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Biomedical subjects

J H Woodring

Publications and source records attributed to J H Woodring.

At least 19 recordsLinked to original sources
PubMed1992

The clinical and imaging spectrum of findings in patients with congenital lobar emphysema.

Congenital lobar emphysema (CLE) is an important cause of infantile respiratory distress that may require surgical intervention. We retrospectively reviewed the clinical and imaging findings in eight infants with CLE. In our series, CLE was more common in females, predominantly involved the right lung, often presented with an opaque lobe from retained fetal lung fluid, and frequently involved the lower lobes, multiple segments or lobes, and both lungs. Most patients with CLE were diagnosed and managed on the basis of clinical and plain radiographic findings alone. Computed tomography, and occasionally ventilation/perfusion scintigraphy, were helpful in confirming the diagnosis and in guiding management decisions in several cases; bronchoscopy showed that stenosis of the right mainstem bronchus was the cause of CLE in one case. Three patients experienced progressive worsening of respiratory distress and required surgical resection of the affected lobe for cure; the remaining five patients were managed medically with eventual remission of symptoms.

Bronchoscopy↗
PubMed1992

The role and limitations of computed tomographic scanning in the evaluation of cervical trauma.

We retrospectively reviewed the medical records, plain films, CT scans and complex-motion tomographic studies (TOMOS) of 216 consecutive patients with cervical injuries to determine the uses and limitations of CT in the evaluation of cervical trauma and the indications, if any, for the continued use of TOMOS in evaluating cervical trauma. There were 453 fractures and 104 subluxations or dislocations of the cervical spine in the 216 patients. Plain films detected 58% (262 of 453) of the fractures and 93% (97 of 104) of the subluxations and dislocations; and 94% (202 of 216) of the patients with abnormalities were identified. Computed tomographic scans detected 90% (406 of 453) of the fractures and 54% (56 of 104) of the subluxations and dislocations; 92% (198 of 216) of the patients with abnormalities were identified. Most of the abnormalities missed on the CT scans involved the dens, C-6, and C-7, and were oriented in the axial plane. Although CT scanning was better than plain films in detecting most types of cervical fractures, plain films were better than CT for detecting fractures of the vertebral body, dens, and spinous processes, and significantly better than CT in detecting subluxation and dislocation. When plain films and CT scans were combined they identified 98% (443 of 453) of the fractures and 99% (103 of 104) of the subluxations and dislocations; 100% (216 of 216) of the patients with abnormalities were identified. In the 20 patients who underwent both CT scanning and TOMOS, TOMOS detected more fractures, subluxations, and dislocations than CT scanning. Complex-motion tomographic studies detected atlanto-occipital dislocation and subluxation of the vertebral bodies and fractures of the spinous processes, lateral masses, articular processes, vertebral bodies, and dens better than CT scanning. Although the more routine use of CT scanning in evaluating cervical trauma should increase the detection of cervical abnormalities to near 100%, TOMOS remain the gold standard of diagnosis for atlanto-occipital dislocation, subluxation of the vertebral bodies, and fractures of the lateral masses, articular processes, vertebral bodies, and dens.

Adolescent↗
PubMed1992

Clinical and imaging evaluation of the solitary pulmonary nodule.

Management of a solitary pulmonary nodule remains a common clinical problem. The main goal of management is to choose a diagnostic and therapeutic scheme that is appropriately matched to the patient's clinical risk of malignancy. Clinical risk can be estimated from consideration of data on the overall prevalence of malignancy in solitary pulmonary nodules in various populations, the size of the pulmonary nodule, the patient's age and the patient's history of smoking. Nodules that have not grown for at least two years and those that are calcified are usually benign and require no further work-up. Suspicious nodules require further evaluation. The approach for patients at low clinical risk for malignancy may be clinical and radiographic observation, while that for patients at moderate to high risk for malignancy may be needle biopsy or thoracotomy. Whenever possible, the patient should be encouraged to participate in the decision-making process concerning the management of this clinical problem.

Adult↗
PubMed1991

Carotid and vertebral artery injury in survivors of atlanto-occipital dislocation: case reports and literature review.

