Dorothy I. McCauley

Computed tomography of bronchiectasis

Computed tomography (CT) was performed on six patients with bronchiectasis. In two cases of advanced cystic bronchiectasis, the diagnosis was apparent on plain chest roentgenograms. In four cases, bronciectasis was initially diagnosed by CT and later confirmed by bronchography. The CT signs of bronchiectasis include air-fluid levels in distended bronchi, a linear array or cluster of cysts, dilated bronchi in the periphery of the lung, and bronchial wall thickening due to peribronchial fibrosis. Distended bronchi must be distinguished from emphysematous blebs, which generally have no definable wall thickness and no accompanying vessels. It is concluded that CT should have a role in establishing the presence and anatomic extent of bronchiectasis.

High Resolution Ct Findings in Miliary Lung Disease

High-resolution CT (HRCT) and chest radiographs were compared in nine patients with miliary lung disease. In all cases, miliary disease was documented to be infectious in etiology; six of these patients proved to be human immunodeficiency virus (HIV) positive. A mixture of both sharply and poorly defined 1-3 mm nodules was seen in all cases, many of the latter having an appearance indistinguishable from airspace nodules. Other features attributable to the presence of nodules included nodular interlobular septae, nodular irregularity of vessels, subpleural dots, and studded fissures. Diffuse intra- and interlobular septal thickening also proved common, seen in all but one case (91%). Based on limited HRCT-pathologic correlation, CT findings appear primarily to be due to granulomatous foci developing in a seemingly random distribution involving both pulmonary airspaces as well as the interstitium. It is concluded that in the appropriate clinical setting this constellation of findings is characteristic of miliary disease; the role of HRCT especially in the early diagnosis of miliary disease in HIV positive patients remains to be determined prospectively.

Early lung cancer action project: annual screening using single-slice helical CT.

The advent of helical CT imaging held promise for the early diagnosis, and thereby, for enhanced curability of lung cancer—a highly fatal disease. In 1993, the Early Lung Cancer Action Project (ELCAP) was initiated and experimentally screened a cohort of 1,000 high‐risk persons. Here we summarize the results of the baseline and annual repeat CT screening of these 1,000 subjects. CT‐based screening (compared to traditional radiology) was clearly shown to enhance the detection of lung cancer at earlier and more curable stages. A discussion follows of the meaning of the results and possible future screening protocols.

Computed tomography of the pulmonary parenchyma. part 1: Distal air-space disease

Because of greatly enhanced contrast resolution and the advantages of cross-sectional visualization of lung anatomy, computed tomography (CT) has the potential to add significantly to the conceptualization of parenchymal lung disease. Although the value of CT has been well documented in the detection and characterization of lung nodules, the role of CT has been less clearly defined for other types of lung disease. This report describes the CT appearance of distal air-space disease. As demonstrated by the use of inflated and contrast-injected lungs obtained at autopsy, air-space disease is definable by the following: poorly marginated nodules ranging up to 1 cm in size; coalescence of nodules; air-bronchograms and air-alveolograms; ground-glass opacification; and distinct zonal patterns of distribution, including central and peripheral configurations. These patterns of air-space abnormalities are further refined by review of case material, including examples of air-space disease secondary to aspiration and primary intraalveolar disease, evaluated by the authors over a five-year period.

Computed tomography of lobar collapse: 1. Endobronchial obstruction.

The computed tomographic (CT) appearance of lobar collapse has yet to be defined. In an attempt to determine the characteristic appearance of collapse 95 cases were reviewed retrospectively in a wide variety of clinical settings over a 3 year period ending January 1983. In this report 38 cases of lobar collapse secondary to endobronchial occlusion are analyzed; the appearance of collapse without endobronchial obstruction forms the basis of a subsequent report. Computed tomography was accurate in determining the site of bronchial occlusion in all cases. In 36 of 38 cases collapse was caused by endobronchial tumors, including bronchogenic carcinoma, bronchial carcinoids, endobronchial metastases, and lymphoma. Differentiation between these tumors was not feasible with CT. Most cases of collapse were caused by central tumor. In those cases in which a bolus of contrast material was used differentiation between tumor mass and collapsed pulmonary parenchyma was possible. Two of 38 cases were found to have benign bronchial occlusion. In one case a mucous plug obstructing the left lower lobe bronchus was accurately defined. In another case a bronchial stricture occluded the right lower lobe bronchus. This represented the only false positive case in this series. It is concluded that CT is an accurate means for establishing the diagnosis of endobronchial obstruction. In most cases the diagnosis of neoplasia was possible, provided a bolus of contrast material was used to define tumor mass. The potential role of CT in evaluating patients with lobar collapse is discussed.

