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Biomedical subjects

C S White

Publications and source records attributed to C S White.

At least 55 records · Page 3Linked to original sources
PubMed1996

Thoracic disease in children with AIDS.

Knowledge of common and uncommon thoracic pathologic conditions in children with acquired immunodeficiency syndrome (AIDS) can expedite disease management. Chest radiography, computed tomography (CT), and magnetic resonance (MR) imaging are useful in cases involving possible complications of thoracic AIDS. Lymphocytic interstitial pneumonitis (LIP) is generally seen on plain radiographs and CT scans as a diffuse, symmetric, reticulonodular or nodular pattern, occasionally associated with mediastinal or hilar adenopathy. Chronic consolidations and bronchiectasis may be observed in pediatric AIDS patients with no evidence of previous LIP. Bacterial pneumonia, a frequent initial manifestation of AIDS, appears as lobar or segmental consolidations on radiographs. Radiographic findings of Pneumocystis carinii pneumonia, the most common infection, include rapidly progressive increased air-space opacity with air bronchograms. Lymphoma often appears as a mediastinal or hilar mass, often without involvement of the lung parenchyma. Thoracic smooth muscle tumors have also been observed in children with AIDS. Multilocular thymic cysts have low attenuation on CT scans and increased signal intensity on T2-weighted MR images. Most pediatric AIDS patients with cardiac disease have cardiomegaly, often associated with pulmonary edema, at chest radiography. An esophagogram may show ulceration, plaque formation, mucosal edema, and dysmotility in patients with candidal esophagitis.

AIDS-Related Opportunistic Infections↗
PubMed1996

Primary carcinoma of the lung overlooked at CT: analysis of findings in 14 patients.

PURPOSE: To describe the appearances of overlooked lung cancer at computed tomographic (CT) examination and to analyze the reasons for failure to diagnose these lesions. MATERIALS AND METHODS: Fourteen patients with 15 overlooked lung cancers were identified by radiologists at three institutions. Location, shape, and cell type of each cancer were reviewed, and other relevant findings of CT examinations were assessed. RESULTS: The missed tumors manifested as endobronchial lesion (n = 10), solitary parenchymal nodule (n = 2), area of focal peripheral air-space disease (n = 2), or pleural-based thickening (n = 1). Eleven (73%) of the 15 lesions were located in a lower lobe. In six (43%) of 14 patients, major distracting findings were present elsewhere in the thorax. CONCLUSION: Endobronchial location and lower lobe predominance were the most common characteristics of overlooked lung cancer at CT. The presence of unrelated major abnormalities at CT may also have contributed to failure to diagnose the tumor.

Diagnostic Errors↗
PubMed1996

Traumatic aortic injury: diagnosis with contrast-enhanced thoracic CT--five-year experience at a major trauma center.

PURPOSE: To review the literature and the authors' experience with admission contrast material-enhanced computed tomography (CT) in patients admitted after blunt trauma. MATERIALS AND METHODS: From January 1990 to December 1994, thoracic CT was performed to evaluate traumatic aortic injury in 677 patients with positive or equivocal findings at chest radiography. CT scans positive for mediastinal hemorrhage or aortic injury were retrospectively reviewed and interpreted by consensus, with angiographic and surgical confirmation. RESULTS: CT findings were negative for TAI in 570 (84%) of the 677 patients. Mediastinal hemorrhage was reported in 100 patients and was the only abnormality in 79 of them. Findings at angiography were negative for traumatic aortic injury in 77 (97%). CT signs of traumatic aortic injury in 21 patients included contour abnormality or pseudoaneurysm (n = 19), intimal flap(s) (n = 8), and pseudocoarctation (n = 3). Findings at angiography were positive for traumatic aortic injury in 19 (90%). For aortic injury and mediastinal hemorrhage, respectively, specificity for traumatic aortic injury was 99% and 87% and sensitivity was 90% and 100%; at meta-analysis of data from the authors and the literature, sensitivity was 97.0% and 99.3% and specificity was 99.8% and 87.1%. Reliance on findings at admission CT rather than radiography to indicate suspicion for traumatic aortic injury before angiography resulted in savings of more than $365,000. CONCLUSION: The CT finding of mediastinal hemorrhage alone is sensitive for traumatic aortic injury, but the finding of aortic injury is more specific.

Angiography, Digital Subtraction↗
PubMed1996

MR imaging evaluation of hemidiaphragms in acute blunt trauma: experience with 16 patients.

