Stanford Type A Acute Aortic Dissection with Left Extra-pleural Hematoma and Lung Hemorrhage / 日本心臓血管外科学会雑誌

A 68-year-old woman with a sudden onset of back pain was brought to our hospital by ambulance. Computed tomography (CT) showed Stanford type A (DeBakey type II) acute aortic dissection, left hemothorax, and hematoma extending along the pulmonary artery ; therefore, the patient underwent emergency operation. We performed a median sternotomy. Pericardial effusion was not observed ; however, a hematoma was found around the ascending aorta. Preoperative CT showed left hemothorax, but pleural effusion was not observed in the left pleural cavity. The left hemothorax, which was detected on preoperative CT, was diagnosed as an extrapleural hematoma. The dissection entry site was located at the proximal aortic arch ; therefore, ascending aorta-hemiarch replacement was performed. After weaning from cardiopulmonary bypass, the patient experienced sudden airway bleeding. The bleeding was attributed to the hematoma extending along the pulmonary artery. Here, we have reported a rare case of Stanford type A acute aortic dissection with the left extrapleural hematoma and lung hemorrhage.

Imaging Findings of Central Nervous System Vasculitis Associated with Goodpasture's Syndrome: a Case Report

Glomerulonephritis and pulmonary hemorrhage are features of Goodpasture's syndrome. Goodpasture's syndrome accompanied with central nervous system (CNS) vasculitis is extremely rare. Herein, we report a rare case of CNS vasculitis associated with Goodpasture's syndrome in a 34-year-old man, who presented with a seizure and sudden onset of right sided weakness. He also had recurrent hemoptysis of one month's duration. Goodpasture's syndrome is histologically diagnosed by intense linear deposits of IgG along the glomerular basement membrane in both renal and lung tissues.

Hemorragia pulmonar y síndrome de insuficiencia respiratoria aguda secundaria a golpe de calor / Pulmonary hemorrhage and acute respiratory distress syndrome secondary to heat stroke

El golpe de calor es una entidad poco frecuente y subdiagnosticada. Se presenta relativamente más en los estados del norte del país, al exponerse los migrantes a condiciones climáticas extremas. La elevacion de la temperatura corporal es la que dispara las disfunciones metabólicas que pueden incluso llevar a la muerte. Se presenta el caso de un migrante chiapaneco que fue encontrado en el desierto de Altar, Sonora en malas condiciones generales; fue traído al Servicio de urgencias del Hospital General del Estado en Hermosillo, Sonora. La evolución inicial fue tórpida, con deterioro de la función respiratoria, infiltrados pulmonares, necesidad de ventilación mecánica, datos de falla renal y cifras muy elevadas de creatinincinasa; se establecieron los diagnósticos de golpe de calor, insuficiencia renal, rabdomiólisis, hemorragia pulmonar y SIRA. Se le dio manejo de sostén con buena evolución, egresó al 21° día de estancia hospitalaria por resolución del problema. El caso nos recuerda que la exposición a condiciones de calor por arriba de la temperatura corporal, lo cual es muy frecuente en las áreas desérticas del norte del país, deteriora los mecanismos de control de calor corporal y metabólico. Es necesario un diagnóstico rápido y un manejo de sostén para conseguir una evolución satisfactoria.

Heat stroke is a rare and underdiagnosed entity, it is more frequently seen in the northern states of Mexico after exposure to high environmental temperatures that induce elevation of the body temperature, triggering metabolic derangements that can result in death. We present the case of a 24 year old immigrant from the southeast state of Chiapas found in the Desert of Altar, in the northern state of Sonora; he was semiconscious, dehydrated and in poor general condition after attempting to cross the desert in his way to the border with the USA. He was brought to our hospital with labored breathing, hemoptysis, lung infiltrates and progressive deterioration of his blood gases. He was intubated and mechanically ventilated; the initial course was characterized by increased CPK levels suggestive of rabdomyolisis, acute renal failure, disseminated intravascular coagulation, lung hemorrhage and acute respiratory distress syndrome secondary to the heat stroke. He spent 14 days in the ICU receiving 4 courses of hemodyalisis, ventilatory support, iv fluids, antibiotics and monitoring of his respiratory, renal, cardiovascular, neurologic and metabolic parameters. He was discharged 21 days after admission. Heat stroke prevention is mandatory by public education; early diagnosis should avoid the full-blown systemic derangements; adequate support can reverse an otherwise potentially fatal course.

