Biomedical subjects
Publications and source records attributed to C V Strimlan.
Primary pulmonary meningiomas are extremely rare. In this article we report one case with benign primary pulmonary meningioma. The literature is reviewed and the clinical manifestations, radiographic findings, and pathologic features are presented.
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Isobutyl nitrite has recently become a popularly abused drug in the United States. Although many adverse effects, including headache, hypotension, and methemoglobinemia, are known to occur following exposure to this class of drugs, little has been written concerning the effects of illicit use of isobutyl nitrite. In this case, severe tracheobronchitis developed following short-term exposure by inhalation of this drug.
A patient with chronic myelogenous leukemia, treated for two years with busulfan, presented with increasing dyspnea of several months' duration. Despite a normal chest radiograph, there was a markedly reduced carbon monoxide (CO) diffusing capacity (41% of predicted normal) and a restrictive ventilatory pattern on pulmonary function testing. Gallium-67 scanning revealed diffuse uptake in both lungs. The busulfan was discontinued and therapy was changed to hydroxyurea. Three months later the patient was without symptoms, the CO diffusing capacity had risen to 64% (of predicted), and the Ga-67 scan had returned to normal. The chest radiograph remained normal. Despite the lack of biopsy proof, we believe Ga-67 scanning was an aid in the early detection of cytotoxic-induced lung disease in a reversible stage. Gallium-67 scanning may be useful in the early deagnosis of pulmonary injury from cytotoxic agents.
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Of 97 patients with mediastinal granuloma, 13 had involvement of the esophagus by extension from adjacent lymph nodes or pleura. A knowledge of the anatomic relationships of these structures is important in understanding the distribution and radiologic features of these lesions. The most common manifestation was extrinsic compression, being present in 7 (54%) of the 13 patients. Three patients (31%) had either a fistula or a sinus tract. Esophageal stricture and diverticulum formation also occurred. Mediastinal granuloma should be considered in the differential diagnosis in patients with any of these findings.
The frequency of HL-A antigens was determined in 31 patients with biopsy-confirmed Wegener's granulomatosis and compared with their frequency in healthy Caucasian control population. There was no significant difference between the two groups for any of the 24 HL-A antigens tested.
Thirteen patients with lymphocytic interstitial pneumonitis were seen at the Mayo Clinic from 1966 through 1976. The group included nine women and four men, with a mean age of 50.7 years. Their primary complaints were cough, dyspnea, and loss of weight. Chest roentgenographic features were predominantly basilar, coarse interstitial-alveolar infiltrations. Pulmonary function studies showed restrictive ventilatory impairments with a low CO diffusing capacity in all 13 patients. Lung biopsies in all cases showed diffuse interstitial infiltrations, consisting of mature lymphocytes and plasma cells. Ten of the 13 patients had an associated dysproteinemia, including two patients with hypogammaglobulinemia. Three patients had coexistent Sjögren's syndrome, including two with localized amyloidosis. Although lymphocytic interstitial pneumonitis is a histologically distinct pulmonary lesions, it occurs with a variety of immune disorders.
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In published reports, the incidence of pleuropulmonary involvement in ankylosing spondylitis varies from 0 to 30%. A review of the records of 2,080 patients with ankylosing spondylitis disclosed 28 who had pleuropulmonary manifestations that we believe are typical of those associated with ankylosing spondylitis (an incidence of 1.3%). Among these 28 patients, the most common abnormality was upper lobe fibrobullous lesions. Five had aspergillomas and two had infections-one caused by Mycobacterium kansasii and one by Mycobacterium avium. Three patients had transient pleural effusion of an exudate with normal sugar content. Two had nonspecific pleuritis, found on pleural biopsy. Thoracotomy for aspergilloma was followed by bronchopleural fistula in one of two cases--approximately the ratio found in the literature.
A review of 95 patients seen at the Mayo Clinic with mediastinal granuloma indicated that ten (10.5%) had esophageal involvement. The primary complaint was dysphagia. Esophageal roentgenographic features included compression, stricture, diverticulum, sinus tract formation, and tracheoesophageal fistula. An esophagogram should be included in the workup of any patient with suspected mediastinal granuloma.
A review of 343 patients with classic Sjogren's syndrome seen at the Mayo Clinic from 1967 through 1974 revealed pulmonary involvement in 31 patients (9 percent). Cough dyspnea, recurrent pneumonitis, and pleuritic pain were the primary complaints. Chest roentgenographic features included diffuse interstitial patterns, diffuse alveolar patterns, and pleural effusions. Laboratory studies revealed hypergammaglobulinemia in 16 of 22 patients tested, and 23 of the 31 patients had positive tests for anti-nuclear antibody, rheumatoid factor, or lupus erythematosus cells. Pulmonary function tests showed a restrictive ventilatory impairment or low diffusion capacity (or both in all 18 patients studied. Pathologic diagnosis included the full range of pulmonary lesions described in Sjogren's syndrome syndrome, ie, lymphocytic interstitial pneumonitis, pseudolymphoma, malignant lymphoma, diffuse interstitial pulmonary fibrosis, and bronchopneumonia. The clinical pulmonary diagnosis included diffuse interstitial fibrosis, recurrent pneumonitis, pleural effusions, and suspected lymphoma or pseudolymphoma. We conclude that pulmonary lesions occur in Sjogren's syndrome more frequently than previously reported.
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In a group of 47 patients with mediastinal granulomas, the most common clinical symptoms were cough, chest pain, dysphagia, hemoptysis, and dyspnea. The main laboratory findings were right paratracheal or hilar mass on chest roentgenogram, positive histoplasmin skin test, and caseating granuloma on histopathologic examination. Complications included fibrosing mediastinitis with superior vena cava obstruction, esophageal compression, and major upper airway compression. Treatment was usually surgical resection or evacuation of caseous contents. The prognosis in most patients with mediastinal granulomas appears to be good--long-term survival with minimal or no disability.