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N L Müller

Publications and source records attributed to N L Müller.

At least 145 records · Page 8Linked to original sources
PubMed1994

Radiologic features of pulmonary tuberculosis: an assessment of 188 cases.

To assess the radiologic patterns of presentation of active pulmonary tuberculosis, the authors studied all patients with active, culture-proven pulmonary tuberculosis who presented in British Columbia between May 1989 and May 1991. The chest radiographs were assessed by two observers. Epidemiologic data were collected to allow examination of differences among ethnic groups. The 188 patients ranged in age from 1 to 96 (median 54) years; only 2 were less than 20 years of age. Thirty of the 188 patients (16%) presented with clinical and radiologic findings consistent with primary tuberculosis; the other 158 (84%) had postprimary disease. Of the second group, typical upper lobe infiltrates were seen in 126 (80%). Less common manifestations included lymphadenopathy (in 14 cases), isolated nodular tuberculoma (in 10), isolated involvement of the lower lung zones (in 10), cavities with air-fluid levels (in 6) and isolated pleural effusion (in 2). The authors conclude that the characteristic upper lobe infiltrates of postprimary disease remain the most common form of presentation of active tuberculosis in adults. However, atypical presentation, due to either an unusual pattern of postprimary tuberculosis or to primary tuberculosis, may be seen in up to 30% of patients.

Adolescent↗
PubMed1994

[High-resolution x-ray computed tomography of bronchiolo-alveolar carcinoma].

Bronchioloalveolar cell carcinoma may cause three main patterns on CT: solitary nodule, parenchymal consolidation, and multicentric disease. The nodules usually have spiculated margins and frequently contain bubble-like lucencies or pseudo-cavitation. When presenting as consolidation, this is due mainly to mucin secretion and results in areas of lower attenuation than soft tissue. Multicentric disease is characterized by the presence of multiple nodules which may mimic metastatic disease. Although bronchioloalveolar cell carcinoma may cause different patterns on high-resolution CT, certain CT findings are sufficiently characteristic to suggest the underlying diagnosis.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1993

Bronchiolitis obliterans: high resolution CT findings and correlation with pulmonary function tests.

In order to characterize the appearances of bronchiolitis obliterans on high-resolution CT (HRCT) and to relate the extent of HRCT abnormalities to pulmonary function tests, the HRCT scans of 18 patients with bronchiolitis obliterans were examined by two independent observers. The underlying causes for the development of bronchiolitis obliterans were penicillamine therapy (n = 5), previous infection (n = 4), graft-vs-host disease (n = 3), and miscellaneous causes (n = 6). Abnormal HRCT findings were present in all cases. The commonest HRCT abnormalities consisted of patchy areas of decreased parenchymal attenuation (n = 15), subsegmental (n = 12) and segmental (n = 6) bronchial dilatation and centrilobular branching structures (n = 5). There was no significant correlation between the extent of abnormalities and the static lung volumes or the impairment in gas transfer (all P values > 0.05). The only significant correlation was between the number of segments with subsegmental bronchial dilatation and the forced expiratory volume in one second (Wilcoxon r = 0.61, P < 0.01). We conclude that the great majority of patients with bronchiolitis obliterans have HRCT abnormalities. However, there is poor correlation between the extent of abnormalities on HRCT and functional impairment.

Adolescent↗
PubMed1993

Acute pulmonary complications in immunocompromised non-AIDS patients: comparison of diagnostic accuracy of CT and chest radiography.

To compare the abilities of computed tomography (CT) and radiography in detection and diagnosis of acute pulmonary complications in immunocompromised non-AIDS patients, the CT scans and radiographs of 45 immunocompromised non-AIDS patients with proven pulmonary disease and 20 normal controls were independently assessed by two observers, without knowledge of clinical or pathologic data. The observers listed the three most likely diagnoses and their degree of confidence in the first-choice diagnosis on a three-point scale. The sensitivity and specificity in detecting pulmonary complications was 100% and 98% for CT, compared to 98% and 93%, respectively, for chest radiography. In the immunocompromised patients, the first-choice diagnosis was correct in 44% of CT and 30% of radiograph readings (P < 0.01). The correct diagnosis was among the top three diagnoses in 70% of CT scans and 53% of radiograph readings (P < 0.01). Confidence level one (definite) was reached in 33% of CT scans and 10% of chest radiographs (P < 0.001). Diseases with a dominant nodular pattern had a higher occurrence of correct first-choice diagnosis (62% vs 34%, P < 0.02) and level one confidence ratings (53% vs 13%, P < 0.001) than diseases with ground-glass opacity, consolidation or irregular linear opacities. We conclude that chest radiographs and CT scans have comparable sensitivity in detecting acute pulmonary complications in immunocompromised non-AIDS patients. CT is superior to chest radiography in the differential diagnosis of acute pulmonary complications in these patients.

Acute Disease↗
PubMed1993

High-resolution computed tomography of the chest: current indications.

