Localization of bronchopleural fistula using ventilation scintigraphy.

It can be difficult to localize or even lateralize the site of persistent bronchopleural fistula in patients who have undergone thoracotomy. If the site of persistent air leak can be identified noninvasively, it may be possible to repair the leak with thoracoscopic techniques and thereby avoid repeat thoracotomy. This article reports experience using 99mTc-DTPA ventilation scintigraphy to localize persistent bronchopleural fistulas in six patients. The site of bronchopleural fistula was identified in four patients. In the other two patients, no leak was identified, and the clinical course confirmed that a significant bronchopleural fistula did not exist.

Diagnosis of primary cardiac leiomyosarcoma by endomyocardial biopsy.

We report a case of a primary right ventricular leiomyosarcoma in a 58-year-old woman diagnosed by endomyocardial biopsy. Clinical findings included a 5-year history of atypical chest pain and atrial fibrillation as well as a 30-lb weight loss. A ventricular mass was identified by echocardiography and magnetic resonance imaging, and an endomyocardial biopsy was performed. Biopsy was guided by right ventriculography, which revealed a mobile mass in the cavity of the right ventricle. Light microscopy revealed a fasciculated, spindle cell sarcoma, most consistent with leiomyosarcoma, and immunohistochemical staining for muscle-specific actin was strongly positive in nearly all tumor cells, confirming its myogenous differentiation. Endomyocardial biopsy provided a definitive tissue diagnosis of this rare primary malignant cardiac neoplasm without the need for a surgical procedure.

Aging, stress, and affective disorders.

The interaction between aging, stress, and affective disorders has interested researchers for many years. Many stressful events occur as a part of aging. The majority of elderly people seem to tolerate this fairly well, but constant uncontrollable stress can lead to changes in the functioning of the hypothalamic-pituitary-adrenal axis. There are also age-related changes in the sensitivity of the hypothalamic-pituitary-adrenal axis, which have little clinical effect on healthy subjects, but may be more significant in the presence of an affective disorder. Stress is a more important predictor of depression in the elderly than are genetic factors. Attempts to minimize stress and the stress response in the elderly may improve treatments of affective disorders in this population.

MR features of arrhythmogenic right ventricular dysplasia.

Arrhythmogenic right ventricular dysplasia is defined as a primary disorder of the right ventricle characterized by partial or total replacement of muscle by adipose or fibrous tissue. Its diagnosis currently rests on techniques that accurately identify specific anatomic and functional abnormalities of the right ventricle. To date, none of these methods (except for autopsy) are specific for right ventricular dysplasia although angiography of the right ventricle is considered to be the current gold standard. MR imaging shows promise in clarifying the diagnosis of right ventricular dysplasia. This pictorial essay describes our current technique for examining the right ventricular myocardium in patients thought to have this disease and illustrates the spectrum of abnormalities encountered in these patients.

Coronary flow reserve: noninvasive measurement in humans with breath-hold velocity-encoded cine MR imaging.

PURPOSE: To measure coronary vasodilator reserve with breath-hold velocity-encoded cine magnetic resonance (MR) imaging. MATERIALS AND METHODS: Eight healthy adult volunteers underwent 1.5-T MR imaging. Velocity-encoded cine images were acquired at seven to 13 temporal phases in 25 seconds, with k-space segmentation and view-sharing reconstruction (+/- 1 m/sec velocity-encoding value) (repetition time msec/echo time msec = 16/9). Flow velocity in the left anterior descending (LAD) artery was measured twice before and twice after administration of dipyridamole (0.56 mg per kilogram of body weight). RESULTS: Peak diastolic coronary flow velocity in the LAD artery was 14.8 cm/sec +/- 1.9 (mean +/- standard deviation) in the baseline state. It increased significantly (P< .01) to 46.3 cm/sec +/- 10.2 after dipyridamole administration, with an average coronary reserve of 3.14 +/- 0.59. Interstudy and interobserver reproducibilities for measurement of peak diastolic velocity were, respectively, 9.5% +/- 1.6 and 7.0% +/- .2.5 in the baseline state and 6.8% +/- 2.2 and 3.4% +/- 1.5 after dipyridamole administration. CONCLUSION: Breath-hold velocity-encoded cine MR imaging provided reproducible assessment of coronary flow reserve in humans.