Evaluating current chest imaging practices of pediatric patients with COVID-19: A retrospective analysis

PurposeThis retrospective analysis aims to examine the effectiveness of the current chest imaging guidelines regarding COVID-19 positive pediatric patients on our study group of patients aged 0 to 18.Materials and methodsWe examined clinical and imaging data of 178 pediatric COVID-19 positive patients confirmed by PCR admitted to the Children's Hospital of Los Angeles between March 6, 2020 and June 23, 2020.ResultsOf 178 patients, only 46 (27%) patients underwent any form of chest imaging. Thirteen (28%) of 46 imaged patients had positive chest X-rays (CXR) or computed tomography (CT) chest findings, with 8 (62%) of the 13 patients suggesting pneumonia or multifocal pneumonia, 3 (23%) patients having acute respiratory distress syndrome, and 2 (15%) patients demonstrating left sided pleural effusions thought to be the result of ruptured appendicitis unrelated to their COVID-19 diagnosis. All but one patient had significant prior medical histories with an associated comorbid medical condition. Of the 46 imaged patients, 17 (37%) patients had a negative chest X-ray, and 15 (33%) patients had suggestive findings of viral etiology. 132 patients were not imaged.ConclusionOur study population corroborated current chest imaging guidelines in pediatric patients. Chest imaging modalities such as CXR and CT should be reserved for patients who are severely symptomatic and/or possess prior comorbidities such as immunosuppression, diabetes, asthma, obesity, or where other differential etiologies must be entertained.     

Cross-sectional imaging of thoracic and abdominal complications of cerebrospinal fluid shunt catheters

This study aims to review the imaging findings of distal (thoracic and abdominal) complications related to ventriculo-peritoneal (VP), ventriculo-pleural (VPL), and ventriculo-atrial (VA) cerebrospinal fluid (CSF) shunt catheter placement. Institution review board-approved single-center study of patients with thoracic and abdominal CSF catheter-related complications on cross-sectional imaging examinations over a 14-year period was performed. Clinical presentation, patient demographics, prior medical history, and subsequent surgical treatment were recorded. The presence or absence of CSF catheter-related infection and/or acute hydrocephalus on cross-sectional imaging was also recorded. There were 81 distal CSF catheter-related complications identified on 47 thoracic or abdominal imaging examinations in 30 patients (age 5–80 years, mean 39.3 years), most often on CT (CT?=?42, MRI?=?1, US?=?4). Complications included 38 intraperitoneal and 11 extraperitoneal fluid collections. Extraperitoneal collections included nine abdominal wall subcutaneous (SC) pseudocysts associated with shunt migration and obesity, an intrapleural pseudocyst, and a breast pseudocyst. There were also two large VPL-related pleural effusions, a fractured catheter in the SC tissues, and a large VA shunt thrombus within the right atrium. Ten patients (33.3 %) had culture-positive infection from CSF or shunt catheter samples. Ten patients (33.3 %) had features of temporally related acute or worsening hydrocephalus on neuroimaging. In four of these patients, the detection of thoracic and abdominal complications on CT preceded and predicted the findings of acute hydrocephalus on cranial imaging. Thoracic and abdominal complications of CSF shunts, as can be identified on CT,  include shunt infection and/or obstruction, may be both multiple and recurrent, and may be predictive of concurrent acute intracranial problems.     

CT平扫对急性胰腺炎及并发症诊断和预测预后的价值

目的 分析腹部CT扫描在急性胰腺炎并发症诊断及预测预后中的价值.方法 选取急性胰腺炎患者151例,分析腹部CT中常见表现与患者并发症和死亡的关系.对比不同Balthazar CT 严重指数 (CTSI)分级患者的预后情况.结果 CT中具有脂肪肝、胸腔积液、肝上间隙积液、肾上腺受侵(AGI)、肾周间隙受侵(PSI)和胃裸区受侵(GBAI)的患者,其并发症发生率显著高于上述CT征象阴性患者(P<0.05).随着CTSI分级加重,患者的禁食时间、发热时间、住院时间、血淀粉酶恢复时间逐渐延长,假性囊肿、中转手术、器官衰竭发生率和死亡率逐渐上升(P<0.05).结论 重度脂肪肝、AGI、GBAI、PSI和肝上间隙积液为急性胰腺炎患者并发症和死亡的危险因素.     

