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At least 271 records · Page 15Linked to original sources
PubMed1986

Radiographic recognition of pneumothorax in the intensive care unit.

Recognizing pneumothorax and hydropneumothorax on chest x-rays of supine ICU patients requires attention to areas other than the lung apex. Pleural air in a supine patient collects in the anterior costophrenic sulcus, producing hyperlucency over the upper abdominal quadrants, and the deep costophrenic sulcus sign. Hydropneumothorax may be recognized when a sharp pleural line is bordered by increased opacity within the pleural space. The presence of pneumothorax and hydropneumothorax can be confirmed by decubitus or upright chest x-rays.

Critical Care↗
PubMed1992

Bronchial cartilage dysplasia with multifocal lobar bullous emphysema and lung torsions in a pup.

Bronchial cartilage dysplasia is believed to have caused lobar bullous emphysema in a 5-month-old Chow Chow that had exercise intolerance, progressive dyspnea, and episodic cough. Radiography of the thorax revealed hyperlucency of the left hemithorax, displacement of the mediastinum and heart to the right, and flattening of the diaphragm. The pup died shortly after the radiographs were obtained. Necropsy revealed massive hyperinflation with 180 degrees torsion of the cranial portion of the left cranial lung lobe, and hyperinflation with less than 180 degrees torsion of the right accessory lung lobe. Histologic examination of the affected lung lobes revealed a lack of bronchial cartilage, loss and displacement of alveolar walls, and bulla formation that resembled congenital (infantile) lobar emphysema of human beings. In this pup, lung lobe torsions may have been predisposed by bronchial cartilage dysplasia.

Animals↗
PubMed1989

[A case report of Swyer-James syndrome].

A 43-year-old man with Swyer-James syndrome (SJS) was reported. The left side of his chest radiograph and computed tomogram was hyperlucent with decreased vascular markings. Pulmonary angiogram and scintigram showed markedly decreased blood flow of the left lung. Statistical study of the patients with SJS in Japan was done.

Adult↗
PubMedDate not supplied

[Respiratory sequelae of viral diseases: from diagnosis to treatment].

OBJECTIVE: The objective of the present article is to present a review of the main clinical issues faced by pediatricians while defining the diagnosis, management and prognosis of postinfectious bronchiolitis obliterans. SOURCES: Data from national and international scientific journals selected from the Lilacs and Medline databases. SUMMARY OF THE FINDINGS: With the purpose of establishing the diagnosis, a radiological investigation shows high levels of pulmonary insufflation, thickened bronchovascular bundles and, less often, bronchiectasis, atelectasis and pulmonary hyperlucency. The CT exam allows the visualization of structural and functional findings, such as air trapping, bronchiectasis and mosaic pattern. Lung function tests in children and infants always reveal significant reduction of expiratory flows. Pulmonary biopsy is not mandatory in order to confirm bronchiolitis obliterans. Diagnosis can be established through the combination of history of bronchiolitis, chronic obstructive pulmonary disease and typical tomographic findings. The treatment used by most services includes oral and inhaled corticosteroids and bronchodilators for long periods. The management of exacerbated conditions often requires antibiotics and physical therapy. CONCLUSIONS: Most patients present a favorable outcome with slow improvement of the pulmonary function and reduced necessity for supplementary oxygen. Some patients present progressive worsening of hypoxemia and CO2 retention, which leads to pulmonary hypertension and cor pulmonale. Postinfectious bronchiolitis obliterans is mild and moderate in most patients, with consequent good prognosis and low mortality.

English Abstract↗
PubMed1996

[Bronchiolitis obliterans in a patient with chronic graft-versus-host disease after bone marrow transplantation].

A 25-year-old with acute lymphoblastic leukemia (FAB:L2) received an allogeneic bone marrow transplant from an HLA-identical sibling during the first remission. Despite administration of adequate immunosuppressant drugs, active chronic graft-versus-host disease developed and continued. The patient complained of progressive dry coughing and breathlessness on exertion 18 months after the transplant and severe hyperlucency and multiple bullae were observed on a chest X-ray film. Three years after the transplant, recurrent bilateral pneumothorax developed and lung cysts were resected twice. Histological examination revealed bronchiolitis obliterans. We speculate that post-transplant bronchiolitis obliterans caused multiple bullae to form by a check-valve mechanism, which then led to recurrent bilateral pneumothorax.

Adult↗
PubMed1983

Congenital lobar emphysema of left upper lobe. A case report.

