Faculty Bibliography

Twenty-four cases of pleural tuberculosis (20 active and 4 inactive) were studied with computed tomography (CT). In 14 patients with proved acute tuberculous pleurisy, CT improved diagnostic accuracy by demonstrating small areas of cavitation not apparent on the chest radiograph and by detecting or confirming lymphadenopathy. In 10 patients with chronic tuberculous pleural disease, CT differentiated active from inactive infection by detecting a collection of fluid within the pleural rind. In both groups, CT also demonstrated complications such as bronchopleural fistula and involvement of the chest wall. CT can be beneficial in such cases because of its ability to show the pleural surfaces in transverse section, discriminate parenchymal from pleural disease, and quantify tissue density

The computed tomographic appearance of collapse without endobronchial obstruction is reviewed. These 57 cases were classified by the etiology of collapse. The largest group consisted of 29 patients with passive atelectasis, i.e., collapse secondary to fluid, air, or both in the pleural space. Twenty-three of 29 proved secondary to malignant pleural disease. Computed tomography accurately predicted a malignant etiology in 22 of 23 cases. The second largest group of patients had lobar collapse secondary to cicatrization from chronic inflammation. In all cases the underlying etiology was tuberculosis. Radiation caused adhesive atelectasis in six patients secondary to a lack of production of surfactant. In each case a sharp line of demarcation could be defined between normal and abnormal collapsed pulmonary parenchyma. Three cases of unchecked tumor growth caused a peripheral form of collapse (replacement atelectasis). This form of collapse was characterized by an absence of endobronchial obstruction and extensive tumor not delineated by the normal boundaries of the pulmonary lobes

The computed tomographic (CT) appearance of lobar collapse has yet to be defined. In an attempt to determine the characteristic appearance of collapse 95 cases were reviewed retrospectively in a wide variety of clinical settings over a 3 year period ending January 1983. In this report 38 cases of lobar collapse secondary to endobronchial occlusion are analyzed; the appearance of collapse without endobronchial obstruction forms the basis of a subsequent report. Computed tomography was accurate in determining the site of bronchial occlusion in all cases. In 36 of 38 cases collapse was caused by endobronchial tumors, including bronchogenic carcinoma, bronchial carcinoids, endobronchial metastases, and lymphoma. Differentiation between these tumors was not feasible with CT. Most cases of collapse were caused by central tumor. In those cases in which a bolus of contrast material was used differentiation between tumor mass and collapsed pulmonary parenchyma was possible. Two of 38 cases were found to have benign bronchial occlusion. In one case a mucous plug obstructing the left lower lobe bronchus was accurately defined. In another case a bronchial stricture occluded the right lower lobe bronchus. This represented the only false positive case in this series. It is concluded that CT is an accurate means for establishing the diagnosis of endobronchial obstruction. In most cases the diagnosis of neoplasia was possible, provided a bolus of contrast material was used to define tumor mass. The potential role of CT in evaluating patients with lobar collapse is discussed

Computed tomography (CT) was used to evaluate nine patients with bronchial adenomas: five carcinoid tumors and four adenoid-cystic carcinomas. Seven patients with lesions of the trachea or proximal bronchi presented with wheezing, hemoptysis, or obstructive pneumonitis. In such cases CT was effective in displaying the total extent of infiltrating lesions including the extraluminal component. The cases of adenoid-cystic carcinoma of the bronchi demonstrated extraluminal spread in a pattern indistinguishable from bronchogenic carcinoma. In one patient, CT demonstrated an exclusively endobronchial carcinoid tumor, and conservative resection was planned and accomplished. In two cases of carcinoid tumors that presented as solitary pulmonary nodules adjacent to bronchi in the midlung zone, CT served as a road map for the bronchoscopist. Computed tomography has been employed in the post-operative patient to evaluate for possible recurrence.

Computed tomography (CT) was performed on six patients with bronchiectasis. In two cases of advanced cystic bronchiectasis, the diagnosis was apparent on plain chest roentgenograms. In four cases, bronciectasis was initially diagnosed by CT and later confirmed by bronchography. The CT signs of bronchiectasis include air--fluid levels in distended bronchi, a linear array or cluster of cysts, dilated bronchi in the periphery of the lung, and bronchial wall thickening due to peribronchial fibrosis. Distended bronchi must be distinguished from emphysematous blebs, which generally have no definable wall thickness and no accompanying vessels. It is concluded that CT should have a role in establishing the presence and anatomic extent of bronchiectasis.

Computed tomography (CT) of the abdomen was performed on 46 patients who had undergone graft replacement of abdominal aortic aneurysms. Twelve postoperative complications were found in nine patients. They included hemorrhage, infection, anastomotic pseudoaneurysms, major vessel occlusion, postoperative pancreatitis, and others. The varied appearance of the normal postoperative graft is also presented. It is concluded that CT is a rapid, sensitive, and noninvasive method for detecting or excluding postoperative complications of abdominal aortic surgery

Thirty patients with lung involvement with Pneumocystis carinii and other opportunistic organisms, many of whom also had Kaposi sarcoma, were seen from December 1980 through March 1982. Clinical manifestations consisted of a prodrome of weeks to months with weight loss, fever, and malaise. When clinical pneumonia became apparent, four distinct radiographic patterns were identified. Pneumocystis carinii was uniformly present, and the most common pattern encountered was a relatively symmetric, homogeneous perihilar pneumonia that progressed to diffuse consolidation. Asymmetric and focal infiltrates were seen in patients who proved to have concomitant opportunistic infection, most commonly fungal in all but two cases. A third pattern of nodular and linear densities with or without adenopathy was seen in patients without pneumonia who had biopsy-positive Kaposi sarcoma involving the lung parenchyma. A fourth pattern represented a combination of any of the first three, and these patients had multiple infections as well as Kaposi sarcoma in the lung. Any significant change in the radiograph indicating progression of disease while on therapy prompted a rebiopsy, and in five of 10 patients other infections and/or Kaposi sarcoma were identified

This report presents a detailed analysis of normal cross-sectional hilar anatomy. Specially prepared cadavers injected with red and blue latex were utilized for correlation with 100 normal computed tomographic examinations. Thorough knowledge of the normal appearance of cross-sectional hilar anatomy is a prerequisite for recognizing abnormalities that affect the pulmonary hila.

Computed tomography can be used to evaluate abnormal pulmonary hila. A series of cases is presented that illustrate the appearance of dilated pulmonary arteries, absent pulmonary artery, hilar adenopathy, and hilar masses.

Computed tomography (CT) can be used to diagnose both inflammatory and neoplastic diseases that arise from or affect the bronchi. The clarity of anatomic detail that can be obtained with CT is demonstrated. This clarity of anatomic detail should be of use in those cases for which bronchoscopy, mediastinoscopy, or other staging procedures are planned. The overall usefulness of CT in patients with bronchial lesions has yet to be established.