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Baritosis: a benign pneumoconiosis.

Baritosis is one of the benign pneumoconioses in which inhaled particulate matter lies in the lungs for years without producing symptoms, abnormal physical signs, incapacity for work, interference with lung function, or liability to develop pulmonary or bronchial infections or other thoracic disease. Owing to the high radio-opacity of barium, the discrete shadows in the chest radiograph are extremely dense. Even in the most well-marked cases with extreme profusion of the opacities, massive shadows do not occur. When exposure to barium dust ceases the opacities begin slowly to disappear. Nine cases of baritosis occurring in a small factory in which barytes was crushed, graded, and milled are described. Two of the cases occurred after only 18 and 21 month's exposure, and 9 of the 10 men employed for more than one and a half years had baritosis. Five of the affected men examined at intervals since their exposure to barytes ceased in 1964 showed marked clearing of their radiological abnormalities.

Adult↗

Prevalence of pig herds affected by pleuropneumonia associated with Haemophilus pleuropneumoniae in eastern England.

A survey for the macroscopic lesions indicative of pneumonic infection in the pig with Haemophilus pleuropneumoniae was made in an abattoir in eastern England. A total of 78 herds located in 11 counties of eastern or central England were seen between December 1982 and August 1983. Lesions were noted in the batches submitted by 44 (56 per cent) of the 78 herds. A further 16 herds (21 per cent) submitted batches containing pigs affected by pleurisy principally of the caudal lobes but without the pneumonic lesions. Lesions suggestive of enzootic pneumonia were also seen in 61 herds (78 per cent). Circumstances restricted corroborative bacteriological examinations to 53 and serological examinations to 33 herds. Strains of H pleuropneumoniae (predominantly serotype 3 but also serotype 2) were isolated from 26 herds. These comprised 22 out of 42 (51 per cent) of those where typically affected plucks, or plucks with caudal lobe pleurisy, were encountered, and four out of 11 (36 per cent) in which there was either no observable thoracic disease or enzootic pneumonia only. Complement fixing antibodies to serotype 3 or 2 antigens occurred in 26 out of 33 herds (79 per cent). These comprised 25 (83 per cent) of 30 herds with batches exhibiting either typical pulmonary lesions and, or, caudal lobe pleurisy and one of three herds without such lesions. Collectively these data indicate that herds containing pigs with pleuropneumonia are common at least in the more easterly parts of England and that H pleuropneumoniae, usually but not always associated with disease, is also widespread.

Abattoirs↗

Major thoracic dehiscence: radiographic considerations.

Postoperative major thoracic dehiscence is an uncommon but potentially fatal complication which is sometimes difficult to detect clinically. Radiography may provide the initial clue to this abnormality. The wire sutures of sternotomy incisions may break, rotate, or become displaced. Disruption of posterolateral incisions is manifested by an increase in the distance between adjacent ribs. Air-fluid collections may be visible in the soft tissues of the chest wall.

Humans↗

Transthoracic US of the chest: clinical uses and applications.

Transthoracic ultrasound (US) of the chest is useful in the evaluation of a wide range of peripheral parenchymal, pleural, and chest wall diseases. Furthermore, it is increasingly used to guide interventional procedures of the chest and pleural space. The technique lends itself to bedside use in the intensive care unit, where suboptimal radiography may mask or mimic clinically significant abnormalities. The authors discuss the uses, techniques and applications of US of the chest. The sonographic appearances of pleural diseases (pleural effusion, pneumothorax, pleural mass, and mesothelioma), parenchymal diseases (pneumonia, neoplasms, heart failure, infarct, and rounded atelectasis), chest wall abnormalities (chest wall tumor and rib fracture), and diaphragmatic paralysis are discussed. The use of US in guiding biopsy, thoracocentesis, and other interventional procedures of the lung, pleural space, and mediastinum are also reviewed.

Biopsy↗

Computed tomography of chest wall masses.

