Radiologic diagnosis of pathologic pulmonary changes in ischemic heart disease]

Combined chest x-ray investigation was performed in 187 CHD patients. Different pulmonary changes were noted in postinfarction and atherosclerotic cardiosclerosis as a result of congested effects in lesser circulation: they depended upon a stage of disturbed circulation (the more circulatory decompensation was noticeable, the more marked were changes in lesser circulation). Pulmonary and cardiac changes in patients with postinfarction cardiosclerosis were more frequent and marked.     

Effects of Irradiation on Lung Function

With refinements in radiotherapeutic techniques in recent years, the incidence of pulmonary damage attributable to irradiation has decreased. A significant number of patients, however, still show radiographic evidence of irradiation pneumonitis, with or without associated symptoms. Although these appearances are usually transitory, in some patients they may persist and be associated with varying degrees of pulmonary insufficiency.This report presents an evaluation of the radiographic changes, symptoms, and pulmonary function following irradiation of the chest wall (as for cancer of the breast) in one group of patients, and following deep irradiation of the chest (as for cancer of the lung) in a second group. Forty patients were studied, of whom 32 are available for assessment (20 with carcinoma of the breast and 12 with bronchogenic carcinoma). These patients were studied preoperatively, and from three to 15 months following irradiation. The findings with respect to radiographic appearance, pulmonary function, and symptoms of these patients are presented.     

Diagnosis of supravalvular stenosis of the aorta

The authors analyzed the potentialities of combined radiodiagnosis of supravalvular stenosis (SS) and concomitant diseases of the heart and major vessels (Williams-Beuren syndrome) in 7 patients aged 7 mos. to 24 yrs. Polypositional chest and heart x-ray procedure, catheterization of the cardiac cavities, pulmonary artery and aorta, left ventriculography (6), right ventriculography (4) and angiopulmonography were used. The diagnostic potentialities of each method were defined. It was proved that SS practically in all patients was accompanied by major vascular changes in the pulmonary, vertebral, coronary, carotid, subclavicular, renal and other arteries, heart failure (atrial septal defect, and mitral incompetence).     

Computed tomographic picture of the mediastinal lymph nodes in health

The results of CT investigations of the chest of 100 patients without changes in the mediastinal and pulmonary organs were used to describe a picture of different groups of unchanged mediastinal lymph nodes, to compare visualization of normal lymph nodes in x-ray and CT studies, to provide data on the frequency of their visualization and sizes.     

Chest X-ray Film in Acute Myocardial Infarction

A total of 185 chest x-ray films taken on 50 consecutive admissions to a coronary care unit were assessed independently for specific abnormalities by three observers. The commonest abnormality was upper lobe pulmonary venous congestion. When this was present by itself it did not appear to affect prognosis. Pulmonary oedema occurred in 12 of the patients, was associated with more pronounced pulmonary venous congestion (but not necessarily with cardiac enlargement), and usually cleared within five days. Generalized cardiac enlargement and septal lines were rarely seen. Clinically silent non-segmental shadows were found in six patients.No consistent change in radiological abnormality was found in the first three days after infarction, but thereafter a gradual improvement occurred, so that before discharge the x-ray picture was nearly normal. There was good correlation between the presence and extent of lung crepitations and the presence of pulmonary oedema on the chest x-ray film.It is suggested that the chest x-ray film is a useful additional index of the severity of heart failure in myocardial infarction.     

X-ray characteristics of acute intestinal obstruction in middle-aged and elderly patients

The authors presented clinical and x-ray findings of 188 patients with mechanical intestinal obstruction (92 of them were middle-aged and advanced in years and 96 were under 60). A combined program of x-ray examination included 3 stages: panoramic polypositional roentgenography of the chest and abdominal cavity, dynamic x-ray control over the state of the abdominal cavity, and contrast study of the G.I. tract. A distinctive feature of the x-ray symptomatology of intestinal obstruction in middle-aged and old patients was the absence of classical x-ray symptoms in some cases during panoramic roentgenography of the abdominal cavity. In patients over 60, x-ray symptomatology was characterized by marked colon distension and intestinal distension of various degree in 77.1%     

Pulmonary segmental resection for solitary lesions of doubtful character

Pulmonary cancer can be diagnosed earlier if patients with pulmonary symptoms of chronic type are given x-ray examination early, if patients over 40 years of age have a yearly roentgen examination of the chest regardless of their state of health, and if those with acute pulmonary illness are examined by x-ray within one month of the onset of illness. Observation of a known intrapulmonary lesion of unknown character should never last for more than one month. If it persists after that period, complete investigation, including thoracotomy, should be carried out if necessary to establish an exact diagnosis. A localized intrapulmonary lesion can be removed by segmental resection so that all healthy functioning lung is conserved if the disease is benign. If, after pathological examination, the lesion is shown to be cancerous, more radical resection can be carried out.     

