Technical aspects of needle aspiration lung biopsy: a personal perspective.
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Biopsy, Needle↗
Biomedical subjects
E H Moore
Publications and source records attributed to E H Moore.
Needle-aspiration lung biopsy: a comprehensive approach to complication reduction.
Complications in needle-aspiration lung biopsy are often related to technique. A step-by-step discussion of lung biopsy focusing on complication reduction is presented. Preparation, needle selection, biopsy approach, needle manipulations, sampling, postprocedure care, and complication management are discussed in detail.
Biopsy, Needle↗
Computed radiography X-ray exposure trends.
RATIONALE AND OBJECTIVES: Computed radiography provides correct optical density on film, independent of the incident radiation exposure, but it can result in under- or overexposure of the imaging plate. In the current study, we evaluated the radiation exposure trends of computed radiography over a 2-year period for portable chest examinations to determine and compare the radiographic techniques of the computed radiography system relative to conventional screen-film detectors. METHODS: A Fuji computed radiography system was interfaced to a digital workstation to track system usage and examination demographics, including examination type and sensitivity number. Hard-copy films were used for diagnosis. The sensitivity number, a value inversely related to incident exposure on the imaging plate, was used to determine whether the proper techniques were used by the technologists. RESULTS: The initial use of the computed radiography system revealed a broad distribution of exposures being used; complaints regarding noisy films (e.g., underexposure) resulted in subsequent overexposure for a significant number of films. A quality-control audit indicating excessive exposure resulted in educational feedback and a tighter distribution of exposures within the optimal range as determined by our radiologists. The average technique was approximately equivalent to a 200-speed system. CONCLUSION: Computed radiography provides excellent dynamic range and rescaling capabilities for proper film optical density, and thus fewer repeat examinations. However, underexposure results in suboptimal image quality that is related to excessive quantum mottle. Overexposure requires film audits to limit unnecessary radiation exposure. In general, the optimal exposures are achieved with approximately 1.5-2 times the incident detector exposure of a 400-speed rare-earth system. The ability of computed radiography to reduce radiation exposure is unlikely when compared with a typical rare-earth screen-film combination (400 speed) in terms of adequate image quality for the diagnosis of subtle, low-contrast findings. For certain diagnostic procedures (e.g., nasogastric tube placement verification), lower exposures can be tolerated.
Humans↗
Primary osteosarcoma of the ribs: CT findings.
We report the CT appearance of primary osteosarcoma of the ribs in three patients. CT evaluation is important because this lesion may present a diagnostic dilemma on chest radiographs. The tumor should be suspected if CT demonstrates dense calcification within a mass that is centered in a rib.
Adult↗
Needle aspiration lung biopsy: reevaluation of the blood patch technique in an equine model.
PURPOSE: To reexamine the blood patch technique in a laboratory model of lung biopsy free of confounding clinical variables. MATERIALS AND METHODS: An equine model of lung biopsy was developed with an excised lobe connected to an insufflation bulb and pressure monitor. Patched and control unpatched punctures were made in the lung surface, and the pressure within the lung was raised to the maximum achievable. Whether air leakage from the puncture sites could be induced was determined and, if so, at what pressure it occurred. RESULTS: At statistical analysis with the Kaplan-Meier test and the Cox proportional hazards regression model, the difference between failure of the patched and unpatched punctures was statistically significant (P < .0001). CONCLUSION: The blood patch technique is effective in the laboratory setting and deserves reevaluation in a clinical series with updated biopsy techniques.
Animals↗
Filter wheel equalization in chest radiography: demonstration with a prototype system.
PURPOSE: To determine the feasibility of using the filter wheel equalization (FWE) technique for radiographic equalization in chest radiography. MATERIALS AND METHODS: An FWE system with two rotating wheels (one for each lung) with 25 lung-shaped, 1.0-mm-thick copper templates was constructed. Preexposure images were acquired; the computer used these images to select and position templates for each lung. An equalized radiograph was then produced. Radiographs were acquired in two male volunteers (both 33 years of age) and in a phantom. RESULTS: Optical densities in the lungs and nonlung areas on a conventional phantom radiograph were 2.07 and 0.55, respectively; after equalization, the corresponding optical densities were 2.06 and 1.42. Outside the lungs, radiographic contrast (difference in optical density) increased threefold; in the lungs, there was a very small decrease in radiographic contrast due to beam hardening. Well-equalized and relatively artifact-free radiographs were obtained with a 20-msec exposure time. CONCLUSION: The FWE system was shown in the laboratory to be feasible.
Absorptiometry, Photon↗
Bacillary angiomatosis in patients with AIDS: multiorgan imaging findings.
