Kiss and tell: what do we know about pre- and early adolescent females who report dating? A pilot study.

STUDY OBJECTIVE: To evaluate the implications of dating in pre- and early adolescent females. DESIGN: Cross-sectional survey. SETTING: Child psychiatry clinic; pediatric clinic; family clinic. PARTICIPANTS: Pre- and early adolescent females (n = 80) aged 11-14 and their parents. INTERVENTION: Pre- and early adolescent females aged 11-14 and a parent were recruited during a regular clinic visit. Pre- and early adolescent females completed a survey that included measures of dating; sensation seeking; lifetime individual and peer drug use; Attention Deficit Hyperactive Disorder, Oppositional Defiant Disorder and Conduct Disorder symptoms; and onset of menses. Parents were asked similar questions about their child's dating behaviors and peer relationships. MAIN OUTCOME MEASURE: Association of early dating with individual and peer drug use, sensation seeking, aggressive behavior, and onset of menses. RESULTS: In pre- and early adolescent females, dating regularly is associated with nicotine and alcohol use, sensation seeking, and aggressive behavior. Dating regularly is also associated with onset of menses and a younger age of onset of menses in those who had started menstruating. Parents under-report their child's dating practices and associated high-risk behaviors. CONCLUSION: Early dating is associated with nicotine and alcohol use, sensation seeking, aggressive behavior, and early onset of menses in adolescent females. Questions about early dating are a simple and efficient way to open inquiry of both parents and children about high-risk behaviors in the clinic setting.

Right hilar pseudomass due to partial right lower lobe atelectasis.

In cases of right lower lobe atelectasis, in which the lobe remains partially aerated, rotation of the right hilum into an anteroposterior plane can result in the formation of a "pseudomass" in the right hilar region on the frontal radiograph. Failure to recognize this variant appearance of right lower lobe atelectasis can result in a false diagnosis of a hilar mass and result in an unnecessary workup for lung cancer. Familiarity with this variant appearance of right lower lobe atelectasis, coupled with careful comparison with recent normal chest radiographs, should allow a correct diagnosis of a "pseudomass" in most cases. Computed tomography of the thorax can reliably exclude a hilar mass in cases in which recent normal chest radiographs are unavailable for comparison.

CT halo sign in pulmonary metastases from mucinous adenocarcinoma of the pancreas.

The CT halo sign was first described in immunocompromised patients with invasive pulmonary aspergillosis. Although the halo sign was originally thought to be specific for invasive pulmonary aspergillosis, it has been reported in a wide variety of pulmonary abnormalities in both immununocompromised and immunocompetent patients. We report a case of mucinous adenocarcinoma of the pancreas metastatic to the lungs in which there were multiple pulmonary nodules showing the halo sign. This case further illustrates the nonspecific nature of the CT halo sign and the need to consider malignancy as a cause in immunocompetent patients.

Noninvasive estimation of pulmonary capillary wedge pressure from computed radiography.

PURPOSE: This study was undertaken to see if computed radiography (CR) could be used to estimate pulmonary capillary wedge pressure (PCWP). METHODS: Radiographic measurements of pulmonary artery-bronchus ratios (ABR), cardiomegaly, interstitial edema, alveolar edema, and pleural effusion, obtained from portable CR images of patients admitted to an intensive care unit, were compared to hemodynamic measurements of PCWP. We prospectively predicted a normal PCWP when ABR was < or = 1.0, and an elevated PCWP when ABR was > or = 1.1. RESULTS: There was a significant difference between mean ABR in those with normal PCWP (1.014 +/- 0.259) and those with elevated PCWP (1.422 +/- 0.234) (p < 0.0001). There was a positive correlation between PCWP and ABR (r = 0.38, r2 = 0.147, p = 0.0001). ABR was 95% sensitive, 86% specific, and 93% accurate in predicting PCWP (p = 0.0001). Cardiomegaly, interstitial edema, alveolar edema, and pleural effusion were not as useful. CONCLUSIONS: Measurements of ABR from portable CR images can be used to estimate PCWP.

Pleural effusion is a cause of round atelectasis of the lung.

OBJECTIVE: The purpose of this study was to determine whether or not pleural effusion could be a cause of round atelectasis of the lung. MATERIALS AND METHODS: The study group consists of 20 patients with round atelectasis who had no evidence of asbestos exposure, who had normal baseline chest radiographs that showed no evidence of preexisting pleural or pulmonary disease, and who developed pleural effusion from a variety of causes. Chest radiographs were examined for signs of round atelectasis at the time of initial presentation of the pleural effusion. Follow-up radiographs, spanning a period of 1 month to 4 years after resolution of the pleural effusion, were also examined in all 20 cases. RESULTS: Round atelectasis was seen initially as a rounded mass-like opacity that produced a focal, upward bulge in the curvilinear meniscus of pleural effusion in 17 cases. In three cases round atelectasis was seen initially as a spherical mass with a comet-tail sign located slightly above the pleural effusion. As the pleural effusion resolved, typical findings of round atelectasis developed in all 20 cases. CONCLUSION: Pleural effusion, in the absence of exposure to asbestos, can cause round atelectasis.

