Distribution-and-analysis-of-chest-radiographic-findings-in-covid19-positive-symptomatic-and-asymptomatic-patients—analysis-of-668-patients-in-india

Current COVID-19 radiological literature is dominated by CT and a detailed description of chest x-ray (CXR) appearances in relation to the disease time course is lacking. However, it poses a great challenge on the radiology department, as it is difficult to decontaminate entire CT suite(Zhao et al., 2020)11. This study is aimed to correlate clinical symptoms with the chest X-ray findings in COVID positive patients and to calculate the sensitivity and specificity of chest x ray in diagnosing COVID 19. The present study compares frequency and distribution of chest radiographic findings in COVID 19 positive symptomatic and asymptomatic patients. Patients with a RT-PCR-positive results for COVID 19 infection were 668. Of these, 437 were males (65.4%), 230 females (34.4%) and 1 transgender (0.04%) with a mean age of 44 years (range 2–87 years). Only 18 CXRs were negative for radiological thoracic involvement (6.4%) among symptomatic patients (280). Among the baseline CXR of 668 patients, 375 (56.1%) were normal and 293 (43.8%) were abnormal. Sensitivity and specificity of CXR were 93.91% and 93.3% respectively. Positive and negative predictive values were 90.97% and 95.51% respectively. We found a statistically significant relationship between CXR severity score and age, symptoms, death (P<0.001).We even found significant relationship between age and symptoms, death of COVID positive patients (P<0.001). The relationship between CXR severity and gender, age and gender were not significant (P=0.539, P=0.864 respectively)

Value of baseline radiograph for COVID-19 infected patients

Introduction: A cluster of pneumonia cases of unknown origin was first reported in Wuhan China then the causative pathogen was identified and named severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) and the associated disease was named coronavirus disease 2019 (COVID-19). Chest radiograph has lower sensitivity for the detection of lung abnormalities but it has a role in disease progression and also in the late stages of COVID19. This study aims to evaluate the value of baseline radiographs in COVID-19-infected patients. Method: This is a retrospective study of COVID-19 patients with RT-PCR confirmation who were admitted to Eka Kotebe General Hospital and had baseline chest x-ray between April and May 2020. Baseline chest x-ray of all patients who have confirmed COVID-19 infection was reviewed and analyzed. Result: The study included 355 patients, 224 (63.1%) were male and 131 (36.9%) were female. Patient age ranged from 4 - 82 years with a mean age of 35. Two hundred twelve patients were symptomatic; the rest 143 were asymptomatic. Of the 355 baseline CXR, only 60 (16.9%) had abnormal radiographs and the rest 295 (83.1%) had normal radiographs. A combination of interstitial changes and GGO were the predominant descriptive finding accounting for 33.3% . Conclusion: Even if chest radiographs are important in the workup of patients with COVID-19 infection, the use of baseline radiographs in COVID-19 infection should not be a routine practice. Disease severity and timing of imaging appear to impact the rates of normal baseline imaging.

Smear-positive pulmonary tuberculosis patients with previously abnormal chest radiographs: missed opportunities for early diagnosis

INTRODUCTION@#It is vital to diagnose and treat pulmonary tuberculosis (PTB) early, in the interests of the patient and public health. At the Singapore Tuberculosis Control Unit (TBCU), it was not uncommon to discover abnormal chest radiographs (CXRs) predating their PTB diagnosis by months to years in the electronic medical records (EMRs) of sputum acid-fast bacilli smear-positive patients. Our study explored this observation.@*METHODS@#The EMRs of sputum smear-positive PTB patients treated at the TBCU from January to July 2014 were viewed for abnormal CXRs preceding their PTB diagnosis. Information in the EMRs pertaining to the indication for the CXRs, radiological reports (including whether the possibility of PTB was stated) and action taken was captured.@*RESULTS@#Of the 254 sputum smear-positive patients, 108 had previous CXRs in their EMRs, of whom 39 (36.1%) had previous CXRs compatible with PTB. Most of these were performed in tertiary institutions and for reasons unrelated to PTB. No action was taken in response to these CXRs in 24 (61.5%) patients. 27 (69.2%) patients had abnormal CXRs dating back more than six months, with 12 (30.8%) dating back more than 30 months before the PTB diagnosis. Patients aged ≥ 55 years were significantly more likely to have previous CXRs that were compatible with PTB.@*CONCLUSION@#PTB patients may be asymptomatic or have chronic indolent disease and remain undiagnosed for years. There is a need for vigilance within our healthcare system to seize opportunities for early diagnosis and treatment to prevent the spread of this infectious disease in Singapore.

