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PubMed1993

Pulmonary arteriovenous malformation in the neonate.

Pulmonary arteriovenous malformation (AVM) is a congenital condition, but because the symptoms usually do not occur until middle age, the diagnosis is often delayed. The authors report on a neonate, diagnosed at 2 weeks of age, who was treated by lobectomy at 35 months of age. This prompted a review of the diagnosis, pathophysiology, and treatment of pulmonary AVM. In the literature there are approximately 500 cases of pulmonary AVM. Special attention is given to the reports involving children. Eight cases have been reported in which the diagnosis was made in the first year of life. In two series, a chest roentgenogram showed abnormalities in all affected patients. Because of the strong association of pulmonary AVM with hereditary telangiectasia (Rendu-Osler-Weber syndrome), it is recommended that family members of affected patients be screened by chest roentgenograms for pulmonary AVM.

Arteriovenous Malformations↗
PubMed1976

The use of methylmethacrylate in the fixation of mandibular fractures in dogs. Experimental results.

The efficacy of self-curing acrylic resin in the fixation of fractured mandibles was studied in eight adult mongrel dogs. Three dogs were killed at 1 month, two at 3 months, and three at 6 months after insertion of the resin. Roentgenograms taken after operation and after the dogs had been put to death demonstrated satisfactory fracture reduction and bony healing. The retentive grooves appeared larger on the postmortem roentgenograms, apparently from fibrous tissue that formed between the acrylic resin and the bone. Sections through the groove and fracture site did not show any fibrocartilage formation between the bone and the resin. Active osteoblastic activity was present at the fibrous capsule-bone interface as well as in the fracture calluses. Most sections showed acute inflammation, with a few giant cells. Whether the inflammatory component resulted from tissue breakdown over the acrylic resin or from the polymethylmethacrylate itself was not determined. There was no evidence of abnormal healing or nonunion along the fracture line and no evidence of necrotic bone. The undecalcified tetracycline-labeled sections confirmed active bone formation at the fibrous capsule-bone interface and in the fracture calluses at 1, 3, and 6 months. No mobility could be detected across the fracture site at any time after the insertion of the acrylic resin. Two of the three dogs that were killed at 1 month had incomplete bony union, as demonstrated by mobility along the fracture line seen in the resected specimens. Mucosal dehiscence over the superior acrylic fixation bar was a consistent finding. Once the resin had been either exfoliated or removed, the mucosa healed uneventfully. The insertion of methylmethacrylate did not result in blood pressure change in the dogs. The dogs maintained their preoperative weight, appetite, and jaw mobility. Although satisfactory bony healing resulted from the intraoral open reduction and fixation with self-curing acrylic resin in dogs, several factors need additional investigation before this technique can be considered for use in human subjects. The following findings in this study may contribute to healing complications in man: (1) loosening of the acrylic resin due to fibrous tissue formation between it and the bone, (2) mucosal dehiscence, (3) inflammation in and around the fibrous tissue adjacent to the acrylic resin, and (4) the necessity of bone removal to facilitate the insertion of the resin.

Animals↗
PubMed1992

33-year follow-up after simple excision of a giant renal oncocytoma with calcifications: case report and review of the literature.

Renal oncocytoma can present with calcification seen on the plain roentgenogram. From a review of the literature (both before and after 1976, when the concept of oncocytoma was popularized in the English literature), 10 cases of calcification in association with renal oncocytoma were found. In three of these 10 cases, the calcifications could be grossly demonstrated on the plain roentgenogram; in the other seven cases, the calcifications were microscopic in nature. The presence of calcification in a renal tumor does not rule out the diagnosis of oncocytoma. Grossly, a renal oncocytoma has a brownish mahogany color. A case is presented in which simple excision of an oncocytoma resulted in a 33-year survival. In the future, excision instead of nephrectomy could become the standard treatment for these tumors.

Adenoma↗
PubMed1983

Osteoid osteoma: 95 cases and a review of the literature.

