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Ron E, Alattar Z, Hoebee S, Kang P, vanSonnenberg E. Current Trends in the Use of Ultrasound Over Chest X-Ray to Identify Pneumothoraces in ICU, Trauma, and ARDS Patients. J Intensive Care Med 2021; 37:5-11. [PMID: 33611954 DOI: 10.1177/0885066620987813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pneumothoraces are a common and potentially fatal complication for critically ill patients in the trauma and intensive care units. Since its use for pneumothorax detection was first reported in 1987, ultrasound has been increasingly used for the detection of thoracic injuries. As ultrasound imaging has improved and operators have potentially become more proficient, it is important to analyze more recent trends in the sensitivities and specificities of ultrasound for the detection of pneumothorax. This literature review and meta-analysis identifies 17 studies that directly compare the sensitivity and specificity of ultrasound and anterior-posterior chest x-ray in the identification of pneumothorax among 2955 patients who developed 793 pneumothoraces as detected by gold standard CT scanning. For the 17 articles analyzed, the pooled sensitivity of trans-thoracic ultrasound was 75.07% (64.92%-85.22%), and the pooled specificity was 98.36% (97.45%-99.26%). The pooled sensitivity of CXR was 45.65% (36.04%-55.26%), and pooled specificity was 99.62% (99.00%-100%). While this review demonstrates an improved sensitivity in the detection of pneumothorax with ultrasound over AP chest x-rays, it did not find a significant trend or improvement in the sensitivity or specificity of ultrasound for detecting pneumothorax over time.
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Affiliation(s)
- Eyal Ron
- 42283University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Zana Alattar
- 42283University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Shelby Hoebee
- 42283University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Paul Kang
- 42283University of Arizona College of Medicine-Phoenix, AZ, USA
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Liu K, Zeng Y, Xie P, Ye X, Xu G, Liu J, Wang H, Qian J. COVID-19 with cystic features on computed tomography: A case report. Medicine (Baltimore) 2020; 99:e20175. [PMID: 32358406 PMCID: PMC7440163 DOI: 10.1097/md.0000000000020175] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE The cystic features of the novel coronavirus disease 2019 (COVID-19) found on computed tomography (CT) have not yet been reported in the published literature. We report the cystic chest CT findings of 2 patients confirmed to have COVID-19-related pneumonia. PATIENT CONCERNS A 38-year-old man and a 35-year-old man diagnosed with severe COVID-19 pneumonia were admitted to the intensive care unit. DIAGNOSES Chest CT findings showed multiple cysts in ground-glass opacities (bilaterally) with/without pneumothorax. The cysts had a smooth inner wall. INTERVENTIONS The patients continued to be given oxygen by mask and received antitussive, phlegm-dispelling treatment. OUTCOMES At follow up, there was a reduction in the number of multiple cystic lesions on CT. To date, 1 patient was discharged from hospital, while the other had been transferred to the rehabilitation department. LESSONS COVID-19 may independently result in pulmonary cyst formation and pneumothorax; the application of a ventilator may be another causative factor.
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Affiliation(s)
| | | | | | | | | | - Jian Liu
- Department of Respiratory and Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu
| | - Hao Wang
- Department of Radiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Jinxian Qian
- Department of Respiratory and Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu
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Sakai M, Hiyama T, Kuno H, Mori K, Saida T, Ishiguro T, Takahashi H, Koyama K, Minami M. Thoracic abnormal air collections in patients in the intensive care unit: radiograph findings correlated with CT. Insights Imaging 2020; 11:35. [PMID: 32162176 PMCID: PMC7066360 DOI: 10.1186/s13244-020-0838-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/23/2020] [Indexed: 11/10/2022] Open
Abstract
An abnormal collection of air in the thorax is one of the most common life-threatening events that occurs in the intensive care unit. Patient management differs depending on the location of the air collection; therefore, detecting abnormal air collection and identifying its exact location on supine chest radiographs is essential for early treatment and positive patient outcomes. Thoracic abnormal air collects in multiple thoracic spaces, including the pleural cavity, chest wall, mediastinum, pericardium, and lung. Pneumothorax in the supine position shows different radiographic findings depending on the location. Many conditions, such as skin folds, interlobar fissure, bullae in the apices, and air collection in the intrathoracic extrapleural space, mimic pneumothorax on radiographs. Additionally, pneumopericardium may resemble pneumomediastinum and needs to be differentiated. Further, some conditions such as inferior pulmonary ligament air collection versus a pneumatocele or pneumothorax in the posteromedial space require a differential diagnosis based on radiographs. Computed tomography (CT) is required to localize the air and delineate potential etiologies when a diagnosis by radiography is difficult. The purposes of this article are to review the anatomy of the potential spaces in the chest where abnormal air can collect, explain characteristic radiographic findings of the abnormal air collection in supine patients with illustrations and correlated CT images, and describe the distinguishing features of conditions that require a differential diagnosis. Since management differs based on the location of the air collection, radiologists should try to accurately detect and identify the location of air collection on supine radiographs.
