Asunto(s)
Neoplasias Pélvicas/radioterapia , Pelvis/efectos de la radiación , Traumatismos por Radiación/diagnóstico por imagen , Neoplasias Urogenitales/radioterapia , Sistema Urogenital/efectos de la radiación , Adulto , Anciano , Braquiterapia , Femenino , Estudios de Seguimiento , Humanos , Aumento de la Imagen , Masculino , Persona de Mediana Edad , Pelvis/diagnóstico por imagen , Dosificación Radioterapéutica , Tomografía Computarizada por Rayos X , UrografíaRESUMEN
AIMS: The development of sarcomas is a recognized complication of radiation therapy. We set out to retrospectively review the clinical and therapeutic demographics, as well as the cross-sectional imaging findings in patients with post-radiation sarcomas. MATERIALS AND METHODS: Sixty-three patients with post-radiation sarcomas were identified at a single institution. Computed tomography and/or magnetic resonance imaging was available for all patients. The medical records were reviewed for the primary diagnoses, the radiation history, and the latency period to the development of the sarcoma. RESULTS: There were 43 women and 20 men with a mean age of 52.8 years. The mean radiation dose delivered was 50.1 Gy, with a mean latency period for the development of the sarcoma of 15.5 years. The most common primary diagnoses were breast cancer, lymphoma and head and neck cancer. The most common sarcoma histopathologies were osteosarcoma and malignant fibrous histiocytoma. The most common imaging findings were a soft tissue mass and bone destruction. CONCLUSIONS: Post-radiation sarcomas, while uncommon, are not rare. The imaging findings are not pathognomonic, but an appreciation of the expected latency period may help to suggest the diagnosis. Sheppard, D. G. and Libshitz, H. I. (2001). Clinical Radiology56, 22-29.
Asunto(s)
Neoplasias Inducidas por Radiación/diagnóstico , Neoplasias Primarias Secundarias/diagnóstico , Sarcoma/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias/radioterapia , Neoplasias Inducidas por Radiación/diagnóstico por imagen , Neoplasias Inducidas por Radiación/etiología , Neoplasias Primarias Secundarias/diagnóstico por imagen , Neoplasias Primarias Secundarias/etiología , Osteosarcoma/diagnóstico , Osteosarcoma/diagnóstico por imagen , Osteosarcoma/etiología , Radioterapia/efectos adversos , Estudios Retrospectivos , Sarcoma/diagnóstico por imagen , Sarcoma/etiología , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/etiología , Tomografía Computarizada por Rayos XRESUMEN
Mycobacterium kansasii was isolated from 25 patients with cancer who were cared for at the University of Texas M. D. Anderson Cancer Center (Houston) from January 1987 through December 1996. Two patients (8%) had disseminated disease, and 23 (92%) had pleuropulmonary isolates only. Signs and symptoms of mycobacterial infection at the time of diagnosis were often minimal or absent despite substantial radiographically evident involvement. The infections responded well to rifampin-based antimycobacterial regimens. M. kansasii is an infrequent but serious cause of pulmonary and, occasionally, disseminated disease in patients with cancer.
Asunto(s)
Infecciones por Mycobacterium no Tuberculosas/complicaciones , Mycobacterium kansasii/aislamiento & purificación , Neoplasias/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/microbiología , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Infecciones por Mycobacterium no Tuberculosas/microbiología , Estudios RetrospectivosRESUMEN
This study was carried out to define the post-treatment appearance of the chest radiographs in 44 consecutive patients with Hodgkin disease who received mantle irradiation with or without chemotherapy and to determine how the incidence and severity of post-treatment abnormalities relate to the radiation parameters and chemotherapeutic regimens. Radiographs of the chest in 44 patients, computed tomograms of the chest in 31 patients and of the abdomen of 35 patients were reviewed, prior to and following treatment, for mediastinal contours, pericardial status, cardiac size and pulmonary fibrosis. All patients were followed for a minimum of 1 year and 27 were followed for more than 5 years. Stable post-treatment imaging studies were correlated with the initial extent of disease, radiation parameters, and chemotherapeutic regimens. Stable post-treatment findings were categorised as follows: the chest radiograph was normal or showed subtle vascular reorientation; moderate paramediastinal fibrosis was present; severe pulmonary fibrosis had occurred with narrowing of the cardiomediastinal silhouette in some patients. In general, the severity of the fibrosis was dependent on (1) the size of the radiation fields and on whether or not the coverage of the hila included a 1- to 2-cm margin; (2) the amounts of chemotherapy and particularly bleomycin containing regimens and (3) individual susceptibility of normal tissue irradiation. Therapy for Hodgkin disease is not necessarily associated with radiographic sequelae regardless of the initial status of the mediastinum or the treatment. However, the post-treatment appearance of the chest radiographs in this study was related strongly to (1) the initial extent of disease and particularly the status of the hila, both of which influenced the amounts of lung parenchyma that were included in the treatment fields; (2) the use of bleomycin in chemotherapy regimens and (3) individual normal tissue radiosensitivity.
