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At least 1,279 records · Page 71Linked to original sources
PubMed1985

A peculiar extra heart sound after artificial pneumothorax in congenital pericardial defect: a diagnostic clue.

A 37-year-old man was admitted to the hospital in order to evaluate the cause of systolic ejection heart murmur and to treat his easy fatigability. The chest roentgenogram showed a marked protrusion of the left second and third arches of the cardiac silhouette. At the diagnostic procedure, 200 ml of air was injected into the left thoracic space. The chest roentgenogram revealed no sign of pneumopericardium, but an abnormal extra heart sound was audible. Addition of another 200 ml of air was needed to reveal a pneumopericardium on the chest roentgenogram. A peculiar extra heart sound after artificial pneumothorax may be useful for the early recognition of congenital pericardial defect.

Adult↗
PubMed1992

Imaging of thoracic Wegener's granulomatosis: the computed tomographic appearance.

PURPOSE: Computed tomography (CT) can play a major role in the examination of patients with diffuse infiltrative disorders of the lung. CT patterns of thoracic Wegener's granulomatosis were retrospectively evaluated in this study. The CT appearance was compared with imaging obtained by conventional plain roentgenograms. PATIENTS AND METHODS: Fourteen patients with Wegener's granulomatosis seen during the last 5 years are described. Conventional chest roentgenograms and CT scans from these patients are reviewed. RESULTS: The most frequent manifestation found in the lungs of patients with Wegener's granulomatosis was that of rounded opacities with or without cavitation. This was observed in 7 of 14 patients. Relatively unexpected was the frequent occurrence of bronchovascular bundle cuffing with a quite constant and characteristic bronchocentric distribution. This finding was observed in 5 of 14 patients. Vasculitis sign was demonstrated in 2 of 14 patients. Widespread acinar infiltrates, usually confluent, were common and were seen in 5 of 14 of our patients; in 2 of the patients, these infiltrates were due to diffuse pulmonary hemorrhage. Tracheal stenosis was the cause of sudden acute respiratory failure that was observed in one patient. Pleural disease was present in 3 of 14 patients. Hilar and mediastinal lymphadenopathy was observed in one patient. An interstitial pattern was observed in 3 of 14 patients. CONCLUSIONS: We conclude that an extremely wide spectrum of radiologic findings may be observed in this disease. In 14 patients we found 11 different roentgenographic manifestations; moreover, in 8 patients it was possible to describe more than 1 radiologic manifestation at the same time or during the course of the disease. This observation is not surprising, if we consider the wide variability and broad spectrum of pathologic features in pulmonary Wegener's granulomatosis. Because conventional roentgenograms failed in a great number of cases to visualize the exact pattern and the extent of thoracic involvement, we believe that CT is particularly helpful for the assessment of pulmonary involvement in Wegener's granulomatosis.

Adolescent↗
PubMed1983

Protocol for the nonoperative treatment of obstructing intramural duodenal hematoma during childhood.

A prospective plan for the nonoperative treatment of obstructing intramural duodenal hematoma was developed to (1) promptly establish the diagnosis and rule out transmural leaks by obtaining a contrast roentgenogram on admission and to subsequently study evolution of the obstructing intramural duodenal hematoma with sequential roentgenograms at 5 to 7 day intervals; (2) identify associated pancreatic injury with ultrasonography and serum amylase and lipase determinations; and (3) to determine effectiveness of nasogastric suction and total parenteral nutrition. Twelve children, who ranged in age from 2 to 15 years, with obstructing intramural duodenal hematoma following blunt injury were admitted over the past 9 years. The two youngest were battered children and two others had subsequently diagnosed clotting disorders (idiopathic thrombocytopenic purpura and von Willebrand's disease). Significant resolution of the obstruction allowed resumption of oral intake by the end of the first week of treatment in eight patients, whereas the remaining four required 13, 14, 22, and 38 days of nasogastric suction and total parenteral nutrition. Residual deformity seen on roentgenograms did not interfere with achieving adequate oral nutrition. Excellent results in this series substantiate the conclusion that a management plan that assesses the evolution of an obstructing intramural duodenal hematoma and provides adequate nutrition is a successful alternative to surgical treatment. The presence of underlying hematologic disorders and child abuse must be suspected.

Abdominal Injuries↗
PubMed1990

Donor-specific cytotoxicity testing: an advance in detecting pulmonary allograft rejection.