Atlanto-occipital dislocation (AOD) usually results in immediate death from transection of the upper cervical spinal cord near the spinomedullary junction. However, over the last several decades increasing numbers of AOD survivors have been identified. Although many of these patients initially demonstrate profound neurologic deficits, a number who survive have regained most or all neurologic functions, indicating that they did not suffer mechanical disruption of the spinal cord at the time of AOD. In the survivors, a growing body of evidence indicates that many of the initial neurologic deficits are related to vascular injury to the carotid or vertebral arteries and their branches. We recently encountered three AOD survivors with no evidence of mechanical injury to the spinal cord in which angiography demonstrated vascular injury to the internal carotid artery in the form of vasospasm in one case and to the vertebral arteries in the forms of focal stenosis at the site of dural penetration, focal stenosis and distal vasospasm, and focal stenosis with distal intimal flap and dissection in one case each. Autopsy after one of the three died after cardiac arrest demonstrated diffuse infarction of the cerebrum, cerebellum, midbrain, brainstem, and upper cervical spinal cord without evidence of mechanical laceration or transection of the spinal cord. Recovery of neurologic function in two cases following prompt immobilization and angiography suggests that neurologic deficits secondary to vascular injury are potentially reversible.

Adolescent↗
PubMed1991

Sagittally oriented fractures of the lateral masses of the cervical vertebrae.

Lateral flexion of the cervical spine may cause a sagittally oriented fracture of the lateral mass with shearing of all or part of the lateral mass away from the vertebral body. We report 22 patients with 24 sagittal fractures of the cervical lateral masses. Cross-table lateral roentgenograms suggested the presence of a sagittal lateral mass fracture in two thirds of the cases based upon malalignment or widening of the facet joints, displaced fracture fragments, subluxation of the spine, or rotation of the spine above the level of abnormality. However, the cross-table lateral roentgenogram was normal in one third of cases. Oblique roentgenograms were available in eight cases; these were positive in five, equivocal in one, and negative in two. Visible fracture lines, often associated with lateral displacement of part or all of the lateral mass, allowed all 24 fractures to be detected on the supine anteroposterior view films. Sagittal lateral mass fractures were unstable in 59% (13/22) of the cases; neurologic deficits, including quadriplegia, hemiplegia, and radiculopathy, were present in 45% (10/22). Computed tomography and complex-motion tomography were useful in confirming the sagittal lateral mass fracture and in detecting other associated fractures.

Adult↗
PubMed1991

A prospective evaluation of plain radiographic signs of chronic obstructive pulmonary disease.

Plain film signs of COPD, spirometric evidence of airflow obstruction, and smoking history were correlated in a group of 182 men aged 32 to 85 years (average, 57.5 years) who presented for evaluation of possible pulmonary disability. There were 148 current or past smokers (range, 0.66 to 150 pack-years; average, 31.89 pack-years) and 34 lifetime nonsmokers. A single observer, who had no knowledge of the other parameters, prospectively evaluated posteroanterior chest radiographs for 11 signs of COPD. Airflow obstruction was defined as a reduction in FEV1/FVC% below the 95% confidence limit of normal. Obstruction was classified on the basis of the reduction in FEV1 as mild (FEV1 greater than 2.5L), moderate (FEV1 greater than 1.0 L and less than 2.5 L), or severe (FEV1 less than 1.0 L). Spirometric evidence of airflow obstruction was present in 67 patients; obstruction was mild in 26, moderate in 36, and severe in 5. We found a statistically significant association between smoking and airflow obstruction on spirometry (P less than 0.001) and an equally significant association between smoking and radiographic signs of COPD on plain chest films (P less than 0.001). Both airflow obstruction and radiologic signs of COPD were generally absent in lifetime nonsmokers. The plain film signs of COPD were only of moderate value in predicting spirometric evidence of airflow obstruction in smokers; spirometric evidence is not the gold standard for the presence of COPD, however, and the strong association between smoking and these radiologic signs may indicate that in smokers the presence of plain film signs of COPD reflects morphologic abnormality in the lungs indicative of disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Computed tomography distinction of central thoracic masses.