Asunto(s)
Enfermedad de Hodgkin/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Adolescente , Adulto , Bleomicina/efectos adversos , Bleomicina/uso terapéutico , Terapia Combinada , Femenino , Estudios de Seguimiento , Enfermedad de Hodgkin/clasificación , Enfermedad de Hodgkin/terapia , Humanos , Pulmón/patología , Masculino , Persona de Mediana Edad , Neumonitis por Radiación/diagnóstico por imagen , Radioterapia/efectos adversos , Tomografía Computarizada por Rayos XRESUMEN
Mycobacterium kansasii was isolated from 25 patients with cancer who were cared for at the University of Texas M. D. Anderson Cancer Center (Houston) from January 1987 through December 1996. Two patients (8%) had disseminated disease, and 23 (92%) had pleuropulmonary isolates only. Signs and symptoms of mycobacterial infection at the time of diagnosis were often minimal or absent despite substantial radiographically evident involvement. The infections responded well to rifampin-based antimycobacterial regimens. M. kansasii is an infrequent but serious cause of pulmonary and, occasionally, disseminated disease in patients with cancer.
Asunto(s)
Infecciones por Mycobacterium no Tuberculosas/complicaciones , Mycobacterium kansasii/aislamiento & purificación , Neoplasias/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/microbiología , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Infecciones por Mycobacterium no Tuberculosas/microbiología , Estudios RetrospectivosRESUMEN
AIM: The aim of this pictorial review is to illustrate the spectrum of manifestations on computed tomography (CT) of malignant pleural mesothelioma. Malignant pleural mesothelioma is the most common primary neoplasm of the pleura, but nevertheless is a rare tumour. It has a strong association with previous occupational exposure to asbestos and has a bleak prognosis. MATERIALS AND METHODS: The pre-treatment CT findings of 70 patients at our institution, and the subsequent findings of the 35 patients who had follow-up CT, have been reviewed by three observers by consensus. 16 patients had surgical resections. RESULTS: The most common pre-treatment findings were pleural thickening (94%) and pleural effusions (76%). Both contraction (27%) and enlargement (10%) of the ipsilateral hemithorax were identified. Extension of disease to the chest wall, mediastinum, thoracic lymph nodes, and below the diaphragm were identified. Concurrent bilateral pleural calcification and plaques indicative of previous asbestos exposure were identified in 16% of patients. CT failed to identify chest wall and mediastinal invasion in a number of patients who underwent surgical resections. CONCLUSION: CT plays an important role in the diagnosis, assessment, and evaluation of treatment response of this tumour, although it has some limitations in specific areas in evaluating patients for surgical resection.