PURPOSE: To describe the varied clinical manifestations and imaging findings encountered in bacillary angiomatosis, an infectious complication of the acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: Clinical, imaging, and histopathologic findings in nine men (aged 26-50 years) with AIDS and bacillary angiomatosis were described. This condition often manifests as vascular skin lesions that resemble those of Kaposi sarcoma, fever, and anemia and is due to infection with Bartonella (Rochalimaea) henselae. RESULTS: Common imaging findings included lung nodules, mediastinal adenopathy, peripheral adenopathy, pleural effusions, ascites, abdominal adenopathy, soft-tissue masses, and low-attenuation lesions in the liver and/or spleen. Most notably, nodes and soft-tissue lesions were dramatically enhanced with injection of contrast material, which is presumably because the lesions are composed to a large extent of well-formed capillaries. CONCLUSION: Bacillary angiomatosis, a treatable infection, should be considered in patients with AIDS, particularly when Kaposi sarcoma is suspected clinically.
Acquired Immunodeficiency Syndrome↗
Atypical mycobacterial infection in the lung: CT appearance.
The author examined computed tomographic (CT) scans of the chest from 40 patients with cultures positive for atypical mycobacteria. Common manifestations included bronchiectasis, air-space disease, nodules, and scarring and/or volume loss. Less commonly observed signs were cavities, lymphadenopathy, and pleural disease. Serial scans were obtained in 10 patients and showed new areas of bronchiectasis and progression of existing bronchiectasis, suggesting that the bronchiectasis was not a preexisting condition but resulted from infection. The anatomic distribution of the above findings was diffuse, not strongly favoring any lung zone. The identification of multifocal coexistent bronchiectasis, air-space disease, and nodules at CT should raise the possibility of atypical mycobacterial lung disease, even in an otherwise healthy patient.
Aged↗
Pulmonary intravascular tumor emboli: dilated and beaded peripheral pulmonary arteries at CT.
The diagnosis of pulmonary intravascular tumor emboli is difficult to establish both clinically and on conventional radiographic studies. Between 1985 and 1991, four cases of pulmonary intravascular metastases were demonstrated on computed tomographic (CT) scans from among 14,000 CT scans of the chest. A retrospective study of these cases was performed, including a review of chest radiographs. All four patients had invasive tumors, including an atrial myxoma, a renal cell carcinoma, an osteosarcoma, and a chondrosarcoma of the pelvis. Three cases had histopathologic documentation of pulmonary artery tumor emboli. At CT, all the patients demonstrated multifocal dilatation and beading of peripheral pulmonary arteries, primarily in a subsegmental distribution involving multiple lobes. Ossification of the pulmonary arteries occurred in one case of metastatic osteosarcoma. In two cases, small, peripheral wedge-shaped opacities distal to some abnormal pulmonary arteries suggested pulmonary infarcts. The finding of dilated and beaded peripheral pulmonary arteries at CT is highly suggestive of metastatic intravascular tumor emboli.
Adolescent↗
Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling.
One hundred forty-three patients with bronchogenic carcinoma were studied prospectively with computed tomography (CT) to determine the accuracy of CT in the evaluation of mediastinal nodal metastases. Mediastinal lymph nodes were localized according to the lymph node mapping scheme of the American Thoracic Society and were considered abnormal if they exceeded 1 cm in short-axis diameter. All patients underwent surgical staging, which consisted of either mediastinoscopy alone or mediastinoscopy and thoracotomy. At the time of surgical staging, all accessible nodes were either removed or sampled. The sensitivity of CT for mediastinal nodes on a per-patient basis was 64%, with a specificity of 62%. The sensitivity of CT for individual nodal stations involved with tumor was only 44%. The presence of obstructive pneumonitis did not appreciably alter the sensitivity of CT, but the specificity was lower (43%). The likelihood of metastases increased with lymph node size; however, seven of 19 (37%) lymph nodes that measured 2-4 cm in short-axis diameter were hyperplastic and did not contain metastases. The relative insensitivity of CT makes formal nodal sampling at the time of mediastinoscopy or thoracotomy essential to detect lymph node metastases.
Adult↗
Effect of patient positioning after needle aspiration lung biopsy.
Fifty-five patients who underwent fluoroscopically guided needle aspiration lung biopsy were randomly assigned to one of two postbiopsy treatment groups: Patients were placed recumbent with puncture site either down (n = 36) or up (n = 19) for at least 1 hour. No significant difference in pneumothorax rate was seen between the two groups. Chest tube placement, however, was required in 21% (four of 19) of the puncture-site-up group versus 3% (one of 36) of the puncture-site-down group, which was a significant difference (P = .04). Puncture-site-down postbiopsy positioning reduces the proportion of patients requiring chest tube placement after lung biopsy.
Biopsy, Needle↗
Diffuse lung disease in the current spectrum of immunocompromised hosts (non-AIDS).