Ten beagle dogs underwent left unilateral lung transplantation and were treated with cyclosporine and azathioprine. After three days, cyclosporine administration was discontinued and azathioprine administration was maintained at a suboptimal dose to allow a graded response to the pulmonary allograft. Dogs were monitored by chest roentgenogram, bronchoalveolar lavage (BAL), and sampling of peripheral blood lymphocytes at weekly intervals. Open lung biopsies also were performed at weekly intervals in 5 of the dogs. Lymphocytes from the BAL and peripheral blood and those grown in culture from open and transbronchial biopsy specimens were tested for donor-specific cytotoxicity (DSC) by testing their responsiveness to lymphocytes from their donor. Rejection was confirmed in all animals. Donor-specific cytotoxicity became detectable in all animals in either the BAL fluid or biopsy specimens. An abnormal chest roentgenogram developed in 9 dogs, but not until after DSC was detected in the BAL in 7. In the open biopsy specimens tested for DSC, all exhibited DSC synchronous with the first changes noted on chest roentgenogram. Donor-specific cytotoxicity was sensitive for detecting rejection in 8 of 9 dogs in the BAL and in 5 of 5 dogs in the open biopsy specimens. Based on these results, 3 additional dogs were maintained on cyclosporine. Two of these dogs did not reject their transplants and had no evidence of DSC. We conclude that donor-specific functional assays provide an advance over less sensitive clinical techniques.

Animals↗
PubMed1991

Transvenous pacemakers in children: relation of lead length to anticipated growth.

Although transvenous pacing is feasible in infants and children, uncertainty remains as to how to allow for future growth at the time of lead insertion. Accordingly, we retrospectively reviewed the relation between age and transvenous lead length. Standard posteroanterior chest roentgenograms were reviewed for 26 patients with transvenous pacemakers inserted at Babies Hospital and Presbyterian Hospital between 1985 and 1989. Sixteen of these were children (age range, 0.75 to 15 years) and 10 were adults (age range, 27 to 90 years). The intravascular length of right ventricular pacing leads was measured as projected on the roentgenogram. In 10 children, the presence of lead loops in the right atrium required the lead length that would have resulted from conventional placement to be estimated. Results for right ventricular pacing lead lengths were correlated with age using linear regression analysis. Average uncorrected lead length measured on the roentgenogram was 345 +/- 35 mm (standard deviation) in adults and 222 +/- 51 mm in children. The use of right atrial loops increased implanted lead length by an estimated 79 mm, from 188 +/- 26 to 267 +/- 43 mm. The difference between lead length in children and adults was analyzed. Approximately 190 mm of additional right ventricular pacing lead in infants and 100 mm in 10-year-old children was needed for growth to adult size. We conclude that an 80-mm right atrial lead loop will allow 6 to 12 years (mean, 8 years) of growth in infants and children without the need for reoperation to adjust lead length.

Adolescent↗
PubMed1979

Factors influencing the design of aiming devices for intraoral radiography and their practical application.

Intraoral roentgenograms can be made according to the long-tube paralleling technique utilizing aiming devices. These instruments consist of a bite block, an indicator rod, and a collimator plate. For the position of the film in relation to the bite block surface, the following data are decisive and therefore studied: the length of the teeth to be radiographed, the enlargement as a result of the divergence of the x-ray beam, and the periapical area necessary for the interpretation and mounting of the roentgenograms. As a result, the bite blocks of the instruments were provided with three vertical steps to permit different film positions needed for the specific situation in the different regions of the mouth. The use of the correct film positions results in roentgenograms with a high diagnostic value. In order to reduce the patients radiation dose the aiming devices include a collimator plate. A description is given of the data used for the design of the plate.

Dental Instruments↗
PubMedDate not supplied

Computed tomography in localization of foreign bodies lodged in the extremities.

Surgical removal of foreign objects (FO) lodged in the body may be difficult because of uncertain 3-dimensional localization on conventional roentgenograms. Furthermore, low-density FO may not be detectable on roentgenograms. CT was performed in 8 patients with FO lodged in the extremities, and was found helpful because, (1) it detected 4 low-density FO's missed on roentgenograms, and (2) it facilitated surgical removal by displaying the precise 3-dimensional location of these objects.

Adult↗
PubMed1991

Massive bilateral diaphragmatic rupture after an apparently minor automobile accident.

