Chest Radiograph (chest + radiograph)

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Sensitivity of Bedside Ultrasound and Supine Anteroposterior Chest Radiographs for the Identification of Pneumothorax After Blunt Trauma

ACADEMIC EMERGENCY MEDICINE, Issue 1 2010
R. Gentry Wilkerson MD
Abstract Objectives:, Supine anteroposterior (AP) chest radiographs in patients with blunt trauma have poor sensitivity for the identification of pneumothorax. Ultrasound (US) has been proposed as an alternative screening test for pneumothorax in this population. The authors conducted an evidence-based review of the medical literature to compare sensitivity of bedside US and AP chest radiographs in identifying pneumothorax after blunt trauma. Methods:, MEDLINE and EMBASE databases were searched for trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: patients included adult (18 + years) emergency department (ED) patients in whom pneumothorax was suspected after blunt trauma. The intervention was thoracic ultrasonography for the detection of pneumothorax. The comparator was the supine AP chest radiograph during the initial evaluation of the patient. The outcome was the diagnostic performance of US in identifying the presence of pneumothorax in the study population. The criterion standard for the presence or absence of pneumothorax was computed tomography (CT) of the chest or a rush of air during thoracostomy tube placement (in unstable patients). Prospective, observational trials of emergency physician (EP)-performed thoracic US were included. Trials in which the exams were performed by radiologists or surgeons, or trials that investigated patients suffering penetrating trauma or with spontaneous or iatrogenic pneumothoraces, were excluded. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. Data analysis consisted of test performance (sensitivity and specificity, with 95% confidence intervals [CIs]) of thoracic US and supine AP chest radiography. Results:, Four prospective observational studies were identified, with a total of 606 subjects who met the inclusion and exclusion criteria. The sensitivity and specificity of US for the detection of pneumothorax ranged from 86% to 98% and 97% to 100%, respectively. The sensitivity of supine AP chest radiographs for the detection of pneumothorax ranged from 28% to 75%. The specificity of supine AP chest radiographs was 100% in all included studies. Conclusions:, This evidence-based review suggests that bedside thoracic US is a more sensitive screening test than supine AP chest radiography for the detection of pneumothorax in adult patients with blunt chest trauma. ACADEMIC EMERGENCY MEDICINE 2010; 17:11,17 © 2010 by the Society for Academic Emergency Medicine [source]


Hypercapnia: what is the limit in paediatric patients?

PEDIATRIC ANESTHESIA, Issue 7 2004
A case of near-fatal asthma successfully treated by multipharmacological approach
Summary We describe a case of prolonged severe hypercapnia with respiratory acidosis occurring during an episode of near-fatal asthma in an 8-year-old boy, followed by complete recovery. After admission to the intensive care unit, despite treatment with maximal conventional bronchodilatative therapy, the clinical picture deteriorated with evident signs of respiratory muscle fatigue. The child was sedated, intubated and mechanically ventilated. Magnesium sulphate, ketamine and sevoflurane were gradually introduced together with deep sedation, curarization and continuous bronchodilatative therapy. Ten hours after admission, arterial pCO2 reached 39 kPa (293 mmHg), pH was 6.77 and pO2 8.6 kPa (65 mmHg). Chest radiograph showed severe neck subcutaneous emphysema, with signs of mediastinal emphysema. No episode of haemodynamic instability was seen despite severe prolonged hypercapnia lasting more than 14 h. Oxygenation was maintained and successful recovery followed without neurological or cardiovascular sequelae. This case shows the cardiovascular and neurological tolerance of a prolonged period of supercarbia in a paediatric patient. The most important lesson to be learned is the extreme importance of maintaining adequate tissue perfusion and oxygenation during an asthma attack. The second lesson is that when conventional bronchodilators fail, the intensivist may resort to the use of drugs such as ketamine, magnesium sulphate and inhalation anaesthesia. In this context deep sedation and curarization are important not only to improve oxygenation, but also to reduce cerebral metabolic requirements. [source]


Progressive stridor: could it be a congenital cystic lung disease?

ACTA PAEDIATRICA, Issue 9 2009
M Zedan
Abstract Bronchogenic cyst of the mediastinum, a cause of stridor early in life, is the result of abnormal budding of the ventral segment of the primitive foregut. Bronchogenic cysts are often asymptomatic in older children and adults. However, symptomatic cases usually manifest early in life with cough, stridor or wheezing due to airway compression. We report a female infant aged 4.5 months with a normal full-term pregnancy, who developed respiratory distress with stridor. This stridor was preceded by a history of slowly progressive noisy breathing. Physical examination revealed evidence of bilateral obstructive emphysema. Chest radiograph revealed bilateral overinflation. Fibro-optic bronchoscopy revealed posterior mediastinal compression. Possibility of congenital cystic lung disease (CCLD) was considered, emphasizing the value of computed tomography (CT) chest, which revealed a cyst probably bronchogenic. Surgical excision was performed with evident histological confirmation of bronchogenic cyst. Conclusion:, we highlight that in any infant, presented with slowly progressive noisy breathing in the first year of life, CCLD should be considered in the differential diagnosis even with normal X-ray chest. CT chest should be performed for exclusion or diagnosis of the case. [source]


