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Biomedical subjects

A V Proto

Publications and source records attributed to A V Proto.

At least 19 recordsLinked to original sources

Conventional chest radiographs: anatomic understanding of newer observations.

Despite the advances in medical imaging modalities over the past several years, conventional chest radiography still remains the most commonly performed imaging examination. In this report, the author discusses four radiographic observations, all visible on the conventional chest radiograph, and the anatomic basis for each: (a) the normal apical opacity, produced by the subclavian artery and easily confused with parenchymal abnormality; (b) vascular reorientation with upper lobe volume loss, a characteristic divergent or parallel pattern helpful in recognizing upper lobe volume loss; (c) extrapleural fat, which simulates pleural plaques along the lateral chest walls and pleural thickening at the chest apices; and (d) mobility of the mediastinum, which contributes to incorrect mediastinal mass localization and creates soft-tissue bands in the retrosternal area.

Adipose Tissue

The left paratracheal reflection.

The left paratracheal reflection, which is found medial to the left subclavian artery reflection, was sought in 302 normal posteroanterior (PA) chest radiographs, 93 conventional chest tomograms, and 113 thoracic computed tomographic (CT) scans. The left paratracheal reflection was visible on 31% of normal PA chest radiographs. Conventional tomography and CT showed that this finding is produced by contact of the lung with the mediastinum anterior to the left subclavian artery. The CT scans studied showed that the left paratracheal reflection actually represents contact of the lung with left paratracheal mediastinal fat 94% of the time, with the proximal 1-2 cm of the lateral wall of the left common carotid artery 5% of the time, and with the left tracheal wall 1% of the time. A variety of entities may alter the left paratracheal reflection.

Adult

Diagnosis of anemia on computed tomography scans of the thorax.

Scans of 14 patients with hemoglobin levels of 7.6 to 10.2 grams/deciliter (gm/dL) were positive for the diagnosis of anemia. All demonstrated the interventricular septum and ascending and descending aortic walls. Scans of 23 patients with hemoglobin levels of 10.5 to 12.8 gm/dL were positive for the diagnosis of anemia in 11 and negative in 12. The ascending and descending aortic walls were seen 39% and 48% of the time, respectively. Scans of 13 patients with hemoglobin levels of 12.9 to 16.0 gm/dL were negative for the diagnosis of anemia.

Adolescent

Lung torsion: case report and literature review.

A 65-year-old woman with endobronchial carcinoma had torsion of the left upper lobe. A posteroanterior chest radiograph showed apparent atelectasis in the left upper lobe, but the lateral view disclosed an inappropriate posterior displacement of the collapsed lobe. The vasculature of the affected area showed an unusual curvature. Review of 21 examples of lung torsion disclosed no characteristic age, sex, or affected lobe. The most common associations were with previous surgery (n = 10) or a history of trauma (n = 5). The most common radiographic findings are opacification of the affected lobe (n = 12), an abnormal vascular pattern (n = 6), and an abnormal location for the atelectatic lung (n = 5). Affected lobes often show hemorrhagic infarction or necrosis.

Aged

Aberrant right subclavian artery: further observations.

One hundred one posteroanterior and 89 lateral chest radiographs were reviewed of patients with proven aberrant right subclavian artery. The patients were 17-96 years old. Three findings were noted on the posteroanterior radiograph: an oblique edge extending to the right from the aortic knob (60%); demonstration of the vessel through the lucency of the tracheal air column (43%) with sharp margins (29%) or as a tubular opacity without sharp margins (14%); and a "mass" effect at the medial right clavicular area (32%). Three findings were noted on the lateral radiograph: retrotracheal opacity (79%), aortic arch obscuration (62%), and posterior tracheal imprint (49%). Two of these findings (tubular opacity and mass effect) are reported as new observations in patients with aberrant right subclavian artery.

Adolescent

Mediastinal anatomy: emphasis on conventional images with anatomic and computed tomographic correlations.

To interpret mediastinal abnormalities, an understanding of the reflections produced by the various areas of lung in contact with the mediastinum is mandatory. In this presentation many of the normal mediastinal reflections are reviewed and correlated with anatomic and CT demonstrations. Emphasis is placed on the similarities and dissimilarities of these reflections and their relationships to mediastinal structures or coronal mediastinal planes. Abnormal examples of these reflections are included, as well as the frequency with which the normal reflections may be seen.

