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1.
Thorax ; 66(5): 414-7, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21357584

RESUMO

BACKGROUND: Initial studies on the use of ultrasound in the detection and sampling of supraclavicular lymph nodes in patients with suspected lung cancer show this to be a promising technique, giving both a cytological diagnosis and pathological N3 (pN3) stage. Leicester published its initial experience in 2005 and the aim of this study was to establish if this had been embedded into the diagnostic pathway, and further to examine the use of ultrasound in diagnosing and staging lung cancer by imaging other areas including pleural effusions, chest wall, bone and liver lesions. METHODS: All patients diagnosed with lung cancer, registered on the Leicester lung cancer database over a two year period between January 2007 and December 2008, had their imaging and pathology retrospectively reviewed; 996 primary lung cancer patients were identified (n=996). Of these, 318 patients underwent an ultrasound examination (n=318), consisting of ultrasound of the neck, pleural cavity, and metastatic lesions potentially amenable to ultrasound guided aspiration/biopsy. RESULTS: The overall malignant yield was 45% of patients scanned (95% CI 39.5% to 50.4%) and 81.3% of patients sampled (95% CI 75.5% to 87%). Of the 996 patients, 14.4% (n=143) had a positive ultrasound guided cytological diagnosis (95% CI 12.2% to 16.5%). Of all the pathological diagnoses (n=765), 18.7% were ultrasound guided (95% CI 15.9% to 21.5%). In particular, 32.2% of patients with CT detected neck or mediastinal nodes had a diagnosis and stage achieved by neck ultrasound. CONCLUSION: The use of ultrasound gives a rapid and less invasive method of diagnosing and staging lung cancer and has become embedded into the diagnostic pathway. We advocate its increased use and availability in patients with lung cancer.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma de Células Pequenas/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/secundário , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Pequenas/secundário , Feminino , Humanos , Neoplasias Pulmonares/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Ultrassonografia de Intervenção/métodos , Adulto Jovem
2.
Br J Radiol ; 84(1005): 796-9, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21159803

RESUMO

OBJECTIVES: Imaging of the pleura by multidetector CT (MDCT) can be challenging. There is no clear evidence or guidelines on contrast infusion parameters for imaging pleura. We compared two contrast protocols for assessing pleural pathology on MDCT. METHODS: This was a prospective study in which consecutive patients with MDCT for suspected pleural disease on chest radiograph were randomised into two groups. The first group received 150 ml of intravenous contrast at a rate of 2.5 ml s(-1) and the second group received 100 ml at 2 ml s(-1). Images were acquired after a 60 s delay. Hounsfield units of the pleura, thoracic aorta, main pulmonary artery, portal vein and superior mesenteric artery were measured and analysed by two independent readers. RESULTS: 40 patients (20 in each group) who had pleural enhancement on MDCT were included for final analysis. The mean pleural enhancement value was 83 HU (Group A) vs 59 HU (Group B) (p = 0.0004). The mean aortic enhancement was 241 HU (A) vs 141 HU (B) (p<0.0001); main pulmonary artery enhancement was 208 HU (A) vs 139 HU (B) (p<0.0002); portal venous enhancement was 169 HU (A) vs 115 HU (B) (p<0.0001); and the superior mesenteric artery enhancement was 215 HU (A) vs 128 HU (B) (p<0.0001). CONCLUSION: Enhancement of the pleura and major vessels was significantly higher in the group receiving more contrast at a greater infusion rate. This technique of a single scan through the entire pleural surface with a delayed acquisition is promising. When pleural disease is suspected, contrast infusion protocols should be modified to achieve the best results and clinicians should be encouraged to specifically request a "pleural CT".


Assuntos
Angiografia , Meios de Contraste/administração & dosagem , Pleura/diagnóstico por imagem , Doenças Pleurais/diagnóstico por imagem , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Pleura/irrigação sanguínea , Doenças Pleurais/fisiopatologia , Estudos Prospectivos , Intensificação de Imagem Radiográfica , Reprodutibilidade dos Testes , Adulto Jovem
3.
Clin Radiol ; 65(11): 881-6, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20933642

