La Radiologia medica
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La Radiologia medica · Jul 1996
[Thoracic radiography and high resolution computerized tomography in the diagnosis of pulmonary disorders caused by amiodarone].
To assess the radiographic patterns of amiodarone-induced pulmonary toxicity, the chest films (32) and HRCT scans (16) were reviewed of 14 patients into amiodarone protocols for 3 months to 6.5 years (average: 40.5 months). All patients were symptomatic and presented with shortness of breath, a general malaise, a fever. The radiographic findings included: intersurface signs, defined as irregular interfaces between parenchyma, bronchi, vessels and visceral pleura, indicating interstitial abnormalities (HRCT: 8 = 50%); septal thickening (Kerley's lines) (chest film: 32 = 100%; HRCT: 6 = 37%); reticular opacities (chest film: 24 = 75%; HRCT: 6 = 37%); peribronchial cuffing (chest film: 2 = 6%; HRCT: 0); interstitial nodules (chest film: 12 = 37%; HRCT: 4 = 25%); alveolar nodules (chest film: 16 = 50%; HRCT: 12 = 75%); consolidations (chest film: 20 = 62%; HRCT: 12 = 75%); parenchymal masses (chest film: 2 = 6%; HRCT: 2 = 12%); fibrosis (chest film: 24 = 75%; HRCT: 16 = 100%); reduced lung volume (chest film: 14 = 43%; HRCT: 4 = 25%); pleural effusion and/or thickening (chest film: 4 = 12%; HRCT: 4 = 25%). ⋯ Amiodarone discontinuation and corticosteroids administration improved the radiographic patterns in 2 patients and attenuated the symptoms, with disappearance of alveolar nodules, in 11 patients. In contrast, clinical symptoms progressed and the radiographic pattern worsened in one patient. Both chest films (Kerley's lines, reticular, interstitial and alveolar opacities without cuffing and pleural effusion or clear fibrosis) and HRCT (fibrosis associated with alveolar opacities) showed sufficiently typical patterns of amiodarone-induced pulmonary toxicity, especially when associated with pleural thickening.
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La Radiologia medica · Jul 1996
[Pulmonary thromboembolism and diagnostic imaging: integration of techniques and methods].
Thromboembolism is presently the third most frequent cardiovascular disease, with an incidence of deep venous thrombosis of 800,000 cases a year in the USA. The clinical diagnosis of the condition is difficult and noninvasive procedures are poorly reliable, which makes the diagnosis and treatment of deep venous thrombosis appropriate in the patient with clinically suspected pulmonary embolism. Color-Doppler US is now replacing phlebography in the diagnosis of deep venous thrombosis. ⋯ In 198 patients in whom no caval filter was implanted, pulmonary embolism did not recur. At present, the role of the radiologist is markedly changing, especially in the management of this condition. On the one hand, radiologists must diagnose thromboembolism as a whole and not only its pulmonary evidence; on the other hand, they play a major operational and interventional role in the treatment of thromboembolism patients.