Osteoid osteoma is a benign bone tumor occurring primarily in patients under the age of 30 yr. Bone pain at night and relief by aspirin or other nonsteroidal antiinflammatory agents is a common symptom complex. The proximal femur and spine are frequent sites of involvement, but almost any bone can be involved. If plain roentgenograms do not demonstrate the lesion, tomography or a bone scan may be helpful. Complete surgical excision is the therapy of choice with a low recurrence rate. Osteoid osteoma may present initially with symptoms suggestive of inflammatory arthritis, degenerative joint disease, neoplasm, or infection. This lesion can therefore be a difficult diagnostic problem, especially if routine roentgenograms are normal. A high index of suspicion is necessary to make the diagnosis.

Adolescent↗
PubMed1990

Clinical associations of antiribonucleoprotein antibodies in patients with systemic lupus erythematosus.

The authors undertook a cross-sectional study to investigate the clinical associations of antiribonucleoprotein (anti-RNP) antibodies in 49 patients with systemic lupus erythematosus (SLE) without other concomitant connective tissue disorders. The traditional counterimmunoelectrophoresis (CIE) and the immunoblotting (IB) technique were compared. Clinically, special attention was given to the identification of sclerodermalike features. All patients completed a detailed questionnaire, physical examination, and additional investigations including pulmonary function tests, chest roentgenogram, radionuclide transit studies of the esophagus, and nailfold capillary microscopy. Pulmonary function testing and radionuclide transit studies of the esophagus were very sensitive for the detection of (subclinical) pulmonary and esophageal involvement, respectively. Within the relatively homogeneous SLE population, a subset was recognized that was characterized clinically by the presence of sclerodermalike features such as Raynaud's phenomenon, sclerodactyly, interstitial changes on chest roentgenogram, and decreased numbers of nailfold capillary loops, and serologically by the presence of anti-RNP antibodies. IB was somewhat more sensitive than CIE for the detection of anti-RNP (anti-Sm/anti-nRNP) antibodies but did not identify other clinical associations. Thus, anti-RNP antibodies in SLE are associated with scleroderma-associated features. For clinical practice, CIE is the technique recommended for their detection.

Adolescent↗
PubMed1989

Whole-lung tomography in urologic malignancy.

The place of whole-lung tomography in urologic malignancy has not been established. We reviewed 88 cases of known or suspected urologic malignancy in which tomography was used. Most patients had renal, bladder, or testicular tumors. Of the 68 patients with negative screening chest roentgenograms, all but 2 had negative tomograms. One of these 2 patients had a normal chest film (the other had extrapulmonary metastasis), and he did not have the renal carcinoma initially suspected. Tomography discovered no metastases from urologic malignancy that was not already known about from the screening x-ray film. In 20 cases with a positive screening x-ray film, tomography was of limited value. It cleared two suspicious chest films and added information on extent of metastatic involvement in three. We conclude that whole-lung tomography adds little information not available by chest roentgenogram in our selected population, and with a negative screening chest film no additional chest study is needed.

Costs and Cost Analysis↗
PubMed1977

CT evidence of grey matter calcification secondary to radiation therapy.

There are four previously reported cases of post-irradiation calcification in the basal ganglia as demonstrated on the conventional skull roentgenograms. We have described two additional cases with grey matter calcification, which were demonstrated 10 and 14 yr after radiation therapy for an optic glioma and a medulloblastoma, respectively. The calcification was clearly demonstrated on CT scan, although it was not apparent on the skull roentgenogram. The extract pathogenesis of this condition is not clear. It appears, however, to be related to radiation vasculitis of the small vessels of the brain with resultant hyalinization and calcification. A long-term follow up study would be necessary to evaluate the significance and implication of post-irradiation calcification of the grey matter. CT is the most sensitive method of demonstrating the intracranial calcification in vivo.

Basal Ganglia↗
PubMedDate not supplied

MRI in osteoarthritis of the hip: gradations of severity.

