Real-time CT fluoroscopy: evolution of an interventional tool.
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Central Nervous System Diseases↗
Biomedical subjects
P A Templeton
Publications and source records attributed to P A Templeton.
Castleman disease of the thorax: radiologic features with clinical and histopathologic correlation.
PURPOSE: To correlate the radiologic manifestations of thoracic Castleman disease with the clinical and histopathologic features. MATERIALS AND METHODS: The clinical, surgical, and histopathologic records; chest radiographs; and computed tomographic (CT) and magnetic resonance (MR) images in 30 pathologically proved cases of thoracic Castleman disease were reviewed. RESULTS: Patients with localized Castleman disease (n = 24) typically had the hyaline-vascular type (n = 23), were asymptomatic (n = 14), and had solitary, well-circumscribed mediastinal masses (n = 24). All lesions at contrast material-enhanced CT (n = 13) enhanced. All lesions at MR imaging (n = 5) were heterogeneous and had increased signal intensity on T1- and T2-weighted images. Three patterns were observed on CT or MR images in 20 patients: a solitary, noninvasive mass (n = 10); a dominant infiltrative mass with associated lymphadenopathy (n = 8); or matted lymphadenopathy without a dominant mass (n = 2). Patients with disseminated Castleman disease (n = 6) typically had the plasma cell type (n = 4), were symptomatic at presentation (n = 5), and had bilateral mediastinal masses on chest radiographs (n = 4). At CT, all lesions manifested with diffuse mediastinal lymphadenopathy. All lesions at contrast-enhanced CT (n = 5) enhanced. CONCLUSION: Localized Castleman disease manifests as either a solitary, well-circumscribed mediastinal mass or an infiltrative mass with associated lymphadenopathy on CT or MR images. Disseminated Castleman disease manifests with diffuse mediastinal lymphadenopathy.
Adolescent↗
Evaluation of biopsy needles and prototypic needle guide devices for percutaneous biopsy with CT fluoroscopic guidance in simulated organ tissue.
The authors evaluated accuracy and success rates for placement of fine-aspiration, core, and coaxial biopsy needles in pork meat with three needle guide devices and computed tomographic fluoroscopic guidance. Accuracy and reliability with a metallic sponge-forceps needle holder was equal to or greater than those with other devices, and it was preferred by operators due to its lighter weight and single-handed manipulation. All needle holders functioned poorly with thin-walled needles.
Animals↗
Real-time CT fluoroscopy: usefulness in thoracic drainage.
OBJECTIVE: The purpose of our study was to review the application of real-time CT fluoroscopy in the drainage of localized pleural and mediastinal collections. SUBJECTS AND METHODS: Between July 1996 and August 1997, 20 patients with 10 loculated pleural effusions, two mediastinal fluid collections, and 12 focal pneumothoraces were treated using CT fluoroscopy. The patient population was 25-77 years old and included 14 men and six women. Methods of drainage included using a modified Seldinger technique with a guidewire and serial dilators in 10 patients and a single-stick trocar technique in the remaining 14. Total room time, procedure time, and CT fluoroscopy time were recorded. RESULTS: All 24 collections were successfully evacuated using either real-time or interrupted real-time CT fluoroscopy. The real-time capability of CT fluoroscopy proved particularly useful for rapid placement of drainage tubes in patients who were unable to cooperate with breathing instructions and in patients who had a narrow window of access. Average total room time was 65 min. Average procedure time was 32 min, and average CT fluoroscopy time was 143 sec. CONCLUSION: CT fluoroscopy permits rapid drainage of intrathoracic collections. CT fluoroscopy is a particularly useful treatment for patients who are unable to perform breath-holding or in whom access to the drainage site is difficult.
Drainage↗
An audit of trauma documentation.
Research into aspects of the care of the injured depends on accurate and complete documentation. Inadequate records make audit almost impossible and are unacceptable medico-legally. An audit was made of the standard of trauma documentation in the Yorkshire region before the introduction of trauma charts in 1992. After it was established that a problem did exist, an audit was made of the standard of documentation before and after introduction of trauma charts in one city teaching hospital. Case notes were inspected for completeness of documentation of respiratory, circulatory and neurological status. Results from 1988-1989 showed that only 39.4 per cent of notes recorded the four parameters under investigation. In 1992-1994 the standard had improved. Without trauma charts documentation increased to 90 per cent, but with trauma charts in primary referrals the result improved to 97 per cent. Only 56 per cent of notes were complete for tertiary referrals when a trauma chart was not used. The standard of documentation in major injuries improved with the use of trauma charts. It is recommended that trauma charts are used routinely for all primary and tertiary referrals of injured patients. Tertiary referral patients should be reassessed fully after hospital transfer and a new trauma chart completed.
Blood Pressure↗
CT-assisted transbronchial needle aspiration: usefulness of CT fluoroscopy.
