The esophageal-pleural stripe: an update.

Observations on the esophageal-pleural stripe were amplified by computed tomography. The relationship of the esophagus to the trachea is variable and, at times, the two may be side by side, the esophagus to the left. Under this condition, the naturally air-filled esophagus may mimic mediastinal emphysema or tracheomegaly; the barium-filled esophagus may mimic displacement by a mediastinal tumor.

A general radiologist looks at congestive heart failure.

Congestive heart failure may be difficult to detect. Determination of cardiac size is untrustworthy. Changes in the hili (vessels, bronchi) are reliable. Pulmonary edema may be atypical. Vascular redistribution must be interpreted accurately. Congestive changes with chronic obstructive lung disease may be difficult or impossible to detect. Pleural fluid may present atypically. Changes in pleural surfaces other than in bases produce "new" signs.

Let us not lose echocardiography.

Despite the unquestioned value of echocardiography in the diagnosis of valvular disease, pericardial effusion, cardiomyopathy and many other cardiac conditions, few residency programs in radiology are offering training in echocardiography. Echocardiograms of the last 100 consecutive patients in a small community hospital demonstrated a surprising breadth of clinical material. Echocardiography should be included in every residency program lest our role in this technique is lost altogether.

Further refinements in the plain radiologic diagnosis of splenic rupture: the air enema.

Plain film radiography, by appraisal of the soft tissues of the descending colon and left paracolonic gutter, comprises a safe, accurate, and quick determination of the presence of free fluid, which, in the proper clinical setting, indicates splenic rupture. The air enema, introduced under fluoroscopic control, is a valuable aid in eliminating false negatives and false positives, and also in distinguishing intraperitoneal clots from subserosal hematoma. The preoperative diagnosis was correct in 27 of 28 cases. The one error occurred in a case in which the interpretation of paravesical fluid (dog ears) was faulty, and in which the air enema had not been used.

Case report: benign liver tumor with central necrosis.

A 38 year old previously well woman had sudden onset of upper abdominal pain and fever. Ultrasound examination revealed a necrotizing lesion in the liver. Arteriography revealed findings consistent with an adenoma or focal nodular hyperplasia. A right lobectomy and wedge resection of a similar lesion in the left lobe were done. Microscopy of both lesions indicated focal nodular hyperplasia. Adenoma is said to be related to the contraceptive oral hormone; focal nodular hyperplasia not. But it is possible that both may have an increased incidence of bleeding in the users of the oral contraceptive hormones.

Laminar avulsion in a cervical vertebra.

An unusual avulsion fracture involving the lamina of a cervical vertebra, most likely due to tear of a ligamentum flavum, is described. Its radiographic features may be quite subtle. Simulation of this fracture on dried skeleton allowed a better understanding of its appearance on the standard projections, its mechanism of occurrence, and its delayed recognition on the patient's anteroposterior view. Only awareness of the existence of this type of fracture and special efforts directed toward its detection will determine its true frequency.

Persistent hyperextension of the neck in breech ("star-gazing fetus") and in transverse lie ("flying-fetus"): indication for cesarean section.

All pregnancies with a breech or transverse lie should be examined roentgenologically, at least after the onset of labor, and those in whom hyperextension of the neck persists should be sectioned to avoid the real danger of injury to the cervical cord incurred in vaginal delivery. The radiologist should not assume a seriously deformed fetus just from the hyperextension; most of these fetuses are otherwise normal.