Hemiazygous continuation of a left inferior vena cava: Misleading radiographic findings in chest trauma

A widened mediastinum was found on chest radiography following blunt chest trauma. Aortography alone could not adequately determine the etiology of the radiographic findings; on computed tomography (CT) benign mediastinal widening was confirmed owing to accessory hemiazygous continuation of a left inferior vena cava (IVC), with communication to the left brachiocephalic vein through an enlarged left superior (highest) intercostal vein. This unusual anatomic variant and its radiographic finding are reviewed, as well as the complementary role of CT in the evaluation of the traumatized thoracic aorta and mediastinum.     

特发性单侧透明肺的影像诊断

目的分析特发性单侧透明肺的影像诊断。方法本组共29例特发性单侧透明肺。29例均拍胸部正侧位片,其中19例行电视透视,14例行胸部CT扫描,2例做支气管造影,1例行体层摄影,1例行肺动脉、主动脉造影。结果29例患肺透亮度增大,其中左全肺23例,左下叶5例,左全肺并右肺中下叶1例。左肺门及肺血管性纹理细小。21例左侧胸廓轻度塌陷,21例纵隔气管左偏,19例电视透视见纵隔摆动,14例CT扫描见左肺动脉细小,其中主干细小9例,左肺下叶动脉细小5例。12例见右下肺动脉干增粗,5例动脉段延长,7例肺动脉段突出,4例心脏增大,19例支气管扩张。结论影像学检查是特发性单侧透明肺的关键确诊手段。     

Unilateral congenital cerebral venous dysgenesis

I report a 30-year-old woman with congenital cerebral venous dysgenesis with absence of the internal cerebral and basal veins and most of the cortical veins. Unlike the more common bilateral picture, she had involvement only on the left side, which delayed presentation and gave relatively mild symptoms. The embryological mechanism and differential diagnosis of unilateral absence of the internal cerebral, basal and cortical veins are discussed. Received: 27 November 1998/Accepted: 13 May 1999     

Radiology residents' on-call interpretation of chest radiographs for pneumonia

RATIONALE AND OBJECTIVES: This study is designed to assess the performance of radiology residents in interpreting emergency department chest radiographs for pneumonia and to characterize chest radiographic findings in patients for which interpretation was amended by an attending radiologist. MATERIALS AND METHODS: We retrospectively reviewed all amended reports for chest radiographs performed on emergency department patients July 2002-June 2003. Reports preliminarily interpreted by residents and amended by a board-certified staff radiologist for the presence or absence of pneumonia were identified. A panel of three experienced radiologists, blinded to reports, jointly reviewed each chest radiograph. If the panel diagnosed pneumonia, the chest radiograph was evaluated for the projection that best showed the pneumonia, its size and location, and the presence or absence of the following features: increased opacity, air bronchograms, loss of vascular markings, silhouette sign, and linear opacities. The resident's post-graduate year (PGY) training level was noted. RESULTS: One percent (134/12,600 reports) of chest radiographic reports were amended for the presence or absence of pneumonia. One hundred chest radiographs were available and comprised the series. There were 56 females and 44 males with a mean age of 45 years (range, 1-99 years). The staff radiologist diagnosed pneumonia in 79% (79/100 radiographs). The panel agreed with the staff in 77% (kappa = 0.76) and the resident in 23% (kappa = 0.43). The panel diagnosed pneumonia in 60% (60/100 radiographs) with the following chest radiographic findings: 100% (60/60), increased opacity; 37% (22/60), air bronchograms; 72% (43/60), loss of vascular markings; 40% (24/60), silhouette sign; and 20% (12/60), linear opacities. The pneumonia was right sided in 52% (31/60), left sided in 37% (22/60), and bilateral in 11% (7/60). Right-sided pneumonias were equally distributed among the three lobes, and left-sided pneumonias had a lower-lobe predominance of 77% (17/22). Seventy-five percent (45/60) of pneumonias were segmental or smaller, and 82% (49/60) of chest radiographs showing pneumonia had both posteroanterior and lateral projections. The pneumonia was conspicuous on only one projection in 43% (21/49); the posteroanterior view in 22% (11/49), and the lateral view in 20% (10/49). Eighty-one percent (81/100) of interpreting residents were PGY-3. CONCLUSION: Interpretation of chest radiographs for pneumonia by PGY-3 residents has a low error rate. Missed pneumonias often were segmental or smaller and conspicuous on only one projection.     

