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The study objective was to determine the relationship between lung resection and the development of postoperative hiatal hernia.Preoperative and postoperative computed tomography imaging from 373 patients from the International Early Lung Cancer Action Program and the Initiative for Early Lung Cancer Research on Treatment were compared at a median of 31.1 months of follow-up after resection of clinical early-stage non-small cell lung cancer. Incidence of new hiatal hernia or changes to preexisting hernias were recorded and evaluated by patient demographics, surgical approach, extent of resection, and resection site.New hiatal hernias were seen in 9.6% of patients after lung resection (5.6% after wedge or segmentectomy and 12.4% after lobectomy;Both open and minimally invasive lung resection for clinical early-stage lung cancer are associated with new or enlarging postoperative hiatal hernia, especially after resections involving the left lower lobe.

Purpose Chronic Obstructive Pulmonary Disease (COPD) includes chronic bronchitis, small airways disease, and emphysema. Diagnosis of COPD requires spirometric evidence and may be normal even when small airways disease or emphysema is present. Emphysema increases the risk of exacerbations, and is associated with all-cause mortality and increased risk of lung cancer. We evaluated the prevalence of emphysema in participants with and without a prior history of COPD. Methods We reviewed a prospective cohort of 52,726 subjects who underwent baseline low dose CT screening for lung cancer from 2003 to 2016 in the International Early Lung Cancer Action Program. Results Of 52,726 participants, 23.8%(12,542) had CT evidence of emphysema. Of these 12,542 participants with emphysema, 76.5%(9595/12,542) had no prior COPD diagnosis even though 23.6% (2258/9595) had moderate or severe emphysema. Among 12,542 participants, significant predictors of no prior COPD diagnosis were: male (OR = 1.47, p Conclusion Emphysema was identified in 23.8% participants undergoing LDCT and was unsuspected in 76.5%. LDCT provides an opportunity to identify emphysema, and recommend smoking cessation.

Understanding gonadal development in lampreys is complicated by their complex life cycle, the long period during which their gonads remain histologically undifferentiated, and their lack of any close living relatives. This chapter synthesizes the available information related to lamprey sex determination, sex differentiation, sexual maturation, and sex steroids, and it identifies key research needs. A detailed review of lamprey sex ratios shows that: (1) adult lampreys (i.e., during the upstream migration or at spawning) exhibit a small but consistent excess of males in virtually all species studied (with significantly female-biased sex ratios noted only in sea lamprey in the three upper Great Lakes following initiation of sea lamprey control); (2) larval sex ratios are generally at parity or with an excess of females; (3) transformers collected above barriers or following lampricide treatment tend to be male biased in the earliest age classes to metamorphose; and (4) there is spatial and temporal variation in sex ratio during the parasitic feeding phase, but overall sex ratio is less male biased than during the adult phase, suggesting that females suffer higher mortality just prior to or during sexual maturation. The shift in sex ratio observed in the upper Great Lakes following initiation of control led to suggestions of environmental sex determination (ESD), specifically density-dependent sex determination, but evidence for ESD in lampreys is equivocal. Sex ratios did not become female biased in the lower Great Lakes, and all five lakes now show a slight excess of males even though abundance has been low and relatively stable for the past several decades. Furthermore, although a significant relationship between larval density and sex ratio has been observed in two non-parasitic species in the southeastern United States, significant relationships between larval density and sex ratio are not evident among contemporaneous sea lamprey populations (i.e., before or after the initiation of control). ESD, usually temperature-dependent sex determination, has been reported in a number of fish species, but no fish species with exclusively ESD have been identified to date. Skewed sex ratios may result from environmental influences on genetic sex determination rather than strict ESD, and the nature of the genotype × environment interactions can differ among populations and over time. However, apart from ruling out “the usual suspects” (i.e., genes implicated in sex determination in other vertebrates), nothing is known regarding the possible genetic basis of sex determination in lampreys. In contrast, many of the genes involved in the sex differentiation process (i.e., development of the undifferentiated gonad into an ovary or testis) tend to be conserved among vertebrates, and initial studies suggest that at least some of the same genes are involved in gonadal development in lampreys. Understanding the factors influencing lamprey sex determination and differentiation has been complicated by lack of knowledge regarding the critical sex differentiation period. Lampreys are sometimes said to pass through an initial female stage or female intersexual stage, because mitosis and meiosis appear to occur in most larvae regardless of future sex. However, meiosis and oocyte growth are more synchronized and extensive in female larvae, and the extent to which oocytes develop and regress in presumptive males either varies among individuals and species or reflects differences in the degree to which these transient processes are detected. Ovarian differentiation is generally thought to be complete at ~1 and 2–3 years of age in non-parasitic and most parasitic lamprey species, respectively, and at 4–5 years in the anadromous sea lamprey. Later and more prolonged mitosis in parasitic species permits elaboration of a larger stock of oocytes, and persistence of a limited number of undifferentiated germ cells in some parasitic species may allow further oocyte recruitment in large larvae. In all species, testicular differentiation occurs at or around the onset of metamorphosis, at which time resumption of mitosis in the remaining undifferentiated germ cells produces spermatogonia. In vivo biopsy studies showed that sea lamprey gonads can remain labile as long as undifferentiated germ cells remain in the gonads (i.e., after the apparent completion of ovarian differentiation, but up until differentiation of the remaining germ cells at the end of the larval stage). The presence of “atypical” gonads (which often developed into typical males in biopsied larvae) in sea lamprey from both the Great Lakes and Atlantic drainages is consistent with delayed gonadal differentiation but requires further study. Despite the apparent lability of the lamprey gonad, hormonal sex control has not been successful. Non-parasitic lampreys begin maturing during the latter stages of metamorphosis; in contrast, parasitic species remain sexually immature until they approach the end of the juvenile feeding phase, and sexual maturation proceeds during the non-trophic spawning migration. Although the rate of maturation varies among species, depending on the duration of migration, all species and life history types appear to converge again during final maturation ~1–2 months before spawning. Oocytes begin to approach their size at maturity (~1 mm in virtually all species), and, at ovulation, the oocytes (now typically called eggs) are synchronously released into the body cavity. The mature ovary constitutes ~25–35% of a female’s total body weight, regardless of species, but the total number of eggs (fecundity) increases approximately with the cubic power of body length so that fecundity in the largest anadromous parasitic species (e.g., mean 172,000 in sea lamprey) is almost two orders of magnitude higher than that of the much smaller non-parasitic species. The mature testis constitutes ~2–10% of a male’s body weight, with gonadosomatic index (GSI) appearing to be higher in males of non-parasitic species compared to parasitic species, although absolute testis size is still much higher in parasitic species. The study of lamprey steroidogenesis and steroid receptors is contributing to our understanding of the evolution of steroid hormones as transcriptions factors in vertebrates, but much still needs to be learned regarding the role of sex steroids in lamprey sex differentiation and sexual maturation.

