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Biomedical subjects

S P Padley

Publications and source records attributed to S P Padley.

At least 19 recordsLinked to original sources
PubMed2004

Imaging features of multicentric Castleman's disease in HIV infection.

AIM: To describe the computed tomography (CT) features of human immunodeficiency virus (HIV)-associated Castleman's disease. MATERIALS AND METHODS: Nine HIV-positive patients with biopsy-proven Castleman's disease were studied. Clinical and demographic data, CD4 count, histological diagnosis and human herpes type 8 (HHV8) serology or immunostaining results were recorded. CT images were reviewed independently by two radiologists. RESULTS: CT findings included splenomegaly (n=7) and peripheral lymph node enlargement (axillary n=8, inguinal n=4). All nodes displayed mild to avid enhancement after intravenous administration of contrast material. Hepatomegaly was evident in seven patients. Other features included abdominal (n=6) and mediastinal (n=5) lymph node enlargement and pulmonary abnormalities (n=4). Patterns of parenchymal abnormality included bronchovascular nodularity (n=2) consolidation (n=1) and pleural effusion (n=2). On histological examination eight patients (spleen n=3, lymph node n=9, lung n=1, bone marrow n=1) had the plasma cell variant and one had mixed hyaline-vascular/plasma cell variant. The majority had either positive immunostaining for HHV8 or positive serology (n=8). CONCLUSION: Common imaging features of multicentric Castleman's disease in HIV infection are hepatosplenomegaly and peripheral lymph node enlargement. Although these imaging features may suggest the diagnosis in the appropriate clinical context, they lack specificity and so biopsy is needed for diagnosis. In distinction from multicentric Castleman's disease in other populations the plasma cell variant is most commonly encountered, splenomegaly is a universal feature and there is a strong association with Kaposi's sarcoma.

Adult↗
PubMed2004

CT techniques for imaging the lung: recommendations for multislice and single slice computed tomography.

The introduction of multislice computed tomography (MSCT) has provided the thoracic radiologist with a powerful tool with which to image the lungs. Enthusiasm for new protocols should be tempered with concerns over the potential increase in radiation dose, and before older protocols are abandoned there should be good evidence that newer protocols are objectively superior. Ultimately, the best protocol is one that provides the most relevant clinical information at the lowest dose possible.

Humans↗
PubMed2001

High-resolution CT of paediatric lung disease.

High-resolution computed tomography (HRCT) has improved our understanding of many lung diseases in adults. The technique is used less often in children due to concerns regarding radiation dose. However, HRCT may provide important diagnostic information in a variety of lung diseases in children including airways diseases and diffuse interstitial lung disease. This review illustrates the HRCT appearances of a variety of conditions and describes the emerging role of the technique in children.

Bronchiolitis Obliterans↗
PubMed2001

Mycobacterial infections: still a millennium bug--the imaging features of mycobacterial infections.

Mycobacterial infection is re-emerging as a major health care concern. Although Mycobacterium tuberculosis(MTB) is still the most important pathogen, atypical mycobacterium (AMB) infections are becoming increasingly common. We present a pictorial review of the imaging features of these infections in the chest, abdomen, brain and musculoskeletal system. Imaging similarities and differences between the normal and the immunocompromised host will be highlighted.

AIDS-Related Opportunistic Infections↗
PubMed2000

Pulmonary MALT lymphoma: imaging findings in 24 cases.

The aim of this study was to describe the imaging features of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. The chest radiographs (n = 18) and CT scans (n = 17) of 24 patients (18 men and 6 women) aged 27-78 years (mean = 56 years), with a known diagnosis of pulmonary MALT lymphoma, were retrospectively reviewed by two radiologists and the imaging findings are described. Six of the 24 patients had a history of an autoimmune disorder and 1 patient had acquired immune deficiency syndrome. Multiple pulmonary lesions were identified in 19 of 24 patients (79%) and solitary lesions in 4 of 24 patients (17%). Diffuse pulmonary infiltration was present in 1 patient. Lesions included masses or mass-like areas of consolidation (n = 21) and pulmonary nodules (n = 18). Associated findings were air bronchograms, airway dilatation, a positive angiogram sign and a halo of ground-glass shadowing at lesion margins. Peribronchovascular thickening was also observed, as were hilar or mediastinal lymph node enlargement and pleural effusions or thickening. Although rare, the diagnosis of pulmonary MALT lymphoma should be considered in patients with the imaging features described, particularly when in association with an indolent clinical course or a history of autoimmune disease.

Adult↗
PubMed2000

Air trapping in sarcoidosis on computed tomography: correlation with lung function.