Utility of portable chest radiographs as a predictor of endotracheal tube cuff pressure.

Increased endotracheal tube cuff pressure causes mucosal ischemia that can lead to necrosis, infection, and, eventually, tracheomalacia or tracheal stenosis. Endotracheally intubated patients frequently undergo portable chest radiography. In this study we explored the relationship of endotracheal tube cuff pressure and the appearance on the tracheal air columns on the portable chest radiograph. We measured the endotracheal tube cuff pressure of intensive care unit patients 124 times immediately before portable chest radiography. On 64 of these radiographs we measured the width of the tracheal air column below the tip of the endotracheal tube and at the maximal diameter of the endotracheal tube balloon. We then analyzed the relationship of cuff pressure to tracheal dilation. The results of ANOVA of tracheal dilation for three groups (safe, borderline, and unsafe cuff pressures) were significant. Large overlapping ranges existed in each group. Regression analysis confirmed a linear relationship between cuff pressure and tracheal dilation (r = 0.435, p < 0.001). Predicted tracheal expansion at 20 mm Hg was a poor screen for endotracheal tube cuff inflation safety; the sensitivity was only 56% and specificity only 71%. The differences in the capacity for tracheal distension between patients make these findings not unexpected. The portable chest radiograph is a poor screening tool for unsafe endotracheal tube cuff pressure.

The lateral chest radiograph in the detection of pericardial effusion: a reevaluation.

The purpose of this study was to evaluate the usefulness of 10 previously published plain film signs for diagnosing pericardial effusion and to determine whether the posteroanterior (PA) or lateral chest radiograph was the better view for detecting pericardial effusion. A retrospective study of 100 consecutive adult patients with pericardial effusions confirmed by echocardiography and/or computed tomography was undertaken. Five signs were found to be useful in detecting pericardial effusion on plain films, and the lateral chest radiograph was found to be better than the PA view in detecting pericardial effusion. The water-bottle configuration, widening of the carinal angle, and the differential-density sign were helpful in diagnosing pericardial effusion on the PA view. However, these signs were only seen in moderate-to-large effusions. The displaced epicardial fat pad sign and the posteroinferior bulge sign on the lateral view improved the detection of moderate-to-large pericardial effusions, and were also present in many of the cases with small pericardial effusions. Recognition of specific signs of pericardial effusion on the lateral chest radiograph may significantly improve the plain film detection of pericardial effusion.

Muscular hypertrophy of the left diaphragmatic crus: an unusual cause of a paraspinal "mass".

We present a case of marked muscular hypertrophy of the muscular portion of the diaphragm and of the diaphragmatic crura in a professional opera singer. In this case the right and left crus each measured 20 mm in maximum thickness. The left crus, by nature of its vertical orientation in the sagittal plane, produced marked deviation of the inferior left paraspinal line near the diaphragm mimicking a retrocrural or paraspinal mass on the posteroanterior chest radiograph. The correct diagnosis was made by computed tomography. Muscular hypertrophy of the diaphragmatic crura should be included in the differential diagnosis of retrocrural or paraspinal masses at the level of the diaphragm.

Focal reexpansion pulmonary edema after drainage of large pleural effusions: clinical evidence suggesting hypoxic injury to the lung as the cause of edema.

BACKGROUND: The purposes of this study were to review possible causes of reexpansion pulmonary edema (RPE) and to attempt to explain atypical distributions of RPE after drainage of large pleural effusions. METHODS: Five patients had focal RPE after routine drainage of large pleural effusions. In these cases, pleural effusion did not completely fill the hemithorax, and part or all of the ipsilateral upper lobe remained aerated. Reexpansion was accomplished by chest tube drainage with -20 cm H2O suction in four cases and by percutaneous needle aspiration without application of negative intrapleural suction in one. RESULTS: In all five cases, RPE developed in the portion of the lung that had been collapsed but did not develop in the portion of the lung that remained aerated. CONCLUSIONS: This suggests that hypoxic injury to the atelectatic lung, rather than mechanical stress, is the most plausible explanation for RPE.

Pulmonary coccidioidomycosis in Kentucky.