Breast lymphoma in Sjögren's syndrome complicated by acute monocular blindness

INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2010
Helmar F. SOLDEVILLA
Abstract A 69-year-old hypertensive woman presented with eye and mouth dryness, bilateral parotid gland enlargement, associated with anasarca and proteinuria. Family history was notable for malignancies including breast, nasopharyngeal and colon cancers. Physical exam disclosed hypertension, bilaterally enlarged, firm, non-tender parotid glands, fine bibasilar crackles and bipedal edema. Anti Ro/Sjögren's syndrome antigen A antibody was positive, with negative tests for anti La/Sjögren's syndrome antigen B and anti-nuclear antibody (ANA). Chest radiographs showed basal infiltrates. Sjögren's syndrome associated with glomerulonephritis and interstitial lung disease was diagnosed, and she received pulse methylprednisololone followed by oral prednisone with dramatic improvement. Two months later, while on prednisone 5 mg/day, she returned to the clinic with an enlarging fixed non-tender right breast mass. She underwent modified radical mastectomy of the right breast, and pathologic report revealed diffuse, small cell, non-Hodgkin's lymphoma of the breast; axillary lymph nodes were negative for tumor. She opted for alternative therapy and did not return to the clinic until 7 months later when she developed sudden monocular blindness in the right eye with no other systemic manifestations. Magnetic resonance imaging (MRI) revealed swelling and enhancement of intracanalicular and pre-chiasmatic segments of the right optic nerve and right side of the optic chiasm. Considerations were Devic's disease versus metastases. She received pulse methylprednisolone therapy (1 g/day for 3 days) with partial recovery of vision. She is scheduled for lymphoma chemotherapy to include rituximab. [source]


Intermandibular malignant mesenchymoma in a crossbreed dog

JOURNAL OF SMALL ANIMAL PRACTICE, Issue 9 2006
S. Murphy
A 12-year-old German shepherd crossbreed dog was presented with a submandibular mass that was initially diagnosed as myxosarcoma on incisional biopsy. Chest radiographs were taken for staging, and magnetic resonance imaging was performed to assess the feasibility of cytoreductive surgery before adjuvant radiotherapy. The dog underwent debulking surgery, and histology permitted reclassification of the tumour as a malignant mesenchymoma (with myxosarcomatous and osteosarcomatous differentiation). The dog was subsequently treated with four fractions of radiotherapy given at seven-day intervals and three doses of carboplatin. The dog remained stable following therapy until its condition acutely deteriorated, and it was euthanased 153 days after surgery. On postmortem examination, there were no signs of local tumour recurrence, but metastases were observed both in the thorax and in the abdomen. [source]


Predictors of Fracture Risk of a Small Caliber Implantable Cardioverter Defibrillator Lead

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2010
ANDREW C.T.
Introduction: The Sprint Fidelis 6949 implantable cardioverter defibrillator (ICD; Medtronic Inc., Minneapolis, MN, USA) lead has a high rate of fracture. Identification of predictors of subsequent fracture is useful in decision making about lead replacement and for future lead design. We sought to determine if there are clinical, procedural, or radiological features associated with a greater risk of subsequent lead fracture. Methods: Patients with Sprint Fidelis 6949 lead fractures (Fracture group) were identified from our institutional database. Each patient in the Fracture group was matched to two controls, immediately preceeding and succeeding Sprint Fidelis 6949 implant. Clinical and procedural characteristics were compared. Chest radiographs performed 2 weeks after ICD implant were reviewed by an observer blinded to outcomes. The following features were assessed: ICD tip location, lead slack, kinking of the lead body (,90°), and presence of lead "crimping" within the anchoring sleeve. Results: Twenty-six patients with Sprint Fidelis 6949 lead fractures were identified and were matched to 52 control patients. On univariate analysis, a higher left ventricular ejection fraction (LVEF), prior ipsilateral device implant, history of prior ICD lead fracture, and noncephalic venous access were associated with risk of lead fracture. On multivariate analysis, a higher LVEF was the only independent predictor of lead fracture (P = 0.006). Radiological features were similar between the two groups. Conclusions: In this study, a higher LVEF was associated with a greater risk of lead fracture in patients with Sprint Fidelis 6949 ICD leads. Radiographic features did not predict subsequent risk of lead fracture in our population. (PACE 2010; 437,443) [source]


Mycoplasma pneumonia: Clinical and radiographic features in 39 children

PEDIATRICS INTERNATIONAL, Issue 3 2007
SHU-CHIANG HSIEH
Abstract Background: The purpose of the present paper was to evaluate the clinical and chest radiographic features of pediatric patients with serologically proven Mycoplasma pneumoniae pneumonia (mycoplasma pneumonia). Methods: The clinical records and chest radiographs of 39 consecutive patients (19 male, 20 female; age 3,13 years) with serologically positive IgG and IgM mycoplasma pneumonia were reviewed. Results: More than 90% of patients presented with fever and cough and 48% of patients had leukocyte count >10 000/mm3. A C-reactive protein (CRP) level >0.375 mg/dL was noted in 28 patients (72%). Chest radiographs displayed four different patterns: (i) peribronchial and perivascular interstitial infiltrates (n= 19, 49%); (ii) airspace consolidations (n= 15, 38%); (iii) reticulonodular opacification (n= 3, 8%); and (iv) nodular or mass-like opacification (n= 2, 5%). Bilateral peribronchial perivascular interstitial infiltrations in central and middle lung zones were frequently seen (n= 19, 49%). Other radiological features were bilateral lesions in 51% of patients, pleural effusion in 23%, and hilar lymphadenopathy in 13%. Means of duration for treatment response and hospitalization were 2.5 and 5 days, respectively. Conclusion: There are various radiological features of mycoplasma pneumonia in children. Bilateral peribronchial and perivascular interstitial infiltrates were most frequently seen in the present patients. [source]


Variation in Ancillary Testing among Pediatric Asthma Patients Seen in Emergency Departments

