Radiation-induced telangiectasia in the brain simulates cryptic vascular malformations at MR imaging.

Purpose: To analyze the magnetic resonance (MR) imaging, clinical, and pathologic features of radiation-induced telangiectasia of the brain.

Materials And Methods: The clinical and radiation therapy records were reviewed of 20 patients who developed focal hypointense lesions on T2-weighted MR images obtained after radiation therapy of the central nervous system. Pathologic material was reviewed in six patients.

Lupus-related myelitis: serial MR findings.

Purpose: To correlate the MR findings in transverse myelitis secondary to systemic lupus erythematosus with clinical findings during disease exacerbation and remission.

Methods: Four patients (ages 33 to 47 years) with episodes of transverse myelitis secondary to systemic lupus erythematosus were identified. Three patients had recurrent transverse myelitis episodes (one patient with two recurrences), for a total of eight episodes.

Asbestos exposure in buildings.

Asbestos-related diseases are dose-related. Among these, asbestosis has occurred only with the heavy exposures of the past, is a disappearing disease, and is of no concern with the very small exposures from building occupancy. A possibly increased incidence of lung cancer has been included in risk analysis, but probably is also related to high exposure in that both epidemiologic and experimental data suggest a link between the process of alveolar inflammation and fibrogenesis and carcinogenesis.

Idiopathic pulmonary fibrosis in asbestos-exposed workers.

Diffuse interstitial lung disease in asbestos-exposed workers is presumed to represent asbestosis. Among 176 asbestos-exposed persons for whom lung tissue was available, we found nine with clinical features consistent with asbestosis, but histologic sections failed to demonstrate asbestos bodies, the usual requirement for pathologic diagnosis of asbestosis (Group I). These nine were compared by analytic electron microscopy with nine persons with idiopathic pulmonary fibrosis (Group II), and with nine persons with all the criteria of asbestosis (Group III).

Pulmonary fibrosis in aluminum oxide workers. Investigation of nine workers, with pathologic examination and microanalysis in three of them.

Epidemiologic surveys have indicated an excess of nonmalignant respiratory disease in workers exposed to aluminum oxide (Al2O3) during abrasives production. However, clinical, roentgenographic, histologic, and microanalytic description of these workers are lacking. This is a report of nine Al2O3-exposed workers with abnormal chest roentgenograms (profusion greater than or equal to 1/0, ILO/UC) from a plant engaged in the production of Al2O3 abrasives from alundum ore.

Multiple cystic fibrohistiocytic tumors of the lung: report of two cases.

We describe two adults with multiple cystic fibrohistiocytic tumors of the lung that manifested as bilateral nodular opacities, cystic lesions, or both on chest roentgenograms. One patient had recurrent episodes of pneumothorax and intermittent shortness of breath; the other was asymptomatic. Open-lung biopsy specimens showed identical histologically benign fibrohistiocytic proliferations associated with formation of cysts that were lined by metaplastic bronchiolar, squamous, or type II alveolar epithelium and old hemorrhage in the cysts.

Asbestos-associated diseases in a cohort of cigarette-filter workers.

To estimate the effects on health of occupational exposure to crocidolite, a highly toxic form of asbestos, we studied a cohort of 33 men who worked in 1953 in a Massachusetts factory that manufactured cigarette filters containing crocidolite fibers from 1951 to 1957. Twenty-eight of the men have died, as compared with 8.3 deaths expected.

Respiratory bronchiolitis-associated interstitial lung disease and its relationship to desquamative interstitial pneumonia.

Respiratory bronchiolitis is a mild inflammatory reaction commonly noted in asymptomatic cigarette smokers. We reviewed 18 cases of respiratory bronchiolitis-associated interstitial lung disease (RB/ILD), which had been diagnosed on the basis of clinical evaluation and open-lung biopsy. All patients were cigarette smokers.

Sonography in patients with suspected acute appendicitis: value in establishing alternative diagnoses.

We reviewed the clinical and sonographic findings in 297 patients who had graded compression sonography for suspected acute appendicitis. The purpose of the study was to determine the accuracy of sonography in detecting other diseases in the 174 patients in this group who proved not to have acute appendicitis. Of the 174 patients without acute appendicitis, 93 patients (53%) were ultimately discharged with a diagnosis of abdominal pain of unknown origin.

Chronic eosinophilic pneumonia. A report of 19 cases and a review of the literature.

Clinical, roentgenographic and pathologic findings in patients with chronic eosinophilic pneumonia, including 19 additional cases, have been reviewed and summarized. Most patients present with subacute respiratory and constitutional symptoms and have failed to respond to therapy for presumptive pneumonia. A previous history of atopy, most often asthma, will be obtained in one-half.

Gastrobronchial fistula: an unusual complication of Nissen fundoplication.

