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1.
Dtsch Med Wochenschr ; 135(45): 2235-8, 2010 Nov.
Article in German | MEDLINE | ID: mdl-21046530

ABSTRACT

HISTORY AND ADMISSION FINDINGS: Due to a retroperitoneal hematoma after cardiac catheterization a 64 year-old woman received two concentrates of red blood cells. Within two hours after transfusion the patient developed acute dyspnoea, anxiety and shivering. INVESTIGATIONS: Computertomography (CT) of the chest revealed a new bilateral, basally accented pulmonary edema. Pulmonary embolism was ruled out. A cardiac cause in terms of cardiogenic shock had been excluded by echocardiography and other non-invasive measurements. Moreover, no circulatory overload (transfusion-associated circulatory overload [TACO]) after transfusion was presented and the stable size of the retroperitoneal hematoma excluded haemorrhagic shock. Hence, the clinical pattern pointed towards a transfusion-related acute lung injury (TRALI). TREATMENT AND COURSE: The patient was intubated and a catecholamine medication was initiated. The weaning process proceeded without complications and the patient was extubated after several days. In the following chest x-ray no pulmonary residuals were left. After two weeks the patient was transferred to a rehabilitation unit. CONCLUSION: TRALI is a life-threatening and an often unconsidered complication after transfusion of plasma containing blood products. According to the criteria of the european haemovigilance networks (EHN-criteria), TRALI is diagnosed by clinical and radiological parameters. In case of suspicious TRALI the involved transfusion center has to be informed. By a crossmatch between donor plasma and recipient granulocytes the causal antibodies are detected in most cases. In 17% of cases no antibodies are detected.


Subject(s)
Acute Lung Injury/diagnosis , Cardiac Catheterization/adverse effects , Coronary Restenosis/therapy , Drug-Eluting Stents , Erythrocyte Transfusion/adverse effects , Hematoma/etiology , Hematoma/therapy , Myocardial Infarction/therapy , Myocardial Revascularization , Pulmonary Edema/etiology , Respiratory Insufficiency/etiology , Retroperitoneal Space , Acute Lung Injury/therapy , Catecholamines/administration & dosage , Combined Modality Therapy , Echocardiography , Female , Humans , Intermediate Care Facilities , Intubation, Intratracheal , Middle Aged , Pulmonary Edema/diagnosis , Pulmonary Edema/therapy , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/therapy , Tomography, X-Ray Computed , Ventilator Weaning
2.
AJR Am J Roentgenol ; 175(3): 867; 870-1, 2000 Sep.
Article in English | MEDLINE | ID: mdl-10954487
4.
Clin Nucl Med ; 23(3): 160-2, 1998 Mar.
Article in English | MEDLINE | ID: mdl-9509930

ABSTRACT

The authors report atypical findings of discordant bone scans and radiography seen in a patient with transient osteoporosis of the hip (TOH). Presented in the case of a 60-year-old man who had spontaneous onset of left hip pain which worsened for 2 months with weight-bearing on the affected side. Initial and follow-up radiographs of the let hip were normal. Bone scan demonstrated intense uptake of Tc-99m MDP in the affected femoral head and neck, corresponding to characteristics of abnormal signal intensity of TOH or transient bone marrow edema syndrome on MRI. This discordant pattern of bone scan and radiographs has rarely been reported in the literature. Its possible mechanism of causation and clinical implication in TOH, together with a review of the literature, are discussed in this report.


