Computed tomography of the thorax in rabbits: a prospective study in ten clinically healthy New Zealand White rabbits

Background

Literature investigating the normal cross-sectional anatomy of rabbits with computed tomography (CT) is sparse and incomplete. The purpose of the present study was to investigate the normal thoracic structures, in particular the cranial thorax, with CT angiography in 10 clinically healthy New Zealand White (NZW) rabbits.

Results

Absolute and relative measurements of the trachea, heart, thoracic caudal vena cava and aorta, right and left principal bronchi, right and left caudal lobar bronchi and the accompanying branches of the right and left pulmonary artery and vein, right and left lung volume and lung density were taken. The three lobes of the thymus (right ventral, right dorsal and left thoracic lobes) were identified in all rabbits. Both the right dorsal and left thoracic lobes of the thymus extended between the heart and thoracic wall in all individuals with the left lobe reaching more caudally in seven animals. Consequently, the craniocaudal extension of the left lung was smaller than the right lung in these rabbits. Volume of the left lung was significantly smaller than the right (P = 0.005). The cranial mediastinal, right and left tracheobronchial and the aortic thoracic lymph nodes were very small and identified in four, four, seven and ten rabbits, respectively. The heart took up a median of 4.0 intercostal spaces, and in seven rabbits, it was located in the 2nd–5th intercostal space. Median relative cardiac height and width measured 74 and 88%, respectively. The median angle of the trachea to the spine was 5°. Median density between the right and left lung did not significantly differ (? 549 and ? 583 Hounsfield units, respectively). In all but one rabbit, atelectasis was present and classified as mild, moderate or severe in six, two and one individuals, respectively. Mild subclinical bronchopneumonia was diagnosed in seven rabbits.

Conclusions

The present study provides species-specific anatomical CT information and reference values for structures in the thorax of the NZW rabbit. Subclinical bronchopneumonia appears to be a common CT finding.

     

SILENT MYOCARDIAL INFARCTION WITH POSTERIOR INFERIOR PSEUDOANEURYSM OF THE LEFT VENTRICLE PRESENTING AS A POSTERIOR LUNG MASS

An asymptomatic 62-year-old man developed a density in his left lower hemithorax in the retrocardiac position on chest roentgenogram, which was discovered during a routine evaluation. This was diagnosed in another hospital as a lung tumor, for which he underwent an exploratory left thoracotomy. This case points out the difficulty in the diagnosis of retrocardiac masses and suggests that echocardiography and cardiac angiography should be accomplished before attempting needle aspiration or an open lung biopsy. The absence of a history of myocardial infarction and classical clinical indications of ventricular aneurysms such as electrocardiographic changes, arrhythmias, and congestive heart failure does not exclude a true aneurysm or pseudoaneurysm of the left ventricle.     

Radiation injury in rat lung. I. Prostacyclin (PGI2) production, arterial perfusion, and ultrastructure

Pulmonary prostacyclin (PGI2) production, arterial perfusion, and ultrastructure were correlated in rats sacrificed from 1 day to 6 months after a single exposure of 25 Gy of gamma rays to the right hemithorax. PGI2 production by the irradiated lung decreased to approximately half the normal value 1 day after irradiation (P less than 0.05), then increased steadily throughout the study. By 6 months postirradiation, the right lung produced two to three times as much PGI2 as did either shielded left lung or sham-irradiated lungs (P less than 0.05). Perfusion scans revealed hyperemia of the right lung from 1 to 14 days after irradiation. From its peak at 14 days postirradiation, however, perfusion of the irradiated lung decreased steadily, then reached a plateau from 3 to 6 months at less than half that in the shielded left lung. Electron micrographs of the right lung revealed perivascular edema from 1 to 30 days after irradiation. The right lung then exhibited changes typical of radiation pneumonitis followed by progressive interstitial fibrosis. Platelet aggregates were not observed at any time. Thus, decreased PGI2 production is an immediate but transient response of the lung to radiation injury. Then from 2 to 6 months after irradiation, the fibrotic, hypoperfused lung produces increasing amounts of the potent vasodilator and antithrombotic agent, PGI2. Pulmonary PGI2 production and arterial perfusion are inversely correlated for at least 6 months after hemithoracic irradiation.     