胸痛患者多巴酚丁胺负荷超声心动图的左心功能变化

目的　探讨胸痛患者在多巴酚丁胺负荷超声心动图 (DSE)情况下的左心功能变化。方法　采用二维、脉冲式多普勒超声检测DSE患者左室收缩和舒张功能。结果　 18名胸痛患者 ,经DSE后 ,出现左室壁局部运动异常 8例 (DSE阳性患者 ) ,左室壁普遍性运动增强 10例 (DSE阴性患者 )。DSE阴性患者的每搏量 (SV)、心输出量 (CO)明显高于DSE阳性患者 (P <0 .0 5 ) ;多巴酚丁胺峰值剂量时E/A比值两组患者均 <1。结论　DSE可作为胸痛患者左室局部、整体收缩功能的较好评估方法 ,而对左室舒张功能的判定尚缺乏合适的指标     

Bronchial atresia of the right lower lobe

Bronchial atresia (BA) is a rare congenital anomaly that is found incidentally in approximately 50% of cases. It predominantly affects young men and generally produces no symptoms. The other 50% of cases have pulmonary symptoms such as fever, cough, or shortness of breath due to recurrent pulmonary infection or overinflation of the involved lung parenchyma. The most common site is the left upper lobe, particularly of the apical-posterior segment. The right lower and middle lobes are affected in only 8% of cases. The radiographic features may be highly suggestive of the diagnosis. The mucus-filled bronchus is seen as a rounded, branching opacity emanating from the hilum and is surrounded by an area of increased hyper-translucency. We report an unusual presentation of BA in a 43-year-old woman with a history of recurrent pulmonary infection and dyspnea. The patient was found to have BA in all the basal segments of the lower lobe of the right lung.     

下呼吸道非金属异物的定位诊断(附150例分析)

目的　探讨下呼吸道非金属异物的X线定位诊断。方法　回顾性分析 15 0例X线诊断与纤维支气管镜检查所见相符合的下呼吸道非金属异物患者。均在透视下以不同角度观察呼吸两相时心影、纵隔、肺野透亮度以及横膈的变化情况 ,以此判断异物所在的位置。结果　 15 0例患者 ,气管异物 3 8例 ,右侧支气管异物 81例 (包括右主支气管 2 5例 ,右上叶支气管 4例 ,右中叶支气管 5例 ,右下叶及段支气管 47例 ) ,左侧支气管异物 3 1例 (包括左主支气管 13例 ,左上叶支气管 2例 ,左下叶支气管 16例 )。由于存在着解剖上的差异 ,右下叶支气管异物较左侧的多。结论　凡疑有下呼吸道异物的病例 ,均应行X线检查 ,透视应作为常规 ,其具有更高的定位诊断准确性     

小儿支原体肺炎54例胸部CT影像分析

目的分析总结小儿肺炎支原体肺炎(MPP)胸部CT影像学特点。方法回顾性分析本院儿科2010年9月—2011年2月间明确诊断的54例MPP患儿的临床资料及胸部CT。结果胸部CT显示病变部位:单侧者39例(72.22%),双侧者15例(27.78%);单侧中右侧者20例(51.28%),左侧者19例(48.72%);多个叶段受累30例(55.56%)多于单个叶段受累24例(44.44%),各受累叶段分布情况为:右下叶18例(33.33%),左下叶15例(27.78%),左上叶11例(20.37%),右上叶7例(12.96%),右中叶7例(12.96%),左中叶2例(3.70%);病变性质显示为大片实变影31例(57.41%),斑点状及斑片状实变影22例(40.74%),云絮状或磨玻璃样或网格样密度增高影各1例(1.85%),双肺散在斑片影7例(12.96%),其中非单个叶段受累者大片实变与斑点状及斑片状实变多同时存在。其他病变还有胸腔积液14例(25.93%),肺门淋巴结肿大7例(12.96%),肺不张7例(12.96%),心包积液1例(1.85%)。婴幼儿MMP胸部CT以散在斑片影为主,年幼儿以斑点状及斑片状实变影为主,年长儿则多表现为大片实变影。结论小儿MPP单侧病变多于双侧,右肺病变多于左肺,大片实变影最多,其次为斑点及斑片状实变影,也可见双肺散在斑片影。其影像学特点与年龄有关。胸部CT影像学特点有助于婴幼儿及年幼儿MPP的诊断及儿童MPP的早期诊断。     

