Selected topics in chest trauma.

Trauma is the leading cause of death of young adults in the United States, and chest trauma is one of the leading causes of trauma-related fatalities. This article presents an approach to the radiological evaluation and diagnosis of pneumothorax, pneumomediastinum, traumatic aortic rupture, and thoracic spine injuries. Also discussed is the radiological assessment of vascular catheters, endotracheal tubes, and thoracostomy tubes.

Pleuropulmonary blastoma simulating an empyema in a young child.

Pleuropulmonary blastoma is a rare childhood malignancy that may simulate an empyema both clinically and radiographically. A 3-year-old boy with fever, cough, and abdominal pain developed complete opacification of the left hemithorax with contralateral mediastinal shift over the course of several weeks. At thoracotomy, a pleuropulmonary blastoma was discovered. The radiology, pathology, and clinical course of this rare neoplasm are discussed.

Pseudometastasis of the chest wall resulting from a Hickman catheter.

A 21-year-old woman with a high-grade soft-tissue sarcoma developed a lesion in the soft tissues of her chest wall at the same time that she developed pulmonary metastases from her primary neoplasm. The chest wall lesion diminished in size on sequential computed tomography (CT) scans, indicating that it was a pseudometastasis caused by removal of the patient's indwelling Hickman catheter. Awareness that removal of tunneled central venous catheters can produce soft-tissue masses in the chest wall that may mimic metastases may prevent inappropriate staging and treatment of these patients.

Pneumorachis and pneumocephalus caused by pneumothorax and multiple thoracic vertebral fractures.

Pneumorachis, or air within the spinal canal, has rarely been described, particularly in conjunction with thoracic trauma. We report a case of pneumorachis and pneumocephalus in a patient with a tension pneumothorax and multiple closed thoracic spinal fractures.

MR imaging in the evaluation of the chest after uncomplicated median sternotomy.

Although complications of median sternotomy are infrequent, they are associated with high morbidity and mortality. Current imaging modalities have proved to be of limited value in the evaluation of these abnormalities. The search for more efficacious means of assessment is continual. The appearance of the thorax was evaluated in 10 patients who were undergoing median sternotomy for coronary artery bypass graft surgery. Three serial magnetic resonance (MR) imaging examinations were performed on each patient. These examinations included a baseline preoperative study and two postoperative studies. Each patient included in the study had an uncomplicated postoperative clinical course. Usual postoperative findings included pleural effusions, pulmonary parenchymal abnormalities, mediastinal edema, and pericardial effusions. On the basis of this limited study, the authors believe that MR imaging is a feasible means of evaluating the chest after surgery. An appreciation of the normal postoperative appearance is essential before complications can be reliably identified and characterized.

Pulmonary artery laceration and tension pneumothorax in blunt chest trauma.

Traumatic laceration of the pulmonary artery is rare and is associated with a high mortality rate. The article describes a patient with pulmonary artery laceration from blunt chest trauma who presented with tension pneumothorax. Potentially life-threatening intrathoracic bleeding was not apparent until the pneumothorax was decompressed.

Developmental lymphatic disorders of the thorax.

Developmental disorders that involve the lymphatic channels of the thorax, although rare, are important and must be distinguished from the more common causes of chest masses or diffuse lung disease. There are four major types of developmental lymphatic disorders that affect the thorax: lymphangiectasis, characterized by congenital anomalous dilatation of pulmonary lymph vessels; localized lymphangioma, a rare and benign, usually cystic, lesion characterized by masslike proliferation of lymph vessels; diffuse lymphangioma, a proliferation of vascular, mainly lymphatic, spaces in which visceral and skeletal involvement are common; and lymphangioleiomyoma, which involves a haphazard proliferation of smooth muscle in the lungs and dilatation of lymphatic spaces. These characteristic findings can be seen with radiographic studies as well as with histologic evaluation. The discovery of one of these lymphatic disorders may prompt an investigation for associated congenital anomalies, including Noonan syndrome, asplenia, Gorham syndrome, and tuberous sclerosis.

Pneumocystis carinii pneumonia: effect of corticosteroid treatment on radiographic appearance in a patient with AIDS.

Dramatic radiographic and clinical resolution of Pneumocystis carinii pneumonia occurred in a patient with acquired immunodeficiency syndrome after corticosteroids were added to his standard antimicrobial treatment regimen. No cause other than P carinii infection could be demonstrated for the patient's pulmonary disease, and his clinical and radiographic abnormalities waxed and waned in synchrony with decreases and increases in his dose of corticosteroids.

Bacterial lung abscess: a review of the radiographic and clinical features of 50 cases.

The radiographic and clinical features of 50 patients with documented bacterial lung abscess are presented. Neither clinical nor radiographic features permit a specific diagnosis of lung abscess to be made; microbiologic or histopathologic material is needed to establish the diagnosis. A surprising percentage of patients (18%) had radiographically occult lung abscesses that were diagnosed only at the time of surgery or autopsy. Possible causes for and means of avoiding this diagnostic pitfall are presented.

Calcified hilar and mediastinal lymph nodes in an AIDS patient with Pneumocystis carinii infection.

An unusual radiologic manifestation of Pneumocystis carinii infection (enlarged, calcified hilar and mediastinal lymph nodes) in a patient with acquired immunodeficiency syndrome is described. This atypical manifestation caused significant diagnostic confusion. Recognition that P carinii infection can cause calcification of hilar and mediastinal lymph nodes may prevent this confusion and facilitate diagnosis and treatment.

Air-fluid level in axillary vein simulating abscess.

Demonstration of an air-fluid level in the body wall on a computed tomography examination usually suggests the presence of an abscess or a postoperative fluid collection. However, the small amount of air that frequently is injected during intravenous contrast administration may result in a similar computed tomography appearance.

The continuum of pulmonary developmental anomalies.

The classic features of six common pulmonary developmental anomalies have been presented. In addition, several overlap cases, each demonstrating features of more than one anomaly, have been illustrated. Such cases serve to emphasize that pulmonary developmental anomalies exist as a continuum, often frustrating our attempts at discrete classification. Future advances in pulmonary embryology may further elucidate the pathogenesis of these entities.

Atypical distribution of Pneumocystis carinii infiltrates during radiation therapy.

Bilateral peripheral pulmonary infiltrates caused by Pneumocystis carinii developed in a patient undergoing mediastinal irradiation after chemotherapy for Hodgkin disease. The paramediastinal part of the lung included within the treatment port remained clear during the 2 1/2 weeks of radiation therapy. The distribution of the pneumocystis infiltrates was altered by the radiation, producing a pattern that is the "radiographic negative" of typical post-radiation therapy paramediastinal fibrosis.