实验猕猴肺部CT影像断层初步观察

目的应用CT技术对成年实验猕猴胸部肺窗进行断层扫描观察,探讨CT技术对猕猴肺部疾病的临床诊断意义,建立正常猴肺部CT断层扫描图谱,为CT技术在猕猴解剖学的研究、疾病的临床诊断及科学实验方面的应用,提供影像学的基础资料。方法经过触诊、叩诊、听诊、体温、呼吸率、心率、呼吸运动、血液常规等检查,选择健康猴10只,雌雄各半,年龄分别为5～10岁,进行肺部CT断层扫描检测。试验猴全身麻醉后,置于CT诊断床上,取头前尾后仰卧位进行肺部扫描,获取肺窗扫描图像。对具有解剖意义的扫描图像的每个层面的主要结构（肺叶、气管、动脉血管、静脉血管等）进行标注。结果 （1）获得具有解剖意义的肺窗扫描图像13张。（2）在断层扫描的图像中,肺、气管、较大血管等组织器官界面清晰。肺为左右两侧,左肺分为上叶、中叶、下叶,右肺分为上叶、中叶、下叶、奇叶四部分。不同的断层面分别可见肺部左主支气管、右主支气管、支气管、血管等组织。（3）肺部较小或细小的血管、神经组织界面不清晰。结论 （1）应用CT获得的正常猕猴胸部肺窗断层扫描图像表明,正常健康猴双肺纹理清晰,走行自然,肺野透光度良好,双肺无异常实质病变影像。（2）获得了健康猕猴肺部的CT影像学资料,为猕猴肺部疾病的诊断,提供了一种安全、方便又准确的新依据,建立了成年健康猕猴肺部CT断层解剖研究的背景资料。     

Transmission to the chest of sound introduced at the mouth

We examined the transmission to the chest wall of white noise and 25-Hz square-wave-generated noise introduced at the mouth of five healthy subjects. The output audio signals were recorded over the left and right upper and lower lung zones, posteriorly. Sound measurements were made during apnea at functional residual capacity, total lung capacity, and residual volume both after breathing air and an 80% He-20% O2 (heliox) gas mixture. We calculated the peak-to-peak amplitude, the peak frequency, and the midpower frequency of the output sound. We found no consistent variations in the values of these indexes due to lung volume or resident gas density. In all cases, the transmitted sound was most intense at the right upper zone. This could not be explained on the basis of technical factors but was probably the result of normal asymmetry of the mediastinal anatomy. These data suggest that sound introduced through the mouth of healthy individuals excites intrathoracic structures but is transmitted through the parenchyma in such a manner that it is not markedly affected by familiar physiological variables. This must be taken into account if objective acoustical tests of lung physiology are to be developed.     

Thoracic pressure and nasal patency

Maximum nasal flow rate in the right and left nostrils was simultaneously determined during expiration with the help of two flowmeters in 10 healthy subjects in different postures and in two patients, one with Horner's syndrome and the other with facial palsy. It was found that pressure on the hemithorax from any surface (i.e., lateral, anterior, posterior, or superior) leads to reduced patency of the ipsilateral nostril but increased patency of the nostril on the opposite site. In the patient with Horner's syndrome, the nostril on the affected side remained blocked even on compression of the opposite hemithorax, and in the one with facial nerve palsy, the nostril on the affected side remained patent despite compression of the hemithorax on that side. The findings suggest that compression of hemithorax leads to changes in the congestion of the nasal mucosa that may be mediated through autonomic nerves.     

Plasminogen activator activity in lung and alveolar macrophages of rats exposed to graded single doses of gamma rays to the right hemithorax

