects), who received 20 private AT lessons at weekly intervals. Spirometric tests, including maximum static mouth pressures, were assessed before and after each course of lessons. Healthy control subjects, matched for age, gender, height, and weight (group 2, ten subjects), without instruction, were tested over a similar interval. Group 1 showed significant increases in PEF (9 percent, p less than .05), MVV (6 percent, p less than .05), MIP (12 percent, p less than .02), and MEP (9 percent, p less than .005) (paired Student's t testing). Group 2 showed no significant changes. Possible mechanisms for the changes in group 1 include increased length and decreased resting tension of muscles of the torso, which in turn may increase their strength, increase thoracic compliance, and/or enhance coordination. We conclude that AT musculoskeletal education may enhance respiratory muscular function in normal adult subjects.
Adult↗
Bronchial carcinoid tumors: assessment with CT of location and intratumoral calcification in 31 patients.
Bronchial carcinoid tumors (BCT) have long been regarded as predominantly central and rarely calcified. The authors retrospectively reviewed computed tomographic (CT) findings in 31 patients (thin-section CT studies in 18) who were seen at their institution with the histopathologic diagnosis of BCT (27 typical, four atypical) during the years 1978-1989. Eighteen BCT (58%) were central and 13 (42%) peripheral, with peripheral defined as located more than 2 cm distal to the origin of the appropriate segmental bronchus. CT scans revealed varied patterns of calcification in seven (39%) of the 18 central BCT and in one (8%) of the 13 peripheral BCT (P less than .1); overall, CT scans revealed calcification in eight (26%) of the BCT. The eight calcified tumors were each of the typical histopathologic type. Peripheral BCT (42%) were nearly as common as central BCT (58%), and CT detection of calcification in BCT was not uncommon (39% of central lesions; 26%, overall).
Adolescent↗
Analysis of the resource-based relative value scale for Medicare reimbursements to academic and community hospital radiology departments.
The authors examined a homogeneous sample of 40 radiologists from four academic centers (ACs) and four community hospitals (CHs) to assess the prevalence, accuracy, and sources of knowledge regarding the resource-based relative value scale (RBRVS) reform of Medicare. The radiologists were also asked to estimate the relative intraservice work values of 12 of the radiologic services in the original RBRVS study, using the same definitions and the same standard service. The radiologists were found to be relatively well informed and accurate regarding the RBRVS-based Medicare reform. However, the standard errors of estimated work in the sample were much greater (from 56% to over 800%) than those reported for the nationally based RBRVS. The AC and CH radiologists also appeared to differ qualitatively in their perceptions of intraservice work. These findings suggest that the RBRVS may not represent accurately the spread of perceived relative work values among radiologists, including differences between AC and CH components in terms of site-specific radiologic work.
Health Knowledge, Attitudes, Practice↗
Complications after CT-guided needle biopsy through aerated versus nonaerated lung.
Findings in patients who underwent computed tomography (CT)-guided percutaneous needle biopsy (n = 131) of lung are described. In those in whom the needle traversed aerated lung, complications developed in 51% (40 of 79). The rate of pneumothorax was 46% (36 of 79). In those in whom the needle did not traverse aerated lung (n = 52), minor hemoptysis in one patient (2%) was the only complication (P less than .0001). When a percutaneous CT-guided lung biopsy needle does not traverse aerated lung, the likelihood of complication appears to be slight.
Air↗
Acute asthma. Admission chest radiography in hospitalized adult patients.
The utility of admission chest radiography has been controversial in the management of adult patients admitted to the hospital with acute asthma. We reviewed the impact of admission chest radiography on in-hospital management of 54 adult patients with acute asthma. Each patient was admitted after a failed 12-h course of bronchodilator therapy in the emergency ward. Major radiographic abnormalities were found in 20 (34 percent) of 58 occasions. These abnormalities included focal parenchymal opacities, IIM, enlarged cardiac silhouette, pulmonary vascular congestion, new solitary pulmonary nodule and pneumothorax. Subsequent antibiotic use correlated with radiographic focal opacities or IIM, even in afebrile patients, but did not correlate with elevated blood leukocyte count. Based on the evidence of in-hospital alteration of management independent of elevated blood leukocyte count and body temperature, we recommend that chest radiographs be obtained for all adult patients admitted because of acute asthma.
Acute Disease↗
Cytomegalovirus pneumonitis after cardiac transplantation.
To evaluate the incidence and clinical features of cytomegalovirus (CMV) pneumonitis after cardiac transplantation, we identified 27 (16%) of 171 consecutive recipients in whom CMV pneumonitis was confirmed by strict diagnostic criteria. Cytomegalovirus pneumonitis occurred in 6 (30%) of 20 patients treated with azathioprine and prednisone, and 8 (25%) of 32 patients treated with azathioprine, cyclosporine, and prednisone, but only 13 (11%) of 119 patients treated with cyclosporine and prednisone. The incidence of CMV pneumonitis was not related to recipient preoperative CMV titers or to postoperative cardiac rejection, but there was a trend toward increased CMV pneumonitis in patients who received organs from CMV-positive donors. Mean onset of CMV pneumonitis was 2.9 +/- 1.6 (SD) months after transplantation. In the azathioprine-prednisone group, CMV was always associated with at least one other respiratory pathogen (Aspergillus, n = 5; Pneumocystis carinii, n = 2). In the two cyclosporine groups, CMV was either the sole respiratory pathogen (n = 9), or associated with P carinii (n = 11). Roentgenographically, diffuse bilateral hazy pulmonary opacities were present in 19 (70%) of 27 patients, but focal subsegmental opacity (26%), small pleural effusion (26%), and lobar consolidation (7%) were also observed. When bronchoscopy was performed, bronchoalveolar lavage was the most sensitive technique for detecting CMV (72%), whereas transbronchial biopsy (39%) and combined washings and brushings (33%) were relatively insensitive techniques. Respiratory failure and death occurred in 52% and 44%, respectively, of patients with CMV pneumonitis. In this population of immunocompromised hosts: (1) CMV pneumonitis, alone or with other respiratory pathogens, was a major cause of morbidity and mortality; (2) localized roentgenographic opacity did not exclude CMV pneumonitis; (3) bronchoalveolar lavage was the most sensitive bronchoscopic technique for detecting CMV pneumonitis.
Adolescent↗
Plain film evaluation of carcinoma of the lung.
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Carcinoma↗