Aspiration-related organizing pneumonia complicating laparoscopic adjustable gastric banding: A lung cancer mimicker

There are several described pulmonary complications due to laparoscopic adjustable gastric banding. We report a rare case of a 32-year-old male who presented with pulmonary symptoms and a solitary lung mass 12 years after laparoscopic adjustable gastric banding. A bronchoscopic lung biopsy showed organizing pneumonia that was induced by aspiration pneumonia. The atypical radiological appearance of the aspiration pneumonia may pose a diagnostic challenge, and clinicians' awareness regarding such an entity is needed to avoid unnecessary intervention

Detectability of choledocholithiasis on CT: The effect of positive intraduodenal enteric contrast on portovenous contrast-enhanced studies

Background/Aim: To retrospectively assess the accuracy of intravenous (IV) contrast-enhanced multidetector CT (MDCT) in choledocholithiasis detectability, in the presence and absence of positive intraduodenal contrast. Patients and Methods: Over a 3-year period, patients in whom endoscopic retrograde cholangiopancreatography (ERCP) was performed within a week from a portovenous (PV)-enhanced abdominal CT were identified. The final cohort consisted of 48 CT studies in which the entire common bile duct (CBD) length was visualized (19 males, 29 females; mean age, 68 years). We identified two groups according to the absence (n = 31) or presence (n = 17) of positive intraduodenal contrast. CT section thickness ranged from 1.25 to 5 mm. Two radiologists, blinded to clinical information and ERCP results, independently evaluated the CT images. Direct CBD stone visualization was assessed according to previously predefined criteria, correlating with original electronic CT reports and using ERCP findings as the reference standard. A third reader retrospectively reviewed all discordant results. The diagnostic performances of both observers and interobserver agreement were calculated for both groups. Results: 77%–88% sensitivity, 50%–71% specificity, and 71%–74% accuracy were obtained in the group without positive intraduodenal contrast, versus 50%–80% sensitivity, 57%–71% specificity, and 59%–71% accuracy in the group with positive intraduodenal contrast. With the exception of the positive predictive value (PPV), all diagnostic performance parameters decreased in the positive intraduodenal contrast group, mostly affecting the negative predictive value (NPV) (71%–78% vs 50%–67%). Conclusion: PV-enhanced MDCT has moderate diagnostic performance in choledocholithiasis detection. A trend of decreasing accuracy was noted in the presence of positive intraduodenal contrast

Detectability of choledocholithiasis on CT: The effect of positive intraduodenal enteric contrast on portovenous contrast-enhanced studies

Background/Aim: To retrospectively assess the accuracy of intravenous (IV) contrast-enhanced multidetector CT (MDCT) in choledocholithiasis detectability, in the presence and absence of positive intraduodenal contrast. Patients and Methods: Over a 3-year period, patients in whom endoscopic retrograde cholangiopancreatography (ERCP) was performed within a week from a portovenous (PV)-enhanced abdominal CT were identified. The final cohort consisted of 48 CT studies in which the entire common bile duct (CBD) length was visualized (19 males, 29 females; mean age, 68 years). We identified two groups according to the absence (n = 31) or presence (n = 17) of positive intraduodenal contrast. CT section thickness ranged from 1.25 to 5 mm. Two radiologists, blinded to clinical information and ERCP results, independently evaluated the CT images. Direct CBD stone visualization was assessed according to previously predefined criteria, correlating with original electronic CT reports and using ERCP findings as the reference standard. A third reader retrospectively reviewed all discordant results. The diagnostic performances of both observers and interobserver agreement were calculated for both groups. Results: 77%–88% sensitivity, 50%–71% specificity, and 71%–74% accuracy were obtained in the group without positive intraduodenal contrast, versus 50%–80% sensitivity, 57%–71% specificity, and 59%–71% accuracy in the group with positive intraduodenal contrast. With the exception of the positive predictive value (PPV), all diagnostic performance parameters decreased in the positive intraduodenal contrast group, mostly affecting the negative predictive value (NPV) (71%–78% vs 50%–67%). Conclusion: PV-enhanced MDCT has moderate diagnostic performance in choledocholithiasis detection. A trend of decreasing accuracy was noted in the presence of positive intraduodenal contrast

Bronchiolitis in young female smokers

WOS: 000318327400012PubMed ID: 23352225Background: Smoking is a growing concern among young women. However, the pulmonary effects of smoking in young female smokers in their 20's are unknown. Objective: The purpose of this study was to determine whether young female smokers demonstrate smoking-related lung abnormalities such as bronchiolitis in their 20's. Methods: We recruited young females (20-30 yr) from Izmir, Turkey; 29 smokers and 31 life-time non-smokers. They were all asymptomatic. All subjects performed complete lung function measurements and underwent thoracic computed tomography (CT) scanning at suspended full inspiration using a Toshiba "Aquilion" multi-slice CT scanner. The CT images were analyzed using custom software (Emphylx-J) and published equations to calculate total lung volume, mean lung density, lung mass, and the extent of emphysema. CT images were also read semi-quantitatively for respiratory bronchiolitis and emphysema by 2 experienced chest radiologists. When there was substantial difference in scoring, a 3rd (independent) radiologist read the CT scans. Plasma biomarkers of smoking were also measured in these subjects. Results: Although none of the subjects demonstrated emphysema on CT images, 41% of smokers (compared with only 15% of non-smokers) had evidence for respiratory bronchiolitis (with a score of 2 or more; p = 0.0301). There was a significant relationship between pack-years of smoking and the severity of respiratory bronchiolitis in smokers. Plasma interleukin (IL)-6 levels were also higher in smokers than in non-smokers (p = 0.028). Quantitative analysis for emphysema or airways disease on CT scans did not reveal any significant differences in the two groups with the exception of lung mass, which was higher in the smokers than in nonsmokers. Lung function was similar between the two groups. Conclusion and clinical relevance: Young female smokers in their 20's and 30's demonstrate CT changes consistent with respiratory bronchiolitis and elevated plasma IL-6 levels. They also have "heavier" lungs compared with lifetime non-smokers. These data indicate that pathologic changes of smoking occur early in young female smokers in the absence of demonstrable airflow limitation or symptoms. Public health efforts to curb smoking in young women are clearly needed to reduce the burden of smoking related lung disease in women. (C) 2013 Elsevier Ltd. All rights reserved.Canadian Institutes of Health Research (ICEBERGS)Canadian Institutes of Health Research (CIHR); GlaxoSmithKline, Turkey; AstraZenecaAstraZeneca; GSK Clinical Scientist AwardThis study was funded jointly by a Team Grant in COPD from the Canadian Institutes of Health Research (ICEBERGS) and an educational grant from GlaxoSmithKline, Turkey.; DDS has received research funding from AstraZeneca and received honoraria for speaking engagements from GlaxoSmithKline, Merck, Takeda, and Grifols, He has also sat on advisory boards for Novartis, Merck and Takeda over the past 3 years.; HC received $4800 in the years 2008-2012 for serving on the steering committee for the ECLIPSE project for GSK. In addition HC was the co-investigator on two multi-center studies sponsored by GSK and has received travel expenses to attend meetings related to the project. HC has three contract service agreements with GSK to quantify the CT scans in subjects with COPD and a service agreement with Spiration Inc to measure changes in lung volume in subjects with severe emphysema. HC has received a fee for speaking at a conference and related travel expenses from AstraZeneca (Australia). HC was the recipient of a GSK Clinical Scientist Award in 2010