Biomedical subjects
Publications and source records attributed to M S Shin.
We have described a case of infection with Strongyloides stercoralis manifested as asthma. As a result of treatment with corticosteroids, hyperinfection developed with aggravation of symptoms. The patient's condition improved only after thiabendazole therapy was instituted and corticosteroids were discontinued.
We reviewed our experience with computerized tomography (CT) of the abdomen in 212 patients with histologically documented liver neoplasms seen during a 30-month period. The CT findings in cavernous hemangioma and focal nodular hyperplasia were specific, and permitted accurate diagnosis of this lesion before biopsy. The CT appearance of all other lesions was variable. We consider CT useful in providing an accurate evaluation of the intrahepatic and extrahepatic extent of the neoplasm.
The radiographic, pathologic, and clinical features of 22 episodes of pneumonia in 18 bone marrow transplant recipients were analyzed retrospectively. These pneumonias could be divided into three diagnostic categories: (1) a transient form of nonspecific interstitial pneumonia resembling pulmonary edema in radiographic appearance occurred in five patients during the first 2 weeks after transplantation; (2) a fatal, progressive form of interstitial pneumonia began from 2 weeks to several months after bone marrow transplantation in seven patients; and (3) airspace pneumonias occurred in nine patients within 2 months of transplantation and were uniformly fatal. While the temporal and radiographic presentation of transient early interstitial pneumonia is often characteristic and may not require biopsy for diagnosis, the airspace and progressive interstitial pneumonias affecting bone marrow transplant recipients present variable patterns that are often radiographically indistinguishable. The direct pulmonary toxicity of high-dose total-body irradiation and chemotherapy may be contributory in producing both the early transient and later progressive forms of nonspecific interstitial pneumonia.
The ongoing epidemic of acquired immune deficiency syndrome (AIDS) has affected homosexual men, intravenous (IV) drug abusers, Haitians, hemophiliacs, and others. Defects in cell-mediated immunity place these patients at risk for opportunistic infections. We recently saw three men from Alabama with disseminated infection due to Histoplasma capsulatum. Two of these men were homosexual and the other was an IV drug abuser. These three patients had evidence of depressed cellular immunity consistent with a diagnosis of AIDS. Infection caused by organisms indigenous to certain geographic areas of the United States may become more common in patients with AIDS as the epidemic continues.
A malignant seroma in the subscapular region of the chest wall developed postoperatively in a 51-year-old man with a malignant right pleural mesothelioma treated with extrapleural pneumonectomy. Computed tomography revealed the direct communication of the seroma with the hydrothorax. Correlation of CT and pathologic findings is made and the mechanism for the development of such a malignant seroma is proposed.
Pulmonary nocardiosis occurs most commonly in immunocompromised patients. Pleural involvement may be seen on a chest radiograph and may provide a clue as to the etiology of the infection, particularly if subcutaneous nodules or bone or joint symptoms are also present.
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Diffuse thymic hyperplasia following chemotherapy for nodular sclerosing Hodgkin's disease is reported in an 18-year-old woman. The patient's course was complicated by drug-induced pulmonary fibrosis and disseminated herpes zoster. Subsequently she developed genuine diffuse thymic hyperplasia with disappearance of herpes zoster and apparently complete remission of Hodgkin's disease. We stress that restoration of the host immune system, particularly the cell-mediated immunity, is essential for successful control of Hodgkin's disease and the thymic hyperplasia is most likely a favorable sign for it, which should not be confused with recurrence of Hodgkin's disease.
The computed tomographic appearance of achalasia of the esophagus is described in three patients. The CT findings should enable one to suggest the diagnosis of achalasia even in those patients in whom this condition is not suspected. The final diagnosis can be confirmed by esophagography and manometric studies.
The computed tomographic characteristics of the pleural empyema were illustrated in three patients. A typical empyema is characterized by lower thorax location, oblong and round contour in cross-section, homogeneous content with or without air spaces or air-fluid levels, regularly thin wall opposing the chest wall (a rim sign), irregularly thick wall opposing the lung parenchyma, and smooth inner and outer margins. By application of such computed tomographic criteria, a pleural empyema can be readily distinguished from a peripheral lung abscess.
Broncholithiasis is often not diagnosed by conventional roentgenography and fiberoptic bronchoscopy. Demonstrated here and three such cases of "recurrent hemoptysis of unknown etiology,". The broncholith in each case was clearly demonstrated only by the thoracic computed tomography (CT). We stress that CT is an extremely useful modality in the diagnosis of broncholithiasis and that the true incidence of broncholithiasis could be greater than was previously believed.
The computed tomography (CT) findings in three patients with invasive pleural mesothelioma are presented, and the invasive route and metastatic extension of the disease in the abdomen and retroperitoneum are discussed. These findings indicate the value of CT in detecting the extrathoracic extension of mesothelioma. Abdominal CT studies should be obtained in evaluating mesothelioma patients for extrathoracic extension of the disease.
A large nonparasitic, non-neoplastic, benign cyst of the spleen in a 24-year-old woman was diagnosed by conventional radiography, radionuclide scintigraphy, and computed tomography. Round contour, sharp margins, and homogenous content of low attenuation value are characteristic computed tomographic features. The histologic study of the cyst and information obtained from the literature provide evidence to support the hypothesis that the cyst develops from an embryonal rest of the primitive coelomic mesothelial cells in the spleen. Mesodermal cyst is therefore a more appropriate designation for such a cyst.
A 17-year-old patient with tricuspid atresia, palliatively corrected by a right Glenn and a left Potts anastomosis during his early childhood and a banding of the left pulmonary artery 6 years ago, developed a false aneurysm of the left pulmonary artery secondary to the erosion of the band fabric through the vascular wall with subsequent thrombosis, infection, and leakage. The diagnosis was confused by both chest roentgenography and angiography but was accurately made by postcontrast computed tomography (CT). We stress the importance and usefulness of CT in the diagnosis of a false aneurysm, not demonstrated by angiography.
Two cases of primary mediastinal seminoma presented as (a) aortic aneurysm with symptoms suggestive of coarctation of the aorta and (b) nonspecific tumor mass with left diaphragmatic paralysis. By computed tomographic (CT) scans both tumors were massive with sharply demarcated borders, loss of fat planes between the tumor and surrounding organs, and homogeneous density (30 to 40 Hounsfield units) only slightly enhanced by contrast medium infusion. Such CT findings should suggest the possibility of a primary mediastinal seminoma.
Retroperitoneal hemorrhage with associated intramural hemorrhage into the renal pelvis and proximal ureter is a well documented complication of coagulation defects. The urographic characteristics of this condition have been well documented by several authors [1-4], but to our knowledge the computed tomographic (CT) findings in patients with this condition have not been reported previously. We describe the CT findings in 2 such cases; one related to thrombocytopenia in leukemia, and the other to anticoagulant therapy in a patient with Budd-Chiari syndrome.
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