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N L Müller

Publications and source records attributed to N L Müller.

At least 55 records · Page 3Linked to original sources
PubMed1999

Thoracic foreign bodies in adults.

AIM: The aim of this pictorial essay is to illustrate a range of imaging manifestations of thoracic foreign bodies. METHODS AND RESULTS: The essay includes documented intrathoracic foreign bodies introduced by inhalation, aspiration, penetrating trauma or ingestion. Imaging modalities include chest radiography and computed tomography (CT). CONCLUSIONS: The majority of foreign bodies are seen on the plain chest radiograph. CT is helpful in demonstrating the presence of radiolucent foreign bodies and determining the exact location of the foreign bodies within the airways or lung parenchyma.

Adult↗
PubMed1999

Lung transplantation for lymphangioleiomyomatosis: role of imaging in the assessment of complications related to the underlying disease.

PURPOSE: To identify the complications and imaging findings related to lymphangioleiomyomatosis (LAM) after lung transplantation. MATERIALS AND METHODS: The authors retrospectively reviewed the clinical histories and imaging studies of 13 patients from five major medical centers who underwent unilateral (n = 8) or bilateral (n = 5) lung transplantation for LAM between 1991 and 1997. Complications related to LAM, both before and after transplantation, were recorded. RESULTS: The following LAM-related complications were found during and after transplantation: excessive pleural adhesions (n = 4), native lung pneumothorax (n = 3), chylous effusion (n = 1), chylous ascites (n = 3), complications from renal angiomyolipomas (n = 4), and recurrent LAM (n = 1). Diagnosis could be made or suggested with computed tomography (CT) in all cases. Four patients (31%) died; one patient died of complications of LAM. CONCLUSIONS: Patients who have undergone lung transplantation for LAM have increased morbidity and mortality due to complications related to their underlying disease. These LAM-related complications can be diagnosed or suggested with CT.

Adult↗
PubMed1999

Clinically suspected pulmonary embolism: utility of spiral CT.

PURPOSE: To prospectively determine the utility of contrast material-enhanced spiral computed tomography (CT) in the examination of patients clinically suspected of having pulmonary embolism (PE). MATERIALS AND METHODS: One hundred ten patients clinically suspected of having PE were examined with contrast-enhanced spinal CT and at least one other imaging modality: ventilation-perfusion scintigraphy, Doppler ultrasonography of deep leg veins, or pulmonary angiography. Chart review or telephone contact with the referring clinician was used to evaluate the contribution of spiral CT to the final clinical diagnosis. RESULTS: Spiral CT helped correctly identify 23 of 25 patients with PE (sensitivity, 92%). In 57 (67%) of the 85 patients without PE, spiral CT provided additional information that suggested or confirmed the alternate clinical diagnosis: pneumonia (n = 14), cardiovascular disease (n = 10), pulmonary fibrosis (n = 7), trauma (n = 6), malignancy (n = 5), pleural disease (n = 4), postoperative changes (n = 4), and other (n = 7). In the remaining 28 patients, spiral CT scans were normal (n = 12), failed to produce findings supportive of the final clinical diagnosis (n = 13), or were false-positive for PE (n = 3; specificity, 96%). CONCLUSION: Spiral CT has good sensitivity and specificity for the diagnosis of PE. In the majority of patients who do not have PE, it also provides important ancillary information for the final diagnosis.

Adolescent↗
PubMed1999

Crazy-paving appearance at thin-section CT: spectrum of disease and pathologic findings.

PURPOSE: To determine the spectrum of disease associated with a fine reticular pattern superimposed on areas of ground-glass opacity (i.e., "crazy-paving" appearance) at thin-section computed tomography (CT) and to determine the underlying pathologic features. MATERIALS AND METHODS: In the in vivo study, the cases of 46 patients (21 male, 25 female; age range, 13-82 years) were retrospectively reviewed, with special attention paid to the size and extent of the reticular network. In the in vitro study, the thin-section CT findings in 20 inflated and fixed lungs were precisely correlated with the gross appearance, contact radiograph findings, stereomicroscopic views, and histologic findings. RESULTS: In the in vivo study, 15 different diseases were identified, including alveolar proteinosis, adult respiratory distress syndrome, acute interstitial pneumonia, diffuse alveolar damage superimposed on usual interstitial pneumonia, and drug-induced pneumonitis. In the in vitro study, the fine networks at pathologic analysis were due to an alveolar filling process (n = 10), an interstitial fibrotic process (n = 7), or a combination of interstitial and intraalveolar processes (n = 3). Twelve (60%) cases did not have thickening of the interlobular septa within the areas of the crazy-paving appearance. CONCLUSION: The crazy-paving appearance is a nonspecific finding seen in a variety of interstitial and airspace lung diseases.