Coccidioidomycosis is a highly infectious disease caused by the dimorphic fungus, Coccidioides immitis that is endemic to the arid and semiarid regions of the southwestern United States, Mexico, Central America, and South America. The majority of infections from C immitis are asymptomatic; however, approximately 40% of infected individuals present with symptoms ranging from a mild flu-like respiratory infection to acute pneumonia that may lead to chronic progressive pulmonary infection or occasionally disseminated disease. Due to the mobility of the population, increasing numbers of cases are being recognized outside endemic areas. We report five patients with coccidioidomycosis diagnosed at the University of Kentucky Medical Center during the period from 1984 to 1993 in order to illustrate the clinical and radiographic spectrum of findings that may be encountered with the disease. In a patient with unexplained pulmonary symptoms, a history of recent travel to or immigration from an endemic area may be an early clue to the diagnosis of coccidioidomycosis.

Pneumothorax ex vacuo.

Pneumothorax ex vacuo is a little-known complication of lobar collapse. In this condition, acute bronchial obstruction from mucous plugs, aspirated foreign bodies, or malpositioned endotracheal tubes causes acute lobar collapse and a marked increase in negative intrapleural pressure around the collapsed lobe. As a result, gas is drawn into the pleural space around the collapsed lobe while the seal between the visceral and parietal pleura of the adjacent lobe or lobes remains intact. The pneumothorax spontaneously resolves when the bronchial obstruction is relieved and the lobe reexpands. Recognition of pneumothorax ex vacuo is crucial in directing treatment to relieve the bronchial obstruction rather than inserting a chest tube into the pleural space.

Clinical and imaging features of pulmonary strongyloidiasis.

We evaluated 20 patients with pulmonary strongyloidiasis for risk factors, clinical and imaging manifestations, complications, treatment, and outcome. Eighteen (90%) had risk factors for strongyloidiasis including steroid use, age greater than 65, chronic lung disease, use of histamine blockers, or chronic debilitating illness. Pulmonary signs and symptoms, including cough, shortness of breath, wheezing, and hemoptysis, were present in 19 (95%); adult respiratory distress syndrome (ARDS) developed in 9 (45%). Pulmonary infiltrates occurred in 18 (90%). Gastrointestinal signs and symptoms were also common. Peripheral blood eosinophilia occurred in 15 (75%). Twelve (60%) had secondary infection, and 3 (15%) had bacterial lung abscesses. All were treated with thiabendazole, 25 mg/kg twice daily; on average, patients without ARDS were treated for 3 days, versus 7 days for those with ARDS. Seventy percent responded to therapy; 30% died. Preexisting chronic lung disease and ARDS were statistically significant predictors of a poor prognosis.

Types and mechanisms of pulmonary atelectasis.

Atelectasis is one of the most commonly encountered abnormalities in chest radiology and remains a daily diagnostic challenge. At times atelectasis can be overlooked, particularly when pulmonary opacification is minimal or absent, and at other times it might be interpreted as being some other form of intrathoracic pathology, particularly pneumonia. The direct signs of atelectasis are crowded pulmonary vessels, crowded air bronchograms, and displacement of the interlobar fissures. Indirect signs of atelectasis are pulmonary opacification; elevation of the diaphragm; shift of the trachea, heart, and mediastinum; displacement of the hilus; compensatory hyperexpansion of the surrounding lung; approximation of the ribs; and shifting granulomas. For descriptive purposes, atelectasis can be divided into the following types: segmental, lobar, or whole lung; subsegmental; platelike, linear, or discoid; round; and generalized or diffuse. Resorption atelectasis is caused by resorption of alveolar air distal to obstructing lesions of the airways; adhesive atelectasis stems from surfactant deficiency; passive atelectasis is caused by simple pneumothorax, diaphragmatic dysfunction, or hypoventilation; compressive atelectasis is due to tension pneumothorax, space-occupying intrathoracic lesions, or abdominal distention; cicatrization atelectasis stems from pulmonary fibrosis; and gravity-dependent atelectasis is the result of gravity-dependent alterations in alveolar volume. Whenever signs of volume loss are present on a chest radiograph, the radiograph should be interpreted as showing atelectasis. By understanding the various mechanisms leading to atelectasis, and by considering the underlying conditions, the radiologist should be able to develop an appropriate list of the possible causes of atelectasis. The diagnosis of atelectatic pneumonia should be based upon the presence of clinical signs and symptoms of pneumonia coupled with the identification of pathogenic bacteria in sputum, tracheal aspirates, or protected bronchoalveolar lavage or bronchial brush specimens rather than on the radiographic identification of atelectasis alone.

Radiographic manifestations of lobar atelectasis.

