PubMed Health⌕ Search

Biomedical subjects

C V Zwirewich

Publications and source records attributed to C V Zwirewich.

At least 19 recordsLinked to original sources
PubMed2001

Ct findings in blunt renal trauma.

Computed tomography (CT) can provide essential anatomic and physiologic information required to determine management of intraabdominal and retroperitoneal injuries sustained during blunt abdominal trauma. It can help in evaluation of the type and severity of parenchymal injury, the extent of perirenal hemorrhage and parenchymal devascularization, and the presence of urinary extravasation. CT can help confirm the presence of major injuries to the vascular pedicle and depict occult renal pathologic conditions. Principal indications for the use of CT in the evaluation of blunt renal trauma include (a) the presence of gross hematuria, (b) microscopic hematuria associated with shock (systolic blood pressure <90 mm Hg), and (c) microscopic hematuria associated with a positive result of diagnostic peritoneal lavage. The majority of renal injuries sustained during blunt abdominal trauma are contusions and minor parenchymal lacerations amenable to nonoperative management. Deep parenchymal lacerations, urinary extravasation, and mild to moderate degrees of parenchymal devascularization may also be treated conservatively. Radiologists should look for coexisting renal lesions such as tumors and traumatic false aneurysms that may alter management.

Abdominal Injuries↗
PubMed2001

The white chest.

Explore the source record for details and available documents.

Adult↗
PubMed1998

Diagnostic accuracy of helical CT for detection of blunt bowel and mesenteric injuries.

OBJECTIVE: To determine the diagnostic accuracy of helical computed tomography (CT) in the detection of blunt bowel and mesenteric injury in a clinical setting. MATERIALS AND METHODS: We evaluated the helical CT and surgical findings in 31 patients with blunt abdominal trauma. Nineteen patients had surgically proven bowel and/or mesenteric injury, and 12 patients had no bowel or mesenteric injury at laparotomy. The CT scans were assessed by three observers in consensus and were graded as showing no injury, minor bowel or mesenteric injury (not requiring urgent surgery), or major bowel or mesenteric injury (requiring immediate surgery). The CT diagnoses were compared with the surgical findings. RESULTS: In the 19 cases of surgically proven bowel injury, CT had an accuracy of 84% (26/31), specificity 84% (16/19), and negative predictive value 89% (16/18) for diagnosis of bowel injury. CT correctly differentiated minor from major bowel injuries in eight of 12 cases (75%). For the 13 cases of mesenteric injury, the accuracy of CT diagnosis was 77% (24/31), specificity 67% (12/18), and negative predictive value 93% (12/13) for diagnosis of mesenteric injury. The CT findings allowed correct differentiation of minor from major mesenteric injuries in seven of 13 cases (54%). CONCLUSION: Helical CT is moderately accurate and has a high negative predictive value in detecting bowel and mesenteric injuries after blunt trauma. Helical CT is not highly accurate in predicting the severity of injury or need for urgent surgery.

Adult↗
PubMed1995

Facial artery pseudoaneurysm: diagnosis by colour Doppler ultrasonography.

Pseudoaneurysms of the facial region are rare and usually result from direct penetrating or blunt trauma. The authors report a pseudoaneurysm of the facial artery in a 22-year-old man injured in a motor vehicle accident. Colour Doppler ultrasonography was used to locate the aneurysm sac and establish its relation to the adjacent facial artery. Successful operative repair of the aneurysm was performed on the basis of the sonographic findings alone, without selective angiography.

Accidents, Traffic↗
PubMed1992

Value of MR imaging in the evaluation of chronic infiltrative lung diseases: comparison with CT.

The value of MR imaging was compared with that of high-resolution CT in assessing chronic infiltrative lung disease in 25 patients. The cases included nine patients with usual interstitial pneumonia, six with sarcoidosis, four with hypersensitivity pneumonitis, and six with miscellaneous conditions. The diagnosis was proved by biopsy (n = 17) or by means of clinical, laboratory, and radiologic criteria (n = 8). All patients had 1.5-T MR imaging and CT of the chest. Cardiac-gated T1-, proton density-, and T2-weighted spin-echo sequences were obtained. Initially, the MR images were assessed independently; later they were compared directly with the corresponding CT scans. In six patients, MR images and CT scans were obtained before open lung biopsy, and the images and scans were assessed prospectively. CT was superior to MR imaging in the anatomic assessment of the lung parenchyma and in showing fibrosis. However, areas of air-space opacification (ground-glass opacities) were seen as well on MR as on high-resolution CT. In the six patients who had open lung biopsy, areas of air-space opacification seen on MR and on CT corresponded to areas of active alveolitis or air-space infiltrates pathologically. Follow-up in six patients showed equal degrees of change in the air-space opacification over time on MR and CT. We conclude that, although MR imaging is inferior to high-resolution CT in the assessment of chronic infiltrative lung diseases, it may play a role in the assessment and follow-up of patients with air-space opacification.

