ABSTRACT
Helical CT has gained wide acceptance in the noninvasive diagnosis of acute pulmonary embolism (APE) and has therefore largely replaced conventional pulmonary angiography as well as ventilation perfusion scan in the work-up of patients suspected of nonsevere pulmonary embolism (PE). Massive PE is life-threatening; its occurrence may require aggressive treatment such as thrombolysis or embolectomy. Identification of patients suffering from major thromboembolic events based solely on clinical grounds may, however, be difficult. Acute right heart failure is the principal cause of circulatory collapse and death for patients with massive PE, and rapid and specific diagnosis and therapy are required in such patients. Bedside echocardiography, a commonly performed first-line examination, demonstrates signs of cor pulmonale, if present, and can identify large central thrombi. However, echocardiography has limitations. In this review, our goal is to discuss the potential role of CT in assessing patients with severe APE. CT evaluation is based on the direct quantification of pulmonary arterial bed obstruction using various scores and the evaluation of morphological heart changes indicating acute cor pulmonale.
Subject(s)
Angiography/methods , Pulmonary Embolism/diagnostic imaging , Tomography, Spiral Computed , Acute Disease , Humans , Severity of Illness IndexABSTRACT
OBJECTIVE: A retrospective study was carried out in two institutions to determine serial changes in the pattern, distribution, and extent of interstitial lung disease (ILD) associated with polymyositis (PM)-dermatomyositis (DM) using HRCT. SUBJECTS AND METHODS: Twenty patients with PM-DM and clinical suspicion of ILD who underwent at least two serial HRCT examinations were retrospectively evaluated by two readers. Patients were classified according to the dominant CT pattern which was correlated with clinical evolution and underlying histology when available (n=6). RESULTS: Patients were classified into four groups according to the dominant pattern: ground-glass attenuation and reticulation (group 1, n=9); honeycombing (group 2, n=4); airspace consolidation (group 3, n=4), and normal or almost normal lung (group 4, n=3). Under medical treatment, serial HRCT showed that the extent of areas of ground-glass opacities (group 1) decreased in five patients, stabilized in two, and increased in two. Pathologic findings demonstrated usual interstitial pneumonia (UIP) in two cases and unspecified interstitial pneumonia in one. In group 2, extent of honeycombing increased in three cases and stabilized in one. In group 3, dramatic resolution of airspace consolidation occurred in three cases. Clinical deterioration with extensive consolidation at CT and diffuse alveolar damage (DAD) at histology occurred in one patient of each of the three previous groups. Lesions stayed invisible or progressed slightly in the fourth group. CONCLUSION: In ILD associated with PM-DM, clinical deterioration and DAD in the follow-up can be observed whatever the HRCT pattern. However, unfavorable evolution is constant when honeycombing is present at the initial CT.
Subject(s)
Dermatomyositis/complications , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/etiology , Lung/diagnostic imaging , Paraneoplastic Syndromes/complications , Tomography, X-Ray Computed/methods , Adult , Aged , Disease Progression , Female , Follow-Up Studies , Humans , Lung Diseases, Interstitial/diagnostic imaging , Male , Middle Aged , Observer Variation , Predictive Value of Tests , Prognosis , Retrospective StudiesABSTRACT
Laryngeal sarcoidosis is a rare manifestation of systemic sarcoidosis. It affects mainly the supraglottic larynx. Involvement of the glottic and subglottic levels are exceptional. We present the case of a 56-year-old man with a 2-year history of systemic sarcoidosis, involving the mucosa of paranasal sinuses, a joint, and mediastinal lymph nodes, who developed laryngeal sarcoidosis. We emphasize the CT appearance of laryngeal sarcoidosis.
