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PubMed1995

[Correlation between roentgenogram and CT scans with the changes of cells in bronchoalveolar lavage fluid in sarcoidosis].

Considering protean and variability of chest findings of sarcoidosis, the correlation between finding on roentgenogram and CT scans with changes of total, differential cell count and subsets of lymphocytes of BALF in 25 cases with sarcoidosis was studied. The results showed that CT could detect more groups of enlarged lymph nodes in the mediastinum and more minimal lesions in lung parenchyma in those patients who showed stage 0 and I on chest roentgenogram. The parenchymal changes were distributed mainly among the bronchovascular sheath. Good correlation was found between findings on CT scan and total cell count in BALF. Fibrotic changes on CT scan were usually associated with an increase in neutrophils of BALF. It indicated that CT could more precisely assess the lesions in the mediastinum and lung parenchyma and be served as an important supplementary diagnostic measure to roentgenogram for patients with sarcoidosis.

Bronchoalveolar Lavage Fluid↗
PubMed1978

An evaluation of plain roentgenograms prior to oral cholecystography in children.

Plain roentgenograms were taken prior to oral cholecystography in 100 children. Three children had their gallstones obscured by the oral cholecystographic agent. Consideration should be given to obtaining plain roentgenograms in children with a strong clinical suspicion of gallbladder disease and a normal oral cholecystogram.

Adolescent↗
PubMed1980

Aortic dissection with "normal" chest roentgenogram.

Two patients were studied who had aortic dissections and chest roentgenograms not suggestive of that diagnosis. Since a normal chest roentgenogram does not necessarily exclude this diagnosis, aortography is indicated, if aortic dissection is strongly suspected clinically.

Aged↗
PubMed1987

Bronchoscopy in patients with haemoptysis and normal chest roentgenograms.

We reviewed the records of 58 patients with haemoptysis and normal chest roentgenograms who underwent fibreoptic bronchoscopy. A diagnosis of malignancy was made in six patients at bronchoscopy. Three patients had bronchogenic squamous cell carcinoma, one a carcinoid tumour and two laryngeal carcinoma. Sputum for cytology was negative for malignant cells in all six patients. Follow-up data were available for the other 52 patients for an average period of 55.7 +/- 29.6 (SD) months. Two patients had a subsequent diagnosis of bronchogenic carcinoma at 2 and 6 years after initial evaluation. Three patients died from conditions not related to pulmonary malignancy and the remaining patients followed a benign course. Our patients come from a predominantly male, elderly population of cigarette smokers. Among such patients, we conclude that bronchoscopy is indicated in the evaluation of those with haemoptysis and a normal chest roentgenogram.

Bronchoscopy↗
PubMed2003

Outcome in patients with lung cancer found on lung cancer mass screening roentgenograms, but who did not subsequently consult a doctor.

GOALS OF THE STUDY: To evaluate the outcome in patients with lung cancer found on lung cancer mass screening roentgenograms, but who did not subsequently consult a doctor. PATIENTS AND METHODS: This study enrolled 198 asymptomatic patients with lung cancer found by lung cancer mass screening during the 9-year period. Five-year survival rates in patients who did not consult a doctor or who stopped consulting a doctor in spite of abnormal shadows detected on last mass screening chest roentgenograms (n=45, delayed consultation group) and in patients who subsequently consulted a doctor when abnormal shadows were detected (n=153, control group) were evaluated by the method of Kaplan and Meier and clinical variables were examined as possible predictors of survival time by the Cox proportional-hazards model. RESULTS: There was a significant difference between the 5-year survival rates in the delayed consultation group and in the control group (21 vs. 51%, log rank: P=0.0003, Wilcoxon: P=0.0009). The risk of death increased 115.0% for the 1-year delay in consultation (hazard ratio: 2.150, 95% CI: 1.203-3.842, P=0.0097). With regard to the reason why they did not consult a doctor, many of them answered that they did not have any respiratory symptoms. CONCLUSION: The 1-year delay in consultation had a great significance in that these patients did not receive any treatment for lung cancer for 1 year, and the 1-year delay in treatment itself affected the outcome.

