The value of clinical work-up in the diagnosis of chest disease.
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A method for collecting body fluids for cytological examination and their subsequent preparation and staining is described. The results of the cytological examination of 80 dogs and 26 cats over a period of three years are reported, indicating the number and types of condition which can be diagnosed, together with the clinicopathological correlations.
Computed tomography of the chest or abdomen may reveal vertebral abnormalities. Images in multiple projections of dry and fresh specimens of the spine demonstrate that osteophytes, end-plate irregularities, and marked obliquity fail to mimic true osteoblastic vertebral lesions. Disk calcification may simulate a metastatic deposit if the section includes both disk and vertebral body. Abdominal or chest "window" settings produce an apparent increase in bone density. Analysis of the bony spine from abdominal and chest images requires gray scale settings different from those used for the study of visceral organs.
The right paratracheal stripe (RPS) is seen on postero-anterior chest radiographs as a thin, water-density stripe between the air column of the trachea and the adjacent right lung. The range of width of the RPS in 1,259 normal subjects was 1 to 4 mm. An RPS width of 5 mm or more is reliable evidence of disease. The differential diagnosis of this finding is lengthy, and best divided into those diseases affecting the (a) trachea; (b) mediastinum; and (c) pleura.
Intrathoracic calcifications occur in a wide variety of disorders. Although they are usually harmless sequelae of remote processes, calcifications provide important information for establishing the diagnosis or for evaluating the progression of known disease. They may arise in the pulmonary parenchyma, mediastinum, hilar and mediastinal lymph nodes, pleura, chest wall, or any combination of these structures. The cause of the calcification may be determined by means of the location and pattern of the calcifications within the lung parenchyma and knowledge of the associated clinical features. Calcifications in the thorax are frequently manifestations of previous infectious processes. Less often, they may be due to neoplasms, metabolic disorders, occupational exposure, or previous medical therapy. Large intrathoracid calcifications are usually identified on conventional chest radiographs; detection of smaller calcifications may require use of other imaging modalities, such as dual-energy digital radiography, fluoroscopy, radionuclide scanning, computed tomography (CT), and high-resolution CT.
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Spectral curve-analysis of arterial flow signals (FS) in patients with pulmonary lesions is able to discriminate FS of bronchial arteries (BA) from FS of pulmonary arteries (PA). In patients with chest wall lesions a different FS from that of the BA/PA can be obtained. The aim of the study was to evaluate and characterize arterial supply of chest wall lesions using quantitative colour Doppler ultrasound (CDS). Between September 2002 and June 2003, 29 consecutive patients with chest wall lesions were examined by CDS. 16 lesions were located strictly to the chest wall (group I). 13 lesions had a chest wall lesion with pulmonary extension (group II). The following parameters were prospectively determined: (1) qualitative CDS (absence or evidence of vascularity); (2) quantitative CDS of intercostal or non-intercostal located arterial FS (resistive index (RI) and pulsatility index (PI)); (3) number of different arterial FS in one lesion using CDS-mapping. In a control group of 17 healthy volunteers quantitative measurement of RI and PI of the intercostal artery (ICA) was performed. 4 of 29 patients (14%) had no FS by CDS mapping. Quantitative CDS parameters of the control group were mean RI of ICA 0.88 (+/-0.056); mean PI of ICA 2.88 (+/-0.643); of group I mean RI of ICA 0.79 (+/-0.127) mean PI of ICA 1.93 (+/-0.641), and of group II mean RI of ICA 0.79 (+/-0.144), mean PI of ICA 2.1 (+/-1.015), mean RI of non-ICA 0.68 (+/-0.675) mean PI of non-ICA 2.5 (+/-2.506). Median RI as well as PI-value obtained within the chest wall (ICA) do not differ between group I, group II, and the control group. Within group II impedance measurements discriminates intercostal from non-intercostal arterial supply. In 29 patients 37 different arterial FS were obtained. None of the 16 patients in group I and 8 of the 13 patients in group II had 2 or more different FS. Lesions strictly located to the chest wall had an arterial supply characteristic for ICA by quantitative CDS. Chest wall lesions with pulmonary extension demonstrate a complex arterial supply by quantitative CDS.
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