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Wilson TA, Legrand A, Gevenois PA, De Troyer A. Respiratory effects of the external and internal intercostal muscles in humans. J Physiol 2001; 530:319-30. [PMID: 11208979 PMCID: PMC2278403 DOI: 10.1111/j.1469-7793.2001.0319l.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The current conventional view of intercostal muscle actions is based on the theory of Hamberger (1749) and maintains that as a result of the orientation of the muscle fibres, the external intercostals have an inspiratory action on the lung and the internal interosseous intercostals have an expiratory action. Recent studies in dogs, however, have shown that this notion is only approximate. In the present studies, the respiratory actions of the human external and internal intercostal muscles were evaluated by applying the Maxwell reciprocity theorem. Thus the orientation of the muscle fibres relative to the ribs and the masses of the muscles were first assessed in cadavers. Five healthy individuals were then placed in a computed tomographic scanner to determine the geometry of the ribs and their precise transformation during passive inflation to total lung capacity. The fractional changes in length of lines with the orientation of the muscle fibres were then computed to obtain the mechanical advantages of the muscles. These values were finally multiplied by muscle mass and maximum active stress (3.0 kg cm-2) to evaluate the potential effects of the muscles on the lung. The external intercostal in the dorsal half of the second interspace was found to have a large inspiratory effect. However, this effect decreases rapidly in the caudal direction, in particular in the ventral portion of the ribcage. As a result, it is reversed into an expiratory effect in the ventral half of the sixth and eighth interspaces. The internal intercostals in the ventral half of the sixth and eighth interspaces have a large expiratory effect, but this effect decreases dorsally and cranially. The total pressure generated by all the external intercostals during a maximum contraction would be -15 cmH2O, and that generated by all the internal interosseous intercostals would be +40 cmH2O. These pressure changes are substantially greater than those induced by the parasternal intercostal and triangularis sterni muscles, respectively.
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Abstract
On chest radiograph, the diagnosis of tracheobronchial tear is usually suspected because of the persistence of a pneumothorax after chest tube insertion. Since this radiographic pattern is nonspecific, the diagnosis is usually made by bronchoscopy and delayed. The fallen-lung sign consists in the fall of the collapsed lung away from the mediastinum occurring when the normal central bronchial anchoring attachment of the lung is disrupted. In contrast to the persistent pneumothorax, this sign is specific but rarely observed. Our purpose is to present the corresponding CT patterns observed in two cases of right stem bronchus tear, consisting in a caudal-dependent displacement of the right upper lobe bronchus which becomes obliquely oriented.
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El-Hajjam M, Gevenois PA, Qanadli SD, Dubourg O, Bourdarias JP, Lacombe P. Diagnosis of saphenous coronary graft aneurysm by spiral computed tomography. Cardiovasc Intervent Radiol 2000; 23:142-4. [PMID: 10795841 DOI: 10.1007/s002709910029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We report two cases of coronary saphenous vein graft aneurysms diagnosed by spiral computed tomography.
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Keyzer C, Gevenois PA. [Quantitative computed tomography of pulmonary emphysema]. Rev Mal Respir 1999; 16:455-60. [PMID: 10549056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Computed tomography, and particularly high-resolution computed tomography, allows a detailed exploration of the pulmonary parenchyma. We discuss here work on the use of this technique in the diagnosis and quantification of pulmonary emphysema. We stress first the subjective quantification then the objective approach based on specific software. We summarize our work which has demonstrated. 1) that the relative surface with density below -950 Hounsfield units and measured on millimetric tomographic slices obtained at the end of maximal inspiration is a valuable measurement of the extent of the macroscopic emphysema and reflects the microscopic emphysema; 2) that subjective quantification overestimates minimally extensive emphysema and shows important intra- and inter-operator variability; 3) that indexes derived from computed tomographic images acquired at the end of expiration reflect more the obstructive syndrome than emphysematous destruction; 4) that age and the size of the lungs influence computed tomographic measurements while hyperinflation appears to have no effect. Finally, we present an example of recent work applying the computed tomographic technique.
