Effectiveness of chest radiography,lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure

Hydrostatic pulmonary edema is as an abnormal increase in extravascular water secondary to elevated pressure in the pulmonary circulation, due to congestive heart failure or intravascular volume overload. Diagnosis of hydrostatic pulmonary edema is usually based on clinical signs associated to conventional radiography findings. Interpretation of radiologic signs of cardiogenic pulmonary edema are often questionable and subject. For a bedside prompt evaluation, lung ultrasound (LUS) may assess pulmonary congestion through the evaluation of vertical reverberation artifacts, known as B-lines. These artifacts are related to multiple minimal acoustic interfaces between small water-rich structures and alveolar air, as it happens in case of thickened interlobular septa due to increase of extravascular lung water. The number, diffusion and intensity of B lines correlates with both the radiologic and invasive estimate of extravascular lung water. The integration of conventional chest radiograph with LUS can be very helpful to obtain the correct diagnosis. Computed tomography (CT) is of limited use in the work up of cardiogenic pulmonary edema, due to its high cost, little use in the emergencies and radiation exposure. However, a deep knowledge of CT signs of pulmonary edema is crucial when other similar pulmonary conditions may occasionally be in the differential diagnosis.     

Epithelioid Hemangioma Involving Three Contiguous Bones: a Case Report with a Review of the Literature

An epithelioid hemangioma involving three contiguous bones in continuity has, to the best of our knowledge, not been reported in the literature. A case of a 48-year-old man presented with radiating pain to the lower thoracic region for two years. A radiograph and CT scan revealed both permeative osteolytic and multiple trabeculated lesions involving the left posterior part of the 10th rib as well as the 9th and 10th vertebral bodies in continuity and was misled as a malignant or infectious lesion. The histopathology and immuno-histochemistry of the lesion confirmed the diagnosis of an epithelioid hemangioma. The lesion was still stable as of three years after surgery.     

纤维性骨皮质缺损的X线、CT诊断价值

目的评价纤维性骨皮质缺损的X线与CT诊断价值。方法18例(21个病灶)均有平片资料,其中13例(14个病灶)有CT资料,8例(9个病灶)经随访观察1~3年,2例手术病理证实。重点分析X线、CT特点。结果18例共21个病灶,其中股骨远侧干骺部10个,胫骨近侧干骺部5个,胫骨骨干3个,股骨近侧干骺部2个,肱骨近侧干骺部1个;单发15例,多发3例。X线表现:多呈类圆形或椭圆形的低密度灶,切线位呈杯口状或碟状的骨皮质缺损区,病灶内缘可见硬化边,周围未见骨膜反应及软组织肿胀。14个病灶CT表现:缺损可位于骨皮质表层(11个)或骨皮质内(3个),位于骨皮质表层者缺损表面无骨壳,局限于骨皮质内者缺损表面骨壳可完整;7个病灶凹向髓腔并以硬化边与髓腔分隔,但无膨胀性改变或突入髓腔;灶内为均匀软组织密度,未见钙化灶。9个病灶经随访观察,其中4个病灶无改变,4个病灶稍有缩小,1个病灶发展为非骨化性纤维瘤。结论典型的纤维性骨皮质缺损单凭平片即可诊断,但CT比平片更有价值。     

严重急性呼吸综合征的影像学分析

目的探讨严重急性呼吸综合征(SARS)的X线及CT表现。资料与方法回顾性分析108例SAPS患者的影像学表现。所有病例均有较完整的胸片资料，其中5例同时行CT检查。结果SARS的影像学表现形式多样，主要表现为肺实质渗出性病变和肺间质渗出性病变两大类型，根据病变早期及进展期表现，又可将其分为5型：(1)单纯局限型：32例，为肺内单一局限病灶，随后病变扩大或无明显增大；(2)局限-广泛型：20例，为肺内单一局限病灶迅速发展为弥漫分布；(3)多发型：28例，为早期即见肺内多发片状和／或结节状病灶；(4)间质-实质型：22例，早期为肺部间质性渗出，随后发展为肺实质渗出性病变；(5)单纯间质型：6例，主要表现为肺间质渗出性病变。结论X线检查是发现SARS的最基本的影像学检查方法，CT能更好地显示病变。在SARS的诊治过程中，有必要了解本病的影像学分型和分期，这有助于判断病情，指导治疗，估计预后。     

Radiographic differentiation between different etiologies of pulmonary edema

We compared the plain chest radiographs of critically ill patients who had different types of pulmonary edema and evaluated the radiographs according to a standardized score sheet of findings. We included 94 total cases of pulmonary edema: 49 with cardiogenic, 33 with permeability, and 12 with renal/overhydration pulmonary edema. Patients with cardiogenic edema had enlarged hearts, vascular engorgement, septal lines, and absence of air bronchograms significantly more often than patients with permeability pulmonary edema. Renal/overhydration patients had enlarged hearts significantly more often than patients with permeability edema. There were no other statistically significant differences. Heart size and presence or absence of septal lines could have been used to distinguish cardiogenic and permeability edema in 83% of cases.     

