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Chest roentgenogram in pulmonary tuberculosis. New data on an old test.

The utility of routine admission chest roentgenograms (CXRs) was evaluated in detecting pulmonary tuberculosis and the relationship between roentgenographic patterns and the likelihood of finding acid-fast bacilli (AFB) on sputum smear. Of 58 patients whose chief complaints were unrelated to pulmonary tuberculosis, the CXR suggested tuberculosis in 52 cases (90 percent). In 45 cases, the emergency room physician failed to elicit the patient's respiratory symptoms and did not consider tuberculosis as a diagnostic possibility. In 18 individuals, the diagnosis was missed in the emergency room because of failure to obtain a CXR. Among patients whose roentgenograms showed cavitation or extensive alveolar infiltrate, sputum smears showed AFB in 98 percent of cases. If alveolar infiltrate was absent, or if the roentgenographic pattern was not that of adult reactivation disease, sputum smears revealed AFB in only one half of the cases. We conclude that routine admission CXRs are useful in hospitals serving populations where tuberculosis is still common, and the probability of detecting AFB on sputum smear is greatly influenced by the roentgenographic findings.

Adolescent↗

The prevalence of pulmonary hypertension in the United States. Adult population estimates obtained from measurements of chest roentgenograms from the NHANES II Survey.

Because a definitive diagnosis of pulmonary hypertension requires cardiac catheterization, there have been no data on the prevalence of pulmonary hypertension in the general population. The diameter of the right descending pulmonary artery, as measured from chest roentgenograms, has been used by clinicians as a noninvasive indicator of pulmonary hypertension. Chest roentgenograms from the Second National Health and Nutrition Examination Survey, a sample survey of the US civilian noninstitutional population, were used in conjunction with estimates of sensitivity and specificity of this technique determined from patients who underwent right heart catheterization to estimate the prevalence of pulmonary hypertension (mean pulmonary artery pressure greater than 20 mm Hg at rest) in the US population aged 25 years and older. The prevalence is estimated to be very low in the population at large, primarily because of the low prevalence in women of all ages. The prevalence in men is 13.4 percent above age 34, and increases to 28.2 percent above age 64. Thus, in elderly men, pulmonary hypertension is relatively common and may have an important impact in the management of this age group.

Adult↗

Correlation of chest roentgenograms with pulmonary function and bronchoalveolar lavage in interstitial lung disease.

We used the ILO classification for occupational lung disease to determine whether there was any correlation between the type and/or severity of pulmonary infiltration on chest roentgenograms and either pulmonary function tests or the types of inflammatory cells present in BAL fluid in patients with interstitial lung disease. Of the 62 patients evaluated (27 with sarcoidosis, 18 with IPF, and 17 with a CV disease and lung involvement), 49 had irregular linear opacities and 13 had normal chest x-rays. There were no significant correlations between the types of cells present in BAL fluid and the various categories of infiltrate or profusion of the infiltrates within each disease group. In patients with sarcoidosis, more extensive infiltration (profusion) was associated with lower FEV, (p less than 0.01). In patients with IPE, linear opacity type, profusion, and the presence or absence of honeycombing were not related to the severity of pulmonary function abnormalities. We conclude that the ILO classification for analysis of chest roentgenograms can be applied to patients with interstitial lung disease not associated with an occupational exposure and that this approach is useful, especially for communication. However, these data provide no information regarding the inflammatory process in the lung and limited information regarding abnormalities in pulmonary function.

Bronchoalveolar Lavage Fluid↗

Natural course of treated pulmonary embolism. Evaluation by perfusion lung scintigraphy, gas exchange, and chest roentgenogram.

