Clinical radiology
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Roentgenographic and clinical findings in a spectrum of malformations of the trachea and oesophagus are discussed. Five previously unreported patients representing four rare anomalies of tracheal agenesis, laryngotracheo-oesophageal cleft, oesophageal atresia with a tracheo-oesophageal (T-E) fistula to the proximal oesophageal pouch, and T-E fistula without oesophageal atresia (H-type fistula) are presented. ⋯ All of the patients were diagnosed roentgenographically. Since the incidence of associated abnormalities is high in babies with these anomalies, a generalised embryological defect must be a basic assumption in any theory to explain the development of T-E anomalies.
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Three hundred and seventeen cases which included 100 normal individuals have been studied for roentgen significance of the thoracic paraspinal line (TPL). The descending thoracic aorta greatly determines the course and configuration of the TPL. In a right-sided aorta, the TPL is seen on the right side as a mirror image of a left-sided TPL. ⋯ Perioesophageal spread of carcinoma of the oesophagus into the posterior mediastinum is indicated by changes in pleuro-oesophageal interface and TPL. Mediastinal lymphadenopathy in cases of testicular tumours may be detected by discovery of TPL deviation on frontal radiographs of the thoracic spine. In extradural masses such as granulomas, abscesses and metastatic deposits, the TPL shows a localised bulge corresponding to the clinical and myelographic level of spinal compression.
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The rationale for a simplified approach to the reporting of intensive therapy unit chest radiographs is presented. Pulmonary shadowing should be reported simply as pulmonary shadowing; histological predictions are unreliable and potentially misleading. One should concentrate on the detection of pneumothorax and the differentiation between pulmonary shadowing, pleural effusion and pulmonary collapse.
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In a study of 42 patients with ankylosing spondylitis, upper lobe fibrosis was present in six (14-3%) patients. All the patients with upper lobe fibrosis had total spinal ankylosis, and half showed peripheral joint involvement. ⋯ There was no correlation between the radiological extent of the disease (spinal changes and pulmonary involvement) and any of the haematological or biochemical parameters measured. Treatment with radiotherapy was not responsible for these changes.
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In the absence of abdominal operative procedures, symptomless spontaneous pneumoperitoneum is uncommon. The case is described of a patient with jejunal diverticulosis who developed spontaneous pneumoperitoneum on three occasions and brief details are given of six other cases of jejunal diverticulosis with pneumoperitoneum from the literature. Other causes of symptomless pneumoperitoneum include pneumatosis intestinalis, perforation in tabes dorsalis or coma, stercoral ulceration, physiological pneumoperitoneum in women due to exercise in the knee-elbow position, and vaginal douches with a bulb syringe or effervescent fluid.