Chest radiographs in Coronavirus Disease 2019 (COVID-19)

@#Objectives: To recognize the radiographic patterns of coronavirus disease 2019 (COVID-19) in Malaysia. Materials and Methods: Chest radiographs of patients confirmed with COVID-19 in Hospital Tawau, Sabah, Malaysia were retrospectively analyzed by two radiologists. The radiographic pattern, distribution among subgroups and evolution of the disease over time were determined. Results: Among the 82 patients studied, 65 (79.3%) were males. Mean age of our cohorts was 37 ± 15 years. Baseline chest radiographs were abnormal in 37 patients (45.1%). Over half (52.9%) of the symptomatic patients had abnormal baseline radiograph. Among the children, patients with comorbidities, and patients 60 years of age and above, the abnormal radiographs were 14.3%, 71.4% and 69.3% respectively. Ground glass opacities were the commonest abnormal radiographic feature (35.4%), were peripherally located (35.4%) with predilection for the lower zones (29.3%). Most radiographic abnormalities were multifocal (20.7%) and frequently located in the left lung (19.5%). Radiographic recovery was observed in 15 of 18 patients (83%). Computed tomography (CT) scan demonstrated greater extent of the disease than observed in radiographs of the same patient. Conclusions: COVID-19 pneumonia presented with a specific radiographic pattern in our cohort of patients, comprising of ground glass opacities in peripheral and basilar distribution, affecting a single lung field and was observed in both symptomatic and asymptomatic patients. Chest radiograph is a useful adjunct screening tool, and in combination with clinical and epidemiological assessment may facilitate in early diagnosis of COVID-19 pneumonia.

Are routine post drain removal chest x-rays necessary after oesophagectomy?

Background: Routine chest X-rays (CXR) are often performed following the removal of chest drains placed during oesophagectomy. CXRs are costly and inconvenient for the patient, often being performed out of working hours. The aim of this study was to evaluate whether routine CXR is necessary following drain removal or if CXRs should only be performed when indicated by the clinical status of the patient.Methods: This was a retrospective study of oesophagectomies performed at a single high volume centre. Routine post chest drain removal CXRs were analyzed and compared to baseline post-operative CXRs. The clinical status of the patient before and after chest drain removal was recorded.Results: 188 patients were identified. 111/188 (59%) had a pleural effusion or pneumothorax on their baseline post-operative CXR. Abnormal findings on post drain removal CXR were common with 72/188 (38.3%) patients having a new or worse pleural effusion or pneumothorax. Only, 5.6% (11/188) of these patients actually developed clinical signs after chest drain removal. Of these, only 2.1% (4/188) required chest drain re-insertion. No patients underwent intervention without showing clinical deterioration. No re-intervention was prompted by CXR finding alone.Conclusions: Routine CXR following chest drain removal is unnecessary. It is safe to only perform CXRs on patients who develop clinical signs.

Diagnostic accuracy of pneumonia in Hospital Tuanku Ja’afar Seremban, a tertiary hospital