Adult↗
PubMed1978

Normal chest roentgenograms in chronic diffuse infiltrative lung disease.

We undertook this study to determine the prevalence of normal roentgenograms in chronic diffuse infiltrative lung diseases. Of 458 patients with such disorders histologically confirmed, 44, or 9.6 per cent, had normal pre-biopsy films. In this group with normal x-ray films, desquamative interstitial pneumonia, sarcoidosis and allergic alveolitis were the most frequent diagnoses. Dyspnea was the principal complaint, and fine rales were common. The vital capacity was reduced in 57 per cent, and the single-breath diffusing capacity in 71 per cent. In half, histological changes and functional impairment were moderately severe. Films may be normal in such cases because isolated foci are too small or too few, because diffuse interstitial or intra-alveolar disease may cast no discrete shadows or because the lesions primarily affect airways or blood vessels. Patients with normal chest roentgenograms and normal mechanics of breathing but with impaired gas exchange should have lung biopsy for early diagnosis and therapy.

Adult↗
PubMed1988

Introduction to critical review of roentgenograms.

Review of available roentgenograms, or x-ray films, by the attending physical therapist may be helpful in precise evaluation of patient status or progress or for educational purposes. This article presents background information on radiology and a simple mnemonic device for use in critically viewing roentgenograms. Eight case studies are presented in a programmed-learning format. Physical therapists are encouraged to adapt the following information to their specific setting and to produce a teaching package suitable for students and new staff members.

Adult↗
PubMed1989

Indications for chest roentgenogram in the febrile young infant.

A combined retrospective and prospective analysis of infants 60 days of age or less evaluated for fever (greater than or equal to 38.3 degrees C) or history of fever who received chest roentgenogram over a one-year period was performed to determine whether clinical characteristics were predictive of pneumonia. Of the 209 patients studied, 115 were reviewed prospectively and 94 retrospectively. Pneumonia was radiographically diagnosed in 16 patients. Individual clinical factors were not found to be highly predictive of pneumonia. However, infants with the following nine factors did not have pneumonia; illness in the summer months; absence of cough, dyspnea, and respiratory distress (grunting/flaring/retracting); respiratory rate less than 60; absence of rales and decreased breath sounds; presence of normal color; and white blood cell count less than 19,000/mm3. We recommend that these clinical characteristics be utilized to determine whether chest roentgenogram is warranted in the young infant evaluated for fever.

Diagnosis, Differential↗
PubMed1988

Effect of tobacco smoking on the presence of asbestosis at postmortem and on the reading of irregular opacities on roentgenograms in asbestos-exposed workers.

A statistically significant association between cigarette smoking and radiologic readings of irregular opacities was observed in a case-control study of 430 South African asbestos miners (OR = 3.03; 95% confidence interval, 1.50; 6.11). In another case-control study of 487 dead South African asbestos miners, no positive association between smoking and autopsy findings for asbestosis was observed (OR = 0.50; 95% confidence interval, 0.20; 1.29). The association between greater than slight asbestosis (moderate and marked) and smoking (yes/no) was not significant (Fisher's exact test, p = 0.44), and the adjusted odds ratio was 1.25 with 95% confidence interval (0.20; 7.78). In addition, the certification in life for asbestosis, based on chest roentgenogram readings for irregular opacities, was also found to have a tendency to be related to smoking. Thus, the findings of these studies do not support the hypothesis that smoking is associated with the presence of asbestosis at autopsy or that smoking and asbestos dust act synergistically in producing asbestosis at autopsy. But the findings of this and other studies suggest that smoking does produce some change in the lung structure that can be visible on the roentgenogram and can be wrongly interpreted as irregular opacities caused by asbestosis.

Asbestos↗
PubMed1982

Clinical predictors of pneumonia as a guide to ordering chest roentgenograms.