Gastrobronchial fistula is a rare complication of antireflux surgery. Presentation can be subacute, with only productive cough. Endoscopy often fails to visualize these fistulae.

Congenital bronchial atresia. A report of 4 cases and a review of the literature.

The clinical, radiographic, and pathologic findings in 82 patients with congenital bronchial atresia (CBA) have been reviewed, and we have discussed 4 additional cases. Most patients are asymptomatic and come to attention because of abnormal radiographic findings of a round or lobulated perihilar, solid, or cystic mass--the mucoid impaction sign. Typically, the region distal to the mass is hyperinflated.

Patient work-up for bullectomy.

A localized area of hypertransradiance often leads to surgical referral. Among 608 cases, 115 were due to local lesions of airways, blood vessels, or parenchyma. Among the remaining 493 with bullae from diffuse emphysema, 21% underwent surgery.

Thoracic surgical problems in asbestos-related disorders.

Among 1,577 persons with asbestos exposure followed up from 3 to 30 years, 113 had thoracic surgical procedures for asbestos-related disorders. Twenty-six individuals suspected of having asbestosis with atypical features underwent open-lung biopsy; a different disease was revealed in 14. Most of the 29 patients with mesothelioma had a small thoracotomy for diagnosis only; chemotherapy in half of them proved entirely ineffective.

Bronchiolitis obliterans organizing pneumonia.

In 50 of 94 patients with bronchiolitis obliterans we found no apparent cause or associated disease, and the bronchiolitis obliterans occurred with patchy organizing pneumonia. Histologic characteristics included polypoid masses of granulation tissue in lumens of small airways, alveolar ducts, and some alveoli. The fibrosis was uniform in age, suggesting that all repair had begun at the same time.

Pulmonary veno-occlusive disease in the middle-aged.

Pulmonary veno-occlusive disease (PVO) is an uncommon cause of pulmonary hypertension which is difficult to diagnose without histology. We report 3 cases of histologically confirmed PVO. Our patients were all middle-aged or older, and 1 had spontaneous improvement in his symptoms suggesting that PVO may occur more commonly among older adults than previously believed and that indolent forms of the disease may exist.

Diffuse pleural thickening in an asbestos-exposed population: prevalence and causes.

Two types of pleural reaction have been described in association with asbestos exposure: pleural plaques and diffuse pleural thickening. This study was undertaken to determine the prevalence and causes of diffuse thickening in asbestos-exposed persons. Serial chest radiographs in 1373 exposed individuals and 717 controls were interpreted according to the ILO scheme by two B readers.

Chronic diffuse infiltrative lung disease. Newer approaches.

A new scheme for description of diffuse infiltrative lung diseases using the graphic terminology of the International Labour Office Classification is described. Conventions for grading the type (rounded, or "pqr," and irregular, or "stu"), severity (profusion in 12 steps), localization of opacities, and pleural disease were retained. Modifications included (a) a third group of opacities, called "xyz," corresponding to reticulonodular patterns; and (b) "ground glass" (alveolar) patterns, subdivided into seven types by character and location.

Crackles in the early detection of asbestosis.

We studied 386 workers exposed to asbestos to assess the value of chest auscultation by a trained technician in detecting asbestosis as defined by previously reported clinical, physiologic, and roentgenologic criteria. The presence and degree of crackles were assessed at preselected basilar lung sites by a technician whose performance was validated by comparison with computer-generated time-expanded waveforms of tape recordings of lung sounds. Asbestosis was present in only 2.

Exercise alveolar-arterial oxygen pressure difference in interstitial lung disease.

Abnormality of gas exchange is best evaluated by the exercise alveolar-arterial oxygen pressure difference, P(A-a)O2. We studied the P(A-a)O2 in 168 patients with sarcoidosis, desquamative interstitial pneumonia (DIP), usual interstitial pneumonia (UIP), berylliosis, and asbestosis who were seen for clinical and disability consultations. The increase of P(A-a)O2 with exercise was greatest in UIP (mean 16 mm Hg), least in sarcoidosis (mean 1 mm Hg), and intermediate in DIP, berylliosis, and asbestosis (means 9, 9, and 7 mm Hg, respectively).

Diffuse infiltrative lung disease: a new scheme for description.

A scheme was devised for semiquantitative description of the diffuse infiltrative lung diseases using the graphic terminology of the International Labour Office and Union Internationale Contre le Cancer (ILO/UC) classification. Conventions for grading the type (rounded or "pqr" and irregular or "stu"), severity (profusion in 12 steps), localization of opacities, and pleural disease were retained. Modifications included: (a) a third group of opacities, called "xyz," corresponding to reticulonodular patterns; (b) "ground glass" (alveolar) patterns, subdivided into 7 types by character and location; (c) notations for severity of emphysema; and (d) hilar node enlargement.