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Biomedical subjects

N L Müller

Publications and source records attributed to N L Müller.

At least 109 records · Page 6Linked to original sources
PubMed1996

High-attenuation mucous plugging in allergic bronchopulmonary aspergillosis.

OBJECTIVE: To assess the prevalence of high-attenuation mucous plugs observed on chest computed tomography (CT) scans in patients with allergic bronchopulmonary aspergillosis. PATIENTS AND METHODS: The CT scans of 14 patients with allergic bronchopulmonary aspergillosis, seen between July 1990 and July 1994 at a single tertiary-care institution, were reviewed. The presence and distribution of high-attenuation mucous plugs were recorded in each case. RESULTS: High-attenuation mucous plugs were present in 4 (28%) of the 14 patients. Mucous plugging was unilobar in three of these four patients. Mucous plugging with attenuation similar to that of chest wall muscle was not found in any of the patients with high-attenuation plugging. CONCLUSIONS: High-attenuation mucous plugs occur in approximately one quarter of patients with allergic bronchopulmonary aspergillosis and may be more common in patients with unilobar plugging.

Adult↗
PubMed1996

Interlobular septal thickening: patterns at high-resolution computed tomography.

Thickening of the interlobular septa is a common and easily recognizable finding at high-resolution computed tomography (HRCT; 1-2 mm collimation high-spatial-frequency reconstruction algorithm). Interlobular septal thickening at HRCT can be smooth, nodular, or irregular in contour. It may be due to fluid, cellular infiltration, or fibrosis. Apparent thickening of septa at HRCT may also be due to abnormalities in the periphery of the secondary pulmonary lobule adjacent to but not involving the interlobular septa. This article illustrates the patterns of interlobular septal thickening at HRCT in various disease entities.

Adult↗
PubMed1996

High-resolution computed tomography and pathologic findings in pulmonary aspergillosis: a pictorial essay.

Aspergillus can cause a wide spectrum of pulmonary complications. It may colonize pre-existing cavities to form mycetomas. In asthmatic patients it may lead to a hypersensitivity reaction involving eosinophilic infiltration of the bronchial wall and mucoid impaction (a condition called allergic bronchopulmonary aspergillosis) or granulomatous inflammation (bronchocentric granulomatosis). In the immunocompromised host, Aspergillus may invade blood vessels, causing hemorrhagic infarction (angioinvasive aspergillosis), or it may cause tracheobronchitis, bronchiolitis or pneumonia (airway invasive aspergillosis), as well as abscess formation with or without adjacent tissue invasion. Each of the manifestations of Aspergillus infection has a distinct histologic and high-resolution computed tomography (CT) appearance. This pictorial essay reviews the characteristic high-resolution CT and corresponding pathologic findings of pulmonary complications due to Aspergillus fumigatus.

Adolescent↗
PubMed1995

Acute lung disease in the immunocompromised host: differential diagnosis at high-resolution CT.

The aim of this manuscript is to review the CT findings of pulmonary complications seen in acquired immunodeficiency syndrome (AIDS) and in non-AIDS immunocompromised patients. The most common pulmonary complications in patients with AIDS include infection, Kaposi's sarcoma, and AIDS-related lymphoma. The most common complications seen in non-AIDS immunocompromised patients include infection, drug-induced lung disease, diffuse pulmonary hemorrhage, and pulmonary edema.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Neuroendocrine cell hyperplasia and obliterative bronchiolitis in patients with peripheral carcinoid tumors.

Specimens from 25 consecutive patients undergoing lung resection for peripheral carcinoid tumor were examined for evidence of neuroendocrine cell hyperplasia and associated obliterative bronchiolitis. Where available, the CT scans (n = 11) were reviewed for evidence of multiple tumors, and pulmonary function data (n = 16) were reviewed for evidence of airflow obstruction. Nineteen of the 25 patients (76%) had neuroendocrine cell hyperplasia in addition to the dominant carcinoid tumor. Eight patients (32%) had lesions of obliterative bronchiolitis associated with foci of neuroendocrine cell hyperplasia, and two of these patients had asymptomatic airflow obstruction that could not be related to smoking or other lung disease. We conclude that multicentric neuroendocrine cell proliferation is common in patients with peripheral carcinoid tumor of the lung. Associated bronchiolar fibrosis occurs in a high proportion of such patients, but it is usually asymptomatic.

Adult↗
PubMed1995

Pulmonary tuberculosis and Mycobacterium avium-intracellulare: a comparison of CT findings.

