CT depiction of regional nodal stations for lung cancer staging.
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Adult↗
Biomedical subjects
J A Shepard
Publications and source records attributed to J A Shepard.
Imaging of lung transplantation.
Lung transplantation is an accepted treatment for a large number of end-stage pulmonary diseases. There are several complications that pertain specifically to lung transplant recipients, including airway ischemia, reperfusion edema, infections, acute rejection, obliterative bronchiolitis, and other postoperative problems relating to surgical technique and immuno-suppressive therapy. Imaging procedures play an important role in the diagnosis and management of these problems.
Graft Rejection↗
Acute pulmonary embolism: assessment of helical CT for diagnosis.
PURPOSE: To determine the sensitivity and specificity of helical computed tomography (CT) for the diagnosis of acute pulmonary embolism. MATERIALS AND METHODS: This prospective study included 47 patients who underwent pulmonary arteriography for evaluation for possible acute pulmonary embolism. Tailored helical CT and pulmonary arteriography were performed within 24 hours of each other. Each CT scan was interpreted by two chest radiologists, blinded to arteriographic results, at two institutions. CT scan interpretations were compared with findings on bilateral selective pulmonary arteriograms interpreted by two vascular radiologists at one institution. RESULTS: Fifteen (32%) of 47 patients had angiographically proved pulmonary embolism. For the readers at the first institution, helical CT had 60% sensitivity, 81% specificity, 60% positive predictive value, 81% negative predictive value, and 75% overall accuracy. For the readers at the second institution, helical CT had 53% sensitivity, 97% specificity, 89% positive predictive value, 82% negative predictive value, and 83% accuracy. CONCLUSION: Detection of pulmonary embolism with helical CT may be less accurate than previously reported. Given its high specificity but relatively low sensitivity, helical CT may not have the ideal attributes of a first-line imaging study for the diagnosis of pulmonary embolism.
Acute Disease↗
The postpneumonectomy syndrome.
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Humans↗
Whipple's disease involving the mediastinum.
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Diagnosis, Differential↗
Mediastinal lymphadenopathy and hazy mediastinal fat: new CT findings of congestive heart failure.
OBJECTIVE: We describe two new CT findings of congestive heart failure (CHF): enlarged mediastinal lymph nodes and hazy heterogeneous mediastinal fat. MATERIALS AND METHODS: Forty-six patients were retrospectively identified who had major and minor clinical signs of congestive heart failure and had undergone chest CT during their symptomatic period. Two radiologists reviewed the CT studies and by consensus documented the presence or absence of imaging findings of CHF, including interstitial abnormalities, vascular redistribution, axial thickening, pleural effusions, cardiac enlargement, and mediastinal abnormalities. RESULTS: Smooth septal thickening, bilateral pleural effusions, vascular redistribution, and cardiac enlargement were the most common CT findings in patients with CHF. Enlarged mediastinal lymph nodes and hazy mediastinal fat were seen in 55% and 33% of cases, respectively. In a cohort of 17 patients with elevated pressures in the pulmonary capillary wedge documented within 24 hr of CT, CT scans revealed lymphadenopathy in 14 patients (82%) and inhomogeneous fat in 10 patients (59%). CONCLUSION: Enlarged mediastinal lymph nodes and hazy mediastinal fat occur in patients with CHF and are revealed by CT. Lymphadenopathy in patients with CHF does not necessarily indicate malignancy or an infectious process.
Adipose Tissue↗
Respiratory syncytial virus-associated infections in adult recipients of solid organ transplants.
BACKGROUND: Although respiratory syncytial virus (RSV) infection is known to cause severe pulmonary infections in bone marrow transplant recipients, less is known concerning its clinical course, diagnosis, and treatment in solid organ transplant recipients. METHODS: We have conducted a retrospective review of seven cases of RSV infection in adult recipients of solid organ transplants. Four patients received lungs, two received kidneys, and one received a heart. RESULTS: The most common presenting complaints were dyspnea (100%), cough (86%), and purulent sputum (57%). Physical findings included fever (43%), rales (100%), and wheezing (29%). Admission studies were significant for leukocytosis (29%), a left shift in the white blood cell differential (86%), and hypoxemia (mean PaO2 = 64). Chest radiographs were unchanged in 29% and showed infiltrates that were bilateral in 43% and unilateral in 29%. Pulmonary function tests in lung transplant recipients showed a mean fall in forced expiratory volume in 1 second of 26% and a fall in diffusion capacity for carbon monoxide of 24%. Five patients were treated with aerosolized ribavirin. Adverse events associated with treatment included wheezing (80%) and mild dyspnea (20%). The conditions of three of five treated patients were believed by their physicians to have improved 7 days after the initiation of therapy. One of the five treated patients died, and both untreated patients survived. CONCLUSIONS: RSV infection in this population has an extremely variable severity and clinical course, usually dominated by lower respiratory symptoms and obstructive airway disease. Ribavirin therapy is well tolerated, but its efficacy remains unknown.
