Esophageal mucocele after surgical isolation of the esophagus.
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Aged↗
Biomedical subjects
W B Gefter
Publications and source records attributed to W B Gefter.
Association of achalasia and pulmonary Mycobacterium fortuitum infection.
A case of achalasia complicated by Mycobacterium fortuitum pulmonary infection and empyema is reported. This association has been documented in the medical literature. Possible mechanisms explaining this association are discussed.
Esophageal Achalasia↗
Polycystic ovaries: MR imaging.
To determine the characteristic appearance of polycystic ovaries on magnetic resonance (MR) images, seven women with polycystic ovarian disease (PCOD) underwent MR examination of the pelvis. These MR images were compared with sonograms. Histologic material was available in two patients. Six of the seven women had characteristic, small peripheral cysts, best seen on T2-weighted MR images; these cysts were seen sonographically in only one case. The centers of nine of 14 ovaries were of low intensity with all MR pulse sequences; this low intensity corresponded with low echogenicity in six cases. Histologically, these areas correlated with hypertrophic cellular stroma. Coexisting central teratomas were seen in three ovaries. The ability of MR to display the findings of PCOD better than ultrasound and its ability to demonstrate coexisting pathologic conditions are valuable in imaging the female pelvis.
Adult↗
Value of CT in the preoperative assessment of lung cancer: a survey of thoracic surgeons.
Practicing thoracic surgeons were randomly surveyed to evaluate how computed tomography (CT) has influenced the preoperative evaluation of bronchogenic carcinoma. Thirty-six percent of the 529 respondents routinely requested CT and 62% did so selectively. Approximately 40% indicated that CT provided useful information in most cases. Nearly all surgeons (98.7%) do not rely on the identification of enlarged lymph nodes with CT to spare the patient surgical staging; however, 77.5% are influenced by CT results in their staging procedures. Fifty-seven percent reported that a negative CT study eliminates surgical staging entirely unless the patient has a "coin lesion," in which case 75% are willing to proceed directly to thoracotomy. For surgeons who use CT selectively, an abnormal mediastinal contour on the radiograph was the most frequent radiologic abnormality to prompt CT (85%). Thirty-seven percent are influenced by tumor histology in their decision to request CT. There was little difference in the pattern of CT use between university and community hospital surgeons.
Health Surveys↗
MRI of joint fluid in the normal and ischemic hip.
MR images in 36 hips with documented avascular necrosis and 80 hips without evidence of joint disease were studied to determine the amount and appearance of fluid in the joint. All MRI examinations were done on a 1.5-T machine and included coronal images made with relative T2 weighting (repetition times = 2000-2500 msec, echo delays = 60-100 msec). The amount of joint fluid, which had an intense signal higher than fat, was graded from 0 to 3 and analyzed with respect to the patient's age and radiographic stage of avascular necrosis. Joint fluid was seen in 84% of presumed normal hips. Only four (5%) of 80 had enough fluid to surround the femoral neck (grade 2), and none had sufficient fluid to distend the joint capsule (grade 3). In comparison, 21 (58%) of 36 hips with avascular necrosis had grade-2 or grade-3 effusions (p less than 0.005), and some fluid was seen in all. Grade-3 effusions were seen in seven (50%) of 14 hips with flattening of the femoral head, compared with only one (5%) of 20 in which the femoral contour was normal. It is concluded that small amounts of fluid are present in both normal hips and those with avascular necrosis. In avascular necrosis, increased joint fluid may be present before radiographic abnormalities occur, but it is greatest after there is flattening of the femoral head. MRI is a highly sensitive method for detecting fluid in the hip joint.
Adolescent↗
Nonlymphomatous lymphoid disorders of the lung.
Nonlymphomatous lymphoid disorders of the lung consist of several entities with varied histology and clinical behavior. On the basis of histologic appearance, six lesions can be identified. They include Castleman's disease, plasma-cell granuloma, pseudolymphoma, lymphocytic interstitial pneumonitis, angioimmunoblastic lymphadenopathy, and lymphomatoid granulomatosis. These conditions in 22 patients, their radiologic and histopathologic features, and their relationship to the malignant lymphomas are discussed. Although a radiographic diagnosis may be suggested, overlapping features mandate open-lung biopsy in most instances. The frequent evolution toward malignant lymphoma with lymphomatoid granulomatosis and pseudolymphoma necessitates close follow-up and sometimes aggressive therapy.
