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Dyspnea, Cough, and Abnormal Thoracic Imaging after Lung Transplantation. Ann Am Thorac Soc 2016; 13:134-6. [PMID: 26730869 DOI: 10.1513/annalsats.201509-648cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Walker CM, Rosado-de-Christenson ML, Martínez-Jiménez S, Kunin JR, Wible BC. Bronchial arteries: anatomy, function, hypertrophy, and anomalies. Radiographics 2015; 35:32-49. [PMID: 25590386 DOI: 10.1148/rg.351140089] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The two main sources of blood supply to the lungs and their supporting structures are the pulmonary and bronchial arteries. The bronchial arteries account for 1% of the cardiac output but can be recruited to provide additional systemic circulation to the lungs in various acquired and congenital thoracic disorders. An understanding of bronchial artery anatomy and function is important in the identification of bronchial artery dilatation and anomalies and the formulation of an appropriate differential diagnosis. Visualization of dilated bronchial arteries at imaging should alert the radiologist to obstructive disorders that affect the pulmonary circulation and prompt the exclusion of diseases that produce or are associated with pulmonary artery obstruction, including chronic infectious and/or inflammatory processes, chronic thromboembolic disease, and congenital anomalies of the thorax (eg, proximal interruption of the pulmonary artery). Conotruncal abnormalities, such as pulmonary atresia with ventricular septal defect, are associated with systemic pulmonary supply provided by aortic branches known as major aortopulmonary collaterals, which originate in the region of the bronchial arteries. Bronchial artery malformation is a rare left-to-right or left-to-left shunt characterized by an anomalous connection between a bronchial artery and a pulmonary artery or a pulmonary vein, respectively. Bronchial artery interventions can be used successfully in the treatment of hemoptysis, with a low risk of adverse events. Multidetector computed tomography helps provide a vascular road map for the interventional radiologist before bronchial artery embolization.
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Affiliation(s)
- Christopher M Walker
- From the Department of Radiology, Thoracic Imaging Section (C.M.W., M.L.R.d.C., S.M.J., J.R.K.) and Interventional Radiology Section (B.C.W.), Saint Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111; and Department of Radiology, University of Missouri-Kansas City, Kansas City, Mo (C.M.W., M.L.R.d.C., S.M.J, J.R.K, B.C.W.)
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Diagnostic accuracy of low-mA chest CT reconstructed with Model Based Iterative Reconstruction in the detection of early pleuro-pulmonary complications following a lung transplantation. Eur Radiol 2015; 26:3138-46. [PMID: 26645864 DOI: 10.1007/s00330-015-4126-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/24/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
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54
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Konheim JA, Kon ZN, Pasrija C, Luo Q, Sanchez PG, Garcia JP, Griffith BP, Jeudy J. Predictive equations for lung volumes from computed tomography for size matching in pulmonary transplantation. J Thorac Cardiovasc Surg 2015; 151:1163-9.e1. [PMID: 26725712 DOI: 10.1016/j.jtcvs.2015.10.051] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 09/29/2015] [Accepted: 10/18/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Size matching for lung transplantation is widely accomplished using height comparisons between donors and recipients. This gross approximation allows for wide variation in lung size and, potentially, size mismatch. Three-dimensional computed tomography (3D-CT) volumetry comparisons could offer more accurate size matching. Although recipient CT scans are universally available, donor CT scans are rarely performed. Therefore, predicted donor lung volumes could be used for comparison to measured recipient lung volumes, but no such predictive equations exist. We aimed to use 3D-CT volumetry measurements from a normal patient population to generate equations for predicted total lung volume (pTLV), predicted right lung volume (pRLV), and predicted left lung volume (pLLV), for size-matching purposes. METHODS Chest CT scans of 400 normal patients were retrospectively evaluated. 3D-CT volumetry was performed to measure total lung volume, right lung volume, and left lung volume of each patient, and predictive equations were generated. The fitted model was tested in a separate group of 100 patients. The model was externally validated by comparison of total lung volume with total lung capacity from pulmonary function tests in a subset of those patients. RESULTS Age, gender, height, and race were independent predictors of lung volume. In the test group, there were strong linear correlations between predicted and actual lung volumes measured by 3D-CT volumetry for pTLV (r = 0.72), pRLV (r = 0.72), and pLLV (r = 0.69). A strong linear correlation was also observed when comparing pTLV and total lung capacity (r = 0.82). CONCLUSIONS We successfully created a predictive model for pTLV, pRLV, and pLLV. These may serve as reference standards and predict donor lung volume for size matching in lung transplantation.