RESUMO

AIM: To evaluate the benefits and logistical safety of computed tomography (CT) imaging in patients undergoing extracorporeal membrane oxygenation (ECMO) therapy in a single institution. MATERIALS AND METHODS: Over a period of 25 months, 134 patients (80 neonates, 19 children, and 35 adults) underwent ECMO therapy at this institution. The imaging of these patients was reviewed to identify patients who had undergone CT imaging whilst on ECMO. Patient notes were retrospectively reviewed. CT findings and subsequent decisions were analysed to assess the benefit of CT imaging. Complications arising due to the logistics of performing the scan were analysed to assess the safety of performing CT in ECMO patients. RESULTS: Of 134 patients, 14 (10%) had a total of 15 CT examinations whilst undergoing ECMO therapy. Indications for CT included new neurology, increased respiratory demand, and increasing requirement for high ECMO flows. There were no major complications and two minor complications associated with the logistics of performing a CT examination on an ECMO patient. Significant findings resulted from 73.3% (11/15) of the CT examinations, and in all 15 examinations information was provided that was used in making further management decisions, including, in some cases, withdrawal of ECMO therapy. CONCLUSION: With an experienced team, CT imaging of patients on ECMO can be performed safely. CT provides valuable information for subsequent management of patients undergoing ECMO therapy.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Insuficiência Respiratória/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Criança , Pré-Escolar , Drenagem , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Sistemas Automatizados de Assistência Junto ao Leito , Radiografia Abdominal/métodos , Radiografia Torácica/métodos , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/efeitos adversos , Resultado do Tratamento
4.
Postgrad Med J ; 86(1011): 8-11, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20065335

RESUMO

INTRODUCTION: Thoracic ultrasound (TUS) is increasingly used in chest medicine in secondary care. The indications for TUS are well known but less is known about their relative frequency. The purpose of this observational study was to describe the common indications for TUS and their relative frequency and the impact of TUS on management in a consecutive group of patients. METHODS: 80 consecutive inpatients and outpatients referred for TUS by the same operator in a UK National Health Service teaching hospital were included. Demographic data, clinical indication, findings and effect of TUS on clinical management were noted. RESULTS: The most common clinical indication was to assess a pleural effusion in 60/80 cases (75%), but other indications included assessment of diaphragmatic function, pleural thickening and chest wall masses. TUS significantly altered patient management in 52/80 cases (65%): it resolved equivocal chest radiograph (CXR) findings and excluded pathology in 20/80 cases (25%), detected effusions not visible on CXR in 14/80 cases (18%), localised a safe site for medical thoracoscopy in 11/80 cases (14%) when not clinically apparent, and detected unexpected septation in 7/80 cases (9%). TUS guided pleural cytology diagnosed pleural fluid metastases in 9/22 cases aspirated (41%). CONCLUSION: There are many clinical indications for TUS but the most common is pleural effusion assessment. TUS can diagnose inoperable pleural metastases, allow safe day case pleural intervention, exclude significant pleural pathology not visible on CXR, and triage further investigation.


Assuntos
Doenças Respiratórias/diagnóstico por imagem , Idoso , Assistência Ambulatorial , Estudos de Coortes , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ultrassonografia
7.
J Gastrointest Surg ; 13(5): 868-73, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19184245

RESUMO

INTRODUCTION: The routine use of positron emission tomography-computed tomography (PET-CT) in the staging of patients with esophageal carcinoma remains contentious, with conflicting reports of its benefit. In our unit, PET-CT has been used routinely in the staging of all patients considered for radical therapy (surgery or chemoradiotherapy). Our aim was to determine the frequency with which PET-CT influenced decision making in the management of patients with carcinoma of the esophagus or gastroesophageal junction. METHODS: CT, PET-CT, and outcome information were collected on 38 patients considered for radical therapy. Patient proformas, with and without PET-CT findings, were constructed and each independently reviewed in a randomized and blinded fashion by five multidisciplinary team members (three surgeons, two oncologists) and a treatment strategy determined. RESULTS: PET-CT changed the staging for ten patients (26%). This translated into a change in management decision for seven patients (18%). The concordance between individual management plans and treatment intent was 79% for CT (150 of 190 decisions) and it was 92% for PET-CT (175 of 190 decisions). Full concordance between multidisciplinary team members was 66% with CT staging and 74% with the addition of PET-CT. CONCLUSION: The use of PET-CT early in the staging algorithm for esophageal carcinoma altered the staging for a quarter of patients and the management for a fifth of patients, supporting its inclusion early in the staging algorithm.


Assuntos
Adenocarcinoma/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias Esofágicas/patologia , Estadiamento de Neoplasias/métodos , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Adenocarcinoma/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Carcinoma de Células Escamosas/terapia , Estudos de Coortes , Detecção Precoce de Câncer , Neoplasias Esofágicas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes
8.
Br J Radiol ; 80(955): e125-7, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17704305

