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At least 1,243 records · Page 69Linked to original sources
PubMed1996

Color Doppler hysterosalpingography in the diagnosis of tubal patency.

OBJECTIVE: To assess tubal patency by color Doppler hysterosalpingography (HSG). DESIGN: Comparative study of color Doppler HSG with roentgenogram HSG and chromolaparoscopy in infertile women of childbearing age. SETTING: Clinical environment. PATIENTS: Sixty female patients (22 to 39 years) with long-lasting infertility problems. INTERVENTION: Sterile saline was transcervically injected into the uterine cavity through a catheter and color Doppler HSG was performed. All the patients were submitted to roentgenogram HSG and chromolaparoscopy. MAIN OUTCOME MEASURES: The diagnostic efficacy of color Doppler HSG and its concordance with "gold standard" chromolaparoscopy were analyzed. RESULTS: Correlation between color Doppler HSG and roentgenogram HSG with chromolaparoscopy occurred in 86% versus 93% of all women studied. CONCLUSIONS: Color Doppler HSG with its accuracy and safety results a promising alternative technique to roentgenogram HSG in diagnosing tubal status in infertile patients.

Adult↗
PubMed2003

Radiological characteristics of pulmonary hydatid disease in children: less common radiological appearances.

OBJECTIVE: To evaluate the chest roentgenogram and CT characteristics of pulmonary hydatid disease (PHD). MATERIAL AND METHODS: Forty-seven (27 male and 20 female, aged between 3 and 11 years) consecutive pediatric patients with surgically proven pulmonary hydatid cysts were enrolled for the study. Posteroanterior and lateral chest roentgenograms, CT of the chest, and laboratory findings (latex agglutination, Casoni skin test, and eosinophil count) were obtained from all of the patients. The radiological features (localization, internal architecture, number, diameter) were determined. RESULTS: On CT examination, a total of 79 cysts were determined. On chest roentgenogram, 57 of 79 cysts were detected in all patients. Single cysts were seen in 33 patients, while multiple cysts were seen in 14. Median CT density of the cysts was 21 Hounsfield units (HU) (0-80). There were six giant cysts (>10 cm of cyst diameter). The crescent sign, water lily sign, and air-fluid level were seen in two, five and eight of the cysts, respectively. Apart from the classically described features of pulmonary hydatid cysts of the lung, a crescent-shaped rim of air at the lower end of the cyst (inverse crescent sign) was detected in three cysts. All of the liquid content of the cyst was expelled to the bronchial system (dry cyst sign) was observed in seven cysts. There were two infected cysts. Heavily calcified curvilinear cyst wall was present in one cyst. Pericystic reaction in the lung tissue was observed in five patients. Other features included pleural effusion (n=2), mediastinal shift (n=6) and atelectasis (n=7). CONCLUSIONS: Chest roentgenogram is helpful for diagnosis of intact cysts but, it is impossible to define entire morphology of the complicated cysts. CT imaging recognize certain details of the lesions and discover others that are not visible by conventional radiography. In conclusion, CT examination should be done to elucidate cystic nature of the lung mass and for accurate localization in the preoperative period. In addition, inverse crescent sign should be recognized as feature of pulmonary hydatid cysts on CT.

Child↗
PubMed1975

Bone scanning: principles, technique and interpretation.

Bone scanning is most useful in the detection of bone metastases. The recent introduction of new radiopharmaceuticals and instrumentation has reduced the time needed to perform the study and its relative cost, while increasing the usefulness of the study in detecting roentgenographically occult diseases. Metastatic disease is used as the pathophysiologic model for understanding the principles of bone scanning. When a tumor invades bone, in addition to causing bone destruction, it also causes reactive bone formation or repair. It is here that radioisotopes are of considerable value, since some radionuclides are incorporated into the hydroxyapatite crystals of reactive bone. Bone repair is described as occurring in three phases. In Phase I, the roentgenogram shows no change in bone density, but the scan is abnormal. In Phase II, both scintigraphic and roentgenographic abnormalities increase, and in Phase III, when the osteoid has calcified completely, the roentgenogram shows radiodensities and the scan appears almost normal. Fewer than 5 per cent of patients have a normal scan in the presence of an abnormal roentgenogram. Presently, most bone scans are performed with phosphate compounds labeled with -99m-Tc. In the past, 85-Sr, 87M-Sr, and 18-F were more broadly used. Scanning may be performed on either a rectilinear scanner or a scintophoto (gamma) camera. Areas which are abnormal on bone scan should be interpreted with current roentgenograms in the light of clinical findings.