Perfusion lung scintigrams, pulmonary gas exchange data, and chest roentgenograms were obtained in 33 patients during acute embolism and over the following six months in order to assess their clinical usefulness in monitoring the effect of therapy. To this purpose, the measurement of pulmonary gas exchange and the presence of chest x-ray findings were compared with perfusion lung scintigraphic abnormalities both at diagnosis and after 7, 30, and 180 days during treatment. More than 50 percent of the pulmonary arterial tree was obstructed at diagnosis, and a large part of perfusion recovery was complete within the first month. All of the gas exchange parameters were abnormal at diagnosis, and the rate of their improvement was related to that of perfusion recovery. Interestingly, PaO2st (ie, PaO2 corrected for hyperventilation) and VE tended to return to normal during the first month as a consequence of the progressive recovery of perfusion, whereas oxygen and carbon dioxide gradients and physiologic dead space showed the persistence of some abnormalities six months after diagnosis. Significant correlations were observed between the number of ULSs evaluated on the perfusion lung scintigram (and considered an index of the severity of pulmonary embolization) and all of the gas exchange parameters at diagnosis (correlation coefficients averaged from 0.41 to 0.73) and after 7 and 30 days. The enlargement of the right descending pulmonary artery and particularly the "sausage" sign and the Westermark sign were significantly associated with a higher degree of gas exchange impairment and with a more severe embolization. In conclusion, this study demonstrates that perfusion lung scintigraphy has a primary role in monitoring the recovery of patients with pulmonary embolism under treatment. Moreover, the chest roentgenogram may help in this purpose. A second major result is that the simple measurement of some gas exchange parameters may allow the assessment of functional recovery of these patients, thus giving additional information about the effect of therapy.

Carbon Dioxide↗

The chest roentgenogram in pulmonary tuberculosis patients seropositive for human immunodeficiency virus type 1.

To determine the impact that co-infection with HIV has on the radiographic presentation of pulmonary tuberculosis, we examined the chest roentgenograms obtained before treatment in 225 HIV-tested adult Haitians with bacillary (smear or culture or both) positive pulmonary tuberculosis. There were 67 HIV-seropositive and 158 HIV-seronegative patients. Intrathoracic adenopathy alone was more common and parenchymal infiltrates less common in HIV-seropositive patients (p less than 0.05). Although a parenchymal infiltrate was less likely to be cavitating in the HIV-seropositive group (p less than 0.05) when cavitary parenchymal disease was present, HIV seropositivity did not affect the number of cavities (single or multiple) or the size of the largest cavity. Patients with AIDS were significantly more likely to have a chest radiographic pattern consistent with primary tuberculosis (80 percent) than HIV-seropositive patients without AIDS (30 percent), and the latter were significantly more likely to have such a pattern than HIV-seronegative patients (11 percent) (p less than 0.05). The HIV-seropositive patients were equally infectious, regardless of the pattern of disease (primary vs postprimary). Even though pulmonary tuberculosis in an HIV-seropositive adult probably results from reactivation of dormant foci or reinfection, the pattern on the chest roentgenogram often suggests primary disease, especially if the patient has AIDS.

Acquired Immunodeficiency Syndrome↗

Initial appearance of an ill-defined shadow on a chest roentgenogram in a patient with aortitis syndrome.

A 20-years-old woman with fever and an abnormal shadow on a chest roentgenogram was admitted to our hospital. High grade fever continued even after gradual disappearance of the ill-defined shadow on the right upper lobe (S3) with minor fissure deviation upward, while neck pain and bruit gradually developed. She was diagnosed as aortitis syndrome from a digital subtraction angiography. The initial appearance of an ill-defined shadow on a chest roentgenogram, considered as pulmonary infarction, is rare in the aortitis syndrome and this kind of onset is interesting in relation to the pathogenesis and diagnosis of this syndrome.

Angiography, Digital Subtraction↗

The erect lateral lumbar roentgenogram in the evaluationof "low back" pain.