Male rats were sacrificed 2 or 6 months after a single dose of 0-30 Gy of 60Co gamma rays to the right hemithorax. At autopsy, macrophages were lavaged from the right lung, counted, and frozen. The right (irradiated) and the left (shielded) lungs were frozen, then assayed for plasminogen activator (PLA) activity by the fibrin plate lysis method. Freeze-thawed macrophages were assayed for both PLA activity (125I-fibrin clot lysis method) and fibrinolytic inhibitor activity (inhibition of urokinase-induced fibrin lysis). There was a linear, dose-dependent decrease in right lung PLA activity over the dose range of 10-30 Gy at 2 and 6 months postirradiation, reductions of 3.1 and 2.6% per Gy, respectively. PLA activity at all radiation doses was 10-15% higher at 6 months than at 2 months (P less than 0.05), indicative of a partial recovery of this endothelial function in the irradiated lung. There were no significant changes in PLA activity in the shielded left lung at any dose or time. There also was a linear, dose-dependent increase in the number of macrophages lavaged from the right lung at both 2 and 6 months postirradiation, with larger numbers recovered after all doses at 2 months. PLA activity per 10(6) macrophages decreased with increasing radiation dose at both autopsy times, closely paralleling lung PLA activity. This radiation-induced decrease in macrophage PLA activity was not due to increased fibrinolytic inhibitor activity in the irradiated macrophages. These data quantitate the dose response and time course of radiation-induced fibrinolytic defects in rat lung and suggest that information obtained from a minimally invasive procedure such as bronchoalveolar lavage may serve as an index of the degree of pulmonary fibrinolytic dysfunction after irradiation.     

Vascular response to fractionated irradiation in the rat lung.

The effects of fractionated hemithorax irradiation on normal lung tissue were examined by measuring changes in the vascular permeability surface area product (PS) and relative lung blood flow in Sprague-Dawley rats. The rats received five daily fractions per week of either 3.0 or 4.0 Gy for 4 weeks to the left lung. Between 3 and 5 weeks after the start of irradiation, the average PS was approximately 50% above normal for the group of rats that received 3.0 Gy/day and 200-300% above normal in the group of rats that received 4.0 Gy/day. Treatment with cyproheptadine, indomethacin, or theophylline had no effect, but treatment with dexamethasone significantly reduced PS to near normal levels. Left-to-right blood flow ratios in the group of rats that received 3.0 Gy/day decreased to 66% of normal levels by 4 weeks. In the group of rats that received 4.0 Gy/day, blood flow decreased to 46% of normal levels by 4 weeks. Treatment with dexamethasone maintained normal blood flow until the drug dose was reduced. These results agree with earlier studies using single-dose irradiation and indicate that the methods used to measure PS and blood flow are sensitive at low doses.     

Single-breath test in lateral decubitus reflects function of single lungs grafted for emphysema.

The slope of alveolar plateau for nitrogen derived from the single-breath test is useful to assess the function of bilateral lung grafts, but this technique is not applicable to patients with single-lung grafts due to the confounding influence of the native lung. We tested the hypothesis that the nitrogen slope measured in lateral decubitus with the graft in nondependent position may primarily reflect the distribution of ventilation in this lung. Fifteen patients with single-lung transplantation for emphysema, 10 healthy controls, and 7 patients with advanced emphysema performed single-breath washouts in right and left lateral decubitus; nitrogen slope was measured between 75 and 100% of expired volume. In 10 transplant recipients, the volume of each lung was measured in the two postures by computerized tomography. Nitrogen slope was unaffected by posture in normal controls and emphysema patients. On the other hand, nitrogen slope in transplant recipients was invariably smaller, with the graft in nondependent vs. in dependent position. Values of nitrogen slope with the graft in nondependent position were similar to those obtained in normal controls but significantly smaller than those obtained in emphysema patients. Computerized tomography studies in this position indicated that the volume expired below functional residual capacity was exclusively contributed by the graft. We conclude that, in patients with single-lung transplantation for emphysema, 1) measuring nitrogen slope in lateral decubitus allows to distinguish between the graft and the native lung, and 2) nitrogen slope obtained with the graft in nondependent position reflects ventilation distribution in this lung.     

The lobular division,bronchial tree and blood vessels of the squirrel monkey lung