The authors argue that CT is superior to other imaging techniques for the examination of the bones and soft tissues of the chest wall. They also note the importance of CT in planning therapy for lesions involving these structures. In support of these theses they present computed tomograms showing 26 different types of lesion involving the chest wall ranging from sternal fracture to malignant fibrous histiocytoma. Malignant neoplasms involving the chest wall by metastasis or direct extension from the breast, lung or mediastinum are emphasized.

Humans↗

Scanned projection radiography of the chest versus standard film radiography: a comparison of 250 cases.

Two hundred fifty patients who had 240 pathological changes of the lungs or mediastinum were examined using both scanned projection radiography (SPR) and standard film radiography, and the diagnostic accuracy of the procedures was compared. The use of standard film radiography led to diagnostic findings in 90.1% of the cases, while 94% of the images obtained at SPR provided diagnostic findings. The equivalent performance and, in part, the slight superiority obtained with the digital technique is a result of the better contrast resolution for objects with diameters greater than 2 mm. A further improvement in the diagnosis of thoracic disease with digital radiography may occur because of the use of special mathematical algorithms for image reconstruction and with the use of dual-energy subtraction radiography rather than by an increase of spatial resolution.

Humans↗

Magnetic resonance of the chest: initial experience with imaging and in vivo T1 and T2 calculations.

Magnetic resonance (MR) imaging of the chest was performed in 33 patients; 28 patients had a variety of malignant tumors and five had benign processes involving the pleura, chest wall, mediastinum, hila , and pulmonary parenchyma. In addition, in vivo T1 and T2 calculations were performed on 17 malignancies and 2 benign processes. Of the 18 patients examined with both MR and computed tomography (CT), 15 MR examinations were considered to be as diagnostic as CT in demonstrating abnormalities. In two cases, CT was superior to MR. In one case without adequate vascular opacification on CT, MR was superior in differentiating a mass from pulmonary artery. It is concluded that, with current technology without respiratory or cardiac gating, MR offers little improvement in diagnosis over contrast-enhanced CT. Furthermore, it does not appear possible to predict tissue type based on T1 and T2 measurements because of a wide overlap in these values.

Carcinoma, Bronchogenic↗

Asymptomatic, palpable, anterior chest wall lesions in children: is cross-sectional imaging necessary?

PURPOSE: To review results from cross-sectional imaging studies performed to evaluate asymptomatic anterior chest wall lesions in children. MATERIALS AND METHODS: All magnetic resonance (MR) images or computed tomographic (CT) scans of the chest obtained from 1989 to 1996 for evaluation of asymptomatic, palpable, focal, anterior chest wall lesions in otherwise healthy children were reviewed. Fifty-one children were considered for the study. Findings from 27 examinations in 27 children (13 underwent MR imaging, and 14 underwent CT) were included in the study. All children had normal radiographs of the region. Twenty-four patients did not meet the inclusion criteria and were excluded. RESULTS: The cause of the lesion palpated at physical examination was identified in 26 of 27 patients: prominent anterior convex ribs in 10 patients; "tilted" sternum in six; prominent asymmetric costal cartilage in four; bifid rib in one; and well-defined, small (< 1-cm) subcutaneous nodule adjacent to costal cartilage in five. One examination demonstrated no abnormality. Of the 27 patients, none required treatment. CONCLUSION: All palpable, asymptomatic, anterior chest wall lesions were benign and usually related to normal variations in the bone or cartilage of the chest wall. The low yield of cross-sectional imaging performed for evaluation of these asymptomatic "bumps" should be considered when decisions are made with regard to imaging.

Adolescent↗

Anterior chest wall: frequency of anatomic variations in children.