RESUMO

Liquid ventilation with perfluorocarbons is used in severe respiratory failure that cannot be managed by conventional methods. Very little is known about the use of liquid ventilation in paediatric patients with respiratory failure and there are no reports describing the distribution and excretion of perfluorocarbons in paediatric patients with severe respiratory failure. The aim of this report is to highlight the prolonged retention of perfluorocarbons in a paediatric patient, mimicking pulmonary calcification and misleading the interpretation of the chest CT scan. A 10-year-old girl was admitted to our intensive care unit with severe respiratory failure due to miliary tuberculosis. Extracorporeal membrane oxygenation (ECMO) was used to support gas exchange and partial liquid ventilation (PLV) with perfluorodecalin was used to aid in oxygenation, lavage the lungs and clear thick secretions. The patient developed a pneumothorax (fluorothorax) on the next day and PLV was discontinued. Multiple bronchoalveolar lavages were performed to clear thick secretions. With no improvement in lung function over the next month a CT scan of the chest was performed. This revealed extensive pulmonary fibrosis and multiple high attenuation lesions suggestive of pulmonary calcification. To exclude perfluorodecalin as the cause for high attenuation lesions, a sample of perfluorodecalin was scanned to estimate the Hounsfield unit density, which was similar to the density of high attenuation lesions on chest CT scan. High-density opacification should be interpreted with caution, especially following liquid ventilation.


Assuntos
Calcinose/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Criança , Diagnóstico Diferencial , Oxigenação por Membrana Extracorpórea , Feminino , Fluorocarbonos/administração & dosagem , Humanos , Ventilação Líquida , Respiração Artificial/métodos , Insuficiência Respiratória/complicações , Insuficiência Respiratória/diagnóstico por imagem , Insuficiência Respiratória/terapia , Tuberculose Miliar/complicações , Tuberculose Miliar/diagnóstico por imagem , Tuberculose Miliar/terapia
9.
Clin Radiol ; 61(8): 700-5, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16843755

RESUMO

BACKGROUND: Pleural biopsy and cytology are standard procedures for the investigation of pleural disease. Recent medical literature has suggested that image-guided pleural biopsy shows improved sensitivity for the diagnosis of pleural malignancy, when compared with the more commonly performed reverse bevel needle biopsy such as Abrams' needle. In our centre there has been an increasing trend towards performing image-guided pleural biopsies, and to our knowledge there is no large published series documenting the complication rate and diagnostic yield. METHODS: The radiology and pathology databases were searched for all image-guided [computed tomography (CT) and ultrasound (US)] pleural biopsies from January 2001 to December 2004. All imaging and histology were reviewed, and final diagnostic information about patients was obtained from the respiratory multidisciplinary team database and patient notes. A record was made of complications following biopsy, presence of pleura in the biopsy, and adequacy of tissue for histological diagnosis. RESULTS: A total of 82 patients underwent 85 image-guided pleural biopsies over a 4-year period. 80 cases were performed under CT and five under US guidance. The rate of new pneumothorax detected by chest radiography was 4.7%. No patient required a chest drain or blood transfusion to treat complications. In 10 (12%) cases, there was inadequate tissue to reach a confident histological diagnosis and in eight (9%) of these, no pleura was present. Assuming all suspicious and inadequate biopsies are treated as benign, which is the worst case scenario, image-guided pleural biopsy has a sensitivity and specificity of 76% and 100%, respectively, for the diagnosis of malignant disease. CONCLUSIONS: Image-guided pleural biopsy is a safe procedure with few associated complications and has a higher sensitivity than previously published series for reverse cutting needle biopsy in the diagnosis of malignant pleural disease.


Assuntos
Pleura/patologia , Doenças Pleurais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos
10.
Clin Radiol ; 60(12): 1237-47, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16291305

RESUMO

Malignant pleural mesothelioma (MPM) is an increasingly prevalent tumour. The death rate associated with MPM is predicted to peak in the next 10 years, although radiologists and clinicians will be encountering cases for the next few decades. Contrast-enhanced CT is an established technique for evaluating suspected malignant pleural disease, but MPM can be reliably diagnosed only by histological sampling. However, even with adequate sampling and the use of immunocytochemistry, histological diagnosis is known to be difficult; definitive diagnosis may involve a combination of clinical presentation, radiological and histological appearances. Percutaneous biopsy is a promising technique for sampling the pleura. In view of its pattern of growth, MPM is a challenging disease to image by any method, and it behaves quite differently from lung cancer. This review aims to highlight the practical aspects of assessing malignant pleural mesothelioma.


Assuntos
Mesotelioma/diagnóstico por imagem , Neoplasias Pleurais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Biópsia por Agulha , Humanos , Imageamento por Ressonância Magnética , Mesotelioma/terapia , Estadiamento de Neoplasias , Pleura/diagnóstico por imagem , Derrame Pleural Maligno , Neoplasias Pleurais/terapia , Tomografia por Emissão de Pósitrons , Interpretação de Imagem Radiográfica Assistida por Computador , Ultrassonografia
12.
Thorax ; 60(3): 229-33, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15741441

RESUMO

BACKGROUND: Lung cancer is the leading cause of death from cancer in the UK. Pathological diagnosis traditionally requires invasive procedures such as bronchoscopy, mediastinoscopy, or image guided biopsy. Ultrasound of the neck with fine needle aspiration cytology (FNAC) of enlarged but impalpable supraclavicular nodes has been used in patients with suspected lung cancer who have N2 or N3 disease on staging computed tomography (CT). If positive, this technique helps to both stage the patient and provide a cytological diagnosis. METHODS: 101 patients were enrolled prospectively over a 1 year period. FNAC was performed on all supraclavicular nodes over 5 mm in size using the capillary aspiration technique. RESULTS: Sixty one of the 101 patients had enlarged supraclavicular nodes and underwent FNAC. The overall malignant yield was 45.5% of patients scanned and 75.4% of patients sampled. As a result of FNAC, 43 patients (42.6%) avoided more invasive procedures. CONCLUSION: Ultrasound guided FNAC is a promising, relatively non-invasive technique for the staging and diagnosis of patients with lung cancer.


