Enhanced pneumothorax visualization in ICU patients using portable chest radiography.

OBJECTIVE: Pneumothorax development can cause precipitous deterioration in ICU patients, therefore quick and accurate detection is vital. Portable chest radiography is commonly performed to exclude pneumothoraces but is hampered by supine patient position and overlying internal and external material. Also, the initial evaluation of the chest radiograph may be performed by a relatively inexperienced physician. Therefore, a tool that could significantly improve pneumothorax detection on portable radiography would be helpful in patient care. The aim of this study was to evaluate the clinical utility of novel enhancement software for pneumothorax detection in readers with varied clinical experience of detecting/excluding pneumothoraces on portable chest radiographs in ICU patients. SUBJECTS AND METHODS: 206 portable ICU chest radiographs, 103 with pneumothoraces, were processed with and without enhancement software and reviewed by 5 readers who varied in reading experience. Images were grouped for different complexity levels. RESULTS: The mean AUC for pneumothorax detection increased for 4/5 readers from 0.846-0.957 to 0.88-0.971 with a largest improvement for the reader with least experience. No significant change was noted for the reader with the longest reading experience. The image complexity had no impact on the interpretation result. CONCLUSION: Pneumothorax detection improves with novel enhancement software; the largest improvement is seen in less experienced readers.

Coronary artery to main pulmonary artery fistulae via a Vieussens' arterial ring.

Coronary artery fistulae are rare abnormal communications between a coronary artery and a cardiac chamber or a great vessel which may shunt blood flow away from the myocardial capillary network. Vieussens arterial ring is usually described as a collateral pathway between the left anterior descending and right coronary arteries, pathology of Vieussens arterial ring are exceedingly rare. We present a case of a complex coronary artery to pulmonary artery fistula via an aneurysmal Vieussens arterial ring, with emphasis on computerized tomography and invasive angiography findings and management.