Pulmonary disease from nontuberculous mycobacteria in patients with human immunodeficiency virus.
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AIDS-Related Opportunistic Infections↗
Biomedical subjects
A M Curtis
Publications and source records attributed to A M Curtis.
Role of computed tomography in the staging of primary melanoma.
PURPOSE: To evaluate the role of body computed tomography (CT) for the staging of patients with early melanoma. PATIENTS AND METHODS: A total of 151 new patients with American Joint Committee (AJC) clinical stage I, II, and III melanoma who received a CT scan of at least the chest and abdomen are the subject of this study. CT scans considered suspicious for metastases were reviewed again by one of the investigators (A.McB.C.). RESULTS: Of 151 patients, 63 had AJC clinical stage I, 61 stage II, and 23 stage III disease. In addition, one patient each had primary melanoma of the anal canal, esophagus, or vulva. Twenty-nine (19%) of 151 patients had a CT scan that was considered suspicious for metastases. The most common radiologic findings were single hepatic, and single or multiple pulmonary nodules. Of these 29 patients with suspicious scans, 24 subsequently proved to have benign processes by biopsy or follow-up studies, three had second primary tumors (well-differentiated lymphocytic lymphoma, Hodgkin's disease, and renal cell carcinoma), and only two were found to have metastatic melanoma. Of these two patients, one had regional nodal disease (unsuspected on physical examination) and one had distant nodal metastases. CONCLUSION: Body CT is not a useful imaging study in the detection of occult metastases in patients with primary melanoma. Although body CT commonly shows suspicious radiologic abnormalities in patients with early melanoma, these abnormalities most likely represent benign processes or a second primary tumor, rather than metastatic melanoma. The value of body CT in patients who present with nodal metastases needs further study.
Abdominal Neoplasms↗
Metastatic disease to the chest in patients with extrathoracic malignancy.
The search for metastases to the lung parenchyma and other intrathoracic structures is a commonly encountered problem. The radiographic appearance of intrathoracic metastases is varied, and multiple imaging modalities may aid in their detection. Knowledge of relative frequency, growth rates, and mechanisms of spread may guide the sequence of radiographic studies.
Adolescent↗
Adult-onset pulmonary tuberculosis.
Medical records and radiographs of 103 adults with primary tuberculosis were reviewed. The shift toward delayed presentation appears to be related to decreasing childhood exposure and an increasing number of compromised hosts. Compared with classic "childhood" tuberculosis, there is a higher incidence of lower-lobe disease, but infiltrates also commonly involve the upper lobe or upper segments of the lower lobe. Adenopathy, cavitation, and tuberculoma are rare. If a pleural effusion is present and tuberculosis is suspected, pleural biopsy is mandatory. Adult respiratory distress syndrome can be a complication, particularly in miliary tuberculosis, and disseminated intravascular coagulopathy usually follows. A normal chest radiograph or clinical improvement of the patient with bed rest and penicillin does not exclude tuberculosis. Increased awareness of adult-onset tuberculosis on the part of radiologists could lead to a more rapid diagnosis and successful management.
Adolescent↗
Thoracic alterations after cardiac surgery.
A series of 92 adult patients undergoing elective cardiac surgery was reviewed to distinguish routine postoperative radiographic alterations from signs of clinically significant complications. Two postoperative complications required decisive clinical intervention: mediastinal hemorrhage (7% of cases) and sternal wound infections (3% of cases). Mediastinal hemorrhage was most often diagnosed by excessive bloody mediastinal tube drainage alone, although progressive mediastinal widening and pleural or apical extrapleural hematomas provided corroborating or, rarely, the sole evidence of mediastinal hemorrhage. Sternal wound infections were most often diagnosed clinically, but increasing pre- and retrosternal gas collections provided radiographic confirmation. Atelectasis was the most common postoperative finding. There were many abnormal gas and soft-tissue collections posteroperatively that were notable for their lack of clinical importance. Serial postoperative films were necessary to demonstrate the progression of radiographic findings which indicate the two important postoperative complications.
Adult↗
The efficacy of full-lung tomography in the detection of early metastatic disease from melanoma.
In a prospective study, 62 patients with proved melanoma and negative chest radiographs underwent full-lung tomography. Of 109 examinations performed, 12 patients had positive findings on tomography; nine were false-positive and three were true-positive. Of the true-positive examinations, two patients already had widespread metastatic disease and one had an advanced local lesion. Clinical staging and therapy were changed in only one patient as a result of information provided by full-lung tomography. It appears from these results that full-lung tomography is of limited use in detection of metastases from melanoma in the presence of a negative chest radiograph.
Adult↗
Roentgen manifestations of carcinoma in the gastric remnant.
Awareness of the increased incidence of carcinoma in the gastric remnant has not been accompanied by improved diagnosis or prolonged survival. The long latent period prior to development of tumor, the insidious nature of symptoms, and the anatomical distortion produced by surgery contribute to the difficulty in detection of these lesions. The radiological spectrum of carcinoma of the gastric remnant is discussed and both characteristic and unique radiographic features are illustrated.
Adenocarcinoma↗
Supradiaphragmatic Hodgkin's disease: significance of large mediastinal masses.
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Follow-Up Studies↗
Primary oesophageal melanocarcinoma.