A case of massive bilateral diaphragmatic rupture following a low impact motor vehicle accident is described. The patient experienced herniation of intraabdominal contents into the thoracic cavity, but suffered no additional injuries. Few cases of bilateral diaphragmatic rupture have been reported and no cases of acute bilateral rupture have been described as an isolated injury. Diaphragmatic rupture in general may be a difficult injury to recognize. Based on our review of recent cases of diaphragmatic rupture (1979-1990), most patients presenting acutely have additional trauma (89.9%) but only vague symptoms related to their diaphragmatic insult. A chest roentgenogram may be a useful diagnostic tool, although many patients with diaphragmatic rupture have only nonspecific findings. A nasogastric tube placed prior to chest roentgenogram may enable the physician to recognize the injury more readily. A high index of suspicion is required to recognize diaphragmatic rupture and should be maintained for all victims of motor vehicle accidents with abnormal but nondiagnostic chest roentgenograms.

Accidents, Traffic↗
PubMed1977

Pathophysiologic assessment of hypertensive heart disease with echocardiography.

Assessment of the pathophysiologic changes associated with systemic hypertension has been limited by difficulty in justifying invasive studies of the left ventricle. Echocardiography, because it is notinvasive, offers an attractive method of assessing cardiac dimensions and function in hypertensive heart disease. Fourteen age-matched normotensive subjects and 31 patients with hypertension (but without clinical evidence of coronary artery disease) were studied before receiving any antihypertensive therapy. The patients with hypertension were classified into three groups on the basis of previously established electrocardiographic and chest X-ray criteria: group I, normal electrocardiogram and chest roentgenogram (13 patients); group II, left atrial abnormality by electrocardiogram and a normal chest roentgenogram (8 patients); and group III, left ventricular hypertrophy by electrocardiogram or chest roentgenogram, or both (10 patients). Mean arterial pressure increased significantly from group I to group II and from group II to group III (P is less than 0.01), and this increase was associated with a similar progressive increase in left ventricular mass assessed with echocardiogram (P is less than 0.01). A significant increase was also found in both posterior wall and septal thickness in groups II (P is less than 0.05) and III (P is less than 0.01). In association with this increased mass a significant decrease in ejection fraction and fractional fiber shortening was demonstrated in groups II (P is less than 0.05) and III (P is less than 0.01) although cardiac index was reduced only in group III (P is less than 0.05). Thus, increased ventricular mass can be identified with echocardiography at an early stage of hypertensive heart disease when only left atrial abnormality is identifiable with electrocardiographic criteria and decreased left ventricular performance occurs with increasing arterial pressure and left ventricular hypertrophy.

Adult↗
PubMed1995

Pitfalls in the diagnosis of blunt diaphragmatic injury.

BACKGROUND: Severe blunt trauma to the torso can result in diaphragmatic disruption. Prompt recognition of this potentially life-threatening injury is difficult when the initial chest roentgenogram is unrevealing and immediate thoracotomy or celiotomy is not performed. This retrospective study was undertaken to: (1) determine the incidence of missed diaphragmatic injuries on initial evaluation; (2) identify factors contributing to diagnostic delays; and (3) formulate a diagnostic approach that reliably detects diaphragmatic rupture following blunt trauma. METHODS: Retrospective review of hospital records and radiographs from our 18-year experience with blunt diaphragmatic injuries. RESULTS: Seven of 57 (12%) blunt diaphragmatic injuries were missed on initial evaluation. Recognition followed 2 days to 3 months later. Two (4%) isolated left-sided injuries initially presented with normal chest roentgenograms. Five patients (9%) (4 with right-sided ruptures) had abnormalities on chest roentgenogram or computed tomography (CT) initially attributed to chest trauma. They were diagnosed by radionuclide, ultrasound, or CT investigations of hemothorax, pulmonary sepsis, and right upper quadrant pain; and, in 1 case, at thoracotomy for a persistent right hemothorax. In the remaining 50 patients (88%), the diagnosis was established within 24 hours. In 21 (42%) of these, the problem was initially recognized at the time of celiotomy for accompanying injuries. CONCLUSIONS: Blunt diaphragmatic injuries are easily missed in the absence of other indications for immediate surgery, since radiologic abnormalities of the diaphragm--particularly those involving the right hemidiaphragm--are often interpreted as thoracic trauma. In this setting, a high index of suspicion coupled with selective use of radionuclide scanning, ultrasound, and CT or magnetic resonance imaging is necessary for early detection of this uncommon injury.

Adolescent↗
PubMed2003

A clinicopathological study of resected subcentimeter lung cancers: a favorable prognosis for ground glass opacity lesions.