The Value of Coronal Image Reconstructions of HRCT using MDCT for the Assessment of Bronchiectasis: Experiment with 64 MDCTs

PURPOSE: The aim of our study was to evaluate the value of coronal image reconstructions of HRCT with using 64 MDCT scans for the assessment of bronchiectasis. MATERIALS AND METHODS: Chest CT scans (0.6-mm collimation, table speed of 14 mm/sec and a rotation time of 0.5 sec) that employed 64 MDCT images (Somatom Sensation 64, Siemens) without contrast media were performed in 56 patients (21 males and 35 females, mean age: 55 years) who displayed hemoptysis. The images were reconstructed with a 1 mm slice thickness in the axial (10 mm apart) and coronal (10 mm apart) planes with using a high frequency algorithm, and they were sent to PACS monitors. The axial images were assessed with and without the coronal images by two radiologists at two separate occasions. The presence of bronchiectasis was decided upon by consensus diagnosis of the two radiologists. The detection rates of bronchiectasis were compared between the readings with using the axial images alone and the readings with using both the axial and coronal images. RESULTS: The detection rate of bronchiectasis was significantly higher with using both the axial and coronal images than with using with axial images alone (82.1%, 46/56 patients Vs 64.3%, 36/56 patients, respectively, p=0.001). The detection rates for all the lobes, except for the superior division of the left upper lobe, were significantly improved with using both the axial and coronal images (RUL; p=0.013, RML; p=0.002, RLL; 0.024, Lt lingular segment; p=0.004, LLL; p=0.018). CONCLUSION: The coronal images of HRCT with using 64 MDCT improved the detection rate of bronchiectasis in the patients with hemoptysis when they were used in conjunction with the standard axial images. We suggest that HRCT with the coronal images should be obtained for the patients with hemoptysis, despite that the simple chest radiographs are often normal or they have non-specific findings.

The Value of Coronal Image Reconstructions of HRCT using MDCT for the Assessment of Bronchiectasis: Experiment with 64 MDCTs

PURPOSE: The aim of our study was to evaluate the value of coronal image reconstructions of HRCT with using 64 MDCT scans for the assessment of bronchiectasis. MATERIALS AND METHODS: Chest CT scans (0.6-mm collimation, table speed of 14 mm/sec and a rotation time of 0.5 sec) that employed 64 MDCT images (Somatom Sensation 64, Siemens) without contrast media were performed in 56 patients (21 males and 35 females, mean age: 55 years) who displayed hemoptysis. The images were reconstructed with a 1 mm slice thickness in the axial (10 mm apart) and coronal (10 mm apart) planes with using a high frequency algorithm, and they were sent to PACS monitors. The axial images were assessed with and without the coronal images by two radiologists at two separate occasions. The presence of bronchiectasis was decided upon by consensus diagnosis of the two radiologists. The detection rates of bronchiectasis were compared between the readings with using the axial images alone and the readings with using both the axial and coronal images. RESULTS: The detection rate of bronchiectasis was significantly higher with using both the axial and coronal images than with using with axial images alone (82.1%, 46/56 patients Vs 64.3%, 36/56 patients, respectively, p=0.001). The detection rates for all the lobes, except for the superior division of the left upper lobe, were significantly improved with using both the axial and coronal images (RUL; p=0.013, RML; p=0.002, RLL; 0.024, Lt lingular segment; p=0.004, LLL; p=0.018). CONCLUSION: The coronal images of HRCT with using 64 MDCT improved the detection rate of bronchiectasis in the patients with hemoptysis when they were used in conjunction with the standard axial images. We suggest that HRCT with the coronal images should be obtained for the patients with hemoptysis, despite that the simple chest radiographs are often normal or they have non-specific findings.