To determine long-term survival of visceral pleural invasion (VPI) and parenchymal invasion (PAI) (angiolymphatic and/or vascular) on survival of NSCLCs less than 30 mm in maximum diameter.Kaplan-Meier survivals for NSCLCs, with and without VPI and/or PAI, were determined for a prospective cohort of screening participants stratified by pathologic tumor size (≤10 mm, 11-20 mm, and 21-30 mm) and nodule consistency. Log-rank test statistics were calculated.The frequency of PAI versus VPI was significantly lower in patients with subsolid nodules than in those with solid nodules (4.9% versus 27.7% [p0.0001]), and correspondingly, Kaplan-Meier lung cancer survival was significantly higher among patients with subsolid nodules (99.1% versus 91.3% [p = 0.0009]). Multivariable Cox regression found that only tumor diameter (adjusted hazard ratio [HR] =1.07, 95% confidence interval [CI]: 1.01-1.14, p = 0.02) and PAI (adjusted HR = 3.15, 95% CI: 1.25-7.90, p = 0.01) remained significant, whereas VPI was not significant (p = 0.15). When clinical and computed tomography findings were included with the pathologic findings, Cox regression showed that the risk of dying of lung cancer increased 10-fold (HR = 10.06, 95% CI: 1.35-75.30) for NSCLCs in patients with solid nodules and more than twofold (by a factor of 2.27) in patients with moderate to severe emphysema (HR = 2.27, 95% CI: 1.01-5.11), as well as with increasing tumor diameter (HR = 1.06, 95% CI: 1.01-1.13), whereas PAI was no longer significant (p = 0.19).Nodule consistency on computed tomography was a more significant prognostic indicator than either PAI or VPI. We propose that patients with NSCLC with VPI and a maximum tumor diameter of 30 mm or less not be upstaged to T2 without further large, multicenter studies of NSCLCs, stratified by the new T status and that classification be considered separately for patients with subsolid or solid nodules.