64层螺旋CT多平面重组显示肺叶间裂变异的价值

目的观察肺叶间裂及变异在64层螺旋CT多平面重组（MPR）的显示及分布。方法64层螺旋CT以0．6mm层厚采样扫描1235例胸部病变患者，使用MPR技术显示肺叶间裂及变异（包括附属裂）。结果1235例患者中肺叶间裂无变异者占80．08％（989例），变异者占19、92％（246例）。变异肺中，双侧变异20．33％（50例）；单侧变异79．67％（196例），其中右肺变异63．01％（155例），左肺16．66％（41例）。右肺既无斜裂亦无水平裂1．22％（3例），左肺无斜裂（6．91％，17例）比右肺多（3．65％，9例）。左肺斜裂不全（8．53％，21例）比右肺多（4．06％，10例）。246例中右肺无水平裂27．24％（67例），水平裂不全9．76％（24例）。肺附属裂83．33％（205例），右肺（53．66％，132例）比左肺多（29．67％，73例），右下叶段（40．65％，100例）明显高于左下叶段（7．72％，19例），舌裂15．85％（39例）。斜裂和水平裂形态和位置改变41．06％（101例），右侧（35．37％，87例）高于左侧（5．69％，14例）。结论64层螺旋CTMPR完全能显示肺叶间裂、肺叶间裂变异和附属裂，而且能区别病变和小血管。     

MRI visualization of the aortic nipple

The aortic nipple, a small “pseudotumor” adjacent to the aortic arch, is the left superior intercostal vein. In our series of 40 patients it was demonstrated in six; all had a right upper thoracic mass and four had a superior vena caval syndrome. Coronal magnetic resonance, images (MRI) of the thorax were superior to all other imaging methods in demonstrating the nipple. It is concluded that in patients with masses in the right upper chest, coronal MR chest examinations are valuable in demonstrating an aortic nipple, a sign of impending present superior vena caval or innominate, vein obstruction.     

Interrupted Aortic Arch Associated with Absence of Left Common Carotid Artery: Imaging with MDCT

Interrupted aortic arch (IAA) is a rare severe congenital heart defect defined as complete luminal and anatomic discontinuity between ascending and descending aorta. Although its association with various congenital heart defects has been reported, absence of left common carotid artery (CCA) in patients with IAA has not been reported previously. We report a case of IAA associated with the absence of left CCA which was clearly shown on multidetector-row spiral CT.     

心血管术后床旁胸片的临床应用评价

目的 :评价心血管术后床旁胸片的临床应用价值及限度。方法 :2 0 6例心血管术后病人 ,使用移动 X线机摄取床旁胸片 ,分析术后新出现的异常。结果 :上述床旁胸片新出现异常率高达 6 0 .7% (12 5 / 2 0 6 ) ,左侧居多占 35 .4% (73/ 2 0 6 )。其中最常见的依次为胸腔积液、肺不张和气胸 ,发生率分别为 36 .4%、2 7.7%和 9.2 %。结论 :床旁胸片是全面了解心血管术后病人胸肺异常的重要和有效的检查手段 ,但有一定限度     

