Reflex sympathetic dystrophy syndrome: a review.

Reflex sympathetic dystrophy syndrome is a serious and potentially disabling condition. Early diagnosis and treatment are essential to control the disorder and restore the patient's quality of life. The cardinal clinical features, radiological changes, etiopathologic advances, and current approaches to proper diagnosis and treatment will be discussed.     

Useful imaging techniques in the diagnosis and follow up of large vessel vasculitis: eco-doppler, angio-CT, angio-RM

Although most vasculitis require histological proof for a definitive diagnosis, diagnostic imaging can be very helpful in this regard, allowing a proper evaluation of the vascular system and monitoring the response to treatment. Even though vasculitis is constituted by different pathological substrates, they show a common semiologic pattern from a radiological standpoint which is represented by inflammation, arterial wall thickening, and potential secondary development of vascular stenosis, occlusions or aneurysms. Differential diagnosis among diverse entities is based, beside clinical criteria, on the anatomical location and topography of the affected vascular territory. The general radiologic semiology is described in this paper from the perspective of the different imaging techniques, addressing their main advantages and drawbacks. Proper knowledge of this techniques will allow us to select the most appropiate one for each clinical condition.     

Critical checking of the radiological diagnosis of "complete remission" and "partial remission" following induction chemotherapy of small-cell lung cancer in the light of postoperative histological examination.

A multimodal therapy concept for small-cell lung cancer, which for patients with established pretherapeutic homolateral lymph-node metastases (N2) prescribes induction chemotherapy with subsequent resection as well as supplemental chemo- and radiotherapy, provided the opportunity to evaluate histologically the radiological diagnoses "complete remission" and "partial remission" using resection specimens. In 17 patients a 75% to 100% reduction in tumor size was achieved according to radiological diagnosis. Predictions of "no evidence of disease" or "evidence of disease" were only correct in ten cases. In the remaining seven cases, histology showed the radiological findings to be incorrect. This gives a 77% sensitivity for radiological diagnosis with no specificity. Moreover, differentiation between therapy effect on the primary tumor and on the N2 metastases gives similar results: sensitivity 64% and 67% respectively, specificity 33% and 25% respectively. It is concluded that, particularly after the tumor responds well to therapy, radiological techniques are unsuitable for establishing a diagnosis of "no evidence of disease" or "evidence of disease" in small-cell lung cancer. This is because on the one hand the radiological methods available do not permit clear differentiation between vital tumor tissue and necrosis or fibrosis, while on the other hand groups of vital tumor cells beyond the resolution power of X-ray technology will escape detection.     

Primary Pulmonary Diffuse Large B-Cell Lymphoma on FDG PET/CT-MRI and DWI

Primary pulmonary diffuse large B-cell lymphoma (PPDLBCL) directly arising from lung tissue is extremely rare. It may usually be misdiagnosed as inflammation including pulmonary tuberculosis, even lung cancer, because its clinical symptoms and signs are often nonspecific. The final diagnosis usually depends on lung biopsy. Herein, we report a case of PPDLBCL and review of diagnosis of this disease, particularly in radiology.A 44-year-old man presented with cough, sputum, and intermittent chest pain for 4 weeks. Multiple radiological examinations showed an irregular mass in the right upper lobe with ground-glass opacities around it and air-filled bronchi in the consolidation. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography-magnetic resonance imaging (MRI) detected positive FDG uptake, and diffusion-weighted imaging indicated abnormal hyperintension in the lesion. Inflammation was suspected, but malignance cannot be excluded.Finally, ultrasound-guided fine-needle aspiration cytology was performed for histological examination and definitive diagnosis yielded lymphomatous cells infiltration in the right upper lobe.This report emphasizes the significance of multimodality radiological examinations. Multimodality imaging contributes to proper diagnosis, staging, and management of lymphomas.     

Bronchiolitis obliterans organizing pneumonia in a patient with Behçet's disease

A 55-year-old male presented a productive cough, haemoptysis, and intermittent fever for 2 weeks. He was diagnosed as having Behcet's disease (BD) with manifestations of recurrent oral ulcers, genital ulcers, erythema nodosum, a gastro/duodenal ulcer, colon ulcers, and folliculitis. After admission, a chest X-ray showed bilateral ill-defined patches. Subsequent chest computerized tomography revealed multiple patchy consolidations over the left and right lower lobes. Because of poor response to oxacillin antibiotic treatment, an open lung biopsy was arranged. Bronchiolitis obliterans organizing pneumonia (BOOP) was diagnosed. Methylprednisolone pulse therapy, followed by prednisolone and cyclophosphamide maintenance, was prescribed. The patient responded well, with clinical and radiological resolution. Early diagnosis with proper treatment is crucial in the management of this lethal pulmonary disease.     