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Bankier AA, De Maertelaer V, Keyzer C, Gevenois PA. Pulmonary emphysema: subjective visual grading versus objective quantification with macroscopic morphometry and thin-section CT densitometry. Radiology 1999; 211:851-8. [PMID: 10352615 DOI: 10.1148/radiology.211.3.r99jn05851] [Citation(s) in RCA: 228] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare subjective visual grading of pulmonary emphysema with macroscopic morphometry and computed tomographic (CT) densitometry. MATERIALS AND METHODS In 62 consecutive patients who underwent thinsection CT before surgical lung resection, emphysema was objectively quantified with computer-assisted macroscopic morphometry and CT densitometry. The percentage of lung macroscopically occupied by emphysema was compared with the percentage occupied on CT scans by pixels with attenuation values lower than a predefined threshold (CT densitometry). Three readers with varying degrees of expertise subjectively graded emphysema with visual assessment at two reading sessions. Data from objective quantification and subjective grading were analyzed with correlation coefficients, and interobserver and intraobserver agreement were calculated. RESULTS Subjective grading of emphysema showed less agreement with the macroscopic reference standard results (r = 0.439-0.505; P < .05) than with objective CT densitometric results (r = 0.555-0.623; P < .001). The 95% CIs for the intercepts of the linear regression lines were suggestive of systematic subjective overestimation of emphysema by all three readers. Interobserver agreement was moderate (kappa = 0.431-0.589). Intraobserver agreement was good to excellent (kappa = 0.738-0.936). The expertise of individual readers did not substantially influence results. CONCLUSION Systematic overestimation and moderate interobserver agreement may compromise subjective visual grading of emphysema, which suggests that subjective visual grading should be supplemented with objective methods to achieve precise, reader-independent quantification of emphysema.
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Cassart M, Verbandt Y, de Francquen P, Gevenois PA, Estenne M. Diaphragm dimensions after single-lung transplantation for emphysema. Am J Respir Crit Care Med 1999; 159:1992-7. [PMID: 10351950 DOI: 10.1164/ajrccm.159.6.9812052] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We used three-dimensional reconstructions obtained with spiral computed tomography to measure total diaphragm surface area (Adi), and the surface area of the dome (Ado) and of the zone of apposition (Aap) of the diaphragm in nine patients with single-lung transplantation (SLT) for emphysema and nine normal subjects matched for age, sex, height, and weight. Measurements were obtained at supine FRC, midinspiratory capacity, and TLC. In the normal subjects, Ado and Adi were greater on the right than on the left side, and the right dome was positioned more cranially than the left one, presumably because of the presence of the liver. Compared with either the ipsilateral side in the controls or the native side in the patients, Ado was smaller on the transplanted side because the mediastinum was shifted toward the graft. Adi showed a similar trend. On the other hand, the radius of curvature of the dome in the coronal and sagittal planes was similar on the side of the graft and on the ipsilateral side in the controls. In conclusion, we found that after SLT for emphysema, diaphragm configuration comes back to normal but Ado, and with it Adi, remain smaller than in normal subjects because the mediastinum is displaced toward the graft.
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Scillia P, Delcroix M, Lejeune P, Mélot C, Struyven J, Naeije R, Gevenois PA. Hydrostatic pulmonary edema: evaluation with thin-section CT in dogs. Radiology 1999; 211:161-8. [PMID: 10189466 DOI: 10.1148/radiology.211.1.r99ap07161] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To identify the hemodynamic determinants of ground-glass opacification on thin-section computed tomographic (CT) scans of hydrostatic pulmonary edema and to compare attenuation and subjective assessments of ground-glass opacification with extravascular lung water. MATERIALS AND METHODS Left atrial pressure, pulmonary arterial pressure, effective pulmonary capillary pressure, and extravascular lung water were measured in six dogs before and during progressive increase of effective pulmonary capillary pressure. A thin-section CT scan was obtained at each step. Lung attenuation and subjective assessments of ground-glass opacification were compared with hemodynamic variables and extravascular lung water. RESULTS Ground-glass opacification was identified when effective pulmonary capillary pressure equaled critical pulmonary capillary pressure. Extravascular lung water increased, and the distribution curve of lung attenuation coefficients shifted to higher attenuation from the second measurement at an effective pulmonary capillary pressure greater than the critical pulmonary capillary pressure. Attenuation was highly correlated (r = 0.98, P < .001) with extravascular lung water; ground-glass opacification was detected before a significant (P = .615, analysis of variance) increase in extravascular lung water. CONCLUSION Thin-section CT depicts ground-glass opacification when effective pulmonary capillary pressure equals critical pulmonary capillary pressure and before a detectable increase in extravascular lung water. Attenuation reflects extravascular lung water.
