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Alexander LF, McComb BL, Bowman AW, Bonnett SL, Ghazanfari SM, Caserta MP. Ultrasound Simulation Training for Radiology Residents-Curriculum Design and Implementation. J Ultrasound Med 2023; 42:777-790. [PMID: 36106721 DOI: 10.1002/jum.16098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
Medical simulation training can be used to improve clinician performance, teach communication and professionalism skills, and enhance team training. Radiology residents can benefit from simulation training in diagnostic ultrasound, procedural ultrasound, and communication skills prior to direct patient care experiences. This paper details a weeklong ultrasound simulation training curriculum for radiology residents during the PGY-1 clinical internship. The organization of established teaching methods into a dedicated course early in radiology residency training with the benefit of a multi-disciplinary approach makes this method unique. This framework can be adapted to fit learners at different skill levels or with specific procedural needs.
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Affiliation(s)
- Lauren F Alexander
- Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Barbara L McComb
- Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Andrew W Bowman
- Division Chair of Hospital & Emergency Imaging | Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | | | | | - Melanie P Caserta
- Division Chair of Sonography | Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida, USA
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2
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Stowell JT, McComb BL, Mendoza DP, Cahalane AM, Chaturvedi A. Axillary Anatomy and Pathology: Pearls and "Pitfalls" for Thoracic Imagers. J Thorac Imaging 2022; 37:W28-W40. [PMID: 35142752 DOI: 10.1097/rti.0000000000000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The axilla contains several important structures which exist in a relatively confined anatomic space between the neck, chest wall, and upper extremity. While neoplastic lymphadenopathy may be among the most common axillary conditions, many other processes may be encountered. For example, expanded use of axillary vessels for access routes for endovascular procedures will increase the need for radiologists to access vessel anatomy, patency, and complications that may arise. Knowledge of axillary anatomy and pathology will allow the imager to systematically evaluate the axillae using various imaging modalities.
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Affiliation(s)
| | | | - Dexter P Mendoza
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Health System, New York
| | | | - Abhishek Chaturvedi
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
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3
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de Groot PM, Chung JH, Ackman JB, Berry MF, Carter BW, Colletti PM, Hobbs SB, McComb BL, Movsas B, Tong BC, Walker CM, Yom SS, Kanne JP. ACR Appropriateness Criteria ® Noninvasive Clinical Staging of Primary Lung Cancer. J Am Coll Radiol 2020; 16:S184-S195. [PMID: 31054745 DOI: 10.1016/j.jacr.2019.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 12/19/2022]
Abstract
Lung cancer is the leading cause of cancer-related deaths in both men and women. The major risk factor for lung cancer is personal tobacco smoking, particularly for small-cell lung cancer (SCLC) and squamous cell lung cancers, but other significant risk factors include exposure to secondhand smoke, environmental radon, occupational exposures, and air pollution. Education and socioeconomic status affect both incidence and outcomes. Non-small-cell lung cancer (NSCLC), including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, comprises about 85% of lung cancers. SCLC accounts for approximately 13% to 15% of cases. Prognosis is directly related to stage at presentation. NSCLC is staged using the eighth edition of the tumor-node-metastasis (TNM) criteria of the American Joint Committee on Cancer. For SCLC the eighth edition of TNM staging is recommended to be used in conjunction with the modified Veterans Administration Lung Study Group classification system distinguishing limited stage from extensive stage SCLC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | | | - Sue S Yom
- University of California San Francisco, San Francisco, California
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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4
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Cox CW, Chung JH, Ackman JB, Berry MF, Carter BW, de Groot PM, Hobbs SB, Johnson GB, Maldonado F, McComb BL, Tong BC, Walker CM, Kanne JP. ACR Appropriateness Criteria® Occupational Lung Diseases. J Am Coll Radiol 2020; 17:S188-S197. [PMID: 32370962 DOI: 10.1016/j.jacr.2020.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 11/28/2022]
Abstract
Ordering the appropriate diagnostic imaging for occupational lung disease requires a firm understanding of the relationship between occupational exposure and expected lower respiratory track manifestation. Where particular inorganic dust exposures typically lead to nodular and interstitial lung disease, other occupational exposures may lead to isolated small airway obstruction. Certain workplace exposures, like asbestos, increase the risk of malignancy, but also produce pulmonary findings that mimic malignancy. This publication aims to delineate the common and special considerations associated with occupational lung disease to assist the ordering physician in selecting the most appropriate imaging study, while still stressing the importance of a multidisciplinary approach. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | | | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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5
