The effect on toxicology, biochemistry and immunology investigations by the use of targeted post-mortem computed tomography angiography.

It is recognised in autopsy practice that investigations such as toxicology can be affected by post-mortem change. Post-mortem computed tomography angiography (PMCT-A) involves the injection of contrast agents. This could cause dilution of a biological fluid sample or cause the circulation of blood after death by mechanical pumping, and thus has the potential to affect laboratory investigations. We undertook a small sample study to consider whether targeted PMCT-A had any significant effect on subsequent samples taken for biochemical, toxicological or immunological investigations. Although the results of our study do illustrate differences between the pre and post PMCT-A results, these differences are considered not to be of diagnostic significance and not due to the direct effect of targeted PMCT-A.

A screening method for knee trauma.

RATIONALE AND OBJECTIVES: The authors performed this study to evaluate whether any one conventional radiographic view is sufficient as a screening method in the detection of acute knee trauma. MATERIALS AND METHODS: The authors prospectively assessed the efficacy of a single conventional radiograph of the knee in the detection of signs of knee fractures in 214 consecutive adults with acute knee trauma. The evaluated efficacy parameters included specificity, sensitivity, negative predictive value (NPV), and positive predictive value. The percentage reduction in the need for additional conventional radiographs was also calculated. RESULTS: Fifty-three of the 214 patients (24.8%) had a knee fracture. The sensitivity of the single lateral view in the detection of knee fractures was 100% (95% confidence interval [CI] = 94.3, 100). The lateral view of the traumatized knee was normal in 143 patients (66.8%). The probability of not having a fracture if the lateral view was normal (NPV) was also 100% (95% CI = 97.9, 100). The need for additional radiographs was reduced 67%. CONCLUSION: A single lateral view as a screening tool for knee fractures has a very high sensitivity and NPV. Because more than 65% of the patients had a normal lateral view in this study, there can be a considerable amount of savings in terms of radiology services for these patients.

Multicenter clinical trial of ultrasmall superparamagnetic iron oxide in the evaluation of mediastinal lymph nodes in patients with primary lung carcinoma.

The purpose of this study was to evaluate the clinical efficacy of ultrasmall superparamagnetic iron oxide particles as a magnetic resonance (MR) contrast agent in differentiating metastatic from benign lymph nodes. Eighteen patients with primary lung malignancy and suspected regional lymph node metastases underwent MR imaging before and after Combidex(R) infusion in a multi-institutional study. All MR sequences were interpreted by one or more board-certified radiologists experienced in imaging thoracic malignancy. Each patient was evaluated for the number and location of lymph nodes, homogeneity of nodal signal, and possible change of MR signal post contrast. All patients underwent resection or sampling of the MR-identified lymph node(s) 1-35 day(s) post contrast MR imaging. In all, 27 lymph nodes or nodal groups were available for histopathologic correlation. Combidex had a sensitivity of 92% and a specificity of 80% in identifying pathologically confirmed metastatic mediastinal lymph nodes. Based on our preliminary data, Combidex MR imaging may provide additional functional information useful in the staging of mediastinal lymph nodes.

The discoverer of x-rays: Wilhelm Conrad Roentgen.

"Immortal is his work. Immortal his name." This dedication to Wilhelm Roentgen, the discoverer of x-rays, is much deserved. As a meticulous scientist, Roentgen devised and repaired all the apparatus needed for his experiments, and he did most of the work himself.

Computed tomography is inaccurate in estimating the severity of adult splenic injury.

Computed tomography (CT) is increasingly utilized in evaluation of adult splenic injury (SI). CT correlation with operative findings, CT relationship to successful nonoperative (NO) management, and CT reading reproducibility were examined. Records of patients > or = 15 years old admitted over a 3-year period were reviewed. Computed tomography scans were graded by two radiologists blinded to clinical results. Computed tomography scans were performed on 49 of 77 patients with SI. Eighteen underwent initial operation (OR) and 31 initial NO. Operative patients had higher Injury Severity Scores and Abdominal Abbreviated Injury Scale scores (p < 0.0001). Grade II readings predominated in the NO group (55%). Nonoperative management was successful for 9 grade III and 3 grade IV readings. Computed tomography matched OR grade in 10 readings, underestimated it in 18, and overestimated it in 6. Computed tomography missed SI in five patients. Radiologists disagreed on 9 of 45 (20%) scans. Computed tomography poorly predicted operative findings. Interobserver variability was common. SI management should not be based solely on CT severity.

Radiology-pathology conference: Robert Wood Johnson Medical School. Eosinophilic granuloma of the lung.

Eosinophilic granuloma of the lung is a nodular infiltration of the interstitium of the lung by histiocytes, plasma cells, lymphocytes, and eosinophils. While radiologic findings of nodules and small cystic spaces of the upper lung zones are present, surgical biopsy is required for diagnosis.

Radiologic diagnosis of cystic fibrosis in adults and children.

RATIONALE AND OBJECTIVES: Most radiologists are familiar with the classic chest radiographic findings of cystic fibrosis (CF) when these occur in children. We hypothesized that given the same findings, a diagnosis of CF would be less likely to be considered in an adult than in a child. METHODS: We compiled 30 pediatric and 28 adult CF chest radiographs and obtained two independent readings on each by different general radiologists among the eight who volunteered to participate as they performed their daily clinical work. The cases were presented to the readers so that they did not know which radiographs were part of the study. The association between the correct diagnosis of CF and whether the patient was an adult or a child was assessed using odds ratios and logistic regression, so that Brasfield score, Schwachman-Kulczycki score, and the patient's sex could also be considered as predictive of correct diagnosis. RESULTS: In 67% of the pediatric cases, at least one of the radiologists considered CF as a possible diagnosis, whereas they considered CF a possibility in only 50% of the adults. Both radiologists suggested the correct diagnosis in 40% of pediatric cases and only 14% of adult cases (p < .05). CONCLUSION: Because the radiographic findings were similar in the two groups of patients according to severity groupings, we believe CF was less commonly considered in the adult patient because of the traditional belief that CF is a childhood disease.