The lobular division, bronchial tree, and blood vessels in lungs of seven squirrel monkeys (Saimiri sciureus) were examined from the viewpoint of comparative anatomy. The right lung of the squirrel monkey consists of the upper, middle, lower, and accessory lobes, whereas the left lung consists of the upper, middle, and lower lobes. These lobes are completely separated by interlobular fissures. In three of seven examples examined the left middle lobe was lacking. The squirrel monkey lung has four bronchiole systems, i.e. dorsal, lateral, ventral, and medial, on both sides. The upper lobes are formed by the first branches of the dorsal bronchiole systems. The middle lobes are formed by the first branches of the lateral bronchiole systems. The remaining bronchioles constitute the lower lobes. In addition to the above lobes, in the right lung, the accessory lobe is present, being formed by the first branch of the ventral bronchiole system. The right pulmonary artery runs across the ventral side of the right upper lobe bronchiole, and then across the dorsal side of the right middle lobe bronchiole. Thereafter, it runs between the dorsal bronchiole and lateral bronchiole systems along the dorso-lateral side of the right bronchus. During its course, the right pulmonary artery gives off the arterial branches which run along each bronchiole. These branches run mainly along the dorsal or lateral side of the bronchioles. In the left lung, the pulmonary artery and its branches run the same course as in the right lung. The pulmonary veins run mainly the ventral or medial side of the bronchioles, and between the bronchioles.     

Pleural pressure as a function of body position in rabbits

Pleural pressure was measured at end expiration in spontaneously breathing anesthetized rabbits. A liquid-filled capsule was implanted into a rib to measure pleural liquid pressure with minimal distortion of the pleural space. Capsule position relative to lung height was measured from thoracic radiographs. Measurements were made when the rabbits were in the prone, supine, right lateral, and left lateral positions. Average lung heights in the prone and supine positions were 4.21 +/- 0.58 and 4.42 +/- 0.51 (SD) cm, respectively (n = 7). Pleural pressure was -2.60 +/- 1.87 (SD) cmH2O at 50.2 +/- 7.75% lung height in the prone position and -3.10 +/- 1.22 cmH2O at 51.4 +/- 6.75% lung height in the supine position. There was no difference between the values recorded in the prone and supine positions. Placement of the capsule into the right or left chest had no effect on the magnitude of the pleural pressure recorded in rabbits in right and left lateral recumbency (n = 12). Measurements over the nondependent lung were repeatable when rabbits were turned between the right and left lateral positions. Lung height in laterally recumbent rabbits averaged 4.55 +/- 0.52 (SD) cm.     

Hypoxia enhances unilateral lung injury by increasing blood flow to the injured lung

We hypothesized that in unilateral lung injury, bilateral hypoxic ventilation would induce vasoconstriction in the normal lung, redirect blood flow to the injured lung, and cause enhanced edema formation. Unilateral left lung injury was induced by intrabronchial instillation of 1.5 ml/kg of 0.1 N HCl. After HCl injury, blood flow to the injured left lung decreased progressively from 0.70 +/- 0.04 to 0.37 +/- 0.05 l/min and percent of flow to the injured left lung (QL/QT) decreased from 37.7 +/- 2.2 to 23.6 +/- 2.2% at 240 min. Exposure to hypoxia (12% O2) for three 10-min episodes did not affect QL/QT in normal animals, but after unilateral HCl injury, it caused blood flow to the injured left lung to increase significantly. A concomitant decrease in blood flow occurred to the noninjured right lung, resulting in a significant increase in QL/QT. The enhanced blood flow to the injured lung was associated with a significant increase in the wet-to-dry lung weight ratio in the dependent regions of the injured lung. These findings demonstrate that in unilateral HCl-induced lung injury, transient hypoxia can enhance blood flow to the areas of injury and increase lung edema formation.     

Humoral Hypercalcemia of Malignancy in a Patient with Large Cell Carcinoma of the Lung: Report of Case and Review of Literature

ObjectiveTo report a case of hypercalcemia associated with parathyroid hormone-related protein (PTHrP) in large cell carcinoma of the lung.MethodsWe present a case of PTHrP-mediated hypercalcemia in a patient with a large cell carcinoma of the lung and review the related literature.ResultsA 43-year-old African American man required medical attention because of lethargy, confusion, and poor oral intake. He had bullous emphysema attributable to a 50-pack-year smoking history. On physical examination, vital signs were normal, he was oriented to place and person but not time, and he had cachexia. Breath sounds were decreased in the left lower lung field. Findings on cardiac and abdominal examination were normal. Results of laboratory studies (and corresponding reference ranges) were as follows: calcium 12.1 mg/dL (8.5 to 10.5), albumin 2.0 g/dL (3.5 to 5.0), phosphorus 2 mg/dL (2.5 to 4.5), alkaline phosphatase 68 U/L (40 to 150), intact parathyroid hormone 5 pg/mL (10 to 60), PTHrP 7.0 pmol/L (0.0 to 1.5), 1,25-dihydroxyvitamin D 20.8 pg/mL (25.1 to 66.1), and 25-hydroxyvitamin D 3.7 ng/mL (10 to 60). Computed tomographic scans of the chest showed a large complex lesion in the left lower hemithorax, a small right pleural effusion, and extensive pulmonary emphysema bilaterally. Open lung biopsy revealed a large cell undifferentiated carcinoma. Abdominal and pelvic computed tomographic scans showed no evidence of metastatic involvement. A bone scan was negative for osseous metastatic lesions.ConclusionAlthough the finding is rare, patients with large cell carcinoma of the lung and hypercalcemia may have humoral hypercalcemia mediated by PTHrP. (Endocr Pract. 2007;13:389-395)     

