Max Coulomb

Central airway stenoses: preliminary results of spiral-CT-generated virtual bronchoscopy simulations in 29 patients

Abstract. The purpose of this study was to determine the feasibility of using virtual bronchoscopy simulations to depict stenoses of the tracheobronchial tree. Virtual bronchoscopy simulations, based on ray casting, were applied to spiral-CT data sets of 29 patients presenting 41 stenoses of the central airways, proved with fiberoptic bronchoscopy. Simulations of the inner walls of the airways were of good quality in 27 of 29 patients. Airway stenoses were depicted in 39 of 41 cases. Evaluation of the length of stenoses and surrounding tissues required simultaneous display of multiplanar reformations. Virtual bronchoscopy provides a valuable road map for bronchoscopy, in an image format familiar to bronchoscopists.

Serial chest CT findings in interstitial lung disease associated with polymyositis–dermatomyositis

OBJECTIVE A retrospective study was carried out in two institutions to determine serial changes in the pattern, distribution, and extent of interstitial lung disease (ILD) associated with polymyositis (PM)-dermatomyositis (DM) using HRCT. SUBJECTS AND METHODS Twenty patients with PM-DM and clinical suspicion of ILD who underwent at least two serial HRCT examinations were retrospectively evaluated by two readers. Patients were classified according to the dominant CT pattern which was correlated with clinical evolution and underlying histology when available (n=6). RESULTS Patients were classified into four groups according to the dominant pattern: ground-glass attenuation and reticulation (group 1, n=9); honeycombing (group 2, n=4); airspace consolidation (group 3, n=4), and normal or almost normal lung (group 4, n=3). Under medical treatment, serial HRCT showed that the extent of areas of ground-glass opacities (group 1) decreased in five patients, stabilized in two, and increased in two. Pathologic findings demonstrated usual interstitial pneumonia (UIP) in two cases and unspecified interstitial pneumonia in one. In group 2, extent of honeycombing increased in three cases and stabilized in one. In group 3, dramatic resolution of airspace consolidation occurred in three cases. Clinical deterioration with extensive consolidation at CT and diffuse alveolar damage (DAD) at histology occurred in one patient of each of the three previous groups. Lesions stayed invisible or progressed slightly in the fourth group. CONCLUSION In ILD associated with PM-DM, clinical deterioration and DAD in the follow-up can be observed whatever the HRCT pattern. However, unfavorable evolution is constant when honeycombing is present at the initial CT.

Endovascular treatment of superior vena cava obstruction in patients with malignancies

Abstract. The aim of this study was to report our experience on the management of superior vena cava obstruction (SVCO) secondary to malignant disease, using endovascular procedures. Twenty-six patients with SVCO due to primary or secondary tumors of the lung or the mediastinum, or catheter inserted for treatment of an extra-thoracic neoplasm, had an endovascular therapy which consisted of stenting, angioplasty, thrombo-aspiration or local fibrinolysis. Immediately after the procedure, rapid relief of symptoms occurred in 24 (90 %) of the patients. The mean Kishis score decreased from 5.5 to 0.96. Immediate complications included one death related to pericarditis bleeding following fibrinolysis. Three patients relapsed after 20 days, 4 months and 6 months, and needed a second stenting. At 6 months the primary patency rate was 83 % and the secondary patency rate was 89 %. Endovascular treatment of SVCOs is a simple and safe procedure to restore the patency of the superior vena cava in malignant SVCO. It should be indicated in most cases as first-line treatment and performed as early as possible.

Case Report. Pulmonary Involvement in Niemann-pick Disease Subtype B: Ct Findings

We present a case of Niemann-Pick disease subtype B in which the excessive storage of sphingomyelin within lung interstitium and alveoli produced an infiltrative lung disease demonstrated on high-resolution CT (HRCT). HRCT findings were correlated to pathological features.

Helical CT with multiplanar and three-dimensional reconstruction of nonneoplastic abnormalities of the trachea

Helical CT is being increasingly used for the evaluation of suspected tracheal diseases. Although nonneoplastic and noninfectious diseases of the trachea are rare, their appearance on CT images may be highly suggestive of the diagnosis. High quality multiplanar and 3D reconstructions including 3D surface-shaded display and virtual bronchoscopy are helpful to characterize tracheal abnormalities and to demonstrate the location and extent of the diseases.

Nodules pulmonaires partiellement ou totalement en verre dépoli

Resume Introduction Les nodules pulmonaires partiellement ou totalement en verre depoli en tomodensitometrie sont d’identification recente. Etat des connaissances Ces nodules representent 2,9 % a 19 % des nodules detectes dans des populations a risque de cancer bronchique. Les correlations anatomo-radio-cliniques revelent une origine benigne (pneumonie chronique, fibrose localisee, hyperplasie adenomateuse atypique) ou maligne (cancer bronchiolo-alveolaire, adenocarcinome, plus rarement metastase). Le risque de cancer est superieur pour ces nodules que pour les nodules solides. Cependant, le temps de doublement des cancers a forme nodulaire en verre depoli est en moyenne superieur a celui des cancers a forme partiellement en verre depoli et largement superieur aux adenocarcinomes a forme solide. Le pronostic des patients est donc correle a la presence et a la proportion de verre depoli au sein du nodule. Perspectives La prise en charge de ces nodules impose une surveillance prolongee pour les nodules 10 mm persistant sur un scanner de controle entre 1 et 3 mois apres leur decouverte et traitement anti-inflammatoire et ou infectieux. Conclusion Les nodules totalement ou partiellement en verre depoli necessitent une prise en charge particuliere.