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Affiliation(s)
- Jeremy A Konheim
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Zachary N Kon
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md.
| | - Qingyang Luo
- Division of Applied Health Services Research, Ochsner Clinic Foundation, New Orleans, La
| | - Pablo G Sanchez
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Jose P Garcia
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Bartley P Griffith
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Jean Jeudy
- Division of Thoracic Radiology, University of Maryland School of Medicine, Baltimore, Md
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Chuck NC, Boss A, Wurnig MC, Weiger M, Yamada Y, Jungraithmayr W. Ultra-short echo-time magnetic resonance imaging distinguishes ischemia/reperfusion injury from acute rejection in a mouse lung transplantation model. Transpl Int 2015; 29:108-18. [DOI: 10.1111/tri.12680] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/07/2015] [Accepted: 08/28/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Natalie C. Chuck
- Institute for Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
| | - Andreas Boss
- Institute for Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
| | - Moritz C. Wurnig
- Institute for Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
| | - Markus Weiger
- Institute for Biomedical Engineering; University of Zurich and Swiss Federal Institute for Technology; Zurich Switzerland
| | - Yoshito Yamada
- Division of Thoracic Surgery; University Hospital Zurich; Zurich Switzerland
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Kligerman SJ, Henry T, Lin CT, Franks TJ, Galvin JR. Mosaic Attenuation: Etiology, Methods of Differentiation, and Pitfalls. Radiographics 2015; 35:1360-80. [PMID: 26274445 DOI: 10.1148/rg.2015140308] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mosaic attenuation is a commonly encountered pattern on computed tomography that is defined as heterogeneous areas of differing lung attenuation. This heterogeneous pattern of attenuation is the result of diverse causes that include diseases of the small airways, pulmonary vasculature, alveoli, and interstitium, alone or in combination. Small airways disease can be a primary disorder, such as respiratory bronchiolitis or constrictive bronchiolitis, or be part of parenchymal lung disease, such as hypersensitivity pneumonitis, or large airways disease, such as bronchiectasis and asthma. Vascular causes resulting in mosaic attenuation are typically chronic thromboembolic pulmonary hypertension, which is characterized by organizing thrombi in the elastic pulmonary arteries, or pulmonary arterial hypertension, a heterogeneous group of diseases affecting the distal pulmonary arterioles. Diffuse ground-glass opacity can result in a mosaic pattern related to a number of processes in acute (eg, infection, pulmonary edema), subacute (eg, organizing pneumonia), or chronic (eg, fibrotic diseases) settings. Imaging clues that can assist the radiologist in pinpointing a diagnosis include evidence of large airway involvement, cardiovascular abnormalities, septal thickening, signs of fibrosis, and demonstration of airtrapping at expiratory imaging.
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Affiliation(s)
- Seth J Kligerman
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
| | - Travis Henry
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
| | - Cheng T Lin
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
| | - Teri J Franks
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
| | - Jeffrey R Galvin
- From the Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201 (S.J.K., C.T.L., J.R.G.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.H.); and Division of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Defense Health Agency, National Capital Region Medical Directorate, Silver Spring, Md (T.J.F.)
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Abstract
Airway complications after lung transplantation present a formidable challenge to the lung transplant team, ranging from mere unusual images to fatal events. The exact incidence of complications is wide-ranging depending on the type of event, and there is still evolution of a universal characterization of the airway findings. Management is also wide-ranging. Simple observation or simple balloon bronchoplasty is sufficient in many cases, but vigilance following more severe necrosis is required for late development of both anastomotic and nonanastomotic airway strictures. Furthermore, the impact of coexisting infection, rejection, and medical disease associated with high-level immunosuppression further complicates care.