OBJECTIVE: The aim of this retrospective study was to evaluate the usefulness of MR imaging in excluding or confirming the diagnosis of diaphragmatic injury after blunt trauma. MATERIALS AND METHODS: MR imaging studies were performed in 16 patients with blunt trauma and with indeterminate radiographs of the chest suspicious for but not diagnostic of diaphragmatic injury. T1-weighted images were obtained in all patients, and fast gradient-echo pulse sequence images were obtained in 11 patients. The results of all imaging studies performed before the MR imaging studies and those performed during out-patient follow-up, including chest radiography and thoracoabdominal CT scanning, were reviewed for evidence of diaphragmatic injury. Medical records were reviewed to ascertain the indications for the MR imaging studies as well as the surgical findings and the duration of outpatient follow-up. RESULTS: MR imaging studies confirmed diaphragmatic injury in seven patients (44%) and revealed an intact diaphragm in nine (66%). In seven patients MR imaging studies were able to correctly reveal the site of the diaphragmatic tear and the abdominal viscera that herniated into the thoracic cavity. None of the nine patients with intact diaphragms on MR imaging studies had delayed presentation of a diaphragmatic rupture on outpatient follow-up. CONCLUSIONS: MR imaging studies can be reliably used to diagnose or exclude injury in blunt trauma patients.

Acute Disease↗
PubMed1996

Apical lung hernia: radiologic findings in six cases.

OBJECTIVE: We performed this study to characterize the clinical and radiologic manifestations of apical lung hernias. CONCLUSION: Apical lung hernias typically manifest as unilateral, right-sided air radiolucencies at the thoracic inlet on chest radiographs. They are frequently intermittent and can cause lateral tracheal deviation. Radiologic studies performed at midinspiration may not show hernias. Airway fluoroscopy or CT performed at maximal inspiration may be necessary to confirm the diagnosis.

Adult↗
PubMed1996

MR evaluation of the pericardium and cardiac malignancies.

The pericardium and cardiac malignancies are well visualized on MR imaging because of the superb contrast resolution and multiplanar capability of the technique. This article highlights some of the clinical uses of MR imaging in evaluating the pericardium and cardiac lesions and provides comparison with echocardiography and CT scan. Specific diseases that are described include pericardial effusion, constrictive pericarditis, neoplastic pericardial disease, congenital abnormalities of the pericardium, benign, malignant and metastatic cardiac tumors, and paracardiac masses. This article discusses the impact of newer MR techniques such as cine MR imaging on the assessment of pericardial disease and cardiac lesions.

Heart↗
PubMed1995

Primary osteosarcoma of the ribs: CT findings.

We report the CT appearance of primary osteosarcoma of the ribs in three patients. CT evaluation is important because this lesion may present a diagnostic dilemma on chest radiographs. The tumor should be suspected if CT demonstrates dense calcification within a mass that is centered in a rib.

Adult↗
PubMed1995

The role of thoracoscopy in the diagnosis of interstitial lung disease.

A study was undertaken to evaluate the safety and efficacy of thoracoscopic lung biopsy for interstitial lung disease. The relation between operative findings, pathologic findings, and preoperative computed tomographic scan findings was examined. Twenty-six patients, 10 male and 16 female, underwent thoracoscopic lung resection to diagnose interstitial lung disease. Sixteen patients were outpatients for an elective procedure; 10 were inpatients including 2 who were ventilator dependent. The mean length of operation was 54 minutes and the mean length of chest tube duration, 1.3 days. There were no deaths. Staphylococcal pneumonia developed in 1 patient postoperatively. One patient with systemic pulmonary hypertension was ventilator dependent for 48 hours. A double-lumen endotracheal tube was used in all but 2 patients. Twelve-millimeter trocar ports were used to allow easy interchange of staplers and endoscopic instruments. Biopsy of at least two lobes was performed in each patient with resection of a piece of grossly abnormal lung. A single chest tube was left routinely. The pathologic diagnosis was usual interstitial pneumonitis in 7 patients. Four patients had interstitial fibrosis and 4, granulomas. Three patients had diffuse alveolar damage and 3, Wegener's granulomatosis. Two patients had bronchiolitis obliterans with organizing pneumonia. One patient each had lymphangioleiomyomatosis, eosinophilic granuloma, and cytomegalovirus. Sixteen patients underwent preoperative computed tomographic scanning. The scans were assessed by 2 radiologists who were blinded to the surgical results. Computed tomography accurately predicted the site of disease in most instances. Four patients had at least one lobe with no evidence of disease on computed tomography but with interstitial lung disease found thoracoscopy.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1995

Subarachnoid-pleural fistula after resection of a pancoast tumor with hyponatremia.

