Biomedical subjects
Publications and source records attributed to A Wand.
Pulmonary dirofilariasis can produce a noncalcified solitary nodule and therefore be mistaken for a lung cancer. Careful analysis of the imaging findings in this disease can suggest the proper evaluation and management in affected patients.
PURPOSE: To investigate the anatomic basis for the juxtaphrenic peak (JP) in upper and/or middle lobe volume loss through radiographic and computed tomographic (CT) correlation. MATERIALS AND METHODS: Chest radiographs and CT scans were reviewed in 32 patients with upper or middle lobe volume loss. The study included 33 cases of volume loss: 12 affected the left upper lobe; 12, the right upper lobe; five, the right upper and middle lobes; and four, the middle lobe. JPs and linear opacities identified on chest radiographs were correlated with juxtadiaphragmatic structures on CT scans. RESULTS: A JP was identified in 22 of 33 (67%) cases, including nine of 12 (75%) with left upper lobe volume loss and eight of 12 (67%) with right upper lobe, four of five (80%) with combined upper and middle lobe, and one of four (25%) with middle lobe volume loss. The JP was due to an inferior accessory fissure in 14 of 22 (64%) cases. Other causes included a medial septum and an accessory fissure other than the inferior accessory fissure. CONCLUSION: The JP sign is seen in the majority of cases with upper lobe or combined upper and middle lobe volume loss. The sign is most commonly related to an inferior accessory fissure.
In summary, the chest radiograph has only moderate accuracy in visualizing opacification caused by cardiopulmonary abnormalities and may be quite nonspecific as to etiology, whereas it has high diagnostic accuracy for detecting malpositioning of tubes and lines. While focal parenchymal abnormalities are usually visualized on chest radiographs, identification of concomitant abnormalities when ARDS or PE already exist is more difficult. Atelectasis, aspiration, pneumonia, pulmonary hemorrhage, pulmonary thromboembolism, atypical cardiogenic edema, asymmetric ARDS, and neoplasms may be indistinguishable. Repeat chest radiographs and different views may be helpful, as the progression and time course of various etiologies can be quite different. On the other hand, Winer-Muram et al found that review of prior radiographs and clinical data did not improve the diagnostic accuracy for either ARDS or pneumonia. Pleural effusions may even be difficult to distinguish from parenchymal processes, particularly when the patient is in the supine position. Additional views with the patient in a different position--semi-erect, decubitus, or cross-table lateral--may be of assistance. In most cases, pneumothorax is readily detected. Additional studies such as the decubitus view occasionally may be necessary for further evaluation when there is uncertainty about the findings. Subcutaneous air is readily visualized radiographically. Pneumomediastinum and interstitial pulmonary emphysema may be more difficult to see. It is well known that CT allows visualization of much smaller abnormal air collections than radiography. Despite this lack of sensitivity and specificity of chest films, studies have shown that up to 65% of daily films in the ICU reveal significant and/or unsuspected abnormalities that may change the patient's diagnosis or management. Based on these results, the consensus opinion of the ACR Expert Panel found that daily chest radiographs are indicated on patients with acute cardiopulmonary problems and those receiving mechanical ventilation. Patients who require cardiac monitoring but are otherwise stable require only an initial admission film. Additional radiographs are indicated only when a new device is placed or when there is a specific question regarding cardiopulmonary status. It is also noteworthy that despite the chest film being the most commonly ordered radiologic examination for inpatients, there are no comprehensive studies evaluating its cost-effectiveness. Although several studies have done a very limited cost accounting of the potential savings by eliminating routine films in the evaluation of specific subsets of patients, overall impact on patient outcome has not been investigated. Thus, a true assessment of cost-effectiveness has yet to be determined.
The association of livedo racemosa and neurological lesions is described as Sneddon's syndrome. A 48-year-old woman with Sneddon's syndrome accompanied by antiphospholipid antibodies is presented.
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Lumboperitoneal shunts have become more prevalent since the introduction of Silastic tubing. One disadvantage of this procedure is the difficulty in obtaining a subsequent myelogram. In the presence of a lumboperitoneal shunt, it may be advisable to modify the usual technique in obtaining a satisfactory myelogram. Use a low lumber puncture for a lumbar study, a C1-2 puncture for the cervical and thoracic regions, and use metrizamide to avoid the potential problem of Pantopaque in the peritoneal cavity.
Proper positioning and assessment of abnormalities and complications of the above-mentioned devices have a significant impact on the management of critically ill patients in the intensive care unit (ICU). The timely assessment of new or rapidly evolving findings is critical. Optimal radiographic technique, availability of images to the clinicians, and rapid reporting by the radiologist all serve to maximize the efficacy of bedside chest radiography in the ICU. Sometimes, changes in cardiopulmonary status may only be appreciated on chest radiographs (CXRs). Complications from ventilatory assistance, such as barotrauma, occur frequently and must be detected promptly. The position of monitoring devices, an important component of critical care management, is best checked radiographically. Indications for CXRs and the recommended frequency for repeat follow-up CXRs are based on the existing literature and the consensus of an expert panel formed by the American College of Radiology.
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