@#Objectives: The primary objective of this study was to describe the accuracy of pneumonia diagnosis, both community-acquired pneumonia (CAP) and hospitalacquired pneumonia (HAP). Secondary objectives were describing the choice of antibiotics used, pathogens isolated, and predictive parameters in diagnosing pneumonia. Methods: This was a prospective cross-sectional study to determine the accuracy of the diagnosis of CAP and HAP admitted to Hospital Tuanku Ja’afar. All patients aged ≥12 years admitted to the general medical ward with the diagnosis of CAP or HAP were included in the study. Chest radiograph interpretation was done by certified radiologists. An accurate diagnosis of pneumonia was defined by clinical signs and symptoms of pneumonia supported by radiographical evidence. Results: A total of 159 patients were enrolled into the study from January 2018 to February 2018. Of these only 59(37.1%) cases were accurately diagnosed as pneumonia. Amongst those with pneumonia diagnosis made by the emergency department, medical officers and specialists of medical department; 65.4%, 60% and 47.3% respectively were not pneumonia. Amoxicillin with clavulanate and azithromycin were amongst the most common first choice of antibiotic used (46.5%). In this study, pathogens were isolated either by blood culture or sputum culture in only 20 (12.6%) patients. There was no significant predictive parameter identified in this study, which included white cell counts, Creactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), and Pao2/FiO2 ratio. Conclusion: About two-thirds of patients diagnosed with pneumonia did not have a compatible radiological finding. Better tools and systems are needed to aid in the diagnosis of pneumonia

Decoding neonatal chest radiographic patterns of disease: retrospective analysis from a tertiary care hospital

Background: To evaluate chest radiographic patterns in neonatal respiratory distress using a predesigned performa and algorithm and to correlate results with the clinical diagnosis.Methods: A retrospective review was done of bedside chest radiographs acquired over a month for respiratory distress from the neonatal intensive care unit. The radiographs were systematically evaluated according to a predesigned performa and algorithm. A presumptive radiographic diagnosis was assigned to each patient based on the combination of radiographic features. Radiographic diagnosis was compared with the clinical diagnosis. The most important diagnostic features were outlined.Results: The radiographic diagnosis correlated with clinical diagnosis in 93.3% of cases. Most common radiographic feature was pulmonary air space opacity (n=21). Air space opacity without any mediastinal shift in absence of any compensatory factors was a reliable diagnostic feature for pneumonic consolidation, which was the most common diagnosis (n=10). Bilateral granular lung fields were a specific indicator of respiratory distress syndrome. Flattening of domes of diaphragm was the most frequent feature for hyperinflation. Bilateral hyperinflation could be accurately used to diagnose bronchiolitis in all but one case (n=4/5). Pleural complications were accurately diagnosed.Conclusions: Systematic evaluation of neonatal chest radiographic patterns of disease has a high diagnostic accuracy.

A randomized controlled study of bedside electrocardiograph-guided tip location technique & the traditional chest radiography tip location technique for peripherally inserted central venous catheter in cancer patients

Background & objectives: The peripherally inserted central catheter (PICC) has the advantages of higher safety, lower infection rate and longer retention time than peripherally inserted catheter. This study was aimed to evaluate the accuracy and safety of bedside electrocardiograph (ECG)-guided tip location technique in PICC in cancer patients, and compared with traditional chest radiography tip location technique. Methods: Patients were randomly assigned into two groups: The ECG test group patients underwent PICC insertion with ECG-guided tip location, while the control group patients had PICC insertion by the conventional method. The precision of tip location was verified by chest radiography in both groups. The groups were compared with regard to the accuracy of tip placement, anxiety levels before and after the procedure; medical cost and incidence of complications at one week, three months and six months after PICC insertion. Results: Accurate tip location was achieved in 99.30 per cent in the ECG test group vs 92.30 per cent in the control group (P<0.001). At 24 h after the procedure, the anxiety level was significantly lower in the ECG test group. The presence of thrombogenesis was significantly lower in the ECG test group at both three months and six months after the procedure (P=0.04 and P=0.03, respectively). Interpretation & conclusions: The ECG-guided PICC tip location technique was accurate and caused fewer procedure-related complications and less anxiety in patients compared to chest radiography tip location technique. Radiographic confirmation of PICC tip position may not be needed when ECG guidance is used and thus it can help avoid radiation exposure.

