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Biomedical subjects

J F Gruden

Publications and source records attributed to J F Gruden.

At least 19 recordsLinked to original sources
PubMed2000

The normal CT appearances of the second carina and bronchial stump after left upper lobectomy.

We retrospectively evaluated the computed tomography (CT) appearance of the bronchial stump and second carina (left upper lobe spur) after left upper lobectomy. There were 69 CT examinations in 38 patients; all were free of recurrent or metastatic disease. The spur was graded as a) sharp (wedge-shaped tip configuration with <90 degrees angulation), b) lobulated (bulbous tip with <90 degrees angulation), or c) widened (>90 degrees angulation regardless of tip configuration). The bronchial stump was evaluated for the presence or absence of soft tissue in proximity to the surgical staples. The spur had a sharp appearance in 33 of 38 patients (87%) and was lobulated in 5 of 38 (13%). No patient had soft tissue at the bronchial stump. Serial examinations showed no change in the appearance of either structure. The spur remains sharp after left upper lobectomy in most patients; lobulation occurs in 13%. No changes occur over time. Interval change, widening of the spur, or soft tissue at the bronchial stump may suggest abnormality. Knowledge of normal and potentially abnormal appearances is essential to proper CT interpretation, particularly in the setting of postoperative surveillance for recurrent or metastatic disease.

Aged↗
PubMed1999

Viral and Pneumocystis carinii infections of the lung in the immunocompromised host.

Viruses and Pneumocystis carinii are significant causes of pneumonia in immunocompromised patients, particularly patients with impaired cell-mediated immunity. They are often simultaneously considered in the differential diagnosis of diffuse pneumonitis in these patients and, because radiographic appearances and the periods of vulnerability to these infections may overlap, may be difficult to differentiate. This article will correlate radiographic findings to evolving histopathologic changes in select specific infections, as they affect three different immune impaired populations: (a) acquired immunodeficiency syndrome, (b) immunosuppression secondary to therapy for underlying malignancy or with solid organ transplantation, and (c) immune impairment in the bone marrow transplant patient. Appreciation of the specific clinical setting in which to consider these infections will be emphasized.

AIDS-Related Opportunistic Infections↗
PubMed1999

Multinodular disease: anatomic localization at thin-section CT--multireader evaluation of a simple algorithm.

PURPOSE: To evaluate the interobserver variability and accuracy of an algorithm for anatomic localization of small nodules evident on thin-section computed tomographic (CT) images of the lungs. MATERIALS AND METHODS: Four experienced chest radiologists independently evaluated thin-section CT images in 58 patients by using an algorithm and a standard score sheet. Nodules were placed into four possible anatomic locations or categories: perilymphatic, random, associated with small airways disease, or centrilobular. Algorithm accuracy was assessed by comparing the localization by the observers to that expected for each specific disease in the study group on the basis of reports in the literature. Interobserver variability was assessed by placing cases into one of three groups: (a) complete concordance, (b) triple concordance, and (c) discordant. RESULTS: All observers agreed in 79% (46 of 58) of the cases with regard to nodule localization; three of the four concurred in an additional 17% (10 of 58). The observers were correct in 218 (94%) of 232 localizations in the 58 cases. There were no apparent differences in the number of either discordant or incorrect localizations between the observers. The most noteworthy source of error and of disagreement between observers was the confusion of perilymphatic and small airways disease-associated nodules in a small number of cases. CONCLUSION: The proposed algorithm is reproducible and accurate in the majority of cases and facilitates nodule localization at thin-section CT.

Adult↗
PubMed1997

Volumetric (helical/spiral) CT (VCT) of the airways.

Volumetric computed tomography (VCT) represents an important improvement over conventional CT for assessing most airway abnormalities. Elimination of misregistration due to variations in respiration coupled with decreased motion artifact and the ability to obtain routine overlapping sections allow a more confident estimation of the presence and extent of disease. Recently, attention has focused on newer reconstruction techniques including: multiplanar reconstructions (MPRs), including curved multiplanar reformations; multiplanar volume reconstructions (MPVRs) using ray projection techniques, such as maximum and minimum projection imaging; external rendering, or 3D-shaded surface displays; and, most recently, internal rendering or so-called "virtual bronchoscopy". Given the often redundant nature of many of these methodologies determining indications for their use remains to be established, especially by comparison to axial imaging. The purpose of this article is to review these various reconstruction techniques and, based on current knowledge, place them in an appropriate clinical context.

