1
|
Roach DJ, Szugye NA, Moore RA, Hossain MM, Morales DLS, Hayes D, Towe CT, Zafar F, Woods JC. Improved donor lung size matching by estimation of lung volumes based on chest X-ray measurements. Pediatr Transplant 2023; 27:e14594. [PMID: 37655840 DOI: 10.1111/petr.14594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023]
Abstract
RATIONALE Organ size matching is an important determinant of successful allocation and outcomes in lung transplantation. While computed tomography (CT) is the gold standard, it is rarely used in an organ-donor context, and chest X-ray (CXR) may offer a practical and accurate solution in estimating lung volumes for donor and recipient size matching. We compared CXR lung measurements to CT-measured lung volumes and traditional estimates of lung volume in the same subjects. METHODS Our retrospective study analyzed clinically obtained CXR and CT lung images of 250 subjects without evidence of lung disease (mean age 9.9 ± 7.8 years; 129 M/121F). From CT, each lung was semi-automatically segmented and total lung volumes were quantified. From anterior-posterior CXR view, each lung was manually segmented and areas were measured. Lung lengths from the apices to the mid-basal regions of each lung were measured from CXR. Quantified CT lung volumes were compared to the corresponding CXR lung lengths, CXR lung areas, height, weight, and predicted total lung capacity (pTLC). RESULTS There are strong and significant correlations between CT volumes and CXR lung areas in the right lung (R2 = .89, p < .0001), left lung (R2 = .87, p < .0001), and combined lungs (R2 = .89, p < .0001). Similar correlations were seen between CT volumes and CXR measured lung lengths in the right lung (R2 = .79, p < .0001) and left lung (R2 = .81, p < .0001). This correlation between anatomical lung volume (CT) and CXR was stronger than lung-volume correlation to height (R2 = .66, p < .0001), weight (R2 = .43, p < .0001), or pTLC (R2 = .66, p < .0001). CONCLUSION CXR measures correlate much more strongly with true lung volumes than height, weight, or pTLC. The ability to obtain efficient and more accurate lung volume via CXR has the potential to change our current listing practices of using height as a surrogate for lung size, with a case example provided.
Collapse
Affiliation(s)
- David J Roach
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Ohio, Cincinnati, USA
| | - Nick A Szugye
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ryan A Moore
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Md Monir Hossain
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio, Cincinnati, USA
- Department of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Ohio, Cincinnati, USA
| | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Don Hayes
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio, Cincinnati, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Ohio, Cincinnati, USA
| | - Christopher T Towe
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Ohio, Cincinnati, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Ohio, Cincinnati, USA
| | - Farhan Zafar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Ohio, Cincinnati, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio, Cincinnati, USA
| |
Collapse
|
2
|
Association between Image Characteristics on Chest CT and Severe Pleural Adhesion during Lung Cancer Surgery. PLoS One 2016; 11:e0154694. [PMID: 27171235 PMCID: PMC4865230 DOI: 10.1371/journal.pone.0154694] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/18/2016] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to investigate the association between image characteristics on preoperative chest CT and severe pleural adhesion during surgery in lung cancer patients. We included consecutive 124 patients who underwent lung cancer surgeries. Preoperative chest CT was retrospectively reviewed to assess pleural thickening or calcification, pulmonary calcified nodules, active pulmonary inflammation, extent of emphysema, interstitial pneumonitis, and bronchiectasis in the operated thorax. The extent of pleural thickening or calcification was visually estimated and categorized into two groups: localized and diffuse. We measured total size of pulmonary calcified nodules. The extent of emphysema, interstitial pneumonitis, and bronchiectasis was also evaluated with a visual scoring system. The occurrence of severe pleural adhesion during lung cancer surgery was retrospectively investigated from the electrical medical records. We performed logistic regression analysis to determine the association of image characteristic on chest CT with severe pleural adhesion. Localized pleural thickening was found in 8 patients (6.5%), localized pleural calcification in 8 (6.5%), pulmonary calcified nodules in 28 (22.6%), and active pulmonary inflammation in 22 (17.7%). There was no patient with diffuse pleural thickening or calcification in this study. Trivial, mild, and moderate emphysema was found in 31 (25.0%), 21 (16.9%), and 12 (9.7%) patients, respectively. Severe pleural adhesion was found in 31 (25.0%) patients. The association of localized pleural thickening or calcification on CT with severe pleural adhesion was not found (P = 0.405 and 0.107, respectively). Size of pulmonary calcified nodules and extent of emphysema were significant variables in a univariate analysis (P = 0.045 and 0.005, respectively). In a multivariate analysis, moderate emphysema was significantly associated with severe pleural adhesion (odds ratio of 11.202, P = 0.001). In conclusion, severe pleural adhesion might be found during lung cancer surgery, provided that preoperative chest CT shows substantial pulmonary calcified nodules or emphysema.
