Lee Sider

Pulmonary Manifestations of Cryptococcosis in Patients with Aids: Ct Features

The computed tomographic (CT) scans and chest radiographs of 10 patients with AIDS and proven pulmonary cryptococcal infections were reviewed. In seven patients (70%), CT demonstrated pulmonary opacities that ranged in appearance from a perihilar interstitial pattern to an area of dense alveolar consolidation. Corresponding chest radiographs were less accurate in detecting interstitial opacities (2 of 5 patients, 40%) than the alveolar opacities (4 of 5 patients, 80%). Pulmonary nodules were identified in three patients (30%) by CT but were identifiable on the chest radiograph in only one patient (10%). The chest radiograph suggested hilar adenopathy in three patients although CT confirmed hilar adenopathy in only one patient. In one patient, a small pleural effusion, not appreciated on the chest radiograph, was detected by CT. CT may add additional information in the diagnosis of pulmonary Cryptococcus neoformans.

Hilar and mediastinal adenopathy in sarcoidosis as detected by computed tomography.

CT of the chest was performed in 25 patients with chest radiographs suspicious for hilar or mediastinal adenopathy, who subsequently proved to have sarcoidosis. In each case, CT detected more extensive adenopathy than suspected on chest radiographs. Adenopathy greater than 1.0 cm was present in the right paratracheal and pretracheal regions in all cases. Adenopathy was also frequently seen in the hilar (92%), anteroposterior window (88%), subcarinal (64%), anterior mediastinal (48%), and posterior mediastinal (16%) lymph node groups. The adenopathy occurred in multiple and varying combinations without a consistent identifiable pattern suggestive of sarcoidosis. It is concluded that while CT detects adenopathy more consistently, it does not offer a clear advantage over chest radiography in confirming a diagnosis of mediastinal and hilar involvement by sarcoidosis.

CT-guided placement of iodine-125 seeds for unresectable carcinoma of the lung

To avoid thoracotomy, we recently placed 70 125I seeds percutaneously with the aid of CT guidance for treatment of an unresectable carcinoma of the lung. We achieved a successful distribution of seeds without complications.

The value of a structured course for an elective in radiology for senior medical students.

The authors recently revised the elective course for senior medical students at Northwestern University Medical School. The new course is well structured with clearly stated objectives, self-instruction seminars, specialized teaching conferences conducted by attendings and residents, student presentations, and a final examination. The enrollment in the course has increased steadily, especially among students not planning a career in radiology. Student surveys obtained immediately after completion of the new course demonstrated a clear positive response despite the increased workload. Follow-up surveys also showed a greater comfort level and expertise with radiographic images in students who participated in the more structured course. Final grade distribution was based on multiple factors and resulted in 16% honors reduced from previous honors rate of 24%.

Complexities of establishing an early diagnosis of allergic bronchopulmonary aspergillosis in children.

The problem of attempting to diagnose allergic bronchopulmonary aspergillosis (ABPA) in children at an early age, prior to the development of undesirable sequelae, such as bronchiectasis, is reviewed. Two cases of ABPA with onset under the age of ten are presented as illustrations of the complexities of securing an early diagnosis of ABPA. ABPA is not infrequent in children, with children under ten representing an estimated 9% to 10% of patients with the disorder. A high index of suspicion and persistence are important in establishing the diagnosis. ABPA may be identified in patients with detectable central bronchiectasis (ABPA-CB) or in patients seropositive (ABPA-S) who do not yet have bronchiectasis. Some complexities in making an early diagnosis of ABPA include: 1) insensitivity of CT scans in detecting central bronchiectasis, 2) lack of current chest radiographic infiltrates, 3) lack of peripheral blood eosinophilia and precipitins to A. fumigatus and 4) weakly reactive immediate skin test to Aspergillus.

Air gap technique for digital subtraction angiography of the extracranial carotid arteries

The technique of applying an air gap between the patient and the x-ray detector reduces scattered radiation from the patients neck sufficiently to allow performance of DSA of the extracranial carotid arteries with the antiscatter grid removed. When compared with the conventional grid technique, air gap allows 25 to 88% reduction of mA without increasing the kVp or exposure time and without loss of spatial resolution or diagnostic image quality. These considerable patient radiation-exposure savings can be implemented on DSA systems that use ordinary under-table x-ray tube fluoroscopic equipment without the purchase of additional hardware.