The plain chest radiograph in uncomplicated Ebstein''s disease

Displacement of the origin of the tricuspid valve into the right ventricle, redundancy of its leaflets and tricuspid incompetence are all present to varying degrees in Ebstein's disease. Cardiac arrhythmias are a common feature. Presentation in infancy with severe displacement of the valve, right-sided heart failure, cyanosis and gross cardiomegaly are the classic features. More recently, echocardiography has revealed a group presenting with arrhythmias but with no significant haemodynamic disturbance, or with an asymptomatic murmur who have a normal or near normal chest radiograph and mild displacement of the valve. Before the availability of echocardiography, most of this group escaped diagnosis as there were insufficient indications for cardiac catheterisation.     

The plain abdominal radiograph in acute gastrointestinal graft-vs.-host disease

The plain abdominal radiographs of 28 patients with acute gastrointestinal graft-vs.-host disease (GVHD) were examined to determine the plain radiographic findings associated with this disorder. These findings, in order of decreasing frequency, included air-fluid levels, bowel wall/mucosal fold thickening, gasless abdomen, bowel dilatation, pneumatosis intestinalis, and ascites. When a number of these findings are present, the plain abdominal radiographs may be sufficiently characteristic to suggest gastrointestinal GVHD. Differentiating acute gastrointestinal GVHD from small-bowel obstruction is often of major clinical importance. Fortunately, the bowel gas pattern in acute gastrointestinal GVHD rarely suggests obstruction and, thus, bowel obstruction can usually be excluded on the basis of plain radiographs alone.     

The chest radiograph in brucellosis

A retrospective study of chest radiographs in patients with brucellosis was undertaken at King Khalid University Hospital, Riyadh. The commonest presenting symptoms were fever, back and joint pains, excessive sweating, headache, and cough. Different chest radiographic abnormalities were detected, including soft miliary mottling, parenchymal nodules, consolidation, chronic diffuse changes, hilar or paratracheal lymphadenopathy and pneumothorax. Soft miliary mottling and pneumothorax have not been described before. The high incidence of lung abnormalities is most probably due to the chronicity of the disease in the present series.     

The plain abdominal radiograph in pneumatosis coli

The clinical features and plain film findings in 14 patients with pneumatosis coli are described. Nine had oxygen treatment. The plain radiographic appearances are analysed and their value in diagnosis is presented. It is concluded that the plain abdominal radiograph is a simple and effective way of monitoring the progress of patients undergoing oxygen therapy.     

The chest radiograph in whooping cough

The chest radiographs of 238 patients admitted to hospital with acute whooping cough are reviewed. Radiographic abnormalities were detected in 63 (26%) patients; pulmonary consolidation was seen in 50 (21%) patients, collapse in nine (4%) and lymphadenopathy in 22 (9%). The most common type of consolidation was peribronchial (72%). Both collapse and consolidation were commoner on the right and tended to involve the lower and middle lobes. These abnormalities were more common in those aged 1 year old or more (p less than 0.001) but no other clinical feature was found to predict those patients with an abnormal chest radiograph. Follow-up radiographs demonstrated no significant radiographic sequelae. Comparison with previous series shows a reduced frequency and change in the pattern of radiological abnormalities over the last 20 years.     

Radiographic manifestations of acute smoke inhalation.

Acute smoke inhalation may lead to serious pulmonary injury and contribute significantly to mortality of fire victims. The chest radiographic findings in 21 patients with acute smoke inhalation are analyzed, and possible pathophysiologic mechanisms responsible for the radiographic abnormalities noted are discussed. Patients with surface injury burns were intentionally eliminated from this study. Our findings indicate that the standard chest radiograph is an insensitive means of determining pulmonary injury by smoke inhalation. The importance of blood carboxyhemoglobin levels and arterial blood gas determinations in the clinical evaluation of patients with acute smoke inhalation is stressed.     

The cervicothoracic junction on chest radiograph

Fractures of the first rib may be detected by indirect signs, including apical extrapleural fluid collection, pneumothorax, and supraclavicular soft tissue mass. Thoracic outlet syndrome represents a complex series of abnormalities that may be clarified utilizing digital subtraction angiography. Major distortions of alignment can produce bony adaptive changes at the cervicothoracic junction simulating intra-spinal canal tumors.     

The chest radiograph in legionnaires'' disease

The chest radiographs of 24 patients with documented Legionnaires' disease were evaluated. Twenty-two of the 24 patients had positive findings for the disease initially. There was unilateral involvement in 68% and the most common lung shadows were poorly marginated round opacities (46%), diffuse patchy (25%) and peripheral opacities (21%). At peak, 70% of patients had a lobar shadow. Pleural effusions were present in 39% of cases but could be explained by underlying congestive heart failure or renal failure in 7 of the 9. Although the findings are not specific, the radiologist should consider this diagnosis in a patient with compatible clinical history, a pneumonia of obscure etiology, and these radiographic manifestations.     

The chest radiograph in ankylosing spondylitis.

In a study of 42 patients with ankylosing spondylitis, upper lobe fibrosis was present in six (14-3%) patients. All the patients with upper lobe fibrosis had total spinal ankylosis, and half showed peripheral joint involvement. A further 13 patients (30-9%) had other focal pulmonary abnormalities compared with only six (14-3%) of a group of age-matched controls. There was no correlation between the radiological extent of the disease (spinal changes and pulmonary involvement) and any of the haematological or biochemical parameters measured. Treatment with radiotherapy was not responsible for these changes.