Shunt vascularity in a young patient with right-sided aortic arch.
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Adolescent↗
Biomedical subjects
C E Ravin
Publications and source records attributed to C E Ravin.
Limited value of interlaced ECG-gated radiography in the presence of a normal chest radiograph.
Twenty-seven patients with normal posteroanterior and lateral chest radiographs, who were undergoing cardiac catheterization because of symptoms strongly suggesting coronary artery disease, also had posteroanterior and lateral interlaced electrocardiogram-gated radiographs made. In 14 patients, the interlaced radiography system underestimated (suggested hypokinesia) the wall motion, which was normal on cardiac catheterization. In two cases the system overestimated the wall motion, in two others it both under- and overestimated the motion, and in only nine cases was the correlation correct. These data suggest that the technique is of limited application, particularly in cases in which the routine chest radiographs are normal.
Cardiac Catheterization↗
Thoracic cryptococcosis: immunologic competence and radiologic appearance.
Cryptococcosis, a potentially fatal pulmonary infection, is being recognized with increased frequency in both immunologically compromised patients and those without obvious predisposing factors. This review of 24 cases of proven pulmonary cryptococcosis includes 15 immunologically compromised patients and nine noncompromised hosts. The noncompromised hosts tended to have a radiographic pattern of a peripheral nodule or nodules. The compromised hosts demonstrated a wider variety of radiographic abnormalities including single nodules, multiple nodules that progressed to confluence and/or cavitation, segmental consolidation, bilateral bronchopneumonia, or mixed patterns. Adenopathy, cavitation, and pleural effusions were limited to the compromised hosts.
Adult↗
Tracheobronchial mucoid pseudotumors.
A collection of mucus, indistinguishable from tumor, can be shown in the tracheobronchial tree, particularly during tomography. These "mucoid pseudotumors" may be distinguished from true tumors by documenting their disappearance after having the patient cough.
Aged↗
Adult-onset pulmonary tuberculosis.
Medical records and radiographs of 103 adults with primary tuberculosis were reviewed. The shift toward delayed presentation appears to be related to decreasing childhood exposure and an increasing number of compromised hosts. Compared with classic "childhood" tuberculosis, there is a higher incidence of lower-lobe disease, but infiltrates also commonly involve the upper lobe or upper segments of the lower lobe. Adenopathy, cavitation, and tuberculoma are rare. If a pleural effusion is present and tuberculosis is suspected, pleural biopsy is mandatory. Adult respiratory distress syndrome can be a complication, particularly in miliary tuberculosis, and disseminated intravascular coagulopathy usually follows. A normal chest radiograph or clinical improvement of the patient with bed rest and penicillin does not exclude tuberculosis. Increased awareness of adult-onset tuberculosis on the part of radiologists could lead to a more rapid diagnosis and successful management.
Adolescent↗
Peripheral middle lobe syndrome.
Classically, the middle lobe syndrome has been described as being caused by a central obstruction. Clinical records and radiologic findings were reviewed in 129 patients examined between 1955-1981 who had chronic disease in the right middle lobe and/or lingula. Fifty-eight patients (45%) had no evidence of a central obstructive lesion. The majority were middle-aged women with histories of chronic cough and chest pain. Bronchoscopic and radiologic evaluation served to exclude central lesions. Surgical confirmation was available in 38 patients. Pathologic study showed varying degrees of chronic inflammation, pneumonia, and bronchiectasis. Surgical results were excellent in isolated disease. Chronic atelectasis and pneumonitis of the right middle lobe and/or lingula do not always imply central obstruction. A lack of collateral ventilation is a plausible theory to explain the pathophysiology in such patients.
Bronchiectasis↗
Lung scan interpretation: effect of different observers and different criteria.
Many nuclear medicine physicians use criteria put forth by McNeil or Biello et al. to interpret lung scintigrams, while others use an integration of these and other reported or personal criteria. Interobserver variation within these schemes has not been assessed, nor have the schemes been compared with each other using the same set of scans. Two experienced nuclear medicine physicians independently read 98 scans that were collected over a two year period and that had angiographic correlation. Perfusion, ventilation, and radiographic abnormalities were described objectively, and each case was assigned to a McNeil category, a Biello category, and an estimate of probability was made based on the reader's own synthesis of criteria (modified criteria). The two readers differed widely in describing the number, size, and location of abnormalities. Despite the large interobserver variation in objective descriptions, there were no statistically significant differences between the receiver operating characteristic (ROC) curves for each reader. When the ROC curves for each set of criteria were compared, the results did not confirm that one set of criteria was clearly superior to another. The Biello and modified criteria did classify fewer cases as indeterminate or intermediate probability without a drop in overall accuracy. When data were subdivided by year, analysis still showed no statistically significant differences between criteria or readers. There was, however, a significant difference (P less than .001) in overall accuracy when ROC curves for the two years were compared. This has implications for data obtained in retrospective studies of lung scintigraphy.
Angiography↗
Midline lucency following median sternotomy.
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Aortic Valve↗
Comparison of CT localization radiography and high-kilovoltage chest radiography.