ACADEMIC EMERGENCY MEDICINE, Issue 6 2007
MHSA, Rachel M. Stanley MD
Background:Variation in the management of acute pediatric asthma within emergency departments is largely unexplored. Objectives:To investigate whether ancillary testing for patients with asthma would be associated with patient, physician, and hospital characteristics. Methods:The authors performed an analysis of a subset of patients from an extensive retrospective chart review of randomly selected charts at all 25 member emergency departments of the Pediatric Emergency Care Applied Research Network. Patients with a diagnosis of asthma were selected for supplemental review and included in this study. Ancillary tests analyzed were chest radiographs and selected blood tests. Hierarchical analyses were performed to describe the associations between ancillary testing and the variables of interest. Results:A total of 12,744 chart abstractions were completed, of which 734 (6%) were patients with acute exacerbations of asthma. Overall, 302 patients with asthma (41%) had ancillary testing. Of the 734 patients with asthma, 198 (27%) had chest radiographs and 104 (14%) had blood tests. Chest radiographs were more likely to be ordered in patients with fever. Less blood testing was associated with physician subspecialty training in pediatric emergency medicine, patients treated at children's hospitals, higher patient oxygen saturation, and patient disposition to home. Conclusions:Ancillary testing occurred in more than one third of children with asthma, with chest radiographs ordered most frequently. Efforts to reduce the use of chest radiographs should target the management of febrile patients with asthma, whereas efforts to reduce blood testing should target providers without subspecialty training in pediatric emergency medicine and patients treated in nonchildren's hospitals who are more ill. [source]


Miliary tuberculosis and necrotizing tuberculous fasciitis , An unusual coexistence in a rheumatoid arthritis patient

INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2010
Hyun-Hee KWON
Abstract We report a case of a 65-year-old Korean female patient with rheumatoid arthritis, who presented with extensive necrotizing fasciitis of the gluteus muscles, as an unusual initial manifestation of miliary tuberculosis. The patient had been previously treated with conventional disease-modifying antirheumatic drugs and low-dose steroids for 7 years. However, she recently developed fever, warmth and painful swelling in her right buttock. Magnetic resonance imaging indicated necrotizing fasciitis of the gluteus muscles and a fasciectomy specimen revealed a Mycobacterium tuberculosis infection. Two weeks after a fasciectomy, miliary tuberculosis of the lung was diagnosed by high resolution chest computed tomography. Soft tissue infection due to M. tuberculosis should be included as a differential diagnosis in the immunocompromised host. Clinicians should be alert to the possibility of miliary tuberculosis even in the absence of respiratory symptoms and normal chest radiograph. [source]


Aortic Calcification Is Associated With Age and Sex but Not Left Ventricular Mass in Essential Hypertension

JOURNAL OF CLINICAL HYPERTENSION, Issue 2 2004
Alexandros Tsakiris MD
The aim of this study was to investigate the prevalence of aortic calcification in patients with essential hypertension and its relationship with age, sex, and left ventricular hypertrophy. Two hundred ninety consecutive patients with essential hypertension were studied. A chest radiograph and an echocardiograph were performed. Aortic calcification was observed in 74/290 (25.5%) patients. Patients with calcification were mostly female (67.6%) and older (71.8±1.9 years), whereas patients without calcification were younger (59.0±0.79) and of both sexes (51.85% female). Left ventricular mass index in male patients with aortic calcification was 147.3±4.32 g/m2 and without calcification was 132.7±2.28 g/m2 (p=0.023). Female patients' values were 131.9±4.32 g/m2 with calcification and 121.2±2.85 g/m2 without calcification (p=0.025). Left ventricular mass was independently associated with age and sex but not with aortic calcification. The prevalence of aortic calcification in essential hypertension is considerably higher compared to the general population. Essential hypertension and age seem to contribute to the concurrent appearance of aortic calcification and increased left ventricular mass. [source]


Intrathoracic gastric volvulus mimicking pyloric stenosis

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 2 2003
JJ Munoz
Abstract: A 5-week-old-infant presented to hospital following the acute onset of non-bilious vomiting with clinical and acid,base features suggestive of pyloric stenosis. A chest radiograph obtained because of intercurrent infection unexpectedly revealed a left-sided congenital diaphragmatic hernia. A barium meal demonstrated the presence of an intrathoracic gastric volvulus, requiring urgent surgical management. We discuss the presentation and management of this rare surgical cause of non-bilious vomiting in infancy. [source]


Sensitivity of Bedside Ultrasound and Supine Anteroposterior Chest Radiographs for the Identification of Pneumothorax After Blunt Trauma