Diagnóstico de neumonía por ultrasonido en el servicio de urgencias / Diagnosis of pneumonia by ultrasound at emergency room

Resumen Comunicamos el caso clínico de un paciente de 54 años de edad que ingresó al servicio por dificultad respiratoria. Inició su padecimiento actual un mes previo a su ingreso con tos productiva con expectoración purulenta abundante, fiebre no cuantificada y pérdida de peso, dos días previos a su ingreso se agregó dificultad respiratoria que se exacerbó aproximadamente tres horas previas a su ingreso. A la exploración física se observó paciente consciente con signos vitales: frecuencia cardiaca 130 lpm, frecuencia respiratoria 27 rpm, presión arterial 115/73 mmHg, temperatura 36.4ºC, con disnea, uso de músculos accesorios, taquicardia, taquipnea, con saturación a aire ambiente de 89%, como antecedentes de importancia destacaron toxicomanías positivas; se integraron datos clínicos de neumonía adquirida en la comunidad; la radiografía de tórax evidenció borramiento del ángulo costofrénico y costodiafragmático por lo que se sospechó derrame pleural; sin embargo, se decidió realizar ultrasonido pulmonar para confirmar derrame pleural vs consolidación pulmonar, en el que se observaron datos compatibles con escaso derrame pleural y zona de consolidación pulmonar basal derecha; se dio tratamiento con doble esquema antibiótico. Con este artículo se demuestra que el ultrasonido pulmonar resulta ser una herramienta efectiva y confiable en el diagnóstico temprano de neumonía en el servicio de Urgencias, sin necesidad de realizar radiografía de tórax, incluso tiene sensibilidad mucho mayor para el diagnóstico de derrame pleural en comparación con la radiografía convencional.

Abstract This paper reports the clinical case of a 54-year-old male patient, which entered to the service due to respiratory difficulty. Patient initiated his current suffering a month before the hospital admission with productive cough with purulent, abundant expectoration, not quantified fever, and loss of weight, two days before to his hospital admission respiratory difficulty was added that was exacerbated approximately 3 hours prior to income. To the physical exploration conscious patient was observed with vital signs: HR 130 bpm, RR 27 bpm, blood pressure 115/73 mmHg, temperature 36.4ºC, with shortness of breath, use of accessory muscles, tachycardia, tachypnea, with saturation to air ambience of 89%; precedents of importance: positive drug dependency; clinic data were integrated of community-acquired pneumonia, X-ray chest evidenced effacement of the costophrenic and costodiaphragmatic angle; thus, it was suspected pleural effusion; however, it was decided to perform pulmonary USG to confirm effusion vs pleural pulmonary consolidation, in which there were data compatible with low pleural effusion and right basal pulmonary consolidation area; handling was started with double antibiotic scheme. This article demonstrates that pulmonary USG turns out to be an effective and reliable tool in the early diagnosis of pneumonia in the Emergency Department, without necessity of chest X-ray, it has even much larger sensitivity for diagnosis of pleural effusion in comparison with conventional radiography.

Diagnostic values of X-ray and CT examinations for traumatic diaphragmatic rupture / 医疗卫生装备

Objective To explore the diagnostic values of X-ray and CT examinations for the traumatic diaphragmatic rupture. Methods Totally 17 patients with traumatic diaphragmatic rupture were retrospectively analyzed, who underwent X-ray chest radiograph and 64-slice spiral CT examinations as well as coronal and sagittal imaging by multi-planar reconstruction with GE ADW 4.6 workstation. Results Of the 17 patients, there were 15 ones had the rupture occurred on the left side (93.7%), one case on the right side (6.3%) and the remained one had no diaphragmatic injury;there were 10 ones of diaphragmatic contour discontinuity, 6 ones of intrathoracic hernia, 2 ones of cervical stenosis, one case of hanging sign and two cases of falling viscera sign. Conclusion Routine chest X-ray radiography has difficulty in diagnosing diaphragmatic rupture, while CT multiplanar imaging contributes to determining traumatic diaphragmatic rupture. Diaphragmatic rupture may occur after multiple trauma, and CT with multiplanar reformations has to be used as the routine examination for diagnosing diaphragmatic rupture.

A case of missed blunt traumatic aortic injury (BTAI)

We are reporting a case of missed blunt traumatic aortic injury (BTAI). A 28 year male presented with chest pain following a motor vehicle accident. He was discharged following normal clinical signs and chest radiograph. The following day he complained of lower limb weakness. Traumatic aortic dissection was revealed via computer tomography (CT) of the thorax. BTAI cannot be ruled out with normal clinical signs and chest radiograph alone. CT thorax is mandatory to rule out BTAI in high impact chest injury.

