Accessory and Incomplete Lung Fissures: Clinical and Histopathologic Implications.

Objective: This article reviews the anatomy, histology, and disease processes of pulmonary fissures, with emphasis on clinical implications of accessory and incomplete fissures.

Conclusion: Accessory and incomplete pulmonary fissures are often overlooked during routine imaging but can have profound clinical importance. Knowledge of fissure anatomy could improve diagnostic accuracy and inform prognosis for oncologists, interventional pulmonologists, and thoracic surgeons.

Imaging pulmonary infection: classic signs and patterns.

Objective: The purposes of this article are to describe common and uncommon imaging signs and patterns of pulmonary infections and to discuss their underlying anatomic and pathophysiologic basis.

Conclusion: Imaging plays an integral role in the diagnosis and management of suspected pulmonary infections and may reveal useful signs on chest radiographs and CT scans. Detected early, these signs can often be used to predict the causative agent and pathophysiologic mechanism and possibly to optimize patient care.

What a differential a virus makes: a practical approach to thoracic imaging findings in the context of HIV infection--part 2, extrapulmonary findings, chronic lung disease, and immune reconstitution syndrome.

Objective: The Centers for Disease Control and Prevention reported more than one million people with HIV infection in the United States in 2006, an increase of 11% over 3 years. Worldwide, nearly 34 million people are infected with HIV. Pulmonary disease accounts for 30-40% of acute hospitalizations of HIV-seropositive patients, underscoring the importance of understanding the range of cardiothoracic imaging findings associated with HIV infection.

What a differential a virus makes: a practical approach to thoracic imaging findings in the context of HIV infection--part 1, pulmonary findings.

Objective: The Centers for Disease Control and Prevention reported more than one million people with HIV infection in the United States in 2006, an increase of 11% over 3 years. Worldwide, nearly 34 million people are infected with HIV. Pulmonary disease accounts for 30-40% of acute hospitalizations of HIV-infected patients, underscoring the importance of understanding the pulmonary manifestations in this population.

Progressive granulomatous pneumonitis in response to cosmetic subcutaneous silicone injections in a patient with HIV-1 infection: case report and review of the literature.

Silicone, commonly used in cosmetic procedures owing to its presumed inertness, can yield serious sequelae including acute embolization and pneumonitis. Chronic pulmonary sequelae in response to silicone injection have not been previously described. We report a case of chronic progressive granulomatous pneumonitis in response to subcutaneous silicone injections in a transgender male-to-female patient infected with human immunodeficiency virus 1 (HIV-1).

CT predictors of mortality in pathology confirmed ARDS.

Objectives: To identify CT findings that predict mortality in acute respiratory distress syndrome (ARDS) and to identify CT findings that differentiate diffuse alveolar damage (DAD) from DAD with prominent histopathological features of organizing pneumonia (DAD-OP).

Methods: Twenty-eight patients with ARDS (corroborated by open biopsy) and chest CT within 2 weeks of biopsy were included in our study. Differences in CT findings in patients with survivors versus nonsurvivors as well as for DAD versus DAD-OP were compared using Fisher's exact test.

The impact of an early-morning radiologist work shift on the timeliness of communicating urgent imaging findings on portable chest radiography.

Purpose: The aim of this study was to assess the potential impact of staggered radiologist work shifts on the timeliness of communicating urgent imaging findings that are detected on portable overnight chest radiography of hospitalized patients.

Methods: The authors conducted a retrospective study that compared the interval between the acquisition and communication of urgent findings on portable overnight critical care chest radiography detected by an early-morning shift for radiologists (3 am to 11 am) with historical experience with a standard daytime shift (8 am to 5 pm) in the detection and communication of urgent findings in a similar patient population a year earlier.

Results: During a 4-month period, 6,448 portable chest radiographic studies were interpreted on the early-morning radiologist shift.

Spatial heterogeneity of lung perfusion assessed with (13)N PET as a vascular biomarker in chronic obstructive pulmonary disease.

Unlabelled: Although it is known that structural and functional changes in the pulmonary vasculature and parenchyma occur in the progress of chronic obstructive pulmonary disease (COPD), information is limited on early regional perfusion (Q(r)) alterations.

Methods: We studied 6 patients with mild or moderate COPD and 9 healthy subjects (6 young and 3 age-matched). The PET (13)NN-labeled saline injection method was used to compute images of Q(r) and regional ventilation (V(r)).

Diffuse cellular and fibrosing interstitial pneumonitis with desquamative interstitial pneumonitis-like features associated with myeloid neoplasia.

Patients with preleukemic myeloid neoplasia can develop nonhematologic disease. Five patients with the myelodysplastic syndrome presented with interstitial lung disease that heralded acute leukemia in 3. Chest radiographs showed diffuse interstitial opacities, and the lung biopsies showed diffuse cellular interstitial and fibrosing pneumonitis with prominent alveolar filling by macrophages.

Comparative cost-effectiveness of voriconazole and amphotericin B in treatment of invasive pulmonary aspergillosis.

Purpose: The comparative cost-effectiveness of voriconazole and amphotericin B in the treatment of invasive pulmonary aspergillosis (IPA) was examined.

Methods: A decision-tree model was constructed comparing 12-week treatment outcomes in a subset of patients enrolled in a clinical trial comparing initial treatment of IPA with amphotericin B versus voriconazole. Patients included those with IPA who underwent a thoracic computed tomographic (CT) scan at baseline.

Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign.

Background: Computed tomography (CT) of the chest may be used to identify the halo sign, a macronodule surrounded by a perimeter of ground-glass opacity, which is an early sign of invasive pulmonary aspergillosis (IPA). This study analyzed chest CT findings at presentation from a large series of patients with IPA, to assess the prevalence of these imaging findings and to evaluate the clinical utility of the halo sign for early identification of this potentially life-threatening infection.

Methods: Baseline chest CT imaging findings from 235 patients with IPA who participated in a previously published study were systematically analyzed.

Treatment of invasive aspergillosis with posaconazole in patients who are refractory to or intolerant of conventional therapy: an externally controlled trial.

Background: Invasive aspergillosis is an important cause of morbidity and mortality in immunocompromised patients. Current treatments provide limited benefit. Posaconazole is an extended-spectrum triazole with in vitro and in vivo activity against Aspergillus species.

Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis.

Background: Voriconazole is a broad-spectrum triazole that is active against aspergillus species. We conducted a randomized trial to compare voriconazole with amphotericin B for primary therapy of invasive aspergillosis.

Methods: In this randomized, unblinded trial, patients received either intravenous voriconazole (two doses of 6 mg per kilogram of body weight on day 1, then 4 mg per kilogram twice daily for at least seven days) followed by 200 mg orally twice daily or intravenous amphotericin B deoxycholate (1 to 1.

Dual-energy digital subtraction chest radiography: technical considerations.

In the evaluation of asbestos-related pulmonary and pleural abnormalities, conventional chest radiography has been shown to have a low sensitivity for the detection of lung nodules and subtle interstitial disease. Pleural plaques may simulate pulmonary nodules, and interstitial processes can be masked by adjacent pleural abnormalities. Dual-energy digital subtraction chest radiography may enable investigators to characterize asbestos-related pulmonary and pleural abnormalities with greater accuracy.