In a 2 1/2-year-old boy chest X-ray examination because of dyspnoea revealed hyperlucency of the left upper lobe with herniation of the hyperinflated lobe into the right hemithorax. Surgical exploration showed the upper lobe of the trilobed lung to be the site of congenital lobar emphysema, while the lingula and left lower lobe were collapsed. Left upper lobectomy was successfully performed.

Black People↗
PubMed1999

Congenital bronchial atresia--presentation of three cases and a pictorial review.

Congenital bronchial atresia (CBA) is a rare anomaly that results from a congenital focal obliteration of a proximal segmental or subsegmental bronchus with the normal development of distal structures. The short atretic segment leads to accumulation of mucus within the distal bronchi to form a bronchocoele and underventilation of the affected part of the lung. The clinical and radiographic features of three cases of CBA are reported and the literature is reviewed. Radiologically, CBA is characterized by the presence of a branching opacity, the bronchocoele, radiating from the hilum surrounded by an area of hyperlucency. These features can be recognized on the chest radiograph but are more clearly defined by computed tomography. Fibreoptic bronchoscopy (FOB) is often required to exclude acquired proximal bronchial obstruction by tumour, foreign body or inflammatory stricture. In CBA a blind-ending bronchus may be revealed, although FOB is often normal. Bronchographic examination is generally abnormal but the appearances may be confusing and is rarely performed. Pathologically, CBA is characterized by a blind-ending bronchus associated with dilated distal bronchi containing impacted mucus. The surrounding lung parenchyma is hyperinflated due to collateral air drift. CBA can be identified accurately by imaging techniques which may make surgery unnecessary in asymptomatic cases.

Adolescent↗
PubMed1988

[MacLeod's syndrome. Observations on 6 cases].

Mac Leod's syndrome is a rarely diagnosed disease; that is why an accurate differential diagnosis is needed by means of radiological imaging. This paper is aimed at discussing the differential diagnosis, with a special emphasis on the pathogenesis of the syndrome. The phenomenon of air trapping in absence of central bronchial lesions is a typical radiographic finding. Chest X-ray is performed in both inspiration and expiration. Posterior oblique tomography at 55 degrees of the affected side is also performed. Diffuse bronchiolitis obliterans in infancy or early childhood is a widely accepted pathogenetic pattern. Pulmonary hypoventilation causes vasoconstriction and underdevelopment of pulmonary vessels, that are reduced in caliber. Differential diagnosis includes all the diseases resulting in pulmonary hyperlucency, i.e. pulmonary and pleural alterations, and skeletal anomalies.

Adult↗
PubMed1993

Imaging of small airways diseases.

The idiopathic (BOOP) and secondary forms of proliferative bronchiolitis have similar radiographic appearances. Both are characterized radiographically by patchy airspace disease, which often is peripheral. The radiographic presentation of BOOP may have prognostic significance. In primary or secondary constrictive bronchiolitis, the chest radiograph often is nonspecific, but the CT appearance of patchy, lobular areas of hyperlucency, with or without bronchiectasis, may be diagnostic. Respiratory bronchiolitis usually can be distinguished from IPF on the chest radiograph, and the diagnosis may be suggested on HRCT by the presence of hazy increase in lung density or fine centrilobular nodules.

Arthritis, Rheumatoid↗
PubMed1991

[Interstitial pulmonary emphysema. Combined therapeutic approach in a retrospective multidisciplinary study].

Pulmonary interstitial emphysema (PIE) may occur spontaneously, as a complication of endotracheal tube displacement, intrauterine viral pneumonia or massive aspiration of formula. Nevertheless PIE occurs more frequently in neonates requiring mechanical ventilation for RDS. Untoward effects of large air collections in the extra-alveolar spaces are based on decreased perfusion and ventilation of the affected lung tissues, compression of adjacent pulmonary parenchyma and mediastinum, possible air embolism. Sometimes PIE spontaneously regress, but in some instances the process is self perpetuating, leading to an "air block syndrome". Fourteen (19.4%) of 72 infants ventilated for RDS in a three-year period had radiological evidence of PIE during the first few days of life. All 5 bilateral, 7 diffuse and 2 localized cases were treated with "vigorous pulmonary therapy". In addition to these procedures, 4 neonates were submitted to a selective bronchial intubation (SBI) and 5 different infants improved after HFV. No one of our patients underwent a surgical procedure. Infants with fine linear hyperlucencies improved sooner. All pneumothoraces (7 of 14) were preceded by X-ray appearances of PIE. Three neonates died. Mortality was observed in newborns with bilateral PIE, because of an intraventricular hemorrhage in two and an intractable under tension pneumothorax in one patient. Plain chest roentgenograms, histological pictures and treatment modalities of PIE remain separated from these considered for congenital lobar emphysema, congenital cystic adenomatoid malformation, bronchogenic cyst or lung sequestration. Surgical treatment of PIE is not as universally accepted as in congenital cystic lesions of the lung, in which it's mandatory.

