RESUMO
OBJECTIVE: To determine if sputum colonization with Aspergillus species in patients with cystic fibrosis (PWCF) correlates with radiological abnormalities and/or a reduction in pulmonary function (FEV1). METHODS: We prospectively evaluated 32 PWCF utilizing high resolution computed tomography (HRCT) of the thorax and pulmonary function testing (PFT). The cohort was assessed as two groups: Aspergillus positive (n=16) and Aspergillus negative (n=16) based on sputum culture for Aspergillus species. A modified Bhalla scoring system was applied to each HRCT scan by two blinded radiologists. RESULTS: Aspergillus positive patients had more severe and significant bronchiectasis compared to those Aspergillus negative (p<0.05). This was most marked in the right upper and lower lobes (RUL, RLL). Total Bhalla score was clinically significant in both groups and approached statistical significance between groups (p=0.063). No difference in pulmonary function between the groups was detected. CONCLUSION: PWCF colonized by Aspergillus species have greater radiological abnormalities undetectable by PFTs. Early radiological evaluation of Aspergillus colonized PWCF is therefore warranted.
Assuntos
Aspergilose/diagnóstico por imagem , Aspergilose/fisiopatologia , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/fisiopatologia , Fibrose Cística/diagnóstico por imagem , Fibrose Cística/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Bronquiectasia/microbiologia , Criança , Humanos , Estudos Prospectivos , Testes de Função Respiratória , Índice de Gravidade de Doença , Escarro/microbiologia , Estatísticas não Paramétricas , Adulto JovemRESUMO
The aim of this retrospective study was to investigate the use of thoracic Computed Tomography (CT) in the Emergency Department of a Dublin Academic Teaching Hospital over a six month period. Data was retrieved using the hospital's computerised information system. There were 202 referrals in total for thoracic CT from the Emergency Department during this time period. The most common indication for thoracic CT referral was for the investigation of pulmonary embolism with 127 (63%) referrals. There were 40 (25%) referrals for suspected malignancy and lung disease, whilst 8 (4%) of the referrals were for investigation of thoracic aortic dissection, 8 (4%) for infection, and 6 (3%) were for investigation of thoracic injury. Only 8 (4%) of all referrals were for investigation of injury as a result of chest trauma.
Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Irlanda , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Traumatismos Torácicos/diagnóstico por imagemRESUMO
Empyema and complicated pleural effusion represent common medical problems. Current treatment options are multiple. The purpose of this study was to access the outcome of image-guided, small-bore catheter drainage of empyema and effusion. We evaluated 93 small-bore catheters in 82 patients with pleural effusion (n = 30) or empyema (n = 52), over a 2-year period. Image guidance was with ultrasound (US; n = 56) and CT (n = 37). All patients were followed clinically, with catheter dwell times, catheter outcome, pleural fluid outcome, reinsertion rates, and need for urokinase or surgery recorded. Ninety-three small-bore chest drains (mean=10.2 Fr; range, 8.2-12.2 Fr) were inserted, with an average dwell time of 7.81 days for empyemas and 7.14 days for effusions (p > 0.05). Elective removal rates (73% empyema vs 86% effusions) and dislodgement rates (12% empyema vs 13% effusions) were similar for both groups. Eight percent of catheters became blocked and 17% necessitated reinsertion in empyemas, with no catheters blocked or requiring reinsertion in effusions (p < 0.05). Thirty-two patients (51%) required urokinase in the empyema group, versus 2 patients (6%) in the effusion group (p < 0.05). All treatment failures, requiring surgery, occurred in the empyema group (19%; n = 12; p < 0.05). In conclusion, noninfected pleural collections are adequately treated with small-bore catheters, however, empyemas have a failure rate of 19%. The threshold for using urokinase and larger-bore catheters should be low in empyema.