Collapse
|
3
|
Pretransplant HRCT Characteristics Are Associated with Worse Outcome of Lung Transplantation for Cystic Fibrosis Patients. PLoS One 2015; 10:e0145597. [PMID: 26698308 PMCID: PMC4689402 DOI: 10.1371/journal.pone.0145597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 12/07/2015] [Indexed: 01/06/2023] Open
Abstract
Objectives Peri- and postoperative complications diminish the outcome of lung transplantation (LTx) in patients with cystic fibrosis (CF). We hypothesized that the degree of pathological findings on pre-LTx high resolution computed tomography (HRCT) is associated with higher morbidity and mortality in CF. Methods All our CF patients undergoing LTx between 2001 and 2011 were included. HRCT examinations were evaluated according to a scoring system for pulmonary disease in CF patients, the Severe Advanced Lung Disease (SALD) score and for pleural involvement. Results Fifty-three patients were included. Dominant infectious/inflammatory disease according to the SALD score was observed in 10 patients (19%). Five (50%) of those patients died within one week after LTx, compared to 2 (5%) patients without dominant infectious/inflammatory disease (p<0.001). This difference in survival percentage remained also significant in multivariate analysis. Patients with infectious/inflammatory disease received more packed red blood cells; 26 versus 8 in the first week (p<0.001). Pleural thickening was associated with higher requirement (10 units) for blood transfusion during LTx, compared to patients with normal pleura (4 units). Conclusions The analysis of HRCT in CF patients according to the SALD score showed that dominant infectious/inflammatory disease is associated with a higher mortality after LTx. If confirmed in other studies, HRCT might aid estimation of surgical risk in some adult CF patients.
Collapse
|
4
|
Camargo JJP, Irion KL, Marchiori E, Hochhegger B, Porto NS, Moraes BG, Meyer G, Caramori M, Holemans JA. Computed tomography measurement of lung volume in preoperative assessment for living donor lung transplantation: volume calculation using 3D surface rendering in the determination of size compatibility. Pediatr Transplant 2009; 13:429-39. [PMID: 18992057 DOI: 10.1111/j.1399-3046.2008.01016.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to describe the use of CT volume quantification assessment of candidates for LLDLT. Six pediatric candidates for LDLLT and their donors were investigated with helical chest CT, as part of the preoperative assessment. The CT images were analyzed as per routine and additional post-processing with CT volume quantification (CT densitovolumetry) was performed to assess volume matching between the lower lobes of the donors and respective lungs of the receptors. CT images were segmented by density and region of interest, using post-processing software. Size matching was also assessed using the FVC formula. Compatible volumes were found in three cases. The other three cases were considered incompatible. All three recipients with compatible sizes survived the procedure and are alive and well. One patient with incompatible size was submitted to the procedure and died because of complications attributed to the incompatible volumes. One patient with incompatible size has subsequently grown and new measurements are to be taken to check the current volumes. Different donors are being sought for the remaining patient whose lung volumes were considered too big for the prospective transplant donor lobes. Under FVC formula criteria, all cases were considered compatible. CT volume quantification is an easy to perform, non-invasive technique that uses CT images for the preassessment of candidates for LDLLT, to compare the volume of the lower lobes from the donors with volume of each lung in the prospective recipients. Size matching based on CT densitovolumetry and FVC may differ.