Diffuse lung disease occurring in an immunocompromised patient is a nonspecific finding that may result from one or more of a variety of infectious and noninfectious causes. Patient history and clinical information are essential in narrowing the differential diagnosis, but in most patients, diagnostic procedures must be performed to determine appropriate therapy. Diagnostic possibilities include infection, spread of malignancy, reactions to chemotherapy or radiation, nonspecific interstitial pneumonitis, hemorrhage, and unrelated medical conditions. An understanding of the specific nature of the patient's immunologic defect and underlying disease allows one to predict the most likely organisms in cases of infection.
Humans↗
Positional precautions in needle aspiration lung biopsy.
The authors performed 308 needle aspiration biopsies of parenchymal lung masses. The patients were then placed with the puncture site down for a period of at least 1 hour or until air leakage stopped. Coughing, talking, and activity were restricted. Complications included pneumothorax, at a rate of 25.0%, and chest tube placement, at a rate of 1.6%. In a subgroup of 262 patients who required only one pleural puncture at biopsy, a pneumothorax rate of 17.9% and a chest tube placement rate of 0.4% were encountered. When compared with a similar series of 143 control patients, significant reductions in both pneumothorax rate (P = .0004) and chest tube placement rate (P = .0001) were demonstrated.
Biopsy, Needle↗
Coronary artery calcifications: significance of incidental detection on CT scans.
A scoring system was devised for the assessment of coronary artery calcifications apparent on computed tomographic (CT) scans, with width and length used to assess severity. The degree of calcification was compared with the presence of stenoses of 70% or greater at cardiac catheterization in 46 patients who underwent both studies. Although many significantly stenosed vessels showed no calcification, heavy calcifications had a high positive predictive value for significant disease. In a separate branch of the study, the perioperative cardiac morbidity and mortality were compared in 30 age- and sex-matched pairs of patients undergoing thoracotomy who did and did not have coronary calcifications on CT scans obtained before surgery. Patients with calcifications had a higher frequency of cardiac complications, including arrhythmias, ischemia, hypotension, myocardial infarction, and death.
Adult↗
Pulmonary infections in renal transplantation patients treated with cyclosporine.
Seventeen cases of pneumonia occurring in renal transplantation patients treated with cyclosporine-prednisone immunosuppression were analyzed with regard to the organisms involved, time of occurrence after transplantation, clinical course, and radiographic findings. In a pattern similar to that encountered with conventional azathioprine-prednisone immunosuppression, opportunistic infections were most common in the period between 1 and 5 months after transplantation. All multiple-organism infections involved cytomegalovirus and carried a poor prognosis. No unexpected radiographic findings were noted.
Adult↗
Plexiform neurofibromatosis of the mediastinum: CT appearance.
We studied the CT findings in four patients with pathologically proved thoracic plexiform neurofibromatosis. In all four patients, CT showed an infiltrative process and masses that involved the mediastinum along the distribution of the sympathetic chains, phrenic, and vagus nerves. The lesions had lower attenuation values than did chest-wall muscle. In one patient, CT revealed calcifications and peripheral enhancement of nodular components after IV infusion of contrast material. In the appropriate clinical setting, CT detection of lesions in the distribution of the mediastinal nerves strongly favors the diagnosis of plexiform neurofibromatosis.
Adult↗
Obstruction of the superior vena cava or subclavian veins: sonographic diagnosis.
The normal subclavian vein shows a respiratory rhythmicity on sonograms and responds to a sudden sniff maneuver by collapsing in a rapid, transient manner secondary to the sudden decrease in intrathoracic pressure. Of 11 patients studied using ultrasound (US) for possible superior vena cava (SVC) obstruction, five patients with proved SVC obstruction had no response of the enlarged subclavian veins to respiratory maneuvers. One patient with a partial obstruction had a minimal response on one side. Two patients with isolated subclavian vein obstructions had no response on the affected side and a normal response on the contralateral side. Three patients proved not to have SVC obstruction had normal responses. Sonography of the subclavian veins may be an effective, indirect screening technique for the presence of SVC obstruction and can also be used to evaluate the patency of the subclavian vein, although the sensitivity and specificity of the method remain to be determined from a larger, prospective study.
Constriction, Pathologic↗
MRI of pulmonary airspace disease: experimental model and preliminary clinical results.
To evaluate the potential of MRI for differentiating the various causes of pulmonary consolidation, 16 patients with known airspace diseases were imaged, and T1 and T2 values were determined. Substantial overlap was encountered between different diagnostic groups of T1 and T2 mapping, although alveolar proteinosis was notable for its low T1 value. In addition, a gelatin phantom simulating consolidation with varying degrees of residual aeration was constructed and tested, demonstrating that the degree of aeration did not influence the T1 and T2 values measured.
Diagnosis, Differential↗