In an analysis of 36 central lung, 54 mediastinal, and 10 central pleural masses, features were sought that would allow accurate localization of the mass by CT. The mass-lung interface was the most useful feature; with few exceptions a mass with a spiculated, nodular, or irregular edge was in the lung, and a mass with a smooth edge was in the mediastinum. In the superior mediastinal, supraazygos, and supraaortic regions lung masses were lateral to the great vessels, and mediastinal masses were medial to the great vessels. Anterior mediastinal masses were typically positioned between the sternum and great vessels; some were more laterally positioned, however, and could only be distinguished from lung masses by the mass-lung interface. In the infraazygos, infraaortic, and paraspinal areas, lung and mediastinal masses were best differentiated by the mass-lung interface. The angles formed between the mass and lung were occasionally helpful in localizing the mass. Central pleural masses were characterized by a lack of intimate mediastinal effect, obtuse angles between the mass and lung, a smooth mass-lung interface, and characteristic association with other similar areas of involvement in the pleural space. These criteria were used for the correct localization of 99 of 100 masses; therefore, they can simplify and focus the work-up of most central thoracic masses.

Adipose Tissue↗
PubMed1991

Mycobacterium fortuitum pulmonary infection complicating achalasia.

Achalasia is a cause of chronic aspiration pneumonia that may be complicated by pulmonary infection with Mycobacterium fortuitum. In any patient with achalasia, the presence of a pulmonary infiltrate that does not respond to routine antibiotic therapy should suggest the possibility of M fortuitum pulmonary infection, and sputum should be cultured for these organisms.

Adult↗
PubMed1991

Pulmonary artery-bronchus ratios in patients with normal lungs, pulmonary vascular plethora, and congestive heart failure.

The pulmonary artery-bronchus ratio (ABR), defined as the external diameter of a pulmonary artery divided by the external diameter of its accompanying bronchus, was measured in the upper and lower lung zones on frontal chest radiographs in the following groups of subjects: erect healthy subjects, erect subjects with pulmonary vascular plethora, erect subjects with clinical evidence of decompensated left-sided congestive heart failure (CHF), supine normal subjects, and supine subjects with clinical evidence of decompensated CHF. Characteristic vascular patterns were found in each group. The positive predictive value of an abnormal vascular pattern determined by means of changes in the ABR on the erect chest radiograph was 100%, with the negative predictive value of a normal pattern being 97%. The erect chest radiograph was 93% accurate in distinguishing between plethora and CHF. The positive predictive value of an abnormal vascular pattern on the supine chest radiograph was 100%, with the negative predictive value of a normal vascular pattern being 97%. Measurements of ABR can be a helpful adjunct to the interpretation of supine and erect chest radiographs.

Adolescent↗
PubMed1991

Congenital tracheobronchomegaly (Mounier-Kuhn syndrome): a report of 10 cases and review of the literature.

Mounier-Kuhn syndrome is a congenital abnormality of the trachea and main bronchi characterized by atrophy or absence of elastic fibers and thinning of muscle, which allows the trachea and main bronchi to become flaccid and markedly dilated on inspiration with narrowing or collapse on expiration or cough. The abnormal airway dynamics and pooling of secretions in broad outpouchings of redundant musculomembranous tissue between the cartilaginous rings predispose to the development of chronic pulmonary suppuration, bronchiectasis, emphysema, and pulmonary fibrosis. A broad spectrum of clinical abnormalities has been documented in Mounier-Kuhn syndrome, ranging from minimal disease with good preservation of pulmonary function to progressive disease leading to respiratory failure and death. In the appropriate clinical setting, Mounier-Kuhn syndrome is diagnosed in women from chest radiographs when the transverse and sagittal diameters of the trachea exceed 21 mm and 23 mm, respectively, and when the transverse diameters of the right and left main bronchi exceed 19.8 mm and 17.4 mm, respectively. In men it is diagnosed when the transverse and sagittal diameters of the trachea exceed 25 mm and 27 mm, respectively, and when the transverse diameters of the right and left main bronchi exceed 21.1 mm and 18.4 mm, respectively. The diagnosis can be confirmed easily by computed tomography.