In a prospective study, 10 patients with well-documented osteoarthritis (O.A.) of the hips were imaged using spin-echo pulse sequences (TR = 0.5 to 1.5 s and TE = 28 to 60 ms). After analyzing the changes observed, an MR grading system for assessing severity of O.A. in the hips was developed. Using this grading system and an established grading system for osteoarthritis using roentgenograms (both systems use grades 0-4), two radiologists independently graded the MR studies and plain films separately, twice. The roentgenogram grading system was more accurate in predicting symptoms in the more severe cases, whereas the MR grading system was slightly more useful in the less severe cases. Our results show that MR can demonstrate a spectrum of changes of O.A. in the hips. Its ability to directly image articular cartilage makes it a powerful research and clinical tool.

Adult↗
PubMed1992

Imaging of pulmonary venous pathway obstruction in patients after the modified Fontan procedure.

To evaluate the efficacy of chest roentgenograms and echocardiograms in identifying pulmonary venous pathway obstruction in patients after the modified Fontan procedure, the records of 297 patients who underwent 307 Fontan procedures between 1984 and 1990 were reviewed. Twelve cases of pulmonary venous pathway obstruction documented by autopsy (3 cases) or cardiac catheterization (9 cases with an A wave gradient greater than or equal to 4 mm Hg) were found in 10 patients (mean age 43 +/- 28 months). The mechanisms of obstruction included narrow pulmonary vein ostia in six cases, narrow left atrial outlet in four and atrial baffle obstruction in three. Two causes of obstruction were present in one case. No patient had pulmonary venous congestion on chest roentgenograms. Pathway diameters indexed to 3 square root of body surface area with two-dimensional echocardiography were found to be 6.8 +/- 1.2 mm/3 square root of m2 in the subcostal frontal view, 7.9 +/- 0.6 mm/3 square root of m2 in the subcostal sagittal view and 6.5 +/- 1.7 mm/3 square root of m2 in the apical "four-chamber" view. These values differed significantly from those in 11 age-matched patients undergoing the Fontan procedure without pulmonary venous pathway obstruction documented by catheterization (p = 0.001). With pulsed Doppler ultrasound, there was a relatively narrow range of velocities distal to the obstruction (1.3 to 2.5 m/s). In five of the seven cases with pulsed Doppler measurements, flow was continuous and the Doppler spectral recordings were not phasic. Thus, in patients who have undergone the Fontan procedure and have pulmonary venous pathway obstruction 1) chest roentgenography cannot be used as a screening tool; 2) distal velocities as low as 1.3 m/s occur, usually with nonphasic, continuous forward flow; and 3) pathway diameters indexed to 3 square root of body surface area may be used as an output-independent parameter to cross-check Doppler data.

Cardiac Surgical Procedures↗
PubMed1988

Cardiopulmonary needle embolization: a complication of central venous drug abuse.

A great variety of complications secondary to drug abuse have been reported in the literature. We report a case of multiple cardiopulmonary needle embolization. A drug addict who had resorted to central venous drug abuse was found on chest roentgenograms to have multiple asymptomatic needle fragments within her chest. In this instance chest roentgenograms and tomographs were more helpful in needle localization than computed tomography. Complications of intracardiac foreign bodies are also briefly reviewed. In attempts to diagnose this complication, a high index of suspicion is necessary as central venous drug abuse becomes increasingly more prevalent.

Adult↗
PubMed1990

Diagnostic difficulties of foreign body aspiration in children.

A case of a 4-year-old child who aspirated a 22-caliber bullet is presented to illustrate the variability of signs and symptoms of foreign body aspiration. Despite the large size of the bullet, cough, dyspnea, and wheezing were absent on presentation. Chest roentgenogram confirmed the diagnosis of a radiopaque bronchial foreign body. A retrospective review of 42 additional children with foreign body aspiration showed 8 (19%) were unwitnessed, 24 (57%) were asymptomatic at presentation, 8 (19%) had normal physical examinations, and 10 (24%) had normal inspiratory/expiratory chest roentgenograms. This demonstrates the importance of considering bronchoscopy for any child who presents with a history of possible foreign body aspiration, but is asymptomatic and has normal roentgenographic findings.

