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Biomedical subjects

D R Aberle

Publications and source records attributed to D R Aberle.

At least 55 records · Page 3Linked to original sources
PubMed1990

Computed tomography and bronchoscopy in chest radiographically occult main-stem neoplasm diagnosis and Nd-YAG laser treatment in 8 patients.

We studied 8 adult patients with variable symptoms of cough, dyspnea, stridor, wheezing, or hemoptysis. Fiberoptic bronchoscopy in all showed complete or nearly complete endobronchial obstruction of a main-stem bronchus by neoplasm with a mean bronchial diameter of 1.9 mm +/- 1.6 mm (mean +/- standard deviation). In 4 patients, a lobar bronchus was also completely obstructed. No mass was visible on chest radiographs of any patient; however, computed tomography in each showed main-stem endobronchial obstruction, lobar obstruction (4 instances in 3 patients), and in 6 patients hypoperfusion of the involved lung. Computed tomographic scan showed additional abnormalities that were unsuspected on viewing chest radiographs or at bronchoscopy, including mediastinal adenopathy in 3 patients and an extraluminal tumor component in 4. After therapy with Nd-YAG laser, main-stem airway diameter increased to a mean of 9.6 mm +/- 1.0 mm (P less than .05) and pulmonary functions improved. Results suggest the complementary role of computed tomography and fiberoptic bronchoscopy in the detection and laser-treatment planning of chest radiographically occult severe neoplastic obstruction of the main-stem bronchus.

Bronchial Neoplasms↗
PubMed1990

Radiologic considerations in the adult respiratory distress syndrome.

ARDS is the clinical consequence of acute lung injury that results in increased-permeability edema. Distinct pathophysiologic stages are reflected in the radiographic evolution of the syndrome. Diffuse microatelectasis, proteinaceous edema fluid, and multifocal in situ pulmonary vascular occlusions characterize the acute stages of injury and result in the appearance of diffuse consolidations and occasional pleural effusions on the radiograph. In the chronic organizing stage of ARDS, the physiologic consequences of subsiding edema and tissue repair may be reflected by a transition to stable interstitial patterns. There is a high frequency of complications related to the decreased compliance of the injured lung that lead to interstitial emphysema and other barotraumatic complications. Survivors of ARDS exhibit various degrees of physiologic impairment and radiographic abnormality that may improve during the first year after survival. The relations between various indices of the severity of ARDS and the ultimate outcome are emerging. Debate continues about the specificity of the chest radiograph in distinguishing increased-permeability edema from hydrostatic edema. In fact, interstitial patterns and pleural effusions are observed in both. Nonetheless, the chest radiograph is a pivotal tool for monitoring patients at risk of serious morbidity from nosocomial lung infection, barotrauma, and the complications accompanying the use of invasive devices. It is hoped that as we develop a more uniform consensus on the clinical definition of ARDS and begin to classify patients according to specific clinical or physiologic observations, chest radiographic observation will acquire greater diagnostic and prognostic significance in these critically ill patients.

Acute Disease↗
PubMed1989

Computed tomography in the diagnosis of asbestos-related thoracic disease.

High-resolution computed tomography (HRCT) has improved the radiologist's ability to detect and potentially quantify the abnormalities of asbestos exposure. It has proved to be more sensitive than chest radiography for detecting pleural plaques and for discriminating between pleural fibrosis and extrapleural fat. HRCT is also more sensitive than chest radiography or conventional CT for detecting parenchymal abnormalities in asbestos-exposed persons. The HRCT findings that correlate with other parameters of asbestosis include (1) septal and centrilobular thickening, (2) parenchymal fibrous bands, (3) honeycomb patterns, (4) subpleural density persisting in the prone position, and (5) subpleural curvilinear lines that persist in the prone position. CT has an important role in evaluating benign and malignant lung and pleural masses in asbestosis.

Asbestosis↗
PubMed1989

Conventional and high resolution computed tomography in the diagnosis of asbestos-related diseases.