PURPOSE: To compare the computed tomographic (CT) findings of tuberculosis and Mycobacterium avium-intracellulare (MAI) infection in immunocompetent patients. MATERIALS AND METHODS: Seventy-seven consecutive immunocompetent patients with culture-proved pulmonary mycobacterial infection (45 with pulmonary tuberculosis, 32 with MAI) underwent thin-section CT. CT scans were randomized and reviewed by two observers; decisions were reached by consensus. RESULTS: Micronodules, consolidation, and cavity formation in the lung were seen with similar frequency in pulmonary tuberculosis and MAI cases. Twenty-three patients (51%) with tuberculosis and four patients (12%) with MAI had interlobular septal thickening (P < .001). Twelve patients (27%) with tuberculosis and 30 patients (94%) with MAI had bronchiectasis (P < .001). Bronchiectasis was seen in a mean of 4.6 +/- 1.8 and 1.8 +/- 1.6 lobes (+/- standard deviation) in each patient with MAI and with tuberculosis, respectively (P < .01). CONCLUSION: Although CT findings of pulmonary tuberculosis and MAI are similar, interlobular septal thickening is more common in patients with tuberculosis and bronchiectasis is more common and more extensive in patients with MAI.

Adolescent↗
PubMed1995

Diaphragmatic rupture: CT findings in 11 patients.

PURPOSE: To determine the signs of diaphragmatic rupture at computed tomography (CT) and the frequency of preoperative diagnosis with CT. MATERIALS AND METHODS: CT scans in 11 consecutive patients with surgically proved tears of the diaphragm due to blunt trauma were reviewed by two chest radiologists. The observers assessed the presence of discontinuity of the diaphragm, herniation of abdominal viscera or omentum, and waistlike constriction of the herniated stomach or bowel (collar sign). Hospital records were reviewed to confirm surgical findings and ascertain whether the diagnosis has been suggested at CT. RESULTS: In eight of 11 patients, rupture of the diaphragm was on the left, and in three it was on the right. In nine patients, diagnostic findings were identified retrospectively on CT scans; these included discontinuity of the diaphragm (n = 9), herniation of the abdominal organs or bowel (n = 7), and constriction of the stomach (n = 3). CONCLUSION: CT enables detection of most diaphragmatic tears due to blunt trauma.

Adult↗
PubMed1995

Bronchiectasis: comparison of preoperative thin-section CT and pathologic findings in resected specimens.

PURPOSE: To compare thin-section computed tomographic (CT) and pathologic findings in patients who have undergone resection for bronchiectasis. MATERIALS AND METHODS: Twenty-two consecutive patients underwent thin-section CT (1.0-1.5-mm collimation) and resection for bronchiectasis. CT scans were reviewed by two observers without knowledge of the pathologic findings. The presence and extent of bronchiectasis and associated findings were assessed. All pathologic specimens were reviewed by a pathologist. RESULTS: Forty-seven lobes had pathologically proved bronchiectasis. CT allowed detection of bronchiectasis in 41 lobes (87%). CT findings included lack of tapering of bronchial lumina (n = 37), internal diameter of bronchi greater than that of the adjacent pulmonary artery (n = 28), visualized bronchi within 1 cm of pleura (n = 21), and mucus-filled dilated bronchi (n = 3). Forty lobes had bronchiolitis. CT scans depicted bronchiolitis in 30 lobes (75%). CT findings of bronchiolitis included mosaic perfusion (n = 21), bronchiolectasis (n = 17), and centrilobular nodules or branching areas of soft-tissue attenuation (n = 10). CONCLUSION: Thin-section CT depicted bronchiectasis in most of the resected bronchiectatic lobes.

Adolescent↗
PubMed1995

Invasive pulmonary aspergillosis in AIDS: radiographic, CT, and pathologic findings.

PURPOSE: To review the radiographic and computed tomographic (CT) manifestations of invasive pulmonary aspergillosis and to correlate the imaging and pathologic findings in patients with acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: Chest radiographs, CT scans, and pathologic specimens were reviewed retrospectively in 10 AIDS patients with proved invasive pulmonary aspergillosis. RESULTS: The most common radiographic finding was the presence of thick-walled cavitary lesions. Less common findings included nodules, consolidation, and pleural effusion. CT depicted more nodules and cavities than did radiography. The predominant pathologic abnormalities consisted of tissue invasion and abscess formation and angioinvasion with or without infarction. All patients had infection with Aspergillus fumigatus as well as other pathogens, the most common being cytomegalovirus and Pseudomonas aeruginosa. CONCLUSION: Thick-walled cavitary lesions are the most common radiologic manifestation of invasive pulmonary aspergillosis in AIDS. The findings are more numerous and better defined on CT scans. The radiologic findings reflect a spectrum of pathologic abnormalities.

AIDS-Related Opportunistic Infections↗
PubMed1995

Intrathoracic lymphoproliferative disorders in the immunocompromised patient: CT findings.

