Frequency and Severity of Pulmonary Hemorrhage in Patients Undergoing Percutaneous CT-guided Transthoracic Lung Biopsy: Single-Institution Experience of 1175 Cases.

Purpose: To evaluate the frequency and severity of pulmonary hemorrhage after transthoracic needle lung biopsy (TTLB) and assess possible factors associated with pulmonary hemorrhage.

Materials And Methods: This retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived.

Hypervascular mediastinal masses: action points for radiologists.

Hypervascular mediastinal masses are a distinct group of rare diseases that include a subset of benign and malignant entities. Characteristic features and known association with syndromes and genetic mutations assist in achieving a diagnosis. Imaging allows an understanding of the vascularity of the lesion and should alert the radiologist and clinician to potential hemorrhagic complications and avoid percutaneous CT guided biopsies.

Congenital lung disease in the adult: guide to the evaluation and management.

A high index of suspicion is required to consider the diagnosis of adult congenital lung disease because of the rarity of presentation in adulthood. The purpose of this article is to provide a framework for evaluation of these lesions and a guide to management. Adults may be asymptomatic, and the abnormality identified as an incidental imaging finding or the individual may present with symptoms of cough, hemoptysis, or recurrent pneumonia.

Cystic lung disease: achieving a radiologic diagnosis.

Diffuse cystic lung disease represents a diverse group of uncommon disorders with characteristic appearance on high resolution CT imaging. The combination of imaging appearance with clinical features and genetic testing where appropriate permits a confident and accurate diagnosis in the majority of the diseases without recourse for open lung biopsy. The mechanism of cyst development disease is unclear but in some disorders appears to be related to small airways obstruction.

Radiology of chest wall masses.

Objective: The purpose of this article is to highlight the role of radiography, CT, PET/CT, and MRI in the diagnosis and management of chest wall lesions. Chest wall masses are caused by a spectrum of clinical entities. The lesions highlighted in this selection of case scenarios include neoplastic, inflammatory, and vascular lesions.

FDG PET/CT patterns of treatment failure of malignant pleural mesothelioma: relationship to histologic type, treatment algorithm, and survival.

Purpose: This study investigated the diagnostic performance and prognostic value of fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in suspected malignant pleural mesothelioma (MPM) recurrence, in the context of patterns and intensity of FDG uptake, histologic type, and treatment algorithm.

Methods: Fifty patients with MPM underwent FDG PET/CT for restaging 11 ± 6 months after therapy. Tumor relapse was confirmed by histopathology, and by clinical evolution and subsequent imaging.

Contrast opacification using a reduced volume of iodinated contrast material and low peak kilovoltage in pulmonary CT angiography: Objective and subjective evaluation.

Objective: The purpose of our study was to evaluate whether a reduced volume of iodinated contrast material for pulmonary CT angiography (CTA) using a low peak kilovoltage (kVp) technique yields equivalent opacification in all vessels.

Materials And Methods: Four hundred fifty-two consecutive pulmonary CTA patients (265 women and 187 men; age range, 18-91 years; mean age, 56.2 years) were retrospectively evaluated.

The spectrum of Castleman's disease: mimics, radiologic pathologic correlation and role of imaging in patient management.

Castleman's disease (CD) is a rare benign lymphoid disorder with variable clinical course. The two principal histologic subtypes of CD are hyaline-vascular and plasma cell variants and the major clinicoradiological entities are unicentric and multicentric CD. Management of CD is tailored to clinicoradiologic subtype.

Vascular enhancement and image quality of MDCT pulmonary angiography in 400 cases: comparison of standard and low kilovoltage settings.

Objective: The purpose of this study was to investigate the vascular enhancement and image quality of pulmonary CT angiography performed with lower peak kilovoltage settings in a large patient sample.

Materials And Methods: This retrospective study was approved by our institutional review board, which waived the requirement for informed consent. Four hundred patients believed to have a pulmonary embolism were studied.

MR imaging of benign and malignant pleural disease.

MR imaging serves as a problem-solving tool in the diagnosis of inflammatory and infectious pleural diseases and primary and secondary pleural malignancies. Knowledge of MR imaging appearance of pleural diseases, including pleural effusions and empyema, benign and malignant pleural tumors, and especially mesothelioma, helps guide treatment decisions and surgical planning.

Routine pelvic and lower extremity CT venography in patients undergoing pulmonary CT angiography.

Objective: The purpose of our study was to assess the utility of performing routine pelvic and lower extremity CT venography (CTV) along with pulmonary CT angiography (CTA) in all patients evaluated for pulmonary embolism.

Materials And Methods: Eight hundred twenty-nine consecutive patients (281 men and 548 women) underwent CTA-CTV for pulmonary embolism. Reports were evaluated as follows: positive or negative for pulmonary embolism with or without deep venous thrombosis (DVT) or with nondiagnostic CTV.

HRCT findings of proximal interruption of the right pulmonary artery.

