[en] The pleural space is a potential space under normal physiologic circumstances. It envelops the lung, the mediastinum, the diaphragm and the chest wall. A thin film of pleural fluid provides lubrication for the two pleural layers; only 2-10 ml of pleural fluid is present in healthy people. For the purposes of this review, pleural abnormalities will be divided into pleural effusion, pneumothorax, and pleural calcification

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[en] Full text: Introduction: It is most unusual for bronchial carcinoma to present as a malignant super scan and is not mentioned in the literature as a specific cause for metabolic super scans. Yet the clinical impression developed that metabolic super scans are not uncommon with bronchial carcinoma possibly associated with paraneoplastic hyperparathyroidism. Purpose: (a) to determine the prevalence of super scans in bronchial carcinoma; (b) to determine a possible association with a specific histological type of carcinoma; (c) to determine the serum Ca⁺⁺, PO₄ and alkaline phosphatase levels pretreatment, thus a possible underlying paraneoplastic hyperparathyroidism. Methods: Hundred patients with bronchial carcinoma were drawn randomly from our files over the last 3 years and studied retrospectively for presence of a possible metabolic super scan. A metabolic super scan was defined as markedly increased diffuse bone uptake without irregularities or possible localized metastases. The kidneys must be absent or scarcely visible. These patients were further evaluated with regards to (a) histopathological type of carcinoma (b) pre therapeutic serum Ca⁺⁺, PO₄ and alkaline phosphatase levels. Results: (i) Metabolic super scans were observed in 11 % of our study group; (ii) The serum Ca⁺⁺ was only slightly increased in one patient. Serum PO₄ was normal in all the patients. Thus we could not prove a serum Ca⁺⁺/PO₄ profile suggestive of hyperparathyroidism in our patients. In two patients parathyroid hormone levels were available and were WNL; (iii) The alkaline phosphatase was moderately increased in 4 patients. (The reason uncertain but probably due to increased bone activity and bone turnover since liver metastases were confirmed in only one of these patients). (iv) Seven patients had non small cell carcinoma, three small cell and one unclassified, thus not limited to epidermoid cancer alone. Conclusion: In this study the underlying pathophysiology for the metabolic super scan of bronchial carcinoma appeared not to be associated with hyperparathyroidism but probably due to another cause. (author)

[en] To discuss the techniques for four dimensional computed tomography of the lungs in tumour patients. The image acquisition in CT can be done using respiratory gating in two different ways: the helical or cine mode. In the helical mode, the couch moves continuously during image and respiratory signal acquisition. In the cine mode, the couch remains in the same position during at least one complete respiratory cycle and then moves to next position. The 4D images are either acquired prospectively or reconstructed retrospectively with dedicated algorithms in a freely selectable respiratory phase. The time information required for motion depiction in 4D imaging can be obtained with tolerable motion artefacts. Partial projection and stepladder-artifacts are occurring predominantly close to the diaphragm, where the displacement is most prominent. Due to the long exposure times, radiation exposure is significantly higher compared to a simple breathhold helical acquisition. Therefore, the use of 4D-CT is restricted to only specific indications (i.e. radiotherapy planning). 4D-CT of the lung allows evaluating the respiration-correlated displacement of lungs and tumours in space for radiotherapy planning. (orig.)

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[en] HRCT pictures of 41 patients with a biopsy-supported diagnosis of intrathoracic sarcoidosis were evaluated. In 82.9% of the patients, nodes in the pulmonary parenchyma were detected, mostly small nodes 3 mm in diameter, with a tendency to fuse. They were in a subpleural position (70.7%), along dilated bronchovascular bundles (41.5%), along the dilated interlobium (46.3%), connected with focal thickening of the pleura (26.8%) and along interlobular septa (26.8%). An increased density of the pulmonary parenchyma was confirmed in 56.1% of the patients, incl. condensation in 43.9% and a ground-glass density in 24.4%. Deformity of the pulmonary structures was found in 19.5%, non-septal hyperdense lines and bands in 43.9% and traction bronchiectasis in 12.2%. Enlargement of the hilar nodes was recorded in 80.5% and of mediastinal nodes in 82.9% of the patients. Comparison of HRCT findings with bronchoalveolar lavage confirmed a good correlation of changes suggesting the active form of sarcoidosis. The investigation confirmed the contribution of HRCT to the diagnosis of intrathoracic sarcoidosis and for the planning of treatment. (author) 1 tab., 9 figs., 15 refs

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[en] Short note