RESUMEN
A radiographic-pathologic correlation study of adult leukemia patients was conducted to determine the frequency and radiographic appearance of leukemic involvement and related complications within the chest. One hundred thirteen autopsy protocols were examined. Radiographic correlation was obtained in 60 of these cases. Autopsy pulmonary findings included hemorrhage in 74% of the cases, infectious infiltrates in 67%, edema or congestion in 57%, and leukemic infiltration in 26%. Only 5% of the chest radiographs were normal. Alveolar or interstitial abnormalities were identified in 90%, pleural effusion in 40%, and lymphadenopathy in 17%. Correlation demonstrated pulmonary infection to be by far the most common cause of radiographic opacity. Because of its frequent occurrence, high associated mortality, and potential reversibility, pneumonia must always be considered first in the differential diagnosis of radiographic opacity in these patients.
Asunto(s)
Leucemia/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Radiografía Torácica , Adulto , Anciano , Femenino , Humanos , Leucemia/complicaciones , Leucemia/patología , Enfermedades Pulmonares/patología , Enfermedades Linfáticas/diagnóstico por imagen , Enfermedades Linfáticas/patología , Masculino , Persona de Mediana Edad , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/patología , Neumonía/diagnóstico por imagen , Neumonía/patología , Edema Pulmonar/diagnóstico por imagen , Edema Pulmonar/patología , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/patología , Estudios RetrospectivosRESUMEN
Computed tomography (CT) has dramatically changed the imaging approach to the mediastinum. CT can depict precise cross-sectional mediastinal anatomic detail defining fat, water, and near muscle density tissues. Not only diagnosis but staging of some disease processes is now possible. The key to understanding the mediastinum is a sound knowledge of normal mediastinal anatomy and the potential disease processes which may affect the mediastinum. Normal CT mediastinal anatomy is illustrated and discussed. Pathological processes involving the thymus, lymphatics, endocrine systems, and great vessels are emphasized describing their clinical presentations, appearance, and the techniques of examination.
Asunto(s)
Enfermedades del Mediastino/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Aneurisma de la Aorta/diagnóstico por imagen , Tumor Carcinoide/diagnóstico por imagen , Enfermedades del Esófago/diagnóstico por imagen , Esófago/lesiones , Bocio Subesternal/diagnóstico por imagen , Humanos , Enfermedades Linfáticas/diagnóstico por imagen , Linfoma/diagnóstico por imagen , Neoplasias del Mediastino/diagnóstico por imagen , Mediastino/diagnóstico por imagen , Mediastino/lesiones , Glándulas Paratiroides/diagnóstico por imagen , Pericardio/diagnóstico por imagen , Rotura , Teratoma/diagnóstico por imagen , Hiperplasia del Timo/diagnóstico por imagen , Neoplasias del Timo/diagnóstico por imagenRESUMEN
Computed tomography (CT) of the neck has been primarily applied to the assessment of malignant disease with few reports describing its utility in benign conditions. The authors report 13 cases of cystic neck masses evaluated by CT. Pathological conditions included brachial cleft cyst, laryngocele, thyroglossal duct cyst, cavernous lymphangioma, necrotic lymphadenopathy, and asymmetric jugular veins. Computed tomography was helpful in correctly predicting the etiology by determining the exact location of these masses in relation to the normal anatomic structures in the neck.
Asunto(s)
Quistes/diagnóstico por imagen , Cuello/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Branquioma/diagnóstico por imagen , Niño , Preescolar , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Humanos , Venas Yugulares/diagnóstico por imagen , Enfermedades de la Laringe/diagnóstico por imagen , Linfangioma/diagnóstico por imagen , Metástasis Linfática , Masculino , Persona de Mediana Edad , Quiste Tirogloso/diagnóstico por imagenRESUMEN
Cystic hygromas of the neck can simulate other benign lesions and occasionally extend into the mediastinum. Using computed tomography, we were able to confirm the suspected diagnosis, exclude other diagnostic considerations, and clearly demonstrate absence of mediastinal extension.
Asunto(s)
Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Linfangioma/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Preescolar , Femenino , Humanos , Cuello/diagnóstico por imagenRESUMEN
Percutaneous transluminal angioplasty of stenotic lesions of the superior mesenteric artery was performed eight times in four patients with ischemic bowel syndrome. All patients were either poor surgical risks or had lesions not amenable to surgical correction. One patient also had angioplasty of a stenotic celiac artery. The four patients in this report have had more than 1 year of follow-up. All have had good results. Superior mesenteric artery angioplasty seems to be a nonsurgical alternative for the treatment of atherosclerotic mesenteric ischemia.
