前纵隔巨大脂肪肉瘤误诊为胸腔积液1例

患者男,32岁.咳嗽伴胸闷、心慌7天.无痰,无低烧,盗汗.查体:气管右偏,左肺呼吸音低,左下肺叩实.实验室检查无异常. 影像学检查:正位胸片显示,左侧胸腔第三前肋以下密实,上缘模糊,内高外低,左心缘、隔肌、肋隔角均被掩盖,纵隔增宽,心脏右移(图1).侧位胸片显示,前中纵隔有较大的结节状及团块状密度增高影,下肺野密度增高,前后肋隔角隐约可见.X线平片诊断:左胸腔积液.     

关于婴幼儿和成人胸部仰卧位中心线的分析

由于放射线技术防护的进步,婴幼儿胸透逐年减少,而胸部照片明显地增加。此外,心脏及肺等胸部手术后和危重病人,床旁照相也逐年增加。因此,解决好婴幼儿和成人仰卧位胸片的质量,须研究讨论的问题不少。本文就X线中心线问题结合临床实践,介绍如下: (一)认识仰卧位与立位胸片X线解剖的变化。是改进照片质量、适应X线诊断的技术基础。 1.纵隔阴影:仰卧位时纵隔阴影缩短增宽,尤以婴幼儿变化显著。 2.心脏阴影:仰卧位时心脏上移,趋向横位,心尖轻度上翘,心影坦平变大,最大与立位心     

隐匿型肺癌X线胸片漏诊分析及CT扫描的临床意义

<正>常规X线和CT是诊断肺癌的重要手段[1],但隐蔽在肺尖、肺门区、支气管内、纵隔及脊柱旁、心影后、奇静脉食管窝、膈肌后或上、胸膜缘及胸水掩盖等处的隐匿型肺癌,常规正位胸片不易发现,有时侧位胸片也显示不清,容易造成漏诊。作者对本院40例X线正位胸片或侧位胸片漏     

用国产200mAX线机投照“矽肺”胸片的初步体会

拍照“矽肺”诊断用的X线胸片,对片质的要求是相当严格的。我们对合格片片质要求是:第1—4胸椎应清晰可见,下部胸椎在心影内隐约显示,肺纹理自肺门到肺野边缘都可以追踪到,心缘旁1—2厘米内较粗些的肺血管纹理能够辩认,骨骼与周围软组织层次分清,肋骨骨小梁出现,为要达到上述片质标准,按理需使用400mA以上大型X线机投照方可。当前,国家财力有限,大多数县、市级医院、卫生防疫站所装备的X线机,仍以国产200—～300MAX线机为多,对拍照“矽肺”胸片,的确是个大难题。     

肺肉瘤1例

患者　男 ,72岁。咳嗽、胸闷 1月就诊。查体 :全身浅表淋巴结无肿大 ,听诊左下肺呼吸音低。血尿常规正常。X线胸片示 :左下肺可见类圆形肿块影 ,大小约 8cm×图 1　后前位胸片见左下肺类圆形阴影 ,与心影重叠　图 2　左侧位胸片显示心后肿块阴影 ,密度均匀10cm ,正位与心影重叠     

胸腔顶部肿块的定位和定性诊断

胸腔顶部为胸腔的最高部位，包括胸膜顶，脊椎旁沟最高部和上叶尖后段的最上部。发生于该部位的病变包括纵隔，胸膜和肺，因此X线定位和定性诊断比较困难，本文胸腔顶部肿块的定义限定于在后前位胸片上肿块的上缘紧贴于第1－2肋骨的下缘，内缘紧贴胸椎旁，自胸腔的最高部凸向肺内的肿块，侧位胸片肿块偏后重叠胸椎的最上部，自胸腔的后上方向胸内凸入，按此定义严格选择，我们在经胸部手术的约1200病例中搜集到25个病例，对这一胸部最高三角区域的肿块性病变的诊断原则取得了一定的经验。     

巨大纵隔畸胎瘤1例报告

患者,女,46岁。无明显诱因出现左侧胸疼,伴胸闷、气短8个月。患者发病初拍胸片诊断为“结核性胸膜炎,左侧胸腔包裹性积液”。经抗痨治疗,无明显效果。体检:左胸呼吸动度减弱,叩诊呈浊音。Ｘ线表现:胸部正位片见左侧胸腔第2前肋以下至膈肌呈普遍性,均匀的密度增高,病变上缘呈弧形、光滑,内缘和纵隔无界线,外缘紧贴侧胸壁,左膈肌显示不清,心影向右轻度偏移。侧位病变位于前、中纵隔及大部分后纵隔(图1,2)。Ｘ线诊断:1.胸腔内包裹性积液;2.肺内囊性病变。ＣＴ检查:左胸腔内巨大囊性肿物,肿物边缘有薄壁包绕,图3　左侧胸腔巨大囊性肿物,密度不均…     