Differentiating diaphragmatic paralysis and eventration

RATIONALE AND OBJECTIVES: Although elevation of the diaphragm can be appreciated on conventional PA and lateral chest radiography, the modality is commonly viewed as inadequate to differentiate diaphragmatic paralysis from eventration. Our objective was to qualitatively and quantitatively measure the utility of chest radiography in determining the presence or absence of diaphragmatic paralysis in patients with an elevated diaphragm. MATERIALS AND METHODS: A retrospective analysis of chest radiographs in 32 patients, whom underwent fluoroscopic sniff test for elevated diaphragm, was performed. Diaphragm function was graded by a senior radiology resident, as either "paralyzed" or "non-paralyzed," based on appearance/shape of elevated hemidiaphragm on PA and lateral radiograph. The diaphragm position and shape for all patients were determined using measurements relating to skeletal structures and radius of curvature, respectively. These results were correlated with the results of the fluoroscopic sniff tests. RESULTS: Of 32 patients with elevated diaphragm on chest radiograph, 17 had diaphragmatic paralysis confirmed with fluoroscopic sniff test. Our results indicate that the radius of curvature or shape of the diaphragm on lateral chest radiograph is the most important factor for detection of the presence or absence of diaphragmatic paralysis. HH/APD > 0.28 suggests against paralysis. CONCLUSION: Conventional chest radiography appears to be a useful modality for assessment of the functional status of an elevated diaphragm. Based on our results, evaluation of the shape of an elevated diaphragm may preclude the need for fluoroscopic sniff test to determine diaphragmatic paralysis.     

异常体动脉供应正常左下肺基底段的胸部X线片和螺旋CT表现

目的 总结异常体动脉供应正常左下肺基底段在胸部X线片和螺旋CT上的特征性表现。方法 回顾分析5例异常体动脉供应正常左下肺基底段的胸部X线片和螺旋CT资料。结果 5例异常体动脉供应正常左下肺基底段在胸部X线片上均表现为心后区肿块，左下肺动脉纹理细小，受累左下肺区域无正常肺动脉分支影分布，但有异常增粗纹理。CT上5例均表现为受累肺组织体积轻度缩小，支气管通畅，2例肺实质呈磨玻璃状改变。5例均可见左下肺动脉在背段动脉起始远侧缺如，增粗扭曲的异常体动脉起自降主动脉，其扩张的分支分布于受累肺段。1例血管造影表现与CT相仿。结论 该病在胸部X线片上的表现有一定特征性。增强螺旋CT扫描可明确诊断，以避免创伤性的血管造影和致命的穿刺活检。     

Dual-source computed tomography in patients with acute chest pain: feasibility and image quality

The aim of this study was to determine the feasibility and image quality of dual-source computed tomography angiography (DSCTA) in patients with acute chest pain for the assessment of the lung, thoracic aorta, and for pulmonary and coronary arteries. Sixty consecutive patients (32 female, 28 male, mean age 58.1±16.3 years) with acute chest pain underwent contrast-enhanced electrocardiography-gated DSCTA without prior beta-blocker administration. Vessel attenuation of different thoracic vascular territories was measured, and image quality was semi-quantitatively analyzed by two independent readers. Image quality of the thoracic aorta was diagnostic in all 60 patients, image quality of pulmonary arteries was diagnostic in 59, and image quality of coronary arteries was diagnostic in 58 patients. Pairwise intraindividual comparisons of attenuation values were small and ranged between 1±6 HU comparing right and left coronary artery and 56±9 HU comparing the pulmonary trunk and left ventricle. Mean attenuation was 291±65 HU in the ascending aorta, 334±93 HU in the pulmonary trunk, and 285±66 HU and 268±67 HU in the right and left coronary artery, respectively. DSCTA is feasible and provides diagnostic image quality of the thoracic aorta, pulmonary and coronary arteries in patients with acute chest pain.     