Autopsy↗
PubMed1995

Medical cost containment: analysis of dual orthopedic/radiology interpretation of X-rays in the trauma patient.

OBJECTIVE: The purpose of this study was to investigate the timing, accuracy, clinical impact, and cost of dual orthopedic and radiology interpretation of orthopedic trauma roentgenograms. DESIGN: The investigation was performed in a combined retrospective-prospective fashion. MATERIALS AND METHODS: Records of 25 retrospective and 25 prospective trauma patients with femoral fractures were reviewed and the radiology and orthopedic roentgenographic interpretations were compared in terms of four criteria: timing, accuracy, clinical impact, and cost. MEASUREMENTS AND MAIN RESULTS: The orthopedic surgeons documented reading 85% of 272 acute roentgenograms in the retrospective patients and 89% of 181 roentgenograms in the prospective patients. The orthopedist readings were immediate, 100% accurate, had significant impact on the patients' care, and incurred no additional cost. The radiologists read 59 and 75% of the retrospective and prospective roentgenograms, respectively. The accuracy rate was 94 and 96%, the time to reading averaged 7 and 4.6 days, and the estimated cost averaged $393 and $200 per patient, respectively. The radiologist readings had no impact on patient care. CONCLUSION: This study suggests that routine radiology consultation of musculoskeletal films read by the orthopedic surgeon is not required for the care of the acute trauma patient.

Baltimore↗
PubMed1995

Clearing the cervical spine in obtunded patients: the use of dynamic fluoroscopy.

OBJECTIVE: Obtunded patients (Glasgow Coma Scale score of < 13) with normal cervical roentgenograms remain in collars until they can be clinically evaluated. Cervical collars provide incomplete immobilization and have complications. Our hypothesis was that cervical spines could be evaluated in obtunded patients with normal cervical roentgenograms using dynamic fluoroscopy. DESIGN: This study was a prospective clinical evaluation. METHODS: Obtunded trauma patients with normal cervical roentgenograms underwent fluoroscopic examination of the cervical spine through a full range of motion. RESULTS: Fluoroscopic evaluations were done in 116 patients. There were 113 true negative examinations. Two patients had facet fractures not diagnosed on cervical roentgenograms, and no instability on fluoroscopy. One patient had a positive exam, with 2 mm of subluxation. There were no neurologic complications. Decubiti were present in 44% and were more frequent when the collar was on > 5 days (p = 0.029). CONCLUSIONS: Dynamic fluoroscopy can safely and effectively clear the cervical spine in obtunded patients. Earlier removal of the collar decreases decubiti.

Adult↗
PubMed1992

Computerized tomography in persons with Down syndrome and atlantoaxial instability.

Atlantoaxial instability has been reported to occur in 9-31% of persons with Down syndrome. The authors studied a subsample of patients with this chromosomal disorder who had both routine roentgenograms and computerized tomographic examinations. Computerized tomography revealed numerous skeletal anomalies of the C1-C2 region as well as spinal cord compression that were not visualized on plain roentgenograms. In addition, an apparent discrepancy of the atlanto-dens interval measurements between the two procedures was noted. The measurements of the plain roentgenograms were significantly greater than those obtained by computerized tomography, which is due to the magnification factor in plain roentgenograms.

Atlanto-Axial Joint↗
PubMed1981

Computed tomographic scanning of the mediastinum in the staging of bronchogenic carcinoma.