Pleuropulmonary manifestations of hepatic amebiasis.

Pleuropulmonary manifestations of hepatic amebiasis occurred in 30 patients; 18 (60%) presented with at least 1 pulmonary complaint and 10 (33%) had multiple pulmonary symptoms. In 14 patients (47%), abnormalities were found on examination of the chest. In 16 chest roentgenograms (53%), there was at least 1 abnormality: right-sided pleural effusion (9 patients) and elevated right hemidiaphragm (8 patients) were the most common. All patients were treated with metronidazole (Flagyl) and had resolution of the amebic liver abscess and pulmonary disease. Pleuropulmonary disease is a common complication of amebic liver abscess. The clinical presentation and chest roentgenograms are virtually diagnostic and obviate the need for invasive procedures to confirm the diagnosis. Pleuropulmonary disease resolves with amebicidal treatment of the hepatic abscess.     

Effect of Diagnostic and Treatment Delay on the Risk of Tuberculosis Transmission in Shenzhen,China: An Observational Cohort Study, 1993–2010

Introduction

To understand better the risk of tuberculosis transmission with increasing delay in tuberculosis treatment, we undertook a retrospective cohort study in Shenzhen, China.

Methods

All pulmonary tuberculosis cases in the Shenzhen tuberculosis surveillance database from 1993–2010 were included. Sputum smear positivity and presence of pulmonary cavity were used as proxies for risk of tuberculosis transmission.

Results

Among 48,441pulmonary tuberculosis cases, 70% presented with symptoms of pulmonary TB, 62% were sputum smear positive, and 21% had a pulmonary cavity on chest x-ray. 95.3% of patients self-presented for evaluation of illness after a median 58 days of delay after symptoms began. The proportion presenting sputum smear positive (p<0.001) and with a pulmonary cavity (p<0.001) increased significantly with increasing duration of delay.

Conclusions

Delayed diagnosis and treatment of tuberculosis is associated with a significantly increased risk of pulmonary sputum smear positivity and pulmonary cavity. To decrease risk of transmission, treatment delay needs to be reduced further.     

PULMONARY SEGMENTAL RESECTION OF SOLITARY LESIONS OF DOUBTFUL CHARACTER

Pulmonary cancer can be diagnosed earlier if patients with pulmonary symptoms of chronic type are given x-ray examination early, if patients over 40 years of age have a yearly roentgen examination of the chest regardless of their state of health, and if those with acute pulmonary illness are examined by x-ray within one month of the onset of illness.Observation of a known intrapulmonary lesion of unknown character should never last for more than one month. If it persists after that period, complete investigation, including thoracotomy, should be carried out if necessary to establish an exact diagnosis. A localized intrapulmonary lesion can be removed by segmental resection so that all healthy functioning lung is conserved if the disease is benign. If, after pathological examination, the lesion is shown to be cancerous, more radical resection can be carried out.     

x线断层容积成像技术在肺动脉畸形中的应用

目的：通过与常规x线胸片比较,探讨胸部x线断层容积成像技术在肺动脉畸形中的应用价值。方法：对20例临床及x线平片怀疑肺动脉畸形者,进一步进行胸部x线断层容积成像检查。其中11例被明确诊断为肺动脉畸形。以CT或超声心动结果为标准,对比两种图像对肺动脉畸形的明确诊断率,分析对比该11例患者的胸部x线断层容积成像图片和普通x线胸片,评价两种方法所获得的图像质量和图片优秀率。结果：20例疑似患者中,11例被CT或超声心动确诊为肺动脉畸形,其x线断层容积成像图片和普通x线胸片经主管技师和副主任医师双盲判读,x线断层容积成像11例均获明确诊断（100％）,普通x线胸片明确诊断2例（18％）,诊断准确率有明显差异（P=0．O001）。容积断层成像优质图像为10例,占总数的90．91％;良好1例,差为0例。11例x片中优秀7例,占总数的63．63％,其中良好3例,差1例。两种图像优秀率比较差异有统计学意义（P=0．0001）。结论：x线断层容积成像技术对肺动脉畸形的图像优秀率和诊断准确率均高于x线平片,对病变的显示更加清晰、立体,提高诊断准确率和客观性,具有重要的临床诊断价值。     