Acetylcysteine↗
PubMed1992

Chronic hypersensitivity pneumonitis: use of CT in diagnosis.

OBJECTIVE: In its subacute or chronic form, hypersensitivity pneumonitis is often difficult to distinguish clinically and physiologically from other idiopathic diffuse lung diseases. The aim of this study was to identify high-resolution CT features that allow distinction of chronic hypersensitivity pneumonitis from other chronic diffuse parenchymal lung diseases. MATERIALS AND METHODS: Six patients with chronic hypersensitivity pneumonitis were examined with pulmonary function testing, bronchoalveolar lavage, lung biopsy, chest radiography, and high-resolution CT. The chest radiographs and high-resolution CT scans were reviewed independently by three observers without knowledge of the patients' clinical status. Discrepancies between the observers were resolved by consensus. RESULTS: The chest radiographs revealed normal lung volumes with a combination of abnormalities: a mixed alveolar/interstitial pattern in five cases, peribronchiolar thickening in three, a diffuse granular pattern in one, and a linear fibrotic pattern in one. In general, the high-resolution CT scans showed more abnormalities than were apparent on the plain chest radiographs. High-resolution CT revealed centrilobular, peribronchiolar, indistinct nodular opacities, of various numbers, in all cases. Four cases had areas of ground-glass density, three cases had lobular areas of hyperlucency, and one case had areas of pulmonary fibrosis and honeycombing. CONCLUSION: We confirm that high-resolution CT can most clearly show the type and distribution of parenchymal abnormalities in patients with hypersensitivity pneumonitis. Importantly, although not pathognomonic, the high-resolution CT finding of centrilobular, peribronchiolar, indistinct nodules should suggest the diagnosis of chronic hypersensitivity pneumonitis.

Alveolitis, Extrinsic Allergic↗
PubMed1982

[Hyperlucent pulmonary areas caused by stenosis or bronchial atresia in children].

From 1976 to 1979, 4 congenital bronchial abnormalities (1 stenosis, 3 atresias) have been observed and cured at Hospital des Enfants Malades Paris. The pulmonary distension with impaction of mucous secretion evocates the diagnosis. The bronchography shows the stenosis of the atresia. The pulmonary function testing confirms the hypoperfusion and the hypoventilation. The surgical indication is done in order to prevent complications and to suppress the compression of the lung. The results are good. The pulmonary testing function is correct long while after the operation. The authors discuss the surgical indication in function of the increasing of the lung.

Bronchi↗
PubMed2006

Congenital bronchial atresia associated with spontaneous pneumothorax.

A 36-year-old woman presented with left chest pain and frequent symptoms of upper respiratory infection. Chest roentgenograms revealed a left pneumothorax and apical bulla, and hyperlucency in the left pulmonary field. She was diagnosed with congenital bronchial atresia associated with a left spontaneous pneumothorax. A thoracoscopy-assisted left superior segmentectomy was performed. There was no recurrence of the pneumothorax or symptoms of recurrent upper respiratory infection at the 1-year follow-up examination. Bulla formation was believed to have resulted from emphysematous changes in the peripheral lung due to congenital bronchial atresia. The pneumothorax may have occurred due to rupture of the bulla.

Adult↗
PubMed1997

[Clinical analysis in seventy-two patients with chronic thromboembolic pulmonary hypertension].

To improve the identification of chronic thromboembolic pulmonary hypertension. We restrospectively analysed clinical data of 72 patients with chronic thromboembolic pulmonary hypertension (CTEPH). The levels of arterial blood gases appeared to be decrease in PaO2 and PaCO2, and increase in P(A-a)O2. There were 80.3% of unsymmetrical pulmonary hyperlucencies on chest radiograph and 76.4% of right ventricular hypertrophy on electrocardiograph, 92.5% and 97.1% of right atrial and right ventricular enlargement, respectively. 11.1% of pericardial effusion was noted on echocardiograph, and 98.5% of rise in pulmonary arterial pressure calculated by Doppler. The mean pulmonary arterial pressure was 6.50 +/- 1.80 kPa (48.75 +/- 13.50 mmHg), in part, by right cardiac catheterazation. Both the incidences of pulmonary embolism were 100.0% on pulmonary angiography and on radionuclide lung perfusion scan. There were 43.1% of the history of deep venous disorders and 75.0% of the positive findings by radionuclide venography in the lower extremities, respectively. The misdiagnostic and the lost diagnosis rate of prehospitalization accounted for 90.3%. The understanding of clinical manifestations and laboratory findings of CTEPH is important to promote diagnostic sense and level of CTEPH.