后纵隔巨大脂肪肉瘤进入后腹膜腔1例

患者女,31岁.3 d前体检发现纵隔肿块,无任何自觉症状.查体:胸、腹部未及明显阳性体征.B超:肝左叶后方、腹主动脉前方的部位实质性肿块,并向胸部延伸.胸片:下纵隔内第9胸椎椎体上缘水平以下见一大小约18 cm×11 cm扁丘形巨大高密度团块影,基底位于膈面,病变与心影中下部重叠,突向两侧胸腔,心影轮廓尚可辨认,病灶下缘境界不清.     

浅析右肺中叶综合症的X线与临床(附病例报告2例)

目的:确定常规X线正位加侧位及前弓位胸片能否提高右肺中叶综合症的诊断准确性。材料与方法:2例右肺中叶综合症患儿(男女各1例:年龄均为6岁)于临床症状出现后3～15天内经常规X线正位片加摄侧位及前弓位胸片检查。结果:X线正位加摄侧位及前弓位胸片显示,右肺中叶呈带状致密影,并与心影重叠相连,右心膈区出现一尖端向内的三角形高密度阴影。结合临床症状与体征,诊断为右肺中叶综合症,后经正规抗痨治疗,胸片上的阴影连同临床症状与体征一起全部消失。结论:常规X线正位片加摄侧位及前弓位胸片能卓有成效地提高右肺中叶综合症的诊断准确性。     

肺恶性纤维组织细胞瘤1例

患者男,36岁.因咳嗽、胸闷、憋气4个月来诊.临床检查:一般情况可,听诊左下肺呼吸音低,化验检查无明显异常. 胸片显示:左胸腔内巨大肿块约25cm×17cm×18cm,上缘起自主动脉弓水平,下达左膈顶部.病灶位置偏后,内侧靠近纵隔并与心影重叠.其边缘清晰、分叶,密度较高(图1,2).     

Digital chest imaging: selenium radiography versus storage phosphor imaging. Comparison of visualization of specific anatomic regions of the chest.

RATIONALE AND OBJECTIVES: To compare selenium- versus phosphor-based digital chest imaging for visualization of various anatomic regions of the chest. METHODS: Thirteen observers analyzed pairs of posteroanterior (PA) and lateral chest radiographs of 63 patients. One radiograph in each pair was obtained with a digital selenium chest radiography system, and the other with a storage phosphor-based technique. Each observer rated the visibility and the radiographic quality of 21 anatomic regions. RESULTS: The observers rated visualization obtained with the selenium system as better than that obtained with the storage phosphor system in 12 anatomic regions (right lower lobe, retrodiaphragmatic, upper lobes, minor fissure, hilum, carina, azygoesophageal recess, ribs, soft tissue, upper mediastinum on the PA image, and major fissure and sternum on the lateral image). Five regions were equally appreciated (retrocardiac on the PA, lower lobes, lingual-middle lobe, soft tissue, and subdiaphragmatic region on lateral images). Four regions were rated better on phosphor imaging than on selenium films (thoracic spine on PA, upper lobes, lower, and upper thoracic spine on lateral films) (17,199 observations, P < 0.05, sign test). CONCLUSIONS: On PA images the digital selenium chest system provides better visualization of most anatomic structures than the phosphor system. Lateral images show an almost equal preference.     

Digital chest radiography with a large-area flat-panel silicon X-ray detector: clinical comparison with conventional radiography

This was a radiologists' preference study to compare a digital chest radiography system that utilizes a large-area silicon flat-panel detector with conventional radiography for visualizing anatomic regions of the chest. Conventional and digital posteroanterior (PA) and lateral chest radiographs were obtained in 115 patients. The PA and lateral image pairs were compared independently by three radiologists rating the overall appearance, 11 anatomic regions in the PA, and 9 in the lateral views. Statistical analysis was performed with the Wilcoxon signed-rank test with Bonferroni-Holm adjustment (p=0.05). For the PA view, the digital system performed significantly better for the overall appearance and for all anatomic regions except for the peripheral pulmonary vasculature and hilum, where no significant difference was found. For the lateral digital images, the regions trachea, costodiaphragmatic recess, and hilum were rated significantly worse. The regions retrosternal and retrocardiac lung were rated significantly better. The other regions and the overall appearance showed no significant differences. The described digital chest radiography system showed statistically superior visualization of anatomic regions for PA and an ambiguous performance for lateral images as compared with conventional radiography. After changing some image processing parameters for the lateral view, this system may be suitable for digitalization of chest radiography.     