ACADEMIC EMERGENCY MEDICINE, Issue 1 2010
R. Gentry Wilkerson MD
Abstract Objectives:, Supine anteroposterior (AP) chest radiographs in patients with blunt trauma have poor sensitivity for the identification of pneumothorax. Ultrasound (US) has been proposed as an alternative screening test for pneumothorax in this population. The authors conducted an evidence-based review of the medical literature to compare sensitivity of bedside US and AP chest radiographs in identifying pneumothorax after blunt trauma. Methods:, MEDLINE and EMBASE databases were searched for trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: patients included adult (18 + years) emergency department (ED) patients in whom pneumothorax was suspected after blunt trauma. The intervention was thoracic ultrasonography for the detection of pneumothorax. The comparator was the supine AP chest radiograph during the initial evaluation of the patient. The outcome was the diagnostic performance of US in identifying the presence of pneumothorax in the study population. The criterion standard for the presence or absence of pneumothorax was computed tomography (CT) of the chest or a rush of air during thoracostomy tube placement (in unstable patients). Prospective, observational trials of emergency physician (EP)-performed thoracic US were included. Trials in which the exams were performed by radiologists or surgeons, or trials that investigated patients suffering penetrating trauma or with spontaneous or iatrogenic pneumothoraces, were excluded. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. Data analysis consisted of test performance (sensitivity and specificity, with 95% confidence intervals [CIs]) of thoracic US and supine AP chest radiography. Results:, Four prospective observational studies were identified, with a total of 606 subjects who met the inclusion and exclusion criteria. The sensitivity and specificity of US for the detection of pneumothorax ranged from 86% to 98% and 97% to 100%, respectively. The sensitivity of supine AP chest radiographs for the detection of pneumothorax ranged from 28% to 75%. The specificity of supine AP chest radiographs was 100% in all included studies. Conclusions:, This evidence-based review suggests that bedside thoracic US is a more sensitive screening test than supine AP chest radiography for the detection of pneumothorax in adult patients with blunt chest trauma. ACADEMIC EMERGENCY MEDICINE 2010; 17:11,17 © 2010 by the Society for Academic Emergency Medicine [source]


Paralysis in the left phrenic nerve after living-donor liver transplantation for biliary atresia with situs inversus

LIVER TRANSPLANTATION, Issue 11 2008
Yukihiro Sanada
A 7-month-old boy with biliary atresia accompanied by situs inversus and absent inferior vena cava (IVC) underwent living-donor liver transplantation (LDLT). Because a constriction in the recipient hepatic vein (HV) was detected during the preparation of the HV in LDLT, a dissection in the cranial direction and a total clamp of the suprahepatic IVC was performed, and the suprahepatic IVC and the graft HV were anastomosed end-to-end. Postoperatively, atelectasis in the left upper lobe and ventilator failure accompanied by an elevation of the left hemidiaphragm were observed and mechanical ventilation was repetitively required. Paralysis in the left phrenic nerve was diagnosed by chest radiograph and ultrasonography. In our patient, conservative treatment was administrated, because weaning him from mechanical ventilation was possible a few days after intubation and the ventilator function was expected to be improved with growth. The disease course was good, and he was discharged from the hospital at 78 days after LDLT. Complications of paralysis in the phrenic nerve after cadaveric liver transplantation have been reported to be high. Although using a conventional technique during the reconstruction of the HV may injure the phrenic nerve directly, use of the piggyback technique with preservation of the IVC is rare. Even if LDLT was undertaken, a dissection of the HV or a total clamp of the suprahepatic IVC as a conventional technique can directly injure the phrenic nerve. Therefore, a dissection of the HV or a total clamp of the suprahepatic IVC at the reconstruction of the HV in LDLT should be carefully performed, and the possibility of paralysis in the phrenic nerve should be considered in patients with a relapse of respiratory symptoms and an elevation of the hemidiaphragm after LDLT. Liver Transpl 14:1659,1663, 2008. © 2008 AASLD. [source]


Pulmonary gas exchange abnormalities in liver transplant candidates

LIVER TRANSPLANTATION, Issue 9 2002
Rosmawati Mohamed
Abnormal diffusing capacity is the commonest pulmonary dysfunction in liver transplant candidates, but severe hypoxemia secondary to hepatopulmonary syndrome and significant pulmonary hypertension are pulmonary vascular manifestations of cirrhosis that may affect the perioperative course. We prospectively assessed the extent of pulmonary dysfunction in patients referred for liver transplantation. A total of 57 consecutive patients with chronic liver disease were evaluated. All patients had a chest radiograph, standing arterial blood gas on room air, pulmonary function testing, and Doppler echocardiogram. Those patients with arterial hypoxaemia (PaO2 < 10 kPa) also underwent 99mTc-macroaggregated albumin lung scan, and nine patients had agitated normal saline injection during echocardiography to define further the existence of pulmonary vascular dilatation. Reduced diffusing capacity for carbon monoxide less than 75% of the predicted value was found in 29 of 57 (51%) patients. Although elevated alveolar-arterial oxygen tension difference was detected in 35% (20/57) of the patients, only four (7%) patients had hypoxemia. We were unable to find evidence of intrapulmonary vascular dilatation either on the lung scan or saline-enhanced echocardiography in any of these patients. Reduction in diffusing capacity for carbon monoxide was noted in 75% (18/24) of patients who were transplanted for primary biliary cirrhosis and was accompanied by widened alveolar-arterial oxygen tension in 10 out of 18 (56%) of patients. This study shows that in liver transplant candidates, diffusion impairment and widened alveolar-arterial oxygen tension difference were frequently detected, especially in patients with primary biliary cirrhosis. [source]


Cephalad origin of the superior vena cava and the level of the central venous catheter tip on chest radiographs

PEDIATRIC ANESTHESIA, Issue 1 2005
TOSHIMI ARAI MD
Summary Background :,There are suggested radiographic landmarks for the lower margin of the superior vena cava (SVC), but none for the cephalad origin of the SVC in children. Therefore, we determined the cephalad origin of the SVC in relation to the level of thoracic vertebrae in children. Methods :,Sixty-five patients (2,96 months) scheduled for routine diagnostic cardiac catheterization were the subjects of the study. Vena cavogram was obtained. The crossing point between the SVC and the innominate vein was considered as the cephalad origin of the SVC, then this point was related to the level of the thoracic vertebra as a radiographic landmark. Results :,In approximately 90% of the patients studied the proximal origin of the SVC was situated above the level of Th4/5 interspace. Conclusion :,We would like to suggest that the position of the tip of central venous line, when inserted via the right internal jugular vein, should optimally be at the level of Th4/5 interspace on the postoperative chest radiograph. [source]


