CT-guided catheter drainage of loculated thoracic air collections in mechanically ventilated patients with acute respiratory distress syndrome.

OBJECTIVE: We report our experience with CT-guided percutaneous catheter drainage of loculated thoracic air collections in mechanically ventilated patients with acute lung injury or acute respiratory distress syndrome. MATERIALS AND METHODS: Nine critically ill patients had 17 air collections (13 pneumothoraces, three pneumatoceles, one tension pneumomediastinum) that either developed despite the presence of standard surgical chest tubes or were in loculated sites that were difficult to access. All nine patients were ventilated mechanically for a clinical diagnosis of acute respiratory distress syndrome. Catheter size ranged from 7- to 28-French. Response was measured by imaging follow-up, ventilatory parameters, and clinical outcome. RESULTS: On follow-up imaging studies, all 17 air collections were shown to have been evacuated successfully. Catheters remained in place for a mean of 11 days (range, 4-28 days). No major complications occurred. Sixteen air collections were treated successfully with CT-guided catheter placement alone; the remaining air collection, a pneumothorax, was treated with subsequent placement of a chest tube by the surgeon at the patient's bedside. No surgery was undertaken for the air collections. Improvement in gas exchange was documented by increase in the hypoxemia ratio (arterial oxygen pressure divided by the inspired fraction of oxygen) in seven of 12 drainages; the other drainages were accompanied either by no improvement or by deterioration. Eight (89%) of the nine patients eventually were extubated and discharged from the hospital. The ninth patient died. CONCLUSION: CT-guided percutaneous catheter drainage provided effective treatment for loculated thoracic air collections and obviated surgical intervention in these critically ill, high-surgical-risk patients.

High resolution computed tomography in cystic fibrosis: correlation with pulmonary function and assessment of prognostic value.

OBJECTIVE: To assess the correlation between HRCT and pulmonary function in patients with CF. Further, to assess the prognostic value of HRCT in these patients. SUBJECTS AND METHODS: Clinical examination, chest radiographs and HRCT scans on 30 CF patients with an average age of 17 were scored using established scoring systems. The results were correlated with FEV1 and FVC both at time of CT scanning and after 30 months. Results were also correlated with the clinical progress of the patients over the follow-up period. RESULTS: HRCT, chest radiograph and clinical examination demonstrated similar correlation (p < 0.001) with FEV1 and FVC at the time of scanning. HRCT demonstrated the closest correlation with the clinical progress of the patients over the follow-up period and with follow-up pulmonary function. A maximum combined score for bronchiectasis and emphysema on HRCT seemed to indicate a poor prognosis. CONCLUSION: HRCT in CF patients correlates well with pulmonary function at time of scanning and at follow-up, and with clinical progress. There may be a role for CT in the identification of adolescent/adult patients who can be expected to need aggressive therapy in the future.

A chest radiograph scoring system in adult cystic fibrosis: correlation with pulmonary function.

The Birmingham scoring system for chest radiographs was assessed in 40 adult cystic fibrosis patients, with particular reference to correlation with pulmonary function values. Forty 'initial' and forty 'follow-up' chest radiographs were scored. The mean initial age of the group was 17.5 +/- 5.0 years, and the mean age at follow-up was 23.3 +/- 5.3 years. The cross-sectional radiographic score correlated significantly with the values of three commonly measured, pulmonary function parameters (r = 0.65, 0.67, 0.58, P less than 0.0001). There was a significant correlation (r = 0.64, P less than 0.0001), between the change in radiographic score, and the change in percent predicted forced vital capacity (FVC%). There was a less significant correlation (r = 0.45, P less than 0.006) between the change in radiographic score and the change in per cent predicted forced expiratory volume in one second (FEV1%). We conclude that the Birmingham radiographic scoring system is suitable for quantitative radiological evaluation in adult cystic fibrosis.