[Bilateral perihilar alveolar opacities with major changes in health status].
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Actinomycosis↗
Biomedical subjects
M F Carette
Publications and source records attributed to M F Carette.
Diffuse panbronchiolitis in an Asian immigrant.
Diffuse panbronchiolitis (DPB) is a disease with chronic inflammation exclusively located in the region of the respiratory bronchiole. It is largely restricted geographically to the Far East, and cases in Western countries are exceptional, even among Asian immigrants. A patient of Asian origin with DPB who had been living in France for 10 years is described. Only re-examination of the initial open lung biopsy specimen after an eight year period allowed this rare disease to be diagnosed correctly. The known efficacy of low dose erythromycin in DPB was again confirmed after failure of long term high dose corticosteroid therapy administered before an accurate diagnosis had been made.
Adult↗
Pulmonary tuberculosis: comparison of CT findings in HIV-seropositive and HIV-seronegative patients.
PURPOSE: To determine the differences in the computed tomographic (CT) appearance of pulmonary tuberculosis (TB) between patients with and patients without human immunodeficiency virus (HIV) infection. MATERIALS AND METHODS: CT scans and chest radiographs of 42 HIV-seropositive and 42 HIV-seronegative patients with pulmonary TB were reviewed. CD4 T-lymphocyte counts, measured in 40 seropositive patients, were at least 200 cells per microliter in 10 patients and were less that 200 cells per microliter in 30. RESULTS: Seropositive patients had a higher prevalence of lymphadenopathy at chest radiography (P< .05). The seropositive patients had a lower prevalence of consolidation (P< .05), cavitation (P< .01), and postprimary pattern (P< .05) at CT. HIV-seropositive patients had a higher frequency of miliary (P< .01) and extrapulmonary disease (P< .001). Similar features of pulmonary TB were observed in seropositive patients with mild and severe immunosuppression. CONCLUSION: HIV-seropositive patients had a lower prevalence of localized parenchymal disease and a higher prevalence of disseminated disease at CT.
AIDS-Related Opportunistic Infections↗
Site-directed bronchoalveolar lavage and transbronchial biopsy in HIV-infected patients with pneumonia.
We have assessed the diagnostic value of site-directed bronchoalveolar lavage (BAL) and combined transbronchial biopsy (TBB) in 29 HIV-infected patients with localized pneumonia, in whom a previous BAL was nondiagnostic and in whom improvement did not occur with empiric antibiotic therapy. All patients but three had a CD4 cell count < 100/microliters. A definite diagnosis could be reached in 26 of 29 (90%) individuals, including 24 pathogens. Neither the radiologic pattern nor the type of Pneumocystis carinii (PC) prophylaxis could predict the positivity of either one of these two diagnostic procedures. Site-directed BAL alone allowed a diagnosis in infection in eight (28%) cases. TBB alone led to diagnosis in eight (28%) cases, including three PC and two toxoplasma gondii, undiagnosed by the site-directed BAL. Both techniques were positive and in agreement in 10 (34%) cases. The majority of the diagnosis led to a specific treatment. Therefore, the patients' survival was positively altered by the procedure. In conclusion, the performance of site-directed BAL and combined TBB markedly optimizes the diagnostic yield of each of these procedures performed separately in HIV-infected patients with localized pneumonia.
Adult↗
Haemodynamics and gas exchange before and after coil embolization of pulmonary arteriovenous malformations.
A complete description of haemodynamics and gas exchange before and after percutaneous coil embolization of multiple pulmonary arteriovenous malformations is reported in a 45 year old woman with hereditary haemorrhagic telangiectasis (HHT). Before treatment, whilst the patient complained of severe dyspnoea during daily activities, an intrapulmonary shunt of 31% was measured (inert gas elimination technique), together with a cardiac output (thermodilution technique) of 12.4 L.min-1, resulting in a resting arterial oxygen tension (PaO2) of 8.53 kPa. Effective occlusion of all visible pulmonary malformations resulted in a rapid and major improvement in exercise tolerance, whilst resting PaO2 remained almost unchanged. A second investigation performed 4 months after treatment revealed a persistent intrapulmonary shunt of 19%, a cardiac output of 7.35 L.min-1, and a resting PaO2 of 10.53 kPa. We conclude that major increases in cardiac output largely contribute to the maintenance of PaO2 in patients with multiple pulmonary arteriovenous malformations and intrapulmonary shunt. The benefit of coil embolization is due both to an improvement in arterial oxygenation and a normalization of cardiac output.