Bronchial Artery and Non-bronchial Systemic Artery Embolization for the Treatment in Patients with Hemoptysis: Analysis of Efficacy of Gelfoam Single Use

PURPOSE: To investigate the efficacy of Gelfoam single use for the management of hemoptysis by analyzing patients with recurrence in embolized artery and other artery, respectively. MATERIALS AND METHODS: Between 1992 and 2000, 131 patients (104 men and 27 women, mean age: 54.4 years) with hemoptysis underwent BAE using gelatin sponge only. After puncturing the femoral artery using the Seldinger method, angiographies of the thoracic aorta, the bronchial arteries, the intercostal arteries, and the systemic collaterals which were suspected of bleeding focus and embolization were performed. Gelfoam was used 1x3 mm and 2x3 mm or 2x5 mm by the diameter of feeding arteries. The cumulative hemoptysis control rate and recurrence rate were analyzed from the previously embolized vessels. RESULTS: Hemoptysis were recurred among 34 of 131 patients. Twenty-two patients had a recurrence from the same vessels and 12 from the different ones. Using the Kaplan-Meier method, the cumulative hemoptysis control rate was obtained in the patients with a recurrence from the same vessels: 88.8% in 1 month, 79.9% in 1 year, and 77.3% in 2 year. The reasons for recurrences of the same lesions are as follows; due to the tortuosity of the vessel (n=3); partial embolization through the common trunk formation between bronchial and anterior spinal artery (n=3); by vessel spasms or autogenous thrombus (n=2); due to the contrast media hypersensitivity (n=1). These 9 patients were not treated successfully. In the remaining 13 cases, hemoptysis were recurred due to recanalization of embolized vessels. Among 161 procedure, complications consisted of fever (n=8), dyspnea (n=8), mild chest discomfort (n=7), lower back pain (n=1), and transient lower leg paralysis (n=1), which were improved within several days. There was no serious complication in this study. CONCLUSION: Bronchial artery embolization using Gelfoam alone maybe effective and safe to control hemoptysis.

Experimental study on lung injury after spinal cord injury / 中华创伤骨科杂志

Objective To study the mechanism, pathology and treatment of the lung injury after spinal cord injury. Methods Models of spinal cord injury were made with modified Allen methods in 40 rabbits and divided into Group A (control group) and Group B (experimental group). Group B was treated with dexamethasone (0.35mg/k/d) by intravenous drip at first 3 days. The rabbits of spinal cord injury were killed for autopsy at different time points and their lungs were observed pathologically. Results Different degrees of lung injury, with hemorrhage of lung (100 %), occurred after spinal cord injury. The hemorrhage of lung in Group B which received the administration of dexamethasone was obviously slighter than that in Group A (P

Poliangiíte microscópica com hemorragia pulmonar / Microscopic polyangiitis with lung hemorrhage

Os autores relatam um caso de Poliangiíte Microscópica em paciente idosa, diabética, que apresentou quadro agudo de dor abdominal, edema dos membros inferiores, dor nas panturrilhas e poliartralgia. Evoluiu com insuficiência renal aguda, sendo dializada. Surgiram púrpuras não palpáveis generalizadas. Enquanto se submetia a hemodialíse, sofreu dispnéia súbita, sendo entubada e aspirado grande quantidade de sangue vivo, falecendo em seguida. A necropsia no Serviço de Patologia do HUAP-UFF revelou aspectos de Poliangiíte Microscópica.

The autors present one fatal case lung hemorrhage caused by microscopic polyangiitis, that was confirmed by postmortem examination. She was a diabetic old woman who complained of acute abdominal pain, purpuric cutaneous lesions myalgia and arthralgia followed by acute renal failure requiring hemodialysis. She had a sudden death in respiratory failure and through the tracheal tube a lange volume of blood was aspirated.