A study was made of the potential value of the erect lateral flexion lumbar roentgenogram in a series of 50 adults, some with symptoms of low back pain and some without such symptoms. The film was made in addition to the standard antero-posterior, lateral and sometimes oblique views taken in the recumbent position. In 11 of 37 patients with low back pain, some narrowing of lumbar discs was visible in both horizontal and erect lateral films, the degree being not significantly different between the two positions. In one patient, localized anterior narrowing of a lumbar disc, which was not visible in the recumbent lateral film, was observed. This finding was confirmed at a subsequent examination. In one of 13 patients without lumbar area symptoms, slight anterior narrowing of a lumbar disc could be seen in the erect lateral film but not in the horizontal. The reason for this is not known; it may be physiologic in this particular patient. The value of the routine erect lateral flexion lumbar roentgenogram was not confirmed by this preliminary study.

Adult↗

Calculation of 3-D deformity in scoliosis by standard roentgenograms.

The standard radiological diagnosis of advanced scoliosis consists of roentgenograms of the total spine in anterior-posterior and lateral views. The deformity of the spine is measured by using the Cobb angle, thus only giving the projected angle of deformity, without showing the true 3-dimensional aspect. The 3-D calculation of the deformity is relevant to diagnosis and therapy of scoliosis. In this paper we define angles according to the Cobb definition, evaluate them trigonometrically and show them in two tables. These angles allow the 3-dimensional deformity in scoliosis to be calculated using the standard roentgenograms in two perpendicular views. This procedure enables us to avoid techniques costly in time and effort in hospital routine, such as stereo radiography, computer-analysis or 3-dimensional reconstruction of CT- and MRI-investigations.

Biometry↗

UNUSUAL CASE OF PULMONARY ARTERIOVENOUS FISTULA CONCEALED BY THE CARDIAC SILHOUETTE ON CHEST ROENTGENOGRAM.

A large pulmonary arteriovenous fistula was discovered in a patient with long-standing cyanosis, clubbing and dyspnea, with no other cardiovascular signs or symptoms and a normal chest roentgenogram at the time of cardiac catheterization and pulmonary angiography. The fistula was overshadowed by the cardiac silhouette. Surgical resection was successful. Although rarely undetected on the chest roentgenogram, this potentially lethal malformation should be considered in the differential diagnosis of cyanosis unaccompanied by other cardiovascular signs or symptoms.

Journal Article↗

Lung volume, diffusing capacity, chest roentgenogram and dyspnea index in interstitial lung disease.

To investigate the physiologic impairment and the role played by pulmonary function tests in interstitial lung disease (ILD), we performed spirometry tests and tested the single-breath carbon monoxide diffusing capacity of 27 patients with diffuse interstitial pulmonary fibrosis (DIPF) and 35 patients with collagen vascular disease (CVD). All of the patients showed irregular linear opacities on their chest X-ray films. Corresponding chest roentgenograms for each patient were evaluated according to the International Labour Organization (ILO) classification. A modified Baseline Dyspnea Index (BDI), which incorporate a patient's physical activity into the recording, was used to quantitate dyspnea. Patients with DIPF demonstrated a comparable reduction in both lung volumes and diffusing capacity. In contrast, patients with CVD had a greater reduction in diffusing capacity than in forced vital capacity (FVC) and total lung capacity (TLC). There were no significant correlations between the type of linear opacities and the severity of the pulmonary function abnormalities, or between the opacities and the dyspnea in either disease group. The profusion of pulmonary infiltrates also did not affect the lung function except for diffusing capacity in patients with DIPF. However, there was a significant loss of FVC, TLC, forced expiratory volume in one second (FEV1) and diffusing capacity with increasing levels of dyspnea. We conclude that pulmonary function parameters may not be equally affected in DIPF and CVD. Approaches using the ILO classification for analysis of chest roentgenograms provide limited information regarding the functional status of patients. Pulmonary functions are significantly related to the extent of a patient's physical activity, if the severity of dyspnea is evaluated carefully using a quantifiable system.

Adult↗

[The selective spatial filtration of roentgenograms in the forensic medical expertise of stab-cutting wounds].

Investigation of 14 roentgenograms of skin preparations with cut-stab wounds, treated by spatial filtration method in medium and high spatial frequency modes was performed using material of 13 specific cases. This resulted in detection of disturbances of skin pattern left at the area of former skin cone in 7 cases while in 2 cases indistinct heel traces were seen. Changes in skin pattern were not recorded on roentgenograms of skin preparation of 12 experimental cut-stab wounds obtained on cadaveric skin.