Adult↗
Relationship between pulmonary artery diameter at computed tomography and pulmonary artery pressures at right-sided heart catheterization. Massachusetts General Hospital Lung Transplantation Program.
RATIONALE AND OBJECTIVES: The purpose of the study was to determine the relationship between pulmonary artery (PA) size at computed tomography (CT) and PA pressures, to develop a noninvasive CT method of PA pressure measurement, and to determine a PA diameter that can enable differentiation of normal subjects from those with pulmonary hypertension. METHODS: PA vessel diameters in 55 candidates for lung and heart-lung transplantation were measured at CT and correlated with PA pressures with both linear and stepwise multiple regression. The multiple regression equations were then tested prospectively in 35 pretransplantation patients. RESULTS: Combined main and left main PA cross-sectional area corrected for body surface area showed the best correlation with mean PA pressure (r = .87). The multiple regression equations helped predict mean PA pressure within 5 mm Hg in 50% of patients with chronic lung disease and in only 8% of patients with pulmonary vascular disease. CONCLUSION: There was a very good correlation between main and left main PA size and mean PA pressure. At present, however, CT has not demonstrated sufficient accuracy to be used clinically.
Adolescent↗
Postpneumonectomy syndrome: another twist.
This report describes the clinical, radiographic, and surgical findings in a patient with a rare postoperative complication, the postpneumonectomy syndrome. To our knowledge, it is the first reported case of postpneumonectomy syndrome after left pneumonectomy in a patient with a left-sided aortic arch.
Adult↗
Preoperative predictors of operative morbidity and mortality in COPD patients undergoing bilateral lung volume reduction surgery.
Bilateral volume reduction surgery (VRS) improves lung function for selected patients with emphysema. However, predictors of outcome are not well defined. We reviewed the preoperative characteristics of the first 47 consecutive patients who underwent bilateral VRS at the Massachusetts General Hospital in order to define potential predictors of unacceptable outcome. Preoperative data included spirometry, plethysmography, diffusion of carbon monoxide (Dco), maximum inspiratory pressure (MIP), maximum expiratory pressure, resting arterial blood gases (ABG), cardiopulmonary exercise testing with ABG and lactate sampling, and radionuclide ventriculography. Prepulmonary and postpulmonary rehabilitation 6-min walk tets (6MWT), and preoperative chest CT scans were also obtained. Twenty-two subjects were male and 17 of the subjects were on the lung transplant list. Patient characteristics included age of 60.5 +/- 7.5 years, FEV1 of 0.67 +/- 0.20 L, total lung capacity of 7.56 +/- 1.7 L, Dco of 7.40 +/- 4.1 mL/min/mm Hg, and PaCO2 of 41.6 +/- 6.4 mm Hg (mean +/- SD). The FEV1, vital capacity, MIP, resting room air PaCO2, prepulmonary and postpulmonary rehabilitation 6MWT, and PaCO2 at maximum oxygen consumption correlated with length of hospitalization (p < 0.05). Based on analysis of 41 of 47 patients for whom there were complete data, the inability to walk more than 200 m on the 6MWT before or after preoperative pulmonary rehabilitation, and resting PaCO2 > or = 45 mm Hg were the best predictors of an unacceptable outcome. If either of these characteristics was present, six of 16 vs zero of 25 died (Fisher's Exact Test, p = 0.0025, one-tailed) and 11 of 16 vs four of 25 had hospital courses > 21 days (p < 0.002). Both the 6MWT < 200 m and resting PaCO2 > or = 45 mm Hg alone correlated with death (p = 0.004 and p = 0.012, respectively) and the resting PaCO2 > or = 45 mm Hg correlated with hospital days > 21 (p = 0.0002). In conclusion, the data suggest that the inability to walk at least 200 m in 6 min before or after pulmonary rehabilitation and a resting room air PaCO2 > or = 45 mm Hg are excellent preoperative predictors of unacceptable postoperative outcomes.
