Assessment of the comparative agreement between chest radiographs and CT scans in intensive care units.

PURPOSE: Chest radiographs in critically ill patients can be difficult to interpret due to technical and clinical factors. We sought to determine the agreement of chest radiographs and CT scans, and the inter-observer variation of chest radiograph interpretation, in intensive care units (ICUs). METHODS: Chest radiographs and corresponding thoracic computerised tomography (CT) scans (as reference standard) were collected from 45 ICU patients. All radiographs were analysed by 20 doctors (radiology consultants, radiology trainees, ICU consultants, ICU trainees) from 4 different centres, blinded to CT results. Specificity/sensitivity were determined for pleural effusion, lobar collapse and consolidation/atelectasis. Separately, Fleiss' kappa for multiple raters was used to determine inter-observer variation for chest radiographs. RESULTS: The median sensitivity and specificity of chest radiographs for detecting abnormalities seen on CTs scans were 43.2% and 85.9% respectively. Diagnostic sensitivity for pleural effusion was significantly higher among radiology consultants but no specialty/experience distinctions were observed for specificity. Median inter-observer kappa coefficient among assessors was 0.295 ("fair"). CONCLUSIONS: Chest radiographs commonly miss important radiological features in critically ill patients. Inter-observer agreement in chest radiograph interpretation is only "fair". Consultant radiologists are least likely to miss thoracic radiological abnormalities. The consequences of misdiagnosis by chest radiographs remain to be determined.

Surgical management of macroglossia secondary to amyloidosis.

The authors report a case of amyloidosis-induced macroglossia treated with surgical reduction of the tongue using a keyhole to inverted T method with particular emphasis on the postoperative sequelae. Significant tongue swelling persisted for longer than anticipated requiring tracheostomy to remain in situ for 14 days.

Maxillofacial injuries in the workplace.

Over a 2-year period we reviewed patients who presented to a UK maxillofacial unit with facial injuries sustained at work. We looked at links between the mechanism, injury, and characteristics of such injuries.

Changes in admission rates for spreading odontogenic infection resulting from changes in government policy about the dental schedule and remunerations.

The government changed the system of payment to general dental practitioners on 1 April 2005 from a fee/item to a banding system. The figures collected have shown that there has been a 62% increase in the number of patients who require admission for surgical treatment of spreading odontogenic infections compared with the 3-year period before this date.

Diver's harpoon gun: facial injury caused by an unusual weapon.

This unusual case of a facial injury caused by being shot with a diver's harpoon gun highlights the importance of good radiological assessment and careful planning before removal of the harpoon, and emphasises the need to control the barb.

Aspergillosis of the maxillary sinus secondary to a foreign body (amalgam) in the maxillary antrum.

We report a case of a Maxillary sinus aspergilloma, which presented after 2 years of symptoms of chronic sinusitis. There was an isolatable triggering event of extrusion of an amalgam filling material into the sinus. This was a complication of surgical extraction of the upper right second molar by his general dental practitioner.