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Affiliation(s)
- Masafumi Sakai
- Department of Diagnostic and Interventional Radiology, Ibaraki Prefectural Central Hospital, Kasama, Japan. .,Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, Amakubo 2-1-1, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Takashi Hiyama
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hirofumi Kuno
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kensaku Mori
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, Amakubo 2-1-1, Tsukuba, Ibaraki, 305-8576, Japan
| | - Tsukasa Saida
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, Amakubo 2-1-1, Tsukuba, Ibaraki, 305-8576, Japan
| | - Toshitaka Ishiguro
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, Amakubo 2-1-1, Tsukuba, Ibaraki, 305-8576, Japan
| | - Hiroaki Takahashi
- Department of Diagnostic Radiology, Mayo Clinic Minnesota, 200 First St. SW, Rochester, MN, 55905, USA
| | - Ken Koyama
- Department of Diagnostic and Interventional Radiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Manabu Minami
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, Amakubo 2-1-1, Tsukuba, Ibaraki, 305-8576, Japan
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Stefanidis K, Moser J, Vlahos I. Imaging of Diffuse Lung Disease in the Intensive Care Unit Patient. Radiol Clin North Am 2019; 58:119-131. [PMID: 31731896 DOI: 10.1016/j.rcl.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
There is a wide variety of causes of diffuse lung disease in the intensive care unit patient, of which adult respiratory distress syndrome is the commonest clinical consideration. Plain radiography, computed tomography, and ultrasound can be used synergistically to evaluate patients with diffuse lung disease and respiratory impairment. Imaging is not limited to characterization of the cause of diffuse lung disease but also aids in monitoring its evolution and in ventilator setting management.
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Affiliation(s)
- Konstantinos Stefanidis
- Radiology Department, King's College Hospital, NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK.
| | - Joanna Moser
- Radiology Department, St. George's University Hospitals, NHS Foundation Trust and School of Medicine, Blackshaw Road Tooting, London SW17 0QT, UK
| | - Ioannis Vlahos
- Radiology Department, St. George's University Hospitals, NHS Foundation Trust and School of Medicine, Blackshaw Road Tooting, London SW17 0QT, UK
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Cereda M, Xin Y, Goffi A, Herrmann J, Kaczka DW, Kavanagh BP, Perchiazzi G, Yoshida T, Rizi RR. Imaging the Injured Lung: Mechanisms of Action and Clinical Use. Anesthesiology 2019; 131:716-749. [PMID: 30664057 PMCID: PMC6692186 DOI: 10.1097/aln.0000000000002583] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Acute respiratory distress syndrome (ARDS) consists of acute hypoxemic respiratory failure characterized by massive and heterogeneously distributed loss of lung aeration caused by diffuse inflammation and edema present in interstitial and alveolar spaces. It is defined by consensus criteria, which include diffuse infiltrates on chest imaging-either plain radiography or computed tomography. This review will summarize how imaging sciences can inform modern respiratory management of ARDS and continue to increase the understanding of the acutely injured lung. This review also describes newer imaging methodologies that are likely to inform future clinical decision-making and potentially improve outcome. For each imaging modality, this review systematically describes the underlying principles, technology involved, measurements obtained, insights gained by the technique, emerging approaches, limitations, and future developments. Finally, integrated approaches are considered whereby multimodal imaging may impact management of ARDS.