Asunto(s)
Angioplastia de Balón , Intestinos/irrigación sanguínea , Isquemia/terapia , Arterias Mesentéricas , Adulto , Angioplastia de Balón/instrumentación , Arteriosclerosis/terapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , SíndromeRESUMEN
Abdominal computed tomography was performed in six patients with suspected ruptured abdominal aortic aneurysm but in whom an alternate clinical diagnosis was seriously considered. In each patient, a large aortic aneurysm was demonstrated in association with a retroperitoneal accumulation of high-density blood. The retroperitoneal blood was primarily confined to the extracapsular perinephric space. In four of the six patients, a focal area of the aortic wall was indistinct on the side of the retroperitoneal hemorrhage at the presumed site of rupture. Five of the six patients underwent emergency surgery, which confirmed the site of aneurysm, presence of rupture, and the location of fresh retroperitoneal blood.
Asunto(s)
Rotura de la Aorta/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Rotura de la Aorta/cirugía , Diagnóstico Diferencial , Urgencias Médicas , Humanos , Riñón , Espacio RetroperitonealRESUMEN
Percutaneous transluminal angioplasty (PTA) was performed for nonhealing ulcers, severe claudication, or rest pain in 10 patients with diabetes mellitus. Twenty-two atherosclerotic lesions were dilated in 15 extremities, including 16 iliofemoral arteries and 6 superficial femoral arteries. The procedure was technically successful in all patients and 8 of 9 (89%) with clinical follow-up showed improvement clinically after the procedure. Diabetes is not a contraindication to PTA; rather this modality can be used effectively to control and treat peripheral vascular insufficiency in diabetic patients.
Asunto(s)
Angioplastia de Balón , Complicaciones de la Diabetes , Angiopatías Diabéticas/terapia , Anciano , Diabetes Mellitus Tipo 1/complicaciones , Femenino , Humanos , Claudicación Intermitente/etiología , Claudicación Intermitente/terapia , Masculino , Persona de Mediana Edad , Dolor/etiología , Manejo del Dolor , Úlcera Cutánea/etiología , Úlcera Cutánea/terapiaRESUMEN
A technique for performing antegrade pyelography during nephrotomy is described--puncture with a 21-gauge, 20-cm Cope needle, placement of a 0.018-inch SMG mandril "coat-hanger"-shaped guidewire, with the needle exchanged for a 3-French multi-sidehole dilator. Use of the 3-French dilator provides more security and less trauma to the renal pelvis; nephrotomy time is also curtailed. In 25 patients the technique was used successfully with 2 minor complications.
Asunto(s)
Riñón/diagnóstico por imagen , Nefrostomía Percutánea/métodos , Humanos , Litotricia , Radiografía , Cateterismo Urinario/métodosRESUMEN
Although the potential for splenic injury during left sided thoracentesis or percutaneous renal biopsy is well known, its occurrence has been rarely reported. In a 1 year period we used computed tomography to detect acute splenic, perisplenic, and intraperitoneal hemorrhage in three patients after percutaneous diagnostic and therapeutic procedures in the lower chest and upper abdomen. One patient was asymptomatic, the second developed left upper quadrant pain, and the third required emergency splenectomy.
Asunto(s)
Enfermedad Iatrogénica , Bazo/lesiones , Tomografía Computarizada por Rayos X , Adulto , Anciano , Biopsia/efectos adversos , Drenaje/efectos adversos , Femenino , Hemorragia/diagnóstico por imagen , Hemorragia/etiología , Humanos , Intubación/efectos adversos , Masculino , Persona de Mediana Edad , Enfermedades del Bazo/diagnóstico por imagen , Enfermedades del Bazo/etiologíaRESUMEN
The surgical treatment of renal calculi has been markedly changed by percutaneous manipulation and ultrasonic dissolution. The low morbidity and decreased cost of this procedure make it an obvious choice over classic surgical operations. We report our experience with percutaneous ultrasonic stone dissolution in 23 patients.
Asunto(s)
Terapia por Ultrasonido/instrumentación , Cálculos Urinarios/terapia , Adulto , Anciano , Endoscopios , Femenino , Humanos , Riñón , Masculino , Persona de Mediana EdadRESUMEN
Traditionally, thyroid imaging has been performed primarily using radionuclide scanning. High-resolution computed tomography (CT) was performed in 18 patients to evaluate the CT appearance of various thyroid abnormalities including diffuse toxic goiter, multinodular goiter, Hashimoto thyroiditis, thyroid adenoma, and malignant thyroid tumors. CT images of the thyroid were correlated with radionuclide scanning, surgical findings, and clinical and laboratory results. CT provided a complementary method for evaluation of the thyroid by defining the morphology of the thyroid gland and more precisely defining the anatomic extent of thyroid abnormalities in relation to the normal structures of the neck and mediastinum.