Thoracopancreatic fistula: clinical and imaging findings

PURPOSE: The goal of this work was to describe the clinical and imaging features of thoracopancreatic fistula, a rare complication of pancreatitis. METHOD: Nine cases of thoracopancreatic fistula proved by thoracentesis, endoscopic retrograde cholangiopancreatography (ERCP), or surgery were retrospectively and independently reviewed by two abdominal radiologists. All available imaging examinations [chest radiographs = 9, CT = 9, MR and MR cholangiopancreatography (MRCP) = 2, and ERCP = 6] were analyzed, and findings were recorded on a standardized datasheet. Available medical records (n = 7) were reviewed to determine the clinical presentation of the patients and thoracentesis results. RESULTS: Seven of the nine patients presented with pulmonary symptoms such as dyspnea or cough. Of the seven patients with pleural fluid analysis, all demonstrated elevated amylase levels (mean 13,007 U/L). Imaging examinations revealed pancreaticopleural fistulas in six patients, a mediastinal pseudocyst in one patient, and both a pancreaticopleural fistula and a mediastinal pseudocyst in two patients. Chest radiography showed pleural fluid collections in eight patients. CT demonstrated a fluid-containing fistula in all nine patients. MR and MRCP depicted a fistula extending from the abdomen to the pleural space in the two patients with MR correlation. ERCP showed pancreatic ductal changes characteristic of chronic pancreatitis in the six patients with ERCP correlation but failed to demonstrate the fistula in two of the six patients. CONCLUSION: The CT, MR, MRCP, or ERCP finding of a fluid-filled tract extending from the pancreas to the thorax is characteristic of a thoracopancreatic fistula, particularly when identified in a patient who presents with pulmonary symptoms and a history of chronic pancreatitis.     

Thoracic computed tomography in patients with suspected malignant pleural effusions

AIM: To assess the role of contrast-enhanced computed tomography (CT) prospectively in patients with suspected malignant pleural effusions.MATERIALS AND METHODS: Forty consecutive patients referred for the investigation of a suspected malignant pleural effusion had contrast-enhanced thoracic CT, thoracoscopy, thoraco-centesis and pleural biopsy, either percutaneously or at thoracoscopy. Final diagnoses were based on histopathological or cytological analysis (n = 30), autopsy findings (n = 3) or clinical follow-up (n = 7). The pleural surfaces were classified at contrast-enhanced CT as normal or abnormal and, if abnormal, as benign or malignant in appearance using previously established CT criteria for malignant pleural thickening by two observers unaware of the pathological diagnosis.RESULTS: Pleural effusions were malignant in 32 patients and benign in eight patients. Pleural surfaces assessed at CT showed features of malignancy in 27 out of 32 patients with a malignant effusion (sensitivity 84%, specificity 100%). Overall, CT appearances indicated the presence of malignancy in 28 of 32 (87%) patients. All eight patients with benign pleural disease were correctly diagnosed by CT.CONCLUSION: Contrast-enhanced CT is of value in patients with suspected malignant pleural effusions. The previously established criteria for malignant pleural thickening of nodularity, irregularity and pleural thickness >1 cm are reliable in the presence of a pleural effusion.     

Sinus cut-off sign: a helpful sign in the CT diagnosis of diaphragmatic rupture associated with pleural effusion

The objective of our study was to describe the "sinus cut-off" sign at CT in the diagnosis of diaphragmatic rupture in patients with blunt abdominal trauma complicated with pleural effusion, and evaluate its utility in an experimental model. Between January 2004 and March 2005, we observed an unusual interruption of costophrenic sinus at CT in three patients with blunt abdominal trauma accompanied with pleural effusion. This observation prompted us to evaluate the utility of this sign in an experimental model. Laparotomically, we created 2 cm diapragmatic lacerations at each hemidiaphragm in two rabbits and pushed up the abdominal viscera with omentum through the defect. To simulate hemothorax, we also injected 5-10 mL of diluted contrast material into the pleural space. Using a dual-slice helical CT scanner, limited thoracoabdominal CT examination was performed before and after injection of intrapleural contrast material. The images were analyzed for the presence of CT signs for diaphragmatic injury. The left posterior costophrenic sulcus was interrupted in all of the three patients with left pleural effusion. While it was associated with other findings of diaphragmatic injury, the "sinus cut-off sign" was the sole finding in one patient. The sinus cut-off sign was observed on the CT scans of 100% of the rabbits with a left and right sided diaphragmatic rupture. The "sinus cut-off sign" is useful and can increase the CT detection of acute diaphragmatic injury associated with pleural effusion.     