AIMS: To document the presence and extent of air trapping on high resolution computed tomography (HRCT) in patients with pulmonary sarcoidosis and correlate HRCT features with pulmonary function tests. METHODS: Twenty-one patients with pulmonary sarcoidosis underwent HRCT and pulmonary function assessment at presentation. Inspiratory and expiratory HRCT were assessed for the presence and extent of air trapping, ground-glass opacification, nodularity, septal thickening, bronchiectasis and parenchymal distortion. HRCT features were correlated with pulmonary function tests. RESULTS: Air trapping on expiratory HRCT was present in 20/21 (95%) patients. The extent of air trapping correlated with percentage predicted residual volume (RV)/total lung capacity (TLC) (r = 0.499;P < 0.05) and percentage predicted maximal mid-expiratory flow rate between 25 and 75% of the vital capacity (r = -0.54;P < 0.05). Ground-glass opacification was present in four of 21 (19%), nodularity in 18/21 (86%), septal thickening in 18/21 (86%), traction bronchiectasis in 14/21 (67%) and distortion in 12/21 (57%) of patients; there were no significant relationships between these CT features and pulmonary function results. CONCLUSION: Air trapping is a common feature in sarcoidosis and correlates with evidence of small airways disease on pulmonary function testing.

Adult↗
PubMed2000

Treatment of iatrogenic femoral artery pseudoaneurysms using ultrasound-guided injection of thrombin.

AIM: To evaluate the use of ultrasound-guided percutaneous injection of thrombin for treatment of femoral artery pseudoaneurysms. METHOD: Nine patients with a confirmed femoral false aneurysm were included in the study. 0.5-1 ml of a 2000 U/ml solution of activated bovine thrombin was injected under ultrasound visualization into the neck of the aneurysm to induce thrombosis. The parent artery and adjacent major vessels were checked during and after the procedure to exclude propagation of thrombus. A check ultrasound examination was undertaken on the following day. RESULTS: Eight patients were successfully treated by a single injection. One patient required a second injection due to recurrence of their pseudoaneurysm 4 days after the initial treatment. The procedure was well tolerated in all cases and no complications were encountered. CONCLUSION: This small series provides further evidence that ultrasound-guided thrombin injection is a promising new method for the treatment of femoral false aneurysms.Hughes, M. J. et al. (2000). Clinical Radiology55, 749-751.

Aneurysm, False↗
PubMed1999

Computed tomography of the thorax in HIV disease.

A wide variety of thoracic disorders can arise in patients infected with the human immunodeficiency virus (HIV), although recent developments in the therapeutic management of AIDS patients has resulted in a changing pattern of chest disease. The use of CT in the diagnosis and management of these thoracic manifestations is discussed along with the CT appearances of the various infectious and non-infectious complications of the acquired immune deficiency syndrome (AIDS) which are commonly encountered in clinical practice.

AIDS-Related Opportunistic Infections↗
PubMed1999

Survey on the use of pulmonary scintigraphy, spiral CT and conventional pulmonary angiography for suspected pulmonary embolism in the British Isles.

AIM: To determine current clinical practice in the radiological diagnosis of acute pulmonary embolism and assess the use of spiral volumetric computed tomography. METHOD: A survey of 327 acute hospitals including cardiothoracic and orthopaedic tertiary referral centres was undertaken to assess current utilization of lung scintigraphy, spiral computed tomography and pulmonary angiography in the investigation of suspected pulmonary embolism. Responses were received from 215/327 (66%) centres. RESULTS: Lung scintigraphy was provided by 208 hospitals (144 on-site and 64 off-site). Spiral CT services were provided by 111 (52%) hospitals (on- or off-site), 142 (66%) units had access to angiographic facilities. Sixty-three centres out of 215 (29%) offered both on-site lung scintigraphy and spiral CT while only 41/215 (19%) hospitals were able to undertake all three tests on-site. On average, 501 perfusion (Q) or ventilation-perfusion (V/Q) scintigrams were performed per hospital per year with 26 spiral CT studies and just 4.6 pulmonary angiograms. CONCLUSION: These data suggest that lung scintigraphy is frequently the only imaging test in patients other than chest radiography, despite the large number of indeterminate results reported in most series.

Angiography↗
PubMed1999

A CT sign of chronic pulmonary arterial hypertension: the ratio of main pulmonary artery to aortic diameter.

