AJR. American journal of roentgenology
-
AJR Am J Roentgenol · Dec 1989
Tears of the trachea and main bronchi caused by blunt trauma: radiologic findings.
Although most of the radiologic changes that have been described in transection or laceration of the trachea or main bronchi are nonspecific, they can be of diagnostic importance in the appropriate clinical setting. In order to reassess the significance of these findings, and to determine the presence of any other changes that might lead to a definitive diagnosis, we retrospectively reviewed the chest radiographs of nine patients who had tears or transection of the trachea and/or main bronchi as a result of blunt chest trauma. The diagnosis was proved by bronchoscopy in all patients and reconfirmed at surgery in five. ⋯ Upper thoracic fractures that involved the clavicles, scapula, sternum, and ribs were present in four patients. Abnormalities in the appearance of an endotracheal tube in two patients (overdistention of the cuff or extraluminal position of the tip), and the presence of the fallen lung sign (collapse of the lung toward the lateral chest wall) in two others provided specific evidence of tracheobronchial injury. We conclude that, although the major importance of the chest radiograph in patients with tracheobronchial transection may be to verify the existence of air leak, the presence of the fallen lung sign and endotracheal tube abnormalities is a reliable indication of airway injury.
-
AJR Am J Roentgenol · Nov 1989
Treatment of loculated pleural effusions with transcatheter intracavitary urokinase.
Surgical thoracostomy tube placement and radiologically guided catheter drainage are standard therapy for loculated pleural fluid collections. Treatment may fail if the catheter is not placed optimally within the loculation or if the fluid is hemorrhagic or fibrinous. We studied the value of transcatheter urokinase instillation in facilitating drainage of hemorrhagic or fibrinous nonhemorrhagic loculated pleural collections in 11 patients with 13 loculated pleural collections. ⋯ In one case, therapy was discontinued after partial resolution for unrelated clinical reasons. There were no complications. These results suggest that transcatheter intracavitary urokinase therapy is a safe and effective method to facilitate drainage of loculated hemorrhagic or fibrinous nonhemorrhagic pleural fluid collections.
-
AJR Am J Roentgenol · Nov 1989
Calcific tendinitis of the long head of the biceps brachii distal to the glenohumeral joint: plain film radiographic findings.
Calcific tendinitis is a painful condition related to deposition of hydroxyapatite crystals; it favors large joints. The shoulder, specifically the tendons of the rotator cuff and the insertion of the long head of the biceps on the superior glenoid rim, is a well-recognized location for this abnormality. The purpose of this article is to describe a second site of calcific tendinitis of the biceps, distal to the joint and corresponding to the junction of the tendon and muscle. ⋯ A site of calcific tendinitis distal to the glenohumeral joint that is detectable on plain films is reviewed. Accurate diagnosis depends on understanding the anatomy of the tendon of the long head of the biceps brachii. The clinical charts of the 11 patients also are summarized, with emphasis on the association between the roentgen finding and bicipital tendinitis and impingement syndrome.
-
AJR Am J Roentgenol · Oct 1989
Clinical Trial Controlled Clinical TrialGastric fluid detected by sonography in fasting patients: relation to duodenal ulcer disease and gastric-outlet obstruction.
We correlated the amount of gastric fluid identified by sonography in 143 fasting patients with the presence of duodenal ulcer disease and gastric-outlet obstruction as seen on barium studies. Unselected consecutive patients who were referred for a barium study of the upper gastrointestinal tract were included in a double-blinded prospective study. Sonograms were obtained in the right lateral decubitus position to allow gastric fluid to accumulate in the antrum, where it was quantified by measuring the maximal cross-sectional area of antral fluid in square centimeters. ⋯ Barium examinations showed a duodenal ulcer in 26 (46%) of the 56 patients with sonographic evidence of a large amount of gastric fluid compared with 10 patients (11%) in the group with little or no fluid on sonography (p = .001). Sonographic evidence of a large amount of fluid was found in all five patients who had gastric-outlet obstruction on barium examination (p = .02). The detection of a large amount of fluid in the stomach on sonography appears to be a feature of duodenal ulcer disease and gastric-outlet obstruction.