To develop criteria for a more efficient approach to the ordering of chest roentgenograms, patients with fever or respiratory symptoms who were being evaluated with this diagnostic test were prospectively monitored. During a six-month period, residents working in a pediatric emergency room collected data on 136 children, 3 months to 15 years of age. Pneumonia, defined by appropriate abnormal chest roentgenographic findings, occurred in 19 per cent. Of the 29 single symptoms or signs examined, the variable which was the best predictor of pneumonia was tachypnea. In addition, a cluster of pulmonary findings was also a good index, for pneumonia. If these clinical criteria had been applied to the patients under investigation, the number of chest roentgenograms obtained would have been reduced by 30 per cent.

Adolescent↗
PubMed1985

Palatopharyngoplasty failure, cephalometric roentgenograms, and obstructive sleep apnea.

Nine patients with obstructive sleep apnea who underwent unsuccessful palatopharyngoplasty (PPP) as documented by polygraphic monitoring had abnormal cephalometric roentgenogram measurements. Findings indicated a small posterior airway space and inferiorly placed hyoid bone. Cephalometry performed with appropriate techniques to investigate soft tissue location should be obtained systematically in obstructive sleep apneic patients before any surgery is performed. The roentgenogram finding is a helpful guide in deciding whether PPP alone or PPP in combination with other surgical procedures would be more efficacious.

Adult↗
PubMed1988

Weightbearing roentgenograms in arthritis of the ankle: a case report.

In specific situations the nonweightbearing roentgenograms of the ankle do not correlate with clinically suspected ankle malalignment or arthrosis, and weightbearing roentgenograms of the ankle joint can be quite helpful. The nature and severity of ankle arthrosis may not be detected with standard x-rays alone. A case is described in which these views contributed significantly to the clinical treatment of a rheumatoid patient.

Aged↗
PubMed1991

Chronic dyspnea unexplained by history, physical examination, chest roentgenogram, and spirometry. Analysis of a seven-year experience.

The purpose of this article is to describe the spectrum and frequency of diseases presenting as unexplained dyspnea and to develop a logical diagnostic approach to such patients. Seventy-two consecutive physician-referred patients had dyspnea greater than one-month duration unexplained by the initial history, physical examination, chest roentgenogram, and spirometry. Patients underwent a standard diagnostic evaluation. A definite cause for dyspnea was recognized in 58 patients, and no answer was found in 14. Twenty-two diseases were recognized in the patient group. Dyspnea was due to pulmonary disease in 26 (36 percent) patients, cardiac disease in ten (14 percent) patients, hyperventilation in 14 (19 percent) patients, and only 3 patients had extrathoracic disease causing dyspnea. Age younger than 40 years, intermittent dyspnea, and normal alveolar-arterial oxygen pressure difference (P[A-a]O2) at rest breathing room air was strongly predictive of bronchial hyperreactivity or hyperventilation. No patient diagnosed as having disease of the lung parenchyma or vasculature had a P(A-a)O2 less than or equal to 20 mm Hg. The differential diagnosis to explain dyspnea in patients with nondirective histories, normal findings from physical examinations, normal chest roentgenograms, and normal spirograms is extensive. The patient's age and measurement of gas exchange at rest help to formulate a diagnostic approach.

Adult↗
PubMed1992

The significance of irregular opacities on the chest roentgenogram.

Scanty irregular opacities are not uncommonly observed on the chest roentgenogram in the absence of interstitial fibrosis of the lungs. In such circumstances the irregular opacities, when present, tend to be relatively scanty and seldom, if ever, exceed an ILO category of 1/1. They are found in association with cigarette smoking, especially when emphysema is also present. The development of irregular opacities is also related to exposure to various mineral and other dusts, and although their prevalence increases with cumulative dust exposure, in general the type of dust, whether fibrogenic or relatively inert, seems to be of little moment. The presence of irregular opacities remains a troublesome confounding factor in epidemiologic studies of both dust-exposed and nonexposed populations. The morbid anatomic changes that occur in the lungs of nondust-exposed workers and which are responsible for the development of irregular opacities in the chest roentgenogram remain unknown.

Age Factors↗
PubMed1979

Chest roentgenograms in primary pulmonary hypertension.