Nonbronchial Systemic Feeding Arteries in Patients with Hemoptysis: Predictive Factors at Radiography

PURPOSE: To determine the radiographic findings which predict the presence of nonbronchial systemic feeding arteries (NBFAs) in patients undergoing embolotherapy to control hemoptysis. MATERIALS AND METHODS: In 48 patients (39 men and 9 women; mean age, 51 years) who underwent embolotherapeutic procedures for controlling hemoptysis, selective angiography was performed at the intercostal, subclavian and bronchial arteries in 65 hemithoraces (right 11, left 20, bilateral 17). Underlying diseases were tuberculosis (n=34, including three patients with aspergilloma), bronchiectasis (n=11), paragonimiasis(n=2) and metastatic cancer (n=1). The presence of NBFA at angiography was correlated with radiographic findings including pleural thickening, parenchymal distortion, and the location of lung lesions. RESULTS: NBFAs were found in 34 (77%) of 44 hemithoraces with pleural thickening, and in six (29%) of 21 without pleural thickening; the sensitivity and specificity of prediction were 85% and 60%, respectively. NBFAs were observed with greater frequency as the thickness of the pleura increased, and the extent of pleural thickening correlated less with the presence of NBFA than did thickness. NBFAs were found in 35 (78%) of 45 hemithoraces with parenchymal distortion, and in five (25%) of 20 without distortion (p<0.001). In addition, the distribution of the underlying disease in the upper lung zone showed close correlation with the presence of NBFAs (p<0.05). CONCLUSION: In patients with hemoptysis, the pleural thickening revealed by radiography has a high sensitivity and a relatively low specificity for predicting the presence of NBFA, and patients with parenchymal distortion and upper lung lesions have a high incidence of NBFA.

Effectiveness of Embolization for Management of Hemoptysis in Pulmonary Tuberculosis: Comparison of Chest Radiographic Study and Angiography

PURPOSE: To compare the effectiveness of embolization of the bronchial artery embolization for the management of hemoptysis in pulmonary tuberculosis cases with the severity of lung parenchymal injury and pleural infiltration, as seen on plain chest radiographs, and with the findings of angiography of the bronchial artery. MATERIALS AND METHODS: Among 265 patients with hemoptysis due to pulmonary tuberculosis, the findings of plain chest radiography and angiography of the bronchial artery were comparatively analyzed in the 206 for whom the results of follow up were available. The chest radiographic findings were lassified as follows: Type I refers to simple pulmonary tuberculosis; Type II includes cases in which pulmonary tuberculosis is complicated by bronchiectasis, aspergillosis, or cavitation; Type III is either Types I or II accompanied by pleural infiltrates limited to the lung apex, and Type IV includes cases in which pleural infiltrates have extended beyond the apex in the whole of the lung. Bronchial angiographic findings were divided into four groups : Group I consists of cases which show abnormalities of only the bronchial artery; Group II includes those in which abnormalities are seen in the bronchial artery and either the internal mammary or an ntercostal artery; Group III comprises cases which belong to Group I or II and in which a branch of the subclavian artery is abnormal, and Group IV includes those in which abnormalities occur in at least two branches of the subclavian artery, or there is direct visualization of hypervascularity of this vessel. The initial post-embolic hemostatic effect and the results of follow up were studied over a six-month period. RESULTS: As compared with simple pulmonary tuberculosis (Type I), we found that as the severity of pleural infiltration and complications revealed by plain chest radiographs increased (Type II, III, IV), so did the severity of the manifestation of systemic collateral arteries other than the bronchial artery, as depicted by increase on bronchial angiography. Early post-embolic hemostasis occurred in 96% of Type-I cases (47/49), 82% of Type II (36/44), 70% of Type III (28/40), and 55% of Type IV (40/73). The average success rate was 74% (151/205). During the six month follow-up period, continued hemostasis was found in 80% of Type-I patients (36/45), 75% of Type II (30/40), 59% of Type III (20/34), and 48% of Type IV (20/42). The average long-term hemostasis rate was 66% (106/161). CONCLUSION: Bronchial angiography shows that in systemic collateral arteries circulation increases very substantially, and in cases in which plain chest radiographs depict extensive pleural infiltration or complications associated with pulmonary tuberculosis, it is therefore difficult to expect good hemostatic results after embolization. In such instances we thus recommend aggressive treatment such as surgical intervention.