Three patients with melanocarcinoma of the oesophagus are described. Reasons are given for believing that these were primary tumours. The clinical features and pathology of the condition are discussed.
Aged↗
Detection of metastatic disease from carcinoma of the breast: limited value of full lung tomography.
Until now no large prospective study has been made to evaluate the efficacy of full lung tomography in detection of pulmonary metastases from carcinoma of the breast in the presence of a negative chest radiograph. In the current study, 144 patients with proven breast carcinoma and a negative chest radiograph underwent full lung tomography. Nodules were demonstrated in three patients and, in two of them, presumably reflected metastatic disease. Both patients had advanced extrapulmonary metastatic disease at the time of full lung tomography and in neither case did a change in therapy result. One presumed false-positive observation was also made. Because of the low propensity for carcinoma of the breast to metastasize to the lungs, full chest tomography does not appear warranted as a screening procedure in these patients.
Adult↗
Air crescent sign of invasive aspergillosis.
Pulmonary infection in immunocompromised patients is frequently difficult to diagnose. Therapy for the more common pathogens differs greatly from that for infection with unusual opportunistic organisms. However, neither of these infectious agents offers specific radiographic signs. The authors report on 4 patients with acute leukemia and invasive aspergillosis whose radiographs demonstrated a distinctive feature of one or more air crescents within an area of pulmonary infiltrate. Autopsy studies correlated the radiographic changes with an infection due to Aspergillus species fungi. While the sign is not pathognomonic for Aspergillus infection, seen in a suitable host, it would suggest the possibility of invasive aspergillosis.
Aspergillosis↗
Gray scale ultrasonography, computerized tomography, and nephrotomography in evaluation of polycystic kidney and liver disease.
A comparison of gray scale ultrasonography and computerized axial tomography in adults with known adult-type polycystic disease and of ultrasonography and high-dose nephrotomography in their progeny is being conducted. Although all three modalities have proved capable of demonstrating cysts of the kidney and liver, ultrasound has been the most consistent in identifying these lesions. Ultrasound is valuable in diagnosing polycystic disease in adult with large, poorly functioning kidneys; in addition, since cysts could be identified by ultrasound in children who had normal nephrotograms, it provides a safe and useful method of obtaining information for genetic counseling.
Connecticut↗
Intraaortic counterpulsation balloon: radiographic considerations.
The intraaortic counterpulsation balloon is being used with increasing frequency in the setting of cardiogenic shock and/or high risk cardiac surgery. The radiologist should be aware of the normal function of this cardiac assist device, as well as its potential complications. The principal complications apparent on the plain chest radiograph are related to improper positioning of the balloon catheter.
Aortic Aneurysm↗
Sequelae of stomach surgery.
Gastric surgery has undergone continuous evolution since the 19th century. At present it is a highly sophisticated technique which provides symptomatic relief for the vast majority of patients operated upon for peptic ulcer disease. Although the overall incidence of complications has decreased, a variety of complications continues to occur and radiological examination plays a critical role in their detection, evaluation, and management. Knowledge of the variations in surgical terminology and commonly used eponyms provides the basic framework for discussion. Familiarity with the radiological appearance of the normal postoperative stomach together with an understanding of its physiology are essential prerequisites to the recognition of possible complications. Operative techniques may result in a radiographic appearance which simulates disease. Conditions as diverse as bezoars, afferent and efferent loop problems, marginal ulceration, anastomotic leakage, prolapse, and intussuception may all be characterized by distinct and highly specific radiographic changes. Physiologic problems such as dumping and malabsorption may also reflect their presence by X-ray changes. The radiographic features in a large number of surgical complications are discussed and illustrated. The importance of the radiographic examination in the postsurgical stomach is emphasized.
Digestive System↗
Thickening of the posterior tracheal stripe: a sign of squamous cell carcinoma of the esophagus.
A thickened posterior tracheal stripe (wider than 4.5 mm) was identified on the lateral check radiographs of 20 patients with squamous cell carcinoma of the esophagus. Autopsy studies confirmed that peri-esophageal lymphatic involvement was responsible for the thickening of the stripe in the nonobstructed esophagus. This sign appeared on the lateral chest radiograph as early as 6 months prior to the development of symptoms in 50% of the cases studied.
Adult↗
Mycoplasma pneumonia. Clinical and roentgenographic patterns.
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Adult↗
The three syndromes of fat embolism: pulmonary manifestations.
The clinical course and radiographs of 30 patients with fat embolism syndrome were reviewed. In all cases the classic triad of neurologic dysfunction, respiratory insufficiency, and petechiae were present. Three responses to embolized fat were noted. The hyperacute response was seen in two patients with paradoxical embolization of fat to the systemic circulation. A "classic response" was noted in 18 patients with transient respiratory compromise and variable radiographic findings. The two deaths in the group responding in the classical manner were attributed to massive pulmonary emboli. The third response, noted in ten patients, consisted of a chest radiograph compatible with pulmonary edema in the clinical setting of the adult respiratory distress syndrome. In this group the degree of respiratory dysfunction and pulmonary damage correlated with the development of disseminated intravascular coagulation. Pathologic correlations are presented and the mechanisms by which embolic fat produces tissue damage are discussed.
Adolescent↗