Computed Tomographic Appearance of Organizing Pneumonia in an Oncologic Patient Population

Abstract We report 25 verified cases of well-differentiated cerebral astrocytomas in adults treated between 1978 and 1988. All patients were diagnosed by computed tomographic (CT); scans, with 5 undergoing a craniotomy for debulking and 20 undergoing a biopsy alone. The median survival for the entire group was 8.2 years, the longest survival yet reported for a series of patients with these tumors. A review of the literature suggests that the longer survival observed in more recent series is the result of the earlier diagnosis of tumors afforded by modern brain imaging. Twenty of our patients presented with seizures in the absence of any other focal findings and would probably not have had a biopsy in the era before CT scans until their tumors had progressed. Only 8% of our patients had papilledema at the time of presentation, in contrast to almost half of the patients with low-grade astrocytomas reported before 1975, supporting the hypothesis that patients in the CT era are diagnosed earlier. None of our patients died from progressive low-grade disease. One patient died from a squamous cell cancer, and 7 died as a consequence of their tumors dedifferentiating into a more malignant astrocytoma or glioblastoma multiforme, with a median time of approximately 5 years after the diagnosis. Our findings, together with the available data in the literature, suggest that death from a focal low-grade astrocytoma, in the absence of malignant degeneration, may be a rare event. Consequently, future therapeutic efforts should be targeted at preventing dediffer-entiation. The use of radiotherapy in this series of patients did not make a significant impact upon either the time to dedifferentiation or the time to death, but the numbers are small. Given the potential long-term detrimental effect of radiotherapy, the use of this treatment modality must be re-evaluated in the light of the earlier diagnosis and longer natural survival of the patient with an astrocytoma diagnosed in the CT era. Moreover, given the longer survival we observed in a patient population diagnosed predominantly by a biopsy alone, the necessity for radical surgery may also need to be reviewed. In view of the evolving nature of this patient population, much of the older literature on astrocytomas may have little relevance in advising and treating the “modern” patient with an astrocytoma.

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Heparin-induced Thrombocytopenia Type II in Subarachnoid Hemorrhage Patients: Incidence and Complications

Neurosurgery ◽

10.1227/01.neu.0000166539.02280.e5 ◽

2005 ◽

Vol 57 (2) ◽

pp. 243-248 ◽

Cited By ~ 22

Author(s):

Brian L. Hoh ◽

Manish Aghi ◽

Johnny C. Pryor ◽

Christopher S. Ogilvy

Keyword(s):

Subarachnoid Hemorrhage ◽

Patient Population ◽

Laboratory Data ◽

Type Ii ◽

High Exposure ◽

Heparin Induced Thrombocytopenia ◽

Computed Tomographic ◽

Fisher Grade ◽

Neurosurgical Patient ◽

Thrombotic Complications

ABSTRACT OBJECTIVE: Heparin-induced thrombocytopenia Type II (HIT II) is the autoimmune-mediated severe form of the disease characterized by a significant reduction in platelets, and it carries a high risk of “paradoxical” serious thrombotic complications. Although HIT II has been studied in several different patient populations, the incidence of HIT II and the rate of thrombotic complications have never been reported in a neurosurgical patient population. Subarachnoid hemorrhage (SAH) patients, among neurosurgical patient populations, have a high exposure to heparin because they are in critical care units and have indwelling vascular catheters. In addition, the increase in neuroendovascular procedures with the associated use of heparinization will increase the exposure of SAH patients to heparin. METHODS: During a 3.5-year period (January 2000–June 2003), 389 consecutive SAH patients were treated at our center. We retrospectively reviewed their laboratory data and medical records and used accepted clinical criteria for the diagnosis of HIT II to determine the incidence of HIT II, thrombotic complications, management, and outcome. RESULTS: Fifty-nine patients (15%) met the clinical diagnostic criteria for HIT II. The average platelet count nadir in the HIT II patients was 68,600 ± 25,300/μl (mean ± standard deviation). Female patients and patients with Fisher Grade 3 were more likely to develop HIT II (P < 0.01). Thirty-six patients (61%) underwent a neuroendovascular procedure. The rate of systemic thrombotic complications in the HIT II patients was 37 versus 7% in SAH patients without HIT II (P < 0.001), and the rate of new hypodensities on head computed tomographic scans was 66% in the HIT II patients versus 40% in the SAH patients without HIT II (P < 0.001). Clinical outcomes were worse in the HIT II patients. The outcome was favorable for 38% in the HIT II patients versus 52% in all SAH patients (P < 0.05), and deaths were more common (29%) in the HIT II patients than in all SAH patients (12%, P < 0.001). CONCLUSION: The incidence of HIT II in SAH patients at a single center was 15%. The SAH patients with HIT II had significantly higher rates of thrombotic complications, new hypodensities on head computed tomographic scans, more deaths, and significantly less favorable outcomes. This is the first report of the incidence of HIT II in a neurosurgical patient population.