The purpose of this study is to present the characteristic HRCT findings of the lung parenchyma in patients with proximal interruption of the right main pulmonary artery. HRCT findings of proximal interruption of the right pulmonary artery demonstrated reticular opacities, septal thickening, subpleural consolidation, cystic lung changes, and pleural thickening in all 5 patients; bronchial dilation and bronchial wall thickening in 4 patients; and subpleural ground glass opacity (GGO) in 3 patients. The changes may be caused by absent pulmonary artery perfusion and development of systemic vessel collateralization.

Radiology in the intensive care unit (Part I).

The increasing complexity of the intensive care patient combined with the recent advances in imaging technology has generated a new perspective on intensive care radiology. The purpose of this 2-part review article is to describe the contribution of radiology to the management of these critically ill patients. The first article will discuss the impact of picture archiving and communication system (PACS) on critical care management and utility of the portable chest radiograph in the detection and evaluation of pulmonary disease with correlation to computed tomography (CT).

Radiology in the intensive care unit (part 2).

This review of intensive care unit (ICU) radiology has been divided into two sections. In Part 1, previously published, the discussion focused on the role of the portable radiograph in the evaluation of the critically ill patient and the impact of the introduction of digital radiography and picture-archiving communications systems on patient care. Part 2 of this review will emphasize the role of computed tomography and the increasing contribution of image-guided interventional procedures in patient management.

CT manifestations of respiratory syncytial virus infection in lung transplant recipients.

Purpose: The purpose of our study was to evaluate CT findings during respiratory syncytial virus (RSV) infection in lung transplant recipients and to identify sequelae.

Method: Thirty-nine CT scans prior to, during, and following acute infection in 10 lung transplant recipients were reviewed. Abnormalities that were new from baseline observations and occurred within 4 weeks of diagnosis were defined as acute.

Mediastinal lymphadenopathy and hazy mediastinal fat: new CT findings of congestive heart failure.

Objective: We describe two new CT findings of congestive heart failure (CHF): enlarged mediastinal lymph nodes and hazy heterogeneous mediastinal fat.

Materials And Methods: Forty-six patients were retrospectively identified who had major and minor clinical signs of congestive heart failure and had undergone chest CT during their symptomatic period. Two radiologists reviewed the CT studies and by consensus documented the presence or absence of imaging findings of CHF, including interstitial abnormalities, vascular redistribution, axial thickening, pleural effusions, cardiac enlargement, and mediastinal abnormalities.

Acute pulmonary embolism: assessment of helical CT for diagnosis.

Purpose: To determine the sensitivity and specificity of helical computed tomography (CT) for the diagnosis of acute pulmonary embolism.

Materials And Methods: This prospective study included 47 patients who underwent pulmonary arteriography for evaluation for possible acute pulmonary embolism. Tailored helical CT and pulmonary arteriography were performed within 24 hours of each other.

Routine addition of an automated biopsy device to fine-needle aspiration of the lung: a prospective assessment.

Objective: The purpose of this study was to prospectively assess the usefulness of the routine addition of an automated biopsy device (ABD) to fine-needle aspiration (FNA) of the lung and to examine the complication rate of this procedure.

Subjects And Methods: Fifty biopsies were performed under CT guidance using a coaxial technique with a 19-gauge introducer needle and a 22-gauge aspirating needle followed by a 20-gauge ABD. An average of 3.

Role of CT in the management of pneumothorax in patients with complex cystic lung disease.

The diagnosis and treatment of pneumothorax in patients with complex cystic lung disease may be difficult when relying on plain chest radiography alone. We report four cases in which management was greatly facilitated by the use of CT scanning of the chest.

Relationship between pulmonary artery diameter at computed tomography and pulmonary artery pressures at right-sided heart catheterization. Massachusetts General Hospital Lung Transplantation Program.

Rationale And Objectives: The purpose of the study was to determine the relationship between pulmonary artery (PA) size at computed tomography (CT) and PA pressures, to develop a noninvasive CT method of PA pressure measurement, and to determine a PA diameter that can enable differentiation of normal subjects from those with pulmonary hypertension.

Methods: PA vessel diameters in 55 candidates for lung and heart-lung transplantation were measured at CT and correlated with PA pressures with both linear and stepwise multiple regression. The multiple regression equations were then tested prospectively in 35 pretransplantation patients.

Preoperative predictors of operative morbidity and mortality in COPD patients undergoing bilateral lung volume reduction surgery.

Bilateral volume reduction surgery (VRS) improves lung function for selected patients with emphysema. However, predictors of outcome are not well defined. We reviewed the preoperative characteristics of the first 47 consecutive patients who underwent bilateral VRS at the Massachusetts General Hospital in order to define potential predictors of unacceptable outcome.

Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules.

Objective: The purpose of this study was to compare the diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of pulmonary nodules less than or equal to 1.5 cm in diameter with those of nodules greater than 1.5 cm in diameter.

Magnetic resonance scanning in cystic fibrosis: comparison with computed tomography.

Comparison has been made between two different spin-echo sequence MR scans and CT scans of the lungs in 17 patients with cystic fibrosis. Scans were assessed for bronchial dilation, bronchial wall thickening and mucus plugging. The resolution of MR does not, at present, compare with CT.