The Arterial Embolization with Glue-Lipiodol Mixture in Patients with Hemoptysis

PURPOSE: To evaluate the efficacy of bronchial and intercostal arterial embolization using a glue-lipiodol mixture in patients with hemoptysis. MATERIALS AND METHODS: Between October 1997 and June 1999, 24 patients underwent 30 sessions of bronchial and intercostal arterial embolization using a glue-lipiodol mixture. The cause of hemoptysis was tuberculosis (n=11), bronchiectasis (n=9) or aspergilloma (n=4). Particular attention was paid to the source of bleeding, type and rate of complication and rate of recurrence, and the cause of recurrence and the duration of the asymptomatic period after bronchial and intercostal arterial embolization in patients with recurrent hemoptysis were also analysed. In addition, the asymptomatic period after bronchial and intercostal arterial emboilzation was classified as 24 hours or less, 7 days or less, or 6months or less. RESULTS: In all 24 cases, hemoptysis ceased immediately after bronchial and intercostal arterial embolization. In 18 cases, the focus of bleeding was a bronchial artery arising from the aorta, and in three of these cases there was also intercostal artery bleeding. In the remaining cases, the focus of bleeding was the right bronchial artery arising from the bronchointercostal trunk (n=5), or the intercostal artery only (n=1). During six of 24 sessions (25%) hemoptysis recurred within six months, but there was no recurrence within 24 hours or 7 days. The causes of recurrence were bleeding from systemic collaterals (n=5) and from another nonembolized bronchial artery (n=1). Retrosternal burning sensation (n=13; 43%) and shoulder pain (n=2; 7%) were detected but no complications critical. CONCLUSION: Because it involves non-recanalization of embolized vessels, bronchial and intereostol arterial embolization with a glue-lipiodol mixture can effectively control hemoptysis.

Recurrent Bleeding After Arterial Embolization in Patients with Hemoptysis: Comparison of Angiographic Findings and Relapsing Period

PURPOSE: To describe the angiographic findings of patients with recurrent hemoptysis after bronchial artery embolization (BAE) according to the point at which relapse occurred. MATERIALS AND METHODS: From 125 patients who underwent BAE due to hemoptysis between 1996 and 2000, we selected 18 of 23 who underwent additional BAE due to recurrent bleeding after initial BAE . Depending on the point at which relapse occurred, they were divided into two groups (I and II, according to whether additional BAE was performed within two weeks of initial BAE or more than two weeks after this). We retrospectively compared the two groups in terms of angiographic findings, number of embolized arteries, and character of feeding arteries at initial and additional BAE. RESULTS: Nine patients in group I (additional BAE: n=10) and nine in group II (additional BAE: n=13) were admitted for recurrent hemoptysis within two weeks of initial BAE and more than two weeks after this, respectively. In group I(n=29) and II(n=31), angiography demonstrated two direct and 27 indirect, and two direct and 29 indirect signs of hemorrhage, respectively. No statistically significant differences were observed (x2=0.005, p=0.945). Among the embolized feeder ressels in group I (n=30) there were 20 bronchial artery and 10 non bronchial systemic collaterals, while for group II(n=35), the corresponding totals were 21 and 14. Again, no statistically significant differences were encountered(x2=0.308; p=0.579). In group I, feeders were newly developed in one case(10%), previously embolized in five(50%), and missed in four(40%), while in group two the corresponding figures were none, twelve(92.3%), and one(7.7%). No significant differences were noted, though the incidence of previously embolized feeders in Group II was very high (x2=5.383, p=0.068). CONCLUSION: Among patients in whom hemoptysis after BAE recurred at different times, the angiographic findings and number of embolized arteries were not significantly different, but differences in the nature of the feeder were noted. Patients in whom hemoptysis recurred more than two weeks after BAE showed more recanalization of previously embolized feeders than those in whom there was recurrence within two weeks.

