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S L Primack

Publications and source records attributed to S L Primack.

At least 37 records · Page 2Linked to original sources
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

Perforated atherosclerotic ulcer of the aorta presenting with upper airway obstruction.

The authors describe an unusual presentation of penetrating atherosclerotic ulcer of the aorta in an 84-year-old man. The ulcer perforated the aorta, and hematoma extended into the soft tissues of the neck, causing upper airway and esophageal obstruction. The results of autopsy proved the findings of prior chest radiography and computed tomography.

Aged↗
PubMed1994

Pulmonary parenchymal abnormalities of vascular origin: high-resolution CT findings.

High-resolution computed tomography (HRCT) is a proved imaging modality for use in assessment of infiltrative lung disease. Findings suggestive of infiltrative lung disease on HRCT scans include ground-glass attenuation, consolidation, nodules, and interlobular septal thickening. Similar patterns, however, may be caused by various vascular abnormalities including regional or diffuse increase in blood flow, pulmonary edema, pulmonary hypertension, and thromboembolism. A correct diagnosis can usually be made by careful analysis of the pulmonary vasculature. Parenchymal abnormalities of vascular origin are associated with increased or decreased vessel diameter, vascular compression, or intraluminal filling defect.

Humans↗
PubMed1994

CT of bronchial and bronchiolar diseases.

Computed tomography (CT) is useful in evaluating bronchial and bronchiolar abnormalities. Common bronchial and bronchiolar abnormalities include bronchiectasis, asthma, bronchial obstruction, and various forms of bronchiolitis. Causes of bronchiectasis include cystic fibrosis, childhood viral infection, allergic bronchopulmonary aspergillosis, and pulmonary fibrosis. On CT scans, cystic fibrosis may manifest with bronchial wall thickening, bronchiectasis (usually cylindrical, with varicose and cystic forms seen in advanced cases), and mucus plugs in the bronchi. Allergic bronchopulmonary aspergillosis is characterized by central, varicose or cystic bronchiectasis, predominantly in the upper lobes, with mucoid impaction in the bronchi. Traction bronchiectasis may be seen on CT scans of pulmonary fibrosis. Asthma is characterized by bronchial wall thickening due to inflammation. Bronchial dilatation and air trapping may also be seen. Bronchiolitis obliterans is manifested by direct and indirect signs on CT scans; the former consist of centrilobular branching structures and nodules, and the latter consist of bronchiectasis and bronchiolectasis, mosaic perfusion, and air trapping. CT findings of bronchiolitis obliterans organizing pneumonia (also known as cryptogenic organizing pneumonia) include air-space consolidation and nodules, with occasional bronchial dilatation and pleural effusions.

Adult↗
PubMed1994

Pulmonary nodules and the CT halo sign.

PURPOSE: To determine whether the "halo sign" at computed tomography (CT) could be used to differentiate hemorrhagic from nonhemorrhagic pulmonary nodules. MATERIALS AND METHODS: CT scans of 12 patients with hemorrhagic pulmonary nodules and of a control group of 10 patients with nonhemorrhagic pulmonary nodules were randomized and reviewed by two chest radiologists. Nodules were considered hemorrhagic if a surrounding halo of ground-glass attenuation was present. RESULTS: Nodules were correctly identified as either hemorrhagic or nonhemorrhagic by both observers in 19 of the 22 cases (86%). Eight of the 12 patients with hemorrhagic nodules had an infectious process including invasive aspergillosis, candidiasis, cytomegalovirus, herpes simplex virus, or coccidioidomycosis. Four of 12 patients with hemorrhagic nodules had a noninfectious cause including Wegener granulomatosis, metastatic angiosarcoma, and Kaposi sarcoma. CONCLUSION: Most hemorrhagic pulmonary nodules have a characteristic CT appearance consisting of a central area of soft-tissue attenuation with a surrounding halo of ground-glass attenuation that allows distinction from nonhemorrhagic nodules.

Adult↗
PubMed1994

Chronic infiltrative lung disease: comparison of diagnostic accuracies of radiography and low- and conventional-dose thin-section CT.

PURPOSE: To compare the accuracy of low-dose thin-section computed tomography (CT), chest radiography, and conventional-dose thin-section CT in diagnosis of chronic infiltrative lung disease (CILD). MATERIALS AND METHODS: Chest radiographs and low-dose (80-mAs) and conventional-dose (340-mAs) thin-section (1.5-mm) CT scans from 50 patients with CILD and 10 healthy control subjects were randomized and analyzed retrospectively. For CT, three images were obtained: at the aortic arch, at the tracheal carina, and 1 cm above the right hemidiaphragm. Two independent observers listed three likely diagnoses and recorded the degree of confidence in their first choice. RESULTS: A correct first-choice diagnosis was made more often with either CT technique than with radiography (P < .02). A high confidence level in the diagnosis was reached in 42% of radiographic, 61% of low-dose CT, and 63% of conventional-dose CT interpretations, which were correct in 92%, 90%, and 96% of the studies, respectively. CONCLUSION: The superior diagnostic accuracy of low-dose thin-section CT was achieved without an increase in effective radiation dose.

