Katashi Satoh

A novel method for determining adjacent lung segments with infrared thoracoscopy.

OBJECTIVESnWe investigated a new technique for identifying the lung intersegmental line using infrared thoracoscopy with intravenous injection of indocyanine green.nnnMETHODSnThis was an experimental animal study, and target segments were established preoperatively. Six adult beagle dogs underwent thoracotomy. After the corresponding pulmonary artery of the target segment had been ligated, indocyanine green was administered intravenously during infrared thoracoscopy. The lung was separated into 2 areas, white and blue, according to the blood flow on the monitor. We marked the visceral pleura with electrocautery along the transition zone showing a change in color from blue to white. The experimental lung was removed and subjected to pathologic and radiologic analysis.nnnRESULTSnAfter injection of indocyanine green, infrared thoracoscopy showed that the area of normal perfusion changed to blue, whereas the area at which perfusion was absent remained white. The transition zone between colors was distinct, and the blue stain remained visible during the marking procedure. Three-dimensional computed tomographic analysis indicated that the marking separated the target segmental bronchus from the adjacent one. Detailed macroscopic and microscopic study confirmed that the marking corresponded to the intersegmental line.nnnCONCLUSIONnBy using infrared thoracoscopy with indocyanine green, it is possible to detect the intersegmental line without inflating the lung.

Comparison of chest computed tomography features in the acute phase of cardiogenic pulmonary edema and acute respiratory distress syndrome on arrival at the emergency department.

Purpose: Discriminating cardiogenic pulmonary edema (CPE) from acute respiratory distress syndrome (ARDS) is a serious problem in emergency departments, and the ability of chest radiographs to differentiate between these 2 entities is limited. We compared the chest computed tomography (CT) findings in the acute phase of CPE with those of ARDS. Materials and Methods: Outpatients with acute respiratory failure presenting to emergency departments with bilateral pulmonary opacities were enrolled. The patients included not only those who visited our hospital first but also those referred from other hospitals. Two intensivists who were blinded to the results of the chest imaging studies reviewed the patients’ clinical records independently in order to determine a diagnosis of CPE or ARDS, and the chest CT findings were independently evaluated by 2 radiologists who were unaware of the patients’ clinical information. The positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of the statistically different findings were calculated using standard definitions. Results: Forty-one patients with CPE and 20 patients with ARDS were assessed. Upper-lobe–predominant ground-glass attenuation, central-predominant ground-glass attenuation, and central airspace consolidation were associated with high PPVs (95.2%, 92.3%, and 92.0%, respectively) and moderate NPVs (47.5%, 51.4%, and 50.0%, respectively) to diagnose as CPE. Left-dominant pleural effusion and small ill-defined opacities revealed relatively high PPVs (71.4% and 58.3%, respectively) and NPVs (72.2% and 73.5%, respectively) to diagnose as ARDS. The overall accuracy of the diagnosis by chest CT was 88.5% (54/61). Conclusions: Chest CT may be a useful tool for differentiating CPE from ARDS in the emergency department setting.

Relationship between CT Findings and the Plasma Levels of Brain Natriuretic Peptide in 29 Patients with Acute Cardiogenic Pulmonary Edema

RATIONALE AND OBJECTIVESnBrain natriuretic peptide (BNP) is a useful biomarker for the assessment of cardiogenic pulmonary edema. This study evaluated the relationship between computed tomography (CT) findings and plasma BNP levels in patients with cardiogenic pulmonary edema.nnnMATERIALS AND METHODSnTwenty-nine consecutive outpatients with severe respiratory failure from cardiogenic edema presenting to emergency departments were enrolled. They underwent chest CT and plasma BNP levels were measured in the emergency room. CT findings were independently evaluated by two radiologists who were unaware of the patients clinical information.nnnRESULTSnThe plasma BNP levels only correlated with the volume of pleural effusion in each side (right: r(s) = 0.519, P = .004; left: r(s) = 0.460, P = .012). No significant correlation was observed between the BNP levels and the findings of lung parenchyma or cardiovascular enlargement.nnnCONCLUSIONnEstimating the pleural effusion volume with CT may be a feasible method as well as measuring the plasma BNP level in the assessment of acute cardiogenic pulmonary edema.

Evaluation of subsubsegmental pulmonary arteries of the posterior and anterior segments of the right upper lobe using multidetector row computed tomography with multiplanar reconstruction images

PurposeWe evaluated the patterns of subsubsegmental pulmonary arteries of the right upper lobe (posterior segment: S2; anterior segment: S3) with multiplanar reconstruction (MPR) images by multidetector row computed tomography (MDCT).Materials and methodsA total of 64 patients who had undergone MDCT scans were included in the study. The subsubsegmental arteries were named by adding “i” or “ii” as the superior or the inferior branch, respectively, of the subsegmental arteries. The subsubsegmental arteries of S2 (A2ai, A2aii, A2bi, A2bii) and S3 (A3ai, A3aii, A3bi, A3bii) were evaluated as arising from either the recurrent artery (RA) or the ascending artery (AA).ResultsA2ai originated from the RA and AA in 43 and 21 patients, respectively. The corresponding numbers were 32 each for A2aii; 28 and 36 for A2bi; 23 and 41 for A2bii; 60 and 4 for A3ai; 43 and 21 for A3aii; 59 and 5 for A3bi; and 54 and 10 for A3bii.ConclusionThe branching pattern of the subsubsegmental pulmonary arteries in the right upper lobe (S2 and S3) could be visualized using MDCT with MPR images.