One does not need to look far to find plenty of evidences of the influence of education on many important aspects of people’s lives. So, if ‘happiness’ is understood in the robust eudaemonist sense of key for perfect living, then education evidently has an enormous impact. Education has become one of the clearest indicators of life outcomes such as employment, income and social status, and is a strong predictor of attitudes, wellbeing, good Quality of Life etc. Following Objectives were formed for the study: (i) To Assess and Compare Quality of Life of educated and uneducated Muslim Housewives. (ii) To assess and compare Well-Being of educated and uneducated Muslim housewife. 100 educated Muslim Housewives and 100 uneducated Muslim housewives were taken from District Aligarh. Snow Ball sampling technique was used for gathering the data. WHOQOL-BREF was used to assess Quality of life and Well- Being Scale was used to assess various well-being dimensions in both the groups. Significant Difference was found between various dimensions of quality of life and well-being of educated and non educated Muslim women of Aligarh district.

Background CT scan measures of emphysema and airway disease have been correlated with lung function in cohorts of subjects with a range of COPD severity. The contribution of CT scan-assessed airway disease to objective measures of lung function and respiratory symptoms such as dyspnea in severe emphysema is less clear. Methods Using data from 338 subjects in the National Emphysema Treatment Trial (NETT) Genetics Ancillary Study, densitometric measures of emphysema using a threshold of −950 Hounsfield units (%LAA-950) and airway wall phenotypes of the wall thickness (WT) and the square root of wall area (SRWA) of a 10-mm luminal perimeter airway were calculated for each subject. Linear regression analysis was performed for outcome variables FEV 1 and percent predicted value of FEV 1 with CT scan measures of emphysema and airway disease. Results In univariate analysis, there were significant negative correlations between %LAA-950 and both the WT ( r = −0.28, p = 0.0001) and SRWA ( r = −0.19, p = 0.0008). Airway wall thickness was weakly but significantly correlated with postbronchodilator FEV 1 % predicted (R = −0.12, p = 0.02). Multivariate analysis showed significant associations between either WT or SRWA (β = −5.2, p = 0.009; β = −2.6, p = 0.008, respectively) and %LAA-950 (β = −10.6, p = 0.03) with the postbronchodilator FEV 1 % predicted. Male subjects exhibited significantly thicker airway wall phenotypes (p = 0.007 for WT and p = 0.0006 for SRWA). Conclusions Airway disease and emphysema detected by CT scanning are inversely related in patients with severe COPD. Airway wall phenotypes were influenced by gender and associated with lung function in subjects with severe emphysema.

Individuals concerned about their risk of lung cancer are recommended to talk with their physicians about computed tomographic screening for lung cancer. To provide the necessary information, the survival benefit of the screening, specific to a particular person for a particular round of screening, is needed. The probability of survival gain from the first, baseline, round of screening was addressed as the product of: 1) the screening resulting in a diagnosis of lung cancer; 2) not dying from some other cause for a sufficiently long period of time; and 3) cure resulting from pre-symptomatic treatment of lung cancer. These probabilities were estimated using the International Early Lung Cancer Action Program data on individuals aged 40-85 yrs with a cigarette smoking history of 0-150 pack-yrs. The estimated probability of survival gain ranged from 0.4% for a 60-yr-old with a 10-pack-yr smoking history who quit smoking 20 yrs ago, to 3.1% for a 70-yr-old current smoker with a 100 pack-yr history and 2.0% for an 85-yr-old current smoker with a 150-pack-yr history. When seeking counsel about initiation of screening for lung cancer, an estimate of the probability of survival gain from the first round of computed tomographic screening, specific to the person's age and history of smoking, can be provided.

Pulmonary embolism (PE) is a significant cause of morbidity and mortality after surgical procedures. Early diagnosis and prompt, effective management of this condition present considerable clinical challenges to surgeons. Imaging studies form the mainstay of diagnosis of PE and include plain radiography, ventilation-perfusion scan, venography, echocardiography, catheter pulmonary angiogram, CT pulmonary angiogram, and MR pulmonary angiogram. Each imaging modality has a role in the diagnosis of PE.

This study was conducted to determine whether significant reduction in radiation dose (250 mAs--50 mAs), in chest computed tomography (CT) using volume acquisition affects image quality or the detectability of pathologic findings in the lung and mediastinum.Phantom studies were conducted to evaluate resolution and noise level, then a patient study was then done. Fifty consecutive patients (10 normal and 40 abnormal) cases were examined. After a scan (250 mAs, 120OkVp) of the entire thorax, five additional slices (50 mAs, 120kVp) at the level of the abnormality were obtained. Three independent observers evaluated the visibility of normal lung and mediastinal structures, as well as image noise. The mean score was compared between the standard and low doses. In a second study, an independent evaluation of the presence or absence of pathologic findings was made by four observers.Lucite phantom studies demonstrated diminished low-contrast resolution and increased noise level for the low-dose technique. Observers assessed more noise in the low-dose images (P0.001). The normal structures were judged to be more visible with standard dose (P0.01), but the magnitude of the judged differences was small especially in the lung. No differences were found in the detection of lung and mediastinal abnormalities (P0.10).The low-dose technique was effective in demonstrating pathologic findings for the lung and mediastinum. Low-dose spiral CT should be considered as a viable alternative to standard-dose spiral CT.

