Purpose: The aim of this study was to identify factors predisposing to lung infarction in patients with pulmonary embolism (PE).Materials and Methods: We performed a retrospective analysis on 154 patients with the final diagnosis of PE being examined between January 2009 and December 2012 by means of a Toshiba Aquilion 64 CT scanner. The severity of clinical symptoms was defined by means of a clinical index with 4 classes. The pulmonary clot load was quantified using a modified severity index of PE as proposed by Miller. We correlated several potential predictors of pulmonary infarction such as demographic data, pulmonary clot burden, distance of total vascular obstruction and pleura, the presence of cardiac congestion, signs of chronic bronchitis or emphysema with the occurrence of pulmonary infarction.Results: Computed tomography revealed 78 areas of pulmonary infarction in 45/154 (29.2 %) patients. The presence of infarction was significantly higher in the right lung than in the left lung (p < 0.001). We found no correlation between pulmonary infarction and the presence of accompanying malignant diseases (r = -0.069), signs of chronic bronchitis (r = -0.109), cardiac congestion (r = -0.076), the quantified clot burden score (r = 0.176), and the severity of symptoms (r = -0.024). Only a very weak negative correlation between the presence of infarction and age (r = -0.199) was seen. However, we could demonstrate a moderate negative correlation between the distance of total vascular occlusion and the occurrence of infarction (r = -0.504).Conclusion: Neither cardiac congestion nor the degree of pulmonary vascular obstruction are main factors predisposing to pulmonary infarction in patients with PE. It seems that a peripheral total vascular obstruction more often results in infarction than even massive central clot burden.

Abstract Purpose: We demonstrate the multislice computed tomography (MSCT) findings of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)-proven hilar and mediastinal lymph node enlargement with signs of anthracosis. Materials and Methods: 53 enlarged lymph nodes in 39 patients (28 male, 11 female) with EBUS-TBNA-confirmed anthracosis were analyzed retrospectively. Results: The mean short axis diameter of the enlarged lymph nodes with signs of anthracosis was 13.7 mm. Lymph nodes most often showed an oval shape (84 %) and were well defined in 66 % of cases. Lymph node confluence was observed in 32 % of cases. Calcifications were documented in 24.5 % of cases. Contrast enhancement and fatty involution were seen seldom (3.8 %). Lymph node necrosis was not seen. Conclusion: Lymph node anthracosis may be found most often in enlarged, well defined lymph nodes with an oval shape, frequently associated with confluence and calcifications. Citation Format: • Kirchner J, Mueller P, Broll M et al. Chest CT Findings in EBUS-TBNA-Proven Anthracosis in Enlarged Mediastinal Lymph Nodes. Fortschr Röntgenstr 2014; 186: 1122 – 1126