We investigated the efficacy of 2-s breath-holding computed tomographic (CT) scans and standard posteroanterior and lateral chest roentgenograms in staging the mediastinum and pulmonary hill in lung cancer. Fifty-one comparisons were made in 49 patients thought to have non-small-cell carcinoma, consecutively chosen to be free of disseminated tumor, and to be suitable candidates for thoracotomy. The CT scans accurately predicted mediastinal neoplastic lymphadenopathy in 15 or 17 instances of proved mediastinal lymph node metastasis for a sensitivity of 88%; specificity was also high (94%) with a true-negative scan in 32 of 34 instances. Standard chest roentgenograms were much less sensitive (47%) than rapid CT scanning in mediastinal staging; there were false-negative interpretations in 9 of 17 instances. Specificity of the methods was the same. both CT scans and standard chest roentgenograms had a sensitivity of only 67% in detecting neoplastic hilar adenopathy; enlarged hilar nodes were noted in only 10 of 15 patients with proved hilar node metastasis. We concluded from this preliminary study that rapid CT scanning shows promise of being useful in the noninvasive staging of the mediastinum of patients with otherwise operable non-small-cell bronchogenic carcinoma; the technique also provides useful guidance during mediastinoscopy and may detect lymphadenopathy not so visualized, but CT scanning appears to have little advantage over standard posteroanterior and lateral chest roentgenograms in staging the pulmonary hill.

Adult↗
PubMed1986

Value of chest ultrasonography versus decubitus roentgenography for thoracentesis.

Chest ultrasonography (CU) has been advocated as an effective tool for diagnosis and localization of pleural fluid. Studies to date supporting the technique have been anecdotal and nonrandomized. To determine if CU was beneficial when thoracentesis was performed by clinicians or house staff, we evaluated prospectively 205 patients presenting with pleural effusion at 2 community teaching hospitals. Decubitus roentgenograms were obtained on all patients, but CU with targeting by skin marker was performed on a randomized basis. Results were evaluated as to (1) whether the quantity of fluid obtained was sufficient for the intent of the procedure, (2) the number of needle insertions required to obtain the fluid, and (3) the incidence of complications such as pneumothorax. One hundred three effusions were evaluated by CU and 102 by roentgenography alone. The effusions in each group were stratified as small (obliteration of less than half of the hemidiaphragm on roentgenogram) or large. Small effusions were further stratified as free flowing or loculated (no layering of fluid on decubitus roentgenograms). By chi-square test, CU was significantly superior to decubitus roentgenograms alone for obtaining adequate fluid samples in small effusions (p less than 0.01). This was true regardless of whether the effusion was loculated (p less than 0.02) or free flowing (p less than 0.05). The technique had no such advantage in large effusions. We did not find that CU significantly reduced the need for multiple attempts nor incidence of complications in any group.

Drainage↗
PubMed1999

Pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography.

PURPOSE: To obtain statistical data on the use of high-resolution computed tomography (HRCT) for early detection of pneumonia in febrile neutropenic patients with unknown focus of infection. MATERIALS AND METHODS: One hundred eighty-eight HRCT studies were performed prospectively in 112 neutropenic patients with fever of unknown origin persisting for more than 48 hours despite empiric antibiotic treatment. Fifty-four of these studies were performed in transplant recipients. All patients had normal chest roentgenograms. If pneumonia was detected by HRCT, guided bronchoalveolar lavage was recommended. Evidence of pneumonia on chest roentgenograms during follow-up and micro-organisms detected during follow-up were regarded as documentation of pneumonia. RESULTS: Of the 188 HRCT studies, 112 (60%) showed pneumonia and 76 were normal. Documentation of pneumonia was possible in 61 cases by chest roentgenography or micro-organism detection (54%) (P < 10(-6)). Sensitivity of HRCT was 87% (88% in transplant recipients), specificity was 57% (67%), and the negative predictive value was 88% (97%). A time gain of 5 days was achieved by the additional use of HRCT compared to an exclusive use of chest roentgenography. CONCLUSION: The high frequency of inflammatory pulmonary disease after a suspicious HRCT scan (> 50%) proves that pneumonia is not excluded by a normal chest roentgenogram. Given the significantly longer duration of febrile episodes in transplant recipients, HRCT findings are particularly relevant in this subgroup. Patients with normal HRCT scans, particularly transplant recipients, have a low risk of pneumonia during follow-up. All neutropenic patients with fever of unknown origin and normal chest roentgenograms should undergo HRCT.

Adult↗
PubMed1982

Bone scanning in the assessment of mandibular invasion by oral cavity carcinomas.

