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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Organ transplant and AIDS patients are at a much higher risk for developing non-Hodgkin's lymphoma than is the general population. This increased risk is directly related to chronic immunosuppression and often is associated with viral infections. In contrast to lymphomas occurring in nonimmunocompromised patients, these tumors typically are of higher grade, are more aggressive, have a worse prognosis, and exhibit a higher frequency of extranodal disease. The most frequent organs involved are the head and neck, bowel, liver, and lungs. Thoracic manifestations of ARL and PTLD are similar, consisting of nodular, diffuse alveolar, and interstitial pulmonary disease, mild to moderate mediastinal adenopathy, and pleural effusions. Of these findings, pulmonary nodules are the most specific, although they can be difficult to differentiate from Kaposi's sarcoma and opportunistic infections. Abdominal findings are also similar for the two diseases, with the most common lesions appearing as low attenuation, hypoechoic masses in the solid abdominal organs; ulcerating nodular or diffusely infiltrating bowel lesions; and bulky retroperitoneal, mesenteric, or omental adenopathy. The identification of solid masses in the abdominal organs in AIDS and transplant patients is highly suspicious for ARL and PTLD. Due to the overlap of imaging characteristics of different pathologies, however, biopsy usually is necessary to confirm the diagnosis. Both ARL and PTLD respond to therapy; however, the prognosis for patients with ARL is uniformly poor, whereas the prognosis for treated PTLD is remarkably good. An awareness of the imaging characteristics of ARL and particularly PTLD can have significant impact on prognosis by allowing for timely diagnosis and therapy.
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PMID:Thoracic and abdominal manifestations of lymphoma occurring in the immunocompromised patient. 157 Mar 97

A case of Kaposi syndrome is described in a 28-year-old heterosexual male with acquired immunodeficiency syndrome. The disease began clinically with pulmonary disease, without mucocutaneous lesions. This form of presentation is extremely infrequent and has not been described in non-homosexual subjects. Clinical manifestations were fever, cough and dyspnea. Thoracic radiography observed a perihilar interstitial pattern which evolved to a bilateral nodular pattern with perihilar adenopathy. There was endobronchial disease, however pulmonary biopsy was required for diagnosis. Complete tumoral remission was achieved with adriamycin, bleomycin and vincristine.
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PMID:[Pulmonary Kaposi's sarcoma in a heterosexual parenteral drug addict patient with the acquired immunodeficiency syndrome]. 172 89

The presence of a large mediastinal mass (bulk disease) in patients with newly diagnosed Hodgkin disease is believed by many to predict a poorer prognosis and to warrant more aggressive treatment. These masses are formed by an aggregate of mediastinal lymph nodes. The determination of bulk disease is confusing, with at least 27 definitions having been proposed. This study seeks to determine the best definition, and determine the role of thoracic computed tomography (CT) versus chest radiographs in the evaluation of mediastinal bulk disease. One hundred seven consecutive newly diagnosed adult patients with Hodgkin disease were evaluated using 13 commonly used definitions of mediastinal bulk. Of the 76 patients with mediastinal disease, 73 had bulk disease as defined by at least one definition. Of the 16 patients who had recurrence of mediastinal disease, only the presence of bulk disease according to one definition (hilar adenopathy, greater than or equal to 2 cm) was statistically significant in its prediction (P = .05). No definition based on the size of the mediastinal nodal mass reliably predicted those patients with recurrence. No differences in our data were found for differing stages or disease cell types, the presence of extension, or with differing treatment regimens. This study highlights the confusion and controversy surrounding the use of bulk disease of the mediastinum as an adverse prognostic indicator. The numerous methods of measuring mediastinal bulk in patients with newly diagnosed Hodgkin disease are confusing, overlap, and are not statistically reliable in predicting recurrence. Efforts to create a standard or ideal definition were unsuccessful. Thoracic CT was useful in those patients whose bulk disease distorted only one side of the mediastinal silhouette on chest radiographs.
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PMID:Mediastinal bulk in Hodgkin disease. Method of measurement versus prognosis. 176 46

