Biomedical subjects
Publications and source records attributed to P C Goodman.
Pulmonary angiography is generally accepted as the standard for diagnosis of pulmonary embolism. Yet this procedure has failed to gain widespread appeal or application. This article will review the extensive literature on pulmonary angiography that has appeared since the first major article was published in 1963.
The diagnosis of congenital dislocation of the hip is easily made on plain film; however, after the patient is placed in a spica cast with abduction, plain films and even tomograms often fail to show the position of the capital femoral epiphysis. The usefulness of computed tomography in the clinical setting is described by a sample case. The decreased radiation and increased accuracy of diagnosis should make computed tomographic scanning of the hips the procedure of choice over plain film or tomogram when evaluating congenital dislocation of the hip.
Conventional chest radiographs and computed tomographic (CT) scans of 70 inflammatory thoracic lesions in 63 patients were reviewed and scored for diagnostic features. Pathologic confirmation of the final diagnosis was available in 42% (5/12) of lung abscesses and 31% (18/58) of empyemas. CT alone was sufficient to correctly diagnose 100% (70/70) of cases. Diagnostic information not available from conventional chest radiographs was obtained in 47% (33/70) of cases; in an additional 34% of patients, CT more accurately defined the extent of disease. The most reliable CT features for the differential diagnosis of lung abscess and empyema were wall characteristics, pleural separation, and lung compression. Conventional radiographic features such as size, shape, and the angle of the lesion with the chest wall were less helpful, though also best assessed by CT.
Conventional chest radiography and computed tomography (CT) were used to evaluate tube thoracostomy drainage of pleural empyema in 26 selected patients. Frontal radiographs alone were inadequate in the evaluation of thoracostomy tube placement, as only one of 21 malpositioned tubes was identified; however, when lateral radiographs were also obtained, eight of nine malpositioned tubes were identified. Suboptimal drainage due to malpositioning was demonstrated best by CT in all 21 cases. Prolongation of hospitalization, serious complications, and death correlated with failure of early tube thoracostomy drainage as demonstrated by CT. Routine frontal and lateral chest radiographs are recommended for all patients after thoracostomy tube placement for empyema. For selected patients with empyema, early use of CT to guide tube repositioning or thoracotomy may reduce morbidity and mortality and decrease hospital costs.
The aortic isthmus in adults has a variable appearance on thoracic aortograms. Its configuration may show a concavity, a straightening or slight convexity, or a discrete focal bulge. The latter finding represents a ductus diverticulum and, in review of 103 aortograms, was found present in 9% of patients. At times a prominent ductus diverticulum may resemble, and be mistaken for, a traumatic pseudoaneurysm of the aortic isthmus. A traumatic pseudoaneurysm may be distinguished from a ductus diverticulum on aortography by demonstration of an intimal flap and/or delayed clearance of contrast material on subtracted films. However, a ductus diverticulum will exhibit neither of these features.
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Digital subtraction pulmonary angiography was performed in 14 patients suspected of having pulmonary embolism. In 13 of 14, useful clinical information was obtained. Four patients were found to have pulmonary emboli. In nine patients, digital subtraction angiography was performed through pulmonary artery catheters already in place for monitoring critically ill patients. Conventional angiography in nine patients confirmed the findings by digital angiography. This initial experience suggests that digital subtraction pulmonary angiography provides adequate image quality in certain circumstances with several advantages over conventional angiography.
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Computed tomography (CT) was the primary diagnostic modality used in the evaluation of 14 patients with 15 surgically proved lesions of the lesser peritoneal sac. CT accurately localized 14 of the 15 abnormalities to the lesser sac. When combined with clinical information, CT correctly suggested the preoperative diagnosis of 13 of 15 lesions. The lesser sac abnormalities included a variety of pathologic entities: pseudocysts, abscesses, hematomas, a perforated gastric ulcer, a biloma, and a malignant neoplasm. The CT anatomy of the normal and abnormal lesser sac is discussed, with emphasis on its various compartments and recesses.
Fifty patients with abdominal trauma and possible splenic injury were evaluated by computed tomography (CT). CT correctly diagnosed 21 of 22 surgically proved traumatic lesions of the spleen (96%). Twenty-seven patients had no evidence of splenic injury. This was confirmed at operation in 1 patient and clinical follow-up in 26. There were one false negative and one false positive. In 5 patients (10%), CT demonstrated other clinically significant lesions, including hepatic or renal lacerations in 3 and large retroperitoneal hematomas in 2. In adolescents and adults, CT is an accurate, noninvasive method of rapidly diagnosing splenic trauma and associated injuries. Further experience is needed to assess its usefulness in evaluating splenic injuries in infants and small children.
Computed tomography (CT) was used in the evaluation of nine patients with nonopaque calculi in the upper urinary tract. In each case the calculus was identified as a very high density object (370-586 Hounsfield units) with calcium oxalate and cystine stones having somewhat higher attenuation values than uric acid or xanthine stones. The differentiation between calculi and other "radiolucent" filling defects was readily made since calculi had much higher attenuation values than blood clot or neoplasm. CT of the upper urinary tract may obviate the need for more invasive procedures such as retrograde pyelography when nonopaque filling defects require differentiation.
A case of pseudomembranous colitis is reported in which computed tomography (CT) played an important role in the diagnosis and differentiation from other causes of fever and abdominal pain. It is important to look for CT evidence of primary bowel disease when scans are performed for possible abdominal abscess, since these two conditions may present similar clinical features.
A variety of diseases produces or mimics multiple, thin-walled, air-containing cavities or cysts in the lung. Although some causes of this pattern are common (bullous emphysema, multiple pneumatoceles), others are relatively rare (cystic bronchiectasis, histiocytosis X, tracheobronchial papillomatosis, and lucite ball plombage). To some extent, the radiographic features of these lesions allow their differentiation, but differential diagnosis can be difficult. This paper reviews their principal features.
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Because of the increased incidence of serious infection in patients who have had splenectomy, conservative management of patients who have had splenic trauma is becoming more prevalent. One newer modality is splenorrhaphy, the suture repair of splenic lacerations. We report a case of splenic trauma treated by splenorrhaphy and later evaluated by computed tomography (CT). Certain characteristic CT features, such as the visualization of Teflon pledgets, illustrate the importance of distinguishing surgical artifacts from traumatic sequelae.
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