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Affiliation(s)
- Michael Machuzak
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Jose F Santacruz
- Pulmonary, Critical Care and Sleep Medicine Consultants, Houston Methodist, Houston, TX 77030, USA
| | - Thomas Gildea
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Goodman P, Prosch H, Herold CJ. Imaging of Pulmonary Infections. DISEASES OF THE CHEST AND HEART 2015–2018 2015. [PMCID: PMC7121828 DOI: 10.1007/978-88-470-5752-4_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pulmonary infection is one of the most frequent causes of morbidity and mortality throughout the world. Many infections occur in individuals with concomitant intrapulmonary or extrathoracic diseases; however, they commonly develop in otherwise healthy people. In the non-immunocompromised population, pneumonia is the most prevalent community-acquired infection and the second most common nosocomial infectious disorder. In immunocompromised patients, in children, and in the elderly, pneumonia, as well as other pulmonary infections, may develop into a life-threatening condition.
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Madan R, Chansakul T, Goldberg HJ. Imaging in lung transplants: Checklist for the radiologist. Indian J Radiol Imaging 2014; 24:318-26. [PMID: 25489125 PMCID: PMC4247501 DOI: 10.4103/0971-3026.143894] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Post lung transplant complications can have overlapping clinical and imaging features, and hence, the time point at which they occur is a key distinguisher. Complications of lung transplantation may occur along a continuum in the immediate or longer postoperative period, including surgical and mechanical problems due to size mismatch and vascular as well as airway anastomotic complication, injuries from ischemia and reperfusion, acute and chronic rejection, pulmonary infections, and post-transplantation lymphoproliferative disorder. Life expectancy after lung transplantation has been limited primarily by chronic rejection and infection. Multiple detector computed tomography (MDCT) is critical for evaluation and early diagnosis of complications to enable selection of effective therapy and decrease morbidity and mortality among lung transplant recipients.
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Affiliation(s)
- Rachna Madan
- Department of Thoracic Imaging, Lung Transplant Program, Brigham and Women's Hospital, Harvard Medical School, Massachusetts, USA
| | - Thanissara Chansakul
- Department of Radiology, Lung Transplant Program, Brigham and Women's Hospital, Harvard Medical School, Massachusetts, USA
| | - Hilary J Goldberg
- Department of Medicine, Lung Transplant Program, Brigham and Women's Hospital, Harvard Medical School, Massachusetts, USA
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61
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HRCT Features of Acute Rejection in Patients With Bilateral Lung Transplantation: The Usefulness of Lesion Distribution. Transplant Proc 2014; 46:1511-6. [DOI: 10.1016/j.transproceed.2013.12.060] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 10/14/2013] [Accepted: 12/16/2013] [Indexed: 11/21/2022]
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62
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Abtahi SM, Mao Y, Prapruttam D, Elmi A, Hedgire SS. Magnetic resonance imaging of pelvic metastases in male patients. Magn Reson Imaging Clin N Am 2014; 22:201-15, vi. [PMID: 24792678 DOI: 10.1016/j.mric.2014.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Magnetic resonance (MR) imaging offers a noninvasive tool for diagnosis of primary and metastatic pelvic tumors. The diagnosis of a pelvic metastatic lesion implies an adverse prognosis and dictates the management strategies. Knowledge of normal MR imaging anatomy of the pelvis and the signal characteristics of normal and abnormal structures is essential for accurate interpretation of pelvic MR imaging. This article reviews imaging manifestations of nodal, visceral, and musculoskeletal metastatic lesions of the pelvis along with current and evolving MR imaging techniques.
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Affiliation(s)
- Seyed Mahdi Abtahi
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA
| | - Yun Mao
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA
| | - Duangkamon Prapruttam
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA
| | - Azadeh Elmi
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA
| | - Sandeep S Hedgire
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA.
