摘要:

The old division of lung edema into two categories—cardiogenic (hydrostatic) and noncardiogenic (increased permeability)—is no longer adequate. For instance, it fails to distinguish between the capillary leak caused by acute respiratory distress syndrome from that caused by interleukin-2 treatment. Further, it fails to account for the capillary leak (‘stress-failure’) that may accompany edema. A modern view of edema must recognize the natural barriers to the formation and spread of edema. These barriers are the capillary endothelium and the alveolar epithelium. Varying degrees of damage to them can account for the varying radiographic and clinical manifestations of lung edema. Thus, interleukin-2 administration causes increased endothelial permeability without causing alveolar epithelial damage. The result is lung edema that is largely confined to the interstitium, causing little hypoxia and clearing rapidly. However, acute respiratory distress syndrome, which is characterized by extensive alveolar damage, causes air-space consolidation, severe hypoxia, and slow resolution. Thus, a reasonable classification of lung edema requires at least four categories: 1) hydrostatic edema; 2) acute respiratory distress syndrome (permeability edema caused by diffuse alveolar damage); 3) permeability edema without alveolar damage; and (4) mixed hydrostatic and permeability edema. The authors emphasize the importance of the barriers provided by the capillary endothelium and the alveolar epithelium in determining the clinical and radiographic manifestations of edema. In general, when the alveolar epithelium is intact, the radiographic manifestations are those of interstitial (not air-space) edema; this radiographic pattern predicts a mild clinical course and prompt resolution.

ISSN:0883-5993    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Hantavirus infection may cause diffuse air space disease, termed hanta-virus pulmonary syndrome (HPS). The authors sought to determine if chest radiographs could differentiate HPS from typical acute respiratory distress syndrome (ARDS). The authors identified patients with either HPS (n= 11) or acute ARDS (n= 32) and selected the earliest chest radiograph showing diffuse airspace disease, and a chest radiograph taken 24 to 48 hours previously. Thoracic and general radiologists first viewed the chest radiograph showing diffuse air space disease, and ranked the likelihood that each case represented HPS versus ARDS. Afterward, readers viewed earlier chest radiographs and rescored each case. Receiver operating characteristic (ROC) curves from both scoring sessions were generated. The mean areas under the ROC curves for the entire group was 0.83 ± 0.12 initially, and improved to 0.87 ± 0.09 (p < 0.05) after viewing prior chest radiographs. Receiver operating characteristic curves of thoracic radiologists described greater areas than those of general radiologists both before and after viewing prior chest radiographs; 0.95 ± 0.01 versus 0.78 ± 0.08 (p < 0.05) and 96 ± 0.02 versus 0.80 ± 0.05 (p < 0.05). The mean sensitivity and specificity of chest radiograph interpretation for HPS was 86 ± 13% and 74 ± 11%, respectively. Chest radiographs can differentiate HPS from ARDS. Accuracy is improved by the use of serial radiographs and more highly trained readers. The chest radiograph findings may represent differences in the extent of alveolar epithelial damage seen in HPS and ARDS.

ISSN:0883-5993    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In patients with chronic pulmonary embolism, pulmonary thromboendar-terectomy may result in a unique form of noncardiogenic pulmonary edema termed reperfusion edema. This report reviews the authors' experience after pulmonary thromboendarterectomy with particular emphasis on the radiographic manifestations of reperfusion edema. The clinical and radiographic record of 25 patients who underwent pulmonary thromboendarterectomy at the University of Pennsylvania from 1985 through 1995 were reviewed. The zonal distribution of radiographic opacity, time to maximal opacity, and the time to clearance of reperfusion edema were determined. The relationship of these radiographic manifestations to clinical severity of disease and clinical outcome was examined. Reperfusion edema, characterized by patchy bilateral perihilar alveolar opacities, occurred in all but one patient. There is a lower lung zone predominance of opacities, but in individual cases, striking unilateral or haphazard arrangements of opacities may be seen. In this small sample of patients, no association between preoperative pulmonary arterial pressures and radiographic appearance or clinical outcome was found. However, severity of radiographic opacities, as measured by the extent of involved lung, correlated with disease severity, as measured by time to extubation and time to discharge. Pneumonia, defined as a radiographic opacity that evolves discordantly with the reperfusion edema opacities, occurred in 20% of cases. Reperfusion edema is a common consequence of pulmonary thromboendarterectomy. The severity of radiographic manifestations and clinical severity of disease are related. This characteristically appears as perihilar alveolar opacities.