Assuntos
Biópsia por Agulha/métodos , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Pequenas/patologia , Neoplasias Pulmonares/patologia , Ultrassonografia de Intervenção , Adulto , Idoso , Idoso de 80 Anos ou mais , Clavícula , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Clin Exp Allergy ; 35(12): 1572-80, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16393323

RESUMO

BACKGROUND: Chemokine receptors (CR) play an important role in T cell migration, but their contribution to lung trafficking is unclear. OBJECTIVE: We hypothesized that if a particular CR was involved in T cell homing its expression would be enriched on lung T cells compared with peripheral blood T cells (PBT). METHODS: We have measured the CR expression on BAL T cells from patients with sarcoid, other interstitial lung diseases (ILD), asthma and healthy volunteers. RESULTS: Of 14 CR studied in sarcoid, CXCR6 expression was the most markedly increased in the lung compared with the blood, a finding that was also seen in ILD patients. A striking although lesser increase was also seen in asthmatics and healthy controls. Analysis of expression of the CXCR6 ligand, CXCL16, by immunohistochemistry suggested that alveolar macrophages (AM) were the major source of CXCL16 in the lung. AM expressed mRNA for CXCL16 and released nanogram quantities after adhesion to plastic as shown by RT-PCR, Western blotting and ELISA. Bronchoalveolar lavage (BAL) fluid from all subjects contained large amounts of CXCL16. The full-length CXCL16 was the predominant isoform in AM lysates, supernatants and BAL. CONCLUSION: This data suggests that CXCR6 and CXCL16 may play a role in T cell recruitment to the lung.


Assuntos
Quimiocinas CXC/análise , Pneumopatias/imunologia , Pulmão/imunologia , Receptores de Citocinas/análise , Receptores Acoplados a Proteínas G/análise , Receptores Depuradores/análise , Receptores Virais/análise , Linfócitos T/química , Adulto , Asma/imunologia , Biomarcadores/análise , Western Blotting , Líquido da Lavagem Broncoalveolar/química , Estudos de Casos e Controles , Quimiocina CXCL16 , Quimiocinas CXC/sangue , Quimiocinas CXC/genética , Feminino , Citometria de Fluxo , Humanos , Imuno-Histoquímica/métodos , Contagem de Linfócitos , Macrófagos Alveolares/imunologia , Masculino , Fibrose Pulmonar/imunologia , RNA Mensageiro/análise , Receptores CXCR6 , Receptores de Quimiocinas , Receptores de Citocinas/sangue , Receptores de Citocinas/genética , Receptores Acoplados a Proteínas G/sangue , Receptores Acoplados a Proteínas G/genética , Receptores Depuradores/sangue , Receptores Depuradores/genética , Receptores Virais/sangue , Receptores Virais/genética , Sarcoidose/imunologia
14.
Clin Radiol ; 58(9): 719-22; discussion 717-8, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12943646

RESUMO

AIM: The purpose of our study was to investigate whether reporting of plain chest radiographs affects immediate management of patients admitted to a medical assessment unit. MATERIALS AND METHODS: During a 3 month period we prospectively evaluated 200 patients who had a plain chest radiograph on admission. After the post on-call ward round, an independent medical specialist registrar reviewed the notes, retrieving relevant clinical details. The plain chest films were reported independently by a trainee radiologist and consultant, reaching a consensus report. RESULTS: There was 93% agreement between trainee and consultant radiologists (95% CI=89-96%). Seventy percent had documented reports by the on-call medical team. There was disagreement between radiology and medical reports in 49% of reported films (95% CI=40-57%). The radiologist's report led to a direct change in the immediate management of 22 patients (11%). CONCLUSION: Only 70% of films had documented reports in the clinical notes despite this being a legal requirement. Radiology reporting does cause a direct change in patient management. Chest radiographs of patients admitted to a medical admissions unit should be reported by a radiologist with the minimum of delay.


Assuntos
Hospitalização , Prontuários Médicos/normas , Planejamento de Assistência ao Paciente/organização & administração , Radiografia Torácica , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Prospectivos , Serviço Hospitalar de Radiologia/organização & administração
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