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Aged↗
Mediastinal mature teratoma: imaging features.
OBJECTIVE: The purpose of this study was to characterize the cross-sectional imaging features of mediastinal mature teratomas. MATERIALS AND METHODS: Sixty-six cases of mediastinal mature teratoma were retrospectively reviewed, noting clinical, radiologic, surgical, and pathologic findings. The patient population consisted of 38 females and 28 males who were 1 week to 67 years old (mean age, 23 years 10 months). RESULTS: Forty-six patients presented with symptoms, predominantly chest pain, dyspnea, and cough. Twenty patients were asymptomatic. Fifty-four tumors were found in the anterior mediastinum, two in the posterior mediastinum, one in the middle mediastinum, and nine in multiple compartments. CT studies (n = 66) showed masses of heterogeneous attenuation with varying combinations of soft tissue, fluid, fat, and calcium. Soft-tissue attenuation was observed in 66 tumors (100%), fluid in 58 tumors (88%), fat in 50 tumors (76%), and calcification in 35 tumors (53%). The most frequent combination of attenuations was soft tissue, fluid, fat, and calcium, which was noted in 26 masses (39%). The combination of soft tissue, fluid, and fat was seen in 16 tumors (24%); and the combination of soft tissue and fluid was seen in 10 tumors (15%). Fat-fluid levels were seen in seven masses (11%). CONCLUSION: Mediastinal mature teratoma typically manifests on CT as a heterogeneous anterior mediastinal mass containing soft-tissue, fluid, fat, or calcium attenuation, or any combination of the four. Fluid-containing cystic areas, fat, and calcification occur frequently. Cystic lesions without fat or calcium were seen in 15% of tumors. Fat-fluid levels, considered highly specific for the diagnosis of mediastinal mature teratoma, are uncommon. CT is the imaging technique of choice in the evaluation of these lesions.
Adolescent↗
Immediate cytological evaluation in CT-guided biopsy.
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Biopsy, Needle↗
Infantile haemangiopericytoma of the hand.
Infantile haemangiopericytomas (IHP) are rare subcutaneous tumours arising from pericytes. Clinically they are difficult to diagnose and pathologically they appear to be locally invasive, but they have a better prognosis than adult haemangiopericytomas. We report a case of IHP affecting the hand of a 7-week-old child that required urgent treatment.
Hand↗
Primary osteosarcoma of the ribs: CT findings.
We report the CT appearance of primary osteosarcoma of the ribs in three patients. CT evaluation is important because this lesion may present a diagnostic dilemma on chest radiographs. The tumor should be suspected if CT demonstrates dense calcification within a mass that is centered in a rib.
Adult↗
The role of thoracoscopy in the diagnosis of interstitial lung disease.
A study was undertaken to evaluate the safety and efficacy of thoracoscopic lung biopsy for interstitial lung disease. The relation between operative findings, pathologic findings, and preoperative computed tomographic scan findings was examined. Twenty-six patients, 10 male and 16 female, underwent thoracoscopic lung resection to diagnose interstitial lung disease. Sixteen patients were outpatients for an elective procedure; 10 were inpatients including 2 who were ventilator dependent. The mean length of operation was 54 minutes and the mean length of chest tube duration, 1.3 days. There were no deaths. Staphylococcal pneumonia developed in 1 patient postoperatively. One patient with systemic pulmonary hypertension was ventilator dependent for 48 hours. A double-lumen endotracheal tube was used in all but 2 patients. Twelve-millimeter trocar ports were used to allow easy interchange of staplers and endoscopic instruments. Biopsy of at least two lobes was performed in each patient with resection of a piece of grossly abnormal lung. A single chest tube was left routinely. The pathologic diagnosis was usual interstitial pneumonitis in 7 patients. Four patients had interstitial fibrosis and 4, granulomas. Three patients had diffuse alveolar damage and 3, Wegener's granulomatosis. Two patients had bronchiolitis obliterans with organizing pneumonia. One patient each had lymphangioleiomyomatosis, eosinophilic granuloma, and cytomegalovirus. Sixteen patients underwent preoperative computed tomographic scanning. The scans were assessed by 2 radiologists who were blinded to the surgical results. Computed tomography accurately predicted the site of disease in most instances. Four patients had at least one lobe with no evidence of disease on computed tomography but with interstitial lung disease found thoracoscopy.(ABSTRACT TRUNCATED AT 250 WORDS)
Biopsy↗
Endobronchial fibrous histiocytoma.
Fibrous histiocytomas are uncommon pulmonary tumors. They generally involve only the lung parenchyma. Endobronchial involvement is extremely rare. Usually, surgical resection of the mass is required for definitive diagnosis and therapy. We report a case of benign atypical fibrous histiocytoma visualized during fiberoptic bronchoscopy and review the clinical findings and pathologic features of this tumor.