Granuloma, Plasma Cell↗
Stereoscopic computed three-dimensional surface displays.
Stereoscopic displays of certain anatomic areas are said consistently to provide clinical information that is not recognized in monoscopic viewing. Computed 3-D displays entail no extra patient irradiation.
Animals↗
Diffuse pulmonary hemorrhage: a review and classification.
Diffuse pulmonary hemorrhage is an uncommon condition that is difficult to differentiate radiographically from diffuse pneumonia or pulmonary edema. The diagnosis should be suspected when a patient has even mild hemoptysis or has one of the diseases known to be associated with diffuse pulmonary hemorrhage. This paper reviews the clinical and radiographic features of diffuse pulmonary hemorrhage and presents a classification scheme depicted as a Venn diagram formed by four overlapping circles representing pulmonary hemorrhage, renal disease, immune complex disease, and antiglomerular basement membrane (anti-GBM) disease. This scheme results in six categories of pulmonary hemorrhage: associated with glomerulonephritis and anti-GBM antibody; associated with renal disease without demonstrable immunologic abnormalities; associated with glomerulonephritis and immune complex disease; associated with immune complex disease without renal disease; associated with anti-GBM antibodies without renal disease; without associated immunologic or renal abnormality. Examples of these disorders are illustrated. Improved clinical-radiographic correlation may lead to earlier diagnosis and treatment of diffuse pulmonary hemorrhage and its causes.
Anemia↗
Invasive pulmonary aspergillosis and acute leukemia. Limitations in the diagnostic utility of the air crescent sign.
The air crescent sign is regarded as an important diagnostic finding in invasive pulmonary aspergillosis (IPA). This study examined the incidence, clinical importance, and natural history of air crescents in 25 patients with acute leukemia and IPA. Twelve (50%) of the patients had cavities (ten with an air crescent) that appeared an average of 15 days after the initial infiltrate. The diagnostic utility of the air crescent sign was relatively minor; cavities developed after the diagnosis was established in 50% of cases and after therapy was started in 75% of cases. In each case, the pneumonia improved at the time of cavitation. In six patients (50%), the cavities resolved over 2-8 months. Three patients (25%), however, experienced massive hemoptysis. Air crescent formation, previously shown to be dependent on granulocyte recovery, was associated with improved survival (67%) compared with the group without cavitation (8%). In the latter group, the pneumonia in ten (77%) of 13 patients progressed to diffuse disease. In patients with leukemia, the diagnostic value of the air crescent sign is limited by cavities that develop relatively late, as the infection improves after white blood cell recovery; cavities that do not occur in patients who remain neutropenic; and associated hemorrhage, at times life-threatening, that obscures the air crescent. The diagnosis of IPA should not await observation of air crescents in these patients.
Acute Disease↗
The troublesome nipple shadow.
In a review of 1000 routine chest examinations, the nipple of the male or female breast was visible about 10% of the time. In 14 instances (1.4%), the reviewing radiologist thought that uncertainty of identification warranted additional films. In four of these instances, the density proved to be something other than nipple. In all other instances when a nipple shadow was identified (8.9%), follow-up was not deemed necessary for various, often somewhat subjective reasons. Thus the frequency of erroneous identification of nipples could have been higher. Certainty of nipple identification would have involved considerable cost and inconvenience in repeat examinations. In another group of 500 patients, identification of the nipple with a lead marker on all patients eliminated uncertainty and the necessity for any repeat examinations. The patients placed low cost markers at the time of disrobing. Convenience and certainty were served by this simple maneuver.
Breast↗
Evaluation of the chest radiograph in the emergency department patient.
This article discusses the differential diagnosis of abnormal radiographic patterns most commonly seen in emergency department patients with chest disease. Conditions associated with trauma are also described.
Acquired Immunodeficiency Syndrome↗
Pneumothorax as a complication of placement of a nasoenteric tube.
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Aged↗
Detection of unsuspected malignant pleural effusion by bone scan.