The bronchial tree and lobular division of the gorilla lung

The bronchial ramification in one specimen of gorilla lung was examined from the viewpoint of comparative anatomy, on the basis of the fundamental structure of bronchial ramification in the mammalian lung (Nakakuki, 1975, 1980). The right lung of the gorilla consists of the upper, middle, lower, and accessory lobes. The right lung has the dorsal, lateral, and ventral bronchiole systems, but the medial bronchiole system is lacking. The upper lobe is formed by the first branch of the dorsal bronchiole system. The middle lobe is formed by the first branch of the lateral bronchiole system. The accessory lobe is formed by the first branch of the ventral bronchiole system. The remaining bronchioles constitute the lower lobe. The left lung consists of the middle and lower lobes; the upper and accessory lobes are lacking. The left lung has the dorsal and lateral bronchiole systems, but the ventral and medial bronchiole systems are lacking. The middle lobe is formed by the first branch of the lateral bronchiole system. The remaining bronchioles constitute the lower lobe. The bronchial ramifications of the gorilla lung are rather similar to those of the human lung.     

Left superior vena cava, a remnant of embryological development

A 46-year-old Brugada syndrome patient underwent insertion of a dual-chamber implantable cardioverter- defibrillator (ICD), revealing a left-sided superior vena cava (SVC), (figure 1), running, characteristically, left from the sternum and flowing into the great cardiac vein. Following this course, the atrial lead was placed in the right atrium (RA) (figure 2, arrow, note dorsal position). The ventricular lead was inserted through the connecting anonymous vein between left and right SVC (figure 1, double arrow), into the right SVC and right ventricle (RV). The presence of a left superior vena cava results from the persistence of the embryonic left anterior cardinal vein. This anomaly is present in approximately 0.5% of the general population and in 3 to 5% of persons with other congenital heart defects, as established by autopsy.     

Implantation of a completely right sided subcutaneous cardioverter-defibrillator in a patient with situs inversus dextrocardia

Dextrocardia is a congenital anomaly where the heart is abnormally located in the right hemithorax. In these patients, the implementation of transvenous implantable cardioverter-defibrillator (TV-ICD) can be technically challenging and pose a higher risk of complications than the general population. We present the case of a male patient that was successfully submitted to right-sided implantation of subcutaneous ICD (S-ICD) as an alternative to transvenous ICD (TV-ICD) for primary prevention of sudden cardiac death. This option is not only feasible but may potentially be ideal for these patients, as it circumvents challenges and potential complications of TV-ICD insertion.     

Regional lung growth following pneumonectomy assessed by computed tomography.

After pneumonectomy (PNX), mechanical strain on the remaining lung is greatly increased. To assess whether remaining lobes expand uniformly after left or right PNX (removing 42 and 58% of lung mass, respectively), we performed high-resolution computed tomography (CT) scans at 45 ml/kg above end-expiratory lung volume on adult male foxhounds after left or right PNX, which were compared with adult Sham controls. Air and tissue volumes were separately measured in each lobe. After left PNX, air and tissue volumes in the right upper and cardiac lobes increased approximately 2.2-fold above and below the heart, whereas volumes in right middle and lower lobes did not change significantly. After right PNX, air and tissue volumes in the left upper and middle lobes increased 2.3- to 2.7-fold across the midline anterior to the heart, whereas the left lower lobe expanded approximately 1.9-fold posterior to the heart. Regional changes in volume density of tissue post-PNX estimated by CT scan parallel postmortem estimates by morphometric analyses. Data indicate heterogeneous regional distribution of mechanical lung strain, which could influence the differential cellular compensatory response following right and left PNX.     