PURPOSE: To evaluate the frequency of anterior chest wall variations in children. MATERIALS AND METHODS: The computed tomographic (CT) images of 200 consecutive infants and children (114 boys and 86 girls; mean age, 10.5 years; age range, 3 months to 19 years) who underwent chest CT during a 20-month period were evaluated for chest wall variations. Children who had undergone chest wall surgery or were suspected of having a chest wall abnormality were excluded. The frequency of chest wall anomalies was compared with age and sex (Fisher exact test). RESULTS: The CT scans of 65 children (33%) depicted one or more variations in the anterior chest wall: titled sternum (n = 29), prominent convexity of anterior rib or costal cartilage (n = 19), prominent asymmetric costal cartilage (n = 20), well-defined paracostal subcutaneous nodule (n = 4), mild pectus excavatum (n = 4), or mild pectus carinatum (n = 4). The frequency of these findings did not vary significantly with age (P = .96) or sex (P = .36). CONCLUSION: Variations in the anterior chest wall are common, occurring in one-third of children, and should be considered normal. These asymptomatic variations should not be considered alarming when palpated at physical examination.

Adolescent↗

Thoracic manifestations of breast cancer and its therapy.

Breast cancer is the second most common cause of cancer-related death in women. In most patients, imaging demonstrates thoracic changes resulting from either treatment, complications of treatment, or tumor recurrence or metastasis. The postsurgical imaging appearance of the chest wall depends on the surgical method used (radical mastectomy, modified radical mastectomy, breast-conserving surgery, breast reconstruction). The most common surgery-related complication is seroma. Radiation therapy frequently causes radiation pneumonitis, which occurs approximately 4-12 weeks after the completion of therapy and is characteristically limited to the field of irradiation. Chemotherapy-related complications include cardiotoxicity, pneumonitis, and infection. Ultrasonography and computed tomography are more sensitive than physical examination for detecting local and regional recurrence. The thorax is a common site of metastasis, which may affect the lymph nodes, bone, lung, pleura, or heart and pericardium. Bone metastasis is usually evaluated with bone scintigraphy and may cause spinal cord compression, a serious complication that requires early diagnosis. Intrapulmonary metastasis may manifest as single or multiple pulmonary nodules, airspace pattern metastasis, lymphangitic metastasis, or endobronchial metastasis. Pleural metastasis usually manifests as pleural effusion, with or without a pleural mass. Familiarity with the spectrum of radiologic findings in breast cancer patients allows accurate image interpretation and correct diagnosis.

Adult↗

Thoracic splenosis twenty-nine years after traumatic splenectomy mimicking intrathoracic neoplasm.

Thoracic splenosis refers to a condition of ectopic splenic tissue in the thoracic cavity. It is usually a consequence of splenic tissue seeding in the pleural cavity after thoracoabdominal trauma. A rare case of thoracic splenosis, in a 62-year-old man who had had a traumatic splenectomy due to thoracoabdominal trauma 29 years earlier, is reported. The patient, a heavy smoker, was admitted for evaluation of a left-side thoracic lesion discovered on a plain chest film. Bronchoscopy, CT scan and needle biopsy proved inconclusive for the diagnosis. Exploratory thoracotomy was necessary to establish the diagnosis. During the operation, a thoracic splenosis was confirmed. To date, only 28 cases of thoracic splenosis have been reported in the literature. The purpose of this report is to present a new case of splenosis of the thoracic cavity simulating intrathoracic neoplasm.

Diagnosis, Differential↗

Unilateral chest wall edema in carcinomatous pleurisy.

21 patients with protracted unilateral pleural effusion were studied with respect to the etiology of their pleurisy. 13 presented with unilateral chest wall edema (UCE). These were classified as group A patients. 8 group B patients suffered from unilateral pleural effusion without UCE. A malignant cause of the effusion was established in 8 out of the 13 patients in group A, and in 2 patients from group B. Empyema was present in 4 additional patients, all of them belonging to group A. The diagnosis of purulent pleural effusion could be made promptly by microscopic examination of the pleural fluid. If excluding the empyema patients, the presence of UCE was significantly associated (p less than 0.025) with a malignant etiology of the pleural effusion. It seems that careful examination of the chest wall skin texture can be a simple and useful method in the initial evaluation of patients with pleurisy.

Adult↗