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Sheeka A, Singaravelou A, Bartlett E, Sivarasan N, Rawal B, Devaraj A, Desai S, Padley S, Ridge C. EP06.01-008 COVID-Protected Pathways for Image Guided Lunc Cancer Intervention During the COVID-19 Pandemic: A Cohort Study. J Thorac Oncol 2022. [PMCID: PMC9452024 DOI: 10.1016/j.jtho.2022.07.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Woodhull S, Bush A, Tang AL, Padley S. Massive paediatric pulmonary haemorrhage in Dieulafoy's disease: Roles of CT angiography, embolisation and bronchoscopy. Paediatr Respir Rev 2020; 36:100-105. [PMID: 32680823 DOI: 10.1016/j.prrv.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
Acute, major pulmonary haemorrhage in children, is rare, may be life-threatening and at times presents atypically. Dieulafoy's disease of the bronchus presenting with recurrent or massive hemoptysis was first described in adults. Prior to reviewing the literature, we report an illustrative case of bronchial Dieulafoy's disease (BDD) in a child presenting unusually with massive apparent hematemesis. The source of bleeding is a bronchial artery that fails to taper as it terminates within the bronchial submucosa. A high index of suspicion is required to identify such lesions via radiological imaging and the role of bronchial artery embolisation is highlighted with video images of angiography included.
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Affiliation(s)
- S Woodhull
- Department of Paediatrics, Subang Jaya Medical Centre, Malaysia.
| | - A Bush
- Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK; Respiratory Paediatrics, National Heart & Lung Institute, Imperial College London, London, UK.
| | - A L Tang
- Department of Radiology, Subang Jaya Medical Centre, Malaysia
| | - S Padley
- Diagnostic and Interventional Radiology, National Heart & Lung Institute, Imperial College London, UK; The Royal Brompton & Harefield NHS Foundation Trust, Sydney St, London SW3 6NP, UK.
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Barnett J, Pulzato I, Javed M, Lee YJ, Choraria A, Kemp SV, Rice A, Jordan S, Shah PL, Nicholson AG, Padley S, Devaraj A. Radiological-pathological correlation of negative CT biopsy results enables high negative predictive value for thoracic malignancy. Clin Radiol 2020; 76:77.e9-77.e15. [PMID: 33059852 DOI: 10.1016/j.crad.2020.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
AIM To evaluate multidisciplinary team (MDT) practice of radiological-pathological correlation of non-malignant biopsy results to examine the additive effect on the predictive values of computed tomography (CT) biopsy for malignancy and their subsequent management and outcomes. MATERIALS AND METHODS A service evaluation of the MDT management of non-malignant lung biopsy results (May 2014- May 2017) was undertaken. RESULTS Sixty patients had a non-malignant diagnosis on initial CT biopsy. Five patients were lost to follow-up leaving 55 in the final cohort. Forty-eight of the 55 patients had biopsy results classified as potentially non-specific, of which 26 were classified as concordant with radiology (e.g., organising pneumonia with compatible CT features), and 22 were classified as discordant (e.g., non-specific inflammation and yet sufficiently suspicious CT features). Patients with concordant negative pathology showed resolution (n=19) or stability (n=6) on imaging follow-up. One lesion demonstrated growth and was proven malignant on surgical resection. Discordant lesions were managed with repeat biopsy (n=8) or surgical resection (n=13), with 12 final benign diagnoses and nine malignancies. The negative predictive value of CT biopsy alone was 44/55 (80%), following repeat biopsy was 44/50 (88%), and following radiological-pathological assessment was 32/33 (97%). No patients underwent a shift in stage from time of biopsy to resection. CONCLUSION Combining radiological-pathological interpretation of negative biopsy results offers superior negative predictive value for lung malignancy without delayed diagnosis of lung cancer.