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Affiliation(s)
- Maurizio Cereda
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Yi Xin
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto, ON, Canada
| | - Jacob Herrmann
- Departments of Anesthesia and Biomedical Engineering, University of Iowa, IA
| | - David W. Kaczka
- Departments of Anesthesia, Radiology, and Biomedical Engineering, University of Iowa, IA
| | | | - Gaetano Perchiazzi
- Hedenstierna Laboratory and Uppsala University Hospital, Uppsala University, Sweden
| | - Takeshi Yoshida
- Hospital for Sick Children, University of Toronto, ON, Canada
| | - Rahim R. Rizi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
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Viswan A, Singh C, Rai RK, Azim A, Sinha N, Baronia AK. Metabolomics based predictive biomarker model of ARDS: A systemic measure of clinical hypoxemia. PLoS One 2017; 12:e0187545. [PMID: 29095932 PMCID: PMC5667881 DOI: 10.1371/journal.pone.0187545] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/20/2017] [Indexed: 12/25/2022] Open
Abstract
Despite advancements in ventilator technologies, lung supportive and rescue therapies, the outcome and prognostication in acute respiratory distress syndrome (ARDS) remains incremental and ambiguous. Metabolomics is a potential insightful measure to the diagnostic approaches practiced in critical disease settings. In our study patients diagnosed with mild and moderate/severe ARDS clinically governed by hypoxemic P/F ratio between 100-300 but with indistinct molecular phenotype were discriminated employing nuclear magnetic resonance (NMR) based metabolomics of mini bronchoalveolar lavage fluid (mBALF). Resulting biomarker prototype comprising six metabolites was substantiated highlighting ARDS susceptibility/recovery. Both the groups (mild and moderate/severe ARDS) showed distinct biochemical profile based on 83.3% classification by discriminant function analysis and cross validated accuracy of 91% using partial least squares discriminant analysis as major classifier. The predictive performance of narrowed down six metabolites were found analogous with chemometrics. The proposed biomarker model consisting of six metabolites proline, lysine/arginine, taurine, threonine and glutamate were found characteristic of ARDS sub-stages with aberrant metabolism observed mainly in arginine, proline metabolism, lysine synthesis and so forth correlating to diseased metabotype. Thus NMR based metabolomics has provided new insight into ARDS sub-stages and conclusively a precise biomarker model proposed, reflecting underlying metabolic dysfunction aiding prior clinical decision making.
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Affiliation(s)
- Akhila Viswan
- Centre of Biomedical Research, Lucknow, Uttar Pradesh, India
- Faculty of Engineering and Technology, Dr. A. P. J Abdul Kalam Technical University, Lucknow, Uttar Pradesh, India
| | - Chandan Singh
- Centre of Biomedical Research, Lucknow, Uttar Pradesh, India
| | - Ratan Kumar Rai
- Centre of Biomedical Research, Lucknow, Uttar Pradesh, India
| | - Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neeraj Sinha
- Centre of Biomedical Research, Lucknow, Uttar Pradesh, India
| | - Arvind Kumar Baronia
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Abstract
This review of intensive care unit (ICU) radiology has been divided into two sections. In Part 1, previously published, the discussion focused on the role of the portable radiograph in the evaluation of the critically ill patient and the impact of the introduction of digital radiography and picture-archiving communications systems on patient care. Part 2 of this review will emphasize the role of computed tomography and the increasing contribution of image-guided interventional procedures in patient management. The deleterious effects of mechanical ventilation due to barotrauma will also be discussed.
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Zompatori M, Ciccarese F, Fasano L. Overview of current lung imaging in acute respiratory distress syndrome. Eur Respir Rev 2014; 23:519-30. [DOI: 10.1183/09059180.00001314] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Imaging plays a key role in the diagnosis and follow-up of acute respiratory distress syndrome (ARDS). Chest radiography, bedside lung ultrasonography and computed tomography scans can provide useful information for the management of patients and detection of prognostic factors. However, imaging findings are not specific and several possible differential diagnoses should be taken into account. Herein we will review the role of radiological techniques in ARDS, highlight the plain radiological and computed tomography findings according to the pathological stage of the disease (exudative, inflammatory and fibroproliferative), and summarise the main points for the differential diagnosis with cardiogenic oedema, which is still challenging in the acute stage.
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Abstract
The degree of perioperative lung injury that patients sustain results from a complex interaction between their current physiologic state, comorbidities, lifestyle choices, underlying surgical diagnosis, operative, and ultimately their cardiopulmonary interaction with a mechanical ventilator. This review addresses primarily the pathophysiology of perioperative lung injury with reference to ventilator-induced lung injury and acute respiratory distress syndrome.