Iatrogenic bile duct injuries： Etiology, diagnosis and management

Iatrogenic bile duct injuries （IBDI） remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux- en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end- to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.     

Comparison of concordance between chuna manual therapy diagnosis methods (palpation,X-ray,artificial intelligence program) in lumbar spine: An exploratory,cross-sectional,prospective observational study protocol

Introduction:Chuna manual therapy (CMT) is a type of manual medicine practiced by Korean medical doctors in South Korea. Spinal diagnosis in CMT uses a system that applies manual diagnostic and X-ray tests to detect specific vertebral malpositions, based on the relative alignment across vertebral bodies. Recently, artificial intelligence (AI) programs have been developed to assist in the radiological diagnosis of CMT using X-ray images. Nevertheless, a few clinical studies have reported on the concordance between diagnosticians, diagnostics methodologies, and the use of AI programs for diagnosing CMT. At present, the evidence to support CMT diagnosis is insufficient. This study thus aims to overcome such limitations by collecting and comparing CMT diagnostic data from experts and non-experts through manual diagnosis, X-ray test, and images obtained using an AI program. The study aims to search for CMT diagnosis methods with more outstanding rationality and consistency and to explore the potential use of AI-based CMT diagnosis programs.Methods/design:This study will be conducted as an exploratory, cross-sectional, prospective observational study that will recruit 100 non-specialist subjects. Each subject will submit a signed consent after the screening test and undergo L-spine standing AP & lateral X-ray imaging. Manual CMT diagnosis will be performed by 3 CMT experts according to the standard operation procedure (SOP). The X-ray images of the 100 subjects will subsequently be used to make the CMT radiological diagnoses according to the same SOP by the CMT expert group (n = 3) and CMT non-expert group (n = 3). Among the subjects, those in the non-expert group will receive another CMT radiological diagnosis with spinal data obtained using the AI program, approximately 1 month from after initial diagnosis.Based on the collected diagnostic data, within- and between-group concordance levels will be assessed for each diagnostic method. The verified level of concordance will be used to test the potential use of CMT diagnostic method and CMT AI programs with high levels of rationality and consistency.Ethics and dissemination:This trial has received complete ethical approval from the Wonkwang University Korean Medicine Hospital (IRB 2021–8). We intend to submit the results of the trial to a peer-reviewed journal and/or conferences.Trial registration:https://cris.nih.go.kr/cris/search/detailSearch.do?search_lang=E&search_page=M&pageSize=10&page=undefined&seq=20613&status=5&seq_group=20613, Identifier: KCT0006707.     

Hereditary angioneurotic oedema: an unusual case of recurring abdominal pain

Two patients with hereditary angioneurotic oedema, a condition characterized by repeated episodes of abdominal pain and oedema, and by an absence of complement-1 esterase inhibitor activity in the plasma are presented in detail. Both underwent multiple surgical procedures before the diagnosis was established. Abdominal pain is often the presenting complaint, and although a complete history will usually lead to the proper diagnosis, cases in which the family history is not clear can present a diagnostic dilemma. Characteristic radiological demonstration of localized intestinal oedema will only be obtained if studies are performed early during the acute attack.     

Morgagni hernia in an adult: atypical presentation and diagnostic difficulties.

Foramen of Morgagni hernias are rare diaphragmatic hernias, usually occurring on the right and located in the anterior mediastinum. Adult patients diagnosed with a foramen of Morgagni hernia are usually asymptomatic and associated with obesity, trauma or other causes of increased intraabdominal pressure. Plain pulmonary roentgenogram, radiological studies of the gastrointestinal system with contrast material, computerized tomography and magnetic resonance imaging studies are helpful in diagnosis. In this article, a 78-year-old female case with a Morgagni hernia incidentally diagnosed on chest X-ray is presented.     

Radiological diagnosis of inflammatory ulcerative diseases of the small bowel

AIM: To analyze the radiological features of ulcerative diseases of the small bowel. METHODS: Thirty-five patients (20 men and 15 women) with inflammatory ulcerative bowel diseases were studied by radiography (barium meal and/or double contrast study). Patient diseases included eleven cases of tuberculosis (TB), thirteen cases of Crohn’s disease, seven cases of bowel Behcet disease, two cases of simple ulcers, and two cases of ischemic bowel disease. Diagnosis was established pathologically in 33 cases and by clinical observation after therapy in two cases. RESULTS: The lesions were located in the ileum of 82% of TB cases, 77% of Crohn’s disease cases, 71% of bowel Behcet disease cases, 50% of simple ulcer cases, and 100% of ischemic bowel disease cases. Ulceration was always present with variable appearances. Longitudinal ulcers, and fissures were noted in Crohn’s disease only. There were five cases of large and deep ulcers, three of which were bowel Behcet disease. Superficial and irregular ulcers were present in ten TB cases, and , and transverse ulcers were identified in two TB cases. CONCLUSION: The morphological appearances of the ulcer, surrounding mucosal alterations, and bowel deformation were the basis for the radiological diagnosis. Correct diagnosis was dependent on optimal X-ray examination techniques and proper interpretation of the morphological changes.     