Bronchiectasis in children with lymphocytic interstitial pneumonia and acquired immune deficiency syndrome. Plain film and CT observations.

In a review of 77 HIV positive children seen between 1981 and 1990, 32 were diagnosed as having lymphocytic interstitial pneumonitis). Four of the LIP group developed bronchiectasis, a finding not previously reported. The precise factors leading to the bronchiectasis are unclear. All patients had chronically consolidated lung with volume loss. A history of recurrent bacterial superinfection was not noted in any of the cases. With more cases of HIV positive children living longer, bronchiectasis, long known to occur in primary immunologic disorders, will probably be more frequently noted.

Radiologic distinction of pyogenic pulmonary infection from Pneumocystis carinii pneumonia in AIDS patients.

Thirty-four episodes of pyogenic pulmonary infection in 30 patients infected with human immunodeficiency virus (HIV) and 30 episodes of Pneumocystis carinii pneumonia (PCP) in 30 AIDS patients were reviewed to determine if the radiologic features were more helpful than clinical and laboratory findings in the differential diagnosis. The radiologic features of pyogenic pulmonary infection included lobar consolidation, nodules, infiltrates with pleural effusions, round infiltrates, and pleural effusions alone. These features are uncommon in PCP. The chest radiograph may be highly suggestive of a pyogenic process, especially when it shows local consolidation or nodules. Since bacterial pneumonias have a more favorable outcome, it is concluded that the radiologic features should be the primary guide to prompt diagnosis and treatment.

Bilateral adrenal myelolipomas with Cushing's syndrome.

A 24-year-old woman with non-pituitary dependent Cushing's syndrome was found to have bilateral adrenal myelolipomas at surgery. These benign tumors consist of bone marrow and fat and are uncommon incidental findings that are discovered by computed tomography. Myelolipomas have rarely been associated with Cushing's syndrome, but the cause of the syndrome has not always been defined, because the reports preceded modern diagnostic methods. Careful examination of the adrenal glands from our patient showed a fusion of myelolipoma elements and adrenal cells without distinct adenomas or the typical nodular pattern of adrenal hyperplasia. This report suggests that adrenal myelolipomas and atypical hyperplasia of the zona fasciculata may be anatomically and functionally related.

Acute focal bacterial nephritis.

Clinical and radiographic characteristics of 12 patients with acute focal bacterial nephritis (AFBN) are presented along with review of the literature. Most patients presented with symptoms of an inflammatory or infectious process. Fever and pyuria were the most frequently encountered clinical characteristics. Imaging modalities that were used to establish a definitive diagnosis of focal bacterial nephritis included ultrasound, computed tomography, and intravenous urography with nephrotomography. Ultrasound was found to be the most effective and least costly method of diagnosis. Misdiagnosis of AFBN as abscess or tumor, which it may stimulate, could lead to inappropriate surgical therapy.

Occlusion of a hepatic arterial aneurysm with gianturco coils in a patient with the Ehlers-Danlos syndrome.

Successful transcatheter occlusion of a proper hepatic arterial aneurysm in a patient with type IV Ehlers-Danlos syndrome is reported. This patient also had multiple, small intrahepatic arterial aneurysms, stenosis, and vascular occlusions. A spontaneous colonic perforation brought this patient to medical attention.

Sacral destruction: foraminal lines revisited.

Although imaging techniques have improved greatly in recent years, plain radiography remains the initial imaging method for evaluation of patients with low back pain. The sacrum, in particular, is a difficult structure to evaluate. In reviewing 12 cases, the authors found an unacceptably high rate of missed sacral metastases (83%). Using a photograph and a radiograph of two bony pelvic specimens to represent normal anatomy and the normal appearance of the sacral foraminal lines, sacral destruction is illustrated in six cases. All lesions were neoplastic and most were metastatic. In each case there was destruction of one or more sacral lines. The importance of careful observation for symmetric appearance of these lines is emphasized.

Integration of the Diagnostic Radiological Health Sciences Learning Laboratory films into a radiology elective for medical students.

The basic Diagnostic Radiological Health Sciences Learning Laboratory (ACR Teaching File) consists of 5000 films (1400 cases). This educational system was developed under contract with the Bureau of Radiological Health, Food and Drug Administration and made available by the American College of Radiology. We report our experience with our own course and the ACR Teaching File for medical student teaching. For 24 of 75 students, the ACR Teaching File provided the basic core film material during a fourth-year elective clerkship. We compared the ACR Teaching File films with our own film material when used in similar teaching circumstances. ACR Teaching File films, when combined with established teaching methods, proved to be satisfactory for medical student teaching.

Salmonella mediastinitis--a rare disease.

A case report is presented of a young man who was seen because of pleuritic chest pain and fever. CT cross sectional imaging defined a mediastinal mass. Diagnosis of acute mediastinitis due to Salmonella java was made from culturing material at mediastonotomy.

Hyperparathyroidism with asymptomatic hypercalcemia.

The many patients with mild, asymptomatic hypercalcemia identified by automated methods of clinical chemistry pose a challenge to the clinician. Which of them are likely to develop manifestations of primary hyperparathyroidism?