Subject(s)
Femur Head/diagnostic imaging , Femur Neck/diagnostic imaging , Osteoporosis/diagnostic imaging , Bone Marrow/pathology , Edema/diagnosis , Femur Head/pathology , Femur Neck/pathology , Hip Joint/diagnostic imaging , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Osteoporosis/diagnosis , Radiography , Radionuclide Imaging , Technetium Tc 99m Medronate
6.
J Perinatol ; 17(6): 428-33, 1997.
Article in English | MEDLINE | ID: mdl-9447527

ABSTRACT

OBJECTIVE: We designed this retrospective study to compare radiologic findings in premature infants with bronchopulmonary dysplasia (BPD) in whom gram-positive cocci (GPC), gram-negative bacilli (GNB), or Ureaplasma urealyticum were colonized. Another objective was to correlate the radiologic findings of these patients with the clinical severity of BPD. STUDY DESIGN: We correlated serial tracheal aspirates with radiographic findings from 183 infants whose birth weight was < or = 1250 gm. BPD severity was assessed by oxygen dependency at 36 weeks of postconceptional age (36 w PCA) and at the time of discharge. Two radiologists independently scored films taken at birth and 1, 7, 14, 21, 28, and 35 days of life. RESULTS: Of the study population, 55% were male and 35% were black; 80% received surfactant and 69% received dexamethasone; 91% survived. GPC isolates from throat cultures were mainly Staphylococcus [corrected] epidermidis and Streptococcus haemolyticus. A superimposed GNB colonization was present in 37% of these infants. Most common isolates were Klebsiella pneumoniae, Enterobacter cloacae, and Escherichia coli. Sepsis caused by GPC developed in 16% of all patients; 7% had sepsis caused by GNB. Infants infected with GNB remained receiving oxygen at 36 w PCA and at the time of discharge twice as often as those noninfected. RADIOLOGIC FINDINGS: Hyperinflation, interstitial changes, and generalized or localized emphysema were prominent features throughout. Mean radiologic scores increased over time in a pattern similar among GPC, GNB, and U. urealyticum infected and noninfected infants. High radiologic scores were not predictive at any time of infants who needed supplemental oxygen at 28 days and at 36 w PCA. Infants infected with U. urealyticum were neither clinically nor radiologically different than noncolonized neonates. CONCLUSION: GPC, GNB, and U. urealyticum airway colonization is not associated with particular radiographic changes at any time. GNB-infected infants had the most severe BPD course, and yet they were radiologically indistinguishable from the other patients. U. urealyticum colonization does not result in more clinically severe BPD or demonstrate a unique radiologic course.


Subject(s)
Bacterial Infections/diagnostic imaging , Bronchopulmonary Dysplasia/diagnostic imaging , Gram-Positive Cocci/growth & development , Ureaplasma urealyticum/growth & development , Bacterial Infections/microbiology , Bronchopulmonary Dysplasia/microbiology , Colony Count, Microbial , Female , Gestational Age , Gram-Positive Cocci/isolation & purification , Humans , Infant, Newborn , Male , Pharynx/microbiology , Radiography, Thoracic , Retrospective Studies , Risk Factors , Severity of Illness Index , Ureaplasma urealyticum/isolation & purification
7.
Radiology ; 199(1): 137-41, 1996 Apr.
Article in English | MEDLINE | ID: mdl-8633137

ABSTRACT

PURPOSE: To assess bronchiectasis depicted with computed tomography (CT) in patients with alpha 1-antitrypsin deficiency and to examine associated clinical correlates. MATERIALS AND METHODS: CT scans in 14 patients with alpha 1-antitrypsin deficiency were evaluated by two thoracic radiologists for the presence and extent of bronchiectasis and emphysema. The findings were correlated with numeric infection scores on the basis of symptoms of sputum production and respiratory infection and with a history of conditions that may predispose to development of bronchiectasis. RESULTS: Six (43%) of 14 patients had CT evidence of bronchiectasis. Patients with bronchiectasis had significantly higher infection scores than did patients without bronchiectasis (P < .005). Two patients had diffuse cystic bronchiectasis, and neither reported a history of illness that may have predisposed them to this condition. CONCLUSION: Bronchiectasis may be more common in patients with alpha 1-antitrypsin deficiency than has been previously recognized. The diagnosis of alpha 1-antitrypsin deficiency should be considered in patients with emphysema and diffuse cystic bronchiectasis.