Arteriovenous Malformations↗
Bronchogenic cyst presenting as mediastinal mass with pleural effusion.
Mediastinal bronchogenic cysts are usually identified on computed tomography (CT) as well-defined masses of variable density that may contain rim calcifications. Pleural effusion has never been described in association with these cysts. We report two cases of bronchogenic cysts with unusual presentation because of an association with a pleural effusion not explained by pulmonary infection. The patients were studied with CT scan (n = 2) and magnetic resonance imaging (MRI) of the chest (n = 1). In the first case, the pleural effusion directed diagnosis towards lung tumour; and the diagnosis of bronchogenic cyst was made on thoracotomy. In the second case, bronchogenic cyst was suspected on MRI findings. Inflammatory reaction was also suspected on the CT scan, which showed enhancement of the cyst edge. In both cases, surgical excision of the cyst was difficult because of pericystic adhesions to adjacent organs. Therefore, solely on the finding of a pleural effusion, pericystic inflammation had to be suspected.
Bronchogenic Cyst↗
Intrathoracic Kaposi's sarcoma. CT findings.
AIM: To describe the thin CT scans findings in AIDS patients with intrathoracic Kaposi's sarcoma (KS). MATERIAL AND METHODS: Fifty-three CT scans of patients with KS were retrospectively reviewed. The diagnosis of intrathoracic KS was established histologically (n = 17) or on the association of skin KS and the visualization of characteristic endobronchial lesions (n = 36). CT scans were performed with thin slices (2 mm) obtained at 10-mm intervals, and a 512 x 512 reconstruction matrix. No patients had Pneumocystis carinii pneumonia within the 3 months preceding the CT scan examination. RESULTS: Numerous nodules (n = 42), tumoral masses (n = 28), bronchovascular pathways thickening (n = 35), and pleural effusions (n = 28) were the most frequent patterns. Septal lines (n = 15), ground-glass opacities (n = 3), and mediastinal adenopathies (n = 8) were not frequent. CONCLUSION: Numerous nodules, tumoral masses, bronchovascular pathways thickening, and bilateral pleural effusions were the main signs of intrathoracic KS; their association (66%) is very characteristic. An opportunistic infection or mycobacteriosis must be sought if the thin CT scans reveal ground-glass opacities and/or mediastinal adenopathies.
Acquired Immunodeficiency Syndrome↗
[Imaging of lipoma of the pericardium].
Pericardial lipoma is a benign mediastinal tumours. Its location into the pericardial space is well demonstrated by MRI or CT if pericardium is visible; otherwise, diagnosis is evoked on the displacement or compression of cardiac cavities.
Female↗
[Hemoptysis in sarcoidosis. Apropos of 6 cases including 4 with fatal outcome].
Haemoptysis rarely occurs in sarcoidosis. Most cases usually occur in patients with advanced disease and major fibrosis. We observed 6 cases including 5 with fibrosis and 1 with inaugural unilateral lymph node involvement. Haemoptysis is a sign of gravity since it is the second most frequent cause of death described in the literature. In our series 4 of the 6 cases were fatal. Aspergillus colonization of a cavity is the most frequently found aggravating factor. Ideally, surgery is indicated but usually cannot be performed due to the patients respiratory function and the extent of the lesions. Oral drugs have little effect. Certain authors have had success with local, initially intrabronchic anti-aspergillus treatment. CT-guided application is often helpful. Embolization may stop the bleeding but in the long-term, a more or less voluminous haemoptysis often recurs. Other causes of bleeding are rare. Systemic hypervascularization of sarcoidosis lesions has been proposed as one mechanism other than infection. The cause may also be a simple granuloma. Symptomatic initial treatment by embolization is also proposed in these cases. Finally, massive haemoptysis can occur by erosion of the pulmonary artery due to a necrotic sarcoidosis lesion. In our series, surgery was impossible in three patients who died. In the three others, embolization was possible in 2 and the third underwent successful surgery.