Usual interstitial pneumonitis (UIP) is a chronic pulmonary process with a characteristic peripheral fibrotic pattern on gross pathologic lung sections and CT scans. This condition is often idiopathic, but asbestosis, rheumatoid arthritis, and scleroderma may cause the same peripheral fibrosis in the lungs. UIP is associated with an increased incidence of pulmonary neoplasms. The purpose of this study was to evaluate the size of mediastinal lymph nodes in patients with UIP in whom no evidence was seen of malignancy or current active infection. CT scans of 14 patients (12 with idiopathic pulmonary fibrosis and two with collagen vascular disorders) were assessed for lymph node location (American Thoracic Society mediastinal map) and size. In 13 of 14 patients, nodes measured greater than threshold size values. Nodes as large as 20 x 30 mm were identified in three patients. Nodal sites 10R, 4R, 2R, 5, and 6 were most commonly abnormal. We conclude that increase in the size of mediastinal lymph nodes as shown on chest CT scans is common in patients with UIP, occurs without superimposed infectious or malignant complications, and is thus presumably part of the chronic inflammatory process. Consequently, lymphadenopathy in these patients does not suggest that they have lung cancer also.
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PMID:Mediastinal lymph node enlargement on CT scans in patients with usual interstitial pneumonitis. 210 8

Seven dogs with pulmonary lymphomatoid granulomatosis were reviewed. The disease occurred in six large-breed and one small-breed dogs. The dogs were five to 14 years old (mean, 8.4; median, 7), and four of seven dogs were males. Three dogs had been previously treated with adulticide therapy for canine dirofilariasis. Clinical histories included a progressive respiratory disease characterized by varying degrees of cough, dyspnea, exercise intolerance, and weight loss. Thoracic radiographic features included hilar lymphadenopathy, pulmonary masses of varying sizes, and mixed pulmonary patterns of lobar consolidation with ill-defined interstitial and alveolar pulmonary infiltrates. Cardiovascular changes compatible with chronic dirofilariasis were present in three dogs. The clinical course was usually progressive and fatal. The survival time ranged from six days to four years (mean, 12.5 mos; median, 3 mos). Gross and histologic features included mass lesions with areas of necrosis that replaced normal pulmonary architecture. Cytologically, these lesions were characterized by infiltration with pleomorphic, angioinvasive mononuclear cells that often resulted in vascular obliteration. The infiltrating cells resembled large lymphoid cells that possessed large hyperchromatic nuclei and small amounts of cytoplasm. Systemic lymphoid neoplasia with peripheral lymphadenopathy was diagnosed in two dogs. In both cases, lymph-node cytology was similar to the cellular infiltrates found in the lungs and consistent with a diagnosis of lymphomatoid granulomatosis. These features are compared with previously reported cases of canine lymphomatoid granulomatosis and those features identified in a similar disease described in man.
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PMID:Pulmonary lymphomatoid granulomatosis in seven dogs (1976-1987). 236 26

Forty-two patients with small cell lung cancer were treated with a combination of carboplatin, ifosfamide and etoposide. Vincristine was given on day 14 of each course, the courses being repeated every 28 days for a maximum of six. Thoracic radiotherapy was given 4 weeks after the last course of chemotherapy but no prophylactic cranial radiotherapy was administered. Thirty patients had clinically limited state disease, the remaining patients having contralateral neck lymphadenopathy and/or pleural effusions. Elevated enzyme levels (alkaline phosphatase, LDH, ALT, GGT) were noted in 69% of patients. Twenty-four patients (57%) achieved a complete response (CR) when assessed one month after the end of treatment. A further 21% of patients had a partial response (PR). Median duration of CR was 14 months and of PR 8 months. Cerebral metastases were the sole site of relapse in 13% of the CR patients. Myelosuppression was severe with a median nadir of neutropenia of 0.2 x 10(9) cells 1-1. However, 74% of the patient group received all six courses of chemotherapy and only 16 courses (7%) were delayed because of toxicity. There were three deaths associated with treatment-related neutropenia. The median survival of the total group was 14 months, with an actuarial 2 year survival of 37% and a minimum follow-up of 18 months. [A recent analysis, March 1989, demonstrated a 33%, 2 year actual survival.]
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PMID:Carboplatin, ifosfamide and etoposide with mid-course vincristine and thoracic radiotherapy for 'limited' stage small cell carcinoma of the bronchus. 255 90