Mandibular invasion alters the staging and treatment of oral cavity squamous cell carcinoma, and thus its detection is essential to the head and neck oncologist. There is little information assessing the accuracy of the radionuclide bone scan and the roentgenogram in determining mandibular invasion. The present study reports data on 40 patients with squamous cell carcinoma of the oral cavity for whom bone scans, mandibular roentgenograms, and histologic examination of the mandible were available. The bone scan correctly predicted mandibular invasion in 8 of 9 cases; the false positive rate was 53% as a result of mandibular inflammatory changes. The bone scan was more accurate than the roentgenogram in predicting tumor invasion of the mandible, but the bone scan had a higher false positive rate. A normal bone scan and roentgenogram virtually precluded tumor involvement of the mandible. We conclude that the bone scan is an important adjunct in the prediction of carcinomatous invasion of the mandible in squamous cell carcinoma of the oral cavity.

Carcinoma, Squamous Cell↗
PubMed1986

Chronic cough in infants and children.

Chronic cough is an important, sometimes frustrating problem, often encountered by the otolaryngologist-head and neck surgeon. Thirty-eight infants and children under age 16 with a normal chest roentgenogram were evaluated for chronic cough persisting for longer than 4 weeks. Specific therapy (rather than symptomatic treatment) of chronic cough lead to a resolution or control of the cough in 33 (87%). Cough-variant asthma was by far the most common cause of chronic cough, followed by sinusitis, aberrant innominate artery, psychogenic cough, and subglottic stenosis. In addition to a detailed history, physical examination, and chest roentgenogram, endoscopy, paranasal sinus roentgenograms, and pulmonary function studies with methacholine challenge testing were particularly effective for establishing a precise diagnosis. Chronic cough is best managed by determining the precise cause of the cough, then specifically treating the underlying disorder. Children with persistent cough and a normal chest roentgenogram should be referred promptly for evaluation by an otolaryngologist when the primary physician's initial efforts at diagnosis and treatment are unsuccessful. Endoscopy is under-utilized in practice and its importance is understated in the literature. It is particularly helpful in establishing a precise diagnosis in infants under 18 months of age.

Adolescent↗
PubMed1993

Assessment of pulmonary edema based on extravascular thermal volume in dogs.

To establish criteria of pulmonary edema by extravascular thermal volume (ETV), ETV and a roentgenogram of the thorax were compared in normal and experimental hydrostatic pulmonary edema dogs. ETV was measured by the double indicator dilution technique using heat as a diffusible indicator and sodium ions as a non-diffusible indicator (thermal-Na method). Mean ETV in 14 dogs under physiologic conditions was 8.20 +/- 1.44 ml/kg. Comparison of ETV with the roentgenogram indicated the density of thoracic the roentgenogram to increase when ETV exceeded 11 ml/kg. Pulmonary edema was recognized clearly in the thoracic roentgenogram at more than 15 ml/kg of ETV. Further increase in ETV did not occur with additional radiographic change. ETV was significantly (P < 0.01) correlated with arterial oxygen tension (PaO2) but not statistically correlated with colloid oncotic pressure (COP), pulmonary arterial wedge pressure (PAWP) or PAWP-COP. Measurement of ETV would thus, appear to be a reliable method for evaluating the severity of pulmonary edema, which has been difficult to diagnose by roentgenography and should facilitate the early diagnosis and management of pulmonary edema.

Animals↗
PubMed1991

Crackles in interstitial lung disease. Comparison of sarcoidosis and fibrosing alveolitis.

