Radiology
-
A review of complications occurring in conjunction with general anesthesia identified eight patients with laryngospasm-induced negative-pressure pulmonary edema after endotracheal intubation. Six male and two female patients (mean age, 31.9 years) developed pulmonary edema immediately or up to 25 minutes after extubation. Radiographs obtained 15-165 minutes after symptoms developed revealed alveolar edema and predominating interstitial edema in four patients each. ⋯ The mean cardiothoracic ratio was 0.54 +/- .07 (normal mean, 0.53). There were no radiologic abnormalities of the trachea. Negative-pressure pulmonary edema should be suspected in young patients with findings of bilateral centralized pulmonary edema, a wide vascular pedicle, and a normal cardiothoracic ratio in the immediate postoperative period.
-
The authors evaluate the reliability of combined indium-111-labeled white blood cell (WBC) and technetium-99m methylene diphosphonate (MDP) bone scan interpretations at sites of suspected periarticular osteomyelitis with radiographic evidence of adjacent traumatic arthropathy. A review of all orthopedic patients who underwent In-111 WBC-Tc-99m MDP scintigraphy over a 7-year period revealed a subset of 32 such cases that also included results of bone-biopsy cultures. Twenty-eight patients had a history of traumatic intraarticular injury, and four had periarticular fracture malunion or nonunion. ⋯ A high prevalence of false-positive In-111 WBC-Tc-99m MDP scans may occur at periarticular sites of patients with associated traumatic arthropathy. This reduces the specificity of this technique for osteomyelitis, making culture confirmation of positive scans necessary. A negative scan is highly predictive of negative culture results at these sites.