Twenty-five patients had localization radiography before chest computed tomography (CT) for evaluation of pulmonary nodules, staging of lung carcinoma, or suspected metastatic disease. Evaluation of the localization radiograph and the 140 k Vp frontal chest radiograph were performed independently and without history by a CT and chest radiologist, respectively. These interpretations were compared to a reference standard compiled from the full CT and chest radiographic reports. Significant abnormalities in the soft tissues, bones, mediastinum, hila, and pleura were detected with about equal frequency by chest and localization radiography. Chest radiography detected all 16 of the lung nodules greater than 1 cm in diameter, while localization radiography detected 12; however, this was not statistically significant. Both the sensitivity and specificity of nodule detection by chest radiography exceeded that of localization radiography. The performance of localization radiography in the detection of chest abnormalities in this and other studies encourages further development of computed chest radiography.
Adolescent↗
Solitary pulmonary metastases in high-risk melanoma patients: a prospective comparison of conventional and computed tomography.
A prospective comparison of chest radiography, conventional tomography, and computed tomography (CT) in the detection or confirmation of solitary pulmonary nodules was made in 42 patients with high propensity for pulmonary metastases due to advanced local (Clark level IV or V) or regional malignant melanoma. Unequivocal nodules were revealed by chest radiography in 11 patients, conventional tomography in 16, and computed tomography in 20 patients. Both plain films and tomography in three of these 20 were normal, but follow-up verified pulmonary metastases. Computed tomography detected more pulmonary nodules than conventional tomography in 11 patients in addition to identifying lesions in extrapulmonary sites. Therefore, chest CT is recommended before institution of immunotherapy or surgical removal of a solitary pulmonary melanoma metastasis. Once chemotherapy had been instituted for bulky regional or cutaneous involvement, however, the findings of either conventional or computed tomography were comparable in this study.
Adult↗
Radiologic evaluation of acute chest trauma.
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Acute Disease↗
A survey of digital chest radiography.
The problems of chest radiography as they relate to digital systems are described, the current approaches to these problems are reviewed, and the utility of digital chest radiography is demonstrated.
Humans↗
The ICU chest film. Cardiopulmonary monitoring and assist devices.
Numerous catheters, tubes, and other devices have been designed in recent years to facilitate monitoring and assistance of cardiopulmonary physiology in the intensive care patient. These devices have resulted in major improvements in care of the critically ill but at the same time have introduced a new group of iatrogenic complications. Some of these are relatively benign, but others are serious and may result in significant morbidity or mortality if not recognized and treated promptly. Many of the more serious complications can be detected by radiographic examination and, indeed, may be nearly impossible to detect clinically. Hence, a careful, systematic review of the chest radiograph with special attention to the potential complications noted above is mandatory in this setting.
Assisted Circulation↗
Radiographic analysis of pulmonary vascular distribution: a review.
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Humans↗
Abdominal radiography in the emergency department: a prospective analysis.
We present a prospective analysis of 100 consecutive abdominal radiographs of 96 emergency patients who were referred to radiology with a variety of abdominal complaints. In patients with diffuse, nonspecific abdominal pain, nausea, vomiting, or gastrointestinal bleeding, 98% of the radiographs were negative or had positive findings which were unrelated to the current clinical problem. Ninety-three percent of the positive radiographs that were related to the acute problem occurred in patients with renal colic; hematuria; ingestion of foreign bodies; previously known surgical conditions, such as incarcerated hernias; intra-abdominal metastatic carcinoma; fecal impaction; or true acute abdominal syndromes.
Diagnostic Tests, Routine↗
Roentgenographic abnormalities in Rocky Mountain Spotted Fever.
Rock Mountain spotted fever (RMSF) is a tick-borne rickettsial disease which produces a widespread vasculitis. A mortality of 7% to 13% has been reported in the United States which is due at least in part to delay in diagnosis and appropriate treatment. The classic features of this disease include a history of tick bite with the clinical presentation of skin rash and fever in association with thrombocytopenia. Few reports have emphasized the radiologic chest abnormalities in this disease or their relationship to thrombocytopenia. We review 70 cases of RMSF with abnormal roentgenographic features and their pathologic correlation.
Adult↗
Comparison of plain radiography, conventional tomography, and computed tomography in detecting intrathoracic lymph node metastases from lung carcinoma.
Forty-two patients with T2 bronchogenic carcinoma were evaluated with plain radiography, conventional 55 degrees oblique hilar and anteroposterior mediastinal tomography, and computed tomography (CT) to compare their accuracy in assessing mediastinal and hilar nodal metastases. Definitive staging was achieved by thoracotomy and histopathological evaluation of resected specimens. All modalities demonstrated about the same accuracy; however, in the 25 patients with hilar and/or mediastinal lymphadenopathy, CT of the mediastinum was more sensitive but not more specific than the other two and conventional tomography was no more accurate than CT for hilar evaluation. Overall, no technique was accurate enough for routine staging; their value may lie in directing biopsy or in treatment planning in patients with inoperable disease.
Carcinoma, Bronchogenic↗
The efficacy of full-lung tomography in the detection of early metastatic disease from melanoma.
In a prospective study, 62 patients with proved melanoma and negative chest radiographs underwent full-lung tomography. Of 109 examinations performed, 12 patients had positive findings on tomography; nine were false-positive and three were true-positive. Of the true-positive examinations, two patients already had widespread metastatic disease and one had an advanced local lesion. Clinical staging and therapy were changed in only one patient as a result of information provided by full-lung tomography. It appears from these results that full-lung tomography is of limited use in detection of metastases from melanoma in the presence of a negative chest radiograph.
Adult↗