PURPOSE: To assess the computed tomographic (CT) findings of intrathoracic lymphoproliferative disorders in the immunocompromised patient. MATERIALS AND METHODS: The authors retrospectively reviewed CT scans of the chest in 18 consecutive patients with pathologically proved intrathoracic lymphoproliferative disorders. Twelve patients had the acquired immunodeficiency syndrome (AIDS), and six were receiving immunosuppressive therapy. Final diagnosis included AIDS-related diffuse lymphoid hyperplasia (n = 1), lymphocytic interstitial pneumonia (LIP) (n = 3), posttransplantation lymphoproliferative disorders (PTLDs) (n = 4), and lymphoma (n = 10). RESULTS: Diffuse areas of ground-glass attenuation were found in the patient with lymphoid hyperplasia and the three patients with LIP. The four patients with PTLDs had multiple, well-circumscribed pulmonary nodules, and nodules in three of the four patients had a halo of ground-glass attenuation. Nine of the 10 patients with lymphoma had well-circumscribed nodules or nodules with consolidation. Mediastinal lymph node enlargement was present in two patients with PTLDs and three patients with lymphoma. CONCLUSION: The intrathoracic CT findings of lymphoproliferative disorders appear to be similar in immunocompromised patients with and without AIDS and are usually extranodal.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Acute lung disease in the immunocompromised host. Diagnostic accuracy of the chest radiograph.

PURPOSE: To assess the diagnostic accuracy of the chest radiograph in the evaluation of acute pulmonary complications in immunocompromised patients. METHODS: The study included the chest radiographs in 149 consecutive acute pulmonary complications seen in immunocompromised patients in whom a definitive diagnosis was made. Twenty-four complications were in patients with AIDS and 125 were in non-AIDS patients. The radiographs were separately reviewed in random order by two independent observers. The observers assessed pattern and distribution of radiographic findings and recorded their first-choice diagnosis. RESULTS: The most common complication in patients with AIDS was Pneumocystis carinii pneumonia (n = 21). In the non-AIDS patients, the most common complications included invasive aspergillosis (n = 25), drug reaction (n = 21), and Pneumocystis pneumonia (n = 20). A correct first-choice diagnosis was made in 90% of patients with AIDS and 34% of non-AIDS patients. IN AIDS patients with Pneumocystis pneumonia, the correct first-choice diagnosis was made in 41 of 42 (98%) readings by the two observers. In non-AIDS patients with invasive pulmonary aspergillosis, drug reaction, and Pneumocystis pneumonia, the correct first-choice diagnosis was made in 38%, 26%, and 43% of readings, respectively. CONCLUSION: The chest radiograph is helpful in the differential diagnosis of acute lung disease in the immunocompromised host, particularly in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Diffuse pulmonary hemorrhage: clinical, pathologic, and imaging features.

Diffuse pulmonary hemorrhage (DPH) is a syndrome characterized by the presence of widespread hemorrhage from the pulmonary microvasculature leading to hemoptysis, iron deficiency anemia, and a chest radiography showing bilateral airspace consolidation. Diagnostic imaging consists primarily of chest radiography, but CT and MR imaging may be helpful in selected cases. There are many causes of DPH, and the differential diagnosis and diagnostic approach depend on whether the patient is immunocompetent or immunocompromised. This review summarizes the clinical, pathologic, and imaging features of DPH and the treatment of its more common causes.

Anemia, Iron-Deficiency↗
PubMed1995

CT of the chest: minimal tube current required for good image quality with the least radiation dose.

OBJECTIVE: We wanted to determine minimal tube current (mAs) required for consistently good image quality on conventional 10-mm collimation chest CT and effect of tube current reduction on detection of mediastinal and lung abnormalities. Tube current reduction is desirable to reduce patient radiation dose. SUBJECTS AND METHODS: Prospectively, 30 consecutive patients (mean weight, 68 kg; range, 34-93 kg) older than 45 undergoing conventional chest CT with standard technique (120 kVp, 400 mAs) had four additional sections imaged at reduced tube current (200, 140, 80, 20 mAs) at two levels (tracheal carina and left atrium). CT scans were evaluated in random order by two independent observers who were blinded to technical factors used. Subjective image quality was graded on a five-point scale from non-diagnostic to excellent. Visualization of mediastinal adenopathy (n = 18), pleural plaques (n = 17), effusions (n = 28), lung parenchymal nodules (n = 37), and emphysema (n = 15) were assessed. The 400 mAs scan was considered the reference standard. RESULTS: When compared with the reference technique (400 mAs), the first and second (200 mAs and 140 mAs) reduction levels showed no significant difference (p > .05) in subjective image quality. A significant difference (p < .001) was seen at the third and fourth (80 mAs and 20 mAs) reduction levels. However, no significant difference (p > .05) was seen in detection of mediastinal or lung parenchymal abnormalities with different tube currents. CONCLUSION: A twofold reduction in tube current (400-140 mAs) and resultant radiation dose did not cause a significant change in subjective image quality or in detection of mediastinal or lung abnormalities with conventional chest CT. One hundred forty milliampere-seconds is the minimal tube current required to provide good image quality in patients of average weight.

