Nimrod Maimon

Chest low-dose computed tomography in neutropenic acute myeloid leukaemia patients.

BACKGROUND We aimed to compare chest low-dose computed tomography (LDCT) with chest radiography (CXR) in the assessment of febrile acute myeloid leukaemia neutropenic patients. METHODS A prospective non-randomized study was carried out between 30 May, 2003 and 3 June, 2004 in consecutive neutropenic patients who required imaging of the thorax and were treated for acute myeloid leukaemia. Each patient had a baseline 2-view chest radiograph followed by LDCT. Both the CXR and the LDCT studies were blindly and independently reviewed by two chest radiologists. RESULTS Forty patients were enrolled: 24 male and 16 female, mean age 53.5 years (range 18-83) and an average neutrophil count of 0.78 x 10(9)/L. Patients had CXR within a mean of 40 min from the LDCT. Overall, 31 (77.5%) of 40 CXR were abnormal, whereas LDCT detected abnormalities in 38 (95%) of 40 patients. LDCT demonstrated three times the number of lung nodules as CXR and twice as many ground-glass opacities. Lung consolidation was detected similarly using both techniques, but LDCT demonstrated more extensive and multi-focal consolidation. The majority of nodules detected only on LDCT were subcentimetre in diameter. The additional information provided by LDCT led to an alteration in the clinical management of 11 (27.5%) of 40 patients. CONCLUSION LDCT is a useful tool in the initial investigation of suspected pulmonary complication in neutropenic patients. This is supported by the additional information it provides to the CXR with reduced radiation when compared to conventional CT.

Fatal pulmonary Mycobacterium xenopi in a patient with rheumatoid arthritis receiving etanercept.

In this case study, a 71 year old man with emphysema and severe rheumatoid arthritis, previously treated with a TNF&agr; receptor antagonist, presented with progressive dyspnoea and weight loss. Thoracic imaging revealed extensive destruction of the left lung and this was associated with positive Mycobacterium xenopi cultures from respiratory samples. Anti-mycobacterial chemoptherapy was poorly tolerated and the patient subsequently died from respiratory failure and generalised wasting.

Tracheobronchial involvement as a sole manifestation of relapsing polychondritis.

Study ObjectivesTo report the clinical, imaging, and pathologic manifestations of case series of patients in whom the only systemic expression of relapsing polychondritis (RP) was their airway complications. DesignRetrospective review of the medical records of all patients with respiratory complications of RP between 1995 and 2007. SettingTertiary care, university-affiliated hospital. ResultsThree patients with RP had just lower airway manifestations as the only sign of their RP. All 3 were women, aged 44, 49, and 54 years. All had an abnormal chest computed tomography scan, although 2 had a completely normal chest x-ray. All had positive tracheal biopsy, which was consistent with the diagnosis of respiratory chondritis. Pulmonary function tests showed severe reduction in forced expiratory volume in 1 second in all patients. Bronchoscopy revealed tracheal narrowing with variable degrees of inflammation and collapsibility in all patients. Two of the 3 patients underwent tracheal and bronchial stent insertion. Pharmacotherapy included prednisone, methotrexate, cyclophosphamide, and leflunomide. The overall outcome was poor. Two patients died as a result of respiratory complications, 25 and 30 months from diagnoses, and 1 is still alive with follow-up of 85 months after presentation. ConclusionsLower airway manifestations of RP can be the only sign of the disease. RP has to be considered in the differential diagnosis of patients with recent onset of progressive dyspnea and severe airflow limitation even without other systemic signs of cartilage damage.