Adolescent↗
[Posterior mediastinal mass].
Bronchogenic cyst of esophagus wall with intracystic haemorrhage in a patient with C hepatitis and portal hypertension. CT and MRI study.
Adult↗
[Thoracic imaging in AIDS].
Chest complications were the first known in AIDS; even, Pneumocystis carinii pneumonia was the initial warning light. At the present time lung complications remain the major cause of death in such patients. A better knowledge of these pathologies often allows to pass an acute episode and perhaps to prevent infectious pathologies, so, leading to the observation of extra-thoracic pathologies. Preventive treatments and increasing survival time allow the appearance of some atypical aspects of Pneumocystis carinii pneumonia such as apical, necrotic or pseudotuberculous forms. On the other hand, lung tuberculosis is observed with a particular frequency in these patients. It has very rarely a nodular or excavated aspect and looks frequently like a primary tuberculosis. If such infectious chest complications have to be recognized very quickly, we have to know the possibility of non infectious disease, and firstly of Kaposi's sarcoma. Radiological aspect, especially from chest-X-ray, is one of the first diagnostic guide. It gives the orientation for other examinations opposing, disseminated or diffused pneumopathy to focal or localized one. In the first group, we have to distinguish alveolo-interstitial patterns from nodular patterns. Necrotic or suppurative aspects and the association with pleural, mediastinal or hilar lesions are important signs, sometimes better shown on CT scan. Moreover, chest-CT scan is able to guide new endoscopic samples or to guide transthoracic biopsies, allowing sometimes to avoid an open lung biopsy.
AIDS-Related Opportunistic Infections↗
Results of chemotherapy in 30 AIDS patients with symptomatic pulmonary Kaposi's sarcoma.
BACKGROUND: The aim of this study was to report the effects of a three-drug chemotherapy regimen in patients with symptomatic AIDS-related pulmonary Kaposi's sarcoma and to analyse prognostic factors for survival. METHODS: Thirty consecutive HIV seropositive patients with respiratory symptoms and proven pulmonary Kaposi's sarcoma were treated with the same therapeutic regimen comprising adriamycin (30 mg/m2), bleomycin (10 mg/m2), and vincristine (2 mg) administered intravenously once every four weeks. RESULTS: Two patients died during the first course of chemotherapy. In the other 28 cases dyspnoea improved and Pao2 rose despite minimal (n = 17) or no (n = 11) improvement in the chest radiographic appearance. The median survival from the beginning of chemotherapy was 6.5 months. Poor prognostic factors for survival were: (1) absence of cutaneous Kaposi's sarcoma; (2) previous opportunistic infection; (3) CD4 cell count < 100/microliters; (4) leucocytes < 3500/microliters; (5) haemoglobin < 10 g/dl; and (6) absence of radiological response. Of the 28 patients 24 experienced at least one episode of neutropenia which was associated with bacterial infection in 16 cases. CONCLUSIONS: Chemotherapy may improve respiratory impairment in patients with extensive pulmonary Kaposi's sarcoma but the outcome remains poor. The efficacy of chemotherapy may be limited by neutropenia.
Acquired Immunodeficiency Syndrome↗
Magnetic resonance imaging findings in pulmonary Kaposi's sarcoma: a series of 10 cases.