The aim of this study was to determine whether the ratio of the diameters of the main pulmonary artery and of the ascending aorta (rPA), as assessed on computed tomography (CT), is predictive of pulmonary arterial hypertension (PAH). We undertook a retrospective review of 50 patients with a wide range of pulmonary and cardiovascular diseases, who had undergone both chest CT and pulmonary arterial pressure measurements at right heart catheterization. Two independent observers made measurements of the diameter of the main pulmonary artery and of the ascending aorta on a single defined CT section. Body surface area (BSA, n = 48), pulmonary arteriolar resistance (n = 39), total lung capacity (n = 40), and aortic pressures (n = 50) were also recorded. rPA and pulmonary arterial diameter (dPA) were positively related to mean pulmonary artery pressure (Rs = 0.74, p < 0.0005 for both analyses). For patients younger than 50 years of age, mean pulmonary artery pressure correlated more strongly with rPA than dPA (Rs = 0.77, p < 0.00005, compared with Rs = 0.59, p < 0.005); and vice versa for patients older than 50 years of age (Rs = 0.63, p < 0.005, compared with Rs = 0.75, p < 0.00005). Using a mean pulmonary artery pressure greater than 20 mm Hg as indicative of PAH and a value of rPA > 1, the sensitivity, specificity, and positive and negative predictive values for determining PAH were 70% (26/37), 92% (12/13), 96% (26/27), and 52% (12/23), respectively. On multivariate analysis, rPA was positively related to mean pulmonary artery pressure (p < 0.0005), and negatively related to age (p < 0.0005), but was not related to BSA. By contrast, dPA showed some dependency on BSA (p < 0.0005), as well as on mean pulmonary arterial pressure. In patients younger than 50 years of age, we have found a strong correlation between rPA and mean pulmonary artery pressure in a heterogeneous study population, and this relationship is independent of BSA and sex. The presence of the sign "rPA > 1" is simple in practical CT reading to determine; if this is identified, there is a very high probability of pulmonary arterial hypertension, and clinicians should be alerted to this possibility.

Adolescent↗
PubMed1999

Visual quantitation and observer variation of signs of small airways disease at inspiratory and expiratory CT.

Areas of decreased pulmonary attenuation representing small airways disease can be identified on computed tomography (CT). The objective was to quantify differences between inspiratory and expiratory CT for the detection of signs of small airways disease by four observers. Observer variation and the superiority of a fine versus a coarse grading system were also evaluated. Inspiratory and expiratory CT scans of 106 patients with conditions characterized by small airways disease and 19 healthy individuals were assessed by four observers. The extent of decreased attenuation was scored on a fine scale to the nearest 5% and also semiquantitatively on a coarser 5-point scale. Decreased attenuation was more extensive on expiratory CT (median. 6.7%; 0-76.7%) than on inspiratory CT (median, 3.8%; 0-81.7%). The fine scoring system had unacceptable interobserver variation (coefficient of variation, 80% for inspiratory CT, 70% for expiratory CT). The semiquantitative system had acceptable interobserver agreement (inspiratory CT k(w) = 0.64; expiratory CT, k(w) = 0.69) and good intra-observer agreement (inspiratory CT, k(w) = 0.80; expiratory CT, k(w) = 0.64). The major CT sign of small airways disease is more confidently quantified on expiratory CT. A fine scoring system is associated with unacceptable observer variation, and a coarse semiquantitative system is more suitable for quantitative studies of small airways disease.

Adolescent↗
PubMed1997

Clinical utility of abdominal CT scanning in patients with HIV disease.

AIM: To evaluate the yield of abdominal computed tomography (CT) in patients with human immunodeficiency virus (HIV) infection and to assess the influence of CT scanning on patient management and diagnosis. METHOD: A retrospective analysis of 216 abdominal CT scans, performed on 156 patients (147 men, nine women; age range 22-57 years), between March 1992 and October 1994 was undertaken. Clinical information, including the indication for performing the scan and the eventual diagnosis, was obtained from the case notes and the contribution of CT scanning to patient management assessed. RESULTS: Indications for CT fell into five main groups: investigation of pyrexia of unknown origin (PUO) (n = 82), staging and response to treatment of previously diagnosed neoplasms (n = 46), investigation of abdominal pain (n = 20), CT undertaken to clarify the results of other imaging investigations (n = 20) and miscellaneous indications (n = 48). An eventual diagnosis thought to account for the clinical presentation was made in 150 cases (68%), reflecting the high level of underlying pathology. CT contributed to patient management in a large proportion of cases (62%), but only led directly to a diagnosis in a minority (12%). CONCLUSION: With the exception of patients presenting with PUO, abdominal CT remains an important investigation in the management of patients with HIV infection. In patients presenting with PUO a thorough infection screen should be undertaken prior to CT scanning. Whilst frequently contributing to patient management, CT rarely leads directly to a diagnosis.

AIDS-Related Opportunistic Infections↗
PubMed1997

Pancreatic abnormalities and AIDS related sclerosing cholangitis.