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Affiliation(s)
- Kayode Adeniji
- Interdepartmental Division of Critical Care, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
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Boriosi JP, Cohen RA, Summers E, Sapru A, Hanson JH, Gildengorin G, Newman V, Flori HR, Flori HR. Lung aeration changes after lung recruitment in children with acute lung injury: a feasibility study. Pediatr Pulmonol 2012; 47:771-9. [PMID: 22298419 PMCID: PMC4169705 DOI: 10.1002/ppul.22508] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 12/17/2011] [Indexed: 11/12/2022]
Abstract
RATIONALE There are several adult studies using computed tomography (CT-scan) to examine lung aeration changes during or after a recruitment maneuver (RM) in ventilated patients with acute lung injury (ALI). However, there are no published data on the lung aeration changes during or after a RM in ventilated pediatric patients with ALI. OBJECTIVE To describe CT-scan lung aeration changes and gas exchange after lung recruitment in pediatric ALI and assess the safety of transporting patients in the acute phase of ALI to the CT-scanner. METHODS We present a case series completed in a subset of six patients enrolled in our previously published study of efficacy and safety of lung recruitment in pediatric patients with ALI. INTERVENTION RM using incremental positive end-expiratory pressure. RESULTS There was a variable increase in aerated and poorly aerated lung after the RM ranging from 3% to 72% (median 20%; interquartile range 6, 47; P = 0.03). All patients had improvement in the ratio of partial pressure of arterial oxygen over fraction of inspired oxygen (PaO(2) /FiO(2)) after the RM (median 14%; interquartile range: 8, 72; P = 0.03). There was a decrease in the partial pressure of arterial carbon dioxide (PaCO(2)) in four of six subjects after the RM (median -5%; interquartile range: -9, 2; P = 0.5). One subject had transient hypercapnia (41% increase in PaCO(2)) during the RM and this correlated with the smallest increase (3%) in aerated and poorly aerated lung. All patients tolerated the RM without hemodynamic compromise, barotrauma, hypoxemia, or dysrhythmias. CONCLUSIONS Lung recruitment results in improved lung aeration as detected by lung tomography. This is accompanied by improvements in oxygenation and ventilation. However, the clinical significance of these findings is uncertain. Transporting patients in early ALI to the CT-scanner seems safe and feasible.
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Affiliation(s)
- Juan P Boriosi
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin 53792-4108, USA.
| | | | | | | | | | | | | | | | - Heidi R. Flori
- Pediatric Critical Care, Children’s Hospital and Research Center Oakland, Oakland, California
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The influence of autonomic dysfunction associated with aging and type 2 diabetes on daily life activities. EXPERIMENTAL DIABETES RESEARCH 2012; 2012:657103. [PMID: 22566994 PMCID: PMC3332074 DOI: 10.1155/2012/657103] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 01/28/2012] [Accepted: 01/30/2012] [Indexed: 11/17/2022]
Abstract
Type 2 diabetes (T2D) and ageing have well documented effects on every organ in the body. In T2D the autonomic nervous system is impaired due to damage to neurons, sensory receptors, synapses and the blood vessels. This paper will concentrate on how autonomic impairment alters normal daily activities. Impairments include the response of the blood vessels to heat, sweating, heat transfer, whole body heating, orthostatic intolerance, balance, and gait. Because diabetes is more prevalent in older individuals, the effects of ageing will be examined. Beginning with endothelial dysfunction, blood vessels have impairment in their ability to vasodilate. With this and synaptic damage, the autonomic nervous system cannot compensate for effectors such as pressure on and heating of the skin. This and reduced ability of the heart to respond to stress, reduces autonomic orthostatic compensation. Diminished sweating causes the skin and core temperature to be high during whole body heating. Impaired orthostatic tolerance, impaired vision and vestibular sensing, causes poor balance and impaired gait. Overall, people with T2D must be made aware and counseled relative to the potential consequence of these impairments.
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Abstract
Since its introduction into the management of the acute respiratory distress syndrome, mechanical ventilation has been so strongly interwoven with its side effects that it came to be considered as invariably dangerous. Over the decades, attention has shifted from gross barotrauma to volutrauma and, more recently, to atelectrauma and biotrauma. In this article, we describe the anatomical and physiologic framework in which ventilator-induced lung injury may occur. We address the concept of lung stress/strain as applied to the whole lung or specific pulmonary regions. We challenge some common beliefs, such as separately studying the dangerous effects of different tidal volumes (end inspiration) and end-expiratory positive pressures. Based on available data, we suggest that stress at rupture is only rarely reached and that high tidal volume induces ventilator-induced lung injury by augmenting the pressure heterogeneity at the interface between open and constantly closed units. We believe that ventilator-induced lung injury occurs only when a given threshold is exceeded; below this limit, mechanical ventilation is likely to be safe.
