Radiographic appearance of lobar collapse

The changes to the chest radiograph that may be expected in lobar collapse are described: changes in density; changes in position; and alterations in the appearances of borders. Pure lobar collapse is rare and the features described only represent a guide. The appearances of collapse of each lobe are described in detail. Examples of radiographs and line drawings describing the movements of the fissures are included. There is a brief comment on subsegmental collapse.     

Radiographic appearance of bronchial carcinoid

Altman, R. L., Miller, W. E., Carr, D. T., Payne, W. S., and Woolner, L. B. (1973).Thorax, 28, 433-434. Radiographic appearance of bronchial carcinoid. The chest radiographs of 67 patients with bronchial carcinoid were reviewed. Seven had negative radiographs. Fifty-five had single abnormalities, the common manifestations being collapse or pneumonitis (21 patients), a small peripheral mass (20 patients), and a hilar or perihilar mass (11 patients). Five patients had multiple abnormalities, the most common combination being a mass with evidence of bronchial obstruction such as collapse of the related segment or lobe. Comparison with other reports revealed a significant difference in the frequency of the various abnormalities, a difference probably due to chance variations in the locations and to the age of the tumours at the time of diagnosis.     

Poor prognosis in atypical Perthes' disease. Radiographic analysis of 19 hips after 35 years.

We analyzed clinical and radiographic long-term results in 96 patients (106 hips) with Perthes' disease 35 years after nonoperative treatment. 19 hips in 17 patients had early radiographic signs indicating atypically severe course of the disease and poor prognosis. None of them was radiographically good at skeletal maturity; 2 cases were fair and 17 poor. At the final follow-up 12 hips had radiographic arthrosis.     

Late appearance of intra-abdominal abscesses after total colectomy for inflammatory bowel disease.

Intra-abdominal abscesses after colon surgery usually appear within eight weeks. Over the past few years, we have observed nine patients who underwent colectomy for inflammatory bowel disease in whom large and relatively asymptomatic abscesses developed, requiring surgical drainage as long as three to five years after the operation. In five patients, there was no report of intraoperative complications such as perforation or fecal spillage. At the time of discharge from the hospital, all patients were afebrile. In three of these patients, abscesses were discovered when they were readmitted to the hospital for elective abdominal procedures; most of the others had localized abdominal pain.     

Early appearance of abscess after biliary operation.

Three patients who had an air shadow and fluid levels within seven days after biliary surgery are discussed. In retrospect, this direct evidence of a postoperative abscess was overlooked because of its early appearance and other sources of fever that coexisted.     

Intertrochanteric varus osteotomy for Perthes' disease. Radiographic changes after 2-16-year follow-up of 126 hips.

We analyzed various prognostic factors in 112 children operated on for Perthes' disease (Catterall's groups II-IV); special attention was paid to acetabular changes and postoperative containment. The radiographic results of 126 intertrochanteric femoral varus osteotomies were analyzed 2-16 years postoperatively. Catterall's grouping or head-at-risk phenomenon, bicompartmentalization of the acetabulum, and preoperative subluxation of the femoral head did not correlate with the result. The result was worse in cases operated on in the healing phase of the disease and in patients operated on at the age of 9 years or older. The strongest prognostic factor was containment of the femoral head after osteotomy.     

Radiographic pulmonary abnormalities after different types of cardiac surgery.

One aim of this study was to determine the incidence of new radiographic pulmonary abnormalities during hospitalization after cardiac surgery. Another aim was to determine if such abnormalities are more common among patients who had left internal mammary artery (LIMA) grafting. The predictive value of radiographic abnormalities for clinically important pulmonary morbidity was also determined. The anteroposterior chest radiographs of 152 patients obtained by portable equipment were evaluated to determine the incidence of new postoperative radiographic pulmonary abnormalities such as atelectasis, consolidation, infiltrate, and pleural effusion. Clinically important pulmonary morbidity was defined as a delay in tracheal extubation or discharge from the hospital because of a pulmonary reason. Among the 89 patients who had LIMA grafting and left pleurotomy, there was an 88% incidence of left-sided pulmonary abnormalities; a 73% incidence of left-sided atelectasis; and a 55% incidence of left-sided effusion. Among the 63 patients who had saphenous vein grafting only and/or valvular surgery, the respective incidences were 68%, 54%, and 35%, which were lower (P less than or equal to 0.05) than those in the patients who had LIMA grafting. There was no significant difference in abnormalities between the saphenous vein grafting and the valvular surgery groups. The 35% incidence of left-sided pleural effusion when LIMA grafting and pleurotomy were not performed was unexpectedly high. There was no association between radiographic abnormalities and age, the duration of cardiopulmonary bypass, and the duration of aortic occlusion, indicating that cardiopulmonary bypass was not a primary etiology of these radiographic abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)     

Radiographic sign of persistent soft-tissue imbalance after knee replacement.