STUDY OBJECTIVE: Determine why crackles on chest auscultation are characteristic of most interstitial lung diseases, but may not be heard in sarcoidosis. DESIGN: All patients with sarcoidosis or cryptogenic fibrosing alveolitis seen during a four-week period were studied. In a second study to relate ausculatory findings to anatomy, patients with fibrotic changes on their chest roentgenogram were studied. SETTING: Patients were recruited from outpatient clinics. PATIENTS: In the first part, all patients seen over the course of one month were studied. In the second study, patients with pulmonary fibrosis seen on chest roentgenograms were studied. INTERVENTIONS: For the first study, two independent observers performed auscultation on five sites for crackles and reviewed four roentgenogram quadrants for changes. For the second study, patients underwent VC measurements, auscultation, and high resolution computer tomography scans. MEASUREMENTS AND RESULTS: For the first study, crackles were noted at greater than 2 sites in all 11 CFA patients, but only one of 17 SARC patients (p less than 0.001). Roentgenogram changes were seen in greater than 2 quadrants in nine of 11 CFA patients and eight of 17 SARC patients (p = ns). In the second study, the VC was similar in the two groups: SARC: 1.96 +/- .90 L (means +/- SD), 58 +/- 20.4 percent predicted; CFA: 1.81 +/- .33 L, 59 +/- 9.2 percent predicted). Only two of 14 SARC patients had crackles in greater than 1 area, while all 14 CFA patients had crackles at greater than 2 sites. The HRCT studies were read by a radiologist unaware of the diagnosis. The presence and degree (0 to 3 scale) of subpleural and peribronchial fibrosis were scored. Twelve SARC patients had peribronchial changes (mean score 1.9 +/- 1.08), while only eight had subpleural fibrosis (mean score .6 +/- .52). There was a significantly different pattern in the CFA patients, where eight had peribronchial fibrosis (mean score = .9 +/- .78, p less than 0.05) and all 14 had subpleural fibrosis (mean score = 1.6 +/- .73, p less than 0.01). CONCLUSIONS: We conclude that crackles are more frequent in fibrosing alveolitis than in sarcoidosis; this difference may be due to the distribution of parenchymal fibrosis.

Auscultation↗
PubMed1996

Necessity of routine chest roentgenography after thoracentesis.

OBJECTIVE: To determine the necessity of posteroanterior chest roentgenography for the identification of pneumothorax and other complications after thoracentesis. DESIGN: Prospective cohort study. SETTING: Tertiary care teaching hospital. PATIENTS: 67 men and 43 women (mean age +/- SD, 62.4 +/- 13.2 years). Exclusion criteria included age younger than 18 years, concurrent pleural biopsy, ultrasound guidance, and use of mechanical ventilation. MEASUREMENTS: 174 thoracenteses done between March 1991 and June 1993. RESULTS: 2 hemothoraces (1.2%) occurred, and 8 patients had a total of 9 pneumothoraces (5.2%). The roentgenograms obtained immediately after the procedures identified 8 pneumothoraces; the other pneumothorax was seen incidentally on a delayed roentgenogram obtained 3 days later. Pneumothorax was suspected in 5 of the 8 cases, and tube thoracostomy was done in 4 of these 5 cases. Patients with unsuspected pneumothorax identified on the roentgenogram obtained immediately after the procedure did not receive treatment for their pneumothoraces. Univariate analysis showed that the variables that correlated significantly with pneumothorax were aspiration of air during the procedure (relative risk ratio, 12.3; 95% CI, 3.7 to 41.4), number of passes with the thoracentesis needle (relative risk ratio, 6.1; CI, 1.6 to 23.3), history of thoracic radiation therapy (relative risk ratio, 10.5; CI, 2.5 to 44.4), and operator suspicion of pneumothorax (relative risk ratio, 25.9; CI, 8.6 to 78.5). CONCLUSION: Among hospitalized patients with pleural effusions, we identified subgroup of patients in whom the risk for pneumothorax is low enough (approximately 1%) with sufficiently minimal clinical consequences to justify the avoidance of about 60% of chest roentgenograms obtained after thoracentesis. These patients are clinically stable, have not previously received chest irradiation, had only one pass at thoracentesis attempted without the aspiration of any air, and give no other indication of pneumothorax.

Aged↗
PubMed1992

The importance of stabilizing the specimen taken at needle localized biopsy of the breast for microcalcifications.

The specimen from a needle localized biopsy of the breast must be compared with its roentgenogram to locate the area of microcalcification within the specimen. Any errors in aligning the specimen to its roentgenogram could result in failure to sample and microscopically examine the area of the microcalcifications. The results of the current study show the importance of maintaining the orientation and position of the specimen from the time the roentgenogram is taken until it is examined by the pathologist. Each of 45 consecutive specimens taken at biopsy were secured to a square of cardboard immediately after excision from the breast to maintain the orientation of the specimen during the process of roentgenography. The histologic findings of this group (group 2) were compared with the preceding 87 biopsies (group 1) in which no effort had been made to immobilize the specimen for a roentgenogram. The presence of microcalcifications was confirmed roentgenographically in all the specimens of each group. Histologic confirmation of the presence of microcalcifications was obtained in 42 of 45 specimens in group 2 and only 71 of 87 in group 1 (p = 0.035). Thirty-one per cent of specimens in group 2 contained a carcinoma compared with 10 per cent in group 1. We conclude that fixing the position of the specimen after excision improves the ability of the pathologist to locate the suspicious area of microcalcifications within the specimen. This may lead to an increase in the yield of these biopsies and the identification of occult carcinomas that might otherwise be missed.