In this article we review the plain radiographic and computed tomographic manifestations of lobar atelectasis. The progression of lobar atelectasis from mild to marked volume loss is emphasized. Common combinations of lobar and whole lung atelectasis are also discussed. Radiographic features that help distinguish lobar atelectasis from pleural thickening, pleural effusion, and mediastinal masses are outlined. Where appropriate, selected examples of segmental atelectasis are also presented. The recognition of lobar atelectasis is important, particularly in cases stemming from obstructing endobronchial tumors. Since all signs of volume loss are not present in any given case, knowing as many signs of lobar atelectasis as possible is useful. Careful analysis of the chest radiograph and subtle alterations in the fissures and hilar vascularity aids in differentiating lobar atelectasis from other intrathoracic processes.

Detection of pneumoperitoneum on chest radiographs: comparison of upright lateral and posteroanterior projections.

OBJECTIVE: This study was done to determine whether upright lateral chest radiographs were more sensitive than upright posteroanterior chest radiographs in detecting pneumoperitoneum. SUBJECTS AND METHODS: We prospectively evaluated the ability of upright posteroanterior and lateral chest radiographs to show subdiaphragmatic air in 100 consecutive patients with known pneumoperitoneum from a variety of causes. The difference in sensitivity between the two was evaluated by means of McNemar's test. RESULTS: The upright lateral chest radiograph showed pneumoperitoneum in 98% of the cases; the upright posteroanterior chest radiograph showed pneumoperitoneum in only 80%. The upright lateral chest radiograph was significantly better at showing pneumoperitoneum than was the upright posteroanterior chest radiograph (p < .01). CONCLUSION: The upright lateral chest radiograph is more sensitive than the upright posteroanterior chest radiograph in detecting small amounts of pneumoperitoneum. When there is a strong clinical suspicion of a perforated hollow viscus, it may be of benefit to include an erect lateral chest radiograph as part of the acute abdominal series.

"Meandering" pulmonary veins: report of a case in an asymptomatic 12-year-old girl.

We report a case of a healthy, asymptomatic 12-year-old girl in whom anomalous pulmonary venous connection to the left atrium occurred as an isolated congenital anomaly. This condition, termed "meandering" pulmonary veins, is closely related to scimitar syndrome and is usually associated with hypogenesis of the right lung and dextropositioning of the heart. To our knowledge, ours is only the second reported case of meandering pulmonary veins occurring as an isolated anomaly.

Management of postpneumonectomy syndrome with a bronchoscopically placed endobronchial stent.

Postpneumonectomy syndrome is a rare complication of right pneumonectomy characterized by marked shift and counterclockwise rotation of the heart and mediastinum into the evacuated hemithorax. Typically the left primary bronchus is draped over the aorta or spine and is markedly compressed. We describe one patient with postpneumonectomy syndrome successfully managed nonsurgically with a bronchoscopically placed Silastic endobronchial stent.

Pulmonary strongyloidiasis: clinical and imaging features.

Strongyloides stercoralis is an important cause of severe pulmonary infection and death in many areas of the world [1, 2]. The nematode is endemic in the tropical and subtropical regions of the world, including the southeastern United States and Puerto Rico, where infection rates may exceed 6% of the population [1, 3-7]. Although pulmonary symptoms from strongyloidiasis can be mild, consisting only of cough and bronchospasm, the potential for severe pulmonary disease and adult respiratory distress syndrome is great in certain persons at high risk for strongyloidiasis [1, 2]. Unfortunately, pulmonary strongyloidiasis is seldom diagnosed until late in the course of the disease, which contributes to a high death rate [1, 2, 5, 8]. We review the clinical and imaging features of pulmonary strongyloidiasis and emphasize clues that can lead to earlier diagnosis, recognition of complications, and prompt treatment.

Congenital pulmonary venolobar syndrome revisited.

The term "congenital pulmonary venolobar syndrome" (CPVS) encompasses a number of congenital abnormalities of the thorax that often occur in combination. Major components of CPVS include hypogenetic lung, partial anomalous pulmonary venous return (this and the former are two of the most constantly occurring components), absence of a pulmonary artery, pulmonary sequestration, systemic arterialization of the lung, absence of the inferior vena cava, and accessory diaphragm. Minor components of CPVS include tracheal trifurcation, eventration and partial absence of the diaphragm, phrenic cyst, horseshoe lung, esophageal and gastric lung, anomalous superior vena cava, and absence of the left pericardium. Most patients with CPVS have no symptoms and require no therapy; however, surgical intervention is often necessary in infants with severe symptoms. The authors review the imaging findings in 29 patients with CPVS and review the literature concerning the diagnosis and management of this complex syndrome in order to improve the understanding of CPVS among radiologists and clinicians.