Differentiation of proximal bronchogenic carcinoma from postobstructive lobar collapse by magnetic resonance imaging. Comparison with computed tomography

MRI and CT studies in 18 patients with proximal bronchogenic carcinoma and postobstructive lobar collapse were analyzed retrospectively. The relative abilities of these imaging techniques to identify central tumor by a contour abnormality and to distinguish tumor mass from collapsed lung by CT attenuation values and MRI signal intensities were compared. MRI and CT were equivalent in their ability to identify a contour abnormality, both succeeding in 13 of 18 (72%) patients. CT was more successful than MRI in differentiating tumor mass from collapsed lung. Dynamic computed tomography scanning differentiated tumor from collapsed lung in eight of ten (80%) patients. MRI demonstrated different signal intensities of tumor and collapsed lung in 8 of 18 (44%) patients. T2-weighted images more often separated tumor from collapsed lung than other imaging sequences.

Relationship between the result of preoperative pulmonary function test and postoperative pulmonary complications

Good preoperative screening and evaluation of patients undergoing surgery is necessary because it serves to identify the individual who is at risk of increased intra-operative and postoperative morbidity and mortality. The retrospective study was done in an attempt to determine if abnormalities in preoperative pulmonary function, detected by routine pulmonary function tests, would predict which patients would suffer from pulmonary complications following surgery. Pulmonary complications in the postoperative period included fever, atelectasis and respiratory failure. The overall incidence of pulmonary complications from our 78 patients undergoing surgery was 37 percent based on clinical criteria. This incidence was high in patients with FEV1 less than 1.0 L/sec, MVV less than 40% of predicted value and PCO2 more than 45 mmHg.

The air bronchogram: sonographic demonstration

A new sonographic pattern of pulmonary consolidation associated with air-filled bronchi in children is presented. The consolidated area of the lung is usually hypoechoic, poorly defined, and wedge-shaped. The air-filled bronchi produce linear, high-amplitude branching echoes that converge toward the lung root. Posterior acoustic shadowing and reverberation artifacts are seen accompanying the proximal large bronchi. A comparative study is presented in which 30 pediatric patients with clinical and radiographic evidence of pneumonia were sonographically evaluated. Twenty-eight patients were successfully examined with sonography. The cases were divided into three groups: (1) consolidated lung without pleural effusion (19 patients); (2) consolidated lung with small pleural effusion (five patients); and (3) consolidated lung with partial compression atelectasis due to large pleural effusion (four patients).

Rounded atelectasis: a new criterion for benignancy

A malignancy must be considered whenever a mass lesion is encountered on a chest roentgenogram. Unless an unequivocal diagnosis of a benign lesion is made, thoracotomy is usually indicated. Rounded atelectasis, while only having been recently described, is being encountered with increasing frequency. As illustrated by our three cases, radiologic diagnosis of this entity is a major criterion for judging the benignity of a mass and obviates the need for a thoracotomy.

Diseases of the thorax

Diagnostic ultrasound is an important adjunct to existing methods in the diagnosis of thoracic disease in the horse. This article discusses scanning techniques, anatomy of the thoracic cavity, and how diagnosis of pleural effusion, pulmonary abscessation, pneumothorax, and vegetative endocarditis may be facilitated by ultrasound.

Round atelectasis in an elderly man: the role of thoracotomy

In summary, a case of round atelectasis appearing subsequent to a pleural effusion in an elderly man 6 months after open heart surgery is reported. Although plain roentgenograms and linear and computerized tomography could help the physician make the diagnosis with confidence, a needle biopsy of the lesion at the very least or exploratory thoracotomy may sometimes still be justified for the properly selected patient.

Diagnostic implications and treatment of massive spontaneous atelectasis in childhood

During a 5-month period five children were treated for spontaneously occurring massive lung atelectasis. In three patients the underlying disease was bronchial asthma; in one patient idiopathic plastic bronchitis; and in another patient, infection with anaerobic Corynebacteria may have been a contributing factor. Types I and III hypersensitivity reactions were not considered to be likely causal factors. The clinical manifestations and management of this relatively rare event are described.

Atelectasis and subpulmonic fluid: a CT pitfall in distinguishing pleural from peritoneal fluid

The ability to distinguish between pleural and peritoneal fluid is important in the management of patients with peridiaphragmatic fluid collections. The differentiation of subphrenic fluid from pleural effusion by CT may be difficult and requires a detailed understanding of the normal appearance of the diaphragm on transaxial images. We report 12 patients in whom peridiaphragmatic fluid collections could potentially be misinterpreted as peritoneal rather than pleural fluid. In all cases the presence of subsegmental, basilar atelectasis with subpulmonic fluid created confusing CT images. Subsegmental atelectasis formed a curvilinear band at the lung base that simulated the hemidiaphragm. Fluid anterior to the atelectasis caused a false impression of subdiaphragmatic (peritoneal) fluid. Computed tomography through the upper abdomen excluded intraabdominal fluid in all cases. In four cases ultrasonography confirmed fluid in a supradiaphragmatic, subpulmonic location, excluded peritoneal fluid, and identified subsegmental atelectasis. The presence of subpulmonic fluid and subsegmental atelectasis requires meticulous interpretation of transaxial CT images to avoid the incorrect localization of peridiaphragmatic fluid collections.

[Lobar emphysema]

The lobes most commonly affected are the left upper and the right middle lobes. The classical sign of respiratory distress is mainly found within the first two months of life. In 14 infants the diagnosis was confirmed by microscopic examination, 13 were treated by surgery and 4 infants, who had associated serious malformations or complications, died. In most cases hypoplastic bronchial cartilage of the concerned bronchi was seen, in some cases a stenosis of the lobar bronchi. It is of great importance to establish the diagnosis as soon as possible. The lobectomy is recommended if the respiratory or cardial failure is worsening despite artificial ventilation.

Atelectasis in childhood

The clinician who identifies atelectasis in a child must determine the mechanism by which atelectasis developed, the functional significance of the collapsed lung, and the etiology responsible for its presence. This article provides a framework to help physicians address these issues and thereby elect the most rational diagnostic and therapeutic interventions at the most appropriate time.

Round atelectasis

Round atelectasis is a little-known form of peripheral pulmonary collapse which may mimic a neoplastic tumor. Usually the atelectasis forms a well-demarcated round or oval intrapulmonary pleural-based mass at the basal, posterior or interlobar pleura. It is thought to be a sequela of a pleural effusion. If the radiographic features are characteristic, and fine-needle biopsy finding negative, the diagnosis of round atelectasis can be made with assurance, and unnecessary procedures such as thoracotomy and pulmonary resection can be avoided. In this paper experiences of 11 patients with this condition are presented. In 4 the diagnosis was established by surgery and in 7 a long-term follow-up confirmed the diagnosis of a nonmalignant intrapulmonary lesion. The pathogenesis, clinical and radiological features, and the diagnostic workup are discussed.