Osteitis condensans ilii or sacro-iliitis?

Eight patients with a radiological diagnosis of Osteitis condensans ilii (OCI) had clinical features similar to those of 8 patients with sacro-iliitis (SI). The X-ray appearances may be very difficult to differentiate on standard films and discrimination between the two conditions has to be made from a combination of clinical and radiological findings. The term OCI should be regarded with suspicion when applied to young people with a history of backache.     

Documento de consenso sobre diagnóstico,tratamiento y prevención de la tuberculosis

Pulmonary TB should be suspected in patients with respiratory symptoms longer than 2–3 weeks. Immunosuppression may modify clinical and radiological presentation. Chest X-ray shows very suggestive, albeit sometimes atypical, signs of TB. Complex radiological tests (CT scan, MR) are more useful in extrapulmonary TB.     

Thoracic actinomycosis: clinical, radiological, and pathological findings in 11 cases]

Most cases of thoracic actinomycosis (TA) have been surgically diagnosed and treated, since it is difficult to distinguish this condition from lung cancer. To clarify the features that are useful for the radiological diagnosis of TA, we analyzed the correlation between the radiological and pathological findings. TA was histologically diagnosed in the 11 patients of the present study, who were admitted to our hospital between 1976 and 2001. In the chest CT, consolidation was observed in 5 cases, a mass-like shadow in 4, a central low attenuation area (LAA) in 7, and bronchial and bronchiolar dilatation in 6. In the pathological findings, all cases showed bronchial dilatation and abscess formation in the bronchi, as well as peribronchial granulation. The evaluation of radiological and pathological correlation revealed that the central LAA in the chest CT corresponded to the abscess formation composing of actinomyces, and the cavity corresponded to the bronchial dilatation. These results suggest that radiological findings, such as LAA and bronchial and bronchiolar dilatation, are characteristic for TA, and can be useful in making a diagnosis of TA.     

Pathogenese,klinische und röntgenologische Kennzeichen der diffusen endolaveolären Pulmolithiasis

The authors discuss in detail the etiology, pathogenesis, pathological-anatomical, clinical and radiological picture of diffuse endoalveolar pulmolithiasis. They maintain that innate anomalies in the metabolism of the alveolar cells and exogenous noxious agents give rise to increased production of superficial active substance (surfactant) of the lung alveoli. Being a physiological product of the lung alveoli, this substance does not cause reactive inflammatory changes. In the course of time, degenerated elements of the superficial active substance form a mucoproteinous basis (matrix) upon which calcium salts are deposited. The authors report 11 cases of this rare disease. They admit that subjective complaints are missing in initial and non-complicated pulmolithiasis because microlites (microstones) lie freely in the alveoli and do not bring about the appearance of an alveolar-capillary block. Some X-ray peculiarities in the observed cases have been mentioned: retouching of the heart and diaphragm contours in initial cases, similar qualitative characteristics of X-ray and morphological changes in the family appearance of the disease, and the appearance of the so-called “pearl necklaces” in the X-ray picture of the lungs during the advanced stage of the disease. The authors propose a new X-ray classification of pulmolithiasis, and maintain that the disease yields pathognomonic X-ray images which offer a reliable diagnosis without the performance of diagnostic thoracthomy or a biopsy investigation of the lung.     

Clinical, laboratory, and radiological information in the diagnosis of pneumonia in children

The relative importance of clinical, laboratory, and radiological information in the diagnosis of pneumonia in children has not been extensively studied. In our study clinicians recorded clinical impressions and anticipated management prior to obtaining a chest radiograph and laboratory tests for 155 children in whom the diagnosis of pneumonia was being considered. This information was compared with the final diagnosis and management plans instituted after obtaining the radiograph and laboratory tests. Agreement occurred with the actual post-radiograph plans in 78% of treatment decisions and in 88% of disposition plans made prior to obtaining the radiograph. The overall clinical impression was more important than individual signs, symptoms, or laboratory data in predicting the radiological diagnosis. No consistent pattern of signs, symptoms, and laboratory tests was found to be useful in making the diagnosis of pneumonia.     

