Radiology
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The author examined computed tomographic (CT) scans of the chest from 40 patients with cultures positive for atypical mycobacteria. Common manifestations included bronchiectasis, air-space disease, nodules, and scarring and/or volume loss. ⋯ The anatomic distribution of the above findings was diffuse, not strongly favoring any lung zone. The identification of multifocal coexistent bronchiectasis, air-space disease, and nodules at CT should raise the possibility of atypical mycobacterial lung disease, even in an otherwise healthy patient.
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The authors evaluated time-of-flight magnetic resonance (MR) angiography in 30 patients with suspected thoracic venous occlusion. The results of the MR studies were compared with results at contrast venography in 22 patients and at central venous cannulation in seven of the remaining eight patients. Twenty-eight patients had abnormalities on MR venograms; 21 of these abnormalities involved multiple veins. ⋯ Correlation was excellent between findings of venous obstruction and occlusion at contrast venography and MR angiography. MR imaging provided more comprehensive information than catheter venography on central venous anatomy and blood flow. For evaluation of central veins, MR angiography is an accurate and graphic technique that may succeed in cases in which other methods may give inadequate findings or may be impossible to perform.
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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.
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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.