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Affiliation(s)
- J Barnett
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK.
| | - I Pulzato
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - M Javed
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - Y J Lee
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - A Choraria
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - S V Kemp
- Department of Respiratory Medicine, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - A Rice
- Department of Pathology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - S Jordan
- Department of Thoracic Surgery, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - P L Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK; National Heart & Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
| | - A G Nicholson
- Department of Pathology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK; National Heart & Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
| | - S Padley
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK; National Heart & Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
| | - A Devaraj
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK; National Heart & Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
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Barnett J, Pulzato I, Burn T, Zafar S, Hine J, Bartlett E, Shah P, Nicholson A, Ridge C, Padley S, Molyneaux P, Kemp S, Devaraj A. P1.11-30 Very Rapid Growth of Small Pulmonary Nodules Predicts Benignity. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bartlett E, Kemp S, Desai S, Mirsadraee S, Ridge C, Morjaria J, Shah P, Morris K, Derbyshire J, Chen M, Peacock C, Ivashniova N, Martins M, Addis J, Padley S, Devaraj A. MA10.10 Uptake in Lung Cancer Screening – Does CT Location Matter? A Pilot Study Comparison of a Mobile and Hospital Based CT Scanner. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Semple T, Edmondson C, Rawal B, Barnett J, Short C, Bauman G, Pusterla O, Bieri O, Tibiletti M, Parker G, Carr S, Hogg C, Davies J, Padley S. P034 MRI as the new gold standard in the assessment of cystic fibrosis lung disease severity? A bespoke cystic fibrosis-MRI protocol combining quantitative ventilation and structural MRI measures to replace CT. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Semple T, Edmondson C, Rawal B, Barnett J, Short C, Bauman G, Pusterla O, Bieri O, Tibiletti M, Parker G, Carr S, Hogg C, Davies J, Padley S. WS17-4 The addition of sinus imaging to a quantitative cystic fibrosis lung MRI protocol demonstrates an association between sinus signal characteristics and lung disease severity. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30220-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barnett J, Pulzato I, Padley S, Jordan S, Nicholson A, Rice A, Choraria A, Javed M, Lee Y, Kemp S, Shah P, Devaraj A. Radiological-pathological correlation of negative CT biopsy results enables high negative predictive value for thoracic malignancy. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30082-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Moser JB, Mak SM, McNulty WH, Padley S, Nair A, Shah PL, Devaraj A. The influence of inspiratory effort and emphysema on pulmonary nodule volumetry reproducibility. Clin Radiol 2017; 72:925-929. [PMID: 28784319 DOI: 10.1016/j.crad.2017.06.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/11/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
AIM To evaluate the impact of inspiratory effort and emphysema on reproducibility of pulmonary nodule volumetry. MATERIALS AND METHODS Eighty-eight nodules in 24 patients with emphysema were studied retrospectively. All patients had undergone volumetric inspiratory and end-expiratory thoracic computed tomography (CT) for consideration of bronchoscopic lung volume reduction. Inspiratory and expiratory nodule volumes were measured using commercially available software. Local emphysema extent was established by analysing a segmentation area extended circumferentially around each nodule (quantified as percent of lung with density of -950 HU or less). Lung volumes were established using the same software. Differences in inspiratory and expiratory nodule volumes were illustrated using the Bland-Altman test. The influences of percentage reduction in lung volume at expiration, local emphysema extent, and nodule size on nodule volume variability were tested with multiple linear regression. RESULTS The majority of nodules (59/88 [67%]) showed an increased volume at expiration. Mean difference in nodule volume between expiration and inspiration was +7.5% (95% confidence interval: -24.1, 39.1%). No relationships were demonstrated between nodule volume variability and emphysema extent, degree of expiration, or nodule size. CONCLUSION Expiration causes a modest increase in volumetry-derived nodule volumes; however, the effect is unpredictable. Local emphysema extent had no significant effect on volume variability in the present cohort.
