Transthoracic needle biopsy of small pulmonary nodules.

PURPOSE: To evaluate the diagnostic accuracy, complications, and usefulness of transthoracic needle biopsy of small pulmonary nodules. MATERIALS AND METHODS: Between January 1993 and January 1995, 302 patients underwent transthoracic needle biopsy of pulmonary lesions. Sixty-four lesions (in 62 patients) represented small nodules, defined as lesions of 15 mm or less maximum diameter. A total of 75 biopsies were performed in the 64 lesions. Approximately 90% of the biopsies were performed with computed tomographic guidance. RESULTS: There were 21 benign lesions and 43 cancers (36 primary, seven metastatic). Transthoracic needle biopsy findings were positive for cancer in 40 cases. In all three false-negative lesions, only one biopsy was performed. There were 21 true-negative results and no false-positive results. Positive and negative predictive values were 100% and 88%, respectively. Pneumothorax occurred in 20 (27%) of 75 biopsies, but chest tube placement was necessary in only three cases (4%). Surgery or thoracoscopy was avoided in 31 patients: 17 of 20 patients with benign disease, seven patients with metastatic disease, and seven patients with inoperable lung cancer. CONCLUSION: Transthoracic needle biopsy of small pulmonary nodules can produce diagnostic yields comparable with published results of transthoracic needle biopsy of larger lesions.

Portal venous gas in a patient with Crohn's disease.

Portal venous gas usually occurs in the setting of an acute abdomen. Several causes for benign portal venous gas (PVG) have been reported. We describe the finding of PVG by computed tomography in a febrile patient with Crohn's disease and discuss the clinical implications of such a finding.

CT-guided fine needle aspiration of a periaortic collection.

Patients with infected aortic grafts suffer considerable morbidity and mortality. Therefore, it is important to make the diagnosis of infection to provide a reasonable chance for survival. Clinical signs of infection are usually apparent in the postoperative period. If absent, the diagnosis becomes more difficult. CT scanning is beneficial in detecting periaortic fluid and gas collections; however, it cannot differentiate postoperative gas from infection in all cases. This is especially true during the first 2 weeks after operation. CT-guided fine needle aspiration can provide a safe and reliable means to answer this clinical question.

Maternal exposure to environmental chemicals and the aetiology of teratogenesis.

Data on exposure of 10,879 pregnant women to various household and agricultural chemicals were obtained by interview; 6,267 of these women were seen both antenatally and postnatally, enabling a genuine prospective study of the association between chemical exposure and congenital abnormalities in the infant. The remaining 4,612 women were privately booked and were first seen postnatally. Statistical analysis of the 2 groups revealed a strong association of malformations with chemical exposure in both groups, even after other known risk factors were taken into account.

Maternal alcohol, tobacco and cannabis consumption and the outcome of pregnancy.

In a prospective study of 7,301 births, associations were sought between maternal alcohol, tobacco and cannabis use and several adverse outcomes of pregnancy. Apparent effects of alcohol use on prematurity, intrauterine growth retardation, congenital abnormalities and low Apgar score were consistent with previously reported work, but were not statistically significant. Infants born to smokers had lower birthweights and were more prone to intrauterine growth retardation, but they did not appear to have an increased risk of prematurity or perinatal death. Only 36 women reported using cannabis 2 or more times a week, not merely as smokers of marijuana but also as users of the more potent resin forms of cannabis. Subsequently 25% of these women gave birth to premature infants.

A prospective study of serial maternal serum zinc levels and pregnancy outcome.

A prospective study of 878 pregnant women in Adelaide, South Australia, examined the relationship of maternal serum zinc concentration to pregnancy outcome. Blood samples were obtained at weeks 18 and 32 of pregnancy, and from the umbilical cord. Additional detailed data were obtained, via standardised antenatal interview and review of clinical records, on antenatal care, personal, behavioural, and sociodemographic characteristics, and, subsequently, on delivery and neonatal assessment. Maternal mid-pregnancy zinc status was negatively correlated, although very weakly, with duration of gestation and with birthweight (including, in particular, the 18 recorded cases of intrauterine growth retardation). This finding accords with recent suggestions that, in non-experimental human studies in populations in which frank zinc deficiency is absent, maternal serum zinc level may be an outcome, rather than a determinant, of fetal growth later in pregnancy. Low mid-pregnancy zinc levels were associated with increased risk of intrapartum haemorrhage. In general, the greatest risk of having some complication or abnormality of delivery or neonatal functional status occurred in pregnant women who had both an initially below-average, and subsequently decreasing, serum zinc concentration. This corroborates other recent research. While it might be inferred that above-average fetal growth, by depressing maternal zinc status, could itself impair delivery and neonatal functioning, our data indicate that these effects operated independently.

Ct of congenital anomalies of the inferior vena cava.