Subject(s)
Bronchiectasis/diagnostic imaging , Tomography, X-Ray Computed , alpha 1-Antitrypsin Deficiency , Bronchiectasis/epidemiology , Bronchiectasis/etiology , Causality , Female , Humans , Lung/pathology , Male , Middle Aged , Phenotype , Pulmonary Emphysema/diagnostic imaging , Pulmonary Emphysema/etiology , Respiratory Tract Infections/epidemiology , Retrospective Studies
8.
Radiology ; 192(3): 819-24, 1994 Sep.
Article in English | MEDLINE | ID: mdl-8058954

ABSTRACT

PURPOSE: To report the spectrum of radiographic findings associated with a new respiratory pathogen: Chlamydia pneumoniae (TWAR strain). MATERIALS AND METHODS: Radiographs of 55 adult patients hospitalized with serologic evidence of C pneumoniae were retrospectively reviewed. RESULTS: On the basis of serologic criteria, two types of acute respiratory infection are possible: primary (first exposure) infections and recurrent, acute infection in a previously exposed individual. In the primary group, alveolar opacities (65%) with a unilateral distribution (71%) were most common at admission. Cavitary disease and hilar or mediastinal lymphadenopathy were uncommon. Small to medium-sized pleural effusions were common in both primary and recurrent groups during hospitalization. Also, both groups tended to progress to bilateral, mixed, interstitial and alveolar changes during the course of infection. CONCLUSION: Different radiographic patterns exist for the two types of acute C pneumoniae infection.


Subject(s)
Chlamydia Infections/diagnostic imaging , Chlamydophila pneumoniae , Respiratory Tract Infections/diagnostic imaging , Acute Disease , Chlamydophila pneumoniae/classification , Female , Humans , Lung/diagnostic imaging , Male , Middle Aged , Radiography , Recurrence , Retrospective Studies
9.
Acad Radiol ; 1(1): 33-9, 1994 Sep.
Article in English | MEDLINE | ID: mdl-9419462

ABSTRACT

RATIONALE AND OBJECTIVES: Little research has explored the use of radiologic services by emergency departments and the factors that influence use. This study aimed to identify and characterize these factors. METHODS: A total of 13,228 consecutive patient emergency charts from a large university emergency department were reviewed, and multiple parameters were entered into a database. The database was studied and statistical testing was done to identify significant parameters for patients who required imaging studies (X-ray group) and those who did not (non-X-ray group). RESULTS: Factors such as age, diagnosis, urgency of illness, and illness severe enough to require hospitalization were statistically significant in determining the need for a radiologic evaluation in the emergency setting. When these factors were equalized for the X-ray and non-X-ray groups by multivariate linear regression analysis, male sex was also found to be statistically significant. Factors such as race and presence or absence of health insurance were not statistically influential on multivariate analysis. CONCLUSIONS: Older age, diagnosis, and factors related to severity of illness affected the use of radiologic services in the emergency setting. Sex differences were also detected.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Hospitals, Teaching/statistics & numerical data , Hospitals, Urban/statistics & numerical data , Radiology Department, Hospital/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Hospital Bed Capacity, 500 and over , Humans , Infant , Infant, Newborn , Male , Middle Aged , Multivariate Analysis , Ohio , Retrospective Studies
10.
Invest Radiol ; 26(4): 304-8, 1991 Apr.
Article in English | MEDLINE | ID: mdl-2032817