Asunto(s)
Mesotelioma/diagnóstico por imagen , Neoplasias Pleurales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Femenino , Humanos , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/etiología , Masculino , Mesotelioma/complicaciones , Persona de Mediana Edad , Invasividad Neoplásica , Enfermedades Pleurales/diagnóstico por imagen , Neoplasias Pleurales/complicaciones , Estudios RetrospectivosRESUMEN
PURPOSE: To determine if filling in of radiation therapy-induced bronchiectatic change is a reliable computed tomographic (CT) sign of locally recurrent lung cancer. MATERIALS AND METHODS: The study included 28 patients who were free of disease and had stable radiation therapy-induced consolidation in ectatic bronchi at least 9 months after completion of radiation therapy for non-small cell lung cancer. Serial CT scans were retrospectively reviewed for evidence of local recurrence. RESULTS: Filling in of previously patent ectatic bronchi occurred in the 20 patients with recurrent disease. Filling in was the first sign of recurrence in six patients (30%), was seen concurrently with other evidence of local recurrence in 11 (55%), and was seen after the occurrence of other signs in three (15%). Eight patients with stable radiation-induced fibrosis and patent bronchi remained disease free. CONCLUSION: Filling in of radiation therapy-induced bronchiectatic change is a reliable CT sign of locally recurrent lung cancer.
Asunto(s)
Bronquiectasia/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/radioterapia , Recurrencia Local de Neoplasia/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Bronquiectasia/etiología , Carcinoma Broncogénico/diagnóstico por imagen , Carcinoma Broncogénico/radioterapia , Femenino , Humanos , Pulmón/efectos de la radiación , Masculino , Persona de Mediana EdadRESUMEN
Symptom control is the goal of palliative irradiation. Approximately 1 month is required before symptomatic relief is accomplished with radiotherapy. However, many patients with cancer-related pain do not receive adequate analgesics, and opioids are often not prescribed until patients fail to respond to palliative irradiation. The presenting symptoms of 108 patients who were referred to a multidisciplinary clinic for bone metastases were evaluated with the Wisconsin Brief Pain Inventory (BPI). This validated instrument evaluates the severity of pain using a 0-10 scale; 10 represents the worst pain imaginable. The population comprised 65 men (60%) and 43 women whose ages ranged from 33 years to 81 years; median age was 55 years, and 69% of patients were less than 65 years of age. Despite the presence of metastatic disease, 21% of patients were working full-time outside the home, and 6% were employed part-time outside the home; 13% were homemakers. Only 17 patients (16%) were unemployed. The time since diagnosis ranged from 2 weeks to 23 years; the median time since diagnosis was 22 months, and 30% of patients had been diagnosed with the past 6 months. Pain was a presenting symptom in 74% (N = 80) of patients at diagnosis. At its worst, the pain was rated as severe (levels 7-10) by 78% and intolerable (level 10) in 22% of the patients in the 24 hr prior to the clinic appointment. On average, the pain was rated moderate to severe (levels 4-10) in 79% and severe in 23% of patients. Only 45% of patients experienced good relief from the prescribed analgesics, and 23% of patients indicated that the prescribed analgesics were ineffective. This survey demonstrates that bone metastases incur significant pain that is often undertreated with analgesics before antineoplastic therapy is administered.
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Neoplasias Óseas/fisiopatología , Neoplasias Óseas/secundario , Servicio Ambulatorio en Hospital , Dolor Intratable/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Cuidados PaliativosRESUMEN
OBJECTIVE: The purpose of this article is to report the coexistence of rounded atelectasis with malignant pleural mesothelioma as revealed by radiography and CT. CONCLUSION: Our five cases show the coexistence of rounded atelectasis and malignant mesothelioma. If rounded atelectasis is associated with a pleural effusion, a pleural mass with or without chest-wall invasion, or thickened pleura not adjacent to the rounded atelectasis, malignant mesothelioma should be strongly considered.