The authors report six congenital abnormalities of the inferior vena cava detected on computed tomography (CT). The CT findings of one of these, the left inferior vena cava, have not been previously reported. The embryology of the inferior vena cava and the possible congenital abnormalities that can occur are discussed. Congenital abnormalities of the inferior vena cava are rare but potentially important to the radiologist, the surgeon, and the patient. They are easily identified on CT and should be considered when interpreting any CT of the abdomen or chest.

Left subclavian arteriography via the translumbar approach.

Selective left subclavian arteriography and thoracic aortography were performed via the translumbar approach. The resultant studies were technically and diagnostically satisfactory. This approach can be used when the femoral and axillary arteries are not available for vascular access.

Somnofluoroscopy.

In the past 30 years, numerous studies have increased our knowledge of the physical process of sleep. One sleep disorder, sleep apnea, has been studied and found to be a serious and life-threatening condition. Diagnosis of sleep disorders is very difficult and requires the use of sophisticated equipment, highly trained personnel, and a unique environment. To confirm the most dangerous form of sleep apnea, obstructive sleep apnea, fluoroscopic evaluation of the upper airway during sleep was performed. This fluoroscopic evaluation of the upper airway during sleep has been termed "somnofluoroscopy."

Percutaneous catheter biliary decompression.

Percutaneous catheter biliary decompression was performed in 42 patients with obstructive jaundice. Internal drainage was accomplished in 27 patients (64.3%), and external drainage in 15 patients (35.7%). Serum bilirubin levels decreased at a mean rate of 1.4 mg/dl/day. Tissue diagnosis was obtained by percutaneous aspiration biopsy in nine patients (21.4%). Complications occurred in 10 patients (23.8%): septic shock, two; bilious pleural effusion, one; hepatic subcapsular hematoma, one; sepsis, six. There was one death related to the procedure. The catheter management problems encountered included pain, catheter dislodgement or migration, lumen occlusion, and external bile leakage.

CT of malignant pleural mesothelioma.

Malignant pleural mesothelioma is a rare tumor. Although the chest film findings of pleural mesothelioma are well described, there are few descriptions of the findings of computed tomography (CT). This report describes the CT findings in five cases of pleural mesothelioma. In each case the CT showed an extensive, irregular, pleural-based mass surrounding the lung, spreading into the fissures, and extending into the mediastinum. In two cases there was also extension into the contralateral chest, and in one case each there was extension into the abdomen and chest wall. In each case the chest radiographs underestimated the extent of disease, when compared to CT. When an irregular, pleural-based mass involving most of the hemithorax is identified on CT, the diagnosis of mesothelioma can be suggested and at the same time the extent of the tumor may be evaluated. This is important because the diagnosis of mesothelioma is difficult and because treatment and prognosis may depend on the extent of the disease.

Acute arterial gastrointestinal hemorrhage: efficacy of transcatheter control.

Sixty-five sites of arterial gastrointestinal hemorrhage in 63 patients were managed with transcatheter therapy. Arterial vasopressin infusion was attempted primarily for all but three sites; embolization was used in these cases and in those for whom vasopressin infusion failed to control bleeding. The results obtained suggest that this regimen, that is, primary vasopressin infusion with embolization reserved for infusion failures or contraindications, is more effective for control of arterial gastrointestinal hemorrhage than the use of either method alone. The role of primary embolization for control of this type of bleeding may need reassessment.

Computed tomographic demonstration of cervical abscess and jugular vein thrombosis. A complication of intravenous drug abuse in the neck.

Cervical abscess and internal jugular vein thrombosis occurred in a 36-year-old man with a history of drug abuse. Computed tomography (CT) and angiography correctly identified the pathologic abnormalities that were surgically confirmed. We stress the use of CT in the evaluation of this condition.

Congenital anomalies in relation to the use of doxylamine/dicyclomine and other antenatal factors: an ongoing prospective study.

Recent publicity regarding possible teratogenic effects of the doxylamine/dicyclomine/pyridoxine combination (Debendox) has led to a degree of apprehension in women for whom the drug is prescribed, and in doctors who prescribe it. This study, based on an ongoing epidemiological surveillance programme, reports an analysis of the records of 1817 women for whom the drug was prescribed compared with 5771 non-users. The object of the study was to evaluate the outcome of pregnancy against exposure to the drug, taking into account the coexistent influences of other factors. Thorough statistical analysis disclosed no evidence of teratogenicity of the doxylamine/dicyclomine/pyridoxine overall, nor in relation to the skeletal or cardiovascular systems in particular. Two unexpected findings were an apparent moderate increase in genital tract abnormalities in users of this drug, and the possibility of a synergistic relationship between tobacco and this drug in early pregnancy, both aspects warranting further investigation.

Transcatheter embolization of hepatic arteriovenous fistulas for control of hemobilia.

Two cases of traumatic hemobilia are presented in which hemorrhage was controlled by transcatheter vascular occlusion with stainless steel coils. Embolic therapy was safely performed without liver necrosis, despite the presence of portal hypertension in 1 patient. The technique is a useful alternative to surgery, which did not control hemorrhage in 1 case.