Female↗
PubMed1999

Idiopathic interstitial pneumonias: diagnostic accuracy of thin-section CT in 129 patients.

PURPOSE: To determine whether idiopathic interstitial pneumonias can be differentiated on the basis of the pattern and distribution of abnormalities at thin-section computed tomography (CT). MATERIALS AND METHODS: Thin-section CT scans in 129 patients with histologically proved idiopathic interstitial pneumonia (35 with usual interstitial pneumonia [UIP], 24 with bronchiolitis obliterans organizing pneumonia [BOOP], 23 with desquamative interstitial pneumonia [DIP], 20 with acute interstitial pneumonia [AIP], and 27 with nonspecific interstitial pneumonia and fibrosis [NIPF]) were independently assessed by two observers without knowledge of clinical or histologic data. The observers recorded the abnormalities, diagnosis, and degree of confidence in their diagnosis. Differential diagnosis was limited to the five types of idiopathic interstitial pneumonia. RESULTS: The two observers made a correct diagnosis, on average, in 74 (57%) cases. On average, the correct diagnosis was made in 25 (71%) cases of UIP, 19 (79%) of BOOP, 14.5 (63%) of DIP, 13 (65%) of AIP, and 2.5 (9%) of NIPF. The two observers made a correct diagnosis with a high degree of confidence in 50 (39%) readings. There was moderate agreement between the observers for the correct diagnosis (k = 0.55) and for the correct diagnosis with a high degree of confidence (k = 0.65). CONCLUSION: Except for NIPF, the various subtypes of idiopathic interstitial pneumonias often have a characteristic appearance that allows differentiation at thin-section CT.

Adult↗
PubMed1999

Acute interstitial pneumonia: thin-section CT findings in 36 patients.

PURPOSE: To characterize the computed tomographic (CT) findings of acute interstitial pneumonia and to correlate the pattern and the extent of abnormalities with the time between symptom onset and CT. MATERIALS AND METHODS: The study included 36 patients (20 men, 16 women; age range, 22-83 years; mean age, 61 years) with histopathologically proved acute interstitial pneumonia who were identified retrospectively. The time between symptom onset and CT was 2-90 days (mean, 22 days; median, 17 days). The presence, extent, and distribution of various CT findings were evaluated. Disease duration and extent of each finding were compared by using the Spearman rank correlation coefficient. RESULTS: Areas with ground-glass attenuation, traction bronchiectasis, and architectural distortion were present in all 36 patients. Airspace consolidation was present in 33 patients (92%). The extent of areas of ground-glass attenuation (r = 0.45, P < .01) and the extent of traction bronchiectasis (r = 0.35, P < .05) correlated with disease duration. No other significant correlation was found between the CT findings and disease duration. CONCLUSION: A combination of ground-glass attenuation, airspace consolidation, traction bronchiectasis, and architectural distortion is seen in the majority of patients with acute interstitial pneumonia. The extent of ground-glass attenuation and traction bronchiectasis increases with disease duration.

Acute Disease↗
PubMed1999

Lymphocytic interstitial pneumonia: thin-section CT findings in 22 patients.

PURPOSE: To assess the thin-section computed tomographic (CT) findings of lymphocytic interstitial pneumonia. MATERIALS AND METHODS: The study included 22 patients (five men, 17 women; age range, 24-83 years; mean age, 50 years) with biopsy-proved lymphocytic interstitial pneumonia. The CT scans were obtained by using 1-3-mm collimation and reconstructed by using a high-spatial-frequency algorithm. RESULTS: The predominant abnormalities consisted of areas of ground-glass attenuation and poorly defined centrilobular nodules present in all 22 patients and subpleural small nodules seen in 19 patients. Other common findings included thickening of bronchovascular bundles (n - 19), interlobular septal thickening (n = 18), cystic airspaces (n = 15), and lymph node enlargement (n = 15). Less common findings included large nodules, emphysema, airspace consolidation, bronchiectasis, architectural distortion, honeycombing, and pleural thickening. CONCLUSION: Lymphocytic interstitial pneumonia is characterized by the presence of ground-glass attenuation, poorly defined centrilobular nodules, and thickening of the interstitium along the lymphatic vessels. Lymph node enlargement is more common than previously recognized; it was seen in 68% of patients.