Mucoepidermoid tumor of the lung is a rare endobronchial neoplasm with a wide spectrum of appearance. We present a case report and describe the plain film and computed tomography (CT) findings.

A case of calcified pulmonary metastases from medullary carcinoma of the thyroid is reported. This uncommon cause of multiple calcified pulmonary nodules is demonstrated on a computerized tomography (CT) scan and proven by pathology.

Imaging is valuable in determining the presence, extent, and severity of myocardial ischemia and the severity of obstructive coronary lesions in patients with chronic chest pain in the setting of high probability of coronary artery disease. Imaging is critical for defining patients best suited for medical therapy or intervention, and findings can be used to predict long-term prognosis and the likely benefit from various therapeutic options. Chest radiography, radionuclide single photon-emission CT, radionuclide ventriculography, and conventional coronary angiography are the imaging modalities historically used in evaluating suspected chronic myocardial ischemia. Stress echocardiography, PET, cardiac MRI, and multidetector cardiac CT have all been more recently shown to be valuable in the evaluation of ischemic heart disease. Other imaging techniques may be helpful in those patients who do not present with signs classic for angina pectoris or in those patients who do not respond as expected to standard management. The ACR Appropriateness Criteria ® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Hepatitis C is a common infection with worldwide prevalence. It has a variable course and can lead to chronic hepatitis, cirrhosis and hepatocellular carcinoma. Until recently alpha-interferon (IFN-alpha) was the only effective treatment available. Combination therapy with IFN-alpha and ribavirin has been found to be more efficacious than IFN-alpha alone. Various side effects have been ascribed to interferon, such as arthralgias, myalgias, fatigue, and gastrointestinal and neuropsychiatric symptoms. Interstitial pneumonitis is a rare but known complication of IFN-alpha when given at a high dosage of 6 to 10 million units per day. Ribavirin is associated with dose-dependent hemolytic anemia, cough, dyspnea, rash, depression, and dyspepsia, although a potential role in interferon-induced interstitial pneumonitis has not been described. We describe a patient with an excellent clinical response of chronic hepatitis C to combination therapy with IFN-alpha at a dosage of 3 million units per day and ribavirin. The patient developed interstitial pneumonitis that resolved after discontinuation of IFN-alpha and ribavirin. Given that interstitial pneumonitis has previously been reported with high-dose IFN-alpha, this case suggests that this complication may occur with lower dosages of IFN-alpha, although a potential role for ribavirin in this disorder at present remains speculative.

RATIONALE AND OBJECTIVES. The authors sought to develop a reliable animal model for experimental pulmonary infarction, to evaluate it with radiologic-pathologic correlation, and to determine the use of high-resolution computed tomography (HRCT) in monitoring parenchymal lung damage due to infarction. METHODS. Selective left lower lobe pulmonary artery occlusion was performed in seven Yorkshire pigs with transcatheter silicone elastomer injection. After occlusion, 99m technetium (99mTc) macroaggregated albumin perfusion lung scans and sequential in vivo HRCT lung scans were obtained from days 0 to 46. The in vivo radiologic findings were correlated with specimen radiography, specimen HRCT, and histologic Findings. RESULTS. A complete and permanent arterial occlusion was achieved, involving up to three orders of branching distal to the catheter. An anatomically defined perfusion defect was seen on 99mTc lung scans corresponding to the occluded area. HRCT changes consisted of confluent densities progressing to mixed alveolar and interstitial opacities within the first week after embolization. In the follow-up period, marked parenchymal clearing was observed. In all cases after pulmonary artery occlusion, the histologic findings were characteristic of pulmonary infarction and demonstrated alveolar edema, hemorrhage, limited alveolar wall damage, and septal thickening followed by residual fibrosis. CONCLUSION. Using this model, it is feasible to produce pulmonary infarction in the pig which may potentially be useful to study the pathophysiologic and radiologic changes of pulmonary infarction.