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63
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Hemmert C, Ohana M, Jeung MY, Labani A, Dhar A, Kessler R, Roy C. Imaging of lung transplant complications. Diagn Interv Imaging 2014; 95:399-409. [DOI: 10.1016/j.diii.2013.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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65
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Dutau H, Vandemoortele T, Laroumagne S, Gomez C, Boussaud V, Cavailles A, Cellerin L, Colchen A, Degot T, Gonin F, Hermant C, Jougon J, Kessler R, Philit F, Pison C, Saint Raymond C, Wermert D, Astoul P, Thomas P, Reynaud-Gaubert M, Vergnon JM. A new endoscopic standardized grading system for macroscopic central airway complications following lung transplantation: the MDS classification. Eur J Cardiothorac Surg 2013; 45:e33-8. [DOI: 10.1093/ejcts/ezt499] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Xie B, Zhu Y, Chen C, Zhao D, Yang C, Ding J, Jiang G. Outcome of TiNi Stent Treatments in Symptomatic Central Airway Stenoses Caused by Aspergillus fumigatus Infections After Lung Transplantation. Transplant Proc 2013; 45:2366-70. [DOI: 10.1016/j.transproceed.2013.02.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/22/2013] [Accepted: 02/16/2013] [Indexed: 10/26/2022]
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Postoperative imaging after lung transplantation. Clin Imaging 2013; 37:617-23. [PMID: 23557663 DOI: 10.1016/j.clinimag.2013.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 02/21/2013] [Indexed: 02/02/2023]
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68
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 715] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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71
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Mineo G, Ciccarese F, Attinà D, Di Scioscio V, Sciascia N, Bono L, Rocca A, Stella F, Zompatori M. Natural history of honeycombing: follow-up of patients with idiopathic pulmonary fibrosis treated with single-lung transplantation. Radiol Med 2012; 118:40-50. [PMID: 22430682 DOI: 10.1007/s11547-012-0810-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 07/06/2011] [Indexed: 12/17/2022]
Abstract
PURPOSE Although honeycombing is one of the key features for the diagnosis of idiopathic pulmonary fibrosis (IPF), its origin and evolution are still poorly understood. The aim of our study was to analyse the natural history of honeycombing in patients treated with single-lung transplantation. MATERIALS AND METHODS We considered seven patients who underwent single-lung transplantation; two of them (28.6%) were excluded from our analysis because they died in the posttransplantation period, whereas the remaining five (71.4%) were evaluated with computed tomography (CT) over 67.6±38.56 months. Each CT scan was assessed for disease extension and cyst size (visual score and size of target cysts); CT scans acquired after 2006 were also assessed for native lung volume. RESULTS All patients showed disease progression (with a concurrent reduction in lung volume in two, 40%) and a progression of honeycombing, with increased number and size of cysts in four (80%). We observed dimensional changes in all target cysts (enlargement or reduction); three patients (60%) also had radiological evidence of complications, such as spontaneous rupture with pneumothorax and development of mycetomas within the cysts. CONCLUSIONS Honeycombing is a dynamic process in which the overall trend is represented by a dimensional increase in cystic pattern; however, single cysts may have a different evolution (enlargement, reduction or complications). This behaviour could be explained by the variety of the pathogenetic processes underlying honeycombing, with cysts that may present abnormal communication with the airway, including the development of a check-valve mechanism.
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Affiliation(s)
- G Mineo
- Radiologia Cardio-Toracica, Policlinico S. Orsola-Malpighi, Bologna, Italy.
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Belmaati EO, Iversen M, Kofoed KF, Nielsen MB, Mortensen J. Scintigraphy at 3 months after single lung transplantation and observations of primary graft dysfunction and lung function. Interact Cardiovasc Thorac Surg 2012; 14:792-6. [PMID: 22407739 DOI: 10.1093/icvts/ivs066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Scintigraphy has been used as a tool to detect dysfunction of the lung before and after transplantation. The aims of this study were to evaluate the development of the ventilation-perfusion relationships in single lung transplant recipients in the first year, at 3 months after transplantation, and to investigate whether scintigraphic findings at 3 months were predictive for the outcome at 12 months in relation to primary graft dysfunction (PGD) and lung function. A retrospective study was carried out on all patients who prospectively and consecutively were referred for a routine lung scintigraphy procedure 3 months after single lung transplantation (SLTX). A total of 41 patients were included in the study: 20 women and 21 men with the age span of patients at transplantation being 38-66 years (mean ± SD: 54.2 ± 6.0). Patient records also included lung function tests and chest X-ray images. We found no significant correlation between lung function distribution at 3 months and PGD at 72 h. There was also no significant correlation between PGD scores at 72 h and lung function at 6 and 12 months. The same applied to scintigraphic scores for heterogeneity at 3 months compared with lung function at 6 and 12 months. Fifty-five percent of all patients had decreased ventilation function measured in the period from 6 to 12 months. Forty-nine percent of the patients had normal perfusion evaluations, and 51% had abnormal perfusion evaluations at 3 months. For ventilation evaluations, 72% were normal and 28% were abnormal. There was a significant difference in the normal versus abnormal perfusion and ventilation scintigraphic images evaluated from the same patients. Ventilation was distributed more homogenously in the transplanted lung than perfusion in the same lung. The relative distribution of perfusion and ventilation to the transplanted lung of patients with and without a primary diagnosis of fibrosis did not differ significantly from each other. We conclude that PGD defined at 72 h does not lead to recognizable changes in ventilation-perfusion scintigrapy at 3 months, and scintigraphic findings do not correlate with development in lung function in the first 12 months.