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Lee C, Colletti PM, Chung JH, Ackman JB, Berry MF, Carter BW, de Groot PM, Hobbs SB, Johnson GB, Maldonado F, McComb BL, Tong BC, Walker CM, Kanne JP. ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompromised Patients. J Am Coll Radiol 2019; 16:S331-S339. [PMID: 31685101 DOI: 10.1016/j.jacr.2019.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 02/08/2023]
Abstract
The immunocompromised patient with an acute respiratory illness (ARI) may present with fever, chills, weight loss, cough, shortness of breath, or chest pain. The number of immunocompromised patients continues to rise with medical advances including solid organ and stem cell transplantation, chemotherapy, and immunomodulatory therapy, along with the continued presence of human immunodeficiency virus and acquired immunodeficiency syndrome. Given the myriad of pathogens that can infect immunocompromised individuals, identifying the specific organism or organisms causing the lung disease can be elusive. Moreover, immunocompromised patients often receive prophylactic or empiric antimicrobial therapy, further complicating diagnostic evaluation. Noninfectious causes for ARI should also be considered, including pulmonary edema, drug-induced lung disease, atelectasis, malignancy, radiation-induced lung disease, pulmonary hemorrhage, diffuse alveolar damage, organizing pneumonia, lung transplant rejection, and pulmonary thromboembolic disease. As many immunocompromised patients with ARI progress along a rapid and potentially fatal course, timely selection of appropriate imaging is of great importance in this setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking, or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Christopher Lee
- Research Author, University of Southern California Keck School of Medicine, Los Angeles, California
| | | | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California, The Society of Thoracic Surgeons
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee, American College of Chest Physicians
| | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina, The Society of Thoracic Surgeons
| | | | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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6
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Jokerst C, Chung JH, Ackman JB, Carter B, Colletti PM, Crabtree TD, de Groot PM, Iannettoni MD, Maldonado F, McComb BL, Steiner RM, Kanne JP. ACR Appropriateness Criteria ® Acute Respiratory Illness in Immunocompetent Patients. J Am Coll Radiol 2019; 15:S240-S251. [PMID: 30392593 DOI: 10.1016/j.jacr.2018.09.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 11/17/2022]
Abstract
Acute respiratory illness, defined as cough, sputum production, chest pain, and/or dyspnea (with or without fever), is a major public health issue, accounting for millions of doctor office and emergency department visits every year. While most cases are due to self-limited viral infections, a significant number of cases are due to more serious respiratory infections where delay in diagnosis can lead to morbidity and mortality. Imaging plays a key role in the initial diagnosis and management of acute respiratory illness. This study reviews the current literature concerning the appropriate role of imaging in the diagnosis and management of the immunocompetent adult patient initially presenting with acute respiratory illness. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brett Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Traves D Crabtree
- Southern Illinois University School of Medicine, Springfield, Illinois; The Society of Thoracic Surgeons
| | | | - Mark D Iannettoni
- University of Iowa, Iowa City, Iowa; The Society of Thoracic Surgeons
| | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Robert M Steiner
- Columbia University Medical Center New York and Temple University Health System, Philadelphia, Pennsylvania
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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7
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Forshee WA, DiSantis DJ, McComb BL. The floating bowel sign. Abdom Radiol (NY) 2018; 43:1837-1838. [PMID: 29030649 DOI: 10.1007/s00261-017-1348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Ravenel JG, Chung JH, Ackman JB, de Groot PM, Johnson GB, Jokerst C, Maldonado F, McComb BL, Steiner RM, Mohammed TL. ACR Appropriateness Criteria ® Imaging of Possible Tuberculosis. J Am Coll Radiol 2018; 14:S160-S165. [PMID: 28473072 DOI: 10.1016/j.jacr.2017.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/17/2022]
Abstract
Pulmonary tuberculosis remains a major cause of disease worldwide and an important public health hazard in the United States. The imaging evaluation depends to a large degree on clinical symptoms and whether active disease is suspected or a subject is at high risk for developing active disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - James G Ravenel
- Principal Author and Panel Chair, Medical University of South Carolina, Charleston, South Carolina.