Occult primary spontaneous pneumothorax

We report a case of occult primary spontaneous pneumothorax in a 30 years-old woman. She developed symptoms and signs that were suggestive of pneumothorax. However, chest radiograph failed to reveal pneumothorax. Therefore, we proceeded with computed tomography (CT) thorax which revealed significantly moderate right pneumothorax. The diagnostic approach and the management of this case are discussed.

A radiological perspective of assessing neonatal respiratory distress syndrome

Background: The causes of respiratory distress in the neonatal period can be classified into abnormalities primarily affecting aeration, circulation or development of the thorax. Conditions of the lungs and cardiovascular system account for the majority but abnormalities of the tracheobronchial tree, chest wall, diaphragm, and a variety of neuromuscular diseases must also be considered in the differential diagnosis. Chest radiography is the most valuable imaging modality in the investigation of neonatal respiratory disorders. Within 48 – 72 hours, the most common disorder that occurs in neonate is respiratory distress. Post natal respiratory distress is the most important indication for chest X-ray. Materials and methods: This was a prospective observational study that was conducted in rural tertiary care center. Anteroposterior chest radiograph in supine position of (59) neonates were taken, presented with a chief complaint of respiratory distress. Chest X-ray was taken with the help of portable X-ray machine in NICU department. Chest X-ray were taken on first day of admission and then follow up chest X-rays were taken. Results: The commonest cause of respiratory distress in neonates which presented with respiratory distress was transient tachypnoea of new born, in my study 32.20% diagnosed with transient tachyponea; 20.3% diagnosed with hyaline membrane disease; 16.94% diagnosed with congenital neonatal pneumonia; 11.86% diagnosed with meconium aspiration syndrome; 1.96% diagnosed with aspiration syndrome; 5.08% diagnosed with cardiac causes; 3.38 % diagnosed with tracheaoesophageal fistula; 3.38% diagnosed with congenital diaphragmatic hernia; 1.69% diagnosed with idiopathic persistent pulmonary hypertension; 1.69% diagnosed with eventeration of diapghram; 1.69% diagnosed with pneumoperitoneum, presented to radiology department with respiratory distress. Jayesh Shah, Nikhil Parvatkar, C. Raychaudhuri. A radiological perspective of assessing neonatal respiratory distress syndrome. IAIM, 2017; 4(12): 10-15. Page 11 Conclusion: Chest radiography is essential in neonates with acute respiratory distress to exclude structural abnormalities such as congenital diaphragmatic hernia or congenital lobar emphysema. One should remember that any sign of post–natal respiratory distress is an indication for roentgenogram of the chest which should be taken as early as possible. Finally chest radiograph should be read by an expert radiologist.

Clinical Features and Radiological Findings of Adenovirus Pneumonia Associated with Progression to Acute Respiratory Distress Syndrome: A Single Center Study in 19 Adult Patients

OBJECTIVE: To describe radiologic findings of adenovirus pneumonia and to understand clinico-radiological features associated with progression to acute respiratory distress syndrome (ARDS) in patients with adenovirus pneumonia. MATERIALS AND METHODS: This study included 19 patients diagnosed with adenovirus pneumonia at a tertiary referral center, in the period between March 2003 and April 2015. Clinical findings were reviewed, and two radiologists assessed imaging findings by consensus. Chi-square, Fisher's exact, and Student's t tests were used for comparing patients with and without subsequent development of ARDS. RESULTS: Of 19 patients, nine were immunocompromised, and 10 were immunocompetent. Twelve patients (63%) progressed to ARDS, six of whom (32%) eventually died from the disease. The average time for progression to ARDS from symptom onset was 9.6 days. Initial chest radiographic findings were normal (n = 2), focal opacity (n = 9), or multifocal or diffuse opacity (n = 8). Computed tomography (CT) findings included bilateral (n = 17) or unilateral (n = 2) ground-glass opacity with consolidation (n = 14) or pleural effusion (n = 11). Patients having subsequent ARDS had a higher probability of pleural effusion and a higher total CT extent compared with the non-ARDS group (p = 0.010 and 0.007, respectively). However, there were no significant differences in clinical variables such as patient age and premorbid condition. CONCLUSION: Adenovirus pneumonia demonstrates high rates of ARDS and mortality, regardless of patient age and premorbid conditions, in the tertiary care setting. Large disease extent and presence of pleural effusion on CT are factors suggestive of progression to ARDS.