Adult↗
PubMed1991

Solitary pulmonary nodule: high-resolution CT and radiologic-pathologic correlation.

Edge and internal characteristics of pulmonary nodules evaluated with high-resolution computed tomography (HRCT) were correlated with the pathologic specimens in 93 patients. Speculation correlated pathologically with irregular fibrosis, localized lymphatic spread of tumor, or an infiltrative tumor growth pattern and was observed in six of 11 benign nodules (55%) and 74 of 85 malignant nodules (87%). Pleural tags were observed in three benign nodules (27%) and 49 malignant lesions (58%); pathologically, these represented fibrotic bands usually associated with juxta-cicatricial pleural retraction. Bubblelike areas of low attenuation within the nodule were observed in 21 malignant lesions (25%) and only one benign nodule (9%). They were observed most commonly in bronchioloalveolar carcinomas (seven of 14) and were due either to patent small bronchi or small, cystic spaces within neoplastic glands. Malignant nodules as a group were larger than benign lesions (P = .02) and more commonly demonstrated a spiculated contour (P less than .05), lobulation (P less than .001), and inhomogeneous attenuation (P less than .05).

Adult↗
PubMed1991

Low-dose high-resolution CT of lung parenchyma.

To evaluate the efficacy of low-dose high-resolution computed tomography (HRCT) in the assessment of lung parenchyma, three observers reviewed the scans of 31 patients. The 1.5-mm-collimation, 2-second, 120-kVp scans were obtained at 20 and 200 mA at selected identical levels in the chest. The observers evaluated the visualization of normal pulmonary anatomy, various parenchymal abnormalities and their distribution, and artifacts. The low-dose and conventional scans were equivalent in the evaluation of vessels, lobar and segmental bronchi, and anatomy of secondary pulmonary lobules, and in characterizing the extent and distribution of reticulation, honeycomb cysts, and thickened interlobular septa. The low-dose technique failed to demonstrate ground-glass opacity in two of 10 cases (20%) and emphysema in one of nine cases (11%), in which they were evident but subtle on the high-dose scans. These differences were not statistically significant. Linear streak artifact was more prominent on images acquired with the low-dose technique, but the two techniques were judged equally diagnostic in 97% of cases. The authors conclude that HRCT images acquired at 20 mA yield anatomic information equivalent to that obtained with 200-mA scans in the majority of patients, without significant loss of spatial resolution or image degradation due to linear streak artifact.

Adult↗
PubMed1990

Multicentric adenocarcinoma of the lung: CT-pathologic correlation.

To evaluate the sensitivity of computed tomography (CT) in detecting multicentric primary bronchogenic adenocarcinoma manifesting as a pulmonary nodule, the authors reviewed CT scans and pathologic specimens of 158 consecutive patients who underwent resection of a pulmonary nodule. Two independent observers assessed the scans without knowledge of the pathologic findings. Lung specimens were fixed in inflation and sectioned transversely, analogous to the plane of the CT scans. In 88 patients the nodule represented adenocarcinoma. Multicentric adenocarcinoma was present in 19 of these patients (22%). The sensitivity of CT in correctly detecting the presence and location of two or more lesions was 0.63 and 0.68 for two observers, with a specificity of 0.86 for both. The CT appearance of multicentric disease varied from well-defined nodules to ill-defined hazy opacities simulating pneumonitis. The data indicate that (a) multicentric adenocarcinomas are more common than generally reported in the literature and (b) meticulous evaluation of CT images enables detection of multicentricity in a high percentage of cases.

Adenocarcinoma↗
PubMed1989

High-spatial-frequency (bone) algorithm improves quality of standard CT of the thorax.

The high-spatial-frequency (bone) reconstruction algorithm has been shown to be superior to the standard algorithm in the assessment of thin-section images of the lung parenchyma. We compared the high-spatial-frequency and standard algorithms in the evaluation of normal and abnormal lung parenchyma and mediastinum on conventional 10-mm-collimation CT scans. Three observers, blinded to the reconstruction algorithm used, compared both algorithms on identical images in 31 patients with a variety of diseases. Lung parenchymal detail was improved with the bone algorithm in 94% of scans (p less than .001). The definition of mediastinal contents with the bone algorithm was judged equal or superior to the standard algorithm in 94% of images (p less than .001). Scanning of a line-pair-resolution phantom demonstrated a 28% improvement in image resolution with the bone algorithm. Although the bone algorithm resulted in an increase in visible noise, the overall visual quality of the images was considered equal to or greater than that of those reconstructed on the standard algorithm in 100% of parenchymal (p less than .001) and 85% of mediastinal (p less than .001) images. We conclude that routine use of the bone algorithm results in improved spatial resolution and definition of pulmonary parenchymal detail without appreciably degrading the overall visual quality of mediastinal images.

Algorithms↗