Mediastinal mass in a man with back pain.
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Adult↗
Biomedical subjects
D J Conces
Publications and source records attributed to D J Conces.
Treatment of pneumothoraces utilizing small caliber chest tubes.
Pneumothorax is a common problem in both hospitalized and emergency room patients. Eight-four pneumothoraces in 79 patients were treated using a No. 9 French catheter. In 76 cases, the catheter was attached to a flutter valve, and in eight cases, suction was applied. The No. 9 French catheter provided definitive treatment in 73 (87 percent) of the pneumothoraces. Causes of catheter failure included kinking, malposition, inadvertent removal by patient, occlusion of the tube or valve by pleural fluid, and large air leak. No complication attributable to tube placement occurred. When the flutter valve was employed, the patient was able to ambulate allowing for potential outpatient therapy. The tube was found to be easy to use, safe, and efficacious in the treatment of pneumothoraces.
Female↗
Motion artifacts on CT simulate bronchiectasis.
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Bronchiectasis↗
Cavitary infiltrate in an immunosuppressed patient. Invasive pulmonary aspergillosis.
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Adolescent↗
Patient positioning for subclavian vein catheterization.
The subclavian vein is a commonly used venous access route. Percutaneous cannulation is associated with complications and malpositioning of the catheter. We studied the potential effect of various body positions on subclavian vein catheterization using gross anatomic dissection and magnetic resonance imaging. Findings show that traditional recommendations for patient positioning with the shoulders retracted and the head turned away can act to distort the subclavian vein anatomy and make successful cannulation more difficult. Positioning the patient flat with the head and shoulders in a neutral position is suggested.
Catheterization, Peripheral↗
Esophageal fistula complicating mediastinal histoplasmosis. Response to amphotericin B.
A 41-year-old man was admitted for evaluation of hemoptysis, dysphagia, and pleuritic chest pain associated with a mediastinal mass. Esophagography demonstrated a fistula between the mass and the esophagus. Results of histoplasmosis complement fixation serologic testing suggested an active infection. A methenamine silver stain of a lymph node obtained at mediastinoscopy revealed Histoplasmosis capsulatum. The patient was successfully treated with amphotericin B. This is believed to be the first reported case of an esophageal fistula as a complication of mediastinal histoplasmosis successfully treated with amphotericin B.
Adult↗
Thoracic needle biopsy. Improved results utilizing a team approach.
Transthoracic needle aspiration biopsy (TNAB) is a useful diagnostic technique in the evaluation of thoracic disease. Previous reports have shown that this technique has a high positive but a low negative predictive value. The latter has limited the clinical usefulness of a negative biopsy. To improve the reliability of a negative TNAB, a series of thoracic needle biopsies was done using a team approach, having a cytopathologist, with the necessary equipment to examine the biopsy specimens, in attendance at the biopsy. As biopsy specimens were obtained, they were reviewed to ensure an adequate and representative sampling. The positive predictive value was 98.6 percent and the negative predictive value was 96.7 percent. The high negative predictive value obtained using this approach allows clinical decisions to be based on the results of a negative TNAB.
Adult↗
Nonangiographic imaging of the pulmonary arteries: CT and MR.
Computed tomography (CT) has provided a imaging modality by which the central pulmonary arteries can be studied noninvasively. CT provides cross-sectional images which accurately depict the pulmonary arteries and adjacent structures. Magnetic resonance (MR) imaging with its ability to image vessels without contrast media provides a potential truly noninvasive means of examining the pulmonary arteries. These modalities are well suited to evaluate pathology involving the central pulmonary arteries. Normal CT and MR anatomy is illustrated and discussed. The clinical presentation and appearance of pathological processes involving the pulmonary arteries are described.
Aneurysm↗
Pulmonary edema induced by intravenous ethchlorvynol.
The intravenous injection of ethchlorvynol is an uncommon cause of noncardiac pulmonary edema. Two cases of intravenous ethchlorvynol-induced pulmonary edema are presented. The patients fell asleep after injecting the liquid contents of Placydil capsules (ethchlorvynol) and awoke several hours later with severe dyspnea. Arterial blood gases demonstrated marked hypoxia. Chest radiographs revealed bilateral diffuse alveolar densities. The patients' symptoms and radiographic findings resolved after several days of supportive care. Changes in the lung caused by ethchlorvynol may be the result of direct effect of the drug on the lung.
Adult↗
Bacteremia during double-contrast barium enema examination.
Forty-five patients undergoing double-contrast barium enema examinations were studied to identify the incidence of transient bacteremia associated with the examination. Blood cultures were obtained immediately prior to the examination and at 5, 10, and 20 minutes after the start of the examination. Blood samples were cultured in both aerobic and anaerobic media, and four of these cultures were positive for organisms that are common skin contaminants. No bacteremia was identified from enteric pathogens. The data herein suggest that patients with cardiac valvular disease are not at greater risk of bacteremia during double-contrast barium enema examinations.