Biopsy↗
PubMed1999

Follicular bronchiolitis: thin-section CT and histologic findings.

PURPOSE: To evaluate the thin-section computed tomographic (CT) findings of follicular bronchiolitis and compare them with the histologic findings. MATERIALS AND METHODS: Thin-section CT scans obtained in 12 patients (age range, 24-77 years; mean age, 47 years) with follicular bronchiolitis proved at open lung biopsy were reviewed by two observers. Underlying conditions included rheumatoid arthritis (n = 8), mixed collagen vascular disorders (n = 2), autoimmune disorder (n = 1), and acquired immunodeficiency syndrome (n = 1). All patients had thin-section CT scans (1.0-1.5-mm collimation, 11 patients; 3.0-mm collimation, one patient; high-spatial-frequency reconstruction algorithm) obtained at 10-mm intervals through the chest. RESULTS: The main CT findings included bilateral centrilobular (n = 12) and peribronchial (n = 5) nodules. All 12 patients had nodules smaller than 3 mm in diameter; six patients also had nodules 3-12 mm in diameter. Areas of ground-glass opacity were present in nine (75%) patients. Histologically, all patients had lymphoid hyperplasia along the bronchioles; eight had peribronchiolar lymphocytic infiltration. CONCLUSION: The cardinal CT feature of follicular bronchiolitis consists of small centrilobular nodules variably associated with peribronchial nodules and areas of ground-glass opacity.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Bronchiectasis: accuracy of high-resolution CT in the differentiation of specific diseases.

OBJECTIVE: The aim of the study was to determine whether various causes of bronchiectasis can be differentiated by the pattern and distribution of abnormalities seen on high-resolution CT. MATERIALS AND METHODS: The retrospective study included 82 consecutive patients who had a specific diagnosis of bronchiectasis proven by appropriate clinical and laboratory criteria. All patients underwent high-resolution CT scanning (1- to 1.5-mm collimation). The CT scans were assessed for the presence, extent, type, and anatomic distribution of bronchiectasis by two independent observers who were not aware of the clinical data. The observers recorded their most likely diagnosis and the degree of confidence in that diagnosis. RESULTS: The two independent observers made a correct diagnosis in 61% of cases (100/164 interpretations). On average, a correct diagnosis was made in 19 (68%) of 28 cases of cystic fibrosis, 16 (67%) of 24 cases of previous tuberculosis, six (43%) of 14 cases of previous childhood infection, five (56%) of nine cases of allergic bronchopulmonary aspergillosis, and four (57%) of seven cases of other causes of bronchiectasis. We found moderate agreement between the observers for the correct diagnosis (kappa = .53) and good agreement for the presence or absence of bronchiectasis in each lobe (kappa = .71). CONCLUSION: The pattern and distribution of abnormalities revealed by high-resolution CT in patients with bronchiectasis are influenced by the underlying cause. Bilateral, predominantly upper lobe, bronchiectasis is seen most commonly in patients with cystic fibrosis and allergic bronchopulmonary aspergillosis, unilateral upper lobe predominance in patients with tuberculosis, and lower lobe predominance in patients after childhood viral infection.

Adolescent↗
PubMed1999

Chronic pulmonary paracoccidioidomycosis (South American blastomycosis): high-resolution CT findings in 41 patients.