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Ahvenjärvi LK, Laurila JJ, Jartti A, Ylipalosaari P, Ala-Kokko TI, Syrjälä HP. Multi-detector computed tomography in critically ill patients. Acta Anaesthesiol Scand 2008; 52:547-52. [PMID: 18261200 DOI: 10.1111/j.1399-6576.2007.01559.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a lack of studies showing the overall impact of multi-detector computed tomography (MDCT) on the treatment of critically ill patients in a general intensive care unit (ICU) setting. METHODS A prospective observational study on the effects of MDCT on the treatment of patients in a 12-bed medical-surgical ICU in a university hospital providing tertiary care. RESULTS During the 9-month study period, there were 343 admissions with ICU length of stay longer than 48 h. Of these patients, 64 (19%) had had inconclusive findings with other modalities of radiological imaging, and they underwent altogether 82 MDCT examinations. Fifty examinations (61%) resulted in a change of treatment. The changes included 22 surgical interventions, 16 percutaneous or paranasal interventions, 15 changes of antimicrobial therapy, three withdrawals of active treatment, and four other changes of treatment. Eight patients underwent two and one patient underwent three changes of treatment. Twenty examinations (24%) were regarded as otherwise necessary for clinical decision-making, although no change in the treatment was indicated. Twelve examinations (15%) failed to provide any additional information relevant to the patient's treatment. CONCLUSION Sixty-one percent of the MDCT examinations led to a change of treatment, and 24% of them otherwise contributed to or supported clinical decision-making, suggesting that MDCT examination is helpful in the case of general ICU patients, with inconclusive findings with other imaging modalities.
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Affiliation(s)
- L K Ahvenjärvi
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
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Rice TW, Rodriguez RM, Barnette R, Light RW. Prevalence and characteristics of pleural effusions in superior vena cava syndrome. Respirology 2006; 11:299-305. [PMID: 16635088 DOI: 10.1111/j.1440-1843.2006.00841.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE AND BACKGROUND The prevalence and characteristics of pleural effusions occurring in adults with the superior vena cava (SVC) syndrome are unknown. The purpose of the present study was to characterize these pleural effusions. METHODS Charts of patients diagnosed with SVC syndrome at a tertiary care referral centre were reviewed. Radiographs were evaluated for the presence and size of pleural effusions, presence and location of masses and mediastinal width. If a pleural effusion was present, the patient's chart and a pre-existing database on pleural effusions were searched to determine whether the effusion was sampled and the results of any laboratory investigations on the fluid. RESULTS The SVC syndrome occurred in 78 patients. Malignancy was the aetiology in 60% of the cases and bronchogenic carcinoma was the most common malignancy. An intravascular device was the aetiology in the majority of benign cases. Pleural effusion was found in 70% of patients with a malignant aetiology and 58% of those with a benign cause (P=0.345). The mean size of the effusions was larger in malignant cases (P=0.012). Of the 44 effusions 22 were sampled (17 in malignancy and five with benign processes); none was transudates, 20 (91%) were exudative (four of these were chylous) and the remaining two were reported as exudates but did not have pleural chemistries documented. CONCLUSIONS More than half of patients with SVC syndrome have pleural effusions, regardless of the aetiology. However, the effusions are larger when associated with malignancy. The majority of these effusions are exudative and occasionally chylous. None was transudates.
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Affiliation(s)
- Todd W Rice
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, and Saint Thomas Hospital, Nashville, Tennessee 37232-2650, USA.
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Woodside KJ, vanSonnenberg E, Chon KS, Loran DB, Tocino IM, Zwischenberger JB. Centromere DNA, proteins and kinetochore assembly in vertebrate cells. Chromosome Res 2005; 18:9-20. [PMID: 15189663 DOI: 10.1177/0885066602239120] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The centromere is a specialized region of the chromosome that is essential for faithful chromosome segregation during mitosis and meiosis in eukaryotic cells. It is the site at which the kinetochore, the functional nucleoprotein complex responsible for microtubule binding and chromosome movement, is assembled through complex molecular mechanisms. Herein, I review recent advances in our understanding of centromeric DNAs as sites for kinetochore assembly and the mechanisms underlying kinetochore assembly in vertebrate cells.