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Robert M Steiner
- Columbia University Medical Center New York and Temple University Health System, Philadelphia, Pennsylvania
| | - Tan-Lucien Mohammed
- Specialty Chair, University of Florida College of Medicine, Gainesville, Florida
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9
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Wallace MB, Pascual JMS, Raimondo M, Woodward TA, McComb BL, Crook JE, Johnson MM, Al-Haddad MA, Gross SA, Pungpapong S, Hardee JN, Odell JA. Minimally invasive endoscopic staging of suspected lung cancer. JAMA 2008; 299:540-6. [PMID: 18252884 DOI: 10.1001/jama.299.5.540] [Citation(s) in RCA: 260] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
CONTEXT In patients with suspected lung cancer, the presence of mediastinal lymph node metastasis is a critical determinant of therapy and prognosis. Invasive staging with pathologic confirmation is recommended. Many methods for staging exist; mediastinoscopy, an invasive procedure requiring general anesthesia, is currently regarded as the diagnostic standard. OBJECTIVE To compare the diagnostic accuracy of 3 methods of minimally invasive endoscopic staging (and their combinations): traditional transbronchial needle aspiration (TBNA), endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA), and transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). In particular, we aimed to compare EBUS-FNA with TBNA. DESIGN, SETTING, AND PARTICIPANTS Invasive staging of the mediastinum among consecutive patients with suspected lung cancer at a US academic medical center from November 2004 through October 2006. INTERVENTION TBNA, EBUS-FNA, and EUS-FNA performed sequentially as a single combined procedure. MAIN OUTCOME MEASURE Sensitivity for detecting mediastinal lymph node metastases, using pathologic confirmation and 6- to 12-month clinical follow-up as the criterion standard. RESULTS Among 138 patients who met all study criteria, 42 (30%) had malignant lymph nodes. EBUS-FNA was more sensitive than TBNA, detecting 29 (69%) vs 15 (36%) malignant lymph nodes (P = .003). The combination of EUS-FNA and EBUS-FNA (EUS plus EBUS) had higher estimated sensitivity (93% [39/42]; 95% confidence interval, 81%-99%) and negative predictive value (97% [96/99]; 95% confidence interval, 91%-99%) compared with either method alone. EUS plus EBUS also had higher sensitivity and higher negative predictive value for detecting lymph nodes in any mediastinal location and for patients without lymph node enlargement on chest computed tomography. CONCLUSIONS These findings suggest that EBUS-FNA has higher sensitivity than TBNA and that EUS plus EBUS may allow near-complete minimally invasive mediastinal staging in patients with suspected lung cancer. These results require confirmation in other studies but suggest that EUS plus EBUS may be an alternative approach for mediastinal staging in patients with suspected lung cancer.
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Affiliation(s)
- Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida 32224, USA.
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10
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Abstract
SUMMARY Radiology has been abounding with technological advances since the chest film first became the mainstay in diagnosing thoracic disease, and yet the conventional chest examination has endured as a front-line tool. The ability to perceive structural alterations is facilitated by a solid foundation in anatomy, which should be easy to achieve in a practice environment in which CT has become so commonplace. Not only is knowledge of anatomic nuances important for analysis of conventional radiographs, but it can only be an asset as multiplanar imaging is increasingly utilized and new modalities are developed over time. Some fundamental anatomic variations are revisited here through correlating the perspective provided by the lateral radiograph with the equally common one provided by routine axial CT images.
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Affiliation(s)
- Barbara L McComb
- Department of Radiology, Mayo Clinic, Jacksonville, FL 32224, USA
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11
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Abstract
Pathology developing within the confines of the superior mediastinum may produce changes that appear quite subtle on conventional radiographs. The zone of contact of lung with the left superior mediastinum is represented radiographically as a series of interrelated pleural reflections. These reflections may be altered by mediastinal disease, and an understanding of this anatomy can facilitate detection of abnormalities.