Fibrobullous disease of the upper lobes: An extraskeletal manifestation of ankylosing spondylitis

Fibrobullous disease of the upper lobes of the lungs is a rare extraskeletal manifestation of ankylosing spondylitis, occurring in 1.3% of patients with ankylosing spondylitis. We present a patient with this disease, and discuss this pulmonary manifestation. Because the radiographic appearance of the chest in this disease resembles that in tuberculosis, many patients are misdiagnosed and treated for tuberculosis despite negative bacteriology. Computed tomography is useful in delineating the extent of pleural thickening, bullous changes, volume loss, parenchymal fibrosis, and bronchiectasis, as well as identifying or excluding an intracavitary pulmonary mycetoma.

Computed tomography of bronchial adenomas

Computed tomography (CT) was used to evaluate nine patients with bronchial adenomas: five carcinoid tumors and four adenoid-cystic carcinomas. Seven patients with lesions of the trachea or proximal bronchi presented with wheezing, hemoptysis, or obstructive pneumonitis. In such cases. CT was effective in displaying the total extent of infiltrating lesions including the extraluminal component. The cases of adenoid-cystic carcinoma of the bronchi demonstrated extraluminal spread in a pattern indistinguishable from bronchogenic carcinoma. In one patient. CT demonstrated an exclusively endobronchial carcinoid tumor, and conservative resection was planned and accomplished. In two cases of carcinoid tumors that presented as solitary pulmonary nodules adjacent to bronchi in the midlung zone, CT served as a road map for the bronchoscopist. Computed tomography has been employed in the postoperative patient to evaluate for possible recurrence.

Unusual cardiac metastasis in hypernephroma: The complementary role of echocardiography and magnetic resonance imaging

13. tion, definition, diagnosis and consequences. Prog Cardiovasc Dis 1982;25:169-92. Bulkley BH, Klacsmann PG, Hutchins GM. Angina pectoris, myocardial infarction and sudden cardiac death with normal coronary arteries: a clinicopathologic study of 9 patients with progressive systemic sclerosis. AM HEART J 1978;95:563-9. Alexander EL, Firestein GS, Weiss JL, Heuser RR, Leitl G, Wagner HN Jr, Brinker JA, Ciuffo AA, Becker LC. Reversible cold-induced abnormalities in myocardial perfusion and function in systemic sclerosis. Ann Intern Med 1986;105: 661-8. Raymond R, Lynch J, Underwood D, Leatherman J, Razavi M. Myocardial infarction and normal coronary arteriography: a 10 year clinical and risk analysis of 74 patients. J Am Co11 Cardiol 1988;11:471-7. Johannessen KA, Nordrehaug JE, von der Lippe G. Left ventricular thrombosis and cerebrovascular accident in acute myocardial infarction. Br Heart J 1984;51:553-6. Weinreich DJ, Burke JF, Pauletto FJ. Left ventricular mural thrombi complicating acute myocardial infarction. Longterm follow-up with serial echocardiography. Ann Intern Med 1984;100:789-94. Arvan S. Left ventricular mural thrombi secondary to acute myocardial infarction: predisposing factors and embolic phenomenon. J Clin Ultrasound 1983;11:467-73. Nair CK, Sketch MH, Mahoney PD, Lynch JD, Mooss AN, Kenney NP. Detection of left ventricular thrombi by computerised tomography. A preliminary report. Br Heart J 1981; 45:535-41. Benichou M, Aubry J, Larbi MB, Romani A, Chiche G, Egre A, Djiane P, Bory M, Serradimigni A. Detection of left intraventricular thrombi in the acute phase of myocardial infarction by Z-dimensional echocardiography. Apropos of 103 cases. Arch Ma1 Coeur 1983;76:1012-9. Bhatnagar SK, Al Yusuf AR. Left ventricular thrombi after acute myocardial infarction. Postgrad Med J 1983

Absent right and persistent left superior vena cava without other congenital anomaly: A rare combination diagnosed by transesophageal echocardiography

9:495-S. Tramarin R, Pozzoli M, Vecchio C. Left ventricular thrombosis in recent myocardial infarction. An echocardiographic study. G Ital Cardiol 1982;12:397-404. Asinger RW, Mike11 FL, Elsperger J, Hodges M. Incidence of left-ventricular thrombosis after acute transmural myocardial infarction. Serial evaluation by two-dimensional echocardiography. N Engl J Med 1981;305:297-302.

Pitfalls in the Diagnosis of Thoracic Aortic Aneurysm by Transesophageal Echocardiography

A 70-year old man with a history of anorexia, weight loss, and progressive shortness of breath was studied by transesophageal echocardiography. In addition to a mass occupying the right ventricular outflow tract, a rare congenital heart anomaly was discovered serendipitously: persistent left superior vena cava, absent right superior vena cava, and no other congenital abnormality. The echocardiographic findings were confirmed by computed tomographic scanning and later during heart surgery performed to resect the malignant tumor.