Bronchi↗
PubMed1989

A biochemical evaluation of the restraints to posterior shoulder dislocation.

The biomechanics of posterior dislocation of the shoulder was evaluated using nine cadaver shoulders. Each was arthroscoped, roentgenograms were obtained, and then each was dislocated in a testing device. Force displacement data was obtained during testing, and posttesting roentgenograms, arthroscopic evaluation, and subsequent open dissections were performed to evaluate the pathology created. Although instability was created in all cases with displacement of the humerus to the diameter of the humeral head, force displacement of the humerus to the diameter of the humeral head, force displacement curves did not show an inflection point, implying a continuum between subluxation and dislocation. All shoulders had posterior Bankart lesions or posterior capsular lesions, or both. Anterior pathology was not seen. Posterior instability is most likely a continuum between subluxation dislocation with progressive injury to the posterior capsule and attachments such as the labrum as the principal restraint to posterior displacement.

Aged↗
PubMed1986

Effects of chincap force on the timing and amount of mandibular growth associated with anterior reversed occlusion (Class III malocclusion) during puberty.

The effects of chincap force on the amount and timing of mandibular growth associated with anterior reversed occlusion (Class III malocclusion) were studied during the pubertal period in 26 Japanese girls. Their records consisted of serial lateral cephalometric roentgenograms, wrist-hand roentgenograms, periodic data of standing height, and time records of chincap use. The stage of pubertal growth was first evaluated by the change of ossification events of hand bones and incremental change of standing height. Mandibular measurements were assessed on this maturational basis. The findings indicated that application of chincap force (500 to 600 g, average 11 to 12 hours per day) hardly alters the general pattern of mandibular growth timing at puberty. With regard to inhibition of growth amounts, the effects seem to take place independently in different parts of the mandible. The length of time of force application per day in the range from 6 to 15 hours did not have a significant role in the change of growth amount and/or timing in the clinical use of the chincap. Individual reactions to the chincap force varied in the effects on mandibular growth variables. Further study of the effects of retrusive orthopedic force on the mandible during the rapid growth phase of puberty is indicated.

Adolescent↗
PubMed1988

Porion and condyle as cephalometric landmarks--an error study.

With the recent increase in the use of functional appliances for orthodontic treatment in which condylar growth plays an important role in the final results, orthodontists and researchers should be aware of the process of growth and development of various components of the skull to see the changes of measurements on cephalometric tracings in different stages of treatment. This study was conducted to assess the reliability of the porion and condyle on the lateral cephalogram. A group of 24 patients was selected randomly from the Orthodontic Department at Tufts University. Two sagittal roentgenograms, one in habitual (centric) occlusion and one with the mouth wide open, were taken. Each cephalogram was traced by two observers to determine discrepancies in tracing the shape and position of the porion and condyle. The Pearson product-moment coefficient of correlation was performed for inter- and intraobserver reliability for locating the porion and condyle in open- and closed-mouth positions. It was concluded that the porion and condyle cannot be located accurately and consistently on sagittal roentgenograms in the closed-mouth position. Therefore it appears advisable to obtain an open-mouth cephalogram and superimpose it onto the respective closed-mouth cephalogram. This will provide greater accuracy and reliability in obtaining cephalometric measurements.

Cephalometry↗
PubMedDate not supplied

Ventriculoperitoneal shunt failure resulting from complications of the thoracic segment of the shunt catheter. Case report.

A case of intrathoracic ventriculoperitoneal (V-P) catheter placement and migration resulting in hydrothorax is presented to direct attention to complications involving the thoracic segment of V-P shunt tubing. Inadequate catheter length and upper and lower thoracic segment disconnections are also discussed in addition to the role of radiography, nuclear medicine, and computed tomography (CT) in their evaluation. The lateral thoracic roentgenogram is useful in screening post shunt patients to exclude catheter deviation. Sonography over the extrathoracic tube course offers a rapid check for adjacent fluid collections as the tubing is frequently palpable and easily located by the anterioposterior roentgenogram.