Adult↗
PubMed1989

[A case of posttraumatic cerebral air embolism].

We report a case of cerebral air embolism that occurred after chest trauma. The diagnosis was confirmed by CT and skull roentgenogram which demonstrated air bubbles in intracranial arteries. It is well recognized that cerebral air embolism is caused by various diagnostic and therapeutic procedures, and trauma. But it may often be overlooked because it is diagnosed clinically and there are no characteristic symptoms nor signs. Although various ways of treatment have been reported, prevention and early diagnosis are the most important. It is very rare that air bubbles are detected in skull roentgenograms in cases of cerebral air embolism. Only three other cases have been reported. One of these cases reported by Westcott awakens our interest because the patient died within only several minutes after the onset and underwent cardiac massage before the roentgenogram was taken, in the same way as our case. We think some artificial force is necessary to push air into intracranial arteries to the extent that it is detected on a skull roentgenogram. Little has been reported on CT findings in cerebral air embolism. Roughly speaking, three kinds of abnormal findings have been reported. They are air, edema, and infarction. In only nine cases including ours, air bubbles were detected on CT. In those cases CT scans were performed soon after the onset, twelve hours at the latest. Abnormal findings were detected in either bilateral hemispheres or in the right hemisphere only. Almost all lesions are located in the territory of the cortical branches, but in one case bilateral, thalamic infarction was noted, which is thought to be caused by embolism of thalamoperforators.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

The nonutility of chest roentgenographic examination in asymptomatic patients with positive tuberculin test results.

To determine the value of chest roentgenograms in the management of asymptomatic persons with positive tuberculin skin test results, we undertook a retrospective review of all tests administered by our Employee Health Service, North Shore University Hospital, Manhasset, NY, between July 1, 1983 and November 1, 1987. Of 5200 tests, 247 results were positive. Two hundred twenty-one of these charts were reviewed for roentgenographic results and the presence of symptoms. All persons were asymptomatic. Chest roentgenograms revealed the following: normal, 188; unrelated abnormalities, 24; apical pleural thickening, 5; granulomas, 2; calcified hilar node, 1; and calcified node plus granuloma, 1. We noted no active tuberculosis, nor did the chest roentgenographic results influence recommendations for isoniazid prophylaxis. We conclude that chest roentgenograms are of value in 0% to 1.3% of asymptomatic people with positive tuberculin test results. A larger study should be undertaken to further define the usefulness of chest roentgenograms in this population.

Adult↗
PubMed1989

Subaxial injuries.

Injuries to the subaxial cervical spine must be suspected in any patient who suffers a head injury or complains of neck pain or neurologic symptoms of the arms or legs following an accident, particularly a motor vehicle or diving accident. Careful neurologic examination and lateral roentgenograms are indicated in all patients with suspected injury. If there is any neurologic deficit, fracture, or dislocation seen on roentgenogram, skull-traction tongs should be applied to provide stability and prevent further damage. If the neurologic examination and roentgenograms are normal, a stretch-test roentgenogram may be indicated to detect an occult ligamentous injury. Muscular strains and first-degree sprains may be treated with a collar and early active exercise. Subluxation and facet dislocations are most reliably treated with a posterior one-level fusion. Comminuted body fractures are best treated with an anterior strut graft. Complex fracture-dislocations of both anterior and posterior columns may be best treated with skull traction followed by combined anterior and posterior stabilization. Halo-jacket immobilization has few indications in subaxial injuries. It does not provide enough stability to maintain reduction of unstable mid- and low-cervical injuries. It may be used for postoperative immobilization in very unstable situations, but its greatest use is in immobilization of C1 and C2 fractures.

Axis, Cervical Vertebra↗