Adult↗
PubMed1990

Pulmonary disease caused by nontuberculous mycobacteria.

Nontuberculous mycobacterial pulmonary infections have become more common in recent years. The diagnosis is often overlooked because the findings may be subtle or because the radiographic appearance may change slowly or not at all for long periods of time. As a rule, the radiographic findings of nontuberculous mycobacterial pulmonary infections are identical to those of tuberculosis in any given patient. Cavitary disease in nontuberculous mycobacterial infections is less common than in tuberculosis. The most common radiographic finding is one or more areas of clustered fibroproductive nodules that change slowly. Mycobacterium kansasii infection responds well to therapy, whereas M avium-intracellulare infection is difficult to treat. Awareness of the radiographic appearance of the nontuberculous mycobacterial pulmonary infections will facilitate their diagnosis so that appropriate therapy may be initiated before the disease is far advanced.

Diagnosis, Differential↗
PubMed1990

Unusual radiographic manifestations of lung cancer.

The majority of lung cancers present as either a solitary parenchymal nodule or mass or as a hilar mass that demonstrates progressive growth with time. Unusual parenchymal manifestations of lung cancer include a nodule or mass that may decrease in size without therapy; intrinsic calcification; thin-walled cavitation; a meniscus sign; unifocal or multifocal alveolar infiltrates; satellite nodules; and multiple well-defined pulmonary nodules or masses. Unusual bronchial manifestations of lung cancer include widely separated areas of segmental or lobar atelectasis, mucoid impaction of bronchi, and obstructive hyperinflation. In the pleural space, bronchogenic carcinoma may occasionally be manifested as spontaneous pneumothorax, diffuse nodular tumor spread, and isolated effusion. Unusual mediastinal manifestations of lung cancer include primary mediastinal bronchogenic carcinoma, "downhill" esophageal varices, pulmonary artery invasion and infarction, pericardial and cardiac invasion, and esophageal obstruction. In addition, lung cancer may arise as a complication of bullous lung disease and a number of conditions that cause focal or diffuse lung scarring. Through increased familiarity with these varied manifestations of lung cancer, and a high index of suspicion, it is hoped that the radiographic detection of lung cancer will be improved.

Bronchography↗
PubMed1989

Air-filled, multilocular, bronchopulmonary foregut duplication cyst of the mediastinum. Unusual computed tomography appearance.

Mediastinal bronchopulmonary foregut duplication cysts are usually identified on computed tomography (CT) as well-defined masses of water density that may contain rim calcification. Occasionally they are heterogenous in attenuation or are of intermediate or high attenuation due to contained calcium. Communication with the tracheobronchial tree or esophagus is rare. We report a bronchogenic cyst that communicated with the trachea and was identified by CT as a multilocolor, completely air-filled cyst adjacent to the trachea and esophagus. This appearance of a bronchogenic cyst has received little attention in the literature.

Adult↗
PubMed1989

Determination of normal transverse mediastinal width and mediastinal-width to chest-width (M/C) ratio in control subjects: implications for subjects with aortic or brachiocephalic arterial injury.

We measured transverse mediastinal width and mediastinal-width to chest-width (M/C) ratio on supine films of 100 nontraumatized controls. In 95% the transverse mediastinal width was less than 7.5 cm and the M/C ratio was less than 0.38. Thus a transverse width of 7.5 cm or more or an M/C ratio of 0.38 or more can be defined as abnormal with 95% confidence. Application of these values to determine abnormality in 32 patients with proven aortic or brachiocephalic injury showed that the transverse mediastinal width was within normal limits in 41% and M/C ratio was normal in 69%. Utilizing smaller values that would identify all abnormals resulted in false positive rates in the controls of 74% and 87%, respectively. However, one or more of eight specific signs of mediastinal abnormality related to hemorrhage or pseudoaneurysm formation were present in 94% of abnormals compared to only 11% of controls. Because of extreme overlap of transverse mediastinal width and M/C ratio between normals and abnormals, precise measurement of the mediastinum cannot reliably separate the two groups. The subjective assessment of anatomic mediastinal abnormality remains a superior plain film method in determining the need for aortography.

