Judith M. Aronchick

Utility of High Resolution Computed Tomography in Predicting Bronchiolitis Obliterans Syndrome Following Lung Transplantation: Preliminary Findings

This study was undertaken to evaluate the efficacy of high resolution computed tomography (HRCT) in predicting the development of bronchiolitis obliterans syndrome (BOS) in lung transplant recipients. Fifty lung transplant patients who were clinically stable and without evidence of BOS were evaluated for the presence of four HRCT features reported to be associated with bronchiolitis obliterans: mosaic attenuation on inspiratory CT (mosaic perfusion), mosaic attenuation on expiratory CT (air trapping), bronchiectasis, and tree-in-bud opacities. CT exams were part of an annual surveillance process with the hope of predicting subsequent development of BOS. Diagnosis of BOS was made in 9 of 50 patients as indicated by a fall in FEV1 of greater than 20% of a stable baseline. None of the radiographic features associated with clinically established BOS were both sensitive and specific in the prediction of BOS. Air trapping demonstrated moderate sensitivity (56%, 5/9) and moderate specificity (76%, 35/46) for prediction of BOS in the year following the CT exam. Bronchiectasis, the most reliable indicator of the presence of BOS was a poor predictor of subsequent BOS with an 11% (1/9) sensitivity but had high specificity (96%, 44/46). No high resolution CT features accurately predicted the development of BOS.

Computed tomography of bronchial carcinoid.

Computed tomography was used to evaluate three patients with endobronchial tumors. In each case the mass showed enhancement following intravenous contrast medium administration. Each patient underwent surgical resection, and pathology showed carcinoid tumor in each case.

Observer variation in the detection of osteopenia

In order to determine observer variation in the detection of osteopenia, 15 pairs of lateral chest radiographs obtained within two weeks of each other were reviewed separately by two radiologists and one orthopedist on three separate occasions. Intra- and interobserver variations were calculated for each individual film and film pairs using Kappa values. The individual observers were not able to give consistent readings on the same film on different days (average Kappa=0.54). When the additional factors of repeat films (average Kappa=0.47), or separate observers (average Kappa=0.38) were analyzed, agreement was even worse. The identification of osteopenia from the lateral view of the thoracic spine is highly subjective and variable from film to film and observer to observer.

Drug-induced pulmonary disease: an update.

The review provides an update of drug-induced pulmonary disorders, focusing on newer agents whose effects on the lung have been studied recently. Included among these drugs are cyclosporine. cytosine arabinoside (Ara-C), amiodarone, interleukin-2 (IL-2), OKT3, tricyclic antidepressants. and bromocriptine. A brief review of the most common cytotoxic and noncytotoxic agents causing pulmonary toxicity is also included.

Recurrent esophageal carcinoma at thoracotomy incisions: diagnostic contributions of CT.

Three cases of surgical implantation of esophageal carcinoma during esophagogastrectomy are presented. The CT and radiographic appearance is demonstrated. A possible etiology and method for decreasing the risk of surgical spread of tumor are discussed.