High-resolution computed tomography (HRCT) may show parenchymal abnormalities in patients with normal or questionable findings on the chest radiograph; and because it provides an accurate assessment of the pattern and distribution of lung disease, it also improves the accuracy of the differential diagnosis. HRCT may be able to distinguish areas of potentially reversible disease from irreversible fibrosis and be a helpful guide to the optimal type and site of lung biopsy. This review summarizes the current indications for HRCT of the chest in the assessment of patients with acute lung disease, chronic infiltrative lung disease, pneumoconiosis, bronchiectasis, and emphysema.

Aged↗
PubMed1993

Pulmonary talcosis: CT findings in three cases.

The authors describe the computed tomographic (CT) appearances in three patients with pulmonary talcosis resulting from chronic intravenous drug abuse. There was widespread ground-glass attenuation in one case and an appearance similar to that of progressive massive fibrosis in two cases. In the latter cases, there were confluent perihilar masses with areas of high attenuation. While the CT appearances may be suggestive of pulmonary talcosis, tissue sampling is required for definitive diagnosis.

Adult↗
PubMed1993

T1 lung cancer: prevalence of mediastinal nodal metastases and diagnostic accuracy of CT.

To determine the prevalence of mediastinal lymph node metastases in T1 non-small cell lung cancer and assess the sensitivity and specificity of computed tomography (CT) in detection of such metastases, the CT scans and surgical findings in 104 patients with T1 lesions were reviewed. Nodes longer than 10 mm on the short or long axis were considered abnormal. All patients underwent thorough mediastinal lymph node dissection at mediastinoscopy or thoracotomy. A total of 362 lymph nodes were sampled. Nodal metastases were present in 22 patients (21%). The sensitivity of CT for metastases to individual nodal stations was 41% for nodes measured on the short axis and 55% for those measured on the long axis. The specificity was 93% and 86%, respectively. When the adjacent nodal stations were included in the analysis, the sensitivity of CT was 59% for nodes measured on the short axis and 77% for those measured on the long axis; the specificity was 91% and 73%, respectively. T1 lung cancer has a higher prevalence of lymph node metastasis than previously reported, and CT is recommended in the preoperative staging of this disease.

Adult↗
PubMed1993

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

To evaluate the findings on thin-section computed tomographic (CT) scans in desquamative interstitial pneumonia (DIP), the CT scans from 22 patients aged 22-71 years (mean age, 43 years) were reviewed. In all patients, DIP was proved with open-lung biopsy performed 1 day to 17 months before or after examination with CT (median interval, 1.5 months). The lungs were divided into three zones (upper, middle, and lower); each zone was evaluated separately. The predominant finding was the presence of areas of ground-glass attenuation that involved the middle and lower lung zones in all patients and the upper lung zones in 18 patients (82%). Such areas had a lower lung zone predominance in 16 patients (73%) and a predominantly peripheral distribution in 13 patients (59%). Irregular lines of attenuation suggestive of fibrosis were seen in 11 patients (50%) and cystic changes, in seven patients (32%). The distribution of abnormalities in DIP is similar to that seen in usual interstitial pneumonia (UIP), but the greater extent of ground-glass attenuation and the paucity of cystic changes in DIP should enable distinction from UIP in most patients.

Adult↗
PubMed1993

Parenchymal opacification in chronic infiltrative lung diseases: CT-pathologic correlation.

To correlate areas of parenchymal opacification on thin-section computed tomographic (CT) scans with histologic findings in patients with chronic infiltrative lung disease, the CT and histologic findings were evaluated in 29 patients with 11 such diseases. Open-lung biopsy was performed after CT. The area of predominant involvement was classified as air space, interstitium, or a mixture of both. A pathologic score of disease activity was assigned, and the extent of fibrosis was assessed whenever fibrosis was present. Parenchymal opacification on CT scans corresponded to abnormalities that affected mainly the air spaces in three patients (10%), the interstitium in 13 patients (45%), or both to a similar degree in 13 patients (45%). In 25 of 29 patients (86%), parenchymal opacification was associated with potentially treatable or reversible disease. Abnormalities considered irreversible were seen in three patients with end-stage fibrosis and one patient with talcosis. Parenchymal opacification on thin-section CT scans is a nonspecific finding in diseases that affect the air spaces, interstitium, or both but usually indicates potentially treatable or reversible disease.

Adult↗
PubMed1993

Acute interstitial pneumonia: radiographic and CT findings in nine patients.

The radiologic findings were reviewed in nine patients with biopsy- or autopsy-proved acute interstitial pneumonia (AIP). All patients had bilateral air-space opacification on radiographs and bilateral, symmetric areas of ground-glass attenuation on computed tomographic (CT) scans. The areas of ground-glass attenuation had a patchy distribution in six patients (67%) and were diffuse in three patients. Air-space consolidation was seen at CT in six patients (67%) and involved mainly the lower lung zones in three patients and upper lung zones in one patient and was diffuse in two patients. A predominantly subpleural distribution of the consolidation was present in two patients. Eight of the nine patients died within 3 months of presentation. The authors conclude that the radiographic and CT features of AIP are similar to those of adult respiratory distress syndrome and represent acute alveolar damage. AIP differs from the more chronic forms of interstitial pneumonia in clinical presentation and in pathologic and radiologic findings.