High resolution CT (HRCT) can image the fine structures of the lung parenchyma and the pleura. Analysis of supine and prone HRCT scans in 300 patients with asbestos exposure shows that asbestosis is characterized the following findings; (1) parenchymal bands, (2) increased interlobular septa, (3) increased intralobular core structures, (4) subpleural lines, and (5) dependent opacity. Pleural disease is well displayed on HRCT scans. Correlated studies with whole lung sections confirm the HRCT findings. Masses in asbestosis may be benign or malignant, and CT helps in their differentiation. HRCT correlates well with radiographic and clinical criteria for asbestosis and is more sensitive than either in detecting abnormalities.

Asbestosis↗
PubMed1989

Bronchoalveolar lavage cell and lymphocyte phenotype profiles in healthy asbestos-exposed shipyard workers.

The cellular and lymphocyte phenotypic composition of bronchoalveolar lavage (BAL) fluid and peripheral blood (PB) from 15 healthy, nonsmoking, asbestos-exposed shipyard workers (AEW) and 10 nonsmoking, age-matched unexposed workers (UEW) were compared. None of the AEW had clinical, radiographic, or physiologic evidence of asbestosis, but six had radiographic evidence of pleural plaques and/or thickening. The mean duration of asbestos exposure was 16.3 +/- 2.3 yr, and the mean period since exposure was 10.8 +/- 0.5 yr. All but three of the AEW and none of the UEW had asbestos bodies detected in the first 20 ml of BAL fluid recovered (0.1 to 35 asbestos bodies/ml). The AEW had a significantly higher mean percentage (19.1 +/- 2.8% versus 9.7 +/- 1.6%) and concentration (31.6 +/- 5.2 x 10(3) cells/ml versus 14.7 +/- 2.5 x 10(3) cells/ml) of BAL lymphocytes compared with that in the UEW, with an increased mean concentration of each phenotype measured. In PB, the mean lymphocyte concentration was also higher in the AEW than in the UEW (2.0 +/- 0.3 x 10(3) cells/ml versus 1.5 +/- 0.3 x 10(3) cells/ml), but the difference was not statistically significant, and there was no increase of any phenotype measured. BAL lymphocytosis did not correlate with exposure history or BAL asbestos body count, but was greater in AEW with pleural abnormality (30.1 +/- 2.9% versus 11.8 +/- 1.6%). BAL concentrations of CD-20, CD-3, and CD-4, but not of CD-8 cells were significantly increased compared with those in the AEW without pleural abnormality. Further longitudinal studies are needed to determine the prognostic significance of these findings.

Adult↗
PubMed1989

Pulmonary alveolar proteinosis. Occurrence with metastatic melanoma to lung.

Pulmonary alveolar proteinosis is characterized by excessive accumulation of surfactant-like material in the alveoli, resulting in part from defective alveolar clearance by macrophages. We present a case of alveolar proteinosis in a patient with malignant melanoma metastatic to lung and discuss possible alteration in macrophage function in the pathogenesis of these two concomitant processes.

Adult↗
PubMed1989

Comparison of 2048-line digital display formats and conventional radiographs: an ROC study.

Observer performance tests were conducted to compare the effects on diagnostic accuracy of digital hard copy and video display formats versus conventional radiographic film. Digital images were obtained by digitizing conventional chest radiographs to a 2048 x 2048 matrix with a laser film scanner. Three digital display formats were used: laser-printed digital film, a 2048-line video monitor without user interaction, and a 2048-line video monitor with user interaction. Thirty-one posteroanterior chest radiographs, determined by consensus of four thoracic radiologists to contain septal lines (n = 11), parenchymal nodules (n = 7), nodules and septal lines (n = 7), or neither abnormality (n = 6), were used for the study. Images were interpreted by four radiologists in four separate viewing sessions. Diagnostic accuracy was determined by receiver-operating characteristic analysis for each observer with each viewing technique. No statistical differences in diagnostic accuracy, determined by the area under the receiver-operating-characteristic curve, were found between the analog film, the digital film, and the two video digital display formats. This preliminary study suggests that 2048-line digital displays may be an acceptable alternative to the traditional lightbox viewing method for the perception of these two abnormalities commonly seen on chest radiographs.

Computer Systems↗
PubMed1989

Initial clinical experience with computed radiography imaging in an emergency department.