Adult↗
PubMed1994

Invasive aspergillosis of the airways: radiographic, CT, and pathologic findings.

PURPOSE: To assess the radiographic, computed tomographic (CT), and pathologic findings in invasive aspergillosis of the airways. MATERIALS AND METHODS: The study included nine consecutive patients (aged 17-65 years [median, 49 years]) with pathologically proved invasive aspergillosis of the airways. All nine underwent chest radiography and seven underwent CT within 3 days of diagnosis. RESULTS: The radiographic findings include normal parenchyma (n = 1), unilateral consolidation (n = 1), bilateral consolidation (n = 5), and ill-defined nodules (n = 2). The main findings at CT included lobar consolidation (n = 1), bilateral predominantly peribronchial consolidation (n = 3), ground-glass attenuation (n = 1), and centrilobular nodules less than 5 mm in diameter (n = 2). At pathologic examination, the peribronchial infiltrates represented bronchopneumonia and the nodules represented Aspergillus bronchiolitis with a variable degree of peribronchiolar organizing pneumonia and hemorrhage. CONCLUSION: Radiographic findings of invasive aspergillosis of the airways consist of consolidation or ill-defined nodules. At CT, the consolidation can be seen to be peribronchial and the nodules centrilobular.

Adolescent↗
PubMed1994

Bronchogenic carcinoma: utility of CT in the evaluation of patients with suspected lesions.

PURPOSE: To assess the utility of computed tomography (CT) in the evaluation of suspected bronchogenic carcinoma. MATERIALS AND METHODS: CT scans were reviewed of 362 patients who had undergone CT for suspected bronchogenic carcinoma. RESULTS: CT findings of 275 patients were consistent with bronchogenic carcinoma. Sixty-five tumors were deemed unresectable on the basis of CT findings, 21 were deemed unresectable on the basis of CT findings and poor surgical risk, 26 proved to be benign, six were metastatic disease from an extrathoracic primary tumor, and 157 were potentially resectable bronchogenic carcinoma. Surgical mediastinal nodal sampling enabled documentation of metastases in 60 of 159 patients. According to nodal station, the sensitivity of CT for metastases was 67% for nodes measured in the long axis and 58% for nodes measured in the short axis; specificity was 56% and 86%, respectively. CONCLUSION: CT can be used to confirm or exclude the presence of bronchogenic carcinoma and to obviate thoracotomy. The specificity of CT is limited, and a histologic diagnosis or follow-up evaluation is necessary. CT has limited value in staging mediastinal lymph nodes.

Carcinoma, Bronchogenic↗
PubMed1994

Diagnosis of thoracic complications in AIDS: accuracy of CT.

OBJECTIVE: The purpose of this study was to assess the accuracy of CT interpretation in the diagnosis of thoracic complications of AIDS. If CT is accurate, more invasive diagnostic procedures can be avoided. MATERIALS AND METHODS: We reviewed the CT scans of 102 patients who had AIDS with proved thoracic complications and 20 HIV-positive patients without active intrathoracic disease. The scans were independently assessed by two observers from a different institution who did not know the clinical or pathologic data. The observers listed the three most likely diagnoses in order of probability and recorded the degree of confidence in their first-choice diagnosis. Imaging diagnoses were compared with final diagnoses based on results of sputum cultures, bronchoscopy, fine-needle aspiration, mediastinoscopy, open lung biopsy, autopsy, gallium scans, other clinical data, and extensive follow-up. RESULTS: Nineteen of the 20 cases in which no active disease was present were correctly identified by one observer, and 18 were correctly identified by the other. All 102 cases of active disease were correctly identified as abnormal by one observer, and 101 cases were identified as abnormal by the second observer. The correct first-choice diagnosis, regardless of the degree of confidence, was made in 66% of the cases. A confident diagnosis was made in 48% of all cases, and the observers were correct in 92% of those cases. There was good agreement between the two observers in the confident diagnosis based on CT (kappa statistic = 0.71). The interpretations of CT scans were most often accurate in the confident diagnosis of pneumocystis pneumonia (94%) and Kaposi's sarcoma (90%) and in the exclusion of active thoracic disease (93%). CONCLUSION: Certain findings on chest CT scans allow confident diagnoses of specific complications in patients with AIDS. CT-based diagnosis may preclude more invasive diagnostic procedures in selected cases.

