David L. Spizarny

Lung torsion : Preoperative diagnosis with angiography and computed tomography

In a patient with lung torsion, computed tomography demonstrated an occluded right upper lobe bronchus with opacified posterior lung. A pulmonary angiogram demonstrated the right upper lobe artery to be posteriorly and inferiorly displaced into the consolidated lung. In selected cases, computed tomography and angiography can help to confirm a torsed lung.

Enlarging pleural effusion after liver transplantation

Ten of 42 patients who underwent liver transplantation were retrospectively found to have enlarging pleural effusions later than 3 days after transplantation. Seven of the 10 patients had subdiaphragmatic pathology, including 4 with hematomas, 1 with a biloma, and 2 with abscesses. One patient with a subphrenic abscess also had an empyema. Patients with an enlarging pleural effusion later than 3 days after transplantation should be evaluated for subdiaphragmatic pathology.

Risk of Lung Cancer Associated with COPD Phenotype Based on Quantitative Image Analysis

Background: Chronic obstructive pulmonary disease (COPD) is a risk factor for lung cancer. This study evaluates alternative measures of COPD based on spirometry and quantitative image analysis to better define a phenotype that predicts lung cancer risk. Methods: A total of 341 lung cancer cases and 752 volunteer controls, ages 21 to 89 years, participated in a structured interview, standardized CT scan, and spirometry. Logistic regression, adjusted for age, race, gender, pack-years, and inspiratory and expiratory total lung volume, was used to estimate the odds of lung cancer associated with FEV1/FVC, percent voxels less than −950 Hounsfield units on the inspiratory scan (HUI) and percent voxels less than −856 HU on expiratory scan (HUE). Results: The odds of lung cancer were increased 1.4- to 3.1-fold among those with COPD compared with those without, regardless of assessment method; however, in multivariable modeling, only percent voxels <−856 HUE as a continuous measure of air trapping [OR = 1.04; 95% confidence interval (CI), 1.03–1.06] and FEV1/FVC < 0.70 (OR = 1.71; 95% CI, 1.21–2.41) were independent predictors of lung cancer risk. Nearly 10% of lung cancer cases were negative on all objective measures of COPD. Conclusion: Measures of air trapping using quantitative imaging, in addition to FEV1/FVC, can identify individuals at high risk of lung cancer and should be considered as supplementary measures at the time of screening for lung cancer. Impact: Quantitative measures of air trapping based on imaging provide additional information for the identification of high-risk groups who might benefit the most from lung cancer screening. Cancer Epidemiol Biomarkers Prev; 25(9); 1341–7. ©2016 AACR.

Dynamic incremental computed tomography of the pulmonary hila using a flow-rate injector.

Dynamic incremental CT of the pulmonary hila using a flow-rate injector is a safe, reliable, and reproducible technique. The technique described allows confident distinction of hilar masses from hilar vessels, while limiting the total amount of contrast medium used and eliminating radiation exposure to the radiologist.

Pseudometastases secondary to film static artifact.

Low density areas in the liver on computed tomography (CT) may be produced by cysts, abscesses, or tumors. A case is reported in which film static resulted in multiple focal low density areas in the liver in a patient with lymphoma. This potential pitfall in CT interpretation can be avoided by taking proper measures to avoid film artifacts and by reviewing all cases on the cathode ray tube (CRT) display as well as the hard copy film.