Bronchiolitis obliterans on high-resolution CT: a pattern of mosaic oligemia

OBJECTIVE

Bronchiolitis obliterans, when not associated with organizing intraalveolar pneumonia or extensive peribronchiolar fibrosis, is often difficult to distinguish clinically and radiographically from other forms of chronic obstructive pulmonary disease. The aim of this study was to demonstrate a pattern on high-resolution CT (HRCT) that could suggest this diagnosis.

MATERIALS AND METHODS

Two patients with a clinical diagnosis of bronchiolitis obliterans, moderate-to-severe obstruction on pulmonary function tests, and normal chest radiography were studied with HRCT.

RESULTS

High-resolution CT of the patients with chronic bronchiolitis demonstrated a mosaic pattern of low attenuation probably corresponding to secondary lobules.

CONCLUSION

We conclude that the low attenuation areas represent either air trapping or hypoxic vasoconstriction in secondary pulmonary lobules from obstruction of small airways. This pattern of mosaic oligemia was, until recently, only recognized with occlusive vascular disease and may suggest obstructive disease in the small airways.

Precision electrocautery excision of pulmonary lesions (Perelman technique): radiologic features

The authors describe the radiologic features of precision electrocautery excision of pulmonary lesions (Perelman technique). Thin-walled cavities were seen on chest radiographs obtained in three patients at the site of the resected lesion subsequent to this surgical procedure. Knowledge of these findings can avoid a false diagnosis of abscess, septic emboli, or additional metastasis.

Views from Capitol Hill--11 congressional leaders paint varying reform scenarios. Interview by Marybeth Burke

The following exclusive interviews with top congressional health care leaders were conducted by Washington-based reporter Marybeth Burke. In the interviews, Burke found that congressional health care leaders are optimistic yet cautious that comprehensive health care reform legislation will pass in 1993 under President Clinton. Some members of Congress believe that the election of a president committed to action on the issue drastically improves the outlook for reform. Others say that long-term controversy over reform will not resolve itself overnight. Lawmakers expect the issue to heat up quickly as soon as Clinton hands Congress a legislative reform package, but they are reluctant to predict quick enactment.

Inflammatory pseudotumor of the heart with vasculitis and venous thrombosis

Inflammatory pseudotumor (IPT) is a tumor-like reactive lesion of unknown etiology. An unusual case of intracardiac IPT with multisystemic involvement, including leukocytoclastic vasculitis, polyarthritis, and inferior vena cava thrombosis in a 17-year-old boy is reported. This unique combination may suggest that immune/autoimmune factors are important in the pathogenesis of IPT.

Standard imaging in silicosis and coal worker's pneumoconiosis

Silicosis and coal worker's pneumoconiosis (CWP) are two relatively common occupational diseases. Silicosis is the most common pneumoconiosis in the United States. It results from inhalation of the particulate form of quartz or other crystalline forms of silicon dioxide with a diameter of less than 5 micrograms. CWP is the result of inhalation of carbon particles. Pathologic features of the two diseases differ, yet their radiologic features are identical. Simple pneumoconiosis is characterized by multiple small rounded opacities of 1 to 5 mm in diameter and with a bias for the upper lung zones. Complicated pneumoconiosis results from confluence of small opacities into large opacities that form conglomerate masses or progressive massive fibrosis.

Radiology of thoracic trauma

Trauma is the leading cause of death in people less than 40 years of age. Blunt and penetrating chest trauma mechanisms and the resultant injuries and complications are reviewed in respect to the chest wall, pleura, lungs, mediastinum, and diaphragm. Recent literature reviewed includes a useful sign of flail chest, the costal "hook sign." New evidence suggests that traumatic aortic rupture may be more common in the pediatric population than was previously reported. The diagnostic evaluation of traumatic aortic rupture continues to be controversial, with imaging modalities ranging from chest radiographs and angiography to CT, MR imaging, and transesophageal echocardiography. Recent integration of these methods has brought to the literature a newly proposed algorithm for the work-up of suspected aortic rupture. Survival and modifying factors in adult respiratory distress syndrome and a comprehensive review of esophageal disease, including trauma, are also presented.