Humans↗
PubMed1997

AIDS-related airway disease.

To our knowledge, the importance of airway disease in HIV-positive patients has been infrequently noted. This deficit likely reflects a combination of factors including lack of familiarity with recent changes in clinical and epidemiologic patterns of pulmonary manifestations of HIV infection and documented limitations of chest radiography for identifying and differentiating airway disease from other causes of pulmonary disease in HIV-positive patients. Familiarity with the imaging findings for these various entities should facilitate prompt diagnosis and treatment. The accuracy of CT in detecting airway disease [55-59] is well established and should be of value in excluding more common diseases that may be initially confused with airway abnormalities [60, 61]. Small airways disease, in particular, which may be occult or mimic an interstitial infiltrate on chest radiography, can be recognized with CT as likely representing infectious bronchitis or bronchiolitis. Patients with findings suggesting bacterial infections may benefit from empiric antibiotic therapy. CT also may be valuable for differentiating between various noninfectious pulmonary diseases, allowing a presumptive diagnosis of parenchymal Kaposi's sarcoma in the appropriate clinical context. In distinction, by detecting localized endobronchial or parenchymal abnormalities in patients with mycobacterial or fungal infections or lymphoma, CT may be valuable for deciding between various invasive methods of obtaining either histologic or bacteriologic diagnoses.

AIDS-Related Opportunistic Infections↗
PubMed1997

High-resolution CT in the evaluation of clinically suspected Pneumocystis carinii pneumonia in AIDS patients with normal, equivocal, or nonspecific radiographic findings.

OBJECTIVE: We prospectively studied AIDS patients with a high clinical pretest probability of Pneumocystis carinii pneumonia (PCP) in whom chest radiographic findings were normal, equivocal, or nonspecific with high-resolution CT (HRCT) to determine the incidence of PCP in these patients, to assess the diagnostic accuracy of HRCT for the presence or absence of PCP, to evaluate the role of HRCT in patient management, and to determine the clinical outcome of all patients 1 month after evaluation. SUBJECTS AND METHODS: All patients were referred to the Division of Pulmonary and Critical Care Medicine for diagnosis of clinically suspected PCP. Thirty-three patients were prospectively evaluated with HRCT within 24 hr of diagnostic bronchoalveolar lavage; 18 other patients who underwent HRCT were managed according to the HRCT interpretation and followed up clinically. All HRCT scans were independently reviewed by three chest radiologists; patchy or nodular ground-glass attenuation was considered to indicate "possible PCP." RESULTS: The incidence of PCP was 12% (6/51). The sensitivity of HRCT was 100%; specificity, 89%; and accuracy, 90% (p < .005). We had five false-positive and no false-negative interpretations. Some form of "airways disease" (n = 23) was the single most common HRCT interpretation. CONCLUSION: HRCT may allow exclusion of PCP in patients with findings that are normal, equivocal, or nonspecific on chest radiographs. Empiric therapy or immediate bronchoscopy can be avoided in many patients on the basis of the HRCT findings.

AIDS-Related Opportunistic Infections↗
PubMed1996

Diffuse lung disease: assessment with helical CT--preliminary observations of the role of maximum and minimum intensity projection images.

PURPOSE: To evaluate assessment of diffuse lung disease with helical computed tomography (CT) and maximum intensity projection (MIP) and minimum intensity projection images. MATERIALS AND METHODS: Six patients with suspected lung disease (the control group) and 20 patients with documented disease underwent axial helical CT through the upper and lower lung fields. Findings on the MIP and minimum intensity projection images of each helical data set were compared with findings on the thin-section scan obtained at the midplane of the series. RESULTS: Owing to markedly improved visualization of peripheral pulmonary vessels (n = 26) and improved spatial orientation, MIP images were superior to helical scans to help identify pulmonary nodules and characterize them as peribronchovascular (n = 2) or centrilobular (n = 7). Minimum intensity projection images were more accurate than thin-section scans to help identify lumina of central airways (n = 23) and define abnormal low (n = 15) and high (ground-glass) (n = 8) lung attenuation. Conventional thin-section scans depicted fine linear structures more clearly than either MIP or minimum intensity projection images, including the walls of peripheral, dilated airways (n = 3) and interlobular septa (n = 3). MIP and minimum intensity projection images added additional diagnostic findings to those on thin-section scans in 13 (65%) of 20 cases. CONCLUSION: MIP and minimum intensity projection images of helical data sets may help diagnosis of a wide spectrum of diffuse lung diseases.