Surveillance of Elderly Hospital Patients for Pulmonary Tuberculosis

A restrospective study of pulmonary tuberculosis in a general hospital showed that the diagnosis had been frequently overlooked in the middleaged or elderly because the patient also suffered from a more acute condition which preoccupied the attention of the doctor. The commonest error was to discount chest x-ray abnormalities by omitting sputum culture or serial radiography.Surveillance was carried out on all patients aged 60 or over admitted to a large general hospital whose routine chest radiograph showed signs of possible pulmonary tuberculosis whether apparently active or inactive. Three sputum samples from each patient were examined for Mycobacterium tuberculosis without reference to the clinical presentation. In a nine-month period six out of 81 patients proved to have active pulmonary tuberculosis (7·4%). It is suggested that this may be a useful method of screening the elderly hospital population for pulmonary tuberculosis.     

Hemoptysis: Diagnosis and Management

Hemoptysis is one of the most important symptoms of cardiopulmonary disease—first, because bleeding even in small amounts may indicate the presence of such serious diseases as bronchogenic carcinoma or active tuberculosis, and second, because untreated massive hemorrhage is associated with a high mortality rate. The cause of hemoptysis may be suggested by the history, physical examination or chest x-ray findings, but often diagnostic procedures such as bronchoscopy, bronchography and pulmonary angiography are needed for definitive diagnosis. The importance of early localization of the bleeding site and surgical intervention in patients with massive hemoptysis is stressed.     

Pulmonary Impairment in Tuberculosis Survivors: The Korean National Health and Nutrition Examination Survey 2008-2012

Objectives

Pulmonary tuberculosis (TB) can affect lung function, but studies regarding long-term follow-up in patients with no sequelae on chest X-ray (CXR) have not been performed. We evaluated lung functional impairment and persistent respiratory symptoms in those with prior pulmonary TB and those with prior pulmonary TB with no residual sequelae on CXR, and determined risk factors for airflow obstruction.

Methods

We used data from adults aged ≥ 40 years from the annual Korean National Health and Nutrition Examination Surveys conducted between 2008 and 2012. P values for comparisons were adjusted for age, sex, and smoking status.

Results

In total of 14,967 adults, 822 subjects (5.5%) had diagnosed and treated pulmonary TB (mean 29.0 years ago). The FVC% (84.9 vs. 92.6), FEV₁% (83.4 vs. 92.4), and FEV₁/FVC% (73.4 vs. 77.9) were significantly decreased in subjects with prior pulmonary TB compared to those without (p < 0.001, each). In 12,885 subjects with no sequalae on CXR, those with prior pulmonary TB (296, 2.3%) had significantly lower FEV₁% (90.9 vs. 93.4, p = 0.001) and FEV₁/FVC% (76.6 vs. 78.4, p < 0.001) than those without. Subjects with prior pulmonary TB as well as subjects with no sequalae on CXR were more likely to experience cough and physical activity limitations due to pulmonary symptoms than those without prior pulmonary TB (p < 0.001, each). In total subjects, prior pulmonary TB (OR, 2.314; 95% CI, 1.922–2.785), along with age, male, asthma, and smoking mount was risk factor for airflow obstruction. In subjects with prior pulmonary tuberculosis, inactive TB lesion on chest x-ray (OR, 2.300; 95% CI, 1.606–3.294) were risk factors of airflow obstruction.

Conclusion

In addition to subjects with inactive TB lesion on CXR, subjects with no sequelae on CXR can show impaired pulmonary function and respiratory symptoms. Prior TB is a risk factor for airflow obstruction and that the risk is more important when they have inactive lesions on chest X-ray. Hence, the patients with treated TB should need to have regular follow-up of lung function and stop smoking for early detection and prevention of the chronic airway disease.     

Chronic cough and gastroesophageal reflux.