Adult↗

[Simplified prediction of postoperative lung function by plain chest roentgenogram in patients with primary lung cancer--in correlation to postoperative respiratory complications].

For the purpose of simplification of prediction of postoperative lung function, we studied to predict lung function by analizing the frontal and lateral view of chest plain roentgenogram and investigate the correlation to respiratory complication on 111 patients with lung cancer. According to TNM classification of lung cancer, prediction was performed as follows. Predicted postoperative lung function = [(42-number of resected subsegments)/(42-number of occupied subsegments)] x preoperative VC or FEV1.0. In this formula, 42 was the number of functioning subsegments of whole lung (right: 22, left: 20), and then preoperative occupied subsegments was ordered by T factor, where T1 lesion in lung field was prescribed as 1 subsegment and T2 was more than 2 subsegments respectively in plain chest roentgenogram. And also, on the patients having hilar lesions, it was required to calculate the number of subsegments in atelectasis, peripheral obstructive pneumonia and/or partial emphysematous change due to intrabronchial lesions. There was uniformly positive correlations in VC (R = 0.7949) and FEV1.0 (R = 0.8235) of the patients studied respectively. The patients having pneumonectomy showed tendency of over estimation, on the other hand, the patients having resection of a few segments showed under estimation. To predict the postoperative respiratory condition, we calculated the predicted post-operative %VC and %FEV1.0 for predicted preoperative normal VC and FEV1.0. Above the al, we tried to investigate the correlation with predicted postoperative %VC, %FEV1.0 and postoperative respiratory complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Assessment of bone mass by image analysis of metacarpal bone roentgenograms: a quantitative digital image processing (DIP) method.

a digital processing (DIP) method for assessing bone mass was developed on the basis of image analysis of roentgenograms. Linearity between DIP values and the actual calcium carbonate content was scarcely affected even if roentgenograms were made with bone phantoms placed in different depths of water or by altering the voltage of X-ray generation. In clinical studies, coefficients of variation (CV) for various measurements were lower than 2.4%. When the correlations between the DIP values and the bone mineral densities in the distal one-third of the radius, and the 2nd to 4th lumbar vertebrae were investigated in 340 females, there were good positive correlations of r = 0.799, and r = 0.611, respectively (p less than 0.001). The DIP value was significantly lower in patients showing a low Singh index and in those with vertebral fractures than in other subjects. These results suggest that the DIP method provides an index with which to assess the efficacy of treatment and which can be used as a criterion in screening for osteoporosis.

Absorptiometry, Photon↗

The role of fiberoptic bronchoscopy in patients with hemoptysis and a normal chest roentgenogram.

We reviewed the charts of 478 patients who had fiberoptic bronchoscopy (FOB) performed for evaluating hemoptysis with a normal chest roentgenogram. FOB provided a definite diagnosis of endobronchial lesion in only 10 patients (2.1%): bronchogenic carcinoma in 2 patients, bronchial adenoma in 1 patient, tracheal cancer in 1 patient, foreign body in 3 patients and endobronchial tuberculosis in 3 patients. FOB neither visualized tumor mass nor localized the bleeding site in 300 (95.8%) of 313 patients with mild hemoptysis. However, the bleeding site could be localized by FOB in 56% of the patients (n = 165) if the bleeding amount exceeded 60 ml/day. In conclusion, in patients with hemoptysis and normal chest roentgenograms, routine FOB may not rule out airway malignancy. In contrast, it is a good diagnostic tool for localizing the bleeding site if patients present with moderate amount of hemoptysis.

Adolescent↗

Idiopathic bronchiolitis obliterans organizing pneumonia with peripheral infiltrates on chest roentgenogram.