Exercise Test↗
Routine addition of an automated biopsy device to fine-needle aspiration of the lung: a prospective assessment.
OBJECTIVE: The purpose of this study was to prospectively assess the usefulness of the routine addition of an automated biopsy device (ABD) to fine-needle aspiration (FNA) of the lung and to examine the complication rate of this procedure. SUBJECTS AND METHODS: Fifty biopsies were performed under CT guidance using a coaxial technique with a 19-gauge introducer needle and a 22-gauge aspirating needle followed by a 20-gauge ABD. An average of 3.5 FNA specimens and 2.5 core specimens were obtained. Cytology and histology specimens were interpreted separately by two experienced pathologists who were unaware of the other's interpretation. Final diagnoses were based on surgery, microbiology, definitive biopsy diagnosis, and clinical follow-up. All complications were recorded. RESULTS: Of 34 malignant lesions, we achieved a diagnostic accuracy of 94% for FNA and 59% for core biopsy (p < .01). Combined accuracy was 94%. Of 16 benign lesions, an accurate definitive diagnosis was made in 31% of cases using FNA and in 69% of cases using core biopsy (p = .08). Combined accuracy was 69%. In the subset of benign lesions that were not acute infections (n = 8), an accurate definitive benign diagnosis was made in 12% of cases using FNA and in 75% of cases using core biopsy (p < .05). No false-positive diagnoses of malignancy occurred. Complications included pneumothorax, nine (18%) of 50 cases; chest tube, one (2%) of 50 cases minor pulmonary hemorrhage, seven (14%) of 50 cases; and minor hemoptysis, two (4%) of 50 cases. CONCLUSION: The complication rates of FNA with the addition of an ABD are similar to those reported in the literature for FNA alone. The addition of an ABD significantly increases the diagnostic accuracy only for the subset of benign lesions that are not acute infections.
Adolescent↗
The bronchi: an imaging perspective.
Recent advances in high-resolution computed tomography (HRCT), inspiratory/expiratory CT staining of the lung, helical multiplanar reconstruction CT, and a broadened experience in magnetic resonance imaging of bronchial pathological conditions provide additional diagnostic information about the bronchi. This article reviews diffuse and focal lesions involving the large bronchi and small airways of the lung.
Bronchial Diseases↗
Surgical flaps in the chest: anatomic considerations, applications, and radiologic appearance.
PURPOSE: To determine the frequency of use of surgical flaps--tissue that is transposed from its normal location to promote healing and prevent complications--in noncardiac thoracic surgery and to demonstrate the typical radiologic appearances of such flaps. MATERIALS AND METHODS: The surgical records of 200 patients who underwent thoracotomy or median sternotomy for noncardiac thoracic surgery were reviewed. Postoperative radiologic studies of randomly selected cases were also reviewed. RESULTS: A total of 213 surgical flaps were used in these patients, including 80 pericardial fat pad flaps (37.6%), 78 greater omental flaps (36.6%), 21 intercostal muscle flaps (9.9%), 16 anterior serratus muscle flaps (7.5%), and 18 greater pectoral muscle, latissimus dorsi muscle, pleural, thymic, or mediastinal fat flaps (8.5%). The flaps produced unusual opacity or attenuation and/or contour of the mediastinum, hilum, or chest wall. CONCLUSION: Knowledge of common thoracic surgical flaps is helpful in interpretation of postoperative radiologic studies.
Adipose Tissue↗
Needle localization of peripheral lung nodules for video-assisted thoracoscopic surgery.