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Cryptogenic Organizing Pneumonia With Lung Nodules Secondary to Pulmonary Manifestation of Crohn Disease

Clinical Medicine Insights Case Reports ◽

10.1177/1179547617710672 ◽

2017 ◽

Vol 10 ◽

pp. 117954761771067 ◽

Cited By ~ 3

Author(s):

Taufiq Zaman ◽

Joseph Watson ◽

Mohammad Zaman

Keyword(s):

Crohn Disease ◽

Case Reports ◽

Pulmonary Involvement ◽

Lung Nodules ◽

Organizing Pneumonia ◽

Extraintestinal Manifestation ◽

Cryptogenic Organizing Pneumonia ◽

Computed Tomographic ◽

Immune Mediated ◽

Bilateral Lung

Crohn disease is an immune-mediated inflammatory condition with gastrointestinal and extraintestinal manifestations in patients. Pulmonary involvement of Crohn disease is one manifestation. There have been case reports which have shown Crohn disease and lung nodules which were noted to be histopathological as cryptogenic organizing pneumonia (COP). In our case, a 22-year-old woman with Crohn disease was seen with complaints of chest pain and cough. Computed tomographic scan of chest showed multiple bilateral lung nodules, for which biopsy was done, which showed COP. The case study is followed by a deeper discussion of COP and the extraintestinal manifestation seen in inflammatory bowel disease.

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Organ Doses and Radiation Risk of Computed Tomographic Coronary Angiography in a Clinical Patient Population

Journal of Computer Assisted Tomography ◽

10.1097/rct.0000000000000253 ◽

2015 ◽

Vol 39 (4) ◽

pp. 591-597 ◽

Cited By ~ 3

Author(s):

Liesbeth Eloot ◽

Daniel Devos ◽

Stephen Van Meerbeeck ◽

Eric Achten ◽

Koenraad Verstraete ◽

...

Keyword(s):

Coronary Angiography ◽

Patient Population ◽

Radiation Risk ◽

Organ Doses ◽

Clinical Patient ◽

Computed Tomographic ◽

Computed Tomographic Coronary Angiography

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Effectiveness of Clinical Decision Tools in Predicting Pulmonary Embolism

Pulmonary Medicine ◽

10.1155/2021/8880893 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Michael A. Simon ◽