64-MDCT左心功能检查左心室收缩和舒张末期期相分析

目的:探讨64-MDCT左心功能检测时左心室舒张末期和收缩末期所对应的期相。方法:随机搜集2010年4月-2011年5月在本科室行64-MDCT冠状动脉造影检查成功的冠心病患者50例,将原始图像重建间隔为5%R-R间期,0%～95%共20个期相的全心动周期薄层图像,输入后处理工作站,采用自动心功能分析软件,计算出各个期相的左心室容积。结果:50例受检者中48例左心室舒张末期为0%期相,2例为95%期相,0%与95%期相左心室容积差异无统计学意义;左心室收缩末期14例为35%期相,29例为40%期相,7例为45%期相,35%与40%期相、35%与45%期相左心室容积差异无统计学意义。结论:64-MDCT心功能检测时,左心室舒张末期多为0%期相,收缩末期为35%～45%期相。     

青石棉所致胸膜间皮瘤CT分析

目的分析因环境接触青石棉所致胸膜间皮瘤病例的CT征象。方法对55例经证实的胸膜间皮瘤病例CT表现进行回顾性分析。结果在55例中,局限型胸膜间皮瘤1例并恶变,伴少量胸水;弥漫型胸膜间皮瘤54例,其中无胸水13例,少或中等量胸水30例,大量胸水11例。右下胸膜间皮瘤伴对侧胸水4例。CT表现为胸膜增厚>2cm,呈花边状、结节状或软组织肿块,增强有强化。结论CT对确定胸膜间皮瘤部位、范围及随访方面作用较大。     

Gd-DOTA tubular transit asymmetry induced by angiotensin-converting enzyme inhibitor in experimental renovascular hypertension

In stenosis of a renal artery, angiotensin-converting enzyme inhibitor (ACEI) can induce a decrease in ipsilateral glomerular filtration. Dynamic MR imaging with gadolinium chelate enhancement was tested to detect this glomerular filtration reduction in experimental renovascular hypertension in the rat. Thirteen rats, with surgically induced left renal artery stenosis, developed hypertension and were studied before and after intravenous injection of ACEI with sequential Gd-DOTA-enhanced MR imaging. The time to onset of the tubular phase, the time of the maximal drop of signal, and the medullary signal-time curves of both kidneys were compared. Before ACEI, tubular phases were symmetric in 11 rats and slightly asymmetric in 2. Twelve rats showed ACEI-induced changes (positive test): absence of tubular phase on the left side (n=8) or delay (n=4) with significant differences (P<.01). Tubular phases remained symmetric in one (negative test). Dynamic MR imaging can identify ACEI-induced Gd-DOTA tubular transit asymmetry, indicative of functionally significant renal artery stenoses, in rats.     

左位下腔静脉的MSCT表现及临床意义

目的 探讨左位下腔静脉的多层螺旋CT(multi-slice spiral CT, MSCT)表现及临床意义。方法 选取腹部MSCT多期增强扫描发现的11例左位下腔静脉患者,结合文献讨论其影像学表现。结果 11例左位下腔静脉MSCT表现为3种类型。Ⅰ型1例（9.09%）,表现为右侧下腔静脉缺失,左右髂总静脉于第5腰椎左前方汇合成下腔静脉主干后,沿腹主动脉左侧垂直上行,沿途先后有右肾静脉和左肾静脉汇入,然后与半奇静脉连接,经上腔静脉汇入右心房。Ⅱ型6例（54.55%）,表现为肾下右侧下腔静脉残余,肾下左位下腔静脉位于腹主动脉左侧,于左肾静脉汇入后从前方跨越腹主动脉向右上走行,与右肾静脉汇合后移行为正常的下腔静脉。Ⅲ型4例（36.36%）,表现为肾下右侧下腔静脉缺失,而左位下腔静脉的起止、位置、走行及属支汇入与Ⅱ型完全相同。结论 左位下腔静脉MSCT表现为3种类型,左位下腔静脉的存在对临床及介入治疗而言具有重要的意义。     

Inadvertent embolic obstruction of abdominal aorta from left atrial thrombus after percutaneous mitral valvuloplasty

Inadvertent embolic obstruction of the distal abdominal aorta and left renal artery during a percutaneous mitral valvuloplasty procedure in a patient with mitral stenosis is reported. The embolism was from a left atrial thrombus which was detected by magnetic resonance imaging (MRI) but not by transesophageal echocardiography.