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Affiliation(s)
- J B Moser
- Department of Radiology, St George's Hospital NHS Foundation Trust, London, UK
| | - S M Mak
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - W H McNulty
- The National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK; Imperial College, London, UK; Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Padley
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - A Nair
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - P L Shah
- The National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK; Imperial College, London, UK; Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A Devaraj
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
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Vieira M, Lazoura O, Nicol E, Rubens M, Padley S. MRI in patients with cardiovascular implantable electronic devices. Clin Radiol 2013; 68:928-34. [DOI: 10.1016/j.crad.2013.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 02/20/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
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Pavitt CW, Lindsay AC, Zielke S, Ray R, Harron K, Padley S, Rubens M, Nicol E. A novel method of coronary artery calcium quantification on CT coronary angiography. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Snow T, Zielke SW, Brinkert M, Lindsay AC, Davies SW, Di Mario C, Rubens M, Padley S, Moat NE, Nicol E. Non rate-controlled CT coronary angiography for the exclusion of obstructive coronary artery disease in the assessment of patients referred for transcatheter aortic valve implantation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pavitt CW, Zielke S, Ray R, Lindsay AC, Padley S, Rubens M, Nicol E. Deriving Coronary Artery Calcium Scores (CACS) from CT-Coronary Angiography (CTCA): a potential change to UK NICE guidelines. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lam HYS, Lazoura O, Sriharan M, Padley S. Single coronary artery from the right sinus of valsalva: an unusual variant of a rare condition. Eur Heart J Cardiovasc Imaging 2013; 14:190-1. [DOI: 10.1093/ehjci/jes177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Patterson C, Nicol E, Bryan L, Woodcock T, Collinson J, Padley S, Bell D. RE: Letter to the Editor regarding 'The effect of applying NICE guidelines for the investigation of stable chest pain on out-patient cardiac services in the UK'. QJM 2012; 105:211-2. [PMID: 22179103 DOI: 10.1093/qjmed/hcr264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Patterson C, Nicol E, Bryan L, Woodcock T, Collinson J, Padley S, Bell D. The effect of applying NICE guidelines for the investigation of stable chest pain on out-patient cardiac services in the UK. QJM 2011; 104:581-8. [PMID: 21317133 DOI: 10.1093/qjmed/hcr011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The National Institute for Health and Clinical Excellence (NICE) recently released guidelines for the investigation of chest pain of recent onset. There is no published data regarding their impact on out-patient cardiac services. AIM This study was undertaken to assess the likelihood of coronary artery disease (CAD) in Rapid Access Chest Pain Clinic (RACPC) patients and the resultant investigation burden if NICE guidance was applied. METHODS Five hundred and ninety-five consecutive patients attending two RACPCs over 6 months preceding release of the NICE guidelines [51% male; median age 55 (range 22-94) years] were risk stratified using NICE criteria and the resultant investigations evaluated. RESULTS One hundred and six (18%) patients had a likelihood of CAD <10%, 123 (21%) between 10% and 29%, 175 (29%) between 30% and 60%, 141 (24%) between 61% and 90% and 50 (8%) >90%. NICE would have recommended 443 (74%) patients for no cardiac investigation, 10 (2%) for cardiac computed tomography (CCT), 69 (12%) for functional cardiac testing and 73 (12%) for invasive angiography. Relative to existing practice, there would have been a trend towards reduced functional cardiac testing (-24%, P = 0.06), no significant change in CCT (43%, P = 0.436) and a significant increase in invasive angiography (508%, P < 0.001). The cost of investigations recommended by NICE would have been £15,881 greater than existing practice. CONCLUSION This study suggests patients attending RACPC will have a greater likelihood of CAD than predicted by NICE. Differences between recommended investigations and existing practice will guide investment in cardiac services. Individual hospitals should assess their RACPC cohorts prior to implementing the NICE guidelines.
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Affiliation(s)
- C Patterson
- Department of Medicine and Therapeutics, Imperial College, London, UK.
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Patterson C, Bryan L, Nicol E, Duncan M, Bell D, Padley S. The consequences of applying NICE chest pain guidelines to an acute medical population: a role for cardiac computed tomography. QJM 2010; 103:959-63. [PMID: 20736181 DOI: 10.1093/qjmed/hcq146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiac computed tomography (CCT) is a well-validated investigation for the non-invasive assessment of coronary artery disease (CAD). The National Institute for Clinical Excellence (NICE) have recently released guidelines incorporating CCT into the diagnostic algorithm for chest pain of recent onset. AIM To assess the frequency of eligibility for CCT in medical admissions with suspected cardiac chest pain using criteria defined by NICE. DESIGN A retrospective, observational study, set in a teaching hospital acute medical unit. METHODS A total of 198 consecutive patients admitted over a 4-month period with suspected cardiac chest pain (57% male; mean age 63.5 years) were assessed for eligibility for CCT based on NICE guideline criteria. RESULTS Of the 198 patients admitted, 65 (33%) patients were excluded by a raised troponin I or ischaemic ECG changes; 100 (51%) patients were excluded by pain categorized as non-anginal and 171 (86%) patients were excluded by a modified Diamond Forrester score outside the range 10-29%. Applying NICE criteria to this population ultimately resulted in 2 (1%) patients recommended for CCT, 12 (6%) for functional cardiac testing and 17 (9%) for invasive angiography. CONCLUSION Applying current NICE guidelines for chest pain of recent onset to medical admissions results in a lesser uptake of CCT than functional testing and invasive angiography. If the NICE guidelines are revised to include patients with an intermediate pre-test probability of CAD, CCT may have a greater role.