Congenital rubella pneumonitis complicated by Pneumocystis jiroveci infection with positive long term respiratory outcome: A case report and literature review

PEDIATRIC PULMONOLOGY, Issue 12 2009
M.O. Sanchez MD
Abstract Rubella remains to be a significant illness in the developing countries because of limited access to immunizations. In congenital rubella syndrome, lung involvement becomes evident within the few months of life, as a manifestation of the "late onset rubella syndrome." The lungs and other organs become involved secondary to immunopathologic mechanisms and immunodeficiency predisposes affected patients to opportunistic pathogens. We report the clinical, respiratory and immunologic data of a young boy who developed rubella pneumonitis and concomitant infection with Pneumocystis jiroveci. Despite the complicated clinical course, the child survived. At follow-up he has a normal pulmonary examination, mild hyperinflation only on his chest radiograph, normal immunology and normal respiratory reactance and resistance. Pediatr Pulmonol. 2009; 44:1235,1239. © 2009 Wiley-Liss, Inc. [source]


A cost effectiveness analysis of omitting radiography in diagnosis of acute bronchiolitis,

PEDIATRIC PULMONOLOGY, Issue 2 2009
Jean Hai Ein Yong MASc
Abstract Objective To carry out a cost-effectiveness analysis of omitting chest radiography in the diagnosis of infant bronchiolitis. Hypothesis Omitting chest radiographs in the diagnosis of typical bronchiolitis was expected to reduce costs without adversely affecting the detection rate of alternate diseases. Study Design An economic evaluation was conducted using clinical and health resources. Emergency department (ED) physicians provided diagnoses pre- and post-radiography as well as a management plan. The primary outcome was the diagnostic accuracy (false-negative rate) of alternate diagnoses with and without X-ray. The incremental costs of omitting radiography in comparison to routine radiography per patient were assessed from a health system perspective. Patient Selection We studied 265 infants, 2,23 months old, presenting at the ED with typical bronchiolitis. Patients with pre-existing conditions or radiographs were omitted from the study. Methodology Expected costs to the health care system of including and excluding chest radiographs were compared, including costs associated with misdiagnosis. Results All alternate diagnoses (two cases) were missed by ED physicians pre- and post-radiography, resulting in a 100% false negative rate. The specificity in detecting alternate diseases was 96.6% pre-radiography and 88.6% post-radiography. Of the 17 cases of coexistent pneumonia, 88% were missed pre-radiography and 59% post-radiography, with respective false positive rates of 10.5% and 16.1%. Omission of routine chest radiograph saved CDN $59 per patient, primarily due to savings in radiography and hospitalization costs. The economic benefit persisted after the inpatient length of stay, ED overhead and radiograph costs were varied. Conclusion For infants with typical bronchiolitis, omitting radiography is cost saving without compromising diagnostic accuracy of alternate diagnoses and of associated pneumonia. Pediatr Pulmonol. 2009; 44:122,127. © 2009 Wiley-Liss, Inc. [source]


Chest radiograph thoracic areas and lung volumes in infants developing bronchopulmonary dysplasia

PEDIATRIC PULMONOLOGY, Issue 1 2009
Caroline May MRCPCH
Abstract Objectives To determine whether chest radiograph (CXR) thoracic areas and lung volumes differed between infants who did and did not develop BPD and according to the severity of BPD developed. Working Hypothesis Infants developing BPD, particularly if moderate or severe, would have low CXR thoracic areas and lung volumes in the perinatal period. Study Design Prospective study. Patient-Subject Selection 53 infants with a median gestational age of 28 (range 24,32) weeks. Methodology CXR thoracic areas were calculated using a Picture Archiving and Communicating System (PACS) and lung volume assessed by measurement of functional residual capacity (FRC) in the first 72 hr after birth. BPD was diagnosed if the infants were oxygen dependent beyond 28 days, mild BPD in infants no longer oxygen dependent at 36 weeks post-menstrual age (PMA) and moderate/severe BPD in infants who required supplementary oxygen with or without respiratory support at 36 weeks PMA. Results Thirty two infants developed BPD, 21 had moderate/severe BPD. The median CXR thoracic areas were higher (P,<,0.0001) and FRCs were lower (P,<,0.0001) in the BPD compared to no BPD infants. The median CXR thoracic areas of the moderate/severe group (P,<,0.001) and the mild group (P,<,0.05) were greater than that of the no BPD group and the median FRC of the moderate/severe BPD group was lower than the no BPD group (<0.001) and the mild BPD group (P,<,0.05). Conclusion These results highlight that in the perinatal period infants developing BPD, particularly if moderate/severe, have low functional lung volumes and may have gas trapping, which likely reflects ventilation inhomogeneity. Pediatr Pulmonol. 2009; 44:80,85. © 2008 Wiley-Liss, Inc. [source]


Treatment of allergic bronchopulmonary aspergillosis (ABPA) in CF with anti-IgE antibody (omalizumab)

PEDIATRIC PULMONOLOGY, Issue 12 2008
Adaobi Kanu MD
Abstract Allergic bronchopulmonary aspergillosis (ABPA) results from IgE induced pulmonary response to aspergillus species. Recognition and management of ABPA is challenging in cystic fibrosis (CF) patients because changes in symptoms, lung function and chest radiograph are similar to that seen in CF related pulmonary infection. Standard therapy for ABPA includes systemic steroids and adjunctive use of antifungal agents. Little has been published regarding the use of monoclonal anti-IgE antibody in those with ABPA. We report a CF patient with her third exacerbation of ABPA who was treated with monoclonal anti-IgE (omalizumab) antibody; she had unfavorable side effects with prednisone therapy. This therapy resulted in improvement of pulmonary symptoms and lung function not achieved with antibiotics or prednisone alone. Pediatr. Pulmonol. 2008; 43:1249,1251. © 2008 Wiley-Liss, Inc. [source]