Adult↗
Treatment of diaphyseal tibial stress fractures associated with knee osteoarthrosis.
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Aged↗
Thoracic mycoses from endemic fungi: radiologic-pathologic correlation.
The endemic fungi Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides immitis are primary human pathogens whose major portal of entry is the respiratory tract. Their clinical manifestations are categorized as acute, chronic or chronic progressive, or disseminated fungal disease. Most acute pulmonary infections are self-limited, and many are asymptomatic. Chronic, progressive, or disseminated disease is much less common and most often occurs in immunocompromised patients. The radiologic manifestations of these disorders are protean. They include interstitial or air-space opacities, solitary or multiple pulmonary nodules, parenchymal masses, cavities, and hilar or mediastinal adenopathy. The diagnosis of a thoracic mycosis requires familiarity with the epidemiology of the fungus in question, the various modes of clinical presentation, and the full spectrum of radiologic manifestations. Although skin and serologic tests can be useful, definitive diagnosis requires culture of the fungus from infected tissue or demonstration of the organism at microscopic examination.
AIDS-Related Opportunistic Infections↗
Thoracic mycoses from opportunistic fungi: radiologic-pathologic correlation.
Fungi of the genera Aspergillus, Candida, and Cryptococcus and the class Zygomycetes are the most common causes of thoracic opportunistic mycoses in immunocompromised patients. Candidiasis and zygomycosis usually manifest as severe, often life-threatening, pneumonias. Aspergillus species are commonly implicated as the causative organisms in a broad spectrum of pulmonary disorders, ranging from hypersensitivity lung disease in atopic patients to invasive pneumonia in immunocompromised patients. Cryptococcus neoformans infects both immunologically normal and abnormal patients, with variable clinical and radiologic findings. The diagnosis of an opportunistic mycosis requires familiarity with the epidemiology of the disease, the various modes of clinical presentation, and the full spectrum of radiologic manifestations. Because many of these fungi may normally colonize in the upper respiratory tract, sputum cultures are considered diagnostically unreliable. Instead, definitive diagnosis hinges on either culture of the fungus from infected tissue or demonstration of the organism at microscopic examination.
Adult↗
Informed consent for percutaneous lung biopsy: comparison of two consent protocols based on patient recall after the procedure.
OBJECTIVE: Informed consent is now required for the majority of radiologic procedures, but few studies have evaluated the efficacy of informed consent protocols. We compared our standard consent protocol of obtaining consent prior to percutaneous lung biopsy with a modified protocol by using patients' recall of procedure risks after the biopsy as an indicator of patients' comprehension. SUBJECTS AND METHODS: The study sample consisted of 50 patients who underwent percutaneous lung biopsy between December 1992 and June 1994. Twenty-seven patients received our standard informed consent procedure in which four important procedure risks were described briefly using our standard method. Twenty-three patients underwent a consent procedure that had the following modification. After the four procedure risks were described, the patient was tested verbally until all risks could be recited to the physician. This change required 5 additional min at most. In both protocols, efficacy of the procedure was evaluated by testing patient recall 4 hr after consent was obtained. We also assessed any effect that might have been introduced by differences between the groups, age, sex, time between consent and recall, and complications during the procedure. RESULTS: Patients' recall was significantly better in the modified consent group than in the standard group (p = .005). This result could not be attributed to differences in age, sex, or time between consent and recall. There was a trend for improved recall in patients with complications. This trend did not appear to influence our principal finding. CONCLUSION: The standard consent procedure for lung biopsy appears inadequate when patients' recall of procedure risks later is used as a measure of the patients' comprehension. Based on this study, the informed consent process may be improved substantially by teaching patients to recite the procedure risks to the physician as part of the informed consent protocol.
Adult↗
The 'floating elbow' in children. Simultaneous supracondylar fractures of the humerus and of the forearm in the same upper limb.
During a six-year period we prospectively studied eight children who presented with supracondylar fractures of the humerus and of the forearm on the same side. They were treated by prompt closed reduction, percutaneous fixation with Kirschner wires, and appropriate management of neurovascular and soft-tissue injuries. The results were assessed clinically and radiographically at a minimum of 12 months after injury. According to a clinical scoring system they were acceptable in seven children and poor in one.
Adolescent↗
MR angiographic diagnosis of recanalization in a thrombosed pulmonary arteriovenous malformation.
Pulmonary arteriovenous malformation (PAVM) results from an anomalous communication between a pulmonary artery and vein and may lead to life-threatening hemoptysis. Pulmonary angiography is the standard diagnostic technique but may be falsely negative in the unusual instance of a thrombosed PAVM. We report a patient with a thrombosed PAVM in which the initial pulmonary angiogram incorrectly suggested pulmonary embolism. A subsequent magnetic resonance (MR) angiogram demonstrated recanalization of the PAVM, thus establishing the true nature of the lesion and leading to appropriate intervention.
Aged↗