We report on the radiological findings in a series of 871 consecutive primary condylar knee replacements followed up for an average of four years. A new radiological sign has been identified, consisting of a smoothly tapering wedge of cement visible beneath the horizontal portion of the tibial component on the anteroposterior radiograph. This was found in 25.4% of our cases and appears to indicate a persistent soft-tissue imbalance following condylar arthroplasty of the knee. The cement-wedge sign was associated with a highly significant increase in radiolucent lines at the tibial cement-bone interface.     

Radiographic appearance of the distal clavicle in relation to the acromion after acromioclavicular joint reconstruction using a braided polyester mesh

ACJ stabilization using a braided polyester mesh has become popular in ACJ injuries. However, concerns have been raised about excessive anterior clavicle displacement. The purpose of this study was to report radiographic position of the distal clavicle in relation to the acromion after ACJ reconstruction using this device immediately postoperative and after 6 months follow-up compared with a healthy control group.Thirty-eight patients with ACJ instability treated with a braided polyester mesh were compared within group (pre-/postoperatively) and between groups (with age/sex matched controls). Biplane radiographic measurements by 2 observers were made preoperatively, immediate postoperatively and at 6 months follow-up. Inter-observer reliability was assessed and clinical outcome scores were recorded.ACJ stabilization significantly reduced vertical displacement immediately postoperatively (13.8 ± 4.2 to 3.5 ± 5.5 mm; p < 0.0001) towards controls (1.7 ± 2.3 mm,p < 0.0873). Slight further superior displacement (4.4 mm) occurred at 6 months follow-up compared to immediately postoperative (p = 0.0029) and 6.2 mm more than mean controls (p < 0.0001). In the axial plane, significant early reduction of posterior displacement was achieved (10.3 ± 8.0 to 1.1 ± 5.1 mm,p = 0.0240) and the clavicle settled back to a more posterior position at 4.5 ± 6.7 mm at 6 months post-surgery (p = 0.3062). At both time points, posterior displacement was comparable with the controls (3.4 ± 3.0 mm,p = 0.4371 postoperative, p = 0.563 at 6 months follow-up). Excessive anterior displacement has been observed in 2 of the 5 available axial radiographs early postoperative and in 4 of 14 available axial radiographs at 6 months. Constant, Oxford Shoulder and Nottingham Clavicle scores significantly improved (25 ± 12 to 43 ± 7:p < 0.0001, 46 ± 27 to 80 ± 19:p = 0.0038, 53 ± 14 to 80 ± 17:p < 0.0001). ACJ stabilization using a braided polyester device in ACJ instability is effective at reducing both superior and posterior clavicle displacement with excellent clinical outcome. Overcorrection in the axial plane seems to occur, however this is of no clinical and radiographic significance. Posterior displacement is significantly reduced towards control values at 6 months follow-up.     

Antibiotic treatment of nosocomial pneumonia

Nosocomial pneumonia is one of the most common infectious diseases acquired in hospital and is often caused by resistant pathogens. For treatment of nosocomial pneumonia an appropriate initial antibiotic therapy is essential and exact knowledge of the specific pathogen spectrum is essential for the correct choice of the empirically calculated antibiotics. In line with a critical reevaluation of the primary treatment, pathogen-specific de-escalation therapy, a diagnosis of possible pulmonary complications (e.?g. pleural empyema) and the identification and appropriate rehabilitation measures of non-pulmonary infections are necessary. To attain the best possible outcome the respective therapy concept needs to be adjusted to the individual risk characteristics. Appropriate initial antibiotic therapy, duration of mechanical ventilation and comorbidities are the key factors for patient outcome. This approach helps to avoid the development of resistant pathogens and saves economic resources.