Parenchymal and pleural findings in patients with and patients without acute pulmonary embolism detected at spiral CT

PURPOSE: To compare the frequencies of parenchymal abnormalities and pleural effusions in patients with and patients without acute pulmonary embolism (PE) detected at spiral computed tomography (CT). MATERIALS AND METHODS: Contrast material-enhanced spiral CT scans obtained in 92 patients clinically suspected of having acute PE were retrospectively reviewed. The presence or absence of parenchymal abnormalities and pleural effusions was noted. The presence of filling defects consistent with central or peripheral PE was recorded. RESULTS: Twenty-eight patients had CT evidence of PE. Central emboli were evident in 27 (96%) of these patients; 23 (82%) had concomitant central and peripheral emboli, and four (14%) had only central emboli. One patient had an isolated subsegmental clot. Parenchymal abnormalities were seen in 24 (86%) patients with PE and 56 (88%) patients without PE. Atelectasis, the most common finding, was present in 20 (71%) patients with PE and 41 (64%) patients without PE. The only parenchymal abnormality significantly associated with PE was peripheral wedge-shaped opacity, which was seen in seven (25%) patients with PE and three (5%) patients without PE (odds ratio, 6.78; 95% CI = 1.60, 28.62). Pleural effusions were seen in 16 (57%) patients with PE and 36 (56%) patients without PE. In 25 (39%) patients without PE, there were additional CT findings that might suggest an alternative explanation for the acute clinical presentation. CONCLUSION: Parenchymal and pleural findings at CT are of limited value for differentiating patients with PE from those without PE.     

The CT frequencies of various non-traumatic acute abdominal emergencies in hemodialysis, peritoneal dialysis patients and the general population

Purpose

To investigate the frequency of non-traumatic acute abdominal emergencies in end-stage renal disease (ESRD) (peritoneal dialysis (PD) and haemodialysis (HD)) patients and in the general population as diagnosed by computed tomography (CT) imaging.

Methods

The abdominal CT findings of ESRD patients with non-traumatic acute abdominal pain during the years 2001–2010 have been retrospectively evaluated. Thirty-three HD (14 females, 19 males, mean age: 62 ± 10.5) and 22 PD patients (12 females, 10 males, mean age: 59 ± 9.4) with acute abdominal pathology based on their CT scans have been included into the study. In addition, 127 individuals (68 females, 59 males, mean age: 40.7 ± 12.8) with normal renal functions who presented with non-traumatic acute abdominal pain diagnosed with an acute abdominal pathology based on their CT scans have been prospectively evaluated during the years 2009–2010.

Results

While the most frequent etiology in PD patients was peritonitis (45.4%), acute pancreatitis (13.6%) and perforation (18.1), and in HD patients it was nonocclusive mesenteric ischemia (18.1%) and spontaneous intraabdominal bleeding (21.2%). The basic causes of acute abdomen in the general population were ureteral stone (34.6%) and appendicitis (18.1%).

Conclusions

The causes of acute abdominal pain in ESRD patients is significantly different when compared to the general population. And within this special patient population the etiology of acute abdomen differs depending on the renal replacement therapy modality they are receiving. Thus, the causes of acute abdomen in PD patients are mostly peritonitis, acute pancreatitis, and perforation, while being mostly nonocclusive mesenteric ischemia and spontaneous intraabdominal bleeding in patients receiving HD therapy.     