OBJECTIVES The objective of this study is to evaluate the mild physiologic changes of elastase-induced pulmonary emphysema in the pig by radionuclide scintigraphy and to correlate these findings with high-resolution computed tomography (HRCT) and histologic examination. METHODS Eight 7- to 12-week-old Yorkshire pigs were studied. Perfusion and ventilation studies were performed in six pigs at 1- or 2-week intervals after elastase instillation. HRCT was simultaneously performed for correlation with radionuclide scintigraphy. For the perfusion scans, technetium 99m (99mTc) macroaggregated albumin (MAA) was used, and both planar and single-photon emission CT (SPECT) images were obtained. Ventilation studies were performed with xenon-133 gas with dynamic sequential imaging. RESULTS Histopathologic findings demonstrated dilatation and destruction of the alveoli and were similar to those previously reported by the authors. The SPECT perfusion images showed significantly impaired perfusion of the involved segment of the lung, corresponding to the region where elastase was instilled. The planar xenon-133 ventilation scintigraphy did not show abnormal air trapping. The mild emphysema induced with elastase manifested as decreased and impaired perfusion with no detectable ventilation abnormalities. The sensitivity of SPECT perfusion studies for the detection of the mild changes of elastase-induced pulmonary emphysema were higher than that of HRCT. CONCLUSIONS The perfusion studies reflect functional or physiologic changes in contrast to structural changes seen on HRCT. This pig model was valuable to study the scintigraphic manifestation of elastase-induced pulmonary emphysema.

Giant cell tumor of soft tissue is a rare tumor first described by Salm and Sissons in 1972 as being a distinct entity. 1 Histologically, it is composed of multinucleated giant cells dispersed among mononuclear cells, and is indistinguishable from its bone equivalent. 2 The majority of these tumors have been reported to occur in the lower extremity. 2 , 3 We describe a case of giant cell tumor of soft tissue within the posterior mediastinum. The only other report of a primary mediastinal giant cell tumor of soft tissue in the English literature was published by Fu et al. in 2002, in which they described two patients with posterior mediastinal masses. 4

In a patient with acute respiratory illness (cough, sputum production, chest pain, and/or dyspnea), the need for chest imaging depends on the severity of illness, age of the patient, clinical history, physical and laboratory findings, and other risk factors. Chest radiographs seem warranted when one or more of the following are present: ageor = 40; dementia; a positive physical examination; hemoptysis; associated abnormalities (leukocytosis, hypoxemia); or other risk factors, including coronary artery disease, congestive heart failure, or drug-induced acute respiratory failure. Chest CT may be warranted in complicated cases of severe pneumonia and in febrile neutropenic patients with normal or nonspecific chest radiographic findings. Literature on the indications and usefulness of radiologic studies for acute respiratory illness in different clinical settings is reviewed.

Primary thymic squamous cell carcinoma is uncommon and has only rarely been linked to a pre-existing thymoma. We are reporting a case of primary thymic squamous cell carcinoma with pituitary metastases, in a patient with a long standing thymoma.

Left ventricular end-diastolic pressure (LVEDP) is a reliable indicator of the diastolic function of the left ventricle. The purpose of this study was to correlate the radiographic assessment of pulmonary hemodynamics with LVEDP. The study population consisted of 104 consecutive patients with four categories of LVEDP: less than 13 mm Hg (n = 26), 13-19 mm Hg (n = 30), 20-24 mm Hg (n = 24), and more than 24 mm Hg (n = 24). Chest radiographs obtained within 24 hours of cardiac catheterization were assessed for evidence of congestive heart failure (CHF) by three experienced radiologists. Findings were graded from 0 to 3 (normal to abnormal) on the basis of the following signs of CHF: redistribution, perihilar and perivascular haze, peribronchial cuffing, pulmonary artery-bronchus ratio, septal lines, subpleural edema, air-space edema, pleural effusion, cardiomegaly, and overall radiographic assessment of CHF. A consensus report was then generated. In patients with LVEDP over 20 mm Hg, 38% did not show CHF in the overall assessment. Correlation between radiographic signs of CHF and LVEDP was limited.