A Case Report of Aberrant Bronchial Artery from Common Carotid Artery: A Potential Hazard in Bronchial Artery Embolization

Embolization of the bronchial artery is a well-established treatment for patients with hemoptysis. To our know ledge, a case involving an aberrant bronchial artery from the common carotid artery has never been reported. The authors describe a case in which an aberrant bronchial artery from the left common carotid artery was a potential hazard during embolization of the bronchial artery.

High-resolution CT Features of Bleeding Foci in Patients with Massive Hemoptysis

PURPOSE: To compare the high-resolution CT features of bleeding foci in patients with massive hemoptysis during embolization with those revealed by angiography. MATERIALS AND METHODS: Between June 1997 and June 1999, we evaluated 25 patients who from among a total of 49 with arterial embolization due to massive hemoptysis underwent HRCT prior to embolization. We retrospectively analyzed medical records, and angiographic and HRCT findings. The time interval between HRCT and arterial embolization varied from two hours to six days. Angiography indicated that the bronchial, intercostal and internal mammary artery, and branches of the subclavian, were the foci of bleeding, and indicated the location of these in each pulmonary lobe. The HRCT findings were evaluated in terms of cavity, air-meniscus sign, bronchial dilatation, consolidation, ground-glass opacity, and fibrotic scar. We analyzed the corresponding sites of HRCT and the angiographic findings of the foci of bleeding. RESULTS: In 24 of 25 patients, the foci of bleeding were angiographically confirmed, their presence being noted in 28 pulmonary lobes. HRCT findings corresponding to the bleeding foci revealed by angiography were the air-meniscus sign (8 of 10 lobes, 80.0%), cavity (7 of 9 lobes, 77.8%), bronchial dilatation (21 of 30 lobes, 70.0%), and fibrotic scar (1 of 23 lobes, 4.3%). The findings in areas of consolidation and/or ground-glass opacity only did not correspond, however. CONCLUSION: As compared with those revealed by angiography, the HRCT features of bleeding foci in patients with massive hemoptysis during embolization are in order of frequency, the air-meniscus sign, cavity, and bronchial dilatation.

Pulmonary Vasculitis: Imaging Features

Vasculitis is defined as an inflammatory process involving blood vessels, and can lead to destruction of thevascular wall and ischemic damage to the organs supplied by these vessels. The lung is commonly affected. A numberof attempts have been made to classify and organize pulmonary vasculitis, but because the clinical manifestationsand pathologic features of the condition overlap considerably, these afforts have failed to achieve a consensus.We classified pulmonary vasculitis as belonging to either the angitiis-granulomatosis group, the diffuse pulmonaryhemorrhage with capillaritis group, or 'other'. Characteristic radiographic and CT findings of the different typesof pulmonary vasculitis are illustrated, with a brief discussion of the respective disease entities.

Bronchial Arterial Embolization for Hemoptysis: Analysis of Outcome in Various Underlying Causes

