Biomedical subjects
M E Gale
Publications and source records attributed to M E Gale.
Bronchopulmonary lavage in pulmonary alveolar proteinosis: chest radiograph observations.
Ten therapeutic bronchopulmonary lavages were performed in four patients with pulmonary alveolar proteinosis. Chest radiographs taken during the lavage procedure showed increased density of the washed lung owing to the presence of instilled lavage saline. Radiographs obtained within the first hours after lavage showed a spectrum of change from minimal improvement to marked worsening compared with prelavage examinations. Subsequent radiographs over the next week showed gradual improvement in the treated lung. By 6 weeks there was moderate to marked improvement of chest radiographs compared with baseline in all cases.
The role of computed tomography in symptomatic aortic aneurysms.
Forty-seven patients with an abdominal aortic aneurysm (AAA) and recent onset of abdominal or back pain were evaluated by emergency computed tomography (CT) to identify those patients with a confined rupture, and unstable aneurysm, nonaneurysmal cause of pain and a stable AAA. CT suggested that 25 per cent of these had a confined rupture and should undergo emergency surgical treatment. Rupture was confirmed at operation in one-half of these instances. Thirteen per cent avoided operation since other significant pathologic factors were identified. The remaining 47 per cent benefited from optimal preoperative evaluation and semielective surgical treatment. No patient ruptured an AAA during the delay for complete preoperative evaluation and preparation. Additionally, a preoperative CT is useful to identify patients with an unsuspected iliac, suprarenal, thoracic or inflammatory aneurysm. Thus, we believe that CT has a particularly important role in the evaluation of the symptomatic AAA, adding it to the list of indications for CT evaluation of difficult aortic disorders.
Bochdalek hernia: prevalence and CT characteristics.
The chest and abdominal computed tomography (CT) scans of 940 patients were reviewed to determine the prevalence of Bochdalek hernias and to evaluate the widely held concept that left-sided hernias occur more than nine times as often as right-sided hernias. Sixty Bochdalek hernias were identified in 52 patients, a prevalence of 6%, which is more than 100 times more frequent than previously reported. Left-sided hernias were found approximately twice as often as right-sided hernias. The Bochdalek hernia is a much more common congenital anomaly in the asymptomatic adult than previously thought and frequently can be identified on routine chest and abdominal CT images.
Esophageal invasion by lung cancer: CT diagnosis.
Esophageal wall invasion by primary lung carcinoma is an uncommon occurrence. When CT demonstrates a large primary parenchymal lung lesion that appears to cross the midline in the posterior mediastinum, dilute oral barium should be given during the CT examination to demonstrate the location of the esophagus. An esophagus involved by lung carcinoma may show contralateral displacement or partial obstruction. Furthermore, a malignant fistula between esophagus and trachea or lung may also be discovered.
Renal toxicity of contrast agents: iopamidol, iothalamate, and diatrizoate.
As part of a general safety study of iopamidol, a nonionic iodinated contrast agent, urine N-acetyl-beta-glucosaminidase enzyme assays were done to compare the renal toxicity of iopamidol with that of iothalamate and diatrizoate. In a randomized study of 30 patients for computed body tomography and another 30 patients for angiography, 10 in each group were injected with iopamidol, 10 with iothalamate, and 10 with diatrizoate. After computed tomography or angiography with the three agents, there was no significant difference in urinary enzyme levels among the groups. The nephrotoxicity of iopamidol appears equivalent to that of diatrizoate and iothalamate.
Role of computerized cranial tomography in the staging of small cell carcinoma of the lung.
Fifty-five patients with small cell lung cancer underwent computerized cranial tomography (CCT) and a complete neurologic examination as part of their staging work-up. Fifteen patients (27%) had evidence of brain metastases detected by CCT at the time of diagnosis. Eleven of these 15 patients had new focal abnormalities upon neurologic examination. Of the 44 patients who had no new focal abnormalities upon neurologic examination, four (9%) had CCT findings consistent with brain metastases, and, in three of these patients, the central nervous system was the only site of metastatic disease. Thus, through the use of CCT as a routine procedure in the staging of small cell lung cancer, three patients whose tumors would otherwise have been classified as limited-stage were found to have extensive-stage disease.
Computed tomography. An effective technique for mediastinal staging in lung cancer.
