Biomedical subjects

M E Gale

Publications and source records attributed to M E Gale.

At least 19 recordsLinked to original sources

PubMed1992

Noncardiac manifestations of rheumatoid arthritis in the thorax.

The noncardiac manifestations of rheumatoid arthritis (RA) in the thorax are complex and varied. The bony thorax, pleura, lung parenchyma, tracheobronchial tree, larynx, an upper airway can all be sites of disease. Drug therapy for RA can result in thoracic disease that is difficult to distinguish from the manifestations of RA itself. This article reviews the available literature pertinent to noncardiac thoracic manifestations of RA and focuses on clinical and radiographic presentations in order to provide an organized approach to patient care.

Arthritis, Rheumatoid↗

PubMed1991

Computed tomography-guided minithoracotomy for the resection of small peripheral pulmonary nodules.

Small peripheral pulmonary nodules ranging in size from 1 mm to 20 mm were excised in 58 patients. Computed tomography was used to mark the skin overlying the nodules to minimize the surgical exposure needed for operative identification. The nodules were 1 cm or less in maximum diameter in 76% of the patients. Twenty-six patients had single nodules and 32 patients had multiple nodules. The preoperative diagnosis was inaccurate in 67% of the patients. In 61% of the patients in whom malignancy was suspected, no tumor was demonstrated. Conversely, of the 20 patients in whom a malignant nodule was excised, the preoperative diagnosis was correct in only 50%. Thirty-one patients required no further treatment apart from their biopsy and 27 required additional intervention. Small peripheral pulmonary nodules require biopsy for diagnosis. When percutaneous needle aspiration biopsy is unsuccessful, or technically difficult, a computed tomography-guided thoracotomy is an effective and minimally invasive surgical alternative.

Adult↗

PubMed1990

Intrathoracic lymphadenopathy. A rare manifestation of rheumatoid pulmonary disease.

This is the first antemortem report of a patient with long-standing RA and interstitial lung disease who developed reactive mediastinal adenopathy coincident with increases in the activity of his interstitial process. Mediastinal adenopathy was discovered by means of CT of the chest as part of an evaluation of interstitial lung disease. The increasing use of better imaging techniques for this purpose will undoubtedly reveal more patients with this finding. Mediastinal lymphadenopathy complicating rheumatoid lung is clinically relevant; speculation is provided regarding the mechanism of the lymph node enlargement in this setting.

Aged↗

PubMed1989

CT of appendicitis. Diagnosis and treatment.

CT may provide valuable information in patients with appendicitis whose clinical presentations are atypical. The abnormal appendix and inflammatory changes in the pericecal fat are shown directly rather than inferentially. CT can reliably distinguish phlegmonous inflammation from a liquified abscess and can accurately delineate the full extent of such inflammatory masses. Percutaneous catheter drainage of well-localized appendiceal abscesses under CT guidance is safe and effective and has a lower morbidity than surgical drainage.

Appendicitis↗

PubMed1988

Eloesser window thoracostomy for treatment of empyema: radiographic appearance.

The modified Eloesser procedure or open-window thoracostomy is a surgical treatment for chronic pleural empyema in which a relatively permanent drainage opening is created in the chest wall. The chest radiographs and CT scans of 13 patients who underwent a modified Eloesser window procedure were studied. On chest films, the Eloesser window characteristically appeared en face as an elliptical or crescent-shaped radiolucency with sharp superior and ill-defined inferior margins. It appeared in profile as a downward-sloping chest-wall defect with round superior and straight inferior margins. The first radiographs made after surgery often showed potentially confusing densities caused by the iodinated gauze used to pack the drained empyema cavity. On sequential chest films, the defect in the chest wall was always detectable, while the pleural cavity diminished in size and usually disappeared within 6 months. This analysis shows that the postoperative chest radiographs and CT scans in patients having the Eloesser window thoracostomy have features that are characteristic of the procedure.

Aged↗

PubMed1987

Pericardial fluid distribution: CT analysis.

Ultrasound and computed tomographic (CT) descriptions of pericardial effusion commonly indicate that fluid accumulates posteriorly within the pericardial sac before filling other areas. However, in a retrospective study of 68 cases of pericardial effusion identified on chest CT, most of the effusions were noted to be located solely or predominantly anterior to the right ventricle. Anatomic features of the pericardium and its fibrous attachments, and the physical principle of buoyancy account for this observation.

Humans↗

PubMed1987

Mediastinal lymph node evaluation by computed tomography in lung cancer. An analysis of 345 patients grouped by TNM staging, tumor size, and tumor location.