Barium Sulfate↗
Gated MR imaging of left atrial myxomas.
Two cases of left atrial myxoma were evaluated with magnetic resonance (MR) imaging. In both cases, the myxoma was clearly defined as to its location, origin, and size. In one case, the myxoma prolapsed through the mitral valve. Our study indicates that MR imaging is valuable in the diagnosis of myxomas.
Aged↗
Aberrant locations and complications in initial placement of subclavian vein catheters.
The subclavian vein approach is frequently used in the placement of catheters into the great intrathoracic veins. Central venous catheters are associated with complications that may be related to the insertion of the catheter or the location of its tip. A retrospective review of 500 subclavian vein catheterizations was undertaken to determine initial catheter tip position and identify complications associated with the initial placement of the catheter. Catheters were properly positioned in 68% of successful placements. The incidence of complications associated with initial catheter placement was 1.6%. The postplacement chest roentgenogram identified clinically useful information in approximately 33% of the cases.
Blood Pressure Determination↗
Opportunistic pneumonia.
Patients with abnormalities in their immune defense mechanisms are frequently encountered in the practice of medicine. These patients have increased susceptibility to infections that often involve the lung. Many of these infections are caused by opportunistic organisms that typically do not produce disease in individuals with a normally functioning immune system. To complicate the evaluation of these patients, they frequently develop noninfectious lung disease, which can have a radiographic appearance that is similar to infection. The purpose of this article is to present an approach to the evaluation of chest radiographic abnormalities in the immunocompromised patient with suspected pneumonia. Clinical information that is pertinent in the evaluation of immunocompromised patients is discussed. The various chest radiographic patterns seen in both infectious and noninfectious diseases that occur in the immunocompromised patient are reviewed. Integration of clinical information and radiographic findings in the development of a list of differential diagnoses is stressed.
AIDS-Related Opportunistic Infections↗
MR of superior mesenteric artery--renal vein fistula.
Traumatic arteriovenous fistulas involving the superior mesenteric artery are rare. Diagnosis is most commonly made shortly after the injury. Symptoms, when present, are usually related to intestinal ischemia. Angiography has been the conventional modality used in diagnosing arteriovenous fistulas. We report a patient with a superior mesenteric artery to left renal vein fistula who presented in overt heart failure five years after a gun shot wound. The fistula was evaluated with magnetic resonance imaging.
Adult↗
MR diagnosis of herniation of the left ventricle through a pericardial window.
The diagnosis of herniation of the left ventricle through a pericardial window was made using MRI. This is a rare type of herniation because it presented 6 years after a pericardial window was made for pericarditis. Herniation of the heart through congenital, traumatic and post surgical pericardial defects are discussed.
Diagnosis, Differential↗
CT evaluation of esophageal perforation following endoscopic sclerotherapy.
We report a case of contained esophageal perforation following endoscopic sclerotherapy for bleeding esophageal varices. CT demonstration of the perforation is presented.
Esophageal Perforation↗
The value of opacification of the esophagus by low density barium paste in computer tomography of the thorax.
A 3% barium paste was used in the CT evaluation of 100 normal and 60 abnormal esophagi. Successful esophageal opacification occurred in 87% of both groups. In cases of extrinsic disease involving the esophagus the contrast medium administration assisted in separating the esophagus from adjacent mass lesions, as well as identifying displacement, compression, proximal dilatation, and length of involvement. In cases of esophageal carcinoma the contrast medium administration assisted in the measurement of wall thickness and length of the lesion as well as identification of the site of origin of the tumor. The contrast medium was simple to administer, well tolerated, and did not produce scan artifacts.
Adenocarcinoma↗
Spiral CT evaluation of the trachea and bronchi.
OBJECTIVE: We report two cases in which spiral CT with three-dimensional (3D) reconstruction was used to evaluate abnormalities of the trachea and bronchi. MATERIALS AND METHODS: Two patients with known airway abnormalities, one with a carinal tumor and the other with a postoperative bronchial stenosis, had spiral CT of the chest performed. Images were reconstructed in the coronal plane as well as using a curved planar reformat and shaded surface display. RESULTS: Spiral CT with 3D reconstruction provided excellent anatomic definition of the central airway abnormalities. In our two cases the information provided was used in both the clinical assessment and treatment planning of the patients. CONCLUSION: Spiral CT was useful in the evaluation of two patients with central airway abnormalities. Further investigation into applications of spiral CT for the evaluation of the central airways appears warranted.
Bronchography↗