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Estenne M, Cassart M, Poncelet P, Gevenois PA. Volume of graft and native lung after single-lung transplantation for emphysema. Am J Respir Crit Care Med 1999; 159:641-5. [PMID: 9927385 DOI: 10.1164/ajrccm.159.2.9802017] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To assess how the presence of the hyperinflated native lung influences the volume of the graft after single-lung transplantation (SLT) for emphysema, we used chest computed tomography to measure the TLC of each lung at a mean of 326 d before and 239, 588, and 932 d after SLT in nine patients. In addition, we obtained measurements of TLC and FRC in these nine patients plus one additional recipient at 697 d after surgery, and in 10 nonsmoking normal subjects matched for age, sex, height, and weight. On the nontransplanted side, TLC averaged 3.57 L before and 3.73 L, 3.70 L, and 3.73 L after SLT (NS). Corresponding values on the transplanted side were 3.42 L before and 2.06 L, 1.96 L, and 1.90 L after surgery, respectively (p < 0. 0002). Compared with the values obtained on the ipsilateral side in the control subjects, the FRC of the graft amounted to 100%, but its TLC was decreased to 79% (p < 0.005). We conclude that (1) the TLC of the graft and of the native lung do not change over time after SLT for emphysema, and (2) compared with the ipsilateral lung in normal control subjects, the TLC of the graft is substantially reduced, but its FRC is within normal limits.
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De Troyer A, Legrand A, Gevenois PA, Wilson TA. Mechanical advantage of the human parasternal intercostal and triangularis sterni muscles. J Physiol 1998; 513 ( Pt 3):915-25. [PMID: 9824728 PMCID: PMC2231324 DOI: 10.1111/j.1469-7793.1998.915ba.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
1. Previous studies in dogs have demonstrated that the maximum change in airway pressure (DeltaPao) produced by a particular respiratory muscle is the product of three factors, namely the mass of the muscle, the maximal active muscle tension per unit cross-sectional area ( approximately 3.0 kg cm-2), and the fractional change in muscle length per unit volume increase of the relaxed chest wall (i.e. the muscle's mechanical advantage). In the present studies, we have used this principle to infer the DeltaPao values generated by the parasternal intercostal and triangularis sterni muscles in man. 2. The mass of the muscles and the direction of the muscle fibres relative to the sternum were first assessed in six cadavers. Seven healthy individuals were then placed in a computed tomographic scanner to determine the orientation of the costal cartilages relative to the sternum and their rotation during passive inflation to total lung capacity. The fractional changes in length of the muscles during inflation, their mechanical advantages, and their DeltaPao values were then calculated. 3. Passive inflation induced shortening of the parasternal intercostals in all interspaces and lengthening of the triangularis sterni. The fractional shortening of the parasternal intercostals decreased gradually from 7.7 % in the second interspace to 2.0 % in the fifth, whereas the fractional lengthening of the triangularis sterni increased progressively from 5.9 to 13.8 %. These rostrocaudal gradients were well accounted for by the more caudal orientation of the cartilages of the lower ribs. 4. Since these fractional changes in length corresponded to a maximal inflation, the inspiratory mechanical advantage of the parasternal intercostals was only 2.2-0. 6 % l-1, and the expiratory mechanical advantage of the triangularis sterni was only 1.6-3.8 % l-1. In addition, whatever the interspace, parasternal and triangularis muscle mass was 3-5 and 1-3 g, respectively. As a result, the magnitude of the DeltaPao values generated by a maximal contraction of the parasternal intercostals or triangularis sterni in all interspaces would be only 1-3 cmH2O. 5. These studies therefore confirm that the parasternal intercostals in man have an inspiratory action on the lung whereas the triangularis sterni has an expiratory action. However, these studies also establish the important fact that the pressure-generating ability of both muscles is substantially smaller than in the dog.