Normal radiographic anatomy of thoracic structures: analysis of 316 lateral chest radiographs

PURPOSE: To study the frequency of visualization and characteristics of normal thoracic structures on lateral chest radiographs in the Japanese population. MATERIALS AND METHODS: We reviewed 316 lateral chest radiographs of men and women ranging in age from 20 to 90 years. The frequency of visualization and configuration of structures including major, minor, superior and inferior accessory fissures, and orifices of the right and left upper lobe bronchi were reviewed. RESULTS: On lateral chest radiographs, major fissure and minor fissure were visualized in 99.4% and 87.3%, respectively. Superior accessory fissure and inferior accessory fissure were visualized in 1.9% and 9.5%, respectively. Orifices of the right and left upper bronchi were seen in 92.4% and 98.4%, respectively. CONCLUSION: Frequency of visualization and characteristics of various normal anatomic structures on lateral chest radiographs in the Japanese population differ from those reported previously from the West. Familiarity with these normal thoracic structures and variations is important for daily image interpretation.     

Effects of image processing on nodule detection rates in digitized chest radiographs: ROC study of observer performance

To evaluate the effects of image processing in digitized chest radiographs when high-resolution images are used, an examination was done in which the detection of pulmonary nodules in unprocessed digitized chest radiographs was compared with that in images that had undergone processing with two methods, adaptive filtration and histogram equalization. The processing techniques have been optimized in previous work to selectively enhance the retrocardiac and subdiaphragmatic areas without significant alteration of detail in the lung. Eight observers were shown 150 test radiographs (50 unprocessed, 50 processed with adaptive filtration, 50 processed with histogram equalization) containing 150 nodules. The results indicate a statistically significant (P less than .03) difference, with highest observer performance in the chest radiographs processed with adaptive filtration (median area under ROC curve = 0.78), compared with unprocessed images (median = 0.68) and chest radiographs processed with histogram equalization (median = 0.62). Performance in the lung was not significantly different. Adaptive filtration applied to selectively enhance underexposed areas of film images may improve nodule detection. Histogram equalization provided no improvement in performance.     

Retrocardiac phantom image on hypocycloidal chest tomograms

A phantom image produced by displaced blur margins of the cardiac silhouette and mimicking a paraspinous retrocardiac mass was noted in 50% of 125 hypocycloidal full chest tomograms. It was reproduced on tomograms of a chest phantom. Careful comparison with routine posteroanterior and lateral chest radiographs prevents misinterpretation.     

Area beam equalization: optimization and performance of an automated prototype system for chest radiography

RATIONALE AND OBJECTIVES: To evaluate the feasibility and performance of an x-ray beam equalization system for chest radiography using anthropomorphic phantoms. MATERIALS AND METHODS: Area beam equalization involves the process of the initial unequalized image acquisition, attenuator thickness calculation, mask generation using a 16 x 16 piston array, and final equalized image acquisition. Chest radiographs of three different anthropomorphic phantoms were acquired with no beam equalization and equalization levels of 4.8, 11.3, and 21. Six radiologists evaluated the images by scoring them from 1-5 using 13 different criteria. The dose was calculated using the known attenuator material thickness and the mAs of the x-ray tube. RESULTS: The visibility of anatomic structures in the under-penetrated regions of the chest radiographs was shown to be significantly (P < .01) improved after beam equalization. An equalization level of 4.8 provided most of the improvements with moderate increases in patient dose and tube loading. Higher levels of beam equalization did not show much improvement in the visibility of anatomic structures in the under-penetrated regions. CONCLUSION: A moderate level of x-ray beam equalization in chest radiography is superior to both conventional radiographs and radiographs with high levels of beam equalization. X-ray beam equalization can significantly improve the visibility of anatomic structures in the under-penetrated regions while maintaining good image quality in the lung region.     