Asunto(s)
Mesotelioma/complicaciones , Neoplasias Pleurales/complicaciones , Atelectasia Pulmonar/complicaciones , Anciano , Humanos , Masculino , Mesotelioma/diagnóstico por imagen , Persona de Mediana Edad , Derrame Pleural/complicaciones , Neoplasias Pleurales/diagnóstico por imagen , Atelectasia Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To provide further information about the presentation of thoracic involvement in Hodgkin disease and non-Hodgkin lymphoma and to compare chest radiography with chest CT findings. MATERIALS AND METHODS: We reviewed the chest radiographs and the CT images of 100 Hodgkin and 100 non-Hodgkin patients, all of them untreated. Our data were compared with those of literature series: the latest study comparing the different patterns of Hodgkin and non-Hodgkin disease appeared in 1976 and it compared chest radiography with conventional tomography, not with CT. RESULTS: Intrathoracic involvement (75% vs 48%) and adenopathy (74% vs 28%) were more frequent in Hodgkin than in non-Hodgkin lymphoma. Ninety-nine per cent of the patients with intrathoracic involvement (74/75) had nodal disease. Paratracheal/prevascular nodes were most frequently involved, namely in 72/74 Hodgkin (97%) and in 27/28 non-Hodgkin patients (96%). The lung parenchyma was more often involved in non-Hodgkin (24%) than in Hodgkin (8%) patients; it was associated with mediastinal/hilar adenopathy in all Hodgkin and in 10/24 (42%) non-Hodgkin cases. Parenchymal involvement was demonstrated with chest radiography in 7/8 Hodgkin (88%) and in 13/24 non-Hodgkin patients (54%). Chest radiography showed paratracheal/prevascular adenopathy more often in Hodgkin (54/72, 75%) than in non-Hodgkin (15/27, 56%) cases. Subcarinal and internal mammary adenopathy was poorly depicted with plain films, while hilar adenopathy was generally identified with both CT and chest radiography. Chest radiography usually missed posterior mediastinal and anterior diaphragmatic adenopathy. CONCLUSIONS: The differences in the presentation of Hodgkin vs non-Hodgkin disease are not sufficiently distinctive to permit radiographic differentiation of the two conditions, but some patterns are helpful. Recognizing the frequency of thoracic involvement and that of the additional CT findings in Hodgkin and non-Hodgkin patients makes a sound basis for lymphoma imaging.
Asunto(s)
Enfermedad de Hodgkin/diagnóstico por imagen , Linfoma no Hodgkin/diagnóstico por imagen , Neoplasias Torácicas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The demographics of tuberculosis (TB) and the therapy of malignancies have significantly changed since the last comprehensive review of TB in cancer patients. Fifty-six patients with both TB and malignancy were identified from January 1989 through December 1994 in a population of 61,931 newly registered cancer patients. The frequency of TB in cancer patients was 90 per 100,000. TB was more frequent in foreign-born patients (p < 0.001) and in racial and ethnic minorities (p < 0.001) than in non-Hispanic whites. TB developed during therapy in 48%. TB was discovered synchronously with the malignancy in 30% and in 21% occurred > or = 18 months after therapy. Pulmonary TB occurred in 50 (89%) patients and extrapulmonary TB in nine (16%) (three had both). Chest radiographic findings did not suggest TB in 20%. TB was less frequent in lung cancer (p < 0.001), head and neck cancer (p = 0.002), and solid hematologic malignancies (p < 0.001) than it had been historically, but the frequency was unchanged in acute leukemia patients (p = 0.46). TB in cancer patients occurs at a nine times greater than in the general population. It is now most frequent in leukemia patients.
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Neoplasias/complicaciones , Tuberculosis Pulmonar/epidemiología , Tuberculosis/epidemiología , Instituciones Oncológicas , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Radiografía , Tuberculosis/complicaciones , Tuberculosis/diagnóstico por imagen , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico por imagenRESUMEN
We reviewed spinal MR images of 58 patients with 98 compressed vertebrae. Benign (47 vertebrae) or malignant (51 vertebrae) etiology was established by biopsy or radiologic follow-up. Compressed vertebrae were analyzed for presence and characteristics of signal abnormality, altered vertebral contour, Schmorl's nodes, pedicular involvement, and contrast uptake. Statistical analysis was performed. Diffuse and homogeneous decrease in signal intensity on T1-weighted images, convex vertebral contour, involvement of the pedicles, and a lumbar location were more frequently observed in malignant fractures (P < .01). A thoracic location, lack of signal change, or a band-like abnormality and absence of pedicular involvement or contour abnormality characterized benign fractures (P < .01). Schmorl's nodes and enhancement did not help establish a diagnosis. When a constellation of MR criteria are applied, the accuracy of the diagnosis of malignant and benign vertebral compression fractures may reach 94%.
