Journal of thoracic imaging
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The most important lung alterations associated with blunt trauma are contusion, laceration, and diffuse alveolar damage. The first two are the direct consequences of injury to the chest, while the third is the indirect result of thoracic or nonthoracic trauma. In addition to these three conditions, there are a number of epiphenomena and less common posttrauma abnormalities that are important to the radiologist involved in the care of injured patients.
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While most injuries to the chest can be diagnosed by a portable supine radiograph, computed tomography (CT) adds significant findings that will influence patient management. In addition to requested CT chest examinations, we routinely obtain a limited chest CT during the initial work-up of traumatized patients referred to our radiology department for other CT examinations. The major categories of new information provided by CT are: occult pneumothorax, malpositon of chest tubes, inadequately drained pleural collections, differentiating between posttraumatic abscess and empyema, noninvasive diagnosis of tracheal rupture, and cause of mediastinal widening.
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Transthoracic needle biopsy of lung was performed under fluoroscopic guidance in 16 patients with AIDS or suspected AIDS for diagnosing 18 episodes of possible P carinii infection. Diagnostic information was obtained in 15 of 18 cases. P carinii (10) and other infections agents (5) were diagnosed by TNB. ⋯ Our incidence of pneumothorax following TNB in patients with diseases other than AIDS is 17% with 4.8% requiring chest tube drainage. Although TNB under fluoroscopic guidance is a cost-effective, rapid procedure with a high diagnostic yield, it is frequently complicated by pneumothorax in AIDS patients with diffuse pulmonary disease. This procedure should therefore only be performed in AIDS patients when transbronchial biopsy has failed to provide the diagnosis and prior to considering such patients for open lung biopsy.
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ARDS is well recognized as a major medical emergency resulting in respiratory failure and refractory hypoxemia. The risk factors and attack rate of ARDS have been identified and principles of management established. ⋯ Certain roentgenographic features can be identified in both acute and late phases of ARDS. The prognosis of survivors is favorable in the long term.
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Ten patients with full-blown ARDS, on mechanical ventilation with PEEP underwent lung CT. Seven normal subjects were also studied. ⋯ Assuming that the three levels were a representative sample of the whole lung, the lung weight was computed from the mean CT number and lung gas volume. Analysis of the CT number frequency distribution revealed three definite patterns of distribution: type 1, bimodal, with one mode in the normal CT number range; type 2, unimodal narrow distribution, with the mode in the CT range of water; and type 3, unimodal broad distribution in the abnormal CT number range.