Chest radiography in the carcinoid syndrome

The chest films of 44 patients with liver metastases from intestinal carcinoid tumors were reviewed in order to evaluate the frequency of significant carcinoid heart disease. Only two patients had obvious signs of cardiac involvement, which is contradictory to most other studies.     

Chest radiography for radiologic technologists

The chest exam is performed more frequently than any other exam in the imaging department. It is important for radiographers to understand the standards for imaging the chest because good chest radiographs are critical in managing patient care. This article provides an overview of chest radiography from the perspective of both the radiologist and the technologist. Readers will gain an understanding of several pathologic processes involving the chest and can use this information to perform optimal radiographic imaging.     

Chest radiography after minor chest trauma

The results of chest radiography in 581 patients with blunt minor thoracic trauma were reviewed. Frontal and lateral views of the chest indicated pathology in 72 patients (12.4%). Pneumothorax was present in 16 patients; 4 had hemothorax. The physical examination and the results of chest radiography were not in accordance because in 6 (30%) of the 20 patients with hemo/pneumothorax the physical examination was normal. Consequently there is wide indication for chest radiography after minor blunt chest trauma.     

Chest radiography based on the interlobar fissures

Recognition of which interlobar fissure in the right lung is major or minor is important in chest radiography. Based on assessment of the interlobar fissure, the location of diseases or the degree of expansion of the lobes is comprehensible. As a general rule, the major fissure is not seen in normal cases. However, the major fissure is visualized in the presence of volume loss of the lower lobe. Although the medial end of the minor fissure is at the intermediate artery between the upper and lower lobe bronchi, that of the major fissure is continuous to the central portion of the mediastinum. The following cases will be presented: post-pleuritis, atelectasis of the superior segment of the lower lobe (S6), obstructive pneumonia in the middle and lower lobes due to stenosis of the intermediate bronchus, pneumonia of the upper lobe, and superior accessory fissure with atelectasis of the upper lobe.     

Chest radiography in the management of breast cancer.

This study was undertaken to assess the utility of chest radiography (CXR) in the management of patients with breast cancer and to devise a suitable imaging policy for such patients. A retrospective analysis was performed of the case notes and the CXRs of a series of 141 patients presenting to this hospital in 1980 with a diagnosis of early breast cancer. Data retrieved covered the entire clinical course to date and included the number of CXRs performed for a clinical reason and the number performed as "routine". Correlation of the result of every CXR requested to subsequent therapeutic decision-making throughout the complete clinical course of each patient was undertaken and the proportion of CXRs initiating a management change, or performed for a clinical reason, out of the total requested was assessed. A total of 1161 CXRs were performed on the 141 patients studied. Of these, only 174 (15%) were undertaken for a direct clinical reason and 987 (85%) were undertaken as part of "routine" follow-up procedures and had no impact on patient management. Four "routine" CXRs (< 0.4%) demonstrated previously undiagnosed pulmonary metastases, in patients with no other history of metastatic disease. Thus, routine chest radiography is not a cost-effective method of monitoring asymptomatic patients with breast cancer for metastasis. It is recommended that outside staging procedures for clinical trials, the CXR is used only to address a clinical problem relating specifically to the thorax. It is anticipated that the cessation of all other chest radiography in patients being followed up for breast cancer at this institution will have significant budgetary implications.     

Chest radiography in acute traumatic rupture of the thoracic aorta

Of 123 patients who had suffered blunt trauma to the chest traumatic aortic rupture was eventually confirmed in 61 and absent in 62 patients. The chest radiographs of these patients were examined for 15 signs reported in the literature as being associated with traumatic aortic rupture. Although many individual signs were significantly more frequent in the aortic rupture group they were not useful in differentiating between patients with and those without rupture of the aorta. By using discriminant analysis combining 2 or 3 signs, patients were classified as having aortic rupture or not. The best discrimination between the two groups was obtained using the combined signs of a widened paratracheal stripe, an opacified pulmonary window, a widened right paraspinal interface and a displaced nasogastric tube.     

Chest radiography in acute aortic syndrome: pearls and pitfalls

Acute aortic syndrome is a group of life-threatening diseases of the thoracic aorta that usually present to the emergency department. It includes aortic dissection, aortic intramural hematoma, and penetrating aortic ulcer. Rare aortic pathologies of aorto-esophageal fistula and mycotic aneurysm may also be included in this list. All these conditions require urgent treatment with complex clinical care and management. Most patients who present with chest pain are evaluated with a chest radiograph in the emergency department. It is important that maximum diagnostic information is extracted from the chest radiograph as certain signs on the chest radiograph are extremely useful in pointing towards the diagnosis of acute aortic syndrome.     

