Systemic artery-to-pulmonary vascular shunt: a complication of closed-tube thoracostomy.
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Adolescent↗
Biomedical subjects
J D Godwin
Publications and source records attributed to J D Godwin.
CT of the pulmonary ligament.
Most computed tomographic (CT) scans of the chest show the inferior pulmonary ligament and an associated septum in the lower lobe, although CT descriptions of these structures have not been reported. Conventional radiography of the ligament has relied on indirect signs: the position of the lower lobe in the presence of pneumothorax or pleural effusion, soft-tissue peaks along the upper surface of the diaphragm, and the rare traumatic paramediastinal pneumatocele (attributed to air in the ligament). CT clarifies the anatomic relations of the ligament and alterations caused by pleural effusion and pneumothorax. The ligament is probably responsible for some long linear shadows at the lung bases, and CT helps to distinguish these from scars, walls of bullae, and normal structures such as the phrenic nerve and the interlobar fissures.
Cystic Fibrosis↗
Acute disease of the aorta. Diagnosis by computed tomography and ultrasonography.
CT and ultrasonography, alone or in combination, have partially replaced aortography for the detection of abnormalities of the native and grafted abdominal aorta. In our medical center, ultrasonography is used to detect or confirm the diagnosis of aortic aneurysm and to determine its size, extent, and relationship to the renal arteries. We usually choose CT to assess suspected rupture of the native aorta and complications of the grafted aorta, such as occlusion, leakage, false aneurysm, or perigraft infection. Acute disease of the abdominal aorta can be detected or excluded using these relatively noninvasive imaging techniques.
Aortic Dissection↗
Computed tomography of lung abscess and empyema.
Lung abscess and empyema can often be distinguished on plain radiographs. Sometimes, oblique or decubitus views may be necessary in order to demonstrate the more specific conventional radiographic features--the shape of the lesion and its relationship to the chest wall. In seriously ill patients, special positioning may be impossible. CT may be easier to perform than special views in some ill patients. In many cases of suppurative disease, both lung and pleura may be involved, and pleural disease in the presence of lung disease is easily missed on plain radiographs. Furthermore, infections located at the periphery or at the apices of the thorax are difficult to define with conventional imaging. CT with cross-sectional images and unequalled density resolution delineates the lung-pleura interface and the periphery and apices of the lung. With CT, lung abscess and empyema show statistically significant differences in shape--round (abscess) or lenticular (empyema); the presence of separation of pleural layers (empyema); the presence of lung compression (empyema); the presence of acute (abscess) or obtuse (empyema) chest wall angles; and wall characteristics--thick, nonuniform, and irregular (abscess) or thin, uniform, and smooth (empyema). Few lesions demonstrate all of these features; however, sufficient information may be obtained from CT to permit a confident diagnosis of lung abscess or empyema. Thus, CT helps in the evaluation of suppurative diseases. CT provides diagnostic information not available from conventional radiographs in 47 per cent of cases, and in 34 per cent of cases, CT gives more accurate delineation of the extent of disease.(ABSTRACT TRUNCATED AT 250 WORDS)
Diagnosis, Differential↗
The solitary pulmonary nodule.
This article provides background information about the solitary pulmonary nodule in terms of statistics, conventional radiology, and recent attempts to apply CT to distinguishing benign from malignant nodules. A proposed scheme for analysis of the nodule is offered.
Absorptiometry, Photon↗
CT densitometry of pulmonary nodules: a phantom study.
Density determinations by computed tomography (CT) have been used to distinguish benign from malignant pulmonary nodules. Unfortunately, clinical scanning of pulmonary nodules frequently yields artifactually low CT numbers because of partial volume artifacts from the surrounding aerated lung. In order to determine the best performance that can be expected from a CT scanner in providing CT numbers for pulmonary nodules free of partial volume artifacts, we scanned a phantom containing plastic spheres surrounded by air to simulate nodules in aerated lung. The relations among size of the sphere, slice thickness (collimation), and centering of the CT slice critically affected the number of accurate voxel values. A simple computer model accurately duplicated the experimental findings. These data enable us to define the basic geometric requirements for accurate CT densitometry of pulmonary nodules.
Densitometry↗
Contrast-related flow phenomena mimicking pathology on thoracic computed tomography.
Flow phenomena occurring after the bolus injection of contrast material can simulate the presence of pathology on thoracic computed tomography. In a review of 50 dynamic scans performed after contrast medium injection, apparent filling defects in the superior vena cava were seen in 46. In four cases, retrograde filling of the azygos or hemiazygos veins occurred. In two cases, layering of contrast material within the descending aorta simulated dissection. In many cases, the dynamic series of scans helped in diagnosing these appearances as flow related.
Aortic Dissection↗
Problems and pitfalls in the evaluation of thoracic aortic dissection by computed tomography.
Several conditions can lead to either false positive or false negative diagnoses of aortic dissection by computed tomography (CT) with intravenous administration of contrast medium. Insufficient contrast enhancement may cause intimal flaps to be missed, leading to a false negative diagnosis. False positive diagnoses result when extraaortic structures (e.g., mediastinal veins, pericardium, thickened pleura, and lung) are mistaken for false channels in the aorta. Superimposition of structures in thick CT slices may cause intimal calcifications to appear displaced. Streak artifacts across the descending aorta can resemble double aortic channels or intimal flaps. Fusiform aneurysms with thrombus are often hard to distinguish from thrombosed dissections by CT as well as by aortography.
Aortic Dissection↗
Distinguishing benign from malignant pulmonary nodules by computed tomography.
