Roentgenogram of the month. Thickened posterior tracheal stripe in a 50-year-old man.
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A young man presented to us with an asymptomatic ovoid mass which appeared to be in the right major fissure. The roentgenographic appearance of the lesion was that of a pseudotumor. The computerized tomography scan suggested tissue density leading to exploration. At surgery, we found the mass to be a portion of liver herniated through a diaphragmatic defect. Thus, we add type 2 hepatic herniation to congestive heart failure, empyema, hemothorax, postinflammatory "fibromas" and malignancies as a cause of interlobar pleural densities.
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Thirty-one patients with biopsy-confirmed sarcoidosis were studied for two to four years to compare serum angiotensin-converting enzyme (ACE) levels to clinical status, 67gallium scans, chest x-ray films, and pulmonary function tests (PFTs). Serum ACE levels and changes in ACE level correlated best with the clinical status of patients and their gallium scans (p less than 0.0005), and less with their chest x-ray films (p = 0.012) or PFTs (p = 0.007). The gallium scan was especially useful for localizing areas of disease involvement. Serial measurements of serum ACE were found to be a sensitive means for following the clinical course of patients with sarcoidosis and at times for predicting clinical relapse or improvement.
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A 33-year-old woman farmer developed an acute episode of fever, cough, and shaking chills with persistent shortness of breath. Her PaO2 was 51 with a restrictive pattern on pulmonary function. Her diffusion capacity was 36 percent of predicted. In spite of these abnormalities, she always had normal chest roentgenographic findings. Further studies, including a lung biopsy, led to the diagnosis of farmer's lung disease.
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