The chest roentgenogram in pulmonary tuberculosis patients seropositive for human immunodeficiency virus type 1

To determine the impact that co-infection with HIV has on the radiographic presentation of pulmonary tuberculosis, we examined the chest roentgenograms obtained before treatment in 225 HIV-tested adult Haitians with bacillary (smear or culture or both) positive pulmonary tuberculosis. There were 67 HIV-seropositive and 158 HIV-seronegative patients. Intrathoracic adenopathy alone was more common and parenchymal infiltrates less common in HIV-seropositive patients (p less than 0.05). Although a parenchymal infiltrate was less likely to be cavitating in the HIV-seropositive group (p less than 0.05) when cavitary parenchymal disease was present, HIV seropositivity did not affect the number of cavities (single or multiple) or the size of the largest cavity. Patients with AIDS were significantly more likely to have a chest radiographic pattern consistent with primary tuberculosis (80 percent) than HIV-seropositive patients without AIDS (30 percent), and the latter were significantly more likely to have such a pattern than HIV-seronegative patients (11 percent) (p less than 0.05). The HIV-seropositive patients were equally infectious, regardless of the pattern of disease (primary vs postprimary). Even though pulmonary tuberculosis in an HIV-seropositive adult probably results from reactivation of dormant foci or reinfection, the pattern on the chest roentgenogram often suggests primary disease, especially if the patient has AIDS.     

The standard chest roentgenogram for determining lung overinflation

The validity of several roentgenographic indices in predicting lung overinflation was assessed by three independent observers in 25 patients with chronic obstructive lung disease. The observers were unaware of the clinical status of the patients or the purpose of the study. There were significant correlations between the observers for several indices whereas the only good correlation between the indices and radiologic total lung capacity (percent predicted) was the level of the diaphragmatic domes.     

The role of the chest roentgenogram in febrile neutropenic patients

In a retrospective review of patients with neutropenia and fever, we sought to determine how often roentgenograms detected pulmonary disease, especially pneumonia, not suggested by signs and symptoms. Further, we sought to determine how often therapy was changed as a result of roentgenographic findings. Overall, 41 (22%) of 187 chest roentgenograms obtained during initial febrile episodes, recurrent fevers, or persistent fevers were abnormal. While most patients had signs and symptoms suggesting the presence of pulmonary disease, 17% had roentgenographic abnormalities detected in the absence of such findings. During initial febrile episodes, therapy was not changed in response to findings on the chest roentgenogram. However, during episodes of persistent or recurrent fever, findings on chest roentgenograms led to changes in therapy in eight (61%) of 13 episodes of which six (40%) resulted in clinical improvement. Chest roentgenograms were therefore found to be an important diagnostic tool in evaluating recurrent or persistent fever in the neutropenic patient but of little use during initial febrile episodes.     

The significance of irregular opacities on the chest roentgenogram.

Scanty irregular opacities are not uncommonly observed on the chest roentgenogram in the absence of interstitial fibrosis of the lungs. In such circumstances the irregular opacities, when present, tend to be relatively scanty and seldom, if ever, exceed an ILO category of 1/1. They are found in association with cigarette smoking, especially when emphysema is also present. The development of irregular opacities is also related to exposure to various mineral and other dusts, and although their prevalence increases with cumulative dust exposure, in general the type of dust, whether fibrogenic or relatively inert, seems to be of little moment. The presence of irregular opacities remains a troublesome confounding factor in epidemiologic studies of both dust-exposed and nonexposed populations. The morbid anatomic changes that occur in the lungs of nondust-exposed workers and which are responsible for the development of irregular opacities in the chest roentgenogram remain unknown.     

The diagnostic attributes of echocardiography in the patient with chest pain or pulmonary edema

In the critically ill or clinically unstable patient, echocardiography is particularly useful in that it provides a safe, painless, and yet reliable bedside method for evaluating the anatomy and physiology of the heart. In addition to diagnostic information, serial echocardiograms may be obtained as often as clinically indicated to monitor and detect hemodynamic changes which may be of prognostic value to the clinician. The ultimate role of echocardiography in coronary artery disease is not yet known, and many of the observations and uses we have discussed are still being investigated and substantiated. For the individual patient with coronary artery disease, it is too early to know whether the information available from the echocardiogram will influence the course or outcome of the disease.     

Clinical presentation of pulmonary edema following esophagectomy on chest radiograph

BACKGROUND/AIMS: To determine whether the clinical presentation of pulmonary edema following esophagectomy can be objectively determined by changes in X-ray density in the lung field on chest radiography. METHODOLOGY: Sixteen patients who underwent esophagectomy for thoracic esophageal cancer and five patients who underwent less radical surgery at Akita University Hospital between July 2000 and March 2001 were recruited to the thoracic esophageal cancer and control groups, respectively. Chest radiography was carried out using five aluminum disks (15, 20, 25, 30 and 35 mm thickness) placed in upper right corner of the film and X-ray density for the disks and chest lung field was measured using a densitometer until POD 7. RESULTS: In the thoracic esophageal cancer group, X-ray density in the lung field, body weight, and respiratory index increased significantly in the immediate postoperative period. The X-ray density in the lung field peaked on POD 2, and remained constant to POD 6. Correlations were found among changes in X-ray density in the lung field, body weight, and respiratory index. CONCLUSIONS: The measurement of X-ray density on a chest radiograph is useful for prediction as well as early management of patients with pulmonary edema following esophagectomy for thoracic esophageal cancer.     

Stump neuroma masquerading as recurrent malignancy on chest roentgenogram

An amputation neuroma is a nerve's attempt at repair following amputation. While many are asymptomatic, some present as a painful mass. We describe a patient who, following a forequarter amputation for sarcoma, developed a stump neuroma that was unusual because it was first discovered on a routine chest roentgenogram.     

Legionella pneumonia presenting as a bulging fissure on chest roentgenogram

We report a case of Legionella pneumonia presenting as a bulging interlobar fissure on the lateral chest roentgenogram. This microorganism should be added to the list of etiologic agents producing a bulging fissure on chest roentgenogram.     

The triage decision in pulmonary edema

The authors studied the clinical courses of 216 prospectively selected patients with cardiogenic pulmonary edema presenting to an emergency ward (EW) to identify which patients should be triaged to the intensive care unit (ICU). The first four hours were considered the EW or pre-triage phase of hospitalization. During the EW phase, 108 patients remained stable; 33 of them developed cardiopulmonary complications over the next two days. Logistic regression identified four significant independent features that distinguished these 33 patients from the remaining patients: four-hour diuresis less than 1L, history of prior pulmonary edema, T-wave abnormalities, and jugular venous distention. A model containing the four variables predicted hospital complications with a sensitivity of 81% and a specificity of 65%. In comparison, the sensitivity of physicians in admitting to the ICU patients who would go on to have complications was 70%, with a specificity of 63%. In a model containing a term for the physicians' actual triage decision, all four independent predictors remained significant, producing an overall sensitivity of 81% and an overall specificity of 69%.