Free AccessCorrespondenceReply to the letter to the Editor by Laney et al: The association between tobacco burden and “dirty chest” is unlikely to follow a linear dose-response patternJ Kirchner, JP Goltz, F Lorenz, A Obermann, EM Kirchner and R KickuthJ KirchnerDepartment of Diagnostic and Interventional Radiology, Allgemeines Krankenhaus Hagen, Hagen, Duisburg, GermanySearch for more papers by this author, JP GoltzDepartment of Radiology, University Hospital of Wuerzburg, Duisburg, GermanySearch for more papers by this author, F LorenzDepartment of Diagnostic and Interventional Radiology, Allgemeines Krankenhaus Hagen, Hagen, Duisburg, GermanySearch for more papers by this author, A ObermannDepartment of Diagnostic and Interventional Radiology, Allgemeines Krankenhaus Hagen, Hagen, Duisburg, GermanySearch for more papers by this author, EM KirchnerClinic for Medicine, Städtisches Klinikum Wedau, Duisburg, GermanySearch for more papers by this author and R KickuthDepartment of Radiology, University Hospital of Wuerzburg, Duisburg, GermanySearch for more papers by this authorPublished Online:13 Feb 2014https://doi.org/10.1259/bjr/70035763SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail AboutThe Editor,We appreciate the extensive experience of Laney et al in the field of pneumoconiosis. Concerning their critical comments on our study, we would like to make some remarks.We have to admit that the method of interpretation in our study could have been more detailed. Therefore we would like to explain that as a first step, the International Labour Office (ILO) classification was independently assessed by the two chest radiologists. Readings were then summarised in consensus. We took it for granted that the radiologists mentioned in our study were experienced and had regularly undergone training in the interpretation of lung opacities.We stated clearly that our results should be considered as preliminary and should therefore be regarded with great caution owing to the relevant limitations of our study (no age-matched non-smoking control, small study group, lack of gold standard). In addition, the occupational exposure history of our patients was evaluated and, with silicosis, an occupational exclusion criterion was explicitly given. This exclusion criterion was of utmost importance, as many of our male patients with lung diseases were former steel workers or coal miners, having worked in the most extensive European coal-mining area in the 1950s and 1960s.In our opinion, the conclusion of Franzblau et al [1], that ILO classifications from laser-printed transparencies show a significantly higher profusion of small opacities than “soft copy” or traditional film-based radiography, has become relative, as the same authors describe the similarity of those radiographs in subsequent studies [2,3].We substantially agree with Laney et al that the operation with guidelines is reasonable to obtain reliable classifications of digital images for pneumoconiosis, thus more easily rendering a direct comparison of studies. Therefore, we will consider those recently published standardised criteria in future investigations.As a consequence of the study's major limitation—the lack of an age-matched non-smoking control group—we inaugurated a corresponding follow-up study. This prospective blinded control study on 200 patients (100 smokers, 100 non-smokers) has already been approved by the ethics committee of the Ruhr-University Bochum and started in August 2011.Yours etc.,References1 Franzblau A , Kazerooni EA , Sen A , Goodsitt MM , Lee SY , Rosenman KD , et al.. Comparison of digital radiographs with film radiographs for the classification of pneumoconiosis. Acad Radiol 2009;16:669–77. Crossref Medline ISI, Google Scholar2 Sen A , Lee SY , Gillespie BW , Kazerooni EA , Goodsitt MM , Rosenman KD , et al.. Comparing film and digital radiographs for reliability of pneumoconiosis classifications: a modeling approach. Acad Radiol 2010;17:511–19. Crossref Medline ISI, Google Scholar3 Larson TC , Holiday DB , Antao VC , Thomas J , Pinheiro G , Kapil V , et al.. Comparison of digital with film radiographs for the classification of pneumoconiotic pleural abnormalities. Acad Radiol 2012;19:131–40. Crossref Medline ISI, Google Scholar Previous article FiguresReferencesRelatedDetails Volume 85, Issue 1012April 2012Pages: 293-472 2012 The British Institute of Radiology History ReceivedDecember 12,2011AcceptedDecember 13,2011Published onlineFebruary 13,2014 Metrics Download PDF

OBJECTIVES:To evaluate the technical success, clinical outcome and safety of percutaneously placed totally implantable venous power ports (TIVPPs) approved for high-pressure injections, and to analyse their value for arterial phase CT scans. METHODS:Retrospectively, we identified 204 patients who underwent TIVPP implantation in the forearm (n=152) or chest (n=52) between November 2009 and May 2011. Implantation via an upper arm (forearm port, FP) or subclavian vein (chest port, CP) was performed under sonographic and fluoroscopic guidance. Complications were evaluated following the standards of the Society of Interventional Radiology. Power injections via TIVPPs were analysed, focusing on adequate functioning and catheter's tip location after injection. Feasibility of automatic bolus triggering, peak injection pressure and arterial phase aortic enhancement were evaluated and compared with 50 patients who had had power injections via classic peripheral cannulas. RESULTS:Technical success was 100%. Procedure-related complications were not observed. Catheter-related thrombosis was diagnosed in 15 of 152 FPs (9.9%, 0.02/100 catheter days) and in 1 of 52 CPs (1.9%, 0.002/100 catheter days) (p<0.05). Infectious complications were diagnosed in 9 of 152 FPs (5.9%, 0.014/100 catheter days) and in 2 of 52 CPs (3.8%, 0.003/100 catheter days) (p>0.05). Arterial bolus triggering succeeded in all attempts; the mean injection pressure was 213.8 psi. Aortic enhancement did not significantly differ between injections via cannulas and TIVPPs (p>0.05). CONCLUSIONS:TIVPPs can be implanted with high technical success rates, and are associated with low rates of complications if implanted with sonographic and fluoroscopic guidance. Power injections via TIVPPs are safe and result in satisfying arterial contrast. Conventional ports should be replaced by TIVPPs.