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Affiliation(s)
- C Patterson
- Department of Medicine and Therapeutics, Chelsea and Westminster Hospital, London SW10 9NH, UK.
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Lim E, Baldwin D, Beckles M, Duffy J, Entwisle J, Faivre-Finn C, Kerr K, Macfie A, McGuigan J, Padley S, Popat S, Screaton N, Snee M, Waller D, Warburton C, Win T. Guidelines on the radical management of patients with lung cancer. Thorax 2010; 65 Suppl 3:iii1-27. [DOI: 10.1136/thx.2010.145938] [Citation(s) in RCA: 298] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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James C, Gupta A, Cheng D, Padley S, Goulden N, Skellett S. A boy frightened of going to bed and bumps in the night. West J Med 2009. [DOI: 10.1136/bmj.b2787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hodgkinson R, Urquhart DS, Thia L, Padley S, Bush A, Gupta A. An 11 month old girl with bilateral wrist swelling. BMJ 2008; 337:a2149. [PMID: 18987032 DOI: 10.1136/bmj.a2149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R Hodgkinson
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP
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Griffin N, Devaraj A, Goldstraw P, Bush A, Nicholson A, Padley S. CT and histopathological correlation of congenital cystic pulmonary lesions: a common pathogenesis? Clin Radiol 2008; 63:995-1005. [DOI: 10.1016/j.crad.2008.02.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Accepted: 02/07/2008] [Indexed: 11/27/2022]
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Jackson G, Padley S. Erectile dysfunction and silent coronary artery disease: abnormal computed tomography coronary angiogram in the presence of normal exercise ECGs. Int J Clin Pract 2008; 62:973-6. [PMID: 18479289 DOI: 10.1111/j.1742-1241.2008.01788.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Erectile dysfunction (ED) and coronary artery disease (CAD) frequently coexist. ED may be present in the absence of cardiac symptoms 3-5 years before a coronary event. Exercise electrocardiography may identify flow-limiting CAD but cardiac computed tomography (CT) may identify early non-calcified plaque disease potentially vulnerable to rupture precipitating an acute event. METHODS Twenty men aged 39-69 years with ED and no cardiac symptoms underwent screening for cardiovascular risk including maximal treadmill exercise testing and CT coronary angiography. ED was confirmed using the Sexual Health Inventory for Men questionnaire. FINDINGS Eighteen had a low-density lipoprotein cholesterol > 3 mmol/l, none were diabetic and seven were hypertensive controlled on medical therapy. Coronary calcium scores were > 50 in 11 men (range: 54-1234) all of whom had angiographic CAD on CT. Nine of these had normal exercise ECGs. Four men had calcium scores of 6-17 and single plaque disease on CT. Five had normal cardiac CT studies. INTERPRETATION Erectile dysfunction may be a predictor of subclinical non-flow limiting CAD not detectable on exercise electrocardiography. Men with organic ED and no cardiac symptoms should be considered as 'cardiac equivalents' and aggressive risk reduction therapy initiated.
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Affiliation(s)
- G Jackson
- Cardiothoracic Centre, Guy's & St Thomas' NHS Hospital Trust, St Thomas' Hospital, London, UK.
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Griffin N, Allen D, Wort J, Rubens M, Padley S. Eisenmenger syndrome and idiopathic pulmonary arterial hypertension: do parenchymal lung changes reflect aetiology? Clin Radiol 2007; 62:587-95. [PMID: 17467397 DOI: 10.1016/j.crad.2007.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2006] [Revised: 12/30/2006] [Accepted: 01/05/2007] [Indexed: 01/15/2023]
Abstract
AIM To document the pulmonary vascular changes on thin-section computed tomography (CT) in patients with Eisenmenger syndrome and idiopathic pulmonary arterial hypertension, and to determine whether there is any correlation with pulmonary arterial pressures or the aetiology of pulmonary hypertension. MATERIAL AND METHODS From the National Pulmonary Hypertension Database, we identified eight patients with idiopathic pulmonary arterial hypertension and 20 patients with Eisenmenger syndrome (secondary to a ventriculoseptal defect) who had also undergone contrast-enhanced thin-section CT. CT studies were reviewed for the presence of centrilobular nodules, mosaicism, neovascularity, and bronchial artery hypertrophy. Haemodynamic data were also reviewed. RESULTS Centrilobular nodules, mosaicism, and neovascularity were seen in both patient groups (p>0.05). A significantly higher number of enlarged bronchial arteries were seen in patients with Eisenmenger syndrome. There was no correlation with pulmonary arterial pressures. CONCLUSION Patients with idiopathic pulmonary arterial hypertension and Eisenmenger syndrome demonstrated similar pulmonary vascular changes on CT. These changes did not predict the underlying cause of pulmonary hypertension or its severity.