To evaluate prospectively the diagnostic performance of the New York Early Lung Cancer Action Project (NY-ELCAP) regimen in the diagnosis of early lung cancer at baseline and annual repeat computed tomographic (CT) screenings.Informed consent and institutional review board approval were obtained for this HIPAA-compliant study of baseline and annual repeat low-dose CT screening performed with a common regimen in asymptomatic individuals at 12 institutions in New York State. All 6295 participants were aged 60 years or older, had smoked for at least 10 pack-years, had no prior cancer, had not undergone chest CT in the previous 3 years, and were medically fit to undergo thoracic surgery. Median age was 66 years, and median smoking history was 40 pack-years. The proportion (and 95% exact confidence intervals [CIs]) of subjects with a positive result, as determined by using nodule size; the diagnoses of lung cancer resulting from subsequent work-up; and the distribution by cancer stage and cell type were determined. When relevant, 95% CIs for the proportions were calculated.Initial CT imaging led to recommendations for further work-up in 14.4% (95% CI: 13.5%, 15.3%) of the 6295 baseline screenings and 6.0% (95% CI: 5.1%, 6.6%) of the 6014 annual repeat screenings. Of 101 patients in whom the diagnosis of lung cancer resulted from baseline screening and three in whom a diagnosis of lung cancer was prompted by symptoms prior to the first scheduled repeat screening, 95 (91.3%) had no clinical evidence of metastases. Of the 20 patients in whom the diagnosis of lung cancer resulted from annual repeat screening, 17 (85%) showed no evidence of metastases. Of the 134 recommended biopsies, 125 (93.3%) resulted in diagnosis of lung cancer or another malignancy, while none of the 24 biopsies performed outside of the recommendation of the regimen resulted in diagnosis of lung cancer.The NY-ELCAP regimen of screening revealed that annual CT screening for lung cancer resulted in identification of a high proportion of patients with early-stage disease.

The solitary pulmonary nodule is traditionally defined as a relatively spherical opacity 3 cm or less in diameter surrounded by lung parenchyma. The choice of imaging test to evaluate solitary nodules is extensive. However, only 2 findings are considered to be sufficient to preclude further evaluation: calcification in a benign pattern and stability in size for more than 2 years.

To determine the frequency and natural course of mediastinal masses in asymptomatic people at high risk for lung cancer who were undergoing computed tomographic (CT) screening.Informed consent and institutional review board approval for this HIPAA-compliant study were obtained at each participating institution. All documented mediastinal masses among the 9263 baseline and 11 126 annual repeat screenings performed in the Early Lung Cancer Action Project (ELCAP) and its successor project, the New York ELCAP, were identified. Two radiologists confirmed all cases, identified the location and measured the diameter (average of length and width) of each mass, and reviewed all subsequent CT and clinical and surgical results. The prevalence and incidence of mediastinal masses were then determined.Of the 9263 individuals, 71 had a mediastinal mass seen at baseline screening (prevalence of 0.77%). Of the 71 masses, 41 were thymic, 16 were thyroidal, two were esophageal cancers, six were tracheal-esophageal diverticula, and six were other masses. Among the 11 126 annual repeat screenings, only one new mediastinal mass was identified (incidence of 0.01%). This suggests a long average duration for mediastinal masses in asymptomatic people. Among the 41 thymic masses, five were larger than 3.0 cm in diameter, and all five were resected; of these five, one was a thymic carcinoma and four were noninvasive thymomas. Of the remaining 36 thymic masses, 25 were evaluated at follow-up CT 1 year later: Five had increased in diameter, two had decreased, and 18 remained unchanged. All 16 thyroid masses were due to goiter; none of these were changed at follow-up CT 1 year later.Mediastinal masses found in the context of CT screening for lung cancer in asymptomatic people should be approached in a "conservative" manner; this includes thymic masses smaller than 3 cm in diameter, as most of these remain unchanged or even decrease in size.

Bronchial-associated lymphoid tissue (BALT) lymphoma is a distinct subgroup of low-grade B-cell extranodal non-Hodgkin's lymphoma, classified as marginal-zone lymphoma. This study was performed in order to assess the natural history of this rare entity. We evaluated retrospectively the clinical data of 22 patients with biopsy-proven BALT lymphoma at two tertiary-care institutions from 1996 to 2002. Immunophenotyping was done to confirm the abnormal populations of B-lymphoid cells in all cases, and clonality was determined by flow cytometry or molecular studies. There were 11 men and 11 women in the sample, median age 61 years (range 21-80 years); nine were asymptomatic at diagnosis. All 13 symptomatic patients had non-specific pulmonary complaints. On computed tomographic examination of the chest, 11 patients had bilateral disease, 12 had lung nodules, and 10 had a mass or air-space consolidation. In all but one case the disease was localised to the lung at diagnosis and none had peripheral blood or bone marrow involvement. Out of 22 patients, 20 received treatment in various combinations, 12 had chemotherapy and/or rituximab, six had surgery, and two received radiation therapy as primary treatment. A complete response (CR) was achieved in nine patients and a partial response was obtained in 10 patients. Seven of 10 patients who had unilateral disease achieved a CR. The estimated progression-free survival was 53 months. All patients were alive during the median follow-up period of 36 months (range 12-76 months). It appears that BALT lymphoma tends to be localised to lung at the time of diagnosis, responds well to local or systemic therapy, and has a favourable prognosis.