Technetium-99m phosphate compounds may occasionally accumulate in malignant pleural effusions. A case of metastatic pleural effusion first diagnosed by bone scan, prior to its clinical or roentgenographic detection, is reported.
Adult↗
Application of ILO classification to a population without industrial exposure: findings to be differentiated from pneumoconiosis.
The International Labour Office (ILO) classification of radiographs of pneumoconiosis is a standard means of assessing the presence or absence of pneumoconiosis in workers exposed to mineral dusts. Using this classification, 200 admission chest radiographs were reviewed on hospitalized patients in an urban university medical center to determine the prevalence and possible significance of "small opacities" in a population without known industrial exposure. Seventy-one men and 129 women were screened with the mean age of 44.2 years (range, 15-84). Thirty-six (18%) of the 200 patients had small opacities at profusion level 1/0 or greater, and this constituted the "positive radiographs" group. Twenty-two patients (11%) with positive radiographs had no documentable dust exposure or other specific medical etiology that would explain the presence of their lung opacities. The high prevalence of small opacities in "normal" older individuals has important implications in the assessment of patients with suspected pneumoconiosis.
Adolescent↗
Radiographic evaluation of asbestos-related chest disorders.
This paper reviews the radiographic, clinical, pathologic, and epidemiological features of pleural and pulmonary parenchymal disorders which have been related to asbestos exposure. In particular, the following are discussed: (1) pleural plaques--radiographic detection by plain films and computed tomography, normal and abnormal densities which may mimic plaques, the 1980 ILO U/C classification, recent epidemiological data on plaques including their relationship to carcinoma and mesothelioma; (2) diffuse pleural thickening; (3) benign asbestos pleural effusions; (4) mesothelioma--emphasizing recent advances in diagnosis, staging, therapy, and prognosis; (5) parenchymal fibrosis--pathogenesis, relationship to fiber exposure, plaques, and carcinoma; (6) bronchogenic carcinoma; (7) rounded atelectasis--recent observations on its association with pleural thickening. A role of radiology in medicolegal aspects of asbestos-related disease is briefly examined.
Asbestos↗
Radiation-induced pneumothorax.
Pneumothorax is an uncommon complication of radiation therapy to the chest. The proposed pathogenesis is radiation-induced fibrosis promoting subpleural bleb formation that ruptures resulting in pneumothorax. We report on two young patients with primary sarcomas without pulmonary metastases who developed spontaneous pneumothorax after irradiation. Neither patient had antecedent radiographic evidence of pulmonary fibrosis.
Adolescent↗
Prolonged dense nephrograms in battered children. Suspect rhabdomyolysis and myoglobinuria.
Prolonged, dense nephrograms were seen on intravenous urography in 5 cases of child abuse presenting with possible renal injury. Each child had oliguria, elevated muscle enzymes, and pigmented urine positive for blood, but without red cells on microscopic examination. These findings are suggestive of myoglobinuria. The abnormalities resolved with appropriate fluid and electrolyte management. This complication of child abuse, not previously emphasized, may be suggested by the urographic findings. Possible factors contributing to the dense nephrograms are presented.
Child↗
Lung disease caused by amiodarone, a new antiarrythmic agent.
Amiodarone hydrochloride, used for prophylaxis of recurrent ventricular tachyarrhythmias that are resistant to other agents, may cause toxic pulmonary reactions associated with abnormal chest radiographs. The authors review four new cases of amiodarone-induced toxicity and eight cases reported in the literature. Peripheral areas of consolidation, predominantly in the upper lobes and resembling chronic eosinophilic pneumonia or tuberculosis, and diffuse interstitial disease were seen. Clinical symptoms included dyspnea on exertion, weakness, and occasionally pleuritic pain. Radiographic abnormalities developed after a median latency period of six months on the drug (600 to 800 mg daily). Pathologic findings suggested a possible toxic effect of the drug on phospholipid metabolism in the lung. Amiodarone toxicity may lead to significant pulmonary insufficiency. The clinical symptoms and radiographic abnormalities were completely reversible upon cessation of drug use and institution of corticosteroid treatment. Resolution generally occurs within three months.
Adult↗