Investigators have been able to distinguish benign pulmonary nodules from malignant ones in about two-thirds of the cases studied by detecting high computed tomography (CT) numbers (attributed to microscopic calcifications) within many benign nodules. This paper reports a similar analysis on a series of 22 benign and 14 malignant pulmonary nodules. Although about one-third of the benign nodules gave high CT numbers, all but one of the nodules diagnosed as benign by CT could also be diagnosed by detection of calcification on plain radiographs or conventional tomograms.
Calcinosis↗
Gated multiplanar cardiac computed tomography.
Multiplanar reformatting was combined with electrocardiographically gated computed tomography (CT) to provide a three-dimensional assessment of the beating heart of a live dog. Separate systolic and diastolic images were made in transverse, sagittal, coronal, and paraxial views. Three-dimensional contour images that outlined the cardiac chambers and the myocardium were then made using a separate research computer. This three-dimensional appreciation of cardiac morphology could be extended to assess regional function. Practical problems that limit the application of these methods are discussed, along with the proposed solutions.
Animals↗
Evaluation of the grafted ascending aorta with computed tomography. Complications caused by suture dehiscence.
Patients who have undergone surgery on the thoracic aorta and placement of a synthetic tubular graft need close, long-term radiological follow-up, as they are at risk of not only complications and progression of the underlying disease (atherosclerosis, dissection, or cystic medial necrosis) but also complications of the procedure, notably suture dehiscence leading to formation of an aneurysm around the graft. In a series of 14 asymptomatic postoperative patients studied by computed tomography (CT), the authors detected leakage of contrast material around the graft in 6 patients, 2 of whom required re-operation to correct suture dehiscence. CT is a noninvasive and sensitive method of postoperative evaluation of patients who have undergone an aortic graft.
Adult↗
Calcification in pulmonary metastases.
A large variety of neoplasms can produce calcified lung metastases. Three unusual examples are presented and the relevant literature is reviewed. Each case involves a neoplasm not previously reported to produce calcified lung metastases: malignant mesenchymoma, fibrosarcoma of the breast, and medullary carcinoma of the thyroid. The sarcomas are reported in the literature to develop calcified lung metastases are osteogenic sarcoma, chondrosarcoma, synovial sarcoma, and giant cell tumour. Among carcinomas, the papillary and mucinous adenocarcinomas are the histological types most likely to develop calcified lung metastases. The metastases of a number of other tumours have calcified after antineoplastic therapy. Calcification in metastases arises through a variety of mechanisms: bone formation in tumour osteoid, calcification and ossification of tumour cartilage, dystrophic calcification and ossification of tumour cartilage, dystrophic calcification and mucoid calcification. Since calcified lung metastases can strongly resemble granulomas or hamartomas, a reasonable suspicion of malignancy is necessary when evaluating calcified pulmonary nodules.
Adult↗
Fatal pneumocystis pneumonia, cryptococcosis, and Kaposi sarcoma in a homosexual man.
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Adult↗
Computed tomographic detection of retrocrural air.
The normal prevertebral space at the level of the diaphragmatic crura contains the aorta, azygos and hemiazygos veins, lymphatics, and nerves. Three patients had gas demonstrated in the retrocrural space by computed tomography (CT). In each patient this gas was shown to represent parts of normal lung insinuated in the retrocrural space. A subsequent prospective evaluation of 100 consecutive CT examinations showed the presence of retrocrural air in 3% of patients. Retrocrural air should not be confused with free retroperitoneal air or gas caused by retroperitoneal abscesses.
Abscess↗
Three-dimensional display of the heart, aorta, lungs, and airway using CT.
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Animals↗
Evaluation of coarctation of the aorta by computed tomography.
We used computed tomography (CT) after contrast medium administration to evaluate three adult patients with coarctation of the aorta. In preoperative scans, CT showed the aortic narrowing and deformity and the poststenotic dilation associated with coarctation. In postoperative examinations, CT was used to check for residual or recurrent narrowing and for the development of complications such as aneurysm or dissection. Since CT is noninvasive, it can be performed as an outpatient procedure. Its potential applications and its limitations with respect to aortography are discussed.
Adult↗
Dynamic computed tomography in the evaluation of vascular lung lesions.
Rapid sequence (dynamic) computed tomography (CT) following the bolus injection of contrast material into a peripheral vein allows a differentiation of vascular and nonvascular lung lesions. The use of time-density curves plotting the changing CT number over time also allows pulmonary arterial supply of lung lesions to be distinguished from systemic (aortic) supply. Of four patients suspected of having pulmonary arteriovenous fistula, two were shown to have nonvascular lesions and two were shown to have vascular malformations by using dynamic CT. In one patient, a pulmonary vein varix was confirmed by using CT. In two patients, systemic arterial supply to abnormal lung was correctly diagnosed with CT; this finding was also shown in both patients by using arteriography. In some cases dynamic CT obviates arteriography; in others, it helps direct further evaluation.
Adult↗
Detection of intraventricular thrombi by computed tomography.
Intraventricular thrombosis (usually occurring after myocardial infarction) can lead to embolization, with serious consequences. Angiocardiography and two-dimensional echocardiography both are limited in their ability to detect intraventricular thrombi. Computed tomography (CT) with intravenous administration of contrast material gave excellent definition of intraventricular thrombi in three patients with recent myocardial infarctions and in one patient with a pericardial patch of the right ventricular apex. A ventricular mural thrombus was detected in a dog after an experimentally induced myocardial infarction. CT offers some advantages over contrast ventriculography and echocardiography in detecting intraventricular thrombosis.
Animals↗