OBJECTIVES: Biliary tract abnormalities are well recognised in AIDS, most frequently related to opportunistic infection with Cryptosporidium, Microsporidium, and cytomegalovirus. We noted a high frequency of pancreatic abnormalities associated with biliary tract disease. To define these further we reviewed the clinical and radiological features in these patients. METHODS: Notes and radiographs were available from two centres for 83 HIV positive patients who had undergone endoscopic retrograde cholangiopancreatography for the investigation of cholestatic liver function tests or abdominal pain. RESULTS: 56 patients had AIDS related sclerosing cholangitis (ARSC); 86% of these patients had epigastric or right upper quadrant pain and 52% had hepatomegaly. Of the patients with ARSC, 10 had papillary stenosis alone, 11 had intra- and extrahepatic sclerosing cholangitis alone, and 35 had a combination of the two. Ampullary biopsies performed in 24 patients confirmed an opportunistic infection in 16. In 15 patients, intraluminal polyps were noted on the cholangiogram. Pancreatograms were available in 34 of the 45 patients with papillary stenosis, in which 29 (81%) had associated pancreatic duct dilatation, often with associated features of chronic pancreatitis. In the remaining 27 patients, final diagnoses included drug induced liver disease, acalculous cholecystitis, gall bladder empyema, chronic B virus hepatitis, and alcoholic liver disease. CONCLUSION: Pancreatic abnormalities are commonly seen with ARSC and may be responsible for some of the pain not relieved by biliary sphincterotomy. The most frequent radiographic biliary abnormality is papillary stenosis combined with ductal sclerosis.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Obliterative bronchiolitis: individual CT signs of small airways disease and functional correlation.

PURPOSE: Individual features of small airways disease depicted at computed tomography (CT) were correlated with functional indexes in patients with obliterative bronchiolitis. MATERIALS AND METHODS: Fifteen patients (all women) who fulfilled the strict criteria for diagnosis of obliterative bronchiolitis underwent thin-section CT at full inspiration and at end expiration. The CT scans were scored by two observers for extent of decreased attenuation of the lung parenchyma; end-expiration CT signs of air trapping; and bronchial dilation, wall thickening, and mucous plugging. The functional importance of each CT sign was evaluated. RESULTS: Areas of decreased attenuation were present in all patients (median score at end expiration, 61%; range, 21%-83%). Bronchial wall thickening was identified in 13 of the 15 patients. Correlations of the extent of decreased attenuation and measures of air-flow obstruction were strongest between decreased attenuation at end expiration and air flow at low lung volumes (r(s) = -.70, P < .005). This relationship remained intact after correction for the severity of bronchial wall thickening. CONCLUSION: In patients with obliterative bronchiolitis, the extent of decreased attenuation at CT was most strongly related to depression of pulmonary function tests of the small airways. Decreased attenuation is the cardinal sign for further quantitative studies of obliterative bronchiolitis.

Adult↗
PubMed1997

Mosaic attenuation pattern on thin-section CT scans of the lung: differentiation among infiltrative lung, airway, and vascular diseases as a cause.

PURPOSE: To determine whether infiltrative lung, airway, or vascular disease can be differentiated as the cause of mosaic attenuation on thin-section computed tomographic (CT) scans of the lung. MATERIALS AND METHODS: Thin-section CT scans were reviewed in 70 patients examined at three institutions. A mosaic attenuation pattern and pathologic or clinical proof of a specific type of disease were demonstrated. Causes of the mosaic pattern included infiltrative lung disease (n = 37), airway disease (n = 22), and vascular disease (n = 11). Thin-section CT findings were assessed independently by two observers blinded to clinical findings. RESULTS: The type of disease was identified correctly at CT in 58 (83%) of 70 patients by observer 1 and 57 (81%) of 70 patients by observer 2. Infiltrative lung disease was diagnosed correctly by both observers in 34 (92%) of 37 cases. Observer 1 identified 21 (95%) of 22 cases of airway disease and three (27%) of 11 cases of vascular disease. Observer 2 identified 19 (86%) of 22 cases of airway disease and four (36%) of 11 cases of vascular disease. CONCLUSION: Infiltrative lung disease and airway disease may be differentiated reliably as the cause of mosaic attenuation on lung CT scans, whereas vascular disease is often misinterpreted as infiltrative lung disease or airway disease.

Adult↗
PubMed1997

Aneurysm of the left brachiocephalic vein: an unusual cause of mediastinal widening.

A case of left brachiocephalic venous aneurysm is presented. Thoracic venous aneurysms are rare with only 27 previous cases in the medical literature, the majority involving the superior vena cava. There are only two previous reports of isolated brachiocephalic venous aneurysm. Venous aneurysms are usually first detected as mediastinal widening on a chest radiograph and can be further defined using CT, MRI or angiography. The aetiology is uncertain. Management is usually conservative, but surgical correction has been performed.

Adult↗