Medical Inspection – Health Blog

The diagnosis of extracardiac tumors is an important clinical application of the cross-sectional echocar­diographic technique. In the present report we de­scribe a unique series of patients who, during routine echocardiographic examination, were each noted to have a large echo-dense extracardiac mass adherent to the lateral aspect of the left ventricle. Although an extracardiac tumor was considered initially in the differential diagnosis of two of these patients, the echo- dense mass was shown subsequently to be an atelec­tatic segment of the left lower lobe of the lung. While the finding of atelectatic lung segments on routine echocardiographic examinations is not infrequent, such atelectatic lung segments are usually visualized as discrete, free-floating echo-dense masses, as op­posed to masses that appear firmly adherent to the heart. Thus, the series of patients described herein represents, to the best of our knowledge, the first description of a pulmonary atelectatic lung mass simulating an extracardiac tumor. The salient diagnos­tic features of this new finding are discussed.

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the number of reference studies and equa­tions available in the literature, surprisingly few equa­tions are widely used. Three studies accounted for 85 percent of the equations used for standard spirometric indices. It was not uncommon for institutions to use a different reference equation for each spirometric pa­rameter. While we are not aware of studies on the effects of this practice, it seems likely to increase the uncertainty that prediction equations will match the clinical population. In general, we recommend refer­ence equations for spirometric indices be selected from a single study which has been matched to the patient population. This should be relatively easy for spirometry, but is more difficult for lung volumes, Deo, and airway resistance because there are few studies available which include complete pulmonary function tests.

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The linear and nonlinear regression techniques have been used to generate equations to predict “normal values” since Hutchinson first provided a quantitative index of pulmonary function based on measurements of vital capacity in more than 2,000 healthy men in 1846. The increasing importance of pulmonary function testing in diagnosing and manag­ing lung disease and assessing impairment has re­quired more accurate definitions of normal. Innova­tions in technology and equipment, standardization of procedures, and changing concepts of normality have stimulated further studies of healthy subjects and there is now a large number of different regression equations from which to choose. Read More…

A fall in FEV, and vital capacity (VC) led to transbronchial biopsy on 29 occasions for either infec­tion or rejection. All the patients had symptoms at this time. On nine other occassions, the FEV, and VC were unchanged at a time of routine TBB and the histologic findings of the lung were normal. These patients did not have symptoms. The battery-operated pocket spirometer performed in these 15 patients without fault during the study and there was no change in calibration. From our experience we recommend that HLT recipients be instructed to record FEV, and VC daily and to contact the hospital when a fall of 10 percent or more occurs after a period of stable spirometry and persists for longer than two days.

In both acute rejection and opportunistic infection of the lungs, inflammatory cell infiltrates are found predominantly in the lung periphery. This is likely to affect compliance and this, we suspect, causes the comparable fall in both FEV! and VC with these complications. Indeed, TLC also falls. Change in Deo is more variable.

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A total of 38 transbronchial biopsies were carried out in the 15 HLT recipients during the period under review. Twenty (52.6 percent) of these showed acute lung rejection. Nine (23.7 percent) demonstrated evidence of infection, of which six were cytomegalo­virus (CMV) pneumonia, two were bacterial bronchi­tis, and one was herpes simplex pneumonitis. The remaining nine biopsy specimens had a normal ap­pearance histologically.

The mean (±SD) values of FEV, and FVC as recorded at home by the patients at the time of the acute rejection episodes were 2.27 ±1.2 L and 2.72 ± 1.3 L, respectively. Corresponding values during infection episodes and also during normal biopsies are shown in Table 1.

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The records of home spirometry and histologic findings of transbronchial biopsy specimens over the six-month period were reviewed. All the values of FEV, and FVC recorded every day by each patient were plotted against time and dates of TBB, both routine and on the occurrences of histologically diag­nosed pulmonary rejection or infection, using a micro­computer (Tandon) (Fig 2).

The change in FEV, or FVC with rejection or infection was defined as the difference in the imme­diately preceding stable recording and that recorded on a day before the time of the TBB. The normal value for each patient was defined by the stable spirometric value corresponding to the time of routine TBB that showed normal appearances histologically.

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