To assess the early phase of radiation-induced lung injury using high-resolution computed tomography (CT) under experimental conditions and to perform precise CT-pathologic correlation. Five Yorkshire pigs received a single dose of 12.5 Gy to the right lower lung. Computed tomographic images were obtained at 2-week intervals. The animals were killed after follow-up periods of 4-16 weeks. The lungs were removed, inflated, fixed, dried, and sliced corresponding to the CT sections. Computed tomography, specimen radiography, and histologic findings were correlated. Various CT findings were observed during the first 16 weeks, including ground-glass opacity, discrete consolidation, patchy consolidation, thickened interlobular septum, and bronchovascular bundle. Ground-glass opacity was associated with thickened alveolar wall and scattered tiny fibrotic foci. Thickened interlobular septum and bronchovascular bundle were the results of fibrosis adjacent to these structures. Discrete consolidation correlated with intraalveolar edema with hemorrhage and infiltration of inflammatory cells. High-resolution CT correlated well with pathology of the lung due to radiation injury as verified by precise radiologic-pathologic correlation. 28 refs., 4 figs., 1 tab.

To establish an animal model for use in evaluation of early morphologic changes of pulmonary fibrosis by means of precise correlation of findings at thin-section computed tomography (CT) and pathologic findings.Bleomycin (1.0-2.5 U per kilogram of body weight) was delivered selectively into the left lower lobe bronchus via balloon catheter in five Yorkshire pigs. Sequential CT examinations were performed at regular intervals. The animals were killed at follow-up of 5 days to 4 weeks. At autopsy, the lungs were removed, inflated, fixed and dried, and subsequently sliced into sections that corresponded to the CT sections. The fixed lungs were examined with thin-section CT, radiography, and histologic studies.There was good correlation between pathologic findings at CT and specimen radiography. Histologic study revealed signs of pneumonitis and developing fibrosis.This disease model is suitable for radiologic and pathologic evaluation of interstitial fibrosis. CT was sensitive in detection of bleomycin-induced abnormalities.

OBJECTIVE The purpose of this investigation was to assess the utility of allowing free adjustment of window width and level in comparison with the use of a fixed lung window in the CT evaluation of diffuse lung disease. MATERIALS AND METHODS Six radiologists each judged 36 cases (28 diffuse lung disease and 8 normal) using a standardized form. In half of the sessions, images were viewed in a fixed lung window (level = -500 HU; width = 2,000 HU). In the other sessions, the observer was able to adjust the window and level freely while viewing the images. Each case was seen twice in separate sessions: once in a fixed lung window and once with window width and level adjusted by the reader. A variety of diagnostic features were evaluated using a 5 point scale. These included visibility of fine lung structures, abnormalities of the lung parenchyma, and overall evaluation of the lung. RESULTS The visibility of lung structures was not improved with adjustable window settings. Receiver operating characteristic (ROC) analysis showed fixed windows to be superior to adjustable windows for overall evaluation of the cases [fixed A(z) = 0.90, adjustable A(z) = 0.84, p < 0.05, jackknife method]. Time to rate each case was increased by 15% with window width and level adjustment. CONCLUSION Free adjustment of window width and level produced no improvement in reader performance over that achieved with fixed window width and level.

The CT findings of a patient with relapsing polychondritis involving the larynx, tracheobronchial tree, and nasal cartilage are described. In the proper clinical setting, a characteristic constellation of findings when noted on CT can aid in differentiating this rare inflammatory disease from other causes of airway compromise. CT is the most useful imaging modality, because cartilage and soft tissue components are well visualized. If diagnosed early, appropriate treatment may prevent life-threatening airway obstruction.

A case of extramedullary plasmacytoma of the larynx is presented. The case is unique for the extramedullary plasmacytoma's marked extension into the mediastinum. The computed tomography (CT) features are described.

The authors evaluated the early morphologic changes of elastase-induced pulmonary emphysema in the pig and correlated the findings with high-resolution computed tomography (HRCT). Nine Yorkshire pigs were included in this investigation; in seven, pulmonary emphysema was induced by 2 mg/kg body weight of elastase instilled selectively into the left lower lobe bronchus. Animals were studied by CT at 0, 1, 2, 3, 7, 14, and 21 days. At the completion of the experiment, the lungs were removed, inflated, fixed and dried, and subsequently sliced corresponding to the CT sections. The gross appearance, histologic appearance, and HRCT were correlated. On HRCT, sequential changes from early edema to development of emphysema were noted. Panlobular, centrilobular and paraseptal emphysema were observed. Elastase-induced pulmonary emphysema in the pig is a useful and reproducible animal model, and high-resolution computed tomography depicts the morphologic changes observed both by gross pathologic observations and histologic observations.