Adult↗
PubMed1996

Presentation of AIDS-related pulmonary Kaposi's sarcoma diagnosed by bronchoscopy.

Kaposi's sarcoma (KS) is the most common neoplasm in persons infected with the human immunodeficiency virus (HIV). However, information about the presenting features of pulmonary KS is limited. To describe the clinical, laboratory, and radiographic features of pulmonary KS, medical records and chest radiographs of 168 patients with pulmonary KS diagnosed by bronchoscopy during a 7-yr period were reviewed. All of the patients were HIV-seropositive males, of whom 95% identified homosexual or bisexual sex as a risk factor for HIV infection. The median CD4 lymphocyte count was 19 cells/microliter. The most common symptoms were cough, dyspnea, and fever. Patients with a concurrent opportunistic pneumonia had a higher median serum lactate dehydrogenase (LDH) concentration than did those with pulmonary KS alone (p<0.001). The most common chest radiograph findings were bronchial-wall thickening, nodules, Kerley B lines, and pleural effusions. The presence of granular opacities or cystic spaces usually indicated concomitant Pneumocystitis carinii pneumonia (p < 0.001). Twenty-six patients (15.5%, 95% CI = 10.2% to 20.8%) had pulmonary KS in the absence of mucocutaneous involvement. The presentation of pulmonary KS is characterized by symptoms that cannot be distinguished from those of a superimposed infection. An elevated serum LDH concentration or a chest radiograph with granular opacities or cystic spaces should raise the suspicion of concurrent opportunistic pneumonia. The diagnosis of pulmonary KS should be considered in an HIV-infected homosexual or bisexual male with respiratory symptoms even in the absence of mucocutaneous lesions.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Acute rupture of the diaphragm due to blunt trauma: diagnostic sensitivity and specificity of CT.

OBJECTIVE: The purpose of this study was to determine the diagnostic sensitivity and specificity of CT in detecting acute rupture of the diaphragm after blunt trauma. MATERIALS AND METHODS: Abdominal CT scans taken before surgery of 11 patients with diaphragmatic rupture (eight left and three right) and 21 patients with intact diaphragms after major acute blunt abdominal trauma were independently reviewed by three observers who were unaware of surgical findings. Retrospective note was made of diaphragmatic discontinuity, intrathoracic herniation of abdominal contents, waistlike constriction of bowel ("collar sign"), and associated findings. Right and left hemidiaphragms were graded as intact or ruptured, and these findings were correlated with surgical findings. Individual and average observer sensitivity and specificity in detecting acute diaphragmatic rupture were calculated. RESULTS: Of the 11 cases of diaphragmatic rupture, diaphragmatic discontinuity was seen in eight, visceral herniation was seen in six, and the "collar sign" was seen in four cases. Hemoperitoneum of hemothorax completely obscured visualization of the ruptured diaphragm in three cases. Individual diagnostic sensitivity for detecting diaphragmatic rupture was 54-73% and specificity was 86-90%. Average sensitivity for the three observers was 61% (95% confidence interval, 41-81%), and average specificity was 87% (95% confidence interval, 76-99%). CONCLUSION: CT is highly specific in diagnosing acute diaphragmatic rupture and detects approximately two thirds of acute diaphragmatic ruptures after blunt trauma.

Abdominal Injuries↗
PubMed1996

Subjective pitfalls in HRCT interpretation.

High-resolution computed tomography (HRCT) allows a detailed assessment of the anatomy and pathology of the pulmonary parenchyma. However, numerous potential pitfalls exist that can hinder or preclude accurate interpretation of HRCT images. These sources of potential diagnostic error can be systematically evaluated with respect to the major categories of HRCT abnormalities: (1) increased parenchymal attenuation, (2) linear opacities and interstitial disease, (3) nodular lung disease, and (4) holes in the lung. Accurate HRCT interpretation depends on the correct recognition and characterization of imaging abnormalities. Technical factors that enhance or limit scan interpretation, HRCT features of subtle disease, and imaging mimics of commonly observed pathology are addressed in detail with regard to each of the above categories of disease. Common pitfalls are illustrated and explained in an effort to increase general awareness of these sources of real and potential diagnostic confusion.