Chest radiographs in the evaluation of the febrile infant

Chest radiographs are often considered an essential part of the workup of the febrile infant. Anteroposterior and lateral radiographs of the chest are frequently obtained in this group of patients, irrespective of respiratory tract symptoms and/or signs. A total of 226 children (less than or equal to 2 years old) with and without signs and symptoms of lower respiratory tract infections were examined to assess the yield of chest radiographs. The radiograph was considered positive only if a focal parenchymal infiltrate was present. Hyperinflation or bronchial thickening was not included as a positive finding because these children usually do not receive antibiotics despite the fact that viral illness or reactive airway disease may be present. In a retrospective study of 105 infants, confidence intervals for yield were established for children with (95% Cl = 12%, 32%) and without (95% Cl = 0%, 14%) symptoms or signs of lower respiratory tract infection. In a prospective study of 121 infants without chest symptoms or signs, confidence levels for positive yield were better defined (95% Cl = 0%, 3%). The data suggest that obtaining chest radiographs to look for parenchymal infiltrates treatable with antibiotics in infants less than 2 years old is necessary only in those infants who have clinical evidence of lower respiratory tract illness.     

Chest radiography for general practitioners: scope for change?

In order to derive guidelines for general practitioners on the value of chest radiography we prospectively reviewed all chest radiographs over a 10 month period. Radiographic chest examinations (frontal with or without a lateral view) were performed on 2017 patients in the radiology department or at the chest clinic. Patient details were noted, referring practice and waiting times monitored. The adequacy of the referral letter was assessed, and specific predetermined clinical findings were correlated with the radiographic findings. Results were divided into three groups (normal, abnormal with a clinically unrelated or chronic abnormality, and abnormal with a clinically related abnormality). Of these patients, 1245 (62%) had normal examinations and 460 (23%) had clinically related abnormalities. Abnormalities were rare in the 10-29 year age group, and when reassurance was sought for patients with symptoms of non-specific chest pain or general ill health. Patients presenting with haemoptysis or with symptoms of lower respiratory infection, or of chronic airways disease often had an abnormal radiograph. A clinical diagnosis was indicated or implied in 1664 (82%) and confirmed in 876 (53%). The most frequent reason for referral was for reassurance (618 patients). Guidelines based on age and symptoms should rationalize the use of chest radiography by general practitioners.     

Chest radiography in the intensive care unit. Indications for radiography and effects of selective archiving of films

Consecutive chest radiographs (n = 2,303) in 601 patients in the intensive care units (ICU) were analyzed with regard to main disease and indication. Two thirds of the patients were transferred for routine post-operative treatment, 14 per cent mainly for cardiopulmonary insufficiency. The remainder were referred because of various clinical conditions. The main indications for chest radiography were routine radiographic follow-up and/or control of the position of catheters, tubes, drainages etc. (50%). Obvious clinical indications appeared in only about 1/4 of the patients. When the patients were discharged from the ICU all chest radiographs were analyzed with regard to their predicted future value. Films considered not worth storing were removed and stored in a separate archive (57%). During a 15-month follow-up period none of the removed films were requested, indicating that a substantial number of films can be sorted out continuously. The possibility to reduce and to 'clinically compress' the amount of data in a future digital picture archive is emphasized.     

Chest radiography in desquamative interstitial pneumonitis: a review of 37 patients

Follow-up radiographs were obtained in 37 cases of desquamative interstitial pneumonitis (DIP) in order to assess the degree to which the radiographic appearance could be used to follow the course of the disease and/or predict prognosis. The films were compared to the clinical outcome in 21 patients and the histology of the original biopsy was studied in 16 cases. The radiographic appearance was most commonly nonspecific, consisting of irregular opacities especially at the bases. Only six cases had the "classic" appearance of hazy, ground-glass densities in the medial parts of the lower lung fields. Of the 21 patients, 16 showed clinical improvement, usually after corticosteroid therapy. The radiographic changes accurately reflected the clinical course in 18 of 21 patients, although specific patterns could not be associated with any specific outcome and the films became completely normal in only four of the 16 patients who improved. Histologic characteristics within the confines of those diagnostic of DIP were not useful in predicting outcome. These results confirm the utility of radiography in following the course of DIP, although specific radiographic appearances cannot be used to predict prognosis. The favorable prognosis demonstrated in DIP favors the separation of DIP and UIP (usual interstitial pneumonitis) as independent diseases.     

Chest radiography and computed tomography in the evaluation of mediastinal adenopathy in lymphoma

Thoracic computed tomography (CT) in 232 patients with either primary staging of new or suggested relapsing lymphoma was compared with conventional chest radiography and both were correlated with clinical staging. Particular attention was given to the possibility of reducing routine thoracic CT, which is the current method used in this hospital in all patients with suggested lymphoma. Mediastinal lymphoma was detected by CT in 95 per cent of patients with clinically active mediastinal lymphoma, and by conventional chest radiography in 56 per cent. CT was found to be less reliable in evaluation of the hilar region than in that of other mediastinal areas. No areas of particular difficulty were found with chest radiography. CT also provided additional information concerning extra-mediastinal lymph adenopathy and involvement of the thoracic wall and pericardium. Routine thoracic CT examination was considered justifiable in all patients with suggested lymphoma.