The characteristics of 59 chest roentgenograms of patients with primary pulmonary hypertension were investigated and compared with roentgenograms of 100 healthy control subjects. The relationship with pulmonary hemodynamics was also examined. In primary pulmonary hypertension, there was remarkable protrusion of the main pulmonary artery; the DPA (T/2) and the PL/T index (see text) had high values. These indices depend mainly on pulmonary hypertension, but are partially determined physically by the size of the individual heart. The width of the descending branch of the right pulmonary artery (dPA) was about double the control value (P less than 0.001). The cardiothoracic ratio was significantly increased in primary pulmonary hypertension and there was a positive correlation between the ratio and the mean right atrial pressure (r = 0.37, P less than 0.01). However, there was no correlation with pulmonary arterial pressure or other pulmonary hemodynamic parameters. These results indicate that the increase in the cardiothoracic ratio in primary pulmonary hypertension is caused mainly by right heart failure.

Adolescent↗
PubMed1988

Utility of fiberoptic bronchoscopy in patients with hemoptysis and a nonlocalizing chest roentgenogram.

The need for fiberoptic bronchoscopy in the patient with hemoptysis and a normal or nonlocalizing chest roentgenogram remains a subject of debate. Currently, diagnostic fiberoptic bronchoscopy is recommended as the investigative procedure of choice. To develop predictors that identify the patient in whom fiberoptic bronchoscopy is most likely to be diagnostic, we reviewed our community's experience with this population over a five-year period. We identified 196 patients with hemoptysis and a normal or nonlocalizing chest roentgenogram who underwent fiberoptic bronchoscopy. Three quarters were active or previous smokers. We examined the relationship of advancing age, sex, smoking, nonspecific roentgenographic findings and the amount, duration, and previous bouts of hemoptysis to the incidence of a diagnostic fiberoptic bronchoscopy. Twelve patients (6 percent) had bronchogenic carcinoma and 33 (17 percent) another specific cause for the hemoptysis identified by fiberoptic bronchoscopy. By univariate and discriminant analyses, we found that the three factors of age of 50 years or more, male sex, and smoking of 40 pack-years or more best predicted a diagnosis of malignancy. Bleeding in excess of 30 ml daily was associated with an increase in overall diagnostic yield. The presence of two of the three factors associated with malignancy or bleeding in excess of 30 ml daily (or both) identified 100 percent of the patients with bronchogenic carcinoma and 82 percent of all of the diagnostic fiberoptic bronchoscopic procedures. use of these criteria in selecting the patient for fiberoptic bronchoscopy could have reduced our use of the bronchoscope by 28 percent, with the remaining patients safely observed.

Adolescent↗
PubMed1988

Obstructive sleep apnea and cephalometric roentgenograms. The role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep.

In a six-month period, 157 obstructive sleep apnea syndrome (OSAS) patients seen consecutively in clinic had standardized cephalometric roentgenograms and underwent polygraphic monitoring during sleep. Different variables, including cephalometric landmarks, body mass index (BMI), and polygraphic results (particularly degree of O2 saturation and number of abnormal breathing events), were statistically analyzed. As a rule, OSAS patients had upper airway anatomic abnormalities and an elevated BMI: massive obesity was associated with less anatomic abnormality, less nocturnal sleep disruption, and longer total sleep time (TST). Patients having a high respiratory disturbance index (RDI) were more likely to have upper airway anatomic abnormalities; they slept for a shorter time and had increased stage 1 non-rapid eye movement (NREM) sleep but decreased stage 3 and 4 and REM sleep. Long mandibular plane to hyoid bone (MP-H) distance and width of the posterior airway space (PAS) (space behind the base of the tongue) were statistically significant predictors of elevated RDI. The cephalometric variables were much less useful for predicting frequency of O2 saturation drops below 80 percent. The patient population can be subdivided into (a) patients with clear anatomic abnormalities and low BMI, (b) patients with morbid obesity with few abnormal cephalometric measurements, and (c) patients who have variably increased BMI and abnormal cephalometric measurements. This is the largest group. We concluded that standardized cephalometric roentgenograms can be useful in determining the appropriate treatment for OSAS patients.

Adult↗