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Affiliation(s)
- Esther Okeke Belmaati
- Department of Radiology, Diagnostic Imaging Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Zondervan RL, Hahn PF, Sadow CA, Liu B, Lee SI. Frequent body CT scanning of young adults: indications, outcomes, and risk for radiation-induced cancer. J Am Coll Radiol 2011; 8:501-7. [PMID: 21723488 DOI: 10.1016/j.jacr.2010.12.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 12/29/2010] [Indexed: 01/03/2023]
Abstract
PURPOSE The aims of this study were to define the magnitude of frequent body CT scanning of young adults and to determine associated patient diagnoses, examination indications, short-term outcomes, and estimated radiation-induced cancer risk. METHODS Patients aged 18 to 35 years who underwent chest or abdominopelvic CT between 2003 and 2007 at any of 3 hospitals were identified and categorized by total number of scans per body part as rarely (<5), intermediately (>5 and <15), or frequently (>15) scanned. Medical records of the frequently scanned were reviewed. Cumulative radiation exposure, calculated from typical effective doses, was used to estimate cancer risk. Cancer incidence and mortality were estimated using the Biological Effects of Ionizing Radiation method. RESULTS A total of 25,104 patients underwent 45,632 scans, of whom 23,851 (95%) and 70 (0.3%) were rarely and frequently scanned, respectively. Among frequently scanned patients, the most common diagnoses were cancer (19 of 36 [52.8%]) and cystic fibrosis with lung transplantation (11 of 36 [30.5%]) for chest CT and cancer (25 of 34 [73.5%]) for abdominopelvic CT. During the mean 5.4 years (range, 0.9-7.6 years) of follow-up, 46% of frequently scanned patients (32 of 70) died. Of the 47 cancers predicted in the entire cohort, 36 (77%) and 2 (3%) were expected in the rarely and frequently scanned. CONCLUSIONS The majority of CT-induced cancers are predicted to result from sporadic rather than frequent scanning. Frequent scanning confers a significant cancer risk but occurs in severely ill patients, a large proportion of who die before any radiation-induced cancer would be a factor in their health.
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Affiliation(s)
- Robert L Zondervan
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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74
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Caruso S, Crino’ F, Milazzo M, Vitulo P, Bertani A, Marrone G, Mamone G, Maruzzelli L, Miraglia R, Carollo V, Luca A, Gridelli B. Thoracic complications following lung transplantation: 64-MDCT findings. Clin Transplant 2011; 25:673-84. [DOI: 10.1111/j.1399-0012.2011.01439.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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75
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Paño B, Sebastià C, Buñesch L, Mestres J, Salvador R, Macías NG, Nicolau C. Pathways of Lymphatic Spread in Male Urogenital Pelvic Malignancies. Radiographics 2011; 31:135-60. [DOI: 10.1148/rg.311105072] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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76
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Tan JH, Fidelman N, Durack JC, Hays SR, Leard LL, LaBerge JM, Kerlan RK, Golden JA, Gordon RL. Management of Recurrent Airway Strictures in Lung Transplant Recipients using AERO Covered Stents. J Vasc Interv Radiol 2010; 21:1900-4. [DOI: 10.1016/j.jvir.2010.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 04/22/2010] [Accepted: 08/30/2010] [Indexed: 10/18/2022] Open
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Connolly GC, Khorana AA. Emerging risk stratification approaches to cancer-associated thrombosis: risk factors, biomarkers and a risk score. Thromb Res 2010; 125 Suppl 2:S1-7. [PMID: 20433985 DOI: 10.1016/s0049-3848(10)00227-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cancer patients are well-known to be at increased risk of venous thromboembolism (VTE). However, the risk varies widely between patients and over the natural history of malignancy. Recent data have identified multiple clinical risk factors as well as biomarkers predictive of VTE. Risk factors include patient-associated factors such as age, obesity and medical comorbidities, cancer-associated factors such as site and stage of cancer, and treatment-associated factors, particularly chemotherapy and anti-angiogenic therapy. Biomarkers associated with increased risk of cancer-associated VTE include leukocyte count, platelet count, and levels of tissue factor, P-selectin and D-dimer. This review focuses on the evidence for risk stratification of cancer patients, based on these risk factors and biomarkers, as well as a recently validated predictive model which can be used to identify patients at highest risk. Targeted thromboprophylaxis utilizing model-based and/or biomarker-based approaches may provide an optimal risk-benefit ratio and is currently the focus of ongoing clinical trials.