To more clearly characterize the role of computed tomography in staging the mediastinal lymph nodes of patients with lung cancer, we analyzed computed tomographic and surgical findings in the chest in 345 consecutive patients with lung cancer who underwent operative staging. Patients were grouped according to the TNM staging system of the American Joint Commission, central or peripheral location of the primary tumor, lobar location of the tumor, and maximum tumor diameter as determined by computed tomography or gross pathology. One third of patients with abnormal findings on the computed tomographic scan did not have mediastinal lymph node metastases. Mediastinal metastases occurred frequently in patients with central cancers (38%). The predictive value of a negative scan in all patients was high (greater than or equal to 90%) except for patients with central T3 lesions (72%), left upper lobe lesions (83%), and central adenocarcinomas (75%). However, only the differences between central T3 and central T2 or T1 lesions, and between central adenocarcinomas and central squamous cell carcinomas, were unlikely to be due to chance alone (p less than 0.05). None of the lobar differences were statistically significant. The frequency of mediastinal metastases in patients with peripheral lesions was 15% (28 of 192 patients); computed tomography correctly identified enlarged mediastinal lymph nodes in all but seven patients. However, there were no true-positive computed tomographic scans in 59 patients with peripheral lesions 2 cm in diameter or smaller; accordingly, we suggest that computed tomography is not indicated for the sole purpose of mediastinal staging in this group. Ninety-four percent of patients in this series undergoing thoracotomy with a curative intent had a curative resection. Only 4% had unresectable lesions; palliative resections were done in 2%.

Adult↗

PubMed1986

Intrafissural fat: CT correlation with chest radiography.

A small collection of supradiaphragmatic fat is occasionally present invaginating into the inferior aspect of the major interlobar fissure. In a review of 212 computed tomography (CT) scans obtained in the immediate supradiaphragmatic region, 39 cases demonstrated some degree of this intrafissural fat collection either unilaterally or bilaterally. On lateral chest radiographs, the intrafissural fat corresponded to a sharply marginated triangular density, the base of which abutted the anterior diaphragmatic surface and the apex of which tapered into the major fissure. The triangular density seen on the chest radiographs was superimposed over the heart and cardiac fat pad but was always easy to distinguish from these owing to the continuity of the density with the oblique fissure.

Adipose Tissue↗

PubMed1986

Anterior diaphragm: variations in the CT appearance.

The anterior portion of the diaphragm has three typical appearances on computed tomographic (CT) scans, depending on the cephalocaudal relation of the xiphoid to the central tendon of the diaphragm. The anterior diaphragm most often appears as a relatively smooth or slightly undulating soft-tissue curve, concave posteriorly and continuous across the midline with the lateral diaphragmatic arcs. In the next most frequent CT appearance, the diaphragmatic line is discontinuous in the midline. On each of these images, the muscular line diverges rather than converges as it approaches the anterior chest wall. Less commonly, the anterior portions of the diaphragm are imaged on CT not as a thin line but instead as a broad band with irregular, ill-defined, or angular margins. Occasionally, the anterior diaphragmatic muscle is not identified on CT because the muscle fibers are inseparable from adjacent structures, or are extremely short or even absent. An understanding of these anatomic variations permits the correct diagnosis of Morgagni hernias and explains previously described variants of plain radiographic configurations of pneumoperitoneum.

Diaphragm↗

PubMed1986

Staging with CT.

Explore the source record for details and available documents.

Humans↗

PubMed1986

Bronchopulmonary lavage in pulmonary alveolar proteinosis: chest radiograph observations.

Ten therapeutic bronchopulmonary lavages were performed in four patients with pulmonary alveolar proteinosis. Chest radiographs taken during the lavage procedure showed increased density of the washed lung owing to the presence of instilled lavage saline. Radiographs obtained within the first hours after lavage showed a spectrum of change from minimal improvement to marked worsening compared with prelavage examinations. Subsequent radiographs over the next week showed gradual improvement in the treated lung. By 6 weeks there was moderate to marked improvement of chest radiographs compared with baseline in all cases.

Humans↗

PubMed1986

The role of computed tomography in symptomatic aortic aneurysms.

Forty-seven patients with an abdominal aortic aneurysm (AAA) and recent onset of abdominal or back pain were evaluated by emergency computed tomography (CT) to identify those patients with a confined rupture, and unstable aneurysm, nonaneurysmal cause of pain and a stable AAA. CT suggested that 25 per cent of these had a confined rupture and should undergo emergency surgical treatment. Rupture was confirmed at operation in one-half of these instances. Thirteen per cent avoided operation since other significant pathologic factors were identified. The remaining 47 per cent benefited from optimal preoperative evaluation and semielective surgical treatment. No patient ruptured an AAA during the delay for complete preoperative evaluation and preparation. Additionally, a preoperative CT is useful to identify patients with an unsuspected iliac, suprarenal, thoracic or inflammatory aneurysm. Thus, we believe that CT has a particularly important role in the evaluation of the symptomatic AAA, adding it to the list of indications for CT evaluation of difficult aortic disorders.

Aorta, Abdominal↗

PubMed1985

Bochdalek hernia: prevalence and CT characteristics.

The chest and abdominal computed tomography (CT) scans of 940 patients were reviewed to determine the prevalence of Bochdalek hernias and to evaluate the widely held concept that left-sided hernias occur more than nine times as often as right-sided hernias. Sixty Bochdalek hernias were identified in 52 patients, a prevalence of 6%, which is more than 100 times more frequent than previously reported. Left-sided hernias were found approximately twice as often as right-sided hernias. The Bochdalek hernia is a much more common congenital anomaly in the asymptomatic adult than previously thought and frequently can be identified on routine chest and abdominal CT images.