Pulmonary Tuberculosis in a Child Presenting with Acute Hemoptysis

PEDIATRIC PULMONOLOGY, Issue 1 2006
Jamaree Teeratakulpisarn MD
Abstract We report on a tuberculous child whose only presenting symptom was acute hemoptysis. His chest radiograph revealed a mass-like lesion occupying the posterior basal segment of the right lower lung field. Multidetector computerized tomography (MDCT) of the chest showed a hypodense mass supplied by the bronchial artery and drained by the pulmonary vein. Surgical specimens revealed caseating granulomatous inflammation, positive for acid-fast bacilli. The child was successfully treated with a short-course (6-month) regimen of antituberculous drugs. Pediatr Pulmonol. © 2005 Wiley-Liss, Inc. [source]


Congenital lobar emphysema: Differential diagnosis and therapeutic approach

PEDIATRICS INTERNATIONAL, Issue 5 2008
Refik Ulku
Abstract Background: Congenital lobar emphysema (CLE) is a rare anomaly of lung development that usually presents in the neonatal period with respirator distress and pulmonary lobar hyperinflation. It is commonly confused with pneumothorax. The aim of the present paper was to review the authors' experience in order to emphasize the importance of differential diagnosis with pneumothorax. Methods: Children with CLE treatment at Department of Thoracic Surgery, Dicle University School of Medicine, Turkey, between January 1993 and June 2004, were reviewed. Results: Ten children consisting of six boys and four girls (age range, 6 h,12 months) had CLE. Major presenting symptoms were tachypnea(n = 100%) and respiratory distress in (n = 80%). On chest radiograph, emphysema was seen in all patients, and shift-herniation to the opposite lung, atelectasis were observed. Computed tomography was performed in all patients, which indicated emphysema in the affected lobes in all cases. Pulmonary perfusion scan was performed in two patients, showing loss of perfusion in the affected lobe. The most common affected lobe was the left upper lobe (50%). In the present series, three patients were mistakenly diagnosed as pneumothorax and intercostal drains were inserted in the emergency department. Eight patients underwent lobectomy, and postoperative course was uneventful. Two patients were followed conservatively. Emphysema was detected in all pathological specimens. One patient was lost to follow up. Mean follow-up duration of all patients was 26.8 ± 29.24 months (range, 1,89 months). Conclusions: CLE is established on combined clinical, radiological and scintigraphic imaging. Surgical excision of the affected lobe is the appropriate treatment. Particularly, differential diagnosis should be made between CLE and pneumothorax. [source]


Pulmonary complications following hematopoietic stem cell transplantation: Diagnostic approaches

AMERICAN JOURNAL OF HEMATOLOGY, Issue 2 2005
Kasem Sirithanakul
Abstract Pulmonary complications are a significant cause of morbidity and mortality in hematopoietic stem cell transplant recipients. Pulmonary infiltrates in such patients pose a major challenge for clinicians because of the wide differential diagnosis of infectious and noninfectious conditions. It is rare for the diagnosis to be made by chest radiograph, and commonly these patients will need further invasive and noninvasive studies to confirm the etiology of the pulmonary infiltrates. This review describes the role of the different diagnostic tools available to reach a diagnosis in a timely manner in this patient population. Am. J. Hematol. 80:137,146, 2005. © 2005 Wiley-Liss, Inc. [source]


Airways obstruction among older construction and trade workers at Department of Energy nuclear sites

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 3 2010
John M. Dement PhD
Abstract Background A study of chronic obstructive pulmonary disease (COPD) among 7,579 current and former workers participating in medical screening programs at Department of Energy (DOE) nuclear weapons facilities through September 2008 was undertaken. Methods Participants provided a detailed work and exposure history and underwent a respiratory examination that included a respiratory history, respiratory symptoms, a posterior,anterior (P,A) chest radiograph classified by International Labour Office (ILO) criteria, and spirometry. Statistical models were developed to generate group-level exposure estimates that were used in multivariate logistic regression analyses to explore the risk of COPD in relation to exposures to asbestos, silica, cement dust, welding, paints, solvents, and dusts/fumes from paint removal. Risk for COPD in the study population was compared to risk for COPD in the general US population as determined in National Health and Nutrition Examination Survey (NHANES III). Results The age-standardized prevalence ratio of COPD among DOE workers compared to all NHANES III data was 1.3. Internal analyses found the odds ratio of COPD to range from 1.6 to 3.1 by trade after adjustment for age, race, sex, smoking, and duration of DOE employment. Statistically significant associations were observed for COPD and exposures to asbestos, silica, welding, cement dusts, and some tasks associated with exposures to paints, solvents, and removal of paints. Conclusions Our study of construction workers employed at DOE sites demonstrated increased COPD risk due to occupational exposures and was able to identify specific exposures increasing risk. This study provides additional support for prevention of both smoking and occupational exposures to reduce the burden of COPD among construction workers. Am. J. Ind. Med. 53:224,240, 2010. © 2009 Wiley-Liss, Inc. [source]


Incidence of tuberculosis and HIV and progression of silicosis and lung function impairment among former basotho gold miners,,

