Analysis of the causes of misdiagnosis on CT films of 45 patients with lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>To analyze the causes of computed tomographic misdiagnosis of pulmonary carcinoma.</p><p><b>METHODS</b>From September 1991 to January 2002, 45 cases of pulmonary carcinoma misdiagnosed by CT were analyzed retrospectively. Twenty-six cases of pulmonary tuberculosis and 15 cases of pulmonary pneumonia misdiagnosed as pulmonary carcinoma by CT were studied as control subjects. All of these cases were confirmed by surgery and clinical course. The CT appearances of these cases were independently reviewed in a double blind method by three experienced radiologists. Then they discussed together in order to search for the factors of CT misdiagnosis and formed a consensus interpretation.</p><p><b>RESULTS</b>Forty-five cases of pulmonary carcinoma were misdiagnosed as pulmonary tuberculosis in 19 cases, pneumonia in 14 cases, abscess in 4 cases, pleural mesothelioma in 2 cases, normal in 2 cases, and others in 4 cases. The fundamental manifestations of misdiagnosed cases were lobar or segmental shadows (26 cases), solitary mass or nodule (19 cases).The reasons of CT misdiagnosis were very confusing. The main factors were:(i) Missed diagnosis (2 cases, 4.5%). One case had an endobronchial mass and another had the erosion of rib. (ii) Twenty-four cases (53.3%) due to mis interpretation and lack of experience. (iii) The manifestations in CT were atypical (19 cases,42.2%).</p><p><b>CONCLUSIONS</b>Not identifying accurately the CT appearances and excessively emphasizing the specificity of some signs are the main causes of the misdiagnosis. A reasonable and careful CT examination, summarizing analysis combined with clinical findings, and the accumulation of diagnostic experience will help to reduce the CT misdiagnostic rate of pulmonary carcinomas.</p>

X-ray Diagnosis of Total Anomalous Connection of Pulmonary Veins: A Report of 5 cases / 第三军医大学学报

Five cases of total anomalous connection of the pulmonary veins, proved by either surgery or autopsy, were reported. The characteristics of the clinical manifestations and findings of plain films and contrast studies of the 4 different types of total anomalous connection of the pulmonary veins were analyzed and reduced. A method of selective pulmonary arteriography with high diagnostic value for this anomaly was recommanded. In additirn, the procedure of arteriographic study for the anomaly and its images were discussed.

X-Ray Observations on Experimental Respiratory Distress Syndrome in Dogs / 第三军医大学学报

Oleic acid was injected intravenously into 29 dogs to induce the experimental 'Respiratory Distress Syndrome'. The chest x-ray manifestations of RDS were observed and analyzed. Correlating the x-ray findings with the findings of patho-anatomical examination, which was done on the killed dogs, the authors tried to investigate the pathogenesis of RDS. Meanwhile the diameter of the first branch of either inferior pulmonary artery was measured to determine the variations of the contractions of the pulmonary arteries.Finally the therapeutic effect of anisodamine and dexamethasone was compared. It seemed that the effect of the former was better than that of the latter from our preliminary trial.

X-ray Diagnosis of Ebstein's Anomaly of Tricuspid Valve / 第三军医大学学报

The roentgenographic characteristics of 6 cases of Ebstein's anomaly of tricuspid valve were analyzed. The most remarkable feature on a plain film was a hugely enlarged heart shadow with a spherical configuration due to the marked dilatation of the right atrium. The infundibulum of the right ventricle was prominent and the pulmonary artery segment was depressed. There was diminished pulmonary vascularity with narrow vascular pedicle. On fluoroscopy and kymograph, except for the upper left border where vigorous pulsations existed, all parts of both cardiac borders showed much weakened pulsations. The angiographic findings of this group of patients were similar to those described in the textbooks or other references.A discussion was made on the differentiation of this anomaly from the tetralogy and trilogy of Fallot on plain films. The differentiation of Ebstein's anomaly from tetralogy was considered to be easy since the cardiac configurations of the two diseases are quite different. Three points were listed to be the differentiating criteria between Ebstein's anomaly and trilogy.In case the diagnosis of Ebstein's anomaly on plain films is not conclusive) or specific anatomical or hemodynamical abnormalities are required to be demonstrated, right cardiac catheterization and angiographic study should be performed.