Computed tomographic scans of the chest were utilized to stage mediastinal disease in 148 instances of bronchogenic carcinoma considered for resection in 146 patients. Nodes greater than or equal to 1.5 cm in diameter were interpreted as abnormal. All nodes positive by computed tomography were evaluated by mediastinoscopy, anterior mediastinotomy, or thoracotomy. All patients with negative computed tomographic findings underwent thoracotomy without prior surgical staging. Patients undergoing thoracotomy were divided into two groups. In Group I (first 51 instances) routine mediastinal exploration was not carried out; in Group II (last 97 instances) the mediastinum was explored in every patient and nodes were submitted for histopathological study. The computed tomographic and pathological findings on the mediastinal lymph nodes were compared. The sensitivity, specificity, and accuracy of computed tomography in Group I were 88%, 94%, and 92%, respectively, in Group II 75%, 89%, and 86%, and in the combined group, 80%, 91%, and 88%. The positive predictive index in Group I, Group II, and in the combined group was 88%, 69%, and 77%, respectively. It was lower for central than peripheral lesions (74% versus 88%) and was lowest for lesions in the right upper and left lower lobes. The negative predictive index was greater than 90% for all groups and all tumor sites except the left upper lobe, where it was 89%. Ten patients had false-positive scans, three with old mediastinitis and seven with postobstructive pneumonia; nine of the 10 had central lesions, and seven of these lesions were located in the right upper lobe. Eight patients had false-negative scans; six had para-aortic, subaortic, or postsubcarinal nodes. These nodes would not have been accessible to mediastinoscopy. In only one patient with false-negative nodes would routine mediastinoscopy have prevented thoracotomy and resection. Computed tomographic staging of mediastinal disease is indicated for all patients with lung cancer in whom operation is contemplated. Computed tomography directs the most appropriate staging procedure for patients with positive findings and obviates invasive staging for patients with negative findings.
Portal architecture: a differential guide to fatty infiltration of the liver on computed tomography.
Fatty infiltration of the liver, like fatty lesions elsewhere in the body, typically appears as low-density areas on computed tomography (CT). Fatty infiltration of the liver should be considered in the differential diagnosis of homogeneous low-density hepatic lesions regardless of distribution or size. As a physiologic rather than anatomic change, fatty infiltration of the liver characteristically leaves the portal venous architecture unaltered. Although fatty infiltration of the liver typically presents with complete or near complete involvement, other unusual patterns may be encountered. In these atypical cases, recognition of the normal portal structures on CT aids in correct diagnosis.
Diagnosis of aortic dissection by computed tomography.
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Computed-tomographic-guided minithoracotomy. A preliminary report of a new approach to open lung biopsy.
The authors describe a simple computed-tomographic method, using precise surface localization, to locate small subpleural nodules or pulmonary lesions. This permits a guided minithoracotomy for chest lesions which are not visible on plain radiographs or are considered inaccessible by percutaneous or transbronchoscopic biopsy.
Hermaphroditism demonstrated by computed tomography.
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Obscure pulmonary masses: bronchial impaction revealed by CT.
Dilated bronchi impacted with mucus or tumor are recognized on standard chest radiographs because they are surrounded by aerated pulmonary parenchyma. When imaged in different projections, these lesions produce a variety of appearances that are generally familiar. This report characterizes less familiar computed tomographic (CT) findings in eight patients with pathologic bronchial distension of congenital, neoplastic, or infectious etiologies and correlates them with chest films. In seven patients, CT readily revealed dilated bronchi and/or regional lung hypodensity. In four of these cases, CT led to the initial suspicion of dilated bronchi. CT should be used early in the evaluation of atypical pulmonary mass lesions or to confirm suspected bronchial impaction because of the high probability it will reveal diagnostic features.
Sagittal and coronal CT reconstruction for demonstration of subcarinal adenopathy.
Although standard sequential axial transverse images of the thorax obtained at 10 mm intervals are usually diagnostic for subcarinal lymph node enlargement, we have found reconstruction of the subcarinal area in both sagittal and coronal computed tomographic (CT) projections to provide a useful format for further defining important anatomic relationships. The normal CT anatomy of the subcarinal area is defined and contrasted with the appearance of adenopathy, esophageal cancer, and left atrial enlargement in various reconstructed formats. The clinical application of such imaging is useful in selected cases. Therefore, radiologists monitoring chest CT should perform appropriate reconstructions when indicated.
Abscess in the aorta following nonresective treatment of an abdominal aortic aneurysm.
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CT appearance of afferent loop obstruction.
Obstruction of the afferent loop may develop in patients who have had a Billroth type II gastrojejunostomy. This obstructed loop has a characteristic but initially confusing computed tomographic appearance that might be mistaken for multiple peripancreatic cystic masses. Three cases of afferent loop obstruction due to gastric carcinoma are reported. In each case, the length of the jejunal segment incorporated into the afferent loop determined the number of cystic masses evident at each scan level. Recognition of the typical anatomic configuration and uniform size of these cystic masses is key to the correct diagnosis.
Computed tomography and ultrasonography for diagnosis and treatment of renal and retroperitoneal abscesses.
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CT appearance of appendicitis and its local complications.
During evaluation for occult fever or nonspecific abdominal pain CT will occasionally identify inflammatory disease of the appendix as the underlying cause. In these cases CT may also provide useful information about the presence of associated mesenteric inflammation, abscess, or perforation. Five cases are presented in which CT provided clinically useful information supplementing that gained from barium studies and clinical presentation. When a periappendiceal lesion is found, the extent and nature of inflammatory changes are shown directly rather than inferentially.