Journal of the Canadian Association of Radiologists
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Case Reports
The importance of proximal and distal air bronchograms in the management of atelectasis.
Correlation of chest radiographic appearances with concurrent fibreoptic bronchoscopy in patients observed while in intensive care, and with lobar or multilobar atelectasis due to retained secretions, suggests that three levels of air bronchogram can be identified: Proximal: air is visible only to the level of the main bronchus, bronchus intermedius or lobar bronchi. Intermediate: air is visible down to the segmental bronchi. ⋯ Proximal or intermediate air bronchograms signify accumulation of secretions in central bronchi and indicate the need for fibreoptic bronchoscopy to aspirate secretions: a distal air bronchogram signifies peripheral bronchial obstruction thus precluding effective fibreoptic bronchoscopy; chest physiotherapy is then a more appropriate treatment. The proximal air bronchogram may change in extent or definition-sometimes rapidly; a receding or an increasingly poorly defined proximal air bronchogram are danger signals of centrally accumulating secretions which may lead to respiratory arrest.
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Anomalies of the inferior vena cava, azygous venous system and renal veins may take many forms. We report a patient with azygous continuation of a left-sided inferior vena cava with an associated retroaortic right renal vein. To our knowledge, this is the first such report.
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Comparative Study
Comparison of digital and radionuclide left ventriculography in patients at risk from conventional left ventriculography.
In this study, two alternative methods of assessing left ventricular (LV) sequential wall motion and ejection fraction (EF) were used in 28 consecutive patients in whom an unstable clinical condition (unstable angina pectoris or severe LV dysfunction) precluded the use of high volume contrast cineventriculography. A new approach, direct small volume contrast digital ventriculography, was compared to radionuclide blood pool ventriculography considered as a "standard" and reliable technique. The qualitative analysis of regional LV contraction by three independent observers showed a complete agreement in 64% of segments studied in the left anterior oblique (LAO) projection and in 69% in the right anterior oblique (RAO) projection; a one-degree disagreement was observed in 13% and 19% respectively, and a discrepancy of two degrees or more in 23% and 12% respectively. ⋯ The radionuclide examination still remains the fastest, easiest and most objective way to appraise global LV function in high risk patients. However, optimal analysis of segmental wall motion requires invasive digital contrast left ventriculography. In future, a more general use of non-ionic contrast media including their intravenous injection and the advent of portable digital devices should permit their widespread use as a safe, rapid and reliable procedure even in the intensive care unit.
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Necrotizing sarcoid-like granulomatosis is one of five forms of pulmonary disease characterized histologically by angiitis and granulomata formation. Although there have been several reports of the clinical and pathological characteristics of the disease, there has been little reported radiographic correlation. ⋯ The radiographic finding of diffuse lesions, either bilateral nodules or nodular densities with or without cavitation, should prompt definitive diagnostic evaluation. Tissue diagnosis is imperative as necrotizing sarcoid-like granulomatosis has a relatively good prognosis when compared with other similar granulomatous diseases.
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Our experience, in a group of 25 patients with chronic low back pain, shows that nuclear imaging of the spine with 99mTc-methylene diphosphonate is of no benefit in predicting the sites at which intraarticular facet blocks may be successful.