Radiologic imaging in otorhinolaryngology.
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Biomedical subjects
Publications and source records attributed to A Bowen.
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Frontal radiographs of two neonates with respiratory distress showed areas of hyperlucency, seemingly caused by abnormal mediastinal collections of air. However, lateral radiographs or direct inspection established that deep sternal depressions caused the hyperlucencies.
Meconium peritonitis occasionally occurs as a localized collection of meconium contained in a cyst made of fibrous granulation tissue. The cyst may contain only meconium or also encase loops of bowel. One such case is reported.
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The radiographic appearance of retrothymic pneumomediastinum is quite specific. The findings include elevation of the thymus away from other mediastinal structures with increased lucency beneath it, visualization of a radiodense line extending from the inferior pole of the thymus to the midportion of the heart, and tenting of the pericardium at the point of attachment of this line. This constellation of findings will aid in the differential diagnosis of medial anterior pneumothorax, pneumopericardium, and intrapulmonary cyst in the infant with air block. The paper details the mediastinal anatomy with special emphasis on a previously undescribed layer of connective tissue that accounts for this specific radiographic appearance.
Twenty-four of 230 patients with patent ductus arteriosus had hypovascularity and hyperlucency in the left lung on preoperative chest roentgenograms. Two of the 24 patients died shortly after operation, and one was unavailable for follow-up. During the postoperative course (mean, three years), roentgenograms of eight of the remaining 21 patients showed persistent, unequal pulmonary vascularity and hyperlucent left lung, with no evidence of air trapping, and two patients had diminished volume of the hyperlucent left lung compared with that of the right lung.
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Marked narrowing of the gastric antrum produced vomiting in a boy with chronic granulomatous disease; the antral stenosis resolved after five months of medical management. A review of the seven previously reported cases indicates that this uncommon lesion may be self-limited and should be given an exhaustive trial of nonsurgical therapy, in view of the high morbidity of surgery in these children. Antibiotics may speed resolution.
In three infants with clinically mild necrotizing enterocolitis, heme-positive stools were initially attributed to anal fissures, delaying diagnosis and treatment of the enterocolitis for 4-10 days. Radiographically, pneumatosis intestinalis involved the entire colon and rectum. A causal relation may exist between necrotizing enterocolitis and anal fissure.
Six neonates receiving assisted ventilation developed loculated posterior mediastinal gas collections. Relation to other mediastinal structures localizes these gas collections to the infraazygous region, and the midline location distinguishes infraazygous pneumomediastinum from air within the pulmonary ligaments. Infraazygous pneumomediastinum does not communicate freely with the anterior mediastinum, but often dissects cephalad and is frequently associated with pneumoperitoneum.
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A modified prone lateral projection of the rectosigmoid colon with horizontal beam is described for double-contrast barium enemas in children. Elevation of the buttocks allows barium to drain retrograde from the air-filled rectum, improving visualization in selected patients.
The premises underlying our understanding of the nature of mental illness and its treatment are subject to cycles of fashion. Recurring emphasis is too often on structures and too seldom on functions within a system. Publicizing paradigms is no substitute for demonstration of efficacy.
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