Collapse
Affiliation(s)
- Jose J P Camargo
- Post graduation Program in Respiratory Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Abstract
The exponentially growing performance of newer scanner generations has increased diagnostic opportunities and utilization of computed tomography. The excellent clinical results with CT, however, have to be weighed against a high radiation exposure. While radiation exposure with modern scanners is well below the diagnostic reference values of the EU for most organ systems, radiation dose for retrospectively gated cardiac examinations can be substantially higher: organ doses can reach 100 mGy, a dose for which cancer induction been proven. For children, the situation may also be critical if scanning parameters are not adapted to their smaller size and increased radiation risk: the risk-benefit ratio may then no longer favor CT. The application of CT for young patients, patients with favorable prognosis and for frequent follow-up examinations will increase the radiation risk to the individual and the population. The growth rates for CT utilization in Germany are well below those in the United States but the increasing number of exams will lead to a substantial increase in population dose even if the dose per individual exam can be reduced. The combination of optimum scanning parameters, automated dose modulation and dose adaptation to the individual patient will help contain radiation dose. Further reduction is possible by reducing the number of scan phases, limiting the scan length and choosing a lower tube voltage. Most important, however, is the close collaboration with referring physicians: scanning technique and choice of imaging modality can only be adapted if the clinical question is clearly defined. In the light of radiation exposure the critical and knowledgeable use of CT becomes the more important the easier it is to request an exam and the better the clinical results.
Collapse
|
6
|
Tiddens HAWM, de Jong PA. Update on the application of chest computed tomography scanning to cystic fibrosis. Curr Opin Pulm Med 2006; 12:433-9. [PMID: 17053494 DOI: 10.1097/01.mcp.0000245717.82009.ca] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To summarize the role of chest computed tomography as a tool to evaluate cystic fibrosis lung disease, and to describe what abnormalities can be detected using computed tomography and how computed tomography can be used in clinical practice. RECENT FINDINGS Pulmonary function tests are only an indirect measure of lung structure, and are insensitive to localized and early structural abnormalities. Computed tomography is able to detect small areas with localized severe damage. The differentiation between normal and abnormal on computed tomography is relatively easy. In half of cystic fibrosis patients, the information obtained from pulmonary function tests is discordant with the information obtained from computed tomography. SUMMARY Cystic fibrosis patients show lung inflammation and infection starting early in life. This leads to irreversible structural lung damage such as bronchiectasis and air trapping. Cystic fibrosis lung disease varies widely between patients. The primary aim of therapy is to prevent structural damage and to conserve lung function. Adequate monitoring of cystic fibrosis lung disease is paramount to tailor treatment to a patient's need. Computed tomography is currently the best tool to monitor lung structure, and pulmonary function tests are the best to monitor lung function.
Collapse
Affiliation(s)
- Harm A W M Tiddens
- Erasmus Medical Centre Rotterdam Sophia Children's Hospital, Department of Pediatric Pulmonology and Allergology, Rotterdam, The Netherlands.
| | | |
Collapse
|
7
|
Tiddens HAWM. Chest computed tomography scans should be considered as a routine investigation in cystic fibrosis. Paediatr Respir Rev 2006; 7:202-8. [PMID: 16938643 DOI: 10.1016/j.prrv.2006.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cystic fibrosis (CF) patients demonstrate lung inflammation and infection beginning early in life. Both inflammation and infection lead to irreversible structural lung damage, primarily as bronchiectasis and fibrosis. The course of CF varies widely between patients due to genotypic and environmental differences. The primary aim of CF therapy is to prevent or delay structural damage and conserve lung function. Adequate monitoring of CF lung disease is paramount to tailoring treatment to a patient's need. Pulmonary function tests (PFTs) are important in monitoring lung function. PFTs, however, are only an indirect measure of lung structure and are insensitive to localised or early damage. By contrast, computed tomography (CT) is currently the most sensitive tool to monitor lung structure. As up to 50% of patients will have discordant staging of lung disease when PFTs are compared to CT findings, both methods are needed to adequately assess a patient's pulmonary condition and tailor the treatment strategy to the patient's needs.
Collapse
Affiliation(s)
- Harm A W M Tiddens
- Erasmus MC-Sophia, Department of Pediatric Pulmonology and Allergology, Dr Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands.
| |
Collapse
|
8
|
Cooper P, MacLean J. High-resolution computed tomography (HRCT) should not be considered as a routine assessment method in cystic fibrosis lung disease. Paediatr Respir Rev 2006; 7:197-201. [PMID: 16938642 DOI: 10.1016/j.prrv.2006.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
High-resolution computed tomography (HRCT) scanning of the chest should not be considered a routine clinical investigation in the management of CF. Although it demonstrates the detection of early lung damage in children with cystic fibrosis (CF), before HRCT can be considered for routine clinical use in CF it needs to be shown that the benefit from the information obtained will out-weigh potential risks. There is insufficient evidence for the benefit of HRCT for its inclusion into routine care. Moreover, in the absence of information resulting in change in management, HRCT has the potential to increase anxiety for both clinicians and families. In order to advocate for incorporating this technology into routine CF care, further support for its role in management decisions is needed.
