Biomedical subjects
Publications and source records attributed to C D Flower.
This is a review of the role of radiological intervention in the pleural space. It discusses the radiological management of effusions, empyemas (including the use of fibrinolytic agents), pneumothoraces and pleural thickening.
We recently changed from using fine needle aspiration cytology to using core biopsy exclusively in the assessment of screen detected abnormalities. Two hundred and two biopsies (1% of women screened) were performed. Surgical histological confirmation was obtained in 111 patients (101 malignant and 10 benign). The remaining patients were either returned to standard 3-yearly screening or early repeat screening after 1 year. Analysis of the results was performed in accordance with the standards specified in the National Health Service Breast Screening Programme (NHSBSP) Publication Number 22. Absolute sensitivity was 89.3%, complete sensitivity was 93.2%, specificity (including patients undergoing both surgical excision and follow-up) was 88.7%. The predictive value of a positive (malignant) core biopsy result was 100%. The false negative rate was 3.9%. Twelve (5.9%) biopsies were classified inadequate for diagnosis. Core biopsy is a safe and accurate way of assessing screen detected abnormalities and can be used as a substitute for fine needle aspiration cytology with results that exceed the National Health Service Breast Screening Programme target standards, even in the learning phase.
The clinical radiologic, and pathologic features of three patients with a combination of pulmonary lymphocytic infiltration and amyloid deposition are presented. We report the distinctive high-resolution computed tomography features that are common to these cases.
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The purpose of our study was to determine interobserver variation in the analysis of high-resolution computed tomography (HRCT) in the lungs of patients with clinically suspected bronchiectasis. HRCT scans of 88 patients were analysed independently by three radiologists with variable experience in thoracic radiology using a subjective scoring system to record bronchi as normal, mildly abnormal or severely abnormal. The presence, severity and distribution of bronchial dilatation and bronchial wall thickening were recorded. Kappa values were calculated for assessment of interobserver agreement. Agreement between the three readers was good for the detection of bronchiectasis (kappa 0.78) and assessment of its severity (0.68), detection of bronchial wall thickening (0.64) and moderately good for the assessment of its severity (0.58) on a per-patient basis. When individual lobes were analysed, agreement was moderately good for the detection of abnormal bronchi (0.59). Agreement on the extent of abnormal bronchi using five categories was only fair (0.39), but was good when differences of one category were ignored (0.63). Interobserver variation with HRCT in suspected bronchiectasis appears satisfactory for comparative studies.
The pulmonary eosinophilias are a diverse group of disorders characterised by pulmonary infiltrates, rich in eosinophils usually associated with a peripheral blood eosinophilia. Known causes of pulmonary eosinophilia include fungi--in particular Aspergillus fumigatus, parasites, toxins and drugs. Pulmonary eosinophilias of unknown cause include Löffler's syndrome, acute and chronic eosinophilic pneumonia, the hypereosinophilic syndrome, bronchocentric granulomatosis and pulmonary eosinophilia associated with vasculitis. The chest radiographic appearances of pulmonary eosinophilia are often characteristic and HRCT in selected cases can give important additional information.
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AIM: To document the phenomenon and distribution of air-trapping on computed tomography in patients with sub-acute extrinsic allergic alveolitis (EAA). PATIENTS AND METHODS: A retrospective analysis of high resolution CT scans was performed on 20 patients with proven EAA. All patients had inspiratory scans and 12 patients had expiratory scans. These were assessed for the presence and distribution of: air-trapping, ground-glass opacification and nodularity. RESULTS: Areas of decreased attenuation consistent with small airways disease was demonstrated in 15/20 patients on inspiratory scans, and confirmed to be areas of air-trapping in 11/12 patients on expiratory scans. Additional areas of air-trapping were identified in 5/11 patients on expiratory scans. 18/20 patients had found-glass opacification and 14/20 patients demonstrated a nodular patter. CONCLUSION: Air-trapping is a common finding in sub-acute extrinsic allergic alveolitis on CT and its detection is enhanced by performing expiratory scans.
The incurability of metastatic breast cancer with conventional chemotherapy has prompted many units to investigate the role of high dose chemotherapy and autologous stem cell rescue in patients with advanced or poor risk primary disease. Although preliminary data from centres treating patients with these modalities are encouraging, both in terms of rapidity of haemopoietic recovery and progression free survival, there is nonetheless a procedure related toxicity. We describe a patient with inflammatory carcinoma of the breast who received high dose cyclophosphamide and thiotepa prior to peripheral blood progenitor cell rescue, and developed a steroid responsive interstitial pneumonitis 10 weeks after stem cell infusion.