软骨母细胞瘤MRI及X线平片和CT的表现特征

目的 研究软骨母细胞瘤的影像表现,探讨其MRI与X线平片、CT征象的对应关系.方法 分析16例经手术、病理证实的良性软骨母细胞瘤的影像资料,总结其MRI表现与X线平片、CT征象的对应关系.结果 16例软骨母细胞瘤均位于骨骺,大小为0.9 cm×0.8 cm×1.0 cm～4.8 cm×4.3 cm×5.1 cm,呈不同程度的分叶状.在T1WI上以等、低信号为主,T2WI上呈混杂信号,CT上为软组织密度,内见钙化和更低密度区.边缘呈长T1、短T2信号,在CT上表现为硬化边.MRI可见病灶周围有骨髓水肿,在X线和CT上表现为骨质硬化区.病灶邻近软组织肿胀.MRI显示骨膜异常9例,8例与病灶不相邻;X线和(或)CT显示骨膜新生骨6例.MRI显示关节积液12例,CT显示6例.MRI上病灶均呈不均匀强化,骨髓水肿、骨膜反应和软组织肿胀均见强化.软骨母细胞瘤在扩散加权成像(DWI)上呈等、高信号,在MR平扫中的等T1、等T2成分和长T1、长T2成分,以及骨髓水肿、骨膜反应和软组织肿胀在DWI上均呈高信号.结论 MRI和X线平片、CT从不同方面反映软骨母细胞瘤的病理改变,联合应用不同检查手段可更全面显示软骨母细胞瘤的特点.     

Pulmonary manifestations of Hodgkin's disease: radiographic and CT findings

The aim of this study was to assess the radiological and CT findings in patients with pulmonary Hodgkin's disease and to analyse to what extent CT provides more diagnostic information. In 37 patients with 41 episodes of pulmonary manifestation of Hodgkin's disease (histological diagnosis: 11, clinical diagnosis: 30) 39 radiographs and 33 CT scans were analysed by two readers in consensus. Pulmonary nodules were recorded in 77% of radiographs (CXR) and 88% of CT scans. Nodules were multiple in 67% (CXR) and 86% (CT) and bilateral in 43% (CXR) and 66% (CT) of cases, respectively. Nodule size ranged from 2 to 100 mm. Of the nodules, 83% at radiography and CT, respectively, were < or =30 mm, and again 83% at radiography and CT, respectively, were irregularly marginated. Diffuse infiltration with and without nodules was less common. With pulmonary manifestations at initial diagnosis of Hodgkin's disease there was always hilar or mediastinal lymphadenopathy. Of 20 episodes, in which radiograph and CT had been obtained within 8 days, CT demonstrated pulmonary involvement when chest radiography was normal in 3 cases and demonstrated more lesions in 12 cases. The typical appearance of pulmonary HD consisted of multiple, irregularly marginated pulmonary nodules. Diffuse infiltration was less common. Computed tomography was superior to radiography not only in characterization of lesions but could also demonstrate pulmonary involvement when the radiograph was normal and should, therefore, be used liberally in addition to radiography.     

颅内淋巴瘤的影像学诊断

目的:探讨原发性颅内淋巴瘤的影像学表现,以提高诊断水平。方法:回顾性分析9例经手术病理证实的原发性颅内淋巴瘤的影像学表现。结果:单发病灶8例,1例为两个病灶,肿瘤常位于额叶或中线附近的脑白质,位于幕上8例,幕下1例。CT平扫呈等或稍高密度,边界较清,增强扫描呈均匀强化。MRI平扫T1WI呈稍低或等信号,T2WI呈等或高信号。肿瘤占位效应轻,轻中度水肿。结论:原发性颅内淋巴瘤的影像学表现有一定的特征性,对诊断和鉴别诊断具有重要价值。     

脊柱转移瘤的CT诊断：附41例分析

笔者报告４１例脊柱转移瘤的ＣＴ表现。原发灶以肺癌、乳腺癌和肝癌较多见。ＣＴ表现主要呈溶骨性（６８．３％），亦可呈成骨性（１４．６％）或混合性（１７．１％）。本组４１例中２０例作平片Ｘ线检查。ＣＴ扫描在发现和估价病变方面较平片Ｘ线检查为敏感，如ｘ线平片发现骨破坏仅为５５％，ＣＴ扫描为１００％；Ｘ线平片显示椎管受累为１４％，ＣＴ扫描为６５％。对脊柱转移瘤的ＣＴ表现、ＣＴ诊断和鉴别诊断价值等进行了讨论。     

SARS的胸部X线与CT诊断

目的 评价X线平片和CT检查在严重急性呼吸综合征(SARS)的诊断价值。方法 回顾性分析29例临床诊断SARS的患者，对发病后的一系列胸片和CT影像进行分析。结果 X线表现：发热后1周内胸片显示单侧或双侧肺局灶性斑片状模糊影，然后迅速扩大到其他肺野，部分呈片团状弥漫分布，部分融合呈大片状，中心密度高，周边密度低，可见支气管气像。按病变高峰期侵犯肺的范围将病变分为轻、中、重度，轻度5例，中度10例，重度14例。CT表现：发病1～10d有4例CT扫描显示两肺多发斑片状实变影，边缘模糊，部分融合成大片状，可见支气管气像。发病10～30d有9例进行CT检查，表现为两肺大部或弥漫磨玻璃样改变，肺间质增厚，呈粗大网状，夹杂斑块状肺实变影，胸膜下区可见小叶过度充气征象；发病30d后，有19例进行检查，2例CT表现正常，17例主要表现为两肺局灶或广泛性不同程度的肺间质增厚影像。结论 SARS同时存在急性肺炎和急性间质性肺炎的影像改变，在治疗过程中，一系列胸片检查有助于掌握病情的变化，CT检查能较准确地评价肺部病变。