ISSN:0883-5993    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In an effort to define the posterior inferior junction line (PIJL) and its clinical associations more precisely, 64 posteroanterior radiographs demonstrating the PIJL or left pleuroesophageal stripe (LPES) were analyzed for the presence of emphysema, kyphosis, air-filled esophagus, and/or tortuous aorta. Pursuant to the possible association of a PIJL or LPES with an air-filled esophagus, posteroanterior radiographs of 66 patients with achalasia were evaluated for the presence of a PIJL or LPES. To determine the components of the PIJL or LPES, 50 randomly selected computed tomographs (CT) of the chest were reviewed. Finally, 118 posteroanterior radiographs of patients with emphysema were analyzed for the presence of a PIJL and/or LPES to determine the sensitivity of the line/stripe for emphysema. The finding of a PIJL and/or LPES had a combined sensitivity of 23% for emphysema. Although certain other anatomic constructs lead to the presence of a line or stripe, emphysema is the most commonly associated clinical entity with a positive predictive value of 65.8%. The line and/or stripe is formed by interfaces between lung/lung, lung/esophagus, or both at different levels.

ISSN:0883-5993    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Using computed tomography (CT), the authors determined significant signs of overinflation. Both the pulmonary function tests (PFT) and CT of 74 patients who underwent thoracic surgery for lung cancer (44 with normal lung function, 30 with chronic obstructive pulmonary disease) were reviewed. The following were correlated with forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC): tracheal index (transverse/anteroposterior diameter), sterno-aortic distance, thoracic cage ratios (anteroposterior/transverse diameters) at the tracheal carina (TC1) and 5 cm below (TC2); and depth of the azygoesophageal recess and the presence of intercostal lung bulging (ILB). Significant correlations were observed between FEV1/FVC and tracheal index (r= 0.578, p < 0.0001), TC1 (r= −0.523, p < 0.0001), TC2 (r= −0.533, p < 0.0001), and ILB (r= −0.462, p < 0.0001). Correlations were significant but weak between FEV1/FVC and sterno-aortic distance (r= −0.351, p = 0.0027) and depth of the azygoesophageal recess (r= −0.308, p = 0.0085). Reduced tracheal index and increased anteroposterior diameter of the thoracic cage correlated most significantly with a pulmonary function index of chronic airway obstruction.

ISSN:0883-5993    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Computed tomography (CT) is used to detect emphysematous changes in the lungs of living patients. It is therefore important to develop a standard method for the radiographic quantification of emphysematous lesions using CT. The authors determine the best CT scanning methods for assessing the degree of pulmonary emphysema. Computed tomography scanning was performed in 85 consecutive patients with stable chronic obstructive pulmonary disease. Scans were obtained using 2-mm or 5-mm collimation, at full inspiration or full expiration, and with standard or high spatial-resolution reconstruction images (eight images each). Emphysema was then assessed by visual scoring using a five-point scale for each lung. Emphysema was scored as significantly less severe using standard reconstruction images. There were no significant differences in CT-scored emphysema on scans obtained with 2-mm and 5-mm collimation. Emphysema was scored as significantly less severe on expiratory scans. The postbronchodilator forced expiratory volume in one second value correlated better with emphysema scored on expiratory scans. Computed tomography-scored emphysema obtained by all methods correlated well with the diffusion capacity and total lung capacity, regardless of the method used. Using a visual scoring system with a five-point scale, narrow collimation is probably not necessary for the quantification of emphysema, although a high spatial-resolution reconstruction appears to be of value. Scans obtained in exhalation appear to underemphasize the severity of emphysema.