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Gevenois PA, Sergent G, De Maertelaer V, Gouat F, Yernault JC, De Vuyst P. Micronodules and emphysema in coal mine dust or silica exposure: relation with lung function. Eur Respir J 1998; 12:1020-4. [PMID: 9863990 DOI: 10.1183/09031936.98.12051020] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to investigate the respective effects of micronodules and pulmonary emphysema, detected by computed tomography (CT), on lung function in workers exposed to silica and coal mine dust. Eighty-three subjects exposed to silica (n=35) or to coal mine dust (n=48), without progressive massive fibrosis, were investigated by high-resolution and conventional CT scans to detect micronodules and to quantify pulmonary emphysema by measuring the relative area of the lung with attenuation values lower than -950 Hounsfield units. Sixty-six (54.5%) subjects had evidence of micronodules on CT scans. Smokers had micronodules more rarely than nonsmokers. Significant correlations were found between the forced expiratory volume in one second (FEV(1); % predicted) (r=-0.41, p<0.001), FEV1/vital capacity (VC) (r=-0.61, p<0.001), diffusing capacity of the lung for carbon monoxide (DL,CO) (r=-0.36, p<0.001) and the extent of emphysema. No difference was demonstrated in the linear relationships between the extent of emphysema and the pulmonary function according to the type of exposure or the presence of micronodules on CT scans. This study suggests that micronodules detected by computed tomography have no influence, by themselves, on pulmonary function and that they should only be considered as a marker of exposure.
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Tannouri F, Lalmand B, Zalcman M, Peny MO, Van Gossum A, Van Gansbeke D, Gevenois PA, Struyven J. Role of the double-contrast barium enema in rectal stenosis due to suppositories containing paracetamol and acetylsalicylic acid. Eur Radiol 1998; 8:1217-20. [PMID: 9724442 DOI: 10.1007/s003300050538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Self-treatment of chronic headache with suppositories containing paracetamol and acetylsalicylic acid may lead to serious complications. We report the radiological features of five cases of rectal stenosis following the use of such suppositories. The role of the double-contrast barium enema in suggesting the diagnosis of this complication of a chronic and often unrecognized self-treatment is emphasized.
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Golzarian J, Dussaussois L, Abada HT, Gevenois PA, Van Gansbeke D, Ferreira J, Struyven J. Helical CT of aorta after endoluminal stent-graft therapy: value of biphasic acquisition. AJR Am J Roentgenol 1998; 171:329-31. [PMID: 9694445 DOI: 10.2214/ajr.171.2.9694445] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We report our prospective study evaluating biphasic helical CT of the aorta after endoluminal stent-graft placement. SUBJECTS AND METHODS Biphasic helical CT scans in 95 patients with abdominal and thoracic aortic aneurysms who had undergone endoluminal stent-graft placement were reviewed. After a test bolus injection of 15 ml of contrast media at a rate of 3.5 ml/sec for the measurement of the optimal start delay, the aorta was scanned using the following parameters: collimation of 5 mm, table speed of 7 mm per rotation, tube rotation time of 0.75 sec, 120 kV, and 295 mA. A delayed helical CT scan was obtained 15 sec after the initial acquisition using the same parameters. RESULTS Biphasic helical CT scans showed perigraft leakage in 45 (47%) of 95 patients. Leakage was shown only on arterial phase CT in eight patients and only on the delayed scans in three patients. In two patients, leakage shown on the delayed acquisition was retrospectively seen on the first scan. Leakage and outflow vessels were most visible on the arterial phase acquisition in 17 patients and on the second acquisition in six patients. Overall, biphasic acquisition was superior to arterial phase acquisition alone in 15 (16%) of 95 patients. CONCLUSION The diagnostic value of biphasic helical CT is superior to arterial phase acquisition alone for the evaluation of the aorta after endoluminal stent-graft therapy.