Assuntos
Cateterismo/métodos , Drenagem/métodos , Empiema Pleural/terapia , Derrame Pleural/terapia , Radiologia Intervencionista/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Screening with low dose chest computed tomographic scanning (LDCCT) may improve survival by identifying early asymptomatic lung cancer. METHODS: Four hundred and forty nine high risk subjects were screened with serial LDCCT scanning over 2 years. Fine needle aspiration biopsy was recommended for non-calcified nodules (NCNs) of >10 mm diameter or demonstrating interval growth. RESULTS: NCNs were identified in 111 subjects (24.7%), three of which were lung cancer. The overall prevalence (0.4%) and incidence (1.3%) rates of lung cancer detection were low. Three of the six lung cancers detected in the study were stage 1 non-small cell lung cancer; the remainder were unresectable central tumours. By contrast, eight subjects developed extrathoracic malignancy during the study period and other incidental pathology was noted in 221 subjects (49.2%). Smoking cessation rates at 19% were higher than in the general population, but 60.8% of subjects continued to smoke. CONCLUSION: LDCCT scanning is useful in detecting early peripheral non-small cell lung cancers but its usefulness as a screening tool is limited by low specificity and by poor sensitivity for central tumours.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Programas de Rastreamento/métodos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Biópsia por Agulha/métodos , Carcinoma Pulmonar de Células não Pequenas/patologia , Seguimentos , Humanos , Pulmão/patologia , Neoplasias Pulmonares/patologia , Pessoa de Meia-Idade , Abandono do Hábito de Fumar , Nódulo Pulmonar Solitário/patologiaRESUMO
BACKGROUND: Lung cancer is the most common cause of cancer related death in Ireland. The majority of lung cancers are inoperable at the time of diagnosis and consequently the overall 5 year survival is less than 10%. The objective of the ProActive Lung Cancer Detection (PALCAD) study was to evaluate whether low dose chest computed tomographic scanning (LDCCT) can detect early stage asymptomatic lung cancer in a high risk urban population. METHODS: Four hundred and forty nine subjects of median age 55 years (range 50-74) with a median pack year smoking history of 45 years (range 10-160), with no previous cancer history and medically fit to undergo thoracic surgery were recruited. After informed consent, LDCCT was performed on all subjects. Non-calcified nodules (NCNs) of >/=10 mm in diameter were referred for biopsy. Follow up with interval LDCCT at 6, 12 and 24 months to exclude growth was recommended for NCNs <10 mm in diameter. RESULTS: Six (1.3%) NCNs of >/=10 mm were detected of which one (0.23%) had non-small cell lung cancer stage 1; 145 NCNs of <10 mm were detected in 87 (19.4%) subjects. Mediastinal masses were detected in three subjects (0.7%)-one small cell lung cancer and two benign duplication cysts. Incidental pathology was noted in 276 patients (61.5%), most commonly emphysema and coronary artery calcification. CONCLUSION: The prevalence of resectable lung cancer detected by LDCCT at baseline screening was low at 0.23%, but there was a high rate of significant incidental pathology.
Assuntos
Neoplasias Pulmonares/prevenção & controle , Programas de Rastreamento/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Fatores de Risco , Saúde da População UrbanaRESUMO
BACKGROUND: Lung cancer is the most common cause of cancer-related death in Ireland. There are few complete data sets available as to the stage and cell type of lung cancers at time of presentation in Ireland. AIM: To audit the lung cancers presenting to a large Dublin teaching hospital over a 12-month period. METHOD: Prospective evaluation of all lung tumours presenting to our institution over a consecutive 12-month period. RESULTS: One hundred and ninety-eight lung cancers presented over the study period. There were 34 cases of small cell carcinoma and 150 cases of non-small cell carcinoma (NSCC). Fourteen patients were too ill or compromised at time of presentation for tissue confirmation. The most common cell type was squamous carcinoma. Eighty-four per cent of the NSCCs were either stage 3 or 4 at presentation. CONCLUSION: Most lung cancers present late in the time course of the disease. Distribution of cell type and location are similar in Ireland and other developed countries.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Pequenas/patologia , Neoplasias Pulmonares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Estudos ProspectivosRESUMO
OBJECTIVE: To investigate a potential association between cervical spine injury and first- and second-rib fractures. METHODS: Retrospective review of the radiologic and medical records of 28 consecutive patients admitted to an acute spinal injury unit. RESULTS: A total of 10 (36%) of the patients with cervical spine trauma also had fractures of either the first or second ribs. Eight of these 10 patients had a fracture or fracture-subluxation of the seventh cervical vertebra or the C6/7 segment. CONCLUSION: Almost one-third of patients with traumatic cervical spine injury have an associated upper-rib fracture. The strongest association is between injury at the C7 level and first-rib fracture.
Assuntos
Vértebras Cervicais/lesões , Fraturas das Costelas/complicações , Fraturas da Coluna Vertebral/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Fraturas das Costelas/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagemRESUMO
BACKGROUND: There is increasing support for the use of noninvasive positive pressure ventilation (NPPV) in the treatment of patients with acute respiratory failure. Highest success rates are recorded in patients with exacerbation of COPD, particularly in patients presenting primarily with hypercarbic respiratory failure. Success has been more limited in patients with acute hypoxemic respiratory failure, and there are few reports of NPPV in patients with acute lung injury (ALI) or ARDS. OBJECTIVES: We report the outcome of 12 episodes of ALI/ARDS in 10 patients treated with NPPV. DESIGN: Experiential cohort study. SETTING: Tertiary referral center and university hospital ICU. INTERVENTION: Provision of NPPV in patients with ALI/ARDS. RESULTS: Group median (range) APACHE (acute physiology and chronic health evaluation) II score was 16 (11 to 29). Success rate (avoidance of intubation and no further assisted ventilation for 72 h) was achieved on six of nine occasions (66%) when NPPV was used as the initial mode of assisted ventilation. It failed after three episodes of planned (1) or self (2) extubation. Duration of successful NPPV was 64.5 h (23.5 to 80.5 h) with ICU discharge in the next 24 to 48 h for three of six patients. Unsuccessful episodes lasted 7.3 h (0.1 to 116 h) with need for conventional ventilation for an additional 5 days (2.7 to 14 days). Survival (ICU and hospital) for the 10 patients was 70%. CONCLUSIONS: In a group of hemodynamically stable patients with severe ALI, NPPV had a high success rate. NPPV should be considered as a treatment option for patients in stable condition in the early phase of ALI/ARDS.