BACKGROUND: Owing to the advent of refined chest computed tomography (CT) images with higher resolution and CT screening programs, more faint and smaller lung cancers are being discovered. These include small-sized lung cancers such as those with a subcentimeter diameter, which had never been picked up on the routine chest roentgenogram films. However their clinicopathological characteristics with special reference to the proper surgical mode are not fully described so far. METHODS: During a 10-year period from 1991 through 2000 a total of 1,769 lung tumors were resected at the National Cancer Center Hospital, Tokyo. According to the pathology files of these patients, 51 patients had a primary tumor with the diameter of 1 cm or less. Three tumors arising in the bronchial lumina of hilum with a squamous cell carcinoma histology were excluded and the remaining 48 tumors of peripheral origin were studied. The clinicopathological features were analyzed according to three types of appearance on high-resolution CT: non-solid ground glass opacity (GGO) type (n = 19); part-solid GGO type (n = 9); and solid type (n = 20). Non-solid GGO is made up of homogeneous moderate increased density on CT, which cannot obscure the bronchovascular structure, whereas partly solid GGO contains a mere solid part but did not exceed 50% of the whole area (n = 9). All other lesions were considered solid type. RESULTS: For the three types of lesions, the distribution of age and sex was similar with the average age of 61 years and an almost even distribution of male/female patients. Although 6 patients had symptoms, the symptoms were not associated with the nodule itself. Twenty-six patients (54%) were screen-detected (16 chest roentgenogram films and 10 CT scans) and the others were detected by incidentally taken chest roentgenogram film or CT for other reasons than nodules detected. Two squamous carcinomas were positive for sputum cytology. Preoperative cytologic/histologic diagnosis was given in 14 patients (29%). The histologic type of GGO lesion was bronchioloalveolar carcinoma in all 28 cases. In solid lesions, besides 16 adenocarcinomas 2 cases of squamous cell carcinoma, 1 case each of small cell carcinoma and carcinoid tumor was seen. Lymph node involvement was seen only in 3 patients with solid lesions (N1 in 2 patients, N2 in 1 patient). As for operative mode, the limited resection was performed for 15 GGO lesions (54%) and 4 solid lesions (20%). Tumor recurrence was seen in 2 patients with solid lesions-1 in bone and the other in locoregional lymph node, and the former died of disease. CONCLUSIONS: Among subcentimeter lung cancers, GGO lesions (both non-solid and part-solid) constitute true early lung cancers. Since they have minimal or no invasive growth, limited resection for cure is justified. Conversely the solid lesion had significant invasive features such as lymph node metastasis. Lobectomy should remain as the standard mode of surgery despite such small size.

Adenocarcinoma↗
PubMed1976

Whole lung tomography in metastatic disease.

Because pulmonary metastases in patients with primary neoplasms have both therapeutic prognostic implications, a review was undertaken of 100 patients with primary neoplasms in whom whole lung tomography and chest roentgenography had been performed. Eight (20%) of 28 patients with solitary metastases on conventional films had more than one lesion on tomography. Due to the tomographic findings, therapy was altered in six of those eight. Two (3%) of 72 patients with normal chest roentgenograms had metastases visible on their tomograms. The data indicate the high value of whole lung tomography in determining therapy whenever a solitary metastasis is visible on conventional chest roentgenograms. The 3% pickup rate of metastases in patients with normal chest roentgenograms is less clear-cut but does suggest the contribution tomography can make in patients with potentially curable lesions.

Aged↗
PubMed1976

Vertebral malformations and associated somaticovisceral abnormalities.

Numerous references to spine abnormalities and associated somatic and/or visceral abnormalities are reported. An implication is present in each that the association is more than just coincidental and some cause and effect relationship might exist. A series of cases was collected in which congenital spine abnormalities were noted on roentgenograms from patients evaluated for varied reasons. Other roentgenograms of these patients and their medical records were reviewed in an attempt to find associated congenital abnormalities. Another group of patients with known congenital visceral malformations had their roentgenograms reviewed to see if they had spinal variations. It was found that patients with congenital vertebral malformations had an extremely high rate of associated visceral abnormalities, especially of the heart and kidneys. Other relationships between the spine and viscera include congenital lesions of the gastrointestinal and respiratory system and other parts of the renal system. This study also suggests the possible relationship between vesicoureteral reflux and spina bifida occulta. Embryologic considerations yield likely reasons for the relationships which have been suggested previously and are emphasised and augmented by this investigation. The supporting argument that a definite relationship exists between spinal variations and visceral abnormalities, as well as the embryologic reasons, is presented in this review of our selected cases and the appropriate literature.

Abnormalities, Multiple↗
PubMed1980

Surgical management of pulmonary metastasis.