Cerebrospinal Fluid Shunts↗
PubMed2005

Surgical treatment of diaphragmatic eventration using video-assisted thoracic surgery: a prospective study.

BACKGROUND: This study seeks to evaluate results regarding the repair of diaphragmatic eventration using video-assisted thoracic surgery (VATS). METHODS: We performed a prospective observational study including patients referred to us for surgical treatment of diaphragmatic eventration during a 12-year period. Clinical, radiologic, and functional data were prospectively recorded. VATS was performed with two thoracoports and a 4-cm mini-thoracotomy. Diaphragmatic plication was performed using two nonresorbable running sutures from periphery to the cardio-phrenic angle. Follow-up data (clinical examination, chest roentgenogram, lung function tests at 3, 6, 12 months, and annually thereafter) were also prospectively recorded. RESULTS: Twelve patients (4 male adults, mean age 57.7 +/- 14.8 years) were operated on between 1992 and 2003. The left side was involved in 8 patients and the mean height of diaphragm elevation was 7.5 +/- 1.8 cm. All patients experienced symptoms related to the disease; in 2 patients the operation was carried out to achieve weaning from mechanical ventilation. The etiologic mechanism could be identified in 11 out of 12 patients (trauma, n = 9; Charcot-Marie disease, n = 1; calcified para-aortic nodes, n = 1). Mean operative time, drainage output, and hospital stay were 77 +/- 15 minutes, 0.8 +/- 04 L, and 3.4 +/- 0.7 days, respectively. No mortality was observed; 1 patient experienced postoperative pneumonia, which was treated using antibiotics. All patients experienced amelioration of symptoms and long-term lung function tests revealed a marked improvement of both the forced volume capacity and the forced expiratory volume at 1 second. No relapses were observed at follow-up chest roentgenogram. CONCLUSIONS: Treatment using VATS is a safe and effective alternative to conventional surgery. Functional improvement persists at long-term follow-up.

Adult↗
PubMed2006

Giant pulmonary hamartoma--a rare presentation of a common tumor.

Hamartomata, the most common benign tumors of the lung, are rarely symptomatic and usually come to clinical attention as coin-shaped lesions on a routine plain chest roentgenogram. We report a case of a 63-year-old woman presenting with reduced endurance on exercise. The plain chest roentgenogram showed a tumor in the left chest. After clinical work-up, the patient underwent radical tumor resection through a lateral thoracotomy. The resected tumor, with two separate nodules, measured 26 x 25 cm and weighed 3.2 kg. The histopathology work-up showed pulmonary hamartoma.

Female↗
PubMed2005

Assessment of left ventricular systolic function by the chest x-ray: comparison with radionuclide ventriculography.

BACKGROUND: The value of the plain chest roentgenogram in predicting cardiac status remains controversial. METHODS AND RESULTS: A total of 111 randomly selected survivors of acute myocardial infarction (age 38 to 83 years) were studied prospectively. X-ray and radionuclide examinations were performed on a morning in the second week after myocardial infarction. From the chest x-ray, left ventricular chamber size and pulmonary vascular congestion were graded visually, and relative cardiac volume was measured to allow for comparison with radionuclide left ventricular end-diastolic volume index (LVEDVI) and left ventricular ejection fraction (LVEF) determined by gated blood pool imaging. Despite significant tendencies for larger radionuclide LVEDVI and lower LVEF with greater radiographic left ventricular size, larger relative cardiac volume, and increasing degrees of pulmonary congestion, wide scatter, and large overlaps between groups precluded reliable radiographic prediction of radionuclide findings. The positive and negative predictive values for radiographic detection of an enlarged LVEDVI ranged from 59% to 80% and 56% to 71%, respectively, and for prediction of a decreased LVEF from 75% to 90% and 40% to 58%, respectively. Accuracy never exceeded 70%. CONCLUSION: Our findings question the value of the chest roentgenogram in the detection and grading of left ventricular systolic dysfunction in patients with recent myocardial infarction.

Adult↗