Adolescent↗
PubMed1989

Coronary artery calcification identified by CT in patients over forty years of age.

In a study of 100 unselected patients forty years of age or older, routine CT of the thorax demonstrated coronary artery calcification in 41%. Calcification of the left anterior descending was most common, occurring in 34%. For patients 60 years of age and over, clinical evidence of coronary artery disease was 1.7 times more common in those with calcification compared to those without; however, for patients under 60, coronary artery disease was 5.5 times more common in those with calcification than those without. Because of the strong relationship that is known to exist between coronary artery calcification and coronary arteriosclerosis, we believe that the incidental discovery of coronary artery calcification on routine CT of the thorax has significance. All patients under 60 with coronary artery calcification discovered on CT should be investigated for hyperlipidemia if this has not been done, and, if they are not known to have a history of coronary artery disease, they should have a stress test and, if positive, arteriography may be warranted.

Adult↗
PubMed1989

Acquired tracheomegaly in adults as a complication of diffuse pulmonary fibrosis.

We studied the chest radiographs of 34 consecutive patients with diffuse pulmonary fibrosis to determine the presence of tracheomegaly and to follow its progression with time. Patients had been identified by a computer search of medical records. We measured the internal transverse diameter of the trachea 2 cm above the top of the aortic arch on erect posteroanterior chest radiographs. Transverse diameters greater than 25 mm in men and 21 mm in women were considered indicative of tracheomegaly. Pulmonary-function tests, available in 30 of the 34 patients, showed restrictive lung disease. The transverse tracheal measurements were compared with the cause of fibrosis, severity of restriction, duration of illness, and other clinical variables. Tracheomegaly was present in 10 (29%) of the patients, including four with fibrosing alveolitis, four with sarcoidosis, and two with chronic progressive histoplasmosis. In seven of these patients, serial radiographs showed that the tracheal dilatation had progressed with time. Nine of 24 patients without tracheomegaly also had progressive increase in transverse tracheal diameter over time. Of the 10 patients with tracheomegaly, pulmonary-function tests were available in eight and showed moderate restrictive lung disease in six and severe restrictive lung disease in two. The duration of illness was 3-6 months in two patients, 10-22 years in five patients, and not recorded in three patients. Chronic cough and repeated respiratory infections were slightly more common in those patients with tracheomegaly than in those without. These data suggest that tracheomegaly develops as a complication of diffuse pulmonary fibrosis in patients who have at least moderate restrictive lung disease and prolonged illness, and it may have some association with chronic cough and repeated respiratory infection.

Adult↗
PubMed1989

The potential effects of radiographic criteria to exclude aortography in patients with blunt chest trauma. Results of a study of 32 patients with proved aortic or brachiocephalic arterial injury.

The purpose of this study was to test the effectiveness, in patients with known aortic or brachiocephalic arterial injury, of five previously published radiographic criteria for excluding aortography in patients with blunt chest trauma. These criteria were (1) normal findings on erect chest radiograph; (2) normal aortic arch and left subclavian artery; (3) normal aortic arch, descending aorta, aortopulmonary window, tracheal position, and left paraspinal interface; (4) normal right paratracheal stripe and nasogastric tube position, and (5) normal aortic arch and tracheal and nasogastric tube position. One or more of these criteria were met in 6% to 25% of patient with major thoracic arterial injury, depending on the criteria used. Interestingly, two (6%) patients had radiographs that showed no specific signs of mediastinal hemorrhage, which indicates that the chest radiograph is limited in its sensitivity to detect major thoracic arterial injury. Because of these results, we do not believe that attempts to limit aortography in patients with supine film evidence of mediastinal abnormality, based on the absence of certain signs of mediastinal hemorrhage, are warranted. Furthermore, an abnormal radiograph cannot be relied on as the sole criterion for aortography if the goal of care is to detect as close to 100% of vascular injuries as possible.

Aorta, Thoracic↗