Collapse
Affiliation(s)
- Peter Cooper
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia.
| | | |
Collapse
|
9
|
McMahon CJ, Dodd JD, Hill C, Woodhouse N, Wild JM, Fichele S, Gallagher CG, Skehan SJ, van Beek EJR, Masterson JB. Hyperpolarized 3helium magnetic resonance ventilation imaging of the lung in cystic fibrosis: comparison with high resolution CT and spirometry. Eur Radiol 2006; 16:2483-90. [PMID: 16871384 DOI: 10.1007/s00330-006-0311-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Revised: 04/20/2006] [Accepted: 04/21/2006] [Indexed: 01/08/2023]
Abstract
The purpose of this study was to compare hyperpolarized 3helium magnetic resonance imaging (3He MRI) of the lungs in adults with cystic fibrosis (CF) with high-resolution computed tomography (HRCT) and spirometry. Eight patients with stable CF prospectively underwent 3He MRI, HRCT, and spirometry within 1 week. Three-dimensional (3D) gradient-echo sequence was used during an 18-s breath-hold following inhalation of hyperpolarized 3He. Each lung was divided into six zones; 3He MRI was scored as percentage ventilation per lung zone. HRCT was scored using a modified Bhalla scoring system. Univariate (Spearman rank) and multivariate correlations were performed between 3He MRI, HRCT, and spirometry. Results are expressed as mean+/-SD (range). Spirometry is expressed as percent predicted. There were four men and four women, mean age = 31.9+/-9 (20-46). Mean forced expiratory volume in 1 s (FEV)1 = 52%+/-29 (27-93). Mean 3He MRI score = 74%+/-25 (55-100). Mean HRCT score = 48.8+/-24 (13.5-83). The correlation between 3He MRI and HRCT was strong (R = +/-0.89, p < 0.001). Bronchiectasis was the only independent predictor of 3He MRI; 3He MRI correlated better with FEV1 and forced vital capacity (FVC) (R = 0.86 and 0.93, p < 0.01, respectively) than HRCT (R = +/-0.72 and +/-0.81, p < 0.05, respectively). This study showed that 3He MRI correlates strongly with structural HRCT abnormalities and is a stronger correlate of spirometry than HRCT in CF.
Collapse
Affiliation(s)
- Colm J McMahon
- Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Mori S, Endo M, Nishizawa K, Murase K, Fujiwara H, Tanada S. Comparison of patient doses in 256-slice CT and 16-slice CT scanners. Br J Radiol 2006; 79:56-61. [PMID: 16421406 DOI: 10.1259/bjr/39775216] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The 256-slice CT-scanner has been developed at the National Institute of Radiological Sciences. Nominal beam width was 128 mm in the longitudinal direction. When scanning continuously at the same position to obtain four-dimensional (4D) images, the effective dose is increased in proportion to the scan time. Our purpose in this work was to measure the dose for the 256-slice CT, to compare it with that of the 16-slice CT-scanner, and to make a preliminary assessment of dose for dynamic 3D imaging (volumetric cine imaging). Our group reported previously that the phantom length and integration range for dosimetry needed to be at least 300 mm to represent more than 90% of the line integral dose with the beam width between 20 mm and 138 mm. In order to obtain good estimates of the dose, we measured the line-integral dose over a 300 mm range in PMMA (polymethylmethacrylate) phantoms of 160 mm or 320 mm diameter and 300 mm length. Doses for both CT systems were compared for a clinical protocol. The results showed that the 256-slice CT generates a smaller dose than the 16-slice CT in all examinations. For volumetric cine imaging, we found an acceptable scan time would be 6 s to 11 s, depending on examinations, if dose must be limited to the same values as routine examinations with a conventional multidetector CT. Finally, we discussed the studies necessary to make full use of volumetric cine imaging.