Adult

CT of the pulmonary nodule: a cooperative study.

To evaluate the role of computed tomography (CT) in the investigation of pulmonary nodules, a special reference phantom that enabled CT densitometric measurements independent of variations between scanners and patients was used in ten institutions. A total of 384 nodules not considered calcified by conventional methods were examined; 118 (31%) proved to be benign, and in 65 of these (55%), unsuspected calcification was demonstrated. In 28 of the 65, definite calcification could be identified on thin-section CT scans by simple inspection of the scans at narrow windows. In the remaining 37, presence of calcification could not be clearly established without comparison with the reference CT number from the calibration phantom. CT was most effective in establishing the benignancy of nodules 3 cm or less in diameter and those with discrete or smooth margins. CT rarely yields a confident diagnosis of benign disease in larger nodules and in those with irregular or spiculated borders. After review of prior spot radiographs, low kilovolt peak spot radiographs, and conventional tomograms, the authors conclude that thin-section CT aided by a reference phantom in equivocal cases should be an integral part of the diagnostic approach to the pulmonary nodule.

Adult

Apical opacity: a normal finding on posteroanterior chest radiographs.

Of 423 posteroanterior chest radiographs in patients aged 21-66 years, 12.8% showed a homogeneous oval opacity with unsharp margins at the right apex and 16.8% at the left apex. Anatomy of the vessel, observations in patients with pneumothorax or atherosclerotic calcification, and fluoroscopic and computed tomographic evidence lead to the conclusion that the apical opacity is produced by the subclavian artery.

Adult

Histiocytosis X. Unusual-confusing features of eosinophilic granuloma.

We report our experience with seven cases of eosinophilic granuloma in which unusual and/or confusing features were encountered. These features include: histologic confusion with desquamative interstitial pneumonitis, diffuse histiocytic lymphoma, eosinophilic pneumonia; cysts filled with air and/or fluid; radiographic onset in the eighth decade of life; intratracheal mass; and focal parenchymal consolidation.

Adolescent

Pulmonary nodules studied by computed tomography.

The authors analyzed 177 pulmonary nodules using thin-section computed tomography (CT), calculating the representative CT number (RCT#) from a computer printout. None of the 96 malignant nodules had an RCT# greater than 151 H. Of the 81 benign nodules, 14 were shown to be calcified by conventional radiography and had an RCT# ranging from 763 and 1,023 H. Thirty had an RCT# greater than 200 H; this included 24 which showed no calcification on conventional tomograms. The remaining 37 benign nodules had an RCT# less than 200 H; 6 of them were hamartomas, including 2 which were diagnosed as such due to their fat content.

Adenocarcinoma

350 kVp chest radiography: review and comparison with 120 kVp.

High kilovoltage radiography had its beginning with super-voltage technique and is presently accomplished with the 350 KV chest x-ray system. The physical reasons to explain the improved visibility with this technique are: (1) absorption coefficients of bone and soft tissue, (2) more uniform bone visibility, (3) x-ray spectrum, (4) visual responses, and (5) depth resolution. In this study, 350 kV and 120 kV chest x-ray techniques were compared by evaluating 15 parameters. Based on our data and the results of previous large clinical studies, a list of disadvantages and advantages is offered. The entrance dose for an average 350 kV posteroanterior chest radiograph is 8 mR, or about one-third that with 90 kV technique.

Absorption

Computed tomography of the mediastinum. Normal anatomy and indications for the use of CT.

Correlative CT studies of a cadaver and a statistical analysis of all thoracic scans performed in the first year of operation of a delta-Scan 50 were undertaken in order to better understand normal mediastinal anatomy as displayed by computed tomography. Several levels are illustrated, and the results of the analysis are reported. The authors propose a list of indications for which CT of the mediastinum seems to be helpful.

Female

Air in the esophagus: a frequent radiographic finding.

While the radiologic literature discusses the presence of air in the esophagus on chest radiographs, this has almost always been reported as a finding associated with other radiologic abnormalities. In a retrospective study, esophageal air was noted on 36% of normal posteroanterior chest radiographs. The radiologic anatomy of the esophagus and the typical locations of air within it are discussed.

Air