We reviewed the charts of 20 patients with chronic cough of unknown cause who had been referred to a tertiary care respiratory centre from 1980 to 1984 to determine whether gastroesophageal reflux (GER) was a contributing factor. Fifteen of the patients complained of symptoms suggestive of GER: radiologic investigation of the upper gastrointestinal tract revealed hiatus hernia and GER in four, hiatus hernia alone in three, GER alone in two, decreased esophageal peristalsis in one and normal findings in four. Fibreoptic bronchoscopy in the four former smokers and one nonsmoker showed diffuse mucosal erythema. A chest x-ray film in one patient showed an infiltrate at the base of the right lung; transbronchial biopsy revealed vegetable material, which confirmed pulmonary aspiration. A 3-month course of medical antireflux treatment (dietary and lifestyle changes, elevation of the head of the bed and administration of cimetidine, antacid and metoclopramide) relieved the chronic cough in 14 of the 20 patients. Of the remaining patients one was lost to follow-up and five had GER confirmed by means of esophagoscopy, esophageal motility testing and long-term intraesophageal pH monitoring; four of the five patients underwent fundoplication and were asymptomatic 3 months after surgery. Antireflux therapy should be considered in patients with chronic cough when other causes have been ruled out, even if there are no GER symptoms. If the treatment fails, full investigation for GER is recommended; if GER is confirmed, surgery should be considered.     

Computed tomography in the x-ray diagnosis of pneumonia

Experience in the use of CT in combined radiodiagnosis of pneumonia was analysed. It has been concluded that CT objectively reflects morphological inflammatory pulmonary changes and permits their all-round assessment over time. The diagnosis of pneumonia in CT is based on classical x-ray symptoms. As compared to survey radiography CT reveals symptoms of pneumonia to the full at earlier stages. CT is an important additional method of investigation of inflammatory pulmonary diseases, but it should not be used separately without survey radiography. In a majority of cases when CT is performed there is no need in x-ray tomography.     

Lung scintigraphy with [123I]IMP in patients with pulmonary tuberculosis

Lung scintigraphy using N-isopropyl-p-[¹²³I]iodoamphetamine (IMP) was performed on 26 patients with pulmonary tuberculosis. Early (5 min after injection) and late images (4 h after injection) were obtained with a large-field γ-camera equipped with a digital computer. Lung scintigraphy using [^99mTc]MAA (MAA) was also done. Although early IMP images showed the same findings as [^99mTc]MAA images, a discrepancy between delayed IMP images and [^99mTc]MAA images was seen in some patients. Increment of activities seen in late images was demonstrated in most patients whose chest x-ray findings included exudative inflammatory changes. Uptake and clearance of IMP was considered to be affected by the active phase of pulmonary tuberculosis.     

Radiodiagnosis of echinococcosis of the lungs]

The paper is devoted to analysis of radio-diagnostic findings of 79 patients with parietal round pulmonary formations. All the patients were investigated by x-ray and ultrasound, perfusion scintigraphy of the lungs with a postural test was performed in 43 of them. Diagnostic x-ray and echographic methods were compared and evaluated in terms of defining the origin of pulmonary formations. The origin of pulmonary formations was established by x-ray in 50 of 79 patients (63.3 per cent) whereas ultrasound findings proved correct in 74 of 79 patients (93.6 per cent). Perfusion scintigraphy can be recommended to patients with pulmonary echinococcosis only for limited indications when a necessity arises to assess the lesser circulatory state in terms of patients' functional operability.     

Antibiotic anaphylaxis

Pulmonary cancer when localized to the lung, is curable by operation. Tumors found by routine x-ray examination before they cause symptoms are much more often confined to the lung and as such are curable. Unlike other internal growths which are more hidden, lung tumors can often be seen early on x-ray films of the chest.X-ray films of the chest were made routinely on all patients entering a hospital, regardless of the nature of their illness. In all, some 40,000 films were made. Sixty patients were found to have unsuspected solitary lesions in the lung. Twenty-four of the lesions were diagnosed and treated by operation and removal. Twelve were diagnosed by other methods. Of the 36, eight were cancer of the lung, an incidence of 22 per cent. There were also 14 localized tuberculous nodules which are best treated by removal. Since early cancer is surgically curable, it is felt that everyone over the age of 40 should have a routine x-ray examination of the chest every six months. Solitary lesions of the lung found should be excised for diagnosis.     

Cosmetic treatment of shagreen patches in selected patients with tuberous sclerosis

Patients with mild forms of tuberous sclerosis may request cosmetic treatment of skin hamartomas. Treatment may consist of planning of an elevated shagreen patch with a Reese dermatome and/or laser treatment of facial angiofibromas. These precise patients, i.e., patients with a forme fruste of tuberous sclerosis, are more likely to have pulmonary involvement than patients with the usual complete disease form. A chest x-ray should be obtained in these patients to rule out pulmonary involvement. Half the patients with pulmonary involvement of tuberous sclerosis die an avoidable death from spontaneous pneumothoraces. Positive-pressure ventilation during anesthesia in these patients should be avoided or monitored closely.