Radiologic-anatomic correlation of thoracic vertebrae and rib shadows in chest digital radiograph

The purpose of this study was to provide an introduction to parsing the radiologic appearance of thoracic vertebrae and ribs. In the study, the radiologic-anatomic correlation technique was applied to promote further understanding of normal chest radiographs. The thoracic vertebrae and ribs of chest radiographs were compared with each macroscopic radiologic and computed tomography (CT) image. The rib parsed the linear shadow of the body of the rib. The macroscopic and radiologic images of thoracic vertebrae and ribs were evaluated to explain their normal radiologic findings. The results of such correlation were summarized as follows: 1) The lamina of the vertebral arch was visualized due to anterior rotation of the upper thoracic vertebrae. 2) The density ratio of the thoracic-vertebrae shadow was almost the same in the vertebral body and vertebral arch. 3) The linear shadow superimposed on the rib corresponded to the inferior margin of the rib. The radiologic-anatomic correlation technique was useful to evaluate normal radiologic findings, and the study was useful to radiological technologists.     

Digital chest radiography with a selenium-based flat-panel detector versus a storage phosphor system: comparison of soft-copy images

OBJECTIVE. We compared the soft-copy images produced by a digital chest radiography system that uses a flat-panel X-ray detector based on amorphous selenium with images produced by a storage phosphor radiography system for the visualization of anatomic regions of the chest. MATERIALS AND METHODS. Two chest radiologists and two residents analyzed 46 pairs of posteroanterior chest radiographs on high-resolution video monitors (2560 x 2048 x 8 bits). In each pair, one radiograph was obtained with a storage phosphor radiography system, and the other radiograph was obtained with a selenium-based flat-panel detector radiography system. Each pair of radiographs was obtained at the same exposure settings. The interpreter rated the visibility and radiographic quality of 11 different anatomic regions. Each pair of images was ranked on a five-point scale (1 = prefer image A, 3 = no preference, 5 = prefer image B) for preference of technique. Statistical significance of preference was determined using the Wilcoxon's signed rank test. RESULTS. The interpreters had a statistically significant preference for the selenium-based radiography system in six (unobscured lung, hilum, rib, minor fissure, heart border, and overall appearance) of 11 anatomic regions (p<0.001) and for the storage phosphor system in two regions (proximal airway and thoracic spine) (p<0.05). Chest radiologists strongly preferred selenium-based images in eight regions, and they did not prefer storage phosphor images in any region. CONCLUSION. The soft-copy images produced by the selenium-based radiography system were perceived as equal or superior to those produced by the storage phosphor system in most but not all anatomic regions.     

The anterior bronchus sign: a new clue to hilar abnormality

One hundred normal posteroanterior chest radiographs were reviewed to determine the frequency of appearance and characteristics of the anterior segmental bronchi of the upper lobes. The bronchus was visible as a sharp circle on the right in 45% of normals, and on the left in 50%. In 90% of normals, there is less than 3 mm of tissue lateral to the bronchus. In 10% of normals, pulmonary vessels may cause 3-5 mm of tissue lateral to the bronchus. Four cases of bronchogenic carcinoma were found to have more than 5 mm of tissue lateral to the bronchus. The presence of more than 5 mm of tissue lateral to the anterior segmental bronchus is termed the "anterior bronchus sign" and is a helpful clue to recognizing hilar region abnormality.     

Chest imaging with flat-panel detector at low and standard doses: comparison with storage phosphor technology in normal patients

The purpose of this study was to evaluate the performance of standard-dose and low-dose cesium iodide (CsI)-doted amorphous silicon (a-Si) flat-panel detector technology (FDT) as compared with storage-phosphor technology (SPT) in the depiction of relevant anatomical structures in chest radiography. In 75 patients referred for thoracic CT, digital chest radiographs were randomly obtained with either SPT at a standard dose (speed class S400, n=25), standard-dose FDT (S400, n=25) or FDT at a low dose (S800, n=25). Five radiologists evaluated the visibility of eight pulmonary and mediastinal anatomical structures using a five-point rating scale. To determine statistically significant differences between the three groups, the Mann-Whitney U-test was employed. No statistically significant differences were found in the depiction of eight criteria between SPT and standard-dose or low-dose FDT chest radiographs. The performance of FDT S400 was equal to SPT for most criteria and better for retrocardiac structures and soft tissue. FDT S800 was inferior to both SPT and FDT S400. Standard-dose FDT is equivalent to SPT in the depiction of relevant anatomical structures of the chest. Our results also indicate that a dose reduction of 50% with FDT may result in small but not significant decrease of image quality.