Parietal pleural changes in empyema: appearances at CT.

The parietal pleura bordering pleural space collections was analyzed with computed tomography (CT) in 35 patients with thoracic empyema, 30 patients with malignant effusion, and 20 patients with transudatory effusion. Enhancement of the parietal pleura was present in 96% of the 25 patients with empyema who underwent contrast material-enhanced examinations. Of the 35 patients with empyema, 86% showed thickening of the parietal pleura, 60% showed thickening of the extrapleural subcostal tissues, and 35% showed increased attenuation of the extrapleural fat.

Idiopathic bronchiolitis obliterans organizing pneumonia with peripheral infiltrates on chest roentgenogram.

We report five patients with chest roentgenograms showing peripheral infiltrates similar to that described for chronic eosinophilic pneumonia (CEP). While lung biopsy specimens (transbronchial and open in two and transbronchial only in three cases) revealed typical changes of bronchiolitis obliterans organizing pneumonia (BOOP) as the predominant finding in all cases, two cases had changes consistent with a resolving CEP. We speculate that (1) it may be common for BOOP to present with peripheral infiltrates, (2) chest roentgenograms showing peripheral infiltrates are not diagnostic of any specific entity, (3) idiopathic BOOP may represent the evolution of untreated CEP, (4) a lung biopsy may be a more appropriate initial approach than the therapeutic trial of corticosteroids when peripheral infiltrates of unknown origin are present, and (5) transbronchial biopsy may be adequate to establish a working clinical diagnosis of BOOP.

Organ envelopment in lymphoma visualised by computed tomography.

In 12 patients computed tomography revealed an unusual pattern of lymphomatous growth resulting in envelopment or engulfment of an organ. The kidneys were involved in eight cases, and the mediastinum and pericardium, oesophagus, stomach and rectosigmoid colon, and psoas muscle in one case each. Ten patients had non-Hodgkin's lymphoma and two had Hodgkin's disease; in every case, lymphomatous masses surrounded but did not destroy the affected tissues.

Combination chemotherapy followed by radiation therapy in patients with regional stage III unresectable non-small cell lung cancer.

A chemotherapy combination of cyclophosphamide, doxorubicin, and cisplatin (CAP) was administered to 30 patients with stage III M0 or M1 (supraclavicular nodes) unresectable non-small cell lung cancer before and after radiotherapy. All patients had mediastinal metastases and most had T2 or T3 primary lesions. The response rate (complete plus partial) after two cycles of CAP was 47%, which increased to 66% (24% complete response rate) following radiotherapy.

The significance of the residual mediastinal mass in treated Hodgkin's disease.

The chest roentgenograms of 65 patients treated for Hodgkin's disease with mediastinal adenopathy were analyzed retrospectively to determine the incidence and significance of residual mediastinal abnormality after treatment. All patients were treated with radiation therapy, and 36 patients received additional chemotherapy. On completion of treatment, 57 (88%) of the 65 patients had some residual mediastinal abnormality.

The efficacy of routine whole lung tomography in germ cell tumors.

A prospective analysis was undertaken to evaluate the efficacy of performing routine whole lung tomography in addition to conventional chest radiography in the initial staging and subsequent management of 120 patients with seminomatous and nonseminomatous germ cell tumors. Two hundred fifty whole lung tomographs were performed on these patients. At presentation, only one patient (0.

Peri- and paracardial involvement in lymphoma: a radiographic study of 11 cases.

Eleven patients with pericardiac and paracardiac lymphomatous involvement were studied. Computed tomography (CT) of the chest was compared to plain chest films for its ability to define the sites and extent of involvement in the paracardiac area. Nine of the 11 patients had abnormalities on chest radiography, which included abnormal contours in the fat pad areas and along the heart border, or an enlarged cardiac silhouette.

Pulmonary complications of chemotherapy regimens containing bleomycin.

Twenty patients with pulmonary complications associated with combination chemotherapy regimens containing bleomycin were studied to determine common patterns of pulmonary radiographic abnormalities. All patients were receiving bleomycin on one of two different regimens of combination chemotherapy. Ten patients with non-Hodgkin lymphoma received a relatively low dose (22-64 mg total) and 10 patients with testicular cancer received a higher dose (360 mg total).

Pathologic patterns of Serratia marcescens pneumonia.

