Clinics in chest medicine
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The development of widespread lung cancer screening programs has the potential to dramatically increase the number of thoracic computed tomography (CT) examinations performed annually in the United States, resulting in a greater number of newly detected, indeterminate solitary pulmonary nodules (SPNs). Additional imaging studies, such as fluorodeoxyglucose F 18 (FDG)-positron emission tomography (PET), have been shown to provide valuable information in the assessment of indeterminate SPNs. Newer technologies, such as contrast-enhanced dual-energy chest CT and FDG-PET/CT, also have the potential to facilitate diagnosis of potentially malignant SPNs.
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Clinics in chest medicine · Jun 2015
ReviewImaging of the central airways with bronchoscopic correlation: pictorial essay.
A wide variety of pathologic processes, both benign and malignant, affect the central airways. These processes may be classified into 4 distinct groups: anatomic variants, lesions that result in focal or diffuse airway narrowing, and those that result in multinodular airway disorder. Key to the accurate assessment of the central airways is meticulous imaging technique, especially the routine acquisition of contiguous high-resolution, 1-mm to 1.5-mm images. ⋯ In addition to diagnosing airway abnormalities, computed tomography (CT) also serves a critical complementary role to current bronchoscopic techniques for both diagnosing and treating airway lesions. Advantages of CT include noninvasive visualization of the extraluminal extent of lesions, as well as visualization of airways distal to central airways obstructions. As discussed and illustrated later, thorough knowledge of current bronchoscopic approaches to central airway disease is essential for optimal correlative CT interpretation.
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Pulmonary involvement is a frequent manifestation of connective tissue disease (CTD)-related thoracic disease. It is important to characterize the underlying pattern when pulmonary involvement occurs in a patient with CTD, and to exclude other causes. ⋯ In complex cases, a multidisciplinary approach should be considered, potentially including the pulmonologist, rheumatologist, radiologist, pathologist, and sometimes the infectious disease specialist or oncologist. New techniques, such as quantitative computed tomography and MRI, are expected to be helpful for evaluation and management of CTD-associated thoracic disease.
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Clinics in chest medicine · Jun 2015
ReviewLow-dose computed tomographic screening for lung cancer.
Low-dose computed tomographic (LDCT) screening is now moving from clinical trials to clinical practice, following the report from the National Lung Screening Trial that LDCT screening for lung cancer can reduce the number of deaths from lung cancer by 20% in current and former smokers, ages 55 to 74 years, with a 30 pack-year smoking history. This article reviews the current evidence for screening, key elements of a successful lung cancer screening clinic, and reporting and management guidelines for LDCT screening findings.
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Diffuse cystic and nodular lung diseases have characteristic imaging findings. The most common causes of cystic lung disease are lymphangioleiomyomatosis and Langerhans cell histiocytosis. ⋯ Diffuse nodular lung disease are categorized as centrilobular, perilymphatic, and random types. In diffuse nodular lung disease, a specific diagnosis is achieved through a combination of history, physical examination, and imaging findings.