ABSTRACT

This study characterizes the appearance of periosteal reaction by magnetic resonance imaging (MRI), and evaluates the efficacy of MRI versus computed tomography (CT), and plain film radiography (PF) in detecting early, experimentally induced periostitis. Acute Staphylococcus aureus osteomyelitis was induced in 30 legs of 20 New Zealand white rabbits. The rabbits were then imaged with MR, contrast-unenhanced CT, and PF 4 days after infection. Histologically, periosteal elevation was present in 27 cases. Periosteal ossification was seen in 23 cases, and cellular reaction without ossification in 4 cases. Periosteal reaction was demonstrated by PF in 21 (78%) and by CT in 20 (74%) cases. Evidence of periostitis was seen by MR in all 27% (100%) cases. MR resulted in two false-positive diagnoses. Multiple concentric, alternating high and low signal arcs demonstrated by MR in 19 (70%) cases represented periosteal ossification surrounded by fibrous or granulation tissue. These findings demonstrate the ability of MR to detect periostitis despite the absence of periosteal ossification. MR was more sensitive than CT (P less than .05) or PF (P less than .05) in the detection of experimentally induced periostitis.


Subject(s)
Magnetic Resonance Imaging , Periostitis/diagnosis , Tomography, X-Ray Computed , Acute Disease , Animals , Periosteum/diagnostic imaging , Periosteum/pathology , Periostitis/diagnostic imaging , Periostitis/pathology , Rabbits , Staphylococcal Infections/diagnosis , Staphylococcal Infections/diagnostic imaging , Staphylococcal Infections/pathology , Tibia
11.
Invest Radiol ; 26(1): 86-9, 1991 Jan.
Article in English | MEDLINE | ID: mdl-2022459

ABSTRACT

The results of a survey of United States and Canadian radiology residency programs in hospitals maintaining major emergency departments indicate that (1) radiologic faculty assignment to emergency medicine may include "all faculty," "specific faculty," "specific and other faculty," "general," and "musculoskeletal" faculty; (2) a chief of emergency radiology section is designated in less than 35% of radiology departments providing emergency room services; (3) radiology resident rotation in emergency radiology occurs in less than 2/3 of the surveyed programs; and (4) radiology resident experience in emergency radiology ranges from two to 16 weeks in 40% of these programs, the remainder being "unspecified." The effect of this circumstance upon the emergency department patient care and resident teaching in emergency radiology is discussed and remedial suggestions presented.


Subject(s)
Emergency Medicine/education , Emergency Service, Hospital , Faculty, Medical , Internship and Residency , Personnel Staffing and Scheduling , Radiology/education , Canada , Data Collection , Emergency Service, Hospital/statistics & numerical data , Faculty, Medical/statistics & numerical data , Hospitals, Teaching/statistics & numerical data , Radiology/statistics & numerical data , United States , Workforce
12.
Radiology ; 174(1): 233-6, 1990 Jan.
Article in English | MEDLINE | ID: mdl-2294554

ABSTRACT

Acute experimental osteomyelitis and abscesses were induced in the proximal tibia and surrounding soft tissues, respectively, in 67 New Zealand white rabbits. Fifty-three rabbits were injected with a Staphylococcus aureus solution and 26, with sterile saline in tibial medullae and/or surrounding soft tissues. Contrast material-enhanced computed tomography (CT) and magnetic resonance (MR) imaging were performed 7 days after inoculation. Immediately after imaging, the animals were killed and necropsy was performed. MR imaging was more sensitive than CT in the detection of osteomyelitis (94% vs 66%, P less than .025) and abscesses (97% vs 52%, P less than .001). MR imaging was equally specific as CT in the exclusion of osteomyelitis (93% vs 97%, chi 2 = 0) but less specific than CT in the exclusion of abscesses (77% vs 100%, P less than .025). The overall accuracy of MR imaging was somewhat, although not significantly, greater than that of CT in the detection of both osteomyelitis (93% vs 80%) and abscesses (87% vs 75%).