To assess the pulmonary impairment in treated pulmonary tuberculosis patients using spirometry

Background: Tuberculosis is one of the leading causes of death due to infectious Disease worldwide, with an estimated 8.9 million new cases and 1.6 million Deaths worldwide. Aim: To study the type and degree of pulmonary impairment in treated pulmonary Tuberculosis patients using spirometry. To co -relate present symptoms and radiological findings and to assess the degree of impairment. For identification of impairment (obstructive, restrictive or mixed) that contribute to long term disability and decreased quality of life. Materials and methods: Retrospective observational study was done in Meenakshi Medical College Hospital. A total of 75 treated pulmonary tuberculosis patients were taken for study with clinical data, chest x-ray pattern, smoking and biomass fuel exposure history were recorded. Their pulmonary function was assessed using spirometry. Results: All patients were symptomatic and most common symptom was breathlessness. Chest radiograph showing 1 or 2 zones involved patients were 40 (53.3%) and more than 3 zones involved were 35 (46.7%).Most of the patients 51 (68%) showed a Restrictive pattern in spirometry, 10 (13.3%) showed an obstructive pattern and 14 (18.7%) showed a mixed pattern. Smoking and Biomass fuel exposure did not show a significant co-relation with spirometry pattern but initial sputum positive patients and defaulter patients showed a significant co-relation with spirometry pattern. Conclusion: The most common pulmonary impairment pattern in treated pulmonary tuberculosis patients was Restrictive pattern. Hence pulmonary tuberculosis need follow up even after treatment for early detection and treatment for their pulmonary disability

Clinics in diagnostic imaging (165). Oesophageal rupture secondary to malposition of an SB tube gastric balloon

Oesophageal rupture is a life-threatening complication of balloon tamponade for bleeding oesophageal varices. We herein describe the clinical course and imaging findings in a 33-year-old Indian man who had a Sengstaken-Blakemore (SB) tube inserted for uncontrolled haematemesis, which was unfortunately complicated by malposition of the gastric balloon with resultant oesophageal rupture. The inflated SB tube gastric balloon was visualised within the right hemithorax on chest radiography after the SB tube insertion. Further evaluation of the thorax on computed tomography confirmed the diagnosis of oesophageal rupture associated with right-sided haemopneumothorax. It is crucial for both the referring clinician and reporting radiologist to recognise early the imaging features of an incorrectly positioned SB tube gastric balloon, so as to ensure prompt intervention and a reduction in patient morbidity and mortality.

Application of electronic chest radiograph scale measurement techniques in the prediction of placed length of peripherally inserted central venous catheters / 中国实用护理杂志

Objective To predict the length of peripherally inserted central venous catheters(PICC) with electronic chest radiograph scale measurement techniques, and observe its clinical effect. Methods A total of 185 breast cancer patients from October 2012 to December 2013 who were treated by PICC combined with MST guided by ultrasonic technology were as control group. A total of 192 breast cancer patients from January to November 2014 were as observation group. Control group adopted from the puncture point to right sternoclavicular joints impreaaion nip down again to the third floor of PICC in vitro measurement method. Observation group used to right sternoclavicular joints from the puncture point plus right sternoclavicular joints to subcarinal 1 vertebral body length, right sternoclavicular joints to subcarinal 1 vertebral body length measurement by electronic chest radiograph scale technology directly measured from the electronic chest radiographs. The accuracy rates and complications between the two measurement methods were compared. Results The accuracy rate in observation group was 97.92%(188/192), which was higher than that in control group (68.11%,126/185 ),and there was significant differencek,χ2=60.15, P<0.01. The complication rate in observation group was 6.77%(13/192), which was lower than that in control group (20.54%, 38/185) ,and there was significant difference,χ2=9.58, P<0.01. Conclusions The electronic chest radiograph scale measurement techniques could effectively improve the accuracy of PICC catheter placed, improve the quality of venipuncture, decrease the complications .