OBJECTIVE: To assess the pulmonary parenchymal findings on high-resolution CT in 41 patients with the chronic form of paracoccidioidomycosis (South American blastomycosis). SUBJECTS AND METHODS: The study included 41 consecutive patients in whom chronic paracoccidioidomycosis had been proven. All patients underwent high-resolution CT (1-mm collimation, high-spatial-frequency reconstruction algorithm) at 12 equally spaced intervals through the chest. The images were analyzed by two radiologists, and each final decision was reached by consensus. RESULTS: Thirty-eight (93%) of the 41 patients had CT scans with abnormal findings. The findings included interlobular septal thickening in 36 patients (88%), 1-25 mm diameter nodules in 34 (83%), peribronchovascular interstitial thickening in 32 (78%), centrilobular opacities in 26 (63%), intralobular lines in 24 (59%), ground-glass opacities in 14 (34%), cavitation in seven (17%), air-space consolidation in five (12%), traction bronchiectasis in 34 (83%), and paracicatricial emphysema in 28 (68%). In approximately 90% of patients, the abnormalities were bilateral and symmetrical and involved all lung zones. CONCLUSION: High-resolution CT findings of paracoccidioidomycosis consist predominantly of interstitial abnormalities and nodules associated with traction bronchiectasis and paracicatricial emphysema in a bilaterally symmetrical distribution.

Adult↗
PubMed1999

Accuracy of CT in the diagnosis of allergic bronchopulmonary aspergillosis in asthmatic patients.

OBJECTIVE: The purpose of this study was to assess the accuracy of high-resolution CT in the diagnosis of allergic bronchopulmonary aspergillosis in asthmatic patients. MATERIALS AND METHODS: The high-resolution CT scans of 44 asthmatic patients with allergic bronchopulmonary aspergillosis and 38 asthmatic patients without allergic bronchopulmonary aspergillosis were analyzed retrospectively and randomly by two independent observers for these features: bronchial wall thickening, bronchiectasis, centrilobular nodules, mucoid impaction, mosaic perfusion, atelectasis, and consolidation. Each observer made a final diagnosis with a stated degree of confidence. The results are expressed as the average number of observations by the two observers. RESULTS: Findings seen more commonly in patients with allergic bronchopulmonary aspergillosis than in patients with asthma alone included bronchiectasis, centrilobular nodules, and mucoid impaction (p < .01, chi-square test). Bronchiectasis was present in 42 (95%) of 44 patients with allergic bronchopulmonary aspergillosis, centrilobular nodules in 41 (93%), and mucoid impaction in 29.5 (67%) (average of two observers). In the asthmatic control group, bronchiectasis was detected in 11 (29%) of 38 patients, centrilobular nodules in 10.5 (28%), and mucoid impaction in 4%. Bronchiectasis was seen in 184 (70%) of 264 lobes of patients with allergic bronchopulmonary aspergillosis compared with 19.5 (9%) of 228 lobes in asthmatic controls (p < .001, chi-square test). CONCLUSION: In asthmatic patients, bronchiectasis affecting three or more lobes, centrilobular nodules, and mucoid impaction are findings on high-resolution CT that are highly suggestive of allergic bronchopulmonary aspergillosis.

Adult↗
PubMed1999

Respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia: different entities or part of the spectrum of the same disease process?

OBJECTIVE: Our objective was to assess high-resolution CT findings of respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia and to determine whether these three entities could be reliably differentiated by radiologic criteria. MATERIALS AND METHODS: CT scans (1- to 3-mm collimation) were reviewed in 40 patients with pathologically proven respiratory bronchiolitis (n = 16), respiratory bronchiolitis-associated interstitial lung disease (n = 8), or desquamative interstitial pneumonia (n = 16). All patients with respiratory bronchiolitis and respiratory bronchiolitis-associated interstitial lung disease were cigarette smokers, and 85% of the patients with desquamative interstitial pneumonia had a history of smoking. CT scans were independently reviewed by two radiologists who assessed the pattern and distribution of abnormalities. RESULTS: The predominant abnormalities in respiratory bronchiolitis were centrilobular nodules (12 [75%] of 16 patients) and ground-glass attenuation (six [38%] of 16). No single abnormality predominated in the respiratory bronchiolitis-associated interstitial lung disease group; findings included ground-glass attenuation (four [50%] of eight), centrilobular nodules (three [38%] of eight), and mild fibrosis (two [25%] of eight). All patients with desquamative interstitial pneumonia showed ground-glass attenuation, and 10 (63%) of the 16 showed evidence of fibrosis. CONCLUSION: The significant overlap between the CT findings of respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia is consistent with the concept that they represent different degrees of severity of small airway and parenchymal reaction to cigarette smoke.

Adult↗