Journal of thoracic imaging
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The aim of this essay was to demonstrate the thoracic venous anatomy as delineated by malpositioned central venous catheters on plain chest radiographs. We therefore used the didactic advantage of clinically inadvertent catheter positions. This approach was chosen to illustrate venous anatomy with plain chest radiographs, and, thereby, to recognize malpositions promptly on the modality with which positions of central venous catheters is routinely performed.
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Comparative Study
Transthoracic needle aspiration biopsy: value in the diagnosis of mycobacterial lung opacities.
The purpose of this study was to assess the value of transthoracic fine-needle aspiration in the diagnosis of mycobacterial infection as the cause of focal lung opacities. Six hundred twelve fine-needle aspiration biopsies were performed from 1985 to 1997 in 587 patients with solitary or multiple lung opacities. Initial procedures, including sputum analysis and bronchoscopy, had been nondiagnostic. ⋯ Fine-needle aspiration biopsy detected acid-fast bacilli in 15 of 24 cases (sensitivity, 62.5%; specificity, 100%). Radiologic findings included upper lobe involvement (17 of 24 cases), single opacities (12 of 24 cases), satellite nodules (4 of 12 cases with single opacities), irregular borders (19 of 24), eccentric calcification (2 of 24), and cavitation (8 of 24). The authors conclude that fine-needle aspiration biopsy must be processed for acid-fast bacilli when nonmalignant cytologic findings result, even if the results of sputum smears, cultures, and bronchoscopy are negative.
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The authors describe a patient with spontaneous pneumopericardium complicating staphylococcal pneumonia and empyema that resulted in cardiac tamponade. Spontaneous pneumopericardium is an unusual disorder. The causes and clinical findings of pneumopericardium are reviewed, as are the radiographic features that differentiate this condition from pneumomediastinum. Early recognition of pneumopericardium is important, because emergent pericardiocentesis may be required if there is clinical evidence of tamponade.
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On computed tomography (CT) scanning, a ground-glass opacity zone surrounding a pulmonary nodule has been named the computed tomography (CT) halo sign. To investigate the frequency and diagnostic value of the CT halo sign, the authors reviewed the CT examinations of 305 patients with proven diseases producing solitary or multiple nodules. The CT halo sign was seen in 22 patients (7%). ⋯ The data showed that the CT halo sign is a nonspecific finding. It is known that in immunocompromised patients the CT halo sign should suggest invasive pulmonary aspergillosis, Kaposi sarcoma, and lymphoproliferative pulmonary disorders. However, in immunocompetent patients, the authors found that a solitary nodule with the CT halo sign and pseudocavitations has a high likelihood of being a bronchioloalveolar carcinoma.
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The authors develop a method to accurately and easily estimate the volume of pleural effusions with computed tomography (CT). In 15 patients with either simple or loculated pleural effusions (14 right-sided and 11 left-sided), routine helical CT examinations of the thorax were obtained. Two experienced radiologists visually estimated the volume of the effusions. ⋯ Although pleural effusion volumes can be estimated by visual inspection with good correlation, some overestimation is consistently seen. Use of the formula d2 x l readily enables estimation of pleural effusion volume from CT, from two simple measurements. This formula-based method of volume estimation provides an accurate and easily measured means of estimation that is readily obtained from routine CT of the chest.