Video-assisted thoracoscopic surgery provides an alternative to conventional thoracotomy for resection of peripheral lung nodules. To localize small peripheral lung nodules that may not be visible or palpable by the surgeon, we have placed a Kopans hook wire percutaneously into the lung as a guide. The indications for localization included previous nondiagnostic percutaneous needle aspiration biopsy (PNAB) (n = 4), nodules too small for PNAB (n = 2), nodules inaccessible to PNAB (n = 3), and planned resection of a known peripheral tumor less than 1 cm (n = 1). The localization procedure was performed with computed tomographic guidance in all patients. The nodules ranged in size from 2 to 15 mm and were located immediately subpleural to 2-cm deep the pleura. A 20-gauge Greene biopsy needle was used as an introducer for a 35-cm-long Kopans hook wire. Patients were sent directly to the operating room in a dependent position. All ten nodules were successfully resected, including hamartoma (n = 1), carcinoid tumors (n = 2), granulomas (n = 3), adenocarcinoma (n = 1), fibrosis (n = 1), benign metastasizing leiomyoma (n = 1), and lymphoma (n = 1). In two patients, the wire slipped out of the lung. Small focal pneumothoraces developed in five patients. There were no major complications. This procedure can safely and effectively localize nonvisible or nonpalpable pulmonary nodules for thoracoscopic surgery for diagnostic purposes or for resection of small peripheral tumors in patients who cannot tolerate a lobectomy or pneumonectomy.
Aged↗
Adenosquamous carcinoma of the lung: radiologic appearance.
OBJECTIVE: To our knowledge, the imaging features of pulmonary adenosquamous carcinoma, a form of bronchogenic carcinoma with a greater propensity for metastases at the time of diagnosis and a poorer prognosis than other forms of bronchogenic carcinoma, have not been reported. Accordingly, we studied the radiologic appearance of this tumor to describe the findings and discern if there are features that distinguish it from other bronchogenic carcinomas. MATERIALS AND METHODS: Clinical and radiologic features of 30 cases of adenosquamous carcinoma were reviewed. Chest radiographs were available in all cases and CT scans were available in 23. In cases without CT scans, planar tomograms were reviewed in five cases and MR images were reviewed in one. Tumors were defined by location, morphology, and TNM classification. RESULTS: The tumors measured 0.6-6.5 cm in diameter (mean, 2.8 cm) on CT scans or chest radiographs. One tumor not seen even in retrospect on CT scans or chest radiographs was found at autopsy. Twenty-five tumors were solid and four were cavitary. Five tumors were central and 25 were peripheral, including one tumor of the superior sulcus of the lung and the tumor not seen at imaging. Tumor margins were poorly defined in 19 and spiculated in 10. Four large masses had heterogeneous attenuation on CT scans; one had punctate calcification. Fifty-three percent of tumors were peripheral nodules 1-3 cm in diameter. Results of fine-needle aspiration of 18 masses indicated malignant tumors in 16 cases, but adenosquamous carcinoma in only two. Evidence of previous lung injury, including tumor in or next to scar, pneumoconiosis, radiation fibrosis, and interstitial fibrosis, was found on CT scans, chest radiographs, and/or pathology in half the patients. CONCLUSION: The radiologic findings of adenosquamous lung carcinoma are a spectrum, typically a peripheral solitary nodule, less commonly a central hilar mass or tumor of the superior sulcus. Scar or fibrosis within the lungs suggests that adenosquamous carcinoma, just as adenocarcinoma, may arise in scarred lung parenchyma.
Aged↗
Imaging of mediastinal foregut cysts.
This study was undertaken to determine the value of magnetic resonance imaging (MRI) in the diagnosis of mediastinal foregut cysts. The MRI scans of 56 patients (with a total of 57 mediastinal masses) were reviewed. The patients (26 women and 30 men) had been examined between March 1986 and April 1991 at a tertiary-care hospital. T1-weighted and T2-weighted spin-echo images were available in all cases. The signal intensity of the lesions was compared with that of normal fat and muscle; the size, shape and location of the mediastinal masses were also noted. The 57 lesions consisted of 15 lymphomas, 10 neurogenic tumours, 10 thyroid masses, 6 thymomas, 6 foregut cysts and 10 other masses. Forty-eight of the masses had a signal intensity similar to that of muscle in T1-weighted images and higher than, equal to or lower than that of fat in T2-weighted images. Nine of the masses appeared bright in T1-weighted images, and the signal intensity was less than or equal to that of fat. Of these, four were foregut cysts and five were lymphomas. Of the six foregut cysts, four had short T1 values (the signal intensity ratio for cyst to fat ranging from 0.78 to 0.98) and long T2 values; two had the characteristic appearance usually associated with cystic lesions containing serous fluid--long T1 and T2 values. All of the foregut cysts appeared to be of soft-tissue attenuation on computed tomography (CT), all were located in the middle or posterior mediastinum, and all were round or oval.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