Correlation of physiological and radiological characteristics in chronic obstructive pulmonary disease.

Background. Diagnosis of chronic obstructive pulmonary disease (COPD) is confirmed on spirometry but the diagnosis of emphysema remains problematic. The objective of this study was to evaluate the utility of chest radiograph (CXR) and computed tomography (CT) for the diagnosis of emphysema and to correlate these findings with pulmonary function tests (PFTs). Methods. Thirty-five patients with COPD were studied. In all of them, CXR, CT and PFTs were done; three patients had bronchiectasis on CT and were excluded from the study. Chest radiographs (CXRs) were scored for signs of hyperinflation. Lung densities were measured on CT. Results. Functional indices of hyperinflation, i.e. functional residual capacity (FRC), residual volume (RV) and RV/total lung capacity (TLC) had significant correlation with CXR scores. The mean retrosternal space (RSP) measurement was 2.63±0.6 cm (range 1.2 to 3.6cm). Mean lung density (MLD) was -867.91 Hounsfield units (HU) which significantly correlated with functional indices of hyperinflation (FRC, RV, TLC, RV/TLC). Conclusions. In Indian population hyperinflation was found to occur even with lesser values of RSP than the western criteria. CT lung density gives good radiological evidence of emphysema and correlates with lung function abnormalities.

Role of routine chest radiographs in the evaluation of patients with stable blunt chest trauma: a prospective analysis / Papelde las radiografías de tórax rutinarias en la evaluación de pacientes contraumas contundentes estables del tórax: análisis prospectivo

OBJECTIVE: The study sought to assess the test performance characteristics of clinical judgement in the evaluation of stable blunt chest trauma patients compared with chest radiography (CXR) in the determination of significant intra-thoracic injury. METHODS: We prospectively enrolled all adult patients (older than 16 years) who were considered to have stable blunt chest trauma over a six-month period (May 1-October 31, 2009). We defined the latter as patients who were unintubated, normotensive (systolic blood pressure > 90 mm Hg) and without hypoxia (oxygen saturation > 95% at room air). Patients eligible for the study were sent for anteroposterior (AP) CXRs which were then interpreted by the same consultant radiologist throughout the study period. Both test (clinical judgement) and disease status (CXR) were assigned and correlated as binary measures. We compared the test performance characteristics such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic likelihood ratios of clinical judgement to CXR findings in the determination of significant intra-thoracic injury. RESULTS: During the six-month period, data were collected from 77 eligible stable blunt chest trauma patients (age over 16 years). Fifty-nine patients (76.6%) were male. Nine patients (11.7%) were radiologically confirmed to have significant blunt chest injuries including rib fractures, pneumothorax and an isolated case of pulmonary contusion. All nine (11.7%) patients had a positive (abnormal) radiograph for rib fractures. In addition, three (3.9%) of them also had both rib fracture and pneumothoraces and one (1.3%) had both a rib fracture and pulmonary contusion. Clinical judgement for the diagnosis of significant blunt chest injuries matched with the CXR finding with 95%confidence intervals (CIs): sensitivity 100% (95% CI 66.4, 100), specificity 32.4% (95% CI 21.5, 44.8), prevalence 11.7%, PPV 16.4% (95% CI 7.77, 28.8), NPV 100% (95% CI 84.6, 100), DLR+ 1. 48 (95% CI 1. 25, 1. 74). CONCLUSION: The majority of patients who sustained blunt chest injuries and were assessed as stable patients do not require CXR routinely. This study revealed that physicians in the local Emergency Department may be over-utilizing CXR for patients who have stable blunt chest trauma.