ISSN:0883-5993    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The authors estimate the relationship between the progression of honeycombing and disease activity of usual interstitial pneumonia (UIP) by open lung biopsy specimen and ground-glass opacity on thin-section computed tomography (CT). Open lung biopsy specimens and the initial and follow-up thin-section CT of 29 patients with proven UIP are reviewed. Follow-up thin-section CTs were performed from 2 to 61 months (mean, 15.3 months) after biopsy. The interval between the initial CT and open lung biopsy was from 2 to 30 days (mean, 10.0 days). Areas of ground-glass opacity and honeycombing were quantified respectively on each CT slice by using a 0%–100% scale with 10% increments. Each open lung biopsy specimen was scored semiquantitatively for alveolar desquamation, alveolar septal inflammation, inflammatory airway narrowing, obstructive pneumonitis, and lymphoid nodules. Patients were classified into either a mild or severe activity group according to the median value of the pathologic score and the median value of the area of ground-glass opacity. The authors compared the progression of honeycombing on follow-up thin-section CT between the groups. The progression of honeycombing in UIP was significantly faster in the severe activity group than in the mild group according to the pathologic score (p = 0.003) and the area of ground-glass opacity (p = 0.0024). In patients with UIP, more active inflammation of the pulmonary interstitium results in faster progression of honeycombing in long-term follow-up.

ISSN:0883-5993    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

To assess the value of spiral computed tomography (CT) with multiplanar reformations for detection of neoplastic extension across pulmonary fissures, 51 patients with a lung neoplasm near a fissure underwent spiral CT, followed by multiplanar reformations, and spaced thin-section CT scans through the area of contact between tumor and fissure. The CT studies were evaluated for visibility of fissures and their relationship to the tumor. Imaging findings were compared with surgical results in 31 patients who underwent thoracotomy. Visibility of fissures on multiplanar reformations was either good or acceptable in 47 (92.2%) patients, and poor in four. Surgical findings of neoplastic extension across the major or the minor fissure were present in seven and eight patients, respectively. Thin-section CT scans were 83.3% sensitive in assessing neoplastic involvement of the major fissure, axial CT scans were 57.1% sensitive, and spiral CT multiplanar images were 100% sensitive. In the evaluation of the minor fissure, thin-section CT and axial spiral CT scans were considered inconclusive in six patients whereas multiplanar reformations enabled correct assessment of the fissure/neoplasm relationship in all but one patient. Spiral CT multiplanar images are accurate for detection of transfissural neoplastic extension, and are superior to axial CT scans for evaluation of tumors near the minor fissure.

ISSN:0883-5993    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Pleural dissemination in lung cancer was prospectively evaluated by helical computed tomography (CT), and the usefulness of thick-section CT (10-mm collimation; pitch 1) and thin-section CT (2-mm collimation; pitch 1) were compared. The study included 54 patients with pulmonary adenocarcinoma in whom plain chest radiographs showed no evidence of pleural effusion and in whom the primary lesion was seen to be contiguous with the pleural surface on thick-section CT. Thin-section CT was performed for evaluation of the costal, mediastinal, interlobar, and diaphragmatic pleural surfaces. Pathologic examination revealed pleural dissemination in 20 patients (8 resected, 12 nonresected). Pleural dissemination was diagnosed in 12 patients on thick-section CT, and in 20 patients on thin-section CT. False negatives occurred in ten and two patients, respectively. The same two patients were false positives by both methods. Accuracy was 78% for thick-section CT and 93% for thin-section CT, and sensitivity was 50% and 90%, respectively. Thin-section CT provided more useful information than thick-section CT for the evaluation of pleural dissemination in lung cancer.

ISSN:0883-5993    

出版商:OVID    

年代:1998

数据来源: OVID