Chest roentgenographic evaluation of the severity of aortic stenosis.

The chest radiographs of 44 adult patients with proven valvular aortic stenosis (AS) were analyzed for the evaluation of severity of the disease. Five parameters were correlated with the aortic valve area (AVA) as the determinant of AS severity: the area of aortic valve calcification (AVCa), the cardio--thoracic (C--T) ratio, the Hoffman-Rigler (H-R) sign, left atrial enlargement (LAE), and the transverse diameter of the thoracic aorta (TDAo). There was a significant correlation between AVCa and severe AS only in women over 40 years of age. The increased C--T ratio and evidence of LAE was predictive of severe AS in men over 40 years of age. The positive H-R sign and an increased TDAo were not useful in assessing the severity of AS. Accordingly, the radiographic analysis of signs is a simple, useful, and noninvasive technique for diagnosing AS and for assessing its severity in patients over 40 years of age.

Pitfall in the CT diagnosis of abdominal abscess--the full stomach.

A case is presented to illustrate that the CT appearance of the unenhanced full stomach may be misinterpreted as an abdominal abscess in the appropriate clinical setting. The need for administering oral contrast material prior to the study is emphasized.

CT of the esophagus: I. Normal appearance.

The thoracic esophagus is easily demonstrable throughout its entire length on thoracic computed tomography (CT). The soft tissue planes separating the esophagus from its adjacent mediastinal structures are normally distinct. Blurring or distortion of these tissue interfaces is a reliable indicator of disease. The normal CT anatomy of the esophagus and mediastinal relationships are described. Air in the esophagus is considered a normal finding.

Mycoplasma pneumonia.

M. pneumoniae is a common cause of pneumonia. The diagnosis is suspected when the patient presents with symptoms suggesting primary atypical pneumonia including cough, fever, chills, headache, and malaise in association with a segmental or subsegmental pulmonary infiltrate(s), the white blood cell count is normal or only slightly elevated, and the Gram stain of the sputum (if any can be obtained) reveals polymorphonuclear leukocytes and few bacteria. The diagnosis is more difficult when the patient presents with symptoms not suggestive of pneumonia including lethargy, dyspnea, and a 1- to 4-week history of shortness of breath without cough or fever in association with diffuse reticulonodular or interstitial pulmonary infiltrates. The disease in the previously healthy host is usually benign and self-limiting. However, the course is shortened by the administration of tetracycline derivatives or erythromycin. M. pneumoniae pneumonia can occur in association with other diseases including sickle cell anemia, sarcoidosis, systemic lupus erythematosus, Hodgkin's disease, and various other immunodeficiency states. In these patients mycoplasma pneumonia can be very serious. Although there is no pathognomonic clinical or radiographic presentation, careful consideration of epidemiologic, clinical, laboratory, and radiographic data are usually sufficient to suggest the diagnosis in most patients.

CT of the esophagus. II. Carcinoma.

Thoracoabdominal computed tomography (CT) scanning was performed prior to treatment on 30 patients with proven carcinoma of the esophagus. Operative, bronchoscopic, and/or autopsy data were reviewed and showed that CT correctly identified the extent of medistinal spread in 27 patients and intraabdominal metastases in 22 patients. The ability of CT to reliably predict the extent of disease should help the surgeon and radiation oncologist plan optimal therapy.

Computed tomography in the diagnosis of intra-abdominal abscesses.

The diagnosis of intra-abdominal abscess by radiographic means often relies on combining the results of several different imaging modalities. Computed tomography (CT) has been shown to be a safe, accurate and rapid diagnostic method of diagnosing these abscesses. Five patients with a variety of intra-abdominal abscesses are presented in whom the CT scan alone provided the correct diagnosis. The various imaging modalities available for the radiologic diagnosis of intra-abdominal abscess are described and are compared to CT diagnosis regarding their pitfalls.

Intraabdominal abscess: current concepts in radiologic evaluation.

Forty patients with suspected abdominal abscess had computed tomography (CT) and plain film examinations; 15 also had ultrasound study. CT was found to be the most consistently accurate examination, both for the detection of abscess and evaluation of its extent. Ultrasound was positive in a high percentage of cases in which it was used. Although plain films correctly suggested the presence of an abscess in over half the proven cases, confirmatory evidence from CT or ultrasound was often required to persuade clinicians of the presence of an abscess and to provide detailed information regarding its extent and configuration.