Thoracic radiology: the past 50 years.

The radiology of 50 years ago was a primitive science compared with the radiology of today. Hospital departments were small and radiologists few in number. Night call was uncommon. Examinations consisted primarily of radiographs of the chest, bones, and gastrointestinal tract, although some early neuroradiologic studies were performed. Chest fluoroscopy was common. Film processing was done manually, often with poor results. Radiographic examinations of the chest were likewise unsophisticated by today's standards. Chest radiographs were made with low-kilovoltage, calcium tungstate phosphors and relatively large focal spots. There were no image intensifiers, nuclear medicine studies, ultrasonography, computed tomography, or magnetic resonance studies. How far we have come!

Lemierre syndrome: forgotten but not extinct--report of four cases.

Four cases of Lemierre syndrome are reported in which metastatic abscesses resulted from septic thrombosis of the internal jugular vein secondary to bacterial pharyngitis. While chest radiographic findings were nonspecific, results of computed tomography (CT) of the thorax in each case were highly suggestive of septic pulmonary emboli. Internal jugular venous thrombosis was demonstrated at ultrasonography and contrast material-enhanced CT.

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.

Health hazard of poorly regulated exposure during manufacture of cemented tungsten carbides and cobalt.

Forty two of 125 former workers in a factory in Syracuse, New York, which manufactured hard metal parts from tungsten carbide and cobalt, were studied by chest radiographs, spirometry, and plethysmographically determined lung volumes. The plant was closed in 1982 and the studies were performed in 1983-5. Recorded measurements of carbide dust concentrations were only mildly excessive by modern standards, but deceitful efforts to reduce the apparent concentration of dust were known to have occurred during an inspection by the Occupational Safety and Health Administration. Lung biopsies in four cases in the study and necropsy in one of the 83 cases not studied during life showed giant cell interstitial pneumonia and appreciable concentrations of tungsten carbide. This information indicates that exposure was substantial. Four workers had evidence of pulmonary fibrosis by chest radiographs; two of these workers had normal pulmonary function. Fourteen had abnormal pulmonary function, five of whom had a restrictive pattern, eight a pattern of air trapping, and one a combined pattern. Thus radiographic, or functional abnormalities, or both occurred in 16 of the 42 cases studied. No correlation with duration of exposure was established. Progressive clinically important disease (one fatal) has been found in four ex-workers, two in each of the restrictive and air trapping groups. These findings suggest that poorly regulated dust concentrations in a hard metals factory possibly cause pulmonary abnormalities and sometimes severe illness.

Human immunodeficiency virus infection in children.

The incidence of Acquired Immune Deficiency Syndrome (AIDS) in the pediatric population is increasing. Estimates are that in 1993 AIDS will be among the five leading causes of death in children. AIDS progresses more rapidly in children than in adults. It also has features that are unique to children, such as recurrent bacterial infections, bronchus-associated lymphoid tissue (BALT), and basal ganglia calcification. This review is written with emphasis on aspects of AIDS unique to children. Features of AIDS that are similar in adults are not discussed.

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.

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.

Pulmonary neoplastic and lymphoproliferative disease in AIDS: a review.

Kaposi sarcoma and lymphoma are the most common forms of neoplastic disease encountered in patients with acquired immunodeficiency syndrome (AIDS). Pulmonary involvement is fairly common with Kaposi sarcoma, while lymphoma only rarely involves the lungs. There has been a significant increase in the number of AIDS patients who develop Kaposi sarcoma, especially male homosexuals. There has also been an increase in the incidence of high-grade (aggressive) lymphoma in male homosexuals (and young men in general). Lymphoid interstitial pneumonia is a chronic condition that primarily affects adults and is becoming more common in patients with AIDS. When present in children less than 13 years old, lymphoid interstitial pneumonia is considered to be an indication of AIDS. Bronchus-associated lymphoid tissue and a condition resembling angioimmunoblastic lymphadenopathy are also being found in children with AIDS. A review of the literature on neoplastic and lymphoproliferative disease in AIDS suggests that a variety of lymphoproliferative disorders in AIDS can be expected in the future.

Pulmonary arterial hypertension: a contemporary review.

Pulmonary arterial hypertension has many causes, only some of which are well understood. The radiographic findings in pulmonary arterial hypertension are very similar regardless of the cause. Some radiographic features such as cardiac chamber enlargement, occur secondary to elevation of pulmonary pressures. In addition, sequential radiographs may demonstrate dramatic changes as the hypertension develops. This article presents examples of the various forms of pulmonary arterial hypertension, with pathologic correlation. Included are chronic pulmonary thromboembolism, plexogenic pulmonary arteriopathy, pulmonary venooclusive disease and persistent fetal circulation. Examples of lesions causing secondary pulmonary arterial hypertension: parenchymal lung disease, pulmonary venous hypertension, and congenital heart disease, are also illustrated.

The diaphragm: anatomic, pathologic, and radiologic considerations.

The diaphragm, by virtue of its complex anatomy and multiple ligamentous connections to both thoracic and abdominal structures, is more than a simple partition between the chest and abdomen. Cross sectional images of the diaphragm and peridiaphragmatic processes can be confusing unless the radiologist is aware of the normal structure of the diaphragm, its attachments to the body wall, and the multiple ligaments that attach to the diaphragm.

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.

Chest tube tracks.

Chest tube tracks may simulate normal structures or pathology. This article will help the radiologist to understand their formation and to recognize them as iatrogenic shadows.

Interstitial pulmonary hemorrhage from mediastinal hematoma secondary to aortic rupture.

The chest radiograph of a 79-year-old man with acute thoracic aortic rupture demonstrated enlarged, ill-defined bronchovascular markings. Examination of the lungs at autopsy revealed extensive dissection of blood from the mediastinum along the bronchovascular sheaths. Recognition that enlarged bronchovascular markings may represent hemorrhage rather than edema in the setting of acute aortic rupture has important therapeutic implications.

The role of computed tomography in the diagnosis and management of lung cancer. An overview.

Computed tomography (CT) is now established as the principal radiographic adjunct to plain film examination in the diagnosis and management of lung cancer. It should be used in the evaluation of every pulmonary nodule to determine whether the nodule is solitary and whether mediastinal metastases are present and to evaluate the mass by assessing its density. In general, nodules with Hounsfield numbers greater than +175 can be presumed to be calcified and, hence, benign. CT is of great value in determining the extent of lung cancer and at present the best imaging modality for evaluating mediastinal lymph nodes. Spread of tumor to mediastinal nodes is evaluated on the basis of node size. Nodes less than 1.0 cm in diameter are considered normal, 1.0-1.5 cm suspicious for tumor, and greater than 1.5 cm have a high probability of being malignant. Node size, however, is dependent on location in the mediastinum and whether infection is present in the lung. Size criteria alone should not be used to deny surgery.