Humans↗
PubMed1995

Identification and evaluation of centrilobular opacities on high-resolution CT.

Abnormal findings on high-resolution CT that are localized to the centrilobular region imply primary disease of the small airways or primary peribronchiolar or perivascular pathology. We review methods of localizing abnormal opacity to the centrilobular region and discuss differential diagnostic considerations for centrilobular disease. Straightforward ways to differentiate between primary small-airways disease and peribronchiolar or perivascular conditions are also emphasized. Although perilymphatic disorders can also be associated with centrilobular opacities, these conditions have a distinctive appearance that warrants separate categorization; distinguishing characteristics of perilymphatic disorders with respect to the centrilobular conditions are discussed.

Bronchial Diseases↗
PubMed1995

Bronchogenic carcinoma in 13 patients infected with the human immunodeficiency virus (HIV): clinical and radiographic findings.

Bronchogenic carcinoma is a cause of parenchymal or hilar masses with or without mediastinal adenopathy in HIV-seropositive smokers. Lung cancer can occur earlier than the more commonly recognized opportunistic infections and in patients not known to be HIV seropositive. Tumor cell types do not differ markedly from those expected in HIV-seronegative young lung cancer patients, but are often poorly differentiated; patients with high-grade malignancies fare poorly independent of their degree of immunocompromise at diagnosis. Computed tomography (CT) scans not only add important information with regard to disease distribution and preferred means of diagnosis, but also result in the detection of new sites of disease with respect to the plain radiography in many patients. Because lung cancer often occurs before the diagnosis of AIDS, the association may not be suspected in some cases; poorly differentiated, rapidly growing tumors in young smokers may raise the suspicion of underlying HIV infection.

Adult↗
PubMed1995

AIDS-related Kaposi sarcoma of the lung: radiographic findings and staging system with bronchoscopic correlation.

PURPOSE: To determine the chest radiographic findings in patients with tracheobronchial Kaposi sarcoma (KS) and to develop a radiographic staging system that allows comparison of radiographic to bronchoscopic findings and allows assessment of the typical temporal progression of pulmonary KS. MATERIALS AND METHODS: The chest radiographs and medical records of 76 male patients, aged 23-60 years (mean, 36 years 4 months) with bronchoscopically proved KS were retrospectively reviewed. Tumor extent at bronchoscopy (grade 1-3) was compared with severity of parenchymal disease (radiographic stage 0-3). RESULTS: There was a statistically significant relationship between extent of tracheobronchial disease and radiographic stage (P = .01). However, in some patients, parenchymal KS of advanced stage was present with no visible endobronchial disease. CONCLUSION: The proposed staging system describes features of early, moderate, and advanced KS. Although there is a correlation between tracheobronchial and parenchymal disease, the latter can occur in the absence of endobronchial lesions.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Centrilobular opacities in the lung on high-resolution CT: diagnostic considerations and pathologic correlation.

Accurate assessment of high-resolution CT scans of the lung requires a knowledge of secondary lobular anatomy. Opacity that localizes to the centrilobular region implies the presence of a disease process that primarily involves centrilobular bronchioles, lymphatics, or pulmonary arterial branches. We illustrate the high-resolution CT findings of many of these processes and provide pathologic correlation for cases in which it was available.

Humans↗
PubMed1993

Percutaneous transthoracic needle biopsy in AIDS: analysis in 32 patients.

PURPOSE: A retrospective study was performed to determine the success of percutaneous transthoracic needle biopsy (TNB) as an aid in diagnosing focal chest and mediastinal disease in patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: The study group was composed of 32 patients seropositive for HIV; 31 of these patients had known AIDS. The subjects underwent chest radiography, computed tomography, and TNB. RESULTS: In 27 of the 32 patients a specific diagnosis was enabled by TNB. Bronchogenic carcinoma was diagnosed most frequently, although infectious agents were isolated in most patients. CONCLUSION: TNB is a safe and effective procedure for evaluation of focal thoracic disease in this patient population and provides information that is often unavailable from alternative diagnostic procedures.

Acquired Immunodeficiency Syndrome↗