Cardiovascular dynamics inCrocodylus porosus breathing air and during voluntary aerobic dives

Summary Pressure records from the heart and out-flow vessels of the heart ofCrocodylus porosus resolve previously conflicting results, showing that left aortic filling via the foramen of Panizza may occur during both cardiac diastole and systole. Filling of the left aorta during diastole, identified by the asynchrony and comparative shape of pressure events in the left and right aortae, is reconciled more easily with the anatomy, which suggests that the foramen would be occluded by opening of the pocket valves at the base of the right aorta during systole. Filling during systole, indicated when pressure traces in the left and right aortae could be superimposed, was associated with lower systemic pressures, which may occur at the end of a voluntary aerobic dive or can be induced by lowering water temperature or during a long forced dive. To explain this flexibility, we propose that the foramen of Panizza is of variable calibre. The presence of a right-left shunt, in which increased right ventricular pressure leads to blood being diverted from the lungs and exiting the right ventricle via the left aorta, was found to be a frequent though not obligate correlate of voluntary aerobic dives. This contrasts with the previous concept of the shunt as a correlate of diving bradycardia. The magnitude of the shunt is difficult to assess but is likely to be relatively small. This information has allowed some new insights into the functional significance of the complex anatomy of the crocodilian heart and major blood vessels.Abbreviations bpm beats per minute - LAo left aorta (aortic) - LV left ventricle (ventricular) - PA pulmonary artery - RAo right aorta (aortic) - RV right ventricle (ventricular) - SC subclavian artery Deceased     

The bronchial tree and lobular division of the chimpanzee lung

The bronchial ramification and lobular division in lungs of two chimpanzees (Pan troglodytes) were examined from the viewpoint of comparative anatomy, on the basis of the fundamental structure of bronchial ramification of the mammalian lung (Nakakuki, 1975, 1980). The right lung of the chimpanzee consists of the upper, middle, and lower lobes, whereas the left lung consists of the middle and lower lobes. The right and left lungs have the dorsal bronchiole system, lateral bronchiole system, and medial bronchiole system. The ventral bronchiole system is lacking on both sides. The right upper lobe is formed by the first branch of the dorsal bronchiole system. The right middle lobe is formed by the first branch of the lateral bronchiole system, and the right accessory lobe bronchiole is lacking. The remaining bronchioles constitute the right lower lobe. In the left lung, the upper and accessory lobes are lacking. The well developed middle lobe is formed by the first branch of the lateral bronchiole system. The left lower lobe is formed by the remaining bronchioles. Furthermore, these bronchioles are compared with those of the human lung byBoyden (1955).     

Left ventricular epicardial admittance measurement for detection of acute LV dilation

There are two implanted heart failure warning systems incorporated into biventricular pacemakers/automatic implantable cardiac defibrillators and tested in clinical trials: right heart pressures, and lung conductance measurements. However, both warning systems postdate measures of the earliest indicator of impending heart failure: left ventricular (LV) volume. There are currently no proposed implanted technologies that can perform LV blood volume measurements in humans. We propose to solve this problem by incorporating an admittance measurement system onto currently deployed biventricular and automatic implantable cardiac defibrillator leads. This study will demonstrate that an admittance measurement system can detect LV blood conductance from the epicardial position, despite the current generating and sensing electrodes being in constant motion with the heart, and with dynamic removal of the myocardial component of the returning voltage signal. Specifically, in 11 pigs, it will be demonstrated that 1) a physiological LV blood conductance signal can be derived; 2) LV dilation in response to dose-response intravenous neosynephrine can be detected by blood conductance in a similar fashion to the standard of endocardial crystals when admittance is used, but not when only traditional conductance is used; 3) the physiological impact of acute left anterior descending coronary artery occlusion and resultant LV dilation can be detected by blood conductance, before the anticipated secondary rise in right ventricular systolic pressure; and 4) a pleural effusion simulated by placing saline outside the pericardium does not serve as a source of artifact for blood conductance measurements.