Mixed Ventilatory Defects in Pulmonary Sarcoidosis: Prevalence and Clinical Features.

BACKGROUND: In cohort studies of pulmonary sarcoidosis, abnormal ventilatory patterns have generally been subdivided into restrictive and obstructive defects. Mixed ventilatory defects have largely been overlooked in pulmonary sarcoidosis, as total lung capacity has seldom been taken into account in historical series. RESEARCH QUESTION: This study evaluated the prevalence of mixed disease in pulmonary sarcoidosis and its clinical associations. STUDY DESIGN AND METHODS: In patients with pulmonary sarcoidosis (N = 1,110), mixed defects were defined according to American Thoracic Society/European Respiratory Society criteria. Clinical data, pulmonary function variables, and vital status were abstracted from clinical records. Chest radiographs were evaluated independently by two experienced radiologists. RESULTS: The prevalence of a mixed ventilatory defect was 10.4% in the whole cohort, rising to 25.9% in patients with airflow obstruction. Compared with isolated airflow obstruction, mixed defects were associated with lower diffusing lung capacity for carbon monoxide levels (50.7 ± 16.3 vs 70.8 ± 18.1; P < .0001), a higher prevalence of chest radiographic stage IV disease (63.5% vs 38.3%; P < .0001), and higher mortality (hazard ratio, 2.36; 95% CI, 1.34-4.15; P = .003). These findings were reproduced in all patient subgroup analyses, including patients with a histologic diagnosis, a clinical diagnosis, incident disease, and prevalent disease. INTERPRETATION: Mixed disease is present in approximately 25% of patients with pulmonary sarcoidosis and airflow obstruction and is associated with lower diffusing lung capacity for carbon monoxide levels, a higher prevalence of stage IV disease, and higher mortality than seen in a pure obstructive defect. These observations identify a distinct phenotype associated with a mixed ventilatory defect, justifying future studies of its clinical and pathogenetic significance.

Mass-forming renal Crohn's disease: a case report with multimodality imaging.

The most common extraintestinal manifestations of Crohn's disease involve the eyes, skin, hepatobiliary tract, and the musculoskeletal and respiratory systems. Mass-forming granulomatous inflammation in extraintestinal organs is extremely rare and there are only a few reports of patients with Crohn's disease presenting with inflammatory pseudotumours of the liver, pancreas and kidneys. We present a case of a mass-forming renal granulomatous inflammation in an adult female with Crohn's disease. The clinical, pathological and imaging features of this case illustrate that renal inflammatory pseudotumour is a rare but important differential diagnosis of a renal mass in patients with Crohn's disease and that radiologists should be aware of its existence when considering other more common pathologies, such as focal pyelonephritis and renal tumours. Renal inflammatory pseudotumour may have relatively non-specific imaging features and a biopsy may be required to make the diagnosis.

Magnetic resonance imaging of intramedullary spinal cord lesions: a pictorial review.

Magnetic resonance imaging (MRI) is the modality of choice for the investigation of intramedullary lesions of the spinal cord. A wide variety of conditions may result in similar imaging findings on MRI, and it is essential that the reporting radiologist have a detailed understanding of spinal cord anatomy, the pertinent imaging features of specific intramedullary lesions and the typical clinical presentation of those conditions to aid clinicians to make a prompt diagnosis. This pictorial essay discusses the clinical features and MRI appearance of a number of intramedullary conditions, which can be broadly categorised as congenital, demyelinating, vascular, neoplastic or infectious, and highlights their differentiating features.

Solid focal liver lesion characterisation with apparent diffusion coefficient ratios.

INTRODUCTION: Non-invasive characterisation of focal liver lesions using diffusion-weighted imaging (DWI) has been heavily investigated and has shown substantial overlap between benign and malignant lesions. We have calculated a ratio of lesion to normal liver to determine if it improves accuracy for correct categorisation. METHOD: All hepatic MRI studies performed between 1st April 2009 and 26th September 2011 were retrospectively reviewed. Patients with solid focal liver lesions in whom a diagnosis could be established and had lesions over 10 mm were included. Haemangiomas, cysts and patients with chronic liver disease were excluded. Apparent diffusion coefficient (ADC) values were calculated for each lesion and adjacent normal liver on breath hold DWI. RESULTS: Two hundred fifty-eight studies were performed and 206 were excluded leaving 52 scans and 58 lesions of which 47 were benign and 11 were malignant. The mean ADC value for benign lesions was 1196.6 (two standard deviations (2SD) = ±399.9) and of benign liver 1101.5 (2SD = ±329.8) with a ratio of benign lesion to benign liver of 1.1005 (2SD = ±0.3783). The mean ADC of malignant lesions was 1153.0 (2SD = ±604.9) and malignant liver of 1080.7 (2SD = ±533.4) giving a malignant lesion to malignant liver ratio of 1.0890 (2SD = ±0.4975). None of these results were statistically significant (all P > 0.5). CONCLUSION: DWI is unable to reliably differentiate solid benign lesions from solid malignant lesions.

Utility of week one radiographs post total hip arthroplasty.

INTRODUCTION: We retrospectively analysed 129 consecutive patients who underwent hip arthroplasty at a university-affiliated hospital in Melbourne, Australia between February and September 2011 with respect to the quality of the week one radiographs, placement of the prosthesis and the presence of a peri-prosthetic fracture or dislocation. METHOD: Patient records and radiographs were reviewed to ascertain whether a deviation in routine management occurred based on the information obtained from week one post-operative radiographs. RESULTS: 116 of the 129 patients met the inclusion criteria for the study. 115 patients underwent routine week one hip radiographs with a mean time after surgery of 2.5 days. 89 (77%) of these patients had radiographs with a typical post-operative appearance. 26 (23%) had radiographs with an atypical appearance defined by the presence of one or more of the following: offset difference of >10 mm (11%), leg length difference of >10 mm (11%), sub-optimal acetabular component inclination of <30° or >50° (9%), sub-optimal femoral stem position of >5° varus or valgus (2%), sub-optimal femoral Greun cement distribution of 2 or more absent zones (2%), cement extrusion (1%), peri-prosthetic fracture (0) or dislocation (0). None of the routine week one radiographs resulted in a change in early post-operative management. 1 patient underwent non-routine, immediate post-operative radiographs. DISCUSSION: Our study did not demonstrate a case where deviation from standard clinical pathways occurred as a result of routine post-operative radiographs. A higher power study would help the established surgeon to determine whether post-operative radiographs could be performed at a more comfortable and convenient time such as the outpatient setting.