Chest and abdominal CT during extracorporeal membrane oxygenation: Clinical benefits in diagnosis and treatment

RATIONALE AND OBJECTIVE: This study aims to evaluate the clinical usefulness of thoracic and abdominal computed tomography (CT) as an adjunct to bedside diagnostic imaging in patients on extracorporeal membrane oxygenation (ECMO) therapy because of severe acute respiratory failure. MATERIALS AND METHODS: Imaging records for 118 consecutive thoracic and abdominal CT examinations performed in 63 patients (22 neonates, 15 children, and 26 adults) on ECMO therapy during an 8-year period were retrospectively reviewed. Reported CT findings were compared with concurrent bedside radiographs and ultrasounds. The clinical importance and effect on treatment of each CT finding was determined by reviewing the medical records. RESULTS: CT showed 30 clinically important complications in 20 different patients that directly impacted on the treatment, but were not diagnosed with bedside imaging. Of the 30 complications, 15 (50%) were surgically treated, 11 (37%) required percutaneous invasive procedures, and 4 (13%) were managed conservatively. Despite the serious complications, 13 of 20 patients (65%) survived. CONCLUSION: Both chest and abdominal CT have an important clinical role in patients on ECMO therapy because of acute respiratory failure, as a complement to bedside imaging, to exclude or show complications and expedite early invasive treatment, when needed.     

CT manifestations of respiratory syncytial virus infection in lung transplant recipients

PURPOSE: The purpose of our study was to evaluate CT findings during respiratory syncytial virus (RSV) infection in lung transplant recipients and to identify sequelae. METHOD: Thirty-nine CT scans prior to, during, and following acute infection in 10 lung transplant recipients were reviewed. Abnormalities that were new from baseline observations and occurred within 4 weeks of diagnosis were defined as acute. Chronic findings were defined as those present >4 weeks after diagnosis. RESULTS: Findings in nine patients were ground-glass (seven), air-space (five), and tree-in-bud (four) opacities and acute bronchial dilatation (four) and wall thickening (four). Patients lacked pleural effusions or lymph node enlargement. Five of seven patients with follow-up exams had new air trapping (three), persistent bronchial dilatation (three), and thickening (two). Three and 2 of the 10 patients developed bronchiolitis obliterans syndrome and obliterative bronchiolitis, respectively. CONCLUSION: During acute infection, patients commonly had ground-glass opacities but lacked pleural effusions and lymph node enlargement. There can be chronic sequelae after infection.     

Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films--bowel obstruction, pneumoperitoneum, and the search of ureteral calculi--are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain.     

CT findings after uncomplicated percutaneous laparoscopic cholecystectomy.

To investigate the postoperative pulmonary and abdominal findings following uncomplicated percutaneous laparoscopic cholecystectomy, 27 patients were studied by upper abdominal CT within 24 h of the surgical procedure. Both pneumoperitoneum (70%) and subcutaneous emphysema (56%) were commonly observed. Postoperative atelectasis and pleural effusions were observed in 44 and 33% of the patients, respectively. Forty-eight percent of the patients had a postoperative ileus demonstrated by CT. Approximately 22% of the patients had fluid in the abdomen as either edema in the gallbladder fossa or small amounts of ascites. In our patients the amount of ascitic fluid was small and no clinical significance could be attributed to the intraabdominal fluid collections.     

Lymphangioleiomyomatosis: CT of diurnal variation of lymphangioleiomyomas.

PURPOSE: To evaluate the imaging and clinical features of lymphangioleiomyomas and to describe the phenomenon of diurnal variation in the size of lymphangioleiomyomas in patients with lymphangioleiomyomatosis. MATERIALS AND METHODS: One hundred twenty-eight patients with lymphangioleiomyomatosis underwent chest and abdominopelvic computed tomography (CT). Thirteen patients underwent CT in the morning and afternoon of the same day to assess diurnal variation in lymphangioleiomyoma size. RESULTS: Twenty-seven of 128 patients (21%) had 54 lymphangioleiomyomas. The vast majority (96%) of these masses contained material of low attenuation at CT. Associated CT findings included enlarged abdominal lymph nodes, pleural effusions, ascites, and dilatation of the thoracic duct. The prevalence of lymphangioleiomyomas was 15% in patients who had mild pulmonary disease, 19% in patients who had moderate disease, and 26% in patients who had severe disease. Diurnal variation in size of masses was demonstrated in 12 of 13 patients. Seven of the 27 patients who had masses underwent biopsy; all seven were confirmed to have lymphangioleiomyomas. The most common symptoms associated with lymphangioleiomyomas were bloating, abdominal pain, and edema of the lower extremities. The majority of the patients reported worsening of symptoms as the day progressed. CONCLUSION: Lymphangioleiomyomas are common in patients with lymphangioleiomyomatosis. Diurnal variation in size may explain worsening of symptoms during the day.     