In the emergency setting, dual imaging was performed in 42 examinations using conventional and computed radiography imaging (CRI) systems. Six specialists considered computed images to be preferable to conventional radiographs in 28% of observations, of equal quality in 50% of observations, and of lesser quality in 22% of observations, even though incorrect processing algorithms were used in 62% of the digital exams. Correct processing improved CRI image characteristics and increased its desirability over conventional studies, suggesting that digital imaging will have greater application in the emergency setting as processing features are simplified.

Emergency Service, Hospital↗
PubMed1988

Asbestos exposure-cigarette smoking interactions among shipyard workers.

We studied the roentgenograms, pulmonary function tests, and physical findings of 294 shipyard workers to evaluate asbestos exposure-cigarette smoking interactions. Roentgenographic parenchymal opacities, decreased pulmonary diffusing capacity for carbon monoxide, decreased flow at low lung volume, rales, and clubbing were each significantly related to the number of years elapsed since first exposure to asbestos and cigarette smoking status when analyzed by logistic regression. A dose-dependent cigarette smoking response that was consistent with synergism was present only for parenchymal opacities and decreased flow at low lung volume. These findings suggest that decreased flow at low lung volume, possibly reflecting peribronchiolar fibrosis, may be a functional corollary to smoking-associated parenchymal roentgenographic opacities among some asbestos-exposed individuals.

Asbestos↗
PubMed1988

Asbestos-related pleural and parenchymal fibrosis: detection with high-resolution CT.

Twenty-nine subjects with occupational asbestos exposure and clinical asbestosis were examined with high-resolution computed tomography (HRCT) to determine its sensitivity, relative to that of conventional computed tomography (CT), for detection of benign asbestos-related disease. Thin-section HRCT scans were obtained at five discrete levels through the mid and lower thorax in both prone and supine positions. The same technique was used in 34 age-similar control patients. Parenchymal abnormalities were seen most frequently in the posterior portion of the lung bases in the asbestos-exposed subjects. HRCT prone scans enabled basal structural abnormalities to be reliably distinguished from gravity-related physiologic phenomena in 25 asbestos-exposed subjects. HRCT was more sensitive than CT in detection of both pleural and parenchymal fibrosis. In subjects with clinical asbestosis, HRCT demonstrated parenchymal abnormality in 96%, compared with 83% for CT. Similarly, pleural thickening was shown in 100% of subjects at HRCT, compared with 93% at CT. HRCT could be an important adjunct in the evaluation of asbestos-related pleuroparenchymal fibrosis. An HRCT study including prone scans is a sensitive, reliable means of detecting thoracic abnormalities in asbestos-exposed individuals.

Adult↗
PubMed1988

Hydrostatic versus increased permeability pulmonary edema: diagnosis based on radiographic criteria in critically ill patients.

To evaluate radiographic criteria recently proposed for determining causes of pulmonary edema, the authors studied 45 patients with severe pulmonary edema. Hydrostatic and increased permeability edemas were distinguished by means of the ratio of pulmonary edema fluid protein to plasma protein concentration and clinical and hemodynamic data. Chest radiographs were classified as showing hydrostatic, increased permeability, or mixed edema by three independent readers without knowledge of the clinical diagnosis. Overall, 87% of patients with hydrostatic edema but only 60% of patients with increased permeability edema were correctly identified. A patchy, peripheral distribution of edema was the single most discriminating criterion and was relatively specific for increased permeability edema, occurring in 13% of patients with hydrostatic and 50% with increased permeability edema (P less than .05). Some features considered more typical of hydrostatic edema were commonly found in patients with increased permeability, including a widened vascular pedicle (56%), pleural effusions (36%), peribronchial cuffs (72%), and septal lines (40%). The authors conclude that chest radiography is limited in the differentiation of type of pulmonary edema in severe cases.

Capillary Permeability↗
PubMed1988

Asbestos-related focal lung masses: manifestations on conventional and high-resolution CT scans.