To characterize the pulmonary lesions caused by Serratia marcescens, the authors reviewed all autopsy-culture-proven cases of S. marcescens pneumonia occurring at their hospital between 1968 and mid-1980. In 16, S.

350 kV chest radiography has no diagnostic advantage: a comparison with 140 kV technique.

It has been suggested that a 350 kV technique will produce better chest radiographs than lower kilovoltage techniques. This is because the 350 kV x-ray spectrum provides better penetration of the overlying bony structures and results in a clearer delineation of the mediastinum. Fifty cases, containing 92 definite and significant abnormalities, were selected from a pool of 500 patients who had both 350 and 140 kV chest radiographs on the same day.

Exogenous lipoid pneumonia.

Eleven patients with exogenous lipoid pneumonia are reported. A history of usage of oil was obtained in all, but in five only retrospectively after thoracotomy. The clinical presentations ranged from occasional cough to severe respiratory difficulties.

Serratia pneumonia.

The clinical and radiological manifestations were correlated with the necropsy findings in the lungs of 18 patients who died of Serratia marcescens infection. Ten died during a hospital epidemic affecting 74 patients. In 14, only Serratia was identified at autopsy; in 4, other organisms were also cultured.

Visibility and sharpness of lung structure at 90, 140, and 350 kV.

Human lung specimens containing a variety of lesions were radiographed at 90, 140, and 350 kV. Nodules less than 3 mm in diameter and linear shadows less than 0.3 mm in diameter were either not visible or poorly seen at 350 kV.

Non-Hodgkin lymphoma of the lungs.

Twenty-seven consecutive cases of pulmonary involvement by non-Hodgkin in lymphoma, including 2 cases of primary pulmonary disease, were anlyzed. The radiological manifestations of illness were divided into (a) nodular (subpleural, deep parenchymal, or perihilar), (b) pneumonic-alveolar (segmental or lobar), (c) bronchovascular-lymphangitic (central bronchovascular or diffuse lymphangitic), and (d) miliary-hematogenous. Histiocytic lymphoma was associated with infiltration of rapid onset in 6, cavitating nodules in 2, and diffuse lymphangitic dissemination in 9.

Pulmonary actinomycosis. A report of three cases.

The diagnosis of thoracic actinomycosis is readily made when the patient presents with the constellation of poor oral hygiene, pulmonary infiltrates, empyema, sinus tracts, and osteomyelitis of the ribs. However, in the absence of rib and chest wall involvement, the disease may be overlooked. Three cases of primary pulmonary actinomycosis are presented showing three different pulmonary forms of the disease and comprising (a) subacute patchy pulmonary infiltrates, (b) a cavitary lesion simulating tuberculosis, and (c) a central mass lesion simulating bronchogenic carcinoma.

The pulmonary-renal syndrome.

The pulmonary-renal syndrome is characterized by the coexistence of life-threatening pulmonary hemorrhage and renal disease in individuals without any concomitant destructive pulmonary disease or coagulopathy. Six patients fulfilled the above criteria despite diverse etiologies and pathomechanisms of disease. Two patients showed evidence of anti-glomerular basement membrane antibodies, while three others showed immune complexes in their kidneys.

Giant hyperplastic parathyroid gland in the mediastinum--partially cystic and calcified.

A large, calcified paratracheal mass was identified in a patient with secondary hyperparathyroidism. The mass proved to be a giant, calcified, cystic, hyperplastic parathyroid gland. Radiographic and ultrasonic imaging techniques were quite useful in diagnostic evaluation.

"Mediterranean abdominal lymphoma" or immunoproliferative small intestinal disease. Part II: pathological aspects.

The pathology of 25 cases of Mediterranean abdominal lymphoma, better designated as immunoproliferative small intestinal disease (IPSID), are reported from the American University of Beirut Hospital. The series includes nine cases with documented alpha heavy chain disease (alpha-HCD). The disease is characterized by the presence of a diffuse and compact bandlike lymphoplasmacytic infiltration of the proximal small intestinal mucosa.

Pulmonary nocardiosis.

Six cases of pulmonary nocardiosis are reported. All patients were compromised hosts treated with corticosteroids and/or immunosuppressive agents. The clinical presentations ranged from malaise to respiratory failure.