Because of the clarity of roentgenograms, the lungs act as a window to the body through which we can "watch" the growth of a metastatic tumor. By obtaining serial roentgenograms, we can follow the course of a tumor, as well as its response to different forms of therapy. Usually the mass seen on roentgenogram is only part of a larger tumor found in other metastatic deposits. However, Farrell, in a study of 75 cases, found that 15% of the patients had metastatic lesions confined to the lung. Therefore, a finding of pulmonary metastasis should not imply a completely hopeless prognosis. Many patients may benefit from pulmonary resection of a metastatic lesion, either in terms of ultimate cure or by palliation. This report will discuss the pathogenesis of pulmonary metastasis and the surgical approach based on histology and biologic behavior of these tumors and current concepts of oncology as viewed through the study of pulmonary metastasis.

Breast Neoplasms↗
PubMed1986

Optimum position for external cardiac compression in infants and young children.

Ninety-seven pediatric patients (age less than 17 years) undergoing routine upright chest roentgenograms in the posteroanterior projection and 90 children undergoing supine anteroposterior chest roentgenograms had lead markers placed at the suprasternal notch and xiphoid prior to taking the roentgenograms. The position of the geometric center of the cardiac silhouette in relation to the sternum was recorded as a percentage of the distance along the sternum. The heart lies under the lower one-third of the sternum (greater than 67%) in all cases at all ages. Ten pediatric patients (between 1 month and 3 years of age) who sustained cardiac arrest while in the Pediatric and Surgical Intensive Care Unit and who had arterial pressure monitoring lines already in place were monitored with a two- or four-channel strip-chart recorder during external cardiac compression (ECC) performed by staff members who were blinded from the results of the strip-chart recording. The ECC performers were instructed to perform ECC at either the midsternum at the level of the victim's nipples or at the lower one-third of the sternum 1.5 to 2 cm above the tip of the xiphoid, and then to switch on command. In every instance in which the patients served as their own controls (ECC performed at both the midsternum and lower one-third of the sternum in random sequence), the performance of ECC over the lower one-third of the sternum resulted in significantly better systolic and mean arterial blood pressures (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Influence of prosthetic joint line position on knee kinematics and patellar position.

Prosthetic joint line position after total knee arthroplasty (TKA) was investigated using sagittal roentgenograms obtained from six fresh frozen cadaver knees. A specially designed knee testing device was developed that allowed for a controlled flexion angle while maintaining a constant quadriceps force. Pre- and postoperative roentgenograms were obtained from 30 degrees to 120 degrees in 15 degrees intervals. Steinman pins inserted into the medial femoral condyle and patella were used as reference points in the roentgenograms. A displacement vector between the medial femoral condyle and tibial plateau was used to analyze the tibiofemoral joint relationship. The functional patellar length (Insall-Salvati ratio), was used to determine correct patellar height. Another displacement vector was used to measure the patellofemoral joint relationship, and the angle between the patellar cut surface and femoral long axis was also calculated. Bone resection thickness from the femoral, tibial, and patellar surfaces was equal to the prosthetic thickness. This reconstructive scheme produced correct ligament balance and flexibility of the knee without the aid of tensioning devices or special measurements. Patellar tracking appeared to be identical before and after surgery. This accurate but simple surgical technique also reproduced normal knee extensor mechanisms that may influence longevity and long-term results of TKA.

Biomechanical Phenomena↗
PubMed1993

Nondiscogenic lumbar radiculopathy: imaging considerations.

This article reviews the differential diagnosis of lumbar radiculopathy, clinical presentations of spinal stenosis, pathological anatomy, and roentgenographic considerations of lumbar spinal stenosis. Most patients suspected of symptomatic spinal stenosis should have plain roentgenograms first to rule out other obvious lesions and to evaluate disc space and foraminal narrowing. Plain roentgenograms also show the sagittal and coronal deformities if present. The next procedure for the evaluation of spinal stenosis after plain roentgenograms should be MRI, as myelogram or CT can be avoided in most cases. In select cases, patients who cannot get MRI or those who underwent MRI with unresolved questions should have a myelogram or CT for further evaluation.

Diagnosis, Differential↗
PubMedDate not supplied

Frequency of sinusitis in the patients with pneumonia.

The aim of this study was to investigate the frequency of sinusitis in patients with pneumonia. Among 50 consecutive patients with pneumonia, 19 cases, which had Waters' roentgenograms in their files, were retrospectively reviewed in relation with sinusitis. Sixteen of them had sinusitis signs in their roentgenograms. The sinusitis frequency was 84% in patients with pneumonia who had paranasal sinus roentgenograms. These findings suggest that sinusitis may be an important causative factor for pneumonia and that it should be considered when evaluating a patient with pneumonia.

Adult↗