Occult alveolar haemorrhage in pulmonary veno-occlusive disease

Pulmonary veno-occlusive disease (PVOD) is a rare cause of pulmonary arterial hypertension that affects predominantly post-capillary pulmonary vessels. A major concern with PVOD is the poor response to available therapies and the risk of pulmonary oedema with continuous intravenous epoprostenol. The present authors hypothesised that alveolar haemorrhage may be a characteristic feature of pulmonary veno-occlusive disease, as compared with other forms of pulmonary arterial hypertension that predominantly involve pre-capillary pulmonary arteries. This paper reports a series of 19 patients with either PVOD (n = 8) or idiopathic pulmonary arterial hypertension (IPAH; n = 11) who underwent bronchoalveolar lavage. Cytological analyses were performed and differential counts were made on Perls-stained preparations. The Golde score was used to assess alveolar haemorrhage. As compared with IPAH, PVOD was characterised by a higher percentage of haemosiderin-laden macrophages (40+/-37 versus 3+/-6%), resulting in elevated Golde scores (81+/-88 versus 4+/-10). It was concluded that occult alveolar haemorrhage is a common feature of pulmonary veno-occlusive disease. Detecting occult alveolar haemorrhage may be of interest in the diagnostic approach of pulmonary veno-occlusive disease.

[Pulmonary hypertension: CT findings in pulmonary veno-occlusive disease]

PURPOSE

To describe the CT findings of pulmonary veno-occlusive disease.

MATERIALS AND METHODS

Pre-therapeutic CT of 15 patients suffering from pulmonary veno-occlusive disease were retrospectively reviewed. Pathologic evaluation of pulmonary veno-occlusive disease was obtained after post mortem examination or pulmonary transplantation. CT protocol always included intravenous helical CT and high resolution CT.

RESULTS

The most frequent CT-findings in pulmonary veno-occlusive disease were the following: ground glass opacity with poorly defined nodular opacities (73%), septal lines (93%), and adenopathy (80%). Pericardial (60%) and pleural effusions (27%) were also noted. Other parenchymal findings were unusual.

CONCLUSION

HRCT must be systematically included in the initial CT evaluation of pulmonary hypertension. Combination of poorly defined nodular opacities, septal lines, and adenopathy are indicative of pulmonary veno-occlusive disease.

[Dosimetry comparison of pelvimetry methods using conventional radiographs and CT]

PURPOSE

To determine the fetal and maternal exposure to radiation by use of thermoluminescent dosimeters in order to compare conventional and CT-scan X-ray. Materials and methods. Dosimetry was performed with an anthropomorph phantom. Thermoluminescent dosimeters were positioned on the surface and in the depth of the phantom. Digital radiography of the pelvis was performed according to a standard technique. CT-scan of the pelvis was performed according to the Buthiau's technique.

RESULTS

With CT, the dose reached 0.31 to 4.95 mGy, with a dose of 2.32 mGy for the fetal gonads. With standard technique, the doses reached 0.03 to 0.39 mGy, with a dose of 0.39 mGy for the fetal gonads.

CONCLUSION

With CT the fetus and the mother were exposed to 1/10th of the total dose delivered using conventional X-rays and the dose distribution was more homogenous.

[Pulmonary embolization from migration of sclerotherapy material]

We present a case of pulmonary embolism which resulted from the migration of an oesophageal variceal sclerosing agent. Despite its frequency, this complication is rarely described in the literature.

Early changes in liver perfusion caused by occult metastases in rats: detection with quantitative CT

PURPOSE

To determine whether computed tomography (CT) can depict liver hemodynamic changes caused by occult hepatic micrometastases in rat.

MATERIALS AND METHODS

Liver micrometastases (mean diameter, 500 micrometer +/- 300) were produced in seven BD IX rats by injecting 10(7) DHDK12 PROb colorectal carcinoma cells into the spleen. Macrometastases (mean diameter, 7 mm +/- 3) were produced in four other rats. Five normal rats were studied as controls. CT images were obtained every 300 msec for 30 seconds during the injection of 1 mL per kilogram of body weight of contrast medium. The time-attenuation curves of the aorta, portal vein, and liver were used to calculate liver perfusion with a deconvolution model designed for the dual blood supply.

RESULTS

Micrometastases in an apparently normal liver caused a 34% decrease in portal blood flow and a 25% increase in the mean transit time for the blood to pass through the liver. These findings suggest increased resistance in the sinusoidal capillaries. Similar but greater changes were found in the macrometastases.

CONCLUSION

Occult liver micrometastases in rats generate changes in liver perfusion that can be detected with CT.

[3-dimensional computed tomography with model preparation before mandibular reconstruction]

Extended mandibular defects resulting from cancer resection are amenable to reconstruction with a free vascularized bone graft transplantation. Between 1992 and 1995, 12 patients were enrolled in a protocol including a preoperative 3D-CT used to develop a custom-made acrylic model of the mandible. Besides contributing to the assessment of tumor extension, 3D-CT helps determine the adequate limits of mandibular resection. 3D-CT has the advantage of providing the surgeon with a more familiar image of the mandible and the mandibular model, allowing better and quicker conformation of the bone flap. The graft can be shaped at the donor site before cutting its vascular pedicle, resulting in a shorter period of ischemia. This series demonstrated that preoperative mandibular modeling with 3D-CT helps improve functional and cosmetic results in mandibular reconstruction.