Resection of superior sulcus neoplasms is associated with a number of complications resulting from the extensive nature of the resection and the necessity to sacrifice certain adjacent structures. One of the complications of resection is the development of subarachnoid-pleural fistula, with the subsequent appearance of air in the cerebrospinal fluid circulation. We report a case in which a subarachnoid-pleural fistula led to persistent pneumocephaly in a patient who exhibited postoperative hyponatremia, confusion, and gait disturbance.

Aged↗
PubMed1995

MR imaging of slipped stacked breast implants: a potential pitfall in the diagnosis of intracapsular rupture.

The integrity of silicone-gel breast implants can be evaluated by MR imaging. The findings of intra- and extracapsular rupture have been described. Increasingly sophisticated breast reconstruction techniques such as stacking of prostheses have lead to a wider range of implant appearances. We report a case where intracapsular rupture was simulated by slippage of two retropectoral stacked implants in relation to each other. The MR and CT findings are described.

Breast↗
PubMed1995

Pictorial review: imaging of traumatic aortic injury.

Traumatic aortic injury is a leading cause of death in patients with blunt trauma of the thorax. More than 120 patients with traumatic aortic injury have been admitted to our institution. This institutional experience is the source of the material that is presented in this pictorial review. The appearance of traumatic aortic injury on chest radiography, thoracic aortography and CT scan is demonstrated.

Aortic Rupture↗
PubMed1995

Psychological science and the use of anatomically detailed dolls in child sexual-abuse assessments.

Many devices are used in child assessment and treatment as communication aids, projective tools, and symbolic means of interaction. None are as hotly debated in their application among mental health professionals as dolls with genital details. Anatomically detailed (AD) dolls are often used in sexual-abuse evaluation and treatment with children, but such applications are controversial. This article is the product of a working group formed to review AD doll research and practice. This article reviews historical use of dolls in clinical inquiry and research on sexual behaviors in children, normative use of AD dolls in nonreferred children, differences in children's play behavior and emotional reactions to AD dolls, and memory and suggestibility issues relating to AD-doll use. Recommendations for future research are provided.

Child↗
PubMed1995

Bacillary angiomatosis in patients with AIDS: multiorgan imaging findings.

PURPOSE: To describe the varied clinical manifestations and imaging findings encountered in bacillary angiomatosis, an infectious complication of the acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: Clinical, imaging, and histopathologic findings in nine men (aged 26-50 years) with AIDS and bacillary angiomatosis were described. This condition often manifests as vascular skin lesions that resemble those of Kaposi sarcoma, fever, and anemia and is due to infection with Bartonella (Rochalimaea) henselae. RESULTS: Common imaging findings included lung nodules, mediastinal adenopathy, peripheral adenopathy, pleural effusions, ascites, abdominal adenopathy, soft-tissue masses, and low-attenuation lesions in the liver and/or spleen. Most notably, nodes and soft-tissue lesions were dramatically enhanced with injection of contrast material, which is presumably because the lesions are composed to a large extent of well-formed capillaries. CONCLUSION: Bacillary angiomatosis, a treatable infection, should be considered in patients with AIDS, particularly when Kaposi sarcoma is suspected clinically.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Calcification of aortic valve detected incidentally on CT scans: prevalence and clinical significance.

OBJECTIVE: Aortic valve calcification that is visualized on chest radiographs is considered a marker for clinically significant aortic stenosis, but the clinical importance of this finding on CT is unknown. Accordingly, we studied the prevalence and clinical relevance of aortic valve calcification found incidentally on CT scans of the chest. MATERIALS AND METHODS: After comparing computer records of chest CTs and echocardiograms, we identified 109 patients who underwent both studies during a 2-year period. Two thoracic radiologists reviewed the CT scans to identify and quantify aortic valve calcification. The quantity of aortic valve calcification was graded on a scale of 1 to 3, with grade 3 indicating the most severe calcification. The prevalence of calcification was correlated with patient age and sex. The findings on CT were correlated with hemodynamic data from echocardiography. At echocardiography, a peak aortic valve gradient of greater than 25 mm Hg was defined as abnormal. RESULTS: Aortic valve calcification was noted on CT scans in 33 (30%) of the 109 patients. Aortic valve calcification shown by CT was significantly more common in patients more than 65 years old (p < .01). Five (15%) of 33 patients with aortic valve calcification shown by CT had abnormal aortic valve gradients at echocardiography. In contrast, none of 76 patients without aortic valve calcification shown by CT had abnormal aortic valve gradients (p < .01). All five patients with abnormal aortic valve gradients had moderate quantities of aortic valve calcification seen on CT scans. Two of the five were younger than 55 years old. CONCLUSION: Aortic valve calcification is a common finding on CT scans and is usually clinically insignificant. Nevertheless, some patients with aortic valve calcification on CT have aortic stenosis, particularly those younger than 55 years old and those with moderately dense aortic valve calcification shown by CT. These patients may benefit from hemodynamic assessment of the aortic valve by echocardiography.

