Clinics in chest medicine
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Lung involvement is common in patients who have complications of connective tissue disease (CTDs) and causes considerable morbidity and mortality. High resolution CT (HRCT) has a pivotal role in the detection of lung fibrosis. In patients who have coexistent pathologic processes, HRCT often allows the predominant process to be identified. ⋯ However, the limitations of HRCT should not be overlooked. In many cases, HRCT appearances are nonspecific and may or may not be related to an underlying CTD. Thus, radiologic findings should never be interpreted without knowledge of the clinical picture.
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Clinics in chest medicine · Mar 2008
ReviewImaging of occupational and environmental lung diseases.
The chest radiograph is the basic tool for identifying occupational and environmental lung diseases; however, its sensitivity and specificity for the diagnosis of occupational and environmental lung diseases are low. High-resolution CT is the optimal method of recognizing parenchymal abnormalities in occupational and environmental disease. With the exception of pleural plaques, the CT findings of occupational and environmental lung diseases are nonspecific. Therefore, correlation of imaging features with history of exposure, other clinical features, and sometimes pathology is needed for the diagnosis of pneumoconiosis.
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Clinics in chest medicine · Mar 2008
ReviewImaging of small airways disease and chronic obstructive pulmonary disease.
CT is a useful tool for identification of small airways diseases, and it can be used to classify these entities into inflammatory and constrictive bronchiolitis. Inflammatory forms of bronchiolitis include cellular bronchiolitis (usually caused by infection or aspiration), respiratory bronchiolitis, panbronchiolitis, and follicular bronchiolitis. Constrictive bronchiolitis may be caused by previous infection, toxic inhalation, collagen vascular disease, or transplantation. CT also helps categorize chronic obstructive pulmonary disease into emphysema predominant and airway predominant forms.
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Clinics in chest medicine · Dec 2007
ReviewMechanical ventilation and acute respiratory distress syndrome in older patients.
As the population of the United States ages, an increasing number of elderly adults will be cared for in intensive care units. An understanding of how aging affects the respiratory system is important for patient care and ongoing research. ⋯ We present a discussion of the management of acute lung injury and acute respiratory distress syndrome with a focus on the role of mechanical ventilation. We conclude with what is known about age and its impact on mortality and functional outcomes after mechanical ventilation.
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Clinics in chest medicine · Dec 2007
ReviewNoninvasive ventilation in the older patient who has acute respiratory failure.
Older patients are at significantly increased risk of acute respiratory failure from multiple causes. Noninvasive positive pressure ventilation has been shown to dramatically improve care of patients with acute respiratory failure. ⋯ The presence of a do-not-intubate order does not necessarily preclude the use of noninvasive positive pressure ventilation, and some patients may derive significant benefit from its use. Overall, noninvasive positive pressure ventilation is a reasonable and justifiable option in the treatment of acute respiratory failure in older patients.