Diffuse, patchy

Figure 7 HRCT images demonstrating diffuse patchy involvement of ground glass opacities, consolidation, and reticulation in a patient with AIP. Abbreviations HRCT, high-resolution computed tomography AIP, acute interstitial pneumonia.

Figure 3 Diffuse alveolar hemorrhage. A 39-year-old man with WG admitted to the medical intensive care unit with hemoptysis, respiratory failure, and renal insufficiency preceded hy a five-month history of recurrent otitis media, epistaxis, nasal congestion, and leukocytoclastic vasculitis of the skin. The CT section shows a cavitary lung nodule (arrow) and diffuse patchy alveolar infiltrates consistent with DAH. Abbreviation DAH, diffuse alveolar hemorrhage.

Sigmoidoscopic examination may reveal a nonspecific diffuse or patchy erythematous colitis without pseudomembranes. 

Fig. 6. Delayed CT 48 h after the administration of contrast medium. The serum creatinine level was high (5.5mg/dl), and the contrast-enhanced areas were more extensive than those in Fig. 2 (serum creatinine 1.6mg/dl). Patchy contrast enhancement changed to diffuse contrast enhancement...

The area of wedge-shaped contrast enhancement increased with the increase in serum creatinine level. When the serum creatinine level exceeded 5 or 6 mg/dl, diffuse contrast enhancement involved the entire kidney. However, even in patients with diffuse contrast enhancement, delayed CT confirmed patchy wedge-shaped contrast enhancement again when the serum creatinine level decreased to 1.2-3.5 mg/dl in the recovery phase (refer to Patient 2 in Fig. 59, Chap. 10, Sect. 1). This finding in the recovery phase cannot be explained by tubular obstruction. 

Fig. 17. Comparison of contrast enhancement 24h afterthe administration of contrast medium between exercise-induced acute renal failure (ALPE) and myoglobinuric acute renal failure (serum creatinine 3mg/dl). The patient with ALPE showed patchy wedge-shaped contrast enhancement, and the patient with myoglobinuric acute renal failure showed diffuse contrast enhancement...

This patient was the first case in our series in which acute renal failure developed after an athletics meeting. After he had participated in a 200-m race, loin pain occurred, leading to acute renal failure. Delayed computed tomography (CT) showed diffuse to patchy contrast enhancement. The details are given in Chap. 2, Sect. 2. 

Delayed CT scan after Patchy wedge-shaped Diffuse enhancement... 

White matter lesions have been already quite extensively studied with CT and the patchy or diffuse abnormalities in the deep white matter, which... 

Differences were found in vertical spread as well. In the Lagrangian run (Fig. 20.5) the concentration fields in the lower free troposphere followed the surface-level concentrations in general. This reflected the simphfied vertical structure of this kernel, in particular, well-mixing assumption for the boundary layer and fixed diffusion term in the free troposphere. In the Eulerian run (Fig. 20.6), the higher-level modeled concentrations were patchy and less correlated with the nearsurface fields in comparison with the Lagrangian run. 

Fig. 33.2 So-called lupoid hepatitis. The left lobe of liver shows an irregularly rippled surface (scattered light reflex) with salmon-pink and yellow colouring, patchy red marking due to highly inflammatory parenchymal zones fine vascular multiplication and whitish scarred areas with diffuse fibrosis...

A chest X-ray showed diffuse interstitial and alveolar infiltrates and small bilateral pleural effusions. A high-resolution CT scan of the chest showed diffuse ground-glass attenuation and patchy peripheral opacities, consistent with an acute hypersensitivity pneumonitis, and other diagnoses were ruled out. He responded to gluco-corticoids. 

Two 19-year-old-girls developed pulmonary edema after taking massive overdoses of verapamil (6000 mg and 7200 mg). In each case a chest X-ray showed diffuse bilateral patchy infiltration. Left ventricular size and function was normal on transthoracic echocardiography. They were both treated successfully with mechanical ventilatory support. 

A 36-year-old man with acute promyelocytic leukemia was given tretinoin 45 mg/m /day, daunorubi-cin, and cytarabine. A week later his platelet count fell to 10 X 10 /1, and the next day he developed dyspnea, hemoptysis, and fever. A chest X-ray showed diffuse bilateral patchy pulmonary infiltrates. Tretinoin was withdrawn, but despite high doses of glucocorticoids and blood products, hemoptysis and respiratory failure continued for 6 weeks, when he improved. 

Experimental determination of He diffusion was attempted by Duddridge et al. (1991), who injected He-rich gas at a depth of 35 m into permeable limestones cut by a fault. They recorded a pulse of He in shallow soil gas 5-20 hours later within 10 m of the fault suboutcrop and up to 53 hours later 20 m from the fault suboutcrop. However, the concentration increase recorded (0.032 ppm) is well within the error of the analytical system (mass spectrometer with constant pressure inlet, as discussed below, and analytical sensitivity of 0.030 ppm), the data are patchy with many samples showing no pulse, and there is no estimate of background variation or the effect of changing environmental conditions. Conclusions about diffusion rates based on these data may not be reliable. 

Lesions on sun-exposed skin, particularly the backs of the hands, forearm, and face, are present in all patients. These lesions are identical to those seen in the other bullous porphyrias (Table 32-4). Increased mechanical fragility of the skin, with trivial trauma leading to erosions, is present in virtually aU patients. Subepidermal bullae, hypertrichosis of the face, and patchy pigmentation are also common. Erosions and bullae heal slowly to leave atrophic scars, milia, and depigmented areas. Patchy or diffuse sclerodermatous changes are less common and, unlike the other skin lesions, may affect areas of the trunk that are not exposed to sun. 

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