PURPOSE: To clarify the short-term effect and long-term results of bronchial arterial embolization forhemoptysis in three groups with tuberculosis, idiopathic bronchiectasis and lung cancer. MATERIALS AND METHODS:This study invo l ved 54 patients who underwent arterial embolization for the control of hemoptysis. Among 54, thecauses of hemorrhage were; pulmonary tuberculosis(n=32), idiopathic bronchiectasis (n=15), and lung cancer(n=7).In all patients, em-bolization was performed using Gelfoam particles and three underwent additional coilemboliza-tion. After the procedure, patients were followed up for between 1 and 95 (mean, 36.7) months. Short-termresults were assessed on the basis of careful observation of patients for 1 month after ar-terial embolization andwere classified as either; successful, indicating complete cessation of he-moptysis for 1 month, or failed,indicating continuing hemoptysis or recurrence within 1 month. Long-term results were evaluated in patients inwhom the procedure was successful in the short term and who could be followed up for at least 6 months. Patientsshowed either complete remis-sion(CR), indicating complete cessation of bleeding during the observation period;partial remis-sion(PR), indicating complete cessation of hemoptysis with recurrent bloody sputum during theobservation period; or recurrence, indicating recurrent hemoptysis, and were grouped accordingly. RESULTS: Noserious procedure related complications occurred except for mild chest pain or fever, of which showed spontaneousrelief within a few day s. The overall short-term success rate was 7 9 .6 %(43/54); individual rates were 84.4%for pulmonary tuberculosis (27/32), 80% for idiopathic bronchiectasis (10/15), and 57.1 % for lung cancer (4/7).Long-term follow-up showed that complete remission was achieved in 24 of 43 cases (55.8 %).The respectivelong-term remission and recur-rence rates were 75 % and 25 % for bronchiectasis, 70.4 % and 29.6 % for pulmonarytuberculosis. While four lung cancer patients whose initial outcome was successful showed no recurrence ofhe-moptysis, three died within 3 months of embolization. CONCLUSION: Embolization of bronchial arteries using aGelfoam sponge is effective as initial treat-ment for moderate or severe hemoptysis caused by benign disease.During long-term follow up, high remission rates were achieved in pulmonary tuberculosis and idiopathicbronchiectasis pa-tients, while the shortest bleeding control was in cases involving lung malignancy.

CT-Guided Au tomated Needle Biopsy of Pulmonary Lesions: Analysis of Successful Biopsy Rate and Frequency of Pneumothorax and Hemorrhage using an 18-Gauge Cutting Needle

PURPOSE: To determine the rate of successful biopsy and frequency of post-biopsy pneumothorax and hemorrhage using an 18-gauge cutting needle in CT-guided automated needle biopsies according to lesion size, and the distance between lesion and pleura. MATERIALS AND METHODS: Ninety-four patients with focal lung lesion who had undergone CT-guided automated needle biopsies using an 18-gauge cutting needle were retrospectively reviewed. We evaluated the relationship between successful biopsy rate and pneumothorax and hemorrhage according to lesion size and distance between lesion and pleura. For the purposes of this study, size and distance were grouped as follows : 3cm . RESULTS: Biopsy was successful in 78 of 94 patients(83%). When lesions were larger than 2cm in size the diagnostic rate increased (P=0.002), but the distance between lung lesion and pleura was not statistically related to successful biopsy (P>0.005). Where there were post-biopsy complications, the pneumothorax rate was higher in lesions less than 2 cm in size (P=0.041) and in those separated by more than 2 cm from the pleura (P= 0.006). Where separation was of this order, the hemorrhage rate was higher (P=0.021), but statistically, this was not affected by lesion size (P>0.05). CONCLUSION: When 18-gauge cutting needle is used in CT-guided automated needle biopsies of pulmonary lesions, the rate of successful biopsy is affected by lesion size ; the pneumothorax rate is also affected by lesion size, as well as by the distance between lesion and pleura; the hemorrhage rate is influenced only by the distance between lesion and pleura.

