Faculty Bibliography

Intuitively, any technique that minimizes the effects of respiratory motion, eliminates misregistration between scans, minimizes intravenous contrast requirements, and allows high quality multiplanar and 3-D image reconstruction is likely to have a tremendous impact on conventional notions concerning routine thoracic CT. Helical scanning is already of proved efficacy for vascular and airway imaging as well as for identifying and characterizing pulmonary nodules. It may be anticipated that the indications for the use of helical imaging will continue to expand. Of particular interest is the ongoing development of reconstruction algorithms that allow high-quality images to be obtained with rapid table incrementation while simultaneously reducing radiation exposure. Given the intrinsically high contrast of structures within the thorax coupled with the disadvantages that result from respiratory motion, it is not unreasonable to conclude that within the near future volumetric techniques will be the standard for nearly all CT applications within the thorax

The precise roles of fiberoptic bronchoscopy (FOB) and computed tomography (CT) of the chest in the evaluation of patients presenting with hemoptysis have not been clearly defined. On the assumption that both procedures would likely provide unique and complementary information, a prospective study with blinded interpreters using a modified high-resolution CT technique (HRCT) and FOB was designed to evaluate 57 consecutive patients admitted to Bellevue Hospital with hemoptysis. Etiologies included bronchiectasis (25 percent), tuberculosis (16 percent), lung cancer (12 percent), aspergilloma (12 percent), and bronchitis (5 percent): in an additional 5 percent of cases, hemoptysis proved to be due miscellaneous causes, while in 19 percent hemoptysis proved to be cryptogenic. Patients with lung cancer all were at least 50 years old, smoked an average of 78 pack-years, and had less severe hemoptysis but of longer duration. All had conditions diagnosed both by HRCT and FOB. High-resolution CT proved of particular value in diagnosing bronchiectasis and aspergillomas, while FOB was diagnostic of bronchitis and mucosal lesions such as Kaposi's sarcoma. Fiberoptic bronchoscopy localized bleeding in only 51 percent of cases. The high sensitivity of CT in identifying both the intraluminal and extraluminal extent of central lung cancers in conjunction with its value in diagnosing bronchiectasis suggest that CT should be obtained prior to bronchoscopy in all patients presenting with hemoptysis

PURPOSE: The accessory cardiac bronchus is a rare congenital anomaly of the tracheobronchial tree that arises from the medial wall of the bronchus intermedius. This report documents the computed tomographic (CT) appearance of this anomaly. MATERIALS AND METHODS: Six patients with this anomaly were identified. All six underwent CT; three underwent correlative bronchoscopy, and one had both bronchoscopic and surgical confirmation. RESULTS: In all six cases, a distinct airway could be identified originating from the medial wall of the bronchus intermedius. Associated lung parenchymal tissue was identified in four cases, while in three cases a discrete soft-tissue mass was seen, presumably representing vascularized bronchial or vestigial parenchymal tissue. In two cases, the lumen of the airway was filled with debris. CONCLUSION: Recognition of this anomaly is important, as associated clinical complications, including recurrent episodes of both infection and hemoptysis, may be anticipated in a small percentage of patients

The role of computed tomography (CT) in the diagnosis of mediastinal tuberculous lymphadenitis was evaluated retrospectively in 25 human immunodeficiency virus (HIV)-infected patients (19 had AIDS). In all cases, the diagnosis of tuberculosis was established by mycobacterial culture and/or histologic evaluation. The most characteristic CT finding was the presence of low-density mediastinal and hilar lymph nodes in 16 of 19 (84 percent) patients with AIDS and four of six (67 percent) HIV-seropositive patients without AIDS. Marked enhancement of the periphery of nodes was identified in five cases, all in patients with documented AIDS. In most cases, lymphadenopathy proved to be massive, presenting as extensive, heterogenous soft-tissue lesions, presumably the result of coalescence of groups of matted nodes. We conclude that low-density mediastinal and/or hilar lymph nodes on CT, while not pathognomonic, is sufficiently characteristic for tuberculosis to warrant empiric antituberculosis therapy pending results of cultures

The occurrence of bronchiectasis has only rarely been noted among the protean manifestations of HIV infection in the lungs. We retrospectively identified bronchiectasis on CT scans in 12 HIV + and/or AIDS patients in the absence of either documented mycobacterial infection or a history of prior recurrent pyogenic infection. Pneumonitis was documented in 10 of 12 cases. In eight cases, bronchiectasis was associated with episodes of pyogenic infection; four of these patients also had documented opportunistic infections, including three cases of Pneumocystis carinii pneumonia (PCP). Two patients had infection due solely to PCP. In two cases, bronchiectasis was found in association with one case each of lymphocytic interstitial pneumonitis and nonspecific interstitial pneumonitis, respectively. Although the true incidence of bronchiectasis in this population remains to be established, in our experience bronchiectasis should be considered among the varied pulmonary manifestations of HIV infection. Furthermore, the seemingly rapid development and extent of bronchiectasis in this population suggest an accelerated form of the disease

CT is the imaging method of choice after standard chest radiography for examining patients with suspected bronchiectasis. In most institutions throughout the world, CT has largely eliminated the need for bronchography in the diagnosis of bronchiectasis. Nonetheless, controversy persists concerning the overall accuracy of CT. In an effort to improve overall diagnostic accuracy, we review the wide range of CT appearances of this protean disorder, and emphasize potential problems and technical pitfalls that may arise in routine clinical imaging

The normal range of postoperative imaging findings are described in 34 asymptomatic patients studied 5-66 months (mean, 28 months) after undergoing the continuous-suture graft-inclusion technique for repair of aortic aneurysms (n = 20) and dissections (n = 14) involving the ascending aorta. All 34 patients underwent magnetic resonance (MR) imaging, and 24 patients also underwent computed tomography (CT). Perigraft thickening was seen in 19 patients (56%) with MR imaging and in eight patients (33%) with CT. Flow outside the graft but contained within the native wrap was noted in five patients (15%) with MR imaging and in four patients (17%) with contrast material-enhanced CT. Thrombus was identified outside the graft and within the wrap in seven patients (21%) with MR imaging and in six patients (25%) with CT. Mass effect on the graft was depicted in four patients (12%) with MR imaging and in three patients (13%) with CT. Of the 14 patients who underwent repair of aortic dissections, an intimal flap was seen distal to the graft in seven of the 14 (50%) evaluated with MR imaging and in four of the 10 (40%) evaluated with contrast-enhanced CT. An accurate postoperative imaging evaluation requires precise knowledge of the surgical technique performed and its anatomic consequences