We undertook this study to determine the prevalence of normal roentgenograms in chronic diffuse infiltrative lung diseases. Of 458 patients with such disorders histologically confirmed, 44, or 9.6 per cent, had normal pre-biopsy films. In this group with normal x-ray films, desquamative interstitial pneumonia, sarcoidosis and allergic alveolitis were the most frequent diagnoses. Dyspnea was the principal complaint, and fine rales were common. The vital capacity was reduced in 57 per cent, and the single-breath diffusing capacity in 71 per cent. In half, histological changes and functional impairment were moderately severe. Films may be normal in such cases because isolated foci are too small or too few, because diffuse interstitial or intra-alveolar disease may cast no discrete shadows or because the lesions primarily affect airways or blood vessels. Patients with normal chest roentgenograms and normal mechanics of breathing but with impaired gas exchange should have lung biopsy for early diagnosis and therapy.
Lymphomatoid granulomatosis is one of a group of pulmonary disorders characterized by necrotizing, aseptic granulomas, usually with angiitis. Multisystem dissemination is common especially to the skin and central nervous system. The diagnosis can be established only by histologic examination. Lymphomatous transformation apparently occurs in 10–20%. Treatment is generally unsatisfactory, although corticosteroids appear to be indicated initially. We present 4 patients, 3 of whom died relatively rapidly with progressive pulmonary lesions despite therapy with corticosteroids and cytotoxic agents. 1 of these patients developed a lymphoma. The fourth recovered after local excision. Pathologic diagnosis, classification, clinical and radiographic features and therapy are discussed.
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