BACKGROUND: There are few published data on the correlation between the clinical findings in subjects with chronic sputum production and the appearances on high resolution computed tomographic (HRCT) scans of the chest. METHODS: HRCT scanning of the chest was performed on 40 subjects with chronic sputum production. Three readers independently reported the scans for the presence or absence of bronchiectasis and the extent of bronchiectasis on the basis of the percentage of involved bronchi in each lobe. Relationships were sought between these findings and the clinical history, physical examination, and laboratory investigations. RESULTS: HRCT scanning showed that 27 subjects had bronchiectasis. Of the clinical features only the continual production of purulent sputum and childhood pertussis were associated with bronchiectasis. There was a positive correlation between the extent of bronchiectasis and dyspnoea, and a negative correlation with forced expiratory volume in one second but not with forced vital capacity. CONCLUSIONS: These results indicate that, in subjects with chronic sputum production, only a few clinical features show any correlation with the presence or extent of bronchiectasis as visualised on HRCT scans.
Bronchiectasis remains an important and relatively common cause of pulmonary disability. High resolution computed tomography has revolutionized imaging of the bronchi and has superseded the chest radiograph and bronchogram in the diagnosis of bronchiectasis. It has enabled a better understanding of the association between clinical features of the disease and structural abnormalities in the airways and has an important role to play in understanding the pathogenesis and natural history of bronchiectasis.
Results were evaluated in 81 patients with suspected acute aortic dissection who were examined on a fast CT system capable of a 1 s data acquisition time. 17 patients had Type A and nine had Type B dissections. Radiological assessment provided 78 confident reports and expressed some uncertainty about the diagnosis in three patients. Overall sensitivity for aortic dissection was 96.2% and specificity was 96.4%. When 78 confident reports alone were considered, both sensitivity and specificity reached 100%. Reconstruction of data at 100 ms intervals allowed discrimination between artefacts in the ascending aorta and Type A dissections. CT can often be used as the single investigation prior to surgery for acute Type A dissections.
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Fibrosing alveolitis and bronchiolitis obliterans are two of the many pulmonary manifestations of the connective tissue disorders. When shortness of breath is the main complaint, it is often difficult to diagnose the individual causative lesion from the clinical examination, lung function tests, and chest radiographic findings. In such cases high resolution computed tomography, with its increased sensitivity and specificity for analysis of the pulmonary parenchyma, provides an excellent diagnostic tool for determining the presence and type of pulmonary abnormality.
PURPOSE: To assess the diagnostic yield of computed tomography (CT)-guided percutaneous cutting needle biopsy of diffuse pleural thickening. MATERIALS AND METHODS: In 42 consecutive adult patients with diffuse pleural disease seen, 45 CT-guided percutaneous biopsies were performed with an 18-gauge cutting needle powered by a hand-held, spring-operated biopsy instrument. Results were assessed retrospectively. RESULTS: Sufficient pleural tissue for histologic diagnosis was obtained in 42 of the 45 biopsies, with a correct histologic diagnosis made in 39 of the 42 specimens. Specificity and sensitivity for helping differentiate malignant from benign disease were 100% and 83%, respectively. Positive and negative predictive values were 1.0 and 0.60, respectively. By combining findings at biopsy and at CT (presence or absence of pleural thickness greater than 1 cm, mediastinal-circumferential involvement, irregular contour), sensitivity and negative predictive values reached 100% and 1.0, respectively. CONCLUSION: Combined findings of CT-guided percutaneous cutting needle biopsy and CT are useful in first-line investigation of diffuse pleural thickening.
High resolution computed tomography (HRCT) is an effective technique for demonstrating the lung parenchyma in detail and overcomes many of the inadequacies of chest radiography in the diagnosis of diffuse lung disease. This article reviews the role of HRCT in the management of patients with chronic infiltrative lung disease, occupational lung disease, airways disease and acute and sub-acute lung disease.
We report our experience of the use of endoscopically inserted expanding stainless steel stents in 18 patients over a period of 31 months. Twelve patients had stents inserted for malignant disease causing narrowing of the tracheobronchial tree, and six for airway complications following heart-lung, single lung or double lung transplantation. In all but one case, stents were satisfactorily positioned, and there were no complications related to stent insertion. Seven patients were alive at follow-up, three of whom had stents inserted for malignancy and four as a result of complications following transplantation.