Diaphragm↗

PubMed1984

Esophageal invasion by lung cancer: CT diagnosis.

Esophageal wall invasion by primary lung carcinoma is an uncommon occurrence. When CT demonstrates a large primary parenchymal lung lesion that appears to cross the midline in the posterior mediastinum, dilute oral barium should be given during the CT examination to demonstrate the location of the esophagus. An esophagus involved by lung carcinoma may show contralateral displacement or partial obstruction. Furthermore, a malignant fistula between esophagus and trachea or lung may also be discovered.

Aged↗

PubMed1984

Renal toxicity of contrast agents: iopamidol, iothalamate, and diatrizoate.

As part of a general safety study of iopamidol, a nonionic iodinated contrast agent, urine N-acetyl-beta-glucosaminidase enzyme assays were done to compare the renal toxicity of iopamidol with that of iothalamate and diatrizoate. In a randomized study of 30 patients for computed body tomography and another 30 patients for angiography, 10 in each group were injected with iopamidol, 10 with iothalamate, and 10 with diatrizoate. After computed tomography or angiography with the three agents, there was no significant difference in urinary enzyme levels among the groups. The nephrotoxicity of iopamidol appears equivalent to that of diatrizoate and iothalamate.

Acetylglucosaminidase↗

PubMed1984

Role of computerized cranial tomography in the staging of small cell carcinoma of the lung.

Fifty-five patients with small cell lung cancer underwent computerized cranial tomography (CCT) and a complete neurologic examination as part of their staging work-up. Fifteen patients (27%) had evidence of brain metastases detected by CCT at the time of diagnosis. Eleven of these 15 patients had new focal abnormalities upon neurologic examination. Of the 44 patients who had no new focal abnormalities upon neurologic examination, four (9%) had CCT findings consistent with brain metastases, and, in three of these patients, the central nervous system was the only site of metastatic disease. Thus, through the use of CCT as a routine procedure in the staging of small cell lung cancer, three patients whose tumors would otherwise have been classified as limited-stage were found to have extensive-stage disease.

Brain Neoplasms↗

PubMed1984

Computed tomography. An effective technique for mediastinal staging in lung cancer.

Computed tomographic scans of the chest were utilized to stage mediastinal disease in 148 instances of bronchogenic carcinoma considered for resection in 146 patients. Nodes greater than or equal to 1.5 cm in diameter were interpreted as abnormal. All nodes positive by computed tomography were evaluated by mediastinoscopy, anterior mediastinotomy, or thoracotomy. All patients with negative computed tomographic findings underwent thoracotomy without prior surgical staging. Patients undergoing thoracotomy were divided into two groups. In Group I (first 51 instances) routine mediastinal exploration was not carried out; in Group II (last 97 instances) the mediastinum was explored in every patient and nodes were submitted for histopathological study. The computed tomographic and pathological findings on the mediastinal lymph nodes were compared. The sensitivity, specificity, and accuracy of computed tomography in Group I were 88%, 94%, and 92%, respectively, in Group II 75%, 89%, and 86%, and in the combined group, 80%, 91%, and 88%. The positive predictive index in Group I, Group II, and in the combined group was 88%, 69%, and 77%, respectively. It was lower for central than peripheral lesions (74% versus 88%) and was lowest for lesions in the right upper and left lower lobes. The negative predictive index was greater than 90% for all groups and all tumor sites except the left upper lobe, where it was 89%. Ten patients had false-positive scans, three with old mediastinitis and seven with postobstructive pneumonia; nine of the 10 had central lesions, and seven of these lesions were located in the right upper lobe. Eight patients had false-negative scans; six had para-aortic, subaortic, or postsubcarinal nodes. These nodes would not have been accessible to mediastinoscopy. In only one patient with false-negative nodes would routine mediastinoscopy have prevented thoracotomy and resection. Computed tomographic staging of mediastinal disease is indicated for all patients with lung cancer in whom operation is contemplated. Computed tomography directs the most appropriate staging procedure for patients with positive findings and obviates invasive staging for patients with negative findings.

Adult↗

PubMed1983

Portal architecture: a differential guide to fatty infiltration of the liver on computed tomography.

Fatty infiltration of the liver, like fatty lesions elsewhere in the body, typically appears as low-density areas on computed tomography (CT). Fatty infiltration of the liver should be considered in the differential diagnosis of homogeneous low-density hepatic lesions regardless of distribution or size. As a physiologic rather than anatomic change, fatty infiltration of the liver characteristically leaves the portal venous architecture unaltered. Although fatty infiltration of the liver typically presents with complete or near complete involvement, other unusual patterns may be encountered. In these atypical cases, recognition of the normal portal structures on CT aids in correct diagnosis.

Fatty Liver↗