The CT appearance of pleural and extrapleural disease in lymphoma.

OBJECTIVE: Pleural effusions in patients with lymphoma that are assumed to be related to malignancy are attributed to either lymphatic obstruction by tumour with resultant decreased clearance of pleural fluid, or direct tumour involvement of the pleura. The purpose of our study was to determine how often pleural or extrapleural disease was detected by computed tomography (CT) of patients with pleural effusions and primary or recurrent lymphoma. METHODS AND MATERIALS: We reviewed CT examinations showing evidence of pleural effusion in 61 patients with a diagnosis of primary or recurrent lymphoma and no history of other systemic disorders, including infection. The study population consisted of patients with non-Hodgkin's lymphoma (n = 44) or Hodgkin's disease (n = 17); both primary disease (n = 11) and recurrent disease (n = 50) were represented. Each CT examination was evaluated for the presence of disease involving the visceral and parietal pleura and extrapleural space, mediastinal adenopathy, and pulmonary parenchymal disease. RESULTS: Fourteen patients (23%) (nine with non-Hodgkin's lymphoma and five with Hodgkin's disease) had parietal pleural disease (thickening or nodules). Eighteen patients (30%) (14 with non-Hodgkin's lymphoma, four with Hodgkin's disease) had tumour or enlarged lymph nodes in the extrapleural space. Forty-three patients (70%) had mediastinal lymphadenopathy. Patients who received intravenous contrast did not have evidence of visceral pleural abnormalities or underlying pulmonary parenchymal disease. CONCLUSION: Forty-one percent of the patients with lymphoma and pleural effusions had CT evidence of pleural and/or extrapleural disease. The majority of the patients with extrapleural disease had adjacent posterior mediastinal disease.     

CT未检出原发灶的胸腔积液或肺不张患者18F-FDG显像结果分析

目的评价^18F-脱氧葡萄糖(FDG)符合线路显像(DHTC)寻找CT未能发现原发灶的胸腔积液或肺不张患者的肺癌原发灶，及其对肺癌伴有胸腔积液的患者胸腔积液良恶性鉴别诊断的价值。方法110例CT未发现肺部原发病灶但疑为肺癌及肺癌转移可能的胸腔积液或肺不张患者(其中胸腔积液8．4例，肺不张26例)，进行^18F-FDG DHTC检查。结果38例患者最终确诊为肺癌，其中伴有胸腔积液30例，伴有肺不张8例；另72例为肺部良性病变。^18F-FDG DHTC对CT未能找到原发灶的胸腔积液或肺不张患者肺癌诊断的灵敏度、特异性和准确性分别为97％、78％和85％。30例伴有胸腔积液的肺癌患者中，21例确诊为恶性胸腔积液。^18F-FDG DHTC对良恶性胸腔积液鉴别诊断的灵敏度为86％，特异性为8／9例。结论^18F-FDG DHTC是寻找胸腔积液或肺不张患者肺癌原发灶灵敏可靠的方法，并对良恶性胸腔积液的鉴别诊断有一定的临床价值。     

Transient splenomegaly in acute pancreatitis

Serial changes in splenic volume of 25 patients (18 men and seven women; 53.4 +/- 20.8 years old, range 25-83) with acute pancreatitis who underwent CT examinations were retrospectively studied. Abdominal CT was performed within 3 days after the onset and there was at least one follow-up CT examination after this time. The percentage changes of splenic volume in the first (4-30 days) and second (31-100 days) follow-up CT were calculated. Splenic volume increased in the first follow-up CT (mean +/- SD: 197.8 +/- 121.0 cm3) compared with the initial CT (124.8 +/- 70.0; p < 0.0001), and then decreased in the second follow-up CT (179.7 +/- 100.7; p < 0.002). The average splenic volume increased 65.5 +/- 88.7% (range -10.4-377.4%) between the initial and first follow-up CT examinations. Five of 25 cases (20%) in whom size of spleen increased more than twice had severe acute pancreatitis (p < 0.05), complicated pseudocyst requiring surgical drainage (p < 0.05), pleural effusion (p < 0.01), splenic vein thrombosis or compression (p < 0.05) and longer hospital stay (p < 0.02) compared with patients with a smaller increase in splenic volume. In conclusion, transient splenomegaly was commonly seen in acute pancreatitis, especially in severe or complicated cases. Congestive splenomegaly caused by obstruction or stenosis of the splenic vein and non-specified acute splenitis were suspected of contributing to the transient splenomegaly.     

