Ultrasonography has proved a valuable tool for the detection of enlarged lymph nodes; however, differentiation between benign and malignant nodal disease remains a problem. High-frequency probes with improved spatial and contrast resolution display superficial nodes to advantage and also show the internal structure of the nodes. Ninety-four superficial nodes in patients with suspected nodal disease were examined by using 7.5-MHz probes to evaluate longitudinal-transverse diameter ratio (L/T), the central hilus, cortical widening, and size. Histologic diagnosis was obtained after sonographic examination in 73 nodes (five reactive nodes, 35 primary nodal malignancies, and 33 nodal metastases). The remaining 21 nodes regressed after either antibiotic or no therapy. Marked differences were observed among the proportions of benign and malignant nodes in terms of L/T, hilus, and cortex; the latter two structures, however, must be interpreted together. Eccentric cortical widening was seen in only malignant nodes. The distribution of nodal size was not significantly (P greater than .1) different for benign and malignant nodes. No differences were observed between primary and secondary nodal malignancies. The sonographic criteria evaluated in this study assist in the differentiation of benign from malignant superficial lymph nodes.

Lung cancer screening with low-dose CT demonstrated a prevalence of asymptomatic cancers in 1.3% of a smoking population, including a high proportion of early tumor stages and a 20% (three of 15) rate of invasive procedures for benign lesions.

Bronchoscopy obtaining bronchoalveolar lavage (BAL) fluid and bronchial secretions (BS) and/or high-resolution computed tomography (CT) of the lungs were performed in 33 patients with pulmonary aspergillosis from 1987 to 1992. The sensitivity of BAL fluid or BS for detecting histologically proven fungal disease was 33 and 50%, respectively, whereas positive serologies were only documented in 8% of the cases. CT scans contributed to the early diagnosis of opportunistic fungal pneumonia: characteristic CT signs were found in 16 of 19 episodes. The more frequent use of bronchoscopy and CT scans between 1990 and 1992 compared to 1987-1989 for the differential diagnosis of new pulmonary infiltrates resulted in earlier appropriate treatment. The average introduction of intravenous (i.v.) antifungal therapy after the onset of pneumonia was shifted from 12 to 7 days (p < 0.05). The timely implementation of i.v. antimycotic therapy had a significant impact on survival. Initiation of antifungal treatment later than 10 days after the onset of pneumonia resulted in a mortality of 90%, as opposed to 41% with an earlier start of antimycotics (p < 0.01). The earlier use of appropriate antifungal therapy in the second treatment period improved survival from 33 to 50% (NS). Bronchoscopy and high-resolution CT scans are mutually complementary diagnostic tools and should be performed as early as possible in the course of pneumonia for patients at high risk for aspergillosis.

Pulmonary nodules were detected reliably at CT with 50 mA and pitch of 2 or with 25 mA and a pitch of 1. However, further reduction of the dose to that used at chest radiography was associated with a significant decrease in the number of nodules 5 mm or smaller that were detected, possibly due to artifacts.

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