The CT scans of 18 patients with documented pulmonary septic emboli were reviewed. CT features of septic emboli included multiple peripheral nodules ranging in size from 0.5 to 3.5 cm (15 of 18 patients [83%]), a feeding vessel sign (n = 12; [67%]), cavitation (n = 9; [50%]), wedge-shaped peripheral lesions abutting the pleura (n = 9 [50%]), air bronchograms within nodules (n = 5 [28%]), and extension into the pleural space (n = 7 [39%]). In six of the 18 patients, CT was the first modality (before radiography) to show lesions compatible with septic emboli. In five clinically unsuspected cases, CT first suggested the correct diagnosis of septic emboli. In eight patients, CT also enabled identification of more parenchymal lesions, presumed to be septic emboli, and more pleural involvement than chest radiographs, thus demonstrating a greater extent of disease. The authors conclude that CT is an important modality for confirming the presence of pulmonary septic emboli even when conventional chest radiographs remain negative. In the proper clinical setting, characteristic CT features of septic emboli can suggest the correct diagnosis.
Electron-beam CT is a sensitive and specific noninvasive method for the diagnosis of PE. It has the potential to replace V-P scanning as the primary screening examination for PE.
Contrast material-enhanced electron-beam computed tomography (CT) (100-msec scan time) was performed to image the pulmonary vasculature in 86 patients, each suspected of having a pulmonary embolism (PE). Thromboembolic material was demonstrated in 39 patients; no emboli were demonstrated in 47. In 25 patients, angiographic or pathologic proof was available. There were 19 proved positive CT scans, four proved negative scans, one false-negative scan, and one false-positive scan. In the 21 patients with CT and angiographic correlation, evidence of thromboembolic disease was seen in 88 vascular zones. Fifty-three zones were positive for PE at both CT and angiography. Eighteen zones were positive for PE at angiography alone, and 17 zones were positive at CT alone. Electron-beam CT is a potentially effective noninvasive means of diagnosing PE.
EVAR reimbursement is presently inadequate to cover hospital expenses. Substantial financial losses occurred at four of the participating centers. University hospitals fared surprisingly better because of higher reimbursement.
The computed tomographic (CT) chest scans of 11 patients who developed respiratory or constitutional symptoms while receiving amiodarone therapy were reviewed. CT findings indicative of significant amiodarone exposure included (a) high-attenuation parenchymal-pleural lesions in eight of the 11 patients (73%), and (b) increased liver and/or spleen attenuation in 10 of the 11 patients (91%). Nonspecific pulmonary infiltrates were identified in nine of the 11 patients (82%). Four patients had interstitial infiltrates, four had mixed alveolar and interstitial disease, and one had a conglomerate mass. CT findings of high-attenuation parenchymal-pleural abnormalities are thought to be related to the iodinated chemistry of the drug and its prolonged half-life within the lung. These unique properties of the drug and the use of CT to discriminate attenuation levels provide a means of identifying patients with significant pulmonary accumulation of amiodarone.
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