Corticosteroids and serious cytarabine-induced pulmonary edema.

A woman with acute leukemia receiving induction chemotherapy with conventional doses of cytarabine (ARA-C) 200 mg/m2/day and daunorubicin 45 mg/m2/day developed acute respiratory distress syndrome. Respiratory failure was attributed to ARA-C primarily by exclusion and radiographic findings. She was weaned rapidly from the ventilator after receiving steroid therapy.

Diffuse metastatic involvement of the breast.

Metastases to the breast are not very common and, according to the recent literature, usually present as nodules, most often single but sometimes multiple, generally without retraction or thickening of the skin. The authors reviewed 21 such cases from the last 15 years. In six patients the metastatic infiltration presented as diffuse thickening of the skin and increased density of the breast, as can be seen in inflammatory diseases or after radiotherapy. In five of these six women lymphangitic spread of the carcinoma was demonstrated by microscopy.

Apical hypertrophic cardiomyopathy with spontaneous post partum coronary artery dissection.

Primary coronary dissection is usually a catastrophic event with a fatal outcome; less than 20 cases of long term survival have been reported. A 32-year-old woman with apical hypertrophic cardiomyopathy who survived a spontaneous dissection of the left anterior descending coronary artery and acute anterior wall infarction two days postpartum is described. To the authors' knowledge, the simultaneous occurrence of these two rare conditions has never been previously reported. Thallium-dipyridamole imaging was performed to estimate the amount of residual viable myocardium in the infarcted area and to evaluate the hemodynamic significance of the residual luminal narrowing. Myocardial perfusion imaging can be useful to decide on surgical versus conservative treatment of these patients.

Bone imaging after cementless press fit total hip arthroplasty.

In view of the high rate of loosening of conventional cemented hip prostheses, cementless implants are gaining popularity in Europe and North America. Smooth-surfaced "press fit" prostheses are designed for autolocking in the femoral canal at the time of installation. Fifteen patients were prospectively followed by bone imaging with Tc-99m MDP at three-month intervals after cementless "press fit" hip arthroplasty to define the "normal" distribution of mechanical stress to the surrounding bone, as well as the incorporation of bone allografts used for reconstruction of resorption sites in cases of revision surgery.

Severe bronchospasm followed by respiratory arrest during thallium-dipyridamole imaging.

We describe the occurrence of sudden severe bronchospasm and respiratory arrest following dipyridamole infusion in a patient with chronic obstructive pulmonary disease predominantly of the emphysematous type. The severe reaction was unexpected because the patient had tolerated well withdrawal of aminophylline derivatives for 48 hours and was receiving chronic prednisone 20 mg qd. Although the diagnostic and prognostic gains from dipyridamole imaging far outweigh the small risk associated with the test, patients with chronic pulmonary obstructive disease must be closely monitored during thallium-dipyridamole imaging.

Lymphomatoid granulomatosis: a review of 12 cases.

We retrospectively studied 12 patients with lymphomatoid granulomatosis (LYG), a form of angiitis and granulomatosis first described in 1972, with emphasis on radiographic findings and clinical presentation. Ten patients had bilateral disease, with middle and lower lung predominance of ill-defined nodular densities being the commonest radiographic presentation. In two patients, chest radiography showed mixed alveolar and interstitial disease. Symptoms of cough, dyspnea, and cutaneous disorders with or without neurologic complications, in a patient with an abnormal chest radiograph, are suggestive of the diagnosis of LYG.

Detection of an asymptomatic gastroduodenal artery aneurysm by real-time and pulsed Doppler sonography.

We describe an asymptomatic gastroduodenal artery aneurysm detected by real-time sonography. This lesion had the ultrasonographic characteristics of an aneurysm except for its unusual location and the absence of turbulent echogenic flow and pulsation. Pulsed-Doppler sonography confirmed the diagnosis by demonstrating bidirectional flow with systolic acceleration in the anechoic portion of the lesion.