We report five patients with chest roentgenograms showing peripheral infiltrates similar to that described for chronic eosinophilic pneumonia (CEP). While lung biopsy specimens (transbronchial and open in two and transbronchial only in three cases) revealed typical changes of bronchiolitis obliterans organizing pneumonia (BOOP) as the predominant finding in all cases, two cases had changes consistent with a resolving CEP. We speculate that (1) it may be common for BOOP to present with peripheral infiltrates, (2) chest roentgenograms showing peripheral infiltrates are not diagnostic of any specific entity, (3) idiopathic BOOP may represent the evolution of untreated CEP, (4) a lung biopsy may be a more appropriate initial approach than the therapeutic trial of corticosteroids when peripheral infiltrates of unknown origin are present, and (5) transbronchial biopsy may be adequate to establish a working clinical diagnosis of BOOP.

Adult↗

Assessment of bone grafts used for acetabular augmentation in total hip arthroplasty. A study using roentgenograms and bone scintigraphy.

Total hip arthroplasty was performed in 13 hips with acetabular bone grafts for secure component fixation. The incorporation and healing of acetabular bone grafts were investigated with the aid of roentgenograms, planar bone scans, and a newer scintigraphic technique, three-dimensional single photon emission computed tomography (SPECT). Conventional roentgenograms proved unreliable in evaluating bone graft reconstitution because of overlapping trabecular bone patterns of the graft and iliac wing. There was no evidence of graft failure or acetabular loosening. Bone grafts in the late follow-up group (four to seven years postoperation) exhibited normal radionuclide activity, whereas grafts less than one year postsurgery demonstrated patterns of increased activity. SPECT was helpful in producing an anatomic reconstruction of the acetabulum. The observation that bone grafts exhibited normal biological viability is crucial for ensuring secure acetabular component fixation on a long-term basis.

Acetabulum↗

[A case of a large thoracic epidural hourglass neurinoma, incidentally detected on routine chest roentgenogram--with respect to the surgical approach].

In case of the advanced extension into the thoracic cavity, it has been difficult to remove a large thoracic spinal hourglass tumor by conventional laminectomy, even adding costotransversectomy, due to high risk of injuring diverse important vessels and other organs by blind manipulation. A case of a large thoracic spinal hourglass neurinoma with advanced extension into the mediastinum is presented. A 49-year-old female was admitted for the further examination of the left mediastinal tumor, incidentally detected on routine chest roentgenogram, which was suspected as the part of spinal hourglass tumor. Her neurological examination was normal except hyperreflexia of bilateral lower extremities. Plain chest roentgenogram showed a left mediastinal mass behind the aortic arch and the descending aorta, which slightly enlarged in size, compared with its previous size in the chest film taken 3 years ago. Thoracic spine tomogram showed the destruction of the left pedicle of T4, the absorption of posterior aspect of the T4 vertebral body and the dilatation of the left intervertebral foramen between T4-T5. Myelogram showed the complete block of dye column at T4. Metrizamide CT scan revealed the large extradural hourglass tumor, which compressed the dural theca anterolaterally and extended through the dilated left T4-T5 intervertebral foramen into the left mediastinum and attached to the descending aorta. Two stage operation, the first for the removal of the left mediastinal tumor by transthoracic approach and the second for intraspinal canal tumor by posterior approach, was performed with success for this large thoracic spinal hourglass tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗

Successive abdominal roentgenograms: a new method of evaluating postoperative small bowel activity.

The technique of two successive abdominal roentgenograms at a five minute interval is proposed as a new method of evaluating small bowel activity in the presence of postoperative intestinal distention. One hundred and forty-four cases of postoperative small bowel distention were studied with this technique and correlated with the clinical evaluation of the bowel sounds and with the development of a variety of postoperative complications. Correlation with the bowel sounds was fairly good, except in the presence of a clinical description of hypoactive sounds. Reduced activity on the successive roentgenograms after the third postoperative day was frequently associated with postoperative complications, while persistent small bowel distention in the presence of significant roentgen activity usually indicated mechanical small bowel obstruction. This method for determination of small bowel activity thus appears to be useful in evaluating postoperative problems.

Humans↗