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Affiliation(s)
- Gregory C Connolly
- James P. Wilmot Cancer Center, Department of Medicine, University of Rochester, Rochester, N.Y., USA
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78
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Hochhegger B, Irion KL, Marchiori E, Bello R, Moreira J, Camargo JJ. Computed tomography findings of postoperative complications in lung transplantation. J Bras Pneumol 2009; 35:266-74. [PMID: 19390726 DOI: 10.1590/s1806-37132009000300012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Accepted: 01/20/2009] [Indexed: 11/22/2022] Open
Abstract
Due to the increasing number and improved survival of lung transplant recipients, radiologists should be aware of the imaging features of the postoperative complications that can occur in such patients. The early treatment of complications is important for the long-term survival of lung transplant recipients. Frequently, HRCT plays a central role in the investigation of such complications. Early recognition of the signs of complications allows treatment to be initiated earlier, which improves survival. The aim of this pictorial review was to demonstrate the CT scan appearance of pulmonary complications such as reperfusion edema, acute rejection, infection, pulmonary thromboembolism, chronic rejection, bronchiolitis obliterans syndrome, cryptogenic organizing pneumonia, post-transplant lymphoproliferative disorder, bronchial dehiscence and bronchial stenosis.
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Affiliation(s)
- Bruno Hochhegger
- Santa Casa Sisters of Mercy Hospital Complex, Porto Alegre, Brazil.
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79
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Belmaati E, Jensen C, Kofoed KF, Iversen M, Steffensen I, Nielsen MB. Primary graft dysfunction; possible evaluation by high resolution computed tomography, and suggestions for a scoring system. Interact Cardiovasc Thorac Surg 2009; 9:859-67. [PMID: 19671582 DOI: 10.1510/icvts.2009.207852] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We have reviewed and discussed current knowledge on existing scoring systems regarding high resolution computed tomography (HRCT) images for the assessment of primary graft dysfunction (PGD) after lung transplantation. Adult respiratory distress syndrome (ARDS) has been more widely studied and appears to have many morphological features similar to what is found in PGD, and might, therefore, be usefully extrapolated to PGD. Principles of HRCT, scoring systems based on HRCT and various terms describing PGD were reviewed and summarized. The sensitivity, inter-intra observer variability, and reproducibility of these systems were discussed. Lastly, the future perspectives for 64-multi-slice computed tomography (MSCT) in relation to PGD were discussed. Few studies on scoring systems of lung tissue by HRCT in ARDS patients and idiopathic pulmonary fibrosis (IPF) patients were found. Most studies were performed on patients with cystic fibrosis (CF). Sensitivity of HRCT for the detection of parenchymal changes is superior to other imaging methods. High levels of reproducibility are achievable amongst observers who score HRCT lung images. Development of standardized criteria that specify the inclusion/exclusion criteria of patients, pilot testing, and training investigators through review of disagreements, were possibilities suggested for decreasing inter/intra observer variability. Factors affecting the image attenuation (Hounsfield numbers) and thus, the reproducibility of CT densitometric measurements were of minimal influence. Studies have reported on how lung tissue images, derived by HRCT, can be scored and graded. There does not seem to be a golden standard for evaluating these images, which makes comparison between methods challenging. These scoring systems assess the presence, severity, and extent of parenchymal change in the lung. HRCT is considered relevant and superior in evaluating disease severity, disease progression, and in evaluating the effects of therapy regimes in the lung. It is, however, not clear to what extent these scoring methods may be implemented for grading PGD. Further efforts could be made to standardize scoring methods for lung tissue with regards to PGD.
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Affiliation(s)
- Esther Belmaati
- Department of Radiology X, Diagnostic Imaging Centre, Rigshospitalet, Copenhagen University Hospital, Denmark.
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