Lateral cavity wall thickening as an early radiographic sign of mycetoma formation.

The sensitivity of chest radiography for the early detection of mycetoma formation within fibrotic cavities is poor. The purpose of this study was to determine the predictive value of the secondary sign of lateral cavity wall thickening for the detection of a radiographically occult mycetoma. The chest radiographs and CT scans of 70 patients who had a total of 109 fibrotic cavities on CT were reviewed by two observers. Dimensions of the cavity, mycetoma, and cavity wall thickness on chest radiography and CT scans were recorded. Mycetomas were visible in 41 of 99 cavities on chest radiographs and in 61 of 109 cavities on CT. Using CT as the gold standard for detecting the presence of mycetomas, the sensitivity of chest radiography for the presence of a mycetoma was 62 % and the specificity 94 %, and the positive and negative predictive values were 93 and 66 %, respectively. On logistic regression analysis, lateral wall thickness on chest radiography was predictive of the presence of a mycetoma (p < 0.0005) independent of other radiographic features. In patients with chronic fibrocavitary disease on chest radiography, the presence of lateral wall thickening is highly suggestive of an underlying mycetoma.

The radiological investigation of suspected lower limb deep vein thrombosis.

A postal survey was performed to determine the current practices and attitudes of radiologists towards the imaging of suspected lower limb deep vein thrombosis (DVT). One hundred and twenty-seven departments responded to a questionnaire sent in March 1996. The results show that 87% of hospitals possess colour Doppler ultrasound (CDUS) machines and that 46% of departments perform ultrasound as the first line investigation in over 90% of cases. Thirty per cent of departments considered calf vein visualization to be generally adequate and 34% thought that clinicians in their hospitals invariably anticoagulated patients with isolated calf thrombus. In hospitals where venography was routinely used as the first line investigation, the most common reasons were: the perceived inferiority of ultrasound (US) in demonstrating below-knee clot, its time-consuming nature and the limited access to suitable ultrasound machines. The widespread use of ultrasound is encouraging, however, there are clearly diverse views. A significant minority of departments depend principally upon venography in the diagnosis of DVT.

Imaging of small cell carcinoma of the male urogenital tract.

Five cases of small cell carcinoma (three of the prostate and two of the bladder) are described to illustrate the unusual behaviour of these tumours. Cerebral, hepatic and bulky lymph node spread with large volume local disease occurred. The role the radiologist may play in these diseases is discussed.