Since chest X-ray and CT scan features of Kaposi's sarcoma (KS) are nonspecific, we wanted to test the hypothesis that the histological components of this tumour and/or the associated haemorrhagic component, may result in a characteristic signal pattern on magnetic resonance imaging (MRI). Thoracic MRI was performed in a prospective manner in ten patients with acquired immune deficiency syndrome (AIDS) and pulmonary KS. MRI examinations (1.5 Tesla) included Spin-echo T1 (SE-T1), before and after gadolinium injection, as well as T2-weighted sequences (SE-T2). For each sequence the signal intensity of lesions was measured and compared with each other as well as with the signal intensity of muscle. Results were compared to the hemosiderin content of macrophages in the bronchoalveolar lavage (BAL) in all patients and with histological findings in three. The results were compared to values obtained in a control group of seven patients with pneumocystis carinii pneumonia. SE-T1 showed focally increased signal intensity in the pulmonary parenchyma (n = 5). Signal enhancement in parenchymal lesions (n = 10) and along peribronchovascular trees (n = 5) was observed after gadolinium injection. The second echo of SE-T2 showed a markedly reduced signal intensity in pathologic areas (n = 10). This last finding was not observed in the control group. In conclusion, we have identified a pattern of MRI signal abnormalities suggestive of Kaposi's sarcoma. The MRI signal intensity of KS lesions may be related to the angiomatous and fibrous components of the tumour.(ABSTRACT TRUNCATED AT 250 WORDS)
AIDS-Related Opportunistic Infections↗
Assessment of bone marrow involvement by magnetic resonance imaging in small cell lung cancer. No significant change of staging.
STUDY OBJECTIVE: This prospective study was performed in an attempt to evaluate (1) the rate of magnetic resonance imaging (MRI) demonstrating bone marrow (BM) abnormalities, (2) the correlation of these abnormalities with a pathologic malignant BM involvement, and (3) the possible modification of patients' usual disease staging in the light of these abnormalities. METHODS: After extensive staging investigations, patients' diseases were classified as limited or extensive. Dorsal and lumbar spine MRI was performed for second staging. RESULTS: Thirty-two patients were eligible for this study. In ten patients (31.2 percent), MRI showed abnormalities; in four of them, the BM sample from the posterior iliac crest was free from malignancy. Three of these four patients had extensive disease. The last patient, because he had limited disease, had biopsy at the site of MRI abnormalities; the biopsy specimen revealed a malignant involvement and therefore this patient, initially classified as having limited disease, was classified in the extensive disease group. In only 1 of 32 patients, BM-MRI data modified initial staging. CONCLUSIONS: The metastases disclosure yield of the MRI in the detection of medullar involvement is higher than BM biopsy but especially in patients with extensive disease. Therefore, MRI should not be considered in routine practice, in particular in patients with extensive disease.
Biopsy↗
[Right hilar mass and pleural effusion].
One case of bronchogenic cyst associated with a pleural effusion is reported. Computed tomography and magnetic resonance imaging (MRI) findings are described.
Bronchogenic Cyst↗
[Contribution of imaging in the diagnosis and follow-up of thoracic tuberculosis].
Imaging as an essential tool for diagnosis and follow-up of pulmonary tuberculosis. Standard radiography is of prime importance, while in a large number of cases computed tomography (CT) and in selected exceptional cases with spinal involvement, magnetic resonance imaging (MRI) offer further precisions. CT is particularly important for diagnosis because of a better spatial visualization of the lesions and a better evaluation of their structure, both in the parenchyma and in the mediastinum; this indication is especially important in black Africans and in AIDS patients. CT can also be used to guide biopsies. It is particularly important for prognosis in the acute phase even though the tuberculosis may be patent and the bacterial strain identified. There is however still room for discussion on the balance between requirements, usefulness and cost. Finally CT is an excellent means of conducting long-term follow-up of sequellae as long as it is performed at least one year after the initial manifestations of the disease.
AIDS-Related Opportunistic Infections↗
[Imaging of thoracic tuberculosis].
This paper reviews the various radiological signs of tuberculosis including cavities and nodules, alveolar foci, hilar or mediastinal lymphadenopathy and serosal, bronchial and vertebral involvement. It describes the various clinical features and the clinical course of tuberculosis depending on the presence or absence of these signs and their combinations and according to the particular clinical context.
AIDS-Related Opportunistic Infections↗
[Accidental finding by tomodensitometry during follow up of bronchial carcinoma].
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Aged↗