Evaluation of CT findings for diagnosis of pleural effusions

Computed tomography studies are usually used to assess patients with pleural effusions, and radiologists should be aware of the significance of different CT findings for the diagnosis of the effusion. The purpose of this study was to evaluate CT findings for etiological diagnosis of pleural effusions. Contrast-enhanced CT of the chest of 211 patients with pleural effusion of definite diagnosis were evaluated. The CT images were evaluated for the presence and extent of pleural effusion, thickening or nodules, extrapleural fat and other changes in the mediastinum or lung. The CT scans were read by two independent observers and correlation between them was evaluated. Comparison of CT findings between benign and malignant effusions, between exudates and transudates, and between empyemas and the other parapneumonic effusions were carried out. Kappa values for most CT findings were > 0.85. Loculation, pleural thickening, pleural nodules, and extrapleural fat of increased density were only present in exudative effusions. Multiple pleural nodules and nodular pleural thickening were the only pleural findings limited to malignant pleural effusions. The signs were also more frequently seen in empyemas than in other parapneumonic effusions. Computed tomography findings can help to distinguish between transudates and exudates. Although there is some overlap between benign and malignant pleural effusions, pleural nodules and nodular pleural thickening were present almost exclusively in the latter. Although differences between CT findings of empyemas and the other parapneumonic effusions exist, there is no finding which can definitely differentiate between them. Received: 27 January 1999; Revised: 24 June 1999; Accepted: 24 August 1999     

Pancreatitis presenting as pleural effusions: computed tomography demonstration of pleural space extension of pancreatitis exudate

Reported are two cases of acute pancreatitis that presented as large pleural effusions in which the route of communication of the pancreatic fossa with the chest was demonstrated on computed tomography. The bloody effusions were right-sided in one case and bilateral in the other. Pleuropulmonary complications of pancreatitis and possible mechanisms for pulmonary involvement are presented.     

Extrapancreatic spread of acute pancreatitis: new observations with real-time US

Real-time ultrasonography (US) was compared with abdominal computed tomography (CT) in 40 patients with moderate to severe acute pancreatitis. Emphasis was placed on the ability of US to disclose peripancreatic involvement of the anterior pararenal spaces, lesser sac, and transverse mesocolon. When a realtime US scanning technique emphasizing semierect patient positioning and coronal views was used, 20 of 26 lesions in the anterior pararenal space (77%) and 14 of 14 abnormalities in the lesser sac (100%) were visualized. Abnormalities in the transverse mesocolon, however, were poorly detected on US scans. Ten patients (25%) in the study had extrapancreatic abnormalities missed by US. CT remains the imaging method of choice in patients with clinically moderate to severe pancreatitis. In patients with mild pancreatitis, the real-time US technique we describe improved extra-pancreatic visualization compared with previous studies using static scanners. A new US observation of perivascular spread of acute pancreatitis around the splenic and portal veins is described.     

Intrathoracic manifestations of metastatic testicular seminoma: a comparison of chest radiographic and CT findings

The chest radiographs and CT scans of 200 patients with pure testicular seminoma were reviewed. The radiographs showed evidence of intrathoracic metastatic disease in 25 patients (12.5%). Of these, 17 had an abnormal mediastinal contour, seven had pulmonary metastases, five had pleural effusions, and two had discrete pleural masses. CT showed evidence of intrathoracic metastatic disease in 30 patients (15%). This included mediastinal nodal enlargement in 21, pulmonary metastases in 12, pleural effusions in six, and pleural masses in two. CT not only showed disease in five patients with normal chest radiographs, but also showed additional sites of disease in four other patients with abnormal chest radiographs. The results suggest that mediastinal nodal enlargement is the most common intrathoracic manifestation of metastatic testicular seminoma. CT is more accurate than chest radiography in the detection of metastatic seminoma in the chest and defines the extent of metastatic disease more precisely.