Collapse
Affiliation(s)
- S Mori
- Department of Medical Physics, National Institute of Radiological Sciences, Chiba 263-8555, Japan
| | | | | | | | | | | |
Collapse
|
11
|
Abstract
BACKGROUND Massive hemoptysis is a complication commonly reported in patients with cystic fibrosis (CF). An understanding of the pathophysiology of this complication and its consequences is important for the management of patients with CF. OBJECTIVES To identify risk factors associated with massive hemoptysis, and to determine the prognosis of patients following an episode of massive hemoptysis. DESIGN A retrospective, observational cohort study of the National CF Patient Registry between the years 1990 to 1999. PATIENTS The Registry contained data on 28,858 patients with CF observed over 10 years at CF centers across the United States. RESULTS Massive hemoptysis occurred with an average annual incidence of 0.87% and in 4.1% of patients overall. There was no increased occurrence by sex, but it was more prevalent in older patients (mean age, 24.2 +/- 8.7 years [+/- SD]) with more severe pulmonary impairment (nearly 60% of patients who had an episode of massive hemoptysis had FEV1 < 40% predicted). The principal risks associated with an increased occurrence of massive hemoptysis included the presence of Staphylococcus aureus in sputum cultures (odds ratio [OR], 1.3) and diabetes (OR, 1.1). There was an increased morbidity (eg, increased hospitalizations and hospital days) and an increased 2-year mortality following massive hemoptysis. CONCLUSION Massive hemoptysis is a serious complication in CF patients, occurring more commonly in older patients with more advanced lung disease. Nearly 1 in 100 patients will have this complication each year. There is an attributable mortality to the complication and considerable morbidity, resulting in increased health-care utilization and a measurable decline in lung function.
Collapse
Affiliation(s)
- Patrick A Flume
- Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, 812-CSB, Charleston, SC 29425, USA.
| | | | | | | | | |
Collapse
|
12
|
Wunsch R, Wunsch C. [Thoracic findings in pediatric patients with cystic fibrosis]. Radiologe 2003; 43:1103-8. [PMID: 14668999 DOI: 10.1007/s00117-003-0987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cystic fibrosis is the most common autosomal recessive metabolic disease in Europe with an incidence of 1:2500. The severity of the lung disease is the most important factor of morbidity and mortality in CF-patients. Because of the better diagnostic and therapeutic modalities life expectancy has increased significantly. The underlying pathology is a defect of chromosome 7, which encodes the regulation of the fluid balance across the cell membrane which effects chloride as well as sodium. The exocrine glands produce a viscous mucus which obstructs the airways and promotes infections. The result is the destruction of lung parenchyma. In daily routine, chest x-ray is still the most important radiological tool, although computed tomography depicts changes in morphology earlier and more exactly. Recent research studies show that MRI has-because of its additional functional options-interesting aspects for the future.
Collapse
Affiliation(s)
- R Wunsch
- Abteilung Radiologie, Vestische Kinder- und Jugendklinik, Universität Witten/Herdecke, Datteln.
| | | |
Collapse
|
13
|
Hadjiliadis D, Sporn TA, Perfect JR, Tapson VF, Davis RD, Palmer SM. Outcome of lung transplantation in patients with mycetomas. Chest 2002; 121:128-34. [PMID: 11796441 DOI: 10.1378/chest.121.1.128] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Lung transplantation has become an acceptable treatment option for many end-stage lung diseases. Pulmonary mycetomas are found in patients with end-stage lung diseases, especially sarcoidosis. The clinical course and long-term outcome of these patients after transplantation remains unknown. METHODS We reviewed retrospectively the pathology reports of the explanted lungs from all lung and heart-lung transplantations performed at our institution between January 20, 1992, and June 26, 2000. Patients were included in our study if mycetomas were present on the specimens. Information on transplant date and type, diagnosis, information on antifungal therapy and fungal infections pretransplant and posttransplant, and clinical course after transplantation was recorded. RESULTS Mycetomas were present in 3.0% of transplant recipients (9 of 303 patients). The underlying pulmonary diagnoses were sarcoidosis (six patients), and emphysema, idiopathic pulmonary fibrosis, and pneumoconiosis (one patient each). Seven patients received bilateral lung transplants, one patient received a heart/lung transplant, and one patient received a single lung transplant. Aspergillus was isolated from culture in five patients pretransplant and from five patients posttransplant. Six patients received treatment with itraconazole, or IV or inhaled amphotericin B prior to transplantation. All patients who survived transplantation received posttransplant antifungal therapy. Four patients died in the first month after transplantation. Two patients died at 17 months and 24 months posttransplant, respectively; one patient received a second transplant 30 months later; and two patients are alive and free from fungal infections 17 months and 18 months, respectively, after transplantation. All of the medium-term survivors received lengthy therapy with inhaled and systemic amphotericin B and itraconazole before and after transplantation. CONCLUSIONS Lung transplant recipients with mycetomas have significantly reduced posttransplant survival. Careful selection of patients and aggressive antifungal therapies before and after transplantation have led to improved outcomes in patients with mycetomas. Additional research is needed to define the best therapeutic strategy for these patients during transplantation.