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Affiliation(s)
- Kenneth J Woodside
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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17
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Shiotani S, Kohno M, Ohashi N, Yamazaki K, Nakayama H, Watanabe K, Oyake Y, Itai Y. Non-traumatic postmortem computed tomographic (PMCT) findings of the lung. Forensic Sci Int 2004; 139:39-48. [PMID: 14687772 DOI: 10.1016/j.forsciint.2003.09.016] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE We attempted to obtain postmortem computed tomographic (PMCT) images of the lung in cases of non-traumatic death and describe the results to distinguish usual postmortem findings from those of specific thoracic causes of death. MATERIALS AND METHODS Our subjects were a total of 150 consecutive non-traumatic cases with cardiopulmonary arrest on arrival who were examined by CT within 2h after certification of death between January 1993 and December 2001. PMCT images of the lung and the frequency of imaging findings (dependent density, ground glass attenuation (GGA), consolidation, pleural effusion, and endotracheal (or endobronchial) air defect) were retrospectively reviewed. Autopsy had been conducted in 16 of the cases. RESULTS The causes of death and frequency percentages of dependent density, GGA, consolidation, pleural effusion, and endotracheal (or endobronchial) air defect were: 91 cases of acute heart failure (AHF) (69, 66, 24, 11, 14%), 23 cases of aortic dissection (57, 39, 4, 52, 0%), 11 cases of pneumonia (18, 82, 100, 45, 27%), 23 other specified cases (52, 30, 13, 17, 9%), and two unspecified cases (0, 0, 0, 50, 0%), [total respective frequency percentages were (60, 57, 25, 21, 12%)]. Autopsy confirmed that GGA on PMCT in AHF cases corresponded to pulmonary edema. CONCLUSION When PMCT of the lung shows no other shadows than dependent density, further analysis is necessary to detect the cause of death.
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Affiliation(s)
- Seiji Shiotani
- Department of Diagnostic Radiology, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, City, Ibaraki 305-8558, Tsukuba, Japan.
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Schöpf UJ, Schaefer-Prokop C, Herold CJ. Pulmonale Zirkulationsstörungen. Thorax 2003. [DOI: 10.1007/978-3-642-55830-6_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Cleverley JR, Screaton NJ, Hiorns MP, Flint JDA, Müller NL. Drug-induced lung disease: high-resolution CT and histological findings. Clin Radiol 2002; 57:292-9. [PMID: 12014876 DOI: 10.1053/crad.2001.0792] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM To compare the parenchymal high-resolution computed tomography (HRCT) appearances with histological findings in patients with drug-induced lung disease and to determine the prognostic value of HRCT. MATERIALS AND METHODS Drug history, HRCT features, histological findings and outcome at 3 months in 20 patients with drug induced-lung disease were reviewed retrospectively. The HRCT images were assessed for the pattern and distribution of abnormalities and classified as most suggestive of interstitial pneumonitis/fibrosis, diffuse alveolar damage (DAD), organizing pneumonia (OP) reaction, or a hypersensitivity reaction. RESULTS On histopathological examination there were eight cases of interstitial pneumonitis/fibrosis, five of DAD, five of OP reactions, one of hypersensitivity reaction and one of pulmonary eosinophilia. The most common abnormalities on HRCT were ground-glass opacities (n = 17), consolidation (n = 14), interlobular septal thickening (n = 15) and centrilobular nodules (n = 8). HRCT interpretation and histological diagnosis were concordant in only nine (45%) of 20 patients. The pattern, distribution, and extent of HRCT abnormalities were of limited prognostic value: all eight patients with histological findings of OP, hypersensitivity reaction, or eosinophilic infiltrate improved on follow-up compared to only five of 13 patients with interstitial pneumonitis/fibrosis or DAD. CONCLUSION In many cases of drug-induced lung injury HRCT is of limited value in determining the histological pattern and prognosis.
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Affiliation(s)
- Joanne R Cleverley
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Jung JI, Choi JE, Hahn ST, Min CK, Kim CC, Park SH. Radiologic features of all-trans-retinoic acid syndrome. AJR Am J Roentgenol 2002; 178:475-80. [PMID: 11804921 DOI: 10.2214/ajr.178.2.1780475] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The treatment of acute promyelocytic leukemia with all-trans-retinoic acid (ATRA) sometimes results in a syndrome characterized by fever, respiratory distress, weight gain, pleural and pericardial effusion, and pulmonary infiltrates. We report the radiologic features of ATRA syndrome. MATERIALS AND METHODS During the past 5 years, 69 patients with acute promyelocytic leukemia were treated with ATRA. Of this group, 15 patients developed ATRA syndrome. Serial chest radiographs of the 15 patients with ATRA syndrome were evaluated retrospectively for the presence of pleural effusion, pulmonary nodules, consolidation, ground-glass opacity, septal lines, increased pulmonary blood volume, peribronchial cuffing, and air bronchogram. Also, we measured the cardiothoracic ratio and the vascular pedicle width. RESULTS Chest radiographs showed increased cardiothoracic ratio in 13 of the 15 patients, increased vascular pedicle width in 13, increased pulmonary blood volume in 13, septal lines in nine, peribronchial cuffing in nine, ground-glass opacity in nine, consolidation in seven, and nodules in seven. Pleural effusion was noted in 11 of the 15 patients, and air bronchogram was noted in five of the 15 patients. Pulmonary hemorrhage developed in three patients who were being treated with ATRA; they showed bilateral, diffuse, poorly defined nodules and ground-glass opacity on radiography. CONCLUSION Most patients with ATRA syndrome have abnormal findings on chest radiographs, and the abnormalities are similar to those of pulmonary edema.