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Affiliation(s)
- N Griffin
- Royal Brompton and Harefield NHS Trust, London, UK.
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Griffin N, Mansfield L, Redmond KC, Dusmet M, Goldstraw P, Mittal TK, Padley S. Imaging features of isolated unilateral pulmonary artery agenesis presenting in adulthood: a review of four cases. Clin Radiol 2007; 62:238-44. [PMID: 17293217 DOI: 10.1016/j.crad.2006.10.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 10/17/2006] [Accepted: 10/20/2006] [Indexed: 11/29/2022]
Abstract
AIM To highlight the variation in clinical manifestations, imaging and management of four cases of unilateral pulmonary artery agenesis presenting in adulthood. METHOD Four patients with unilateral pulmonary artery agenesis were referred to our institution between 1995 and 2005. They underwent a series of investigations, including chest radiography, echocardiography, ventilation perfusion scintigraphy, angiography, computed tomography (CT) and magnetic resonance imaging (MRI). RESULTS Two of the four patients had absence of the right main pulmonary artery, whilst the remaining two patients had absence of the left main pulmonary artery. One patient showed a restrictive defect on pulmonary function tests. Two patients who had ventilation perfusion scintigraphy showed absent perfusion and reduced ventilation on the affected side. Angiography (where performed), CT and MRI confirmed the anatomy and the presence of multiple collaterals. Bronchiectasis was demonstrated on CT in two patients, with one also demonstrating a mosaic attenuation pattern. One patient had an incidental lung tumour on the side of the agenesis, which was diagnosed as a chondroid hamartoma on histology. Three of the four patients eventually underwent resection of the affected lung. CONCLUSION Isolated unilateral pulmonary artery agenesis has a non-specific presentation. Awareness of this condition can lead to earlier diagnosis, with cross-sectional imaging making an important contribution.
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Affiliation(s)
- N Griffin
- Royal Brompton and Harefield NHS Trust, London, UK.
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Affiliation(s)
- A Zambanini
- Section of Clinical Pharmacology, Imperial College School of Medicine, London, UK
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Abstract
The objectives of this study were to describe the clinical and radiological features at presentation, and the natural history of HIV-related bronchopulmonary Kaposi's sarcoma. A retrospective review of medical records and chest radiographs was performed in 106 HIV-infected homosexual men with bronchopulmonary Kaposi's sarcoma diagnosed at bronchoscopy between September 1988 and November 1994. The majority of patients had evidence of advanced HIV disease at diagnosis (median CD4 cell count was 15 x 10(6)/l, range 0-288), and 93% had had a diagnosis of cutaneous Kaposi's sarcoma for a median duration of 11 months prior to diagnosis of their bronchopulmonary disease. The most frequent symptoms at presentation were cough (92%), dyspnoea (69%), pleuritic pain (20%), haemoptysis (13%) and wheezing (10%). The most common radiological finding in 73% of our series was of poorly defined and confluent opacities, with predominant middle and lower zone involvement. Median survival was 4 months (range 0-37 months) from diagnosis and 9 months (range 1-25) from the onset of symptoms. Treatment with either chemotherapy or radiotherapy was associated with a significantly reduced risk of death (hazards ratio (HR)=0.48, 95% CI=0.26-0.87). Factors associated with a poor survival, after adjustment for treatment effect were older age (HR=1.79, 95% CI=1.22-2.84) for each 10-year increase in age; a history of pleuritic pain (HR=2.97, 95% CI=1.39-6.32); presence of pleural effusion on X-ray (HR=2.01, 95% CI=1.13-3.59) and a prior diagnosis of cutaneous Kaposi's sarcoma (HR=1.8, 95% CI=1.00, 3.24). Bronchopulmonary Kaposi's sarcoma occurs mainly in patients with advanced HIV disease and a prior history of cutaneous disease. Survival is poor, and adverse prognostic factors include older age at diagnosis and the presence of pleural disease.