Asunto(s)
Enfermedades de la Tiroides/diagnóstico por imagen , Glándula Tiroides/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Femenino , Bocio/diagnóstico por imagen , Enfermedad de Graves/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Cintigrafía , Estudios Retrospectivos , Neoplasias de la Tiroides/diagnóstico por imagen , Tiroiditis Autoinmune/diagnóstico por imagenRESUMEN
Thirteen patients with benign angiomatous lesions of the extremities were evaluated by CT. The relationship of the lesion to specific muscle groups and fascial planes was defined better by CT than on plain radiography or angiography. Computed tomography without contrast enhancement demonstrated well circumscribed masses of lower attenuation value than the surrounding muscle. Eight of the 11 patients who received intravenous injection of contrast material showed characteristic punctate or curvilinear structures within the mass, which had attenuation values similar to normal blood vessels. The characteristic CT features of benign angiomatous lesions of the extremities are presented.
Asunto(s)
Extremidades/diagnóstico por imagen , Hemangioma/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Angiografía , Malformaciones Arteriovenosas/diagnóstico por imagen , Niño , Diatrizoato/administración & dosificación , Extremidades/irrigación sanguínea , Femenino , Hemangioma/patología , Hemangioma Cavernoso/diagnóstico por imagen , Humanos , Masculino , FlebografíaRESUMEN
Subcutaneous collateral veins were identified by computed tomography (CT) in 12 patients. These were seen as enhancing round or tubular structures surrounded by subcutaneous fat, and most were associated with occlusion of a major vein in the abdomen or thorax. The CT appearance of deep vein occlusions included an intraluminal thrombus with an enhancing rim, a mass replacing the nonvisualized vein and distortion of the vein by an adjacent mass. The subcutaneous fat was examined on the CT scans of 50 patients not suspected of having deep venous occlusions. The appearance of normal subcutaneous structures and the differential diagnosis are discussed.
Asunto(s)
Circulación Colateral , Tromboflebitis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Humanos , Estudios Retrospectivos , Tromboflebitis/fisiopatologíaRESUMEN
Paramediastinal masses adjacent to the aorta require a diagnostic evaluation to differentiate between tumor and aneurysm. It has been suggested that neoplasm may enhance sufficiently to be confused with a vascular structure or that a clot filled aneurysm may simulate a neoplasm by not filling with contrast medium. Five patients, two with thoracic aneurysms, two with malignancy, and one with a malignancy and an aortic dissection, are presented in whom bolus injection computed tomography (CT) was able to distinguish between aneurysm and mass. The CT examination also accurately visualized the point of communication of the aneurysm with the aorta, defined the relationship of the aneurysm to vital mediastinal structures for planning surgical resection, and helped plan the approach for percutaneous transthoracic needle aspiration when tumor was suspected. Bolus injection CT represents a rational alternative to aortography for mediastinal paraaortic masses.
Asunto(s)
Aneurisma de la Aorta/diagnóstico por imagen , Carcinoma de Células Pequeñas/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Aorta Torácica/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Mediastino/diagnóstico por imagen , Persona de Mediana Edad , Radiografía Torácica , Tomografía Computarizada por Rayos X/métodosRESUMEN
Computed tomography (CT) has a reported accuracy of 45%-97% in assessment of patency of coronary artery bypass grafts. Dynamic CT was done in 26 patients (47 grafts) with recurrent cardiac symptoms after graft surgery. Although CT was 79% accurate (with selective angiography as the standard), the authors do not believe that it provides sufficient information for the assessment of symptomatic patients. Four patients had high-grade stenoses in their grafts, and 50% of patients had significant progression of atherosclerosis in their native coronary arteries. Neither of these conditions could be detected by CT. The clinical contribution of CT will probably be greatest for routine screening of asymptomatic patients soon after operation. Technical problems with CT scanning for graft patency are discussed.