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Affiliation(s)
- Jung Im Jung
- Department of Radiology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 62 Yeouidodong, Youngdungpo-gu, Seoul 150-713, South Korea
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Gattinoni L, Caironi P, Pelosi P, Goodman LR. What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med 2001; 164:1701-11. [PMID: 11719313 DOI: 10.1164/ajrccm.164.9.2103121] [Citation(s) in RCA: 441] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- L Gattinoni
- Istituto di Anestesia e Rianimazione, Università degli Studi di Milano, Ospedale Maggiore Policlinico-IRCCS, Milano, Italy.
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Abstract
Acute respiratory distress syndrome (ARDS) is an acute form of severe alveolar-capillary injury that evolves after a direct or indirect lung insult. It begins as noncardiogenic pulmonary edema and develops into a neutrophilic alveolitis, and, later, pulmonary fibrosis. Mortality remains high among children with ARDS, particularly when serious underlying conditions co-exist, sepsis occurs, and when there is multi-organ failure. Lung function improves with time among survivors, but pulmonary fibrosis may persist. Advances in the care of children with ARDS include the use of lung-protective ventilator strategies, permissive hypercapnia, inhaled nitric oxide, high-frequency ventilation, and extra-corporeal life support. These approaches reduce ventilator-associated lung injury and may improve survival when used in combination with one another. Interventions that reduce alveolar inflammation, enhance alveolar fluid removal, and reduce pulmonary fibrosis will further improve survival and recovery from ARDS in the future.
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Affiliation(s)
- G J Redding
- Pulmonary Medicine Division Department of Pediatrics, Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA.
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Tomiyama N, Müller NL, Johkoh T, Cleverley JR, Ellis SJ, Akira M, Ichikado K, Honda O, Mihara N, Kozuka T, Hamada S, Nakamura H. Acute respiratory distress syndrome and acute interstitial pneumonia: comparison of thin-section CT findings. J Comput Assist Tomogr 2001; 25:28-33. [PMID: 11176289 DOI: 10.1097/00004728-200101000-00005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this work was to compare the thin-section CT findings of acute respiratory distress syndrome (ARDS) with those of acute interstitial pneumonia (AIP). METHOD The thin-section CT scans from 25 patients with ARDS and 25 with AIP were independently assessed by two observers without knowledge of clinical and pathologic data. The presence, extent, and distribution of various CT findings were independently analyzed. RESULTS Honeycombing was seen more frequently in lobes of patients with AIP (26%) than in lobes with ARDS (8%) (p < 0.001). Compared with patients with ARDS, a greater number of patients with AIP had a predominantly lower lung zone distribution (p < 0.05) and a symmetric distribution (p < 0.05) of the parenchymal abnormalities. CONCLUSION Patients with AIP have a greater prevalence of honeycombing and are more likely to have a symmetric bilateral distribution and a lower lung zone predominance than patients with ARDS. However, significant overlap exists among the CT findings.
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Affiliation(s)
- N Tomiyama
- Department of Radiology, Osaka University Medical School, Suita, Japan.
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Affiliation(s)
- D J Tattersall
- Department of Radiology, Churchill Hospital, Oxford Radcliffe Hospitals, Old Road, Headington, Oxford, OX3 7LJ, UK
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25
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Jantz MA, Sahn SA. Pleural Disease in the Intensive Care Unit. J Intensive Care Med 2000. [DOI: 10.1046/j.1525-1489.2000.00063.x] [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]
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26
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Jantz MA, Sahn SA. Pleural Disease in the Intensive Care Unit. J Intensive Care Med 2000. [DOI: 10.1177/088506660001500201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pleural disease itself is an unusual cause for admission to the intensive care unit (ICU). Pleural complications of diseases and procedures in the ICU are common, however, and the impact on respiratory physiology is additive to that of the underlying cardiopulmonary disease. Pleural effusion and pneumothorax may be overlooked in the critically ill patient due to alterations in radiologic appearance in the supine patient. The development of a pneumothorax in a patient in the ICU represents a potentially life-threatening situation. This article reviews the etiologies, pathophysiology, and management of pleural effusion, pneumothorax, tension pneumothorax, and bronchopleural fistula in the critically ill patient. In addition, we review the potential complications of thoracentesis and chest tube thoracostomy, including re-expansion pulmonary edema.