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Gevenois PA, de Maertelaer V, Madani A, Winant C, Sergent G, De Vuyst P. Asbestosis, pleural plaques and diffuse pleural thickening: three distinct benign responses to asbestos exposure. Eur Respir J 1998; 11:1021-7. [PMID: 9648950 DOI: 10.1183/09031936.98.11051021] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to investigate by computed tomography (CT) whether asbestosis, diffuse pleural thickening and/or pleural plaques are statistically associated. We also tried to find criteria to differentiate between diffuse and circumscribed pleural thickening. From 231 exposed workers, only those subjects whose radiograph showed neither bilateral calcified pleural plaques nor small pulmonary opacities higher than 1/1 grade according to the 1980 International Labour Office (ILO) Classification were considered. Scans were assessed for the presence of subpleural curvilinear lines, septal and intralobular lines, parenchymal bands, honeycombing, rounded atelectasis, pleural plaques and diffuse pleural thickening. CT scans revealed pleural and/or lung abnormalities in 99 workers. Pleural plaques were unilateral in one-third of cases with plaques. Diffuse pleural thickening, parenchymal bands and rounded atelectasis were unilateral in, respectively, 62 and 69 and 75% of cases with the abnormality. Septal and intralobular lines, and honeycombing were always bilateral. CT signs could be grouped into three patterns: 1) septal and intralobular lines, and honeycombing corresponding to pulmonary fibrosis; 2) pleural plaques corresponding to parietal pleural fibrosis; and 3) diffuse pleural thickening, rounded atelectasis and parenchymal bands corresponding to visceral pleural fibrosis. In these workers with a normal or near-normal radiograph, three groups of subjects with different responses were distinguished. Crow's feet and rounded atelectasis help to differentiate plaques from diffuse thickening.
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Trogrlic S, Gevenois PA, Schroeven M, De Vuyst P. Pericardial effusion associated with asbestos exposure. Thorax 1997; 52:1097-8. [PMID: 9516906 PMCID: PMC1758473 DOI: 10.1136/thx.52.12.1097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The case history is presented of a 60 year old man who developed a pericardial effusion. Chest radiography showed pleural thickening and calcification. Pericardiotomy was performed and revealed nonspecific inflammatory lesions. Occupational exposure to asbestos and exclusion of other causes led to the diagnosis of benign asbestos pericardial effusion.
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Knoop C, Mairesse M, Lenclud C, Gevenois PA, De Vuyst P. Pleural effusion during bromocriptine exposure in two patients with pre-existing asbestos pleural plaques: a relationship? Eur Respir J 1997; 10:2898-901. [PMID: 9493681 DOI: 10.1183/09031936.97.10122898] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Two patients with pleural plaques developed pleural effusion and subsequent diffuse pleural fibrosis 50 and 39 yrs after their first exposure to asbestos. The diagnosis of benign asbestos pleural effusion was suggested, but the work-up finally suggested bromocriptine-induced pleural disease in both patients. These two cases illustrate that drug-induced pleural effusion is an important differential diagnosis of benign asbestos pleural effusion. It is, moreover, possible that pre-existing asbestos pleural lesions, or even asbestos exposure, increases the risk of developing bromocriptine-induced pleural disease.
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Cassart M, Pettiaux N, Gevenois PA, Paiva M, Estenne M. Effect of chronic hyperinflation on diaphragm length and surface area. Am J Respir Crit Care Med 1997; 156:504-8. [PMID: 9279231 DOI: 10.1164/ajrccm.156.2.9612089] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We have used three-dimensional reconstructions obtained with spiral computed tomography to measure total diaphragm length (Ldl) and surface area (Adl), the length (Ldo) and surface area (Ado) of the dome, and the length (Lap) and surface area (Aap) of the zone of apposition in 10 hyperinflated patients with severe chronic obstructive pulmonary disease, or COPD (FEV1 = 27% predicted: FRC = 225% predicted) and 10 normal subjects matched for age, sex, and height. Measures of Ldl, Adl, Lap, and Aap decreased linearly between FRC and TLC in the two groups, but Ldo and Ado did not change. On average, patients' Adl and Aap at FRC were reduced to 73% and 54% of normal values, whereas Ado was unaffected. When compared at similar absolute lung volumes, mean diaphragm dimensions were similar in patients with COPD and normal subjects, but individual values were very variable in both groups. This variability was partly accounted for by differences in body weight: i.e., the greater the weight, the longer the diaphragm. We conclude that (1) patients with COPD have marked reductions in Adl and Aap at FRC but have diaphragm dimensions similar to those of normal subjects when compared at similar absolute lung volumes, and (2) normal subjects and patients with COPD show substantial intersubject variability in diaphragm dimensions that is partly explained by differences in body weight.