Assuntos
Lesão Pulmonar , Respiração com Pressão Positiva , Síndrome do Desconforto Respiratório/terapia , APACHE , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipóxia/etiologia , Hipóxia/terapia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Síndrome do Desconforto Respiratório/etiologiaAssuntos
Neoplasias Ósseas/diagnóstico , Imageamento por Ressonância Magnética , Osteossarcoma/diagnóstico , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Neoplasias Ósseas/diagnóstico por imagem , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteossarcoma/diagnóstico por imagemAssuntos
Candidatura a Emprego , Radiologia , Humanos , Internato e Residência , Radiologia/educaçãoRESUMO
Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults. This pictorial essay describes and illustrates the clinical, pathologic, and radiologic features of MFH. The cross-sectional imaging features on CT and MRI are emphasized in relation to the diagnosis and staging of MFH.
Assuntos
Histiocitoma Fibroso Benigno/diagnóstico , Imageamento por Ressonância Magnética , Neoplasias de Tecidos Moles/diagnóstico , Adulto , Terapia Combinada , Histiocitoma Fibroso Benigno/patologia , Histiocitoma Fibroso Benigno/terapia , Humanos , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/terapia , Tomografia Computadorizada por Raios XRESUMO
Radiation therapy has important applications in curative, adjuvant, and palliative therapy for a wide range of malignant conditions. Evidence of radiation therapy may be seen on radiologic images obtained subsequent to therapy. Bone growth disturbances may be observed in the immature axial or appendicular skeleton. Complications in the mature skeleton include osteoradionecrosis, pathologic fracture, and radiation-induced neoplasms. Radiologic features of mandibular osteoradionecrosis include ill-defined cortical destruction without sequestration. In osteoradionecrosis of the ribs, clavicle, scapula, and humerus, radiography may demonstrate osteopenia, disorganization and coarsening of trabecular architecture, and cortical irregularity; computed tomography more clearly depicts subtle fractures, alterations in bone architecture, and dystrophic soft-tissue calcification. In osteoradionecrosis of the spine, hematopoietic cellular elements of the spinal marrow are replaced with fat, which has high signal intensity on T1-weighted magnetic resonance images and intermediate signal intensity on T2-weighted images. Radiation-induced changes in the pelvis include osteopenia, increased bone density, and widening and irregularity of the sacroiliac joints. Radiation-induced osteochondromas are radiographically identical to those that arise spontaneously. Radiographic findings in radiation-induced sarcoma demonstrate an aggressive pattern of bone destruction. Awareness of the varied radiographic manifestations of radiation-induced changes in bone and correlation with clinical features and the radiation field will usually allow distinction of these changes from those associated with other pathologic conditions.
Assuntos
Doenças do Desenvolvimento Ósseo/diagnóstico , Neoplasias Ósseas/diagnóstico , Fraturas Espontâneas/diagnóstico , Neoplasias Induzidas por Radiação/diagnóstico , Osteorradionecrose/diagnóstico , Doenças do Desenvolvimento Ósseo/etiologia , Neoplasias Ósseas/etiologia , Feminino , Fraturas Espontâneas/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Radioterapia/efeitos adversos , Tomografia Computadorizada por Raios XRESUMO
Pulmonary complications are a major cause of morbidity and mortality in patients with AIDS. The aim of this pictorial essay is to familiarize radiologists with the CT appearances of the pulmonary complications of AIDS. These include a wide range of opportunistic infections, neoplastic conditions and lymphoproliferative disorders. Although this is by no means an exhaustive review of the subject, the conditions illustrated constitute the vast majority of pulmonary complications encountered in this setting.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Pneumopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico por imagem , Adulto , Feminino , Humanos , Pneumopatias/complicações , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Linfoma Relacionado a AIDS/diagnóstico por imagem , Masculino , Pessoa de Meia-IdadeRESUMO
Merkel cell carcinoma is a rare highly malignant tumour. There have been previous descriptions of the CT appearances of this tumour, but to our knowledge this is the first MRI description. MRI may be a more sensitive method of initial evaluation of the local extension of the primary tumour.
Assuntos
Músculos Abdominais , Carcinoma de Célula de Merkel/diagnóstico , Neoplasias Musculares/diagnóstico , Músculos Abdominais/patologia , Músculos Abdominais/cirurgia , Carcinoma de Célula de Merkel/patologia , Carcinoma de Célula de Merkel/cirurgia , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Musculares/patologia , Neoplasias Musculares/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Lesões por Radiação/diagnóstico por imagem , Radioterapia de Alta Energia/efeitos adversos , Doenças Torácicas/diagnóstico por imagem , Doenças Torácicas/etiologia , Neoplasias Torácicas/radioterapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/etiologia , RadiografiaRESUMO
Giant cell tumour of bone is a relatively common neoplasm with limited potential for metastatic spread. These tumours usually occur at the ends of bones with their epicentre in the epiphysis. This essay will review the various common and some of the less frequently encountered manifestations of giant cell tumours at multiple different sites, as well as postoperative recurrence. Different imaging modalities including plain film, tomography, computed tomography and magnetic resonance imaging are shown.