OBJETIVO: Este estudio se propuso evaluar las características de rendimiento de test del juicio clínico, a la hora de evaluar pacientes con traumatismos contundentes torácicos estables, en comparación con la radiografía de tórax al determinar lesiones intra-torácicas significativas. MÉTODOS: De forma prospectiva, fueron enrolados todos los pacientes adultos (mayores de 16 años) de quiénes se consideraba que habían tenido un trauma contundente torácico estable por un período de más de seis meses (1ero de mayo al 31 de octubre, 2009). Definimos a estos últimos como pacientes no entubados, normotensos (tensión arterial sistólica > 90 mm Hg) y sin hipoxia (saturación de oxígeno > 95% en el aire de la habitación). Los pacientes elegibles para el estudio fueron enviados a hacerse una radiografía torácica anteroposterior (AP), la cual fue entonces interpretada por el mismo radiólogo consultante a cargo de ese análisis durante todo el periodo de estudio. Tanto el test (juicio clínico) como el estatus de la enfermedad (rayos X del tórax) fueron asignados y correlacionados como medidas binarias. Se compararon las características de rendimiento del test, tales como la sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo, las tasas de probabilidad diagnóstica del juicio clínico, con los hallazgos de los rayos X de tórax para la determinación de la lesión intra-torácica significativa. RESULTADOS: Durante el periodo de seis meses, se recogieron datos de 77 pacientes elegibles con traumatismos contundentes estables de tórax (mayores de 16 años). Cincuenta y nueve pacientes (76.6%) eran varones. En nueve pacientes (11.7%) se habían confirmado radiológicamente lesiones de tórax significativas, incluyendo fracturas de las costillas, pneumotórax, y un caso aislado de contusión pulmonar. Los nueve (11.7%) pacientes todos tenían una radiografía positiva (anormal) de las fracturas de las costillas. Además, tres de ellos (3.9%) tenían fractura de la costilla y además pneumotórax, en tanto que uno (1.3%) presentaba fractura de las costillas y contusión pulmonar también. El juicio clínico para el diagnóstico de lesiones contundentes estables de tórax significativas se correspondía con los hallazgos de las radiografías torácicas, como lo muestran los siguientes resultados de la prueba, con intervalos de confianza (ICs) de 95%: sensibilidad 100% (95% IC 66.4, 100), especificidad 32.4% (95% IC 21.5, 44.8), prevalencia, 11.7%, PPV 16.4% (95% IC 7.77, 28.8), NPV 100% (95% IC 84.6, 100), DLR+ 1.48 (95% IC 1.25, 1.74). CONCLUSIÓN: La mayoría de los pacientes que han sufrido traumatismos contundentes de tórax, y fueron evaluados como pacientes estables no requieren rayos C de tórax rutinariamente. Este estudio reveló que los médicos en el Departamento de Emergencias local pueden estar haciendo un uso excesivo de las radiografías torácicas en el caso de pacientes con traumas torácicos contundentes estables.

Computer-Aided Detection of Malignant Lung Nodules on Chest Radiographs: Effect on Observers' Performance

OBJECTIVE: To evaluate the effect of computer-aided detection (CAD) system on observer performance in the detection of malignant lung nodules on chest radiograph. MATERIALS AND METHODS: Two hundred chest radiographs (100 normal and 100 abnormal with malignant solitary lung nodules) were evaluated. With CT and histological confirmation serving as a reference, the mean nodule size was 15.4 mm (range, 7-20 mm). Five chest radiologists and five radiology residents independently interpreted both the original radiographs and CAD output images using the sequential testing method. The performances of the observers for the detection of malignant nodules with and without CAD were compared using the jackknife free-response receiver operating characteristic analysis. RESULTS: Fifty-nine nodules were detected by the CAD system with a false positive rate of 1.9 nodules per case. The detection of malignant lung nodules significantly increased from 0.90 to 0.92 for a group of observers, excluding one first-year resident (p = 0.04). When lowering the confidence score was not allowed, the average figure of merit also increased from 0.90 to 0.91 (p = 0.04) for all observers after a CAD review. On average, the sensitivities with and without CAD were 87% and 84%, respectively; the false positive rates per case with and without CAD were 0.19 and 0.17, respectively. The number of additional malignancies detected following true positive CAD marks ranged from zero to seven for the various observers. CONCLUSION: The CAD system may help improve observer performance in detecting malignant lung nodules on chest radiographs and contribute to a decrease in missed lung cancer.