Pulmonary Edema: Radiographic Differential Diagnosis

PURPOSE: To evaluate the feasibility of using chest radiography to differentiate between three different etiologies of pulmonary edema. MATERIALS AND METHODS: Plain chest radiographs of 77 patients, who were clinically confirmed as having pulmonary edema, were retrospectively reviewed. The patients were classified into three groups: group 1(cardiogenic edema : n=35), group 2(renal pulmonary edema : n=16) and group 3(permeability edema :n=26). We analyzed the radiologic findings of air bronchogram, heart size, peribronchial cuffing, septal line, pleural effusion, vascular pedicle width, pulmonary blood flow distribution and distribution of pulmonary edema. In a search for radiologic findings which would help in the differentiation of these three etiologies, each finding was assessed. RESULTS: Cardiogenic and renal pulmonary edema showed overlapping radiologic findings, except for pulmonary blood flow distribution. In cardiogenic pulmonary edema(n=35), cardiomegaly(n=29), peribronchial cuffing(n=29), inverted pulmonary blood flow distribution(n=21) and basal distribution of edema(n=20) were common. In renal pulmonary edema(n=16), cardiomegaly(n=15), balanced blood flow distribution(n=12), and central(n=9) or basal distribution of edema(n=7) were common. Permeability edema(n=26) showed different findings. Air bronchogram(n=25), normal blood flow distribution(n=14) and peripheral distribution of edema(n=21) were frequent findings, while cardiomegaly(n=7), peribronchial cuffing(n=7) and septal line(n=5) were observed in only a few cases. CONCLUSION: On plain chest radiograph, permeability edema can be differentiated from cardiogenic or renal pulmonary edema. The radiographic findings which most reliably differentiated these two etiologies were air bronchogram, distribution of pulmonary edema, peribronchial cuffing and heart size. Only blood flow distribution was useful for radiographic differentiation of cardiogenic and renal edema.

The Difference in the Appearance of Proximal Humeral Epiphyseal Ossification Center on Chest Radiograph between the preterm and Full-term Infants

PURPOSE: To assess the difference in the appearance of the proximal humeral epiphyseal ossification center, as seen on chest radiograph, between preterm and full-term infants at the same corrected ages. MATERIALS AND METHODS: Forty two preterm infants born at 26-35 weeks of gestational age and 218 normal full-term infants born at 38-42 weeks were investigated. Because of various perinatal problems, the preterm infants were treated at a neonatal intensive care unit. Proximal humeral epiphyseal ossification centers were evaluated from chest radiographs, and in cases of preterm infants, the corected age of 0 month was defined as postconceptional 40 weeks. In preterm infants, the numbers of chest radiographs obtained were 42 at 0 month, 40 at 1 month, 37 at 2 months and 36 at 3 months of corrected age, while in those who were full-term, the numbers were 103 cases at 0 month, 42 at 1 month,42 at 2 months and 31 at 3 months of age. In the preterm group, alkaline phosphatase, calcium, phosphorus levels and simple wrist radiographs were checked. We then evaluated the difference of appearance of the proximal humeral epiphyseal ossification center between preterm and full-term infants at the same corrected ages, as well as the difference between causative diseases, between the normal and abnormal serologic group and between the normal and abnormal wrist group in preterm infants at the same corrected ages. Using Fisher's exact test, the data were analysed. RESULTS: The incidences of the proximal humeral epiphyseal ossification center in preterm infants were 2.4% (1/42) at 0 month, 20.0% (8/40) at 1 month, 43.2% (16/37) at 2 months and 69.4% (25/36) at 3 months; infull-term infants, the figures were 24.3% (25/103) at 0 month, 66.7% (28/42) at 1 month, 83.3% (35/42) at 2 months and 90.3% (28/31) at 3 months. At 0, 1, and 2 months, the incidences were thus seen to be lower in preterm than infull-term infants(p0.05). In preterm infants, there were no statistical differences between causative diseases, between the normal and abnormal serologic group and between the normal and abnormal wrist group(p>0.05). CONCLUSION: Up to the age of two months, the proximal humeral epiphyseal ossification center of preterm infants appears later than that of full-term infants at the same corrected age.

Primary Malignant Mesothelioma of the Pericardium: A Case Report

Primary malignant mesothelioma of the pericardium is a very rare and highly lethal neoplasm. Diagnosis is a difficult problem and most of the cases reported in the literature were diagnosed at postmortem. We report a caseof primary malignant mesothelioma of the pericardium in a 22 year-old man. CT and MR imaging both showed diffuse irregular pericardial thickening, soft tissue density with cystic lesion, nodular bulging into the myocardium, permeative growth of the tumor, and encasement of the heart and two great vessels.

Incidence of the Appearance of the Proximal Humeral Ossification Center of the Neonates and Infants on Plain Chest Radiograph

PURPOSE: To ascertain the incidence of proximal humeral epiphyseal ossification centers, as shown on chest radiographs, in neonates and infants. MATERIALS AND METHODS: The distribution of corrected age(CA) of the infantswas from 24 weeks of gestational age to 6 months of postnatal age. They were obtained from inborn and outborn infants without developmental problems. Proximal humeral epiphyseal ossification centers were evaluated by two radiologists from a total of 440 chest radiographs. Of these, 196 were of the female chest and 244 were of themale. Corrected ages based on postnatal age are expressed as weeks before two months of age and as months after two months of age. The ossified or nonossified epiphyses of the humeral heads were plotted against corrected age. From these graphs, the percentages of ossification according to their corrected age was observed. RESULTS: 37weeks of corrected age in which 9.1%(1/11) was ossified was the earliest age of humeral epiphyseal ossification in the female. While 35 weeks of CA in which 6.3%(1/16) was ossified was the earliest age in the male. In full-term neonates(=40 weeks of CA), 20%(6/30) of epiphysis was ossified in the female and 23.3%(7/30) in the male. The female group of 43-44 weeks of corrected age showed ossification of 50% and the male group of 44-45 weeks of corrected age showed ossification of 50%. By five months of corrected age, 100% of epiphyses, both in the female and in the male, were ossified. CONCLUSION: Humeral ossification centers are seen from 35-37 weeks of correctedage. By five months of age, all humeral epiphyses are ossified.