CT-Guided Au tomated Needle Biopsy of Pulmonary Lesions: Analysis of Successful Biopsy Rate and Frequency of Pneumothorax and Hemorrhage using an 18-Gauge Cutting Needle

PURPOSE: To determine the rate of successful biopsy and frequency of post-biopsy pneumothorax and hemorrhage using an 18-gauge cutting needle in CT-guided automated needle biopsies according to lesion size, and the distance between lesion and pleura. MATERIALS AND METHODS: Ninety-four patients with focal lung lesion who had undergone CT-guided automated needle biopsies using an 18-gauge cutting needle were retrospectively reviewed. We evaluated the relationship between successful biopsy rate and pneumothorax and hemorrhage according to lesion size and distance between lesion and pleura. For the purposes of this study, size and distance were grouped as follows : 3cm . RESULTS: Biopsy was successful in 78 of 94 patients(83%). When lesions were larger than 2cm in size the diagnostic rate increased (P=0.002), but the distance between lung lesion and pleura was not statistically related to successful biopsy (P>0.005). Where there were post-biopsy complications, the pneumothorax rate was higher in lesions less than 2 cm in size (P=0.041) and in those separated by more than 2 cm from the pleura (P= 0.006). Where separation was of this order, the hemorrhage rate was higher (P=0.021), but statistically, this was not affected by lesion size (P>0.05). CONCLUSION: When 18-gauge cutting needle is used in CT-guided automated needle biopsies of pulmonary lesions, the rate of successful biopsy is affected by lesion size ; the pneumothorax rate is also affected by lesion size, as well as by the distance between lesion and pleura; the hemorrhage rate is influenced only by the distance between lesion and pleura.

Pulmonary Hemosiderosis Due to Mitral Valvular Heart Disease

We report a case of biopsy-proven secondary hemosiderosis of the lung in a 58-year-old patient with mitralvalvular heart disease. Both chest radiography and high-resolution CT demonstrated patchy areas of ground-glassopacity; the former indicated that it was in both lungs, while the latter showed inter- and intralobular septalthickening. These findings were reversible when pulmonary venous hypertension was corrected.

Radiologic Findings of Diffuse Pulmonary Hemorrhage

PURPOSE: To describe the chest radiographic and CT findings of diffuse pulmonary hemorrhage. MATERIALS AND METHODS: Two radiologists retrospectively analysed the chest radiographic and CT findings of six patients withdiffuse pulmonary hemorrhage. Using open lung biopsy (n=2) and transbronchial lung biopsy or bronchoalveolarlavage (n=4), diagnosis was based on the presence of hemosiderin-laden macrophage or intra-alveolar hemorrhage.Underlying diseases were Wegener's granulomatosis (n=2), antiphospholipid antibody syndrome (n=2),Henoch-Schonlein purpura (n=1), and idopathic pulmonary hemosiderosis (n=1). In all patients, sequential chestradiographs, obtained during a one to six-month period, were available. HRCT scans were obtained in five patients,and conventional CT scans in one. Follow-up HRCT scans were obtained in two. We also analyzed the patterns ofinvolvement, distribution and sequential changes in the pulmonary abnormalities seen on chest radiographs and CTscans. RESULTS: Chest radiographs showed multifocal patchy consolidation (n=6), ground-glass opacity (n=3), andmultiple granular or nodular opacity (n=3). These lesions were intermingled in five patients, while in one therewas consolidation only. Sequential chest radiographs demonstrated the improvement of initial pulmonaryabnormalities and appearance of new lesions elsewhere within 5-6 days, though within 7-25 (average, 13) days,these had almost normalized. HRCT scans showed patchy consolidation (n=5), multiple patchy ground-glass opacity(n=5), or ill-defined air space nodules (n=4). These lesions were intermingled in five patients, and in one,ground-glass opacity only was noted. In two patients there were interlobular septal thickening and intralobularreticular opacity. The distribution of these abnormalities was almost always bilateral, diffuse with no zonalpredominancy , and spared the apex of the lung and subpleural region were less affected. CONCLUSION: Althoughchest radiographic and CT findings of diffuse pulmonary hemorrhage are nonspecific, sequential changes inbilateral multifocal patchy consolidation and ground-glass opacity, accompanied by clinical symptoms such ashemoptysis or anemia, may be helpful in the diagnosis of diffuse pulmonary hemorrhage.