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Affiliation(s)
- F B Hannon
- Department of Radiotherapy and Oncology, Chelsea and Westminster Hospital, London, UK
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Padley S. Book reviewsTemporal Bone and Posterior Cranial Fossa ( CD-ROM). Ed. by HillenB, 1994 (Elsevier Science B V, Amsterdam), $540.00. ISBN 0444820167. Br J Radiol 1995. [DOI: 10.1259/0007-1285-68-812-938-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Padley S. Book reviewFundamentals of Diagnostic Radiology. Ed. by BrantW E and HelmsC A, pp.1312, 1994 (Williams & Wilkins, London), £124.00. ISBN 0683010115. Br J Radiol 1995. [DOI: 10.1259/0007-1285-68-808-440-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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31
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Abstract
High resolution computed tomography (HRCT) is an effective technique for demonstrating the lung parenchyma in detail and overcomes many of the inadequacies of chest radiography in the diagnosis of diffuse lung disease. This article reviews the role of HRCT in the management of patients with chronic infiltrative lung disease, occupational lung disease, airways disease and acute and sub-acute lung disease.
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Affiliation(s)
- S Padley
- Department of Radiology, Chelsea and Westminster Hospital, London, UK
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Padley S. Book reviewsTeaching Atlas of Thoracic Radiology. By LangeS and StarkP, pp. ix + 290, 1993 (Thieme Medical Publishers Inc., Stuttgart), DM 198.00. ISBN 313 7917018. Br J Radiol 1994. [DOI: 10.1259/0007-1285-67-803-1145-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Bronchioloalveolar cell carcinoma has a wide spectrum of pathologic and radiologic appearances. Some of the radiologic features are characteristic enough to suggest the underlying pathologic changes. This article illustrates the various manifestations of bronchioloalveolar cell carcinoma on high-resolution CT (1.5-mm collimation reconstructed with a high-spatial-frequency algorithm). Correlations between the CT and pathologic findings are included.
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Affiliation(s)
- B Adler
- Department of Radiology, University of British Columbia, Vancouver, Canada
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Abstract
The term cryptogenic organising pneumonia has been used for the combination of dyspnoea, cough, pleuritic pain, widespread shadows on chest radiographs, and histological evidence of intra-alveolar organisation with buds of granulation tissue within the alveoli. We report 12 patients with seasonal recurrence of this disorder for between 3 and 11 years. In all 12 patients, symptoms recurred between late February and early May every year, tending to increase in severity each year, and resolved between June and January. Chest radiography and computed tomography showed bilateral consolidation. Lung biopsy samples showed intra-alveolar buds of granulation tissue. There were many neutrophils within the lumina of medium-sized airways and terminal bronchioles showed evidence of obstruction by granulation tissue. Functionally, the predominant defect was restrictive and only 2 patients (life-long non-smokers) had airflow limitation. All 12 patients had very high activities of liver enzymes, suggesting intrahepatic cholestasis, but no other evidence of liver disease. Cultures of blood, sputum, lung tissue, and bronchoalveolar lavage fluid, viral screening, and complement fixation tests were consistently negative. In all patients all abnormalities responded rapidly to oral steroid therapy. These findings suggest a seasonal syndrome of organising pneumonia and biochemical abnormalities indicative of intrahepatic cholestasis. No aetiological factor has been identified, but the nature and periodicity of the illness point to an inhaled agent present in the environment for a limited period every year.
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Abstract
We present a case of tracheobronchomegaly seen in association with ankylosing spondylitis. To the authors' knowledge this combination has not been previously described. A review of the chest radiographs of 30 other patients with ankylosing spondylitis revealed no evidence of tracheal dilatation.
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Affiliation(s)
- S Padley
- Department of Radiology, Addenbrookes' Hospital, Cambridge
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Abstract
The lumbosacral spine radiographs of 200 patients with unexplained low back pain and without neurological signs were reviewed. The purpose of the study was to determine whether significant diagnostic information would be lost by replacing the standard three film series with a single radiograph, either in the lateral or antero-posterior projection. The contribution of the coned lumbosacral junction view was also assessed. The results show that a single lateral radiograph is diagnostically satisfactory and would have the added advantages of reducing patient radiation dose and radiographic workload.
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Affiliation(s)
- S Padley
- Department of Radiology, Addenbrooke's Hospital, Cambridge
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Affiliation(s)
- S Padley
- Department of Radiology, Addenbrooke's Hospital, Cambridge
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