Adolescent↗
PubMedDate not supplied

Early smoking-induced lung lesions in asymptomatic subjects. Correlations between high resolution dynamic CT and pulmonary function testing.

PURPOSE: To evaluate the prevalence and significance of the pathological effects of cigarette smoking on the lung and the sensitivity of high-resolution CT (HRCT) in the recognition of early smoking-induced lesions in asymptomatic former or current smokers. MATERIALS AND METHODS: We performed a prospective and consecutive analysis of 36 volunteers (16 males, 20 females), 10 non-smokers (3 males; 7 females) and 26 smokers (13 males; 13 females / 17 current smokers; 9 former smokers), all asymptomatic and with normal respiratory flows. These subjects underwent lung function testing and HRCT, after providing written informed consent for the study. The HRCT scans were obtained at three pre-selected levels (aortic arch, tracheal carina and venous hilum). The same scans were obtained in post-expiration phase. At the level of the apical segmental bronchus of the right upper lobe, we measured on the monitor wall thickening, and the total and internal diameters using the techniques reported in literature. Each study was independently evaluated by two radiologists that were blinded to all clinical and functional data; they also evaluated the presence, prevalence and type of emphysema, areas of patchy hyperlucency and oligoemia in the inspiration phase and areas of expiratory air trapping. The extension was evaluated with the visual score method. The data obtained were analysed with the Windows SPSS package for statistical analysis. RESULTS: The two groups (non smokers and smokers) showed significant differences in some functional tests such as FEV1 (p<0.005) and Tiffeneau index (p<0.005), which were lower in current-smokers or former-smokers, although still within the normal range. The HRCT study did not show areas of emphysema or air trapping in non smokers. In the smokers' group, air trapping was observed in 30.7% of cases: 33.3% former-smokers and 29.4% current smokers (mean extension was 21.36% in former smokers and 9.48% in current smokers). Mean extension in the smokers' group was 13.94%. Pulmonary emphysema was found in 34.6% of cases in the smokers' group: 33.3% former-smokers and 35.2% current-smokers. Emphysema was prevalent in the upper lobes (88.8%). Mean extension was 8.76% in the former smokers group and 18.81% in current-smokers, with a total mean extension of 15.47% in the smokers' group. Statistically, there was a significant difference between non-smokers and smokers as regards emphysema extension and expiratory air trapping (p=0.034 and p=0.050, respectively). The smokers' group had a significantly wider diameter of the apical segmental bronchus of the right upper lobe than the controls. There was no significant statistical correlation between this dilatation and the emphysema score (r=0.051; p=0.81). The entity of smoking history did not correlate with emphysema extension or air trapping or with the size of the apical segmental bronchus of the right upper lobe. CONCLUSIONS: Our study demonstrates that HRCT is more sensitive and specific than commonly-used functional tests for the evaluation of initial emphysema in asymptomatic smokers. We observed expiratory air trapping only in the smokers' group, and only of the lobular type, without evidence of disease in inspiratory scans. Among the smokers and former-smokers, air trapping was found in 30.7% of subjects, with a mean extension lower than 10%. Our results therefore suggest that, even in asymptomatic subjects, expiratory air trapping is probably pathological and, once bronchial asthma has been excluded, it may be related to cigarette smoking and indicate early inflammatory bronchiolar damage. HRCT may therefore be regarded as a useful tool in the early diagnosis of smoking-related lung disease.

Bronchography↗
PubMedDate not supplied

Swyer-James syndrome documented by spiral CT angiography and high resolution inspiratory and expiratory CT: an accurate single modality exploration.

Spiral CT angiography was performed in a patient suspected of having pulmonary embolism. The right pulmonary system was normal. The left arterial system was small but patent. The left upper lobe was small and hyperlucent. The left lower lobe was collapsed and contained bronchiectasis. The bronchi were patent. High resolution CT in inspiration and expiration confirmed air trapping in the left upper lobe. A diagnosis of Swyer-James syndrome of the left upper lobe was made.

Acute Disease↗