Can lung cancer screening by computed tomography be effective in areas with endemic histoplasmosis?

OBJECTIVE: Low-dose chest computed tomography (CT) is being evaluated in several national trials as a screening modality for the early detection of lung cancer. The goal of the present study was to determine whether lung cancer screening could be done while minimizing the number of benign biopsy specimens taken in an area endemic for histoplasmosis. METHODS: The subjects were recruited by letters mailed to area physicians and local advertisement. The inclusion criteria were age older than 50 years and at least a 20 pack-year smoking history. The exclusion criteria were symptoms suggestive of lung cancer or a history of malignancy in the previous 5 years. The participants completed a questionnaire and underwent a chest CT scan at baseline and annually for 5 years. The management of positive screening results was determined using a defined algorithm: annual follow-up CT scan for nodules less than 5 mm; 6-month follow-up CT scan for nodules 5 to 7 mm; review by our multidisciplinary tumor board for nodules 8 to 12 mm; and biopsy for nodules greater than 12 mm. RESULTS: A total of 132 patients were recruited. Of the 132 patients, 61% had positive baseline CT findings and 22% had positive findings on the annual CT scans. Six cancers were detected. Of these 6 patients, 5 had stage I disease and underwent lobectomy, and 1 had stage IIIA disease and underwent induction chemotherapy and radiotherapy followed by lobectomy. All patients were alive and disease free at a mean follow-up of 41.7 ± 18.6 months. No biopsies were performed for benign lesions. Also, no cancers were missed when the protocol was followed. CONCLUSIONS: Screening with CT can be done effectively in an area endemic for histoplasmosis while minimizing benign biopsies.

Endobronchial Carcinoid Tumor in an HIV-infected Patient.

Endobronchial carcinoid is an uncommon pulmonary neoplasm. In this brief report, we present a case of an HIV-infected patient with an incidentally identified endobronchial carcinoid. This case illustrates the importance of a broad differential diagnosis for lung lesions in HIV-infected patients.

Cardiopulmonary imaging in sarcoidosis.

Sarcoidosis is a disease with protean clinical manifestations ranging from no symptoms to sudden death. Radiologic tests are often the key to diagnosis. In this article, the authors review current imaging techniques and discuss emerging technologies used in the noninvasive cardiopulmonary evaluation of the patient who has sarcoidosis.

A pilot study of subclinical coronary atherosclerosis in systemic sclerosis: coronary artery calcification in cases and controls.

OBJECTIVE: Systemic sclerosis (SSc) is associated with vasculopathy and endothelial cell injury, which could potentially increase the risk of coronary atherosclerosis. Multidetector computed tomography, a noninvasive procedure, generates a coronary calcium score (CCS) as a marker for coronary atherosclerosis. Serum proinflammatory high-density lipoprotein (piHDL) is a potential novel marker of atherosclerotic risk. The objective of the pilot study was to determine 1) the prevalence of subclinical coronary atherosclerosis in SSc and 2) serum piHDL levels as a potential novel marker of atherosclerotic risk in SSc. METHODS: A cross-sectional study of 17 patients with SSc and 17 age-, sex-, and race-matched healthy controls in Cincinnati, Ohio, was conducted. Measurements included CCS; body mass index; lipid profile; and serum levels of high-sensitivity C-reactive protein, homocysteine, and piHDL. RESULTS: Patients with SSc were slightly older (mean 52.8 years) than control subjects (mean 50.6 years; P = 0.01). Coronary calcium was found in 12 participants (9 with SSc, 3 controls; P = 0.03). The mean +/- SD CCS in patients with SSc was significantly greater than the controls (126.6 +/- 251.0 versus 14.7 +/- 52.2; P = 0.003). Five patients with SSc (29%), but no controls, had detectable levels of piHDL (P = 0.06). CONCLUSION: Prevalence of subclinical coronary atherosclerosis is greater in patients with SSc compared with healthy controls. These findings should be confirmed in a larger study.

Radiological manifestations of sarcoidosis.

Sarcoidosis is an immune system disorder characterised by non-necrotising granulomas. Pulmonary involvement is the most common presentation of sarcoidosis, but it can manifest in any organ. Other commonly involved organ systems include the lymph nodes (especially the intrathoracic nodes); the skin; the eyes; the liver; the heart; and the nervous, musculoskeletal, renal, and endocrine systems. The typical and atypical imaging features of multisystemic involvement of sarcoidosis have been discussed with review of the gamut of radiological manifestations of thoracic, cardiac, CNS, abdominal and musculoskeletal sarcoidosis.

Pulmonary hypertension in sarcoidosis.

BACKGROUND: Pulmonary hypertension has been notreported in some patients with sarcoidosis. METHODS: We retrospectively studied 53 sarcoidosis patients with persistent dyspnea despite systemic therapy for their sarcoidosis. All patients underwent cardiac catheterization to determine pulmonary artery (PA) pressure. RESULTS: Of the 53 patients, six were found to have left ventricle (LV) dysfunction, including four cases of diastolic dysfunction. Of the remaining 47 patients, 26 had a systolic PA pressure > or = 40 Torr and 25 had a mean PA pressure > or = 25 Torr. Using univariate analysis of those patients with normal LV function, echocardiography, vital capacity, and diffusion lung of carbon monoxide (D(L)co) correlated with systolic and/or mean pulmonary artery pressure. For the PA systolic, only the echocardiographic estimated PA pressure and D(L)CO % predicted remained in the multiple regression model (Coefficient of determination = 0.76, p < 0.005 for both). For the PA mean pressure, the only independent variable was the echocardiographic estimate of the PA pressure (Coefficient of determination = 0.70, p < 0.005). While echocardiography was useful in many cases, in nine cases PA pressure could not be estimated because there was no tricuspid regurgitation seen. Seven of these patients had a measured PA pressure of > or = 40 Torr. Seven patients with moderate to severe pulmonary hypertension were treated with pulmonary vasodilator therapy. Five patients experienced good clinical response. CONCLUSION: Pulmonary hypertension was commonly found in sarcoidosis patients with persistent dyspnea. For some of these patients, treatment of the pulmonary hypertension was associated with improved clinical status.