AIDS-Related Opportunistic Infections↗
PubMed1994

Metastatic pulmonary calcification in patients with hypercalcemia: findings on chest radiographs and CT scans.

OBJECTIVE: The objective of this study was to characterize the findings on chest radiographs and CT scans in patients with metastatic pulmonary calcification due to hypercalcemia. MATERIALS AND METHODS: The chest radiographs and CT scans of seven patients with biopsy-proved metastatic pulmonary calcification were reviewed by two observers. Metastatic calcification was due to chronic renal failure (n = 4), T-cell leukemia (n = 1), multiple endocrine neoplasia type I syndrome (n = 1), and idiopathic hypercalcemia (n = 1). RESULTS: Numerous nodular opacities measuring 3-10 mm in diameter were seen on the chest radiographs in five cases, and patchy areas of parenchymal opacification were seen in two cases. Calcification of the nodules was evident in two cases. On CT scans, pulmonary nodules were present in all seven cases. These nodules were predominant in the upper lung zone in three cases, were diffuse in three cases, and were predominant in the lower lung zone in one case. Calcification of the nodules was evident on the CT scans in four of the seven cases, and calcification of vessels in the chest wall was evident in six of seven cases. Other findings on CT scans included diffuse areas of ground-glass attenuation (n = 3) and patchy consolidation (n = 2). CONCLUSION: Numerous small nodules are the most common finding on the chest radiographs of patients with metastatic pulmonary calcification. The calcific nature of the nodules is seldom obvious, however. Pulmonary nodules are also the most common finding on CT scans, where the calcific nature of the nodules is more readily apparent. Additionally, calcification is often seen in the vessels of the chest wall on CT scans. The combination of calcified nodules and calcified vessels in the chest wall on CT scans may be characteristic.

Adult↗
PubMed1994

Combined lobar atelectasis of the right lung: imaging findings.

Combined lobar atelectasis refers to the condition in which the volumes of two lobes of the lung are decreased simultaneously. Because the right lung has three lobes, three combinations of combined atelectasis are possible. The most frequent combination is that of middle and lower lobar atelectasis caused by obstruction of the bronchus intermedius [1,2]. Combined atelectasis of the upper and middle lobes is uncommon, although it occurs more frequently than anticipated [1]. The least common combination is that of right upper and lower lobe atelectasis. Awareness of the radiographic and CT findings of combined lobar atelectasis of the right lung is important in making the correct diagnosis. In this pictorial essay, we illustrate the spectrum of radiographic and CT features of this condition.

Adult↗
PubMed1994

High-resolution computed tomography in acute diffuse lung disease in the immunocompromised patient.

A number of studies have shown that high-resolution CT (HRCT) scanning may be helpful in the assessment of acute diffuse lung disease in immunocompromised patients. HRCT may demonstrate abnormalities when the radiograph is normal and may allow for a more confident diagnosis in patients with nonspecific radiographic findings. Because HRCT is superior in demonstrating the distribution and extent of parenchymal abnormalities, it is also helpful as a guide to the optimal type and site of lung biopsy. This article reviews the HRCT manifestations of the most common causes of acute diffuse lung disease in the immunocompromised host, including infection, drug-induced lung disease, pulmonary edema, and neoplasms.

AIDS-Related Opportunistic Infections↗
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

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

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↗
PubMedDate not supplied

MRI of infiltrative lung disease: comparison with pathologic findings.

OBJECTIVE: Our goal was to compare MRI with pathologic findings in patients with chronic infiltrative lung disease. MATERIALS AND METHODS: The study included 22 consecutive patients who had MRI and lung biopsy performed within 21 days (median 4 days). Fifteen patients had open lung biopsy: five with idiopathic pulmonary fibrosis, three with extrinsic allergic alveolitis, and seven with miscellaneous conditions. Seven patients had transbronchial biopsy: four with sarcoidosis and three with miscellaneous conditions. All patients had 1.5 T MRI with cardiac-gated T1-, proton density-, and T2-weighted SE sequences. RESULTS: The predominant patterns of abnormality seen on MR included parenchymal opacification (n = 12), parenchymal opacification and reticulation (n = 2), reticulation (n = 3), nodularity (n = 3), and interlobular septal thickening (n = 1); normal findings were found in 1. The 14 patients with parenchymal opacification included 9 with ground-glass intensity and 5 with consolidation. In 12 of these 14 patients the parenchymal opacification represented an active inflammatory process including alveolitis, pneumonia, and granulomatous inflammation, while in 2 patients it represented fibrosis. Reticulation was shown to represent fibrosis in five of five cases. The three patients with nodules had sarcoidosis. CONCLUSION: The MR findings correlate closely with those seen on lung biopsy. Parenchymal opacification on MR usually indicates the presence of potentially reversible disease, while reticulation usually indicates irreversible fibrosis.

Adult↗