Aged↗
PubMed1995

Can CT distinguish hypersensitivity pneumonitis from idiopathic pulmonary fibrosis?

OBJECTIVE: The clinical management of patients with idiopathic pulmonary fibrosis differs markedly from that of patients with hypersensitivity pneumonitis. However, the two diseases often cannot be differentiated on clinical grounds. The purpose of this study was to establish whether CT can be used to make the distinction. MATERIALS AND METHODS: Thirty-six patients with idiopathic pulmonary fibrosis and 27 patients with hypersensitivity pneumonitis were studied. All diagnoses were confirmed or supported by open lung biopsy. Three of the patients with idiopathic pulmonary fibrosis had desquamative interstitial pneumonia, and the remainder had usual interstitial pneumonia. In 19 of the 27 patients with hypersensitivity pneumonitis, the disease was chronic (symptoms lasting more than 1 year), while eight had acute or subacute symptoms. Two radiologists, who had not previously seen any of the cases and were blinded to the diagnosis, reviewed the CT images by consensus. The extent and distribution of CT features (including ground-glass attenuation, honeycombing, and micronodules) were recorded. In each case, a CT diagnosis was made, and the level of diagnostic confidence was recorded. RESULTS: A CT diagnosis was made with a high level of confidence in 39 (62%) of 63 patients. In these patients, the CT diagnosis was correct in 35 cases (90%): 23 of 26 patients with a CT diagnosis of idiopathic pulmonary fibrosis and 12 of 13 patients with a CT diagnosis of hypersensitivity pneumonitis. In the three patients with desquamative interstitial pneumonia, the CT diagnoses were probable hypersensitivity pneumonitis in two cases and definite hypersensitivity pneumonitis in one case. Of the 19 patients with chronic hypersensitivity pneumonitis, only seven had a definite diagnosis of hypersensitivity pneumonitis based on CT findings; three had a definite diagnosis of idiopathic pulmonary fibrosis. The patients with idiopathic pulmonary fibrosis and usual interstitial pneumonia were more likely to have honeycombing and peripheral or lower lung zone predominance of disease, and less likely to have micronodules, than were patients with chronic hypersensitivity pneumonitis. The patients with idiopathic pulmonary fibrosis and desquamative interstitial pneumonia had widespread ground-glass opacity indistinguishable from some cases of acute or subacute hypersensitivity pneumonitis. CONCLUSION: Our results show that CT can be used to distinguish idiopathic pulmonary fibrosis from hypersensitivity pneumonitis in most but not all cases. Desquamative interstitial pneumonia cannot reliably be distinguished from acute or subacute hypersensitivity pneumonitis. Chronic hypersensitivity pneumonitis may have findings identical to those of usual interstitial pneumonia. Lung biopsy should still be considered the gold standard for diagnosis of interstitial lung disease.

Alveolitis, Extrinsic Allergic↗
PubMed1995

Cryptogenic organizing pneumonia in the immunocompromised patient: radiologic findings and follow-up in 12 patients.

OBJECTIVE: To assess the radiographic, computed tomography (CT) and pathologic findings and response to therapy of cryptogenic organizing pneumonia in immunocompromised patients. PATIENTS AND METHODS: The study group consisted of 12 consecutive immunocompromised patients (seven men and five women), examined between July 1988 and July 1993, who had pathologically proven cryptogenic organizing pneumonia and for whom chest radiographs and CT scans had been obtained within 9 days of diagnosis. The 12 patients were treated with corticosteroids and underwent follow-up radiography. RESULTS: The findings of chest radiography included consolidation (in 10 patients), reticulation (in 3) and small nodules (in 2). None of the radiographic abnormalities were localized to particular zones of the lung. The CT findings included ground-glass attenuation (in nine patients), consolidation (in six), small nodules (in five) and reticulation (in two). In 8 of the 12 patients (67%) these abnormalities were most marked in the subpleural and peribronchovascular regions. The follow-up radiographs showed improvement in 11 (92%) of the patients. CONCLUSIONS: The most common radiographic abnormality associated with cryptogenic organizing pneumonia in these immunocompromised patients was consolidation, and the most common CT finding was ground-glass attenuation with or without associated consolidation or nodules. Most of the patients responded to corticosteroid therapy, irrespective of the initial radiologic pattern.

Adult↗
PubMed1995

Solitary tracheal plasmacytoma: computed tomography and pathological findings.

Extramedullary plasmacytomas most frequently occur in the head and the neck, although intrathoracic cases have occasionally been described. Solitary tracheal plasmacytomas are exceedingly rare. The authors describe the computed tomography and pathological appearance of a solitary tracheal plasmacytoma and briefly discuss the treatment and implications of such a lesion.

Humans↗