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 12 2009
Harriet H. Park MPH
Abstract Background Pulmonary tuberculosis and HIV incidence, mortality, and the progression of silicosis and lung function impairment are described over a 1-year period in migrant ex-gold miners from Lesotho. Methods Seven hundred seventy-nine Basotho miners were followed for 1 year starting 18 months after lay-off from a South African gold mine in 1998. At baseline and follow-up, they underwent a respiratory symptom interview, physical examination, HIV test, chest radiograph, and spirometry. Results Five hundred thirteen of 779 (65.9%) participants attended both baseline and follow-up visits. HIV incidence was 5.4/100 person-years (95% CI: 3.4,8.2). Prevalence of silicosis (ILO score ,1/1) was 26.6% at baseline and 27.0% at follow-up. Active tuberculosis diagnosed at baseline was a strong predictor of radiological progression of silicosis. Lung function as measured by FEV1 declined an average of 91,ml between visits (95% CI: 67,116,ml). Calculated minimum incidence of tuberculosis was 3,085/100,000/years (95% CI: 1,797,4,940) at follow-up. Of those seen at baseline, 18 died before their scheduled follow-up visit (mean age: 51 years). Conclusions High rates of mortality and of HIV infection and pulmonary tuberculosis were found in this cohort after leaving the South African goldmines. Continuing lung function loss was also apparent. A partnership between the South African mining industry and governments in labor-sending areas of Southern Africa is needed to provide continuity of care and access to HIV and tuberculosis treatment and prevention services. Active silicosis surveillance and an improved statutory compensation system are also needed. These findings can serve as a baseline against which the impact of such interventions can be assessed. Am. J. Ind. Med. 52:901,908, 2009. © 2009 Wiley-Liss, Inc. [source]


Asbestos-related disease among sheet metal workers 1986,2004: Radiographic changes over time,,

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 7 2009
FACOEM, Laura S. Welch MD
Abstract Background In 1985, the Sheet Metal Workers International Association and the Sheet Metal and Air Conditioning National Association formed The Sheet Metal Occupational Health Institute Trust (SMOHIT) to examine the health hazards of the sheet metal industry. Between 1986 and 2004 18,211 individuals were examined. At the time of the first examination 9.6% of all participants (1,745) had findings consistent with parenchymal disease (ILO,>,1/0), and 21% (3,827) had pleural scarring. Methods 2181-Two thousand hundred eighty-one who had no radiographic evidence of pneumoconiosis on baseline examination underwent a second examination. Results By the second examination, 5.3% had developed parenchymal disease on chest radiograph; an additional 12.4% had developed pleural scarring without parenchymal disease. Factors that predicted new cases of pneumoconiosis on radiograph were the calendar year the worker entered the sheet metal trade, smoking, and shipyard work. Forty-seven percent of those smoking at the time of initial exam reported having quit smoking by the second examination. Conclusions Asbestosis is still occurring 50 years after first exposure. Exposed workers benefit from medical screening programs that incorporate smoking cessation. Am. J. Ind. Med. 52:519,525, 2009. © 2009 Wiley-Liss, Inc. [source]


A comparative study of pleurodesis using talc slurry and bleomycin in the management of malignant pleural effusions

RESPIROLOGY, Issue 2 2000
Kian Chung Ong
Objective: Differing success rates of various pleurodesis agents have been reported in the management of malignant pleural effusions. A randomized clinical trial was conducted to compare the efficacy of two commonly used agents, talc and bleomycin, for the pleurodesis of malignant pleural effusions. Methodology: Inclusion in the study required proof of a malignant pleural effusion by fluid cytology or pleural biopsy. Exclusion criteria included trapped lung, loculated effusions, recurrent effusions and life expectancy < 1 month. Five grams of talc or 1 unit per kilogram bodyweight of bleomycin mixed in 150 mL of normal saline was administered via tube thoracostomy after complete drainage of the pleural effusion in each patient. Treatment success was defined as the absence of recurrent pleural effusion on the chest radiograph 1 month after pleurodesis. Results: Treatment success was achieved in 16 out of 18 patients (89%) in the talc slurry group versus 14 out of 20 patients (70%) in the bleomycin group (P = 0.168). Fever and pain were the only side-effects of pleurodesis in both groups. Conclusion: These results indicate that talc slurry is as effective as bleomycin in preventing early recurrence of malignant pleural effusions. Pleurodesis with talc instead of bleomycin can result in significant cost savings. [source]


A prospective evaluation of hemoptysis cases in a tertiary referral hospital

THE CLINICAL RESPIRATORY JOURNAL, Issue 3 2010
uz Uzun
Abstract Background and Aims:, Hemoptysis is symptomatic of a potentially serious and life-threatening thoracic disease. The purpose of this study was to evaluate the relative frequency of the different causes of hemoptysis, the change of the frequency of diseases, the value of the evaluation process and the outcome in a tertiary referral hospital. Methods:, A prospective study was carried out on consecutive patients presented with hemoptysis. Results:, A total of 178 patients (136 male, 42 female) were included to the study. Lung cancer (51), pulmonary embolism (23) and bronchiectasis (23) constituted most of the diagnosis. The most frequent cause of hemoptysis in males was by far lung carcinoma (50). Twelve cases of bronchiectasis and 11 cases of pulmonary embolism were observed in females. While lung cancer and pulmonary embolism were associated with mild to moderate amounts of bleeding (84% and 100%, respectively), patients with active tuberculosis and pulmonary vasculitis had severe to massive hemoptysis (50% and 44%, respectively). Transthoracic and other organ biopsies, spiral computed tomography (CT) angiography (X pres/GX model TSX-002a, Toshiba, Tochigi Ken, Japan) and aortography yielded high diagnostic results in our group (100%, 67%, 59% and 100%, respectively). The most frequent final diagnosis in patients with normal chest radiograph was pulmonary embolism (seven cases). Conclusions:, Lung cancer, pulmonary embolism and bronchiectasis were the main causes of hemoptysis in this prospective cohort; however, this is the first report showing pulmonary embolism as a leading cause of hemoptysis. CT angiography with high-resolution CT should be the primary diagnostic modality if the initial investigation is inconclusive in hemoptysis cases. Please cite this paper as: Uzun O, Atasoy Y, Findik S, Atici AG and Erkan L. A prospective evaluation of hemoptysis cases in a tertiary referral hospital. The Clinical Respiratory Journal 2010; 4: 131,138. [source]