OBJECTIVES:Cigarette smoking-induced airway disease commonly results in an overall increase of non-specific lung markings on chest radiography. This has been described as "dirty chest". As the morphological substrate of this condition is similar to the anthracosilicosis of coal workers, we hypothesised that it is possible to quantify the radiological changes using the International Labour Organization (ILO) classification of pneumoconiosis. The aims of this study were to evaluate whether there is a correlation between the extent of cigarette smoking and increased lung markings on chest radiography and to correlate the chest radiographic scores with findings on CT studies. METHODS:In a prospective analysis a cohort of 85 smokers was examined. The cigarette consumption was evaluated in pack years (defined as 20 cigarettes per day over 1 year). Film reading was performed by two board-certified radiologists. Chest radiographs were evaluated for the presence of thickening of bronchial walls, the presence of linear or nodular opacities, and emphysema. To correlate the smoking habits with the increase of overall lung markings in chest radiography, the ILO profusion score was converted to numbers ranging from zero to nine. Chest radiographs were rated according to the complete set of standard films of the revised ILO classification. RESULTS:63/85 (74%) of the smokers showed an increase in overall lung markings on chest radiography; 32 (37%) had an ILO profusion score of <1/1, 29 (34%) had an ILO profusion score of <2/2 and 2 (2%) had an ILO score of ≥ 2/2. There was a significant positive linear correlation between the increase of overall lung markings on chest radiography and the cigarette consumption quantified as pack years (r=0.68). The majority of the heavy smokers (>40 pack years) showed emphysema; there was no significant difference between the prevalence of emphysema as diagnosed by CT (62%) or chest radiography (71%) (p<0.05).The most common findings in CT were thickening of bronchial walls (64%) and the presence of emphysema (62%) and of intralobular opacities (61%). Ground-glass opacities were seen in only 7% of our patients. CONCLUSION:Bronchial wall thickening and intralobular opacities as seen in CT showed a positive linear correlation with the increase of overall lung markings on chest radiography.

INTRODUCTION To evaluate the frequency of enlarged hilar or mediastinal lymph nodes in patients suffering from chronic obstructive pulmonary disease (COPD). METHODS In a retrospective study, 89 patients with proven COPD were analysed. Exclusion criteria were history of malignant disease or clinical evidence of pneumonia. Prevalence, size, and localisation of enlarged lymph nodes were assessed by multi-slice computed tomography (MSCT) and correlated with the clinical stages following the GOLD classification as well as the MSCT findings of bronchitis and emphysema. RESULTS 44/89 (49%) of our patients showed enlarged lymph nodes. Lymph node enlargement was more often seen in the mediastinum (48%) than the hilar region (20%). The most common localisation of enlarged mediastinal lymph nodes was the regional station 7 following the ATS mapping (infracarinal). Patients with a stage I following the GOLD classification showed enlarged lymph nodes in 49% (18/37), stage II in 46% (12/26), stage III in 58% (7/12) and stage IV in 50% (7/14). These findings did not differ significantly (P > 0.05). Severe airway wall thickening (42/89) was significantly more often associated with an increase of nodal enlargement (64%) (P < 0.05). CONCLUSION The present study demonstrates that enlarged hilar and mediastinal lymph nodes may occur in a rather high percentage of patients suffering from COPD, especially in those with the MSCT finding of severe bronchitis.

Lymphangiosis carcinomatosa bezeichnet eine diffuse Durchsetzung des pulmonalen Lymphgefäßsystems durch Tumorzellen, am häufigsten ist sie beim Mammakarzinom. Differenzialdiagnostisch ist sie abzugrenzen von u. a. einem „capillary-leak-syndrome“, einer pulmonalen Stauung nach Antracyclin-Therapie, einer radiogenen Pneumonitis, einer durch Immunsuppression bedingten atypischen Pneumonie und einer kardial bedingten Stauung. Trotz der sehr schlechten Spontanprognose ist ein therapeutischer Nihilismus keinesfalls gerechtfertigt. Neben der supportiven Therapie (Diuretika, Steroide, Theophyllin, Heparin, Analgetika) sollte eine tumorspezifische Behandlung nicht vernachlässigt werden, beispielsweise durch 5-FU (i.v., z. B. bei Mamma-, Magenkarzinom), Anthrazykline (nicht vorbehandeltes Mammakarzinom), Taxane und neue Zytostatika (Vinorelbin, Taxotere, Gemcitabin), Immuntherapeutika bzw. -modulatoren (Herceptin, Erlotinib). Im Falle sensibler Tumoren kommt der spezifischen hormonellen Therapie besondere Bedeutung zu.