Sanford A. Rubin

Pulmonary zygomycosis : a radiographic and clinical spectrum

Eight documented cases of pulmonary zygomycosis were analyzed retrospectively with regard to radiographic and clinical features. Predisposing factors were diabetes mellitus in six cases, lymphoblastic lymphoma in one case, and surgery to correct a tracheoesophageal fistula in one case. Two of the patients with diabetes had also undergone renal transplantation for diabetic nephropathy and were immunosuppressed. The more usual radiographic findings of pulmonary zygomycosis represent a spectrum that comprises a normal chest radiograph, a lung abscess, subacute or chronic pneumonia that often evolves into a lung abscess, and rapidly progressive fatal pneumonia. Awareness of the various presentations of pulmonary zygomycosis is important because early diagnosis and appropriate therapy clearly have been shown to improve the survival rate of these patients. Zygomycosis should be included in the differential diagnosis when patients with diabetes mellitus, patients with leukemia or lymphoma, or immunocompromised patients present with or develop perplexing pulmonary abnormalities.

Pulmonary calcification in long-term hemodialysis: a mimic of pulmonary thromboembolism

Metastatic pulmonary calcification is a frequent complication of chronic renal failure, especially in patients undergoing maintenance hemodialysis. We report a patient with chronic renal failure, who developed chest pain and hypoxia suggestive of pulmonary thromboembolism (PTE) and subsequently died. The ventilation/perfusion (V/Q) scan was also interpreted as consistent with PTE. At autopsy the areas of reduced perfusion on the scan corresponded to the areas of pulmonary calcification with no evidence of PTE. Physicians should be aware that this condition may mimic PTE, and that pulmonary angiography may be necessary to confirm the diagnosis prior to the initiation of anticoagulation.

Intrathoracic Gastric Balloon: Radiographic Recognition of Esophageal Perforation

Perforation of the esophagus is an uncommon but life-threatening complication of balloon tamponade for bleeding esophageal varices. We report 2 cases in which the inflated gastric balloon was seen in the chest on radiographs. This finding strongly suggests esophageal perforation, and prompt intervention is required.

Interventional procedures used for diagnosing and treating lung cancer

In recent years interventional radiology has played an increasingly important role in the diagnosis and treatment of lung cancer. Useful interventional procedures include biopsy techniques, direct infusion of chemotherapeutic agents into neoplasms, and a number of palliative procedures. The article reviews the indications, contraindications, techniques, and complications of these procedures with emphasis on some of the newer procedures.

Nephrobronchial fistula: an uncommon manifestation of inflammatory renal disease.

It is well known that inflammatory diseases of the kidney may involve the perirenal space and spread contiguously to other organs, such as the stomach, colon, gallbladder and duodenum. It is less well known that fistulas may develop between the kidney and the lung. Presenting symptoms may suggest either renal or pulmonary disease. Two cases are reported. Familiarity with this entity should help to avoid misdiagnosis, especially when presenting symptoms are related to the respiratory system.

Radiology of immunologic diseases of the lung.

In the last two decades research in immunology has greatly expanded our knowledge of this important medical specialty. Many diseases of previously unknown etiology are now much better understood. This review emphasizes the basics of immunology in order to assist the reader in understanding the mechanisms that cause immunologic lung disease. The radiologic appearance of these diseases is discussed.

Alumni perceptions of adequacy of training in diagnostic radiology.

Former residents who completed an accredited university radiology residency between 1953 and 1983 were surveyed using a written questionnaire. Seventy-five percent responded with opinions concerning their satisfaction with the various aspects of their training, including whether the program had met the specific needs of their practice. Most were satisfied with their training. Many believed the program should offer formal training in nonclinical areas such as quality control, equipment selection, administration, economics, and contract negotiations. Nearly all (96%) believed they had been adequately prepared for the Board examination. The majority (75%) believed a postgraduate clinical year was important prior to entering a radiology residency. We believe the written survey is a useful means for gathering data regarding adequacy of residency training. With the current interest in residency program curricula, such data may be useful in the dynamic process of structuring residency programs.