Thoracic manifestations of sarcoidosis are well recognized on conventional radiographs. Less well known are the CT appearances of sarcoidosis. This article reviews the spectrum of CT findings in sarcoidosis; highlighting distributions of lymphadenopathy on CT, patterns of parenchymal involvement, and pulmonary complications of sarcoidosis as demonstrated by CT.
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PMID:The computed tomographic spectrum of thoracic sarcoidosis. 272 55

CT examinations in 37 patients with proved small-cell bronchogenic carcinoma studied before treatment were reviewed. The distribution of lymphadenopathy in the mediastinal compartments designated by the American Thoracic Society was assessed. The frequency of lymph node enlargement was right hilum (43%), left hilum (49%), one or both hila (84%), right upper paratracheal (32%), right lower paratracheal (54%), right tracheobronchial (65%), left upper paratracheal (14%), left lower paratracheal (38%), left peribronchial (35%), paraesophageal (14%), anterior mediastinum (24%), and subcarinal (65%). We also assessed the frequency of additional findings including pleural effusion (38%), pericardial thickening (38%), displacement or narrowing of either the tracheobronchial tree (68%) or major vessels (68%), and hepatic masses (24%). Mediastinal involvement was present in 92% of cases, as compared with 13% reported in a large series based on conventional radiography. These data show the spectrum of intrathoracic CT findings in proved, untreated cases of small-cell bronchogenic carcinoma.
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PMID:Small-cell bronchogenic carcinoma: CT evaluation. 282 50

Thoracic computed tomography (CT) in 232 patients with either primary staging of new or suggested relapsing lymphoma was compared with conventional chest radiography and both were correlated with clinical staging. Particular attention was given to the possibility of reducing routine thoracic CT, which is the current method used in this hospital in all patients with suggested lymphoma. Mediastinal lymphoma was detected by CT in 95 per cent of patients with clinically active mediastinal lymphoma, and by conventional chest radiography in 56 per cent. CT was found to be less reliable in evaluation of the hilar region than in that of other mediastinal areas. No areas of particular difficulty were found with chest radiography. CT also provided additional information concerning extra-mediastinal lymph adenopathy and involvement of the thoracic wall and pericardium. Routine thoracic CT examination was considered justifiable in all patients with suggested lymphoma.
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PMID:Chest radiography and computed tomography in the evaluation of mediastinal adenopathy in lymphoma. 296 13

Sarcoidosis is being increasingly recognized in India. Over the last 7 years we studied 40 patients. Older males out numbered young females. Thoracic (98%), constitutional (50%) and ocular (40%) involvement dominated the clinical profile. In addition, erythema nodosum (20%), facial palsy (13%), parotid enlargement (8%), lymphadenopathy (42%), hepatomegaly (37%) and splenomegaly (17%) were also observed. Radiologically, 53%, 30% and 15% of patients were in Stage I, II and III respectively at presentation. Kveim test was positive in 45% of those tested. The diagnosis was histologically confirmed in 80% of patients. The remaining eight patients (20%) were relatively asymptomatic, all had bilateral hilar lymphadenopathy and either erythema nodosum or uveitis or both. 88% were tuberculin negative. Systemic steroids were used in 60% and topical steroid eye drops in a further 20%. Response to therapy was excellent except in Stage III disease where radiological and spirometric deterioration was observed in three patients. There were no fatalities. The overall clinical behaviour of north Indian patients with sarcoidosis was quite similar to that of patients in England but different from previously reported Indian patients.
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PMID:Sarcoidosis in north India: the clinical profile of 40 patients. 365 20


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