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Imagen por Resonancia Magnética , Enfermedades de la Columna Vertebral/diagnóstico , Fracturas de la Columna Vertebral/diagnóstico , Neoplasias de la Columna Vertebral/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Médula Ósea/patología , Medios de Contraste , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Fracturas Espontáneas/diagnóstico , Fracturas Espontáneas/etiología , Humanos , Aumento de la Imagen , Modelos Logísticos , Vértebras Lumbares/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Enfermedades de la Columna Vertebral/complicaciones , Fracturas de la Columna Vertebral/etiología , Neoplasias de la Columna Vertebral/complicaciones , Vértebras Torácicas/patologíaAsunto(s)
Plexo Braquial/patología , Imagen por Resonancia Magnética , Axila , Plexo Braquial/efectos de los fármacos , Plexo Braquial/efectos de la radiación , Humanos , Metástasis Linfática , Cuello , Neoplasias/terapia , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/etiología , Traumatismos por Radiación/patologíaAsunto(s)
Candidiasis/diagnóstico por imagen , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico por imagen , Adulto , Enfermedades Gastrointestinales/diagnóstico por imagen , Enfermedades Gastrointestinales/microbiología , Humanos , Lactante , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Radiografía , Infecciones Urinarias/diagnóstico por imagenRESUMEN
Radiotherapy causes changes in a treated malignancy and the surrounding normal tissue which must be included in the radiation fields. Awareness of the expected appearance of these changes frequently permits differentiation of them from superimposed infection, recurrent malignancy, radiation-induced tumors, and the other true complications of radiation therapy. Radiotherapy changes are a function of the tissue volume treated, field shape, total dose and how it was delivered, time from completion of therapy, and the possible effect of other therapies. Timing of radiation changes varies in the different organs. Acute radiation pneumonitis is generally seen approximately 2 months after completion of radiotherapy, but radiation pericarditis not until 6-9 months after therapy. Radiation-induced sarcomas do not develop on average until 10-15 years after radiation therapy. An overview of expected findings and complications in the lungs, heart, gastrointestinal tract, genitourinary tract, and bones is presented.
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Sistema Digestivo/efectos de la radiación , Corazón/efectos de la radiación , Pulmón/efectos de la radiación , Neoplasias Inducidas por Radiación , Sistema Urinario/efectos de la radiación , Niño , Humanos , Pericarditis/diagnóstico , Pericarditis/etiología , Neumonitis por Radiación/diagnóstico , Radioterapia/efectos adversosAsunto(s)
Neoplasias Inducidas por Radiación , Rabdomiosarcoma/etiología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Neoplasias de los Músculos/diagnóstico , Neoplasias de los Músculos/etiología , Músculo Esquelético/efectos de la radiación , Neoplasias Inducidas por Radiación/diagnóstico , Radioterapia/efectos adversos , Rabdomiosarcoma/diagnóstico , Neoplasias Testiculares/radioterapia , Factores de TiempoRESUMEN
BACKGROUND: Metastasis of bronchogenic carcinoma to axillary lymph nodes is rare. The pathways and possible significance of axillary lymph node metastasis from bronchogenic carcinoma were investigated. METHODS: Seventeen patients with probable axillary lymph node metastases from bronchogenic carcinoma were identified by computed tomography. There were 15 nonsmall cell lung cancers and 2 small cell lung cancers. Axillary lymph node metastasis was proven by biopsy in six cases. Metastases were presumed because of an increase in the size of axillary lymph nodes compared with prior studies in six patients and enlarged axillary lymph nodes associated with biopsy-proven ipsilateral supraclavicular lymph node metastasis in five patients. RESULTS: Four of 10 right-sided lung cancers had ipsilateral and six had contralateral axillary lymph node metastases. Six of seven left-sided cancers had ipsilateral and one had contralateral axillary lymph node metastases. Patients with ipsilateral lymph node disease had chest wall involvement and/or supraclavicular and mediastinal lymph node metastases. All seven patients with contralateral axillary lymph node metastases had supraclavicular and/or mediastinal lymph node metastases. CONCLUSION: Bronchogenic carcinoma may involve ipsilateral axillary lymph nodes via either chest wall invasion or retrograde spread from supraclavicular lymph nodes. Contralateral axillary lymph node involvement requires involvement of contralateral mediastinal and supraclavicular lymph nodes with retrograde spread to the axillary lymph nodes.