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[en] A number of nontumorous diseases may affect the trachea and main-stem bronchi, and their nonspecific symptoms may include coughing, dyspnea, wheezing and stridor. The clinical course is often long-term and a misdiagnosis of bronchial asthma is common. The imaging findings of these nontumorous conditions are, however, relatively characteristic, and diagnosis either without or in conjunction with clinical information is often possible. For specific diagnosis, recognition of their imaging features is therefore of prime importance. In this pictorial essay, we illustrate the imaging features of various nontumorous conditions involving the trachea and main-stem bronchi
[en] Radioaerosol inhalation imaging (RII) has been used in radionuclide pulmonary studies for the past 20 years. The method is well accepted for assessing regional ventilation because of its usefulness, easy fabrication and simple application system. To evaluate its clinical utility in the study of impaired regional ventilation in bronchial asthma, we obtained and analysed RIIs in 31 patients (16 women and 15 men; age ranging 21-76 years) with typical bronchial asthma at the Department of Radiology, Kangnam St. Mary's Hospital, Catholic University Medical college, from January, 1988 to August, 1989. Scintiscans were obtained with radioaerosol produced by a HARC(Bhabha Atomic Research Center, India) nebulizer with 15 mCi of 99mTc-phytate. The scanning was performed in anterior, posterior and lateral projections following 5-minute inhalation of radioaerosol on sitting position. The scans were analysed and correlated with the results of pulmonary function study and the findings of chest radiography. Fifteen patients had concomitant lung perfusion image with 99mTc-MAA. Follow-up scans were obtained in 5 patients after bronchodilator therapy. 1 he patients were divided into (1) attack type (4 patients), (2) resistant type (5 patients), (3) remittent type (10 patients) and (4) bronchitic type (12 patients). Chest radiography showed hyperinflation, altered pulmonary vascularity, thickening of the bronchial wall and accentuation of hasal interstitial markings in 26 of the 31 patients. Chest radiographs were normal in the remaining 5 patients. Regardless of type, the findings of RII were basically the same, and characterized by the deposition of radioaerosol in the central parts or in the main respiratory air ways along with mottled nonsegmental ventilation defects in the periphery. Peripheral parenchymal defects were more extensive than that of expected findings from clinical symptoms, pulmonary function test and chest radiograph. Broomstick sign was present in 1.7 patients. The abnormality of RII was poorly correlated with perfusion scans. In all 5 patients treated with bronchodilators, follow-up study demonstrated a decrease in the degree of radioaerosol deposition in the central air way with improved ventilation defects. This study indicates that RII is a useful technique for the evaluation of regional ventilation abnormality and the effect of treatment with bronchodilators in patients with bronchial asthma.
[en] Toxic lung injury may manifest itself in many different ways, ranging from respiratory tract irritation and pulmonary edema in severe cases to constrictive bronchiolitis, being a more distant consequence. It is most often the result of accidental exposure to harmful substances at work, at home, or a consequence of industrial disaster. This article presents a case of toxic lung injury which occurred after inhalation of legal highs, the so-called “artificial hashish” and at first presented itself radiologically as interstitial pneumonia with pleural effusion and clinically as hypoxemic respiratory insufficiency. After treatment with high doses of steroids, it was histopathologically diagnosed as organizing pneumonia with lipid bodies. Due to the lack of pathognomonic radiological images for toxic lung injury, information on possible etiology of irritants is very important. As novel psychoactive substances appeared in Europe, they should be considered as the cause of toxic lung injury
[en] Neurofibromatosis type I is an autosomal dominant disease with variable clinical manifestations related to dermatologic, neurologic, skeletal, and endocrine system. Lung parenchymal involvement such as lung fibrosis and massive bullous emphysema is infrequent. Here, we report on a 36-year-old man with symptoms of dyspnea, and who has a spontaneous pneumothorax, multiple bullae, and pathologically confirmed neurofibromatosis type I
[en] The pneumonia is an inflammatory process unchained by a pathogen that affects bronchioles, alveoli and interstice causing exudative consolidation and alteration in the gassy exchange. The paper includes epidemiology, physiopathology, etiology and factors of risk among other topics
[en] Congenital tracheal web is a rare entity often misdiagnosed as refractory asthma. Clinical suspicion based on patient history, examination, and pulmonary function tests should lead to its consideration. Bronchoscopy combined with CT imaging and multiplanar reconstruction is an accepted, highly sensitive means of diagnosis. (orig.)
[en] We report here on the redistributed regional ventilation abnormalities after the administration of a bronchodilator and as seen on xenon-inhaled dual-energy CT in a patient with asthma. The improved ventilation seen in the right lower lobe and the decreased ventilation seen in the right middle lobe after the administration of a bronchodilator on xenon-inhaled dual-energy CT could explain a positive bronchodilator response on a pulmonary function test. These changes may reflect the heterogeneity of the airway responsiveness to a bronchodilator in patients with asthma.
[en] The changing nature of industries associated with exposure to hazardous dusts in manufacture or in use, as well as better control methods, might be expected to be associated with a reduction in incidence of pneumoconiosis and other lung diseases. Data collected by the University of Manchester's ODIN/THOR network on work-related ill-health in the UK (as diagnosed by specialist physicians) can be used to estimate time trends in the lung diseases reported to the surveillance schemes. Reporters of work-related lung diseases in THOR (previously ODIN) mainly comprise two groups, namely clinical specialists in respiratory medicine and occupational physicians. These reporters return information on work-related cases of ill-health using postal reporting cards or an on-line web form. 'Report cards' are returned even if no new cases are seen, with responses recorded each month i.e. whether a card is returned and number of cases returned. Probabilities of a non response and, for returned cards, of a 'zero' return were modelled as a function of calendar time and/or membership time using 2-level logistic models. Annual change in disease incidence (all work-related respiratory disease and specific diagnoses) was estimated using 2-level Poisson models controlling for reporter characteristics, season, and whether or not a first report. The impact of membership time on reporting was also investigated. Case reports include information on patient demographics, diagnoses, industry, occupation, and suspected agents/exposures. These case details are coded and analysed using SPSS. Annual change in incidence of all work-related respiratory disease reported by specialist chest physicians (1999-2006) was -1.7% (95% CI: -3.1%, -0.2%). Specific diagnoses reported by chest physicians showed that the annual change in incidence for asthma was -3.1% (95% CI: -5.8%, -0.4%), for mesothelioma was -4.1% (95% CI: -6.7%, -1.5%), for benign pleural plaques was +1.1 (95% CI; -1.0%, +3.2%), and for pneumoconiosis was -2.6 (95% CI: -6.6, +1.5) over the same time period. Occupational physicians' reporting showed a change in incidence of -6.1% (95% CI: -11.6%, -0.4%) for all respiratory disease, and -8.4% (95% CI: -15.3%, -0.9%) for asthma. Given variation between reporter groups, and according to model assumptions, time trends from surveillance data need to be interpreted with caution, but may have some place in planning interventions aimed at improving the health of a workforce. Further work to investigate case details (such as suspected agent/exposures) should also add to this knowledge base.