In 260 asbestos-exposed individuals evaluated by means of computed tomography (CT), 43 unsuspected pulmonary masses were found in 27 individuals. The masses included fissural pleural plaques (n = 10), dense fibrotic bands (n = 3), round atelectasis (n = 11), carcinomas (n = 3), and other presumed benign masses (n = 16). The most helpful features in the diagnosis of rounded atelectasis with CT were (a) contiguity to areas of diffuse pleural thickening, (b) a lentiform or wedge-shaped outline, (c) evidence of volume loss in the adjacent lung, and (d) a characteristic "comet tail" of vessels and bronchi sweeping into the margins of the mass. Less advanced areas of focal atelectasis had fewer classic features. Intrafissural pleural plaques were readily identified with high-resolution CT. In asbestos-related masses, the demonstration of stability over time is necessary. Careful interpretation of CT and high-resolution CT features and close surveillance can obviate the need for biopsy in the majority of instances.

Asbestos↗
PubMed1988

High-resolution CT of benign asbestos-related diseases: clinical and radiographic correlation.

We prospectively analyzed benign asbestos-related pleural and parenchymal abnormalities on high-resolution CT scans and correlated them with clinical diagnoses in 100 asbestos-exposed workers. All subjects had high-resolution CT scans in conjunction with conventional CT at the time of clinical evaluation. To evaluate for asbestosis, we ranked high-resolution CT scans as high, intermediate, or low probability of asbestosis on the basis of the multiplicity and extent of observed parenchymal changes. By linear regression analysis, the most distinctive high-resolution CT features of asbestosis included thickened nondependent interstitial short lines and parenchymal bands. In 45 subjects satisfying clinical criteria of asbestosis, high-resolution CT probability of asbestosis was high in 38 (84%), intermediate in five (11%), and low in two (4%). In 20 (36%) of 55 subjects without clinical asbestosis, parenchymal abnormalities indicative of a high probability of asbestosis were observed on high-resolution CT. High-resolution CT probability scores had a strong positive correlation with chest radiographic profusion scores (p less than .0001) and asbestos-related pleural thickening (p less than .0001). Significant inverse correlations were seen with forced vital capacity (p less than .006) and single-breath diffusing capacity (p less than .03), both functional measures of restrictive interstitial lung disease. Neither clubbing nor rales were sufficiently prevalent to have statistical correlation with high-resolution CT scores. High-resolution CT is sensitive in detecting both pleural and parenchymal abnormalities in the asbestos-exposed subject. Asbestos-related pleural changes are observed more frequently on high-resolution CT than on conventional CT or chest radiography. The probability of asbestosis based on high-resolution CT parenchymal features has a significant correlation with existing clinical determinants of disease, and high-resolution CT can detect abnormality when other methods are not diagnostic.

Adult↗
PubMed1987

Pulmonary lymphangitic spread of carcinoma: appearance on CT scans.

Chest computed tomography (CT), including high-resolution CT with thin (1.5-mm) sections was used to evaluate proved (pathologically or clinically) lymphangitic spread (LS) of tumor in 12 patients. These appearances were compared with thin-section scans obtained in 11 healthy subjects. Thin-section CT demonstrated findings consistent with thickening of the normal lung interstitium. In all patients, thin sections showed an increase in the number of peripheral lines (1-2 cm in length) that were diffuse in generalized disease and localized in focal disease. Normal peripheral arcades were not increased in number, but the limbs forming the arcades were thickened in all patients. A diffuse increase in linear and curvilinear structures (reticular pattern) was seen toward the center of the lung. Polygonal structures 1-2 cm in diameter were seen in seven patients with LS but not in healthy subjects. Fissures were thickened in nine patients. Selected 1.5-mm-thick CT sections are recommended through abnormal areas (seen at CT or on chest radiographs) or if these are normal at three levels (midapex, hilus, and 3 cm above the diaphragm) when scanning patients with tumors known to cause LS.

Adult↗
PubMed1987

Fatal systemic arterial air embolism following lung needle aspiration.

Fatal systemic arterial air embolism occurred as a complication of percutaneous fine-needle aspiration of the lung, immediately following cytologic sampling of a vasculitic lesion of Wegener granulomatosis. This complication is extremely rare, and it may have been caused by the biopsy of abnormal veins, in which transmural inflammation prevented the normal vasoconstrictive responses to injury.

Biopsy, Needle↗