In this report, we challenge the commonly held assumption that the adult respiratory distress syndrome (ARDS) is a homogeneous process associated with generalized and relatively uniform damage to the alveolar capillary membrane. We studied 13 patients with ARDS, comparing the pulmonary parenchymal changes seen by standard bedside chest roentgenograms with those seen by computed tomography of the chest. Three patients demonstrated generalized lung involvement by both radiologic techniques. In another eight patients, despite the appearance of generalized involvement on the standard chest x-ray film, the computed tomographic scans showed patchy infiltrates interspersed with areas of normal-appearing lung. Two patients showed patchy involvement by both techniques. The fact that ARDS spares some regions of lung parenchyma is useful knowledge in understanding the gas-exchange abnormalities of ARDS, the variable responsiveness to positive end-expiratory pressure, and the occurrence of oxygen toxicity. The problem of regional inhomogeneity should also be kept in mind when interpreting lung biopsy specimens or bronchoalveolar lavage fluid in patients with ARDS.
OBJECTIVELong-term survival after development of pulmonary lymphangitic carcinomatosis is considered unusual. However, modem chemotherapy can result in surprising stability or only gradual progression of lymphangitic carcinomatosis.We evaluated the course of radiographic findings in 10 patients with chronic lymphangitic carcinomatosis. MATERIALS AND METHODS. Ten patients met our criterion of having lymphangitic carcinornatosis for at least 6 months. The primary tumor was a carcinoma of the breast in six cases, the ovary in two, the pancreas in one, and the skin in one. Serial radiographs (all cases) and CT scans (eight cases) were analyzed retrospectively.RESULTS. Survival with lymphangitic carcinomatosis ranged from 11 to 30 months (median, 13 months). With chemotherapy, the radiographic abnormalities and pulmonary symptoms initially regressed in six patients, progressed in two, and remained unchanged in two; the radiographic findings of lymphangitic carcinomatosis were progressing at the time of death in four patients. All patients had periods of at least 4 months of relative stability or slow progression of pulmonary radiographic abnormalities. Serial transbronchial biopsies in one case confirmed persistent lymphangitic carcinornatosis despite therapy, and autopsy disclosed persistent lymphangitic tumor in two others.CONCLUSION. Stability or slow progression of radiographic findings can occur in some patients with lymphangitic carcinomatosis. Therefore, chronicity of radiographic findings should not be taken as evidence against lymphangitic carcinomatosis as the cause of an interstitial abnormality in a patient with cancer.
The accuracy of lymphography was prospectively evaluated in a series of 632 consecutive, unselected patients with Hodgkin disease and non-Hodgkin lymphoma. The cases were newly diagnosed and previously untreated. The following five parameters of lymphographic accuracy were achieved: sensitivity 91%, specificity 91%, overall accuracy 91%, accuracy of positive diagnosis 84%, and accuracy of negative diagnosis 95%. Before this useful imaging modality is prematurely abandoned, comparable studies of the accuracy of ultrasound and computed tomography, perhaps with a less extensive series, should be carried out.
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