Standard, thin-section, and reference phantom computed tomography (CT) were performed to evaluate 75 consecutive patients with solitary pulmonary nodules. Follow-up was available for 62 nodules in 59 patients; 53 of the nodules were benign and nine were malignant. Twenty-one of the 62 nodules were assessed as benign with thin-section CT, while 33 of the 62 nodules were assessed as benign with reference phantom CT. Two of the nodules classified as benign with both thin-section and reference phantom CT proved to be malignant (a peripheral, ossified carcinoid and a 3.5-cm-diameter calcified carcinoma). The sensitivity of reference phantom CT (58%) for classification of benign nodules was higher than the sensitivity of thin-section CT (36%). The sensitivity of standard CT was lowest (12%). The presence of fat at thin-section CT was a reliable criterion for benignancy in six hamartomas. While both thin-section and reference phantom CT were useful in the identification of benign pulmonary nodules, reference phantom CT increased sensitivity by 22% compared with thin-section CT.

A case of an isolated mesenteric desmoid (fibroma) is presented with two unusual characteristics. First, it arises from the mesentery of the appendix. Second, it presents as a twisted desmoid. The CT and US characteristics are presented. This patient was without risk factors for mesenteric fibrosis such as Gardner's syndrome or previous surgery.

Figure 1. Lucite-Ball Plombage. Posteroanterior and lateral chest x-ray films (Panel A and Panel B, respectively) were obtained in a 64-year-old woman who was being evaluated for an upper respiratory tract infection. The patient had been treated for tuberculosis 41 years earlier by stripping the parietal pleura from the chest wall and packing the space with inert Lucite balls (arrows). A sample of these balls, each approximately 2.5 cm (1 in.) in diameter (two thirds the size of a Ping-Pong ball), taken post mortem from another patient, is shown in Panel C. The patient has been free of tuberculosis since . . .

Reported is the case of a 24-year-old white man with inoperable giant cell carcinoma of the thyroid who achieved tumor regression following therapy with bleomycin, Adriamycin and cisplatinum. After 2 courses of chemotherapy, the tumor was deemed operable, and the patient underwent total thyroidectomy followed by radiation to the neck and upper mediastinum without maintenance chemotherapy. Two-and-one-half years after the initial diagnosis, he developed pulmonary metastases which again responded to Adriamycin and cisplatinum therapy. The above approach suggests that inoperable thyroid carcinoma can be made operable by preoperative combination chemotherapy. This treatment program deserves further exploration for a greater number of patients.

The purpose of this investigation was to optimize the reconstruction algorithm and the slice thickness of computed tomography (CT) for the study of the fine structure of the lung. In 75 patients, we performed routine thoracic CT examination and obtained two high-resolution CT (HRCT) slices at the same level using the standard and bone algorithms, or using the slice thickness of 1.5 mm and 3.0 mm. Side-by-side comparison of the standard and bone images revealed that more branching of the small vessels and more small bronchi could be recognized on the bone image than on the standard image. Thickened bronchovascular bundles and interlobular septa were demonstrated more clearly on the bone image than on the standard image. There was no significant difference in the CT attenuation value between the standard and bone images. The difference between 1.5 mm and 3.0 mm images when demonstrating the small vessels and bronchi was minimal in such lesions as lymphangitis carcinomatosa and radiation fibrosis. Thus HRCT, with a slice thickness of 1.5 mm and 3.0 mm reconstructed by the bone algorithm, is suitable for the demonstration of the fine structure of the lung.

A 16-year-old youth was involved in an unusual automobile accident which resulted in brant chest trauma localized to the right hemithorax. There were no rib fractures on the side of injury, but contusion of the right lung with severe and persistent right hemothorax necessitated a thoracotomy, whereupon multiple deep lacerations were found involving all the lobes of the right lung. In addition, there was disruption of the bronchi and major vessels, and right pneumonectomy was performed. This is the first reported case of pneumonectomy being required for rang laceration complicating brant chest trauma. Postoperatively there were two episodes of spontaneous pneumothorax in the contralateral pleural space, as well as a transient air leak into the pneumonectomy space. The possible mechanisms for the lung injury and the postoperative tension disorders are described.