Collapse
Affiliation(s)
- Denis Hadjiliadis
- Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | | | | | | | | | | |
Collapse
|
14
|
Bremner RM, Woo MS, Arroyo H, Nigro JJ, Horn MV, Wells WJ, Barr M, Starnes VA. The Effect of Pleural Adhesions on Pediatric Cystic Fibrosis Patients Undergoing Lung Transplantation. Am Surg 2001. [DOI: 10.1177/000313480106701204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The degree of pleural scarring complicating cystic fibrosis (CF) lung disease is thought to impact on the outcome of adult lung transplantation. This has not been previously studied in the pediatric population. We studied all patients undergoing lung transplantation at Children's Hospital Los Angeles from 1993 through 2000. Operative times, grade of pleural scarring, blood product transfusion requirements, and perioperative mortality were compared for patients with cystic fibrosis (35) versus those without this diagnosis (11). Patients with CF were slightly older (14.7 ± 3.8 vs 10.6 ± 5.6 years; P = 0.01) but had similar weights (34.8 ± 8.7 vs 34.4 ± 12.3 kg). The degree of pleural scarring was greater in the CF group but was only severe in four patients. Scarring did not impact on operative times (237 ± 46 vs 219 ± 39 minutes; P = 0.22) or cardiopulmonary bypass times (127 ± 40 vs 133 ± 49 minutes). Total perioperative blood requirements for the two groups were similar (35.6 ± 14.9 vs 42.8 ± 76.7 cm3/kg; P = 0.82). Pleural scarring in the pediatric CF patients undergoing lung transplantation is only severe in a minority of patients. It does not increase duration of operation nor blood transfusion requirements. CT scanning is consequently unnecessary in the preoperative workup of CF patients being evaluated for transplantation. CF patients undergoing transplantation have perioperative outcomes similar to those of noncystic patients.
Collapse
Affiliation(s)
- Ross M. Bremner
- Cardioihoracic Transplant Team, Department of Cardiothoracic Surgery
| | - Marilyn S. Woo
- Division of Pediatric Pulmonology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hector Arroyo
- Cardioihoracic Transplant Team, Department of Cardiothoracic Surgery
| | - John J. Nigro
- Cardioihoracic Transplant Team, Department of Cardiothoracic Surgery
| | - Monica V. Horn
- Cardioihoracic Transplant Team, Department of Cardiothoracic Surgery
| | - Winfield J. Wells
- Cardioihoracic Transplant Team, Department of Cardiothoracic Surgery
| | - Mark Barr
- Cardioihoracic Transplant Team, Department of Cardiothoracic Surgery
| | - Vaughn A. Starnes
- Cardioihoracic Transplant Team, Department of Cardiothoracic Surgery
| |
Collapse
|
15
|
Abstract
Bronchial diseases are common in children, and are usually associated with disturbances of aeration. This article briefly summarizes the embryological development and respiratory physiology pertinent to pediatric bronchial diseases. Current diagnostic imaging tools are discussed, with an emphasis on CT, which can demonstrate bronchial pathology such as bronchial obstruction and bronchiectasis in larger bronchi, as well as indirectly show the peripheral physiologic consequences of bronchial disease, such as alterations in aeration. Computed tomography measurements of lung attenuation may aid in diagnosis in problematic cases. Diseases that affect the pediatric airways at different ages are reviewed. Knowledge of these entities is important for accurate interpretation of imaging studies.
Collapse
Affiliation(s)
- N A Kothari
- Department of Radiology The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | | |
Collapse
|