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Gevenois PA, Trogrlic S. [Imaging of the pleura]. LA REVUE DU PRATICIEN 1997; 47:1304-7. [PMID: 9248096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We review the respective informations yielded to the physician bu the different techniques of medical imaging (conventional radiography, ultrasounds, and computed tomography) according to the presentation of pleural diseases. Conventional radiography is always useful for diagnosis. Ultrasound is useful to confirm and localize pleural effusion. Computed tomography contributes to precise the location of pneumothorax and pleural effusion, and the possible underlying pulmonary disorders. Computed tomography also allows to precisely characterize the different types of pleural thickening, including malignant mesothelioma.
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Abstract
Four patients with asbestos-related diseases and with unusual exposures underwent bronchoalveolar lavage (BAL) for mineralogical analysis. Asbestos bodies (AB) were counted by light microscopy and analyzed by transmission electron microscopy and X-ray energy spectrometry. AB's were found in all cases, after a mean delay from the end of exposure of 27.7 years. Analysis of the core fibers indicated the type of alveolar asbestos burden and was compared with the previous exposures: Pleural plaques due to household exposure to amosite and crocidolite. Pleural plaques due to occult occupational exposure to crocidolite in a coal miner. Asbestosis due to environmental exposure to tremolite in Turkey. Asbestosis, pleural plaques, and peritoneal mesothelioma due to a short, intense exposure to crocidolite. AB counting in BAL and identification of the central fibers by analytical electron microscopy is a useful, non-invasive and reliable method to evaluate the alveolar retention of bio-persistent fibers and to relate them to specific exposures.
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Wicky S, Cartei F, Mayor B, Frija J, Gevenois PA, Giron J, Laurent F, Perri G, Schnyder P. Radiological findings in nine AIDS patients with Rhodococcus equi pneumonia. Eur Radiol 1996; 6:826-30. [PMID: 8972317 DOI: 10.1007/bf00240680] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Rhodococcus equi (R. equi) infections have been incidentally reported as a cause of pulmonary infection in severely immunocompromised hosts, including AIDS patients. Our purpose is to describe the radiological findings in nine AIDS patients with R. equi pneumonia assessed by bronchoalveolar lavage (BAL), biopsies, cultures of sputum, and hemocultures. All patients were examined by chest radiographs and contrast-medium-enhanced chest CT. Dense pulmonary consolidations with or without cavitations accounted for the most striking radiological patterns. Chest CT also revealed six mediastinal involvements, strongly mimicking a lymphoma. Two of them had multiple bilateral pulmonary nodular opacities. Pleural effusion was not identified. Although intensive therapies were administered, seven among nine patients died within few months. In an AIDS patient living in a rural area or exposed to horses and presenting these radiological patterns, the possibility of R. equi pneumonia should be considered in the differential diagnosis along with other infectious diseases or lymphomas.