Pulmonary nodules with the CT halo sign.

Accessible online at: www.karger.com/journals/res A 65-year-old male was admitted to hospital because of dyspnea and polypnea (20/min). The patient had a past medical history of primary tuberculosis at the age of 8 years, insulin-dependent diabetes mellitus, anterior myocardial infarct at the age of 48 with chronic congestive heart failure (ejection fraction was 40–50%) and supraventricular arrhythmia. He was a current smoker (30 pack years). He was treated with oral anticoagulants, furosemide, amiodarone (200 mg daily 5 days a week, having started 3 years previously) and transcutaneous nitroglycerin. Physical examination revealed crackles in both bases, the chest radiograph showed an interstitial pattern predominating in the right lung (fig. 1a) and a CT scan of the chest revealed multiple nodular densities with the CT halo sign (fig. 1b). Bronchoscopic examination with biopsies and bronchial brushings showed a 30% stenosis in the right upper lobe bronchus corresponding to chronic inflammation of the bronchial mucosa without malignancy. The biochemical profile was normal with the exception of renal insufficiency (creatinine level: 172 Ìmol/l). The full blood count and liver function tests were normal. Antinuclear antibodies (ANF) and antineutrophil cytoplasmic antibodies (ANCA) were negative. Rheumatoid factor was positive with a titer of 1/480. Aspergillus serology was normal. What diagnosis should be considered in this patient? What is your next step in the diagnostic workup?

Imagerie des tumeurs carcinoïdes bronchiques : diagnostic et bilan d'extension loco-régionale

Resume Objectif Decrire l’aspect en imagerie des tumeurs carcinoides bronchiques. Preciser la place du scanner dans la strategie diagnostique et pre-therapeutique. Patients et methode Analyse retrospective de 54 tumeurs carcinoides bronchiques. Comparaison des donnees cliniques, radiologiques, scanographiques, fibroscopiques et anatomopathologiques. Resultats L’âge moyen des patients est de 48,5 ans (14-81 ans). La presentation clinique est liee a l’obstruction bronchique dans 55,7 % des cas ; les tumeurs sont majoritairement proximales (72 %). Leur densite est tissulaire avec calcifications (26 %) et rehaussement apres injection iodee (60 %). Les tumeurs carcinoides bronchiques typiques et atypiques different par leur taille, leur extension ganglionnaire, et non par leur topographie. L’apport principal de la TDM par rapport a la fibroscopie est de montrer les tumeurs proximales a developpement exo-bronchique (7,4 %), des lesions distales (20,4 %) et les complications pulmonaires en aval des tumeurs obstructives. Concernant le bilan d’extension ganglionnaire, la sensibilite et la valeur predictive positive de la tomodensitometrie sont tres faibles, respectivement de 28 et 20 %. Conclusion Le scanner est indispensable pour le diagnostic positif, la localisation topographique des tumeurs carcinoides bronchiques. Cependant, les faibles sensibilite et valeur predictive positive pour le bilan d’extension locale et ganglionnaire ne permettent pas, au terme du seul bilan scanographique, d’envisager une strategie therapeutique conservatrice reposant sur l’exerese tumorale endoscopique exclusive.

CT findings in a case of laryngeal sarcoidosis.

Abstract. Laryngeal sarcoidosis is a rare manifestation of systemic sarcoidosis. It affects mainly the supraglottic larynx. Involvement of the glottic and subglottic levels are exceptional. We present the case of a 56-year-old man with a 2-year history of systemic sarcoidosis, involving the mucosa of paranasal sinuses, a joint, and mediastinal lymph nodes, who developed laryngeal sarcoidosis. We emphasize the CT appearance of laryngeal sarcoidosis.

Paradoxical emboli: demonstration using helical computed tomography of the pulmonary artery associated with abdominal computed tomography

Abstract. We report the case of a 60-year-old woman with a recent history of a cerebrovascular accident. Because of clinical suspicion of pulmonary embolism and negative Doppler ultrasound findings of the lower limbs, spiral computed tomography of the pulmonary artery was performed and demonstrated pulmonary emboli. We emphasize the role of computed tomography of the abdomen, performed 3 min after the thoracic acquisition, which showed an unsuspected thrombus within the abdominal aorta and the left renal artery with infarction of the left kidney. Paradoxical embolism was highly suspected on computed tomography data and confirmed by echocardiography which demonstrated a patent foramen ovale.