Charles E. Putman

Cytotoxic drug-induced lung disease

Cytotoxic drugs, principally bleomycin, methotrexate and busulfan, have been associated with pulmonary toxicity. Cytotoxic drug-induced lung disease may be difficult to establish with certainty because other causes of pulmonary disease are frequently present. We discuss the clinical, roentgenographic and histologic effects of the administration of bleomycin, methotrexate, busulfan and other cytotoxic agents on the lungs and suggest that these agents may also cause pulmonary malignancies. We note the importance of careful patient monitoring and withdrawal of a demonstrated offending agent.

Textbook of diagnostic imaging

Three volumes provide information organized by major topics covering the state-of-the-art for all imaging procedures. It includes coverage of the fundamentals of diagnostic imaging, and a system-by-system approach.

A ventilator for magnetic resonance imaging.

Breathing motion severely degrades the quality of magnetic resonance images (MRI) of the thorax and upper abdomen and interferes with the acquisition of quantitative data. To minimize these motion effects, we built an MRI compatible ventilator for use in animal studies. Solid state circuitry is used for controlling ventilation parameters. The ventilator can be triggered internally at frequencies of 0.1 to 30 Hz or it can be triggered externally such as by the MRI pulse sequence. When triggered by the scanner, ventilation is synchronized to occur between image data acquisitions. Thus, image data are obtained when there is no breathing motion and at a minimum lung volume when hydrogen density is maximum. Since the ventilator can be adjusted to operate at virtually any frequency from conventional to high frequency, ventilation can be synchronized to all commonly used repetition times (100 ms to 2000 ms or more; 600 to 30 breaths/min). Scan synchronous ventilation eliminates breathing motion artifacts from most imaging sequences (single and multiple spin echo and inversion recovery). Best image quality is obtained when scan synchronous ventilation is combined with cardiac gating. These methods are also useful for quantitative research studies of thoracic and abdominal organs.

Hydrostatic pulmonary edema an analysis of lung density changes by computed tomography

The computed tomographic (CT) appearance of pulmonary edema induced by elevated left atrial (LA) pressure was examined. Dogs, in the prone position, were scanned during suspended ventilation at functional residual capacity. A surgically implanted LA balloon was inflated to elevate LA pressure for 30 to 140 minutes to a mean pressure of 29.8 mm Hg. Lung water, measured gravimetrically, averaged 14.7 ml/kg body weight compared with 5.7 ml/kg in nonedema control dogs. Lung density in dogs with edema was 69.5% higher than base-line density, while in the control group final lung density was only 4% higher than base line. Analysis of regional density indicated that there were greater increases in density in more central and dependent (ventral) zones of the lung and relatively smaller increases in nondependent (dorsal) peripheral zones. These results are in contrast to the previously reported pattern of density change seen with oleic acid injury in which density increases were primarily in peripheral zones of the lung.

The clinical assessment of roentgenographically atypical pulmonary sarcoidosis.

We studied 89 patients in whom the clinical diagnosis of sarcoidosis was supported by the findings on tissue biopsy. A chest roentgenogram in 14 of the patients showed one of the following atypical features: large pulmonary nodules, an alveolar parenchymal pattern or a pleural effusion. Diagnoses of infection, malignancy or vasculitis were suggested by interpretations of atypical chest roentgenograms in eight of these 14 patients. Nonspecific and misleading clinical information contributed. The diagnosis of sarcoidosis was corroborated by extrathoracic tissue biopsies in 11 of the 14 patients. Over an average observation period of 38 months, the 14 patients remained classified as having sarcoidosis. This suggests that an extrathoracic tissue biopsy, whose findings are consistent with sarcoidosis, is often sufficient to support a clinical diagnosis of some forms of roentgenographically atypical pulmonary sarcoidosis.

Pulmonary edema: a CT study of regional changes in lung density following oleic acid injury.

Transmission computed tomography (CT) was used to study the global and regional density changes in the dog lung associated with oleic acid induced lung injury. The same level of the lower thorax was scanned (5 s scan) during suspended ventilation at functional residual capacity prior to and after oleic acid infusion (0.05 ml kg) into the right atrium. The first signs of edema were usually seen within 15 to 30 min after oleic acid infusion and consisted of patchy areas of increased density primarily in the peripheral and dependent /ones. Mean CT density (Hounsfield units t 1.000) of lung cross sections from five dogs was 198 ± 9 (SUM) during base line: density significantly (p 0.05) increased to 24.3 ± 14 30 min after infusion and reached an apparent plateau of 294 ± 31 75 min after oleic acid infusion. Thermal-dye dilution measurements indicated that extravascular lung water increased by 3.8 ml kg from base line to 75 min after oleic acid infusion.

Traumatic disruption of the thoracic aorta: significance of the left apical extrapleural cap

The plain chest film may be critical in deciding whether a seriously injured patient should undergo aortography in order to exclude traumatic aortic rupture. The roentgen findings suggestive of aortic transection reflect the presence of mediastinal bleeding. A left apical extrapleural cap is frequently seen in these patients but heretofore has not been emphasized in the literature.

Chest Radiographic-Pathologic Correlation in Adult Leukemia Patients

A radiographic-pathologic correlation study of adult leukemia patients was conducted to determine the frequency and radiographic appearance of leukemic involvement and related complications within the chest. One hundred thirteen autopsy protocols were examined. Radiographic correlation was obtained in 60 of these cases. Autopsy pulmonary findings included hemorrhage in 74% of the cases, infectious infiltrates in 67%, edema or congestion in 57%, and leukemic infiltration in 26%. Only 5% of the chest radiographs were normal. Alveolar or interstitial abnormalities were identified in 90%, pleural effusion in 40%, and lymphadenopathy in 17%. Correlation demonstrated pulmonary infection to be by far the most common cause of radiographic opacity. Because of its frequent occurrence, high associated mortality, and potential reversibility, pneumonia must always be considered first in the differential diagnosis of radiographic opacity in these patients.

Evaluation of bronchospasm during excretory urography.

Mean pulmonary function was significantly decreased in 57 patients during excretory urography. Patients with a history of allergy had significantly greater mean decreases in flow rates than those without. Twelve did not have significant decreases in pulmonary function after needle puncture and intravenous injection of 5% dextrose in water. Eight healthy subjects did not have significant mean decreases after intravenous injection of 5% saline. Most patients undergoing excretory urography have bronchospasm that is greater in magnitude in those with a history of allergy.

Morphology of oleic acid-induced lung injury observations from computed tomography, specimen radiography, and histology

Previously, we reported that oleic acid infusion in dogs produced a patchy and predominantly peripheral increase in lung density. The present study examines in more detail the morphology of the early stages of development of the oleic acid lesion using computed tomography (CT), specimen radiography, and conventional histology. Dogs were sacrificed 10, 30, 60, and 240 minutes after infusion of oleic acid (.05 ml/kg). After freezing in dry-ice, the thorax was scanned and cut into 1-cm thick sections. Frozen sections were then contact radiographed and sampled for histology. Within 10 minutes of infusion, subtle increases in peripheral lung density were visible on the contact radiographs. Patchy areas of peripheral density, resembling secondary lobules, were especially prominent 60 and 240 minutes after infusion. These lesions were often clearly associated with the distal bronchovascular structures. Histologic signs of edema were present in all animals sacrificed 30 or more minutes after receiving oleic acid. These correlative studies provide additional insight into the early subgross development of oleic acid-induced injury by showing the relationship between the developing edema and the bronchovascular structure of the lung.