Pulmonary cystic disease: comparison of Pneumocystis carinii pneumatoceles and bullous emphysema due to intravenous drug abuse.

A rare pulmonary manifestation of the acquired immunodeficiency syndrome or intravenous (IV) drug abuse is upper lobe cystic disease--pneumatoceles in Pneumocystis carinii pneumonia (PCP) and bullous emphysema in IV drug abuse. Because these disorders overlap, the radiographic findings in 56 patients were compared. During a 12-month period, 16 patients less than 40 years of age were found to have bullous emphysema; the 10 who were IV drug abusers constituted group 1. In the same time period, 40 patients with PCP were encountered; the eight (20%) who had or developed pneumatoceles constituted group 2. In both groups, the conventional radiographic manifestations of upper lobe cystic disease were similar. Eight patients underwent computed tomography of the chest. In five patients with bullous disease, the distribution of the bullous lesions was peripheral, with sparing of the central portions of the lungs. In contrast, PCP pneumatoceles in three patients were dispersed throughout the lung parenchyma.

Pneumatosis intestinalis in bone-marrow transplantation patients: diagnosis on routine chest radiographs.

We report seven cases of pneumatosis intestinalis that was initially detected on routine chest radiographs made in adult bone-marrow transplantation patients. The cases were collected over a 13-month period. The chest radiographs generally underestimated the extent of the pneumatosis, as subsequently seen on plain abdominal films. However, the portions of bowel most extensively involved were those seen on the chest radiographs (transverse colon, hepatic and splenic flexures, stomach). One patient had pneumoperitoneum also. Pneumatosis developed within 6-293 days after transplantation. The cause of pneumatosis intestinalis was multifactorial. Three patients were asymptomatic. Clinical management of all seven patients was altered because of the detection of pneumatosis. The dose of steroids was increased in three patients to treat graft-vs-host disease, antibiotic drugs were given to three patients for enteric pathogens, and bowel rest was prescribed for one patient with mucosal injury from intense chemotherapy and radiation therapy. These cases show that the chest radiograph makes early diagnosis of pneumatosis intestinalis possible in posttransplantation patients.

Flow study and SPECT imaging for the diagnosis of giant cell tumor of bone.

A case of giant cell tumor of bone is reported in which the blood flow study along with SPECT imaging improved the visualization and diagnosis of the abnormality.