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Affiliation(s)
- B L McComb
- Department of Radiology, Mayo Clinic, Jacksonville, FL 32224, USA
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12
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Odell JA, Alvarez S, Cvitkovich DG, Cortese DA, McComb BL. Multiple lung abscesses due to Ochroconis gallopavum, a dematiaceous fungus, in a nonimmunocompromised wood pulp worker. Chest 2000; 118:1503-5. [PMID: 11083712 DOI: 10.1378/chest.118.5.1503] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
An occurrence of multiple chronic lung abscesses managed by lobectomy is described. These abscesses were present for 13 years in the patient, a nonimmunocompromised wood pulp worker. The patient had hemoptysis at presentation. The organism isolated was Ochroconis gallopavum, a dematiaceous fungus known to cause disease in immunocompromised patients and epidemic encephalitis in poultry. The fungus is typically found in warm environments and in decaying compost; for this reason, we postulate that his illness was occupationally acquired.
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Affiliation(s)
- J A Odell
- Section of Cardiovascular/Thoracic Surgery, Mayo Clinic Jacksonville, FL 32224, USA
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13
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Goldberg BB, Steiner RM, Liu JB, Merton DA, Articolo G, Cohn JR, Gottlieb J, McComb BL, Spirn PW. US-assisted bronchoscopy with use of miniature transducer-containing catheters. Radiology 1994; 190:233-7. [PMID: 8259411 DOI: 10.1148/radiology.190.1.8259411] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To demonstrate the value of ultrasound (US) guidance during flexible bronchoscopic procedures in a series of patients with known or suspected pulmonary neoplasms. MATERIALS AND METHODS US-guided bronchoscopy was carried out as an adjunct to conventional bronchoscopy for the diagnosis of mediastinal, hilar, or parenchymal neoplasms in 25 patients with masses previously detected with chest radiography or computed tomography. Miniature transducer-containing catheters were inserted through the biopsy port of the flexible bronchoscope, and cross-sectional real-time US scans of tumors, lymph nodes, and blood vessels were obtained. RESULTS Among six cases of peripheral masses and 19 cases of central masses, additional information was provided in 18 cases (72%). This information was used to choose the optimal site for transmural biopsy. CONCLUSION These preliminary results suggest that this US procedure may become an important diagnostic tool during bronchoscopy, due to the ability to identify structures beyond the lumen of the tracheobronchial tree.
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Affiliation(s)
- B B Goldberg
- Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical School, Philadelphia, PA 19107
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14
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Israel HL, McComb BL. Chlorambucil treatment of sarcoidosis. Sarcoidosis 1991; 8:35-41. [PMID: 1669938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
1) PURPOSE: To demonstrate usefulness of chlorambucil in patients with severe sarcoidosis unresponsive to, or intolerant of, corticosteroids. 2) PATIENTS AND METHODS: Corticosteroid therapy was required in 192 (48%) of 401 patients with sarcoidosis seen at Thomas Jefferson University Hospital 1985-89. Chlorambucil was given to 31 of these patients because complicating diseases or problems made adequate corticosteroid dosage impossible (5 cases) or because of failure of corticosteroid in tolerable doses to control the disease (26 cases). 3) RESULTS: Marked improvement was observed in 15 cases, and moderate improvement in 13 others. Chlorambucil was well tolerated and complications attributable to immunosuppression did not occur. A six month course of chlorambucil was often followed by relapse, and prolonged therapy in reduced dosage appears necessary in most patients requiring this treatment. 4) CONCLUSION: Failure of corticosteroids in tolerable dosage to control sarcoidosis is not uncommon, and in such patients chlorambucil treatment is a useful alternative.
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Affiliation(s)
- H L Israel
- Department of Medicine, Jefferson Medical College, Philadelphia, PA 19107
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15
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Abstract
Calcification in bronchogenic carcinoma is rare. When found it is usually focal in nature and felt by many to be coincidental granulomatous disease. To our knowledge this case report is the first computerized tomography (CT) description of diffuse, amorphous calcification in bronchogenic carcinoma, specifically, small cell.
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Abstract
CT scans demonstrated a localized collection of gas adjacent to a normal sacroiliac joint in 5 patients. In each case the lesion was sharply demarcated by a thin sclerotic rim. A benign bone cyst was confirmed histologically in 2 cases. The radiologist should be aware of this appearance so as to avoid invasive procedures based on a misdiagnosis of infection or neoplasm.
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