Serious Bacterial Infections in Febrile Infants in the Post,Pneumococcal Conjugate Vaccine Era

ACADEMIC EMERGENCY MEDICINE, Issue 7 2009
Sherri L. Rudinsky MD
Abstract Objectives:, The objective was to identify the epidemiology of serious bacterial infections (SBI) and the current utility of obtaining routine complete blood counts (CBC) and blood cultures to stratify infants at risk of SBI, in the study population of febrile infants in the post,heptavalent pneumococcal conjugate vaccine (PCV7) era. Methods:, A cohort study with nested case-controls was undertaken at a tertiary care military hospital emergency department (ED) from December 2002 through December 2003. Irrespective of clinical findings at the initial encounter, patients were included if they were under 3 months of age and had a home or ED temperature of ,100.4°F or if they were between 3 and 24 months of age with a temperature of ,102.3°F. Data abstracted included age, temperature, peripheral white blood cell (WBC) count, and discharge diagnosis. Culture (blood, urine, and cerebrospinal fluid [CSF]) and chest radiograph (CXR) results were obtained through review of the electronic hospital archives. SBI was defined as pneumonia, urinary tract infection (UTI), meningitis, or bacteremia. Results:, A total of 985 children aged 0 to 24 months were enrolled. Fifty-five percent were male, the median age was 12 months (interquartile range = 8,17 months), and 79% had received at least one PCV7. A total of 132 cases of SBI were identified in 129 infants (13.1%): 82 pneumonias, 45 UTI, five bacteremias, and no cases of bacterial meningitis. The frequency of bacteremia was 0.7%. No statistical difference was detected in the WBC count between the SBI and non-SBI groups (13.8 ± 5.8 and 11.7 ± 5.6, respectively; p = 0.055). No readily available WBC cutoff on the receiver operating characteristic (ROC) curve proved to be an accurate predictor of SBI. No statistical difference was detected in mean temperature between the SBI and non-SBI groups (103.3 ± 1.2 and 103.2 ± 1.2°F, respectively; p = 0.26), nor was there a difference noted when groups were broken down by age or height of fever. Conclusions:, The WBC count and height of fever were not found to be accurate predictors of SBI in infants age 3 to 24 months. UTI and pneumonias made up the vast majority of SBI in this population of infants. The overall bacteremia frequency was well below 1%. This calls into question the continued utility of obtaining routine complete cell counts and blood cultures in the febrile infant in the post-PCV7 era. [source]


Oncological outcome of 100 laparoscopic radical nephrectomies for clinically localized renal cell carcinoma

ANZ JOURNAL OF SURGERY, Issue 7 2005
Man-Chiu Cheung
Background: Laparoscopic renal surgery is now accepted within the urological community and its indication is extended to oncological operation. The oncological outcome and survival of patients undergoing laparoscopic radical nephrectomy for clinically localized renal cell carcinoma were evaluated. Methods: From October 1998 to July 2003, 100 patients underwent laparoscopic radical nephrectomy for clinically localized renal cell carcinoma. All operations were performed by transperitoneal approach with early vascular control. Perioperative events and pathological data were recorded prospectively. Patients were followed up by clinical examination, chest radiograph, ultrasonography and/or computed tomography where appropriate. Results: The median age of patients was 61 years. Median operating time was 120 min and blood loss was 100 mL. There were five open conversions. There was no perioperative mortality but 11 patients had complications. Resection margins were clear in all but one patient. The median tumour size was 4.6 cm. The median follow-up time was 30 months. All patients survived up to the date of review. No patient developed port-site recurrence but two patients had recurrence at the renal bed 1 year after the operation. Five patients developed distant metastases involving liver, lung and bone. Conclusion: Laparoscopic radical nephrectomy is a safe and efficacious treatment option for clinically localized renal cell carcinoma. The intermediate-term oncological outcome appears favourable. [source]


Hidradenitis suppurativa responding to treatment with infliximab

AUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 3 2010
Anita Lasocki
ABSTRACT A series of four cases of severe recalcitrant hidradenitis suppurativa treated with infliximab is presented. All patients had failed to respond to prior medical and surgical management. Baseline Quantiferon-TB Gold and chest radiograph were carried out before commencement of treatment. No patients had associated Crohn's disease. All patients received induction infusions of infliximab 5 mg/kg at weeks 0, 2 and 6, followed by eight weekly maintenance infusions. The total number of infusions varied between 4 and 6. Skin photography with Sartorius scoring was used to evaluate response to treatment. All patients experienced marked improvement in their disease activity, with a mean 48% improvement in Sartorius score after one infusion (week 2, P < 0.01), and 70% improvement after three infusions (week 14, P < 0.01). Time to relapse following cessation of therapy ranged from 6 weeks to 4 months. Further studies examining the efficacy of infliximab and its effect on the course of the disease, particularly relating to long-term management, are required. [source]