Acute Disease↗
PubMed1993

Intracavitary aspergilloma: transthoracic percutaneous injection of amphotericin gelatin solution.

For aspergillomas in patients with fibrocavitary lung disease, surgery is often not recommended. Injection or lavage of the cavities with solutions of potassium iodide or antifungal agents has had varying success and requires repeated sessions because of nonretention of the therapeutic agent within the cavity. In three patients with four aspergillomas, the authors used fluoroscopic or computed tomographic (CT) guidance to inject amphotericin in gelatin as a liquid that solidifies within the cavity at body temperature. The patients were followed up with serial chest radiography or CT. The mixture was successfully instilled in every case. Three of the four aspergillomas completely resolved within 3 months or less, with no evidence of recurrence at follow-up of 6-18 months. The remaining aspergilloma decreased in size, but the patient needed pneumonectomy because of recurrent hemoptysis within 6 months of amphotericin injection. Transthoracic instillation of a liquid mixture of amphotericin and gelatin that solidifies rapidly at body temperature may be useful as a one-step treatment for aspergillomas.

Adult↗
PubMed1993

Subacute and chronic bird breeder hypersensitivity pneumonitis: sequential evaluation with CT and correlation with lung function tests and bronchoalveolar lavage.

PURPOSE: To evaluate lung involvement in the subacute (group 1) and chronic (group 2) stages of bird breeder hypersensitivity pneumonitis. MATERIALS AND METHODS: Computed tomographic (CT) findings in 45 patients were correlated with pulmonary function testing and bronchoalveolar lavage. Twenty-seven patients underwent sequential CT examination 0.3-4 years apart, with functional evaluation in 20 of them. RESULTS: In group 1, CT showed diffuse micronodules, ground-glass attenuation, focal air trapping or emphysema, and mild fibrotic changes, with normal lung volumes but impaired diffusing capacity and a predominant lymphocyte alveolitis. In group 2, two categories of chronic forms were identified at CT on the basis of presence or absence of honeycombing. After cessation of exposure, CT showed a return to normal or dramatic improvement in group 1 and considerable reduction in ground-glass attenuation and micronodules in group 2. CT depicted no fibrotic or emphysematous changes during follow-up. CONCLUSION: Subacute bird breeder hypersensitivity pneumonitis may share CT features with other types of hypersensitivity pneumonitis. CT may help in identification of emphysematous and fibrotic forms of chronic disease.

Acute Disease↗
PubMed1993

End-stage lung disease: CT findings in 61 patients.

PURPOSE: To determine whether the cause of end-stage lung disease could be determined on the basis of pattern and distribution of abnormalities at computed tomography (CT). MATERIALS AND METHODS: The CT scans from 61 consecutive patients with end-stage lung disease were independently assessed by two observers without knowledge of clinical or pathologic data. End-stage lung disease was defined by the presence of honeycombing, extensive cystic changes, or conglomerate fibrosis. The observers listed the three most likely diagnoses and recorded the degree of confidence in the first-choice diagnosis on a three-point scale. RESULTS: The observers made a correct first-choice diagnosis in an average of 87% of cases. A correct first-choice diagnosis was made most often in silicosis (100%), Langerhans cell histiocytosis (100%), asbestosis (90%), usual interstitial pneumonia (88%), extrinsic allergic alveolitis (87%), and sarcoidosis (83%). There was good agreement between the two observers on the first-choice diagnosis (kappa statistic, 0.89). CONCLUSION: The pattern and distribution of abnormalities in end-stage lung disease are determined by the underlying cause. In most cases, a specific diagnosis can be made on the basis of the CT findings.

Alveolitis, Extrinsic Allergic↗
PubMed1993

Limited contribution of emphysema in advanced chronic obstructive pulmonary disease.

Previous studies on autopsy specimens or surgically resected lobes or lungs have reached varying conclusions regarding the importance of small airways disease and emphysema in causing fixed expiratory airflow limitation in patients with chronic obstructive pulmonary disease (COPD). We obtained high resolution CT scans of the lung and lung function in 56 consecutive patients with fixed expiratory airflow limitation. There was poor correlation between CT emphysema score and either FEV1/FVC% (r = -0.36) or FEV1 % predicted (r = -0.20). In only 10 of the 35 patients with FEV1 < 50% predicted, the CT emphysema score was > 40, indicating significant emphysema. A strong negative correlation between diffusing capacity % predicted and diffusing capacity per alveolar volume and CT emphysema score was found only in patients with FEV1 > or = 1 L (r = -0.75, p < 0.0001). Thus, emphysema does not appear to be primarily responsible for expiratory airflow limitation in COPD. A low diffusing capacity may be spuriously misleading in patients with FEV1 < 1 L and no or trivial emphysema.

Aged↗