Adult↗
PubMed1995

Carcinoma of the lung in HIV-positive patients: findings on chest radiographs and CT scans.

OBJECTIVE: Several recent clinical studies have described an association between HIV seropositivity and lung cancer. The purpose of this study was to describe the spectrum of imaging findings in HIV-positive patients who had proved carcinoma of the lung. In particular, we attempted to define the role of CT in diagnosing HIV-associated lung cancer. MATERIALS AND METHODS: The study population consisted of 23 HIV-positive patients from two institutions who had lung cancer diagnosed between 1989 and 1993. All patients had both chest radiographs and CT scans. The group included 19 men and four women with a mean age of 42 years. The diagnosis of lung cancer was confirmed by bronchoscopy in eight patients, by pleural fluid aspiration or pleural biopsy in seven, by percutaneous needle biopsy of a lung lesion in three, by biopsy of an extrathoracic site in four, and by thoracotomy in one. Two thoracic radiologists retrospectively evaluated the chest radiographs and CT scans to identify parenchymal masses, lymphadenopathy, pleural disease, chest wall or mediastinal invasion, and metastatic lesions. RESULTS: Fifteen (65%) of the 23 patients had a central or peripheral mass or nodule. Eight (35%) had extensive pleural disease, either as an isolated finding or in combination with other abnormalities. CT scans showed the malignant lesion underlying the extensive pleural disease in all but one case. All patients with extensive pleural disease had adenocarcinoma. No patient in the study was considered a candidate for resection on the basis of clinical and radiologic evaluation. CONCLUSION: Lung cancer in HIV-positive patients manifested most often on chest radiographs as a central or peripheral mass or nodule. Extensive pleural disease in the absence of an apparent primary lesion was the second most common major manifestation. Lung cancer therefore merits serious consideration in the differential diagnosis of extensive pleural disease in HIV-positive patients. CT was most useful in evaluating malignant lesions associated with extensive pleural disease.

Adenocarcinoma↗
PubMed1995

Informed consent for percutaneous lung biopsy: comparison of two consent protocols based on patient recall after the procedure.

OBJECTIVE: Informed consent is now required for the majority of radiologic procedures, but few studies have evaluated the efficacy of informed consent protocols. We compared our standard consent protocol of obtaining consent prior to percutaneous lung biopsy with a modified protocol by using patients' recall of procedure risks after the biopsy as an indicator of patients' comprehension. SUBJECTS AND METHODS: The study sample consisted of 50 patients who underwent percutaneous lung biopsy between December 1992 and June 1994. Twenty-seven patients received our standard informed consent procedure in which four important procedure risks were described briefly using our standard method. Twenty-three patients underwent a consent procedure that had the following modification. After the four procedure risks were described, the patient was tested verbally until all risks could be recited to the physician. This change required 5 additional min at most. In both protocols, efficacy of the procedure was evaluated by testing patient recall 4 hr after consent was obtained. We also assessed any effect that might have been introduced by differences between the groups, age, sex, time between consent and recall, and complications during the procedure. RESULTS: Patients' recall was significantly better in the modified consent group than in the standard group (p = .005). This result could not be attributed to differences in age, sex, or time between consent and recall. There was a trend for improved recall in patients with complications. This trend did not appear to influence our principal finding. CONCLUSION: The standard consent procedure for lung biopsy appears inadequate when patients' recall of procedure risks later is used as a measure of the patients' comprehension. Based on this study, the informed consent process may be improved substantially by teaching patients to recite the procedure risks to the physician as part of the informed consent protocol.

Adult↗
PubMed1995

MR evaluation of the pericardium.

The pericardium is well visualized on magnetic resonance imaging (MRI) because of the superb contrast resolution and multiplanar capability of the technique. This article highlights some of the clinical uses of MRI in evaluating the pericardium and provides comparison with echocardiography and computed tomography (CT) scan. Specific pericardial diseases that are described include pericardial effusion, constrictive pericarditis, neoplastic pericardial disease, congenital abnormalities of the pericardium, and paracardiac masses. The value of MRI in differentiating constrictive pericarditis from restrictive cardiomyopathy is emphasized. The article discusses the impact of newer MRI techniques such as cine MRI on the assessment of pericardial disease.

Heart Diseases↗