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Affiliation(s)
- Michael A. Jantz
- From the Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC
| | - Steven A. Sahn
- From the Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC
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Abstract
PURPOSE Our purpose is to describe the CT findings in pulmonary fat embolism syndrome (FES). METHOD Chest radiographs and CT scans of six patients with pulmonary FES were reviewed. Initial and follow-up CT findings were noted, and the extent of CT abnormalities was correlated with partial pressure of arterial oxygen (PaO2). RESULTS Focal areas of consolidation or ground-glass opacity and nodules were seen in all patients, predominantly in the upper lobes of the lungs. Association between these opacities and pulmonary vessels was indicated in three patients. In the lower lobes of all patients, gravity-dependent opacities predominated. Diffuse ground-glass opacity was noted in five patients. Follow-up CT scans showed rapid improvement in three patients, but the gravity-dependent opacity progressed. The extent of CT abnormalities correlated positively with PaO2 (r = 0.8, p < 0.05). CONCLUSION CT findings reflect the pathophysiology of this syndrome, which differs from that of simple capillary permeability pulmonary edema.
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Affiliation(s)
- H Arakawa
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki City, Japan
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Aquino SL, Dunagan DP, Chiles C, Haponik EF. Herpes simplex virus 1 pneumonia: patterns on CT scans and conventional chest radiographs. J Comput Assist Tomogr 1998; 22:795-800. [PMID: 9754119 DOI: 10.1097/00004728-199809000-00024] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The goal of our study was to describe the herpes simplex virus type 1 (HSV 1) pneumonia patterns on CT scans and chest radiographs. METHOD We retrospectively reviewed clinical records and chest radiographs of 24 patients with HSV 1 pneumonia and 10 with pneumonia from combined HSV and mixed flora infection. We also reviewed CT scans available for eight patients with HSV pneumonia and four with mixed pneumonia. RESULTS CT scans of eight patients with HSV pneumonia demonstrated multifocal segmental and subsegmental ground-glass opacities (n = 8), additional focal areas of consolidation (n = 6), scattered distribution (n = 6), and pleural effusions (n = 7). Chest radiographs (23 patients) showed patchy segmental and subsegmental ground-glass opacities and consolidation (n = 23), scattered distribution (n = 20), and pleural effusions (n = 12). Radiographic patterns for isolated HSV pneumonia and mixed flora pneumonia were not significantly different. CONCLUSION With a growing population of at-risk immunosuppressed patients, it is important to recognize CT and chest radiography patterns consistent with, although nonspecific for, HSV 1 pneumonia.
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Affiliation(s)
- S L Aquino
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1088, USA
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Goodman LR. CONGESTIVE HEART FAILURE AND ADULT RESPIRATORY DISTRESS SYNDROME. Radiol Clin North Am 1996. [DOI: 10.1016/s0033-8389(22)00665-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Heffner JE, McDonald J, Barbieri C. Recurrent pneumothoraces in ventilated patients despite ipsilateral chest tubes. Chest 1995; 108:1053-8. [PMID: 7555119 DOI: 10.1378/chest.108.4.1053] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The incidence of recurrent pneumothoraces was analyzed in mechanically ventilated patients with the adult respiratory distress syndrome (ARDS) or non-ARDS causes of respiratory failure who had ipsilateral chest tubes in place. The radiographs of 39 consecutive patients with 47 initial pneumothoraces were evaluated for pneumothorax recurrence and chest tube positioning, which was prospectively defined as having a "vertical" or "horizontal" orientation. "Horizontal" positioning indicated that the chest tube may have been placed into a major fissure or the posterior hemithorax. Sixteen of the 47 pneumothoraces in all study patients, 14 of the 21 pneumothoraces in patients with ARDS, and 2 of the 26 pneumothoraces in patients without ARDS recurred (p < 0.0001) despite an ipsilateral chest tube; 9 of the 14 ARDS pneumothorax recurrences were tension types. "Horizontal" chest tube positioning in patients with ARDS had a positive predictive value of 86% and 64% for recurrences of pneumothoraces and tension pneumothoraces, respectively. Recurrent pneumothoraces occur commonly in mechanically ventilated patients with ARDS despite ipsilateral chest tubes. Because pneumothorax recurrences appear to be related to horizontal chest tube placement, imaging studies should verify that chest tubes are placed in optimally in the anterior hemithorax away from interlobar fissures in this patient population.
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Affiliation(s)
- J E Heffner
- Department of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85001, USA
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