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Dyspnoea, defined as an uncomfortable awareness of breathing, together with thoracic pain are two of the most frequent symptoms of presentation of thoracic diseases in the Emergency Department (ED). Causes of dyspnoea are various and involve not only cardiovascular and respiratory systems. In the emergency setting, thoracic imaging by standard chest X-ray (CXR) plays a crucial role in the diagnostic process, because it is of fast execution and relatively not expensive. Although radiologists are responsible for the final reading of chest radiographs, very often the clinicians, and in particular the emergency physicians, are alone in the emergency room facing this task. In literature many studies have demonstrated how important and essential is an accurate direct interpretation by the clinician without the need of an immediate reading by the radiologist. Moreover, the sensitivity of CXR is much impaired when the study is performed at bedside by portable machines, particularly in the diagnosis of some important causes of acute dyspnoea, such as pulmonary embolism, pneumothorax, and pulmonary edema. In these cases, a high inter-observer variability of bedside CXR reading limits the diagnostic usefulness of the methodology and complicates the differential diagnosis. The aim of this review is to analyze the radiologic signs and the correct use of CXR in the most important conditions that cause cardiac and pulmonary dyspnoea, as acute exacerbation of chronic obstructive pulmonary disease, acute pulmonary oedema, acute pulmonary trombo-embolism, pneumothorax and pleural effusion, and to focus indications and limitations of this diagnostic tool.

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Non-invasive Breath Analysis of Pulmonary Nodules.

J Thorac Oncol. 2012 Aug 27;

Authors: Peled N, Hakim M, Bunn PA, Miller YE, Kennedy TC, Mattei J, Mitchell JD, Hirsch FR, Haick H

Abstract
INTRODUCTION:: The search for non-invasive diagnostic methods of lung cancer (LC) has led to new avenues of research, including the exploration of the exhaled breath. Previous studies have shown that LC can, in principle, be detected through exhaled-breath analysis. This study evaluated the potential of exhaled-breath analysis for the distinction of benign and malignant pulmonary nodules (PNs). METHODS:: Breath samples were taken from 72 patients with PNs in a prospective trial. Profiles of volatile organic compounds were determined by (1) gas chromatography/mass spectrometry (GC-MS) combined with solid-phase microextraction and (2) a chemical nanoarray. RESULTS:: Fifty-three PNs were malignant and 19 were benign with similar smoking histories and comorbidities. Nodule size (mean ± SD) was 2.7 ± 1.7 versus 1.6 ± 1.3 cm (p = 0.004), respectively. Within the malignant group, 47 were non-small-cell lung cancer and six were small-cell lung cancer. Thirty patients had early-stage disease and 23 had advanced disease. Gas chromatography/mass spectrometry analysis identified a significantly higher concentration of 1-octene in the breath of LC, and the nanoarray distinguished significantly between benign versus malignant PNs (p < 0.0001; accuracy 88 ± 3%), between adeno- and squamous-cell carcinomas (p < 0.0001; 88 ± 3%) and between early stage and advanced disease (p < 0.0001; 88 ± 2%). CONCLUSIONS:: In this pilot study, breath analysis discriminated benign from malignant PNs in a high-risk cohort based on LC-related volatile organic compound profiles. Furthermore, it discriminated adeno- and squamous-cell carcinoma and between early versus advanced disease. Further studies are required to validate this noninvasive approach, using a larger cohort of patients with PNs detected by computed tomography.

PMID: 22929969 [PubMed - as supplied by publisher]

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Targeted therapy for lung cancer.

Anticancer Drugs. 2012 Aug 27;

Authors: Petrosyan F, Daw H, Haddad A, Spiro T

Abstract
Lung cancer is considered the number one killer among all cancers. Recent observations have altered the treatment paradigm for non-small-cell lung cancer (NSCLC). The discovery of activating mutations in the epidermal growth factor receptor and anaplastic lymphoma kinase positivity has made personalized treatment for NSCLC more feasible. Both erlotinib and crizotinib have been shown to be effective and safe for subgroup populations, and now personalized treatment for nonsquamous NSCLC has progressed even further. New tyrosine kinase inhibitors are being tested, resistant mutations are being studied, and new detection systems are being incorporated; all these developments will make the detection and treatment of the deadliest cancer more affordable, practical, and effective. The National Comprehensive Cancer Network has already incorporated these new developments into their guidelines for advanced nonsquamous NSCLC.

PMID: 22932130 [PubMed - as supplied by publisher]

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Carcinoid tumours: predicting the location of the primary neoplasm based on the sites of metastases.

Eur Radiol. 2012 Aug 30;

Authors: Bhosale P, Shah A, Wei W, Varadhachary G, Johnson V, Shah V, Kundra V

Abstract
OBJECTIVES: To predict the primary neuroendocrine tumour of the gastrointestinal tract site based on observed metastatic sites. METHODS: We studied data from the radiology database of a single, large cancer centre on 250 patients with pathologically confirmed neuroendocrine tumours. Primary tumour sites and the locations of metastases were collected from pathologic and radiologic reports of all available imaging modalities, such as computed tomography (CT), positron emission tomography (PET/CT), magnetic resonance imaging (MRI) and octreotide scans in the database. A nominal regression model was used to predict primary tumour site using the observed metastatic sites. Regression coefficients that were not statistically significant at the 5 % level were eliminated from the model in a stepwise procedure. RESULTS: Lung and liver metastases were not statistically significant predictors of the location of primary tumours (p = 0.86 and 0.074, respectively); whereas, lymph node, bone, and peritoneal metastases were significant predictors (p < 0.0001, 0.0004, and 0.014, respectively). CONCLUSIONS: Metastatic neuroendocrine tumours to the lymph nodes, bone, and peritoneum can be used to predict the primary neuroendocrine site; however, metastases in the lung and liver alone cannot predict the site of the primary tumour site. KEY POINTS : • Imaging helps one to diagnose the location of primary neuroendocrine neoplasm and the associated metastases. • Diffuse metastatic disease often makes identification of the primary difficult. • A prediction model developed may help identification of the primary in this setting. • It may also help identify occult metastases and thereby assist in management.

PMID: 22932740 [PubMed - as supplied by publisher]