Clinical and radiological features of ankylosing spondylitis in the 1950's and in 1976 at the same hospital.

The clinical and radiological pictures of AS in two patient series were compared to ascertain whether or not the course of AS has changed since the 1950's. Clinical and radiological features were analysed from X-ray pictures and records of patients with a diagnosis of AS treated at the Rheumatism Foundation Hospital in 1952--59 (168 patients) and 1976 (160 patients). No significant difference in the clinical findings could be demonstrated between the two patient series. The radiological progression in the sacroiliacal joints and the lumbar spine was more rapid in the 1950's than in 1976. In the 1950's 82.1% of all patients had grade III or IV sacro-iliitis, whereas the figure for 1976 was 67.5%. The difference is statistically significant (p less than 0.01). Two-thirds of patients with a duration of the disease of less than 4 years had grade III or IV sacro-iliitis in the 1950's compared with only one-third in 1976. 14.6% of the patients in the 1950's and 4.8% in 1976 had more than 10 lumbar syndesmophytes. The difference is statistically significant (p less than 0.01). Possible reasons for the difference observed are discussed.     

显微镜下多血管炎的临床和影像学诊断体会

目的探讨显微镜下多血管炎（microscopic polyangiitis,MPA）肺部表现的临床特点及误诊原因。方法对有肺部表现的3例MPA患者的诊断过程、误诊原因和胸部影像学表现进行回顾性分析。结果3例MPA患者都有肺部损害,以发热、咳嗽、咯血、呼吸困难为主要临床表现,胸部影像主要表现为两肺弥漫性斑片状或大片磨玻璃样和实变阴影。3例MPA患者抗中性粒细胞胞浆抗体阳性。确诊前曾被误诊为肺炎、肺结核、间质性肺炎等。确诊后给予甲基强的松龙联合环磷酰胺冲击治疗,临床症状及肺部表现近期内迅速好转。结论肺是MPA的常见累及脏器之一。误诊原因主要是对本病及其肺损害的特点认识不足。     

Catastrophic antiphospholipid syndrome presented with abdominal, pulmonary, and bone marrow complications

We are presenting a case of catastrophic antiphospholipid syndrome in an adult female manifesting with abdominal thrombosis, pancytopenia, and alveolar hemorrhage. Alveolar hemorrhage is infrequently reported as it is difficult to diagnose, but it is considered as a life-threatening condition. The diagnosis should be made promptly based on clinical symptoms coupled with radiological features. Once this diagnosis is suspected, treatment with corticosteroids and anticoagulation must be initiated as soon as possible in order to reduce severe morbidity and high mortality.     

The diagnosis and misdiagnosis of tuberculosis

There are two worlds when it comes to the diagnosis of tuberculosis (TB). One world has only smear microscopy at its disposal. There may also be some radiological facilities, usually at the patients' expense. The other world has all modern techniques available, including culture, nucleic acid amplification, molecular diagnostics and sophisticated radiological techniques such as computed tomography and positron emission tomography scanning. The ability to diagnose or misdiagnose TB will vary across these two worlds. In this review, we provide an overview of clinical, radiological, molecular and immunological diagnosis of TB and highlight the common difficulties and pitfalls in TB diagnosis.     

Bronchiolitis obliterans in children: clinical profile and diagnosis

OBJECTIVE: The aim of the study was to determine the clinical profile, aetiology and radiological categories in children diagnosed with bronchiolitis obliterans (BO). METHODOLOGY: We undertook a review of the medical records and radiological studies of 14 children with BO. RESULTS: Unresolving cough and wheeze after a short respiratory illness was the commonest presentation. A viral pneumonitis was identified as the initial respiratory event prior to the development of BO in six children and Mycoplasma pneumoniae was the cause in another three children. Chest X-ray findings could be divided into four distinct patterns that were hyperinflation (n=5), mixed pattern of atelectasis, hyperlucency and bronchial thickening (n=4), unilateral small hyperlucent lung (n=3) and unilateral collapse of one lung (n=2). High resolution computed tomogram (HRCT) chest showing areas of hyperaeration and mosaic ground glass patterns with bronchial thickening were commonly found in patients whose chest X-ray showed bilateral changes. Patients with bilateral lung changes were more likely to have failure to thrive and persistent respiratory symptoms on follow up. CONCLUSION: A diagnosis of BO can be made from typical clinical features combined with an understanding of the different chest X-ray categories and HRCT of the chest. A viral aetiology was the commonest cause for BO in our series.