The terminal chest radiographs of ten patients with pulmonary leukostasis were correlated with the autopsy findings. In six patients, no abnormalities attributable to leukostasis were seen on chest radiographs. In four patients, diffuse alveolar consolidations were caused by alveolar edema following leukostasis. Leukostasis should be considered in leukemia patients with severe dyspnea who have normal chest radiographs or diffuse alveolar edema.
To evaluate the efficacy of AMBER, a multiple-beam equalization system for chest radiography, the authors performed a nodule detection study using an anthropomorphic chest phantom. AMBER and conventional images were compared. The images were read by four observers, and analysis was done by means of modified receiver-operating characteristic (ROC) curves (free ROC curves [FROC]). The results of the FROC analysis show a significant increase in the detectability of nodules (P less than .001) projected over the mediastinum with the use of AMBER. No significant difference between AMBER and conventional images was noted in detectability of nodules projected over the lung.
A bronchioloalveolar carcinoma presented as a large cavitatory lesion with an irregular lining in a 28 year old man.Bronchioloalveolar carcinoma is a malignancy that may appear as a radiologically well circumscribed, solitary peripheral nodule, in which cavitation is extremely rare. The clinical and pathological features of a cavitating bronchioloalveolar carcinoma in a young man are discussed. Case reportA 28 year old man was admitted for evaluation ofacute right sided pleuritic chest pain. He denied cough, dyspnoea, anorexia, loss of weight, or fever. No recent journeys abroad had been made. He had been smoking 20 cigarettes a day for 10 years. Because of haemoptysis a chest radiograph had been taken at another institution one year previously. This showed a sharply circumscribed, thin walled cavitary lesion (4-5-5 cm in diameter) in the right lower lobe (fig 1). No further action was taken at that time and the haemoptysis did not recur. Other previous chest radiographs were not available.At presentation we saw a young man in apparent good health. Physical examination indicated nothing abnormal apart from a right basal pleural rub. Routine laboratory investigations showed no abnormalities except for increased serum lactate dehydrogenase activity (397 (normal < 160) U/1). Notably the erythrocyte sedimentation rate, white blood cell count, and total eosinophil count were normal. He was tuberculin negative and had negative sputum cultures. A chest radiograph and tomogram showed that the cavitary lesion in the posterobasal segment of the right lower lobe had grown. The originally smooth inner lining of the lesion now showed an irregular, nodular contour. An aortogram showed no evidence of lung sequestration. Bronchoscopy showed no abnormalities, and bronchial washings did not disclose acid fast bacilli or malignant cells.Over the next few days a high fever (39-5°C) developed and the patient started to cough, producing purulent sputum that in culture yielded Staphylococcus aureus. On the chest radiograph the cavity was partly filled with fluid (fig 2). The patient was treated with flucloxacillin for 10 days and underwent thoracotomy once the fever had subsided.Address for reprint requests: Dr P M de Jong, Department of Pulmonology, University Hospital, Rynsburgerweg 10, 2333 AA Leiden, The Netherlands. Accepted 2 December 1988At thoracotomy a smooth surfaced and partly necrotic tumour mass (11 cm in diameter) was found, fixed to the diaphragm. Lobectomy with total removal ofthe tumour was performed. Microscopically this was seen to be a bronchioloalveolar carcinoma. Lymph nodes were not affected. DiscussionBronchioloalveolar carcinoma is known as a malignancy with an insidious onset.' It accounts for 1-6 5% of primary lung carcinomas and commonly appears as a localised, well circumscribed, solitary peripheral nodule in the lung parenchyma.23 Cavitation must be very rare, for in several large series with a total of 358 patients this radiographic appearance was never mentioned,'4 though a recent textbook stat...
To evaluate the loss of information in the process of digitizing radiographs, followed by reprinting these on film, a study was performed. Radiographs were taken of a 3M chest phantom with a random distribution of lucite cylinders, simulating pulmonary nodules, using two different dose techniques: a conventional technique, and an equalization technique (AMBER). All radiographs were digitized to a 2048 *2048 *8 matrix by means of a Konica KFDR -S laser scanner, and reprinted on film by means of a 3M laser printer. A traditional ROC study was performed, presenting the films to four radiologists. Results indicate no information loss for the conventional chest radiographs, but slight loss of nodule detectability in the equalized radiographs. 1. INTRODt ICTION SPIE Vol. 1090 Medical Imaging III: Image Formation (1989) / 393 Downloaded From: http://proceedings.spiedigitallibrary.org/ on 06/24/2016 Terms of Use: http://spiedigitallibrary.org/ss/TermsOfUse.aspx SPIE Vol. 1090 Medical Imaging III: Image Formation (1989) / 395 Downloaded From: http://proceedings.spiedigitallibrary.org/ on 06/24/2016 Terms of Use: http://spiedigitallibrary.org/ss/TermsOfUse.aspx
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