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Gevenois PA, Scillia P, de Maertelaer V, Michils A, De Vuyst P, Yernault JC. The effects of age, sex, lung size, and hyperinflation on CT lung densitometry. AJR Am J Roentgenol 1996; 167:1169-73. [PMID: 8911175 DOI: 10.2214/ajr.167.5.8911175] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test our proposal that, on high-resolution CT scans, the relative area of the lung with attenuation values lower than -950 H (RA950) can be a measurement of pulmonary emphysema, we examine the possible influences of sex, age, lung size, and hyperinflation on CT lung densitometry. SUBJECTS AND METHODS The RA950 and the mean lung density (MLD) were measured in 42 healthy subjects (21 men, 21 women) from 23 to 71 years old, in 10 patients with asthma before and after a bronchial challenge test, and in seven patients with asthma who have irreversible hyperinflation (defined as an increased total lung capacity). RESULTS In the healthy subjects, we found no significant difference between sexes and no significant correlation between age and the MLD, but we found a significant correlation between age and the RA950. In addition, we found a significant correlation between the total lung capacity expressed as absolute values and both the RA950 and the MLD. We did not observe any effect of acute airflow limitation either on the MLD or on the RA950 in the asthmatic subjects after the bronchial challenge test. Likewise, we observed no change in either the MLD or the RA950 in the asthmatic subjects with chronic hyperinflation. CONCLUSION This study shows that CT lung densitometry is influenced by total lung capacity and, to a lesser degree, by age. Thus, this study suggests that normal CT attenuation values for the lung should be established.
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Cassart M, Gevenois PA, Estenne M. Rib cage dimensions in hyperinflated patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996; 154:800-5. [PMID: 8810622 DOI: 10.1164/ajrccm.154.3.8810622] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Using computed tomography we assessed rib cage dimensions at the levels of Th4, Th6, Th8, and Th10 in seven supine patients with COPD who were severely obstructed (FEV1, 25 +/- 7% of predicted) and hyperinflated (FRC, 234 +/- 34% of predicted) and seven matched normal control subjects. The midsagittal anteroposterior (AP) diameter, the maximal AP diameter of the right and left hemithorax, and the maximal transverse (T) diameter were measured on scans obtained at relaxed TLC, FRC, and RV. At each volume, AP diameters were invariably 2 to 3 cm greater in patients with COPD than in normal subjects, but no significant differences in T diameters were found. When compared at a given absolute lung volume, T diameters at all thoracic levels and AP diameters at Th4-6 were smaller in patients with COPD than in normal subjects; in contrast, at Th8-10, AP diameters were similar in the two groups. We conclude that the marked hyperinflation of patients with severe COPD produces complex changes in rib cage dimensions: (1) there is an increase in AP but not in T diameters such that the rib cage adopts a more circular shape; (2) at a given absolute lung volume, AP diameters are smaller in patients with COPD than in normal subjects in the upper but not in the lower portion of the rib cage. These differences in rib cage dimensions may have implications regarding respiratory muscle length and function in patients with COPD.
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Avni EF, Cassart M, de Maertelaer V, Rypens F, Vermeylen D, Gevenois PA. Sonographic prediction of chronic lung disease in the premature undergoing mechanical ventilation. Pediatr Radiol 1996; 26:463-9. [PMID: 8662064 DOI: 10.1007/bf01377203] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aims of the study are to investigate the possible role of ultrasound (US) of the chest in predicting the development of chronic lung disease (CLD) in patients with hyaline membrane disease (HMD) and to determine the optimal age for the sonographic examination. One hundred and five consecutive prematures undergoing mechanical ventilation were prospectively studied by US of the chest. The US examinations were performed at birth and at least once a week until discharge from the neonatal unit. The sonographic patterns observed behind the diaphragm and their evolutions were recorded and correlated with the clinical and radiological data at day 28, which corresponds to the currently accepted limit for determining the presence of CLD. CLD is currently defined as oxygen dependency on day 28 with radiographic abnormalities. A diffuse retrodiaphragmatic hyperechogenicity was observed in all the patients with HMD. The hyperechogenicity resolved completely in patients with an uncomplicated clinical evolution. In contrast, in patients with CLD the hyperechogenicity resolved only partially, resulting in less diffuse and less extensive hyperechogenicity. Day 18 was the earliest day where the persistence of the abnormal retrodiaphragmatic hyperechogenicity was observed in 100% of the patients presenting CLD at day 28. At that time, 95.2% of the patients without abnormal hyperechogenicity showed uncomplicated evolution and no CLD. US can be a useful diagnostic tool to determine the occurrence of CLD and to predict as early as day 18 the prematures at risk for the disease.