Subject(s)
Abscess/diagnosis , Magnetic Resonance Imaging , Muscular Diseases/diagnosis , Osteomyelitis/diagnosis , Staphylococcal Infections/diagnosis , Tomography, X-Ray Computed , Animals , Rabbits , Tibia
13.
Chest ; 93(4): 722-6, 1988 Apr.
Article in English | MEDLINE | ID: mdl-3349827

ABSTRACT

Computed tomography (CT) of the chest offers improved resolution and sensitivity for evaluating chest pathologic conditions compared with other imaging techniques. Intensive care unit patients with portable chest findings that diverge from the clinical course may actually have severe intrathoracic disease that can be detected with CT. Our three patients demonstrate chest CT can aid in the diagnosis of significant intrathoracic pathologic conditions which have been significantly underestimated by portable chest roentgenography. We discuss the reasons for this improved detectability by CT, as well as suggest alternative techniques that can be performed at the bedside in patients whose initial portable chest roentgenogram and clinical course do not correlate.


Subject(s)
Intensive Care Units , Lung Diseases/diagnostic imaging , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods , Adult , Aged , Bronchial Fistula/diagnostic imaging , Female , Humans , Lung Abscess/diagnostic imaging , Male , Middle Aged , Pericardial Effusion/diagnostic imaging , Pleural Diseases/diagnostic imaging , Pneumothorax/diagnostic imaging
14.
Radiology ; 158(3): 689-90, 1986 Mar.
Article in English | MEDLINE | ID: mdl-3945739

ABSTRACT

Two patients with aneurysmal bone cysts of the pelvis were imaged using a 1.5-T magnetic resonance imaging device. Findings included multiple internal septations, cysts with fluid-fluid levels of varying intensity, and an intact rim of low-intensity signal completely surrounding the lesion. These findings allow a specific diagnosis of aneurysmal bone cyst to be made.


Subject(s)
Bone Cysts/diagnosis , Adolescent , Adult , Bone Cysts/diagnostic imaging , Female , Humans , Magnetic Resonance Spectroscopy , Male , Tomography, X-Ray Computed
15.
Ann Emerg Med ; 13(8): 627-9, 1984 Aug.
Article in English | MEDLINE | ID: mdl-6465638

ABSTRACT

Ingestion of coins by children is a common event that rarely causes serious complications. We present a case of asymptomatic esophageal perforation by a penny in a child who presented with wheezing six months after the ingestion. When esophagography and triple endoscopy failed to show the perforation, thoracotomy resulted in successful removal of the foreign body, which was encased in granulation tissue between the trachea and esophagus. Complications of foreign body ingestion are discussed.


Subject(s)
Esophageal Perforation/etiology , Esophagus , Foreign Bodies/complications , Metals , Child, Preschool , Foreign Bodies/diagnostic imaging , Foreign Bodies/surgery , Humans , Male , Radiography , Thoracic Surgery
16.
AJR Am J Roentgenol ; 142(1): 85-8, 1984 Jan.
Article in English | MEDLINE | ID: mdl-6606969

ABSTRACT

In a review of 17 surgically proven cases of acute traumatic diaphragmatic hernia, a nasogastric tube had been inserted preoperatively in eight. In six of these patients the tube followed a characteristic course, indicating the diagnosis of gastric herniation into the left hemithorax. In four cases the passage of the tubing established the diagnosis; in the other two cases the diagnosis was suggested by plain films alone, but subsequent passage of the nasogastric tube provided confirmation.


Subject(s)
Hernia, Diaphragmatic, Traumatic/diagnostic imaging , Intubation, Gastrointestinal , Adult , Aged , Bronchography , Female , Humans , Male , Middle Aged , Rupture
18.
Radiology ; 125(1): 39-46, 1977 Oct.
Article in English | MEDLINE | ID: mdl-897185

ABSTRACT

Eight cases of wandering spleen demonstrate that this rare entity has a characteristic constellation of findings which, though nonspecific, are highly suggestive of the diagnosis. Angiography or isotopic imaging specific for the spleen confirms the diagnosis. Asymptomatic patients may be carefully observed, with the institution of splenectomy should signs of torsion develop.


Subject(s)
Spleen/abnormalities , Adult , Angiography , Female , Humans , Infant , Male , Middle Aged , Radionuclide Imaging , Spleen/diagnostic imaging , Splenic Artery/diagnostic imaging , Ultrasonography , Urography
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