The radiologic features of cardiac rotation: a pictorial essay

Rotation of the heart results from enlargement of individual cardiac chambers and influences significantly the configuration of the cardiomediastinal silhouette. Left ventricular enlargement leads to dextrorotation. Conversely, right ventricular enlargement leads to levorotation. The axis of rotation is nearly vertical and extends from the top of the aortic arch through the anterior wall of the left atrium and the proximal interventricular septum. Pericardial defect, deformity of the thoracic skeleton, and lower lobe atelectasis can also lead to cardiac rotation. An understanding of this concept facilitates the interpretation of chest radiographs in patients with heart disease. The terms clockwise and counterclockwise rotation of the heart should be abandoned.

A 102-center prospective study of seizure in association with bupropion

BACKGROUND

This trial was conducted to determine the incidence of seizures associated with the use of bupropion.

METHOD

A total of 3341 depressed patients from 102 sites were enrolled in this 8-week, prospective, open trial. Following the 8-week treatment phase, patients could elect to enroll in a humanitarian continuation phase of unlimited duration. Dosing was initiated at 225 mg/day and increased to 450 mg/day as tolerated. Investigators carefully monitored seizure occurrences and rated their patients' response to and tolerance of bupropion.

RESULTS

A total of 1986 patients (61%) completed the 8-week treatment phase, and 1616 (81%) of these elected to be maintained on bupropion treatment in the humanitarian continuation phase. The observed seizure rate was 0.24% for the treatment phase and 0.40% for the entire study. An 8-week survival analysis performed on patients with a dosing regimen of 300 to 450 mg/day yielded a cumulative rate of 0.36%. Patients, including those previously resistant to antidepressant treatment, responded to and tolerated bupropion well.

CONCLUSION

These rates confirm earlier seizure estimates and fall within accepted parameters for antidepressant drugs. This trial enhances bupropion's position as a valuable alternative for the management of depression.

[Magnetic resonance tomography of Fallot's tetralogy]

We present four patients with tetralogy of Fallot, imaged with magnetic resonance. MRI is useful in clearly depicting the dilated ascending aorta, the infundibular stenosis, ventricular septal defect, right ventricular hypertrophy and dilated bronchial arteries. The pulmonary outflow tract can be visualized better with MR imaging than with ultrasound.

Hemophagocytosis by small cell lung carcinoma

A 60-year-old woman with disseminated small cell carcinoma of the lung and hemophagocytosis by the metastatic cells in the bone marrow is presented. It is the first clinicopathologic report on phagocytosis of erythrocytes by lung tumor cells in concordance with a recently described evidence of a macrophage origin of small cell carcinoma of the lung.

Magnetic resonance imaging--the evaluation of choice in residual shunt after congenital heart disease surgery?

Accurate anatomic diagnosis presents a dilemma in patients with residual shunt after corrective surgery for congenital heart disease. We describe a patient who, after atrial septal defect repair, developed dyspnea and central cyanosis despite normal pulmonary arterial pressures and right heart chamber size. A role for early MRI is suggested.

Manifestations of esophageal disease on plain chest radiographs

The chest film appearances of various esophageal abnormalities are illustrated. Inability to recognize these abnormalities on chest radiographs can result in confusion and misinterpretation. This pictorial essay should assist the radiologist in recognizing esophageal abnormalities on chest films and in recognizing their place in the spectrum of chest film abnormalities.

[Magnetic resonance tomographic study of aortic isthmus stenosis]

We present four patients with coarctation of the aorta, whose work-up was facilitated by MRI. Magnetic resonance has the potential for displacing angiography in imaging these patients.

Vacuole sign and nodule sign in early peripheral bronchogenic carcinoma. Diagnostic value and pathologic correlation

We analyzed the radiological and pathological characteristics of 30 peripheral lung masses 1.5-3 cm in diameter. We describe the vacuole and the nodule sign. Retrospective examination of 100 conventional tomograms of peripheral pulmonary masses and comparison with the histological diagnoses allowed us to determine the usefulness of these two signs in differentiating small peripheral bronchogenic carcinomas from tuberculomas.