Asunto(s)
Angiografía Coronaria , Puente de Arteria Coronaria , Tomografía Computarizada por Rayos X , Angiografía , Enfermedad Coronaria/diagnóstico por imagen , Vasos Coronarios/cirugía , Estudios de Evaluación como Asunto , Estudios de Seguimiento , Humanos , Tecnología RadiológicaRESUMEN
Susceptibility testing of Mycobacterium tuberculosis is seriously limited by the time required to obtain results. We show that susceptibility testing of clinical isolates of M. tuberculosis can be accomplished rapidly with acceptable accuracy by using flow cytometry. The susceptibilities of 35 clinical isolates of M. tuberculosis to various concentrations of isoniazid, rifampin, and ethambutol were tested by the agar proportion method and by flow cytometry. Agreement between the results from the two methods was 95, 92, and 83% for isoniazid, ethambutol, and rifampin, respectively. Only 11 discrepancies were detected among 155 total tests. The results of flow cytometric susceptibility tests were available within 24 h of inoculation of drug-containing medium, while the proportion method required 3 weeks to complete. The flow cytometric method is also simple to perform.
Asunto(s)
Antituberculosos/farmacología , Etambutol/farmacología , Citometría de Flujo , Pruebas de Sensibilidad Microbiana/métodos , Mycobacterium tuberculosis/efectos de los fármacos , Agar , Antibióticos Antituberculosos/farmacología , Fluoresceínas/metabolismo , Humanos , Isoniazida/farmacología , Mycobacterium tuberculosis/aislamiento & purificación , Reproducibilidad de los Resultados , Rifampin/farmacologíaRESUMEN
We showed previously that susceptibility testing for Mycobacterium tuberculosis labeled with fluorescein diacetate could be accomplished rapidly by using flow cytometry. However, safety was a major concern because mycobacteria were not killed prior to flow cytometric analysis. In this study, we developed a biologically safe flow cytometric susceptibility test that depends on detection and enumeration of actively growing M. tuberculosis organisms in drug-free and antimycobacterial agent-containing medium. The susceptibilities of 17 clinical isolates of M. tuberculosis to ethambutol, isoniazid, and rifampin were tested by the agar proportion and flow cytometric methods. Subsequently, all flow cytometric susceptibility test samples were inactivated by exposure to paraformaldehyde before analysis with a flow cytometer. Agreement between the results from the two methods was 98%. In addition, the flow cytometric results were available 72 h after the initiation of testing. The flow cytometric susceptibility assay is safe, simple to perform, and more rapid than conventional test methods, such as the BACTEC system and the proportion method.
Asunto(s)
Antituberculosos/farmacología , Pruebas de Sensibilidad Microbiana/métodos , Mycobacterium tuberculosis/efectos de los fármacos , Citometría de Flujo/métodos , Pruebas de Sensibilidad Microbiana/normas , Control de Calidad , Seguridad , Factores de TiempoRESUMEN
Pulmonary angiography is sensitive and specific in the diagnosis of pulmonary thromboembolism, but it remains an invasive procedure. Experience with 1,350 pulmonary angiograms was reviewed to ascertain the incidence, etiologies, and avoidance of complications. There were three deaths, all of which were secondary to cor pulmonale in patients with pulmonary hypertension and right ventricular end diastolic pressure (RVEDP) equal to or greater than 20 mmHg. Other complications consisted of cardiac perforation in 14 patients and endocardial or myocardial injury in six without sequelae, 11 significant arrhythmias and five cardiac arrests successfully treated, minor contrast material reactions in 11 patients, and a few insignificant complications. Carefully performed pulmonary angiography is safe if one avoids injecting contrast material into a patient with an elevated RVEDP.
Asunto(s)
Angiografía/efectos adversos , Arteria Pulmonar , Tromboembolia/diagnóstico por imagen , Angiocardiografía/efectos adversos , Arritmias Cardíacas/etiología , Cateterismo Cardíaco/efectos adversos , Medios de Contraste/administración & dosificación , Medios de Contraste/efectos adversos , Diástole , Paro Cardíaco/etiología , Lesiones Cardíacas/etiología , Humanos , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/diagnóstico por imagen , Inyecciones Intraarteriales , Embolia Pulmonar/diagnóstico por imagen , Estudios RetrospectivosRESUMEN
Patients who have undergone surgery on the thoracic aorta and placement of a synthetic tubular graft need close, long-term radiological follow-up, as they are at risk of not only complications and progression of the underlying disease (atherosclerosis, dissection, or cystic medial necrosis) but also complications of the procedure, notably suture dehiscence leading to formation of an aneurysm around the graft. In a series of 14 asymptomatic postoperative patients studied by computed tomography (CT), the authors detected leakage of contrast material around the graft in 6 patients, 2 of whom required re-operation to correct suture dehiscence. CT is a noninvasive and sensitive method of postoperative evaluation of patients who have undergone an aortic graft.