Christopher Tan ◽

Patrick Hilden ◽

Lyle Gesner ◽

Barry Julius

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Patient Population ◽

Clinical Decision ◽

Decision Tools ◽

Computed Tomographic ◽

The Common ◽

Revised Geneva Score ◽

High Index Of Suspicion ◽

D Dimer

Objective. The Wells criteria and revised Geneva score are two commonly used clinical decision tools (CDTs) developed to assist physicians in determining when computed tomographic angiograms (CTAs) should be performed to evaluate the high index of suspicion for pulmonary embolism (PE). Studies have shown varied accuracy in these CDTs in identifying PE, and we sought to determine their accuracy within our patient population. Methods. Patients admitted to the Emergency Department (ED) who received a CTA for suspected PE from 2019 Jun 1 to 2019 Aug 31 were identified. Two CDTSs, the Wells criteria and revised Geneva score, were calculated based on data available prior to CTA and using the common D-Dimer cutoff of >500 μg/L. We determined the association between confirmed PE and CDT values and determined the association between the D-Dimer result and PE. Results. 392 CTAs were identified with 48 (12.1%) positive PE cases. The Wells criteria and revised Geneva score were significantly associated with PE but failed to identify 12.5% and 70.4% of positive PE cases, respectively. Within our cohort, a D-Dimer cutoff of >300 μg/L was significantly associated with PE and captured 95.2% of PE cases. Conclusions. Both CDTs were significantly associated with PE but failed to identify PE in a significant number of cases, particularly the revised Geneva score. Alternative D-Dimer cutoffs may provide better accuracy in identifying PE cases.

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Independent Validation of the Secondary Intracerebral Hemorrhage Score With Catheter Angiography and Findings of Emergent Hematoma Evacuation

Neurosurgery ◽

10.1227/neu.0b013e31822fbf43 ◽

2011 ◽

Vol 70 (1) ◽

pp. 131-140 ◽

Cited By ~ 12

Author(s):

Josser E. Delgado Almandoz ◽

Bharathi D. Jagadeesan ◽

Christopher J. Moran ◽

DeWitte T. Cross ◽

Gregory J. Zipfel ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Ct Angiography ◽

Patient Population ◽

Area Under The Curve ◽

Catheter Angiography ◽

Characteristic Analysis ◽

Vascular Abnormality ◽

Hematoma Evacuation ◽

Computed Tomographic ◽

Significant Difference

Abstract BACKGROUND The secondary intracerebral hemorrhage (SICH) score, derived from a cohort of patients with intracerebral hemorrhage examined with computed tomographic (CT) angiography, predicts a patient's risk of harboring a vascular etiology. OBJECTIVE To validate the SICH score in an independent patient population. METHODS We retrospectively reviewed all adults with nontraumatic ICH who presented to our institution during a 5.4-year period and were evaluated with catheter angiography or underwent emergent hematoma evacuation, and applied the SICH score to this cohort. Receiver operating characteristic analysis was performed to determine the area under the curve (AUC) and maximum operating point (MOP). Patients with subarachnoid hemorrhage in the basal cisterns were excluded. RESULTS The study included 341 patients, with a mean age of 57.2 years (range, 18–88). Of these, 179 patients were male (52.5%) and 162 were female (47.5%). Two hundred ninety-two patients were evaluated with catheter angiography (85.6%), and 49 underwent emergent hematoma evacuation (14.4%). The SICH score successfully predicted an increasing risk of underlying vascular etiologies in the independent patient cohort, which was similar to the cohort examined with CT angiography. The MOP was reached at a SICH score >2, with the highest incidence of vascular etiologies in patients with SICH scores of 3 (18.8%), 4 (39%), and 5 (79.2%). There was no significant difference in the AUC between the 2 cohorts (0.82-0.87). CONCLUSION The SICH score successfully predicted the risk of a patient with ICH of harboring a vascular etiology in an independent patient population. This scoring system could be used to select patients with ICH for neurovascular evaluation to exclude an underlying vascular abnormality.

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High-Resolution Computed Tomographic Features of Bronchiolitis Obliterans Organizing Pneumonia

CHEST Journal ◽

10.1378/chest.102.1_supplement.26s ◽

1992 ◽

Vol 102 (1) ◽

pp. 26-31 ◽

Cited By ~ 31

Author(s):

Koichi Nishimura ◽

Harumi Itoh

Keyword(s):

High Resolution ◽

Bronchiolitis Obliterans ◽

Organizing Pneumonia ◽

Bronchiolitis Obliterans Organizing Pneumonia ◽

Computed Tomographic

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