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Gevenois PA, De Vuyst P, de Maertelaer V, Zanen J, Jacobovitz D, Cosio MG, Yernault JC. Comparison of computed density and microscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 1996; 154:187-92. [PMID: 8680679 DOI: 10.1164/ajrccm.154.1.8680679] [Citation(s) in RCA: 401] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The purpose of this prospective study was to verify whether the percentage area of lung occupied by lowest attenuation values on high-resolution computed tomography (HRCT) scans reflects microscopic emphysema and to compare this quantification with the information yielded by the most widely used pulmonary function tests (PFT). Preoperative HRCT scans were obtained with 1-cm intervals in 38 subjects. With a semiautomatic evaluation procedure, the percentage areas occupied by attenuation values inferior to thresholds ranging from -900 Hounsfield units (HU) to -970 HU were calculated for the lobe or lung to be resected. Emphysema was microscopically quantified by using a computer-based method, measuring the perimeters and interwall distances of alveoli and alveolar ducts. The strongest correlation was found for -950 HU. As a second step, we evaluated possible correlations between PFT and microscopic measurements. Finally, considering the microscopic measurements as a standard, we tried to investigate their relationships with each of the PFT and with the relative area occupied by attenuation values lower than -950 HU for both lungs. This revealed that the diffusing capacity for carbon monoxide associated with HRCT quantification is sufficient to predict microscopic measurements. We concluded that the percentage area of lung occupied by attenuation values lower than -950 HU is a valid index of pulmonary emphysema.
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Gevenois PA, De Vuyst P, Sy M, Scillia P, Chaminade L, de Maertelaer V, Zanen J, Yernault JC. Pulmonary emphysema: quantitative CT during expiration. Radiology 1996; 199:825-9. [PMID: 8638012 DOI: 10.1148/radiology.199.3.8638012] [Citation(s) in RCA: 164] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To determine whether measurement of the relative area of lung with attenuation coefficients lower than a certain threshold on thin-section computed tomographic (CT) scans obtained during expiration is a valuable method of quantifying the extent of pulmonary emphysema. MATERIALS AND METHODS Eighty-nine patients underwent CT (with 1-mm collimation) preoperatively during inspiration and expiration. Relative areas of lung with attenuation coefficients lower than various thresholds were calculated. These relative areas were compared with areas found macroscopically to have emphysema (59 patients [51 men, eight women; aged 40-77 years]) and with two microscopic indices (35 patients [29 men, six women; aged 42-77 years]) assessed on the resected specimens. RESULTS The valid expiratory CT thresholds were found to be -820 and 910 HU for microscopic and macroscopic emphysema, respectively. However, results of stepwise multiple regression analyses showed that the inspiratory threshold of -950 HU was superior for both macroscopically and microscopically quantified emphysema. The correlation coefficients in expiratory CT were higher for the pulmonary volumes but similar for the diffusing capacity. CONCLUSION Expiratory quantitative CT is not as accurate as inspiratory CT for quantifying pulmonary emphysema and probably reflects air trapping more than reduction in the alveolar wall surface.
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Peche R, Estenne M, Gevenois PA, Brassinne E, Yernault JC, De Troyer A. Sternomastoid muscle size and strength in patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996; 153:422-5. [PMID: 8542153 DOI: 10.1164/ajrccm.153.1.8542153] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) imposes a major strain on the respiratory muscle pump, and it is conventionally thought that the inspiratory muscles of the neck adapt to this chronic overload by developing hypertrophy. Yet previous anthropometric studies have shown atrophy of the sternomastoid muscles. To solve this discrepancy, we have measured the cross-sectional area of these muscles by computed tomography. Ten stable patients with severe airflow obstruction (FEV1 = 0.76 +/- 0.12 L) and hyperinflation (FRC = 210 +/- 29% of predicted) and 10 control subjects matched for age, sex, and height were studied. The sternomastoid cross-sectional area in the patients averaged (mean +/- SD) 4.29 +/- 1.48 cm2, and that in the control subjects was 3.96 +/- 0.82 cm2. This small difference could be entirely accounted for by hyperinflation, and it was not statistically significant. Sternomastoid muscle torque in patients was also similar to that in the control subjects. In patients with severe COPD, therefore, the sternomastoid muscles are essentially normal. As a corollary, their frequent prominence on clinical examination is only apparent.
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